（附论）
夫痰之为害。多因外感五邪。乃寒暑燥湿风。内伤七气。乃喜怒忧思惊恐恚。因五邪而
得者
多因
气。
华。
宜
因热而得者。宜服金沸草散、柴胡半夏汤。因暑而得者。消暑丸。因气不调。郁结而成者。
宜服参苏饮、四七汤、二陈汤。痰在上者。以瓜蒂散吐之。在下者。以控涎丹利之。虽曰可
吐可下。亦要观人之勇怯。察脉之虚实。方可投之。切记不痛击暴下。所以初虞世有金虎碧
霞之戒者此也。儒门事亲云。一妇人心下脐上结硬如斗。按之如石。人皆作病胎。针灸毒药
。祷祈无数。如捕风然。一日戴人见之曰。此寒痰。诊其两手寸脉皆沉。非寒痰而何。以瓜
蒂散吐之。连吐六七升。其块立消过半。俟数日后。再吐之。其涎沫类鸡黄腥臭特殊。约吐
去二三升。凡如此者三。投以人参调中汤、五苓散调之。腹已平矣。又云。妇人从年少时。
因大哭罢。痛饮冰水。困卧。水停心下。渐发痛闷。医氏咸以为冷积。治之以温热剂。及禁
食冷物。一闻茶气。病辄内作。如此数年。燔针烧艾。疮孔数十。十余年后。小便赤黄。而
大便秘闷。两目加昏。积水转甚。流于两胁。世谓水癖。或谓支饮。 、漆、棱、术。攻磨
之药。竟施之矣。食日衰。积日茂。上至鸠尾。旁至两胁及脐下。但发之时。按之如水声。
小腹结硬。手不可近者月发五七次。甚则欲死。诸药皆厌。二十余年。求戴人发药。诊其脉
。寸口独沉而迟。此胸中有痰。先以瓜蒂散涌痰五七升。不数日。再越。痰水及斗。又数日
。上涌数升。凡三涌三下。汗如水者亦三。其积皆去。以流湿消饮之药调之。月余大瘥。
方
旋复花丸（出御药院方）治停痰积饮在胁下。久而不愈。渐成癖。心腹胀满
羸
瘦。不能食。
水。将根据两胁注痛
旋复花（去梗） 桂心（去皮） 枳实（麸炒去瓤） 人参（各一两） 干姜（炮） 芍
药白术（各
炒干） 橘皮（去瓤
黑心） 浓朴（去粗皮生姜炙
一两七钱半） 上为末。水糊为丸。
柴胡半夏汤（出永类钤方）治痰热头痛。利膈除烦闷。手足烦热。荣卫不
调。
筋骨拘倦。身
柴胡（八两） 半夏（二两半） 人参（去芦） 甘草 黄芩 麦门冬（各二两） 白
术（二两） 上
四七服（出济生拔粹）治喜怒悲思忧恐惊之。结成痰涎。状如破絮。或如梅
核。在咽喉之间
盛喘急。或因痰饮中积。呕逆恶心。并宜服之。妇人性热者。不能宽解。多被七气所
伤。遂致气损胸臆。或如梅
以香附子。药久服取效。不可谓
紫苏（二两） 浓朴（三两） 茯苓（四两） 半夏（五两） 上 咀。每服四钱。水
一盏半。
姜七
丸子
大半夏汤（出大全良方）治痰饮及脾胃不和。
半夏 白茯苓 生姜（各一分） 上 咀。作一服。每遇膈间有寒痰。以水二盏。煎至
一
盏。
二陈
瓜蒂散（出大全良方）病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞
硬。
气上冲咽喉。
瓜蒂（炒黄） 赤小豆（各半两） 上为细末。取一钱。头一服。汤七合。使先渍之。
须臾
煮作
脉
茯苓丸（出大全良方）
茯苓（一两） 半夏（二两） 枳壳（半两炮制） 风化朴硝（一分） 上为末。姜汁
煮。糊为丸如
控涎丹（出大全良方）凡人忽患胸背手足颈项腰胯隐痛。不可忍。连筋骨牵
