of the chest. They are the minister herbs and, together with the emperor herb, treat"Fullness above". – Rou Gui warms the Kidneys, expels Cold, stimulates the Kidney grasping of Qi andtherefore calms breathlessness. – Dang Gui nourishes the Blood and tonifies the Liver. Together with Rou Gui, whichtonifies the Kidneys, it tonifies the “Emptiness below”. It also stops cough and subduesrebellious Qi. – Sheng Jiang and Su Ye are the assistant herbs and they scatter Cold and hlep to calmbreathlessness by subduing rebellious Qi. – Zhi Gan Cao and Da Zao, messenger herbs, harmonize the Middle.This prescription differs from the previous two in that it deals with both the "Emptiness below"and the “Fullness above”. It is therefore better indicated when there is pronounced fullness of thechest with expectoration of white phlegm and cough. It deals with both the Manifestation(accumulation of Qi in the Lungs) and the Root (deficiency of the Kidneys).Variations– If Qi rebels upwards and there is a feeling of movement under the umbilicus, add ChenXiang Lignum Aquilariae.Patent RemedySu Zi Jiang Qi Wan(Perilla-seed Descending Qi Pill)Su Zi Fructus Perillae frutescentisBan Xia Rhizoma Pinelliae ternataeHou Po Cortex Magnoliae officinalisQian Hu Radix PeucedaniChen Pi Pericarpium Citri reticulataeChen Xiang Lignum AquilariaeDang Gui Radix Angelicae sinensisSheng Jiang Rhizoma Zingiberis officinalis recensDa Zao Fructus Ziziphi jujubaeGan Cao Radix Glycyrrhizae uralensis© Giovanni Maciocia 1994 Published by Churchill Livingstone.
ExplanationThis remedy is similar in composition to the homonymous formula. It restores the descending ofLung-Qi and tonifies Kidney-Yang.The tongue presentation appropriate to this remedy is a Pale and Swollen body.Case History 3.2 Breathlessness: Lung- and Kidney-Yang Deficiency-Female, Age 48A 48-year-old woman had been suffering from breathlessness for the previous 10 years. Shefound it difficult to breathe in and was worse at night. The breathlessness seemed to have startedafter being caught in a dust storm in the Middle East, after which she contractedbroncho-pneumonia. She had had pneumonia previously as a child. She also experienced fluidretention in the abdomen and ankles for the previous ten years. She was often constipated andfelt cold, especially in the legs.Her pulse was Fine and Deep and particularly Weak in both Rear positions. Her tongue was Paleand Swollen and had a sticky-white coating (Plate 3.1(97)).Diagnosis This is a clear condition of breathlessness from Lung- and Kidney-Yangdeficiency. She obviously had had a weakness in the Lungs sincechildhood deriving from the pneumonia, later aggravated by thebronchio-pneumonia 10 years before. Due to her age, the Kidney energystarted to decline and, combining with the Lung deficiency, triggeredoff the onset of her breathlessness. The Kidney-Yang deficiency isconfirmed by the fluid retention, the constipation, the cold feeling of thelegs and the very Weak pulse on both Rear positions.Treatment This lady was treated with both acupuncture and herbs. The acupuncturetreatment was very simple, basically aimed at tonifying the Lungs andKidneys with ST-36 Zusanli, SP-6 Sanyinjiao, BL-13 Feishu, Du-12Shenzhu and BL-23 Shenshu. In addition to these points, the Directingvessel opening points were used every time, i.e. LU-7 Lieque on theright and KI-6 Zhaohai on the left to tonify Lungs and Kidneys.The herbal prescription used was a variation of Su Zi Jiang Qi TangPerilla Seed Lowering Qi Decoction:Su Zi Semen Perillae frutescentis 6 gFa Ban Xia Rhizoma Pinelliae ternatae 6 gQian Hu Radix Peucedani 4 gHou Po Cortex Magnoliae officinalis 4 g© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Rou Gui Cortex Cinnamomi cassiae 1.5 gDang Gui Radix Angelicae sinensis 6 gRou Cong Rong Herba Cistanchis 6 gZhi Gan Cao Radix Glycyrrhizae uralensis praeparata 3 gThe combination of acupuncture and Chinese herbs produced animmediate improvement which then continued steadily until most of hersymptoms were relieved after a few months.Case History 3.3 Breathlessness: Lung- and Kidney-Yang Deficiency-Female, Age 42A 42-year-old lady suffered from breathlessness since the age of 7. It had got worse sincemoving to an old and dusty house 13 years previously. She found it difficult to breathe in, wasworse at night and worse from exposure to cold or dust. She also suffered from lower backacheand dizziness. She had two children and her breathelessness had been better during bothpregnancies. She felt cold easily and her ankles often swelled up.When she was 6 months old she contracted whooping cough which lasted for a long time.Her pulse was Deep and Weak, especially on both Rear positions (Kidneys). Her tongue wasRed, Stiff and had a shallow Stomach crack with a yellow coating (Plate 3.2(98)).Diagnosis The breathlessness was due to a deficiency of the Yang of both Lungsand Kidneys. Originally, it may have been due to a Lung deficiencyonly, following the weakening of the Lungs from whooping cough.Later on, the onset of Kidney deficiency contributed to thebreathlessness. Difficulty in breathing in, feeling cold, backache,swollen ankles, dizziness and Weak pulse on Rear positions, allindicated Kidney (Yang) deficiency. The fact that she got better duringthe pregnancies also pointed to a Kidney deficiency. However, thetongue pointed to another co-existing condition of Heat and Phlegm.The deficient Lung and Kidneys failing to transform fluids led to theformation of Phlegm which further aggravated the breathlessness. Aftera long time, Phlegm easily leads to the formation of Heat. Thus, thiscase shows a clear combination of Deficiency (of Lungs and Kidneys)and Excess (Phlegm-Heat in the Lungs) and of Cold (fromKidney-Yang deficiency) and Heat (in the Lungs). The Root is thedeficiency of Lung- and Kidney-Yang while the Phlegm-Heat in theLungs is the Manifestation.Treatment Since this is an internal condition we can treat both the Root and theManifestation simultaneously, i.e. tonifying Lung- and Kidney-Yang,restoring the descending of Lung-Qi and resolving Phlegm and clearing© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Heat. As the pathogenic factor is internal, we can simultaneously tonifythe body’s Qi (i.e. Lung- and Kidney-Yang) and expel the pathogenicfactor (i.e. Phlegm-Heat).She was treated with acupuncture only using the following points atvarious times during 12 months of treatment:Ren-12 Zhongwan, Ren-9 Shuifen and ST-40 Fenglong were used toresolve Phlegm. In addition, ST-40, in combination with P-6 Neiguan,opens the chest and helps breathing. P-6 Neiguan was used to open the chest and alleviate breathlessness. Directing vessel (i.e. LU-7 Lieque on the right and KI-6 Zhaohai on theleft) was used several times to restore the descending of Lung-Qi andstimulate the Kidney’s grasping of Qi. This extraordinary vessel is veryimportant for the treatment of chronic breathlessness from Lung andKidney deficiency. BL-13 Feishu, BL-20 Pishu and BL-23 Shenshu were used to tonifyand warm Lungs, Spleen and Kidneys with needles and moxa. LU-5 Chize was used to clear Heat and resolve Phlegm from the Lungs. KI-7 Fuliu and SP-6 Sanyinjiao were used to tonify Spleen andKidney-Yang and resolve oedema. Needles and moxa were used.This patient’s attacks of breathlessness drastically decreased in intensityand frequency over a 12-month period of treatment.Case History 3.4 Breathlessness: Lung- and Kidney-Yang Deficiency-Female, Age 39A 39-year-old woman suffered from breathlessness since the age of 4. She found it difficult tobreathe in, sweated easily in daytime and felt usually cold. She felt easily tired and also sufferedfrom what was diagnosed as allergic rhinitis. Her nose was almost always running (white mucus)and she frequently sneezed when exposed to dust and dogs or cats. She also had myomas in theuterus which occasionally caused bleeding in between periods. The blood was not dark and therewere no clots.Her pulse was generally Weak and her tongue was Pale, with swollen edges (of the Spleen-type),a dirty coating all over and two deep transversal cracks in the Lung area.Diagnosis This breathlessness is also due to Lung- and Kidney-Yang deficiency. Itstarted in childhood with a Lung deficiency most probably due torepeated invasions of Wind not treated properly (see two transversal© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Lung cracks). It later affected the Kidneys as well becoming unable tograsp Qi. The Spleen is also deficient as evidenced by the tiredness, theswelling on the edges of the tongue and the Weak pulse. Symptoms ofLung deficiency are the breathlessness and the daytime sweating. Thedifficulty in breathing in is due to Kidney deficiency. Besides this, thereis also Phlegm deriving from the deficiency of Spleen, Lungs andKidneys. The Phlegm can be observed in the swelling of the tongue, thedirty tongue coating and the myomas in the uterus. These could also bedue to stasis of Blood but this is not the case here as the blood is notdark with clots.Treatment In this case, as in the previous one, the condition is internal and we cantreat both the Root (deficiency of Yang of the Spleen, Lungs andKidneys) and the Manifestation (Phlegm). On the one hand, one cantonify the body’s Qi and on the other one can resolve Phlegm.This woman was treated with acupuncture only with the followingselection of points over a period of 8 months😃irecting vessel (i.e. LU-7 Lieque on the right and KI-6 Zhaohai on theleft). This combination of points opens the Directing Vessel, restores thedescending of Lung-Qi and stimulates the grasping of Qi by theKidneys.Ren-12 Zhongwan, Ren-9 Shuifen and ST-40 Fenglong to resolvePhlegm.ST-36 Zusanli and BL-20 Pishu with needles and moxa to warm andtonify the Spleen.BL-13 Feishu and Du-12 Shenzhu to tonify and warm the Lungs.BL-23 Shenshu and KI-7 Fuliu to tonify and warm the Kidneys.L.I.-20 Yingxiang to expel Wind and stop sneezing.Lung- and Kidney-Yin DeficiencyClinical ManifestationsChronic breathlessness, difficulty in breathing in, dry throat, dry cough, night sweating, 5-palmheat, malar flush.Tongue: Red without coating, cracks in Lung area, dry.Pulse: Floating-Empty.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Generally speaking, the Kidney’s grasping Qi is a Yang function. However, when Kidney-Yin isdeficient, it also fails to grasp Qi leading to breathlessness.Treatment PrincipleNourish Yin, strengthen Lung and Kidneys, calm breathlessness.AcupunctureGeneral PrescriptionLU-9 Taiyuan, Ren-17 Shanzhong, ST-36 Zusanli, SP-6 Sanyinjiao, Ren-12 Zhongwan, Ren-4Guanyuan, KI-3 Taixi, LU-7 Lieque and KI-6 Zhaohai in combination, KI-25 Shencang.Explanation– LU-9 and Ren-17 tonify the Lungs and promote the descending of Lung-Qi. – ST-36 and Ren-12 strengthen Earth to reinforce Metal. – SP-6 and Ren-4 nourish Yin. – KI-3 nourishes the Kidneys. – LU-7 and KI-6 nourish Kidney-Yin, restore the descending of Lung-Qi, and benefit thethroat. They open the Directing Vessel and are ideal for this type of breathlessness. – KI-25 is a local point to stimulate the Kidney grasping of Qi in chronic breathlessnessfrom Kidney deficiency.Herbal TreatmentPrescriptionsBa Xian Chang Shou Wan(Eight Immortals Longevity Pill)Shu Di Huang Radix Rehmanniae glutinosae praeparata 24 gShan Zhu Yu Fructus Corni officinalis 12 gShan Yao Radix Dioscoreae oppositae 12 gZe Xie Rhizoma Alismatis orientalis 9 gMu Dan Pi Cortex Moutan radicis 9 g© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Fu Ling Sclerotium Poriae cocos 9 gMai Men Dong Tuber Ophiopogonis japonici 9 gWu Wei Zi Fructus Schisandrae chinensis 6 gExplanationThis is the main formula for deficiency of both Lung and Kidney Yin. It is a variation of Liu WeiDi Huang Wan Six-Ingredient Rehmannia Pill (which nourishes Liver and Kidney Yin) with theaddition of Mai Men Dong Tuber Ophiopogonis japonici and Wu Wei Zi Fructus Schisandraechinensis to nourish Lung-Yin and absorb leakages (such as night sweating).VariationsTo treat chronic breathlessness, one or two herbs to stimulate the descending of Lung-Qi shouldbe added, as indicated for the previous prescriptions.– In case of symptoms of rising Yang (such as dizziness and headaches) add Long Gu OsDraconis and Mu Li Concha Ostreae.Empirical Prescription by Dr Dong Jian Hua 7(99)Dong Chong Xia Cao Sclerotium Cordicipitis chinensis 5 gSheng Di Huang Radix Rehmanniae glutinosae 12 gShu Di Huang Radix Rehmanniae glutinosae praeparata 12 gShan Zhu Yu Fructus Corni officinalis 6 gZi Shi Ying Fluoritum 15 gChen Xiang Lignum Aquilariae 0.9 gChuan Xiong Radix Ligustici wallichii 6 gWu Wei Zi Fructus Schisandrae chinensis 6 gXing Ren Semen Pruni armeniacae 6 gSha Ren Fructus seu Semen Amomi 3 gExplanation– Dong Chong Xia Cao tonifies both Kidney-Yin and Kidney-Yang as well as Lung-Yin. – Sheng Di Huang, Shu Di Huang and Shan Zhu Yu tonify the Kidneys and Liver. – Zi Shi Ying and Chen Xiang strongly promote the descending of Lung-Qi and stopbreathlessness.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– Chuan Xiong enters the Blood portion in order to open up the Qi passages for Qi todescend. – Wu Wei Zi tonifies the Lungs. – Xing Ren helps to stimulate the descending of Lung-Qi. – Sha Ren resolves Dampness and is here to counterbalance the “stickiness” of the Liverand Kidney tonics in the prescription.Patent RemedyBa Xian Chang Shou Wan(Eight-Immortal Longevity Pill)Mai Men Dong Tuber Ophiopogonis japoniciWu Wei Zi Fructus Schisandrae chinensisShu Di Huang Radix Rehmanniae glutinosae praeparataShan Yao Radix Dioscoreae oppositaeShan Zhu Yu Fructus Corni officinalisZe Xie Rhizoma Alismatis orientalisFu Ling Sclerotium Poriae cocosMu Dan Pi Cortex Moutan radicisExplanationThis remedy has the same ingredients and functions as the homonymous prescription above.The tongue presentation appropriate to this remedy is a Red tongue without coating.Case History 3.5 Breathlessness: Lung- and Kidney-Yin Deficiency-Male, Age 43A 43-year-old man complained of hay fever and breathlessness for the past 18 years. He found itdifficult to breathe in and often sweated at night. His lower back was sore and he suffered fromslight tinnitus in one ear. His throat was dry. His pulse was slightly Floating-Empty in generaland Weak in the right Front position. His tongue was slightly Red, with rootless coating and dry.Diagnosis This man’s breathlessness was due to Lung- and Kidney-Yin deficiency.The Lung-Yin deficiency is evident from the dry throat and the rootlesscoating on the tongue. The Kidney-Yin deficiency caused the backache,© Giovanni Maciocia 1994 Published by Churchill Livingstone.
tinnitus, difficulty in breathing in, night sweating and Floating-Emptypulse.Treatment A variation of Ba Xian Chang Shou Wan Eight Immortals LongevityPill was used:Shu Di Huang Radix Rehmanniae glutinosae praeparata 12 gShan Zhu Yu Fructus Corni officinalis 4 gShan Yao Radix Dioscoreae oppositae 6 gZe Xie Rhizoma Alismatis orientalis 4 gMu Dan Pi Cortex Moutan radicis 4 gFu Ling Sclerotium Poriae cocos 6 gMai Men Dong Tuber Ophiopogonis japonici 6 gWu Wei Zi Fructus Schisandrae chinensis 4 gXing Ren Semen Pruni armeniacae 4 gSu Zi Semen Perillae frutescentis 6 gZhi Gan Cao Radix Glycyrrhizae uralensis praeparata 3 gLung and Kidney Yang Deficiency, Fluids Overflowing to Heart and LungsClinical ManifestationsChronic breathlessness, cough with expectoration of white-watery sputum, a feeling ofoppression of the chest, palpitations, oedema, scanty urination, chilliness.Tongue: Pale, Swollen, wet.Pulse: Deep-Weak-Slow.This condition is due to deficiency of Yang of Lung and Kidneys leading to the accumulation ofPhlegm-Fluids in the Lungs and Heart. The expectoration of white-watery sputum is typical ofPhlegm-Fluids.Treatment PrincipleTonify and warm Lung and Kidneys, resolve Phlegm-Fluids, stimulate the descending ofLung-Qi.AcupunctureGeneral PrescriptionLU-7 Lieque, L.I.-6 Pianli, Ren-17 Shanzhong, Ren-12 Zhongwan, Ren-9 Shuifen, KI-7 Fuliu,Ren-6 Qihai, SP-6 Sanyinjiao, ST-40 Fenglong, P-6 Neiguan, BL-20 Pishu, BL-23 Shenshu,BL-22 Sanjiaoshu, BL-13 Feishu, BL-15 Xinshu. All with reinforcing method except for LU-7,© Giovanni Maciocia 1994 Published by Churchill Livingstone.
L.I.-6 and Ren-9 which should be needled with even method. Moxa.Explanation– LU-7, L.I.-6 and Ren-17 stimulate the descending of Lung-Qi and open the Lung Waterpassages to resolve oedema. – Ren-12, Ren-9 and Ren-6 tonify Qi and resolve oedema. – KI-7 and SP-6 tonify the Kidneys and resolve oedema. – ST-40 resolves Phlegm. – P-6 opens the chest thus relieving the feeling of oppression of the chest and tonifiesHeart-Yang. – BL-20, BL-23 and BL-22 tonify Spleen and Kidney Yang and stimulate thetransformation of fluids in the Lower Burner to resolve oedema. – BL-13 and BL-15 tonify Lung and Heart Yang.Herbal TreatmentPrescriptionZhen Wu Tang Variation(True Warrior Decoction)Fu Zi Radix Aconiti carmichaeli praeparata 10 gBai Zhu Rhizoma Atractylodis macrocephalae 12 gFu Ling Sclerotium Poriae cocos 15 gBai Shao Radix Paeoniae albae 6 gSheng Jiang Rhizoma Zingiberis officinalis recens 3 slicesGui Zhi Ramulus Cinnamomi cassiae 6 gHuang Qi Radix Astragali membranacei 12 gFang Ji Radix Stephaniae tetrandae 9 gXing Ren Semen Pruni armeniacae 6 gExplanation– The Zhen Wu Tang True Warrior Decoction tonifies and warms Spleen- and© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Kidney-Yang and resolves Phlegm-Fluids.– Gui Zhi warms Yang to move fluids and resolve oedema. – Huang Qi tonifies Lung-Qi and stimulates the Lungs to disperse and descend fluids. Italso opens the Lung’s Water passages and resolves oedema. – Fang Ji resolves oedema. – Xing Ren stimulates the descending of Lung-Qi and relieves breathlessness.Variations– In case of Heart-Yang deficiency as well, with Phlegm-Fluids in the Heart leading tostasis of Blood (purple face, cyanotic lips, dark nails, Purple tongue) add Dan Shen RadixSalviae miltiorrhizae, Hong Hua Flos Carthami tinctorii, Tao Ren Semen Persicae andChuan Xiong Rhizoma Ligustici wallichii.Patent RemedyJin Gui Shen Qi Wan(Golden Chest Kidney-Qi Pill)Gui Zhi Ramulus Cinnamomi cassiae (or Rou Gui Cortex Cinnamomi cassiae)Fu Zi Radix Aconiti carmichaeli praeparataShu Di Huang Radix Rehmanniae glutinosae praeparataShan Yao Radix Dioscoreae oppositaeShan Zhu Yu Fructus Corni officinalisZe Xie Rhizoma Alismatis orientalisFu Ling Sclerotium Poriae cocosMu Dan Pi Cortex Moutan radicisExplanationThis remedy treats only the Root, i.e. tonifies Kidney-Yang, and not the Manifestation (Wateroverflowing to Heart and Lungs).The tongue presentation appropriate to this remedy is a Pale and wet body.Lung-, Heart- and Kidney-Yang Deficiency, Fluids Overflowing to Heart© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Clinical ManifestationsChronic breathlessness, a feeling of oppression and pain of the chest, nausea, cyanotic lips,purple face and nails, expectoration of white-watery sputum, difficulty in lying down, oedema,chilliness, backache, weak knees, scanty but pale urine.Tongue: Bluish-Purple and Swollen.Pulse: Deep-Slow-Knotted.This condition only occurs in old people suffering from chronic breathlessness. It ischaracterized by deficiency of Yang of Lungs, Kidneys and Heart leading to the formation ofPhlegm-Fluids (manifesting with white-watery expectoration). These overflow to Lungs andHeart. In the Lungs they further impair the descending of Lung-Qi and aggravate thebreathlessness. In the Heart they obstruct the circulation of Blood in the chest leading to pain inthe chest and cyanotic colour of face, nails, lips and tongue. The deficiency of Kidney-Yangcauses backache, weak knees and scanty urination.Treatment PrincipleTonify and warm Lungs, Heart and Kidneys, resolve Phlegm, restore the descending of Lung-Qi,move Blood and eliminate stasis.AcupunctureGeneral PrescriptionLU-7 Lieque, L.I.-6 Pianli, Ren-17 Shanzhong, Ren-12 Zhongwan, Ren-9 Shuifen, KI-7 Fuliu,Ren-6 Qihai, SP-6 Sanyinjiao, ST-40 Fenglong, P-6 Neiguan, BL-20 Pishu, BL-23 Shenshu,BL-22 Sanjiaoshu, BL-13 Feishu, BL-15 Xinshu, BL-17 Geshu, SP-10 Xuehai.Reinforcing method except on LU-7, L.I.-6, Ren-9, SP-6 and ST-40 which should be needledwith even method. Moxa.Explanation– LU-7, L.I.-6 and Ren-17 stimulate the descending of Lung-Qi and open the Lung’sWater passages to resolve oedema. – Ren-12, Ren-9 and Ren-6 tonify Qi and resolve oedema. – KI-7 and SP-6 tonify the Kidneys and resolve oedema.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– ST-40 resolves Phlegm. – P-6 opens the chest thus relieving the feeling of oppression and tonifies Heart-Yang. – BL-20, BL-23 and BL-22 tonify Spleen and Kidney-Yang and stimulate thetransformation of fluids in the Lower Burner to resolve oedema. – BL-13 and BL-15 tonify Lung and Heart Yang. – BL-17 and SP-10 move Blood and eliminate stasis.Herbal TreatmentPrescriptionLing Gui Zhu Gan Tang, Ling Gan Wu Wei Jiang Xin Tang and Zhen Wu Tang(Variation)(Poria-Ramulus Cinnamomi-Atractylodes-Glycyrrhiza Decoction,Poria-Glycyrrhiza-Schisandra-Zingiber-Asarum Decoction and True WarriorDecoction)Fu Ling Sclerotium Poriae cocos 15 gGui Zhi Ramulus Cinnamomi cassiae 9 gBai Zhu Rhizoma Atractylodis macrocephalae 9 gZhi Gan Cao Radix Glycyrrhizae uralensis praeparata 6 gWu Wei Zi Fructus Schisandrae chinensis 6 gGan Jiang Rhizoma Zingiberis officinalis 3 gXi Xin Herba Asari cum radice 1.5 gFu Zi Radix Aconiti carmichaeli praeparata 6 gBai Shao Radix Paeoniae albae 6 gDan Shen Radix Salviae miltiorrhizae 6 gChuan Xiong Radix Ligustici wallichii 6 gSang Bai Pi Cortex Mori albae radicis 6 gSu Zi Fructus Perillae frutescentis 6 gExplanationAlthough this is a variation of three prescriptions, there is quite an overlap of ingredients amongthe three prescriptions so that the total ingredients are not too many.– The first prescription Ling Gui Zhu Gan Tang (Poria-RamulusCinnamomi-Atractylodes-Glycyrrhiza Decoction) tonifies Spleen-Yang and resolves© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Phlegm-Fluids in the chest. It alleviates nausea, a feeling of oppression of the chest andbreathlessness.– The second prescription Ling Gan Wu Wei Jiang Xin Tang(Poria-Glycyrrhiza-Schisandra-Zingiber-Asarum Decoction) warms the Lungs, resolvesPhlegm-Fluids and relieves breathlessness and a feeling of oppression of the chest.– The third prescription, used for the previous pattern, tonifies Spleen- and Kidney-Yangand resolves oedema.– To these three prescriptions was added Chuan Xiong and Dan Shen to move Blood inthe chest and eliminate stasis, and Sang Bai Pi and Su Zi to restore the descending ofLung-Qi.Patent RemedyJin Gui Shen Qi Wan(Golden Chest Kidney-Qi Pill)ExplanationAs mentioned above, this remedy treats only the Root and, actually, only part of the Root, i.e.Kidney-Yang deficiency. It does not treat the Manifestation.Case History 3.6 Breathlessness: Lung-, Heart- and Kidney-Yang Deficiency-Female, Age75A 75-year-old woman suffered from breathlessness for 40 years. The breathlessness started afterdouble pneumonia and collapse of a lung. She was treated with Prednisolone for many years. Shefound it difficult to breathe in or out, had a sensation of oppression of the chest and slightnausea. Her lips were slightly cyanotic and she expectorated white-watery sputum. She felteasily cold and her back and knees ached. Occasionally she felt palpitations.Her tongue was very Pale but also Bluish on the sides (chest area) and very Swollen. Her pulsewas Deep, Weak and Slow. It was particularly Weak on both Rear positions.Diagnosis This condition is due to extreme deficiency of Yang of the Lungs,Heart, Spleen and Kidneys, leading to Phlegm-Fluids in the Lungs andHeart.Treatment Due to her age and the prolonged use of Prednisolone her condition© Giovanni Maciocia 1994 Published by Churchill Livingstone.
could only be improved but not cured. She was treated with herbalmedicine using a variation of Ling Gui Zhu Gan Tang, Ling Gan WuWei Jiang Xin Tang and Zhen Wu Tang (Poria-RamulusCinnamomi-Atractylodes-Glycyrrhiza Decoction,Poria-Glycyrrhiza-Schisandra-Zingiber-Asarum Decoction and TrueWarrior Decoction).Fu Ling Sclerotium Poriae cocos 10 gGui Zhi Ramulus Cinnamomi cassiae 3 gBai Zhu Rhizoma Atractylodis macrocephalae 9 gZhi Gan Cao Radix Glycyrrhizae uralensis praeparata 3 gWu Wei Zi Fructus Schisandrae chinensis 4 gGan Jiang Rhizoma Zingiberis officinalis 1.5 gFu Zi Radix Aconiti carmichaeli praeparata 3 gBai Shao Radix Paeoniae albae 6 gDan Shen Radix Salviae miltiorrhizae 4 gChuan Xiong Radix Ligustici wallichii 4 gSang Bai Pi Cortex Mori albae radicis 6 gSu Zi Fructus Perillae frutescentis 6 gXing Ren Semen Pruni armeniacae 4 gPrognosis and PreventionBoth acupuncture and herbal medicine are effective in treating breathlessness. The kind ofresults obtained depend on the duration of the disease and the condition of the patient. Generallyspeaking, acute patterns respond very quickly while chronic conditions obviously respondslowly.For example, the first three patterns described, i.e. Wind-Cold invading the Lungs, Wind-Coldon the Exterior, Phlegm-Fluids in the Interior and Cold on the Exterior, Heat in the Interior areacute conditions and should therefore respond to treatment in a few sessions with a combinationof acupuncture and herbs. The other Excess patterns of Phlegm-Heat in the Lungs, TurbidPhlegm in the Lungs, Lung-Qi Obstructed and Liver-Fire invading the Lungs will take longer totreat, between a few weeks and a few months depending on the severity of the condition. Themost difficult to treat out of these four patterns is that of Turbid Phlegm in the Lungs.Of the Deficiency patterns, the most difficult to treat is that of Lung-, Heart- and Kidney-YangDeficiency. This is a very chronic condition which only occurs in old people and is characterizedby the presence of Phlegm-Fluids affecting both Heart and Lungs. Phlegm-Fluids is a type ofPhlegm which is always very difficult to treat.As for the relative importance of acupuncture and herbs, in general herbs are necessary© Giovanni Maciocia 1994 Published by Churchill Livingstone.
whenever there is Phlegm as they are better than acupuncture at resolving Phlegm. Acupunctureon its own gives particularly good results in the two Liver-related patterns, i.e. Lung-QiObstructed and Liver-Fire insulting the Lungs.As for prevention, after a successful treatment it is important to take certain preventive measuresso that the breathlessness will not recur.DietA person who has been successfully treated for breathlessness should abstain from eating dairyfoods (milk, cheese, butter, cream, yoghurt, icecream) because these tend to form Phlegm whicheasily settles in the Lungs and obstructs breathing. For the same reason, greasy and fried foodsshould be kept to a minimum.It is also best to advise the patient not to eat too much fresh fruit and raw vegetables. Although inmoderation these foods are beneficial, in excess they also tend to form Phlegm and injure Yang.This advice is particularly important for those patients whose breathlessness was caused bydeficiency of Yang.Life HabitsPersons who suffered from breathlessness should take great care in protecting themselvesadequately from wind and cold. All too often the dictates of fashion are not conducive tosensible dressing. Patients who have been suffering from breathlessness should especially takecare to protect the upper back and chest.Preventive TreatmentBoth moxa and herbs can be used to prevent a recurrence of breathlessness.Indirect moxibustion with garlic can be applied in the summertime at 10-day intervals on thefollowing three groups of points:First Group– Extra-point Bai Lao(on the occiput one cun below the hairline and one cun from the midline).– BL-13 Feishu© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– BL-43 GaohuangshuSecond Group– Du-14 Dazhui– BL-12 Fengmen– BL-20 PishuThird Group– BL-11 Dashu– BL-13 Feishu– BL-23 ShenshuA herbal plaster can also be applied on the same three groups of points at the same interval insummertime. The herbs used for the plaster are:Bai Jie Zi Semen Sinapis albaeXi Xin Herba Asari cum radiceGan Sui Radix Euphorbiae KansuiShe Xiang Secretio Moschus moschiferiYan Hu Suo Rhizoma Corydalis yanhusuo.Grind these herbs (She Xiang can be omitted as it is very expensive) into a powder in acoffee-grinder, add ginger juice and honey, shape into tiny pieces (about the size of an “O”),place on a plaster and stick this on the acupuncture points. Keep the plasters on not more than 2hours as the herbs are blistering.Patients who are prone to Lung-Qi deficiency could take a course of Yu Ping Feng San JadeWind Screen Powder towards the end of August of each year.Patients who are prone to Kidney deficiency can take the Jin Gui Shen Qi Wan Golden ChestKidney-Qi Pill (as a pill) during the winter months. In case of Kidney-Yin deficiency, theyshould take Liu Wei Di Huang Wan Six-Ingredient Rehmannia Pill instead.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Western DifferentiationDyspnoea (breathlessness) can have many different causes in Western medicine. However, apartfrom general causes such as anemia, they all relate either to the lungs or heart.In fact, breathlessness can arise either from a disease of the lungs themselves (such as asthma,bronchitis or emphysema), or from a heart disease affecting the lungs (such as left ventricularheart failure).The most common causes of chronic breathlessness can be summarized with a diagram (Figure3.2Figure 3.2).Causes in LungsAsthmaThis consists in the constriction of the bronchi on exhalation. It may arise during childhood inatopic individuals, i.e. those who easily form antibodies to commonly-encountered allergenssuch as house dust, pollen or house-dust mites. Such patients often suffer from other allergicdiseases such as allergic rhinitis or atopic eczema. This is called early-onset or extrinsic asthmaand will be discussed in a separate chapter (Chapter 5). In other cases, it starts in later life innon-atopic individuals and is called late-onset or intrisic asthma. This type of asthma is not dueto an allergic reaction.In both types the main manifestations are breathlessness on exertion and wheezing and coughingwhich may be worse at night.Chronic BronchitisThis is due to narrowing of the bronchioles by mucus and oedema of mucous membranes withinthe lungs. It is this narrowing that causes the breathlessness.This condition occurs in middle-aged or elderly people and the main distinguishing sign todifferentiate it from asthma is a chronic productive cough with abundant expectoration. It alsodiffers from asthma in so far as the breathlessness is often worse in the morning (rather than atnight as in asthma). Another feature of this condition is the propensity to frequent chestinfections.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
With time, chronic bronchitis may lead to emphysema, i.e. overdistension of the alveoli.EmphysemaThis condition is due to a permanent and irreversible overdistension of the alveoli. It frequentlydevelops from chronic bronchitis as explained above. After years of overdistension, anincreasing proportion of the alveolar wall disintegrates with progressive obliteration of thevascular bed of the lungs. This is the most common cause of right ventricular heart failure,which, in itself, also causes breathlessness.The main clinical features are breathlessness first on exertion and, with time, also at rest. Insevere cases the breathlessness is constant, the chest movements are limited, the breath soundsinaudible and there may be cyanosis.Emphysema can be clearly differentiated from asthma as the breathlessness is constant, whereasin asthma, it comes in bouts. It can be differentiated from chronic bronchitis as there is no coughnor abundant sputum.The differentiation between asthma, chronic bronchitis and emphysema is important forprognosis as the first two react well to acupuncture and herbal treatment, whilst emphysema lessso (Table 3.1Table 3.1).Carcinoma of BronchiThis is statistically the most common of all carcinomas and it accounts for 40% of all maledeaths from malignant disease.The main clinical manifestations are a cough, with scanty sputum which may be blood-tinged,chest pain and breathlessness, although this may appear only in quite late stages.Causes in HeartLeft Heart FailureWhen the left ventricle of the heart loses strength of contraction blood accumulates behind theleft ventricle in the pulmonary veins and lungs. The resulting pulmonary congestion reduces thesupply of oxygen to the alveoli and causes breathlessness.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Left ventricular failure may be caused by:– Cardiac infarction– Aortic disease– Mitral incompetence– Essential hypertension.The patient is severely breathless on exertion and has to sit up in bed to breathe, gasping forbreath. He or she may wake up suddenly and feel hot. The breathlessness gets progressivelyworse until it is constant. There may also be a cough at night with watery-frothy sputum,palpitations, giddiness, nausea, vomiting, diarrhoea and abdominal pain. The phenomenon of"pulsus alternans" may be heard on the sphygmomanometer: at the upper limit only half the heartbeats come through but when the pressure is lowered by 10 mm or more all the beats becomeaudible. For example, at 180 mm the pulse rate may appear to be 50, whilst at 160 mm it is 100.General CausesAnaemiaBreathlessness on exertion is a feature of anaemia.The causes of breathlessness are summarized in Table 3.2Table 3.2.“Xiao” indicates a wheezing sound which may resemble that of whistling, snoring or sawing. It isusually accompanied by breathlessness with an inability to breathe when lying down.The “Prescriptions of the Golden Chest” by Dr Zhang Zhong Jing was the first book to refer towheezing: "For cough with a moor-hen sound in the throat, use Belamcanda-EphedraDecoction."1(101) The “moor-hen sound in the throat” is wheezing. In later times wheezing wasalso variously described as “hidden Yin”, “sip cough”, “howling wheezing” and "snoring© Giovanni Maciocia 1994 Published by Churchill Livingstone.
wheezing".In subsequent dynasties the symptoms of wheezing (Xiao) and breathlessness (Chuan) were notdifferentiated. Dr Zhu Dan Xi (1281-1358) was the first to use the term “Xiao-Chuan” andconsidered it due to Phlegm. He therefore indicated that the main principle of treatment was totonify the body’s Qi and, in acute cases, expel pathogenic factors.The book “Orthodox Medical Record” (1515) by Dr Yu Tuan distinguishes between Wheezing(Xiao) and Breathlessness (Chuan) for the first time:Wheezing is named after its sound, Breathlessness after the breath. If breathing israpid and there is a sound in the throat like a moor-hen, it is Wheezing [Xiao]; ifbreathing is rapid continuously and there is breathlessness, it is calledBreathlessness [Chuan].2(102)The “Case Reports for Clinical Practice” (1766) by Dr Ye Gui differentiates the two conditionsby saying:If the pathogenic factor is expelled, breathlessness [Chuan] stops and will neverreturn … In wheezing [Xiao], the pathogenic factor is hidden in the Interior andin the Lungs, it is sometimes active and sometimes quiescent, and there arefrequent episodes over many years.3(103)Doctors of subsequent dynasties reverted to considering Wheezing and Breathlessness as onecondition.In modern China they are also considered together and modern books usually say that they maycorrespond to the two separate conditions of “bronchial asthma” or “asthmatic bronchitis”(chronic bronchitis leading to breathlessness).There are different types of asthma and they may be summarized in three groups:1. Allergic (or atopic) asthma which starts in early childhood and is often associatedwith eczema: this will be discussed in a separate chapter (Chapter 5).2. Asthma which starts early during childhood after repeated invasions of externalWind leading to chest infections.3. Asthma which starts later in life as a consequence of repeated invasions ofexterior Wind, irregular diet, emotional strain, overwork and excessive sexualactivity.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
The symptom of “Wheezing” discussed in this chapter corresponds to nos 2. and 3. above.AetiologyExternal Pathogenic FactorsExternal Wind-Cold or Wind-Heat may invade the body, penetrate deeper and settle in theLungs. Here they obstruct Lung-Qi, which then cannot transform fluids; and the fluidsaccumulate into Phlegm.DietThe excessive consumption of cold, sour, or sweet-greasy foods injures the Spleen so that itcannot transform and transport food essences properly. When this happens, Phlegm forms, itaccumulates in the Lungs, obstructs Lung-Qi and causes wheezing. Old books distinguished"food-wheezing", “sugar-wheezing” or “sour-wheezing” according to the particular type of foodresponsible.Weak Body ConditionA weakened body condition after a long illness (which in children may happen after measles orwhooping cough) may deplete Lung-Qi and Spleen-Qi. When this happens, fluids are nottranformed properly and Phlegm forms.If the Yin of the body is depleted, Empty-Heat arises; this evaporates and condenses fluids intoPhlegm.PathologyThe main pathological factor in Wheezing is “hidden Phlegm” stored in the Lungs. The upwardsmovement of Phlegm propelled by rebellious Qi narrows the airways and causes wheezing. The"Supplement to Diagnosis and Treatment" (1687) by Li Yong Cui says:Chronic wheezing and breathlessness are due to: 1) obstruction of Qi in theInterior; 2) an attack of an exterior pathogenic factor; 3) sticky Phlegm in thediaphragm. These three factors combine to obstruct the Qi passages and whenbreath is forced out there is a wheezing sound.4(104)© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Factors which may trigger the upwards movement of rebellious Qi and Phlegm are weatherchanges, diet, emotional stress and overwork.Phlegm may be cold or hot. Cold Phlegm may derive from frequent exposure to cold whichinjures the Lungs or from excessive consumption of cold foods which injure Spleen-Yang. ColdPhlegm is more likely to be stirred by external pathogenic factors. It both derives from andcauses Yang deficiency.Hot Phlegm may derive from excessive consuption of sour, sweet, or greasy foods. Yindeficiency may contribute to forming Phlegm-Heat.In chronic cases Cold Phlegm injures Spleen-Yang while Hot Phlegm injures Lung-Yin. Thedisease becomes therefore characterized by a combination of Fullness (Phlegm) and Emptiness(of the Lungs, Spleen or Kidneys). Deficient Lungs, Spleen and Kidney may in turn all lead toPhlegm. In particular, if Kidney-Yang is deficient there will be Cold Phlegm; if Kidney-Yin isdeficient there will be Phlegm-Heat.In severe and prolonged cases, when the deficient Lungs fail to control the blood vessels andharmonize the channels, Heart-Blood cannot circulate properly, the Fire of the Gate of Vitalitycannot rise to the Heart and this causes a deficiency of Heart-Yang.Differentiation and TreatmentIn order to apply the correct principle of treatment a clear distinction must be made between theacute and chronic phases. In general one follows the principle of treating the Manifestationduring the acute phase, and the Root during the chronic phase. This means that in the acute phaseone must expel pathogenic factors, resolve Phlegm and restore the descending of Lung-Qi.During the chronic phase attention should be turned to tonifying the body’s Qi, particularly of theLungs, Spleen or Kidneys.In some chronic cases, it may be necessary to treat both Manifestation and Root simultaneously.The patterns discussed are:ACUTE PHASECold PhlegmHot Phlegm© Giovanni Maciocia 1994 Published by Churchill Livingstone.
