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Experience in the use of Liuwei Xiao Chaihu Tang for the treatment of obstinate cough


熊兴江 中国中医科学院广安门医院

Dr. Xing-jiang Xiong  (Guang An Men Hospital, Beijing, China)



The herbal formula Liuwei[1] Xiao[2] Chaihu Tang[3] consists of Chaihu, Huangqin, Banxia, Gancao, dried ginger and Wuweizi. It comes from the introduction for the modification of the herbal formula Xiao Chaihu Tang in the  96th paragraph in the book <<Shang Han Lun>>. For it is the modified formula of the Xiao Chaihu Tang, and it consists of only six herb ingredients, it is called “Liu Wei Xiao Chaihu Tang”. I have been using this formula for the treatment of common cold, acute and chronic bronchitis, and so on. If the formula is used for a matched condition, it works very fast to stop cough and reduce the fever. This has been proven again and again.


We found that, when a disease is in the Shaoyang phase, there could have three different outcomes for the further development of the disease: first, pure Shaoyang phase. The disease sticks in the Shaoyang phase. In clinic, the Shaoyang-calming therapy (Shaoyang-harmanizing therapy) should be used. Second, the co-exist of the Shaoyang and the Yangming phases. The Shaoyang condition tends to become “hotness-developing”. This might be due to the body is in Yang overwhelming condition before the diseased, or due to the Shaoyang phase further develops into the Yangming phase; or due to the disease develops from the Yangming back into the Shaoyang phase. For example, in the external disease, the disease is in Shaoyang phase, but the person starts to have dry mouth and thirsty with desire to drink cold water, have fever with red color in face and has no cold-dislike feeling. This is the condition of Xiao Chaihu Tang plus Shigao. If the person has cough with yellow and sticky phlegm, the herb Jiegen and Yiyiren should be used. The third, the Shaoyang phase co-exists with the Taiyin phase. The Shaoyang condition tends to have “cold-developing” phenomenon, which might be due to the person usually is weak in the Spleen-stomach system.


The typical conditions for the use of the Xiao Chaihu Tang is bitter taste in mouth, dry throat, dizziness in eyes, cold-hot shift feeling, annoying bloating feeling in the chest and in the upper side of the belly, silent and no appetite, annoyed and tends to have vomit, headache, belly pain, and string pulse, etc. Based on the principle in the use of the herb formula, that the herb formula should match the body condition, it is not hard to find that the herbal condition for the use of this Liuwei Xiao Chaihu Tang is the condition to use the Xiao Chaihu Tang plus the condition to use the herb dried ginger and Wuweizi. This means that, the herbal formula should be used if the patient has some of the conditions indicating to use the Xiao Chaihu Tang, together with the conditions to use the dried ginger and Wuweizi, such as “cold cough” and “cold diarrhea”, dry cough, or white and sticky phlegm, or obstinate cough for long time, diarrhea (loss stool).


Here is a case example for the treatment of a chronic obstinate cough


Mrs. Wang, female,33 years of old. She visited the clinic on Nov. 27, 2009.


The patient started to cough when she was one year old. Every year in winter, she could have cough without any triggering reasons. The cough is mostly a no-phlegm cough, or spit only little white and sticky phlegm. The cough would become worse when she exposed to cold, oily smoke, physically exhausted, or loudly speaking. In this case, she needed to have continuous cough for up to tens of minutes to stop. Every winter was the same and the symptoms stop once the spring comes. Then she had no any symptom. In spring, summer and fall, the cough would come again with strong emotional stimulation, and the symptoms would be the same as in winter. Her condition has been diagnosed as “Chronic bronchitis”. She was given herbal therapy (the use of Jiegen, Xingren and Banxia, etc.), as well as western medicine, for many years without clear improvement. Half month ago, she started to have the cough again.


