敬兄向在金华贸易，恙患咳血，医治无效，食微肌瘦，虑成损怯。予时至兰溪，友人荐
延诊
视。阅前诸方，偏于温补，谓曰∶古人治血证，虽有此法，然须审其证属虚寒，方为合辙。
据兹脉证，责诸肺肾阴亏，肝阳上僭，咳甚火炎，血随溢出，理应滋水生木，润肺保金，得
以咳稀，血当自止。服药投机，予欲辞回，敬兄固留，为治月余，咳血全好，餐加神旺，肌
肉复生。
安波按∶温热治虚损与草菅人命何异?故前贤云男子阳常有余。阴常不足。盖男子气恒
有余者
多，血患不足者不少。以温热治虚损者，仲圣建中之类也。其内以稼穑作甘之本味，急建其
中气，俾中宫得强，饮食增而津液旺，以至充血生精，而复其真阴之不足。愚意以治脾虚损
怯则可，若肾阴耗乏，相火燥金，见咳呛累血，形销骨折，遗泄潮热等 ，投之如抱薪救火
矣。
黄敬修兄店内，有同事鲍宗海者，因感风寒，喘嗽多日，就彼地某姓老医看视，谓其证
属内
亏，药与地归参术。予见方劝其勿服，宗海以为伊芳体素虚，老医见识不谬，潜服其药。是夜
喘嗽益甚，次日复往加减，医谓前药尚轻，更增黄 五味子，服后胸高气筑，莫能卧下，呷
呀不休，闭闷欲绝。敬兄询知其故，嘱予拯治。予曰∶前药吾原劝其勿服，伊芳不之信，况加
酸敛，邪锢益坚，如何排解?敬兄云∶渠与我同事多年，不忍见其死而不救，揣摩至再，立
方用麻黄、桂枝、细辛、半夏、甘草、生姜、杏仁、葶苈子，并语之曰∶此乃风寒客肺，气
阻痰凝，因而喘嗽，医不开解，反投敛补，以致闭者愈闭，壅者愈壅，酿成肺胀危证。《金
匮》云∶咳逆倚息不得卧，小青龙汤主之。予于方中除五味白芍之酸收，加葶苈杏仁之苦泻
者，盖肺苦气上逆，急食苦以泻之。如救眉燃，不容缓待也。敬兄欣以为然，即令市药煎服
，少顷嗽出稠痰两盂，胸鬲顿宽，再服复渣，又吐痰涎盏许，喘定能卧。宗海始悟前药之误
，泣求救援。予笑曰∶无妨，枉自吃几日苦耳。次剂麻桂等味分两减轻，参入桔梗橘红茯苓
苏子，更为调和肺胃而痊。
安波按∶风寒咳嗽，亦一大症也，不可渺视为轻浅者。徐氏灵胎，苦志三十年，始能
治咳，先生于小青龙，去味芍加葶杏，真善法古人而不泥古人者也。
黄敬修兄此前在金华经商，患病咳血，经过治疗无效，饮食减少且身体消瘦，担心发展成虚劳病。我时常到兰溪，朋友推荐我去诊治。查看之前的处方，偏向于温补，我对他说：“古人治疗血证，虽然有这种方法，但必须审查其证候属于虚寒，才符合治疗原则。”根据这里的脉象和症状，责任在于肺肾阴液亏损，肝阳上亢，咳嗽剧烈导致火气炎上，血液随之溢出，理应滋补肾水以涵养肝木，润肺以保护肺金，使得咳嗽减少，出血自然会停止。服药对症后，我想辞别回去，黄敬修坚决挽留，为他治疗了一个多月，咳血完全痊愈，食欲增加，精神旺盛，肌肉重新生长。
安波按语：用温热药治疗虚损病，与草菅人命有什么区别？所以前贤说男子阳气常有余，阴气常不足。大概男子气机常有余的多，患血虚不足的也不少。用温热药治疗虚损的，是张仲景建立中气的方剂之类。其内部以稼穑之甘味为本，急切地建立中气，使中焦得到强健，饮食增加而津液旺盛，以至于充血生精，从而恢复真阴的不足。我认为用来治疗脾虚引起的虚劳是可以的，如果是肾阴耗竭，相火灼伤肺金，出现咳嗽带血、形体消瘦、遗精滑泄、潮热等症状，投用这种药就像抱着柴草去救火一样（适得其反）。
黄敬修兄的店里，有一位同事叫鲍宗海，因为感受风寒，喘嗽多天，在当地某姓老中医处就诊，医生认为他的证候属于内里亏虚，用药给予地黄、当归、人参、白术。我看到处方劝他不要服用，宗海认为他体质素来虚弱，老医生的见识没有错误，偷偷服用了药物。当天晚上喘嗽更加严重，第二天再去复诊加减，医生说前面的药力还轻，又增加了黄芪、五味子，服用后胸部胀满气息上逆，不能躺下，发出呷呀的声音不停，憋闷快要断气。黄敬修询问知道原因后，嘱咐我去救治。我说：“前面的药我原本劝他不要服用，他不相信，况且又加了酸敛的药物，邪气更加固结，如何能化解？”黄敬修说：“他与我共事多年，不忍心看着他死而不救，反复揣摩，立下处方使用麻黄、桂枝、细辛、半夏、甘草、生姜、杏仁、葶苈子，并告诉他说：‘这是风寒客居于肺，气机阻滞痰液凝结，因而导致喘嗽，医生不采用开解的方法，反而投用收敛补益的药，导致闭塞的更加闭塞，壅滞的更加壅滞，酿成肺胀的危重证候。’《金匮要略》说：‘咳逆倚息不得卧，小青龙汤主之。’我在方中去除了五味子、白芍的酸收作用，加入葶苈子、杏仁的苦泻作用，这是因为肺苦气上逆，急需食用苦味药来泻降肺气。如同救火烧眉毛一样紧急，不容迟缓等待。”黄敬修欣然同意，立即让人买药煎服，过了一会儿咳出两盂稠痰，胸膈顿时宽松，再服用剩下的药渣，又吐出痰涎约一盏的量，喘定能够躺下。宗海才明白之前用药的错误，哭着请求救援。我笑着说：“没关系，只是白白吃了几天苦头罢了。”第二剂方子将麻黄、桂枝等药的剂量减轻，加入桔梗、橘红、茯苓、苏子，更加调和肺胃而痊愈。
安波按语：风寒咳嗽，也是一大病症，不可轻视视为轻微浅表的疾病。徐灵胎先生，刻苦钻研三十年，才能治好咳嗽，先生在《小青龙汤》的基础上，去掉五味子、白芍，加入葶苈子、杏仁，真是善于效法古人而不拘泥于古人的做法啊。
Brother Huang Jingxiu had previously been trading in Jinhua, suffering from hemoptysis (coughing up blood). Despite treatment, it was ineffective; his appetite decreased, and he emaciated, raising concerns that he might develop consumptive disease (Xu Lao). I frequently visited Lanxi, and a friend recommended me for consultation. Reviewing previous prescriptions, they leaned towards warming and tonifying. I told him: "Although ancients used this method for treating blood disorders, one must examine whether the syndrome belongs to deficiency-cold to be appropriate." Based on the pulse and symptoms here, the issue lies in the yin deficiency of the Lung and Kidney, with hyperactive Liver Yang ascending. Severe coughing causes fire to flare up, leading to blood溢ing out. The principle should be to nourish Kidney Water to support Liver Wood, moisten the Lung to protect Lung Metal, so that coughing decreases and bleeding stops naturally. After taking medicine that matched the syndrome, I wished to leave, but Brother Huang insisted I stay. He treated him for over a month, after which hemoptysis completely ceased, appetite increased, spirit became vigorous, and muscle mass returned.
An Bo's Commentary: Using warm-hot medicines to treat consumptive disease is no different from disregarding human life. Thus, former sages said that men often have excess Yang and deficient Yin. Generally, men often have excess Qi, while many suffer from Blood deficiency. Using warm-hot medicines to treat consumptive disease refers to Zhang Zhongjing's methods of establishing the Middle Jiao, such as those involving the sweet flavor of grain (Jia Se), urgently strengthening the Middle Qi. This allows the Central Palace to become strong, increasing food intake and flourishing fluids, thereby generating blood and essence to restore the insufficiency of True Yin. I believe this is suitable for treating Xu Lao caused by Spleen deficiency. However, if Kidney Yin is exhausted and Ministerial Fire scorches Lung Metal, presenting with coughing up blood, emaciation, seminal emission, tidal fever, etc., administering such medicine is like carrying firewood to put out a fire.
