出类拔萃的治咳专方(黎小裕)

  Acupuncture can help
 

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出类拔萃的治咳专方(转帖) 

Excellent herbal formula for the treatment of cough (transferred article)

 

黎小裕

Author: Xiaoyu Li

 

女患,26岁,19921013日初诊。

Case report:  The patient was a young lady, 26 years of old. She came for consultation on October 13, 1992.

患者3个月前淋雨受凉,鼻塞流清涕,恶寒,周身酸痛,咳嗽痰多。服荆防败毒散合杏苏散2剂,诸症显著减轻,惟咳嗽不减。因图速效,改用西药,口服病毒灵、氯化铵合剂、麦迪霉素,肌注青霉素3天,不效;又配合输液7天,亦少效。不得已复用中药,先后更医4人,服药20余剂,大多为止咳化痰之品,并配服中成药如祛痰止咳冲剂、蛇胆川贝液、痰咳净、鲜竹沥等,仍然咳嗽不止。

The patient had exposed to rain and got cold. She felt stiff in nose, running water-like nose, cold-disliking feeling, sour and pain all over the body, cough with more phlegm. She took Jingfang Baidu San plus Xing Su San for two doses. The symptoms subsided dramatically, but the cough remained. To speed up the healing, she changed to use western medicine, by use of moroxydine, ammonia chloride solution, midecamycin, and penicillin, for three days. For no any effect, she was given introvein infusion for additional seven days, with very little improvement. So, she had to turn back to use Chinese herbal therapy. She changed totally four herbal therapists, and took about 20 doses of herbs, which were mostly to stop cough, and to dissolve phlegm, as well as took some herbal products such as Wutang Zhike Congji, Shedan Chuanbei Ye, Tang Ke Jing, and fresh Zhuli, etc. The cough remained no stop.

现症:咽喉发痒,咳嗽频频,早晚尤甚,痰少难咯,稍感气紧,时而呛咳;舌质偏淡,苔白(中根部略厚),脉细带滑。查血、胸透及拍片均未见异常。

The current condition: she felt itch in throat. She had continuous cough, especially in the morning and at night. The phlegm is little but hard to spit out. She felt slight short of breath. From time to time, she could have a continuous cough. Her tongue is light pink and the tongue cover was white with slight thick at the lower middle part. The pulse was thin with kind of slippery feeling. The lab test for blood and the chest X-ray did not find anything wrong.

 

辨证论治

Chinese herbal therapy

[老师] 在肺系疾病中,咳嗽最为常见,但棘手者亦不少。俗云“名医不治咳喘”,是怕治不好而有损声誉。此虽有寡过之嫌,却也是阅历之言。因为有的病人总以为咳嗽都是小毛病,你连咳嗽都治不好,还治得好“大病”吗? 我就有过这样的经历。而时至今日,犹不敢保其“十全”,此中甘苦事,得失寸心知!

The teacher:  For the disease in the respiratory system, the cough is very common. In many cases, the cough is hard to cure. It is generally said that, “famous doctor does not treat the cough”. It is because it may hurt his/her reputation by failure in the treatment of cough. Though it is somehow overstated, but it is really true that the cough is not easy to treat. Some patient would think that if the doctor fails to solve a minor symptom as cough, how can the doctor be expected to solve a “severe” disease? However, I have had such experience. Even up to today, I cannot promise to be able to solve all the cases with cough. I know how difficult it is to treat a cough!

[学生甲] 咳嗽若迁延失治,有时就很难理清头绪。如本例外感咳嗽,选用中西药物乏效,迁延3个月,很容易诊断为虚证或虚实夹杂证。

Student A: If the cough was not solved and it has been delayed for some time, it would be difficult sometimes to make a clear diagnosis. For example in this case, she got external common cold and cough. The western medicine did not work for her and the cough has been there for three months. It is pretty easy to be diagnosed as weakness condition or the mixture of a weakness and an overwhelming condition.

