Shortness of Breath

Shortness of Breath

If a person does not breathe, how can Qi remain stable and blood be expelled accordingly? Therefore, in blood-related conditions, no one escapes shortness of breath. There are two types: real shortness of breath and virtual shortness of breath. Real shortness of breath has two manifestations: stagnation and urgency. Stagnation occurs when Qi cannot reach the exterior and instead accumulates internally. In blood-related conditions, Yang often overwhelms Yin, making this phenomenon common. For those experiencing shortness of breath due to Shang Han, Ma Huang and Gui Zhi are used to disperse the stagnation. However, blood-related conditions prohibit sweating and avoid stimulating blood circulation, unlike the method used in Shang Han to relieve stagnation. In such cases, Xiao Chai Hu Tang supplemented with Xing Ren is recommended to open up the body’s channels, allowing the Ying and Wei to harmonize and Qi to flow outward, rather than accumulating internally and causing shortness of breath. If there is external pathogenic obstruction that needs to be relieved, use Xiang Su Yin supplemented with Xing Ren, Ku Qin, and Gan Cao; or use Qian Jin Mai Men Dong Tang, leveraging Ma Huang to relieve external obstruction while simultaneously using internal-clearing herbs to avoid excessive sweating and depletion of Yin. Urgency, on the other hand, refers to shortness of breath caused by excessive Qi flowing upward against the natural flow of Qi. In blood-related conditions, fire often dominates and presses down on blood, resulting in coarse Qi (1). In such cases, it is necessary to vigorously dissipate the fire and bring Qi back to a balanced state. Use Hou Pu, Zhi Shi, and Da Huang to clear the pathways, allowing Qi to descend smoothly and preventing it from rushing upward. If there is blood stasis inside the body, blocking the airways and causing shortness of breath, use the same three herbs supplemented with Dang Gui, Bai Shao, Tao Ren, and Dan Pi. If phlegm blocks the airways, use Qing Hua Wan. If urination is blocked, the lower openings (2) are clogged, causing the upper openings (3) to become congested as well; in such cases, use Wu Lin San supplemented with Fang Ji, Xing Ren, Sang Bai Pi, and Ting Li Zi.

Virtual shortness of breath also has two manifestations: lung deficiency and kidney deficiency. Lung deficiency causes shortness of breath because the lungs occupy the upper burner, controlling the five organs and opening the nasal passages to allow external Qi to enter and internal Qi to exit. When blood is deficient, fire becomes overly active and damages the lungs, causing the lung leaves to weaken and lose their ability to descend. As a result, Qi cannot descend, leading to nasal flaring and shortness of breath; in severe cases, the nose may even collapse, resembling a closed door (4), which is a serious symptom of lung weakness. In such cases, replenish the lungs with fluids and use Qing Zao Jiu Fei Tang to clear the stagnation; for cases involving both fire and phlegm, use Bao He Tang or Tai Ping Wan. I believe that when the lung leaves drop, it is necessary to combine methods of calming and consolidating, using San Cai Tang supplemented with Sheng Mai San, plus Bai He, Wu Bei Zi, Bai Ji, Hua Fen, Xing Ren, Chuan Bei Mu, and Zhong Lu Shi to treat the issue. Additionally, if shortness of breath is caused by nasal congestion, the fire in the lungs blocks the nasal passages, causing Qi to concentrate in the mouth and resulting in shortness of breath. In such cases, Tai Ping Wan supplemented with Musk is an excellent remedy for opening up the nasal passages, different from the nasal congestion treatment in Shang Han, so do not confuse the two.

Kidney deficiency causes shortness of breath because the root of Qi originates in the kidneys. In blood-related conditions, fire is too intense and water is too scarce, making it impossible to transform Qi, resulting in shortness of breath, coughing, and nasal congestion. In such cases, use Da Bu Yin Wan supplemented with Niu Xi and Wu Wei Zi to lower the Qi. If Yin is deficient and Yang has nowhere to return, use Di Huang Tang supplemented with Sheng Mai San, plus Ci Shi, Niu Xi, and Shen Xiang to nourish the Qi. If small water cannot be transformed and there is also lower back pain, it indicates that the Yang in the kidneys cannot transform Qi, so use Shen Qi Wan to treat the issue, and Shen Fu Tang supplemented with Wu Wei Zi and Fu Ling can also be used.

