哲言
哮以声响言，喘以气息言。又喘促而喉中如水鸡声者谓之哮，气促而连续不能以息者谓之喘。（《医学正传》）
哮即痰喘之久而常发者。因内有壅塞之气，外有非时之感，膈有胶固之痰，三者相合，闭拒气道，搏击
有声，发为哮病。（《证治汇补》）
哮与喘相类，但不似喘开口出气之多，而有呀呷之音。呷者口开，呀者口闭，开口闭口，尽有其声，呷
呀二音，合成哮字，以痰结喉间，与气相击故也。（《证治准绳》）
哮有夙根，遇寒则发，或遇劳而发者，亦名哮喘。未发时以扶正为主，既发时以攻邪为主。扶正须辨阴
阳，阴虚者补其阴，阳虚者补其阳。攻邪者须分微甚，或散其风，或温其寒，或清其痰火。然发久者气无不虚，
宜于消散中酌加温补，或于温补中量加消散。总须 以元气为念，必使元气渐充，庶可望其渐愈。若攻之太
过，未有不日甚而危者。（张景岳）
哮与喘微有不同，其证之轻重缓急亦异。盖哮多有兼喘，而喘有不兼哮。要知喘证之因，若由外邪壅遏
而致者，邪散则喘自止，后不复发，此喘证之实者也；若因根本有亏，肾虚气逆，浊
阴上冲而喘者，此不过一、二日之间，势必危笃，用药亦难奏功，此喘证之虚者也。若夫哮证，亦由初感外邪，
失于表散，邪伏于里，留于肺俞，故频发频止，淹缠岁月，更有痰哮、咸哮、醋哮，过食生冷及幼稚天哮诸证，
大概以温通肺脏，下摄肾真为主。久发中虚，又必补益中气。其辛散苦寒，豁痰破气，在所不用。此证若得针
灸之医，按穴灸治，尤易除根，然难遇其人耳。○宿哮沉痼，起病由于寒入背俞，内合肺系，宿邪阻气阻痰。
病发，喘不得卧，譬之宵小潜伏里 ，若不行动犯窃，难以强执。虽治当于病发，投以搜逐，而病去必当养正。
（《临证指南》）
哮喘遇冷则发，其证有二∶一者属中外皆寒，治宜参苏温肺汤；二者属寒包热，治宜越婢加半夏汤，或于
未寒时先用承气汤下其热，至冬寒时，无热可包，自不发作。（《医学纲目》）
别有哮证，似喘而非，呼吸有声，呀呷不已。良由痰火郁于内，风寒束其外，或因坐卧寒湿，或因酸咸过
食，或因积火熏蒸，病根深久，难以卒除。避风寒，节浓味，禁用凉剂，恐风邪难解；禁用热剂，恐痰火易升。
理气疏风，勿亡根本，为善治也。（《医宗必读》）
哮喘一证，古无良方，盖因其病有痰有火，有血虚，有真阴涸竭。若竟消痰清火，病未减而元气日亏。若
欲补原，又有助火滞痰之害。惟前明易思兰一方，标本兼治，深得其情。（王协中）
选案
文学顾明华，十年哮嗽，百药无功。诊其两寸，数而涩。余曰∶涩者，痰火风寒，久久盘踞，根深蒂固矣。
须补养月余，行吐下之法。半年之间，凡吐下十次，服补药百余剂，遂愈。更以补中益气汤，加鸡子、秋石为
丸，服年许，不复发。（李士材）
附方
治哮喘方 立方本旨，以二陈治痰，栀豉清火，当归养血，熟地滋阴，金沸咸能润下，海石咸以消痰，重
以镇下。熟地五钱，当归一钱，茯苓、橘红、半夏、金沸草、麦冬各钱半，甘草五分，黑山栀一钱，淡豆豉一
钱，海石二钱。
又法 治久哮，用生姜汁浆布衫背心，贴肉穿之，易数次，甚效。
哲言
哮病以声音为特征，喘证以气息急促为特征。又有一种情况是呼吸急促且喉间发出像水鸡（青蛙）一样的叫声，这叫做哮；如果是气促且连续不断、无法顺畅呼吸的，这叫做喘。（《医学正传》）
哮病就是痰喘日久且经常发作的疾病。因为体内有壅塞之气，体外有非时节的邪气侵袭，膈间有胶固难化的痰浊，这三者相结合，闭塞拒阻气道，相互搏击而发出声音，从而发为哮病。（《证治汇补》）