[老师] 从病史看,初为风寒感冒兼咳嗽,服荆防败毒散合杏苏散2剂后,风寒表症显著减轻,惟咳嗽不减。此时若撤去辛温发散,而以宣疏肃降为主,辅以化痰止咳,可能会很快好转。但病人止咳心切,改用西药稀释痰液、抗菌消炎,及复用中药专事止咳化痰等,均失于宣疏肃降以逐邪外出,致令风邪恋肺,而迁延缠绵。

The teacher: from the history of this case, her condition was first diagnosed as Wind-Cold common cold with cough. After two doses of Jingfeng Baidu San plus Xing Su San, the overall symptoms subsided dramatically, with only cough left. At that time, the condition should be quickly improved if the spicy-warming therapy is stop to use, but the herbal therapy is changed to expanding-descending therapy, with help of phlegm-dissolving and cough-stopping therapy. However, the patient was eager to stop the cough, and she had had various western medicine drugs, as well as using some herbal products, all of which did not work to dispel the Xie Qi out of the body, so as to keep the Xie Qi in the lung for a longer time and made the disease lasted for a longer time.

再从现症看,咽痒则咳,气紧呛咳,痰少难咯,苔白,脉细带滑等,亦是“风邪恋肺、肺失宣肃”之象。治之者宜遵“咳无止法”及“不止咳而咳自止”之古训,无论病程久暂,皆宜以宣疏肃降为主。若但见病程较长便套用“久咳多虚”、“久咳多内伤”,则误诊误治矣。此虽迁延3个月,仍属风邪恋肺,肺失宣肃之证。

From the current condition point of view, she had cough when she felt itch in throat. She felt tight in breath and had continuous and urgent cough. The phlegm is not much but it is difficult to spit. The tongue cover is white in color and the pulse is thin with slippery feeling. All the phenomenon indicates the presence of Wind Xie Qi in the lung, and the lung fails to disperse and to expand. For the treatment, it should be remembered that “ There is no cough-stopping therapy to stop the cough” and “the cough would stop with herbal therapy that is not aimed to stop the cough”. No matter how long the cough lasted, the therapy should all focused on dispersing and descending.

If the doctor always believes that “for a long time cough, there would mostly be a weakness condition in the person” and “a long time cough would tend to hurt the inside of the body”, it would be easy to make a wrong diagnosis and launch a wrong treatment. For this case, though the cough has lasted for three months, it still belongs to the Wind-stick in the lung and the Lung fails to disperse.

予疏散风寒、宣肃肺气之金沸草散加减:

旋复花10g(包煎) 白芍12g,生甘草5g,荆芥15g,苏叶10g,前胡10g,法夏10g,杏仁10g,白芥子10g,桔梗10g2剂。

The herbal therapy given to her is to disperse the Wind-Cold, to disperse the Lung Qi. The formula used is Jinfeicao with some modification: Xuanfuhua 10 g (fold in gauze when cook in water), Baishao 12 g, Gancao 5 g, Jingjie 15 g, Suye 10 g, Qianhu 10 g, Fa Banxia 10 g, Xingren 10 g, Baijiezi 10 g, Jiegen 10g. Two doses.

二诊:咽痒消失,咳嗽大减,咯痰爽利。上方合止嗽散加减:旋复花10g(包煎),白芍12g,生甘草5g,荆芥10g,桔梗10g,炙紫菀15g,炙百部10g,前胡10g,杏仁10g,仙鹤草30g 3剂。

The second visit: the itch in throat subsided. The cough was much reduced, and the phlegm was easier to spit out. The above herbal formula was combined with Zhi Su San: Xuanfuhua 10 g (fold), Baishao 12 g, Gancao 5 g, Jinegjie 10 g, Jiegen 10 g, Zhi Ziyuan 15 g, Zhi Baipu 10 g, Qianhu 10 g, Xingren 10 g, Xianhecao 30 g. Three doses.

三诊:白天已不咳嗽,唯夜间偶尔咳几声。转用民间验方“止咳十一味”善后:当归,川芎,法夏,茯苓,陈皮,生甘草,桑皮,青皮,杏仁,五味子(捣碎),川贝母 (轧细吞服)2剂,未服完而咳止。

The third visit: after the herbal therapy above for three days, the cough stopped during day time. The cough only happened little bit at night. She was then changed to Folk Therapy by using “Zhi Ke Shiyi Wei” to solve the remaining symptoms: Danggui, Chuanxiong, Fa Banxia, Fuling, Chenpi, Gancao, Sangbaipi, Qingpi, Xingren, Wuweizi (chopped), Chuan Beimu (grind, and swallow directly). Two doses. The cough stopped without finish of the herbs.

