喘古又称之上气，气即气息之谓，故巢太医书，以短气少气等，并而为一门。今亦取彼二证，以附于后。若
夫喘与嗽者，证治相因，则宜与前卷互参，固不待言矣。
源由 肺主于气，邪乘于肺则肺胀，胀则肺管不利，不利则气道涩，故气上喘逆鸣息不通。（《病源
论》）
肺主气也，一呼一吸，上升下降，荣卫息数，往来流通，安有所谓喘。惟夫邪气伏藏，痰涎浮涌，呼不得呼，
吸不得吸，于是上气促急，填塞肺脘，激动争鸣，如鼎之沸，而喘之形状具矣。有肺虚挟寒而喘者，有肺实挟热而
喘者，有水气乘肺而喘者，有惊忧气郁肺胀而喘者。又有胃络不和，喘出于阳明之气逆；真元耗损，喘生于肾
气之上奔。如是等类，皆当审证而主治之。（《直指》）
愚谓上气者，气上而不下也。人之气以呼吸出入相通，今气壅满于胸臆，出应急而入应不下，谓之上气。呼
出心与肺，吸入肾与肝，肺主乎气，为五脏盖。今气壅则肺叶张，秘塞气道而不下，作喘急也。亦有下元气虚，
根本不固，致气泛壅，上气喘息，甚者唇白，鼻头焦黑，为危恶之证，宜急以温暖镇坠固气药投之。（《万安方》
引《可用方》）
有自童幼时，被酸咸之味，或伤脾，或抢肺，以致痰积气道，积久生热，妨碍升降而成哮证，一遇风寒即发。
缘肺合皮毛，风寒外束，弗得发越，内热壅郁，新痰复生，因新痰而致旧痰并作也。是以气高而哮，抬肩拮项，
不得仰卧，面赤头疼，恶寒发热。治宜散表，表散热解，气道流通，庶亦暂可。有饮食浓味伤脾，不能运化而发
者，脾伤则津液不得布散而生痰涎，壅塞经隧，肺气为之不利，则胸满腹痛，盗
汗潮热，昼夜发哮，声如拽锯。治宜消食健脾，清痰利气，斯亦定矣。有房劳太过，肾水衰少，不能制火下降，
火寡于畏而侮所胜，肺金受伤，金伤则生化之源绝矣。病则下午潮热，哮声如雷，头疼面赤，盗汗烦躁，昼轻
夜重，脉数无力。治当补肾制火，清金润燥，庶或得安。有气逆而发者，经曰怒则气上，有升无降，又曰大怒
则火起于肝，又曰上升之气自肝而出，中挟相火。肺虚不能平木，病则胸满胁痛，耳聋眼赤，气出如火，治宜抑肝
利气。是疾也，气浓者当劫而吐之，拔其病根，根拔又当速补中气，中气充实，痰不再作矣。（《赤水》）（按∶
病因诸说，更见证治总说及虚实条中，宜参看。）
喘嗽之异 肺为五脏六腑之华盖，主行气温于皮毛。形寒饮冷则伤肺，肺一受邪，安能统摄诸气，气乱
胸中而病生焉，重则为喘，轻则为嗽。喘之为病，由痰实而气不散，上激咽喉，哮吼作声，咯不出，咽不下，憧
憧而急，喝喝而散，张口抬肩，摇身辊肚。嗽之为病，由气激而痰随上浮，风生喉靥，淫淫如痒，习习如哽，涕
唾稠浓，声音重浊，甚则续续不已，坐卧不安。所以古人于喘嗽二证，治法颇同，但剂有轻重耳。（《简易》）
脉候 脉出鱼际，逆气喘息。（《脉经》）
上气喘息低昂，其脉滑，手足温者生，脉涩，四肢寒者死。上气注液，其脉虚宁宁伏匿者生，坚疆者死。
（同上）
（按∶《千金翼》作其脉虚慢伏匿者生，牢弦者死。）
其脉滑者生，快者死也。（《病源论》）（《千金翼》大而快者死。）
大凡喘脉宜浮迟，不宜急数。（《原理》）
脉来弦紧而有力者，实也。脉见紧促短数者，虚也。沉
实有力者，实也。实则可治，虚不可为。证虚而脉实兼缓者可治，证实而脉虚兼数者难治。（《绳墨》）
喘有虚有实，有缓有急者矣。且如实喘可治而虚不可为，缓则易治而急不可施。设若喘气虽急，而脉势和
缓者可治；喘势不急，而脉势急促者难治。喘势又急而脉势虚促者不治，散乱者不治，歇止者不治。（同上）
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。具有外见浮洪，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。若弦强之甚则为真脏，真脏已见，不可为也。（《景岳》）
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。（同上）
大抵喘属肺中火盛，脉浮滑者可治；若沉滑，为肾虚阴火上逆，难治。（《医通》）
两寸脉下陷者死。（《苍生司命》）
证治总说 凡喘证，世为危恶之疾，有病喘数十年，每发至危笃而复愈者，有忽因佗疾，才发喘而便
致不救者，有利下而愈者，有因泻而死者，有服金石药接助真气而愈者。以诸家所说亦不同，使学人莫知适从，
或才见发喘，便以为不可治者。凡喘而不得卧者，若咳嗽而喘息有音、不得卧者，是阳明经气逆也。若肺胀膨
膨而喘者，皆当于春秋之交
发作，宜以温中下气等药治之。若但坐而不得卧，卧而气上冲者，是水气之客肺经也，当身肿小便不利。夫水
者循津液而流行，水气上乘于肺，故喘而不得卧。支饮亦上喘不得眠，身体肿者，此欲变为水证也。《内经》曰∶
诸痿呕喘，皆属于上。（脉浮紧者，与小青龙汤，大桂枝汤。脉沉弦者，与泻肺汤、万安丸。）若四肢厥冷，
脉息沉细，或寸大尺小，六脉促急，或心下胀满或结硬，或冷汗自出，或大便频数，气急喘促，或咽喉不利者，
此是本气极虚，内外挟寒冷所致，使阴寒内消，阳气得复则愈，宜用返阴丹、来苏丹及理中汤、四逆汤之类。
《内经》曰∶阴争于内，阳扰于外，魄汗未藏，四逆而起，起则熏肺，使人喘喝。及着灸诸穴，若灸之手足不
