A 35 year-old female on Wednesday, March 31, 2010 presented with a chief complaint of cough and a hot tongue.

The previous day she had a runny nose and felt like she was getting a cold. She also reported that both of her kids had strep throat, which in the past she would get a couple times a year.

Currently she had a dull and achy sore throat. Her cough was mildly productive with congealed thick discolored phlegm. She felt like she was breathing fire, felt hot, irritable, had a dry mouth, no sweat, no chills, and had some eyelid twitching. Her bowels were not moving and when they did they were black and hard. She had a sensation of abdominal bloating and had no appetite.

Upon further inquiry she reported having some dental work on 3/24/10 where she was given a course of Clindamycin 300mg TID, Flagyl 500mg q 6 hours taken with Phenergan, and Diflucan due to some infectious complications. She noticed a red dry rash appear on the dorsal part of her hands after taking these meds.

Tongue: very red body with no coat

Pulse: Slippery and rapid

Diagnosis: Heat in the qi and nutritive level, clumping of the stools.

Treatment principles: Open the bowels, facilitate resolution of heat via the urine, vent the pathogen from the nutritive aspect, and enrich the fluids.

Prescription:

dà huáng (Rhei Radix et Rhizoma) (add) 9g  
máng xiäo (Natrii Sulfas) (add)  6g    
chì sháo (Paeoniae Radix rubra) 6g                             
mǔ dān pí (Moutan Cortex) 6g    
shuǐ niú jiǎo (water buffalo horn) 15g                          
shēng dì huáng (Rehmannia root, Chinese foxglove root) 15g    
dàn zhú yè (Lophateri Herba) 6g   
lián qiào (Forsythiae Fructus) 15g    
dēng xīn cǎo (Junci Medulla) 1g    
huáng lián (Coptidis Rhizoma) 2g

Cooking Instructions: 1 bag=2 days. Cook time =45 minutes. Taken between  meals 2-3 times a day.

Outcome: After taking two bags of herbs all of her symptoms were resolved except for a slightly warm feeling on the tongue and slight thirst. We then switched to a constitutional formula. Note: she stopped all pharmaceuticals after initial consultation.

Commentary: Although many consider antibiotics and other similar pharmaceuticals as cold one must always observe what is happening in the body and treat what they see. In this situation the multiple pharmaceuticals seemed to have pushed the heat pathogen deep into the qi and nutritive level. One clue was the rash on the hands, even though this was “caused by the pharmaceuticals.” An aggressive approach was needed to evict the pathogen and prevent damage to the yin and possibly entering the pericardium. Of note, there were no herbs in the formula to directly treat the chief complaint of the cough. Although this seemed to be the most pressing sign to the patient, there was clearly a bigger fish to fry.

Questions or comments?

Location: Boulder, Colorado