[Patient] Hu, a 46 year old female, had [suffered from] cough and wheezing for seven years. She recently contracted a wind-cold invasion which manifested as a blockage and stifling sensation in the chest, hindered breathing, cough and wheezing with profuse phlegm, and water sounds in the throat. The tongue coat was white and the pulse was floating.  Two packets of a modified ma huang tang (Ephedra Decotion) prescription was given:

ma huang (Ephedrae Herba) 6g
gui zhi (Cinnamomi Ramulus) 9g
hou po (Magnoliae officinalis Cortex) 9g
zhi shi (Aurantii Fructus immaturus) 9g
xing ren (apricot seed or kernel) 9g
gan cao (Glycyrrhizae Radix) 6g

After taking the herbs, the cough and wheezing was reduced. Two packets of the above formula was given minus hou po (Magnoliae officinalis Cortex) with the addition of  chen pi (Citri reticulatae Pericarpium) 3g. [Following this] the cough stopped, wheezing was pacified, and the breathing was easy and smooth.

Transalted by: Jason Blalack

Source: 陕西中医学院学报1990;<l>:3

Original Chinese: 姜春华医案:胡某某，女，46岁。咳喘已七年，近受风寒侵袭，胸闷窒塞，呼吸不利，咳喘多痰，喉间作水鸣声，苔白，脉软。以麻黄汤加味，处方:麻黄6克，桂枝9克，川朴9克，棋实9克，杏仁9克，甘草6克，2剂。药后咳喘减轻，上方去川朴，加陈皮3克，又服2剂，咳止喘平，呼吸通畅。

Commentary: This is a practical and fairly straightforward use of ma huang tang (Ephedra Decotion). In this case the patient had a constitutional condition of phlegm and thin mucus internally lurking in the Lungs. She contracted a wind cold pathogen which triggered an exacerbation of her cough and wheezing. Ma huang tang (Ephedra Decotion) not only externally resolves to wind cold but also internally diffuses the Lung qi. zhi shi (Aurantii Fructus immaturus) and hou po (Magnoliae officinalis Cortex) were added in order to clarify the Lungs and direct qi downwards.

Case by Fei Sheng-Fu (费绳甫）

The wife of Mr. Zhu Zhushi from Zhejiang was ill with cough and panting so that it was difficult for her to lie down at night. Her heart was irritable and vexed, she had a stifling sensation in the upper abdomen, and the mouth was greasy with little intake of either food or drink. The face was puffy and the legs swollen, and at night she could not sleep. The momentum [of this disorders] was extremely serious. When I examined her the pulse came overflowing, big, wiry and rapid.

[Diagnosis & Pathodynamic]: Both qi and yin fluids were deficient so that Liver yang ascended excessively. This combined with habitually steaming phlegm dampness blocking Lungs and Stomach so that clarifying and directing downward had no force.

[Treatment Principle]: The [appropriate] strategy was to build and nourish qi and yin fluids, clear the Liver and transform phlegm.

[Prescription]:

Ginseng Radix (rén shën) 3g
Panacis quinquefolii Radix (xï yáng shën) 4.5g
Eucommiae Cortex (dù zhòng) 9g
Poriae Sclerotium pararadicis (fú shén) 6g
Fritillariae cirrhosae Bulbus (chuän bèi mû) 9g
Aurantii Fructus (zhî ké) 3g
Trichosanthis Pericarpium (guä lóu pí) 9g
Ligustri lucidi Fructus (nu zhën zî) 9g
Armeniacae Semen (xìng rén) 9g
Paeoniae Radix alba (bái sháo) 4.5g
Ostreae Concha (mû lì) 12g
Fossilia Dentis Mastodi (lóng chî) 6g
Benincasae Semen (döng guä zî) 12g
Bambusae Caulis in taeniam (zhú rú) 3g

After two prescriptions the momentum of the excessively ascending Liver yang was gradually being pacified, the heart irritability and vexation had stopped, and she was able to sleep at night. I continued the previous formula with the addition of Dendrobii Herba (shí hú) 9g, five slices of pear, and five pieces of Eleocharitis Rhizoma (bí qì). As the bowel moved [regularly] phlegm was being drained from below so that Stomach and Lungs clarified and directed downward [once more], and wheezing and coughing were pacified, and she could lie down at night. The appetite gradually returned and the facial swelling and swelling of the legs subsided. I continued the formula with the addition of mao yan (毛燕), regulating [the condition] for half a month until she was cured.

** Translated by: Volker Scheid

Volker’s Commentary: This case by FSF does not correspond to any of his own or FBX’s manifestation patterns for swelling and edema. It thereby demonstrates that these patterns, where they are made explicit, constitute a general assessment of the terrain from which pathological processes can be deduced and not an attempt to provide prescriptive protocols. Here, the overflowing rapid pulse when related to the symptom pattern indicates the pathological process described by FSF. Hence, while facilitating the clearing and downward directing functions of Lungs and Stomach is necessary to treat the manifestations, root treatment focuses on pacifying hyperactive Liver yang. 

Jason’s Commentary: This 毛燕 (mao yan) is a type of bird’s nest (燕窝, yan wo) that is of a relatively inferior quality. It is grey colored and contains many feathers.