五六日已发汗复下胸胁满微结小便不利渴而不呕但头汗出往来寒热心烦为未解柴胡桂姜汤太阳汗吐下解后心下痞
硬噫气不除者旋复代赭石汤太阳先发汗不解而复下之脉浮者则知病在外当须解外桂枝汤发汗若下之病仍不解烦躁不得
眠茯苓四逆汤大汗若大利而厥者四逆汤下后复发汗昼日烦躁不得眠夜而安静不呕不渴无表证脉沉微身无大热干姜附子
汤下后复发汗必振寒脉微细此内外俱虚也伤寒本寒后复吐下之食入口即吐干姜黄连黄芩人参汤发汗吐下后虚烦不得眠
剧者反复颠倒心中懊 栀子豉汤发汗若下之烦热胸中窒栀子豉汤吐下后不大便五六日至十余日日晡发潮热不恶寒独语
如见鬼状循衣摸床脉弦者生涩者死但发热谵语者大承气汤吐下后腹胀满邪热入胃也调胃承气汤太阳吐下后微烦小便数
大便硬小承气汤吐下后七八日不解结热在里表里俱热时时恶风大渴舌上干躁烦欲饮水白虎加人参汤吐下后心下逆满气
上冲胸头眩脉沉紧发汗则动经身为振摇茯苓桂枝白术甘草汤
成 肺主气形寒饮冷则伤肺故其气逆而上行冲冲而气急喝喝而息数张口抬肩摇身滚肚是为喘也有邪在表致气不
利而
喘者麻黄汤桂枝加浓朴杏子汤有水射肺而喘者小青龙汤发汗后饮水多必喘以水灌之亦喘及伤寒心下有水气干呕发热而
咳或喘者小青龙去麻黄加杏仁是欲发散水寒也经曰喘而汗出者与葛根黄芩黄连汤以利之（此邪气内攻气逆不利因喘而汗
出见其邪气在里也虽表未解未可和之）汗出而喘者与麻黄甘草石膏汤以发之（此外邪壅盛使气不利汗出而喘不已见其邪
气在表也虽经汗下亦可发之）若伤寒止于邪气在表而喘者心腹必濡而不坚设或腹满而喘则又为可下之证经曰短腹气满而
喘有潮热者此外欲解可攻里也又汗出发润喘不休者为肺绝身汗如油喘而不休为命绝直视谵语喘满者死是皆不治之喘也
太阳 病（汗）头痛发热身痛腰痛骨节痛恶风无汗而喘麻黄汤太阳与阳明合病喘而胸满者不可下麻黄汤
许 有人病伤寒脉浮而长喘而胸满身热头痛腰脊强鼻干不得卧予曰太阳阳明合病仲景云中有三证下利葛根汤不
下
利呕逆者加半夏喘而胸满者麻黄汤也治以麻黄汤得解
伤寒表不解心下有水气干呕发热而咳或喘者小青龙汤（方见太阳病）发汗后饮水多必喘以水灌之亦喘（喘肺病饮水
多而喘者饮冷伤肺也以冷水灌洗而喘者形寒伤肺也或用小青龙加杏仁猪苓汤）伤寒心下有水气咳而微喘发热不渴服汤已
渴者此寒去欲解也小青龙汤喘家有汗桂枝汤加浓朴杏仁佳（太阳病为诸阳主气风甚气壅则生喘也与桂枝汤以散风加浓朴
杏仁以降气）太阳病下之微喘者表未解故也桂枝加浓朴杏仁汤主之（下后大喘则为里气大虚邪气传里正气将脱也下后微
喘则为里气上逆邪不能传里犹在表也与桂枝汤以解外加浓朴杏仁以下逆气）
桂枝加浓朴杏仁汤方
桂枝（去皮） 芍药 生姜（切各三两） 浓朴（炙去皮） 甘草（炙各二两） 杏仁（去皮尖五十枚） 大枣（十
二枚擘）上七味以水七升煮取三升去滓温服一升
发汗后不可更行桂枝汤汗出而喘无大热者可与麻黄杏仁甘草石膏汤主之（成 发汗后喘当作桂枝加浓朴杏仁汤汗出
则喘愈令汗出而喘为邪气壅甚桂枝汤不能发散故不可更行桂枝汤汗出而喘有大热者内热气甚也无大热者表邪必甚也与
麻黄杏子甘草石膏汤以散其邪张 予观仲景常言发汗后乃表邪悉解止余一证而已故言不可更行桂枝汤今汗出而喘无大
热乃上焦余邪未解当用麻黄杏仁甘草石膏汤以散之夫桂枝加浓朴杏仁汤乃桂枝证悉具而加喘者用之注言汗出而喘以为
邪气壅甚非桂枝所能发散此误也况身无大热更无证何故复言表邪必甚其后章下后不可更行桂枝汤条下注曰汗下虽殊既
不当损正气则一其言有至理存焉可见汗后所注之误矣原其理当时因事发机前后失于照应故有此等之弊也）下后不可更行
桂枝汤若汗出而喘无大热者可与麻黄杏仁甘草石膏汤（成 上条云发汗后不可更行桂枝汤汗出而喘无大热者为与此证治
同汗下虽殊既不当损正气则一邪气所传既同遂用一法治之经所谓若发汗若下若吐后是矣）
麻黄杏仁甘草石膏汤方
麻黄（四两去节） 杏仁（五十枚去皮尖） 甘草（炙二两） 石膏（半斤碎绵裹）上四味以水七升先煮麻黄减二
升去上沫纳诸药煮取二升去滓温服一升（肝苦急急食甘以缓之风气通于肝风邪外甚故以甘剂发之）
