尝慨天地人。三才也。天地一日夜。凡二息。则亘古不弊。人一日夜。凡一万
三千五百息。则度百岁乃去。何若是之相悬哉。盖天地之气合。而人之气
分。天地之于人。又未始须臾而离。彼春之温。为夏之热。彼秋之忿。为冬之
怒。人在气交中。一呼则以天之气而接人之气。一吸则以人之气而接天
之气。所谓天食人以五气是也。况呼出心与肺。在上为阳。吸入肾与肝。在
下为阴。脾居中州而调之。故徐而不迫。则合其一万三千五百息之常度
也。若有所劳倦。则气耗而喘出于肺。有所忧虑。则气结而喘出于心。有所
饥饱。则气馁而喘出于脾。有所暴怒。则气逆而喘出于肝。有所纵欲。则气
竭而喘出于肾。故在脾肺者益其气。气得补而喘自止。在肾肝者滋其阴。
阴得返而喘自定。虽有痰喘水喘火喘。及六淫之邪。为患最多。亦不过标
者其暂。而本者宜固也。试观之天地。有时而怒涛。有时而晦冥。有时而奔
溃。有时而崩陷。其暴疾之可畏实同乎喘。而终古不坏者。不失其潮汐之
常。而以清以宁者如故也。而人之患喘者。使其清升浊降。不改故常。即至
诸邪交侵。亦安足虑哉。如余治喘证多矣。未有若儒者钱曾一室人。庚戌
秋。患喘二旬余。始延治。比至。闻声如痰哮。按脉则微促。心肺肾肝。壅逆而
上。痛不可忍。上膈则实。下腹则空。检方药。消痰降气无遗用。余因谓曰。此
阴虚发喘。因喘而阴将绝矣。约以六味汤加杜仲阿胶。连进二十剂可愈。
否则不救。当晚即进一剂。觉胸膈痛遂止。阅旦视之。谓曰。此药不胜病。亟
取煎剂。余坐进之。连饮二盏。胸次觉宽。遂命以一日三剂。由是喘定索粥。
五脏安和。得保其生。可见天地间之理。固有至正不易者。而岂容泛泛哉。
一丙午季秋。幼儿患肺风痰喘。因避热乘凉所致。痰喘四五日。胸骨俱高。
消痰降喘药。俱不效。延郡中曹子叔明视之曰。此虽天热。而肺则受寒
也。以麻黄三分。杏仁五粒。桔梗枳壳广皮荆防前胡之属。进一剂而得
汗。喘稍定。余以贝母栝蒌霜连饮之。以保破残之肺。获安。向非叔明见
之精切。则喘何由而定哉。因录之以鸣感。且以示后之同患者。
三拗汤 治寒湍。
麻黄（一钱） 杏仁（十粒） 甘草（三分）
姜三片。水煎。
苏子栝蒌汤 治痰火发喘。
苏子（研） 桑白皮（蜜炒） 川贝母（去心研） 栝蒌霜（各一钱） 杜仲（一钱盐水炒） 茯苓（一钱） 广
皮（一钱） 前胡（一钱） 桔梗（一钱） 甘草（三分炙）
姜一片。水煎。热甚加黄芩。
二冬汤 治肺火而喘。
天门冬（一钱半去心） 麦门冬（一钱去心） 款冬花（一钱） 紫菀茸（一钱）
桔梗（一钱） 甘草（三分） 广陈皮（一钱） 川贝母（一钱） 百合（一钱） 马兜苓（一钱） 阿胶（一钱）
水煎。
半夏汤 治水逆而喘。
半夏（一钱） 茯苓（一钱） 炙甘草（三分） 桑白皮（一钱） 广皮（一钱） 泽泻（七分） 白术（一钱）
姜枣水煎。
仲景用木防己汤
木防己（二钱） 石膏（二钱） 桂枝（一钱） 人参（二钱）
水煎。
我曾感叹，天、地、人被称为“三才”。天地在一个昼夜之间，只有两次呼吸（指大气的一升一降），因此能亘古长存而不衰败。人在一个昼夜之间，有一万三千五百次呼吸，寿命不过百岁便离去。为何两者相差如此悬殊呢？这是因为天地之气是合一的，而人之气是分开的。天地与人，从未有一刻分离。那里的春天的温和，转化为夏天的炎热；那里的秋天的肃杀，转化为冬天的凛冽。人处在天地气交之中，呼气时以天之气来接续人气，吸气时以人气来接续天之气。这就是所说的“天食人以五气”（指自然界清气滋养人体）。况且呼出之气关联心与肺，位于上部属阳；吸入之气关联肾与肝，位于下部属阴。脾居中焦而调理气机，所以呼吸缓慢而不急促，这就符合了一万三千五百次呼吸的正常规律。
如果有所劳倦，则气耗散而气喘发于肺；有所忧虑，则气郁结而气喘发于心；有所饥饱失调，则气馁弱而气喘发于脾；有所暴怒，则气上逆而气喘发于肝；有所纵欲过度，则气枯竭而气喘发于肾。所以对于病位在脾肺的气喘，应补益其气，气得到补充气喘自然停止；对于病位在肾肝的气喘，应滋补肾肝之阴，阴液得以恢复气喘自然平息。即使有痰喘、水喘、火喘，以及六淫邪气致病，虽然为患最多，也不过是标症暂时存在，而根本应当固护。试看天地，有时会有愤怒般的波涛，有时昏暗不明，有时奔溃，有时崩陷。这些突发剧烈的变化确实与气喘相似，但天地最终不坏，是因为不失其潮汐的正常规律，依然保持清澈安宁。人若患气喘，只要能使清阳上升、浊阴下降，不改其常态，即使各种邪气交互侵犯，又有什么可担忧的呢？
