Jin Zhao’s three power questions for the respiratory microbiome: 

1. Do you have a dry mouth? 

2. Do you feel thirsty? 

3. Do they need to bear down to have a bowel movement or have obstructed urination?

Questions 1 and 2: These are separate ideas in Chinese. A dry mouth with no thirst indicates that the water is there, but not reaching the upper part of the body. This can be a sign of qi deficiency or phlegm blocking the gaseous metabolism (气化) as you see with diabetes. They present with dry mouth and yet are thirsty. No dry mouth with thirst indicates that the gaseous metabolism is occurring but that the metabolism is high and running hot. This suggests that they are getting exercise and if they are sedentary it’s typically a fever which will give them this type of metabolism .It is said that “Flavor arrives via the spleen qi, water arrives to the mouth via the lung qi.”

The sensation of dryness or thirst tells us about the role of the respiratory microbiome on fluid metabolism.

With these two questions and some contextual clues he’s able to get a lot of information. 

It isn’t always as easy to use this in the West.

Chinese women tend to drink tea or warm water. They are drinking warm liquid slowly over time. It’s fairly easy to feel that they aren’t that thirsty because they have the social clues that other people are drinking more. 

My cultural adaptation of this question is “Do you feel thirsty or do you have to remind yourself to drink.”

This is the answer I get: “I take a water bottle with me everywhere!” They are typically proud of themselves because they read somewhere that they need x liters of water a day. 

Then I ask the follow up question, “Do you keep the water bottle to make sure that you are hydrated or do you often find yourself looking for a glass of water, filling it,  and draining it?

“Oh no I don’t drain it.”

This is the clue. Athletic and generally active people do look for water and drink a lot of it. That they need a reminder is a clue that their fluid physiology has been compromised.

If they must remind themselves, then it’s a sign of damp cold. In these cases consider using “Wind Tea” (xiao chai hu and san ren tang”

If they feel true thirst, then it’s a sign of damp heat. Consider using “Peak Tea” (san ren with yin chen hao and chai hu.)

Question 3: When he asks, “Do they need to bear down to have a bowel movement or have obstructed urination?” he is looking for the lungs ability to disseminate and distribute qi to see if the lung function has been obstructed.

The diagnosis in this case is that there is dysbiosis in the respiratory microbiome interfering with fluid physiology and immune function. [In CM language this means… and abundance of damp?”

The gaseous [qi] movement of the disease state is entering and sinking. To remove this we want to encourage sweating and increase bowel movements to cause the gases to exit and sink. This is like venting the greenhouse and removing the compost pile. This will automatically reduce the temperature, and help make bowel movements easier.

To summarize: 

For signs of cold or a neutral condition we will use Wind Tea. For signs of heat such as thirst or redness in the face or other signs of inflammation we may need to use the cooler variation of this formula called “Peak” which is san ren with yin chen hao and chai hu.

Lack of Sweating: The compost pile effect

This lack of sweating also gives a presentation of false heat. Imagine three compost piles piled on top of each other in a small greenhouse. The heat generated from the microorganisms in compost piles can get so hot that it will actually catch fire. As the pile heats up it kills beneficial bacteria that you want in your garden. In order to avoid it causing a fire you would first open the door and windows of the greenhouse to let the heat vent out and then turn it to vent the heat and increase the microbial diversity.

This heat is also generated in the human body. The inflammation causes excess nitric oxide to close the pores instead of allowing them to open as it does when nitric oxide is within a healthy range. This traps the liquid. Imagine adding water to those compost piles. The more water that accumulates will only nourish more bacteria and fungal metabolism. This creates inflammation and heat. These types of people will have a fat tongue, yet the tongue will have no coating. Most common doctors will say, “This is heat” and proceed to give them cold herbs or antibiotics.

This initially works in that reduces some of the bacterial activity, however, it further compromises fluid metabolism which causes even more water to enter, further closes the pores and makes the internal heat even worse.