俗语云喘无善证，诚以喘证无论内伤外感，皆为紧要之证也。然欲究喘之病因，当先明呼吸之枢机何脏
司之。喉为气管，内通于肺，人之所共知也，而吸气之入，实不仅入肺，并能入心，入肝，入冲任，以及
于肾。何以言之？气管之正支入肺，其分支实下通于心，更透膈而下通于肝（观肺心肝一系相连可知），由
肝而下更与冲任相连以通于肾。倘曰不然，何以妇人之妊子者，母呼而子亦呼，母吸而子亦吸乎？呼吸之
气若不由气管分支通于肝，下及于冲任与肾，何以子之脐带其根蒂结于冲任之间，能以脐承母之呼吸之气，而
随母呼吸乎？是知肺者发动呼吸之机关也。喘之为病，《神农本草经》名为吐吸，因吸入之气内不能容，而速吐出
也。其不容纳之故，有由于肺者，有由于肝肾者。试先以由于肝肾者言之。
肾主闭藏，亦主翕纳，原所以统摄下焦之气化，兼以翕纳呼吸之气，使之息息归根也。有时肾虚不能统摄
其气化，致其气化膨胀于冲任之间，转挟冲气上冲，而为肾行气之肝木（方书谓肝行肾之气），至
此不能疏通肾气下行，亦转随之上冲，是以吸入之气未受下焦之翕纳，而转受下焦之冲激，此乃喘之所由来，
方书所谓肾虚不纳气也。当治以滋阴补肾之品，而佐以生肝血、镇肝气及镇冲、降逆之药。方用大怀熟地、生
怀山药各一两，生杭芍、柏子仁、甘枸杞、净萸肉、生赭石细末各五钱，苏子、甘草各二钱。热多
者可加玄参数钱。汗多者可加生龙骨、生牡蛎各数钱。
有肾虚不纳气，更兼元气虚甚，不能固摄，而欲上脱者，其喘逆之状恒较但肾虚者尤甚。宜于前方中去
芍药、甘草，加野台参五钱，萸肉改用一两，赭石改用八钱。服一剂喘见轻，心中觉热者，可酌加天冬数钱。
或用拙拟参赭镇气汤亦可。有因猝然暴怒，激动肝气、肝火，更挟冲气上冲，胃气上逆，迫挤肺之吸气
不能下行作喘者，方用川楝子、生杭芍、生赭石细末各六钱，浓朴、清夏、乳香、没药、龙胆草、桂枝尖、苏
子、甘草各二钱，磨取铁锈浓水煎服。以上三项作喘之病因，由于肝肾者也，而其脉象则有区别。阴虚不纳
气者，脉多细数；阴虚更兼元气欲脱者，脉多上盛下虚；肝火肝气挟冲气胃气上冲者，脉多硬弦而
长。审脉辨证，自无差误也。
至喘之由于肺者，因肺病不能容纳吸入之气，其证原有内伤外感之殊。试先论肺不纳气之由于内伤者。一
一辟，呼吸自然之机关也。至问其所以能呼吸者，固赖胸中大气为之斡旋，又赖肺叶具有活泼机能，以遂
其辟之用。乃有时肺脏受病，肺叶之 辟活泼者变为易 难辟，而成紧缩之性。暑热之时其紧数稍
缓，犹可不喘，一经寒凉，则喘立作矣。此肺劳之证，多发于寒凉之时也。宜用生怀山药轧细，每用两许
煮作粥，调以蔗白糖，送服西药百布圣七八分。盖肺叶紧缩者，以其中津液减少，血脉凝滞也。有山药蔗糖
以润之，百布圣以化之（百布圣为小猪小牛之胃液制成故善化），久当自愈。其有顽痰过盛者，可再用蓬砂细末
二分，与百布圣同送服。若外治，灸其肺 穴亦有效，可与内治之方并用。若无西
药百布圣处，可代以生鸡内金细末三分，其化痰之力较百布圣尤强。
有痰积胃中，更溢于膈上，浸入肺中，而作喘者。古人恒用葶苈大枣泻肺汤或十枣汤下之，此乃治标
之方，究非探本穷源之治也。拙拟有理痰汤，连服十余剂，则此证之标本皆清矣。至方中之义，原方下论之甚
详，兹不赘。若其充塞于胸膈胃府之间，不为痰而为饮，且为寒饮者（饮有寒热，热饮脉滑，其人多有神经
病，寒饮脉弦细，概言饮为寒者非是），其人或有时喘，有时不喘，或感受寒凉病即反复者，此上焦之阳分虚
也，宜治以《金匮》苓桂术甘汤，加干姜三钱，浓朴、陈皮各钱半，俾其药之热力能胜其寒，其饮自化而下
行，从水道出矣。又有不但上焦之阳分甚虚，并其气分亦甚虚，致寒饮充塞于胸中作喘者，其脉不但弦细，且
甚微弱，宜于前方中加生箭 五钱，方中干姜改用五钱。壬戌秋，严××为其友问二十六七年寒饮结胸，
