bubble_chart Concept

Panting, abbreviated as "喘" (chuan), is a clinical symptom characterized by rapid breathing. In severe cases, it may even involve open-mouth breathing, shoulder lifting, flaring of the nostrils, and an inability to lie flat. It is commonly seen in the course of various acute and chronic sexually transmitted diseases.

Panting has been referred to by many names in historical medical texts. For example, in Suwen, it is called "喘息" (chuan xi) or "喘逆" (chuan ni); in Jingui Yaolue, it is referred to as "abnormal rising of qi"; in Zhubing Yuanhou Lun, it is called "逆氣" (ni qi); and in Jingyue Quanshu, it is termed "panting".

In medical literature before the Jin and Yuan dynasties, there was no strict distinction between panting and wheezing, and the two were often conflated. However, they differ in terms of disease cause, mechanism of disease, and clinical manifestations, and thus should be distinguished. Wheezing has a deep-rooted cause and manifests as episodic phlegm-induced panting, characterized by rapid breathing and wheezing sounds in the throat; whereas panting often occurs in conjunction with various acute and chronic sexually transmitted diseases, involving rapid breathing but without wheezing sounds in the throat. Yixue Zhengzhuan ．asthma states: "Generally, wheezing is named for the sound, while panting is named for the breath. Panting with a sound like a water chicken in the throat is called wheezing; rapid and continuous breathing that cannot be controlled is called panting." This shows that wheezing must involve panting, but panting does not necessarily involve wheezing.

bubble_chart Pattern Analysis

1. Wind-cold Obstructing the Lung︰The clinical manifestations include rapid panting and chest tightness, accompanied by cough, expectoration of thin and clear white phlegm. In the early stages, it is often accompanied by aversion to cold with fever, absence of sweating, headache and body pain, absence of thirst, thin white tongue coating, and floating-tight pulse manifestation. This is due to the invasion of wind-cold pathogens into the skin and hair, which then internally affects the lungs, leading to impaired lung diffusion and descent, and the inability to regulate and distribute body fluids. Hence, symptoms such as panting, cough, chest tightness, and expectoration of thin and clear phlegm appear. The external binding of wind-cold and the stagnation of lung-defense result in the pattern of common cold due to wind-cold. The phlegm is thin and clear, accompanied by aversion to cold with fever, absence of sweating, headache and body pain, and floating-tight pulse, indicating an exterior cold pattern. The treatment should focus on releasing the exterior with pungent-warm herbs, ventilating the lung, and relieving panting. Canopy Powder can be modified for use.
2. Wind-heat Invading the Lung︰It manifests as rapid and restless panting, accompanied by coughing and expectoration of thick yellow phlegm; or fever, sweating, aversion to wind, thirst, and chest pain. The tongue coating is thin white or thin yellow, and the pulse is floating and rapid. This is caused by the invasion of wind-heat pathogens into the skin and hair, which then affects the lungs, leading to excessive heat and qi stagnation, impaired lung function in dispersing and descending, and fluid damage due to intense heat, transforming into phlegm. The interaction of phlegm and heat results in symptoms such as restless panting and coughing, expectoration of thick yellow phlegm, thirst, and chest pain. The stagnation of wind-heat steams the muscle surface, causing the striae and interstices to loosen, hence presenting a pattern of common cold due to wind-heat. Therefore, the key points for differentiating these two syndromes lie in the nature of the phlegm and the external manifestations. The phlegm is thick and yellow, accompanied by fever, slight aversion to wind and cold, sweating, and a floating and rapid pulse, indicating an exterior heat pattern. The treatment should focus on clearing heat to release the exterior, ventilating the lungs, and relieving panting. The recommended formula is modified Ma Xing Shi Gan Tang.
3. Exterior Cold and Interior Heat︰It often manifests as rapid breathing and chest tightness, fever and chills, headache and body pain, along with restlessness and thirst, thick and sticky sputum, a tongue coating that is both yellow and white, and a floating and rapid pulse. This is caused by unresolved exterior cold and lung heat stagnation, presenting both symptoms and signs of wind-cold obstructing the lungs, as well as manifestations of interior heat such as restlessness, thirst, and thick, sticky sputum. Treatment should focus on releasing the exterior with pungent-warm herbs, ventilating the lungs to relieve panting, and clearing interior heat. The recommended formula is Canopy Powder supplemented with Gypsum and Skullcap Root.
4. Turbid Phlegm Obstructing Lung︰The symptoms include panting with coarse breathing, gurgling phlegm sounds, accompanied by cough with thick phlegm, difficulty expectorating, stuffiness in the chest, or nausea and anorexia, a white and greasy tongue coating, and a slippery pulse. This is caused by the lung's failure to distribute fluids, leading to the accumulation of phlegm, or dysfunction of the spleen in transportation, resulting in dampness accumulation and phlegm-turbidity obstructing the lungs. The clinical characteristics are copious and sticky phlegm. The treatment should focus on descending qi and resolving phlegm to relieve panting. The recommended prescription is Three-Seed Filial Devotion Decoction combined with Two Old Ingredients Decoction with modifications.
5. Lung Injury Due to Qi Stagnation︰Symptoms include panting, chest tightness, a sensation of throat obstruction, distending pain in the chest and hypochondrium, accompanied by mental depression, irritability, insomnia, palpitations, and other manifestations. The tongue coating is thin and white, and the pulse is wiry. This is caused by the liver's failure to regulate free flow, leading to upward rebellion of liver qi invading the lungs, with excessive ascent and insufficient descent. Its characteristics include manifestations of liver qi depression such as throat obstruction and distending pain in the chest and hypochondrium, as well as symptoms like mental depression and irritability. The treatment should focus on soothing the liver and relieving depression, descending qi, and alleviating dyspnea. Five Milled Ingredients Drink is the primary prescription.
6. Deficiency of Both Lung Qi and Yin︰Shortness of breath, aggravated by exertion, weak and low voice, spontaneous sweating, aversion to wind, prone to common cold, dry mouth, flushed face, pale red tongue texture, weak pulse. This is caused by the dual impairment of qi and yin, leading to the failure of qi to function properly and the weakening of the defensive exterior, resulting in symptoms such as weak and low voice, spontaneous sweating, aversion to wind, and susceptibility to common cold. Insufficient lung yin manifests as dry mouth and flushed face. Clinically, panting due to lung deficiency is often a deficiency of both qi and yin, but it can also be primarily lung qi deficiency or primarily lung yin deficiency. As a manifestation of simple lung deficiency, the treatment should focus on tonifying the lung and relieving panting, and can be addressed with modified Pulse-Reinforcing Powder. For panting due to failure of the kidney to receive qi, the treatment should aim at improving qi reception and relieving dyspnea, and options such as Ginseng and Walnut Decoction or Black Tin Pill can be selected.
7. Failure of Kidney to Receive Qi︰The manifestations include prolonged panting, shortness of breath, more exhalation and less inhalation, which worsens with activity, accompanied by soreness and weakness in the waist and knees, a bluish complexion and cold limbs, a pale tongue texture, and a deep, thin pulse. This is caused by insufficient kidney yang, failure to control and receive qi, and qi failing to return to its origin, resulting in more exhalation and less inhalation along with symptoms of insufficient kidney yang such as soreness and weakness in the waist and knees, a bluish complexion, and cold limbs. The differentiation between these two syndromes lies in the presence of manifestations of insufficient kidney yang.
8. Kidney Deficiency with Phlegm Obstruction︰Manifested as cough with shortness of breath, more exhalation than inhalation, profuse phlegm, chest tightness, accompanied by soreness in the waist, cold limbs, frequent urination, white and greasy tongue coating, deep and thin or soft and slippery weak pulse. Additionally, there are symptoms of excessive phlegm retention, with the {|###|}mechanism of disease{|###|} being phlegm retention above and {|###|}kidney qi{|###|} deficiency below. The treatment should focus on {|###|}descending qi and resolving phlegm{|###|}, warming the kidneys and promoting absorption, using modified Perilla Fruit Qi-Descending Decoction.
9. Waterlogging and Flooding︰The symptoms include wheezing, cough, and shortness of breath, making it difficult to lie flat, accompanied by palpitation and fear of cold, soreness in the lower back, cold limbs, scanty urine, edema, a swollen and pale tongue with a white and slippery coating, and a deep and thin pulse. Additional manifestations include palpitation, scanty urine, and edema. The disease mechanism is attributed to insufficient kidney yang, leading to water failing to transform into qi and ascending to harass the heart and lungs. The treatment should focus on warming yang and excreting water, with the prescription selected from True Warrior Decoction with modifications.

