Session 02

Lecture – Chronic respiratory

Chinese Medicine
Asthma: Western medicine perspective

“Asthma is a chronic disease of the air passages characterised

by inflammation and narrowing of the airways. Symptoms
include shortness of breath, cough and wheezing. It
commonly presents in childhood and is usually associated
with conditions such as eczema and hay fever.”
(Hashmi et al., 2023)

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Asthma: Western medicine perspective

Can be very mild or life-threatening due to airway closure.

Key feature is hyper-responsiveness triggered by:
Viral respiratory tract infections
Exercise
Gastroesophageal reflux disease
At least 50% of asthma
Chronic sinusitis exacerbations in
Environmental allergens children are associated
Aspirin, beta-blockers with viral infection.
(Pappas, 2018)
Tobacco smoke
Insects, plants, chemical fumes
Obesity

Emotional factors - stress

(Hashmi et al., 2023)
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Asthma: Western medicine perspective

Asthma is associated with genetic predisposition – personal or

family history of atopy (propensity to allergy e.g., eczema,
hay fever and asthma).
Prevalence: 15-20% people in developed countries have
asthma.
Not all paediatric asthma continues to become adult asthma.
40% children have a wheeze, 1% adults have asthma.
66% cases diagnosed before age 18.
Almost 50% children with asthma have a decrease in severity
or disappearance of symptoms during early adulthood.

(Hashmi et al., 2023)

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Asthma: Special testing, imaging, investigations

Pulse oximetry – assess severity of asthma attack for

monitoring
Urea and electrolytes (kidney function)
Electrocardiogram (ECG)
Chest X-ray or chest CT scan
Spirometry – diagnostic method (amount of air one can breathe
in and out of lungs, and how easily / fast one can blow it out)
Histamine challenge – tests airway hyper-reactivity.
Exercise spirometry – exercise induced bronchoconstriction

(Hashimi et al., 2023)

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Asthma: Western medicine treatment

Bronchodilators & inhaled steroids

Weight management
Remove possible allergens – environment control.
Monoclonal antibody therapy (expensive, lowers IgE levels)
Bronchial thermoplasty
High flow oxygen inhalation, systemic steroids, back-to-back
nebulizations (beta-2 agonists) and short acting muscarinic
antagonists.

(Hashmi et al., 2023)

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Asthma PROMs

Asthma Control Questionnaire (ACQ)

Asthma Control Test (ACT)
Asthma Life Impact Scale (ALIS)
Asthma Quality of Life Questionnaire (AQLQ)
COPD and Asthma Sleep Impact Scale (CASIS)
Patient Satisfaction and Preference Questionnaire (PASAPQ)
St Georges Respiratory Questionnaire (SGRQ)

(ACSQHC, n.d.)
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Asthma: Patient support and resources

Asthma Australia

National Asthma Council Australia

Lung Foundation Australia

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Asthma: Chinese medicine research

Effects of acupuncture in asthma treatment

“…include reducing the numbers of inflammatory cells, such as

neutrophils and eosinophils, regulating the adaptive immune
system (i.e., maintaining the balance of T-helper cell activity,
reducing the levels of proinflammatory cytokines, and
promoting the production of anti-inflammatory cytokines),
ameliorating signs of airway remodeling, and regulating
hypothalamic-pituitary-adrenal (HPA) axis function.”
(Nurwati et al., 2020)

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Chronic Obstructive Pulmonary Disorder (COPD)
Patients with COPD often have both chronic bronchitis &
emphysema.
Chronic bronchitis: Excessive secretion of bronchial mucous
and productive cough for a minimum of three months in at
least two consecutive years.
Emphysema: Abnormal, permanent enlargement of distal air
spaces of the terminal bronchiole with destruction of the
walls. No significant fibrosis.
COPD Key signs and symptoms: excessive cough, sputum
production, shortness of breath.

(Feng et al., 2016; Shi & Zeng, 2011)

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Chronic Obstructive Pulmonary Disorder (COPD)

Slow onset and progression.

10+ years duration, progressively worsening frequency &
intensity.

Complicated by other pulmonary and cardiovascular conditions

(acute and chronic): pneumonia, thromboembolism,
hypertension, pulmonary failure, ventricular failure.
Smoking cessation is essential – major contributor to COPD
development.
The National Safety and Quality Health Service (NSQHS) is
currently developing clinical care standards for COPD.
(ACSQHC, n.d.; Feng et al., 2016; Shi & Zeng, 2011)
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Chronic Obstructive Pulmonary Disorder (COPD)

Underlying deficiency with susceptibility to exterior pathogen

exacerbation.
Deficient root, excess branch.

Table 20

COPD Phases

Acute exacerbation episode Remission phase

Exterior Wind-Cold triggering latent Phlegm-dampness accumulation in the
congested fluids Lung
OR Phlegm-heat obstruction in the Lung
Exterior Wind-Cold with Phlegm-Heat Lung or Kidney deficiency
accumulation Spleen & Kidney Yang deficiency

Note. Adapted from Essentials of Chinese medicine: Internal medicine (2nd ed.)(p. 342), by A.
Shi and D. Zeng, 2011, Bridge Publishing Group. Copyright 2011 by Bridge Publishing Group.

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COPD & acupuncture Research

Feng et al. (2016) two-arm, randomised, multicentre, sham-

controlled study.
Small sample size (n=72)
Both groups same acupoints 3x per week for 8 weeks
Points: LU1, LU9, LI18, ST36, GB12, BL13, BL20, BL23.
Primary outcome: dyspnoea with exertion (6 minute walk test)
& health related Quality of Life (QOL) evaluation.
Both outcomes significantly better in the acupuncture group vs
sham group.

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COPD & acupuncture research

Research typically reveals positive associations between

acupuncture and COPD outcome measures, however, the
methodological quality of the research is generally poor and
therefore limits the usefulness of the studies.

(Chun et al., 2021; Fernández-Jané et al., 2020; Hsieh et al., 2020; Ruan et al., 2022; Tsai et al., 2021)
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Wheezing & dyspnoea

“Wheeze is a musical, high-pitched, adventitious sound

generated anywhere from the larynx to the distal
bronchioles during either expiration or inspiration.”
(Patel et al., 2023)

“Dyspnoea, also known as shortness of breath or

breathlessness, is a subjective awareness of the sensation
of uncomfortable breathing. It may be of physiological,
pathological or social origin.”
(Coccia et al., 2016)

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Wheezing: Red flags, cautions & contraindications

Many patients who experience wheezing or other breathing

difficulties take medication for their symptoms. As Chinese
Medicine practitioners, we do not instruct patients to reduce
or cease medications as this is beyond our scope of practice
and breaches CMBA Code of Conduct.

Red flag – cough with severe episodic shortness of breath and

expiratory wheezing indicates possible moderate to severe
chronic asthma. Urgent referral (same day) if undiagnosed.

(Ahpra & National Boards, 2022; Anzaldua, 2010; Maclean et al., 2018)
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Wheezing & dyspnoea

Wheezing & dyspnoea are symptoms only which may be

present in a range of pulmonary conditions such as asthma,
bronchitis, emphysema and more.
All wheezing presents with some level of dyspnoea.
Not all patients with dyspnoea have a wheeze.
Dyspnoea is generally acquired.
Wheeze often has an inherited component.
Difficulty inhaling – Kidneys not grasping Qi
Difficulty exhaling – poor Lung D & D

(Maclean et al., 2018)

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Wheezing: Chinese medicine approach

Treatment in two phases:

Acute episode or frequent wheezing attacks – treatment

principle is to descend Lung Qi as quickly as possible to stop
wheezing and improve breathing. Treat the branch.

Between wheezing attacks or when wheezing is infrequent or

well controlled – nourish Lung Qi to prevent future attacks or
to reduce the severity and frequency of attacks. Treat the
root.

