【因】外感风寒。内发哮喘。但有夹痰饮寒哮。痰火热哮之异。寒哮较多于热哮。寒包热哮则尤多。
【证】素有痰饮寒哮。猝受风寒大发者。一起即头痛身热。恶寒无汗。喘咳稀痰。喉中作水鸡声。
日夜俯几而坐。不得着枕。胸膈痞满。舌苔白滑。中后满布而浓。素有痰火热哮。猝被风寒外束者。
一起即头疼发热。畏风恶寒。喘咳浓痰。喉中有痰吼声。日夜坐不得卧。面浮睛突。胸前痞塞。舌苔
黄滑。中后满布浓腻。
【脉】左弦紧。右弦滑者。风寒夹冷哮痰喘也。左浮弦。右滑数者。风寒夹热哮痰火也。
【治】冷哮痰喘。先用射干麻黄汤。以发表散寒为主。送下冷哮丸（麻黄、川乌、细辛、蜀椒、
白矾、牙皂、半夏曲、陈胆星、杏仁、甘草各一两、紫菀、款冬花各二两、上为细末、姜汁调神曲末、
打糊为丸、每遇发时、临卧生姜汤服二钱、羸者一钱。）除寒哮以定喘。俟表邪去而哮喘平。即用
六君子汤。扶正气以涤饮。外用冷哮涂法以除根。（白芥子、延胡索各一两、甘遂、细辛各五钱、共
为末、入麝香五分杵匀、调涂肺俞膏肓百劳等穴、涂后、麻瞀疼痛、切勿便去、候三炷香足、
方去之。十日后涂一次、三次病根去矣。）热哮痰喘。先用白果定喘汤。以宣气豁痰为主。
口噙清金丹。除热哮以平喘。若表邪去而喘未平。继用导痰汤加旋复、海石、苏子、白前。肃肺气
以除痰。终用加减玉竹饮子以保肺。总之哮喘一症。寒包火为最多。遇寒即发。饮冷亦发。虽亦
有感温暑而发。初治必兼辛散。开发肺气切不可纯用寒凉。使痰壅肺闭。猝致闷毙。惟见胸突背驼者。
必为痼疾。不可救药。
【秀按】哮症与喘不同。盖哮症多有兼喘。而喘有不兼哮者。因哮症似喘而非。呼吸有声。呀呷不已。
良由痰火郁于内。风寒束其外。古方如浓朴麻黄汤。越婢加半夏汤。时方如白果定喘汤。五虎汤加节斋
化痰丸。表散寒邪。整肃痰火。此四方最为的对。或由初感寒邪。失于表散。邪伏于里。留于肺俞。此
即冷哮痰喘。若因遇冷即发。顽痰结聚者。宜用小青龙汤。送下立除冷哮散。（用胡椒四十九粒、入活
癞虾蟆腹中、盐泥裹 存性、分五七服、若有伏热者忌用。）如因病根深久。难以猝除。频发频止。淹
缠岁月者。即当口噙钟乳丸。（滴乳石、制法、酒湿研七日、水飞七次、甘草汤煮三伏时、蘸少许捻开、
光亮如 鱼为度。麻黄、醋汤泡焙干、光杏仁、炙甘草各三钱、研极细匀、炼白蜜丸、弹子大、五更临
卧各噙化一丸、去枕仰卧、勿开言、数日效、但必一生忌术、以石药 悍、白术壅滞、犯之恐有暴绝
之虞。）逐渐以缓消之。或因坐卧寒湿。遇冷则发。此属中外皆寒。苓术二陈煎加麻、杏。调下芦吸散。
〔款冬花、川贝母、肉桂、炙甘草各三钱、鹅管石 透五钱（即钟乳之最精者）、共研细匀、每服一分、
若平时、但以芦管吸少许、噙化咽之。日三五次。〕外灸肺俞、膏肓、天突三穴以除根、或因酸盐过食。
遇冷冻饮料食而发者。宜用三白饼子。（用白面粉白糖各二钱、饴糖饼化汁、捻作饼子、炉内 熟、划出、
加轻粉四钱捣匀、分作二三服、令病患食尽、吐出病根即愈、体虚及年幼者、分四五次服之。）搜涤淤
积以涌痰。继用异功散加细辛。补助宗气以保肺。三涌三补。屡建奇功。或因积火薰蒸。遇风而发。
用五虎汤加竹沥达痰丸。上宣肺气。下逐痰火。再避风寒。节浓味。自能痊愈。总之哮症禁用纯凉剂。
恐风邪难解。禁用大热剂。恐痰火易升。宣气疏风。勿忘病根。轻品如杏仁、橘红、薄荷、前胡。重则
如麻、桂、细辛、苏、葶。未发时以扶正气为主。《外台》茯苓饮、苓术二陈煎酌用。既发时以攻邪
气为主。大概以温通肺脏。古方如小青龙、射干麻黄汤等。时方如白果定喘、苏子降气汤等。继则下
摄肾真为要。古方如《金匮》肾气汤、真武合桂苓甘味汤等。时方如新加八味地黄汤、六味地黄汤加
青铅。若久发中虚。又
必补益中气。其辛散苦寒。豁痰破气之剂。在所不用。
【廉勘】《内经》有喘无哮。至唐宋始哮喘并论。虽皆属呼吸困难。而病理证候不同。哮者气闭而不得出。其初
多冷痰入肺窍。寒闭于上。则气之开阖不利。遂抑郁而发声。故俗称气吼病。有肺症。有胃症。有督脉症。肺
症多起于风寒。遇冷则发。气急欲死。其时惟麻黄、砒石之性味猛烈。始可开其关而劫其痰。麝香之气性走
窜。始能通其窍而宣其气。予治哮症。审其外内皆寒者。每用麻黄二陈汤。迅散外邪以豁痰。送下加味紫金
丹。（信砒五分、研细、水飞如粉、淡豆豉晒干研末、一两五钱、麻黄去节四钱、当门子四分、共研细而极
匀、真绿豆粉捣和为丸、如芥菜子大、每服十丸、少则五丸。）速通内闭以除哮。用以救人。屡多神效。审其
客寒包火者。每用白果定喘汤。调下猴麝二宝散（猴枣一钱、麝香一分、共研细匀、每服二分。）用以治哮。
屡奏殊功。
胃症多起于痰积。内兼湿热。惟脾有积湿。胃有蕴热。湿与热交蒸。脾胃中先有顽痰胶粘不解。然后入胃之
水。遇痰而停。化为浊痰热饮。不能疾趋于下。渐滋暗长。绵延日久。致肺气呼吸不利。因之呀呷有声而为
哮。遇风遇劳皆发。秋冬以后。日夜如此。痰虽因引而潮上。而其气较肺症稍缓。必待郁闷之极。咳出一二点
宿痰。如鱼脑髓之形。而气始宽。哮渐减。予治此症。审其湿痰上泛。窒滞中气者。初用香苏二陈汤。（沉香
汁两小匙冲、苏子、竹沥半夏各二钱、广皮红、生枳壳、真川朴各一钱、光杏仁、广郁金各三钱、生苡仁、浙
茯苓各六钱、生姜汁四滴冲、费伯雄先生方。）调下导痰开关散。或送下丹溪豁痰丸。（制南星、姜半夏、轻
粉各三钱、飞滑石六钱、巴霜一分半、研极细匀、皂角仁浸浓汁为丸、如芥菜子大、辰砂为衣、每服十粒、多
则十五粒、开水送下亦可。）继用三子导痰汤加炙皂角。豁痰利气以燥湿。终用丹溪湿痰丸。（姜制南星、姜
半夏各一两、海蛤粉二两、上青黛二钱共研细匀、神曲糊丸、如梧桐子大、朝晚各服钱半或二钱、广皮汤送
下。）日夜久服以除根。审其痰随火升。上壅胸膈者。初用竹沥涤痰汤。（栝蒌仁四钱、生桑皮、川贝、光杏
仁各三钱、旋复花二钱拌包飞滑石六钱、石决明八钱、天竺黄钱半、淡竹沥半杯、姜汁两滴同冲、挟肝火者加
羚角一钱。费伯雄先生验方。）送下节斋化痰丸。以蠲痰而降火。继用费氏鹅梨汤。（鹅管石 研、蜜炙麻
黄各三分、栝蒌仁四钱、光杏仁三钱、川贝、茯苓各二钱、广皮红、竹沥半夏、苏子各钱半、射干一钱、梨
汁两大瓢、姜汁四滴同冲、费伯雄先生验方。）缓通肺窍、除其积痰以芟根。
督脉症与肺常相因。多起于太阳经受风寒。内伤冷冻饮料水果。积成冷痰。日久浸淫于肺脏。乃成哮喘。
遇冷即发。背脊恶寒。喘息不得着枕。日夜俯几而坐。初起虽用小青龙汤加减。辛散太阳以温肺。继用金匮肾
气汤加减。温通肾阳以煦督。亦多时止时发。盖因伏饮久踞。始则阳衰浊泛。继则阴亦渐损。每见咳痰不出。
上气郁闷。勉强咳出一二口。痰中稍杂以血点。此哮喘属于虚寒。而阳伤略及阴分也。用药偏刚偏柔。两难措
置。予仿吴门缪松心治范某哮喘案法。初用金水六君煎加减。（熟地炭四钱、当归炭、青盐陈皮各一钱、川贝
二钱、盐水炒光杏仁、浙茯苓、生苡仁各三钱、炙甘草四分。）继则晨用通补肺督丸。（生 皮、杏仁霜、
姜半夏各两半、米泔水浸晒生于术、云茯苓、炙黄羊脊骨、生晒菟丝子各三两、嫩毛鹿角镑二两、桂枝木七钱、
蜜炙麻黄、北细辛各三钱、广皮红一两、炙黑甘草五钱、共研为末、用生苡仁煮浆糊丸、每服三钱。）以治病
之本。晚用加味苓桂术甘丸。（米泔浸生于术、浙茯苓、鹿脊骨用麻黄四钱煎汤炙各三两、桂枝木八钱、竹
沥半夏二两、杏仁霜两半、北细辛三钱、炙甘草六钱、水泛丸、每服钱半至二钱、淡姜盐汤送下。）以治病
之标。终用纳肾通督丸。（熟地水煮四两、归身、嫩毛鹿角、泽泻、姜半夏炒黄各一两五钱、茯苓、生白术
米泔浸晒干、羊脊骨炙黄打碎、杏仁霜各三两、橘红晒一两、炙黑甘草五钱、熟附子七钱、怀牛膝一两
四钱、生牡蛎研细水飞、二两、北细辛晒三钱、蛤蚧两对、去头足炙为末、薏苡煮浆捣丸、每服三钱、早晚
空肚、淡姜盐汤
送下。）摄纳肾阳。温通督脉。疏刷肺气。开豁浊痰。标本兼顾。每多宿疾全瘳。病势稍轻者。酌用新加金水
六君丸。（熟地四两、姜半夏、归身各两半、茯苓三两、广橘红一两、炙黑甘草五钱、淡附子七钱、北细辛三
钱、五味子二钱、煮米仁浆糊丸、外用水澄生半夏生姜二粉为衣、每服三钱、早晚空心、淡姜盐汤送下。）以
治积虚哮喘。效亦如神。此外若能按穴灸治。外贴膏药。尤易除根。
总之感症夹哮。纯寒症固多。寒包热者亦不少。久必实中夹虚。总必色脉合参。随证辨其寒热虚实。而施治
法。不必拘于冷痰入肺窍一语。横于胸中。偏执辛散温补之法也。至若但夹喘症。气升而不得降者。多由表寒
外束。痰涎内郁。则肺气出入不利。随逼迫而直升。故俗称气急病。每用白果定喘、苏子降气二汤。临证奏效
者多。虽然。喘症之因。在肺为实。在肾为虚。实证易治。如实而寒者。必有凝痰宿饮。上阻气机。酌用小青
龙、桂枝加朴杏汤。实而热者。不外痰火湿热。上乾清窍。酌用麻杏石甘加桑皮、苏子。苇茎汤加葶苈、大
枣。外寒散而内热清。则喘自止。后少复发。虚证难医。若因根本素亏。肾虚气逆。阴火上冲而喘者。此不过
一二日之间。势必危笃。但有精伤气脱之分。填精以浓浓之剂。必兼镇摄。《济生》肾气汤加铁落、沉香。都气汤
