喘者。气上冲而不得倚息也。有内外实虚四症。宜与痰饮咳嗽参看。外则不离乎风寒。
内则不离乎水饮。实则为肺胀。虚则为肾虚。宜分别治之。
脉宜浮滑。 忌短涩。
一外感风寒。及伤暑伤燥。方治详于咳嗽门。不赘。
一水饮之病。小青龙汤为第一方。若支饮内痛。亦可暂用十枣汤。如因支饮满而气闭。
气闭则呼吸不能自如。宜用葶苈大枣泻肺汤。今人畏不敢用多。致因循误事。
一咳而上气为肺胀。其人喘。目如脱。脉浮大者。用麻黄三钱。生石膏四钱。半夏二钱。
甘草一钱。生姜一钱五分。大枣二枚。水二杯半。先煮麻黄去沫。入诸药。煮八分服。日二
服即愈。名越脾加半夏汤。○或咳嗽甚而烦躁者。小青龙。加生石膏四钱。
一肾虚气喘。方治详于咳嗽门。不赘。
一黑锡丹。为气喘必用之药。宜预制之以备急。
一喘症。起于七情气逆者。宜四磨饮。起于痰喘胀满者。宜苏子降气汤。二方为喘症之
良方。
四磨饮。（二十九） 苏子降气汤。（二十七）
一圣济总录云。枸杞汤治气短。方用枸杞四钱。姜枣水煎服。又云。紫苏汤治卒气短。
方用紫苏四钱。陈皮一钱。枣二枚。水酒各半煎服。○按二方同治气短。何以彼此悬殊。而
不知一治肺。一治肾也。肺主出气。皮毛为肺之合。风寒客于皮毛。则肺之窍道闭。窍道闭
则出气不利而短。故用紫苏陈皮之辛以开之。书中卒字一字大有意义。肾主纳气。肾虚。则
吸气不能归根而短。故用枸杞之补肾精以填之。与八味地黄丸同意。但任专则效速。所以舍
彼而用此也。
过服辛燥等药。喘促愈盛者。可用贞元饮。然为缓剂。若痰多喘甚者。大忌之。
一喘气诸家之说最杂。近有张心在之论。深合鄙意。余所以数千里而神交之也。心在云。
喘气专在口也。鼻息出入。气未始不至于口。而专在口。则喘矣。天气通于鼻。一呼一吸。
吐故而纳新。果顺其常。则出心肺而入肝肾。脾居中而转运。（此句最精。可以悟出绝妙心
法。）何喘之有。唯鼻失其职。或肺壅窍塞。不能上达其气。复返心脾而出于口。或肺虚力
弱不能下引其气。上到心脾而出于口。则喘作焉。皆肺之过也。至若气短症。鼻气有出无入。
能呼而不能吸则责在肝肾之绝。肺不任咎矣。
喘症，是指气机上冲而不能平卧呼吸。分为外感、内伤、实证、虚证四种类型，应当与痰饮、咳嗽等病症参照阅读。外感病因离不开风寒，内伤病机离不开水饮。实证多为肺胀，虚证多为肾虚，应当分别进行治疗。
脉象宜见浮滑，忌讳短涩。
一是外感风寒，以及伤暑、伤燥引起的喘促，治疗方法详见“咳嗽”章节，此处不再赘述。
二是水饮致病，小青龙汤是第一方剂。如果是支饮导致胸中疼痛，也可以暂时使用十枣汤。如果因为支饮导致胸满且气机闭塞，气闭则呼吸不能自如，应当使用葶苈大枣泻肺汤。现在的人畏惧不敢多用，导致延误病情。
三是咳嗽伴气逆上冲为肺胀，患者气喘，眼睛突出像要脱出一样，脉象浮大的，用麻黄三钱，生石膏四钱，半夏二钱，甘草一钱，生姜一钱五分，大枣两枚，水两杯半。先煮麻黄去掉浮沫，再加入其他药物，煮至八分，服用。每日两次即可痊愈。此方名为越婢加半夏汤。或者咳嗽严重且伴有烦躁的，用小青龙汤，加入生石膏四钱。
四是肾虚引起的气喘，治疗方法详见“咳嗽”章节，此处不再赘述。
五是黑锡丹，是治疗气喘必须使用的药物，应当预先制备以备急用。
六是喘症，起因于七情（喜怒忧思悲恐惊）导致气机逆乱的，适宜用四磨饮；起因于痰喘、胸腹胀满的，适宜用苏子降气汤。这两个方子是治疗喘症的良方。
七是《圣济总录》记载：枸杞汤治疗气短。方剂用枸杞四钱，姜枣水煎服。又记载：紫苏汤治疗突发气短。方剂用紫苏四钱，陈皮一钱，枣两枚，水和酒各一半煎服。按：这两个方子都治疗气短，为什么效果差异如此之大？这是因为不知道一个治肺，一个治肾。肺主呼气，皮毛是肺的外合，风寒客居于皮毛，则肺的窍道闭塞，窍道闭塞则呼气不利而短促，所以用紫苏、陈皮的辛味来开泄它。书中“卒”字大有深意。肾主纳气，肾虚，则吸气不能归根而短促，所以用枸杞补肾精以填补它。这与八味地黄丸的道理相同，但单味药专攻则见效快，所以舍弃复方而用单方。
八是过服辛温燥烈等药物，导致喘促更加严重的，可以使用贞元饮。但这属于缓剂，如果痰多喘促严重的，绝对禁止使用。
九是关于喘气的各家学说最为杂乱，近来有张心在的论述，非常符合我的意见，所以我虽相隔千里却神交已久。张心在说，喘气主要表现在口部。鼻子的呼吸出入，气息未尝不到达口部，但如果气息专门从口出，那就是喘了。天气通过鼻子进入，一呼一吸，吐出浊气接纳新鲜空气，如果顺应常态，则气由心肺进入肝肾，脾居中焦负责转运。（这一句最精妙，可以悟出绝妙的医理。）哪里会有喘呢？只有当鼻的功能失职，或者肺壅塞窍道闭塞，不能将气上达，反而返回心脾而从口出；或者肺气虚弱无力，不能将气下引，气上到心脾而从口出，这样喘症就发作了。这都是肺的过错。至于气短症，鼻气只有出没有入，能呼不能吸，这就责任在于肝肾之气衰竭，肺不承担过错。