温，气息转高者，此名五脏气逆，肾水乘克于心，为大逆不可治。《内经》曰连经则生，连脏则死者，正谓此
也。其余如阳明病，汗出不恶寒，腹满而喘，有潮热者，宜下之。若脉浮无汗而喘者，乃太阳证尚在，宜麻黄
汤。若表邪未解，误服下药利不止，脉促，喘而汗出者，宜葛根黄连黄芩汤。若微喘者，桂枝浓朴杏子汤。汗出
而喘若无大热者，宜麻黄杏子甘草石膏汤。若表邪未解，心下有停水，喘而发热或呕者，小青龙汤。肺痹者亦
烦满喘而呕，心下痹者亦上气而喘，及香港脚喘满之类，此皆因他疾而发喘，当只从本病治之，则喘证自已，不专
用治喘之药。（《鸡峰》）
凡人患喘，其证有三∶一曰寒，二曰热，三曰水。病热者，发于夏而不发于冬。冷病者，遇寒则发也。水病
者，胸膈满闷，脚先肿也。热病者，宜蛤蚧丸。冷病，宜煮肺散。水病审其冷热虚实。虚而冷者，紫金丹。热而
实者，防己丸。此出《养生必用方》，不合防己丸，但言腹有湿热。欲
验喘疾是水不是水者，小便涩，脚微肿而喘者，水证也，当作水治之。小便不涩，脚不肿，只作喘治之。沈存中
《良方》蒲颓叶、孙大资麻黄梓朴汤，不拘冷热，皆可服也。（《医说》引《医余》）
肺虚肺寒，必有气乏表怯、冷痰如冰之证，法当温补，如官桂、阿胶之类是也。肺实肺热，必有壅盛胸满、
外烘上炎之状，法当清利，如桑白皮、葶苈之类是也。水气者，漉漉有声，怔忪浮肿，与之逐水利小便，如小半夏
茯苓汤、五苓散辈。惊忧者，惕惕闷闷，引息鼻张，与之宽中下气，如四七汤、桔梗枳壳汤辈。阳明之气下行，
今逆而上行，古人以通利为戒，如分气紫苏饮、《指迷》七气汤加半夏、二陈汤加缩砂施之为当。真阳虚惫，肾
气不得归元，固有以金石镇坠、助阳接真而愈者，然亦不可峻骤，且先与安肾丸、八味丸辈，否则人参煎汤，下
养正丹治之。雄黄、麻黄、马兜铃、汉防己、鸡内金诸品，非不主喘也，如前治法，大要究其受病之原。至若伤寒
发喘，表汗里下；香港脚喘满，疏导收功。此则但疗本病，其喘自安，丸机之士，可以举隅而反矣。（《直指》）
戴云∶有痰喘，有气急喘，有胃虚喘，有火炎上喘。痰喘者，凡喘便有痰声。气急喘者，呼吸急促而无痰声。
有胃虚喘者，抬肩撷肚，喘而不休。火炎上喘者，乍进乍退，得食则减，食已则喘。大概胃中有实火，膈上有稠
痰，得食入咽，坠下稠痰，喘即止。稍久食已入胃，反助其火，痰再升上，喘反大作。俗不知此，作胃虚治以
燥热之药者，以火济火也。昔叶都督患此，诸医作胃虚治之不愈，后以导水丸利五、六次而安矣。（《金匮钩玄》）
哮证喘吼如水鸡之声，牵引背胸，气不得息，坐卧不
安，或肺胀胸满，或恶寒肢冷。病者夙有此根，又因感寒作劳气恼，一时暴发，轻者三、五日而宁，重者半月或
一月而愈。治法专以祛痰为先，兼用解散，如九宝汤、三拗汤、苏子降气汤皆可选用。（《统旨》）
虚实（虚似实、实似虚治验）哮喘之证，有实有虚，盖因痰火内郁，厥气上逆所致。但实者气盛而息
粗，多系外感；虚者气微而息迟，多由内伤。治疗之法，虚者补之以甘温，实者散之以辛凉，加之以治火治痰之
剂，无有不效。学人临证，宜深察焉。（《原理》）
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，一曰虚证
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，胸喘气粗，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，皇皇然若气欲断，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。（《景岳》）（按∶此下说脉候，
既出上。）
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，则营血暴竭，孤阳无根据而为喘者，此名孤阳绝阴，剥极之候，已为难治，更毋蹈剥肤之戒也。（同
上）
实喘之证，以邪实在肺也。肺之实邪，非风寒则火邪耳。盖风寒之邪，必受自皮毛，所以入肺而为喘。火之
炽盛，金必受伤，故亦以病肺而为喘。治风寒之实喘，宜以温散。治火热之实喘，宜以寒凉。又有痰喘之说，前
人皆曰治痰，不知痰岂能喘，而必有所以生痰者，此当求其本而治之。（同上）
实喘之证有四∶一曰风寒，夫肺之合皮也，其荣毛也。风寒之邪，受自皮毛，故得以入肺而为喘。其治则
宜辛散，如定喘汤、参苏饮之类是也。一曰火热，夫肺属金，其畏火。火热炽盛，金气必伤，故亦以病肺而为喘。
其治宜用寒凉，如泻白散、桑白皮汤之类是也。一曰气逆，夫肺居上焦而司气化。若暴怒所加，上焦闭郁，则呼
吸奔迫而为喘。其治则宜开散或润降之，如四磨、四七、苏子降气之类是也。一曰水饮，夫肺气清虚，不容一物。
若痰饮水气上乘于肺，则气道壅塞而为喘。其治则宜消导，如神秘、导痰、二陈、半夏、茯苓之类是也。而虚喘之
证有二∶一者由乎脾肺。夫肺为气之主，而脾则肺之母也。脾肺有亏则气化不足，不足则短促而喘，此病在上中二
焦，而根蒂未伤，其病，犹浅，且补益其气，则喘自止，有热者生脉散，无热者独参之类是也。一者由乎肝肾。夫
