A 45-year-old woman with a half-year history of a recurrent cough triggered by a cold was managed using a Lung Qi-tonifying and pathogen-dispelling herbal strategy.

Case ID: CHC-0036

Case Summary

This case describes a 45-year-old woman who presented with a recurrent cough lasting for over six months following an initial cold. The original report documented a conventional diagnosis of bronchitis and a TCM assessment of Cough driven by Lung Qi Deficiency. The patient was managed through a dynamic herbal approach designed to tonify the underlying Lung and Spleen Qi weakness while actively expelling the lingering wind-cold pathogen.

Patient Presentation

• Patient: 45-year-old female (Surname: Jiang).
• Main Complaint: Recurrent cough for over half a year, significantly worse at night, accompanied by shortness of breath and a low, weak cough sound.
• History: The patient sought consultation on March 3, 2018. She reported that her cough originally worsened after catching a cold in late September 2017. For the past six months, the cough had been persistent, particularly at night. She produced no sputum, but her cough sounded timid and lacked force. She experienced significant physical and mental fatigue, a pale complexion, nasal congestion with a runny nose, an itchy throat, and an aversion to cold without sweating. Previous treatments at other hospitals had yielded poor results.

Examination and Diagnosis

• Conventional Diagnosis: Bronchitis.
• TCM Tongue and Pulse: The tongue body was pale red with a black coating (the practitioner noted the black coating was a false sign caused by recently consuming Wugong Wan / Centipede pills, rather than a pathological indicator). The pulse was sunken (脉沉).

TCM Assessment

The original practitioner interpreted the presentation as Cough driven by Lung Qi Deficiency (咳嗽 – 肺气虚型).

According to the principles of yin and yang Chinese Medicine the Lungs govern the body’s defensive Qi and regulate the respiratory pathways. The original report noted that the patient’s foundational Lung Qi was depleted (evidenced by her pale complexion, severe fatigue, pale red tongue, sunken pulse, and the weak, timid sound of her cough).

Because her Lung Qi was weak, her body failed to properly vaporize fluids, which gathered into hidden phlegm and impaired the Lung’s natural descending function, causing the chronic cough. Furthermore, this internal weakness meant her defensive exterior was insecure, allowing an external Wind-Cold pathogen to easily invade and linger for months. This unresolved external pathogen caused the active nasal congestion, runny nose, itchy throat, and aversion to cold.

Treatment Approach

The primary treatment principle was to tonify Lung Qi, dispel pathogens, and stop the cough (补益肺气，祛邪止咳). The strategy required a delicate balance: heavily fortifying the patient’s internal energy (righteous Qi) while simultaneously pushing out the lingering acute symptoms (the pathogenic wind-cold).

Herbal Formulas and Modifications

• Initial Formula (March 3, 2018): A 14-herb decoction combining tonification with exterior-releasing herbs.
  • Tonifying Lung and Spleen Qi: Dang Shen Pian (30g) and Ren Shen Ye (10g) strongly replenish Lung and Spleen Qi. Zheng Bai Zhu (10g) and Gan Cao Pian (10g) fortify the Spleen to nourish the Lungs (Earth generating Metal).
  • Clearing Lungs and Stopping Cough: Pi Pa Ye (10g), Zhe Bei Mu (15g), and Ku Xing Ren (10g) clear the Lungs, transform hidden phlegm, and restore the downward descent of Lung Qi. Gan Cao Pao Di Long (10g) clears heat, resolves toxicity, and stops coughing.
  • Dispelling Wind-Cold: Mi Ma Huang (10g), Guang Huo Xiang (10g), and Gan Jiang (10g) actively disperse the wind-cold pathogen from the surface and dry dampness. Qian Hu (10g) disperses wind while descending Qi.
  • Dissipating Nodules and Warming: Mao Zhao Cao (30g) resolves toxicity and dissipates nodules. Yan Du Zhong (10g) warms the Kidneys and assists Yang to dispel the deep cold.
• Second Visit (March 7, 2018): The night cough and shortness of breath slightly improved, but the nasal congestion, itchy throat, and aversion to cold persisted. The practitioner removed the deep warming herbs Yan Du Zhong and Gan Jiang. Gang Mei (20g) was added to clear heat and detoxify, Fu Ling (20g) to strengthen the Spleen and drain dampness, and Huang Qin Pian (10g) to clear heat and descend Lung Qi.
• Third Visit (March 13, 2018): The night cough was now only occasional, and the nasal congestion, runny nose, and aversion to cold were fully resolved. The tongue coating shifted to a grayish-white, and the pulse was sunken and stringy. The practitioner removed Di Long, Ma Huang, and Fu Ling. Chan Tui (10g) and Sheng Jiang (10g) were added specifically to dispel remaining wind, benefit the throat, and stop the lingering itch.

Follow-Up

• Following the third visit and the four prescribed doses, subsequent follow-ups reported that the patient was fully cured, and her six-month chronic cough completely resolved with no remaining discomfort.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated management of a chronic illness that is complicated by an acute, lingering pathogen. A chronic cough lasting six months typically points to a deep deficiency, but this patient still exhibited acute wind-cold symptoms (aversion to cold, runny nose).

If the practitioner had only used tonics (like Ginseng) to treat the weakness, it would have trapped the wind-cold pathogen inside. If they had only used strong exterior-releasing herbs (like Ephedra), it would have further exhausted the patient’s already depleted Lung Qi. By combining strong Qi tonics (Dang Shen, Ren Shen Ye) with precise exterior-releasing herbs, the formula effectively rebuilt the patient’s engine while simultaneously pushing out the lingering cold.

Additionally, the practitioner’s observation of the “black tongue coating” provides a crucial clinical lesson: they correctly identified it as a false stain from the patient’s recent consumption of Wugong Wan (Centipede pills) rather than a sign of extreme internal heat or cold, ensuring the diagnosis remained accurate.

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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: Qingyuan Maternal and Child Health Hospital (清远市妇幼保健院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】曾宪进：补益肺气，祛邪止咳法治疗肺气虚型支气管炎案
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 27, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation