凡虚喘之证，无非由气虚耳。气虚之喘，十居七八，但察其外无风邪，内无实热而喘者
，即皆虚喘之证。若脾肺气虚者，不过在中上二焦，化源未亏，其病犹浅。若肝肾气虚，则
病出下焦而本末俱病，其病则深，此当速救其根以接助真气，庶可回生也。其有病久而加以
喘者，或久服消痰散气等剂而反加喘者，或上为喘咳而下为泄泻者，或妇人产后亡血过多，
则营气暴竭，孤阳无根据而为喘者，此名孤阳绝阴，剥极之候，已为难治，更毋蹈剥庐之戒也
。
一、虚喘证，其人别无风寒咳嗽等疾，而忽见气短似喘，或但经微劳，或饥时即见喘促
，或于精泄之后，或于大汗之后，或于大小便之后，或大病之后，或妇人月期之后而喘促愈
甚，或气道噎塞，上下若不相续，势剧垂危者，但察其表里无邪，脉息微弱无力，而诸病若
此，悉宜以贞元饮主之，加减如本方，其效如神。此外如小营煎、大营煎、大补元煎之类，
俱可择用。经曰∶肝苦急，急食甘以缓之，即此之类。若大便溏泄兼下寒者，宜右归饮、右
归丸、圣术煎之类主之。
一、脾肺气虚，上焦微热微渴而作喘者，宜生脉散主之。或但以气虚而无热者，惟独参
汤为宜。若火烁肺金，上焦热甚，烦渴多汗，气虚作喘者，宜人参白虎汤主之。若火在阴分
，宜玉女煎主之，然惟夏月或有此证。若阴虚，自小腹火气上冲而喘者，宜补阴降火，以六
味地黄汤加黄柏、知母之类主之。
一、水病为喘者，以肾邪干肺也。然水不能化而子病及母，使非精气之败，何以至此，
此其虚者十九，而间乎虚中挟实，则或有之耳。故凡治水喘者，不宜妄用攻击之药，当求肿
胀门诸法治之，肿退而喘自定矣。古法治心下有水气上乘于肺，喘而不得卧者，以《直指》
神秘汤主之。但此汤性用多主气分，若水因气滞者用之则可，若水因气虚者，必当以加减金
匮肾气汤之类主之。
一、老弱人久病气虚发喘者，但当以养肺为主。凡阴胜者宜温养之，如人参、当归、姜
、桂、甘草，或加以 、术之属。阳胜者宜滋养之，如人参、熟地、麦冬、阿胶、五味子、
梨浆、牛乳之属。
一、关格之证为喘者，如《六节藏象论》曰∶人迎四盛已上为格阳，寸口四盛已上为关
阴，人迎与寸口俱盛四倍已上为关格。此关格之证以脉言，不以病言也。今人之患此者颇多
，而人多不知，且近时察脉者不论人迎，惟在寸口，但其两手之脉浮弦至极，大至四倍已上
者，便是此证，其病必虚里跳动而气喘不已。此之喘状，多无咳嗽，但觉胸膈舂舂，似胀非
胀，似短非短，微劳则喘甚，多言亦喘甚，甚至通身振振，慌张不宁。此必情欲伤阴，以致
元气无根，孤阳离剧之候也，多不可治。方论详关格门。
一、凡病喘促，但察其脉息微弱细涩者，必阴中之阳虚也；或浮大弦芤按之空虚者，必
阳中之阴虚也。大凡喘急不得卧而脉见如此者，皆元气大虚，去死不远之候，若妄加消伐，
必增剧而危，若用苦寒或攻下之，无不即死。
凡是虚喘的病症，无非都是由气虚引起的。气虚导致的喘息，占七八成，只要观察患者体表没有风邪侵袭，体内没有实热而出现的喘息，就都属于虚喘的范畴。如果是脾肺两脏气虚，病位仅在中上二焦，化源（气血生化之源）尚未亏损，病情还算浅显。如果是肝肾气虚，则病发于下焦，导致根本与枝叶同时受病，病情深重，此时应当迅速救助其根本以接续和辅助真气，才可能挽回生命。那些患病日久又加上喘息的，或者长期服用消痰理气等药物反而加重喘息的，或者上部出现喘咳而下部出现泄泻的，或者妇女产后失血过多，导致营气突然枯竭，孤阳无所依附而引发喘息的，这叫做“孤阳绝阴”，是剥落至极的危重征候，已经难以治疗，更不要再犯下破坏根基的错误。
一、对于虚喘证，如果患者没有其他风寒咳嗽等疾病，却突然出现气短似喘的症状，或者稍微劳累，或者饥饿时即见喘促，或者在精液泄出之后，或者在大汗之后，或者在大小便之后，或者大病初愈之后，或者妇女月经期之后喘息更加严重，或者气道阻塞，上下气息不相接续，形势危急垂死的，只要观察表里都没有邪气，脉象微弱无力，出现上述各种情况，都适宜用贞元饮作为主方，根据本方进行加减，效果如神。此外，像小营煎、大营煎、大补元煎这类方剂，也可以酌情选用。《内经》说：“肝苦急，急食甘以缓之”，指的就是这类情况。如果大便溏泄兼有下部寒象的，适宜用右归饮、右归丸、圣术煎之类的主治。
一、脾肺气虚，上焦有轻微发热口渴而引发喘息的，适宜用生脉散主治。如果只是单纯气虚而没有热象的，只有独参汤最为适宜。如果火邪灼伤肺金，上焦热盛，烦躁口渴多汗，因气虚而作喘的，适宜用人参白虎汤主治。如果火邪位于阴分，适宜用玉女煎主治，但这通常只在夏季有此证型。如果是阴虚，从小腹有火气上冲而引发喘息的，适宜采用补阴降火的方法，以六味地黄汤加黄柏、知母之类的主治。
一、由水病引起的喘息，是因为肾中邪气干扰了肺脏。然而水液不能气化，子病及母，如果不是精气败坏，怎么会到这种地步呢？这种情况十之八九属于虚证，偶尔夹杂虚实相兼的情况。所以凡是治疗水气引起的喘息，不应当随意使用攻伐的药物，应当参考水肿门的各种方法进行治疗，肿胀消退后喘息自然平息。古法治疗心下有停水之气上乘于肺，导致喘息不能平卧的，用《直指方》的神秘汤主治。但是这个汤剂的药性多针对气分，如果是因气滞导致的水饮，使用它可以；如果是因气虚导致的水饮，必须用加减金匮肾气汤之类的主治。
一、年老体弱之人久病气虚引发喘息的，只应当以养肺为主。凡是阴偏胜的，适宜温养，如人参、当归、生姜、肉桂、甘草，或者加入白术、苍术之类的药物。阳偏胜的，适宜滋养，如人参、熟地黄、麦冬、阿胶、五味子、梨浆、牛乳之类的药物。
一、关格病症引发的喘息，如《素问·六节藏象论》所说：人迎脉搏动比寸口大四倍以上为格阳，寸口脉搏动比人迎大四倍以上为关阴，人迎与寸口脉搏动都大四倍以上的为关格。这个关格病症是从脉象而言，不是从疾病名称而言。现在患此病的人很多，但人们大多不知道。而且近来诊脉者不论人迎，只看寸口，但如果两手脉象浮弦至极，盛大达到四倍以上的，就是此证，其病必然表现为虚里跳动且气喘不停。这种喘息症状，大多没有咳嗽，只觉得胸膈间冲击不适，似胀非胀，似短非短，稍微劳累则喘息加重，多说话也喘息加重，甚至全身颤抖，慌张不安。这必定是由于情欲损伤阴精，导致元气无根，孤阳离决的危重征候，大多不可治愈。方剂论述详见关格门。
一、凡是生病出现喘促，只要观察脉象微弱细涩的，必然是阴中之阳虚；或者脉象浮大弦芤，按之空虚的，必然是阳中之阴虚。大凡喘息急促不能平卧而脉象呈现上述情况的，都是元气大虚，离死不远征候，如果妄加消导攻伐，必定加重病情并危及生命，如果使用苦寒或攻下的药物，无不立即死亡。
