人不喘息。则气平静。血何由随之吐出哉。故失血家。未有不喘息者。有实喘。有虚喘。实喘之证有二。一是
郁闭。一是奔迫。郁闭者。气不达于外。而壅郁于内也。失血家阳来乘阴。此证为多。伤寒喘息者。用麻桂发
之。血家忌汗。又忌升发以动其血。与伤寒开郁闭之法不同。宜小柴胡汤加杏仁。以转枢外达。使腠理通。
荣卫和。斯达气于外。不壅于内而为喘矣。如果有外感闭束。不得不疏解者。宜香苏饮。加杏仁枯芩甘草。
或千金麦门冬汤。借麻黄以解外。而兼用清里之药。不致过汗亡阴。乃为调剂得宜。奔迫者。上气喘息。由
于气盛于下。而逆于上。失血家火盛逼血。往往其气粗贲。宜大泻其火。火平则气平。用浓朴枳壳大黄。使
地道通。气下泻。则不上逆矣。若内有瘀血。气道阻塞。不得升降而喘者。亦宜上三味。加当归白芍桃仁丹
皮治之。若是痰气阻塞者。清化丸主之。若小便闭者。下窍塞。故上窍壅也。宜五淋散。加防己杏仁桑白皮葶苈子。
虚喘亦有二证。一是肺虚。一是肾虚。肺虚作喘者。以肺居上焦。制节五脏。开窍于鼻。以通外气。以敛内气。
血虚则火盛津伤。肺叶痿而不下垂。故气不得降。喘息鼻张。甚则鼻敞若无关阑。乃肺痿之重证也。生津
补肺。宜清燥救肺汤。兼治郁火痰滞者。宜保和汤。或太平丸。吾谓肺叶下坠。宜兼用镇敛之法。三才汤合
生脉散。再加百合五倍子白芨花粉杏仁川贝母钟乳石治之。又有喘息由于鼻窒不通者。以肺中之火
郁闭鼻管。故气并于口而为喘也。太平丸。加麝香。即是上通鼻窍之妙药。与伤寒鼻塞有异。毋误治也。
肾虚喘息者。以气之根原于肾。失血家。火甚水枯。不能化气。是以气短而喘。咳逆喘息。颊赤咽干。宜大补
阴丸。加牛膝五味以潜降之。若是阴虚。阳无所附。气不归根者。地黄汤合生脉散。加磁石牛膝沉香。以滋
纳之。若小水不化。兼腰痛者。乃是肾中之阳。不能化气。宜肾气丸治之。参附汤。加五味茯苓亦可。
上系肺肾分治之法。如欲兼而治之。即从诸方化裁可也。此外如苏子降气汤。四磨汤。皆肺肾兼治。但未
能照顾血证。用者须知加减。
又曰。中宫虚则气少。人参主之。中宫实则气粗。大黄主之。
If a person does not pant, the Qi will be calm; how could blood follow and be vomited out? Therefore, patients with hemorrhage invariably experience panting. Panting is divided into Excess Panting (Shi Chuan) and Deficiency Panting (Xu Chuan). There are two types of Excess Panting: one is Qi stagnation and closure, and the other is Qi rushing and urgency. "Qi stagnation and closure" refers to Qi failing to reach the exterior and becoming obstructed and stagnant within. In patients with hemorrhage, Yang invades Yin, making this pattern common. For panting caused by Cold Damage (Shanghan), Ma Huang Tang or Gui Zhi Tang are used to induce sweating and release the exterior. However, patients with hemorrhage contraindicate sweating therapies and also avoid ascending and dispersing agents that might disturb the blood; thus, the method differs from treating closure in Cold Damage. It is appropriate to use Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Xing Ren (Apricot Seed) to pivot the mechanism and direct it outward, allowing the Cou Li (pores/skin texture) to open and Ying Wei (Nutritive and Defensive Qi) to harmonize. This allows Qi to reach the exterior without stagnating internally, thereby preventing panting. If there is indeed an external pathogen binding the exterior necessitating resolution, Xiang Su Yin (Fragrant Perilla Drink) with Xing Ren, Ku Qin (Scutellaria Root), and Gan Cao (Licorice Root) is suitable, or Qian Jin Mai Men Dong Tang (Million Gold Ophiopogon Decoction) may be used. Borrowing the power of Ma Huang (Ephedrae Herba) to resolve the exterior while simultaneously using interior-clearing herbs prevents excessive sweating and loss of Yin fluids, which represents proper adjustment. "Qi rushing and urgency" refers to upward-rebellious Qi causing panting, due to excess Qi in the lower jiao rebelling upward. In patients with hemorrhage, excessive Fire forces the blood, often resulting in coarse and surging respiration. One should vigorously purge the Fire; once the Fire is pacified, the Qi becomes calm. Using Hou Po (Magnolia Bark), Zhi Ke (Aurantium Fructus), and Da Huang (Rhei Radix et Rhizoma) unblocks the intestinal pathway, directing Qi downward so it does not rebel upward. If internal Blood stasis obstructs the airway, preventing the ascent and descent of Qi and causing panting, the aforementioned three herbs (Hou Po, Zhi Ke, Da Huang) plus Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Tao Ren (Persicae Semen), and Dan Pi (Moutan Cortex) are also suitable. If Phlegm-Qi obstruction is the cause, Qing Hua Wan (Clearing and Transforming Pill) is the primary formula. If urination is blocked, it is because the lower orifice is sealed, causing upper orifice congestion; Wu Lin San (Five Strangury Powder) with Fang Ji (Stephaniae Tetrandrae Radix), Xing Ren, Sang Bai Pi (Mori Cortex), and Ting Li Zi (Lepidii Semen) is indicated.