太阳病（和解）桂枝证医反下之利遂不止脉促者表未解也喘而汗出者葛根黄芩黄连汤（方见下利）
阳明 中风（汗）口苦咽干腹满微喘发热恶寒脉浮而紧若下之则腹满小便难麻黄汤阳明脉浮无汗而喘者发汗则愈宜
麻黄汤阳明病（和）脉浮而紧咽燥口苦腹满而喘发热汗出不恶寒反恶热身重白虎汤五苓散伤寒四五日脉沉而喘满沉为正
里而反发其汗津液越出大便为难表虚里实久则谵语（邪气入内之时得脉沉而喘满里证具也则当下之反发其汗令津液越出
胃中干燥大便必难久则屎燥必发谵语也大承气汤）阳明病脉迟虽汗出不恶寒者其身必重短气腹满而喘有潮热者此外欲解
可攻里也手足 然而汗出者此大便已硬也大承气汤主之病患小便不利大便乍难乍易时有微热喘冒不能卧者有燥屎也宜
大承气汤
诊 伤寒吐下后不大便潮热若剧则不识人循衣摸床微喘直视脉弦者生涩者死（详循衣摸床）湿家下后额汗微喘
大小
便利者死（论见体痛）少阴病息高者死（详见厥利论见欲寐）厥冷无脉灸之不还反微喘者死（详见厥利）直视谵语喘满
者死（论见谵语）脉浮洪汗出如油发润喘不休为命绝
附
活 阴证喘促者返阴丹主之四肢逆冷喘促入口便佳（方见阴毒）病患小渴与水剧饮之致停饮心下满结者喘死甚
众当
以五苓散或陷胸丸主之（方见渴及结胸）
戴 喘嗽有阴阳太阳经喘嗽略于前本经言之详见嗽门少阳有嗽无喘有喘非少阳也其见少阳证而喘者宜小柴胡汤
加
北五味子六分干姜四分阳明有喘无嗽有嗽非正阳明也其阳明证喘有潮热者宜大承气汤阴证喘惟少阴有之若四肢沉重疼
痛小便如常大便自利而嗽者真武汤去芍药加北五味干姜各半钱细辛三钱此阴中之阴若四肢厥逆腹中痛泄利下重而咳四
逆汤加北五味干姜各半钱下利呕渴身烦不得眠而咳嗽者猪苓汤此阴中之阳诸阴喘促最为危证宜用返阴丹
吴 凡表有寒发喘者脉浮紧恶寒身疼无汗也宜麻黄汤汗之若表有风发喘者脉浮缓恶风自汗也宜桂枝汤加浓朴杏
仁
主之凡阳明内实不大便腹满短气发潮热而喘者大柴胡加浓朴杏仁汤或小承气汤凡阴证厥逆脉沉细而微气促而喘无汗者
宜四逆汤加五味杏仁凡虚人脉伏若手足逆冷而喘者五味子汤凡暴冒风寒脉浮无汗而喘苏沈九宝汤凡热盛有痰脉弦数而
喘不可汗不可下以小柴胡汤加知母贝母栝蒌仁胸满者加枳壳桔梗心下满者加枳实黄连舌燥饮水而喘者加知母石膏主之
古人云诸喘为恶故非轻也华佗曰盛则为喘盖非肺气盛也乃肺中之邪火盛也所以泻白者泻肺中之火也非泻肺也又为泻心
汤乃泻心下之痞满者也卫生宝鉴曰凡看文本有余当认作不足者盖受病为不足病气为有余也
五味子汤（方见厥门）
苏沈九宝汤
桑白皮（上） 甘草（下） 大腹皮（下） 官桂（下） 麻黄（中） 薄荷（下） 陈皮（上） 紫苏（中） 杏
仁（去皮尖炒中） 生姜（三片） 乌梅（半个）上用水二钟煎至八分去滓通口服
加减泻白散 治烦热胸膈不利上气喘促口干或咳者
桑白皮（二钱） 知母 橘红 栝蒌仁（去壳） 细黄芩 贝母 桔梗 甘草（各一钱五分） 地骨皮（一钱）上
煎服法同前
【背景信息】
书名：证治准绳·伤寒 作者：王肯堂 朝代：明 章节：汗吐下后不解 / 喘 类别：伤寒
【原文翻译】
（前文方剂条文）
病程五六天，已经发过汗又用了泻下法，胸胁部胀满且轻微结滞，小便不通利，口渴但不呕吐，只有头部出汗，寒热往来，心中烦闷，这是病邪未解，用柴胡桂姜汤。
太阳病经过发汗、催吐或泻下治疗后，心下部痞塞坚硬，嗳气持续不除的，用旋复代赭石汤。
太阳病先发汗病未解，又用泻下法，脉象仍浮的，说明病邪仍在表，应当解表，用桂枝汤。
发汗或者泻下后，病仍未解，出现烦躁、无法入睡的，用茯苓四逆汤。
大汗出或者严重腹泻导致四肢厥冷的，用四逆汤。
泻下后又发汗，白天烦躁不能入睡，夜间却安静，不呕吐、不口渴，没有表证，脉象沉微，身体没有大热的，用干姜附子汤。
泻下后又发汗，病人必定战栗恶寒，脉象微细，这是内外气血都虚损的表现。
伤寒本是寒邪，之后又用催吐或泻下法，食物入口即吐出，用干姜黄连黄芩人参汤。
发汗、催吐、泻下后，因虚而心烦，无法入睡；症状严重的，翻来覆去，心中烦闷懊恼的，用栀子豉汤。
