经曰。诸病喘满。皆属于热。（寒则息迟气微。热则息数气粗。）咳嗽上气。厥在胸中。过
在手阳明太阴。气有余则喘咳。上气不足则息利少气。肺气虚。则鼻塞不利。少气。实则喘喝。
胸盈仰息。秋脉不及。则令人喘。呼吸少气。劳则喘息汗出。邪
入六腑。则身热不得卧。上为喘呼。夜行则喘出于肾。淫气病肺。有所堕恐。喘出于肝。淫气害
脾。有所惊恐。喘出于肺。淫气伤心。渡水跌仆。喘出于肾与骨。肝脉若搏。因血在胁下。令人
喘逆。喘咳者。是水气并阳明也。不得卧。卧则喘者。是水气之客也。起居如故而息有音者。此
肺之络脉逆也。二阳之病发心脾。其传为息贲者。死不治。（二阳阳明也。土不能生金。而心火
复刑之则肺伤。故息上奔而喘。）乳子中风热。喘鸣肩息者。脉实大而缓则生。急则死。（乳子。
言产后以乳哺子时。非婴儿也。）戴复庵云。有痰喘。有气急喘。有胃气虚喘。有火炎上喘。痰
喘者。凡喘便有痰声。气急喘者。呼吸急促而无痰声。胃气虚喘者。抬肩撷项。喘而不休。火炎
上喘者。乍进乍退。得食则减。食已则喘。大概胃中有实火。膈上有稠痰。得食入咽。坠下稠痰。
喘即暂止。稍久食已入胃。助其湿火。痰再升上。喘反大作。俗不知此。作胃虚治。治以燥热之
药者。是以火济火也。
赵养葵曰。喘与短气分。则短气是虚。喘是实。然喘多有不足者。短气间有有余者。新病亦
有本虚者。不可执论也。如实喘者。气实脉盛。呼吸不利。肺窍壅塞。右寸沉实。宜泻肺。虚喘
者。先觉呼吸气短。两胁胀满。右尺大而虚。宜补肾。此肾虚证。非新病虚者乎。邪喘者。由寒
邪伏于肺中。关窍不通。呼吸不利。若寸沉而紧。此外感也。亦有六部俱伏者宜发散。则身热退
而喘定脉出此郁证。人所难知。非短气中之有余者乎。又一等似火非火。似喘非喘者。诸阳气浮。
无所根据归。故上气而喘也。其人平日若无病。但觉气喘。非气喘也。乃气不归源也。不知者。以
其有火也误以凉药清之。以其喘急难禁也又用四磨之类宽之。下咽之后。似觉稍宽。少顷依然。
岂知宽一分。更耗一分矣。惟大剂参、 补剂。加补骨脂、阿胶等以镇于下。后以八味丸加五味、
鹿茸。不时服之。又一等火郁之证。六脉俱涩。甚至沉伏。四肢
悉寒。甚至厥逆。拂拂气促而喘。却似有余。而脉不紧数。欲作阴虚。而按尺鼓指。此为蓄郁已
久。阳气拂遏。不能营运于表。以致身冷脉微。而闷乱喘急。当此之时。不可以寒药下之。又不
可以热药投之。惟逍遥散合佐金丸之类宣通蓄热。得汗而愈。后仍以六味丸养阴和阳可也。
喻嘉言曰。喘病无不本于肺。惟兼三阴者为最剧。而三阴又以肾为最剧。有此证者。首重在
节欲。收摄肾气。不使上攻可也。故喘病兼少阴肾者为最剧。肾火动则水气升。其次则太阴脾。
脾火动则湿气升。又次则厥阴肝。肝火动则风气升。是故治喘以治火为先也。然浊气既随火而升。
火降而气不降者何耶。以浊气虽居于下。而肺之窠囊。可以侨寓其中。转使清气逼处不安。是虽
以治火为先。然治火而不治痰无益也。治痰而不治窠囊之痰。虽治与不治等也。惟姜汁、竹沥。
可以透窠囊耳。
李士材曰。内经论喘。其因众多。究不越于火逆上而气不降也。虽然。火则一。而虚实攸分。
每见世俗一遇喘家。纯行破气。于太过者当矣。于不及者可乎。余尝论证。因虚而死者十九。因
实而死者十一。治实者攻之即效。无所难也。治虚者补之。未必即效。须悠久成功。其间转折进
退。良非易也。故辨证不可不急。而辨喘证尤为急也。巢氏严氏。止言实喘。独王海藏云。肺气
果盛。则清肃下行。岂复为喘。皆以火烁真气。气衰则喘。所谓盛者非肺气也。肺中之火也。斯
言高出前古。惜乎但举其端。未能缕悉。请得其详而言之。气虚而火入于肺者。补气为先。生脉
散。有痰。六君子汤。阴虚而火乘金不得卧者。壮水为急。六味丸。虚则合生脉散。风寒者解其
邪。华盖散。湿气胜者利其水。渗湿汤。暑邪者涤其烦。白虎汤。痰壅者消其痰。二陈汤。气郁
者疏其郁。四七汤。肺胀者散其邪。脉浮大者。越婢加半夏汤。脉浮者。小
青龙加石膏汤。肾虚火不归源。八味丸。肾虚水邪泛滥。济生肾气丸。此治喘之大法也。
喘嗽气从脐下冲上。而尺脉洪盛或数。兼见盗汗潮热。属阴虚。六味丸作汤。加补骨脂、五
味子。送下灵砂丹。误用四磨必死。若作痰治亦危。有因气而喘者。遇恼便发。脉必沉弦。此气
滞其痰也。苏子降气汤。若但喘不嗽。不分远近。前汤吞灵砂丹。秋冬感寒。每夜连嗽不绝。大
喘至天明方缓。胁动痞闷者。麻黄苍术汤。肺虚受寒而喘。参苏温肺汤。寒郁热邪。而喘中有积
痰。遇冷即发。麻黄定喘汤。远年咳逆上气。胸满痞塞。声不出者。人参定喘汤。虚冷上气。劳
嗽喘乏。千金用半夏一升。人参、生姜、桂心、甘草各一两。水煎。分三次服。喘咳上气不得卧。
生姜、橘红、人参、紫苏各一钱。五味数粒。煎服。肾与肺胃俱虚。喘嗽乏力。人参一钱。核桃
肉三枚连皮蜜炙。煎服神验。肾气上逆而喘。用连皮核桃肉三枚。生姜三片。临卧细嚼即安。七
情郁结。上气喘急。四磨汤、四七汤选用。肥盛多痰。喘不得休。不能卧。人扶而坐数日者。千
缗汤一服即安。或千缗汤合导痰汤尤妙。然惟元气未衰者宜之。虚人未可轻试也。喘而诸药不效。
腹坚脉实者。神保丸大。便溏者勿用。气实人误服参、 而喘者。三拗汤泻之。但伏不得卧。咳
逆上气。面目浮肿者。古今录验续命汤。气盛有余。脉来滑实者勿用。经年喘嗽。遇寒更甚者。
九宝汤、宁嗽化痰汤选用。一切喘证。属有余者。治之即愈。若属虚证。误与泄气。祸不旋踵。
即暴喘腹胀。大便实者。方可用药。加以溏泄。必死勿治。此阴火暴逆于手足太阴。所以喘胀。
肾气失守。所以便溏。其人虽强。不久当呕血而死。
〔诊〕脉宜浮迟。不宜急疾。喘逆上气。脉数有热。不得卧者难治。上气面浮肿。肩息脉浮大
