喻昌曰∶天积气耳，地积形耳，人气以成形耳。惟气以成形，气聚则形存，气散则形亡。气之关于形也，岂不巨哉？
然而身形之中，有营气、有卫气、有宗气、有脏腑之气、有经络之气，各为区分。其所以统摄营卫、脏腑、经络，而令
充周无间，环流不息，通体节节皆灵者，全赖胸中大气，为之主持。大气之说，《内经》尝一言之，黄帝问地之为下否乎？
岐伯曰∶地为人之下，太虚之中者也。曰∶冯乎，曰∶大气举之也。可见太虚寥廓而其气充周磅因礴，足以包举地
之积形而四虚无着，然后寒、暑、燥、湿、风、火之气，六入地中而生其化。设非大气足以苞地于无外，地之震崩坠陷，
且不可言。胡以巍然中处而永生其化耶？人身亦然，五脏六腑，大经小络，昼夜循环不息，必赖胸中大气，斡旋其间。
大气一衰，则出入废，升降息，神机化灭，气立孤危矣。如之何其可哉，《金匮》亦常一言之，曰∶营
卫相得，其气乃行；大气一转，其气乃散。见营卫两不和谐，气即痹而难通。必先令营卫相得，其气并行不悖，后乃俟
胸中大气一转，其久病驳劣之气始散。然则大气之关于病机若此，后人不一表章，非缺典乎？或谓大气即膻中之气，所
以膻中为心，主宣布政令，臣使之官。然而参之天运膻中臣使，但可尽寒暑燥湿风火六入之职，必如太虚中，空洞 穆，
无可名象，包举地形，永奠厥中，始为大气。膻中既为臣使之官，有其职位矣，是未可言大气也。或谓大气即宗气之别
名，宗者尊也主也，十二经脉，奉之为尊主也。讵知宗气与营气、卫气，分为三隧，既有隧之可言，即同六入地中之气，
而非空洞无着之比矣。膻中之诊，即心包络。宗气之诊在左乳下，原不与大气混诊也。然则大气于何而诊之？《内经》
明明指出，而读者不察耳。其谓上附上，右外以候肺，内以候胸中者，正其诊也。肺主一身之气，而治节行焉。胸中包
举肺气于无外，故分其诊于右寸主气之天部耳。《金匮》独窥其微，举胸痹心痛短气，总发其义于一门。有谓气分心下
坚大如盘，边如旋杯，水饮所作。形容水饮久积胸中不散，伤其 之气，乃至心下坚大如盘，遮蔽大气不得透
过，只从旁边辘转，如旋杯之状，正举空洞之位水饮占据为言。其用桂枝去芍药，加麻黄、附子，以通胸中阳气者，阳
主开，阳盛则有开无塞，而水饮之阴可见 耳。其治胸痹心痛诸方，率以薤白白酒为君，亦通阳之义也。若胸中之阳不
亏，可损其有余，则用枳术汤足矣。用枳必与术各半，可过损乎？识此以治胸中之病，宁不思过半乎？人身神藏五，形
藏四，合为九藏，而胸中居一焉。胸中虽不藏神，反为五神之主，孟子之善养浩然，原思之歌声若出金石，其得全于天，
不受人损为何如。今人多暴其气而罔顾，迨病成，复损其气以求理。如本草云枳壳损胸中至高之气，亦有明言，何乃恣
行无忌耶？总由未识胸中为生死第一关耳。特于辨息之余，补大气论以明之。
【律一条】
凡治病，伤其胸中正气，致令痞塞痹痛者，此为医咎。虽自昔通弊，限于不知，今特着为戒律，不可获罪于冥冥矣。
喻昌说：天是由气积聚而成的，地是由形体积聚而成的，人则是凭借气而形成了形体。正因为气构成了形体，所以气聚集则形体存在，气消散则形体消亡。气对于形体的关系，难道不是极其重大吗？
然而，在身体之中，有营气、卫气、宗气、脏腑之气、经络之气，它们各自有所区分。之所以能够统摄营卫、脏腑、经络，使它们充盈周遍、没有间隙，循环流动、永不停息，让全身上下各个关节都灵敏自如的，完全依赖于胸中的大气来主持。关于大气的说法，《黄帝内经》曾提到过一次，黄帝问：“大地是在下面的吗？”岐伯回答说：“大地在人的下面，但在太虚（宇宙空间）之中。”黄帝又问：“大地是依靠什么悬浮的呢？”岐伯说：“是靠大气托举着它。”由此可见，太虚空旷辽阔，其中的气充盈磅礴，足以包举大地的有形实体，使其四下虚无而不落，然后寒、暑、燥、湿、风、火这六气进入大地中而产生变化。如果不是大气足以将大地包容在无外的空间中，大地的震动、崩塌、坠落和陷落，就不可言说了。大地怎么能巍然居中而永远产生生化作用呢？人身也是如此，五脏六腑，大经小络，昼夜循环不息，必须依赖胸中的大气在其中斡旋运转。一旦大气衰弱，那么气的出入就会废弃，升降就会停止，神机（生命活动的主宰）就会化灭，气立（生命赖以存在的条件）就会孤立危险。这怎么可以呢？《金匮要略》也多次提到过，说：“营卫和谐，气才能运行；大气一转，病邪之气才能消散。”这说明当营卫不和谐时，气就会痹阻而难以通畅。必须先让营卫和谐，气并行而不违背，然后等待胸中的大气转动，那些久病产生的驳杂劣质的气才会消散。既然大气对病机的关系如此重要，后人却不加以表彰阐发，这不是缺失的制度吗？
有人说大气就是膻中之气，所以膻中被称为“臣使之官”，主要发布政令。然而参照天体运行，膻中作为臣使之官，只能尽到应对寒暑燥湿风火六气的职责，必须像太虚那样，空洞穆清，没有具体的形象和名状，包举地形，永远安定其中，这才是大气。膻中既然已经是臣使之官，有了职位，就不能称之为大气了。
有人说大气就是宗气的别名，“宗”意为尊贵、主宰，十二经脉奉它为尊主。哪里知道宗气与营气、卫气分为三条通道，既然有通道的概念，那就同于进入大地的六气一样，而不是那种空洞无着的状态了。诊察膻中，即诊察心包络。诊察宗气则在左乳下，原本就不与大气混在一起诊察。那么大气在哪里诊察呢？《黄帝内经》明明指出了，只是读者没有察觉罢了。文中所说的“上附上，右外以候肺，内以候胸中者”，正是对大气的诊察方法。肺主管一身之气，治理节律随之而行。胸中包举肺气于无外，所以将诊察部位分在右寸脉的天部，以主气。《金匮要略》独自洞察其细微之处，将胸痹、心痛、短气等症状，总括在一门中阐述其义理。其中有说到“气分心下坚大如盘，边如旋杯，水饮所作”。这是形容水饮长久积聚在胸中不散，损伤了胸中的阳气，以至于心下坚硬巨大如盘，边缘像倒扣的杯子，遮蔽了大气使其无法透过，只能从旁边旋转流动，如同旋杯的形状，这正是指出空洞的位置被水饮占据。使用桂枝去芍药加麻黄、附子汤，来通达胸中的阳气，因为阳主开泄，阳气旺盛则有开无塞，水饮的阴邪自然可见消散。治疗胸痹心痛的各方剂，大都以薤白、白酒为君药，也是通达阳气的意义。如果胸中的阳气没有亏损，只是有余邪，那么使用枳术汤就足够了。使用枳实必须与白术各半，难道能过度损耗吗？认识到这一点来治疗胸中的疾病，岂不是事半功倍吗？人身有神藏五，形藏四，合为九脏，而胸中位居其一。胸中虽然不藏神，反而是五神的主宰。孟子善于培养浩然正气，原思唱歌的声音若出金石，他们得全于天，不受人为损害，是怎样的境界啊。现在的人多肆意耗损自己的气而不顾后果，等到病已成，又通过损耗正气来求取调理。如本草书中说枳壳会损伤胸中至高之气，也有明确说明，为何还恣意行事无所顾忌呢？总归是因为没有认识到胸中是生死的第一关罢了。特在辨别呼吸之余，补充大气论来阐明这个道理。
