Exopathic Cough 1) Wind-Cold type cough Signs & Symptoms:

1. Exopathic Cough 1) Wind-Cold type cough Signs & Symptoms: • Main Sym. : Newly-occurred cough, coughing sound being lower and vague, white & thin sputum • Concurrent sym.: headache, nasal stuffiness, nasal clear discharge, painful sensation in the joints, aversion to cold & no sweating • Tongue: white body with thin coating • Pulse: Floating • Treatment Protocol: • Expel the Wind • Release the cold • Restore the Descending and Dispersing Function of the LU Qi

2. Formula: Modifications: Aversion to cold -- Mang Huang, Fang Fen, Qiang Huo Sputum - Chen Pi, Ban Xia Headache -- Chuang Xiong, Bai Zi Cough with sore & dry throat, thirst, severer fever, yellow fur, floating rapid pulse - Ma Xing Shi Gan Tang

3. Exopathic Cough 2) Wind-Heat type cough Signs & Symptoms: • Main Sym. : Dry cough or cough with loud voice, thick sputum • Concurrent sym.: fever & aversion to wind, headache, sweating, sore throat, thirst, runny nose with yellow discharge, sneezing, slight thirst, slightly dark urine. • Tongue: slightly red sides • Pulse: Floating & rapid • Treatment Protocol: • Release the exterior • Expel the wind • Clear the heat • Restore the Descending of Lu Qi and stop cough

4. Formula: Modifications: Aversion to wind -- Jin Jie, Fang Feng Severer lung Heat - Huang Qin, Shi Gao Cough - Niu Pang Zi, Qian Hu, Zhe Bei Mu, Pi Pa Ye throat itching -- Fang Feng Sore throat - Niu Pang Zi, Ma bo, Ban Lan Geng Sputum being difficult to be expectorated - Quan Gua Lou nosebleed - Mao Geng, Ou Jie oppressed feeling in the chest, thick white fur, soft pulse - Yi Ni ren, Hou Pu restlessness, thirsty, dark urine in summer - Huo Xiang, Pei lan

5. Exopathic Cough 3) Wind-Dry type cough Signs & Symptoms: • Main Sym. : Dry and ticklish cough without sputum or sputum being difficult to be expectorated, dry-itchy-sore throat • Concurrent sym.: sore sensation in the upper chest, cough with blood sputum, dry lips, dry mouth, stuffed nose, headache, slight aversion to cold and slght shivers • Tongue: slightly red sides or tip, thin yellow dry coating • Pulse: Floating or slightly rapid • Treatment Protocol: • Release the exterior • Promote fluids and stop cough • Restore the Descending of Lu Qi

6. Formula: Modifications: severer cough with itching throat -- Qian Hu, Chan Tui, Jie Geng, Gan cao sore throat -- Ma Bo, Xuan Shen nose bleeding or bloody sputum -- Bai Mao Geng, Shen Di Huang severer lung heat - Zhi Mu, Shi Gao Cough - Niu Pang Zi, Qian Hu Dryness -- Yu Zu, Mai Meng Dong, Tian Hua Feng Dry-cold attack lung - Jing Jie, Fang feng, Zi Wan, Kuang dong Hua ( reduce zhizi, bei mu, pear skin)

7. Internal injury Cough 1) Phlegm-dampness type cough Signs & Symptoms: • Main Sym. : Chronic cough, abundant sputum being white color and easy to be expectorated • Concurrent sym.: chest distress, poor appetite, tiredness, weakness and frequent loose stool, cough is aggravated in the morning or after intake of sweet and greasy food • Tongue: white greasy coating • Pulse: soft • Treatment Protocol: • Strengthen the spleen • Removing dampness • Restore the Descending of Lu Qi

8. Formula: Modifications: Oppressed feeling in the chest -- Cang Zhu, Hou pu, Xing Ren, Yi yi Ren Severer cough -- Ma Huang, Xing Ren, Zi Su Zi Phlegm-cold sym: aversion to cold -- Gan Jiang, Xi Xin Spleen Def. : pale tongue, week pulse and diarrhea -- Dang Sheng, Bai Zhu Cough with strike reverse flow of qi -- San zi yang qin tang

9. Internal injury Cough 2) Phlegm-heat accumulation type cough Signs & Symptoms: • Main Sym. : Cough, shortness of breath, yellow greasy phlegm • Concurrent sym.: distending and painful sensation in the chest when coughing, bitter taste, dry mouth, thirst, stinking phlegm or bloody phlegm or fever • Tongue: yellow greasy tongue coating • Pulse: slipper rapid • Treatment Protocol: • Strengthen the spleen • Removing dampness • Restore the Descending of Lu Qi

