喘证虽有寒热之不同，要皆其本在肾，其标在肺。所以上逆，其原在胃，宜降气开郁。
热则清之，寒则温之，久病敛之，初病发之，甚则从其性以导之，乃治喘之大法也。
验案
一人气喘不得眠，此寒凝气滞于上、中二焦，水火相搏而肺喘也。用山药、茯苓以理其
中，而使肺有生生之气，苏梗以开其郁，杏仁以利其气，姜、桂、吴萸以敛其火，使之下行而温
肾，肾温则肺亦暖而行下降之令，喘可息矣。
一人每日早晨喘，自汗，此肺虚则阳气不足。早晨胃中宿食消尽，肺无所禀，则气不能
行降下之令，故上逆而喘；肺主皮毛，皮毛不敛而自汗也。用补中益气汤加附子、炮姜、五味，
一人喘，服清气化痰药，不效。此中气虚寒，阳不上升而浊气不降也。用人参、炮姜、
白术、炙甘草、白芍各一钱，五味五分，有汗加肉桂，无汗加麻黄，效。
一妇四季发喘，喜饮冷水，遍体作胀，胸中饱闷。医作痰火治之更甚，二年不愈。盖久
喘乃肺之虚，非肺之实也。用四君子汤加半夏、五味、白芍、杏仁、炮姜、肉桂、麻黄、枳
壳，一服即止。再发再服必止，治之如神。
咳嗽不一，所因不同也。因于风，宜辛凉以散之，前胡、紫苏、防风、葛根之属；因于
寒，宜辛温以发之，麻黄、羌活、细辛之属；因于湿，宜燥之，六君子汤，或半夏、桑皮之
属，或二陈汤；因于火，宜清润之，麦冬、紫菀、花粉、元参之属；因于虚，宜补之，人参
、黄 之属，或保元、四君、六君；因于气逆，宜清而降之，杏仁、苏子、陈皮、百合之属
；因于痰，实则疏之，虚则补之，水泛则温而敛之。盖肺属金，金受火烁，则煎熬津液而成
痰，宜清其火，火息则痰消；寒则肺不下降，肺液壅而成痰，宜温其肾，水暖则肺金下降之
令行而痰消。此治咳之大略也。若夫神而明之，在乎辨脉证之寒热虚实也。
咳嗽骨节痛，不能走履，此肺气不足，不能制肝，肝邪炽而风痰横溢也。肝主筋，筋伤
故运动不舒；肝克脾，脾伤故湿不化而成病；且肝主风，肝盛则风溢而痰横矣。故肺气不足
，乃病之本；肝脾之强弱，乃病之标。用四君子以补脾肺之不足，加陈皮以疏肝气之有余，
用以醒脾消痰，是正治之法也。
验案
一人咳嗽粪黑，医以为火，予投桂、附温其下焦而愈。盖病有阳有阴，阴者粪虽软，落
水而
故粪黑也。温暖下焦，阳气归原，则嗽止而黑自除。若以火论之，不明之甚也。
一人咳嗽，喉咙紧急，渐渐吐红，又兼肠风，已半年矣。予看得久病伤脾，脾脏润泽之
气不升于肺，肺气不降而成火，故咳嗽喉紧；脾不统血，故吐血、肠风。用白术二钱、甘草一钱
补脾，陈皮一钱理气，煨姜二钱散火。服五帖病减半。次升提之，用补中益气汤十帖；次调
和气血、消痰，用八珍汤加半夏、陈皮，二帖而痊。
一人十月患痢，半月后发喘咳，声哑口臭，头汗如雨，作火证治，至春不愈。诊其脉大
缓而无力，乃久病无阳，脾虚不统。用白术、茯苓各二钱，人参三钱，甘草、炮姜、白芍、生地
各一钱，半夏一钱五分，五味五分。三帖全愈。
一妇恼怒后，身热咳嗽，吐血痰，臭气难闻，胸膈饱闷，背胀。此郁火，宜发之。紫苏
、干葛、桔梗、前胡、枳壳、半夏、杏仁、五味、白芍、甘草、苡仁、生姜。一服而痊。
一人患内伤，二膝痛甚。此血分虚，阳气不能达下也。用四物汤送和中丸，元气流行，
血暖而痛止。至十余日，泄泻，发热，头痛，咳嗽。此内伤多下寒上热，所以然者，郁火上散，
寒气下行也。用补中益气汤加附子，温阳气而散火邪。二帖而愈。
喘证虽然存在寒证和热证的不同，但其根本在于肾，其标象在于肺。气之所以上逆，根源在于胃，治疗宜采用降气开郁的方法。
热证则用清热法，寒证则用温里法，久病用收敛法，初病用发散法，病情严重则顺应其病性以引导之，这是治疗喘证的总原则。
验案
有一人气喘严重到无法入睡，这是寒邪凝滞、气机阻滞于上焦和中焦，水火相搏导致肺失宣降而喘。使用山药、茯苓来调理中焦，使肺脏获得生生之气；苏梗来开通郁结；杏仁来利顺肺气；干姜、肉桂、吴茱萸来收敛浮火，使其下行并温补肾阳。肾阳温暖则肺脏亦暖，从而执行下降的职能，喘息即可平息。
有一人每天早晨气喘，伴有自汗，这是肺气虚弱导致阳气不足。早晨胃中宿食消化完毕，肺脏得不到水谷精气的禀受，因此气不能执行下降的职能，所以上逆而喘；肺主皮毛，皮毛不能固敛所以自汗。使用补中益气汤加附子、炮姜、五味子。
