Coughing is a common manifestation of respiratory system diseases, with various conditions such as colds and bronchitis triggering cough symptoms. In Traditional Chinese Medicine (TCM), cough can be classified into several syndromes, such as Phlegm-Damp Cough (Tan Shi Ke Sou) and Phlegm-Heat Cough (Tan Re Ke Sou). Although they differ by only one character, there are significant differences in etiology, symptoms, treatment methods, and medication choices, which we will explore in detail.
1. Phlegm-Damp Cough (Tan Shi Ke Sou)
Overview: Phlegm-Damp Cough is a type of internal injury cough, primarily caused by spleen and stomach dysfunction. When the spleen and stomach are impaired, the transformation and transportation of fluids are hindered, leading to the accumulation of phlegm and dampness. This phlegm obstructs the lungs, preventing their ability to disperse and descend, resulting in cough with phlegm production. This condition is commonly seen in chronic bronchitis and similar diseases.
Characteristics: Often accompanied by symptoms of spleen dysfunction.
Main Manifestations: Persistent or recurrent cough, with copious phlegm that is white or grayish in color, thick and sticky in texture, difficult to expel. Coughing may worsen in the morning or after consuming rich or cold foods. The cough is relieved when phlegm is expelled. Accompanying symptoms may include chest tightness, abdominal distension, nausea, poor appetite, and loose stools. The tongue coating is white and greasy, and the pulse is slippery.
Treatment Principles: Strengthen the spleen, dry dampness, stop cough, and resolve phlegm.
Medication Choices: Er Chen Wan (Er Chen Pill), Liang Jun Zi Wan (Six Gentlemen Pill), etc.
✎ Medication Analysis (Er Chen Wan): Er Chen Wan consists of Chen Pi (Chen Pi), Zhi Ban Xia (Processed Pinellia), Fu Ling (Poria), and Gan Cao (Licorice). The chief herb, Zhi Ban Xia, dries dampness and resolves phlegm while harmonizing the stomach and descending rebellious qi. Chen Pi regulates qi and strengthens the spleen, enhancing the action of the chief herb. Fu Ling promotes urination and resolves dampness, assisting the chief and deputy herbs in drying dampness and resolving phlegm, while also strengthening the spleen to prevent phlegm generation. Gan Cao harmonizes the other herbs and strengthens the spleen. Together, these four herbs work to dry dampness, resolve phlegm, and regulate qi, used for treating cough with copious phlegm due to phlegm-damp stagnation, along with symptoms of chest fullness, nausea, and vomiting.
2. Phlegm-Heat Cough (Tan Re Ke Sou)
Overview: Phlegm-Heat Cough is also a type of internal injury cough, primarily caused by external pathogens or internal organ injuries leading to phlegm-heat accumulation in the lungs. This condition prevents the lungs from dispersing and descending, causing cough. It is commonly seen in infectious lung diseases.
Characteristics: Often accompanied by signs of yang heat.
Main Manifestations: Frequent and severe cough, with coarse breathing or a rattling sound in the throat, copious phlegm that is thick and yellow, difficult to expel, possibly with a fishy or hot taste, or even blood-streaked phlegm. Accompanying symptoms may include fever, flushed face, chest and rib fullness, dry mouth and throat, and a desire to drink. The tongue is red with a thin yellow or greasy coating, and the pulse is slippery and rapid.
Treatment Principles: Clear heat, disperse the lungs, resolve phlegm, and stop cough.
Medication Choices: Jiang Hong Wan (Tangerine Peel Pill), Compound Xian Zhu Li Ye (Compound Fresh Bamboo Juice), San She Dan Chuan Bei Tang (Three Snake Gall and Fritillaria Syrup), etc.
✎ Medication Analysis (Compound Xian Zhu Li Ye): Compound Xian Zhu Li Ye consists of Fresh Bamboo Juice, Yuxingcao (Houttuynia), Sheng Ban Xia (Raw Pinellia), Sheng Jiang (Fresh Ginger), Pi Pa Ye (Loquat Leaf), Jie Geng (Platycodon), and Bo He (Mint Oil). The chief herb, Fresh Bamboo Juice, is sweet and bitter, cold in nature, and has the effect of clearing heat and resolving phlegm. Yuxingcao clears heat, detoxifies, and reduces abscesses. Sheng Ban Xia, Pi Pa Ye, and Jie Geng dry dampness, resolve phlegm, and moisten the lungs to stop cough, serving as deputy herbs. Sheng Jiang harmonizes the stomach and resolves phlegm. Bo He is acrid and cool, dispersing heat evil and alleviating throat discomfort, serving as the envoy herb. Together, these herbs clear heat, resolve phlegm, and stop cough, used for phlegm-heat cough.
Summary of Differences Between Phlegm-Damp Cough and Phlegm-Heat Cough
| Phlegm-Damp Cough | Phlegm-Heat Cough | |
| Key Syndrome | Phlegm and Dampness | Phlegm and Heat |
| Treatment Core | Clear Heat | Dry Dampness, Strengthen Spleen |
| Phlegm Color and Quality | White or grayish, thick | Yellow, thick, possibly blood-streaked |
| Phlegm Taste | Sweet taste | Fishy or foul odor |
| Accompanying Symptoms | Chest tightness, abdominal fullness, nausea, poor appetite, loose stools | Fever, flushed face, dry mouth and throat, sore throat |
| Representative Medication | Er Chen Wan | Compound Xian Zhu Li Ye |
Combined Medication for Phlegm-Damp Cough and Phlegm-Heat Cough
In treating Phlegm-Damp Cough and Phlegm-Heat Cough, in addition to selecting appropriate TCM patent medicines based on syndrome differentiation, it is also possible to combine expectorants such as Ambroxol Hydrochloride, Carbocisteine, and N-acetylcysteine to significantly improve the condition of thick phlegm that is difficult to expel. Specific combinations are as follows:
-
Phlegm-Damp Cough: Er Chen Wan + Ambroxol Hydrochloride Oral Solution + Jian Pi Wan (Strengthen Spleen Pill)
(The purpose of combining Jian Pi Wan is to improve spleen and stomach function, enhancing their ability to transform and transport fluids.)
-
Phlegm-Heat Cough: Compound Xian Zhu Li Ye + Lian Zhi Xiao Yan Pian (Lotus Mushroom Anti-Inflammatory Tablets) + Carbocisteine Oral Solution
(If an infection is confirmed, antibiotics should be combined for treatment.)
This concludes a brief introduction to Phlegm-Damp and Phlegm-Heat Cough. In the differentiation of cough syndromes, in addition to the two types discussed in this article, common cough syndromes also include Wind-Heat Cough, Wind-Cold Cough, Wind-Dry Cough, Yin Deficiency Cough, and Liver Fire Invading the Lungs Cough. Each of these syndromes has distinct characteristics, and accurate differentiation followed by appropriate medication treatment is essential for achieving the best therapeutic effect.
Note: Some text and image resources in this article are sourced from the internet. The purpose of reproducing this article is to convey more information. If there are any errors in source attribution or infringement of your legal rights, please notify us immediately, and we will delete it promptly and apologize to you.
Recommended Reads