涂蔚生曰∶喘以气息言，气促而连属不能以息者，谓之喘。哮以声响言，喉中如拽锯及水鸡声者、谓之哮。
喘者多虚而少实，哮者多实而少虚。喘者，多不兼哮，而哮者，每多兼喘。虽同为肺主，而喘者究有虚实寒热之
分焉。如大病久病之后，或久吐久泻之余，败症毕见，忽然张口大喘，此下元亏损，真气浮散。呼吸既不归根，
脱绝即在目前。速施滋补，或可挽救，否则，其命已尽，而参茸亦无所用其力矣。其由于肺气虚者，宜独参汤以
治之。有寒加干姜，有热加寸冬。其由于肾气虚者，宜参茸并用。若由肾阴先亏，肾阳无归而后喘者，则宜六味
地黄汤，加参茸以治之。有寒加桂附，有热则加知柏，此虚喘之概略也。实寒之喘，非由于风寒之闭塞肺窍，即
由于水饮之上冲肺脏。其由于风寒者，必发热恶寒，唇红面赤，鼻息不利，清便自调，宜麻黄汤、荆防葛根汤，
以解散之。由于水饮者，饮水则剧，安眠不得以息，宜葶苈大枣泻肺汤及小半夏汤以治之。热症之喘，其关于虚
者，余于上条已言之矣。其关于实者，非由于食之积，即由于热之甚，积热攻发，气急上逆，形体健壮，不见羸
态，宜二陈汤，加枳壳浓朴山楂神曲麦芽等治积，人参白虎汤，加知柏芩连等以治热。至哮症则见周梦觉解。
独参汤
人参
上以人参一味，量儿之大小强弱，以为药之轻重，浓煎取汁服之。如家贫难购，或市远难获，可以潞参代
之。因潞参虽较人参力弱，而多则亦可力大也。
仲景六味地黄汤
生地（一钱） 萸肉（一钱） 山药（一钱） 丹皮（一钱） 茯苓（一钱） 泽泻（一钱）
仲景麻黄汤（见前伤寒方内）
荆防葛根汤
葛根（一钱） 荆芥（一钱） 防风（一钱） 桔梗（一钱） 枳壳（六分） 杏仁（一钱） 白芍（一钱）
甘草（一钱）
仲景葶苈大枣泻肺汤
葶苈子（一钱） 大枣（一枚）
先将葶苈子炒令黄色，捣研为末，再煮大枣数沸，纳葶苈子同煎，取汁服。
二陈汤（见上咳方内）
人参白虎汤（见上温病方内）
周梦觉曰∶《内经》有喘无哮，至汉方哮喘并论，喘之源不一，哮之源止有冷痰入肺窍而已。夫肺为娇脏，
清虚之质，不容些毫芥蒂，悬于胸间。其窍仰上，一有所入，则不能出。而食果饮水，积成冷痰，浸淫于内，是
为痰母。物交物则引之而已，一为潮上，肺窍为之闭塞，呼吸乱矣。呼吸乱而二十七脉之迭见而杂出者，无所
不至。其遇寒而发者，寒与寒感，痰因感而潮上也。其遇热而发者，寒为热蒸，痰因蒸而潮上也。必待郁闷之极，
咳出一点如鱼脑之形，而症斯愈，脉亦随之而平。本草所训，性味猛烈，惟麻黄砒石，可以开其关，而劫其痰，
麻黄能发汗，一列哮症，虽盛暑之月不发汗。砒石能伤人，一到哮症，虽羸弱之躯不伤人。有是症有是药，而卒不
能除其根者。麻黄能开
寒痰之路，而不能拔痰踞之窠。砒石能剿痰招之党，而不能歼痰伏之魁。药到即愈，愈而复发者此也。余尝见少年
患痨伤，咳嗽吐血，体瘦脉数，败症备矣，询其素有哮症，痨无可治者，以二药治其哮，得愈者数人。又尝见老
人患上气咳嗽，喘闷脉急，不寐，困顿极矣，问其素有哮症，气无可治者，以二药治其哮，得愈者亦数人。瑶池古
冰雪，肺为凝冷痰。斯言近之矣。
制砒石法，以淡豆豉晒干，研末一两，砒石一钱，饭和为丸。
涂蔚生说：喘是指气息而言，气短促且连续不断，无法顺畅呼吸的，称为喘。哮是指声响而言，喉咙中发出像拉锯声或水鸡叫声的，称为哮。
喘证多属虚证而少实证，哮证多属实证而少虚证。喘证通常不兼有哮证，但哮证往往多兼有喘证。虽然两者都与肺有关，但喘证终究有虚、实、寒、热的区别。例如在大病或久病之后，或者在长期呕吐、腹泻之后，各种败象毕现，突然张口大喘，这是下元亏损，真气浮散。呼吸不能归根，脱绝之症就在眼前。迅速施以滋补之法，或许可以挽救，否则，性命已尽，即使使用人参、鹿茸也无济于事了。如果是由于肺气虚引起的，适宜用独参汤来治疗。如果有寒象加干姜，有热象加麦冬。如果是由于肾气虚引起的，适宜用人参和鹿茸并用。