肾为气之根，而肝则肾之子也。肝肾有亏则气道不纳，不纳则浮散而喘，此病出乎下焦，而本末俱病，其病则深。
非速救其根，则气不复，轻者八味肾气，重者黑锡、正元之类是也。（《病机汇论》）
邵新甫曰∶喘证之因，在肺为实，在肾为虚，先生揭此二语为提纲。其分别有四∶大凡实之寒者，必挟凝痰
宿饮，上干阻气，如小青龙、桂枝加朴杏之属也。实而热者，不外乎蕴伏之邪，蒸痰化火。有麻杏甘膏、《千金》
苇茎之治也。虚者有精伤、气脱之分。（《临证指南》）
丹溪谓新病属实，久病属虚。按新病亦有虚者，如其人本虚而忽感风寒，是新病亦有虚也。久病亦有实者，
如其人痰塞肺窍，久而不开，喘何由除，是久病亦有实也。（《医碥》）
喘，古时又被称为上气。所谓“气”，即指气息，因此《巢氏病源》将短气、少气等证候合并为一门。如今也采纳这两种证候，附在本文之后。至于喘与咳嗽，其症状与治疗相互关联，应当与前卷内容互相参考，这自不待言。
病因来源：肺主司气，邪气侵袭肺部则导致肺胀，肺胀则使肺管不通利，肺管不利则气道涩滞，因此气机上逆，出现喘息、呼吸有声且不通畅。（出自《诸病源候论》）
肺主司气，一呼一吸，气机上升下降，营卫之气的运行次数，往来流通，哪里会有所谓的喘呢？只有当邪气潜伏藏匿，痰涎浮泛涌起，呼气不能呼出，吸气不能吸入，于是上气急促紧迫，填塞于肺脘，激动争鸣，如同鼎中水沸腾一般，喘的症状就完全具备了。有因肺虚兼夹寒邪而致喘的，有因肺实兼夹热邪而致喘的，有水气乘袭肺部而致喘的，有因惊恐忧思导致气郁、肺胀而致喘的。又有因胃络不和，阳明之气上逆而导致喘；真元耗损，肾气上奔而导致喘。像这一类情况，都应当审察证候而主治。（出自《医学六要·直指方》）
我认为，“上气”是指气向上冲而不向下行。人的气通过呼吸出入相通，现在气壅满于胸臆，呼气急迫而吸气不能下行，这就叫作上气。呼出的气由心与肺主管，吸入的气由肾与肝主管，肺主司气，为五脏之华盖（覆盖）。现在气机壅滞则肺叶张开，闭塞气道而不能下行，从而产生喘急。也有因下元气虚，根本不固，导致气泛溢壅滞，上气喘息，严重时嘴唇发白，鼻头焦黑，这是危重的证候，应当立即投用温暖、镇坠、固摄气机的药物治疗。（出自《万安方》引《可用方》）
有的人从童幼时期开始，因食用酸咸之物，或损伤脾脏，或冲击肺部，导致痰积于气道，日久生热，妨碍气机升降而形成哮证，一旦遇到风寒就会发作。因为肺合皮毛，风寒外束，不得发散，内热壅郁，新痰复生，因而导致旧痰与新痰并发作。所以气高而哮，抬肩缩颈，不能仰卧，面赤头痛，恶寒发热。治疗应当解表散邪，表散热解，气道流通，或许可以暂时缓解。有因饮食厚味损伤脾胃，不能运化而发作者，脾伤则津液不得布散而生痰涎，壅塞经络隧道，肺气因此不利，则出现胸满腹痛，盗汗潮热，昼夜发作哮证，声音如拉锯。治疗应当消食健脾，清化痰浊，利降肺气，这样就能安定。有因房劳过度，肾水衰少，不能制约火气下降，火气缺乏畏惧而反侮其所胜之金，导致肺金受伤，金伤则生化之源断绝。发病则下午潮热，哮声如雷，头疼面赤，盗汗烦躁，昼轻夜重，脉数无力。治疗应当补肾制火，清金润燥，或许能得到安宁。有因气逆而发作者，《内经》说：“怒则气上”，有升无降；又说：“大怒则火起于肝”；还说：“上升之气自肝而出，中间夹杂相火”。肺虚不能平抑肝木，发病则胸满胁痛，耳聋眼赤，气出如火，治疗应当抑制肝气，利降气机。这种病，气盛者应当采用劫夺吐法以拔除病根，根除后又应当迅速补益中气，中气充实，痰就不再发作了。（出自《赤水玄珠》）（按：关于病因的各种说法，更详细的见见证治总说及虚实条中，宜参看。）
喘与嗽的区别：肺是五脏六腑的华盖，主司行气温煦皮毛。形体受寒、饮用冷物则会伤肺，肺一旦受邪，怎能统摄诸气？气乱于胸中而生病，重则为喘，轻则为嗽。喘这种病，是由痰实导致气机不散，上激咽喉，发出哮吼声，咯吐不出，吞咽不下，心中惶恐而急促，喝喝作响而散漫，张口抬肩，摇身滚肚。嗽这种病，是由气激而痰随之上浮，风生于喉间，感觉淫淫如痒，习习如哽，涕唾稠浓，声音重浊，甚至连续不断，坐卧不安。所以古人对于喘和嗽两种证候，治疗方法颇为相同，只是药剂的轻重有所不同罢了。（出自《世医得效方》）
脉象候诊：脉象出现在鱼际部位，是逆气喘息的征象。（出自《脉经》）
上气喘息，呼吸高低不平，脉象滑利，手足温暖的预后良好；脉象涩滞，四肢寒冷的预后不良（死证）。上气伴有流涎，脉象虚弱、宁静、伏匿的预后良好；脉象坚硬的预后不良（死证）。（同上）
（按：《千金翼方》记载为：脉象虚弱缓慢、伏匿的预后良好，脉象牢弦的预后不良。）
脉象滑利的预后良好，脉象疾快的预后不良。（出自《诸病源候论》）（《千金翼方》记载为：脉大而疾快的预后不良。）
脉来弦紧而有力，属于实证。脉见紧促短数，属于虚证。脉沉实有力，属于实证。实证可治，虚证难治。证候属虚而脉象实兼缓的可治，证候属实而脉象虚兼数的难治。（出自《医宗金鉴·绳墨》）
喘证有虚有实，有缓有急。例如如实喘可治而虚喘难治，缓证易治而急证难施。如果喘气虽然急促，但脉势和缓的可治；喘势不急，但脉势急促的难治。喘势又急而脉势虚促的不治，脉象散乱的不治，脉有歇止的不治。（同上）