(Maclean et al., 2018; Shi & Zeng, 2011)

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Wheezing: Chinese medicine aetiology

Exterior pathogens attacking Lungs

Improper diet

Constitutional deficiency or weakness post-illness

(Shi & Zeng, 2011)

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Wheezing: Acute phase treatment

Identify pathogens:
Exterior Wind (analogous to allergens such as dust mites, pollens, chemicals) or
in combination with Heat or Cold. Can trigger latent Phlegm in Lungs.
Phlegm (due to impaired fluid metabolism & triggered by latent phlegm in the
Lungs)
Identify excess or deficiency:
Excess – acute episodes, high pitched, forceful/heavy breathing, strong pulse,
‘sounding asthma’.
Deficiency – between episodes, prolonged course, low pitched, weak/shallow
breathing, deep/thready pulse, ‘soundless asthma’. Inhalation more difficult than
exhalation.
Identify stages:
Aura, Acute, Remission

(Maclean et al., 2018; Shi & Zeng, 2011)

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Wheezing (acute): Chinese medicine diagnosis
Table 1

Diagnosis

COLD TYPE HOT TYPE

Wind Cold invasion of Lungs constricts airways. Wind Heat invasion of Lungs stirs up latent Phlegm
in chest. Wind and Phlegm prevent Lung Qi from
descending which causes accumulation in the chest
and results in wheezing.
Response to temperature change, infection, cold Response to temperature change, hot weather, hot
weather, exercise, airborne particles. foods/drinks, exercise, smoke/dust, or a lingering
pathogen.
More likely for patients with underlying Yang Phlegm which is thick, dry or sticky is difficult to
deficiency shift. Herbal medicine (in addition to acupuncture)
may be required.
May be diagnosed as acute bronchial asthma, May be diagnosed as acute bronchitis or
asthma due to common cold or influenza, asthmatic exacerbation of chronic bronchitis, asthmatic
bronchitis, acute viral infection or upper respiratory bronchitis, common cold or influenza, allergic rhinitis
tract infection. or asthma.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1502-1503) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

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Wheezing (acute): Chinese medicine treatment
Table 2 * CV22 use with caution if Phlegm is copious as
it may direct Phlegm deeper into Lungs and
cause further obstruction
Diagnosis

COLD TYPE HOT TYPE

Acute or frequent episodes of wheezing and cough, Acute wheezing and cough with or without sticky,
with or without sputum. yellow or green sputum.
When sputum is present it is thin and watery, or Wheezing is loud, breath rough and rapid.
sticky but white.
Chest feels markedly distended and tight. Pale, Pronounced tightness, burning or stifling sensation
ashen complexion. in chest. Red complexion.
May be signs of external invasion: fever/chills, May be mild to moderate fever, irritability and thirst.
myalgia, occipital headache.
Tongue: thin, white coat Tongue: red tongue body with thick, greasy or dry &
yellow coat
Pulse: floating, or floating & tight Pulse: slippery & rapid

TP: Warm Lungs, dispel Cold, transform Phlegm, TP: Clear Heat, transform Phlegm, diffuse the
diffuse Lungs & direct Lung Qi down Lungs and direct Lung Qi down
Dìngchuăn, BL12, BL13, CV17, CV22*, LU7, LI4, Dìngchuăn, BL12, BL13, CV17, CV22*, LU6, LU7,
ST40
She Gan Ma Huang Tang Ding Chuan Tang
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1502-1503) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean. 23

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Wheezing (acute): Chinese medicine diagnosis
Table 3

Diagnosis

LUNG & LIVER QI CONSTRAINT LINGERING PATHOGEN (SHAO YANG

SYNDROME)
Constrained Liver Qi rebels against Lung in the Pathogen trapped due to ignored or mistreated WC
control cycle → disrupts descending of Lung Qi → or WH, or inhalation of harmful ‘pathogenic’
Lung Qi not diffused, bronchi constrict. substances to Lungs → stimulate persistent low-
grade fever.
Aggravated by emotional state, wheezing relieved Heat in Qi level irritates, inflames and dries lining of
when patient is relaxed. Lungs – increases sensitivity.
Chronic Qi constraint often complicated by Heat or Lingering pathogens in Qi level often complicated
Blood deficiency. by fluid damage and Qi deficiency.
May be diagnosed as anxiety, asthma, or stress- May be diagnosed as residual respiratory infection,
related breathing difficulties. post-febrile asthma, allergic asthma, post-viral
syndrome or chemotherapy side effects.
Long term results require stress management plan: Common cause of wheezing in adults. Tonify and
Qi-regulating diet, regular exercise (incl. those with strengthen once pathogen is eliminated.
Shen calming effect), meditation, Cognitive
Behavioural Therapy (CBT), avoid irritants.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1505-1507) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
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Wheezing (acute): Chinese medicine treatment
Table 4

