【纲】仲景曰。趺阳脉微而紧。紧则为寒。微则为虚。微紧相抟。则为短气。
【目】张元素曰。此为短气之虚者也。
成无己曰。短气者。气短而不能相续。似喘非喘。有气上冲。而实非气上冲也。喘则张口抬肩。
摇身滚肚。气上冲。则腹里气时时上逆。所谓短气者。呼吸虽数。而不能相续。似喘而不摇肩。似呻
吟而无痛也。要识其短气之真者。气急而短促。俗谓之气短者是也。
【纲】仲景曰。阳明病。脉迟。微汗出。不恶寒者。其身不重。短气腹满而喘。有潮热者。此
外欲解。可攻里也。
【目】张元素曰。此为短气之实者也。
【纲】仲景曰。风湿相搏。汗出短气。小便不利。恶风。不欲去衣。甘草附子汤主之。短气。但
坐。以汗出不彻故也。
【目】张元素曰。此邪在表而短气者也。
陶华曰。短气者。呼吸短促。不能相续也。千金方谓少气不足以息也。大抵心腹胀满而短气者。邪
在里而为实。承气
汤下之。心腹濡满而短气者。邪在表而为虚。桂枝汤解之。食少饮多。水停心下而短气者。小半夏
汤主之。
李中梓曰。若汗出不彻。以致短气。葛根加人参汤。水停心下短气。五苓散。
【纲】仲景曰。干呕。短气。汗出。不恶寒者。此表解里故未和也。十枣汤主之。太阳病。医反
下之。短气。烦躁。心中懊 。阳气内陷。心下因硬。则为结胸。大陷胸汤主之。
【目】张元素曰。此邪在里而短气者也。
成无己曰。虚也。实也。在表也。在里也。皆作短气。又何以辨虚实也。大凡心腹胀满而短气
者。邪在里而为实也。胸腹濡满而短气者。邪在表而为虚也。
王肯堂曰。短气。骨节痛。不得屈伸。汗出。小便不利。恶风身肿者。由于风湿。宜甘草附子
汤。短气。腹满胁痛。若脉浮弦大。外不解。无汗。嗜卧。身黄。小便难。有潮热者。小柴胡汤。此
皆为表症。若表未解。手足 然汗出。或有潮热者。宜大承气汤。若表解。心下痞硬。干呕短气者。
宜十枣汤。此皆为里症。短气烦躁。若发汗不彻。续微汗出。不恶寒。表症不罢。面赤者。为并病。
更发汗则愈。此为汗不彻之症。若下后心中懊 。心下硬痛者。大陷胸汤。此为下后之症。
吴绶曰。因汗吐下后元气虚弱。脉来微虚。气不能相接而短少者。人参益气汤。凡阴症脉弱沉
细而迟。手足逆冷。面上恶寒如刀刮。口鼻之气难以布息而短者。四逆汤加人参。又食少饮多。水
停心下。令人短气烦闷。茯苓甘草汤。
[General Principle] Zhang Zhongjing stated: When the foot-Yang (Duyang) pulse is both faint and tight, the tightness indicates cold, and the faintness indicates deficiency. The interplay of faintness and tightness results in shortness of breath (Duǎnqì).
[Commentary] Zhang Yuansu stated: This refers to deficiency-type shortness of breath.
Cheng Wuji stated: Shortness of breath is characterized by breath that is short and cannot be sustained continuously. It resembles panting but is not panting; it feels like Qi rushing upward, yet it is not truly a case of Qi rebellion. Panting involves opening the mouth and raising the shoulders, shaking the body, and rolling the abdomen. Qi rebellion involves the constant upward counterflow of Qi within the abdomen. True shortness of breath, although involving frequent respirations, lacks continuity. It resembles panting without shoulder movement, and resembles groaning without pain. To identify true shortness of breath, one looks for急促 (rapid) and short breathing, commonly known as "Qi duǎn".
[General Principle] Zhang Zhongjing stated: In Yangming disease, with a slow pulse, slight sweating, aversion to cold absent, and the body not feeling heavy, accompanied by shortness of breath, abdominal fullness, and wheezing, if tidal fever (Cháorè) is present, this indicates the exterior syndrome has resolved, and purgation of the interior is indicated.
[Commentary] Zhang Yuansu stated: This refers to excess-type shortness of breath.
