【歌】气喘无痰呼吸粗,抬肩撷肚胃家虚。火炎上喘时轻重,痰喘喉中声韵呼。短气自然无接续,补虚泻
实勿模糊。
【论】夫肺为五脏华盖,主持诸气,所以通荣卫,统脉络,合阴阳,升降出入,营运不息,循环无端,无
过不及,何喘之有?其或肺气有所受伤,呼吸之息不得宣通,则喘病生焉。气喘者,呼吸急促而无痰声;痰喘
者,动作便有痰声;火喘者,乍进乍退,得食则减,食已则发,此有余之喘也。胃虚喘者,抬肩撷肚,喘而不
休,此不足之喘也。若肺气太虚,气不能布息,呼吸不相接续,出多入少,名曰短气,此虚之极也。若气欲绝
者,则汗出如油,喘而不休,此六阳气脱也,不治。
【脉】脉滑而手足温者生,脉沉涩而四肢寒者死,数者
亦死,为其形损故也。
痰喘
风痰上逆而喘者,千缗汤或导痰汤。痰喘者,先降气,气降则痰自清,四磨汤、定肺汤。
千缗汤
半夏(七个,泡,每个切四片) 皂荚(一寸,炙,去皮弦) 甘草(炙,一寸)
一方合导痰汤服;一方加雄黄。
上,作一剂,水二盏,生姜一片,煎至八分,温服。
导痰汤(方见痰证条。)
定肺汤
治上气喘急。
紫菀 五味子 橘红 甘草(炙) 苏子(炒) 杏仁(去皮尖,炒) 桑白皮(炒) 半夏(制) 枳壳
(炒) 紫苏叶(各等分)
上,用生姜五片,水二盏,煎一盏服。
喘甚加葶苈,痰多加栝蒌仁。
四磨汤
治七情郁结,上气喘急。
人参 槟榔 沉香 乌药(各一钱,浓磨汁)
上,取水七分,煎一、二沸,温服。
气喘
气上逆而喘,苏子降气汤。气实,因服补药而喘者,三拗汤。上气而喘者,神秘汤。
苏子降气汤
治虚喘上攻,气不升降,上盛下虚。
苏子(一钱) 半夏曲(一钱) 陈皮(去白,七分) 浓朴(姜汁拌炒,五分) 前胡(五分) 当
归(五分) 肉桂(三分) 甘草(三分)
上锉,一剂,姜三片,水二钟,煎八分,空心服。
三拗汤
治感冒风寒,鼻塞声重,语言懒出,咳嗽喘急,外感客邪有余之证。
生甘草 麻黄(不去节) 杏仁(留皮尖,各等分)
上,用生姜五片,水二盏,煎一盏,温服,得汗出为度。
神秘汤
治上气喘急不得卧者。
橘红 桔梗 紫苏 五味子 人参(各等分)
上,每服四钱,水二盏,煎八分,食前服。
火炎上喘
火炎上喘者,枳桔二陈汤 加芩、连、山栀。阴虚火盛,自脐下上冲而喘,四物汤加知母、黄柏、麦门冬、
五味子,或六味丸料服之。
枳桔二陈汤
即二陈汤加枳壳、桔梗。(方见痰证条。)
四物汤(方见血证条。)
六味丸(方见虚损。)
胃虚喘
胃虚而喘,五味子汤加白术。久病喘者,气虚也,气不接续,生脉散加阿胶、白术、陈皮。
五味子汤
五味子(九粒) 人参(一钱) 麦门冬(八分) 杏仁(八分) 陈皮(一钱) 生姜(三片) 大枣(二枚)
上锉,一剂,水二盏,煎八分,温服。
生脉散
人参(一钱) 麦门冬(一钱) 五味子(十粒)
上,用水一盏半,煎七分服。
附 哮喘
哮喘者,内有痰热,而寒包之,必须薄滋味,用二陈汤加苍术、黄芩,或麻黄汤加紫苏、半夏、枳壳、桔
梗、黄芩。天寒时,再加桂枝,以温散之。
二陈汤(方见痰证条。)
麻黄汤(方见发热条。)
【歌诀】
气喘且无痰,呼吸声粗重,抬肩缩腹是胃气虚弱。
火邪上炎致喘,症状时轻时重;痰阻气道致喘,喉间有声韵呼噜。
短气自然气息不接续,治疗需补虚泻实,不可模糊不清。
【论述】
