喘症最重而难医。吾观庸医凡遇喘症，必投苏子降气汤一二剂；不愈，即用贞元饮治之
；不愈，即加沉香、黑铅、磁石、牛膝之类。曰∶吾遵景岳法施治，无如其病深弗效也。斯
说也，倡之于某老医，今已传为成矩，诚可痛恨。余即以景岳之说正之。景岳曰∶喘有虚实。
实者胸胀气粗，声高息涌，膨膨然若不能容，惟呼出为快也。论中未尝不以风寒燥火怒气
痰饮分别而治之。又曰∶虚喘者，慌张气怯，声低息短，皇皇然若气欲断，提之若不能
升，吞之若不能降，劳动则甚，但得引长一息为快也。论中未尝不以老弱久病，脾肺肾脏大
虚，及血后汗后、妇人产后等症，胪列而分治之。其中不无语病者，盖未研究《伤寒论》、《金匮》
之旨，而徒涉猎医书，无怪其有肤浅处、有似是而非处也。余俯从时好，即景岳虚实两语，
而参以古法，罗列经方及妥当时方，以为临症择用。
越婢加半夏汤
咳而上气，此为肺胀，其人喘，目如脱，脉浮大者。
小青龙汤
肺胀咳而上气，心下有水气，脉浮者。
桂苓五味甘草汤
小青龙汤虽治寒饮咳嗽上气之良方，而下虚之人，不堪发散，动其冲气，急用桂苓伐肾邪，
五味敛肺气，以辑其火，甘草调中气，以制其水。
桂苓五味甘草加姜辛汤（方各见《金匮》）
既藉桂苓之方，下其冲气，而反更咳胸满者，是寒邪贮胸，虽用桂而邪不服，嫌其偏于
走表而去之。加干姜、细辛，取其大辛大热，以驱寒泄满也。
《金匮》法，前症兼冒而呕者，加半夏以驱饮，名桂苓五味甘草去桂加干姜细辛半夏汤；
前症兼形肿者，是肺气滞而为肿，加杏仁利之，名苓甘五味加姜辛半夏杏仁汤；前症又兼面
热如醉，此为胃热上冲其面，加大黄三钱以利之。（脉气不利，滞于外而形肿，滞于内而胃
热，既以杏仁利其胸中之气，复以大黄利其胃中之热。）名苓甘五味加姜辛半夏大黄汤。
徐忠可曰∶仲景数方，俱不去姜、辛，即面热亦不去姜、辛，何也？盖以姜、辛最能泄满止咳
，凡饮邪未去，须以此二味刻刻预防也。
桂枝加浓朴杏仁汤（方见《伤寒》）
喘家主之，太阳病下之，微喘，以此解表。
射干麻黄汤
咳而上气，喉中作水鸡声者。
皂荚丸
咳逆上气，时时唾浊，但坐不得眠。（稠痰粘肺，非此方不能清涤稠痰矣）
葶苈大枣泻肺汤
肺因支饮满而气闷，气闭则呼吸不能自如，此方苦降以泄实邪。
十枣汤
支饮家咳烦，胸中痛者。
喻嘉言曰∶五饮之中，独膈上支饮，最为咳嗽根底。外邪入而合之固嗽，即无外邪而支饮渍
入肺中，自令人咳嗽不已。况支饮久蓄膈上，其下焦之气逆冲而上者，尤易上下合邪也。夫
以支饮之故，而令外邪可内，下邪可上，不去支饮，其咳嗽终无宁宇矣。
麦冬汤（方各见《金匮》）
火逆上气，咽喉不利，止逆下气，此方主之。
泻白散
治肺火喘嗽。
四磨饮
治七情气逆而为咳，并治一切实喘。
苏子降气汤(方各见《时方》)
治痰嗽胀满喘促，上盛下虚。
紫苏汤（《圣济》）
治卒气短。
紫苏（四钱） 陈皮（一钱） 红枣（二枚）
水酒煎服。
喘症是最为严重且难以治疗的疾病。我观察庸医凡是遇到喘症，必定投用苏子降气汤一二剂；如果无效，就立即用贞元饮治疗；如果还无效，就加上沉香、黑铅、磁石、牛膝之类的药物。他们说：“我们遵循张景岳的方法进行治疗，无奈病情深重而无效。”这种说法，是由某位老医生倡导的，如今已传为定法，实在令人痛恨。我便以张景岳的说法来纠正他们。张景岳说：“喘症有虚证和实证之分。”实证表现为胸部胀满、气息粗重，声音高亢、呼吸急促汹涌，胸廓膨隆好像不能容纳，只有呼出气体才感到舒畅。医论中未曾不以风寒燥火怒气痰饮分别进行治理。他又说：“虚喘者，慌张气怯，声音低微、气息短促，惊慌失措好像气欲断绝，提之若不能升，吞之若不能降，劳动则加重，只有能引长一口气才感到舒畅。”医论中未曾不以年老体弱久病、脾肺肾脏大虚，以及血后汗后、妇人产后等症，详细列举并分别治疗。其中不无错误之处，大概是因为没有深入研究《伤寒论》、《金匮要略》的宗旨，而只是肤浅地涉猎医书，难怪会有肤浅之处、有似是而非之处。我顺应时好，即根据张景岳虚实两句话，参酌古法，罗列经方及妥当时方，以为临症择用。
越婢加半夏汤：咳嗽兼上气，这是肺胀，其人喘，眼睛突出如脱出状，脉象浮大的。
小青龙汤：肺胀咳嗽兼上气，心下有停水之气，脉象浮的。
桂苓五味甘草汤：小青龙汤虽然是治疗寒饮咳嗽上气的良方，但下虚之人，不堪发散，会动其冲气，急用桂枝茯苓伐肾邪，五味子敛肺气，以平息其火，甘草调中气，以制约其水。
桂苓五味甘草加姜辛汤（方各见《金匮要略》）：既然借助桂枝茯苓的方子，下其冲气，反而更咳嗽胸满的，是寒邪贮留胸中，虽然用桂枝而邪气不服，嫌其偏于走表而去之。加干姜、细辛，取其大辛大热，以驱寒泄满也。
《金匮要略》法，前症兼冒而呕的，加半夏以驱饮，名桂苓五味甘草去桂加干姜细辛半夏汤；前症兼形肿的，是肺气滞而为肿，加杏仁利之，名苓甘五味加姜辛半夏杏仁汤；前症又兼面热如醉，此为胃热上冲其面，加大黄三钱以利之。（脉气不利，滞于外而形肿，滞于内而胃热，既以杏仁利其胸中之气，复以大黄利其胃中之热。）名苓甘五味加姜辛半夏大黄汤。
