Common+Cold

Western Diagnosis
A. URI - upper respiratory tract infection B. Usually viral - inflammation in any or all airways

**Etiology**
1. Viral -picorna: rhino, echo, coxsackie; up to 50% from >100 types of rhino -influenza, parainfluenza, respiratory syncytial, corona, adeno 2. Fatigue, emotional distress, allergic nasopharyngeal, midphase of menstrual cycle 3. Most important factor is presence of specific neutralizing antibody - indicates previous exposure and offers protection

**Signs & Symptoms**
1. Short (1-3 day) incubation 2. Abrupt onset 3. Nasal or throat discomfort, sneezing, rhinorrhea, malaise, no fever, pharyngitis, laryngitis, tracheitis, watery nasal discharge becoming mucopurulent, cough 4. Resolves in 4-10 days if no complications

**Diagnosis**
-Clinical, but non-specific -R/O allergies, bacteria -Smear of exudate - bacteria, eosinophils if allergic

Treatment
1. Warm, comfortable environment 2. Prevent direct spread 3. Symptomatic relief 4. No antibiotics 5. Exercise shortens duration, esp. at beginning 6. Drink plenty of fluids 7. Vitamin C 8. Elderberry 9. Yin Qiao Tang or Gan Mao Ling 10. Garlic 11. Zinc (preferably lozenge): 50-60mg. 1-3x/day 12. Vitamin A 50-100,000 units - use cautiously d/t possible liver toxicity

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Common Cold/Găn Mào
Caused by attack of exogenous pathogenic Wind. The underlying pathologies are: -failure of Wei Qi to consolidate the surface of the body -failure of the Lung Qi to disperse and descend More common in winter and spring

Symptoms
Aversion to cold/chills, sensation of heat/fever, headache, nasal congestion and discharge, sneezing, sore throat, slight cough (note: if cough, HA, or congestion is the main complaint, TCM considers these separate disease categories and tx is directed to the disease/complaint) Symptoms usually last 5-7 days If many cases are observed over a large area with similar symptoms, TCM terms this //shi xing gan mao// (epidemic cold).

Relevant Biomedical Conditions
URI (adenovirus, echovirus, parainfluenza virus, respiratory synctial virus, rhinovirus) Influenza (A, B, or C) Stomach “flu”

Etiology and Pathogenesis
External Factors: Exogenous Pathogenic Factors: Wind is the main cause of the common cold; it usually combines with Cold, Heat, and Summer Heat-Dampness (Dryness too, though this usually results in cough being the chief complaint/TCM disease)


 * Theoretically, Wind-Cold is most common in autumn and winter; Wind-Heat in spring and summer, and Wind with Summer Heat-Dampness in the late summer.

Internal Factors: Aging, congenital vacuity, chronic illness, overwork, emotional strain, poor diet: weakened zheng qi results in failure of Lung Qi to disperse; as a result, Wei Qi fails to consolidate the surface, making a person susceptible to attack by exogenous pathogenic factors.

Comparison of Mild, Severe, and Epidemic Cold
Both mild and severe cold are known as common cold (Cold/Gan Mao): Mild cold is caused by common pathogens pertaining to the corresponding seasons, such as Wind-Cold in winter and spring Severe cold is considered to be caused by invasion of pathogens at times other than their normal seasons, such as Wind-Cold in summer and Summer-Heat in winter

Epidemic cold is caused by epidemic pathogenic factors that are highly contagious; this overlaps with measles, German measles, chickenpox, poliomyelitis, smallpox, scarlet fever, whooping cough, meningitis, and certain forms of influenza in biomedicine.

Treatment Principles

 * Wind-Cold:** used acrid, warm herbs to induce sweating
 * Wind-Heat:** use acrid, cool herbs to clear Heat and release the exterior
 * Summer Heat-Dampness:** clear Summer Heat, eliminate Dampness, release the exterior
 * Exterior conditions with pre-existing vacuity:** support Zheng Qi while releasing the exterior
 * Epidemic cold:** clear Heat, relieve toxicity, release the exterior

Invasion of Wind-Cold
aversion to cold, slight fever, no sweating, headache, general body aches Ma Huang Tang (Ephedra Decoction) -[Ma Huang (Ephedra herb) 9g, Gui Zhi (Cinnamon twig) 6g, Xing Ren (Apricot kernel) 9-12g, Zhi Gan Cao (Honey-fried Licorice root) 3g]
 * Additional Symptoms:** nasal congestion with clear discharge, itchy throat, slight cough with thin, white sputum, no thirst
 * Tongue:** thin, white coat
 * Pulse:** floating, tight
 * Treatment Principles:** Dispel Wind, scatter Cold, release the exterior
 * Acupuncture Treatment:** [LI4, GB 20, LU7, GV16, BL12]; [LU-7, LI-20, SI-7, BL-12, GB-20, LI-4]; [LI-4, GB-20, BL-12, BL-13, GV-14]
 * Patent Medicine:** Gan Mao Ling, Gan Mao Qing Re Chong Ji, Chuan Xiong Cha Tiao Wan
 * Herbal Treatment:**

//Jing Fang Bai Du San// (Schizonepeta &Saposhnikovia Toxin-Vanquishing Powder) -[ Jing Jie (Schizonepeta spike) 4.5g, Fang Feng (Saposhnikovia root) 4.5g, Qiang Huo (Notopterygium root) 4.5g, Du Huo (Pubescent angelica root) and 4.5g, Chai Hu (Bupleurum root) 4.5g, Qian Hu (Peucedanum root) 4.5g, Chuan Xiong (Ligusticum root) 4.5g, Zhi Shi (Unripe Bitter Orange) 4.5g, Fu Ling (Poria) 4.5g, Jie Geng (Platycodon root) 4.5g, Gan Cao (Licorice root) 1.5g] Strengthen acrid and warming effects: + Ma Huang, Gui Zhi Copious sputum: Chen Pi, Ban Xia Significant qi stagnation: Xiang Fu, Su Geng Cold on exterior & heat interior: use Ma Xing Shi Gan Tang
 * Modifications:**

Invasion of Wind-Heat
fever, slight aversion to cold, sweating, headache -[Jin Yin Hua (Lonicerae flower) 9-15g, Lian Qiao (Forsythiae fruit) 9-15g, Jie Geng (Platycodi root) 3-6g, Niu Bang Zi (Arctium seed) 9-12g, Bo He (Mint) 3-6g, Dan Dou Chi (Fermented Soybean) 3-6g, Jing Jie (Schizonepeta spike) 3-6g, Dan Zhu Ye (Black Bamboo leaf) 3-6g, Xian Lu Gen (Phragmitis root) 15-30g, Gan Cao (Licorice root) 3-6g] Severe distending headache: Sang Ye, Ju Hua Cough w/ excessive sputum: Zhe Bei Mu, Qian Hu, Xing Ren Yellow viscous sputum: + Huang Qin, Zhi Mu, Gua Lou Pi Swollen sore throat: + Xuan Shen, Tu Niu Ye Wind-heat turning into dryness: + Bei Sha Shen, Tian Hua Fen, Li Pi Epidemic toxic heat: + Da Qing Ye, Pu Gong Ying
 * Additional Symptoms:** nasal congestion with yellow discharge, sore throat, slight cough with sticky, yellow sputum, thirst
 * Tongue:** normal color or slightly red tip or sides; thin, white or slightly yellow coat
 * Pulse:** floating, rapid
 * Treatment Principles:** Dispel Wind, clear Heat, release the exterior
 * Acupuncture Treatment:** [LI4, LI11, TB5, GV14, LU10, LU11]; [LU-5, GB-20, LI-11, LI-4, GV-14, TW-5]; [GV-14, BL-12, LI-11, LI-4, TW-5]
 * Patent Medicine:** Yin Qiao Jie Du Pian, Gan Mao Ling, Ban Lan Gen Chong Ji
 * Herbal Treatment:** //Yin Qiao San// (Lonicera and Forsythia Powder)
 * Modifications:**

Invasion of Summer Heat-Dampness
unsurfaced fever, slight aversion to cold, slight sweating, headache with a heavy sensation (as though head were tightly bandaged), aching and heaviness in the limbs and joints //Xin Jia Xiang Ru Yin// (Newly Augmented Elsholtzia Beverage) -[Xiang Ru (Elsholtzia herb) 6g, Jin Yin Hua (Lonicera flower) 9g, Bian Dou Hua (Lablab flower) 9g, Hou Po (Magnolia bark) 6g, Lian Qiao (Forsythiae fruit) 6g] //Huo Xiang Zheng Qi San// (Agastache Formula) - Internal damp-heat prominent //San Ren Tang// - Damp & heat lodge in the surface extreme summer heat: + Huang Lian, Qing Hao, He Ye, Lu Gen Excessive exterior dampness: + Huo Xiang, Pei Lan Dampness lingering in middle burner w/ thick greasy coat: + Cang Zhu, Bai Dou Kou, Ban Xia, Chen Pi Dark scanty urine: + Hua Shi, Gan Cao, Chi Fu Ling
 * Additional Symptoms:** cough with sticky sputum, greasy feeling in the mouth, or pressure and in the chest, distention and formless in the epigastrium and abdomen, loose stools, nausea, no thirst or thirst without desire to drink
 * Tongue:** yellow, greasy coating
 * Pulse:** soft, rapid
 * Treatment Principles:** Clear Summer Heat, transform Dampness, release the exterior
 * Acupuncture Treatment:** LI4, LU6, TB6, CV12, ST36, SP9
 * Patent Medicine:** Huo Xiang Zheng Qi Pian, Xing Jun San, Liu Shen Shui, Bao Ji Wan, Shen Qu Cha
 * Herbal Treatment:**
 * Modifications:**

With Pre-Existing Qi Vacuity
strong aversion to cold, slight fever, headache, general body aches, propensity to catch colds, nasal congestion with clear discharge, slight cough with thin, white sputum -[Ren Shen (Ginseng root) 9g, Zi Su Ye (Perilla leaf) 9g, Ge Gen (Pueraria root) 6g, Qian Hu (Peucedanum root) 6g, Fa Ban Xia (Pinellia tuber) 6g, Fu Ling (Poria) 6g, Zhi Ke (Bitter Orange) 3g, Chen Pi (Tangerine peel) 3g, Jie Geng (Platycodon root) 3g, Mu Xiang (Saussurea root) 3g, Gan Cao (Licorice root) 3g, Sheng Jiang (Fresh Ginger root) 3pcs., Da Zao (Jujube) 3pcs.] Severe Qi deficiency: + Huang Qi Constitutional Qi deficiency w/ spontaneous sweating & recurrent cold: use Yu Ping Feng San
 * Additional Symptoms:** fatigue, shortness of breath, reluctance to speak, spontaneous sweating, pale complexion
 * Tongue:** pale with thin, white coat
 * Pulse:** floating, forceless
 * Acupuncture Treatment:** W-C points + ST36, CV6, BL13, BL20
 * Treatment Principles:** Dispel Wind, scatter Cold, boost Qi, release the exterior
 * Patent Medicine:** Shen Su Yin, Yu Ping Feng Wan
 * Herbal Treatment:** //Shen Su Yin// (Ginseng and Perilla Beverage)
 * Modifications:**

With Pre-Existing Yin Vacuity
fever, slight aversion to wind or cold, slight or no sweating, headache, dry cough with scanty sputum -[Yu Zhu (Solomon's seal root) 6 - 9g, Cong Bai (White scallion) 6g, Jie Geng (Platycodon root) 6g, Bai Wei (Cynanchi root) 3g, Dan Dou Chi (Fermented soybean) 9g, Bo He (Mint) 6g, Da Zao (Jujube) 2 pieces, Zhi Gan Cao (Honey-fried Licorice root) 1.5g] Excessive exterior pathogen: + Jing Jie, Fang Feng Dry throat, cough w/ sticky sputum that is difficult to expectorate: Niu Bang Zi, Gua Lou Pi Thirst and dry throat: + bei Sha Shen, Mai Men Dong Yin deficient heat w/ irritability and thirst: Zhu Ye, Tian Hua Fen
 * Additional Symptoms:** thirst, dry mouth, dry throat, dizziness, Five Center Heat,
 * Tongue:** red with scanty or no coat
 * Pulse:** thin, rapid
 * Treatment Principles:** Dispel Wind, clear Heat, nourish Yin, release the exterior
 * Acupuncture Treatment:** W-H points + KI3, SP6, KI7, BL43
 * Patent Medicine:** Gan Mao Ling, Shi San Tai Bao Wan
 * Herbal Treatment:** //Jia Jian Wei Rui Tang// (Solomon’s Seal Decoction with Additions and Subtractions)
 * Modifications:**

Acupuncture for Common Cold/Găn Mào

 * Wind-Cold:** LI4, GB 20, LU7, GV16, BL12
 * Wind-Heat:** LI4, LI11, TB5, GV14, LU10, LU11
 * Summer Heat-Dampness:** LI4, LU6, TB6, CV12, ST36, SP9
 * Pre-Existing Qi vacuity:** W-C points + ST36, CV6, BL13, BL20
 * Pre-existing Yin vacuity**: W-H points + KI3, SP6, KI7, BL43

Gua Sha Cupping Bleeding: LU11, LU10, LI1 for sore throat Auricular: Lung, Trachea, Internal nose, Ear Apex, Stomach, Spleen, San Jiao (2-3 points each session) Frontal: Yin Tang, LI4 Temporal: Tai Yang
 * Headache:**
 * Nasal congestion:** LI20, Bi Tong, LI4

Clinical Notes for Common Cold/Găn Mào
Herbs for the treatment of Common Cold/Găn Mào should be boiled gently and not concocted too long so as to preserve their aromatic constituents. Avoid excessive diaphoresis: a mild sweat is appropriate when treating a cold; however, excessive sweating damages Zheng Qi and may prolong the condition.

Constitutional vacuity tends to pre-dispose individuals to contracting certain exogenous pathogens. Those with constitutional Qi or Yang vacuity tend to contract Wind-Cold; goes with constitutional Yin vacuity tend to contract Wind-Heat. In general, tonic herbs are contraindicated in the treatment of Common Cold/Găn Mào. However, in cases of significant vacuity, they may be added to the prescriptions.

In cases of epidemic cold, Heat or Fire Toxicity is a common pattern and must be addressed to avoid complications such as pneumonia. Large doses of herbs such as Jin Yin Hua, Ban Lan Gen, and Pu Gong Ying can be added in such cases to clear Heat and relieve toxicity. Prophylactic measures to prevent common cold include daily moxibustion at ST36 (direct, scarring is best with 3-5 cones), CV4, and BL13.