Kidneys and breathing depth in Chinese medicine

In Chinese medicine, although breathing is dominated by the lungs, other internal organs are also involved. Nan Jing, a theoretical book of Chinese medicine, says, ” Breathe out by the heart and lungs, and breathe in by the kidneys and the liver.” The sentence links exhaling to the heart and lungs, and inhaling to the kidneys and liver. Breathing is primarily concerned with lungs and kidneys. Therefore, Lei Zheng Zhi Cai, a nineteenth-century book on Chinese medicine, states, “The lungs are the dominator of Qi, and the kidneys are the root of Qi.”

Air is a kind of Qi. The kidneys have the function of holding Qi, which means that kidney Qi enables the lungs to inhale enough clear Qi from nature to maintain the depth of inhalation and maintain normal breathing. The lungs govern breathing, and breathing out relies on the raising and dispersing functions of lung Qi, while breathing in relies on the purifying and descending functions of lung Qi. However, for maintaining the depth of inhaling, in addition to the purifying and descending functions of lung Qi, it also relies on the holding function of kidney Qi.

When the kidney Qi is sufficient, kidneys can hold Qi effectively, so the breathing is even and harmonious with enough depth. If the kidney Qi is weakened, kidneys is unable to hold Qi, the person may have shortness of breath, or exhale more and inhale less, and pant while doing a physical activity.

Syndromes caused by kidneys not holding Qi

Coughing for a long time harms the kidneys

In the theory of the five elements, the lungs have the attribute of metal and the kidneys have the attribute of water, and metal generates water. Coughing for a long time leads to the deficiency of the lungs, metal does not generate water, lung disease impacts the kidneys, so coughing has symptoms of kidney deficiency.

Coughing caused by deficiency of lung Yin is characterised by short coughs without sputum or little white sticky sputum, dry mouth and throat, afternoon’s sudden feeling of heat, flush cheeks, night sweating, emaciation and fatigue. The treatment is to nourish Yin and clear heat, moisten the lungs and relieve cough, and the representative recipe is Sha Shen Mai Dong Tang. Coughing for a long time injures the kidney Yin, so Wu Wei Zi can be added to the recipe. Wu Wei Zi can not only hold lung Qi, but also nourish kidney Yin, so it is an important herb for the treatment of coughing for a long time and short breathing caused by deficiency. If the centre areas of palms and soles feel hot, and the lower back and knees are painful and lack strength, Huang Bo, Nyu Zhen Zi, and Han Lian Cao can be added to the recipe.

Coughing caused by deficiency of lung Qi lasting for a long time impacts the spleen and kidneys, leading to the deficiency of the spleen and kidneys. This kind of coughing has symptoms of coldness, characterised by white, thin sputum, fatigue, lack of appetite, shortness of breath, unwillingness to speak, or even panting. There is a saying that if the lungs are not injured, there is no coughing; if the spleen is not injured, there is no coughing for a long time; if the kidneys are not injured, there is no panting; and if the disease is prolonged, coughing and panting occur together. The treatment is invigorating the spleen and the kidneys, warming the lungs and dissolving phlegm, and the recipe can be Bu Zhong Yi Qi Tang plus Ling Gan Wu Wei Jiang Xin Tang, with herbs added or subtracted as appropriate.

Wheezing in remission stage – the syndrome with deficiency of the kidneys

Both wheezing and panting are characterised by shortness of breath. The syndrome of wheezing always has the symptoms of panting, but the syndrome panting may not have the symptoms of wheezing. Wheezing is related to the sound, which is characterised by the noise in the throat during an attack, while panting is related to the breath, which is characterised by shortness and difficulty in breathing.

The remission stage of wheezing with deficiency of the kidneys is characterised by shortness of breath, which becomes worse when doing a physical activity, long exhaling and short inhaling; coughing with sticky and frothy sputum, dizziness and tinnitus, aching and weakness of the lower back and legs, palpitations, and getting tired easily; or hot feeling in the centres of palms, soles and the heart region, flushed cheeks, and dry mouth; or the fear of coldness, coldness of the limbs, and a pale face; a pale and fat tongue with white covering, or a red tongue with few covering, and a sunken and thin pulse or a thin and rapid pulse.

The treatment is to invigorate the kidneys and hold Qi, and the representative recipe is Jin Gui Shen Qi Wan or Qi Wei Du Qi Wan. The former recipe focuses on warming the kidneys for supporting Yang, and it is especially suitable for the syndrome with deficiency of kidney Yang, while the latter recipe focuses on invigorating the kidneys for holding Qi.

