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(Shortness of Qi, Scarcity of Qi, Rebellious Qi - Appendix)
The Lung is the master of Qi, and the Kidney is the root of Qi. The Lung governs exhalation, and the Kidney governs inhalation (receiving Qi). When Yin and Yang interact harmoniously, respiration becomes balanced. If the functions of excretion and reception, ascending and descending become disordered, asthma/wheezing (Chuan) will occur.
Mouth open and shoulders raised, with a rushing sensation in the airways,
Pathogenesis theory states that all diseases involving wheezing and fullness belong to Heat. Haizang (Zhang Yuansu) believed that Fire scorching True Qi leads to Qi deficiency and subsequent wheezing, which has its rationale. Wheezing is divided into Excess and Deficiency patterns. The Classics state: "When pathogenic factors enter the Six Fu organs, the body becomes hot; one cannot lie down at proper times, and upwardly manifests as wheezing and calling." It also states: "Inability to lie down, or wheezing upon lying down, is caused by Water-Qi lodging therein," which illustrates an Excess pattern. The Classics say: "An Autumn pulse that is insufficient indicates Deficiency of Metal (Lung)." This causes people to wheeze and have shortness of breath with scanty Qi. It also says: "Labor leads to wheezing and sweating," clearly indicating a Deficiency pattern of wheezing. In Excess wheezing, the breath is long and surplus; in Deficiency wheezing, the breath is rapid and insufficient. In Excess wheezing, there is chest fullness and coarse sounds, caused by external pathogens interfering with the Lung and stagnation of Qi in the Upper Jiao; treatment focuses on unblocking and promoting circulation; Dingchuan Tang (Stabilize Asthma Decoction) is generally used. In Deficiency wheezing, exhalation is long and inhalation is short, the Kidney fails to receive Qi, and solitary Yang lacks a root; treatment should focus on securing and grasping. Liuwei Wan (Six-Ingredient Pill with Rehmannia), removing Mu Dan Pi (Cortex Moutan) and Ze Xie (Rhizoma Alismatis), added with Niu Xi (Radix Achyranthis Bidentatae), Wu Wei Zi (Fructus Schisandrae), Bu Gu Zhi (Fructus Psoraleae), and Hu Tao Rou (Semen Juglandis). Therefore, Excess wheezing is blamed on the Lung, and Deficiency wheezing is blamed on the Kidney. Ye Tianshi also stated: "The cause of wheezing is Excess in the Lung and Deficiency in the Kidney." Xu Lingtai, in his commentary on *Yizong Jinjian*, said: "Wheezing in the Lung is Excess, in the Kidney is Deficiency." If Excess and Deficiency are treated indiscriminately, survival is rare; however, distinguishing between them when symptoms are ambiguous is extremely difficult. Mr. Xiangyan (Ye Tianshi) further proposed that difficulty in exhaling indicates Lung disease, while noise during inhalation indicates Kidney disease, making accurate diagnosis even more difficult. For treating wheezing, whenever the Lung orifices are obstructed, breathing is difficult, Qi is abundant, and the pulse is Excess, slippery, rapid, and forceful, these are all signs of an Excess condition. For example, if wind-cold invades the Lung causing wheezing, use San'ao Tang (Three Unbinding Decoction) or Huagai Tang (Canopy Decoction). If Lung heat and phlegm-fire cause wheezing, use Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction). If Lung cold and fluid retention cause rebellious wheezing, use Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction augmented with Magnolia Bark and Apricot Kernel). If summerheat and excessive fire cause wheezing, use Xiangru Yin (Elsholtzia Drink) or Baihu Tang (White Tiger Decoction). If turbid rebellion due to dampness causes wheezing, use Siling San (Four-Ling Powder) augmented with Xing Ren (Semen Armeniacae Amarum), Hou Po (Cortex Magnoliae Officinalis), Sang Bai Pi (Cortex Mori Radicis), Tong Cao (Medulla Tetrapanacis), and Ting Li Zi (Semen Lepidii seu Descurainiae). If Lung Qi fails to descend, causing edema and wheezing, use Mahuang Tang (Ephedra Decoction) removing Guizhi (Ramulus Cinnamomi Cassiae), augmented with Sang Bai Pi, Yi Yi Ren (Semen Coicis), and Fu Ling (Poria). If Lung distension with water retention causes upper wheezing