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(Attached Note:)
General Summary: Asthma (Chuan) is a dire condition known since ancient times. One must carefully examine the rapid breathing and physical symptoms. Baihu Tang (White Tiger Decoction) and Meihua Yinzi (Plum Blossom Drink) can resolve acute conditions; a single dose disperses the pathogen, ensuring recovery.

Pulse Diagnosis: A pulse that is floating, slow, and slippery indicates vitality. A pulse that is choppy, rapid, fine, and deficient indicates impending death. The pulse should be floating and slow, not rapid. A rapid pulse indicates heat; if accompanied by asthma, cough, hemoptysis, it is critical. Inability to lie flat due to qi rebellion indicates death. Qi rebellion with facial edema and audible breathing sounds, with a floating and large pulse, is difficult to treat; acupuncture exacerbates it.

The *Neijing* states: All rebellious qi rushing upward belongs to Fire. It also states: When daily activities are normal but breathing produces sound, this is due to the reversal of lung meridians.

Hejian (Liu Wansu) stated: Excessive fire manifests as summer heat, while deficient fire manifests as winter cold. Thus, in cold diseases, respiration is weak and qi is faint; in heat diseases, qi is abundant and respiration is coarse. Cold and water belong to Yin, governing slowness and delay; hot fire and water belong to Yang, governing rapidity and frequency. Therefore, cold causes slow respiration and faint qi, while heat causes frequent respiration and coarse qi, leading to asthma. Generally, "Xiao" (Wheezing) is named for its sound, "Chuan" (Asthma/Dyspnea) for breath status, and "Cu" (Shortness of Breath) for shortness of air. Wheezing with throat sounds like a water frog is called Xiao; continuous, unremitting rapid breathing is called Chuan. However, these are invariably caused by internal stagnation of phlegm-fire or external invasion of wind-cold. In cases where cold damage causes lung qi congestion and asthma, the exterior is unresolved; treat with herbs such as Ephedrae Herba (Mahuang), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao), and Gypsum Fibrosum (Shigao), distinguishing true cold from false heat.

In cases of wind injury with cough and lung deficiency causing asthma, treat with modifications of Mahuang Xingren Gancao Sanwu Tang (Ephedra, Apricot Seed, and Licorice Three-Ingredient Decoction).

For asthma triggered by fright, with qi rebelling against the heart and lungs, sudden open-mouth breathing, and mental restlessness with fatigue, use Huatan Dingchuan Wan (Phlegm-Resolving and Asthma-Calming Pill).

For wheezing and roaring asthma with throat sounds like sawing wood, take Meihua Yinzi (Plum Blossom Drink). For asthma caused by acidic food intake, consume raw tofu. For heat patterns, use cooling asthma-calming preparations.

When asthma and distension occur together, they inevitably involve impaired urination. Asthma leads to distension, and distension leads to asthma. One must distinguish the root and branch, and their sequence. If asthma precedes distension, the root is in the Lung; if distension precedes asthma, the root is in the Spleen. The Lung Metal governs descending, controls the skin and hair externally, receives all vessels, regulates water passages, and transmits downward to the bladder. When the Lung is invaded by pathogens, it loses its descending function, causing urine output to decrease gradually. Water overflows into the skin, causing distension. Here, asthma is the root and distension is the branch; treatment should focus on clearing Lung heat and descending fire, with promoting urination as secondary. The Spleen Earth dislikes dampness and governs muscles; Earth controls Wood. If Spleen Earth is injured and cannot control water, water overflows and infiltrates muscles. As water overflows upward, pathogens invade the Lung, preventing qi descent and causing asthma. Here, distension is the root and asthma is the branch; treatment should focus on strengthening the Spleen and promoting urination, with clearing Lung heat as secondary. Using drying Spleen herbs for Lung disease dries Lung Metal and worsens asthma. Using Lung-clearing herbs for Spleen disease chills the Spleen and increases distension. How can one fail to distinguish these?

Danxi (Zhu Zhenheng) stated: For chronic asthma, use Ginseng Radix (Renshen), Donkey-hide Gelatin (Ejiao), and Schisandrae Fructus (Wuweizi); for acute asthma with excess qi, use Moutan Cortex (Sangbaipi - *Note: Text says Sangbaipi*, Morus Alba Root Bark), Ephedrae Herba (Mahuang), and Armeniacae Semen Amarum (Xingren).

If there is phlegm, asthma always presents with phlegm sounds; resolving phlegm is the priority. If there is qi asthma, breathing is rapid without phlegm sounds; descending qi is the priority.

If there is Stomach deficiency, with shoulder lifting and abdomen pulling, unceasing asthma, harmonizing the Stomach and resolving phlegm is the priority. If there is fire-phlegm, symptoms fluctuate, improving after eating but worsening after meals; clearing fire and cooling the Lung is the priority.

Rebellious qi with dryness and asthma indicates Lung distension, potentially developing into Fengshui (Wind-Water edema); sweating resolves it. Another view states that cough with rebellious qi and Lung distension, with a deep pulse, indicates fluid retention under the heart.

(Parenthetical Note: There are three types of asthma: Heat asthma occurs in summer, not winter; Cold asthma occurs in winter; Water asthma results from retained fluids, causing chest fullness and swelling starting in the feet.)

Qian Zhongyang (Qian Yi) stated: Distension with severe asthma indicates a serious condition. Why? Excessive Kidney Water suppresses Spleen Earth; strong Spleen Earth suppresses Heart Fire; Heart Fire then suppresses Lung Metal. Since the Lung is suppressed by Heart Fire, asthma occurs. Question: If Heart Fire attacks the Lung, and the Lung was previously deficient, why does it present as excess asthma? Answer: There are two reasons. First, Lung Water asthma, which is reversal of the Five Zang organs. Second, Kidney Water qi rebels upward, invading the Lung laterally, causing severe asthma. Both are difficult to treat.

[Attached Formulas]
Huatan Dingchuan Wan (Phlegm-Resolving and Asthma-Calming Pill): Realgar (Xionghuang), Cinnabar (Zhusha), Cicada Slough (Chanyi), Scorpion (Quanxie), Bombyx Batryticatus (Jiangcan), Pinelliae Tuber (Nanxing), Typhonii Rhizoma (Baifuzi), Calomelas (Qingfen).

Meihua Yinzi (Plum Blossom Drink): Borax (Pengshi), Mirabilite (Mangxiao), Ginseng Radix (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao), Cinnabar (Chensha), Moschus (Shexiang), Machaya Xiang (Malay Camphor/Borneol mix), Borneolum Syntheticum (Bingpian). Grind into powder, store in a porcelain vessel. Take with Ophiopogonis Decoction (Mendong Tang) for asthma; with Morus Alba Root Bark Decoction (Sangbaipi Tang) for asthma with cough; with Mint Decoction (Bohe Tang) for daily maintenance.