者危。上气喘息低昂。脉滑手足温者生。脉涩手足寒者死。右寸沉实而紧。为肺感邪。亦有六部俱伏者。宜发散。大抵喘属肺中火盛。脉浮滑者可治。若沉滑为肾虚阴火上逆难治。
短气 短气者。一属支饮。脉必弦滑。平人无寒热。冒眩。短气不足出息者。实也。金匮云。
短气有微饮。当从小便去之。苓桂术甘汤主之。肾气丸亦主之。仲景并出二方。分呼吸之短而治。
妙义益彰。呼气之短。用苓桂术甘汤以通其阳。阳气化。则小便能出矣。吸气之短。用肾气丸以
通其阴。肾气通。则小便之关门利矣。又云。咳逆倚息。不得卧。小青龙汤。胀满者。浓朴大黄
汤。（即小承气汤。）一属气虚。东垣云。短气者。肺主诸气。五脏之气皆不足。而阳道不行也。
气短小便利者。四君子去茯苓加黄 。如腹中气不转者倍甘草。肺气短促或不足者。倍参加白芍。
使肝胆之邪不敢犯之。若失血后阴火上乘而短气不足以息。或肾虚发热唾痰者。生脉散加归、 、
生地。病后产后。一切疮疽溃后。气虚不能接续。及年高病久。正气耗散之人。虽有痰火。不可
作有余治。误用耗气之药。祸不旋踵。须大剂生脉散为君。少佐陈皮。扶接元气为主。
少气 少气者。气少不足以言也。经曰。怯然少气者。是水道不行。形气消索也。又云。言
而微。终日乃复言者。此夺气也。又云。气虚者。言无常也。又云。脾脉搏坚而长。其色黄。当
病少气。其治法不离独参汤、生脉散、保元汤、异功散之类。
逆气 经曰。人有逆气。不得卧而息有音者。是阳明之逆也。足三阳下行。今逆而上行。故
息有音也。阳明者胃脉也。胃者六腑之海。其气亦下行。阳明逆不得从其道。故不得卧而息有音也。
夫起居如故而息有音者。是肺之络脉逆也。络脉不得随经上下。故留经而不行。络脉之病患也微。
故起居如故而息有音也。夫不得卧卧则喘者。是水气
之客也。夫水者。循津液而流也。肾者水脏。主津液。主卧与喘也。若四磨汤、七气汤。皆治阳
明之气逆。杏子汤、小青龙汤、越婢汤、苏子降气汤。皆治肺络之气逆。麻黄附子细辛汤、肾气
丸、灵砂丹。皆治肾气之逆。
哮 哮证多属寒包热邪。所以遇寒即发。喉中水鸡声。有积痰在肺络中。必用吐法以提散之。
不可纯用寒凉。常须兼带辛散。小青龙汤探吐最妙。年高气弱人忌吐。凡喘未发时。以扶正气为
主。既发时。以散邪为主。哮喘遇冷则发。其法有二。一属中外皆寒。温肺汤、钟乳丸、冷哮丸
选用。并以三建膏护肺俞穴最妙。一属寒包热。越婢加半夏汤、麻黄定喘汤。表散其邪。平时用
芦吸散亦妙。古人治寒包热邪。预于八九月未寒之时。用滚痰丸下其热痰。后至冬无热可包。则
不发矣。丹方治冷哮痰喘。用胡椒四十九粒。入活虾蟆腹中。盐泥 存性。卧时。分三次醇酒服
之。羸者凉分五七服。用之辄效。若有伏热者误用。喘逆倍剧。不可不辨。冷哮灸肺俞膏肓天突。
有应有不应。夏月三伏中。用白芥子涂法。往往获效。方用白芥子净末一两。延胡索一两。甘遂、
细辛各半两。共为细末。入麝香半钱。杵匀。姜汁调涂肺俞膏肓百劳等穴。涂后麻瞀疼痛。切勿
便去。候三炷香足。方可去之。十日后涂一次。如此三次。病根去矣。遇浓味则发者。用莱菔子
炒研一两。猪牙皂荚烧存性三钱。共为细末。姜汁调蒸饼为丸。绿豆大。每服五十丸。沸汤或枳
实汤下。名清金丹。消其食积。则肺胃自清。仍当薄滋味以清肺胃之气。伤咸冷冻饮料食而喘者。用
白面二钱。砂糖二钱。饴糖饼化汁。捻作饼子。炉内炸熟。划出。加轻粉四钱。令患人食尽。吐
出病根即愈。年幼体虚者。分三四次服之。盖咸哮肺胃受伤。白面、砂糖、胶饴甘温恋膈。使之
留连病所。引领轻粉搜涤淤积之痰上涌。三涌三补。屡建奇功。补用五味异功稍加细辛服之。醋
呛而嗽。甘草二两。中半劈开。用猪胆汁五枚。浸五日。火炙为末。蜜丸。茶
清吞二钱。临卧服之。凡哮证见胸凸背驼者。此肺络败。为痼疾。不治。
飞畴治韩顺溪内子。患喘证月余。服破气宽胸豁痰清火等药。不效。发表利水亦不应。其疾
转急。稍动则喘难休息。诊之。六脉细数。而面赤戴阳。用大剂六味地黄作汤。加青铅两许。一
服而缓。二服而止。
《黄帝内经》说：各种疾病出现喘满症状，大多属于热证。（寒证则呼吸缓慢、气息微弱；热证则呼吸急促、气息粗重。）咳嗽且气逆上冲，病邪厥在于胸中，病变涉及手阳明大肠经和手太阴肺经。肺气有余就会喘咳，肺气不足就会呼吸通畅但气息短少。肺气虚弱，就会出现鼻塞不通畅、气息短少；肺气实证则会喘息有声、胸部胀满、仰面呼吸。秋季脉象不及（软弱无力），就会使人气喘、呼吸短少。劳累就会喘息出汗，邪气侵入六腑，就会身体发热、不能安卧，表现为上部的喘呼。夜间行走则喘息出于肾，淫邪之气伤肺；若有堕坠惊恐之事，喘息出于肝，淫邪之气伤害脾；若有惊恐之事，喘息出于肺，淫邪之气伤害心；渡水跌仆，喘息出于肾与骨。肝脉若搏动有力，是因为血液瘀滞在胁下，令人喘逆。喘咳，是水气并犯阳明经所致。不能平卧，一躺下就喘的，是水气客居体内。起居如常但呼吸有声音的，这是肺的络脉气机逆乱。足阳明胃和足太阴脾的病发于心脾，其传变成为息贲病的，预后不良，难以治愈。（二阳指阳明经，脾土不能生肺金，而心火又克制它，导致肺受伤，所以气息上奔而喘。）产后哺乳期妇女感受风热，出现喘鸣、耸肩呼吸的，如果脉象实大而缓则生机尚存，脉象急疾则死亡。（乳子，指产后正在哺乳婴儿的妇女，并非指婴儿。）戴复庵说：有痰喘，有气急喘，有胃气虚喘，有火炎上喘。痰喘，凡是喘促伴有痰声的；气急喘，呼吸急促但没有痰声；胃气虚喘，抬肩撷颈，喘促不停；火炎上喘，病情时轻时重，进食后减轻，吃完饭后反而喘促加重。大抵是胃中有实火，膈上有稠痰，食物咽下后，坠下稠痰，喘促暂时停止；过一会儿食物进入胃中，助长湿火，痰再次升上，喘促反而大作。世人不知道这个道理，当作胃虚来治，用燥热药物治疗，这是以火救火。
