喘与气短不同。喘者。促促气急。喝喝息数。张口抬肩。摇身撷肚。短气者。呼吸虽数。而不能接续。似
喘而不抬肩。似呻吟而无痛。呼吸虽急而无痰声。宜详辨之。丹溪云。须分虚实新久。久病是气虚。宜补之。新
病是气实。宜泻之。
愚按喘与短气分。则短气是虚。喘是实。然而喘多有不足者。短气间亦有有余者。新病亦有本虚者。不可
执论也。
金匮云。实喘者。气实肺盛。呼吸不利。肺窍壅塞。若寸沉实。宜泻肺。虚喘者肾虚。先觉呼吸短气。两
胁胀满。左尺大而虚。宜补肾。此肾虚证非新病虚者乎。
邪喘者。由肺受邪。伏于肺中。关窍不通。呼吸不利。若寸沉而紧。此外感也。亦有六部俱伏者。宜发
散。则身热退而喘定。此郁证。人所难知。非短气中之有余乎。
论人之五脏。皆有上气。而肺为之主。居于上而为五脏之华盖。通荣卫。合阴阳。升降往来。无过不及。
何病之有。若为风寒暑湿所侵。则肺气胀满而为喘。呼吸迫促。坐卧不安。或七情
内伤。郁而生痰。或脾胃俱虚。不能摄养。一身之痰。皆能令人喘。
真知其风寒也。则用仲景青龙汤。真知其暑也。则用白虎汤。真知其湿也。则用胜湿汤。真知其七情郁结
也。则用四磨四七汤。又有木郁火郁土郁金郁水郁。皆能致喘。治者察之。（以上俱属有余之证。）
东垣云。病机云。诸痿喘呕。皆属于上。辩云伤寒家论喘。以为火热者。是明有余之邪中于表。寒变为热。心火太
旺攻肺。故属于上。又云。膏粱之人。奉养太过。及过爱小儿。亦能积热于上而成喘。宜以甘寒之剂治之。饮食不节。
喜怒劳役不时。水谷之寒热感则害人六腑。皆由中气不足。其 胀腹满。咳喘呕食不下。宜以大甘辛热之剂治之。脉经
云。肺盛有余。则咳嗽上气渴烦。心胸满短气。皆冲脉之火行于胸中而作。系在下焦。非属上也。观东垣之辩。可见
起于伤寒者有余之邪。杂病者。不足之邪。自是标本判然条析。如遇标病。或汗或吐或下。一药而痰
去喘定。奏功如神。粗工以其奏功如神也。执而概施之不足之证。岂不殆哉。娄全善云。凡下痰定喘诸方。
施之形实有痰者神效。若虚而脉浮大。按之涩者。不可下之。下之必反剧而死。
经云。诸喘皆属于上。又谓诸逆冲上。皆属于火。故河间叙喘病在于热条下。华佗云。肺气盛为喘。活人
书云。气有余则喘。后代集证类方。不过遵此而已。独王海藏辩云。气盛当作气衰。有余当认作不足。肺气
果盛与有余。则清肃下行。岂复为喘。以其火入于肺。炎烁真阴。衰与不足而为喘焉。所言盛与有余者。非肺之
气也。肺中之火也。海藏之辩。超出前人。发千古之精奥。惜乎起其端。未竟其火之所由来。愚谓火之有余。
水之不足也。阳之有余。阴之不足也。凡诸逆冲上之火。皆下焦冲任相火。出于肝肾者也。故曰冲逆。肾水虚
衰。相火偏胜。壮火食气。销铄肺金。乌得而不喘焉。丹溪云。喘有阴虚。自小腹下火起而上。宜四物汤加青
黛竹沥陈皮。入童便煎服。如挟痰喘者。四物加枳壳半夏。补阴以化痰。夫谓阴虚发喘。丹溪实发前人之所未
发。但如此治法。实流弊于后人。盖阴虚者。肾中之真阴虚也。岂四物汤阴血之谓乎。其火起者。下焦龙雷之火
也。岂寒凉所能降乎。其间有有痰者。有无痰者。有痰者。水挟木火而上也。岂竹沥枳半之能化乎。须用六味
地黄。加门冬五味大剂煎饮。以壮水之主。则水升火降。而喘自定矣。盖缘阴水虚故有
火。有火则有痰。有痰则咳嗽。咳嗽之甚则喘。当与前阴虚相火论参看。
又有一等。似火而非火。似喘而非喘者。经曰。少阴所谓呕咳上气喘者。阴气在下。阳气在上。诸阳气
浮。无所根据归。故上气喘也。黄帝针经云。胃络不和。喘出于阳明之气逆。阳明之气下行。今逆而上行故喘。
真元耗损。喘出于肾气之上奔。其人平日若无病。但觉气喘。非气喘也。乃气不归元也。视其外证。四
肢厥逆。面赤而烦燥恶热。似火非火也。乃命门真元之火。离其宫而不归也。察其脉两寸虽浮大而数。两
尺微而无力。或似有而无为辨耳。不知者以其有火也。少用凉药以清之。以其喘急难禁也。佐以四磨之类以宽
之。下咽之后。似觉稍快。少顷依然。岂知宽一分。更耗一分。甚有见其稍快。误认药力欠到。倍进寒凉快气
之剂。立见其毙矣。何也。盖阴虚至喘。去死不远矣。幸几希一线牵带在命门之根。尚尔留连。善治者。能求
其绪。而以助元接真镇坠之药。俾其返本归原。或可回生。然亦不可峻骤也。且先以八味丸安肾丸养正丹之类。
煎人参生脉散送下。觉气若稍定。然后以大剂参 补剂。加破故纸阿胶牛膝等。以镇于下。又以八味丸加河车
为丸。日夜遇饥则吞服方可。然犹未也。须远房帏。绝色欲。经年积月。方可保全。不守此禁。终亦必亡而
已。予论至此。可为寒心。聪明男子。当自治未病。毋蹈此危机。
又有一等火郁之证。六脉微涩。甚至沉伏。四肢悉寒。甚至厥逆。拂拂气促而喘。却似有余。而脉不
紧数。欲作阴虚。而按尺鼓指。此为蓄郁已久。阳气拂遏。不能营运于表。以致身冷脉微而闷乱喘急。当此之
时。不可以寒药下之。又不可以热药投之。惟逍遥散加茱连之类。宣散蓄热。得汗而愈。愈后仍以六味
地黄。养阴和阳方佳。此谓火郁则发之。木郁则达之。即金匮所云六脉沉伏。宜发散。则热退而喘定是也。经曰。火郁
之发。民病少气。治以诸凉。或问喘者多不能卧何也。素问逆调论云。夫
不得卧。卧则喘者。水气之客也。夫水者。循经液而流也。肾者水藏。主津液。主卧与喘也。东垣云。病患不
得卧。卧则喘者。水气逆行乘于肺。肺得水而浮。使气不得流通也。
