Exopathic CoughExopathic Cough 1) Wind-Cold Wind-Cold type cough

Signs & Symptoms:

– Main Sym. : Newly-occurred cough, coughing sound being lower and vague, white & thin sputum

– Concurrent sym.: headache, nasal stuffiness, nasal clear discharge, painful sensation in the joints, aversion to cold & no sweating

– Tongue: white body with thin coating

– Pulse: Floating

• Treatment Protocol:

– Expel the Wind – Release the cold– Restore the Descending and Dispersing Function of the LU Qi

Formula:

Modifications:Aversion to cold

-- Mang Huang, Fang Fen, Qiang HuoSputum

- - Chen Pi, Ban Xia

Headache -- Chuang Xiong, Bai Zi

Cough with sore & dry throat, thirst, severer fever, yellow fur, floating rapid pulse - Ma Xing Shi Gan Tang

Xing su San

Xing Ren Zi Su Chen Pi Ban Xia Sheng Jiang Zhi ke

Jie geng Qianhu Fu ling Gan cao Da Zhao

Jin Fei Cao San

Xuan Fu HuaXuan Fu Hua Bai Shao Bai Shao Gan CaoGan Cao Zhi Gan Cao Qian Hu

Jing Jie Sheng Jiang Da Zhao Jiang Ban xia Ma Huang

Zhi Ke Shi San Wei

Chuan Xiong Ban Xia Fu ling Sang bai pi Gan Cao

Qing Pi Xing Ren Wu wei zi Chuan bei muj Chen Pi

Exopathic CoughExopathic Cough 2) Wind-Heat Wind-Heat type cough

Signs & Symptoms:

– Main Sym. : Dry cough or cough with loud voice, thick sputum

– Concurrent sym.: fever & aversion to wind, headache, sweating, sore throat, thirst, runny nose with yellow discharge, sneezing, slight thirst, slightly dark urine.

– Tongue: slightly red sides

– Pulse: Floating & rapid

• Treatment Protocol:

– Release the exterior– Expel the wind– Clear the heat– Restore the Descending of Lu Qi and stop cough

Formula:

Modifications: Aversion to wind

-- Jin Jie, Fang Feng Severer lung Heat

- - Huang Qin, Shi GaoCough

- Niu Pang Zi, Qian Hu, Zhe Bei Mu, Pi Pa Ye

throat itching-- Fang Feng

Sore throat- Niu Pang Zi, Ma bo, Ban Lan Geng

Sputum being difficult to be expectorated- Quan Gua Lou

nosebleed- Mao Geng, Ou Jie

oppressed feeling in the chest, thick white fur, soft pulse- Yi Ni ren, Hou Pu

restlessness, thirsty, dark urine in summer- Huo Xiang, Pei lan

Sang Ju Yin

Sang Ye Ju hua Bo he Xing Ren Jie Geng Lu Geng

Jie geng Lian Qiao Gan Cao

Exopathic CoughExopathic Cough 3) Wind-DryWind-Dry type cough

Signs & Symptoms:

– Main Sym. : Dry and ticklish cough without sputum or sputum being difficult to be expectorated, dry-itchy-sore throat

– Concurrent sym.: sore sensation in the upper chest, cough with blood sputum, dry lips, dry mouth, stuffed nose, headache, slight aversion to cold and slght shivers

– Tongue: slightly red sides or tip, thin yellow dry coating

– Pulse: Floating or slightly rapid

• Treatment Protocol:

– Release the exterior– Promote fluids and stop cough– Restore the Descending of Lu Qi

Formula:

Modifications:severer cough with itching throat

-- Qian Hu, Chan Tui, Jie Geng, Gan caosore throat

-- Ma Bo, Xuan Shennose bleeding or bloody sputum

-- Bai Mao Geng, Shen Di Huang severer lung heat

- Zhi Mu- Zhi Mu, Shi GaoCough

- Niu Pang Zi, Qian HuDryness

-- Yu Zu, Mai Meng Dong, Tian Hua Feng

Dry-cold attack lung- Jing Jie, Fang feng, Zi Wan, Kuang dong Hua ( reduce zhizi, bei mu, pear skin)

Sang Xing Tang

Sang Ye Xing Ren Sha Sheng Zhe Bei Mu Dan dou Chi

Shan Zhi zi Pear skin

Internal injury CoughInternal injury Cough 1) Phlegm-dampnessPhlegm-dampness type cough

