Cough

Ke Shiwen

Department,

Jiangxi Hospital of Traditional Chinese Medicine

1. Cough in ancient books
There is a systematic analysis in “Huang Di Nei Jing” about the
cause, symptoms, syndrome classification, pathology and
treatment of cough.

For instance, the section of Xuan Ming Wu Qi: Discussion on the

Elucidation of Five-Qi in the book Su Wen states that “The five zang-
organs and the six fu-organs all can lead to cough, not only the lung”,
stressing that both pathogenic factors attack the lung and
disharmony among zang-fu organs may cause cough.
And the section Manifestation of Cough in the book Treatise on
Causes and Manifestations of Various of Sui Dynasty recorded 10
types of syndrome and symptom for cough: wind cough, cold cough,
bronchia cough, gallbladder cough, reverting yin cough, five-zang
cough and so on.
Zhang Jingyue (张景岳) of Ming Dynasty classified cough into two
types: external contraction cough and internal damage cough. So far,
the syndrome classification of cough was more comprehensive and
clinically practical.
 external internal
contraction damage
cough cough

2. Key points of syndrome differentiation for cough

First, differentiating external contraction or internal damage.

external internal
contraction damage
cough cough

• acute attack • recurrent attack

• short duration • long duration
• exterior • syndromes of
syndrome of lung other organs

Second, differentiating excess or deficiency syndrome.

external internal
contraction damage
cough cough

▪ all manifest excess ▪ excess pathogen and

syndrome deficient healthy qi
▪ wind-cold, wind-heat ▪ deficiency syndrome
and wind-dryness.
3. Therapeutic principles of cough
As to the treatment of cough, it is essential to identify :
× healthy qi,
× pathogenic qi,
× deficiency
× excess.
▪ External contraction cough pertains mainly to excess syndrome.
▪ Its treatment should differentiate the different nature of
pathogen.
▪ Eliminate pathogen to promote functions of lung.

▪ Internal damage cough pertains mainly to syndrome of excess

pathogen and deficient healthy qi.
▪ So its treatment should eliminate pathogen to relieve cough,
reinforce healthy qi and tonify deficiency.

eliminate pathogen reinforce healthy qi and

to relieve cough tonify deficiency

▪ And for the treatment to external contraction cough, astringing

method should be prohibited.
▪ Cough is a pathogenic manifestation of the body’s eliminating
pathogen outwards, therefore, its treatment shouldn’t be purely
 treating cough for cough’s sake, and instead, it should be
treated respectively according to different causes.

4. How to treat external contraction cough

There are three types of external contraction cough :
▪ Syndrome of wind-cold attacking lung
▪ Syndrome of wind-heat invading lung
▪ Syndrome of wind-dryness damaging lung

a. Syndrome of wind-cold attacking lung

▪ Its common manifestations maybe itching throat, cough
with deep voice, fast breath, white and thin phlegm.
▪ And often with nasal congestion, thin snivel, headache, sour
limbs and body, aversion to cold, fever without sweat, white
and thin tongue coating, floating pulse or floating and tight
pulse.
▪ Treatment: dispersing wind, dissipating cold, ventilating
lung and relieving cough.
▪ The common formulas are San Ao Tang with Zhi Sou San.
▪ The common medicinal herbs are Ma Huang, Jing Jie, Xing
Ren, Zi Wan, Bai Qian, Bai Bu, Chen Pi, Jie Geng and Gan
Cao, etc.
▪ For serious cough, Ai Di Cha and Jin Fei Cao can be added to
dispel phlegm and relieve cough.
▪ For serious throat itching, Niu Bang Zi and Chan Yi can be
added to expel wind and eliminate itching.
▪ For nasal congestion and deep voice, Xin Yi Hua and Cang Er
Zi can be added to dredge nasal orifice.
▪ For cases with phlegm-dampness, sticky phlegm, stuffy
chest and slimy coating, Ban Xia, Hou Po and Fu Ling can be
added to dry dampness and resolve phlegm.
 ▪ And for cases with exterior cold and internal heat, harsh
voice, fast breath, thick and sticky phlegm, thirst and
vexation or fever, Sheng Shi Gao, Sang Bai Pi and Huang Qin
can be added to release exterior and clear interior.

b. Syndrome of wind-heat invading lung

▪ Its common manifestations are frequent and serious cough
with harsh voice and sweat, rough breathing, dry and sore
throat, difficult expectoration of thick, sticky phlegm or
yellowish sticky phlegm.
▪ And often accompanied with yellowish snivel, thirst and
headache, aching pain of limbs, aversion to wind, fever, thin
and yellowish tongue coating, floating and rapid pulse or
floating and slippery pulse.
▪ Treatment : dispersing wind, clearing heat, ventilating lung
and relieving cough.
▪ The common formula is Sang Jv Yin or Ma Xing Gan Shi Tang.
▪ The common medicinal herbs are Sang Ye, Jv Hua, Bo He,
Xing Ren, Jie Geng, Gan Cao, Lian Qiao and Lu Gen.
▪ For serious cough : Qian Hu, Pi Pa Ye and Ze Bei Mu can be
added to ventilate and clear lung qi, resolve phlegm and
relieve cough.
▪ For exuberant lung heat : Huang Qin, Zhi Mu or Sheng Shi
Gao can be added to clear lung heat.
▪ For sore throat and harsh voice : She Gan and Shan Dou Gen
can be added to clear heat and relieve sore-throat.
▪ For wind-heat damaging collaterals, epistaxis or blood in
phlegm : Bai Mao Gen and Sheng Di Huang can be added to
cool blood and stop bleeding.
▪ For cases accompanied with summerheat : Liu Yi San and
Xian He Ye can be added to clear summerheat.
c. Syndrome of wind-dryness damaging lung
▪ Its common manifestations are itching, dry and sore throat,
dry and choking cough, dry mouth and nose, no phlegm or
difficult expectoration of scanty and sticky phlegm, or
phlegm with blood streak.
▪ Initial stage maybe accompanied with nasal congestion,
headache, little cold and fever, red and dry tongue with little
fluid, thin and white or yellowish coating, floating and rapid
pulse or small and rapid pulse.
▪ Treatment : dispersing wind, clearing lung heat, moistening
dryness and relieving cough.
▪ The common formula is Sang Xing Tang.
▪ The common medicinal herbs are Sang Ye, Dou Chi, Xing Ren,
Xiang Bei Mu, Nan Sha Shen, Li Pi and Shan Zhi, etc.
▪ If fluid are seriously damaged : Mai Dong and Yu Zhu can be
added to nourish lung yin.
▪ As to serious fever : Sheng Shi Gao and Zhi Mu can be added
to clear lung heat.
▪ If there is blood in phlegm : Sheng Di Huang and Bai Mao Gen
can be added to clear heat, cool blood and stop bleeding.
▪ In addition, there is syndrome of cool-dryness damaging
lung, which combines dryness syndrome with wind-cold.
▪ The manifestations are dry cough with little or no phlegm, dry
throat and nose, accompanied with aversion to cold and
fever, headache with no sweat, white, thin and dry tongue
coating.
▪ The medicinal herbs should be warm and moistening instead
of being dry and cool in nature.
▪ The formula is modified Xing Su San.
▪ The herbs are Su Ye, Xing Ren, and Qian Hu with acrid flavor
to disperse wind and dissipate cold.
 ▪ Zi Wan, Kuan Dong Hua, Bai Bu and Gan Cao can moisten
lung and relieve cough.

5. How to treat internal damage cough

On the other hand, there are four types of internal damage cough :
× Syndrome of phlegm-dampness accumulating in lung
× Syndrome of phlegm-heat stagnating in lung
× Syndrome of liver-fire invading lung
× Syndrome of lung-yin deficiency

a. Syndrome of phlegm-dampness accumulating in lung

▪ Its main manifestations are recurrent cough with deep and
harsh voice (especially serious in the morning), stuffy chest
that will be relieved after expectoration of phlegm, profuse
sticky and slimy phlegm or thick phlegm clot, with white or
gray colour.
▪ And often accompanied with lassitude, gastric fullness,
abdominal distention, reduced appetite, sloppy feces, white
and slimy tongue coating, soggy and slippery pulse.
▪ Treatment : drying dampness, resolving phlegm, regulating
qi and relieving cough.
▪ The common formula is Er Chen Tang with San Zi Yang Qin
Tang.
▪ The common herbs are Fa Ban Xia, Chen Pi, Fu Ling, Hou Po,
Cang Zhu, Bai Jie Zi, Su Zi, Lai Fu Zi, etc.
▪ For cold, sticky phlegm with white froth, aversion to cold,
cold back, and serious cough : Gan Jiang, Xi Xin or Kuan
Dong Hua, Zi Wan, Ai Di Cha can be used to warm lung and
resolve phlegm to relieve cough.
 ▪ For obvious spleen deficiency syndrome : Sheng Huang Qi,
Dang Shen and Bai Zhu can be added to invigorate spleen
and replenish qi.
▪ When the situation becomes stable, modified Liu Jun Zi
Tang can be taken for further consolidation.

