According to Dr. Hu Xi-Shu, the main cause of coughing is the invasion of phlegm-rheum, which should be treated by warm transformation, descending counterflow, and calming (the cough).

When treating coughs in general, there are numerous formulas to choose from, some may even go so far as to say that there are thousands upon thousands, but Dr. Hu would most commonly use the formula Ban Xia Hou Po Tang (Pinellia and Magnolia decoction). When asked about the reasoning for this, he would answer that in the Jin Gui Yao Lue’s (Essential formulas from the golden cabinet) section on coughs it is said that there exists an intimate relationship between phlegm-rheum and coughs, and that many cases are in fact due to the upward invasion of phlegm-rheum, which causes qi counterflow with an inability to descend. In regards to the treatment of phlegm-rheum, it is said in the Jin Gui Yao Lue,

“In phlegm-rheum diseases, one must harmonize with warm medicinals”. 

This is the most important main treatment principle when treating phlegm-rheum conditions, and in addition is the main treatment principle when treating coughs. When adapting this principle (in the treatment of coughs), one must also use appropriate medicinals to guide the treatment downwards in order to descend (counterflow). Clinical practice offers us many opportunities to promptly offer a resolution of this symptom.

To read one of Dr. Hu’s cases utilizing this formula, click here.

A commonly seen presentation in wheezing and panting is the contraction of an external pathogenic factor with simultaneous retention of phlegm-rheum.  In patients who are constitutionally predisposed to phlegm-damp retention, usually the initial attack by an external factor will stir the interior phlegm which will counterflow into the lung, invariably causing the wheezing and panting.  This pattern is mentioned in the Shang Han Lun, where it states:

“In cold damage where the exterior is unresolved, (and) there is water qi below the heart….”

In these cases treatment generally involves, effusion to resolve the exterior, with simultaneous warm transformation of fluids.  The various manifestations of this condition can be treated with the following prescriptions:

She Gan Ma Huang Tang: (Belamcanda and Ephedra Decoction)

射干麻黄汤

Main signs:  Aversion to cold, generalized body pain, copious phlegm, and the sound of phlegm in the back of the throat.  If this pattern is accompanied by signs such as a dry mouth, dry tongue, and heart vexation, Sheng Shi Gao may be added.

Xiao Qing Long Tang: (Minor Blue-Green Dragon Decoction)

小青龙汤

Main signs:  Aversion to cold, generalized body pain, an absence of sweating, coughing with a need to rest and lean up against something, yet unable to lie down.  (This is normally due to the presence of copious phlegm), severe coughing with frothy phlegm.  If this is accompanied by signs such as a dry throat, vexation and agitation, Sheng Shi Gao may be added.

Ge Gen He Xiao Xian Xiong Tang: (Minor Sinking into the Chest Decoction with Pueraria)

葛根和小陷胸汤

Main signs:  Hypertonic back and nape, chest fullness, oppression or pain, heat effusion, aversion to cold and panting.  If heart vexation is quite obvious, then Sheng Shi Gao may be added.

Ling Gan Wu Wei Jiang Xin Xia Xing Tang: (Poria, Licorice, Schisandra, Ginger, Asarum, Pinellia and Apricot Seed Decoction)

苓甘五味姜辛夏杏汤

Main signs:  Coughing, panting with chest fullness, spitting up of frothy phlegm and a normal taste in the mouth.

Ma Huang Fu Zi Xi Xin Tang: (Ephedra, Asarum and Prepared Aconite Decoction)

麻黄附子细辛汤

Main signs:  Aversion to cold, absence of sweating, perhaps an aversion to cold felt in the back, counterflow cold of the extremities, a fatigued spirit, and a deep-thin pulse.

Patterns where blood stasis is the primary cause of wheezing and panting.

Originally when blood stasis is laying dormant in the interior, any changes caused by external contraction, food damage or damage from the seven affects will induce and entice the movement of blood stasis which will eventually invade the liver and lungs and cause wheezing and panting.  If this stasis is not eliminated than the wheezing and panting will endure and recovery would be difficult to achieve.  Therefore many cases of wheezing and panting due to cold, or summer-heat that fail to resolve, usually contain elements of static blood.  The following are a couple formulas that can effectively treat these presentations.

