论
《内经》曰∶诸逆冲上，皆属于火。又曰∶夫起居如故而息有音者，此肺之络脉逆也。河间曰∶火气甚为夏热，衰
为冬寒，故病寒则气衰而息微，病热则气盛而息粗。又寒水为阴，主乎迟缓，热火为阳，主乎急数，是以寒则息迟气微，
热则息数气粗而为喘也。大抵哮以声响名，喘以气息言。夫喘促喉中如水鸡声者，谓之哮；气促而连属不能以息者，谓
之喘。虽然未有不由痰火内郁、风寒外束而致之者欤。外有阴虚发喘，气从脐下起，直冲清道而上者。又有气虚发喘，
而短气不能以接续者。是故知喘之为证，有实有虚，治法天渊悬隔者也。若夫损不足而益有余者，医杀之耳，学人不可
不详辨焉。
脉法
喘急，脉滑而浮者生，涩而数者死。
脉宜浮迟，不宜急数。
脉数有热，喘咳吐血上气，不得卧者死。
上气面浮肿肩息，脉浮大不治，又加利尤甚。
上气躁而喘者为肺胀，欲作风水，发汗则愈。一云∶咳而上气肺胀，其脉沉，心下有水气也。（《要略》《千金》、《外
台》沉作浮。）
寸口伏，胸中有逆气。尺寸俱沉、关上无有者，苦心下喘。
方法
丹溪曰∶喘急者，气为火所郁而稠痰在肺胃也。有痰者，有火炎者，有阴虚自小腹下火起而上逆者，有气虚而致气
短而喘者。
哮专主于痰，宜用吐法。亦有虚而不可吐者，谨之。
治哮必使薄滋味，不可纯用寒凉药，必兼散表。
戴氏曰∶痰者，凡喘便有痰声。火炎者，乍进乍退，得食则减，食已则喘。大概胃中有实火，膈上有稠痰，得食坠
下其痰，喘则暂止，稍久食已入胃，反助其火，痰再升上，喘反大作。俗不知此，作胃虚，治以燥热之药，以火济火也。
昔叶都督患此证，诸医作胃虚治之不愈，后以导水丸利五、六次而安。气短喘急者，呼吸急促而无痰声。又有胃虚喘者，
抬肩拮肚，喘而不休者是也。
痰者，降痰化气为主。火炎者，降心火，清肺金。
阴虚痰喘者，补阴降火，四物汤加枳壳、半夏。一云∶阴虚气喘，四物汤加陈皮、甘草些少以降气补阴。白芍药须
以酒浸，日干，忌火。
气虚发喘，以参、 补之而愈。
凡人喘未发时，以扶正气为主；已发，以攻邪为主。
喘急甚者，不可用苦寒药，火盛故也，宜温劫之。劫药用椒目五、七钱，研为极细末，生姜汤调服。喘止之后，因
痰治痰，因火治火。
千缗汤 治痰喘不得卧，人扶而坐数日，一服而安。（方见痰门。）
一方 用导痰汤合千缗汤服。
一方 用莱菔子二两蒸熟，皂角五钱烧存性，栝蒌仁、海粉、南星（用白矾一钱半，研细入水，浸一宿，曝干，
各一两，为末，炼蜜为丸，噙化。一方无南星、栝蒌、海粉。）
一方 治喘而嗽，用南星、栝蒌、半夏、香附、橘红、莱菔子、青黛、皂角为末，神曲糊丸，姜汤送下。（一方
有杏仁。）
喘用阿胶，须分虚实。若久病发喘，必是肺虚，故用阿胶、人参、五味子之类补之。若新病肺实而发喘者，宜桑白
皮、葶苈子、麻黄、杏仁之类泻之。（东垣曰∶久嗽郁热在肺，不用人参；新病未成郁热者，用人参。未知孰是。）
气实人，因服黄 过多而喘者，宜服三拗汤以泻气。
三拗汤 治肺感风寒，喘急不已。（方见咳嗽门。）
（以上丹溪方法凡十四条）
葶苈大枣泻肺汤（河间） 治肺壅胀，胸膈满闷，上气喘急，身体面目浮肿等证。
葶苈子（不拘多少，炒黄为末，炼蜜丸如弹子大）
上以水三盏，大枣十枚，煎至二盏，去枣，入葶苈一丸，再煎至一盏，温服之。
葶苈散（济生） 治过食煎 ，或饮酒过度，致肺壅喘不得卧，及肺痈，咽燥不渴，浊唾腥臭。
甜葶苈子（炒） 桔梗（去芦） 栝蒌子 升麻 薏苡仁 桑白皮（蜜炙） 葛根（各八分） 甘草（四分）
上细切，作一服，加生姜五片，水一盏半，煎至一盏，温服。
泻白散 治大人小儿，风寒伤肺，喘急咳嗽。
桑白皮（一钱） 地骨皮（一钱） 生甘草（五分）
上细切，作一服，加姜，水煎服。
一方，加防风、荆芥各七分半。又方，加麻黄、杏仁各五分，其效尤捷。
（祖传方）
治远年喘急。
桑木内蠹虫粪（炒，一升） 莱菔子（炒，半升） 杏仁（不去皮尖，炒，半升） 甘草（生，二两）
共为极细末，汤浸蒸饼为丸，如梧桐子大，每服五、七十丸，淡姜汤送下。
又方 治哮喘，用苎麻根和砂糖烂煮，时时嚼咽下，永绝病根，神效。
又方 用猫儿头骨烧灰，酒调二、三钱，一服便止。
又方 用郭公 刺根煎服，即止而不发。
（医案）
东阳一羽士，年五十余，素有喘病，九月间得发热恶寒证，喘甚，脉洪盛而似实。一医作伤寒治，而用小柴胡汤加
枳壳、陈皮等药，六日后欲行大承气。一医曰∶不可，当作伤食治，宜用枳实导滞丸。争不决，召予视之。二医皆曰∶
脉实气盛，当泻。予为诊后，晓之曰∶此火盛之脉，非真实也。观其气短不足以息，当作虚治。乃用补中益气汤加麦门