Signs & Symptoms:

– Main Sym. : Chronic cough, abundant sputum being white color and easy to be expectorated

– Concurrent sym.: chest distress, poor appetite, tiredness, weakness and frequent loose stool, cough is aggravated in the morning or after intake of sweet and greasy food

– Tongue: white greasy coating

– Pulse: soft

• Treatment Protocol:

– Strengthen the spleen– Removing dampness – Restore the Descending of Lu Qi

Formula:

Modifications:Oppressed feeling in the chest

-- Cang Zhu, Hou pu, Xing Ren, Yi yi Ren

Severer cough-- - Ma Huang, Xing Ren, Zi Su Zi

Phlegm-cold sym: aversion to cold-- Gan Jiang, Xi Xin

Spleen Def. : pale tongue, week pulse and diarrhea-- Dang Sheng, Bai Zhu

Cough with strike reverse flow of qi-- San zi yang qin tang

Er Cheng Tang

Chen Pi Ban Xia Fu Ling Zhi Gan Cao

San Zi Yang Qin Tang

Zi Su zi Bai Jie Zi Lai Fu Zi

Internal injury CoughInternal injury Cough 2) Phlegm-heat accumulationPhlegm-heat accumulation type cough

Signs & Symptoms:

– Main Sym. : Cough, shortness of breath, yellow greasy phlegm

– Concurrent sym.: distending and painful sensation in the chest when coughing, bitter taste, dry mouth, thirst, stinking phlegm or bloody phlegm or fever

– Tongue: yellow greasy tongue coating

– Pulse: slipper rapid

• Treatment Protocol:

– Strengthen the spleen– Removing dampness – Restore the Descending of Lu Qi

Formula:

Modifications:Sticking phlegm

-- Yu Xing Cao, Lian Qiao, Yi Ni Ren, Dong Gua RenPurulent sputum

-- Dan Nan Xing, Yi Yi Ren, Dong Gua Ren Feeling of oppression in the chest with severe cough and constipation

-- - Ting li Zi or Da Huang Phlegm heat damage fluid: thirsty

-- Sha Sheng, Tian Hua FengBloody phlegm

-- Mao Geng, Ou JieFluids being injured

-- Sha Sheng, Tian Meng Dong, Tian Hua Feng

Qing Jin Hua Tan Tang

Huang qin Shan zhi zi Jie Geng Mai Dong Sang Bai Pi Bei Mu

Zhi Mu Gua Lou Ju Hong Fu Ling Gan cao

Internal injury CoughInternal injury Cough 3) Liver-fire insulting lungLiver-fire insulting lung type cough

Signs & Symptoms:

– Main Sym. : Cough induced pain involving the chest & hypochondrium

– Concurrent sym.: Flushed face, dry throat & mouth, pain on coughing, bitter taste, dark urine, dry stools, irritability and a dry mouth, symptoms are along with the change of emotional activity

– Tongue: yellow thin tongue coating with less moisture

– Pulse: wiry rapid

• Treatment Protocol:

– Smooth the liver qi– Clear the lung heat – Restore the descending of Lung-Qi and stop cough

Formula:

Modifications:Cough:

-- Jie Geng, Gan CaoLiver Fire:

-- Long Dan CaoFever

-- Huang Qin, Shan Zhi Zi, Mu Dan PiSputum & sever cough

-- - Bei Mu, Gua Lou, Zhu Ru, Su Zi, Pi Pa YeSymptoms of rebellious Qi: Fullness of chest

-- Qin Pi, Chen Pi, Zhi ShiChest Pain

-- Yu JinYin Def.

-- Sha Shen, Mei Meng Dong, Tian Hua Feng

Xie Bai San

Sang Bai Pi Di Gu Pi Sheng Gan Cao Jing Mi

Dai Ge San

Qing Dai Hai Ge Ke

Internal injury CoughInternal injury Cough 4) lung Yin Deficiencylung Yin Deficiency type cough

Signs & Symptoms:

– Main Sym. : Chronic cough, dry cough with less sputum or with bloody sputum, afternoon tidal fever

– Concurrent sym.: Flushed cheeks, feverish sensation in the palms and soles, insomnia, night sweating, lack of vitality, tiredness and restlessness,

– Tongue: red tongue with less coating

– Pulse: thready rapid

• Treatment Protocol:

– Nourish Yin– Clear the lung heat– Resolving sputum and relieving cough

Formula:

Modifications:Tidal fever

-- Bie Jia, Di Gu Pi, Qin Hao, Yin Cai Hu, Bai Weisevere cough

-- Wu Wei zi, He zi Profuse night sweating

-- Wu mei, fu xiao mai, - Wu mei, fu xiao mai, Cough with yellow sputum

-- Zhi Mu, Huang QinBloody phlegm

-- Ou Jie, Xian He Cao, Bai je, E Jiao, San Qi ( Mao Geng ?)