In Brother Huang Jingxiu's shop, there was a colleague named Bao Zonghai. Due to contracting Wind-Cold, he suffered from wheezing and coughing for many days. He consulted an old doctor of a certain surname in that area, who believed his syndrome belonged to internal deficiency and prescribed Rehmanniae Radix (Dihuang), Angelicae Sinensis Radix (Danggui), Ginseng Radix et Rhizoma (Renshen), and Atractylodis Macrocephalae Rhizoma (Baizhu). Seeing the prescription, I advised him not to take it. Zonghai believed his constitution was inherently weak and the old doctor's judgment was correct, so he secretly took the medicine. That night, his wheezing and coughing worsened significantly. The next day, he went back for adjustment. The doctor said the previous dosage was too light and added Astragali Radix (Huangqi) and Schisandrae Fructus (Wuweizi). After taking it, his chest felt distended with Qi rebelling upwards, making it impossible to lie down. He made gasping sounds incessantly, feeling suffocated and near death. Brother Huang inquired about the cause and instructed me to save him. I said: "I originally advised against taking the previous medicine. He did not believe me, and moreover, acid-astringent herbs were added, causing the pathogen to become even more entrenched. How can it be resolved?" Brother Huang said: "He has worked with me for years; I cannot bear to see him die without rescue. After repeated deliberation, I formulated a prescription using Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Asari Radix et Rhizoma (Xixin), Pinelliae Rhizoma Preparatum (Banxia), Glycyrrhizae Radix et Rhizoma (Gancao), Zingiberis Rhizoma Recens (Shengjiang), Armeniacae Semen Amarum (Xingren), and Lepidii Fructus (Tinglizi). I told him: 'This is Wind-Cold lodging in the Lung, causing Qi obstruction and Phlegm condensation, leading to wheezing and coughing. The doctor failed to use dispersing methods but instead administered astringent and tonifying herbs, causing the obstructed to become more obstructed and the congested to become more congested, brewing into a critical syndrome of Lung Distension (Fei Zhang).' The *Jin Gui Yao Lue* states: 'For coughing and rebellion of Qi with inability to lie flat, Xiao Qing Long Tang governs.' In my formula, I removed the acid-astringent effects of Schisandrae Fructus (Wuweizi) and Paeoniae Radix Alba (Baishao), adding the bitter-draining effects of Lepidii Fructus (Tinglizi) and Armeniacae Semen Amarum (Xingren). This is because the Lung dislikes Qi rebelling upwards, and bitter substances are urgently needed to drain it. It is as urgent as putting out a fire at one's eyebrows; delay is not an option." Brother Huang agreed happily and immediately ordered the medicine to be purchased and decocted. Shortly after, he coughed up two basins of thick phlegm, and his chest and diaphragm instantly relaxed. Taking the remaining dregs again, he vomited about a cup of phlegm-saliva, his wheezing stopped, and he could lie down. Zonghai finally realized the error of the previous medicine and cried, begging for rescue. I smiled and said: "No harm done; you just suffered needlessly for a few days." For the second dose, the dosages of Ephedrae Herba (Mahuang) and Cinnamomi Ramulus (Guizhi) were reduced, and Platycodonis Radix (Jiegeng), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), and Perillae Fructus (Suzi) were added to better harmonize the Lung and Stomach, leading to recovery.
An Bo's Commentary: Wind-Cold coughing is also a major syndrome and should not be dismissed as minor or superficial. Dr. Xu Lingtai struggled for thirty years before mastering the treatment of coughing. By modifying *Xiao Qing Long Tang*, removing Schisandrae Fructus (Wuweizi) and Paeoniae Radix Alba (Baishao) and adding Lepidii Fructus (Tinglizi) and Armeniacae Semen Amarum (Xingren), Mr. An truly exemplifies skillfully following the ancients without being bound by them.