喘症之因。大抵三法前多实喘。三法后多虚喘。在肺为实。在肾为虚。实喘宜开太
阴。虚喘宜固少阴。外感之喘治肺。内伤之喘治肾。
邵评∶喘有风寒、火邪、水气、痰饮、寒包火郁等因。由于外邪在肺。是为实喘。下焦
元海无根。肾虚气逆而发喘者。为虚喘。实喘宜开肺。虚喘宜固肾。至三法者。汗
吐下也。虽云三法前多实。三法后多虚。然亦不可执。总之。外邪为实。宜治肺。内伤为虚。宜治肾。
虚实之辨。实喘。气急、张口、抬肩、欠肚、虚喘、气短、似喘非喘、而不张口、抬肩、欠肚也。
实喘。肺气不得宣畅。满闷只在膈间。虚喘。肾气不能接续。阻塞在于气道。
邵评∶实喘由肺有外邪。气不宣畅。而气急发喘。病在上焦。故满闷只在膈间也。
虚喘由肾气不纳。虚气上逆。短气发喘。病属下元亏乏也。
太阳病不解。用小青龙汤治喘者。治水气干肺也。用桂枝汤加浓朴杏子治喘者。
治寒邪在肺也。用麻杏石甘汤治喘者。治寒包肺火也。（述古）
邵评∶表有风寒。内挟水饮。犯肺而喘。用小青龙散邪涤饮。若寒邪在表。气郁于
肺而作喘。用桂枝加朴杏散寒下气。但寒无汗而喘者。用麻黄汤。此则肺有火
邪。外寒包住内火。故以麻黄汤去桂枝。而加石膏。
阳明病。发热。汗出。不恶寒。胸满而喘。用栀子豉汤者。此阳明内热出表。非治外感
也。又阳明病。直视微喘。用承气者。此阳明坏病也。（述古）
邵评∶胸中为阳明之表。满而喘者。热上扰而气不下降也。邪在膈间。用栀豉汤以泄膈间热邪。
此阳明经病之表症。若阳明腑病。直视微喘者。由于误治。而阴伤邪实。用承气者。去邪以救正也。
伤寒有暴感寒邪。恶寒无汗。头疼身痛。寸脉沉伏。而喘急者。此寒邪郁于太阳。痰
气交阻于肺也。法当开太阳之邪。用麻黄、川桂枝、半夏、杏仁、旋复花、紫苏叶、橘红、
生姜、白芥子之类。辛温汗之。
邵评∶肺与太阳。均为主表。太阳表邪不解。每每上侵于肺。故开太阳表邪。即是
开肺。治法本相通也。此开肺疏表。涤痰降气之法。
如外感寒邪。内束伏火。咳喘烦渴。气口脉沉而数者。宜外散寒邪。内清肺火。麻杏
石甘汤加桑皮、枯芩、桔梗主之。
邵评∶此肺热火盛。轻寒抑遏于表。只用麻黄一味散表。余俱开肺清火之剂。此
条寒包肺火。与上条表寒侵肺不同。上条辛温散表为治。此条辛凉开肺为主。病情不同。治法亦异。最当详辨。
若咳嗽口干。气逆而喘。而不头痛恶寒者。火邪在肺也。当以泻白散加二母、枯芩、
羚羊角之类。以泻肺火。
邵评∶此肺火发喘。外无表寒。与上二条不同。只清肺火为治。
若气逆咳喘。胸膈凝闷。气口脉闭。喘咳有痰声者。痰喘也。治痰为主。如前胡、苏子、
杏仁、葶苈子、橘红、象贝、蒌霜、半夏、桑皮、枳壳、薄荷、桔梗、竹沥、姜汁之类。选用。
邵评∶痰随气而上升。肺气逆而不降。则咽中痰声而气喘也。治以清痰降气为主。
伤寒有表解之后。而胸闷喘急者。亦痰也。急当治其痰。盖外感表邪虽去。而内痰
复发。故喘。必寸脉沉闭。胸膈闷塞可证。不可因表解后。作虚治也。（以上皆实喘治肺）
邵评∶表寒已解。而内伏之痰上升。其气阻于胸膈。故闷而喘急也。治以涤痰开化一法。盖此是痰喘。
无外邪夹杂。与前数条因外邪发喘者不同。且痰阻脉道。故脉沉闭。痰滞上焦。肺气不宣。故胸膈
闷塞。是实喘而非虚喘也。
若因汗下之后发喘者。乃真气不能接续。气短似喘也。病源在下。其症呼吸喘促。
自丹田以上。气道阻塞不通。提不能升。咽不能降。呼吸不能接续。主治在肾。以肾
主纳气也。当以景岳贞元饮主之。气虚脉微。汗大出者。合参、麦、五味。收之纳之。或
生脉合左归亦可。足冷脉微者。熟附都气饮。加胡桃肉以纳之。（以上是虚喘治肾）
邵评∶汗下之后。邪退正虚而发喘者。乃元海无根。真气不纳。短气不能接续。似
喘非喘。由于下焦肾气大亏。此是虚喘。与前列之实喘大异。盖丹田在下焦。升逆直冲而上。肺气不得
下行。阻塞升降之机。呼吸短促。不能接续而似喘。由于肾真失纳。根蒂不固所致。治以摄肾固真纳气为主。
若饮邪犯肺作喘。当以温药和之。二陈汤加桂枝、姜汁。
邵评∶寒饮射肺。肺逆作喘。当理肺涤饮治之。古人云。治痰饮者。宜温药和之也。
The causes of asthma (Chuan Zheng) are generally: before the three methods (sweating, vomiting, purging), it is mostly excess-type asthma; after the three methods, it is mostly deficiency-type asthma. When located in the Lung, it is excess; when located in the Kidney, it is deficiency. Excess asthma should be treated by opening Taiyin (Hand-Taiyin Lung Meridian), and deficiency asthma should be treated by consolidating Shaoyin (Foot-Shaoyin Kidney Meridian). Asthma caused by external contraction is treated focusing on the Lung, while asthma caused by internal injury is treated focusing on the Kidney.
