【肺胀之症】喘不得卧，短息倚肩，抬身撷肚，肩背皆痛，痛引缺盆，此肺胀之症也。
【肺胀之因】内有郁结，先伤肺气，外复感邪，肺气不得发泄，则肺胀作矣。
【肺胀之脉】寸口独大，或见浮数，或见浮紧，浮数伤热，浮紧伤寒；寸实肺壅，浮芤
气脱，和缓易治，代散则绝。
【肺胀之治】脉实壅盛者，葶苈泻肺汤；肺受热邪，加味泻白散；肺受寒邪，小青龙汤
加石膏，家秘立加味泻白散、前胡汤、三因神秘汤，随症加减治之。
加味泻白散
桑白皮 地骨皮 陈皮 石膏 桔梗 黄芩 知母 甘草
胸前满闷，加枳壳、苏梗。
前胡汤
前胡 桑白皮 半夏 苏子 杏仁 甘草 陈皮 枳壳 桔梗
有风，加防风。有寒，加麻黄。有热，加石膏、黄芩。
三因神秘方
苏梗 桔梗 桑白皮 地骨皮 青皮 陈皮 木香 枳壳
东垣云∶诸痿喘呕，皆属于上。伤寒家论喘呕，以为有余之邪中于外，寒变为热攻肺，
故属于上。又有膏粱之人，奉养口腹，及过爱小儿，皆能积热成喘，宜以甘寒治之。丹溪云
，喘因气虚，火入于肺，有痰者，有火炎者，有阴虚小腹冲上者，有气虚，有水气乘肺者。
戴复庵云，痰喘者，喘有痰声；火炎者，乍进乍退，得食稍减，食久仍喘，此胃中有实火，
膈上有稠痰，得食压下痰火，喘即暂止。食已入胃，反助其火，喘仍大作，不独喘症，咳逆
呃哕，属火者，亦皆如此。若作胃寒治，便是以火济火。若胃绝而喘，抬肩撷肚，而无停止
。丹溪云，喘须分虚实，气虚用人参阿胶五味汤。实喘者，肺窍壅滞，右寸口沉实，宜泻肺
。虚喘者，先觉呼吸气短，两胁胀满，左尺大而虚，宜补肾。邪喘者，肺受外邪，伏于关窍
，右寸紧盛者，宜散肺邪。亦有六部俱伏者，亦宜发散，则身热退。《三因方》云，肺实者
，上气喘逆，咽中逆，如欲呕状，自汗出，右寸气口脉有力。肺虚者少气不足，右寸气口脉
必无力。丹溪云，喘自小腹下直冲于上者，阴虚喘也，用四物汤加青黛、竹沥、陈皮，补阴
化痰。夫阴虚作喘，实发人未发，但此方止可治血虚火冲者，若肾中真阴虚，非四物补阴血
之谓，宜六味丸加门冬、五味、黄柏、知母，或知柏天地煎，煎大剂饮之，壮水之主，水升
火降而喘自定，当与阴虚龙雷相火同看。若概云阴虚，则失分血虚、精虚矣。若肝肾皆虚，
精血皆不足，宜以家秘肝肾丸，兼而治之。按丹溪治阴火上冲作呃，用四物汤加知柏；今治
阴火上冲而喘，用四物汤加青黛、竹沥，以呃无痰而喘必兼痰也。总之，治喘之法，真知其
寒者，则用青龙汤等。真知其风者，则用防风汤等。真知其暑者，则用清暑益元散。真知其
湿者，则用燥湿胜湿汤。真知其火与燥者，则用栀连汤。此皆外感也。若内伤诸喘，血虚者
，四物汤加竹沥、童便。若阴精不足，则补肾，地黄丸或家秘知柏天地煎。至于元气不足，
【肺胀的症状】气喘无法平卧，呼吸短促需倚靠肩膀支撑，身体抬起并用手托住腹部，肩背部均感疼痛，疼痛牵引至缺盆穴部位，这就是肺胀的症状。
【肺胀的成因】体内有郁结之气，首先损伤肺气，外部又感受邪气，导致肺气不能宣发疏泄，于是肺胀发作。
【肺胀的脉象】寸口脉单独变大，或者表现为浮数脉，或者表现为浮紧脉；浮数脉表示伤于热邪，浮紧脉表示伤于寒邪；寸部实大表示肺气壅塞，浮芤脉表示气脱；脉象和缓容易治疗，若出现代脉或散脉则预后不良（绝症）。
【肺胀的治疗】脉象实而壅盛者，使用葶苈泻肺汤；肺受热邪者，使用加味泻白散；肺受寒邪者，使用小青龙汤加石膏。另有家传秘方的立加味泻白散、前胡汤、三因神秘汤，根据症状加减治疗。
加味泻白散