气盛而有邪的脉象，必定滑数有力；气虚无邪的脉象，必定微弱无神，这是脉候的不同之处。凡是外在表现为浮洪，或芤大至极，稍按即无的，这是无根之脉；或往来弦甚而极大极数，全无和缓之意的，这是胃气败绝的表现，都属于大虚的候象。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。然而轻重的区分，也只能从这里来考察，大概脉象微弱的尚且顺而易医，脉象浮空的最危险且多变。如果脉象弦强到极点，就是真脏脉，真脏脉已现，就无法救治了。（出自《景岳全书》）
凡是患喘促的病，只要察其脉息微弱细涩的，必定是阴中之阳虚；或者脉象浮大弦芤，按之空虚的，必定是阳中之阴虚。大凡喘急不能平卧，而脉象如此表现的，都是元气大虚，离死不远之候。如果妄加消伐药物，必定加重病情而危险。如果使用苦寒或攻下的药物，无不立即致死。（同上）
大抵喘证属于肺中火盛，脉浮滑者可治；若脉沉滑，为肾虚阴火上逆，难治。（出自《医学入门·医通》）
两寸脉下陷的预后不良（死证）。（出自《苍生司命》）
证治总说：大凡喘证，世间认为是危重的疾病，有病喘数十年，每次发作至危笃而后又痊愈的；有忽然因其他疾病，才发喘便导致无法救治的；有利下（腹泻）而愈的；有因泻而死的；有服用金石药接助真气而愈的。由于各家说法不同，使学习者不知听从谁，或者才见到发喘，便认为不可治。大凡喘而不能平卧的，如果咳嗽而喘息有音、不能平卧的，这是阳明经气逆。如果肺胀膨膨然而喘的，都应当在春秋之交发作，适宜用温中下气等药物治疗。如果只是坐着不能平卧，躺下则气上冲的，这是水气客于肺经，应当身体浮肿、小便不利。水气循津液流行，水气上乘于肺，所以喘而不能平卧。支饮也是上喘不得眠，身体肿的，这是欲变为水证。《内经》说：各种痿、呕、喘，都归属于上焦。（脉浮紧者，给予小青龙汤、大桂枝汤。脉沉弦者，给予泻肺汤、万安丸。）如果四肢厥冷，脉息沉细，或寸大尺小，六脉促急，或心下胀满或结硬，或冷汗自出，或大便频数，气急喘促，或咽喉不利，这是本气极虚，内外挟寒冷所致，使阴寒内消，阳气得复则愈，适宜用返阴丹、来苏丹以及理中汤、四逆汤之类。《内经》说：阴争于内，阳扰于外，魄汗未藏，四逆而起，起则熏肺，使人喘喝。以及灸治各个穴位，如果灸后手足不温，气息转高的，这叫五脏气逆，肾水乘克于心，为大逆不可治。《内经》说：连经则生，连脏则死的，正是说的这种情况。其余如阳明病，汗出不恶寒，腹满而喘，有潮热的，应当攻下。如果脉浮无汗而喘的，是太阳证尚在，适宜用麻黄汤。如果表邪未解，误服下药导致利不止，脉促，喘而汗出的，适宜用葛根黄连黄芩汤。如果微喘的，用桂枝加厚朴杏子汤。汗出而喘若无大热的，适宜用麻黄杏仁甘草石膏汤。如果表邪未解，心下有停水，喘而发热或呕吐的，用小青龙汤。肺痹者也会烦满喘而呕，心下痹者也会上气而喘，以及脚气喘满之类，这都是因其他疾病而发喘，应当只从本病治疗，则喘证自然停止，不专门使用治喘的药物。（出自《鸡峰普济方》）
凡人患喘，其证候有三种：一是寒，二是热，三是水。患热病的，发于夏季而不发于冬季。患冷病的，遇寒则发作。患水病的，胸膈满闷，脚先肿。热病者，适宜用蛤蚧丸。冷病，适宜用煮肺散。水病需审察其冷热虚实。虚而冷的，用紫金丹。热而实的，用防己丸。这出自《养生必用方》，其中不合防己丸，只说腹有湿热。想要验证喘疾是否由水引起的，如果小便涩，脚微肿而喘的，是水证，当作水病治疗。如果小便不涩，脚不肿，只当作喘病治疗。沈存中的《良方》蒲颓叶、孙大资的麻黄梓朴汤，不拘冷热，都可以服用。（出自《医说》引《医余》）
肺虚肺寒，必定有气乏表怯、冷痰如冰的证候，治法应当温补，如官桂、阿胶之类。肺实肺热，必定有壅盛胸满、外烘上炎的状态，治法应当清利，如桑白皮、葶苈之类。水气者，漉漉有声，怔忪浮肿，给予逐水利小便的药物，如小半夏茯苓汤、五苓散之类。惊忧者，惕惕闷闷，引息鼻张，给予宽中下气的药物，如四七汤、桔梗枳壳汤之类。阳明之气本应下行，现在逆而上行，古人以通利为戒，如分气紫苏饮、《指迷》七气汤加半夏、二陈汤加缩砂仁施治为当。真阳虚惫，肾气不得归元，固然有用金石镇坠、助阳接真而痊愈的，但也不可峻猛急骤，且先给予安肾丸、八味丸之类，否则用人参煎汤，送下养正丹治疗。雄黄、麻黄、马兜铃、汉防己、鸡内金诸品，并非不主治喘，如前所述治法，大要探究其受病的根源。至于伤寒发喘，表证用汗法，里证用下法；脚气喘满，疏导收功。这仅仅是治疗本病，其喘自然安定，丸剂制作的人士，可以举一反三了。（出自《医学六要·直指方》）
戴云说：有痰喘，有气急喘，有胃虚喘，有火炎上喘。痰喘者，凡是喘都有痰声。气急喘者，呼吸急促而没有痰声。有胃虚喘者，抬肩撷肚，喘而不休。火炎上喘者，乍进乍退，得食则减轻，食后即喘。大抵胃中有实火，膈上有稠痰，得食入咽，坠下稠痰，喘即停止。稍久食已入胃，反而助其火，痰再升上，喘反而大作。世俗不知道这一点，当作胃虚治疗而用燥热药物的，是以火济火。昔日叶都督患此病，众医生当作胃虚治疗而未愈，后来用导水丸利下五六次而安宁。（出自《金匮钩玄》）
哮证喘吼的声音如水鸡之声，牵引背胸，气不得息，坐卧不安，或肺胀胸满，或恶寒肢冷。患者素来有此病根，又因感寒、作劳、气恼，一时暴发，轻者三、五天而安宁，重者半月或一月而愈。治法专以祛痰为先，兼用解散，如九宝汤、三拗汤、苏子降气汤都可以选用。（出自《杂病广要·统旨》）