引
钓痛。坐卧不
疑是风毒结聚。
涎。手脚重坠。冷痹气不通。误认为瘫痪。亦非也。凡有此疾。但以此药。不过数服。
\x其疾自痊
甘遂（去心） 大戟（去皮） 真白芥子（各等分炒） 上为末。糊丸如梧桐子大。临
卧淡姜汤吞
（附论）
痰这种病邪造成的危害，大多是因为外感五邪所致，即寒、暑、燥、湿、风。内伤七情所致，即喜、怒、忧、思、惊、恐、恚（愤怒）。因五邪而得的，多与气机有关。
因热而得的，适宜服用金沸草散、柴胡半夏汤。因暑而得的，服用消暑丸。因气机不调、郁结而成的，适宜服用参苏饮、四七汤、二陈汤。痰在身体上部的，用瓜蒂散催吐；在下部的，用控涎丹通利泻下。虽然说可以吐可以下，但也必须观察病人的勇敢或怯弱体质，诊察脉象的虚或实，才可以投药。切记不可猛烈攻下，所以初虞世有“金虎碧霞”的告诫，说的就是这个道理。《儒门事亲》记载：一位妇人心窝到脐上的部位结块坚硬如斗，按压起来像石头一样，人们都认为是怀孕的病状，针灸、服药、祈祷无数，如同捕风捉影一般无效。有一天戴人（张从正）见到她，说：“这是寒痰。”诊察她的两手寸脉都沉，不是寒痰是什么？于是用瓜蒂散催吐，连续吐出六七升，肿块立刻消减了一半。等待几天后，再次催吐，吐出的涎沫像鸡黄一样腥臭特殊，大约吐去二三升。像这样的情况进行了三次。随后用人参调中汤、五苓散调理，腹部已经平复了。又记载：一位妇女从年轻时开始，因为大哭之后，痛饮冰水，困倦躺卧，导致水液停聚在心下，逐渐发作疼痛闷胀。医生们都认为是冷积，用温热剂治疗，并且禁止食用冷物。一闻到茶气，病痛就在体内发作。这样持续数年，使用燔针烧艾，疮孔数十个。十多年后，小便赤黄，大便秘结闷滞，两眼更加昏花，积水加重，流注到两胁，世人称为水癖，或者称为支饮。三棱、莪术、白术等攻磨的药物，全都施用了。饮食日渐衰弱，积滞日益茂盛，向上至鸠尾穴，旁至两胁及脐下，每当发作时，按压有水声，小腹结硬，手不能靠近，每月发作五六次，严重时甚至想死。各种药物都厌恶（无效），二十多年，求戴人用药。诊察他的脉象，只有寸口脉沉而迟，这是胸中有痰。先用瓜蒂散涌吐痰涎五七升，没过几天，再次涌吐，痰水达到一斗。又过了几天，上部涌吐数升。总共三次涌吐三次泻下，出汗如水的情况也有三次。积滞全部去除，用流湿消饮的药物调理。一个多月后大病痊愈。
方剂：
旋复花丸（出自《御药院方》）：治疗停痰积饮在胁下，久而不愈，逐渐形成癖块，心腹胀满，身体消瘦，不能进食，水气根据两胁注痛。
组成：旋复花（去掉梗）、桂心（去掉皮）、枳实（麸炒去瓤）、人参（各一两）、干姜（炮制）、芍药、白术（各炒干）、橘皮（去瓤黑心）、浓朴（去掉粗皮，生姜炙，一两七钱半）。以上研为末，用水糊制作成丸。
柴胡半夏汤（出自《永类钤方》）：治疗痰热头痛，利膈除烦闷，手足烦热，营卫不调，筋骨拘倦，身体...（原文此处可能有缺字，依文意推测为身体不适相关症状）。
组成：柴胡（八两）、半夏（二两半）、人参（去芦）、甘草、黄芩、麦门冬（各二两）、白术（二两）。以上...（原文此处可能有缺字，依文意推测为煎服法）。
