短气者,呼吸短促而不能相续也。《千金方》云∶少气不足以息,是也。似喘而不摇
肩,似呻吟而无痛者,短气也。心腹胀满,邪在里而为实;心腹喘满,邪在表而为虚。有停
水心下,亦有短气。随证攻治,无不愈矣。
【更汗】短气但坐,以汗出不彻故也,更发汗则愈,葛根加人参汤。
【两解】有短气腹满而喘,有潮热者,此短气之实也,大柴胡汤。
【温经】腹濡满而短气者,邪在表而为虚也。趺阳脉浮而紧,紧则为痛,微则为虚,
相搏则为短气之虚也。风湿相搏,汗出短气,小便不利,恶风不欲去衣,甘草附子汤。
【分利】水停心下短气,五苓散。
【下】干呕短气,汗出不恶寒,此表解里未和,十枣汤。太阳病下之早,心下硬为结
胸,大陷胸汤。
蛔厥者,食即吐蛔。此为脏寒,蛔上入膈,故时或发烦,须臾复止,得食而呕,又
烦。又烦者,蛔闻会气,其人当自吐蛔。或因发汗,胃中冷,故长虫出。又有胃气困乏,
虽饥不能食,食到口,蛔闻食气而上,虚寒并于胸中,所以食与蛔并吐而出也,仲景止用乌
梅丸。
【温】《活人书》谓吐蛔为胃中虚冷,先用理中丸,或四逆汤。
【利】渴、吐蛔,理中加大黄,入蜜以利之。
水气为水饮也。水为至阴,其性寒。有内热,得水则消;身热内寒,得水,两寒相
搏,故水停心下。
【两解】表不解,心下有水气,干呕发热,喘喝,或利,或小便不利,少腹满,小青
龙汤。心下有水气,喘而咳,热不渴,服汤已渴者,此寒去欲解,小青龙汤。
【分利】中风伤寒六七日,渴欲饮水,水入即吐,有表里证,名水逆,五苓散。
【下】结胸,无大热,此水结在胁,但头汗出,大陷胸汤。
【温】少阴腹痛,小便不利,四肢疼痛下利,此有水气,或咳呕,或小便利,真
武汤。厥而心下悸,宜先治水,茯苓甘草汤。
短气,是指呼吸短促且气息不能接续的症状。《千金方》中说:少气以至于呼吸不足,指的就是这种情况。这种症状类似喘证但肩膀不耸动,类似呻吟但没有疼痛感,这就是短气。如果心腹胀满,说明病邪在里且属于实证;如果心腹部胀满且伴有喘息,说明病邪在表且属于虚证。如果有水饮停滞在心下部位,也会出现短气。根据具体证候进行针对性治疗,没有不能治愈的。
【发汗法】如果是因出汗不彻底导致的短气,患者只能坐着(无法平卧),此时应再次发汗即可痊愈,使用葛根加人参汤。
【表里双解法】如果有短气、腹部胀满且伴有喘息,同时有潮热症状,这是短气的实证,使用大柴胡汤。
【温经法】如果腹部柔软而胀满并伴有短气,说明病邪在表且属于虚证。趺阳脉呈现浮而紧的脉象,紧脉主痛,微脉主虚,虚实相搏就会导致虚性的短气。如果是风湿之邪相互搏结,出现出汗、短气、小便不利、怕风不想脱掉衣服等症状,使用甘草附子汤。
【攻下法】如果有干呕、短气、出汗且不恶寒,这说明表证已解但里证未和,使用十枣汤。太阳病过早使用攻下法,导致心下硬满形成结胸证,使用大陷胸汤。
蛔厥,是指进食后立即呕吐出蛔虫。这是因为内脏寒冷,蛔虫向上进入膈部,所以有时会出现心烦,片刻后又停止,进食后就会呕吐,并且再次感到心烦。之所以再次心烦,是因为蛔虫闻到了食物的气味,病人应当会自动吐出蛔虫。也有因为发汗过度,导致胃中寒冷,所以长虫(蛔虫)排出。还有因为胃气困乏虚弱,虽然饥饿却无法进食,食物刚到嘴边,蛔虫闻到食气就向上爬,虚寒之气聚集在胸中,所以食物和蛔虫一起被吐出来,张仲景仅使用乌梅丸治疗。
【温中法】《活人书》认为吐蛔是胃中虚冷所致,先用理中丸,或者四逆汤。
【通利法】如果有口渴、吐蛔症状,在理中丸基础上加大黄,加入蜂蜜以起到通利作用。
水气,就是水饮之邪。水属于至阴之物,性质寒凉。体内有热时,得水则能消散;如果身体发热而内部寒冷,遇到水,两寒相互搏结,所以水会停滞在心下。
【表里双解法】表证未解,心下有停水,出现干呕、发热、气喘急促,或者腹泻,或者小便不利,小腹胀满,使用小青龙汤。心下有停水,气喘且咳嗽,身体发热但不口渴,服药后感到口渴的,这是寒气去除即将痊愈的表现,仍用小青龙汤。
【分利法】中风或伤寒六七天,想喝水,水喝进去就吐出来,既有表证又有里证,称为水逆,使用五苓散。
【攻下法】结胸证,体表没有大热,这是水结聚在胁部,只有头部出汗,使用大陷胸汤。
【温阳法】少阴病腹痛,小便不利,四肢疼痛伴腹泻,这是有水气,或者伴有咳嗽呕吐,或者小便通畅,使用真武汤。四肢厥冷且心下悸动,应当先治疗水饮,使用茯苓甘草汤。
Shortness of breath refers to a symptom where respiration is rapid and shallow, with an inability to sustain the flow of Qi. The *Qianjin Fang* states: "Lack of Qi resulting in insufficient respiration," which describes this condition. This symptom resembles panting but without shoulder movement, and resembles groaning but without pain; this is shortness of breath. If there is distension and fullness in the heart and abdomen, the pathogenic factor is in the interior and constitutes an Excess pattern; if there is distension, fullness, and panting in the heart and abdomen, the pathogenic factor is in the exterior and constitutes a Deficiency pattern. If water retention occurs below the heart (epigastrium), shortness of breath may also occur. Treating according to the specific syndrome will invariably lead to recovery.