像我治疗过的喘证很多了，没有像儒者钱曾的妻子那样严重的。庚戌年秋天，她患气喘二十多天，才开始请我诊治。等到我去时，听到她的声音像痰哮一样，诊脉则微促。心肺肝肾之气壅滞逆乱而上冲，疼痛难以忍受。上膈部感觉实满，下腹部感觉空虚。检查之前的方药，消痰降气的药物都用过了。我对她说：“这是阴虚引发的喘证，因为气喘导致阴气即将耗尽。”约定用六味地黄汤加杜仲、阿胶，连续服用二十剂可以痊愈，否则无法救治。当晚立即服下一剂，觉得胸膈疼痛随即停止。第二天早上查看病情，我说：“这药还不足以胜病，赶快取煎好的药剂。”我坐着看着她连喝两盏，胸部感觉宽舒，于是命令她一天服用三剂。从此气喘平息，索要粥食，五脏安和，得以保全生命。可见天地间的道理，本来就有至正不可改变的，难道容得马虎对待吗？
另一次，丙午年深秋，我的幼儿患肺风痰喘，是因为避暑乘凉所致。痰喘持续四五天，胸骨都高高隆起，消痰降喘的药物都不见效。请郡中的曹叔明先生诊治，他说：“这虽然是天气热，但肺却受了寒。”用麻黄三分、杏仁五粒，加上桔梗、枳壳、广陈皮、荆芥、防风、前胡等药，服一剂后出汗，气喘稍微平息。我用贝母、栝蒌霜让他连续服用，以保护受损的肺脏，获得安宁。如果不是曹叔明见解精切，气喘怎么能平息呢？因此记录下来以表达感慨，并且展示给后来有同样病患的人参考。
三拗汤：治疗寒喘。
麻黄（一钱） 杏仁（十粒） 甘草（三分）
姜三片，水煎服。
苏子栝蒌汤：治疗痰火引发的喘证。
苏子（研碎） 桑白皮（蜜炒） 川贝母（去心研碎） 栝蒌霜（各一钱） 杜仲（一钱，盐水炒） 茯苓（一钱） 广陈皮（一钱） 前胡（一钱） 桔梗（一钱） 甘草（三分，炙）
姜一片，水煎服。热象严重加黄芩。
二冬汤：治疗肺火引发的喘证。
天门冬（一钱半，去心） 麦门冬（一钱，去心） 款冬花（一钱） 紫菀茸（一钱）
桔梗（一钱） 甘草（三分） 广陈皮（一钱） 川贝母（一钱） 百合（一钱） 马兜铃（一钱） 阿胶（一钱）
水煎服。
半夏汤：治疗水饮逆乱引发的喘证。
半夏（一钱） 茯苓（一钱） 炙甘草（三分） 桑白皮（一钱） 广陈皮（一钱） 泽泻（七分） 白术（一钱）
姜枣水煎服。
I have often lamented that Heaven, Earth, and Man constitute the "Three Powers" (San Cai). Within a day and night, Heaven and Earth undergo only two breaths (referring to the rising and falling of atmospheric Qi), thus enduring eternally without decay. In contrast, humans breathe thirteen thousand five hundred times in a day and night, yet their lifespan barely reaches one hundred years before they depart. Why is there such a vast discrepancy? This is because the Qi of Heaven and Earth is unified, whereas human Qi is differentiated. Yet, Heaven and Earth are never separated from humans for even an instant. The warmth of spring transforms into the heat of summer; the severity of autumn transforms into the anger of winter. Humans exist within the intersection of these Qi dynamics. Upon exhalation, one connects human Qi with Heavenly Qi; upon inhalation, one connects Heavenly Qi with human Qi. This is what is meant by "Heaven nourishes humans with the Five Qi" (referring to the clear Qi from nature nourishing the body). Furthermore, exhaled