CHRONIC PHASELung DeficiencySpleen DeficiencyKidney DeficiencyAcute PhaseThis includes not only treatment during the actual acute attack but also treatment during a periodof time when attacks are frequent. The main differentiation to be made is that between Cold orHot Phlegm and the main principle of treatment is to resolve Phlegm and restore the descendingof Lung-Qi.Cold PhlegmClinical ManifestationsRapid breathing, wheezing, a feeling of fullness and oppression of the chest, cough, scantyphlegm, a bluish-white complexion, no thirst, or a desire for warm drinks, feeling cold, worse incold weather.Tongue: Swollen with a sticky-white coating.Pulse: Tight and Slippery.Treatment PrincipleWarm the Lungs, scatter Cold, resolve Phlegm, relieve breathlessness.AcupunctureGeneral PrescriptionLU-7 Lieque, BL-13 Feishu, LU-1 Zhongfu, LU-6 Kongzui, Ren-22 Tiantu, Ren-17 Shanzhong,ST-40 Fenglong, P-6 Neiguan. All with reducing or even method. Moxa is applicable.Explanation– LU-7, BL-13 and LU-1 restore the descending of Lung-Qi and stop wheezing. – LU-6, Accumulation point, stops wheezing and breathlessness in acute cases.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– Ren-22 restores the descending of Lung-Qi and resolves Phlegm. – Ren-17 moves Qi in the chest and affects the Lung channel. With direct moxa, it candispel Cold from the Lungs. – ST-40 and P-6 open the chest, relieve breathlessness and resolve Phlegm.Herbal TreatmentPrescriptionShe Gan Ma Huang Tang(Belamcanda-Ephedra Decoction)She Gan Rhizoma Belamcandae chinensis 6 gMa Huang Herba Ephedrae 9 gGan Jiang Rhizoma Zingiberis officinalis 3 gXi Xin Herba Asari cum radice 3 gBan Xia Rhizoma Pinelliae ternatae 9 gZi Wan Radix Asteris tatarici 6 gKuan Dong Hua Flos Tussilaginis farfarae 6 gGan Cao Radix Glycyrrhizae uralensis 3 gWu Wei Zi Fructus Schisandrae chinensis 3 gDa Zao Fructus Ziziphi jujubae 3 datesExplanation– She Gan and Ma Huang restore the descending of Lung-Qi, stop wheezing, resolvePhlegm, calm breathlessness and benefit the throat. – Gan Jiang, Xi Xin and Ban Xia warm the Lungs and resolve Cold Phlegm. – Zi Wan, Kuan Dong Hua and Gan Cao resolve Phlegm and stop cough. – Wu Wei Zi absorbs Lung-Qi and moderates the scattering effect of the other herbs(especially Ma Huang and Xi Xin). – Da Zao harmonizes.Variations© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– If there are symptoms of exterior Cold and internal Phlegm-Fluids, use Xiao Qing LongTang Small Green Dragon Decoction instead.– In a chronic case with Yang deficiency and frequent attacks with wheezing that soundslike low snoring, breathing not rapid, watery sputum, a dull-pale complexion, coldsweating, a Deep pulse and a Pale tongue, one must treat both the Manifestation and theRoot simultaneously. One must resolve Phlegm and restore the descending of Lung-Qi onone hand, and tonify Kidney-Yang on the other hand. This therapeutic aim may beachieved by using Su Zi Jiang Qi Tang Perilla Seed Lowering Qi Decoction. Add to thisformula: Dang Shen Radix Codonopsis pilosulae, Hu Tao Rou Semen Juglandis regiaeand Qi Dai Umbilical cord to tonify Spleen and Kidneys, and Chen Xiang LignumAquilariae to restore the descending of Lung-Qi.– In cases of very severe symptoms of Yang deficiency (such as severe chilliness and avery Pale and wet tongue) add Fu Zi Radix Aconiti carmichaeli praeparata.Hot PhlegmClinical ManifestationsWheezing with a loud noise, breathlessness, distended chest, cough, yellow-sticky sputum,irritability, sweating, a red face, a bitter taste, thirst, a feeling of heat.Tongue: Red with a yellow-sticky coating.Pulse: Slippery-Rapid.Treatment PrincipleClear Heat, restore the descending of Lung-Qi, resolve Phlegm, stop wheezing.AcupunctureGeneral PrescriptionLU-5 Chize, LU-10 Yuji, LU-6 Kongzui, BL-13 Feishu, LU-1 Zhongfu, L.I.-11 Quchi, P-5Jianshi, ST-40 Fenglong, Ren-22 Tiantu.Explanation– LU-5 resolves Phlegm-Heat from the Lungs.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– LU-10 clears Lung-Heat. – LU-6, Accumulation point, stops wheezing and breathlessness in acute cases. – LU-1 and BL-13, Front-Collecting and Back-Transporting point respectively, clearLung-Heat and restore the descending of Lung-Qi, especially in acute cases. – L.I.-11 clears Heat. – P-5 and ST-40 resolve Phlegm and open the chest. – Ren-22 resolves Phlegm, restores the descending of Lung-Qi and benefits the throat.Herbal TreatmentPrescriptionDing Chuan Tang(Stopping Breathlessness Decoction)Ma Huang Herba Ephedrae 9 gHuang Qin Radix Scutellariae baicalensis 6 gSang Bai Pi Cortex Mori albae radicis 9 gXing Ren Semen Pruni armeniacae 9 gBan Xia Rhizoma Pinelliae ternatae 9 gKuan Dong Hua Flos Tussilaginis farfarae 9 gSu Zi Fructus Perillae frutescentis 6 gBai Guo Semen Ginkgo bilobae 9 gGan Cao Radix Glycyrrhizae uralensis 3 gExplanation– Ma Huang and Bai Guo are coordinated: one is scattering, the other sour and absorbing.The two together restore the dispersing and descending of Lung-Qi and stop wheezing. – Huang Qin and Sang Bai Pi clear Lung-Heat and also restore the descending ofLung-Qi. – Xing Ren and Su Zi restore the descending of Lung-Qi and stop wheezing.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
– Ban Xia resolves Phlegm and subdues rebellious Qi. – Kuan Dong Hua stops cough and wheezing. – Gan Cao harmonizes.Variations– If there are simultaneous symptoms of exterior Cold add Gui Zhi Ramulus Cinnamomicassiae and Sheng Jiang Rhizoma Zingiberis officinalis recens.– If there are symptoms of Fire (as opposed to Heat) such as constipation, dark urine, drystools, dry mouth and a dry-yellow tongue coating, add Da Huang Rhizoma Rhei andMang Xiao Mirabilitum.– If there is vomiting of sticky-yellow phlegm add Zhi Mu Radix Anemarrhenaeasphodeloidis, Hai Ge Ke Concha Cyclinae sinensis and She Gan Rhizoma Belamcandaechinensis.– If Heat has injured the Yin add Mai Men Dong Tang Ophiopogon Decoction.– If Phlegm is the main problem without any clear-cut hot or cold symptom, use San ZiYang Qin Tang Three-Seed Nourishing the Parents Decoction.Patent RemediesZhi Sou Ding Chuan Wan(Stopping Cough and Calming Breathlessness Pill)Ma Huang Herba EphedraeXing Ren Semen Pruni armeniacaeShi Gao Gypsum fibroumZhi Gan Cao Radix Glycyrrhizae uralensis praeparataExplanationThis remedy corresponds to the prescription for combined Greater Yang and Bright Yangpatterns of the Six Stages from the “Discussion of Cold-induced Diseases”. However, its mainimpact is to clear Lung-Heat and restore the descending of Lung-Qi.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
The tongue presentation appropriate to this remedy is a Red body in the front part.Case History 4.1 Wheezing: Hot Phlegm-Male, Age 58A 58-year-old man had been suffering from asthma for 6 years. At the time of consultation, theasthma was very severe with frequent attacks every day. He was using a Ventolin inhaler,Becoforte (cortico-steroid) spray and cortico-steroids orally. His chest felt extremely tight and hecould not lie down. He was prone to chest infections, developing expectoration of yellowsputum. He also experienced epigastric fullness and distension. His tongue was slightly Red,with swollen edges (of the Spleen-type) and a sticky coating (Plate 4.1(105)). His pulse wasRapid, Full and Slippery.Diagnosis This is non-allergic late-onset asthma from Hot Phlegm against abackground of Spleen deficiency.Treatment principle Since the attacks are severe and frequent, this is treated as an acute caseand attention must be turned to treating the Manifestation, i.e. resolvePhlegm, clear Heat and restore the descending of Lung-Qi.Treatment This patient was treated with acupuncture only. He had to be treatedevery other day initially, followed by a gradual spacing-out oftreatments. The main points used were:SP-4 Gongsun and P-6 Neiguan, open the Penetrating Vessel, relax thechest and subdue rebellious Stomach-Qi. The Lung and Stomachchannels are closely connected and rebellious Stomach-Qi willadversely affect Lung-Qi.LU-5 Chize, LU-7 Lieque and LU-6 Kongzui restore the descending ofLung-Qi. LU-6, Accumulation point, is specific for acute cases. LU-5also clears Phlegm from the Lungs.LU-1 Zhongfu and BL-13 Feishu, Front-Collecting andBack-Transporting points respectively, clear Lung-Heat and restore thedescending of Lung-Qi.ST-40 Fenglong and SP-6 Sanyinjiao resolve Phlegm. ST-40 also opensthe chest and eases breathing.Dingchuan, extra point 0.5 cun lateral to Du-14 Dazhui, is an empiricalpoint for acute asthma.With treatment on alternate days, he started to improve gradually. Thetreatment was slowed down by his use of oral cortico-steroids.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
However, these were gradually reduced and discontinued after 3months. As he started to improve, after 3 months the treatment includedsome tonification of the Spleen (with Ren-12 Zhongwan, BL-20 Pishuand ST-36 Zusanli) and the use of the patent remedy Ping Chuan WanCalming Breathlessness Pill which tonifies Spleen and Kidneys andrestores the descending of Lung-Qi.Chronic PhaseDuring the chronic phase the main priority is to tonify Lungs, Spleen, or Kidneys.Lung DeficiencyClinical ManifestationsSweating, chilliness, propensity to catching colds, sneezing, a runny nose, shortness of breath,slight wheezing with a low sound, a slight cough.Tongue: Pale.Pulse: Weak.Treatment PrincipleTonify the Lungs and consolidate the Exterior.AcupunctureGeneral PrescriptionLU-9 Taiyuan, ST-36 Zusanli, Ren-6 Qihai, BL-13 Feishu, Du-12 Shenzhu, LU-7 Lieque. Allwith reinforcing method.Explanation– LU-9, BL-13 and Du-12 tonify Lung-Qi and consolidate the Exterior. – ST-36 and Ren-6 tonify Qi in general. – LU-7 restores the descending of Lung-Qi and stops wheezing and cough.Herbal Treatment© Giovanni Maciocia 1994 Published by Churchill Livingstone.
PrescriptionYu Ping Feng San(Jade Wind Screen Powder)Huang Qi Radix Astragali membranacei 30 gBai Zhu Rhizoma Atractylodis macrocephalae 60 gFang Feng Radix Ledebouriellae sesloidis 30 gExplanation– Huang Qi and Bai Zhu tonify Lung-Qi and consolidate the Exterior. – Fang Feng, in combination with the previous two, consolidates the Exterior and preventsinvasion of exterior Wind.Note that the above dosages are for making a batch of powder and not a decoction.Variations– If there are Cold symptoms add Gui Zhi Ramulus Cinnamomi cassiae, Bai Shao RadixPaeoniae albae, Sheng Jiang Rhizoma Zingiberis officinalis recens and Da Zao FructusZiziphi jujubae.– If there is both Qi and Yin deficiency add Sheng Mai San Generating the PulseDecoction.Spleen DeficiencyClinical ManifestationsSlight wheezing that has a low sound, poor appetite, slight abdominal distension, intolerance tocertain foods, tiredness, shortness of breath, dislike of speaking, desire to lie down, weariness.Tongue: Pale.Pulse: Weak.Treatment PrincipleTonify the Spleen and resolve Phlegm.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
AcupunctureST-36 Zusanli, SP-3 Taibai, BL-20 Pishu, BL-21 Weishu, Ren-12 Zhongwan, ST-40 Fenglong,LU-7 Lieque, LU-9 Taiyuan, BL-13 Feishu, Ren-6 Qihai. All with reinforcing method. Moxa isapplicable.Explanation– ST-36, SP-3, BL-20, BL-21 and Ren-12 tonify Stomach and Spleen. – ST-40 resolves Phlegm. – LU-7 restores the descending of Lung-Qi. – LU-9 and BL-13 tonify Lung-Qi. – Ren-6 tonifies Qi in general.Herbal TreatmentPrescriptionLiu Jun Zi Tang(Six Gentlemen Decoction)Ren Shen Radix Ginseng 10 gBai Zhu Rhizoma Atractylodis macrocephalae 9 gFu Ling Sclerotium Poriae cocos 9 gZhi Gan Cao Radix Glycyrrhizae uralensis praeparata 6 gChen Pi Pericarpium Citri reticulatae 9 gBan Xia Rhizoma Pinelliae ternatae 12 gExplanation– Ren Shen, Bai Zhu, Fu Ling and Gan Cao tonify Qi. – Chen Pi and Ban Xia resolve Dampness.Variations– If there are pronounced symptoms of Cold add Gui Zhi Ramulus Cinnamomi cassiae and© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Gan Jiang Rhizoma Zingiberis officinalis.Patent RemedyQi Guan Yan Ke Sou Tan Chuan Wan(Bronchial Cough, Phlegm and Dyspnoea Pill)Qian Hu Radix PeucedaniXing Ren Semen Pruni armeniacaeYuan Zhi Radix Polygalae tenuifoliaeSang Ye Folium Mori albaeChuan Bei Mu Bulbus Fritillariae cirrhosaeChen Pi Pericarpium Citri reticulataePi Pa Ye Folium Eriobotryae japonicaeKuan Dong Hua Flos Tussilaginis farfaraeDang Shen Radix Codonopsis pilosulaeMa Dou Ling Fructus AristolochiaeWu Wei Zi Fructus Schisandrae chinensisSheng Jiang Rhizoma Zingiberis officinalis recensDa Zao Fructus Ziziphi jujubaeExplanationThis pill tonifies Spleen-Qi, resolves Phlegm and stimulates the descending of Lung-Qi. It issuitable for chronic wheezing with a background of Spleen deficiency and Phlegm. It isappropriate for both Cold or Hot Phlegm.Case History 4.2 Wheezing: Spleen Deficiency-Female, Age 45A 45-year-old woman had been suffering from asthma for 8 years since she stopped smoking.She found it difficult to breathe in and had a constant nasal discharge. She constantly felt catarrhin her throat and chest and sometimes coughed up some sticky-yellow phlegm. She oftenexperienced a feeling of oppression of the chest and slight nausea. She was slightly deaf in oneear and her urine was rather pale. She often complained of bad digestion, slight thirst and acidregurgitation. She frequently had hiccups for long periods of time.She was overweight, particularly around her stomach and abdomen. Her tongue body was of anormal colour although slightly Purple on the sides (chest area), was very Swollen, and with aStomach crack in the middle with a rough, dirty-yellow coating in it (Plate 4.2(106)). Her pulsewas definitely Slippery on the whole and slightly Weak on the right side.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Diagnosis This is a clear case of retention of Phlegm-Heat with a background ofSpleen deficiency. The symptoms of Phlegm-Heat are: expectoration ofsticky-yellow phlegm, nasal discharge, feeling of oppression of thechest, nausea, overweight body, Swollen tongue and Slippery pulse.Although this is Phlegm-Heat because the mucus is yellow, the Heat isonly slight and the predominant aspect is the Phlegm rather than Heat.There is also a slight, secondary Kidney-Yang deficiency as shown bythe slight deafness and pale urine.A third pathological condition is the retention of Phlegm-Heat in theStomach as shown by the acid regurgitation, bad digestion and Stomachcrack with rough, yellow coating inside it. The presence of Phlegm-Heatinduced Stomach-Qi to rebel upwards causing frequent hiccups. Therebelling upwards of Stomach-Qi contributed to the asthma.The fact that her asthma started after stopping smoking is puzzling butinteresting. One possible explanation could be that the conditions tocause asthma were already present but tobacco, which has a hot anddrying energy, constantly dried up Phlegm, thus delaying the onset ofthe disease. A sudden cessation of smoking means that the drying actionof tobacco is abruptly withdrawn and Phlegm therefore overflowsprofusely.Treatment principle Since this is a chronic condition the treatment principle is to treat Rootand Manifestation simultaneously, i.e. tonify the body’s Qi and expelpathogenic factors. Treating the Root involves primarily tonifyingSpleen-Qi and secondarily tonifying Kidney-Yang. Treating theManifestation involves resolving Phlegm from the Lungs, restoring thedescending of Lung-Qi, resolving Phlegm-Heat from the Stomach andsubduing rebellious Stomach-Qi.Treatment This patient was treated with both acupuncture and herbs. Theacupuncture treatment was focused on tonifying the Spleen, restoringthe descending of Lung-Qi and subduing Stomach-Qi.The main points used at various times were:SP-4 Gongsun on the right and P-6 Neiguan on the left, to open thePenetrating Vessel and subdue rebellious Stomach-Qi. The Lung andStomach channels are closely connected and Qi rebelling upwards inone channel easily affects the other. It was therefore important in thiscase to subdue Stomach-Qi as well as stimulate the descending ofLung-Qi. The Penetrating Vessel is excellent to subdue rebelliousStomach-Qi, especially in overweight people.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
ST-40 Fenglong to resolve Phlegm and open the chest.Ren-12 Zhongwan, BL-20 Pishu and Ren-9 Shuifen to tonify theSpleen and resolve Phlegm.LU-7 Lieque, Ren-22 Tiantu and LU-5 Chize to restore the descendingof Lung-Qi.BL-23 Shenshu and KI-7 Fuliu to tonify Kidney-Yang.Since acupuncture was aimed at treating the Root by tonifying theSpleen and Kidneys, the herbs were used mainly to treat theManifestation, i.e. to resolve Phlegm, as they are better thanacupuncture at doing this. The main formula used was a variation ofWen Dan Tang Warming the Gall-Bladder Decoction which resolvesPhlegm-Heat from both Lungs and Stomach:Zhu Ru Caulis Bambusae in Taeniis 6 gZhi Shi Fructus Citri aurantii immaturus 6 gBan Xia Rhizoma Pinelliae ternatae 6 gFu Ling Sclerotium Poriae cocos 6 gChen Pi Pericarpium Citri reticulatae 4 gSheng Jiang Rhizoma Zingiberis officinalis recens 3 slicesDa Zao Fructus Ziziphi jujubae 3 datesXing Ren Semen Pruni armeniacae 4 gSu Zi Fructus Perillae frutescentis 6 gHou Po Cortex Magnoliae officinalis 4 gExplanation The first seven herbs constitute the Wen Dan Tang which resolvesPhlegm-Heat.Xing Ren and Su Zi restore the descending of Lung-Qi.Hou Po moves Qi and relieves fullness and oppression of the chest.As the treatment progressed and she improved, a few herbs tostrengthen the Spleen were added, such as Bai Zhu RhizomaAtractylodis macrocephalae and the dosage of Fu Ling SclerotiumPoriae cocos was increased.This patient achieved great improvement in 9 months of treatment.Kidney DeficiencyClinical ManifestationsShortness of breath, slight wheezing that has a low sound, greater difficulty in breathing in,© Giovanni Maciocia 1994 Published by Churchill Livingstone.
