治阴虚不纳气作喘逆。
生山药（一两） 大熟地（五钱） 萸肉（五钱，去净核） 柿霜饼（四钱，冲服） 生杭芍（四钱）
牛蒡子（二钱，炒捣） 苏子（二钱，炒捣） 甘草（二钱，蜜炙） 生龙骨（五钱，捣细）
前方，治阴阳两虚作喘，此方，乃专治阴虚作喘者也。方书谓肝肾虚者，其人即不能纳气，此言亦近理，
然须细为剖析。空气中有氧气，乃养物之生气也。人之肺脏下无透窍，而吸入之养气，实能隔肺胞，息息通过，
以下达腹中，充养周身。肝肾居于腹中，其气化收敛，不至膨胀，自能容纳下达之气，且能导引使之归根。有
时肾虚气化不摄，则上注其气于冲，以冲下连肾也。夫冲为血海，实亦主气，今因为肾气贯注，则冲气又必上逆于
胃，以冲上连胃也。由是，冲气兼挟胃气上逆，并迫肺气亦上逆矣，此喘之所由来也。又《内经》谓肝主疏，
泄肾主闭藏。夫肝之疏泄，原以济肾之闭藏，故二便之通行，相火之萌动，皆与肝气有关，方书所以有肝行肾
气之说。今因肾失其闭藏之性，肝遂不能疏泄肾气使之下行，更迫于肾气之膨胀，转而上逆。由斯，其逆气可
由肝系直透膈上，亦能迫肺气上逆矣，此又喘之所由来也。方中用地黄、山药以补肾，萸肉、龙骨补肝即以敛
肾，芍药、甘草甘苦化阴，合之柿霜之凉润多液，均为养阴之妙品，苏子、牛蒡又能清痰降逆，使逆气转而下
行，即能引药力速于下达也。至方名薯蓣纳气汤者，因山药补肾兼能补肺，且饶有收敛之力，其治喘之功最弘也。
或问∶养气虽能隔肺胞通过，亦甚属些些无多，何以当吸气内入之时，全腹皆有膨胀之势？答曰∶若明此
理，益知所以致喘之由。人之脏腑皆赖气以撑悬，是以膈上有大气，司肺呼吸者也；膈下有中气，保合脾胃者
也，脐下有元气，固性命之根蒂者也。当吸气入肺之时，肺胞膨胀之力，能鼓舞诸气，节节运动下移，而周身
之气化遂因之而流通。且喉管之分支下连心肝，以通于奇经诸脉，当吸气内入之时，所吸之气原可由喉管之分
支下达，以与肺中所吸之气，相助为理也。下焦肝肾（奇经与肾相维系）属阴，阴虚气化不摄则内气膨胀，遂
致吸入之气不能容受而急于呼出，此阴虚者所以不纳气而作喘也。
生山药（一两） 大熟地（五钱） 山茱萸肉（五钱，去净核） 柿霜饼（四钱，冲服） 生白芍（四钱）
牛蒡子（二钱，炒后捣碎） 苏子（二钱，炒后捣碎） 甘草（二钱，蜜炙） 生龙骨（五钱，捣细）
前方（指张锡纯前文所述方剂），治疗阴阳两虚引起的喘息；此方，则是专门治疗阴虚引起的喘息的。医书说肝肾虚弱的人，就不能纳气，这种说法也接近事理，但需要仔细剖析。空气中含有氧气，是滋养万物的生气。人的肺脏下方没有透穿的孔窍，而吸入的养气，实际上能穿透肺泡，一呼一吸之间通过，向下到达腹部，充养全身。肝肾位于腹部，它们的气化功能具有收敛特性，不会使腹部膨胀，自然能够容纳下达之气，并且能引导它回归根本。有时肾虚导致气化不能固摄，那么上注的气就会进入冲脉，因为冲脉下端连接肾脏。冲脉为血海，同时也主管气，现在因为肾气灌注其中，冲气又必然向上逆行于胃，因为冲脉上端连接胃。由此，冲气兼挟胃气一起上逆，并迫使肺气也上逆，这就是喘息产生的原因。另外，《黄帝内经》说肝主疏泄，肾主闭藏。肝的疏泄功能，原本是为了辅助肾的闭藏，所以大小便的通畅、相火的萌动，都与肝气有关，医书中因此有“肝行肾气”的说法。现在因为肾失去了闭藏的特性，肝就不能疏泄肾气使其下行，反而受到肾气膨胀的逼迫，转而向上逆行。因此，逆气可以由肝系直接透达膈肌以上，也能迫使肺气上逆，这又是喘息产生的原因。方中使用地黄、山药来补肾，山茱萸、龙骨补肝以起到收敛肾气的作用，白芍、甘草甘苦化合生成阴液，加上柿霜的凉润多液，都是滋养阴液的妙品，苏子、牛蒡子又能清化痰浊、降逆气，使逆气转而向下运行，就能引导药力迅速下达。至于方名薯蓣纳气汤，是因为山药补肾兼能补肺，且富有收敛之力，其治疗喘息的功效益宏大。有人问：养气虽然能穿透肺泡通过，但也确实很少，为什么在吸气内入的时候，全腹都有膨胀的趋势？回答说：如果明白这个道理，更知道导致喘息的原因。人的脏腑都依赖气来支撑悬挂，所以在膈肌上有大气，主管肺的呼吸；膈肌下有中气，保护脾胃；脐下有元气，巩固性命的根基。当吸气进入肺时，肺泡膨胀的力量，能鼓舞各种气，节节运动向下移动，从而周身的气化因此流通。而且喉管的分支下连心肝，与奇经各脉相通，当吸气内入时，所吸入的气原本可由喉管的分支下达，以与肺中所吸之气，互相协助调理。下焦的肝肾（奇经与肾相维系）属阴，阴虚导致气化不能固摄则内气膨胀，于是导致吸入之气不能被容纳而急于呼出，这就是阴虚者不能纳气而产生喘息的原因。
Treats panting and counterflow qi caused by Yin deficiency failing to grasp Qi.
Raw Dioscoreae Rhizoma (Shanyao, 30g) Raw Rehmanniae Radix Praeparata (Shudi, 15g) Corni Fructus (Rou, 15g, pits removed completely) Persimmon Frost Cake (Shishuang Bing, 12g, dissolved and taken with the decoction) Raw Paeoniae Radix Alba (Baishao, 12g)
Arctii Fructus (Niubangzi, 6g, stir-fried and crushed) Perillae Fructus (Suzi, 6g, stir-fried and crushed) Glycyrrhizae Radix et Rhizoma (Gancao, 6g, honey-fried) Raw Longgu (Ostreae Concha, 15g, finely crushed)
The previous formula treats panting due to dual deficiency of Yin and Yang; this formula is specifically for treating panting due to Yin deficiency. Medical texts state that those with Liver and Kidney deficiency cannot grasp Qi; this statement is reasonable but requires detailed analysis. Oxygen in the air is the vital Qi that nourishes living things. The human Lung has no perforating orifices below it, yet the inhaled oxygen can actually penetrate through the alveoli, passing through with every breath, descending to the abdomen to nourish the whole body. The Liver and Kidneys reside in the abdomen; their Qi transformation possesses a converging nature, preventing abdominal distension, thus naturally accommodating the descending Qi and guiding it to return to its root. Sometimes, when Kidney deficiency fails to control Qi transformation, the Qi ascends and pours into the Chong Mai (Penetrating Vessel), as the Chong Mai connects inferiorly to the Kidney. The Chong Mai is the Sea of Blood and also governs Qi; now, infused with Kidney Qi, the Chong Qi inevitably rebels upward toward the Stomach, as the Chong Mai connects superiorly to the Stomach. Consequently, Chong Qi carries Stomach Qi upward in rebellion, forcing Lung Qi to rebel as well; this is the origin of panting. Furthermore, *Huangdi Neijing* states that the Liver governs dispersing and draining, while the Kidney governs storing and retaining. The Liver's dispersing function originally aids the Kidney's storing function; therefore, the unobstructed passage of urine and feces, and the stirring of Ministerial Fire, are all related to Liver Qi, which is why medical texts speak of "Liver moving Kidney Qi." Now, because the Kidney has lost its storing nature, the Liver cannot disperse Kidney Qi to descend it, and instead, pressured by the expansion of Kidney Qi, it turns to rebel upward. Thus, rebellious Qi can pass directly through the Liver channel above the diaphragm, forcing Lung Qi to rebel; this is another origin of panting. In the formula, Shudi and Shanyao tonify the Kidney; Rou and Longgu tonify the Liver to converge Kidney Qi; Baishao and Gancao transform sweet and bitter flavors into Yin fluids; combined with the cooling, moistening, and fluid-rich Shishuang, they are excellent products for nourishing Yin. Suzi and Niubangzi can clear phlegm and direct rebellious Qi downward, causing the rebellious Qi to turn and descend, thereby guiding the medicinal power to reach the lower part quickly. As for the name "Shuyu Naqi Tang" (Dioscorea Grasping Qi Decoction), it is because Shanyao tonifies the Kidney and also benefits the Lung, possessing strong converging power, making its efficacy in treating panting most significant. One might ask: Although oxygen passes through the alveoli, the amount is indeed small; why does the entire abdomen seem to expand during inhalation? I reply: Understanding this principle further reveals the cause of panting. Human Zang-Fu organs rely on Qi to support and suspend them; thus, above the diaphragm there is Da Qi (Great Qi) governing Lung respiration; below the diaphragm there is Zhong Qi (Middle Qi) preserving the Spleen and Stomach; below the umbilicus there is Yuan Qi (Original Qi) consolidating the root of life. When inhaling into the Lung, the expanding force of the alveoli can inspire various Qi, moving step by step downward, causing the Qi transformation of the whole body to circulate. Moreover, branches of the trachea connect inferiorly to the Heart and Liver, communicating with the extraordinary vessels; when inhaling, the inhaled Qi can originally descend via the branches of the trachea, assisting and coordinating with the Qi inhaled into the Lung. The Lower Jiao Liver and Kidney (extraordinary vessels are connected to the Kidney) belong to Yin; Yin deficiency leads to Qi transformation failing to retain, causing internal Qi to expand, resulting in the inability to accommodate inhaled Qi, leading to urgent exhalation. This is why those with Yin deficiency fail to grasp Qi and develop panting.