shanghanlun

Pueraria, Skullcap and Coptis Decoction for Damp-heat Diarrhea with Panting (line 34)

By Fornia ⋅ March 11, 2008 ⋅  Print This Post ⋅ Post a comment

太阳病，桂枝证，医反下之，利遂不止，脉促者，表未解也… (line 34a)

When happened was that a person with exterior symptoms (cinnamon twig pattern) was treated with precipitation. Now, the poor person is of course suffering from medicine-induced diarrhea on top of his earlier problem of an exterior pattern. His pulse is rough and his loose stool is ever flowing. On top of that he’s still feeling aversion to cold, has some fever and perhaps an aching body.

喘而汗出者，葛根黄芩黄连汤主之。 (line 34b)

The second part to line 34 suggests that heat is not just present in the enteric system, it’s there in the lungs too. Internal heat is causing panting as well as perspiration. But just looking at the formula, we realize that none of the herbs actually deal with the panting and perspiration – Ephedra (麻黄) would make more sense.

Treatment:

We use Pueraria (葛根) to treat his exterior symptom. Interestingly, Cinnamon Twig (桂枝) is not used. While both herbs are acrid in nature, Pueraria (葛根) is cooling while Cinnamon Twig (桂枝) is warm. In my opinion, the wind-cold has transformed into heat (化热). Either that or the medicine used to induce precipitation is warm in nature and hence not of the Rhubarb (大黄) variety. In any case, what we have is damp-heat.

Treatable using the Coptis (黄连) and Skullcap (黄芩). Both are not just cold and bitter, they have a drying action and take away dampness.

My take on this

1. Using TCM theory, we can say that the lung and large intestines are inter-related in an inetrio-exterior sort of way (肺与大肠相表里). Which to me still begs the question.
2. This is a deficient person, so he doesn’t need to open his airways using beta agonists like Epehdra. He just needs something to work on his blood vessels and regulate his system. I know it’s kinda vague here, but we know both Cinnamon Twig (桂枝) and Pueraria (葛根) do just that, the only difference being their nature (warm or cooling).
3. In the end, the problem in the lung functional system (i.e. breathing problems and perspiration) is not the main problem here. The idea is that by dealing with the diarrhea, the rest will resolve on their own.

But what if the panting is also intense?

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