喘急之证。有因暴惊触心者。有因风寒之邪壅盛者。有因膏粱积热熏蒸清道者。有因过服消
导脾胃气虚者。然喘与气急。有轻重之别。喘则欲言不能。隘于胸臆。气急则但息短心神迷闷耳。
治法。因惊者。抱龙丸。风寒伤肺气者。小
青龙汤。或三拗汤加减。热伤肺气者。当凉肺定喘。痰声如锯者。小剂金匮麦门冬汤加牙硝。脾
肺气虚者。面色青白。四肢不温。大便不实。五味异功散。薛云。前证因脾肺气虚。腠理不密。
外邪所乘。真气虚而邪气实者为多。若已发之际。散邪为主。未发之先。补脾为主。设概攻其邪。
则损真气。径补其肺。则壅其邪。惟在临证之活法耳。凡喘嗽小便不利。则必生胀。胀则必生喘。
当分先后标本治之。
小儿脾胃俱伤。则呕泄并作。伤辛热停滞。则呕吐出酸秽。或黄色乳。或腹痛下利者。泻黄
散、保和丸选用。胃虚食不化而发热者。六君子加黄连、吴茱萸、木香。若停滞已去。泄泻不已。
理中汤去参加茯苓、木香。胃气不能化食。益黄散。若伤生冷腹痛。泻利青白。六君子加砂仁、
木香、炮姜。若伤鱼肉等物。六君子加山楂、砂仁。若泻红黄赤黑。肠胃俱热也。养胃汤加木香、
黄连。若夏秋伤热。吐泻色黄者。玉露散。若夏秋霍乱吐泻。手足心热。口干唇燥。喜饮冷水者。
五苓散。凡霍乱吐泻。手足逆冷。喜饮热汤者。理中汤。若泻利青白。乳食不化。额上微汗。脉
沉迟而或哕逆者。由胃气虚甚。过服克伐。使清气不升浊气不降。以致气不宣通而作也。若泻而
嗳臭吞酸。胸腹满痛。按之益甚者。虽作泻而所伤之物未消也。保和丸消导之。腹痛按之不哭者。
乳食已消也。异功散加木香。惊泻者。肝主惊。木盛必传克于脾。脾土既衰。则乳食不化。水道
不调。故泄泻色青。或兼发搐也。亦有因乳母脾虚受惊。及怒动肝火。致儿吐泻色青。异功、六
君加柴胡、钩藤钩、蝎梢之属。实脾以宁肝胆之气。慎勿用峻攻之药。脾气益虚。肝邪弥甚。甚
至抽搐反张也。若母食
浓味而乳热者。清胃散。若母饮烧酒而乳热。或子母身赤。或昏愦吐泻。丹方用锡掇盛滚水。盖
良久。取盖上蒸气水服之即解。同气相求之义也。吐痰涎及绿水者。胃虚受冷也。吴茱萸汤。小
儿衣甚薄。则腹中乳食不消。不消则大便酸臭。此欲为癖之渐也。便将紫丸微消之。乳哺自当如
常。若儿不受食哺。而但欲乳者。此是有癖。当下之。不下必致寒热吐利。失下之故也。凡小儿
屎黄而臭甚。此腹中有伏热。龙胆汤微下之。若白而酸臭者。此宿食不消也。当与紫丸。微者少
与药令内消。甚者稍增药令小下。节乳哺数日。令胃气平和。若不节乳哺。则病易复。复下之则
令腹胀满必发痫。此为食痫。轻则下之。重则难疗。大凡吐乳泻青色。手足乍冷乍热者。属惊。
法当平肝补脾。若吐泻青白色而不甚臭。手足指冷。或昏睡露睛者。属虚。法当温补脾土。若吐
泻黄赤色而臭秽异常。或喜冷冻饮料而睡不露睛。手足指热者。属实。法当消导清理脾胃。此验虚实
补泻法也。
The syndrome of panting and urgency involves several etiologies: some arise from sudden fright disturbing the Heart; others from the congestion of Wind-Cold pathogens; some from the steaming of accumulated heat caused by rich, greasy foods affecting the clear pathways; and some from excessive use of digestive agents leading to Spleen-Stomach Qi deficiency. However, there is a distinction in severity between Panting (Chuan) and Urgent Breathing (Qi Ji). Panting manifests as an inability to speak due to obstruction in the chest and diaphragm, whereas Urgent Breathing is characterized merely by shortness of breath and mental confusion or stifling sensation.
Treatment methods vary by etiology: For cases caused by fright, Bao Long Wan (Dragon Embracing Pill) is used. For Wind-Cold injuring Lung Qi, Xiao Qing Long Tang (Minor Blue Dragon Decoction) or San Ao Tang (Three Unbinding Decoction) with modifications are indicated. For Heat injuring Lung Qi, cooling the Lungs and stabilizing panting is required. If phlegm sounds like a saw, a small dose of Jin Gui Mai Men Dong Tang (Golden Casket Ophiopogon Decoction) with Ya Xiao (Saltpeter) is added. For Spleen-Lung Qi deficiency, presenting with blue-white complexion, cold limbs, and loose stools, Wu Wei Yi Gong San (Five-Ingredient Extraordinary Efficacy Powder) is prescribed. Xue Ji stated that these conditions are mostly due to Spleen-Lung Qi deficiency, where the interstices are not dense, allowing external pathogens to invade, resulting in a pattern of True Qi deficiency and Pathogenic Qi excess. During the acute phase, dispersing pathogens is primary; before onset, tonifying the Spleen is primary. If one indiscriminately attacks pathogens, True Qi is damaged; if one directly tonifies Lung Qi, pathogens become stagnant. This requires flexible clinical judgment. Generally, if panting and coughing are accompanied by difficult urination, distension will inevitably follow; if distension occurs, panting will inevitably result. Treatment must distinguish between the root and branch, and priority and sequence.
