喘之为病也，其类有四∶曰气急，曰气逆，曰气短，曰气脱。其因有寒，有热，有虚，
有实。缕析于下∶
气急者，寒也。气之呼吸，取道肺脘，而胃脘附之，二脘者，气之所并行也。或风寒从
毛窍
，从背脊，入于肺络，侵及肺脘；或饮食寒冷太过，伤于胃脘。二脘相附，其气相通，有寒
则彼此相移，二脘俱缩而不展，不展则气之道窄。寒微但呛咳而已，甚则肺中诸窍皆紧，气
出不利，逼迫膻中不得上达，风寒与水饮相搏，夜不安枕，渐致摇肩仰息矣。经曰∶形寒寒
饮则伤肺，气逆而上行。非逆而上也，乃伏而不得上也。近时医见呛咳，即投清降，以致二
脘得药愈紧，阳气愈下，结愈上促，病者烦 不堪，如有捉其咽喉，缚其胸膈者是也。故近
时患小青龙证，无不终致劳损者，徐灵胎谓为风寒不醒成劳病也。
气逆者，痰也。有湿寒，有湿热，病属在里，非由外感，肥人多有此证。凡人之气，由
口鼻
呼吸出入者，其大孔也；其实周身八万四千毛孔，亦莫不从而嘘吸。痰阻经隧，则气之呼吸
不得旁达，而聚于膻中，只能直上咽喉，出于口鼻，已觉冲激矣。更有时痰涎壅盛，横格膻
中，而气道愈狭矣，此湿寒、湿热成痰成饮者所常有也。此人若感风寒，即近哮证矣。
气短者，热也。亦有水气射肺，非风寒之外束，非痰证之有形，乍觉呼吸至膈而止，不
能下
达。非全不达也，入迟出疾，不能久留于内也。所以然者，肝、肾血热，阴气不敛也。又有
感受风热，肺中津液为亢气所耗，不得柔润，膻中干燥，孔窍生烟，是气管因津液而燥急，
气行不能开阖匀布也。伤暑者必有此证。凡气之流行，必有津以润 之，始能开阖滑利，燥
则阴虚阳亢，觉开而不得阖矣。水气射肺者，或因渴饮乍多，或因汗出乍闭，湿逼热气上冲
，如火得水以沃之，非真有胶固之水饮也。更有略无所因，而脾胃不运，大便久秘，肠中浊
气上蒸于肺，以致升降不利，呼吸短促者。仲景曰∶平人无寒热，短气不足以息者，实也。
注谓∶实为饮邪，非也，大便秘结之故也。(温病有燥屎冲膈，气喘、舌黑、齿枯者，不治
。)
气脱者，乃真喘也。真气离根，呼吸至胸而还，不能下达丹田，自觉气无所根据，张皇失
措，
摇肩俯仰，烦躁不宁，无力下吸，出多入少。此或因久咳，或因大汗、吐、下，亡血、失精
，阴脱而阳无所恋矣。急则危在顷刻，缓亦不过数日。仲景曰∶少阴病，下利止，息高者是
也。亦有下焦肝肾久受寒湿，渐逼命火上越，肺气不能下纳者。
其他自觉气少下陷，呼吸不足、不利，而不见喘促低昂、抬肩撼胸外形者，或禀赋不足
，
或脾胃有湿，或大病初愈，或过泄伤气，不可枚举，然病因大略如此，但有微甚而已。
夫气急者，气不得出也，哮之微者，非喘也。气逆者，气不得散也，近于呕哕而非呕哕
，亦
非喘也。气短者，气不得聚，呼吸不续，近于喘矣，以其乍见，无他证，故无伤于根本也。
三者皆病在于肺，而兼在胃。气脱者，散而不聚，升而不降，病独在肾。与前证情形迥别，
本最易辨，惟夫气急之人，气逆之甚，渐至于脱者，其形想象，然病至此，真气已孤，直谓
之脱亦可矣。尝诊一妇，自冬病喘，至春不愈，始延予诊。至则见其形状，非喘也，乃哮也
。寒气束肺，气塞不出，日久邪深，真气内陷，便溏下气，肺中寒涎注满，真气已不能到；
其脉两关以下洪大滑数，两关以上细微如丝，其肤外凉内热，重抚如焚，病患自觉头上
胸中不知何处，缺少一件本体，是肺中已无生气矣；夜静昼剧，阳气孤危，其哮逼苦状，实
不忍见。予谢不敏，延后一月始殁。故知邪气逼塞，非正气自脱者，虽至极危，犹可稍延时
日云。
又按∶喘有三焦之辨。经云∶邪气在上，此风寒伤肺，气之不得升也；浊气在中，此湿
热痰
饮聚于胃，气之滞于升降也；清气在下，此寒湿之地气，从下焦脚膝之筋骨上入肝肾，直捣
命门，命火不得安其宫，肺气不得归其窟，有呼无吸，此气之不得降也，是真喘也。其上二
焦之病，非喘也，乃哮也。然哮亦有二，皆风寒与痰饮相结，但互有轻重耳!凡不分四时，
受寒即发，发即气闭迫塞欲死，滴水不入，彻夜无眠者，此上焦之风寒重于痰饮者也，数日
即愈，复如常人矣。凡春暖即愈，秋凉即发，发即呼吸短促，昼夜相等，饮食减少或如常者
，此中焦痰饮，因天寒肺气不舒而激发者也。若不新感风寒，其病势未至逼急欲死也。治之
之法，上焦之治，从小青龙；中焦之治，从平胃散。各随轻重而互参之。此即太阳、阳明之
别也。太阳者，风寒由肺俞内侵肺络，入伤肺脘，是病起于气分，致太阳之气化不行，而后
水邪上泛也。阳明者，是胃中本有湿痰，肺中久为浊气所据，天寒呼吸寒气，而肺中浊气遂
结矣。一由俞络，一由呼吸，故治异也。若夫正气离根，气上不下，及胸而还，稍动即汗出
，久卧又气阻，仅能伏几危坐者，命火熄，水邪肆，阴风惨淡，日色无光，是何等象耶!治
之惟黑锡丹一法，差堪尝试，不敢必效也。经曰∶喘喘连属，其中微曲。此言脉也。而摩绘
喘病，亦自逼真，谓其气连连直上，微有反曲耳!然则喘之为气升不降也，岂可与气塞而不
得出者同称耶?
喘这种病，其类型有四种：叫气急，叫气逆，叫气短，叫气脱。其病因有寒，有热，有虚，有实。详细分析如下：
气急，属于寒证。呼吸之气，经由肺脘（肺脏及其相关通道），而胃脘（胃腑及其相关通道）依附于旁，这两处脘道，是气并行通过的部位。或是风寒从毛孔、从背脊侵入肺络，进而侵犯肺脘；或是饮食过于寒冷，损伤了胃脘。两脘相邻，气息相通，一旦受寒，寒气便彼此转移，导致两脘都收缩而不能舒展，不能舒展则气行通道变窄。寒邪轻微时仅表现为呛咳，严重时肺中所有窍道皆紧缩，呼气不畅，逼迫膻中（胸中气海）之气无法上达，风寒与水饮相互搏结，夜间无法安睡，逐渐发展到耸肩仰面呼吸的程度。《内经》说：形体受寒、饮用冷食就会伤肺，气逆而上行。并非气真的向上逆行，而是伏留体内不得上升。近代医生见到呛咳，就立即投用清降类药物，致使两脘因药物作用更加紧缩，阳气更加下陷，郁结在上部的症状更加急促，病人烦躁痛苦不堪，就像被人抓住咽喉、捆绑胸膈一样。所以近代患有小青龙汤证（解表散寒、温肺化饮之方）的病人，没有不最终导致虚劳损伤的，徐灵胎认为这是风寒未愈转化为劳病。
