Additional Discussion on Infantile Tuberculosis

Additional Discussion on Infantile Tuberculosis

The world says that when a woman is pregnant, she may develop cough, fever, and bone-steaming symptoms, or even hemoptysis, or experience nocturnal emissions during sleep—this condition is known as "child-bearing tuberculosis." The fetus often fails to reach full term; sometimes it miscarries at seven or eight months, other times at five or six months, and the child never fully develops. Moreover, if a woman gives birth, she often dies within a month after delivery. Ancient texts do not discuss this condition in detail, and modern physicians lack effective treatments, so people generally regard it as a fatal disease. Indeed, deaths from this condition are frequent, which is truly lamentable. When a woman becomes pregnant, her qi and blood nourish the fetus; however, if she also suffers from illness, her qi and blood are further depleted. With such limited resources, how can she possibly sustain two sources of depletion? Consequently, the fetus cannot grow properly, while the mother is overwhelmed by the burden of pregnancy and further afflicted by disease. It is like using two axes to chop down a withered tree—how could it not die? Nevertheless, given the gravity of the situation, as some say, if an appropriate treatment were available, reviving the dead would not be difficult at all. My wife once suffered from this condition and was personally treated by me, ultimately saving her life. From this experience, I realized that the reason why child-bearing tuberculosis is often incurable lies in the failure to provide proper treatment. A couple's blood must be harmonious for them to conceive a child. If the blood is diseased, the fetus will also be affected. Therefore, the key to treating this condition is to first assess the specific symptoms: sometimes the priority is to stabilize the fetus, and once the fetus is stable, the mother will naturally recover; other times, the focus is on curing the underlying disease, and once the disease is gone, the fetus will naturally become strong. Based on the patient’s condition, we can prescribe medication accordingly, and there is always a way to cure the illness. In general, people believe this disease is extremely severe and debilitating, but in fact, it is often caused by excess pathogenic factors. Why do I say this? Because, except for the gastrointestinal tract, no other part of the human body should have any obstruction or blockage. Even a brief needle insertion or acupuncture point stimulation can obstruct the flow of qi. Moreover, the fetus is a large mass that occupies the lower part of the body; when it blocks the lower region, qi becomes stagnant, leading to shortness of breath, nausea, and even internal heat—all due to this obstruction. During pregnancy, a woman essentially harbors a precious treasure (2), and the fetus itself is like a mass of accumulated waste. Thus, the pulse during pregnancy is deep and thready, similar to the pulse associated with lower-jiao masses. However, once the mass is cleared and the blockage is removed, the pathogenic factors are eliminated, and both the mother and the fetus benefit. Unfortunately, there is no direct method to clear the blockage affecting the fetus, making treatment challenging. Nonetheless, when there is an accumulation of pathogenic factors, we must take a comprehensive approach, combining tonification with elimination, so as not to leave lingering problems. Only by completely removing all constraints can we save cases that seem hopeless. As the "Inner Canon" states, "If there is a cause, there will be no disaster" (3). This means that, regardless of any restrictions, focusing solely on treating the disease is the best way to ensure fetal stability. Therefore, for child-bearing tuberculosis, especially when accompanied by hemoptysis and severe qi rebellion, we should not worry about the fetus; instead, we should cool the blood and remove stasis. For example, peony bark and peach kernel are perfectly acceptable, because once the blood stasis is cleared, the heat will dissipate, allowing new blood to nourish the fetus. If the qi is excessively rebellious and fiery, ordinary herbs like apricot kernel, citrus peel, and dried scutellaria will not suffice; in such cases, stir-fried rhubarb with wine can also be used. Furthermore, in this condition, the fetal qi tends to stagnate in the lower part of the body and then rise to affect the lungs, so treating child-bearing tuberculosis requires prioritizing lung health. The Qingzao Jiufei Tang and Ziyuan San are particularly suitable for this purpose. For patients with phlegm-heat accumulation and persistent coughing, Huotan Wan is effective. For those whose lungs are congested with fluid, causing swelling and coughing that prevents them from lying down, Tingli Dazao Xiefei Tang is recommended. Jiegeng Ningfei Tang balances tonification and drainage, while Baohuo Tang emphasizes tonification over drainage; both should be used judiciously. Although this disease originates in the uterus, its root lies in the lower part of the body. Cleaning the lungs is only a symptomatic treatment. However, since the fetus is located in the lower region and cannot directly address the root cause, we must focus on treating the symptoms—namely, supporting lung health to counteract the pathogenic qi. Even though the pathogenic qi rises upward, this does not pose a problem. Moreover, the lungs serve as the “canopy” of the body; although they are positioned high up, they also regulate water metabolism, sending fluids downward to the bladder and controlling the rhythm of bowel movements. When the lungs function properly, the bowels remain unobstructed, and qi can be discharged through the intestines, thus reducing the upward pressure on the fetus. Similarly, when the lungs are well-regulated, urine flows smoothly, and qi can be released through the urinary system, allowing the qi in the uterus to be drained as well. After all, the