Lung Heat

Understanding Lung Heat

The Lungs are described as delicate and as the organ most exposed to the air. When Heat settles in them, the phlegm thickens and turns yellow and the airways become irritable.

The cough brings up thick yellow or greenish phlegm and may be painful in the chest. Fever and thirst accompany it, and the breath may feel hot.

The tongue is red with a yellow dry coat and possible raised red points on the front third. The pulse is rapid and often slippery or forceful.

It follows an unresolved Wind-Heat invasion, a Wind-Cold that has transformed, hot and spicy food, smoking or environmental irritants.

Treatment clears Lung Heat and transforms the phlegm. The distinction from Wind-Heat is depth: the pulse is no longer floating and the phlegm is thick and yellow rather than thin.

Signs and symptoms

Key signs

• Cough with thick yellow phlegm
• Fever
• Thirst

Also seen

• Chest pain with coughing
• A sore throat
• Breathlessness on exertion
• A dry mouth
• Restlessness
• Yellow nasal discharge

Variations

• Coughing blood-streaked sputum in severe cases
• Wheeze
• A hoarse voice

Timing

• The fever is worse in the afternoon and evening.
• It follows a cold that has worsened rather than resolved.

Practitioner notes

• The tongue is red with a yellow dry coat and possible raised red points on the front third.
• The pulse is rapid and slippery or forceful, and no longer floating.
• The distinction from Wind-Heat is depth: thick yellow phlegm and a non-floating pulse show the Heat is inside the Lungs.
• The distinction from Phlegm-Heat is emphasis: here the Heat is primary, while Phlegm-Heat has abundant phlegm as the leading feature.

Causes

Common causes

• External Wind-Heat invasion
• Wind-Cold transforming into Heat
• Hot, spicy and rich diet
• Smoking and environmental irritants

How it develops

• It develops from an unresolved surface Heat pattern.
• If the phlegm thickens further, it becomes Phlegm-Heat.

Diagnosis

Diagnosis rests on thick yellow phlegm with fever and a red tongue with a yellow coat.

Tongue

• Body: Red, with possible raised red points on the front third.
• Coating: Yellow and dry.
• Note: A white coat would indicate Cold or an early surface pattern.

Pulse

Rapid, Slippery, Forceful

No longer floating, which shows the Heat has moved inward.

Observation

• Flushed face
• Dry lips
• Restlessness

Listening

• A loose or harsh cough with sputum
• A hoarse voice

Palpation

• Abdomen: Unremarkable.
• Channels: The skin may be warm; LU-5 and BL-13 may be tender.

Questions that separate it from look-alikes

• What colour is the phlegm?
• Is there fever or thirst?
• Any chest pain on coughing?
• How long has it lasted, and does smoking play a part?

Treatment

Principles

• Clear Lung Heat
• Transform thick phlegm
• Redirect Lung Qi downward
• Protect the fluids from the Heat

Herbs

Formulas

• Ma Xing Shi Gan Tang - The reference formula for Lung Heat with cough and thirst, clearing and descending.
• Xie Bai San - For Lung Heat with cough and breathlessness, draining the Heat.
• Qing Qi Hua Tan Wan - For cough with thick yellow phlegm, clearing and transforming.
• Wei Jing Tang - For Lung Heat with abundant phlegm, transforming it while clearing.
• Sang Ju Yin - For the earlier Wind-Heat stage with cough.
• Yin Qiao San - For Wind-Heat with a sore throat, before the Heat moves deeper.

Acupoints

• Lieque LU-7 - Opens the Lungs and regulates their Qi.
• Dazhui DU-14 - Clears Heat from the body.
• Quchi LI-11 - Clears Heat from the upper body.
• Feishu BL-13 - The Lung back-shu point, used for cough and Lung Heat.

Personalising the plan

• If phlegm dominates, transforming herbs are increased.
• If fever dominates, cooling herbs are increased.
• If thirst is marked, fluid-generating herbs are added.
• If the pattern is chronic, Lung support is added.

Self-care

Diet

• Cooling fluids and light food: pear, cucumber, mung bean
• Avoid spicy, fried and greasy food
• Stop smoking and avoid smoky environments

Lifestyle

• Rest, especially with fever
• Cool well-ventilated room
• Avoid strenuous exercise during the fever

Qigong and movement

• Not during the febrile phase; gentle breathing practice during recovery.

How it differs from look-alikes

Patterns that can be mistaken for lung heat, and the contrast that separates them.

Where it appears

Skin conditions in which this pattern is commonly seen.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

This page describes a TCM pattern, not a diagnosis, and a pattern can accompany more than one skin condition. Get urgent medical help for a rash with fever, confusion or feeling very unwell; skin that is blistering, peeling or spreading quickly; swelling of the face, lips or throat, or difficulty breathing; or a lesion with increasing pain, warmth, red streaks or pus. For anything persistent, severe or changing, have it assessed by a clinician before treating it yourself.

Read the skin condition pages for the red flags that belong to a specific presentation.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.

Related patterns