无寒热他病。饮食如常。忽然大喘。有行动即喘。静卧稍减者。有行动稍可。不能正卧者。此二大病也。皆寒
湿冷痰。注入命门之故。前证由于冬月伏寒。或多年久湿。自膝胫上冲少腹。过膀胱而入肺。亦有外循太阳经上行
脊背而入肺者。必先见咳嗽。邪气自下上逆。元气浮动。不能归窟。故动甚也。后证由于冷痰发于阳明。循冲任而
下溜。必先见两乳间。隐隐不舒之兆。或发于脊背。循腰肾而下溜。必先有两腰内隐隐 胀之兆。冷痰有形。自上
下扑。元气遏抑。正卧则膻中气愈不续。故卧甚也。治法。前证宜仿寒湿香港脚疝气奔豚法。逐邪下出。兼咳者。兼
仿小青龙法。轻剂饭后。微开其上。后证宜生鹿角紫石英肉桂泽泻直捣命门。佐生附子石菖蒲以温阳明冲任。狗脊
独活刀豆以温腰脊。古方如赤丸大建中汤。大乌头煎黑锡丹。破阴丹。半硫丸。三石寒食散。皆良方也。待痰开喘
定。再视转证。而随调之。曾诊谢妇患前证。其脉两寸短缩。关后洪弦。隐指动摇。如战栗状。以法治之。畏药峻
不肯服。逾月而逝。时在于春。又诊杨某患后症。其脉左关陷而不起。两尺厥厥动摇。断而不续。以法治之。三剂
喘定。脉起且续矣。却嫌太盛。戒曰。宜静养。而以敛阳安阴之药调之。勿懈也。奔走酒食如故。又止药半月。喘
复发。自服麻杏石甘汤而逝。时在于秋。杨自命精医者也。予为言病势甚险。根甚深。机甚微。将来邪气出路。或
在二便。或在于肺。幸发于秋。尚可从容调治。若发于春。神丹不及也。杨颇谓然。且HT 示背有痰瘤。大如覆
碗数十年。今忽消。以征冷痰下溜之妙识也。而竟中途易辙。天命乎。人事乎。又程某因冶游宵征。忽于夜半后。
冷气自脐上冲。心慌气浮。脑顶高摇。自汗不止。势如欲脱。以生附子肉桂子胡芦巴桑螵蛸。加山萸牛膝一剂定。
连十剂已。又杨某因先患热病。重用茯苓泽泻而愈。遂畏温药如鸩砒。一日胸痹气窒。上下不续呼吸抬肩。势欲作
喘。予曰。非沉香肉桂不可。勉强服之。一剂定。四五剂已。此非自病。但因药误。故挽回较易也。
又按暴喘与前篇水气凌心证。若势急药力不及施。势重药力不能制。须灸膻中关元。并灸肩井缺盆大椎极效。
关元在脐下三寸。以名中食三指横度取之。又尝治风湿入络。气痹似喘。分上下前后灸法。厥功甚伟。附录于此。
凡脊背气下引。不能升提甚至尾间两臀坠胀者。灸肓门胃仓。兼灸章门。肓门当腰外两旁各三寸所季肋骨上缝中。
胃仓又在其上一肋骨缝中也。胸前气下陷。不能升提。甚至脐腹坠胀者。灸关元及脐旁肓俞及章门。或兼灸乳下两
旁食窦。胸背绕肩上气壅塞。呼吸不舒者。灸肩井大椎缺盆。亦或兼灸食窦及膈俞也。若鼓胀作喘者。灸上诸穴外。
并灸水分天枢水道。及挟尻上两旁也。每灸诸穴后。皆兼灸肩井各二三壮。以防火气上冲。
没有寒热等外感症状，饮食正常。突然发生剧烈喘息，活动时喘息加重，静卧时稍减轻的，属于第一种大病；活动时尚可忍受，但不能平躺仰卧的，属于第二种大病。这两种病证，都是由于寒湿冷痰注入命门所致。
前一种病证（动则喘甚），是由于冬季潜伏的寒邪，或多年久留的湿气，从膝胫向上冲至少腹，经过膀胱而入肺；也有沿太阳经上行至脊背而入肺的。必然先出现咳嗽，邪气自下向上逆乱，元气浮动，不能归位潜藏，所以活动时喘息加剧。后一种病证（卧则喘甚），是由于冷痰发于阳明经，沿冲任二脉向下流注。必然先在两乳之间出现隐隐不适的先兆，或者发于脊背，沿腰肾向下流注，必然先在两腰内部出现隐隐胀满的先兆。冷痰是有形之邪，自上向下扑击，遏制压抑元气，平卧时膻中部位的气机更加不连贯，所以平卧时喘息加剧。
治疗方法：前一种病证宜仿照治疗寒湿脚气、疝气、奔豚的方法，引导邪气从下排出。兼有咳嗽的，兼仿小青龙汤法，用轻剂在饭后服用，微微宣开上焦肺气。后一种病证宜用生鹿角、紫石英、肉桂、泽泻直捣命门，佐以生附子、石菖蒲来温通阳明和冲任二脉，狗脊、独活、刀豆来温补腰脊。古方如赤丸、大建中汤、大乌头煎、黑锡丹、破阴丹、半硫丸、三石寒食散，都是良方。待痰浊开通、喘息平息后，再观察病情转化，随之调理。
我曾诊治谢姓妇人患前一种病证，其脉象两寸短缩，关部之后洪大弦急，隐指动摇，如战栗状。按法治之，但她畏惧药性峻烈不肯服用，一个月后去世，当时是春季。又曾诊治杨姓患者患后一种病证，其脉象左关部陷伏不起，两尺部厥厥动摇，断绝而不连续。按法治之，服三剂药后喘息平息，脉象起且连续了。但脉象却嫌过于盛大，我告诫说：“宜静养，并用收敛阳气、安定阴液的药物调理，不要松懈。”但他奔走饮酒进食依旧，停药半个月后，喘息复发，自行服用麻杏石甘汤后去世，当时是秋季。杨某自认为精通医术。我对他说：病势非常危险，病根深固，病机微妙，将来邪气排出的途径，或在大小便，或在肺。幸好发作于秋季，还可以从容调治。如果发作于春季，神丹妙药也来不及救治了。杨某颇为赞同，并且展示背部有一个像倒扣碗大的痰瘤已有数十年，现在忽然消失，以此验证冷痰下流的精妙认识。然而竟中途改变治疗方向，这是天命呢？还是人事呢？
又有一位程姓患者，因冶游夜行，忽然在半夜后，冷气从脐上冲，心慌气浮，头顶高摇，自汗不止，势态如欲脱阳。我用生附子、肉桂、胡芦巴、桑螵蛸，加山萸肉、牛膝，一剂即定，连服十剂痊愈。又有一位杨姓患者，先前患热病，重用茯苓、泽泻而愈，于是畏惧温药如同毒药砒霜一样。一日突发胸痹气窒，上下气机不续，呼吸抬肩，势欲作喘。我说：“非沉香、肉桂不可。”勉强服用，一剂即定，四五剂痊愈。这不是自身疾病，而是因为误药所致，所以挽回比较容易。
又按语：暴喘与前篇所述的水气凌心证，如果势急药力不及施展，势重药力不能控制，须灸膻中、关元穴，并灸肩井、缺盆、大椎穴，极为有效。关元穴在脐下三寸，用中指、食指、无名指三指横度取之。我又曾治疗风湿入络，气痹似喘的情况，分上下前后施灸，功效很大。附录于此。凡是脊背气下引，不能升提，甚至尾闾及两臀坠胀的，灸肓门、胃仓穴，兼灸章门穴。肓门穴在腰部外侧两旁各三寸左右，季肋骨上的缝隙中。胃仓穴又在上一肋骨缝中。胸前气下陷，不能升提，甚至脐腹坠胀的，灸关元及脐旁肓俞穴及章门穴，或兼灸乳下两旁食窦穴。胸背绕肩上气壅塞，呼吸不舒的，灸肩井、大椎、缺盆穴，也或兼灸食窦及膈俞穴。若鼓胀作喘的，除灸上述穴位外，并灸水分、天枢、水道穴，以及挟尻上两旁穴位。每灸诸穴后，皆兼灸肩井穴各二三壮，以防火气上冲。
