经义
诸痿喘呕，皆属于上。○故犯贼风虚邪者，阳受之，阳受之则入六腑，入六腑则身热不时卧，上为喘呼。
○夜行则喘出于肾，淫气病肺。有所堕恐，喘出于肝，淫气害脾。有所惊恐，喘出于肺，淫气伤心。度水跌仆，
喘出于肾与骨。○肺，手太阴也。是动则病肺胀满，膨膨而喘咳。○肺病者，喘咳气逆，肩背痛，汗出。
○肺之壅，喘而两 满。○肾，足少阴也。是动则病饥不欲食，咳唾有血，喝喝而喘。○肾病者，腹大胫肿，
喘咳，身重。○颈脉动，喘疾咳，曰水。○喘咳者，是水气并阳明也。○气有余则喘咳上气，不足则息利少气。
○劳则喘息汗出，外内皆越，故气耗矣。○阴争于内，阳扰于外，魄汗未藏，四逆而起，起则熏肺，使人喘鸣。（《素问》）
哲言
喘，但呼而不能吸，出而不纳也。哮，呼吸不能自由，出纳留滞也。短气，下气不上续，能吸不能呼，
纳而不出也。（《医阶辨证》）
喘者，气为火所郁而为痰，在肺胃间也。其证有痰逆者，有火炎者，有阴虚气自少腹而上冲者，有气虚
而致气短者，有水气乘肺者，有肺虚挟寒而喘者，有肺实挟热而喘者，有惊忧气郁肺胀而喘者，有胃络不和而
喘者，有肾气虚损而喘者。虽然，未有不由痰火内郁，风寒外束而致也。（朱丹溪）
喘证，有痰喘，有气喘，有胃虚喘，有火炎上喘。痰喘者，凡喘便有痰声。气喘者，呼吸急促而无痰声。
胃虚而喘者，抬肩撷肚，喘而不休。火炎上而喘者，乍进乍退，得食则减，食已则喘。大概胃中有实火，膈上
有稠痰，得食入咽，坠下其痰，喘故即止；稍久，食已入胃，反助其火，痰再升上，喘反大作。俗不知此，认
作胃虚，治以燥热之药，是以火济火也。（戴复庵）
气虚发喘者，必自汗出。阴虚发喘者，疾行则喘甚，静坐则喘息，此秘验也。《金匮》云∶短气不足以息
者，实也。此言痰实。《内经》曰∶言而微，终日复言者，此气夺也。是言气虚。（余午亭）
喘证最为危候，治失其要，鲜不误人。欲辨之者，亦惟二证而已。所谓二证者，一曰实喘，一曰虚喘，二
证相反，不可混也。盖实喘者有邪，邪气实也；虚喘者无邪，元气虚也。实喘者，气
长而有余；虚喘者，气短而不续。实喘者，胸胀气粗，声高息涌，澎澎然若不能容，惟呼出为快也；虚喘者，
慌张气怯，声低息短，惶惶然若气欲断，提之若不能升，吞之若不相及，劳动则甚，而急促似喘，但得引长一
息为快也。此其一为真喘，一为似喘。真喘者，其责在肺；似喘者，其责在肾。何也？盖肺为气之主，肾为气
之根。肺主皮毛而居上焦，故邪气犯之，则上焦气壅而为喘。气之壅滞者，宜开宜破也。肾主精髓而在下焦，
若真阴亏损，精不化气，则上下不交而为促。促者，断之基也。气既短促而再加消散，如压卵矣。且气盛有邪
之脉，必滑数有力；气虚无邪之脉，必微弱无神，此脉候之不同也。其有外见浮洪，或芤大至极，而稍按即无
者，此无根之脉也。或往来弦甚，而极大极数，全无和缓者，此胃气之败也。但脉之微弱者，真虚易知；脉之
浮空弦搏者，假实难辨。微弱犹顺而易医，浮空最险而多变。若弦强之甚，则为真脏，真脏已见，不可为矣。
（张景岳）
补编
咳而上气，此为肺胀。其人喘，目如脱状，脉浮大者，越婢加半夏汤主之。○肺胀，咳而上气，烦躁而喘，
脉浮者，心下有水，小青龙加石膏汤主之。（《金匮》）
喘证之因，在肺为实，在肾为虚。实之寒者，必挟凝痰宿饮，上干阻气，如小青龙、桂枝加朴杏之属也；
实而热者，不外蕴伏之邪，蒸痰化火，有麻杏甘膏、苇茎之治也。虚者有精伤、气脱之分，填精以浓、浓之剂，
必兼镇摄，肾气加沉香，都气入青铅，从阴从阳之异也；气脱则根浮，吸伤元海，危亡可立而待，思草木之无
情，刚柔所难济，又有人参、河车、五味、石英之属，急续真元，挽回顷刻。更有中气虚馁，土不生金而喘者，
则用人参建中。层次轻重之间。丝丝入扣，学人宜深玩而得焉。（《临证指南》）
喘者，促促气急不能平卧也。外感邪入而为喘，属肺受风寒，
其来暴，其脉实，其人强壮，数日之间，忽然气壅喘咳，乃肺经受病，药宜甘桔汤加减。此属实喘也。若内伤
作喘，其来渐，其脉虚，其人倦怠，或因病后，或因咳久，而喘促渐甚，乃肾元亏损，肾气不纳而上出于肺，
肺为门户而主气，肾气上冲，肺不能主，出多入少，又肺叶胀大，不能收敛，卧则叶向脊上，阻塞气道之路，
因而喘咳更甚矣。此属虚喘也，治宜大补肺肾之原。第内伤之喘，有阴虚阳虚之异∶如面赤口渴，大便秘，属
阴虚；如面白不渴，大便泄，手足冷，属阳虚。阴虚者，六味汤加麦冬、沙参、玉竹、阿胶、童便之属；阳虚
者，八味汤加人参、河车、枸、菟、杜仲、鹿胶之属。然阴虚作喘，补阴是矣，第阴中有阳，若服六味汤不应，
又宜加人参、枸、菟、杜仲、河车，取阴阳互根之义也。阳虚作喘，补阳是矣，第阳中有阴，若服八味汤不应，
又宜加沙参、麦冬、玉竹、童便，取阴阳相济之义也。（《会心录》）
实喘之证，以邪实在肺也。肺之实邪，非风寒即火邪耳。盖风寒之邪，必受自皮毛，所以入肺而为喘；火
