“Lola” is a 35 y.o. female presenting with a barking cough, shortness of breath, and nighttime anxiety due to an inability to breathe.  The condition has been off-and-on for four months.  She is an earth/kidney constitution, meaning she gathers weight around the mid-section, craves sweets and refined carbohydrates, and retains water.  This type is classified in some schools of psychology as “viscerotonic.”

Five days before coming to the office, she had been given a Ventolin inhaler and been diagnosed with asthmatic-bronchitis.  She had also been taking a Chinese herbal formula aimed primarily at clearing excess, herbs that are cold and known biochemically to have strong anti-viral and anti-bacterial effects.  These had been consumed irregularly in capsule form for about two months.  About a month prior she had taken a course of antibiotics and was unwilling to take them again.

Assessment

Lola has a combination pattern of excess and deficiency, expressing in both the lungs and the spleen.  Specifically, excess in the lung is characterized by inflammation, barking cough, and the weight that accumulates about her midsection.  The deficiency is the anxiety at night, the weakness that ensues from labored breathing and coughing, and the digestive and metabolic deficiencies that can be in inferred from the accumulation of phlegm, which is present in the lungs and midsection.  The Chinese medical diagnosis is Lung Heat with Phlegm & Lung and Spleen Qi Deficiency.

If acupuncture is applied, treatment can be focused on clearing heat from the Yang-ming and Tai-yin channels.  The remainder of this discussion, however, will alternatively focus on a why the formula she was taking in addition to the Ventolin proved insufficient in resolving the root issue and why the formula prescribed for her condition was.

Treating Phlegm and Tonifying Qi

Although the inflammation contained in lungs may be biomedically defined as being viral or bacterial, Chinese medicine pays careful attention to where in the body the pathogen expresses.  Conditions of the same pathogen will be treated differently if expressed in the liver than in the lung.  In formulas that clear heat and treat toxin, one must be certain that the herbs go to the affected organ, in this case the lung.  Many formulas like Yin-chiao (Yin-qiao), which are popular for colds and respiratory conditions, work at superficial levels as the pathogen makes its way to the lung, but once the pathogen has settled in the lung itself other treatment principles become necessary.  The distinction “where not what” a pathogen is is what makes the biomedical designations of anti-viral and antibacterial meaningful but impossible to correlate with an accurate Chinese medical treatment principle.  The locus of distress determines the herbs that will be used not the specific virus or bacteria.

Formulas like Yin-chiao do not tonify qi or resolve phlegm. Although Yin-chiao is a very cold formula, which means it should affect the presence of heat (infection) in the body, it does nothing to move the phlegm.  This means that much of the wheezing and coughing will not be resolved because it is the phlegm obstructing the air passages that is causing the difficulty breathing.  Similarly, the physical taxation from wheezing, the anxiety, and gathering of weight about the center of the body, offer clear signs of qi deficiency.  Think of qi as a verb not as a noun, a designation of metabolism, assimilation, and activity.  It takes qi to breakdown a formula, to expel and metabolize phlegm, and to breathe freely.  Having a “yin” for sweets and refined carbohydrates, ensures that the central metabolic functions of digestion are in need of tonification.

There is a view within Chinese medicine that holds, when a pathogen is present, one should avoid tonification.  This central tenet must be seen within the overall presentation of the patient.  Formulas balance imbalance.  There are numerous classical formulas that exhibit tonification within an overall strategy of expelling a toxin.  In fact, implicit within these formulas is an understanding that pathogenic expulsion will not occur if the body doesn’t have the strength to expel it.   In other words, if the patient is constitutionally qi deficient or if a condition has lagged on for more than a month, one can assume that the qi is damaged enough to render clearing formulas like Yin-chiao insufficient.  This is because a straight attack cannot be made if the inside is not strong.  Such formulas also introduce coldness, which can further deplete or depress the body’s metabolism.  It doesn’t mean that such herbs are thoroughly inappropriate but ineffective if not balanced with herbs that tonify qi.  The quantity of qi tonics within an “attacking” formula is considerably less than the amount of the clearing herbs, but their function should be targeted to assist lung qi function.      

Conclusion

Lola was prescribed a formula that focused on treating qi deficiency and the pathogenic heat accumulation in the lung.  With the first bag she felt less anxiety and experienced less cough.  By the end of the second bag, she reported that her breathing was noticeably better and was coughing up some phlegm.  The case was considered resolved, though true resolution will require strengthening spleen function and expelling phlegm primarily through diet.  Her coughing and wheezing, however, stopped completely after about one week on an individually prescribed formula.