A long-term patient recently called me with an interesting question concerning herbal formulas. The patient, a 73-year-old female, asked why a formula that is helping her 35-year-old son does not seem to be helping her.
“Our chiropractor gave us this formula for coughs,” she said. “It’s really helping my son, but does not seem to be helping me. Actually, it seems to be aggravating my cough, I’m confused” was her basic message. I asked her to text me a picture of the formula in question: Er Chen Tang.
Once I was aware of the formula she was using, so much made sense to me. I won’t comment on a chiropractor prescribing Chinese medicine, but I will focus on the important aspect of finding the correct pattern for a patient’s unique symptoms.
Upon inquiry, her son’s cough was wet and productive; her cough was dry and unproductive. Her son is 35; she is 73. These two factors alone make it clear why this herbal formula is effective for one patient and aggravating to another patient. This was a unique opportunity to educate a patient on the subtle nuances of traditional Chinese medicine and pattern differentiation.
Er Chen Tang
The formula Er Chen Tang (Two-Cured Concoction) is traditionally composed of ban xia, chen pi, fu ling, and gan cao. Traditional recipes often instruct that this be taken with sheng jiang and one piece of wu mei; however, most contemporary formulas simply add sheng jiang and omit the wu mei.
Er Chen Tang dissolves and dispels phlegm, dries dampness, regulates qi, and harmonizes the stomach and spleen. Hearing that the patient’s son’s cough was wet and productive, it is very clear why Er Chen Tang was highly effective at resolving his cough.
Effective for One Patient, But Not the Other One
Chinese Herbal Medicine: Formulas and Strategies, by Bensky and Barolet, notes that regarding Er Chen Tang: “The improper use of this formula can lead to excessive thirst and a dry throat. Unless modified, it is contraindicated for cases with cough associated with Lung Yin deficiency.”
After hearing that my patient’s cough was aggravated by Er Chen Tang, I asked for a photo of her tongue. I was very familiar with her past history and age. Her tongue was red, with geographic coating and many deep cracks. Her dry cough was worse at night and she was also feeling hot at night.
Taking all of these signs and symptoms into consideration, I explained to her the concept of lung yin deficiency and how Er Chen Tang can aggravate this particular pattern presentation.
A Better Treatment Choice: Bai He Gu Jin Tang
Instead of Er Chen Tang, I prescribed Bai He Gu Jin Tang for her unique pattern of cough with lung yin deficiency. Bai He Gu Jin Tang nourishes lung yin, moistens the lungs, nourishes kidney yin, clears heat, and dissolves phlegm. A typical tongue for this particular formula is red body with a dry, yellow coat or no coat, possible cracked or geographic.
After two days on this formula, her cough had lessened and was now productive. After five days on Bai He Gu Jin Tang, her cough was completely resolved and she was feeling less warm in the evenings during sleep.
I instructed her to keep the remaining amount of Bai He Gu Jin Tang on hand for future issues with dry coughs or dry, unproductive coughs, and recommended specific foods that nourish lung yin. I also explained the difference between Er Chen Tan and Bai He Gu Jin Tang to her son. Both were very interested in how two different formulas for cough could have such drastic differences in action.
Find the Right Fit
This case is a beautiful example of the uniqueness of the appropriate prescription of Chinese medicine. It is also a wonderful lesson on how each clinical encounter, even a simple cough, can be an opportunity to educate patients on the unique capabilities of professionally practiced Chinese medicine.
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