 

思辨解惑

Questions and answers:

[学生乙] 据我所知,中医高校内科学教材所载的治疗风寒咳嗽的首选方,二版教材为金沸草散,五版教材则罗列杏苏散、三拗汤、止嗽散等,有点令人无所适从。老师何以独选金沸草散呢?

Student B: So far as I know, the recommended herbal formula in the second edition of the textbook of Chinese medicine is Jinfeicao San, and on the fifth edition of it is Xingsu San, San Ao Tang, Zhi Su San, etc. It makes people confused to choose. How do you only use the Jingfeicao San?

[老师] 一种治法可以统率很多首方剂,这就给初涉临床者带来了困惑:到底哪一首是高效方?有人说,“条条道路通罗马”,但并非每一条都是捷径呀! 据我临床验证,以上诸方化裁恰当,虽皆可治疗风寒咳嗽,但是疗效有所差别,而以金沸草散疗效最佳。金沸草散与其余诸方一样,体现了疏风散寒、宣肃肺气的治法,而其特异性在于金沸草 (现代多用旋复花)、白芍、甘草3味药的关键性作用。

The teacher: For one clinic condition, there would have many herbal formula to choose. This causes confusion for doctors who have had no lots of clinic experience. Which herbal formula would be the most effective one? Though it is said that every road to Roma, not every road is a direct road or the shortest road. In my clinic experience, when used in a proper manner, the herbal formula above all can be used for the treatment of Wind-Cold cough. But the healing effect is variable of course. Among them, the Jingfeicao San is the most effective one. As other of these herbal formula, the Jingfeicao San works to dispel Wind, and warm the Cold, to disperse the Lung Qi. The difference between the Jingfeicao San from other herbal formula is the key function of its three ingredients, the Jingfeicao (nowadays it commonly uses Xuanfuhua), Baishao and Gancao.

古今阐释旋复花者,大多以为其只有消痰降气之功,是囿于“诸花皆升,旋复独降”之谚。不可否认,旋复花肃肺降气、豁痰蠲饮之功是颇宏的 (病人服后往往有胸膈滞气下降之感)。但其不可埋没的功效还有:其味辛,辛者能散能横行,而能宣散肺气达于皮毛,一降一宣,便可恢复肺主制节之权;其味咸,咸者入肾,而能纳气下行以归根,使胃中的痰涎或水饮息息下行而从浊道出,不复上逆犯肺,便可恢复肺的清虚功能态。可见旋复花一味药之功,竟可使肺胃肾三脏戴泽,上中下三焦通利。

From history, whenever doctors explain the function of the herb Xuanfuhua, most of them believed that it functions to dissolve phlegm and down-directing the Qi. Such narrowed concept comes from the statement that “All the flowers, in herbal therapy, cause rising effect, while the Xuanfuhua alone causes descending effect”. No doubt that the Xuanfuhua has strong effect to down-directing the Lung Qi, to dissolve the phlegm and to clear the condensed water. (After intake, patient usually feels down-movement of Qi from chest). However, it has some other functions. For its spicy state, the spicy functions to disperse, to move in horizontal, so as to disperse the Lung Qi to the skin layer. That both the down-directing and the dispersing function work together enables the recovery of the Lung. It has also salty taste. The salty taste goes into the kidney, so as to help to direct the Qi down to come into its root, so as to make the phlegm or extra water that are accumulated in the stomach down move and dispel from the urine or stool, not reverse into the Lung to affect the Lung function, so to restore the Lung function. Clearly, the three functions of one herb Xuanfuhua helps the Lung, the Stomach and the Kidney, the three organs/systems and makes the upper Jiao, the middle Jiao, and the Lower Jiao, all clearly conducted smoothly.

而白芍配甘草为“芍药甘草汤”,酸甘化阴,能滋养肺津,舒缓肺气。现代药理研究证实其能缓解支气管平滑肌的痉挛。

In the formula, the herb Baishao and the Gancao works as the Shaoyao Gancao Tang, it works to develop Yin for its sour-sweet taste, to nourish the Lung liquid part and to release the Lung Qi. The modern scientific research find that the couple works to relax the spasm of the smooth muscles.

故用本方时,诸药均可损益,唯旋复花、白芍、甘草3味为不可挪移之品。

Therefore, in the use of this herbal formula, any herbal ingredients might be omitted, but not the Xuanfuhua, the Baishao and the Gancao.

[学生丙]老师是怎样悟出此中奥妙的呢?

