Common Cough Theory Of Experience And Sang Ju Yin

1. PrefaceCough is one of common seen disease.Almost everyone has ever suffered.One of thecommon symptom of cold is cough. It is because of the high incidencerate,and alsobecause of its complex cause,often repeated attack and difficult to be cured. InTraditional Chinese Medicine (TCM) there are two concepts of Cough: one is coughwith sound but no phlegm called"KE"(å'³) and second is cough with phlegm but nosound called"SOU"(å—½). In TCM classics《Neijing》it is said that cough is caused bypathogen invasion on the superficies,also that five zang organ and six fu organ all canlead to acough,not just the lung organ. TCM had a significant advantage in treatingcough case,but wrong diagnosis could worsened the symptoms,and could lead toasthma,lung distention,etc.External invasion cough in modern western medicine is related to a cute bronchitis,chronic bronchitis acute exacerbation,chronic pharyngitis,etc.Although my clinical experience time is not very long,but during that period themost common disease that I encounter was external invasion cold,and cough patientwas the majority of them. In these 3 years under my teacher Prof Wangqi (DongzhimenHospital respiratory physician,Oriental Hospital vice president) guidance,I have anew understanding about external invasion cough and their commonlyused prescriptions.Prof Wangqi is an expert in treatment of external invasion cough,and his common useprescriptionis Sangjuyin Decoction.This thesis content is the results from my research of cough common useprescriptions(major is heat invasion cough),and how to used it in clinical.2 Clinical Experience2.1Differentiation of cough2.1.1External invasion cough and internal injurycoughFirstly, cough are divided into 2 kinds: external invasion cough and internal injurycough.External invasion cough include swind-cold cough,wind-heat cough,dry-heatcough and summer-damp cough (San ren decoction syndrome).In northern part of China(Beijing and Dong bei province) summer-damp cough is rarely seen, but in clinical we some times still can see it. In ternal injurycough is the result of other disease that evolvesinitsprocess,itusuallyrelatedtolung,spleen,liverandkidneyorgan.2.1.2 Difference about with Phlegmor without phlegmIn Traditional Chinese Medicine (TCM) there are woconcepts of ough: one is withno hlegm called"KE"(å'³)and second is cough with phlegm called"SOU"(å—½),butusually"KE"and"SOU"coexistsoit called"KESOU"(cough)."KE"is related withlungy in deficiency,mostl happen on patient with yin deficiency physique."SOU"isrelated with lung and spleen(spleen is source of phlegm,lung is phlegm receptacle),mostlyhappen onpatient with phlegm-humid physique.2.1.3 ColdandheatCough also had difference in cold and heat. The combine diagnosis of mainsymptom with others smaller symptoms is essential in deciding the nature of the cough.2.1.4 External invasion cough typesThere are 2 types of external invasion cough: new exogenous cough,inner-exogenous combined pathogen which caused cough .2.2 Colddrugs-heat drugs combine theoryAlthough there are differences between cold cough and heat cough,but in clinicalpractice there is no simple cold cough and simple heat cough,usually both of the marecoexist. The most significant difference is usually one side is stronger than the other. Intreating external invasion cough Prof. WangQi often combines cold drugs with heatdrugs. This treatment is based on Prof ShiJinmo."7:3theory",ex: the ratio between thecold drugs and heat drugs are 7:3 or vice versa.2.3 Release heat depression theoryIn external invasion cough,lung heat depression can lead to heat depression. Lungheat depression restrict lung dispersion then lead to fever,cough,even asthma,etc.In this case the treatment principle will be the dispersion of depressed heat therapymethod.2.4 External invasion cough relation to qi mechanism (upward and downward movementof qi)In treating cough sometimes by just adjusting the lung qi movement also can curecough without having to use other drugs to remove phlegmmor to stop the cough. TCM famous doctor LiuHejianin《HejianLiushu》said:"to treat cough,first treat the phlegm;to treat phlegm,downward qi movement is the best treatment".2.5 Lung-liver theoryTo cure external invasion cough,it's important to restore liver smoothing anddraining flow function,because lung qi movement depends on liver normal function. Ifliver and lung qi upward downward movement are normal,qi movement will be normal.If liver qi is not moving upward,lung qi will not move downward. This treatmentmethod basic is to normalize the function of liver and lung organ in order to smoothenthe flow of qi movement between the two organs.2.6 External invasion cough with lung and its relations to other zang organs.Lung organ in its pathological process can evolve and it can influences other zangorgans. So in treating cough we might want to consider treating other zang organs too. InTCM classics《Neijing》said"All of five zang or gans and six fu organs can lead tocough,not just lung zang organ".2.7 Modified TreatmentExternal invasion cough can evolves very rapidly and it's hard to predict the changesof heat and cold. Modify decoction is the best way to treat external invasion cough.Modifie dDecoction can get the best treatment effects in the shortest amount of time.3 ConclusionTo treat cough disease properly it's essential to know the characteristic of thecough itself,that is to differentiate between external invasion cough or internal injurycough.《JingyueQuanshu》said:"All kind of cough syndrome is related to lung organ,and lung organ disease can be divided into two kinds: external invasion syndrome andinternal injury syndrome". In general,external invasion cough has an obvious cause ofdisease,includes: wind,cold,summer-heat,damp,dryness and fire. In whichwind-cold,wind-heat and dryness was the majority of them. External invasion coughhad a short course of disease,mostly acute,excess syndrome characteristic. And it isusuallycoexist with exterior syndrome.In most case,the course of disease (the length of time) is important to determinethe basic nature of the cough itself. First it is important to differ between old cough and new cough,second step would be to determine whether it is cold cough or heat cough,and further,decide wich one stood stonger. By then we could choose the rightDecoction. But from cold drugs heat drugs theory we know that in clinical practice thereis no simple cold cough and simple heat cough,usually both of them coexist,socombining decoction is the best way for treating external invasion cough. Besides thatwe also have to pay attention to others accompanying symptoms especially phlegm,then decide the right treatment method.In clinical practice,Sangjuyin Decoction is the most common used decoction totreat external invasion cough. It is also could be modified to trea twind-cold cough,wind-dryness cough or phlegm-heat cough,etc,It is even can be used to treat internalinjury cough disease. Although Sangjuyin Decoction is a good cough decoction,but themost important mean in treating external invasion cough is to differentiate thesymptoms,syndrome to choose the right treatment,because in clinical practice thereare also similar external invasion cough that can be treated with GuiZhi Decoction orMaHuang Decoction.. Modify decoction is also a good way to cure external invasioncough,because external invasion cough have aquick changes of its nature between coldand heat. By modifying the decoction it can function better to adjust the changes of heatand cold.