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《喘》[View] [Edit] [History]

1 喘者,氣短而促,吸不歸根,呼吸之氣不應皮毛之開合也。有實喘,有虛喘,有半虛半實喘。
2 實者,風寒之邪,傷其毛腠,致肌表不和。毛,皮毛也,主表:腠,腠理也,主肌。經云:三焦、膀胱者,腠理毫毛其應。是三焦應肝血之腠理以主肌,膀胱應肺氣之皮毛以主表。若寒邪凝斂於皮毛,皮毛之氣不通於腠理,則喘;風邪中傷於腠理,腠理之氣不通於皮毛,亦喘。然此喘也,必病之初起,微微氣急,或無汗惡寒,或有汗惡風,斯時和其肌表,散其風寒,喘自平矣。
3 半虛半實者,手足太陰之氣,不相交合也。手太陰肺金,天也;足太陰脾土,地也。地氣上升,則天氣下降,或寒逆於肺而肺金寒,或濕滯於脾而脾土濕,則脾氣不升,肺氣不降,痰涎在中,上下不交而為喘。然此喘也,必兼咳也。夫脾肺不交,則為虛;寒濕內凝,則為實。虛實相半,則補瀉並施;虛多實少,則補多瀉少;
4 實多虛少,則瀉多補少。寒涼之藥,在所禁也。《傷寒論》中,有麻黃杏子石膏湯、葛根黃連黃芩湯以治喘,乃病太陽之標陽,而毛腠不通,陽熱過盛,病在氣化,不在經脈也。又有冷風哮喘,乃胃積寒痰,三焦火熱之氣然之不力,火虛土弱,土弱金虛,致中有痰而上咳喘。此緩病也,亦痼疾也,久久不愈,致脾腎並傷,胃無穀神,則死矣。
5 至虛喘者,水天之氣不相交接也。肺,天也;腎,水也。天體不連地而連水。經云其本在腎,其末在肺,以明水天一氣。若天水違行,則肺腎不交而喘,治不得宜,將離脫矣。當用參、苓、 、術以補肺,辛、味、桂、附以補腎,肺腎相交,則喘平而能臥;若上下不交,晝夜不臥,喘無寧刻,則太陽標本之氣,亦幾乎息矣。蓋太陽以寒為本,以熱為標。寒本,膀胱之水也,氣根於腎;
6 熱標,皮毛之陽也,氣合於肺。此肺腎不交,而太陽標本之氣,將以孤危,前藥所以必需也。若外道之藥,消削於前,其後亦無濟矣。余曾以前方治半月之虛喘,一劑而安,舉家欣喜,即以告餘,問前方可再服否?余曰:姑俟明日。病家曰:何也?余曰:安臥者,肺氣下交,子時一陽初生,腎氣上行,方為交合,恐憊極而腎氣之不升也。至寅時,果死矣。經云:升降息,則氣立孤危;出入廢,則神機化滅。其即肺腎不交,太陽氣絕之喘病為然乎!
URN: ctp:ws74099

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