b. Syndrome of phlegm-heat stagnating in lung

▪ Its main manifestations are cough with fast and harsh
breath, profuse gurgling phlegm with thick, sticky or thick,
yellow features, difficult to be expectorated, or with blood or
foul smell, distension and fullness in chest and
hypochondrium, cough with dragging pain.
▪ Red complexion, or fever, dry mouth with sticky sensation
and desire to drink, red tongue with yellowish and slimy
coating, slippery and rapid pulse.
▪ Treatment : clearing heat, purifying lung, eliminating phlegm
and relieving cough.
▪ The common formula is Qing Jin Hua Tan Tang.
▪ The herbs are Huang Qin, Shan Zhi, Zhi Mu, Sang Bai Pi, Bei
Mu, Gua Lou, Jie Geng, Chen Pi, Gan Cao and Mai Dong.
▪ For yellow pus-like phlegm or phlegm with foul smell : Yu
Xing Cao, Jin Qiao Mai Gen, Bai Mao Xia Ku Cao, Xiang Bei
Mu and Dong Gua Ren can be adpoted to clear heat and
resolve phlegm.
▪ For chest fullness, cough with dyspnea, emetic phlegm and
constipation : Ting Li Zi, Da Huang can be used to purge lung
and dredge fu-organs to expel phlegm.
▪ For dry mouth due to phlegm-heat damaging fluid, red
tounge with scanty fluid : Bei Sha Shen, Tian Dong and Tian
Hua Fen can be used to nourish yin and promote fluid
production.
c. Syndrome of liver-fire invading lung
▪ Its manifestations are paroxysmal cough with dyspnea, red
complexion when coughing, dry throat with bitter taste in
mouth, little and sticky phlegm in throat difficult to be
expectorated.
▪ Distention and fullness in chest and hypochondrium, cough
with dragging pain, symptoms alleviated or aggravated with
mood fluctuation, red tongue or tongue margins, thin and
yellow coating with scanty fluid, wiry and rapid pulse.
▪ Treatment : clearing liver, purging lung, resolving phlegm and
relieving cough.
▪ The common formulas are Dai Ge San and Huang Qin Xie Bai
San.
▪ The herbs are Qing Dai, Hai Ge Qiao, Huang Qin, Sang Bai Pi,
Di Gu Pi, Pi Pa Ye, Dan Pi, Zhi Zi, etc.
▪ For stuffy chest and counterflow of qi : Ting Li Zi and Gua Lou
can be used to smooth qi and descend counterflow of qi.
▪ For chest pain : Yu Jin and Si Gua Luo can be used to regulate
qi and harmonize collaterals.
▪ For sticky phlegm difficult to be expectorated : Hai Fu Shi, Bei
Mu, Dong Gua Ren and Zhu Li can be used to clear heat and
eliminate phlegm.
▪ For fire depression damaging fluid, dry mouth and throat
and prolonged cough : Bei Sha Shen, Bai He, Mai Dong and
Ke Zi can be used to nourish yin, promote fluid production
and astringe lung.
d. Syndrome of lung-yin deficiency
▪ The manifestations are dry cough with short and rapid breath,
blood in phlegm, low fever, afternoon flushed cheeks, night
sweat, dry mouth.
▪ Red tongue with little coating, thin and rapid pulse.
▪ Treatment : nourishing yin, moistening lung, resolving phlegm
and relieving cough.
▪ The common formula is Sha Shen Mai Dong Tang.
▪ The common herbs are Bei Sha Shen, Mai Dong, Yu Zhu, Tian
Hua Fen, Sheng Bian Dou, Dong Sang Ye, Gan Cao, Bei He,
Bai Bu, etc.
▪ For long duration of cough and fever due to exuberant
dryness-heat in lung : Di Gu Pi 30g can be used to clear lung
heat.
▪ For serious cough : Chuan Bei Mu, Tian Xing Ren and Tian
Jiang Ke can be used to moisten lung and relieve cough.
▪ For failure of lung-qi to astringe and cough with rapid breath :
Wu Wei Zi and Ke Zi can be used to astringe lung-qi.
▪ For low fever : Gong Lao Ye, Yin Cai Hu, Qing Hao and Di Gu
Pi can be used to clear deficiency-heat.
▪ As to night sweat : Ruo Dao Gen and Fu Xiao Mai can be used
to arrest sweat.
▪ For expectoration of yellow phlegm : Hai Ge Fen, Zhi Mu and
Huang Qin can be used to clear heat and resolve phlegm.
▪ And for blood in phlegm : Dan Pi, Shan Zhi, Ou Jie and Bai Mao
Gen can be used to clear heat, cool blood and stop bleeding.
Summarize and review :: Cough in Chinese Internal Medicine

External Contraction Cough Internal Damage Cough

1. Syndrome of wind-cold 1. Syndrome of phlegm-heat
attacking lung stagnating in lung
2. Syndrome of wind-heat 2. Syndrome of phlegm-dampness
invading lung accumulating in lung
3. Syndrome of wind-dryness 3. Syndrome of live-fire invadung
damaging lung lung
4. Syndrome of cool-dryness 4. Syndrome of lung-yin deficiency
damaging lung

External Contraction Cough

1. Syndrome of wind-cold
San Ao Tang with Zhi Sou San
attacking lung →
2. Syndrome of wind-heat
Sang Jv Yin or Ma Xing Gan Shi Tang
invading lung →
3. Syndrome of wind-dryness
Sang Xing Tang
damaging lung →
4. Syndrome of cool-dryness
Xing Su San
damaging lung →

Internel Damage Cough

5. Syndrome of phlegm-heat Qing Jin Hua Tan Tang
stagnating in lung
6. Syndrome of phlegm-
dampness accumulating Er Chen Tang with San Zi Yang Qin
in lung Tang

7. Syndrome of live-fire
Dai Ge San and Huang Qin Xie Bai
invadung lung San
8. Syndrome of lung-yin
Sha Shen Mai Dong Tang
deficiency
Hong Guangxiang : the Great TCM master

Professor Hong, with his noble morality and

consummate medical skills, cured many
patients with difficult and severe diseases.
During his long-term period of medical
treatment, teaching and researching, he has
accumulated rich experience in TCM
treatment to difficult and complicated
diseases, and especially distinguishes
himself in treating disease of pulmonary
system.

Case 1 Mr. Yang, 26 years old, male

When visiting his friends a week ago, the patient caught cold and had
headache, nasal congestion, thin snivel, slight aversion to wind and
cold, cough with deep voice, thin and white phlegm difficult to be
expectorated, stuffy chest, itching throat and no thirsty. He took VC Yin
Qiao Pian, Pi Pa Zhi Ke Lu and Gan Mao Ke Sou Chong Ji with no
improvement and frequent cough. So he came here for treatment.
There is light red tongue with white and slightly slimy coating, floating,
wiry and slippery pulse.
Answer :
Syndrome of wind-cold attacking lung → San Ao Tang with Zhi Sou San
The treatment is dispersing wind, dissipating cold, ventilating lung and
relieving cough.
▪ It was syndrome of external contraction of wind-cold, led to failure
of lung to disperse and depurate.
▪ The therapeutic method was dispersing wind, dissipating cold,
ventilating lung and relieving cough.
▪ The formula was Dong Wan Zhi Ke Tang (empirical formula of Prof.
Hong).
▪ The common formulas in textbook are San Ao Tang with Zhi Sou San.
Dong Wan Zhi Ke Tang:
× Sheng Ma Huang 10g, Sheng Jiang 10g, Xi Xin 3g, Zi Wan
10g, Kuan Dong Hua 10g, Fa Ban Xia 10g, Cang Er Zi 10g,
Xin Yi Hua 10g.
× 5 doses decocted with water, 1 dose per day.
▪ On the second visit, he stated that the situation was greatly
improved after taking 1 dose, and cough stopped with other
symptoms disappeared after taking 5 doses.
▪ He was asked to take another 5 doses to consolidate the therapeutic
effects.

Case 2 Mr. Li, 46 years old, male

× The patient had chronic bronchitis for 6 years that occurred
obviously in winter or being attacked by cold.
× Cough reoccurred 5 days ago for his catching of cold. After seeing
the doctor of western medicine, he took roxithromycin and Pi Pa Zhi
Ke Tang Jiang, but there was no improvement. So he came to
respiratory department of the hospital for TCM treatment.
× The manifestations were paroxysmal cough with difficult, thin and
white phlegm, deep and harsh nasal voice, stuffy chest, whooping
phlegm in throat, slight aversion to wind and cold, no thirst and no
fever, slight dark red tongue with white, yellowish and slimy coating,
floating, wiry and slippery pulse, with right cun pulse being thready,
slippery and weak, and right guan pulse being wiry and slippery.
× The patient fears of cold in normal times and is susceptible to
common cold.
× Induced by wind-cold, it pertained to syndrome of cold fluid-
retention obstructing lung, led to failure of lung to disperse and
depurate.
× Therapeutic methods should be warming lung and dissipating cold
to ventilate lung and relieve cough.
× The formula was modified Wen Fei Jian (empirical formula of Prof.
Hong).
× Wen Fei Jan : Sheng Ma Huang 10g, Xi Xin 3g, Fa Ban Xia 10g, Zi Wan
10g, Kuan Dong Hua 15g, Sheng Jiang 10g, Ai Di Cha 20g, Tian Jiang
Ke 15g, Nan Xing Ren 10g, Jie Geng 15g, Qing Pi 15g, Chen Pi 15g.
× 5 doses decocted with water, 1 dose per day.
× When he returned for the second visit, he stated that cough was
reduced by four fifth, phlegm was easy to be expectorated, and
nasal obstruction and stuffy chest disappeared. This indicated that
exterior pathogenic wind and cold were expelled.
× Therefore, the formula was changed to modified Yi Qi Hu Wei Tang
(empirical formula of Prof. Hong) to replenish qi, protect defensive
qi and consolidate root.
× Yi Qi Hu Wei Tang : Sheng Huang Qi 30g, Gui Zhi 10g, Bai Shao 10g,
Sheng Jiang 10g, red dates 6 pieces, Zhi Gan Cao 10g, Fang Feng
15g, Bai Zhu 10g, Lu Lu Tong 15g, Ai Di Cha 20g, Tian Jiang Ke 15g.

Case interpretation
▪ Case 1 is syndrome of wind-cold attacking lung, i.e. acute bronchitis
in western medicine caused by virus infection.
▪ There is no effect after taking VC Yin Qiao Pian, Pi Pa Zhi Ke Lu and
Gan Mao Ke Sou Chong Ji.
▪ After analyzing we find that the ingredients of the above medicines
he took are mainly in pungent-cool nature with the purpose to clear
and moisten.
Dong Wan Zhi Ke Tang
▪ Dong Wan Zhi Ke Tang is empirical formula of Prof. Hong for treating
acute bronchitis with syndrome of wind-cold attacking lung.
▪ It works well in treating wind-cold cough syndrome. It is consistent
with its pathogenesis (i.e. wind-cold attacking lung led to failure of
lung to depurate and descend) and the theories that “the lung opens
into the nose” and “the nose is the door to the lung”.
▪ The formula is to relieve cough by treating lung and nose
simutaneously with two-ways regulation.
▪ Dong Wan Zhi Ke Tang has already been developed into Class III
national new Chinese patent medicine.
▪ And II, III period clinical experimentsshowed that the obvious effect
rate is 72.1% and total effect rate 95.1%, with good effect in relieving
cough, resolving phlegm, anti-inflammation, anti-virus, clearing
heat and antibiosis.
Sheng Ma Huang 10g Sheng Jiang 10g
Xi Xin 3g Zi Wan 10g
Kuan Dong Hua 10g Fa Ban Xia 10g
Cang Er Zi 10g Xin Yi Hua 10g.
▪ From the perspective of TCM, it works well in expelling wind,
dissipating cold, ventilating lung, relieving cough and simultaneous
treatment to lung and nose, propriate for acute bronchitis with wind-
cold cough syndrome.
Case interpretation
▪ Case 2 is acute attack of chronic bronchitis caused by wind-cold.
▪ The patient often fears of cold in normal times and is susceptible to
common cold as well as thready and weak right cun pulse,
indicating he had yang and qi deficiency.
▪ Slippery right cun pulse and wiry, slippery right guan pulse indicated
phlegm and fluid-retention hidden in lung with spleen deficiency
and profuse phlegm.
▪ His symptoms of floating pulse, slight aversion to wind and cold,
deep and harsh nasal voice, aggravated cough and phlegm
expecotation were obviously caused by wind-cold attacking lung
and defensive qi, resulted in stagnation and blockage of lung-qi, and
failure of lung to depurate and descend.
▪ Phlegm, fluid-retention, wind and cold are yin pathogens.
▪ So phlegm and fluid-retention should be warmed while wind and
cold should be dispersed.
▪ The lung-qi stagnation and blockage is its excess branch whereas
yang and qi deficiency is the root.
▪ According to the principle “relieving the branch aspect in acute
cases”, we first warm lung and dissipate cold to ventilate lung and
relieve cough.
▪ Wen Fei Jian is empirical formula of Prof. Hong.
Sheng Ma Huang 10g Xi Xin 3g
Fa Ban Xia 10g Zi Wan 10g
Kuan Dong Hua 15g Sheng Jiang 10g
Ai Di Cha 20g Tian Jiang Ke 15g
▪ This formula works well for cough with syndrome of cold phlegm (or
fluid-retention) hidden in lung caused by wind-cold. If there is
serious cold fluid-retention, Ling Gui Zhu Gan Tang can be added to
warm yang and resolve fluid-retention.
Ai Di Cha (Japanese Ardisia Herb)
▪ Ai Di Cha has neutral nature and
acrid, lightly bitter flavor with
actions of resolving phlegm,
relieving cough, draining
dampness and activating blood.
▪ It can be used to treat chronic
bronchitis with serious dyspnea
and profuse phlegm, applicable
to both lung-cold and lung-
heat.
▪ The common decocting dosage is 15g to 30g, with no obvious side
effect.
▪ With its actions of dissipating stasis and stopping bleeding, it can be
also used to treat cough and hemoptysis of tuberculosis and
bronchiectasia, relieving cough and stopping bleeding.
Tian Jiang Ke (Japamese Metaplexis Pericarp)
▪ Tian Jiang Ke has actions of ventilating
lung, resolving phlegm, relieving cough
and dyspnea, and promoting eruption.
▪ Clinically it is used to treat failure of lung
to ventilate, cough with profuse phlegm
and asthma.
▪ It is good at ventilating lung and relieving
cough, so it is often used to treat cough
with profuse phlegm and asthma of
acute and chronic bronchitis, for better
efficacy with Ai Di Cha. And its common
dosage is 10g to 15g.
Case interpretation
▪ Zhang Jingyue stated in the book Jing Yue Quan Shu (Jing Yue’s
Collected Works), “six qi would make one cough, of which wind-cold
is the main cuase”.
▪ Cheng Zhongling emphasized in the book Yi Xue Xin Wu
(Comprehension of Medicine), “nine of ten causes of cough are
wind-cold”.

