33.喘息喝喝数张口, 短气似喘不抬肩, 促难布息为实证, 短不续息
作虚观, 内因饮病或痰热, 外因阴阳表里看, 直视神昏汗润发, 脉微
肢厥命难全.
【注】喘息, 气急喝喝而数张口, 抬肩, 欠肚者, 喘也. 短气, 则似
喘非喘, 而不张口抬肩也. 二证皆胸中气病. 肺主气, 故属肺也. 无
论喘急, 短气, 若气促壅塞不能布息, 为有余之实证. 若气短空乏不
能续息, 为不足之虚证. 内因, 谓饮冷伤肺, 或因痰热也. 外因, 谓
形寒伤表, 表主皮毛, 肺之合也, 皮毛受邪, 其次及肤, 及肌, 及胸
,及腹入胃, 皆令病喘, 当审阴阳表里, 从化主治可也. 喘急, 短气
,兼直视神昏, 汗出润发, 脉微四肢厥冷, 皆死候也. 与三阴寒证同
见,是为阴喘, 宜四逆加杏仁, 五味子, 虚者倍加人参. 与三阳热证
同见, 是为阳喘, 宜白虎, 葛根黄芩黄连汤. 与太阳表证同见, 是为
表喘, 无汗者麻黄汤, 兼烦躁者大青龙汤, 有汗者桂枝加厚朴杏子汤
.与阳明里证同见, 是为里喘, 宜大承气汤, 兼结胸者, 宜大陷胸丸
.若兼水气, 表实者, 小青龙汤, 表虚者及小便不利, 均宜五芩散加
葶苈子. 里实者, 宜葶苈大枣汤, 兼腹胁硬痛者, 宜十枣汤. 里寒者
,宜真武汤. 若脉微细, 口鼻气短喘乏, 而无阴阳表里证, 此气虚喘
也,宜保元汤加五味子, 杏仁. 若喘而唾痰稠粘, 喉间漉漉有声, 此
痰喘也, 重者宜瓜蒂散、礞石滚痰丸, 轻者二陈加苦葶苈子, 苏子之
类也.
33. 喘息时喉咙发出“喝喝”的声音，频繁张口呼吸；短气则类似喘证但不抬举肩膀。呼吸急促、气息难以顺畅布散属于实证；呼吸短促、气息不能接续则视为虚证。内因多为水饮停聚或痰热蕴结；外因需从阴阳表里进行辨析。若出现两眼直视、神志昏迷、汗出如油且头发湿润、脉象微弱、四肢厥冷，则病情危重，性命难保。
【注】所谓喘息，是指气息急促，喉咙发出“喝喝”声，频繁张口，抬举肩膀，腹部凹陷（即吸气时肋间及上腹部内陷），这就是喘证。短气，则是看似喘证其实不是喘，不张口也不抬肩。这两种证候都属于胸中气机病变。肺主司气，因此归属于肺脏。无论是喘急还是短气，如果气息急促壅塞，无法顺畅呼吸，属于有余的实证；如果气息短少空乏，无法接续呼吸，属于不足的虚证。内因，指的是饮用冷水损伤肺气，或者因为痰热所致。外因，指的是形体受寒损伤体表，体表主管皮毛，是肺的外合组织，皮毛感受邪气，进而依次波及皮肤、肌肉、胸部、腹部直至胃，都会导致发生喘证，应当审察阴阳表里的病机，根据病证的转化规律进行治疗即可。喘急和短气，如果兼见两眼直视、神志昏迷、汗出如油润湿头发、脉象微弱、四肢厥冷，都是死症的表现。如果与三阴经的寒证同时出现，称为阴喘，适宜使用四逆汤加杏仁、五味子，虚损严重的加倍加入人参。如果与三阳经的热证同时出现，称为阳喘，适宜使用白虎汤、葛根黄芩黄连汤。如果与太阳经表证同时出现，称为表喘，无汗的用麻黄汤，兼有烦躁症状的用大青龙汤，有汗的用桂枝加厚朴杏子汤。如果与阳明经里证同时出现，称为里喘，适宜使用大承气汤，兼有结胸证的，适宜使用大陷胸丸。如果兼有水气，表实证的用小青龙汤，表虚证以及小便不利的，均适宜使用五苓散加葶苈子。里实证的，适宜使用葶苈大枣汤，兼有腹部和胁部硬痛的，适宜使用十枣汤。里寒证的，适宜使用真武汤。如果脉象微细，口鼻气息短少喘乏，而没有阴阳表里的其他证候，这是气虚喘，适宜使用保元汤加五味子、杏仁。如果喘咳并吐出粘稠的痰液，喉间有漉漉的水声，这是痰喘，重症适宜使用瓜蒂散、礞石滚痰丸，轻症适宜使用二陈汤加苦葶苈子、苏子之类的药物。
33. In wheezing, the throat produces a "he-he" sound, and the mouth opens frequently; in shortness of breath, it resembles asthma but without shoulder elevation. Rapid breathing with difficulty in distributing breath indicates an excess syndrome (Excess Syndrome), while shortness of breath with inability to sustain respiration is viewed as a deficiency syndrome (Deficiency Syndrome). Internal causes involve fluid retention or phlegm-heat; external causes require differentiation based on Yin-Yang and exterior-interior levels. If accompanied by fixed staring, coma, sweating that makes hair damp and oily, faint pulse, and cold limbs, life is difficult to save.
