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Abbreviation: LU. The large located in the chest responsible for breathing. The lung belongs to metal. It is in charge of breathing and governs the qì of the body. The lung’s own qì has the actions of diffusion and depurative downbearing. The lung governs the skin and body hair. Its outer orifice is the nose, its humor is snivel (nasal mucus), and its mind is worry. It stands in internal-external relationship with the large intestine. The lung holds the office of Minister-Mentor. Plain Questions (素问 sù wèn) states, The lung is the canopy of the viscera. Hence the appellation florid canopy, which was coined later.

For additional details about the functions and attributes of the lung further to the description below, analogy in Chinese medicine: lung, metal, Minister-Mentor.

Lung Functions

The Lung Governs Qì (肺主气 fèi zhǔ qì)

The statement that the lung governs qì is significant in two ways. First, it means that the lung controls respiration and, second, that it governs the qì of the whole body. This twofold meaning rests on the fact that the term qì means both the diffuse substance that powers activity in the body and the notion of air, breath, and respiration.

Overview of the Lung

Functions Governs qì: it controls respiration and governs the qì of the whole body Governs diffusion and depurative downbearing (and governs regulation of the waterways) Assembles the hundred vessels Associations Phase: Metal Bowel: Large intestine Channel: Hand greater yīn (tài yīn) lung channel Orifice: Nose Body constituent: Skin Bloom: Body hair Humor: Snivel (nasal mucus) Spiritual entity: Corporeal soul Mind: Worry Office: Minister-Mentor

The lung controls respiration (肺司呼吸 fèi sī hū xī): The lung constantly inhales clear qì and exhales turbid qì. Respiration is powered by the lung’s own qì but is reliant on ancestral qì to perform this task.

The lung governs the qì of the whole body (肺主一身之气 fèi zhǔ yī shēn zhī qì): The lung is involved in the production of qì and its movement around the body.

• The qì of the body, especially ancestral qì, is largely produced by a combination of the clear qì inhaled by the lung and the essence of grain and water (i.e., nutrients) absorbed by the spleen.
• The respiratory action of the lung has a regulatory effect on the movement of qì throughout the body.

The lung’s action of governing qì is complemented by its role of governing qì absorption. The kidney assists the downbearing function of lung qì of drawing clear qì (air) into the body. Hence, it is said that the lung is the governor of qì (肺为气之主 fèi wéi qì zhī zhǔ), while the kidney is the root of qì (肾为气之根 shèn wéi qì zhī gēn). If the kidney fails to perform its task, the condition is called the kidney failing to absorb qì, which manifests in severe panting.

Furthermore, the lung’s action of regulating the movement of qì further complements the liver’s governance of free coursing.

The Lung Governs Diffusion and Depurative Downbearing (肺主宣散、肃降 fèi zhǔ xuān sàn、sù jiàng)

Lung qì is the substance that accounts for the activity of the lung. It moves in two directions:

• an upward and outward movement, called diffusion.
• a cleansing downward movement, called depurative downbearing.

Diffusion and depurative downbearing are each associated with distinct functions, but both are involved in the distribution of fluids around the body. Hence, the lung also governs regulation of the waterways. Furthermore, both are easily disturbed by external evils entering with the breath; hence, the lung is called the delicate viscus.

Diffusion of lung qì manifests in three ways:

• It expels turbid qì (used, dirty air) from the lung.
• It distributes throughout the whole body the essence of grain and water transported to it by the spleen.
• It diffuses defense qì and regulates the interstices (loosely equated with sweat glands and pores), allowing fluids to be discharged in the form of sweat.

The Líng Shū (Chapter 30) states, The upper burner opens and effuses; it diffuses the five grain flavors, steams the skin, fills the body, gives the body hair luster, like the watering of mist and dew (上焦开发, 宣五谷味, 熏肤, 充身, 泽毛, 若雾露之溉 shàng jiāo kāi fā, xuān wǔ gǔ wèi, xūn fū, chōng shēn, zé máo, ruò wù lù zhī gài). The Líng Shū (Chapter 81) states, The upper burner sends out qì to warm the divided flesh, nourish the bones, and keep the interstices free (上焦出气, 以温分肉而养骨节, 通凑里 shàng jiāo chū qì, yǐ wēn fēn ròu ér yǎng gǔ jié, tōng còu lǐ).

Impairment of lung qì’s diffusion can result from insufficiency of lung qì or evils or external or internal origin. It manifests in a variety of pathological signs depending on the cause.