如果是由肾阴先亏，导致肾阳无所依附而后出现喘证的，则适宜用六味地黄汤，加入人参、鹿茸来治疗。如果有寒象加肉桂、附子，有热象则加知母、黄柏，这是虚喘的大致概况。实寒性质的喘证，不是由于风寒闭塞肺窍，就是由于水饮上冲肺脏。如果是由于风寒引起的，必定伴有发热恶寒，嘴唇红面色赤，鼻息不畅，大小便正常，适宜用麻黄汤、荆防葛根汤来解散表邪。如果是由于水饮引起的，饮水后症状加剧，睡眠时因呼吸困难而不能安卧，适宜用葶苈大枣泻肺汤及小半夏汤来治疗。热性喘证，其中属于虚证的，我在上一条已经说过了。其中属于实证的，不是由于食积，就是由于热盛，积热攻发，气急上逆，形体健壮，不见虚弱之态，适宜用二陈汤，加入枳壳、厚朴、山楂、神曲、麦芽等治疗食积；用人参白虎汤，加入知母、黄柏、黄芩、黄连等治疗热盛。至于哮证，详见周梦觉的解说。
独参汤
人参
以上仅用人参一味药，根据患儿的大小强弱，决定药量的轻重，浓煎取汁服用。如果家境贫寒难以购买，或者地处偏远难以获取，可以用潞党参代替。因为潞党参虽然比人参药力弱，但用量大也可以产生强大的药效。
仲景六味地黄汤
生地（一钱） 山茱萸肉（一钱） 山药（一钱） 丹皮（一钱） 茯苓（一钱） 泽泻（一钱）
荆防葛根汤
葛根（一钱） 荆芥（一钱） 防风（一钱） 桔梗（一钱） 枳壳（六分） 杏仁（一钱） 白芍（一钱）
甘草（一钱）
仲景葶苈大枣泻肺汤
葶苈子（一钱） 大枣（一枚）
先将葶苈子炒至黄色，捣研成粉末，再煮大枣数沸，纳入葶苈子同煎，取汁服用。
二陈汤（见上咳方内）
人参白虎汤（见上温病方内）
周梦觉说：《内经》中有喘证而无哮证，到了汉代方书将哮喘并论。喘的来源不一，哮的来源只有冷痰进入肺窍而已。肺是娇脏，具有清虚的本质，不容许丝毫异物阻滞，悬于胸间。其窍口向上，一旦有异物进入，就无法排出。而吃水果、喝水，积聚形成冷痰，浸淫于体内，这就成为了“痰母”。物引动物，顺势而为，一旦痰浊潮涌而上，肺窍就会因此闭塞，呼吸就会紊乱。呼吸紊乱，全身二十七脉的症状便会交错杂出，无所不至。那些遇寒而发作的，是寒与寒相感，痰因寒而潮涌而上。那些遇热而发作的，是寒被热蒸腾，痰因热蒸而潮涌而上。必须等到极度郁闷之时，咳出一点像鱼脑形状的痰块，病症才会痊愈，脉象也随之平和。本草所记载的，性味猛烈的药物，只有麻黄和砒石，可以开通关窍，劫夺痰浊。麻黄能发汗，一旦列出哮证，即使在盛夏酷暑也不发汗。砒石能伤人，一旦遇到哮证，即使是羸弱的身体也不受其伤害。有这种病就用这种药，但最终不能除根的，就是这个原因。麻黄能开通寒痰的道路，但不能拔除痰踞守的巢穴。砒石能剿灭痰浊招引的同党，但不能歼灭潜伏的痰浊魁首。药到病愈，愈后又复发的，就是这种情况。我曾经见到少年患痨伤，咳嗽吐血，身体消瘦脉数，败象具备，询问他平素有哮证，痨病无可治者，用这两味药治疗他的哮证，治愈了几个人。又曾经见到老人患上气咳嗽，喘闷脉急，失眠，困顿至极，询问他平素有哮证，气病无可治者，用这两味药治疗他的哮证，治愈的人也几个。瑶池古冰雪，肺为凝冷痰。这话是有道理的。
Tu Weisheng stated: "Chuan" (Asthma/Wheezing with shortness of breath) refers to the state of breath; when breathing is rapid, continuous, and cannot be sustained smoothly, it is called Chuan. "Xiao" (Wheezing with sound) refers to the sound; when there is a sound in the throat resembling a sawing noise or the call of a water chicken, it is called Xiao.
