Experience with the application of Yanghe Decoction (Part 3)
3. Treating stubborn phlegm by focusing on "deficiency and coldness"
"Phlegm is the root cause of all diseases," but it is ultimately due to deficiency of kidney yang, and the manifestations are caused by spleen deficiency, water dampness retention, and obstruction of qi circulation by pathogenic factors. When the lung qi fails to spread and descend, it loses its function of regulating water passages, and becomes the root cause of chronic illnesses. Internally, there is obstruction of qi circulation; externally, there is different susceptibility to pathogenic factors, resulting in the emergence of various symptoms. Zhongjing advocated the use of warm medicinals to treat phlegm and fluid retention. Qinbo Wei's "Qianzhai Lectures on Medical Science" first introduced the use of Yanghe Decoction to treat stubborn phlegm and coughing. With appropriate modifications based on the specific symptoms, the treatment has achieved significant results.
Case 3: Mr. X, male, 56 years old. He had a history of "chronic bronchial asthma" with frequent coughing and wheezing, shortness of breath, excessive and sticky phlegm, and difficulty in expectoration. His complexion was dull, urine was clear and long. His tongue was swollen with a white and dry coating, and his pulse was deep, thin, and weak. The pathogenic factors were lingering in the lung Yu point, and the long-term illness affected the kidneys. The lung lost its function of spreading and descending, while the kidneys lost their function of receiving and containing. The treatment should focus on promoting lung function, transforming phlegm, and tonifying the kidneys. The prescription used was: 3g of Ma Huang, Gui Zhi, Gan Jiang, Xi Xin, and Gan Cao each, 30g of cooked Rehmannia, 10g each of Su Zi, Xing Ren, Chen Pi, Ban Xia, and Lu Jiao Jiao (dissolved), and 12g of fried white mustard seed. After 5 doses, the symptoms were alleviated. The original prescription was modified by removing Gui Zhi and adding 6g of Bei Wu Wei Zi. After another 5 doses, the coughing and wheezing were relieved, and the other symptoms were not prominent. He was advised to take Jin Kui Shen Qi Wan to consolidate the results.
Note: In this case, the deficiency of kidney yang led to the transformation of body fluids into phlegm. Therefore, the Yanghe Decoction was used with a focus on the special properties of cooked Rehmannia, which are to "strengthen, stabilize, nourish, and retain," together with Lu Jiao Jiao to tonify the kidney yang and contain the qi. Ma Huang combined with Su Zi and Xing Ren promotes lung function and descends qi; Gui Zhi disperses coldness on the surface; Gan Jiang, Xi Xin, Chen Pi, and white mustard seed warm yang and transform phlegm internally. "Pungent herbs generate lung qi," "use pungent herbs to induce purgation," taking into account both the surface and interior, and addressing both the manifestations and root cause. "Urgently consume sour substances to consolidate," "use sour substances to nourish," in order to receive and contain the treatment for a faster recovery.
