🌿 Folk Prescriptions

I. On the Use of Platycodon
Platycodon is commonly used in prescriptions for exogenous cough. Xu Lingtai repeatedly criticized its use in his commentary on *Clinical Guide to Medical Cases*, arguing that Platycodon ascends and is unsuitable for cough patients. Although Platycodon Decoction (Platycodon, licorice) is a formula from Zhang Zhongjing, it should use more licorice and less Platycodon. The main effect of Platycodon is expectorant. Historically, scholars have considered it to ascend, hence calling it the “boatman among herbs,” but this actually refers only to its expectorant action. Patients with abundant phlegm and cough can certainly use it. Although Platycodon ascends, pairing it with descending herbs like Aurantii Fructus or Peucedani Radix balances the ascending and descending actions, thus facilitating qi movement and relieving chest and throat discomfort. However, it should be avoided in dry cough without phlegm. Golden buckwheat and Polygala are slightly stronger in expectorant action than Platycodon, and their use in irritative dry cough is often ineffective. The usual dosage of Platycodon is 3–6 grams.
II. On Cough-Relieving Formulas
As previously mentioned, the treatment of exogenous cough should primarily target the cause. This reflects the TCM principle of “treating the root cause.” The concept of “treating the root cause” is broad; for specific diseases, symptoms (like cough) are the manifestation (the branch), while the cause (such as wind-cold or wind-heat) is the root. Zhang Jiebin stated that vital energy, yin essence, and stomach qi are the fundamental causes of all diseases; the initiating factor is the true root. *The Spiritual Pivot* says, “When treatment reaches its ultimate, it is one—the root lies in understanding this.” Thus, exogenous cough should be treated according to the six climatic factors, and once the cause is eliminated, cough will cease.
However, there are cases where wind dissipates, cold clears, heat resolves, and dryness restores, yet cough persists. In such cases, check for accompanying conditions (like phlegm-dampness, blood stasis, food accumulation) or organ deficiencies (such as spleen, kidney, or lung deficiency). If present, treat the accompanying issues, and especially prioritize addressing deficiencies. For example, if cough continues along with poor appetite, loose stools, fatigue, and spontaneous sweating with aversion to wind—indicating spleen-lung deficiency—using formulas to disperse, descend, resolve phlegm, and stop cough would further damage already deficient spleen and lung functions. Instead, shift to tonifying deficiency, possibly even ignoring cough entirely, as Ye Tianyi said: “After losing appetite and experiencing loose stools, how can one afford to fuss over coughing?” By strengthening the spleen, invigorating qi, and warming the lungs, treating the root causes, cough will naturally subside. Here, the concept of “root” shifts to “disease is the branch, person is the root.”
If no signs of the six climatic factors remain, nor any accompanying conditions or organ deficiencies, yet cough persists, consider using cough-relieving formulas. During the Song and Yuan dynasties, opium poppy shell and winterflower were commonly used. *The Complete Collection of Holy Remedies* frequently used Stemonae Radix (e.g., Stemonae Radix Pill: Stemonae Radix, Winterflower, Heavenly Bamboo, Fritillaria, Platycodon, Purple Gromwell—this formula may be the prototype of Cheng Zhongling’s Cough-Relieving Powder; Stemonae Radix Decoction: Stemonae Radix, Rehmannia, Ginger, Lily, Ophiopogon; Purple Gromwell Powder: Purple Gromwell, Winterflower, Stemonae Radix). Also, Nine Immortals Powder (Winterflower, Opium Poppy Shell, Fritillaria, Ginseng, Mulberry Bark, Schisandra, Prunus Mume, Donkey-hide Gelatin, Platycodon).
Modern practitioners such as Jiang Chunhua use the Cough-Stop Formula (Ligustrum Fruit, Stemonae Radix, Puffball, Sky-Capsule), removing Puffball and adding Schisandra for prolonged cough with deficiency; Yao Shanzhi uses the Cough-Stop Formula (Roasted Beehive, Cicada Skin, Chebulic Myrobalan, Zhejiang Fritillaria, Sichuan Fritillaria, Bitter Silk Tree, Platycodon, White Front, Scrophularia, Wild Buckwheat, Forsythia); Zhang Menglin uses the Rapid Cough-Relief Formula (Honey-fried Winterflower, Honey-fried Silkworm, Sichuan Fritillaria, Honey-fried Poppy Shell, Platycodon, Whole Scorpion). These prescriptions can serve as references for clinical practice. Generally, avoid such formulas if exterior symptoms remain or phlegm is abundant. For prolonged cough with deficiency, combine with tonifying methods.
Ligustrum Fruit is the red fruit of Ligustrum lucidum; adult dosage per prescription does not exceed 6 grams. Sky-Capsule, also known as Sky-Head Capsule, is the fruit of Calotropis gigantea; use three capsules per prescription.