Diagnosis

LUNG & LIVER QI CONSTRAINT LINGERING PATHOGEN

Shaoyang
Wheezing with tightness or fullness in chest, difficult Acute or recurrent wheezing traceable to event or
inhalation. Mild wheeze, perhaps only audible with infection. May only be audible with auscultation.
auscultation. Minimal sputum. Clear emotional Worse at night & accompanied by irritating, dry
upset noted. Anxious/panic in acute episodes. cough. Triggered by exposure to environmental
Aggravated around menstrual bleed. factors.
Abdominal/epigastric distension, loss of appetite, Low-grade fever, thirst, dry mouth/lips/throat,
cold extremities (fingers/toes), sweating, night sweats, insomnia, restlessness,
depression/moody/quick-tempered, plum-pit Qi. fatigue, swollen lymph nodes.
Tongue: unremarkable; or red edges & thin, yellow Tongue: slightly pale to slightly red & dry, little to no
coat (if Heat); or pale/orange edges & thin, white coat or a patchy coat
coat (if Blood deficiency)
Pulse: wiry, or wiry & rapid, or wiry & fine Pulse: weak, fine, rapid

TP: Nourish Lungs & Kidneys, transform Phlegm, TP: Vent lingering pathogen from the Qi level, tonify
invigorate Blood. Qi and generate fluids, direct Lung Qi downwards,
stop wheezing.
Yintang, CV17, LR14, BL13, BL18, PC6, LR3 LU7, Dìngchuăn, GV14, BL12, BL13, CV17, LI11

Wu Mo Yin Zi Zhu Ye Shi Gao Tang

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.) 25
(p. 1505-1507) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Wheezing (acute): Chinese medicine diagnosis & treatment
Table 5

Diagnosis
DEFICIENCY TYPE

Acute exacerbation of low-grade chronic wheezing.

Underlying Lung, Spleen and/or Kidney Qi deficiency OR

Cold-Phlegm in the Lungs with Kidney Yang deficiency (excess above/deficiency below)

Weakness may be inherited (childhood onset) or acquired (older age group)

Acute episodes can be slow to respond to treatment – frequency and severity of episodes can be reduced
with persistent treatment.
Interspersed periods of dyspnoea, low-level wheezing, or respiratory discomfort. Wheezing worse for cold,
activity & fatigue. Perhaps intermittent, productive, weak cough. Pale/ashen complexion, lethargic, clammy,
softly spoken. Purplish lips, nails, palms. Possible urinary issues.
Tongue: pale & scalloped, or pale purple

Pulse: weak & fine; may extend up to thenar eminence

TP: Tonify Lungs & Kidneys, transform Phlegm, invigorate Blood.

Exercise (to strengthen Lungs & Spleen), and Spleen & Yang nourishing diet are essential

Dìngchuăn, BL43, BL13, LU9 Herbs: Ren Shen Ge Jie San or Sheng Mai San
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1508) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean. 26

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Wheezing: Constitutional treatment between episodes
Table 6

Diagnosis

LUNG QI DEFICIENCY SPLEEN QI DEFICIENCY

Sudden exacerbation with or without Wind Pronounced wheezing due to Phlegm (rattle)
invasion
Lung Qi and Lung Yin deficiency Poor diet & recurrent illnesses treated with
antibiotics
Inherited (childhood) or acquired (post illness) Mixed excess (Phlegm) and LU/SP deficiency

Greater difficulty with exhalation, sensitive to Thick, sticky, difficult to expectorate Phlegm.
temperature change, colds/flus, tendency to Wheezing worse in morning, worse for eating
allergies. Pale face, slender build. Phlegm producing foods. Bloating, poor appetite,
loose stools.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1510-1512) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

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Wheezing: Constitutional treatments between episodes
Table 7

Diagnosis

LUNG QI DEFICIENCY SPLEEN QI DEFICIENCY

Pale tongue, weak pulse. Pale, scalloped tongue with greasy coat. Weak,
fine pulse and slippery when Phlegm present.
TP: Tonify Lung Qi TP: Tonify Spleen, transform Phlegm, restore Lung
D&D
GV14, BL13, BL43, BL20, CV12, LU9, LU7, ST36, GV14, BL13, BL20, CV12, LU9, ST36, ST40, SP3,
SP6 SP6
Ear: Lung, Dyspnoea, Adrenal, Endocrine, Ear: Point zero, Spleen, Lung, Dyspnoea, Adrenal,
Shénmén Endocrine, Shénmén
Yu Ping Feng San Liu Jun Zi Tang

