Six Proven TCM Formulas for Laryngeal Cough
Laryngeal cough (hou yuan xing kesou) is a disease characterized by paroxysms of intolerable throat itching and incessant dry cough; it is a common clinical condition. In the early 1980s, the famous otolaryngology TCM physician Professor Gan Zuwang first proposed this disease name in his TCM Laryngology, describing its features in detail. Common presentations include throat itching as if ants are crawling inside, a foreign-body/phlegm obstruction sensation in the throat, and frequent paroxysmal cough. Throat itching is the main symptom, paroxysmal, usually dry with no sputum. No itching, no cough; patients often need to cough lightly a few times to clear the throat and relieve the itching. Such patients' cough starts above the glottis, comes in paroxysms and, when severe, is spasmodic, after which a little white sticky sputum may be brought up. Although this cough and the gastroesophageal reflux cough I described earlier are both common chronic coughs, their causes differ.
Modern medical biology suggests this disease may be due to abnormal function of the carrier protein that transports chloride ions on the patient's bronchial-cell surface, causing excess mucus in the upper airway. Patients with a long course show chronic congestion of the pharyngeal mucosa, a sensitive gag reflex, and hyperplasia of lymphoid follicles on the posterior pharyngeal wall.
Based on different scholars' treatment experience, the following proven formulas may be used for TCM treatment of this disease:
1. Modified Zhisou San Combined with Shegan Mahuang Tang (Lin Yongjun's empirical formula)
Ziwan (Asteris Radix) 6 g, Baibu 6 g, Jingjie (Schizonepetae Herba) 6 g, Jiegeng (Platycodi Radix) 3 g, Chenpi 3 g, Baiqian (Cynanchi Stauntonii Radix) 6 g, Shegan (Belamcandae Rhizoma) 6 g, Zhi Mahuang (processed ephedra) 3 g, Xixin 3 g, Kuandonghua 6 g, Fangfeng 6 g, Sangye (Mori Folium) 9 g, Xingren 3 g, Niubangzi (Arctii Fructus) 6 g, Bohe (Menthae Folium) 3 g (added near the end), Juhua (Chrysanthemi Flos) 3 g (added near the end).
Indication:不利的 throat due to lung qi failing to diffuse, with sudden onset, throat itching as if ants crawling, relieved by drinking; prolonged cough may cause hoarseness; examination shows no special changes or mild congestion in the throat, and no changes or mild congestion of the vocal cords; floating pulse, thin white coating, pale red tongue. For wind-cold invading the lung, treat by dispersing wind and diffusing the lung, soothing the throat and stopping cough.
This is a modification of Zhisou San (Cough-Stopping Powder, composed of Jiegeng, Jingjie, Ziwan, Baibu, Baiqian, Gancao and Chenpi) combined with Shegan Mahuang Tang (Belamcanda and Ephedra Decoction, composed of Shegan, Mahuang, Xixin, Ganjiang, Banxia, Ziwan, Baibu, Wuweizi and Dazao), and also incorporates the meaning of Sangxing Tang (Mulberry and Apricot Decoction); all three are historically famous cough formulas. Chronic laryngeal cough is initially mostly caused by wind-cold, but later becomes cold-heat mixed, making treatment complex and requiring cold and hot herbs together; this formula therefore contains wind-cold-expelling Mahuang and Xixin along with wind-heat-expelling Sangye, Niubangzi and Bohe, but the emphasis remains on symptomatic cough relief.
This formula may be simmered into a thick paste: decoct with 10-20 times the amount, reduce to a syrup, add white honey to finish the paste until it is as thick as Chuanbeim loquat syrup; take 10-20 ml directly or dissolved in warm water.
In addition, such laryngeal cough patients easily relapse after catching cold, heat, wind or fatigue; they should keep warm, ensure adequate sleep and take preventive care during seasonal transitions.