之炽盛，金必受伤，故亦病肺而为喘。治风寒之实喘宜温散，治火热之实喘宜清凉。○虚喘之证，无非由气虚
耳。气虚之喘，十居七、八，但察其外无风邪，内无实热者，即皆虚喘之证。若脾、肺气虚者，不过在中、上
二焦，化源未亏，其病犹浅。若肝肾气虚，则病出下焦，而本末俱病，其病则深，速救其根，接助真气，庶可
回生。○其有久病而加喘者，或久服消痰散气等剂而加喘者，或上为喘嗽而下为泄泻者，或妇人产后亡血，营
气暴竭，孤阳无根据而为喘者，凡此皆为孤阳绝阴剥极之候，均为难治。（张景岳）
《经》云∶诸痿喘呕，皆属于上。又云∶诸逆冲上，皆属于火。故河间叙喘病在于热条下。华佗云∶肺气
盛为喘。《活人》云∶气有余则喘。后世集证类方，不过遵此而已。独王海藏辨云∶气盛当认作气衰，有余当
认作不足。使肺气果盛与有余，则清肃下行，岂复为喘？以其火入于肺，炎铄真阴，衰与不足而为喘焉。
所言盛与有余者，非肺气盛也，肺中之火盛也。此辨超出前人，发千古之精奥。惜乎虽启其端，然未竟其火之
所由来。愚谓火之有余，水之不足也；阳之有余，阴之不足也。凡诸逆冲上之火，皆下焦冲任相火出于肝肾者
也。肾水虚衰，相火偏胜，壮火食气，销铄肺金，乌得而不喘耶？丹溪云∶喘有阴虚，火自少腹而上，宜四物
汤加青黛、竹沥、陈皮，入童便煎服。如挟痰喘者，四物加枳壳、半夏，补阴以化痰。夫谓阴虚发喘，亦发前
人之所未发。但如此治法，实流弊于后人。盖阴虚者，肾中之真阴虚也，岂阴血之谓乎？其火起者，下焦龙雷
之火也，岂寒凉所能降乎？其间有有痰者，有无痰者。有痰者，水挟木火而上也，岂竹沥、枳、半之能化乎？
须用六味地黄汤加麦冬、五味，以壮水之主，则水升火降而喘自定矣。○又有一等似火非火、似喘非喘者。
《经》曰∶少阴所谓呕咳上气喘者，阴气在下，阳气在上，诸阳气浮，无所根据归，故上气喘也。又云∶胃络不
和，喘出于阳明之气逆；真元耗损，喘出于肾气之上奔。其人平日若无病，但觉气喘，乃气不归原也。视其外
证，肢厥面赤，烦躁恶热，乃命门真元之火离其宫而不归。察其脉，两寸虽浮大而数，两尺则微而无力，不知
者以其有火也，用凉药清之，以其喘急难禁也，佐以四磨之类宽之，下咽稍快，少顷依然，岂知宽一分更耗一
分。何也？盖阴虚致喘，去死不远，幸几希一线，牵带命门之根。善治者，能求其绪，而以助元接真镇坠之药，
俾其返本归原。先以八味丸、安肾丸、养正丹煎生脉散送下，觉气稍定，然后以大剂参、 加故纸、阿胶、牛
膝等，以镇于下。又以八味加河车为丸，日夜遇饥吞服，远房帏，绝色欲，经年积月，方可保全。不守此禁，
终亦必亡。○有一等火郁之证，六脉俱涩，甚至沉伏，四肢悉寒，甚至厥逆，气促而喘，却似有余。然脉不紧
数，欲作阴虚，而按尺鼓指，此为蓄郁已久，阳气拂遏，不能营运于表，以致身冷脉微，而闷乱喘急。此时不
可以寒药下之，又不可以热药投之，
惟逍遥散合左金丸之类，宣散蓄热，得汗而愈。后以六味丸养阴和阳，所谓火郁发之，木郁达之是也。（赵氏《医贯》）
治喘之法，真知其寒者，则用青龙汤等；真知其风者，则用防风汤等；真知其暑者，则用清暑益元散等；
真知其湿者，则用胜湿汤等；真知其火与燥者，则用栀连汤等。此皆外感之治法也。若内伤诸喘，血虚者四物
汤，阴精不足地黄丸，元气不足参橘煎合四君子汤。（《证因脉治》）
治喘大法，外邪则散之，气郁则开之，痰则豁之，火则清之，停饮者吐之，脾虚者温之。气虚而火入于肺
者，补气为先；阴虚而火来乘金者，壮水为亟。水寒火不归经者，导龙入海；肾虚水邪泛溢者，逐水下流。
（《证治汇补》）
脉候
喘证，脉滑手足温者生，脉涩四肢寒者死。脉宜浮迟，不宜急数。（《脉经》）
上气脉数，身热不得卧者死。上气面浮，脉浮大者死。右寸脉实而紧，为肺感寒邪。亦有六脉沉伏者，并
宜发散，则热退喘止。（《证治汇补》）
选案
楝友昔病胁痛，痰涌气喘，形瘦，脉涩歇至。审其中虚，每剂用人参七钱，渐加至一两而愈。又汪如江腹
胀气急喘嗽，彼畏参不敢用，予阴加参三钱，一帖喘嗽俱定。即此二证，其他可知。缘痰因气运而行，中气既
虚，不能健运，则痰滞矣。痰滞则肺窍不能流通而喘作矣。故须大补其气，肺气实则流通，痰因之流利而喘定
矣。此治本之法也。（吴篁池）
一人病喘，声如雷，诊脉浮数，肺部尤鼓指，所服皆温补之剂。谓曰∶肺有实热，非凉不可。用二冬甘露
饮，喘定安卧。（程华仲）
韩顺溪内子患喘证月余，服破气宽胸豁痰清火等药，不效，
发表利水亦不应。其疾转急，稍动则喘难休息，诊之六脉细数而面赤戴阳。用大剂六味地黄汤，加青铅两许，
一服而缓，二服而止。（《张氏医通》）
一商日游狭斜，忽患奇证，心胸胀大，身汗气喘，不能坐卧，昼夜惟行步，不能暂停，两手虚空浮拍。医
咸不知其证，无所措手。予诊脉浮而微，右寸似无，方用人参五钱、生姜十片，水煎，频频缓服，喘急少安，
能以就枕。再服遂愈。人以为奇而问焉，予曰∶人之五脏，他脏虚则瘦小而实则丰隆，惟肺不然，愈虚愈大。
