凡喘而卧不得，其脉浮，按之虚而涩者，为阴虚，去死不远，慎勿下之，下之必死，宜四物加童便、
竹沥、青黛、门冬、五味、枳壳、苏叶服之。
〔丹〕胡安人年六十八，恶寒发热，自四月来得痰嗽，眠不得，食少，心膈痛，口中连嗽，五更颇甚。
白术（三钱） 枳壳（炒） 黄连（各二钱） 芍药（二钱半） 片芩（七钱半） 桔梗 苏梗叶（各一两）
木通（五分） 甘草（炙些） 五味（二十一粒）
上入竹沥煎服。
一丈夫因病喘不可卧，肺脉沉而涩，此外有风凉湿气遏内热不得舒。
黄芩 陈皮 木通（各一钱半） 麻黄 苏叶 桂枝（各一钱） 黄连 干姜 甘草（炙）
开二教体虚，感寒发热，气喘难卧。
苍术 麻黄 白术 片芩（炒。各五分） 桂枝（三分） 半夏 枳壳（各一钱） 木通（三分） 甘草（炙）
上生姜二片同煎，加研碎杏仁五个。（此方半夏为君，必是吐痰多之人也。）
上解表三方，前一方寒热多者设，后二方寒多者设。
咳逆上气，时时浊唾，但坐不得眠者，皂荚丸主之。
用皂荚八两，刮去皮，酥炙，上一味为末，蜜丸如桐子大。以枣膏和汤服三十丸，日三夜一。
女人年六十，自来无汗多痰，今得喘病，眠不得，曾与青州白丸子。
半夏（半两） 枳壳（炒，四钱） 桔梗 陈皮 木通 黄芩（二钱） 麻黄（一钱半） 紫苏 防风（各一钱）
甘草（炙，五分）
上分作五帖，生姜三片，水煎去渣，入竹沥两蚶壳许，热饮。
〔《素》〕夫不得卧，卧则喘者，是水气之客也。夫水者，循津液而流也。肾者水脏，主津液，主卧与喘
也。（逆调论）
〔垣〕神秘汤 治病患不得眠，眠则喘者，水气逆行，上乘于肺，肺得水而浮，使气不流通，其脉沉大，宜此治
之。
苏叶 陈皮 生姜 人参（各五钱） 茯苓 桑白皮 木香（各二钱）
上 咀，水煎去渣，大温，分二服。
〔仲〕咳逆倚息不得卧，小青龙汤主之。（方见伤寒 又云∶支饮亦喘不得卧，加短气，其脉平也。）
青龙汤下已，多唾，口燥，寸脉沉，尺脉微，手足厥逆，气从小腹上冲胸咽，手足痹，其面翕然如醉状，因复
下流阴股，小便难，时复冒者，与茯苓桂枝五味子甘草汤治其气冲。
桂枝（去皮） 茯苓（各四两） 甘草（炙，三两） 五味子（半升）
上四味，以水八升，煮取三升，去渣，分温三服。
冲气即低，而反更咳，胸满者，用桂枝茯苓五味甘草汤去桂，加干姜细辛各三两，以治其咳满。咳满即止，
而更复渴，冲气复发者，以细辛、干姜为热药也，服之当遂渴，而渴反止者，为支饮也。支饮者法当冒，冒者
必呕，呕者复纳半夏半升以去其水。（于桂苓甘草五味汤中去桂，加干姜、细辛、半夏是也。）
水去呕止，其人形肿者，加杏仁半升主之，其证应内麻黄，以其人遂痹，故不纳之，若逆而纳之必厥，所
以然者，以其人血虚，麻黄发其阳故也，用∶
茯苓（四两） 甘草 干姜 细辛（各三两） 五味子 半夏 杏仁（各半升，去皮尖）
上煎去渣，温日三服。
若面热如醉，此胃为热所冲熏其面，加大黄三两以利之。
〔无〕真应散 治远年喘急不能眠，百药不效者。
白石英（四两，通明者，以生绢袋盛，用雄猪肚一个，以药入内缝定煮熟，取药出，再换猪肚一个如前法煎三次，
煮了取药出，晒干，研）
上为末，以官局款冬花散二钱，入药末二钱，再加桑白皮二寸，生姜三片，枣子一个，水一盏半，煎至七
分，通口服。猪肚亦可吃，只不得用酱醋盐椒姜等调和。（款冬花散方，用款冬花一钱，贝母、知母、桑叶、杏仁、
半夏、阿胶、甘草各二钱，麻黄去节四钱，为粗末是也。）
〔《本》〕治多年肺气喘急，哮嗽，夕不得卧，紫金丹。
砒（水飞，半钱） 豌豆（好者，二钱，用水略润少时，以纸挹干研成膏）
上用膏子和砒同杵极匀，丸如麻子大。每服十五丸，小儿量大小与之，并用蜡茶清，极冷吞下。临卧，以
知为度。有一亲戚妇人患十年，遍求医者皆不效。忽有一道人货此药，漫赎一服，是夜减半，数服顿愈。遂
多金丐得此方，予屡用以救人，时为神异。
〔《素》〕不得卧而息有音者，是阳明之逆也。足三阳者下行，今逆而上行，故息有音也。阳明者，胃脉
也，胃者六腑之海，其气亦下行。阳明逆，不得从其道，故不得卧也。《下经》曰∶胃不和则卧不安。此之谓
也。（逆调论《千金》白前汤治喉中水鸡声不得卧，方见咳喉中作声。）
感寒喘不得卧，治法见产后喘。
〔《甲》〕咳喘不得卧，不得坐，呼吸气索咽不得，胸中热，云门主之。咳逆烦满不得卧，胸中满，喘不
得息，背痛，太渊主之。
上针灸喘不得卧，天突穴甚效，予治数人皆中。
Whenever there is panting and the patient cannot lie down, with a pulse that is floating on superficial palpation but empty and choppy on deep pressure, this indicates Yin deficiency. Death is imminent; do not use purgatives under any circumstances, as doing so will certainly lead to death. It is appropriate to administer Siwu Tang (Four Substance Decoction) added with Tongbian (Child's Urine), Zhuli (Bamboo Sap), Qingdai (Indigo Naturalis), Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), Zhike (Aurantium Fruit), and Ziye (Perilla Leaf).
