喘急之证。有因暴惊触心者。有因风寒之邪壅盛者。有因膏粱积热熏蒸清道者。有因过服消
导脾胃气虚者。然喘与气急。有轻重之别。喘则欲言不能。隘于胸臆。气急则但息短心神迷闷耳。
治法。因惊者。抱龙丸。风寒伤肺气者。小
青龙汤。或三拗汤加减。热伤肺气者。当凉肺定喘。痰声如锯者。小剂金匮麦门冬汤加牙硝。脾
肺气虚者。面色青白。四肢不温。大便不实。五味异功散。薛云。前证因脾肺气虚。腠理不密。
外邪所乘。真气虚而邪气实者为多。若已发之际。散邪为主。未发之先。补脾为主。设概攻其邪。
则损真气。径补其肺。则壅其邪。惟在临证之活法耳。凡喘嗽小便不利。则必生胀。胀则必生喘。
当分先后标本治之。
小儿脾胃俱伤。则呕泄并作。伤辛热停滞。则呕吐出酸秽。或黄色乳。或腹痛下利者。泻黄
散、保和丸选用。胃虚食不化而发热者。六君子加黄连、吴茱萸、木香。若停滞已去。泄泻不已。
理中汤去参加茯苓、木香。胃气不能化食。益黄散。若伤生冷腹痛。泻利青白。六君子加砂仁、
木香、炮姜。若伤鱼肉等物。六君子加山楂、砂仁。若泻红黄赤黑。肠胃俱热也。养胃汤加木香、
黄连。若夏秋伤热。吐泻色黄者。玉露散。若夏秋霍乱吐泻。手足心热。口干唇燥。喜饮冷水者。
五苓散。凡霍乱吐泻。手足逆冷。喜饮热汤者。理中汤。若泻利青白。乳食不化。额上微汗。脉
沉迟而或哕逆者。由胃气虚甚。过服克伐。使清气不升浊气不降。以致气不宣通而作也。若泻而
嗳臭吞酸。胸腹满痛。按之益甚者。虽作泻而所伤之物未消也。保和丸消导之。腹痛按之不哭者。
乳食已消也。异功散加木香。惊泻者。肝主惊。木盛必传克于脾。脾土既衰。则乳食不化。水道
不调。故泄泻色青。或兼发搐也。亦有因乳母脾虚受惊。及怒动肝火。致儿吐泻色青。异功、六
君加柴胡、钩藤钩、蝎梢之属。实脾以宁肝胆之气。慎勿用峻攻之药。脾气益虚。肝邪弥甚。甚
至抽搐反张也。若母食
浓味而乳热者。清胃散。若母饮烧酒而乳热。或子母身赤。或昏愦吐泻。丹方用锡掇盛滚水。盖
良久。取盖上蒸气水服之即解。同气相求之义也。吐痰涎及绿水者。胃虚受冷也。吴茱萸汤。小
儿衣甚薄。则腹中乳食不消。不消则大便酸臭。此欲为癖之渐也。便将紫丸微消之。乳哺自当如
常。若儿不受食哺。而但欲乳者。此是有癖。当下之。不下必致寒热吐利。失下之故也。凡小儿
屎黄而臭甚。此腹中有伏热。龙胆汤微下之。若白而酸臭者。此宿食不消也。当与紫丸。微者少
与药令内消。甚者稍增药令小下。节乳哺数日。令胃气平和。若不节乳哺。则病易复。复下之则
令腹胀满必发痫。此为食痫。轻则下之。重则难疗。大凡吐乳泻青色。手足乍冷乍热者。属惊。
法当平肝补脾。若吐泻青白色而不甚臭。手足指冷。或昏睡露睛者。属虚。法当温补脾土。若吐
泻黄赤色而臭秽异常。或喜冷冻饮料而睡不露睛。手足指热者。属实。法当消导清理脾胃。此验虚实
补泻法也。
喘急的病症，有因突然受惊触动心神的，有因风寒邪气壅盛阻滞的，有因过食肥甘厚味积热熏蒸清道的，有因过度服用消导药物导致脾胃气虚的。然而，喘和气急是有轻重之别的：喘证表现为想要说话却说不出来，胸膈间气息阻塞；气急则只是呼吸短促、心神昏乱闷塞而已。
治疗方法：因惊恐引起的，用抱龙丸；风寒伤及肺气的，用小青龙汤，或者三拗汤加减；热邪伤及肺气的，应当凉肺定喘；痰声如拉锯般的，用小剂量金匮麦门冬汤加入牙硝；脾肺气虚的，见面色青白、四肢不温、大便不成形，用五味异功散。薛己说：上述病症多因脾肺气虚，腠理不致密，外邪乘虚而入，属于真气虚弱而邪气实盛的居多。如果在发作期间，以疏散邪气为主；在未发作之前，以补脾为主。如果一概攻伐邪气，就会损伤真气；直接补益肺气，就会壅滞邪气。这全在于临证时的灵活变通罢了。凡是喘咳且小便不利的，必然会产生胀满；产生胀满的，必然会导致气喘。应当分清先后标本进行治疗。
小儿脾胃都受损时，呕吐和泄泻会同时发生。若因辛热食物停滞，则呕吐出酸腐秽浊之物，或是黄色乳汁，或是腹痛下利，选用泻黄散或保和丸。胃虚不能消化食物而发热的，用六君子汤加黄连、吴茱萸、木香。如果停滞已去，但泄泻不止，用理中汤去掉茯苓、木香。若是胃气不能化食，用益黄散。若因生冷食物导致腹痛，泻下青色白色粪便，用六君子汤加砂仁、木香、炮姜。若因食用鱼肉等物导致，用六君子汤加山楂、砂仁。若泻下红黄赤黑各色粪便，说明肠胃俱热，用养胃汤加木香、黄连。若夏秋季节伤于热邪，吐泻颜色黄的，用玉露散。若夏秋季节霍乱吐泻，手足心热，口干唇燥，喜欢喝冷水的，用五苓散。凡是霍乱吐泻，手足逆冷，喜欢喝热汤的，用理中汤。若泻下青色白色粪便，乳食不化，额头微汗，脉象沉迟或伴有呃逆的，这是由于胃气极度虚弱，过度服用克伐药物，使得清气不升、浊气不降，导致气机宣通受阻而发病。若腹泻且嗳气有臭味、吞酸，胸腹部满痛，按压后疼痛加剧的，虽然表现为腹泻，但所伤的食物尚未消化，用保和丸消导。腹痛时按压而不哭闹的，说明乳食已经消化，用异功散加木香。惊恐引起的泄泻，肝主惊，肝木旺盛必然克制脾土，脾土既已衰弱，则乳食不化，水道不调，所以泄泻颜色青，有时兼见抽搐。也有因乳母脾虚受惊，以及怒动肝火，导致婴儿吐泻颜色青的，用异功散、六君子汤加柴胡、钩藤钩、蝎梢之类。通过实脾来安宁肝胆之气，千万不要使用峻猛攻伐的药物，否则脾气更加虚弱，肝邪更加严重，甚至出现抽搐反张。如果母亲食用浓味食物导致乳汁热，用清胃散。如果母亲饮用烧酒导致乳汁热，或者母子身体发红，或者神志昏愦吐泻，丹方建议用锡器盛满滚水，盖上很久，取盖上的蒸气水服用即可解，这是同气相求的道理。呕吐痰涎及绿水的，是胃虚受冷，用吴茱萸汤。小儿衣服穿得很薄，则腹中乳食不消化，不消化则大便酸臭，这是癖积形成的先兆，立即用紫丸轻微消导它，乳哺自然能恢复正常。如果孩子不接受固体食物，只想吃奶，这是有癖积，应当攻下，如果不攻下必然导致寒热吐利，这是失于攻下的缘故。凡是小儿大便黄而且气味很臭的，这是腹中有伏热，用龙胆汤轻微攻下。若大便白而且酸臭的，这是宿食不消化，应当给紫丸，轻症少给药令其内部消散，重症稍增加药量令其轻微攻下，节制乳食数日，使胃气平和，如果不节制乳食，病容易复发，再次攻下则会导致腹胀满并引发癫痫，这称为食痫，轻症攻下可愈，重症难治。大凡小儿吐乳泻青色，手足忽冷忽热的，属于惊，治法应当平肝补脾。若吐泻青白色且不甚臭，手足指冷，或昏睡露睛的，属于虚，治法应当温补脾土。若吐泻黄赤色且臭秽异常，或喜欢冷冻饮料且睡觉不露睛，手足指热的，属于实，治法应当消导清理脾胃。这是验证虚实进行补泻的方法。
The syndrome of panting and urgency involves several etiologies: some arise from sudden fright disturbing the Heart; others from the congestion of Wind-Cold pathogens; some from the steaming of accumulated heat caused by rich, greasy foods affecting the clear pathways; and some from excessive use of digestive agents leading to Spleen-Stomach Qi deficiency. However, there is a distinction in severity between Panting (Chuan) and Urgent Breathing (Qi Ji). Panting manifests as an inability to speak due to obstruction in the chest and diaphragm, whereas Urgent Breathing is characterized merely by shortness of breath and mental confusion or stifling sensation.