赵养葵说：将喘与短气区分开，则短气属虚，喘属实。然而喘症多由正气不足引起，短气间或有实证。新发病也有本虚的情况，不可固执己见。如实喘，气实脉盛，呼吸不利，肺窍壅塞，右寸脉沉实，宜泻肺；虚喘，先感觉呼吸气短，两胁胀满，右尺脉大而虚，宜补肾。这是肾虚证，不是新病的虚证吗？邪喘，是由于寒邪潜伏在肺中，关窍不通，呼吸不利，如果寸脉沉而紧，这是外感病。也有六部脉都伏匿的，宜发散，则身热退而喘定脉出，这是郁证，人们很难知晓，不是短气中的有余者吗？又有一类似火非火、似喘非喘的，是诸阳气浮越，无所归依，所以上气而喘。这个人平时若无病，只觉气喘，其实不是气喘，而是气不归源。不知情的人，因为他有火，误用凉药清之；因为他喘急难忍，又用四磨汤之类宽胸理气。喝下去之后，似乎觉得稍宽，片刻后又恢复原状。哪里知道宽一分，更耗损一分元气啊！只有用大剂量人参等补剂，加补骨脂、阿胶等药物镇摄于下，后用八味丸加五味子、鹿茸，不时服用。又一类是火郁之证，六脉俱涩，甚至沉伏，四肢悉冷，甚至厥逆，气息急促而喘，却看似有余，而脉不紧数，想诊断为阴虚，但按尺脉鼓指。这是因为蓄郁已久，阳气拂遏，不能营运于体表，以致身冷脉微，而闷乱喘急。在这个时候，不可以用寒药攻下，也不可以用热药投喂。只有用逍遥散合佐金丸之类宣通蓄热，得汗而愈，后仍以六味丸养阴和阳即可。
喻嘉言说：喘病没有不根源于肺的，只有兼及三阴经的为最严重，而三阴经中以肾为最严重。有此证的人，首要在于节制欲望，收摄肾气，不让其上攻即可。所以喘病兼少阴肾的为最严重，肾火动则水气升；其次则是太阴脾，脾火动则湿气升；又次则是厥阴肝，肝火动则风气升。因此治疗喘病以治火为先。然而浊气既然随着火而上升，火降了而气不降是什么原因呢？因为浊气虽然居于下，但肺的窠囊可以寄居其中，反而使清气逼处不安。所以虽然以治火为先，但治火而不治痰是无益的。治痰而不治窠囊之痰，虽然治了和不治一样。只有姜汁、竹沥，可以透入窠囊。
李士材说：《内经》论述喘症，原因众多，究其根本不离火逆上而气不降。虽然火是一样的，但虚实有所区别。常见世俗之人一遇到喘症，纯用破气药，对于太过者是对的，对于不及者可以吗？我曾经论证，因虚而死的是十分之九，因实而死的是十分之一。治实证攻伐即见效，没有什么难的；治虚证补益，未必立即见效，需要长久才能成功，其间转折进退，实在不容易。所以辨证不可不急，而辨喘证尤为紧急。巢元方、严用和只谈实喘，唯独王海藏说：“肺气果盛，则清肃下行，岂复为喘？”都认为火灼伤真气，气衰则喘。所谓盛者不是肺气盛，而是肺中之火。这话高出前古，可惜只是举其端绪，未能详尽。请让我详细说明。气虚而火入于肺的，补气为先，用生脉散；有痰的，用六君子汤；阴虚而火乘金不得卧的，壮水为急，用六味丸；虚则合用生脉散。风寒的解其邪，用华盖散；湿气胜的利其水，用渗湿汤；暑邪的涤其烦热，用白虎汤；痰壅的消其痰，用二陈汤；气郁的疏其郁，用四七汤；肺胀的散其邪，脉浮大的用越婢加半夏汤，脉浮的用小青龙加石膏汤；肾虚火不归源的，用八味丸；肾虚水邪泛滥的，用济生肾气丸。这是治疗喘症的大法。
喘嗽气从脐下冲上，而尺脉洪盛或数，兼见盗汗潮热，属阴虚，用六味丸作汤剂，加补骨脂、五味子，送服灵砂丹。误用四磨汤必死。若作痰治也危险。有因气而喘的，遇恼怒便发作，脉必沉弦，这是气滞导致痰阻，用苏子降气汤。若但喘不嗽，不分远近，前汤吞服灵砂丹。秋冬感寒，每夜连嗽不绝，大喘至天明才缓解，胁动痞闷的，用麻黄苍术汤。肺虚受寒而喘，用参苏温肺汤。寒郁热邪，而喘中有积痰，遇冷即发的，用麻黄定喘汤。远年咳逆上气，胸满痞塞，声不出的，用人参定喘汤。虚冷上气，劳嗽喘乏，千金方用半夏一升，人参、生姜、桂心、甘草各一两，水煎，分三次服。喘咳上气不得卧，用生姜、橘红、人参、紫苏各一钱，五味子数粒，煎服。肾与肺胃俱虚，喘嗽乏力，用人参一钱，核桃肉三枚连皮蜜炙，煎服神验。肾气上逆而喘，用连皮核桃肉三枚，生姜三片，临睡前细嚼即安。七情郁结，上气喘急，选用四磨汤、四七汤。肥盛多痰，喘不得休，不能卧，人扶而坐数日的，千缗汤一服即安。或千缗汤合导痰汤尤妙。然惟元气未衰者适宜，虚人不可轻试。喘而诸药不效，腹坚脉实的，用神保丸大便溏泄者勿用。气实人误服人参等补气药而喘的，用三拗汤泻之。但伏不得卧，咳逆上气，面目浮肿的，用古今录验续命汤。气盛有余，脉来滑实的勿用。经年喘嗽，遇寒更甚的，选用九宝汤、宁嗽化痰汤。一切喘证，属有余的，治之即愈。若属虚证，误用泄气药，祸不旋踵。即暴喘腹胀，大便实者，方可用药，加以溏泄，必死勿治。这是阴火暴逆于手足太阴，所以喘胀；肾气失守，所以便溏。其人虽强，不久当呕血而死。
〔诊〕脉宜浮迟，不宜急疾。喘逆上气，脉数有热，不得卧的难治。上气面浮肿，肩息脉浮大的危重。上气喘息低昂，脉滑手足温的生存，脉涩手足寒的死亡。右寸沉实而紧，为肺感邪。也有六部脉都伏匿的，宜发散。大抵喘属肺中火盛，脉浮滑者可治。若沉滑为肾虚阴火上逆难治。
短气 短气，一种属于支饮，脉必弦滑。平人无寒热，冒眩，短气不足以息的，属实。《金匮要略》说：短气有微饮，应当从小便去除，苓桂术甘汤主之。肾气丸也主之。张仲景同时列出这两个方子，分别针对呼气短和吸气短进行治疗，妙义更加彰显。呼气短，用苓桂术甘汤以通其阳，阳气化，则小便能出。吸气短，用肾气丸以通其阴，肾气通，则小便的关门利。又说：咳逆倚息，不得卧，用小青龙汤。胀满的，用浓朴大黄汤（即小承气汤）。另一种属于气虚。李东垣说：短气，肺主诸气，五脏之气皆不足，而阳道不行。气短小便利的，四君子汤去茯苓加黄芪。如腹中气不转的倍甘草。肺气短促或不足的，倍人参加白芍，使肝胆之邪不敢侵犯。若失血后阴火上乘而短气不足以息，或肾虚发热唾痰的，用生脉散加当归、黄芪、生地。病后产后，一切疮疽溃后，气虚不能接续，及年高病久，正气耗散之人，虽有痰火，不可作有余治，误用耗气药，祸不旋踵。须大剂生脉散为君，少佐陈皮，扶接元气为主。
