Herbal Formulas for Treating Bronchitis
By Cara Frank, R. Ac.
In treating bronchitis, it is important to differentiate the correct TCM pattern of disharmony. One must ask the patient a series of pointed questions to do so, including: type of phlegm (usually difficult, since it is stuck in the chest); and quality of cough (a cough will be evident in bronchitis).
With either type of expectoration, and in 90 percent of the cases, the formula that Cara starts with is Bei Mu Gua Lou San (Frittilaria trichosanthis powder), which she modifies to suit the patient's needs. The function of the formula is to clear phlegm heat and moisten the phlegm. Generally, the patient will have sticky sputum, which you want to moisten in order to facilitate expectoration.
The first ingredient in the formula is Zhe Bei Mu Chuan Bei Mu, in more chronic cases, where the cough is drier. The second ingredient is Gua lou, or trichosanthis (melon). Gua lou pi (peel) is useful for tightness in the chest; use the whole melon if there is no tightness. Gua lou ren is the seed, which is more moistening. Do not use the seed when diarrhea or loose stools accompany the bronchitis.
Another ingredient in this formula is Tian Hua Fen (trichosanthis root). Use minimal amounts (6 gms) of this herb if there is little thirst. Increase to 9 or 12 gms in cases of greater thirst. Other ingredients include: Fu Ling (poria) and Chen Pi (tangerine peel), which both transform phlegm. Chen Pi should be eliminated if the phlegm is really dry and sticky. Jie Geng (platycodon), another ingredient, directs the formula to the Lungs, stops coughing, and moistens the throat.
Additional questions should be asked to decide whether to include or exclude an herb. For example:
- How long has the patient had the symptoms?
- Is the chest tight?
- What color is the phlegm?
- Is the patient thirsty?
Modifications can be made, as necessary, after asking additional questions:
For example, is there wheezing? If so, you may add Ma Huang (ephedra). This is useful if the person feels chilled, which indicates the presence of a cold pathogenic factor. You can also add Qian Hu (peucedani) to the formula, which dispels wind/heat and phlegm heat.
Next, you will want to ask the patient to cough for you so you can hear what type it is. If it is a dry cough, you may wish to add more of a moistening agent with a yin tonic. To loosen the cough, add Lung Yin tonics, such as Mai Men Dong (ophiopogon) and Sha Shen (Glehnia).
Ban Xia (pinellia) can be added to transform the phlegm, and Bai Bu (stemona) can be added to stop the cough and moisten the lungs. Pi Pa Ye (Loquat leaves) can also be a moistening antitussive.
Another modifying formula is Zhi Sou San (Stop Cough Powder), which can be used for coughs with external pathogens. This contains the following herbs: Zi Wan (aster), Bai Bu (stemona), Jie Geng (platycodon), and Bai Qian (cynanchi), which stops wheezing and is less scattering than Ma Huang.
If there is a sinus infection, you need to ask the patient about the color of the phlegm (white/yellow/green), and whether he is experiencing headaches and pain. The representative formula for sinus infections is Cang Er San (Xanthium powder), which is a short formula that you can work into others. It contains: Cang Er Zi (xanthium), Xin Yi Hua (magnolia flower buds), Bo He (mint) and Bai Zhi (angelica dahurica). The magnolia buds and angelica dahurica are the best ingredients to choose. This formula is spicy and warm and expels phlegm and enters the Yang Ming channels.
In general, the intake gives you information about which herb and formula to use. You want to know the quality of the cough, whether it hurts, if it is worse when lying down (indicating excess and possible post-nasal drip), and if the ribs hurt (Mu Hu Die or oroxylum will relax and open up the ribcage, functioning like acupuncture points Liver 14 and Lung 1).
Incidentally, cold thin phlegm will not usually appear with bronchitis, but will occur with allergies. If the patient is experiencing a burning sensation, this means heat. You can use the herbs discussed earlier or, if there is also loud wheezing, a hard cough, and yellow phlegm, you can use Shi gao (gypsum). The formula Ma Xing Shi gan Tang (Ma Huang and gypsum soup) can be used for Lung heat wheezing.
If there is yellow sticky sputum without wheezing, add Huang Qin (Scutellariae), which affects the upper burner, reduces inflammation, and is also useful for allergic sinus formulas.
In cases with fever, use Shi Gao (gypsum) if the fever is high. If the fever is milder, use Jin Yin Hua (honeysuckle).
If the person has a stuffy nose but no sinus infection, you could add Zi Su Ye (perilla leaf), which is warm, aromatic, and releases the Wind Cold.
