喘者，气短而促，吸不归根，呼吸之气不应皮毛之开合也。有实喘，有虚喘，有半虚半实喘。
实者，风寒之邪，伤其毛腠，致肌表不和。毛，皮毛也，主表∶腠，腠理也，主肌。经云∶三焦、膀胱者，腠理
毫毛其应。是三焦应肝血之腠理以主肌，膀胱应肺气之皮毛以主表。若寒邪凝敛于皮毛，皮毛之气不通于腠理，
则喘；风邪中伤于腠理，腠理之气不通于皮毛，亦喘。然此喘也，必病之初起，微微气急，或无汗恶寒，或
有汗恶风，斯时和其肌表，散其风寒，喘自平矣。
半虚半实者，手足太阴之气，不相交合也。手太阴肺金，天也；足太阴脾土，地也。地气上升，则天气下
降，或寒逆于肺而肺金寒，或湿滞于脾而脾土湿，则脾气不升，肺气不降，痰涎在中，上下不交而为喘。然此
喘也，必兼咳也。夫脾肺不交，则为虚；寒湿内凝，则为实。虚实相半，则补泻并施；虚多实少，则补多泻少；
实多虚少，则泻多补少。寒凉之药，在所禁也。《伤寒论》中，有麻黄杏子石膏汤、葛根黄连黄芩汤以治喘，
乃病太阳之标阳，而毛腠不通，阳热过盛，病在气化，不在经脉也。又有冷风哮喘，乃胃积寒痰，三焦火热之
气然之不力，火虚土弱，土弱金虚，致中有痰而上咳喘。此缓病也，亦痼疾也，久久不愈，致脾肾并伤，胃无
谷神，则死矣。
至虚喘者，水天之气不相交接也。肺，天也；肾，水也。天体不连地而连水。经云其本在肾，其末在肺，
以明水天一气。若天水违行，则肺肾不交而喘，治不得宜，将离脱矣。当用参、苓、 、术以补肺，辛、味、桂、
附以补肾，肺肾相交，则喘平而能卧；若上下不交，昼夜不
卧，喘无宁刻，则太阳标本之气，亦几乎息矣。盖太阳以寒为本，以热为标。寒本，膀胱之水也，气根于肾；
热标，皮毛之阳也，气合于肺。此肺肾不交，而太阳标本之气，将以孤危，前药所以必需也。若外道之药，消
削于前，其后亦无济矣。余曾以前方治半月之虚喘，一剂而安，举家欣喜，即以告余，问前方可再服否？余曰∶
姑俟明日。病家曰∶何也？余曰∶安卧者，肺气下交，子时一阳初生，肾气上行，方为交合，恐惫极而肾气之
不升也。至寅时，果死矣。经云∶升降息，则气立孤危；出入废，则神机化灭。其即肺肾不交，太阳气绝之喘
病为然乎！
喘证，表现为气息短促、急促，吸气不能归根，呼吸之气与皮毛的开合功能不相协调。喘证分为实喘、虚喘和半虚半实喘三种类型。
所谓实喘，是风寒邪气侵袭皮毛腠理，导致肌表不和。“毛”指皮毛，主司体表；“腠”指腠理，主司肌肉。《内经》记载：“三焦和膀胱对应于腠理和毫毛。”这说明三焦通过肝血所主的腠理来调控肌肉，膀胱通过肺气所主的皮毛来调控体表。如果寒邪凝滞收敛于皮毛，致使皮毛之气无法通达腠理，就会发生喘证；如果风邪损伤腠理，致使腠理之气无法通达皮毛，也会发生喘证。然而这种喘证，必定出现在疾病初起阶段，表现为轻微的气急，或者无汗且恶寒，或者有汗且恶风。此时调和肌表，疏散风寒，喘证自然平息。
所谓半虚半实喘，是手太阴肺经与足太阴脾经的气机不相交合。手太阴肺属金，象征天；足太阴脾属土，象征地。地气上升，天气下降，二者相交。如果寒气上逆犯肺导致肺金寒冷，或者湿气停滞于脾导致脾土湿困，就会导致脾气不升、肺气不降，痰涎阻滞在中焦，上下气机不交而发为喘证。然而这种喘证，必定兼有咳嗽。脾肺不交属于虚证，寒湿内凝属于实证。虚实各半，则补法与泻法并用；虚多实少，则补法多于泻法；实多虚少，则泻法多于补法。寒凉性质的药物，在此情况下是禁忌的。《伤寒论》中，有麻黄杏子石膏汤、葛根黄连黄芩汤用于治疗喘证，这是针对太阳病标阳亢盛，导致毛腠不通，阳热过盛，病在气化层面而非经脉层面的情况。另外还有冷风哮喘，这是由于胃中积存寒痰，三焦火热之气蒸化无力，火虚土弱，土弱进而导致金虚，致使中焦有痰而上逆引发咳喘。这是一种慢性久病，也是顽固性疾病，若久久不愈，会导致脾肾双双受损，胃中失去水谷精微的神气滋养，最终导致死亡。
至于虚喘，则是天水之气（肾水与肺金）不相交接。肺象征天，肾象征水。天的本体不直接连接地，而是连接水。《内经》说：“病的根本在肾，病的末梢在肺”，以此阐明水天一气的关系。如果天水运行失常，导致肺肾不交而发生喘证，治疗不当，将会出现气脱危象。应当用人参、茯苓、[此处原文缺字，通常指白术或山药等健脾益肺之品]、白术来补益肺气，用细辛、五味子、肉桂、附子来温补肾阳，使肺肾相交，则喘平并能安卧；如果上下气机不交，昼夜无法安卧，喘促没有片刻安宁，那么太阳经标本之气也几乎要熄灭了。盖因太阳经以寒为本，以热为标。寒之本源于膀胱之水，其气根于肾；热之标源于皮毛之阳，其气合于肺。这就是肺肾不交，导致太阳经标本之气孤危的原因，所以前述药物是必需的。如果使用外道（非正统中医）的药物，前期进行消削攻伐，后期也就无济于事了。我曾以前方治疗一位半月患虚喘的患者，服用一剂后病情安定，全家欣喜，便来询问前方是否可以继续服用？我说：“暂且等到明天。”病人家属问：“为什么？”我说：“能够安卧，说明肺气已下交，子时一阳初生，肾气上行，这才是真正的交合。我担心患者极度疲惫，导致肾气无法上升。”到了寅时，患者果然去世了。《内经》说：“升降停止，则气立孤危；出入废止，则神机化灭。”这大概就是指肺肾不交、太阳气绝的喘证吧！
Wheezing (Chuan) is characterized by shortness of breath and rapid respiration, where inhalation fails to reach its root, and the respiratory qi does not coordinate with the opening and closing of the skin and hair. There are three types: Excess Wheezing (Shi Chuan), Deficiency Wheezing (Xu Chuan), and Half-Excess Half-Deficiency Wheezing (Ban Xu Ban Shi Chuan).
Excess wheezing occurs when pathogenic Wind-Cold invades the skin and hair (Mao) and interstices (Cou), causing disharmony in the muscle surface. "Mao" refers to the skin and hair, governing the exterior; "Cou" refers to the interstices, governing the muscles. The Classics state: "The Sanjiao and Bladder correspond to the interstices and fine hairs." This indicates that the Sanjiao governs the muscles through the interstices associated with Liver Blood, while the Bladder governs the exterior through the skin and hair associated with Lung Qi. If Cold pathogen condenses and constricts the skin and hair, preventing the qi of the skin and hair from communicating with the interstices, wheezing occurs; if Wind pathogen damages the interstices, preventing the qi of the interstices from communicating with the skin and hair, wheezing also occurs. However, this type of wheezing must appear at the initial stage of the disease, presenting with slight tachypnea, or anhidrosis with aversion to cold, or diaphoresis with aversion to wind. At this time, harmonizing the muscle surface and dispersing Wind-Cold will naturally resolve the wheezing.
