, with kidney qi deficiency as the main symptom, such as shortness of breath, fatigue, poor appetite, and other symptoms. The condition is relatively stable,

, with kidney qi deficiency as the main symptom, such as shortness of breath, fatigue, poor appetite, and other symptoms. The condition is relatively stable, and the pathogenesis is characterized by more deficiency than excess. The primary treatment principle is to tonify the righteous qi and consolidate the root. Therapeutic approach should focus on benefiting qi and tonifying the kidneys, warming yang and strengthening the spleen. In the Liuwei Dihuang Decoction, Shudi Huang is used to nourish yin and tonify the kidneys, replenish essence and marrow; Shan Yu Rou nourishes the liver and kidneys and can also astringe essence, embodying the concept of "the liver and kidneys share the same origin"; Shanyao benefits the spleen and kidneys and can also consolidate the kidneys; Zexie drains dampness and clears renal turbidity, while also reducing the greasiness of Shudi Huang; Fuling lightly dries dampness in the spleen and assists Shanyao in strengthening its function, working together with Zexie to clear renal turbidity and help true yin regain its proper position; Danpi clears deficient heat and moderates the warmth and astringency of Shan Yu Rou. The Dingchuan Decoction is used for asthma and cough caused by wind-cold exterior contraction and phlegm-heat interior accumulation. In this formula, Ma Huang is pungent and warm, dispersing lung qi and relieving asthma, as well as releasing exterior pathogens; Bai Guo is sweet and astringent, consolidating lung qi and stabilizing asthma, eliminating phlegm and stopping cough. When these two herbs are combined, one disperses while the other collects, which not only enhances the effect of relieving asthma but also prevents Ma Huang from excessively dispersing and depleting lung qi. Xing Ren, Su Zi, Kuang Dong Hua, and Ban Xia all can descend qi, relieve asthma, transform phlegm, and stop cough. Sang Bai Pi, being sweet and cool, and Huang Qin, being bitter and cold, clear lung heat, stop cough, and calm asthma. Gan Cao harmonizes the herbs and adjusts the formula. Together, these two formulas support the righteous qi and dispel the pathogenic factors, jointly achieving the effects of descending and dispersing lung qi, stopping cough and calming asthma, clearing heat and transforming phlegm, so that when phlegm-heat is cleared, exterior cold is resolved, and lung qi descends, all symptoms of cough and asthma will naturally disappear. 7. A Collection of Theories from Ancient and Modern Medical Scholars Chronic bronchitis is mainly characterized by cough, sputum production, and wheezing. The "Su Wen · Cough Chapter" has already provided a systematic discussion on the symptom of cough: "The Yellow Emperor asked: What causes people to cough? Qi Bo replied: All five viscera and six bowels can cause cough, not just the lungs... ... The skin and hair are the organs associated with the lungs, and they are the first to be invaded by pathogenic factors, which then spread through their connection to the lungs. When cold food enters the stomach, it travels up the lung meridians to reach the lungs, causing lung cold. When the lungs are cold, both external and internal pathogenic factors combine and invade, resulting in lung cough. Each of the five viscera becomes diseased at different times; if it's not the right time, the disease spreads to others. Humans are in harmony with heaven and earth, so each of the five viscera gets sick when it encounters cold at the wrong time—mild cases result in cough, while severe cases lead to diarrhea or pain. In autumn, the lungs are the first to be invaded; in spring, the liver is first affected; in summer, the heart is first affected; in the rainy season, the spleen is first affected; and in winter, the kidneys are first affected." Liu Hejian said: "Cold, heat, dryness, humidity, wind, and fire—the six qi—all can cause cough." Zhang Jingyue also stated: "In cases of actual asthma, the pathogenic factor resides in the lungs; the real pathogenic factor in the lungs is either wind-cold or fire." According to the "Danxi Xinfa," "When the lungs are distended and one coughs, unable to sleep on either side, it's because phlegm mixed with blood stasis obstructs the flow of qi, leading to illness." The "Xue Zheng Lun" says: "The human airway must never be blocked. If there's blood stasis inside, it obstructs the airway and prevents qi from rising and falling, thus causing cough... It should be known that the stagnation of phlegm and water is caused by blood stasis, but once the blood stasis is removed, the phlegm and water will naturally dissipate." Modern medical scholars all have their own different views and