In the contemporary clinical setting, encountering patients who chronically use cannabis is increasingly common. In my 25 years of clinical practice, this is one of the most common presentations I see. In fact, in my past 15 years of clinical practice, I have seen more patients smoking cannabis than tobacco.
With this chronic use comes some predictable patterns that may manifest in the respiratory system. Let's focus on two specific patterns clinicians are likely to encounter and two formulas that can be used synergistically to help resolve potential health challenges related to cannabis use.
Two Formulas, Two Patterns
The two most common patterns I have encountered with chronic cannabis use are lung phlegm heat and lung yin deficiency. These two patterns often appear as stand-alone presentations; however, they can also often appear in sequence, with lung yin deficiency following cases of unresolved lung phlegm heat. Qing Qi Hua Tan Wan and Bai He Gu Jin Tang are useful when chronic smokers experience unique respiratory problems, including acute respiratory challenges such as wind heat invasions..
Qing Qi Hua Tan Wan
This herbal medicine is the primary formula for treating lung phlegm heat. The actions of Qing Qi Hua Tan Wan include dissolving phlegm, clearing heat, descending lung qi, and relieving cough. The primary symptoms for its use are acute or chronic cough with accumulation of yellow, sticky phlegm, often accompanied by rattling cough and difficulty breathing. The pulse is typically rapid and slippery, and the tongue is typically normal / red with a thick, greasy coating.
Qing Qi Hua Tan Wan aggressively clears heat and dissolves phlegm. (If used long term, it can easily damage lung yin; therefore, it is ideal for short-term use until the main symptoms are relieved.)
When using this formula, it is important to examine the patient's tongue to ascertain whether the pattern is an excess pattern without signs of lung yin deficiency. If the pattern is clearly excess lung phlegm heat, Qing Qi Hua Tan Wan can be a highly effective formula for both acute and chronic cough with excess phlegm. If the patient's cough shows any indications of dryness and/or the patient's tongue is dry with cracks, Qing Qi Hua Tan Wan is not the formula of choice.
Bai He Gu Jin Tang
Chronic smoking of cannabis or tobacco dries the delicate organs of the lungs, easily causing lung yin deficiency. Patients with lung yin deficiency are most often not aware of the unique nature of this particular pattern and often resort to allopathic over-the-counter remedies, which further exacerbate the deficiency.
Bai He Gu Jin Tang is an extremely important formula for clinicians to consider with this pattern presentation, as it nourishes lung yin, moistens the lungs, nourishes kidney yin , clears heat, and dissolves phlegm.
With this wide range of actions, Bai He Gu Jin Tang is a highly effective formula for chronic smokers experiencing respiratory issues such as low-grade cough, cough worse at night when lying down, and cough exacerbated when smoking.
Bai He Gu Jin Tang is also an important formula for resolving post-lung phlegm heat issues. Cases of lung phlegm heat, even when resolved, can damage lung yin – both from the effects of heat and use of herbal medicines that dry and resolve phlegm. After the use of such formulas, the delicate organs of the lungs often experience yin deficiency.
The aforementioned formula Qing Qi Hua Tan Wan, although highly effective for clearing lung phlegm heat, can in some cases damage the yin aspect of the lungs. Chronic smokers with underlying yin deficiency can be hard to clearly diagnose if excess symptoms are the main pattern expression, and tongue and pulse are unclear or confusing. Patients also may have a constitutional underlying yin deficiency that does not express via the tongue, pulse or organs.
In such cases, after the use of formulas such as Qing Qi Hua Tan Wan, the patient may develop a chronic dry cough. In such cases, Bai He Gu Jin Tang is an effective therapy for healing the lungs by deeply nourishing lung and kidney yin; as well as gently clearing any residual heat that may remain due to chronic smoking.
Clinical Takeaway
Qing Qi Hua Tan Wan and Bai He Gu Jin Tang each address unique and specific respiratory conditions. While each formula targets a unique lung pattern, these two formulas can also be used in a synergistic manner if excess cases evolve into deficiency cases. This evolution from excess to deficiency is extremely common in cases of chronic smoking.
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