次日复诊，脉略起，睡时略减。当与原方加减。五日，而痧疹出，微汗与俱。疹密布周身，稠逾其他痧孩。痧布达五日之久，而胸闷不除，大热不减，当与麻杏甘石重剂，始获痊愈。一月后，高公子又以微感风寒，复发嗜寐之恙，脉转微细，与前度仿佛。此时，余已成竹在胸，不虞其变，依然以麻黄附子甘草汤轻剂与之，四日而蒇。
【按】麻黄能开肺气，附子能强心脏，甘草能安肠胃，三者合则为麻黄附子甘草汤，能治虚人之受邪，而力不足以达邪者。若麻黄附子细辛汤则以细辛易甘草，其力更伟。盖细辛芳香，能蠲痰饮而辟秽浊故也。夫脉微细但欲寐如本案所云固为少阴病，若更进而兼身热恶寒踡卧，亦为少阴病，不过有轻重缓急之分尔。
而东人山田氏必欲补恶寒二字，使成少阴之为病，脉微细，但恶寒欲寐也一条，其可以已乎？曹颖甫曰：予治脉微细但欲寐者，往往以四逆汤取效。然姜生所治高姓小儿，实由太阳表证内伏少阴。故非麻黄不能奏功，断非四逆汤所能治。盖四逆汤仅能由少阴外达肌腠，以干姜炙草能温脾胃，脾胃固主肌肉也。若改干姜为麻黄，方能由少阴直达肺部，而皮毛为之开泄，以肺主皮毛故也。观其证治三变，而始终不脱麻黄，其用心之细密，殆不可及。况身热而不恶寒，似无用麻黄之必要，此证竟毅然用之，其识解尤不可及乎。盖呼之则醒，听其自然则寐，有蒙蔽之象，故可决为非少阴之病，而为太阳内陷之证。且以小儿纯阳之体，不当有此少阴病故也。
小青龙汤证（附列门人治验）
张志明住五洲大药房初诊十月十八日暑天多水浴，因而致咳，诸药乏效，遇寒则增剧，此为心下有水气，小青龙汤主之。
净麻黄钱半川桂枝钱半大白芍二钱生甘草一钱北细辛钱半五味子钱半干姜钱半姜半夏三钱
【按】张君志明为余之好友，尝患疔毒。自以西药治之，增剧，因就余以中药治愈，乃叹中药之神。自后恙无大小，每必垂询，顾余以事冗，居恒外出，致常相左。某晨，君又贲临，曰：咳嗽小恙耳，何中医久治不差？并出方相示，则清水豆卷、冬桑叶、前胡、杏仁、赤苓、枳壳、桔梗、竹茹、牛蒡，贝母、瓜蒌皮、冬瓜子、枇杷叶之属。因询之曰：君于夏月尝习游泳乎？曰：然。君之咳遇寒则增剧乎？曰：然。余乃慰之曰：此证甚易，一剂可愈，幸毋为虑。因书上方与之。越二日，来告日：咳瘥矣。即为书下方调理焉。
二诊十月二十。咳已全愈，但觉微喘耳，此为余邪，宜三拗汤轻剂，夫药味以稀为贵。
净麻黄六分光杏仁三钱甘草八分余屡用本方治咳，皆有奇效。顾必审其咳而属干水气者，然后用之，非以之尽治诸咳也。水气者何？言邪气之属于水者也。如本案张君因习游泳而得水气，其一例也。又如多进果品冷饮，而得水气，其二例也。又如远行冒雨露，因得水气，其三例也。更如夙患痰饮，为风寒所激，其四例也。凡此种水气之咳，本汤皆能优治之。顾药量又有轻重之分。其身热重，头痛恶寒甚者，当重用麻桂。其身微热，微恶寒者，当减轻麻桂，甚可以豆豉代麻黄，苏叶代桂枝。其痰饮水气甚者，当重用姜辛半味，因此四者协力合作，犹一药然，吾师用五味尝多至三钱，切勿畏其酸收。其咳久致腹皮挛急而痛者，当重用芍草以安之。否则，轻用或省除之，奏效如一。要之小青龙证。在里为水气，在表为咳（咳之前喉可常作痒）其表证之重轻，初可勿拘，其舌苔亦不必限于白腻。遑论其他或喘或渴或利或噎哉？此皆经验之谈，不必泥于书本者也。本年夏，友好多人皆习游泳，耽之不倦，虽雨天不已，一月前后，十九患咳，余悉以本汤加减愈之。
曹颖甫曰：予近日治丁姓妇十年痰饮，遇寒即剧，日晡所恶寒而喘，亦用此方。方用麻黄三钱，细辛二钱，乾姜三钱，白术三钱，半夏二钱，桂枝四钱。服经二剂，咳喘略减，而无汗恶寒如故。再加麻黄二钱，合五钱，细辛加一钱，合三钱，外加杏仁四钱，炮附子四钱，效否待明日方知。然则姜生治张君，两用轻剂而即效者，实由本年新病，不同宿疾之未易奏功也。
射干麻黄汤证
冯仕觉七月廿一日自去年初冬始病咳逆，倚息，吐涎沫，自以为痰饮。今诊得两脉浮弦而大，舌苔腻，喘息时胸部间作水鸣之声。肺气不得疏畅，当无可疑。昔人以麻黄为定喘要药，今拟用射干麻黄汤。
射干四钱净麻黄三钱款冬花三饯紫苑三钱北细辛二钱制半夏三钱五味子二钱生姜三片红枣七枚生远志四钱桔梗五钱拙巢注：愈。
曹颖甫曰：有张大元者向患痰饮，初，每日夜咯痰达数升，后咯痰较少，而胸中常觉出气短促，夜卧则喉中如水鸡声，彻夜不息。当从金匮例投射干麻黄汤，寻愈。又有杨姓妇素患痰喘之证，以凉水浣衣即发，发时咽中常如水鸡声，亦用金匮射干麻黄汤应手辄效，又当其剧时，痰涎上壅，气机有升无降，则当先服控涎丹数分，以破痰浊，续投射干麻黄汤，此又变通之法也。
苓甘五味加姜辛半夏杏仁汤证
叶瑞初君丽华公司化妆部初诊二月十七日咳延四月，时吐涎沫，脉右三部弦，当降其冲气。
茯苓三钱生甘草一钱五味子一钱干姜钱半细辛一钱制半夏四钱光杏仁四钱二诊二月十九日两进苓甘五味姜辛半夏杏仁汤，咳已略平，惟涎沫尚多，咳时痰不易出，宜与原方加桔梗。
茯苓三钱生草一钱五味子五分干姜一钱细辛六分制半夏三钱光杏仁四钱桔梗四钱
【按】叶君昔与史惠甫君为同事，患咳凡四阅月，问治于史。史固辞之，以习医未久也。旋叶君咳见痰中带血，乃俱而就师诊。服初诊方凡二剂，病即减轻。服次诊方后，竟告霍然。
皂荚丸证其一
《要略》曰：咳逆上气，时时吐浊，但坐，不得眠，皂荚丸主之。按射干麻黄汤证但云咳而上气，是不咳之时，其气未必上冲也。
若夫本证之咳逆上气，则喘息而不可止矣。病者必背拥叠被六七层，始能垂头稍稍得睡。倘叠被较少，则终夜呛咳，所吐之痰黄浊胶粘。
此证予于宣统二年，侍先妣邢太安人病亲见之。先妣平时喜进厚味，又有烟癖，厚味被火气薰灼，因变浊痰，气吸于上，大小便不通。予不得已。自制皂荚丸进之。长女昭华煎枣膏汤，如法昼夜四服。以其不易下咽也，改丸如绿豆大，每服九丸。凡四服，浃晨而大小便通，可以去被安睡矣。后一年，闻吾乡城北朱姓老妇，以此证坐一月而死，可惜也！
曹颖甫曰：有黄松涛者，住城内广福寺左近，开设玉器店，其母年七旬许，素有痰饮宿疾，数年未发，体甚健。某秋，忽咳嗽大作，浊痰稠粘，痛牵胸胁，夜不能卧，卧则咳吐，胀痛更甚，前所未见。病发三日，乃延余诊，其脉弦数，气急促，大便三日未行，力惫声嘶，喘不能续，证已危险。余乃告其家人曰，此属痰饮重证，势将脱，君不急救，再延片刻，无能为矣。于是急取控涎丹一钱五分，以开水冲元明粉三钱吞送。不久，咳减，气急稍定。至晚，大便下，作黑色，能安眠。达旦，诸恙尽失。于是始知控涎丹系十枣汤变其体制，用以备急者也。
