Wind-Cold-Water invading the Lungs

Understanding Wind-Cold-Water invading the Lungs

The tradition distinguishes thin watery fluid, called water or fluid retention, from thicker Phlegm. When Wind and Cold close the surface while fluid already pools inside, the Lungs are congested with thin water rather than sticky phlegm.

The sputum is copious, thin, white and frothy rather than thick. There is wheeze or shortness of breath and a feeling of chest tightness, and lying flat makes it worse.

Chills and an aversion to cold are present, usually with little sweating and no thirst, or only thirst for warm drinks. The tongue is pale and puffy with a white slippery coat that has a watery sheen.

It follows exposure to Wind and Cold on top of pre-existing fluid retention, or cold and raw food and drink, or living in cold damp conditions.

Treatment releases Wind-Cold at the surface and transforms the fluid in the Lungs at the same time. Doing only one leaves the other: releasing alone leaves the fluid, warming the fluid alone leaves the surface closed.

Signs and symptoms

Key signs

• Cough with copious thin white frothy sputum
• Wheezing or shortness of breath
• Chills or aversion to cold
• Chest tightness or fullness

Also seen

• No sweating
• No thirst, or only for warm drinks
• A stuffy nose with clear discharge
• Puffiness in the face
• Lying flat worsens the breathlessness
• Aching limbs

Variations

• Frothy sputum that is worse in the morning
• A rattling chest
• Swelling of the ankles in chronic cases

Timing

• It comes on after cold exposure and is worse at night and when lying flat.
• Chronic cases recur each winter.

Practitioner notes

• The tongue is pale and puffy with teeth marks and a white slippery coat with a watery sheen.
• The pulse is floating and tight, or wiry and slippery if the fluid is more established.
• The distinction from Wind-Cold invading the Lungs is the volume of thin watery sputum and the wheeze.
• The distinction from Phlegm is the thinness of the fluid: Phlegm is thick and sticky, this is watery.

Causes

Common causes

• Exposure to Wind and Cold
• Pre-existing internal fluid retention
• Cold and raw food and drink
• Living or working in cold damp environments

How it develops

• It can be acute after exposure, or chronic and relapsing each winter.
• If it persists, the fluid can settle and weaken the Lungs over time.

Diagnosis

Diagnosis rests on copious thin frothy sputum with chills and a floating tight pulse.

Tongue

• Body: Pale and puffy with teeth marks.
• Coating: White slippery with a watery sheen.
• Note: A yellow coat would indicate Heat.

Pulse

Floating, Tight, Slippery

Floating and tight shows Wind-Cold at the surface; slippery shows the fluid.

Observation

• Pale face
• Warm clothing
• A rattling chest

Listening

• A rattling cough with thin sputum
• Wheeze

Palpation

• Abdomen: May feel cool; no guarding.
• Channels: The skin may feel cool and dry; LU-1 and BL-13 may be sensitive.

Questions that separate it from look-alikes

• Is the sputum thin and frothy or thick?
• Any chills or sweating?
• Is there thirst, and for warm or cold drinks?
• Is breathing worse lying flat?

Treatment

Principles

• Release Wind-Cold from the exterior
• Transform and drain the water-fluid in the Lungs
• Warm the Lungs
• Redirect Qi downward to settle the breathing

Herbs

Formulas

• Xiao Qing Long Tang - The reference formula for Wind-Cold with water-fluid in the Lungs, releasing and transforming together.
• Ma Huang Tang - For Wind-Cold without sweating; used where the surface is tightly closed.
• Ling Gan Wu Wei Jiang Xin Tang - For cold fluid in the Lungs with chronic cough and watery sputum.
• Shi Gao Tang - Used in selected cases where Heat is also present, balancing the warming herbs.

Acupoints

• Zhongfu LU-1 - The Lung front-mu point, used for cough and chest congestion.
• Fengmen BL-12 - The Wind gate, used to release Wind-Cold from the surface.
• Hegu LI-4 - Releases the exterior and moves Qi in the upper body.
• Dingchuan EX-B-1 - An extra point used for wheeze and breathlessness.
• Fenglong ST-40 - The principal point for transforming Phlegm and fluid.

Personalising the plan

• If the surface signs dominate, releasing herbs are increased.
• If the fluid dominates, transforming and draining herbs are increased.
• If the person is depleted, strong releasing is reduced and support added.
• If Heat appears, cooling is added - a yellow coat is the signal.

Self-care

Diet

• Warm cooked food; ginger tea
• Avoid cold, raw and iced food and drink
• Reduce dairy, which is described as adding to fluid

Lifestyle

• Keep warm, especially the chest and back
• Sleep propped up if breathless lying flat
• Avoid cold damp environments
• Seek urgent care for severe breathlessness

Qigong and movement

• Gentle breathing practice; not during the acute phase.

How it differs from look-alikes

Patterns that can be mistaken for wind-cold-water invading the lungs, 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.