加青铅、蚧尾。则分从阴从阳以治之。气脱则元海无根。阴竭阳越。全真益气汤。参麦散加河车、石英、坎
气。急续元真以挽之。若平时气弱。呼吸不调。呼气短者。酌用苓桂术甘汤。吸气短者。酌用金匮肾气丸。则
分补中纳下以治之。
【荣斋按】哮与喘相似而不同，秀山先生已有指出，但其主要的差别∶喘为呼吸急促，哮是喉中有声，不如
喘开口出气之多。一般治法，以吐痰为主。若遇冷而发者，宜温疏肺气，若寒包其热者，宜清肺药中兼加发
散。齐有堂认为∶“因肺窍中积有冷痰，一遇寒气，从背心鼻孔而入，则肺胀作声，每发如服紫金丹，不过
七、八次，觉吐出痰涎腥臭，必愈。紫金丹──白砒（生用一钱）白矾（ 枯三钱）同研细末；淡豆豉（水润
去皮蒸熟捣如泥一两）和前药合匀，搓如绿豆大，遇症发时，先以冷茶送七丸，以不喘为愈。不必多增丸数，
慎之。小儿止服二、三丸，神应之至。”他又指出∶“脉浮而滑者易治，微细者难疗。”关于紫金丹，
他列举几个治例，一再强调实验，并经过廉臣先生加减，事实证明，的确是一个治病救人的好方。
[Pathogenesis] Exogenous wind-cold pathogen invades, triggering the latent asthma condition internally. This is further differentiated into cold asthma complicated by phlegm-fluid retention and hot asthma complicated by phlegm-fire. Cold asthma occurs more frequently than hot asthma, while "cold wrapping heat" asthma is even more common.
[Manifestations] In patients with a history of cold asthma due to phlegm-fluid retention, sudden exposure to wind-cold triggers an acute attack. Upon onset, symptoms include headache, feverish body sensation, aversion to cold, absence of sweating, wheezing and coughing with thin sputum, a croaking sound in the throat resembling that of a water-fowl (frog), inability to lie down on a pillow day or night (preferring to sit leaning forward on a desk), chest and diaphragm fullness and oppression, and a white, slippery tongue coating that is thick and covers the middle and posterior regions. In patients with a history of hot asthma due to phlegm-fire, sudden external constraint by wind-cold leads to an attack characterized by headache, fever, aversion to wind and cold, wheezing and coughing with thick sputum, a rattling sound in the throat, inability to lie flat day or night (preferring to sit), facial edema, protruding eyes, chest oppression, and a yellow, slippery tongue coating that is thick and greasy in the middle and posterior regions.
[Pulse] A wiry-tight pulse on the left and a wiry-slippery pulse on the right indicate wind-cold complicated by cold asthma-phlegm-wheezing. A floating-wiry pulse on the left and a slippery-rapid pulse on the right indicate wind-cold complicated by hot asthma-phlegm-fire.
[Treatment] For cold asthma-phlegm-wheezing, first use Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) primarily to release the exterior and dispel cold, administered alongside Lengxiao Wan (Cold Asthma Pill). [Lengxiao Wan Composition: Ephedrae Herba (Mahuang), Aconiti Lateralis Radix Praeparata (Chuanwu), Asari Radix (Xixin), Zanthoxyli Pericarpium (Shujiao), Alumen (Baijian), Gleditsiae Sinensis Spina (Yazao), Massae Fermentatae Medicinalis (Banxiaqu), Pinelliae Rhizoma Preparatum (Chendanting), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao) each 1 liang; Asteris Radix (Ziwan), Farfarae Flos (Kuandonghua) each 2 liang. Processed into fine powder, mixed with ginger juice and Shenqu powder paste, formed into pills. Dosage: Take 2 qian before bed with ginger soup at onset; 1 qian for frail patients.] This eliminates cold asthma and calms wheezing. Once the exterior pathogen is resolved and asthma subsides, immediately use Liujunzi Tang (Six-Gentlemen Decoction) to support healthy qi and drain fluid retention. Externally apply Lengxiao Tu Fa (Cold Asthma External Application) to eradicate the root cause. [Application Formula: White Mustard Seed (Baijiezhi), Corydalis Rhizoma (Yanhusu) each 1 liang; Kansui Radix (Gansui), Asari Radix (Xixin) each 5 qian. Powdered, mixed with 5 fen of Moschus (Shexiang), applied as a paste to Feishu (BL13), Gaohuang (BL43), Bailao (EX-B1) points. After application, numbness and pain are normal; do not remove until three incense sticks have burned. Apply once every ten days; three applications remove the root.] For hot asthma-phlegm-wheezing, first use Baiguo Dingchuan Tang (Ginkgo Anti-Wheezing Decoction) primarily to diffuse lung qi and resolve phlegm, while holding Qingjindan (Clear Metal Pill) in the mouth to clear hot asthma and calm wheezing. If the exterior pathogen is gone but wheezing persists, follow with Daotan Tang (Phlegm-Resolving Decoction) added with Inulae Flos (Xuanfu), Pteridis Rhizoma (Haishi), Perillae Fructus (Suzi), and Cynanchi Stauntonii Radix (Baiqian) to descend lung qi and eliminate phlegm. Finally, use Jiayian Yuzhu Yinzi (Modified Jade Bamboo Drink) to nourish the lungs. In summary, for asthma, the "cold wrapping heat" type is most common. It is triggered by cold or cold drinks. Although it can be triggered by warm-heat pathogens, initial treatment must include acrid-diffusing herbs to open lung qi; pure cold-natured herbs must be avoided to prevent phlegm obstruction and lung closure leading to suffocation. Patients presenting with protruding chest and hunched back likely have incurable chronic disease.