Da Chai Hu Tang He Gui Zhi Fu Ling Wan (Major Bupleurum Decoction combined with Cinnamon Twig and Poria Pill)

大柴胡汤和桂枝茯苓丸

Main signs:  Chest and rib-side bitter fullness, difficulty breathing, hypertonic epigastrium, bitter taste in the mouth, dry throat, and dry bowel movements.

Da Chai Hu Tang He Tao He Cheng Qi Tang (Major Bupleurum Decoction combined with Peach Pit Decoction to Order the Qi)

大柴胡汤和桃核承气汤

Main signs:  Similar symptoms to the above, with the addition of abdominal distension and fullness, and difficult bowel movements.

Modifications to the above formulas: 

With signs of dry mouth, throat or tongue, vexation, agitation and/or vexation thirst, add Sheng Shi Gao

With signs of external contraction with symptoms of heat effusion, aversion to cold and an absence of sweating, combine with Ge Gen Tang.

With signs of sweating and significant wheezing, combine with Ma Xing Shi Gan Tang

Patterns where both phlegm-rheum and blood stasis are the primary cause

  If for example our patient presents with a Xiao Qing Long Tang presentation with elements and signs of Da Chai Hu Tang He Gui Zhi Fu Ling Wan, then these three formulas may be combined.

With difficult bowel movements it is easy to see signs of either Gui Zhi Fu Ling Wan or Tao He Cheng Qi Tang.  If in this case a She Gan Ma Huang Tang presentation exists, then the combination of these formulas would be applicable.

If signs of mouth or tongue dryness, or vexation and agitation are seen with the above formulas, then Sheng Shi Gao may be added.

Why Da Chai Hu Tang?

Dr Hu explained that many patients presenting with wheezing and/or panting manifest a Shao-Yang, Yang-Ming combination disease. Therefore, the cardinal Shang Han Lun formula Da Chai Hu Tang (Major Buplureum Decoction) may be used with quite astonishing results. Many of Dr. Hu’s students would often ask him why when treating wheezing he wouldn’t just use Ma Huang (Radix Ephedra)? He would simply state that unless the case presenting was a Ma Huang pattern, its use was not warranted. In the Shang Han Lun (On Cold damage) it states that “In wheezing with chest fullness, Ma Huang is appropriate, but in wheezing with abdominal fullness, Ma Huang should not be used”. 


Dr. Hu would explain that in order to diagnose a Shao-Yang Yang-Ming case of wheezing and panting, we need to look for symptoms such as; wheezing and panting with occasional chest fullness, rib-side pain, sweating, dry throat, dry bowel movements, etc.

Dr. Hu was a master at utilizing classical formulas for the treatment of a wide array of syndromes. The following is a list of his most commonly used formulas and their specific patterns for the treatment of pain.

I. Ge Gen Jia Zhu Tang (Kudzu Decoction plus Atractylodes Decoction)(葛根加术汤):

Neck and nape tightness and pain, heat effusion, aversion to cold, lumbar soreness, generalised heaviness, white tongue coating, wiry-slippery pulse.

Ge Gen 4 qian (Radix Puerariae)

Ma Huang 3 qian (Ephedrae, Herba)

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Bai Shao 2 qian (Paoniae Lactiflorae, Radix)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Cang Zhu 5 qian (Atractylodis, Rhizoma)

This formula is used in both acute and chronic inflammatory joint problems, especially when manifesting with heat effusion, an absence of sweating and aversion to cold. The use of this formula is still warranted in cases of acute joint inflammation without the presence of neck and nape pain. This formula may be utilised in treating cases of lumbar muscular injury, hyperosteogenesis, ankylosing spondylitis and chronic arthritis.

II. Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction)

(麻杏薏甘汤):

Whole body joint pain, late afternoon heat effusion, body heaviness or swelling of the joints in the four extremities, harmony in the mouth* or sticky taste in the mouth, greasy-white tongue coating, deep-wiry-slippery pulse.

Ma Huang 3 qian (Ephedrae, Herba)

Xing Ren 2 qian (Pruni Armeniacae, Semen)

Yi Yi Ren 6 qian (Coicis Lachryma-jobi, Semen)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula pattern is commonly seen in cases of chronic and acute rheumatoid arthritis with a tendency towards damp heat. 