发汗或者泻下后，烦热感在胸部窒塞的，用栀子豉汤。
催吐或泻下后，多日不大便，从五六天到十几天，傍晚时分发作潮热，不恶寒，独自说话好像看见鬼怪一样，手抓衣被摸弄床沿，脉象弦的有生机，脉象涩的死；如果只是发热说胡话的，用大承气汤。
催吐或泻下后，腹部胀满，这是邪热进入胃腑，用调胃承气汤。
太阳病经过催吐或泻下后，轻微心烦，小便频数，大便干硬，用小承气汤。
催吐或泻下后七八天病仍未解，热邪结聚在里，表里都热，时时怕风，极度口渴，舌面干燥，想喝水，用白虎加人参汤。
催吐或泻下后，心下部逆满，气上冲胸部，头晕目眩，脉象沉紧，如果再用发汗法就会扰动经络，导致身体震颤摇晃，用茯苓桂枝白术甘草汤。
成无己注：肺主气，形体受寒或饮用冷物就会损伤肺，所以肺气上逆。气息冲冲急促，呼吸声喝喝且次数多，张口抬肩，摇动身体滚动肚子，这就是喘。
有邪气在表导致气机不利而喘的，用麻黄汤、桂枝加厚朴杏子汤。
有水饮射肺而喘的，用小青龙汤。
发汗后饮水过多必然致喘，用冷水浇洗身体也会致喘。以及伤寒心下有停水气，干呕、发热而咳嗽，或者喘的，用小青龙汤。
发汗后饮水过多必然致喘，因为冷水浇灌身体也是致喘的原因。（有的用小青龙汤加杏仁，或用猪苓汤）。
伤寒心下有停水气，咳嗽且轻微气喘，发热不渴，服药后感到口渴的，这是寒气已去，病将要解除的表现，原方为小青龙汤。
患有喘疾且有汗出的，用桂枝汤加厚朴、杏仁较好。（太阳病统领诸阳之气，风气盛则气机壅滞而生喘，给予桂枝汤以疏散风邪，加厚朴、杏仁以降气）。
太阳病误用泻下法后轻微气喘的，是因为表证未解，用桂枝加厚朴杏子汤主治。（泻下后出现大喘，则是里气大虚，邪气传入里，正气即将脱失；泻下后轻微气喘，则是里气上逆，邪气不能传入里，仍然在表，给予桂枝汤以解表，加厚朴、杏仁以降逆气）。
桂枝加厚朴杏子汤方
桂枝（去皮）、芍药、生姜（切，各三两）、厚朴（炙，去皮）、甘草（炙，各二两）、杏仁（去皮尖，五十枚）、大枣（十二枚，掰开）。以上七味药，用水七升，煮取三升，去渣，温服一升。
发汗后，不可再使用桂枝汤。汗出而喘，身上没有大热的，可以用麻黄杏仁甘草石膏汤主治。（成无己注：发汗后喘，应当用桂枝加厚朴杏子汤。如果汗出后喘反而加重，说明邪气壅盛，桂枝汤不能发散，所以不可再用桂枝汤。汗出而喘，如果有大热，是内热炽盛；如果没有大热，说明表邪必甚，用麻黄杏仁甘草石膏汤以发散邪气。张景岳注：我观察仲景常言“发汗后”，是指表邪完全解除，只余一个证候而已，所以说不可再用桂枝汤。现在汗出而喘，没有大热，这是上焦余邪未解，当用麻黄杏仁甘草石膏汤以散之。桂枝加厚朴杏子汤是用于桂枝汤证悉具且伴有气喘的情况。注释中说“汗出而喘”是因为邪气壅盛，非桂枝汤所能发散，这是错误的。况且身体没有大热，更无其他证候，为何又说表邪必甚？在后来的章节“下后不可更行桂枝汤”条下的注中说：“汗法和下法虽然不同，既然都不应当损伤正气，那么道理是一致的。”这话很有至理，可见前面关于汗后的注解是错误的。推究其原理，当时是因事生发，前后未能照应，所以有此弊端。）
泻下后不可再用桂枝汤。如果汗出而喘，身上没有大热的，可以用麻黄杏仁甘草石膏汤。（成无己注：上一条说发汗后不可再用桂枝汤，汗出而喘无大热，与此证治疗相同。汗法和下法虽然不同，既然都不应当损伤正气，那么道理是一致的；邪气所传既同，遂用同一法治之。经书所谓“若发汗、若下、若吐后”就是这种情况。）
麻黄杏仁甘草石膏汤方
麻黄（四两，去节）、杏仁（五十枚，去皮尖）、甘草（炙，二两）、石膏（半斤，碎，绵裹）。以上四味药，用水七升，先煮麻黄，减二升，去掉上面的浮沫，加入其他药物，煮取二升，去渣，温服一升。（肝苦急，急食甘以缓之。风气通于肝，风邪外盛，故用甘剂发散。）
太阳病（和解法）：桂枝证，医生反而用泻下法，导致腹泻不止，脉象促的，说明表证未解；气喘且汗出的，用葛根黄芩黄连汤。（方见下利篇）