时发大喘，极畏寒凉，曾为开去此方（方中生箭 用一两干姜用八钱非极虚寒之证不可用此重剂），
连服十余剂全愈。方中所以重用黄 者，以其能补益胸中大气，俾大气壮旺自能运化寒饮下行也。上所
论三则，皆内伤喘证之由于肺者也。
至外感之喘证，大抵皆由于肺。而其治法，实因证而各有所宜。人身之外表，卫气主之，卫气本于胸
中大气，又因肺主皮毛，与肺脏亦有密切之关系。有时外表为风寒所束，卫气不能流
通周身，以致胸中大气无所输泄，骤生膨胀之力，肺悬胸中，因
受其排挤而作喘。又因肺与卫气关系密切，卫气郁而肺气必郁，亦可作喘。此《伤寒论》麻黄汤所主之证，多
有兼喘者也。然用麻黄汤时，宜加知母数钱，汗后方无不解之虞。至温病亦有初得作喘者，宜治以薄荷叶、牛
蒡子各三钱，生石膏细末六钱，甘草二钱，或用麻杏甘石汤方亦可，然石膏万勿 用，而其分量又宜数
倍于麻黄（石膏可用至一两麻黄治此证多用不过二钱）。此二证之喘同而用药迥异者，因伤寒之脉浮紧，
温病之脉洪滑也。
有外感之风寒内侵，与胸间之水气凝滞，上迫肺气作喘者，此《伤寒论》小青龙汤证也。当必效《金匮》
之小青龙加石膏法，且必加生石膏至两许，用之方效。又此方加减定例，喘者去麻黄，加杏仁。而愚用此方治
喘时，恒加杏仁，而仍用麻黄一钱。其脉甚虚者，又宜加野台参数钱。更定后世所用小青龙汤分量，可参观也。
又拙拟从龙汤方，治服小青龙汤后喘愈而仍反复者。用之曾屡次奏效。上所论两则治外感作喘之大略也。
有其人素有劳疾喘嗽，少受外感即发，此乃内伤外感相并作
喘之证也，宜治以拙拟加味越婢加半夏汤。因其内伤外感相并作喘，故所用之药亦内伤外感并用。
特是上所论之喘，其病因虽有内伤、外感、在肝肾、在肺之殊，约皆不能纳气而为吸气难，即《神农
本草经》所谓吐吸也。乃有其喘不觉吸气难而转觉呼气难者，其病因由于胸中大气虚而下陷，不能鼓动肺脏以
行其呼吸，其人不得不努力呼吸以自救，其呼吸迫促之形状有似乎喘，而实与不纳气之喘有天渊之分。设或辨
证不清，见其作喘，复投以降气纳气之药，则凶危立见矣。然欲辨此证不难也，盖不纳气之喘，其剧者必然
肩息（肩上耸也）；大气下陷之喘，纵呼吸有声，必不肩息，而其肩益下垂。即此二证之脉论，亦迥不同，
不纳气作喘者，其脉多数，或尺弱寸强；大气下陷之喘，其脉多迟而无力，尺脉或略胜于寸脉。察其状而审其
脉，辨之固百不失一也。其治法当用拙拟升陷汤，以升补其胸中大气，其喘自愈。
有大气下陷作喘，又兼阴虚不纳气作喘者，其呼吸皆觉困难，益自强为呼吸而呈喘状，其脉象微弱无力，
或脉搏略数，或背发紧而身心微有灼热。宜治以生怀山药一两，玄参、甘枸杞各六钱，生箭 四钱，知母、
桂枝尖各二钱，煎汤服。方中不用桔梗、升、柴者，恐与阴虚不纳气有碍也。上二证之喘，同中有异，升
陷汤后皆有验案可参观也。
有肝气胆火挟冲胃之气上冲作喘，其上冲之极至排挤胸中大气下陷，其喘又顿止，并呼吸全无，须臾忽
又作喘，而如斯循环不已者，此乃喘证之至奇者也。曾治一少妇，因夫妻反目得此证，用桂枝尖四钱，恐
其性热，佐以带心寸冬三钱，煎汤服下，即愈。因读《神农本草经》桂枝能升大气兼能降逆气，用之果效如
影响。夫以桂枝一物之微，而升陷降逆两擅其功，此诚天之生斯使独也。
俗话说“喘证没有好的征象”，确实因为喘证无论是由内伤还是外感引起，都属于危急严重的病证。然而，若要探究喘证的病因，应当先明确呼吸的枢纽由哪一脏腑所主管。喉部是气管，内部连通于肺，这是人们所共知的常识；但吸气进入体内，实际上不仅进入肺，还能进入心、肝、冲脉与任脉（合称冲任），以及肾。为什么这样说呢？气管的正支进入肺，其分支实则向下连通于心，更穿透膈肌向下连通于肝（观察肺、心、肝三者相连可知），由肝向下又与冲任相连从而通于肾。如果说不是这样，那么为什么妇女怀孕时，母亲呼气胎儿也呼气，母亲吸气胎儿也吸气呢？呼吸之气若不由气管分支通于肝，下及于冲任与肾，那么胎儿的脐带其根基结在冲任之间，怎么能通过脐带承接母亲的呼吸之气，并随着母亲的呼吸而运动呢？由此可知，肺是发动呼吸的机关。喘这种病，《神农本草经》称之为“吐吸”，是因为吸入的气在体内不能被容纳，而迅速被吐出。它不能被容纳的原因，有由于肺的，也有由于肝肾的。试先从由于肝肾引起的说起。
