CHAPTER 39 Cough During Pregnancy
Cough in pregnancy is a condition that is characterized not only by a persistent cough but also by mental restlessness and a feeling of heat.
Aetiology
Overwork
Overwork may injure Yin; as in pregnancy the Kidneys are taxed from nourishing the fetus, Kidney-Yin may develop easily. If the woman also has emotional problems such as worry, grief or sadness, the Yin deficiency will affect the Lungs also, causing a persistent cough.
Irregular diet, emotional problems
Excessive consumption of dairy and greasy foods injures the Spleen and leads to the formation of Phlegm; this may settle in the Lungs and prevent the proper descending of Lung-Qi, causing a cough. Emotional problems such as anger, frustration, resentment and worry may lead to Qi stagnation which, with time, may generate Fire. Fire combines with Phlegm easily and it may injure Lung-Yin, causing a cough.
Pathology
Thus, the pathology of cough in pregnancy consists in Lung-Qi deficiency, Lung-Yin deficiency or Phlegm-Heat obstructing the Lungs. The two patterns may also coexist as the Fire within Phlegm-Heat may injure Lung-Yin and lead to Yin deficiency. A cough from Lung-Yin deficiency is of course a dry cough with dryness of the throat, while a cough from Phlegm-Heat will be productive of yellow sputum.
Identification of patterns and treatment
The treatment principle in cough in pregnancy is either to nourish Lung-Yin and moisten the Lungs or to resolve Phlegm and clear Heat and, in both cases, to restore the descending of Lung-Qi. In addition to these treatment principles, one should also adopt the principle of calming the fetus as a persistent cough in pregnancy may lead to miscarriage. Particular care should be exercised when prescribing herbs that make Qi descend, or dry, pungent herbs that resolve Phlegm, or herbs that drain Dampness through urination during pregnancy, as all these types of herbs may cause miscarriage if used in excess.
Lung-Qi deficiency
Clinical manifestations
Mild cough, shortness of breath, tiredness, weak voice, propensity to catching colds. Tongue: Pale. Pulse: Empty.
Acupuncture
LU-7 Lieque, LU-9 Taiyuan, BL-13 Feishu, Ren-12 Zhongwan (if within 3 months of pregnancy), ST-36 Zusanli, ST-37 Shangjuxu. All with reinforcing method.
Herbal treatment
Prescription
Explanation
This formula tonifies Lung-Qi, restores the descending of Lung-Qi and stops cough.
Lung-Yin deficiency
Clinical manifestations
A dry, persistent cough that starts during the second trimester and is worse in the evenings, a dry throat, thirst with desire to drink in small sips, night sweating. Tongue: without coating and cracked; the body may be Red if there is Empty-Heat or normal if there is no Empty-Heat. Pulse: Floating-Empty, or Fine-Rapid if there is Empty-Heat.
Treatment principle
Nourish Lung-Yin, restore the descending of Lung-Qi, moisten the Lungs, calm the fetus.
Acupuncture
LU-9 Taiyuan, Ren-17 Shanzhong, KI-6 Zhaohai, BL-13 Feishu, BL-43 Gaohuangshu. All with reinforcing method.
Herbal treatment
Prescription
Explanation
Lung-Yin deficiency
A dry, persistent cough that starts during the second trimester and is worse in the evenings, a dry throat, thirst with desire to drink in small sips, night sweating. Tongue: without coating and cracked; the body may be Red if there is Empty-Heat or normal if there is no Empty-Heat. Pulse: Floating-Empty, or Fine-Rapid if there is Empty-Heat.
Phlegm-Heat in the Lungs
Clinical manifestations
Cough that is productive of yellow sputum, a feeling of oppression of the chest. Tongue: Swollen with a sticky, yellow coating. Pulse: Slippery and Rapid.
Acupuncture
SP-9 Yinlingquan, ST-40 Fenglong, BL-20 Pishu, LU-5 Chize, LU-6 Kongzui. All with even method, except for BL-20 which should be needled with reinforcing method.
Herbal treatment
b Prescription
c Prescription
Explanation
The first six herbs constitute the formula Er Chen Tang which resolve Damp-Phlegm.
To compare and contrast the above three formulae for cough in pregnancy, the first one, Xiao Xian Xiong Tang, purely resolves Phlegm-Heat and does not have a strong Lung-Qi-descending action: it is therefore indicated if Phlegm and Heat predominate and the woman has a lot of mucus while the cough is not too severe. The second one, Qing Jin Jiang Huo Tang, has a stronger effect in resolving Phlegm and, in addition, it also strongly promotes the descending of Lung-Qi to stop coughing. The third one, Zhi Jie Er Chen Tang, resolves Damp-Phlegm rather than Phlegm-Heat.
Phlegm-Heat in the lungs
Cough that is productive of yellow sputum, a feeling of oppression of the chest. Tongue: Swollen with a sticky, yellow coating. Pulse: Slippery and Rapid.
Prognosis and prevention
Cough in pregnancy responds well to treatment, and especially with herbs rather than with acupuncture. The pattern from Yin deficiency is more difficult to treat than the one from Phlegm-Fire. Although most cases will react to treatment, the woman needs to be patient as some cases of cough can be quite stubborn and resistant to treatment. On average, the treatment should give good results in about one month.
If the woman suffers from the pattern of Phlegm-Heat, it is important for her to refrain from eating too many dairy foods or greasy foods; she should also abstain from eating spicy, hot foods.
), People’s Health Publishing House, Beijing, Vol. 3, p. 57. First published in 1742..