My Experienced Formula for COVID-Induced Cough and Wheezing: Yiqi Huayu Pills

Doctor zhou
In Various Proven Recipes I Use for COVID-19 and Its Complications, I have already described how to treat ordinary COVID-induced cough. Patients with ordinary cough can click the link to read that article and follow the treatment options outlined there.
In this article I focus on sharing my experience in treating severe COVID-induced cough and wheezing. Most patients infected with the Omicron variant develop cough, but the great majority recover spontaneously within 1–4 weeks. If the cough is gradually improving on its own, there is no need to rush into treatment; after a few more days their own immunity will usually resolve the cough completely. Over 90% of patients do not develop long-term cough.
However, recent data released by China's National Health Commission shows that 8% of patients in this wave developed pneumonia. A considerable number of patients still have a cough that has not eased by the fourth week of illness, or is even progressively worsening. When these patients get a CT scan, most show pneumonia, and some have pleural effusion ("white lung").
I have previously introduced several experienced formulas for cough. I have tried them all in my own practice, and among all these formulas, the most effective for viral pneumonia due to COVID and for long-term cough following viral pneumonia is my self-formulated Yiqi Huayu Pills.
The formula is as follows: raw Huangqi (Astragalus) 50 g, Xiyangshen (American ginseng) 10 g, Maidong (Ophiopogon) 20 g, Tiandong (Asparagus radix) 20 g, Wuweizi (Schisandra) 20 g, Dilong (earthworm/Pheretima) 10 g, Rougui (cinnamon bark) 5 g, Danggui (Angelica sinensis) 10 g. Grind all the herbs into fine powder, mix with refined honey to form pills the size of a soybean; take 15–40 pills per dose.
I originally indicated this formula for patients who are constitutionally weak and who develop fatigue and breathlessness after COVID infection. In the current wave, of all the formulas I have used for severe COVID-induced cough and wheezing, this one has given the best results.
If patients cannot have pills made, the formula can be converted to a decoction with the following doses: raw Huangqi 10 g, Xiyangshen 2 g, Maidong 4 g, Tiandong 4 g, Wuweizi 4 g, Dilong 2 g, Rougui 1 g, Danggui 2 g. Decoct the above in water. Take one decoction packet per dose; 2–3 packets may be taken per day.
COVID-19 does not usually cause prolonged cough and wheezing in people with normal immunity. Patients who develop prolonged cough and wheezing after COVID generally have some kind of immune deficiency—for example the elderly, cancer patients, diabetics, COPD patients, or others with reduced immunity due to causes such as surgery. Once such patients are entangled by chronic cough and wheezing, they may suffer from it for a long time.
The course of treatment for this type of patient is long. It is best to have the above formula processed into honey pills by a local Chinese pharmacy or TCM hospital for long-term use, rather than taking decoctions. Most Chinese pharmacies and TCM hospitals across the country can make pills on the patient's behalf at a reasonable cost; patients need not prepare the pills themselves.
If you wish to prepare the pills yourself, you can search Baidu for methods of making Chinese herbal pills. Do not ask me how to make them—I do not know; I always ask the pharmacy to do it for me.
This formula has worked surprisingly well for COVID-induced cough and wheezing, because I originally designed it to prevent long COVID sequelae. Over the past three years I have read many research reports published by international medical experts; these reports show that the main long-term sequelae in most COVID patients are fatigue, breathlessness, and difficulty concentrating—and this formula is well targeted at those.
The formula I created is based on the famous TCM formula Shengmai Powder (Pulse-Generating Powder), with additions. Shengmai Powder is used for viral myocarditis, which is also one of the sequelae of COVID. So I did not originally intend this formula to treat cough in COVID patients; it only solved the cough problem of some patients by accident during clinical use.
