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Chuan (Asthma/Wheezing) refers to rapid and labored breathing, which is common among those engaged in physical labor. (For example, panting after running.) In terms of pathogenesis, it is caused by Qi rushing upward.

Ancients also referred to it as "Duan Qi" (Shortness of Breath), meaning the breath is short and rapid. However, there is a distinction between Shi Chuan (Excess Asthma) and Xu Chuan (Deficiency Asthma), which should be carefully differentiated. Shi Chuan arises from pathogenic factors, indicating an excess of pathogens; Xu Chuan arises from the absence of pathogens, indicating a deficiency of healthy Qi. The manifestations of Shi Chuan include opening the mouth and raising the shoulders, swaying the body and contracting the abdomen, chest distension with coarse breathing, loud voice and surging respiration, with relief only upon exhalation. The manifestations of Xu Chuan include insufficient and discontinuous breath, panic and shortness of spirit, low voice and faint respiration, and a sense of alarm as if breath were about to cease. (This condition resembles asthma but without shoulder lifting, resembles groaning but without pain, and although breathing is rapid, there is no phlegm sound.)

Shi Chuan may result from external contraction, where the Six Excesses (Six Pathogenic Factors) obstruct Lung Qi, leading to chest fullness and upper asthmatic breathing. It may also result from internal injury, where emotional disturbances (Seven Emotions and Five Wills) generate fire, or dietary stagnation of alcohol, food, phlegm, and dampness generates latent heat, which congests upward into the Lung causing asthma. There is also a category of severe Fire Stagnation, where the upward rush causing asthma is indistinguishable from other forms of Shi Chuan. However, if Yang Qi is internally stagnant to the extreme and cannot circulate freely, leading to cold limbs and submerged, choppy pulses (which beat firmly under pressure), this condition cannot be treated with hot herbs nor purged with cold herbs (using cold herbs will further stagnate the fire). Instead, Xiaoyao San (see Stagnation chapter) plus Evodiae Fructus (Zhu) and Scutellariae Radix (Lian) should be used to disperse accumulated heat. Recovery follows sweating, and afterwards, Liuwei Dihuang Wan (see Deficiency Damage chapter) should be used for regulation.

Xu Chuan may result from Yang Deficiency. When Lung Qi is sufficient, it descends clearly and purely; when Spleen Qi is sufficient, it transforms and transports effectively. If deficient, it cannot descend and instead floats upward. Xu Chuan may also result from Yin Deficiency. Liver and Kidney Yin Deficiency (referring to both Water and Fire) causes Fire to flare upward, representing the depletion of True Yuan and the upward rush of Mingmen Fire from below. Such individuals appear healthy normally but feel asthmatic fatigue. Their pulse is rapid, large, and empty, or faint and weak.

Li Dongyuan stated: Hua Tuo said that "excess leads to asthma," and the *Ren Shu* also stated that asthma is due to excess Qi. However, what is called "excess" leading to asthma is not an excess of Lung Qi. An appearance of Qi excess should be recognized as Qi deficiency; an appearance of sufficiency should be recognized as insufficiency. If Lung Qi were truly excessive, it would descend clearly and purely without asthma. Asthma occurs because Fire enters the Lung, causing Lung Qi deficiency. Therefore, "excess" refers not to Lung Qi excess, but to Pathogenic Fire excess. Thus, using bitter-cold herbs to purge does not purge Lung Qi, but rather purges Fire in the Lung, which thereby tonifies Lung Qi. While Li Dongyuan's statement is correct, robust individuals may suddenly be attacked by pathogens, so one cannot immediately assume Qi deficiency. However, since asthma causes Qi to scatter, it inevitably becomes deficient over time.

Zhu Danxi stated: New diseases are Excess, old diseases are Deficiency. In reality, new diseases can also be Deficient; if a person is inherently deficient and suddenly contracts Wind-Cold, this is a new disease presenting as Deficiency. Old diseases can also be Excess; if a person has phlegm blocking the Lung orifices for a long time without resolution, asthma cannot cease, indicating an old disease presenting as Excess. Treatment methods for Shi Chuan: For Wind-Cold invasion, use Wuhu Tang, San'ao Tang, Dingchuan Tang, or Huagai San. For Cold binding Heat transforming into Phlegm, use Chenpi Tang, adding Cinnamon Twig (Guizhi) in cold weather. For symptoms that fluctuate and improve after eating (because food weighs down the phlegm), but worsen immediately after eating, indicating Phlegm-Fire, use Jiegeng Erchen Tang. For wheezing accompanied by phlegm sounds upon movement, indicating Phlegm, use Dingchuan Tang plus Trichosanthis Fructus (Gualou); after three doses, treat according to Phlegm patterns. For severe cases, use Shenxian Zhu Chuan Tang. For asthma without phlegm, indicating Qi Excess, use Suzi Jiangqi Tang; for severe cases, add Descurainiae Semen (Tingli) and Peucedani Radix (Qianhu). For emotional stagnation causing upper asthmatic urgency, in Excess patterns, use Simo Yin or Siqi Tang. All forms of Shi Chuan contraindicate astringent, binding, ascending, tonifying, drying, hot, sour, and salty agents. Instead, agents that direct Qi downward, clear Fire, moisten the Lung, and disperse with acrid flavors should be used, such as Perillae Fructus (Suzi), Mulberry Root Bark (Sangbai), Loquat Leaf (Pipaye), Peucedani Radix (Qianhu), Linderae Radix (Wuyao), Aurantii Fructus (Zhike), Pinellia Rhizome (Banxia), Gardeniae Fructus (Shanzhi), Scrophulariae Radix (Xuan Shen), Anemarrhenae Rhizoma (Zhimu), Indigo Naturalis (Qing Dai), Scutellariae Radix (Huang Qin), Fritillariae Bulbus (Beimu), Asparagus Fern Root (Dongqing/Dongbi), Trichosanthis Radix (Huafen), Prunus Armeniaca Seed (Xingren), Floatstone (Haishi), and Tangerine Peel (Juhong). If the pulse is flooding and solid, with systemic Phlegm-Qi and Fire, causing inability to sit or lie down, use Huanglian Gao. For Water Asthma, where Water Qi rebels and Lung Qi floats due to water (observable when bathing in a river and water reaches the chest), causing inability to lie down due to asthma, use Tingli Dazao Tang or Guiling Zhugan Tang, or induce sweating. For dampness, use Shen Shi Tang. For Summerheat-Heat Asthma, use Baihu Tang plus Trichosanthis Fructus (Gualou), Aurantii Fructus (Zhike), and Scutellariae Radix (Huang Qin). For Food Asthma, where asthma begins abruptly at the onset of illness, it is mostly due to food retention. Passing gas or even biting (in severe cases) indicates digestion resolves the issue. In children, rapid walking causing asthmatic breathing is mostly due to food retention. For Food Asthma with external contraction, disperse pathogens and digest food. The *Classic* mentions "Stomach Asthma," where Stomach collaterals are disharmonious, causing Qi rebellion and asthma. (Stomach Qi naturally descends, and the Yangming meridians run from head to foot; if they do not descend but rebel upward, asthma results.) The causes of this rebellion are Fire, food retention, or Phlegm, requiring careful differentiation. Another condition is Lung Accumulation named Xiben. (Ben is synonymous with Ben/Run. When Lung Qi stagnates and forms an accumulation, respiratory Qi rushes upward.) It presents as a cup-like mass under the right hypochondrium, causing asthma and cough, potentially developing into Lung Abscess; see the Accumulation-Mass chapter. Treatment methods for Xu Chuan: For Lung Qi Deficiency, use Ginseng Radix et Rhizoma (Renshen), Schisandrae Fructus (Wuweizi), and Donkey-hide Gelatin (Ejiao). Powder Ginseng, mix with egg white and fresh water, take one qian. For exhaustion-induced asthma, use 9 qian of Walnut Kernel (Hetaoren) retaining its skin, 1 qian Ginseng, and 2 qian Apricot Seed (Xingren) peeled and de-husked; decoct with Ginger and Jujube, consume with dregs; recovery follows one bowel movement. Two people once walked together; one holding Ginseng did not wheeze, while the other did, demonstrating that Deficiency requires tonification. For Kidney Water Deficiency, Ministerial Fire rushes up via the Chong and Ren vessels, unmanageable by Siwu Tang or cold-cooling herbs. The phlegm overflowing from Kidney Water cannot be resolved by Bamboo Sap (Zhuli), Atractylodis Rhizoma (Zhishi), or Pinellia (Banxia). One must use Liuwei Dihuang Wan plus Asparagus Fern Root (Mendong) and Schisandrae Fructus (Wuweizi), decocted in large doses, to raise Water and lower Fire, settling the asthma. For Kidney Fire Deficiency, Yin-Cold in the Lower Jiao forces floating Yang to rebel upward causing asthma. External signs include red face (Floating Yang/Daiyang), irritability, and a floating, large, rapid pulse, indicating imminent death. Use herbs to assist Yuan, connect True Qi, and anchor/subdue. Recovery is possible but must not be abrupt. Initially use Bawei Dihuang Wan, He Xi Dan, or Yangzheng Dan, taken with Shengmai San. Once Qi stabilizes slightly, use large doses of Ginseng, Cinnamon Bark (Rougui), Psoraleae Fructus (Pogu Zhi), Donkey-hide Gelatin (Ejiao), and Achyranthes Root (Niuxi) to anchor downwards. Then prepare pills of Bawei Dihuang Wan plus Placenta Hominis (Zheche), taken when hungry, to preserve health. When Fire rebels up via Chong and Ren, Stomach Qi descending also rebels upward. Li Dongyuan used Tiaozhong Yiqi Tang plus Evodiae Fructus (Wuzhuyu, washed to remove bitterness). However, treating the Kidney is fundamental.

