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It is commonly said that "asthma has no favorable signs," which is indeed true because asthma, whether caused by internal injury or external contraction, is always a critical and serious condition. However, to investigate the etiology of asthma, one must first clarify which Zang-Fu organ governs the pivot of respiration. The throat is the trachea, internally connected to the Lung (Fei), which is common knowledge; yet inhaled air does not merely enter the Lung but can also enter the Heart (Xin), Liver (Gan), Chong and Ren vessels (Chong Ren), and Kidney (Shen). Why is this so? The main branch of the trachea enters the Lung, while its branches actually connect downward to the Heart, further penetrating the diaphragm to connect downward to the Liver (as can be seen from the connection among the Lung, Heart, and Liver), and from the Liver downward, it connects with the Chong and Ren vessels to reach the Kidney. If this were not the case, why would a pregnant woman's fetus exhale when the mother exhales, and inhale when the mother inhales? If respiratory qi did not pass through the tracheal branches to the Liver, down to the Chong and Ren vessels and Kidney, how could the fetus's umbilical cord, rooted between the Chong and Ren vessels, receive the mother's respiratory qi via the umbilicus and move with her breathing? Thus, we know that the Lung is the mechanism initiating respiration. Asthma, as described in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica), is called "spitting inhalation" (Tu Xi), meaning the inhaled air cannot be retained within and is quickly expelled. The reason for this non-retention may lie in the Lung or in the Liver and Kidney. Let us first discuss those arising from the Liver and Kidney.

The Kidney governs closure and storage, as well as "Xi Na" (convergence and reception), originally intended to regulate the Qi transformation of the Lower Jiao and to converge and receive respiratory qi, causing each breath to root downwards. Sometimes, Kidney deficiency fails to regulate this Qi transformation, causing it to expand between the Chong and Ren vessels, subsequently carrying the Chong Qi upward rushing. The Wood of the Liver, which executes the Kidney's Qi (as medical texts state, the Liver moves the Kidney's Qi), reaches this point unable to unblock the downward flow of Kidney Qi, and thus rushes upward along with it. Consequently, inhaled qi is not received by the convergence of the Lower Jiao but is instead agitated by it. This is the origin of asthma, known in medical texts as "Kidney deficiency failing to receive Qi." Treatment should employ herbs that nourish Yin and tonify the Kidney, assisted by herbs that generate Liver Blood, calm Liver Qi, settle the Chong vessel, and direct rebellious Qi downward. The formula uses Da Huai Shu Di (Prepared Rehmannia Root from Huaiqing), Sheng Huai Shan Yao (Fresh Chinese Yam from Huaiqing) each 1 liang, Sheng Hang Shao (Fresh White Peony Root from Hangzhou), Bai Zi Ren (Biota Seed), Gan Gou Qi (Goji Berry), Jing Yu Rou (Processed Cornus Fruit), Sheng Zhe Shi (Raw Ocher powder) each 5 qian, Su Zi (Perilla Fruit), and Gan Cao (Licorice Root) each 2 qian. For cases with more heat, add Xuan Shen (Scrophularia Root) several qian. For cases with excessive sweating, add Sheng Long Gu (Raw Dragon Bone) and Sheng Mu Li (Raw Oyster Shell) several qian each.

If there is Kidney deficiency failing to receive Qi, compounded by severe Yuan Qi (Primal Qi) deficiency unable to secure and hold, leading to a desire for upward collapse, the symptoms of asthmatic rebellion will be more severe than in simple Kidney deficiency. In the aforementioned formula, remove Shao Yao (Peony) and Gan Cao, add Ye Tai Shen (Wild Ginseng from Taihang) 5 qian, change Yu Rou to 1 liang, and change Zhe Shi to 8 qian. After taking one dose, if the asthma lightens but the chest feels hot, add Tian Dong (Asparagus Tuber) several qian as appropriate. Alternatively, my formulated Shen Zhe Zhen Qi Tang (Ginseng and Ocher Decoction to Settle Qi) may be used. In cases where sudden violent anger stirs up Liver Qi and Liver Fire, which then carries Chong Qi upward, accompanied by Stomach Qi rebelling upward, pressing against the Lung's inhalation preventing it from descending and causing asthma, use Chuan Lian Zi (Sichuan Chinaberry Seed), Sheng Hang Shao, Sheng Zhe Shi powder each 6 qian, Nong Po (Magnolia Bark), Qing Xia (Processed Pinellia), Ru Xiang (Frankincense), Mo Yao (Myrrh), Long Dan Cao (Gentian Root), Gui Zhi Jian (Cinnamon Twig Tip), Su Zi, and Gan Cao each 2 qian. Decoct these using thick rust water prepared from grinding iron. These three causes of asthma arise from the Liver and Kidney, yet their pulse presentations differ. In Yin deficiency failing to receive Qi, the pulse is often fine and rapid; in Yin deficiency combined with impending collapse of Yuan Qi, the pulse is often full at the top and deficient at the bottom; in Liver Fire and Liver Qi carrying Chong and Stomach Qi upward, the pulse is often hard, wiry, and long. Examining the pulse and differentiating the syndrome ensures no error.