Any syndrome of deficiency panting (Xu Chuan) is nothing but due to Qi deficiency. Panting caused by Qi deficiency accounts for seven or eight out of ten cases. If one observes that there is no external wind pathogen and no internal excess heat, yet panting occurs, it belongs entirely to the category of deficiency panting. In cases of Spleen and Lung Qi deficiency, the pathology remains in the Middle and Upper Jiao, and the source of transformation (Hua Yuan, referring to the generation of Qi and Blood) is not depleted; thus, the disease is still shallow. However, in cases of Liver and Kidney Qi deficiency, the pathology originates from the Lower Jiao, affecting both the root and the branches, making the disease deep. At this stage, it is imperative to rapidly rescue the root to assist and support the True Qi, so as to potentially restore life. For those who have been ill for a long time and developed panting, or whose panting worsened after long-term use of phlegm-resolving and Qi-moving formulas, or who present with panting and coughing above and diarrhea below, or women who suffer from excessive blood loss postpartum leading to sudden exhaustion of Ying Qi (Nutritive Qi), causing isolated Yang to lack foundation and resulting in panting—this is named "Isolated Yang and Absolute Yin" (Gu Yang Jue Yin), representing a critical state of extreme depletion. Such conditions are already difficult to treat; one must avoid further damaging the foundation.
1. Regarding deficiency panting, if the patient has no other ailments such as wind-cold cough, but suddenly presents with shortness of breath resembling panting, or experiences panting upon slight exertion, hunger, emission of essence, profuse sweating, defecation or urination, recovery from severe illness, or after menstruation in women—with worsening panting, airway obstruction where upper and lower breaths seem disconnected, and a critical, perilous condition—if one observes no pathogenic factors in the exterior or interior, and the pulse is weak and forceless, all such presentations should be primarily treated with Zhenyuan Yin (True Origin Decoction), with modifications according to the base formula, yielding miraculous effects. Additionally, formulas such as Xiaoying Jian (Minor Camp Decoction), Daying Jian (Major Camp Decoction), and Dabu Yuanyuan Jian (Great Tonification of the Original Source Decoction) may be selected as appropriate. The Classic states: "The Liver suffers from tension; urgently feed sweet flavors to relax it," which refers to such cases. If loose stools are accompanied by cold in the lower body, Yougui Yin (Right Restoration Decoction), Yougui Wan (Right Restoration Pill), or Shengshu Jian (Holy Atractylodes Decoction) are suitable.
