Recurrent Cough in Chronic Obstructive Pulmonary Disease - National TCM Master Deng Tietao’s “Tonify Earth to Generate Gold: Cough-Suppressing and Root-Securing Formula”
24. Recurrent Cough in Chronic Obstructive Pulmonary Disease - National TCM Master Deng Tietao’s “Tonify Earth to Generate Gold: Cough-Suppressing and Root-Securing Formula”
Deng Tietao, a National Master of TCM, advocated the “Tonify Earth to Generate Gold” approach in treating chronic pulmonary diseases - not merely treating the Lung, but placing equal emphasis on strengthening the Spleen.
Pathogenesis
Chronic bronchitis, prolonged in course, leads to dual deficiency of Spleen and Lung. Spleen deficiency impairs its transportive and transformative functions, causing internal generation of phlegm-dampness that ascends and accumulates in the Lung. The Lung loses its ability to disperse and descend, resulting in cough and reversed Qi. Over time, this depletes Qi and further worsens Spleen deficiency, forming a vicious cycle. This formula takes the Four Gentlemen Decoction to strengthen the Spleen and treat the root, combined with cough-suppressing and phlegm-transforming herbs to descend Qi and treat the branch, thereby tonifying Earth to generate Gold.
Formula Composition
Tonify Earth to Generate Gold: Cough-Suppressing and Root-Securing Formula (Pei Tu Sheng Jin Zhi Ke Gu Ben Fang)
Composition: Five-Finger Hairy Fig Root 20g, Honey-processed Astragalus 15g, Codonopsis 12g, Processed Pinellia 10g, Tangerine Peel 10g, Poria 15g, Perilla Seed 10g, Rapeseed 10g, Honey-processed Aster 10g, Honey-processed Stemonaria 10g, Northern Apricot 10g, Pumice 10g, Winter Melon Seed 10g, Tangerine Peels 6g, Honey-processed Licorice 5g
Efficacy: Boosts Qi and strengthens the Spleen, transforms phlegm and descends Qi, supplements the Lungs and stops cough, tonifies Earth to generate Gold
Indications: Chronic bronchitis (dual Spleen-Lung deficiency with internal phlegm-dampness pattern), characterized by recurrent cough, white abundant phlegm, fatigue, poor appetite, pale tongue with white greasy coating
Five-Finger Hairy Fig Root, Honey-processed Astragalus, and Codonopsis serve as the sovereign herbs, boosting Qi and strengthening the Spleen, tonifying Earth to generate Gold. Five-Finger Hairy Fig Root is the root of Five-Finger Hairy Fig (Mango Tree Root), also known as “Southern Astragalus”; it boosts Qi without being warming-drying, supports the righteous without impeding pathogenic factors; combined with Astragalus and Codonopsis, the three herbs jointly build the foundation of Spleen-strengthening and Qi-boosting. Poria, Processed Pinellia, and Tangerine Peel serve as the ministers, strengthening the Spleen and draining dampness, drying dampness and transforming phlegm - taking the spirit of the Two Cents Decoction to cut off the source of phlegm generation, while also regulating Qi and harmonizing the Stomach. Perilla Seed and Rapeseed serve as the ministers, descending Qi to dispel phlegm, suppressing cough and calming asthma - taking the spirit of the Three Seeds Nourishing the Parents Decoction; Perilla Seed descends Lung Qi, while Rapeseed digests food and transforms phlegm. Honey-processed Aster, Honey-processed Stemonaria, and Northern Apricot serve as the assistants, moistening the Lungs and transforming phlegm, descending Qi and stopping cough - Aster and Stemonaria are honey-processed to enhance their moistening properties, while Northern Apricot disperses and descends Lung Qi. Pumice, Winter Melon Seed, and Tangerine Peels serve as the assistants, clearing the Lungs and transforming phlegm, softening hardness and unblocking the collaterals - Pumice resolves stubborn old phlegm, Winter Melon Seed clears the Lungs and expels turbidity, Tangerine Peels move Qi and unblock the collaterals. Honey-processed Licorice serves as the envoy, boosting Qi and harmonizing the middle, moderating all the herbs.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Sovereign | Five-Finger Hairy Fig Root 20g, Honey-processed Astragalus 15g, Codonopsis 12g | Boost Qi and strengthen the Spleen, tonify Earth to generate Gold; Five-Finger Hairy Fig Root (Southern Astragalus) boosts Qi without being warming-drying; combined with Astragalus and Codonopsis, the three herbs build the foundation of Spleen-strengthening |
