Lung Distension Lung 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
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Lung Distension TCM Diagnoses and Treatments Lung distension results from development of multiple chronic pulmonary disease and is characterized as thoracic.
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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.
– 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
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
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