Pattern Differentiation & Treatment
Differential Diagnosis of Common Symptoms — Dyspnea (Asthmatic Breathing)
Dyspnea (asthmatic breathing), characterized by rapid breathing with more exhalation than inhalation, is closely related to the lung and kidney and is differentiated into cold, heat, deficiency, and excess types. This article systematically outlines seven patterns — wind-cold assailing the lung, wind-heat invading the lung, phlegm-fluid obstructing the lung, cold fluid lodged in the lung, lung deficiency dyspnea, kidney failing to receive qi, and suspended fluid disorder — detailing accompanying symptoms, tongue and pulse features, and core pathogenesis for each, offering a practical differential guide for TCM pattern identification.
Dyspnea refers to rapid, hurried breathing in which exhalation is prolonged and inhalation is shortened, and in severe cases, the patient breathes with an open mouth and raised shoulders. It is a common symptom of respiratory system diseases in clinical practice. It is closely related to the lung and kidney, and is differentiated into cold, heat, deficiency, and excess types.
- Dyspnea accompanied by cough, expectoration of phlegm, chest oppression, fever and aversion to cold, with sweating or absence of sweating, thin white tongue coating, and a floating, tight pulse: this is the wind-cold assailing the lung pattern. It is caused by wind-cold pathogens fettering the lung, leading to impaired diffusion and descent and resulting in inhibited lung qi.
- Dyspnea accompanied by cough, expectoration of thick yellow phlegm, and in severe cases, flaring of the nostrils, fever and aversion to cold, thirst with a desire to drink, sweating, red tongue with thin yellow coating, and a floating, rapid pulse: this is the wind-heat invading the lung pattern. It is caused by wind-heat pathogens attacking the lung, leading to impaired diffusion and descent with counterflow of lung qi.
- Dyspnea with coarse breathing, accompanied by cough, expectoration of large amounts of frothy phlegm, poor appetite, nausea, chest oppression, white slimy tongue coating, and a slippery pulse: this is the phlegm-fluid obstructing the lung pattern. It is caused by phlegm-fluid retained in the lung, leading to inhibited lung qi.
- Dyspnea, in severe cases with open-mouth breathing and raised shoulders making it difficult to lie flat, accompanied by cough with frothy phlegm, white slimy tongue coating, and a slippery pulse, with each episode triggered by a new contraction of external pathogens, or with worsening of the condition: this is the cold fluid lodged in the lung pattern. It is caused by pre-existing phlegm retained in the lung, stirred by newly contracted pathogens, leading to inhibited lung qi.
- Dyspnea accompanied by cough with scant phlegm, mental fatigue and lack of strength, a low, faint voice, spontaneous sweating, shortness of breath, dryness of the throat, pale tongue with scant coating, and a vacuous pulse: this is the lung deficiency dyspnea pattern. It is caused by lung qi deficiency with impaired depurative downbearing.
- Dyspnea accompanied by distention and fullness in the chest and hypochondriac region, with pain on coughing, white tongue coating, and a deep, wiry pulse: this is suspended fluid disorder (xuan yin). It is caused by phlegm-fluid lodged in the chest and flanks, leading to inhibited lung qi.
- Dyspnea with prolonged exhalation and shortened inhalation, aggravated by exertion, in severe cases with open-mouth breathing and raised shoulders, accompanied by emaciation, mental fatigue and lack of strength, slightly cold extremities, a bluish or darkened facial complexion, soreness and weakness of the lower back and knees, pale tongue, and a deep, thin pulse: this is the kidney failing to receive qi pattern. It is caused by kidney qi deficiency with loss of the capacity to grasp and receive qi, leading to inhibited lung qi.