Bronchial asthma is a recurrent respiratory disease that is classified under the " wheezing disease" and " panting syndrome" categories in traditional Chinese medicine (TCM). The theory of six climatic factors—manifestation, root cause, and middle qi—opening-closing-pivoting, originates from the Huangdi Neijing, which outlines the relationship between the five evolutive phases and the six climatic factors. These six factors include Taiyang Cold water, Jueyin Wind wood, Shaoyin Sovereign fire, Shaoyang Ministerial fire, Taiyin Damp earth, and Yangming Dry metal, and manifestation, root cause and middle qi, and opening-closing-pivoting are the operation rules of the six climatic factors. The six climatic factors represent the six operating states of the rise and fall of primordial qi; therefore, the six climatic factors are actually one qi. When these factors operate harmoniously, the primordial qi circulates smoothly, maintaining the balance between the human body and the natural environment. The natural environment and the human body have six climatic factors. Disruptions in the six climatic factors can lead to imbalances in the ascending, descending, exiting, and entering processes, which contribute to the development of various diseases. In the case of bronchial asthma, the primary pathogenesis involves the upward reversal of lung qi. This reversal is often triggered by the dysfunction of the six climatic factors, leading to imbalances of the ascending, descending, exiting, and entering processes, which may directly or indirectly cause the upward reversal of lung qi. The treatment strategies involve opening Taiyang to disperse Cold water; descending Yangming to moisten Dry metal; harmonizing Shaoyang to restrain Ministerial fire; opening Taiyin to dry Damp earth; warm Shaoyin to illuminate Sovereign fire; and close Jueyin to smooth Wind wood. This article aims to explore bronchial asthma differentiation and treatment based on the theory of six climatic factors—manifestation, root cause, and middle qi—opening-closing-pivoting to provide insights for differentiation and treating this disease using TCM.