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Zhe Yan (Philosophical Remarks)

Xiao (Asthma with stridor) is characterized by sound, while Chuan (Wheezing/Dyspnea) is characterized by rapid breathing. Furthermore, when there is rapid breathing accompanied by a sound in the throat like that of a water chicken (frog), it is called Xiao; when there is rapid breathing that is continuous and cannot be sustained smoothly, it is called Chuan. (*Yixue Zhengzhuan*)

Xiao is essentially Tan Chuan (Phlegm-Wheezing) that has persisted for a long time and frequently recurs. It occurs because internal Qi is obstructed, external pathogenic factors from inappropriate seasons invade, and phlegm on the diaphragm is tenacious and fixed. These three factors combine, blocking and rejecting the airway, striking against each other to produce sound, thereby developing into the disease of Xiao. (*Zhengzhi Huibu*)

Xiao and Chuan are similar, but unlike Chuan which involves much open-mouth exhalation, Xiao is accompanied by "Ya-Xia" sounds. "Xia" refers to an open mouth, and "Ya" refers to a closed mouth. Whether the mouth is open or closed, this sound is present. The combination of the sounds "Xia" and "Ya" forms the character "Xiao," due to phlegm knotting in the throat and striking against the Qi. (*Zhengzhi Zhunsheng*)

Xiao has a latent root (Su Gen). It triggers upon exposure to cold or exertion, and is also named Xian Chuan (Asthma-Wheezing). During remission, treatment focuses on supporting healthy Qi (Fu Zheng); during attacks, it focuses on expelling pathogenic factors (Gong Xie). Supporting healthy Qi requires distinguishing between Yin and Yang deficiency: tonify Yin if Yin is deficient, and tonify Yang if Yang is deficient. Expelling pathogens requires assessing severity: disperse Wind, warm Cold, or clear Phlegm-Fire. However, in chronic cases, Qi is invariably deficient. Therefore, dispersing methods should include moderate warming and tonification, or tonifying methods should include moderate dispersal. The primary consideration must always be Yuan Qi (Primal Qi); only as Yuan Qi gradually replenishes can gradual recovery be hoped for. If expulsion is too aggressive, the condition will inevitably worsen daily and become critical. (Zhang Jingyue)

Xiao and Chuan differ slightly, and their severity and urgency vary. Generally, Xiao often accompanies Chuan, but Chuan does not necessarily accompany Xiao. One must understand the etiology of Chuan: if caused by external pathogens obstructing the body, once the pathogens disperse, the wheezing stops spontaneously without recurrence; this is the Excess type of Chuan. If caused by fundamental deficiency, Kidney deficiency with rebellious Qi, and turbid Yin rushing upward, the condition becomes critical within one or two days, and medication is difficult to effect; this is the Deficiency type of Chuan. As for Xiao, it also originates from initial external pathogen invasion that was not properly released via sweating, allowing pathogens to lie dormant internally and remain in the Lung Shu region. Thus, it recurs frequently over years. There are also types such as Tan Xiao (Phlegm Asthma), Xian Xiao (Salty Asthma), Cu Xiao (Vinegar Asthma), asthma from excessive consumption of raw/cold foods, and Tian Xiao (Congenital Asthma) in children. Generally, treatment prioritizes warming and unblocking the Lungs and grasping/reducing Kidney Zhen Qi (Kidney True Qi). Chronic attacks causing Middle Jiao deficiency require tonifying Middle Qi. Pungent-dispersing and bitter-cold herbs, as well as those that resolve phlegm and break Qi, are contraindicated. If treated by an acupuncturist who applies moxibustion according to specific points, radical cure is easier, though such practitioners are rare. ○ Chronic, entrenched Xiao arises from Cold entering the Back Shu points and merging with the Lung system; old pathogens obstruct Qi and Phlegm. Upon attack, severe wheezing prevents lying down, akin to thieves hiding inside who cannot be caught unless they act. Although treatment during an attack uses drugs to search out and expel pathogens, post-attack care must focus on nourishing Zheng Qi (Upright Qi). (*Linzheng Zhinan Yian*)

Asthma triggered by cold presents in two patterns: one is Cold in both interior and exterior, treated with Shen Su Wen Fei Tang (Ginseng and Perilla Decoction to Warm the Lungs); the other is Cold wrapping Heat (Exterior Cold with Interior Heat), treated with Yue Bi Jia Ban Xia Tang (Mahuang Decoction plus Pinellia), or using Cheng Qi Tang (Order the Qi Decoction) to purge heat before the cold season arrives, so that when winter cold comes, there is no heat to wrap, preventing recurrence. (*Yixue Gangmu*)

There is another form of Xiao resembling Chuan but distinct, with audible breathing and incessant Ya-Xia sounds. This is largely due to Phlegm-Fire郁结 (stagnating) internally and Wind-Cold binding externally, or due to sitting/lying in cold-dampness, excessive consumption of sour/salty foods, or steaming from accumulated Fire. The disease root is deep and long-standing, difficult to eradicate quickly. Patients must avoid Wind-Cold and regulate diet, avoiding cooling agents (as Wind pathogens may be hard to resolve) and heating agents (as Phlegm-Fire may rise). Regulating Qi and dispersing Wind without neglecting the Root constitutes good treatment. (*Yizong Bidu*)

For the syndrome of Asthma, ancient texts lack excellent prescriptions because the disease involves Phlegm, Fire, Blood deficiency, and exhaustion of True Yin. Simply resolving Phlegm and clearing Fire depletes Yuan Qi without reducing the disease. Tonifying the Origin risks aiding Fire and stagnating Phlegm. Only the formula by Yi Silan from the Ming Dynasty achieves both root and branch treatment, accurately addressing the pathology. (Wang Xiezhi)

Selected Case

Gu Minghua, a scholar, suffered from Asthma-Cough for ten years with no efficacy from various medicines. His Cun (Inch) pulses on both hands were Rapid and Choppy. I stated: "Choppy indicates that Phlegm-Fire, Wind, and Cold have lodged deeply for a long time, forming a firm root." He required one month of tonic therapy, followed by emetic and purgative methods. Within half a year, he underwent ten rounds of vomiting and purging, and took over a hundred doses of tonics, resulting in a cure. Subsequently, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was administered with Chicken Egg and Qiu Shi (Natrii Carbonas) prepared as pills. After taking them for over a year, the disease did not recur. (Li Shicai)

Attached Formulas

Formula for Treating Asthma
The principle of this prescription is: Er Chen Tang resolves Phlegm; Zhi Chi Qing Huo clears Fire; Dang Gui nourishes Blood; Shu Di Huang nourishes Yin; Jin Fei Cao (Salviae Miltiorrhizae Radix et Rhizoma / Leech Grass - *Note: Context implies Salvia or similar descending herb, literally 'Boiling Boil Grass' usually refers to Jin Fei Cao which is often Salvia miltiorrhiza or related, here interpreted as descending moistening*) is salty and descends/moistens; Hai Shi (Pumice) is salty and resolves Phlegm; heavy substances anchor and descend.
Ingredients: Shu Di Huang 5 qian, Dang Gui 1 qian, Fu Ling, Ju Hong, Ban Xia, Jin Fei Cao, Mai Dong each 1.5 qian, Gan Cao 0.5 qian, Hei Shan Zhi 1 qian, Dan Dou Chi 1 qian, Hai Shi 2 qian.

Another Method
For chronic Asthma, soak a cloth vest in fresh ginger juice, wear it next to the skin, and change it several times. This is very effective.