Shengmai Powder consists of Renshen (ginseng, or Dangshen codonopsis, Xiyangshen American ginseng, or Shashen glehnia), Maidong (Ophiopogon), and Wuweizi (Schisandra). According to traditional TCM theory, the main action of Shengmai Powder is to tonify lung qi and nourish yin and generate fluids. I added raw Huangqi to Shengmai Powder, which makes Huangqi Shengmai Powder and strengthens the action of boosting qi and nourishing yin. I then added Tiandong (Asparagus radix), which moistens the lung and stops cough; Dilong (earthworm), which calms wheezing and protects the heart and brain blood vessels; Danggui (Angelica), which invigorates blood and stops cough; and Rougui (cinnamon bark), which warms yang and invigorates blood—and this is how the formula was composed.
The reason I use Dilong is that it both activates blood and resolves stasis, and promotes diuresis and calms wheezing, and it is virtually non-toxic. I have long used Dilong when treating lung cancer, and it is also included in Buyang Huanwu Decoction, Wang Qingren's famous Qing-dynasty formula for stroke sequelae. Dilong not only stops cough and calms wheezing but also promotes diuresis, gradually drawing exudate out of the body. In addition, modern pharmacological research shows that Dilong is an excellent herb for protecting the heart and brain blood vessels.
Most patients who developed chronic cough and wheezing after this COVID infection are elderly or have long been frail. These patients belong to what TCM calls "insufficient lung qi" and "sinking middle qi." Western medicine, when treating COVID pneumonia, places great emphasis on boosting the patient's immunity, which is why it uses corticosteroids and gamma globulin. Shengmai Powder is a TCM tonifying formula, and Xiyangshen is a strongly tonifying substance that can greatly supplement the patient's original qi. Therefore, using Shengmai Powder as the main treatment for such patients coincides remarkably well with the Western medical strategy of treating this wave's viral pneumonia primarily by boosting immunity.
For elderly and immunocompromised patients, the COVID virus is a rather terrifying pathogen. We urgently need drugs to boost their immunity; it is hard to rely on their own immune systems to defeat the virus. So treatment of such patients should emphasize supplementation and downplay attack—tonify as the main strategy, with clearing as the auxiliary. My Yiqi Huayu Pills are precisely nine parts tonification and one part clearing. Perhaps that is exactly why they have shown such good clinical efficacy.
Of course, different patients also need other drugs added.
If the patient still has fever with aversion to cold and coughs white sputum, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) should be used at the same time: Chaihu (Bupleurum) 24 g, Guizhi (cinnamon twig) 9 g, Renshen (ginseng) 9 g, Fabanxia (processed Pinellia) 12 g, Huangqin (Scutellaria) 9 g, Baishao (white peony) 9 g, Shengjiang (fresh ginger) 7 slices, Dazao (jujube) 12 pieces.
If the patient still has fever with aversion to cold and coughs yellow or thick sputum with dry mouth and parched tongue, replace Fabanxia in Chaihu Guizhi Tang with Tianhuafen (Trichosanthes root): Chaihu 24 g, Guizhi 9 g, Renshen 9 g, Tianhuafen 12 g, Baishao 9 g, Huangqin 9 g, Shengjiang 7 slices, Dazao 12 pieces.
If the patient has fever with aversion to cold and abundant sputum that is hard to expectorate, combine Chaihu Guizhi Tang with Er Chen Tang (Two-Aged Decoction): Guizhi 9 g, Huangqin 9 g, Renshen 9 g, Zhigancao (honey-fried licorice) 6 g, Fabanxia 12 g, Baishao 9 g, Chaihu 24 g, Juhong (tangerine exocarp) 30 g, Fuling (Poria) 30 g, Wumei (smoked plum) 10 g, Dazao 12 pieces, Shengjiang 7 slices. If the patient's sputum is yellow, replace Fabanxia in this formula with Tianhuafen.
Once the fever and aversion to cold have resolved, all of the above formulas should be stopped; from then on use only Yiqi Huayu Pills on their own.
If the patient has fever without aversion to cold, and possibly with aversion to heat, constipation, scanty dark urine, abdominal distension, and clouded consciousness, use Tiaowei Chengqi Tang (Stomach-Regulating Qi-Coordinating Decoction): raw Dahuang (rhubarb) 3–10 g, Mangxiao (Glauber's salt) 10–30 g, raw Gancao (licorice) 10 g. Stop Tiaowei Chengqi Tang once bowel and bladder movements are normal and the fever has subsided; then use Yiqi Huayu Pills alone.
