bubble_chart Concept

Flaring of the nasal wings refers to the symptom where the wings of the nostrils move due to rapid breathing.

This symptomYouke Fahuicalls "nasal distension,"Guang Wenre Luncalls "flaring nostrils,"Yishacaocalls "nasal flaring,"Wenre Jingweicalls "nasal lifting," and "Yu Xie Ma Ke He Bi" calls "nostrils flaring." It is commonly seen in cases of phlegm-heat congestion, lung qi stagnation, or critical conditions where the source of lung qi is about to be exhausted.

bubble_chart Pattern Analysis

1. Wind-warmth Invading the Lung︰The wings of the nose slightly flare, coughing with coarse breathing, fever with aversion to wind, slight sweating, thirst, a red tongue with thin white or slightly yellow coating, a floating and rapid pulse, and purplish-red finger venules. It is caused by wind-warmth attacking the lung, where the wind-heat pathogen surges upward, the lung is oppressed by heat, the lung qi fails to disperse and descend, and the function of purification and descending is impaired. Therefore, the key diagnostic points are severe coughing with coarse breathing, flaring of the nasal wings, slight thirst, and scanty phlegm. For wind-warmth attacking the lung, the treatment involves clearing heat and ventilating the lung. The recommended formulas are Mulberry Leaf and Chrysanthemum Decoction or Mulberry Leaf and Apricot Kernel Decoction.
2. Phlegm-heat Obstructing the Lung︰Panting with flaring nostrils, elevated chest and sunken ribs, shrugging shoulders and shaking body, wheezing in the throat, high fever, dry mouth and lips, or even cyanosis around the mouth, constipation, dark yellow urine, red tongue with yellow coating, wiry, slippery, and rapid pulse, or cyanotic fingerprints extending straight to the life pass. Due to intense heat scorching the lungs, transforming fluids into phlegm, phlegm-heat obstructing the airways, impaired qi movement, lung qi distension, and upward rebellion, the key diagnostic points are severe flaring nostrils, rapid wheezing, elevated chest and sunken ribs, dry mouth and lips, constipation, dark yellow urine, or even cyanotic lips. For phlegm-heat obstructing the lungs, the treatment involves clearing heat and resolving phlegm, promoting the diffusion and descent of lung qi. The prescription used is Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction combined with Perilla and Lepidium Pill. For cases with severe heat damaging fluids, Adenophora and Ophiopogon Decoction is used, or artificial cow-bezoar and antelope horn may be added as appropriate.
3. Lung and Kidney Dual Deficiency︰The wings of the nose flutter slightly, accompanied by panting and shortness of breath, shallow and rapid breathing, a pale or dull {|###|}complexion{|###|}, listlessness, cyanosis around the mouth, and in severe cases, oily sweating on the head and body, cold limbs, a pale red or scorched red tongue, and a deep, thin, and rapid pulse. Unlike the previous two conditions, this is caused by the decline of {|###|}healthy qi{|###|}, the impending exhaustion of the lung's transformative source, the failure of {|###|}kidney deficiency{|###|} to retain qi, and the simultaneous decline of lung and kidney qi. Therefore, the key diagnostic points are weak flaring of the nasal wings, shallow and rapid breathing, panting and shortness of breath, a pale {|###|}complexion{|###|}, cold limbs, cyanosis around the mouth, and purple nails. As stated in Youyou Jicheng．Treatment of Asthma{|###|}: "There is also a condition of virtual collapse, where the patient suddenly opens the mouth wide to gasp, inhaling little and exhaling much, with unimpeded movement of breath. This is due to the kidney's failure to absorb qi, causing it to scatter outward." For cases where both the lung and kidney are damaged, and there is insufficiency of qi and yin, treatment involves {|###|}tonifying qi{|###|} and nourishing yin, using the modified Pulse-Reinforcing Powder. If there is true {|###|}yang deficiency{|###|} on the verge of collapse, then Ginseng and Aconite Decoction with added magnetite and raw oyster shell is used.

In the diagnosis and treatment of nasal flaring, it is essential to first distinguish between deficiency and excess. Slight nasal flaring with cough but no wheezing is often an excess pattern caused by wind-warmth invading the lungs. Severe nasal flaring with rapid breathing, acute onset, coarse breath sounds, and loud phlegm noises usually indicates an excess pattern of phlegm-heat obstructing the lungs. Weak nasal flaring with faint breathing, feeble gasping, and weak panting often signifies a critical deficiency syndrome involving both the lungs and kidneys.

bubble_chart Documentation

1. Yizong Jinjian Pediatrics Zabing Xinfa Yaojue．Wheezing Syndrome Section: "Infantile acute asthma, commonly known as sudden dyspnea, is caused by cold Xieke affecting the lung points, transforming into heat and blocking the lung meridian, leading to high chest and rapid breathing, lung distension, wheezing and fullness, flaring of both flanks, sinking and pitting, flaring nostrils, and mental confusion. Initially, it is urgent to take Five-Tiger Decoction, followed by One-Pinch-Amount Gold purgation. If the qi opens, the wheezing will stop on its own."
2. Guang Wenre Lun．Volume 3: "Flaring nostrils have three causes; one is phlegm congestion in the lungs, with audible breathing, wheezing and coughing, chest fullness, and no thirst, suitable for Trichosanthis Fruit Fritillaria Bulb, mulberry bark, and cultivated purple perilla fruit to purge the lungs, and lung qi will naturally recover; one is heat stagnation in the lungs, with hot breathing, slight external binding of the stagnant heat, the ancients mainly used Spleen-Qi Effusing Decoction, to disperse the external binding and clear the internal stagnation, used in seasonal epidemics with Pueraria Root replacing Ephedra, or Pueraria, Skullcap and Coptis Decoction is also acceptable; one is kidney qi deficiency with upward reversal, with weak breathing, mostly fatal, this must result from repeated sweating or profuse sweating, palpitation and deafness, urgently suitable for large doses of Six-Ingredient Decoction combined with Pulse-Reinforcing Powder plus Achyranthes Root and Barbary Wolfberry Fruit, or perhaps one or two out of a hundred can be saved."