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Pulse is weak upon palpation, inevitably accompanied by dry throat with scanty fluids and shortness of breath; this is a Lung Deficiency syndrome. (The right side distinguishes between deficiency and excess patterns. The preceding text discussed only draining excess methods. Now, tonifying deficiency methods are described below.)

Li Dongyuan stated: When the lungs are distended and swollen with wheezing and cough, chest and diaphragm fullness, and qi stagnating and rushing upward, add Schisandrae Fructus (Wuweizi) in large amounts to the formula prescribed according to the pattern, followed by Ginseng Radix et Rhizoma (Renshen), then Ophiopogonis Radix (Maidong), and a small amount of Coptidis Rhizoma (Huanglian). If the condition is severe, manifesting as crossing hands over the heart and visual confusion, it indicates a great deficiency of true qi. If there is shortness of breath, add Phellodendri Cortex (Huangbai), Schisandrae Fructus (Wuweizi), and Ginseng Radix et Rhizoma (Renshen). If qi is excessive (excess heat), remove Schisandrae Fructus (Wuweizi) and Ginseng Radix et Rhizoma (Renshen), and add Scutellariae Radix (Huangqin) and Schizonepetae Spica (Jingjie Sui). In winter, remove Schizonepetae Spica (Jingjie Sui) and add Alpiniae Katsumadai Semen (Caodoukou Ren). Zhu Danxi stated: For those with qi deficiency, use Ginseng Radix et Rhizoma (Renshen), honey-fried Phellodendri Cortex (Huangbai), Ophiopogonis Radix (Maidong), and Lycii Cortex (Digupi). Materia Medica records that for treating cough with upper qi rebellion and rapid breathing, using only Ginseng Radix et Rhizoma (Renshen) ground into powder, mixed with egg white and new water, taken as one qian, is effective. Once, two people ran together; one held Ginseng Radix et Rhizoma (Renshen) in the mouth, the other did not. After running about three to five li, the one without ginseng panted heavily, while the one with ginseng breathed normally. This demonstrates the power of Ginseng Radix et Rhizoma (Renshen). Lou Quanshan treated a woman in her fifties who had chronic phlegm-cough. Suddenly, she experienced severe panting, expectorating sputum like a spring, sweating profusely like oil, with a floating and surging pulse, appearing as if near death. Quickly, Mai Men Dong Si Qian Tang was used: Ophiopogonis Radix (Maidong) 4 qian, Ginseng Radix et Rhizoma (Renshen) 2 qian, Schisandrae Fructus (Wuweizi) 1.5 qian. After one decoction, panting stopped and sweating ceased. After three doses, sputum gradually decreased. Then, the previous formula was modified by adding Trichosanthis Semen (Gualou Ren) 1.5 qian, Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Shaoyao), and Scutellariae Radix (Huangqin) each 1 qian. After more than twenty doses, she recovered. This was indeed the merit of Ophiopogonis Radix (Maidong), Schisandrae Fructus (Wuweizi), and Ginseng Radix et Rhizoma (Renshen). If spontaneous sweating accompanies abdominal fullness, with a deep, solid pulse and panting, it is an interior excess pattern. Purging should be employed. (Above are examples of treating qi deficiency.) Zhu Danxi stated: There is yin-deficiency panting, where fire rises from below the lower abdomen. Si Wu Tang (Four Substances Decoction) added with Qingdai (Indigo Naturalis), Zhuli (Bamboo Sap), and Chenpi (Citri Reticulatae Pericarpium), decocted with Tongbian (Child's Urine), is suitable. For yin-deficiency complicated with phlegm-panting, Si Wu Tang (Four Substances Decoction) added with Zhiqiao (Aurantii Fructus) and Banxia (Pinelliae Rhizoma) is used to nourish yin and descend fire. I believe that Danggui (Angelicae Sinensis Radix) and Dihuang (Rehmanniae Radix) are cloying and obstruct the diaphragm, generating phlegm; Zhiqiao (Aurantii Fructus) and Banxia (Pinelliae Rhizoma) are drying and purgative, damaging yin. It is better to use Asparagi Radix (Tianmendong), Bombycis Batryticatus (Sangpi), Fritillariae Thunbergii Bulbus (Beimu), Aristolochiae Fructus (Madouling), Lycii Cortex (Digupi), Ophiopogonis Radix (Maidong), and Loquat Leaf (Pipaye). (Above are examples of treating yin deficiency.) Li Dongyuan said: The *Neijing* states that various atrophy syndromes, panting, and vomiting belong to the Upper Jiao. Analysis clarifies that when Taiyang physicians attribute panting and vomiting to fire-heat, it is because obvious excess pathogenic factors invade the exterior, cold transforms into heat, Heart Fire becomes too vigorous and attacks Lung Metal, thus belonging to the Upper Jiao. It also states that individuals consuming rich foods