Half-excess half-deficiency wheezing results from the failure of the Qi of the Hand-Taiyin Lung Meridian and Foot-Taiyin Spleen Meridian to intersect. The Hand-Taiyin Lung belongs to Metal, symbolizing Heaven; the Foot-Taiyin Spleen belongs to Earth, symbolizing Earth. When Earth Qi ascends, Heaven Qi descends, facilitating their intersection. If Cold rebels against the Lung causing Lung Metal to become cold, or Dampness stagnates in the Spleen causing Spleen Earth to become damp, then Spleen Qi fails to ascend and Lung Qi fails to descend. Phlegm-saliva obstructs the middle jiao, and the lack of upper-lower intersection leads to wheezing. However, this type of wheezing must be accompanied by coughing. The non-intersection of Spleen and Lung constitutes Deficiency; the internal condensation of Cold and Dampness constitutes Excess. If Excess and Deficiency are equal, tonification and purgation should be applied simultaneously; if Deficiency exceeds Excess, tonification should outweigh purgation; if Excess exceeds Deficiency, purgation should outweigh tonification. Cold-natured medicines are contraindicated here. In *Shanghan Lun* (Treatise on Cold Damage Disorders), Mahuang Xingzi Shigao Tang (Ephedra, Apricot Seed, and Gypsum Decoction) and Gegen Huanglian Huangqin Tang (Pueraria, Coptis, and Scutellaria Decoction) are used to treat wheezing. These address cases where the Mark Yang of Taiyang is excessive, leading to blocked skin and interstices, overwhelming Yang-Heat, where the pathology lies in Qi transformation rather than the meridians. Additionally, there is Cold-Wind Asthma, caused by accumulated Cold-Phlegm in the Stomach. The Fire-Qi of the Sanjiao fails to vaporize it effectively due to weak Fire and weak Earth, which subsequently weakens Metal. This leads to phlegm in the middle jiao rising up to cause coughing and wheezing. This is a chronic, stubborn disease. If unresolved for a long time, it injures both the Spleen and Kidney. When the Stomach loses the spiritual nourishment of grain, death ensues.
As for Deficiency Wheezing, it involves the failure of Heaven (Lung/Metal) and Water (Kidney/Water) Qi to intersect. The Lung symbolizes Heaven; the Kidney symbolizes Water. The form of Heaven connects not directly to Earth but to Water. The Classics state: "Its root is in the Kidney, its branch is in the Lung," clarifying the unity of Water and Heaven. If Heaven and Water deviate from their normal course, resulting in non-intersection of Lung and Kidney, wheezing occurs. If treatment is inappropriate, Qi collapse may follow. One should use Renshen (Ginseng Radix), Fuling (Poria), [text missing, likely Baizhu or similar], and Baizhu (Atractylodis Macrocephalae Rhizoma) to tonify Lung Qi, and Xixin (Asari Radix), Wuweizi (Schisandrae Fructus), Guizhi (Cinnamomi Ramulus), and Fuzi (Aconiti Lateralis Radix Praeparata) to tonify Kidney Yang. When Lung and Kidney intersect, wheezing subsides, and the patient can lie down. If upper and lower do not intersect, and the patient cannot lie down day or night, with ceaseless wheezing, the Biao-Ben Qi of Taiyang is nearly extinguished. Taiyang takes Cold as its Ben (Root) and Heat as its Biao (Mark). The Cold Root is the Water of the Bladder, with Qi rooted in the Kidney; the Heat Mark is the Yang of the skin and hair, with Qi combining with the Lung. This non-intersection of Lung and Kidney leaves the Biao-Ben Qi of Taiyang isolated and precarious, hence the necessity of the aforementioned medicines. If heterodox medicines are used to deplete and attack initially, later treatments will be ineffective. I once treated a case of half-month deficiency wheezing with the aforementioned formula. After one dose, the patient was stabilized. The family rejoiced and asked if they could continue taking the prescription. I said, "Wait until tomorrow." They asked why. I replied, "The ability to lie peacefully indicates that Lung Qi has descended. At Zi hour (11 PM - 1 AM), Yang begins to generate, and Kidney Qi ascends, achieving true intersection. I fear extreme exhaustion prevents Kidney Qi from ascending." At Yin hour (3 AM - 5 AM), the patient indeed died. The Classics state: "When ascent and descent cease, the Qi establishment becomes isolated and precarious; when exit and entry are abolished, the Spirit mechanism perishes." This likely describes the wheezing disease of Lung-Kidney non-intersection and Taiyang Qi exhaustion!