III. On Phlegm Color: White Indicates Cold, Yellow Indicates Heat
This is generally true; textbooks state this, and it is not incorrect. However, judging cold or heat solely by phlegm color is insufficient and may lead to misdiagnosis. Whether phlegm is white or yellow is not the key issue; rather, whether it is thick or sticky matters. Thick, sticky phlegm indicates true heat. Such phlegm is difficult to expel, and patients often say, “It sticks in my throat and won’t come out.” Yellow and sticky phlegm indicates heat; white and sticky phlegm indicates even greater heat. Yellow and thin phlegm that is easy to expel does not necessarily indicate heat—it merely suggests it has been lingering in the body longer. White, sticky, glue-like phlegm results from body fluids being scorched and concentrated by dry-heat, transforming into phlegm before it can linger long in the body—thus indicating heat and dryness. Of course, this analysis focuses solely on phlegm, not replacing comprehensive four-diagnosis integration.
IV. On Dryness Pathogen
As previously discussed, autumnal dryness has become increasingly common due to various reasons. Besides dryness arising from wind carrying warmth or cold transforming into heat and dryness, modern factors such as air pollution, car exhaust, smoking, and living in high-rise buildings also contribute to dryness. I wish to emphasize distinguishing internal dryness from external dryness. External dryness has two types: first, dry pathogenic factors contracted during autumn; second, pathological changes resulting from wind-cold or wind-heat transforming into dryness. At initial stages, the pathogen resides in the exterior defensive layer, so despite dry cough without phlegm, dry mouth, and sore throat, the pathogen must still be dispelled outwardly. For dryness caused by cold or heat transformation, clearing heat will naturally relieve dryness, with just a little nourishing yin and moistening fluids added. These are all examples of external dryness. Internal dryness differs—it arises from depletion of the five zang organs’ essence, blood, and body fluids in miscellaneous diseases. Though the manifestations resemble external dryness, the severity is far greater. Understanding this clarifies why Yu Shi’s theory addresses yin deficiency and lung dryness, and why Ren Shen (ginseng) is chosen instead of Sha Shen (adlay root) in Qing Zao Jiu Fei Tang. This formula is not suited for “warm dryness injuring the lung” or “lightly dispersing lung dryness,” but rather for internal dryness in miscellaneous diseases. Twenty-five years ago, while attending Dr. Fang Yuzhong at Xiyuan Hospital, a worker from a Beijing factory with lung cancer came for consultation. His symptoms included dry cough, sticky phlegm in the throat that wouldn’t come out, shortness of breath, and wheezing. Dr. Fang prescribed Qing Zao Jiu Fei Tang with ginseng, adding Zhejiang Fritillaria and Cordyceps powder—resulting in good outcomes. I followed up on this case for several years, so the impression remains strong.
V. On Throat Itch
Throat itch is common in exogenous cough. Itching belongs to wind, so wind-induced cough—whether wind-cold or wind-heat—initially presents with throat itch. Herbs like Schizonepeta, Saposhnikovia, Mentha, Arctium, and Cicada Slough can relieve throat itch. When wind-cold transforms into heat, causing wind due to heat, clearing heat will extinguish fire and calm wind, thus relieving itch. When dryness injures the lung, severe dryness leads to dryness and loss of moisture in the airway, requiring sweet-cool, moisturizing remedies. In phlegm-damp cough, obstruction of the airway leads to upward lung qi, so lowering qi and resolving phlegm will open the airway and relieve itch. Examples include Aristolochia and Perilla; for the latter, Citrus Peel and Pinellia. Sometimes I also use Buthus martensii and bee hive.
VI. On Constitution
Ye Tianyi said: “When discussing illness, first assess constitution, appearance, and pulse pattern, because illness is an external addition to the body.” (See *Clinical Guide to Medical Cases*, Cai Woman Case). Hence, although this article discusses exogenous cough, the patient’s constitution cannot be overlooked. Clinically, constitution largely determines susceptibility to different pathogens and the tendency toward pathological changes after illness. Generally, those with plump bodies and soft flesh, indicating yang deficiency, tend to have dampness and phlegm and loose skin pores, making them more susceptible to wind-cold invasion. Conversely, those with lean bodies and sallow complexion, indicating yin deficiency, tend to have dryness and heat, making them more prone to wind-heat invasion. Thus, in yin-deficient individuals suffering from wind-heat or dry-heat cough, attention must be paid to nourishing yin. As seen in Ye Tianyi’s prescriptions, ingredients like Polygonatum, Adlay Root, Trichosanthes, Ophiopogon, and sugarcane juice are often included for this reason. For wind-cold cough in yang-deficient individuals, directly tonify yang. Zheng Qin’an stated that yang-deficient individuals always show fatigue, lack of speech, weakness in limbs, dull spirit, pale or bluish lips, preference for hot drinks and food, no fever, and clear foamy phlegm—especially fond of spicy foods like chili and ginger. Tonifying yang will naturally stop cough; do not treat phlegm by resolving it or stop cough by suppressing it. I once treated patients who had coughed for months, triggered by cold drafts or cold food. Reviewing their prior treatments, most matched Zheng’s description—overuse of common herbs like apricot seed, Fritillaria, Purple Gromwell, Winterflower, Pinellia, Aconite, etc., leading to “bad disease.” Switching to constitution-based treatment, ignoring cough entirely, warming yang and dispersing cold, the cough resolved. This aligns with the earlier idea: “disease is the branch, person is the root.”