and coughing with a floating pulse, use Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction augmented with Gypsum). With a deep pulse, use Da Yuebi Jia Banxia Tang (Major Yuebi Decoction augmented with Pinellia). For water disease with wheezing and fullness, where Kidney pathology attacks the Lung, it is appropriate to unblock Yang and drain turbidity, using Zhenwu Tang (True Warrior Decoction) combined with Siyu San (Four-Stagnation Powder) removing Bai Zhu (Rhizoma Atractylodis Macrocephalae). Phlegm-wheezing must have its source cleared; if Qi stagnation generates saliva/phlegm, use Wendan Tang (Warm Gallbladder Decoction). If Fire agitation generates phlegm, use Qingge Jian (Clear Diaphragm Decoction). If anger-induced wheezing requires calming the Qi, use Sixia Tang (Four-Gentlemen-like Decoction for Seven Emotions). If inhalation sound is quite rapid, worsening with labor, with weak Qi and a faint pulse, or floating, large, and wiry but empty upon pressure, observing no external pathogens and no internal excess heat, these are all signs of a Deficiency condition. If Lung Deficiency with Dry Metal, use Shengmai San (Generate Pulse Powder). If Stomach Deficiency with rising Yang, use Renshen Wuwei Tang (Ginseng and Schisandra Decoction) augmented with Fu Ling and Zhi Gancao (Honey-fried Licorice). If Kidney Yin is deficient with essence injury, Chong and Ren meridians are deficient, Dantian fire blazes, and Lung Metal is scorched, use a large dose of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) augmented with Maidong (Rhizoma Ophiopogonis) and Wuwei Zi. If Kidney Yang is deficient with Qi collapse, solitary Yang floats upward, causing red face and irritability, with Fire not returning to its origin, use Qiwei Dihuang Wan (Seven-Ingredient Rehmannia Pill) augmented with Renshen (Radix Ginseng) and Maidong. If Kidney fails to receive Qi, moving the body induces wheezing, and the pivot of Yin and Yang loses interaction, urgent sedation and grasping are needed; use Shenqi Tang (Kidney Qi Decoction) added with Chenxiang (Lignum Aquilariae Resinatum). To draw Yang from Yin, use Duqi Wan (Nine-Ingredient Pill) with Qingqian (Lead Oxide). To draw Yin from Yang, if Kidney, Lung, and Stomach are all deficient, with wheezing, coughing, and fatigue, use 1 qian of Renshen and 3 Walnuts, honey-roasted with skin. Decoct and take orally for efficacy. Post-illness wheezing is Lung Deficiency; use Shengmai San plus Ejiao (Donkey-hide Gelatin), Baizhu, and Chenpi (Pericarpium Citri Reticulatae). Post-illness wheezing with cough and sputum, facial edema, and cold feet indicates Yang Deficiency; use Bawei Wan (Eight-Ingredient Pill). Postpartum wheezing indicates solitary Yang and severed Yin, which is most critical. Due to sudden exhaustion of Ying Qi, Wei Qi remains alone, residing solely in the Lung, thus causing urgent wheezing. Administer Dushen Tang (Single Ginseng Decoction) via灌 (pouring/drinking). If blood enters the Lung, with red face and near-death wheezing, use Susu Yin (Perilla Drink). If failed blood rushes to the Heart, causing chest fullness and upward Qi, expel the failed blood, and wheezing will settle naturally; use Xuejie San (Dragon's Blood Powder). For elderly patients with chronic illness, wheezing and coughing preventing sleep, use Xingren Wan (Apricot Kernel Pill). Wheezing upon movement is mostly due to deficiency and decline; use Songya Pipi Wan (Songya Spleen-Kidney Pill). For Yin Deficiency, nourishment is suitable: Shudi (Prepared Rehmannia Root), Yurou (Cornus Fruit), Wuwei Zi, Ejiao, Gouqi (Goji Berry), Hutao Rou, Gejie Wei (Tail of Gecko). For Yang Deficiency, warming and nourishing is suitable: Renshen, [Missing Character], Danggui (Angelica Sinensis), Baizhu, Fushen (Poria with Hostwood), Lianzi (Lotus Seed), Shanyao (Dioscorea Rhizome), Zhi Gancao. For non-interaction of Yin and Yang, grasping and securing the Lower Yuan, use Haishen Jiao (Sea Cucumber Gelatin), Dancai Jiao (Dried Mussel Gelatin), Shudi, Fuling, Niuxi, Yuanzhi (Radix Polygalae), Guzhi (Psoralea Fruit), Qingyan (Rock Salt), and Shiying (Quartz). By applying treatment according to these symptom differentiation, the principles are clear as lines arranged before the eyes.

