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Acupuncture Today
November, 2007, Vol. 08, Issue 11
 
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Pertussis (Whooping Cough)

By Tanya L. Carleton, LAc

Pertussis, or whooping cough, "is an acute, highly communicable infection of the respiratory tract caused by Bordetella pertussis. B pertussis organisms attach to the ciliated respiratory epithelium and multiply there."1 The disease has an insidious onset.

Initial symptoms include rhinitis, sneezing, cough and possibly fever. After a couple of weeks, the cough becomes spasmodic, and the disease progresses to the second stage. Patients may or may not present with the characteristic "whooping" sound when coughing. Vomiting may often follow a coughing jag. Sweating, exhaustion and pallor accompany coughing. This stage usually lasts for two to four weeks, with gradual improvement. Spasmodic coughing jags may continue for months.

In adults, older children and partially immunized individuals, symptoms may consist of only an irritating cough that lasts one to two weeks. In the younger child who has not been immunized or has not yet completed the primary vaccination series, these symptoms could persist for as long as several months. The condition is most serious in this subset of the population, with this group accounting for the most deaths from whooping cough. A patient with pertussis will have an elevated white blood-cell count and an elevated lymphocyte count. The diagnosis can be confirmed by a culture of the patient's nasal secretions. Immunity is experienced following a bout of pertussis.

Transmission

Pertussis is transmitted via direct contact with an infected person. Adults and adolescents who have mild respiratory illness that has not been recognized as pertussis are a common source of infection. In the United States, 8,296 cases were reported in 2002. The incidence of pertussis has increased since the 1980s, and there has been a disproportionate increase in adolescent and adult infection.2 The fact that immunity wanes five to 10 years after the vaccination is what makes youth and adolescents susceptible to this illness. In practice, pertussis is most commonly seen in children in elementary and middle school.

Chinese Medicine

The early stage of whooping cough is due to a pathogenic invasion of the lung and the wei system, which results in lung qi rebelling upward. This causes a cough similar to the common cold. If the pathogen is not dispelled, it turns into fire and condenses the body fluids into phlegm. This combination of fire and phlegm blocks the airway and further disrupts the flow of lung qi. In the later stage of the illness, phlegm and heat have usually dissipated, while the main presentation is one of an injured lung and spleen with deficiency of both qi and yin.

Differentiation

Invasion of Lung by Pathogenic Wind (Early Stage):3 Presentation is similar to the early stages of a common cold. Symptoms are worse at night and aggravate during the first few weeks. Sputum is clear and dilute, with an aversion to cold. Tongue coating is thin and white. Pulse is superficial and tense.

Retention of Phlegm Fire in the Lung (Stage of Gasping Cough):3 This presentation occurs when the early-stage invasion has progressed into fire. The patient may present with gasping cough, thick sputum that is difficult to expectorate, noisy drawing of breath, vomiting and a flushed face. Bleeding of the gums and nose may accompany, as well as blood-tinged sputum. Typical tongue appears red, with a sticky, yellow coating. Pulse is rolling and rapid.

Deficiency of Both Lung and Spleen (Recovery Stage):3 Spasmodic coughing jags and noisy, labored breathing that gradually subsides. This combination of deficiency of lung yin and deficiency of spleen qi presents as a weaker cough with a more frail and raspy voice. Patient may be thirsty. The tongue may appear pale, with a red tip and scanty coat. Pulse is rapid and weak.

Treatment

Western treatment includes erythromycin for exposed family members, as well as for the patient. This antibiotic is "the drug of choice, since it promptly terminates respiratory tract carriage of B pertussis."1 In addition, albuterol inhalers are prescribed to relax the airway.

Both Chinese and Western approaches acknowledge the importance of nutritional support to rebuild the patient's strength. The patient should focus on eating food that is easily digestible. Warm, homemade vegetable soups with rice, including chicken, beef or lamb stock, are very nourishing, easy to digest, and avoid the sodium of canned varieties. Moistening fruits and vegetables are also recommended, such as: watermelon, pears, apricots and asparagus (which also benefits lung yin). Fried foods and cold dairy products are to be avoided. These foods will aggravate both phlegm and fire conditions.

Because whooping cough often presents like the common cold, many patients do not seek treatment until the disease has progressed for a few weeks. By this time, patients may be in the phlegm fire stage of the illness. Some chest pain may be manifesting. Resolving phlegm and promoting the correct flow of lung qi is a primary treatment principle in all stages of the disease. While in the beginning, the focus should be to promote the lung's function in dispersing; during the middle stage, treatment involves reducing the excess phlegm and fire in the lung; and lastly, moistening the lung and repairing the yin during the last stage of illness.

Herbal Formulas3

Recommended dosages are in grams, and dosage is modified according to the size of the patient and the time between treatments. I recommend contacting your herb supplier if herbal substitutes are required, such as for ma huang in Sanao Tang.

Wind Cold or Wind Heat

The use of Sanao Tang for wind cold or Sang Ju Yin for wind heat is recommended.

Sanao Tang

  • 5g - ma huang
  • 10g - xing ren
  • 5g - gan cao
  • 10g - zhi bai bu
  • 5g - bai qian
  • 10g - tian zhu zi

This formula is pungent and warm. It is effective in promoting the lungs' function in dispersing and eliminating cold. The addition of bai bu, bai qian and tian zhu zi strengthens the effect of stopping cough and resolving phlegm.

Sang Ju Yin

  • 10g - sang ye
  • 10g - ju hua
  • 10g - niu bang zi
  • 10g - xing ren
  • 5g - gan cao
  • 5g - jie geng
  • 10g - dai ge san (powder of Indigo naturalis and Concha meretricis seu cyclinae)

This formula is pungent and cool in nature. It is effective in treating a cough and has a mild way of promoting the lungs' function in dispersing. This is why I prefer it for children. The addition of dai ge san strengthens the effect of clearing heat and resolving phlegm.

Retention of Phlegm Fire in the Lung

In my practice, I have found a modified Sang Bai Pi Tang to be effective during this phase of the illness. I use ban xia with discretion and on a case-by-case basis, due to its toxicity.

  • 8g - sang bai pi
  • 8g - huang qin
  • 2.5g - huang lian
  • 2.5g - zhi zi
  • 5g - su zi
  • 5g - xing ren
  • 2.5g - chuan bei mu
  • 5g - ting li zi
  • 5g - fu ling
  • 5g - bai zhu
  • 2.5g - chen pi
  • 2.5g - fa ban xia

This formula clears heat in the lungs, dispels phlegm and promotes the downward flow of qi. I add fu ling and bai zhu to support the middle jiao and mildly address the deficiency aspect. Ban xia is added as a potent ingredient to resolve phlegm.

Deficiency of Both Lung and Spleen

Ren Shen Wu Wei Zi Tang

  • 10g - chao dang shen
  • 10g - chao bai zhu
  • 10g - fu ling
  • 5g - gan cao
  • 10g - mai dong
  • 5g - wu wei zi
  • 5g - chen pi
  • 10g - fa ban xia

Acupuncture Treatment

The treatment principle is to clear heat from the lung and resolve phlegm. In addition, I focus on promoting the smooth flow of qi. This is achieved through the use of: Lu 5, LI 4, LI 11, St 40, UB 13, bitong, ren 22 (stop cough), and Liv 3. In addition, St 36, Sp 8 and Sp 6 can be used to gently tonify, when appropriate. GB 34, SI 7 and Sp 10 are supplemental points that I find helpful with moving qi and blood, as well as clearing heat. I use blue Sierin needles to disperse and yellow ones to tonify, with shorter retention time for pediatric patients. In addition, the use of a plum blossom needle to tap on either side of the cervical and upper thoracic vertebrae around GB 20 to UB 12 and UB 13 proves to be beneficial. Cupping this area is also effective.

I have found the use of Chinese medicine highly effective in placating the symptoms of this disorder. After an initial treatment, patients often experience a reduced need for albuterol inhalers and over-the-counter cough syrups. The sequelae of the disease seem to linger for several weeks, with afternoon tiredness, weakness, shakiness and diarrhea being some of the persistent symptoms. I would recommend treatment every week for at least one month.

References

  1. Hay W, Hayward A, Levin M, Sondheimer J. Current Pediatric Diagnosis and Treatment, 14th ed. New York: Lange Medical Books/McGraw Hill, 1999.
  2. Department of Health and Human Services. Centers for Disease Control and Prevention. Coordinating Center for Infectious Diseases/Division of Bacterial and Mycotic Diseases. Oct. 13, 2005. Available at www.cdc.gov (Accessed Dec. 2006).
  3. Cao J, Su X Essentials of Traditional Chinese Pediatrics. Beijing: Foreign Language Press, 1990:170-4.

Tanya Carleton is an assistant clinical supervisor and the academic dean at the Colorado School of Traditional Chinese Medicine. She also practices at the Wisdom of the Ancients Clinic in Denver.


 

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