Anger, frustration, irritation, resentment over a long period of time cause Liver-Yang or
Liver-Fire to rise. This can rise to invade the Lungs and obstruct the descending of Lung-Qi. In
5-Element terms this is called "Wood insulting Metal". This is a fairly common cause of
breathlessness particularly in tense young people or children who are in a stressful family
situation.

Fatigue, Chronic Illness

Overwork over a long period of time weakens Kidney-Yin. A deficiency of Kidney-Yin leads to
the impairment of various Kidney functions, in this case that of receiving Qi. Thus the deficient
Kidneys cannot receive and grasp Qi, Qi rebels upwards and obstructs the descending of
Lung-Qi. This leads to a situation of Excess above and Deficiency below and therefore chronic
breathlessness.

Physical overexertion over a long period of time, or standing for too long, weakens Kidney-Yang
which cannot receive and hold Qi down. This leads to chronic breathlessness in exactly the same
way as outlined above. Thus a kidney deficiency (whether of Yin or Yang) is nearly always
present in chronic breathlessness. For this reason Ye Tian Shi (1667-1746) said of
breathlessness: "If the Lungs are the cause, it is of the Excess type; if the Kidneys are the cause,
it is of the Deficiency type".5(94)

A chronic deficiency of Lung-Qi or Lung-Yin such as one following an external invasion of
Wind, prevents Lung-Qi from descending and therefore leads to chronic cough and
breathlessness.

Pathology

As outlined above, the causes of breathlessness centre around the Lungs and Kidneys primarily.
The Lungs, which govern Qi, are always involved as in breathlessness Lung-Qi fails to descend.
Lung-Qi fails to descend when it is obstructed by exterior Wind or by Phlegm, or when it is
deficient.

The Kidneys are the root of Qi and receive and hold Qi down. Lung and Kidney work in
coordination for proper breathing as Lung-Qi descends to the Kidneys and the Kidneys hold it
down. The Lungs control exhalation and the Kidney inhalation. Thus in chronic breathlessness a
difficulty in inhalation indicates Kidney deficiency, whilst a difficulty in exhalation points to a
Lung deficiency. Although the pattern of Kidneys not receiving Qi, which is typical of chronic
breathlessness, is a Yang-deficiency pattern, both Kidney-Yin and Kidney-Yang deficiency can
lead to chronic breathlessness.