Damage From Sorrow

Wáng Xùgāo’s Treatment of Cough

This week, I am continuing the discussion of cough with some translations of Wáng Xùgāo (王旭高, 1798-1862), which has been a sort of side-side-project of mine. First, the chapter on cough from Yī Xué Chú Yán (Medical Ruminations), followed by a couple of cough cases from Wáng Xùgāo Lín Zhèng Yī Àn (Wang Xugao's Clinical Records).

第十二章　咳嗽

古人云：五臟六腑皆有咳，總不離乎肺。以余驗之，外感風寒，內傷精氣，皆能致咳，總不離乎痰飲，以痰飲為致咳之根也。惟虛實二字，最宜分別，不可誤也。

外感咳　外感風寒暴咳，必鼻塞頭痛，惡寒發熱，用前胡、紫蘇、杏仁、橘紅、桔梗、象貝、款冬花、桑葉、荊芥。

內傷咳　內傷精氣久咳，倦怠微熱咽乾，肺陰雖虧，而脾腎未傷者，如沙參、麥冬、杏仁、川貝、玉竹、桑皮、枇杷葉。

以上兩種，若苔白口膩者，必加半夏、茯苓、澤瀉。

肺虛咳　若久咳肺虛，傷及脾胃者，必食少便溏，宜六君子加杏仁、川貝、冬花、麥冬、五味等。

腎虛咳　若肺腎交虛，必氣逆短促，陰虛必痰中帶血，宜生地、阿膠、白芍、茜草炭；水飲必舌白麵浮，宜人參、附子、茯苓、乾薑、半夏、白朮、白芍、五味；甚則黑錫丹以鎮之。

咳嗽氣急　咳嗽氣急，當以蘇子降氣湯為主。

水飲咳喘　水飲浮腫咳喘者，葶藶大棗瀉肺湯，加麻黃、杏仁、射干、半夏、沉香、茯苓、澤瀉等味。

哮喘　哮喘以定喘湯為主，只能見效，難許斷根。

Chapter 12 Cough

The ancients said: The five zàng and six fǔ organs all have cough, but in every case it never leaves the lung. On the basis of my observations, exterior contraction of wind-cold and internal damage to essence-qì can both cause cough; but in every case it never gets far away from phlegm-rheum, and so phlegm-rheum is the root cause of cough. However, the two words vacuity and repletion are extremely important to differentiate, and one cannot be mistaken for the other.

Exterior Contraction Cough: Exterior contraction of wind cold causes sudden coughing, and there will be nasal congestion, headache, aversion to cold with heat effusion. Use Qián Hú [Rx Peucedani], Zǐ Sū [Fm Perillae], Xìng Rén [Sm Armeniacae], Jú Hóng [Pc Citri Reticulatae Rubra], Jié Gěng [Rx Platycodi], Xiàng Bèi [Blb Fritillariae Thunbergii], Kuǎn Dōng Huā [Fl Farfarae Tussilago], Sāng Yè [Fm Mori], Jīng Jiè [Hb Schizonepetae].

Internal Damage Cough: Internal damage to essence-qì produces a chronic cough, fatigue, slight heat effusion, dry throat; although lung yīn is depleted, the spleen and kidney have not yet been damaged. Use medicinals such as Shā Shēn [Rx Glehniae], Mài Dōng [Rx Ophiopogonis], Xìng Rén, Chuān Bèi [Blb Fritillariae Cirrhosae], Yù Zhú [Rz Polygonati Odorati], Sāng Pí [Cx Mori], Pí Pá Yè [Fm Eriobotryae]. For the above two types, if the tongue coating is white and the mouth is greasy, it is necessary to add Bàn Xià [Rz Pinelliae], Fú Líng [Poria], and Zé Xiè [Rz Alismatis].

Lung Vacuity Cough: In cases of chronic cough due to lung vacuity, the damage has reached the spleen and stomach; there will be reduced food intake and sloppy stools. Liù Jūn Zǐ [Six Gentlemen Decoction], add Xìng Rén, Chuān Bèi, [Kuǎn] Dōng Huā, Mài Dōng, Wǔ Wèi [Fr Schisandrae], etc.

Kidney Vacuity Cough: If there is insufficient interaction of the lung and kidney, there will be counterflow qì with short hurried [breathing]; in yīn vacuity there will be phlegm containing blood. It is appropriate to use Shēng Dì [Rx Rehmanniae], Ē Jiāo [Colla Corii Asini], Bái Sháo [Rx Paeoniae Alba], Qiàn Cǎo Tàn [Rx Rubiae Carbonisatus]. In water rheum the tongue will be white as if flour were floating on it; it is appropriate to use Rén Shēn [Rx Ginseng], Fù Zǐ [Rx Aconiti Lateralis Praeparata], Fú Líng, Gán Jiāng [Rz Zingiberis], Bàn Xià, Bái Zhú [Rz Atractylodis Macrocephalae], Bái Sháo, Wǔ Wèi; if severe use Hēi Xī Dān [Lead Special Pill] to settle it.

Cough with Rapid Breathing: For cough and rapid breathing, one should use Sū Zǐ Jiàng Qì Tāng [Perilla Seed Qi-Downbearing Decoction] as the main formula.

Water Rheum Cough and Panting: Water rheum with puffy swelling, coughing and panting, Tíng Lì Dà Zǎo Xiè Fèi Tāng [Lepidium and Jujube Decoction to Drain the Lungs], add Má Huáng [Hb Ephedrae], Xìng Rén, Shè Gān [Rz Belamcandae], Bàn Xià, Chén Xiāng [Lignum Aquilariae], Fú Líng, Zé Xiè, etc.

Wheezing and Panting: Wheezing and panting is mainly treated with Dìng Chuǎn Tāng [Stop Wheezing Decoction], which can only have the desired effect [i.e., settle the wheezing], but it is difficult to cut off the root.

Mulch comment: The passage on internal damage cough makes the point that differentiating the level of disease is important; thus we see use of medicinals that treat dryness and moisten the lung vs heavier kidney yīn tonic herbs. I see a fair amount of allergic asthma that never really reaches much deeper than the lung; Shā Shēn Mài Mén Dōng Tāng is my go-to formula in those cases. Hēi Xī Dān [Lead Special Pill] contains lead and so shouldn’t be used unmodified. Tíng Lì Dà Zǎo Xiè Fèi Tāng [Lepidium and Jujube Decoction to Drain the Lungs] contains just Tíng Lì Zǐ and Dà Zǎo; the combination can be found in Golden Flower’s Ling Zhi Lung Formula.

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Here are a couple of cases from Wáng Xùgāo Lín Zhèng Yī Àn (Wang Xugao's Clinical Records).

Case 1

許　咳嗽面白為金傷，脈數而洪屬虛火，是脈克色而火勝金也。夏至一陰生，正屬火令，為剝極則復之際。倘若剝而不復，頗有火灼金銷之慮。

黨參　黃耆　炙甘草　茯苓　懷山藥　麥冬　沙參　五味子　紫菀　陳皮

此生脈散合六君子湯加紫菀。夫四君去朮加黃耆、山藥、陳皮，亦名六君，在《醫方集解》中。

Xǔ: Cough with white face, caused by damage to metal, with a pulse that is rapid and flooding, categorized as vacuity fire, the pulse overcomes the complexion and so fire prevails over metal.

At the summer solstice, the first yīn is engendered; it is rightly classified as fire season, on account of it being a time of restoring what is peeled away from the extreme, and if it is not restored, there is the great worry that fire will scorch and melt metal.

Dǎng Shēn [Rx Codonopsitis], Huáng Qí [Rx Astragali] Zhì Gān Cǎo (Rx Glycyrrhizae Praeparata), Fú Líng, Huái Shān Yào [Rz Dioscoreae], Mài Dōng, Shā Shēn, Wǔ Wèi Zi, Zǐ Wǎn [Rx Asteris], Chén Pí [Pc Citri Reticulatae]. This is Shēng Mài Sàn [Generate the Pulse Powder] combined with Liù Jūn Zǐ Tāng and adding Zǐ Wǎn.

From Sì Jūn remove Bái Zhú and add Huáng Qí, Shān Yào, Chén Pí, this is also known as Liù Jūn [Six Gentlemen], found in the Yī Fāng Jí Jiě [Collected Explanations of Medical Prescriptions, Wāng Áng, 1682] .