| Minister | Poria 15g, Processed Pinellia 10g, Tangerine Peel 10g | Strengthen the Spleen and drain dampness, dry dampness and transform phlegm; taking the spirit of Two Cents Decoction to cut off phlegm generation, also regulating Qi and harmonizing the Stomach |
| Minister | Perilla Seed 10g, Rapeseed 10g | Descend Qi to dispel phlegm, suppress cough and calm asthma; taking the spirit of Three Seeds Nourishing the Parents Decoction |
| Assistant | Honey-processed Aster 10g, Honey-processed Stemonaria 10g, Northern Apricot 10g | Moisten the Lungs and transform phlegm, descend Qi and stop cough; honey-processing enhances moistening; Northern Apricot disperses and descends Lung Qi |
| Assistant | Pumice 10g, Winter Melon Seed 10g, Tangerine Peels 6g | Clear the Lungs and transform phlegm, soften hardness and unblock collaterals; Pumice resolves stubborn old phlegm, Winter Melon Seed clears the Lungs, Tangerine Peels move Qi |
| Envoy | Honey-processed Licorice 5g | Boost Qi and harmonize the middle, moderate all the herbs |
Pattern-Based Modifications
| Coexisting Pattern | Modified Herbs |
|---|---|
| Cough severe with abundant clear thin phlegm | Add White Mustard Seed 10g, enhance warming-transformation of cold phlegm |
| Obvious panting and difficulty breathing | Add Goose Pipe Stone 30g (decoct first), warm the Lungs and descend counterflow to calm asthma |
| Food stagnation with abdominal distension, thick greasy coating | Add Buzha Leaf 15g, Mango Kernel 10g, digest food and guide stagnation |
| Exogenous wind-cold trigger, aversion to wind and itchy throat | Add Xiqiancao 15g, Mulberry Leaf 10g, Mint 6g (add near end of decoction), disperse wind and disperse the Lungs |
| Autumn dryness with dry cough, dry throat with sticky phlegm | Add Glehnia 15g, White Pear Skin 15g, moisten the Lungs and generate fluids |
| Dual Lung-Kidney deficiency, panting on exertion | Add Gecko 1 pair, Schisandra 6g, gather Qi and return it to the Kidneys |
| Phlegm-heat congestion, yellow phlegm with yellow tongue coating | Add Scutellaria 12g, Trichosanthes 15g, Tianzhuhuang 10g, clear and transform heat-phlegm |
Summary
This formula is a modification of the Four Gentlemen Decoction (Five-Finger Hairy Fig Root replacing Prince Ginseng, combined with Honey-processed Astragalus and Codonopsis) to strengthen the Spleen and boost Qi to consolidate the root; combined with the Two Cents Decoction method to dry dampness and transform phlegm, and the Three Seeds Nourishing the Parents Decoction method to descend Qi and dispel phlegm to treat the branch; with Aster, Stemonaria to moisten the Lungs and stop cough; Pumice, Winter Melon Seed, and Tangerine Peels to clear and resolve old phlegm. It is suitable for the chronic phase of chronic bronchitis belonging to dual Spleen-Lung deficiency with internal phlegm-dampness - recurrent cough, white abundant phlegm, fatigue and poor appetite, pale tongue with white greasy coating - it should not be used during acute infection periods.
References
[1] Deng Tietao. Deng Tietao’s Clinical Experience Collection [M]. Beijing: China Medical & Health Technology Press, 1998.
[2] Deng Tietao. Deng Tietao’s Medical Collection [M]. Beijing: People’s Medical Publishing House, 1995.
[3] Deng Zhongguang, Qiu Shijun, et al. Introduction to Professor Deng Tietao’s Empirical Formulas [J]. New TCM, 1998.
24. 老慢支咳嗽反覆，國醫大師鄧鐵濤「培土生金止咳固本方」
鄧鐵濤國醫大師，治慢性肺病主張”培土生金”——不獨治肺，重在健脾。
病機
慢性支氣管炎遷延日久，脾肺兩虛。脾虛失運，痰溼內生，上貯於肺；肺失宣降，咳嗽氣逆，日久耗氣又加重脾虛，形成惡性循環。本方以四君子湯健脾治本，合止咳化痰藥降氣治標，培土以生金。
方藥組成
培土生金止咳固本方
五爪龍 20g 炙黃芪 15g 黨參 12g 法半夏 10g
陳皮 10g 茯苓 15g 蘇子 10g 萊菔子 10g
蜜紫菀 10g 炙百部 10g 北杏仁 10g 浮海石 10g
冬瓜仁 10g 橘絡 6g 炙甘草 5g
| 藥組 | 藥物 | 功用 |
|---|---|---|
| 君 | 五爪龍 20g、炙黃芪 15g、黨參 12g | 益氣健脾，培土生金。五爪龍即五指毛桃根，又稱”南芪”，補氣而不溫燥、扶正而不礙邪；合黃芪、黨參，三味共築健脾益氣之基 |
| 臣 | 茯苓 15g、法半夏 10g、陳皮 10g | 健脾滲溼，燥溼化痰。取二陳湯之意，絕生痰之源，兼理氣和胃 |
| 臣 | 蘇子 10g、萊菔子 10g | 降氣消痰，止咳平喘。取三子養親湯之意，蘇子降肺氣、萊菔子消食痰 |
| 佐 | 蜜紫菀 10g、炙百部 10g、北杏仁 10g | 潤肺化痰，降氣止咳。紫菀、百部炙用增強潤性，北杏仁宣降肺氣 |
| 佐 | 浮海石 10g、冬瓜仁 10g、橘絡 6g | 清肺化痰，軟堅通絡。浮海石化老痰頑痰，冬瓜仁清肺排濁，橘絡行氣通絡 |
| 使 | 炙甘草 5g | 益氣和中，調和諸藥 |
加減法
| 兼證 | 加減藥物 |
|---|---|
| 咳甚痰多清稀 | 加白芥子 10g，增強溫化寒痰之力 |
| 喘促明顯 | 加鵝管石 30g（先煎），溫肺降逆平喘 |
| 食滯腹脹、苔厚膩 | 加布渣葉 15g、芒果核 10g，消食導滯 |
| 外感觸發、惡風咽癢 | 加豨籤草 15g、桑葉 10g、薄荷 6g（後下），疏風宣肺 |
| 秋燥乾咳、咽乾痰黏 | 加沙參 15g、雪梨皮 15g，潤肺生津 |
| 肺腎兩虛、動則氣喘 | 加蛤蚧 1對、五味子 6g，納氣歸腎 |
| 痰熱壅盛、痰黃苔黃 | 加黃芩 12g、瓜蔞 15g、天竺黃 10g，清化熱痰 |
五、小結
本方以四君子湯化裁（五爪龍代太子參合黃芪、黨參）健脾益氣培其本，二陳湯法燥溼化痰、三子養親湯法降氣消痰治其標，佐紫菀、百部潤肺止咳，浮海石、冬瓜仁、橘絡清化老痰。適用於慢性支氣管炎遷延期屬脾肺兩虛、痰溼內蘊者——咳嗽反覆、痰白量多、神疲納差、舌淡苔白膩——急性感染期不宜。
參考文獻
[1] 鄧鐵濤. 鄧鐵濤臨床經驗輯要[M]. 北京：中國醫藥科技出版社，1998.
[2] 鄧鐵濤. 鄧鐵濤醫集[M]. 北京：人民衛生出版社，1995.
[3] 鄧中光，邱仕君，等. 鄧鐵濤教授經驗方介紹[J]. 新中醫，1998.