Lung DistensionLung Distension

TCM Diagnoses and Treatments Lung distension results from development of multiple

chronic pulmonary disease and is characterized as thoracic bulge & fullness, cough, panting with reversed flow of qi, worsening while making exertion, stuff chest & abundant sputum.

Etiology & Pathology:Etiology:

1) Lung def. due to chronic disease ( chronic pulmonary disease: obstruction emphysema, cough, asthma, pneumonectomy, chronic pulmonary heart disease, senile pneumonectomy, etc)

2) Exogenous pathogens affection

Main Points for differentiationMain Points for differentiation

Lung Qi Def.Lung Qi Def.

Lung Qi & Yin Def.Lung Qi & Yin Def.

Lung & Spleen Def.Lung & Spleen Def.

Lung & Kidney Def.Lung & Kidney Def.

Spleen & Kidney Yang Def.Spleen & Kidney Yang Def.

Wheeze, Panting & Lung distensionWheeze, Panting & Lung distension

TreatmentTreatment 1) Phlegm Accumulation

Signs & Symptoms:

– Main Sym. : cough with abundant sputum, white sticky or thin, panting, worsening on exertion.

– Concurrent sym.: shortness of breath, gasp, aversion to wind, frequent sweating, cold limbs, fullness in the stomach, poor appetite, weakness

– Tongue: pale body with thin greasy coating

– Pulse: small, taunt & slippery pulse

• Treatment Protocol:

– Resolving the sputum– Strengthen Sp. & nourish Lu.

Formula:

Modifications:fullness in the chest , abundant sputum, inability to lie flat

-- Ting Li Ziwith exterior wind-cold sym.

-- Xiao Qing Long Tang

Su Zi Jiang Qi Tang

Zi Su Zi Ju Pi Ban Xia Dang Gui Qian Hu Hou Pu

Rou Gui Gan Cao Sheng Jiang

San Zi Yang Qing Tang

Su Zi Bie Jie Zi Lai Fu Zi

Liu Jun Zi Tang

Ren Sheng Fu Ling Bai Zhu Chen Pi Ban Xia Zhi Gan Cao

TreatmentTreatment 2) Phlegm heat Accumulation

Signs & Symptoms:

– Main Sym. : cough with yellowish and sticky-white sputum being difficult to spit out, asthmatic breathing, coarse voice.

– Concurrent sym.: irritability, fever, sweating, brown urine, constipation, thirsty,

– Tongue: red body with yellow or yellow greasy coating

– Pulse: rapid & slippery pulse

• Treatment Protocol:

– Resolving the sputum– Clear the lung heat– Stop asthma

Formula:

Modifications:Sticky sputum and difficulty to be spit out

-- Gua Lou, Hai Ge Ke, Yu Xing CaoWheezing & inability to lie flat

-- She Gan, Ting Li ZiThirsty

-- Tian Hua Feng, Lu GengYin Def.

-- Sha Sheng, Mai dong

Yue Bi Jia Ban Xia Tang

Ma Huang Shi Gao Sheng Jiang Da Zhao Bai Zhu Ban Xia

Sang Bai Pi Tang

Sang Bai pi Ban Xia Su Zi Xing Ren Bei Mu Huang Qin

Huang Lian Shan Zhi Zi

TreatmentTreatment 3) Lung & Kidney Qi Def.

Signs & Symptoms:

– Main Sym. : Rapid shallow respiration, dyspnea, panting worsening on exertion.

– Concurrent sym.: Gasp for breath with open mouth & shoulders elevated, inability to lie flat, lower voice, shortness of breath, cough, white sputum being difficult to spit out, stuffy chest, palpitation, cold limbs & sweating.

– Tongue: Pale or purplish

– Pulse: deep, thready, rapid and weak or uneven pulse

• Treatment Protocol:

– Tonify Lung & Kidney– Stop panting

Formula:

Modifications:Lung def. + cold

-- Rou Gui, Gang JiangYin def. + lower fever

-- Sheng Di, Mai dong, Yu ZhuBlood stasis

-- Dang gui, Dan Shen, Shu MuYin Def.

-- Sha Shen, Mai dong

Ping Chuan Gu Ben Tang

Dang Shen Wu Wei Zi Dong Chong Xia Cao Ci shi Su Zi

Ban Xia Chen Xiang Hu Tao rou Ju Hong Kuang DongHua

Bu Fei Tang

Ren Sheng Huang Qi Shu Di Wu Wei zi Zi Wan Sang Bai Pi

TreatmentTreatment 4) Edema due to Yang Def.

Signs & Symptoms:

– Main Sym. : Asthma, cough, dyspnea, edema in face, eye-lipids & lower limbs or even in the whole body.

– Concurrent sym.: Clear thin sputum, less urination, fullness in the stomach, poor appetite, palpitation, abdominal distension and fullness.