仲景云。短气皆属饮。金匮云。短气有微饮。当从小便去之。苓桂木甘汤主之。肾气丸亦主之。
以上详论阴虚发喘之证治。若阳虚致喘。东垣已详尽矣。外感发喘。仲景已详尽矣。兹
为补天立论。故加意于六味八味云。
Asthma (Chuan) and shortness of breath (Duan Qi) are different. Asthma is characterized by rapid and labored breathing, audible gasping sounds, frequent respiration, opening the mouth and raising the shoulders, shaking the body, and contracting the abdomen. Shortness of breath involves frequent respiration but an inability to sustain the breath, resembling asthma without shoulder elevation, resembling groaning without pain, and being urgent without phlegm rales. Careful differentiation is required. Danxi stated that one must distinguish between deficiency and excess, and new versus old conditions. Old diseases belong to Qi deficiency and should be tonified; new diseases belong to Qi excess and should be purged.
I observe that when distinguishing between asthma and shortness of breath, shortness of breath is typically deficiency, while asthma is typically excess. However, many cases of asthma involve insufficiency, and some cases of shortness of breath involve excess. New-onset conditions may also have a root deficiency; thus, one cannot adhere rigidly to fixed theories.
The *Jin Gui Yao Lue* states: In excess asthma, there is Qi excess and Lung fullness, with obstructed respiration and blocked lung orifices; if the Cun pulse is deep and excess, the Lung should be purged. In deficiency asthma, there is Kidney deficiency, initially manifesting as shortness of breath and distension in both hypochondria; if the left Chi pulse is large and deficient, the Kidney should be tonified. Is this Kidney deficiency not a form of deficiency seen in new diseases?
Excess-type asthma arises from external pathogens invading the Lung and lingering within, blocking the orifices and causing difficult respiration; if the Cun pulse is deep and tight, it indicates an external contraction. There are also cases where all six pulses are hidden; these should be treated with dispersing methods, after which fever subsides and asthma resolves. This is a constraint syndrome, often misunderstood by people, akin to the "excess" type within shortness of breath.