气逆，属于痰证。有湿寒痰，有湿热痰，病位在里，不是由外感引起，肥胖的人多有此证。凡是人的气，通过口鼻呼吸出入的，那是大孔窍；其实周身八万四千个毛孔，也没有不随之呼吸的。痰浊阻塞经络隧道，则气的呼吸不能向旁侧通达，而聚集在膻中，只能直冲咽喉，出于口鼻，已经觉得冲激有力了。再加上有时痰涎壅盛，横亘阻隔在膻中，气道就更加狭窄了，这是湿寒、湿热形成痰饮者常有的情况。这种人如果感受风寒，就接近哮证（发作性痰鸣气喘）了。
气短，属于热证。也有水气射肺的情况，但不是风寒外束，也不是有形之痰证，乍觉呼吸至膈肌而停止，不能下达。并非完全不能下达，而是吸入迟缓、呼出急促，不能在体内久留。之所以这样，是因为肝、肾血热，阴气不能收敛。又有感受风热，肺中津液被亢盛的阳气耗伤，得不到柔润，膻中干燥，孔窍生烟，气管因津液枯竭而燥急，气机运行不能开阖均匀布散。中暑的人一定有此证。凡是气的流行，必须有津液来滋润它，才能开阖滑利，燥则阴虚阳亢，感觉能张开却不能闭合。水气射肺的情况，可能是因为口渴饮水突然过多，或者因为出汗突然闭塞，湿气逼迫热气上冲，就像火遇到水浇灌一样，并不是真有胶固的水饮。更有毫无原因，脾胃运化失常，大便长期秘结，肠中浊气上蒸于肺，导致升降不利，呼吸短促的。张仲景说：平人无寒热，短气不足以息的，属实证。注解说：实证为饮邪，不对，是大便秘结的缘故。（温病中有燥屎阻滞胸膈，出现气喘、舌黑、齿枯的，属不治之症。）
气脱，才是真正的喘证。真气脱离根基，呼吸至胸部即返回，不能下达丹田，自觉气无所依托，惊慌失措，耸肩俯仰，烦躁不宁，无力向下吸气，呼多吸少。这可能是因为久咳，或者因为大汗、呕吐、泻下，亡血、失精，阴气脱失而阳气无所依恋。急则危在旦夕，缓则也不过数日。张仲景说：少阴病，下利停止，但呼吸浅表高起的，就是这种情况。也有下焦肝肾长期受寒湿侵袭，逐渐逼迫命门之火上浮，肺气不能下纳的情况。
其他自觉气少下陷，呼吸不足、不利，但没有看到喘促起伏、抬肩撼胸等外形表现的，或者是禀赋不足，或者是脾胃有湿，或者是大病初愈，或者是过度泄利损伤正气，不可枚举，但病因大致如此，只是有轻重的区别而已。
所谓气急，是气不能外出；哮证的轻微表现，不是喘。气逆，是气不能疏散，接近于干呕哕逆而不是干呕哕逆，也不是喘。气短，是气不能聚拢，呼吸不连续，接近于喘了，但因为乍现，没有其他证候，所以不伤及根本。这三种病都在肺，兼涉胃。气脱，是气散而不聚，升而不降，病独在肾。与前几种证候情形截然不同，本来最容易辨别，只是那些气急之人，气逆严重，逐渐发展到气脱的，其形态难以想象，然而病至此地步，真气已孤绝，直接称为脱也可以。我曾诊治一位妇人，从冬天患喘，到春天未愈，才请我诊治。到了之后见其形状，不是喘，而是哮。寒气束肺，气塞不出，日久邪气深入，真气内陷，大便溏泄下气，肺中寒涎注满，真气已不能到达；其脉象两关以下洪大滑数，两关以上细微如丝，皮肤外表凉内部热，重按如火烧，病患自觉头上胸中不知何处，缺少一件本体，这是肺中已无生气；夜晚安静白天加重，阳气孤危，其哮逼之苦状，实在不忍目睹。我推辞能力不足，延后一个月病人去世。所以知道邪气逼塞，不是正气自脱的，虽然极其危险，还可以稍延时日。
又按：喘有三焦的辨别。经书说：邪气在上，这是风寒伤肺，气不能上升；浊气在中，这是湿热痰饮聚于胃，气滞于升降之间；清气在下，这是寒湿的地气，从下焦脚膝筋骨上入肝肾，直捣命门，命火不能安居其宫，肺气不能回归其窟，有呼无吸，这是气不能下降，是真喘。上二焦的病，不是喘，是哮。然而哮也有两种，都是风寒与痰饮相结，只是轻重不同罢了！凡是不分四季，受寒即发，一发即气闭迫塞欲死，滴水不进，彻夜无眠的，这是上焦的风寒重于痰饮，数日即愈，恢复如常人。凡是春暖即愈，秋凉即发，一发即呼吸短促，昼夜相等，饮食减少或正常的，这是中焦痰饮，因天寒肺气不舒而激发。如果不新感风寒，其病势未到逼急欲死的程度。治疗的方法，上焦的治疗，用小青龙汤；中焦的治疗，用平胃散。各随轻重互相参考。这就是太阳病、阳明病的区别。太阳病，是风寒由肺俞穴内侵肺络，进入损伤肺脘，是病起于气分，导致太阳之气化不行，而后水邪上泛。阳明病，是胃中本有湿痰，肺中长久被浊气占据，天寒呼吸寒气，肺中浊气遂结。一由俞穴络脉，一由呼吸，所以治法不同。至于正气离根，气上不下，至胸而还，稍微活动即汗出，久卧又气阻，只能趴在几案上勉强坐着的，命火熄灭，水邪肆虐，阴风惨淡，日光无光，这是什么景象啊！治疗只有黑锡丹一法，勉强可以尝试，不敢保证有效。经书说：喘喘连属，其中微曲。这是指脉象。而描绘喘病，也自然逼真，说其气连连直上，微有反曲耳！那么喘作为气升不降，怎么能和气塞而不能出出的同称呢？
The disease of panting (Chuan) has four categories: Qi Ji (rapid breathing), Qi Ni (rebellious Qi), Qi Duan (shortness of breath), and Qi Tuo (collapse of Qi). The causes include Cold, Heat, Deficiency, and Excess. Detailed analysis follows:
