按：脾虚运化功能失调，不能蒸化水液，湿邪浸渍肌肤，停聚成饮，故见肢体浮肿，湿困中焦，停聚成饮，寒饮迫上，水气凌心，心阳阻遏，则见心悸气短。水湿内聚，三焦决渎失司，膀胱气化不利，则出现小便不利，水走大肠而大便稀。综上所述，一切症状都是水湿内停阳气不运之故。本案病机在于脾虚，以致寒湿浸渍。，治法当理气健脾，通阳利水，故以五皮饮加减治之，寒湿尽除，心悸自止。
案三李某，女，28岁。门诊号：57207。
1963年6月10日初诊：因分娩时出血过多，面色苍黄，心悸失眠，气短乏力，苔薄白，脉虚无力。此证属心血不足，胸阳不振。治宜益气养血，安神止惊。处方：
党参7．5克麦冬6克五味子6克炒枣仁9克 当归4．5克 菖蒲4．5克茯神7．5克甘草6克
2剂，水煎服。
按：本案病机在于气血不足，因而益气养血为其正治，故气生而心悸除。方以党参、甘草、麦冬、五味子益气养阴；枣仁、当归和血敛津；茯神、菖蒲通窍安神。
案四 冯某，男，45岁。门诊号：73800。
1964年2月7日初诊：心悸失眠，健忘，自汗，气短，不思饮食，苔薄白，脉细弱。此证乃思虑过度，劳伤心神。治宜健脾养心，益气补血。归脾汤加减：
党参4．5克 白术6克黄芪4．5克 当归4．5克茯神6克远志4．5克木香6克元肉4．5克五味子3克
2剂，水煎服。
按：本案病机在于心血亏虚，故以归脾汤治之，使气旺血生，则心悸自愈。
胸
痛
胸痛总关气血瘀滞 治则不离活血利气
胸痛是以胸膺满闷不舒、疼痛时作为主症的疾病，甚则左胸疼痛如绞，彻背引臂。胸痛是病人的一种自觉症状，多发于中年人或老年人。历代医家对本病多有论述，有“胸阳不足”、“痰热壅肺”、“瘀血痹阻”等各家学说，众说各有建树，丰富了中医对胸痛的理论认识和治疗经验，但亦存在各执偏极之嫌。李老认为，心、肺两脏居于上焦胸中，心主血。肺主气，前者为血液运行之主导，后者为一身气化之总司．血赖气推方能运行，气赖血载方能布达，气血以流通为顺。“通则不痛，不通则痛”，不论任何原因引起的胸痛，其表现总归不出气血瘀滞不通。治疗大法不外活血利气(行气)。因此，李老自拟活血利气汤，临证时在此基础方之上，根据不同病情适当加味，治疗各种胸痛病人而每获良效。
活血利气汤组成：旋覆花9克 茜草6克 瓜蒌9克五灵脂6克 生蒲黄6克
处方大意：方中五灵脂、生蒲黄合用为《局方》“失笑散”。功擅活血祛瘀，散结止痛，用于各种瘀血停滞，胸腹头身疼痛等症。茜草活血祛瘀，以助上二药加强行瘀之力。瓜蒌利气宽胸，并能清肺化痰，旋覆花降气止呕，消痰利水。后二味重在宣降肺气，宽胸利气。诸药配伍活血利气，行瘀散滞，为治疗气血瘀滞之胸痛的一个理想基础方。
加减运用原则：瘀血较甚者。加归尾、桃仁或丹参、赤芍；气滞较甚者，加郁金、香附、枳壳；痰湿较甚，食欲不振者，加陈皮、半夏、鸡内金；胸阳不振者，加薤白、益智仁；气虚者，加生黄芪。
附案：
案一 王某，男，54岁。门诊号：32478。
1960年3月8日初诊：胸痛胸憋3个月，性格急躁易怒，不欲饮食，舌苔薄白，脉弦。气性喜散，蕴结而不散，则为气郁，气为血帅，故气滞血必瘀。治宜理气降气，活血化瘀。方用活血利气汤加味：
旋覆花9克 茜草6克 瓜蒌9克 桃仁6克 郁金3克 当归尾7。5克 五灵脂6克 生蒲黄6克 薤白9克
2剂，水煎服。
服药后胸痛消失，胸憋减轻。于上方中加枳壳3克，桔梗4．5克，五灵脂、蒲黄各减3克。服药2剂而愈。
按：本例患者，属胸痛而血瘀气滞较重，同时兼有胸阳不振，故用活血利气汤加桃仁、归尾、郁金、枳壳、桔梗以加强活血行气之力，加薤白以振奋心阳。
案二 赵某，男，39岁。门诊号：70218。
1963年7月28日初诊：胸痛、胸憋2年，每逢情绪激动而加重，食欲不振，舌苔薄白，脉弦。肝气失于条达，气滞血瘀故胸痛，肝气郁结，辄易乘脾，故见食欲不振，舌苔薄白，脉弦。治宜疏肝理气，活血化瘀。方用活血利气汤加味：
旋覆花9克 茜草4．5克 瓜蒌9克 陈皮6克 鸡内金6克 半夏7．5克 五灵脂4．5克 生蒲黄4。5克专病论治
2剂，水煎服。
服药后，胸痛、胸憋减轻，但食欲不振，咯白色泡沫样痰，故用陈皮、鸡内金、半夏理气健脾，燥湿祛痰，痊愈。
案三 常某，男，37岁。门诊号：79656。
1964年4月26日初诊：胸痛、胸憋已3—4个月，食欲不振，厌油食，大小便正常，舌苔薄白，脉弦。方用活血利气汤加味：
全瓜蒌15克 旋覆花9克 茜草6克 五灵脂6克生蒲黄6克 郁金4．5克 当归尾7．5克 枳壳4．5克
2剂，水煎服。
服药后，症状明显减轻。方中枳壳、郁金、归尾有理气活血止痛的作用。嘱咐患者勿再生气。
案四 赵某，女，26岁。门诊号：45532。
1961年5月20日初诊：胸部憋闷，月经期下腹部胀痛，月经最少，舌苔薄白，脉紧。方用活血利气汤加味：
旋覆花9克 茜草6克 丹参15克 全瓜蒌9克 香附4．5克 当归尾7．5克 赤芍7．5克 五灵脂4．5克生蒲黄4．5克
2剂，水煎服。
按：本例患者除胸憋之外，兼有痛经，故加香附以理气。气为血帅，血为气母，气行血行，气滞血瘀。故用理气活血化瘀之品以理气活血，通则不痛。
案五 陈某，女，45岁。门诊号：92907。
1965年10月27日初诊：胸痛已3年余，伴气短乏力，太息为快，小便不禁，舌苔薄白，脉沉细。方用活血利气汤加味：
旋覆花9克 茜草4．5克 全瓜蒌9克 五灵脂4.5克100生蒲黄4．5克 生黄芪7．5克 益智仁6克
水煎服，服药2剂后好转。
按：患者除有胸痛之外，兼有气短、乏力、小便不禁之气虚症状，故加黄芪补气升阳，益智仁温中助阳固涩。
慢性肺原性心脏病本虚标实寒热相间 病位心肺治从心肾
慢性肺原性心脏病，简称肺心病，多发于地处寒冷的东北、华北、西北等北方地区。是由慢性支气管炎、肺气肿及其他肺胸疾病引起的心脏病。多因喘咳等肺系疾病迁延不愈，渐至肺、心、脾、肾等脏器功能失调，出现气喘、心悸、水肿、腹胀、唇青舌紫等表现。李老认为，肺心病是一个非常复杂的危重证候，中医学虽无“肺原性心脏病”这一名称，但历代文献对本病之诊治记载颇详，大致属于咳喘、心悸、痰饮、水肿等范畴。
由于本病发病缓慢，病程较长，多表现为慢支——肺气肿一一肺心病不可逆转的发展过程，且多为年老、久病、体衰患者，故临床表现以本虚为主，急性发作期以虚中夹实、痰热壅肺为特点，而血瘀见症，不论急性期、慢性期均普遍存在。本病迁延日久不愈，多伤及脾肾之阳，易造成下焦脾肾虚寒与上焦心肺郁热相间出现的虚实寒热错综复杂的危重证候。
从病的先后和传变来看，本病由肺而起，逐渐波及心，长期反复发作，进一步影响到脾、肾，后期则以心肾功能衰退为主要表现。具体来讲，肺主气，司呼吸，上通气道、咽喉，开窍于鼻，外合皮毛，肺为五脏之华盖，又属娇脏，不耐寒热，因此，外邪侵袭人体，首先犯肺，导致肺失宣降，肺气逆乱，发为咳喘。咳喘既久，痰热内蕴，渐至肺气虚而短气、喘促，肺伤日久，必及于心。心与肺同居上焦，肺主气，朝百脉，辅心而行血脉。肺气虚、气滞，不能治理调节心血的运行，则心气虚衰，无力推动血脉，血流不畅，而致血瘀，出现心悸、唇甲紫绀、胁下痞块等血瘀之候。心血不足，血不养心，则更加重瘀滞及水肿。肾主水而肺为水之上源，《景岳全书》载： “盖水为至阴，故其本在肾，水化于气，故其标在肺，水惟畏土，故其制在脾。今肺虚，则气不化精而化水，脾虚则土不制水而反克，肾虚则水无所制而妄行。”水液代谢失调，溢于肌肤，则为水肿；水液停积，则为痰饮；水邪泛滥，则面浮肢肿；水饮上凌心肺，故心悸喘咳。又肺失肃降，也可导致肾阳不升，肾不纳气，则气喘更为加剧。因此，本病虽曰肺心，实则以心血瘀阻、肾不主水、阳虚水泛为病机之根本，故应着重从肾心论治。