The above discussion outlines a method of treating lung and kidney separately, but if one wishes to treat them together, modifications can be made based on various prescriptions. Additionally, Su Zi Jiang Qi Tang and Si Mo Tang both treat lung and kidney simultaneously, but they do not take blood-related conditions into account, so users should be aware of this limitation when applying them.

It is also worth noting that if the central palace is empty, Qi will be scarce, and Ren Shen will be the primary remedy; if the central palace is full, Qi will be abundant, and Da Huang will be the primary remedy.

[Note] (1) Ben (bēn): Refers to vigorous Qi. In this context, it describes rapid and forceful breathing. (2) Lower openings: Refers to the genitalia, urethra (some say including the seminal ducts), and anus. (3) Upper openings: Refers to the eyes, ears, mouth, and nose. (4) Closed door: Refers to an impassable barrier. “Guan” means to close, while “lan” means to block.

[Commentary] Shortness of breath is divided into two types: real and virtual. Real shortness of breath is further subdivided into stagnation and urgency. Stagnation occurs when Qi cannot reach the exterior and instead accumulates internally; in blood-related conditions, this is often addressed with Ma Huang and Gui Zhi. However, blood-related conditions prohibit sweating, so Xiao Chai Hu Tang is recommended for harmonization, especially when there is external pathogenic influence, in which case Xiang Su Yin can be used as a substitute for Ma Huang and Gui Zhi. Urgency, on the other hand, refers to shortness of breath caused by excessive Qi flowing upward against the natural flow of Qi. In blood-related conditions, fire often dominates and presses down on blood, resulting in coarse Qi (1). In such cases, it is necessary to vigorously dissipate the fire and bring Qi back to a balanced state. Use Hou Pu, Zhi Shi, and Da Huang to clear the pathways, allowing Qi to descend smoothly and preventing it from rushing upward. If there is blood stasis inside the body, blocking the airways and causing shortness of breath, use the same three herbs supplemented with Dang Gui, Bai Shao, Tao Ren, and Dan Pi. If phlegm blocks the airways, use Qing Hua Wan. If urination is blocked, the lower openings (2) are clogged, causing the upper openings (3) to become congested as well; in such cases, use Wu Lin San supplemented with Fang Ji, Xing Ren, Sang Bai Pi, and Ting Li Zi.

Virtual shortness of breath is divided into two categories: lung deficiency and kidney deficiency. Lung deficiency often results from blood deficiency and excessive fire damaging Yin, causing the lung leaves to burn and lose their ability to descend, leading to Qi being unable to descend and nasal flaring. In severe cases, the nose may even collapse, resembling a closed door (4), which is a serious symptom of lung weakness. In such cases, replenish the lungs with fluids and use Qing Zao Jiu Fei Tang to clear the stagnation; for cases involving both fire and phlegm, use Bao He Tang or Tai Ping Wan. The author believes that in such cases, it is urgent to calm and consolidate the lung leaves before they can descend, so use Sheng Mai San and San Cai Tang supplemented with Bai He, Wu Bei Zi, Bai Ji, Hua Fen, Xing Ren, Chuan Bei Mu, and Zhong Lu Shi to treat the issue. Kidney deficiency causes shortness of breath because the root of Qi originates in the kidneys. In blood-related conditions, fire is too intense and water is too scarce, making it impossible to transform Qi, resulting in shortness of breath, coughing, and nasal congestion. In such cases, use Da Bu Yin Wan supplemented with Niu Xi and Wu Wei Zi to lower the Qi. If Yin is deficient and Yang has nowhere to return, use Di Huang Tang supplemented with Sheng Mai San, plus Ci Shi, Niu Xi, and Shen Xiang to nourish the Qi. If small water cannot be transformed and there is also lower back pain, it indicates that the Yang in the kidneys cannot transform Qi, so use Shen Qi Wan to treat the issue, and Shen Fu Tang supplemented with Wu Wei Zi and Fu Ling can also be used.