[General Principle] Zhang Zhongjing stated: When Wind-Dampness pathogens contend with each other, presenting with sweating, shortness of breath, difficulty in urination, aversion to wind, and reluctance to remove clothing, Gancao Fuzi Tang (Licorice and Aconite Decoction) is the primary treatment. For shortness of breath where the patient can only sit still, it is due to incomplete sweating.
[Commentary] Zhang Yuansu stated: This is shortness of breath caused by pathogens remaining in the exterior.
Tao Hua stated: Shortness of breath refers to rapid, shallow breathing that cannot be sustained. The *Qianjin Fang* calls it "Shǎoqì bùzúyǐ xī" (insufficient Qi to maintain respiration). Generally speaking, shortness of breath accompanied by abdominal distension and fullness indicates pathogens in the interior constituting an excess pattern, treated with Chengqi Tang (Gut-Purging Decoction) to purge. Shortness of breath accompanied by soft abdominal distension indicates pathogens in the exterior constituting a deficiency pattern, treated with Guizhi Tang (Cinnamon Twig Decoction) to release the exterior. Shortness of breath caused by drinking excessively while eating little, leading to fluid retention under the heart, is treated with Banxia Tang (Pinellia Decoction).
Li Zhongzi stated: If shortness of breath results from incomplete sweating, Gegen Jiarenshen Tang (Kudzu and Ginseng Decoction) is used. If shortness of breath results from fluid retention under the heart, Wuling San (Five-Ingredient Powder with Poria) is used.
[General Principle] Zhang Zhongjing stated: Dry retching, shortness of breath, sweating, and absence of aversion to cold indicate that the exterior has resolved but the interior is disharmonious; Shizao Tang (Ten Jujubes Decoction) is the primary treatment. In Taiyang disease, if the physician erroneously uses purgation, resulting in shortness of breath, irritability, and mental restlessness (Àonáo), with internal sinking of Yang Qi and hardness below the heart, this forms Jie Xiong (Chest Binding), treated with Daxiexiong Tang (Major Sinking Chest Decoction).
[Commentary] Zhang Yuansu stated: This is shortness of breath caused by pathogens in the interior.
Cheng Wuji stated: Whether deficiency or excess, whether in the exterior or interior, all can manifest as shortness of breath. How then to distinguish between deficiency and excess? Generally, shortness of breath with abdominal distension and fullness indicates pathogens in the interior constituting an excess pattern. Shortness of breath with soft chest and abdominal distension indicates pathogens in the exterior constituting a deficiency pattern.
Wang Kentang stated: Shortness of breath accompanied by joint pain, inability to flex or extend, sweating, difficulty in urination, aversion to wind, and bodily swelling is due to Wind-Dampness, suitable for Gancao Fuzi Tang. Shortness of breath accompanied by abdominal fullness and hypochondriac pain, with a floating, wiry, and large pulse, unresolved exterior, absence of sweating, drowsiness, yellowish skin, difficult urination, and tidal fever, is treated with Xiaochaihu Tang (Minor Bupleurum Decoction). These are all exterior syndromes. If the exterior remains unresolved, with continuous sweating on the hands and feet, or tidal fever, Dachengqi Tang (Major Gut-Purging Decoction) is suitable. If the exterior has resolved, with epigastric stuffiness and hardness, dry retching, and shortness of breath, Shizao Tang is suitable. These are all interior syndromes. Shortness of breath with irritability, resulting from incomplete sweating, followed by continued slight sweating, absence of aversion to cold, unresolved exterior symptoms, and red face, is termed Bingbing (Combined Disease); administering sweat-inducing therapy again will lead to recovery. This is a symptom of incomplete sweating. If after purgation, there is mental restlessness and hardness/pain below the heart, Daxiexiong Tang is used. This is a symptom following erroneous purgation.
Wu Shou stated: After sweating, vomiting, or purgation therapies, if Yuan Qi (Primal Qi) is weakened, the pulse is faint and deficient, and Qi cannot connect, resulting in shortness, Renshen Yiqi Tang (Ginseng Qi-Nourishing Decoction) is used. In Yin syndromes, if the pulse is weak, deep, fine, and slow, with cold extremities, facial aversion to cold as if scraped by a knife, and difficulty in distributing breath through the mouth and nose resulting in shortness, Sini Tang (Frigid Extremities Decoction) plus Ginseng is used. Furthermore, if eating little and drinking much leads to fluid retention under the heart, causing shortness of breath and stifling sensation, Linggan Jiangzhong Tang (Ginger and Poria Decoction) is used.