发病脏腑虽然以心肾为主，但肺、肝、脾等脏往往多被涉及，痰饮、瘀血、气滞、气虚、阴虚、阳虚、寒象、热象常相夹在一起，只不过随着病情的变化，出现孰者为主，孰者为辅，孰多孰少而已。故在治疗用药上，也应随着证候的变化，在抓住主要原因进行治疗的同时，不忘辅以第二位、第三位的治疗方法，以达到标本兼顾、综合治理、提高疗效的目的。
基于上述思路，结合多年的治疗肺心病之经验。李老常将肺心病分为五种证型，详见下述： 一、心肾阳虚，痰饮阻滞型 [证候表现]气短咳喘不能平卧，吐泡沫痰，轻度浮肿，四肢厥冷，怯寒，舌苔白，脉沉细弱或沉细微而数。
[治则]宣阳化饮。
[方药]真武汤加减：
附子3～6克 茯苓5克 白术6克 白芍6克 生姜3片 杏仁3克 人参3克
[加减]瘀血阻滞，轻度紫绀者，加丹参6克。
[案例]
刘某，男，55岁。门诊号：86274。
1964年1月21日初诊：咳嗽30多年，咳喘气短，上坡或用力、负重时加重20余年。近1年来日渐严重，尤其最近入冬以来，咳喘气短，不能平卧，心悸浮肿。经用氨茶碱、抗生素类药物无效，后改予中药止咳定喘治疗2个月亦无效。现症怯寒，四肢厥冷，脉沉微。治宜温肾化饮。方用真武汤加减：
附子5克 党参3克 杏仁3克 陈皮6克 茯苓5克白术6克 白芍6克 生姜3片
服药2剂后气短稍见好转，以后根据腹胀时加厚朴3克，咳嗽严重时加紫菀6克的加减法，治疗1个月，浮肿、气短、咳喘诸症大多消失。
按：本案证属心肾阳虚，痰饮上冲，故在温阳利水湿之真武汤基础上加杏仁、陈皮以温化寒痰，党参益气健脾，合苓、术以治生痰之源。 二、上实下虚，痰浊中阻型 [证候表现]咳喘而不能平卧， 胃脘痞满，口苦口千，颜面或眼睑浮肿较重，头部时时汗出，足冷，或手足厥冷，舌苔黄厚，或黄腻，脉弦滑。
[治则]化痰降逆温肾。
[方药]苏子降气汤加减：
苏子9克 橘红6克 半夏6克 当归6克 前胡6克厚朴6克 肉桂5～6克 黑锡丹3克 人参3克
[案例]
安某，女，46岁。门诊号：56972。
1962年11月22日初诊：咳嗽30余年，喘20多年，近三四年来加重，尤其今年入冬以来，病情更重，喘咳吐痰，不能乎卧，颜面、四肢、腹部均浮肿，尤以食后咳喘更重，头汗出，足冷如冰，舌苔黄厚而腻，口唇、舌、面颊、手指均青紫，脉弦滑。证属上实下虚、痰饮不化之重症。治宜化痰降逆温肾。方用苏子降气汤加减：
苏子9克 橘红6克 半夏9克 当归9克 前胡9克厚朴9克 肉桂9克 黑锡丹3克 党参6克 补骨脂9克
服药2剂后咳喘好转，又继服4剂后，根据情况改予金匱肾气丸合黄芪鳖甲散加减治之，2月而安。
按：本例患者为上实下虚、痰饮不化之重症，故用苏子降气汤加重肉桂用量，另加补肾助阳之补骨脂，意在加强温肾助阳，益火之源，以救下虚。 三、肾阳不足．寒水上冲型 [证候表现]咳喘不能平卧，头汗如珠，腰腿疼痛，足冷如冰，下肢浮肿，舌苔白，脉弦紧，尺大或两尺均微。
[治则]温肾纳气。
[方药]金匮肾气丸加减：
生地9克 山药9克 山萸肉9克 五味子9克 茯苓9克 泽泻9克 丹皮9克 附子9克 肉桂5～9克 车前子9克 怀牛膝9克
若无山萸肉，可改用补骨脂9克。
[案例]
张某，女，40岁。门诊号：27898。
1960年3月18日初诊：咳喘数十年，近1月来连续喘嗽不止，不能平卧，心悸，腰酸背困，足冷如冰，7～8天来下肢出现浮肿，咳喘更加严重，头汗时出，但足趾更冷，经西药抗生素、氨茶碱，中药小青龙汤、苏子降气汤、射干麻黄汤、定喘汤等治疗半月余无效。口唇舌质微青紫，舌苔白，脉沉细，尺大而弦。治宜温肾纳气。方用金匮肾气丸加减：
生地12克 山药9克 山萸9克 茯苓9克 五味子9克 泽泻9克 丹皮9克 车前子9克 附子9克 肉桂9克 怀牛膝9克
服药2剂，咳喘明显改善，浮肿亦大部分消失．继续原方治疗半月，症状大部分消失。
按：本例咳喘患者属肾阳虚，肾不纳气型，故用济生肾气丸温阳补肾而利水。方中五味子与六味地黄汤合用名都气丸，主治肾阴虚而气喘呃逆者，五味子功擅纳气平喘，故本方能在温补肾阳之基础上增加利水消肿、纳气平喘之功效。 四、痰饮不化．气阴两虚．气滞血瘀型 [证候表现]咳嗽气短，不得平卧，全身浮肿，口苦口千，头晕头痛，心烦心悸，时而胸胁窜痛，烦躁易怒，舌苔白，质暗，口唇紫暗，脉弦滑。
[治则]治宜补气养阴以培本，理气化痰祛瘀治其标。
按语：脾虚导致运化功能失调，不能蒸腾气化水液，湿邪浸渍肌肤，停聚形成饮邪，因此出现肢体浮肿；湿气困阻中焦，停聚成饮，寒饮逼迫向上，水气凌犯心脏，心阳被阻遏，则出现心悸、气短。水湿在内聚集，三焦决渎（疏通水道）功能失职，膀胱气化不利，则出现小便不通畅，水湿流入大肠则大便稀溏。综上所述，所有症状都是由于水湿内停、阳气运行不畅所致。本案的病机在于脾虚，导致寒湿浸渍。治疗方法应当调理气机、健脾、通阳利水，因此使用五皮饮加减进行治疗，待寒湿尽除，心悸自然停止。
案三 李某，女性，28岁。门诊号：57207。
1963年6月10日初诊：因分娩时出血过多，面色苍白萎黄，心悸失眠，气短乏力，舌苔薄白，脉象虚弱无力。此证属于心血不足，胸阳不振。治疗宜益气养血，安神定惊。处方：
党参7.5克，麦冬6克，五味子6克，炒酸枣仁9克，当归4.5克，石菖蒲4.5克，茯神7.5克，甘草6克。
服2剂，水煎服。
按语：本案病机在于气血不足，因此益气养血是正治之法，故气生则心悸消除。方中以党参、甘草、麦冬、五味子益气养阴；酸枣仁、当归和血敛津；茯神、石菖蒲通窍安神。
案四 冯某，男性，45岁。门诊号：73800。
1964年2月7日初诊：心悸失眠，健忘，自汗，气短，不思饮食，舌苔薄白，脉细弱。此证乃思虑过度，劳伤心神。治疗宜健脾养心，益气补血。归脾汤加减：
党参4.5克，白术6克，黄芪4.5克，当归4.5克，茯神6克，远志4.5克，木香6克，龙眼肉4.5克，五味子3克。
服2剂，水煎服。
按语：本案病机在于心血亏虚，故用归脾汤治疗，使气旺血生，则心悸自愈。
胸痛
胸痛总与气血瘀滞有关，治疗原则不离活血理气。
胸痛是以胸膺部满闷不舒、疼痛时发为主症的疾病，严重时左胸疼痛如绞，放射至背部并牵引手臂。胸痛是患者的一种自觉症状，多发于中年人或老年人。历代医家对本病多有论述，有“胸阳不足”、“痰热壅肺”、“瘀血痹阻”等各家学说，众说各有建树，丰富了中医对胸痛的理论认识和治疗经验，但也存在各执偏颇之嫌。李老认为，心、肺两脏居于上焦胸中，心主血，肺主气，前者为血液运行的主导，后者为一身气化的总司。血赖气推方能运行，气赖血载方能布达，气血以流通为顺。“通则不痛，不通则痛”，不论任何原因引起的胸痛，其表现总归不出气血瘀滞不通。治疗大法不外乎活血理气（行气）。因此，李老自拟活血理气汤，临证时在此基础方之上，根据不同病情适当加味，治疗各种胸痛病人而每获良效。
活血理气汤组成：旋覆花9克，茜草6克，瓜蒌9克，五灵脂6克，生蒲黄6克。
处方大意：方中五灵脂、生蒲黄合用为《局方》“失笑散”。功效擅长活血祛瘀，散结止痛，用于各种瘀血停滞，胸腹头身疼痛等症。茜草活血祛瘀，以助前两药加强行瘀之力。瓜蒌理气宽胸，并能清肺化痰；旋覆花降气止呕，消痰利水。后两味重在宣降肺气，宽胸理气。诸药配伍，活血理气，行瘀散滞，为治疗气血瘀滞之胸痛的一个理想基础方。
加减运用原则：瘀血较甚者，加当归尾、桃仁或丹参、赤芍；气滞较甚者，加郁金、香附、枳壳；痰湿较甚，食欲不振者，加陈皮、半夏、鸡内金；胸阳不振者，加薤白、益智仁；气虚者，加生黄芪。
