加味六君子汤
治肺脾虚寒，痰嗽气喘。
人参 白术（炒） 茯苓 半夏（各二钱） 陈皮 甘草（炙） 干姜（各一钱） 细辛（八分） 五味（七分）
水煎服。
参附汤
治元气虚脱，手足逆冷，汗出不止，气短欲绝。
愚按∶此上中下俱脱之症。若中焦脾气脱者，以白术一两代人参，名术附汤；上焦肺气
脱者，以炙黄 一两代人参，名 附汤，但黄 轻浮，必加麦冬三钱，五味一钱以纳之；下焦
肾气脱者，以熟地黄一两代人参。但熟地性滞，非痰所宜，且功缓，非急症所倚，须加茯苓
四钱导之，方为稳当。观仲景茯苓甘草汤、茯苓桂枝白术甘草汤、真武汤三方，皆以茯苓为
君，皆治汗出不止。盖以汗之大泄，必引肾水上泛，非茯苓不能镇之。此以平淡之药，用为
救逆之品，仲景之法，所以神妙也。
黑锡丹
治脾胃虚冷，上实下虚，奔豚，五种水气，中风痰潮危症。
喻嘉言曰∶凡遇阴火逆冲，真阳暴脱，气喘痰鸣之急证，舍此再无他法之可施。予每
用小囊佩带随身，恐遇急症不及取药，且欲吾身元气温养其药，借手效灵，厥功历历可纪。
徐灵胎曰∶镇纳元气，为治喘必备之药，当蓄在平时，非一时所能骤合也。
六味丸（方各见《时方》）
治肾阴虚不能纳气者，加麦冬五钱、五味一钱。
肾气丸（方见《金匮》）
治肾阳虚不能纳气。
全真一气汤（《冯氏锦囊》）
治上焦虚热，下焦虚冷，此方清肃在上，填实在下之法。
熟地（一两） 人参（一二三钱或一两另炖调复） 麦冬 牛膝（各二钱） 冬白术（炒，三钱） 五味（七分） 附
子（一钱，须重用）
水煎服。
枸杞汤（方见《时方》）
治气短。
贞元饮（见《三字经》）
余推景岳制方之意，以气为阳，血为阴。大汗亡血，产后及热病之后，血虚则气无附丽
。孤阳无主，时见喘促，故以此饮济之缓之。其要旨在“济之缓之”四字，今人顺口读过，便致
许多误事。盖阴血枯竭，最喜熟地之濡润以济之，犹恐济之不及济，故加当归以助其济之之
力；呼吸气促，最宜甘草之大甘以缓之，犹恐缓之不能缓，故用至二三钱，以成其缓之之功。
熟地（三五钱至一两） 当归 炙草（各二三钱）
水煎服。
长孙男心典按∶气为夫，血为妻。无妻夫必荡，自然之势也。此方补血为主，使气有归
附，渐渐而平，缓剂也。今人于真阳暴脱、气喘痰涌危症，不知议用附子汤、真武汤及黑锡
丹等药，而以贞元饮投之，则阴霾冲天，痰涎如涌，顷刻死矣。
此方入经，不能入肾，不可不知。
真武汤
治水气咳呕，小便不利，四肢肿，腹痛。
次男元犀按∶以上治喘等方，多主水饮。因仲景云“短气皆属饮”一语，悟出无数方法，药
到病瘳，指不胜屈。方知取法贵上也。
真武为北方水神。以之名汤者，借以镇水也。附子辛热，壮肾之元阳，则水有所主；白
术之温燥建中土，则水有所制；附子得生姜之辛散，于补水中寓散水之意；白术合茯苓之淡
渗，于制水中寓利水之道；尤妙在芍药之苦降，以收真阳之上越。盖芍药为春花之殿，交夏
而枯，借其性味，亟令阳气归根于阴也。
附子汤（方各见《伤寒》）
此方即真武汤，去生姜加人参，其补阳镇阴。分歧只一味与分两略殊。学人读古人书，
必于此处究心，方能受益。
《金匮》云∶气短有微饮，当从小便去之，苓桂甘术汤主之，肾气丸亦主之。
喻嘉言曰∶饮邪阻碍呼吸，故气短。但呼吸几微之介，不可辨。若呼之气短，是心肺之
阳有碍，宜苓桂术甘汤以通其阳，阳气通，则膀胱之气窍利矣；若吸之气短，是肝肾之阴有
碍，宜肾气丸以通其阴，阴通则少阴之关开矣。
按∶气短分及呼吸，其旨微矣。
加味六君子汤
治疗肺脾虚寒，痰多咳嗽气喘。
人参、白术（炒）、茯苓、半夏（各二钱）、陈皮、甘草（炙）、干姜（各一钱）、细辛（八分）、五味子（七分）。
用水煎服。
参附汤
治疗元气虚脱，手足逆冷，汗出不止，气短欲绝。
