▲Yan Zhenghua, Master of Traditional Chinese Medicine (1920.2-)
Cough refers to a pulmonary syndrome in which the lungs are lost, the lung qi is reversed, and the coughing sound is made, or the sputum is coughed. Cough is both a major symptom of pulmonary disease and an independent disease. "The Yellow Emperor's Neijing" cloud: "The five Tibets and six mansions all make people cough, not only lungs. "Treatise on Typhoid Fever and Miscellaneous Diseases" has made specific discussions on the syndrome differentiation and treatment of cough, such as "Treatise on Typhoid Fever" to treat typhoid fever incomprehension, water vapor under the heart, retching and fever and cough Xiaoqinglong soup, "Jin Kui Yaolu" to treat the evil and cold drink cough and wheezing reversal of the ephedra soup. Chao Yuanfang's "Treatise on the Origin and Syndrome of Diseases" in the Sui Dynasty divided cough into ten categories, namely, wind cough, cold cough, branch cough, liver cough, heart cough, spleen cough, lung cough, kidney cough, bile cough, and syncope cough. During the Jin and Yuan dynasties, "Confucianism" believed that external causes and six qi could cause coughing. The Ming Dynasty's "Jingyue Quanshu" divided cough into two categories: external and internal injuries, and believed that the external cough was caused by the lungs of the six external evils, and the internal injury cough was caused by the dysfunction of the internal organs and the dry lungs of the internal evils. Regardless of whether the evil enters from the outside or the evil grows from the inside, it can cause the lungs to lose their breath and cause coughing. Generally speaking, the external cough is mostly a new disease, which is evil, and the treatment is mainly to promote the lungs and disperse the evil. Internal injury cough is mostly a chronic disease, often recurring, mostly evil, positive and false, treatment should be dispelled evil, and the symptoms and root causes are treated. Diseases such as upper respiratory tract infection, acute and chronic bronchitis, bronchiectasis, pneumonia, tuberculosis, emphysema and other diseases with cough as the main symptoms in Western medicine can be treated with reference to this disease.
Professor Yan Zhenghua admired the "Jingyue Quanshu". He has a deep understanding of the causes, symptoms and classification of cough. It is believed that cough is mainly divided into two categories: external and internal. External cough can be divided into wind-cold cough, wind-heat cough, dry heat cough, etc. Internal injury cough can be divided into phlegm and dampness in the lungs, liver fire in the lungs, lung qi deficiency, lung and kidney yin deficiency, kidney yang deficiency, etc.
Classification is the treatment of extragenous cough
Wind chill cough
Wind and cold cough is mostly cough with thin phlegm, nasal congestion and runny nose, headache, chills without sweating, thin white tongue, and floating pulse. Cure to promote the lungs and disperse the wind and cold. Those who cough up and vomit thin phlegm should be added with drizzling and moistening phlegm medicine. Professor Yan Zhenghua often uses the addition and subtraction of apricot susan. Commonly used medicines: almond, Su leaf, raw licorice, bellflower, front hu, citrus aurantium, Fabanxia, orange, Poria cocos, ginger.
Wind-heat cough
Wind-heat cough is mostly characterized by yellow and thick phlegm, thirst and sore throat, body heat, headache, bad wind, sweating, thin yellow tongue coating, and pulse floating. The treatment is to disperse wind and heat and promote the lungs. Professor Yan Zhenghua often uses mulberry chrysanthemum drink to add or subtract. Commonly used medicines: mulberry leaves, chrysanthemum, forsythia, peppermint, bellflower, almond, raw licorice, reed root;
Hot and dry cough
Dry cough is dry cough without phlegm, or phlegm like thread powder, not easy to cough up, dry nose and throat, cough or even chest pain, red tongue, thin yellow moss, and thin pulse. Treat the lungs and moisturize the dryness. Professor Yan Zhenghua often uses mulberry apricot soup to add or subtract. Commonly used medicines: mulberry leaves, tempeh, almonds, Zhejiang fritillary, gardenia, sea cucumber, pear peel. Dry cough and even add ginseng, wheat winter, smallpox pollen, phlegm more than Zhejiang, melon. In addition, you can also choose to add or subtract the dry lung soup.
Cough
Professor Yan Zhenghua's clinical evidence of patients who have a lingering cough with external sensations is added or subtracted every time they use cough san to achieve miraculous results. Commonly used medicines: nepeta, platycodon, orange, aster, baibu, white front. Those who are affected by wind and cold should add Su leaf and parsnip, those who are affected by wind and heat should add honeysuckle, forsythia, and mint; those who have been coughing for a long time should add almonds, large fritillary, and coltsfoot; those with a lot of phlegm should add Banxia and Poria cocos; those with lung fever should add mulberry bark, skullcap, and houttuynia cordata; those with long-term cough and qi deficiency should add Codonopsis and Atractylodes; and those with yin deficiency should add sand ginseng, wheat Dong, and Schisandra chinensis.