Treatment methods vary by etiology: For cases caused by fright, Bao Long Wan (Dragon Embracing Pill) is used. For Wind-Cold injuring Lung Qi, Xiao Qing Long Tang (Minor Blue Dragon Decoction) or San Ao Tang (Three Unbinding Decoction) with modifications are indicated. For Heat injuring Lung Qi, cooling the Lungs and stabilizing panting is required. If phlegm sounds like a saw, a small dose of Jin Gui Mai Men Dong Tang (Golden Casket Ophiopogon Decoction) with Ya Xiao (Saltpeter) is added. For Spleen-Lung Qi deficiency, presenting with blue-white complexion, cold limbs, and loose stools, Wu Wei Yi Gong San (Five-Ingredient Extraordinary Efficacy Powder) is prescribed. Xue Ji stated that these conditions are mostly due to Spleen-Lung Qi deficiency, where the interstices are not dense, allowing external pathogens to invade, resulting in a pattern of True Qi deficiency and Pathogenic Qi excess. During the acute phase, dispersing pathogens is primary; before onset, tonifying the Spleen is primary. If one indiscriminately attacks pathogens, True Qi is damaged; if one directly tonifies Lung Qi, pathogens become stagnant. This requires flexible clinical judgment. Generally, if panting and coughing are accompanied by difficult urination, distension will inevitably follow; if distension occurs, panting will inevitably result. Treatment must distinguish between the root and branch, and priority and sequence.