有一人气喘，服用清气化痰药，无效。这是中气虚寒，阳气不能上升而浊气不能下降。使用人参、炮姜、白术、炙甘草、白芍各一钱，五味子五分，有汗加肉桂，无汗加麻黄，见效。
有一位妇女四季都发作气喘，喜欢喝冷水，全身肿胀，胸中饱闷。医生当作痰火治疗反而加重，两年不愈。大概久喘乃是肺气虚弱，并非肺实证。使用四君子汤加半夏、五味子、白芍、杏仁、炮姜、肉桂、麻黄、枳壳，服一次即停止。再次发作再服用必然停止，治疗效果如神。
咳嗽原因不一，致病因素也不同。因风邪所致，宜用辛凉药物疏散，如前胡、紫苏、防风、葛根之类；因寒邪所致，宜用辛温药物发汗解表，如麻黄、羌活、细辛之类；因湿邪所致，宜用燥湿法，如六君子汤，或半夏、桑白皮之类，或二陈汤；因火邪所致，宜用清润法，如麦冬、紫菀、天花粉、玄参之类；因虚损所致，宜用补益法，如人参、黄芪之类，或保元汤、四君子汤、六君子汤；因气逆所致，宜清肃而降气，如杏仁、苏子、陈皮、百合之类；因痰饮所致，实证则疏泄之，虚证则补益之，水饮泛滥则温阳而收敛之。大概肺属金，金被火灼烧，则煎熬津液而成痰，宜清其火，火熄灭则痰消除；寒邪则肺不能下降，肺液壅滞而成痰，宜温其肾，水温暖则肺金下降的职能执行而痰消除。这是治疗咳嗽的大略原则。至于神妙明达之处，在于辨别脉证的寒热虚实。
咳嗽伴骨节疼痛，不能行走，这是肺气不足，不能制约肝木，肝邪炽盛而风痰横溢。肝主筋，筋受伤故运动不舒展；肝克脾，脾受伤故湿气不化而成病；且肝主风，肝盛则风溢而痰横。所以肺气不足，是疾病的根本；肝脾的强弱，是疾病的标象。使用四君子汤来补益脾肺的不足，加陈皮来疏泄肝气的有余，用以醒脾消痰，这是正治之法。
验案
有一人咳嗽且大便色黑，医生认为是火证，我投予桂枝、附子温补下焦而痊愈。大概疾病有阳证有阴证，阴证者大便虽软，落水后下沉（注：原文此处似有缺字，结合语境意为沉底或黑色属阴），所以大便色黑。温暖下焦，阳气归位，则咳嗽停止而黑色自除。如果当作火证论治，是非常不明智的。
有一人咳嗽，喉咙紧急，渐渐吐血，又兼肠风（便血），已经半年了。我看他是久病伤脾，脾脏润泽之气不能升于肺，肺气不降而成火，所以咳嗽喉紧；脾不统血，所以吐血、肠风。使用白术二钱、甘草一钱补脾，陈皮一钱理气，煨姜二钱散火。服用五帖病减半。其次升提中气，使用补中益气汤十帖；其次调和气血、消痰，使用八珍汤加半夏、陈皮，两帖而痊愈。
有一人十月患痢疾，半月后发作气喘咳嗽，声音嘶哑口臭，头部出汗如雨，医生作火证治疗，到春天仍未痊愈。诊其脉大缓而无力，这是久病无阳，脾虚不能统摄。使用白术、茯苓各二钱，人参三钱，甘草、炮姜、白芍、生地各一钱，半夏一钱五分，五味子五分。三帖全愈。
有一位妇女恼怒后，身体发热咳嗽，吐血腥臭难闻的痰，胸膈饱闷，背部胀满。这是郁火，宜用发散法。紫苏、干葛、桔梗、前胡、枳壳、半夏、杏仁、五味子、白芍、甘草、薏苡仁、生姜。服一次而痊愈。
有一人患内伤，双膝疼痛剧烈。这是血分虚，阳气不能到达下肢。使用四物汤送服和中丸，元气流行，血液温暖而疼痛停止。到了十多天，出现泄泻、发热、头痛、咳嗽。这是内伤多表现为下寒上热，之所以这样，是因为郁火上散，寒气下行。使用补中益气汤加附子，温补阳气而散火邪。两帖而愈。
Although asthma (asthma syndrome) presents with differences between cold and heat patterns, its root lies in the Kidney, while its branch manifestation is in the Lung. The reason for Qi rebelling upward originates in the Stomach; therefore, treatment should prioritize descending Qi and resolving stagnation.