附案：
案一 王某，男性，54岁。门诊号：32478。
1960年3月8日初诊：胸痛胸闷3个月，性格急躁易怒，不欲饮食，舌苔薄白，脉弦。气性喜散，蕴结而不散，则为气郁，气为血帅，故气滞血必瘀。治疗宜理气降气，活血化瘀。方用活血理气汤加味：
旋覆花9克，茜草6克，瓜蒌9克，桃仁6克，郁金3克，当归尾7.5克，五灵脂6克，生蒲黄6克，薤白9克。
服2剂，水煎服。
服药后胸痛消失，胸闷减轻。于上方中加枳壳3克，桔梗4.5克，五灵脂、蒲黄各减3克。再服2剂而愈。
按语：本例患者，属胸痛而血瘀气滞较重，同时兼有胸阳不振，故用活血理气汤加桃仁、归尾、郁金、枳壳、桔梗以加强活血行气之力，加薤白以振奋心阳。
案二 赵某，男性，39岁。门诊号：70218。
1963年7月28日初诊：胸痛、胸闷2年，每逢情绪激动而加重，食欲不振，舌苔薄白，脉弦。肝气失于条达，气滞血瘀故胸痛，肝气郁结，辄易乘脾，故见食欲不振，舌苔薄白，脉弦。治疗宜疏肝理气，活血化瘀。方用活血理气汤加味：
旋覆花9克，茜草4.5克，瓜蒌9克，陈皮6克，鸡内金6克，半夏7.5克，五灵脂4.5克，生蒲黄4.5克。
专病论治
服2剂，水煎服。
服药后，胸痛、胸闷减轻，但食欲不振，咯白色泡沫样痰，故用陈皮、鸡内金、半夏理气健脾，燥湿祛痰，痊愈。
案三 常某，男性，37岁。门诊号：79656。
1964年4月26日初诊：胸痛、胸闷已3—4个月，食欲不振，厌油腻食物，大小便正常，舌苔薄白，脉弦。方用活血理气汤加味：
全瓜蒌15克，旋覆花9克，茜草6克，五灵脂6克，生蒲黄6克，郁金4.5克，当归尾7.5克，枳壳4.5克。
服2剂，水煎服。
服药后，症状明显减轻。方中枳壳、郁金、归尾有理气活血止痛的作用。嘱咐患者勿再生气。
案四 赵某，女性，26岁。门诊号：45532。
1961年5月20日初诊：胸部憋闷，月经期下腹部胀痛，月经量最少，舌苔薄白，脉紧。方用活血理气汤加味：
旋覆花9克，茜草6克，丹参15克，全瓜蒌9克，香附4.5克，当归尾7.5克，赤芍7.5克，五灵脂4.5克，生蒲黄4.5克。
服2剂，水煎服。
按语：本例患者除胸闷之外，兼有痛经，故加香附以理气。气为血帅，血为气母，气行血行，气滞血瘀。故用理气活血化瘀之品以理气活血，通则不痛。
案五 陈某，女性，45岁。门诊号：92907。
1965年10月27日初诊：胸痛已3年余，伴气短乏力，太息（长叹气）为快，小便不禁，舌苔薄白，脉沉细。方用活血理气汤加味：
旋覆花9克，茜草4.5克，全瓜蒌9克，五灵脂4.5克，生蒲黄4.5克，生黄芪7.5克，益智仁6克。
水煎服，服药2剂后好转。
按语：患者除有胸痛之外，兼有气短、乏力、小便不禁之气虚症状，故加黄芪补气升阳，益智仁温中助阳固涩。
慢性肺原性心脏病本虚标实寒热相间 病位心肺治从心肾
慢性肺原性心脏病，简称肺心病，多发于地处寒冷的东北、华北、西北等北方地区。是由慢性支气管炎、肺气肿及其他肺胸疾病引起的心脏病。多因喘咳等肺系疾病迁延不愈，渐至肺、心、脾、肾等脏器功能失调，出现气喘、心悸、水肿、腹胀、唇青舌紫等表现。李老认为，肺心病是一个非常复杂的危重证候，中医学虽无“肺原性心脏病”这一名称，但历代文献对本病之诊治记载颇详，大致属于咳喘、心悸、痰饮、水肿等范畴。
由于本病发病缓慢，病程较长，多表现为慢支——肺气肿——肺心病不可逆转的发展过程，且多为年老、久病、体衰患者，故临床表现以本虚为主，急性发作期以虚中夹实、痰热壅肺为特点，而血瘀见症，不论急性期、慢性期均普遍存在。本病迁延日久不愈，多伤及脾肾之阳，易造成下焦脾肾虚寒与上焦心肺郁热相间出现的虚实寒热错综复杂的危重证候。
从病的先后和传变来看，本病由肺而起，逐渐波及心，长期反复发作，进一步影响到脾、肾，后期则以心肾功能衰退为主要表现。具体来讲，肺主气，司呼吸，上通气道、咽喉，开窍于鼻，外合皮毛，肺为五脏之华盖，又属娇脏，不耐寒热，因此，外邪侵袭人体，首先犯肺，导致肺失宣降，肺气逆乱，发为咳喘。咳喘既久，痰热内蕴，渐至肺气虚而短气、喘促，肺伤日久，必及于心。心与肺同居上焦，肺主气，朝百脉，辅心而行血脉。肺气虚、气滞，不能治理调节心血的运行，则心气虚衰，无力推动血脉，血流不畅，而致血瘀，出现心悸、唇甲紫绀、胁下痞块等血瘀之候。心血不足，血不养心，则更加重瘀滞及水肿。肾主水而肺为水之上源，《景岳全书》载：“盖水为至阴，故其本在肾，水化于气，故其标在肺，水惟畏土，故其制在脾。今肺虚，则气不化精而化水，脾虚则土不制水而反克，肾虚则水无所制而妄行。”水液代谢失调，溢于肌肤，则为水肿；水液停积，则为痰饮；水邪泛滥，则面浮肢肿；水饮上凌心肺，故心悸喘咳。又肺失肃降，也可导致肾阳不升，肾不纳气，则气喘更为加剧。因此，本病虽曰肺心，实则以心血瘀阻、肾不主水、阳虚水泛为病机之根本，故应着重从肾心论治。
发病脏腑虽然以心肾为主，但肺、肝、脾等脏往往多被涉及，痰饮、瘀血、气滞、气虚、阴虚、阳虚、寒象、热象常相夹在一起，只不过随着病情的变化，出现孰者为主，孰者为辅，孰多孰少而已。故在治疗用药上，也应随着证候的变化，在抓住主要原因进行治疗的同时，不忘辅以第二位、第三位的治疗方法，以达到标本兼顾、综合治理、提高疗效的目的。
基于上述思路，结合多年的治疗肺心病之经验。李老常将肺心病分为五种证型，详见下述：
一、心肾阳虚，痰饮阻滞型
[证候表现]气短咳喘不能平卧，吐泡沫痰，轻度浮肿，四肢厥冷，怯寒，舌苔白，脉沉细弱或沉细微而数。
[治则]宣阳化饮。
[方药]真武汤加减：
附子3～6克，茯苓5克，白术6克，白芍6克，生姜3片，杏仁3克，人参3克。
[加减]瘀血阻滞，轻度紫绀者，加丹参6克。
[案例]
刘某，男性，55岁。门诊号：86274。
1964年1月21日初诊：咳嗽30多年，咳喘气短，上坡或用力、负重时加重20余年。近1年来日渐严重，尤其最近入冬以来，咳喘气短，不能平卧，心悸浮肿。经用氨茶碱、抗生素类药物无效，后改予中药止咳定喘治疗2个月亦无效。现症怯寒，四肢厥冷，脉沉微。治宜温肾化饮。方用真武汤加减：
附子5克，党参3克，杏仁3克，陈皮6克，茯苓5克，白术6克，白芍6克，生姜3片。
服药2剂后气短稍见好转，以后根据腹胀时加厚朴3克，咳嗽严重时加紫菀6克的加减法，治疗1个月，浮肿、气短、咳喘诸症大多消失。
按语：本案证属心肾阳虚，痰饮上冲，故在温阳利水湿之真武汤基础上加杏仁、陈皮以温化寒痰，党参益气健脾，合苓、术以治生痰之源。
二、上实下虚，痰浊中阻型
[证候表现]咳喘而不能平卧，胃脘痞满，口苦口干，颜面或眼睑浮肿较重，头部时时汗出，足冷，或手足厥冷，舌苔黄厚，或黄腻，脉弦滑。
[治则]化痰降逆温肾。
[方药]苏子降气汤加减：
苏子9克，橘红6克，半夏6克，当归6克，前胡6克，厚朴6克，肉桂5～6克，黑锡丹3克，人参3克。
[案例]
安某，女性，46岁。门诊号：56972。
1962年11月22日初诊：咳嗽30余年，喘20多年，近三四年来加重，尤其今年入冬以来，病情更重，喘咳吐痰，不能平卧，颜面、四肢、腹部均浮肿，尤以食后咳喘更重，头汗出，足冷如冰，舌苔黄厚而腻，口唇、舌、面颊、手指均青紫，脉弦滑。证属上实下虚、痰饮不化之重症。治宜化痰降逆温肾。方用苏子降气汤加减：
苏子9克，橘红6克，半夏9克，当归9克，前胡9克，厚朴9克，肉桂9克，黑锡丹3克，党参6克，补骨脂9克。
服药2剂后咳喘好转，又继服4剂后，根据情况改予金匮肾气丸合黄芪鳖甲散加减治之，2月而安。