- 2. Sufu Liyan Tang (Lung-Diffusing, Throat-Soothing Decoction; source: Liaoning Journal of TCM, 2016, 43(8))
Chantui (Cicadae Periostracum) 6 g, Jiangcan (Bombyx batryticatus) 6 g, Jingjie 5 g, Bohe (added near the end) 3 g, Xingren 6 g, Jiegeng 3 g, Zhe Beimu 8 g, Gancao 3 g. For marked wind-heat, add Jinyinhua and Lianqiao; for marked wind-cold, add Zisu Ye and Fangfeng; for hoarse voice, add Mumudie (Oroxylum indicum); for marked sore throat, add Maboo (Lasinosphaera); for marked throat itching, add Baibu; for dry throat, add Shashen and Tianhuafen; for pharyngeal congestion, add Taoren and Chishao; for marked hyperplasia of posterior pharyngeal-wall lymphoid follicles, add Danshen; for yellow sputum, add Huangqin; for qi stagnation and blood stasis, add Yujin; for liver-kidney deficiency with collateral obstruction and blood stasis, add Niuxi; for lung-defense qi deficiency with insecure exterior, add Huangqi and Baizhu.
One dose daily, decocted in water in two divided doses. Zhu Mingxin and colleagues used the above modified formula to treat 30 children with wind-evil attacking the lung causing laryngeal cough: 4 cured, 11 markedly effective, 13 effective, for a total effective rate of 93.9%.
This is a pediatric formula for common pediatric laryngeal cough, so the doses are light. Pediatric laryngeal cough often lingers and relapses frequently, but may resolve on its own as the child grows and develops. Besides seeking treatment during cough attacks, parents should care for the child's clothing, food, housing and daily routine, ensuring adequate sleep and appropriate temperature.
3. Chanjiang Zhike Tang (Cicada-Bombyx Cough-Stopping Decoction; source: Lishizhen Medicine and Materia Medica Research, 2000, 11(4): 332)
Chantui 10 g, Jiangcan 10 g, Baibu 15 g, Ziwan 15 g, Xingren 10 g, Jiegeng 6 g, Juhong 4 g, Baiqian 6 g, Fa Banxia 6 g, Beimu 10 g, Gancao 4 g. Modifications: for thick yellow sputum, add Lugen 15 g, Huangqin 10 g and Gualou Pi (Trichosanthis Pericarpium) 10 g; for cough with vomiting, add Zhi Pipaye 10 g and Xuanfuhua 10 g; for dry mouth and throat with red tongue and little coating, add Bei Shashen 10 g and Maidong 10 g; for congested, painful pharyngeal mucosa, add Jinyinhua 10 g, Xuanshen 10 g and Shegan 10 g.
One dose daily, decocted in water; five days per course. Yan Dongming and colleagues used the above modified formula to treat 112 laryngeal cough patients: 78 cured, 28 markedly effective, 6 ineffective, for a total effective rate of 94.6%.
Chantui and Jiangcan in this formula are two animal herbs from the famous TCM Shengjiang San (Ascending-Descending Powder). Chantui disperses wind-heat, soothes the throat, vents rashes, brightens the eyes and removes nebulae, and relieves spasm; Jiangcan resolves phlegm and dissipates nodules, and extinguishes wind and relieves spasm. Physicians through the ages often combine them for spasmodic cough, and some have ground just these two into a powder for spasmodic cough. Baibu, Ziwan, Xingren, Jiegeng, Juhong, Baiqian, Fa Banxia, Beimu and Gancao are all common TCM phlegm-resolving, cough-stopping herbs—an example of combining category-herbs. Adding different targeted herbs according to the patient's concurrent signs is indeed a good composing approach.
4. Modified Zhisou San (source: Liaoning Journal of TCM, 2004, 31(10): 842-843)
Ziwan 12 g, Baibu 10 g, Jiegeng 10 g, Baiqian 10 g, Chenpi 6 g, Jingjie 12 g, Gancao 6 g. Modifications: for hoarseness, add Mumudie and Xianzhufeng (Spatholobi? — salt-pressed bee); for marked throat itching, add Fangfeng and Jiangcan; for sore, swollen throat, add Niubangzi and Gangmeigen (Ilicis Asprellae Radix); for dry throat, add Shashen and Pangdahai (Scaphium); for nasal congestion and discharge, add Cang'erzi (Xanthii Fructus) and Xinyihua (Magnoliae Flos).
