齐氏云∶肺痈肺痿,因脾肺气虚,腠理不密,外邪所乘。或母食辛辣浓味,遗
热于儿。或儿有病,过于汗下,内亡津液,虚火烁肺。或服克伐之药,亏损脾胃,
不能生肺金。其证恶风咳嗽,鼻塞项强,呼吸不利,甚则四肢微肿,咳唾脓血,若
吐臭秽,胸中隐痛,脉数而实者为肺痈,咳唾涎沫,脉数而虚者为肺痿。恶寒喘嗽
者,寒邪内蕴也,小青龙汤。咳唾脓秽者,肺痈内溃也,桔梗汤。窃谓前证若喘咳
短气者,脾肺气虚也,五味异功散。咳唾脓痰左尺脉数而无力者,肾气虚也,六味
地黄丸。咳唾脓痰右关脉数而无力者,脾气虚也,七味白术散。若发热喘嗽唾脓不
食者,脾肺虚甚也,难治。大要,补脾肺,滋肾水,为善。(仍审五脏相胜,乳母七情,
后证仿此)
小青龙汤 治伤风冒寒,咳嗽喘急,肺胀胸满,鼻塞流涕,或干呕热咳,或作渴,
或作噎,或小便不利,或小腹胀满。(此仲景之法,审有是证,用之及时,殊有良验)
麻黄(去节) 赤芍药 半夏(各七钱) 细辛 干姜(炮) 甘草(炙) 桂枝(各三钱)
五味子(半两,杵) 附子(二钱脉浮,不用)
上,每服二钱,水煎。
桔梗汤 治咳嗽,脓血腥秽,已成痈证。
桔梗(炒) 贝母(去心) 知母(炒) 桑白皮(炒) 枳壳(各一钱) 地骨皮 栝蒌仁
薏苡仁 杏仁(杵。各五分) 当归 黄 (炒。各一钱) 五味子(杵,炒) 百合(炒。各一钱
五分) 防己(一钱) 甜葶苈(炒,五分)
上,每服二三钱,水煎服。
升麻汤 治肺痈,脓血秽臭,胸乳皆痛。
升麻 桔梗(炒) 薏苡仁 地榆 条芩(炒) 牡丹皮 芍药(炒) 甘草(各等分)
上,每服二三钱,水煎。
排脓散 治肺痈,此方排脓补肺。
黄 (盐水拌,炒) 白芷 人参 五味子(炒,研。各等分)
上为末。每服一二钱,蜜汤调下。
射干汤 治胃脘痈吐脓血。
射干(去毛) 栀子仁 赤茯苓 升麻 赤芍药(一两三钱) 白术(五钱)
上,每服三五钱,水煎,入地黄汁少许再煎,服。
人参平肺散 治心火克肺金,传为肺痈,咳嗽喘呕,痰涎壅盛,胸膈痞满,咽嗌
不利。
人参 陈皮 甘草 地骨皮 茯苓(各一钱) 知母(炒,七分) 五味子(炒) 青皮 天门冬
(去心,四分) 桑白皮(炒,一钱)
上,每服二三钱。
参 补脾汤 治肺痈,脾气亏损,咳吐脓涎,或中满不食,必服此药补脾土以生肺
金,否则不治。
人参 白术(各二钱) 黄 (炒,二钱五分) 茯苓 陈皮 当归(各一钱) 升麻(三分)
麦门冬(七分) 桔梗(炒,六分) 甘草(炙,五分) 五味子(杵,四分)
上,作三服,姜枣水煎。
人参补肺汤 治肺证咳喘短气,或肾水不足,虚火上炎,痰涎壅盛,或吐脓血发热,
小便短涩。
人参 黄 (炒) 白术 茯苓 陈皮 当归(各一钱) 山茱萸干山药 五味子(杵) 麦
门冬(去心) 甘草(炙) 熟地黄(自制) 牡丹皮(各五分)
上,每服五钱,水煎服。
齐氏说:肺痈和肺痿,是由于脾脏和肺脏气虚,腠理(皮肤毛孔及肌肉间隙)不致密,导致外邪侵袭。或者是母亲食用辛辣浓厚的食物,将热邪遗留给婴儿。或者是婴儿患病后,过度使用发汗或泻下的治疗方法,导致体内津液耗亡,虚火灼烧肺脏。或者是服用攻伐损伤的药物,亏损了脾胃之气,导致脾胃不能生化肺金(土生金)。其症状表现为怕风、咳嗽、鼻塞、项背强直、呼吸不畅,严重时四肢轻微浮肿,咳吐脓血,如果吐出臭秽之物,胸部隐痛,脉象数而有力的是肺痈;咳吐涎沫,脉象数而无力的则是肺痿。怕冷、气喘咳嗽的,是寒邪内蕴所致,用小青龙汤治疗。咳吐脓秽物的,是肺痈内部溃破所致,用桔梗汤治疗。我认为前述病症如果出现气喘咳嗽、呼吸短促的,是脾肺气虚,用五味异功散治疗。咳吐脓痰且左尺脉数而无力的,是肾气虚,用六味地黄丸治疗。咳吐脓痰且右关脉数而无力的,是脾气虚,用七味白术散治疗。如果出现发热、气喘咳嗽、咳吐脓血、不能进食的,是脾肺极度虚弱,难以治愈。大致的原则是,补益脾肺,滋补肾水,才是善治之法。(仍需审查五脏之间的相克关系,以及乳母的情绪变化,后续病症仿照此法处理)
小青龙汤 治疗伤风冒寒,咳嗽气喘急促,肺部胀满胸中憋闷,鼻塞流涕,或者干呕伴有热咳,或者口渴,或者吞咽梗阻,或者小便不利,或者小腹胀满。(这是张仲景的方法,审察是否有这些证候,及时使用,效果显著)
麻黄(去节) 赤芍药 半夏(各七钱) 细辛 干姜(炮制) 甘草(炙烤) 桂枝(各三钱)
五味子(半两,捣碎) 附子(二钱,若脉浮则不用)
以上药物,每次服用二钱,用水煎煮。
桔梗汤 治疗咳嗽,咳出脓血腥秽之物,已成肺痈证候。
桔梗(炒制) 贝母(去心) 知母(炒制) 桑白皮(炒制) 枳壳(各一钱) 地骨皮 栝蒌仁 薏苡仁 杏仁(捣碎。各五分) 当归 黄芪(炒制。各一钱) 五味子(捣碎,炒制) 百合(炒制。各一钱五分) 防己(一钱) 甜葶苈(炒制,五分)
以上药物,每次服用二三钱,用水煎服。
升麻汤 治疗肺痈,脓血秽臭,胸部和乳房都疼痛。
升麻 桔梗(炒制) 薏苡仁 地榆 条芩(炒制) 牡丹皮 芍药(炒制) 甘草(各等分)
以上药物,每次服用二三钱,用水煎煮。
排脓散 治疗肺痈,此方能排出脓液并补益肺脏。
黄芪(用盐水拌,炒制) 白芷 人参 五味子(炒制,研末。各等分)
以上药物制成粉末。每次服用一二钱,用蜜水调服。
射干汤 治疗胃脘部痈肿,吐脓血。
射干(去毛) 栀子仁 赤茯苓 升麻 赤芍药(一两三钱) 白术(五钱)
以上药物,每次服用三五钱,用水煎煮,加入少许地黄汁再煎煮,服用。
人参平肺散 治疗心火克制肺金,传变为肺痈,咳嗽气喘呕吐,痰涎壅盛,胸膈痞闷胀满,咽喉不利。
人参 陈皮 甘草 地骨皮 茯苓(各一钱) 知母(炒制,七分) 五味子(炒制) 青皮 天门冬(去心,四分) 桑白皮(炒制,一钱)
以上药物,每次服用二三钱。
参 补脾汤 治疗肺痈,脾气亏损,咳吐脓涎,或者腹部胀满不能进食,必须服用此药补益脾土以生化肺金,否则无法治愈。
人参 白术(各二钱) 黄芪(炒制,二钱五分) 茯苓 陈皮 当归(各一钱) 升麻(三分)
麦门冬(七分) 桔梗(炒制,六分) 甘草(炙烤,五分) 五味子(捣碎,四分)
以上药物,分为三服,用生姜、大枣水煎煮。
人参补肺汤 治疗肺病咳嗽气喘呼吸短促,或者肾水不足,虚火上炎,痰涎壅盛,或者吐脓血发热,小便短少涩滞。
人参 黄芪(炒制) 白术 茯苓 陈皮 当归(各一钱) 山茱萸 干山药 五味子(捣碎) 麦门冬(去心) 甘草(炙烤) 熟地黄(自制) 牡丹皮(各五分)
以上药物,每次服用五钱,用水煎服。
Qi stated: Lung abscess (Fei Yong) and lung atrophy (Fei Wei) are caused by deficiency of Qi in the Spleen and Lung, with loose interstices (Cou Li, referring to skin pores and muscle intervals), allowing external pathogenic factors to invade. Alternatively, it may result from the mother consuming spicy and rich foods, transmitting heat to the infant. Or, after the infant falls ill, excessive use of diaphoretic or purgative treatments leads to the depletion of body fluids internally, causing deficient fire to scorch the Lung. Or, the consumption of harsh, attacking medicines damages the Spleen and Stomach, impairing their ability to generate Metal for the Lung (Earth generating Metal). The symptoms include aversion to wind, cough, nasal congestion, stiffness of the neck, and difficult breathing; in severe cases, slight swelling of the four limbs occurs, along with expectoration of pus and blood. If foul-smelling material is vomited, accompanied by dull pain in the chest and a rapid, forceful pulse, it is diagnosed as Lung Abscess (Fei Yong); if saliva and foam are expectorated with a rapid but empty pulse, it is diagnosed as Lung Atrophy (Fei Wei). Aversion to cold, wheezing, and cough indicate internal accumulation of Cold Pathogen, treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). Expectoration of purulent and foul matter indicates internal ulceration of Lung Abscess (Fei Yong), treated with Jie Geng Tang (Platycodon Decoction). I believe that if the aforementioned conditions present with wheezing, cough, and shortness of breath, it signifies deficiency of Spleen and Lung Qi, treated with Wu Wei Yi Gong San (Five-Ingredient Powder for Extraordinary Merit). If pus and phlegm are expectorated with a rapid and weak pulse at the left Chi position, it indicates Kidney Qi deficiency, treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). If pus and phlegm are expectorated with a rapid and weak pulse at the right Guan position, it indicates Spleen Qi deficiency, treated with Qi Wei Bai Zhu San (Seven-Ingredient Powder of Atractylodes