(肺主气形寒饮冷则伤肺故气逆上行急迫而张口抬肩是名为喘或水寒射肺者或邪在
表者或邪在里而喘心腹必濡而不坚若腹满即为可下至于汗出如油喘而不休及直视谵语而喘满
者皆死症也)
太阳病。无汗而喘。(麻黄汤)太阳与阳明合病。喘而胸满。不可下。(麻黄汤)表不解。
心下有水气。干呕而喘。(小青龙汤)汗后饮水多。必喘。(小青龙汤加杏仁猪苓)喘家有汗。(桂
枝汤加浓朴杏仁)汗下后。不可更行桂枝。若汗出而喘。无大热者。(麻黄杏仁甘草石膏汤)
太阳病桂枝证。医反下之。利遂不止。脉促者。表未解也。喘而汗出。(葛根黄芩黄连汤)阳
明口苦咽干。腹满微喘。发热恶寒。脉浮紧。(麻黄汤)阳明脉浮紧。咽燥口苦。腹满而喘。
发热汗出。不恶寒。反恶热。身重。(白虎汤五苓散)脉沉喘满。沉为在里。反发其汗。津液越
出。大便为难。表虚里实。久则谵语。(大承气汤)阳明脉迟。汗出。不恶寒。身重腹满而喘
。手足 然汗出。大便已硬。(大承气汤)小便不利。大便乍难乍易。微热。喘冒不卧。有燥
屎也。(大承气汤)阴症喘促。四肢逆冷。(返阴丹)
按心火刑金。肺受迫而喘呼。如人有难而叫号。故古人以诸喘为恶。至于阴喘。则无根
虚火。泄越于上。根本将脱。更为危恶。华佗曰。盛则为喘。指邪气盛。非肺气盛也。所谓泻白
者。非泻肺也。泻邪气以救肺也。故曰。气即是火。其义了然。
(肺主司气,若形体受寒或饮食生冷,则会损伤肺脏,导致肺气上逆、急促,出现张口抬肩的症状,这被称为“喘”。如果是水寒之邪射入肺中,或者病邪在表,或者病邪在里而致喘,此时心腹部必然柔软而不坚硬;如果腹部胀满,则说明可以使用下法。至于汗出如油、喘息不止,以及目直视、说胡话且伴有喘满的,都属于死症。)
太阳病,无汗且气喘。(用麻黄汤)太阳病与阳明病合病,气喘且胸部胀满,不可使用下法。(用麻黄汤)表证未解,心下有停饮,干呕且气喘。(用小青龙汤)发汗后饮水过多,必然导致气喘。(用小青龙汤加杏仁、猪苓)素有喘疾的人出汗。(用桂枝汤加厚朴、杏仁)经过发汗和攻下治疗后,不可再使用桂枝汤。如果汗出且气喘,没有大热的症状。(用麻黄杏仁甘草石膏汤)太阳病桂枝证,医生反而用了下法,导致腹泻不止,脉象急促,说明表证未解,气喘且出汗。(用葛根黄芩黄连汤)阳明病,口苦咽干,腹部胀满轻微气喘,发热恶寒,脉浮紧。(用麻黄汤)阳明病脉浮紧,咽燥口苦,腹部胀满且气喘,发热出汗,不恶寒,反恶热,身体沉重。(用白虎汤、五苓散)脉沉且喘满,沉脉表示病在里,反而发汗,导致津液外泄,大便困难,表虚里实,时间久了会出现说胡话。(用大承气汤)阳明病脉迟,出汗,不恶寒,身体沉重,腹部胀满且气喘,手足濈然汗出,大便已经变硬。(用大承气汤)小便不利,大便时而难时而易,微热,气喘头晕不能卧,这是有燥屎。(用大承气汤)阴证气喘急促,四肢厥冷。(用返阴丹)
按语:心火克制肺金,肺受逼迫而气喘呼叫,就像人遇到危难时呼号一样,所以古人认为各种喘证都是凶险的。至于阴喘,则是无根的虚火,向上发泄,根本即将脱失,更加危险恶劣。华佗说:“盛则为喘”,指的是邪气盛,而不是肺气盛。所谓“泻白”(清泻肺热),并不是泻肺本身,而是通过泻除邪气来拯救肺脏。所以说,“气即是火”,其中的道理就很清楚了。
(The Lung governs Qi. If the body is exposed to cold or if one consumes cold drinks and food, the Lung will be injured, causing Qi to rebel and ascend urgently, resulting in opening the mouth and raising the shoulders; this is named "Wheezing" (Chuan). If it is due to water-cold attacking the Lung, or if the pathogen is in the Exterior, or if the pathogen is in the Interior causing wheezing, the chest and abdomen must be soft and not hard; if the abdomen is full, purgation may be indicated. However, sweating like oil with ceaseless wheezing, as well as fixed staring, delirium accompanied by wheezing and fullness, are all fatal signs.)
