bubble_chart Concept

Wheezing is a common clinical symptom characterized by rapid breathing and a whistling sound in the throat. Since wheezing is always accompanied by panting, it is generally referred to as asthma.

In various medical texts throughout history, wheezing has been given many names. In "Suwen," it is called "panting and wheezing," and in "Jingui Yaolue," in the section on lung atrophy, lung abscess, cough, abnormal rising of qi, and abnormal pulse syndromes and treatments, it is described as "the sound of a water chicken in the throat." "Zhubing Yuanhou Lun" refers to it as "coughing with a wheezing sound." It was not until the Yuan Dynasty that Zhu Dan-xi clearly named it "wheezing." Later, it was also referred to as asthma, wheezing roar, and roaring panting.

Although wheezing is always accompanied by panting, panting is not always accompanied by wheezing, so wheezing and panting should still be distinguished.

bubble_chart Pattern Analysis

1. Cold Phlegm Obstructing the Lung︰It belongs to the category of cold wheezing, triggered by exposure to cold, often manifested as rapid breathing, wheezing in the throat, chest and diaphragm fullness, white and sticky phlegm, or clear and thin with foam, {|###|}complexion{|###|} dull and bluish, no thirst, or thirst with a preference for hot drinks, {|###|}tongue coating{|###|} white and slippery, {|###|}pulse manifestation{|###|} floating and tight, or accompanied by {|###|}aversion to cold{|###|}, fever, absence of sweating, headache, and body pain, among other {|###|}exterior patterns{|###|}. The phlegm is white and sticky, or clear and thin with foam, and presents with cold signs such as {|###|}complexion{|###|} dull and bluish, no thirst, or thirst with a preference for hot drinks, combined with an {|###|}exterior pattern{|###|} primarily characterized by {|###|}aversion to cold{|###|}. Treatment should focus on {|###|}warming the lung and dissipating cold{|###|}, {|###|}resolving phlegm{|###|} to stop wheezing, and the prescription selected is Minor Green-Blue Dragon Decoction with modifications.
2. Heat-phlegm Obstructing the Lung︰This syndrome falls under the category of heat wheezing, triggered by heat exposure. Its main clinical manifestations include rapid breathing, wheezing in the throat, loud and coarse breath, restlessness, thick and sticky yellow phlegm that is difficult to expectorate, flushed face with spontaneous sweating, thirst with a desire to drink, red tongue with a yellow greasy coating, slippery and rapid pulse, or accompanied by fever, mild aversion to wind and cold, headache, and other exterior patterns. The phlegm is yellow, thick, and sticky, making expectoration difficult. Differentiating based on systemic symptoms, there are signs of heat such as flushed face with spontaneous sweating, thirst with a desire to drink, red tongue with a yellow coating, along with an exterior pattern primarily marked by fever and mild aversion to wind and cold. Treatment should focus on ventilating the lungs to clear heat and resolving phlegm to stop wheezing. Modified Spleen-Qi Effusing plus Pinellia Decoction can be used.
3. Cold and Heat in Complexity︰It manifests as rapid breathing, wheezing in the throat, yellow and sticky phlegm, or white and sticky phlegm that is difficult to expectorate, chest tightness, restlessness, accompanied by {|###|}aversion to cold with fever{|###|}, {|###|}without sweating{|###|}, headache and body pain, {|###|}tongue coating{|###|} yellow and white, and a floating, tight, and rapid pulse. This syndrome is caused by heat-phlegm lurking in the lungs, or cold-phlegm stagnating and transforming into heat, which is internally lodged in the lungs, while {|###|}wind-cold{|###|} pathogens externally bind the surface. It is commonly referred to as {|###|}"cold enveloping fire"{|###|}. Internally, there is yellow and sticky phlegm, or white and sticky phlegm that is difficult to expectorate, with chest heat and restlessness—a {|###|}pattern of phlegm and heat{|###|}. Externally, there is {|###|}aversion to cold with fever{|###|}, {|###|}without sweating{|###|}, headache, and body pain—an {|###|}exterior cold pattern{|###|}, i.e., a {|###|}pattern of exterior cold and interior heat{|###|}. Treatment should focus on dispersing cold and clearing heat, {|###|}ventilating the lung and resolving phlegm{|###|}. The modified Panting-Arresting Decoction can be prescribed.
4. Yang Deficiency with Phlegm Obstruction︰It also falls under the category of cold wheezing, manifested as rapid breathing, wheezing in the throat, shortness of breath that is difficult to sustain, worsening with movement, pale face with sweating, cold body and limbs, {|###|}tongue texture{|###|} pale, swollen, and tender, or pale purple, with a deep, weak, and feeble pulse. Common symptoms include a pale face with sweating, cold body and limbs, {|###|}bland taste in the mouth{|###|} without thirst, shortness of breath that is difficult to sustain, worsening with movement, clear urine and {|###|}loose stool{|###|}, {|###|}tongue texture{|###|} pale, swollen, and tender, or pale purple, with a deep, weak, and feeble pulse, among other signs of {|###|}yang deficiency internal cold{|###|}, along with copious white, thin, and clear phlegm. The treatment should focus on {|###|}warming yang and replenishing qi{|###|}, supplemented by {|###|}descending qi and resolving phlegm{|###|}, using modified Kidney Qi Pill combined with Three-Seed Filial Devotion Decoction.
5. Phlegm Obstruction Due to Yin Deficiency︰It also falls under the category of heat wheezing, primarily manifested as rapid breathing, wheezing in the throat, sticky and scanty phlegm, emaciation, dry throat, night sweats due to deficiency-heat, red tongue with scant fluid, thin yellow tongue coating, and thin rapid pulse. It often presents with emaciation, dry throat, tidal fever and night sweats, vexing heat in the chest, palms, and soles, flushed cheeks in the afternoon, red tongue with scant fluid, and thin rapid pulse, among other signs of yin deficiency. The phlegm is often yellow, thick, and sticky. Treatment should focus on {|###|}nourishing yin and clearing heat{|###|}, {|###|}descending qi and resolving phlegm{|###|}. The recommended formula is Ophiopogon Decoction with modifications.