肾主闭藏，也主翕纳（收敛吸纳），原本是用来统摄下焦的气化功能，兼以翕纳呼吸之气，使气息息息归根。有时肾虚不能统摄其气化，导致其气化膨胀于冲任之间，转而挟带冲气上冲，而为肾行气的肝木（医书称肝行肾之气），到了这里不能疏通肾气下行，也转而随之上冲，因此吸入之气未受到下焦的翕纳，反而受到下焦的冲激，这就是喘产生的由来，即医书所说的“肾虚不纳气”。治疗应当用滋阴补肾的药物，并辅以生肝血、镇肝气以及镇冲、降逆的药物。方剂使用大怀熟地、生怀山药各一两，生杭芍、柏子仁、甘枸杞、净萸肉、生赭石细末各五钱，苏子、甘草各二钱。热象多者可加玄参数钱。汗多者可加生龙骨、生牡蛎各数钱。
如果有肾虚不纳气，更兼元气极度虚弱，不能固摄，而有欲向上脱逸的趋势，其喘逆的症状通常比单纯肾虚者更为严重。应当在前方中去掉芍药、甘草，加野台参五钱，萸肉改用一两，赭石改用八钱。服用一剂后喘证减轻，心中感觉发热者，可酌情加天冬数钱。或者使用我拟定的参赭镇气汤也可以。有因突然暴怒，激动肝气、肝火，更挟带冲气上冲，胃气上逆，迫挤肺的吸气不能下行而作喘的，方剂使用川楝子、生杭芍、生赭石细末各六钱，浓朴、清夏（法半夏）、乳香、没药、龙胆草、桂枝尖、苏子、甘草各二钱，磨取铁锈浓水煎服。以上三项造成喘证的病因，都是由于肝肾引起的，但其脉象则有区别。阴虚不纳气者，脉多细数；阴虚更兼元气欲脱者，脉多上盛下虚；肝火肝气挟冲气胃气上冲者，脉多硬弦而长。审察脉象辨证，自然没有差错。
至于喘证由于肺引起的，是因为肺病不能容纳吸入之气，其证候原有内伤与外感的不同。试先论述肺不纳气由于内伤的情况。肺叶的开阖（辟阖），是呼吸自然的机关。至于问其所以能呼吸的原因，固然依赖胸中大气为之斡旋，又赖肺叶具有活泼机能，以实现其开阖之用。有时肺脏受病，肺叶的开阖活泼变为困难，而成紧缩之性。暑热之时其紧数稍缓，还可以不喘，一经寒凉，则喘立刻发作。这就是肺劳（肺痨）的证候，多发于寒凉之时。适宜用生怀山药轧成细粉，每次用一两左右煮成粥，调以蔗白糖，送服西药百布圣七八分。因为肺叶紧缩，是由于其中津液减少，血脉凝滞所致。有山药蔗糖来滋润它，百布圣来化解它（百布圣是用小猪小牛之胃液制成，故善于消化），久了应当自愈。其中有顽痰过盛者，可再用蓬砂（硼砂）细末二分，与百布圣同送服。如果采用外治法，灸其肺俞穴也有效，可与内治之方并用。如果没有西药百布圣的地方，可用生鸡内金细末三分代替，其化痰之力较百布圣更强。
有痰积在胃中，更溢于膈上，浸入肺中，而作喘的。古人常用葶苈大枣泻肺汤或十枣汤攻下，这乃是治标的方剂，终究不是探本穷源的治法。我拟定有理痰汤，连服十余剂，则此证的标本皆清。至于方中的义理，原方下的论述很详细，此处不再赘述。如果其充塞于胸膈胃府之间，不为痰而为饮，且为寒饮者（饮有寒热之分，热饮脉滑，其人多有神经病，寒饮脉弦细，概言饮为寒者是不对的），其人有时喘，有时不喘，或感受寒凉病即反复者，这是上焦之阳分虚也，适宜治疗用《金匮要略》苓桂术甘汤，加干姜三钱，浓朴、陈皮各钱半，使其药的热力能胜其寒，其饮自化而下行的，从水道排出。又有不但上焦之阳分甚虚，并其气分亦甚虚，致寒饮充塞于胸中作喘的，其脉不但弦细，且甚微弱，适宜在前方中加生箭芪（黄芪）五钱，方中干姜改用五钱。壬戌年秋天，严某某为其朋友咨询二十六七年寒饮结胸，时常发作大喘，极畏寒凉，曾为他开出此方（方中生箭芪用一两、干姜用八钱，非极虚寒之证不可用此重剂），连服十余剂全愈。方中所以重用黄芪，是因为它能补益胸中大气，使大气壮旺自能运化寒饮下行也。上面所论三则，都是内伤喘证由于肺引起的。