Regarding ancients equating Duan Qi with Chuan and distinguishing Excess/Deficiency as previously described: if following later scholars who distinguish Duan Qi and Chuan as two separate entities, defining Duan Qi as Deficiency Asthma and Chuan strictly as Excess Asthma is acceptable. Refer to the Shortness of Breath and Little Qi section.

Xiao (Wheezing with Sound) involves phlegm-Qi making noise in the throat, caused by excessive phlegm in the chest adhering to the throat, creating sound upon contact with respiratory air. It results from excessive consumption of sour and salty tastes (frequent salt and vinegar intake in childhood often leads to this, commonly known as Salt Xiao). This penetrates the trachea, causing phlegm accumulation. Upon exposure to Wind-Cold, Qi stagnation and Phlegm congestion trigger an attack, usually occurring in early winter. Light diet and Qi-moving, Phlegm-resolving measures are required. Cold agents are contraindicated to avoid trapping Wind-Cold; hot agents are contraindicated to avoid intensifying Phlegm-Fire. Perillae Fructus (Suzi), Mulberry Root Bark (Sangbai), Aurantii Fructus (Zhike), Citri Reticulatae Pericarpium Viride (Qingpi), Pinellia Rhizome (Banxia), Peucedani Radix (Qianhu), Apricot Seed (Xingren), and Gardeniae Fructus (Shanzhi) are essential. Using Chengqi Tang in August-September to pre-purge heat prevents summerheat/winter heat entrapment, which is a clever method. For chronic Xiao, split one Citri Reticulatae Pericarpium Viride (Qingpi), insert one Crotonis Fructus (Badou), tie securely, roast on tile until yellow, take 3-5 fen with Ginger-Wine. After cure, use Pinellia Rhizome (Banxia) 8 liang, Gypsum Fibrosum (Shigao) 4 liang, Perillae Fructus (Suzi) 2 liang, made into pills. Another method: lightly crack an eggshell without damaging the membrane, soak in urine vat for 3-4 nights, boil and eat; effective for removing Wind-Phlegm. Alternatively, burn cat feces to ash, take with sugar water. Prepare pills from Soap Bean (Zaojia) peeled of skin, strings, and seeds, honey-fried 2 qian; Alum (Mingfan) 1 qian; Apricot Seed (Xingren) 1 qian; Aster Root (Ziwan), Mulberry Root Bark (Sangbai), Honey-fried Licorice (Zhigancao), Acorus Rhizome (Shichangpu), Pinellia Rhizome (Banxia) each 2 qian; White Morning Glory Seed (Bai Chou) powder 1 qian; Arisaema Cum Bile (Danning) 1.5 qian; Stemona Root (Baibu) boiled into paste. Make pills size of mung beans, take 70 pills per dose. For attacks triggered by rich foods, use Qingjin Dan.