Cough according to Chen Shi-Duo of the Qing Dynasty

Our current second- and third-year students translated the following passage from Chen Shi-Dou's (陳士鐸) Records of Pattern Discrimination (辨證錄 ) (1687).


When a person catches a wind cold, then has a cough and a stuffy obstructed nose, the cough will have copious phlegm that is first clear then turbid. There is fear of wind and cold. This is wind and cold entering through skin and bodyhair (superficial tissue) and the Lung channel is the first to receive it. 


The clear orifice of the Lung opens to the nose. When the Lung is affected by a wind cold pathogen, the nose is blocked, and the metal qi of the Lung is blocked. 


The Lung orifices are unable to open and the body's fire cannot spread through the channels and collaterals. The fire then enters the Lungs and assists the wind and cold. 


In the early stage of the cough, we must first dispel wind and cold, and secondarily use a little bit of medicinals to help dispel fire. We should not  use large amounts of cooling medicinals to suppress the fire and we should not overuse hot and dry medicinals that would assist the pathogen.  Harmonizing is the most clever treatment, with a formula like Gan Jie Tang or Xiao Chai Hu Tang, for example. 


Too many people fail to treat minor diseases with a sense of urgency. Over time then the Lung qi will become deficient and it will be difficult to treat. At that point, the logic of supplementing the mother and the child is appropriate. 


Supplementing the mother means supplementing the Spleen and Stomach; supplementing the child means supplementing the Kidney water. It seems like these are two methods suitable for treatment of chronic cough. 


Yet, I actually have used both methods combined to treat, so that it's beneficial to mother and child, and its good for recovery from cough. Regardless of whether the cough is new or old, this treatment gets results.

方用善散汤:麦冬(三钱) 苏叶(二钱) 茯苓(三钱) 玄参(三钱) 甘草(一钱) 黄芩(八分) 天门冬(三钱) 款冬花(五分) 贝母(一钱)水煎服。

The formula used is Shan San Tang: "Effective Dispersing Decoction"

  • mai [men] dong (3 qian) 9g

  • [zi] su ye (2 qian) 6g

  • fu ling (3 qian) 9g

  • xuan shen (3 qian) 9g

  • gan cao (1 qian) 3g

  • huang qin (8 fen) 2.5g

  • tian men dong (3 qian) 9g

  • kuan dong hua (5 fen) 1.5g

  • bei mu (1 qian) 3g

  • water decoct


This formula uses mai men dong and tian men dong to quiet the Lung qi, use fu ling; gan cao to strengthen the Spleen and Stomach earth; xuan shen to moisten the Kidney channel's water; and zi su ye and kuan dong hua to dissipate the yin and yang wind pathogen. We also add huang qin to clear upper burner fire and bei mu to dispel phlegm within the diaphragm. Consider its suitability, adjust accordingly, and achieve a good effect.  

此证亦可用宁嗽丹苏叶 甘草 天花粉 天冬 款冬花(各一钱) 桔梗 生地(各三钱) 麦冬(五钱)水煎服。二剂愈。

This pattern also be treated with Ning Sou Dan (Special Pill to Calm Cough):  zi su ye, gan cao, tian hua fen, tian men dong, kuan dong hua (each 1 qian), jie geng and sheng di (each 3 qian) mai men dong (5 qian) water decoct. 2 bags is curative. 


When the wind-cold is already dispelled, the phlegm qi has not cleared, and there is still cough and qi counterflow, which affects the low back and abdomen, so that the person is bent over in discomfort, people think that you must urgently treat the phlegm. 

然而治痰而痰愈多,嗽愈急、咳愈重者何也? 盖治痰之标,而不治痰之本耳。

However, when they treat the phlegm, it gets even more copious, and the cough becomes more urgent and intense; why is this? It is because treating phlegm is treating the branch symptom and not treating the root of the phlegm. 


The branch of the phlegm is in the lung, the root of the phlegm is in the Kidney. Treating the Lung without treating the Kidney is why the phlegm never completely goes away, so the coughing cannot be healed. 


When someone eats, what they eat should transform into essence and not into phlegm. If the Kidney qi is deficient, the fluids transformed within the Stomach should enter the Kidney, but the Kidney cannot receive them, so then they flood upwards and become phlegm.  


Because the body fluids produced through Stomach transformation are not enough, they are insufficient to moisten the dryness of the Lung, and Heart fire takes advantage and invades. Fluids cannot nourish the Lung and then turn into phlegm that comes more to exterior. 


So when treating it, it is suitable to greatly supplement Kidney water to make it boundless. Once you do that, it will control Heart fire's excess, and even more, it can help the Lung metal's deficiency. Then, Heart fire won't attack, Stomach qi will recover, and as a natural result, the body fluids will moisten the lower, the Kidney channel will receive them, and transform them into essence and not into phlegm. 

方用:熟地(二两) 麦冬(二两) 甘草(一钱) 柴胡(一钱) 白芍(五钱)水煎服。

The formula to use:

  • shou di (2 liang)

  • mai men dong (2 laing)

  • gan cao (1 qian)

  • chai hu (1 qian)

  • bai shao (5 qian)

  • water decoct.


This formula is called Zi Mu Liang Fu Tang (Decoction to Make the Mother and Child Abundant) with modifications.  


The formula contains shou di huang to greatly enrich Kidney water and mai men dong to greatly calm Lung metal. I add shao yao, chai hu, and gan cao to soothe the Liver and Gallbladder qi, so that they do not attack the Spleen and Stomach. Then, the qi of the Spleen and Stomach can easily rise upwards to rescue the Lung, and also go down to rescue the Kidney. In this way, the pathogen can be easily dispersed. It is a very effective strategy.