Regarding the five Zang organs, all can exhibit upward-rebellious Qi, but the Lung acts as the master. Located superiorly, it serves as the canopy over the five Zang organs, connecting Ying and Wei, harmonizing Yin and Yang, and regulating ascending and descending movements without excess or deficiency. How could disease arise? If invaded by Wind-Cold, Summer-heat, or Dampness, Lung Qi becomes distended, leading to asthma, urgent respiration, and restlessness. Alternatively, internal injury from Seven Emotions may cause stagnation and phlegm production; or Spleen and Stomach deficiency may fail to nourish the body, allowing phlegm from anywhere in the body to induce asthma.
If it is truly identified as caused by Wind-Cold, use Zhang Zhongjing's Qing Long Tang (Blue Dragon Decoction). If truly caused by Summer-heat, use Bai Hu Tang (White Tiger Decoction). If truly caused by Dampness, use Sheng Shi Tang (Winning Over Dampness Decoction). If truly caused by emotional stagnation, use Si Mo Tang (Four-Mortar Decoction) or Si Qi Tang (Four-Seven Decoction). Additionally, Wood, Fire, Earth, Metal, and Water constraints can all lead to asthma; practitioners must discern them. (All above belong to excess syndromes.)
Dongyuan cited the *Jing Yue Quan Shu*: "All flaccidity, asthma, and vomiting belong to the Upper Jiao." He clarified that when Taiyang scholars discuss asthma as heat-related, they mean that excess pathogenic factors attack the exterior, transforming cold into heat, causing excessive Heart Fire to attack the Lung, hence belonging to the Upper Jiao. He further stated that those consuming rich foods or overindulging in children may accumulate heat in the upper Jiao, causing asthma, treatable with sweet-cold agents. Irregular diet, emotions, and labor affecting the Six Fu organs due to cold/heat of food and drink stem from Middle Qi deficiency, presenting with abdominal distension, cough, asthma, vomiting, and anorexia, treatable with large sweet-acrid-hot agents. The *Mai Jing* states: Lung excess causes cough, upward-rebellious Qi, thirst, irritability, chest fullness, and shortness of breath; this is Chong Mai fire acting in the chest, rooted in the Lower Jiao, not the Upper Jiao. Viewing Dongyuan's clarification, it is evident that asthma from Taiyang disease stems from excess pathogens, while miscellaneous diseases stem from deficiency pathogens, clearly distinguishing root and branch. When treating branch symptoms, using sweating, vomiting, or purging methods can resolve phlegm and calm asthma instantly. Unskilled physicians, seeing such miraculous efficacy, indiscriminately apply these to deficiency syndromes, which is dangerous. Lou Quanshan noted that phlegm-resolving and asthma-calming formulas are effective for robust patients with phlegm, but contraindicated for deficient patients with floating-large, choppy pulses; purging them will worsen the condition and cause death.
The Classics state: All asthma belongs to the Upper Jiao. Also, all rebellious upward movement belongs to Fire. Hence, Hejian classified asthma under heat. Hua Tuo said: Lung Qi excess causes asthma. The *Huo Ren Shu* said: Excess Qi leads to asthma. Later compilations merely followed these views. Only Wang Haizang argued that "Qi excess" should be interpreted as "Qi deficiency," and "excess" as "insufficiency." If Lung Qi were truly excess and abundant, it would descend clearly and cleanly; why would it cause asthma? It is because Fire enters the Lung, scorching True Yin, leading to deficiency and asthma. The "excess" mentioned refers not to Lung Qi but to Fire in the Lung. Wang's argument surpasses predecessors, revealing profound truths, yet he did not fully explore the origin of this Fire. I propose that Fire excess is Water insufficiency; Yang excess is Yin insufficiency. All rebellious upward Fire originates from the Minister Fire of the Chong and Ren vessels in the Lower Jiao, stemming from Liver and Kidney. Thus it is called "rebellious upward." With Kidney Water deficiency and Minister Fire hyperactivity, vigorous Fire consumes Qi and scorches Lung Metal, inevitably causing asthma. Danxi stated: Deficiency-type asthma involves Fire rising from the lower abdomen; treat with Si Wu Tang (Four Substances Decoction) added with Qing Dai (Indigo Naturalis), Zhu Li (Bamboo Sap), Chen Pi (Tangerine Peel), and Tong Bian (Human Urine). For asthma with phlegm, add Zhi Ke (Aurantium) and Ban Xia (Pinellia) to Si Wu Tang to tonify Yin and resolve phlegm. While Danxi innovated on deficiency-type asthma, his method has led to misuse. "Deficiency" here refers to True Yin of the Kidney, not merely the Yin Blood addressed by Si Wu Tang. The rising Fire is the Dragon-Lei Fire of the Lower Jiao, unyielding to cold-bitter herbs. Phlegm here results from Water carrying Wood-Fire upward, not resolvable by Zhu Li or Zhi Ke/Ban Xia alone. One must use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) added with Mai Dong (Ophiopogon) and Wu Wei Zi (Schisandra) in large doses to strengthen the Master of Water (Kidney Yin), allowing Water to ascend and Fire to descend, resolving asthma. Since Yin Water deficiency generates Fire, Fire generates Phlegm, Phlegm causes Cough, and severe Cough leads to Asthma, refer to the discussion on Yin Deficiency and Minister Fire.