Commentary by Shao: Asthma has various causes such as Wind-Cold, Fire Pathogen, Water Qi, Phlegm-Fluid, Cold Wrapping Fire Stagnation, etc. Asthma due to external pathogens affecting the Lung is called excess asthma. Asthma arising from the rootlessness of the Primordial Sea in the Lower Jiao, where Kidney Deficiency leads to rebellious Qi, is called deficiency asthma. Excess asthma should benefit the Lung, and deficiency asthma should consolidate the Kidney. The "three methods" refer to sweating, vomiting, and purging. Although it is said that there is more excess before the three methods and more deficiency after them, one must not adhere rigidly to this. In summary, diseases caused by external pathogens are excess and should treat the Lung; diseases caused by internal injury are deficiency and should treat the Kidney.
Differentiation between Excess and Deficiency: Excess asthma presents with rapid breathing, opening the mouth, raising the shoulders, and abdominal movement (abdominal heaving); deficiency asthma presents with shortness of breath, resembling asthma but not truly so, without opening the mouth, raising shoulders, or abdominal movement.
In excess asthma, Lung Qi fails to diffuse and descend smoothly, causing fullness and oppression only in the diaphragmatic region. In deficiency asthma, Kidney Qi fails to receive and connect, causing obstruction in the airway.
Commentary by Shao: Excess asthma arises from external pathogens in the Lung, causing Qi stagnation and rapid breathing; the disease is in the Upper Jiao, hence fullness is confined to the diaphragm.
Deficiency asthma arises from the Kidney's failure to receive Qi, with deficient Qi rebelling upward, causing shortness of breath and asthma; the disease belongs to the depletion of the Lower Yuan.
If Taiyang Disease (disease pattern resulting from pathogenic invasion of the Taiyang meridian) is unresolved, Xiao Qing Long Tang (Little Blue Dragon Decoction) is used to treat asthma to address Water Qi interfering with the Lung. Gui Zhi Tang (Cinnamon Twig Decoction) added with Hou Po (Magnolia Bark) and Xing Ren (Apricot Seed) is used to treat cold pathogens in the Lung. Ma Xing Shi Gan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) is used to treat Cold Wrapping Lung Fire. (These cite ancient methods)
Commentary by Shao: When there is Wind-Cold on the exterior and water-fluid retention internally, attacking the Lung and causing asthma, Xiao Qing Long San (Little Blue Dragon Powder) is used to dispel pathogens and eliminate fluids. If cold pathogens are on the exterior, causing Qi stagnation in the Lung and asthma, Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction augmented with Magnolia Bark and Apricot Seed) is used to dissipate cold and direct Qi downward. If there is no sweat due to cold binding and asthma occurs, Ma Huang Tang (Ephedra Decoction) is used. Here, however, there is fire pathogen in the Lung wrapped by external cold; thus, Gui Zhi (Cinnamon Twig) is removed from Ma Huang Tang, and Shi Gao (Gypsum) is added.
