喘与胀二症相因，必皆小便不利，喘则必生胀，胀则必生喘，但要识中标本先后。先喘而后胀者主
于肺，先胀而后喘者主于脾，何则？肺金司降，外主皮毛。经曰∶肺朝百脉，通调水道，下输膀胱。又
曰∶膀胱者，州都之官，津液藏焉，气化则能出矣。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，而生胀满焉。此则喘为本，而胀为标，治当清金
降火为主，而行水次之。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，浸渍肌
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，治当实脾行水为主，而清金次
之。苟肺症而用燥脾之药，则金得燥而喻愈加；脾病而用清金之药，则脾得寒而胀愈甚矣。近世治二症，
但知实脾行水，而不知分别脾肺二症，予故为发明之。
愚按前症若肺中伏热不能生水，而喘且渴者，用黄芩清肺饮以治肺，用五淋散以清小便；若脾肺虚弱，
不能通调水道者，宜用补中益气汤以培元气，用六味地黄丸以补肾水；若膏粱浓味，脾肺积热而喘者，宜
清胃散以治胃，用滋肾丸以利小便；若心火克肺金而不能生肾水者，用人参平肺散以治肺，用滋阴丸以滋
小便；若肾经阴亏，虚火烁肺金而小便不生者，用六味地黄丸以补肾水，用补中益气汤以培脾土；若脾气虚
弱不能相制而喘者，用补中益气汤以培元气，用六味地黄丸以生肾水；若肝木克脾土不能相制而喘者，用
六君、柴胡、升麻以培元气，六味地黄丸以补肾水；若脾胃虚寒不能相制而胀者，用八味丸以补脾肺、生
肾水；若脾肾虚寒不能通调水道而胀者，宜用金匮加减肾气丸补脾肺、生肾水；若酒色过度，亏损足三阴
而致喘、胀、痰涌、二便不调或大小便道相牵作痛者，亦宜用此丸，多有生者。
一富商，饮食起居失宜，大便干结，常服润肠等丸，后胸腹不利，饮食不甘，口干，体倦，发热，吐
痰，服二陈、黄连之类，前症益甚，小便滴沥，大便泄泻，腹胀少食，服五苓、瞿麦之类，小便不通，体
肿，喘嗽，用金匮肾气丸、补中益气汤而愈。
一儒者，失于调养，饮食难化，胸膈不利。或用行气消导药，咳嗽喘促；用行气化痰，肚腹渐胀；用
行气分利，睡卧不能，两足浮肿，小便不利，大便不实。肺肾脉浮大，按之微细，两寸皆短。朝用补中益
气汤加姜、附，夕用金匮肾气丸加骨脂、肉果，各数剂，诸症渐愈，再佐以八味丸，两月乃能步履，却服
补中、八味，半载而康。
喘证与胀满二症相互关联，必然都伴有小便不利的症状。喘证发作后必然会导致胀满，胀满发生后也必然会导致喘证，关键在于要识别其中的标本和先后顺序。先出现喘证而后出现胀满的，病机主要在于肺；先出现胀满而后出现喘证的，病机主要在于脾。为什么呢？因为肺属金，主司肃降，外合皮毛。《内经》说：“肺朝百脉，通调水道，下输膀胱。”又说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”这说明小便的通利，是由于肺气肃降下行并输布转化所致。如果肺受邪气侵袭而上逆作喘，就会失去肃降的功能，导致小便逐渐短少，致使水湿泛滥于皮肤，从而产生胀满。这种情况下，喘是本，胀是标，治疗应当以清肺金、降虚火为主，利水渗湿为辅。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，那么水湿就会妄行，浸渍肌肉，水湿既已上泛，邪气反而侵犯肺脏，肺气不得肃降而产生喘证。这种情况下，胀是本，喘是标，治疗应当以健脾实土、利水渗湿为主，清肺金为辅。如果是肺的病证却使用燥湿健脾的药物，那么肺金得到燥性而喘证更加严重；如果是脾的病证却使用清泻肺金的药物，那么脾土得到寒凉而胀满更加厉害。近代医生治疗这两种病症，只知道健脾利水，却不知道区分脾肺两种不同的病证，所以我特意阐明这一点。
我认为上述病症，如果是肺中伏热不能生水，导致喘且口渴的，用黄芩清肺饮来治疗肺，用五淋散来清利小便；如果是脾肺虚弱，不能通调水道的，宜用补中益气汤来培补元气，用六味地黄丸来补肾水；如果是由于膏粱厚味，导致脾肺积热而喘的，宜用清胃散来治疗胃，用滋肾丸来通利小便；如果是心火克制肺金而不能生肾水的，用人参平肺散来治疗肺，用滋阴丸来滋润小便（注：此处原文“滋小便”疑为笔误或特定语境，结合上下文及滋阴丸功效，通常指滋阴以助气化或润燥，但依指令忠实翻译）；如果是肾经阴亏，虚火灼伤肺金而导致小便不生的，用六味地黄丸来补肾水，用补中益气汤来培补脾土；如果是脾气虚弱不能相互制约而喘的，用补中益气汤来培补元气，用六味地黄丸来滋生肾水；如果是肝木克制脾土不能相互制约而喘的，用六君子汤、柴胡、升麻来培补元气，用六味地黄丸来补肾水；如果是脾胃虚寒不能相互制约而胀的，用八味丸（即金匮肾气丸）来补脾肺、滋生肾水；如果是脾肾虚寒不能通调水道而胀的，宜用金匮加减肾气丸来补脾肺、滋生肾水；如果是酒色过度，亏损足三阴经脉而导致喘、胀、痰涌、二便不调或大小便道相互牵引作痛的，也适宜用此丸，往往有治愈的病例。
有一位富商，饮食起居不合规律，大便干结，经常服用润肠等丸剂，后来出现胸腹不适，饮食无味，口干，身体疲倦，发热，吐痰，服用二陈汤、黄连之类的药物，前面的症状更加严重，小便点滴难出，大便泄泻，腹胀食少，又服用五苓散、瞿麦之类的药物，导致小便完全不通，身体浮肿，喘咳，最后用金匮肾气丸、补中益气汤而痊愈。
有一位读书人，疏于调养，饮食难以消化，胸膈部不适。有人使用行气消导药，导致咳嗽气喘急促；使用行气化痰药，肚腹逐渐胀满；使用行气分利药，导致睡眠无法安卧，两脚浮肿，小便不利，大便不成形。诊得肺肾脉象浮大，重按微细，两手寸脉皆短。早晨服用补中益气汤加生姜、附子，晚上服用金匮肾气丸加骨碎补、肉豆蔻，各服数剂，各种症状逐渐好转，再辅以八味丸，两个月后才能行走，之后继续服用补中益气汤和八味丸，半年后康复。
