伊芳 先寒后热。不饥不食。继浮肿喘呛。俯不能仰。仰卧不安。古人以先喘后胀治肺。先胀后喘
治脾。今由气分 郁。以致水道阻塞。大便溏泄。仍不爽利。其肺气不降。二肠交阻。水谷蒸腐
之湿。横趋脉络。肿由渐加。岂乱医可效。粗述大略。与高明论证。（肺郁水气不降）
肺位最高。主气。为手太阴脏。其脏体恶寒恶热。宣辛则通。微苦则降。若药气味重浊。直入
中下。非宣肺方法矣。故手经与足经大异。当世不分手足经混治者。特表及之。
麻黄 苡仁 茯苓 杏仁 甘草
某 气逆咳呛喘促。小青龙去桂枝芍草加杏仁人参。
某 气逆咳呛喘急。
淡干姜 人参 半夏 五味 茯苓 细辛
单 疮毒内攻。所进水谷不化。蒸变湿邪。渍于经隧之间。不能由肠而下。膀胱不利。浊上壅遏。
肺气不降。喘满不堪着枕。三焦闭塞。渐不可治。议用中满分消之法。必得小便通利。可以援救。
葶苈 苦杏仁 桑皮 浓朴 猪苓 通草 大腹皮 茯苓皮 泽泻
汪 脉弦坚。动怒气冲。喘急不得卧息。此肝升太过。肺降失职。两足逆冷。入暮为剧。议用仲景
越婢法。（肝升饮邪上逆）
又 按之左胁冲气便喘。背上一线寒冷。直贯两足。明是肝逆挟支饮所致。议用金匮旋复花汤法。
旋复花 青葱管 新绛 炒半夏
姜 劳烦哮喘。是为气虚。盖肺主气。为出气之脏。气出太过。但泄不收。则散越多喘。是喘症之
属虚。故益肺气药皆甘。补土母以生子。若上气散越已久。耳目诸窍之阻。皆清阳不司转旋
之机。不必缕治。（中气虚）人参建中汤去姜。
沈（二三） 晨起未食。喘急多痰。此竟夜不食。胃中虚馁。阳气交升。中无弹压。下焦阴伤。已延及胃。难
以骤期霍然。（胃虚）
黄精 三角胡麻 炙草 茯苓
吴 浊饮自夜上干填塞。故阳不旋降。冲逆不得安卧。用仲景真武法。（肾阳虚浊饮上逆）
人参 淡熟附子 生淡干姜 茯苓块 猪苓 泽泻
徐（四二） 色痿腠疏。阳虚体质。平昔喜进膏粱。上焦易壅。中宫少运。浓味凝聚蒸痰。频年咳嗽。但内
伤失和。薄味自可清肃。医用皂荚搜攒。肺伤气泄。喷涕不已。而沉锢胶浊。仍处胸背募俞之
间。玉屏风散之固卫。六君子汤之健脾理痰。多是守剂。不令宣通。独小青龙汤。彻饮以就太
阳。初服喘缓。得宜通之意。夫太阳但开。所欠通补阳明一段工夫。不得其阖。暂开复痹矣。且
喘病之因。在肺为实。在肾为虚。此病细诊色脉。是上实下虚。以致耳聋鸣响治下之法。壮水
源以熄内风为主。而胸次清阳少旋。浊痰阻气妨食。于卧时继以清肃上中二焦。小剂守常。
调理百日图功。至于接应世务。自宜节省。勿在药理中也。（肾气不纳）
熟地（砂仁制） 萸肉 龟甲心 阿胶 牛膝 茯苓 远志 五味 磁石 秋石
蜜丸。早服。卧时另服威喜丸。竹沥姜汁泛丸。
张（三十） 幼年哮喘已愈。上年夏令。劳倦内伤致病。误认外感乱治。其气泄越。哮喘音哑。劳倦不复。
遂致损怯。夫外感之喘治肺。内伤之喘治肾。以肾主纳气耳。
加减八味丸每服二钱五分盐汤下 六服。
胡（六十） 脉沉。短气以息。身动即喘。此下元已虚。肾气不为收摄。痰饮随地气而升。有年。陡然中厥
最虑。
熟地 淡附子 茯苓 车前 远志 补骨脂
吴 气不归元。喘急跗肿冷汗。足寒面赤。中焦痞结。先议通阳。
熟附子 茯苓 生姜汁 生白芍
王（十九） 阴虚喘呛。用镇摄固纳。
熟地 萸肉 阿胶 淡菜胶 山药 茯神 湖莲 芡实
翁（四二） 脉细尺垂。形瘦食少。身动即气促喘急。大凡出气不爽而喘为肺病。客感居多。今动则阳
化。由乎阴弱失纳。乃吸气入而为喘。肾病何辞。治法惟以收摄固真。上病当实下焦。宗肾气
方法意。
熟地 萸肉 五味 补骨脂 胡桃肉 牛膝
茯苓 山药 车前子 蜜丸。
沈（二三） 阴虚阳升。气不摄纳为喘。
熟地 萸肉 五味 海参胶 淡菜胶 茯神 山药 芡实 湖莲肉 紫胡桃
杨（六一） 老年久嗽。身动即喘。晨起喉舌干燥。夜则溲溺如淋。此肾液已枯。气散失纳。非病也。衰也。
故治喘鲜效。便难干涸。宗肾恶燥。以辛润之。
熟地 杞子 牛膝 巴戟肉 紫衣胡桃 青盐 补骨脂
陈（氏） 咳喘则暴。身热汗出。乃阴阳枢纽不固。惟有收摄固元一法。
人参 炙草 五味 紫衣胡桃 熟地 萸肉炭 茯神 炒山药
又 摄固颇应。
人参 附子 五味 炙黄 白术
某 疮痍疥疾。致气喘咳出血痰。固是肺壅热气。今饮食二便如常。行动喘急。与前喘更有分
别。缘高年下虚。肾少摄纳。元海不固。气逆上泛。是肿胀之萌。宜未雨绸缪。六味丸加牛膝 车前胡桃。
孙 望八大年。因冬温内侵。遂致痰嗽暮甚。诊脉大而动搏。察色形枯汗泄。吸音颇促。似属痰
阻。此乃元海根微。不司藏纳。神衰呓语。阳从汗出。最有昏脱之变。古人老年痰嗽喘症。都从
脾肾主治。今温邪扰攘。上中二焦留热。虽无温之理。然摄固下真以治根本。所谓阳根于阴。
岂可不为讲究。
熟地炭 胡桃肉 牛膝炭 车前子 云茯苓 青铅
某 热炽在心。上下不接。冲逆陡发。遍身麻木。喘促昏冒。肾真不固。肝风妄动。久病汤药无功。
暂以玉真丸主之。
喘症之因。在肺为实。在肾为虚。先生揭此二语为提纲。其分别有四。大凡实而寒者。必挟
凝痰宿饮。上干阻气。如小青龙桂枝加朴杏之属也。实而热者。不外乎蕴伏之邪。蒸痰化
火。有麻杏甘膏。千金苇茎之治也。虚者。有精伤气脱之分。填精以浓浓之剂。必兼镇摄。肾
气加沉香。都气入青铅。从阴从阳之异也。气脱则根浮。吸伤元海。危亡可立而待。思草木