In Yangming Disease (disease pattern resulting from pathogenic invasion of the Yangming meridian), if there is fever, sweating, aversion to cold absent, chest fullness, and asthma, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is used. This indicates Yangming internal heat emerging to the exterior, not treating an external contraction. Furthermore, in Yangming Disease, if there is fixed staring and slight asthma, Cheng Qi Tang (Purgative Decoction) is used. This is a complicated disease (Bing) of Yangming resulting from mismanagement. (These cite ancient methods)
Commentary by Shao: The chest is the exterior of Yangming. Fullness and asthma indicate heat disturbing upward and Qi failing to descend. With pathogen in the inter-diaphragmatic region, Zhi Chi Tang is used to drain inter-diaphragmatic heat pathogens; this is an exterior symptom of Yangming Channel disease. If it is Yangming Fu-organ disease, presenting with fixed staring and slight asthma, it results from mismanagement leading to Yin damage and excess pathogen; Cheng Qi Tang is used to eliminate the pathogen to rescue healthy Qi.
In Shanghan (Cold Damage), if there is sudden contraction of cold pathogens, aversion to cold, absence of sweat, headache, body pain, deep and hidden pulse at the Cun position, and urgent asthma, this is cold pathogens stagnating in the Taiyang meridian and Phlegm-Qi obstructing the Lung. The method should be to release Taiyang pathogens, using Ma Huang (Ephedrae Herba), Chuan Gui Zhi (Cinnamomi Ramulus), Ban Xia (Pinelliae Rhizoma), Xing Ren (Armeniacae Semen Amarum), Xuan Fu Hua (Inulae Flos), Zi Su Ye (Perillae Folium), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Sheng Jiang (Zingiberis Rhizoma Recens), Bai Jie Zi (Sinapis Semen), etc., to induce sweating with acrid-warm herbs.
Commentary by Shao: The Lung and Taiyang meridian both govern the exterior. Unresolved Taiyang exterior pathogens often invade the Lung upwards; thus, releasing Taiyang exterior pathogens is equivalent to opening the Lung. The treatment principles are inherently connected. This is a method of opening the Lung, dispersing the exterior, eliminating phlegm, and directing Qi downward.
If external cold pathogens bind internal latent fire, causing coughing, asthma, irritability, thirst, and a deep and rapid pulse at the Qi Kou position, one should disperse cold pathogens externally and clear Lung fire internally. Ma Xing Shi Gan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) added with Sang Bai Pi (Mori Cortex), Ku Qin (Scutellariae Radix), and Jie Geng (Platycodonis Radix) should be used.
Commentary by Shao: This indicates abundant Lung fire and heat, suppressed slightly by cold on the exterior. Only Ma Huang (Ephedrae Herba) is used to disperse the exterior, while the rest are herbs to open the Lung and clear fire. This case of "Cold Wrapping Lung Fire" differs from the previous case of "Exterior Cold Invading the Lung." The previous case was treated with acrid-warm exterior dispersion; this case prioritizes acrid-cool Lung opening. Since the conditions differ, the treatments differ, requiring careful differentiation.
If there is coughing, dry mouth, rebellious Qi with asthma, but no headache or aversion to cold, this is fire pathogen in the Lung. One should use Xie Bai San (White-Draining Powder) added with Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Bulbus), Ku Qin (Scutellariae Radix), and Ling Yang Jiao (Capricornus Cornu) to drain Lung fire.
Commentary by Shao: This is asthma caused by Lung fire, without exterior cold, differing from the previous two cases. Treatment focuses solely on clearing Lung fire.