[Annotation] Wheezing refers to rapid breathing, a "he-he" sound in the throat, frequent opening of the mouth, shoulder elevation, and abdominal retraction during inspiration; this is asthma. Shortness of breath resembles asthma but is not true asthma, characterized by no mouth-opening or shoulder-elevation. Both conditions belong to Qi disorders in the chest. The Lung governs Qi, so these are attributed to the Lung. Whether rapid asthma or shortness of breath, if breathing is rapid, obstructed, and unable to distribute breath smoothly, it is an excess syndrome (Excess Syndrome) due to surplus. If breath is short, empty, and unable to continue, it is a deficiency syndrome (Deficiency Syndrome) due to insufficiency. Internal causes refer to lung injury from drinking cold fluids or due to phlegm-heat. External causes refer to body cold injuring the exterior; the exterior governs skin and hair, which are the exterior connections of the Lung. When pathogens affect the skin and hair, they subsequently spread to the skin, muscles, chest, abdomen, and stomach, all causing asthma. One must examine Yin-Yang and exterior-interior patterns and treat according to the transformation of the disease. Asthma and shortness of breath, when combined with fixed staring, coma, sweating making hair damp and oily, faint pulse, and cold limbs, are signs of death. If seen together with Cold syndromes of the Three Yin channels, it is called Yin Asthma, suitable for Sini Tang (Four Reversal Decoction) added with Xingren (Apricot Seed) and Wuweizi (Schisandra Fruit); increase Renshen (Ginseng) for deficiency. If seen together with Heat syndromes of the Three Yang channels, it is called Yang Asthma, suitable for Baihu Tang (White Tiger Decoction) or Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction). If seen together with Taiyang Exterior syndromes, it is called Exterior Asthma: use Mahuang Tang (Ephedra Decoction) for no sweat, Da Qinglong Tang (Major Green Dragon Decoction) for irritability, and Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction Added with Magnolia Bark and Apricot Seed) for sweating. If seen together with Yangming Interior syndromes, it is called Interior Asthma, suitable for Dachengqi Tang (Major Order to Yield the Decoction); if combined with Jie Xiong (Chest Binding), Daxiexion Wan (Major Chest-Breaking Pill) is suitable. If combined with Water Qi, for Exterior Excess, Xiaolongtan Tang (Minor Green Dragon Decoction) is used; for Exterior Deficiency and unfavorable urination, Wuling San (Five-Poria Powder) added with Tinglizi (Lepidium Seed) is suitable. For Interior Excess, Tingli Dazao Tang (Lepidium and Jujube Decoction) is suitable; for hardness and pain in the abdomen and hypochondrium, Shizao Tang (Ten Date Decoction) is suitable. For Interior Cold, Zhenwu Tang (True Warrior Decoction) is suitable. If the pulse is faint and fine, and breath is short and weak at the mouth and nose, without other Yin-Yang or exterior-interior syndromes, this is Qi Deficiency Asthma, suitable for Baoyuan Tang (Protect Origin Decoction) added with Wuweizi (Schisandra Fruit) and Xingren (Apricot Seed). If asthma is accompanied by spitting thick, sticky phlegm and a gurgling sound in the throat, this is Phlegm Asthma. Severe cases suit Guiti San (Melon Pedicle Powder) or Mengshi Gun Tan Wan (Mica Rolling Phlegm Pill); mild cases suit Erchen Tang (Two-Aged Decoction) added with Ku Tinglizi (Bitter Lepidium Seed) and Suzi (Perilla Seed).