豕畜亦然，养之不肥，其肺必大。盖六畜无七情，惟有气病，以肺主气，人之肺亦相类，虚则大，大则开而不
敛，所以手拍不能坐卧，汗出而喘不休也。人参补肺定喘，肺实则收敛而汗自止矣。又问生姜何以用至十大片？
曰∶此五行生克之理。方其肺金虚时，肝木强盛，肝主筋，寡于所畏，是以手足动摇。天生五味以养五脏，肺
属金喜辛，生姜味辛，用佐人参，引经补肺以制肝耳。（程星海）
附短气少气
喘与气短不同，喘者，促促气急，喝喝息数，张口抬肩，摇身撷肚；短气者，呼吸虽数而不能接续，似
喘而不抬肩，似呻吟而无痛楚，呼吸虽急而无痰声。宜详辨之。○愚按∶喘与短气，分则短气是虚，喘是实。
然而喘多有不足者，短气间有有余者。新病亦有本虚者，不可执论也。（《赵氏医贯》）
短气者，息促似喘非喘也。少气者，气少不足以言也。○短气少气，治法亦有异也∶短气仍有虚、有实，
有补、有泻；少气则纯不足，治惟有补而已。（《赤水玄珠》）
仲景论短气皆属饮。《金匮》云∶夫短气有微饮，当从小便去之。又云∶咳逆倚息，短气不得卧，其形
如肿，谓之支饮。又云∶支饮亦喘而不得卧，加短气，其脉平也。又云∶膈上有留饮，其人气短而渴，四肢历
节痛。脉沉者有留饮。又云∶肺饮不弦，
但苦喘短气。（《证治准绳》）
《金匮》云∶短气有微饮，当从小便去之，苓桂术甘汤主之，肾气丸亦主之。仲景并出二方，分呼、吸
之短而治，妙义益彰。呼气之短，用苓桂术甘汤以通其阳，阳气化则小便能出矣；吸气之短，用肾气丸以通其
阴，肾气通则小便之关门利矣。（赵以德）
【经典理论】
各种痿证、喘证和呕吐，病机都归属于上焦。○所以遭受贼风虚邪侵袭的，阳气先受邪，阳气受邪则传入六腑，传入六腑则身体发热且不能按时安卧，向上表现为喘息呼叫。
○夜间行走则气喘源于肾，淫邪之气伤肺。若有堕坠惊恐之事，气喘源于肝，淫邪之气伤害脾。若有突然惊恐，气喘源于肺，淫邪之气伤害心。渡水或跌仆受伤，气喘源于肾与骨骼。○肺，属于手太阴经。经脉变动时病症为肺胀满，膨膨胀满而喘咳。○患肺病的人，出现喘咳气逆，肩背部疼痛，出汗。
○肺气壅塞，喘息且两胁下胀满。○肾，属于足少阴经。经脉变动时病症为饥饿但不想进食，咳唾带血，喉间发出喝喝声而喘。○患肾病的人，腹部肿大，小腿肿胀，喘咳，身体沉重。○颈部脉搏跳动，喘息急促咳嗽，称为水气病。○喘咳，是水气并犯阳明经所致。○气有余则喘咳气逆，气不足则呼吸通畅但气息微弱。
○劳累则喘息出汗，内外之气皆外越，所以气被耗损。○阴气在内争斗，阳气在外扰动，魄汗未能固藏，四肢厥冷而起，起来后热气熏蒸肺部，使人喘息有声。（《素问》）
【哲人言论】
喘，只是呼气而不能吸气，气出而不纳。哮，呼吸不能自由，气之出纳留滞不畅。短气，下焦之气不能上续，能吸不能呼，气纳入而不能呼出。（《医阶辨证》）
喘证，是气被火邪郁结而生痰，病位在肺胃之间。其症状有痰气上逆者，有火炎上炎者，有阴虚气自少腹向上冲逆者，有气虚导致气短者，有水气凌犯肺者，有肺虚挟寒而喘者，有肺实挟热而喘者，有惊忧气郁致肺胀而喘者，有胃络不和而喘者，有肾气虚损而喘者。虽然如此，没有不是由痰火内郁，风寒外束所导致的。（朱丹溪）
喘证，有痰喘，有气喘，有胃虚喘，有火炎上喘。痰喘者，凡是喘都有痰声。气喘者，呼吸急促但没有痰声。胃虚而喘者，抬肩缩肚，喘个不停。火炎上而喘者，病情忽轻忽重，进食后减轻，食毕则喘作。大抵胃中有实火，膈上有稠痰，食物咽下，坠下其痰，喘故立即停止；稍久，食物入胃，反而助长火势，痰再次升上，喘反而大作。世俗之人不懂此理，误认为胃虚，用燥热药物治疗，这是以火救火。（戴复庵）
气虚发喘者，必定自汗出。阴虚发喘者，疾走则喘加重，静坐则喘息缓解，这是秘验之法。《金匮要略》说：短气不足以息者，属实证。这是指痰实。《内经》说：说话声音细微，终日反复言说，这是气夺。这是指气虚。（余午亭）
喘证是最为危重的候象，治疗若不得要领，很少不误人的。想要辨别它，也只有两种证型罢了。所谓两种证型，一是实喘，一是虚喘，两证相反，不可混淆。大概实喘是有邪气，邪气盛实；虚喘是无邪气，元气虚弱。实喘者，气长而有余；虚喘者，气短而不续。实喘者，胸腹胀满，气粗，声音高亢，呼吸涌急，澎澎然好像容不下，只有呼出才舒服；虚喘者，慌张气怯，声音低微，呼吸短促，惶惶然好像气欲断绝，提之若不能上升，吞之若不相接，劳动则加重，急促似喘，但得引长一息才舒服。这是一个是真喘，一个是似喘。真喘，责任在肺；似喘，责任在肾。为什么呢？因为肺为气之主，肾为气之根。肺主皮毛而居上焦，所以邪气侵犯它，则上焦气壅塞而为喘。气之壅滞者，宜开宜破。肾主精髓而在下焦，若真阴亏损，精不化气，则上下不交而致促。促者，是断绝的基础。气既短促如果再加以消散，如同压卵一样危险。而且气盛有邪的脉象，必滑数有力；气虚无邪的脉象，必微弱无神，这是脉候的不同。那些外见浮洪，或芤大至极，稍微按压即无的，这是无根之脉。或往来弦紧甚，而极大极数，全无和缓之意的，这是胃气败坏的表现。但脉象微弱者，真虚容易知晓；脉象浮空弦搏者，假实难以辨别。微弱尚且顺而易治，浮空最险而多变。如果弦强之甚，则为真脏脉，真脏脉已现，就不可治了。（张景岳）