Classification is used to treat cough from internal injuries
Phlegm dampness in the lungs
The phlegm-damp lung type is characterized by cough with a lot of phlegm, white and thin phlegm, stuffy chest, white and thick moss, and slippery pulse. It is used to strengthen the spleen and dampness, dissolve phlegm and relieve cough. Professor Yan Zhenghua often uses Erchen soup with magnolia bark and almonds to cure it. Commonly used medicines: banxia, orange red, poria cocos, licorice, magnolia, almond. For example, for those who also feel wind and cold, they often use Xingsu Powder to add or subtract, such as those who are mixed with cold and heat, they often use to stop cough and disperse cough, and if phlegm is damp and heat, and phlegm and fire offend the lungs, they often use Qingqi and phlegm decoction to add or subtract.
Liver fire offender lungs
The main symptoms of the liver fire offender pulmonary type are qi reversal cough, red face and dry throat, cough and flank pain, thin yellow tongue and Shaojin, and pulse number of strings. The treatment is to clear the lungs, calm the liver, and reduce the fire. Professor Yan Zhenghua often uses the addition and subtraction of Epsom Baisan. Commonly used medicines: mulberry white bark, digu bark, raw licorice, japonica rice. For example, there is blood in the sputum, or even hemoptysis, go to japonica rice, add Dai clam powder, skullcap, smallpox pollen, etc.
Deficiency of lung qi
The main symptoms of lung qi deficiency type are prolonged cough, shortness of breath, self-sweating, and pulse deficiency. The treatment is to replenish lung qi and relieve cough and asthma. Professor Yan Zhenghua often uses ginseng and walnut soup to add or subtract four gentlemen's soup. Commonly used medicines: ginseng (or Codonopsis), walnut meat, fried atractylodes, Poria cocos, boiled licorice, coltsfoot, baibu, tangerine peel. For example, those with lung and kidney deficiency, long-term cough, shortness of breath, fatigue, self-sweating, and soreness in the waist and knees should be added or subtracted with lung tonic decoction. Commonly used medicines: ginseng, astragalus, rehman, schisandra, burnt mulberry white bark, and those with qi and yin deficiency use shengmai drink.
Yin deficiency in the lungs and kidneys
The main symptoms of lung and kidney yin deficiency are cough, dry or sore throat, irritability of hands and feet, or blood in sputum, red tongue and little lichen, and thin pulse. It is used to nourish yin, moisten the lungs, and relieve cough. Professor Yan Zhenghua often uses lily solid gold soup to add or subtract. Commonly used medicines: raw land, rehmannia, wheat winter, scutellaria, lily, raw licorice, angelica, white peony, Sichuan fritillary, bellflower, etc.
Deficiency of kidney yang
The main symptoms of the kidney yang deficiency type are recurrent cough, thin phlegm and salivation, dizziness and palpitations, chills and cold limbs, poor urination, white tongue coating, and smooth pulse. The treatment is to dissipate the cold with warm yang, and turn gas into water. Professor Yan Zhenghua often uses Kidney Qi Pill Heling Guishu Gantang to add or subtract. Commonly used medicines: Poria cocos, cinnamon branch, atractylodes, rehmannia root, yam, dogwood, Ze Yuan, Poria cocos, Danpi, cinnamon branch, aconite, etc.
医案举角
Case 1 Li, female, 36 years old. First visit: February 14, 2009.
Chief complaint: cough for 1 month.
History of present illness: cough for 1 month, multi-colored white matter with sputum, chest tightness. Plain likes to eat, easy to stomach distention, acid reflux, hiccups, odor in the mouth, dry mouth, dry stool, 1 line a day 2, normal urination, easy irritability, easy to sweat. Last menstrual period: February 12, black, acceptable. The tip of the tongue is red, the moss is thin and yellow, and the veins are thin.
Syndrome differentiation: phlegm and dampness obstruct the lungs, liver and stomach disharmony.
Treatment: Regulate qi and dissolve phlegm, and clear the stomach.
Prescription: Nepeta 6g, Platycodon 6g, Citrus Peel 10g, Almond 10g, Fritillary 10g, Whole Melon 30g, Cassia Seed 30g, Xiangfu 10g, Divine Comedy 12g, Raw Wheat Sprouts 12g, Fried Citrus Aurantium 10g, Bergamot 6g, Motherwort 15g, 7 doses, decoction in water, 1 dose per day.
Second visit: February 21, 2009. After the medicine, the mood improved, still like to eat, Nado, cough, chest tightness and shortness of breath, sputum multi-colored gray yellow, nasal congestion and yellow discharge, itchy and sore throat, left hypochondrium tenderness, stool regulation, yellow urine, red tongue, thin and smooth pulse.
Prescription: Nepeta 6g, Honeysuckle 15g, Skullcap 10g, Houttuynia cordata 30g, Platycodon 6g, Raw Licorice 5g, Almond 10g, Fritillary 10g, Melon Peel 12g, Tangerine Peel 10g, Tulip 12g, Citrus Aurantium 10g, Coltsfoot 10g, Zhuru 6g. 14 doses, decoction in water, 1 dose per day.
Third visit: March 14, 2009. Cough with a lot of phlegm, white and easy to cough, irritability, itchy throat, loose stool, thin white red moss on the tip of the tongue, and smooth pulse.
Prescription: Nepeta 6g, Houttuynia cordata (lower back) 30g, Platycodon 6g, Raw licorice 6g, Coltsfoot 10g, Baibu 10g, Baiqian 10g, Citrus Citrus Peel 10g, Poria Cocos 30g, Coix Seed 30g, Xiangfu 10g, Motherwort 20g. 14 doses, decoction in water, 1 dose per day.
Fourth visit: March 28, 2009. Cough and chest tightness are relieved, throat itching is red, and the second stool is adjusted. Last menstrual period: March 26. The tongue is thin and white, and the veins are fine. The top goes to the incense and motherwort. After menstruation, increase 10g of fritillary, 12g of honeysuckle, and 10g of forsythia. After taking 10 doses, all symptoms were relieved.
Note: In this case, the patient likes to eat normally, and his diet is not modest, which damages the spleen and stomach, and the spleen is unhealthy, resulting in phlegm dampness and endogen, stained on the lungs, and coughing up a lot of phlegm. Phlegm obstruction machine, stomach loss and drop, so stomach distention, acid reflux, hiccups, oral odor, etc. Yan Lao grasped the key to the pathogenesis and chose bellflower, tangerine peel, almond, large fritillary, and whole melon to regulate qi and dissolve phlegm. Add a few nepeta ears to evacuate external evils. In view of the patient's irritability and menstruation, bergamot, incense and motherwort are added to the recipe to regulate qi, activate blood and regulate menstruation. With Divine Comedy, raw wheat sprouts, and fried citrus aurantium husks to digest food and stomach, Cassia Seed is specially designed for stool drying. At the second diagnosis, the patient still had a cough, but it was yellow sputum, indicating that the heat had been dissolved, and there was nasal congestion, yellow discharge, itchy and sore throat, so on the basis of the prescription of the first diagnosis, honeysuckle, skullcap, Houttuynia cordata, and bamboo ru were added to evacuate and clear heat, and coltsfoot was added to enhance the power of cough and phlegm. Subsequently, in the third and fourth diagnoses, according to the changes in the condition, drugs were flexibly added or subtracted, and the disease was finally cured.
Case 2 Qiu, female, 31 years old. First visit: July 19, 1998.
Chief complaint: cough for more than 3 months, exacerbated for 1 week.
History of present illness: cold 3 months ago, recurrent episodes, with cough. Recently, the cough has intensified, chest tightness and pain, a large amount of phlegm, swollen and painful gums, fever, body temperature of 37.5 °C, slight chills, dry mouth and likes to drink, Naco, two stools, red tongue, and smooth pulse. CHEST Χ LINE EXAMINATION SHOWED THICKENED LUNG MARKINGS. Western medical diagnosis: bronchitis.
辨证：风热袭肺，痰热内蕴。
Treatment: Clearing wind and heat, dissolving phlegm and relieving cough.
Prescription: Nepeta 6g, Honeysuckle 12g, Forsythia 10g, Almond 10g, Zhejiang Fritillary 10g, Raw Licorice 5g, Baibu 10g, Baiqian 10g, Tulip 12g, Houttuynia cordata (lower back) 30g. 4 doses, decoction with water, 1 dose per day.
Second visit: July 25, 1998. After taking 4 doses, the cough and other symptoms subsided. The effect is not more square, and it is slightly adjusted on the basis of the front.
Prescription: Nepeta 5g, Honeysuckle 12g, Forsythia 10g, Almond 10g, Fritillary 10g, Platycodon 5g, Raw Licorice 5g, Citrus Citrus Peel 6g, Skullcap 10g. 7 doses, decoction with water, 1 dose per day.
Follow-up showed that after taking 7 doses, the disease was cured, and the cough did not recur for half a year.