少气 少气，是气少不足以说话。《内经》说：怯然少气的，是水道不行，形气消索。又说：言语轻微，终日才再说一次，这是夺气。又说：气虚的，言语无常。又说：脾脉搏坚而长，其色黄，当病少气。其治法不离独参汤、生脉散、保元汤、异功散之类。
逆气 《内经》说：人有逆气，不得卧而息有音的，是阳明之逆。足三阳下行，今逆而上行，故息有音。阳明是胃脉，胃是六腑之海，其气亦下行。阳明逆不得从其道，故不得卧而息有音。夫起居如常而息有音的，是肺之络脉逆。络脉不得随经上下，故留经而不行。络脉之病患也微，故起居如常而息有音。夫不得卧卧则喘的，是水气之客。夫水，循津液而流。肾是水脏，主津液，主卧与喘。若四磨汤、七气汤，皆治阳明之气逆。杏子汤、小青龙汤、越婢汤、苏子降气汤，皆治肺络之气逆。麻黄附子细辛汤、肾气丸、灵砂丹，皆治肾气之逆。
哮 哮证多属寒包热邪，所以遇寒即发，喉中水鸡声，有积痰在肺络中，必用吐法以提散之，不可纯用寒凉，常须兼带辛散。小青龙汤探吐最妙。年高气弱人忌吐。凡喘未发时，以扶正气为主。既发时，以散邪为主。哮喘遇冷则发，其法有二。一属中外皆寒，温肺汤、钟乳丸、冷哮丸选用。并以三建膏护肺俞穴最妙。一属寒包热，越婢加半夏汤、麻黄定喘汤，表散其邪。平时用芦吸散亦妙。古人治寒包热邪，预于八九月未寒之时，用滚痰丸下其热痰，后至冬无热可包，则不发矣。丹方治冷哮痰喘，用胡椒四十九粒，入活虾蟆腹中，盐泥固存性，卧时，分三次醇酒服之。羸者凉分五七服，用之辄效。若有伏热者误用，喘逆倍剧，不可不辨。冷哮灸肺俞、膏肓、天突，有应有不应。夏月三伏中，用白芥子涂法，往往获效。方用白芥子净末一两，延胡索一两，甘遂、细辛各半两，共为细末，入麝香半钱，杵匀，姜汁调涂肺俞、膏肓、百劳等穴。涂后麻瞀疼痛，切勿便去，候三炷香足，方可去之。十日后涂一次，如此三次，病根去矣。遇浓味则发的，用莱菔子炒研一两，猪牙皂荚烧存性三钱，共为细末，姜汁调蒸饼为丸，绿豆大，每服五十丸，沸汤或枳实汤下，名清金丹，消其食积，则肺胃自清。仍当薄滋味以清肺胃之气。伤咸冷冻饮料食而喘的，用白面二钱，砂糖二钱，饴糖饼化汁，捻作饼子，炉内炸熟，划出，加轻粉四钱，令患人食尽，吐出病根即愈。年幼体虚者，分三四次服之。盖咸哮肺胃受伤，白面、砂糖、胶饴甘温恋膈，使之留连病所，引领轻粉搜涤淤积之痰上涌，三涌三补，屡建奇功。补用五味异功稍加细辛服之。醋呛而嗽，甘草二两，中半劈开，用猪胆汁五枚，浸五日，火炙为末，蜜丸，茶清吞二钱，临卧服之。凡哮证见胸凸背驼的，此肺络败，为痼疾，不治。
飞畴治疗韩顺溪的妻子，患喘证月余，服破气宽胸豁痰清火等药，不效。发表利水亦不应。其疾转急，稍动则喘难休息。诊之，六脉细数，而面赤戴阳，用大剂六味地黄作汤，加青铅约一两，一服而缓，二服而止。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Various diseases presenting with panting and fullness mostly belong to heat patterns. (Cold patterns feature slow respiration and faint breath; heat patterns feature rapid respiration and coarse breath.) Cough accompanied by qi rebellion upward, with pathogenic reversal in the chest, involves the Hand-Yangming Large Intestine Channel and the Hand-Taiyin Lung Channel. When lung qi is in excess, there will be panting and cough; when lung qi is deficient, breathing may be clear but breath is short. If lung qi is deficient, there will be nasal congestion and obstruction, and shortness of breath. If lung qi is in excess, there will be noisy panting, chest fullness, and仰breathing (breathing with the body leaning backward). If the autumn pulse is deficient (weak), it causes panting and shortness of breath. Labor leads to panting and sweating; pathogenic factors invading the Six Fu Organs cause fever and inability to lie down, manifesting as upper respiratory panting. Walking at night causes panting originating from the