阳明病：中风（汗法）：口苦、咽干、腹部胀满、轻微气喘、发热、恶寒、脉浮而紧。如果用泻下法，则腹部胀满、小便困难，应用麻黄汤。
阳明病脉浮，无汗而气喘的，发汗则愈，宜用麻黄汤。
阳明病（和法）：脉浮而紧，咽燥、口苦、腹部胀满而气喘、发热、汗出、不恶寒反恶热、身体沉重，用白虎汤。五苓散也可用于伤寒四五日，脉沉而气喘腹胀，沉脉主正里，反而发汗使津液外越，导致大便困难，表虚里实，时间久了会出现说胡话的症状（邪气入内之时，得脉沉而气喘腹胀，里证具备，则当下之，反而发汗令津液外越，胃中干燥，大便必难，久了屎燥必发谵语，用大承气汤）。
阳明病脉迟，虽然汗出但不恶寒，身体必然沉重，短气、腹部胀满而气喘，有潮热的，这是表证欲解，可以攻里。手足濈然汗出的，这说明大便已经硬结，用大承气汤主治。
病患小便不利，大便乍难乍易，时有微热，气喘头昏不能卧的，是有燥屎，宜用大承气汤。
诊法：
伤寒经过催吐或泻下后，多日不大便，有潮热，如果病情严重则不认识人，手抓衣被摸弄床沿，轻微气喘，直视，脉弦的有生机，脉涩的死。
湿家经过泻下后，额头出汗，轻微气喘，大小便通畅的，死。（论见体痛篇）
少阴病，呼吸浅表息高的，死。（详见厥利论及欲寐篇）
四肢厥冷，无脉，灸治后脉不还，反而轻微气喘的，死。（详见厥利篇）
直视、说胡话、气喘腹胀的，死。（论见谵语篇）
脉浮洪，汗出如油，头发湿润，气喘不休的，为命绝。
附录：
活法：
阴证气喘急促的，用返阴丹主治。四肢逆冷，气喘急促，药入口便觉舒适的（方见阴毒篇）。
病患稍微口渴，给水大量饮用，导致停饮、心下部满结的，气喘而死的人很多，应当用五苓散或陷胸丸主治。（方见渴及结胸篇）
戴元礼注：
喘嗽分阴阳。太阳经的喘嗽在前面略述，本经言之，详见嗽门。
少阳有嗽无喘，有喘就不是少阳病。见到少阳证而喘的，宜用小柴胡汤加北五味子六分、干姜四分。
阳明有喘无嗽，有嗽就不是正阳明病。阳明证气喘且有潮热的，宜用大承气汤。
阴证气喘只在少阴病中有。如果四肢沉重疼痛，小便正常，大便自利而咳嗽的，用真武汤去芍药，加北五味子、干姜各半钱，细辛三钱。这是阴中之阴。
如果四肢厥逆，腹中痛，泄利下重而咳嗽的，用四逆汤加北五味子、干姜各半钱。
下利、呕吐、口渴、身体烦闷、无法入睡而咳嗽的，用猪苓汤。这是阴中之阳。
诸阴气喘急促最为危重，宜用返阴丹。
吴崑注：
凡是表有寒邪引发气喘的，脉浮紧，恶寒，身疼，无汗，宜用麻黄汤发汗。
凡是表有风邪引发气喘的，脉浮缓，恶风，自汗，宜用桂枝汤加厚朴、杏仁主治。
凡是阳明内实，不大便，腹部胀满，短气，发潮热而气喘的，用大柴胡汤加厚朴、杏仁或小承气汤。
凡是阴证厥逆，脉沉细而微，气促而喘，无汗的，宜用四逆汤加五味子、杏仁。
凡是虚人脉伏，若手足逆冷而气喘的，用五味子汤。
凡是突然冒受风寒，脉浮，无汗而气喘的，用苏沈九宝汤。
凡是热盛有痰，脉弦数而气喘，不可发汗，不可泻下，用小柴胡汤加知母、贝母、栝蒌仁。胸满的加枳壳、桔梗。心下满的加枳实、黄连。舌燥饮水而气喘的，加知母、石膏主治。
古人说诸种气喘都是恶症，所以不轻率对待。华佗说：盛则为喘，盖非肺气盛也，乃肺中之邪火盛也。所以泻白散是泻肺中之火，并非泻肺。又，泻心汤是泻心下痞满的药。《卫生宝鉴》说：凡看文本有余，当认作不足者，盖受病为不足，病气为有余也。
苏沈九宝汤
桑白皮（上）、甘草（下）、大腹皮（下）、官桂（下）、麻黄（中）、薄荷（下）、陈皮（上）、紫苏（中）、杏仁（去皮尖炒，中）、生姜（三片）、乌梅（半个）。以上用水二钟，煎至八分，去渣，通口服。
加减泻白散
治烦热、胸膈不利、上气喘促、口干或咳嗽者。
桑白皮（二钱）、知母、橘红、栝蒌仁（去壳）、细黄芩、贝母、桔梗、甘草（各一钱五分）、地骨皮（一钱）。煎服法同前。
[Background Information]
Book: Zhengzhi Zhunsheng · Shanghan (Standard of Diagnosis and Treatment · Cold Damage)