• Cough (usually with expectoration of phlegm) can occur in any lung pattern.
• Breathing difficulties (scantness of breath, shortness of breath, panting) can occur in most lung patterns.
• Runny nose, nasal congestion, sneezing, painful swollen throat, itchy throat, and hoarse voice are mostly attributable to external evils.
• Susceptibility to common cold reflects insufficiency of lung qì affecting defense qì, causing insecurity of the defensive exterior.

Depurative downbearing of lung qì manifests in three ways:

• It draws in clear qì (clean air) into the body.
• It ensures the downward movement of the clear qì inhaled by the lung and the essence of grain and water delivered by the spleen. It also carries waste fluids down to the kidney (see lung governs movement of water below).
• It clears away phlegm and other foreign matter from the lung and airways, carrying it downward. The lung easily gets clogged up with phlegm. For this reason, it is said that the lung is the receptacle that holds phlegm (肺为贮痰之器 fèi wéi zhù tán zhī qì). Phlegm in the lung arises when the spleen fails to move and transform water-damp and allows it to gather and concentrate. Therefore, the spleen is known as the source of phlegm formation. By depurative downbearing, the lung continually strives to keep itself clean of phlegm.

Lung and the Exterior

The lung is intimately related to the exterior. By its power, defense qì reaches the exterior to resist external evils and control the opening and closing of the interstices (sweat glands and sweat pores). It is the only viscus that is regularly affected when external evils invade the exterior―a fact that is recognized in warm disease theory. Many exterior-warming medicinals are said to enter the lung. (Others are said to enter the bladder channel, which is the channel associated with the exterior in cold damage theory). The lung controls the opening and closing of the interstices, whose outer openings are called qì gates (sweat glands and pores). These are so called because they are believed to allow the release of turbid qì from the body.

When the depurative downbearing function is disturbed, counterflow ascent of lung qì causes shortness of breath, panting, wheezing, expectoration of phlegm, and in some cases coughing of blood.

The lung is more susceptible to evils than other viscera. The lung is a spongy organ often described as vacuous like a honeycomb (虚如蜂窝 xū rú fēng wō) and clear and vacuous (清虚 qīng xū). It is penetrated by the clear qì from outside the body, easily allowing it to be invaded by external evils. It is also easily clogged with phlegm. Hence it is said that the lung is the delicate viscus (肺为娇脏 fèi wéi jiāo zàng). A further reason for this epithet is that when the lung is affected by external evils, it is treated gently with clear and light medicinals that are diffusing and dispersing. Excessively hot, cold, or dry medicinals are to be avoided. The Wēn Bìng Tiáo Biàn (Systematized Identification of Warm Diseases) states, Treat the upper burner like feathers; without lightness it cannot be lifted (治上焦如羽, 非清不举 zhì shàng jiāo rú yǔ, fēi qīng bù jǔ).

The lung governs movement of water (肺主行水 fèi zhǔ xíng shuǐ): Although the lung is chiefly involved in the intake of air as a key constituent of the body’s qì, it also plays a major role in water metabolism.

• The diffusing action of lung qì carries fluid to the periphery of the body. This enables it to be released in the form of sweat.
• The downbearing action of lung qì carries water downwards to the kidney and the bladder, where it is released from the body in the form of urine.

This important role in the movement of fluid in the body is summed up in the phrases, the lung governs the movement of water and the lung governs regulation of the waterways. (肺主通调水道 fèi zhǔ tōng tiáo shuǐ dào). The lung’s role in water metabolism is second only to that of the kidney, which governs water and produces urine. Consequently, it is also said that the lung is the upper source of water (肺为水之上源 fèi wéi shuǐ zhī shàng yuán).

Disturbance of the lung’s governance of movement of water can give rise to phlegm-rheum and water swelling.

Note that the term waterways is an abstraction. No clearly defined pathways are described.

The Lung Assembles the Hundred Vessels (肺潮百脉 fèi cháo bǎi mài):

The word hundred in this phrase simply means numerous or all. In the original metaphor, the lung is like a prime minister who assembles his subordinates before him. This describes how the numerous vessels converge in the lung, carrying blood in and out of the lung. The main significance of the lung assembling the hundred vessels is that it helps to move the blood.

Helping to move the blood: The heart governs the blood and vessels; its qì propels the blood through the vessels. The lung governs the qì of the whole body and regulates the qì dynamic throughout the body. Hence, the lung provides a supporting role in the movement of blood. When lung qì is debilitated and cannot help the heart move blood, this influences the heart’s function of governing blood, causing impaired blood flow that manifests in oppression in the chest, heart palpitation, and green-blue lips or purple lips and tongue.