Case 3 Miss Wang, 28 years old, female

▪ The patient had cough due to common cold with yellow phlegm for
half a month and there was no improvement after taking Chinese
herbs and western medicines.
▪ The manifestations were paroxysmal high-pitched choking cough
with throat itching, little white and yellow phlegm difficult to be
expectorated, dry mouth with desire to drink, dragging pain in chest
and hypochondrium, dry stool.
▪ Her chest X-ray showed there were increased lung markings.
▪ And the total numbers of white blood cell and neutrophilic cell were
normal.
▪ Her tongue was slightly red with white, yellowish and slimy coating;
and her pulse was floating, thready, wiry and slippery, with left guan
pulse being wiry and thread.
Question : External contraction cough or internal damage cough ?
Which syndrome is ?
Answer :
✓ The syndrome was phlegm-heat obstructing lung, resulting in failure
of lung to ventilateand depurate, with external cold pathogen
lingering and liver qi counter-restricting lung.
✓ The therapeutic methods should be clearing heat, ventilating lung,
clearing liver and tranquillizing lung.
✓ The formula should be Ma Xing Gan Shi Tang, Qian Jin Wei Jing Tang
with modified Dai Ge San.
Ma Xing Gan Shi Tang, Qian Jin Wei Jing Tang with modified Dai Ge
San：
× Sheng Ma Huang 10g, Nan Xing Ren 10g, Sheng Gan Cao
10g, Wei Jing 30g, Huang Qin 10g, Dong Gua Ren 30g, Sang
Bai Pi 10g, Quan Gua Lou 30g, Jing Qing Dai 6g, Hai Ge Qiao
20g, and Jin Qiao Mai 20g.
× 5 doses decocted with water, 1 dose per day.
▪ On the second visit, the patient showed relieved cough, absence of
yellow phlegm, smooth defecation, no dragging pain in chest and
hypochondrium, no floating pulse.
▪ So, keep taking 5 doses of the original formula.
▪ On the third visit, signs and symptoms of lung system disappeared
totally without any obvious discomfort.
▪ So Mai Men Dong Tang was prescribed to replenish qi and nourish
yin for further consolidation.
Case interpretation
▪ The cause of this case was originally external contraction wind-cold,
and then cold depression generating fever, lung qi being obstructed,
resulted in failure of lung to depurate and descend, and cough with
dyspnea.
▪ High-pitched choking cough with yellow phlegm was caused by
phlegm-heat obstructing lung.
▪ White phlegm, throat itching and floating pulse were obviously
caused by lingering wind-cold pathogen.
▪ Choking cough with dragging pain in chest and hypochondrium, red
tongue and wiry pulse were sympotoms of liver-cough.
▪ And young female often had liver qi counterflow, which counter-
restricted lung and led to frequent cough.
 ▪ The modified combination of Ma Xing Gan Shi Tang with Qian Jin Wei
Jing Tang can clear heat, ventilate lung, eliminate external pathogen,
resolve phlegm, purify lung and tranquilize cough.
▪ Besides, according to the interior-exterior relationship between lung
and large intestine, Quan Gua Lou and Dong Gua Ren were used
with large dosage to clear phlegm heat, smooth fu-organ qi
movement, promote defecation, descend lung qi and resolve
cough.

Case 4 Mrs. Chen, 46 years old, female

▪ She was withdrawn, introverted, weak and unhappy. Recently, her
undesirable household affaires induced the disease with the
following manifestations: stuffy chest, frequent choking cough with
dragging pain in hypochondrium, dyspnea, dysphoria and irritability,
dry throat and thirst with desire to drink, red tongue (especially in the
margins) with thin, yellow coating and scanty fluid, wiry, thready and
forceful pulse.
▪ Her chest X-ray showed increased lung markings. There was no
improvement after taking western medicines.
Question : External contraction cough or internal damage cough ?
Which syndrome is ?
▪