Taiyang disease (Disease of the Taiyang channel), without sweat and with wheezing. (Ma Huang Tang / Ephedra Decoction) Combination of Taiyang and Yangming diseases, wheezing and chest fullness, cannot use purgation. (Ma Huang Tang / Ephedra Decoction) Exterior not resolved, fluid retention in the epigastrium, dry heaving and wheezing. (Xiao Qing Long Tang / Minor Blue Dragon Decoction) After sweating, drinking too much water inevitably causes wheezing. (Xiao Qing Long Tang / Minor Blue Dragon Decoction added with Xing Ren / Semen Armeniacae Amarum and Zhu Ling / Polyporus) A patient with chronic wheezing has sweat. (Gui Zhi Tang / Cinnamon Twig Decoction added with Hou Po / Cortex Magnoliae Officinalis and Xing Ren / Semen Armeniacae Amarum) After sweating and purging, Gui Zhi Tang / Cinnamon Twig Decoction should not be used again. If there is sweating and wheezing without significant heat. (Ma Huang Xing Ren Gan Cao Shi Gao Tang / Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) Taiyang disease with Gui Zhi pattern, but the physician incorrectly used purgation, leading to unceasing diarrhea. The pulse is rapid/crisp, indicating the exterior is not yet resolved, with wheezing and sweating. (Ge Gen Huang Qin Huang Lian Tang / Pueraria, Scutellaria, and Coptis Decoction) Yangming disease, bitter taste in the mouth and dry throat, abdominal fullness with slight wheezing, fever and aversion to cold, floating and tight pulse. (Ma Huang Tang / Ephedra Decoction) Yangming disease, floating and tight pulse, dry throat and bitter taste, abdominal fullness and wheezing, fever and sweating, no aversion to cold but aversion to heat, heavy body. (Bai Hu Tang / White Tiger Decoction and Wu Ling San / Five-Ingredient Powder with Poria) Pulse is deep with wheezing and fullness; deep indicates interior location. Incorrectly inducing sweating causes fluids to escape, making defecation difficult; exterior deficiency and interior excess, leading to delirium over time. (Da Cheng Qi Tang / Major Order the Qi Decoction) Yangming disease, slow pulse, sweating, no aversion to cold, heavy body, abdominal fullness and wheezing, continuous sweating on hands and feet, stool already hardened. (Da Cheng Qi Tang / Major Order the Qi Decoction) Urination is difficult, stool is alternately difficult and easy, slight fever, wheezing, dizziness, inability to lie down, indicating dry feces. (Da Cheng Qi Tang / Major Order the Qi Decoction) Yin syndrome with urgent wheezing and cold extremities. (Fan Yin Dan / Return to Yin Pill)
Commentary: Heart Fire insulting Metal (Lung) forces the Lung to wheeze and call out, similar to a person crying for help in distress; thus, ancients regarded various forms of wheezing as ominous. As for Yin wheezing, it involves rootless deficient fire venting upward, with the foundation about to collapse, which is even more critical. Hua Tuo said, "Excess leads to wheezing," referring to the excess of pathogenic factors, not the excess of Lung Qi. What is termed "Xie Bai" (Clearing/Draining White/Lung) does not mean draining the Lung itself, but rather rescuing the Lung by draining pathogenic factors. Therefore, it is said that "Qi is essentially Fire," making the meaning clear.