1. 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

3. Main Points for differentiation Lung Qi Def. Lung Qi & Yin Def. Lung & Spleen Def. Lung & Kidney Def. Spleen & Kidney Yang Def. Wheeze, Panting & Lung distension

4. Treatment 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.

5. Formula: Modifications: fullness in the chest, abundant sputum, inability to lie flat -- Ting Li Zi with exterior wind-cold sym. -- Xiao Qing Long Tang Su Zi Jiang Qi Tang Zi Su ZiJu PiBan XiaDang GuiQian HuHou Pu Rou GuiGan CaoSheng Jiang San Zi Yang Qing Tang Su ZiBie Jie ZiLai Fu Zi Liu Jun Zi Tang Ren ShengFu LingBai ZhuChen PiBan XiaZhi Gan Cao

6. Treatment 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

7. Formula: Modifications: Sticky sputum and difficulty to be spit out -- Gua Lou, Hai Ge Ke, Yu Xing Cao Wheezing & inability to lie flat -- She Gan, Ting Li Zi Thirsty -- Tian Hua Feng, Lu Geng Yin Def. -- Sha Sheng, Mai dong Yue Bi Jia Ban Xia Tang Ma HuangShi GaoSheng JiangDa ZhaoBai ZhuBan Xia Sang Bai Pi Tang Sang Bai piBan XiaSu ZiXing RenBei MuHuang Qin Huang LianShan Zhi Zi

8. Treatment 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

9. Formula: Modifications: Lung def. + cold -- Rou Gui, Gang Jiang Yin def. + lower fever -- Sheng Di, Mai dong, Yu Zhu Blood stasis -- Dang gui, Dan Shen, Shu Mu Yin Def. -- Sha Shen, Mai dong Ping Chuan Gu Ben Tang Dang ShenWu Wei ZiDong Chong Xia CaoCi shiSu Zi Ban XiaChen XiangHu Tao rouJu HongKuang DongHua Bu Fei Tang Ren ShengHuang QiShu DiWu Wei ziZi WanSang Bai Pi

10. Treatment 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

11. Formula: Modifications: Panting + severe edema -- Ting Li Zi, Cheng Xiang Blood stasis sym. -- Dan Shen, Yi Mu Cao Zheng Wu Tang Fu ZiBai ZhuFu LingShao YaoSheng Jiang Wu ling Tang Gui ZhiFu LingBai ZhuZhu LingZhe Xie

12. Case History 1. Male 67 years Medical history: Patient has suffered chronic pulmonary heart heart disease for years. 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

13. Case History 1. Male 67 years Medical history: Medical history: Patient has suffered chronic pulmonary heart heart disease for years. 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

14. Case History 1. Male 67 years Medical history: Medical history: Patient has suffered chronic pulmonary heart heart disease for years. 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

15. Sputum 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

17. Main Points for differentiation 1) Location 2) Def. & Excess 3) Coexistence of two or more syndromes Cold & Heat Exterior & Interior Qi Stag. & Blood Stasis Qi Def. & Blood Stasis

18. Difference of dampness, water, fluid retention and sputum DampnessWaterFluid retentionSputum Property & texture Sticky & No fixed shape Clear fluidThinThick & Turbid FocusEverywhereSpread 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

19. Main Points for therapeutic Principles 1) Warming & Reducing Exhaustion of Yang & Hyperactivity of Yin Combined with dispelling, inducing diuresis & diaphoresis herbs 2) Proper method should be taken according to the symptoms. Water retention – dispelling pathogen Exhaustion of Yang – Warming Exterior syn. – Warming + dispelling + sweating Interior Syn. – Warming + dispelling + diuresis-inducing Weak body resistance – Reinforcing Excess of pathogens – Purging Coexistence of excess of pathogens & weakness of body resistance -- eliminating + reinforcing -- eliminating + reinforcing Coexistence of fluid retention & heat Syn. -- Warming + cooling

20. Treatment 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

21. 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 LingGui ZhiBai ZhuGan CaoSheng Jiang Xiao Ban Xia Jia Fu Ling Tang ( stopping vomiting) Fu LingBanXiaSheng Jiang

22. Treatment Excess 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

23. Formula: Modifications: Fullness of chest or epigastric -- Zhi Shi, Hou Pu Gan Sui Ban Xia Tang ( fluid in St.) Gan SuiBan XiaBai ShaoHoneyGan Cao Ji Jiao Li Huang Pill ( Fluid in intestine) Fang JiJiao MuTing Li ZiDa Huang

24. Treatment Excess 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

25. 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 MuSheng JiangChen PiBan XiaSang Bai PiGuaLou Fu LingSu ZiTing Li ZiDa Huang

26. Treatment Excess 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

27. 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 HuangGui ZhiBai ShaoGan CaoGan JiangXi Xing Ban XiaWu Wei Zi

28. Treatment Excess 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

29. Formula: Modifications: Sticky sputum -- Bai Jie Zi, lai Fu Zi Xiao Qing Long Tang Ma HuangGui ZhiBai ShaoGan CaoGan JiangXi Xing Ban XiaWu Wei Zi

30. Treatment Def. Type 1) Weakness of Sp. Yang Hypofunction 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

31. 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 ShengBai ZhuGan JiangZhi Gan Cao

32. Treatment Def. Type 2) Weakness of Kid. Yang Aged 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

33. 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 ZiBai ZhuBai ShaoFu LingSheng Jiang JIng Gui Sheng Qi Wan

34. Case History 1. Male 72 years Medical History: patient has suffered panting with abundant sputum for several years. First visiting: Main complain: panting with abundant sputum Coughing 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