For heat patterns, clear them; for cold patterns, warm them; for chronic illness, astringe them; for acute illness, disperse them; and for severe cases, guide them according to their nature. This constitutes the general principles for treating asthma.
Clinical Case 1
A patient suffered from severe asthma preventing sleep. This was due to Cold congealing and Qi stagnating in the Upper and Middle Jiao, with Water and Fire clashing, causing Lung asthma. Shanyao (Dioscoreae Rhizoma) and Fuling (Poria) were used to regulate the Middle Jiao, allowing the Lung to receive vital energy. Sugen (Perillae Caulis) was used to open stagnation, Xingren (Armeniacae Semen Amarum) to facilitate Qi flow, Jiang (Zingiberis Rhizoma Preparatum), Rougui (Cinnamomi Cortex), and Wuyu (Evodiae Fructus) to constrain floating Fire and direct it downward to warm the Kidney. Once the Kidney is warmed, the Lung becomes warm and executes its descending function, and the asthma subsides.
A patient experienced daily morning asthma accompanied by spontaneous sweating. This indicates Lung deficiency leading to insufficient Yang Qi. In the morning, after stomach residue is digested, the Lung lacks nourishment from grain essence, so Qi cannot execute its descending function, rebelling upward to cause asthma. Since the Lung governs the skin and hair, failure of the skin and hair to consolidate results in spontaneous sweating. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was administered with Fuzi (Aconiti Lateralis Radix Preparata), Paojiang (Zingiberis Rhizoma Preparatum), and Wuweizi (Schisandrae Fructus).
A patient with asthma showed no improvement after taking drugs that clear Heat and resolve Phlegm. This indicated deficiency-cold in the Middle Qi, where Yang failed to ascend and turbid Qi failed to descend. Renshen (Ginseng Radix), Paojiang, Baizhu (Atractylodis Macrocephalae Rhizoma), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparatum), and Baishao (Paeoniae Radix Alba) were each prescribed at one qian, Wuweizi at five fen. If sweating was present, Rougui was added; if absent, Mahuang (Ephedrae Herba) was added. The treatment was effective.
A woman suffered from seasonal asthma attacks throughout the year, desired drinking cold water, experienced generalized swelling, and chest fullness. Physicians treated her as Phlegm-Fire, which worsened her condition, leaving her ill for two years. Chronic asthma is typically Lung deficiency, not excess. Sijunzi Tang (Four Gentlemen Decoction) was used with Banxia (Pinelliae Rhizoma), Wuweizi, Baishao, Xingren, Paojiang, Rougui, Mahuang, and Zhike (Aurantii Fructus). One dose stopped the symptoms. Recurrence was also halted by subsequent doses, yielding miraculous results.
Cough arises from various causes. For Wind etiology, use acrid-cool dispersants such as Qianhu (Peucedani Radix), Zisu (Perillae Folium), Fangfeng (Saposhnikoviae Radix), and Gegen (Puerariae Lobatae Radix). For Cold etiology, use acrid-warm diaphoretics such as Mahuang, Qianghuo (Notopterygii Rhizoma et Radix), and Xixin (Asari Radix et Rhizoma). For Dampness etiology, use drying methods like Liujunzi Tang (Six Gentlemen Decoction), or Banxia, Sangpiao (Mori Cortex), or Erchen Tang (Two Aged Things Decoction). For Fire etiology, use clearing and moistening agents such as Maidong (Ophiopogonis Radix), Ziwan (Asternis Radix), Huafen (Trichosanthis Radix), and Yuanshen (Scrophulariae Radix). For Deficiency etiology, use tonics such as Renshen, Huangqi (Astragali Radix), or Baoyuan Tang (Preserve the Origin Decoction), Sijunzi Tang, or Liujunzi Tang. For Qi rebellion, use clearing and descending agents such as Xingren, Suzi (Perillae Fructus), Chenpi (Citri Reticulatae Pericarpium), and Baihe (Lilii Bulbus). For Phlegm etiology, treat excess by draining and deficiency by tonifying; for flooding water, warm and astringe. Generally, the Lung belongs to Metal. If Metal is scorched by Fire, body fluids are concentrated into Phlegm; thus, clear the Fire, and once extinguished, the Phlegm dissipates. If Cold prevails, the Lung fails to descend, and Lung fluids accumulate into Phlegm; thus, warm the Kidney, and once the Water is warm, the Lung's descending function resumes, and the Phlegm dissipates. These are the general principles for treating cough. Profound understanding depends on distinguishing the cold, heat, deficiency, and excess in pulse and symptom patterns.