Chuan syndrome is mostly deficiency and rarely excess; Xiao syndrome is mostly excess and rarely deficiency. Chuan usually does not accompany Xiao, but Xiao often accompanies Chuan. Although both are related to the Lung, Chuan ultimately has distinctions of deficiency, excess, cold, and heat. For example, after severe or chronic illness, or following prolonged vomiting and diarrhea, when all signs of collapse appear, sudden open-mouthed gasping occurs. This indicates depletion of the Lower Yuan (Kidney essence and Qi), with floating and scattering of True Qi. Since respiration fails to return to its root, imminent collapse is at hand. Rapid application of tonifying methods may save the patient; otherwise, life is lost, and even Ginseng and Deer Antler will be ineffective. If caused by Lung Qi deficiency, Dushen Tang (Single Ginseng Decoction) is suitable. If accompanied by Cold, add Ganjiang (Dried Ginger); if accompanied by Heat, add Mudong (Ophiopogon Tuber). If caused by Kidney Qi deficiency, Ginseng and Deer Antler should be used together. If caused by initial Kidney Yin deficiency leading to unrooted Kidney Yang resulting in Chuan, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Ginseng and Deer Antler is suitable. If accompanied by Cold, add Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root); if accompanied by Heat, add Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark). This outlines the general principles for Deficiency Chuan.
Excess-Cold Chuan is either due to Wind-Cold blocking the Lung orifices or due to Fluid Retention rushing up to the Lung. If due to Wind-Cold, it must present with fever and aversion to cold, red lips and flushed face, nasal obstruction, and normal bowel movements. Mahuang Tang (Ephedra Decoction) or Jingfang Gegen Tang (Schizonepeta, Saposhnikovia, and Kudzu Decoction) should be used to release the exterior. If due to Fluid Retention, symptoms worsen upon drinking water, and sleep is impossible due to dyspnea. Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) and Xiaobanxia Tang (Minor Pinellia Decoction) should be used.
Regarding Heat-type Chuan, the deficiency type was discussed above. The excess type is either due to Food Stagnation or excessive Heat. Accumulated Heat attacks, causing urgent Qi reversal upward; the body is robust without emaciation. Erchen Tang (Two-Aged Decoction) added with Zhike (Bitter Orange Peel), Houpo (Magnolia Bark), Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), and Maiya (Germinated Barley Fruit) treats stagnation; Renshen Baihu Tang (Ginseng and White Tiger Decoction) added with Zhimu, Huangbai, Huangqin (Scutellaria Root), and Huanglian (Coptis Rhizome) treats Heat. As for Xiao syndrome, refer to Zhou Mengjue's explanation.
**Dushen Tang (Single Ginseng Decoction)**
Renshen (Ginseng Root)
Use only one herb, Renshen. Determine the dosage strength based on the child's size and constitution. Decoct strongly to extract the juice and administer. If family poverty makes purchase difficult, or remote location makes acquisition hard, Luzhenshen (Pseudostellaria Root from Lu) can be used as a substitute. Although Luzhenshen is weaker than Renshen, large doses can achieve strong effects.
