Treatment Principle: Strengthen the spleen, tonify the lungs, and consolidate defensive qi.

Symptoms: Spontaneous sweating, aversion to wind, easy susceptibility to colds, frequent flare-ups triggered by climate change, nasal congestion and runny nose before attacks, shortness of breath with low voice, clear and thin white sputum, poor appetite, abdominal distension, pale tongue coating, weak and fine pulse. Treatment Principle: Strengthen the spleen, tonify the lungs, and consolidate defensive qi. Prescription: Yupingfeng Powder, modified Liujunzi Decoction. Huangqi 30g, Baizhu 10g, Fangfeng 12g, Dangshen 10g, Fuling 12g, Gancao 6g, Chenpi 6g, Banxia 6g. If there is obvious coldness and limb coldness, add Guizhi, Baishao, ginger, jujube, etc.; if both qi and yin are deficient, with paroxysmal coughing, sticky and viscous sputum, dry mouth and throat, and red tongue, use Shengmai Powder with Beisha Shen, Yuzhu, Huangqi, etc., to tonify qi and nourish yin. 2. Spleen and Kidney Deficiency Symptoms: Shortness of breath and wheezing, worsening with activity, difficulty inhaling, scanty and sticky sputum, palpitations, fatigue, shortness of breath, weak speech, soreness in the lower back and knees, tinnitus, easily triggered after exertion. Or aversion to cold and limb coldness, spontaneous sweating, pale complexion, pale and plump tongue coating, deep and fine pulse; or flushed cheeks, feverish sensation, sticky hands from sweating, red tongue with little coating. Treatment Principle: Strengthen the spleen and kidney to collect qi. Prescription: Jingui Shenqi Pill or Qiwai Duqi Pill. Jingui Shenqi Pill warms and tonifies kidney qi: Fuzi 6g, Rougui 3g, Shengdihuang 12g, Shanyao 10g, Shanyu rou 15g, Zexie 10g, Fuling 12g, Mudanpi 6g. Qiwai Duqi Pill nourishes kidney qi and collects qi: Shengdihuang 12g, Shanyao 10g, Shanyu rou 15g, Zexie 10g, Fuling 12g, Danpi 6g, Wuweizi 3g. V. Professor Pei Zhengxue's Prescription Analysis Professor Pei Zhengxue divides the clinical treatment of asthma into attack and remission phases. First, he distinguishes between deficiency and excess in asthma, and treatment should follow the principle of "treat the symptom in acute cases, treat the root cause in chronic cases," meaning that during the attack phase, treatment mainly focuses on addressing excess, differentiating between cold and heat, and either warming and dispersing lung qi or clearing and purifying lung qi. During the remission phase, treatment mainly focuses on addressing deficiency, but it should be noted that due to prolonged illness and repeated attacks, patients often develop deficiencies in the lung, kidney, and spleen, presenting as a mixture of deficiency and excess, with the root cause being deficiency and the symptom being excess. Therefore, treatment often combines addressing both root and symptom, while also considering yin and yang, and selecting methods such as tonifying the lungs, strengthening the spleen, and nourishing the kidneys based on syndrome differentiation. Thus, while categorizing and treating according to syndromes, the main focus is on distinguishing between cold and heat, grasping the two key aspects of eliminating pathogenic factors and tonifying deficiency—namely, "treating the lungs during attacks" and "treating the kidneys during remission"—to achieve unobstructed airways, protect lung openings, and strengthen the root cause to improve patients' lung function and enhance their resistance to disease. During the attack phase, due to cold and inherent yang deficiency, phlegm transforms into cold phlegm, resulting in cold asthma; therefore, Shegan Mahuang Decoction (Shegan, Mahuang, Zi, Kuandonghua, processed Banxia, ginger, Xixin, Wuweizi, Dazao) is used. According to the "Essential Prescriptions · Lung Atrophy, Lung Cough, and Qi Disorders" section, "For cough accompanied by rising qi, with a sound like a water chicken in the throat, Shegan Mahuang Decoction is the primary