Note: Professor Yan Zhenghua believes that although the patient in this case has been coughing for more than 3 months, he still has fever and chills, indicating that the evil has not been eliminated and is still in the lungs. The 100 parts of the recipe are Jun, the taste is bitter, all enter the lung meridian, the sex is warm but not hot, moist but not cold, and it can be used for new cough. Platycodon has a bitter taste, is good at opening up lung qi, and has a spicy and sweet taste before white, and is good at reducing gas and dissolving phlegm; almond is also a good product for reducing gas and relieving cough. The three are synergistic, and they are the subordinate medicine, so as to enhance the power of the medicine to relieve cough and reduce phlegm. Nepeta is spicy and slightly warm, dispelling wind and dissolving the surface, in order to remove the remaining evil on the surface, as an adjuvant. Licorice not only has the function of relieving cough in the throat, but also has the ability to reconcile various medicines, which is an adjunct product. Professor Yan Zhenghua knew in detail that the patient in this case had swollen and painful gums, yellow phlegm, red tongue, yellow moss and other hot signs, so he applied honeysuckle, forsythia, houttuynia cordata, and large fritillary to clear heat and dissolve phlegm. Looking at the prescription of the three diagnoses, both lifting and lowering, clearing and dispersing at the same time, between the seemingly simple and ordinary compatibility, it shows the subtlety of Professor Yan Zhenghua's medication.
Case 3: Fang X, female, 56 years old, first visit: August 8, 2008.
Chief complaint: cough with sputum for 20 years.
History of present illness: cough with sputum for more than 20 years. Perennial stool is not formed, poor bowel movements, 2~3 times a day, back pain, fatigue, heel pain, joint pain, abdominal distention, dry nose, dry eyes, Naco, sleep, easy to get angry, bruising under the tongue, thin yellow tongue, smooth pulse.
Syndrome differentiation: phlegm turbidity obstructs the lungs, and the spleen and kidney are deficient.
Treatment: Cough and phlegm, spleen and qi, strong muscles and bones.
Prescription: Almond 10g, Coix Seed 30g, Fritillary 10g, Tangerine Red 10g, Baibu 10g, Baiqian 10g, Raw Licorice 5g, Fried Citrus Aurantium 10g, Fried Atractylodes Macrocephalus 12g, Poria Cocos 30g, Skullcap 6g, Loquat Leaf (Hairless) 10g, Mulberry Branch 10g, Mulberry Parasitism 15g, Chuanduan 15g. 14 doses, 1 dose per day, decoction in water.
Second visit: October 18, 2008. After the medicine, the symptoms were reduced, and the effect was not better, and 14 doses were followed.
Third visit: December 6, 2008. Stool is formed, 1 time a day. Cough remains, but the amount of sputum is reduced. Half a month ago, I had a cold again, with a red throat, dry nose, low-grade fever, self-sweating, dark red tongue, and thin white moss.
Prescription: Honeysuckle 12g, Forsythia 10g, Platycodon 6g, Raw Licorice 5g, Fritillary 10g, Tangerine Red 10g, Baibu 10g, Baiqian 10g, Zombie Silkworm 10g, Fried Citrus Aurantium 10g, Fried Atractylodes Macrocephalus 12g, Poria Cocos 30g, Skullcap 6g, Coix Seed 30g, Zhuru 10g. 7 doses, decoction with water, 1 dose per day.
After taking the medicine, the patient was followed up and the cold was cured, and other symptoms were also significantly improved.
Press: The spleen is the mother of the lungs, the patient coughs up phlegm for more than 20 years, the lung disease is long, involving the mother's organs, there is fatigue, stool is not formed and other signs of spleen deficiency, long-term illness will be poor and kidney, kidney main bone, then see back pain, heel pain and other symptoms.
Therefore, this case was identified as phlegm turbidity obstruction of the lungs, and deficiency of the spleen and kidney. Professor Yan Zhenhua comprehensively considered the condition and selected three groups of medicines: almond, large fritillary, orange red, baibu, baiqian, raw licorice, loquat leaves to relieve cough and phlegm; raw licorice, fried citrus aurantium, fried atractylodes, poria cocos, coix seed to regulate qi and strengthen the spleen, among which Poria cocos and coix seed can also promote dampness to reduce the generation of phlegm and dampness; The drug and the syndrome are compatible, and the symptoms are alleviated. In the second diagnosis, for colds, honeysuckle, forsythia, and zombie silkworms were used to disperse wind and detoxify, so that the flexible selection of drugs with the symptoms finally made the chronic disease significantly improved.
[Content compiled from: "China Traditional Chinese Medicine News" October 16, 2020 Fifth Edition Author: Zhang Bing, Chief Physician, Department of Traditional Chinese Medicine, Guoyitang Hospital of Beijing University of Chinese Medicine]