Some time ago I wrote an article on the seven stages of acute cough.iv In this article I went to lengths to advise practitioners to carefully differentiate the exact stage of a cough, and to give an appropriate formula. In acute pediatric cough, the stages that come into the clinic most frequently are category #2 Lung Fire, #3 Profuse Phlegm Heat, and #4 Sticky Phlegm-Heat, with this last stage the most common presentation. The Lung Fire stage is an early presentation, and comes and goes within 24 hours before it changes to #3 or #4. Lung Fire is harsh, barky and non-productive, and is seen in croup. Most parents do not bring their child in at this point. They bring their child in once the cough is established and they realize it is not going away. It is very important to impress upon parents that early common cold should be treated right away, and also, if the cold turns into a cough, the child should be seen before the cough becomes entrenched. Cough can be stubborn, even with Chinese herbs.

At any rate, parents usually bring the child in when the cough is harsh and constant. It may or may not be productive, and on occasion has a rattle quality. Children tend to swallow their phlegm, so it is difficult to know if it is productive, but a stethoscope will help reveal what is going on inside the lung. Questioning the parent or child is helpful—how long have they been coughing? Do they cough at night? How often? Do their lungs hurt when they cough? Ninety-five per cent of coughs are viral in naturev and will respond to Chinese herbal formulas that include addressing the viral component. Do not be put off by a Western diagnosis of “pneumonia” or “walking pneumonia”. In my experience, these are almost always viral events that will respond to the herbal medicines. (MDs insist on antibiotics for possible “secondary” infections, but I feel this is potentially harmful to the patient.) Our formula addresses the sticky-viral stage as well as the more productive, rattley phlegm-heat stage, which are the two stages most commonly seen. Some practitioners believe early cough to be wind-cold invasion, and think of formulas like Xiao Qing Long Tang, but this is not the case clinically, and counterproductive. Harsh cough is always due to heat, and even if precipitated by cold, it quickly turns to heat in the lung. Viral toxins either are the causative agent, or come into production as the lung is injured, and by the time children come into the clinic, both heat and toxic viral heat present. 

Our strategy is to clear lung-heat and viral toxins and address accumulation of phlegm-heat. The lead herb, she gan, not only clears phlegm-heat, but is also very good for sore throat. It has been shown to have strong antiviral effects.vi Other herbs that clear lung-heat include zhi zi and huang qin. The formula addresses lung phlegm-heat by combining zhe bei mu and qian hu. Jie geng reinforces transformation of phlegm, and helps lead the formula to the lungs. Sang bai pi and xing ren clear lung heat to resolve cough. Zhi ke relaxes costal tension, and helps lead lung qi downwards. I have found it to be a very effective formula for pediatric cough.

source: Golden Flower Chinese herb’s new line of Pediatric MediCinal syrups                                                              by Jake Paul Fratkin, OMD, LAc