ABSTRACT

This paper discussed the pathogenesis and the principle of treatment of the dry cough with yellow greasy coating. Combined the clinic observation with the TCM theory, we found that the main reasons about this dry cough are dryness in lung and stagnated phlegm. And heavy dosages herbs which can nourish Yin and clear away the heat should be adopted.

1. Introduction

One of the most difficult issues on cough in clinic is dry cough with yellow greasy coating. It often appears with irritative feeling in throat after catching a cold or wind, or laying flat on bed. Then the irritative feeling become serious followed by dry cough. Normally just a little bit phlegm could be spit out after continuous hard cough. And the dry cough may relieve while the symptoms like sore throat, hoarse voice, dry mouth, thirsty and irritation, etc emerge.

At the beginning in this case, besides the characteristic of yellow greasy coating and dry cough, a superficial syndrome could also be expressible as well as patterns in other coughs. Normally the superficial syndrome could be relieved after being treated in the first stage. But the yellow greasy coating still exists and the dry cough turns serious. The whole syndrome may evolve into a chronic one. So patient complaining on dry cough with yellow coating could have a history of several months, yeas, even extending to more than ten years. TCM doctors may often consider it as a warm dry pathogens attacking at the lung so as to use herbs just to clear and disperse away dryness in the lung. But it proved to be invalid. Sometimes the doctors just focus on the yellow greasy coating and decided that it is due to heat-dampness so as to use herbs to clear away the heat-dampness. But the symptoms still exist, even sometimes turn worse. When the patients in this case go to see western doctors because TCM therapy seem to have no effect, they will get a diagnostic like tracheitis. But after several certain periods of treatments like antibiotics, diminishing inflammation, desensitization，antitussive etc, many patients still cannot get well. This paper might broaden the clinical thinking model of this issue.

2. Analysis of the Pathogenesis of the Dry Cough with Yellow Greasy Coating

Just as the comments of famous TCM doctors in history Xu Songnian, “Lung always suffers from dryness, and dryness leads to irritation in throat. This makes the continue cough” [1], dry cough with little phlegm which is hard to clear out is always considered into the syndrome of dry pathogens attacking or dryness in lung with fluid consumption. But another point of view held by famous TCM expert Mr. Yue Meizhong suggested that dry cough with sticky phlegm is quite a difficult issue with a subtle difference to dryness cough. Cough with the phlegm hard to clear out is due to dryness in the lung. So moistening and dispersing method to nourish the lung and to accelerate the flowing of Qi is the key to organize the prescription [2]. This reveals that the key issue in dry cough is the failure of the lung’s activity to dispel the phlegm. And dryness in lung and stagnation of the phlegm contribute most to the occurrence of the disease. Focus on the special characteristic of little phlegm and difficult dispersal about dry cough with yellow greasy coating, we can see that the main reason about this syndrome is dryness in lung and stagnated phlegm.

But for a syndrome like this, normally we will see a red tongue with little phlegm or exfoliated coating. Why here it represents a yellow greasy one? The answer is the core part on its pathology. One of the best TCM doctors in last century in Peking Mr. Kong Bohua concluded a representative regulation about the occurrence of Warm Febric Disease in his long clinic practice. He considered that the Warm Febric Disease can take place during the whole year. Even in coldest winter can be triggered by cold pathogen when heat accumulated enough inside body. So for Warm Febric Disease the latent pathogen is quite often seen, especially when heat-dampness exists [3]. His words reminds that the combination of latent pathogen (heat) and heat-dampness (more heat with less heatdampness) is the main style of the existence of Warm Febric Disease. In north China where Mr. Kong lived things happens like this, so more we can get this conclusion in the seaside of the warm damp place in the south. By now then we can easily explain the phenomenon of dry cough with yellow greasy coating. Cough with heat normally belongs to Warm Febric Disease. When warm pathogens attack the patients with heat accumulated inside, dry cough may possible take place with yellow greasy tongue. In this process, latent heat-dampness conglutinates in the Wei level of the lung. Then soon the heat consume the Yin and condenses the body fluid into phlegm. So the yellow greasy coating with dry cough can occur with dryness in lung and stagnated phlegm come into being. More accurately here for the yellow greasy coating we can say that it is the expression of the dryness in lung and stagnated phlegm derived from latent fire and heat-dampness.