虚实（虚似实、实似虚治验）：哮喘之证，有实有虚，大概是因为痰火内郁，厥气上逆所致。但实证者气盛而息粗，多系外感；虚证者气微而息迟，多由内伤。治疗之法，虚证用甘温补之，实证用辛凉散之，加上治火治痰的药物，没有不有效的。学者临证，应当深入体察。（出自《景岳全书·原理》）
气喘之病，最为危候，治疗失其要领，很少不误人的。想要辨别它，也只有两个证候而已。所谓两个证候，一是实喘，一是虚喘。这两个证候相反，不可混淆。那么如何辨别呢？大概实喘者有邪，邪气实；虚喘者无邪，元气虚。实喘者，气长而有余；虚喘者，气短而不续。实喘者，胸喘气粗，声高息涌，膨膨然好像不能容纳，惟呼出为快；虚喘者，慌张气怯，声低息短，皇皇然好像气欲断，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。这是一个是真喘，一个是似喘。真喘的责任在肺，似喘的责任在肾。为什么呢？因为肺为气之主，肾为气之根。肺主皮毛而居上焦，所以邪气犯之，则上焦气壅而为喘，气之壅滞者，宜清宜破。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，促者是断绝的基础，气既短促而再加消散，如同压卵。（出自《景岳全书》）（按：以下说脉候，既已在上文出现。）
大凡虚喘之证，无非由气虚耳。气虚之喘，十居七八，只要察其外无风邪、内无实热而喘的，即都是虚喘之证。如果脾肺气虚，不过在中上二焦，化源未亏，其病尚浅。如果肝肾气虚，则病出下焦，而本末俱病，其病则深，这应当速救其根以接助真气，或许可以回生。如果有病久而加上喘的，或久服消痰散气等剂而反而加重喘的，或上为喘咳而下为泄泻的，或妇人产后亡血过多，则营血暴竭，孤阳无根据而为喘的，这叫孤阳绝阴，剥极之候，已经难治，更不要蹈剥肤之戒。（同上）
实喘之证，是因为邪实在肺。肺之实邪，不是风寒就是火邪。风寒之邪，必定从皮毛受之，所以入肺而为喘。火之炽盛，金必受伤，所以也以病肺而为喘。治疗风寒之实喘，适宜用温散。治疗火热之实喘，适宜用寒凉。又有痰喘的说法，前人皆说治痰，不知道痰岂能致喘，而必有所以生痰的原因，这应当求其本而治之。（同上）
实喘之证有四：一是风寒，肺合皮毛，其荣在毛。风寒之邪，从皮毛受之，所以得以入肺而为喘。其治则宜辛散，如定喘汤、参苏饮之类。二是火热，肺属金，畏火。火热炽盛，金气必伤，所以也以病肺而为喘。其治宜用寒凉，如泻白散、桑白皮汤之类。三是气逆，肺居上焦而司气化。若暴怒所加，上焦闭郁，则呼吸奔迫而为喘。其治则宜开散或润降之，如四磨、四七、苏子降气之类。四是水饮，肺气清虚，不容一物。若痰饮水气上乘于肺，则气道壅塞而为喘。其治则宜消导，如神秘、导痰、二陈、半夏、茯苓之类。而虚喘之证有二：一者由乎脾肺。肺为气之主，而脾则肺之母也。脾肺有亏则气化不足，不足则短促而喘，此病在上中二焦，而根蒂未伤，其病尚浅，且补益其气，则喘自止，有热者用生脉散，无热者用独参汤之类。一者由乎肝肾。肾为气之根，而肝则肾之子也。肝肾有亏则气道不纳，不纳则浮散而喘，此病出乎下焦，而本末俱病，其病则深。非速救其根，则气不复，轻者用八味肾气丸，重者用黑锡丹、正元丹之类。（出自《医宗金鉴·病机汇论》）
邵新甫说：喘证之因，在肺为实，在肾为虚，先生揭出这两句话作为提纲。其分别有四：大凡实之寒者，必定挟凝痰宿饮，上干阻气，如小青龙、桂枝加朴杏之属。实而热者，不外乎蕴伏之邪，蒸痰化火。有麻杏甘膏、《千金》苇茎之治。虚者有精伤、气脱之分。（出自《临证指南医案》）
丹溪谓新病属实，久病属虚。按新病亦有虚者，如其人本虚而忽感风寒，是新病亦有虚也。久病亦有实者，如其人痰塞肺窍，久而不开，喘何由除，是久病亦有实也。（出自《医碥》）
Wheezing, in ancient times, was also referred to as "Shang Qi" (Ascending Qi). The term "Qi" refers to breath; therefore, the *Niao Shi Bing Yuan* (Chao's Book of Pathogenesis) grouped syndromes such as Shortness of Breath (Duan Qi) and Scanty Breath (Shao Qi) into a single category. Currently, these two syndromes are also adopted and appended here. As for wheezing and coughing, their symptoms and treatments are interrelated, so it goes without saying that they should be cross-referenced with the previous volume.