Kidney; excessive pathogenic qi damages the Lung; if there is a fall or fright, panting originates from the Liver, and excessive qi harms the Spleen; if there is fright, panting originates from the Lung, and excessive qi harms the Heart; wading through water or falling causes panting originating from the Kidney and bones. If the Liver pulse beats forcefully, it is due to blood stasis under the hypochondrium, causing rebellious panting. Panting and cough are caused by water qi combining with the Yangming channels. Inability to lie flat, with panting worsening upon lying down, indicates water qi lodging in the interior. Normal daily activities but with audible respiration indicate rebellion of the collateral vessels of the Lung. Diseases of the Foot-Yangming Stomach and Foot-Taiyin Spleen originating in the Heart and Spleen, transmitting to become Xiben disease (accumulation of qi in the chest), have a poor prognosis and are difficult to treat. (Yangming refers to the Stomach and Large Intestine channels; Earth [Spleen] fails to generate Metal [Lung], and Heart Fire further attacks it, damaging the Lung, hence qi rushes upward causing panting.) Postpartum women who are breastfeeding and contract wind-heat, presenting with wheezing and shoulder-lifting respiration, will survive if the pulse is solid, large, and slow, but die if the pulse is rapid and tense. ("Ruzi" refers to postpartum women nursing infants, not infants themselves.) Dai Fu'an stated: There is phlegm-panting, qi-rapid panting, stomach-qi deficiency panting, and fire-flaring-up panting. Phlegm-panting is characterized by audible phlegm sounds during panting. Qi-rapid panting features rapid breathing without phlegm sounds. Stomach-qi deficiency panting involves lifting shoulders and pulling the neck, with continuous panting. Fire-flaring-up panting fluctuates in severity; it improves after eating but worsens after digestion. Generally, this is due to excess fire in the Stomach and thick phlegm above the diaphragm. When food is swallowed, it pushes down the thick phlegm, temporarily stopping the panting. Later, as food enters the Stomach, it aids damp-fire, causing phlegm to rise again, making the panting worse. Laypeople do not understand this and treat it as stomach deficiency using drying and heating medicines, which is adding fire to fire.
