《三因方》云∶喘病肺实者，肺必胀，上气，咽中逆，如欲呕状，自汗。肺虚者，必咽
干无
液，少气不足以息也。王宇泰云∶喘而无汗，烦躁，脉浮大者，汗之。喘而有汗，腹满，脉
沉实者，下之。又云∶喘而自汗，腹满便秘，气口脉大于人迎，下之无疑，外此则不宜轻下
也。
咳嗽气急，喉声如鼾者为虚。喉中如水鸡声者为实。戴复庵云∶有痰喘，有气喘，有胃
虚喘
，有火炎上喘。痰喘者，凡喘便有痰声。气喘者，呼吸急促而无痰声。胃气虚喘者，抬肩撷
肚，喘而不休。火炎上喘者，乍进乍退，得食则减，食已复甚。大概胃中有实火，膈上有稠
痰，得食入咽，坠下痰涎，其喘即止。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。
肺虚如器而不容物，痰热实之，则气不得宣，呼吸壅滞，喘急妨闷，胸膈痞痛彻背者，
宜
《济生》栝蒌实丸。此与水气相似，但水即饮也，饮体稀而痰质稠，饮多寒而痰多热耳。
《济生》栝蒌实丸
栝蒌实（研） 枳实（去瓤，麸炒） 桔梗 半夏（等分）
上为末，姜汁打糊为丸，如梧子大，每服五七十丸，食后淡姜汤下。
《元戎》葶苈大枣汤
葶苈（二两，炒紫色，杵成丸）
以水三升，大枣二十枚，同煮取二升，去滓，内麻黄、五味子各半两，取清，令二日服
一剂
尽，瘥。《外台》方∶葶苈、杏仁二味，杵末，枣肉丸。此又加麻黄、五味，其用弥广矣。
《三因方》记载：喘病属于肺实证时，肺部必然胀满，气逆向上，咽喉部有气逆感，好像要呕吐的样子，伴有自汗。肺虚证时，必然咽喉干燥无津液，气息短少，呼吸不足以接续。王宇泰说：喘而无汗，烦躁，脉象浮大的，应当用发汗法治疗。喘而有汗，腹部胀满，脉象沉实的，应当用泻下法治疗。又说：喘而自汗，腹部胀满且便秘，气口脉大于人迎脉的，用泻下法毫无疑问，除此之外则不宜轻易使用泻下法。
咳嗽且气急，喉间声音像打鼾的是虚证。喉中发出像水鸡（青蛙）叫声的是实证。戴复庵说：有痰喘，有气喘，有胃虚喘，有火炎上喘。痰喘，凡是喘都伴有痰声。气喘，呼吸急促但没有痰声。胃气虚喘，表现为抬肩撷肚，喘息不止。火炎上喘，症状忽轻忽重，进食后减轻，吃完后又加重。大抵是因为胃中有实火，膈上有稠痰，食物咽下后坠下痰涎，喘息随即停止。稍久之后，食物进入胃中，反而助长火势，痰再次升腾上来，喘息反而大作。世俗之人不了解这一点，将其当作胃虚，用燥热药物治疗，这是以火救火。
肺虚就像容器一样不能容纳异物，若被痰热充实，则气机不得宣通，呼吸壅滞不畅，喘息急促且胸闷，胸膈痞痛牵引至背部者，适宜使用《济生方》栝蒌实丸。这与水气病相似，只是水即饮邪，饮邪质地稀薄而痰浊质地粘稠，饮邪多寒而痰浊多热罢了。
《济生方》栝蒌实丸
栝蒌实（研碎） 枳实（去瓤，麸炒） 桔梗 半夏（以上四味等分）
将上述药物研为细末，用姜汁调糊制成丸药，如梧桐子大小，每次服用五七十丸，饭后用淡姜汤送服。
《元戎》葶苈大枣汤
葶苈（二两，炒至紫色，捣成丸状）
用水三升，大枣二十枚，共同煮取二升药液，去掉药渣，加入麻黄、五味子各半两，煎取清液，令患者两天内服完一剂，病愈。《外台秘要》方：葶苈、杏仁两味药，研为细末，用枣肉做成丸剂。这个方子又加入了麻黄、五味子，其应用范围更加广泛了。
According to *San Yin Fang* (Treatise on the Three Causes): In cases of asthma due to excess in the Lung, the Lung must be distended, with rebellious Qi rising upward, a sensation of Qi rebellion in the throat resembling the urge to vomit, accompanied by spontaneous sweating. In cases of deficiency in the Lung, there must be dryness of the throat without fluid, shortness of Qi, and insufficient breath to sustain respiration. Wang Yutai stated: For asthma without sweating, restlessness, and a floating and large pulse, treatment should employ diaphoresis (sweating method). For asthma with sweating, abdominal fullness, and a deep and solid pulse, treatment should employ purgation (draining method). He further stated: For asthma with spontaneous sweating, abdominal fullness, constipation, and a Qi Kou pulse larger than the Ren Ying pulse, purgation is undoubtedly indicated; otherwise, purgation should not be used lightly.