组成：桑白皮、地骨皮、陈皮、石膏、桔梗、黄芩、知母、甘草。
若胸前满闷，加枳壳、苏梗。
前胡汤
组成：前胡、桑白皮、半夏、苏子、杏仁、甘草、陈皮、枳壳、桔梗。
若有风邪，加防风。若有寒邪，加麻黄。若有热邪，加石膏、黄芩。
三因神秘方
组成：苏梗、桔梗、桑白皮、地骨皮、青皮、陈皮、木香、枳壳。
李东垣说：各种痿证、喘证、呕吐，病位都归属于上焦。伤寒家论述喘呕，认为是有余的邪气侵袭体表，寒邪转化为热邪攻冲肺部，所以归属于上焦。又有那些饮食肥甘厚味的人，注重口腹享受，以及过分溺爱小儿，都能积热导致喘息，应当用甘寒的方法治疗。朱丹溪说，喘息是因为气虚，火邪进入肺部，有的伴有痰，有的是火炎上，有的是阴虚导致小腹之气冲逆向上，有的是气虚导致水气乘袭肺部。戴复庵说，痰喘的患者，喘息时伴有痰声；火炎导致的喘息，病情时轻时重，进食后稍减轻，过一会儿又喘息，这是因为胃中有实火，膈上有稠痰，进食后压下痰火，喘息暂时停止。食物进入胃中，反而助长火势，喘息再次大作。不仅喘证，咳嗽、气逆、呃逆属于火邪引起的，也都是这样。如果当作胃寒治疗，就是以火救火。如果是胃气绝败导致的喘息，抬肩托肚，且没有停止的时候。朱丹溪说，喘息必须分虚实。气虚喘息用人参阿胶五味汤。实喘者，肺窍壅滞，右寸口脉沉实，应当泻肺。虚喘者，先感觉呼吸气短，两胁胀满，左尺脉大而虚，应当补肾。邪气导致的喘息，肺受外邪，潜伏在关窍，右寸脉紧盛者，应当疏散肺邪。也有六部脉都伏匿不见的，也应当发散，则身热退去。《三因方》说，肺实证，上气喘逆，咽喉中气逆，像要呕吐的样子，自汗出，右寸气口脉有力。肺虚证，少气不足以息，右寸气口脉必然无力。朱丹溪说，喘息从小腹下直冲向上的，是阴虚喘，用四物汤加青黛、竹沥、陈皮，补阴化痰。所谓阴虚作喘，实际上多发生在未发病之前，但这个方子只可治疗血虚火冲的情况，如果是肾中真阴虚，就不是四物汤补阴血的意思了，应当用六味丸加麦冬、五味子、黄柏、知母，或者知柏天地煎，煎煮大剂服用，壮水之主，使水升火降而喘息自定，这应当与阴虚龙雷相火一同看待。如果一概说是阴虚，就分不清是血虚还是精虚了。如果肝肾都虚，精血都不足，应当用家传的肝肾丸，兼而治之。按朱丹溪治疗阴火上冲导致呃逆，用四物汤加知母、黄柏；现在治疗阴火上冲导致喘息，用四物汤加青黛、竹沥，因为呃逆无痰而喘息必兼有痰。总之，治疗喘息的方法，真正知道是寒邪的，就用青龙汤等。真正知道是风邪的，就用防风汤等。真正知道是暑邪的，就用清暑益元散。真正知道是湿邪的，就用燥湿胜湿汤。真正知道是火邪与燥邪的，就用栀连汤。这些都属于外感。如果是内伤引起的各种喘息，血虚的，用四物汤加竹沥、童便。如果阴精不足，则补肾，用地黄丸或家传知柏天地煎。至于元气不足，
[Symptoms of Lung Distension] Panting with inability to lie flat, shortness of breath requiring leaning on the shoulders for support, lifting the body and holding the abdomen with hands, pain in both shoulders and back radiating to the Quren (Jiaochong) acupoint. These are the symptoms of Lung Distension.