Another category resembles Fire but is not Fire, and resembles Asthma but is not Asthma. The Classics state: Shaoyin disorders involving vomiting, cough, and asthma occur because Yin is below, Yang is above, and Yang Qi floats without root, causing upper asthma. The *Huang Di Zhen Jing* states: Disharmony of Stomach collaterals causes asthma due to reversal of Yang Ming Qi. Yang Ming Qi should descend; its reversal upward causes asthma. Exhaustion of True Yuan causes asthma due to ascending Kidney Qi. Patients usually appear healthy but feel asthmatic; this is not true asthma but Qi failing to return to its source. External signs include cold limbs, red face, irritability, and aversion to heat—resembling Fire but not Fire. This is the True Yuan Fire of the Gate of Vitality leaving its palace. Pulses show floating-large-rapid Cun pulses but weak-powerless Chi pulses, sometimes indistinct. Ignorant practitioners mistake this for Fire, using small amounts of cooling herbs and Si Mo Tang to relieve distress. Initially, relief occurs, but soon returns. Relieving constriction consumes more Qi. Some mistakenly increase cold/bitter herbs, leading to immediate death. Why? Severe Yin deficiency with asthma is near fatal. Survival depends on the root at the Gate of Vitality. Skilled practitioners seek the root and use herbs to assist Yuan, connect True Qi, and anchor/repress rebellion to restore origin, avoiding harsh treatments. Start with Ba Wei Wan (Eight-Ingredient Pill), An Shen Wan, or Yang Zheng Dan, taken with Ren Shen Sheng Mai San (Ginseng Pulse-Nourishing Decoction). Once Qi stabilizes, use large doses of Shen Fu Bu Ji (Ginseng and Aconite Tonifying Formula) with Po Gu Zhi (Cibotium), E Jiao (Donkey-Hide Gelatin), and Niu Xi (Achyranthes) to anchor downward. Then use Ba Wei Wan plus Placenta Humanum (Zi He Che) as pills, taken during hunger. Strict abstinence from sexual activity is required for years to maintain health; otherwise, death is inevitable. This discussion is chilling. Wise men should prevent disease before it arises.
Another category is Fire Constraint. Pulses are faint-choppy or deep-hidden; limbs are cold or inverted; breathing is rapid and asthmatic, appearing like excess but pulses are not tight-rapid. Pressing the Chi pulse feels forceful. This is long-standing constraint suppressing Yang Qi, preventing circulation at the surface, causing cold body, faint pulses, confusion, and urgent asthma. Do not use cold purgatives or hot tonics. Use Xiao Yao San (Free and Easy Wanderer Powder) added with Zhu Yu (Evodia) and Lian Xin (Coptis) to disperse constrained heat; recovery follows sweating. Post-recovery, use Liu Wei Di Huang Wan to nourish Yin and harmonize Yang. This illustrates "disperse Fire constraint" and "ventilate Wood constraint," as stated in *Jin Gui*: deep-hidden pulses require dispersal to resolve heat and asthma. The Classics state: Fire constraint causes Qi deficiency. Treatment uses cooling herbs. Question: Why can asthmatics not lie down? *Su Wen: Ni Diao Lun* states: Inability to lie down with worsening asthma upon lying is due to Water Pathogen invasion. Water flows through meridians and fluids. Kidney is the Water Organ, governing fluids, sleep, and asthma. Dongyuan stated: Water Qi reverses to attack the Lung; Lung becomes buoyant with water, obstructing Qi flow.
Zhongjing stated: Shortness of breath belongs to Fluid retention. *Jin Gui* states: Shortness of breath from mild fluid retention should be treated via urination with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) or Shen Qi Wan (Kidney Qi Pill).
Above detailed the treatment of Yin-deficiency asthma. Yang-deficiency asthma was thoroughly discussed by Dongyuan. Exterior-contraction asthma was thoroughly discussed by Zhongjing. This text aims to supplement foundational theory, hence emphasizing Liu Wei Wan and Ba Wei Wan.