【补编】
咳嗽而上气，这是肺胀。其人喘，眼睛像要脱出状，脉浮大的，用越婢加半夏汤主治。○肺胀，咳嗽而上气，烦躁而喘，脉浮的，心下有停水，用小青龙加石膏汤主治。（《金匮要略》）
喘证的病因，在肺为实证，在肾为虚证。实之寒者，必挟凝痰宿饮，上干阻气，如小青龙汤、桂枝加厚朴杏子汤之类；实而热者，不外蕴伏之邪，蒸痰化火，有麻杏甘膏汤、苇茎汤的治疗。虚者有精伤、气脱之分，填精用浓腻之剂，必兼镇摄，如肾气丸加沉香，都气丸入青铅，是从阴从阳的不同；气脱则根浮，吸伤元海，危亡可立而待，想到草木无情，刚柔难济，又有人参、紫河车、五味子、石英之类，急续真元，挽回顷刻。更有中气虚馁，土不生金而喘者，则用人参建中汤。层次轻重之间，丝丝入扣，学人应深究而得之。（《临证指南医案》）
喘，是促促气急不能平卧。外感邪气入里而为喘，属肺受风寒，其来势暴急，脉实，人体质强壮，数日之间，忽然气壅喘咳，乃肺经受病，药宜甘桔汤加减。这属实喘。若内伤作喘，其来势渐缓，脉虚，人体倦怠，或因病后，或因咳久，而喘促渐甚，乃肾元亏损，肾气不纳而上出于肺，肺为门户而主气，肾气上冲，肺不能主，出多入少，又肺叶胀大，不能收敛，卧则肺叶向脊背上方，阻塞气道之路，因而喘咳更甚。这属虚喘，治宜大补肺肾之原。只是内伤之喘，有阴虚阳虚的区别：如面赤口渴，大便秘结，属阴虚；如面白不渴，大便泄泻，手足冷，属阳虚。阴虚者，六味地黄汤加麦冬、沙参、玉竹、阿胶、童便之类；阳虚者，八味地黄汤加人参、紫河车、枸杞、菟丝子、杜仲、鹿角胶之类。然而阴虚作喘，补阴是对的，但阴中有阳，若服六味地黄汤不应，又宜加人参、枸杞、菟丝子、杜仲、紫河车，取阴阳互根之义。阳虚作喘，补阳是对的，但阳中有阴，若服八味地黄汤不应，又宜加沙参、麦冬、玉竹、童便，取阴阳相济之义。（《会心录》）
实喘之证，是因为邪实在肺。肺之实邪，非风寒即火邪而已。大概风寒之邪，必从皮毛而入，所以入肺而为喘；火之炽盛，金必受伤，故亦病肺而为喘。治风寒之实喘宜温散，治火热之实喘宜清凉。○虚喘之证，无非由气虚耳。气虚之喘，十居七八，只要察其外无风邪，内无实热者，即皆为虚喘之证。若脾、肺气虚者，不过在中、上二焦，化源未亏，其病犹浅。若肝肾气虚，则病出下焦，而本末俱病，其病则深，速救其根，接助真气，庶可回生。○那些久病而加重喘者，或久服消痰散气等剂而加重喘者，或上为喘嗽而下为泄泻者，或妇人产后亡血，营气暴竭，孤阳无根据而为喘者，凡此皆为孤阳绝阴剥极之候，均为难治。（张景岳）
《内经》说：诸痿喘呕，皆属于上。又说：诸逆冲上，皆属于火。所以河间将喘病叙述在热条之下。华佗说：肺气盛为喘。《活人书》说：气有余则喘。后世集证类方，不过遵循这些而已。唯独王海藏辨析说：气盛应当认作气衰，有余应当认作不足。假如肺气果真是盛与有余，则清肃下行，岂复为喘？是因为火入于肺，炎灼真阴，衰与不足而为喘。他所说的盛与有余者，不是肺气盛，而是肺中之火盛。这种辨析超出前人，发千古之精奥。可惜虽开启端倪，但未穷尽火之所由来。我认为火之有余，是水的不足；阳之有余，是阴的不足。凡诸逆冲上之火，都是下焦冲任相火出于肝肾者也。肾水虚衰，相火偏胜，壮火食气，销铄肺金，怎能不喘呢？丹溪说：喘有阴虚，火自少腹而上，宜四物汤加青黛、竹沥、陈皮，入童便煎服。如挟痰喘者，四物汤加枳壳、半夏，补阴以化痰。这谓阴虚发喘，也是发前人之所未发。但这种治法，实际流弊于后人。因为阴虚者，是肾中之真阴虚，岂是阴血之谓乎？其火起者，是下焦龙雷之火，岂是寒凉所能降乎？其间有有痰者，有无痰者。有痰者，是水挟木火而上也，岂是竹沥、枳壳、半夏之能化乎？须用六味地黄汤加麦冬、五味子，以壮水之主，则水升火降而喘自定矣。○又有一等似火非火、似喘非喘者。《内经》说：少阴所谓呕咳上气喘者，阴气在下，阳气在上，诸阳气浮，无所根据归，故上气喘也。又说：胃络不和，喘出于阳明之气逆；真元耗损，喘出于肾气之上奔。其人平日若无病，但觉气喘，乃气不归原也。视其外证，肢厥面赤，烦躁恶热，乃命门真元之火离其宫而不归。察其脉，两寸虽浮大而数，两尺则微而无力，不知者以为有火，用凉药清之，因其喘急难禁，佐以四磨汤之类宽之，下咽稍快，少顷依然，岂知宽一分更耗一分。为什么呢？盖阴虚致喘，去死不远，幸几希一线，牵带命门之根。善治者，能求其绪，而以助元接真镇坠之药，俾其返本归原。先以八味丸、安肾丸、养正丹煎生脉散送下，觉气稍定，然后以大剂人参、[缺字]加故纸、阿胶、牛膝等，以镇于下。又以八味加河车为丸，日夜遇饥吞服，远房帏，绝色欲，经年积月，方可保全。不守此禁，终亦必亡。○有一等火郁之证，六脉俱涩，甚至沉伏，四肢悉寒，甚至厥逆，气促而喘，却似有余。然脉不紧数，欲作阴虚，而按尺鼓指，此为蓄郁已久，阳气拂遏，不能营运于表，以致身冷脉微，而闷乱喘急。此时不可以寒药下之，又不可以热药投之，惟逍遥散合左金丸之类，宣散蓄热，得汗而愈。后以六味丸养阴和阳，所谓火郁发之，木郁达之是也。（赵氏《医贯》）
