石顽曰。痰火一证。方书罕及。近惟郢中梁仁甫国医宗旨。专为立言。然皆泛引肤辞。且所
用方药。专事降泄。略无切于病情。殊非指南之谓。夫所谓痰火者。精髓枯涸于下。痰火凭陵于
上。有形之痰。无形之火。交固于中。良由劳思伤神。嗜欲伤精。加以饮食不节。血肉之味。蕴
酿为痰为火。变动为咳为喘。其在平居无恙之时。贮积窠囊之中。或时有所触发。则冲膈透膜。
与潮宗之泛滥无异。观其外显之状。颇有似乎哮喘。察其内发之因。反有类乎消中。消中由阴邪
上僭。摄之可以渐疼。哮喘由表邪内陷。温之可以暂安。此则外内合邪。两难分解。温之燥之升
之摄之。咸非所宜。况乎触发多端。治非一律。何怪时师之茫无统绪乎。予由是而因病制宜。特
立玉竹饮子一方。为是证之专药。临证以意增减。庶几款洽病情。其有兼挟客邪者。又须先彻标
证。然后从本而施。自然信手合辙。如因感风寒而发。则香苏散为至当。略加细辛以开肺气。香
豉以通肾邪。散标最捷。盖香、苏性降。可无升举浊垢之虞。他如麻黄、桂枝、柴、防、升、葛、
羌、独、川芎等味。能鼓动痰气。薄荷、荆芥、橘皮、苏子等味。能耗散真气。芩、连、知、柏、
赤白芍、栝蒌根、石膏等味。能敛闭邪气。皆宜远之。因饮食而发。只宜金匮枳术汤。随所伤之
物而为参用。谷伤曲、 。酒伤煨葛。肉伤炮楂。麸面伤加草果。鸡鸭卵伤加杏仁。痰食交结。
则加橘、半。食积发热。必加黄连。黄连与枳实同用。善消痞满。半夏与白术同用。专运痰湿。
然须生用力能豁痰。痰去则津液流通。热渴自解。非苍术、南星燥烈伤津之比。因恼怒而发。沉
香降气散和
滓煎服。不但理气化痰。亦可消运食滞。其或兼冒微风。另煎香苏散以协济之。原其触发之因。
不出风食气三者为甚。然皆人所共知。惟是触感风热而发者。世所共昧。盖寒伤形而不伤气。气
本乎肺。肺气受伤。咳嗽喘满。势所必致。而寒客皮毛。皮毛为肺之合。邪从皮毛而入伤于肺。
咳嗽喘满。亦势所必致。何怪举世医师。一见喘咳。概以表散为务。良由不辨内因外因之故耳。
曷知外因从表而伤有形之津。证属有余。故一咳其痰即应。而痰沫清稀。内因从肺而伤无形之气。
证属不足。故屡咳而痰不得出。咳剧则呕。此不但肺病而胃亦病矣。是予玉竹饮子方中。茯苓、
甘草专为胃家预立地步也。至于标证散后。余火未清。人参未宜遽用。玉竹饮子。尤为合剂。病
势向衰。即当滋养肺胃。异功散加葳蕤。取橘皮为宣通气化之报使。气虚不能宣发其痰。又需局
方七气汤。借肉桂为热因热用之向导。若其人形体虽肥。而色白气虚。则以六君子汤加竹沥、姜
汁。即有半夏。亦无妨碍。食少便溏者。竹沥又为切禁。宜用伏龙肝汤代水煎服。脾气安和。津
液自固。可无伤耗之虑矣。瘦人阴虚多火。六味地黄去泽泻合生脉散。使金水相生。自然火息痰
降。去泽泻者。以其利水伤津也。若命门脉弱。真火式微。或不时上冲。头面哄热。又须六味地
黄加肉桂、五味子以摄火归阴。阴平阳秘。精神乃治。须知治痰先治火。治火先养阴。此为治痰
治火之的诀。然后有真气浮散之极。草根木实。无济于用。又须金石以镇固之。予尝借服食方中
灵飞散。取云母以摄虚阳。钟乳以通肺窍。菊花以清旺气。兼天冬、地黄、人参之三才。以固精
气神之根本。即修内丹。不外乎此。所谓知其要者。一言而终。不知其要。流散无穷。敢以此言质之梁子。
梁仁甫云。病痰火者。或吐血。或衄血。或喉疼身热溺黄。皆热证也。庸医妄投苦寒泻火之
剂。不知苦寒能泻脾胃。脾
胃土也。乃人身之本也。今火病而泻其土。火未尝除而土已病矣。土病则胃虚。因而饮食减少。
甚至泄泻肌肉消瘦。不可救药矣。世俗谓病痰火者。服童便最好。余治痰火。每禁服童便。盖童
便降火虽速。而损胃多矣。故治火病。以理脾为主。此真诀也。
〔诊〕痰脉沉弦细滑。大小不匀。皆痰气为病。左右手关前脉浮大而实者。膈上有稠痰也。关
上脉伏而大者。清痰也。丹溪云。人得涩脉。痰饮胶固。脉道阻滞。卒难得开。必费调理。
石顽说：痰火这一证候，医书中很少提及。近来只有郢中梁仁甫的《国医宗旨》专门为此立论。然而那些论述都泛引肤浅之辞，且所用方药，专事降泄，丝毫不切病情，实在不能称为指南之作。所谓痰火，是精髓在下枯竭，痰火在上肆虐，有形的痰与无形的火，在中焦交结固着。这大多是由于劳神思虑损伤心神，嗜欲过度损伤肾精，再加上饮食不节制，食用血肉厚味之物，酝酿而成痰火，变动表现为咳嗽气喘。在平日身体无恙时，痰火贮积在窠囊之中；有时受到触发，就会冲膈透膜，与潮宗水泛滥无异。看它外在显现的症状，颇似哮喘；察它内在发作的原因，反而类似消中（消渴病）。消中是由于阴邪上僭，收敛摄纳可以逐渐缓解；哮喘是由于表邪内陷，温煦治疗可以暂时安定。此证则是内外合邪，两难分解。温补、燥湿、升提、摄纳等方法，都不适宜。况且触发原因多种多样，治疗方法并非一律，难怪当时的医生茫然没有统绪。我因此因病制宜，特别创立玉竹饮子一方，作为此证的专用药物。临证时根据具体情况增减，希望能契合病情。如果有兼挟外邪的情况，又必须先解除标证，然后从本病施治，自然能信手合辙。如果因感受风寒而发作，则香苏散最为恰当，略加细辛以开宣肺气，加香豉以通达肾邪，解散标证最快捷。因为香、苏性降，可无升举浊垢的忧虑。其他如麻黄、桂枝、柴胡、防风、升麻、葛根、羌活、独活、川芎等药味，能鼓动痰气；薄荷、荆芥、橘皮、苏子等药味，能耗散真气；黄芩、黄连、知母、黄柏、赤白芍、栝蒌根、石膏等药味，能敛闭邪气，这些都应该远离避免。如果因饮食而发作，只宜用金匮枳术汤，根据所伤之物配合使用：谷食伤加神曲、麦芽；酒伤加煨葛根；肉食伤加炮制山楂；麸面伤加草果；鸡鸭卵伤加杏仁。痰食交结，则加橘红、半夏；食积发热，必加黄连。黄连与枳实同用，善于消除痞满；半夏与白术同用，专门运化痰湿。但必须用生半夏，其力能豁痰，痰去则津液流通，热渴自解，不像苍术、南星那样燥烈伤津。如果因恼怒而发作，用沉香降气散和渣煎服，不但理气化痰，也可消运食滞。如果兼冒微风，另煎香苏散来协助救治。推究其触发原因，不出风、食、气三者为甚。然而这些都是人所共知的，唯独感触风热而发作的，世人普遍不明白。大概寒邪伤形而不伤气，气本乎肺，肺气受伤，咳嗽喘满，是势所必致；而寒客皮毛，皮毛为肺之合，邪从皮毛而入伤于肺，咳嗽喘满，也是势所必致。难怪举世医师，一见喘咳，一概以表散为务，实在是由于不辨内因外因的缘故啊。怎知外因从表而伤有形之津，证属有余，所以一咳其痰即应，而痰沫清稀；内因从肺而伤无形之气，证属不足，所以屡咳而痰不得出，咳剧则呕，这不但肺病，胃也病了。