Internal Medicine – Lung Disorders

Asthma
Common Cold
Cough
Dyspnea
Lung Distention
Lung Paralysis
Pulmonary Consumption
Pulmonary Abscess
Functions of taiyin Lungs

Important: as with all items posted here, it is very strongly recommended that you seek proper advise from your healthcare professional before administering any form of treatment to yourself.  This website is for informational purposes and does not replace the proper diagnosis of your physician.  

Overview Of  Lung Function

Lungs govern Qi and respiration and are in charge of inhaling air.  They open in the skin and control the pores and therefore sweating.  The lungs also help the heart Qi control blood circulation within blood vessels.  They control water passages and play a major role in the movement of body fluids throughout the body.  The lungs disperse defensive Qi (Wei Qi) and body fluids throughout the body protecting the body from external pathogens.  The lungs send post-haven Qi and body fluids down to where the kidneys hold it.  This is referred to as the lungs descending function.  Disorders of the lungs include the common cold, coughing, asthma, dyspnea, pulmonary abscess, pulmonary consumption, lung distension and lung paralysis.

Acute sudden onset of difficult breathing (dyspnoea) with wheezing sound in throat, recurring with cough.

Causes

Hidden phlegm           -dysfunction of spleen produces phlegm stored in lung)
External pathogens    -attack lung creating lung dysfunction, produce hidden phlegm
Diet                             -over consumption of greasy, sweet, alcohol, smoking
Emotion                      -too much stress
Deficiency
Season                                    -aggravated in fall season

Differentiate:

Cold    - wheezing- water sounding gurgle with white clear phlegm
Hot      - wheezing – loud, sawing rough sound with sticky yellow phlegm

Treat the branch of the problem during an attack and treat the root of the problem during remission.

DURING ATTACK (Eliminate phlegm)

Cold Type
• Wind cold symptoms, itchy throat/nose, watery phlegm with cough, tightness in chest, coldness on upper back, pale complexion,
• T: pale, white slippery coating             P – floating tense
• Treatment         expel wind cold, promote lung function to eliminate phlegm
• Formula            Shi Gan Ma Huang Tang
                          Xiao Gan Long Tang
                          Hou Pi Ma Huang Tang
                          Jiu Bao Tang
   
Hot Type
• Wind heat symptoms, difficulty breathing, fast shallow (panting) breaths, loud wheezing, sweating, yellow sticky phlegm, irritable, tight chest, fever, thirst, constipation
• T: Red, yellow coating                                    P – slippery, rapid
• Treatment         clear heat, disperse lung function to eliminate phlegm
• Formula            Yue Bi Jia Ban Xia
                          Ding Chuan Tang
   
Kidney/Lung Deficient Type
1. Between attacks slight wheezing all the time, palpitations, spontaneous sweating, agg. By over exertion, weaker than hot/cold type
2. T: pale, white coating                                      P – deep, weak
3. Treatment         tonify lung and kidney, eliminate phlegm
4. Formula            Ping Chuan Gu Ben

DURING REMISSION (treat organ deficiency, LU/SP/KD)

Lung Qi Deficiency
• Pale, low voice, spontaneous sweat, easily gets cold
• Treatment:        Tonify lung Qi to eliminate hidden phlegm
• Formula            Yu Ping Feng San
   
Spleen Qi Deficiency
• Digestive symptoms, easily bloated, tired after eating
• Treatment:        Tonify Spleen Qi to eliminate hidden phlegm
• Formula            Si Jun Zi Tang
   
Spleen Yang Deficiency
• General cold symptoms, and spleen Qi deficiency symptoms, indigested food in stool
• Treatment:        Strengthen Spleen yang to eliminate cold and hidden phlegm
• Formula            Fu Zi Li Zhong
   
Kidney Yang Deficiency
• Urine and bowel symptoms, usually spleen yang deficiency with kidney yang deficiency symptoms, lower back/knee pain
• Treatment:        Strengthen Kidney yang to eliminate hidden phlegm
• Formula            Shen Qi Wan
   
Kidney Yin Deficiency
• Deficient heat symptoms (dizzy, vertigo, poor memory, lack of concentration, poor hearing, long term, 5-centre heat sensation, menstruation disorders
• Treatment:        Nourish Kidney yin to eliminate hidden phlegm
• Formula            Liu Wei Di Huang Wan

Gan Mao deals with lung system disorders resembling the common cold which include sudden onset, sore throat, fever, head ache and nasal discharge.

Lung functions:              descending and dispersing \ governing Zi \ regulating temperature \ controlling breathing \  controlling open/close of pores \ regulate water passage \ controls vessels

Pathology

Cold on top of Fire  -patient usually hot but catches cold Gan Mao
Wind Heat               -impairs lung descending function
Summer Heat          -usually appears in summer, commonly accompanied with dampness
Qi Deficiency          -patient usually catch’s colds throughout the year, has general fatigue shortness of breath and a weak voice.
Yang Deficiency      -all Qi deficient symptoms but feels more cold
Blood Deficiency     -general blood deficient symptoms
Yin Deficiency         -general yin deficient symptoms

Distinguish between:

Wind cold or Wind heat
Dryness or Dampness
Deficiency or Excess

Cold on top of Fire
• Fever, aversion to cold, no perspiration, H/A, body ache, stuffy nose, sore throat, cough with white/yellow phlegm.
• Treatment:        promote lung function, expel wind cold, to relieve superficial symptoms.
• Formula            Cong chi tang  
                          With Damp  - Huo Xiang Zheng Qi San
                          With Heat    - Ma Xing Shi Gan Tang
   
Wind Heat
• Fever, sweating, aversion to wind, cough, sore throat, H/A, yellow phlegm
• T - thin yellow  coat  - P:  floating, rapid
• Treatment:        promote lung function, expel wind heat, and relieve superficial area
• Formula            Sang Ju Yin
                          Yin Qiao San
   
Summer Heat
• Similar to wind heat symptoms but hotter.  Thirst, nausea, dizzy, heavy head, high fever.
• T: yellow greasy coat                          P – rapid soft, floating
• Treatment:        Clear summer heat and dampness and relieve superficial area.
• Formula            Xin Jia Xiang Ru Yin
   
Qi Deficiency
• Easily feels cold, spontaneous sweating, general wind cold superficial symptoms.
• T: white coating –  - P: floating, weak
• Treatment: Nourish Qi, harmonize defensive Qi and relieve superficial area.
• Formula            Huang Qi Gui Zhi Wu Wu Tang
                                      Shen Su Yin
   
Yang Deficiency
• Spontaneous sweating, (more cold after sweat), aching muscle/joint with cold sensation, pale complexion, puffy face.
• T: pale swollen with white coating  - P:  deep, thin, weak
• Treatment:        warm up yang, relieve superficial area
• Formula            Fu Zi Gui Zhi Tang
   
Blood Deficiency:
• Aversion to wind, fever, H/A, dizziness, floaters, lips/fingers pale, poor memory, insomnia
• T: pale –  - P: thin
• Treatment:        nurish blood, relieve superficial area
• Formula            Cong Bai Qi Wei Yin
   
Yin Deficiency:
• low grade fever in evening, 5-centre heat sensation, night sweat, emaciation, dry mouth/skin and throat, aversion to wind, H/A
• T: red, peeled –  - P: thin, rapid
• Treatment:        nurish yin, relieve superficial area
• Formula            Jia Jian Wei Rui Tang

Bronchitis / Cough is due to lung Qi up surging, the Qi can’t descend meaning the lung cannot complete it’s descending function. 

Ke Sou can be caused by both external pathogens and internal pathogens

Internal:            - slow onseT: may be induced by anger
External:           - quick onseT: agg. by wind and cold – joint and muscle aching.

Pathology

Heat                - thirst and/or fever, constant continual cough
Dry                  - itchy throat with dry symptoms
Damp              - aching joints, heavy body, foggy in head
Yin deficient   - dry hacking cough, hoarseness, sticky phlegm
Qi deficient     - weak cough, large amount of thin phlegm

Distinguish between

Pulmonary Tuberculosis: cough blood, chest pain, tidal fever
Asthma: wheezing cough, lung distension, breathing difficult

Syndromes

Wind Cold
• Cough with white thin phlegm, superficial syndrome, tickle in throat
• T: thin white coat                                                        P – floating / tense
• Treatment:        expel wind cold, promote lung function, disperse lung Qi to relieve cough.
• Formulas          Xing Su San
                          Jin Fuo Cao San
   
External Cold with Internal Heat
• Heavy hacking cough, thick phlegm, chest pain, thirst, sore throat
• T: white greasy yellow coat                                         P – rapid, tense
• Treatment:        Expel cold and clear heat
• Formula      Ma Xing Shi Gan Tang
   
Cool Dry
• Dry cough, dry nose, dry mouth, dry throat, superficial wind cold symptoms, no sweat.
• T - dry coating                                                  P – floating, tense
• Treatment:  expel wind-cold, moisten lung to relieve cough
• Formula      Xing Su San
   
External Fire
• Loud, dry cough, scanty bloody phlegm, thirst, red complexion, chest/hypochondriac pain, constipation, red tongue
• T: red                                                             P – forceful, rapid
• Treatment:        Purge lung fire, induce bowel movement
• Formula            Liang Ge San
   
Internal Phlegm Damp
• Cough with large amount of phlegm(white/sticky), fullness in chest, poor appetite, fatigue
• T: greasy white coating                                   P – slippery, soft
• Treatment:        Invigorate spleen, dry dampness, promote lung Qi to eliminate phlegm.
• Formula            Er Chen Tang
                          Excess Phlegm - San Zi Yang Qin Tan
   
Wind Heat
• Thick yellow sticky phlegm, dry mouth, sore throat, fever, H/A, aversion to wind, nasal discharge, (sweating?)
• T: tip/sides red                                                            P – floating, rapid
• Treatment:        expel wind, clear heat and descend Qi by promoting lung function to relieve cough.
• Formula            Yin Chao San
                          Sang Jue Yin
   
Wind Damp-Heat
• Thick yellow sticky phlegm, dry mouth, sore throat, fever, H/A, aversion to wind, nasal discharge, sticky sweat - MORE PHLEGM, TIGHT/FULL CHEST
• T - greasy white                                                            P – soft, rapid
• Treatment:        expel wind, clear heat, expel dampness and descend lung Qi by promoting lung function to relieve cough.
• Formula            With Summer HeaT: Ching Hao / Xiang Ru
   
Warm Dryness
• Small amount of phlegm (sticky, possible blood spots), dry mouth, nose, throat, nose bleed, chest pain, aversion to wind, fever, H/A
• T: tip/sides red, thin yellow dry coat                P – thin, rapid
• Treatment:        clear lung heat, moisten dryness, expel wind to relieve cough
• Formula            Sand Xing Tang            *diet-pears lubricate dry lung.
   
Phlegm Heat
• Yellow thick sticky phlegm, chest fullness, dry mouth bitter taste in mouth, sore throat
• T: red, yellow greasy                                      P – slippery, rapid
• Treatment:        Clear heat, eliminate phlegm, promote lung function
• Formula            Qing Jing Hua Tang
   
Liver Fire Cough
• (liver qi stagnation turns into fire attacking lung) Cough fresh blood, agg by anger/stress, moving pain in chest/hypochondria
• T: red, yellow coat                                                      P – wiry, rapid
• Treatment:        purge lung and liver fire
• Formula:         Dai Ge San
                        Xie Bai San
   
Yin Deficiency
• Dryness, evening dry cough, little/no phlegm, dry symptoms, night sweat
• T: red                                                             P – thin, rapid
• Treatment:        nourish lung yin, lubricate lung
• Formula:         Er Dong
                       Tian Meng Dong
   
Lung Qi Deficiency
• Weak cough, low voice, shortness of breath, thin phlegm, easily catch cold all year, aversion to cold, spontaneous sweat.
• T: pale, thin, white                                                      P – weak
• Treatment:        nourish Qi, transform phlegm
• Formula            Bu Fei Tong
   
Yang Deficiency
• Originates as sp/kd deficiency.  Cough with watery frothy clear phlegm, palpitation, dizziness, edema, averion to cold
• T: swollen purple, white coat                           P – deep, slippery
• Treatment:        Warm up spleen, kidney yang, eliminate water, expel cold
• Formula            Zhen Wu Tang

Breathing disorder – shortness of breath, cannot lay down flat, must sit up, must rise shoulders to breath, flapping of ala nazi, purple lips/tongue (pneumonia, chronic bronchitis, emphysema)

Causes

External pathogen: invades lung blocking respiratory tract (acute dyspnoea)
Internal pathogens: fluid/phlegm retention blocking respiratory tract
Emotion: all seven  emotions cause stagnation of Qi – causes fluid  retention or blood stasis
diet: spleen produces phlegm, phlegm blocks function of lung
deficiency: Lung and Kidney def.  

Differentiate between:

Excess: more acute onset, rise shoulders, loud, rough sounding
Deficient: onset slow, difficult to inhale, inhale is shallow, fast respiration, quiet sounding, agg by activity

• Asthma: difficulty catching breath with WEEZING (disease)
• Dyspnea: difficulty catching breath (symptoms)
   

   

Wind Cold
• Fullness in chest, rising shoulder, aversion to cold, shivering, sneezing, cough, runny nose, watery mucus, slight or no fever, no sweating, no thirst
• T: thin white coat                                                        P – floating, tense
• Treatment:        pungent warm herbs
• Formula            Ma Huang Tang
   
External Cold, Internal Fluid Retention
• Fluid retention in chest, distended chest, copious sputum
• Treatment:        warm lung, expel cold, transform fluids
• Formula            Xiao Qing Long Tong
   
