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Module 5   Lesson 8   Fei

Lungs: all patterns

Cough, breathlessness, phlegm or dryness: is it the Lungs falling short, something from outside, or Phlegm lying inside, and which finding decides?

After this lesson you know the Lung patterns of ch. 35 as deficiency, exterior excess, interior excess and combined, with signs, tongue, pulse, cause and principle; you see where patterns 16 and 17 from module 1 sit; and you can read the four kinds of Phlegm in the Lungs by colour, thickness and temperature. The features are learning anchors, not validated criteria.

EXTERIOR, p. 579 INTERIOR EXCESS, p. 584 DEFICIENCY, p. 573 17 Wind-Cold 17 Wind-Heat Wind-Water Wind-Dryness, textbook pulse floating: release first Lung-Heat Phlegm-Heat Damp-Phlegm Cold-Phlegm Phlegm-Fluids 16 Lung- and Wei-Qi Lung-Yin deficiency Lung Dryness weak Wei: prone to Wind Dryness can become Yin xu the Spleen makes Phlegm, the Lungs store it Combined, p. 594 Lungs and Spleen: Qi Lungs and Kidneys: Yin Kidney-Lung: lesson 10 Liver-Fire: lesson 7 Heart and Lungs: lesson 5
Schematic; xu is the Chinese for deficiency. Headings after Maciocia ch. 35: deficiency p. 573, exterior excess p. 579, interior excess p. 584, combined p. 594. Blue deficiency, red excess; border blue Cold, red Heat; grey and dotted is textbook knowledge or another lesson. Damp-Phlegm with Heat becomes Phlegm-Heat, with Cold it becomes Cold-Phlegm; Wind-Heat that goes deeper becomes Lung-Heat; long-standing Lung-Heat consumes the Yin (textbook knowledge).

Know by heart

  • Deficiency: Qi, Yin, Dryness. 16 Lung- and Wei-Qi deficiency: short of breath, weak voice, spontaneous sweating, frequent colds; pale; empty, especially the right Cun; tonify. Lung-Yin deficiency: dry cough or scanty sticky phlegm, hoarse voice, night sweats; red without coating; thin-rapid; nourish Lung-Yin. Lung Dryness: dry without Heat; tongue dry; moisten. mnemonic: weak, scorched, parched.
  • From outside: Wind with a companion. 17 Wind-Cold (chills more than fever; floating, tight) and Wind-Heat (fever more than chills, sore throat; floating, rapid): release the Exterior. Wind-Water: sudden swelling of the face and eyelids; floating-slippery; release the Exterior and drain water. mnemonic: if the pulse floats, the pathogen is outside.
  • Lung-Heat. Acute cough, fever, thirst, chest pain, scanty phlegm; red with yellow coating; overflowing or full, rapid; clear Lung-Heat, make Lung-Qi descend.
  • Four kinds of Phlegm in the Lungs. Damp-Phlegm: profuse, white, sticky. Cold-Phlegm: white and watery, with cold. Phlegm-Heat: thick yellow or green; red, sticky yellow coating; slippery-rapid. Phlegm-Fluids: thin, frothy, wheezing, worse with cold. Each time resolve Phlegm and make Lung-Qi descend, plus warm or clear. mnemonic: white sticks, white and wet is cold, yellow is hot, froth is water.
  • The Spleen makes Phlegm, the Lungs store it. With chronic Phlegm in the Lungs you also tonify the Spleen. Combined patterns: Lungs and Spleen (Qi; Earth nourishes Metal) and Lungs and Kidneys (Yin).
  • Red flag. Coughing up blood, a cough for more than three weeks, sudden breathlessness, fever with rapid breathing, swollen eyelids after a sore throat: see a doctor first.

The rest of this lesson is reference.

Lungs: all patterns: Cough, breathlessness, phlegm or dryness: is it the Lungs falling short, something from outside, or Phlegm lying inside, and which finding decides?
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Three practice questions from this lesson

Case. Teacher, 40: five colds every winter, sweats easily in the daytime, soft voice, short of breath on the stairs. Scanty phlegm. Tongue pale; pulse weak, especially at the right Cun.
  1. 16 Lung- and Wei-Qi deficiency
  2. Damp-Phlegm in the Lungs
  3. Lung-Yin deficiency with Empty-Heat

Answer: 16 Lung- and Wei-Qi deficiency. Too little Qi for breath and voice, too little Wei-Qi to close the skin. No dryness, no red tongue and no Empty-Heat, so not Lung-Yin deficiency; scanty phlegm, so not Damp-Phlegm. First: have recurrent infections checked.

Case. Woman, 55: a dry cough for months, now and then a little sticky phlegm, hoarse voice, sweating at night, warm cheeks in the afternoon. Tongue red without coating; pulse thin and rapid.
  1. Invasion by Wind-Dryness
  2. Lung Dryness
  3. Lung-Yin deficiency

Answer: Lung-Yin deficiency. Dry with Empty-Heat and a red tongue without coating: Yin deficiency. Lung Dryness lacks the Empty-Heat; Wind-Dryness is acute with a floating pulse. First: a cough for more than three weeks and night sweats go to the GP (chest X-ray, tuberculosis).

Case. Man, 30, since the wood stove has been lit: dry cough, dry nose and lips, dry skin. No night sweats, not warm. Tongue dry, normal colour.
  1. Lung-Heat
  2. Lung Dryness
  3. Lung-Yin deficiency

Answer: Lung Dryness. Dryness without Empty-Heat and without a red tongue. Textbook knowledge: if it stays dry, it can become Yin deficiency.

The rest of this lesson

In the course you get the step-by-step explanation, 14 case-based practice questions, 17 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 5: Patterns.

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