Qi Ji belongs to Cold syndrome. Respiratory Qi passes through the Fei Wan (lung cavity/channels), adjacent to Wei Wan (stomach cavity/channels); these two cavities are parallel pathways for Qi. Wind-Cold may enter from the hair pores or along the spine into the Lung collaterals, invading the Fei Wan; or excessive consumption of cold food/drink may injure the Wei Wan. Since the two cavities are adjacent and their Qi connects, Cold shifts between them, causing both to contract and fail to expand. Failure to expand narrows the Qi pathway. Mild Cold causes only choking cough; severe Cold tightens all orifices in the Lung, making exhalation difficult, forcing Qi in Dan Zhong (Chest Sea) to fail to ascend. Wind-Cold and Fluid retention struggle against each other, preventing peaceful sleep at night, gradually leading to shoulder shrugging and仰息 (breathing with head tilted back). The Classic states: "Cold form and cold drink injure the Lung, causing Qi to rebel and ascend." It is not that Qi truly rebels upward, but rather it is trapped and fails to ascend. Recent physicians, seeing choking cough, immediately administer clearing and descending herbs, causing the two cavities to tighten further due to the medicine, Yang Qi to sink lower, and upper constriction to worsen. Patients suffer unbearable irritability, as if their throat were grabbed and chest bound. Thus, recent patients with Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) indications often ultimately develop Lao Sun (consumptive disease). Xu Lingtai stated this is because unresolved Wind-Cold transforms into consumptive disease.
Qi Ni belongs to Phlegm syndrome. There is Wet-Cold Phlegm and Wet-Heat Phlegm. The pathology is interior, not caused by external invasion, and is common in obese individuals. While Qi enters and exits via the nose and mouth (large orifices), the 84,000 pores throughout the body also breathe. When Phlegm blocks the meridians, respiratory Qi cannot spread laterally but gathers in Dan Zhong, rushing straight up to the throat and out of the mouth/nose, creating a sense of impact. If Phlegm-saliva becomes abundant and obstructs Dan Zhong horizontally, the airway narrows further. This is common in those with Wet-Cold or Wet-Heat forming Phlegm/Fluid. If such a person contracts Wind-Cold, it approaches Xiao Zheng (Wheezing Syndrome).
