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



Author: Xiaoyu Li



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


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.


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.



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.


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.


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.



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.


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.


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


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.


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.


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>>.


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).


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. 


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); 


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);


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


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


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


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


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


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);


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


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);


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”.


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.


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.


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.


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.


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.