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Sangyu Zi said: "Jing (Essence) transforms into Qi (Vital Energy), and when Qi condenses, Shen (Spirit) gathers. Therefore it is said that if Shen can control Qi, then the nasal respiration will not be abnormal." Tan Zixiao said: "Shen is like a mother, and Qi is like a son. To summon Qi with Shen is like a mother summoning her son. Whenever there is sound in respiration, it is 'Feng' (Wind/Abnormal breathing sound), not 'Xi' (Normal breath). Holding onto this 'Feng' leads to dispersion. Although without sound, if there is a sensation of obstruction or dryness in the nose, it is 'Chuan' (Wheezing/Asthma), not 'Xi'. Holding onto this 'Chuan' leads to stagnation. Without sound and without obstruction, but with traceable movement coming and going, it is 'Qi', not 'Xi'. Holding onto this 'Qi' leads to exhaustion. The so-called 'Xi' refers to the state where breath enters and exits subtly, seemingly present yet seemingly absent. It is continuous and dense, as if existing and as if perishing; the mind does not attach to external realms, there is no self and no other, what breath is there to regulate? At this stage, Shen naturally returns, Xi naturally settles, Xin (Heart/Mind) and Xi rely on each other, Water (Kidney Yin) and Fire (Heart Yang) interact, and every breath roots back to its origin; this is the mother of forming the Golden Elixir (Jin Dan)." Qiu Changchun said: "If there is even the slightest instability in the breath, life is not under one's own control." From these words, we can see that the relationship between breath and humans is immense! Therefore, compared to sounds, it is even more necessary to distinguish them carefully.

When Qi comes short and hurriedly, insufficient to support respiration, and breathing is difficult to coordinate, this indicates extreme deficiency.
If there are no chills or fever historically, but there is shortness of breath that is hard to sustain, it is known to be an Excess syndrome.
If there are no chills or fever, indicating a balance of Yin and Yang, yet there is still shortness of breath and inability to distribute Qi, this is due to obstruction in the Middle Jiao (Middle Burner), or harm caused by Phlegm-Fire.
If inhalation is slightly rapid and frequent, the disease is in the Middle Jiao.
Due to Excess pathogenic factors solidifying in the Middle Jiao, inhalation cannot enter, instead exiting and re-entering; thus the pulse appears slightly rapid and frequent. This is also an Excess syndrome, either Phlegm or Food Stagnation, which can be treated with purgative methods.
Excess syndromes can be cured; Deficiency syndromes are incurable.
Excess syndromes can be treated with purgatives. If the Middle Jiao is deficient, inhalation fails to enter fully and the pulse is slightly rapid, this indicates the impending extinction of Liver and Kidney Qi; how can it be saved?
Inhalation is short and hurried in the Upper Jiao, and deep and distant in the Lower Jiao. When Upper and Lower contradict each other, how can treatment be applied?
When disease is in the Upper Jiao, Qi should descend and unblock; when disease is in the Lower Jiao, Qi should ascend and reach upwards. Only when Upper and Lower Qi communicate freely can the disease heal. Now, if the Upper Jiao inhalation is short and cannot descend, and the Lower Jiao inhalation is deep and cannot ascend, and Upper and Lower do not communicate, how can the disease be easily treated! As for body trembling and shaking during respiration, where Qi cannot support the form, this is definitely a fatal sign.

The sky accumulates Qi, the earth accumulates Form, and humans acquire their formed bodies through Qi. Only Qi forms the body; when Qi gathers, the body exists; when Qi scatters, the body perishes. Is the relationship between Qi and Form not tremendous!
