喘急者，气为火所郁，而积谈在肺胃也。膏粱之人，奉养太过，及过爱小儿，皆
能积热于上，而为喘咳，宜以甘寒之剂治之。《脉经》云，肺盛有余，则咳嗽上气，
喘渴心烦，胸满短气，皆冲脉之火行于胸中而作，系在下焦，非属上也。盖杂病不足之
邪，起于有余，病机之邪，自是标本病传。凡饮食劳役，喜怒不节，及水谷之寒热，感
则害人六腑，皆由中气不足，故 胀腹满，咳嗽呕食，宜皆以大甘辛热之剂治之。又
曰∶寸口阴脉实者，肺实也。肺必胀，上气喘逆，咽中塞加呕状，自汗皆肺实之证。右
寸阴脉虚者，肺虚也，必咽干无津，少气不足以息，然实者，肺中邪气实也，虚者，肺
中正气虚也，故华佗云∶盛则为喘，减则为枯，《活人》云∶发喘者，气有余也，非言
肺气盛及有余，乃言肺中之火盛。及火有余也，故泻以苦寒之剂，非泻肺也，泻肺中之
火，实补肺也，《金匮》又曰∶实喘者，气实肺盛，呼吸不利，肺窍壅塞，若寸沉实宜
泻肺，虚喘者，气短肾虚，先觉呼吸少气，两胁胀满，左尺大而虚，此肾虚症，治宜补
肾，勿谓小儿无欲肾实，如禀先天不足者，尤为真虚耳，故实则清理其上，虚则温补其
下，况上病疗下，治法之要领也，然大抵初喘多属外因，宜从标治，或因风痰壅塞者，
必兼壮热咳嗽，鼻塞头疼；因痘疹未出者，必兼惊厥烦燥，身热足冷∶因停滞胀满者，
必兼呕吐恶食，嗳臭肚疼；因惊痫痰热者，必兼抽掣搐搦，面青啼叫；因痰哮大喘者，
必发秋冬暴冷，张口抬肩。如非前症，继诸病后，非子令母虚，即脾肺两困，多从本
治。况有短气少气，似喘非喘，更难与喘同例也。诸喘久而不愈者，不妨先用劫药一二
服即止，既止之后，因痰治痰，因火治火可也。然喘胀二症相因，并皆小便不利，故喘
则必胀，胀则必喘，先喘而后胀者，主于肺，先胀而后喘者，主于脾。《经》曰∶肺
朝百脉，通调水道，下输膀胱∶又曰∶膀胱者，州都之官，津液藏焉，气化则能出矣
是小便之行，由于肺气之降下而输化。若肺受邪而喘，则失降下之令，以致水溢皮肤，
而生肿满，此是喘为本，肿为标，治宜清金降气为主，而行水次之。更脾主肌肉，恶湿
克水，若脾虚不能制水，则水湿妄行，外侵肌肉，内壅溢上，因肺气不得下降而喘乃
生，此是肿为本喘为标，治当买脾行水为主，而清金次之，肺症而用燥脾之药，则金
得燥而喻愈加；脾病而用清金之药，则脾得寒而胀愈甚矣，如无故喘声陡发如锯，身不
热而目窜者；鼻孔、胁肋、心胸俱为开张者；腹硬青筋，口吐涎沫，面无神色而唇曰
者；诸病小痊之后，勿交子午时喘呜者；喘促目急，黑睛出汗，印堂青色者，皆为不
治，其脉滑而手足温者，生；脉涩四肢寒者，死。《经》曰∶喘鸣肩息者，脉实大也
缓则生，急则死，盖喘鸣肩息者，阳症也脉当实大，更实大中而缓，则邪气渐退，故
可得生，若实大中而急，则邪气愈增，病当死矣。
喘急，是因为气被火邪郁结，导致痰浊积聚在肺和胃。饮食精细、生活优渥的人，以及过度溺爱小儿者，都容易在上部积热，从而引发喘咳，适宜用甘寒性质的药剂来治疗。《脉经》说：肺气盛有余，就会出现咳嗽、气逆上冲、喘促口渴、心烦、胸中满闷、呼吸短促等症状，这都是冲脉的火气运行于胸中所致，病根在下焦，而非属于上部病变。一般来说，杂病中的不足之邪，往往起于有余（实证），而病机传变中的邪气，则是从本到标的传变。凡是饮食不节、劳役过度、喜怒情绪失控，以及摄入水谷的寒热不适，一旦感邪就会伤害六腑，这些都是因为中气不足所致，因此出现腹胀、腹满、咳嗽、呕吐食物等症状，适宜全部用大甘辛热的药剂来治疗。又说：寸口脉阴实，说明肺实。肺必定胀满，上气喘逆，咽喉堵塞伴有呕吐状，自汗，这些都是肺实的证候。右寸口脉阴虚，说明肺虚，必定咽喉干燥无津液，气短不足以呼吸。然而，所谓“实”，是指肺中邪气实；所谓“虚”，是指肺中正气虚。所以华佗说：“盛则为喘，减则为枯。”《活人书》说：“发喘者，是气有余。”这并不是说肺气盛及有余，而是说肺中的火盛，以及火有余。因此用苦寒的药剂泻火，并非泻肺，而是泻肺中的火，这实际上是补肺。《金匮要略》又说：“实喘，是气实肺盛，呼吸不利，肺窍壅塞，如果寸脉沉实，适宜泻肺；虚喘，是气短肾虚，先感觉呼吸少气，两胁胀满，左尺脉大而虚，这是肾虚症，治疗适宜补肾。”不要认为小儿没有欲望就不会肾实，如果是禀受先天不足者，更是真正的虚证。所以实证清理其上，虚证温补其下，况且上病治下，是治疗的要领。但大致来说，初起的喘多属外因，应从标治疗。或因风痰壅塞者，必定兼有壮热咳嗽、鼻塞头疼；因痘疹未出者，必定兼有惊厥烦躁、身热足冷；因停滞胀满者，必定兼有呕吐恶食、嗳气臭秽肚疼；因惊痫痰热者，必定兼有抽搐掣动、面色青白啼叫；因痰哮大喘者，必定在秋冬暴冷时发作，张口抬肩。如果不是上述症状，而是在其他疾病之后继发的，不是子令母虚，就是脾肺两困，多从本治疗。况且有短气少气，似喘非喘的情况，更难与喘同例。各种喘症久治不愈的，不妨先用劫药一二服使其停止，既止之后，再根据痰治痰，根据火治火即可。然而喘和胀两个病症相互关联，都伴有小便不利，所以喘则必胀，胀则必喘。先喘而后胀的，病主在肺；先胀而后喘的，病主在脾。《内经》说：“肺朝百脉，通调水道，下输膀胱。”又说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”这说明小便的通利，是由于肺气降下而输布化生。如果肺受邪气而喘，就失去了降下的功能，导致水液溢于皮肤，产生肿满，这是喘为本，肿为标，治疗宜以清金降气为主，而行水利尿为辅。另外脾主肌肉，恶湿克水，如果脾虚不能制水，则水湿妄行，外侵肌肉，内壅溢上，导致肺气不得下降而喘乃生，这是肿为本，喘为标，治疗当以健脾行水为主，而清金为辅。肺症如果用燥脾的药，则金得燥而喘更加厉害；脾病如果用清金的药，则脾得寒而胀更加严重。如果无故喘声突然发出如拉锯声，身体不热而眼球上窜；鼻孔、胁肋、心胸俱为开张者；腹部硬且有青筋暴露，口吐涎沫，面无神色而嘴唇发黑者；诸病稍愈之后，每逢子午时喘鸣者；喘促目急，黑睛出汗，印堂青色者，都属于不治之症。其脉滑而手足温的，可生；脉涩四肢寒的，死。《内经》说：“喘鸣肩息的，脉象实大，缓则生，急则死。”盖喘鸣肩息者，是阳症，脉应当实大，如果在实大中见缓象，则邪气渐退，故可得生；若实大中见急象，则邪气愈增，病当死矣。
Panting and urgency arise when Qi is constrained by Fire, leading to the accumulation of phlegm in the Lung and Stomach. Individuals who consume rich and fine foods, or those who are overly indulgent with children, easily accumulate heat in the upper Jiao, resulting in panting and coughing; such cases should be treated with sweet and cold formulas. The *Mai Jing* (Classic of Pulse Diagnosis) states: "When Lung Qi is excessive, there will be cough, upward rushing of Qi, panting, thirst, vexation, chest fullness, and shortness of breath. These are all caused by the Fire of the Chong Mai (Penetrating