[Dan] Hu Anren, aged sixty-eight, suffered from aversion to cold and fever. Since April, he had developed phlegm and cough, insomnia, poor appetite, pain in the heart and diaphragm, continuous coughing, with symptoms worsening significantly at dawn (Wugeng).
Baizhu (Atractylodis Rhizoma, 3 qian), Zhike (Aurantium Fruit, stir-fried), Huanglian (Coptidis Rhizoma, each 2 qian), Shaoyao (Paeoniae Radix, 2.5 qian), Pianqin (Scutellariae Radix, 7.5 qian), Jiegeng (Platycodonis Radix), Sugengye (Perillae Caulis and Leaf, each 1 liang), Mutong (Akebiae Caulis, 5 fen), Gancao (Glycyrrhizae Radix et Rhizoma, roasted slightly), Wuweizi (Schisandrae Fructus, 21 grains).
Decoct these ingredients with Zhuli (Bamboo Sap) for oral administration.
A male patient suffered from severe panting preventing him from lying down. His Lung pulse was deep and choppy. This indicated that external wind-cold-dampness was obstructing internal heat, preventing it from dispersing.
Huangqin (Scutellariae Radix), Chenpi (Citri Reticulatae Pericarpium), Mutong (Akebiae Caulis) (each 1.5 qian); Mahuang (Ephedrae Herba), Ziye (Perillae Folium), Guizhi (Cinnamomi Ramulus) (each 1 qian); Huanglian (Coptidis Rhizoma), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, roasted).
Kai Erti, whose constitution was deficient, contracted cold and fever, resulting in panting difficult enough to prevent lying down.
Cangzhu (Atractylodis Rhizoma), Mahuang (Ephedrae Herba), Baizhu (Atractylodis Rhizoma), Pianqin (Scutellariae Radix, stir-fried) (each 5 fen); Guizhi (Cinnamomi Ramulus, 3 fen); Banxia (Pinelliae Rhizoma), Zhike (Aurantium Fruit) (each 1 qian); Mutong (Akebiae Caulis, 3 fen); Gancao (Glycyrrhizae Radix et Rhizoma, roasted).
Decoct with two slices of Shengjiang (Zingiberis Rhizoma Recens). Add five crushed Xingren (Armeniacae Semen Amarum). (Banxia is the sovereign herb in this formula, indicating the patient likely has excessive phlegm.)