It should be remembered in this context that the action of both the heart and lung is influenced by ancestral qì.

Vitalizing the blood: A further explanation of the lung assembling the hundred vessels is that lung vitalizes the blood by adding clear qì to it.

The Lung’s Associations and Epithets

The Lung and Large Intestine Stand in Exterior-Interior Relationship (肺与大肠相为表里 fèi yǔ dà cháng xiāng wéi biǎo lǐ)

The lung and large intestine are interconnected by their respective channels. The large intestine is responsible for removing excess fluid from the waste in the digestive tract, and hence it is said to govern liquid. Its action is therefore complementary to the lung’s function of regulating the waterways.

Furthermore, the large intestine’s function of carrying waste out of the body resembles the lung’s function of depurative downbearing in that both are cleansing actions. The most important aspect of the relationship between the large intestine and lung, however, is found in the context of therapy. For example, phlegm-heat congestion in the lung can sometimes be effectively treated by freeing the stool; constipation can sometimes be treated with certain medicinals that enhance the diffusion and depurative downbearing of lung qì.

The Lung Channel (肺经 fèi jīng)

Hand greater yīn (tài yīn) lung channel (LU).

The lung is the florid canopy (肺为华盖 fèi wéi huá gài)

The lung is the uppermost of all the viscera; hence, it is described in the classics as the florid canopy. The term florid canopy originally referred to the canopy of the emperor’s carriage, which provided protection from the elements. This metaphor, like many others used to describe the nature of internal organs, is political in nature. It emphasizes the role of the lung as Minister-Mentor to the sovereign (the heart).

The Lung Opens at the Nose (肺开窍于鼻 fèi kāi qiào yú bí)

Air entering and leaving the lung passes through the nose; hence the lung is said to open at the nose. Nasal congestion, runny nose, sneezing, and severe panting (labored breathing) with flaring nostrils all reflect illness of the lung. Further, it is said that the ability to sense fragrance and fetor (good sense of smell) depends on the lung being in harmony.

The throat is the gate of the lung (喉为肺门 hóu wèi fèi mén, 喉为肺之门户 hóu wéi fèi zhī mén hù); the lung governs the voice (肺主声 fèi zhǔ shēng)

The throat connects the lung with its outer orifice, the nose, while the voice is located in the throat. These airways are sometimes called the lung connector (肺系 fèi xì). Contraction of external heat impairing diffusion of lung qì can cause painful swollen throat, itchy throat, or hoarse voice. When phlegm obstructs the lung, there may be panting and wheezing or phlegm rale in the throat. Several lung conditions can manifest in hoarse voice and loss of voice. See the lung belongs to metal below.

The Lung Governs the Skin and Body Hair (肺主皮毛 fèi zhǔ pí máo)

The Nèi Jīng says that the lung has its fullness (充 chōng) in the skin and has its bloom in the skin and body hair. The skin and body hair naturally protect the body against physical injury. They are also the first line of defense against external evils, which mostly enter through the exterior.

• Lung qì and defense qì work together to bring warmth and moisture to the skin and body hair. When lung qì and defense qì are exuberant, the skin is moist and lustrous.
• Lung qì and defense qì control the opening and closing of the interstices. When lung qì and defense qì are exuberant, the interstices are kept tight, so that sweating is not excessive. When lung qì and defense qì are weak, they fail to keep the exterior secure. This is often called insecurity of the defensive exterior (卫表不固 wèi biǎo bù gù) and manifests in outward discharge of fluid through abnormal sweating and in the vulnerability of the body to invasion by external evils.

The Lung Has Its Bloom in the Body Hair (肺, 其华在毛 fèi, qí huá zài máo)

See lung governs the skin and body hair above..

Snivel is the Humor of the Lung (肺, 在液为涕 fèi, zài yè wéi tì)

The nose is the outer orifice of the lung, and the fluid of the nose is snivel, that is, nasal mucus. When the lung functions normally, nasal mucus moistens the nasal orifices without flowing out. Nasal congestion, runny nose, and sneezing are all signs of disturbance in lung qì’s diffusion.