2. For Spleen and Lung Qi deficiency presenting with slight heat and thirst in the Upper Jiao leading to panting, Shengmai San (Generate the Pulse Powder) is indicated. If there is only Qi deficiency without heat, Dushen Tang (Single Ginseng Decoction) is most appropriate. If fire scorches Lung Metal, causing significant heat in the Upper Jiao, restlessness, thirst, and profuse sweating, with panting due to Qi deficiency, Ren Shen Baihu Tang (Ginseng White Tiger Decoction) is indicated. If the fire resides in the Yin aspect, Yunnv Jian (Jade Maiden Decoction) is indicated, though this pattern typically occurs only in summer. If Yin deficiency causes fire Qi to rush upward from the lower abdomen leading to panting, the method should be tonifying Yin and descending fire, using Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome).
3. Panting caused by water disorders results from Kidney pathogens interfering with the Lung. Since water cannot transform, the child disease affects the mother; unless Jing-Qi (Essence-Qi) is exhausted, how could it reach this state? Ninety percent of these cases are deficiency patterns, with occasional mixed deficiency and excess patterns. Therefore, when treating water-induced panting, one should not recklessly use attacking drugs. Instead, refer to the treatments in the Edema chapter; once the edema subsides, the panting will naturally settle. Ancient methods for treating panting and inability to lie flat due to water qi accumulating under the heart and ascending to the Lung recommend Shenyi Tang (Mysterious Elixir Decoction) from *Zhizhi Fang*. However, this decoction primarily targets the Qi aspect; it is suitable if the water retention is due to Qi stagnation, but if it is due to Qi deficiency, Jiajian Jingui Shenqi Tang (Modified Golden Chamber Kidney Qi Decoction) should be used.
4. For elderly and frail individuals suffering from long-term Qi deficiency leading to panting, the primary approach should be nourishing the Lung. For patterns with Yin excess, warming and nourishing is appropriate, using herbs such as Ren Shen (Ginseng Root), Dang Gui (Angelica Sinensis Root), Sheng Jiang (Fresh Ginger Rhizome), Rou Gui (Cinnamon Bark), Gan Cao (Licorice Root), possibly added with Bai Zhu (Atractylodes Macrocephala Rhizome) or Cang Zhu (Atractylodes Lancea Rhizome). For patterns with Yang excess, nourishing is appropriate, using herbs such as Ren Shen (Ginseng Root), Shu Di Huang (Prepared Rehmannia Root), Mai Dong (Ophiopogon Tuber), E Jiao (Donkey-hide Gelatin), Wu Wei Zi (Schisandra Berry), pear juice, and cow's milk.
5. Panting caused by Guan Ge (Obstruction and Repletion) syndrome: As stated in the *Su Wen: Chapter on the Six Periods and Viscera Manifestations*, when the Renying pulse is four times larger than the Cunkou pulse, it is called Ge Yang (Repletion of Yang); when the Cunkou pulse is four times larger than the Renying pulse, it is called Guan Yin (Obstruction of Yin); when both Renying and Cunkou pulses are more than four times larger, it is called Guan Ge. This definition of Guan Ge refers to the pulse, not the disease name per se. Many people today suffer from this condition but are unaware of it. Moreover, contemporary practitioners often examine only the Cunkou pulse, disregarding the Renying. If the pulses in both wrists are floating, wiry, and extremely vigorous, reaching more than four times the normal size, this indicates the condition. The pathology necessarily involves palpitations at Xulijump point (Vul Li) and incessant panting. This type of panting usually lacks cough; the patient feels a pounding sensation in the chest and diaphragm, feeling distended yet not truly distended, feeling short of breath yet not truly short of breath. Panting worsens with slight exertion or excessive talking, and may even progress to whole-body trembling and agitation. This is inevitably due to emotional desires injuring Yin, leading to rootless Yuan Qi (Original Qi) and severe separation of isolated Yang—a critical state that is mostly incurable. Detailed discussions on formulas can be found in the Guan Ge chapter.
6. In any case of panting and rapid breathing, if the pulse is weak, fine, and choppy, it indicates deficiency of Yang within Yin; if the pulse is floating, large, wiry, and hollow (Kou), feeling empty upon pressure, it indicates deficiency of Yin within Yang. Generally, if panting is urgent and the patient cannot lie down, accompanied by such pulses, it signifies severe deficiency of Yuan Qi, a sign of impending death. Reckless use of draining or attacking methods will inevitably exacerbate the condition and cause danger. The use of bitter-cold or purgative drugs will lead to immediate death.