Library

Yu Chang stated: Respiration originates from the nose, and its qi distributes to the Shanzhong (Chest Center) region. The Zongqi (Pectoral Qi) at Shanzhong primarily governs the respiratory pathway of the Upper Jiao (Upper Burner), and is constantly connected with the Lung and Stomach. Whether respiration is clear and slow, or short and rapid, all suffice to indicate the abundance or deficiency of Zongqi. Therefore, the *Classic* (Huangdi Neijing) states: "Below the breast, if the pulsation is visible through the clothing, it indicates leakage of Zongqi." How can people run about without restraint, causing Zongqi to become excessive while leading to panting, rapid breathing, and urgency, thereby turning excess into deficiency? This points out that exhalation is one aspect of "respiration" (Xi). When daily activities are normal but there is sound during respiration, this is due to the reversal of the collateral vessels of the Lung. Inability to lie flat accompanied by sound during respiration indicates the reversal of Yangming Stomach channel qi. This further demonstrates that the qi distributing respiration is connected to the Lung and Stomach; this is another aspect pointing out that exhalation is part of "respiration." Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver; within the process of breathing, the Spleen and Stomach are in charge. Thus, only the Middle Jiao (Middle Burner) governed by the Spleen and Stomach serves as the master control of respiration. If qi accumulates at the cardia (Bumen, upper opening of the stomach) and does not disperse, obstructing entry and exit, it constitutes a critical state of survival or death. Those skilled in health preservation allow the qi from the cardia to transmit to the pylorus (Youmen, lower opening of the stomach), and the qi from the pylorus to transmit to the two yin openings (anterior and posterior orifices) for discharge, thus avoiding harm. The Upper and Lower Jiaos respectively govern exhalation and inhalation; one cannot simply use the single character "respiration" to generalize all diseases. This principle was known only by Zhang Zhongjing, who stated: "Shoulders moving with respiration indicates firmness in the heart center; respiration drawing qi upward from the chest causes cough; open-mouthed shortness of breath indicates Lung萎 (Fei Wei, Lung Atrophy/Withering) with spittle." He separated respiration, focusing specifically on diseases related to exhalation without mentioning inhalation together, which seems like an innovative theory. However, Zhang Zhongjing's work was based on exposition of classics, rooted in the *Inner Canon*. My previous proposal of two aspects of exhalation as respiration is insufficient to cover everything. Generally, when Heart Fire invades the Lung, exhalation becomes urgent and rapid, which is inevitable. Exhalation belongs to the Yang of the Heart and Lung, and naturally should not be confused with the Yin of the Kidney and Liver. Shoulders moving with respiration occur because the shoulders move with the breath; only Fire causes such movement. Respiration drawing qi upward from the chest causing cough occurs because the Lung Metal's function of contracting and descending fails, leading to rebellious qi and cough; only Fire causes such cough. Open-mouthed shortness of breath, Lung Withering with spittle, are also untreatable conditions where Metal is damaged by Fire, all named "respiration" due to rough exhalation. Then why not simply call it "exhalation"? The answer is: There is inhalation within exhalation, and exhalation within inhalation; separating them strictly is beyond the scope of sage wisdom. It is merely understood that abnormalities in exhaled air govern diseases of exhalation, and abnormalities in inhaled air govern diseases of inhalation, which goes without saying. The *Classic* mentions that infants suffering from wind-heat present with wheezing, shoulder-respiration (panting with shoulder movement), and various sounds during respiration, among many other examples. Because these were not mentioned alongside inhalation, inhalation-related diseases became easier to identify. However, fearing later generations might not fully understand, I supplement the meaning: Mild and rapid inhalation indicates excess in the Middle Jiao, which heals immediately after purgation; deficiency cases are untreatable. Inhalation that is short and rapid indicates disease in the Upper Jiao; inhalation that is slow and delayed indicates disease in the Lower Jiao; both are difficult to treat. Respiration accompanied by whole-body trembling indicates untreatability. Seeing mild and rapid inhalation means the return journey of qi in the Middle Jiao is fast; this must be excess, treated by purgation to unblock the Middle Jiao obstruction, leading to immediate cure. If it is deficiency, the root of the Kidney and Liver is unstable, qi floats and escapes to the Yang level, making it untreatable. This is what I previously referred to as the critical state caused by the blockage between the cardia and pylorus. Inhalation that is short and rapid in the Upper Jiao occurs because the pathways of the Heart and Lung are close to True Yin; if True Yin is deficient, qi rises via Yang Fire and does not enter the Lower Jiao. Thus, short inhalation shows that the Upper Jiao can indeed be diagnosed via inhalation. Inhalation that is slow in the Lower Jiao occurs because the pathways of the Kidney and Liver are distant from Yuan Yang; if Yuan Yang is declining, qi is trapped by latent Yin pathogens and struggles to rise, hence slow inhalation. Since True Yin and Yuan Yang are diseased, both are difficult to treat. If respiration involves whole-body trembling, the qi of Ying and Wei circulating has been exhausted, leaving only a thread of respiration; what can be done? Students should first distinguish the entry and exit of respiration to ascertain the condition; once the condition is known, combining it with other methods yields accurate results. If one only discusses respiration generally, how can one differentiate the governance of the Upper, Middle, and Lower Jiaos? Alas, the principle is subtle.

[Rule One]
In diagnosing respiration, failing to distinguish between exhalation and inhalation to determine the pathology leads to errors of miles for every inch; this is the fault of the physician.