have excessive nourishment, or those who overly dote on children, can accumulate heat in the Upper Jiao leading to panting and coughing, which should be treated with sweet-cool agents. *Mai Jing* further states that when Lung Qi is excessive, it causes cough, upper qi rebellion, panting, thirst, vexation, chest fullness, and shortness of breath. This is caused by Chong Mai (Penetrating Vessel) fire acting in the chest. The root lies in the Lower Jiao, not the Upper Jiao. Therefore, deficiencies in miscellaneous diseases arising from excess pathogenesis involve many discussions on root-branch transmission. Dietary labor, unregulated emotions, and cold/heat from food and drink, when contracted, harm the Six Fu Organs, all due to insufficiency of Middle Qi. Abdominal distension, coughing, panting, vomiting, and inability to eat are treated immediately with large doses of sweet-acrid-hot agents. Below are two formulas for Heat Panting and Cold Panting. Renshen Pingfei San (Ginseng Calms the Lungs Powder) treats Heart Fire punishing Lung Metal, transmitting to Fei Wei (Lung Atrophy), causing cough, panting, vomiting, abundant saliva/phlegm, chest oppression, and throat obstruction. Shensu Wenfei Tang (Ginseng and Schizonepeta Warming the Lungs Decoction) treats lung injury from cold exposure and cold drinks, causing panting, vexation, chest fullness, and shortness of breath without free flow. Tiaozhong Yiqi Tang (Regulate Middle Boost Qi Decoction) modification: In autumn/winter, if the Stomach Meridian pathways are reversed by the Chong Mai (Penetrating Vessel), and the Shaoyang pathways under the ribs reverse upward, the disease is named Jue Ni (Reversal Cold/Counterflow). Symptoms include qi rushing to the throat preventing respiration, audible panting, and inability to lie down. Add Evodiae Fructus (Zhuyu) 0.5 or 1 qian, washed to remove bitterness, dosed according to the degree of counterflow qi. If this occurs in summer, it is a Great Heat pattern. Generally, this pattern varies with the seasons' cold/heat/warmth/coolness. Use equal parts of Wine-processed Coptidis Rhizoma (Huanglian), Wine-processed Phellodendri Cortex (Huangbai), and Wine-processed Anemarrhenae Rhizoma (Zhimu), ground to fine powder, made into pills the size of paulownia seeds with hot water. Take 200 pills per dose with warm water, on an empty stomach. Drink plenty of hot water after taking. Shortly after, consume a good meal to prevent the medicine from staying in the stomach, guiding it to the Lower Yuan to drain Chong Mai pathogens. Generally, diseases from diet and fatigue belong to Xu Lao Seven Damages (Deficiency Consumption Seven Losses), treated fundamentally with warm-neutral medicines that are sweet-dominant and acrid-minimal. If intermittent chills and fever occur, it is a Four Seasons pattern. If improper care, excessive alcohol/food, spicy-hot foods, cold foods, or extreme environments exacerbate the illness, temporary drastic cold/heat treatments may be used for effect, which is a flexible approach. Do not use them long-term just because they work, or premature death will result. *Huangdi Zhenjing* states: For conditions rising from below, guide them outward. For insufficiency of Upper Qi, push and uplift it. Upper Qi refers to the Qi of Heart/Lung Upper Jiao. Yang disease in Yin aspects requires drawing Yang from Yin. Use herbs entering Kidney/Liver Lower Jiao to guide sweet-dominant/acrid-minimal herbs to raise Spleen/Stomach Qi, and subsequently expel pathogens from Cou Li (interstices) and skin/hair. It also states: Where pain occurred previously, treat it first. This uses Miu Ci (Needling opposite sides) to drain meridian blockage caused by blood stasis. Treat this first, then other diseases. (Above are examples distinguishing cold and heat.) Stomach Collateral disharmony causes panting from Mingyang Qi rebellion. (Mingyang Qi should descend; now it rebels upward. Ancients advised against obstruction. Formulas like Fenqi Zisu Yin, Zhimi Qi Qi Tang plus Banxia, Er Chen Tang plus Suisha are appropriate.) True Yuan depletion causes panting from Kidney Qi rushing upward. (True Yang deficiency leads to Kidney Qi failing to return to its source. While heavy minerals can settle and assist Yang, do not act too harshly. First use An Shen Wan or Ba Wei Wan. Otherwise, use Ginseng decoction to administer Yang Zheng Dan.) Lung deficiency causes shortness of breath and panting. Classic says: Autumn pulse corresponds to Lung. If Autumn pulse is insufficient, panting occurs, with short breath and cough, upper qi bleeding, and abnormal sounds heard below. Treatment