Paediatric Respiratory Diseases – Cough and Asthma

Chinese Medicine Perspective


Paediatric Respiratory Diseases – Cough and Asthma


Material taken from the February 2008 Health World TCM Seminar on Chinese Medicine Pediatrics – Respiratory Disorders, by Peter Gigante, edited by Dagmar Riley



Respiratory diseases are frequently encountered in children whose resistance is tested by immature immunological development and exposure to temperature changes. Children under three years of age are especially prone, and the younger the child, the more severe the pathological manifestations will be. The combination of visible distress of tangible cause, with Western medical inadequacy in persistent cases, leads many parents to explore traditional Chinese medicine, often for the first time.


This newsletter presents an overview of treating cough and asthma, featuring a general discussion of the aetiology and pathology of the disease or syndrome, describing important indicators for diagnosis and differentiation, and presenting indicative formulas modified for children, with some explanation and variations. It must be noted however that in practice the diagnosis, treatment strategies, and methods often overlap and therefore they can only serve as a guide. Also please consider that all formula recommendation are on the basis that Ma Huang [Ephedra] is not available in Australia.


Cough – Ke Sou 咳嗽

Cough Caused by Exogenous Pathogenic Factors

外感咳嗽 Wai Gan Ke Sou

When weather is changeable, particularly in Winter and Spring, and the child is inadequately dressed, the six exogenous pathogenic factors will easily attack the lung, resulting in cough due to the impairment of the purifying and descending function of the lung and abnormal rising of lung Qi. Since children are still learning to adapt to external conditions, sudden changes are too rapid for the young body to adjust, sufficiently diminishing the defensive systems of the body and making it vulnerable to attack. As a result of the subsequent sluggishness of Lung Qi, interior retention and accumulation of body fluids will result, leading to formation of sputum, obstruction of the air passages and productive cough.


Initial symptoms of cough are usually those of the common cold or mild ‘flu. These include chills or aversion to cold, fever, cough and blocked nose (indicating dysfunction of Lung’s dispersing role). After 2 to 3 days, residual phlegm and damp is stirred up, combining internal and external pathogenic factors which rise and block the Lung function. Since the presence of external factors is accompanied by phlegm it is difficult to eradicate and may lead to weakness. Since wind and cold or heat remain trapped in the body, they may cause other symptoms such as disturbed spirit and insomnia, bowel disruption and so on.


Stagnation of Phlegm in the Interior

Since children have a weak Spleen and Stomach, injury due to improper feeding of milk and food can easily occur, disrupting the transforming and transporting functions of the Spleen, and resulting in the internal accumulation of dampness. This can easily transform into phlegm which, since it is stored in the Lung, can then obstruct the air passages, inhibiting smooth respiration and leading to cough. In addition, since the Yin of children is fragile, such obstruction can easily lead to heat and the transformation into phlegm heat syndromes, frequently complicated by depletion of fluids congealing of phlegm and injury to Yin.


Weak Constitution

Young children are inherently deficient, and weak in constitution. If the Spleen is especially weak, the Lungs will be deficient. If the Spleen and Stomach are functioning well, the Lungs will be healthy. Due to their inherent vulnerability, children are particularly prone to recurrent invasion of exogenous pathogenic factors, further weakening the body and leading to recurrent cough. Since Yin is weak and a child has pure Yang, exogenous factors can quickly transform into heat, injuring Yin and drying fluids. Chronic cough injures the Spleen and Lung, resulting in cough caused by internal injury due to Spleen and Lung deficiency and consumption of Lung Yin. This may be complicated by accumulation of fluids in the Lung due to disturbance of the spreading and descending functions, with reduced urination, or by movement of reckless blood caused by Yin deficiency and heat, leading to blood in the urine or bloody sputum.


Main Points of Diagnosis

Initial onset of cough caused by exogenous factors is usually accompanied by symptoms of common cold such as chills, runny nose with nasal congestion, headache, muscular aches and pains, sore and itchy throat. After a day or two, it is primarily marked by cough. Initially the cough may be deep, loud or with vocal sound, usually mild in the day and worse at night, and may be associated with vomiting and thin, whitish or thick, yellow sputum, which the child is unable to expectorate. The tongue may be red with thin white coating. If the tongue coating is yellow and greasy, it indicates the pathogenic factor has transformed to heat and penetrated the interior to the Large Intestine.


Cough due to internal injury is caused by repeated exposure to external pathogens, improper treatment, weak constitution or poor nutrition, which all result in weaker defence, accumulation of internal dampness or cold, consumption of Yin fluids and transformation into phlegm and heat. In such cases the course of the syndrome will be longer, the cough more severe, and may manifest as a weak or low cough with non-productive sputum and prolonged or recurrent low fever, especially in the afternoon or night.

  • If the vein at the bridge of the nose is visible for over 3mm long, or 5mm wide, this indicates the child is vulnerable to invasion. Traditionally this indicator was ascribed to the Spleen, while some doctors believe this is more indicative of Kidney deficiency.
  • If the complexion is bluish-green around the mouth and nose, this sign may indicate wind disease.
  • If the child is dark under the eyes, this indicated Spleen exhaustion, but if with a reddish hue, it indicates allergy involvement.
  • According to tradition, redness of the left cheek indicates Liver syndrome of heat and wind. This should be treated using Qing gan qu feng – Clear the Liver and dispel wind. Redness of the right cheek indicates Lung heat. This should be treated according to the principle Qing fei re – Clear Lung heat.