肺为五脏之华盖(覆盖于其他脏腑之上的保护性器官),主持全身诸气,因此能通达营卫,统率脉络,调和阴阳,负责气的升降出入,运行不息,循环无端,只要没有过与不及的情况,怎么会有喘证呢?如果肺气受到损伤,呼吸之气不能宣通,那么喘病就产生了。所谓气喘,是呼吸急促但没有痰声;痰喘,是活动时就有痰声;火喘,是症状乍进乍退,进食后减轻,食后发作,这属于有余(实证)的喘。胃虚导致的喘,表现为抬肩缩腹,喘息不止,这属于不足(虚证)的喘。如果肺气太虚,气不能布散呼吸,呼吸不相接续,出多入少,称为短气,这是虚损到了极点。如果气欲绝,则汗出如油,喘息不止,这是六阳之气脱失,无法救治。
【脉诊】
脉象滑利且手足温暖者生,脉象沉涩且四肢寒冷者死,脉数快者亦死,因为形体已受损的缘故。
【痰喘】
风痰上逆导致喘息的,用千缗汤或导痰汤。痰喘患者,先降气,气降则痰自清,用四磨汤、定肺汤。
千缗汤
半夏(七个,浸泡,每个切四片) 皂荚(一寸,炙烤,去皮及筋络) 甘草(炙烤,一寸)
一方配合导痰汤服用;一方加雄黄。
以上药材,作一剂,用水二盏,生姜一片,煎至八分,温服。
定肺汤
治疗上气喘急。
紫菀 五味子 橘红 甘草(炙烤) 苏子(炒制) 杏仁(去皮尖,炒制) 桑白皮(炒制) 半夏(炮制) 枳壳(炒制) 紫苏叶(各等分)
以上药材,用生姜五片,水二盏,煎至一盏量服用。
喘甚加重葶苈子,痰多加瓜蒌仁。
四磨汤
治疗七情郁结,上气喘急。
人参 槟榔 沉香 乌药(各一钱,浓磨取汁)
以上,取药汁七分,煎煮一、二沸,温服。
【气喘】
气上逆而喘,用苏子降气汤。气实,因服用补药而导致喘息的,用三拗汤。上气而喘的,用神秘汤。
苏子降气汤
治疗虚喘上攻,气不升降,上盛下虚。
苏子(一钱) 半夏曲(一钱) 陈皮(去白,七分) 厚朴(姜汁拌炒,五分) 前胡(五分) 当归(五分) 肉桂(三分) 甘草(三分)
以上锉碎,一剂,姜三片,水二钟,煎至八分,空腹服用。
三拗汤
治疗感冒风寒,鼻塞声重,语言懒出,咳嗽喘急,外感客邪有余的证候。
生甘草 麻黄(不去节) 杏仁(留皮尖,各等分)
以上,用生姜五片,水二盏,煎至一盏,温服,以得汗出为限度。
神秘汤
治疗上气喘急不得卧者。
橘红 桔梗 紫苏 五味子 人参(各等分)
以上,每服四钱,水二盏,煎至八分,饭前服用。
【火炎上喘】
火炎上喘者,用枳桔二陈汤 加黄芩、黄连、山栀。阴虚火盛,自脐下上冲而喘,用四物汤加知母、黄柏、麦门冬、五味子,或服用六味丸料。
【胃虚喘】
胃虚而喘,用五味子汤加白术。久病喘者,是气虚,气不接续,用生脉散加阿胶、白术、陈皮。
五味子汤
五味子(九粒) 人参(一钱) 麦门冬(八分) 杏仁(八分) 陈皮(一钱) 生姜(三片) 大枣(二枚)
以上锉碎,一剂,水二盏,煎至八分,温服。
生脉散
人参(一钱) 麦门冬(一钱) 五味子(十粒)
以上,用水一盏半,煎至七分服用。
【附:哮喘】
哮喘者,内有痰热,而寒邪包裹之,必须清淡饮食,用二陈汤加苍术、黄芩,或麻黄汤加紫苏、半夏、枳壳、桔梗、黄芩。天寒时,再加桂枝,以温散之。
[Song]
Asthma without phlegm, with coarse breathing; raising shoulders and drawing in the abdomen indicates deficiency of the Stomach Qi.