然考此病本皂荚丸证。金匮所谓咳逆上气，时时吐浊，但坐不得眠，皂芙丸主之是也。但此证来势暴厉，病体已不支，恐皂荚丸性缓，尚不足以济急耳。
皂荚丸证其二
门人卢扶摇之师曹殿光，芜湖人，年五十所，患痰饮宿疾，病逾十载，扶摇不能治，使来求诊，其证心下坚满，痛引胸胁，时复喘促，咳则连声不已，时时吐浊痰，稠凝非常，剧则不得卧。余谓其喘咳属支饮，与《伤寒论》之心下有水气，《痰饮篇》之咳逆不得卧，证情相类，因投以小青龙汤，不效。更投以射干麻黄汤，合小半夏汤，又不效。而咳逆反甚，心殊焦急。更思以十枣汤攻之，而十枣又为胸胁悬饮之方。思以葶苈大枣降之，而泻肺系为肺胀肺痈而设，皆非的对之剂。纵投之，徒伤元气，于病何补？因念其时吐痰浊，剧则不得卧，与《金匮》所载皂荚丸证，大旨相同。遂以皂荚炙末四两，以赤砂糖代枣和汤，与射干麻黄汤间服之。共八剂，痰除喘平，诸恙尽退。
皂荚丸证其三
余尝自病痰饮，喘咳，吐浊，痛连胸胁，以皂荚大者四枚炙末，盛碗中，调赤砂糖，间日一服。连服四次，下利日二三度，痰涎与粪俱下，有时竟全是痰液。病愈后，体亦大亏。于是知皂荚之攻消甚猛，全赖枣膏调剂也。夫甘遂之破水饮，葶苈之泻痈胀，与皂荚之消胶痰，可称鼎足而三。惟近人不察，恒视若鸩毒，弃良药而不用，伊谁之过软？曹颖甫曰：余治张大元喘咳，不得卧，亦用控涎丹法，一下而愈。近数年来大元染有烟癖，浓痰和水而出，一夜得一大玻璃杯。诸痰饮方绝无功用，皂荚灰亦无济。大约水气太甚者，既不当用涤除油垢之法，而中有浓痰者又非温药所能治乎？
皂荚丸证其四
郑左住方浜路口年八十二岁湿痰之体，咳嗽，四肢浮肿，病情属溢饮，原当发汗利小便。但以浊痰阻于胸隔，咳而上气，但坐不眠，痰甚浓厚。病急则治其标，法当先用皂荚丸以下胸隔之痰，俾大小便畅行，得以安睡，方是转机。今按两脉结代，结代之脉，仲景原以为难治。药有小效，方议正治。
土皂荚去黑皮去子去弦酥炙研细蜜丸如桐子大每服三丸日三服以黑枣二十枚浓煎去渣送丸拙巢注：病家将此方询诸他医，医以剂峻，劝勿服。其后究竟如何，不可得而知矣。
曹颖甫曰：皂荚丸之功用，能治胶痰，而不能去湿痰。良由皂荚能去积年之油垢，而不能除水气也。然痰饮至于嗽喘不已，中脘必有凝固之痰，故有时亦得取效。惟皂荚灰之作用乃由长女昭华发明。彼自病痰饮，常呕浓厚之痰，因自制而服之。二十年痰饮竟得劖除病根。予服之而效。曹殿光适自芜湖来诊，病情略同，故亦用之而效也。
【按】《金匮》本方云：皂荚八两，刮去皮用，酥炙。右一味，末之，蜜丸，桐子大，以枣膏和汤，服三丸，日三，夜一服。刮去皮用者，刮去其外皮之黑衣也。酥炙者，用微火炙之，使略呈焦黄即得，勿成黑炭也。服三丸者，每服三丸也。日三夜一服者，日中三服，夜间一服，竟日共四服，计十二丸也。故或云本药荡涤刺激之力甚大，一日用量不得过梧子大三丸者，非也。枣膏和汤者，言预用枣肉煎熬成膏，及应用时，取膏加热水，使混和成汤，送本丸也。尤氏云：饮以枣膏，安其本也。此说甚是。伸言之，即恐皂荚入胃，非但去浊痰，并将殃及胃中宝贵之津液，故必用枣膏以固护之，此吾友吴凝轩之说也。吾师代枣膏以砂糖，无非取其便捷，然其保津之功，恐不及枣膏远甚。顾二者皆属甘味，与甘草之安肠生津，饴糖之建中定痛，有异曲同工之妙。
综计以上本汤四案，第一案邢太安人先一日四服，共进如梧子大者十二丸，次一日共进如绿豆大者三十六丸。今案凡蜜丸如梧子大之丸药，每钱约得十余丸，则如梧子大十二丸者，量仅钱许耳。第二案曹殿光用皂荚末四两者，乃共八日间之总量也。即先一日服皂荚末一两，次日改服射干麻黄汤一剂，以后第三、第五、第七日同第一日，第四、第六、第八日同第二日。按每日服末一两较第一案之钱许量已大增，但此为皂荚焦黑之灰，彼为同品炙黄之质。黑者力微，黄者力巨，故其量为反比，而二者病情又有重轻之分，故量虽迥异，并非矛盾。第三案吾师自以皂荚大者四枚炙末，盛之得一小半碗。余尝试择大皂荚一枚，不去皮弦与子，衡之，得新秤一两许。又取大者二枚，炙之使焦，研之为末，衡之，得六钱许。
是四枚末约为一两二钱许，与第二案所称之两许，亦尚相合。第四案如古法，与第一案同。按本药究属峻品，无经脸之医生初次试用，宁自每服五分递加，较为妥当。
又按用皂荚无非取其荡涤胶痰，而其能荡涤胶痰者，盖即赖其中含有石碱素。西国谓驱痰剂西药如西尼加根，中药如远志，桔梗，皂荚，中皆含有石碱素，所谓刺激性驱痰剂是也。故用牙皂之荚，可以代西尼加根云云。中西学说相通，信哉。
曹颖甫曰：除痰之药有碱性者为长，故咯痰不出者，用桔梗甘草汤，无不克日取效，以桔梗含有碱性故也。痰粘胸隔而不出，则用有碱性之桔梗以出之，所谓在高者引而越之也。胶痰在中脘，则用有碱性之皂荚以下之，所谓在下者引而竭之也。凡用药有彻上彻下之异，可因此而观其通矣。
泽泻汤证
管右住南阳桥花场九月一日咳吐沫，业经多年，时眩冒，冒则呕吐，大便燥，小溲少，咳则胸满，此为支饮，宜泽泻汤。
泽泻一两三钱生白术六钱
【按】本案病者管妇年三十余，其夫在上海大场蒔花为业。妇素有痰饮病，自少已然。每届冬令必发，剧时头眩，不能平卧。师与本汤，妇服之一剂，既觉小溲畅行，而咳嗽大平。续服五剂，其冬竟得安度。明年春，天转寒，病又发。
师仍与本方，译泻加至二两，白术加至一两，又加苍术以助之，病愈。至其年冬，又发。宿疾之难除根，有如是者！以上自小青龙汤至泽泻汤凡五证，皆治痰饮。小青龙汤以心下有水气为主，射干麻黄汤以喉中水鸡声为主，苓桂五味加姜辛半夏杏仁汤以吐涎沫为主，皂荚丸以胶痰为主，泽泻汤以眩目为主，此其大较也。
桂枝加龙骨牡蛎汤证其一
次日复诊，脉象略有起色，睡眠时症状稍减。应当对原方进行加减调整。到了第五天，痧疹发出，伴随微微出汗。疹子密布全身，比其他的患痧儿童更为稠密。痧疹持续了五天之久，但胸闷仍未消除，高热不退，此时给予麻杏甘石汤的重剂量，才获得痊愈。一个月后，高公子又因轻微感受风寒，复发嗜睡之症，脉象转为微细，与之前的情况相似。这时，我心中已有把握，不担心病情变化，依然给予麻黄附子甘草汤的轻剂量给他服用，四天后病愈。
