W7 - Panting - Diagnosing Shortness of Breath, Panting, and Related Syndromes in TCM

Jul 9, 2024

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.