– Tongue: dim enlarged tongue, white slippery fur

– Pulse: deep thready pulse

• Treatment Protocol:

– Warming the kidney & strengthening the spleen– Removing water & fluid retension

Formula:

Modifications:Panting + severe edema

-- Ting Li Zi, Cheng XiangBlood stasis sym.

-- Dan Shen, Yi Mu Cao

Zheng Wu Tang

Fu Zi Bai Zhu Fu Ling Shao Yao Sheng Jiang

Wu ling Tang

Gui Zhi Fu Ling Bai Zhu Zhu Ling Zhe Xie

Case History

1. Male 67 years Medical history:Medical history: Patient has suffered chronic pulmonary heart heart disease for years. First visiting:First visiting:

Main complain: panting & coughing for several days Several days ago, patient start coughing & panting again due to cold

weather, with white foamy sputum but difficultly to be expectorated. Severe panting, inability to lie flat. Fullness & distention in the chest and abdomen, no appetite, loose stools, tiredness, face & four limbs edema, cold limbs, pale face color.

Tongue: pale body with white slippery coating Pulse: deep thready

TCM diagnose: Lung Def. +cold water retention in the lung + Kid & Sp Yang

Def. Treatment protocol:

disperse lung Qi & removing the water + Warm up Sp & Kid yang Formula:

Shen Fu Tang + Xiao Qing Long Tang Ren Shen 9, Fu zi 15, Bai Zhu 12, Ma Huang 4.5, Xing Ren 12, Gan

Jiang 3, Wu Wei Zi 3, Ban Xia 9, Chen Pi 4.5, Xi Xing 3, Fu Ling 15, Zhi Gan Cao 3, Cheng Xiang 3 X 2 bags

Case History

1. Male 67 years Medical history:Medical history: Patient has suffered chronic pulmonary heart heart disease for years. Second visiting:Second visiting:

Main complain: panting & coughing has become much better Fullness & distention in the chest and abdomen are also getting

better, edema on the ankle is reduced, appetite is little better, no spontaneous sweating

other symptoms are still.. Tongue: pink body with white coating Pulse: deep thready + slippery

TCM diagnose: Lung Def. +cold water retention in the lung + Kid & Sp Yang

Def. Treatment protocol:

descending lung Qi & Stopping panting + strengthen sp function Formula:

Dang Sheng 15, Fu zi 9, Bai Zhu 12, Ma Huang 3, Xing Ren 9, Gan

Jiang 3, Wu Wei Zi 3, Su Zi 9, Sha Ren 3, Jiao Qu 12, Fu Ling 12, Yin xing 5,

X 3 bags

Case History

1. Male 67 years Medical history:Medical history: Patient has suffered chronic pulmonary heart heart disease for years. Third visiting:Third visiting:

Main complain: Cough is reduced and no panting No fullness & distention in the chest and abdomen, no edema on the

legs, appetite is better, sleeping is also better, no loose stools, Face edema, sputum not so difficult to spit out, Tongue: pink body with thin white coating Pulse: soft + slippery

TCM diagnose: Lung Def. +cold water retention in the lung + Kid & Sp Yang

Def. Treatment protocol:

tonify Qi + Warm Kid yang + tonify Sp Formula:

Dang Sheng 15, Huang Qi 9, Fu zi 9, Fu Ling 9, Bai Zhu 12, Gui Zhi

3, Ma Huang 3, Xing Ren 9, Ban Xia 9, Chen Pi 4.5, Xi Xing 2, Hong Zao 5,

X 3 bags

Sputum RetentionSputum Retention

TCM Diagnoses and Treatments Sputum retention is referred to a category of

disease caused by abnormal stagnation of water fluid in a certain part of the body because of disorder of its distribution, transformation and transportation.

Etiology & Pathology:Etiology:

1) Dysfunction of the lung, spleen and kidney

Main Points for differentiationMain Points for differentiation

1) Location1) Location

2) Def. & Excess2) Def. & Excess

3) Coexistence of two or more syndromes3) Coexistence of two or more syndromes

Cold & Heat

Exterior & Interior

Qi Stag. & Blood Stasis

Qi Def. & Blood Stasis

Difference of dampness, water, fluid retention and sputum

Dampness Water Fluid retention Sputum

Property

& texture

Sticky & No fixed shape

Clear fluid Thin Thick & Turbid

Focus Everywhere Spread within the muscles &

skin of the whole body: the

lower part & flaccid part

Appear in the topical part of the

body: St., intestines, chest,

Hy., 4 limbs

Everywhere

Property of the

disease

Cold & Heat

Exterior & interior

Yang-water or Yin-water

Results from accumulation of body fluid: Yang def. or Yin cold

Cold & heat type

Main Points for therapeutic PrinciplesMain Points for therapeutic Principles

1) Warming & Reducing1) Warming & Reducing

Exhaustion of Yang & Hyperactivity of YinExhaustion of Yang & Hyperactivity of Yin

Combined with dispelling, inducing diuresis & diaphoresis Combined with dispelling, inducing diuresis & diaphoresis herbsherbs

2) Proper method should be taken according to the symptoms. 2) Proper method should be taken according to the symptoms.