【按语】麻黄能宣开肺气，附子能增强心脏功能，甘草能安定肠胃，三者合用即为麻黄附子甘草汤，能够治疗体质虚弱之人感受外邪，而正气不足以驱邪外出的情况。如果将麻黄附子甘草汤中的甘草换成细辛，即成为麻黄附子细辛汤，其药力更为强大。这是因为细辛气味芳香，能够祛除痰饮并辟除秽浊之气。像本案中提到的“脉微细、只想睡觉”确实是少阴病的表现，如果再进一步出现身体发热、恶寒、蜷缩而卧的症状，也属于少阴病，只不过有轻重缓急的区别罢了。
然而日本学者山田氏一定要补上“恶寒”二字，将其定为“少阴之为病，脉微细，但恶寒欲寐也”这一条，这种做法可以吗？曹颖甫说：我治疗脉微细、只想睡觉的病人，往往使用四逆汤取得疗效。然而姜生所治疗的高姓小儿，实际上是由太阳表证内伏于少阴所致。所以非用麻黄不能奏效，绝对不是四逆汤所能治疗的。因为四逆汤只能由少阴向外达于肌腠，其中干姜和炙甘草能温补脾胃，而脾胃主司肌肉。如果将干姜改为麻黄，才能由少阴直达肺部，使皮毛开泄，因为肺主皮毛的缘故。观察其证治三次变化，而始终不离麻黄，其用心之细密，简直难以企及。况且身热而不恶寒，似乎没有使用麻黄的必要，此证竟然毅然使用它，其见识见解更是难以企及。因为呼唤则醒，听其自然则睡，有蒙蔽之象，所以可以断定这不是少阴病，而是太阳病内陷的证候。而且以小儿纯阳之体，不应当出现这种少阴病，因此如此判断。
小青龙汤证（附列门人治验）
张志明住在五洲大药房，初诊日期为十月十八日。暑天多次游泳洗澡，因而导致咳嗽，各种药物无效，遇寒冷则加重，这是心下有水气，主治用小青龙汤。
净麻黄一钱半，川桂枝一钱半，大白芍二钱，生甘草一钱，北细辛一钱半，五味子一钱半，干姜一钱半，姜半夏三钱。
【按语】张先生志明是我的好友，曾经患疔毒。自行用西药治疗，病情加重，于是找我用中药治愈，便感叹中药的神奇。此后无论大病小病，每次必定咨询，但我因事务繁忙，经常外出，导致常常错过见面。某天早晨，他又来访，说：“咳嗽只是小毛病，为什么中医久治不愈？”并拿出处方给我看，上面是清水豆卷、冬桑叶、前胡、杏仁、赤茯苓、枳壳、桔梗、竹茹、牛蒡子、贝母、瓜蒌皮、冬瓜子、枇杷叶之类的药物。于是我问他：“您夏天曾练习游泳吗？”他说：“是的。”“您的咳嗽遇冷会加重吗？”他说：“是的。”我便安慰他说：“这个证候很容易，一剂药即可痊愈，希望您不要忧虑。”于是写下上面的处方给他。过了两天，他来告诉我：“咳嗽已经好了。”于是我又写下下方的处方让他调理。
二诊日期为十月二十日。咳嗽已经完全痊愈，只感觉轻微气喘，这是余邪未清，宜用三拗汤的轻剂量，药物的味道以精简为贵。
净麻黄六分，光杏仁三钱，甘草八分。
我屡次使用本方治疗咳嗽，都有奇效。但必须仔细审查其咳嗽属于水气引起的，然后才使用它，并不是用它来治疗所有的咳嗽。什么是水气？说的是属于水邪的邪气。如本案张先生因练习游泳而得水气，这是一例。又如多吃果品冷饮而得水气，这是第二例。又如远行冒雨淋露而得水气，这是第三例。再如素患痰饮，被风寒激发，这是第四例。凡是这种水气引起的咳嗽，本汤都能很好地治疗。但是药量又有轻重之分。如果身热重，头痛恶寒严重的，应当重用麻黄和桂枝。如果身微热，微恶寒的，应当减轻麻黄和桂枝的量，甚至可以用豆豉代替麻黄，苏叶代替桂枝。如果痰饮水气严重的，应当重用干姜、细辛、半夏、五味子，因为这四者协力合作，犹如一味药一样，我的老师使用五味子常常多达三钱，千万不要害怕它的酸收作用。如果咳嗽久了导致腹皮挛急疼痛的，应当重用白芍和甘草来安抚它。否则，轻用或省略它们，疗效也是一样的。总之，小青龙汤证，在里是水气，在表是咳嗽（咳嗽之前喉咙常作痒），其表证的轻重，起初可以不拘泥，舌苔也不必局限于白腻，更不用说其他如喘、渴、利、噎等情况了？这些都是经验之谈，不必拘泥于书本。今年夏天，许多朋友都练习游泳，乐此不疲，即使是雨天也不停止，前后一个月左右，十九个人都患了咳嗽，我都用本汤加减治好了他们。
曹颖甫说：我最近治疗一位丁姓妇女十年的痰饮病，遇寒即加重，傍晚时分恶寒且气喘，也用了此方。方中用麻黄三钱，细辛二钱，干姜三钱，白术三钱，半夏二钱，桂枝四钱。服药两剂后，咳喘略微减轻，但无汗恶寒依旧。再加麻黄二钱，合计五钱，细辛加一钱，合计三钱，外加杏仁四钱，炮附子四钱，效果如何等明天才知道。然而姜生治疗张先生，两次使用轻剂量就见效，确实是因为本年新得的病，不同于宿疾那样不容易见效。
射干麻黄汤证
冯仕觉，七月二十一日自述自去年初冬开始患病，咳嗽气逆，倚靠呼吸，吐涎沫，自己认为是痰饮。现在诊得两脉浮弦而大，舌苔腻，喘息时胸部间作水鸣之声。肺气不得疏畅，这无可怀疑。古人认为麻黄是定喘的要药，现在打算使用射干麻黄汤。
射干四钱，净麻黄三钱，款冬花三钱，紫菀三钱，北细辛二钱，制半夏三钱，五味子二钱，生姜三片，红枣七枚，生远志四钱，桔梗五钱。拙巢注：病愈。
曹颖甫说：有一位张大元，向来患痰饮病，起初每天夜里咯痰达数升，后来咯痰较少，但胸中常觉得出气短促，夜间躺下时喉中如水鸡声，彻夜不息。应当遵循《金匮要略》的例子投予射干麻黄汤，不久痊愈。又有一位杨姓妇女素患痰喘之证，用凉水洗衣服就发作，发作时咽中常如水鸡声，也用《金匮要略》射干麻黄汤，应手辄效。另外在其发作剧烈时，痰涎上壅，气机有升无降，则应当先服用控涎丹数分，以破除痰浊，随后投予射干麻黄汤，这又是变通的方法。
苓甘五味加姜辛半夏杏仁汤证
叶瑞初君，丽华公司化妆部，初诊日期二月十七日。咳嗽延续四个月，时常吐涎沫，脉右三部弦，应当降其冲气。
茯苓三钱，生甘草一钱，五味子一钱，干姜一钱半，细辛一钱，制半夏四钱，光杏仁四钱。
二诊日期二月十九日。连服两次苓甘五味姜辛半夏杏仁汤，咳嗽已略微平息，只是涎沫还多，咳嗽时痰不易出，宜在原方中加入桔梗。
茯苓三钱，生甘草一钱，五味子五分，干姜一钱，细辛六分，制半夏三钱，光杏仁四钱，桔梗四钱。