experiences: Cheng Menxue believes that cough and asthma are related to both the lungs and the kidneys. Generally speaking, "when the lungs are full of pathogenic factors, it's an excess condition; when the kidneys are deficient, it's a deficiency condition." Therefore, he divides cough and asthma into two major syndromes: lung excess and kidney deficiency, and advocates the principles of "treating cough and asthma without neglecting the lungs, but not limiting oneself to the lungs" and "treating deficiency-related asthma by tonifying the kidneys and treating excess-related asthma by tonifying the lungs." Lung-excess cough and asthma are more common among young people, while kidney-deficiency cough and asthma are more common among middle-aged and elderly people. However, Cheng also points out that clinical observations do not always conform to this pattern: if young people frequently consume cold drinks and speak loudly, or if middle-aged and elderly people suffer from long-term persistent cough, lung-deficiency cough and asthma may also be observed. Therefore, clinical treatment of cough and asthma should also pay attention to the aspect of lung deficiency. As for lung-excess cough and asthma, Cheng believes there are mainly two types: those caused by external pathogenic factors and those caused by phlegm turbidity. Among the former, there are further subdivisions such as wind-warmth, wind-cold, and wind-dryness; among the latter, there are cold phlegm and hot phlegm. In addition, there are also various combinations of the two, such as wind-cold combined with hot phlegm, wind-warmth combined with cold phlegm, and so on. For treating these types of cough and asthma, he often uses methods such as dispersing lung qi, purifying lung qi, clearing lung qi, moistening lung qi, and consolidating lung qi. Dispersing lung qi mainly uses Ma Huang, followed by Su Geng, Chan Yi, and Zi, which are also commonly selected. Purifying lung qi uses Zisu Zi, Xing Ren, Ban Xia, Kuang Dong Hua, Bai Qian, and Pipa Ye. Clearing lung qi is divided into two types: one is clearing lung qi and nourishing yin, using herbs such as Sha Shen, Xuan Shen, Mai Dong, Huafen, and Yu Zhu; the other is clearing lung heat, using herbs such as Sang Bai Pi, Zi, Di Gu Pi, and Huang Qin. Moistening lung qi also has two types: one is warm moisturizing, the other is cool moisturizing. The former uses Xing Su San, while the latter uses Qing Zao Jiu Fei Tang. Consolidating lung qi uses Bai Guo and Wu Wei Zi, among others. Most of these methods are used in combination. In addition, phlegm-transforming methods are also commonly used. Cheng believes that if cough and asthma are not properly treated to transform phlegm, the effect will not be ideal. Phlegm turbidity is inherent in the patient's deficiency, even for those whose lungs are invaded by external pathogenic factors, so attention should still be paid to transforming phlegm. The commonly used formula for transforming phlegm is Er Chen Tang, with additional ingredients such as Bai Jie Zi and Xing Ren for excessive phlegm, and Huang Qin, Beimu, Hai Fu Shi, and Hai Ge Ke for phlegm mixed with heat. If phlegm turbidity is particularly severe, other methods such as eliminating phlegm, loosening phlegm, smoothing phlegm, and cleansing phlegm should also be considered. Eliminating phlegm can be done with Bai Jie Zi, Lai Ye Zi, and Xue Geng Tang (sea cucumber head and water chestnut), loosening phlegm can be done with Quan Shi, Yu Jin, and Yuan Zhi, smoothing phlegm can be done with Zhu Li and Zhu Ru, and cleansing phlegm can be done with Zao Jia Wan and Zun Da Zao Jiu Fei Tang. As for Shi Gun Tan Wan, Zhi Mi Fu Ling Wan, and Dao Tan Tang, they are generally not used to stop cough and calm asthma, so they are not included here. When using phlegm-transforming methods, attention should be paid to the patient's constitution; elderly and frail patients should use them with caution. Xi Yong Dingchuan Tang believes that this formula uses Ma Huang to disperse lung qi and release exterior pathogens to relieve asthma, Bai Guo to consolidate lung qi and eliminate phlegm to stabilize asthma, Zisu Zi, Xing Ren, Ban Xia, and Kuang Dong Hua to descend qi, relieve asthma, and stop cough and eliminate phlegm, Sang Bai Pi and Huang Qin to clear lung heat and stop cough and calm asthma, and Gan Cao to harmonize the herbs. By integrating the methods of dispersing lung qi, purifying lung qi, clearing lung qi, consolidating lung qi, and transforming phlegm into one cohesive whole, this formula provides a relatively satisfactory solution for stopping cough and calming asthma. These views are consistent with Professor Pei Zhengxue's views. If there is an external wind-cold invasion and internal fluid retention, then use Zhongjing's Xiao Qinglong Tang or Shegan Ma Huang Tang with modifications. If this condition is also accompanied by signs of heat, or if the fluids have turned to heat, resulting in symptoms such as bitter taste, dry mouth, irritability, redness, and unsatisfactory phlegm production, then switch to Xiao Qinglong plus gypsum soup, or Xiao Qinglong plus Huang Qin, or Houpu Ma Huang Tang. If cough and asthma are accompanied by heat, in addition to the above formulas, mild cases can also use Xie Bai San; if hemoptysis occurs, then use Dai Ha San and Shi Hui Wan together for treatment. If the exterior pathogenic factors are gradually resolving, then consider the deficiency of righteous qi as well, and use Ze Qi Tang. In summary, Cheng Menxue's treatment principles are completely consistent with Professor Pei Zhengxue's views. Qin Bowei argues that for treating external cough, one should disperse lung qi and remove exterior pathogens. He believes that the general treatment principle for external cough is "dispersing lung qi and removing exterior pathogens." Furthermore, considering the characteristics of external cough, he advocates transforming phlegm and regulating qi, so that exterior pathogens can be dispersed, lung qi can be cleared, and cough will naturally stop. It is strictly forbidden to simply suppress the cough, as this will block the flow of lung qi, cause exterior pathogens to stagnate internally, make it difficult to eliminate phlegm turbidity, and exacerbate the cough. At the same time, since the disease affects the upper jiao, the medicine should be light and uplifting, as the saying goes, "the upper jiao is like a feather—it cannot be lifted unless it's light." The method of dispersing lung qi with pungent and mild flavors is suitable for the early stages of external cough, when the signs of wind-cold or wind-heat are not obvious. Ma Huang 2g, fried burdock seed 6g, Xing Ren 9g, Zhe Bei Mu 9g, orange peel 3g, and Gan Cao 2g. The method of warming the lungs is used for wind-cold cough with abundant phlegm and chills, or accompanied by low-grade fever. Zisu 4.5g, fried cow seeds 6g, Chai Hu 4.5g, Ban Xia 4.5g, Xing Ren 9g, Ji Gong 3g, fried quan shell 4.5g, and ginger 2 slices. The method of dispersing lung qi with pungent and cool flavors is suitable for wind-heat cough accompanied by dry mouth or low-grade fever. Mint 3g, mulberry leaves 4.5g, cicada slough 3g, Xing Ren 9g, Zhe Bei Mu 9g, Lian Qiao 6g, Ji Gong 3g, and Gan Cao 2.5g. The method of clearing dryness and dispersing lung qi is suitable for autumn dry cough. Fried soybeans 9g, mulberry leaves 4.5g, Qian Hu 4.5g, Nan Sha Shen 4.5g, Gua Wei Pi 9g, Jiao Zhi Zi 4.5g, sweet and bitter almonds 4.5g each. The method of dispersing lung qi with pungent and warm flavors is suitable for long-standing external cough that does not heal, or for cases where the condition slightly worsens again, causing throat itch and difficulty in expectorating phlegm, even leading to shortness of breath and facial flushing. Jing Sui 4.5g, Bai Qian 6g, Chen Pi 6g, Gan Cao 2.5g, and Pipa Ye 9g. Observing Qin Bowei's medication dosage for treating external cough, it is extremely small, which is worth learning from. Huang Wendong argues that when treating cough, one should first remove exterior pathogens. He believes that the method of treating cough should first remove exterior pathogens, and treatment should be carried out separately according to wind, cold, dryness, and heat; then follow up with methods such as clearing lung qi, nourishing lung yin, and strengthening the body's defenses. For cough and asthma where exterior pathogens have not yet been cleared, methods such as nourishing yin, benefiting qi, and strengthening the body's defenses should not be used too early; instead, they should be appropriately combined with wind-dispelling and exterior-releasing methods to avoid leaving behind pathogenic factors. After treatment, when cough and asthma gradually subside and phlegm turbidity gradually clears, but cases frequently relapse, one should, according to the severity of the condition, use methods such as strengthening the spleen and tonifying the kidneys to support the righteous qi and resist pathogenic factors, while also taking preventive measures. For milder cases, emphasis should be placed on treating both the lungs and the spleen. Using Ling Gui Shu Gan Tang as the basic formula, adding Su Zi, Xing Ren, Chen Pi, Fa Ban Xia, Zi Bi, and Dang Gui, etc.; for more severe cases, the kidneys cannot hold qi, and breathing becomes labored, so add Jin Gui Shen Qi Wan. Anatomical physiology and pathology Bronchial asthma is a chronic inflammatory disease of the airways involving multiple cells (such as eosinophils, mast cells, T lymphocytes, neutrophils, airway epithelial cells, etc.) and cellular