The above division of labor between lung and kidney treatment seems more appropriate than the general statement that “real shortness of breath is treated by the lungs, while virtual shortness of breath is treated by the kidneys.” The examples of Xiang Su Yin, Xiao Chai Hu Tang, Bao He Tang, and Da Bu Yin Wan are all highly suitable for blood-related conditions. At the end of the article, it is pointed out that “if the central palace is empty, Qi will be scarce, and Ren Shen will be the primary remedy; if the central palace is full, Qi will be abundant, and Da Huang will be the primary remedy.” This has important implications for the treatment of shortness of breath in blood-related conditions. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Chronic illness accompanied by hiccups is often considered a sign of severe gastric deficiency; however, one must carefully examine the pulse and symptoms to make an accurate diagnosis, rather than simply attributing the hiccups to a fatal condition. In cases of blood loss, qi stagnation and disharmony are common, frequently leading to hiccups. For newly developed conditions characterized by excess heat, the underlying pathogenic factors may be latent heat that suddenly erupts, with fire ascending upward, causing qi to reverse and resulting in hiccups. In such cases, clearing heat and regulating qi are essential; the Sanwu Decoction or Chaihu Meilian Powder combined with Zhike and Binlang are appropriate treatments. If phlegm obstructs the diaphragm, the Gun Tan Pill or Zhi Mi Fuling Pill should be used. Additionally, when blood stasis leads to hiccups, patients typically present with stabbing pain and distension; in these situations, the Da Chaihu Decoction supplemented with Taoren, Danpi, and Sumu, along with the Xuefu Zhuyu Decoction, can be effective. For chronic cases where hiccups occur due to deficiency and weakness, it indicates emptiness in the stomach, with external pathogenic factors disturbing the diaphragm—these external factors often include phlegm, fire, and qi. To address phlegm and qi, the Xuanfu Daizhe Shi Decoction or Erchen Decoction with Dingxiang and Zhike are recommended; for fire-related issues, the Yuniujian with Xuanfuhua, Zhezhi, and Shidi, or Meilian Powder with Shidi, Zhike, and Wuweizi, would be suitable. Common folk remedies for hiccups often rely solely on Dingxiang and Shidi, but since Dingxiang has warming properties that dispel phlegm while Shidi is cooling and clears fire, this dual approach often fails to produce satisfactory results. Therefore, it is crucial to differentiate between cold and hot patterns when prescribing treatment.

Hiccups refer to the expulsion of gas. Among patients with blood disorders, hiccups are the most common symptom, and their treatment is similar to that of hiccups. However, if hiccups are caused by food stagnation and obstruction in the stomach, the Yueju Pill combined with Xuanfuhua, Zhike, and Laifuzi is indicated.

All of the above pertain to treatments for the stomach. Yet, when heart qi is not smooth, hiccups and belching may also occur. It is common for individuals experiencing depression and poor heart qi to feel as though something is stuck in their chest and throat, occasionally triggering hiccups and belching, making it difficult to breathe freely. The appropriate treatment involves clearing the heart and regulating qi, which can be achieved using Erchen Decoction with Huanglian, Lianqiao, Niubangzi, Jiegeng, Gualou Shuang, Danggui, and Chuanbeimu. Further details can be found in the section on phlegm and fluid retention.

[Commentary] First, the traditional notion that "chronic illness accompanied by hiccups signifies severe gastric deficiency" is criticized, followed by a detailed discussion of how to treat this condition based on different patterns. Hiccups can be categorized into two types: acute conditions characterized by excess heat and chronic conditions marked by deficiency. The former is often caused by latent heat that suddenly flares up, requiring heat-clearing and qi-regulating therapies, such as Houpu Sanwu Tang or Chaihu Lianmei Tang; for those with phlegm accumulation in the diaphragm, Mengshi Gun Tan Wan or Fuling Zhi Mi Wan are recommended; and for cases involving blood stasis and sharp pain, Da Chaihu Tang with Taoren, Sumu, and Danpi, along with Xuefu Zhuyu Tang, are effective. In contrast, chronic cases are usually due to phlegm and fire, so treatments targeting phlegm include Xuanfu Daizhe Shi Tang or Erchen Tang with Dingxiang and Zhike; for fire-related issues, Yuniujian with Xuanfuhua, Zhezhi, and Shidi, or Meilian Powder with Shidi, Zhike, and Wuweizi are suitable. Hiccups involve the expulsion of gas, and their treatment is broadly similar to that of hiccups, except that when they are caused by food stagnation, Yueju Pill can be used.