[Causes of Lung Distension] Internal stagnation first damages Lung Qi; subsequently, external pathogens invade. When Lung Qi cannot be diffused and discharged, Lung Distension occurs.
[Pulse of Lung Distension] The Cun (inch) position pulse is exclusively enlarged. It may appear as a Floating-Rapid pulse or a Floating-Tight pulse. A Floating-Rapid pulse indicates injury by Heat pathogens; a Floating-Tight pulse indicates injury by Cold pathogens. A Solid pulse at the Cun position indicates Lung congestion; a Floating-Hollow (Kou) pulse indicates Qi depletion. A Harmonious and Moderate pulse is easy to treat; a Choppy (Dai) or Scattered pulse indicates a critical condition (terminal).
[Treatment of Lung Distension] For pulses that are Solid and congested, use Tingli Xiefei Tang (Descurainia Seed Decoction to Drain the Lungs). For Lungs affected by Heat pathogens, use Jia Wei Xiebai San (Modified Bland-Draining Powder). For Lungs affected by Cold pathogens, use Xiao Qinglong Tang (Minor Blue Dragon Decoction) added with Shigao (Gypsum Fibrosum). Additionally, there are family-secret formulas: Li Jia Wei Xiebai San (Newly Added Modified Bland-Draining Powder), Qianhu Tang (Peucedani Radix Decoction), and Sanyin Shenmi Tang (Three Causes Mysterious Secret Decoction), which are treated with modifications according to symptoms.
Jia Wei Xiebai San (Modified Bland-Draining Powder)
Ingredients: Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Chenpi (Citri Reticulatae Pericarpium), Shigao (Gypsum Fibrosum), Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
If there is fullness and oppression in the chest, add Zhike (Aurantii Fructus) and Sugeng (Perillae Caulis).
Qianhu Tang (Peucedani Radix Decoction)
Ingredients: Qianhu (Peucedani Radix), Sangbaipi (Mori Cortex), Banxia (Pinelliae Rhizoma), Suzi (Perillae Fructus), Xingren (Armeniacae Semen Amarum), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Zhike (Aurantii Fructus), Jiegeng (Platycodonis Radix).
If Wind is present, add Fangfeng (Saposhnikoviae Radix). If Cold is present, add Mahuang (Ephedrae Herba). If Heat is present, add Shigao (Gypsum Fibrosum) and Huangqin (Scutellariae Radix).
Sanyin Shenmi Fang (Three Causes Mysterious Secret Formula)
Ingredients: Sugeng (Perillae Caulis), Jiegeng (Platycodonis Radix), Sangbaipi (Mori Cortex), Digupi (Lycii Cortex), Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Muxiang (Aucklandiae Radix), Zhike (Aurantii Fructus).