Chronic asthma: Avoid cold, cool, raw foods, dairy, excess sweet, excess meat. Include duck, carp,
grapes, cauliflower, carrots, onions, oats, short-grain glutinous rice, aniseed, ginger, garlic, rosemary,
thyme, chestnuts, almonds, black sesame, sunflower seeds, walnuts, poultry, beef, fennel, basil.
(Kastner, 2021).

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1510-1512) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

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Wheezing: Constitutional treatment between episodes
Table 8

Between episodes

KIDNEY YANG DEFICIENCY KIDNEY YIN DEFICIENCY

Kidneys not grasping Qi; Kidneys not metabolising Common with long term medication (bronchodilator
fluids; Yang xu cold constricting bronchi. & oral steroids).

Older age group. Often complicated by Blood stasis. Often complicated by Qi deficiency and Blood
stasis.
Aggravated by cold weather or exertion. Constant and marked – ever increasing medication
dose. Inspiration difficult. Little sputum, worse at
night.
Low grade wheezing between attacks. Copious, Overdeveloped accessory muscles – thick neck,
thin, watery sputum & easy to expectorate. Back barrel chest. Malar flush, warm/dry skin, heat
pain, urination difficulties, cold intolerance, tinnitus, sensation in chest, night sweats, dry mucous
purple lips/nails membranes. Chronic sore throat, lower back pain,
urinary difficulties.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1513-1515) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

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Wheezing: Constitutional treatment between episodes
Table 9

Between episodes

KIDNEY YANG DEFICIENCY KIDNEY YIN DEFICIENCY

Pale tongue, dark sublingual veins. Pulse deep and Red, dry tongue with little/no coat. Pulse is fine and
fine. rapid.

TP: Tonify Kidneys and aid grasping of Qi TP: Tonify and moisten Kidney & Lung Yin, aid
grasping of Qi
GV14, Dìngchuăn, CV17, CV4, BL13, BL43, BL23, CV17, CV4, BL13, BL43, BL23, LU9, LU7, KI6,
GV4, LU9, KI3 KID3

Ear: Lung, Kidney, Dyspnoea, Adrenal, Endocrine, Shénmén

Jin Gui Shen Qi Wan Liu Wei Di Huang Wan or Sheng Mai San

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 1513-1515) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

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Wheezing: Case study

A 19-year-old male was diagnosed as asthmatic when he was a child. He

experienced fewer episodes during adolescence but lately he has been
very stressed with tertiary studies, finances and various other life
pressures. Over the past week he has been having daily episodes of
high stress accompanied by shortness of breath, wheezing and difficult
inhalation. He is also having trouble sleeping through the night and
reports epigastric discomfort.
His tongue is red with a thin yellow coat. His pulses are wiry and rapid.
What are the 8PP?
What is his CM diagnosis and associated treatment principles?
State 5 relevant acupuncture points for this case.
Are any referrals necessary?
What diet and lifestyle advice would you give this patient?

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Wheezing: Case study

A father brings his 8-year-old son, Tom, to your clinic for help with his
asthma. Just like his father, Tom was diagnosed as asthmatic at age 3
and developed eczema around the same time. Tom has always been a
fussy eater with a low appetite. He is less active than other kids his age,
has a weak voice and pale face. His pulses are slightly weak. His tongue
is slightly pale with a thick and greasy, white coat. He mentions that this
might be due to the milkshake he had an hour before his appointment.
Tom has a productive cough during the consultation and is wheezing
between coughs.
What are the 8PP?
What is his CM diagnosis and associated treatment principles?
State 5 relevant acupuncture points for this case.
Are any referrals necessary?
What diet and lifestyle advice would you give this patient?
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Dyspnoea (chuăn bìng): Chinese medicine aetiology