【按语】叶先生以前与史惠甫先生是同事，患咳嗽共四个月，向史先生求治。史先生坚决推辞，因为习医时间不长。随后叶先生咳嗽见痰中带血，于是恐惧地来拜师求诊。服用初诊方共两剂，病情即减轻。服用次诊方后，竟然完全康复。
皂荚丸证其一
《金匮要略》说：咳嗽气逆，时时吐浊痰，只能坐着，不能躺下睡觉，主治用皂荚丸。按射干麻黄汤证只说咳嗽而上气，是不咳嗽的时候，其气未必上冲。
如果是本证的咳嗽气逆，则是喘息而不能停止。病人必须背拥叠六七层被子，才能垂头稍稍入睡。如果叠被较少，则整夜呛咳，所吐之痰黄浊胶粘。
这个证候我在宣统二年，侍奉先母邢太安人患病时亲眼见过。先母平时喜欢吃厚味食物，又有吸烟癖好，厚味被火气熏灼，因而变成浊痰，气吸于上，大小便不通。我不得已，自制皂荚丸给她服用。长女昭华煎枣膏汤，按照方法昼夜服用四次。因为不容易吞咽，改制成绿豆大的丸药，每次服用九丸。共服用四次，过了一整天，大小便通畅，可以去掉被子安稳睡觉了。一年后，听说我乡城北朱姓老妇人，因为这个证候坐卧不安一个月而死，真可惜啊！
曹颖甫说：有一位黄松涛，住在城内广福寺附近，开设玉器店，他的母亲七十岁左右，素有痰饮宿疾，几年未发，身体很健康。某年秋天，忽然咳嗽大作，浊痰稠粘，痛牵胸胁，夜间不能卧，卧则咳吐，胀痛更甚，前所未见。发病三天，才请我去诊治，其脉弦数，气急促，大便三日未行，体力疲惫声音嘶哑，喘不能续，证候已经危险。我于是告诉他的家人说，这属于痰饮重证，势将脱绝，您不急救，再拖延片刻，就没有办法了。于是急忙取控涎丹一钱五分，用开水冲元明粉三钱吞送。不久，咳嗽减少，气急稍微安定。到了晚上，大便下来，呈黑色，能安眠。到天亮，各种病症全失。于是才知道控涎丹是十枣汤改变体制，用来备急的。
然而考证此病本是皂荚丸证。《金匮要略》所谓“咳逆上气，时时吐浊，但坐不得眠，皂荚丸主之”就是说的这个。但这个证候来势暴厉，病体已经不支持，恐怕皂荚丸药性缓慢，尚不足以济急。
皂荚丸证其二
门人卢扶摇的老师曹殿光，芜湖人，五十多岁，患痰饮宿疾，病逾十年，卢扶摇不能治愈，派我来求诊。其证候心下坚满，痛引胸胁，时常喘促，咳嗽则连声不已，时时吐浊痰，稠凝非常，剧烈时不能卧。我认为其喘咳属于支饮，与《伤寒论》之心下有水气，《痰饮篇》之咳逆不得卧，证情相类，于是投以小青龙汤，无效。再投以射干麻黄汤，合小半夏汤，又无效。而咳逆反而加重，心中非常焦急。再想以十枣汤攻之，而十枣汤又是治疗胸胁悬饮的方子。想用葶苈大枣泻肺汤降之，而泻肺系是为肺胀肺痈而设，都不是对症的药剂。即使投用，徒伤元气，对病有什么好处？于是想到他时时吐痰浊，剧烈时不能卧，与《金匮要略》所载皂荚丸证，主旨相同。于是用皂荚炙末四两，用赤砂糖代替枣和汤，与射干麻黄汤交替服用。共八剂，痰除喘平，各种病症全退。
皂荚丸证其三
我曾经自己患痰饮，喘咳，吐浊痰，痛连胸胁，用大皂荚四枚炙末，盛碗中，调赤砂糖，隔天服用一次。连续服用四次，腹泻每天两三次，痰涎与粪便一起排出，有时竟全是痰液。病愈后，身体也大大亏损。于是知道皂荚的攻消非常猛烈，全靠枣膏调剂。甘遂破水饮，葶苈泻痈胀，与皂荚消胶痰，可称鼎足而三。只是近人不察，常视若鸩毒，弃良药而不用，这是谁的过错呢？曹颖甫说：我治疗张大元喘咳，不得卧，也用控涎丹法，一下而愈。近年来大元染有烟癖，浓痰和水而出，一夜得一大玻璃杯。各种痰饮方绝无功用，皂荚灰也无济于事。大约水气太甚的，既不当用涤除油垢之法，而中有浓痰的又不是温药所能治的吗？
皂荚丸证其四
郑左住方浜路口，八十二岁，湿痰之体，咳嗽，四肢浮肿，病情属溢饮，原本应当发汗利小便。但因为浊痰阻于胸膈，咳而上气，只能坐着不能睡觉，痰非常浓厚。病急则治其标，法当先用皂荚丸以下胸膈之痰，使大小便畅行，得以安睡，这才是转机。现在按两脉结代，结代之脉，仲景原本认为难治。药有小效，才议正治。
土皂荚去黑皮，去子，去弦，酥炙，研细，蜜丸如桐子大。每服三丸，日三服。以黑枣二十枚浓煎去渣送丸。拙巢注：病家将此方询问其他医生，医生认为药剂峻猛，劝其不要服用。其后究竟如何，不可得知。
曹颖甫说：皂荚丸的功能，能治胶痰，而不能去湿痰。良由皂荚能去积年的油垢，而不能除水气。然而痰饮至于嗽喘不已，中脘必有凝固之痰，所以有时也能取效。只有皂荚灰的作用乃是长女昭华发明的。她自患痰饮，常呕浓厚之痰，因而自制而服用。二十年痰饮竟得斩除病根。我服用有效。曹殿光恰好从芜湖来求诊，病情略同，所以也用之而有效。
【按语】《金匮要略》本方云：皂荚八两，刮去皮用，酥炙。右一味，末之，蜜丸，桐子大，以枣膏和汤，服三丸，日三，夜一服。刮去皮用者，刮去其外皮之黑衣也。酥炙者，用微火炙之，使略呈焦黄即得，勿成黑炭也。服三丸者，每服三丸也。日三夜一服者，日中三服，夜间一服，竟日共四服，计十二丸也。故有人说本药荡涤刺激之力很大，一日用量不得超过梧子大三丸的，这是不对的。枣膏和汤者，言预用枣肉煎熬成膏，及应用时，取膏加热水，使混和成汤，送本丸也。尤氏云：饮以枣膏，安其本也。此说甚是。伸言之，即恐皂荚入胃，非但去浊痰，并将殃及胃中宝贵之津液，故必用枣膏以固护之，这是我朋友吴凝轩的说法。我的老师用代枣膏以砂糖，无非取其便捷，然其保津之功，恐怕不及枣膏远甚。顾二者皆属甘味，与甘草之安肠生津，饴糖之建中定痛，有异曲同工之妙。
综计以上本汤四案，第一案邢太安人先一日四服，共进如梧子大者十二丸，次日共进如绿豆大者三十六丸。今案凡蜜丸如梧子大之丸药，每钱约得十余丸，则如梧子大十二丸者，量仅钱许耳。第二案曹殿光用皂荚末四两者，乃共八日间之总量也。即先一日服皂荚末一两，次日改服射干麻黄汤一剂，以后第三、第五、第七日同第一日，第四、第六、第八日同第二日。按每日服末一两较第一案之钱许量已大增，但此为皂荚焦黑之灰，彼为同品炙黄之质。黑者力微，黄者力巨，故其量为反比，而二者病情又有重轻之分，故量虽迥异，并非矛盾。第三案吾师自以皂荚大者四枚炙末，盛之得一小半碗。我曾尝试择大皂荚一枚，不去皮弦与子，衡之，得新秤一两许。又取大者二枚，炙之使焦，研之为末，衡之，得六钱许。
是四枚末约为一两二钱许，与第二案所称之两许，亦尚相合。第四案如古法，与第一案同。按本药究属峻品，无经验的医生初次试用，宁可自每服五分递加，较为妥当。