Syndrome of panting caused by deficiency

Panting is characterised by difficult breathing, even with the opening of the mouth and the lifting of the shoulders, the flaring of nostrils and the inability to lie down.

Yi Zong Jin Jian, an 18th-century series of books on Chinese medicine, says, “Panting is a disease of the lungs. The lungs control the Qi and govern breathing, therefore, quick and shallow breathing is called panting. If both breathing out and breathing in are short, it is the disease of exhaling and inhaling, caused by obstruction of moving upwards and moving downwards of Qi, so panting is related to the middle Jiao; if breathing out is short and breathing in is long, it is the disease of exhaling, and as the saying ‘breathing out through the heart and the lungs’, panting is related to the upper-Jiao; if breathing out is long and breathing in is short, it is the disease of inhaling, and as the saying ‘breathing in through the kidneys and the liver’, panting is related to the lower-Jiao.” According to the theory of triple-Jiao, the heart and the lungs are in the upper-Jiao; the spleen and the stomach are in the middle-Jiao; the kidneys are in the lower-Jiao. Here the liver is in the lower-Jiao, showing the development of the theory of triple-Jiao.

Panting caused by deficiency is mainly related to the kidneys. Because of the deficiency of kidney Qi, the exhaling and inhaling that are controlled by the lungs and kidneys are in disorder.

Syndrome of panting due to deficiency of the lungs

This syndrome may have the symptoms: quick and shallow breathing, timid and low voice, snoring in the throat; coughing with low sound and thin sputum, easy sweating and fear of wind; or choking sometimes, with little sticky sputum, feeling restless and hot, dry mouth, uncomfortable throat, and flushed cheeks; tongue is light red, or the tongue is red with little covering; the pulse is soft and weak, or the pulse is thin and rapid.

The treatment is to nourish the lungs and strengthen the Qi, and the representative recipe is Sheng Mai San plus Bu Fei Tang. The former reciple enhances Qi and nourishes Yin, while the latter recipe focuses on strengthening the lungs and invigorating the kidneys. If the syndrome has the symptoms of the deficiency of the kidneys, and panting becomes more serious when doing a physical activity, Shan Zhu Yu, Hu Tao Rou and Ge Jie are added to the recipe.

Syndrome of panting due to deficiency of the kidneys

This syndrome may have the symptoms: panting lasts for a long time, becoming worse when doing a physical activity, with long exhaling and short inhaling, and even being hard to breathe; emaciation, fatigue, swelling of upper areas of the feet, easy sweating, coldness of the limbs, bluish face, and purplish lips; or coughing at the same time, with a flushed face, restlessness, dryness of the mouth and throat, coldness of the feet, and sticky sweat like oil; the tongue is pale, the covering of the tongue is white, or the covering of the tongue is blackish and moist, or the tongue is red with little fluid; the pulse is sunken and weak, or the pulse is thin and rapid.

The treatment is to strengthen the kidneys and hold Qi, and the representative recipe is Jin Gui Shen Qi Wan plus Shen Ge San. The former recipe focuses on warming the Yang, and is used for the syndrome with prolonged panting and mild symptoms; the latter recipe focuses on strengthening the Qi, and is used for the syndrome with heavy panting and severe symptoms. If there is a throbbing feeling below the umbilicus and a feeling of Qi rushing up from the lower abdomen to the chest and throat, it is due to the kidneys failing to hold Qi, Zi Shi Ying, Ci Shi and Chen Xiang may be added to the recipe. This syndrome is usually caused by the deficiency of kidney Yang and kidney Qi. If the syndrome has symptoms of deficiency of kidney Yin, the recipe is changed to Qi Wei Du Qi Wan plus Sheng Mai San with the adding or removing of herbs as appropriate.

The syndrome of collapse caused by severe panting

This syndrome may have the following symptoms: panting is very severe, with opening of the mouth, lifting of the shoulders, flaring of the nostrils, and inability to lie down, and when slightly doing a physical activity, coughing and panting are ceaseless, as if the life is going to be lost; there is the sound of sputum in the throat sometimes, and the person suffers from palpitations and restlessness, with coldness of the limbs, bluish face and purplish lips, and has sweats which look like beads; the pulse is floating, large and rootless, or the pulse is very weak as if it is going to be lost.

The treatment is to strengthen Yang for relieving collapse, and hold the kidney Qi. The representative recipe is Shen Fu Tang, while taking Hei Xi Dan. The former recipe strengthens Yang and Qi for relieving collapse, and the latter recipe holds kidney Qi. Powdered Ge Jie can be added to Shen Fu Tang to warm kidney Yang for removing coldness caused by the deficiency of Yang, and to lower Qi that moves upwards abnormally for calming panting caused by deficiency.

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