[Xiu's Commentary] Asthma (Xiao) differs from wheezing (Chuan). Generally, asthma often accompanies wheezing, but wheezing does not necessarily accompany asthma. Asthma resembles wheezing but is distinct: breathing is accompanied by sounds, with audible gasping. This is caused by phlegm-fire郁结 (stagnating) internally and wind-cold constraining externally. Ancient formulas such as Houpo Mahuang Tang (Magnolia Bark and Ephedra Decoction) and Yuespi Jia Banxia Tang (Jade Bi Decoction plus Pinellia); contemporary formulas such as Baiguo Dingchuan Tang (Ginkgo Anti-Wheezing Decoction) and Wuhu Tang (Five Tigers Decoction) plus Jiezhai Huatan Wan (Jiezhai Phlegm-Resolving Pill) effectively release exterior cold and regulate phlegm-fire. These four categories are most appropriate. Some cases arise from initial wind-cold invasion neglected by exterior-releasing methods, allowing pathogen to lurk internally and remain at Feishu (BL13); this is cold asthma-phlegm-wheezing. If triggered by cold with stubborn phlegm accumulation, use Xiaoqinglong Tang (Minor Green Dragon Decoction) sent with Lichu Lengxiao San (Instant Cold Asthma Removal Powder). [Formula: 49 grains of Piperis Longi Fructus (Hujiao) placed inside a living Toad (Laixama), wrapped in salt mud and calcined. Divide into 5-7 doses. Contraindicated if latent heat exists.] If the disease root is deep-seated and difficult to cure quickly, with frequent attacks and remissions over years, use Zhongru Wan (Stalactite Pill) held in the mouth. [Stalactite Preparation: Grind with wine for 7 days, water-classify 7 times, boil in Licorice decoction for 3 shichen. Dry until shiny like fish scales. Mix with Ephedrae Herba (Mahuang) soaked in vinegar and baked, Armeniacae Semen Amarum (Guang Xingren), and Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao) each 3 qian. Fine powder, honey pills size of a bullet. Hold one pill at dawn and bedtime, supine without pillow, silent. Effective in days. Lifelong avoidance of Atractylodis Macrocephalae Rhizoma (Baizhu) is required as stone drugs are harsh and Baizhu is cloying, risking sudden death.] Eliminate gradually. Cases due to sitting/lying in cold-dampness, triggered by cold, belong to internal and external cold; use Lingzhu Erchen Jian (Poria and Atractylodes Decoction of the Second House) plus Ephedrae Herba (Mahuang) and Armeniacae Semen Amarum (Xingren), adjusted with Luxi San (Reed Tube Inhalation Powder). [Formula: Farfarae Flos (Kuandonghua), Fritillariae Bulbus (Chuanbeimu), Cinnamomi Ramulus (Rougui), Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao) each 3 qian; Psilomeli Pulvis (Eguanshi/Toug) 5 qian (finest stalactite). Fine powder. Dose: 1 fen. Inhale small amount via reed tube, hold and swallow. 3-5 times daily. Moxa Feishu (BL13), Gaohuang (BL43), Tiantu (CV22) to remove root. Cases due to excess sour/salty food and cold drinks/food: use Sanbai Bingzi (Three Whites Cake). [Formula: Wheat flour and white sugar each 2 qian, malt syrup melted, formed into cakes, baked. Add Calomelas (Qingfen) 4 qian, pounded uniform. Divide into 2-3 doses for patient to eat completely to vomit out root. Frail/young divide into 4-5 doses.] This purges stagnation to induce vomiting of phlegm. Follow with Yigong San (Extraordinary Assistance Powder) plus Asari Radix (Xixin) to supplement Zongqi (Gathering Qi) and protect lungs. Three purgations followed by tonification achieve remarkable results. Cases due to accumulated fire steaming, triggered by wind: use Wuhu Tang (Five Tigers Decoction) plus Zhuli Datang Wan (Bamboo Juice Phlegm-Purging Pill) to diffuse lung qi above and purge phlegm-fire below. Avoid wind-cold, restrict rich flavors, and recovery will occur. In summary, pure cooling agents are forbidden in asthma (fear of trapping wind); strong heating agents are forbidden (fear of raising phlegm-fire). Diffuse qi and wind, remembering the root. Light herbs: Armeniacae Semen Amarum (Xingren), Citri Reticulatae Pericarpium (Juhong), Menthae Haplocalycis Herba (Bohe), Peucedani Radix (Qianhu). Heavy herbs: Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Asari Radix (Xixin), Perillae Folium (Suye), Lepidii Fructus (Tinglizi). During remission, focus on supporting healthy qi: Waitai Fuling Yin (External Classic Poria Drink), Lingzhu Erchen Jian酌情 (as appropriate). During attack, focus on expelling pathogenic qi, generally warming and unblocking the lungs. Ancient formulas: Xiaoqinglong Tang (Minor Green Dragon Decoction), Shegan Mahuang Tang (Belamcanda and Ephedra Decoction). Contemporary formulas: Baiguo Dingchuan Tang (Ginkgo Anti-Wheezing Decoction), Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). Subsequently, grasping Kidney Essence is crucial. Ancient formulas: Jin Gui Shenqi Tang (Essence Kidney Qi Decoction from Golden Cabinet), Zhenwu Tang combined with Guiling Ganwei Tang (Aconite, Poria, Cinnamon, Licorice, Ginger Decoction). Contemporary formulas: Xinjia Bawei Dihuang Tang (Newly Added Eight-Ingredient Rehmannia Decoction), Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) plus Qianqian (Lead Pellets). If chronic attacks cause Middle Jiao deficiency, tonify Middle Qi. Acrid-diffusing, bitter-cold, phlegm-resolving, qi-breaking agents are contraindicated.