External pathogen invasion

Improper diet

Emotional Stress

Chronic illness, exhaustion, overwork

Environmental factors, smoking, chemical exposure

(Maclean et al., 2018; Shi & Zeng, 2011)
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Dyspnoea (chuăn bìng): CM exterior excess pathogenesis
Figure 1 Impaired
Obstructs Lung
Qi; dries Lung Qi
Pathogenesis
Wind mucous dispersing
membranes function Dyspnoea
Dry

Obstructs
Acute Lung Qi;
External Wind forms Phlegm Impaired
Pathogenic Heat Lung Qi
Invasion descending
function
Impaired Lung
Qi dispersing
With internal function
heat
Obstructs Lung
Wind Qi; contracts
Cold superficial
region

(Maclean et al., 2018)

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 Dyspnoea (chuăn bìng): CM interior excess pathogenesis
Figure 2

Pathogenesis Phlegm
Damp Accumulates
Improper diet, Spleen T&T Generates in Lungs &
damp environment, impaired damp obstructs D&D
worry Phlegm
Heat
May invade Spleen

Stagnation Liver
Emotional Liver Qi
stagnates → Heat → insults Dyspnoea
stress / anger
Fire Lungs

Lung disease, Lung Qi Blood

physical trauma stagnates stasis
Accumulation
generates Heat
& Phlegm in
Food Impeded Lungs
Stomach Qi
Poor eating stagnation in Lung
cannot
habits Stomach descending
descend
function
(Maclean et al., 2018)
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Dyspnoea (chuăn bìng): CM interior deficiency pathogenesis
Figure 3

Pathogenesis
Overwork,
Weakens Spleen can not Lung & Spleen
worry, sedentary
Spleen Qi nourish Lungs; Qi deficiency
lifestyle, poor
poor Lung D&D
diet

Environment, Dries mucous

Impaired Lung Qi & Yin
smoking, chemical membranes,
Lung D & D deficiency
exposure damages lining
Dyspnoea

Consumes Empty Heat

Chronic illness, Kidney &
Kidney Yin & damages
exhaustion, Lung Yin
generates Lung Yin (dries
overwork, ageing deficiency
Empty Heat fluids)

Kidney not Inspired Qi

Chronic illness, grasping & floats upwards.
exhaustion, Kidney Yang
anchoring Lung Fluid
overwork, ageing deficiency Qi. Poor fluid accumulates in
metabolism. Lungs.
(Maclean et al., 2018)
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Dyspnoea (chuăn bìng): Chinese Medicine diagnosis
Table 10

Diagnosis

Wind Dry Wind Heat Wind Cold

Marked thirst, dry lips/mouth/ Acute onset dyspnoea, laboured Acute onset dyspnoea, cough,
throat/skin & mucous breathing with scanty, sticky, chest tightness, occipital
membranes. Dry cough (maybe hard-to-expectorate sputum. headache, stiff neck, muscle
blood streaked) – focal chest and Tightness in chest. aches. May trigger latent Phlegm
retrosternal pain. (thin mucous) in Lungs or
combine with Internal Heat to
become Phlegm-Heat.
Mild fever & chills, aversion to Mild to moderate fever, minimal Possible chills/fever, no
wind. chills if any, mild sweating, nasal sweating. Nasal obstruction or
obstruction, thick yellow/green runny nose with thin, watery
nasal discharge. Sore, dry throat, mucous, sneezing.
thirst.

Red tongue tip. Thin Normal tongue, red tip, thin white Thin, white tongue coat.
dry/white/yellow coat, or no coat. or yellow coat.

Floating and rapid pulse. Floating and rapid pulse. Floating and tight pulse.
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 508-514) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
37

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine treatment
Table 11

Diagnosis

Wind Dry Wind Heat Wind Cold

TP: Dispel Wind-Dryness, TP: Dispel Wind-Heat, diffuse the TP: Dispel Wind-Cold, direct Lung
moisten the Lungs, direct Lung Qi Lungs, direct Lung Qi downward Qi downward and stop wheezing.
downward to alleviate dyspnoea. to alleviate dyspnoea.
Dìngchuăn, GV14, GV12, CV17, Dìngchuăn, GV14, GV12, CV17, Dìngchuăn, GV14, CV12, CV17,
CV22, BL12, BL13, LU7, KID6, CV22, LI11, LI4, TE5, LU10, LU6, LI4, LU7, BL13, ST40 + SP3
SP6. LU5, LU11. (latent Phlegm), LU10 + LU5
(Internal Heat), TE6 (open chest).
Auricular: Lung, Dyspnoea point, Adrenal, Shénmén