Answer :
Syndrome of liver-fire invading lung → Dai Ge San and Huang Qin Xie Bai
San.
The treatment is clearing liver, purging lung, resolving phlegm and
relieving cough
✓ It was syndrome of qi depression transforming into fire that
transversely invades lung, resulted in the failure of lung to depurate
and descend. Therapeutic methods should be clearing liver, purging
fire, depurating lung and relieving cough.
✓ The formula was modified combination of Dai Ge San with Dan Zhi
Si Ni San.
✓ Dai Ge San with Dan Zhi Si Ni San : Jing Qing Dai 6g (wrapped up with
cloth before decocting), Hai Ge Qiao 20g, Mu Dan Pi 15g, Sheng Zhi
Zi 10g, Bei Cai Hu 10g, Bai Shao 10g, Zhi Shi 10g, Sheng Gan Cao
10g, Nan Xing Ren 10g and Pi Pa Ye 10g.
✓ 7 doses decocted with water, 1 dose per day.
✓ On the second visit, she stated that cough reduced greatly after
taking 3 doses and all symptoms disappeared after taking 7 doses.
✓ So, another 7 doses were prescribed to consolidate the effect and
she was instructed to regulate mood to avoid reoccurrence of the
disease.
Case interpretation
▪ In this case, qi depression transforming into fire that transversely
invades lung, resulted in the failure of lung to depurate and descend,
frequent choking cough with dragging pain in hypochondrium,
dysphoria and irritability, wiry, thready and forceful pulse.
▪ These manifestations pertain to syndrome of “wood-fire tormenting
metal”, namely “liver cough” stated in the Chapter Ke Lun:
Discussion on Cough in the book Su Wen(《素问·咳论》).
▪ Modified combination of Dai Ge San with Dan Zhi Si Ni San was used
to clear liver, pruge fire, depurate lung and relieve cough.
▪ The root cause of liver cough is in liver but it influences lung, so the
symptoms of liver disease often appear first when the disease
occurs. Liver qi is ascending in nature, but lung is the fragile organ
that cannot endure the pathogen’s invasion.
▪ Therefore, the medicinals for liver cough should be of the following
features in nature: clearing, cooling and descending instead of
drying, ascending and dispersing.
Case 5 Mr. Jiang, male, 21 years old
▪ He was hospitalized on Sept. 29.
▪ Medical history: irregular fever for 5 months.
▪ He got wet in the rain in May, and there appeared high fever, aversion
to cold, headache and nasal congestion the second day.
▪ The situation was improved after taking western medicines in local
clinic.
▪ There was low fever in June with temperature being about 37.6℃ and
aversion to cold before the occurrence of fever.
▪ He was treated in local hospital as malaria and the temperature
became normal after taking medicines for 3 days.
▪ No plasmodium was found but he got fever again after one week and
had serious aversion to cold that could be alleviated by wearing
more clothes and quilts. The patient had no treatment then but
recovered himself.
▪ The same symptoms appeared again in August, so he was examined
“anti-o 1250U” in county hospital, and diagnosed as rheumatic
fever.
▪ But the symptoms recurred after antirheumatic treatment, so he
came here for treatment.

Present symptoms : irregular low fever that was more serious in the
afternoon, stuffy chest and abdomen, sweet and sticky mouth
without bitter taste, slight thirst, little cough with dark red blood in
phlegm in recent days, dull pain in right chest induced distending
pain in right back, slight aversion to cold in back, scanty white and
sticky phlegm, normal appetite, urine and stool, no feverish feeling
in palms and soles, dark red tongue with thick yellow and slimy
coating, and wiry, slippery and rapid pulse.
Lab examinations : hemoglobin 82%, white blood cell 10.0×109/L,
neutrophilic cell 68%, lymphocyte 24%, eosinophils 8%, negative
rheumatoid factor, anti-o 600U, normal urine routine, erythrocyte
sedimentation rate 90mm/h, phlegm for acid-fast bacillus negative.
Chest X-ray examination: inflammation in upper right lung field.

Question : External contraction cough or internal damage cough ?

