Fall is fast approaching and with Fall we enter the element of Metal (Jin 金). Metal represents not just autumn but also dryness and white coloration, and in TCVM it is considered superficial and light.

Metal is also associated with the Lung. Lung Yin support the Lung Qi which controls the Lung function. Dryness and Heat can easily damage Lung Yin causing respiratory malfunction such as asthma or coughing. The Lung ensures the entire body has sufficient Qi with the breathing process will takes in new Qi and expels stale Qi.

The Lung is the most External Zang organ and has both an ascending and descending function. When Lung Qi descends it moves Qi and Body Fluids. When Lung Qi ascends it moves Wei Qi and Body Fluids to the Exterior to warm, provide moisture and protect the body. The Lung functions include:

Case Study by Dr. Alex Kintz-Konegge

Species: Feline 
Breed: Ragdoll 
Age: 8 years 
Gender: FS, 9 lb 

History: history of seasonal allergies, usually spring and fall, living in Western PA. She is kept inside only and is a single pet, with no other cats or dogs in the household. Her symptoms include military dermatitis all over her body with intense pruritus leading to barbering of her belly and medial legs, both front and back, and traumatic alopecia. The owner maintains year round flea prevention with a topical over the counter product. 

Clinical Diagnosis (conventional): feline asthma with allergic dermatitis. 

Conventional Indications:  

She has developed a dry cough, that seems worse in the early morning. Her respiration is labored at times with an increased respiratory rate of 40 breaths a minute. Occasionally an abdominal component to her breathing is observed, but no open mouth breathing has occurred. Her appetite has diminished greatly and she is more thirsty than usual. 

Chest x-rays confirm a bronchial pattern in both lungs, leading to a Western diagnosis of feline asthma with allergic dermatitis. Her lab work demonstrates a normal white blood cell count with an increased number of eosinophils and mild lymphopenia. Her serum chemistry and thyroid levels are within normal limits. 

Western treatment approach: oral prednisolone, 4 mg sid, tapering to 2 mg once skin lesions resolved for 2 more weeks. Plan to switch to Aerocat inhaler with maintenance steroid after oral steroid course completed 

Traditional  Indications: 
Tongue: dry, red 
Pulse: deep and feel wiry, they are fairly even in strength with maybe a slightly weaker pulse on the left. 
Coat: somewhat dry and brittle 
The body surface does not feel warm, but Sarah is cool seeking, which surprises the owner, as the cat is usually looking for the warmest spot in the house. 

TCVM Assessment:  

• Seasonal allergies with itching: external wind 
• Decreased appetite: spleen qi deficiency 
• Increased thirst: yin deficiency 
• Harsh dry cough: lung yin deficiency 
• Brittle, dry coat: blood deficiency 
• Cool seeking: yin deficiency 
• Weaker pulse on left: yin deficiency 

TCVM Diagnosis:  Lung Yin deficiency with external wind. 

Treatment principles: 

• Nourish Yin 
• Stop cough 

Acupuncture: 

weekly intervals for first four weeks, then monthly for maintenance. 

Acupoint Prescription:  

• Gv20: permission point 
•  Gv14: support immune system 
•  Bl13: Back-Shu association point for the lung 
• Fei Men, Fei Pan: stop cough 
•  Sp21: stop itching 
•  Bai Hui: qi point and permission point 
•  Ki3: tonify yin 

Herbal Prescription:  

Lily Formula, one teapill (160 mg) twice a day. 

Results:  

With acupuncture and herbs Sarah was able to wean off her oral steroids within a few weeks and has not needed the inhalant steroid treatments. Her respiratory rate and effort have been normal. She still occasionally coughs. 

Further therapeutic steps include taking her off dry food and introduce wet food with cooling proteins like turkey and fish to help nourish yin. 

Hypothetical Case 

Species: Feline
Breed: DSH
Age: 3 years
Gender: N

Clinical Diagnosis (conventional): Asthma

Conventional Indications:

Roscoe presented to his family veterinarian with a history of chronic, repetitive asthma attacks which occurred weekly. These attacks have been occurring for more than 2 years.  Roscoe is being treated with prednisolone 2.5 mg PO EOD.  This decreased the frequency of attacks from 3 times per week. Radiographs were unremarkable.

Traditional  Indications:

Roscoe’s appetite is fine, but not ravenous.  His energy has been somewhat less than usual. He sneezes soft sneezes occasionally. His ears are two finger cool. He prefers warmer places to hang out such as on the rug in the sun. Occasional soft cough.

Tongue: Pale

Pulse: Soft

TCVM Diagnosis:  Lung Qi Deficiency

TCVM Assessment:

• Asthma-Asthma has a Wind component and frequently Phlegm
• Sneezes- Rebellious Lung Qi
• Soft Cough-Weak cough, Rebellious Lung Qi most likely due to Qi Deficiency
• Pale Tongue-Qi Deficiency
• Soft Pulse-Qi Deficiency, +/- some Damp

Treatment Principles:

• Tonify Lung Qi
• Stop cough/asthma

Acupoint Prescription:

LU-7, LU-9, BL-13, BL-20, BL-23, ST-36, ST-40, CV-22, Ding-chuan, Fei-man, Fei-pan

• LU-7: Clears the channel
• LU-9: Yuan (Source) Point. Tonifies both Yin and Yang
• BL-13: Back-Shu Association Point for the Lung
• BL-20: Back-Shu Association Point for the Spleen
• BL-23: Back-Shu Association Point for the Kidney
• ST-36: Called the 3-mile Point, this acupoint is a major acupoint to tonify Qi everywhere in the body
• ST-40: Influential Point for Phlegm but also opens the chest and consolidates the Wei Qi by consolidating the Exterior. It also calms the Mind.ⁱ
• CV-22: Stops cough
• Ding-chuan: Stop cough
• Fei-man, Fei-pan: Stop cough

Chinese Herbal Prescription:

Bu Fei San^P

• Dose at 0.5g/ 10 lbs of body weight twice daily.

  ⁱMaciocia, Giovanni. The Foundations of Chinese Medicine E-Book (p. 989). Elsevier Health Sciences. Kindle Edition.

  Edited by Greg Todd, DVM, CVA. Cases by Alex Kintz-Konegger, DVM, CVA, CVTP and Greg Todd, DVM, CVA