Sang Xing Tang Sang Ju Yin Ma Huang Tang

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 508-514) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

According to Maclean et al. (2018, p. 517), “acupuncture is

useful for expelling wind and alleviating dyspnoea but is of
limited value in moistening dryness.”
Discuss herbs and foods which can remedy this.
38

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine diagnosis
Table 12

Diagnosis

Phlegm Damp Liver Qi invading Lungs

Chronic. Phlegm diet / recurring RTIs & antibiotics. Liver Qi rebels along controlling cycle.
Dyspnoea & productive cough, copious thick Dyspnoea with emotional trigger. Tight chest,
white/clear sputum. Rattle in chest, worse at night difficult inhalation, little/no sputum. May be
and first thing morning, worse after eating, sputum worse with menses.
difficult or easy to expectorate (depends on
thick/sticky)
Stifling sensation in chest. Abdominal distension. Cold extremities (fingers/toes), depression,
Poor appetite, nausea, vomiting, loose stools, moodiness, quick temper, abdominal/epigastric
fatigue, heaviness, sleepiness. pain, poor appetite, constipation, loose stools,
‘plum pit Qi’.
Swollen tongue with thick, greasy, white coat.
Pale/scalloped if Spleen Qi Xu. Darkish tongue, red sides, yellow coat (heat) or
pale/orangey sides (with blood deficiency).
Wiry and slippery pulse. Soft/slippery if Spleen Qi
Xu. Wiry / wiry & rapid / wiry & fine pulse.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 518-520) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

39

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine treatment
Table 13

Diagnosis

Phlegm Damp Liver Qi invading Lungs

TP: Transform and expel Phlegm and alleviate TP: Dredge the Liver, regulate Qi, relieve
dyspnoea. Strengthen the Spleen and dry constraint, direct Lung Qi downwards and
Dampness. alleviate dyspnoea.

Dìngchuăn, CV17, CV22, CV12, PC6, LU7, Yintang, CV17, LR14, BL13, BL18, PC6, LR3.
ST40, PC5. Auricular: Lung, Liver, Dyspnoea, Adrenal,
Auricular: Lung, Dyspnoea point, Adrenal, Sympathetic, Shénmén
Shénmén

Copious thin, white sputum (moxa upper back

shu points)
Spleen Qi deficiency ST36, BL20, LR13

Er Chen Tang
Wu Mo Yin Zi

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 518-520) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean. 40

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine diagnosis
Table 14

Diagnosis

Blood Stasis Food Stagnation

Chronic Lung disease, history of damage. Acute Dyspnoea, chest tightness, stifling sensation
onset, laboured breathing, sit upright helps, aggravated by irregular eating, over-eating,
distended respiratory muscles, blood-streaked certain foods.
sputum, focal chest pain.
Purple complexion, lips & nail beds. Spider nevi Abdominal distension, constipation or irregular
over chest, discolouration of extremities, cold stools, belching, halitosis, copious flatulence,
extremities. acid reflux, heartburn.
Purple or mauve tongue, petechiae, dark Thick, white or yellow, greasy tongue coating.
sublingual veins.
Wiry & choppy pulse, irregular or intermittent. Wiry & slippery or rapid & slippery pulse.

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 522-525) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
41

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine treatment
Table 15

Diagnosis

Blood Stasis Food Stagnation

TP: Invigorate Blood and eliminate stasis. Clear TP: Relieve food stagnation and harmonise the
the Lungs and direct Lung Qi downwards to Stomach. Direct Lung and Stomach Qi downward
alleviate dyspnoea. and alleviate dyspnoea.
Dìngchuăn, BL13, BL15, BL17, Huatojiaji T3-8 Dìngchuăn, CV17, CV22, CV12, ST36, LI10,
(palpate for hardness), CV17, CV22, PC6, ST40, ST44, LU7. Auricular: Point Zero, Lung,
SP6. Auricular: Lung, Heart, Liver, Dyspnoea, Stomach, Dyspnoea Point, Adrenal, Shénmén
Adrenal, Shénmén
Xue Fu Zhu Yu Tang Bao He Wan

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 522-525) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

