咳嗽咯痰的中医治疗

The treatment of cough and phlegm by Chinese medicine

这里所讨论的咳嗽和咯痰，可以是咽炎，支气管炎，或肺炎，胸膜炎等原因所致。

Here we are going to talk about the treatment of cough and phlegm by Chinese herbal therapy, acupuncture and cupping. The reasons for the cough and phlegm could be due to either pharyngitis, bronchitis, or pneumonia, or pleurisy.

治疗咳嗽咯痰，需要区别是急性还是慢性咳嗽，还有就是区别是干咳或咳嗽伴有咯痰。

Upon the treatment of the cough, we need to make it clear if it is acute cough or chronic cough, and if it comes with phlegm or only a dry cough per se.

急性咳嗽有痰

Acute cough with phlegm:

急性咳嗽，病人有感冒症状，比如身冷，发烧，头痛，身体痛，鼻塞，打喷嚏，流清鼻，咽痛等，如果病人体质健壮而身上不出汗，这是中医的风寒外感，表实感冒我们用麻黄汤治疗。如果基本上就是咳嗽，而其他症状不明显，可以改为三坳汤。如果病人有这些症状，但是体质较弱，或身上有汗，或很容易出汗，这是风寒外感，表虚感冒，我们用桂枝汤治疗。表虚感冒而口干或烦躁者，用桂枝加石膏汤。如果难以判断，就用麻黄桂枝各半汤，人参败毒散，或者用荆防败毒散治疗。

For acute cough, if the patient has symptoms of common cold, such as chilly, or fever, headache, pain on the body and joints, stiff nose, sneeze, water-running nose, sour throat, etc., and if the patient if strong in the body constitution and has no sweat now, we use herbal formula Ma Huang Tang. This is a Wind-Cold type of common cold, and further more it belongs to body suffice sufficient sub-type of the common cold. In this case, if the cough is the most symptom, other symptoms are not strong, we can use more simply formula called San Ao Tang.

If the patient has those symptoms, but the body constitution is weak, or if the patient has sweat, it belongs to body surface insufficient subtype of Wind-Cold common cold. We use Gui Zhi Tang. In this case, if there is dry mouth and anxiety, use Gui Zhi Tang jia Shi Gao.

If it is hard to tell if the common cold belongs to body surface sufficient or insufficient subtype, we can use half Ma Huang Tang and half Gui Zhi Tang, or use Ren Shen Bai Du San, or Jing Fang Bai Du San.

如果感冒后咳嗽，咯较多量的痰，或流大量清水样鼻涕，或清水样眼泪，我们用小青龙汤治疗。如果这里病人同时有咽干，或咽痛，喜欢饮冷水，用小青龙汤加石膏治疗。

If the cough is with lots of water-like clear phlegm, or water-like clear running nose or tear, we use Xiao Qing Long Tang. If these patients also feel dry mouth of anxiety, we use Xiao Qing Long Tang jia Shi Gao. 

如果感冒咳嗽，而发热较明显，病人烦躁明显，口干，用大青龙汤治疗。

If there are cough and fever, and if the patient feel very anxiety and dry mouth, we use Da Qing Long Tang.

感冒咳嗽，但以气短哮喘为主，用麻黄汤（体质健壮而无汗），或桂枝加厚朴杏子汤（体弱，有汗），或麻杏石甘汤（口干，胸闷，微汗，烦躁），或大青龙汤（体质好，可有汗，但是烦躁为甚）治疗。

If the cough is with short of breath or asthma, use Ma Huang Tang (if the body constitution is strong and the person has no sweat); or Gui Zhi Jia Hou Pu Xing Zi Tang (if the body is weak and has sweat); or Ma Xing Shi Gang Tang (if there is dry mouth, chest tightness, slight sweat, and anxiety), or Da Qing Long Tang (if the body is strong, with or without sweat, but more anxiety). 

如果感冒咳嗽，病人发热，或时而发热，时而畏寒，恶心，上部胀满不适或痛，头晕，口苦咽干，或耳内有堵塞感，用小柴胡汤加减治疗。

If the patient has cough, fever, and also some times has fever and some other times has chilly, nausea, bloating feeling in the upper stomach, dizziness, bitter taste and dry feeling in mouth, or block feeling inside the ears, we use Xiao Chai Hu Tang.

如果咳嗽有痰，痰粘难出（不必过分注重痰的颜色），病人喜欢冷饮，有便秘，或有长期吸烟饮酒史，我们用瓜蒌枳实汤化痰止咳。

If the cough is with phlegm, and the phlegm is difficult to spit out (no matter what color the phlegm is), and if the patient likes to drink cold water and has constipation, or has a long history of cigarette smoking or alcohol drinking, we use Gua Lu Zhi Shi Tang to clear the phlegm and to stop the cough.

急性咳嗽无痰

Acute cough without phlegm:

感冒后仅仅以咳嗽为主，很少咯痰，或根本就没有痰，或咳嗽为晨起为著者，用瓜蒌枳实汤。

If it is mostly dry cough, almost no any phlegm, and if the cough is worse in the early morning, we use Gua Lu Zhi Shi Tang. This formula is also used if the phlegm is very difficult to spit out.

如果平素体弱，感冒后咳嗽不断，痰少，咳嗽为阵发性，刺激性考虑用百合固金汤。这种病人老年人较多。

If the body is usually weak, and there are lots of cough after the common cold, the cough is paroxysmal and stimulating one, we use Bai He Gu Jin Tang.

咳嗽是由于慢性咽炎刺激者，用半夏厚朴汤。

If the cough is due to the tingling from throat, use Ban Xia Hou Pu Tang.

以上讨论的主要是风寒感冒后的咳嗽咯痰。如不感冒后病人没有畏寒感，而是很快就发热汗出口渴，要特别小心是传染病的早期，需要特别治疗，最好找西医医生。对于中医来说，我们会立刻按照温病治疗，用麻杏石甘汤，葛根汤，白虎汤等治疗。这是一刻也不能耽搁的病。

The discussion above is for the cough and phlegm after a Wind-Cold type of common cold. If the patient feel no chilly, but soon a fever, dry mouth, and sweat, we have to be very careful if it is the early stage of an infectious disease. We recommend the patient to see a western medicine doctor as well to have our Chinese medicine treatment. For us, we will treat such patient right soon according to an infectious disease. The herbal formula used would be such as Ma Xing Shi Gan Tang, Ge Gen Tang, and Bai Hu Tang, etc.

慢性咳嗽

Chronic cough

慢性咳嗽多少都有咯痰和气短。多为脾，肾，肝的病变。常需要辩证选方，常用的方剂有百合固金汤，金匮肾气丸，真武汤，六味地黄丸，金水六君子汤，黄芩泻白散合黛蛤散，厚朴麻黄汤，射干麻黄汤，小青龙汤，沙参麦冬汤，导痰汤等。

Chronic cough is usually with phlegm and short of breath. It could be caused by either Spleen, Liver, or Kidney disease (those are Chinese medicine concept, not western medicine concept), or combination of these organ systems. We must make very clear TCM diagnosis before the treatment. The commonly used herbal formula are Bai He Gu Jin Tang, Jin Kui Shen Qi Wan, Zheng Wu Tang, Liu Wei Di Huang Wan, Jin Shui Liu Jun Zi Tang, Huang Qin Xie Bai San plus Dai He San, Hou Pu Ma Huang Tang, She Gan Ma Huang Tang, Xiao Qing Long Tang, Sha Shen Mai Dong Tang, or Dao Tan Tang.

针灸也可以治疗咳嗽。常用针灸的穴位是迎香，肺俞，肾俞，曲池，列缺，合谷，膻中，鸠尾，少泽，气海，三阴交等。

Acupuncture also works for cough. The commonly used acupuncture points are Yin Xiang, Fei Shu, Shen Shu, Qu Chi, Lie Que, He Gu, Shan Zhong, Jiu Wei, Shao Ze, Qi Hai, and San Yin Jiao, etc. When used together with Chinese herbal therapy, the cough can be stopped much sooner.

对于急性感冒咳嗽发热的病人，还可以用刺血疗法，就是在手指甲根旁边刺一下，挤出数滴血液。也可以在肘窝处或舌下静脉出刺血放血。这种疗法对于缓解症状，退烧很有效。

For acute cough with fever, we can also use bleeding therapy. It works to release the symptoms and reduce fever. For the common cold and cough, the bleeding therapy means to punch the blood vesicles on the skin at the nail root of fingers, on the elbows, and under the tongue.

我们还常用拔罐疗法，就是在前胸和后背上拔罐。这对于舒缓肺气，止咳平喘很有好处。

We also use cupping therapy. The cups are mostly put on the chest and on the upper back.

感冒咳嗽，应该休息，减少体力和脑力劳动，让身体有更多的能力抵抗疾病，而不是更多的运动和锻炼而消耗人体的能量。我们应该理解：感冒症状是人体对我们的提示和警告，要我们放慢生活和工作的节奏和强度，而不是提醒我们更加剧烈地工作。尊重自然，是中医治病的原则之一。

During the common cold and cough, we should have a break to reduce the level of physical and emotional mind work, so as to allow our body to share more energy for the healing. We should not have too much physical exercise or mental work to diverse body energy. We should understand that the pain, the cough, are the signals of our body asking us to slow down our steps of life, not to ask us to work more hard or to do more heavy job. To respect the nature is one of the principles in Chinese medicine practice.