However, within the physical body, there are Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Zong Qi (Gathering Qi), Zang-Fu Qi (Viscera and Bowels Qi), and Jing-Luo Qi (Meridian Qi), each distinct. What enables them to integrate Ying, Wei, Zang-Fu, and Jing-Luo, making them full and uninterrupted, circulating endlessly, and keeping the whole body agile, relies entirely on the 'Da Qi' (Great Qi) in the chest to preside over. The large and small meridians of the Zang-Fu organs circulate day and night without rest, relying on the Da Qi in the chest to pivot and rotate among them. Once the Da Qi declines, entry and exit cease, ascending and descending stop, the Shen Ji (Spirit Mechanism) perishes, and the Qi Li (Qi Establishment) becomes isolated and precarious. As for breath emerging from the nose, its Qi spreads to the Dan Zhong (Chest center/Shanzhong). The Zong Qi at Dan Zhong governs the respiratory pathway of the Upper Jiao. It constantly connects with the Lung and Stomach; whether clear and slow or short and hurried, it suffices to predict the prosperity or decline of Zong Qi. Thus, *Su Wen · Ping Ren Qi Xiang Lun* states: "Movement below the nipples that affects clothing indicates leakage of Zong Qi." How can people act recklessly without limit, causing Zong Qi to become excessive leading to panting and rapid breathing, turning surplus into insufficiency! This points out one aspect of 'Xi' being exhalation. It also says, "If daily activities remain normal but respiration has sound, this is reversal of the Lung collateral meridians. If unable to lie down and respiration has sound, this is reversal of the Yangming Meridian." This again observes that the Qi distributing respiration connects with the Lung and Stomach, pointing out another aspect of 'Xi' being exhalation. Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver; within respiration, the Spleen and Stomach govern. Therefore, only the Middle Jiao governed by the Spleen and Stomach is the master switch of respiration. If Qi accumulates at the Ben Men (Cardia) and does not disperse, blocking both entry and exit, this is a critical situation of survival or death. Those skilled in nurturing life ensure that Qi from the Ben Men transmits to the You Men (Pylorus), and Qi from the You Men transmits to the orifices of the two Yin extremities to exit, thereby avoiding harm. The Upper and Lower Jiao respectively govern exhalation and inhalation; one cannot use the single character 'Xi' to summarize all diseases. This principle was known only by Zhang Zhongjing. He stated: "Respiration accompanied by shoulder movement indicates firmness in the Heart region. Respiration drawing upward Qi from the chest indicates cough. Respiration with open mouth and shortness of breath indicates Fei Wei (Lung萎/Sagging Lung) with spittle." Separating the discussion to focus specifically on exhalation without mentioning inhalation seems like a novel theory. However, unknown to many, Zhongjing elaborated based on creation, rooting everything in the *Nei Jing*. The previously proposed aspects of exhalation as 'Xi' are insufficient to cover it all. Generally, Heart Fire attacking Lung Metal causes hurried exhalation, which is inevitable. Exhalation belongs to the Yang of Heart and Lung, and naturally cannot be confused with the Yin of Liver and Kidney. Shoulder movement during respiration, where shoulders move with breath, occurs only due to Fire. Cough induced by upward Qi during respiration occurs because the Lung Metal's contracting and descending function fails, leading to upward reversal and cough, again due to Fire. Open-mouthed shortness of breath and Lung Sagging with spittle are cases of Metal suffering from Fire punishment, incurable. All are named 'Xi' merely because of rough exhalation. Then why not simply call it 'Hu' (Exhale)? The answer is: Exhalation contains inhalation, inhalation contains exhalation; forcibly splitting them in half is beyond even the Sage's capability. It is just that the exiting part of Xi governs diseases of exhalation, and the entering part governs diseases of inhalation, which goes without saying. *Su Wen · Tong Ping Xu Shi Lun* states: "Infants suffering from Wind-Heat wheeze, make noise, and breathe with shoulder movement." And cases of noisy respiration are numerous. Because they are not mentioned together with inhalation, diseases of inhalation become easier to identify. However, fearing later generations might not fully understand, he supplemented the meaning: "Inhalation that is slightly rapid indicates Excess in the Middle Jiao; purging it leads to recovery, while Deficiency is incurable. In the Upper Jiao, inhalation is short; in the Lower Jiao, inhalation is distant; all these are difficult to treat. Respiration accompanied by trembling and shaking is incurable." Seeing inhalation as slight and rapid, with inhalation returning quickly in the Middle Jiao, this must be Excess; purging it clears the congestion in the Middle Jiao and leads to recovery. If it is Deficiency, the root of Liver and Kidney is unstable, Qi is light and floating, escaping via Yang, and is incurable. This is what was meant earlier by the blockage between Ben Men and You Men being a critical situation. In the Upper Jiao, inhalation is short because the pathways of Heart and Lung are close; those with True Yin deficiency rise via Yang Fire and do not descend into the lower, hence short inhalation. This shows that the Upper Jiao can indeed be assessed via inhalation. In the Lower Jiao, inhalation is distant because the pathways of Liver and Kidney are far; those with Yuan Yang (Primordial Yang) decline are hindered by latent Yin pathogens and struggle to ascend, hence distant inhalation. This is illness of True Yin and Yuan Yang, hence all are difficult to treat. If respiration involves trembling and shaking, the Qi of Ying and Wei returning and forth has been exhausted, leaving only a thread of respiration remaining; how can this be saved! Students of medicine should first distinguish the entry and exit of breath to ascertain the condition. Once the condition is understood, combining it yields no error. If one only discusses respiration generally, how can one distinguish the diseases governed by the Upper, Middle, and Lower Jiao? The implication is subtle.