**Etiology and Pathogenesis:** The Lung governs Qi. When pathogenic factors invade the Lung, it causes Lung distension (Fei Zhang). Distension leads to obstruction of the bronchial tubes, which in turn causes stagnation of the airway. Consequently, Qi rebels upward, resulting in wheezing, audible breathing sounds, and obstruction of airflow. (*Zhuzheng Yaolue* / *Source of Diseases*)
The Lung governs Qi. Through inhalation and exhalation, Qi rises and descends; Ying and Wei Qi circulate smoothly. How could there be wheezing? Only when pathogenic factors lie dormant and phlegm-fluids surge upwards can one fail to exhale properly or inhale deeply. Thus, upper Qi becomes urgent and rapid, filling the chest and lungs, causing agitation and roaring sounds like boiling water in a cauldron, thereby manifesting the full picture of wheezing. There is wheezing due to Lung deficiency combined with cold; wheezing due to Lung excess combined with heat; wheezing due to water-Qi attacking the Lung; and wheezing due to fright, worry, Qi depression, and Lung distension. Additionally, there is wheezing arising from disharmony of the Stomach collaterals and rebellion of Yangming Qi; and wheezing arising from depletion of true Yuan Qi and rushing up of Kidney Qi. For such cases, one must examine the syndrome and treat accordingly. (*Zhi Zhi Fang*)
I consider "Shang Qi" (Ascending Qi) to mean Qi moving upward without descending. Human Qi connects through respiration. Now, if Qi is congested in the chest, with urgent exhalation and failure of inhalation to descend, this is called Shang Qi. Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver. The Lung governs Qi and serves as the canopy over the five Zang organs. When Qi is congested, the lung lobes expand, blocking the airway and preventing descent, leading to urgent wheezing. There are also cases where lower Yuan Qi is deficient and the root is unstable, causing Qi to overflow and congest, leading to upper Qi wheezing. In severe cases, the lips turn white and the tip of the nose turns scorched black; this is a critical condition requiring immediate administration of warming, sedating, and stabilizing Qi medications. (*Wan An Fang*, citing *Ke Yong Fang*)
Some individuals, since childhood, have consumed sour and salty foods, damaging the Spleen or impacting the Lung, leading to phlegm accumulation in the airways. Over time, heat generates, obstructing ascending and descending movements, forming Asthma (Xiao Zheng). Upon encountering wind-cold, it triggers an attack. Since the Lung combines with the skin and hair, external wind-cold binds the exterior, preventing dispersion, while internal heat congests and depresses, generating new phlegm, which causes old phlegm to act together. Thus, Qi rises and wheezes, shoulders lift, neck contracts, supine position is impossible, face is red, head aches, aversion to cold and fever occur. Treatment should focus on releasing the exterior. Once the exterior is dispersed and heat resolved, airways flow freely, offering temporary relief. Some attacks arise from rich flavors damaging the Spleen, impairing transformation and transportation, leading to fluid retention and phlegm generation. Phlegm blocks meridians, hindering Lung Qi, causing chest fullness, abdominal pain, night sweats, tidal fever, and day-and-night wheezing with sounds like sawing wood. Treatment should focus on digesting food, strengthening the Spleen, clearing phlegm, and promoting Qi flow. Some attacks arise from excessive sexual activity depleting Kidney Water, failing to control Fire descent. Fire, lacking restraint, insults Metal (Lung), damaging it. With Lung Metal damaged, the source of production is cut off. Symptoms include afternoon tidal fever, thunderous wheezing, headache, red face, night sweats, irritability, worse at night, and rapid but weak pulse. Treatment should tonify the Kidney, control Fire, clear Metal, and moisten dryness. Some attacks arise from Qi rebellion. The *Neijing* states: "Anger causes Qi to rise," having only ascent without descent. It also states: "Great anger causes Fire to rise from the Liver," and "Ascending Qi originates from the Liver, carrying Ministerial Fire." If Lung deficiency fails to soothe Wood (Liver), symptoms include chest fullness, hypochondriac pain, deafness, red eyes, and fiery exhalation. Treatment should suppress the Liver and promote Qi flow. For this disease, if Qi is abundant, one should use emetics to expel pathogens and remove the root. After removing the root, quickly tonify Middle Qi. If Middle Qi is substantial, phlegm will not recur. (*Chi Shui Xuan Zhu*) (Note: Various theories on etiology are further detailed in the General Discussion of Syndromes and Treatments and the Deficiency/Excess sections; consult them.)
**Distinction between Wheezing and Coughing:** The Lung is the canopy of the five Zang and six Fu organs, governing the distribution of Qi and warmth to the skin and hair. Cold exposure and cold drinks injure the Lung. Once injured, the Lung cannot regulate all Qi. Qi chaos in the chest generates disease: severe cases result in wheezing, mild cases in coughing. Wheezing arises from phlegm-excess causing Qi stagnation, irritating the throat, producing roars, with phlegm stuck—unable to expectorate or swallow, causing panic and urgency, loud breathing, open mouth, lifted shoulders, shaking body, and rolling abdomen. Coughing arises from Qi agitation dragging phlegm upward, wind generating in the throat, feeling itchy or choking, with thick sputum and turbid voice, sometimes continuous, causing restlessness day and night. Thus, ancients treated wheezing and coughing similarly, differing only in dosage strength. (*Jian Yi Fang*)
**Pulse Diagnosis:** A pulse appearing at the Yuji area indicates rebellious Qi and wheezing. (*Mai Jing*)
For Shang Qi with wheezing and uneven breathing: if the pulse is slippery and hands/feet are warm, survival is likely; if the pulse is choppy and limbs are cold, death is likely. For Shang Qi with drooling: if the pulse is weak, quiet, and hidden, survival is likely; if hard and rigid, death is likely. (*Mai Jing*)
(Note: *Qianjin Yi Fang* records: weak/slow/hidden pulse indicates survival; firm/wiry pulse indicates death.)
A slippery pulse indicates survival; a rapid pulse indicates death. (*Bing Yuan Lun*) (*Qianjin Yi Fang*: large and rapid pulse indicates death.)
Generally, the pulse for wheezing should be floating and slow, not rapid and hurried. (*Yuan Li*)
