桑榆子曰∶“精化为气，气化而神集焉。故曰，神能御气，则鼻不失息。”谭紫霄曰∶“神犹母也，气犹子也。
以神召气，如以母召子。凡呼吸有声者，风也，非息也。守风则散。虽无声而鼻中涩滞者，喘也，非息也。守
喘则结。不声不滞，而往来有迹者，气也，非息也。守气则劳。所谓息者，不出不入之义。绵绵密密，若存若
亡，心不着境，无我无人，更有何息可调？至此则神自返，息自定，心息相根据，水火相媾，息息归根，金丹之
母。”丘长春云∶“息有一毫之未定，命非己有。”以此言之。息之所关于人大矣哉！故较之于声，尤所当
辨也。
气来短促，不足以息，呼吸难应，乃为虚甚。素无寒热，短气难续，知其为实。
无寒热则阴阳和平，而亦短气不能布息，此中焦有碍，或痰火为害。
吸而微数，病在中焦。
中实吸不得入，还出复入，故脉来微数，亦系实证，非痰即食，可以攻下。
实则可生，虚者不治。
实则可下。中虚吸不尽入而微数者，肝肾欲绝，焉能救乎？
上焦吸促，下焦吸远，上下暌违，何以施疗？
病在上焦，气宜通下；病在下焦，气宜达上。上下交通，病斯愈矣。今上焦者吸促而不能通下，下焦者吸
远而不能达上，上下不交通，病岂易治乎！至于呼吸动摇，振振而气不载形者，必死之证矣。
天积气耳，地积形耳，人气以成形耳。惟气以成形，气聚则形存，气散则形亡，气之关于形也，岂不巨哉！
然而身形之中，有营气，有卫气，有宗气，有脏腑之气，有经络之气，各为区分。其所以统摄营卫脏腑经
络，而令充周无间，环流不息，通体皆灵者，全赖胸中大气主持。夫脏腑大经小络，昼夜循环不息，必赖
胸中大气斡旋其间。大气一衰，则出入废，升降息，神机化灭，气立孤危矣。若夫息出于鼻，其气布于膻
中。膻中宗气主上焦息道。恒与肺胃关通，或清而徐，或短而促，足以占宗气之盛衰。所以《素问·平
人气象论》曰∶“乳之下其动应衣，宗气泄也。”人顾可奔迫无度，令宗气盛喘数急，有余反成不足
耶！此指呼出为息之一端也。其谓“起居如故，而息有音，此肺之络脉逆也。不得卧而息有音者，是阳
明之逆也。”盖见布息之气，关通肺胃，又指呼出为息之一端也。呼出心肺主之；吸入肾肝主之；呼吸
之中，脾胃主之。故惟脾胃所主中焦为呼吸之总持。设气积贲门不散，两阻其出入，则危急存亡非常
之候。善养生者，使贲门之气传入幽门，幽门之气传二阴之窍而出，乃不为害。其上焦下焦，各分呼出
吸入，未可以息之一字统言其病矣。此义惟仲景知之。谓“息摇肩者，心中坚。息引胸中上气者，咳。息
张口短气者，肺痿唾沫。”分其息专主乎呼而不与吸并言，似乎创说。不知仲景以述为作，无不本之
《内经》，即前所拟呼出为息，二端不足尽之。盖心火乘肺，呼气奔促，势有必至。呼出为心肺之阳，自不
得以肝肾之阴混之耳。息摇肩者，肩随息动，惟火故动也。息引胸中上气咳者，肺金收降之令不行，上
逆而咳，惟火故咳也。张口短气、肺痿唾沫，又金受火刑不治之证。均以出气之粗名为息耳。然则曷不
径以呼名之耶？曰，呼中有吸，吸中有呼，剖而中分，圣神所不出也。但以息之出者主呼之病，而息之入
者主吸之病，不待言矣。《素问·通评虚实论》谓∶“乳子中风热，喘鸣肩息。”以及息有音者不一而足，
惟其不与吸并言，而吸之病转易识别。然尚恐后人未悉，复补其义云∶“吸而微数，其病在中焦实也，
当下之即愈，虚者不治。在上焦者其吸促，在下焦者其吸远，此皆难治。呼吸动摇振振者不治。”见吸
微且数，吸气之往返于中焦者速，此必实者下之，通其中焦之壅而即愈。若虚则肝肾之本不固，其气
轻浮，脱之于阳，不可治矣。前所指贲门幽门不下通，为危急存亡非常之候者，此也。在上焦者其吸促，
以心肺之道近，其真阴之虚者，则从阳火而升，不入于下，故吸促。是上焦未尝不可候其吸也。下焦者
其吸远，肝肾之道远，其元阳之衰者，则因于阴邪所伏，卒难升上，故吸远。此真阴元阳受病，故皆难治。
若呼吸往来振振动摇，则营卫往返之气已索，所存呼吸一线耳，尚可为哉！学人先分息之出入，以求
病情。既得其情，合之不爽。若但统论呼吸，其何以分上中下三焦所主乎？意微矣。
桑榆子说：“精转化为气，气凝聚则神汇聚。所以说，神能够驾驭气，那么鼻息就不会失常。”谭紫霄说：“神就像母亲，气就像儿子。用神来召引气，就像母亲召唤儿子一样。凡是呼吸有声音的，是风，不是息。守着风会导致散乱。虽然没有声音但鼻中涩滞不畅的，是喘，不是息。守着喘会导致郁结。没有声音也不滞涩，而且往来有迹可循的，是气，不是息。守着气会导致劳损。所谓的‘息’，是不出也不入的意思。绵绵密密，似存似亡，心不执着于外境，无我无人，还有什么息可以调呢？到了这种境界，神自然返还，息自然安定，心与息相互依托，水与火相互交媾，每一息都归根，这是金丹之母。”丘长春说：“息有一毫未能安定，生命就不属于自己。”从这些话来看，息对人的关系太大了啊！所以比起声音，更应当加以辨别。
气来短促，不足以支撑呼吸，呼吸难以相应，这是虚证极重。平素没有寒热症状，但短气难以接续，知道它是实证。
没有寒热说明阴阳平和，却依然短气不能布散气息，这是因为中焦有阻碍，或者是痰火为害。
中焦实邪阻滞，吸气不得入内，反而复出再入，所以脉象来势轻微而数，也属于实证，不是痰就是食积，可以用攻下法治疗。
实证可以治愈，虚证则无法救治。
实证可以用攻下法。如果中焦虚弱，吸气不尽而入且脉微数，这是肝肾之气欲绝，怎么能救得回来呢？
病在上焦，气机宜通降下行；病在下焦，气机宜通达上行。上下气机交通，病才能痊愈。如今上焦吸气短促而不能通降下行，下焦吸气深长而不能通达上行，上下不交通，病难道容易治吗！至于呼吸时身体动摇，振颤而气不能承载形体，这是必死的证候。
天积聚的是气，地积聚的是形，人依靠气而形成形体。只有气才能形成形体，气聚则形体存在，气散则形体死亡，气对于形体的关系，难道不是巨大吗！
然而身形之中，有营气，有卫气，有宗气，有脏腑之气，有经络之气，各自区分。它们之所以能统摄营卫、脏腑、经络，使气血充盈周遍无间，环流不息，全身皆灵动，全赖胸中大气主持。脏腑的大经小络，昼夜循环不息，必定依赖胸中大气在中间斡旋。大气一旦衰弱，则出入废止，升降停止，神机化灭，气立孤危了。至于息出于鼻，其气散布于膻中。膻中的宗气主管上焦的息道。恒常与肺胃关窍相通，或清徐，或短促，足以占测宗气的盛衰。所以《素问·平人气象论》说：“乳下部位跳动应衣，是宗气外泄。”人岂可奔迫无度，令宗气盛满喘息数急，有余反而变成不足呢！这是指出呼气为息的其中一个方面。所谓“起居如故，而息有音，这是肺的络脉逆乱。不能卧倒而息有音的，是阳明经气逆乱。”这又是看到布散气息的气，关联肺胃，又指出呼气为息的另一个方面。呼气由心肺主宰；吸气由肾肝主宰；呼吸之间，脾胃主宰。所以只有脾胃所主的中焦是呼吸的总持。假如气积聚在贲门不散，两阻其出入，这是危急存亡非常之候。善于养生的人，使贲门之气传入幽门，幽门之气传至二阴之窍而出，才不为害。其上焦下焦，各分呼出吸入，不可以用一个‘息’字统括其病。这个道理只有张仲景知道。他说“息摇肩者，心中坚。息引胸中上气者，咳。息张口短气者，肺痿唾沫。”分别论述息专主于呼而不与吸并言，似乎是创说。不知道仲景是以述为作，无不本于《内经》，即前面所拟定的呼气为息，两个端点不足以尽之。大概心火乘肺，呼气奔促，势在必然。呼出是心肺之阳，自然不得以肝肾之阴混淆。息摇肩者，肩随息动，唯有火故动。息引胸中上气咳者，肺金收降之令不行，上逆而咳，唯有火故咳。张口短气、肺痿唾沫，又是金受火刑不治之证。均以出气粗名为息罢了。那么为什么不直接称为呼呢？回答说，呼中有吸，吸中有呼，剖开而中分，这是圣神所不出的道理。只是以息的出者主呼的病，而息的入者主吸的病，不用说也知道了。《素问·通评虚实论》说：“乳子中风热，喘鸣肩息。”以及息有音的情况不一而足，只是它不与吸并言，而吸的病转易识别。然而还担心后人未悉，又补充其义说：“吸而微数，其病在中焦实也，当下之即愈，虚者不治。在上焦者其吸促，在下焦者其吸远，此皆难治。呼吸动摇振振者不治。”见吸微且数，吸气之往返于中焦者速，这必是实证，下之，通其中焦之壅塞而即愈。若虚则肝肾之本不固，其气轻浮，脱之于阳，不可治矣。前所指贲门幽门不下通，为危急存亡非常之候者，就是这个意思。在上焦者其吸促，因为心肺之道近，其真阴之虚者，则从阳火而升，不入于下，故吸促。是上焦未尝不可候其吸也。下焦者其吸远，肝肾之道远，其元阳之衰者，则因于阴邪所伏，卒难升上，故吸远。此真阴元阳受病，故皆难治。若呼吸往来振振动摇，则营卫往返之气已索，所存呼吸一线耳，尚可为哉！学人先分息之出入，以求病情。既得其情，合之不爽。若但统论呼吸，其何以分上中下三焦所主乎？意微矣。
