大意
诸病喘满。皆属于热。（内经）故病寒则气衰而息微。病热则气盛而息粗。（河间）盛则为喘。减则为枯。（华佗）盛
者肺中之火邪盛也。减者肺中之元气衰也。（汇补）
内因
肺居五脏之上。升降往来。无过不及。或六淫七情之所伤。或食饱碍气之为病。由是呼吸之气。不得宣畅
而生喘。（汇补）
外候
气喘者。呼吸急促。无痰而有声。痰喘者。喘动有痰而有声。火喘者。乍进乍退。得食则减。食已大发。水喘者。
辘辘有声。怔忡浮肿。此有余之喘也。气虚喘者。呼吸急促。不能接续。胃虚喘者。抬肩撷肚。饮食不进。阴虚
喘者。气从脐下直冲清道。此不足之喘也。（汇补）
喘分虚实
虚者。气乏身凉。冷痰如冰。实者。气壮胸满。身热便硬。（入门）
短气分辨
若夫少气不足以息。呼吸不相接续。出多入少。名曰气短。气短者。气微力弱。非若喘症之气粗奔迫也。（汇补）
死候
发汗如油。汗出如珠。抬肩撷肚。直视谵语。鼻煽口开。及胸前高起。脉络散张。手足厥冷。脉散及数者死。
（入门）
脉法
脉滑手足温者生。脉涩四肢寒者死。脉宜浮迟。不宜急数。（脉经）上气脉数。身热不得卧者死。上气面浮。脉
浮大者死。右寸脉实而紧。为肺感寒邪。亦有六脉沉伏者。并宜发散。则热退喘止。（汇补）
治法
外邪则散之。气郁则开之。痰则豁之。火则清之。停饮者吐之。脾虚者温之。气虚而火入于肺者。补气为先。
阴虚而火来乘金者。壮水为亟。水寒火不归经者。导龙入海。肾虚水邪泛溢者。逐水下流。（汇补）
用药
主以二陈汤。加桔梗、枳壳、苏子等。寒郁。加麻黄、杏仁。风痰。加南星。火痰。加黄连、山栀。水气。加猪苓、
泽泻。胃虚。四君子汤。肾经阴虚。六味地黄汤。阳虚。安肾丸。妇人产后。及跌扑损伤。瘀血入肺喘者。二味参苏饮。
脾肾两虚。观音应梦散。或参胡汤、八味丸。凡喘盛。不可用苦寒。以火盛故也。
喘病选方
二陈汤 统治喘病。为其能顺气和中化痰也。（方见痰症）
安肾丸 治肾虚水涸。气孤阳浮致喘者。
肉桂（五两） 破故纸 山药 石斛 白术 茯苓
肉苁蓉 萆 巴戟 蒺藜 桃仁（各十五两） 川乌（炮去皮脐五两）
蜜丸。空心。温酒或盐汤服。
二味参苏饮 治产后瘀血入肺。咳嗽喘急。
人参（一两） 苏木（二两）
若口鼻气急黑色者。加附子救之。如愈后。即服六君子汤为妙。
三拗汤 治风寒郁闭。喘促不得息。
麻黄（一钱） 杏仁（七粒） 甘草（五分）
水煎。热服取汗。
应梦散 治肾气烦冤。喘促不得卧。
人参（一两） 胡桃肉（二枚连衣） 生姜（五片） 大枣（二枚）
水煎。临卧服。
千缗汤 治风痰上喘。
半夏（七枚） 皂荚（一寸） 甘草（一寸）
合导痰汤同煎更效。
苏子降喘汤
苏子（炒捣碎） 杏仁 桑皮 前胡 橘皮 半夏 桔梗（各一钱） 甘草（四分）
水煎。
五味子汤 治胃虚喘促。脉伏而数者。
五味子（二钱） 人参 麦冬 杏仁 陈皮（各二钱半） 生姜（三片） 大枣（三枚）
水煎服。
四君子汤 治胃虚气弱。水气上乘作喘。（方见中风）
参胡汤 治喘急随绝者。余屡用之有效。功不可尽述。
人参（二钱） 胡桃肉（二枚不去衣膈）
水煎服。
八味丸（方见中风） 越婢加半夏汤（方见咳嗽）
华盖散 治风寒致哮。
麻黄 紫苏 杏仁 桑皮 赤茯苓 橘红 甘草
加姜煎。
参苏温肺汤
人参 肉桂 甘草 木香 五味 陈皮 半夏 桑皮 白术 紫苏（各五钱） 茯苓（三分）
冬月加麻黄。
劫法
椒目研极细末。姜汤调下二钱。未效再服。俟喘止后。分痰分火治之。
[General Principle]
Various diseases presenting with panting and fullness generally belong to Heat syndromes. (From *Neijing*) Therefore, when the disease is Cold, vital Qi declines and respiration becomes faint; when the disease is Heat, vital Qi flourishes and respiration becomes coarse. (From Liu Hejian) Flourishing manifests as panting, while decline manifests as withering. (From Hua Tuo) "Flourishing" refers to the flourishing of Fire pathogenic factors in the Lung; "decline" refers to the decline of Original Qi in the Lung. (From *Zhengzhi Huibu*)
[Internal Causes]
The Lung resides above the other five Zang organs, governing the ascending and descending movement of Qi, neither excessive nor deficient. If injured by the Six Exogenous Pathogens (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sadness, Fear, Fright), or if obstructed by overeating which hinders Qi mechanism, causing the respiratory Qi to fail to circulate freely, panting arises. (From *Zhengzhi Huibu*)
[External Manifestations]
Panting (Chuan): characterized by rapid breathing, without phlegm but with sound. Phlegm-panting (Tan Chuan): panting accompanied by phlegm and sound. Fire-panting (Huo Chuan): symptoms fluctuate, improving after eating but exacerbating immediately after meals. Water-panting (Shui Chuan): rattling sounds in the throat, accompanied by palpitations and edema. These are excess-type pantings. Qi-deficiency panting: rapid breathing with inability to sustain inhalation. Stomach-deficiency panting: raising shoulders and drawing in the abdomen, with loss of appetite. Yin-deficiency panting: Qi rushing directly from below the umbilicus up the clear passages. These are deficiency-type pantings. (From *Zhengzhi Huibu*)
[Differentiation of Deficiency and Excess in Panting]
Deficiency: lack of Qi, cool body, cold phlegm like ice. Excess: robust Qi, chest fullness, hot body, hard stool. (From *Yizong Rumeng*)