治喘之法，真知其寒者，则用青龙汤等；真知其风者，则用防风汤等；真知其暑者，则用清暑益元散等；真知其湿者，则用胜湿汤等；真知其火与燥者，则用栀连汤等。此皆外感之治法也。若内伤诸喘，血虚者四物汤，阴精不足地黄丸，元气不足参橘煎合四君子汤。（《证因脉治》）
治喘大法，外邪则散之，气郁则开之，痰则豁之，火则清之，停饮者吐之，脾虚者温之。气虚而火入于肺者，补气为先；阴虚而火来乘金者，壮水为亟。水寒火不归经者，导龙入海；肾虚水邪泛溢者，逐水下流。（《证治汇补》）
【脉候】
喘证，脉滑手足温者生，脉涩四肢寒者死。脉宜浮迟，不宜急数。（《脉经》）
上气脉数，身热不得卧者死。上气面浮，脉浮大者死。右寸脉实而紧，为肺感寒邪。亦有六脉沉伏者，并宜发散，则热退喘止。（《证治汇补》）
【选案】
楝友昔日患胁痛，痰涌气喘，形体消瘦，脉涩且有歇止。审察其中气虚，每剂用人参七钱，渐加至一两而愈。又汪如江腹胀气急喘嗽，他畏惧人参不敢用，我在滋阴药中加入人参三钱，一帖喘嗽俱定。仅以此二证为例，其他可知。因为痰因气运而行，中气既虚，不能健运，则痰滞矣。痰滞则肺窍不能流通而喘作矣。故须大补其气，肺气实则流通，痰因之流利而喘定矣。这是治本之法。（吴篁池）
一人患喘，声如雷，诊脉浮数，肺部尤鼓指，所服皆温补之剂。我说：肺有实热，非凉不可。用二冬甘露饮，喘定安卧。（程华仲）
韩顺溪之妻患喘证月余，服破气宽胸豁痰清火等药，不效，发表利水亦不应。其疾转急，稍动则喘难休息，诊之六脉细数而面赤戴阳。用大剂六味地黄汤，加青铅约一两，一服而缓，二服而止。（《张氏医通》）
一商人游妓院，忽患奇证，心胸胀大，身汗气喘，不能坐卧，昼夜惟行步，不能暂停，两手虚空浮拍。医生都不知道是什么证，无所措手。我诊脉浮而微，右寸似无，方用人参五钱、生姜十片，水煎，频频缓服，喘急稍安，能以就枕。再服遂愈。人们以为奇而问我，我说：人的五脏，他脏虚则瘦小而实则丰隆，惟肺不然，愈虚愈大。猪也是如此，养之不肥，其肺必大。大概六畜无七情，惟有气病，以肺主气，人之肺亦相类，虚则大，大则开而不敛，所以手拍不能坐卧，汗出而喘不休也。人参补肺定喘，肺实则收敛而汗自止矣。又问生姜何以用至十大片？我说：这是五行生克之理。当其肺金虚时，肝木强盛，肝主筋，寡于所畏，是以手足动摇。天生五味以养五脏，肺属金喜辛，生姜味辛，用佐人参，引经补肺以制肝耳。（程星海）
【附短气少气】
喘与气短不同，喘者，促促气急，喝喝息数，张口抬肩，摇身撷肚；短气者，呼吸虽数而不能接续，似喘而不抬肩，似呻吟而无痛楚，呼吸虽急而无痰声。宜详辨之。○我认为：喘与短气，分则短气是虚，喘是实。然而喘多有不足者，短气间有有余者。新病亦有本虚者，不可执论也。（《赵氏医贯》）
短气者，息促似喘非喘也。少气者，气少不足以言也。○短气少气，治法亦有异也：短气仍有虚、有实，有补、有泻；少气则纯不足，治惟有补而已。（《赤水玄珠》）
仲景论述短气皆属饮。《金匮要略》说：夫短气有微饮，当从小便去之。又说：咳逆倚息，短气不得卧，其形如肿，谓之支饮。又说：支饮亦喘而不得卧，加短气，其脉平也。又说：膈上有留饮，其人气短而渴，四肢历节痛。脉沉者有留饮。又说：肺饮不弦，但苦喘短气。（《证治准绳》）
《金匮要略》说：短气有微饮，当从小便去之，苓桂术甘汤主之，肾气丸亦主之。仲景并出二方，分呼、吸之短而治，妙义益彰。呼气之短，用苓桂术甘汤以通其阳，阳气化则小便能出矣；吸气之短，用肾气丸以通其阴，肾气通则小便之关门利矣。（赵以德）
[Classical Theory]
Various flaccidity syndromes (Wei syndrome), asthma (Chuan), and vomiting all belong to the Upper Jiao. ○ Therefore, those who suffer from thieving wind and empty evils, Yang receives it first; when Yang receives it, it enters the Six Fu organs; entering the Six Fu organs leads to body fever and inability to lie down at proper times, manifesting upward as asthma and calling out.