Regarding asthma caused by the Lung, it arises because lung disease prevents the retention of inhaled air. These conditions differ into internal injury and external contraction. Let us first discuss lung failure to receive Qi due to internal injury. The opening and closing (Pi He) of the lung lobes are the natural mechanisms of respiration. The ability to breathe relies on the Great Qi in the chest rotating and moving, and also on the lively function of the lung lobes to facilitate this opening and closing. Sometimes, due to lung disease, the lively opening and closing of the lung lobes becomes difficult, resulting in a contracted nature. During summer heat, this contraction and frequency may slow slightly, allowing one to avoid asthma; however, upon exposure to cold, asthma immediately occurs. This is the syndrome of Lung Lao (Lung Consumption/Tuberculosis), which often develops during cold periods. It is suitable to use Sheng Huai Shan Yao (Fresh Chinese Yam from Huaiqing) ground into fine powder, boiled into porridge with about 1 liang per dose, mixed with cane sugar and white sugar, and taken with 7-8 fen of the Western medicine Pepzin (Bupenzheng/Bismuth Subgallate?). Since lung lobe contraction is due to reduced body fluids and stagnant blood vessels, the yam and cane sugar moisten it, and Pepzin resolves it (Pepzin is made from piglet and calf gastric juices, hence good at digestion); with time, it will heal itself. For cases with excessive stubborn phlegm, add 2 fen of Peng Sha (Borax) powder fine, taken together with Pepzin. For external treatment, moxibustion on Fei Shu (BL13) is also effective and can be combined with internal treatment. Where Pepzin is unavailable, Sheng Ji Nei Jin (Fresh Chicken Gizzard Lining) 3 fen powder can substitute, having stronger phlegm-resolving power than Pepzin.

In cases where phlegm accumulates in the Stomach, overflows above the diaphragm, infiltrates the Lung, and causes asthma, ancients often used Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) or Shi Zao Tang (Ten Date Pill) to purge it. These are symptomatic treatments, not fundamental cures. My formulated Li Tan Tang (Phlegm-Regulating Decoction), taken continuously for over ten doses, clears both the root and branch of this condition. The rationale of the formula is detailed in the original text, so I will not repeat it here. If the pathogen fills the chest, diaphragm, and Stomach Fu organs, manifesting not as phlegm but as fluid retention (Yin), specifically cold fluid retention (fluid retention has cold and heat types; heat fluid retention presents with a slippery pulse and often involves neurological issues; cold fluid retention presents with a wiry and fine pulse; generally stating all fluid retention is cold is incorrect), the patient may have intermittent asthma or relapse upon cold exposure. This indicates deficiency of Yang in the Upper Jiao. Treatment should use Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) from *Jin Gui Yao Lue*, adding Gan Jiang (Dried Ginger) 3 qian, Nong Po, and Chen Pi (Tangerine Peel) each 1.5 qian. This allows the medicinal heat to overcome the cold, transforming the fluid retention so it descends and exits via the water passages. In cases where not only the Yang of the Upper Jiao is severely deficient but also the Qi aspect is very deficient, causing cold fluid retention to fill the chest and cause asthma, the pulse is not only wiry and fine but also extremely weak. Add Sheng Jian Qi (Raw Astragalus Root) 5 qian to the previous formula, and change Gan Jiang to 5 qian. In autumn of the Renxu year, Yan XX consulted for his friend regarding twenty-six to twenty-seven years of cold fluid retention binding the chest, frequent severe asthma attacks, and extreme aversion to cold. I prescribed this formula (using 1 liang of Raw Astragalus and 8 qian of Dried Ginger; such heavy doses are only for extreme deficiency-cold syndromes). After ten doses, he was completely cured. Heavy use of Huang Qi (Astragalus) in the formula is because it tonifies the Great Qi in the chest; when the Great Qi is robust, it naturally transforms and descends cold fluid retention. The three cases discussed above are all internal-injury asthma originating from the Lung.

External contraction asthma generally originates from the Lung. Its treatment methods vary according to the specific syndrome. The exterior of the human body is governed by Wei Qi (Defensive Qi), which originates from the Great Qi in the chest. Since the Lung governs the skin and hair, it has a close relationship with the Lung Zang. Sometimes, the exterior is constrained by Wind-Cold, preventing Wei Qi from circulating throughout the body. Consequently, the Great Qi in the chest has no outlet, suddenly generating expansive force. Suspended in the chest, the Lung is squeezed by this force, causing asthma. Furthermore, due to the close relationship between the Lung and Wei Qi, stagnation of Wei Qi leads to stagnation of Lung Qi, also causing asthma. This is the syndrome treated by Ma Huang Tang (Ephedra Decoction) in *Shang Han Lun*, which often includes asthma. However, when using Ma Huang Tang, it is advisable to add Zhi Mu (Anemarrhena Rhizome) several qian to ensure resolution after sweating without risk. In Warm Diseases (Wen Bing), asthma may also occur initially. Treatment should use Bo He Ye (Mint Leaf) and Niu Bang Zi (Arctium Fruit) each 3 qian, Sheng Shi Gao (Raw Gypsum) powder 6 qian, and Gan Cao 2 qian. Or Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be used. However, Shi Gao must never be calcined, and its dosage should be several times that of Ma Huang (Gypsum can be used up to 1 liang, while Ma Huang for this syndrome rarely exceeds 2 qian). Although the asthma in these two syndromes is similar, the medications differ significantly because the pulse in Cold Damage (Shang Han) is floating and tight, whereas in Warm Disease it is surging and slippery.

