February 8, 2010

Hu Xi Shu (胡希恕) Case #2-Cough


38 year old female first seen on Feb 12 1966. Patient had suffered with a dry cough and itchy throat for over a month. She had taken a modified version of Zhi Sou San (Stop Cough Powder), and modified versions of Sang Xing Tang (Mulberry Leaf & Apricot Kernel Decoction) and Mai Men Dong Tang (Ophiopogonis Decoction). The cough not only failed to improve but actually got worse. Currently she presents with a dry cough, itchy throat, dry mouth with no desire to drink, belching, chest oppression, loose bowel movements occurring once or twice daily, a thick slimy tongue coating and a slippery thin pulse.
Prescription given was Ling Gan Wu Wei Jiang Xin Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum and Pinellia Decoction) with additions and subtractions:

Fu Ling 4qian
Xi Xin 2 qian
Wu Wei Zi 4 qian
Ban Xia 5 qian
Zhi Gan Cao 2 qian
Chen Pi 5 qian
Sheng Jiang 3 qian
Xing Ren 3 qian
Ku Jie Geng 3 qian
Zhi Pi Pa Ye 3 qian

Results: After taking one package of the above formula, the cough had decreased. After three packages the cough stopped.

The above patient suffered from a dry cough, itchy throat and dry mouth commonly seen in Lung heat, Liver fire or yin vacuity. In addition this patient also had no desire to drink, belching, chest oppression, sloppy stools, a thick slimy tongue coating and a slippery pulse. All these signify a phlegm-rheum pattern. The dry cough is from phlegm-rheum invading the lung and impaired diffusion and downbearing of the lung. The dry cough and itchy throat are a result of stagnation and obstruction to fluids which are unable to bear upwards. Therefore when treating this type of dry cough, using bitter cold, heat clearing herbs or sweet cold Yin enriching herbs will only worsen the stagnation and obstruction of fluids and cause phlegm-rheum to harass the upper (burner) and delay recovery. Because phlegm was treated by restraint and the formula was chosen on the basis of the pattern, the use of only three packages were needed for recovery.

4 comments:

Steve Bonzak said...

Hi Eran-

This is my first post. Love your site and will be checking back frequently to see what you have translated.

I love this case because, for me, it represents something that is very common thing to see in the sequelae of colds and flus. I recently had a case of a woman who had a very dry sounding cough that would become spasmodic at times and make it difficult for her to talk. It had been going on for about three weeks after she had had a cold. The cough was markedly worse on lying down. She had some tightness in the chest. The sputum was scanty, but clear when anything came up. She also reported a history of dizziness and palpitations. Her pulse was deep and thin. I gave her ling gui zhu gan tang plus ganjiang wuweizi gualou and xiebai. She recovered in two days.

-Steve

Eran Even said...

Hey Steve.

Thanks for checking out the blog. I agree, this is definitely a common presentation following colds and flus. I'll admit that I have made the above mistake several times and given cool moistening herbs to patients with dry coughs while totally missing the phlegm congestion. I would get totally baffled as to why these patients weren't getting better. Amazing what a little deeper investigation will bring out :)

Thanks for sharing your insightful case. Out of curiosity, what made you come up with your diagnosis of phlegm stagnation? Was it the dizziness or palpitations? Would love to hear about your thought process regarding the formula selection.
Thanks again,
Eran

Steve Bonzak said...

Hi Eran-

Man, have I made some patients worse with yin tonifying herbs when it was not necessary! I have some cases of my own mistreatment that I always share with students lest they think their teacher is infallible.

I currently study with Arnaud Versluys, so I make a lot of diagnosis decisions based on the pulse. She had a dong pulse on the right hand side between the cun and guan position. In our system of SHL this translates as some phlegm stuck in the sanjiao/chest area. The fact that her cough is worse when lying down always makes me suspicious of rheum patterns. The deep thin pulse with the dizziness and palpitations points directly toward ling gui zhu gan tang (using guizhi is imperative so I did not pick ling gan wuwei jiang xin tang which also treats rheum patterns in the LU).

-Steve

Eran Even said...

Great! Thanks Steve.
I'd love to study with Arnaud as well. Just waiting for his course to start up again in Seattle or better yet up here in Vancouver :)

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