Whooping cough is an infectious disease commonly seen in children and characterized by peculiar paroxysms of cough, which end in a prolonged crowing or whooping respiration or are accompanied by vomiting. It may last as long as two to three months.

Etiology and Pathogenesis

Intrinsically, the insufficiency of healthy qi with retention of phlegm and, extrinsically, the attack of seasonal pestilent evil constitute the etiology of whooping cough. The evil invades the lungs through the mouth and nose and elicits a superficies-syndrome at the onset. As the evil combines with the accumulated phlegm causing production of fire, the phlegm-fire obstructs the respiratory tract leading to the adverse ascending of lung-qi, thus whooping cough ensues. The paroxysms of cough will be not relieved until the thick sputum is eliminated. Although the lungs are the organ chiefly involved in the disease, other organs may also be affected. When the stomach is involved, there appears adverse ascending of stomach-qi, leading to vomiting. As the liver is attacked, there will be hyperactivity of liver-qi, resulting in distending pain over hypochondria and irritability. When phlegm-heat attacks the pericardium and disturbs liver-wind, coma and convulsions may occur. In the late stage of whooping cough, when the evil is weakened and the healthy qi becomes deficient, symptoms of deficiency of lung-qi and spleen-qi or dryness of the lungs and impairment of yin may appear.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) The character of the sputum: In the early stage, thin, white sputum indicates a wind-cold syndrome, and thick, yellow sputum denotes a wind-heat syndrome. In the stage of spasmodic cough, it is considered a phlegm-fire syndrome when the sputum is thick and a phlegm-dampness syndrome when the sputum is profuse, white and thin. In the convalescence, a little thick sputum or absence of sputum is a result of insufficiency of lung-yin, and a little thin sputum is attributed to deficiency of lung-qi and spleen-qi.

(b) The character of the cough: In the early stage and the stage of spasmodic cough, a loud and high-tune cough is usually attributed to a sthenia syndrome, and a gander cough indicates a malady caused by phlegm-fire. While in the convalescent stage, mostly manifested as asthenia syndrome, those with puffiness of face, shortness of breath and coughing with low and weak voice denote qi deficiency, and those with dry choking cough indicate deficiency of lung-qi and spleen-qi.

B. Therapeutic principles

In the early stage when the lungs are attacked, the therapy of releasing the inhibited lung-qi and dissipating phlegm is recommended. In the intermediate stage when phlegm-fire is overwhelming and lung-qi ascends adversely, the therapy of purging lung-fire and dissipating phlegm should be employed. In the late stage when the lungs are dried and yin is impaired, the therapies of nourishing yin, benefiting qi and tonifying spleen and lungs are advisable.

Classification and Treatment

A. The early stage (one to two weeks)

(a) Wind-cold syndrome

Manifestations: Cough with loud voice, discharge of thin, white sputum, sneezing, runny nose, low fever, chilliness, no sweating, white, thin tongue coating and floating and tense pulse.

Therapeutic principles: Expel wind-cold, release the inhibited lung-qi, and dissipate phlegm.

Prescription: The Modification of Three Crude Drugs Decoction

Herba Ephedrae 30 g
Semen Armeniacae Amarum 10 g
Radix Glycyrrhizae 3 g
Rhizoma Cynanchi Stauntonii 10 g
Rhizoma Pinelliae Praeparata 6 g
Exocarpium Citri Grandis 5 g
Radix Asteris 6 g
Radix Stemonae Praeparata 10 g

(b) Wind-heat syndrome

Manifestations: Cough with thick, yellowish sputum, runny nose, flushed face, red lips, dry mouth, congestion of throat, low fever with sweating, red tongue with yellowish coating and floating and rapid pulse.

Therapeutic principles: Dispel wind, clear away heat, relieve cough, and dissipate phlegm.

Prescription: The Modified Decoction of Mori and Chrysanthemi

Folium Mori 10 g
Flos Chrysanthemi 10 g
Semen Armeniacae Amarum 10 g
Fructus Forsythiae 10 g
Herba Menthae (decocted) 10 g
Radix Platycodi 5 g
Rhizoma Phragmitis 10 g
Radix Glycyrrhizae 3 g
Bulbus Fritillariae Thunbergii 5 g
Radix Stemonae Praeparata 10 g

B. The stage of spasmodic cough (four to six weeks and as long as over two months)

Manifestations: Paroxysmal hacking cough ending as cock crowing and recurring until a lot of sputum is expectorated or after vomiting, flushed face, redness of eyes, tearing, runny nose, incontinence of urine or stool, palpebral edema, subconjunctional hemorrhage, sublingual ulceration, epistaxis or hemoptysis, constipation, yellow urine, thin and yellow or yellow and greasy tongue coating and smooth and rapid pulse.