Sangyu Zi said: "Jing (Essence) transforms into Qi (Vital Energy), and when Qi condenses, Shen (Spirit) gathers. Therefore it is said that if Shen can control Qi, then the nasal respiration will not be abnormal." Tan Zixiao said: "Shen is like a mother, and Qi is like a son. To summon Qi with Shen is like a mother summoning her son. Whenever there is sound in respiration, it is 'Feng' (Wind/Abnormal breathing sound), not 'Xi' (Normal breath). Holding onto this 'Feng' leads to dispersion. Although without sound, if there is a sensation of obstruction or dryness in the nose, it is 'Chuan' (Wheezing/Asthma), not 'Xi'. Holding onto this 'Chuan' leads to stagnation. Without sound and without obstruction, but with traceable movement coming and going, it is 'Qi', not 'Xi'. Holding onto this 'Qi' leads to exhaustion. The so-called 'Xi' refers to the state where breath enters and exits subtly, seemingly present yet seemingly absent. It is continuous and dense, as if existing and as if perishing; the mind does not attach to external realms, there is no self and no other, what breath is there to regulate? At this stage, Shen naturally returns, Xi naturally settles, Xin (Heart/Mind) and Xi rely on each other, Water (Kidney Yin) and Fire (Heart Yang) interact, and every breath roots back to its origin; this is the mother of forming the Golden Elixir (Jin Dan)." Qiu Changchun said: "If there is even the slightest instability in the breath, life is not under one's own control." From these words, we can see that the relationship between breath and humans is immense! Therefore, compared to sounds, it is even more necessary to distinguish them carefully.