冬、五味子，入附子三分，煎服。二帖脉收敛，四帖而病轻减，六帖病痊安。
论
《黄帝内经》说：凡是气逆冲上的病症，都属于火邪。又说：起居如常但呼吸有声音的，这是肺的络脉之气上逆所致。刘河间说：火气旺盛表现为夏季的热，衰弱表现为冬季的寒，所以患寒病则气衰而呼吸微弱，患热病则气盛而呼吸粗重。另外，寒水属阴，主迟缓；热火属阳，主急数，因此寒证则呼吸慢、气息微弱，热证则呼吸快、气息粗重而导致喘息。大致来说，哮以声响命名，喘以气息状态描述。如果气喘急促且喉中有如水鸡叫声的，称为哮；如果气息急促连续不断、无法顺畅呼吸的，称为喘。虽然如此，但没有不是由于痰火内郁、风寒外束所导致的吧。此外还有阴虚引起的喘息，气从脐下发起，直冲清道而上行。又有气虚引起的喘息，表现为短气且不能接续。因此知道喘这个病症，有实证也有虚证，治疗方法如同天壤之别。如果损伤不足的正气而增加有余的邪气，那就是医生害死了病人，学习者不可不详细辨别。
脉法
喘息急促，脉象滑而浮的预后良好（生），涩而数的预后不良（死）。
脉象宜浮迟，不宜急数。
脉数且有热，伴有喘息咳嗽、吐血、气逆上冲、不能平卧的，预后不良（死）。
气逆上冲、面部浮肿、抬肩呼吸（肩息），脉象浮大者难治，如果再兼见腹泻则更严重。
气逆躁动而喘的是肺胀，想要发展为风水病，发汗治疗即可痊愈。另一种说法是：咳嗽伴气逆、肺胀，脉象沉，说明心下有停饮。（《金匮要略》《千金方》《外台秘要》中“沉”作“浮”解。）
寸口脉伏，说明胸中有逆气。尺寸部脉皆沉、关部无脉的，为心中苦痛且喘息。
方法
朱丹溪说：喘息急促，是因为气被火邪郁遏，且肺胃中有稠痰。有的有痰，有的有火炎，有的阴虚导致小腹下火起而上逆，有的气虚导致气短而喘。
哮症专门主治于痰，适宜用吐法。也有虚证不可用吐法的，需谨慎。
治疗哮症必须饮食清淡，不可纯用寒凉药物，必须兼用发散表邪的方法。
戴氏说：痰症，凡是喘息都有痰声。火炎症，症状时轻时重，进食后减轻，吃完后又喘。大概是胃中有实火，膈上有稠痰，进食后坠下其痰，喘息暂时停止，稍久食物入胃，反而助长火势，痰再次升上，喘息反而加重。世俗之人不懂此理，误认为是胃虚，用燥热药物治疗，是以火救火。过去叶都督患此症，众医按胃虚治疗未愈，后来用导水丸利大小便五六次才安定。气短喘息急促的，呼吸急促但没有痰声。又有胃虚引起的喘息，表现为抬肩缩腹，喘息不止。
痰症，以降痰化气为主。火炎症，降心火，清肺金。
阴虚痰喘者，补阴降火，用四物汤加枳壳、半夏。另一种说法：阴虚气喘，四物汤加陈皮、甘草少许以降气补阴。白芍药须用酒浸，晒干，忌用火炒。
气虚引起的喘息，用人参、黄芪等补益而痊愈。
凡人在喘息未发作时，以扶助正气为主；已发作时，以攻逐邪气为主。
喘息极严重的，不可用苦寒药，因为火盛，适宜用温性劫药。劫药用椒目五至七钱，研为极细末，生姜汤调服。喘息停止之后，因痰治痰，因火治火。
千缗汤 治疗痰喘不能平卧，让人扶着坐几天，服用一次即安。（方剂见痰门。）
一方 用导痰汤合千缗汤服用。
一方 用莱菔子二两蒸熟，皂角五钱烧存性，栝蒌仁、海粉、南星（用白矾一钱半，研细入水，浸泡一夜，晒干，各一两，研为末，炼蜜为丸，含化。另一方无南星、栝蒌、海粉。）
一方 治疗喘息兼咳嗽，用南星、栝蒌、半夏、香附、橘红、莱菔子、青黛、皂角为末，神曲糊丸，姜汤送下。（另一方有杏仁。）
喘息用阿胶，须分辨虚实。如果是久病发喘，必定是肺虚，所以用阿胶、人参、五味子之类补益。如果是新病肺实而发喘的，适宜用桑白皮、葶苈子、麻黄、杏仁之类泻之。（李东垣说：久嗽郁热在肺，不用人参；新病未成郁热的，用人参。不知谁对。）
气实之人，因服用黄芪过多而喘的，适宜服用三拗汤以泻气。
三拗汤 治疗肺感风寒，喘息不止。（方剂见咳嗽门。）
（以上丹溪方法共十四条）
葶苈大枣泻肺汤（河间） 治疗肺壅胀，胸膈满闷，上气喘急，身体面目浮肿等证。
葶苈子（不拘多少，炒黄为末，炼蜜丸如弹子大）
以上用水三盏，大枣十枚，煎至二盏，去枣，入葶苈丸一丸，再煎至一盏，温服。
葶苈散（济生） 治疗过食煎炸油腻食物，或饮酒过度，导致肺壅喘不得卧，以及肺痈，咽燥不渴，浊唾腥臭。
甜葶苈子（炒） 桔梗（去芦） 栝蒌子 升麻 薏苡仁 桑白皮（蜜炙） 葛根（各八分） 甘草（四分）
以上细切，作一服，加生姜五片，水一盏半，煎至一盏，温服。
泻白散 治疗大人小儿，风寒伤肺，喘急咳嗽。
桑白皮（一钱） 地骨皮（一钱） 生甘草（五分）
以上细切，作一服，加姜，水煎服。
一方，加防风、荆芥各七分半。又方，加麻黄、杏仁各五分，其效尤捷。