When the patient feels phlegm stuck in the throat (plum pit qi), you can use Ban Xia Hou Po Tang (pinellia/ magnolia bark), which helps clear phlegm from the throat.
In cases of green phlegm, tangerine peel, gypsum, and red peony reduce sinus heat. If there is blood in the phlegm, you want to moisten it with Sha Shen, Mai Men Dong, E Jiao, ass glue (a moistening hemostatic agent).
All of these modifications come from the central, flexible herb formula Bei Mu Gua Lou San. This is even helpful for people who say they have no phlegm. It eliminates the need for antibiotics and prevents pneumonia.
For post-nasal drip, try huo Xiang (agastaches).
With an incessant cough, use a heavier anti-spasmotic, such as Di Long (earthworms). This is the medicinal of choice, a bronchodilator which is an antispasmodic and stops wheezing.
In general, bronchitis requires raw herbs. Powders and pills do not work for acutely sick people. China Herb Company's liquid herbs can be used as an alternative, doubling the dosage.
Cara mentioned a patent herb available in Chinatown, which she believes is one of the few that works for mild bronchitis: San She Dan Chuan Bei Ye (Three Snake Gallbladders). This formula comes in bottles of syrup and 10cc ampules. It is used to stimulate the cough (expectorate phlegm). It is best for wet coughs with yellow phlegm.
Another drying expectorant that stops incessant coughing in Yuanchi Pi Pa Gao is a loquat patent herb syrup best for dry coughs, and packaged in a large red box. Cara cautions against using Western cough syrups that contain cough suppressants. The use of these drugs could precipitate pneumonia. Instead, you can use teas that are herb decoctions, taken in half-cup increments, every four hours.
Bronchitis involves a sequella of events. It is important to continue taking herbs during the recovery period, and to do so correctly. One week after the acute stage, there will be less coughing, so less potent herbs are needed. If the herbs do not work and bronchitis worsens, the patient will suffer interruptions in sleep and will become rundown, creating a deficiency syndrome. This is especially true if the bronchitis becomes pneumonia, which can result in deficient qi of the chest. Yin deficiency can result from fever or heat. In this case, the formula to use is Qing Zao Jiu Fei Tang (clear and moisten lung decoction). The ingredients are: Sang Ye (mulberry leaves); gypsum; E Jiao; Mai Men Tong; Hu Ma Ren (flax seeds); Ren Shen (ginseng)1 ; Xing Ren (apricot seeds); Pi Pa Ye (loquat leaves); Gan Cao (licorice).
Another patent formula for bronchitis is Qing Qi Hua Tan Wan (clear the lungs and resolve phlegm pill). It contains Dan Tian Xing, a cold drying herb for yellow phlegm and heat. You can use this, rather than Bei Mu Gua Lou San, when there is more heat. Other ingredients are: Huang Qin (Scutellariae), Gua Lou Ren (trichosanthis seed), and Zhi Shi (immature bitter orange), which descends qi. Trichosanthis always moistens and cools. If this is not achieved, the phlegm will congeal. If phlegm is not difficult to expectorate, you can use Qing Qi Hua Tan Wan, but still add Dan Tian Xing to cool.
In addition to herbal formulas, acupuncture points may be added to treat bronchitis. Cara prefers using TCM combinations to transform phlegm, such as: ST 40 and CV 12. She also adds LU 1 or LU 2 to move and circulate the Lung qi. Additional points include LU 5 and LU 6, which descends qi and moistens the Lung.
If there are signs of an EPF (external pathogenic factor), figure out the patient's situation using the 6 Divisions approach. If Tai Yang, use LU 7 and LI 4; if Shao Yang or Yang Ming, use TH 5 and LI 4; if wei qi is weak, use ST 36. Other points include: Liv 14 and Lu 1; CV 15; SP 21 (if ribs hurt); and PC 5 (transforms phlegm and opens chest more effectively than PC 6, moving phlegm more).
If a week has passed and the patient is exhausted, use Lu 9, the warmest and most nourishing point on the Lung channel, with ST 36 to boost qi. This is important to help the patient recover, since he or she may be vulnerable to pathogens and may end up with bronchitis every year. These points help the person to recover his vitality.
Cara Frank, R.Ac. received her degree at the New England School of Acupuncture in 1983 and trained at Xi Yuan Hospital in Beijing, China, in 1988. She has been teaching Chinese herbology for the Cara is in private practice in Philadelphia, and is owner of China Herb Company.
