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Asthma (Chuan) can be caused by Cold, Heat, or Water retention. Cold asthma manifests upon exposure to cold; heat asthma occurs in summer but not in winter. Water retention asthma is characterized by scanty and difficult urination, fullness and oppression in the chest and diaphragm, and slight swelling of the feet. These conditions must be carefully distinguished. Furthermore, asthma caused by Lung Heat, Lung Deficiency, Stomach Heat, and Kidney Deficiency should also be differentiated.

Rapid breathing is termed Asthma (Chuan), while wheezing with sound in the throat is termed Wheezing (Xiao). If asthma is caused by abundant phlegm, treatment should focus on resolving phlegm as the root, and regulating Qi as the branch. If asthma is caused by Excess Qi, then rebellious Qi is the root, and phlegm is the branch. When asthma/wheezing is not active, the priority is to support healthy Qi (Zheng Qi); when it is active, the priority is to attack pathogenic factors. If asthma arises from fire Qi rushing upward from the lower abdomen, Yin-nourishing methods should be used to consolidate and restrain it. For cases where coughing prevents lying flat, and the pulse is floating on superficial pressure but weak and choppy on deep pressure, this indicates Yin Deficiency. Death is imminent; purgatives must never be used, as their use will certainly lead to death. The most appropriate treatment is to nourish Yin and strengthen Fire (to guide it back to its source), so that Qi and Phlegm do not float upward.

In cases of asthma triggered by Lung Deficiency due to chronic illness, there is invariably shortness of breath accompanied by asthma, with a faint or empty and large, forceless pulse at the Right Cun position. Treatment should involve tonifying with Ejiao (Donkey-hide Gelatin), Renshen (Ginseng), and Wuweizi (Schisandra Berry). In new-onset asthma due to Qi Excess, the Cun pulse is deep and solid, with abundant salivary phlegm and difficulty in breathing. Treatment should involve draining with Sangbaipi (Morus Bark) and Kutingli (Periploca Seed). If asthma presents without phlegm during the acute phase but expectorates phlegm as it resolves, it is because phlegm blocked the airways during the onset, causing severe asthma. At that time, opening the phlegm pathways will easily alleviate the asthma. Suitable formulas include Jiegeng Tang (Platycodon Decoction) along with Zhike (Aurantium Fructus), Gualou (Trichosanthes Fruit), and Xingren (Apricot Seed) to draw out the phlegm. Once the phlegm is expelled and asthma subsides, then regulate the Deficiency and Excess.

Asthma is characterized by gaping mouth and lifting shoulders. Shortness of breath (Duan Qi) is characterized by frequent respiration that cannot continue, resembling asthma but without shoulder movement, and resembling groaning but without pain. Dai Fu'an stated: Shortness of breath involves lower Qi failing to connect and upper Qi failing to arrive, with weak voice. It requires tonifying deficiency using Sigui Yin (Four Cinnamon Drink) with reduced Muxiang (Aucklandia Root), plus Shanyao (Dioscorea Rhizome) and Huangqi (Astragalus Root), each 1 qian. Li Dongyuan stated: Chest fullness, little Qi, and shortness of breath occur because the Lung governs Qi, and insufficiency of Qi leads to shortness of breath. If urination is clear and abundant, use Sijunzi Tang (Four Gentlemen Decoction) minus Fuling (Poria), plus Huangqi (Astragalus Root). He further stated that the treatment for "little Qi" and "shortness of breath" differs. Shortness of breath can be Deficient or Excessive, requiring tonification or purgation respectively. Thus, if shortness of breath is due to fluid retention, the pulse will be wiry and slippery; treat with Shenling Baizhu San variations (Fuling, Baizhu, Gancao, Guizhi) to leach out dampness, or eliminate via urination. If it is due to Qi Deficiency, the pulse will be insufficient. "Little Qi" is purely a state of insufficiency, treated only by tonification. In middle-aged patients after illness, symptoms such as rapid breathing, phlegmy cough, cold and swollen legs/feet, severe lumbar pain, facial edema, and Taiyang headache all belong to Declining Fire of the Mingmen (Gate of Life) and Yang Deficiency. Bawei Wan (Eight-Ingredient Pill) is excellent. Treating this as phlegm will lead to immediate danger.

