1. Acute heart failure with lung edema, frothy sputum - would this be an example of phlegm fluids obstructing the lungs? 2. Middle -aged man with petechiae on both lower legs for several years, (probably autoimmune vasculitis from a western diagnosis perspective) that get better when on an anti-inflammatory diet with good night's sleeps and worse when getting lax on these. Petechiae usually worse at night. Occasional nausea , shakiness and anxiety upon waking. Excessive soreness in muscles after working out. Occasional dry cough with no mucus (person had COVID twice in 2020). Would this be any particular pattern you can think of? thanks Andrew

Andrew said: 1. It could be! Very possibly that would be a good diagnosis to use for the acute aspect (and maybe chronic too) of the disease. My question for you is: Can you look a bit deeper into the symptom picture to see what pattern is underlying? Phlegm-fluids obstructing could be the primary pattern. However, you might also be able to find an even deeper pattern for the chronic aspect of the disease. 2. I might think of spleen not controlling blood. It would explain several symptoms: Healthy diet lessens the burden on the spleen qi and allows it to recover, poor diet taxes the spleen. Poor sleep exhausts qi and blood (manufactured by spleen). Petechia= bleeding. Nausea and cough = qi counterflow; nausea because spleen-stomach ascending-descending relationship impaired, cough because earth must nourish metal on the generation cycle. Muscles belong to the spleen. The anxiety, dry nature of the cough, and symptoms worse at night may be related to damaged yin. Having COVID, especially if there was a fever, can damage yin and fluids.

Thank you Andrew. To answer your question in number 1 - I might think of kidney yang deficiency, if there is cold patterns in patient history. Ming men fire not evaporating fluids... although we said it would mostly affect lower jiao with edema (which is actually common in heart failure like pitting edema in legs etc.). Or spleen qi deficiency and spleen not transforming fluids properly and thus the phlegm. Earth (spleen) is also mother to metal (lungs)... Either of these correct?

Andrew said: Hi Adam. I like both of those patterns and I think either could be relevant! Which one simply depends upon all of the other signs and symptoms you see in the case. Remember, kidney yang deficiency is a deeper-seated, longer-term condition. So, it could be very appropriate. Go back to the kidney patterns on the PowerPoint slides, take a look at kidney yang deficient, water overflowing to lungs. In this presentation, the fluid overflow IS a major sign of “cold”.