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Cheng Wuji: Shortness of breath (Duan Qi) is characterized by rapid and shallow breathing, resembling panting but not true panting. In panting (Chuan), the patient opens their mouth and raises their shoulders; in shortness of breath, there is merely rapid breathing that cannot continue smoothly, resembling panting without raising the shoulders, or resembling groaning without pain. Some attribute shortness of breath to excess patterns (The Classic states: "Shortness of breath with abdominal fullness and panting, accompanied by tidal fever, indicates that the exterior pathogen is about to resolve and interior purgation can be applied; this type of shortness of breath is due to excess"). Some attribute it to deficiency patterns (The Classic states: "When the Dubyang pulse is faint and tight, tight indicates cold, and faint indicates deficiency; when faint and tight interact, shortness of breath results; this type of shortness of breath is due to deficiency"). Some cases are located in the exterior (The Classic states: "Shortness of breath caused solely by incomplete sweating will heal with further diaphoresis; if combined with wind-dampness, presenting with sweating, shortness of breath, difficult urination, and aversion to wind, Gancao Fuzi Tang [Licorice and Aconite Decoction] should be used; this is shortness of breath due to pathogens in the exterior"). Some cases are located in the interior (The Classic states: "Dry retching, shortness of breath, sweating, and absence of aversion to cold indicate that the exterior has resolved but the interior is disharmonious; Shizao Tang [Ten Jujube Decoction] should be used. If a physician incorrectly applies purgation to a Taiyang disease, resulting in shortness of breath, irritability, mental vexation, epigastric hardness, and formation of Chest Binding (Jie Xiong), Daxiexiong Tang [Major Yellow Dragon Decoction] should be used; this is shortness of breath due to pathogens in the interior"). Treatments vary accordingly. Generally, shortness of breath is often an excess pattern. The Synopsis of Prescriptions of the Golden Chamber states: "Shortness of breath where respiration is insufficient indicates excess." Additionally, fluid retention in the heart region also causes shortness of breath. The Synopsis of Prescriptions of the Golden Chamber states: "Consuming little food and drinking much water leads to fluid retention in the heart region; mild cases manifest as shortness of breath." Scholars must carefully distinguish these.

Exterior Patterns: Shortness of breath accompanied by joint pain, inability to flex or extend, sweating, difficult urination, aversion to wind, and body swelling indicates Wind-Dampness, for which Gancao Fuzi Tang [Licorice and Aconite Decoction] is appropriate (see commentary under 'Body Pain'). Shortness of breath with abdominal fullness and hypochondriac pain, where the patient presents with a wiry, floating, and large pulse, unresolved exterior, anhidrosis, lethargy, jaundice, difficult urination, and tidal fever, calls for Xiaochaihu Tang [Minor Bupleurum Decoction] (see commentary under 'Stomach Excess' and formula commentary under 'Alternating Chills and Fever').

Interior Patterns: If the exterior is unresolved, with continuous sweating from the hands and feet or tidal fever, Dachengqi Tang [Major Order the Qi Decoction] is appropriate (see commentary under 'Tidal Fever'). If the exterior has resolved, with epigastric stuffiness and hardness, dry retching, and shortness of breath, Shizao Tang [Ten Jujube Decoction] is appropriate (see formula under 'Hypochondriac Fullness and Pain').

Incomplete Sweating: Shortness of breath and irritability occur if sweating was incomplete; subsequent slight sweating, absence of aversion to cold, unresolved exterior patterns, and red face indicate a concurrent disease (Bing Bing); further diaphoresis will lead to recovery (see commentary under 'Red Face').

After Purgation: If after purgation there is mental vexation and epigastric hardness and pain, Daxiexiong Tang [Major Yellow Dragon Decoction] should be used (see commentary under 'Chest Binding').

Diagnosis: When the Dubyang pulse is faint and tight, tight indicates cold, faint indicates deficiency; the interaction of faint and tight causes shortness of breath. Sitting while leaning forward indicates shortness of breath.

Appendix:
Tao Hua: In Shanghan (Cold Damage), failure to apply sweating or purging, or weakness following sweating/purging, leading to rebellious qi that fails to connect continuously, is named shortness of breath. It must be treated by distinguishing excess and deficiency. This differs from panting.
Wu Qian: After sweating, vomiting, or purging, if primal qi is weak, the pulse is faint and deficient, and qi fails to connect causing shortness, Renshen Yiqi Tang [Ginseng Qi-Boosting Decoction] should be used. For any Yin-pattern diseases with weak, fine, deep, and slow pulses, cold extremities, facial aversion to cold as if scraped by a knife, and difficulty in distributing breath through the mouth and nose resulting in shortness, Sini Tang [Frigid Extremities Decoction] added with Renshen [Ginseng] is indicated. Furthermore, consuming little food and drinking much water, causing fluid retention in the heart region and leading to shortness of breath and vexation, should be treated with Linggan Fuzi Tang [Poria, Licorice, and Atractylodes Macrocephala Decoction].