Source:  Acupuncture and Moxibustion.  Chinese Medical College Text, ED: Nan Jing Medical College.  Shanghai Science & Technology Publishing House, p. 278

Panting Pattern

Disease Mechanism

The primary reasons for the panting (wheezing-type) pattern are Replete Evil and Right Vacuity.  Replete panting is often caused by a Wind-Cold Evil attacking and invading the Lungs.  The Evil becomes stuck in the muscle layer of the exterior and, consequently, the Exterior Qi loses its ability to smooth and drain, and the Lung Qi is obstructed and not able to diffuse and descend. 

If the patient is inclined to constitutional Phlegm and Damp which flourishes and, after a long time, accumulates and transforms to Heat which rises up and causes Lung Dryness, the result will be that the Lung Qi’s depuration of the clear is no longer powerful. 

Vacuity panting is often due to long term disease and Lung weakness.  The Qi and Fluids are depleted and there is a failure to govern the Lung Qi.  Perhaps the Kidney Yuan is not abundant, the essential Qi is deficient and exhausted,  and/or the Root is not secure, so the Kidney Qi loses it’s ability to grasp (promote absorption). 

Pattern Differentiation

With the panting pattern there is a cough on exhalation and the inhalation is short, acute and urgent accompanied by a gaping mouth and raised shoulders.  The Evil is either Excess or Deficient (Vacuous) or a combination of the two.

1) Excess Panting:

 If caused by Wind-Cold , it appears with the following symptoms: patient coughs up thin, watery phlegm; the body is cold; headache; no sweat; no thirst; pulse is floating and tight; fur is thin and white. 

If caused by Phlegm-Heat, it appears with the following symptoms: coughing of copious amounts of sticky, greasy, yellow-colored phlegm; retching or vomiting; chest vexation and fullness; drawing-type chest pain when coughing; perhaps there is fever and thirst; there may be constipation or bound stools; the pulse is slippery and rapid; the tongue fur is yellow and slimy.

2) Deficiency Pattern: 

Disease onset is more gradual with shortness of breath and rapid breathing; feeble enunciation; sweating easily with exertion; tongue body is pale and perhaps faint-red in color; pulse is soft and forceless. 

Panting becomes faster as time passes; if the Kidney Qi is deficient and weak, the patient’s body is thin and the spirit is exhausted; Qi is not sufficient and panting becomes continuous; there is sweating and the limbs are cold; the pulse is appears sunken and thin.

Treatment

1) Excess Panting: 

Select the ruling Hand Tai Yin points.  Use filiform needles to drain and expel.  With Wind-Cold, act on discretion regarding the use of moxa.  With Phlegm-Heat, select both the foot Yang Ming channel points.  Needle only, no moxa.

Points are Shan Zhong (Ren 17); Lie Qu (LU 7); Fei Shu (UB 13); Chi Ze (LU5)

For Wind-Cold, add Feng Men (UB 12)

For Phlegm-Heat, add Feng Long (ST 40)

Lie Qu (LU 7) and Chi Ze (LU 5) free the Hand Tai Yin Channel Qi; Feng Men (UB 12) courses and frees the Foot Tai Yang Channel Qi.  The Lung governs the skin and body hair and Tai Yang also governs the exterior of the body.  If you resolve the Evil through the exterior, then the Lung qi will be spontaneously freed and able to downbear.  Shan Zhong (Ren 17), Fei Shu (UB 13) are simultaneously able to regulate the Lung and normalize the Qi flow.  Add in Feng Long (ST 40) to harmonize the Stomach and transform the phlegm.  Altogether these points achieve the treatment results.

2)  Deficiency (Vacuity) Panting:

Regulate and supplement Lung and Kidney Qi.  Use filiform needles and a supplementing and expelling method.  Moxa may be used at practitioner’s discretion.

Points:  Fei Shu (UB 13), Gao Huang (UB 43), Qi Hai (Ren 6), Shen Shu (UB 23), Zu San Li (ST 36), Tai Yuan (LU 9), Tai Xi (KI 3)

Tai Yuan (LU 9) is the Source Point of the Lung and Tai Xi (KI 3) is the Source Point of the Kidney.  These Source Points supplement the Lung and Kidney and store their respective Source Qi.  Furthermore, moxa Fei Shu (UB 13) and Gao Huang (UB 43) to bank up and boost the upper jiao Lung Qi; Shen Shu (UB 23) and Qi Hai (Ren 6) to bank up and nourish the lower jiao Kidney Qi.  When Kidney Qi and Lung and Kidney Qi are sufficient, then the upper can govern and the lower is able to absorb.  The Qi mechanism rises and downbears spontaneously and the system works normally.

Select Zu San Li (ST 36) to regulate and harmonize the Stomach Qi, foster the source of Post-Heaven Qi, and to assist in the transformation of essence gleaned from food.  The upper (Lung) is restored and there is a turn from disease toward healing.