徐忠可说：仲景数个方子，都不去掉姜、辛，即使面热也不去掉姜、辛，为什么呢？盖因为姜、辛最能泄满止咳，凡饮邪未去，须以此二味刻刻预防也。
桂枝加浓朴杏仁汤（方见《伤寒论》）：喘家主之，太阳病下之，微喘，以此解表。
射干麻黄汤：咳嗽兼上气，喉中作水鸡声的。
皂荚丸：咳逆上气，时时唾浊，但坐不得眠。（稠痰粘肺，非此方不能清涤稠痰矣）
葶苈大枣泻肺汤：肺因支饮满而气闷，气闭则呼吸不能自如，此方苦降以泄实邪。
十枣汤：支饮家咳烦，胸中痛的。
喻嘉言说：五饮之中，独膈上支饮，最为咳嗽根底。外邪入而合之固嗽，即无外邪而支饮渍入肺中，自令人咳嗽不已。况支饮久蓄膈上，其下焦之气逆冲而上者，尤易上下合邪也。夫以支饮之故，而令外邪可内，下邪可上，不去支饮，其咳嗽终无宁宇矣。
麦冬汤（方各见《金匮要略》）：火逆上气，咽喉不利，止逆下气，此方主之。
泻白散：治肺火喘嗽。
四磨饮：治七情气逆而为咳，并治一切实喘。
苏子降气汤(方各见《时方》)：治痰嗽胀满喘促，上盛下虚。
紫苏汤（《圣济总录》）：治卒气短。
紫苏（四钱） 陈皮（一钱） 红枣（二枚）
水酒煎服。
Asthma (Chuan Zheng) is the most severe and difficult-to-treat condition. I have observed that quack doctors, whenever they encounter asthma, invariably prescribe Su Zi Jiang Qi Tang (Perilla Fruit Descending Qi Decoction) for one or two doses; if it fails, they immediately use Zhen Yuan Yin (True Origin Drink); if still ineffective, they add Chen Xiang (Aquilaria Wood), Hei Qian (Black Lead), Ci Shi (Magnetite), Niu Xi (Achyranthes Root) and similar substances. They say: "We follow Jing Yue's method of treatment, but unfortunately the disease is deep-rooted and ineffective." This assertion was initiated by a certain old doctor and has now become a rigid rule, which is truly lamentable. I shall correct this view using Jing Yue's own words. Jing Yue stated: "Asthma is divided into deficiency (Xu) and excess (Shi)." Excess type manifests as chest distension and coarse breathing, loud voice and surging respiration, with the chest appearing swollen and unable to contain air, finding relief only in exhalation. The treatises never fail to differentiate treatment based on wind-cold, dryness, fire, anger, phlegm, and fluid retention. He further stated: "Deficiency-type asthma presents with panic and shortness of breath, low voice and short respiration, looking terrified as if breath were about to cease; lifting seems impossible, swallowing seems impossible, worsening with exertion, finding relief only in taking a long breath." The treatises never fail to list and differentiate treatment for conditions such as advanced age, chronic illness, severe deficiency of Spleen, Lung, Kidney, post-hemorrhage, post-sweating, and