喘与气促不同,喘者气粗而壅,壅而急,喘为肺邪有余也;促者气促而短,上下不相接续,
促为肺肾不足也。此二者一实一虚,反如冰炭,若或误治,无不死也,当详辨之。
一、寒邪在肺作喘者,此外感之证,必咳嗽多痰,或鼻塞,或身有微热,或胸满不清,治当
疏散肺邪,宜六安煎,或二陈汤加苏叶主之。若寒邪外闭之甚者,仍宜加麻黄、北细辛之类。
若兼气血不足,而风寒在肺作喘者,惟金水六君煎为最。
一、痰因火动而为喘急者,当以清痰降火为主。若痰涎上壅者,先治其痰,宜抱龙丸、清
膈煎之类主之。
若火上刑肺,肺热叶举,大热大喘者,宜人参石膏汤。若微热作渴,肺燥液衰而喘者,宜人参
麦门冬散。若夏月热甚,火犯肺金而喘者,仲景竹叶石膏汤,或六味竹叶石膏汤。若火伏三焦,
肺胃大肠俱热,胸腹胀,大便秘结而喘者,前胡枳壳汤。
一、喘以气虚者,人多不能知之。凡下泻而上喘者,必虚喘也。凡小儿喘息,觉在鼻尖
而气不长者,必虚喘也,此实气促,原非气喘。若见此证,急须速补脾肺,或救肾阴,轻则参
姜饮、六气煎,甚则六味回阳饮。若下为泄泻而上为喘促者,急用六味回阳饮,或九味异功
煎,不可疑也。若大便不泻,而或为多汗,或为腹膨,或见痰饮、狂躁,但以阴虚水亏,
气短似喘,而脉气无神者,急宜贞元饮加人参煨姜之类主之。若治喘促用清痰降火等剂而愈甚
者,此必虚证也,速宜改用温补如前诸法,犹有可救,迟则恐无及矣。
一、痘疹发喘,乃恶候也,若利止喘定者生,其有泻利不止,或加胀满,或为狂躁,或
痘毒入肺,口张息肩,目闭足冷而喘甚者,皆不治之证。
喘证与气促不同。喘证表现为呼吸粗重且气机壅滞,因壅滞而急促,属于肺邪有余的实证;气促表现为呼吸短促,气息上下不能接续,属于肺肾不足的虚证。这两种情况一实一虚,截然相反,如同冰炭不相容,如果误治,没有不导致死亡的,应当仔细辨别。
一、寒邪在肺引起的喘证,属于外感病证,必然伴有咳嗽多痰,或者鼻塞,或者身体有轻微发热,或者胸部胀满不清爽,治疗应当疏散肺邪,适宜使用六安煎,或者二陈汤加紫苏叶为主方。如果寒邪外闭严重的,仍然适宜加入麻黄、北细辛之类的药物。如果兼有气血不足,而风寒在肺引起喘证的,以金水六君煎最为适宜。
一、痰因火动而引发的喘急,应当以清化痰热、降火为主。如果痰涎上壅的,先治疗其痰,适宜使用抱龙丸、清膈煎之类的主方。如果火上刑克肺脏,肺热叶举,出现大热大喘的,适宜使用人参石膏汤。如果微热口渴,肺燥津液衰少而喘的,适宜使用人参麦门冬散。如果夏季暑热甚盛,火邪侵犯肺金而喘的,使用张仲景的竹叶石膏汤,或者六味竹叶石膏汤。如果火邪伏留于三焦,肺、胃、大肠俱热,胸腹胀满,大便秘结而喘的,使用前胡枳壳汤。
一、因气虚导致的喘证,人们大多不知道。凡是下利泄泻而上部喘促的,必然是虚喘。凡是小儿喘息,感觉气息仅在鼻尖而气不长者,必然是虚喘,这实际上是气促,原本就不是气喘。如果出现这种证候,急需迅速补益脾肺,或者救补肾阴,轻症用参姜饮、六气煎,重症用六味回阳饮。如果下部为泄泻而上部为喘促的,急需使用六味回阳饮,或者九味异功煎,不可迟疑。如果大便不泻,但有多汗,或者腹部膨隆,或者见痰饮、狂躁,只是因为阴虚水亏,气短似喘,而脉气无神的,急需适宜贞元饮加人参、煨姜之类的主方。如果治疗喘促使用清痰降火的药剂反而加重,这必然是虚证,速宜改用温补如前所述的各种方法,还有可救的机会,迟缓则恐怕来不及了。
一、痘疹发喘,是恶候,如果腹泻停止、喘定者生,如果有腹泻不止,或者加上胀满,或者为狂躁,或者痘毒入肺,口张肩抬(呼吸困难),目闭足冷而喘严重的,都是不治之证。
Wheezing (Chuan) differs from shortness of breath (Cu). Wheezing is characterized by coarse and obstructed respiration, which becomes rapid due to the obstruction; it indicates an excess condition of pathogenic factors in the Lung. Shortness of breath is characterized by rapid and shallow breathing, where Qi fails to connect between the upper and lower body; it indicates a deficiency of the Lung and Kidney. These two conditions are one excess and one deficiency, mutually exclusive like ice and charcoal. If treated incorrectly, death is inevitable; therefore, they must be carefully distinguished.