又按用皂荚无非取其荡涤胶痰，而其能荡涤胶痰者，盖即赖其中含有石碱素。西国谓驱痰剂西药如西尼加根，中药如远志，桔梗，皂荚，中皆含有石碱素，所谓刺激性驱痰剂是也。故用牙皂之荚，可以代西尼加根云云。中西学说相通，信哉。
曹颖甫说：除痰之药有碱性者为长，故咯痰不出者，用桔梗甘草汤，无不克日取效，以桔梗含有碱性故也。痰粘胸隔而不出，则用有碱性之桔梗以出之，所谓在高者引而越之也。胶痰在中脘，则用有碱性之皂荚以下之，所谓在下者引而竭之也。凡用药有彻上彻下之异，可因此而观其通矣。
泽泻汤证
管右住南阳桥花场，九月一日咳吐沫，业经多年，时眩冒，冒则呕吐，大便燥，小溲少，咳则胸满，此为支饮，宜泽泻汤。
泽泻一两三钱，生白术六钱。
【按语】本案病者管妇三十多岁，其夫在上海大场种花为业。妇人素有痰饮病，自少已然。每届冬令必发，剧时头眩，不能平卧。老师给此汤，妇人服之一剂，既觉小溲畅行，而咳嗽大平。续服五剂，其冬竟得安度。明年春，天转寒，病又发。
老师仍给本方，泽泻加至二两，白术加至一两，又加苍术以助之，病愈。至其年冬，又发。宿疾之难除根，有如是者！以上自小青龙汤至泽泻汤凡五证，皆治痰饮。小青龙汤以心下有水气为主，射干麻黄汤以喉中水鸡声为主，苓桂五味加姜辛半夏杏仁汤以吐涎沫为主，皂荚丸以胶痰为主，泽泻汤以眩目为主，此其大较也。
桂枝加龙骨牡蛎汤证其一
On the following day, during the follow-up consultation, the pulse had slightly risen, and symptoms were slightly reduced during sleep. Modifications should be made to the original prescription. By the fifth day, the scarlet fever rash appeared, accompanied by slight sweating. The rash was densely distributed over the entire body, thicker than that of other children with similar conditions. Although the rash persisted for five days, chest tightness remained unrelieved, and high fever did not subside. At this point, a heavy dose of Mahuang Xinggan Shigao Tang (Ephedra, Apricot Kernel, Glycyrrhiza, and Gypsum Decoction) was administered, leading to recovery. One month later, Mr. Gao contracted a mild wind-cold invasion, causing a recurrence of lethargy. His pulse became faint and fine, resembling the previous episode. At this time, I was confident in my diagnosis and did not fear complications. I prescribed a light dose of Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction), and he recovered after four days.
[Commentary] Mahuang (Ephedrae Herba) can open Lung Qi; Fuzi (Aconiti Lateralis Radix Praeparata) can strengthen the heart; Gancao (Glycyrrhizae Radix et Rhizoma) can stabilize the stomach and intestines. When combined, they form Mahuang Fuzi Gancao Tang, which treats deficiency-type patients who have contracted pathogenic factors but lack sufficient righteous Qi to expel them. If Gancao is replaced by Xixin (Asari Radix et Rhizoma) in this formula, it becomes Mahuang Fuzi Xixin Tang, which has greater potency. This is because Xixin has an aromatic nature capable of dispelling phlegm-fluids and eliminating turbid pathogens. As mentioned in this case, "faint and fine pulse with desire to sleep" is indeed a Shaoyin disease. If further complicated by fever, aversion to cold, and curling up while lying down, it also belongs to Shaoyin disease, differing only in severity and urgency.
