喘因水气乘肺者,经所谓不得卧,卧则喘者,是水气喘而不客也。古法∶心下有水气,
上
乘于肺,得卧者,以《直指》神秘汤主之。若肾中水邪干肺者,则《济生》肾气丸主之。
神秘汤
人参 陈皮 桔梗 紫苏 半夏 桑皮 槟榔(各一钱) 炙甘草(五分) 五味子(十五
粒)
上用水姜煎,食远温服。
喘因寒邪入肺者,经曰∶邪在肺,则病皮肤痛,寒热,上气喘咳动肩背,因背受寒邪,
伏于
肺中,关窍不通,呼吸不利,右寸沉而紧,亦有部俱伏者,宜发散,则身热退而喘定。小青
龙、三拗汤之属。若内兼火热,外显烦躁者,宜散而兼清,麻杏甘石之属。
小青龙汤
麻黄 桂枝 芍药 细辛 甘草(各三两) 干姜(三两) 半夏 五味子(各半升)
上以水一升,先煮麻黄去上沫,内诸药,煮取三升,强人服一升,羸者减之。
三拗汤(方见咳门。)
喘因夏月火烁肺金者,上焦热甚、烦渴,多汗,肺主气而属金,金畏火逼,气不得降而
反上行,从化于火也。
人参白虎汤
人参 石膏 知母 甘草 粳米
喘因肾虚,气吸不下者,或因气自小腹下起而上逆者,但经微劳,或饥时即发。宜以六
味补阴之属,壮水配火。若足冷面热者,须以八味安肾之属,导火归元。
安肾丸
肉桂(去粗皮,不见火) 川乌头(炮,去皮脐,各十六两) 桃仁(麸炒) 白蒺藜(炒去
刺) 巴戟
(去心) 山药 茯苓 肉苁蓉(酒浸,炙) 石斛(去根,炙) 萆 白术 破故纸(各四十
八两)
上为末,炼蜜为丸梧子大,每服三十丸,盐汤送下,空心食前。
小安肾丸 治肾虚冷惫,阴火上升、喘嗽、齿痛,腰痛。
香附子 川乌头 川楝子(以上各一斤,用盐四两,水四升,同煮,侯干切焙) 茴香(
十二两) 熟地黄(八两) 川椒(去目及闭口者,炒出微汗,四两)
上六味为细末,酒糊丸桐子大,每服二十丸,至三十丸,空心临卧,盐汤温酒任下。
喘证因水气侵犯肺脏的,正如《内经》所说“不能平卧,一躺下就气喘”,这是水气上逆而并非外邪客犯。古法认为:心下有停饮(水气),上乘于肺,若能平卧的,用《直指方》的神秘汤主治。如果是肾中水邪干犯肺脏的,则用《济生方》的肾气丸主治。
神秘汤
人参、陈皮、桔梗、紫苏、半夏、桑白皮、槟榔(各一钱),炙甘草(五分),五味子(十五粒)。
以上药物用水和生姜煎煮,饭后稍远时温服。
喘证因寒邪侵入肺脏的,《内经》说:“邪气在肺,就会引起皮肤疼痛,恶寒发热,气逆上冲而咳嗽,喘息时耸动肩背。”这是因为背部受寒邪侵袭,寒邪伏留于肺中,导致关窍不通,呼吸不利,脉象右寸部沉而紧,也有全部脉象伏匿不见的,适宜用发散法治疗,这样身热退去而气喘平息。可用小青龙汤、三拗汤这类方剂。如果内部兼有火热,外部显现烦躁症状的,适宜用发散兼清热的治法,可用麻杏甘石汤这类方剂。
小青龙汤
麻黄、桂枝、芍药、细辛、甘草(各三两),干姜(三两),半夏、五味子(各半升)。
以上药物用水一升,先煮麻黄,去掉浮沫,再加入其他药物,煮取三升药液,体质强壮的人服用一升,体弱者减量服用。
三拗汤(方剂见咳嗽门。)
喘证因夏季火热灼伤肺金的,表现为上焦热盛、心烦口渴、多汗。肺主气而五行属金,金畏惧火逼,肺气不得下降反而上行,随火势化热。
用人参白虎汤。
人参、石膏、知母、甘草、粳米。
喘证因肾虚,吸气不能下达的,或者气从小腹下部向上逆冲的,只要稍微劳累,或饥饿时就会发作。适宜用六味地黄丸等补阴的方剂,通过壮水制火来治疗。如果出现脚冷面热的症状,必须用八味地黄丸等安肾的方剂,引导虚火回归本源。
安肾丸
肉桂(去除粗皮,不经过火烤),川乌头(炮制,去皮脐,各十六两),桃仁(麸炒),白蒺藜(炒后去刺),巴戟天(去心),山药,茯苓,肉苁蓉(酒浸,炙),石斛(去根,炙),萆薢,白术,破故纸(即补骨脂,各四十八两)。
以上药物研为细末,用炼蜜制成梧桐子大小的丸药,每次服用三十丸,用盐汤送下,空腹饭前服用。
小安肾丸 治疗肾虚寒冷疲惫,阴火上炎、气喘咳嗽、牙齿疼痛、腰痛。
香附子、川乌头、川楝子(以上各一斤,用盐四两、水四升,共同煮至水干,切片焙干),茴香(十二两),熟地黄(八两),川椒(去除椒目及闭口者,炒至微出汗,四两)。
以上六味药物研为细末,用酒糊制成梧桐子大小的丸药,每次服用二十丸至三十丸,空腹及临睡前,用温酒盐汤任其送服。
Asthma caused by water qi invading the lung is described in the classics as "inability to lie flat, with wheezing upon lying down"; this indicates that the wheezing is due to the rebellion of water qi rather than an invasion by external pathogens. Ancient methods state: when there is retained fluid (water qi) below the heart that ascends to invade the lung, and the patient can lie flat, it should be treated with Shenmi Tang (Mysterious Decoction) from *Zhizhi Fang*. If the pathogen is water evil from the kidney interfering with the lung, then Shengji Shenqi Wan (Kidney Qi Pill) from *Jisheng Fang* should be used.
