Dyspnea from Chronic Lung Failure Treated with Morphine and Moxa

 The same patient with pulmonary carcinoid described in a previous clinical case (https://pensieridiunmedico.blogspot.com/2025/05/agopuntura-per-trattare-la-dispnea-in.html) presents with dyspnea at rest despite self-administration of morphine (she does not tolerate fentanyl or continuous morphine due to excessive drowsiness, given her highly active nature).  

She responds moderately well to acupuncture sessions but has marked skin sensitivity to needles, making each puncture a small source of discomfort.  

The radiological picture has also changed, with a dorsal paravertebral lesion and some brain lesions in addition to the usual hepatic ones.  

I proposed a treatment with moxibustion alone, without needles:  

First day: LU7, LU1, LU5, LU6, BL12-13.  

Immediate benefit on dyspnea, but too short-lived: approximately one hour of reduced breathlessness.  

I deliberately did not measure the NRS, but the breathlessness was reported as moderate even at rest. She does not wish to use additional medications, only unconventional therapies.  

I intentionally did not quantify the benefit numerically, as sometimes, especially with patients less inclined to numerical quantification, it is truly a futile exercise, particularly when clinical studies are not involved (I will discuss my reflections on NRS and VAS elsewhere).  

A few days later, I decided to delve into Giovanni Maciocia’s study on different types of dyspnea and framed her case (with some differences and, for certain aspects, somewhat forcibly) in this excerpt from the book “The Clinical Practice of Chinese Medicine”:  

“Deficiency of Lung and Kidney Yang, Fluids overflowing to the Heart and Lungs.  

Clinical manifestations: Chronic dyspnea, cough with white and watery expectoration, a sensation of chest oppression, palpitations, edema, scanty urine, cold sensation.  

Tongue: Pale, swollen, and wet.  

Pulse: Deep (Chen), Weak (Ruo), and Slow (Chi).  

This pattern is caused by a deficiency of Lung and Kidney Yang, leading to an accumulation of Phlegm-Fluids in the Lungs and Heart. The watery and white expectoration is typical of Phlegm-Fluids.  

Treatment principles: Tonify and warm the Lungs and Kidneys, dissolve Phlegm-Fluids, promote the descent of Lung Qi.  

Points: LU7 Lieque, LI6 Pianli, CV17 Shanzhong, CV12 Zhongwan, CV9 Shuifen, KI7 Fuliu, CV6 Qihai, SP6 Sanyinjiao, ST40 Fenglong, PC6 Neiguan, BL20 Pishu, BL23 Shenshu, BL22 Sanjiaoshu, BL13 Feishu, BL15 Xinshu.  

- All points in tonification except LU7 Lieque, LI6 Pianli, and CV9 Shuifen, which should be harmonized.  

- Moxibustion can be used.”  

Additionally, I drew inspiration from the following statement, likely also from Maciocia:  

“ST40, especially in combination with PC6, opens the chest and facilitates breathing.”  

For other reasons (I believe nausea and fatigue, if I recall correctly), I added ST36 to the “recipe.”  

In conclusion, I used:  

LU7, BL20, BL13, BL15, LU7, ST40, ST36, PC6, CV17, CV12.  

Treatment lasted approximately 30 minutes.  

Result: A benefit that extends for several hours and partially persists into the following day.

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