When Qi comes short and hurriedly, insufficient to support respiration, and breathing is difficult to coordinate, this indicates extreme deficiency.
If there are no chills or fever historically, but there is shortness of breath that is hard to sustain, it is known to be an Excess syndrome.
If there are no chills or fever, indicating a balance of Yin and Yang, yet there is still shortness of breath and inability to distribute Qi, this is due to obstruction in the Middle Jiao (Middle Burner), or harm caused by Phlegm-Fire.
If inhalation is slightly rapid and frequent, the disease is in the Middle Jiao.
Due to Excess pathogenic factors solidifying in the Middle Jiao, inhalation cannot enter, instead exiting and re-entering; thus the pulse appears slightly rapid and frequent. This is also an Excess syndrome, either Phlegm or Food Stagnation, which can be treated with purgative methods.
Excess syndromes can be cured; Deficiency syndromes are incurable.
Excess syndromes can be treated with purgatives. If the Middle Jiao is deficient, inhalation fails to enter fully and the pulse is slightly rapid, this indicates the impending extinction of Liver and Kidney Qi; how can it be saved?
Inhalation is short and hurried in the Upper Jiao, and deep and distant in the Lower Jiao. When Upper and Lower contradict each other, how can treatment be applied?
When disease is in the Upper Jiao, Qi should descend and unblock; when disease is in the Lower Jiao, Qi should ascend and reach upwards. Only when Upper and Lower Qi communicate freely can the disease heal. Now, if the Upper Jiao inhalation is short and cannot descend, and the Lower Jiao inhalation is deep and cannot ascend, and Upper and Lower do not communicate, how can the disease be easily treated! As for body trembling and shaking during respiration, where Qi cannot support the form, this is definitely a fatal sign.
The sky accumulates Qi, the earth accumulates Form, and humans acquire their formed bodies through Qi. Only Qi forms the body; when Qi gathers, the body exists; when Qi scatters, the body perishes. Is the relationship between Qi and Form not tremendous!
However, within the physical body, there are Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Zong Qi (Gathering Qi), Zang-Fu Qi (Viscera and Bowels Qi), and Jing-Luo Qi (Meridian Qi), each distinct. What enables them to integrate Ying, Wei, Zang-Fu, and Jing-Luo, making them full and uninterrupted, circulating endlessly, and keeping the whole body agile, relies entirely on the 'Da Qi' (Great Qi) in the chest to preside over. The large and small meridians of the Zang-Fu organs circulate day and night without rest, relying on the Da Qi in the chest to pivot and rotate among them. Once the Da Qi declines, entry and exit cease, ascending and descending stop, the Shen Ji (Spirit Mechanism) perishes, and the Qi Li (Qi Establishment) becomes isolated and precarious. As for breath emerging from the nose, its Qi spreads to the Dan Zhong (Chest center/Shanzhong). The Zong Qi at Dan Zhong governs the respiratory pathway of the Upper Jiao. It constantly connects with the Lung and Stomach; whether clear and slow or short and hurried, it suffices to predict the prosperity or decline of Zong Qi. Thus, *Su Wen · Ping Ren Qi Xiang Lun* states: "Movement below the nipples that affects clothing indicates leakage of Zong Qi." How can people act recklessly without limit, causing Zong Qi to become excessive leading to panting and rapid breathing, turning surplus into insufficiency! This points out one aspect of 'Xi' being exhalation. It also says, "If daily activities remain normal but respiration has sound, this is reversal of the Lung collateral meridians. If unable to lie down and respiration has sound, this is reversal of the Yangming Meridian." This again observes that the Qi distributing respiration connects with the Lung and Stomach, pointing out another aspect of 'Xi' being exhalation. Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver; within respiration, the Spleen and Stomach govern. Therefore, only the Middle Jiao governed by the Spleen and Stomach is the master switch of respiration. If Qi accumulates at the Ben Men (Cardia) and does not disperse, blocking both entry and exit, this is a critical situation of survival or death. Those skilled in nurturing life ensure that Qi from the Ben Men transmits to the You Men (Pylorus), and Qi from the You Men transmits to the orifices of the two Yin extremities to exit, thereby avoiding harm. The Upper and Lower Jiao respectively govern exhalation and inhalation; one cannot use the single character 'Xi' to summarize all diseases. This principle was known only by Zhang Zhongjing. He stated: "Respiration accompanied by shoulder movement indicates firmness in the Heart region. Respiration drawing upward Qi from the chest indicates cough. Respiration with open mouth and shortness of breath indicates Fei Wei (Lung萎/Sagging Lung) with spittle." Separating the discussion to focus specifically on exhalation without mentioning inhalation seems like a novel theory. However, unknown to many, Zhongjing elaborated based on creation, rooting everything in the *Nei Jing*. The previously proposed aspects of exhalation as 'Xi' are insufficient to cover it all. Generally, Heart Fire attacking Lung Metal causes hurried exhalation, which is inevitable. Exhalation belongs to the Yang of Heart and Lung, and naturally cannot be confused with the Yin of Liver and Kidney. Shoulder movement during respiration, where shoulders move with breath, occurs only due to Fire. Cough induced by upward Qi during respiration occurs because the Lung Metal's contracting and descending function fails, leading to upward reversal and cough, again due to Fire. Open-mouthed shortness of breath and Lung Sagging with spittle are cases of Metal suffering from Fire punishment, incurable. All are named 'Xi' merely because of rough exhalation. Then why not simply call it 'Hu' (Exhale)? The answer is: Exhalation contains inhalation, inhalation contains exhalation; forcibly splitting them in half is beyond even the Sage's capability. It is just that the exiting part of Xi governs diseases of exhalation, and the entering part governs diseases of inhalation, which goes without saying. *Su Wen · Tong Ping Xu Shi Lun* states: "Infants suffering from Wind-Heat wheeze, make noise, and breathe with shoulder movement." And cases of noisy respiration are numerous. Because they are not mentioned together with inhalation, diseases of inhalation become easier to identify. However, fearing later generations might not fully understand, he supplemented the meaning: "Inhalation that is slightly rapid indicates Excess in the Middle Jiao; purging it leads to recovery, while Deficiency is incurable. In the Upper Jiao, inhalation is short; in the Lower Jiao, inhalation is distant; all these are difficult to treat. Respiration accompanied by trembling and shaking is incurable." Seeing inhalation as slight and rapid, with inhalation returning quickly in the Middle Jiao, this must be Excess; purging it clears the congestion in the Middle Jiao and leads to recovery. If it is Deficiency, the root of Liver and Kidney is unstable, Qi is light and floating, escaping via Yang, and is incurable. This is what was meant earlier by the blockage between Ben Men and You Men being a critical situation. In the Upper Jiao, inhalation is short because the pathways of Heart and Lung are close; those with True Yin deficiency rise via Yang Fire and do not descend into the lower, hence short inhalation. This shows that the Upper Jiao can indeed be assessed via inhalation. In the Lower Jiao, inhalation is distant because the pathways of Liver and Kidney are far; those with Yuan Yang (Primordial Yang) decline are hindered by latent Yin pathogens and struggle to ascend, hence distant inhalation. This is illness of True Yin and Yuan Yang, hence all are difficult to treat. If respiration involves trembling and shaking, the Qi of Ying and Wei returning and forth has been exhausted, leaving only a thread of respiration remaining; how can this be saved! Students of medicine should first distinguish the entry and exit of breath to ascertain the condition. Once the condition is understood, combining it yields no error. If one only discusses respiration generally, how can one distinguish the diseases governed by the Upper, Middle, and Lower Jiao? The implication is subtle.