这是我玉竹饮子方中，茯苓、甘草专为胃家预立地步的原因。至于标证散后，余火未清，人参不宜遽用，玉竹饮子尤为合剂。病势向衰，即当滋养肺胃，用异功散加葳蕤（玉竹），取橘皮为宣通气化的报使。气虚不能宣发其痰，又需局方七气汤，借肉桂为热因热用的向导。如果其人形体虽肥，而色白气虚，则以六君子汤加竹沥、姜汁，即使有半夏，也无妨碍。食少便溏者，竹沥又是禁忌，宜用伏龙肝汤代水煎服。脾气安和，津液自固，可无伤耗的忧虑了。瘦人阴虚多火，用六味地黄丸去泽泻合生脉散，使金水相生，自然火息痰降。去泽泻的原因，是因为它利水伤津。如果命门脉弱，真火式微，或不时上冲，头面哄热，又须六味地黄丸加肉桂、五味子以摄火归阴，阴平阳秘，精神乃治。须知治痰先治火，治火先养阴，这是治痰治火的诀要。然后才有真气浮散之极，草根木实，无济于事，又须金石以镇固之。我曾借用服食方中的灵飞散，取云母以摄虚阳，钟乳以通肺窍，菊花以清旺气，兼天冬、地黄、人参之三才，以固精气神的根本。即修内丹，也不外乎此。所谓知其要者，一言而终；不知其要，流散无穷。敢以此言质之于梁子。
梁仁甫说：患痰火病的，有的吐血，有的衄血，有的喉疼身热溺黄，都是热证。庸医妄投苦寒泻火的药剂，不知道苦寒能泻脾胃。脾胃属土，是人身之本。现在火病而泻其土，火未曾除去而土已病了。土病则胃虚，因而饮食减少，甚至泄泻肌肉消瘦，不可救药了。世俗认为患痰火病的人，服用童便最好。我治痰火，每每禁止服用童便。因为童便降火虽快，而损胃太多了。所以治火病，以理脾为主，这才是真正的诀要。
【诊法】痰脉沉弦细滑，大小不匀，都是痰气为病。左右手关前脉浮大而实者，膈上有稠痰。关上脉伏而大者，是清痰。丹溪说：人得涩脉，痰饮胶固，脉道阻滞，卒难得开，必费调理。
Shiwan stated: The syndrome of Phlegm-Fire (Tan Huo, phlegm and fire) is rarely mentioned in medical books. Recently, only Liang Renfu's *Guoyi Zongzhi* (The Essence of National Medicine) from Yingzhong has specifically addressed this topic. However, the discussions therein merely cite superficial remarks, and the formulas and herbs used focus exclusively on descending and purging, lacking relevance to the actual condition, which certainly does not constitute a proper guide. What is meant by Phlegm-Fire is the depletion of essence and marrow at the lower jiao, while phlegm and fire dominate at the upper jiao; tangible phlegm and intangible fire are interlocked and solidified in the middle jiao. This is largely due to mental labor and overthinking damaging the Shen (Spirit), and excessive desires damaging the Jing (Essence), compounded by irregular diet and the consumption of rich animal products, which ferment into phlegm and fire, manifesting as cough and asthma. During times of health, phlegm and fire accumulate in "cocoons" (pockets); when triggered, they surge through the diaphragm and penetrate membranes, resembling the flooding of tidal waters. Externally, its symptoms resemble asthma; internally, its etiology resembles Xiao Zhong (Xiao Ke, wasting-thirst syndrome). Xiao Zhong is caused by Yin pathogens usurping upwards, and can be gradually alleviated by astringing and gathering; asthma is caused by exterior pathogens sinking inward, and can be temporarily stabilized by warming. This syndrome, however, involves both interior and exterior pathogens combined, making it difficult to resolve separately. Warming, drying, ascending, and astringing methods are all inappropriate. Moreover, since triggers vary widely, treatment is not uniform, so it is no wonder that contemporary physicians are confused and lack a systematic approach. Therefore, I