按语：本例患者为上实下虚、痰饮不化之重症，故用苏子降气汤加重肉桂用量，另加补肾助阳之补骨脂，意在加强温肾助阳，益火之源，以救下虚。
三、肾阳不足，寒水上冲型
[证候表现]咳喘不能平卧，头汗如珠，腰腿疼痛，足冷如冰，下肢浮肿，舌苔白，脉弦紧，尺大或两尺均微。
[治则]温肾纳气。
[方药]金匮肾气丸加减：
生地9克，山药9克，山萸肉9克，五味子9克，茯苓9克，泽泻9克，丹皮9克，附子9克，肉桂5～9克，车前子9克，怀牛膝9克。
若无山萸肉，可改用补骨脂9克。
[案例]
张某，女性，40岁。门诊号：27898。
1960年3月18日初诊：咳喘数十年，近1月来连续喘嗽不止，不能平卧，心悸，腰酸背困，足冷如冰，7～8天来下肢出现浮肿，咳喘更加严重，头汗时出，但足趾更冷，经西药抗生素、氨茶碱，中药小青龙汤、苏子降气汤、射干麻黄汤、定喘汤等治疗半月余无效。口唇舌质微青紫，舌苔白，脉沉细，尺大而弦。治宜温肾纳气。方用金匮肾气丸加减：
生地12克，山药9克，山萸9克，茯苓9克，五味子9克，泽泻9克，丹皮9克，车前子9克，附子9克，肉桂9克，怀牛膝9克。
服药2剂，咳喘明显改善，浮肿亦大部分消失。继续原方治疗半月，症状大部分消失。
按语：本例咳喘患者属肾阳虚，肾不纳气型，故用济生肾气丸温阳补肾而利水。方中五味子与六味地黄汤合用名都气丸，主治肾阴虚而气喘呃逆者，五味子功擅纳气平喘，故本方能在温补肾阳之基础上增加利水消肿、纳气平喘之功效。
四、痰饮不化，气阴两虚，气滞血瘀型
[证候表现]咳嗽气短，不得平卧，全身浮肿，口苦口干，头晕头痛，心烦心悸，时而胸胁窜痛，烦躁易怒，舌苔白，质暗，口唇紫暗，脉弦滑。
[治则]治宜补气养阴以培本，理气化痰祛瘀治其标。
Note: Spleen deficiency leads to dysfunction of transportation and transformation, failing to vaporize and transform body fluids. Dampness pathogen infiltrates the skin and muscles, stagnating to form fluid retention (Yin), thus presenting with edema of limbs; dampness encumbers the Middle Jiao, stagnating to form fluid retention; cold-fluid forces upward, water qi assaults the Heart, obstructing Heart Yang, thus presenting with palpitations and shortness of breath. Internal accumulation of water-dampness causes failure of the Triple Burner's drainage function and unfavorable Qi transformation of the Bladder, leading to difficult urination; water flows into the Large Intestine causing loose stools. In summary, all symptoms are due to internal retention of water-dampness and impaired Yang Qi movement. The pathogenesis of this case lies in Spleen deficiency, leading to infiltration of cold-dampness. The treatment method should regulate Qi, strengthen the Spleen, unblock Yang, and promote diuresis. Therefore, Wupi Yin (Five Peel Decoction) is modified for treatment. Once cold-dampness is eliminated, palpitations will cease naturally.
Case 3: Li, Female, 28 years old. Outpatient No.: 57207.
First visit on June 10, 1963: Due to excessive blood loss during childbirth, she presented with pale and sallow complexion, palpitations, insomnia, shortness of breath, and fatigue. Tongue coating was thin and white; pulse was weak and powerless. This syndrome belongs to insufficiency of Heart Blood and depression of Chest Yang. Treatment should focus on benefiting Qi and nourishing Blood, calming the Spirit and arresting fright. Prescription:
Codonopsis Radix (Dangshen) 7.5g, Ophiopogonis Radix (Maidong) 6g, Schisandrae Fructus (Wuweizi) 6g, Ziziphi Spinosae Semen (Chao Zaoren) 9g, Angelicae Sinensis Radix (Danggui) 4.5g, Pogostemonis Herba (Shichangpu) 4.5g, Poria (Fushen) 7.5g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g.
Take 2 doses, decocted in water and taken orally.
Note: The pathogenesis of this case lies in insufficiency of Qi and Blood; therefore, benefiting Qi and nourishing Blood is the correct treatment. Thus, when Qi is generated, palpitations subside. The formula uses Codonopsis Radix, Glycyrrhizae Radix et Rhizoma, Ophiopogonis Radix, and Schisandrae Fructus to benefit Qi and nourish Yin; Ziziphi Spinosae Semen and Angelicae Sinensis Radix harmonize Blood and astringe fluids; Poria and Pogostemonis Herba open orifices and calm the Spirit.
