Cough – warm pathogen (YTS)

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Original Case by: Ye Tian-Shi (叶天士)

A warm pathogen assaulted the outer body. There was a cough and head distention. It is appropriate to clear the upper burner. [The prescription given was]

Xing Ren (Armeniacae Semen)
Sang Bai Pi (Mori Cortex)
Jie Geng (Platycodi Radix)
Zhe Bei Mu (Fritillariae Thunbergii Bulbus)
Tong Cao (Tetrapanacis Medulla)
Lu Gen (Phragmitis Rhizoma)

Qin Bo-Wei’s Commentary: This case’s only presenting symptoms are cough and head distention, making it difficult to come up with a clear diagnosis. However since we are given the diagnosis of “warm pathogen assaulting the outer body” we can deduce additional symptoms that are related to wind warmth. From the section of Ye Tian-Shi’s text entitled “Externally-contracted Warm Heat” we get a better idea of what this means. For example,

When a warm pathogen assaults the outer body, it first accosts the Lungs.”

Also there is,

The Lungs govern the qi and connect with the skin and body hair. Therefore [the Lungs] reside in the exterior. When the pathogen is in the exterior one should first use an acrid, cool, and light prescription. If occurring in conjunction with wind then one should add Bo He (Menthae haplocalycis Herba) and Niu Bang Zi (Arctii Fructus). If occurring in conjunction with damp one should add Lu Gen (Phragmitis Rhizoma) and Hua Shi (Talcum). This will, respectively, vent the wind to the outside of the heat, or leach the damp away from under the heat, so that [neither of these pathogens] interacts with the heat, and it will be isolated.”

It can be seen that in this case that the cough is the chief patho-condition, but there also should be concurrent symptoms such as headache, phlegm that is difficult to cough up, dry mouth, scanty yellow urination etc. The pulse and tongue was not given, but it ought to be something along the lines of a slippery and rapid pulse with a yellow greasy coat. Therefore the formula uses Xing Ren (Armeniacae Semen), Zhe Bei Mu (Fritillariae Thunbergii Bulbus), and Jie Geng (Platycodi Radix) to dispel wind [by diffusing the Lungs and transforming] phlegm. Sang Bai Pi (Mori Cortex) was used to clear heat. All of these focus on the Lungs. In addition Tong Cao (Tetrapanacis Medulla) and Lu Gen (Phragmitis Rhizoma) were added to clear heat and leach out dampness through their bland flavor.

Translated by: Jason Blalack

Original Chinese: 案四:温邪外袭,咳嗽、头胀,当清上焦。杏仁、桑皮、桔梗、象贝、通草、芦根.

Source: Case from the Cough chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》. Commentary from Complete Famous Medical Works of Qin Bo-Wei.

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