adapted treatment to the specific disease and specially created the formula Yuzhu Yinzi (Polygonatum Decoction) as a specific remedy for this syndrome. In clinical practice, modifications are made according to circumstances to ensure the treatment fits the pathology. If there are concurrent external pathogens, the exterior symptoms must first be resolved before treating the root cause, ensuring the treatment aligns perfectly with the principles. If triggered by Wind-Cold, Xiangsu San (Perilla Powder) is most appropriate, with slight additions of Xixin (Asarum) to open Lung Qi and Xiangchi (Fermented Soybean) to unblock Kidney pathogens, providing the quickest relief for exterior symptoms. Since Xiang and Su have descending properties, there is no risk of raising turbid filth. Other herbs such as Mahuang (Ephedra), Guizhi (Cinnamon Twig), Chaihu (Bupleurum), Fangfeng (Saposhnikovia), Shengma (Cimicifuga), Gegen (Pueraria), Qianghuo (Notopterygium), Duhuo (Angelica Pubescens), and Chuanxiong (Ligusticum) can stir up phlegm and Qi; Bohe (Mint), Jingjie (Schizonepeta), Chenpi (Citrus Peel), and Suzi (Perilla Seed) can consume and disperse true Qi; Huangqin (Scutellaria), Huanglian (Coptis), Zhimu (Anemarrhena), Huangbai (Phellodendron), Chi Shao (Red Peony Root), Bai Shao (White Peony Root), Gualougen (Trichosanthes Root), and Shigao (Gypsum) can trap and close pathogens; these should all be avoided. If triggered by dietary indiscretion, only Jinkui Zhizhu Tang (Atractylodes and Immature Bitter Orange Decoction from the Golden Cabinet) should be used, modified according to the ingested substance: for grain injury, add Qu (Medicated Leaven) and Maiya (Barley Sprout); for wine injury, add Ge Gen (Kudzu Root); for meat injury, add Pao Zha (Fried Hawthorn); for flour/noodle injury, add Caoguo (Black Cardamom); for chicken/duck egg injury, add Xingren (Apricot Seed). For phlegm-food accumulation, add Ju Hong (Tangerine Peel) and Banxia (Pinellia); for food stagnation with fever, add Huanglian (Coptis). Huanglian combined with Zhishi (Immature Bitter Orange) effectively eliminates fullness and palpitations; Banxia combined with Baizhu (Atractylodes Macrocephala) specifically transforms phlegm-dampness. Raw Banxia must be used for its ability to expel phlegm; once phlegm is removed, body fluids circulate, and heat/thirst resolves naturally, unlike Cangzhu (Atractylodes Lancea) or Nanting (Arisaema Cum Bile), which are drying and damaging to fluids. If triggered by anger, Chenxiang Jiangqi San (Agarwood Descending Qi Powder) should be decocted with dregs taken orally; this not only regulates Qi