If there is rebellious Qi with coughing and asthma, coagulation and oppression in the chest and diaphragm, closed pulse at the Qi Kou position, and rattling sounds during coughing and asthma, this is Phlegm Asthma. Treatment focuses on resolving phlegm. Select from Qian Hu (Peucedani Radix), Su Zi (Perillae Fructus), Xing Ren (Armeniacae Semen Amarum), Ting Li Zi (Lepidii Fructus), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Xiang Bei (Fritillariae Thunbergii Bulbus), Lou Shuang (Trichosanthis Pericarpium), Ban Xia (Pinelliae Rhizoma), Sang Bai Pi (Mori Cortex), Zhi Ke (Aurantii Fructus Immaturus), Bo He (Menthae Haplocalycis Herba), Jie Geng (Platycodonis Radix), Zhu Li (Bambusae Caulis in Taedia), and Jiang Zhi (Zingiberis Juice), etc.
Commentary by Shao: Phlegm rises with Qi; if Lung Qi rebels and fails to descend, there will be phlegm sounds in the throat and asthma. Treatment focuses on clearing phlegm and directing Qi downward.
In Shanghan, if after the exterior syndrome resolves, there is chest oppression and urgent asthma, it is also due to phlegm. Urgently treat the phlegm. Although external contraction pathogens have left, internal phlegm recurs, causing asthma. This is confirmed by a deep and closed pulse at the Cun position and chest/diaphragmatic oppression. Do not treat it as deficiency simply because the exterior has resolved. (All above belong to treating the Lung for excess asthma)
Commentary by Shao: After exterior cold resolves, internally stored phlegm rises, obstructing Qi in the chest and diaphragm, causing oppression and urgent asthma. Treatment uses the method of eliminating phlegm and transforming stagnation. This is Phlegm Asthma, without mixed external pathogens, differing from previous cases of asthma caused by external pathogens. Moreover, phlegm obstructs the pulse pathway, causing a deep and closed pulse; phlegm stagnates in the Upper Jiao, preventing Lung Qi diffusion, causing chest/diaphragmatic oppression. It is excess asthma, not deficiency.
If asthma develops after sweating or purging methods, it is because True Qi cannot connect, manifesting as shortness of breath resembling asthma. The source of the disease is in the lower part. Symptoms include rapid breathing, obstruction in the airway above the Dantian, inability to ascend or descend, and discontinuous respiration. Treatment focuses on the Kidney, as the Kidney governs receiving Qi. Jing Yue's Zhen Yuan Yin (True Origin Decoction by Zhang Jingyue) should be used. If Qi is deficient, pulse is faint, and sweating is profuse, combine with Ren Shen (Ginseng Radix et Rhizoma), Mai Dong (Ophiopogonis Tuber), and Wu Wei Zi (Schisandrae Fructus) to collect and receive Qi. Alternatively, Sheng Mai San (Generate the Pulse Powder) combined with Zuo Gui Wan (Left Restoring Pill) may be used. If feet are cold and pulse is faint, use Shu Fu Du Qi Yin (Prepared Aconite Duqi Decoction) added with Hu Tao Rou (Juglandis Semen) to receive Qi. (Above belongs to treating the Kidney for deficiency asthma)
Commentary by Shao: After sweating and purging, when pathogens retreat and healthy Qi becomes deficient, asthma arises due to rootlessness of the Primordial Sea and failure of True Qi to receive. Shortness of breath is discontinuous, resembling asthma but not truly so. It results from severe depletion of Kidney Qi in the Lower Jiao. This is deficiency asthma, greatly different from the previously listed excess asthma. The Dantian is in the Lower Jiao; rebellious Qi rushes upward directly, preventing Lung Qi from descending, obstructing the mechanism of ascending and descending. Respiration is short and discontinuous, resembling asthma. It is caused by the Kidney's loss of reception and insecure roots. Treatment focuses on securing the Kidney, consolidating True Qi, and receiving Lung Qi.
If fluid pathogens attack the Lung causing asthma, warm herbs should be used to harmonize. Er Chen Tang (Two-Aged Decoction) added with Gui Zhi (Cinnamomi Ramulus) and Jiang Zhi (Zingiberis Juice) is used.
Commentary by Shao: Cold fluid shooting into the Lung causes Lung rebellion and asthma; one should regulate the Lung and eliminate fluids. As ancients said: "To treat phlegm-fluid, warm herbs should be used to harmonize."