However, the Japanese scholar Yamada insisted on adding "aversion to cold" to define it as "Shaoyin disease: faint and fine pulse, merely aversion to cold and desire to sleep." Is this approach acceptable? Cao Yingfu stated: "In my treatment of patients with faint and fine pulses and desire to sleep, I often achieve results using Sini Tang (Frigid Extremities Decoction). However, the child surnamed Gao treated by Jiang Sheng actually suffered from Taiyang exterior syndrome internalized into Shaoyin. Therefore, only Mahuang could be effective; Sini Tang alone would certainly not work. Sini Tang can only guide pathogenic factors from Shaoyin outward to the muscle layer; Dried Ginger (Shengjiang) and Roasted Licorice (Zhi Gancao) warm the Spleen and Stomach, which govern the muscles. If Dried Ginger is replaced by Mahuang, it can reach the Lungs directly from Shaoyin, opening the skin and hair, because the Lungs govern the skin and hair. Observing the three changes in his syndrome and treatment, yet always retaining Mahuang, his meticulousness is unparalleled. Moreover, although there was fever without aversion to cold, seemingly making Mahuang unnecessary, he resolutely used it, showing insight beyond reach. Since he wakes when called but sleeps naturally, indicating a state of obscuration, we can conclude this is not a Shaoyin disease but a Taiyang syndrome internalized. Furthermore, given the child's pure Yang constitution, such a Shaoyin disease should not occur."
Xiao Qing Long Tang Syndrome (Including Case Records of Disciples)
Zhang Zhiming, residing at Wuzhou Pharmacy, first consultation on October 18th. Due to frequent swimming baths during the hot summer, he developed coughing. Various medications proved ineffective, and symptoms worsened upon exposure to cold. This indicates fluid retention in the epigastrium (Heart region); Xiao Qing Long Tang is indicated.
Purified Mahuang (Ephedrae Herba) 1.5 qian, Chuan Guizhi (Cinnamomi Ramulus) 1.5 qian, Da Baishao (Paeoniae Radix Alba) 2 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 1 qian, Bei Xixin (Asari Radix et Rhizoma) 1.5 qian, Wuweizi (Schisandrae Fructus) 1.5 qian, Ganjiang (Zingiberis Rhizoma) 1.5 qian, Jiang Banxia (Pinelliae Tuber Preparatum) 3 qian.
[Commentary] Mr. Zhang Zhiming is a close friend of mine. He once suffered from carbuncles. After self-treatment with Western medicine exacerbated his condition, he sought my Traditional Chinese Medicine treatment and was cured. He then marveled at the efficacy of TCM. Since then, regardless of illness severity, he always consulted me. However, due to my busy schedule and frequent absences, we often missed each other. One morning, he visited again, saying, "Coughing is a minor ailment; why has TCM failed to cure it for so long?" He showed me his prescription, which included Qingshui Doujuan (Vigna angularis var. nipponensis), Dong Sangye (Mori Folium), Qianhu (Peucedani Radix), Xingren (Armeniacae Semen Amarum), Chi Ling (Poria cum Ligno), Zhiqiao (Aurantii Fructus), Jiegeng (Platycodonis Radix), Zhuru (Bambusae Caulis in Taeniam), Niubangzi (Arctii Fructus), Beimu (Fritillariae Bulbus), Gualoupi (Trichosanthis Pericarpium), Dongguazi (Trichosanthis Semen), and Pipaye (Loquafolium). I asked him, "Did you practice swimming in the summer?" He replied, "Yes." "Does your cough worsen with cold?" He replied, "Yes." I comforted him, saying, "This syndrome is very easy to treat; one dose will suffice. Do not worry." I wrote the above prescription for him. Two days later, he reported, "My cough has healed." I then provided the following prescription for conditioning.
Second consultation on October 20th. The cough has completely resolved, but slight wheezing remains, indicating residual pathogens. A light dose of San'ao Tang (Three Unblocking Decoction) is appropriate. Medicinal ingredients should be kept minimal.
Purified Mahuang 6 fen, Guang Xingren (Armeniacae Semen Amarum) 3 qian, Gancao 8 fen.
I have frequently used this formula to treat coughing with remarkable effects. However, one must carefully verify that the cough is caused by fluid retention before using it; it is not a universal remedy for all coughs. What is "fluid retention"? It refers to pathogenic factors associated with water. For example, Mr. Zhang acquired fluid retention through swimming (Case 1). Another example is consuming excessive fruits and cold drinks (Case 2). Another is traveling long distances exposed to rain and dew (Case 3). Another is having chronic phlegm-fluids aggravated by wind-cold (Case 4). For all such coughs caused by fluid retention, this decoction is highly effective. However, dosages vary based on severity. If fever is severe, with significant headache and aversion to cold, heavy doses of Mahuang and Guizhi are needed. If fever and aversion to cold are mild, reduce the dosage of Mahuang and Guizhi; even substituting Mahuang with Douchi (Sojae Semen Preparatum) and Guizhi with Zi Su Ye (Perillae Folium) is possible. If phlegm-fluid retention is severe, increase the dosage of Ganjiang, Xixin, Banxia, and Wuweizi, as these four herbs work synergistically like a single agent. My teacher often used up to 3 qian of Wuweizi; do not fear its sour astringent properties. If prolonged coughing leads to abdominal wall spasms and pain, increase Baishao and Gancao to soothe the area. Otherwise, use lightly or omit them, achieving similar efficacy. In summary, Xiao Qing Long Tang syndrome involves fluid retention internally and cough externally (often preceded by throat itching). Initially, the severity of exterior symptoms need not be strictly adhered to, nor must the tongue coating be limited to white and greasy. Other symptoms like wheezing, thirst, diarrhea, or choking are secondary. These are empirical observations and should not be rigidly bound by textbooks. This summer, many friends practiced swimming relentlessly, even in the rain. Within a month, nearly twenty developed coughs, all cured by modifications of this decoction.
Cao Yingfu stated: "Recently, I treated a Mrs. Ding suffering from ten-year-old chronic phlegm-fluids. Symptoms worsened with cold, featuring evening aversion to cold and wheezing. I used this formula: Mahuang 3 qian, Xixin 2 qian, Ganjiang 3 qian, Baizhu 3 qian, Banxia 2 qian, Guizhi 4 qian. After two doses, cough and wheezing slightly improved, but anhidrosis and aversion to cold persisted. I increased Mahuang by 2 qian (total 5 qian) and Xixin by 1 qian (total 3 qian), added Xingren 4 qian and Paofuzi 4 qian. Effectiveness awaited confirmation. However, Jiang Sheng’s success with light doses for Mr. Zhang was due to the acute nature of the new illness, unlike chronic conditions which are harder to resolve quickly."
Shegan Mahuang Tang Syndrome
Feng Shijue, July 21st. Coughing and airway obstruction began last early winter, requiring leaning forward to breathe, with expectoration of saliva and foam. He considered it phlegm-fluids. Current pulse is floating, wiry, and large; tongue coating is greasy. During喘息, water-like sounds are heard in the chest. Obstruction of Lung Qi is undeniable. Historically, Mahuang is considered a key herb for calming asthma. I propose using Shegan Mahuang Tang.
Shegan (Belamcandae Rhizoma) 4 qian, Purified Mahuang 3 qian, Kuandonghua (Farfarae Flos) 3 qian, Ziwan (Asteri Radix et Rhizoma) 3 qian, Bei Xixin 2 qian, Zhi Banxia 3 qian, Wuweizi 2 qian, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Hongzao (Jujubae Fructus) 7 pieces, Sheng Yuanzhi (Polygalae Radix) 4 qian, Jiegeng 5 qian. Note by Zhuochao: Recovered.