10. Formula: Modifications: Sticking phlegm -- Yu Xing Cao, Lian Qiao, Yi Ni Ren, Dong Gua Ren Purulent sputum -- Dan Nan Xing, Yi Yi Ren, Dong Gua Ren Feeling of oppression in the chest with severe cough and constipation -- Ting li Zi or Da Huang Phlegm heat damage fluid: thirsty -- Sha Sheng, Tian Hua Feng Bloody phlegm -- Mao Geng, Ou Jie Fluids being injured -- Sha Sheng, Tian Meng Dong, Tian Hua Feng

11. Internal injury Cough 3) Liver-fire insulting lung type cough Signs & Symptoms: • Main Sym. : Cough induced pain involving the chest & hypochondrium • Concurrent sym.: Flushed face, dry throat & mouth, pain on coughing, bitter taste, dark urine, dry stools, irritability and a dry mouth, symptoms are along with the change of emotional activity • Tongue: yellow thin tongue coating with less moisture • Pulse: wiry rapid • Treatment Protocol: • Smooth the liver qi • Clear the lung heat • Restore the descending of Lung-Qi and stop cough

12. Formula: Modifications: Cough: -- Jie Geng, Gan Cao Liver Fire: -- Long Dan Cao Fever -- Huang Qin, Shan Zhi Zi, Mu Dan Pi Sputum & sever cough -- Bei Mu, Gua Lou, Zhu Ru, Su Zi, Pi Pa Ye Symptoms of rebellious Qi: Fullness of chest -- Qin Pi, Chen Pi, Zhi Shi Chest Pain -- Yu Jin Yin Def. -- Sha Shen, Mei Meng Dong, Tian Hua Feng

13. Internal injury Cough 4) lung Yin Deficiency type cough Signs & Symptoms: • Main Sym. : Chronic cough, dry cough with less sputum or with bloody sputum, afternoon tidal fever • Concurrent sym.: Flushed cheeks, feverish sensation in the palms and soles, insomnia, night sweating, lack of vitality, tiredness and restlessness, • Tongue: red tongue with less coating • Pulse: thready rapid • Treatment Protocol: • Nourish Yin • Clear the lung heat • Resolving sputum and relieving cough

14. Formula: Modifications: Tidal fever -- Bie Jia, Di Gu Pi, Qin Hao, Yin Cai Hu, Bai Wei severe cough -- Wu Wei zi, He zi Profuse night sweating -- Wu mei, fu xiao mai, Cough with yellow sputum -- Zhi Mu, Huang Qin Bloody phlegm -- Ou Jie, Xian He Cao, Bai je, E Jiao, San Qi ( Mao Geng ?)

15. Modifications Summarize: distention feeling in the chest -- Zhi Ke, Jie Geng distension feeling with abundant sputum -- Qian Hu, Jie Geng Aversion to wind -- Fang Feng, Jin Jie Aversion to cold -- Zi Su, Qian Hu Aversion to heat -- Lian Qiao, Bo He cough with chest pain -- Ju Ruo, Gua Lou Abundant sputum + Vomiting -- Zu ru, Ban Xia Qi rebellion sym. -- Dai Zhe Shi, xuan Fu Hua lung heat + sticky sputum -- Hai Fu Shi, Gua Lou

18. Case History 1. Female 26 years old Got cold 3 months ago due to walk in a raining day. At that time: stuffy nose with clear discharge, ache of whole body, cough with lot sputum. She took JinFangBaiDuSan + Xin Su San for 2 days, and all the symptoms got better except cough. She took the antibiotics medicine, but not working. After changing 4 TCM doctors and taking 20 bags of stopping coughing herbs, still not working Sym now: Cough with itching throat, less sputum and hard to be expectorated, Tongue: white coating and little thick in the middle & root Pulse: slipper & thready Treatment Protocol: First visiting of clinic: Restore the descending of Lung-Qi expel the wind-cold Xuan fu Hua 10, Bai Shao 12, Gan Cao 5, Jin Jie 15, ZiSu Ye 10, Qian Hu 10, Ban xia 10, Xin Ren 10, Bai Jie Zi 10, Jie Geng 10 ( 2 bags) Second visiting: sym: cough is getting much better, no itching throat, sputum is easily expectorated XuanFuHua10, BaiShao12, GanCao5, JinJie15, Jie Geng10, ZiYu15, BaiBu10, QianHu10, XingRen10, XianHeCao30 (3 Bags) Third visiting Sym: No coughing in daytime, still little cough at night Zhi ke shi San Fang

19. Brachial wheezing syndrome TCM Diagnoses and Treatments Wheezing (Xiao) indicates a wheezing sound which may resemble that of whistling, snoring or sawing. It is usually accompanied by breathlessness with an inability to breathe when lying down Etiology & Pathology: Etiology: 1. External pathogenic factors Wind-cold Wind-heat 2. Diet 3. Weak body condition ( Lu, Sp, Kid)

20. Pathology:

21. Differentiation & Treatment Acute Phase Cold Phlegm Heat Phlegm Treatment Principle: Resolve Phlegm Restore the descending of Lu Qi Chronic Phase Lu. Def. Sp. Def. Kid. Def. Treatment principle: Tonify Lu. Sp. Kid.