[Shortness of Qi] Rapid breathing that cannot continue, resembling wheezing but without phlegm sounds. There are two types of this symptom: One belongs to Zhi Yin (Branch Fluid Retention). *Jin Gui Yao Lue* states: "For shortness of Qi with slight fluid retention, it should be eliminated via urination." Use Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) as the main formula; Shenqi Tang (Kidney Qi Decoction) is also applicable. Because shortness of exhalation is treated with Linggui Zhugan Tang to unblock Yang Qi; once Yang Qi is unblocked, urination can occur. Shortness of inhalation is treated with Shenqi Tang to transform Yin Qi; once Kidney Qi transforms, the gate of urination opens. The other type belongs to Qi Deficiency. Li Dongyuan stated: "The Lung governs all Qi. Shortness of Qi means the Qi of the Five Zang organs is insufficient, and the Yang pathway does not function." For shortness of Qi with frequent urination, use Sijunzi Tang (Four Gentlemen Decoction) removing Fuling, adding Huangqi (Astragalus Root). If abdominal Qi does not circulate, double the amount of Gancao (Licorice). For short and hurried Lung Qi, double Renshen and add Baishao (White Peony Root), so that Liver and Gallbladder pathogens dare not invade. If after blood loss, Yin Fire rises, causing shortness of Qi and inability to breathe fully, or Kidney Deficiency fever with spitting phlegm, use Shengmai San plus Danggui, Huangqi, and Shengdi (Rehmannia Root).

[Scarcity of Qi] Insufficient Qi to speak. The Classics state: "Timidly scarce of Qi" indicates that water pathways do not flow, and form and Qi are exhausted. It also says: "Speaking faintly, only speaking again after a whole day, this is Qi depletion." It also says: "If the Spleen pulse is firm and long, and the complexion is yellow, one suffers from Scarcity of Qi." Use Dushen Tang, Shengmai San, Baoyuan Tang (Protect Origin Decoction), and Yigong San (Extraordinary Merit Powder).

[Rebellious Qi] Qi rebels upward, preventing sleep, with sounds during respiration. The Classics state: "The Stomach is the sea of the Six Fu organs; its Qi descends. If the Yangming meridian rebels, it cannot follow its proper path, thus preventing sleep and causing respiratory sounds." If daily activities remain normal but respiratory sounds exist, it is because the collateral vessels of the Lung rebel. Collateral vessels cannot move up and down with the meridians, thus lingering in the meridians without circulating. Pathology of collateral vessels is minor in humans, hence daily activities remain normal despite respiratory sounds. Those who cannot lie down and wheeze upon lying down are affected by lodging Water-Qi. Water flows following fluids; the Kidney is the Water organ, governing fluids, and governing sleep and wheezing. To treat rebellion of Yangming Qi, use Simo Tang (Four-Mortar Decoction) or Qiqi Tang (Seven-Air Decoction). To treat rebellion of Lung collateral Qi, use Xingzi Tang (Apricot Seed Decoction), Xiao Qinglong Tang (Minor Green Dragon Decoction), Zhaobi Tang (Zhao's Concubine Decoction), or Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). To treat rebellion of Kidney Qi, use Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), Shenqi Tang, or Lingsha Dan (Spirit Sand Pellet).