postpartum states among women. There are indeed errors within these statements, likely due to a failure to deeply study the principles of Shang Han Lun (Treatise on Cold Damage) and Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet), relying merely on superficial reading of medical texts, hence the presence of shallow and seemingly plausible yet incorrect points. Adapting to contemporary preferences, I base my approach on Jing Yue's distinction between deficiency and excess, incorporating ancient methods, listing classic prescriptions (Jing Fang) and appropriate contemporary formulas (Shi Fang) for clinical selection.
Yue Bi Jia Ban Xia Tang (Ma Huang Decoction plus Pinellia): Cough accompanied by rebellious Qi, indicating Lung Distension (Fei Zhang). The patient wheezes, eyes appear protruding as if falling out, pulse is floating and large.
Xiao Qing Long Tang (Minor Green Dragon Decoction): Lung Distension with cough and rebellious Qi, fluid retention below the heart, pulse is floating.
Gui Ling Wu Wei Gan Cao Tang (Cinnamon Twig, Poria, Schisandra, and Licorice Decoction): Although Xiao Qing Long Tang is an excellent formula for cold-fluid retention causing cough and rebellious Qi, patients with lower deficiency cannot tolerate dispersing methods, which may stir up Chong Qi (Rebellious Qi). Urgently use Gui Zhi (Cinnamon Twig) and Fu Ling (Poria) to attack Kidney pathogenic factors, Wu Wei Zi (Schisandra) to astringe Lung Qi and quell fire, and Gan Cao (Licorice) to regulate Middle Qi and control fluids.
Gui Ling Wu Wei Gan Cao Jia Gan Xin Tang (Cinnamon Twig, Poria, Schisandra, Licorice plus Ginger and Asarum Decoction) (See Jin Gui Yao Lue): Having utilized the Gui Ling formula to subdue Chong Qi, if cough and chest fullness worsen, it indicates cold pathogen stored in the chest. Although Gui Zhi is used, the pathogen remains unconquered, as it tends to disperse via the exterior. Add Gan Jiang (Dried Ginger) and Xi Xin (Asarum), utilizing their pungent and hot nature to expel cold and relieve fullness.