Asthma (Chuan) refers to the upward rushing of Qi, resulting in the inability to lie flat and breathe. It is categorized into four types: exterior, interior, excess, and deficiency. It should be read in conjunction with conditions such as Phlegm-Fluids (Tan Yin) and Cough (Ke Sou). Exterior causes are inseparable from Wind-Cold (Feng Han), while interior causes are inseparable from Water-Fluids (Shui Yin). Excess patterns typically manifest as Lung Distension (Fei Zhang), while deficiency patterns typically manifest as Kidney Deficiency (Shen Xu). They must be treated separately.
The pulse should be floating and slippery (Fu Hua); short and choppy (Duan Se) pulses are contraindicated.
First, asthma caused by exterior contraction of Wind-Cold (Feng Han), as well as injury from Summer-Heat (Shang Shu) or Dryness (Shang Zao), is detailed in the "Cough" chapter; no further elaboration is provided here.
Second, for diseases caused by Water-Fluids (Shui Yin), Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) is the primary formula. If Branch Fluids (Zhi Yin) cause internal pain, Shi Zao Tang (Ten Date Decoction) may also be used temporarily. If Branch Fluids (Zhi Yin) cause chest fullness and Qi obstruction, where Qi blockage leads to involuntary breathing difficulties, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) should be used. Modern practitioners often fear using it due to its potency, leading to delays that worsen the condition.
Third, cough accompanied by rebellious Qi is Lung Distension (Fei Zhang). The patient wheezes, eyes appear protruding as if detached, and the pulse is floating and large. Use Ma Huang (Ephedrae Herba) 3 qian, Sheng Shi Gao (Gypsum Fibrosum) 4 qian, Ban Xia (Pinelliae Rhizoma Preparatum) 2 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 qian, Sheng Jiang (Zingiberis Rhizoma Recens) 1.5 qian, and Da Zao (Jujubae Fructus) 2 pieces. Add 2.5 cups of water. First boil Ma Huang to remove the foam, then add the remaining herbs. Boil until reduced to 0.8 parts and take. Twice daily will result in recovery. This formula is named Yue Bi Jia Ban Xia Tang (Ma Xing Shi Gan Tang variant with Ban Xia). Alternatively, for severe cough with irritability, use Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) with the addition of Sheng Shi Gao (Gypsum Fibrosum) 4 qian.