Coughing with rapid breathing and a snoring sound in the throat indicates deficiency. A sound in the throat like that of a water chicken (frog) indicates excess. Dai Fu'an stated: There is phlegm-induced asthma, Qi-induced asthma, Spleen-Stomach deficiency-induced asthma, and Fire-flaring-upward-induced asthma. Phlegm-induced asthma is characterized by wheezing accompanied by phlegm sounds. Qi-induced asthma is characterized by rapid breathing without phlegm sounds. Spleen-Stomach Qi deficiency-induced asthma presents with lifting of the shoulders and drawing in of the abdomen, with continuous wheezing. Fire-flaring-upward-induced asthma features symptoms that fluctuate in intensity, improving after eating but worsening shortly thereafter. Generally, this occurs because there is excess fire in the Stomach and thick phlegm above the Diaphragm; when food enters the throat and pushes down the phlegm-saliva, the wheezing stops. However, after a while, once the food enters the Stomach, it instead fuels the fire, causing the phlegm to rise again, leading to a severe exacerbation of wheezing. Laypeople do not understand this and treat it as Spleen-Stomach deficiency using drying and hot medicines, which is akin to adding fuel to the fire.
When the Lung is deficient, it is like a vessel that cannot accommodate foreign matter; if filled with phlegm-heat, Qi cannot circulate freely, resulting in obstructed and stagnant respiration, urgent wheezing with chest oppression, and epigastric and precordial stuffiness and pain radiating to the back. In such cases, *Ji Sheng Fang* Gua Lou Shi Wan (Trichosanthes Fruit Pill) is appropriate. This condition resembles water-Qi disease, but water refers to fluid retention, which has a thin consistency, whereas phlegm has a thick consistency; fluid retention is mostly cold, while phlegm is mostly heat.
*Ji Sheng Fang* Gua Lou Shi Wan (Trichosanthes Fruit Pill)
Gua Lou Shi (Fructus Trichosanthis, crushed) Zhi Shi (Fructus Aurantii Immaturus, pith removed, stir-fried with bran) Jie Geng (Radix Platycodonis) Ban Xia (Rhizoma Pinelliae) [All in equal proportions]
Grind the above herbs into powder, mix with ginger juice to form a paste, and make pills the size of a wu zi (fruit of the Chinese parasol tree). Take 50-70 pills per dose, administered after meals with light ginger soup.
*Yuan Rong* Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction)
Ting Li (Semen Descurainiae, 2 liang, stir-fried until purple, pounded into pills)
Add 3 sheng of water and 20 jujubes, boil together until 2 sheng remains, strain the dregs, add Ma Huang (Herba Ephedrae) and Wu Wei Zi (Fructus Schisandrae), each 0.5 liang, decoct to obtain clear liquid. The patient should take one dose over two days until cured. *Wai Tai Mi Yao* formula: Semen Descurainiae and Radix Armeniacae Amarum in equal parts, pounded into powder, formed into pills with jujube pulp. This formula adds Ma Huang and Wu Wei Zi, broadening its application significantly.