1. Wheezing caused by Cold pathogen in the Lung belongs to exterior contraction syndromes. It must be accompanied by cough with profuse phlegm, nasal congestion, slight fever, or chest fullness and discomfort. Treatment should focus on dispersing Lung pathogens. Liu'an Decoction (Six-Safe Decoction) is appropriate, or Erchen Tang (Two-Aged Decoction) added with Perilla Leaf (Ziye). If external closure by Cold pathogen is severe, Ephedra Herb (Mahuang) and Northern Asarum Root (Beixixin) may still be added. If there is concomitant deficiency of Qi and Blood with Wind-Cold in the Lung causing wheezing, Jinshui Liujun Decoction (Metal-Water Six-Gentlemen Decoction) is most suitable.
2. Wheezing urgency caused by Phlegm stirred by Fire should primarily be treated by clearing Phlegm and descending Fire. If Phlegm-fluids are obstructing upwards, treat the Phlegm first; Baolong Pill (Embracing Dragon Pill) or Qingge Decoction (Clear Diaphragm Decoction) are appropriate. If Fire insults the Lung, causing Lung Heat and upward flipping of Lung leaves, presenting with high fever and severe wheezing, Renshen Shigao Tang (Ginseng and Gypsum Decoction) is indicated. If there is slight fever with thirst, Lung dryness with fluid depletion causing wheezing, Renshen Maidong San (Ginseng and Ophiopogon Powder) is indicated. If summer heat is severe, with Fire invading Lung Metal causing wheezing, Zhang Zhongjing's Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or Liuwei Zhuye Shigao Tang (Six-Ingredient Bamboo Leaf and Gypsum Decoction) are used. If Fire lurks in the Triple Burner, with Heat in the Lung, Stomach, and Large Intestine, accompanied by chest and abdominal distension, constipation, and wheezing, Qianhu Zhike Tang (Peucedanum and Bitter Orange Decoction) is indicated.
3. Wheezing due to Qi deficiency is often unknown to people. Wheezing accompanied by downward diarrhea is necessarily deficiency wheezing. In children, wheezing where breath seems confined to the nose tip without deep extension is necessarily deficiency wheezing; this is essentially shortness of breath (Cu), not true wheezing (Chuan). Upon seeing this syndrome, urgently tonify the Spleen and Lung, or rescue Kidney Yin. For mild cases, Shenjiang Yin (Ginger and Ginseng Drink) or Liuqi Jian (Six-Qi Decoction); for severe cases, Liuwei Huiyang Yin (Six-Ingredient Return-Yang Drink). If lower body has diarrhea and upper body has wheezing urgency, urgently use Liuwei Huiyang Yin or Jiawei Yigong Jian (Nine-Ingredient Yi-Gong Decoction); do not hesitate. If stool is not loose, but there is excessive sweating, abdominal distension, presence of Phlegm-Fluids, or mania/restlessness, solely due to Yin deficiency and Water depletion, with shortness of breath resembling wheezing and pulse lacking spirit, Zhenyuan Yin (True Origin Drink) added with Ginseng and Roasted Ginger is indicated. If treating wheezing urgency with Phlegm-clearing and Fire-descending formulas worsens the condition, this is definitely a deficiency syndrome. Quickly switch to warming and tonifying methods as described above; there is still hope for rescue, but delay may prove fatal.
4. Wheezing during the eruption of smallpox/rubella is a malignant sign. Survival is possible if diarrhea stops and wheezing settles. However, if diarrhea persists, or adds distension, or leads to mania, or if toxin enters the Lung causing mouth opening and shoulder lifting (accessory muscle use in breathing), closed eyes, cold feet, and severe wheezing, these are all untreatable conditions.