The Lung Stores the Corporeal Soul (肺藏魄 fèi cáng pò)

The corporeal soul (魄 pò) is a spiritual entity that arises at birth and dies with the body. This concept is rarely discussed in modern clinical literature, presumably because it reflects ancient supernatural beliefs considered to have little clinical value. It is explained as the animating and sensitizing principle that gives humans the ability of movement and physical sensation. Being responsible for instinctive and involuntary actions, it enables the newborn to cry and suckle from the breast and enables us to see, hear, taste, smell, and feel sensations. The Sù Wèn (Chapter 9) states, The lung… is the place of the corporeal soul (肺者… 魄之处也 fèi zhě… pò zhī chù yě). According to the Lèi Jīng (The Classified Classic, 类经, Zhāng Jiè-Bīn, CE 1604), The corporeal soul (魄 pò) enables the body to move and perform its functions; pain and itching are felt by it.

Worry is the Mind of the Lung (肺, 在志为忧 fèi, zài zhì wéi yōu)

Worry is the mental state associated with the lung. It is understood to overlap with sorrow among the seven affects, which can damage the lung. Excessive worry and sorrow both damage lung qì, causing shortness of breath or scantness of breath and laziness to speak, fatigue and lack of strength. Conversely, insufficiency of lung qì can make patient more vulnerable to the stimuli that cause worry and sorrow.

The Lung Belongs to Metal (肺属金 fèi shǔ jīn)

Metal is the working of change. It is associated with autumn, the west; dryness, white, and acridity. The pairing of the lung with metal at first sight seems obscure, but there are cogent reasons for it.

The nature of metal: Metal is said to be the working of change (从革 cóng gé). Metal is a substance used to create implements that harvest crops, fell trees, cut wood, and slaughter animals―activities associated with both destruction and creation. The metal phase is associated with autumn, the time of the year when purifying frosts descend on earth to destroy life and cleanse nature in preparation for new growth in the year to come. Hence, a purification action is implicit in metal’s ability to work change. In terms of the human economy, autumn is the time of harvest, when metal scythes are used to cut the staple grain crops that provide food for the long winter months. At this time, animals are slaughtered so that they do not use up precious reserves of food for the wintertime. Their meat is preserved with salt, so as to provide additional reserves of food for the winter (saltiness is the flavor of water, associated with the water phase and winter). Hence, autumn is the time of purification of nature and gathering of winter sustenance.

Why the lung is ascribed to metal: The pairing of the lung with metal is based on several counts.

Purification and gathering: The notions of purification and the gathering of sustenance are reflected in the lung’s breathing function. When we inhale, we draw in clear qì required to make the body’s own qì. When we exhale, we expel turbid qì, thereby purifying the body of stale qì. Purification is also reflected in the lung’s function of depurative downbearing, which keeps the lung clear of foreign matter.

Metal, qì, and the rain cycle: The lung governs qì, which is responsible for all the transformations in the body, just as metal is the working of change.

The Sù Wèn, whose authors were very much aware of how analogy influenced their thinking, describes this in Chapter 5 as follows: The qì of earth ascends to form clouds; the qì of heaven descends as rain. Rain produces the qì of earth; clouds produce the qì of heaven 地气上为云，天气下为雨，雨出地气，云出天气 dì qì shàng wèi yún, tiān qì xià wèi yǔ, yǔ chū dì qì, yún chū tiān qì). Chapter 21 of the Sù Wèn describes a corresponding process in the body: Imbibed liquids enter the stomach, are churned to spill essential qì, which is transported upward to the spleen and finally to the lung, which, by regulating the waterways, transports [fluid] down to the bladder and distributes the water essence to the four quarters [i.e., everywhere] through the five channels (饮入于胃，游溢精气，上输于脾，上归于肺，通条水道，下输膀胱，水精四布，五经并行 yǐn rù yú wèi, yóu yì jīng qì, shàng shū yú pí, shàng guī yú fèi, tōng tiáo shuǐ dào, xià shū páng guāng, shuǐ jīng sì bù, wǔ jīng bìng xíng). Fluids rise from spleen-earth, just as water evaporates from the earth and transpires from plants. They reach the lung, which is a light spongy organ in the upper body, corresponding to the planet’s atmosphere. From here, they spread all over the body, as moisture spreads through the atmosphere. They then descend to the bladder, as rain drains away in rivers and streams.

In accordance with the rain-cycle analogy described above, we might speculate that the lung may have been associated with metal because the cold qì of the atmosphere causes water to condense, just as condensation easily forms on metal. The function of the lung, conceived of as sending water to the kidney, thus reflects the notion of metal engendering water. A further expression of the relationship between the lung and kidney is seen in the kidney’s function of helping the lung’s depurative downbearing and governance of the waterways, whereby water flows from lung-metal to kidney water as autumn gives way to winter.