The Classics state: "If the Cun Kou pulse is Excess, the Lung is Excess; the Lung will surely distend, with upper wheezing and rebellion, throat obstruction, vomiting-like sensations, and spontaneous sweating, all signs of Lung Excess." If the Right Cun pulse is Deficient, the Lung is Deficient; there will surely be dry throat without fluids, and scarcity of Qi insufficient for breathing.
*YiTong* states: "Lung Deficiency with cold invasion causing wheezing" uses Shen Su Wen Fei Tang (Ginseng and Perilla Warming Lung Decoction). "Cold constraint with Heat pathogen causing wheezing, with hot phlegm inside, triggered by cold" uses Mahuang Dingchuan Tang (Ephedra Stabilizing Asthma Decoction). "Remote chronic cough-rebellion and upward Qi, chest fullness and blockage, inability to produce voice" uses Renshen Dingchuan Tang (Ginseng Stabilizing Asthma Decoction). "Deficient Cold upward Qi, labor-fatigue wheezing and coughing" in *Qianjin Fang* uses Banxia (Pinellia Tuber), Renshen, Ginger, Guixin (Cinnamon Heart), and Gancao decocted together. "Upward Qi preventing sleep" uses Shengjiang (Fresh Ginger), Renshen, Juhong (Exocarpium Citri Grandis), Zisu (Perilla Leaf) each 1 qian, and several Wuweizi. "Obese with much phlegm, wheezing preventing sleep, Yuan Qi not yet depleted" uses Qianmin Tang (Thousand Strings Decoction) or combined with Daotan Tang (Great Phlegm Decoction). "Chronic wheezing and coughing for years, worse with cold" uses Jiubao Tang (Nine-Treasure Decoction) or Ansou Huatan Gao (Calming Cough and Resolving Phlegm Paste). "Wheezing and coughing, Qi rushing up from below the navel, Chi pulse flooding and rapid, accompanied by night sweats and tidal fever" belongs to Yin Deficiency. Use Liuwei Tang plus Buguzhi and Wuweizi, taken with Lingsha Dan.
For wheezing and urgency in severe chronic illness or postpartum, all are Scarcity of Qi; even if there is chronic phlegm-fire, it is also due to Qi Deficiency. A large dose of Shengmai San is required. If Deficient and on the verge of collapse, the Root of Yuan Sea shakes, Fire rushes from below the navel upward, resembling wheezing but not quite, swallowing seems insufficient, urgent vigorous tonification and sedation of the Dantian are needed. Use a large dose of Liuwei Tang plus Wuweizi, Niuxi, Qingqian, Yuanwu Jiaxin (Turtle Plastron Center), and Cishi (Magnetite).
Wheezing and Distension (Zhang) are interdependent, both involving inadequate urination; thus, wheezing leads to distension, and distension inevitably leads to wheezing. If wheezing precedes distension, treatment focuses on the Lung; if distension precedes wheezing, treatment focuses on the Spleen. The Classics state: "The Lung faces all vessels, regulates water passages, and transmits downward to the Bladder." The Bladder is the official of the reservoir, storing fluids; Qi transformation allows them to exit. Thus, the passage of urine depends on the descending and transforming action of Lung Qi. If the Lung is invaded by pathogens, it loses the command of descending, leading to water overflowing the skin and generating swelling and fullness. Here, wheezing is the root, and swelling is the branch; treatment should prioritize clearing Metal and descending Qi, with promoting urination secondary. Since the Spleen governs muscles and dislikes dampness controlling water, if Spleen Deficiency fails to control water, water-dampness acts recklessly, invading muscles externally and stagnating upward internally, preventing Lung Qi from descending, thus generating wheezing. Here, swelling is the root, and wheezing is the branch; treatment should prioritize strengthening the Spleen and promoting urination, with clearing Metal secondary. If Lung disease is treated with drugs that dry the Spleen, Metal becomes dry and wheezing worsens; if Spleen disease is treated with drugs that clear Metal, the Spleen becomes cold and distension increases.