According to Jin Gui Yao Lue: If the aforementioned symptoms are accompanied by dizziness and vomiting, add Ban Xia (Pinellia) to expel fluid, named Gui Ling Wu Wei Gan Cao Qu Gui Jia Gan Jiang Xi Xin Ban Xia Tang (Cinnamon Twig, Poria, Schisandra, Licorice minus Cinnamon Twig plus Dried Ginger, Asarum, and Pinellia Decoction); if accompanied by edema, it indicates Lung Qi stagnation causing swelling, add Xing Ren (Apricot Seed) to promote drainage, named Ling Gan Wu Wei Jia Gan Xin Ban Xia Xing Ren Tang (Poria, Licorice, Schisandra plus Dried Ginger, Asarum, Pinellia, and Apricot Seed Decoction); if additionally accompanied by facial heat resembling intoxication, this indicates Stomach Heat rushing upward to the face, add Da Huang (Rhubarb) 3 qian to promote drainage. (Qi and pulse are obstructed, stagnating externally causing edema, internally causing Stomach Heat. After using Xing Ren to benefit Qi in the chest, Da Huang is used to clear Heat in the Stomach.) Named Ling Gan Wu Wei Jia Gan Xin Ban Xia Da Huang Tang (Poria, Licorice, Schisandra plus Dried Ginger, Asarum, Pinellia, and Rhubarb Decoction).
Xu Zhongke stated: Among Zhongjing's several formulas, Ginger and Asarum are never removed, even when facial heat is present. Why? Because Ginger and Asarum are best at relieving fullness and stopping cough. Whenever fluid pathogen remains, these two herbs must be constantly employed for prevention.
Gui Zhi Jia Nong Po Xing Ren Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Seed) (See Shang Han Lun): Indicated for asthma. If Tai Yang disease is treated with purgatives leading to slight asthma, this formula resolves the exterior.
She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction): Cough with rebellious Qi, sound of water fowl in the throat.
Zao Jia Wan (Soap Pod Pill): Rebellious Qi and cough, frequent expectoration of turbid saliva, inability to lie down, can only sit. (Thick phlegm adhering to the lungs; only this formula can thoroughly cleanse thick phlegm.)
Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung): Lung obstruction due to Zhi Yin (Supporting Fluid) causing fullness and stifling sensation. Qi closure prevents free respiration. This formula uses bitter descent to drain excess pathogen.
Shi Zao Tang (Ten Date Decoction): For patients with Zhi Yin experiencing cough, irritability, and chest pain.
Yu Jiayan stated: Among the five types of fluid retention, only Ge Shang Zhi Yin (Supporting Fluid above the Diaphragm) is the root cause of cough. External pathogens entering and combining with it certainly cause cough; even without external pathogens, Zhi Yin infiltrating the lungs naturally causes persistent cough. Moreover, since Zhi Yin accumulates long-term above the diaphragm, Qi from the Lower Jiao rebelling upward easily combines with upper pathogenesis. Due to Zhi Yin, external pathogens can enter inward, and lower pathogenic factors can rise upward. Without eliminating Zhi Yin, cough will never find peace.
Mai Men Dong Tang (Ophiopogon Decoction) (See Jin Gui Yao Lue): Fire rebellion causing upward Qi, unsmooth throat. This formula governs stopping rebellion and descending Qi.
Xie Bai San (Drain White Powder): Treats Lung Fire causing asthma and cough.
Si Mo Yin (Four Knocks Drink): Treats cough caused by Qi rebellion due to seven emotions, and also treats all types of excess asthma.
Su Zi Jiang Qi Tang (Perilla Fruit Descending Qi Decoction) (See Shi Fang): Treats phlegm-cough, distension, fullness, asthma, with excess above and deficiency below.
Zi Su Tang (Perilla Decoction) (See Sheng Ji Zong Lu): Treats sudden shortness of breath.
Zi Su (Perilla Leaf) 4 qian, Chen Pi (Tangerine Peel) 1 qian, Hong Zao (Jujube) 2 pieces.
Decoct in water and wine, take orally.