components. This chronic inflammation leads to high airway reactivity and causes recurrent episodes of wheezing, shortness of breath, chest tightness, or cough, often occurring at night and/or in the morning. It usually presents with widespread reversible airflow limitation, and most patients can recover on their own or with treatment. However, if left untreated or mismanaged, it can be life-threatening. According to relevant statistics, there are approximately 150 million asthma patients worldwide, and about 180,000 people die from asthma each year. In China, the prevalence of asthma is about 1%, and in some areas it even reaches 5%. Moreover, both the global prevalence and mortality rates are currently on the rise, making asthma one of the major chronic diseases that seriously threaten public health today. Bronchial asthma (hereinafter referred to as "asthma") falls under categories such as "asthma," "asthma syndrome," "wheezing syndrome," and "cough" in traditional Chinese medicine. When there is a whistling sound in the throat, it is called "wheezing"; when breathing becomes difficult, it is called "wheezing"; when both occur together, it is called "asthma." Since wheezing always accompanies asthma, it is often collectively referred to as "asthma." Combining modern medicine, traditional Chinese medicine defines asthma in a broad and narrow sense. The broad sense refers to wheezing symptoms caused by various diseases of the cardiovascular and respiratory systems, i.e., "wheezing syndrome"; the narrow sense refers to bronchial asthma, i.e., "asthma syndrome." To distinguish it from wheezing syndrome, modern traditional Chinese medicine defines bronchial asthma as "asthma disease." The earliest record of this disease in traditional Chinese medicine dates back to the "Yellow Emperor's Inner Canon" two thousand years ago, where it was called "wheezing," as stated in the "Su Wen · Yin Yang Bie Lun": "When it rises, it scorches the lungs and makes people wheeze." During the Han Dynasty, Zhang Zhongjing pointed out in the "Jin Gui Yao Lue" that "coughing and shortness of breath, with a chicken-like sound in the throat, are best treated with Shegan Ma Huang Tang." From a pathological perspective, he classified it as latent drinking. In the "Pu Ji Ben Shi Fang," it was stated that "this disease can last a lifetime for some, while others pass it down from parent to child." Observing family history revealed some genetic traces of this disease. It wasn't until the Yuan Dynasty that Zhu Danxi first coined the term "asthma" and further elaborated on its pathogenesis. Later medical scholars continuously improved the etiology, pathogenesis, clinical classification, and treatment plans based on this foundation. 2. Western medical diagnosis and treatment (---) Clinical diagnosis

1. Diagnostic criteria for bronchial asthma According to the 2020 edition of the "Guidelines for the Prevention and Treatment of Bronchial Asthma." (1) Recurrent episodes of wheezing, difficulty breathing, chest tightness, or cough, often associated with exposure to various allergens such as cold air, physical or chemical stimuli, viral upper respiratory infections, exercise, etc. (2) During an attack, scattered or diffuse wheezing sounds can be heard in both lungs, mainly during exhalation, with prolonged exhalation. (3) The above symptoms can resolve on their own or with treatment. (4) Other diseases causing wheezing, chest tightness, or cough are excluded. (5) For atypical cases (such as those without obvious wheezing or signs), at least one of the following tests must be positive: ① Positive bronchial provocation test or exercise test. ② Positive bronchial dilation test (forced expiratory volume in one second FEV increases by more than 15%, and the absolute increase in FEV is greater than 200ml). Maximum expiratory flow (PEF) daily variation rate or diurnal fluctuation rate ≥ 20%. If criteria 1–4 are met, or criteria 4 and 5 are met, a diagnosis of bronchial asthma can be made. 2. Diagnostic criteria for cough variant asthma (CVA) (1) Cough is the main symptom, lasting or recurring for more than one month, often occurring at night and/or in the morning, worsening after exercise, with little sputum, no clinical signs of infection, or ineffective antibiotic treatment. (2) Bronchodilator treatment can relieve cough attacks, especially long-acting bronchodilators taken at night can improve symptoms, allowing for a definitive diagnosis. (3) Having a personal or family history of allergies, with positive skin test for allergens as auxiliary diagnosis. (4) Airway shows high reactivity, with positive bronchial provocation test as auxiliary diagnosis. (5) Eosinophils in sputum are positive, and lung function can be normal. (6) Other causes of chronic cough are excluded.
