Translated by Charles Chace
In Chinese medicine the specific nature of a given illness may define it as a sub-category of the illness in question. Thus, while we may speak of cough (ke sou) and panting (chuan) as traditional Chinese medical disease entities, we also speak of throaty coughs, dry- coughs and night-coughs as specific types of cough which posses their own unique characteristics and treatment strategies. It is common to think of coughs which are worse at night as typically being due to yin vacuity. However, this is only one of a number of potential pathodynamics which are commonly seen in clinical practice. What follows is an article addressing night cough from the perspective of a mutual binding of phlegm stasis.)
Angelica Two-Cured Decoction in the Treatment of Night Cough
The author has treated 324 cases of night cough since 1986 with Angelica Two Cured Decoction (Dang Gui Er Chen Tang) with additions and has achieved exemplary results. 150 of these patients were men and 174 were women. In 90 cases the illness had persisted one week, in 132 cases the illness had persisted one to two weeks, and in 102 cases the illness had persisted for more than two weeks. Patients ranged in age from one year to 68 years. In many cases the symptom developed subsequent to catching a cold or developing acute bronchitis. In a few cases the symptoms appeared within the context of chronic bronchitis or late stage pneumonia. The night cough was the primary symptom regardless of the diagnosis.
246 cases achieved a complete cure as defined by a complete disappearance of the symptom (75.9%). 60 cases were improved as defined by disappearance of the night cough and a persistent although diminished daytime cough (18.5%). 18 cases showed no improvement as defined by no change in the symptoms after administration of 3 ji of the formula.
Angelica Two Cured Decoction (Dang Gui Er Chen Tang) with additions contains:
Radix Angelicae Sinensis (Dang Gui) 15-30g
Pericarpium Citri Reticulatae (Chen Pi) 10g
processed Rhizoma Pinellia Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling) 10-15g each
Radix Glycyrrhizae Uralensis (Gan Cao)
Radix Asteris Tartarici (Zi Wan)
Radix Stemonae (Bai Bu) 15g each
This is the daily dose for an adult, reduce accordingly for children.
If the exterior is not resolved, then for wind-cold add: Herba Schizonepetae Tenuifoliae (Jing Jie), Folium Perillae Frutescentis (Zi Su Ye), and Herba cum Radice Asari (Xi Xin).
For wind-heat, add: Flos Lonicerae (Jin Yin Hua), Fructus Arctii Lappae (Niu Bang Zi) and Folium Mori Albae (Sang Ye).
For yin vacuity add cooked Radix Rehmanniae (Shu Di), Tuber Ophiopogonis Japonici (Mai Men Dong), Tuber Asparagi Cochinchinensis (Tian Men Dong), and Bulbus Lilii (Bai He).
For yang vacuity, add Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi Pian), Cortex Cinnamomi Cassiae (Rou Gui), Herba Epimedii (Yin Yang Huo), and dry Rhizoma Zingiberis (Gan Jiang).
For phlegm heat, add Radix Scutellariae Baicalensis (Huang Qin), Fructus Gardeniae Jasminoidis (Zhi Zi), Herba Houttuyniae Cordatae Cum Radice (Yu Xing Cao), Bulbus Fritillariae Thunbergii (Zhe Bei Mu), and Radix Platycodi Grandiflori (Jie Geng).
For dry heat, add Fructus Aristolochiae (Ma Dou Ling), Folium Eriobotryae Japonicae (Pi Pa Ye), Fructus Trichosanthis Kirilowii (Quan Gua Lou), and Radix Adenophorae Seu Glehniae (Sha Shen).
For phlegm dampness, add Rhizoma Atractylodis (Cang Zhu) and use a heavy dose of Radix Pinelliae Ternatae (Ban Xia).
Night cough as a symptom is often due to a heat pathogen or and upward steaming of both sovereign and ministerial fire into lung metal which scorches the fluids and causes the lungs to lose their moisture. Their regulatory capacities of clearing and depuration become compromised. Thus lung qi becomes depressed and counterflows upward producing cough counterflow and ascension of qi. Supplemented Angelicae Two Cured Decoction (Jia Wei Dang Gui Er Chen Tang) downbears counterflow and transforms phlegm. Radix Asteris (Zi Wan), Radix Stemonae (Bai Bu) are efficacious medicinals for arresting cough whether it be due to external contraction or internal damage. The single ingredient Radix Angelicae Sinensis (Dang Gui) supplements the blood. If the heart and liver blood is sufficient then the sovereign fire is restrained, and the ministerial fire is latent. When the fire is latent and metal is clear, then the lung qi naturally does not ascend and counterflow to produce cough. Whenever one has a persistent cough, such enduring illnesses enter the network vessels. By day these conditions are mild but they grow severe at night, and the cough becomes so severe at night that it is difficult to lie down. In this case there is a mutual binding of blood stasis and phlegm and the lung qi cannot be perfused. The presence of Radix Angelicae Sinensis within a phlegm transforming prescription promotes phlegm transformation and stasis dispersal, which in turn promotes perfusion and depuration of the qi. The classic (i.e., the Nei Jing) states that, "Radix Angelicae Sinensis (Dang Gui) governs cough and the counterflow ascension of qi." Most often the night cough would disappear and the day cough would diminish after only 1 ji of the above prescription, and in 1/5th of the patients treated the patient would be entirely cured after only one ji.
In the following study, children with acute bronchitis and upper respiratory tract infections were treated exclusively with Vaccaria seeds applied to ear points. While an effective treatment strategy must be based on a rigorous Chinese medical diagnosis, Western biomedical concepts may greatly augment a therapeutic effect. Of particular note is the selection of the ear-prostate point which has been shown to relax smooth muscle spasm particularly in the bronchial, region demonstrating an interesting and clinically efficacious integration of both Chinese and Western medical thinking.)
Pressure Applied to Ear Points in the Treatment of 370 Cases of Pediatric Cough and Panting
Pediatric cough and panting is most commonly seen in the winter and spring months. Between the years 1988-1992, the author treated this condition using pressure applied to ear points. The results are summarized below.
Of the 370 cases, 209 were male and 161 were female. One hundred ninety-two of the patients ranged from 1-3 years of age, 105 of the patients ranged from 4-5 years of age, and 72 of the patients were 6 years and older. Two hundred fifty of the patients were diagnosed as having acute bronchitis and 370 were diagnosed as having upper respiratory tract infection based upon radiography lab work and physical examination.
The points used included bronchi, lung, adrenal, and prostate. If the panting was severe, then the Calm Panting point was added. If the phlegm was copious, then the spleen point was added.
The ear was first disinfected with a 75% solution of alcohol. Next, the points were stimulated with an ear probe to elicit a positive reaction. Then, one Vaccaria seed was placed on a 0.8x0.8mm plaster which was then affixed to the reactive points. Gentle use of finger pressure elicited a how distending pain reaction. This gentle pressure was applied for 2-5 minutes, 4-6 times daily. Seven times constituted a course of treatment, after which the patient rested for three days.
Of the 370 patients treated, 225 achieved a complete cure as defined by a complete disappearance of symptoms. The shortest treatment lasted two times and the longest 21 times. Ninety-two cases achieved some significant improvement as defined by a disappearance in the fundamental symptoms and an occasional cough. The shortest treatment lasted five times and the longest 14 times. Forty-six cases achieved some improvement as defined by a lessening of the fundamental symptoms. The shortest treatment lasted six times and the longest 21 times. Five cases achieved no result. Of the 250 cases diagnosed with acute bronchitis, 138 achieved a complete cure, 75 achieved significant improvement, 35 achieved some improvement, and two cases achieved no results. Of the 120 cases diagnosed with upper respiratory tract infection, 87 achieved a complete cure, 21 achieved significant improvement, nine achieved some improvement, and three cases achieved no results. These results yielded a 98.6% amelioration rate.
Stimulation of the ear point Bronchi, combined with Adrenal has a anti-inflammatory and hypo-allergenic and effect as well as calming panting. In recent years research has revealed that the Prostate point may promote the production of prostaglandins which promotes rapid expansion of smooth muscle in the bronchi, increases free flow of air in the lungs, and relaxes bronchial spasm. At the same time it benefits smooth muscle relaxation in the bronchi. The spleen enables the transportation and transformation of water and dampness, and as such is essential to the circulation of fluids within the body. Thus the Spleen point is indicated in this illness.
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