我按语：这是上、中、下三焦都出现脱证的病症。如果是中焦脾气脱，用一两白术代替人参，名为术附汤；如果是上焦肺气脱，用一两炙黄芪代替人参，名为芪附汤，但黄芪性质轻浮，必须加入三钱麦冬、一钱五味子以收敛之；如果是下焦肾气脱，用一两熟地黄代替人参。但熟地黄性质黏滞，不适合有痰的情况，且药效缓慢，不是急症所依赖的，必须加入四钱茯苓来引导药力，这样才稳妥。观察张仲景的茯苓甘草汤、茯苓桂枝白术甘草汤、真武汤三方，都以茯苓为君药，都治疗汗出不止。因为大汗淋漓，必然导致肾水上泛，非茯苓不能镇压它。这是用平淡的药物作为救逆的药品，张仲景的方法，所以神妙啊。
黑锡丹
治疗脾胃虚冷，上实下虚，奔豚病，五种水气病，中风痰涌等危重病症。
喻嘉言说：凡是遇到阴火逆冲，真阳暴脱，气喘痰鸣的急症，除了此方再无其他方法可施。我每次用小囊佩带在身上，恐怕遇到急症来不及取药，而且想借我身体的元气温养这药，借助我的手发挥灵验的功效，其功劳历历可数。
徐灵胎说：镇纳元气，是治疗气喘必备的药物，应当平时储备，不是一时能突然配齐的。
六味丸（方剂见《时方》）
治疗肾阴虚不能纳气的，加麦冬五钱、五味子一钱。
全真一气汤（出自《冯氏锦囊》）
治疗上焦虚热，下焦虚冷，此方是清肃在上、填实在下的方法。
熟地黄（一两）、人参（一二三钱或一两另炖调服）、麦冬、牛膝（各二钱）、冬白术（炒，三钱）、五味子（七分）、附子（一钱，须重用）。
用水煎服。
贞元饮（见《三字经》注本）
我推究张景岳制方的意思，认为气属阳，血属阴。大汗亡血，产后及热病之后，血虚则气无所依附。孤阳无主，时常出现喘促，所以用此饮来救济并缓和它。其要点在于“济之缓之”四个字，现在的人顺口读过，就导致许多误事。因为阴血枯竭，最喜欢熟地黄的濡润来救济它，还担心救济得不够，所以加入当归以助其救济之力；呼吸气促，最适合甘草的大甘味来缓和它，还担心缓和得不够，所以用到二三钱，以成就其缓和之功。
熟地黄（三五钱至一两）、当归、炙甘草（各二三钱）。
用水煎服。
长孙心典按语：气为夫，血为妻。没有妻子丈夫必然放荡，这是自然的趋势。此方以补血为主，使气有所归附，渐渐平复，是缓剂。现在的人对于真阳暴脱、气喘痰涌的危症，不知道议论使用附子汤、真武汤及黑锡丹等药，而用贞元饮投治，那么阴霾冲天，痰涎如涌，顷刻间就会死亡。
此方入经络，不能入肾，不可不知道。
真武汤
治疗水气引起的咳嗽呕吐，小便不利，四肢浮肿，腹痛。
次男元犀按语：以上治疗气喘等方剂，大多主治水饮。因为张仲景说“短气皆属饮”，由此悟出无数方法，药到病除，数不胜数。才知道取法古人贵在高尚。
真武是北方的水神。用它来命名汤剂，是借以镇压水邪。附子辛热，壮补肾的元阳，则水有所主宰；白术温燥建立中土，则水有所制约；附子得到生姜的辛散，在补水中寓含散水之意；白术合茯苓的淡渗，在制水中寓含利水之道；尤其妙在芍药的苦降，以收摄真阳的上越。因为芍药是春花中的殿军，交夏至枯，借用它的性味，急切地令阳气归根于阴。
附子汤（方剂见《伤寒论》）
此方就是真武汤，去掉生姜加入人参，用来补阳镇阴。分歧只在一味药和分量上略有不同。学人读古人的书，必须在这些地方用心探究，才能受益。
《金匮要略》说：气短伴有轻微的水饮，应当从小便去除，苓桂甘术汤主治，肾气丸也主治。
喻嘉言说：饮邪阻碍呼吸，所以气短。但在呼吸极其细微的界限，难以辨别。如果呼气时气短，是心肺的阳气有阻碍，宜用苓桂术甘汤来通其阳，阳气通畅，则膀胱的气窍就利了；如果吸气时气短，是肝肾的阴气有阻碍，宜用肾气丸来通其阴，阴气通畅则少阴的关隘就开了。
按语：气短分为呼气与吸气，其中的旨意很微妙。
Jiawei Liujunzi Tang (Modified Six Gentlemen Decoction)
Treats deficiency-cold of the Lung and Spleen, with phlegm, cough, and wheezing.
Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), Banxia (Pinelliae Tuber, each 2 qian), Chenpi (Citri Reticulatae Pericarpium), Gancao (Licorice Root, honey-fried), Ganjiang (Zingiberis Rhizoma, each 1 qian), Xixin (Asari Radix et Rhizoma, 8 fen), Wuweizi (Schisandrae Fructus, 7 fen).
Decoct in water and take orally.
Shenfu Tang (Ginseng and Aconite Decoction)
Treats collapse of Yuan Qi (Original Qi), with cold reversal of the hands and feet, incessant sweating, and shortness of breath nearing extinction.
My commentary: This is a syndrome of collapse affecting the Upper, Middle, and Lower Jiao. If it is the Middle Jiao Pi Qi (Spleen Qi) that has collapsed, replace Renshen with 1 liang of Baizhu; this is named Shufu Tang. If it is the Upper Jiao Fei Qi (Lung Qi) that has collapsed, replace Renshen with 1 liang of Zhi Huangqi (Honey-fried Astragali Radix); this is named Qifu Tang. However, Huangqi is light and floating, so one must add 3 qian of Maidong (Ophiopogonis Radix) and 1 qian of Wuweizi to anchor it. If it is the Lower Jiao Shen Qi (Kidney Qi) that has collapsed, replace Renshen with 1 liang of Shudihuang (Rehmanniae Radix Preparata). However, Shudihuang is cloying and sticky, making it unsuitable for cases with phlegm, and its action is slow, not suitable for acute emergencies relying on rapid effect. One must add 4 qian of Fuling to guide the action, which is then steady and appropriate. Observing Zhang Zhongjing’s three formulas—Fuling Gancao Tang (Poria and Licorice Decoction), Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction), and Zhenwu Tang (True Warrior Decoction)—all use Fuling as the Sovereign herb, and all treat incessant sweating. This is because massive sweating inevitably draws Kidney Water upward; only Fuling can suppress it. Using bland herbs as emergency rescue agents demonstrates the divine subtlety of Zhang Zhongjing’s methods.
Heixi Dan (Black Concretion Pill)
Treats deficiency-cold of the Spleen and Stomach, excess above and deficiency below, Ben Tun (Running Piglet sensation), five types of Water Qi disorders, and critical conditions of stroke with phlegm turbulence.
Yu Jiayan stated: Whenever encountering urgent syndromes of Yin Fire counterflow or sudden collapse of True Yang, presenting with wheezing and rattling phlegm, there is no other method besides this formula. I always carry it in a small pouch close to my body, fearing that in an emergency there may not be time to prepare medicine, and wishing to let my body’s Yuan Qi warm and nourish the medicine, utilizing my hand to achieve efficacy; its merits are clearly recordable.
Xu Lingtai stated: Anchoring and grasping Yuan Qi is an essential medicine for treating wheezing; it should be stored in advance, as it cannot be rapidly assembled in a moment.
Liujun Wan (Six-Ingredient Rehmannia Pill) (Formula seen in *Shifang*)
Treats Kidney Yin deficiency failing to grasp Qi. Add Maidong (5 qian) and Wuweizi (1 qian).
Shenqi Wan (Kidney Qi Pill) (Formula seen in *Jingui Yaolue*)
Treats Kidney Yang deficiency failing to grasp Qi.
Quanzhen Yiqi Tang (Complete True One-Energy Decoction) (From *Fengshi Jinnang*)
Treats deficiency-heat in the Upper Jiao and deficiency-cold in the Lower Jiao. This formula employs the method of clearing and purifying above while filling and solidifying below.
Shudihuang (1 liang), Renshen (1–3 qian or 1 liang separately decocted and mixed), Maidong, Niuxi (each 2 qian), Dong Baizhu (stir-fried, 3 qian), Wuweizi (7 fen), Fuzi (1 qian, must be heavily used).
Decoct in water and take orally.
Gouqi Tang (Goji Berry Decoction) (Formula seen in *Shifang*)
Treats shortness of breath.
Zhengyuan Yin (Prime Origin Infusion) (Seen in *Sanszijing* annotations)
I deduce Zhang Jingyue’s intent in formulating this: Qi belongs to Yang, Blood belongs to Yin. After massive sweating causing blood loss, or postpartum, or after febrile diseases, Blood deficiency leads to Qi having no attachment. Solitary Yang lacks a master, occasionally presenting with panting; thus, this infusion is used to relieve and soothe it. The key lies in the four characters "relieve and soothe" (Ji zhi huan zhi). Modern people read through it casually, leading to many errors. When Yin and Blood are exhausted, they most appreciate the moistening nature of Shudihuang to relieve them; yet fearing the relief is insufficient, Danggui (Angelicae Sinensis Radix) is added to assist this relieving power. For rapid breathing, the great sweetness of Gancao is most suitable to soothe it; yet fearing the soothing is inadequate, 2–3 qian are used to accomplish the soothing function.
Shudihuang (3–5 qian to 1 liang), Danggui, Zhi Gancao (honey-fried Licorice Root, each 2–3 qian).
Decoct in water and take orally.
Commentary by Changsun Xin Dian: Qi is the husband, Blood is the wife. Without a wife, the husband will surely wander; this is the natural trend. This formula focuses on nourishing Blood, allowing Qi to have a place to attach, gradually calming down; it is a mild/slow-acting formula. Today, people facing critical conditions of sudden True Yang collapse with wheezing and surging phlegm do not consider using Fuzi Tang, Zhenwu Tang, or Heixi Dan, but instead administer Zhengyuan Yin. In such cases, Yin-Cold rises like smoke, phlegm saliva surges, and death occurs within moments.
This formula enters the meridians but does not enter the Kidneys; this must be known.
Zhenwu Tang (True Warrior Decoction)
Treats Water Qi causing cough and vomiting, difficult urination, edema of the four limbs, and abdominal pain.
Commentary by second son Yuan Xi: The above formulas for treating wheezing mostly target Water-Fluid retention. Because Zhang Zhongjing stated "Shortness of breath all belongs to Fluid," countless methods were derived from this insight. The medicine reaches the disease and heals it, too numerous to mention. One realizes that emulating the ancients requires aiming high.
Zhenwu is the Water Deity of the North. Naming the decoction after him borrows the meaning of suppressing Water. Fuzi is acrid and hot, strengthening the Yuan Yang of the Kidney, so Water has a master; Baizhu’s warm and drying nature establishes the Middle Earth, so Water has control; Fuzi combined with the acrid dispersion of Shengjiang (Fresh Ginger) contains the intention of dispersing Water within tonification; Baizhu combined with the light and penetrating nature of Fuling contains the way of promoting urination within controlling Water; especially wonderful is the bitter descent of Shaoyao (Paeoniae Radix Alba), which gathers the upward flight of True Yang. Shaoyao is the finale of spring flowers, withering when summer arrives; borrowing its nature and flavor, it urgently causes Yang Qi to return to its root in Yin.
Fuzi Tang (Aconite Decoction) (Formulas seen in *Shanghan Lun*)
This formula is exactly Zhenwu Tang, removing Shengjiang and adding Renshen, to tonify Yang and suppress Yin. The divergence lies only in one herb and slight differences in dosage. Students reading ancient texts must investigate these points carefully to benefit.
The *Jingui Yaolue* states: Shortness of breath with slight fluid retention should be eliminated via urination; Linggui Gan Zhu Tang governs it, and Shenqi Wan also governs it.
Yu Jiayan stated: Fluid pathogens obstruct respiration, causing shortness of breath. However, the boundary where breathing becomes extremely subtle is hard to distinguish. If exhalation is short of breath, it indicates an obstruction of Heart-Lung Yang; one should use Linggui Zhu Gan Tang to unblock Yang. Once Yang is unblocked, the Qi apertures of the Bladder become smooth. If inhalation is short of breath, it indicates an obstruction of Liver-Kidney Yin; one should use Shenqi Wan to unblock Yin. Once Yin is unblocked, the gates of Shaoyin open.
Commentary: Distinguishing shortness of breath by exhalation versus inhalation reveals profound principles.