When external Wind-Cold invades internally,凝滞 (stagnating) with water qi in the chest, pressing upward on Lung Qi to cause asthma, this is the Xiao Qing Long Tang (Minor Blue Dragon Decoction) syndrome from *Shang Han Lun*. One must strictly follow the method of adding Shi Gao to Xiao Qing Long Tang from *Jin Gui Yao Lue*, adding Sheng Shi Gao to approximately 1 liang for effectiveness. Additionally, the standard modification rule for this formula states that for asthma, remove Ma Huang and add Xing Ren (Apricot Kernel). However, when I use this formula to treat asthma, I consistently add Xing Ren but still retain Ma Huang 1 qian. For patients with a very deficient pulse, add Ye Tai Shen several qian. The revised dosages for Xiao Qing Long Tang used in later generations can be referenced here. Also, my formulated Cong Long Tang (Following Dragon Decoction) treats cases where asthma recurs after recovery following Xiao Qing Long Tang administration. It has repeatedly proven effective. The above two points outline the general treatment for external-contraction asthma.

For individuals with chronic consumption-related asthma and cough who develop symptoms upon slight external contraction, this is a syndrome of simultaneous internal injury and external contraction causing asthma. It should be treated with my formulated Jia Wei Yue Bi Jia Ban Xia Tang (Modified Yue Bi plus Pinellia Decoction). Because internal and external factors simultaneously cause asthma, the medication combines treatments for both.

However, although the aforementioned asthmas differ in etiology (internal/external, Liver/Kidney/Lung), they generally involve the inability to receive Qi, making inhalation difficult, i.e., "spitting inhalation" mentioned in *Shennong Bencao Jing*. Yet, there are asthmatic cases where inhalation is not difficult, but exhalation is. The etiology here is deficiency and sinking of the Great Qi in the chest, unable to drive the Lung to perform respiration. The person must strive to breathe to save themselves. The urgency of breathing resembles asthma but is fundamentally different from asthma due to failure to receive Qi. If differentiation is unclear, and one sees asthma and prescribes herbs to direct Qi downward and receive Qi, danger will appear immediately. Differentiating this syndrome is not difficult. Severe failure to receive Qi asthma必然 (necessarily) involves "shoulder breathing" (shrugging shoulders); Great Qi sinking asthma, even if breathing is noisy, will not involve shoulder shrugging, but rather drooping shoulders. Even comparing the pulses of these two syndromes reveals distinct differences: failure to receive Qi asthma often presents with a rapid pulse, or weak Chi position and strong Cun position; Great Qi sinking asthma often presents with a slow and powerless pulse, or the Chi position slightly surpasses the Cun position. Observing the signs and examining the pulse ensures accurate differentiation. The treatment should use my formulated Sheng Xian Tang (Ascending Sinking Decoction) to raise and tonify the Great Qi in the chest, curing the asthma.

In cases where Great Qi sinking causes asthma, combined with Yin deficiency failing to receive Qi causing asthma, breathing is difficult in both aspects. The person strives to breathe, presenting an asthmatic appearance. The pulse is weak and powerless, or slightly rapid, or the back feels tight with slight burning sensation in the body and mind. Treatment should use Sheng Huai Shan Yao 1 liang, Xuan Shen, Gan Gou Qi each 6 qian, Sheng Jian Qi 4 qian, Zhi Mu, and Gui Zhi Jian each 2 qian, decocted in water. Do not use Jie Geng (Platycodon Root), Sheng Ma (Cimicifuga Rhizome), or Chai Hu (Bupleurum Root) in the formula, lest they hinder the treatment of Yin deficiency failing to receive Qi. The asthmas in the above two syndromes share similarities but have differences; verified cases for Sheng Xian Tang are available for reference.

There is a rare case where Liver Qi and Gallbladder Fire carry Chong and Stomach Qi upward rushing to cause asthma. When this upward rush reaches its extreme, it squeezes the Great Qi in the chest downward, causing the asthma to stop abruptly, and breathing ceases entirely. Suddenly, asthma returns, cycling endlessly. This is the most bizarre form of asthma. I once treated a young woman who developed this syndrome due to marital discord. I used Gui Zhi Jian (Cinnamon Twig Tip) 4 qian. Fearing its heat, I assisted it with Dai Xin Cun Dong (Ophiopogon with heart) 3 qian. Decocted in water and taken, she was cured immediately. Reading *Shennong Bencao Jing*, Gui Zhi can raise Great Qi and simultaneously direct rebellious Qi downward. Using it proved effective instantly. Though small, Gui Zhi excels in both raising sinking and directing rebellious Qi downward. This is truly a unique gift of Heaven.