喘胀二因，皆小便不利，喘则必生胀，胀则必生喘，但证有先后之殊，而复有标本之异
，可
得而辨焉。何则？先喘而后胀者，生于肺；先胀而后喘者，生于脾。盖肺金司降，外主皮毛
。经曰∶肺朝百脉，通调水道，下输膀胱，是小便之行，由于肺气之降下而输化也。若肺受
邪而上喘，则失降下之令，故小便渐短，以致水溢皮肤而生肿满焉，此则喘为本而胀为标也
。脾土恶湿，外主肌肉，土能克水，若脾土受伤，不能制水，则水湿妄行，漫渍肌肉，水既
上溢，则邪反侵肺，气不得降而生喘矣，此则胀为本而喘为标也。属肺者，当清金降气，而
行水次之；属脾者，当实脾行水，而清金次之。苟肺证而用燥脾之药，则金得燥而喘愈加
；脾病而用清金之药，则脾得寒而胀愈甚矣。治喘胀者，但知实脾行水，不知分别脾肺先后
之证，故为发明之。
经云∶出入废则神机化灭，升降息则气立孤危。又云∶一息不运则机缄穷，一毫不续则
穹壤
判。此言人生之气出入升降，贵乎往来不穷，乃成生生之妙用。若外为六淫所伤，内为七情
所结，则喘哮、短气、少气、气逆、息贲之证，种种作矣。然何以辨之？喘者，促促气急，
喝喝痰声，张口抬肩，摇身撷肚，由于肺气感邪，肺叶张举，或虚而挟寒；或实而挟热，或
水气上乘，虚火上炎；或气郁所感，脾胃不足，皆有此候。风寒必有冷痰如冰之证；实热必
有壅盛燥渴之证；水气必胁下胀满有声，四肢浮肿；虚火必得食即减，食已即发，乍进乍退
；气郁必鼻息引张，烦闷胸满，胃虚必气道奔急，喘甚不休。治者随证而施。使浮游之火下
降，清肃之令下行，自不复有火矣。哮者与喘相类，但不似喘开口出气之多。《圣济总录》
名为呷嗽是也，以胸中多痰，结于喉间，与气相系，随其呼吸有呀呷之声。得之咸酸太过，
积热胶痰，痰去则声少息。倘不节口，而胸中未尽之痰，得新味相结，哮又作矣，治之以吐
痰为生。若遇冷而发者，因中外皆寒，宜温其肺金。若寒包其热者，宜清肺药中兼加发散，
则自然愈也。短气者，呼吸虽急而不接续，似喘无痰声，亦不摇肩呻吟，而无痛禁，虽若气
上冲，实非气上冲也。凡气食阻者宜泻之，元气虚者宜补之。少气者，气少不足以言，即经
所谓言而微，终日复言，为夺气之候，皆因中气不足所致，故短气犹有属实，少气惟有补虚
而
已。逆气者，但气上奔急，肺壅而不下，若有不能呼吸之状，实于哮喘短气不同。息贲者，
五积中之肺积也，喘息奔急，亦名息积，右胁下必有积块以别之。人之五脏，皆有上气，而
肺为之总司，其体清虚，有升有降，即出入皆利，其用健运，少气少血，即升降无资。故喘
哮诸证，皆在肺金分野，治之亦宜在肺。然属实者，毋庸更论；属虚者，又应变通。如土虚
而
不能生金者，则治在脾而中枢能运；或肾虚而不能纳气者，治在肾而北门有锁。皆以气味浓
药，实其中下二焦之间，不得泥夫壅逆之候，而束手逡巡也。
喘证和胀证这两种病，其共同点都是小便不利。喘证必然导致胀证，胀证也必然导致喘证，但病情表现有先后顺序的不同，且有本证与标证的差异，可以加以辨析。为什么呢？先出现喘证而后出现胀证的，病源在肺；先出现胀证而后出现喘证的，病源在脾。因为肺属金，主司肃降，外合皮毛。医经说：肺朝百脉，通调水道，向下输注至膀胱，这说明小便的排泄，是由于肺气肃降下行而输布转化的结果。如果肺受邪气侵袭而上逆作喘，就失去了肃降的功能，因此小便逐渐短少，导致水湿泛滥于皮肤而生肿胀满闷，这是以喘为本、以胀为标。脾属土，厌恶湿气，外主肌肉，土能克水。如果脾土受伤，不能制约水湿，则水湿妄行，浸渍肌肉，水湿既已上溢，邪气反而侵犯肺脏，气机不得肃降而产生喘证，这是以胀为本、以喘为标。属于肺脏病变的，应当清肃肺气、降逆平喘，其次再利水消肿；属于脾脏病变的，应当健脾益气、利水渗湿，其次再清肃肺气。如果是肺证却使用燥湿健脾的药物，那么肺金得到燥性，喘证会更加严重；如果是脾病却使用清泻肺金的寒凉药物，那么脾土受到寒凉，胀证会更加剧烈。治疗喘证和胀证的人，只知道健脾利水，不知道分辨脾肺病变的先后主次，所以我对此进行阐明。
医经说：出入功能废弛，则神机化灭；升降运动停止，则气立孤危。又说：一息之气不运，则生机穷尽；丝毫之气不续，则天地判然分离。这是说人体之气的出入升降，贵在往来无穷，才能形成生生不息的奇妙作用。如果外受六淫邪气伤害，内为七情所结滞，那么喘哮、短气、少气、气逆、息贲等证候，就会种种发作。然而如何辨别它们呢？喘证，表现为气息急促，喉间有痰鸣声，张口抬肩，摇动身体，撷缩腹部，这是由于肺气感受邪气，肺叶张举所致，或是虚证兼夹寒邪，或是实证兼夹热邪，或是水气上乘，或是虚火上炎，或是气郁所感，或是脾胃不足，都有这种征候。风寒证必有冷痰如冰的表现；实热证必有壅盛燥渴的表现；水气证必有胁下胀满有声、四肢浮肿的表现；虚火证必是进食后减轻，食后即发，时好时坏；气郁证必是鼻息引张，烦闷胸满；胃虚证必是气道奔急，喘促不休。治疗者根据证候施治。使浮游之火下降，清肃之令下行，自然不再有火邪了。哮证与喘证相似，但不像喘证那样开口出气多。《圣济总录》称之为呷嗽，是因为胸中多痰，结于喉间，与气相系，随着呼吸发出呀呷的声音。这是因为咸酸太过，积热胶结痰液，痰去则声音减少、喘息平息。如果不节制饮食，胸中未尽之痰与新味相结合，哮证又会发作，治疗以吐痰为生路。如果遇到寒冷而发作的，是因为内外皆寒，宜温补肺金。如果是寒包热证，宜在清肺药中兼加发散药，则自然痊愈。短气证，呼吸虽然急促但不能接续，似喘证但没有痰声，也不摇肩呻吟，更没有痛禁，虽然好像气上冲，其实并非气上冲。凡是气食阻滞的应当泻之，元气虚弱的应当补之。少气证，气少不足以说话，即医经所说的“言语轻微，终日反复重复”，这是夺气的征候，都是因为中气不足所致，所以短气还有属于实证的，少气只有补虚这一种治法。逆气证，只是气向上奔急，肺壅塞而不能下行，好像不能呼吸的样子，实际上与哮喘、短气不同。息贲证，是五积中的肺积，喘息奔急，也叫息积，右胁下一定有积块来区别它。人的五脏，都有上气（气机上逆）的情况，而肺为之总司，肺体清虚，有升有降，如果出入都通畅，其功能健运，如果少气少血，那么升降就没有凭借。所以喘哮诸证，都在肺金的分野，治疗也应当在肺。然而属于实证的，无需多论；属于虚证的，又应当变通。如土虚不能生金者，则治疗在脾，中枢得以运转；或肾虚不能纳气者，治疗在肾，北门（指肾）有锁固。都是用气味浓厚的药物，充实其中下二焦之间，不得拘泥于壅逆的证候，而束手无策、犹豫不前。
Both asthma (Chuan) and distension (Zhang) share the common symptom of difficult urination. Asthma inevitably leads to distension, and distension inevitably leads to asthma. However, there are differences in the sequence of symptoms and in the distinction between root (Ben) and branch (Biao), which can be differentiated. Why is this so? When asthma precedes distension, the pathology originates in the Lung; when distension precedes asthma, the pathology originates in the Spleen. The Lung belongs to Metal and governs descending, while externally governing the skin and hair. The Classics state: "The Lung faces all vessels, regulates water passages, and transmits downward to the Bladder." This indicates that the excretion of urine depends on the descending and transforming function of Lung Qi. If the Lung is invaded by pathogenic factors and causes upward rebellion leading to asthma, it loses its descending command. Consequently, urine becomes scanty, leading to water overflowing into the skin and causing swelling and fullness. In this case, asthma is the root and distension is the branch. The Spleen belongs to Earth, dislikes dampness, and externally governs muscles. Earth controls Water. If the Spleen Earth is injured and cannot control Water, then water-dampness runs wild, soaking into the muscles. Once water overflows upward, the pathogen invades the Lung, and Qi fails to descend, generating asthma. Here, distension is the root and asthma is the branch. For cases originating in the Lung, one should clear Lung Metal and direct Qi downward, with promoting diuresis as secondary. For cases originating in the Spleen, one should strengthen the Spleen and promote diuresis, with clearing Lung Metal as secondary. If a Lung syndrome is treated with drugs that dry the Spleen, the Lung Metal will become dry, and asthma will worsen. If a Spleen disease is treated with drugs that clear Lung Metal, the Spleen Earth will suffer from cold, and distension will intensify. Those who treat asthma and distension often only know how to strengthen the Spleen and promote diuresis, failing to distinguish the sequential syndromes of the Spleen and Lung. Therefore, I elucidate this point.
