BRONCHITIS 气 管 炎

Copyright Giovani Maciocia

“Bronchitis” is a Western medicine term; in Chinese medicine, it would be

found under “Cough”. I will concentrate primarily on bronchitis after an
invasion of Wind, therefore primarily acute bronchitis in the context of acute
exterior diseases. Therefore, this corresponds to the Qi Level of the 4 Levels
or Upper Burner within the 3 Burners.
The 6 Stages do not even envisage such a pattern and that is another reason
why I primarily use the 4 Levels in the treatment of acute external diseases.
Bronchitis (or Phlegm-Heat in the Lungs with cough) is the most common
pattern seen at the Qi level. A huge number of hospitalizations are due to
bronchitis. Two other important reasons why we need to be very skilled at
treating bronchitis is a) it may have serious complications for the elderly; b)
it often gives rise to residual pathogenic factor and chronic bronchitis.

妻 管 严
The Lung pattern at the Qi Level actually describes a situation of Lung-Heat
but its treatment principle is applicable to situations of Phlegm-Heat in the
Lungs.
When we say that “bronchitis” corresponds to “Cough”, we shold be clear
that is corresponds only to one type of cough. Cough may be internal or
external and acute or chronic. When we discuss bronchitis, we therefore
mean an acute cough of exterior origin. Please note that the cough is of
exterior origin (after an invasion of Wind): the actual Qi Level pattern is
internal and is characterized by internal Heat: from the 8 Principles point of
view, it is Hot, Internal, Full, Yang.
AETIOLOGY
This ia by definition an invasion of external Wind at the Wei level; the
pathogenic factor is not expelled, it becomes interior and it turns into Heat.
The main external pathogenic factor causing this is Wind (as opposed to
Dampness). Wind will affect the Lungs for various reasons. Firstly, Wind affects
the Lung Wei portion already at the Wei level; Wind invades the skin which is
controlled by the Lungs. Also, Wind-Heat enters through the nose which is an
orifice of the Lungs.
There is a tendency for this pathogenic factor to become internal and enter the
Lung organ because the Lungs are a “delicate” organ (more so in children and
the elderly).
PATHOLOGY
We have discussed why the pf enters the Lungs at the Qi level. Yet
another reason not discussed above is that the Lungs are in the Upper
Burner; Wind invades the top part of the body hence the Lungs are
more prone to be invaded. (Dampness has a tendency to invade the
Middle Burner and the Stomach and Spleen.
Why Heat and why Phlegm? Heat because internal pf have a tendency
to generate Heat. (For example, Latent Heat is a manifestation of this
principle). Phlegm is formed for various reasons. The first is that
Heat by itself tends to condense the fluids into Phlegm.
Another reason is that, once internal, the pf does affect Stomach and
Spleen too impairing the ascending of Spleen-Qi and descending of
Stomach-Qi. Both Heat and Phlegm obstruct the Lungs and impair the
diffusing and descending of Lung-Qi: the latter causes the cough and
breathlessness.
DIAGNOSIS
-Cough worse at night: usually external cough
- Cough with loud sound or barking cough: Full condition
- Expectoration: Phlegm

CLINICAL MANIFESTATIONS
Acute cough after a cold or influenza, (occasionally it may start
without previous obvious symptoms of common cold or influenza),
fever, expectoration of sticky-yellow-greenish phlegm which may
also be blood-tinged), breathlessness, cough worse at night, a feeling
of oppression of the chest, thirst, red face. Tongue: Red with sticky-
yellow-brown coating. Pulse: Slippery-Rapid.
TREATMENT PRINCIPLES
The treatment principle for bronchitis is based on three main thrusts:

1) to clear Heat, i.e. qing 清. Of course, it means Lung-Heat

2) to restore the diffusing xuan 宣 and descending jiang 降 of Lung-Qi

3) To resolve Phlegm hua Tan 化 痰

It is not usually necessary to tonify the Spleen to resolve Phlegm in

acute bronchitis (it is very important in chronic bronchitis)
PATTERNS AND TREATMENT
Although we are discussing bronchitis and therefore Qi level, I will
discuss two external patterns with cough at the Wei level. There are cases
of patterns at the Wei level when cough is a predominant symptom.

The general symptoms of Qi level are: fever, feeling of heat, thirst, red
face, Overflowing pulse, Red tongue with coating.

The two main symptoms Wei level are simultaneous aversion to cold and
fever (fa re 发 热)
1) WIND-COLD IN THE LUNGS WEI PORTION

All the manifestations of invasion of Wind-Cold plus a persistent cough

with expectoration of thin-white phlegm.

Treatment principle: release the Exterior, expel Wind, restore the

descending of Lung-Qi.

