Exopathic Cough 1) 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 Huo Sputum - 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 Hua Bai Shao Gan Cao Zhi Gan Cao Qian Hu Jing Jie Jiang Ban xia Ma Huang Zhi Ke Shi San Wei Chuan Xiong Sang bai pi Qing Pi Wu wei zi Chuan bei muj

Exopathic Cough 2) 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: -- Jin Jie, Fang Feng Severer lung Heat - Huang Qin, Shi Gao Modifications: Aversion to wind -- Jin Jie, Fang Feng Severer lung Heat - Huang Qin, Shi Gao Cough - 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 Cough 3) Wind-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: -- Qian Hu, Chan Tui, Jie Geng, Gan cao severer cough with itching throat -- Qian Hu, Chan Tui, Jie Geng, Gan cao sore throat -- Ma Bo, Xuan Shen nose bleeding or bloody sputum -- Bai Mao Geng, Shen Di Huang severer lung heat - Zhi Mu, Shi Gao Cough - Niu Pang Zi, Qian Hu Dryness -- 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

1) Phlegm-dampness type cough Internal injury Cough 1) Phlegm-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: -- Cang Zhu, Hou pu, Xing Ren, Yi yi Ren 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

2) Phlegm-heat accumulation type cough Internal injury Cough 2) Phlegm-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 Ren Purulent 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 Feng Bloody phlegm -- Mao Geng, Ou Jie Fluids 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

3) Liver-fire insulting lung type cough Internal injury Cough 3) Liver-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 Cao Liver Fire: -- Long Dan Cao Fever -- Huang Qin, Shan Zhi Zi, Mu Dan Pi Sputum & sever cough -- Bei Mu, Gua Lou, Zhu Ru, Su Zi, Pi Pa Ye Symptoms of rebellious Qi: Fullness of chest -- Qin Pi, Chen Pi, Zhi Shi Chest Pain -- Yu Jin Yin 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

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

Sha shen mai meng dong tang Formula: Modifications: Tidal fever -- Bie Jia, Di Gu Pi, Qin Hao, Yin Cai Hu, Bai Wei severe cough -- Wu Wei zi, He zi Profuse night sweating -- Wu mei, fu xiao mai, Cough with yellow sputum -- Zhi Mu, Huang Qin Bloody 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 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 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 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 herbs Name 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: 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 visiting Sym: No coughing in daytime, still little cough at night Zhi ke shi San Fang

Brachial 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-cold Wind-heat 2. Diet 3. Weak body condition ( Lu, Sp, Kid)

Pathology:

Acute Phase Differentiation & Treatment 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.

Differentiation of cold & heat Main 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

Differentiation of deficiency & access Main 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

Treatment 1) Acute 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 Tang long 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 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

Treatment 1) Acute 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

Treatment 2) Chronic 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: -- Tai Zi Sheng, Dang Sheng, Yin Def. Qi Def. -- Tai Zi Sheng, Dang Sheng, Yin Def. -- Sheng Di, Sha Sheng, Dong Chong Xia Cao Yang Def. -- Fu Zi, Rou Gui Blood stasis -- Dan Sheng, Chuan xiong Spleen Def. -- Liu Jun Zi Tang Exterior sym. Severe -- Gui Zhi, Bai shao, Da Zhao Cough -- Zi Wan, Sang Bai pi Yu Ping Feng San Huang Qi Bai Zhu Fang Feng Dang Shen Mai dong Wu wei zi

Treatment 2) Chronic 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

Treatment 2) Chronic 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

Modifications: Formula: 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