Without chills or fever, and other external diseases. Diet remains normal. Suddenly severe panting occurs. Panting worsens with movement and slightly decreases during quiet lying down; this is one of the two major diseases. Movement is slightly tolerable, but cannot lie flat on the back; this is the second major disease. Both are caused by cold-dampness and cold-phlegm injecting into the Mingmen (Gate of Life). The former condition results from latent cold in winter or long-standing dampness rising from the knees and shins to the lower abdomen, passing through the Bladder channel to enter the Lungs. There are also cases where it follows the Taiyang (Greater Yang) channel upward along the spine and back to enter the Lungs. Coughing must appear first. Pathogenic qi reverses from below upwards, causing Yuan Qi (Original Qi) to float and fail to return to its nest, hence worsening with movement. The latter condition results from cold-phlegm originating in the Yangming (Yang Brightness) channel, flowing downward along the Chong (Penetrating) and Ren (Conception) vessels. A sign of hidden discomfort between the two breasts must appear first, or it originates in the spine/back, flowing downward along the waist and Kidneys, with a sign of hidden distension inside both waists appearing first. Cold-phlegm is tangible pathogen, attacking from above downwards, suppressing Yuan Qi. Lying flat causes Qi in the Shanzhong (Chest Center) to become even more discontinuous, hence worsening when lying down. Treatment method: For the former condition, imitate the methods for cold-damp Hongjiao (Gouty Arthritis), hernia, and Bentun (Rushing Pig) to drive pathogens out downward. If accompanied by cough, additionally imitate Xiao Qinglong Tang (Minor Blue Dragon Decoction), using a mild dose after meals to slightly open the upper Jiao. For the latter condition, use raw Lujiaojiao (Deer Antler Glue), Zishiyingshi (Hematite), Rougui (Cinnamon Bark), and Zexie (Alisma) to strike directly at Mingmen. Assist with raw Fuzi (Aconite Lateral Root) and Shichangpu (Acorus Rhizome) to warm Yangming and the Chong and Ren vessels. Use Gouji (Cibotium Rhizome), Duhuo (Angelica Pubescens Root), and Daodou (Dolichos Bean Seed) to warm the waist and spine. Ancient formulas such as Chi Wan (Red Pill), Da Jianzhong Tang (Major Construct the Middle Decoction), Da Wutou Jian (Major Aconite Decoction), Heixi Dan (Black Tin Pill), Poyin Dan (Break Yin Pill), Banshu Wan (Half-Sulfur Pill), and Sanshi Hanshi San (Three Stones Cold Food Powder) are all excellent prescriptions. Once phlegm clears and panting settles, observe the transformed syndrome and adjust accordingly.