treatment." Xiaochenglong Decoction (Mahuang, Shaoyao, Guizhi, Xixin, Dried Ginger, Gancao, Wuweizi, Banxia) is mentioned in the "Treatise on Cold Damage" section: "For those who have asthma, Xiaochenglong Decoction is the primary treatment." "In cases of cold damage, there is water qi in the abdomen, with mild wheezing and fever, but no thirst; after taking the decoction, the thirst disappears, indicating that the cold has been eliminated, so Xiaochenglong Decoction is used." "For reverse coughing, leaning on one's side and unable to lie down, with a floating and string-like pulse, Xiaochenglong Decoction is the primary treatment." Professor Pei Zhengxue points out that both belong to the category of exterior-releasing and phlegm-transforming formulas, but the former is mainly used for milder wind-cold exterior patterns, while the latter is used for cases where phlegm-dampness is stagnant and lung qi is reversed. Therefore, based on Xiaochenglong Decoction, he reduces Guizhi, Shaoyao, and Gancao, adding Shegan, Kuandonghua, Zi, and other herbs that dispel phlegm, benefit the lungs, and relieve cough and wheeze. In this formula, Mahuang and Guizhi work synergistically: Mahuang induces sweating and dispels cold to eliminate exterior pathogenic factors, while Mahuang also disperses lung qi and relieves cough and wheeze; Guizhi helps transform qi and facilitates the transformation of interior dampness. When the etiology is heat and the individual has inherent yang excess, phlegm transforms into hot phlegm, resulting in heat asthma. Alternatively, when "internal phlegm-heat accumulates while external wind-cold constrains it," a pattern of cold enclosing heat may appear, in which case Dingchuan Decoction (Mahuang, Xingren, Sangbaipi, Huangqin, Banxia, Suzi, Kuandonghua, Baiguo, Gancao) is used to address the external wind-cold constraint, while the internal phlegm-heat causes asthma, cough, and wheezing, with thick, yellow sputum, chest tightness, and wheezing in the throat, sometimes accompanied by chills and fever, thin yellow tongue coating, and slippery, rapid pulse. Among them, Kuandonghua moistens, Baiguo consolidates and stabilizes asthma while clearing metal, Huangqin clears lung heat, Suzi lowers lung qi, and Banxia dries damp phlegm; Maxing Shigan Decoction (Mahuang paired with Shigao, Xingren, Gancao) is formulated to clear lung heat and relieve asthma. Modern pharmacological research shows that ephedrine in Mahuang has a relaxing effect on bronchial smooth muscle, and methyl ephedrine can dilate bronchi; ephedra extract solution has a significant antitussive effect. Alternatively, large and small versions of Qinglong Compound (Mahuang, Guizhi, Xingren, Gancao, Shigao, Sangbaipi, Digupi, Zunzi, Dazao, Drying Ginger, Xixin, Wuweizi, Banxia ) and Da Wei Compound (Dafupi, Wuweizi, Yuanzhi, Banxia, Chenpi, Fuling, Gancao, Danggui, Chuanxiong, Shi, Jiegeng, Qingpi, Zhebei) are used for chronic bronchitis complicated by asthma. Or Sanzi Yangqin Decoction (Zisu, Baijingzi, Laizi), where Zisu mainly treats asthma and cough, Baijingzi mainly transforms phlegm, Laizi mainly addresses abdominal distension and phlegm, originally intended for elderly people with weak qi and poor digestion, where food and drink are transformed into phlegm, leading to qi blockage and lung qi not descending properly, resulting in poor appetite and excessive phlegm, coughing, and wheezing. All three "children" are products that move qi and dissipate phlegm, following the principle of "using dissipation to supplement," and are used together, each leveraging its strengths to make phlegm dissipate and qi flow smoothly, alleviating cough and wheezing, while also embodying the idea of "children nurturing parents." During the remission phase, methods such as tonifying the lungs, strengthening the spleen, and nourishing the kidneys are employed. Yupingfeng Powder ( Huangqi, Baizhu, Fangfeng) focuses on consolidating defensive qi, while Liujunzi Decoction (Dangshen, Fuling, Gancao, Chenpi, Banxia, Baizhu) focuses on strengthening the spleen to eliminate the source of phlegm. For long-term kidney issues, from cough to wheezing, kidney tonification and qi collection are emphasized. Jingui Shenqi Pill (Fuzi, Rougui, Shengdihuang, Shanyao, Shanyu rou, Zexie, Fuling, Mudanpi) warms and tonifies kidney qi, while Qiwai Duqi Pill (Shengdihuang, Shanyao, Shanyu rou, Zexie, Fuling, Danpi, Wuweizi) nourishes kidney qi and collects qi. Commonly used incense, cinnamon, purple quartz, and chicken gizzard are employed to stabilize qi and calm asthma. Or asthma pills (200g of gecko, 200g of soybeans, 95g of agarwood, 5g of white powder. All ground into powder and sieved, then packed into 0.25g capsules, taken three times daily, one capsule each time). Or emphysema pills (Shengdihuang 120g, Yu 60g, Shanyao 100g, Danpi 100g, Fuling 120g, Zexie 100g, Rougui 30g, Maidong 100g, Wuweizi 30g, Purple death 100g, Kuandonghua 100g, Purple quartz 300g, Agarwood 30g, Ginseng 100g, Suzi 100g, Xingren 100g, Banxia 60g, Chenpi 60g, Shengjiang 10g, Zhishi 100g, Jiegeng 120g). VI. Case Studies by Professor Pei Zhengxue Case 1: Zhang, male, 12 years old, first visit on October 31, 2015. Since childhood, the patient has a history of bronchial asthma. One week ago, due to a sudden drop in temperature, the child developed coughing, rapid breathing, wheezing in the throat, copious white sputum, aversion to cold, pale tongue, white and greasy tongue coating, and a floating, tight pulse. Western medical diagnosis: Bronchial asthma. TCM syndrome differentiation: Cold asthma. Treatment principle: Warm the lungs and dispel cold, transform phlegm and stop coughing. Prescription: Modified Xiaochenglong Decoction combined with Mahuang Decoction, and Maxing Shigan Decoction. Mahuang 10g, Guizhi 10g, Xingren 10g, Dried Ginger 6g, Xixin 3g, Wuweizi 3g, Chenpi 6g, Banxia 6g, Suzi 10g, Zi 10g, Baibu 10g, Jing 10g, Poppy shell 20g. Decocted in water, one dose per day. Second visit: November 7, 2015. The child's cough, wheezing, and sputum production have all decreased, and symptoms have improved. During the intermission phase of asthma, Xiaochenglong Decoction combined with Xiangsha Liujunzi Decoction strengthens the spleen and stomach, followed by 14 doses of Jiaosanxian and fried Laizi, after which symptoms disappeared. Comment: During the attack phase of asthma, the focus is on warming and transforming cold phlegm, dispersing lung qi, and stopping coughing. Given the patient's history of asthma and internal dampness, cold weather triggers latent phlegm to flare up, resulting in asthma. The copious white sputum indicates cold phlegm, the pale tongue and white, greasy coating, and the tight pulse all point to external cold and internal dampness. The prescription uses Xingren, Chenpi, and Banxia to strengthen the spleen and dry dampness, transforming phlegm and stopping coughing; Suzi lowers qi and transforms phlegm, Mahuang disperses lung qi and relieves cough and wheeze; Zi and Baibu transform phlegm and stop coughing; Xixin and Wuweizi warm the lungs and transform dampness, gathering lung qi and stopping coughing, while Gancao harmonizes the herbs and also has phlegm-transforming and cough-stopping effects. Overall, the formula effectively warms the lungs and transforms dampness, as well as transforms phlegm and stops coughing, hence the good therapeutic effect. Case 2: Xie, male, 72 years old, first visit on November 23, 2005. Has a history of bronchial asthma. Recently, after catching a cold, he developed a fever, with a body temperature of 37.8°C. Symptoms include: wheezing in the throat like a roar, chest high and sides swollen, paroxysmal coughing, yellow, sticky, thick sputum that is difficult to expel, restlessness and irritability, sweating, flushed face, bitter taste in the mouth, thirst and preference for drinks, red tongue with yellow, greasy