Postpartum asthma in women is an acute, critical condition often leading to death, named "Lone Yang and Absolute Yin." Due to excessive blood loss, Ying Blood (Nutritive Blood) is suddenly exhausted, leaving Wei Qi (Defensive Qi) without foundation, gathering solely in the Lungs, causing rapid asthma and urgent throat breathing. Strongly decocted Dushen Tang (Single Ginseng Decoction) or a large dose of Xionggui Tang (Szechwan Lovage and Angelica Decoction) are suitable. If lochia (postpartum discharge) is not smooth, causing stagnant blood to condense and harass the Lungs upward, also causing urgent asthma, resolving the lochia will naturally settle the asthma.

The Classic states: All rebellious Qi rushing upward belongs to Fire. Hua Tuo said: Excess Lung Qi causes asthma. Huoren Shu (Book of Vitality) said: Excess Qi leads to asthma. Later compilations of symptoms and formulas merely followed these principles. Only Haicang (Zhang Bi) argued: "Qi Excess" should be understood as Qi Deficiency, and "Excess" as Insufficiency. If Lung Qi were truly excessive, its clearing and descending function would operate normally, why would asthma occur? It is because Fire scorches Yin, leading to Qi Deficiency and insufficiency, causing asthma. The "excess" mentioned refers not to Lung Qi, but to Fire in the Lungs. Haicang's differentiation elucidated profound ancient wisdom, though he did not fully explore the origin of this Fire. Excess Fire stems from Insufficient Water; Excess Yang stems from Insufficient Yin. All rebellious Fire originates from the Ministerial Fire of the Chong and Ren vessels in the Lower Jiao, arising from the Liver and Kidneys. When Kidney Water declines, Ministerial Fire prevails. Vigorous Fire consumes Qi and scorces Lung Metal, inevitably causing asthma. Danxi (Zhu Zhenheng) said: There is Yin-Deficiency asthma originating from the lower abdomen rising upward. Treat with Siwu Tang (Four Substances Decoction) plus Qingdai (Indigo Naturalis), Zhuli (Bamboo Juice), Chenpi (Tangerine Peel), decocted with Tongbian (Child's Urine). If complicated by phlegm, add Zhike (Aurantium Fructus) and Banxia (Pinellia Tuber) to Siwu Tang to resolve phlegm by nourishing Yin. Although Danxi revealed this aspect of Yin-deficiency asthma, his treatment method has led to errors in later generations. "Yin Deficiency" refers to the True Yin of the Kidney, not merely the Yin Blood addressed by Siwu Tang. The fire arising is the Dragon-Lei Fire of the Lower Jiao, which cannot be subdued by cold herbs. Cases may have phlegm or no phlegm. With phlegm, it is Water carrying Wood-Fire upward, which Zhuli and Zhike/Banxia cannot resolve. One must use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry) in large doses to strengthen the Master of Water (Kidney Yin). Then Water rises, Fire descends, and asthma settles. Because Kidney Yin/Water is deficient, Fire arises; with Fire, Phlegm forms; with Phlegm, Cough occurs; severe Cough leads to Asthma.