A wiry, tight, and forceful pulse indicates Excess. A tight, hurried, short, and rapid pulse indicates Deficiency. A deep, solid, and forceful pulse indicates Excess. Excess is treatable; Deficiency is difficult. If the syndrome is Deficient but the pulse is Excess with slowness, it is treatable; if the syndrome is Excess but the pulse is Deficient with rapidity, it is difficult. (*Sheng Mo*)
Wheezing has Deficiency and Excess, slowness and urgency. Generally, Excess wheezing is treatable, Deficiency is not; Slowness is easy to treat, Urgency is hard to manage. If wheezing is urgent but the pulse momentum is moderate, it is treatable; if wheezing is not urgent but the pulse is hurried, it is difficult. If wheezing is urgent and the pulse is weak and hurried, it is untreatable; scattered pulses are untreatable; intermittent pulses are untreatable. (*Sheng Mo*)
Pulses for Qi abundance with pathogens are necessarily slippery, rapid, and forceful; pulses for Qi deficiency without pathogens are necessarily weak, faint, and spiritless. This is the difference in pulse signs. If externally floating and洪 (Hong/Large) or Kou (Kou/Hollow) to the extreme, vanishing upon slight pressure, this is a Rootless Pulse. If wiry, extremely large and rapid, lacking any moderation, this is the collapse of Stomach Qi. Both indicate severe Deficiency. Weak pulses show true Deficiency easily; floating/empty/wiry/beating pulses show false Excess, which is hard to distinguish. However, severity is discerned here: weak pulses are favorable and easier to treat; floating/empty pulses are most dangerous and variable. Extreme wiry/strength indicates True Zang Pulse; once seen, it is untreatable. (*Jing Yue*)
For all wheezing/panting, if the pulse is weak, fine, and choppy, it is definitely Yang Deficiency within Yin. If floating, large, wiry, hollow, and empty upon pressure, it is definitely Yin Deficiency within Yang. Generally, urgent wheezing with inability to lie flat accompanied by such pulses indicates massive Yuan Qi Deficiency, near death. Mistakenly using draining/reducing methods will worsen it dangerously. Using bitter-cold or purgative methods will lead to immediate death. (*Jing Yue*)
Generally, wheezing belongs to Fire Excess in the Lung; a floating-slippery pulse is treatable. A deep-slippery pulse indicates Kidney Deficiency with Yin Fire rebelling upward, which is difficult to treat. (*Yi Tong*)
Depression of pulses in both Cun positions indicates death. (*Cang Sheng Si Ming*)
**General Discussion of Syndromes and Treatments:** Wheezing is considered a critical disease in the world. Some suffer for decades, reaching critical points yet recovering; some die suddenly upon onset due to other illnesses; some recover after diarrhea; some die from diarrhea; some recover taking mineral drugs to support True Qi. Divergent opinions confuse students, who may deem any wheezing untreatable. Generally, wheezing with inability to lie flat, accompanied by coughing, audible wheezing, and orthopnea, indicates Yangming Meridian Qi rebellion. Lung distension with wheezing often occurs during spring-autumn transitions; treat with warming and descending Qi formulas. Sitting upright with inability to lie flat, or lying down causing Qi rushing up, indicates Water-Qi invading the Lung, accompanied by edema and dysuria. Water flows with fluids; when Water-Qi surges to the Lung, wheezing and inability to lie flat occur. Branch-Drink (Zhi Yin) also causes upper wheezing and insomnia with edema, suggesting impending Water Syndrome. *Neijing* states: "All flaccidity, vomiting, and wheezing belong to the Upper Jiao." (For floating-tight pulse, give Xiao Qing Long Tang or Da Gui Zhi Tang. For deep-wiry pulse, give Xie Fei Tang or Wan An Wan.) If limbs are cold, pulse deep/fine, or Cun large/Chi small, six pulses hurried, epigastric fullness/hardness, cold sweat, frequent stool, urgent wheezing, or throat obstruction, this is extreme Root Qi Deficiency with internal/external cold. Resolve internal Yin-Cold, restore Yang. Use Fan Yin Dan, Lai Su Dan, Li Zhong Tang, Si Ni Tang. *Neijing* states: "Yin struggles internally, Yang disturbs externally,魄汗 (Po Sweat) uncontained, four reversals arise, rising to smoke the Lung, causing wheezing." Acupuncture moxibustion: if limbs remain cold and breathing heightens after moxa, this is Five Zang Qi rebellion, Kidney Water insulting Heart, a great reversal, untreatable. *Neijing* states: "Connecting meridians leads to life, connecting Zang leads to death." Regarding Yangming disease: sweating, no aversion to cold, abdominal fullness, wheezing, tidal fever—purge. Floating pulse, no sweat, wheezing—Taiyang syndrome remains, use Ma Huang Tang. Exterior unresolved, mistaken purgatives causing diarrhea, hurried pulse, wheezing with sweat—Ge Gen Huang Lian Huang Qin Tang. Mild wheezing—Gui Zhi Hou Po Xing Zi Tang. Sweating, wheezing, no significant heat—Ma Huang Xing Zi Gan Cao Shi Gao Tang. Exterior unresolved, fluid retention in Heart, wheezing with fever/vomiting—Xiao Qing Long Tang. Lung Bi causes irritability, fullness, wheezing, vomiting. Heart Bi causes upper Qi and wheezing. Tinea/Jia Ji wheezing/fullness—all secondary to other diseases; treat the primary disease, and wheezing resolves spontaneously, without specific anti-wheezing drugs. (*Ji Feng*)
Humans suffering from wheezing have three types: Cold, Heat, Water. Heat type occurs in summer, not winter. Cold type triggered by cold. Water type involves chest/diaphragm fullness and foot swelling first. Heat type: Ge Jie Wan. Cold type: Zhu Fei San. Water type: assess cold/heat/deficiency/excess. Deficient-Cold: Zi Jin Dan. Excess-Heat: Fang Ji Wan. (*Yang Sheng Bi Yong Fang*). Note: *Fang Ji Wan* is excluded here, only mentioning damp-heat in abdomen. To verify if wheezing is due to water: if urine is astringent, feet slightly swollen, and wheezing present, it is a Water Syndrome, treat as water. If urine is not astringent and feet not swollen, treat as wheezing. Shen Cunzhong's *Liang Fang* Pu Tui Ye and Sun Da Zi's Ma Huang Zi Po Tang can be used regardless of cold/heat. (*Yi Shuo* citing *Yi Yu*)