In children, when both Spleen and Stomach are injured, vomiting and diarrhea occur simultaneously. If caused by stagnation of pungent and hot foods, vomiting of sour, foul matter, yellow milk, abdominal pain, and diarrhea may occur; Xie Huang San (Yellow-Draining Powder) or Bao He Wan (Harmony-Preserving Pill) are selected. For stomach deficiency with food stagnation and fever, Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Huang Lian (Coptis Rhizome), Wu Zhu Yu (Evodia Fruit), and Mu Xiang (Aucklandia Root) is used. If stagnation has cleared but diarrhea persists, Li Zhong Tang (Regulate the Middle Decoction) without Fu Ling (Poria) and Mu Xiang is used. For Stomach Qi failing to transform food, Yi Huang San (Yellow-Spleen Powder) is indicated. If caused by raw/cold foods leading to abdominal pain and green/white stools, Liu Jun Zi Tang plus Sha Ren (Amomum Fruit), Mu Xiang, and Pao Jiang (Prepared Ginger) is used. If caused by fish/meat, Liu Jun Zi Tang plus Shan Zha (Hawthorn Fruit) and Sha Ren is used. If stools are red, yellow, dark red, or black, indicating heat in both intestines and stomach, Yang Wei Tang (Nourish-Stomach Decoction) plus Mu Xiang and Huang Lian is used. For summer-autumn heat injury causing yellow vomiting/diarrhea, Yu Lu San (Jade Dew Powder) is used. For summer-autumn cholera-like vomiting/diarrhea with hot palms/soles, dry mouth/lips, and preference for cold drinks, Wu Ling San (Five-Ingredient Powder with Poria) is used. For cholera-like vomiting/diarrhea with cold extremities and preference for hot drinks, Li Zhong Tang is used. If stools are green/white, undigested food is present, there is slight sweating on the forehead, pulse is deep/slow, or hiccups occur, this is due to severe Stomach Qi deficiency and overuse of harsh purgatives, causing failure of Clear Qi to ascend and Turbid Qi to descend, leading to blocked Qi mechanism. If diarrhea is accompanied by foul belching, acid regurgitation, chest/abdominal fullness/pain worsened by pressure, although diarrhea is present, the ingested food has not yet digested; Bao He Wan is used for digestion. If abdominal pain does not cause crying upon pressure, the food has digested; Yi Gong San plus Mu Xiang is used. For fright-induced diarrhea, since the Liver governs fright, excessive Liver Wood must overcome Spleen Earth. With weakened Spleen Earth, food fails to transform and water passages become disordered, resulting in green stools or convulsions. It may also stem from a nursing mother’s Spleen deficiency/fright or Liver Fire agitation, causing the infant’s green vomiting/diarrhea; Yi Gong San or Liu Jun Zi Tang plus Chai Hu (Bupleurum Root), Gou Teng Gou (Uncaria Hook), and Xie Shao (Scorpion Tail) is used. By strengthening the Spleen, Liver/Gallbladder Qi is pacified; harsh purgatives must be avoided, lest Spleen Qi further weaken and Liver Pathogens intensify, potentially leading to convulsions and opisthotonos. If the mother consumes rich flavors causing hot milk, Qing Wei San (Clear-Stomach Powder) is used. If the mother drinks liquor causing hot milk, or if mother/infant have red bodies, or unconsciousness/vomiting/diarrhea, a folk prescription suggests covering boiling water in a tin vessel for a long time and administering the condensed steam water, based on the principle of "similar energies seeking each other." Vomiting of phlegm-saliva and green water indicates Stomach deficiency with Cold; Wu Zhu Yu Tang is used. If infants wear thin clothes, food in the abdomen fails to digest, leading to sour-smelling stools, which is a precursor to Pi accumulation (masses); Zi Wan (Purple Pill) should be used mildly to dissipate it, restoring normal feeding. If the child refuses solid food but desires breast milk, this indicates Pi accumulation requiring purgation; failure to purge will lead to alternating chills/fever and vomiting/diarrhea due to missed treatment. Yellow, foul-smelling stools indicate latent heat in the abdomen; Long Dan Tang (Gentian Decoction) is used mildly to purge. White, sour-smelling stools indicate undigested old food; Zi Wan is given. Mild cases receive small doses to dissolve internally; severe cases receive slightly increased doses for mild purgation. Breastfeeding should be restricted for several days to harmonize Stomach Qi; otherwise, relapse is likely. Repeated purgation leads to abdominal distension and epilepsy, known as Food Epilepsy (Shi Xian). Mild cases respond to purgation; severe cases are difficult to treat. Generally, vomiting milk and green diarrhea with alternating cold/hot extremities indicates Fright; treatment should calm the Liver and tonify the Spleen. Green/white vomiting/diarrhea with little odor, cold toes, or sleeping with eyes open indicates Deficiency; treatment should warm and tonify Spleen Earth. Yellow/red vomiting/diarrhea with extreme foul odor, preference for cold drinks, sleeping with eyes closed, and hot toes indicates Excess; treatment should resolve stagnation and clear the Spleen/Stomach. This constitutes the method for verifying Excess/Deficiency to apply Tonification/Purgation.