Among the above three exterior-resolving formulas, the first is designed for cases with significant alternating chills and fever, while the latter two are for cases with predominant cold.
When coughing and rebellious Qi cause upward rushing, frequent expectoration of turbid saliva, and the patient can only sit up而不能 lie down, Zaowan (Soapberry Pill) is the primary treatment.
Use eight liang of Zaoguo (Gleditsiae Fructus), scrape off the skin, and roast with Su (lard or butter). Grind this single ingredient into powder. Form pills the size of Sophora seeds using honey. Take thirty pills mixed with Zao Gao (Date Paste) and warm water, three times during the day and once at night.
A sixty-year-old woman, who historically had no sweat and abundant phlegm, now suffers from panting and insomnia. She was previously treated with Qingzhou Baiwanzi (Qingzhou White Pills).
Banxia (Pinelliae Rhizoma, half liang), Zhike (Aurantium Fruit, stir-fried, 4 qian), Jiegeng (Platocodonis Radix), Chenpi (Citri Reticulatae Pericarpium), Mutong (Akebiae Caulis), Huangqin (Scutellariae Radix, 2 qian), Mahuang (Ephedrae Herba, 1.5 qian), Zisu (Perillae Folium), Fangfeng (Saposhnikoviae Radix) (each 1 qian).
Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 5 fen).
Divide into five doses. Decoct with three slices of Shengjiang (Zingiberis Rhizoma Recens), remove the dregs, add an amount of Zhuli (Bamboo Sap) equivalent to half a clam shell, and drink hot.
[Suwen] Those who cannot lie down and pant when they do lie down are suffering from the invasion of Water Qi. Water flows along with body fluids. The Kidney is the Water Organ, governing body fluids, and also governing sleep and panting. (From *Ni Diao Lun*)
[Li Dongyuan] Shenmi Tang (Mysterious Decoction) treats patients who cannot sleep and pant upon sleeping. This is caused by Water Qi counterflowing upwards to the Lung. The Lung becomes buoyant due to the water, causing Qi stagnation. The pulse is deep and large. This formula is suitable for treatment.
Ziye (Perillae Folium), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), Renshen (Ginseng Radix et Rhizoma) (each 5 qian); Fuling (Poria), Sangbaipi (Mori Cortex), Muxiang (Aucklandiae Radix) (each 2 qian).
Chop the herbs, decoct in water, remove dregs, and take warm in two divided doses.
[Zhang Zhongjing] Coughing, rebellious Qi leaning on support to breathe, inability to lie down: Xiao Qinglong Tang (Minor Blue Dragon Decoction) is the primary treatment. (Formula seen in *Shanghan Lun*. Also stated: Zhi Yin [Branch Fluid] causes panting and inability to lie down, accompanied by shortness of breath, with a normal pulse.)
After administering Xiao Qinglong Tang, if the patient experiences excessive salivation, dry mouth, deep Cun pulse, faint Chi pulse, cold extremities, Qi rushing from the lower abdomen to the chest and throat, numbness in hands and feet, facial flushing resembling drunkenness, followed by downward flow to the inner thighs, difficulty urinating, and occasional vertigo, treat the Qi rush with Fuling Guizhi Wuzi Gancao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction).
Guizhi (Cinnamomi Ramulus, bark removed), Fuling (Poria) (each 4 liang); Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 3 liang); Wuzi (Schisandrae Fructus, half sheng).
Take these four ingredients, add eight sheng of water, boil to obtain three sheng, remove dregs, and divide into three warm doses.
If the Qi rush subsides but cough and chest fullness worsen, use Guiling Fuling Wuzi Gancao Tang (Cinnamon Twig, Poria, Schisandra, and Licorice Decoction) removing Guizhi, and adding Ganjiang (Zingiberis Rhizoma) and Xixin (Asari Radix et Rhizoma), each 3 liang, to treat the cough and fullness. Once cough and fullness cease, if thirst recurs and the Qi rush reappears, it is because Xixin and Ganjiang are hot herbs; taking them should cause thirst. If thirst does not occur, it indicates Zhi Yin. Patients with Zhi Yin typically experience vertigo; those with vertigo often vomit. In such cases, add Banxia (Pinelliae Rhizoma), half sheng, to eliminate fluid retention. (This refers to removing Guizhi from Guiling Gancao Wuzi Tang and adding Ganjiang, Xixin, and Banxia.)
