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Shortness of breath (Duan Qi) refers to rapid and short breathing, where the breath cannot continue smoothly. It resembles panting but is not true panting, and resembles groaning but produces no sound. There are excess patterns (Shi Zheng), deficiency patterns (Xu Zheng), patterns located in the exterior (Biao), patterns located in the interior (Li), and cases where fluid retention occurs beneath the heart. It can also result from improper use of sweating or purging methods, or from extreme deficiency after such treatments; all these can cause shortness of breath. Misusing tonification and draining methods is more dangerous than wielding a blade; one must carefully examine the pulse and symptoms before treating. Additionally, individuals with inherent deficiency who undergo sweating or purging and fail to receive proper regulation and tonification may suddenly exhibit symptoms resembling panting, speaking weakly with little energy. Their pulse may be only two or three beats per cycle, deep and thin like a hair, or even imperceptible. This is extreme deficiency causing shortness of breath, not true panting. Immediate warm tonification is required; delay renders it incurable, and treating it as panting will lead to death. If this presentation occurs due to the overuse of harsh resolving agents after sweating or purging, the treatment is the same. In summary, shortness of breath can involve exterior/interior, excess/deficiency, and cold/heat patterns, though deficiency patterns are more common. One must carefully analyze the pulse and accompanying symptoms.

Plague (Wen Yi) complicated by summerheat (Shu) is difficult to distinguish clearly. Summerheat pathogenic factors in the exterior present with headache, irritability, high fever, floating pulse with panting, dry mouth, greasy complexion, spontaneous sweating, and cold extremities reversed upwards. This is named Summerheat Jue (Shu Jue); convulsions are named Summerwind (Shu Feng); unconsciousness is named Severe Summerheat (Zhong Shu). These symptoms easily confuse with the exterior signs of plague. Summerheat in the interior presents with vomiting, belching, diarrhea, epigastric and abdominal fullness and stuffiness, or distending pain, which easily confuses with the interior signs of plague. Differentiation relies on the triad of shortness of breath, fatigue, and intense thirst. Although plague also causes thirst, when the plague pathogen is in the exterior, thirst is mild and becomes severe only upon transmission to the interior. In contrast, summerheat causes thirst regardless of whether it is in the exterior or interior; moreover, when in the exterior, the thirst is much more intense than that of plague in the exterior. Using this criterion helps ascertain the true nature of the condition. If it is indeed plague complicated by summerheat, one should use formulas that resolve plague and dispel summerheat. One need not rigidly adhere to the days of illness; treat the exterior if exterior signs appear, and treat the interior if interior signs appear. It is advisable to treat the plague first; once the plague is resolved, the summerheat will recede accordingly. Ma Maolin used Wu Wen Dan (Five Plagues Pill) to treat plague-summerheat, but the formula lacks herbs for treating summerheat, serving merely as a cooling and dispersing agent, so it is not entirely suitable. In such cases, one should modify Da Yuan Yin (Origin-Reaching Powder) by adding or subtracting herbs to dispel summerheat. Wu Wen Dan can be prepared in advance during winter each year for future use. Formulas for dispelling summerheat are recorded under the category of Summerheat diseases and are not repeated here. (Plague fever has no cessation, while summerheat fever comes and goes; this serves as a differentiating factor. However, if plague and summerheat are combined, this criterion alone is insufficient, and careful examination of pulse and symptoms remains necessary.)