Generally, once the patient's other accompanying symptoms are eliminated, the patient can take Yiqi Huayu Pills alone for a period. If the patient has no symptoms other than severe but weak cough, use Yiqi Huayu Pills alone.
It should also be noted that this strongly tonifying formula is best avoided by children and young adults, unless they are debilitated by a serious chronic disease; otherwise taking such a strongly tonifying formula is of no benefit. But elderly people and frail young people must use such a strongly tonifying formula early, and must not use heat-clearing, detoxifying, phlegm-resolving, or cough-stopping herbs, because those will only make the condition worse. Such people's immunity is too poor; unless we help them boost their immunity, their problem cannot be solved.
Robust people who take Yiqi Huayu Pills may experience mental excitation and insomnia. If a robust person takes it for a short period, it is best to take one dose after getting up in the morning and one after the midday nap, and not at other times, so as not to disturb sleep, and the dose should be small. When robust people use this formula, Huangqi may be removed and Xiyangshen replaced by Beishashen (coastal glehnia).
I tried taking Yiqi Huayu Pills myself, about 30 pills at a time. The effect was immediate: the cough immediately improved by 80–90% and breathing became extraordinarily unobstructed. But I became mentally excited and did not fall asleep until 2 a.m. My elder brother and my teacher's wife are both very frail; after taking Yiqi Huayu Pills they got excellent cough suppression and wheezing relief without any effect on sleep. My teacher's wife had previously been unable to sleep because of cough and wheezing; after taking Yiqi Huayu Pills her sleep duration clearly increased, her sleep quality improved greatly, and she did not have the excitation I experienced.
The fundamental reason is that I exercise long-term and have a strong constitution; my stamina had already returned to its pre-infection level, so taking this kind of tonifying formula was overkill for me.
Based on our recent experience, the optimal adult dose of Yiqi Huayu Pills is 20–30 pills per dose. Start with 10 pills and increase by 5 each time; if there are no side effects, keep increasing. The expected responses after taking the medicine are: marked reduction of cough, rapid rise in blood oxygen saturation, improved stamina, improvement in chest tightness and chest pain, and absorption of pneumonia. If none of these occurs after taking the medicine, the dose may be moderately increased, but should not exceed 30 pills. If there is no clear improvement after two consecutive days of taking it, a doctor should be consulted to re-prescribe.
For children, reduce the dose according to age and weight: one-third of the adult dose for toddlers aged 1–3; half the adult dose for children aged 3–10; and the adult dose for children over 10.
This medicine is not recommended for ordinary sick children, but children with severe immune deficiency (such as leukemia or neuroblastoma patients) who are frail, have insufficient lung qi, have continuous cough and wheezing after infection, and have low blood oxygen saturation may take Yiqi Huayu Pills.
This medicine can also be used as a recovery tonic for ordinary elderly people after recovery, but the dose should be reduced: take it 1–2 times daily, 5–15 pills each time, after waking in the morning or after the midday nap.
In addition, Yiqi Huayu Pills can be combined with Qingfei Tang (Lung-Clearing Decoction); the combined effect is also very good.
Qingfei Tang is as follows: Huangqin 8 g, Xingren (apricot kernel) 8 g, Chuanbei (Sichuan fritillary) 8 g, Zhuru (bamboo shavings) 8 g, Maidong 12 g, Sheng Gancao 4 g, Jiegeng (platycodon) 8 g, Zhizi (gardenia) 8 g, Chenpi (tangerine peel) 8 g, Fuling 12 g, Wuweizi 2 g, Sangbaipi (mulberry bark) 8 g, Tiandong 8 g, Danggui 12 g, Dazao 8 g, Shengjiang 2 g. One packet daily, decoct twice, and divide into 2–3 doses taken after meals. This is the adult dose; one-quarter to one-third for infants aged 0–3, half for children aged 3–10, and the adult dose for children over 10. This is the Japanese kampo Qingfei Tang formula, used for lung-heat cough and wheezing, dry mouth and parched tongue, and cough with yellow sputum or thick white sputum.

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