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Pediatric Pulmonary Cough

Pulmonary cough is a common lung disorder in children characterized by fever, productive cough, dyspnea, moving of alae nasi, absence of nasal discharge and tears, breathing through the mouth and lifting of the shoulders.

Pneumonia and the serious case of acute bronchitis in children may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

The exogenous factor is the attack of wind (wind-heat or wind-cold), and the endogenous factors are the delicate zang-fu organs which are not fully developed in children and their low body resistance. Moreover, it may appear as a complication of measles, whooping cough or common cold. Its pathogenesis is the stagnation of lung-qi with production of heat-evil, leading to the accumulation of sputum which obstructs the lung collaterals and the respiratory tract. In the serious case, involvement of the Jueyin meridian and exhaustion of heart yang may ensue.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Identification of the characteristic symptoms: In the early stage, the disorder is similar to the common cold, but its manifestation of superficies-syndrome lasts only a short time and interior-heat syndrome appears readily. Its characteristic symptoms are fever, cough, dyspnea, moving of alae nasi and absence of tears and nasal discharge.

(b) Differentiation between wind-cold and wind-heat syndrome: The case due to wind-cold manifest itself as a low fever with marked chilliness, coughing with a low voice, profuse and thin expectoration, thin, white tongue coating and floating and tense pulse. The case due to wind-heat manifests itself as high fever with mild chilliness, coughing with a loud voice, thick and yellow expectoration, red tip of tongue with thin and white or yellow coating and floating and rapid pulse.

(c) Differentiation between phlegm and heat syndrome: Those cases with phlegm as the predominant syndrome manifest themselves as severe cough with profuse expectoration, dyspnea, moving of alae nasi, wheezing sound, red tongue with thick or yellow and greasy coating and smooth and rapid pulse. Those cases with heat as the predominant syndrome manifest themselves as continuous high fever, flushed face, redness of lips, irritability, dry cough, constipation, red tongue with yellow and rough coating and full pulse.

B. Therapeutic principles Releasing the stagnated lung-qi, relieving dyspnea, eliminating phlegm and clearing away heat are the basic therapeutic principles for this disorder. In the early stage when the lungs are blocked by wind, releasing the stagnated lung-qi is the main principle recommended. When there appears retention of phlegm-heat obstructing lung-qi, the principles of dissipating phlegm, opening lung-qi, clearing away heat and relieving dyspnea are advisable. As for the longstanding case with consumption of qi and yin, tonifying qi and nourishing yin should be the principal therapies.

Classification and treatment

A. Attack of wind to the lungs

(a) Retention of wind-cold in the lungs

Manifestations: Fever, anhidrosis, choking cough with white and thin expectoration, dyspnea, white and thin or greasy tongue coating and floating and tense pulse.

Therapeutic principles: Dispel the evil from superficies with acridwarm drugs, release the stagnated lung-qi, and relieve cough.

Prescription: The Modified Powder of Huagai

Herba Ephedrae 3 g
Semen Armeniacae Amarum 10 g
Fructus Perillae 10 g
Cortex Mori Radicis 10 g
Poria 10 g
Exocarpium Citri Grandis 6 g
Radix Asteris 6 g
Radix Glycyrrhizae Praeparata 3 g
 

Remarks: Add Semen Raphani (6 g) and Rhizoma Pinelliae Praeparata (6 g) for cases with profuse sputum.

(b) Retention of wind-heat in the lungs

Manifestations: Fever, sweating, thirst, irritability, cough with profuse and yellow expectoration, dyspnea, flushed face, redness of lips, red tongue with thin and white or yellowish coating and floating, rapid and smooth pulse.

Therapeutic principles: Dispel the evil from superficies with acrid-cool drugs, release the stagnated lung-qi, and eliminate phlegm.