Author: Wang Kentang
Dynasty: Ming
Chapter: Unresolved After Sweating, Vomiting, or Purging / Asthma
Category: Shanghan (Cold Damage)
[English Translation]
(Previous Formula Articles)
On the fifth or sixth day, after sweating has been applied followed by purging, if there is fullness in the chest and hypochondrium with slight binding, dysuria, thirst without vomiting, only sweating on the head, alternating chills and fever, and irritability, this indicates the pathogen has not yet resolved; use Chaihu Guijin Tang (Bupleurum and Cinnamon Twig Decoction).
After sweating, vomiting, or purging in Taiyang disease (Disease of the Taiyang Channel), if there is epigastric stuffiness and hardness with persistent belching that does not resolve, use Xuanfuzhe Shi Tang (Inula and Hematite Decoction).
In Taiyang disease, if sweating was first applied but the condition did not resolve, followed by purging, and the pulse remains floating, it indicates the pathogen is still in the exterior; exterior resolution is required using Guizhi Tang (Cinnamon Twig Decoction).
After sweating or purging, if the condition remains unresolved accompanied by irritability and insomnia, use Fuling Sini Tang (Poria and Counterflow to Yang Decoction).
After profuse sweating or severe diarrhea leading to cold extremities, use Sini Tang (Counterflow to Yang Decoction).
After purging followed by sweating, if there is irritability during the day preventing sleep but quietness at night, without vomiting or thirst, no exterior syndrome, a deep and faint pulse, and no significant heat in the body, use Ganjiang Fuzi Tang (Dried Ginger and Aconite Root Decoction).