Prescription
SAN NIU TANG Three Obstinate Decoction Variation
Jing Jie Herba Schisonepetae
Zi Wan Radi Asteris
Ma Huang Herba Ephedrae
Bai Bu Radix Stemonae
Xing Ren Semen Armeniacae
Zi Su Ye Folium Perillae
Jie Geng Radix Platycodi
Bai Qian

Acupuncture
LU-5, LU-7, Ren-17, BL-12, BL-13, LI-4.
2) WIND-HEAT IN THE LUNG WEI PORTION
All the manifestations of Wind-Heat, plus persistent slightly barking cough,
expectoration of sticky-yellow phlegm, soreness of chest on coughing.

Treatment principle: release the Exterior, expel Wind, restore the descending of
Lung-Qi.

Prescription
SANG JU YIN Morus-Chrysanthemum Decoction Variation
Sang Ye Folium Mori Jie Geng Radix Playtcodi
Ju Hua Flos Chrysanthemi Bo He Folium Menthae
Lian Qiao Fructus Forsythiae Xing Ren Semen Armeniacae
Lu Gen Radix Phragmitis communis

Acupuncture
LU-7, LI-4, LI-11, Ren-17, LU-5, BL-12, BL-13.
3) LUNG-HEAT (Qi Level)
Cough without much expectoration, thirst, red face, fever, breathlessness,
feeling of heat, dry throat. Tongue: Red with yellow coating, dry. Pulse:
Overflowing-Rapid.
Treatment principle: clear Heat, clear the Lungs, restore the descending of
Lung-Qi.
Prescription
SANG XING TANG Morus-Armeniaca Decoction Variation
Sang Ye Folium Mori Jie Geng Radix Platycodi
Xing Ren Semen Armeniacae Lian Qiao Fructus Forsythiae
Bei Sha Shen Adenophora Shan Zhi Zi Gardenia
Chuan Bei Mu Fritillaria
Dan Dou Chi Semen Sojae preparatum

Acupuncture: LU-5, LU-7, Ren-17, BL-13, LU-6, SP-6.

4) PHLEGM-HEAT IN THE LUNGS
Persistent cough with profuse sticky-yellow-brown coating, breathlessness,
fever, thirst, sticky taste, barking cough that is worse at night, red face, chest
soreness on coughing. Tongue: red with thick-sticky-yellow-brown coating.
Pulse: Slippery-Rapid.
Treatment principle: clear Lung-Heat, resolve Phlegm, restore the descending
of Lung-Qi.
Prescription
QING JIN HUA TAN TANG Clearing Metal and Resolving Phlegm Decoction
Variation
Sang Bai Pi Cortex Mori Gua Lou Ren Semen Trichosanthis
Huang Qin Radix Scutellariae Jie Geng Radix Platycodi
Shan Zhi Zi Gardenia Chen Pi Pericarpium Citri reticulatae
Chuan Bei Mu Fritillaria Zhi Mu Radix Anemarrhenae
QING QI HUA TAN TANG Clearing Qi and Resolving Phlegm Decoction

Gua Lou Ren Semen Trichosanthis

Chen Pi Pericarpium Citri reticulatae
Huang Qin Radix Scutellariae
Xing Ren Semen Armeniacae
Zhi Shi Fructus Aurantii
Fu Ling Poria
Dan Nan Xing Rhizoma Arisematis
Ban Xia Rhizoma Pinelliae preparatum

XUAN BAI CHENG QI TANG 宣 白 承 气 汤 Diffusing White Conducting Qi

Decoction
Shi Gao Gypsum
Da Huang Rhizoma Rhei
Xing Ren Semen Armeniacae
Gua Lou Pi Cortex Thichosanthis
XIAO XIAN XIONG TANG
Gua Lou Ren Semen Trichosanthis
Huang Lian Radix Coptis
Ban Xia Rhizoma Pinelliae preparatum

WEN DAN TANG

Ban Xia Rhizoma Pinelliae preparatum
Fu Ling Poria
Chen Pi Pericarpium Citri reticulatae
Zhu Ru Caluis Bambusae in taeniam
Zhi Shi Fructus Aurantii
Gan Cao Radix Glycyrrhizae
Sheng Jiang Rhizoma Zingiberis recens
5) LUNG-YIN DEFICIENCY
Sequelae of bronchitis: dry cough, dry throat, chest soreness.
Prescription
SHA SHEN MAI DONG TANG Variation
Bei Sha Shen
Mai Men Dong
Yu Zhu
Tian Hua Fen
Sang Ye
Chuan Bei Mu
Zhi Mu
NEI JING – SU WEN
“Cough with sound and without phlegm indicates injury of the Lungs;
cough with phlegm without sound indicates injury of the Spleen;
cough with sound and phlegm indicates injury of both”.

The Su Wen mentions 10 types of cough:

1) Wind cough
2) Cold cough
3) Prop-up cough
4) Liver cough
5) Heart cough
6) Spleen cough
7) Lung cough
8) Kidneys cough
9) Gall-Bladder cough
10) Jue Yin cough