42

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea (chuăn bìng): Chinese Medicine diagnosis
Table 16

Diagnosis

Lung & Spleen Qi deficiency Lung & Kidney Yin deficiency Kidney Yang deficiency

Weak constitution. Dyspnoea, Chronic and constant dyspnoea, Chronic dyspnoea. Stifling
sense of fullness in chest, ever-increasing medication. Difficult sensation in chest. Severe
worse for exertion or acute inspiration. Little sputum. Worse at (orthopnoea – dyspnoea worse
illness. Weak cough, watery & night. Accessory breathing muscles lying down). Inhalation worse than
thin sputum, soft & low voice. well developed. exhalation. Worse for cold exposure
Poor posture – hunched. and exertion. Thin, watery sputum if
any.

Frequent colds, flu & Malar flush, warm & dry skin, 5 Cold intolerance. Cold limbs and
infections. Abdominal palm heat, night sweats, dry mouth lower back. Scanty urination, ankle
distension, loose stools, poor & throat. Chronic sore throat, oedema, frequent & clear urination,
appetite, copious mucous, aching lower back & knees, spontaneous sweating, fatigue,
food sensitivities. frequent urination, nocturia. exhaustion, dizziness, palpitation,
abdominal pain, loose stools.

Pale tongue, scalloped and Red and dry tongue with little or no Pale, swollen and scalloped tongue.
swollen with a thin, white coat. coat. Moist, white coat.

Fine & weak pulse.

Fine & rapid pulse. Deep, fine and weak pulse or deep
and slippery pulse.
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
43
(p. 526-528) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health
Dyspnoea (chuăn bìng): Chinese Medicine treatment
Table 17

Diagnosis

Lung & Spleen Qi deficiency Lung & Kidney Yin deficiency Kidney Yang deficiency

TP: Strengthen Lungs and TP: Nourish and moisten Lung & TP: Warm & tonify Kidney Yang,
Spleen, tonify Qi, fortify Kidney Yin, assist Kidneys in assist Kidneys in grasping Qi and
protective Qi and alleviate grasping Qi and alleviate alleviate dyspnoea.
dyspnoea. dyspnoea.

Dìngchuăn, GV14, CV17, Dìngchuăn, CV17, CV4, BL13, Dìngchuăn, CV17, CV4, BL13,
CV12, CV4, BL13, BL43, BL20, BL43, BL23, LU9, LU7, KI6, KI3. BL43, BL23, GV4, LU9, KI3.
LU9, LU7, ST36, SP6. Auricular: Lung, Kidney, Auricular: Lung, Kidney,
Auricular: Lung, Point Zero, Dyspnoea, Adrenal, Endocrine, Dyspnoea, Adrenal, Endocrine,
Dyspnoea, Adrenal, Shénmén Shénmén Shénmén

Bu Zhong Yi Qi Wan Liu Wei Di Huang Wan Jin Gui Shen Qi Wan Shen Ge
San

Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p. 526-528) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.

44

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

Dyspnoea: Case study

A 59-year-old female complains of shortness of breath. It is worse for

exertion – even walking to the corner store or up one or two flights of
stairs is uncomfortable. She has always been a bit overweight and put on
a lot of extra weight during menopause. She believes this is why her
lower back and knees hurt. She feels cold and tired all the time and finds
it difficult to motivate herself to exercise. Her tongue is pale and swollen.
Her pulses are deep, weak, and slow.
What are the 8PP?
What is her likely CM diagnosis and associated treatment principles?
State 5 relevant acupuncture points for this case.
State any other treatments you would use.
What diet and lifestyle advice would you give her?
Are any referrals necessary?

45

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

 Chinese Medicine Library Resource Links

APA 7th Edition Referencing Guide reference tips with examples

APA 7 FAQs questions submitted by students with examples provided by librarians
Chinese Medicine Library Guides

Databases, Journals & Web Links:

Anatomy TV
Natural Medicines
Journal of Chinese Medicine Article Archive
A Manual of Acupuncture [App]
Chinese Medicine Formula Image Database

46

CMCM311 / CHINESE MEDICINE DEPARTMENT / 22-08-2023 © Endeavour College of Natural Health

References
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standards/chronic-obstructive-pulmonary-disease-clinical-care-standard

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