Metal and the voice: Metal is prized for its sound-producing qualities, something certainly of great attraction in China during the Hàn Dynasty, when the technology of casting musical bells that produced precisely pitched notes was reaching unprecedented refinement. In the human body, the sound-producing quality of metal is reflected in the lung’s governing of the voice. This is echoed in conceptions of lung conditions. Replete metal failing to sound (金实不鸣 jīn shí bù míng) refers to a lung clogged with evils that disturb the sound of breathing and voice, like a bell filled with matter that prevents it from ringing. Similarly, broken metal failing to sound (金破不鸣 jīn pò bù míng) refers to insufficiency of yīn-liquid of the lung depriving the voice of moisture. See the lung governs the voice above.

Acridity: Acridity is associated with metal because metal gives off an acrid smell during smelting and forging processes. It is associated with the lung because it is the only one of the five flavors that is detected by the nose, which is the orifice of the lung. Acrid medicinals such as mint free the nasal passages of snivel. Acrid medicinals also treat exterior patterns arising when external evils affect the opening and closing of the interstices (sweat glands and pores), which are controlled by lung qì and defense qì. The acrid dispersing action of medicinals such as má huáng (Ephedrae Herba) and guì zhī (Cinnamomi Ramulus) induces sweating and allows the evil to leave the body, thereby resolving the exterior. Acrid medicinals such as bàn xià (Pinelliae Rhizoma) and tiān nán xīng (Arisaematis Rhizoma) are also used to disperse phlegm, which often clogs the lungs.

Lung:WuhanBells

Autumn: Lung qì resonates with the qì of autumn, which means that lung qì is most exuberant in autumn. In China, autumn weather is dry. However, excessive dryness easily damages lung liquid causing dry cough, dry mouth, and dry nose. Autumn is associated with the withdrawal of nature that inspires feelings of lugubriousness. Similarly, the lung is associated with worry and sorrow.

Cyclical relationships: Lung-metal is engendered by spleen-earth and engenders kidney-water. It is restrained by heart-fire and restrains liver-wood.

The Lung Holds the Office of Minister-Mentor (肺者相傅之官.

fèi zhě xiàng fù zhī guān)

The Sù Wèn (Chapter 8) states, The lung holds the office of Minister-Mentor; it is responsible for management and regulation (肺者, 相傅之官也, 治节出焉 fèi zhě, xiāng fù zhī guān yě, zhì jié chū yān). Minister refers to the 宰相 zǎi xiàng, the prime minister, whose responsibility is to ensure the day-to-day running of the country in accordance with the sovereign’s orders. Mentor refers to 太傅 tài fù, the personal tutor/advisor to the emperor, who provides calm advice to temper any impulsiveness of the sovereign.

The functions of the Minister-Mentor are reflected in the lung. The lung occupies a high position in the body and surrounds the heart (the sovereign). The image of prime minister reflects the lung’s governance of qì, which moves the blood around the body keeping the whole of the empire-body in integrated working order. The lung is said to govern management and regulation because the lung plays a supporting role in many functions of the body: it conveys essence to the skin and body hair, it is connected with defense qì, and it regulates the waterways through the three burners.

The mentor, who provides wise counsel to the sovereign, reflects the power of breathing to calm the emotions. Breathing is the only internal function that can be voluntarily controlled. We take a deep breath to brace ourselves for a shock or an injection. We calm our breath to deal with episodes of emotional stress. Depending on how we breathe, we can alter our heart rate and calm or excite the nervous system. Breath control has been shown to relieve asthma, worry, grief, depression, post-traumatic stress, and insomnia. Those who engage in breathing practices can become skilled not only in controlling their emotional and mental states, thoughts, and desires but also in developing mental focus. Controlled breathing is an antidote to all negative emotions and hence promotes joy, the mind of the heart.

The Lung Is Averse to Cold (肺恶寒 fèi wù hán)

This statement from the Nèi Jīng reflects the observation that the lung is susceptible to cold in the environment. Upper respiratory tract diseases are most common in cold weather, and many of them manifest in cold signs. It is no coincidence that we speak of the common cold in English. However, the lung is susceptible to dryness and heat as well as cold.

Lung Disease Signs

Signs of lung disease fall into three categories:

• Chest: Cough, panting, shortness of breath, and scantness of breath are disturbances of diffusion and depurative downbearing that occur in many lung disease patterns. Chest pain may result from heat or phlegm.
• Nose and throat: Nasal congestion, runny nose, hoarse voice, painful swollen throat, and itchy throat are all disturbances of lung qì diffusion.
• Exterior: Sweating disturbances and susceptibility to common cold reflect disturbances of lung qì diffusion.