[Lian's Analysis] The Neijing mentions wheezing (Chuan) but not asthma (Xiao); they were discussed together starting in Tang/Song dynasties. Both involve dyspnea but differ pathologically. Asthma involves qi closure preventing exit, initially caused by cold-phlegm entering lung orifices, cold blocking above, impairing qi opening/closing, causing depression and sound production (popularly called Qi Hou Disease). It has Lung, Stomach, and Du Meridian types. Lung type starts with wind-cold, triggered by cold, severe dyspnea. Only pungent/herbaceous potency of Ephedrae Herba (Mahuang) and Realgar (Pishi/Ashi) can open orifices and rob phlegm. Moschus (Shexiang) moves through orifices to diffuse qi. I treat internal/external cold asthma with Mahuang Erchen Tang (Ephedra and Pinellia Decoction) to rapidly disperse exterior pathogen and resolve phlegm, sent with Jiawei Zijin Dan (Modified Purple Gold Pill). [Formula: Ashi (Realgar) 5 fen, finely ground/water-classified; Fermented Sojae Semen Praeparatum (Danshi) dried/powdered 1.5 liang; Ephedrae Herba (Mahuang) de-stemmed 4 qian; Moschus (Dangmenzi) 4 fen. Mixed fine, bound with Mung Bean Powder into mustard-seed sized pills. Dose: 10 pills, min 5.] Rapidly opens internal closure to stop asthma. For external cold wrapping internal heat, use Baiguo Dingchuan Tang (Ginkgo Anti-Wheezing Decoction) adjusted with HouShe Erbao San (Monkey-Moschus Two Treasures Powder). [Formula: Monkey Gallstone (Houzao) 1 qian, Moschus (Shexiang) 1 fen. Fine powder. Dose: 2 fen.] Achieves great success.
Stomach type starts with phlegm accumulation, internal damp-heat. Spleen dampness + Stomach heat steams, creating sticky stubborn phlegm in Middle Jiao. Water entering stomach stops on phlegm, turning into turbid-hot fluid, unable to descend, accumulating over time, impairing lung respiration, causing gasping sounds. Triggered by wind/labor, worse in autumn/winter. Phlegm rises when provoked, but qi is slower than Lung type. Relief comes only after coughing up old phlegm like fish brain matter. I treat damp-phlegm flooding obstructing Middle Qi with Xiangsu Erchen Tang (Fragrant Perilla and Pinellia Decoction). [Formula: Aquilariae Lignum Resinatum (Chenxiang) juice 2 small spoons; Perillae Fructus (Suzi), Pinelliae Rhizoma cum Bambusae Succo (Zhuli Banxia) each 2 qian; Citri Reticulatae Pericarpium (Guangpihong), Aurantii Fructus Immaturus (Shengzhike), Magnoliae Officinalis Cortex (Zhen Chunghou) each 1 qian; Armeniacae Semen Amarum (Guang Xingren), Curcumae Radix (Guang Yujin) each 3 qian; Coicis Semen (Sheng Yiren), Poria (Zhe Fuling) each 6 qian; Zingiberis Rhizoma Recens (Shengjiang) juice 4 drops. Dr. Fe Boxiong's formula.] Adjusted with Daotan Kaiguan San (Phlegm-Resolving Orifice-Opening Powder) or sent with Danxi Huotan Wan (Danxi Phlegm-Resolving Pill). [Formula: Pinelliae Rhizoma Preparatum (Zhi Nanting), Zingiberis Rhizoma Preparatum (Jiang Banxia), Calomelas (Qingfen) each 3 qian; Talcum (Fei Huashi) 6 qian, Crotonis Fructus (Bashuang) 1.5 fen. Fine powder, bound with Gleditsiae Sinensis Spica (Zaojiao) juice into mustard-seed pills, coated with Cinnabar. Dose: 10-15 pills, water.] Follow with Sanzi Daotan Tang (Three Seeds Phlegm-Resolving Decoction) plus Zhi Zaojiao to resolve phlegm, benefit qi, dry dampness. Finally, Danxi Shitan Wan (Danxi Damp-Phlegm Pill) taken long-term to remove root. [Formula: Zhi Nanting, Jiang Banxia each 1 liang; Clam Shell Powder (Hai Ge Fen) 2 liang, Indigo Naturalis (Qingdai) 2 qian. Fine powder, Shenqu paste pills, wu-tong seed size. Dose: 1.5-2 qian morning/evening, Tangerine Peel Soup.] Treat phlegm rising with fire obstructing chest/diaphragm with Zhuli Ditang Tang (Bamboo Juice Phlegm-Cleansing Decoction). [Formula: Trichosanthis Fructus (Gualouren) 4 qian; Morus Cortex (Sheng Sangpi), Fritillariae Bulbus (Chuanbei), Armeniacae Semen Amarum (Guang Xingren) each 3 qian; Inulae Flos (Xuanfuhua) 2 qian wrapped with Talcum (Fei Huashi) 6 qian; Halitae Lapis (Shijueming) 8 qian, Angelicae Dahuricae Radix? No, Typhonii Rhizoma? Text says Tianzhuhuang 1.5 qian; Bamboo Juice (Dan Zhuli) half cup, Ginger Juice 2 drops mixed. Add Antelope Horn (Lingjiao) 1 qian if Liver Fire. Dr. Fe Boxiong's verified formula.] Sent with Jiezhai Huatan Wan to clear phlegm and descend fire. Follow with Fe Shi E Li Tang (Dr. Fe's Goose Pear Decoction). [Formula: Psilomeli Pulvis (Eguanshi) ground, Ephedrae Herba (Mahuang) honey-fried each 3 fen; Trichosanthis Fructus (Gualouren) 4 qian, Armeniacae Semen Amarum (Guang Xingren) 3 qian, Fritillariae Bulbus (Chuanbei), Poria (Fuling) each 2 qian; Citri Reticulatae Pericarpium (Guangpihong), Pinelliae Rhizoma cum Bambusae Succo (Zhuli Banxia), Perillae Fructus (Suzi) each 1.5 qian; Belamcandae Rhizoma (Shegan) 1 qian; Pear Juice 2 large scoops, Ginger Juice 4 drops mixed. Dr. Fe Boxiong's verified formula.] Slowly opens lung orifices, removes accumulated phlegm to cut root.
