Liver qi offending the lung and spleen dampness offending the lung are two common clinical signs of lung offending, and both are actual. The difference lies in the fact that one is actual fire in the liver and lung and the other is phlegm-dampness in the lung. Therefore, the diagnosis of liver qi offending the lung should be differentiated from spleen dampness offending the lung to avoid misdiagnosis and aggravation of the disease. The differentiation between liver qi offending lung and spleen dampness offending lung is as follows: 1. Liver qi offending lung: liver is wood and lung is gold, so this evidence is also called wood fire interfering with gold evidence. It is caused either by the patient having liver fire, which cannot be eliminated, or by liver qi stagnation, which does not resolve for a long time and turns into fire to offend the lung. The clinical manifestations include coughing fits, sputum that is small and thick, or coughing up bright red blood, as well as vague pain or burning pain in the chest and hypochondrium, irritability, irritability, dizziness, redness of the head and eyes, red tongue, thin yellow fur, and stringiness of the pulse. It is advisable to clear the liver and lung. 2, spleen dampness offending the lung: Chinese medicine believes that “the spleen is the source of phlegm, the lung is the storage device of phlegm”. If the spleen is not healthy and the diet is not well-functioning, dampness and phlegm will be collected and then the lung will be offended by spleen-dampness. The clinical manifestations of this evidence are coughing with phlegm, white and thin, easy to cough out, tightness in the chest, abdominal constipation and poor appetite, dry mouth without drinking, light mouth or sweetness in the mouth, light tongue with white and thick greasy coating, and smooth or moist pulse. The treatment should be to dry dampness and resolve phlegm, lower the Qi and stop cough. In conclusion, the former is a case of liver fire followed by lung heat, while the latter is a case of spleen-dampness obstruction followed by phlegm-dampness stagnation in the lung. Although they are both real evidence, the treatments are very different. Therefore, in the diagnosis of liver qi offending the lung, we need to pay attention to careful differentiation to avoid misdiagnosis and mistreatment.