以宗气为切入点探讨机械通气患者困难撤机的中医病机及诊疗思路。根据五脏相关学说，认为困难撤机与宗气密切 相关，宗气不足、肺脾肾虚损为其核心病机，宗气痹阻、气血失和为中心环节；治疗可采用四君子汤、补肺汤、参苓白术 散等补益宗气，以补中益气汤、升陷汤、举元煎等升阳举陷，同时应注意调和气血，并根据五脏之虚实加以辨证调护，以 期提高脱机成功率。基于宗气与五脏相关学说探讨中医辅助治疗困难撤机可为困难撤机的中西医结合治疗提供思路。

This article takes pectoral qi as the starting point to discuss the traditional Chinese medicine（TCM） pathogenesis as well as the diagnostic and therapeutic approach to difficult withdrawal of mechanical ventilation in mechanically ventilated patients. According to the five-viscera correlation theory，it is believed that the onset of difficult withdrawal of mechanical ventilation is closely related to pectoral qi. The core pathogenesis of difficult withdrawal of mechanical ventilation is due to the insufficiency of pectoral qi and the deficiency of the lung，spleen and kidney，and the obstruction of pectoral qi and disharmony of qi and blood contribute to the key pathogenesis. Chinese medicine treatment can be carried out by the usage of Sijunzi Tang（Four Mild-Drug Decoction），Bufei Tang（Decoction for Replenishing Lung），Shenling Baizhu San（Powder of Radix Ginseng，Poria and Rhizoma Atractylodis Macrocephalae）to supplement and benefit pectoral qi，and by the utilization of Buzhong Yiqi Tang （Decoction for Tonifying Middle Energizer and Replenishing Qi）， Shengxian Tang（Decoction for Lifting the Sinking of Qi in Chest），Juyuan Jian（Decoction for Replenishing Qi and Lifting the Sunken Qi）to elevate yang and lift the sinking of Qi. Moreover，herbs for regulating qi and blood should be added，and the management of the diet and daily living based on the identification of the deficiency and excess of the five viscera is stressed，so as to enhance the success rate of withdrawal of mechanical ventilation. The exploration will provide ideas for the treatment of difficult withdrawal of mechanical ventilation with the integrated Chinese and western medicine.

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