Wheezing (Chuan) and Distension (Zhang) are two symptoms that cause each other; both must be accompanied by difficulty in urination. Wheezing inevitably leads to distension, and distension inevitably leads to wheezing. The key lies in identifying the root (Ben) and branch (Biao), as well as the sequence of onset. If wheezing occurs first followed by distension, the pathology is primarily located in the Lung (Fei); if distension occurs first followed by wheezing, the pathology is primarily located in the Spleen (Pi). Why? Because Metal (Jin) governs descent, and externally controls the skin and hair (Mao Pi). The Classics state: "The Lung receives all vessels, regulates water passages, and transmits fluids downward to the Bladder." It also states: "The Bladder is the official of the capital, storing body fluids; when Qi transformation occurs, they can be excreted." This indicates that the flow of urine depends on the descending and transforming function of Lung Qi. If the Lung is invaded by pathogenic factors and wheezes upward, it loses its descending command, causing urine volume to gradually decrease. Consequently, water overflows into the skin, generating distension. In this case, wheezing is the root, and distension is the branch; treatment should focus mainly on clearing Lung Metal and descending fire, with promoting urination as secondary. Earth (Tu) dislikes dampness and externally controls muscles; Earth can control Water. If Spleen Earth is injured and cannot control Water, damp-water will run wild, infiltrating the muscles. Once water overflows upward, pathogens invade the Lung, preventing Qi from descending and generating wheezing. In this case, distension is the root, and wheezing is the branch; treatment should focus mainly on strengthening the Spleen and promoting urination, with clearing Lung Metal as secondary. If a Lung condition is treated with drying Spleen herbs, Lung Metal will become drier, worsening the wheezing; if a Spleen condition is treated with cooling Lung herbs, Spleen Earth will become colder, worsening the distension. Modern physicians, when treating these two conditions, only know how to strengthen the Spleen and promote urination, failing to distinguish between Spleen and Lung conditions. Therefore, I have elucidated this point.