Sha shen mai meng dong tang

Sha shen Mai dong Yu zhu Bai he Tian hua feng

Chuan bei mu Xing ren Sang ye Gan cao Bian dou

Modifications Summarize:

distention feeling in the chest-- Zhi Ke, Jie Geng

distension feeling with abundant sputum-- Qian Hu, Jie Geng

Aversion to wind-- Fang Feng, Jin Jie - Fang Feng, Jin Jie

Aversion to cold-- Zi Su, Qian Hu

Aversion to heat-- Lian Qiao, Bo He

cough with chest pain-- Ju Ruo, Gua Lou

Abundant sputum + Vomiting-- Zu ru, Ban Xia

Qi rebellion sym.-- Dai Zhe Shi, xuan Fu Hua

lung heat + sticky sputum-- Hai Fu Shi, Gua Lou

Difference of all stop coughing herbs

Name characters Actions Treatable disease Caution

Xing Ren Bitter, Warm, little toxin, Lu. LI.

Direct Lu. Qi downward: Wind-heat; Wind-cold; Lu. Qi Rebellion

Lu. Qi def. or chronic cough

Zi Wan Bitter, Spicy, little warm, Lu.

Smooth Lu. Qi, Moisten Lu. ( spicy but not dry; moisten but not cold; tonify but not greasy)

Stop various cough

Ban Xia Spicy, Lu. Sp. St. Redirects Qi downward, resolve phlegm ( dry), Cough with lots phlegm

Yin & blood def. (wu tou)

Bai Bu Sweet, bitter, Lu. Little toxinLittle toxin

Moisten Lu. , redirects Qi downward All types of cough, particularly chronic & def. type

Weak digestion & diarrhea

Zi Su Zi Spicy, warm, Lu. LI.

Strongly redirects Qi downward Stops cough & asthma

Qi sink or def.

Kuan Dong Hua

Spicy, litter bitter, Warm, Lu.

Moisten Lu. , Redirect Qi downward Cold cough or chronic cough

Cough due to heat or fire

Xuan Fu Hua

Bitter, Spicy, salty, little warm, Lu. Liv. St. Sp.

Redirect Qi Downward; Reduce the phlegm & promotes the dissipation of pathogenic water

Cough with phlegm & water accmulation

Qi def. and diarrhea

Wu Wei Zi Sour, sweet, Warm, Lu. Ht. Kid.

Contain the leakage of Lu. Qi & stop cough Chronic cough Cough due to external evil attack

Chen Pi Bitter, Spicy, Warm, Lu. Sp. St.

Regulate the Qi, Dry & transform the Phlegm Cough with phlegm or Middle Jiao Qi Stag.

Qi def.

Xi Xin Spicy, warm, Lu. Kid. Little toxinLittle toxin

Warm the Lu. Stop cough, open the nose Cough with nose congestion

Bai Qian Spicy, sweet, little warm

Redirect Qi Downward, reduce phlegm, Exterior Cough with phlegm

Weak and def. patient

Difference of all stop coughing herbsName Taste Actions Disease Caution

Jie Geng Spicy, bitter, Lu.

Reduce phlegm, benefit the throat, Guide herb to the lung

Cough with phlegm and sore throat

Def. cough or dry cough without phlegm

Lai Fu Zi Spicy, sweet, Lu.

Reduce phlegm and middle Jiao Qi stagnation

Cough with phlegm or abdominal distention

Qi def. or cough without phlegm

Bai He Sweet, Lu. Ht. Tonify Lung Yin and stop cough Cough due to lung Yin def. or dryness

Exterior cold

Bai Guo Sweet, Bitter, little toxin Lu.

