A 31-year-old woman, nine weeks pregnant, who developed a refractory cough following an episode of anger was managed using a Shaoyang-harmonizing and Liver-soothing herbal strategy.

Case ID: CHC-0023

Case Summary

This case describes a 31-year-old woman who presented with a two-week history of a persistent cough and chest distension that began after an emotional upset. She was nine weeks pregnant at the time of consultation. The original report documented a conventional diagnosis of cough and a TCM assessment of Pregnancy Cough (Zi Ke) driven by Shaoyang Stagnant Fire. The patient was managed with a customized herbal prescription aimed at venting the trapped emotional heat, resolving phlegm, and safely calming the fetus.

Patient Presentation

• Patient: 31-year-old female.
• Main Complaint: Cough producing white, sticky phlegm, accompanied by chest and hypochondriac distension for two weeks.
• History: The patient, currently 9 weeks pregnant, reported that her symptoms began two weeks prior following an episode of intense anger. She developed a persistent cough with white, sticky phlegm. She also experienced a bitter taste in her mouth and uncomfortable swelling and pain in her chest and rib-side (hypochondriac) area. She had no fever or sore throat and had not sought previous medical treatment. Her appetite was normal, sleep was average, and bowel movements and urination were regular.

Examination and Diagnosis

• Conventional Diagnosis: Cough.
• TCM Tongue and Pulse: The tongue was red with a white, greasy coating. The pulse was stringy and slippery (弦滑).

TCM Assessment

The original practitioner interpreted the presentation as Pregnancy Cough driven by Shaoyang Stagnant Fire (子咳 – 少阳郁火).

According to the principles of yin and yang Chinese Medicine, pregnancy inherently draws upon the mother’s Yin fluids and blood to nourish the fetus, often leaving the mother in a state of relative Yin deficiency and making her highly susceptible to internal heat.

The original report noted that an episode of anger caused her Liver Qi to stagnate. In her vulnerable pregnant state, this stagnation rapidly transformed into Liver Fire (trapped in the Shaoyang meridian, explaining the bitter taste and rib pain). The overactive Liver “Wood” then attacked the Spleen “Earth,” impairing digestion and generating phlegm (evidenced by the white greasy tongue coating). Concurrently, the Liver Fire rebelled upward to scorch the Lungs (a dynamic known as “Wood Fire Punishing Metal”). This combination of ascending heat and sticky phlegm obstructed the Lung’s natural descending function, resulting in the persistent cough.

Treatment Approach

The primary treatment principle was to harmonize the Shaoyang, ventilate the Lungs to stop coughing, and regulate Qi to transform phlegm (和解少阳，宣肺止咳，理气化痰). The strategy required clearing the inflammatory heat and respiratory symptoms without using harsh botanicals that could disturb the pregnancy.

Herbal Formulas and Modifications

• Formula Prescribed (Initial Visit – December 13, 2017): A customized 9-herb decoction based heavily on the structure of Chaiqin Wendan Tang (Bupleurum and Scutellaria Decoction to Warm the Gallbladder).
• Action and Composition:
  • Harmonizing Shaoyang and Clearing Heat: Bei Chai Hu (Bupleurum, 10g) ascends and disperses stagnant Liver Qi, while Huang Qin (Scutellaria, 10g) descends and clears the trapped heat. Together, they clear the “Shaoyang pivot.” Huang Qin is also classically utilized for its fetus-calming properties.
  • Transforming Phlegm and Stopping Cough: Jiang Zhu Ru (Ginger-processed Bamboo Shavings, 15g) and Hua Ju Hong (Pummelo Peel, 15g) regulate Qi, dry dampness, and clear phlegm from the chest. Sang Ye (Mulberry Leaf, 15g) disperses wind-heat and moistens the Lungs to stop the cough.
  • Strengthening the Spleen and Calming the Fetus: Bai Zhu (Atractylodes, 15g) and Fu Ling (Poria, 20g) strongly fortify the digestive system to eliminate the root source of the phlegm. Bai Zhu is considered a premier botanical for stabilizing a pregnancy.
  • Dispersing Wind and Harmonizing: Fang Feng (Saposhnikovia, 15g) gently releases the exterior, while Gan Cao Pian (Licorice, 10g) harmonizes the entire prescription and soothes the throat.

Follow-Up

• December 18, 2017 (Second Visit): After consuming five daily doses of the decoction, the source reported that the patient’s cough, phlegm, and chest pain completely resolved, with no remaining discomfort. The practitioner advised her to maintain emotional balance and limit her intake of sweets and stimulating foods to prevent the damp-heat and liver fire from returning.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the management of a respiratory symptom through the Liver and Gallbladder pathways, particularly during the delicate first trimester of pregnancy. Conventional cough suppressants are often contraindicated or used with extreme caution during early pregnancy.

The original practitioner recognized the strict cause-and-effect relationship between the patient’s emotional anger and her cough. Instead of relying solely on standard, heavy Lung-clearing herbs, the treatment targeted the Shaoyang meridian to vent the trapped emotional fire. By pairing heat-clearing and Qi-regulating herbs with specific fetus-calming botanicals (Huang Qin and Bai Zhu), the practitioner safely dismantled the pathological mechanism (“Wood Fire Punishing Metal”) without disturbing the pregnancy, achieving complete resolution in just five days.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：子咳频频扰夜眠，和解少阳咳即安]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 19, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation