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Female patient, 26 years old, first consultation on October 13, 1992. Three months prior to the visit, the patient caught a cold after being exposed to rain and cold, presenting with nasal congestion, runny clear nose, aversion to cold (Aversion to Cold), generalized body ache, cough with profuse sputum. After taking two doses of Jingfang Baidu San (Jing Fang Bai Du Decoction) combined with Xingsu San (Xing Su Powder), all symptoms significantly subsided, except for the cough which persisted. Seeking rapid relief, she switched to Western medicine: oral Amantadine Hydrochloride (Virus Ling), Ammonium Chloride Mixture, Midecamycin, and intramuscular Penicillin for 3 days, without effect; followed by intravenous infusion for 7 days, also with minimal effect. Reluctantly returning to Traditional Chinese Medicine (TCM), she consulted four different doctors in succession, taking over 20 doses of prescriptions, mostly consisting of antitussive and expectorant herbs, along with patent medicines such as Qutan Zhike Granules, Shedan Chuanbei Liquid, Tankejing, and Fresh Bamboo Sap. However, the cough remained unrelieved. Current symptoms: itchy throat, frequent coughing, worse in the morning and evening, scanty difficult-to-expectorate sputum, slight shortness of breath, occasional paroxysmal coughing; tongue body slightly pale, white coating (slightly thicker in the middle and root areas), fine and slippery pulse. Blood tests, chest fluoroscopy, and X-rays showed no abnormalities. Although the condition had persisted for three months, it still belonged to the pattern of Wind pathogen lingering in the Lung, with loss of the Lung's dispersing and descending functions. Treatment adopted Jinfeicao San (Jin Fei Cao Decoction) modified to disperse Wind-Cold and regulate Lung Qi: Inula Flower 10g (wrapped for decoction), White Peony Root 12g, Raw Licorice Root 5g, Schizonepeta 15g, Perilla Leaf 10g, Peucedanum Root 10g, Processed Pinellia Tuber 10g, Apricot Seed 10g, White Mustard Seed 10g, Platycodon Root 10g. Two doses. Second consultation: Throat itch disappeared, cough greatly reduced, sputum expectorated smoothly. The previous formula combined with Zhisou San (Zhi Sou Powder) modified: Inula Flower 10g (wrapped), White Peony Root 12g, Raw Licorice Root 5g, Schizonepeta 10g, Platycodon Root 10g, Honey-fried Aster Root 15g, Honey-fried Stemona Root 10g, Peucedanum Root 10g, Apricot Seed 10g, Agrimony 30g. Three doses. Third consultation: No cough during the day, only occasional coughs at night. Switched to folk prescription "Eleven Herbs for Stopping Cough" for consolidation: Angelica Sinensis, Szechwan Lovage Rhizome, Processed Pinellia Tuber, Poria, Tangerine Peel, Raw Licorice Root, Mulberry Bark, Green Citrus Peel, Apricot Seed, Schisandra Berry (crushed), Fritillaria Bulb (finely ground and swallowed). Two doses, cough stopped before completion.

Teacher: Among diseases of the Lung system, cough is the most common, yet difficult cases are not few. As the saying goes, "Famous doctors do not treat cough and asthma," fearing that failure to cure would damage their reputation. While this may seem like an excuse, it reflects experience. Some patients always consider cough a minor ailment; if you cannot even cure a cough, how can you treat "major diseases"? I have had similar experiences. Even today, I dare not guarantee "perfection" in every case; the joys and sorrows are known only to my heart!

Advanced Student A: If cough persists and is untreated, it can be hard to clarify the situation. For example, in this case of exogenous cough, repeated use of both Chinese and Western medicines failed, persisting for three months, easily leading to misdiagnosis as Deficiency or Mixed Excess-Deficiency patterns. But when you diagnosed it as "Wind pathogen lingering in the Lung, loss of Lung dispersing and descending," what was your basis?

Teacher: From the medical history, it initially presented as Wind-Cold common cold with cough. After two doses of Jingfang Baidu San combined with Xingsu San, the exterior Wind-Cold symptoms significantly subsided, but the cough remained. At this point, if one were to withdraw acrid-warm dispersing herbs and focus mainly on dispersing and descending, assisted by resolving phlegm and stopping cough, improvement might occur quickly. However, anxious to stop the cough, the patient switched to Western medicines to thin sputum and fight inflammation, and later used Chinese medicines solely for stopping cough and resolving phlegm. All these approaches lacked the action of dispersing and descending to expel pathogens, causing the Wind pathogen to linger in the Lung and become chronic. Looking at current symptoms: cough triggered by throat itch, tightness of breath with paroxysmal coughing, scanty difficult sputum, white coating, fine and slippery pulse—these are also signs of Wind pathogen lingering in the Lung and loss of Lung dispersing and descending. Practitioners should follow the ancient maxim "there is no specific method to simply stop cough" and "cough stops itself when not forcibly suppressed." Regardless of duration, treatment should prioritize dispersing and descending. If one merely sees a long duration and applies "long-term cough often indicates Deficiency" or "long-term cough often indicates internal injury," it leads to misdiagnosis and mistreatment.

Advanced Student B: According to my knowledge, the preferred formula for Wind-Cold cough in TCM Internal Medicine textbooks varies: Version 2 uses Jinfeicao San, while Version 5 lists Xingsu San, San'ao Tang, and Zhisou San, causing confusion. Why did you choose Jinfeicao San exclusively?

Teacher: One therapeutic principle can govern many formulas, bringing confusion to beginners: which one is highly effective? Some say, "All roads lead to Rome," but not every road is a shortcut! Based on my clinical verification, although all the aforementioned formulas can treat Wind-Cold cough if properly modified, their efficacy differs, with Jinfeicao San showing the best results.

Advanced Student B: Why?

Teacher: Like other formulas, Jinfeicao San embodies the principles of dispersing Wind, scattering Cold, and regulating Lung Qi. Its specificity lies in the key roles of Inula Flower (modernly often using Inulae Flos/Rotundifoliae Flos), White Peony Root, and Licorice Root. Ancient and modern interpretations of Inula Flower mostly attribute to it only the function of resolving phlegm and directing Qi downward, constrained by the proverb "all flowers ascend, but Inula descends alone." Undeniably, Inula Flower's power to descend Lung Qi, resolve phlegm, and eliminate fluid retention is significant (patients often feel a sensation of stagnation in the chest and diaphragm moving downward after ingestion). However, its overlooked efficacy includes: its Acrid taste allows it to disperse and move horizontally, thereby dispersing Lung Qi to the skin and hair; one descent and one dispersion restore the Lung's authority over regulation. Its Salty taste enters the Kidney, guiding Qi downward to return to its root, allowing phlegm-fluid or water-retention from the Stomach to descend continuously through the turbid pathways, preventing upward rebellion against the Lung, thus restoring the Lung's pure and empty functional state. Thus, the single herb Inula Flower can benefit the Lung, Stomach, and Kidney, and promote the free flow of the Upper, Middle, and Lower Jiao. White Peony Root paired with Licorice Root forms Shaoyao Gancao Tang (Peony and Licorice Decoction); Sour and Sweet generate Yin, nourishing Lung fluids and soothing Lung Qi. Modern pharmacological research confirms it can relieve bronchial smooth muscle spasms. Therefore, when using this formula, other herbs can be added or removed, but Inula Flower, White Peony Root, and Licorice Root are indispensable.

Advanced Student C: How did you realize this subtlety?

Teacher: This was entirely taught by the old TCM practitioner Jiang Erxun. In his early years, Old Jiang was weak and suffered from frequent coughing, finding relief with Zhisou San, Xingsu San, Liu'an Jian, etc. But once, despite trying all proven formulas, he achieved no effect. His cough was frequent, throat itchy, itching triggering cough, persisting for over ten days. Consulting medical books, he saw Chen Xiuyuan's *Yixue Congzhong Lu* stating, "For mild cases, Liu'an Jian; for severe cases, Jinfeicao San." He tried one dose, and the cough and throat itch stopped immediately. Astonished, he applied it to others, achieving swift results. For decades, Old Jiang favored modifying this formula for treating cough, regardless of new or old onset, exterior or interior, Cold or Heat, Excess or Deficiency. Some patients with cough lingering for 2-3 months, ineffective to various Chinese and Western medicines, found relief after a few doses of this formula. Patients copied and shared the formula among themselves, frequently resulting in sudden recovery.

Advanced Student D: But there are two Jinfeicao Sans in ancient medical texts. One appears in *Nanyang Huoren Shu*, composed of Inula Flower, Peucedanum Root, Schizonepeta, Asarum, Poria, Ginger, Jujube, Licorice; the other in *Heji Jufang*, lacking Poria and Asarum, but adding Ephedra Stem and White Peony Root. Additionally, the *Sanjin Ji Yi Bingzheng Fanglun* Xuanfu Hua Tang adds Apricot Seed, Poria, and Schisandra Berry to the *Heji Jufang* Jinfeicao San. Which version did Old Jiang use clinically?

Teacher: Old Jiang did not strictly adhere to any single formula when using Jinfeicao San. Instead, he comprehensively selected from the three versions, and combined them with Liu'an Jian (Erchen Tang plus Apricot Seed and White Mustard Seed) and Jiegeng Tang (Platycodon Root and Licorice Root) according to the syndrome. Scholarship advances with time. Over decades of using this formula, Old Jiang accumulated a complete set of effective modification methods, some incorporating formulas within formulas, greatly expanding its scope. For instance, alternating chills and fever, add Bupleurum Root and Scutellaria Root (intent of Xiaochaihu Tang); high fever and wheezing, add Ephedra Stem and Raw Gypsum (intent of Maxing Shigan Tang); fever and sore throat, add Honeysuckle Flower, Forsythia Fruit, and Belamcanda Rhizome (intent of Yinqiao San); profuse sticky sputum, add Zhejiang Fritillaria Bulb and Trichosanthes Kernel (intent of Beimu Gualou San); asthma with phlegm rattle, add Perilla Seed and Lepidium Seed (intent of Tingli Dazao Xiefei Tang); fever, aversion to wind, spontaneous sweating, add Cinnamon Twig and Magnolia Bark (intent of Guizhi Jia Houpo Xingzi Tang); persistent long-term cough, add Aster Root, Stemona Root, and Loquat Leaf (intent of Zhisou San); constitutional weakness prone to colds, add Astragalus Root, Atractylodes Macrocephala Rhizome, and Saposhnikovia Root (intent of Wuping Feng San); Spleen deficiency with poor appetite or loose stools, add Codonopsis Root and Atractylodes Macrocephala Rhizome (intent of Liujunzi Tang); clear thin saliva/drool, dizziness, fullness below the heart, add Cinnamon Twig and Atractylodes Macrocephala Rhizome (intent of Linggui Zhugan Tang).

Intern A: There are so many modifications for Jinfeicao San, covering exterior-interior, Cold-Heat, Excess-Deficiency. It is difficult for beginners to master them all. Can we simplify it to make it more practical?

Teacher: Actually, Old Jiang's modifications go beyond these. Some are designed for missed or mistaken treatments, others for constitution; all come from clinical practice and are effectively reproducible. Therefore, I believe it is better to solidly master the treatment of Wind-Cold cough rather than arbitrarily "simplify complexity." Everyone knows that most coughs are exogenous; among exogenous coughs, Wind-Cold is predominant. If one can appropriately select formulas and herbs that disperse Wind-Cold and regulate Lung Qi, rapid efficacy is often achieved. Some modern practitioners speak of "intercepting" the disease, which implies the same meaning. If this were true, how much utility would Jinfeicao San's numerous modifications have? Unfortunately, reality is different. Old Jiang wrote frankly: Some diagnose "Wind-Heat" or "Phlegm-Heat" upon seeing fever (or elevated temperature), directly using Sangju San or Yinqiao San, or even heat-clearing and phlegm-resolving drugs and antibiotics; some mistake throat itch or scanty difficult sputum for "Wind-Dryness" or "Yin Injury," indiscriminately using moistening-drying or Yin-nourishing formulas; some assume deficiency cough due to persistent long-term cough, repeatedly administering tonics. All these result from failing to timely disperse and regulate, causing cough to linger and potentially turning into consumptive cough. Zhang Jingyue also indignantly stated, "The vulgar saying goes that untreated wind-cold becomes consumption; how can wind-cold turn into consumption?"

Intern B: What is the approximate cure rate for Jinfeicao San modified to treat exogenous cough?

Teacher: Over 80%.

Intern B: What formulas are used for those not cured?