Contain and tonify the lung Qi Asthma with cough Cough with thick phlegm

San Bai Pi Sweet, Spicy, cold

Clear Lu. Fire, Promote urine reduce swollen

Lung heat type cough (with swollen)

Qi def. or exterior cold

Pi Pa Ye Bitter, Lu. St. Clear lung & st. heat, redirect qi downward,

Lung heat type cough (with vomiting or nausea)

Chuan Bei Mu

Bitter, sweet, Lu. Ht. little cold

Moisten Lu. Redirect qi downward, reduce phlegm

Cough due to yin def.

Zhe Bei Mu

Bitter, Lu. Ht. cold

Drain heat, disperse the exterior wind-heat

Exterior cough

Case History 1. Female 26 years old Got cold 3 months ago due to walk in a raining day. At that time: stuffy nose with clear discharge, ache

of whole body, cough with lot sputum. She took JinFangBaiDuSan + Xin Su San for 2 days, and all the symptoms got better except cough. She took the antibiotics medicine, but not working. After changing 4 TCM doctors and taking 20 bags of stopping coughing herbs, still not working Sym now:Sym now: Cough with itching throat, less sputum and hard to be expectorated, Tongue: white coating and little thick in the middle & root Pulse: slipper & thready

Treatment Protocol:

First visiting of clinic:Restore the descending of Lung-Qi

expel the wind-cold

Xuan fu Hua 10, Bai Shao 12, Gan Cao 5, Jin Jie 15, ZiSu Ye 10, Qian Hu 10, Ban xia 10, Xin Ren 10, Bai Jie Zi 10, Jie Geng 10 ( 2 bags)

Second visiting:sym: cough is getting much better, no itching throat, sputum is easily expectorated

XuanFuHua10, BaiShao12, GanCao5, JinJie15, Jie Geng10, ZiYu15, BaiBu10, QianHu10, XingRen10, XianHeCao30 (3 Bags)

Third visitingSym: No coughing in daytime, still little cough at night

Zhi ke shi San Fang

Brachial wheezing syndromeBrachial wheezing syndrome TCM Diagnoses and Treatments

Wheezing (Xiao) indicates a wheezing sound which may resemble that of whistling, snoring or sawing. It is usually accompanied by breathlessness with an inability to breathe when lying down

Etiology & Pathology:Etiology: 1. External pathogenic factors

Wind-coldWind-heat

2. Diet 3. Weak body condition ( Lu, Sp, Kid)

Pathology:

Differentiation & TreatmentDifferentiation & Treatment Acute Phase

Cold Phlegm

Heat Phlegm

Treatment Principle:

Resolve Phlegm

Restore the descending of Lu Qi

Chronic Phase

Lu. Def.

Sp. Def.

Kid. Def.Treatment principle:

Tonify Lu. Sp. Kid.

Main Points for differentiationMain Points for differentiation

Differentiation of cold & heat

Heat type Cold type

Sputum Thick, yellow & sticky Thin, while & clear

expectoration Difficult Easy

Onset due to Summer-heat Cold-evil, allergy

Accompanied by

Headache, sore throat, fever, slight aversion to cold

Headache, aversion to cold, fever,

Tongue Red body with yellow greasy coating

White greasy or white slippery coating

Pulse Slippery rapid Floating & tight

Main Points for differentiationMain Points for differentiation

Differentiation of deficiency & access

Def. type Access type

Pathology Chronic wheezing Newly-occurred

Stage Intermission stage During the attack stage

Sym. Spontaneous sweating, aversion to wind, pale complexion face…

Breathlessness, distended chest, cough, feeling comfortable if having a long expiration

Tongue Red body with less coating Red tongue with thin coating

Pulse weak strong

TreatmentTreatment 1) Acute phaseAcute phase a) Cold-phlegm

Signs & Symptoms:

– Main Sym. : rapid breathing, wheezing, full & oppress feeling of the chest, cough, scanty phlegm

– Concurrent sym.: a blush-white complexion, no thirst, or a desire for warm drinks, feeling cold, worse in cold weather

– Tongue: swollen with a sticky-white coating

– Pulse: tight & slippery

• Treatment Protocol:

– Warm the lung & expel the cold– Resolve phlegm– Relieve breathlessness

Formula:

Modifications:Exterior sym. Severe + internal phlegm

-- Xiao Qin Long Tanglong illness + kid. Yang def.

