The pattern of liver fire invading the lung, also known as the "pattern of liver fire invading the lung," refers to a series of symptoms caused by emotional depression, qi depression transforming into fire, scorching lung yin, or pathogenic heat accumulating in the liver meridian and attacking the lung, leading to the failure of lung qi in purification.

The main clinical manifestations include: paroxysmal cough, qi counterflow, yellow and sticky phlegm, even coughing up fresh blood, pain in the chest and hypochondrium, irritability and tendency to anger, vexation, bitter taste in the mouth, dizziness, red eyes, dry stool, yellow and red urine, red tongue with thin yellow coating, and wiry and rapid pulse.

The pattern of liver fire invading the lung is commonly seen in diseases such as "cough" and "hemoptysis."

This syndrome should be differentiated from the "pattern of phlegm-heat obstructing lung."

bubble_chart Differentiation and Treatment

pattern of liver fire invading the lung

1. In cough, it manifests as paroxysmal cough, often feeling middle qi in the chest rising and choking, chest and hypochondriac pain during coughing, yellow and thick sputum with little quantity, red face and dry throat, thirst, dysphoria and irritability, red tongue with thin yellow coating and little fluid, and wiry and rapid pulse. It is caused by stagnation of liver qi, which over time transforms into fire, the fire qi counterflows and invades the lung, scorching fluids to form phlegm, the metal (lung) being weak cannot control the wood (liver), and the lung qi losing its purifying and descending function. Treatment should focus on draining the lung and clearing metal, calming the wood and reducing fire, using Danqing Decoction (Yichun Shengyi).
2. In hemoptysis, it manifests as coughing with blood in the sputum, or coughing up fresh blood, chest and hypochondriac pain, dysphoria and irritability, dry stool, dark urine, red tongue texture with thin yellow coating, and wiry and rapid pulse. It is caused by excessive liver fire, fire pathogen invading the lung, lung qi failing in purification, damage to the yang collaterals, and blood leaving the vessels. Treatment should focus on clearing heat and purifying the lung, calming the liver and pacifying the collaterals, cooling blood and stopping bleeding, using White-Draining Powder (Xiao'er Yaozheng Zhijue), Dai Ge San (empirical formula) combined with Gentian Liver-Draining Decoction (Yizong Jinjian) with modifications.

The pattern of liver fire invading the lung often occurs in individuals who are usually irritable and prone to anger, as anger is associated with the liver, rage causing qi to rise, excess qi turning into fire, and the fire qi counterflowing and inevitably invading the lung meridian. In the mechanism of disease progression, it is often troubled by the burning of wood fire, invading the lung and overwhelming the spleen, restricting the element that should be restricted, and insulting the element that should not be restricted, consuming qi and damaging fluids, thus forming the pattern of qi and yin deficiency in the lung. Overall, it is due to excessive liver qi, manifesting as cough with sticky sputum that is difficult to expectorate, or dry cough with little sputum, dry mouth and throat, hoarse voice, afternoon tidal fever, feverish feeling in the palms and soles, night sweat, emaciation, scant or peeled tongue coating, and thin and rapid pulse.

bubble_chart Differentiation of Similar Patterns

1. Pattern of phlegm-heat obstructing the lung and pattern of liver fire invading the lung: Both can clinically present with symptoms of the lung meridian. However, the former is mostly caused by external contraction of warm-heat pathogens, or wind-cold invading the lung, stagnating and transforming into heat, which scorches body fluids, leading to the accumulation of phlegm. Phlegm-heat obstructs the lung meridian, resulting in lung qi failing in purification, which is a pathological change of the lung's Benjing. Therefore, the main symptoms are cough with coarse breathing, expectoration of yellow, purulent, and foul-smelling phlegm, chest tightness, chest pain, sore throat, thirst, constipation, scanty urine, red tongue with yellow coating, and rapid pulse, all indicative of phlegm-heat obstructing the lung. The latter, on the other hand, arises from the stagnation of seven emotions, liver depression transforming into fire, and wood fire tormenting metal. The disease originates in the liver and affects the lung. Thus, in addition to symptoms of the lung meridian such as cough, qi counterflow, and hemoptysis, there must also be manifestations of liver depression transforming into fire, such as burning pain in the chest and hypochondrium, irritability, and susceptibility to anger, which can be used for differentiation.

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bubble_chart Documentation

1. 《Medical Compass‧Coughing Blood》: "When fire punishes metal and the lung lobes dry and wrinkle, it causes itching, and itching leads to coughing. This does not necessarily involve phlegm, hence it is called dry cough. Excessive coughing injures the lung collaterals, leading to bleeding. Coughing with phlegm, where the phlegm contains streaks of blood, also involves bleeding from the lung collaterals."
2. 《Medical Compass‧Spitting Blood》: "Blood pattern are due to fire... Anger causes fire to rise from the liver," "If there is pulling pain in both hypochondriac regions, or frequent anger and depression, alternating chills and fever, this disease is in the liver."
3. 《Medical Compass‧Cough》: "Fire punishes lung metal, causing dryness and unbearable itching that leads to coughing. Coughing is due to itching, and itching is due to fire and dryness, thus coughing must involve fire... Internal damage is considered severe when there is coughing, such as with liver and kidney fire, which initially only affects the lower energizer and does not immediately ascend. Over time, as it becomes more intense, it reaches the lungs, and the condition becomes severe... Coughing with urgent vomiting and hypochondriac pain indicates liver fire, and (referring to adding to the original formula White-Draining Powder) green tangerine peel, Indigo, etc. are added."