○ Walking at night causes asthma originating from the Kidney, with excessive Qi damaging the Lung. Falling or fright causes asthma originating from the Liver, with excessive Qi harming the Spleen. Sudden fright causes asthma originating from the Lung, with excessive Qi damaging the Heart. Wading through water or falling causes asthma originating from the Kidney and bones. ○ The Lung belongs to the Hand-Taiyin meridian. When the meridian moves, the disease is lung distension and fullness, bloated with asthma and cough. ○ In lung diseases, there is asthma, cough, rebellious Qi, shoulder and back pain, and sweating.
○ Lung congestion causes asthma and fullness in both hypochondria. ○ The Kidney belongs to the Foot-Shaoyin meridian. When the meridian moves, the disease is hunger without desire to eat, coughing and spitting blood, and asthmatic breathing with a "he-he" sound. ○ In kidney diseases, there is abdominal swelling, leg edema, asthma and cough, and heavy body. ○ Pulsation in the neck, rapid asthma and cough, indicates Water pathology. ○ Asthma and cough are caused by Water Qi invading the Yangming channel. ○ Excess Qi leads to asthma, cough, and rebellious Qi; deficiency of Qi leads to smooth respiration but shortness of breath.
○ Labor causes panting and sweating, with internal and external Qi escaping, thus depleting Qi. ○ Yin struggles internally, Yang disturbs externally,魄汗 (Po sweat) is not stored, cold limbs arise; rising up, heat steams the Lung, causing wheezing and asthma sounds. (Su Wen)
[Philosophical Statements]
Asthma (Chuan) is exhalation without inhalation, air coming out but not being retained. Wheezing (Xiao) is free breathing impairment, where intake and output are stagnant. Shortness of breath (Duan Qi) is lower Qi failing to connect upwards, able to inhale but not exhale, air taken in but not expelled. (Yi Jie Bian Zheng)
Asthma syndrome occurs when Qi is constrained by Fire, generating Phlegm, located between the Lung and Stomach. Symptoms include rebellious Phlegm, flaming Fire, Yin deficiency with Qi rushing up from the lower abdomen, Qi deficiency leading to shortness of breath, Water Qi attacking the Lung, Lung deficiency with Cold, Lung excess with Heat, fright/worry causing Qi stagnation and lung distension, stomach collateral disharmony, and Kidney Qi deficiency. Although varied, none are not caused by internal constraint of Phlegm-Fire and external binding of Wind-Cold. (Zhu Danxi)
Asthma includes Phlegm-Asthma, Qi-Asthma, Stomach Deficiency Asthma, and Flaming Fire Asthma. Phlegm-Asthma has phlegm sounds during breathing. Qi-Asthma has rapid breathing without phlegm sounds. Stomach deficiency asthma involves raising shoulders and pulling in the belly, continuous panting. Flaming fire asthma fluctuates, improves after eating, and worsens after digestion. Generally, real fire in the Stomach and thick phlegm above the diaphragm: food swallows the phlegm down, stopping asthma temporarily; later, food aids fire, phlegm rises again, worsening asthma. Laypeople mistake this for stomach deficiency and use drying-hot medicines, which is adding fire to fire. (Dai Fuan)
Qi deficiency asthma presents with spontaneous sweating. Yin deficiency asthma worsens with brisk walking and improves with sitting still; this is a secret effective method. Jin Gui says: Shortness of breath with insufficient inspiration indicates Excess (Phlegm). Nei Jing says: Whispering voice, repeating words throughout the day, indicates Qi depletion (Deficiency). (Yu Wuting)
Asthma is a critical condition; improper treatment often harms patients. Differentiation relies on two types: Real Asthma and Deficient Asthma. Real asthma has pathogenic factors (Excess); deficient asthma has no pathogens (Yuan Qi deficiency). Real asthma features long, abundant Qi; deficient asthma features short, uncontinuous Qi. Real asthma shows chest distension, coarse Qi, loud voice, surging breath, feeling unable to contain Qi, relieved by exhalation. Deficient asthma shows panic, timid Qi, low voice, short breath, feeling like Qi will cut off, unable to lift or swallow, worsened by labor, relieved only by deep sighing. One is true asthma (Lung responsibility); one is pseudo-asthma (Kidney responsibility). Lung is master of Qi, Kidney is root of Qi. Lung governs skin/hair, resides in Upper Jiao; pathogens invade, causing Upper Jiao congestion and asthma. Congested Qi needs opening/breaking. Kidney governs essence/marrow, resides in Lower Jiao; if True Yin is damaged, essence fails to transform into Qi, causing failure of upper-lower interaction, leading to急促 (Cu). Cu is the basis of severance. If Qi is already short and further dispersed, it is like pressing an egg. Pulse in excess Qi with pathogens is slippery-rapid-forceful; pulse in Qi deficiency without pathogens is weak-spiritless. Floating-hong or Kou-da pulses that vanish upon slight pressure indicate rootless pulse. Wandering-taut extreme-large-rapid pulses without harmony indicate defeat of Stomach Qi. Weak pulses indicate easy-to-know true deficiency; floating-empty taut pulses indicate difficult-to-distinguish false excess. Weak is favorable/easy; floating-empty is dangerous/changeable. Extreme taut-strength indicates True Zang pulse; once seen, incurable. (Zhang Jingyue)
[Supplement]
Cough with rebellious Qi indicates Lung Distension. Patient pants, eyes protrude like falling out, pulse floating-large: treat with Yesheng Banxia Decoction. ○ Lung distension, cough with rebellious Qi, irritability, asthma, floating pulse, water below heart: treat with Xiao Qinglong Plus Shigao Decoction. (Jin Gui Yao Lue)