【律一条】
凡是治病，损伤了胸中的正气，导致痞塞痹痛的，这是医生的过错。虽然自古以来这是普遍弊端，限于人们不知道，现在特别著为此戒律，不可在冥冥之中获罪。
Yu Chang stated: Heaven is an accumulation of Qi, Earth is an accumulation of Form, and humans are formed through Qi. Because Qi constitutes Form, when Qi gathers, Form exists; when Qi scatters, Form perishes. Is not the relationship between Qi and Form extremely significant?
However, within the body, there are Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Zong Qi (Pectoral Qi), Zang-Fu Qi (Visceral and Bowel Qi), and Jing-Luo Qi (Meridian Qi), each with its own distinction. What unifies and controls Ying Qi, Wei Qi, Zang-Fu Qi, and Jing-Luo Qi, making them fill the body without gaps, circulate endlessly, and keep every joint of the whole body agile and responsive, is entirely dependent on the Da Qi (Great Qi) in the chest to preside over it. The concept of Da Qi was mentioned once in *Huangdi Neijing* (The Yellow Emperor's Inner Canon). When the Yellow Emperor asked if Earth is below, Qibo replied, "Earth is below humans, but within the Tai Xu (Great Void/Cosmic Space)." The Emperor asked, "What supports it?" Qibo said, "It is supported by Da Qi." This shows that the Great Void is vast and empty, yet filled with Qi that is abundant and powerful, sufficient to encompass the accumulated form of Earth so that it does not fall into the four directions. Only then can the Qi of Cold, Heat, Dryness, Dampness, Wind, and Fire enter Earth and generate transformations. If not for Da Qi encompassing Earth from without, the shaking, collapsing, falling, and sinking of Earth would be unimaginable. How could Earth stand majestically in the center and perpetually generate transformations? The human body is the same. The Five Zang and Six Fu organs, major and minor meridians, circulate day and night without rest, relying entirely on the Da Qi in the chest to pivot and rotate within. Once Da Qi declines, the exit and entry of Qi cease, the ascending and descending stop, the Shen Ji (Spirit Mechanism) perishes, and the Qi Li (Qi Establishment) becomes isolated and precarious. How can this be acceptable? *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet) also frequently mentions it, stating: "When Ying and Wei are harmonious, their Qi flows; when Da Qi rotates, pathogenic Qi dissipates." This indicates that when Ying and Wei are disharmonious, Qi becomes bi-occluded and difficult to flow. One must first make Ying and Wei harmonious so that their Qi runs parallel without conflict, and then wait for the rotation of Da Qi in the chest, so that the stale and inferior Qi of chronic illness can finally dissipate. Since the role of Da Qi in pathogenesis is thus, why do later generations fail to highlight it? Is this not a missing protocol?