Flame-type asthma fluctuates in severity; phlegm-type asthma presents with rhonchi in the throat.
Shortness of breath naturally lacks continuity; treatment must tonify deficiency and drain excess, without ambiguity.
[Dissertation]
The Lung is the canopy (protective covering) of the five Zang organs, governing all Qi. Thus, it connects Ying and Wei (Nutritive and Defensive Qi), commands the meridians, harmonizes Yin and Yang, and manages ascending, descending, exiting, and entering movements. Its operation is ceaseless, circulating without end. As long as there is no excess or deficiency, how can asthma arise? If Lung Qi is injured, and the breath cannot be freely diffused, then asthma disease arises. "Qi asthma" refers to rapid breathing without phlegm sounds; "Phlegm asthma" refers to phlegm sounds appearing upon movement; "Flame asthma" refers to symptoms that come and go, alleviated by eating but recurring after meals; this is an Excess-type asthma. "Stomach deficiency asthma" manifests as raising shoulders and drawing in the abdomen, with unceasing panting; this is a Deficiency-type asthma. If Lung Qi is extremely deficient, Qi cannot distribute respiration, breathing is discontinuous, with more exhalation than inhalation, it is called Shortness of Breath (Duan Qi); this is extreme deficiency. If Qi is about to collapse, sweat flows like oil, and panting is unceasing; this is the collapse of the Six Yang Qi, which is untreatable.
[Pulse Diagnosis]
If the pulse is slippery and the hands and feet are warm, life is preserved; if the pulse is deep and choppy and the four limbs are cold, death ensues; if the pulse is rapid, death also ensues, because the physical form has been damaged.
[Phlegm Asthma]
For asthma caused by Wind-Phlegm rushing upward, use Qianmin Decoction or Daotan Decoction. For Phlegm asthma, first direct Qi downward; when Qi descends, Phlegm clears itself. Use Simo Decoction or Dingfei Decoction.
Qianmin Decoction
Banxia (Pinelliae Rhizoma, 7 pieces, soaked, each cut into 4 slices) Zaojiao (Gleditsiae Fructus Spina, 1 cun, roasted, skin and fibers removed) Gancao (Licorice Root, roasted, 1 cun)
One prescription combines with Daotan Decoction; another adds Xionghuang (Realgar).
Process these as one dose: add 2 liang of water and 1 slice of Shengjiang (Fresh Ginger), decoct until 0.8 liang remains, take warm.
Daotan Decoction (See entry for Phlegm Syndrome.)
Dingfei Decoction
Treats upper Jiao asthma and urgency.
Ziwan (Astrodis Radix et Rhizoma) Wuweizi (Schisandrae Fructus) Juhong (Citri Reticulatae Pericarpium Rubrum) Gancao (Licorice Root, roasted) Suzi (Perillae Fructus, stir-fried) Xingren (Armeniacae Semen Amarum, peeled and core removed, stir-fried) Sangbaipi (Morus Cortex, stir-fried) Banxia (Pinelliae Rhizoma, processed) Zhike (Aurantii Fructus Immaturus, stir-fried) Zisuye (Perillae Folium) (All in equal parts)
Process these: add 5 slices of Shengjiang (Fresh Ginger) and 2 liang of water, decoct until 1 liang remains, take.
If asthma is severe, add Tinglizi (Descurainiae Semen seu Lepidii Semen); if phlegm is copious, add Gualouren (Trichosanthis Semen).
Simo Decoction
Treats asthma and urgency due to emotional stagnation.
Renshen (Ginseng Radix et Rhizoma) Binglang (Arecae Semen) Chenxiang (Aquilariae Lignum Resinatum) Wuyao (Mesaeae Ramulus) (Each 1 qian, ground thickly to extract juice)
Process these: obtain 0.7 part of the liquid, boil for one or two boils, take warm.
[Asthma]
For Qi rebelling upward causing asthma, use Suzi Jiangqi Decoction. For Excess Qi type, where asthma results from taking tonifying medicines, use San'ao Decoction. For Upper Qi rebellion causing asthma, use Shenmi Decoction.