至于外感的喘证，大体上都由于肺。而其治法，实在因证而异各有适宜。人身的外表，由卫气主管，卫气本源于胸中大气，又因肺主皮毛，与肺脏也有密切的关系。有时外表被风寒束缚，卫气不能流通周身，以致胸中大气无所输泄，骤生膨胀之力，肺悬于胸中，因而受其排挤而作喘。又因肺与卫气关系密切，卫气郁滞则肺气必郁，也可作喘。这是《伤寒论》麻黄汤所主治的证候，多有兼喘的。然而使用麻黄汤时，宜加知母数钱，汗出后方无不解的忧虑。至于温病也有初得病就作喘的，适宜治疗用薄荷叶、牛蒡子各三钱，生石膏细末六钱，甘草二钱，或者用麻杏甘石汤方也可以，然而石膏万万不可煅用，而且其分量又宜数倍于麻黄（石膏可用至一两，麻黄治此证多用不过二钱）。这两个证候的喘相同而用药迥异，是因为伤寒之脉浮紧，温病之脉洪滑。
有外感的风寒内侵，与胸间的水气凝滞，上迫肺气作喘的，这是《伤寒论》小青龙汤证。应当必定效法《金匮要略》的小青龙加石膏法，且必加生石膏至一两许，用之才有效。另外此方加减定例，喘者去麻黄，加杏仁。而我用此方治喘时，恒加杏仁，而仍用麻黄一钱。其脉甚虚者，又宜加野台参数钱。更定后世所用小青龙汤分量，可以参考。另外我拟定的从龙汤方，治疗服用小青龙汤后喘愈而仍反复者。用它曾屡次奏效。上面所论两则是治疗外感作喘的大略。
有这人素有劳疾喘嗽，少受外感即发，这是内伤外感相并作喘的证候，适宜治疗用我拟定的加味越婢加半夏汤。因为其内伤外感相并作喘，所以所用的药物也是内伤外感并用。
只是上面所论的喘，其病因虽有内伤、外感、在肝肾、在肺的不同，大约都不能纳气而为吸气难，即《神农本草经》所谓吐吸。然而有喘不觉吸气难而转觉呼气难的，其病因由于胸中大气虚而下陷，不能鼓动肺脏以行其呼吸，其人不得不努力呼吸以自救，其呼吸迫促的形状似乎像喘，而实际与不纳气之喘有天渊之别。假如辨证不清，见其作喘，又投以降气纳气的药，则凶危立刻出现。然而想要辨别此证不难，大概不纳气之喘，其剧烈者必然肩息（肩上耸也）；大气下陷之喘，纵呼吸有声，必不肩息，而其肩益下垂。仅就这两个证候的脉象论述，也迥然不同，不纳气作喘者，其脉多数，或尺弱寸强；大气下陷之喘，其脉多迟而无力，尺脉或略胜于寸脉。观察其状而审察其脉，辨别它确实百不失一。其治法当用我拟定的升陷汤，以升补其胸中大气，其喘自愈。
有大气下陷作喘，又兼阴虚不纳气作喘的，其呼吸皆觉困难，益自强为呼吸而呈喘状，其脉象微弱无力，或脉搏略数，或背发紧而身心微有灼热。适宜治疗用生怀山药一两，玄参、甘枸杞各六钱，生箭芪四钱，知母、桂枝尖各二钱，煎汤服。方中不用桔梗、升麻、柴胡者，是恐怕与阴虚不纳气有妨碍。上述两个证候的喘，同中有异，升陷汤后皆有验案可供参考。
有肝气胆火挟冲胃之气上冲作喘，其上冲的极至排挤胸中大气下陷，其喘又顿止，并呼吸全无，须臾忽又作喘，而如此循环不已的，这是喘证之至奇者也。曾治一少妇，因夫妻反目得此证，用桂枝尖四钱，恐其性热，佐以带心寸冬（麦冬）三钱，煎汤服下，即愈。因为读《神农本草经》桂枝能升大气兼能降逆气，用之果然效如影响。夫以桂枝一物之微，而升陷降逆两擅其功，这真是上天独生此物啊。
