I now wish to discuss various respiratory conditions that you may see in clinic. (Some conditions or diseases have been specifically left out as these will be very unlikely to be seen in clinic as they are more serious and typically dealt with in hospital).
Sinusitis
As we are now aware the nose is the beginning of the respiratory system and a common condition seen in clinic is that of Sinusitis.
An inflammatory condition affecting the air-filled cavities of the head known as sinuses, their function being to warm and moisten inhaled air.
Typically affected after as part or after a common cold where mucus is or has been the main symptom, this collection of mucus in these cavities creates symptoms.
Symptoms: blocked nose, yellow or green nasal discharge, frontal headaches and extreme facial pain are often associated with this condition.
Conventional treatment protocols will include use of a decongestant such as Pseudoephedrine hydrochloride, Saline spray, mild pain killers such as Paracetamol/Ibuprofen, nasal corticosteroid such as sodium cromoglicate and in severe cases antibiotics are prescribed such as Doxycycline and Clarithromycin.
Chinese medicine sees this type of condition as a Lung Qi deficiency due to invasion from a wind cold/ heat.
The failure of the Lungs function to descend and disperse fluid as it becomes compromised now congeals creating mucus and now accumulates in these cavities.
Treatment: Symptomatic relief can often be given to this condition by local needling at Li 20 and threading the needle up towards bitong, an off channel extra point.
Additional points useful are Yin tang, Li4,11, Lu7,5, St40.
Tan balance method: would consider Li4, St 43, Lv3, Kd2, Lu10 as an alternative approach.
Sore throat / Tonsillitis
This respiratory condition is considered conventionally, as a viral or bacterial infection causing inflammation to the local area, although there are no distinguishing differences between the two causes. Often an anti biotic such as Penicillin (e.g Amoxicillin) is typically prescribed.
From a Chinese Medicine perspective, it is common that ‘Wind Heat invasion’ has affected the Lung or Stomach.
Treatment: traditional points prescribed are Lu 10,11, St 44
Tan style would use Lu9,10, St41, Sp5, P7, Li 5
Coughs
One of the most common aspects of a cold are caused by two mechanisms.
1. Stimulation by a foreign body, secretions, smoke heat on the sensory nerves in the epithelium.
2. Over sensitivity of the cough reflex receptors which presents as a tickling sensation in the throat from viral infection.
The Chinese view on this respiratory condition is of Lung Qi deficiency and the Lungs failing to descend qi.
This failure now creates an excess of Qi in the upper Jiao due to deficiency and coughing is the body’s natural mechanism to re balance the Qi of the chest.
Damage to the Lungs can be from external or internal conditions.
External pathogen invades the Lungs by passing the Wei Qi barrier, compromising its functions or internally from itself or other organs.
Lung yin deficiency causing Lung dryness, will fail to descend Lung Qi or Kidney Qi failing to grasp Lung Qi, results in coughing.
Also, if Spleen yang deficiency is present, this now fails to transport fluid to the Lung, causing damp and phlegm as its mechanism of Transportation and Transpiration is impaired.
Treatment: Typical points prescribed will be Lu 7,9, Bl13 & Ren17
Asthma
This respiratory condition typically presents itself with Shortness of breath and the exhalation process is particularly difficult giving a sensation of the chest fullness and over inflation. Another typical symptom is that of a cough and a whistling sound during the expiration process. For obvious reasons, this can be a serious medical condition leading to a panic attack as the person fights to breath.
The condition occurs due to hyper sensitivity of the airways, affecting the Bronchi.
When these react to a stimulus, three processes take place resulting in obstruction of air flow and the reduction of air entering the Lungs.
1. Constriction of the smooth muscle. The bronchus of the lung and the smooth muscle in it, reacts and tenses resulting in the narrowing of the air way and restriction of the amount of air into the Lung.
2. Excessive levels of mucus, this occurs from the inner lining of respiratory passages as they become irritated, they begin to produce increased amounts to help flush and move said irritant.
3. Edema, this occurs due to increased mucus levels that now accumulates in the bronchus walls.
There are several reasons why stimulation of this nature occurs causing Asthma, the most common being that of an Allergy.
Inhaled substances act on mast cells found in the walls of the bronchi. These cells form part of the immune system and when stimulated secrete several substances, one being histamine. The most common triggers are dust mites and other air borne irritants that also trigger hay fever.
Other trigger situations linked to this condition are..
1. Emotional stress – in Western medicine it is unknown what the link and mechanism is, but I would suggest from a Chinese perspective that the link is concerning the spiritual connection of the Shen to the Po.
2. Medication is also a known trigger the most common being aspirin.
3. Physical exercise can also affect it by the process of rapid breathing and the inhalation of cold air.
4. Respiratory infection from chest infections is sometimes a precursor to an attack.
Treatment is administered via a hand-held inhalers, this vasodilates widening the bronchi and relaxes the smooth muscle reducing construction. One of the most common prescribed inhalers are Salbutamol but a preventer inhaler containing a steroid such as Beclomethasone, is also frequently prescribed.
Treatment: Useful points during an Astma attack would be Ren 17, P6 (to open the chest), Lung 1,7 (to descend Qi), Yin Tang to calm shen. Sp5 to Sp6 would balance the stomach channel over the throat and upper chest.
Chronic Obstructive Pulmonary disease (COPD)
This common respiratory condition presents initially with a cough, especially first thing in the morning, is the result of the body attempting to remove accumulated secretions formed in the bronchial tree during sleep after laying down flat. From this, dark phlegm is produced and eliminated to clear the air waves.
This dark phlegm is the result of two primary factors
- Long-term Smoking
- Severe air pollutants.
These pollutants or soot particles, in regard to smoking, damages the hairs that are found on respiratory mucosa cells whose function is to remove secretion and dirt particles trapped in the mucus, clearing the airways.
Further progression of the illness affects the smooth muscle lining of the bronchi, causing irritation, contraction and restricted airflow resulting in breathing difficulties.
It has several similarities to Asthma with increased mucus production, as the body attempts to flush the irritation from the respiratory system but unlike Asthma, has no emotional link. This is seen purely as a condition where contaminated air quality has entered the Lungs and damaged it over a prolonged period.
Typical treatment is given using Bronchi dilators such as Salbutamol and expectorants such as Carbocisteine to assist the removal of phlegm.
Acute Bronchitis
Is a respiratory condition where inflammation of the Trachea and Bronchi occur. Arising usually from viral infection, especially in the previously healthy but a bacterial precursor such as strep or influenza could have lead to a viral infection and especially in patients with pre-existing conditions.
Starting with an unproductive, tickly cough with discomfort behind the sternum and tightness of chest, wheezing and breathlessness. The cough later becomes productive with yellow or green phlegm, mild fever and a wheezing, popping sound can be heard during respiration.
In healthy patients, the condition can spontaneously improve within 7 days, but chronic conditions or for patients with pre-existing conditions, antibiotics such as amoxicillin will be prescribed.
Occupational Lung Diseases
Pneumoconios is a condition found with patients who worked in the coal industry. Coal dust particles are retained in the airways of the Alveoli and the conditions severity relates to amount of dust exposure, especially with face workers having the highest incidence.
Silicosis is a condition found in stone masonry, sand blasters and foundry workers where inhalation of silicon dioxide (silica) has occurred. Unlike coal dust this kind is highly fibrogenic requiring only 3g of silica to kill a patient as it is very toxic to the alveolar macrophage in the Lung.
Asbestosis comes from the inhalation of a mixture of silicates, Iron, Nickel, Cadmium Magnesium and Aluminum making up fibers which are used widely for the roofing and the fireproofing industry. Development from exposure may see no related diseases for many years later with typical symptoms of breathlessness and chest pain and finally death through Lung cancer.
Respiratory Conditions in Chinese Medicine and its Lung Patterns/ Syndromes
The Lungs, often referred to as the delicate organ, controls the skin and influences defensive Wei Qi and as such, is the most susceptible of the organs to be directly affected by an EPF.
Once a pathogen engages in it’s struggle with Wie Qi, the Lungs defusing and descending function is impaired and symptoms such as sneezing, blocked nose and coughing begin once impaired through various means of external & internal patterns of disharmony.
Diet is also a major contributing factor as food has energetic qualities and large consumption of hot or cold or raw food will all influence the Spleen (the mother to the Lung in the 5 element model). Cold and raw food creates phlegm, it is often said the spleen creates phlegm and the Lungs store it.
In the case of phlegm heat, increased amounts of greasy or spicy foods and alcohol will on contribute to this pattern.
Smoking has a drying hot quality leading to yin deficiency.
Lung Qi and Yin are both affected by overuse of the voice and people with speaking jobs e.g. teachers may suffer from this.
The emotions have a key fundamental effect on the Lung also, as the prolonged emotion of sadness and grief causes Lung Qi deficiency and further emotion of worry also knots the Qi of the chest, giving rise to symptoms of tight chest and breathlessness, this is often seen during panic attacks.
Our modern lifestyle also contributes to weakness to Lung qi as sitting for prolonged periods bent over a desk impairs normal flow of qi in the chest.
Finally, the most important aspect of healthy Lung Qi is the understanding that no heredity weakness has been passed on in your Jing! “You are your parents”…as if one of the parents had a Lung disease at a patients conception, this would in theory give a pre disposition to Lung weakness.
Empty/ XuPatterns of the Lungs
Lung Qi Xu
Sx -This pattern symptoms begins to show minor deficiency in the various aspects to of the Lungs Function. When trying to identify the symptoms of lung Qi deficiency try to think of how Qi deficiency would manifest, so tiredness, empty slow pulse and a pale tongue, whilst knowing what functions the Lung does will clearly identify the pattern.
Typical manifestations of Lung Qi Xu are slight breathlessness, minor cough, spontaneous day time sweating, weak voice, fatigue from talking, bright pale complexion.
Tongueis pale
Pulseis empty especially in the Lung position
Rx -Points prescription: Lu 7,9, Ren 12,6, St 36, Bl 13
Lung Yin Xu
Sx-This pattern presents with typical Lung style symptoms from above, but now adds more signs of Heat and Dryness. So dry mouth & night sweating, dry cough, dry throat, hoarse voice are all enough symptoms to diagnose the Lung pattern from Qi Xu to Yin Xu.
Tonguewithout coat in front position
Rx -Points prescription: Lu9,10 Ren17, 12, 4, Kd6, Li 11, Bl13, 43
Lung Dryness
Sx -This is a precursor to Lung Yin deficiency, so symptoms are more towards dryness such as dry skin, dry throat, dry cough, dry Tongue, hoarse voice. The condition arises by exterior dryness maybe from working conditions working in hot dry environments or through lengthened spells in dry arid environments. Irregular eating times and eating late at night or worrying whilst eating can all induce lung dryness.
Rx -Points prescription: Lu9, Ren 4, Kd 6, Sp 6, Ren 12, St 36
Exterior
Full Patterns.
Wind cold/ heat
Invasion by wind cold and wind heat are the two primary exterior full patterns.
This section has already been discussed in length involving the Wei Qi disfunction and why the functions of the Lungs now become impaired. Just remember the Lungs open into the nose and control breathing combined with aversion to cold and Tai yang pains is enough to diagnose wind invasion
Wind Cold -Clinical manifestations for diagnosis are Aversion to cold and fever, cough, itchy throat, slight breathlessness, sneezing, runny nose but clear mucus, achy body, occipital headaches.
Tongue -Thin white coating
Pulse –Floating and tight.
Wind Heat Invasion –is the above symptoms with heat signs such as sore throat, thirst, slight sweating, the mucus colour now changes from clear to yellow indicating heat presence in the Lung.
Tongue –is redder in front lung position
Pulse-is Rapid and floating or above qi in nature.
Rx –Points Prescription, Lu7, Li6, 7, 4 Ren9, Du 26, Bl12, 13
Invasion of Lung by Wind-Water
Sx -This pattern slightly differs from a standard wind cold attack in that the main presenting condition is facial edema, swelling of the eyes that’s spreads over the body.
It occurs from wind cold invasion, but it directly effects the lungs function of controlling the passage of the up source of water and fails now to direct fluid downwards, hence edema of the face and upper body is seen rather than lower where the Kidney qi dysfunctions.