四七汤（出自《济生拔粹》）：治疗因喜怒悲思忧恐惊等情绪，结成痰涎，形状像破絮，或者像梅核，卡在咽喉之间，导致盛喘急迫。或因痰饮中积，呕吐逆恶心，都适宜服用。妇人性热者，不能宽解，多被七气所伤，遂致气损胸臆，或者像梅核...（原文此处可能有缺字）。以香附子...（原文此处可能有缺字）药久服取效，不可谓...（原文此处可能有缺字）。
组成：紫苏（二两）、浓朴（三两）、茯苓（四两）、半夏（五两）。以上切碎，每服四钱，用水一盏半，生姜七片...（原文此处可能有缺字，依文意推测为煎煮方法）。
大半夏汤（出自《大全良方》）：治疗痰饮及脾胃不和。
组成：半夏、白茯苓、生姜（各一分）。以上切碎，作为一服。每当遇到膈间有寒痰，用水二盏，煎至一盏...（原文此处可能有缺字，依文意推测为服用方法）。
二陈汤（原文仅列名，无详细论述，但在前文提及）
瓜蒂散（出自《大全良方》）：病症像桂枝证，但头不痛，项不强，寸脉微浮，胸中痞硬，气上冲咽喉...（原文此处可能有缺字）。
组成：瓜蒂（炒黄）、赤小豆（各半两）。以上研为细末，取一钱，第一次服用，用汤七合，先浸泡片刻...（原文此处可能有缺字，依文意推测为煎煮服用方法）。
茯苓丸（出自《大全良方》）
组成：茯苓（一两）、半夏（二两）、枳壳（半两炮制）、风化朴硝（一分）。以上研为末，用姜汁煮，水糊制作成丸...（原文此处可能有缺字，依文意推测为丸剂大小及服用方法）。
控涎丹（出自《大全良方》）：凡人忽然患胸背手足颈项腰胯隐痛，不可忍受，连筋骨牵引钓痛，坐卧不安...（原文此处可能有缺字）。不要怀疑是风毒结聚...（原文此处可能有缺字）。涎唾，手脚重坠，冷痹气不通，误认为瘫痪，也不是。凡是有此疾，只用此药，不过几服，其疾自然痊愈。
组成：甘遂（去心）、大戟（去皮）、真白芥子（各等分炒）。以上研为末，水糊制作成梧桐子大小的丸。临睡前用淡姜汤吞服。
(Attached Discussion)
The harm caused by Phlegm (Tan, 痰) often stems from external contraction of the Five Pathogenic Factors (Wu Xie, 五邪), namely Cold (Han, 寒), Summerheat (Shu, 暑), Dryness (Zao, 燥), Dampness (Shi, 湿), and Wind (Feng, 风). It also arises from internal injury to the Seven Emotions (Qi Qi, 七气), namely Joy (Xi, 喜), Anger (Nu, 怒), Worry (You, 忧), Thought (Si, 思), Fright (Jing, 惊), Fear (Kong, 恐), and Resentment (Hui, 恚). Those acquired through the Five Pathogenic Factors are mostly related to Qi (Qi, 气).
