Lung – Metal

From Shen Jin’ao, Doctor Shen’s Compendium of Honoring Life (Shen Shi Zunsheng Shu), 1773:

The lung is the master of qi. Above, it connects to the throat; below, it connects to the orifices of the heart and the liver. It is in charge of inhalation and exhalation, and, in more general terms, the flux of coming in and going out.

It is situated atop the other organs, so that it can keep them in check and push the body’s waste materials downward, all the way into the large intestine. In other words, it takes in clear qi and gives off murky refuse; it absorbs the yin within taiyang to sustain the body’s yang qi [it absorbs the material essence of universal qi to sustain the body’s functions], and it commands the yang within taiyin to propel the body’s yin substances [it commands the descending force to move out the waste]. In cooperation with the foot taiyin spleen network, it transports qi and provides it to all the other organs; it is for this reason that both the lung and the spleen are both called taiyin.

The lung is associated with the phase element metal, the direction west, and the season of autumn. In autumn, the seasonal qi turns crisp and clear, and all living things rely on its force to become ripe and complete. Metal is the mother of water. Lung qi, therefore, generally moves downwards. When our bodies rest, it descends into the kidney palace and combines with water, a process the Neijing refers to as ‘the mother concealing herself inside the newly conceived offspring.’

Only the kidney is ‘true water,’ conceived in the heavenly spheres where the state of oneness prevails. It is thus only appropriate that the kidney’s mother, the lung, resides at the very top of the dome that is formed by the body’s main cavity. In a cosmic context, this would be like being situated at the upper source of the stream of heavenly energy, flowing downwards through the head, and finally entering the [kidney’s] Dragon Gate below to combine [with true water] to form the ocean [of bodily qi]. Since the lung thus functions by transporting essence to the other organs, its main action could also be compared to the climatic process of sprinkling morning dew, a heavenly substance which is dispensed generously every morning to nourish all living creatures [below] on earth.

Typically, the lung is sensitive to dryness as well as to cold and heat. This means that the lung’s function of lubricating the other organs with essence has a tendency to deviate from its mode of smooth operation by providing either not enough or too much lubrication. Or, if invaded by evil qi, it will be unable to assume its commanding role among the organ networks, and will instead produce diseases of a dry or a hot or a cold nature. This is the reason why the ancient books all refer to the lung as ‘the delicate organ.’

From Ye Tianshi, A Handbook of Clinical Case Histories (Linzheng Zhinan Yian, 1746:

The lung is the main pump behind the action of inhalation and exhalation. It is located at the highest point of the body, and thus is in a position to receive the clear qi that ascends from the other organ networks. Its nature is to be clear and aloft, and its functional quality is to expand downwards-be in charge of all descending movement within the body. Also, the lung is known as the delicate organ, which is extremely sensitive to the influence of evil qi. Each of the six influences [liuyin], therefore, can easily cause a state of imbalance in the lung. The lung has an innate aversion to cold, to heat, to dryness, to dampness, and most of all, to fire and wind. In the presence of these kinds of pernicious influences the lung easily loses its clear and crisp equilibrium; it will be inhibited in its function to descend and command, and as a result of this, normally free flowing qi will become obstructed and stagnate.

From Yu Chang, The Statutes of Medicine (Yimen Falü, 1658:

All bodily qi has its physical origin in the lung. If the lung’s qi is clear and straightforward, then there is not a single type of qi in the body that will not obey and flow along smoothly. However, if the lung qi becomes obstructed and turns murky, then the qi dynamics of the entire body will start to go against their natural flow and start to move upwards instead of downwards.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng, ca. 1590. This paragraph appears in the chapter on the lung channel, and is marked as a quote from an older Daoist source, The Original Classic of Guiding the Breath (Daoyin Benjing:

The lung is the lid of the five organ networks. It produces the voice, and it provides proper moisturization to the skin. As soon as there is either internal damage due to the seven harmful emotions, or external injury due to the six climatic influences, the rhythmical process of inhaling and exhaling and the general qi flow between the body’s inside and outside are disturbed; the lung metal then loses its clear quality. If we want to restore purity in the metal, we must first strive to regulate the breath. Once the breath is regulated, erratic movement will not occur and the heart fire will calm down all by itself. The process is as follows: first, we must concentrate on the dantian, this will quiet the heart; then, we must relax and broaden the center of our torso; and finally, we must visualize that the qi comes and goes freely through every single pore of our body. Soon, there will be no obstruction, and if we focus diligently enough our actual breath will become very fine and subtle. This, then, can be called the true breath [as achieved during meditation]. The breath, therefore, has its origin in the heart. When the heart is at peace, the qi is in a state of harmony and can return to its root in the lower abdomen with every breath we take. In this fashion, the lung and its breath can truly fulfill their assigned role as the mother of the [lower] dantian.

From The Hidden Tao: A Collection (Daozang; Ming Dynasty compilation of esoteric Taoist texts (ca. 1600), some of them dating back to 600 B.C.:

Qi disorders of the lung manifest as coughing. The secretion [ye] associated with the lung is nasal discharge. The lung qi connects with the brain above and the spleen below. In general, all types of bodily qi are governed by the lung. Laying down for too long harms the lung. The lung is the source of inhaling and exhaling. It is the officer in charge of qi. If noxious kidney qi enters the lung, there will be lots of nasal discharge.

The large intestine is the bowel associated with the lung. If it is in harmony with the lung, the hair of the body and head will be lustrous. If the hair becomes dry and falls off, the lung is exhausted.

The Central Juncture Classic (Huangting Jingstates: ‘The lung palace can be compared to a lid. In its innermost part reside the seven lads in charge of regulating the qi. In the outside world, it corresponds to Mt. Song [the highest of China’s Five Holy Mountains]. The nose is its surface site. ‘Shang’ is its sound, pungent is its flavor, tart is its smell. If noxious heart qi enters the lung, the person will experience an aversion to tart, putrid smells. Its disposition is righteousness, its humor is anger, its fluid [jin] is saliva. If a patient suffers from lung consumption, there will be lots of saliva. During the three months of autumn, the Metal King carries out his chore of termination, and everything withers. The wise person who wants to put his po spirits to rest and thus preserve his material body, must restrain his seed [avoid ejaculation of sperm], nourish things, be merciful, and not be too exuberant in his expressions.’

The lung makes a pair with the large intestine. On the body surface, it assumes form in the nose. If lung wind is present, the nose will be congested. If the face appears withered, the lung is dry. If the nose itches, there is a worm in the lung. If a person is panicky and constantly frightened, the po spirits are leaving the lung. If white and black spots appear all over the body, the lung is weak. If somebody has a powerful voice, the lung is strong. If somebody cannot bear exposure to cold, the lung is in shambles. If somebody craves pungent food, the lung is deficient. If somebody experiences constipation, the lung is obstructed. If somebody has a glossy white face color, the lungs are healthy.

If the lung is diseased, there will be frequent coughing, symptoms of upward qi movement, a puffy face, an excessive desire to lay down, blemishes in the face, a yellow-white face color, a cold nose, a headache, pain and distention in chest and back, restless extremities, itching of the skin, obstruction in the throat, dreams of beautiful ladies clad in silken fabrics and fancy jewelry-oneself wearing scaled armor-or of speckled banners and lofty heroes. We can remove these conditions by working with the mantra “ssssssssssssssssssss” and by clicking our teeth at sunrise nine times: first, pull in fresh air through your nostrils, then gently “sssssssssss” thirty-six times to expel lung heat and all other kinds of noxious qi which may lodge there.

The Lung Network: Properties and Functions

1.  The Lung is in Charge of QI

According to the traditional Chinese world view, every process and every thing represents a transformation of one and the same qi. Yin (matter) and yang (function) are the two most basic differentiations of this-ONE-universal Qi.

According to various references in the Neijing, the term qi, when used in the context of the human body, has essentially two meanings:

  1. material building blocks that are essential for the maintenance of physical life, as in yuan qi (original qi), da qi (breath), or gu qi (food qi);
  2. functional aspects of specific organ networks, such as stomach qi, liver qi, taiyang channel qi, etc.

Qi in the body is produced and maintained by two basic sources: prenatal jing qi (essence) of the kidney and postnatal air and food qi that is processed in the lung and spleen/stomach systems.

Qi, by definition, moves. It is the uninhibited movement of bodily qi which facilitates health. The basic movements of qi are ascending (sheng), descending (jiang), going out (chu), and coming in (ru).

The basic functions of bodily qi are:

  1. Moving and circulating structural body substances (blood circulation, distribution of fluids, growth process, function of organ/channel networks).
  2. Warming the various layers of the body (if skin and muscles are not warmed due to qi deficiency, there will be aversion to cold, cold hands and feet, etc.).
  3. Creating a protective shield effect against external pathogens such as wind or cold as well as, in modern terms, viruses and bacteria.
  4. Stabilizing and holding the structural parts of the body in place (otherwise bleeding, sweating, enuresis, prolapse of organs may occur).
  5. Driving metabolism (e.g., in the process of blood production, or in the functioning of certain organs, such as qi transformation facilitating water metabolism in the bladder).

There are many different layers of bodily qi which are referred to by the following terms:

Yuan Qi (original qi), also called jing qi (essence qi) or shenjian dong qi (qi that spirals out from between the kidneys). It is created by the interaction of the body’s yuan yang (original yang) and yuan yin (original yin). It is considered to be the most fundamental qi of the human body, the root source of metabolism. The Qing dynasty medical scholar Xu Lingtai states in his influential treatise, Discussing the Origins and the Development of Medicine (Yixue Yuanliu Lun, 1757): “And where, then, is this so called original qi located? All five organ networks possess their own true jing which is their piece of the original qi. However, the true home of this substance is what the Daoist classics call the dantian, or what the Nanjing (Classic of Difficulties) calls mingmen (gate of life), and what the Neijing calls ‘the little heart next to the seventh vertebrae.'”

Da Qi (great qi), also called tian qi (heavenly qi): the breath.

Gu Qi (grain qi), also called di qi (earthly qi): qi distilled from food.

Zhen Qi (true qi): the body’s total energy, being the combination of prenatal original qi and postnatal air/food qi.

Zong Qi (ancestral qi): combination of the two aspects of postnatal qi, the breath, and distilled food essence. It gathers in the middle dantian that is located between the nipples, and surfaces in the throat to support the breath and the voice. It also enters the heart channel to promote circulation of qi and blood.

Ying Qi (nutritive qi): manufactured from the denser portion of food essence; circulates inside the blood vessels; can combine with fluids to produce blood; helps blood to circulate. Ying (nutritive qi) and xue (blood) can therefore be differentiated only theoretically-in physical form they are always one.

Wei Qi (protective qi): made from the more ethereal portion of food essence; circulates outside the vessels; warms the muscles, moistens the skin, is in charge of opening and closing the pores. This is why it can protect the body against the invasion of pernicious qi invading from the outside.

Zheng Qi (righteous qi), Xie Qi (pernicious qi): righteous qi can be understood as the traditional equivalent to the immune system, responding to the invasion of external pathogens. The scholar Xie Liheng once made the following remark about the origins of righteous qi: “zheng qi (righteous qi) is actually a manifestation of the power of yuan qi (original qi).” His colleague Li Zhongzhai elaborated on the meaning of its antagonist, pernicious qi: “xie qi (pernicious qi, evil qi) is nothing else but the six pathogenic influences of wind, cold, summer heat, dampness, dryness, and fire.”

Zangfu Jingluo Zhi Qi (organ and channel network qi): organ qi (liver qi, spleen qi, etc.) refers to the respective functions of different organ networks. Channel network qi refers to the qi flowing through the meridians that produces the feeling of local distention during needling or acupressure.

Zhong Qi (central qi): qi of spleen and stomach. Mostly refers to the transporting function of the spleen, specifically referring to its rising action. When the central qi collapses, there will be signs of downward leakage such as diarrhea, profuse urination, prolapse of anus, etc.

It is important to note that all of these different types or layers of qi are governed by the lung, and can be coordinated in a fruitful way only by the lung. In other words, all four of the basic qi movements of ascending, descending, going out, and coming in are influenced by the lung. This governing of the qi includes influence on the spleen qi raising food essence to the lung, from where it is distributed over the entire body; stomach qi descending, passing waste to the intestines to be discarded; kidney yang “steaming” vital fluids (jing) upwards; liver qi rising; lung qi descending. etc.

2. The Lung Contains the PO Spirits

Po is an ancient astronomical term designating the material body of the moon, while its counterpart, hun, is used to specify the light of the moon. In nature, the term po is thus used to represent the visceral life force that lies latent in the earth, and in medicine it is used to describe both measurable physiological functions and development. The scholar Kong Yingda explains: “The spirit of form is called po. When human beings are first born, they can see and hear, their hands and feet can move; these actions are due to the workings of po.” Zhang Jingyue, the master physician of the Ming Dynasty, further elaborated: “The effect of po is that we can move and do things, that there is itching and pain.” In sum, po entails the basic instincts that we possess from birth, enabling us to see and hear and eat and cry, even with the early state of awareness and activity of a baby. Since breathing is the most fundamental of all instincts, the lung is the residence of the po spirits.

According to the classic definition in the Neijing, “Po follows jing.” In Chinese colloquial language, people with a voluminous voice, intense eyes, or reflexes suited to the performance of martial arts are said “to have a lot of qi po.”

3.  The Lung is in Charge of Orderly Flow (Administration)

The lung is closely associated with the heart, just as the qi is closely associated with the blood. The administrating aspect of the lung mostly refers to its controlling and harmonizing function in regard to the flow of blood. As the Neijing definition reads: “The lung opens the one hundred vessels.” Concerning the intimate relationship of qi and blood, the classic further states: “Qi is the commander of blood; if qi moves, blood moves.”

4.  The Lung is the delicate organ (Cannot endure heat and cold)

Just like a metal object absorbs the temperature of its environment in an instant, the metal organ (lung) is most easily influenced by external influences of pernicious heat or cold.

5.  The Lung is in charge of the descending movement of qi and thus, of opening and regulating the water channel

Lung qi constantly descends, moving water downwards: it thus provides the rest of the organ networks with fluids, and even regulates urination. The defining Neijing line reads: “The lung is the upper source of water.” If it loses its crucial descending function, there may be symptoms of stuffy chest, cough, asthma, or signs of water stagnation such as phlegm, urinary problems, edema, etc.

6.  The Lung is in charge of the outward dissipation and dissemination of qi and thus connects wit hthe skin and body hair.

The lung qi is in charge of propelling the protective qi (wei qi), the fluids, and the food essence over the entire body. It thus warms the muscles and the surface, harmonizes the opening and closing action of the surface pores, and moistens the body hair and the skin. If lung qi is weak, the protective qi (wei qi) cannot nourish the body hair properly, causing it to become brittle. Similar to the pores on the surface of the lung, moreover, the pores on the surface of the skin are qi gates in charge of “body breathing.” If the protective qi is too weak to properly close the pores, sweat pours out. If there is an excess of pernicious qi in the lung, on the other hand, the opening mechanism of the pores easily gets jammed; then the ventilating function of the pores gets disturbed, and there may be symptoms of inhibited sweating, such as no sweating during a fever.

7.  The Lung connects with the large intestine below

A branch of the lung channel connects with the large intestine below, thus forming a pair. The lung is known as yin (structural, essence storing) metal, the large intestine as yang (hollow, transmitting) metal. Lung qi is the pushing power behind the large intestine’s action of transporting and discarding waste materials. From a more general perspective, it could be said that the large intestine acts in accordance with the qi from the five organ networks which reaches it via the lung. Constipation may be due to a deficiency or stagnation of propelling power, or a fluid problem (dryness) related to the lung. The anus, because of the large intestine’s intimate relationship with the lung, is called the po gate.

8.  The Lung has it’s opening in the nose and connects with the throat

The nose is in charge of breathing and smelling; functions that depend entirely on a healthy lung. Also, the nose is one possible gateway through which external pernicious qi can invade the lung. If the lung is invaded by pernicious qi, there may be nasal symptoms such as stuffy nose, nasal discharge, or loss of smell. If there is an acute obstruction of qi due to lung heat, there will be asthmatic breathing, in which case the nose may quiver.

The throat is in charge of the voice, which can be compared to the sound emanating from a metal bell. When the metal organ (lung) is afflicted by disease, the voice may appear changed, muffled, or even lost as in the case of sore or hoarse throat.

The Lung Network: Pathogenesis

Abnormal Upbearing and Downbearing of Lung Qi: If the body surface is invaded by cold, or if there is internal heat obstructing the lung, the smooth process of dissipating qi, as governed by the lung, will be disturbed. This disturbance of outwardly flowing qi typically results in sensations of chills, drafts, fever, spontaneous sweating, or inhibited sweating-a symptom complex that is generally labeled as a “disharmony between the body’s ying (nutritive) and wei (protective) layers.”

If lung qi is deficient, and thus falls short in fulfilling its physiological duties of “misting” postnatal essence over the organ networks or disseminating wei qi and essence to the skin and body hair, then dry skin, spontaneous sweating, or a propensity to catch frequent colds may result. Every disturbance of outward qi flow, moreover, will necessarily involve disruption of the downward distribution of qi. Coughing, asthmatic breathing, and a stuffy sensation in the chest are typical indications for a reversal of the lung’s downward qi flow.

Lung Imbalance Affecting Its Opening and Regulating Affect on the Water Pathways: The lung is situated in the upper burner and referred to as the upper source of water. If lung qi fails to descend, it cannot open and regulate the water pathways and ensure the unobstructed transportation of fluids to the bladder. Signs of water stagnation will inevitably ensue, such as phlegm buildup, a puffy face, edema, or inhibited urination. As the Neijing points out: “Lung qi disperses jing; in the upper part of the body, it is rooted in the lung; below, it feeds into the bladder.” The lung disseminates essential fluids: physiological jing (essence), jin (body fluids), and ye (body humors). At the same time, it feeds into and excretes superfluous fluids from the body via the bladder. Lung malfunction therefore can easily cause pathological changes in water metabolism, particularly bladder function.

Dryness Affecting the Lung Causing a Depletion of Liquids and Humors: External conditions like environmental cold, heat, and dryness, or internal dryness of the lung or large intestine all have the potential to injure the fluid supply of the body and cause dryness symptoms in the nose, throat, lungs, skin, body hair, or intestines. The Neijing comments: “The lung has a natural aversion to dryness.” In addition to being easily harmed by dryness, it passes on the condition as symptoms of dryness elsewhere.

Grief and Sadness Harming the Lung: Grief, sadness, and melancholy are associated with the lung. If one indulges in these emotional states, harm to the lung network will result and symptoms of emaciation, lack of energy, or dry skin may occur. The other way around, a low supply of lung qi can cause a gloomy state of mind. A particularly sad experience, moreover, may cause a person to adopt a pessimistic attitude toward life (which is really a state of dampened qi). “If a person is sad,” it is said in the Neijing, “his qi will dissipate.”

Lung Disease Influencing the Nose, Throat, and Large Intestine: If external pathogens invade the lung, its orifice, the nose, will manifest symptoms of stuffiness, nasal discharge, inability to distinguish smell, or quivering nostrils (in asthma patients). Since the throat is governed by lung qi, an invasion of external pathogens can easily cause a loss of voice. Both external (excess) and internal (deficiency) conditions, moreover, can be the cause of swelling and pain in the throat, including enlargement and suppuration of the tonsils. If the lung is unable to disseminate enough fluids to its associated fu organ below, the large intestine, or if the fluids are scorched by lung heat, there will be constipation. As the primary text of the fever school, Systematic Differentiation of Warm Diseases (Wenbing Tiaobian), describes: “If somebody suffers from invasion of pernicious dry metal qi that is prominent during the fall, it will gradually lead to intestinal coagulation that will become harder and harder, and that must be purged.” Heat accumulation in the large intestine, in turn, can interrupt the proper up/down dynamics of lung qi, and become a potential cause of coughing or asthmatic breathing.

Representative Formulas for the Treatment of Lung Disorders

Dissipate lung qi (xuan fei): platycodon (jiegeng), scallions (congbai), fermented soy (dan douchi), lotus leaf (heye).

Open up the surface (fa biao): ma-huang (mahuang), perilla leaf (zisuye), schizonepeta (jingjie), mentha (bohe), angelica (baizhi).

Clear lung heat (qing fei): scute (huangqin), morus leaf (sangye), phragmites (lugen), anemarrhena (zhimu), gypsum (shigao).

Moisten lung yin (run fei): lily (baihe), ophiopogon (maimendong), scrophularia (xuanshen), polygonatum (yuzhu), trichosanthes root (tianhuafen).

Astringe the lung (lian fei): schizandra (wuweizi), mume (wumei), (yingsuke), terminalia (hezi).

Stop coughing (zhi ke): stemona (baibu), aster (ziwan), (madouling), tussilago (kuandonghua).

Calm asthmatic breathing (ping chuan): ma-huang (mahuang), apricot seed (xingren), perilla seed (zisuzi), honey baked eriobotrya (zhi pipaye).

Disinhibit phlegm (li tan): pinellia (banxia), peucedanum (qianhu), fritillaria (beimu), bamboo skin (zhuru), bile treated arisaema (dan nanxing).

Purge lung qi (xie fei): lepidium (tinglizi), morus bark (sangbaipi), water melon rind (xiguapi), (baiqiangen)

Raise lung qi (sheng fei qi) :platycodon (jiegeng), cimicifuga (shengma).

Tonify lung qi (bu fei qi): ginseng (renshen), astragalus (huangqi), gecko (gejie).

Clear heat in the large intestine (qing chang): phellodendron (huangbai), coptis (huanglian), rhubarb (dahuang), sterculia (pangdahai).

Moisten the large intestine (run chang): linum (huoma ren), trichosanthes seeds (gualou ren), apricot seed (xingren), cistanche (roucongrong), tang-kuei (danggui).

Basic Guidelines for the Treatment of Lung Disorders

Since the lung is primarily in charge of qi, lung therapy should mostly utilize medicinal substances that affect the qi, not the blood. It is the particular function of lung qi to dissipate outwards, and to descend and dispense downwards. If these functions are compromised, they need to be rectified by restoring the outwardly dissipating function of the lung (primarily by opening up the surface with diaphoretics), and/or restoring the downward flow of lung qi (by calming coughing and asthmatic breathing, or opening up the water passages, or purging lung qi).

Since the lung is located in the highest position of the organ networks, it is accustomed to a clear and pure environment comparable to the crisp and fresh air on a mountain top. It is most appropriate, therefore, to treat lung disorders with light and purifying herbs (consisting mostly of the leaf and blossom parts of plants). The lung, moreover, is known as the “fragile organ,” and thus should not be treated with methods that are extreme. Ideal herbs are pungent (but not too hot or too cold), and sweet and moistening.

If phlegm or heat accumulation obstructs the downward flow of lung qi (primarily manifesting in coughing or asthmatic breathing), the lung should be purged by the application of bitter herbs that initiate downward movement, such as apricot seeds (xingren), scute (huangqin), or lepidium (tinglizi).

Lung tonification, in addition to using qi tonics with a specific affinity to the metal system (like ginseng or astragalus), entails astringing the patient’s surface energy. In order to achieve this astringing affect, sour and moisturizing herbs (particularly schizandra) are often included in therapeutic approaches to chronic lung disorders.

Pungent flavors have a particular affinity for the lung network. It is a characteristic of spicy substances that they generally have a dispersing effect. In a healthy individual, pungent food assists the lung’s outwardly dissipating function which is involved in nourishing and regulating the pores on the body surface. In a person suffering from a common cold, pungent substances can help to relieve the blocked surface by inducing diaphoresis. Chinese peasants often take a pungent decoction of ginger, garlic, and scallions to fight off wind cold disorders. Horseradish, garlic, onions, ginger, mustard, and other pungent foods and spices are deemed beneficial to the lung if used in moderation. “Pungent flavors generate the lung,” states the Neijing. The Classic warns immediately, however, that if used inappropriately or excessively, they will cause harm to the lung, the skin, and the body hair. Eating too much pungent food disperses the lung’s physiological qi and dries its yin.

If there is excess heat in the lung network, the large intestine can be purged to relieve lung heat and restore the descending dynamic of the lung system. If there is constipation due to lack of fluids in the large intestine, consider possible causes in its zang organ pair: nourish lung yin to moisturize the zang and fu metal organs (e.g., use trichosanthes root), and/or fortify lung qi (e.g., use astragalus) so that physiological fluids can be properly distributed to the large intestine.

