(Originally published in the online journal 'The Junkyard Daoist')
For the last few years I have been engaged in quite extensive research and study in the unique methods and treatment style of Dr. Hú Xī-Shù. Although I have never personally studied with him (I was only eight years old when he died), I have always felt a very deep connection to his approaches. To be a student of the Jīng Fāng current one must become intimate with the classic writings of Zhòng-Jǐng (仲景), Fāng Yǒu-Zhí (方有执), Xú Líng-Tāi (徐灵胎), and the modern writings of Hú Xī-Shù (胡希恕), Liú Dù-Zhōu (刘渡舟), Fàn Zhōng-Lín (范中林), and Huáng Huáng (黄煌), to name just a few. There are obviously countless physicians of the past and present that have contributed to this fascinating and clinically relevant specialty however; these are the physicians that have exerted the greatest influence on my practice.
There are currently very few books available on the Jīng Fāng current available in the English language, and it is for this exact reason that my colleague Michael Max and I are in the process of translating a very important clinical text exemplifying the strategies and methods utilized by some of these doctors mentioned above. It is my hope that this text will assist in raising the level of study in North America, and contribute to the ever-evolving state of Chinese medicine in the west.
The following is the first part of a translation with commentary on the treatment of coughs, taken from Dr. Hú’s ‘Popular Lectures on Cold Damage’ (伤寒论通俗讲话). It includes his various theories on treatment and includes representative case studies to illustrate these methods. Part two will follow in the next issue.
Coughing is mainly caused by the invasion of phlegm and thin-fluids. Treatment should involve warm transformation, descending counterflow and calming
There are numerous formulas that are able to effectively treat coughs, some may even say that there are ‘thousands upon thousands’ (成千上万). However, when treating coughs, Dr. Hú would most commonly use the formula Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction), taken from the Jīn Guì Yào Lüè (Essentials from the Golden Cabinet), where it clearly illustrates an intimate relationship between coughing and phlegm and thin-fluids. Numerous cases of coughing are due to the upward invasion of phlegm and thin-fluids, causing qì to run counterflow and not descend. The treatment of phlegm and thin-fluids is clearly elucidated in the Jīn Guì Yào Lüè where it states:
“In diseases of phlegm, and thin-fluids, one should harmonize with warm medicinals”.
This is a very important treatment principle in addressing phlegm, thin-fluids, and coughs. Adhering to these principles when selecting suitable formulas, will increase our clinical effectiveness.
Huang, Female, 38 years old
Initial diagnosis was on Feb 12, 1966: Patient presented with a cough combined with expectoration of white phlegm, an itchy throat, chest fullness, a dry throat with no desire for fluids and bilateral rib side distension. She has already taken several packages of herbal formulas to no avail. Her tongue coating was thick and slimy, and her pulse was slippery-thin.
This pattern belongs to phlegm and thin-fluids harassing the upper (burner), and impaired depurative downbearing of the lungs. This was treated by warm transformation and downbearing counterflow with Bàn Xià Hòu Pò Tāng with additions and subtractions.
Bàn Xià 4 qián,
Hòu Pò 3 qián,
Fú Líng 4 qián,
Sū Zǐ 3 qián,
Jú Pí 5 qián,
Xìng Rén 3 qián,
Jié Gěng 3 qián
Shēng Jiāng 3 qián
Results: After taking only 2 packages of the above herbs, the cough had stopped.
Bàn Xià Hòu Pò Tāng is originally from the Jīn Guì Yào Lüè in the miscellaneous gynaecological diseases section. Originally used for “female patients with the sensation of fried meat in the back of the throat”
Dr. Hú believed this formula to be Xiǎo Bàn Xià Jiā Fú Líng Tāng with the additions of Hòu Pò and Sū Yè. It is used in phlegm-thin fluids qì bind manifesting with chest fullness, throat blockage and cough. It warms and transforms phlegm and thin-fluids, downbears counterflow, and regulates qì. The patient above was manifesting with a cough due to phlegm and thin-fluids, therefore the use of this formula offered a quick resolution.
