TCM and Pertussis

I used to live in an apartment building with many neighbors and thin walls. Building acoustics were quite remarkable. In my head, I’d prescribe herbs to neighbors based on their coughs. Dry coughs, wet coughs, weak and strong coughs, each one has a Traditional Chinese Medicine (TCM) diagnosis and a formula or two. A severe hacking cough that ends in a high-pitched gasp or whoop, is no doubt whooping cough. Fact: Whooping cough or pertussis can present without the whoop. Caused by the bacteria Bordetella pertussis, this highly communicable disease, is known in TCM as “The Hundred Day Cough”.

Pertussis is most serious for babies, where the bacteria, can stop lung function resulting in death. All ages are susceptible to varying degrees of severity depending on vaccination status and general health. The infection is generally milder in teens and adults, especially those who have gotten the pertussis vaccine. As a bacterial infection it can be treated with antibiotics. This doesn’t take away the symptoms, the result of the distressed tissues, but the patient is no longer contagious. The bacteria are spread via droplets when sneezing, coughing or laughing.

TCM treats pertussis as it would treat a common cold. The herbal strategy addresses the symptoms, alleviates discomfort and prevents the pathogen from becoming trapped. Trapped pathogens can affect health in both the short and long-term. In the short term, the illness can take longer to resolve or turn into a secondary infection. Long-term effects range from poor immunity to chronic inflammatory conditions. There are three stages to this disease and TCM formulas appropriate to symptoms of each.

Stage One is the Catarrhal Phase and lasts one to two weeks.

It presents like an unremarkable common cold. There is sneezing, runny nose and tearing eyes. The patient is listlessness. A low-grade fever is optional. Then a dry hacking cough gradually makes an appearance, most likely at night. This stage is highly contagious. TCM calls this is an invasion of the Lung by Wind. All pathogens or evils enter the body on Wind. The initial symptoms described are typical Wind-Cold. The formula to reach for is Gan Mao Ling. There are herbs in this formula are good for Wind-Cold and Wind-Heat.⁽¹⁾ This is handy as the Wind-Cold turns to Wind-Heat during Stage One. Wind-Heat presents with more coughing, thicker, colored phlegm and a sore throat. When there are heat signs a cooling formula is needed. Choose Yin Qiao if a sore throat is prevalent .⁽⁷⁾ If the sore throat is very pronounced with swollen glands opt for Chuan Xin Lian.⁽¹⁾ For a cough that has increasingly thick, yellow phlegm the formula is Qi Qing Hua Tan Wan.⁽¹⁾ If the symptoms are severe use the formula of choice with Gan Mao Ling. This first stage is ironic. It is the most contagious and yet it is unclear that the illness is anything other than a gnarly cold.

Consider coughing. A cough moves at 60 miles per hour. Each cough is a tiny 60 mph wind. Storm force winds start at about 58 mph. As the chosen vehicle of a bacterial infection spread by droplets, a cough is quite effective. Inside the body each cough is a storm ripping through the lungs, drying them and distressing the lung tissue. In TCM the Lungs are known as the “delicate organ” due to their susceptibility to invasion. One of their functions is to bring in Qi from the air and govern the Qi of the body. Coughing illnesses are exhausting because this function is disrupted.⁽²⁾

The second stage is the Paroxysmal Phase.

This consists of one to four weeks of frequent coughing fits. These can occur up to 50 times in a day. They are sudden and intense. The coughing can produce large amounts of phlegm that is difficult to expectorate. Sometimes a fit ends in vomiting. It is at this stage that whooping appears. Factoid: Pertussis can be present without whooping. This stage is less contagious than the first, though the patient may feel worse; out of the frying pan and into the fire. TCM labels these symptoms as hot phlegm turning into fire phlegm. The gasping or whoop is the result of the fire drying the phlegm to the extent it is difficult to expectorate. The herbal tactic is to clear the heat and dissipate the thickened phlegm.

Formulas that include the herb Huang Lian should be used. This herb has broad spectrum antibiotic effects which include inhibition of Bordetella pertussis. Huang Lian works best with friends. When used in a formula Huang Lian reportedly enhances the antibiotic effectiveness over tenfold with little incidence of resistance.^(3)(4)(5)(6) In this second stage with a cough that has sticky phlegm and whooping or gasping Huang Lian Jie Du Wan is a good choice.⁽⁷⁾ This formula contains our antibiotic star Huang Lian, and others with similar properties. Belamcanda 15 made by Seven Forests is right for a cough and sore throat. It doesn’t have Huang Lian in it. It does have herbs which calm cough, dispel phlegm, restore the Yin to the dried out tissues. If the cough is predominantly dry this is a deficiency of Lung Yin. Find some Bai He Gu Jin Wan or Sha Shen Mai Men Dong Wan (Autumn Rain Teapills made by Plum Flower).⁽⁷⁾

The third and final stage is the Recovery Phase.

This phase starts around week 4 and can last 7 weeks. The cough is less severe and gradually goes away. The patient is no longer contagious. In TCM this stage represents the damage of Lung and Spleen by long-term coughing, causing a deficiency of Qi and Yin. Depending on the constitution of the patient residual coughing and fatigue can last for months. There are two herbs which help with both the Qi and the Yin, Cordyceps and American Ginseng. Cordyceps or Dong Chong Xia Cao is the carcass of a caterpillar (Hepialus variant) and the fungus that grows on it. Humble beginnings. Cordyceps nourishes both Yang and Yin. It warms the Kidney Yang to combat Qi exhaustion. In the Lungs it nourishes the Yin for chronic coughing.⁽⁷⁾ American Ginseng or Xi Yang Shen nourishes the Yin more than Cordyceps. This root is useful at the end game of an illness when the symptoms are weakness, irritability, and thirst. Like Cordyceps, American Ginseng nourishes the Lung Yin, treating dry chronic cough, wheezing and blood-streaked sputum.⁽⁷⁾ If symptoms include night sweats, hot palms, and soles, dry throat, this indicates deeper damage to the Yin. Add in Bai He Gu Jin Wan or Sha Shen Mai Men Dong Wan (Autumn Rain by Plum Flower).⁽⁸⁾

Serving size: Consume according to label directions or instructions from your knowledgeable healthcare practitioner.

Disclaimer: Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

Stay well and if you do get sick cover your cough, your sneeze, and your laugh. Wash your hands often and stay home from work or school. Not spreading your illness is one of the kindest things you can do.

References

1 Fratkin, J., Chinese Herbal Patent Formulas, Shya Publications, 1986

2 Maciocia, G., The Foundations of Chinese Medicine, Churchill Livingstone, 1989

3 Chen, J., Chen, T., Chinese Medical Herbology and Pharmacology, Art of Medicine Press, 2004

4 Zhong Yao Xue, Chinese Herbology, 1988

5 Zhong Hua Yi Xue Za Zhi, Chinese Journal of Medicine, 1958

6 Zhong Xi Yi Jie He Za Zhi, Journal of Integrated Chinese and Western Medicine, 1989

7 Bensky, Scheid, Ellis, Barolet Formulas and Strategies. Portable 2nd edition. Eastland Press Inc. 2015

8 Bensky, Gamble, Chinese Herbal Materia Medica, Eastland Press, 1993