and transforms phlegm but also aids digestion. If accompanied by mild wind, Xiangsu San should be decocted separately to assist. Analyzing the triggers, they primarily involve Wind, Food, and Qi. While these are commonly known, the trigger of Wind-Heat contact is often misunderstood by the world. Cold damages the Form but not Qi; Qi resides in the Lung, so Lung Qi damage inevitably leads to cough and asthma. Cold lodging in the skin and hair (the exterior connection of the Lung) causes pathogens to enter via the skin and damage the Lung, also inevitably leading to cough and asthma. No wonder physicians universally treat cough and asthma with dispersing methods; this stems from failing to distinguish between internal and external causes. External causes damage tangible body fluids from the exterior, resulting in excess syndromes where phlegm appears immediately upon coughing, clear and thin. Internal causes damage intangible Qi from the Lung, resulting in deficiency syndromes where repeated coughing fails to produce phlegm, and severe coughing leads to vomiting, indicating that both the Lung and Stomach are diseased. This is why Fuling (Poria) and Gancao (Licorice) in my Yuzhu Yinzi formula are specifically prepared to support the Stomach. After resolving exterior symptoms, if residual fire remains, Renshen (Ginseng) should not be used hastily; Yuzhu Yinzi is particularly suitable. As the disease wanes, nourishing Lung and Stomach is required, using Yigong San (Extraordinary Efficacy Powder) plus Weirui (Polygonatum Odoratum/Jade Bamboo), with Chenpi acting as a guide for promoting Qi transformation. If Qi deficiency prevents the expulsion of phlegm, Ju Fang Qi Qi Tang (Seven Qi Decoction from the Bureau of Taiyi) should be used, borrowing Rougui (Cinnamon Bark) as a guide for "treating heat with heat." If the patient is obese but pale and Qi-deficient, Liu Jun Zi Tang (Six Gentlemen Decoction) plus Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice) is used; even with Banxia present, it is not contraindicated. For those with poor appetite and loose stools, Zhuli is strictly forbidden; instead, Fulonggan Tang (Dragon Liver Soil Decoction) should be used as water for decoction. When Spleen Qi is harmonious, body fluids are secured, eliminating concerns about depletion. Thin individuals with Yin deficiency and abundant fire should use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) minus Zexie (Alisma) combined with Shengmai San (Generate Pulse Powder) to promote Metal-Water mutual generation, naturally extinguishing fire and reducing phlegm. Zexie is removed because it promotes