Teacher: Based on my clinical observation, about three scenarios show poor efficacy with this formula: First, Inula Flower has a bitter and astringent taste, difficult to swallow; some patients vomit easily after ingestion, so they fear vomiting and cannot complete the course. Second, some patients relapse with cough (milder symptoms) a few days after recovery. Third, some patients always leave a "tail" of occasional coughing, as seen in this case. The proverb says, "Sweet melons have bitter stems; nothing in the world is perfect." Is there a "perfect" formula? My handling methods are: For those prone to vomiting, advise small frequent doses; if vomiting persists and fear remains, switch to Chen Shiduo's Shufei Tang (Cinnamon Twig, Perilla Leaf, Platycodon Root, Licorice Root, Poria, Trichosanthes Root) combined with Liu'an Jian. For relapse after a few days, continue with Chaihu Guizhi Tang plus Honey-fried Aster Root, Cicada Slough, and Oroxylum Indicum Seed. For the lingering "tail," continue with "Eleven Herbs for Stopping Cough" (Third Consultation Formula of this case), a folk prescription originally for Tuberculosis cough. Over 20 years ago, I accidentally treated an exogenous cough case where external symptoms resolved, cough decreased but persisted for over ten days; one dose stopped the cough. Subsequently, successful cases increased, and I began using it as a "cleanup formula" for exogenous cough. This formula consists of very plain herbs but has a bizarre combination, hard to explain strongly. Furthermore, for a very small number of exogenous cough patients, initial use of modified Jinfeicao San reduces cough, but subsequent use of "Eleven Herbs" fails to clean up, gradually leading to dry cough without sputum, worsening at night, clean tongue without coating. At this time, try my proposed "Stubborn Cough Formula": Scrophularia Root 15g, Ophiopogon Tuber 15g, Schisandra Berry 6g, Raw Licorice Root 6g, Platycodon Root 10g, Agrimony 30g, Honey-fried Aster Root 30g, Peach Kernel 10g, Safflower 6g, Lotus Root Rhizome 30g, Raw Oyster Shell 30g. If individual patients have reduced but persistent dry cough after two doses, alternate with Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) to achieve complete success.

Lying flat brings comfort, rising causes dizziness

Dong Hanliang, Director, Shaoxing Hospital of Traditional Chinese Medicine, Zhejiang Province

Zhao XX, Male, 74 years old, retired cadre, consulted in April 1992. The patient had been bedridden for over a year. Previous physicians treated him based on post-stroke sequelae, heart failure, coronary heart disease, hypertension, etc., using both Chinese and Western medicine, with minimal effect; introduced to me by acquaintances. ECG indicated: Coronary artery insufficiency. EEG indicated: Cerebral blood supply insufficiency. Ultrasound of Liver, Gallbladder, Kidneys showed no abnormalities. Blood pressure unstable, fluctuating high and low. Comfortable lying flat, dizzy and vertiginous upon sitting up, nauseous, sometimes vomiting; thus brought by double-wheel flat cart lying down, and due to inability to sit, family requested consultation beside the cart. Symptoms: Patient supine, complexion bright white, conscious, satisfactory response, poor appetite and lethargy, limb weakness, bland taste in mouth, difficult bowel movement, voluntary urination, limbs movable freely, no hemiplegia, no obvious emaciation. When family supported him to sit up, after a moment, dizziness and vertigo occurred, followed by nausea shortly after, then returned to supine position, after which symptoms gradually subsided. Pulse slow and sluggish, tongue pale with white greasy coating. Blood pressure 11.6/6.6 kPa, regular rhythm, heart rate 60 bpm, occasional premature beats, abdomen flat and soft, liver and spleen not palpable, no masses. Lower limb pressing does not pit. Syndrome belongs undoubtedly to "Vertigo." Although Western medicine diagnosed multiple geriatric diseases, based on pulse and symptoms, it presents as Liver and Kidney deficiency in the elderly, Qi and Blood insufficiency, Phlegm and Stasis congealing internally, Clear Yang failing to ascend. Suitable to Nourish Liver and Benefit Kidney, Replenish Qi and Raise Yang to treat the root; Resolve Phlegm and Invigorate Blood, Unblock Collaterals to treat the branch. Use Dongyuan's Buzhong Yiqi Tang combined with Jingyue's Zhenyuan Yin modified. Prescription: Kudzu Root 30g, Astragalus Root 30g, Atractylodes Macrocephala Rhizome 10g, Cimicifuga Rhizome 10g, Leech 10g, Prepared Rehmannia Root 30g, Angelica Sinensis 15g, Szechwan Lovage Rhizome 10g, Lotus Leaf 30g, Honey-fried Licorice Root 5g. One dose daily, taken for 5 doses to observe efficacy. After 5 doses, reported by his son via message: Spirit improved, appetite gradually increased, bowel movements smooth, supported sitting up, dizziness did not occur immediately. Medication hit the mark, efficacy achieved, do not change formula. Add Epimedium 30g, Curculigo Rhizome 10g to previous formula, continue for 5 doses. After 10 days, "dizziness upon rising" symptom significantly reduced, but due to fear of "vertigo," dared not sit long, could sit for 5-10 minutes then lie down. Adjusted previous formula with additions/deletions for 20 doses: If constipation for 3-5 days, add Rhubarb 5g, Cistanche 10g; Poor appetite, add Fried Hawthorn Fruit 30g, Raw Barley Sprout 30g; Abdominal distension, add Areca Peel 10g; Greasy root coating, add Alisma Rhizome 15g; Chest tightness and discomfort, add Whole Trichosanthes Fruit 10g, Macrostemon Rhizome 10g, etc. After one day, "dizziness upon rising" basically controlled, but unable to get out of bed, could only semi-recumbent or upright sitting. Combined with moxibustion at Baihui (GV20), using sesame-sized moxa cones, direct moxibustion 7 moxa cones. After internal and external combined treatment, effect was significant, dizziness and vertigo平息ed, able to walk with cane. Patient and family were very surprised and delighted, medication stopped accordingly, advised dietary regulation, frequent intake of Lotus Seed Soup, Lily Bulb Soup, light diet, less fat and sugar. Now recovered like a normal person.