It is commonly said that "asthma has no favorable signs," which is indeed true because asthma, whether caused by internal injury or external contraction, is always a critical and serious condition. However, to investigate the etiology of asthma, one must first clarify which Zang-Fu organ governs the pivot of respiration. The throat is the trachea, internally connected to the Lung (Fei), which is common knowledge; yet inhaled air does not merely enter the Lung but can also enter the Heart (Xin), Liver (Gan), Chong and Ren vessels (Chong Ren), and Kidney (Shen). Why is this so? The main branch of the trachea enters the Lung, while its branches actually connect downward to the Heart, further penetrating the diaphragm to connect downward to the Liver (as can be seen from the connection among the Lung, Heart, and Liver), and from the Liver downward, it connects with the Chong and Ren vessels to reach the Kidney. If this were not the case, why would a pregnant woman's fetus exhale when the mother exhales, and inhale when the mother inhales? If respiratory qi did not pass through the tracheal branches to the Liver, down to the Chong and Ren vessels and Kidney, how could the fetus's umbilical cord, rooted between the Chong and Ren vessels, receive the mother's respiratory qi via the umbilicus and move with her breathing? Thus, we know that the Lung is the mechanism initiating respiration. Asthma, as described in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), is called "spitting inhalation" (Tu Xi), meaning the inhaled air cannot be retained within and is quickly expelled. The reason for this non-retention may lie in the Lung or in the Liver and Kidney. Let us first discuss those arising from the Liver and Kidney.
