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The disease of panting (Chuan) has four categories: Qi Ji (rapid breathing), Qi Ni (rebellious Qi), Qi Duan (shortness of breath), and Qi Tuo (collapse of Qi). The causes include Cold, Heat, Deficiency, and Excess. Detailed analysis follows:

Qi Ji belongs to Cold syndrome. Respiratory Qi passes through the Fei Wan (lung cavity/channels), adjacent to Wei Wan (stomach cavity/channels); these two cavities are parallel pathways for Qi. Wind-Cold may enter from the hair pores or along the spine into the Lung collaterals, invading the Fei Wan; or excessive consumption of cold food/drink may injure the Wei Wan. Since the two cavities are adjacent and their Qi connects, Cold shifts between them, causing both to contract and fail to expand. Failure to expand narrows the Qi pathway. Mild Cold causes only choking cough; severe Cold tightens all orifices in the Lung, making exhalation difficult, forcing Qi in Dan Zhong (Chest Sea) to fail to ascend. Wind-Cold and Fluid retention struggle against each other, preventing peaceful sleep at night, gradually leading to shoulder shrugging and仰息 (breathing with head tilted back). The Classic states: "Cold form and cold drink injure the Lung, causing Qi to rebel and ascend." It is not that Qi truly rebels upward, but rather it is trapped and fails to ascend. Recent physicians, seeing choking cough, immediately administer clearing and descending herbs, causing the two cavities to tighten further due to the medicine, Yang Qi to sink lower, and upper constriction to worsen. Patients suffer unbearable irritability, as if their throat were grabbed and chest bound. Thus, recent patients with Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) indications often ultimately develop Lao Sun (consumptive disease). Xu Lingtai stated this is because unresolved Wind-Cold transforms into consumptive disease.

Qi Ni belongs to Phlegm syndrome. There is Wet-Cold Phlegm and Wet-Heat Phlegm. The pathology is interior, not caused by external invasion, and is common in obese individuals. While Qi enters and exits via the nose and mouth (large orifices), the 84,000 pores throughout the body also breathe. When Phlegm blocks the meridians, respiratory Qi cannot spread laterally but gathers in Dan Zhong, rushing straight up to the throat and out of the mouth/nose, creating a sense of impact. If Phlegm-saliva becomes abundant and obstructs Dan Zhong horizontally, the airway narrows further. This is common in those with Wet-Cold or Wet-Heat forming Phlegm/Fluid. If such a person contracts Wind-Cold, it approaches Xiao Zheng (Wheezing Syndrome).

Qi Duan belongs to Heat syndrome. There is also Water Qi attacking the Lung, but this is not external Wind-Cold constraint nor有形 (formate) Phlegm. One suddenly feels respiration stopping at the diaphragm, unable to descend. It is not completely unable to descend, but inhalation is slow and exhalation fast, failing to stay inside long enough. This occurs because Liver and Kidney Blood Heat prevents Yin Qi from gathering. Alternatively, contracting Wind-Heat consumes Lung fluids with hyperactive Qi, leaving them unmoistened. Dan Zhong becomes dry, orifices generate smoke-like sensations; the trachea becomes dry and tense due to fluid depletion, preventing smooth opening/closing and uniform distribution of Qi. Summerheat injury always presents this syndrome. Qi circulation requires fluid moistening to open/close smoothly; dryness leads to Yin deficiency and Yang hyperactivity, feeling open but unable to close. Water Qi attacking the Lung may result from sudden excessive drinking after thirst, or sudden closure of sweat pores after sweating, where dampness forces heat Qi upward, like fire doused by water—not truly solidified fluid retention. More commonly, without specific cause, Spleen/Stomach failure to transport leads to chronic constipation; turbid Qi from intestines steams upward to the Lung, impairing ascending/descending functions and causing shortness of breath. Zhang Zhongjing said: "A healthy person without cold/heat symptoms having shortness of breath insufficient for respiration indicates Excess." Commentaries claim Excess refers to Fluid pathogen, which is incorrect; it is due to fecal impaction. (In Warm Diseases, dry stool blocking the diaphragm causing panting, black tongue, and withered teeth is incurable.)

Qi Tuo is true panting. True Qi detaches from its root; respiration reaches the chest and returns, unable to descend to the Lower Dantian. The patient feels Qi has no foundation, panics, shrugs shoulders, looks up/down, is irritable, lacks strength to inhale deeply, exhaling more than inhaling. This may result from chronic cough, profuse sweating, vomiting, purging, blood loss, or essence loss, leading to Yin collapse where Yang has nothing to cling to. Acute cases are critical within moments; chronic cases last only days. Zhang Zhongjing said: "Shaoyin disease, diarrhea stops, but respiration is high/shallow," describes this. Also, long-term Cold-Damp in Lower Jiao Liver/Kidney may gradually force Ming Men Fire upward, preventing Lung Qi from descending.