Cough (咳嗽 ké sòu): This can occur in any form of lung disease and is associated with disturbances of diffusion and depurative downbearing. It is commonly associated with the coughing of phlegm, and in some cases with the coughing of blood.

Panting (咳血 ké xuè): Severe breathing difficulty with discontinuity in breathing (failure to catch one’s breath), raised shoulders, and flaring nostrils.

Shortness of breath (短气 duǎn qì): Breathing difficulty milder than panting with discontinuity in breathing in severe cases, but without raised shoulders or flaring nostrils. It can occur in vacuity or repletion patterns.

Scantness of breath (少气 shǎo qì): The mildest breathing difficulty in which patients feel they do not have sufficient qì to breathe or speak. In contrast to shortness of breath or panting, no discontinuity of breathing is observed. It is a sign of qì vacuity. It does not occur in repletion patterns.

Nasal congestion (鼻塞 bí sè); runny nose (流鼻涕 liú bí tì): Nasal congestion is the clogging of the nose by excess snivel (nasal mucus). It is mostly the result of wind-cold or wind-heat. Wind-cold causes thin clear nasal mucus and runny nose. Wind-heat causes thick, yellow nasal mucus resulting in nasal congestion.

Hoarse voice (声音嘶哑 shēng yīn sī yǎ); loss of voice (失音 shī yīn): Partial or complete loss of the ability to produce sounds from the larynx can occur in vacuity and repletion.

Painful swollen throat (咽喉红肿痛 yān hóu hóng zhǒng tòng): This is usually a sign of wind-heat.

Itchy throat (喉痒 hóu yǎng): This is caused by wind-heat, dryness, or yīn vacuity.

Susceptibility to common cold (易于感冒 yì yú gǎn mào): Recurrence of colds and flu is usually associated with lung qì vacuity (preventing diffusion of defense qì).

Lung Patterns

For fuller information than is given below, follow the pattern links. See lung pattern identification.

The lung is susceptible to insufficiency of its qì and its yīn. It is vulnerable to the external evils wind-cold, wind-heat, and dryness. It is also vulnerable to heat, cold, and phlegm of internal origin.

Insufficiency

Lung qì vacuity (肺气虚 fèi qì xū): Lung qì vacuity is characterized by forceless cough with expectoration of clear thin phlegm or panting exacerbated by physical exertion. These signs are accompanied by general qì vacuity signs such as faint low voice, laziness to speak lassitude of spirit and physical fatigue, and susceptibility to common cold. The facial complexion is pale or bright-white. The tongue is pale with white tongue fur. The pulse is vacuous.

Lung yīn vacuity (肺阴虚 fèi yīn xū): This is characterized by cough with little or no phlegm, and a hoarse voice. This is accompanied by signs of yīn vacuity with internal heat, such as emaciation, slight heat effusion, postmeridian tidal heat effusion (heat effusion recurring in the late afternoon or evening every day), vexing heat in the palms and soles, and tidal reddening of the cheeks. The tongue is red with scant liquid. The pulse is fine and rapid. In severe cases, the phlegm is flecked with blood or coughing of blood.

Invasion by External Evils

The lung is the viscus most susceptible to external evils (wind, cold, heat, dryness), which disturb the normal diffusion of its qì. Lung patterns arising from external contractions differ from the vacuity patterns described above by being relatively swift in onset with the absence of marked vacuity signs. The first three are associated with exterior patterns and are therefore characterized by heat effusion and aversion to cold. The last is an interior heat pattern.

Wind-cold fettering the lung (风寒束肺 fēng hán shù fèi) is characterized by cough with clear phlegm, accompanied by aversion to cold, nasal congestion and runny nose, and absence of sweating. The tongue fur is thin and white. The pulse is floating and tight. In severe cases, panting is observed.

Wind-heat invading the lung (风热犯肺 fēng rè fàn fèi) is marked by cough with thick yellow phlegm, accompanied by nasal congestion and thick yellow nasal mucus, heat effusion, aversion to wind, dry mouth, and painful swollen throat. The tongue is red at the tip with a yellow fur. The pulse is floating and rapid.

Dryness evil invading the lung (燥邪犯肺 zào xié fàn fèi) occurs mostly in the autumn in China. It is marked by dry cough with little phlegm, dry nose, lips, mouth, and skin, with mild heat effusion and aversion to cold. The tongue fur is thin and dry. Constipation and scant urine may also be seen. Distinction is made between cool dryness and warm dryness, the first being characterized by a pulse that is floating and rapid, and the latter by a pulse that is floating and tight.