Case 4: Feng, Male, 45 years old. Outpatient No.: 73800.
First visit on February 7, 1964: Palpitations, insomnia, forgetfulness, spontaneous sweating, shortness of breath, poor appetite. Tongue coating was thin and white; pulse was fine and weak. This syndrome results from excessive overthinking damaging the Heart Spirit. Treatment should focus on strengthening the Spleen and nourishing the Heart, benefiting Qi and replenishing Blood. Guipi Tang (Restore the Spleen Decoction) modified:
Codonopsis Radix (Dangshen) 4.5g, Atractylodis Macrocephalae Rhizoma (Baizhu) 6g, Astragali Radix (Huangqi) 4.5g, Angelicae Sinensis Radix (Danggui) 4.5g, Poria (Fushen) 6g, Polygalae Radix (Yuanzhi) 4.5g, Aucklandiae Radix (Muxiang) 6g, Euphorbiae Litchi Seed (Yuanrou) 4.5g, Schisandrae Fructus (Wuweizi) 3g.
Take 2 doses, decocted in water and taken orally.
Note: The pathogenesis of this case lies in deficiency of Heart Blood; therefore, Guipi Tang is used to make Qi vigorous and Blood generated, so that palpitations heal spontaneously.
Chest Pain
Chest pain is always related to Qi and Blood stasis; the treatment principle never departs from invigorating Blood and promoting Qi circulation.
Chest pain is a disease characterized by fullness, oppression, and discomfort in the chest region, with intermittent pain, and even severe pain in the left chest like twisting, radiating to the back and arm. Chest pain is a subjective symptom of the patient, mostly occurring in middle-aged or elderly people. Physicians of past dynasties have discussed this disease extensively, with theories such as "insufficiency of Chest Yang," "phlegm-heat congesting the Lung," and "blood stasis blocking collaterals." These diverse views have enriched TCM's theoretical understanding and treatment experience of chest pain, but there is also a suspicion of bias. Master Li believes that the Heart and Lung organs reside in the Upper Jiao chest. The Heart governs Blood, and the Lung governs Qi. The former is the leader of blood circulation, and the latter is the general manager of Qi transformation in the body. Blood relies on Qi to push it to circulate, and Qi relies on Blood to carry it to distribute. Qi and Blood take smooth flow as favorable. "When there is free flow, there is no pain; when there is obstruction, there is pain." Regardless of the cause, the manifestation of any chest pain ultimately boils down to obstruction of Qi and Blood stasis. The major treatment principle is nothing more than invigorating Blood and promoting Qi circulation (moving Qi). Therefore, Master Li self-formulated Huoxue Liqi Tang (Invigorate Blood and Promote Qi Decoction). In clinical practice, based on this basic formula, appropriate additions are made according to different conditions, treating various patients with chest pain with good efficacy.
Composition of Huoxue Liqi Tang: Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 6g, Trichosanthis Fructus (Gualou) 9g, Trogopterori Faeces (Wulingzhi) 6g, Typhae Pollen (Sheng Puhuang) 6g.
General Idea of Prescription: Wulingzhi and Sheng Puhuang combined in the formula constitute "Shixiao San" (Laughing Powder) from *Ju Fang*. It excels at invigorating Blood and dispelling stasis, dissipating nodules and relieving pain, used for various stagnant blood conditions, pain in the chest, abdomen, head, and body. Qiancao invigorates Blood and dispels stasis, assisting the first two herbs to enhance blood-moving power. Gualou promotes Qi circulation and broadens the chest, and can clear Lung heat and resolve phlegm; Xuanfuhua directs Qi downward, stops vomiting, resolves phlegm, and promotes diuresis. The latter two focus on diffusing and descending Lung Qi, broadening the chest and promoting Qi circulation. The combination of these herbs invigorates Blood and promotes Qi circulation, moves stasis and disperses stagnation, making it an ideal basic formula for treating chest pain due to Qi and Blood stasis.
Principles for Modification: For severe blood stasis, add Angelicae Sinensis Radix Cauda (Guwei), Persicae Semen (Taoren), or Salviae Miltiorrhizae Radix (Danshen), and Achyranthis Bidentatae Radix (Chishao); for severe Qi stagnation, add Curcumae Radix (Yujin), Cyperi Rhizoma (Xiangfu), and Aurantii Fructus (Zhike); for severe phlegm-dampness with poor appetite, add Tangerine Peel (Chenpi), Pinelliae Rhizoma (Banxia), and Endothelium Corneum Gigeriae Galli (Jineijin); for depression of Chest Yang, add Allii Macrostemonis Bulbus (Xiebai) and Alpiniae Oxyphyllae Fructus (Yizhiren); for Qi deficiency, add Astragali Radix (Sheng Huangqi).
Attached Cases:
Case 1: Wang, Male, 54 years old. Outpatient No.: 32478.
First visit on March 8, 1960: Chest pain and tightness for 3 months, irritable and prone to anger, poor appetite. Tongue coating was thin and white; pulse was wiry. Qi nature likes to disperse; if it accumulates and does not disperse, it becomes Qi depression. Qi is the commander of Blood; thus, Qi stagnation leads to Blood stasis. Treatment should focus on regulating and directing Qi downward, invigorating Blood and resolving stasis. Formula: Huoxue Liqi Tang modified:
Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 6g, Trichosanthis Fructus (Gualou) 9g, Persicae Semen (Taoren) 6g, Curcumae Radix (Yujin) 3g, Angelicae Sinensis Radix Cauda (Guwei) 7.5g, Trogopterori Faeces (Wulingzhi) 6g, Typhae Pollen (Sheng Puhuang) 6g, Allii Macrostemonis Bulbus (Xiebai) 9g.
Take 2 doses, decocted in water and taken orally.
After taking the medicine, chest pain disappeared, and chest tightness relieved. Add Aurantii Fructus (Zhike) 3g and Platycodonis Radix (Jiegeng) 4.5g to the above formula; reduce Trogopterori Faeces and Typhae Pollen by 3g each. Take 2 more doses and recover.
Note: This patient suffers from chest pain with severe blood stasis and Qi stagnation, accompanied by depression of Chest Yang. Therefore, Huoxue Liqi Tang was used with Taoren, Guwei, Yujin, Zhike, and Jiegeng to strengthen the power of invigorating Blood and moving Qi, and Xiebai was added to振奋 Heart Yang.
Case 2: Zhao, Male, 39 years old. Outpatient No.: 70218.
First visit on July 28, 1963: Chest pain and tightness for 2 years, aggravated by emotional excitement, poor appetite. Tongue coating was thin and white; pulse was wiry. Liver Qi fails to be smooth and spreading; Qi stagnation and Blood stasis cause chest pain. Liver Qi depression easily attacks the Spleen, hence poor appetite, thin white tongue coating, and wiry pulse. Treatment should focus on soothing the Liver and regulating Qi, invigorating Blood and resolving stasis. Formula: Huoxue Liqi Tang modified:
Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 4.5g, Trichosanthis Fructus (Gualou) 9g, Citri Reticulatae Pericarpium (Chenpi) 6g, Endothelium Corneum Gigeriae Galli (Jineijin) 6g, Pinelliae Rhizoma (Banxia) 7.5g, Trogopterori Faeces (Wulingzhi) 4.5g, Typhae Pollen (Sheng Puhuang) 4.5g.
Special Disease Treatment
Take 2 doses, decocted in water and taken orally.
After taking the medicine, chest pain and tightness relieved, but poor appetite persisted, and white foamy sputum was coughed up. Therefore, Chenpi, Jineijin, and Banxia were used to regulate Qi and strengthen the Spleen, dry dampness and resolve phlegm, leading to recovery.
Case 3: Chang, Male, 37 years old. Outpatient No.: 79656.
First visit on April 26, 1964: Chest pain and tightness for 3-4 months, poor appetite, aversion to oily food, normal bowel movements and urination. Tongue coating was thin and white; pulse was wiry. Formula: Huoxue Liqi Tang modified:
Whole Trichosanthis Fructus (Quangu lou) 15g, Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 6g, Trogopterori Faeces (Wulingzhi) 6g, Typhae Pollen (Sheng Puhuang) 6g, Curcumae Radix (Yujin) 4.5g, Angelicae Sinensis Radix Cauda (Guwei) 7.5g, Aurantii Fructus (Zhike) 4.5g.
Take 2 doses, decocted in water and taken orally.
After taking the medicine, symptoms significantly relieved. Zhike, Yujin, and Guwei in the formula have the effect of regulating Qi, invigorating Blood, and relieving pain. Advised the patient not to get angry again.
Case 4: Zhao, Female, 26 years old. Outpatient No.: 45532.
First visit on May 20, 1961: Chest tightness, lower abdominal distension and pain during menstruation, minimal menstrual flow. Tongue coating was thin and white; pulse was tight. Formula: Huoxue Liqi Tang modified:
Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 6g, Salviae Miltiorrhizae Radix (Danshen) 15g, Whole Trichosanthis Fructus (Quangu lou) 9g, Cyperi Rhizoma (Xiangfu) 4.5g, Angelicae Sinensis Radix Cauda (Guwei) 7.5g, Achyranthis Bidentatae Radix (Chishao) 7.5g, Trogopterori Faeces (Wulingzhi) 4.5g, Typhae Pollen (Sheng Puhuang) 4.5g.
Take 2 doses, decocted in water and taken orally.
Note: Besides chest tightness, this patient also has dysmenorrhea, so Xiangfu was added to regulate Qi. Qi is the commander of Blood, Blood is the mother of Qi; Qi moves then Blood moves, Qi stagnation leads to Blood stasis. Therefore, herbs that regulate Qi, invigorate Blood, and resolve stasis were used to regulate Qi and invigorate Blood. When there is free flow, there is no pain.
Case 5: Chen, Female, 45 years old. Outpatient No.: 92907.
First visit on October 27, 1965: Chest pain for over 3 years, accompanied by shortness of breath and fatigue, relief after sighing, urinary incontinence. Tongue coating was thin and white; pulse was deep and fine. Formula: Huoxue Liqi Tang modified:
Inulae Flos (Xuanfuhua) 9g, Rubia Cordifolia Radix et Rhizoma (Qiancao) 4.5g, Whole Trichosanthis Fructus (Quangu lou) 9g, Trogopterori Faeces (Wulingzhi) 4.5g, Typhae Pollen (Sheng Puhuang) 4.5g, Astragali Radix (Sheng Huangqi) 7.5g, Alpiniae Oxyphyllae Fructus (Yizhiren) 6g.