Macrocephala). If fever, wheezing, cough, expectoration of pus and blood, and anorexia occur, it signifies extreme deficiency of the Spleen and Lung, which is difficult to treat. The general principle is to tonify the Spleen and Lung, and nourish Kidney Water, which constitutes good treatment. (One must still examine the mutual overcoming relationships among the Five Zang organs and the emotional states of the nursing mother; subsequent conditions should be handled analogously.)
Xiao Qing Long Tang (Minor Blue Dragon Decoction) treats wind-cold invasion, cough and acute wheezing, lung distension with chest fullness, nasal congestion with runny nose, dry retching with hot cough, thirst, dysphagia, difficulty in urination, or lower abdominal fullness. (This is the method of Zhang Zhongjing; when these syndromes are identified and applied promptly, it yields excellent results.)
Ma Huang (Ephedrae Herba, stems removed) Chi Shao Yao (Radix Paeoniae Rubra) Ban Xia (Rhizoma Pinelliae, each 7 qian) Xi Xin (Herba Asari) Gan Jiang (Radix Zingiberis Preparata, processed) Gan Cao (Radix Glycyrrhizae Preparata, honey-fried) Gui Zhi (Ramulus Cinnamomi, each 3 qian)
Wu Wei Zi (Fructus Schisandrae, 0.5 liang, crushed) Fu Zi (Radix Aconiti Lateralis Preparata, 2 qian; omit if pulse is floating)
The above ingredients: take 2 qian per dose, decoct in water.
Jie Geng Tang (Platycodon Decoction) treats cough with expectoration of purulent, bloody, and foul matter, indicating established Lung Abscess (Fei Yong).
Jie Geng (Radix Platycodi, stir-fried) Bei Mu (Bulbus Fritillariae Cirrhosae, heart removed) Zhi Mu (Rhizoma Anemarrhenae, stir-fried) Sang Bai Pi (Cortex Mori, stir-fried) Zhi Ke (Fructus Aurantii, each 1 qian) Di Gu Pi (Cortex Lycii) Gua Lou Ren (Semen Benincasae) Yi Yi Ren (Semen Coicis) Xing Ren (Semen Pruni, crushed, each 5 fen) Dang Gui (Radix Angelicae Sinensis) Huang Qi (Radix Astragali, stir-fried, each 1 qian) Wu Wei Zi (Fructus Schisandrae, crushed and stir-fried) Bai He (Bulbus Lilii, stir-fried, each 1.5 qian) Fang Ji (Radix Stephaniae Tetrandrae, 1 qian) Ting Li Zi (Semen Lepidii et Descurainiae, stir-fried, 5 fen)
The above ingredients: take 2–3 qian per dose, decoct in water and drink.
Sheng Ma Tang (Cimicifugae Decoction) treats Lung Abscess (Fei Yong) with foul-smelling pus and blood, and pain in the chest and breasts.