**Zhongjing Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia by Zhang Zhongjing)**
Shengdi (Rehmanniae Radix Preparata) - 1 qian
Yurou (Corni Fructus) - 1 qian
Shanyao (Dioscoreae Rhizoma) - 1 qian
Danpi (Moutan Cortex) - 1 qian
Fuling (Poria) - 1 qian
Zexie (Alismatis Rhizoma) - 1 qian
**Zhongjing Mahuang Tang (Ephedra Decoction by Zhang Zhongjing)** (See previous Shanghan formulas)
**Jingfang Gegen Tang (Schizonepeta, Saposhnikovia, and Kudzu Decoction)**
Gegen (Puerariae Lobatae Radix) - 1 qian
Jingjie (Schizonepetae Spica) - 1 qian
Fangfeng (Saposhnikoviae Radix) - 1 qian
Jiegeng (Platycodonis Radix) - 1 qian
Zhike (Aurantii Fructus Immaturus) - 6 fen
Xingren (Armeniacae Semen Amarum) - 1 qian
Baishao (Paeoniae Radix Alba) - 1 qian
Gancao (Glycyrrhizae Radix et Rhizoma) - 1 qian
**Zhongjing Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung by Zhang Zhongjing)**
Tinglizi (Descurainiae Semen Lepidii Seminis) - 1 qian
Dazao (Jujubae Fructus) - 1 piece
First stir-fry Tinglizi until yellow, crush and grind into powder. Then boil Dazao for several boils, add the Tinglizi powder, decoct together, extract the juice, and administer.
**Erchen Tang (Two-Aged Decoction)** (See previous Ke cough formula)
**Renshen Baihu Tang (Ginseng and White Tiger Decoction)** (See previous Wenbing warm disease formula)
Zhou Mengjue stated: "Neijing" contains descriptions of Chuan but not Xiao. It was not until Han dynasty formulas that Asthma and Wheezing were discussed together. The origins of Chuan are diverse, whereas the origin of Xiao is solely cold-phlegm entering the Lung orifices. The Lung is a delicate organ, possessing a clear and empty nature, intolerant of any obstruction, suspended in the chest. Its orifice faces upward; once an object enters, it cannot exit. Eating fruits and drinking water accumulate into cold-phlegm, which infiltrates internally, becoming the "mother of phlegm." Objects attract similar objects; once phlegm-turbidity surges upward, the Lung orifices become blocked, and respiration becomes chaotic. Chaotic respiration leads to the intermingling of symptoms across the twenty-seven meridians. When triggered by Cold, Cold interacts with Cold, causing phlegm to surge due to Cold. When triggered by Heat, Cold is steamed by Heat, causing phlegm to surge due to steaming. One must wait until extreme oppression occurs, coughing out a small amount of phlegm shaped like fish brain, for the syndrome to heal and the pulse to normalize. Materia Medica teaches that among herbs with fierce properties, only Mahuang (Ephedra Herb) and Pishi (Arsenic Trioxide) can open the gates and劫 (rob/drive out) the phlegm. Mahuang induces sweating; however, in Xiao syndrome, even in midsummer, sweating is not induced. Pishi harms people; however, in Xiao syndrome, even for frail bodies, it does not cause harm. There is a specific disease and a specific medicine, yet they cannot eradicate the root. Mahuang opens the path for cold-phlegm but cannot uproot the nest where phlegm resides. Pishi destroys the followers of phlegm but cannot annihilate the chief phlegm lying in ambush. This is why the condition resolves upon medication but recurs later. I have seen youths suffering from consumption (Lao), coughing blood, emaciated with rapid pulses, showing signs of collapse. Upon inquiry, they had a history of Xiao. While consumption was incurable, treating their Xiao with these two herbs cured several individuals. I have also seen elderly patients with upper Qi rebellion, coughing, wheezing, rapid pulse, insomnia, and extreme exhaustion. Upon inquiry, they had a history of Xiao. While Qi disorders were incurable, treating their Xiao with these two herbs also cured several individuals. "Ancient ice and snow of Yaochi, the Lung holds congealed cold phlegm." This statement is apt.
**Method for Preparing Pishi (Arsenic Trioxide):**
Dry Jiangshi (Sojae Semen Praeparatum / Fermented Soybean) in the sun, grind into powder (1 liang). Mix with Pishi (1 qian). Form pills using rice paste.