Student C: How do you realize this mysterious, sir?

[老师] 这全是江尔逊老中医传授的。江老早年体弱,经常咳嗽,每用止嗽散、杏苏散、六安煎等取效。但有一次咳嗽,遍用历验诸方,毫无寸效。咳嗽频频,咽喉发痒,痒心咳嗽,迁延旬余。

The teacher: All are taught by old TCM doctor, Mr. Er-Xiong Jiang. Doctor Jiang was very weak in body condition when he was young. He often had cough. It usually worked when he used herbal formula Zhi Su San, Xing Su San, or Liu An Jian, etc. However in one time, he tried all the herbal formula that worked before but not work at all this time. He coughed and coughed, with itch feeling in throat. The condition lasted for months then.

他查阅方书,见陈修园《医学从众录》中说,“轻则六安煎,重则金沸草散”。便试服1剂,咳嗽、喉痒即止。他感到惊异,便用于别人,亦收捷效。几十年来,江老治疗咳嗽,无论新久,亦无论表里寒热虚实,都喜用本方化裁。有的病人咳嗽缠绵23个月,几乎遍用中西药物乏效,服本方数剂而安。以致病人间辗转传抄本方,竟亦屡有霍然而愈者。

He checked various medical books. He saw in the book <<Yixue Cong Zhong Lu>> by Dr. Xiu-Yuan Chen that “To treat the cough, use Liu An Jian in mild case and use Jinfeicao San in severe case”. He so tried one dose. The cough stopped and the itch feeling in throat disappeared. He felt very surprising, and he so used it for other patients. It worked very well. For tens of years, whenever he treated the cough, no matter the cough come newly or lasted for a long time, and no matter it belongs the body surface condition or inside, to the Cold or Hotness condition, to the weakness or a overwhelming condition, he used the Jinfeicao San with some modifications. Some patient may have cough for 2 to 3 months, and may have been using various western medical therapy or Chinese herbal therapy but in vain. The cough could subside after use of this herbal formula only several doses. Thereafter, the herbal formula was cited by people to use by themselves. There are again and again successful stories by use of this formula.

但古医书上有两个金沸草散。一见于《南阳活人书》,由金沸草、前胡、荆芥、细辛、茯苓、生姜、大枣、甘草组成;一见于《和剂局方》,方中无茯苓、细辛,而添麻黄、白芍。此外《三因极一病证方论》旋复花汤,又在《和剂局方》金沸草散的基础上添加杏仁、茯苓、五味子。

In old books on Chinese herbal therapy, there were two versions for the Jinfeicao San. One is seen in the book <<Nanyang Huo Ren Shu>>, which consist of herb Jinfeicao, Qianhu, Jingjie, Xixing, Fuling, fresh ginger, Chinese date, and Gancao; another version is seen in the book <<He Ji Ju Fang>>, in which there is no Fuling and Xixing, but is Mahuang ang Baishao. In addition, in the book <<San Yin Ji Yi Bing Zhen Fang Lun>>, there is another formula called Xuanfuhua Tang, in which there are herbs as Xingren, Fuling and Wuweizi on the based of the Jinfeicao San in the book <<He Ji Ju Fang>>.

江老使用金沸草散,并不拘守某一方,而是综合取舍三方,以及随证合用六安煎(二陈汤加杏仁、白芥子)和桔梗汤(桔梗、甘草)

The Jinfeicao San used by Dr. Jiang is not either of these formula, but the combination of the three formula. He also use the modified Jinfeicao San, as well as the Liu An Jian (which is the Er Chen Tang plus Xingren and Baijiezi) and Jiegen Tang (Jiegen and Gancao).

学问之道,贵与年俱进。江老使用本方几十年,积累了—整套行之有效的加减方法,有的加减方法还方中寓方,大大地拓宽了本方的适用范围。

It is very important to be able to understand the truth of the nature along the time past. Dr. Jiang has been using this formula for many years and developed important guidelines (e.g. how to modify the formula) for the use of this formula in various clinic conditions. In some guideline, the modified formula could contain more old formula in the one, which makes the spectrum of the healing by the new modified formula much broad. 