Evils in the Interior

The following patterns are caused by evils entering the interior from the exterior or arising in the interior. They are interior patterns because even though they may involve heat that produces heat effusion, the aversion to cold characteristic of exterior patterns is absent. The only exception is the last pattern below, which is a combined pattern of external wind (with heat or cold) and water-damp arising internally.

Intense lung heat (肺热炽盛 fèi rè chì shèng) occurs when warm-heat evil invades the lung, when wind-cold transforms into heat, enters the interior, and settles in the lung, or when internal heat affects the lung. It is characterized by cough and rapid panting, with flaring nostrils, painful swollen throat, constipation (the last being a major sign of interior repletion heat), and short voidings of reddish urine. The tongue is red with yellow fur. The pulse is surging, rapid, and forceful.

Phlegm-heat congesting the lung (痰热壅肺 tán rè yōng fèi) arises most commonly when evil heat invades the lung, causing intense lung heat that scorches lung liquid and condenses it into phlegm. It can also arise when depressed phlegm transforms into heat. It is characterized by heat effusion, cough and panting, copious thick yellow phlegm, phlegm rale in the throat (wheezing), thirst, short voidings of yellow urine, and constipation. In some cases, there is coughing of fetid phlegm, pus, and blood. The tongue fur is yellow and slimy. The pulse is slippery and rapid.

Cold phlegm obstructing the lung (寒痰阻肺 hán tán zǔ fèi): Also called cold rheum collecting in the lung and phlegm turbidity obstructing the lung. This is a pattern of cold rheum or phlegm turbidity gathering in the lung, impairing the lung’s diffusion and downbearing, and causing cough with easily expectorated copious white phlegm, panting, and oppression in the chest. In some cases, there is a wheezing phlegm rale in the throat. There are cold signs such as fear of cold or cold limbs. The tongue is pale with a slimy white or glossy white fur. The pulse is stringlike or slippery.

Rheum collecting in the chest and rib-side (饮停胸胁 yǐn tíng xiōng xié): This pattern arises when cold evil combines with phlegm-rheum and congests the lung and impairs its diffusing and depurative downbearing functions. The signs are oppression and fullness in the chest, pain in the chest and rib-side triggered or exacerbated by coughing or turning sides, shortness of breath, and in some cases dizziness. The tongue fur is white and glossy. The pulse is sunken and stringlike.

Wind and water contending with each other (风水相搏 fēng shui3 xiang1 bo2): This pattern arises when wind evil (wind-cold or wind-heat) assails the outer body, impairing the diffusion of lung qì, which causes water-damp to spill outward into the skin. The signs are sudden puffy swelling of the head and face with exterior signs, which is often referred to as a yang2 water pattern (as distinct from a yīn water pattern, which is swelling of the lower limbs). A distinction is made between wind-cold and wind-heat. Wind-cold is marked by pronounced aversion to cold and mild heat effusion, absence of sweating, a thin white tongue fur, and a pulse that is floating and tight. Wind-heat is marked by pronounced heat effusion with mild aversion to cold, painful swollen throat, a thin yellow tongue fur, and a pulse that is floating and rapid.

The Lung’s Relationships

Lung and Heart

The lung governs qì, while the heart governs the blood; the lung governs respiration, while the heart moves the blood. In these functions, both viscera rely on the help of ancestral qì. Hence, the relationship between the lung and the heart is closely linked to the relationship between qì and blood.

Lung affecting the heart: The lung’s function of governing qì and controlling respiration is complementary to the heart’s action of moving the blood. Lung qì vacuity or impaired diffusion and depuration can influence the heart’s function of moving the blood, causing blood stasis that manifests in oppression in the chest, changes in the heart rate, green-blue lips, and a purple tongue.

Heart affecting the lung: The heart’s function of moving the blood helps to maintain the lung’s function of controlling respiration. Insufficiency of heart qì or heart yang2 can cause heart vessel stasis obstruction, which can affect the lung’s functions of governing diffusion and depurative downbearing, giving rise to counterflow ascent of lung qì, which manifests in cough and rapid breathing.

Lung and Spleen

The relationship between the lung and spleen is chiefly seen in the production of qì and distribution of fluids.