In my opinion, for the aforementioned conditions: If latent heat in the Lung fails to generate fluids, resulting in wheezing and thirst, use Huangqin Qingfei Yin (Scutellaria Decoction to Clear the Lung) to treat the Lung, and Wulin San (Five-Difficulty Powder) to clear the urinary tract. If Spleen and Lung are weak and fail to regulate water passages, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to cultivate Yuan Qi (Primal Qi), and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify Kidney Water. If excessive consumption of rich foods causes accumulation of heat in Spleen and Lung leading to wheezing, use Qingwei San (Clear the Stomach Powder) to treat the Stomach, and Zishen Wan (Nourish the Kidney Pill) to facilitate urination. If Heart Fire overacts on Lung Metal, failing to generate Kidney Water, use Renshen Pingfei San (Ginseng Powder to Calm the Lung) to treat the Lung, and Ziyin Wan (Nourish Yin Pill) to nourish the urinary system (Note: Contextually implies nourishing yin to aid fluid metabolism). If Kidney Yin deficiency allows deficient fire to scorch Lung Metal, resulting in failure of urine production, use Liuwei Dihuang Wan to tonify Kidney Water, and Buzhong Yiqi Tang to cultivate Spleen Earth. If Spleen Qi is weak and fails to mutually restrain, causing wheezing, use Buzhong Yiqi Tang to cultivate Yuan Qi, and Liuwei Dihuang Wan to generate Kidney Water. If Liver Wood overacts on Spleen Earth, failing to mutually restrain, causing wheezing, use Liujunzi Tang (Six-Gentlemen Decoction), Chaihu (Bupleuri Radix), and Shengma (Cimicifugae Rhizoma) to cultivate Yuan Qi, and Liuwei Dihuang Wan to tonify Kidney Water. If Spleen and Stomach are deficient and cold, failing to mutually restrain, causing distension, use Bawei Wan (Eight-Ingredient Pill, i.e., Jin Gui Shenqi Wan) to tonify Spleen and Lung, and generate Kidney Water. If Spleen and Kidney are deficient and cold, failing to regulate water passages, causing distension, use Jin Gui Ji Jian Shenqi Wan (Modified Kidney Qi Pill from the Golden Cabinet) to tonify Spleen and Lung, and generate Kidney Water. If excessive alcohol and sexual activity damage the three Yin meridians of the foot, leading to wheezing, distension, surging phlegm, irregular bowel and bladder movements, or pain radiating between the large and small intestine tracts, this pill is also suitable, with many cases of recovery.
A wealthy merchant, due to improper diet and lifestyle, suffered from dry stools. He frequently took Run Chang pills. Later, he experienced chest and abdominal discomfort, loss of appetite, dry mouth, fatigue, fever, and expectoration. After taking Erchen Tang (Two-Aged Decoction) and Coptis (Huanglian), his previous symptoms worsened. He developed scanty urination, diarrhea, abdominal distension, and poor intake. After taking Wuling San (Five-Ling Powder) and Polygonum aviculare (Qumai), he developed complete urinary retention, generalized edema, wheezing, and cough. He was cured using Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) and Buzhong Yiqi Tang.
A scholar, neglecting self-care, had difficulty digesting food and experienced chest and diaphragmatic discomfort. Treatment with Qi-moving and digestion-promoting herbs led to coughing and rapid breathing. Treatment with Qi-moving and phlegm-resolving herbs led to gradual abdominal distension. Treatment with Qi-moving and diuretic herbs led to insomnia, edema of both feet, difficult urination, and loose stools. Pulmonary and Kidney pulses were floating and large but fine upon deep pressure; both Cun positions were short. He took Buzhong Yiqi Tang added with Ginger (Shengjiang) and Aconite (Fuzi) in the morning, and Jin Gui Shenqi Wan added with Gujibu (Drynariae Rhizoma) and Rouguou (Myristicae Semen) in the evening. After several doses, various symptoms gradually improved. Subsequently, he supplemented with Bawei Wan. After two months, he could walk. Continuing Buzhong Yiqi Tang and Bawei Wan for half a year, he fully recovered.