如乍寒乍热,加柴胡、黄芩(小柴胡汤意)

For example, if the patient has sudden cold feeling this time, but sudden hot feeling another time, add herb Chaihu and Huangqin in the Jinfeicao San (the modified formula then bears the meaning of Xiao Chaihu Tang); 

高热气喘,加麻黄、生石膏(麻杏石甘汤意)

If the patient has high fever and short of breath, add Mahuang and Shigao (it bears the meaning of the formula Ma Xing Shi Gan Tang);

发热咽痛,加银花、连翘、射干(银翘散意)

If the patient has fever and sour throat, add Yinhua, Lianqiao, and Shegan (it bears the meaning of formula Yiqiao San);

痰多稠粘,加浙贝母、瓜蒌仁(贝母瓜蒌散意)

If the cough is with more phlegm which is sticky, add Zhe Beimu and Gualuren (it bears the meaning of Beimu Gualu San);

哮喘痰鸣,加苏子、葶苈子(葶苈大枣泻肺汤意)

If there is asthma and phlegm noise, add Suzi and Qinglizi (it bears the meaning of Qinli Dazao Tang);

发热恶风、自汗,加桂枝、厚朴(桂枝加厚朴杏子汤意)

If there is fever and sweat, add Guizhi and Houpu (it bears the meaning of Guizhi plus Houpu Xingzi Tang);

久咳不止,加紫菀、百部、枇杷叶(止嗽散意)

If the cough lasts for long long time, add Ziyuan, Beipu and Piba leaves (it bears the meaning of Zhi Su San);

体虚易感冒,加黄芪、白术、防风(玉屏风散意)

If the patient is weak in body constitution and is easy to catch cold, add Huangqi, Baizhu and Fangfeng (it bears the meaning of Yu Ping Feng San);

脾虚食少或便溏,加党参、白术(六君子汤意)

If there is Spleen deficiency, poor appetite and loss stool, add Dangshen, and Baizhu (It bears the meaning fo Liu Jun Zi Tang);

痰涎清稀,头眩,心下满,加桂枝、白术(苓桂术甘汤意)

If the phlegm is clear as water, and if there is dizziness, bloating feeling in the upper stomach, add Guizhi and Baizhu (it bears the meaning of Ling Gui Zhu Gan Tang);

其实江老的化裁方法还不止这些,有的是为失治或误治而设,也有照顾体质的;且均从临床实践中来,又能有效地重复使用。

In fact, there are much more ways to modify the Jinfeicao San by Dr. Jiang. Some of the modified formula is to correct the symptoms due to a wrong way of treatment, and some others are to correct the body constitution. All the modifications are developed from clinic experience and are used effectively back in the clinic practice.

所以与其削足适履地“化繁为简”,倒不如扎扎实实地把好风寒咳嗽这一关。大家知道,咳嗽一证,外感居多;外感咳嗽,风寒居多。而治疗风寒咳嗽,倘能恰当地遣选疏散风寒、宣肃肺气的方药,多能迅速获效。今人有谓“截断”者,亦是此意。果真如此,金沸草散的那么多化裁方法还有多少用武之地呢? 可惜事实并非如此。

It is however more important to cure the Wind-Cold cough, than to develop a single herbal formula with aim to use it for any case with cough, by such way “to simplify the complex into the simple”.

江老曾秉笔直书道:有一见发热(或体温升高)便断为“风热”或“痰热”,而直用桑菊或银翘辈,或径用清热化痰药及抗生素;有因喉痒或痰少难咯便认作“风燥”或“阴伤”而恣用润燥或养阴方药;有因久咳不止便认作虚咳,而屡进补益药物者。凡此皆因失于及时疏散、宣肃,而致咳嗽迁延缠绵,甚则转成劳嗽。张景岳亦曾愤激而言,“俗云伤风不愈变成劳,夫伤风岂能成劳”?

Dr. Jiang has ever written an article to criticize some wrong ways in the treatment of cough in clinic. For example, some patients have fever (or body temperature rises). The doctor would diagnose the condition as the “Wind Fire”, or “Phlegm Fire” right away, so to use the Sangju- or Yinqai-containing herbal formula, or to use herbs that are supposed to clear the Fire and to dissolve the phlegm, or to use antibiotics. Some patients might have itch in throat or have very little phlegm. The condition is diagnosed as “Wind Dryness” or “Yin exhaustion” condition, so to use Wet-nourishing or Yin-nourishing formula. Some patients has the cough for a long time. It would be believed to be a weakness cough, so the nourishing herbs are used. All of these wrong ways fail to disperse the Lung Qi or to expand the Lung Qi, so as to cause the cough lasts for long time, or even into a exhausting cough condition.