urination and damages fluids. If the Mingmen (Gate of Life) pulse is weak, indicating declining True Fire, or if fire surges intermittently causing facial flushing, Liuwei Dihuang Wan plus Rougui and Wuweizi (Schisandra) should be used to guide fire back to the Yin, achieving Yin-Yang balance and spiritual harmony. It must be understood that treating phlegm requires treating fire first, and treating fire requires nourishing Yin first; this is the key principle. Only then, when True Qi is extremely scattered, will herbal roots and barks be ineffective, requiring mineral substances to stabilize and secure. I have borrowed Lingfei San (Spirit Flight Powder) from ingestion prescriptions, using Yunmu (Mica) to grasp floating Yang, Zhongru (Milky Stone) to open Lung orifices, and Juhua (Chrysanthemum) to clear vigorous Qi, combined with Tian Dong (Asparagus Root), Dihuang (Rehmannia), and Renshen (Ginseng)—the Three Talents—to consolidate the foundation of Essence, Qi, and Spirit. This is also the essence of internal alchemy cultivation. As stated, he who knows the essentials needs but one word to finish; he who does not know them wanders endlessly. I dare to offer these words to Mr. Liang.
Liang Renfu stated: Patients with Phlegm-Fire may experience hematemesis, epistaxis, sore throat, fever, and yellow urine, all indicating Heat syndromes. Quack doctors recklessly administer bitter-cold fire-purging agents, unaware that bitter-cold can purge the Spleen and Stomach. Spleen and Stomach belong to Earth, the root of the human body. Now, in treating Fire disease, purging Earth causes Earth to become diseased before Fire is eliminated. Earth disease leads to Stomach deficiency, resulting in reduced food intake, and eventually diarrhea and emaciation, becoming incurable. The common belief is that drinking infant urine (Tong Bian) is best for Phlegm-Fire. However, I strictly prohibit infant urine in treating Phlegm-Fire. Although infant urine descends fire quickly, it damages the Stomach significantly. Therefore, treating Fire disease should prioritize regulating the Spleen; this is the true secret.
[Diagnosis] Phlegm pulses are deep, wiry, fine, and slippery, unequal in size, all indicating Phlegm-Qi pathology. Pulses floating, large, and excess at the front of the Guan position on both hands indicate thick phlegm above the diaphragm. A pulse that is hidden and large at the Guan position indicates clear phlegm. Danxi said: Obtaining a choppy pulse indicates that phlegm-fluids are sticky and solid, blocking the pulse channels, making them difficult to open suddenly, requiring prolonged regulation.