之无情。刚柔所难济。则又有人参河车五味石英之属。急续元真。挽回顷刻。补天之治。古
所未及。更有中气虚馁。土不生金。则用人参建中。案集三十。法凡十九。其层次轻重之间。
丝丝入扣。学人宜深玩而得焉。（邵新甫）
徐评 此篇治下之法已备。治上之法尚多遗漏。不可不讲也。
[Background Information]
Book: *Lin Zheng Zhi Nan Yi An* (Medical Cases Guided by Clinical Practice)
Author: Ye Gui (Ye Tianshi)
Dynasty: Qing
Chapter: Asthma (Chuan)
Category: Medical Discussion
[Translation]
A patient presented with initial aversion to cold followed by fever. There was no sensation of hunger and inability to eat. Subsequently, generalized edema, asthma, and choking cough developed. The patient could not lie on their back but could not bear lying flat either. Ancient texts state that asthma preceding distension is treated in the Lung, while distension preceding asthma is treated in the Spleen. In this case, the condition arises from Qi stagnation in the Qi level, leading to obstruction of the water passages, loose stools, and incomplete defecation. This is due to the failure of Lung Qi to descend, causing obstruction in the Large and Small Intestines. Dampness generated from the steaming and rotting of food and fluids spreads horizontally into the collaterals, causing gradual worsening of edema. Such a condition cannot be effectively treated by mediocre physicians. I briefly outline the general principles for discussion by experts. (Pathogenesis: Lung Qi stagnation, failure of Water Qi to descend)
The Lung is located at the highest position, governs Qi, and belongs to the Hand-Taiyin organ system. Its nature dislikes both cold and heat; pungent flavors promote circulation and unblockage, while slightly bitter flavors promote descent. If medicinal flavors are heavy and turbid, they will directly enter the Middle and Lower Jiao, which is not the method for diffusing the Lung. Therefore, the treatment of the Hand meridians differs significantly from that of the Foot meridians. It is pointed out here that contemporary practitioners often treat them indiscriminately.
Prescription: Ephedrae Herba (Mahuang), Coicis Semen (Yiyiren), Poria (Fuling), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao).