Therapeutic principles: Purge lung-fire, dissipate phlegm, descend the adverse qi, and relieve cough.

Prescription: The Modified Powder for Expelling Lung-Heat and Decoction of Phragmitis of Thousand Gold

Cortex Mori Radicis 10 g
Cortex Lycii Radicis 10 g
Semen Coicis 10 g
Semen Benincasae 10 g
Semen Persicae 6 g
Radix Scutellariae 10 g
Rhizoma Pinelliae 6 g
Semen Armeniacae Amarum 10 g
Fructus Perillae 10 g
Rhizoma Phragmitis 10 g
Radix Glycyrrhizae 3 g

Remarks: Add Rhizoma Imperatae (15 g) and Cacumen Biotae (10 g) for cases with epistaxis or hemoptysis. Add Ignited Yellow Earth (15 g), Rhizoma Pinelliae (6 g) and Caulis Bambusae in Taeniam (10 g, prepared by Zingiberis Recens) for those with vomiting. Add Ramulus Uncariae cum Uncis (10 g) and Semen Plantaginis (6 g, wrapped in cloth) and Radix Stemonae Praeparata (10 g) for those with severe cough. Add Semen Lepidii seu Descurainiae (6 g) and Semen Plantaginis (10 g) for those with palpebral edema. Add Radix Bupleuri (6 g) and Radix Curcumae (6 g) for those with hypochondriac pain. For cases with retention of phlegm-heat in the lungs and those with involvement of the Jueyin meridian, the treatment may be referred to the section on Pulmonary Cough and Infantile Convulsions.

C. The convalescent stage (about two to three weeks)

(a) Yin-deficiency syndrome

Manifestations: Cough with a little thick phlegm, hoarseness of voice, flushed cheeks, night sweating, feverish sensation over the palms, soles and chest or hectic fever, dryness and bitter taste in the mouth, red tongue with little coating and thready, rapid and weak pulse.

Therapeutic principles: Nourish yin, and moisturize thelungs.

Prescription: The Modified Decoction of Adenophorae Strictae and Ophiopogonis

Radix Adenophorae Strictae 10 g
Radix Ophiopogonis 10 g
Rhizoma Polygonati Odorati 10 g
Semen Dolichoris 10 g
Folium Mori 10 g
Radix Stemonae Praeparata 10 g
Folium Eriobotryae Praeparata 10 g
Radix Platycodi 5 g
Radix Glycyrrhizae 3 g

(b) Qi-deficiency syndrome

Manifestations: Cough with a low voice, scanty and thin expectoration, emaciation, mental fatigue, pale complexion, spontaneous sweating, poor appetite, abdominal distention, loose stool, clear urine, pale tongue with thin and white or no coating and deep and weak pulse.

Therapeutic principles: Invigorate the lungs and spleen.

Prescription: The Modified Decoction of Codonopsis Pilosulae and Schisandrae

Radix Codonopsis Pilosulae 10 g
Fructus Schisandrae 6 g
Radix Ophiopogonis 10 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae Praeparata 10 g
Radix Glycyrrhizae 3 g
Rhizoma Zingiberis Recens 3 pcs
Fructus Jujubae 5 pcs

Remarks: Add Radix Astragali (10 g) and Fructus Tritici Levis (wizened, 10 g) for cases with spontaneous sweating and fatigue.

Experiential Prescriptions

A. Chicken bile (half of a gallbladder for year of age per day, but not exceeding 3 pieces of gallbladder); mixed with sugar and steamed; taken in two divided doses daily for five to seven days; applicable to the stage of spasmodic cough.

B. Radix Stemonae Praeparata (10 g), Rhizoma Cynanchi Stauntonii Praeparata (10 g) and a pear (cut into small pieces); decocted with a small amount of sugar; taken in three divided doses daily for five to seven days; applicable to the stage of spasmodic cough.

Copyright 1995 Hopkins Technology