Lung Deficiency/Cold presents with Qi fatigue, surface timidity, and cold phlegm like ice; treat with warming/tonifying (e.g., Guan Gui, E Jiao). Lung Excess/Heat presents with chest fullness, outward burning, upward flaming; treat with clearing/draining (e.g., Sang Bai Pi, Ting Li). Water-Qi presents with gurgling sounds, palpitations, edema; treat with draining water/promoting urination (e.g., Xiao Ban Xia Fu Ling Tang, Wu Ling San). Fright/Worry presents with fearfulness, oppression, nasal flaring; treat with opening middle/lowering Qi (e.g., Si Qi Tang, Jie Geng Zhi Ke Tang). Yangming Qi should descend; now it rebels upward. Ancients warned against pure draining. Use Fen Qi Zi Su Yin, *Zhi Mi* Qi Qi Tang + Ban Xia, Er Chen Tang + Sha Ren. True Yang Deficiency, Kidney Qi failing to return to origin: although mineral sedatives/tonics work, do not use harshly. Start with An Shen Wan, Ba Wei Wan. Alternatively, Ren Shen decoction with Yang Zheng Dan. Xiong Huang, Ma Huang, Ma Dou Ling, Han Fang Ji, Ji Nei Jin all treat wheezing, but one must investigate the root cause as per previous methods. For Shanghan wheezing, release exterior/purge interior. For Jia Ji wheezing, dredge and resolve. Treating the root cures the symptom; formulators can infer from this. (*Zhi Zhi Fang*)
Dai Yun says: There is Phlegm Wheezing, Qi-Urgency Wheezing, Stomach-Deficiency Wheezing, and Fire-Flaming Wheezing. Phlegm Wheezing: wheezing with phlegm sounds. Qi-Urgency Wheezing: rapid breathing without phlegm sounds. Stomach-Deficiency Wheezing: shoulder lifting, belly pulling, continuous wheezing. Fire-Flaming Wheezing: fluctuating severity, relieved by eating, worsening after eating. Generally, Stomach Excess-Fire and Diaphragm Thick-Phlegm: eating pushes phlegm down, stopping wheezing. Later, food enters Stomach, fuels fire, phlegm rises again, wheezing worsens. Laypeople mistake this for Stomach Deficiency and use drying-hot herbs, adding fire to fire. General Ye Du suffered this; doctors failed treating as Stomach Deficiency. Later cured by Dao Shui Wan purging 5-6 times. (*Jin Kui Gou Xuan*)
Asthma/Wheezing roaring like a water-frog, pulling back/chest, breathlessness, restlessness, or Lung distension/chest fullness, aversion to cold/cold limbs. Patients have a chronic root, triggered by cold, labor, or anger. Mild cases resolve in 3-5 days; severe in half a month to a month. Treatment focuses primarily on resolving phlegm, combined with dispersing. Examples: Jiu Bao Tang, San Ao Tang, Su Zi Jiang Qi Tang. (*Tong Zhi*)
**Deficiency and Excess (Treatment of Deficiency Mimicking Excess, Excess Mimicking Deficiency):** Asthma/wheezing has Excess and Deficiency, caused by internal depression of Phlegm-Fire and rebellious Jue Qi. Excess: Qi abundant, breath coarse, mostly external contraction. Deficiency: Qi faint, breath slow, mostly internal injury. Treatment: Deficiency tonified with sweet-warm; Excess dispersed with pungent-cool, plus Fire/Phlegm remedies. Effective. Scholars must observe closely. (*Yuan Li*)
Wheezing is critical; mistreatment harms. Differentiation lies in two syndromes: Excess Wheezing and Deficiency Wheezing. They are opposite. Excess: has pathogen, pathogen is real. Deficiency: no pathogen, Yuan Qi is deficient. Excess: long Qi, surplus. Deficiency: short Qi, discontinuous. Excess: chest full, Qi rough, voice high, breath surging, distended, relief by exhalation. Deficiency: panicked, Qi timid, voice low, breath short, anxious, breath seems cut, lifting fails, swallowing fails, worsens with labor, relief by deep inhalation. One is True Wheezing, one is Pseudo-Wheezing. True Wheezing责 (responsibility/blame) in Lung; Pseudo-Wheezing in Kidney. Why? Lung is Master of Qi, Kidney is Root of Qi. Lung governs skin/hair, resides in Upper Jiao; pathogen invasion causes Upper Jiao congestion and wheezing. Congested Qi needs clearing/breaking. Kidney governs essence/marrow, resides in Lower Jiao; True Yin depletion, Essence fails to transform Qi, Lower fails to connect Upper, causing urgency (Du), a basis for severance. Adding dispersal to short Qi is like crushing an egg. (*Jing Yue*) (Note: Pulse discussion follows above.)
All Deficiency Wheezing stems from Qi Deficiency. Qi Deficiency wheezing accounts for 70-80%. If no external wind-pathogen or internal Excess-Heat, it is Deficiency Wheezing. Spleen/Lung Qi Deficiency affects Middle/Upper Jiao, source intact, disease shallow. Kidney/Liver Qi Deficiency affects Lower Jiao, root and branch diseased, disease deep. Must save root/support True Qi to revive. Chronic wheezing worsened by phlegm-resolving/Qi-moving drugs, or upper wheezing/cough with lower diarrhea, or postpartum blood loss causing sudden Ying Blood depletion, solitary Yang unsupported (Solitary Yang Absolute Yin, Peeling Extremis): difficult to treat, avoid further damage. (*Jing Yue*)
Excess Wheezing is due to Pathogen Excess in Lung. Lung Excess pathogens are Wind-Cold or Fire. Wind-Cold enters via skin/hair to Lung. Fire damages Metal (Lung). Treat Wind-Cold Excess with warming dispersion. Treat Fire Excess with cold cooling. Phlegm Wheezing: predecessors said treat phlegm, but phlegm doesn't cause wheezing alone; find the cause of phlegm generation and treat the root. (*Jing Yue*)
Four types of Excess Wheezing: 1. Wind-Cold: Lung combines with skin/hair. Pathogen enters via skin to Lung. Treat with pungent dispersion (Ding Chuan Tang, Shen Su Yin). 2. Fire-Heat: Lung is Metal, fears Fire. Fire damages Metal. Treat with cold cooling (Xie Bai San, Sang Bai Pi Tang). 3. Qi Rebellion: Lung in Upper Jiao governs Qi transformation. Anger closes Upper Jiao, breathing rushes. Treat with opening/dispersing or moistening/descending (Si Mo, Si Qi, Su Zi Jiang Qi). 4. Water-Drink: Lung is clear/empty, tolerates nothing. Phlegm/Water-Qi surges to Lung, blocking airway. Treat with resolving/guiding (Shen Mi, Dao Tan, Er Chen, Ban Xia, Fu Ling). Two types of Deficiency Wheezing: 1. Spleen/Lung: Lung is Master, Spleen is Mother. Spleen/Lung deficiency causes insufficient Qi transformation, shortness, wheezing. Disease in Middle/Upper Jiao, root intact, shallow. Tonify Qi to stop wheezing. With Heat: Sheng Mai San. Without Heat: Du Shen Tang. 2. Kidney/Liver: Kidney is Root, Liver is Child. Kidney/Liver deficiency fails to receive Qi, Qi floats/scatters, wheezing. Disease in Lower Jiao, root/branch diseased, deep. Must save root. Mild: Ba Wei Shen Qi Wan. Severe: Hei Xi Dan, Zheng Yuan Dan. (*Bing Ji Hui Lun*)
Shao Xinpu says: Etiology of wheezing: Excess in Lung, Deficiency in Kidney. These two phrases are the outline. Four distinctions: 1. Excess-Cold: carries congealed phlegm/stagnant drink, obstructing Qi. Treat with Xiao Qing Long, Gui Zhi + Hou Po/Xing Zi. 2. Excess-Heat: latent pathogen steams phlegm to Fire. Treat with Ma Xing Gan Shi, Qian Jin Wei Jing Tang. 3. Deficiency: Essence injury vs. Qi collapse. (*Lin Zheng Zhi Nan*)
Danxi says: New disease is Excess, old disease is Deficiency. However, new disease can be Deficient (if constitutionally deficient contracting wind-cold). Old disease can be Excess (if phlegm blocks Lung orifices chronically, wheezing won't cease). (*Yi Que*)