Another patient presented with rebellious Qi causing cough, choking cough, and rapid breathing. Xiao Qing Long Tang (Minor Blue Dragon Decoction) was modified by removing Cinnamomi Ramulus (Guizhi), Paeoniae Radix (Shaoyao), and Glycyrrhizae Radix et Rhizoma (Gancao), adding Armeniacae Semen Amarum (Xingren) and Ginseng Radix (Renshen).
Another patient presented with rebellious Qi causing cough, choking cough, and urgent asthma.
Prescription: Dried Ginger (Ganjiang), Ginseng Radix (Renshen), Pinelliae Tuber (Banxia), Schisandrae Fructus (Wuweizi), Poria (Fuling), Asari Radix (Xixin).
Patient surnamed Shan presented with internal invasion of carbuncle toxins. Ingested food and fluids were not digested, transforming into damp-evil, soaking between the meridians and collaterals. Unable to descend through the intestines, the Bladder’s transformation was impaired, causing turbid Qi to obstruct upwards. Lung Qi failed to descend, resulting in severe asthma and chest fullness preventing sleep. The Triple Burner was blocked, and the condition gradually became incurable. It is proposed to use the method of resolving middle-jiao fullness (Zhong Man Fen Xiao), ensuring free urination to save the life.
Prescription: Lepidii Fructus (Tinglizi), Armeniacae Semen Amarum (Kuxingren), Morus Cortex (Sangpifu), Magnoliae Officinalis Cortex (Houpo), Polyporus (Zhu Ling), Akebiae Caulis (Tong Cao), Arecae Pericarpium (Dafupi), Poria Cum Ligno Quercus (Fulingpi), Alisma Rhizoma (Zexie).
Patient surnamed Wang presented with a wiry and firm pulse. Anger caused Qi rushing upward, resulting in urgent asthma preventing recumbency. This is due to excessive Liver Qi ascending and failure of Lung Qi to descend. Both feet were cold, worsening in the evening. It is proposed to use Zhang Zhongjing’s Yue Bi Fa (Method of Yue Bi Decoction). (Pathogenesis: Liver Qi ascending, Phlegm-Fluids counterflowing upward)
Re-examination: Pressing the left hypochondrium triggered rebellious Qi and asthma. A line of coldness on the back extended straight down to both feet. This clearly indicates Liver rebellion carrying Branch Fluids (Zhi Yin). It is proposed to use the Xuan Fu Hua Tang (Inula Flower Decoction) method from the *Jin Gui Yao Lue*.