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions. 

III. Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) (桂枝芍药知母汤):

Whole body joint pain, joint swelling in the extremities or knees, stiffness and/or deformities in the extremities, fingers or toes, dizziness, shortness of breath, white tongue coating, wiry pulse.

Gui Zhi 4 qian (Cinnamomi Cassiae, Ramulus)

Ma Huang 2 qian (Ephedrae, Herba)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Sheng Jiang 5 qian (Zingiberis Officinalis Recens, Rhizoma)

Bai Zhu 5 qian (Atractylodis Macrocephalae, Rhizoma)

Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)

Fang Feng 4 qian (Ledebouriellae, Radix)

Pao Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

Gan Cao 2 qian (Glycyrrhizae Uralensis, Radix)

This formula pattern is commonly seen in chronic rheumatic cases such as damp-heat type rheumatoid arthritis and is classified as a combination of the Shao-Yin and Tai-Yin disease stages. This formula is especially indicated in cases of swelling with joint deformities accompanied by upward rising qi and nausea. In cases where redness, swelling and heat are significant, Sheng Shi Gao (Gypsum) may be added to the above formula. 

IV. Gui Zhi Jia Ling Zhu Fu Tang (Cinnamon Twig plus Poria, Atractylodis, and Aconite Decoction) (桂枝加苓术附汤):

Lumbar, knee or shoulder joint pain, head, neck and nape pain, possibly accompanied by palpitations, epigastric pain, sweating, aversion to wind, cold extremities, harmony of the mouth, white tongue coating, wiry pulse. 

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Zhi Gan Cao 3 qian (Glycyrrhizae Radix Preperata)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Cang Zhu 3 qian (Atractylodis, Rhizoma)

Fu Ling 3 qian (Poriae cocos, Sclerotium)

Pao Fu Zi 3 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

This was one of Dr. Hu’s most commonly used formulas. If joint pain was more evident on one side of the body, he would consider this obstruction and stasis of blood and would add a small dose of Da Huang (Radix Rhubarb) in order to quicken the blood and free the collaterals. 

V. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig plus Astragali Decoction)

(桂枝加黄芪汤):

Enduring joint pain, obvious sweating and aversion to wind, cold extremities, with perhaps a warm body and numbness in the extremities. Thin-white tongue coating, moderate pulse. 

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Huang Qi 3 qian (Astragali Membranacei, Radix)

This formula is used in cases of exterior vacuity combined with water-damp evils seen in cases of impediment pain, numbness and sores. 

VI. Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San (Bupleurum, Cinnamon Twig, and Ginger Decoction, plus Tangkuei and Peony Powder)

(柴胡桂枝干姜汤合当归芍药散):

Lumbar and/or pelvic pain, neck and back pain, weak knees, palpitations, fullness below the heart, spontaneous or night sweating, lower extremity oedema, white tongue coating, deep-thin-wiry pulse.

Chai Hu 4 qian (Bupleuri, Radix)

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)

Gan Jiang 2 qian (Zingiberis Officinalis, Rhizoma)

Huang Qin 3 qian (Scutellariae Baicalensis, Radix)

Hua Fen 4 qian (Trichosanthis Kirilowii, Radix)

Sheng Mu Li 5 qian (Ostreae, Concha)

Dang Gui 3 qian (Angelicae Sinensis, Radix)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Chuan Xiong 2 qian (Ligustici Chuanxiong, Radix)

Bai Zhu 3 qian (Atractylodis Macrocephalae, Rhizoma)

Ze Xie 5 qian (Alismatis Orientalis, Rhizoma)

Fu Ling 4 qian (Poria cocos, Sclerotium)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula is commonly used in the treatment of lumbar and cervical hyper-osteogenesis, osteoporosis, ankylosing spondylitis and wind-damp type rheumatic disorders. The location of this disease is found in both the Jue-Yin and Tai-Yin levels and is a pattern of blood vacuity with damp exuberance therefore treatment involves resolving the two Yin’s nourishing the blood and disinhibiting water. 

According to numerous recorded cases studies, Dr. Hu commonly employed this formula in the treatment of Systemic Lupus erythematosus (SLE).