For those acquired due to Heat (Re, 热), it is appropriate to take Jinfei Cao San (Golden Fern Grass Powder) or Chaihu Banxia Tang (Bupleurum and Pinellia Decoction). For those acquired due to Summerheat (Shu, 暑), Xiaoshu Wan (Summerheat-Relieving Pill) should be taken. For those formed due to Qi (Qi, 气) dysfunction and stagnation, it is appropriate to take Shen Su Yin (Ginseng and Perilla Drink), Siqi Tang (Four-Seven Decoction), or Erchen Tang (Two-Aged Decoction). If Phlegm (Tan, 痰) is in the upper part of the body, induce vomiting with Gou Di San (Melon Seed Powder); if in the lower part, promote drainage with Kongxian Dan (Control Saliva Elixir). Although it is said that vomiting and purging can be used, one must observe the patient's constitution (brave or timid) and examine the pulse for deficiency or excess before administering medication. One must strictly avoid violent purging; this is why Chu Yushi had the warning of "Jin Hu Bi Xia" (Golden Tiger and Jade Clouds), referring to this principle. *Rumen Shiqin* records: A woman had a hard mass from the epigastrium to above the umbilicus, as hard as a bucket and stone upon palpation. People thought it was a pregnancy-related disease. Acupuncture, drugs, and prayers were numerous but ineffective like catching wind. One day, Dai Ren (Zhang Congzheng) saw her and said, "This is Cold Phlegm (Han Tan, 寒痰)." Palpating the Cun (Cun, 寸) pulses of both hands, they were both deep. How could it not be Cold Phlegm? He used Gou Di San (Melon Seed Powder) to induce vomiting, continuously expelling six or seven sheng of phlegm. The mass immediately reduced by more than half. After waiting several days, he induced vomiting again. The expelled saliva resembled chicken yolk, extremely fishy and foul-smelling, about two or three sheng. This was done three times in total. Then, Renshen Tiao Zhong Tang (Ginseng Regulating Middle Decoction) and Wu Ling San (Five-Ling Powder) were administered for regulation, and the abdomen became flat. Another record states: A woman, since her youth, after crying bitterly, drank ice water greedily and lay down drowsily. Water accumulated in the heart region, gradually causing pain and oppression. Doctors all considered it Cold Accumulation (Leng Ji, 冷积) and treated it with warm-hot agents, forbidding cold food. Upon smelling tea, the illness would flare up internally. This lasted for years. Burning needles and moxa were used, resulting in dozens of sores. More than ten years later, urine became red and yellow, stool became constipated and obstructed, eyes grew dimmer, and water accumulation worsened, flowing into the hypochondriac regions. The world calls this Shui Pi (Water Pi, 水癖) or Zhi Yin (Branching Fluid Retention, 支饮). Drugs like San Leng (Curcuma zedoaria Rhizome), E Zhu (Curcuma phaeocaulis Rhizome), and Bai Zhu (Atractylodis Macrocephalae Rhizome) for attacking and grinding were all applied. Food intake declined daily, while accumulation grew daily. Up to Jiutui (CV15), sideways to the hypochondriac regions and below the umbilicus, whenever it flared up, pressing produced a sound of water. The lower abdomen became hard and knotted, intolerable to touch, occurring five or seven times a month. Severe cases led to a desire to die. All medicines were rejected. For over twenty years, she sought Dai Ren for treatment. Palpating the pulse, only the Cun (Cun, 寸) pulse was deep and slow. This indicated Phlegm (Tan, 痰) in the chest. First, Gou Di San (Melon Seed Powder) was used to涌吐 (induce vomiting) five to seven sheng of phlegm. Within a few days, vomiting was repeated, expelling a dou of phlegm and water. Several days later, several sheng were vomited from above. In total, there were three rounds of vomiting and three rounds of purging, and sweating like water occurred three times. The accumulation was completely removed. Medications for draining dampness and resolving fluid retention were used for regulation. After more than a month, the major illness improved significantly.
Formulas:
Xuanfu Hua Wan (Inula Flower Pill) (from *Yuyao Yuan Fang*): Treats retained Phlegm (Tan, 痰) and accumulated fluid retention in the hypochondriac region, persisting for a long time without healing, gradually forming a Pi mass (Pi, 癖). Symptoms include abdominal distension and fullness, emaciation, inability to eat, and pain radiating along the hypochondriac regions due to water qi.
Ingredients: Xuanfu Hua (Inulae Flos, remove stems), Guixin (Cinnamomi Cortex, remove bark), Zhishi (Immature Bitter Orange, stir-fried with bran, remove pith), Renshen (Ginseng Radix et Rhizoma) (each 1 liang), Ganjiang (Dried Ginger, processed), Shaoyao (Paeoniae Radix), Baizhu (Atractylodis Macrocephalae Rhizome) (each stir-fried until dry), Jupi (Citri Reticulatae Pericarpium, remove pith and black heart), Houpo (Magnoliae Officinalis Cortex, remove rough bark, stir-fried with fresh ginger, 1 liang 7 qian 5 fen). Grind all into powder, make pills using water paste.
Chaihu Banxia Tang (Bupleurum and Pinellia Decoction) (from *Yong Lei Qian Fang*): Treats headache due to Phlegm-Heat (Tan Re, 痰热), unblocks the diaphragm, relieves irritability, treats vexing heat in hands and feet, disharmony of Ying (Nutritive) and Wei (Defensive) levels, stiffness and fatigue of sinews and bones, and bodily discomfort.