Student A: Teacher, this syndrome is undoubtedly "Vertigo," why are Gastrodia Rhizome and Uncaria Hook not included in the formula? I wish to hear the reason.

Teacher: Gastrodia Rhizome and Uncaria Hook are indeed excellent herbs for dispelling Wind and stopping vertigo, such as Tianma Gouteng Yin and Banxia Baizhu Tianma Tang, which are important formulas for treating vertigo. Vertigo is mostly attributed to the Liver; *Neijing* states, "All Wind tremors and vertigo belong to the Liver"; Gastrodia Rhizome and Uncaria Hook calm Liver and subdue Yang, making them good choices for vertigo caused by Liver Yang rising, hence commonly used; but clinically it is not always so. Physicians throughout history have discussed vertigo extensively, such as Zhu Danxi proposing "No Phlegm, No Vertigo," Zhang Jingyue believing "No Deficiency, No Vertigo," Xu Chunpu distinguishing by Excess and Deficiency, Chen Xiuyuan treating by Wind, Fire, Phlegm, Deficiency, and Yu Bo supplementing "Blood Stasis causing Vertigo." Thus, regarding Vertigo, divided by Excess and Deficiency, Wind, Fire, Phlegm, Stasis causing vertigo are Excess; Qi, Blood, Yin, Yang deficiency causing dizziness are Deficiency. In clinical observation, there are no purely Deficient or purely Excess syndromes; mostly it is Deficiency mixed with Excess, or Root Deficiency with Branch Excess. This patient suffers from Liver and Kidney deficiency in old age, lacking strength, hence bedridden for long, lethargic and weak; Qi and Blood insufficiency leads to bright white complexion, dull appetite, bland taste; Spleen deficiency and weak Qi, Clear Yang failing to ascend, Phlegm and Stasis blocking collaterals, Qi and Blood unable to nourish the head, thus comfortable lying flat, dizzy upon rising. This presents as Root Deficiency with Branch Excess. Treatment should Replenish Qi and Raise Yang, taking the intent of Dongyuan's Buzhong Yiqi Tang (Astragalus Root, Atractylodes Macrocephala Rhizome, Angelica Sinensis, Cimicifuga Rhizome, Honey-fried Licorice Root); Replenish Qi and Nourish Blood, Tonify Liver and Kidney, selecting Jingyue's Zhenyuan Yin (Prepared Rehmannia Root, Angelica Sinensis, Honey-fried Licorice Root). And add Kudzu Root, Szechwan Lovage Rhizome, Leech to invigorate Blood and resolve Stasis, targeting the head and neck directly; Lotus Leaf raises Clear and descends Turbid, lowers lipids and prevents Phlegm, combining to remove Phlegm and Stasis in collaterals, treating both root and branch, unblocking collaterals, allowing Qi and Blood to nourish the head, thus eliminating vertigo without using Gastrodia Rhizome and Uncaria Hook.

Student B: Regarding the added herbs in the formula (Kudzu Root, Leech, Szechwan Lovage Rhizome, Lotus Leaf), what are your application insights? We hope for your guidance.