（祖传方）
治疗多年喘息急促。
桑木内蛀虫粪（炒，一升） 莱菔子（炒，半升） 杏仁（不去皮尖，炒，半升） 甘草（生，二两）
共为极细末，汤浸蒸饼为丸，如梧桐子大，每服五、七十丸，淡姜汤送下。
又方 治疗哮喘，用苎麻根和砂糖烂煮，时时嚼咽下，永绝病根，神效。
又方 用猫儿头骨烧灰，酒调二、三钱，一服便止。
又方 用郭公树刺根煎服，即止而不发。
（医案）
东阳一位道士，五十多岁，素有喘病，九月间出现发热恶寒证，喘息严重，脉象洪盛而似实证。一位医生当作伤寒治疗，用小柴胡汤加枳壳、陈皮等药，六日后欲用大承气汤。另一位医生说：不可以，应当当作伤食治疗，适宜用枳实导滞丸。争论不决，召我诊治。两位医生都说：脉实气盛，应当泻下。我为其诊脉后，告诉他们：这是火盛的脉象，并非真实实证。观察他气短不足以息，应当当作虚证治疗。于是用补中益气汤加麦门冬、五味子，加入附子三分，煎服。服两帖后脉象收敛，四帖后病情减轻，六帖后病愈安康。
Discussion
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All rebellious qi rushing upward belongs to Fire." It also says: "When daily activities remain normal but breathing produces sound, this is due to the rebellion of the collateral vessels of the Lung." Liu Wansu stated: "Excessive Fire manifests as summer heat, while deficient Fire manifests as winter cold. Therefore, in Cold diseases, qi is deficient and respiration is faint; in Heat diseases, qi is abundant and respiration is coarse." Furthermore, Cold Water belongs to Yin and governs slowness and retardation, while Hot Fire belongs to Yang and governs urgency and rapidity. Thus, Cold results in slow respiration and faint qi, while Heat results in rapid respiration, coarse qi, and panting. Generally speaking, *Xiao* (Wheezing with a whistling sound) is named for its sound, while *Chuan* (Panting/Asthma) is described by its breath state. If panting is urgent with a sound like a water frog in the throat, it is called *Xiao*; if breath is urgent, continuous, and unable to be sustained smoothly, it is called *Chuan*. Nevertheless, are there not cases caused by internal stagnation of Phlegm-Fire and external constraint by Wind-Cold? Additionally, there is panting caused by Yin deficiency, where qi rises from below the navel straight up the clear pathways. There is also panting caused by Qi deficiency, characterized by shortness of breath that cannot be connected. Thus, knowing