Cao Yingfu stated: "Mr. Zhang Dayuan previously suffered from chronic phlegm-fluids. Initially, he expectorated several liters of phlegm daily and nightly. Later, volume decreased, but he felt shortness of breath, especially at night when lying down, with a 'water-frog' sound in the throat persisting all night. Following the *Jinkui Yaolue*, I prescribed Shegan Mahuang Tang, resulting in quick recovery. Another patient, Mrs. Yang, suffered from chronic phlegm-wheezing triggered by washing clothes with cold water. During attacks, she heard a 'water-frog' sound in her throat. Shegan Mahuang Tang from *Jinkui Yaolue* was effective immediately. However, during severe attacks with phlegm obstructing the upper jiao and qi mechanism rising without descending, one should first administer Kongyan Dan (Control Phlegm Pill) in small doses to break up turbid phlegm, followed by Shegan Mahuang Tang. This is a modified approach."
Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang Syndrome
Ye Ruichu, Lihua Company Cosmetics Department, first consultation on February 17th. Cough persisted for four months, with frequent expectoration of saliva and foam. Pulse in the right three positions is wiry. The rebellious Qi should be directed downward.
Fuling (Poria) 3 qian, Sheng Gancao 1 qian, Wuweizi 1 qian, Ganjiang 1.5 qian, Xixin 1 qian, Zhi Banxia 4 qian, Guang Xingren 4 qian.
Second consultation on February 19th. After two doses of Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Tang, cough slightly subsided, but saliva/foam remains abundant, and phlegm is difficult to expectorate. Add Jiegeng to the original formula.
Fuling 3 qian, Sheng Gancao 1 qian, Wuweizi 5 fen, Ganjiang 1 qian, Xixin 6 fen, Zhi Banxia 3 qian, Guang Xingren 4 qian, Jiegeng 4 qian.
[Commentary] Mr. Ye was formerly a colleague of Mr. Shi Huifu. He suffered from cough for four months and sought treatment from Mr. Shi. Mr. Shi declined, citing his limited medical experience. Subsequently, blood appeared in Mr. Ye's sputum, causing him to fearfully seek my treatment. After two doses of the first prescription, his condition improved. After the second prescription, he fully recovered.
Zao Jiao Wan Syndrome I
The *Jinkui Yaolue* states: "Coughing with airway obstruction, frequent expectoration of turbid material, ability only to sit, inability to lie down and sleep; Zao Jiao Wan (Soapberry Pill) is indicated." Regarding Shegan Mahuang Tang syndrome, it mentions "coughing with airway obstruction," implying that when not coughing, the Qi does not necessarily rush upward.
In contrast, this syndrome features continuous coughing and airway obstruction with unstoppable wheezing. The patient must pile six or seven layers of blankets behind their back to lean forward and sleep slightly. With fewer blankets, they suffer from nocturnal choking coughs, expectorating thick, yellow, sticky phlegm.
I witnessed this syndrome firsthand in the second year of the Xuantong era while caring for my late mother, Lady Xing. My mother usually enjoyed rich foods and had a smoking habit. The rich foods, heated by internal fire, transformed into turbid phlegm, causing Qi to rise upwards and blocking bowel and bladder movements. Reluctantly, I prepared Zao Jiao Wan for her. My eldest daughter, Zhaohua, decocted Jujube Paste Soup and administered it according to the method, four times day and night. Due to difficulty swallowing, we changed the pills to the size of mung beans, nine per dose. After four doses, spanning one full day, bowel and bladder movements resumed, allowing her to remove the blankets and sleep peacefully. A year later, I heard of an elderly woman surnamed Zhu in the north of our village who died after sitting uncomfortably for a month due to this syndrome—what a pity!
Cao Yingfu stated: "Mr. Huang Songtao, residing near Guangfu Temple in the city, ran a jade shop. His mother, around seventy years old, had a history of chronic phlegm-fluids that had been dormant for years, keeping her healthy. One autumn, she suddenly developed severe coughing with thick, sticky phlegm, pain radiating to the chest and flanks, and insomnia. Lying down worsened the cough and pain. Seeking my consultation on the third day, her pulse was wiry and rapid, breathing急促, no bowel movement for three days, fatigue, hoarseness, and inability to sustain breath. The condition was critical. I told her family, 'This is a severe phlegm-fluid syndrome, approaching collapse. Immediate rescue is necessary; any delay will be futile.' We urgently administered Kongyan Dan 1.5 qian, swallowed with Yuanmingfen (Mirabilite) 3 qian dissolved in boiling water. Soon, coughing decreased, and breathing stabilized. That evening, black stool passed, and she slept peacefully. By dawn, all symptoms vanished. Thus, I learned that Kongyan Dan is a modification of Shizao Tang, prepared for emergencies.
However, this case fundamentally matches Zao Jiao Wan syndrome: 'Coughing with airway obstruction, frequent expectoration of turbid material, ability only to sit, inability to lie down and sleep; Zao Jiao Wan is indicated.' But given the sudden onset and frailty, Zao Jiao Wan's slow action might be insufficient for emergency relief."
Zao Jiao Wan Syndrome II
Mr. Cao Dianguang, teacher of my disciple Lu Fuyao, a native of Wuhu, aged fifty, suffered from chronic phlegm-fluids for over ten years. Lu Fuyao could not cure him and sent him to me. Symptoms included hardness and fullness in the epigastrium, pain radiating to the chest and flanks, occasional wheezing, continuous coughing spells, frequent expectoration of extremely thick and congealed turbid phlegm, and inability to lie down during severe episodes. I diagnosed the wheezing and coughing as Zhi Yin (Fluids under the diaphragm), similar to "fluid retention in the epigastrium" in *Shanghan Lun* and "coughing with inability to lie down" in the *Phlegm-Fluids Chapter*. I prescribed Xiao Qing Long Tang, but it failed. Then I tried Shegan Mahuang Tang combined with Xiao Banxia Tang, also failing. The coughing and airway obstruction worsened, causing great anxiety. I considered attacking with Shizao Tang, but that is for Xuan Yin (Hanging Fluids in the chest/flanks). I thought of Tingli Dazao Xiefei Tang to drain the Lungs, but that is designed for Fei Zhang (Lung Distension) and Fei Yong (Lung Abscess). Neither was appropriate; administering them would only damage righteous Qi. Recalling his frequent expectoration of turbid phlegm and inability to lie down, it closely matched the Zao Jiao Wan syndrome in *Jinkui Yaolue*. I therefore used 4 liang of roasted Zao Jiao powder, mixed with Red Sugar instead of Jujube Paste, alternating with Shegan Mahuang Tang. After eight doses, phlegm cleared, wheezing stopped, and all symptoms resolved.