Suzi Jiangqi Decoction
Treats deficiency asthma attacking upward, failure of Qi to ascend and descend, excess above and deficiency below.
Suzi (Perillae Fructus, 1 qian) Banxiaqu (Pinelliae Rhizoma Praeparatum cum Alumine et Zingibere, 1 qian) Chenpi (Citri Reticulatae Pericarpium, white pith removed, 0.7 qian) Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice, 0.5 qian) Qianhu (Peucedani Radix, 0.5 qian) Danggui (Angelicae Sinensis Radix, 0.5 qian) Rougui (Cinnamomi Cortex, 0.3 qian) Gancao (Licorice Root, 0.3 qian)
Process these: cut into small pieces, one dose, add 3 slices of ginger and 2 zhong of water, decoct until 0.8 zhong remains, take on an empty stomach.
San'ao Decoction
Treats cold-damp invasion, nasal congestion with heavy voice, reluctance to speak, coughing and urgent asthma, representing an Excess syndrome of external pathogenic factors.
Shenggancao (Raw Licorice Root) Mahuang (Ephedrae Herba, nodes not removed) Xingren (Armeniacae Semen Amarum, skin and tips retained) (All in equal parts)
Process these: add 5 slices of Shengjiang (Fresh Ginger) and 2 liang of water, decoct until 1 liang remains, take warm. Stop when sweating occurs.
Shenmi Decoction
Treats upper Jiao asthma and urgency preventing lying down.
Juhong (Citri Reticulatae Pericarpium Rubrum) Jiegeng (Platycodonis Radix) Zisu (Perillae Folium) Wuweizi (Schisandrae Fructus) Renshen (Ginseng Radix et Rhizoma) (All in equal parts)
Process these: take 4 qian per dose, add 2 liang of water, decoct until 0.8 liang remains, take before meals.
[Flame-type Asthma]
For Flame-type asthma, use Zhijie Erchen Decoction plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhizi (Gardeniae Fructus). For Yin deficiency with flourishing Fire, where Qi rushes upward from below the navel causing asthma, use Siwu Decoction plus Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Maimendong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus), or administer Liujun Wan material.
Zhijie Erchen Decoction
Is Erchen Decoction plus Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodonis Radix). (See entry for Phlegm Syndrome.)
Siwu Decoction (See entry for Blood Syndrome.)
Liujun Wan (See entry for Deficiency Damage.)
[Stomach Deficiency Asthma]
For Stomach deficiency causing asthma, use Wuweizi Decoction plus Baizhu (Atractylodis Macrocephalae Rhizoma). For chronic asthma, it is Qi deficiency with discontinuous Qi; use Shengmai San plus Ejiao (Asini Corii Colla), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium).
Wuweizi Decoction
Wuweizi (Schisandrae Fructus, 9 grains) Renshen (Ginseng Radix et Rhizoma, 1 qian) Maimendong (Ophiopogonis Radix, 0.8 qian) Xingren (Armeniacae Semen Amarum, 0.8 qian) Chenpi (Citri Reticulatae Pericarpium, 1 qian) Shengjiang (Fresh Ginger, 3 slices) Dazao (Jujubae Fructus, 2 pieces)
Process these: cut into small pieces, one dose, add 2 liang of water, decoct until 0.8 liang remains, take warm.
Shengmai San
Renshen (Ginseng Radix et Rhizoma, 1 qian) Maimendong (Ophiopogonis Radix, 1 qian) Wuweizi (Schisandrae Fructus, 10 grains)
Process these: add 1.5 liang of water, decoct until 0.7 liang remains, take.
[Appendix: Asthma]
Asthma involves internal Phlegm-Heat wrapped by Cold. One must consume bland flavors, using Erchen Decoction plus Cangzhu (Atractylodis Rhizoma) and Huangqin (Scutellariae Radix), or Mahuang Decoction plus Zisu (Perillae Folium), Banxia (Pinelliae Rhizoma), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), and Huangqin (Scutellariae Radix). In cold weather, add Guizhi (Cinnamomi Ramulus) to warm and disperse.
Erchen Decoction (See entry for Phlegm Syndrome.)
Mahuang Decoction (See entry for Fever.)