Decocted in water and taken orally. Improved after 2 doses.
Note: Besides chest pain, the patient also has Qi deficiency symptoms such as shortness of breath, fatigue, and urinary incontinence. Therefore, Huangqi was added to tonify Qi and raise Yang, and Yizhiren was added to warm the Middle and assist Yang to consolidate and secure.
Chronic Cor Pulmonale: Root Deficiency and Branch Excess, Interwoven Cold and Heat; Location in Heart and Lung, Treatment from Heart and Kidney
Chronic Cor Pulmonale, abbreviated as Pulmonary Heart Disease, is prevalent in cold northern regions such as Northeast, North China, and Northwest China. It is heart disease caused by chronic bronchitis, emphysema, and other pulmonary and pleural diseases. It often arises from prolonged unresolved lung diseases such as wheezing and coughing, gradually leading to dysfunction of organs including the Lung, Heart, Spleen, and Kidney, presenting with manifestations such as asthma, palpitations, edema, abdominal distension, cyanotic lips, and purple tongue. Master Li believes that Pulmonary Heart Disease is a very complex and critical syndrome. Although Traditional Chinese Medicine (TCM) has no name for "Pulmonary Heart Disease," historical documents record detailed diagnoses and treatments for this disease, roughly falling under the categories of coughing and wheezing, palpitations, fluid retention, and edema.
Since the onset of this disease is slow and the course is long, it mostly shows an irreversible development process of chronic bronchitis -- emphysema -- pulmonary heart disease. It mostly affects elderly, chronically ill, and debilitated patients. Therefore, clinical manifestations are mainly root deficiency. During acute exacerbations, it is characterized by deficiency mixed with excess and phlegm-heat congesting the Lung. Blood stasis signs are universally present in both acute and chronic phases. Prolonged persistence of this disease damages the Yang of the Spleen and Kidney, easily creating a critical syndrome where deficiency-cold of the Lower Jiao Spleen and Kidney interweaves with depression-heat of the Upper Jiao Heart and Lung, resulting in a complex mix of deficiency-excess and cold-heat.
From the perspective of disease sequence and transmission, this disease starts from the Lung, gradually affecting the Heart, and with long-term recurrent episodes, further affects the Spleen and Kidney. In the late stage, decline of Heart and Kidney functions is the main manifestation. Specifically, the Lung governs Qi and respiration, connects upwards to the airways and throat, opens into the nose, and combines externally with the skin and hair. The Lung is the canopy of the five Zang organs and is a delicate organ, intolerant to cold and heat. Therefore, when external pathogens invade the human body, they first attack the Lung, causing loss of diffusion and descent of Lung Qi, chaotic reversal of Lung Qi, leading to coughing and wheezing. After prolonged coughing and wheezing, phlegm-heat accumulates internally, gradually leading to Lung Qi deficiency with shortness of breath and panting. Long-term damage to the Lung inevitably affects the Heart. The Heart and Lung reside together in the Upper Jiao; the Lung governs Qi, gathers all vessels, assists the Heart in circulating blood vessels. Lung Qi deficiency and Qi stagnation fail to govern and regulate the circulation of Heart Blood, leading to Heart Qi deficiency and decline, inability to push blood vessels, poor blood flow, resulting in blood stasis, presenting with palpitations, cyanosis of lips and nails, and hypochondriac masses. Insufficiency of Heart Blood and Blood failing to nourish the Heart further aggravate stasis and edema. The Kidney governs Water, and the Lung is the source of Water above. *Jing Yue Quan Shu* records: "Water is extreme Yin, so its root is in the Kidney; Water transforms via Qi, so its branch is in the Lung; Water fears Earth, so its control is in the Spleen. Now, Lung deficiency means Qi cannot transform essence into water but transforms into water; Spleen deficiency means Earth cannot control Water but is counter-controlled; Kidney deficiency means Water has no control and acts recklessly." Dysregulation of water metabolism, overflowing into skin and muscles, causes edema; accumulation of water forms phlegm-fluid; flooding of water evil causes facial and limb swelling; fluid attacking the Heart and Lung causes palpitations and wheezing. Furthermore, loss of Lung descending function can lead to failure of Kidney Yang to ascend and Kidney failing to grasp Qi, worsening asthma. Therefore, although this disease is called Lung-Heart, its fundamental pathogenesis is actually Heart Blood stasis, Kidney failing to govern Water, and Yang deficiency with water flooding. Thus, treatment should focus on the Kidney and Heart.
Although the affected organs are mainly the Heart and Kidney, the Lung, Liver, and Spleen are often involved. Phlegm-fluid, blood stasis, Qi stagnation, Qi deficiency, Yin deficiency, Yang deficiency, cold signs, and heat signs often combine, merely varying in prominence, assistance, and quantity as the condition changes. Therefore, in medication, while grasping the main cause for treatment, one should not forget to supplement with second and third-line treatment methods according to syndrome changes, aiming to address both root and branch, comprehensive management, and improving efficacy.
Based on the above思路, combined with years of experience treating Pulmonary Heart Disease, Master Li often divides Pulmonary Heart Disease into five syndromes, as detailed below:
I. Heart-Kidney Yang Deficiency, Fluid Retention Obstruction Type
[Syndrome Manifestations] Shortness of breath, coughing, wheezing unable to lie flat, expectoration of foamy sputum, mild edema, cold extremities, aversion to cold, white tongue coating, deep, fine, weak pulse or deep, fine, minute, and rapid pulse.
[Treatment Principle] Disseminate Yang and transform fluid.
[Prescription] Zhenwu Tang (True Warrior Decoction) modified:
Aconiti Lateralis Radix Praeparata (Fuzi) 3-6g, Poria (Fuling) 5g, Atractylodis Macrocephalae Rhizoma (Baizhu) 6g, Paeoniae Radix Alba (Baishao) 6g, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Armeniacae Semen Amarum (Xingren) 3g, Ginseng Radix (Renshen) 3g.
[Modifications] For blood stasis obstruction with mild cyanosis, add Salviae Miltiorrhizae Radix (Danshen) 6g.
[Case]
Liu, Male, 55 years old. Outpatient No.: 86274.
First visit on January 21, 1964: Cough for over 30 years, coughing and wheezing with shortness of breath, aggravated by climbing slopes, exertion, or carrying heavy loads for over 20 years. Severely worsened in the past year, especially since winter recently, with coughing, wheezing, shortness of breath, inability to lie flat, palpitations, and edema. Ineffective after using Aminophylline and antibiotics, and ineffective after 2 months of TCM cough-stopping and asthma-calming treatment. Current symptoms: aversion to cold, cold extremities, deep and minute pulse. Treatment should focus on warming the Kidney and transforming fluid. Formula: Zhenwu Tang modified:
Aconiti Lateralis Radix Praeparata (Fuzi) 5g, Codonopsis Radix (Dangshen) 3g, Armeniacae Semen Amarum (Xingren) 3g, Citri Reticulatae Pericarpium (Chenpi) 6g, Poria (Fuling) 5g, Atractylodis Macrocephalae Rhizoma (Baizhu) 6g, Paeoniae Radix Alba (Baishao) 6g, Zingiberis Rhizoma Recens (Shengjiang) 3 slices.
After 2 doses, shortness of breath slightly improved. Subsequently, based on bloating, added Magnoliae Officinalis Cortex (Houpo) 3g; based on severe cough, added Asteris Radix (Ziwan) 6g. After 1 month of treatment, most symptoms of edema, shortness of breath, and coughing/wheezing disappeared.
Note: This case belongs to Heart-Kidney Yang deficiency with fluid rushing upward. Therefore, on the basis of Zhenwu Tang which warms Yang and promotes diuresis, Xingren and Chenpi were added to warm-transform cold-phlegm, Dangshen was added to benefit Qi and strengthen the Spleen, combined with Fuling and Baizhu to treat the source of phlegm production.
II. Upper Excess and Lower Deficiency, Phlegm-Turbidity Obstructing the Middle Type
[Syndrome Manifestations] Coughing and wheezing unable to lie flat, epigastric fullness, bitter and dry mouth, heavier edema of face or eyelids, frequent sweating on the head, cold feet, or cold hands and feet, thick yellow or greasy yellow tongue coating, wiry-slippery pulse.
[Treatment Principle] Resolve phlegm, direct rebellious Qi downward, and warm the Kidney.
[Prescription] Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) modified:
Perillae Fructus (Suzi) 9g, Citri Reticulatae Pericarpium (Juhong) 6g, Pinelliae Rhizoma (Banxia) 6g, Angelicae Sinensis Radix (Danggui) 6g, Peucedani Radix (Qianhu) 6g, Magnoliae Officinalis Cortex (Houpo) 6g, Cinnamomi Ramulus (Rougui) 5-6g, He Xi Dan (Black Tin Pill) 3g, Ginseng Radix (Renshen) 3g.
[Case]
An, Female, 46 years old. Outpatient No.: 56972.
First visit on November 22, 1962: Cough for over 30 years, wheezing for over 20 years, worsened in the past 3-4 years, especially severely since winter this year. Wheezing, coughing, expectoration, inability to lie flat, edema of face, limbs, and abdomen, especially worse after eating, sweating on the head, feet cold as ice, thick greasy yellow tongue coating, cyanosis of lips, tongue, cheeks, and fingers, wiry-slippery pulse. Syndrome belongs to severe upper excess and lower deficiency with untransformed fluid retention. Treatment should focus on resolving phlegm, directing rebellious Qi downward, and warming the Kidney. Formula: Suzi Jiangqi Tang modified:
Perillae Fructus (Suzi) 9g, Citri Reticulatae Pericarpium (Juhong) 6g, Pinelliae Rhizoma (Banxia) 9g, Angelicae Sinensis Radix (Danggui) 9g, Peucedani Radix (Qianhu) 9g, Magnoliae Officinalis Cortex (Houpo) 9g, Cinnamomi Ramulus (Rougui) 9g, He Xi Dan (Black Tin Pill) 3g, Codonopsis Radix (Dangshen) 6g, Psoraleae Fructus (Buguzhi) 9g.
After 2 doses, coughing and wheezing improved. Continued for 4 more doses, then changed to Jin Gui Shen Qi Wan combined with Huangqi Biejia San modified according to condition. Recovered in 2 months.
Note: This patient suffered from severe upper excess and lower deficiency with untransformed fluid retention. Therefore, Suzi Jiangqi Tang was used with increased Rougui dosage, plus Buguzhi to tonify Kidney and assist Yang, intending to strengthen warming the Kidney and assisting Yang, benefiting the source of Fire to save the lower deficiency.
III. Kidney Yang Insufficiency, Cold Water Rushing Upward Type
[Syndrome Manifestations] Coughing and wheezing unable to lie flat, sweat on head like pearls, waist and leg pain, feet cold as ice, lower limb edema, white tongue coating, wiry-tight pulse, large radial pulse or both radial pulses minute.
[Treatment Principle] Warm the Kidney and grasp Qi.
[Prescription] Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) modified:
Rehmanniae Radix (Shengdi) 9g, Dioscoreae Rhizoma (Shanyao) 9g, Corni Fructus (Shanzhuyu) 9g, Schisandrae Fructus (Wuweizi) 9g, Poria (Fuling) 9g, Alismatis Rhizoma (Zexie) 9g, Moutan Cortex (Danpi) 9g, Aconiti Lateralis Radix Praeparata (Fuzi) 9g, Cinnamomi Ramulus (Rougui) 5-9g, Plantaginis Semen (Cheqianzi) 9g, Achyranthis Bidentatae Radix (Huainiuxi) 9g.
If Shanzhuyu is unavailable, replace with Psoraleae Fructus (Buguzhi) 9g.
[Case]
Zhang, Female, 40 years old. Outpatient No.: 27898.
First visit on March 18, 1960: Coughing and wheezing for decades, continuous non-stop wheezing and coughing for the past month, unable to lie flat, palpitations, sore waist and tired back, feet cold as ice. Lower limb edema appeared in the past 7-8 days, coughing and wheezing became more severe, occasional sweating on the head, but toes colder. Ineffective after half a month of Western antibiotics, Aminophylline, and TCM Xiao Qing Long Tang, Suzi Jiangqi Tang, Shegan Mahuang Tang, Dingchuan Tang. Lips and tongue slightly cyanotic, white tongue coating, deep-fine pulse, large and wiry radial pulse. Treatment should focus on warming the Kidney and grasping Qi. Formula: Jin Gui Shen Qi Wan modified:
Rehmanniae Radix (Shengdi) 12g, Dioscoreae Rhizoma (Shanyao) 9g, Corni Fructus (Shanzhuyu) 9g, Poria (Fuling) 9g, Schisandrae Fructus (Wuweizi) 9g, Alismatis Rhizoma (Zexie) 9g, Moutan Cortex (Danpi) 9g, Plantaginis Semen (Cheqianzi) 9g, Aconiti Lateralis Radix Praeparata (Fuzi) 9g, Cinnamomi Ramulus (Rougui) 9g, Achyranthis Bidentatae Radix (Huainiuxi) 9g.
After 2 doses, coughing and wheezing significantly improved, and most edema disappeared. Continued original prescription for half a month, and most symptoms disappeared.
Note: This coughing and wheezing patient belongs to Kidney Yang deficiency and Kidney failing to grasp Qi type. Therefore, Jisheng Shenqi Wan was used to warm Yang, tonify Kidney, and promote diuresis. Wuweizi combined with Liuwei Dihuang Tang forms Duqi Wan, mainly treating Kidney Yin deficiency with asthma and hiccups. Wuweizi excels at grasping Qi and calming asthma. Thus, this formula adds water-promoting, edema-reducing, Qi-grasping, and asthma-calming effects on the basis of warming and tonifying Kidney Yang.
IV. Untransformed Fluid Retention, Dual Deficiency of Qi and Yin, Qi Stagnation and Blood Stasis Type
[Syndrome Manifestations] Coughing, shortness of breath, inability to lie flat, whole-body edema, bitter and dry mouth, dizziness and headache, vexation, palpitations, intermittent stabbing pain in chest and hypochondrium, irritability and anger, white tongue coating, dark tongue body, dark purple lips, wiry-slippery pulse.
[Treatment Principle] Benefit Qi and nourish Yin to cultivate the root; regulate Qi, resolve phlegm, and resolve stasis to treat the branch.