After purging followed by sweating, the patient will likely experience tremors and aversion to cold with a faint and fine pulse; this indicates deficiency in both interior and exterior.
Shanghan (Cold Damage) originates from cold pathogens; subsequent vomiting or purging may cause food to be vomited immediately upon entry; use Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction).
After sweating, vomiting, or purging, deficiency leads to irritability and insomnia; if severe, with tossing and turning and profound mental restlessness, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
After sweating or purging, if there is irritability and heat with a sensation of obstruction in the chest, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
After vomiting or purging, if there is constipation for five to ten days, evening tidal fever, aversion to cold absent, muttering as if seeing ghosts, picking at bedclothes and bedsides, a string-taut pulse indicates survival, while a choppy pulse indicates death; if only fever and delirium are present, use Dachengqi Tang (Major Order the Qi Decoction).
After vomiting or purging, abdominal fullness indicates heat evil entering the stomach; use Weichengqi Tang (Minor Order the Qi Decoction).
After Taiyang disease is treated with vomiting or purging, slight irritability, frequent urination, and hard stool indicate the use of Xiaochengqi Tang (Lesser Order the Qi Decoction).
After vomiting or purging, if seven or eight days pass without resolution, heat binds in the interior with exterior and interior heat, occasional aversion to wind, extreme thirst, dry tongue, and desire to drink water, use Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
After vomiting or purging, if there is rebellious fullness in the epigastrium, qi rushing to the chest, dizziness, and a deep, tight pulse, further sweating will disturb the collaterals causing body tremors; use Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction).
Cheng Wuji's Commentary: The Lung governs Qi. Physical cold or drinking cold substances injures the Lung, causing Qi to reverse and ascend. Rapid breathing, noisy respiration, opening the mouth and raising shoulders, shaking the body, and rolling the abdomen constitute asthma (wheezing/dyspnea).
When pathogenic factors are in the exterior causing Qi stagnation leading to asthma, use Mahuang Tang (Ephedra Decoction) or Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Plus Magnolia Bark and Apricot Kernel Decoction).
When water-fluid retention attacks the Lung causing asthma, use Xiaoqinglong Tang (Minor Green Dragon Decoction).
After sweating, excessive water intake inevitably causes asthma; bathing with cold water also causes asthma. In Shanghan with water-fluid retention in the epigastrium, presenting with dry heaves, fever, cough, or asthma, use Xiaoqinglong Tang.
Excessive water intake after sweating causes asthma due to cold damaging the Lung; cold water bathing causes asthma due to physical cold damaging the Lung. Some use Xiaoqinglong Tang plus Xingren (Apricot Kernel) or Zhuling Tang (Polyporus Decoction).
In Shanghan with water-fluid retention in the epigastrium, coughing with slight asthma, fever, and no thirst: if thirst occurs after taking medicine, it indicates cold has departed and the disease is resolving; the original formula is Xiaoqinglong Tang.
For patients with chronic asthma and sweating, Guizhi Tang plus Houpo (Magnolia Bark) and Xingzi (Apricot Kernel) is preferable. (Taiyang disease governs Yang Qi; excessive Wind causes Qi stagnation leading to asthma. Guizhi Tang disperses Wind, while Houpo and Xingzi direct Qi downward.)
If Taiyang disease is mistakenly purged leading to slight asthma, it is because the exterior syndrome remains unresoved; treat with Guizhi Jia Houpo Xingzi Tang. (Profuse asthma after purging indicates severe interior deficiency and impending collapse of Righteous Qi; slight asthma indicates interior Qi rebellion with pathogen remaining in the exterior. Guizhi Tang resolves the exterior, while Houpo and Xingzi direct rebellious Qi downward.)
Guizhi Jia Houpo Xingzi Tang Formula
Guizhi (Cortex Cinnamomi, peeled), Shaoyao (Radix Paeoniae Rubra), Shengjiang (Rhizoma Zingiberis Recens, sliced, each 3 liang), Houpo (Cortex Magnoliae Officinalis, processed, peeled), Gancao (Radix Glycyrrhizae, processed, each 2 liang), Xingren (Semen Pruni Armeniacae, peeled and de-husked, 50 seeds), Dazao (Fructus Jujubae, 12 pieces, split). Seven ingredients. Boil in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm.