If fluid retention ceases and vomiting stops, but the patient develops edema, add Xingren (Armeniacae Semen Amarum), half sheng. Although Mahuang would normally be indicated, it is omitted because the patient already has numbness; adding it against this pattern would cause Jue (cold extremities/shock). This is because the patient has Blood deficiency, and Mahuang would disperse Yang Qi. Use:
Fuling (Poria, 4 liang); Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma) (each 3 liang); Wuzi (Schisandrae Fructus), Banxia (Pinelliae Rhizoma), Xingren (Armeniacae Semen Amarum, husked and core removed, each half sheng).
Decoct, remove dregs, and take warm, three times daily.
If the face is hot like drunkenness, this is due to Stomach Heat rushing and steaming the face. Add Dahuang (Rhei Radix et Rhizoma), 3 liang, to drain the heat.
[Zhu Danxi] Zhenying San (True Response Powder) treats chronic severe panting and insomnia unresponsive to other medicines.
Baishiying (Quartz, 4 liang, transparent quality, placed in a raw silk bag). Use one male pig stomach, insert the medicine inside, sew shut, and boil until cooked. Remove the medicine, replace with another pig stomach, and repeat the boiling process three times. After cooking, remove the medicine, dry it, and grind it.
Mix this powder with 2 qian of Guanju Kuandonghua San (Official Bureau Winterflower Powder) and 2 qian of the prepared powder. Add Sangbaipi (Mori Cortex, 2 cun), Shengjiang (Zingiberis Rhizoma Recens, 3 slices), and one date. Add one and a half sheng of water, boil to seven-tenths volume, and take orally in one dose. The pig stomach may also be eaten, but do not season with soy sauce, vinegar, salt, pepper, or ginger. (Kuandonghua San formula consists of Kuandonghua (Farfarae Flos, 1 qian), Beimu (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), Sangye (Mori Folium), Xingren (Armeniacae Semen Amarum), Banxia (Pinelliae Rhizoma), Ejiao (Colla Corii Asini), Gancao (Glycyrrhizae Radix et Rhizoma) (each 2 qian), and Mahuang (Ephedrae Herba, de-stemmed, 4 qian), ground into coarse powder.)
[Bencao] For chronic lung panting, asthma, wheezing cough, and inability to lie down at night, use Zijin Dan (Purple Gold Pill).
Pi (Arsenic Trioxide, water-purified, half qian); Wandou (Pisum Sativum, high quality, 2 qian, moistened slightly with water, dried with paper, and ground into paste).
Mix the paste and arsenic thoroughly by pounding. Form pills the size of sesame seeds. Take fifteen pills per dose; for children, adjust according to age/size. Swallow with very cold Lacha Qing (Wax Tea Clear Liquid). Take before bed until effective. A relative's wife suffered for ten years without success from various doctors. A Daoist priest sold this medicine; she bought one dose arbitrarily. That night, symptoms halved; after several doses, she recovered completely. She spent much gold to acquire the formula. I have used it frequently to save lives, and it was considered miraculous at the time.
[Suwen] Inability to lie down accompanied by noisy breathing indicates reversal of Yangming Qi. The Foot Three Yang meridians normally descend; now they reverse and ascend, causing noisy breathing. Yangming is the Stomach meridian. The Stomach is the sea of the Six Fu organs, and its Qi also descends. When Yangming Qi reverses and cannot follow its proper pathway, the patient cannot lie down. The *Xia Jing* states: "When the Stomach is disharmonious, sleep is uneasy." This refers to this condition. (From *Ni Diao Lun*; *Qianjin Fang*'s Baiqian Tang treats hoarse breathing like a water frog and inability to lie down; see entry for "cough with sound in throat".)
For panting and inability to lie down due to cold contraction, see the treatment for postpartum panting.
[Jiayi Jing] Cough and panting preventing lying down, inability to sit, rapid breathing seeming to cut off, heat in the chest: Yunmen (LU 2) governs this. Cough, rebellious Qi, irritability, fullness, inability to lie down, chest fullness, panting with difficulty breathing, back pain: Taiyuan (LU 9) governs this.
Regarding acupuncture and moxibustion for panting and inability to lie down, Tianchu (CV 22) is very effective. I have treated several patients with successful results.