Qi relates to the Heart and Lungs, located in the upper part and belonging to Yang; inhaled Qi relates to the Kidneys and Liver, located in the lower part and belonging to Yin. The Spleen resides in the Central Region (Zhong Jiao) to regulate this process, ensuring breathing is slow and unforced, thereby conforming to the normal rhythm of thirteen thousand five hundred breaths per day.
If one labors excessively, Qi dissipates, leading to panting originating from the Lung; if one worries excessively, Qi becomes knotted, leading to panting originating from the Heart; if one suffers from irregular eating or fasting, Qi becomes weak, leading to panting originating from the Spleen; if one experiences sudden rage, Qi rebels upward, leading to panting originating from the Liver; if one indulges in sexual excesses, Qi is exhausted, leading to panting originating from the Kidney. Therefore, for panting rooted in the Spleen and Lung, one should tonify Qi; once Qi is replenished, panting ceases naturally. For panting rooted in the Kidney and Liver, one should nourish Yin; once Yin returns, panting settles naturally. Even if there are cases of Phlegm Panting, Water Panting, or Fire Panting, or ailments caused by the Six Excesses (Liu Yin), although these cause frequent suffering, they represent temporary branch symptoms (Biao), while the root (Ben) must be secured. Observe Heaven and Earth: sometimes there are raging waves, sometimes darkness, sometimes collapse, sometimes subsidence. These sudden violent changes are indeed comparable to panting, yet the world remains intact because it does not lose its regular tidal rhythms, remaining clear and tranquil as before. If humans suffering from panting can ensure Clear Qi ascends and Turbid Qi descends, maintaining their original state, then even if various pathogens invade simultaneously, what is there to fear?