Exhalation follows Yang exiting, inhalation follows Yin entering. Ascending and descending harmonize Yin and Yang. If rebellious Qi disrupts this, Qi fails to descend, becoming obstructed in the Diaphragm, forcing the Airway, resulting in urgent, noisy asthma. Thus, the Classic states: Inability to lie flat with noisy respiration indicates reversal of Yangming Qi. Also: Normal daily activities but noisy respiration indicates reversal of Lung collateral Qi. However, there is a type resembling Fire but not Fire, resembling Asthma but not Asthma. The Classic states: Shaoyin disease involving vomiting, cough, and upper asthma occurs because Yin is below, Yang is above, and all Yang Qi floats without foundation, causing upper asthma. This is due to depletion of True Yuan, with asthma arising from Kidney Qi rushing upward. The patient appears healthy normally but feels asthmatic; this is not true asthma but Qi failing to return to its source. External signs include cold extremities, red face, irritability, and aversion to heat resembling Fire, but it is not Fire. It is the True Yuan Fire of the Mingmen leaving its palace and not returning. Pulse examination shows floating, large, and rapid pulses at both Cun positions, but faint and forceless pulses at both Chi positions, or seemingly present yet absent. Unaware practitioners, seeing "Fire," use small amounts of cooling herbs to clear it, or use Simo Tang (Four-Mortar Decoction) to relieve urgency. After ingestion, there may be temporary relief, but soon returns. Relieving slightly consumes more Qi. Some mistakenly increase cold/clearing herbs upon slight relief, leading to immediate death. Severe Yin Deficiency asthma is near fatal. A sliver of life remains connected to the Mingmen. Skilled physicians trace the root, assist True Yuan, and help it return to its origin, potentially saving life, but must avoid harsh or rapid treatments. Initially use Bawei Wan, Anshen Wan, or Yangzheng Dan, delivered with Renshen Shengmai San (Ginseng and Pulse-Nourishing Decoction). Once Qi stabilizes, use large doses of Renshen and Huangqi tonics, plus Poguozhi (Psoralea Fruit), Ejiao, and Nixi (Achyranthes Root) to anchor downward. Then use Bawei Wan added with Heche (Placenta) as pills, taken during hunger day and night. Crucially, one must abstain from sexual activity. Only through long-term adherence can life be preserved. Violation of these prohibitions leads to death. Wise men should prevent disease before it arises.

Another type is Fire Depression syndrome. All six pulses are choppy, even deep and hidden. Extremities are cold, even cold to the point of inversion. Restless, rapid breathing and asthma appear Excess-like, but the pulse is not tight or rapid. Pressing the Chi pulse reveals drumming strength, indicating long-standing depression where Yang Qi is constrained and cannot circulate to the exterior, causing cold body, faint pulse, confusion, and urgent asthma. At this stage, do not use cold purgatives or hot tonics. Use Xiaoyao San (Free and Easy Wanderer Powder) plus Zhuyu (Evodia) and Huanglian (Coptis) to vent and disperse accumulated heat. Recovery comes with sweating. Afterwards, use Liuwei Dihuang Wan to nourish Yin and harmonize Yang. This illustrates "Vent Fire Depression, Reach Wood Depression," as stated in Jin Gui: Deep/hidden pulses require dispersion, leading to heat resolution and asthma settling. Why does asthma often prevent lying down? The Kidney is the Water Organ, governing fluids, sleep, and asthma. Asthma when lying down results from Water Qi counterflow harassing the Lungs. The Lung becomes buoyant with water, and Qi cannot circulate freely.

After illness or postpartum, and in all ulcerative sores, asthma appearing after ulceration is essentially shortness of breath, belonging to Qi Deficiency. Even if there is pre-existing Phlegm-Fire, in elderly or chronically ill patients with depleted Zheng Qi, treating it as Excess and using draining/cold methods leads to immediate collapse. Urgently use large doses of Shengmai San to support Yuan Qi, or use warm tonification to guide Qi and Fire back to their source. Asthma and phlegm will resolve spontaneously. Nine-tenths of asthma deaths are due to Deficiency; one-tenth due to Excess. Excess is easily cured by attacking. Deficiency is hard to treat with tonification, as effects are not immediate, requiring careful navigation. After taking warm tonics, even if the patient desires cool drinks, cold water must absolutely be avoided. Dry throat and mouth result from un-submerged Deficient Fire and lack of generated fluids. Drinking cold water extinguishes the warm tonic's power entirely. Moreover, Cold Qi entering the Dantian causes Dragon-Lei Fire to float even more.