Tongue -has a sticky white coat Pulse-is Floating and slippery.
Rx -Points Prescription Lu7, Li 4,6 Ren 9, Bl 12, 13
Interior
Full patterns
Lung Heat
This is typically from initial external heat invasion that has penetrated through the levels and is residing in the organ.
Other causes are from a digestive basis. Through the consumption of hot energetic foods/drinks on a regular basis, in the five-element model, heat is transferred through the Spleen to its child the Lung.
Also, smoking adds heat into the Lung and contributes to the drying of the Lungs.
Sx -Typical symptoms of this pattern include coughing and breathlessness now combined with heat signs of sensation of hot chest, aching in the chest, thirst and red face. If this continues this pattern can progress into Lung Yin deficiency.
Tongue –Red with yellow coat
Pulse -Rapid and above Full and robust.
Rx –Points prescription Lu 1, 5, 7, 10, Li11
Damp-Phlegm in the Lung
This condition derives from two factors…
1.Deficiency of the Lungs to disperse and descend allowing fluid to congeal and form phlegm, this now becomes retained in the Lung
2.From Damp, by a dysfunction of the spleen’s ability to correctly T&T, hence the phrase the spleen produces phlegm and the Lungs store it.
Although born of deficiency, it creates an excess pattern of phlegm and is viewed as an excess interior cold pattern.
Sx -Typical symptoms with this pattern are now a chronic cough, with profuse white sticky sputum which is productive in nature. Patients typically have a pasty white complexion, short of breath and dislike lying flat.
Tongue –is swollen with sticky white coat
Pulse -is Slippery or Soggy.
Rx -Points prescription: Lu 5,7, Ren17,12, P6, St 40.
Cold phlegm in the Lung
This is similar to damp phlegm, but now has more cold manifestations and the characteristics of the phlegm changes from sticky, to now watery and white with formation in throat.
The patient may also complain of signs of coldness in the hands or other parts of body.
Tongue -is swollen wet with sticky white coat
Pulse –Slow & Slippery
Rx –Points prescription: Lu 1,7, Ren17, P6, St 40, Bl13, 20, 23
Phlegm Heat in The Lungs
Principle differentiation for this pattern is one of a Barking cough with sticky yellow or green phlegm.
The pathology is the same as the above patterns but with heat signs also, like thirst, phlegm in the throat, feeling hot, insomnia & agitation.
Tongue -is Red, Swollen with sticky yellow coating
Pulse –Rapid and slippery
Rx -Point prescription: Lu 5,10, Li 11 St40, Bl13, Du 14
Acupuncture points to treat respiratory conditions
Lung 1(ZhongFu) Middle Palace
Located 6 cunfrom the lateral midline, in the first intercostal space 1cun inferior to Lung 2
Transverse oblique insertion, medially along the intercostal space 0.5 cunmax
• Indicated for excess lung patterns
• Descends lung Qi
• Resolves phlegm clears heat
• Disperses fullness of chest
This is the front Mu point of the lung and acts directly on the organ itself, not the channel.
It is a great point to clear all excess types of chest conditions where two much qi of the chest is residing in the upper and is failing to descend whether through deficiency or excess.
Indications: Coughing, coughing blood, coughing phlegm, asthma or breathlessness when chest feels full even painful.
Lung 5(Chi ze) Cubit Marsh, outside marsh.
Located lateral to the bicep brachia tendon and in a depression of the cubical crease
Perpendicular insertion 0.5-1cun depth avoiding the cubical vein
• Descends rebellious lung Qi
• Clears lung heat.
• Resolves phlegm retention in lungs
• Regulates passage of water
Lu5 is the water point of the lung channel and as such has great heat clearing properties, whether the condition is excess or deficient.
The point is also a very important point to regulate the passage of water, if the lung fails to descend and disperse, regulation of urination can be impaired or swelling of the four limbs cab occur
Indications: Cough, asthma, wheezing breathlessness, fullness of chest.
Lung 7 (Lie que) Broken sequence
Located 1.5 cunproximal to the wrist crease on radial side of the forearm. The point is slightly medial to the mid line of the radius and between two clefts of two tendons.
Transverse insertion proximal or distal along the channel 0.5-1 cun
• Descends lung Qi
• Circulates Wei Qi release the Exterior expels wind
• Regulates passage of water
• Headaches and stiffness of Neck
• One sided headache
• Calms the Po
Lung 7 is also referred to as the master point of the head and can treat many issues of the head and neck.
It Is the opening point of the RenMai or conception vessel, tonifyingthe Yin and regulating the uterus.
The point has a major importance in the treatment of wind from either interior or exterior.
From a spiritual perspective, this is an important point in the treatment of sadness and grief settling the Po or lung spirit.
Lung 9 (Tai yuan) Great Abyss
Level with the wrist crease the point is in a depression at the radial stylus process
Perpendicular insertion 0.3-0.5 avoiding radial artery.
• Tonifylung Qi and Yin
• Descends lung Qi
• Regulates the 100 vessels
Lung 9 is the Shustream/yuansource point of the lung Meridian. The point is indicated for deficiency Xutype. Indications causing breathlessness, coughing or wheezing. This point assists in resolving phlegm from deficiency of lung qi and Yin.
Can be used for Emotion Grief and depression.
Lung 9 is said to influence blood vessels and the circulation of blood throughout the body.
Lung 10(Yu Ji) Fish border
Located on the Palmer aspect of the hand at the mid-way point of the first metacarpal bone of the thumb, in a depression between the bone and the thenarmuscle.
Perpendicular insertion 0.5-1 cundepth
• Clears Lung heat
• Benefits throat, sore/ dry/ loss of voice
• Clears blood from heat in the three Jiao’s
Lung 10 is the Ying Spring point of the channel and as such is used for clearing heat from the channel and its associated Zang.
Used extensively for a wide range of throat disorders ranging from sore throats to obstructed even loss of voice. The point is associated with bleeding disorders such as coughing of blood, vomiting blood or urination of blood. This is from the lung’s association with the vessels and heat from the lung being transmitted through them. Due to the mutually connected relationship with the heart any heat of the lung is easily transmitted to the heart and thus can cause many emotional issues causing agitation, anger even mania. So, this point could be used
Bladder 11 (Da zhu) Great Shuttle
Located 1.5 cunlateral to the spine from the first thoracic vertebra
Oblique insertion towards the spine 0.5 to1 cun
Caution Perpendicular insertion could cause pneumothorax.
• Benefits the bones and joints
• Expels pathogenic wind
• Descends rebellious lung qi benefits the chest.
Bladder 11 is a Huimeeting point of the bones and as such is indicated for various bone diseases rigidity and pain especially in the upper back and neck. It is typically used in Bi syndrome conditions that have affected the bones and joints.
The point is very useful for releasing exterior wind in the early stages when the pathogen is in the Tai Yang channel
Bladder 12 (Fengmen) Wind Gate
Located 1.5 cunlateral to the spine from the second thoracic vertebra
Oblique insertion towards the spine 0.5 to 1 cun
Caution Perpendicular insertion could cause pneumothorax.
• Expels pathogenic wind from the exterior
• Strengthens Wei Qi and closes the pores.
• Descends and disperses Lung Qi
• Benefits the Nose
As the name suggests, Wind Gate (Bladder 12) has major implications in the expelling and releasing of wind and can be either needled or cupped.
It has an ability to what’s termed as “firm the exterior”, as the Lung controls the opening and closing of the pores this point strengthens the body’s ability to close the body, so pathogens cannot enter through the skin.
The point is also associated with all kinds of nasal disorders, nosebleeds, blockages and discharges
Bladder 13 (FeiShu) Lung Shu
Located 1.5 cunlateral to the spine from the second thoracic vertebra
Oblique insertion towards the spine 0.5 to 1 cun
Caution Perpendicular insertion could cause pneumothorax
• TonifiesLung Qi
• Nourishes Lung Yin
• Clears Heat from the Lung
• Releases EPF from the exterior
Bladder 13 the Back Shupoint of lung is the number one point for treating Lung disorders. It can be used for excess and deficiency conditions and is the primary point for Lung Qi and Yin deficiency. It treats conditions associated with Lung Qi Xusuch as Breathlessness, coughing, weak voice, Asthma. Used to tonifythe lung where through prolonged sadness and grief has occurred depleting it and drying the lung Yin
Bladder 43(Gaohuangshu) Vital region
Located 3 cunlateral to the mid line of the spine level with the fourth vertebra and adjacent to the medial border of the scapula
Oblique 0.3 insertion
Caution deep insertion medially will result in pneumothorax
• TonifiesQi of Lung, Heart, Kidneys, Spleen, Stomach and Pericardium
• Nourishes Yin and Clears Heat
• Calms the Shen
• Resolves Phlegm
This is a primary Tonificationpoint of the entire body and is used for all forms of exhaustion, chronic illness and general deficiency. Ancient scriptures discuss the use of this point primarily used with moxaand was stated that no disease was beyond its reach and no disease it could not cure but all mention it used with moxanot acupuncture to achieve this.
Gallbladder 20 (FengChi) Wind Pool
Located under the occiput of the skull midway from Du16 to Sj17 behind the ear, a palpable depression can be noted
Oblique insertion towards the opposite eye up to 1 cun
• Expels Wind
• Benefits the Head
• Clears Headaches/ Dizziness/ Hypertension
• Opens the sense organs/ unblocks ears and nose.
Located on the back of the head the depression is said to represent a pond or pool, the location of it is prone to invasion which effects the head and neck. As such, it is a primary point to expel exterior pathogenic wind. This point has a duel wind purpose in that is also expels internal wind generated by the Liver
Stomach 40 (FengLong) Abundant Bulge
Located on the Lateral aspect of the lower leg mid-way between the popliteal crease and the lateral malleolus the point is one cunlateral to ST 38
Perpendicular or Oblique insertion 1-1.5 cun
• Transforms Phlegm of any kind or any part of the body
• Clears Damp
• Clears Lung Phlegm resolves coughing
• Calms the mind/ Clears the head
Stomach 40 is the most empirical point to resolve phlegm in the body it is said the spleen produces phlegm and the lungs store it.
I would suggest that with the intertwined connection of the earth element (that of stomach and spleen), little differentiation should be made.
Mental illness in Chinese medicine can be associated with Phlegm visible and invisible, so this point should be used on all conditions affecting the mind
Du 14 (Da Zhui) Great Vertebra
Located on the midline of the spine in a depression inferior to C7 vertebra
Perpendicular –oblique superior 0.5 to1 cun
• Expels wind
• TonifiesWei Qi
• Clears Heat
• TonifiesDeficiency
• Shoulder and Neck issues pain
• Problems of the voice/ Throat
Du 14 is the meeting point of all the Yang channels and as such has an action on all six channels either by tonifyingthe Yang of the back, strengthening the exterior weiqi or clearing heat from them. Classical scripture states that this point is to be used for deficiency and exhaustion cases.
Large intestine 4(He Gu) Joining Valley
Location is on the dorsum of the hand at the midpoint of the second metacarpal bone between Ling Guand Da Bai
Perpendicular insertion up to 1.5 cun
Contraindicated in Pregnancy
• Master point of the Face
• Expels wind Releases the exterior
• Regulates Wei Qi and adjusts sweating.
• Induces Labor
This is the Yuan source point of the Large intestine and probably the most commonly used point. Its primary function is to expel wind cold/ heat from the exterior.
It is classed as the most important point in the treatment of conditions associated with the face. The Point has a strong action on promoting labor and so is contraindicated in pregnancy but can only be used to help induce if the baby has gone beyond full term.
Large intestine 11(QuChi) Pool at the bend
Located on the elbow crease midway between lu5 and the lateral epicondyle of the humerus
Perpendicular insertion up to 1.5 cun
• Clears Heat
• Cools blood
• Benefits the skin
• Regulates Qi and Blood
• TonifiesDigestive system regulates counterflowof Qi
Large intestine 11 is one of the most important points to clear heat from the body, so it is extremely useful in the treatment of febrile disease and is very important in its usage of various skin conditions. The point has a usage in modern conditions and is an Empirical point in the treatment of hypertension.