Fourth, asthma caused by Kidney Deficiency (Shen Xu) is detailed in the "Cough" chapter; no further elaboration is provided here.
Fifth, Hei Xi Dan (Black Tin Pill) is an essential medicine for treating asthma and should be prepared in advance for emergencies.
Sixth, asthma arising from emotional stagnation causing Qi rebellion is suitable for Si Mo Yin (Four Fragments Infusion). Asthma arising from Phlegm-Asthma and abdominal distension is suitable for Su Zi Jiang Qi Tang (Perilla Fruit Descending Qi Decoction). These two formulas are excellent remedies for asthma.
Si Mo Yin (Formula No. 29). Su Zi Jiang Qi Tang (Formula No. 27).
Seventh, *Sheng Ji Zong Lu* states: Gou Qi Tang (Goji Berry Decoction) treats Shortness of Breath (Qi Duan). The formula uses Gou Qi (Lycii Fructus) 4 qian, decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus). It also states: Zi Su Tang (Perilla Leaf Decoction) treats sudden Shortness of Breath (Qi Duan). The formula uses Zi Su Ye (Perillae Folium) 4 qian, Chen Pi (Citri Reticulatae Pericarpium) 1 qian, and Da Zao (Jujubae Fructus) 2 pieces, decocted with half water and half wine. Commentary: Both formulas treat Shortness of Breath, yet their effects differ significantly because one treats the Lung and the other treats the Kidney. The Lung governs exhalation, and the skin/hair is the exterior correspondence of the Lung. When Wind-Cold invades the skin/hair, the Lung's orifices become blocked. Blockage of the orifices leads to difficult exhalation and shortness of breath. Therefore, the acrid properties of Zi Su Ye (Perillae Folium) and Chen Pi (Citri Reticulatae Pericarpium) are used to open them. The character "Su" (Sudden) in the text is significant. The Kidney governs grasping Qi. In Kidney Deficiency (Shen Xu), inhaled Qi cannot root itself, leading to shortness of breath. Therefore, Gou Qi (Lycii Fructus) is used to tonify Kidney Essence and fill the deficiency. This aligns with the principle of Ba Wei Di Huang Wan (Eight-Ingredient Pill Rehmanniae). However, a single herb acting specifically yields faster results, hence the preference for this simple prescription over complex ones.
Eighth, for cases where excessive consumption of acrid and drying medicines exacerbates asthma, Zhen Yuan Yin (True Origin Infusion) can be used. However, this is a mild/slow-acting formula. If there is abundant phlegm and severe asthma, it is strictly contraindicated.
Ninth, theories on asthma among various schools are most diverse. Recently, the discussion by Zhang Xin Zai deeply aligns with my views, which is why I have felt spiritually connected to him across thousands of miles. Zhang Xin Zai stated that asthma manifests primarily at the mouth. Nasal respiration involves Qi entering and exiting, but the Qi does not necessarily reach the mouth; however, if Qi is expelled specifically through the mouth, it constitutes asthma. Heaven's Qi enters through the nose. With each inhalation and exhalation, turbid Qi is expelled and fresh Qi is received. If following normal physiology, Qi moves from the Heart and Lung to the Liver and Kidney, while the Spleen, residing in the center, facilitates transportation. (This sentence is the most profound, allowing one to comprehend exquisite medical principles.) Where would asthma arise? Only when the nose loses its function, or the Lung is obstructed and orifices are blocked, preventing Qi from ascending, causing it to return to the Heart and Spleen and exit via the mouth; or when Lung Qi is deficient and weak, unable to draw Qi downward, causing it to ascend to the Heart and Spleen and exit via the mouth, thus triggering asthma. All these are faults of the Lung. Regarding Shortness of Breath (Qi Duan), if nasal Qi has only exhalation without inhalation, being able to exhale but not inhale, the responsibility lies in the exhaustion of Liver and Kidney Qi, and the Lung bears no blame.