Zhao Yangkui said: Distinguishing between panting and shortness of breath, shortness of breath is deficiency, while panting is excess. However, panting often arises from insufficiency, and shortness of breath occasionally has excess characteristics. New-onset cases may also have underlying deficiency; one must not adhere rigidly to these distinctions. For example, in true excess panting, qi is excess and the pulse is vigorous, with obstructed respiration and blocked lung orifices; the right Cun pulse is deep and solid, indicating a need to drain the Lung. In deficiency panting, there is initially a sensation of shortness of breath and distension in both hypochondria; the right Chi pulse is large and empty, indicating a need to tonify the Kidney. This is a Kidney deficiency pattern, not merely new-onset deficiency. Pathogenic panting occurs when cold pathogens hide in the Lung, blocking the orifices and obstructing respiration; if the Cun pulse is deep and tight, it indicates an external contraction. In cases where all six pulses are hidden, dispersing methods should be used; once fever subsides and panting settles, the pulse emerges. This is a depression pattern, difficult for people to recognize, akin to the "excess" type within shortness of breath. Another category resembles fire but is not fire, resembles panting but is not panting; this is floating of all yang qi without root, causing upper qi rebellion and panting. The patient feels normal otherwise but experiences panting; this is not true panting but qi failing to return to its source. Uninformed practitioners, seeing signs of fire, mistakenly use cooling herbs; seeing severe panting, they use Si Mo Tang (Four-Monk Decoction) to widen the chest. After ingestion, there is slight relief, but soon returns. Worsening the condition by widening consumes more qi. Only large doses of Ren Shen (Ginseng Radix et Rhizoma) and other tonics, plus Guboluozi (Psoraleae Fructus) and Ejiao (Colla Corii Asini) to anchor qi downward, followed by Shewei Wan (Eight-Ingredient Pill) with Wuweizi (Schisandrae Fructus) and Lurong (Cornu Cervi Pantotrichum), taken intermittently, is appropriate. Another type is fire depression, where all six pulses are choppy or even hidden, limbs are cold or inverted, and respiration is rapid with panting, seemingly excess but the pulse is not tight or rapid. Although it resembles yin deficiency, pressing the Chi pulse reveals a drum-like beat. This is long-standing stagnation suppressing yang qi, preventing it from circulating on the surface, leading to cold body, faint pulse, restlessness, and urgent panting. At this time, cold purgatives are contraindicated, as are hot tonics. Instead, Xiaoyao San (Free and Easy Wanderer Powder) combined with Zuojin Wan (Assist the Metal Pill) should be used to ventilate stagnant heat; recovery comes with sweating, followed by Liuwei Wan (Six-Ingredient Pill with Rehmanniae) to nourish yin and harmonize yang.
Yu Jiayan stated: All panting diseases originate in the Lung. Those involving the Three Yin channels are most severe, with Kidney involvement being the most critical. Patients must prioritize abstaining from sexual desire to conserve Kidney qi and prevent it from rushing upward. Thus, panting involving Shaoyin Kidney is most severe; when Kidney fire moves, water qi rises. Next is Taiyin Spleen; when Spleen fire moves, dampness rises. Next is Jueyin Liver; when Liver fire moves, wind rises. Therefore, treating panting prioritizes controlling fire. However, why does turbid qi fail to descend even after fire is controlled? Although turbid qi resides below, the "nest" of the Lung can harbor it, displacing clear qi. Thus, while controlling fire is primary, treating fire without treating phlegm is useless. Treating phlegm without addressing the phlegm in the Lung "nest" is equivalent to no treatment. Only Jiangzhi (Ginger Juice) and Zhuli (Bamboo Sap) can penetrate the nest.
Li Shicai stated: The *Neijing* lists many causes for panting, ultimately revolving around fire rebelling upward and qi failing to descend. Although fire is the common factor, deficiency and excess differ greatly. Common practitioners use qi-breaking herbs for all panting; this is correct for excess but inappropriate for deficiency. I have argued that nine-tenths of deaths from panting are due to deficiency, and only one-tenth due to excess. Treating excess with attack yields immediate results; treating deficiency with tonification requires long-term effort and careful adjustment. Therefore, differentiation is urgent, especially for panting. Chao Yuanfang and Yan Yonghe only discussed excess panting. Wang Haicang uniquely stated: "If Lung qi were truly excessive, it would descend clearly and turbidly; how could it cause panting?" He believed that fire scorches true qi, and qi deficiency causes panting. What appears as "excess" is not Lung qi but fire in the Lung. This insight surpasses ancient texts, though he did not elaborate fully. Let me detail it: For qi deficiency with fire entering the Lung, tonifying qi is primary, using Shengmai San (Generate the Pulse Powder); if phlegm is present, Liujunzi Tang (Six-Gentleman Decoction) is used. For yin deficiency with fire attacking Metal causing inability to lie down, strengthening Water is urgent, using Liuwei Wan (Six-Ingredient Pill); combine with Shengmai San for deficiency. For wind-cold, resolve the pathogen with Huagai San (Canopy Powder); for excess dampness, promote urination with Shenshi Tang (Damp-Draining Decoction); for summerheat, clear烦热 with Baihu Tang (White Tiger Decoction); for phlegm obstruction, resolve phlegm with Erchen Tang (Two-Aged Decoction); for qi depression, soothe it with Siqi Tang (Seven-Emotion Decoction); for Lung distension with floating-large pulse, use Yeshibi Jia Banxia Tang (Yebishi Decoction plus Pinellia); with floating pulse, use Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction plus Gypsum). For Kidney deficiency with fire failing to return to its source, use Shewei Wan (Eight-Ingredient Pill); for Kidney deficiency with flooding water qi, use Jisheng Shenqi Wan (Kidney-Qi Pill from the Prescriptions of the Sage). These are the general principles for treating panting.