Du Meridian type links with Lung, starting with Taiyang wind-cold and internal injury from cold drinks/fruits, forming cold-phlegm, infiltrating lungs over time. Triggered by cold, back aversion to cold, dyspnea preventing lying down, sitting forward day/night. Initially use modified Xiaoqinglong Tang (Minor Green Dragon Decoction) to disperse Taiyang and warm lungs. Follow with Jin Gui Shenqi Tang (Essence Kidney Qi Decoction) to warm Kidney Yang and nourish Du Meridian. Often intermittent because latent fluid lingers, initially Yang deficiency with turbid flooding, later Yin damage. Coughing without expectoration, upper qi oppression, forcing out 1-2 mouthfuls with blood spots indicates deficiency-cold asthma with Yang injury affecting Yin. Hard to balance rigid/soft drugs. I mimic Miao Songxin's treatment of Fan's asthma. Initial: Jinshui Liujun Jian (Metal-Water Six-Gentlemen Decoction). [Formula: Rehmanniae Radix Preparata (Shuditan) 4 qian; Angelicae Sinensis Radix Preparata (Dangguitan), Sal (Qingyan), Citri Reticulatae Pericarpium (Chenpi) each 1 qian; Fritillariae Bulbus (Chuanbei) 2 qian; Salt-fried Armeniacae Semen Amarum (Guang Xingren), Poria (Zhe Fuling), Coicis Semen (Sheng Yiren) each 3 qian; Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao) 4 fen.] Morning: Tongbu Feidu Wan (Unblocking-Nourishing Lung-Du Pill). [Formula: Astragali Membranacei Radix (Sheng Huangqi), Armeniacae Semen Amarum Frost (Xingrenshuang), Pinelliae Rhizoma (Jiang Banxia) each 1.5 liang; Atractylodis Macrocephalae Rhizoma (Sheng Baizhu) rice-water soaked/dried, Poria (Yun Fuling), Ovis/Cervus Spine Bone Roasted (Huangyangjigu), Cuscutae Semen (Sheng Tusizi) each 3 liang; Cervus Cornu Tenuis (Nenmao Lu jiao) shaved 2 liang; Cinnamomi Ramulus (Guizhimu) 7 qian; Ephedrae Herba (Mahuang) honey-fried, Asari Radix (Beixixin) each 3 qian; Citri Reticulatae Pericarpium (Guangpihong) 1 liang; Glycyrrhizae Radix et Rhizoma Praeparata (Hei Zhigancao) 5 qian. Powder, Coix decoction paste pills. Dose: 3 qian.] Treats root. Evening: Jiawei Linggui Zhugan Wan (Modified Poria, Cinnamon, Atractylodes, Licorice Pill). [Formula: Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Deer Spine Bone roasted in Ephedra decoction each 3 liang; Cinnamomi Ramulus (Guizhimu) 8 qian; Pinelliae Rhizoma cum Bambusae Succo (Zhuli Banxia) 2 liang; Armeniacae Semen Amarum Frost (Xingrenshuang) 1.5 liang; Asari Radix (Beixixin) 3 qian; Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao) 6 qian. Water pills. Dose: 1.5-2 qian, light ginger-salt soup.] Treats branch. Final: Nashen Tongsu Wan (Kidney-Grasping Du-Unblocking Pill). [Formula: Rehmanniae Radix (Shudi) boiled 4 liang; Angelicae Sinensis Radix (Guishen), Cervus Cornu Tenuis (Lu jiao), Alismatis Rhizoma (Zexie), Pinelliae Rhizoma (Banxia) fried yellow each 1.5 liang; Poria (Fuling), Atractylodis Rhizoma (Baizhu) rice-water soaked/dried, Sheep Spine Bone roasted/broken, Armeniacae Semen Amarum Frost (Xingrenshuang) each 3 liang; Citri Reticulatae Pericarpium (Juhong) dried 1 liang; Glycyrrhizae Radix et Rhizoma Praeparata (Hei Zhigancao) 5 qian; Aconiti Lateralis Radix Praeparata (Shufu) 7 qian; Achyranthis Bidentatae Radix (Huainiuxi) 1.4 liang; Ostreae Concha (Sheng Musi) water-classified 2 liang; Asari Radix (Beixixin) dried 3 qian; Gecko (Gejie) 2 pairs, head/feet removed, roasted/powdered. Coix decoction paste pills. Dose: 3 qian morning/evening empty stomach, light ginger-salt soup.] Grasps Kidney Yang, warms/unblocks Du Meridian, clears lung qi, resolves turbid phlegm, treats root/branch simultaneously. Chronic cases often cured. Milder cases use Xinjia Jinshui Liujun Wan (Newly Added Metal-Water Six-Gentlemen Pill). [Formula: Rehmanniae Radix (Shudi) 4 liang; Pinelliae Rhizoma (Banxia), Angelicae Sinensis Radix (Guishen) each 1.5 liang; Poria (Fuling) 3 liang; Citri Reticulatae Pericarpium (Juhong) 1 liang; Glycyrrhizae Radix et Rhizoma Praeparata (Hei Zhigancao) 5 qian; Aconiti Lateralis Radix Praeparata (Dan Fu) 7 qian; Asari Radix (Beixixin) 3 qian; Schisandrae Fructus (Wuweizi) 2 qian. Rice-Coix paste pills, coated with raw Pinellia/Ginger powder. Dose: 3 qian morning/evening empty stomach, light ginger-salt soup.] Treats chronic deficiency asthma, effective. Moxibustion/acupoints and external plasters aid root removal.