Ingredients: Chaihu (Bupleuri Radix, 8 liang), Banxia (Pinelliae Rhizoma, 2.5 liang), Renshen (Ginseng Radix et Rhizoma, remove rhizome), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix) (each 2 liang), Baizhu (Atractylodis Macrocephalae Rhizome, 2 liang). [Preparation instructions implied].
Siqi Tang (Four-Seven Decoction) (from *Jisheng Baci*): Treats Phlegm-saliva congealed due to emotions such as joy, anger, sorrow, thought, worry, fright, and fear. The sensation resembles broken cotton wadding or a plum pit stuck in the throat, leading to severe panting and urgency. Also suitable for retching and nausea caused by middle jiao accumulation of Phlegm-fluid (Tan Yin, 痰饮). Women with hot constitutions who cannot relax are often injured by the Seven Emotions (Qi Qi, 七气), leading to Qi damage in the chest/epigastrium, or the sensation of a plum pit. Use Xiangfu (Cyperi Rhizoma)... taking medicine for a long time yields results. Do not say...
Ingredients: Zisu (Perillae Folium, 2 liang), Houpo (Magnoliae Officinalis Cortex, 3 liang), Fuling (Poria, 4 liang), Banxia (Pinelliae Rhizoma, 5 liang). Cut into pieces. Take 4 qian per dose, decoct with 1.5 sheng of water and 7 slices of fresh ginger.
Dabanxia Tang (Major Pinellia Decoction) (from *Daquan Liang Fang*): Treats Phlegm-fluid (Tan Yin, 痰饮) and spleen-stomach disharmony.
Ingredients: Banxia (Pinelliae Rhizoma), Fuling (Poria), Shengjiang (Fresh Ginger) (each 1 fen). Cut into pieces. Prepare as one dose. Whenever there is Cold Phlegm (Han Tan, 寒痰) in the diaphragm, decoct with 2 sheng of water until 1 sheng remains.
Erchen Tang (Two-Aged Decoction) [Mentioned in text, no detailed formula provided here].
Goudi San (Melon Seed Powder) (from *Daquan Liang Fang*): Symptoms resemble Guizhi Zheng (Cinnamon Twig Syndrome), but without headache or neck stiffness. The Cun (Cun, 寸) pulse is slightly floating. There is stuffiness and hardness in the chest, with Qi rushing up to the throat.
Ingredients: Gou Di (Momordicae Semen, stir-fried until yellow), Chi Xiaodou (Adzuki Bean) (each 0.5 liang). Grind into fine powder. Take 1 qian for the first dose. Mix with 0.7 sheng of liquid, soak for a moment, then boil/decoct.
Fuling Wan (Poria Pill) (from *Daquan Liang Fang*)
Ingredients: Fuling (Poria, 1 liang), Banxia (Pinelliae Rhizoma, 2 liang), Zhike (Aurantii Fructus, 0.5 liang, processed), Fenghua Poxiao (Natrii Sulfas exsiccatus, 1 fen). Grind into powder. Cook with Jiangzhi (Ginger Juice), make pills using water paste.
Kongxian Dan (Control Saliva Elixir) (from *Daquan Liang Fang*): When a person suddenly suffers from hidden pain in the chest, back, hands, feet, neck, waist, and hips, unbearable, with牵引 (traction/pulling) pain connecting to sinews and bones, restlessness in sitting and lying down. Do not suspect it is Wind-Toxin (Feng Du, 风毒) aggregation. Saliva, heavy and drooping limbs, cold bi (obstruction) with blocked Qi, mistakenly diagnosed as paralysis, is also incorrect. For such diseases, using this medicine for just a few doses will naturally cure the illness.
Ingredients: Gansui (Kansui Radix, remove heart), Daji (Euphorbiae Pekinensis Radix, remove bark), Zhen Baijiezhi (Sinapis Albus Semen, equal parts, stir-fried). Grind into powder, make pills the size of paulownia seeds using water paste. Swallow with light ginger soup before bedtime.