[Diaphoresis Method] If shortness of breath occurs only when sitting due to incomplete sweating, re-inducing diaphoresis will result in recovery; use Gegen Jia Renshen Tang (Pueraria Decoction with Ginseng).
[Simultaneous Resolution of Exterior and Interior] If there is shortness of breath, abdominal fullness, panting, and tidal fever, this is an Excess pattern of shortness of breath; use Da Chaihu Tang (Major Bupleurum Decoction).
[Warming the Meridians Method] If the abdomen is soft yet full accompanied by shortness of breath, the pathogenic factor is in the exterior and constitutes a Deficiency pattern. A Fuyang pulse that is Floating and Tight indicates that Tightness signifies pain, while Moderateness signifies deficiency; their interaction leads to deficient shortness of breath. If Wind-Dampness pathogens interact, causing sweating, shortness of breath, difficulty in urination, aversion to wind, and reluctance to remove clothing, use Gancao Fuzi Tang (Licorice and Aconite Decoction).
[Separation and Purging Method] For shortness of breath caused by water retention below the heart, use Wuling San (Five-Ingredient Powder with Poria).
[Purgative Method] For dry retching, shortness of breath, sweating, and absence of aversion to cold, indicating that the exterior has resolved but the interior remains disharmonious, use Shizao Tang (Ten Jujube Decoction). If Taiyang disease is treated with purgatives too early, resulting in hardness below the heart forming a Chest Bind (Jie Xiong), use Daxiexiong Tang (Major Alumen Decoction).
Hui Jue (Roundworm Cold Reversal) involves vomiting roundworms immediately after eating. This is due to cold in the zang organs, causing roundworms to ascend into the diaphragm, thus occasionally causing irritability, which ceases after a moment. Eating induces vomiting and renewed irritability. The renewed irritability occurs because the roundworms smell the food odor, and the patient should naturally vomit them out. Alternatively, excessive sweating may cause cold in the stomach, leading to the expulsion of long worms. Another scenario involves weak stomach Qi; although hungry, the patient cannot eat. When food reaches the mouth, the roundworms sense the food odor and ascend. Deficient cold accumulates in the chest, causing both food and roundworms to be vomited together. Zhang Zhongjing prescribed only Wumei Wan (Mume Pill).
[Warming the Middle Method] The *Liuren Shu* states that vomiting roundworms is due to deficiency-cold in the stomach; initially use Lizhong Wan (Regulate the Middle Pill) or Sini Tang (Frigid Extremities Decoction).
[Unblocking and Draining Method] For thirst and vomiting roundworms, add Dahuang (Rhubarb Root and Rhizome) to Lizhong Wan and incorporate honey to facilitate unblocking.
Shuiqi (Water Qi) refers to fluid retention. Water belongs to Extreme Yin and its nature is cold. If there is internal heat, water will dissipate it; however, if the body is hot externally while cold internally, encountering water causes two colds to interact, leading to water retention below the heart.
[Simultaneous Resolution of Exterior and Interior] If the exterior is unresolved and there is water Qi below the heart, presenting with dry retching, fever, wheezing, diarrhea, or difficulty in urination, and lower abdominal fullness, use Xiaqinglong Tang (Minor Blue Dragon Decoction). If there is water Qi below the heart, causing wheezing and coughing, with heat but no thirst, and thirst develops after taking the decoction, this indicates the cold is departing and resolution is imminent; continue using Xiaqinglong Tang.
[Separation and Purging Method] After six or seven days of Fengzhong (Wind Strike) or Shanghan (Cold Damage), if the patient desires to drink water but vomits immediately upon ingestion, presenting with both exterior and interior signs, this is named Shuini (Water Inversion); use Wuling San.
[Purgative Method] In cases of Chest Bind with no significant external heat, this indicates water binding in the hypochondrium, manifesting as sweating only on the head; use Daxiexiong Tang.
[Warming Yang Method] In Shaoyin disease with abdominal pain, difficulty in urination, limb pain, and diarrhea, this indicates the presence of water Qi, possibly accompanied by coughing or vomiting, or with normal urination; use Zhenwu Tang (True Warrior Decoction). For cold extremities accompanied by palpitations below the heart, water retention should be treated first; use Fuling Gancao Ganjiang Tang (Poria, Licorice, and Ginger Decoction).