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W7 - Panting - Diagnosing Shortness of Breath, Panting, and Related Syndromes in TCM
Jul 9, 2024
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Lecture Notes: Diagnosing Shortness of Breath, Panting, and Related Syndromes in TCM
Introduction
Organizing Symptomology
: Move through body symptoms from headaches, cough, panting, chest pain, to palpitations.
Focus for Today
: Discussing panting, translating 'shran', and differential diagnoses related to lung and kidney functions.
Panting (Shran)
Definition
: Typically shortness of breath or hasty breathing, not as full as normal.
Bio-medical Term
: Dyspnea.
Asthma
: Often diagnosed as shrin in TCM.
Differentiation from Wheezing
: Audible sounds indicate wheezing (associated with phlegm).
Diagnostic Differentiation
Key Points:
Lung Qi Deficiency
: Main symptom is shortness of breath and fatigue. Chief sign differentiating from Spleen Qi Deficiency.
Spleen Qi Deficiency
: Fatigue, poor appetite, potential indigestion.
Kidney Qi Deficiency
: Adds symptoms like frequent urination and lower back pain.
Heart Qi Deficiency
: Fatigue, palpitations, sometimes emotional symptoms like anxiety.
Pulse Examination:
Lung Qi Deficiency
: Weaker pulse in the first position.
Spleen Qi Deficiency
: Weaker pulse in the Guan position.
Kidney Qi Deficiency
: Weaker pulse in the third position.
Heart Qi Deficiency
: Textbook example includes palpitation awareness.
Pathways of Respiration
Organ Involvement
: Lung (exhale) and Kidney (inhale).
Lung & Kidney
: Roles in respiration. Guideline for inhale (kidney) and exhale (lung).
Patterns of Respiration Dysfunction
Heat Evil Congesting the Lung
Symptoms
: Panting, loud cough, thick yellow/green expectorant, potential chest pain.
Tongue & Pulse
: Yellow coat, red body, rapid, may be slippery.
Progression
: Could start as wind-cold exterior invasion leading to phlegm heat in the lung.
Phlegm Obstructing the Lung
Symptoms
: Panting, potential wheezing, chest fullness, heavy limbs.
Tongue & Pulse
: Sticky tongue coat, slippery/rolling pulse.
Associations
: Potential digestive signs like constipation or sticky stools.
Chi Differentiation for Panting
Suspended Rheum
: Hasty panting in chest and ribs, may overlap with phlegm obstruction symptoms but less digestive involvement.
Propping Rheum
: Positional preference for relief, floating edema.
Spillage Rheum/Water-Cold
: Swelling of limbs, may inherit spleen and kidney Yang deficiency.
Accompanying TCM Patterns
Exercise-Induced Issues
: Usage of ancillary muscles around neck and shoulders for breathing.
Kidney Yang Deficiency
: General cold signs, fluid accumulation, weak pulses.
Kidney Yin Deficiency
: Dryness, thirst, heat signs, potentially premature aging.
Clinical Practice Points
Pregnancy & Shortness of Breath
: Normal due to increased blood volume and diaphragm displacement.
Throat Wind
: Used to describe acute throat issues, including infections and anaphylaxis.
Lung Yin vs. Chi Deficiency
: Differentiating by dryness, thirst, heat signs for Yin deficiency, more long-lasting issues.
Conclusion
Diagnosis in Elderly & Severe Cases
: Dual lung and kidney deficiency indicates serious end-stage conditions.
Understand Patterns
: Recognize signs and symptoms to accurately diagnose and differentiate lung and kidney related breathing issues.
Next Steps
Prepare for Further Patterns Analysis
: Recognize complex syndromes like dual vacuity and miscellaneous conditions like throat wind.
Clinical Application
: Focus on practical application through patient questioning and clear diagnosis.
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