The Kidney governs closure and storage, as well as "Xi Na" (convergence and reception), originally intended to regulate the Qi transformation of the Lower Jiao and to converge and receive respiratory qi, causing each breath to root downwards. Sometimes, Kidney deficiency fails to regulate this Qi transformation, causing it to expand between the Chong and Ren vessels, subsequently carrying the Chong Qi upward rushing. The Wood of the Liver, which executes the Kidney's Qi (as medical texts state, the Liver moves the Kidney's Qi), reaches this point unable to unblock the downward flow of Kidney Qi, and thus rushes upward along with it. Consequently, inhaled qi is not received by the convergence of the Lower Jiao but is instead agitated by it. This is the origin of asthma, known in medical texts as "Kidney deficiency failing to receive Qi." Treatment should employ herbs that nourish Yin and tonify the Kidney, assisted by herbs that generate Liver Blood, calm Liver Qi, settle the Chong vessel, and direct rebellious Qi downward. The formula uses Da Huai Shu Di (Prepared Rehmannia Root from Huaiqing), Sheng Huai Shan Yao (Fresh Chinese Yam from Huaiqing) each 1 liang, Sheng Hang Shao (Fresh White Peony Root from Hangzhou), Bai Zi Ren (Biota Seed), Gan Gou Qi (Goji Berry), Jing Yu Rou (Processed Cornus Fruit), Sheng Zhe Shi (Raw Ocher powder) each 5 qian, Su Zi (Perilla Fruit), and Gan Cao (Licorice Root) each 2 qian. For cases with more heat, add Xuan Shen (Scrophularia Root) several qian. For cases with excessive sweating, add Sheng Long Gu (Raw Dragon Bone) and Sheng Mu Li (Raw Oyster Shell) several qian each.
If there is Kidney deficiency failing to receive Qi, compounded by severe Yuan Qi (Primal Qi) deficiency unable to secure and hold, leading to a desire for upward collapse, the symptoms of asthmatic rebellion will be more severe than in simple Kidney deficiency. In the aforementioned formula, remove Shao Yao (Peony) and Gan Cao, add Ye Tai Shen (Wild Ginseng from Taihang) 5 qian, change Yu Rou to 1 liang, and change Zhe Shi to 8 qian. After taking one dose, if the asthma lightens but the chest feels hot, add Tian Dong (Asparagus Tuber) several qian as appropriate. Alternatively, my formulated Shen Zhe Zhen Qi Tang (Ginseng and Ocher Decoction to Settle Qi) may be used. In cases where sudden violent anger stirs up Liver Qi and Liver Fire, which then carries Chong Qi upward, accompanied by Stomach Qi rebelling upward, pressing against the Lung's inhalation preventing it from descending and causing asthma, use Chuan Lian Zi (Sichuan Chinaberry Seed), Sheng Hang Shao, Sheng Zhe Shi powder each 6 qian, Nong Po (Magnolia Bark), Qing Xia (Processed Pinellia), Ru Xiang (Frankincense), Mo Yao (Myrrh), Long Dan Cao (Gentian Root), Gui Zhi Jian (Cinnamon Twig Tip), Su Zi, and Gan Cao each 2 qian. Decoct these using thick rust water prepared from grinding iron. These three causes of asthma arise from the Liver and Kidney, yet their pulse presentations differ. In Yin deficiency failing to receive Qi, the pulse is often fine and rapid; in Yin deficiency combined with impending collapse of Yuan Qi, the pulse is often full at the top and deficient at the bottom; in Liver Fire and Liver Qi carrying Chong and Stomach Qi upward, the pulse is often hard, wiry, and long. Examining the pulse and differentiating the syndrome ensures no error.
Regarding asthma caused by the Lung, it arises because lung disease prevents the retention of inhaled air. These conditions differ into internal injury and external contraction. Let us first discuss lung failure to receive Qi due to internal injury. The opening and closing (Pi He) of the lung lobes are the natural mechanisms of respiration. The ability to breathe relies on the Great Qi in the chest rotating and moving, and also on the lively function of the lung lobes to facilitate this opening and closing. Sometimes, due to lung disease, the lively opening and closing of the lung lobes becomes difficult, resulting in a contracted nature. During summer heat, this contraction and frequency may slow slightly, allowing one to avoid asthma; however, upon exposure to cold, asthma immediately occurs. This is the syndrome of Lung Lao (Lung Consumption/Tuberculosis), which often develops during cold periods. It is suitable to use Sheng Huai Shan Yao (Fresh Chinese Yam from Huaiqing) ground into fine powder, boiled into porridge with about 1 liang per dose, mixed with cane sugar and white sugar, and taken with 7-8 fen of the Western medicine Pepzin (Bupenzheng/Bismuth Subgallate?). Since lung lobe contraction is due to reduced body fluids and stagnant blood vessels, the yam and cane sugar moisten it, and Pepzin resolves it (Pepzin is made from piglet and calf gastric juices, hence good at digestion); with time, it will heal itself. For cases with excessive stubborn phlegm, add 2 fen of Peng Sha (Borax) powder fine, taken together with Pepzin. For external treatment, moxibustion on Fei Shu (BL13) is also effective and can be combined with internal treatment. Where Pepzin is unavailable, Sheng Ji Nei Jin (Fresh Chicken Gizzard Lining) 3 fen powder can substitute, having stronger phlegm-resolving power than Pepzin.