Prescription: Inulae Flos (Xuanfuhua), Scallion Stem (Qingcong Guan), New Crimson Dye (Xinjiang), Stir-fried Pinelliae Tuber (Chao Banxia).
Patient surnamed Jiang presented with labor-induced asthma due to mental fatigue, belonging to Qi deficiency. The Lung governs Qi and is the organ of exhalation. Excessive exhalation without retention leads to dispersion and increased asthma. This type of asthma belongs to deficiency. Therefore, herbs tonifying Lung Qi are mostly sweet. Tonifying the Earth (Spleen) generates Metal (Lung). If Upper Qi has been dispersed for a long time, blockages in the orifices of the ears and eyes are due to the loss of clear Yang’s rotating mechanism. Detailed treatment is unnecessary. (Pathogenesis: Middle Qi deficiency) Use Ren Jian Zhong Tang (Ginseng Middle-Building Decoction) removing Ginger.
Patient surnamed Shen (23 years old) presented with urgent asthma and profuse phlegm upon waking before eating. This is due to fasting all night, causing empty and weak Stomach Qi. Yang Qi rises, but the Middle Jiao lacks pressure. Lower Jiao Yin is damaged, extending to the Stomach. Recovery cannot be expected immediately. (Pathogenesis: Stomach deficiency)
Prescription: Polygonati Rhizoma (Huangjing), Sesame Seed (Sanjiao Huma), Roasted Licorice Root (Zhicao), Poria (Fuling).
Patient surnamed Wu presented with turbid fluid invading upward from night, blocking Yang Qi from descending. Rebellious Qi prevents comfortable lying. Use Zhang Zhongjing’s Zhen Wu Fa (Method of Zhen Wu Decoction). (Pathogenesis: Kidney Yang deficiency, turbid fluid counterflowing upward)
Prescription: Ginseng Radix (Renshen), Prepared Aconite Root (Dan Shu Fuzi), Raw Dried Ginger (Sheng Dan Ganjiang), Poria Block (Fuling Kuai), Polyporus (Zhu Ling), Alisma Rhizoma (Zexie).
Patient surnamed Xu (42 years old) presented with sallow complexion and loose pores, indicating a Yang-deficient constitution. Habitually consuming rich foods led to upper Jiao congestion and poor middle Jiao transport. Rich flavors condensed into steaming phlegm, causing chronic cough. However, this is internal injury and disharmony; bland diet naturally clears the Lung. Physicians used Sinapis Semen (Zao Jiao) to scrape phlegm, damaging Lung Qi and causing continuous sneezing. Deep-seated turbid phlegm remains in the chest and back shu points. Yu Ping Feng San secures the defensive Qi, Liu Jun Zi Tang strengthens the Spleen and resolves phlegm; these are mostly static formulas lacking diffusion. Only Xiao Qing Long Tang thoroughly removes fluid to reach the Taiyang channel. Initial dose relieved asthma, fitting the principle of diffusion. However, Taiyang only opened, lacking the work of diffusing and tonifying Yangming. Without Yangming closing, temporary opening leads to re-obstruction. Asthma causes: excess in Lung, deficiency in Kidney. Careful diagnosis shows upper excess and lower deficiency, causing tinnitus. Treatment of the lower part focuses on nourishing water to extinguish internal wind. Clear Yang in the chest rotates little; turbid phlegm blocks Qi and appetite. At bedtime, continue clearing the Upper and Middle Jiao with small doses for routine regulation, aiming for results in 100 days. Save energy for worldly affairs, do not waste it on pharmacology. (Pathogenesis: Kidney Qi failing to grasp)
Prescription: Prepared Rehmannia Root (Shudi, processed with Amomum), Cornus Fruit (Yurou), Turtle Plastron Heart (Guijia Xin), Donkey-hide Gelatin (Ejiao), Achyranthes Root (Niuxi), Poria (Fuling), Polygala Root (Yuanzhi), Schisandra Fruit (Wuweizi), Magnetite (Cishi), Sea Salt (Qushi).
