Library

Shortness of breath (Duan Qi) refers to rapid, shallow breathing that cannot be sustained continuously. It resembles panting (Chuan) but is not true panting; it feels as if there is Qi rushing upward, yet in reality, there is no actual upward rush of Qi. It presents similarly to panting without shoulder movement, and resembles groaning without pain. The *Jin Gui Yao Lue* states: "In a healthy person without exterior cold or heat symptoms, shortness of breath with insufficient respiration indicates an Excess pattern." (Zhu Danxi treated Mr. Xu from Baiyun for spleen and hip pain accompanied by shortness of breath. He employed drastic emetic and purgative therapies for over twenty days, eventually expelling a large bucket of viscous phlegm resembling rotten fish intestines or fried dough sticks, after which the patient recovered.)

Zhang Zhongjing's discussions on shortness of breath generally attribute it to Fluid Retention (Yin). The *Jin Gui Yao Lue* states: "For shortness of breath caused by mild fluid retention, one should promote urination to eliminate it; Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction) is the primary formula, and Shen Qi Wan (Kidney Qi Pill) also treats this condition." It further states: "Coughing and wheezing while leaning on an object for support, shortness of breath, inability to lie flat, and bodily swelling are termed Zhi Yin (Branching Fluid Retention)." It also says: "Zhi Yin also causes wheezing and inability to lie flat, accompanied by shortness of breath, while the pulse may remain normal." Additionally: "Fluid retention above the diaphragm causes shortness of breath and thirst, pain in all joints of the four limbs, and a deep pulse, indicating the presence of retained fluid." Furthermore: "Fluid retention in the Lung does not present with a wiry pulse; rather, the patient suffers from wheezing and shortness of breath. Treatment methods include: Xiao Qing Long Tang (Minor Blue Dragon Decoction) for critical conditions; Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) for distension and fullness; Ling Gui Zhu Gan Tang and Ze Xie Tang (Alisma Decoction) for dizziness and vertigo; Ting Li Da Zao Tang (Semen Lepidii and Jujube Decoction) for dyspnea; and Fang Ji Tang (Stephania Decoction) and similar formulas for cases unresponsive to emesis and purgation."

[Thoracic Bi Syndrome] Chest tightness and shortness of breath are primarily treated with Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Seed, and Licorice Decoction); Ju Zhi Jiang Tang (Citrus Peel, Immature Bitter Orange, and Ginger Decoction) also treats this condition. Thoracic Bi syndrome, characterized by wheezing, coughing up saliva, chest and back pain, and shortness of breath, is primarily treated with Gua Lou Xie Bai Ban Xia Tang (Trichosanthes Fruit, Macrostemon Rhizome, and Pinellia Tuber Decoction).

[Moving Accumulation] Sun Zhao's Zheng Yuan San treats shortness of breath due to discontinuous Qi flow, and also addresses slippery discharge and frequent urination. The prescription consists of 1 liang of Eze Rhizome (Curcuma zedoaria), 2.5 qian of processed Sichuan Chinaberry Fruit (Meliae Toosendan Fructus) with seeds removed, ground into powder, mixed with 1 qian of Borax (Borax), sifted and finely ground together. Take 2 qian per dose, administered with salt water or warm wine on an empty stomach.

[Supplementing Deficiency] Li Dongyuan stated: "Chest fullness, scanty Qi, and shortness of breath occur because the Lung governs all Qi; when Qi of the five Zang organs is deficient, Yang pathways fail to circulate." For shortness of breath with free urination, Si Jun Zi Tang (Four Gentlemen Decoction) with Poria removed, plus Astragalus Root (Huang Qi), should be used to tonify. If abdominal Qi stagnation persists, add half the amount of Licorice Root (Gan Cao). For急促 or insufficient Lung Qi, add Ginseng Root (Ren Shen) and White Peony Root (Bai Shao Yao); using White Peony Root at the Middle Jiao raises Spleen Yang, preventing pathogenic factors from the Liver and Gallbladder from invading. If shortness of breath results from thin clothing, add layers and reside in windless areas; if shortness of breath persists despite added clothing, fumigate the mouth and nose with boiling water to relieve symptoms. If thick clothing in a poorly ventilated area causes shortness of breath, reduce clothing, massage sweat pores to close them, and reside in breezy areas. Shortness of breath caused by living in high buildings or being suppressed by cold and dampness should also be treated with fumigation as described above. Shortness of breath resulting from residing in tightly enclosed small rooms or from extreme heat followed by exposure to cold should be addressed by seeking windy and sunny environments. Generally, patients with shortness of breath should consume nourishing soups and drinks to harmonize Stomach Qi. Dai Fuan stated: "Shortness and fatigue indicate that Lower Qi fails to connect with Upper Qi, resulting in weak respiration and feeble speech; deficiency should be supplemented with Si Zhu Yin (Four Pillar Drink), with reduced Mu Xiang, plus 1 qian each of Astragalus Root (Huang Qi) and Chinese Yam (Shan Yao). For those who cannot tolerate hot herbs or have excessive phlegm, replace prepared Aconite Root (Fu Zi) with raw Aconite Root; application requires flexibility, following other examples accordingly. If the medication is too mild for the severity of the disease, Si Zhu Yin may be ineffective; remove Mu Xiang from the base formula and add 15 roasted Sichuan Pepper grains (Chuan Jiao). If still ineffective, use Jiao Fu Tang (Pepper and Aconite Decoction). For Upper Jiao dryness where hot herbs are intolerable, add 1 qian of Ginseng Root (Ren Shen) to Jiao Fu Tang. While Ginger and Aconite are typically used for common conditions, they are contraindicated in cases of Upper Jiao excess heat and dryness; this formula is most suitable. For individuals with shortness of breath and fatigue, besides medication, one can select a robust male to inhale his own Qi and exhale it into the patient's mouth several times; this assists medicinal efficacy. This method is effective not only for deficiency fatigue but also for hiccups caused by sudden rebellious Qi."

[Acupuncture] The *Ling Shu* states: "For shortness of breath with discontinuous respiration and Qi depletion upon movement, tonify the Shaoyin channel and bleed the collateral vessels."

[Pulse Diagnosis] A deep pulse at the Cun Kou position indicates shortness of breath in the chest. A superficial pulse that is both faint and tight indicates Cold (tight) and Deficiency (faint); the combination of faint and tight pulses leads to shortness of breath.