哮病与喘证相似，但不像喘证那样张口出气多，而是伴有呀呷（xī xiā）的声音。“呷”指口开，“呀”指口闭，无论是开口还是闭口，都有这种声音，“呷”和“呀”两个音合起来构成“哮”字，这是因为痰结在喉间，与气流相互搏击的缘故。（《证治准绳》）
哮病有宿根（夙根），遇到寒冷就会发作，或者因劳累而发作的，也叫做哮喘。未发作时以扶正（扶助正气）为主，发作时以攻邪（祛除病邪）为主。扶正必须辨别阴阳，阴虚者补其阴，阳虚者补其阳。攻邪必须分清楚病情的轻重，或者疏散风邪，或者温散寒邪，或者清化痰火。然而病程久者，气无不虚，应当在消散病邪中酌情加入温补之法，或者在温补之中适量加入消散之法。总要以元气为重，必须使元气逐渐充盛，才有望逐渐痊愈。如果攻伐太过，没有不日益加重甚至危及生命的。（张景岳）
哮病与喘病略有不同，其病证的轻重缓急也有差异。大概哮病多兼有喘证，而喘证不一定兼有哮病。要知道喘证的成因，如果是由于外邪壅遏所致，邪气散去则喘自然停止，之后不再复发，这是喘证中的实证；如果是由于根本亏虚，肾虚气逆，浊阴上冲而导致喘的，这不过一两天之间，势必危重笃急，用药也难以奏效，这是喘证中的虚证。至于哮证，也是由初感外邪，失于表散，邪气伏留于体内，停留在肺俞穴所在区域，所以频繁发作又频繁停止，缠绵岁月。更有痰哮、咸哮、醋哮，以及过食生冷及儿童先天性的天哮等各种证候，大抵以温通肺脏、下摄肾真（肾中真气）为主。久发导致中焦虚弱，又必须补益中气。那些辛散苦寒、豁痰破气的药物，都在禁用之列。此证如果遇到精通针灸的医生，按穴位进行灸治，更容易除根，然而很难遇到这样的人。○宿哮沉疴痼疾，起病原因由于寒邪侵入背俞穴，内合肺系，宿邪阻碍气机并阻滞痰浊。发病时，喘息严重不能平卧，好比宵小（坏人）潜伏在内，如果不行动犯窃，难以强行抓捕。虽然治疗应当在发病时，投用搜逐病邪的药物，但病去之后必须调养正气。（《临证指南医案》）
哮喘遇到寒冷就会发作，其证候有两种：一种属于内外皆寒，治疗宜用参苏温肺汤；另一种属于寒包热（外寒内热），治疗宜用越婢加半夏汤，或者在尚未受寒时先用承气汤泻下其热，到了冬季寒冷之时，没有热可包，自然就不会发作。（《医学纲目》）
另有哮证，看似喘而非喘，呼吸有声，呀呷声不止。良由痰火郁结于内，风寒束缚于外，或者因为坐卧寒湿之地，或者因为酸咸食物吃得过多，或者因为积火熏蒸，病根深久，难以立刻消除。应当避风寒，节制浓味饮食，禁用凉剂，恐怕风邪难以解除；禁用热剂，恐怕痰火容易上升。调理气机、疏解风邪，且不忘记固护根本，才是善于治疗的方法。（《医宗必读》）
哮喘这一证候，古代没有良方，大概是因为此病涉及痰、火、血虚、真阴涸竭等多种因素。如果单纯消痰清火，病未减轻而元气日渐亏损。如果想要补元，又有助火滞痰的危害。只有前明代的易思兰的一个方子，能标本兼治，深得病情之要领。（王协中）
选案
文学顾明华，患哮嗽十年，各种药物均无效。诊察其两手寸脉，数而涩。我说：“脉涩，说明痰火风寒长久盘踞，根深蒂固了。”需要补养一个月左右，然后施行吐法和下法。半年之间，总共进行了十次吐下治疗，服用补药一百多剂，于是痊愈。后来改用补中益气汤，加入鸡蛋和秋石制成丸药，服用一年多，不再复发。（李士材）
附方
治哮喘方 立方的本旨，是用二陈汤治疗痰浊，栀子豉汤清火，当归养血，熟地黄滋阴，金沸草咸味能润下，海浮石咸味能消痰，重用这些药物以镇降下行。熟地黄五钱，当归一钱，茯苓、橘红、半夏、金沸草、麦冬各一钱半，甘草五分，黑山栀一钱，淡豆豉一钱，海浮石二钱。
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.