Sheng Ma (Rhizoma Cimicifugae) Jie Geng (Radix Platycodi, stir-fried) Yi Yi Ren (Semen Coicis) Di Yu (Radix Sanguisorbae) Tiao Qin (Radix Scutellariae, stir-fried) Mu Dan Pi (Cortex Moutan) Shao Yao (Radix Paeoniae, stir-fried) Gan Cao (Radix Glycyrrhizae, equal parts)
The above ingredients: take 2–3 qian per dose, decoct in water.
Pai Nong San (Pus-Expelling Powder) treats Lung Abscess (Fei Yong); this formula expels pus and tonifies the Lung.
Huang Qi (Radix Astragali, mixed with salt water and stir-fried) Bai Zhi (Radix Angelicae Dahuricae) Ren Shen (Radix Ginseng) Wu Wei Zi (Fructus Schisandrae, stir-fried and ground, equal parts)
The above ingredients: grind into powder. Take 1–2 qian per dose, mix with honey water and swallow.
She Gan Tang (Belamcandae Decoction) treats gastric epigastrium abscess with expectoration of pus and blood.
She Gan (Rhizoma Belamcandae, hairs removed) Zhi Zi Fructus Gardeniae) Chi Fu Ling (Poria cum Radix Pini, red part) Sheng Ma (Rhizoma Cimicifugae) Chi Shao Yao (Radix Paeoniae Rubra, 1 liang 3 qian) Bai Zhu (Rhizoma Atractylodis Macrocephalae, 5 qian)
The above ingredients: take 3–5 qian per dose, decoct in water, add a small amount of Di Huang juice, decoct again, and consume.
Ren Shen Ping Fei San (Ginseng Powder to Calm the Lung) treats Heart Fire suppressing Lung Metal, transforming into Lung Abscess (Fei Yong), with cough, wheezing, vomiting, abundant phlegm and saliva, chest and diaphragm stuffiness and fullness, and throat discomfort.
Ren Shen (Radix Ginseng) Chen Pi (Pericarpium Citri Reticulatae) Gan Cao (Radix Glycyrrhizae) Di Gu Pi (Cortex Lycii) Fu Ling (Poria, each 1 qian) Zhi Mu (Rhizoma Anemarrhenae, stir-fried, 7 fen) Wu Wei Zi (Fructus Schisandrae, stir-fried) Qing Pi (Pericarpium Citri Reticulatae Viride) Tian Men Dong (Radix Asparagi, heart removed, 4 fen) Sang Bai Pi (Cortex Mori, stir-fried, 1 qian)
The above ingredients: take 2–3 qian per dose.
Can Bu Pi Tang (Ginseng Decoction to Tonify the Spleen) treats Lung Abscess (Fei Yong) due to Spleen Qi damage, with expectoration of pus and saliva, or abdominal fullness and anorexia. One must take this medicine to tonify Spleen Earth to generate Lung Metal; otherwise, it is incurable.
Ren Shen (Radix Ginseng) Bai Zhu (Rhizoma Atractylodis Macrocephalae, each 2 qian) Huang Qi (Radix Astragali, stir-fried, 2.5 qian) Fu Ling (Poria) Chen Pi (Pericarpium Citri Reticulatae) Dang Gui (Radix Angelicae Sinensis, each 1 qian) Sheng Ma (Rhizoma Cimicifugae, 3 fen)
Mai Men Dong (Radix Ophiopogonis, 7 fen) Jie Geng (Radix Platycodi, stir-fried, 6 fen) Gan Cao (Radix Glycyrrhizae Preparata, honey-fried, 5 fen) Wu Wei Zi (Fructus Schisandrae, crushed, 4 fen)
The above ingredients: divide into three doses, decoct in water with fresh ginger and jujube.
Ren Shen Bu Fei Tang (Ginseng Decoction to Tonify the Lung) treats Lung syndrome with cough, wheezing, and shortness of breath, or insufficient Kidney Water with deficient fire flaming upward, abundant phlegm and saliva, expectoration of pus and blood with fever, and scanty, difficult urination.
Ren Shen (Radix Ginseng) Huang Qi (Radix Astragali, stir-fried) Bai Zhu (Rhizoma Atractylodis Macrocephalae) Fu Ling (Poria) Chen Pi (Pericarpium Citri Reticulatae) Dang Gui (Radix Angelicae Sinensis, each 1 qian) Shan Zhu Yu (Fructus Corni) Shan Yao (Rhizoma Dioscoreae) Wu Wei Zi (Fructus Schisandrae, crushed) Mai Men Dong (Radix Ophiopogonis, heart removed) Gan Cao (Radix Glycyrrhizae Preparata, honey-fried) Shu Di Huang (Radix Rehmanniae Preparata, homemade) Mu Dan Pi (Cortex Moutan, each 5 fen)
The above ingredients: take 5 qian per dose, decoct in water and drink.