Some say Da Qi is simply the Qi of Dan Zhong (Conception Vessel/Pericardium region), hence Dan Zhong is called the "Minister Official," responsible for promulgating orders. However, referring to celestial movements, Dan Zhong as a Minister Official can only handle the duties related to the six climatic factors (Cold, Heat, Dryness, Dampness, Wind, Fire). It must be like the Tai Xu, hollow and serene, without specific shape or name, encompassing the terrain of Earth and eternally stabilizing it, which truly constitutes Da Qi. Since Dan Zhong is already the Minister Official with its position, it cannot be called Da Qi.
Others say Da Qi is another name for Zong Qi. "Zong" means respected and masterful, as the Twelve Meridians respect it as their master. Little do they know that Zong Qi, Ying Qi, and Wei Qi are divided into three separate tunnels. Since there is a concept of tunnels, it is akin to the Qi entering Earth, rather than the state of being hollow and unattached. The diagnosis of Dan Zhong corresponds to the Pericardium Luo (Collaterals). The diagnosis of Zong Qi is located under the left nipple, originally not mixed with the diagnosis of Da Qi. So where is Da Qi diagnosed? *Huangdi Neijing* clearly points it out, though readers often overlook it. It states: "At the upper level, externally it diagnoses the Lung, internally it diagnoses the Chest." This is precisely the diagnosis of Da Qi. The Lung governs the Qi of the whole body, and regulation follows. The chest encompasses Lung Qi without limit, hence its diagnostic area is assigned to the Right Cun pulse at the Tian Bu (Heaven Level) to govern Qi. *Jinkui Yaolue* alone penetrated these subtleties, summarizing the principles of Xiong Bi (Chest Bi/Pain), Heart Pain, and Shortness of Breath in one chapter. It mentions: "In the Qi division, the epigastrium is hard and large like a plate, with edges like an inverted cup, caused by fluid retention." This describes long-standing fluid retention in the chest that fails to dissipate, damaging the Yang Qi of the chest, resulting in hardness and largeness like a plate, with edges like an inverted cup. This blocks Da Qi, preventing it from passing through, forcing it to rotate around the sides like an inverted cup. This precisely refers to the hollow position being occupied by fluid retention. Using Gui Zhi Tang (Cinnamon Twig Decoction) removing Shao Yao (Peony), plus Ma Huang (Ephedra) and Fu Zi (Aconite Root), aims to unblock the Yang Qi of the chest. Yang governs opening; when Yang is prosperous, there is opening without blockage, and the Yin of fluid retention can be seen dissipating. In treating various formulas for Chest Bi and Heart Pain, all generally use Xie Bai (Macrostemon Bulb) and Bai Jiu (White Wine) as the sovereign herbs, which also embodies the principle of unblocking Yang. If the Yang Qi in the chest is not deficient, but merely excessive, using Zhi Zhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) would suffice. Using Zhi Shi (Immature Bitter Orange) must be paired equally with Bai Zhu (Atractylodes Macrocephala Rhizome); how could it cause excessive damage? Recognizing this to treat diseases of the chest, would one not achieve half the result with twice the effort? The human body has Five Spirit Stores and Four Form Stores, totaling Nine Stores, with the Chest occupying one. Although the Chest does not store Spirit, it is the master of the Five Spirits. Mencius's ability to nourish his Hao Ran Zhi Qi (Noble Spirit), and Yuansi's singing voice sounding like metal and stone, represent those who are complete according to Heaven and not damaged by humans—what a state this is! Nowadays, people recklessly exhaust their Qi without regard, and only when disease is established do they further damage their Qi seeking treatment. As Materia Medica states, Zhi Ke (Immature Bitter Orange Peel) damages the highest Qi in the chest, which is explicitly stated. Why then act recklessly without fear? It is all due to failing to recognize that the Chest is the first pass of life and death. Specifically, after distinguishing respiration, I supplement this Treatise on Great Qi to clarify this matter.
[Rule One]
Whenever treating disease, if the Zheng Qi (Upright Qi) in the chest is injured, leading to fullness, obstruction, and pain, this is the fault of the physician. Although this has been a common flaw since ancient times due to ignorance, I now specifically establish this as a warning rule, so as not to incur guilt in the unseen realm.