that the syndrome of *Chuan* has both Excess and Deficiency types, their treatment methods are worlds apart. To damage the insufficient Zheng Qi (Upright Qi) and benefit the excessive pathogenic factors is merely killing the patient through medical error; students must distinguish these carefully.
Pulse Diagnosis
In urgent panting, a slippery and floating pulse indicates survival, while a choppy and rapid pulse indicates death.
A pulse should be floating and slow, not urgent and rapid.
A rapid pulse with Heat, accompanied by panting, coughing, hemoptysis, rebellious Qi, and inability to lie flat, indicates death.
Rebellious Qi with facial edema and shoulder-assisted breathing (Shanxi), with a floating and large pulse, is difficult to treat; if accompanied by diarrhea, it is even more severe.
Rebellious Qi with restlessness and panting indicates Lung Distension (Fei Zhang), which may develop into Wind-Water (Fengshui); sweating therapy will lead to recovery. Another view states: Cough with rebellious Qi and Lung Distension, with a deep pulse, indicates fluid retention under the heart. (The *Jin Gui Yao Lue*, *Qian Jin Fang*, and *Wai Tai Mi Yao* interpret 'deep' as 'floating'.)
A hidden pulse at the Cun position indicates rebellious Qi in the chest. A deep pulse at both Cun and Chi positions with no pulse at the Guan position indicates heart pain and panting.
Methods
Zhu Danxi said: Urgent panting occurs when Qi is constrained by Fire and thick Phlegm resides in the Lung and Stomach. Some cases involve Phlegm, some involve blazing Fire, some involve Yin deficiency causing Fire to rise from the lower abdomen, and some involve Qi deficiency leading to shortness of breath and panting.
*Xiao* (Wheezing) is primarily treated by addressing Phlegm, using emetic therapy. However, in deficiency cases where emesis is contraindicated, caution is required.
