A 40-year-old woman with a progressively worsening night cough, white phlegm, and an itchy throat triggered by a sudden weather change was managed using a wind-dispersing and Lung-ventilating herbal strategy.

Case ID: CHC-0032

Case Summary

This case describes a 40-year-old woman who presented with an acute onset of coughing following exposure to a sudden drop in temperature. The original report documented a conventional diagnosis of acute bronchitis and a TCM assessment of Cough driven by Wind-Cold invading the Lungs. The patient was successfully managed with a customized 10-herb decoction designed to release the exterior cold, ventilate the Lungs, and prevent secondary organ imbalances.

Patient Presentation

• Patient: 40-year-old female (Surname: Liang).
• Main Complaint: Frequent coughing with thin, white phlegm, an itchy throat, and nasal congestion with a runny nose.
• History: The patient sought consultation on January 9, 2023. She reported that her symptoms began following a recent, sudden change in weather where she contracted an external wind-cold pathogen. The cough was mild initially but gradually worsened, becoming particularly severe at night and severely disrupting her sleep. She had attempted to self-medicate with over-the-counter cough suppressants, but the results were poor. At the time of the visit, her mind was clear and her overall spirit was acceptable.

Examination and Diagnosis

• Conventional Diagnosis: Acute bronchitis.
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was floating and tight (脉浮紧).

TCM Assessment

The original practitioner interpreted the presentation as Cough driven by Wind-Cold invading the Lungs (咳嗽 – 风寒犯肺).

According to the holistic principles of yin and yang Chinese Medicine the Lungs govern the body’s exterior and control the respiratory pathways. The original report noted that the sudden weather change allowed a Wind-Cold pathogen to invade the patient’s superficial defensive layers.

This external cold “bound” the exterior, blocking the nasal passages and causing her runny nose. Furthermore, the Wind-Cold pathogen directly constrained the Lungs, impairing their natural ability to diffuse and descend Qi. This blocked Lung Qi rebelled upward, manifesting as a frequent cough with white, thin phlegm. The pale red tongue with a thin white coating, combined with the classic floating and tight pulse, provided definitive objective confirmation of an acute, external Wind-Cold invasion.

Treatment Approach

The primary treatment principle was to disperse wind and dispel cold, ventilate the Lungs, and stop the cough (疏风散寒，宣肺止咳). The strategy focused on actively pushing the external pathogen out of the body while simultaneously supporting the digestive system to prevent further phlegm production.

Herbal Formulas and Modifications

• Formula Prescribed (January 9, 2023): A highly precise, 10-herb decoction balancing exterior-releasing herbs with internal organ protection.
  • Ventilating Lungs and Stopping Cough: Hua Ju Hong (Pummelo Peel, 15g), Bai He (Lily Bulb, 10g), and Chao Ku Xing Ren (Stir-baked Bitter Apricot Seed, 10g) served as the core combination to ventilate the Lungs, moisten the respiratory tract, resolve phlegm, and calm the coughing and wheezing.
  • Dispersing Wind and Releasing the Exterior: Fang Feng (Saposhnikovia, 15g) and Jing Jie Sui (Schizonepeta Spike, 10g) were heavily utilized to actively expel the wind and cold pathogens from the body’s surface, addressing the itchy throat and nasal congestion.
  • Strengthening the Spleen to Aid the Lungs: Bai Zhu (Atractylodes, 15g) and Fu Ling (Poria, 20g) were included to fortify the digestive system and drain dampness, adhering to the TCM principle that a strong Spleen (Earth) naturally supports the Lungs (Metal).
  • Clearing Heat and Harmonizing: Zhu Ru (Bamboo Shavings, 15g) was strategically added to clear heat and transform phlegm, acting as a preventative measure so the trapped cold would not transform into internal phlegm-heat. Gan Cao Pian (Licorice, 10g) harmonized the entire prescription.
  • Protecting the Lungs from the Liver: Chao Bai Shao (Stir-baked White Peony, 10g) was specifically included to nourish the blood and soften the Liver, preventing hyperactive Liver “Wood” from overacting on and further damaging the Lung “Metal” during acute coughing fits.
• Administration: 6 doses were prescribed, taken daily as a water decoction, served warm morning and evening.

Follow-Up

• January 16, 2023 (Second Visit): After consuming the initial six doses, the source reported a highly successful outcome. The patient stated her cough was significantly reduced, her phlegm volume decreased, and her nighttime sleep had markedly improved. The practitioner instructed her to continue with 3 more doses of the identical formula. Following this, the cough essentially disappeared with no remaining discomfort.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated formulation used for what appears to be a simple “common cold” or acute bronchitis. Rather than just throwing heavy cough suppressants at the symptom, the practitioner constructed a highly defensive, multi-organ strategy.

While Jing Jie Sui and Fang Feng actively pushed the cold out, the inclusion of Bai Zhu and Fu Ling ensured the Spleen didn’t produce more phlegm. Furthermore, the preventative foresight is remarkable: the practitioner added Zhu Ru to stop the cold from turning into heat, and Chao Bai Shao to stop the physical mechanics of the coughing from aggravating the Liver. This demonstrates the classical TCM approach of treating the immediate pathogen while simultaneously guarding the body’s internal vulnerabilities to ensure a rapid, complete recovery without lingering post-viral symptoms.

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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: Guangdong Provincial Administration of Traditional Chinese Medicine / Beijing University of Chinese Medicine Shenzhen Hospital
• Original title: 【以案说医】王进东：风寒侵肺咳频起，妙方宣散疾渐离
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 10, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation