Panting syndromePanting syndrome

TCM Diagnoses and Treatments Panting syndrome is one of the respiratory disease characterized by rapid breathing

even with mouth open and shoulders elevated, flaring of nares, dyspnea, worsening while making exertion.

Etiology & Pathology:Etiology: Kidney & Lung

Full Type: obstruction of the lu. by exogenous evils

Def. TypeHypofunction of Lu. & Kid.

<<Jin Yue Quan Shu>>: “Excess-type panting due to exogenous evils, and Def.-type panting

due to Yuan Qi Def. without exogenous evils”

<<lei Zheng Zhi Cai>>“Treat the lung if panting is excess-type; Treat the

Kidney if panting is def.-type”

Main Points for differentiationMain Points for differentiation

Differentiation of def. & Excess

Def. type Excess type

Breathing Rapid breathing, dyspnea, comfort if having a deep inspiration, lower voice

Deep & long; feeling comfortable when exhaling, coarse respiration

Duration Long short

Onset Repeated attack Sudden & acute attack

Accompanied by

Lune or Kid def. sym. Exterior syndromes

Tongue Pale Thin white coating

Pulse Large, hollow, weak Rapid & forceful

Main Points for differentiationMain Points for differentiation

Differentiation of Panting & shortness of breath

Panting Syn. Shortness of B.

Breathing Abnormal breathing

Dyspnea with mouth open & shoulder lifting or even being unable to lie flat

Feeble breathing

Type Excess & Def. Def. type only

Which is often seen in various acute & chronic disease

(Asthma)

Onset Repeated attack Usually happened after doing light physical labor

Accompanied by Lune or Kid def. sym Lassitude, being reluctant to speak

Main Points for differentiationMain Points for differentiation

Differentiation of Panting & wheezing

Panting Syn. Wheezing

Breathing Abnormal breathing

Rapid breathing without production of louder sound,

Loud sound in the throat,

Syndromes is short, combined with rattles due to phlegm in the throat

Type Excess & Def. Def. type only

Which is often seen in various acute & chronic disease (Asthma)

Pathology Qi disorder Obstruction of Qi by phlegm

etiology Invasion of evils or chronic of disease but no perennial root

Has its perennial root and predisposing causes

Onset No this character Paroxysm, repeated attack & stubborn

independence A complication of multiple chronic disease.

A dependent disease ( could include panting syn.)

TreatmentTreatment 1) Excess-typeExcess-type a) Wind-cold

Signs & Symptoms:

– Main Sym. : Rapid breathing, distending feeling in the chest, abundant white thin sputum

– Concurrent sym.: headache, aversion to cold, cough, no sweating, no thirsty

– Tongue: white, thin and slippery tongue coating

– Pulse: floating, rapid

• Treatment Protocol:

– Expel the cold– Dispersing the Lung Qi

Formula:

Modifications:Headache

-- Chuan Xiong, Bai Zhi

Abundant Sputum

-- Bai Jie Zi, Lai fu zi

Cough with sputum

-- Jie Geng, Gan Cao

Distending feeling in the chest

-- Gua Lou, Xie Bai

Ma Huang Tang

Ma Huang Xing Ren Gui Zhi Gan Cao Ju Hong Ban Xia

Su Zi Fu Ling Bai Qian Hu Tao rou

TreatmentTreatment 1) Excess-typeExcess-type b) Wind-heat

Signs & Symptoms:

– Main Sym. : Gasping, Rapid breathing, flaring of nares, yellow sticky & thick sputum difficult to be expectorated.

– Concurrent sym.: chest pain, irritability, headache, fever, sweating, constipation, thirsty, dark urine

– Tongue: thin white or yellow tongue coating

– Pulse: floating, slippery rapid

• Treatment Protocol:

– Clear the exterior-heat– ventilating the Lung & stopping panting

Formula:

Modifications:Headache

-- Man Jin Zi, Chuan Xiong, Yellow Sputum

-- Qian Hu, Gua Lou, Bei MuConstipation

-- Da Huang, Dark urine

-- Hua shi, Tong Cao, Chi Xiao douIrritability

-- Shan Zhi Zi,

Ma xing Shi Gan Tang

Ma Huang Xing Ren Shi Gao Gan Cao Huang Qin Gua Lou

Lian Qiao Lou Lu Jie Geng

TreatmentTreatment 1) Excess-typeExcess-type c) Phlegm Accumulation

Signs & Symptoms:

– Main Sym. : Panting, cough, profuse, white & sticky phlegm, fullness sensation in the chest

– Concurrent sym.: poor appetite, stickiness in the mouth, no thirsty, nausea or vomiting in severe cases

– Tongue: thick, greasy, white tongue coating

– Pulse: slippery

• Treatment Protocol:

– Resolving sputum– Restore the reversed flow of Qi

Formula:

Modifications:Panting

-- Xuan Fu Hua Fullness sensation in the chest

-- Gua Lou, Zhi KePoor appetite

-- Bai Zhu, Shan Yao Nausea or Vomiting

-- Zhu ru, Sheng JiangDampness

-- Cang Zhu, Sha Ren

Er Chen Tang + San Zi Yang Qing Tang

Chen Pi Ban Xia Fu Ling Gan Cao Su zi Bai Jie Zi

Lai Fu Zi Hou Pu Xing Ren

TreatmentTreatment 1) Excess-typeExcess-type d) Phlegm-heat Accumulation

Signs & Symptoms:

– Main Sym. : Panting, cough, dyspnea, irritable feverish sensation & distending pain in the chest, yellow sticky sputum

– Concurrent sym.: thirsty, like cold drinking, flushed face, dry throat, dark urine, constipation or bloody sputum

– Tongue: yellow greasy coating

– Pulse: slippery & rapid

• Treatment Protocol:

– Resolving sputum– Eliminate lung heat

Formula:

Modifications:Fever

-- Shi Gao, Zhi Mu Sticky sputum

-- Hai Ge KeAbundant sputum + constipation

-- Ting Li Zi, Da Huang, Mang Xiaostinking sputum

-- Yu Xing Cao, Yi Yi Ren, Dong Gua Ren, Lu Geng

Sang Bai Pi Tang

Sang Bai Pi Huang Lian Huang Qin Zhi zi Bei mu Xing ren

Su zi Ban Xia

TreatmentTreatment 1) Excess-typeExcess-type e) Stagnated Qi impairs the Lung

Signs & Symptoms:

– Main Sym. : Panting, short and rapid breathing, a feeling of obstruction in the throat, which are evoked usually by mental stress.

– Concurrent sym.: frequent insomnia, palpitation, chest stuffiness, chest pain

– Tongue: thin coating

– Pulse: string

• Treatment Protocol:

– To deal with the mental depression– Descending adverse flow of Lung Qi

Formula:

Modifications:Modifications:Palpation & insomnia

-- Bai He, he Huan Hua, Zao Ren, Yuan zhi Chest distension & pain

-- Xiang Fu, Xuan Fu HuaQi Stag + Liver fire

-- Dan Zhi Xiao Yao san

Wu Mo Ying zi

Chen Xiang Mu Xiang Bing Lang Wu yao Zhi ke

Mu Xiang Xiang Fu Wu yao

Regular Qi movement & stop the pain

Sp. St. Liver Kidney

Smooth Qi Regular Qi Warm

Middle Jiao Qi Stag.

digesting

Hypochondrium pain; dysmenorrhea

Hernia; dysmenorrhea; frequent urine;

TreatmentTreatment 2) Def.-typeDef.-type a) Qi deficiency (Lung & Spleen)

Signs & Symptoms:

– Main Sym. : dyspnea, tachypnea, short breath, low & weak voice, lower cough sound

– Concurrent sym.: spontaneous sweating & aversion to wind, pale complexion, lassitude, epigastric distension & loose stool after meal, or defecation soon after meal.

– Tongue: thin white or white & greasy coating

– Pulse: thready

• Treatment Protocol:

– Strengthening Spleen– Nourish Lung Qi

Formula:

Modifications:Thin sputum + aversion to cold

-- Gan jiangLoose stools

-- Shan Yao, bian dou

Yu Ping Feng San + Liu Jun zi Tang

Dang Shen Huang Qi Bai Zhu FuLing Ban Xia Chen Pi

Jie Geng Gan Cao

TreatmentTreatment 2) Def.-typeDef.-type b) Yin deficiency (Kidney & Lung)

Signs & Symptoms:

– Main Sym. : Panting & short breath worsening on exertion, thirsty, tidal fever, night sweating, sticky sputum with less amount and difficulty to be expectorated

– Concurrent sym.: flushed face, irritability, feverish sensation in the palm & soles

– Tongue: red tongue with thin yellow coating

– Pulse: thready & rapid

• Treatment Protocol:

-- Nourish Lung & Kidney

Formula:

Modifications:Lung Yin Def.

-- Bai He, Sha Sheng, Yu ZuKid Yin Def.

-- Long Gu, Mu LiPanting

-- Ci Shi ( specify for kid yin def. type panting)

Shen Mai San + Liu Wei Di Huang Wan

Dang Shen Mai Dong Tian dong Shen di Shan yu rou Ze xie

Dan Pi Gan Cao

TreatmentTreatment 2) Def.-typeDef.-type c) Yang deficiency (Kidney & Spleen)

Signs & Symptoms:

– Main Sym. : Chronic panting, more expiration & less inspiration, worse while making exertion, shortness of breath

– Concurrent sym.: sweating, cold limbs, edema of face & legs, profuse, clear thin sputum, soreness of waist, lower back pain, pale or darkish complexion, frequent urination and polyuria during night

– Tongue: Pale and enlarged tongue

– Pulse: thready & deep & week ; large and rootless

• Treatment Protocol:

-- Warming Yang

Formula:

Modifications:Up-adverse flow of Qi

-- Zi Shi yin, Ci Shi, Cheng XiangEdema

-- Ting Li Zi, Fang Ji,

Jin Gui Shen Qi Wan + Shen Ge san

Gui Zhi Fu Zi Ren Sheng Shen di Shan yu rou Ze xie

Dan Pi Gan Cao Ge Jie Bai Guo Wu wei zi Zu Ri

Prevention:

1. Fresh air, full sunlight, suitable temperature & humidity in the room

2. No smoking, no drinking3. Have light food, avoiding too salty, too sore, hot or

irritable food4. In the stage of attack, patient should lie in bed.

When necessary, give the patient with oxygen inhalation.

5. In the stage of intermission of panting, courage the patient to do more exercise to strengthen constitution.

Case History

1. Male 73 years

Medical history:Medical history: Panting & coughing for several years, especially worse in winter. First visiting:First visiting:

Main complain: panting & coughing for several days Got cold several days ago and started coughing. Not stopping cough in

the whole day, flaring of nares, yellow sticky & thick sputum difficult to be expectorated. distension feeling in the chest. Panting at night even can not fall in sleep. Fever & aversion to cold in every afternoon. Thirsty, no appetite, constipation, dark urine

Tongue: red body less moisture with dry yellow coating Pulse: floating & slippery & rapid

TCM diagnose: Wind-cold invasion + phlegm-heat accumulation + Yin Def. +

lu. dryness Treatment protocol:

Release the cold + clear the lung heat Formula:

Ma Xing Shi Gan Tang: Ma huang 9, Xing Ren 9, Shi Gao 15, Gan Cao 3, Huang Qin 9, Zi Su

Geng 9, Sang Ye 9, Zhi Ke 9, Jie Geng 6, Ji Nei Jing 6, Zu Ru 9

Case History

1. Male 73 years

Medical history:Medical history: Panting & coughing for several years, especially worse in winter.

Second visiting:Second visiting:

Main complain: Panting & coughing

Fever is almost gone, no aversion to cold, appetite is getting better, still cough & panting, however, patient could take a half lying position now, sticky sputum with little blood, dark urine

Tongue: moisture red body with thin yellow coating Pulse: slippery & rapid

TCM diagnose:

Lung Dryness & heat

Treatment protocol:

Clear the lung heat, moisten the lung dryness

Formula:

Qin Zao Jiu Fei Tang:

Sha Sheng 9, Sang Ye 9, Shi Gao 15, Chuan Bei Mu 9, Pi Pa Ye 9, Mai Dong 9, Bai Mao Geng 15, Ce Bai Ye 9, Zhi Mu 9, Gan Cao3

X 5 bags

Case History

1. Male 73 years

Medical history:Medical history: Panting & coughing for several years, especially worse in winter.

Third visiting:Third visiting:

Main complain: Panting & coughing

No fever, cough is getting better, no bloody sputum, still little sticky sputum, panting is getting calm down at night, appetite is better, Still feel tired and exhausted, little dizziness,

Tongue: moisture red body with thin yellow coating Pulse: thready rapid

TCM diagnose:

Yin Def. + Lu. Dryness + Sp Qi Def.

Treatment protocol:

Nourish Yin, moisten the lung dryness, tonify the Sp Qi

Formula:

Sha Sheng mai Dong Tang:

Sha Sheng 9, Sang Ye 9, Pi Pa Ye 9, Mai Dong 9, Fu Ling 15, Bian Dou 9,

Lian Zi rou 12, Yuan Zhi 6, Kuan Dong Hua 9, Gan Cao 3

Lung DistensionLung Distension

TCM Diagnoses and Treatments Lung distension results from development of multiple

chronic pulmonary disease and is characterized as thoracic bulge & fullness, cough, panting with reversed flow of qi, worsening while making exertion, stuff chest & abundant sputum.

Etiology & Pathology:Etiology:

1) Lung def. due to chronic disease ( chronic pulmonary disease: obstruction emphysema, cough, asthma, pneumonectomy, chronic pulmonary heart disease, senile pneumonectomy, etc)

2) Exogenous pathogens affection

Main Points for differentiationMain Points for differentiation

Lung Qi Def.Lung Qi Def.

Lung Qi & Yin Def.Lung Qi & Yin Def.

Lung & Spleen Def.Lung & Spleen Def.

Lung & Kidney Def.Lung & Kidney Def.

Spleen & Kidney Yang Def.Spleen & Kidney Yang Def.

Wheeze, Panting & Lung distensionWheeze, Panting & Lung distension