Water retention – dispelling pathogenWater retention – dispelling pathogen

Exhaustion of Yang – Warming Exhaustion of Yang – Warming

Exterior syn. – Warming + dispelling + sweatingExterior syn. – Warming + dispelling + sweating

Interior Syn. – Warming + dispelling + diuresis-inducingInterior Syn. – Warming + dispelling + diuresis-inducing

Weak body resistance – ReinforcingWeak body resistance – Reinforcing

Excess of pathogens – PurgingExcess of pathogens – Purging

Coexistence of excess of pathogens & weakness of body Coexistence of excess of pathogens & weakness of body resistance resistance

-- eliminating + reinforcing-- eliminating + reinforcing

Coexistence of fluid retention & heat Syn. Coexistence of fluid retention & heat Syn.

-- Warming + cooling-- Warming + cooling

TreatmentTreatment Excess type 1) Fluid retention in the stomach without heat-transformation

Signs & Symptoms:

– Main Sym. : Chest fullness, epigastric stuffiness, water-shaking sound over the abdomen, thirsty without desire for drinking, or being readily to vomit on drinking water, throwing up clear water or thin saliva.

– Concurrent sym.: dizziness, palpitations, shortness of breath, – Tongue:

pale body with white & slippery coating– Pulse:

deep, taunt & slippery pulse

• Treatment Protocol:

– Warming Yang– promote diuresis

Formula:

Modifications:Dizziness + less urination

-- Cang Zhu, Ze Xie, Zhu Ling,

Fullness of chest or epigastric

-- Zhi Shi, Hou Pu

Cold sensation on the back being about a palm size

-- Gan Jiang, Hu Zhu Yu, Rou Gui

Ling Gui Zhu Gan Tang

Fu Ling Gui Zhi Bai Zhu Gan Cao Sheng Jiang

Xiao Ban Xia Jia Fu Ling Tang ( stopping vomiting)

Fu Ling BanXia Sheng Jiang

TreatmentTreatmentExcess TypeExcess Type

2) Fluid retention in St. & transform to heat

Signs & Symptoms:

– Main Sym. : Rigidity, fullness & pain sensations in the epigastrium & abdomen, sustained rigidity and fullness despite having a normal urination, or water moving sound in the intestines, abdominal fullness, constipation, dry mouth & tongue

– Concurrent sym.: – Tongue:

greasy, or white or yellow coating– Pulse:

deep, taunt pulse

• Treatment Protocol:

– Purging water retention

Formula:

Modifications:

Fullness of chest or epigastric

-- Zhi Shi, Hou Pu

Gan Sui Ban Xia Tang ( fluid in St.)

Gan Sui Ban Xia Bai Shao Honey Gan Cao

Ji Jiao Li Huang Pill ( Fluid in intestine)

Fang Ji Jiao Mu Ting Li Zi Da Huang

TreatmentTreatmentExcess TypeExcess Type

3) Fluid retention in the Hypochondrium (Pleurisy)(Always due to Lu Def. + season evils invasion)

Signs & Symptoms:

– Main Sym. : Distending pain over the chest & hypochondrium, aggravated by coughing, even breathing or turning round body, fullness in the hypochondrium on the affected side.

– Concurrent sym.: Alternate attack of chills & fever in most case, or tidal fever, bitter taste, dry throat. After long illness: night sweating…(Yin def.)

– Tongue: First stage: white or yellowish coating; Last stage: red tongue with less coating

– Pulse: taunt & rapid pulse

• Treatment Protocol:

– Purging Lung heat– Expel excessive fluid

Formula:

Modifications:

Excessive Phlegm-damp Sym: Fullness of chest & greasy coating

-- Xie Bai, Xing Ren,

No appetite + weakness

-- Ling Gui Zhu Gan Tang

Jiao Mu Gua Lou Tang

Jiao Mu Sheng Jiang Chen Pi Ban Xia Sang Bai Pi GuaLou

Fu Ling Su Zi Ting Li Zi Da Huang

TreatmentTreatmentExcess TypeExcess Type

4) Fluid retention in the chest ( Zhi Ying )

Signs & Symptoms:

– Main Sym. :cough, dyspnea, orthopnea, profuse white foamy sputum

– Concurrent sym.: puffiness in the face and the ankle part in severe cases. Could see cold or heat exterior symptoms.

– Tongue: white greasy coating

– Pulse: taunt & tense pulse

• Treatment Protocol:

– Warming Lung– Remove fluid retention

Formula:

Modifications:Sticky sputum

-- Bai Jie Zi, lai Fu Zi

In severe case: more fluid retention, less exterior syn., severe dyspnea, cough, inability to lie flat

-- Ting Li Da Zao Xie fei tang

Warm Yang & regular Qi

-- Gui Zhi, Chen Pi

Warm Yang & Desending Qi

-- Su Zi, Ban Xia, Da Fu Pi, Xing Ren

Eliminate water retention

-- Zhu Ling, Fu Ling

Xiao Qing Long Tang

Ma Huang Gui Zhi Bai Shao Gan Cao Gan Jiang Xi Xing

Ban Xia Wu Wei Zi

TreatmentTreatmentExcess TypeExcess Type

4) Fluid retention in the four limbs ( Yi Ying or Anasarca)Wind-cold attacking + Lu & Sp def.

Signs & Symptoms:

– Main Sym. : Joints pain, heaviness sensation & edema in the four limbs, aversion to cold, no sweating

– Concurrent sym.: puffiness in the face and the ankle part in severe cases.

– Tongue: white greasy coating

– Pulse: taunt & tense pulse

• Treatment Protocol:

– Expel the exterior– Remove fluid retention

Formula:

Modifications:Sticky sputum

-- Bai Jie Zi, lai Fu Zi

Xiao Qing Long Tang

Ma Huang Gui Zhi Bai Shao Gan Cao Gan Jiang Xi Xing

Ban Xia Wu Wei Zi

TreatmentTreatmentDef. TypeDef. Type

1) Weakness of Sp. YangHypofunction of sp in transportation & transformation + dampness

Signs & Symptoms:

– Main Sym. : fullness & discomfort in the chest and hypochondrium, being comfortable if the abdomen pressed or warmed. Frequent vomiting thin fluid or sputum, thirsty but no desire for drinking

– Concurrent sym.: dizziness, palpitation, shortness of breath, no appetite, loose stools, weakness, water shaking sound in the abdomen, eyelid puffiness after getting up in the morning, lower limb edema in the afternoon.

– Tongue: white slippery coating

– Pulse: taunt, thread slippery pulse

• Treatment Protocol:

– Warm & reinforcing Sp – Remove fluid retention

Formula:

Modifications:

Yin hyperactivity due to Yang def.

-- Fu Zi, Wu Zhu Yu, Rou Gui

Vomiting thin fluid & thin sputum

-- Gui Zhi, Bai Zhu, Fu Ling, Zhu Ling, Ze Xie ( Wu Ling San)

Fullness in the chest & hypochondrium

-- Mu Xiang, Sha Ren, Chen Pi

Li Zhong Wan

Ren Sheng Bai Zhu Gan Jiang Zhi Gan Cao

TreatmentTreatmentDef. TypeDef. Type

2) Weakness of Kid. YangAged people or patient with impairment of the kidney due to

chronic disease

Signs & Symptoms:

– Main Sym. : chills, cold limbs, cramping & numbness sensation or tremor in the lower abdomen, rapid breathing, shortness of breath, worsening on exertion, vomiting, abundant sputum

– Concurrent sym.: dizziness, vomiting of foamy fluid. – Tongue:

enlarged body with white slippery coating or white greasy coating– Pulse:

thready & slippery

• Treatment Protocol:

– Warming Kid. – Remove fluid retention

Formula:

Modifications:

Sp & Kid yang def.

-- Jing Gui Sheng Qi Wan + Ling Gui Zhu Gan tang

Bad appetite

-- Chen Pi, Ban Xia

Fluid retention

-- Wu Ling San

Zheng Wu Tang

Fu Zi Bai Zhu Bai Shao Fu Ling Sheng Jiang

JIng Gui Sheng Qi Wan

Case History

1. Male 72 years Medical History: patient has suffered panting with abundant sputum for several years. First visiting:First visiting:

Main complain: panting with abundant sputumCoughing with abundant foamy sputum, breath with mouth

open and shoulders elevated, inability lie flat in whole day, even couldn’t get into sleep, exhausted. Patient even can’t talk longer which will cause panting symptoms worse. Face & legs edema.

Tongue: white greasy coating Pulse: taunt slippery

TCM diagnose: Fluid retention in the chest & lung + Sp yang Def.

Treatment protocol:Removing water retention + Warm up yang

Formula: Ting Li Zi 9, Bai Zhu 9, Sheng Jiang Pi 5, Gui Zhi 5, Su

Zi 12, Xing Ren 12, Fu Ling 12, Zhu Ling 12, Fang Ji 12, Ban Xia 6, Chen Pi 6, Dong Gua Ren 12