22. Main Points for differentiation

23. Main Points for differentiation

24. Treatment 1) Acute phase a) Cold-phlegm Signs & Symptoms: • Main Sym. : rapid breathing, wheezing, full & oppress feeling of the chest, cough, scanty phlegm • Concurrent sym.: a blush-white complexion, no thirst, or a desire for warm drinks, feeling cold, worse in cold weather • Tongue: swollen with a sticky-white coating • Pulse: tight & slippery • Treatment Protocol: • Warm the lung & expel the cold • Resolve phlegm • Relieve breathlessness

25. Formula: Modifications: Exterior sym. Severe + internal phlegm -- Xiao Qin Long Tang long illness + kid. Yang def. -- Su Zi Jiang qi Tang + Dang shen, hu tao rou, zi shi yin, chen xiang Abundant sputum -- san zi yang qin tang Kid. Yang def -- Fu Zi, bu gu zhi

26. Treatment 1) Acute phase b) Heat-phlegm Signs & Symptoms: • Main Sym. : wheezing with a loud voice, breathlessness, distended chest, cough, yellow-sticky sputum • Concurrent sym.: irritability, sweating, a red face, bitter taste, thirst, a feeling of heat • Tongue: red with a yellow-sticky coating • Pulse: slippery-rapid • Treatment Protocol: • Clear the heat • Resolve phlegm • Restore the descending of Lung-Qi & stop wheezing

27. Formula: Modifications: Cough -- Jin Fei Cao, Qian Hu, Bai Qian Wheezing -- Xuan Fu Hua, Sang Bai Pi, Di Long Abundant sputum -- chuan Bei mu, Chen pi, Jie Geng Yellow sticky sputum -- Zhi Mu, Hai Ge Ke, She Gan, Yu xing Cao Fever -- shi Gai, Zhi Mu Yin def. -- Sha Shen, Wu Wei Zi, Mei meng Dong Tang Constipation -- Da Huang, Mang Xiao

28. Treatment 2) Chronic phase a) Lung Def. Signs & Symptoms: • Main Sym. : spontaneous sweating, aversion to wind, sneezing, runny nose, pale complexion, frequent common cold due to abnormal changes of climate • Concurrent sym.: shortness of breath, low voice, slight wheezing with a low sound • Tongue: Pale tongue with thin white coating • Pulse: weak or def. large • Treatment Protocol: • Tonify the lungs • Consolidate the Exterior

29. Formula: Modifications: Qi Def. -- Tai Zi Sheng, Dang Sheng, Yin Def. -- Sheng Di, Sha Sheng, Dong Chong Xia Cao Yang Def. -- Fu Zi, Rou Gui Blood stasis -- Dan Sheng, Chuan xiong Spleen Def. -- Liu Jun Zi Tang Exterior sym. Severe -- Gui Zhi, Bai shao, Da Zhao Cough -- Zi Wan, Sang Bai pi

30. Treatment 2) Chronic phase b) Spleen Def. Signs & Symptoms: • Main Sym. : poor appetite, loosing stools, slight abdominal distension, intolerance to certain foods • Concurrent sym.: tiredness, shortness of breath, dislike of speaking, desire to lie down, weariness • Tongue: Pale tongue with thin white coating • Pulse: weak or def. large • Treatment Protocol: • Tonify the spleen • Resolve phlegm

31. Formula: Modifications: Yang Def. -- Gui Zhi, Gan Jiang

32. Treatment 2) Chronic phase 3) Kidney Def. Signs & Symptoms: • Main Sym. : shortness of breath, worsening while making exertion, dyspnea, soreness & weakness of the waist & legs, • Concurrent sym.: poor memory, tinnitus • Tongue: pale • Pulse: deep weak • Treatment Protocol: • Tonify the kidney • Resolve phlegm

33. Formula: Modifications: Yang Def. -- Gui Zhi, Gan Jiang, Ge Jie Yin Def. -- Nu Zhen Zi, Shi hu Cough with sputum -- xing Ren, Su zi, Ban Xia Bad appetite -- sheng Qu, Shan Zha