Some ways we differentiate respiratory symptoms and decide how to treat

Included are a few of the terms commonly used in discussions of the treatment of respiratory disorders. It is by no means exhaustive. It is offered as a way to help those of us not fluent in Chinese medical terminology to better understand how the physiology and pathology of the lung is understood in Chinese. I feel this better helps us make clearer diagnoses and leads to more efficient and effective treatments.

Diffusionxuan (宣), to lead off (liquids): to drain
Diffusion of the lungs xuan fei (宣肺), Diffusion and promotion of free flow xuan tong (宣通)
This is the most general function of lung qi; it is diffused. This implies the overall circulation of lung qi. Contraction of external pathogens obstructs the healthy diffusion of lung qi.

Non diffusion of lung qi fei qi bu xuan (肺气不宣) – most often refers to a failure of lung qi circulation in the early stages of external contraction, whereas inhibition of lung qi – fei qi bu li (肺气不利) suggests the same phenomena due to internal damage particularly affecting pulmonary water metabolism. Symptoms of a failure of diffusion of lung qi are cough, nasal obstruction, shortness of breath, and chills and fever. Symptoms of inhibition of lung qi are cough, panting dysuria and edema.

Treatment methods of diffusion free the lung qi by employing medicinals such as Herba Ephedrae (Ma Huang), Semen Pruni Armeniacae (Xing Ren), Radix Platycodi (Jie Geng), and Folium Perillae (Zi Su Ye). These medicinals tend to be in the surface resolving categories but may also appear in other categories. Although many medicinals do both, diffusion must be discriminated from simply suppressing cough.

The promotion of the diffusion of lung qi is often associated with phlegm transformation. One diffuses the lungs and transforms phlegm- xuan fei hua tan (宣肺化痰). In this case the above medicinals are combined with those which transform phlegm such as Rhizoma Pinelliae Ternatae (Ban Xia), and Pericarpium Citri Reticulatae (Chen Pi).

Inhibition – bu li (不利),
Inhibition of lung qi- fei qi bu li (肺气不利)
Bu li – a lack of ease, naturalness (of liquids) or difficulty (of movement, urination or speech)
Inhibition refers to the failure of the circulatory function of the lung qi. The term is most often used in the context of pathologies of an internal nature, particularly those involving water metabolism.

 

Depuration – su (肅), Qi Depuration (气肅)

Downbearing – jiang (降)
Depurative downbearing or clarifying and descending – su jiang (肅降)
Su – to purge, to clean, clarifying
Jiang – fall, drop, causing to descend

Depurative downbearing or clarifying and descending. is a function of the lungs comprising two aspects:
1) ensuring regular flow throughout the waterways (i.e. ensuring passage of water down to the kidneys)
2) sending qi absorbed from the air down to the kidney

Depurative downbearing is the overall downbearing function of the lungs. Medicinals from many categories may promote depurative downbearing. For instance, they may be cough suppressors such as Flos Tussilaginis Farfarae (Kuan Dong Hua), phlegm transformers such as Rhizoma Pinelliae Ternatae (Ban Xia). Virtually any medicinal which enters the lung channel and has a downbearing function may potentially promote depurative downbearing.

Absorption of qina qi (納气)
Na- to absorb, to assimilate, accept (kidneys), takes in (stomach, liver)
Absorption of qi is a function of the kidneys which draws the qi of the lungs downward facilitating inhalation. It acts in tandem with, but is distinct from depurative downbearing which is a function of the lungs. Medicinals which promote the absorption of qi tend to be kidney boosters. If the kidney fails to absorb the qi then the qi drawn in by the lung accumulates in the chest causing pulmonary distension, panting, fullness and congestion. The panting is characterized by short, rapid, distressed breathing, exacerbated by physical movement.

Qi ascent – shang qi (上气)
Panting due to counterflow ascent of qi: corresponds roughly to expiratory dyspnea in Western medicine.

Eliminating phlegm, or expelling, drives, or reins in qu tan (驅痰)
A general category reflecting the treatment principle of eliminating phlegm by any means. Other methods of phlegm resolution such as transforming phlegm are subcategorizes of this.

