We Compare Two Formulas for Dryness in the Lung
In Traditional Chinese Medicine (TCM) theory, the Lung encompasses the entire respiratory system including the nose, nasal and oral cavities, sinuses, pharynx, and larynx, trachea, bronchi, the structures of the lungs such as bronchioles and alveoli, and the diaphragm. These tissues comprising the Lung are the Yin aspect. The Lung’s Qi aspect is to govern Qi in the body, particularly its dispersing and descending functions. In addition, the Lungs (plus the skin and muscles) are the location of the Defensive Qi (Wei qi 衛氣) which protect the body from invasion of Evil Qi.
The Lung is known as the ‘tender or delicate organ’ since it is the only Zāng fǔ 髒腑 open to the exterior. For this reason, the Lung is the organ that is most easily and directly affected by external Evil Qi (Xiéqì 邪氣) particularly Wind, Heat, Fire, Cold, Dampness, and Dryness. This discussion will focus on Dryness affecting the Lungs and possible ameliorating remedies.
The Lung prefers to be moist, but not soggy or damp, which is an important consideration for maintaining normal Lung function. Consequently, Dryness is a particularly insidious etiological factor that may cause patients’ discomfort. Dryness in the Lung may be the result of Wind Heat or Heat scorching the Lung Yin, exposure to environmental dryness such as that found in a particularly dry climate, contact with ‘warm, dry air’ including smoke from tobacco, cannabis, or fires, or even mouth breathing while sleeping in a warm, dry bedroom. Traditionally, due to the general climate in China, this dry condition is thought to occur most often in late autumn or early winter months and corresponds to the season associated with the Metal Element and the Lung. Dryness passing from the Exterior into the Wei or Qi Levels may appear with an acute onset or it may be a factor in a chronic unresolved condition that is exacerbated by constitutional deficiency.
These two formulas, although comprised of completely different herbs, can be used for either etiology, although there are subtle differences in clinical signs and symptoms that may provide guidance in their selection. The first is more commonly used for acute conditions and the second is indicated in more chronic cases.
Qīng Zào Jiù Fèi Sàn / 清燥救肺散
Decoction to Eliminate Dryness in the Lung
Qing Zao Jiu Fei San is a Qing Dynasty formula that was first published in Yī Mén Fǎlǜ 醫門法律 (Medical Law) in 1765. This modified, classic herb prescription counteracts the symptoms associated with warmth and dryness damaging the Lung. A Heat or Wind-Heat invasion may result in inflammation ‘burning’ the Lung resulting in damage to Lung tissues. This Yin damage impairs the Lung Qi’s normal clearing, moistening and descending functions. Typical symptoms include a mild or occasional dry, non-productive cough, usually with no phlegm or with scanty phlegm that is difficult to expectorate, headache, fever, the possibility of wheezing due to failure of the Lung Qi to descend, thirst, possible hiccups, and dry nose and mouth. In addition, there may be fullness and stuffiness in the chest and diaphragm, and even minor hypochondrial pain. Ancillary signs of warm and dry damage to the lungs include a dry tongue with a thin white coat (or very little coating) and, if Wind Heat is still present, there may be a red tip. The pulse may be weak, perhaps thin, but large and rapid. A weak pulse indicates that the condition is challenging the Zhèng qì 正氣 and a large pulse (Dà mài 大脈) indicates either Evil Qi entering the body or possibly Yang deficiency. A rapid pulse may be an indication of residual Heat.
The diagnosis is Warm-Dryness attacking the Lung and leading to rebellious Lung Qi with slight injury to the Lung Qi and Yin. The treatment plan is Clear Heat, Eliminate Dryness, Moistens the Lung, and Restore Downward Flow of Lung Qi. The prescription uses the four methods of dispersing, clearing, moistening, and descending Qi at the same time, which replenishes both Qi and Yin, and disperses without consuming Qi, clears Heat without hurting the Middle Jiao, and moisturizes without creating dampness below the Diaphragm.
Usage
Dosage guidance: Administer half an hour before or one hour after eating. In the initial phases, dosage may be increased to 3-4 grams every 2-4 hours, then reduced to a maintenance dose as the formula takes effect. May be used short to medium-term for several days to several weeks.
Importantly, once the acute symptoms of the external invasion are resolved, this formula should be discontinued or replaced with an appropriate Lung Qi and Yin tonic, such as Sha Shen Mai Dong San or Sheng Mai San.
Contraindications: Use with caution in Spleen deficient patients with a tendency to loose stools, diarrhea, poor appetite or chronic digestive weakness. Contraindicated for deficiency in the absence of symptoms of a warm dryness external invasion.
Qing Zao Jiu Fei San
| Sang ye | Morus alba leaf | Clears and disperses Lung Dryness and stops cough | |
| Shi gao | Gypsum fibrosum mineral | Clears Lung Heat and nourishes body fluids | |
| Nan sha shen | Adenophora tetraphylla root | Nourishes Yin, moistens the Lungs, dispels Phlegm and stops coughing; Clears Heat, generates fluids, and Nourishes the Stomach | |
| Mai men dong | Ophiopogon japonicus tuber | Moistens the Lungs, nourishes Yin, stops coughing and generates Fluids | |
| Pi pa ye (zhi) | Eriobotrya japonica leaf (honey-fried) | Descends Lung Qi, moistens the Lungs, transforms Phlegm and clears Lung Heat | |
| Hei zhi ma | Sesamum indicum seed | Moistens the Lungs and nourishes Yin | |
| E jiao | Equus asinus gelatin | Moistens the Lungs and nourishes Yin | |
| Xing ren (ku) | Prunus armeniaca seed | Descends Lung Qi, moistens the Lungs and stops coughing and wheezing | |
| Gan cao | Glycyrrhiza uralensis root | Moistens the Lungs, stops cough, clears Heat and harmonizes |
Bèi Mǔ Guā Lóu Sàn / 贝母瓜蒌散
Fritillaria and Trichosanthis Powder
Another herb formula to consider from the Qing Dynasty is Bei Mu Gua Lou Powder, which was first published in Yīxué xīn wù医学心悟 (Medical Insights). The keynote difference that suggests this formula is the actual presence of viscous and sticky ‘dry’ phlegm, that is also difficult to expectorate. The Dry Phlegm syndrome that is treated by this prescription is caused by Dry Heat damaging the Lung, burning body fluids to form Phlegm, Dry Phlegm blocking the Lung, and the Lung losing its ability to clear and purify. An example is the common chronic cough that is dry, usually non-productive, and weak, although it may be hacking, and it is sometimes worse upon rising after a night’s sleep. Sometimes, the patient will reveal that it can arise during extended speaking or when laughing. This sort of damage to the Lung is closely related to the long-term smoking of tobacco or cannabis, ‘smoker’s cough’, repeated exposure to other respiratory irritants, or living in a home with a fireplace or wood-burning stove. Evidence shows that ‘vaping’ of tobacco or cannabis also challenges the Lung since, although there is less ‘smoke’, the combustion products of vaping are also a vector for Heat and subsequent damage to the Lung Yin. Additionally, there is recent research suggesting that gas stoves release combustion products that may damage the Lung. Other symptoms include shortness of breath, possible wheezing and/or dyspnea, dry mouth and throat, perhaps a raspy or weak voice, and occasionally a minor sore throat. Ancillary signs include a tongue that is red and dry with a scanty coat and a rapid, thin, strong (perhaps wiry) pulse. If the pulse is wiry, consideration of Wood insulting Metal may be indicated.
The diagnosis is Phlegm-Heat and Dryness in the Lung or Lung Yin Deficiency with Phlegm-Fire. The treatment plan is to Moisten the Lung, Clear Heat, Regulate Qi, and Transform Phlegm. The prescription uses herbs that are clearing, moistening and dispersing, and that harmonize the Lung and Spleen, focusing on moistening the lungs and resolving phlegm, and resolving phlegm without damaging body fluid.
Usage
Dosage guidance: Administer half an hour before or one hour after eating. In the initial phases, dosage may be increased to 3-4 grams 3 times per day, then reduced to a maintenance dose as the formula takes effect. May be used long-term for several weeks to several months. May be used over the course of several years.
Contraindications: Contraindicated for cough due to Yin deficiency. Smokers must stop smoking entirely or the condition will not improve and may lead to worsening symptoms.
Bei Mu Gua Lou San
| Chuan bei mu | Fritillaria cirrhosa bulb | Moistens the Lungs, clears Heat, transforms Phlegm and stops coughing | |
| Gua lou shi | Trichosanthes kirilowii fruit | Clears Heat, moistens Dryness, regulates Qi and expels Phlegm to remove obstruction from the chest and diaphragm | |
| Tian hua fen | Trichosanthes kirilowii root | Clears and drains Lung Heat, transforms Phlegm, moistens Lung Dryness, generates fluids and relieves toxicity | |
| Fu ling | Poria cocos sclerotium | Promotes urination. resolves Dampness, strengthens the Spleen, harmonizes the Middle Jiao and transforms Phlegm | |
| Ju hong or Chen pi | Citrus rubrum peel or Citrus reticulata peel | Regulates Qi, dries Dampness, transforms Phlegm, descends Qi, harmonizes the Middle and regulates the Stomach | |
| Jie geng | Platycodon grandiflorum root | Opens the Lungs, expels Phlegm and pus, benefits the throat and directs the effects of other herbs to the upper body |
Both formulas are available in extract powder/granule form. Mayway’s Plum Flower™ Formulas contain no excipients and are 100% extracted herbs. They are also available from Mayway’s Dispensary where they can be used as a base formula that a practitioner can augment as desired. As always, any product or prescription can be shipped directly to your patient and billed to you.
Dryness affecting the Lung is an increasingly common condition seen in patients. Although cigarette smoking is waning, cannabis smoking (and vaping) is on the rise. Additionally, wildfire incidence is more common with the obvious increase in global temperature along with drought in many areas. These two formulas may provide relief to some of the difficulties that patients experience.
Please note that Qing Zao Jiu Fei San contains E Jiao and cannot be shipped within California. Click here for more information.
References
- Maciocia, G., Diagnosis in Chinese Medicine: A comprehensive guide, Churchill Livingstone: London 2004.
- Maciocia, G., The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists, Churchill Livingstone: London 1989.
- Penner, J., American Dragon https://www.americandragon.com/
- Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
- baike.baidu.com
- zysj.com.cn
- baike.baidu.com
- zysj.com.cn