Asthma etiology: Lung is Excess, Kidney is Deficiency. Cold Excess involves congealed phlegm/old fluid obstructing Qi, treated with Xiao Qinglong Tang, Guizhi Houpo Xingzi Tang. Heat Excess involves latent pathogens steaming phlegm into fire, treated with Mahuang Xinggan Gao Tang, Weijing Tang. Deficiency splits into Essence damage and Qi collapse. Essence damage uses rich/nourishing agents with calming/subduing herbs, e.g., Shenqi Wan + Chenxiang, Duqi Wan + Qingqian (Yin/Yang differentiation). Qi collapse shows floating root, injury to Yuanhai, imminent danger; requires Renshen, Heche, Wuweizi, Shiyin to urgently restore True Yuan. Middle Qi deficiency failing to generate Metal (Lung) causes asthma, treated with Renshen Jianzhong Tang. Layers and severity must be carefully studied. (Lin Zheng Zhi Nan)
Asthma is rapid, urgent breathing unable to lie flat. External pathogens cause asthma via Lung Cold/Wind, sudden onset, solid pulse, strong constitution, sudden Qi congestion/cough after days: Lung meridian disease, treat with Ganjie Tang modifications (Real Asthma). Internal injury asthma has gradual onset, deficient pulse, fatigue, post-illness or chronic cough, worsening asthma due to Kidney Yuan damage, Kidney Qi failing to grasp, rushing to Lung. Lung is gate/Qi master; Kidney Qi rushes up, Lung cannot control, more out than in, lung lobes expand, cannot contract, lying blocks airway, worsening asthma: Deficient Asthma. Treat by tonifying Lung/Kidney origins. Internal injury asthma differs in Yin/Yang deficiency: Red face/thirst/constipation = Yin deficiency (Liujun Zi Tang + Maidong, Shashen, Yuzhu, Ejiao, Tongbian); Pale face/no thirst/diarrhea/cold limbs = Yang deficiency (Bawei Tang + Renshen, Heche, Gouqi, Tuszus, Duzhong, Lu Jiao Jiao). Yin deficiency asthma: tonify Yin, but Yin contains Yang; if Liujun Zi Tang fails, add Renshen, Gouqi, Tusizi, Duzhong, Heche (mutual root). Yang deficiency asthma: tonify Yang, but Yang contains Yin; if Bawei Tang fails, add Shashen, Maidong, Yuzhu, Tongbian (mutual aid). (Hui Xin Lu)
Real asthma is due to pathogenic excess in Lung. Pathogens are Wind-Cold or Fire. Wind-Cold enters via skin/hair to Lung; Fire damages Metal (Lung). Treat Wind-Cold real asthma with warming dispersal; treat Fire-Heat real asthma with cooling clearing. Deficient asthma is purely Qi deficiency (70-80%). If no external Wind-Cold or internal Heat, it is deficient. Spleen/Lung Qi deficiency affects Middle/Upper Jiao, source intact, shallow disease. Liver/Kidney Qi deficiency affects Lower Jiao, root and branch diseased, deep disease; save root, assist True Qi to survive. Chronic asthma worsening, or worsening after long-term phlegm-dispersing drugs, or asthma/cough with diarrhea below, or postpartum blood loss with sudden Ying Qi depletion and lone Yang causing asthma: all indicate lone Yang/severed Yin/extreme peeling, difficult to treat. (Zhang Jingyue)
Jing says: All Wei, Chuan, Ou belong to Upper. Jing says: All rebellious rushing upward belong to Fire. Hejian places asthma under Heat. Hua Tuo says: Lung Qi excess causes asthma. Huoren says: Qi excess causes asthma. Later collections follow this. Wang Haicang argues: Qi excess should be recognized as Qi decline, surplus as insufficiency. If Lung Qi were truly excess/surplus, it would descend clearly, not cause asthma. It is Fire entering Lung, burning True Yin, causing decline/insufficiency. The "excess" refers to Fire in Lung, not Lung Qi itself. This insight surpasses predecessors. However, origin of Fire is unclear. I believe Fire excess is Water insufficiency; Yang excess is Yin insufficiency. Rebellious Fire comes from Lower Jiao Chongren Ministerial Fire from Liver/Kidney. Kidney Water deficiency, Ministerial Fire hyperactivity, Strong Fire consumes Qi, melts Lung Metal, how can there be no asthma? Danxi says: Yin deficiency asthma, Fire rises from lower abdomen, use Siwu Tang + Qingdai, Zhuli, Chenpi, Tongbian. With Phlegm, add Zhike, Banxia (tonify Yin to resolve Phlegm). This reveals previous unknowns. But this method has flaws later. Yin deficiency refers to True Yin in Kidney, not just Yin Blood. Fire is Lower Jiao Dragon-Lei Fire, not lowered by cold/bitter. Phlegm cases: Water carries Wood-Fire up, Zhuli/Zhike/Banxia cannot resolve. Use Liujun Zi Di Huang Tang + Maidong, Wuweizi to strengthen Water Master, so Water rises/Fire descends, asthma settles. ○ Another type: seeming Fire not Fire, seeming Asthma not Asthma. Jing says: Shaoyin vomiting/cough/rebellious Qi/Asthma: Yin below, Yang above, Yang floats without root, hence asthma. Also: Stomach collateral disharmony, asthma from Yangming rebellious Qi; True Yuan depletion, asthma from Kidney Qi rushing up. Usually healthy person feels asthma, Qi not returning to origin. Signs: cold limbs, red face, irritability, aversion to heat: Mingmen True Yuan Fire leaves palace. Pulse: Cun floating-large-rapid, Chi weak-powerless. Ignorant people see Fire, use cold meds; see urgency, use Simo Tang to widen. Swallowing brings slight relief, then returns. Widening consumes Qi. Yin deficiency asthma is near death, barely holding Mingmen root. Good doctors seek origin, use Yuan-aiding/True-connecting/subduing meds to return to origin. First Bawei Wan, Anshen Wan, Yangzheng Dan with Shengmai San. When Qi stabilizes, large dose Renshen, [missing char], Gupi, Ejiao, Niuxi to subdue below. Then Bawei + Heche pills, taken when hungry, avoid sex, months/years to preserve. Without abstinence, death ensues. ○ Fire constraint syndrome: six pulses choppy/deep, limbs cold/revulsion, rapid asthma seeming excess. Pulse not tight-rapid, suggests Yin deficiency, Chi drumming finger: long-standing constraint, Yang blocked, cannot circulate exterior, cold body/micro pulse, stifled urgent asthma. Do not use cold purgatives or hot meds. Use Xiaoyao San + Zuojin Wan to disperse constrained heat, cure with sweat. Then Liujun Zi Wan to nourish Yin/harmonize Yang. Fire constraint released, Wood constraint reached. (Zhao Yi Guan)