The Lung Network: Typical Disease Patterns

LUNG QI DEFICIENCY (fei qi xu): primary symptoms include a pale face; shortness of breath during physical activity; a low voice; a general aversion to cold temperatures; cough/asthma without force; and spontaneous or inhibited sweating. Lung qi deficiency usually entails surface deficiency, manifesting either in a proneness to colds and flus; or a general sense of “being invaded” or overwhelmed by people or events. Secondary symptoms may be fatigue; disinclination to talk; chronic presence of clear and watery phlegm. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak.

Representative Herbs: astragalus (huangqi), ginseng (renshen), atractylodes (baizhu), dioscorea (shanyao), schizandra (wuweizi), jujube (dazao), licorice (gancao), siler (fangfeng).

Representative Formulas: Ginseng and Astragalus Combination (Buzhong Yiqi Tang); Jade Screen Formula (Yuping Feng San); Decoction for Replenishing Original Qi (Baoyuan Tang) minus cinnamon bark (rougui) plus schizandra (wuweizi).

LUNG YIN DEFICIENCY (fei yin xu): primary symptoms include a dry cough with no phlegm or small amounts of sticky phlegm (possibly with traces of impacted blood); dry nose and throat; and hoarseness or loss of voice. Secondary symptoms include a skinny constitution; chronic sore throat; hot flashes; flushed cheeks in the afternoon; a burning sensation in the palms or soles of the feet; and night sweats. The tongue typically presents with a dry body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: lily (baihe), ophiopogon (maimendong), glehnia (bei shashen), scrophularia (xuanshen), polygonatum (yuzhu), white tree fungus (yin’er), cordyceps (dongchong xiacao), raw rehmannia (sheng dihuang), asparagus (tianmendong), fritillaria (beimu), platycodon (jiegeng).

Representative Formulas: Lily Combination (Baihe Gujin Tang); Nourish the Yin and Clear Heat in the Lung Decoction (Yangyin Qingfei Tang).

LUNG YANG DEFICIENCY (fei yang xu): symptoms similar to lung qi deficiency, with emphasis on cold symptoms that require warming.

Representative Herbs: dry ginger (ganjiang), asarum (xixin).

Representative Formulas: Licorice and Ginger Decoction (Gancao Ganjiang Tang); Hoelen, Licorice, Schizandra, and Asarum Decoction (Ling Gan Wuwei Jiang Xin Tang).

LUNG QI AND YIN DEFICIENCY (fei qi yin liang xu zheng): primary symptoms are chronic cough without force; shortness of breath when physically active; spontaneous sweating and/or night sweats; dry mouth and throat. Secondary symptoms may include mental and physical fatigue; low voice; pale face; flushed cheeks; little but sticky phlegm; traces of blood in the phlegm; low grade afternoon fevers; and skinny constitution. The tongue is typically pale with a gloss of tender redness; and the pulse tends to be fine and weak.

Representative Herbs: ginseng (renshen), ophiopogon (maimendong), astragalus (huangqi), schizandra (wuweizi), dioscorea (shanyao), raw rehmannia (sheng dihuang), lily (baihe), anemarrhena (zhimu), fritillaria (beimu), peony (baishao), licorice (gancao).

Representative Formulas: Generate the Pulse Powder; Ginseng and Ophiopogon Formula (Shengmai San); Lily Combination (Baihe Gujin Tang).

WIND COLD INVADING THE LUNG (feng han fan fei): primary symptoms are chills; stuffy nose; clear and copious discharge, and/or cough. Secondary symptoms may include headache; sneezing; obstructed voice; fever; and body pain. The tongue is typically covered with a thin white coating; the pulse is floating.

Representative Herbs: ephedra (mahuang), apricot seeds (xingren), cinnamon twig (guizhi), asarum (xixin), fresh ginger (shengjiang), citrus (chenpi), pinellia (banxia), platycodon (jiegeng), aster (ziwan).

Representative Formulas: Ma-huang Combination (Mahuang Tang); Apricot Seed and Perilla Formula (Xing Su San).

WIND HEAT INVADING THE LUNG: primary symptoms are fever with slight aversion to wind and cold, and sore throat or cough with possibly some sticky or yellow phlegm. Secondary symptoms may include nasal discharge; thirst; asthma; red and itchy skin rashes; and restlessness. The tongue typically presents with a red tip, is covered with a thin white or yellow coating; the pulse is floating and rapid.

Representative Herbs: morus leaves (sangye), platycodon (jiegeng), forsythia (lianqiao), lonicera (yinhua), ma-huang in combination with gypsum (shigao), apricot seeds (xingren), phragmites (lugen), houttuynia (yuxingcao).

Representative Formulas: Morus and Chrysanthemum Combination (Sang Ju Yin); Lonicera and Forsythia Formula (Yin Qiao San).

DRYNESS INVADING THE LUNG (zao xie fan fei): primary symptoms are dry cough without phlegm; dry nose and throat. Possibly small amounts of sticky phlegm that is hard to expectorate or causes pain when coughing; traces of blood in the phlegm; headache. The tongue is typically red and covered with a thin; dry yellow coating; and the pulse is floating; fine; and rapid.

Representative Herbs: glehnia (bei shashen), eriobotrya (pipaye), fritillaria (beimu), trichosanthes root (gualou), phragmites (lugen).

Representative Formulas: Eriobotrya and Ophiopogon Combination (Qingzao Jiufei Tang); Morus Leaf and Apricot Seed Decoction (Sang Xing Tang).

COLD PHLEGM OBSTRUCTING THE LUNG (han tan zu fei): primary symptoms are expectoration of runny white phlegm, or asthmatic breathing accompanied by an inability to lay down on the back. Secondary symptoms include profuse amounts of phlegm that is easy to cough up; rattling phlegm sound in throat; aversion to cold; stuffy sensation in chest; white and greasy tongue coating; and a deep and slow pulse that is often slippery in the first pulse positions.

Representative Herbs: perilla seed (zi suzi), sinapis (baijiezi), raphanus (laifuzi), asarum (xixin), citrus (chenpi), pinellia (banxia), hoelen (fuling); ma-huang (mahuang), apricot seed (xingren), belamcanda (shegan).

Representative Formulas: Belamcanda and Ma-huang Combination (Shegan Mahuang Tang); Atractylodes and Hoelen Combination (Ling Gui Zhu Gan Tang).

HEAT PHLEGM OBSTRUCTING THE LUNG (tan re yong fei): primary symptoms are coughing or asthmatic breathing accompanied by phlegm sounds in the chest or throat; and expectoration of thick, yellow phlegm. Secondary symptoms include fever and choppy breathing; coagulation of phlegm into rubbery clots that are difficult to expectorate; traces of blood in phlegm; stuffiness and distention in the chest. Patient typically presents with red tongue with yellow and greasy coating, and a slippery and possibly rapid pulse.

Representative Herbs: trichosanthes fruit (gualou), fritillaria (beimu), bamboo skin (zhuru), scute (huangqin), houttuynia (yuxingcao), morus bark (digupi), peucedanum (qianhu), eriobotrya (pipaye), apricot seed (xingren), lepidium (tinglizi).

Representative Formulas: Minor Trichosanthes Combination (Xiao Xianxiong Tang); Phragmites Combination (Weijing Tang).

WATER AND COLD AFFLICTING THE LUNG (shui han she fei): primary symptoms are coughing; asthmatic breathing accompanied by an inability to lay down on one’s back; and edema or swelling in the lower extremities. Secondary symptoms include copious amounts of phlegm; stuffiness and fullness in sides of chest; distention and fullness in the lower abdomen; cold pain in the lower back; cold knees; inhibited urination; or chills and fever with body pain and no sweat. Patient typically presents with a thin white and moist (or greasy) tongue coating; and a floating and tight pulse.

Representative Herbs: ma-huang (mahuang), cinnamon twig (guizhi), asarum (xixin), dry ginger (ganjiang), aster (ziwan), apricot seed (xingren), perilla seed (zi suzi), aconite (fuzi), hoelen (fuling), alisma (zexie), atractylodes (baizhu).

Representative Formula: Minor Blue Dragon Combination (Xiao Qinglong Tang).

Credit to:  Heiner Fruehauf Ph.D


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