I have treated many cases of panting, but none were as severe as the wife of the scholar Qian Zeng. In the autumn of the Gengxu year, she suffered from panting for over twenty days before seeking treatment. When I arrived, her sound resembled phlegm-wheezing, and her pulse was slightly rapid and forceful. The Qi of the Heart, Lungs, Kidneys, and Liver was congested and rebelling upward, causing unbearable pain. The upper chest felt full and excess, while the lower abdomen felt empty. Reviewing previous prescriptions, all measures to resolve phlegm and direct Qi downward had been employed. I told her, "This is panting caused by Yin deficiency, where the panting has led to the near-extinction of Yin." I prescribed Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) supplemented with Du Zhong (Eucommia Bark) and E Jiao (Donkey-hide Gelatin), advising that twenty consecutive doses would cure her, otherwise, she could not be saved. She took the first dose that evening, and the chest pain ceased immediately. The next morning, upon examination, I said, "This medicine is insufficient to overcome the disease; quickly prepare another decoction." I watched her drink two cups continuously, after which her chest felt relaxed. I then instructed her to take three doses daily. From then on, her panting settled, she requested porridge, her Five Viscera harmonized, and she survived. This demonstrates that the principles of Heaven and Earth possess an ultimate correctness that does not change, and cannot be treated casually.
Another instance occurred in the late autumn of the Bingwu year. My young son suffered from Lung Wind Phlegm Panting due to cooling off while avoiding heat. The phlegm-panting persisted for four or five days, with his sternum protruding significantly. Medications for resolving phlegm and calming panting were ineffective. I invited Mr. Cao Shuming from the county to examine him. He stated, "Although the weather is hot, the Lung has contracted cold." He prescribed Ma Huang (Ephedrae Herba) 3 fen, Xing Ren (Prunus Armeniaca Seed) 5 grains, along with Jie Geng (Platycodon Root), Zhi Ke (Aurantii Fructus Immaturus), Guang Pi (Tangerine Peel), Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), and Qian Hu (Peucedani Radix). After one dose, he sweated, and the panting subsided slightly. I then administered Bei Mu (Fritillaria Bulb) and Gua Lou Shuang (Trichosanthes Peel Powder) continuously to protect his damaged Lung, resulting in recovery. Without Mr. Cao's precise diagnosis, how could the panting have been resolved? I record this to express my feelings and to inform future practitioners facing similar cases.
San'ao Tang (Three-Uninhibited Decoction): Treats Cold Panting.
Ma Huang (1 qian) Xing Ren (10 grains) Gan Cao (3 fen)
Add 3 slices of Ginger, decoct in water.
Suzi Gualou Tang (Perilla Seed and Trichosanthes Decoction): Treats Panting caused by Phlegm-Fire.
Su Zi (Crushed) Sang Bai Pi (Honey-fried) Chuan Bei Mu (Heart removed, crushed) Gua Lou Shuang (Each 1 qian) Du Zhong (1 qian, stir-fried with salt water) Fu Ling (1 qian) Guang Pi (1 qian) Qian Hu (1 qian) Jie Geng (1 qian) Gan Cao (3 fen, honey-fried)
Add 1 slice of Ginger, decoct in water. Add Huang Qin (Scutellaria Root) if heat is severe.
Er Dong Tang (Two-Dong Decoction): Treats Panting caused by Lung Fire.
Tian Men Dong (1.5 qian, heart removed) Mai Men Dong (1 qian, heart removed) Kuan Dong Hua (1 qian) Zi Wan Rong (1 qian)
Jie Geng (1 qian) Gan Cao (3 fen) Guang Chen Pi (1 qian) Chuan Bei Mu (1 qian) Bai He (1 qian) Dou Ling (1 qian) E Jiao (1 qian)
Decoct in water.
Ban Xia Tang (Pinellia Decoction): Treats Panting caused by Water Rebellion.
Ban Xia (1 qian) Fu Ling (1 qian) Zhi Gan Cao (3 fen) Sang Bai Pi (1 qian) Guang Pi (1 qian) Ze Xie (7 fen) Bai Zhu (1 qian)
Decoct with Ginger and Jujube in water.
Mu Fang Ji Tang (Stephania Tetrandra Decoction) used by Zhang Zhongjing:
Mu Fang Ji (2 qian) Shi Gao (2 qian) Gui Zhi (1 qian) Ren Shen (2 qian)
Decoct in water.