For panting and cough with qi rushing up from below the navel, with a洪盛 (surging-full) or rapid Chi pulse, accompanied by night sweats and tidal fever, it belongs to yin deficiency. Use Liuwei Wan as a decoction, add Guboluozi and Wuweizi, and take with Lingsha Dan (Cinnabar Pill). Mistakenly using Simo Tang will cause death. Treating it as phlegm is also dangerous. For panting due to qi stagnation, triggered by anger, with a deep-wiry pulse (qi stagnation causing phlegm blockage), use Suzi Jiangqi Tang (Perilla Seed Descending-Qi Decoction). For panting without cough, regardless of duration, take the previous decoction with Lingsha Dan. For winter/autumn cold invasion with continuous coughing and severe panting until dawn, with hypochondriac movement and stuffiness, use Mahuang Cangzhu Tang (Ephedra and Atractylodes Macrocephala Decoction). For Lung deficiency with cold-induced panting, use Renshen Suwen Fei Tang (Ginseng and Perilla Warming-Lung Decoction). For cold depressing heat with accumulated phlegm in panting, triggered by cold, use Mahuang Dingchuan Tang (Ephedra Calming-Panting Decoction). For chronic cough and rebellious qi with chest fullness and inability to speak, use Renshen Dingchuan Tang (Ginseng Calming-Panting Decoction). For deficiency-cold rebellious qi and labor-induced cough/panting, Qianjin Fang uses Banxia (Pinelliae Rhizoma) 1 sheng, Renshen, Shengjiang (Fresh Ginger), Guixin (Cinnamon Twig), and Gancao (Licorice Root) each 1 liang, decocted in water, divided into three doses. For panting/cough/rebellious qi unable to lie down, use Shengjiang, Juhong (Tangerine Peel), Renshen, Zisu (Perilla Leaf) each 1 qian, and Wuweizi several grains, decocted. For combined Kidney/Lung/Stomach deficiency with weak panting/cough, use Renshen 1 qian and Hetaoren (Walnut Kernel) 3 pieces with skin, honey-roasted, decocted. For Kidney qi rebellion causing panting, chew Hetaoren (3 pieces with skin) and Shengjiang (3 slices) before bed. For seven-emotions depression causing upper panting, choose Simo Tang or Siqi Tang. For obese patients with much phlegm, continuous panting, inability to lie down, requiring support to sit for days, Qianmin Tang (Thousand-Silk Decoction) provides relief in one dose; combining with Daotan Tang (Great-Phlegm Decoction) is excellent. This is suitable only for those with unimpaired yuan qi, not for deficient patients. For panting unresponsive to other medicines, with hard abdomen and solid pulse, Shenbao Wan (Divine-Preservation Pill) is used; avoid if stool is loose. For excess qi patients mistakenly taking tonics like Renshen causing panting, use San'ao Tang (Three-Unobstructed Decoction) to purge. For inability to lie prone, cough/rebellious qi, and facial edema, use Jinlu Lu Yan Xuming Tang (Ancient Record Verification Reviving Master Decoction). Avoid if pulse is slippery-solid indicating excess. For year-round panting/cough worsening with cold, choose Jiubao Tang (Nine-Treasure Decoction) or Ningsou Huatan Tang (Calming-Cough Resolving-Phlegm Decoction). All excess panting resolves with treatment. Deficiency panting mistreated with qi-draining herbs leads to swift disaster. Only in sudden panting with abdominal distension and solid stool can medicine be used; if diarrhea accompanies it, death is certain and untreatable. This is sudden rebellion of yin-fire in Hand-Foot Taiyin, causing panting/distension; Kidney qi loss causes diarrhea. Though the patient seems strong, hematemesis and death will follow soon.
[Diagnosis] The pulse should be floating and slow, not rapid. Panting with rebellious qi, rapid pulse with heat, and inability to lie down are difficult to treat. Rebellious qi with facial edema, shoulder-lifting, and floating-large pulse is critical. Rebellious qi with varying intensity of panting, smooth pulse, and warm hands/feet indicates survival; choppy pulse with cold hands/feet indicates death. Right Cun deep-solid-tight indicates Lung pathogen invasion; if all six pulses are hidden, use dispersing methods. Generally, panting due to Lung fire excess with floating-smooth pulse is treatable. Deep-smooth pulse indicates Kidney deficiency with yin-fire rebellion, which is difficult to treat.
Shortness of Breath (Duǎnqì): One type belongs to Zhiyin (Branching Fluid Retention), with a stringy-smooth pulse. In healthy people without cold/heat, experiencing dizziness and shortness of breath insufficient for exhalation, it is excess. *Jinkui Yaolue* states: Shortness of breath with mild fluid retention should be treated via urination; Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is indicated. Shenqi Wan (Kidney-Qi Pill) is also indicated. Zhang Zhongjing provided both formulas, treating shortness of breath based on exhalation vs. inhalation difficulties, revealing profound wisdom. Exhalation difficulty uses Linggui Zhugan Tang to unblock yang; when yang transforms, urination occurs. Inhalation difficulty uses Shenqi Wan to unblock yin; when Kidney qi flows, the bladder gate opens. It also states: Cough/rebellious qi leaning on support, unable to lie down, uses Xiao Qinglong Tang. With distension, use Nongpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction, i.e., Xiao Chengqi Tang). Another type is qi deficiency. Li Dongyuan stated: Shortness of breath occurs because Lung governs all qi, and qi of all five zang organs is insufficient, with yang pathways blocked. Shortness of breath with frequent urination uses Sijunzi Tang minus Fuling, plus Huangqi (Astragali Radix). If abdominal qi stagnates, double Gancao. Short/crisp Lung qi deficiency doubles Renshen and adds Baishao (Paeoniae Radix Alba) to prevent Liver/Gallbladder pathogenic invasion. After blood loss, with yin-fire ascending causing shortness of breath, or Kidney deficiency fever with sputum, use Shengmai San plus Danggui (Angelicae Sinensis Radix), Huangqi, and Shengdi (Rehmanniae Radix Preparata). Post-illness/postpartum, after ulceration of sores, qi deficiency failing to connect, or elderly/chronically ill with depleted zheng qi, even if phlegm-fire exists, do not treat as excess. Mistakenly using qi-consuming herbs leads to swift disaster. Use large-dose Shengmai San as the sovereign herb, with minor Chenpi (Citri Reticulatae Pericarpium) to support yuan qi.