Her conditions when she visited were: she had dry cough, which was triggered by itch in throat or by belch, and which was worse after exposure to oily-smoke or loud speaking. The continuous cough needed about 15 minutes to stop. She had hot temple and had continuous talk. It was not easy for her to have sweat. She had multiple acne on face, which were dark red in color. Her appetite and sleep were normal. The urine was little yellow in color. Bowel movement was normal. Her tongue was thin and small in shape. The tongue cover was thin and little. The pulse was thin, weak and frequent. Blood pressure was 145/90 mmHg. The breath sound on the lung was harsh. The heart beat was 105 times per minute. The rhythm was normal. The diagnosis was chronic bronchitis by western medicine and cough by the Chinese medicine with Liver Qi sluggish and Lung Qi not descending. The herbal therapy was given to dredge the Liver, to clear the hotness, to warm the Lung and to stop the cough. She was given the Liuwei Xiao Chaihu Tang. The herbal ingredients were: Chaihu 12 g, Guangqin 10 g, Banxia 12 g, Dried ginger, Wuweizi 6 g, Gancao 6 g. The herbs were cooked in water. Five doses were prescribed, one dose every day.  


The second visit on the Dec. 3. After three days of the herbal therapy, her cough was much improved. The itch feeling in throat disappeared. She could have dry cough again occasionally after loud speaking but it lasted a very short time before stop. After additional two doses, all the symptoms subsided. The herbal therapy was changed to treat the facial acne. She was also asked to keep some amount of the Liuwei Xiao Chaihu Tang at home in case she has cough again. Following up so far, she had no any recurrence.


Comment: This patient has cough after itch feeling in throat or exposure to oily smoke. The cough comes and goes.  If there is no clear evidence for phlegm condition, for body surface condition or Yang deficiency, it can be regarded as an expanded concept of “cold-hotness shift that comes and goes”, which is one of the key condition to diagnose Shaoyang phase. This is the indication for use of herb Chaihu. One of the typical clinic conditions to diagnose Chaihu condition is the silent and no-desire emotion. Therefore, it is generally believed that it is the key point to diagnose the Chaihu condition, or a Chaihu body constitution, is when the patient shows depression, low appetite, introvert personality, etc. all of which belong to Chaihu condition or Chaihu body constitution. However, we found that, in clinic, the Chaihu condition is not always showing as such. The Chaihu condition can also show as hyperactive spirit, hot temple, no-end talk, anxiety, even scared or phobia feeling, such Liver Fire developed from Liver Qi sluggish. The patient in this case has hot temple, tends to talk too much, easy to get anxiety and rising spirit, easy to have blood pressure fluttered and heart beat speeds up, and has more and worse cough after emotional stimulation, all of which indicate the Chaihu and Huangqin condition too. It is typical “cold cough” when the cough becomes worse in winter but less in spring, which is the herbal indication for the use of Wuweizi and dried ginger. That the cough comes after belching, which suggests the Stomach Qi reversely rushing up, is the indication for Banxia. That after the use of the herbal therapy with Liuwei Xiao Chaihu Tang, the cough subsided dramatically proves the correct and the match between the herbal therapy and the body condition.


It is worthwhile to note that it is more emphasized on the condition or syndrome diagnosis for an acute disease, and on the body constitution diagnosis for a chronic disease. Therefore, the disease usually has both the “disease/syndrome” and the “body constitution” aspects. Dr. Xing-de Shi believed that, a chronic disease usually means under some kinds of body constitutions, the patient has some diseases. That the tongue is small and thin, that the tongue cover is thin, and that the pulse is thin, weak and frequent, and that there are many acne on face, all are the typical condition for Liver Yin deficiency. The reason for the Liver Yin deficiency might be due to blood loss that exhaust the Yin, or to the exhaustion of the Yin by the Fire that develops from the overwhelming of emotional stimulations. For the patient in this case, she has normal menstruation, and no history of blood loss. It is therefore deduced that her Liver Yin deficiency might be due to her hot temple. The truth for her disease is the Liuwei Xiao Chaihu Tang condition and the Liver Yin deficiency. It should be pointed out that, though there is an opinion that “Chaihu exhausts Liver Yin”, the Chaihu still needs to be used if there is indication to use it in the disease. In this case, the Liuwei Xiao Chaihu Tang was stopped after the cessation of the disease. The herbal formula was changed after the stop of the cough to correct the body constitution. Therefore, there was no worry for the hurt to the patient.

[1] Liuwei: six herbal ingredients.

[2] Xiao: small.

[3] Tang: herbal extract.