coating, and a string-like, slippery pulse. Western medical diagnosis: Bronchial asthma. TCM syndrome differentiation: Heat asthma. Treatment principle: Clear heat and diffuse lung qi, transform phlegm and stabilize asthma. Prescription: Modified Dingchuan Decoction combined with Sanzi Yangqin Decoction. Mahuang 10g, Baiguo 10g, Kuandonghua 6g, Banxia 6g, Sangbaipi 10g, Huangqin 10g, Shegan 10g, Suzi 10g, Baijingzi 10g, Laizi 10g, Gancao 6g. Decocted in water, one dose per day. Second visit: November 30, 2005. Asthma has subsided, with less sputum, followed by Maxing Shigan Decoction combined with Xiaochenglong Decoction to consolidate the effect, with another 7 doses, after which all symptoms have disappeared. Comment: External cold triggers latent phlegm, internal phlegm-heat accumulates, lung qi fails to clear and purify, lung qi reverses, resulting in wheezing in the throat, chest high and sides swollen, heat vaporizes liquid and generates phlegm, phlegm-heat binds together, making sputum sticky and difficult to expel. Combined with tongue and pulse findings, the syndrome differentiation indicates internal phlegm-heat accumulation. The prescription uses Mahuang to disperse lung qi and stabilize asthma, Huangqin and Sangbaipi to clear heat and purify lung qi, Xingren, Banxia, Kuandonghua, Suzi to transform phlegm and reverse qi, Baiguo to gather lung qi, and Gancao to harmonize the herbs. Given the patient's advanced age, Sanzi Yangqin Decoction is added to strengthen the effect of lowering qi and transforming phlegm. Case 3: Yang, female, 5 years old, first visit on December 4, 2004. The child has a 3-year history of bronchial asthma and a history of allergies to pollen, mutton, and fried foods. This episode of asthma has now been cured, but she feels fatigued, has poor appetite, and experiences loose stools; even a small amount of greasy food causes diarrhea.

Often, asthma is triggered by improper diet, leading to shortness of breath and weak speech. Tongue is pale, coating is thin and greasy, pulse is fine and soft. Western medical diagnosis: Bronchial asthma. TCM syndrome differentiation: Deficiency of both lung and spleen. Treatment principle: Strengthen the spleen and transform phlegm. Prescription: Modified Liujunzi Decoction. Chenpi 6g, Banxia 6g, Dangshen 10g, Baizhu 10g, Fuling 12g, Jiaosanxian each 10g, Chicken gizzard 10g, Fried Laizi 10g, Gancao 6g. Decocted in water, one dose per day. Taken continuously for 10 doses. Second visit: December 11, 2004. All symptoms have healed. Comment: During the remission phase of asthma, it's important to identify deficiency patterns. Spleen deficiency means the spleen lacks the power to transport food, resulting in poor appetite and loose stools, often triggered by improper diet. Insufficient qi leads to fatigue, weak speech, pale tongue with thin, greasy coating, and a fine, soft pulse—all signs of spleen deficiency. Treatment should focus on strengthening the spleen and transforming phlegm to aid digestion. Chenpi and Banxia dry dampness and transform phlegm, Dangshen and Baizhu strengthen the spleen and tonify qi, while Jiaosanxian and Chicken gizzard mainly help digest food. Case 4: Wang, female, 54 years old, first visit on April 23, 2005. Has a history of asthma. Recently, after catching a cold, she developed nasal congestion, coughing, wheezing, and a small amount of yellow-white sputum. Symptoms include: wheezing in the throat, chest high and sides swollen, paroxysmal coughing, yellow-white mixed sputum, pale tongue, white and slightly yellowish coating, and a string-like, slippery pulse. Western medical diagnosis: Bronchial asthma. TCM syndrome differentiation: Internal accumulation of phlegm-dampness. Treatment principle: Disperse lung qi and promote water metabolism, transform phlegm and stabilize asthma. Prescription: Self-formulated Da Wei Compound with modifications.

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