Soak the herbs in 300 ml water for 20 minutes, decoct for 15 minutes and collect 150 ml; one dose daily in two post-meal divided doses. Chen Xuemei and colleagues used this to treat 39 laryngeal cough patients: 33 cured, 1 ineffective, for a total effective rate of 97.4%.
This formula is quite similar to the first, being a modification of Zhisou San, but it treats a somewhat different population. It is more suitable for wind-cold patterns, as it leans toward dispelling wind and cold while resolving phlegm and stopping cough.
5. Modified Xuanfei Liyan Zhike Fang (Lung-Diffusing, Throat-Soothing Cough-Stopping Formula; source: Chinese Archives of Traditional Chinese Medicine, 2007, 25(2): 241-242)
Mahuang 6 g, Shegan 10 g, Chantui 8 g, Sangye 12 g, Xingren 10 g, Ziwan 12 g, Jiegeng 12 g, Pipaye 15 g, Baibu 15 g. Modifications: for marked dry throat, add Mumudie and Xuanshen; for lung yin deficiency, add Shashen and Maidong; for prolonged cough with insufficient lung qi, add Renshen, Maidong and Wuweizi; for severe cough with flushing, or chest and hypochondriac distending pain, add Haigeqiao (Meretricis Cyclinae), Gouteng (Uncariae Ramulus) and Qingdai.
One dose daily, decocted in water, in 2-3 warm divided doses. Also take oral ketotifen tablets, 1 mg twice daily. Tang Xiaobo and colleagues used the above modified formula to treat 60 laryngeal cough patients: 35 cured, 22 markedly effective, for a total effective rate of 95%.
This is a combined Chinese-Western regimen with better symptomatic supportive effect.
6. Jiu Sou Yi Fu Yin (One-Dose Beverage for Chronic Cough; source: Journal of TCM, 1998, 39(2): 82)
Ziwan 15 g, Kuandonghua 20 g, Bei Xingren 12 g, Fa Banxia 12 g, Zisu Ye 10 g, Ejiao 10 g, Wumei 10 g, Guya (Oryzae Fructus germinatus) 10 g, Baibu 12 g, Gancao 5 g, Shengjiang 10 g. Modifications: for dry throat with thick yellow sputum, add Maidong 12 g, Huangqin 12 g and Chuanbeimu 10 g; for marked throat itching, add Shegan 12 g and Chantui 10 g; for congested, painful throat, remove Shengjiang and add Banlangen 15 g and Niubangzi 10 g; for bland taste with cough leading to vomiting, increase Shengjiang to 15 g. Li Jingchang used the above modified formula to treat 138 laryngeal cough patients: 89 cured, 38 improved, 11 ineffective, for a total effective rate of 92%.
The above formulas are broadly similar in their herbs. Treatment of laryngeal cough is mainly symptomatic; in reality the disease easily relapses and is hard to root out, and treatment works only in stages. Its root may be genetic: certain genes cause abnormal function of the chloride-transporting carrier protein on bronchial-cell surfaces, which is usually hard to reverse. In clinical practice I have seen many patients with a family history of chronic laryngeal cough; the disease may have a genetic component.
Another observation: combining medical treatment with care gives better results for this disease. As long as enough rest is ensured, the interval between relapses can be effectively prolonged. Generally, when such patients' cough flares, a short nap eases it; when the cough is severe, ensuring 8 or more hours of sleep each night markedly reduces it. After keeping such hours for a while, the cough may even disappear entirely for a period. But later it easily relapses with fatigue or weather changes. Patients should therefore maintain good rest habits long-term, especially in bad-weather seasons.
In addition, I have also tried moxibustion and hot compresses on the Gaohuang (Feishu? — Gaohuangshu) and Feishu (Feishu) points for this disease, with some effect; internal medicine is therefore not the only approach. This disease has a long course and may be lifelong; patients should lower expectations and learn to live with it. Such diseases usually do not cause cancer or threaten life, so failure to cure is no great worry, and patients need not bear excessive psychological burden.