A 56-year-old woman with a persistent post-viral cough exacerbated by consuming cold foods was managed using a Wind-dispersing herbal strategy combined with acupoint moxibustion.

Case ID: CHC-0051

Case Summary

This case describes a 56-year-old woman who presented with a chronic cough that lingered for six months after an initial cold. The cough recently worsened following the consumption of raw and cold foods, leading to an increase in thick white sputum. The original report documented a conventional diagnosis of cough-variant asthma and a TCM assessment of Cough driven by Wind-Cold invading the Lungs. She was managed through a comprehensive approach utilizing a modified Zhisou San (Stop Coughing Powder) herbal decoction alongside localized acupoint moxibustion therapy to simultaneously disperse external cold and fortify her internal digestion.

Patient Presentation

• Patient: 56-year-old female (Surname: Chen).
• Main Complaint: Persistent cough with copious, sticky white sputum and an itchy throat.
• History: The patient sought consultation on May 9, 2022. In November 2021, she caught a cold with nasal congestion, a runny nose, and coughing. She received conventional treatment at a local clinic (including Chaihu injections, amoxicillin, and compound licorice tablets), which provided partial relief, but a lingering cough remained. One week prior to this visit, she ate raw and cold foods, which triggered a severe exacerbation of the cough and a significant increase in phlegm. Self-medication with Shedan Chuanbei liquid yielded no obvious improvement. Associated symptoms included a fair appetite, poor sleep, and loose stools (1-2 times daily). Her urination was normal.

Examination and Diagnosis

• Conventional Diagnosis: Cough-variant asthma (CVA).
• TCM Tongue and Pulse: The tongue had a thin, white coating. The pulse was floating (脉浮).

TCM Assessment

The original practitioner interpreted the presentation as Cough driven by Wind-Cold Invading the Lungs, with the Lungs Losing their Diffusing and Descending Functions (咳嗽 – 风寒犯肺，肺失宣肃).

According to the holistic principles of yin and yang Chinese Medicine the Lungs govern the exterior and are highly susceptible to environmental pathogens. The original report noted that the patient’s initial wind-cold pathogen was never fully expelled from her system. This lingering cold trapped the Lung Qi, preventing its normal downward descent, which caused the chronic, lingering cough.

Crucially, her condition severely worsened after eating raw and cold food, and she presented with loose stools. This indicated that the cold had not only affected her Lungs but had also damaged the Yang energy of her Spleen and Stomach. A weakened Spleen fails to transform fluids, generating internal damp-phlegm that travels upward to congest the Lungs. The thin white tongue coating and the floating pulse objectively confirmed the presence of this active external wind-cold pathogen.

Treatment Approach

The primary treatment principle was to disperse wind, scatter cold, diffuse the Lungs, and stop the cough (疏风散寒，宣肺止咳). The strategy integrated internal herbal medicine to resolve the phlegm and regulate Qi, combined with external acupoint moxibustion to forcefully warm the Lungs and expel the deep-seated cold.

Herbal Formulas and TCM Therapies

• Initial Herbal Formula (May 9, 2022): A 16-herb decoction acting as a modified Zhisou San.
  • Diffusing Lungs and Stopping Cough: Jie Geng (Platycodon, 10g), Qian Hu (Peucedanum, 10g), Chan Ku Xing Ren (Blanched Bitter Apricot Seed, 10g), and Ping Bei Mu (Fritillaria, 10g) formed the core to aggressively open the Lungs, descend rebellious Qi, and transform the sticky white phlegm.
  • Dispersing Wind and Cold: Zi Su Ye (Perilla Leaf, 15g) and Bei Chai Hu (Bupleurum, 10g) were utilized to actively push the lingering wind-cold pathogen out of the body’s exterior. She Chuang Zi (Cnidium, 10g) was added to warm the Kidneys and scatter deep cold.
  • Regulating Qi and Dampness: Chen Pi (Tangerine Peel, 10g), Zhi Ke (Aurantium, 10g), Fo Shou (Finger Citron, 10g), Fu Ling (Poria, 10g), and Sha Ren (Amomum, 6g, added near the end) moved the stagnant Qi in the chest and strengthened the Spleen to dry the dampness (addressing the loose stools).
  • Soothing Throat and Relieving Spasm: She Gan (Belamcanda, 10g), Gou Teng (Uncaria, 10g), and Can Sha (Silkworm Feces, 10g) cleared the throat and relieved the bronchial spasms. Zhi Gan Cao (Honey-fried Licorice, 10g) harmonized the decoction.
  • Administration: 7 doses prescribed, water decocted to 300ml, taken warm twice daily, 2 hours after meals.
• Acupoint Moxibustion Therapy: The patient received localized acupoint patches containing warming herbs like Xi Xin (Asarum) and Bai Jie Zi (White Mustard Seed). These were applied to the bilateral Fei Shu (BL13 – Lung Shu) acupoints on the upper back for 1 hour daily, totaling 14 applications, to continuously warm the Lung meridians.
• Second Visit (May 15, 2022): The cough was reduced, sputum was easier to expectorate, and the itchy throat and sleep had improved. However, the patient still had loose stools. To focus more heavily on strengthening the Spleen and drying dampness, the practitioner added Bai Zhu (Atractylodes, 12g) and Guang Huo Xiang (Agastache, 10g) to the base formula. (7 doses prescribed).
• Third Visit (May 23, 2022): The cough was significantly relieved, with only occasional thin, white sputum. Her sleep was peaceful, and her stools had normalized to once a day. The practitioner instructed her to complete 7 more doses of the modified formula to consolidate the cure before stopping the medication.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the holistic management of cough-variant asthma (CVA). CVA is a specialized form of asthma where chronic coughing is the only symptom, frequently occurring after a viral cold.

Professor Zeng notes that treating this condition requires looking beyond the Lungs to address the Spleen, Liver, and Kidneys. This patient’s flare-up was explicitly triggered by eating cold foods, which damaged her Spleen. By dynamically adding Bai Zhu and Huo Xiang in the second visit, the practitioner addressed the root “phlegm factory” (the Spleen) rather than just the Lungs. Furthermore, combining oral herbs with warming moxibustion on the Fei Shu points forcefully expelled the cold. For prevention, the practitioner emphasizes lifestyle modifications (avoiding cold, raw, spicy, and overly sweet foods) and routine acupoint stimulation, such as massaging Ying Xiang (LI20) and applying moxibustion to Zu San Li (ST36) to continuously boost the body’s defensive Qi.

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Source Original source: Qingyuan Maternal and Child Health Hospital / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】曾宪进：灸法联合止嗽散治疗咳嗽变异性哮喘案 Practitioner: Professor Zeng Xianjin (曾宪进) Publication date: September 12, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation