如禀受素弱,转运不调,饮食不化,而心下痞者,宜用白术、山楂、神曲、陈皮。心下
须用枳实、黄连。如肥人心下痞,乃是湿痰,宜苍术、半夏、砂仁、茯苓、滑石。如瘦人心
下痞,乃是湿热,宜枳实、黄连、葛根、升麻。挟血成窝囊而痞者,用桃仁、红花、香附、
山栀子、大黄之类。
乃湿热积于脾而出,伏于肺胃之间,必以吴茱萸炒黄连为君,用二陈加此二味,冬月倍
吴茱萸,夏月倍黄连为丸,姜汤下。
嘈杂者,火动其痰也,宜二陈加黄芩、青黛。恶心者,无物无声,心中欲吐不吐者是,
心经之病,皆在胃口上。宜用生姜佐诸药,能开豁胃痰也。呕吐者,胃中有热,膈上有痰,
二陈汤加炒山栀、黄连、生姜。
气虚短气而喘甚者,不可用苦寒药,火气盛故也。宜导痰汤、千缗汤。(见《局方》。)
汗,小腹火起,冲于上喘者。宜降心火,补阴。有火痰者,宜降心火,清肺金。诸喘不止者
,用椒目研末,生姜汤调下一二钱。劫止之后,因痰治痰,因火治火。又法,以萝白子蒸熟
为君,皂角烧灰等分,共为末,生姜汁炼蜜丸,每五七丸,噙化止之。气虚气短者,用人参
、(蜜炙)黄柏、麦冬、地骨皮之类,治喘症,必用阿胶。
戴云∶痰喘者,喘便有痰声。气急喘者,呼吸急促,而无痰声;有胃气虚喘者,抬肩撷
项,喘而不休;火炎上喘者,乍进乍退,得食则减,食已则喘。大抵有实火,膈上有稠痰。
凡喘症,上喘下必胀,要识标本。先喘而后胀者,主于肺,则喘为本,而肿为标。治当
清肺
不得降而生喘,此则肿为本,而喘为标。治当实脾行水为主,而清肺次之。
如果患者先天体质虚弱,气机运行失调,饮食无法消化,导致心下(胃脘部)痞塞胀满的,适宜使用白术、山楂、神曲、陈皮。若心下痞塞严重,须加用枳实、黄连。如果是肥胖之人出现心下痞塞,这是由于湿痰所致,适宜使用苍术、半夏、砂仁、茯苓、滑石。如果是瘦弱之人出现心下痞塞,这是由于湿热所致,适宜使用枳实、黄连、葛根、升麻。若夹杂瘀血形成痞块而致痞塞的,使用桃仁、红花、香附、山栀子、大黄之类的药物。
这是湿热积聚于脾脏并外发,潜伏在肺和胃之间的病证,必须以吴茱萸炒制的黄连作为君药,配合二陈汤加入这两味药,冬季加倍使用吴茱萸,夏季加倍使用黄连,制成丸剂,用姜汤送服。
嘈杂感,是火邪扰动痰浊所致,适宜在二陈汤基础上加黄芩、青黛。恶心,表现为没有食物吐出也没有声音,心中想吐却吐不出来,这是心经的病证,病位都在胃口上方。适宜使用生姜辅助各种药物,能够开豁胃中的痰浊。呕吐,是因为胃中有热,膈上有痰,使用二陈汤加炒山栀子、黄连、生姜。
气虚导致短气且喘息严重的,不可使用苦寒药物,因为此时火气旺盛。适宜使用导痰汤、千缗汤。(见《太平惠民和剂局方》。)若是汗出后,小腹有热气升起,冲逆向上导致喘息的,适宜清降心火,滋补阴液。若有火痰的,适宜清降心火,清肃肺金。对于各种喘息不止的情况,使用椒目研成粉末,用生姜汤调服一二钱。劫夺止喘之后,根据痰则治痰,根据火则治火。另一种方法,以萝白子蒸熟作为君药,皂角烧成灰等量,共同研成粉末,用生姜汁和炼蜜制成丸剂,每次五至七丸,含化以止喘。气虚短气的,使用人参、(蜜炙)黄柏、麦冬、地骨皮之类的药物,治疗喘息病症,必须使用阿胶。
戴云说:痰喘,是指喘息时伴有痰声。气急喘,是指呼吸急促,但没有痰声;有胃气虚导致的喘息,表现为抬肩撷项,喘息不停;火炎上导致的喘息,表现为时轻时重,进食后减轻,食后即喘。大抵是有实火,膈上有稠痰。凡是喘息病症,上部喘息下部必然胀满,要识别标本关系。先喘息而后出现胀满的,病主在肺,则喘息为本,胀满为标。治疗应当以清肺为主。若因肺气不得下降而生喘息,此则是胀满为本,喘息为标。治疗应当以健脾益气、行水为主,清肺为辅。
If the patient has a constitutionally weak endowment, with dysregulated Qi transformation and inability to digest food, resulting in fullness and obstruction in the epigastrium (heart below), Baizhu Tang (Atractylodis Macrocephalae Decoction) ingredients such as Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Crataegi Fructus (Shanzha, 山楂), Massamedica Fermentata (Shenqu, 神曲), and Tangerine Peel (Chenpi, 陈皮) are suitable. If the epigastric fullness is severe, Zhi Shi (Immature Bitter Orange, 枳实) and Coptidis Rhizoma (Huanglian, 黄连) must be added. For obese individuals with epigastric fullness, this is due to damp-phlegm; Cangzhu (Atractylodis Rhizoma, 苍术), Pinelliae Tuber (Banxia, 半夏), Amomi Fructus Rotundus (Sharen, 砂仁), Poria (Fuling, 茯苓), and Talcum (Huashi, 滑石) are suitable. For thin individuals with epigastric fullness, this is due to damp-heat; Zhi Shi (Immature Bitter Orange, 枳实), Huanglian (Coptidis Rhizoma, 黄连), Kudzu Root (Gegen, 葛根), and Cimicifugae Rhizoma (Shengma, 升麻) are suitable. If blood stasis complicates the condition forming a lump-like fullness, Tao Ren (Persicae Semen, 桃仁), Carthami Flos (Honghua, 红花), Cyperi Rhizoma (Xiangfu, 香附), Gardenia Fruit (Shanzhizi, 山栀子), and Rheum Palmatum Radix et Rhizoma (Dahuang, 大黄) are used.
This refers to damp-heat accumulating in the Spleen and manifesting externally, lying dormant between the Lung and Stomach. Wu Zhu Yu (Evodiae Fructus, 吴茱萸) stir-fried with Huanglian (Coptidis Rhizoma, 黄连) should serve as the sovereign drug. Er Chen Tang (Two-Cured Decoction) is combined with these two herbs. In winter, double the dosage of Wu Zhu Yu; in summer, double the dosage of Huanglian. Form into pills and take with Ginger Decoction.
Za Cao (burning sensation or discomfort in the stomach/epigastrium) is caused by fire disturbing phlegm; Er Chen Tang (Two-Cured Decoction) added with Scutellariae Radix (Huangqin, 黄芩) and Indigo Naturalis (Qingdai, 青黛) is suitable. E Nausea, characterized by no vomitus and no sound, with a desire to vomit but inability to do so, is a disease of the Heart Meridian, located above the gastric opening. Sheng Jiang (Fresh Ginger Rhizome, 生姜) should be used to assist other herbs to open and disperse gastric phlegm. Vomiting is caused by heat in the Stomach and phlegm above the diaphragm; Er Chen Tang (Two-Cured Decoction) added with stir-fried Gardenia Fruit (Shanzhizi, 山栀子), Huanglian (Coptidis Rhizoma, 黄连), and Sheng Jiang (Fresh Ginger Rhizome, 生姜) is used.
For shortness of breath and severe wheezing due to Qi deficiency, bitter-cold drugs must not be used because fire Qi is abundant. Dao Tan Tang (Phlegm-Guiding Decoction) and Qian Min Tang (Thousand-Mill Decoction) are suitable. (See *Ju Fang*). If sweating occurs followed by heat rising from the lower abdomen rushing upward causing wheezing, one should descend Heart Fire and tonify Yin. If there is fire-phlegm, one should descend Heart Fire and clear Lung Metal. For persistent wheezing that does not stop, Jiao Mu (Semen Lepidii et Descurainiae, 椒目) ground into powder, taken with Ginger Decoction, one or two qian, is used. After arresting wheezing forcefully, treat according to phlegm if phlegm is present, or according to fire if fire is present. Another method: use Luobai Zi (Semen Raphani, 萝卜子) steamed until cooked as the sovereign drug, equal parts of Saponariae Fructus (Zaojiao, 皂角) burned to ash, ground together into powder, formed into pills with Ginger Juice and refined honey. Take five to seven pills, holding them in the mouth to dissolve to stop wheezing. For Qi deficiency and shortness of breath, Renshen (Ginseng Radix, 人参), Honey-fried Phellodendri Cortex (Huangbai, 黄柏), Ophiopogonis Tuber (Maidong, 麦冬), and Lycii Cortex (Digupi, 地骨皮) are used. To treat wheezing disorders, Ejiao (Donkey-hide Gelatin, 阿胶) must be used.
Dai Yun stated: Tan Chuan (Phlegm Wheezing) involves wheezing accompanied by phlegm sounds. Qi Ji Chuan (Urgent Breathing Wheezing) involves rapid breathing without phlegm sounds. Wei Qi Xu Chuan (Stomach Qi Deficiency Wheezing) involves lifting shoulders and pulling the neck, with continuous wheezing. Huo Yan Shang Chuan (Fire Flaring Upward Wheezing) involves fluctuating severity, improving after eating, and worsening immediately after eating. Generally, there is excess fire and thick phlegm above the diaphragm. In all wheezing disorders, upper wheezing is accompanied by lower abdominal distension; one must distinguish the root and branch. If wheezing precedes distension, the pathology originates in the Lung; thus, wheezing is the root and swelling/distension is the branch. Treatment should focus on clearing the Lung. If wheezing arises because Lung Qi fails to descend, then distension/swelling is the root and wheezing is the branch. Treatment should primarily focus on strengthening the Spleen and promoting water metabolism, with clearing the Lung as secondary.