bladder is like a chamber within the uterus; when the bladder functions smoothly, the qi in the uterus can also be relieved, thereby weakening the upward pressure. For patients with constipation, it is essential to use Qingzao Jiufei Tang combined with fire hemp seeds, white peony, cistanche, citrus peel, magnolia bark, and angelica root. For those with difficulty urinating, Qingzao Jiufei Tang should be supplemented with grass tips, rehmannia, woodruff, stephania, zhi mu, and mulberry bark. Urine exits the bladder, which belongs to the Taiyang meridian and governs the skin and hair; feces exit the large intestine, which belongs to the Yangming meridian and governs the muscles. When these two meridians are balanced, the qi of the skin and muscles is cleared and does not stagnate, preventing cold and heat from arising. The qi associated with the skin and muscles can be avoided, but the heat generated by the blood, which belongs to the blood category, is unrelated to these two meridians. The body’s qi is governed by the Three Jiao, which is associated with the Fire element and resides in the liver and gallbladder, while the lower part is hidden in the uterine cavity. Now that the uterine cavity is occupied by the fetus, the Fire element is forced to accumulate upward, leading to vomiting. This is common among women who lose blood, as the Fire element spreads outward along the meridians, accumulating in the skin and causing cold and heat, and even bone-steaming symptoms. Looking at the root cause, since the uterine cavity is occupied by the fetus, the Fire element cannot move freely, resulting in stagnation. At this point, we cannot remove the fetus, but we can clear the qi in the uterine cavity, allowing the Fire element to find an outlet, thus avoiding excessive accumulation. Therefore, we should use Siwu Tang combined with huangbai, zhi mu, chifuling, ze xie, shanyu rou, gan cao shao, and cistanche to nourish the Fire element in the uterine cavity. We can also apply Xiao Chaihu Tang externally to harmonize the skin and flesh. For those experiencing severe heat, Qinggu San can be used to dissipate it, which is a targeted treatment for clearing the Fire element in the Shaoyang meridian. Since the uterine cavity is not conducive to intensive treatment, we should focus more on clearing the Shaoyang meridian to address the symptoms, even if it does not lead to a complete cure, it will still help eliminate the pathogenic qi. If we want to treat the uterine cavity comprehensively, we can combine Siwu Tang with Chaihu Qinggu San. Although the root cause of child-bearing tuberculosis lies in the uterine cavity, the actual illness affects the lungs. The lungs are deficient in yin essence and unable to transmit energy downward, causing the water in the uterine cavity to rise and create problems. Regardless of whether it is a case of cough and fever, we should always nourish the lungs thoroughly, ensuring that the lung essence is balanced and the lung qi is regulated. Then, even if the water and fire in the uterine cavity try to rise, they will not cause harm. Lung-nourishing soups, Ziyuan San, Taiping Wan, Baohuo Tang, Ginseng Lung-Nourishing Soup, and Ejiao White-Dissolving Powder can all be taken regularly. When the water and fire in the uterine cavity rise, the disease manifests in the lungs, and the root of the problem actually lies in the kidneys. The Fire element in the uterine cavity corresponds to the yang energy in the kidneys, while the yin water in the uterine cavity corresponds to the Tian Gui water. We must vigorously nourish the kidneys, so that the water does not turn into phlegm, and the yin is sufficient to prevent the fire from flaring up. This is the fundamental approach to addressing the root cause. If the kidneys are deficient in yin and the fire is active, the water will coagulate into phlegm, leading to coughing, swelling, and urinary retention, as well as bone-steaming symptoms. In such cases, we can use Di Huang Tang combined with apricot kernel, schisandra, ophiopogon, mulberry bark, huangbai, and zhi mu to clear the blockage. If the kidneys are deficient in yang and unable to transform water, the water will stagnate, causing drinking, coughing, swelling, urinary retention, and poor digestion. In such situations, we can use Di Huang Tang combined with old paper, eucommia, mugwort, fuzi, tai wu yao, agarwood, and woodruff to warm the yang. If the kidney’s phlegm-fire rises to extreme levels, causing incessant coughing and wheezing, and the fetus is also pushed upward, we can use Liu Wei Di Huang Tang combined with dragon bone, oyster shell, stalactite, achyranthes, pinellia, schisandra, ophiopogon, and fritillaria to address the issue. These descending medicines are often described in various texts as inducing abortion, but healthy fetuses should never be subjected to such treatments. Now that there is kidney qi rebellion, we can suppress the upper-level qi, allowing the sick fetus to descend to its proper position, rather than being pushed upward. This ensures that the fetus remains in its correct position and does not get pushed upward, so there is no need for an abortion. As for extreme qi rebellion, which leads to hemoptysis, vomiting, coughing, hiccups, and other upward symptoms, we should use qi-reducing agents such as citrus peel, magnolia bark, tongzi, and betel nut in appropriate amounts. For fire-reducing agents, we can use rhubarb with wine, turmeric, zhi mu, huangbai, and gentian as needed, which is also acceptable. Moreover, when the fetus bleeds, it is often due to blood stasis and incompatibility between the fetal qi and maternal qi, leading to bleeding. To remove blood stasis, we can use peach kernel, peony bark, five spirit fat, safflower, and yanhusuo. Simply adhering to restrictions is no different from letting a festering wound fester. If doctors can break free from conventional wisdom and truly understand the underlying mechanisms, then treating child-bearing tuberculosis will not be difficult at all.

Furthermore, although medication does not necessarily require strict adherence to restrictions, it is still important to carefully assess the condition and stop when the disease is under control, rather than recklessly prescribing drugs without considering their severity. Caution is essential.

The reason why a postpartum mother is tied to the fetus is the belt-like ligament. Once the belt-like ligament loosens, the fetus will fall. If there is lower back pain, we should promptly use angelica root, white atractylodes, cooked rehmannia, Chinese yam, eucommia, old paper, shanyu rou, turtle glue, huangbai, astragalus, zhi mu, dodder seed, goji berry, continued fracture, cloud fungus, and other herbs to treat it. For other treatments related to the belt-like ligament, please refer to the sections on menstrual blood and postpartum blood. If a postpartum mother suffers from child-bearing tuberculosis and is extremely exhausted, unable to protect the fetus, then there is no need to preserve the fetus; the priority should be to ensure the safety of the mother. For example, Guixiong Tang combined with ginseng, glutinous rice, ramie root, and ejiao can be used to stabilize the mother, whether she is saved or not. Once the fetus has fallen, we should follow standard procedures and treat it according to the law, removing stasis and promoting regeneration, so that there is always a chance of recovery.

In addition, child-bearing tuberculosis already causes significant depletion before childbirth, and once the baby is born, the risk of complications is even higher than in normal deliveries, so prevention is especially important.

For instance, if a woman sweats profusely and cannot stop, we can use Dushen Tang to rescue her; for those with floating heat and a rapid pulse, we can add fuzi to draw yang into yin. Although this is a common pre-birth condition, characterized by dry heat and impending yang deficiency, we should not continue to treat it with dry heat methods. Instead, we can use Siwu Tang combined with fried ginger, which also draws yang into yin, and both approaches are worth considering.

If a woman experiences shortness of breath, which indicates qi depletion, we can use Shenfu Tang combined with five flavor berries and agarwood to treat it.

If a woman experiences massive hemorrhage, which indicates blood depletion, we can use Guipi Tang combined with blood residue ash, palm ash, cuttlefish bone, and fish glue to treat it. There are also cases where liver fire is agitated, leading to massive hemorrhage; in such cases, we can use Guipi Tang combined with bupleurum and gardenia to treat it.

These three critical conditions are common in normal deliveries, but they are inevitable for patients with child-bearing tuberculosis, so both doctors and patients should take preventive measures.

Generally speaking, the fetus is hot before birth and becomes cold after birth, which is true for most people. However, for patients with child-bearing tuberculosis, the condition before birth is invariably hot, while after birth it is not necessarily cold. This is because the fetus is already deficient in yin before birth, and after birth, excessive blood loss further depletes the yin, leading to fever and cough, especially severe dryness and weakness. If we simply adhere to the postnatal warming and tonifying approach, it is very likely to hasten death. Instead, we should use Zuogui Yin combined with ejiao, honeysuckle, baibu, ginseng, ophiopogon, yuzhu, and five flavor berries to treat it. For those with bone-steaming cough, we can use Tuanyu Wan. For those with yin deficiency and fire stirring up water, leading to dehydration, we can use Siwu Tang combined with Erchen Tang, adding bupleurum, scutellaria, ginger juice, bamboo sap, zhuhuang, dan nanxing, gold foil, and ox bile to treat it. Other miscellaneous symptoms can be treated according to obstetric protocols, and there is almost always a way to cure them. What we have discussed here is the postpartum treatment for child-bearing tuberculosis, which is slightly different from normal deliveries, but we have only outlined the main points, and there is still much room for doctors to expand and refine it.

First, when treating child-bearing tuberculosis, we must thoroughly study the sections on menstrual blood, fetal blood, and postpartum blood in my book, and also consult the gynecology section to tailor the treatment appropriately.

Second, child-bearing tuberculosis must be treated as early as possible. Even if the treatment is not yet fully effective, as long as the medication is administered correctly, there is a good chance of recovery after childbirth. If the treatment is not known, the outcome after childbirth will inevitably be fatal, so both doctors and patients should be cautious.

The above outlines the general principles of treating child-bearing tuberculosis. However, if external pathogens are involved, we can adjust the treatment according to the methods for treating colds in the blood category; if internal injuries are present, we can adjust the treatment according to dietary guidelines for blood-related conditions; if anger exacerbates the illness, we can use the medications specified in the section on anger management; if overwork aggravates the condition, we can use the medications specified in the section on overwork. There are many additional methods beyond these, which are difficult to describe in writing.

[Notes]

(1) Child-bearing tuberculosis: A condition similar to pregnancy complicated by chronic wasting diseases, such as heart disease or pulmonary tuberculosis.

(2) Not inferior to treasuring: Meaning the fetus is as precious as a treasure.

(3) If there is a cause, there will be no disaster: From "Suwen·Liu Yuan Ji Da Lun": "If there is a cause, there will be no disaster, and if there is no cause, there will be no disaster either." This means that if a pregnant woman suffers from a severe heat-related condition and uses powerful medicines to attack the disease, it will not harm the fetus.

[Commentary] Traditional Chinese medicine holds that this condition has a poor prognosis and is quite difficult to treat. However, based on his long-term clinical practice, the author believes that as long as the treatment is appropriate, ideal results can still be achieved. Contrary to popular belief, he argues that this condition is often caused by excess pathogenic factors and excessive heat, so doctors should dispel their doubts and boldly administer treatment, employing both attacking and eliminating methods. For patients with blood stasis, blood circulation can also be promoted and stasis removed. Only in this way can we achieve the goal of eliminating pathogenic factors. Eliminating pathogenic factors allows us to strengthen the body's vital energy, and strengthening the body's vital energy helps protect the fetus—this is a correct dialectical relationship. Guided by this idea, the author has achieved results in treating this condition that are rare among previous practitioners, demonstrating his practical application of the "If there is a cause, there will be no disaster" therapeutic principle from the "Inner Canon." Regarding the pathogenesis of this disease, the author believes that the lungs are the "canopy" of the five viscera and six bowels, and that fetal qi frequently surges upward to affect the lungs, making the lungs the primary site of onset. Based on this, he proposes that treating the lungs should be the first priority in treating this condition, commonly using Qingzao Jiufei Tang, Tingli Dazao Xiefei Tang, and Jiegeng Ningfei Tang. His view is that as long as the lungs are healthy, even if fetal qi surges upward, it will ultimately not cause disease. At the same time, the lungs and large intestine are closely related; when the lungs are well-regulated, the large intestine remains unobstructed, and the pathogenic qi in the uterus can be discharged through the large intestine. The lungs also regulate water metabolism, sending fluids downward to the bladder, and when the lungs are well-regulated, the bladder functions smoothly, allowing the pathogenic qi in the uterus to be discharged through urine as well. Since the pathogenic qi descends, the upward force is correspondingly reduced, so treating this condition requires ensuring smooth bowel movements. The author often adds ingredients such as fire hemp seeds, cistanche, white peony, and citrus peel to lung-nourishing formulas to keep the bowels moving smoothly, and includes woodruff, stephania, mulberry bark, and zhi mu to keep the urine flowing smoothly. In addition to treating the lungs, the treatment of this condition must also start with the liver and kidneys, because the kidneys govern the uterine cavity and contain the Fire element, while the liver and kidneys share a common origin; moreover, the water and fire in the lungs are fundamentally dependent on the kidneys, which embodies the principle of metal-water mutual generation. If the former is out of balance, external cold and heat appear, and internal bone-steaming symptoms arise; if the latter is out of control, either yang deficiency leads to phlegm rising upward, or yin deficiency causes bone-steaming fire to flare up. Treatment of the liver involves adjusting Siwu Tang, while treatment of the kidneys involves adjusting Di Huang Tang. Based on the degree of imbalance in yin, yang, qi, and blood, clinicians can make adjustments on the spot, and the clinical results are quite satisfactory. In addition, the author believes that the treatment of this condition should prioritize the safety of the mother. As for the fetus, if it can be saved, it should be saved; if it cannot be saved, there is no need to preserve it.

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