Differentiation of Syndromes

辯證 Bian Zheng

In Chinese medicine, the nature of the cough, the time of cough, the quality and quantity of sputum, the degree of dryness and heat, and the strength or weakness of the patient all indicate different pathological mechanisms. Different herbs and combinations are used according to differentiation. Following is a brief review of some differentiating signs and symptoms.


Type of Cough

  • If the cough is strong and coarse, it indicates excess syndromes.
  • If the child’s cough is accompanied by loud, piercing and/or intermittent crying, chest pain is likely to be present.
  • In acute conditions, strong voice or crying is an indicator of strong Qi while forceful and coarse breathing indicates excess of pathogenic heat in the interior.
  • If the breathing is coarse and the nostrils are flared, cold has turned to heat in the Lung and the Lung Yin is disturbed, while coarse wheezing and shortness suggests retention of phlegm of excess type.
  • If the breathing is even and unforced, the Lungs are robust, but if uneven or sticky indicates phlegm, and if shallow the Lung Qi is weak.
  • If weak with a feeble voice it indicates deficiency syndromes.
  • If the cough is weak, the child is probably less strong, or the disease may be more severe.
  • Feeble/difficult breathing accompanied by shortness of breath indicates deficiency of Lung and/or Kidney.
  • If there is uncontrolled urination with cough, it is known as Shen ke, or Kidney cough.

Time of Cough

This indicator is very important in the differentiation of cough of children.

  • If cough is worse in the morning, it generally indicates affectation by exterior pathogenic factors, resulting in adverse flow of Lung Qi.
  • If worse in the afternoon, generally indicates Yin deficiency and Lung dryness.
  • If worst around dusk, it often indicates Lung fire.
  • If worse at night, generally indicates Lung phlegm and heat.
  • If in the early morning, usually around 4-5am, it often indicates phlegm and fire are percolating in the lung inducing Lung Qi to flow adversely.
  • If all day and night, it usually indicates accumulation of phlegm.

Type of Sputum

The sputum is an important indicator for children. Whether it is clear, frothy sticky, thin, thick, and the colour, all indicate the involvement of different pathogenic factors and different Zang fu.

  • If there is retention of phlegm dampness in the Spleen and Lung, exogenous invasion will also cause coughing as a result of the disturbance of phlegm damp due to exogenous factors. This type of cough will sound moist and produce copious sputum.
  • If the sputum is white or clear, retention of phlegm is predominant.
  • If the sputum is yellow and purulent, the phlegm is associated with heat and infection.
  • If unproductive, or with small amounts of thick and sticky mucus, it indicates injury to the lung fluids due to pathogenic dryness (or Lung Yin deficiency).

Treatment Strategies

The following sections will examine therapeutic strategies and prescriptions for treating cough of various aetiologies. The prescriptions are all modified for administration for children taking account of their physiological characteristics, and some variations are provided. Dosage and combinations are as a guide only, and all should be customised according to the individual needs. Prepared formulas are suggested for most patterns and have the benefit of convenience and flexibility in administration and dosage and can be easily modified or combined.


Cough, bronchitis, pneumonia and asthma are all diseases characterised by the counter-flow ascent of the Qi mechanism Qi ji shang ni 氣機上逆. By combinations of exogenous factors, their transformation within the body when interacting with the conditions within the internal environment and the child’s stage of development and constitution. Thus, they may be considered part of a spectrum of pathological change and the treatments suggested should be applied according to the predominant characteristics of the presentation.


Treatment of the First Stage

Treatment of the first stage is aimed at eliminating the pathogenic factors and promoting the dispersing and spreading function of the lung. Exogenous factors include wind, cold, heat, dampness and dryness. Since the Yin of children is easily consumed, Lung heat is more frequently encountered in clinic. If there is interior heat and exterior cold, or both the child and the pathogen are strong, Shao Yang syndrome is often encountered. Therefore these patterns are determined by the nature of the pathogenic factors, the child’s constitution and the prevailing environmental conditions.


Cough Due to Wind Cold – Feng Han Ke Sou 風寒咳嗽

  • Signs and symptoms: Strong cough with thin white sputum, nasal obstruction with clear discharge, no sweating, mild fever, aversion to cold (preference for warm clothing), thin white tongue coating.
  • Treatment Principle: To promote the lung function in dispersing using pungent and warm exterior untying herbs.
  • Formulas:
  • Sun Ten # 401 Zhi Sou San [Platycodon & Schizonepeta Formula]: Cough due to exterior pathogens (wind attacking the lungs). Stops coughing and transforms phlegm, dispels wind and relieves exterior symptoms, or
  • Sun Ten # 356: Shen Su Yin [Ginseng & Perilla Combination]: Qi vacuity phlegm-damp type wind-cold cough. Supplements Qi and resolves the exterior, transforms phlegm and stops cough, rectifies Qi and harmonises the stomach, or
  • Xing Su San [Apricot Kernel and Perilla Leaf Powder], plus Su Zi [Perilla Seed] 6: Indications: External invasion of cool dryness disrupting the lungs functioning. Gently disperses cool-dryness, disperses Lung Qi, transforms phlegm-fluids.
  • Modifications:
  • If the exterior syndrome is more severe and the breathing is coarse, add: Fang Feng [Siler] 6.
  • If the exterior syndrome has been relieved but the cough is pronounced, add: Kuan Dong Hua [Coltsfoot Flower] 6, Bai Bu [Stemona Root ]10.

Cough Due to Wind Heat – Feng Re Ke Sou 風熱咳嗽

Cough Due to Wind Dryness – Feng Zao Ke Sou 風燥咳嗽

Cough Due to Dryness in the Lungs – Zao Xie Fan Fei 燥邪犯肺

Share this Post:

Related Posts