1. Panting syndrome TCM Diagnoses and Treatments Panting syndrome is one of the respiratory disease characterized by rapid breathing even with mouth open and shoulders elevated, flaring of nares, dyspnea, worsening while making exertion. Etiology & Pathology: Etiology: Kidney & Lung Full Type: obstruction of the lu. by exogenous evils Def. Type Hypofunction of Lu. & Kid. >: “Excess-type panting due to exogenous evils, and Def.-type panting due to Yuan Qi Def. without exogenous evils” > “Treat the lung if panting is excess-type; Treat the Kidney if panting is def.-type”

3. Main Points for differentiation Differentiation of def. & Excess Def. typeExcess type BreathingRapid breathing, dyspnea, comfort if having a deep inspiration, lower voice Deep & long; feeling comfortable when exhaling, coarse respiration DurationLongshort OnsetRepeated attackSudden & acute attack Accompanied by Lune or Kid def. sym.Exterior syndromes TonguePaleThin white coating PulseLarge, hollow, weakRapid & forceful

4. Main Points for differentiation Differentiation of Panting & shortness of breath Panting Syn.Shortness of B. BreathingAbnormal breathing Dyspnea with mouth open & shoulder lifting or even being unable to lie flat Feeble breathing TypeExcess & Def.Def. type only Which is often seen in various acute & chronic disease (Asthma) OnsetRepeated attackUsually happened after doing light physical labor Accompanied byLune or Kid def. symLassitude, being reluctant to speak

5. Main Points for differentiation Differentiation of Panting & wheezing Panting Syn.Wheezing BreathingAbnormal breathing Rapid breathing without production of louder sound, Loud sound in the throat, Syndromes is short, combined with rattles due to phlegm in the throat TypeExcess & Def.Def. type only Which is often seen in various acute & chronic disease (Asthma) PathologyQi disorderObstruction of Qi by phlegm etiologyInvasion of evils or chronic of disease but no perennial root Has its perennial root and predisposing causes OnsetNo this characterParoxysm, repeated attack & stubborn independenceA complication of multiple chronic disease. A dependent disease ( could include panting syn.)

6. Treatment Excess-type 1) Excess-type a) Wind-cold Signs & Symptoms: –Main Sym. : Rapid breathing, distending feeling in the chest, abundant white thin sputum –Concurrent sym.: headache, aversion to cold, cough, no sweating, no thirsty –Tongue: white, thin and slippery tongue coating –Pulse: floating, rapid Treatment Protocol: –Expel the cold –Dispersing the Lung Qi

7. Formula: Modifications: Headache -- Chuan Xiong, Bai Zhi Abundant Sputum -- Bai Jie Zi, Lai fu zi Cough with sputum -- Jie Geng, Gan Cao Distending feeling in the chest -- Gua Lou, Xie Bai Ma Huang Tang Ma HuangXing RenGui ZhiGan CaoJu HongBan Xia Su ZiFu LingBai QianHu Tao rou

8. Treatment Excess-type 1) Excess-type b) Wind-heat Signs & Symptoms: –Main Sym. : Gasping, Rapid breathing, flaring of nares, yellow sticky & thick sputum difficult to be expectorated. –Concurrent sym.: chest pain, irritability, headache, fever, sweating, constipation, thirsty, dark urine –Tongue: thin white or yellow tongue coating –Pulse: floating, slippery rapid Treatment Protocol: –Clear the exterior-heat –ventilating the Lung & stopping panting

9. Formula: Modifications: Headache -- Man Jin Zi, Chuan Xiong, Yellow Sputum -- Qian Hu, Gua Lou, Bei Mu Constipation -- Da Huang, Dark urine -- Hua shi, Tong Cao, Chi Xiao dou Irritability -- Shan Zhi Zi, Ma xing Shi Gan Tang Ma HuangXing RenShi GaoGan CaoHuang QinGua Lou Lian QiaoLou LuJie Geng

10. Treatment Excess-type 1) Excess-type c) Phlegm Accumulation Signs & Symptoms: –Main Sym. : Panting, cough, profuse, white & sticky phlegm, fullness sensation in the chest –Concurrent sym.: poor appetite, stickiness in the mouth, no thirsty, nausea or vomiting in severe cases –Tongue: thick, greasy, white tongue coating –Pulse: slippery Treatment Protocol: –Resolving sputum –Restore the reversed flow of Qi

11. Formula: Modifications: Panting -- Xuan Fu Hua Fullness sensation in the chest -- Gua Lou, Zhi Ke Poor appetite -- Bai Zhu, Shan Yao Nausea or Vomiting -- Zhu ru, Sheng Jiang Dampness -- Cang Zhu, Sha Ren Er Chen Tang + San Zi Yang Qing Tang Chen PiBan XiaFu LingGan CaoSu ziBai Jie Zi Lai Fu ZiHou PuXing Ren

12. Treatment Excess-type 1) Excess-type d) Phlegm-heat Accumulation Signs & Symptoms: –Main Sym. : Panting, cough, dyspnea, irritable feverish sensation & distending pain in the chest, yellow sticky sputum –Concurrent sym.: thirsty, like cold drinking, flushed face, dry throat, dark urine, constipation or bloody sputum –Tongue: yellow greasy coating –Pulse: slippery & rapid Treatment Protocol: –Resolving sputum –Eliminate lung heat

13. Formula: Modifications: Fever -- Shi Gao, Zhi Mu Sticky sputum -- Hai Ge Ke Abundant sputum + constipation -- Ting Li Zi, Da Huang, Mang Xiao stinking sputum -- Yu Xing Cao, Yi Yi Ren, Dong Gua Ren, Lu Geng Sang Bai Pi Tang Sang Bai PiHuang LianHuang QinZhi ziBei muXing ren Su ziBan Xia

14. Treatment Excess-type 1) Excess-type e) Stagnated Qi impairs the Lung Signs & Symptoms: –Main Sym. : Panting, short and rapid breathing, a feeling of obstruction in the throat, which are evoked usually by mental stress. –Concurrent sym.: frequent insomnia, palpitation, chest stuffiness, chest pain –Tongue: thin coating –Pulse: string Treatment Protocol: –To deal with the mental depression –Descending adverse flow of Lung Qi

15. Formula: Modifications: Palpation & insomnia -- Bai He, he Huan Hua, Zao Ren, Yuan zhi Chest distension & pain -- Xiang Fu, Xuan Fu Hua Qi Stag + Liver fire -- Dan Zhi Xiao Yao san Wu Mo Ying zi Chen XiangMu XiangBing LangWu yaoZhi ke Mu XiangXiang FuWu yao Regular Qi movement & stop the pain Sp. St.LiverKidney Smooth QiRegular Qi Warm Middle Jiao Qi Stag. digesting Hypochondrium pain; dysmenorrhea Hernia; dysmenorrhea; frequent urine;

16. Treatment Def.-type 2) Def.-type a) Qi deficiency (Lung & Spleen) Signs & Symptoms: –Main Sym. : dyspnea, tachypnea, short breath, low & weak voice, lower cough sound –Concurrent sym.: spontaneous sweating & aversion to wind, pale complexion, lassitude, epigastric distension & loose stool after meal, or defecation soon after meal. –Tongue: thin white or white & greasy coating –Pulse: thready Treatment Protocol: –Strengthening Spleen –Nourish Lung Qi

17. Formula: Modifications: Thin sputum + aversion to cold -- Gan jiang Loose stools -- Shan Yao, bian dou Yu Ping Feng San + Liu Jun zi Tang Dang ShenHuang QiBai ZhuFuLingBan XiaChen Pi Jie GengGan Cao

18. Treatment Def.-type 2) Def.-type b) Yin deficiency (Kidney & Lung) Signs & Symptoms: –Main Sym. : Panting & short breath worsening on exertion, thirsty, tidal fever, night sweating, sticky sputum with less amount and difficulty to be expectorated –Concurrent sym.: flushed face, irritability, feverish sensation in the palm & soles –Tongue: red tongue with thin yellow coating –Pulse: thready & rapid Treatment Protocol: -- Nourish Lung & Kidney

19. Formula: Modifications: Lung Yin Def. -- Bai He, Sha Sheng, Yu Zu Kid Yin Def. -- Long Gu, Mu Li Panting -- Ci Shi ( specify for kid yin def. type panting) Shen Mai San + Liu Wei Di Huang Wan Dang ShenMai DongTian dongShen diShan yu rouZe xie Dan PiGan Cao

20. Treatment Def.-type 2) Def.-type c) Yang deficiency (Kidney & Spleen) Signs & Symptoms: –Main Sym. : Chronic panting, more expiration & less inspiration, worse while making exertion, shortness of breath –Concurrent sym.: sweating, cold limbs, edema of face & legs, profuse, clear thin sputum, soreness of waist, lower back pain, pale or darkish complexion, frequent urination and polyuria during night –Tongue: Pale and enlarged tongue –Pulse: thready & deep & week ; large and rootless Treatment Protocol: -- Warming Yang

21. Formula: Modifications: Up-adverse flow of Qi -- Zi Shi yin, Ci Shi, Cheng Xiang Edema -- Ting Li Zi, Fang Ji, Jin Gui Shen Qi Wan + Shen Ge san Gui ZhiFu ZiRen ShengShen diShan yu rouZe xie Dan PiGan CaoGe JieBai GuoWu wei ziZu Ri

22. Prevention: 1.Fresh air, full sunlight, suitable temperature & humidity in the room 2.No smoking, no drinking 3.Have light food, avoiding too salty, too sore, hot or irritable food 4.In the stage of attack, patient should lie in bed. When necessary, give the patient with oxygen inhalation. 5.In the stage of intermission of panting, courage the patient to do more exercise to strengthen constitution.

23. Case History 1. Male 73 years Medical history: Medical history: Panting & coughing for several years, especially worse in winter. First visiting: Main complain: panting & coughing for several days Got cold several days ago and started coughing. Not stopping cough in the whole day, flaring of nares, yellow sticky & thick sputum difficult to be expectorated. distension feeling in the chest. Panting at night even can not fall in sleep. Fever & aversion to cold in every afternoon. Thirsty, no appetite, constipation, dark urine Tongue: red body less moisture with dry yellow coating Pulse: floating & slippery & rapid TCM diagnose: Wind-cold invasion + phlegm-heat accumulation + Yin Def. + lu. dryness Treatment protocol: Release the cold + clear the lung heat Formula: Ma Xing Shi Gan Tang: Ma huang 9, Xing Ren 9, Shi Gao 15, Gan Cao 3, Huang Qin 9, Zi Su Geng 9, Sang Ye 9, Zhi Ke 9, Jie Geng 6, Ji Nei Jing 6, Zu Ru 9

24. Case History 1. Male 73 years Medical history: Medical history: Panting & coughing for several years, especially worse in winter. Second visiting: Main complain: Panting & coughing Fever is almost gone, no aversion to cold, appetite is getting better, still cough & panting, however, patient could take a half lying position now, sticky sputum with little blood, dark urine Tongue: moisture red body with thin yellow coating Pulse: slippery & rapid TCM diagnose: Lung Dryness & heat Treatment protocol: Clear the lung heat, moisten the lung dryness Formula: Qin Zao Jiu Fei Tang: Sha Sheng 9, Sang Ye 9, Shi Gao 15, Chuan Bei Mu 9, Pi Pa Ye 9, Mai Dong 9, Bai Mao Geng 15, Ce Bai Ye 9, Zhi Mu 9, Gan Cao3 X 5 bags

25. Case History 1. Male 73 years Medical history: Medical history: Panting & coughing for several years, especially worse in winter. Third visiting: Main complain: Panting & coughing No fever, cough is getting better, no bloody sputum, still little sticky sputum, panting is getting calm down at night, appetite is better, Still feel tired and exhausted, little dizziness, Tongue: moisture red body with thin yellow coating Pulse: thready rapid TCM diagnose: Yin Def. + Lu. Dryness + Sp Qi Def. Treatment protocol: Nourish Yin, moisten the lung dryness, tonify the Sp Qi Formula: Sha Sheng mai Dong Tang: Sha Sheng 9, Sang Ye 9, Pi Pa Ye 9, Mai Dong 9, Fu Ling 15, Bian Dou 9, Lian Zi rou 12, Yuan Zhi 6, Kuan Dong Hua 9, Gan Cao 3

26. 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

28. 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