Qi Duan belongs to Heat syndrome. There is also Water Qi attacking the Lung, but this is not external Wind-Cold constraint nor有形 (formate) Phlegm. One suddenly feels respiration stopping at the diaphragm, unable to descend. It is not completely unable to descend, but inhalation is slow and exhalation fast, failing to stay inside long enough. This occurs because Liver and Kidney Blood Heat prevents Yin Qi from gathering. Alternatively, contracting Wind-Heat consumes Lung fluids with hyperactive Qi, leaving them unmoistened. Dan Zhong becomes dry, orifices generate smoke-like sensations; the trachea becomes dry and tense due to fluid depletion, preventing smooth opening/closing and uniform distribution of Qi. Summerheat injury always presents this syndrome. Qi circulation requires fluid moistening to open/close smoothly; dryness leads to Yin deficiency and Yang hyperactivity, feeling open but unable to close. Water Qi attacking the Lung may result from sudden excessive drinking after thirst, or sudden closure of sweat pores after sweating, where dampness forces heat Qi upward, like fire doused by water—not truly solidified fluid retention. More commonly, without specific cause, Spleen/Stomach failure to transport leads to chronic constipation; turbid Qi from intestines steams upward to the Lung, impairing ascending/descending functions and causing shortness of breath. Zhang Zhongjing said: "A healthy person without cold/heat symptoms having shortness of breath insufficient for respiration indicates Excess." Commentaries claim Excess refers to Fluid pathogen, which is incorrect; it is due to fecal impaction. (In Warm Diseases, dry stool blocking the diaphragm causing panting, black tongue, and withered teeth is incurable.)
Qi Tuo is true panting. True Qi detaches from its root; respiration reaches the chest and returns, unable to descend to the Lower Dantian. The patient feels Qi has no foundation, panics, shrugs shoulders, looks up/down, is irritable, lacks strength to inhale deeply, exhaling more than inhaling. This may result from chronic cough, profuse sweating, vomiting, purging, blood loss, or essence loss, leading to Yin collapse where Yang has nothing to cling to. Acute cases are critical within moments; chronic cases last only days. Zhang Zhongjing said: "Shaoyin disease, diarrhea stops, but respiration is high/shallow," describes this. Also, long-term Cold-Damp in Lower Jiao Liver/Kidney may gradually force Ming Men Fire upward, preventing Lung Qi from descending.