Li Dongyuan stated: All cases of Wei syndrome (flaccidity), panting, and vomiting belong to the Upper Jiao. Scholars of Cold Damage discuss panting and vomiting as excess pathogens attacking from the exterior, where Cold transforms into Heat and attacks the Lungs, thus belonging to the Upper Jiao. Furthermore, those who consume rich and sweet foods, indulging their appetites, or those who excessively dote on children, can accumulate Heat leading to panting; these should be treated with Sweet-Cold methods. Zhu Danxi stated that panting is due to Qi deficiency, with Fire entering the Lungs. Cases may involve Phlegm, blazing Fire, Yin deficiency causing Qi rushing up from the lower abdomen, or Qi deficiency allowing Water-Qi to assault the Lungs. Dai Fu'an stated that in Phlegm-panting, there is a rattling sound during breathing; in Fire-blazing panting, symptoms fluctuate, improving slightly after eating but returning later. This is because there is Excess Fire in the Stomach and thick Phlegm above the diaphragm; food presses down the Phlegm-Fire temporarily stopping the panting. However, once food enters the Stomach, it aids the Fire, causing severe panting again. This applies not only to panting but also to cough, counterflow Qi, and hiccups caused by Fire. Treating this as Stomach Cold would be like adding fire to fire. If panting results from Stomach Qi exhaustion, characterized by shoulder-lifting and abdominal-holding without cessation... Zhu Danxi stated that panting must be differentiated into Excess and Deficiency. For Qi-deficiency panting, use Renshen Ejiao Wuwei Tang (Ginseng, Donkey-Hide Gelatin, and Schisandra Decoction). For Excess panting, where Lung orifices are congested and the Right Cun pulse is Deep-Solid, one should drain the Lungs. For Deficiency panting, initially felt as shortness of breath and distension in both hypochondria, with a Large-Empty Left Chi pulse, one should tonify the Kidneys. For Pathogen panting, where external pathogens lodge in the orifices and the Right Cun pulse is Tight-Exuberant, one should disperse Lung pathogens. Even if all six positions show Hidden pulses, dispersion is indicated, leading to the subsidence of fever. The *San Yin Fang* states: In Lung Excess, there is upper-body panting and counterflow, throat obstruction resembling nausea, spontaneous sweating, and a Forceful Right Cun/Qikou pulse. In Lung Deficiency, there is shortness of breath and insufficiency, with an Ineffective Right Cun/Qikou pulse. Zhu Danxi stated that panting rushing directly upward from the lower abdomen is Yin-deficiency panting, treated with Siwu Tang (Four Substances Decoction) added with Qingdai (Indigo Naturalis), Zhuli (Bambusa Textilis Sap), and Chenpi (Citri Reticulatae Pericarpium) to tonify Yin and resolve Phlegm. True Yin-deficiency panting often manifests before overt onset; however, this formula is only suitable for Blood-deficiency with Fire rushing up. If it is True Yin deficiency of the Kidney, it is not addressed by Siwu Tang's blood-tonifying action; instead, use Liuwei Wan (Six-Ingredient Pill) added with Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma), or Zhibai Tiandi Jian (Anemarrhena, Phellodendron, Heaven-and-Earth Decoction), brewed in large doses. This strengthens the source of Water, raising Water and descending Fire to settle panting. This should be viewed similarly to Yin-deficiency Long-Lei Minister Fire. If one generally refers to Yin deficiency, one fails to distinguish between Blood deficiency and Essence deficiency. If both Liver and Kidney are deficient with insufficient Essence and Blood, use the family-secret Ganshen Wan (Liver-Kidney Pill) to treat both. According to Zhu Danxi, treating hiccups caused by Yin-Fire rushing up uses Siwu Tang added with Zhi Mu and Huang Bai; now, treating panting caused by Yin-Fire rushing up uses Siwu Tang added with Qingdai and Zhuli, because hiccups lack Phlegm while panting necessarily involves Phlegm. In summary, the methods for treating panting: if truly identified as Cold, use Qinglong Tang (Blue Dragon Decoction) etc. If truly identified as Wind, use Fangfeng Tang (Saposhnikovia Decoction) etc. If truly identified as Summerheat, use Qingshu Yiyuan San (Clear Summerheat and Benefit Origin Powder). If truly identified as Dampness, use Zaoshi Shengshi Tang (Dry Dampness and Overcome Dampness Decoction). If truly identified as Fire and Dryness, use Zhilian Tang (Gardenia and Coptis Decoction). These all pertain to External Contraction. If they are internal injuries causing various pantings: for Blood deficiency, use Siwu Tang added with Zhuli (Bambusa Textilis Sap) and Tongbian (Infant Urine). If Yin-Essence is insufficient, tonify the Kidney using Dihuang Wan (Rehmannia Pill) or the family-secret Zhibai Tiandi Jian. As for Yuan Qi (Original Qi) insufficiency,