Make honey pills, take in the morning. Take Wei Xi Wan at bedtime, made into pills with Bamboo Sap and Ginger Juice.
Patient surnamed Zhang (30 years old) had childhood asthma cured. Last summer, labor-induced internal injury caused illness. Misdiagnosed as external contraction and treated incorrectly, leading to Qi dispersion, hoarse asthma, and failure to recover from labor, resulting in consumptive weakness. External contraction asthma is treated in the Lung; internal injury asthma is treated in the Kidney because the Kidney grasps Qi.
Prescription: Modified Ba Wei Wan (Eight-Ingredient Pill), 2.5 qian per dose, taken with salt water, six doses.
Patient surnamed Hu (60 years old) presented with a deep pulse, shortness of breath, and asthma upon movement. This indicates deficiency of the Lower Yuan, failure of Kidney Qi to retain, and phlegm-fluids rising with Earth Qi. Due to advanced age, sudden stroke (Zhong Jue) is feared.
Prescription: Prepared Rehmannia Root (Shudi), Mild Aconite Root (Dan Fuzi), Poria (Fuling), Plantago Seed (Cheqian), Polygala Root (Yuanzhi), Psoralea Fruit (Buguzhi).
Patient surnamed Wu presented with Qi not returning to its source, urgent asthma, dorsal edema, cold sweat, cold feet, and red face. Middle Jiao is obstructed. First discuss unblocking Yang.
Prescription: Prepared Aconite Root (Shu Fuzi), Poria (Fuling), Ginger Juice (Sheng Jiang Zhi), Raw White Peony Root (Sheng Baishao).
Patient surnamed Wang (19 years old) presented with Yin deficiency causing asthma and choking. Use sedation and consolidation methods.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Donkey-hide Gelatin (Ejiao), Mussel Gelatin (Dan Cai Jiao), Chinese Yam (Shanyao), Poria Spirit (Fushen), Lotus Seed (Hulian), Euryale Seed (Qianshi).
Patient surnamed Weng (42 years old) presented with fine pulse, sinking at the Chi position, emaciation, and poor appetite. Movement causes shortness of breath and urgent asthma. Generally, difficulty exhaling with asthma indicates Lung disease, mostly from external pathogens. Now, movement transforms Yang due to weak Yin failing to grasp. Inhalation triggers asthma; how can this be anything other than Kidney disease? Treatment must focus on gathering and securing the True Qi. Upper disease should be treated by solidifying the Lower Jiao, following the intent of Shen Qi Wan.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Schisandra Fruit (Wuweizi), Psoralea Fruit (Buguzhi), Walnut Meat (Hutaorou), Achyranthes Root (Niuxi), Poria (Fuling), Chinese Yam (Shanyao), Plantago Seed (Cheqianzi).
Make honey pills.
Patient surnamed Shen (23 years old) presented with Yin deficiency and Yang rising, Qi failing to grasp causing asthma.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Schisandra Fruit (Wuweizi), Sea Cucumber Gelatin (Haishen Jiao), Mussel Gelatin (Dan Cai Jiao), Poria Spirit (Fushen), Chinese Yam (Shanyao), Euryale Seed (Qianshi), Lotus Seed Meat (Hulian Rou), Purple Walnut (Zi Hetao).
Patient surnamed Yang (61 years old) presented with chronic cough in old age, asthma upon movement, dry throat and tongue in the morning, and frequent urination like strangury at night. Kidney fluids are exhausted, Qi is dispersed and fails to grasp. This is not disease, but aging. Thus, treating asthma yields little effect. Constipation and dryness occur. Following the principle that the Kidney dislikes dryness, use acrid-moistening methods.
Prescription: Prepared Rehmannia Root (Shudi), Goji Berry (Qizi), Achyranthes Root (Niuxi), Morinda Root (Baji Rou), Purple-skin Walnut (Ziyi Hetao), Green Salt (Qingyan), Psoralea Fruit (Buguzhi).