Treating *Xiao* requires bland diet and avoiding purely cold-natured herbs; dispersing exterior pathogens must be combined.
Dai Shi said: In Phlegm syndromes, there is always a phlegm sound during panting. In Fire-blazing syndromes, symptoms fluctuate; they improve after eating but worsen after digestion. This is generally because there is Excess Fire in the Stomach and thick Phlegm above the diaphragm. Eating causes the Phlegm to settle temporarily, stopping the panting, but once food enters the Stomach, it fuels the Fire, causing Phlegm to rise again and worsening the panting. Laypeople do not understand this and mistakenly treat it as Stomach Deficiency using drying-hot medicines, which is adding fire to fire. Previously, General Ye suffered from this condition. Physicians treated it as Stomach Deficiency without success. Later, he was stabilized after using Dao Shui Wan (Water-Guiding Pill) to promote urination and defecation five or six times. Shortness of breath with urgent panting involves rapid breathing without phlegm sounds. There is also panting due to Stomach Deficiency, characterized by lifting the shoulders and retracting the abdomen, with unceasing panting.
For Phlegm syndromes, the main method is to descend Phlegm and transform Qi. For Fire-blazing syndromes, descend Heart Fire and clear Lung Metal.
For Yin-deficient Phlegm-panting, tonify Yin and descend Fire using Si Wu Tang (Four Substance Decoction) plus Zhi Ke (Bitter Orange Fruit) and Ban Xia (Pinellia Tuber). Another view: For Yin-deficient asthma, Si Wu Tang plus Chen Pi (Tangerine Peel) and Gan Cao (Licorice Root) in small amounts to descend Qi and tonify Yin. Bai Shao Yao (White Peony Root) must be soaked in wine and sun-dried; avoid frying over fire.
For panting caused by Qi deficiency, recovery is achieved by tonifying with Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root).
When panting has not yet erupted, the primary approach is to support Zheng Qi (Upright Qi); when it has erupted, the primary approach is to attack the pathogen.
In severe panting, bitter-cold medicines should not be used because Fire is abundant; warm, drastic medicines should be used instead. The drastic medicine uses Jiao Mu (Black Pepper Seed) 5-7 qian, ground to an extremely fine powder, taken with Ginger Decoction. After the panting stops, treat according to the cause: treat Phlegm if due to Phlegm, treat Fire if due to Fire.
Qian Min Tang treats Phlegm-panting with inability to lie flat. Supporting the patient to sit for several days, one dose brings relief. (Formula see Phlegm Section.)
One prescription: Use Dao Tan Tang (Phlegm-Guiding Decoction) combined with Qian Min Tang.
One prescription: Use Radish Seeds (Lai Fu Zi) 2 liang steamed, Gleditsia Sinensis Fruit (Zao Jiao) 5 qian charred but retaining nature, Trichosanthes Seed (Gua Lou Ren), Sea Powder (Hai Fen), and Pinellia Ternata Tuber (Nan Xing - prepared with 1.5 qian Alum, ground fine, soaked in water overnight, dried). Each herb 1 liang, ground to powder, made into pills with refined honey, held in mouth to dissolve. Another version lacks Nan Xing, Gua Lou, and Hai Fen.
One prescription: For panting with cough, use Nan Xing, Gua Lou, Ban Xia, Xiang Fu, Ju Hong, Lai Fu Zi, Qing Dai, and Zao Jiao ground to powder, bound with Fermented Rice Dough (Shen Qu), taken with Ginger Decoction. (Another version includes Xing Ren.)
Using E Jiao (Donkey-Hide Gelatin) for panting requires distinguishing Excess and Deficiency. If chronic panting, it is certainly Lung Deficiency, so tonify with E Jiao, Ren Shen, and Wu Wei Zi. If acute panting due to Lung Excess, drain with Sang Bai Pi (Mulberry Root Bark), Ting Li Zi (Sedum Seed), Ma Huang (Ephedra Herb), and Xing Ren (Apricot Seed). (Li Dongyuan said: For chronic cough with stagnant Heat in the Lung, do not use Ren Shen; for acute illness without stagnant Heat, use Ren Shen. Uncertain which is correct.)