The Classics say: "If exit and entry cease, the Spirit mechanism perishes; if ascent and descent stop, the Qi establishment stands alone in peril." It also says: "If breath does not move for an instant, the mechanism is exhausted; if continuity is lost for even a moment, heaven and earth are separated." This speaks to the fact that human Qi's exit and entry, ascent and descent, must flow endlessly to achieve the wonderful function of life. If externally injured by the Six Evils (Liu Yin) or internally constrained by the Seven Emotions, various syndromes such as asthma-wheezing (Chuan Xiao), shortness of breath (Duan Qi), insufficient Qi (Shao Qi), rebellious Qi (Qi Ni), and surging breath (Xi Ben) will arise. How then to differentiate them? Asthma (Chuan) is characterized by hurried, rapid breathing, audible phlegm sounds, opening the mouth and raising the shoulders, shaking the body, and pulling in the abdomen. It arises from Lung Qi being affected by pathogens, causing the lung lobes to expand. It may be deficiency accompanied by cold, excess accompanied by heat, water qi surging upward, deficient fire flaming upward, emotional Qi stagnation, or insufficiency of the Spleen and Stomach. Wind-cold syndromes necessarily present with cold phlegm like ice; excess-heat syndromes necessarily present with congestion, fullness, and dry thirst; water-qi syndromes necessarily present with distension and sound in the hypochondrium and edema of the four limbs; deficient-fire syndromes necessarily improve after eating and recur immediately after meals, fluctuating in intensity; Qi-stagnation syndromes necessarily present with drawn nasal breathing, irritability, and chest fullness; Stomach-deficiency syndromes necessarily present with urgent rushing of the airway and unceasing severe asthma. The practitioner treats according to the syndrome. By directing the floating fire downward and allowing the clear, pure command to descend, the fire will naturally cease. Wheezing (Xiao) is similar to asthma but differs in that it does not involve as much open-mouthed exhalation. The *Shengji Zonglu* calls it "Xi Sou" (gurgling cough). It occurs because there is much phlegm in the chest, knotting in the throat, connected with Qi, producing a gurgling sound with respiration. It results from excessive salty and sour flavors, accumulating heat and gumming up phlegm. When the phlegm is removed, the sound decreases and breathing rests. If dietary habits are not regulated, the remaining phlegm in the chest binds with new flavors, and wheezing recurs. Treatment focuses on expelling phlegm. If triggered by cold, it is due to cold inside and outside, requiring warming of the Lung Metal. If it is cold enveloping heat, one should add dispersing herbs to the Lung-clearing formula, and it will naturally heal. Shortness of breath (Duan Qi) involves rapid breathing that is not continuous. It resembles asthma but lacks phlegm sounds, shoulder shaking, groaning, or pain/stiffness. Although it seems like Qi surging upward, it is not truly Qi surging. For cases where Qi and food are obstructed, purgation is indicated; for cases of Yuan Qi deficiency, tonification is indicated. Insufficient Qi (Shao Qi) means there is not enough Qi to speak. This corresponds to the Classic's description of "whispering voice, repeating words throughout the day," which is a sign of Qi depletion, caused by insufficiency of Middle Qi. Thus, shortness of breath can still belong to excess, whereas insufficient Qi requires only tonifying deficiency. Rebellious Qi (Qi Ni) is simply Qi rushing upward urgently, with Lung congestion preventing downward movement, resembling an inability to breathe. It is distinct from asthma, wheezing, and shortness of breath. Xi Ben (Surging Breath) is the Lung accumulation among the Five Accumulations (Wu Ji). It features urgent panting and is also called Xi Ji (Accumulated Breath). There must be a mass under the right hypochondrium to distinguish it. All five Zang organs can have ascending Qi, but the Lung is the master. Its structure is clear and empty, with ascent and descent. If exit and entry are smooth, its function operates vigorously. If Qi and Blood are scarce, ascent and descent lack support. Therefore, asthma and wheezing syndromes fall within the domain of Lung Metal, and treatment should focus on the Lung. However, for excess syndromes, no further discussion is needed; for deficiency syndromes, flexibility is required. If Earth deficiency fails to generate Metal, treatment focuses on the Spleen, allowing the central pivot to rotate. If Kidney deficiency fails to grasp Qi, treatment focuses on the Kidney, securing the "North Gate." One uses herbs with strong flavors and properties to fill the middle and lower Jiao. One must not be stuck by the condition of congestion and rebellion, leaving one helpless and hesitant.