2. Occupational asthma Occupational asthma refers to asthma triggered in healthy individuals or those with atopic predisposition after exposure to occupational asthma-inducing factors. Occupational asthma-inducing factors include: pollen, grain dust, wood dust, cotton dust, castor bean dust, flax dust, and flour dust—these are plant-based dusts; silkworm pupae, silkworm cocoons, and the fur and excrement of cattle, sheep, horses, pigs, and poultry; pollen and fungal spores—these are antigens; toluene diisocyanate and other isocyanate compounds; nickel, chromium, vanadium, and platinum salts; phthalic anhydride and other plastic industry raw materials; pesticides and gunpowder, etc. Diagnostic basis: ① Asthma clinical symptoms; ② Objective lung function tests proving reversible bronchial stenosis and high airway reactivity; ③ History of asthma attacks after exposure to occupational asthma-inducing substances, with asthma alleviating or disappearing after leaving the environment; ④ Positive occupational antigen skin test (+), or specific bronchial provocation test positive. Specific IgE or IgG antibody tests for S antigens, as well as radioallergosorbent tests (RAST), enzyme-linked immunosorbent assays, and fluorescence analysis, can help diagnose the cause. Skin tests and inhalation provocation tests are dangerous and must be conducted under strict supervision.
3. Clinical staging (1) Attack phase (seasonal attacks, year-round attacks). (2) Remission phase.
4. Severity level (1) Mild: ① After removing allergens or other triggering factors, wheezing can be relieved. ② Can be controlled by ordinary bronchodilators. ③ Can carry out daily activities. (2) Moderate: ① After removing allergens or other triggering factors, wheezing can be partially relieved. ② Ordinary bronchodilators can only achieve partial relief, sometimes requiring corticosteroids. ③ Daily activities are restricted. (3) Severe: ① Asthma persists despite ordinary bronchodilators. ② Greatly affects daily life. (4) Critical: ① During an asthma attack, the wheezing sound significantly weakens or disappears. ② Electrocardiogram shows rightward deviation of the electrical axis, tall P waves, low blood pressure, and paradoxical pulse. ④ Respiratory acidosis and/or metabolic acidosis. ⑤ Confusion of consciousness. (II) Western medical treatment Treatment for acute asthma attacks generally relies heavily on Western medicines. Beta-adrenergic agonists, theophylline, adrenal cortical hormones, etc., often work quickly and effectively, with treatment graded according to the severity of the condition—mild, moderate, or severe. However, beta-adrenergic agonists can cause tachycardia, arrhythmia, and decreased sensitivity as side effects; theophylline can lead to gastrointestinal reactions, arrhythmia, convulsions, and even respiratory and cardiac arrest; anticholinergic aerosols can cause dry mouth and nausea; long-term use of glucocorticoids can lead to Cushing's syndrome, osteoporosis, diabetes, psychiatric symptoms, and weakened immunity, increasing the risk of secondary infections or hormone dependence. Traditional Chinese medicines such as Xixin, Ma Huang, Gan Cao, and Jiang Ban Xia can all inhibit the release of allergic mediators, lower IgE levels, and increase cAMP content, thereby relaxing bronchial smooth muscle and relieving asthma. Although their effect on relieving asthma is not as rapid as Western medicines, they have no obvious toxic side effects and their effects are long-lasting. Therefore, it is recommended that, on the basis of the Western medicine tiered treatment plan, traditional Chinese medicines be used simultaneously to disperse lung qi, transform phlegm, and descend qi to relieve asthma, thereby improving efficacy, accelerating the downgrade of Western medicines, shortening the duration of Western medicine use, and reducing their side effects.
5. Professor Pei Zhengxue's way of thinking The "Su Wen · Yin Yang Bie Lun" says: "... ... When it rises, it scorches the lungs and makes people wheeze." The "Jin Gui Yao Lue" states: "Coughing and shortness of breath, with a chicken-like sound in the throat, are best treated with Shegan Ma Huang Tang"; "There is phlegm in the upper part of the body, full of wheezing and coughing, with alternating cold and heat, back pain and waist pain, tears flowing from the eyes, and the person trembling violently—there must be latent drinking." The "Su Wen · Mai Yao Jing Wei Lun" says: "Because blood is in the flank, it causes wheezing." The "Symptom Cause Pulse Treatment · Asthma Disease" also points out