Madam Chen presented with sudden cough and asthma, fever, and sweating. The pivot of Yin and Yang is insecure. Only the method of gathering and securing the Origin is applicable.
Prescription: Ginseng Radix (Renshen), Roasted Licorice Root (Zhicao), Schisandra Fruit (Wuweizi), Purple-skin Walnut (Ziyi Hetao), Prepared Rehmannia Root (Shudi), Charred Cornus Fruit (Yurou Tan), Poria Spirit (Fushen), Stir-fried Chinese Yam (Chao Shanyao).
Re-examination: Consolidation method showed good response.
Prescription: Ginseng Radix (Renshen), Aconite Root (Fuzi), Schisandra Fruit (Wuweizi), Roasted Astragalus Root (Zh Huangqi), Atractylodes Macrocephala Rhizome (Baizhu).
Another patient presented with skin sores and scabies, leading to asthma, cough, and blood-streaked phlegm. Although this is Lung congestion with heat, now digestion and excretion are normal, but movement causes urgent asthma, differing from previous asthma. Due to advanced age and lower deficiency, Kidney fails to grasp, and the Source Sea is insecure. Qi rebels and floods upward, marking the onset of swelling. Preventive measures are needed: Liu Wei Wan (Six-Ingredient Pill) added with Achyranthes Root (Niuxi), Plantago Seed (Cheqian), and Walnut.
Patient surnamed Sun, of advanced age, contracted Winter-Warmth pathogen internally, leading to worse phlegm-cough in the evening. Pulse is large and thready/beating. Complexion is withered with sweating. Inhalation sound is rapid, seemingly due to phlegm obstruction. Actually, the Root of the Source Sea is weak, failing to store and grasp. Spirit is depleted, muttering delirium, Yang escapes with sweat. Danger of collapse looms. Ancients treated elderly phlegm-cough-asthma primarily from Spleen and Kidney. Now warm evil disturbs, leaving heat in Upper and Middle Jiao. Although warming is not indicated, securing the Lower True Qi treats the root. Yang roots in Yin; this must be considered.
Prescription: Charred Prepared Rehmannia Root (Shudi Tan), Walnut Meat (Hutaorou), Charred Achyranthes Root (Niuxi Tan), Plantago Seed (Cheqianzi), Cloud Poria (Yun Fuling), Lead (Qingqian).
Another patient presented with intense Heat in the Heart, disconnection between Upper and Lower, sudden rebellious attack, numbness over the body, urgent asthma, and confusion. Kidney True Qi is insecure, Liver Wind moves recklessly. Long-term herbal medicine failed. Temporarily use Yu Zhen Wan.
The cause of asthma: Excess in Lung, Deficiency in Kidney. Mr. Ye highlights these two phrases as the outline. There are four distinctions. Generally, excess-cold carries congealed phlegm and retained fluid, obstructing Qi upwards, such as Xiao Qing Long Tang or Gui Zhi Hou Po Xing Zi Tang. Excess-heat involves latent pathogens steaming phlegm into fire, treated with Ma Xing Shi Gan Tang or Qian Jin Wei Jing Tang. Deficiency involves damage to Essence or depletion of Qi. Nourishing Essence requires thick agents combined with sedation, such as Shen Qi Wan adding Agaricum (Chenxiang), or Du Qi Wan adding Lead (Qingqian), differing in Yin and Yang approaches. Qi depletion means floating root, injuring the Source Sea; danger of death is imminent. Considering the insensitivity of herbs, hard and soft cannot easily assist, thus Ginseng, Placenta (Heche), Schisandra (Wuweizi), and Quartz (Shiying) are used to urgently restore True Qi. Heaven-mending therapy is unprecedented. For Middle Qi deficiency where Earth does not generate Metal, Ren Jian Zhong Tang is used. This collection has 30 cases, 19 methods, meticulously layered and graded. Students should deeply ponder to understand. (Commentary by Shao Xinpu)
Xu’s Commentary: The methods for treating the Lower Jiao in this chapter are complete, but methods for treating the Upper Jiao have many omissions and must be studied.