Treat asthma: Know Cold -> Qinglong Tang; Know Wind -> Fangfeng Tang; Know Summerheat -> Qingshu Yiyuan San; Know Dampness -> Shengshi Tang; Know Fire/Dryness -> Zhilian Tang. These are external treatments. Internal injury asthma: Blood deficiency -> Siwu Tang; Yin/Essence insufficiency -> Dihuang Wan; Yuan Qi insufficiency -> Canju Jian + Sijunzi Tang. (Zheng Yin Mai Zhi)
General rules: External pathogen -> disperse; Qi constraint -> open; Phlegm -> resolve; Fire -> clear; Fluid retention -> vomit; Spleen deficiency -> warm. Qi deficiency with Fire in Lung -> tonify Qi first; Yin deficiency with Fire attacking Metal -> strengthen Water urgently. Cold Water/Fire not returning to meridian -> guide Dragon to sea; Kidney deficiency/Water flooding -> drain water downward. (Zheng Hui Bu)
[Pulse Signs]
Asthma: Slippery pulse, warm hands/feet -> survival. Choppy pulse, cold limbs -> death. Pulse should be floating-slow, not rapid-numerous. (Mai Jing)
Rebellious Qi: Rapid pulse, fever, insomnia -> death. Rebellious Qi, facial edema, floating-large pulse -> death. Right Cun pulse solid-tight -> Lung Cold pathogen. Six pulses deep-hidden -> disperse, heat retreats, asthma stops. (Zheng Hui Bu)
[Selected Cases]
Lian You had hypochondriac pain, phlegm surge, asthma, emaciation, choppy pulse with interruptions. Diagnosed middle deficiency, used Renshen 7 qian per dose, increased to 1 liang, cured. Wang Rujiang had abdominal distension, urgent Qi, asthma/cough, feared Renshen, I added 3 qian Renshen to yin-nourishing formula, one dose stopped asthma/cough. From these two, others known. Phlegm moves with Qi; middle deficiency fails to transport, phlegm stagnates, lung orifices block, asthma starts. Must greatly tonify Qi; Lung Qi solidifies, phlegm flows, asthma stops. Root treatment. (Wu Huangchi)
One patient had asthma, thunderous sound, floating-rapid pulse, Lung area drumming finger, took warming-tonic meds. I said: Lung has real heat, must cool. Used Er Dong Ganlu Yin, asthma stopped, slept well. (Cheng Huazhong)
Han Shunxi's wife had asthma for a month, took Qi-breaking/chest-widening/phlegm-resolving/fire-clearing meds, ineffective. Exterior-releasing/diuretics ineffective. Condition worsened, slight movement caused severe asthma/restlessness. Six pulses fine-rapid, red face, Dai Yang (floating yang). Used large dose Liujun Zi Di Huang Tang + ~1 liang Qingqian. One dose eased, two doses stopped. (Zhang Shi Yi Tong)
A merchant visited a brothel, suddenly had strange syndrome: chest/heart distension, sweating, asthma, unable to sit/lie, walked day/night, could not stop, hands floated/patted emptily. Doctors confused. I diagnosed floating-micro pulse, Right Cun seemed absent. Formula: Renshen 5 qian, Ginger 10 slices, decoct, sip slowly. Asthma eased, could lie down. Second dose cured. Asked why? Five Zang: others shrink when deficient, swell when excess. Lung is different: more deficient, larger. Pigs same: unfed, lungs large. Livestock have no emotions, only Qi disease. Lung governs Qi. Human lung similar: deficient -> large -> open not contracting -> hand patting, unable to sit/lie, sweating, continuous asthma. Renshen tonifies Lung/stops asthma; Lung solid -> contracts -> sweat stops. Why 10 ginger slices? Five Elements theory. When Lung Metal deficient, Liver Wood strong. Liver governs sinews, lacks fear -> limb tremors. Five flavors nourish five Zang. Lung Metal likes Pungent. Ginger is pungent. Assist Renshen, guide meridian, tonify Lung to control Liver. (Cheng Xinghai)
[Appendix: Shortness of Breath & Scarcity of Qi]
Asthma differs from Shortness of Breath (Duan Qi). Asthma: rapid urgent breathing, he-he sound count, open mouth raise shoulders, shake body pull belly. Shortness of Breath: frequent breathing but unconnected, seems like asthma but no shoulder raising, seems like groaning but no pain, rapid breathing but no phlegm sound. Distinguish carefully. ○ I note: Separately, Duan Qi is Deficiency, Chuan is Excess. However, Chuan often has deficiency; Duan Qi sometimes has excess. New diseases may have root deficiency; do not stick to rigid theories. (Zhao Yi Guan)
Shortness of Breath: rapid breathing seems like asthma but isn't. Scarcity of Qi (Shao Qi): Qi too little to speak. ○ Treatment differs: Duan Qi has Deficiency/Excess, Tonify/Drain; Shao Qi is pure insufficiency, only Tonify. (Chi Shui Xuan Zhu)
Jing Yue discusses Shortness of Breath as Fluid retention. Jin Gui says: Shortness of breath with slight fluid, remove via urination. Cough/rebellious Qi, shortness of breath unable to lie, shape like swelling -> Zhi Yin (Branch Fluid). Zhi Yin also asthmatic unable to lie, adds shortness of breath, pulse level. Fluid retention above diaphragm -> shortness of breath/thirst, limb/joint pain. Deep pulse indicates fluid retention. Lung fluid not taut, only suffers asthma/shortness of breath. (Zheng Zhi Zhun Sheng)
Jin Gui says: Shortness of breath with slight fluid, remove via urination, Ling Gui Zhu Gan Tang main, Shenqi Wan also main. Jing Yue offers two formulas, treating exhalation/inhalation shortness separately, profound meaning revealed. Exhalation shortness: Ling Gui Zhu Gan Tang to unblock Yang, Yang transforms, urine exits. Inhalation shortness: Shenqi Wan to unblock Yin, Kidney Qi unblocks, urine gate opens. (Zhao Yi De)