Production of qì: The qì of the body is dependent upon the respiratory function of the lung and the movement and transformation function of the spleen. The clear qì inhaled by the lung and the essential qì of grain and water that is moved and transformed by the spleen provide the material basis for the production of ancestral qì, provisioning qì, and defense qì. Hence, the health of qì is dependent on the health of the lung and spleen.

When spleen qì is weak, it can cause insufficiency of lung qì, which is often referred to as earth failing to engender metal and is treated by the method of banking up earth to engender metal.

Enduring lung disease can affect the spleen, causing splenic movement and transformation failure, which manifests in reduced eating, abdominal distension, sloppy stool, and even water swelling. This is often called disease of the upper body affecting the center. In medicinal therapy, this is also treated by banking up earth to engender metal. There is no special method for treating spleen qì vacuity stemming from lung qì vacuity, because qì vacuity in any bowel or viscus is primarily treated by fortifying the spleen.

Distribution of fluids: The lung and spleen perform mutually complementary functions in the realm of fluid distribution.

• The lung’s diffusion, depurative downbearing, and regulation of the waterways help the spleen to move and transform water and prevent internal dampness from arising.
• The spleen’s function of moving and transforming water-damp and spreading essence to the lung is not only necessary for normal regulation of the waterways, but also provides the lung with nourishment.

When splenic movement and transformation are impaired, fluid often collects and stagnates, leading to phlegm and rheum, which affect the diffusion and depurative downbearing functions of the lung and cause cough with copious phlegm. For this reason, it is said that the spleen is the source of phlegm formation and the lung is the receptacle that holds phlegm.

Lung and Liver

The lung governs regulation and management; the liver governs free coursing. The relationship between the lung and liver is mainly seen in the upward and downward bearing of qì. The lung governs downbearing, while the liver governs upbearing. These mutually complementary actions coordinate to ensure regulated qì dynamic throughout the whole body.

Liver affecting the lung: If the liver’s upbearing action is excessive, the result can be counterflow ascent of qì and fire, which manifests in cough and counterflow ascent of qì, in some cases with expectoration of blood. This is called liver fire invading the lung. In terms of five-phase theory, it is wood rebelling against metal when the restrained phase, wood, grows inordinately strong. Hence, it is also called wood fire tormenting metal.

Lung affecting the liver: When the lung’s clearing depuration is impaired, and dryness-fire is internally exuberant, this can affect the liver by inhibiting free coursing. When this happens, there is cough together with liver signs such as distending pain in the chest and rib-side, dizziness, headache, and red face and eyes. In terms of the five phases, this is wood rebelling against metal when the restraining phase, wood, grows inordinately weak.

Lung and Kidney

The relationship between the lung and the kidney is mainly observed in water metabolism and respiration.

Water metabolism: The lung governs regulation of the waterways; the kidney is the water viscus. When coordinated, the lung and kidney ensure normal distribution and discharge of fluids. The lung’s function of governing regulation of the waterways is reliant upon the kidney’s steaming and qì transformation action, while the kidney’s function of governing water is also reliant on the diffusion and depurative downbearing action of the lung.

Impaired depurative downbearing and impaired kidney qì transformation are mutually conducive, giving rise to water swelling, scant urine, with cough, panting, aching lumbus and limp knees.

Respiration: The lung governs respiration; the kidney governs qì absorption. Inhaled clear qì is carried downward by the depurative downbearing action of lung qì. However, the lung also requires the complementary action of kidney qì to perform deep breathing and carry the inhaled qì downward. Thus, the lung’s depurative downbearing function and the kidney’s action of absorbing qì are mutually complementary. For this reason, it is said that the lung is the governor of qì and the kidney is the root of qì.

Lung qì vacuity with impaired depurative downbearing and insufficiency of kidney qì with qì absorption failure (kidney failing to absorb qì) are also mutually conducive, causing qì counterflow with panting at the slightest exertion, oppression in the chest, together with cough, aching lumbus and limp knees.

When kidney yang2 vacuity manifests in yang2 vacuity water flood (described above), accumulation of water within the body can affect the lung, giving rise to panting. This is called water-cold shooting into the lung.

Yīn qì: The yīn qì of the lung and kidney are mutually nurturing. Kidney yīn is the root of the yīn qì of the whole body. It nurtures the yīn of the other viscera and is also dependent upon them for nourishment.

Lung yīn vacuity can damage kidney yīn, and kidney yīn vacuity can spread to the lung. In either case, the result is lung-kidney yīn vacuity, which is characterized by tidal reddening of the cheeks, tidal heat effusion, night sweating, dry cough, hoarse voice, and limp aching lumbus and knees.

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