[Differentiation of Shortness of Breath]
When there is insufficient Qi to breathe, respiration cannot continue smoothly, with exhalation exceeding inhalation, this is called Shortness of Breath (Duan Qi). Those with Shortness of Breath have faint Qi and weak strength, unlike the coarse and urgent breath of Panting syndrome. (From *Zhengzhi Huibu*)
[Signs of Death]
Sweat like oil, sweat like pearls, raising shoulders and drawing in the abdomen, fixed gaze and delirious speech, nasal flaring with open mouth, chest protrusion, scattered and distended collaterals, cold extremities, and scattered or rapid pulse indicate death. (From *Yizong Rumeng*)
[Pulse Diagnosis]
Slippery pulse with warm hands and feet indicates survival; choppy pulse with cold limbs indicates death. The pulse should be floating and slow, not rapid and frequent. (From *Maijing*) For Shangqi (Rebellious Qi), rapid pulse with fever and inability to lie down indicates death. Floating face with floating and large pulse indicates death. Solid and tight pulse at the Right Cun position indicates Lung invasion by Cold pathogen; even if all six pulses are deep and hidden, dispersing methods are suitable, leading to resolution of heat and cessation of panting. (From *Zhengzhi Huibu*)
[Therapeutic Methods]
For external pathogens, use dispersing methods; for Qi stagnation, use opening methods; for phlegm, use resolving methods; for Fire, use clearing methods; for retained fluids, use emetic methods; for Spleen deficiency, use warming and tonifying methods. For Qi deficiency with Fire entering the Lung, tonifying Qi is primary; for Yin deficiency with Fire attacking Metal (Lung), nourishing Water (Kidney Yin) is urgent; for Cold Water with Fire not returning to its source, guide the Dragon to the Sea (lead fire back to origin); for Kidney deficiency with overflowing Water pathogen, drain water downwards. (From *Zhengzhi Huibu*)
[Medication]
The main formula is Erchen Tang (Two-Cured Decoction), added with Jiegeng (Platycodon Root), Zhike (Aurantii Fructus Immaturus), and Suzi (Perilla Fruit). For Cold stagnation, add Mahuang (Ephedra Stem) and Xingren (Apricot Seed); for Wind-phlegm, add Nanting (Arisaema Cum Bile); for Fire-phlegm, add Huanglian (Coptis Rhizome) and Shanzhi (Gardenia Fruit); for Water-Qi, add Zhuling (Polyporus) and Zexie (Alisma Rhizome); for Stomach deficiency, use Sijunzi Tang (Four Gentlemen Decoction); for Kidney Meridian Yin deficiency, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill); for Yang deficiency, use Anshen Wan (Kidney-Anchoring Pill); for postpartum women or trauma patients with Blood stasis entering the Lung causing panting, use Erwei Rensu Yin (Two-Ingredient Ginseng and Sappanwood Decoction); for simultaneous Spleen and Kidney deficiency, use Guanyin Yingmeng San (Guanyin’s Dream-Fulfilling Powder) or Shenhutang (Ginseng and Bupleurum Decoction), Bawei Wan (Eight-Ingredient Pill). In cases of severe panting, bitter-cold herbs should not be used due to existing Fire excess.
[Selected Formulas for Panting]
Erchen Tang (Two-Cured Decoction): Governs various panting syndromes as it harmonizes Qi, moderates the Middle, and resolves phlegm. (See Phlegm Syndrome chapter for formula details)
Anshen Wan (Kidney-Anchoring Pill): Treats panting caused by Kidney deficiency, dryness of Water, isolated Qi, and floating Yang.
Rougui (Cinnamon Bark, Rougui) 5 liang, Poguaizi (Psoralea Fruit, Poguaizi), Shanyao (Chinese Yam Rhizome, Shanyao), Shihu (Dendrobium Stem, Shihu), Baizhu (Atractylodes Macrocephala Rhizome, Baizhu), Fuling (Poria, Fuling), Rongrong (Cistanche Herb, Rongrong), Biji (likely Dioscorea Hypoglauca Rhizome or similar, listed as Biji in text), Bajitian (Morinda Officinalis Root, Bajitian), Jili (Tribulus Fruit, Jili), Taoren (Persica Seed, Taoren) each 15 liang; Chuanwu (Prepared Aconite Lateral Root, Chuanwu) 5 liang (processed, skin and core removed).
Made into honey pills, taken on an empty stomach with warm wine or salt water.
Erwei Rensu Yin (Two-Ingredient Ginseng and Sappanwood Decoction): Treats cough and urgent panting caused by blood stasis entering the Lung postpartum.
Renshen (Ginseng Root, Renshen) 1 liang, Sumu (Sappanwood, Sumu) 2 liang.
If breath is urgent and nose/mouth turn black, add Fuzi (Prepared Aconite Lateral Root, Fuzi) for rescue. After recovery, taking Liujunzi Tang (Six-Gentleman Decoction) is advisable.
San'ao Tang (Three-Uninhibited Decoction): Treats panting and suffocation due to closure by Wind-Cold.
Mahuang (Ephedra Stem, Mahuang) 1 qian, Xingren (Apricot Seed, Xingren) 7 grains, Gancao (Licorice Root, Gancao) 0.5 qian.
Decoct in water, take hot to induce sweating.
Yingmeng San (Dream-Fulfilling Powder): Treats vexation of Kidney Qi and urgent panting preventing lying down.
Renshen 1 liang, Hetaoren (Walnut Kernel, Hetaoren) 2 pieces (with skin), Shengjiang (Fresh Ginger Rhizome, Shengjiang) 5 slices, Dazao (Jujube Fruit, Dazao) 2 pieces.
Decoct in water, take before bedtime.
Qianmin Tang (Thousand-Silk Decoction): Treats upper panting due to Wind-phlegm.
Banxia (Pinellia Tuber, Banxia) 7 pieces, Zaojiao (Gleditsia Fruit, Zaojiao) 1 cun, Gancao 1 cun.
Decoct together with Daotan Tang (Phlegm-Resolving Decoction) for better efficacy.
Suzi Jiangchuan Tang (Perilla Fruit Descending-Panting Decoction)
Suzi (Perilla Fruit, Suzi) stir-fried and crushed, Xingren, Sangbapi (Mulberry Bark, Sangbapi), Qianhu (Peucedanum Root, Qianhu), Chenpi (Tangerine Peel, Chenpi), Banxia, Jiegeng (Platycodon Root, Jiegeng) each 1 qian, Gancao 0.4 qian.
Decoct in water.
Wuweizi Tang (Schisandra Decoction): Treats Stomach deficiency panting with deep and rapid pulse.
Wuweizi (Schisandra Fruit, Wuweizi) 2 qian, Renshen, Maidong (Ophiopogon Root, Maidong), Xingren, Chenpi each 2.5 qian, Shengjiang 3 slices, Dazao 3 pieces.
Decoct in water and take.
Sijunzi Tang (Four Gentlemen Decoction): Treats panting caused by Water-Qi rising due to Stomach deficiency and weak Qi. (See Stroke chapter for formula details)
Shenhutang (Ginseng and Bupleurum Decoction): Treats critical panting nearing cessation. I have used it frequently with good effect; its merits cannot be fully described.
Renshen 2 qian, Hetaoren 2 pieces (skin and septum not removed).
Decoct in water and take.
Bawei Wan (Eight-Ingredient Pill) (See Stroke chapter) Yebishu Jia Banxia Tang (Yebishu plus Arisaema Decoction) (See Cough chapter)
Huagai San (Canopy Powder): Treats asthma induced by Wind-Cold.
Mahuang, Zisu (Perilla Leaf, Zisu), Xingren, Sangbapi, Chifuling (Poria with Red Mycelium, Chifuling), Juhong (Red Tangerine Peel, Juhong), Gancao.
Decoct with Ginger.
Rensu Wenfei Tang (Ginseng and Sappanwood Warming-Lung Decoction)
Renshen, Rougui, Gancao, Muxiang (Aucklandia Root, Muxiang), Wuwei (Wuweizi), Chenpi, Banxia, Sangbapi, Baizhu, Zisu each 5 qian, Fuling 0.3 qian.
Add Mahuang in winter months.
[Emergency Method]
Jiaomu (Zanthoxylum Seed, Jiaomu) ground into extremely fine powder, mixed with Ginger Decoction and taken orally (2 qian). Repeat if ineffective. After panting ceases, treat according to Phlegm or Fire differentiation.