Shaoqi (Lesser Qi): Defined as insufficient qi to speak. The *Neijing* says: Feeling timid with less qi indicates failure of water pathways and depletion of form and qi. It also says: Speaking faintly, only speaking again after a whole day, indicates qi deprivation. Also: Qi deficiency manifests as irregular speech. Also: Firm-long Spleen pulse with yellow complexion indicates Shaoqi disease. Treatment includes Dushen Tang (Single-Ginseng Decoction), Shengmai San, Baoyuan Tang (Protect-Origin Decoction), and Yigong San (Extraordinary Skill Powder).
Niqi (Rebellious Qi): The *Neijing* states: People with rebellious qi cannot lie down and have audible respiration; this is Yangming rebellion. Foot-Sanjyang normally descends but now rebels upward, causing audible respiration. Yangming is the Stomach channel; the Stomach is the sea of Six Fu organs, and its qi descends. Yangming rebellion prevents following its pathway, causing inability to lie down and audible respiration. Normal activity with audible respiration indicates Lung collateral rebellion. Collaterals cannot follow meridians up/down, lingering in meridians. Collateral diseases are minor, hence normal activity with audible respiration. Inability to lie down with panting indicates water qi lodging. Water follows fluids. Kidney is the Water Organ, governing fluids, sleep, and panting. Simo Tang and Qiqi Tang treat Yangming qi rebellion. Xingzi Tang, Xiao Qinglong Tang, Yeshibi Tang, and Suzi Jiangqi Tang treat Lung collateral qi rebellion. Mahuang Fuzi Xixin Tang, Shenqi Wan, and Lingsha Dan treat Kidney qi rebellion.
Xiao (Wheezing/Asthma): Xiao syndrome mostly belongs to cold enveloping heat pathogens, triggering attacks upon cold exposure, with sound like a water chicken in the throat, and accumulated phlegm in Lung collaterals. Vomiting methods must be used to disperse it; pure cold herbs are contraindicated, always combining with acrid-dispersing herbs. Xiao Qinglong Tang inducing vomiting is best. Elderly/weak patients should avoid vomiting. Before asthma attacks, tonify righteous qi; after onset, disperse pathogens. Asthma triggered by cold has two methods: 1. Internal/external cold: choose Wenfei Tang (Warming-Lung Decoction), Zhongru Wan (Milky Stone Pill), or Lengxiao Wan (Cold-Asthma Pill). Applying Sanjian Gao (Three-Construct Paste) to Feishu (BL13) is excellent. 2. Cold enveloping heat: Yeshibi Jia Banxia Tang or Mahuang Dingchuan Tang to disperse exterior pathogens. Using Luxi San (Reed-Sucker Powder) regularly is also good. Ancients treated cold-enveloping-heat by using Untan Wan (Rolling-Phlegm Pill) in Aug/Sep to purge hot phlegm, preventing winter attacks. Alchemical prescription for cold-asthma-phlegm: 49 peppercorns inserted into a living toad, preserved in salt-clay, taken at bedtime in three doses with pure wine. Weak patients take in 5-7 divided doses; effective. Misuse in latent heat worsens panting drastically. Acupuncture for cold-asthma: Feishu (BL13), Gaohuang (BL43), Tiantu (CV22). Responses vary. During Summer Sanfu, apply Baijiezi Tu Fa (White Mustard Seed Paste Method): Baijiezi (Sinapis Semen) 1 liang, Yanshusuo (Cyperi Rhizoma) 1 liang, Gansui (Kansui Radix) and Xixin (Asari Radix et Rhizoma) half liang each, powdered fine, mixed with Shexiang (Musk) half qian, pounded uniform, adjusted with ginger juice, applied to Feishu, Gaohuang, Bailao (EX-B1) etc. Do not remove immediately if numb/painful; wait for three incense sticks. Apply every ten days, three times total, to remove root. Attacks triggered by rich flavors: Fried/studied Laifuzi (Radish Seed) 1 liang, roasted Ziya (Gleditsiae Sinensis Fructus Spina) 3 qian, powdered, adjusted with ginger juice and steamed dough into pills, size of mung beans, 50 pills per dose with boiling water or Zhishi (Aurantii Fructus) decoction, named Qingjindan (Clear Gold Pill), resolving food stagnation to clear Lung/Stomach. Maintain bland diet. Asthma from salty/frozen drinks: 2 qian wheat flour, 2 qian sugar, malt sugar melted, formed into cakes, fried, removed, mixed with Qinfen (Lead Subcarbonate) 4 qian. Patient eats all, vomits out pathogen root, cured. Children/weak split into 3-4 doses. Salty asthma damages Lung/Stomach; sweet/warm wheat/sugar/malt adheres to diaphragm, keeping Qinfen at the site to search/dredge stagnant phlegm upward. Three vomits, three tonifications, achieving miracles. Tonify with Wuwei Yigong slightly adding Xixin. Cough from vinegar irritation: 2 liang Gancao, split, soaked in 5 pig bile for 5 days, roasted to powder, honey pills, 2 qian with tea water before bed. Chest convex/back hunched in asthma indicates broken Lung collaterals and chronic disease, untreatable.
Feichou treated Han Shunxi's wife with panting for over a month. Qi-breaking, chest-widening, phlegm-resolving, fire-clearing herbs failed. Exterior-releasing and diuretic methods failed. Condition worsened; slight movement caused exhausting panting. Pulses were fine and rapid; face was red with floating yang (Daiyang). Used large-dose Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with Qingqian (Galena) approx. 1 liang. Relieved after one dose, stopped after two.