Other cases involve subjective sensation of Qi sinking, insufficient/unsmooth respiration, without visible panting起伏 (ups and downs) or shoulder lifting/chest shaking. Causes include congenital insufficiency, Spleen/Stomach dampness, recovery from major illness, or Qi damage from over-purging. These are countless, but the general etiology is as above, differing only in severity.
Qi Ji means Qi cannot exit; mild Xiao (wheezing) is not Chuan. Qi Ni means Qi cannot disperse; it resembles Ouyue (dry heaving) but is not, nor is it Chuan. Qi Duan means Qi cannot gather, respiration is discontinuous, approaching Chuan, but since it appears suddenly without other symptoms, it does not damage the root. These three diseases reside in the Lung, involving the Stomach. Qi Tuo involves dispersion without gathering, ascending without descending, residing solely in the Kidney. This is distinctly different from previous syndromes, easily distinguished. However, when Qi Ji or severe Qi Ni progresses to Tuo, the manifestation is unimaginable; yet at this stage, True Qi is isolated, so calling it Tuo is appropriate. I once treated a woman who had panting since winter, unrelieved by spring. Upon examination, her presentation was not Chuan, but Xiao. Cold constrained the Lung, Qi blocked from exiting; prolonged pathogen depth caused True Qi to sink internally, loose stools with downward Qi, cold phlegm saliva filling the Lung, True Qi unable to reach. Pulse was surging, slippery, and rapid below the Guan position, but fine and thread-like above. Skin was cool externally but hot internally, burning on heavy pressure. The patient felt something missing in her head/chest, indicating no vital Qi in the Lung. Symptoms worsened during day, quiet at night; Yang Qi was solitary and precarious. The suffering of wheezing was unbearable. I declined treatment due to inability, and she died one month later. Thus, obstruction by pathogen, unlike spontaneous collapse of Zheng Qi, though critical, allows some time.
Furthermore, Chuan is differentiated by the Three Jiaos. Classics state: Pathogen in Upper Jiao is Wind-Cold injuring Lung, preventing Qi ascent; Turbid Qi in Middle Jiao is Damp-Heat/Phlegm/Fluid gathering in Stomach, stagnating Qi ascent/descent; Clear Qi in Lower Jiao is Cold-Damp earth Qi entering Liver/Kidney from legs/knees, attacking Ming Men directly. Ming Fire cannot rest in its palace, Lung Qi cannot return to its nest; there is exhalation without inhalation. This is Qi failing to descend, constituting true Chuan. Diseases of Upper/Middle Jiao are not Chuan, but Xiao. Xiao has two types, both Wind-Cold combining with Phlegm/Fluid, differing in weight. Those affected regardless of season, triggered by cold, with sudden air closure threatening death, inability to swallow, insomnia for nights, have Upper Jiao Wind-Cold heavier than Phlegm/Fluid; they recover in days. Those recovering in warm spring, triggering in cool autumn, with shortness of breath equal day/night, reduced appetite, have Middle Jiao Phlegm/Fluid triggered by cold weather inhibiting Lung Qi expansion. Without new Wind-Cold, severity is less. Treatment: Upper Jiao uses Xiao Qing Long Tang; Middle Jiao uses Ping Wei San, adjusted by severity. This distinguishes Taiyang and Yangming patterns. Taiyang pattern: Wind-Cold invades Lung collaterals via Fei Shu acupoint, injuring Fei Wan, starting in Qi level, impairing Taiyang transformation, leading to water pathogen flooding. Yangming pattern: Pre-existing damp-phlegm in Stomach, Lung occupied by turbid Qi for long; cold air inhalation in cold weather causes Lung turbid Qi to knot. One enters via acupoints/collaterals, one via respiration; thus treatments differ. For True Qi detachment, Qi rising not descending, returning at chest, sweating upon slight movement, Qi blockage upon lying down, able only to sit leaning forward critically: Ming Fire extinguished, Water pathogen rampant, gloomy Yin wind, dim sunlight—what a scene! Only Hei Xi Dan (Black Tin Pill) offers a tentative treatment, efficacy uncertain. Classics say: "Panting connected continuously, slightly curved within." This refers to pulse. Depictions of panting are accurate, describing Qi rising continuously with slight curvature. Thus, Chuan as Qi ascending not descending cannot be equated with Qi blocked from exiting.