Vessel) moving within the chest; the root lies in the Lower Jiao, not the Upper Jiao." Generally, deficiency patterns in miscellaneous diseases often originate from excess conditions, while pathogenic factors in disease transmission follow a pattern from Root to Branch. Any irregularity in diet, overexertion, unregulated emotions, or consumption of food and drink that is too hot or cold can damage the Six Fu Organs if contracted; these are all due to insufficiency of Middle Qi, manifesting as abdominal distension, fullness, cough, and vomiting of food. Such cases should be treated with large doses of sweet, acrid, and hot formulas. It is also stated: "If the Yin pulse at the Cun position is Excess, it indicates Lung Excess. The Lung will necessarily be distended, with upward rushing of Qi, obstruction in the throat accompanied by vomiting sensations, and spontaneous sweating—all signs of Lung Excess. If the Yin pulse at the right Cun position is Deficient, it indicates Lung Deficiency, manifesting as dry throat without fluids, and insufficient Qi for breathing. However, 'Excess' refers to the excess of pathogenic factors in the Lung, while 'Deficiency' refers to the insufficiency of righteous Qi in the Lung." Therefore, Hua Tuo said: "Excess leads to panting, reduction leads to withering." The *Huo Ren Shu* (Book of Vitality) states: "Panting arises from excess Qi." This does not mean Lung Qi is excessive, but rather that Fire within the Lung is excessive. Thus, bitter and cold formulas are used to drain, not to drain the Lung itself, but to drain the Fire within the Lung, which effectively tonifies the Lung. The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) further states: "In real panting (Shi Chuan), Qi is excess and Lung is盛 (prosperous/excessive), with difficult respiration and blocked lung orifices. If the Cun pulse is deep and excess, draining the Lung is appropriate. In false panting (Xu Chuan), Qi is short and Kidney is deficient, initially feeling short of breath, with fullness in both hypochondria. If the left Chi pulse is large and deficient, this is a Kidney Deficiency syndrome, and treatment should tonify the Kidney. Do not assume children have no desires and thus cannot have Kidney Excess; those with congenital insufficiency are truly deficient." Therefore, excess is cleared from above, and deficiency is warmed and tonified from below. Moreover, treating lower disorders for upper symptoms is a key principle of treatment. Generally, initial panting is mostly due to external causes and should be treated according to the Branch. For example, if due to wind-phlegm obstruction, it must be accompanied by high fever, cough, nasal congestion, and headache; if due to unruptured smallpox/rash, it must be accompanied by convulsions, irritability, body heat, and cold feet; if due to stagnation and distension, it must be accompanied by vomiting, aversion to food, belching with foul odor, and abdominal pain; if due to fright-epilepsy and phlegm-heat, it must be accompanied by twitching and spasms, blueish complexion, and crying; if due to phlegmatic asthma with severe panting, it must occur suddenly in