Which syndrome is ?
Answer :
✓ On Oct. 8, he was diagnosed with syndrome of damp-heat
stagnating in lung, resulted in failure of lung to ventilate.
✓ Therapeutic method was focused on dispersion and elimination.
✓ The formula herbs were : Pi Pa Ye 10g, Huang Qin 10g, Lian Qiao 15g,
Xing Ren 10g, Chang Pu 10g, Si Gua Luo 10g, Lu Gen 30g, Jin Yin Hua
20g, Yi Yi Ren 10g, Yu Jin 10g, Ou Jie 30g, and Ju Luo 5g.
✓ The situation was improved, no blood in phlegm and temperature
being normal after taking the formula.
✓ So he continued to take the same formula.
✓ Reexamination on Oct. 12: Eosinophils 11%, absolute counting
0.528×109/L, erythrocyte sedimentation rate 73mm/h.
✓ Reexamination on Oct. 25: X-ray reported inflammatory in upper
right lung field was largely absorbed.
✓ The patient was diagnosed as pulmonary eosinophilia based on the
facts that the reoccurrence of the disease had lasted for more than
half a year, the absolute counting of eosinophils was several times
more than normal number, and there was inflammation in lung.
Second visited on Nov. 11:
▪ There was aching pain in his chest and back, lassitude, cough
with phlegm, stuffy chest, dark red tongue, thick and slimy
coating with yellow and white colour, wiry, slippery and slightly
rapid pulse.
▪ It pertained to syndrome of phlegm-dampness hidden in lung,
with its depression transforming into heat.
▪ The therapeutic method was to dry dampness, resolve phlegm
and clear heat.
▪ The formula included : Fa Ban Xia 15g, Fu Ling 15g, Chen Pi 10g,
Sheng Gan Cao 5g, Bai Jie Zi 10g, Huang Qin 10g, Zhi Shi 30g, Bai
Xian Pi 15g, Di Fu Zi 15g, and Tu Fu Ling 15g.
▪ One dose per day decocted with water.
▪ Examinations before taking the doses : erythrocyte
sedimentation rate 72mm/h, white blood cell 7.2×109/L,
neutrophilic cell 70%, lymphocyte 24%, eosinophils 6%,
absolute counting 1.25×109/L.
▪ Re-examinationon Nov. 23 showed the symptoms were almost
disappeared. And the absolute counting of eosinophils
0.2×109/L, erythrocyte sedimentation rate 25mm/h, anti-o
400U. Skin test of allergen: house dust (+), cotton fiber (+), mites
(++).
▪ The case pertains to phlegm-dampness cough syndrome in TCM
and eosinophilia in western medicine, with the absolute
counting of eosinophils beyond 0.4×109/L in blood.
▪ The related diseases with eosinophilia are of wide scope and
various symptoms, among which was pulmonary infiltration
with eosinophilia syndrome with the characteristics of
increasing eosinophils and pulmonary infiltration. According to
the above clinic symptoms, this case was diagnosed as
simplepulmonary infiltration with eosinophilia syndrome.
 ▪ The patient had recurrent low fever, cough and chest pain; the
absolute counting of eosinophils was beyond 0.4×109/L, and the
X-ray chest showed inflammation changes.
▪ There was not obvious improvement after repeated anti-
inflammatory and symptomatic treatment. The symptoms were
consistent with simple pulmonary infiltration with eosinophilia
syndrome.
▪ Form the angle of TCM, the symptoms such as recurrent low
fever, sticky and sweet sense in mouth, stuffy chest and
abdomen, lassitude, white and sticky phlegm, cough with chest
pain, thick and slimy tongue coating of yellow and white colour
showed it was related to damp pathogens.
▪ In the initial, there was dampness with wind-cold, and wind-
cold was eliminated after treatment but dampness retained.
▪ As time went by, the external dampness had transformed into
internal one.
▪ Dampness with heaviness, turbidity, viscosity and recurrence as
its pathogenic characteristic pertains to yin pathogen.
▪ Young male’s dampness tends to transform into heat, resulting
in complexity of dampness and heat, worsening the state of the
disease.
▪ Wang Tingzhen referred it as “half yin and half yang”.
▪ Wu Jutong stated “qi transforming fails if lung suffers from
dampness pathogen”.

The functions of eosinophils

▪ To constrain the functions of basophilic granulocyte in
immediate hypersensitivity.
▪ To function in worm immunoreaction.
 ▪ There are many causes for the absolute counting of
eosinophils beyond normal amount in blood, which is
closely related with protopathic disease.
▪ On the one hand, eosinophils can kill parasites and regulate
allergic reaction.
▪ On the other hand its some particles and lipid oxidation
products can damage normal tissues.
▪ Eosinophilia indicates hypersensitivity or parasites.
Case interpretation
▪ This case is closely related with pulmonary eosinophilia,
pertaining to allergy.
▪ The treatment lasted more than half a year and that
eosinophilia wasn’t effectively controlled was mainly
responsible for his recurrent disease.
▪ The treatment of reexamination on Nov.11 was focused on
the key problem of inhibiting eosinophilia.
▪ According to former clinical experiences, it seems that the
symptoms of allergy or eosinophilia have close relation with
dampness or damp-heat.
▪ On Nov. 11, in addition to Er Chen Tang, we added Zhi Shi,
Bai Xian Pi, Di Fu Zi and Tu Fu Ling to clear damp-heat.
▪ The prominent feature of this formula is the large dose of Zhi
Shi 30g.
Zhi Shi（AURANTII FRUCTUS IMMATURUS)
▪ Shen Nong Ben Cao Jing (《神农本草经》, Shennong’s Classic of
Materia Medica ) states that “Zhi Shi can treat itching skin caused by
severe pathogenic wind, eliminate binding of cold and heat, and
relieve dysentery.”
▪ According to the statement, Zhi Shi can be used to cure allergic
symptoms of skin such as urticaria, measles.
▪ Pharmacological studies indicate that Zhi Shi has obvious influence
on allergic reaction.
▪ With rats being sensitized by egg white, Zhi Shi decoction can inhibit
their isolated intestine’s contracture caused by specific antigen.
▪ Either water or alcoholic extract of Zhi Shi can inhibit release of
anaphylactic mediators.
▪ Zhi Shi has powerful antiallergic activity in inhibiting passive
cutaneous anaphylaxis (PCA) and release of mastocyte histamine.
▪ Bai Xian Pi, Di Fu Zi and Tu Fu Ling that are powerful in clearing heat
and draining dampness can be used to cure syndromes of pruritus.
▪ By combining the three herbs with large dose of Zhi Shi, the
therapeutic effect in clearing heat and draining dampness is
obviously reinforced, thus, inhibiting eosinophilia with good
therapeutic effect.
▪ This case’s analysis shows that eosinophilia could be treated from
the perspective of damp-heat and there is important function of Zhi
Shi, Bai Xian Pi, Di Fu Zi and Tu Fu Ling in inhibiting eosinophilia.