In cases where phlegm accumulates in the Stomach, overflows above the diaphragm, infiltrates the Lung, and causes asthma, ancients often used Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) or Shi Zao Tang (Ten Date Pill) to purge it. These are symptomatic treatments, not fundamental cures. My formulated Li Tan Tang (Phlegm-Regulating Decoction), taken continuously for over ten doses, clears both the root and branch of this condition. The rationale of the formula is detailed in the original text, so I will not repeat it here. If the pathogen fills the chest, diaphragm, and Stomach Fu organs, manifesting not as phlegm but as fluid retention (Yin), specifically cold fluid retention (fluid retention has cold and heat types; heat fluid retention presents with a slippery pulse and often involves neurological issues; cold fluid retention presents with a wiry and fine pulse; generally stating all fluid retention is cold is incorrect), the patient may have intermittent asthma or relapse upon cold exposure. This indicates deficiency of Yang in the Upper Jiao. Treatment should use Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) from *Jin Gui Yao Lue*, adding Gan Jiang (Dried Ginger) 3 qian, Nong Po, and Chen Pi (Tangerine Peel) each 1.5 qian. This allows the medicinal heat to overcome the cold, transforming the fluid retention so it descends and exits via the water passages. In cases where not only the Yang of the Upper Jiao is severely deficient but also the Qi aspect is very deficient, causing cold fluid retention to fill the chest and cause asthma, the pulse is not only wiry and fine but also extremely weak. Add Sheng Jian Qi (Raw Astragalus Root) 5 qian to the previous formula, and change Gan Jiang to 5 qian. In autumn of the Renxu year, Yan XX consulted for his friend regarding twenty-six to twenty-seven years of cold fluid retention binding the chest, frequent severe asthma attacks, and extreme aversion to cold. I prescribed this formula (using 1 liang of Raw Astragalus and 8 qian of Dried Ginger; such heavy doses are only for extreme deficiency-cold syndromes). After ten doses, he was completely cured. Heavy use of Huang Qi (Astragalus) in the formula is because it tonifies the Great Qi in the chest; when the Great Qi is robust, it naturally transforms and descends cold fluid retention. The three cases discussed above are all internal-injury asthma originating from the Lung.
External contraction asthma generally originates from the Lung. Its treatment methods vary according to the specific syndrome. The exterior of the human body is governed by Wei Qi (Defensive Qi), which originates from the Great Qi in the chest. Since the Lung governs the skin and hair, it has a close relationship with the Lung Zang. Sometimes, the exterior is constrained by Wind-Cold, preventing Wei Qi from circulating throughout the body. Consequently, the Great Qi in the chest has no outlet, suddenly generating expansive force. Suspended in the chest, the Lung is squeezed by this force, causing asthma. Furthermore, due to the close relationship between the Lung and Wei Qi, stagnation of Wei Qi leads to stagnation of Lung Qi, also causing asthma. This is the syndrome treated by Ma Huang Tang (Ephedra Decoction) in *Shang Han Lun*, which often includes asthma. However, when using Ma Huang Tang, it is advisable to add Zhi Mu (Anemarrhena Rhizome) several qian to ensure resolution after sweating without risk. In Warm Diseases (Wen Bing), asthma may also occur initially. Treatment should use Bo He Ye (Mint Leaf) and Niu Bang Zi (Arctium Fruit) each 3 qian, Sheng Shi Gao (Raw Gypsum) powder 6 qian, and Gan Cao 2 qian. Or Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be used. However, Shi Gao must never be calcined, and its dosage should be several times that of Ma Huang (Gypsum can be used up to 1 liang, while Ma Huang for this syndrome rarely exceeds 2 qian). Although the asthma in these two syndromes is similar, the medications differ significantly because the pulse in Cold Damage (Shang Han) is floating and tight, whereas in Warm Disease it is surging and slippery.