In summary, infection-complicated asthma is mostly pure cold, but cold-wrapping-heat is also common. Chronic cases involve excess with deficiency. Always combine inspection and palpation, differentiate cold/heat/deficiency/excess, and treat accordingly. Do not rigidly adhere to "cold-phlegm entering lung orifices" or bias solely towards acrid-diffusing/warming-tonifying methods. Regarding simple wheezing (Chuan) with ascending qi failing to descend, usually due to exterior cold constraint and internal phlegm-fluid郁结 impairing lung qi movement, forcing qi upward (popularly Qi Ji Disease). Commonly use Baiguo Dingchuan Tang (Ginkgo Anti-Wheezing Decoction) and Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) with good results. Wheezing causes: Lung = Excess, Kidney = Deficiency. Excess is easier to treat. Excess-Cold:凝固 phlegm/fluid blocking qi; use Xiaoqinglong Tang (Minor Green Dragon Decoction) or Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel). Excess-Heat: phlegm-fire/damp-heat disturbing clear orifices; use Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, Licorice) plus Mulberry Bark, Perilla Seed; or Weijing Tang (Reed Root Decoction) plus Lepidii Fructus, Jujube. Exterior cold dispersed, interior heat cleared, wheezing stops. Deficiency is hard to treat. Fundamental deficiency, Kidney deficiency with rebellious qi, Yin fire rushing up causes wheezing; critical within 1-2 days. Differentiate essence loss vs qi collapse. Fill essence with heavy tonics plus anchoring: Jisheng Shenqi Tang (Essential Works Kidney Qi Decoction) plus Iron Filings (Tieluo), Agarwood (Chenxiang); Douqi Tang (Douqi Decoction) plus Lead Pellets (Qianqian), Gecko Tail (Jiewei). Treat Yin/Yang respectively. Qi collapse: Yuan Sea rootless, Yin exhausted, Yang floating. Quanzhen Yiqi Tang (Complete True Qi-Boosting Decoction), Shenmai San (Ginseng-Ophiopogon Powder) plus Placenta Human (Heche), Quartz (Shiyin), Kanqi (Genital organ). Urgently restore Yuan Zhen. Weak qi, irregular breathing, short exhalation: Linggui Zhugan Tang (Poria, Cinnamon, Atractylodes, Licorice Decoction). Short inhalation: Jin Gui Shenqi Wan (Essence Kidney Qi Pill). Tonify middle, grasp lower.
[Rongzhai's Note] Asthma and wheezing are similar but different, as noted by Mr. Xiushan. Main difference: Wheezing is rapid breathing; Asthma has throat sounds, less air expulsion than wheezing. General treatment focuses on vomiting phlegm. Cold-triggered: warm/diffuse lung qi. Cold-wrapping-heat: clear lung with diffusing herbs. Qi You Tang believes: "Cold-phlegm accumulates in lung orifices; cold enters back/nose, lung swells/makes sound. Taking Zijin Dan (Purple Gold Pill) 7-8 times, vomiting foul-smelling phlegm ensures cure." [Zijin Dan: Realgar (Baipi) 1 qian raw, Alum (Baifan) calcined 3 qian, fine powder. Fermented Soybean (Danshi) 1 liang soaked/steamed/mashed. Mix pills mung-bead size. At onset, take 7 pills with cold tea until wheezing stops. Do not increase dose. Caution. Children: 2-3 pills. Divine efficacy.] He adds: "Floating-slippery pulse easy to treat; thready-fine pulse difficult." Regarding Zijin Dan, he cites cases, emphasizes experimentation, and notes Lian Chen's modifications prove it a life-saving formula.