Characteristics and Treatment of Cough Caused by Pleural Effusion

Pleural effusion is a common complication of lung cancer and many other chronic lung diseases. Once fluid accumulates in the pleural cavity, patients often develop cough, profuse sputum, chest tightness, chest pain, and frequent or scanty urination; severe cases may show edema of the legs or face. The cough is affected by body position: it slightly improves when sitting or lying prone, worsens on the side or supine, and also worsens when bending or stooping. The cough seriously disturbs sleep; some patients sit up all night unable to lie flat. This is most obvious in late-stage lung cancer and asthma patients. Diuretics usually relieve such symptoms.

TCM commonly treats such patients with Jisheng Shenqi Wan, Jinkui Shenqi Wan, Liuwei Dihuang Wan, and Zhibai Dihuang Wan. I often combine TCM diuretics with the Western diuretic spironolactone for faster effect. TCM summarizes the mechanism in these kidney-deficiency patients as "kidney failing to grasp qi," hence the Shenqi Wan series.

Shenqi Wan is a common treatment for asthma in the middle-aged and elderly. Japan's Ministry of Health, Labour and Welfare also lists Niuchi Shenqi Wan (i.e., the Chinese Jisheng Shenqi Wan formula; the Tongrentang Jinkui Shenqi Wan containing Niuxi and Cheqianzi is also Jisheng Shenqi Wan) as an adjunct for pleural and ascitic effusion in cancer patients. The Shenqi Wan formulas are good diuretics, especially Jisheng Shenqi Wan with Niuxi and Cheqianzi. Once diuretics are used, the pleural effusion is excreted in urine and related symptoms ease markedly.

Of course, treating pleural effusion is not limited to Shenqi Wan: Shizao Tang, Ling Gui Zhu Gan Tang, Huangqi Fangji Tang, Fangji Fuling Tang, Xiao Qinglong Tang, Tingli Dazao Xiefei Tang, Wuling San, Zhuling Tang, and Zhenwu Tang can all be used. Which formula suits a patient depends on the accompanying symptoms.

The grandmother of a classmate of mine developed pleural effusion with severe cough after lung cancer. She used a folk remedy, brewing a handful of Lalyang (Humulus scandens) as tea every day; after a while her symptoms improved markedly, and after several months the cough disappeared entirely.

I previously wrote an article, The Folk Herb Lalyang Relieves Cough and Promotes Diuresis, about this common weed. Lalyang is both anti-inflammatory/antibacterial and diuretic, so it does have good efficacy for pleural effusion. But I tried it myself and found it can also cause skin allergy, so patients with a history of skin hypersensitivity should use it cautiously.

Many patients, families, and even some doctors treat cough simply by stopping cough, giving standard antitussives to patients with pleural effusion, with no effect at all. This is because the clinical diagnosis is wrong; abusing drugs without understanding medical and pharmacological principles can never work.

Of course, malignant pleural effusion treated only with diuretics has a low success rate and must be combined with anticancer drugs. If cancer-cell growth is not effectively suppressed, even if effusion is temporarily controlled, the benefit will not last. So malignant pleural effusion requires a combined approach treating both the root and the branch.