Cold-phlegm obstructing the lung asthma and heat-phlegm obstructing the lung asthma: These two syndromes are the most common in asthma. Zhengzhi Huibu．wheezing disease》 states: "Wheezing is a long-standing and frequently occurring form of phlegm-induced asthma, caused by internal congestion of qi, external untimely influences, and the presence of stubborn phlegm in the diaphragm. These three factors combine to block the airway, creating audible sounds, resulting in wheezing disease." "The presence of stubborn phlegm in the diaphragm" is the common mechanism of disease for these two syndromes, but the nature of the phlegm differs, one being cold and the other hot, entirely distinct.

Yang deficiency phlegm-obstructing asthma and yin deficiency phlegm-obstructing asthma: Both syndromes involve a combination of deficiency and excess, and differentiation should focus on systemic symptoms.

Cold-phlegm obstructing the lung asthma and yang deficiency phlegm-obstructing asthma: Both present with white, thin, and clear sputum, and systemic cold signs, but one is excess cold, and the other is deficiency cold, which must be distinguished.

Heat-phlegm obstructing the lung asthma and yin deficiency phlegm-obstructing asthma: Both present with yellow, sticky, and thick sputum, and systemic heat signs, but one is excess heat, and the other is deficiency heat, requiring differentiation.

Wheezing is a paroxysmal disorder, and the pattern identification and treatment during an attack are as described above. After an attack, healthy qi is inevitably deficient, so during the asthma remission stage, supporting the healthy qi is essential. This can be approached by regulating the spleen and kidney, based on the theories of "the spleen being the acquired foundation" and "the kidney being the innate foundation," by strengthening the spleen, tonifying the kidney, and also considering lung ventilation. Additionally, attention should be paid to dietary and lifestyle adjustments to reduce attacks and aim for a cure.

bubble_chart Documentation

1. 《Ancient and Modern Medical Mirror: Wheezing and Roaring》: "Wheezing and roaring are primarily caused by phlegm, and emetic therapy should be used. However, there are cases of deficiency where vomiting is not suitable, as this condition involves cold enveloping heat. The treatment must involve a light diet, and one should not solely use cold and cooling methods; it is necessary to always include surface-dispersing techniques."
2. 《Medical Treatise: Wheezing and Asthma》: "Excessive consumption of sour and salty foods penetrates the trachea, leading to the accumulation of phlegm. When wind-cold is encountered, qi depression and phlegm congestion trigger the condition, which often occurs in winter and spring."
3. Leizheng Zhicai ．Asthma: "Generally, new illnesses are mostly excess, while chronic illnesses are mostly deficiency. A throat sound like snoring indicates deficiency, while a sound like a water chicken indicates excess. Wheezing triggered by wind-cold is cold wheezing, which is excess. Wheezing triggered by summerheat injury and heat is heat wheezing, which is deficiency. Salt-induced asthma, alcohol-induced asthma, and sugar-induced asthma are all types of deficiency asthma."