[Case study]One case of chronic cough with phlegm and tight chest for years

One patient, male, Asian, 54 years old, complained of pharyngeal discomfort and throat clearing for more than ten years. At the same time, the cough has not been relieved after a cold two years ago. The specific manifestations include: rales can be heard when breathing, and frequent throat clearing, a very tight chest slight releasing with the pressing, and the position is probably between Tiantu and Tanzhong points. Thick white and clear phlegm in green bean size, very difficult to cough up. A gritty foreign body sensation in the throat. Dry throat, like to drink a large amount of water, acid reflux, frequent urination, late sleep, not hungry or sleepy. Hay fever. The middle and rear part of the tongue is thick and the sublingual vein is tortuous. The whole pulse is deep, taut, fast, and tight overall, the right Cun sinking position is strong, and the right Chi is slightly stiff.

There are many health issues in this patient. We solve the main complaint first- the lung problem. The principals are focusing on opening up the chest and regulating qi, reducing phlegm and descending lung qi, and taking into account blood stasis as well.

After the first week of medication, the patient was very happy with the effect and reported that the rales disappeared, the chest tension was significantly improved, the phlegm basically disappeared, the sleep was improved, and he started to feel more sleepy at night. After the second week of medication, the patient said that he felt no different from before the illness. However, although the pulse has been better, it has not been completely improved, and he is instructed to continue to take medicine to consolidate.

A few points to discuss here:

First, as the Chinese saying goes: sickness comes like a mountain falling down, sickness goes like a thread pulling out. For the treatment of chronic diseases in the excess situation like this patient,  the effect can be very fast, but in order to completely remove the root of the disease, the patient needs to be more patient and spend more time removing all the root issues. Generally speaking, for the treatment of non-deficiency diseases, it may only take 30% of the time to improve the first 70% of symptoms, but it takes 70% of the time to improve the symptoms of the last 30%.

Second, the importance of pulse syndrome is also clearly reflected in this case. Although the patient feels normal, only by feeling the qi with pulse check,  the patient’s degree of improvement can be truly and objectively reflected. If the important role of the pulse is ignored, and only the formula-symptom corresponding method in TCM is used to formulate the prescription, it is impossible to accurately evaluate the condition of the patient who has “no manifested symptoms”.