金沸草散化裁治疗外感咳嗽,其治愈率大约有 80%以上。

It can be said that, the effectiveness of the Jinfeicao San is about more than 80%, when it is used, with modifications, for the treatment of cough due to external common cold.

服本方疗效欠佳者,约有三种情形:一是旋复花的药味苦涩难咽,有的病人服后易呕逆,因惧呕而不能竟剂;二是有的病人愈后几天又复咳(症状较轻);三是有的病人总是遗留一个咳嗽“尾巴”偶尔咳嗽几声,如本例便属之。

If the formula does not work, there would be three reasons: fist, the herb extract is too bitter and astringent due to the taste of the Jinfeicao. Some patients may have nausea, so fear to finish the drink of the herb extract. Second, in some patients, the cough stopped but recurred some days later (though the cough is not severe). Third, some patients may have cough occasionally after the stop of the main cough course, e.g. a tail cough, such as in this case.

谚曰:“甘瓜苦蒂,物无全美”,世上岂有“十全”之方药?我的处理方法是:服之易呕逆者,可嘱其少量频服;若仍呕而惧服者,则改用陈士铎的舒肺汤(桂枝、苏叶、桔梗、甘草、茯苓、天花粉)合六安煎。

There is saying that “the melon is sweet but its stem is bitter, e.g. nothing would be perfect”. How can we expect a perfect herbal formula in the world? My way to solve these remaining problems are: for the nausea after drink of the herbs, let the patient drink it little by little with more frequent. If there is still nausea after drink and fear to drink the herbal tea, change to the formula Shu Fei Tang by Dr. Shize Chen (Guizhi, Suye, Jiegen, Gancao, Fuling, Tianhuafen) plus formula Liu An Jian.

若愈后几天复咳者,可继服柴胡桂枝汤加炙紫菀、蝉衣、木蝴蝶。

If the cough comes back after several days, use herbal formula Chaihu Guizhi Tang plus Ziyuan, Chanyi and Muhudie.

若遗留咳嗽“尾巴”者,则继服“止咳十—味” (本案三诊方),此方流传在民间,原治肺结核咳嗽。20余年前我偶然移治1例外感咳嗽,外症已解,咳减而旬余不止者,1剂咳止。尔后治验渐多,便作为外感咳嗽的“扫尾方”来使用。本方药味十分平淡,但组合离奇,很难强为之诠解。

For the occasional cough, e.g. the tail cough, use herbal formula “Zhi Ke Shiyi Wei”. This formula is spreading in the folk. It is originally used to treat the cough in tuberculosis. Twenty years ago, I by chance used it for the treatment of cough due to common cold. The patient had no any other symptoms due to common cold, but the cough. One dose stopped the cough. Later, I tried this way in many other cases and most of them worked. So, I used it as the closing formula for the cough. The ingredients of the formula is very simple and not special, but the consistent is interesting and hard to explain why it works when such ordinary herbs are added together into one formula.

还须说明的是,极少数外感咳嗽病人,初服金沸草散化裁,咳嗽虽减,但继服“止咳十一味”后,却不能扫尾,渐渐干咳无痰,夜间加重,舌净无苔。此时可试用我拟的“顽咳方”:玄参15g,麦冬15g,五味子6g,生甘草6g,桔梗10g,仙鹤草30g,炙紫菀30g,桃仁10g,红花6g,芦根30g,生牡蛎30g。若个别病人服本方2剂后,干咳减轻而不止者,可与清燥救肺汤交替服用,以收全功

It should be pointed out that, there are very little patients, who had cough due to common cold, and the cough was reduced by use of the Jinfeicao San, but the cough could not be completely stopped after the use of the “Zhi Ke Shiyi Wei”. Gradually, the cough is dry, no phlegm, and worse at night. The tongue is clear without tongue cover. At this time, I try my own formula “Wan Tan Fang”: Xuanshen 15 g, Maidong 15 g, Wuweizi 6 g, Gancao 6 g, Jiegen 10 g, Xianhecao 30 g, Zhi Ziyuan 30g,Taoren 10 g, Honghua 6 g, Lugen 30 g, Muli 30 g. If some patients have the cough reduced but not stopped, after take the herbal formula for two days, try to use the formula Qing  Zao Jiu Fei Tang in turn.