After sweating, do not use Guizhi Tang again. If there is sweating with asthma and no significant heat, Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be used. (Cheng Wuji notes: Post-sweating asthma should typically be treated with Guizhi Jia Houpo Xingzi Tang. If sweating exacerbates asthma, it indicates severe pathogenic congestion where Guizhi Tang cannot disperse; thus, Guizhi Tang is contraindicated. Significant heat indicates interior excess; absence of significant heat suggests exterior pathogen is severe. Use Ma Huang Xing Ren Gan Cao Shi Gao Tang to disperse the pathogen. Zhang Jingyue notes: Zhongjing often says "after sweating" implying exterior pathogens are fully resolved leaving only one syndrome. Here, sweating with asthma and no significant heat indicates residual upper Jiao pathogens requiring Ma Huang Xing Ren Gan Cao Shi Gao Tang. Guizhi Jia Houpo Xingzi Tang is for complete Guizhi syndrome with added asthma. The commentary claiming "sweating with asthma" implies severe congestion non-responsive to Guizhi Tang is erroneous. Furthermore, without significant heat or other signs, claiming severe exterior pathogen is inconsistent. Later comments on "post-purging" state that although sweating and purging differ, neither should damage Righteous Qi, implying consistency in principle. This reveals an error in the earlier post-sweating commentary due to lack of coordination.)
After purging, do not use Guizhi Tang. If there is sweating with asthma and no significant heat, Ma Huang Xing Ren Gan Cao Shi Gao Tang may be used. (Cheng Wuji notes: Similar to the previous article regarding post-sweating treatment. Although sweating and purging differ, neither damages Righteous Qi; since the pathogen transmission is similar, the same treatment applies, as stated in the Classics: "Whether after sweating, purging, or vomiting.")
Ma Huang Xing Ren Gan Cao Shi Gao Tang Formula
Mahuang (Herba Ephedrae, 4 liang, de-jointed), Xingren (Semen Pruni Armeniacae, 50 seeds, peeled and de-husked), Gancao (Radix Glycyrrhizae, processed, 2 liang), Shigao (Gypsum Fibrosum, 0.5 jin, crushed, wrapped in silk). Four ingredients. Boil in 7 sheng of water; first boil Mahuang to reduce by 2 sheng, remove foam, add remaining herbs, boil to obtain 2 sheng. Strain and take 1 sheng warm. (The Liver dislikes constraint and seeks sweetness to relax. Wind corresponds to the Liver; external Wind excess requires sweet agents to disperse.)
Taiyang Disease (Harmonizing Method): If a Guizhi syndrome is mistakenly purged, leading to continuous diarrhea and a rapid pulse indicating unresolved exterior, with asthma and sweating, use Gegen Qinlian Tang (Kudzu Root, Scutellaria, and Coptis Decoction). (See Diarrhea section).
Yangming Disease: Wind Strike (Sweating Method): Bitter taste in mouth, dry throat, abdominal fullness, slight asthma, fever, aversion to cold, floating and tight pulse. If purged, abdominal fullness and dysuria occur; use Mahuang Tang.
Yangming disease with floating pulse, no sweat, and asthma: sweating resolves it; use Mahuang Tang.
Yangming Disease (Harmonizing Method): Floating and tight pulse, dry throat, bitter taste, abdominal fullness with asthma, fever, sweating, aversion to heat rather than cold, heavy body: use Baihu Tang (White Tiger Decoction). Wuling San (Five-Ingredient Powder with Poria) is also applicable for Shanghan on the fourth or fifth day with deep pulse and asthma/fullness. Deep pulse indicates interior; mistaken sweating causes fluid loss and difficult defecation, leading to exterior deficiency and interior excess, eventually causing delirium. Use Dachengqi Tang (Major Order the Qi Decoction).
Yangming disease with slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness with asthma, and tidal fever indicates exterior resolution and readiness for interior attack. Continuous sweating on hands and feet indicates hardened stool; use Dachengqi Tang.
Patients with dysuria, intermittent difficulty in defecation, slight fever, asthma, vertigo, and inability to lie down have dried feces; use Dachengqi Tang.
Diagnosis:
After Shanghan vomiting/purging, constipation with tidal fever, progressing to unconsciousness, picking at bedclothes, slight asthma, fixed gaze, string-taut pulse indicates survival; choppy pulse indicates death.
Patients with dampness after purging, forehead sweating, slight asthma, and normal bowel/bladder function die. (See Body Pain discussion).
Shaoyin disease with high respiratory rate indicates death. (See Jue-Li and Sleepiness discussions).
Cold extremities, pulseless, unresponsive to moxibustion, with slight asthma indicates death. (See Jue-Li discussion).
Fixed gaze, delirium, asthma, and abdominal fullness indicate death. (See Delirium discussion).