In children, when both Spleen and Stomach are injured, vomiting and diarrhea occur simultaneously. If caused by stagnation of pungent and hot foods, vomiting of sour, foul matter, yellow milk, abdominal pain, and diarrhea may occur; Xie Huang San (Yellow-Draining Powder) or Bao He Wan (Harmony-Preserving Pill) are selected. For stomach deficiency with food stagnation and fever, Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Huang Lian (Coptis Rhizome), Wu Zhu Yu (Evodia Fruit), and Mu Xiang (Aucklandia Root) is used. If stagnation has cleared but diarrhea persists, Li Zhong Tang (Regulate the Middle Decoction) without Fu Ling (Poria) and Mu Xiang is used. For Stomach Qi failing to transform food, Yi Huang San (Yellow-Spleen Powder) is indicated. If caused by raw/cold foods leading to abdominal pain and green/white stools, Liu Jun Zi Tang plus Sha Ren (Amomum Fruit), Mu Xiang, and Pao Jiang (Prepared Ginger) is used. If caused by fish/meat, Liu Jun Zi Tang plus Shan Zha (Hawthorn Fruit) and Sha Ren is used. If stools are red, yellow, dark red, or black, indicating heat in both intestines and stomach, Yang Wei Tang (Nourish-Stomach Decoction) plus Mu Xiang and Huang Lian is used. For summer-autumn heat injury causing yellow vomiting/diarrhea, Yu Lu San (Jade Dew Powder) is used. For summer-autumn cholera-like vomiting/diarrhea with hot palms/soles, dry mouth/lips, and preference for cold drinks, Wu Ling San (Five-Ingredient Powder with Poria) is used. For cholera-like vomiting/diarrhea with cold extremities and preference for hot drinks, Li Zhong Tang is used. If stools are green/white, undigested food is present, there is slight sweating on the forehead, pulse is deep/slow, or hiccups occur, this is due to severe Stomach Qi deficiency and overuse of harsh purgatives, causing failure of Clear Qi to ascend and Turbid Qi to descend, leading to blocked Qi mechanism. If diarrhea is accompanied by foul belching, acid regurgitation, chest/abdominal fullness/pain worsened by pressure, although diarrhea is present, the ingested food has not yet digested; Bao He Wan is used for digestion. If abdominal pain does not cause crying upon pressure, the food has digested; Yi Gong San plus Mu Xiang is used. For fright-induced diarrhea, since the Liver governs fright, excessive Liver Wood must overcome Spleen Earth. With weakened Spleen Earth, food fails to transform and water passages become disordered, resulting in green stools or convulsions. It may also stem from a nursing mother’s Spleen deficiency/fright or Liver Fire agitation, causing the infant’s green vomiting/diarrhea; Yi Gong San or Liu Jun Zi Tang plus Chai Hu (Bupleurum Root), Gou Teng Gou (Uncaria Hook), and Xie Shao (Scorpion Tail) is used. By strengthening the Spleen, Liver/Gallbladder Qi is pacified; harsh purgatives must be avoided, lest Spleen Qi further weaken and Liver Pathogens intensify, potentially leading to convulsions and opisthotonos. If the mother consumes rich flavors causing hot milk, Qing Wei San (Clear-Stomach Powder) is used. If the mother drinks liquor causing hot milk, or if mother/infant have red bodies, or unconsciousness/vomiting/diarrhea, a folk prescription suggests covering boiling water in a tin vessel for a long time and administering the condensed steam water, based on the principle of "similar energies seeking each other." Vomiting of phlegm-saliva and green water indicates Stomach deficiency with Cold; Wu Zhu Yu Tang is used. If infants wear thin clothes, food in the abdomen fails to digest, leading to sour-smelling stools, which is a precursor to Pi accumulation (masses); Zi Wan (Purple Pill) should be used mildly to dissipate it, restoring normal feeding. If the child refuses solid food but desires breast milk, this indicates Pi accumulation requiring purgation; failure to purge will lead to alternating chills/fever and vomiting/diarrhea due to missed treatment. Yellow, foul-smelling stools indicate latent heat in the abdomen; Long Dan Tang (Gentian Decoction) is used mildly to purge. White, sour-smelling stools indicate undigested old food; Zi Wan is given. Mild cases receive small doses to dissolve internally; severe cases receive slightly increased doses for mild purgation. Breastfeeding should be restricted for several days to harmonize Stomach Qi; otherwise, relapse is likely. Repeated purgation leads to abdominal distension and epilepsy, known as Food Epilepsy (Shi Xian). Mild cases respond to purgation; severe cases are difficult to treat. Generally, vomiting milk and green diarrhea with alternating cold/hot extremities indicates Fright; treatment should calm the Liver and tonify the Spleen. Green/white vomiting/diarrhea with little odor, cold toes, or sleeping with eyes open indicates Deficiency; treatment should warm and tonify Spleen Earth. Yellow/red vomiting/diarrhea with extreme foul odor, preference for cold drinks, sleeping with eyes closed, and hot toes indicates Excess; treatment should resolve stagnation and clear the Spleen/Stomach. This constitutes the method for verifying Excess/Deficiency to apply Tonification/Purgation.