Mulch comment: The pulse is rapid and flooding, so it is of the fire type, the complexion is white, so it is of the metal type. “Restoring what is peeled away from the extreme” is a reference to Hexagram 23 [剝 bāo] and is a metaphor for extreme or utmost yáng giving rise to yīn; if it does not, fire will burn out of control. Thus the strategy of strengthening earth (mother of metal) with Liù Jūn Zǐ Tāng and nourishing lung yīn with Mài Dōng, Shā Shēn, and so forth; an example of a five-phase approach to herbal medicine.

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Case 2

闕　體弱素虧，頻年屢患咳嗽。今春產後悲傷，咳嗽復作，背寒內熱，氣逆痰多，脈虛數，大便溏。延今百日，病成蓐勞。按產後血舍空虛，八脈之氣先傷於下，加以悲哀傷肺，咳嗽震動，衝脈之氣上逆。經云：衝脈為病，逆氣裡急。陽維為病苦寒熱。頻進疏風清熱，脾胃再傷，以致腹痛便溏，食減無味，斯皆見咳治咳之弊。越人謂上損及脾，下損過胃，俱屬難治。姑擬通補奇經，鎮攝衝脈，復入扶脾理肺。未能免俗，聊復爾爾。

大熟地（砂仁炒炭）　當歸（小茴三分拌炒）　紫石英　白芍（桂枝三分拌炒）　白茯苓　川貝　牛膝（鹽水炒）

Què: Her whole body is debilitated and plainly exhausted, and she has been suffering from recurring cough year after year. Now, in the spring, there is post-partum damage from sorrow, recurring cough, coldness of the back with internal heat, counterflow qì with copious phlegm, pulse empty and rapid, and sloppy stools. It has now extended to a hundred days, and the illness has become childbed taxation. In light of the postpartum emptiness in the abode of blood, the qì of the eight [extraordinary] vessels is first injured in the lower, additionally sorrow and grief injure the lung, cough vigorously stirs, and the qì of the chōng mài ascends counterflow. The classic says: In chōng mài disease, qì suddenly counterflows inside. Yángwéi becomes diseased with bitterness, and [alternating] cold and heat. Frequent taking of wind-coursing, heat-clearing [medicinals] can damage the spleen and stomach, so consequently there can be abdominal pain and sloppy stool, reduced food intake and lack of [ability to] taste, these are all apparent hazards of treating coughs. Yuèrén said that damage to the upper reaches the spleen, and damage to the lower goes through the stomach, all categorized as difficult to treat. For now, the plan is to free and supplement the extraordinary vessels, settle and contain the chōng mài, restore intake, assist the spleen and regulate the lung. I’m unable to rise above convention, so I’ll just say it like that.

Dà Shú Dì [Rx Rehmanniae Praeparatae] (fried with Shā Rén [Fr Amomi Villosi] until blackened), Dāng Guī [Rx Angelicae Sinensis] (mix-fried with 3 fēn of Xiǎo Huí [Fr Foeniculi]), Zǐ Shí Yīng [Fluoritum], Bái Sháo (mix-fried with 3 fēn of Guì Zhī [Rm Cinnamomi]), Bái Fú Líng [Poria], Chuān Bèi, Niú Xī [Rx Achyranthis] (fried in brine).

Mulch comment: This is a very interesting case of incorporating extraordinary vessels into herbal medicine. Note the choice of medicinals:

• Shú Dì fried with Shā Rén, to guide it into the lower jiao/ dān tián.

• Zǐ Shí Yīng, which enters the chōng mài and rèn mài (Chace & Shima, 2010).

• Dāng Guī, which “masters diseases of the chōng mài”, mix-fried with Xiǎo Huí Xiāng, which “enters the extraordinary vessels” (Chace & Shima, 2010).

• Bái Sháo, which “masters yángwéi feverishness and chills” mix-fried with Guì Zhī, which “travels to the yángwéi vessel” (Chace & Shima, 2010).

• Fú Líng strengthens the spleen and seeps dampness; Chuān Bèi moistens the lung, transforms phlegm and relieves cough; and Niú Xī fried in brine aids in descending the qì.

That’s all for now. As always, thanks for reading

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Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Chace, C., & Shima, M. (2010). An exposition on the eight extraordinary vessels: Acupuncture, alchemy, and herbal medicine. Eastland Press.

Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html

Wáng, X, & Fāng, R. (1897). Wáng Xùgāo lín zhèng yī àn. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html