Shenmi Tang (Mysterious Decoction)
Renshen (Ginseng Radix), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Zisu (Perillae Folium), Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine), Sangbaipi (Morus Albae Cortex), Binglang (Arecae Semen) (each 1 qian), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) (0.5 qian), Wuweizi (Schisandrae Fructus) (15 grains).
Decoct these ingredients with water and fresh ginger; take warm after meals, at a time distant from eating.
Asthma caused by cold evil entering the lung: The classics state, "When pathogenic factors are in the lung, skin pain, aversion to cold, fever, upward rebellion of qi with cough, and shoulder/back movement during wheezing occur." This results from cold evil invading the back, lodging in the lung, blocking the orifices, causing difficult respiration. The pulse at the right Cun position is deep and tight, or all pulses may be hidden. Treatment should involve dispersing methods; once body heat subsides, asthma will settle. Formulas such as Xiao Qinglong Tang (Minor Blue Dragon Decoction) and San'ao Tang (Three Unblocking Decoction) are suitable. If internal heat is present alongside external restlessness, treatment should combine dispersing and clearing methods; formulas such as Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) are appropriate.
Xiao Qinglong Tang (Minor Blue Dragon Decoction)
Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Xixin (Asari Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma) (each 3 liang), Ganjiang (Zingiberis Rhizoma), Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine), Wuweizi (Schisandrae Fructus) (each half sheng).
Take one sheng of water. First decoct Mahuang, remove the foam on top, then add other herbs. Decoct to obtain three sheng of liquid. Strong individuals take one sheng; frail individuals reduce the dose.
San'ao Tang (Three Unblocking Decoction) (Formula seen in the Cough section.)
Asthma caused by summer fire scorching lung metal presents with excessive heat in the upper jiao, irritability, thirst, and profuse sweating. The lung governs qi and belongs to metal; metal fears being forced by fire, so lung qi fails to descend and instead rebels upward, transforming into fire.
Use Renshen Baihu Tang (Ginseng White Tiger Decoction).
Renshen (Ginseng Radix), Shigao (Gypsum Fibrosum), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Jingmi (Oryza Sativa Var. Glutinosa).
Asthma caused by kidney deficiency, where inhalation cannot reach the lower dantian, or where qi rises upward from the lower abdomen, typically occurs with slight exertion or hunger. Treatment should use formulas like Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish yin, strengthening water to control fire. If cold feet and hot face are present, Anshen Wan (Kidney-Calming Pill) or similar formulas should be used to guide fire back to its source.
Anshen Wan (Kidney-Calming Pill)
Rougui (Cinnamomi Cortex, removed coarse bark, not exposed to direct fire), Chuanwutou (Aconiti Radix Lateralis Preparata, peeled and de-navel, each 16 liang), Taoren (Persicae Semen, bran-fried), Bjlili (Tribuli Fructus, fried and thorns removed), Bajitian (Morinda Officinalis Radix, de-core), Shanyao (Dioscoreae Rhizoma), Fuling (Poria), Roucongrong (Cynomorii Herba, wine-soaked and stir-baked), Shihu (Dendrobii Caulis, de-root and stir-baked), Bibi (Dioscoreae Hypoglaucae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Poguzhi (Psoraleae Fructus) (each 48 liang).
Grind into powder, make pills with refined honey the size of wutong seeds. Take 30 pills per dose, washed down with salt water, before meals on an empty stomach.
Xiao Anshen Wan (Minor Kidney-Calming Pill) treats kidney deficiency with cold and exhaustion, rising yin-fire, asthma and cough, toothache, and lower back pain.
Xiangfu (Cyperi Rhizoma), Chuanwutou (Aconiti Radix Lateralis Preparata), Chuanlianzi (Toosendan Fructus) (above each 1 jin, boiled together with 4 liang of salt and 4 sheng of water until dry, then sliced and dried-roasted), Huixiang (Foeniculi Fructus) (12 liang), Shudihuang (Rehmanniae Radix Preparata) (8 liang), Chuanjiao (Zanthoxyli Pericarpium, remove eyes and closed ones, stir-fry until slight sweat appears) (4 liang).
Grind these six ingredients into fine powder, make pills with wine paste the size of wutong seeds. Take 20 to 30 pills per dose, before meals and before sleep, washed down with warm wine and salt water.