3. The Principle of Treatment of the Dry Cough with Yellow Greasy Coating

Since the stagnated phlegm and dryness in lung are the key factors of the occurrence of dry cough with yellow greasy coating, the principle for clinic treatment is to nourish Yin and clear away the heat, with the same time to resolve the stagnated phlegm. But for such a long history case with serious evolvement, heavy dosages should be adopted. We suggest to take the Maimendong Tang (Ophiopogon Decoction) which was formed by Mr. Zhang Zhongjin in history originally to treat adverse fire cough, to nourish Yin and clear away the fire to recover the consumed fluid of lung and stomach. And another formula called Beimu Gualou Powder (Fritillaria and Trichosanthes Powder) is also necessary to clear and drive off the stagnated phlegm in the lung. When the two formulas are used in combination, dry cough with yellow greasy coating can be cured.

According to the clinic observation, the patients always feel a lot of phlegm arising in throat, and more can be easily spit out after taking this prescription. And symptoms like dry cough and irritation in throat will relieve a lot. Normally after 12 - 15 dosages the cough can be entirely cured. Here it should be pointed out that in some cases the patients may get diarrhea after heavy dosages of prescription nourishing Yin, clearing heat, moistening lung and resolve the phlegm. But normally this diarrhea will disappear after the third day of treatment. For the eager of final healing, most patients can cooperate actively with the doctor to make the process going well when the doctors explain previously before the treatment.

4. Typical Case

Mrs. Huang, 45 years old women.

Record:

Main complain: Dry cough for 6 month.

First interview: 12^th, May, 2003

The natives of the patients’ area have a custom of nourishing the body with worm-natured herbs. So in last winter, she took great deal of herbs like Huangqi (astragallus), ginseng and cordyceps etc. But at that moment she caught a cold and then began to dry cough with yellow greasy coating and has a little phlegm difficult to spit out. Then she frequently consulted for doctors between TCM and western medicine during the past 6 month. The medicine she had taken included various type of antibiotics and over hundred of dosages of herbs for clearing heat and dispersing the superficial pathogen, or for diffusing the lung to stop the cough, or for moistening the lung and resolve the phlegm, or for clearing the heat and disinhibiting the dampness. In recent days the patient turned for 3 times of acu-points injection in the ENT department because of torture of severe dry cough. After then the symptom in throat become relieve but dry cough still exists. Now it often occurs when catch a wind or lay on the bed in night with a little bit phlegm hard to dispel out. Normally the dry cough can be relieved a little while after a short time of severe choking cough with a little bit gummy phlegm in blood taste spit out. The tongue is red with yellow greasy coating. The pulse is slippery and fast.

Because the patient has yellow greasy coating and slippery pulse, so first it is considered that this case belongs to a syndrome of heat phlegm with Yin consumption. A prescription was made to nourish Yin and resolve the phlegm including herbs:

Shu Di (cooked rehmannia) 12 g

Angelicae 6 g

Chen Pi (tangerine peel) 3 g

Ban Xia (pinellia) 6 g

Fu Ling (poria) 9 g

Licorice 3 g

Mai Dong (ophiopogon) 9 g

Zhi Zi (gardenia) 6 g

Dan Douchi (fermented soybean) 12 g

Fu Hai Shi (pumice) 9 g

Xuan Fu Hua (inula flower) 3 g

Dai Ge Powder (indego and clamshell powder).

The second interview: 15^th, May, 2003

After first 3 dosages her dry cough relieved but yellow greasy coating remained.

The third interview: 21^st, May, 2003

During the next 6 dosages none effect was receive. And an overall inspection was made to find that though the patient had a slippery pulse, it was not in a strong sense but represented a little hollow one. Combing with the symptoms of dry cough and sticky phlegm, it can be decided that this is a syndrome of dryness in lung with stagnated phlegm. The treatment principle is to nourish the stomach and the lung’s fluid while moistening the lung and resolve simultaneously. Prescription:

Mai Dong (ophiopogon) 60 g

Gua Lou (trichoasnthes) 45 g

Ban Xia (pinellia) 6 g

Angelicae 6 g, Chen Pi (tangerine peel) 6 g

Fu Ling (poria) 9 g

Jie Geng (platycondon) 6 g

Dang Sheng (condonopsis) 6 g

Tian Hua Fen (trichosanthes root) 9 g

6 Jujubes

Licorice 3 g

4 pieces of ginger

The fifth interview: 31^st, May, 2003

After the first dosage of the prescription above, white and watery phlegm that easy to expel out rose in the patient’s throat continuously. Then the irritation in throat and dry cough relieved a lot. But she had diarrhea for several times in this process. During the rest dosage, the diarrhea, a yellow greasy coating and fast slippery pulse relieved. After another 9 dosages the dry cough lasting obstinately for 6 months was finished.

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