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Chinese medicine does not look as asthma as just asthma. Each asthma patient exhibits symptoms that can be classified as either cold or hot, sometime even cold covering hot.

The most oft-used formula for asthma is called 小青龙汤. However, please do not be fooled into thinking that if you have asthma, you should use this decoction. There are other considerations, the most important of which is “cold or hot?”

A typical person who presents with cold symptoms will be like a running tap. The mucus from his nose and the phlegm from his airways will be clear, whitish and bubbly. He may feel cold in the chest. The pulse is slippery and the tongue coating is white and slippery.

On the other hand, the person with hot symptoms will be may sport a fever or feel heat, have yellow phlegm. The tongue red and with yellow coating, while the pulse is fast and slippery.

What in it does what?

Check it out here.

What can 小青龙汤 do？

Look here.

What if it’s “hot” asthma?

If we use 小青龙汤 for “hot” asthma, there’s a high likelyhood that his heaty symptoms will get worse. 小青龙汤 is made up of several heaty herbs - 麻黄、桂枝、细辛、干姜、半夏 to name a few. Yes, 五味子 is warm too, but I’d say more sour. In any case, to treat “hot” asthma, we have to find cooling herbs that can get rid of the asthmatic symptoms (namely panting and wheezing caused by the bronchial spasms).

Perhaps there weren’t any better solutions during Mr. Zhang’s day and age. Try to think of cooling alternatives to 麻黄, for example. Perhaps only a heaty drug like that has such properties.

We know that 石膏 is the freeze agent among Mr. Zhang’s arsenal of pharmacopoeia. To solve a fully “hot” asthma problem, we can use 麻黄 together with 石膏 to get rid of the breathing problems PLUS get rid of the heat. That essentially is 越婢汤. Add in 半夏 and that would be 越婢加半夏汤.

Cold Wrapping Hot Asthma

The ancients thought of it as cold wrapping hot since cold on the surface closes up sweat pores and you don’t sweat. This kind of heat is distinguished from the typical “hot” asthma where the heat causes the patient to sweat profusely. In such a situation can you use 越婢加半夏汤?

Good question. The solution - it seems - is to revert to the 麻黄汤 basis i.e. Use the 麻、桂 combination instead of the 麻、膏 combination. Why? Because it’s not just heat you’re dealing with now. You need to get rid of the heat, but more importantly, you need the sweat pores open. Hence, you use all the heaty herbs in 小青龙汤 which burns all the fluids up and lets them out through the pores. And then? Well, 石膏 is also added in, because you also want to reduce the heat. The representative formula is 小青龙汤加石膏.