Chapter 64: A Child's Persistent Cough Is Not Necessarily Due to Lung Heat

"Hmm." Zhang Jing nodded and continued to ask, "Little one..."

"Doctor Uncle, my name is Xuanxuan." Liu Zixuan once again softly interrupted him.

Zhang Jing smiled slightly, then corrected himself, "I'm sorry, Uncle made a mistake. It's Xuanxuan."

Xuanxuan's mother glared fiercely at her daughter, then turned to her mother-in-law and said, "Granny, you take Xiaobao outside to wait first. I still have some questions for the doctor."

The old woman tactfully came over to pick up Xuanxuan and hurried out of the consulting room.

"When does Xuanxuan's cough usually get the worst? Is there any phlegm? What does the phlegm look like—is it watery, foamy, white and sticky, or yellow and thick?" Zhang Jing continued to ask.

"Her grandmother says the coughing is worst at night, but starting yesterday, she has been coughing quite a bit during the day too, especially when playing outdoors."

"Her voice sounds like she has phlegm, but she doesn't know how to cough it up, so we don't know what kind of phlegm it actually is."

Zhang Jing went on: "How is her appetite? Does she drink a lot of water? How are her bowel movements? Aside from the first urination in the morning, is the color of her urine yellowish?"

"She is quite picky with her food normally, and since getting sick these past few days, she is even less willing to eat. Every day she just drinks a little milk powder or pure milk and eats very little rice. Her bowels are a bit constipated, moving about once every two days; the beginning part is a bit hard, but the rest is fine. I haven't paid much attention to her urination, but it should be considered normal, I suppose."

By this point, Zhang Jing had a completely clear understanding of Xuanxuan's condition.

He gave a slight nod. "That's enough. Xuanxuan's condition is not serious. I'll prescribe three doses of herbal medicine first. After she finishes those, come back for a few more doses of conditioning herbs, and just pay attention to her diet from now on."

Although Xuanxuan's mother had already heard from Huanhuan's mother that Zhang Jing cured Huanhuan's diarrhea with just a single dose of medicine, she also knew very well that, generally speaking, a cough is much more troublesome than diarrhea.

So she asked timidly, "I'm sorry, Dr. Zhang, it's not that I don't trust you. If my Xiaobao's cough gets severe, can she take Western medicine along with it during this period?"

Before Zhang Jing could reply, Xuanxuan's mother immediately pulled several boxes of medicine out of her handbag.

"Look, all the medicine prescribed by the hospital is right here."

Zhang Jing glanced at them: Azithromycin granules, Ambroxol hydrochloride oral solution, and a box of Pediatric Lung-Cleansing and Cough-Relieving oral solution.

Xuanxuan's mother pointed to the Pediatric Lung-Cleansing and Cough-Relieving oral solution and said, "The doctor said this seems to be a Chinese patent medicine, and I often see it advertised in elevator commercials. How does that catchphrase go again? Ah yes, it's something like: 'When children's coughs just won't heal, most likely it's lung heat.'"

"Dr. Zhang, is my Xiaobao's cough really caused by lung heat?"

Zhang Jing frowned and said, "This is indeed a Chinese patent medicine for treating lung heat, but Xuanxuan's condition is definitely not lung heat; it's lung cold. In Traditional Chinese Medicine, this is called 'cold fluids attacking the lungs,' also known as the syndrome of external cold with internal fluid retention."

"Ah? Then didn't the doctors at the children's hospital prescribe the exact opposite? No wonder she never gets better! But wait, what's going on with that commercial then?" Xuanxuan's mother asked, looking a mix of angry and puzzled.

"It's not surprising that they prescribed the wrong thing, because most of the doctors who prescribe these Chinese patent medicines are trained in Western medicine. They haven't studied Traditional Chinese Medicine, so how could they possibly differentiate syndromes? Therefore, they can only treat Chinese patent medicines like Western medicines, prescribing them directly based on the disease name." Zhang Jing shook his head helplessly.

"As for that commercial, I believe the manufacturers are not short of experts in Chinese medicine and herbal remedies. However, the purpose of advertising is simply to sell more products. Therefore, they often exaggerate the effects or mislead consumers."

"The causes of coughing are diverse. As the *Plain Questions: Chapter on Coughing* states: 'The five organs and six bowels can all cause a person to cough, not the lungs alone.' Although clinically, coughs caused by the lungs are the majority, they are not mostly caused by lung heat. At least from what I have seen, the majority of cases involve the lungs suffering from cold."

Zhang Jing paused slightly, then continued with indignation, "So, this advertisement is extremely irresponsible and very easily misleads the public. Furthermore, and most importantly, I believe that all medicines, especially Chinese patent medicines, must be purchased under the guidance of a traditional Chinese medicine practitioner or pharmacist. There shouldn't be any 'brainwashing' false advertising campaigns like this at all."