Prescription: The Modified Decoction of Ephedrae, Armeniacae Amarum, Glycyrrhizae and Gypsum Fibrosum and Powder of Lonicerae and Forsythiae

Herba Ephedrae 3 g
Semen Armeniacae Amarum 10 g
Gypsum Fibrosum 25 g
Radix Glycyrrhizae 3 g
Flos Lonicerae 10 g
Fructus Forsythiae 10 g
Herba Menthae 3 g
Fructus Arctii 10 g
Radix Platycodi 5 g
Rhizoma Phragmitis 15 g
 

Remarks: Add Radix Stemonae Praeparata (10 g) for cases with severe cough. Add Bulbus Fritillariae Cirrhosae (5 g) and Pumex (10 g) for those with profuse sputum.

B. Retention of phlegm-heat in the lungs

Manifestations: Fever, irritability, cough, dyspnea, moving of alae nasi, flushed face, thirst, wheezing sounds in the throat, vomiting, chest distress, breathing through the mouth, lifting of the shoulders and vigorous movement of the hypochondria, cyanotic lips, red tongue with yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, release the stagnated lung-qi, dissipate sputum, and relieve dyspnea.

Prescription: The Modified Decoction of Ephedrae, Armeniacae Amarum, Glycyrrhizae and Gypsum Fibrosum and Three Seeds Decoction for the Aged

Herba Ephedrae 3 g
Semen Armeniacae Amarum 10 g
Gypsum Fibrosum 30 g
Radix Glycyrrhizae 3 g
Fructus Perillae 10 g
Semen Raphani (fried) 5 g
Semen Lepidii seu Descurainiae 6 g
Radix Scutellariae 10 g
Pulvis Indigo Naturalis and Gecko (wrapped in cloth) 10 g
 

Remarks: For cases with marked dyspnea, profuse expectoration and constipation, add Pulvis Semen Phabitidis (2.5 g, mixed with the decoction), Radix et Rhizoma Rhei (5 g, decocted later) and Semen Arecae (6 g) to dissipate sputum and induce purgation. For cases with cyanosis, add Radix Salviae Miltiorrhizae (10 g), Radix Paeoniae Rubra (10 g) and Flos Carthami (6 g) to activate blood circulation and eliminate blood stasis.

C. Deficiency of healthy qi with retention of evil

(a) Yin deficiency and retention of heat in the lungs

Manifestations: Hectic fever, night sweating, flushed face, red lips, dry cough, red and dry tongue without coating and thready and rapid pulse.

Therapeutic principles: Nourish yin, clear away heat, moisturize the lungs, and relieve cough.

Prescription: The Modified Decoction of Adenophorae Strictae and Ophiopogonis

Radix Adenophorae Strictae 10 g
Radix Ophiopogonis 10 g
Rhizoma Polygonati Odorati 10 g
Folium Mori 10 g
Semen Dolichoris 10 g
Radix Trichosanthis 10 g
Radix Glycyrrhizae 3 g
Cortex Lycii Radicis 10 g
Radix Asteris 10 g
Semen Armeniacae Amarum 10 g
Folium Eriobotryae Praeparata 10 g
 

Remarks: Add Herba Artemisiae Annuae (10 g) and Cortex Moutan Radicis (6 g) for cases with low fever. Add Radix Stemonae Praeparata (10 g) and Bulbus Fritillariae Cirrhosae (5 g) for those with severe cough. Add Fructus Oryzae Germinatus (10 g), Fructus Hordei Germinatus (10 g) and Fructus Crataegi (10 g) for those with poor appetite.

(b) Deficiency of lung-qi and spleen-qi

Manifestations: Pale and lusterless complexion, sweating, cough with weak voice, wheezing sounds in the throat, emaciation, mental fatigue, eye opening during sleep, anorexia, loose stool, low fever, pale tongue with white and thin or smooth coating and thready, slow and weak pulse.

Therapeutic principles: Benefit qi and invigorate the spleen. Prescription: The Modified Decoction of Ginseng and Schisandrae

Radix Ginseng 10 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae (fried) 10 g
Radix Glycyrrhizae 10 g
Fructus Schisandrae 6 g
Pericarpium Citri Reticulatae 6 g
Rhizoma Pinelliae 6 g
Rhizoma Zingiberis Recens 2 pcs
Fructus Jujubae 5 pcs
 

Remarks: Add Radix Astragali (10 g) for cases with profuse sweating. Add Radix Asteris (10 g) and Flos Farfarae (10 g) for cases with serious cough.

D. Exhaustion of heart-yang

Manifestations: Sudden onset of pallor, cyanosis, dyspnea, sweating on the forehead, coldness of limbs, restlessness, a mass appearing on the right hypochondrium, purplish tongue with thin, white coating and feeble and rapid pulse.

Therapeutic principles: Warm and tonify the heat-yang, restore the depleted yang, and relieve collapse.

Prescription: Decoction of Ginseng, Aconiti Lateralis Praeparata, Os Draconis and Concha Ostreae for rescuing the patient from danger

Radix Ginseng 10 g
Radix Aconiti Lateralis Praeparata 10 g
Radix Glycyrrhizae Praeparata 3 g
Os Draconis (decocted) 10 g
Concha Ostreae (decocted) 10 g
Radix Paeoniae Alba 10 g
 

Remarks: For cases with cyanosis and a visible mass on the right hypochondrium, add Radix Angelicae Sinensis (10 g), Flos Carthami (6 g) and Radix Salviae Miltiorrhizae (10 g) to activate blood circulation and eliminate blood stasis.

E. Attack of Jueyin meridian by internal heat evil

Manifestations: Sthenic fever, coma, irritability, delirium, convulsions, upward staring of eyes, stiffness of neck or even opisthotonos, crimson tongue with yellow dry coating and thready and rapid pulse.

Therapeutic principles: Wake up the patient from unconsciousness by clearing away heat-fire, calm the liver, and suppress wind.

Prescription: The Modified Decoction of Cornu Saigae Tataricae and Uncariae cum Uncis

Cornu Saigae Tataricae 1.5 g
Radix Rehmanniae 10 g
Radix Paeoniae Alba 10 g
Folium Mori 10 g
Flos Chrysanthemi 10 g
Ramulus Uncariae cum Uncis 10 g
Radix Scutellariae 10 g
Fructus Gardeniae 3 g
Rhizoma Acori Graminei 10 g
Calculus Bovis Bolus or Purple Snow Pill is also applicable.

Remarks: Add one piece of Scolopendra and 1.5 gram of Scorpio for cases with frequent episodes of convulsions.

Experiential Prescriptions

A. Herba Ephedrae (3 g), Semen Armeniacae Amarum (10 g), Gypsum Fibrosum (25 g), Radix Glycyrrhizae (3 g), Radix Scutellariae (10 g), Semen Raphani (6 g) and Folium Isatidis (10 g); prepared as decoction; applicable to cases with retention of phlegm-heat in the lungs.

B. Cortex Mori Radicis (10 g), Cortex Lycii Radicis (10 g), Radix Adenophorae Strictae (12 g), Radix Scutellariae (6 g), Semen Armeniacae Amarum (10 g), Semen Coicis (10 g), Radix Ophiopogonis (10 g), Pulvis Indigo Naturalis and Gecko (wrapped in cloth, 10 g) and Folium Eriobotryae (10 g); prepared as decoction; applicable to cases with retention of phlegm-heat and consumption of lung-yin manifested as cough with profuse yellow sputum, thirst and red tongue with yellow coating.

C. External use: Pulvis Semen Sinapis Albae (30 g) and flour (30 g); mixed with water to form a paste; applied on the back for 15 minutes until the skin is reddened; once daily for three days; applicable to intractable cases or those with profuse sputum and prolonged existence of moist rales over the lungs.

Copyright 1995 Hopkins Technology


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