When external Wind-Cold invades internally,凝滞 (stagnating) with water qi in the chest, pressing upward on Lung Qi to cause asthma, this is the Xiao Qing Long Tang (Minor Blue Dragon Decoction) syndrome from *Shang Han Lun*. One must strictly follow the method of adding Shi Gao to Xiao Qing Long Tang from *Jin Gui Yao Lue*, adding Sheng Shi Gao to approximately 1 liang for effectiveness. Additionally, the standard modification rule for this formula states that for asthma, remove Ma Huang and add Xing Ren (Apricot Kernel). However, when I use this formula to treat asthma, I consistently add Xing Ren but still retain Ma Huang 1 qian. For patients with a very deficient pulse, add Ye Tai Shen several qian. The revised dosages for Xiao Qing Long Tang used in later generations can be referenced here. Also, my formulated Cong Long Tang (Following Dragon Decoction) treats cases where asthma recurs after recovery following Xiao Qing Long Tang administration. It has repeatedly proven effective. The above two points outline the general treatment for external-contraction asthma.
For individuals with chronic consumption-related asthma and cough who develop symptoms upon slight external contraction, this is a syndrome of simultaneous internal injury and external contraction causing asthma. It should be treated with my formulated Jia Wei Yue Bi Jia Ban Xia Tang (Modified Yue Bi plus Pinellia Decoction). Because internal and external factors simultaneously cause asthma, the medication combines treatments for both.
However, although the aforementioned asthmas differ in etiology (internal/external, Liver/Kidney/Lung), they generally involve the inability to receive Qi, making inhalation difficult, i.e., "spitting inhalation" mentioned in *Shennong Bencao Jing*. Yet, there are asthmatic cases where inhalation is not difficult, but exhalation is. The etiology here is deficiency and sinking of the Great Qi in the chest, unable to drive the Lung to perform respiration. The person must strive to breathe to save themselves. The urgency of breathing resembles asthma but is fundamentally different from asthma due to failure to receive Qi. If differentiation is unclear, and one sees asthma and prescribes herbs to direct Qi downward and receive Qi, danger will appear immediately. Differentiating this syndrome is not difficult. Severe failure to receive Qi asthma必然 (necessarily) involves "shoulder breathing" (shrugging shoulders); Great Qi sinking asthma, even if breathing is noisy, will not involve shoulder shrugging, but rather drooping shoulders. Even comparing the pulses of these two syndromes reveals distinct differences: failure to receive Qi asthma often presents with a rapid pulse, or weak Chi position and strong Cun position; Great Qi sinking asthma often presents with a slow and powerless pulse, or the Chi position slightly surpasses the Cun position. Observing the signs and examining the pulse ensures accurate differentiation. The treatment should use my formulated Sheng Xian Tang (Ascending Sinking Decoction) to raise and tonify the Great Qi in the chest, curing the asthma.
In cases where Great Qi sinking causes asthma, combined with Yin deficiency failing to receive Qi causing asthma, breathing is difficult in both aspects. The person strives to breathe, presenting an asthmatic appearance. The pulse is weak and powerless, or slightly rapid, or the back feels tight with slight burning sensation in the body and mind. Treatment should use Sheng Huai Shan Yao 1 liang, Xuan Shen, Gan Gou Qi each 6 qian, Sheng Jian Qi 4 qian, Zhi Mu, and Gui Zhi Jian each 2 qian, decocted in water. Do not use Jie Geng (Platycodon Root), Sheng Ma (Cimicifuga Rhizome), or Chai Hu (Bupleurum Root) in the formula, lest they hinder the treatment of Yin deficiency failing to receive Qi. The asthmas in the above two syndromes share similarities but have differences; verified cases for Sheng Xian Tang are available for reference.
There is a rare case where Liver Qi and Gallbladder Fire carry Chong and Stomach Qi upward rushing to cause asthma. When this upward rush reaches its extreme, it squeezes the Great Qi in the chest downward, causing the asthma to stop abruptly, and breathing ceases entirely. Suddenly, asthma returns, cycling endlessly. This is the most bizarre form of asthma. I once treated a young woman who developed this syndrome due to marital discord. I used Gui Zhi Jian (Cinnamon Twig Tip) 4 qian. Fearing its heat, I assisted it with Dai Xin Cun Dong (Ophiopogon with heart) 3 qian. Decocted in water and taken, she was cured immediately. Reading *Shennong Bencao Jing*, Gui Zhi can raise Great Qi and simultaneously direct rebellious Qi downward. Using it proved effective instantly. Though small, Gui Zhi excels in both raising sinking and directing rebellious Qi downward. This is truly a unique gift of Heaven.