Cough accompanied by joint pain and inability to walk indicates Lung Qi insufficiency failing to control Liver Wood. Consequently, Liver pathogenic factors become vigorous, causing Wind-Phlegm to overflow. The Liver governs sinews; sinew injury leads to stiff movement. The Liver overacts on the Spleen; Spleen injury leads to dampness accumulation and disease. Furthermore, the Liver governs Wind; Liver excess causes Wind overflow and Phlegm stagnation. Thus, Lung Qi insufficiency is the root of the disease, while the strength or weakness of the Liver and Spleen is the branch. Sijunzi Tang was used to tonify Spleen and Lung deficiencies, plus Chenpi to vent Liver Qi excess, thereby awakening the Spleen and resolving Phlegm. This is the orthodox treatment method.
Clinical Case 2
A patient with cough had black stools. Physicians attributed this to Fire. I prescribed Guizhi (Cinnamomi Ramulus) and Fuzi to warm the Lower Jiao, resulting in recovery. Diseases have Yang and Yin aspects. In Yin patterns, although stool may be soft, it sinks in water, hence the black color. Warming the Lower Jiao restores Yang to its origin, stopping the cough and eliminating the black stool. Diagnosing this as Fire would be highly misguided.
A patient with cough experienced throat tightness, gradual hemoptysis, and intestinal wind (hematochezia) for half a year. I diagnosed chronic Spleen injury: the Spleen's moistening Qi failed to ascend to the Lung, causing Lung Qi to fail to descend and generate Fire, leading to cough and throat tightness. Spleen failure to control blood caused hemoptysis and intestinal wind. Baizhu (two qian) and Gancao (one qian) were used to tonify the Spleen; Chenpi (one qian) to regulate Qi; and Wei Jiang (Baked Ginger, two qian) to scatter Fire. After five doses, symptoms halved. Subsequently, Bu Zhong Yi Qi Tang (Ten doses) was used to lift Qi. Finally, Bazhen Tang (Eight Treasures Decoction) with Banxia and Chenpi was used to harmonize Qi and Blood and resolve Phlegm, curing the patient in two doses.
A patient contracted dysentery in October. Half a month later, asthma and cough developed, with hoarseness, foul breath, and profuse head sweating. Treated as Fire pattern without improvement until Spring. The pulse was large, slow, and powerless, indicating chronic illness with Yang deficiency and Spleen deficiency failing to control blood. Baizhu and Fuling (each two qian), Renshen (three qian), Gancao, Paojiang, Baishao, and Shengdi (Rehmanniae Radix, each one qian), Banxia (one qian five fen), and Wuweizi (five fen) were prescribed. Full recovery occurred after three doses.
A woman developed fever, cough, and expectoration of foul-smelling bloody sputum, chest fullness, and back distension following anger. This was constrained Fire, requiring dispersion. Zisu, Gange (Puerariae Radix), Jiegeng (Platycodonis Radix), Qianhu, Zhike, Banxia, Xingren, Wuweizi, Baishao, Gancao, Yiyiren (Coicis Semen), and Shengjiang (Fresh Ginger) were prescribed. Cure was achieved after one dose.
A patient with internal injury suffered severe knee pain. This indicated Blood deficiency preventing Yang Qi from reaching the lower limbs. Siwu Tang (Four Substances Decoction) was taken with Hezhong Wan (Harmonize the Middle Pill). As Yuan Qi circulated and Blood warmed, pain ceased. Ten days later, diarrhea, fever, headache, and cough appeared. Internal injuries often manifest as Cold below and Heat above, due to constrained Fire scattering upward and Cold descending. Buzhong Yiqi Tang with Fuzi was used to warm Yang Qi and scatter Fire pathogens. Recovery occurred after two doses.