winter/autumn cold, with mouth open and shoulders raised. If it is not the aforementioned symptoms, but occurs after other diseases, it is either "daughter causing mother's deficiency" or simultaneous Spleen and Lung exhaustion, and should mostly be treated according to the Root. Furthermore, shortness of breath resembling panting but not being true panting is harder to categorize with panting. For various panting syndromes that persist and do not heal, one may first use astringent/purgative drugs (Jie Yao) for one or two doses to stop them; after stopping, treat according to phlegm or fire respectively. However, panting and distension are interrelated, both involving difficulty in urination; thus, panting leads to distension, and distension leads to panting. Panting preceding distension indicates the Lung as the primary organ; distension preceding panting indicates the Spleen as the primary organ. The *Jing* (Classic) states: "The Lung governs all vessels, regulates water passages, and transmits downward to the Bladder." It also states: "The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted." This indicates that urination depends on the descending function of Lung Qi. If the Lung is affected by pathogens and pants, it loses its descending command, causing water to overflow into the skin and generate edema/fullness. Here, panting is the Root, and edema is the Branch; treatment should focus primarily on clearing Metal (Lung) and descending Qi, with promoting urination secondary. Additionally, the Spleen governs muscles and dislikes dampness controlling water. If Spleen Qi is deficient and cannot control water, water-dampness acts recklessly, invading muscles externally and overflowing internally upwards, preventing Lung Qi from descending and causing panting. Here, edema is the Root, and panting is the Branch; treatment should focus primarily on strengthening the Spleen and promoting water movement, with clearing Metal secondary. Using drying-Spleen herbs for Lung syndromes will make the Metal drier and panting worse; using cooling-Metal herbs for Spleen syndromes will make the Spleen colder and distension more severe. If panting sounds suddenly erupt like a saw without fever, with eyes rolling up; nostrils, hypochondria, and chest opening wide; abdomen hard with visible green veins, spitting saliva, lack of facial luster, and black lips; panting/wheezing occurring specifically during Zi and Wu hours after other illnesses have slightly improved; panting with urgent eyes, sweat on the black part of the eye, and bluish color at the Yintang point—these are all untreatable cases. If the pulse is slippery and hands/feet are warm, survival is possible; if the pulse is choppy and limbs are cold, death ensues. The *Jing* states: "For panting with wheezing and shoulder lifting, the pulse should be Excess and Large. Slow indicates survival, rapid indicates death." Since panting with wheezing and shoulder lifting is a Yang syndrome, the pulse should be Excess and Large. If Excess and Large but slow, pathogenic factors recede, so survival is possible. If Excess and Large but rapid, pathogenic factors increase, and death is certain.