The original formula contains (Zǐ) Sū Yè, but Dr. Hú prefered to use (Zǐ) Sū Zǐ. If there are obvious exterior signs present, then (Zǐ) Sū Yè may be added, and you may also add either Guì Zhī Tāng or Má Huáng Tāng. If heat signs are present then Shēng Shí Gāo may be added. If there is an enduring cough due to cold thin-fluids, without any obvious exterior signs, then combine with Líng Gān Wǔ Wèi Jiāng Xīn Xià Tāng (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction).
Enduring depressed phlegm and thin-fluids frequently transform into heat, and therefore true cold, and false heat signs need to be clearly distinguished
In clinical practice, numerous patients with coughs are frequently seen. Quite often they have taken several decoctions yet their symptoms fail to improve, even to the point where some of these patients symptoms intensify. One of the main reasons for this is the inability to clearly differentiate between cold and heat. The following case study illustrates this problem.
A 63-year-old male presented at the clinic on January 4, 1966 complaining of a cough accompanied by spitting up of yellowish-white sputum that has been going on for the last four months. This initially started last year in October with symptoms of a productive cough and throat pain, for which he had taken various medicinals that offered no relief and in fact caused some wheezing. The main formula he was initially prescribed was a modified version of Sāng Xìng Tāng (Mulberry Leaf and Apricot Kernel Decoction). He had also mentioned that in this time he has consumed over one kilo of Chūan Bèi Mǔ (Fritillariae cirrhosae Bulbus).
Current signs and symptoms: Cough with copious amounts of yellowish-white sputum, irritability, chest fullness, aversion to cold in the back, dry mouth with a desire to drink, yet after every time he drank water, his abdomen would be uncomfortable. He had a yellow slimy tongue coat, red tongue tip, and a wiry, slippery, thin pulse.
Dr. Hú prescribed Xiǎo Qīng Lóng Jiā Shí Gāo Tāng (Minor Blue-Green Decoction plus Gypsum)
Má Huáng3 qián
Guì Zhī 3 qián
Xì Xīn 2 qián
Gān Jiāng 2 qián
Bái Sháo 3 qián
Zhì Gān Cǎo 3 qián
Wǔ Wèi Zǐ 3 qián
Bàn Xià 5 qián
Shēng Shí Gāo 1.5 liǎng
After writing this formula a question was posed to Dr. Hú asking why so many warm natured herbs were used, if heat signs were so obvious? Dr. Hú replied:
“This patient has already taken numerous formulas containing heat clearing medicinals, and his symptoms have only gotten worse. The medicinals were not prescribed according to the presentation. We can see from his current symptoms that he has an aversion to cold in his back, and abdominal discomfort after drinking water. This is a pattern of thin-fluids collecting in the interior, and specifically cold thin-fluids. Now if we were to administer bitter cold medicinals in order to clear heat and transform phlegm, not only would we fail to remove the phlegm, but we would further damage this patients’ yáng qì and the phlegm would in fact get worse. When there is a substantial amount of phlegm and thin-fluids, that collect and stagnate for long periods of time, they will inevitably transform into heat, which invades the heart and chest causing irritability and chest fullness. Therefore, by not removing the phlegm and thin-fluids, we would be unable to eliminate the heat, and the cough would fail to subside. This is a pattern of exterior cold, with thin-fluids collecting internally, accompanied by upper (burner) heat. Xiǎo Qīng Lóng Jiā Shí Gāo Tāng matches the presentation. Xiǎo Qīng Lóng Tāng is used to resolve the exterior and eliminate phlegm in order to treat the root. Shēng Shí Gāo is used to clear upper burner heat to expel the branch. Whether or not we can achieve a positive outcome will be determined after the formula is taken”.
Results: after taking three packages of the formula, his irritability and chest fullness were reduced, as was the yellow phlegm and dry mouth. His tongue coating was slightly slimy, so Xì Xīn, and Gān Jiāng were increased to 3 qián, and Shēng Shí Gāo was decreased to 1 liǎng. This was continued for six more packages in which time his aversion to cold in the back was gone, the spitting up of phlegm was reduced, and no yellow sputum was seen. Shēng Shí Gāo was removed from the formula and he was given twelve more packages, after which his condition completely resolved.