The clinical differentiation of panting primarily lies in distinguishing between deficiency and excess. Jingyue Quanshu states: "Panting is a critical condition; failure to treat it correctly often leads to mistakes. To differentiate, there are only two syndromes: one is excess-type dyspnea, and the other is deficiency-type dyspnea." This clearly emphasizes the importance of distinguishing between deficiency and excess in panting. The common characteristics of excess-type dyspnea include a sudden onset, deep and prolonged breathing with ease in exhaling, coarse and loud breathing sounds, and a rapid, forceful pulse. The common characteristics of deficiency-type dyspnea include a gradual onset, short and difficult breathing with ease in inhaling, worsened panting upon exertion, timid and low breathing sounds, and a weak or floating and feeble pulse. Linzheng Zhinan Yi'an mentions: "In the lungs, it is excess; in the kidneys, it is deficiency." Therefore, the treatment for excess-type dyspnea focuses on expelling pathogenic factors and regulating qi, with emphasis on the lungs. The treatment for deficiency-type dyspnea focuses on nourishing and consolidating, with emphasis on the kidneys. As for complex cases involving both deficiency and excess, it is essential to differentiate the primary and secondary aspects, assess the urgency, and apply pattern differentiation and treatment accordingly.

bubble_chart Documentation

1. Shengji Zonglu．cold-damage disease section: "It is said that cold-damage disease panting has various symptoms. There are cases where pathogenic qi is on the surface, the surface is not resolved without sweating and panting occurs; there are cases where pathogenic qi is inside, sweating occurs without aversion to cold, abdominal distension and fullness and panting occurs. There are cases with tidal fever. There are cases where there is water below the heart and panting occurs. The ancients treated it, each seeking its root. Therefore, those on the surface should be treated with sweating, those inside should be treated with purging, and as for those with water below the heart and panting, they should be treated by promoting urination."
2. Zhengyin Maizhi．Panting syndrome discussion: "All meridians can cause panting, but it mostly occurs in the lung and stomach. Panting with cough and phlegm is due to the lung; panting with vomiting is due to the stomach."
3. Zhengyin Maizhi．External contraction panting: "Summerheat dampness panting and counterflow syndrome, restless thirst, rough breathing, talkativeness, heavy body, sweating but still feeling hot, this is the panting syndrome of summerheat dampness."
4. Zhengyin Maizhi．Internal damage panting: "Food accumulation panting and counterflow syndrome, chest fullness, epigastralgia abdominal pain, aversion to food and feeling of fullness, constipation or diarrhea, abnormal rising of qi panting and counterflow, panting vomiting and belching, this is the panting and counterflow syndrome of food accumulation."
5. Jingyue Quanshu．Panting: "The syndrome of anuria and vomiting causing panting,... the disease must have weak interior pulsation and continuous panting. This type of panting often has no cough, but feels like the chest and diaphragm are pounding, seemingly distended but not distended, seemingly short but not short, slightly exerting oneself causes severe panting, talking too much also causes severe panting, even to the point of the whole body trembling, anxious and restless, this must be due to emotional desires damaging yin, leading to the original qi being rootless, a sign of solitary yang separation."