Phlegm Damp in Lung
• Cough with yellow phlegm and dyspnoea, fullness in chest, nauseous
• T: white greasy coating                                                     P – slippery, rapid
• Treatment:        eliminate phlegm and damp, promote lung function
• Formula            Er Chen Tang
                          San Zi Yang Qin
   
Wind Heat Invasion
• Wind heat superficial symptom and dyspnoea
• Treatment:        expel wind heat, promote lung function
• Formula            Sang Jue Yin
   
Dry Heat in Lung
• Dry symptoms with dyspnoea, sore/dry throat, dry tongue, hoarse, fever
• T: red, yellow coat                                                             - P: rapid
• Treatment         clear heat, lubricate lung
• Formula            San Xing Tang
   
Accumulation of  Phlegm Heat
• Full onset of Pneumonia, fever, thirst, yellow phlegm
•             T: thick sticky yellow coat                                           P – slippery, rapid
• Treatment         clear heat, eliminate phlegm
• Formula            Ma Xing Shi Gan Tang
   
Deficient Lung and Spleen Qi
• Shortness of breath, weak voice, bright white complexion, no appetite, loose stools, lung and spleen Qi deficiency signs
• T: pale, puffy                                                   - P: empty
• Treatment         Nourish spleen and Lung Qi
• Formula            Bu Zhong Yi Qi Tang
                          Sheng Mai San
   
Kidney Yang Deficiency
• Shallow inhale, difficult to catch breath, kidney yang deficiency symptoms frequent urination, edema of lower extremities, coldness, cold/weak back
• T: pale                                                                        P – deep/thin
• Treatment         warm up kidney yang Qi
• Formula            Shen Qi Wan
   
Kidney Yin Deficiency
• Reproductive system deficient symptoms, dry mouth at night, night sweats
• T- red, peeled                                                              P – thin, rapid
• Treatment         nourish kidney yin
• Formula            Liu Wei Di Huang Wan
                          Essence           - Qi Wei Du Qi Wan
                          Grasping         - He Che Da Zao Wan

Chronic lung disorders become Fei Zhang, emphysema  

Chronic condition  –     chronic cough – asthma – dyspnea (lung/spleen/kidney become def.) with phlegm, distended chest and edema.

Long term Respiratory diseases cause:

STAGNATION.

Fullness in chest, distended chest aggravated by activity, cough with phlegm, edema.  Worse case = purple lips and tongue, dark complexion with edema

EXCESS

Cold Fluid Attack Lung (spleen/kidney yang def.)
• Superficial wind cold symptoms, cough, thin-frothy large amount of phlegm, dyspnea, full-distended chest.
• T - white, slippery  - P: Floating, tense
• Treatment:        expel wind cold, eliminate internal fluids
• Formula            Xiao Qing Long Tang
   
Phlegm Heat in Lung (invasion of wind-heat (or wind-cold turn to heat))
• Wind heat symptoms, cough, phlegm, dyspnea, edema
• T - red, yellow coat  - P: floating, rapid
• Treatment:        clear lung heat, resolve phlegm, descend lung Qi to relieve distension
• Formula            Qing Qi Hua Tan Tang

DEFICIENCY

Lung and Kidney Qi Deficiency
• Shortness of breath, fullness in chest, kidney and lung deficiency symptoms, fatigue, weak voice, easily catch cold
• T: pale, white coat – P: deep, weak
• Treatment:        nourish lung and kidney Qi
• Formula            Ren Shen Ge Jie San
   
Lung and Kidney Yin Deficiency
• Shortness of breath, fullness in chest, kidney and lung deficiency symptoms, fatigue, weak voice, easily catch cold, deficient heat symptoms
• T: pale, white coat – P: deep, weak
• Treatment:        nourish lung and kidney Yin
• Formula            Bai He Gu Jin Tang
   
Spleen and Kidney Yang Deficiency
1. Problems inhaling, general yang deficiency symptoms, pale, puffy complexion
2. T - pale, white coating  - P: weak
3. Treatment:        Nourish spleen and kidney yang
4. Formula            Shen Qi Wan

Resolves from chronic lung disorders

 Shortness of breath, white-frothy thin phlegm (possible blood), emaciation, fatigue, dry mouth/lips, weak voice, recurrent, lung becomes stiff, slowly gets worse and worse

Differentiate:

Lung paralysis: not contagious
Lung T.B. bacterium contagious

Deficient Heat
• Blood in phlegm-sticky, general yin deficiency symptoms, dry symptoms, emaciation, dry mouth/skin
• T: red, scanty coat – P: thin, rapid
• Treatment         clear deficient heat and nourish yin
• Formula            Bai Hu Gu Jin Tang
                          Zhu Ye Shi Gao
   
Deficient Cold
• Cough, large amount of clear-thin-frothy phlegm, whole body deficiency cold symptoms, frequent urination (possible spleen or kidney deficiency)
• T: puffy – P: weak
• Treatment:        warm up lung and spleen Qi to expel cold
• Formula            Shen Qi Wan
                          Gan Cao Gan Jiang
   
Deficient Heat and Deficient Cold
• Upper jiao heat with lower jiao cold,
• Treatment:        warming and clearing to harmonize cold and heat
• Formula            Ma Huang Sheng Ma Tang

Infectious, chronic disease with cough, coughing up of blood, tidal fever, night sweat, chest pain and emaciation (possible Tuberculosis)

Distinguish

Tuberculosis:   chronic, tidal fever, yin deficient cough
Lung Abscess:  acute, high fever, large amount of sticky-yellow phlegm, toxic heat, cough from excess heat

Lung Yin Deficiency
• deficient heat in lung, night sweat, 5-centre heat sensation
• T: tip/sides red, scanty coating – P: thin, rapid
• Treatment:        Nourish lung yin, clear def heat
• Formula            Yue Hua Wan
   
Lung and Kidney Yin Deficiency
• severe yin deficiency syndromes, steaming bone with tidal fever, tinnitus, reproductive disorders, menses disorders, insomnia
• T: red, geographic peeling, dry coa – P: thin, rapid, weak
• Treatment:        nourish lung and kidney, clear deficient fire, kill lao chong
• Formula            Bai He Gu Jin Tang & Kidney essence tonic.
   
Qi and Yin Deficiency
• Lung yin deficiency and Spleen Qi Deficiency symptoms, no prominent fever,    aversion to wind,  spontaneous sweat, night sweat, easily catch cold, spleen qi  deficient symptoms, pale/puffy complexion, zygomatic flush
• T: pale – P: weak, thin, rapid
• Treatment:        nourish spleen Qi and lung Yin
• Formula            Bao Zhen Tang
   
Deficient Ying and Yang
• (later stage) – Yang and Yin def. = lung/spleen/kidney are all deficient.
• Tidal fever, cold symptoms, very weak, emaciation, spontaneous sweat, night sweat, morning diarrhea, amenorhhea, impodence, spermatorrhea, frothy-purple phlegm with blood
• T: Dark purple – P:  floating big or deep thin
• Treatment:        nourish ying and yang, strengthen primary(original) Qi.
• Formula            Bu Tian Da Zao Wan

Acute infection of the lung with fever, cough, chest pain, smelly-large amount of phlegm coughed up with possible blood.

Four stages:

Primary Stage: external pathogen invasion (wind heat or wind cold turns to wind heat)
Secondary Stage: Abscess forming stage, accumulation of phlegm heat in lung (stagnation and heat)
Third Stag: Bursting stage – lots of phlegm (pus)
Fourth Stage: Recovery stage – deficiency of Qi and yin of lung.

Differentiate between Lung Abscess and Phlegm/Fluid retention

Lung Abscess: Acute, pain, phlegm with significant odour
Phlegm Retention: Slow, chronic with little or no odour.

Lung Abscess has to have HEAT AND STAGNATION.

4 STAGES

First Stage (primarily wind heat)

• One area on chest is painful, sticky phlegm
• Treatment:        expel wind heat and promote lung function
• Formula          Ying Chao San
   

Second Stage (Forming stage)

• noon and afternoon high fever, cough, hypochondriac pain (where abscess is forming)  breathing difficult due to pain, thick-pusy-phlegm with odour,  irritable, thirst.
• T: yellow, greasy – P: slippery, rapid
• Treatment:        Clear heat, detoxify, promote lung function and relieve stagnation
• Formula            Qian Jin Wei Jin Tang
   

Third Stage (Bursting Stage) – 3 layer phlegm

• large amount of pusy phlegm with strong-intense odour, thirst, dysphoria
• T: yellow, greasy – P: slippery, rapid
• Treatment:        Clear heat, detoxify, dissolve stagnation and discharge pus.
• Formula            Qian Jin Wei Jin Tang
                          Jia We Jie Geng Tang
   

Fourth Stage (Recovery)

• Slight fever, cough and phlegm reduce, deficiency signs (tidal fever, night sweat)
• T: \ – P: Thin, rapid
• Treatment:        Nourish lung Qi and yin, expel rest of pathogen
• Formula            Sha Shen Yang Fei Tang

 

Links - Lung: Metal Energy Yin Organ (Bioenergetics)