Hearing this, Xuanxuan's mother nodded repeatedly. "It really is too despicable! Unscrupulous pharmaceutical merchants are tossing aside their decency just to make money!"

Then, changing the subject, she asked, "By the way, there's one more thing I'd like to ask Dr. Zhang while we're at it. Why was my Xiaobao's constitution perfectly fine before, and she rarely got sick, but as soon as she started attending the junior class at kindergarten, she catches colds and coughs every other day?"

"That's very easy to explain. Before the age of three, children are kept by their parents and protected extremely well, just like flowers in a greenhouse. But once they enter kindergarten, it's equivalent to suddenly being set free to roam, especially with so many children crammed into one classroom. That is when the real test of their constitution—meaning their resistance—officially begins."

"Oh... so that's how it is." Xuanxuan's mother suddenly understood.

Then she asked anxiously, "Does that mean our Xiaobao has a very weak constitution?"

Zhang Jing smiled slightly. "Not necessarily. It's just that due to the excessive use of Western anti-inflammatory drugs recently, especially intravenous infusion treatments, her constitution has suffered a certain degree of damage."

"What should we do?" Xuanxuan's mother seemed even more anxious.

"Xuanxuan's mum, really don't worry. As I just said, first take the three doses of herbal medicine to cure the current cough. Afterward, come back and get a few more doses of conditioning herbs, and just pay attention to dietary taboos from now on. There won't be any problems."

"Oh. Then what are the things she cannot eat?" Seeing Zhang Jing's confident tone, Xuanxuan's mother finally set her mind at ease.

"There are quite a few things to list, and you need to strictly avoid them, especially during the coughing period. Let me finish writing the prescription first, and then I'll tell you, alright?"

"Okay, okay, I'm sorry, I was too impatient." Xuanxuan's mother hurriedly apologized.

Zhang Jing began to write seriously in the medical record book.

Patient: Female, 3 years old. Ever since starting kindergarten in September, she has suffered from recurrent exogenous coughs, treated continuously with Western anti-inflammatory and phlegm-resolving medications as well as Chinese patent medicines for clearing heat and resolving phlegm, during which intravenous infusions were administered several times.

Currently on the third day of the present cough, predominantly at night, with phlegm she cannot cough out, clear nasal discharge, nasal congestion at night, occasional sneezing, slightly poor appetite, normal bowel and bladder functions.

Examination:明顯 (clear) moist rales in the right lung; pale tongue body, thin white and greasy coating, floating and weak pulse.

Writing up to this point, Zhang Jing recited silently in his heart:

*Treatise on Cold Damage*, Article 40: If cold damage has exterior syndromes that are not yet resolved, and there is water qi below the heart, accompanied by dry retching, fever, and coughing, or thirst, or diarrhea, or choking sensations, or difficulty in urination, or fullness in the lower abdomen, or wheezing, Minor Blue-Green Dragon Decoction governs it.

*Treatise on Cold Damage*, Article 41: In cold damage, with water qi below the heart, coughing and slight wheezing, fever, and absence of thirst; if after taking the decoction, thirst develops, this indicates the cold is departing and the condition is about to be resolved; Minor Blue-Green Dragon Decoction governs it.

Ephedra 3 Liang (nodes removed), Peony 3 Liang, Dried Ginger 3 Liang, Licorice 3 Liang (charred), Cinnamon Twig 3 Liang (bark removed), Asarum 3 Liang, Schisandra Fruit 0.5 Sheng, Pinellia 0.5 Sheng (washed).

These eight ingredients, take 1 Dou of water, first boil the Ephedra, reduce by 2 Sheng, skim off the froth, add the other herbs, boil to obtain 3 Sheng, remove the dregs, and take 1 Sheng warm.

If thirsty, remove Pinellia and add Trichosanthes Root 3 Liang. If slightly diarrheic, remove Ephedra and add Daphne Genkwa the size of a chicken egg, dry-fried until red. If there is a choking sensation in the throat, remove Ephedra and add 1 processed Aconite accessory root. If urination is difficult and the lower abdomen is full, remove Ephedra and add Poria 4 Liang. If wheezing, remove Ephedra and add Apricot Kernel 0.5 Sheng (peeled and pointed tips removed).

Synthesizing his thoughts, he began to write again:

Diagnosis: Taiyang Disease (Syndrome of External Cold and Internal Fluid Retention)
Prescription: Modified Minor Blue-Green Dragon Decoction (one-tenth of the original formula dosage)

Raw Ephedra 4.5g, White Peony 4.5g, Asarum 4.5g, Dried Ginger 4.5g, Cinnamon Twig 4.5g, Schisandra Fruit 4g, Ginger-Prepared Pinellia 6.5g.

Additionally: Bring your own fresh ginger 3 slices (about the size and thickness of a one-yuan coin), scallion white (scallions with the green parts removed), and 3 jujubes (broken apart).