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Both asthma (Chuan) and distension (Zhang) share the common symptom of difficult urination. Asthma inevitably leads to distension, and distension inevitably leads to asthma. However, there are differences in the sequence of symptoms and in the distinction between root (Ben) and branch (Biao), which can be differentiated. Why is this so? When asthma precedes distension, the pathology originates in the Lung; when distension precedes asthma, the pathology originates in the Spleen. The Lung belongs to Metal and governs descending, while externally governing the skin and hair. The Classics state: "The Lung faces all vessels, regulates water passages, and transmits downward to the Bladder." This indicates that the excretion of urine depends on the descending and transforming function of Lung Qi. If the Lung is invaded by pathogenic factors and causes upward rebellion leading to asthma, it loses its descending command. Consequently, urine becomes scanty, leading to water overflowing into the skin and causing swelling and fullness. In this case, asthma is the root and distension is the branch. The Spleen belongs to Earth, dislikes dampness, and externally governs muscles. Earth controls Water. If the Spleen Earth is injured and cannot control Water, then water-dampness runs wild, soaking into the muscles. Once water overflows upward, the pathogen invades the Lung, and Qi fails to descend, generating asthma. Here, distension is the root and asthma is the branch. For cases originating in the Lung, one should clear Lung Metal and direct Qi downward, with promoting diuresis as secondary. For cases originating in the Spleen, one should strengthen the Spleen and promote diuresis, with clearing Lung Metal as secondary. If a Lung syndrome is treated with drugs that dry the Spleen, the Lung Metal will become dry, and asthma will worsen. If a Spleen disease is treated with drugs that clear Lung Metal, the Spleen Earth will suffer from cold, and distension will intensify. Those who treat asthma and distension often only know how to strengthen the Spleen and promote diuresis, failing to distinguish the sequential syndromes of the Spleen and Lung. Therefore, I elucidate this point.

The Classics say: "If exit and entry cease, the Spirit mechanism perishes; if ascent and descent stop, the Qi establishment stands alone in peril." It also says: "If breath does not move for an instant, the mechanism is exhausted; if continuity is lost for even a moment, heaven and earth are separated." This speaks to the fact that human Qi's exit and entry, ascent and descent, must flow endlessly to achieve the wonderful function of life. If externally injured by the Six Evils (Liu Yin) or internally constrained by the Seven Emotions, various syndromes such as asthma-wheezing (Chuan Xiao), shortness of breath (Duan Qi), insufficient Qi (Shao Qi), rebellious Qi (Qi Ni), and surging breath (Xi Ben) will arise. How then to differentiate them? Asthma (Chuan) is characterized by hurried, rapid breathing, audible phlegm sounds, opening the mouth and raising the shoulders, shaking the body, and pulling in the abdomen. It arises from Lung Qi being affected by pathogens, causing the lung lobes to expand. It may be deficiency accompanied by cold, excess accompanied by heat, water qi surging upward, deficient fire flaming upward, emotional Qi stagnation, or insufficiency of the Spleen and Stomach. Wind-cold syndromes necessarily present with cold phlegm like ice; excess-heat syndromes necessarily present with congestion, fullness, and dry thirst; water-qi syndromes necessarily present with distension and sound in the hypochondrium and edema of the four limbs; deficient-fire syndromes necessarily improve after eating and recur immediately after meals, fluctuating in intensity; Qi-stagnation syndromes necessarily present with drawn nasal breathing, irritability, and chest fullness; Stomach-deficiency syndromes necessarily present with urgent rushing of the airway and unceasing severe asthma. The practitioner treats according to the syndrome. By directing the floating fire downward and allowing the clear, pure command to descend, the fire will naturally cease. Wheezing (Xiao) is similar to asthma but differs in that it does not involve as much open-mouthed exhalation. The *Shengji Zonglu* calls it "Xi Sou" (gurgling cough). It occurs because there is much phlegm in the chest, knotting in the throat, connected with Qi, producing a gurgling sound with respiration. It results from excessive salty and sour flavors, accumulating heat and gumming up phlegm. When the phlegm is removed, the sound decreases and breathing rests. If dietary habits are not regulated, the remaining phlegm in the chest binds with new flavors, and wheezing recurs. Treatment focuses on expelling phlegm. If triggered by cold, it is due to cold inside and outside, requiring warming of the Lung Metal. If it is cold enveloping heat, one should add dispersing herbs to the Lung-clearing formula, and it will naturally heal. Shortness of breath (Duan Qi) involves rapid breathing that is not continuous. It resembles asthma but lacks phlegm sounds, shoulder shaking, groaning, or pain/stiffness. Although it seems like Qi surging upward, it is not truly Qi surging. For cases where Qi and food are obstructed, purgation is indicated; for cases of Yuan Qi deficiency, tonification is indicated. Insufficient Qi (Shao Qi) means there is not enough Qi to speak. This corresponds to the Classic's description of "whispering voice, repeating words throughout the day," which is a sign of Qi depletion, caused by insufficiency of Middle Qi. Thus, shortness of breath can still belong to excess, whereas insufficient Qi requires only tonifying deficiency. Rebellious Qi (Qi Ni) is simply Qi rushing upward urgently, with Lung congestion preventing downward movement, resembling an inability to breathe. It is distinct from asthma, wheezing, and shortness of breath. Xi Ben (Surging Breath) is the Lung accumulation among the Five Accumulations (Wu Ji). It features urgent panting and is also called Xi Ji (Accumulated Breath). There must be a mass under the right hypochondrium to distinguish it. All five Zang organs can have ascending Qi, but the Lung is the master. Its structure is clear and empty, with ascent and descent. If exit and entry are smooth, its function operates vigorously. If Qi and Blood are scarce, ascent and descent lack support. Therefore, asthma and wheezing syndromes fall within the domain of Lung Metal, and treatment should focus on the Lung. However, for excess syndromes, no further discussion is needed; for deficiency syndromes, flexibility is required. If Earth deficiency fails to generate Metal, treatment focuses on the Spleen, allowing the central pivot to rotate. If Kidney deficiency fails to grasp Qi, treatment focuses on the Kidney, securing the "North Gate." One uses herbs with strong flavors and properties to fill the middle and lower Jiao. One must not be stuck by the condition of congestion and rebellion, leaving one helpless and hesitant.