Deficiency Panting also has two patterns: one is Lung Deficiency, and the other is Kidney Deficiency. Panting due to Lung Deficiency arises because the Lung resides in the Upper Jiao, regulates the five Zang organs, opens at the nose to connect with external air, and gathers internal Qi. Blood deficiency leads to Fire excess and fluid injury, causing the lung tissue to become flaccid and fail to descend. Consequently, Qi cannot descend, leading to panting and nasal flaring; in severe cases, the nostrils remain wide open as if lacking a barrier, which is a severe stage of Fei Wei (Lung Flaccidity). To generate fluids and tonify the Lung, Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lung Decoction) is suitable. For cases complicated by stagnant Fire and Phlegm stasis, Bao He Tang (Harmonizing Preservation Decoction) or Tai Ping Wan (Peaceful World Pill) are appropriate. I believe that for descending lung tissue, calming and astringent methods should be combined. San Cai Tang (Three Talents Decoction) combined with Sheng Mai San (Generate the Pulse Powder), plus Bai He (Lilii Bulbus), Wu Bei Zi (Galla Chinensis), Bai Ji (Bletillae Rhizoma), Hua Fen (Tetraspermi Semen), Xing Ren, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), and Zhong Ru Shi (Calcareous Deposit), can be used. Another type of panting results from nasal obstruction, where Fire in the Lung obstructs the nasal passages, causing Qi to congregate at the mouth and form panting. Tai Ping Wan with She Xiang (Moschus) is an excellent remedy for opening the nasal orifices; this differs from nasal congestion in Cold Damage, so do not treat it erroneously.
Panting due to Kidney Deficiency occurs because the root of Qi originates in the Kidney. In patients with hemorrhage, Fire is excessive and Water is dry, preventing Qi transformation, resulting in shortness of breath and panting, coughing with rebellious Qi, red cheeks, and dry throat. Da Bu Yin Wan (Great Tonifying Yin Pill) with Niu Xi (Achyranthis Bidentatae Radix) and Wu Wei Zi (Schisandrae Fructus) is suitable to submerge and descend the Qi and Fire. If Yin is deficient and Yang has no anchor, causing Qi to fail to return to its root, Di Huang Tang (Rehmannia Decoction) combined with Sheng Mai San, plus Ci Shi (Magnetitum), Niu Xi, and Chen Xiang (Aquilariae Lignum Resinatum), is used to nourish and grasp Qi. If urination fails to transform and is accompanied by lower back pain, this indicates that Kidney Yang cannot transform Qi; Shen Qi Wan (Kidney Qi Pill) is indicated. Can Fu Tang (Ginseng and Aconite Decoction) with Wu Wei Zi and Fu Ling (Poria) is also acceptable. The above discusses separate treatments for the Lung and Kidney. If simultaneous treatment is desired, these formulas can be modified accordingly. Additionally, Su Zi Jiang Qi Tang (Perilla Fruit Descending Qi Decoction) and Si Mo Tang (Four Fragrances Decoction) both treat the Lung and Kidney simultaneously but do not fully account for the specifics of hemorrhagic conditions; users must know how to add and subtract ingredients.
It is also said: When the Middle Palace (Spleen/Stomach) is deficient, Qi is scant, treated primarily with Ren Shen (Ginseng Radix); when the Middle Palace is excess, Qi is coarse, treated primarily with Da Huang (Rhei Radix et Rhizoma).