Floating and洪 (surging) pulse, sweating like oil, wet hair, and incessant asthma indicate death of life force.
Appendix:
Living Methods:
Asthma with rapid breathing in Yin syndromes is treated with Fanyin Dan (Return to Yin Pill). Effective for cold extremities and rapid breathing. (See Yin Toxin section).
Patients with slight thirst who drink excessively may develop fluid retention and epigastric binding, leading to fatal asthma; treat with Wuling San (Five-Ingredient Powder with Poria) or Xianxiong Wan (Chest-Breaking Pill). (See Thirst and Chest Binding sections).
Dai Yuanli's Commentary:
Asthma and cough are differentiated by Yin and Yang. Taiyang asthma/cough is discussed previously.
Shaoyang presents with cough but not asthma; presence of asthma excludes Shaoyang. For Shaoyang symptoms with asthma, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Bei Wuweizi (Schisandra Berry) and Ganjiang (Dried Ginger).
Yangming presents with asthma but not cough; presence of cough excludes proper Yangming. For Yangming asthma with tidal fever, use Dachengqi Tang.
Yin syndrome asthma occurs only in Shaoyin. Heavy limbs, pain, normal urine, loose stool with cough: Zhenwu Tang (True Warrior Decoction) minus Shaoyao, plus Bei Wuweizi and Ganjiang, plus Xixin (Asarum). This is Yin within Yin.
Cold extremities, abdominal pain, dysentery with heaviness, and cough: Sini Tang plus Bei Wuweizi and Ganjiang.
Diarrhea, vomiting, thirst, irritability, insomnia with cough: Zhuling Tang. This is Yang within Yin.
Yin asthma is critical; use Fanyin Dan.
Wu Kun's Commentary:
Exterior Cold causing asthma: floating/tight pulse, aversion to cold, body pain, no sweat: use Mahuang Tang to sweat.
Exterior Wind causing asthma: floating/relaxed pulse, aversion to wind, spontaneous sweating: use Guizhi Tang plus Houpo and Xingzi.
Yangming interior excess with constipation, abdominal fullness, shortness of breath, tidal fever, and asthma: Da Chaihu Tang plus Houpo and Xingzi, or Xiaochengqi Tang.
Yin syndrome Jue with deep/faint pulse, rapid breathing, asthma, no sweat: Sini Tang plus Wuweizi and Xingzi.
Deficiency pulse hidden, cold extremities with asthma: Wuweizi Tang.
Sudden exposure to Wind-Cold, floating pulse, no sweat, asthma: Su Shen Jiu Bao Tang.
Heat excess with phlegm, string-taut/rapid pulse, asthma (no sweating or purging): Xiaochaihu Tang plus Zhimu (Anemarrhena), Beimu (Fritillaria), Gualouren (Trichosanthes Seed). Add Zhike (Aurantii Fructus) and Jiegeng (Platycodon) for chest fullness; add Zhishi (Aurantii Fructus Immaturus) and Huanglian (Coptis) for epigastric fullness; add Zhimu and Shigao (Gypsum) for dry tongue/thirst.
Ancients state asthma is serious. Hua Tuo said: "Excess leads to asthma," meaning Lung Fire excess, not Lung Qi excess. Xiebai San clears Lung Fire. Xiexin Tang clears epigastric fullness. *Wei Sheng Bao Jian* states: Treat apparent excess as deficiency, as the body is deficient while pathogen is excess.
Wuweizi Tang (See Jue Section).
Su Shen Jiu Bao Tang
Sangbaipi (Cortex Mori Radicis), Gancao (Radix Glycyrrhizae), Dafupi (Pericarpium Arecae Catechu), Guangui (Cortex Cinnamomi Cassiae), Mahuang (Herba Ephedrae), Bohe (Herba Menthae), Chenpi (Pericarpium Citri Reticulatae), Zisu (Folium Perillae), Xingren (Semen Pruni Armeniacae), Shengjiang (Rhizoma Zingiberis Recens), Wumei (Fructus Mume). Boil in 2 zhong of water to 8 fen. Strain and drink.
Jiajian Xiebai San
Treats irritability, chest discomfort, upper asthma, dry mouth, or cough.
Sangbaipi (2 qian), Zhimu (Anemarrhena Rhizoma), Juhong (Pericarpium Citri Reticulatae Viride), Gualouren (Semen Trichosanthis), Huangqin (Radix Scutellariae), Beimu (Bulbus Fritillariae Cirrhosae), Jiegeng (Radix Platycodonis), Gancao (Radix Glycyrrhizae, each 1.5 qian), Digupi (Cortex Lycii Radicis, 1 qian). Decoct and take as before.