absent-mindedness, poor memory, tinnitus, weakness and soreness of the lower back,breathlessness on exertion.Kidney-Yang deficiency: chiliness, Pale tongue, Deep-Weak pulse.Kidney-Yin deficiency: feeling of heat, Red tongue without coating, Floating-Empty pulse.Treatment PrincipleTonify the Kidneys, strengthen the Kidney’s grasping of Qi.AcupunctureGeneral PrescriptionKI-3 Taixi, SP-6 Sanyinjiao, Ren-4 Guanyuan, BL-23 Shenshu, BL-13 Feishu, Du-12 Shenzhu,KI-25 Shencang. All with reinforcing method. Use moxa for Kidney-Yang deficiency.Explanation– KI-3, SP-6, Ren-4 and BL-23 tonify the Kidneys. – BL-13 and Du-12 strengthen the Lungs. – KI-25 is an important local point to relieve wheezing due to a Kidney deficiency.Herbal TreatmentPrescription for Kidney-Yang DeficiencyJin Gui Shen Qi Wan(Golden Chest Kidney-Qi Pill)Fu Zi Radix Aconiti carmichaeli praeparata 3 gGui Zhi Ramulus Cinnamomi cassiae 3 gShu Di Huang Radix Rehmanniae glutinosae praeparata 24 gShan Zhu Yu Fructus Corni officinalis 12 gShan Yao Radix Dioscoreae oppositae 12 gZe Xie Rhizoma Alismatis orientalis 9 gMu Dan Pi Cortex Moutan radicis 9 gFu Ling Sclerotium Poriae cocos 9 g© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Variations– For severe Yang deficiency add Bu Gu Zhi Fructus Psoraleae corylifoliae and Lu JiaoCornu cervi.– To strengthen the Kidney’s grasping of Qi add Hu Tao Rou Semen Juglandis regiae.Prescription for Kidney-Yin DeficiencyMai Wei Di Huang Wan (Ba Xian Chang Shou Wan)(Ophiopogon-Schisandra-Rehmannia Pill (Eight Immortals Longevity Pill))Shu Di Huang Radix Rehmanniae glutinosae praeparata 24 gShan Zhu Yu Fructus Corni officinalis 12 gShan Yao Radix Dioscoreae oppositae 12 gZe Xie Rhizoma Alismatis orientalis 9 gMu Dan Pi Cortex Moutan radicis 9 gFu Ling Sclerotium Poriae cocos 9 gMai Men Dong Tuber Ophiopogonis japonici 6 gWu Wei Zi Fructus Schisandrae chinensis 6 gVariation– To strengthen the Kidney’s grasping of Qi add Hu Tao Rou Semen Juglandis regiae andZi He Che Placenta hominis.Patent RemediesBa Xian Chang Shou Wan(Eight Immortals Longevity Pill)ExplanationThis pill has the same ingredients and indications as the above formula.The tongue presentation appropriate to this remedy is a Red body without coating in the frontpart.Li Fei Wan (or Li Fei Tang Yi Pian)(Benefiting the Lungs Pill (Benefiting the Lungs Sugar-Coated Tablet))© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Dong Chong Xia Cao Sclerotium Cordicipitis chinensisGe Jie GeckoBai He Bulbus LiliiWu Wei Zi Fructus Schisandrae chinensisBai Ji Rhizoma Bletillae striataeBai Bu Radix StemonaeMu Li Concha OstreaePi Pa Ye Folium Eriobotryae japonicaeGan Cao Radix Glycyrrhizae uralensisExplanationThis pill nourishes Lung and Kidney-Yin and stimulates the descending of Lung-Qi.It is suitable for the chronic stage of wheezing, when the wheezing attacks are slight andinfrequent on a background of Kidney-Yin deficiency.The tongue presentation appropriate to this remedy is a Red body without coating or withrootless coating.Ping Chuan Wan(Calming Breathlessness Pill)Dang Shen Radix Codonopsis pilosulaeDong Chong Xia Cao Sclerotium Cordicipitis chinensisGe Jie GeckoXing Ren Semen Pruni armeniacaeChen Pi Pericarpium Citri reticulataeGan Cao Radix Glycyrrhizae uralensisSang Bai Pi Cortex Radicis Mori albaeBai Qian Radix et Rhizoma Cynanchii stautoniMeng Shi Lapis ChloritisWu Zhi Mao Tao Radix Fici simplicissimaeMan Hu Tui Zi Semen Elaeagni glabrae Thunb.ExplanationThis pill tonifies Kidney-Yang and Spleen-Qi and stimulates the descending of Lung-Qi. It issuitable for chronic wheezing from a deficiency of Kidney-Yang.The tongue presentation appropriate to this remedy is a Pale body.© Giovanni Maciocia 1994 Published by Churchill Livingstone.
Case History 4.3 Wheezing: Kidney-Yang Deficiency-Female, Age 42A 42-year-old woman had been suffering from asthma for 10 years. It started after the birth ofher second child. She experienced a feeling of oppression of the chest and sometimes coughedup some yellow phlegm.She also suffered from lower backache and often felt dizzy. Occasionally she experiencedtinnitus and her urine was pale and frequent. She felt very tired.Her tongue was slightly Pale but with a yellow coating and her pulse was Deep and Weak,especially on both Kidney positions.Diagnosis This is a clear case of asthma from deficiency of Kidney-Yang, with theKidneys not grasping Qi. There is also some Phlegm-Heat (yellowsputum and yellow tongue coating), but not significant.Treatment principle The treatment principle must therefore be aimed primarily atstrengthening Kidney-Yang and secondarily at tonifying the Spleen andresolving Phlegm.Treatment This patient was treated only with acupuncture. The main points usedwere:BL-23 Shenshu, Ren-4 Guanyuan and KI-3 Taixi, with moxa, to tonifyKidney-Yang.LU-7 Lieque on the right and KI-6 Zhaohai on the left, to open theDirecting Vessel, tonify the Kidneys and restore the descending ofLung-Qi.LU-5 Chize and Ren-22 Tiantu to restore the descending of Lung-Qi.BL-20 Pishu and Ren-12 Zhongwan to tonify the Spleen.ST-40 Fenglong and SP-6 Sanyinjiao to resolve Phlegm.P-6 Neiguan to open the chest and relieve breathlessness.This patient was treated every two weeks (as she lived quite far away)for 18 months, after which time there was an improvement of about80% in her condition and she experienced only occasionalbreathlessness.© Giovanni Maciocia 1994 Published by Churchill Livingstone.