-- Su Zi Jiang qi Tang + Dang shen, hu tao rou, zi shi yin, chen xiang Abundant sputum

-- san zi yang qin tang - san zi yang qin tang Kid. Yang def

-- Fu Zi, bu gu zhi

She Gan Ma Huang Tang

She gan Ma Huang Gan Jiang Xi Xin Ban Xia Zi Wan

Kuan Dong Hua Gan Cao Wu Wei Zi Da Zao Bian dou

TreatmentTreatment 1) Acute phaseAcute phase b) Heat-phlegm

Signs & Symptoms:

– Main Sym. : wheezing with a loud voice, breathlessness, distended chest, cough, yellow-sticky sputum

– Concurrent sym.: irritability, sweating, a red face, bitter taste, thirst, a feeling of heat

– Tongue: red with a yellow-sticky coating

– Pulse: slippery-rapid

• Treatment Protocol:

– Clear the heat– Resolve phlegm– Restore the descending of Lung-Qi & stop wheezing

Formula:

Modifications:

Cough-- Jin Fei Cao, Qian Hu, Bai Qian

Wheezing-- Xuan Fu Hua, Sang Bai Pi, Di Long

Abundant sputum -- - chuan Bei mu, Chen pi, Jie Geng

Yellow sticky sputum-- Zhi Mu, Hai Ge Ke, She Gan, Yu xing Cao

Fever-- shi Gai, Zhi Mu

Yin def. -- Sha Shen, Wu Wei Zi, Mei meng Dong Tang

Constipation-- Da Huang, Mang Xiao

Ding Chuan Tang

Ma Huang Huang Qin Sang Bai Pi Xing Ren Ban xia Su Zi

Kuan Dong Hua Bai Guo Gan Cao

TreatmentTreatment 2) Chronic phaseChronic phase a) Lung Def.

Signs & Symptoms:

– Main Sym. : spontaneous sweating, aversion to wind, sneezing, runny nose, pale complexion, frequent common cold due to abnormal changes of climate

– Concurrent sym.: shortness of breath, low voice, slight wheezing with a low sound

– Tongue: Pale tongue with thin white coating

– Pulse: weak or def. large

• Treatment Protocol:

– Tonify the lungs– Consolidate the Exterior

Formula:

Modifications:Qi Def.

-- Tai Zi Sheng, Dang Sheng, Yin Def.

-- Sheng Di, Sha Sheng, Dong Chong Xia CaoYang Def.

-- Fu Zi, Rou GuiBlood stasis

-- Dan Sheng, Chuan xiongSpleen Def.

-- Liu Jun Zi TangExterior sym. Severe

-- Gui Zhi, Bai shao, Da Zhao Cough

-- - Zi Wan, Sang Bai piZi Wan, Sang Bai pi

Yu Ping Feng San

Huang Qi Bai Zhu Fang Feng Dang Shen Mai dong Wu wei zi

TreatmentTreatment 2) Chronic phaseChronic phase b) Spleen Def.

Signs & Symptoms:

– Main Sym. : poor appetite, loosing stools, slight abdominal distension, intolerance to certain foods

– Concurrent sym.: tiredness, shortness of breath, dislike of speaking, desire to lie down, weariness

– Tongue: Pale tongue with thin white coating

– Pulse: weak or def. large

• Treatment Protocol:

– Tonify the spleen– Resolve phlegm

Formula:

Modifications:

Yang Def.

-- Gui Zhi, Gan Jiang

Liu Jun Zi Tang

Dang Sheng Bai Zhu Fe Ling Chen Pi Ban xia Gan cao

TreatmentTreatment 2) Chronic phaseChronic phase 3) Kidney Def.

Signs & Symptoms:

– Main Sym. : shortness of breath, worsening while making exertion, dyspnea, soreness & weakness of the waist & legs,

– Concurrent sym.: poor memory, tinnitus– Tongue:

pale – Pulse:

deep weak

• Treatment Protocol:

– Tonify the kidney– Resolve phlegm

Formula:

Modifications:Yang Def.

-- Gui Zhi, Gan Jiang, Ge Jie

Yin Def.

-- Nu Zhen Zi, Shi hu

Cough with sputum

-- xing Ren, Su zi, Ban Xia

Bad appetite

-- sheng Qu, Shan Zha

Jin Gui Shen Qi Wan

Shu di huang Shan Zhu Yu

Shan Yao Ze Xie Mu Dan Pi Fu Ling

Mai men Dong Wu Wei Zi Bu Gu Zhi Hu Tao rou