Zaojia Wan (Gleditsia Pill) zào jiá wán · 皂荚丸

Safety. One ingredient. The line that records it is three clauses long and two of them are things a clinician today can see from the doorway: 时时吐浊, the repeated spitting of turbid matter, and 但坐不得眠, the person can sit but cannot lie down. This library has met the second clause before, in a chapter about chest pain. 不得卧 changes the nature of a complaint rather than its severity: breathlessness that arrives on lying flat is orthopnea, and orthopnea is connected today to left heart failure and pulmonary congestion. It is also one of the few respiratory complaints that can be quantified by a question — how many pillows, and does the person wake shortly after lying down. Paroxysmal nocturnal dyspnoea is the same phenomenon with a clock on it. It is not only the heart: people with severe obstructive lung disease sit up to use the accessory muscles, and large pleural effusions, diaphragmatic paralysis, severe obesity and late pregnancy produce the same posture. NT-proBNP, a chest radiograph and an echocardiogram separate those from each other; the posture alone does not. 时时吐浊 is the other clause. Repeated spitting of turbid matter is sputum, and sputum has a volume: twenty-four-hour sputum volume is a measured quantity in bronchiectasis, and the old observation that a large specimen settles into layers — froth on top, thin fluid in the middle, pus at the bottom — belongs to the same picture. A foul smell points towards anaerobic organisms. A quantity of hundreds of millilitres a day belongs to bronchiectasis and to lung abscess. What the line does not record is the colour, and the colour is where blood would have shown up. The material has a record that has to be stated each time it appears. 皂荚 is the fruit of Gleditsia sinensis, and it is classed in Chinese materia medica as 小毒 — slightly toxic. It is rich in triterpenoid saponins, the reason a watery preparation of it foams when shaken, and saponins lyse red cells in vitro. This library does not claim that lysis occurs by the oral route; it records that the in-vitro effect is documented and that the compound class is a mucosal irritant. The irritant property is not a matter of inference: powdered Gleditsia is a classical sneezing agent, and sneezing after it is the irritation, not a benefit. Nausea, vomiting, abdominal pain and diarrhoea after concentrated preparations, and haemolysis in serious poisonings, are reported. Three names around this one are regularly confused and are not the same drug: 皂角刺 is the spine, 皂荚子 is the seed, and 猪牙皂 is the sterile deformed fruit of Gleditsia officinalis. The pill is made with honey. Honey is a real sugar load, and honey given to an infant under twelve months is an absolute exclusion because of infant botulism. One further point belongs here and is easy to lose. A medicine whose known action is to irritate the mucosa into producing and expelling phlegm is acting on a reflex that is protective. Cough with a large volume of sputum is a clearance mechanism; suppressing it is the wrong direction. Modern mucolytics and expectorants have mixed evidence, and this library does not adjudicate that literature. Reliable safety data for pregnancy are lacking, the material is classed as slightly toxic and is a strong mucosal irritant, and this library does not recommend its use in pregnancy. Chinese-language clinical literature reports observations of this pill and of Gleditsia preparations in cough with copious phlegm, small in scale and methodologically limited. This library records that such studies exist; it does not record that benefit has been established.