Other cases involve subjective sensation of Qi sinking, insufficient/unsmooth respiration, without visible panting起伏 (ups and downs) or shoulder lifting/chest shaking. Causes include congenital insufficiency, Spleen/Stomach dampness, recovery from major illness, or Qi damage from over-purging. These are countless, but the general etiology is as above, differing only in severity.

Qi Ji means Qi cannot exit; mild Xiao (wheezing) is not Chuan. Qi Ni means Qi cannot disperse; it resembles Ouyue (dry heaving) but is not, nor is it Chuan. Qi Duan means Qi cannot gather, respiration is discontinuous, approaching Chuan, but since it appears suddenly without other symptoms, it does not damage the root. These three diseases reside in the Lung, involving the Stomach. Qi Tuo involves dispersion without gathering, ascending without descending, residing solely in the Kidney. This is distinctly different from previous syndromes, easily distinguished. However, when Qi Ji or severe Qi Ni progresses to Tuo, the manifestation is unimaginable; yet at this stage, True Qi is isolated, so calling it Tuo is appropriate. I once treated a woman who had panting since winter, unrelieved by spring. Upon examination, her presentation was not Chuan, but Xiao. Cold constrained the Lung, Qi blocked from exiting; prolonged pathogen depth caused True Qi to sink internally, loose stools with downward Qi, cold phlegm saliva filling the Lung, True Qi unable to reach. Pulse was surging, slippery, and rapid below the Guan position, but fine and thread-like above. Skin was cool externally but hot internally, burning on heavy pressure. The patient felt something missing in her head/chest, indicating no vital Qi in the Lung. Symptoms worsened during day, quiet at night; Yang Qi was solitary and precarious. The suffering of wheezing was unbearable. I declined treatment due to inability, and she died one month later. Thus, obstruction by pathogen, unlike spontaneous collapse of Zheng Qi, though critical, allows some time.

Furthermore, Chuan is differentiated by the Three Jiaos. Classics state: Pathogen in Upper Jiao is Wind-Cold injuring Lung, preventing Qi ascent; Turbid Qi in Middle Jiao is Damp-Heat/Phlegm/Fluid gathering in Stomach, stagnating Qi ascent/descent; Clear Qi in Lower Jiao is Cold-Damp earth Qi entering Liver/Kidney from legs/knees, attacking Ming Men directly. Ming Fire cannot rest in its palace, Lung Qi cannot return to its nest; there is exhalation without inhalation. This is Qi failing to descend, constituting true Chuan. Diseases of Upper/Middle Jiao are not Chuan, but Xiao. Xiao has two types, both Wind-Cold combining with Phlegm/Fluid, differing in weight. Those affected regardless of season, triggered by cold, with sudden air closure threatening death, inability to swallow, insomnia for nights, have Upper Jiao Wind-Cold heavier than Phlegm/Fluid; they recover in days. Those recovering in warm spring, triggering in cool autumn, with shortness of breath equal day/night, reduced appetite, have Middle Jiao Phlegm/Fluid triggered by cold weather inhibiting Lung Qi expansion. Without new Wind-Cold, severity is less. Treatment: Upper Jiao uses Xiao Qing Long Tang; Middle Jiao uses Ping Wei San, adjusted by severity. This distinguishes Taiyang and Yangming patterns. Taiyang pattern: Wind-Cold invades Lung collaterals via Fei Shu acupoint, injuring Fei Wan, starting in Qi level, impairing Taiyang transformation, leading to water pathogen flooding. Yangming pattern: Pre-existing damp-phlegm in Stomach, Lung occupied by turbid Qi for long; cold air inhalation in cold weather causes Lung turbid Qi to knot. One enters via acupoints/collaterals, one via respiration; thus treatments differ. For True Qi detachment, Qi rising not descending, returning at chest, sweating upon slight movement, Qi blockage upon lying down, able only to sit leaning forward critically: Ming Fire extinguished, Water pathogen rampant, gloomy Yin wind, dim sunlight—what a scene! Only Hei Xi Dan (Black Tin Pill) offers a tentative treatment, efficacy uncertain. Classics say: "Panting connected continuously, slightly curved within." This refers to pulse. Depictions of panting are accurate, describing Qi rising continuously with slight curvature. Thus, Chuan as Qi ascending not descending cannot be equated with Qi blocked from exiting.