己未岁初秋越三日。奉召至六盘山。至八月中。霖雨不止。时承上命治不邻吉歹元帅夫人。年逾
五旬。身体肥盛。因饮酒吃 乳过度。遂病腹胀喘满。声闻舍外。不得安卧。大小便涩滞。气口脉
大两倍于人迎。关脉沉缓而有力。予思霖雨之湿。饮食之热。湿热大盛。上攻于肺。神气躁乱。故
为喘满。邪气盛则实。实者宜下之。故制平气散以下之。
【平气散】
青皮（去白） 鸡心槟榔（各三钱） 大黄（七钱） 陈皮（去白。五钱）
白牵牛（二两。半生半炒。取头末一半）
上为末。每服三钱。煎生姜汤一盏调下。无时一服减半。再服喘愈。止有胸膈不利。烦热口干
。时时咳嗽。以加减泻白散治之。
内经曰。肺苦气上逆。急食苦以泻之。故白牵牛苦寒。泻气分湿
热。上攻喘满。故以为君。陈皮苦温。体轻浮。理肺气。青皮苦辛平。散肺中滞气。故以为臣。槟
榔辛温。性沉重、下痰降气。大黄苦寒。荡涤满实。故以为使也。
【加减泻白散】
知母 陈皮（去白。各五钱） 桑白皮（一两） 桔梗
地骨皮（各五钱） 青皮（去白）。 甘草 黄芩（各三钱）
上 咀。每服五钱。水二盏。煎至一盏。去渣。温服。食后。数服良愈。
华佗云。盛则为喘。减则为枯。活人书云。发喘者气有余也。凡看文本。须要晓会得本意。且
盛而为喘者。非肺气盛也。喘为气有余者。亦非肺气有余也。气盛当认作气衰。有余当认作不足。
肺气果盛又为有余。当清肃下行而不喘。以火入于肺。衰与不足而为喘焉。故言盛者非言肺气盛也。
言肺中之火盛。言有余者。非言肺气有余也。言肺中之火有余也。故泻肺用苦寒之剂者。非泻肺也
。泻肺中之火。实补肺气也。用者不可不知。
己未年（1259年）初秋，过了三天。我奉召前往六盘山。到了八月中秋，连绵阴雨不停。当时我承接上级命令，治疗不邻吉歹元帅的夫人。这位夫人年龄超过五十岁，身体肥胖壮实。因为饮酒和吃乳制品过度，于是患上腹部胀满、气喘的症状，声音传到屋外，无法安稳躺卧，大小便排泄不畅涩滞。诊脉时，气口脉比人迎脉大两倍，关脉沉缓而有力。我思考：连绵阴雨带来湿气，饮食不当产生热邪，湿热之邪盛大，向上攻冲肺部，导致神气躁动紊乱，所以出现气喘胀满。邪气盛实属于实证，实证应当用泻下法治疗。因此我配制了平气散来泻下实邪。
【平气散】
青皮（去掉白色内层）三钱，鸡心槟榔三钱，大黄七钱，陈皮（去掉白色内层）五钱，白牵牛二两（一半生用，一半炒制，取最细粉末的一半）。
以上药物研成细末。每次服用三钱，用一盏生姜汤煎好后调服。如果不定时服药，剂量减半；再服药后气喘痊愈，只剩下胸膈部感觉不利索，心烦发热，口干，不时咳嗽。此时用加减泻白散进行治疗。
《内经》说：“肺脏厌恶气机上逆，急忙食用苦味食物以泻除它。”所以白牵牛味苦性寒，能泻除气分中的湿热，消除因湿热上攻导致的气喘胀满，因此作为君药。陈皮味苦性温，质地轻浮，能调理肺气；青皮味苦辛性平，能疏散肺中停滞之气，因此作为臣药。槟榔味辛性温，性质沉重，能降痰下气；大黄味苦性寒，能荡涤腹中满实积滞，因此作为使药。
【加减泻白散】
知母，陈皮（去掉白色内层，各五钱），桑白皮一两，桔梗，地骨皮（各五钱），青皮（去掉白色内层），甘草，黄芩（各三钱）。
以上药物切碎。每次服用五钱，加水两盏，煎煮至一盏，去渣滓，温热服用。饭后服用，多次服用后良效痊愈。
华佗说：“气盛则表现为气喘，气减则表现为枯槁。”《活人书》说：“发作气喘是因为气有余。”凡是阅读医书文本，必须领会其本意。况且所谓“盛而为喘”，并不是指肺气盛；所谓“喘为气有余”，也不是指肺气有余。这里的“气盛”应当理解为气衰，“有余”应当理解为不足。如果肺气真的旺盛且有余，应该清肃下行而不会气喘。这是因为火邪进入肺部，导致肺气衰败与不足从而引发气喘。所以说“盛者”并非指肺气盛，而是指肺中的火邪盛；说“有余者”并非指肺气有余，而是指肺中的火邪有余。所以使用苦寒药剂泻肺，并不是在泻肺气，而是在泻肺中的火邪，这实际上是在补益肺气。使用者不可不知道这一点。
In the early autumn of the Jiwei year (1259), three days later, I was summoned to Liupan Mountain. By mid-August, continuous heavy rain persisted. At that time, I received orders from superiors to treat the wife of Marshal Bulin Jidai. She was over fifty years old and had a robust, obese physique. Due to excessive consumption of alcohol and dairy products, she developed abdominal distension and wheezing with fullness; her breathing sounds could be heard outside the house, and she was unable to lie down comfortably. Her urination and defecation were obstructed and difficult. The Qi Kou pulse was twice as large as the Ying Shou pulse, and the Guan pulse was deep, slow, and forceful. I reasoned that the dampness from the continuous rain combined with the heat from improper diet resulted in an excess of damp-heat attacking the Lungs upwards, causing agitation and disorder of the Shen (Spirit). Thus, wheezing and fullness occurred. When pathogenic factors are excessive, it constitutes a Excess syndrome (Shi Zheng); Excess syndromes should be treated with purgation. Therefore, I formulated Pingqi San (Balancing Qi Powder) for purgation.
[Pingqi San]