Zao Jiao Wan Syndrome III
I once suffered from phlegm-fluids myself, with wheezing, coughing, and expectoration of turbid phlegm radiating pain to the chest and flanks. I used four large Zao Jiao pods, roasted and powdered, placed in a bowl, mixed with Red Sugar, taken every other day. After four doses, I experienced diarrhea two to three times daily, expelling phlegm and feces together, sometimes entirely phlegm. After recovery, my body was significantly depleted. Thus, I realized Zao Jiao's purgative power is fierce, relying entirely on Jujube Paste for moderation. Gansui breaks water-fluids, Tingli drains lung distension/abscesses, and Zao Jiao dissolves sticky phlegm; these three are equally potent. Unfortunately, modern practitioners often view them as poisonous, discarding good medicines. Who is to blame? Cao Yingfu stated: "I treated Mr. Zhang Dayuan's wheezing and coughing with inability to lie down using Kongyan Dan, achieving a cure in one dose. In recent years, Mr. Dayuan developed a smoking habit, producing thick phlegm mixed with water, filling a large glass bottle overnight. All phlegm-fluid formulas were useless, and Zao Jiao ash provided no help. Perhaps when water-fluids are too severe, detergent methods are inappropriate, and when thick phlegm is present, warming herbs are ineffective."
Zao Jiao Wan Syndrome IV
Mr. Zheng Zuo, residing at Fangbang Road intersection, aged eighty-two, had a wet-phlegm constitution. He suffered from coughing and edema of the four limbs. The syndrome belonged to Yi Yin (Overflowing Fluids), originally requiring sweating and promoting urination. However, turbid phlegm blocked the chest and diaphragm, causing coughing with airway obstruction, inability to lie down, and very thick phlegm. In acute cases, treat the branch first; thus, Zao Jiao Wan should be used initially to descend phlegm from the chest/diaphragm, ensuring free bowel/bladder movements and restful sleep, marking a turning point. Currently, both pulses are Knotted and Intermittent (Jie Dai), which Zhang Zhongjing considered difficult to treat. With slight medicinal effect, discuss definitive treatment.
Native Zao Jiao, remove black skin, seeds, and strings, roast with butter, grind finely, honey-pill sized like Toona seeds. Take three pills per dose, three times daily. Send down with decoction of twenty black Jujubes, strained. Note by Zhuochao: The patient's family consulted other doctors, who advised against it due to the harshness of the formula. The outcome remains unknown.
Cao Yingfu stated: "Zao Jiao Wan treats sticky phlegm but cannot eliminate wet-phlegm. This is because Zao Jiao removes accumulated grease but not water-fluids. However, if phlegm-fluids cause persistent coughing/wheezing, there must be congealed phlegm in the Middle Jiao, so it can sometimes be effective. Only the use of Zao Jiao Ash was invented by my eldest daughter, Zhaohao. She suffered from phlegm-fluids, often vomiting thick phlegm, so she prepared and took it herself, curing her twenty-year phlegm-fluid root cause. I found it effective. When Mr. Cao Dianguang came from Wuhu with similar symptoms, I used it successfully.
[Commentary] The *Jinkui Yaolue* states: "Zao Jiao 8 liang, scrape off skin, roast with butter. Grind the single ingredient into powder, make honey-pills the size of Toona seeds, take three pills with Jujube Paste soup, three times daily, one at night. 'Scrape off skin' means removing the black outer layer. 'Roast with butter' means roasting over low heat until slightly yellow-brown, avoiding charcoal. 'Take three pills' means three per dose. 'Three times daily, one at night' means four doses total, twelve pills per day. Therefore, claims that the daily limit should not exceed three pills are incorrect. 'Jujube Paste soup' means pre-cooking Jujube flesh into paste, mixing with hot water to send down the pills. You Shi said: 'Drinking with Jujube Paste stabilizes the root.' This is correct. Elaborating, it prevents Zao Jiao from damaging precious stomach fluids while clearing turbid phlegm. My friend Wu Ningxuan explained this. My teacher substituted sugar for Jujube Paste for convenience, though its fluid-preserving power is inferior. Both are sweet, working similarly to Gancao (soothing intestines/generating fluids) and Yitang (building middle/stopping pain).
Summarizing the four cases: Case 1 (Lady Xing) took twelve Toona-sized pills on day one, thirty-six Mung-bean-sized pills on day two. Modern Toona-sized honey-pills yield about ten per qian; thus, twelve pills equal roughly one qian. Case 2 (Cao Dianguang) used 4 liang of Zao Jiao powder over eight days. Day 1: 1 liang powder; Day 2: Shegan Mahuang Tang; Days 3,5,7: same as Day 1; Days 4,6,8: same as Day 2. Daily intake of 1 liang is much higher than Case 1's 1 qian, but this was charred ash (weak potency) vs. roasted yellow substance (strong potency), inversely proportional to dosage. Also, disease severity differed. Case 3 (Teacher himself): Four large pods yielded half a small bowl. Testing one pod (unprocessed) weighed ~1 liang; two pods (charred/powdered) weighed ~6 qian. Four pods ≈ 1.2 liang, consistent with Case 2. Case 4 follows ancient methods like Case 1. Since this is a harsh drug, inexperienced doctors should start with 5 fen per dose and titrate upwards.
Furthermore, Zao Jiao is used for its ability to cleanse sticky phlegm, attributed to its saponin content. Western expectorants like Senega Root contain saponins, as do TCM herbs like Yuanzhi, Jiegeng, and Zao Jiao, known as stimulant expectorants. Thus, Zao Jiao can replace Senega Root. Eastern and Western theories converge here.
Cao Yingfu stated: "Alkaline herbs are best for resolving phlegm. For stuck phlegm, Jiegeng Gancao Tang works quickly due to Jiegeng's alkalinity. For phlegm stuck in the chest/diaphragm, alkaline Jiegeng draws it out ('Above, induce vomiting'). For sticky phlegm in the Middle Jiao, alkaline Zao Jiao drives it down ('Below, exhaust it'). Understanding this vertical differentiation helps grasp herbal applications."
Zexie Tang Syndrome
Guan You, residing at Nanyang Bridge Flower Field, September 1st. Coughing and expectorating foam for many years, intermittent dizziness and vertigo, vomiting during vertigo, dry stools, scanty urine, chest fullness upon coughing. This is Zhi Yin (Fluids under the diaphragm); Zexie Tang is indicated.
Zexie (Alismatis Rhizoma) 1.3 liang, Sheng Baizhu (Atractylodis Macrocephalae Rhizoma) 6 qian.
[Commentary] Patient Guan, a woman in her thirties, whose husband grew flowers in Dachang, Shanghai. She had chronic phlegm-fluids since youth, worsening in winter with severe vertigo preventing lying flat. Teacher prescribed this decoction. After one dose, urination flowed freely, and coughing greatly subsided. Five more doses allowed her to pass the winter safely. Next spring, upon cooling weather, relapse occurred.
Teacher repeated the formula, increasing Zexie to 2 liang and Baizhu to 1 liang, adding Cangzhu (Atractylodis Rhizoma) to assist. Condition resolved. Relapsed again that winter. Such stubborn chronic diseases are hard to eradicate! From Xiao Qing Long Tang to Zexie Tang, these five syndromes all treat phlegm-fluids. Xiao Qing Long Tang focuses on fluid retention in the epigastrium; Shegan Mahuang Tang on 'water-frog' sounds in the throat; Ling Gui Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang on expectorating saliva/foam; Zao Jiao Wan on sticky phlegm; Zexie Tang on vertigo. These are the general principles.
Guizhi Jia Longgu Muli Tang Syndrome I