Transforming phlegm hua tan (化痰)
Transformation denotes change of a gentle nature as opposed to transmutation bian (±ä) which denotes a sudden violent change. Hence, transformation of phlegm denotes a regressive change in the quantity and quality of phlegm in the body

Dispersing, scouring phlegm xiao tan (滌痰)
Dispersing or scouring phlegm denotes a purgation of stagnant phlegm turbidity. Heavy use of this method damages the original qi and it should be used with caution in people with weak constitutions. One typically disperses phlegm and calms panting- xiao tan ping chuan (滌痰平喘). The term dispersing phlegm is also used in the case of depressive qi and phlegm (one resolves depression and disperses phlegm), when there is an actual hardness or mass (one disperses phlegm and soften hardness), where there is blood stasis combining with phlegm (one eliminates stasis and disperses phlegm) and where there is food stasis mixing with phlegm (one disperses food and transforms phlegm).

Flushing phlegm – di tan (滌痰)
di – to wash away, to cleanse, to flush, to scours out
Flushing denotes the forceful elimination of pathogens, in this case phlegm.

 

Sweeping, or dislodges phlegm huo tan (豁痰)
Sweeping huo refers to the forceful elimination of pathogens, particularly phlegm and heat which is clouding the heart orifices, however it is also used to refer to the vigorous elimination of sticky phlegm from the lungs.

 

Cough – ke (咳) Ke denotes cough without matter.

 

Cough – sou (嗽) Sou denotes matter without sound. The combined term is often used loosely in the sense of cough with or without expectoration.

Qi cough (Nigel-cough) qi sou (气嗽) is a disease pattern referring to cough due to an inhibition of the qi dynamic with symptoms of fullness and oppression. This is most often due to lung vacuity and congestion of pathogenic qi. Treatment is indicated to diffuse the lungs and transform phlegm. It may also denote a cough resulting to internal damage to the seven emotions. This typically manifests as cough with rapid breathing, and thick sticky phlegm, a sensation of something lodged in the throat that cannot be ejected or swallowed. The pulse is floating surging slippery and rapid. Treatment is indicated to transform phlegm and resolve depression.

 

Cough qi cu (气粗) rough breathing.

Wheezing xiao (哮) a respiratory rale that accompanies panting and indicates the presence of phlegm.

Panting chuan (喘) is a symptom name referring to labored breathing characterized by rapidity and distress, and frequently associated with wheezing; often translated as panting.

Qi panting (Nigel-panting, dyspnea) qi chuan (气喘) may be a general term for respiratory difficulty, or it may indicate panting due to factors involving the essence spirit. Typically, damage to the seven affects binds and depresses the qi dynamic. One will then see hasty rapid respiration without phlegmatic sounds. In the extreme this may cause nasal respiration, which may be accompanied by agitation, fright and depression oppression. Treatment is indicated to course and rectify the qi dynamic, normalize the qi and resolve depression.

Panting and cough chuan ke (喘咳) simply refers to the simultaneous occurrence of panting and cough.

Panting and counterflow chuan ni (喘逆) simply reinforces the pathomechanism of panting, as that as counterflow. It is not fundamentally different from simple panting (chuan).

Panting and fullness chuan man (喘滿) refers to panting accompanied by a sensation of thoracic fullness.

Panting respiration chuan xi (喘吸) is a pattern name referring to periodic qi panting respiration. It is not fundamentally different from simple panting (chuan)

Panting and distension chuan zhang (喘脹) is a symptom name referring to panting characterized by swelling and distension that may be due to either vacuity or repletion.

Hasty panting chuan cu (喘促) is a disease pattern indicating periodic rapid and hasty respiration.

Rapid panting chuan ji (喘急) Hasty panting and rapid panting appear to by synonymous.

Dsypneic ralechuan ming (喘鳴) is a pathocondition referring to rapid hasty respiration accompanied by a phlegmy sound in the throat. This is the primary symptom of wheezing and panting (xiao chuan). A dyspneic rale is essentially a wheeze, thus the terms are synonymous.  

Calm panting ping chuan (哮喘) a treatment method aimed specifically at arresting panting associated with asthma.

Suppress, or stops Coughzhi sou or zhi ke(止嗽, 止咳)  a treatment method aimed a specifically at arresting cough.

Dry Coughke qiang (咳嗆) refers to a cough characterized by an absence of phlegm. It is not fundamentally different from a dry cough gan ke sou ().

Shortness of breath duan qi (短气) shallow rapid breathing, usually a sign of qi vacuity but may be due to repletion. It is urgent and discontinuous, similar to panting but without any phlegmatic sound, and also without raised shoulders. The lungs have an accumulation that cannot descend. Repletion patterns include phlegm rheum, stasis obstruction, and qi stagnation. Vacuity patterns include bodily weakness, and damage to the true original subsequent to a chronic illness.

 Shortage of qi shao qi (少气) refers to symptoms of a forceless voice, and respiration that is weak short and hasty.