气喘之病,最为危候,治失其要,鲜不误人,欲辨之者,亦惟二证而已。所谓二证者,
一曰实喘,一曰虚喘也。此二证相反,不可混也。然则何以辨之?盖实喘者有邪,邪气实也
;虚喘者无邪,元气虚也。实喘者气长而有余,虚喘者气短而不续。实喘者胸胀气粗,声高
息涌,膨膨然若不能容,惟呼出为快也;虚喘者慌张气怯,声低息短,惶惶然若气欲断,提
之若不能升,吞之若不相及,劳动则甚,而惟急促似喘,但得引长一息为快也。此其一为真
喘,一为似喘,真喘者其责在肺,似喘者其责在肾。何也?盖肺为气之主,肾为气之根。肺
主皮毛而居上焦,故邪气犯之,则上焦气壅而为喘,气之壅滞者,宜清宜破也。肾主精髓而
在下焦,若真阴亏损,精不化气,则下不上交而为促,促者断之基也,气既短促,而再加消
散,如压卵矣。且气盛有邪之脉,必滑数有力,而气虚无邪之脉,必微弱无神,此脉候之
有不同也。其有外见浮洪,或芤大至极,而稍按即无者,此正无根之脉也。或往来弦甚而极
大极数,全无和缓者,此正胃气之败也,俱为大虚之候。但脉之微弱者,其真虚易知,而脉
之浮空弦搏者,其假实难辨,然而轻重之分,亦惟于此而可察矣。盖其微弱者,犹顺而易医
,浮空者,最险而多变,若弦强之甚,则为真藏,真藏已见,不可为也。
气喘这一病症,属于最为危急的证候,如果治疗没有抓住关键,很少有不误人的。想要辨别它,也不过只有两种证型罢了。所谓两种证型,一是实喘,二是虚喘。这两种证型性质相反,不能混淆。那么如何辨别呢?大概实喘是因为有邪气,邪气盛实;虚喘是因为没有邪气,元气虚弱。实喘表现为呼吸深长且有余力,虚喘表现为呼吸短促且接续不上。实喘表现为胸胁胀满、气息粗重,声音高亢、呼吸急促涌盛,胸部膨隆好像容纳不下,只有呼出气体才感到舒畅;虚喘表现为惊慌慌张、气息怯弱,声音低微、呼吸短促,惶恐不安好像气息将要断绝,提气好像升不上去,吞气好像接不上来,稍微劳动就会加重,只是呈现出急促类似喘的样子,但只有深吸一口气才感到舒畅。这其中的一个是真正的喘,一个是类似喘的症状,真正的喘责任在肺,类似喘的责任在肾。为什么呢?因为肺是气的主体,肾是气的根本。肺主管皮毛且位于上焦,所以邪气侵犯它,就会导致上焦气机壅滞而发为喘,对于气机壅滞的情况,应当采用清泄或破气的方法。肾主管精髓且位于下焦,如果真阴亏损,精不能化气,就会导致下焦之气不能上交而上逆急促,急促是气断的基础,既然气已经短促,如果再使用消散攻伐的药物,就像压碎鸡蛋一样危险。而且气盛且有邪气的脉象,必定滑数有力,而气虚无邪气的脉象,必定微弱无神,这是脉候的不同之处。那些外表呈现浮洪,或者芤大至极,稍微按压就感觉不到的,这是无根的脉象。或者往来弦急且极大极数,完全没有和缓之意的,这是胃气败坏的表现,都属于大虚的证候。但是脉象微弱的,其真虚容易知晓,而脉象浮空弦搏的,其假实难以辨别,然而虚实轻重的区分,也只能从这里来观察了。大概脉象微弱的,还算顺症且容易医治,脉象浮空的,最危险且变化多端,如果弦强得厉害,就是真脏脉显现,真脏脉已经显现,就无法救治了。
The disease of asthma and panting is among the most critical conditions. If treatment fails to grasp the key points, it rarely avoids causing harm. To distinguish it, one need only consider two patterns: so-called "two patterns" refer to one being excess panting (Shi Chuan) and the other being deficiency panting (Xu Chuan). These two patterns are opposite and must not be confused. How then can they be distinguished? Generally, excess panting involves pathogenic factors, characterized by an excess of pathogenic qi; deficiency panting involves no pathogenic factors, characterized by a deficiency of primordial qi. In excess panting, breathing is deep and long with surplus strength; in deficiency panting, breathing is short and discontinuous. In excess panting, there is chest distension and coarse breathing, high-pitched voice, and surging, rapid respiration, with the chest feeling bloated as if unable to contain air, finding relief only upon exhalation; in deficiency panting, there is panic and timidity, low-pitched voice, and short breath, with a sense of impending suffocation, where lifting the qi feels impossible to raise, swallowing feels disconnected, symptoms worsen with exertion, presenting merely as rapid panting-like breathing, finding relief only after drawing a long breath. One of these is true panting, the other is panting-like; true panting's responsibility lies with the Lung, while panting-like panting's responsibility lies with the Kidney. Why? Because the Lung is the master of Qi, and the Kidney is the root of Qi. The Lung governs the skin and hair and resides in the Upper Jiao; thus, when pathogenic factors invade, Qi stagnates in the Upper Jiao leading to panting. For Qi stagnation, clearing or breaking methods are appropriate. The Kidney governs essence and marrow and resides in the Lower Jiao; if True Yin is depleted and Essence fails to transform into Qi, lower Qi fails to ascend and connect, leading to急促 (cu, hurried/shortness), which is the basis for Qi interruption. Since Qi is already short and hurried, using dispersing or draining methods would be as dangerous as crushing an egg. Furthermore, the pulse for excess Qi with pathogenic factors must be slippery, rapid, and forceful, whereas the pulse for deficient Qi without pathogenic factors must be weak and faint, lacking spirit; this is the difference in pulse signs. Those appearing floating and flooding, or extremely hollow and large, vanishing slightly upon pressure, are pulses without root. Those that are wiry, coming and going, extremely large and rapid, completely lacking harmony and slowness, indicate the failure of Stomach Qi; both represent severe deficiency. However, while weak pulses make true deficiency easy to recognize, floating, empty, wiry, and pounding pulses make false excess difficult to distinguish. Yet, the distinction between severity and lightness can be observed here. Generally, weak pulses are favorable and easier to treat; floating pulses are most dangerous and variable. If the pulse becomes excessively wiry and strong, it indicates the manifestation of Zang-Fu organ pulses (Zhen Zang Mai); once Zhen Zang Mai appears, the condition is incurable.