uses Maidong, Wuweizi, Renshen. Fei Bi (Lung Obstruction) and Fei Ji (Lung Accumulation) cause chronic panting. Classic says: Pathogenic qi causing panting accumulates in the Lung. Also: Fei Bi symptoms include vexation, fullness, panting, and vomiting. Treatment for Fei Bi panting involves releasing the exterior or inducing vomiting to open the Qi. *Nan Jing* states: Lung accumulation is named Xi Ben, located under the right hypochondrium, cup-shaped. Long-standing, it causes panting/cough and Fei Yong (Lung Abscess). Treatment is Xi Ben Wan to grind away the accumulation. (Right side: Treating Lung Panting.) Stomach panting causes body heat and vexation. Classic says: Stomach Qi rebels. Also: Invading wind/pathogens affect Yang meridians, entering Six Fu Organs, causing body heat, insomnia, and upper panting. Also: Yangming Jue Ni (Counterflow) causes panting and [spasms], aversion to people. Some die from panting, some live. Why? Jue Ni connecting to Zang organs leads to death; connecting to Jing meridians leads to survival. Wang Bing notes: Internal heat depression causes vexation. Treatment for Stomach panting uses Jiajian Baihu Tang (Modified White Tiger Decoction). (Right side: Treating Stomach Panting.) Kidney panting causes vomiting and cough. Classic says: Shaoyin vomiting/cough and upper qi panting occur because Yin Qi is below, Yang Qi is above, all Yang Qi floats without foundation. Treatment by Li Dongyuan uses Xie Bai San. (Right side: Treating Kidney Panting.)

[Panting with Inability to Lie Down] Any panting with inability to lie down, with a floating pulse that is deficient and choppy upon pressure, indicates Yin Deficiency, nearing death. Do not purge; purging will cause death. Use Si Wu Tang (Four Substances Decoction) added with Tongbian (Child's Urine), Zhuli (Bamboo Sap), Qingdai (Indigo Naturalis), Mendong (Ophiopogon), Wuweizi (Schisandra), Zhike (Aurantium), and Ziye (Perilla Leaf). *Suwen · Nidiao Lun* states: Inability to lie down, panting when lying down, is due to Water Qi invasion. Water flows with Jin Ye (Body Fluids). Kidney is the Water Organ, governing Jin Ye, and controlling sleep and panting. Li Dongyuan said: Patients unable to sleep, panting when sleeping, have Water Qi reversing upward, attacking the Lung. Lung becomes buoyant with water, Qi circulation stops, pulse is deep. Shenmi Tang (Divine Mystery Decoction) is highly suitable. Zhang Zhongjing said: Cough/rebellion leaning on support, unable to lie down, treated with Xiao Qinglong Tang (Minor Blue Dragon Decoction). (Zhi Yin (Branch Fluid Retention) also causes panting/inability to lie down, with shortness of breath, but pulse is normal.) After Xiao Qinglong Tang, if there is much saliva, dry mouth, deep Cun pulse, shallow Chi pulse, cold limbs, Qi rushing from lower abdomen to chest/throat, limb numbness, flushed face like drunkenness, Qi flowing down to inner thighs, difficult urination, and occasional vertigo, give Fuling Guizhi Wuweizi Gancao Tang (Poria, Cinnamon Twig, Schisandra, Licorice Decoction) to treat Qi rushing. When Qi rushing subsides but cough/chest fullness worsen, use Guizhi Fuling Wuweizi Gancao Tang removing Guizhi, adding Ganjiang (Dried Ginger) and Xixin (Asarum) 3 liang each, to treat cough/fullness. When cough/fullness stop but thirst recurs and Qi rushing returns, it is because Xixin/Ganjiang are hot. They should cause thirst; if thirst stops, it indicates Zhi Yin (Branch Fluid). Zhi Yin causes vertigo; vertigo causes vomiting. Add Banxia (Pinellia) to remove water. (Remove Guizhi from Guiling Gancao Wuwei Tang, add Ganjiang, Xixin, Banxia.) When water goes and vomiting stops, but body swelling remains, add Xingren (Apricot Seed) 0.5 sheng. Normally Mahuang (Ephedra) would be added, but due to existing numbness, it is omitted. Adding it reversely would cause Jue Ni (Cold Extremities). Reason: Blood deficiency; Mahuang disperses Yang. Use Fuling 4 liang, Gancao, Ganjiang, Xixin 3 liang each, Wuweizi, Banxia, Xingren (de-husked) 0.5 sheng each. Decoct, strain, take warm, three times daily. If face is hot like drunkenness, this is Stomach Heat rushing up, steaming the face. Add Dahuang (Rhubarb) 3 liang to drain it. *Suwen · Nidiao Lun*: Inability to lie down with noisy breathing is reversal of Yang Dao. Foot Three Yang meridians descend; now they reverse upward, causing noisy breathing. Yangming is Stomach Meridian. Stomach is Sea of Six Fu Organs, Qi descends. Yangming reversal prevents following its path, causing inability to lie down. *Xia Jing* says: Stomach disharmony leads to restless sleep. Treatment seen previously.

[Xiao/Wheezing] Similar to Chuan (Panting), but does not involve opening the mouth for exhalation as much. E.g., *Shengji Zonglu* mentions "Xi Sou" (Sipping Cough). Chest has much phlegm, knotting in the throat, tied to Qi. With breathing, it makes "ya-xia" sounds in the throat. "Xia" is open mouth, "Ya" is closed mouth; both have sound. Throat is the gate for Qi entry/exit. Huiyan (Epiglottis) is the door of voice. Xianyong (Uvula) is the latch of voice. Breathing is naturally silent. Chest phlegm rises with Qi, sticking to throat/Huiyan/Xianyong. Qi cannot move freely, colliding with phlegm to make sound. This phlegm comes from excessive salty/sour flavors, accumulating heat over time, sticking to Lung channels like lacquer. Only when phlegm in throat is expelled does sound cease. If diet is not regulated, remaining phlegm binds with new flavors, and Xiao recurs. This is the pattern. Zhu Danxi said: Xiao is primarily due to phlegm; expectoration method is suitable. Treat Xiao with bland diet, not purely cooling herbs, must include releasing exterior herbs. Formula: Crack eggshell slightly without breaking membrane, soak in urine vat for 3-4 nights, boil and eat. Egg clears Wind-Phlegm. Another formula: Burn cat feces to ash, mix with brown sugar water for immediate effect. Xiao triggered by cold has two patterns: 1. Interior/Exterior Cold. Treat with Li Dongyuan's Shensu Wenfei Tang, Tiaozhong Yiqi Tang plus Zhuyu, or Zijin Dan to seize Cold-Phlegm. 2. Cold wrapping Heat. Treat with Zhang Zhongjing/Zhu Danxi's Yebing Jia Banxia Tang (Yebing Plus Pinellia Decoction) and other releasing formulas. Or in Aug/Sep before cold, use Dachengqi Tang (Major Order the Qi Decoction) to purge heat. In winter cold, no heat to wrap, so it doesn't flare. Triggered by rich flavors: Qingjin Dan.

[Postpartum Panting] Postpartum throat urgency and panting is due to excessive blood loss, sudden exhaustion of Ying Blood (Nutrient Blood), Wei Qi (Defensive Qi) losing master, gathering alone in Lung, causing panting. Named Gu Yang Jue Yin (Lone Yang Absolute Yin), difficult to treat. Chen Wuyue said: Use large dose Xiong Gui Tang (Ligusticum and Angelica Decoction), or Dushen Tang (Single Ginseng Decoction) is excellent. If Lochia is slow, blood stagnates, steams Lung, causing urgent panting. Use Dueming Dan, Shensu Yin, Xuejie San. If injured by Wind-Cold, use Xuanfuhua Tang. If due to sorrow/anger stagnation, use Xiaotiaojing San, administered with Sangbaipi (Mulberry Bark) and Xingren (Apricot Seed) decoction. Lou Quanshan treated wife of Wu Hui from Pujiang. Swollen feet during pregnancy. Delivered early July. Two months postpartum, bathing caused panting. Could only sit, not lie down, for five months. Averse to wind, relieved by warmth. Guan pulses active, Cun/Chi deficient. Hundreds of medicines failed. Used Mudanpi, Taoren, Guizhi, Fuling, Ganjiang, Zhishi, Houpo, Sangbaipi, Zisu, Wuweizi, Gualou Ren decoction. Immediately felt relief. After 2-3 doses, could lie down. Sputum seemed lost. Treated as Stagnant Blood with Cold injury. If panting from salty/frozen drinks/food, use Jian HT Wan.

[Diagnosis] Panting: Lung governs Qi. Cold body/cold drinks injure Lung. Qi rebels upward, rushing and noisy, rapid breathing, opening mouth, raising shoulders, shaking body, rolling belly. This is Panting. Panting with rebellious Qi, rapid pulse with heat, inability to lie down: Difficult to treat. Rebellious Qi, facial edema, shoulder breathing, floating-large pulse: Critical. Rebellious Qi, panting varying in intensity, slippery pulse, warm limbs: Survival. Choppy pulse, cold limbs: Death. Right Cun deep-solid-tight: Lung infected by Cold. All six positions submerged: Release exterior, heat retreats, panting settles. Right Cun deep-solid: Lung Excess. Left Chi large: Kidney Deficiency.