For individuals with Qi Excess who developed panting due to excessive consumption of Huang Qi, San Ao Tang (Three Unbinding Decoction) should be used to drain Qi.
San Ao Tang treats Lung affected by Wind-Cold with unceasing urgent panting. (Formula see Cough Section.)
(Above are fourteen methods from Danxi.)
Ting Li Da Zao Xie Fei Tang (Sedum and Jujube Decoction to Drain the Lung, attributed to Hejian) treats Lung obstruction and distension, fullness and oppression in the chest and diaphragm, upper body urgent panting, and edema of the body and face.
Ting Li Zi (any amount, fried yellow and ground), made into pills the size of a bullet with refined honey.
Take three cups of water and ten jujubes, decoct to two cups, remove jujubes, add one pill of Ting Li Zi, decoct to one cup, take warm.
Ting Li San (Sedum Powder, from Jisheng) treats lung obstruction and panting with inability to lie flat due to overconsumption of fried/greasy foods or excessive alcohol, as well as Lung Abscess (Fei Yong), dry throat without thirst, and foul-smelling turbid saliva.
Sweet Ting Li Zi (fried), Jie Geng (Platycodon Root, remove rhizome), Gua Lou Zi (Trichosanthes Seed), Sheng Ma (Cimicifuga Rhizome), Yi Yi Ren (Coix Seed), Sang Bai Pi (Mulberry Root Bark, honey-fried), Ge Gen (Kudzu Root) (each 8 fen), Gan Cao (Licorice Root) (4 fen).
Cut finely, make one dose, add five slices of fresh ginger, 1.5 cups of water, decoct to one cup, take warm.
Xie Bai San (Drain White Powder) treats adults and children with Wind-Cold injuring the Lung, resulting in urgent panting and cough.
Sang Bai Pi (1 qian), Di Gu Pi (Lycium Root Bark) (1 qian), Sheng Gan Cao (Raw Licorice Root) (5 fen).
Cut finely, make one dose, add ginger, decoct in water, take.
One prescription adds Fang Feng (Saposhnikovia Root) and Jing Jie (Schizonepeta Spike) each 7.5 fen. Another prescription adds Ma Huang and Xing Ren each 5 fen, which is even more effective.
(Ancestral Prescription)
Treats long-standing urgent panting.
Silkworm excrement from mulberry wood (fried, 1 sheng), Fried Radish Seeds (Lai Fu Zi) (0.5 sheng), Fried Apricot Seeds (Xing Ren, skin and tip not removed) (0.5 sheng), Raw Licorice Root (Gan Cao) (2 liang).
Grind to extremely fine powder, mix with dough made from rice flour soaked in water and steamed, form pills the size of sophora seeds. Take 50-70 pills per dose with light ginger soup.
Another prescription: Treat asthma by boiling Ramie Root (Zhu Ma Gen) with brown sugar until soft, chew and swallow occasionally. This permanently eliminates the root of the disease and is miraculous.
Another prescription: Burn Cat Head Bone (Mao Er Tou Gu) to ash, mix with wine 2-3 qian, one dose stops it.
Another prescription: Decoct and drink the roots of the Thorn of the Cuckoo Tree (Guo Gong Ci), which stops it immediately and prevents recurrence.
Medical Case
A Daoist priest in Dongyang, over fifty years old, had a history of panting. In September, he developed fever and aversion to cold with severe panting. His pulse was surging and full, resembling an Excess pattern. One physician treated it as Cold Damage (Shang Han) using Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Zhi Ke and Chen Pi. After six days, he intended to use Da Cheng Qi Tang (Major Order the Qi Decoction). Another physician said: "No, treat it as Food Retention, using Zhi Shi Dao Zhi Wan (Immature Bitter Orange and Digestion-Guiding Pill)." Disputing without resolution, they summoned me. Both physicians said: "The pulse is Excess and Qi is abundant, so purgation is indicated." After examining his pulse, I explained: "This is a pulse of abundant Fire, not true Excess. Observing his shortness of breath and inability to sustain respiration, it should be treated as Deficiency." I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Mai Men Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry), adding 3 fen of Fu Zi (Aconite Lateral Root). After two doses, the pulse converged; after four doses, the illness lightened; after six doses, the patient recovered fully.