Qingpi (Green Tangerine Peel, removed albedo) 3 qian, Jixin Binglang (Chicken-heart Areca Seed) 3 qian, Dahuang (Rhubarb Root) 7 qian, Chenpi (Aged Tangerine Peel, removed albedo) 5 qian, Bai Qianniu (White Morning Glory Seed) 2 liang (half raw, half stir-fried, taking only half of the finest powder).
Grind all ingredients into fine powder. Take 3 qian per dose, mixed with one cup of decoction made from fresh ginger. If taken at irregular intervals, reduce the dose by half. After a second dose, the wheezing subsided, leaving only discomfort in the chest and diaphragm, irritability, fever, dry mouth, and occasional coughing. These symptoms were then treated with Jiajian Xiebai San (Modified Bupleurum Decoction for Clearing the Lung).
The *Neijing* states: "The Lung dislikes rebellious Qi rising; urgently consume bitter substances to drain it." Therefore, Bai Qianniu is bitter and cold; it drains damp-heat from the Qi level and eliminates wheezing and fullness caused by upward attack, serving as the Sovereign herb (Jun Yao). Chenpi is bitter and warm, with a light and floating nature, regulating Lung Qi; Qingpi is bitter, acrid, and neutral, dispersing stagnant Qi in the Lung; thus, they serve as Minister herbs (Chen Yao). Binglang is acrid and warm, with a heavy and sinking nature, descending phlegm and Qi; Dahuang is bitter and cold, sweeping away fullness and excess accumulation; thus, they serve as Envoy herbs (Shi Yao).
[Jiajian Xiebai San]
Zhimu (Anemarrhena Rhizome), Chenpi (Aged Tangerine Peel, removed albedo, each 5 qian), Sangbaipi (Mulberry Bark) 1 liang, Jiegeng (Platycodon Root), Digupi (Groundcherry Root Bark, each 5 qian), Qingpi (Green Tangerine Peel, removed albedo), Gancao (Licorice Root), Huangqin (Scutellaria Root, each 3 qian).
Cut all ingredients into small pieces. Take 5 qian per dose, add two cups of water, boil down to one cup, strain, and take warm after meals. Multiple doses lead to good recovery.
Hua Tuo said: "Excess manifests as wheezing; deficiency manifests as withering." The *Huoren Shu* (Book of Living People) states: "Wheezing indicates an excess of Qi." When reading medical texts, one must understand the original intent. The phrase "excess leads to wheezing" does not mean Lung Qi is excessive; nor does "wheezing indicates Qi excess" mean Lung Qi itself is abundant. "Qi excess" here should be interpreted as Qi deficiency, and "abundance" as insufficiency. If Lung Qi were truly abundant and excessive, it would descend clearly and turbidly without wheezing. Wheezing occurs because Fire enters the Lung, causing Lung Qi to become deficient and insufficient. Therefore, "excess" refers not to Lung Qi being excessive, but to Fire in the Lung being excessive; "abundance" refers not to Lung Qi being abundant, but to Fire in the Lung being abundant. Thus, using bitter-cold formulas to "drain the Lung" is not draining Lung Qi, but draining the Fire in the Lung, which actually tonifies Lung Qi. Practitioners must be aware of this.