I once treated Mrs. Xie suffering from the former condition. Her pulse was short and contracted in both Cun (Inch) positions, and surging and wiry behind the Guan (Bar) position, trembling under light pressure like shivering. Treated according to the method, but she feared the harshness of the medicine and refused to take it. She passed away after a month. It was spring. I also treated Patient Yang suffering from the latter condition. His pulse was sunken and unrising in the left Guan position, and trembled violently in both Chi (Cubit) positions, intermittent and discontinuous. Treated according to the method. After three doses, panting settled, and the pulse rose and became continuous. However, the pulse seemed too vigorous. I warned him: "Rest quietly, and regulate with herbs that astringe Yang and calm Yin. Do not relax." But he continued running around, drinking alcohol, and eating as before. Stopping medication for half a month, the panting recurred. He took Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) on his own and died. It was autumn. Yang considered himself an expert in medicine. I told him: "The disease trend is very dangerous, the root is deep, and the mechanism is subtle. The future exit path for pathogenic qi may be in the bowel movements or urine, or in the Lungs. Fortunately, it occurred in autumn, allowing time for calm regulation. If it had occurred in spring, even divine pills would not suffice." Yang agreed quite well, and showed that a phlegm tumor on his back, large as an inverted bowl, had existed for decades but suddenly disappeared now, verifying the efficacy of my recognition of cold-phlegm flowing downward. Yet he changed course midway. Is this destiny? Or human action?
Another case: Cheng suffered from nocturnal wandering and night travel. Suddenly after midnight, cold qi rushed up from the navel, heart palpitations and floating qi, high shaking of the crown, incessant spontaneous sweating, a state resembling collapse. Using raw Fuzi (Aconite Lateral Root), Rougui (Cinnamon Bark), Hulusba (Cibotium Barometz Spore), Sangpiaoxiao (Mantis Egg Case), added with Shanzhuyu (Cornus Fruit) and Niuxi (Achyranthes Root), one dose stabilized it. Ten consecutive doses cured it. Another case: Yang suffered from a febrile disease previously, cured by heavy use of Fuling (Poria) and Zexie (Alisma). Consequently, he feared warming herbs as if they were poison arsenic. One day, sudden chest bi (obstruction) and qi stagnation occurred, upper and lower qi failing to connect, breathing requiring shoulder lifting, trending toward panting. I said: "Only Chenxiang (Aquilaria Wood) and Rougui (Cinnamon Bark) will do." Reluctantly taken, one dose stabilized it. Four to five doses cured it. This was not self-inflicted illness but due to medicinal error, thus easier to reverse.
Further note: Sudden panting and the previous chapter's Water Qi Overwhelming Heart syndrome, if the trend is urgent and drug power insufficient to apply, or the severity is great and drug power cannot control, moxibustion on Shanzhong (CV17) and Guanyuan (CV4) is required, along with moxibustion on Jianjing (GB21), Quepen (ST12), and Dazhui (GV14), which is extremely effective. Guanyuan is three cun below the umbilicus, measured by the width of the middle, index, and ring fingers. I have also treated wind-damp entering collaterals, causing Qi Bi resembling panting, applying moxibustion separately to upper/lower and front/back areas, achieving great merit. Recorded here for reference. Whenever back Qi pulls downward, unable to rise, even to the point of heaviness and distension in the Weijian (tailbone) and buttocks, moxa Mingsmen (BL52) and Weicang (BL49), plus Zhangmen (LR13). Mingsmen is located about three cun lateral to the waist, in the seam of the floating ribs. Weicang is in the seam of the rib above it. When chest Qi sinks, unable to rise, even to the point of heaviness and distension in the umbilical-abdomen, moxa Guanyuan (CV4), Huangshu (CV15) beside the umbilicus, and Zhangmen (LR13), or additionally ShiDou (ST24) beside the nipples. When chest-back Qi wraps over the shoulder, causing congestion and uncomfortable breathing, moxa Jianjing (GB21), Dazhui (GV14), and Quepen (ST12), possibly adding ShiDou (ST24) and GeShu (BL17). If drum-like distension causes panting, besides the above acupoints, also moxa Shuifen (CV9), Tianshu (ST25), and Shuidao (ST28), as well as the sides above the sacrum. After moxa-ing various points, always add 2-3 moxa cones to Jianjing (GB21) each side to prevent Fire Qi from rushing upward.