CLINICAL APPLICATIONS

* Cough

§ with associated symptoms such as sputum, chest congestion, wheezing and dyspnea

§ from acute conditions, such as common cold, influenza and lung infection

§ chronic cough induced by various conditions, such as post-nasal drip, infection, drugs, and smoking

§ cough in tuberculosis or lung cancer

 

WESTERN THERAPEUTIC ACTIONS

* Antitussive effect to suppress cough

* Expectorant effect to eliminate phlegm and reduce congestion

* Bronchodilating effect to relieve wheezing and dyspnea

* Antibiotic effect to treat cough with infection

* Antiallergic and antihistamine effects to dry up nasal discharge and stop post-nasal drip

 

CHINESE THERAPEUTIC ACTIONS

* Releases wind from the exterior

* Eliminates phlegm

* Nourishes yin

* Descends Lung qi

 

DOSAGE

The standard dosage for adults is 4 to 6 capsules three times daily. This is a potent formula; therefore, the dosage must be carefully adjusted based on age, body weight and severity of the condition, especially for pediatric and geriatric patients.

 

INGREDIENTS

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Jie Zi (Semen Sinapis)

Ku Xing Ren (Semen Armeniacae Amarum)

Mai Dong (Radix Ophiopogonis)

Sheng Jiang (Rhizoma Zingiberis Recens)

Tian Zhu Zi (Fructus Nandina)

Wu Mei (Fructus Mume)

Zi Su Ye (Folium Perillae)

Zi Su Zi (Fructus Perillae)

 

BACKGROUND

Cough is an explosive expiratory maneuver intended to clear the airways. Acute cough is often caused by upper respiratory infection, post-nasal drip, pneumonia or COPD exacerbation. Chronic cough is frequently due to postnasal drip, chronic bronchitis, airway hyper-responsiveness after resolution of an infection, or gastroesophageal reflux disease. Proper treatment of cough requires accurate diagnosis and treatment of the cause and the management of the symptoms.

 

FORMULA EXPLANATION

Respitrol (CF) is an empirical formula designed to treat cough due to various causes, including but not limited to external (wind-cold or wind-heat), or internal causes (heat, phlegm, or yin deficiency). This formula contains herbs that release wind from the exterior, eliminate phlegm, nourish yin, and descend Lung qi.

        In this formula, Zi Su Ye (Folium Perillae) and Sheng Jiang (Rhizoma Zingiberis Recens) release wind-cold from the exterior, eliminate phlegm, and stop coughing. Jie Zi (Semen Sinapis) eliminates phlegm and opens the airways. Tian Zhu Zi (Fructus Nandina) and Ku Xing Ren (Semen Armeniacae Amarum) have a marked effect to suppress cough, as they cause Lung qi to descend. Mai Dong (Radix Ophiopogonis) nourishes yin and relieves chronic cough due to Lung deficiency. Zi Su Zi (Fructus Perillae) eliminates phlegm and descends Lung qi to relieve cough. Lastly, Wu Mei (Fructus Mume) astringes Lung qi and relieves cough. The use of Mai Dong (Radix Ophiopogonis) and Wu Mei (Fructus Mume) also help to control the warm, dispersing and drying nature of the formula from consuming yin and fluids. Gan Cao (Radix et Rhizoma Glycyrrhizae) harmonizes the formula.

        In short, Respitrol (CF) is an excellent empirical formula to symptomatically treat cough. However, if the cause can be identified, the overall treatment will be more effective if another formula is used to address the cause.

 

CAUTIONS & CONTRAINDICATIONS

* Cough is a symptom that has many causes, such as infection (bronchitis or pneumonia), pre-existing diseases (tuberculosis or emphysema), airway irritation (smoke, dust and fumes), and aspiration (upper airway secretion or gastric contents). It is very important to identify and treat the underlying cause, in addition to treating the symptom.

* In cases of lung infection, cough is a beneficial protective mechanism for clearing respiratory secretions and foreign materials. Optimal treatment in these situations requires use of medicines to treat the infection and the cough (if necessary) concurrently. Suppressing the symptom without treating the cause may delay the overall recovery. Though this formula contains herbs with antibiotic effect, it is necessary to combine with additional formulas to reinforce the overall effect to treat infection.

* Do not use an excessive amount of this formula, as gross overdose of any medicinal substances will inevitably contribute to unwanted reactions. In this case, Ku Xing Ren (Semen Armeniacae Amarum) and Tian Zhu Zi (Fructus Nandina) have excellent functions to stop coughing by suppressing respiratory reflex in the brain. Hence, gross overdose of these two herbs may suppress respiration and cause difficulty breathing.[1],[2] Other potential side effects associated with gross overdose include dizziness, weakness, nausea, vomiting, abdominal pain, burning sensations in the upper abdominal region, increased blood pressure, and increased respiration.[3] Due to the potent effect of these herbs, this formula should be used with caution for pediatric or geriatric patients, and is contraindicated during pregnancy and nursing.

 

CLINICAL NOTES

* Respitrol (CF) is most effective when:

§ The cause of the cough is not known or a specific treatment is not possible.

§ The cough performs no useful function, or causes significant discomfort.

§ If the cause if known, then this formula may be used as a useful adjunct to suppress cough.

* Certain drugs, such as angiotensin-converting enzyme (ACE) inhibitors [Capoten (captopril), Zestril (lisinopril) and Vasotec (enalapril)], may cause non-productive cough in up to 20% of patients. This drug-induced cough may begin as soon as one week after starting that therapy, but may be delayed by as much as six months.[4] This type of cough may be treated with Respitrol (CF) and Nourish (Fluids).

* Gastroesophageal reflux is a common cause of cough that should be remembered but is often overlooked.

 

SUPPLEMENTARY FORMULAS

* For cough due to common cold or influenza, use with Lonicera Complex.

* For cough caused by postnasal drip, add Magnolia Clear Sinus or Pueraria Clear Sinus .

* For cough due to lung infection (such as in bronchitis or pneumonia), use with Herbal ABX.

* To enhance the overall antiviral function, add Herbal AVR.

* For cough with sore throat from a sinus infection, add Herbal ENT.

* For cough due to gastroesophageal reflux, combine with GI Care.

* For cough due to airway hyper-responsiveness after resolution of an infection characterized by dryness and yin deficiency, add Nourish (Fluids).

* For cough with chest congestion and profuse phlegm, use with Pinellia XPT.

* With more underlying damp and phlegm with Spleen qi deficiency, add Pinellia Complex.

* For cough with wheezing and dyspnea due to Lung heat, use with Respitrol (Heat).

* For cough with wheezing and dyspnea due to Lung cold, use with Respitrol (Cold).

* For chronic cough with wheezing and dyspnea due to Lung deficiency, use with Respitrol (Deficient) or Cordyceps 3.

* For high fever, add Gardenia Complex.

* For cough due to stress, add Calm.

* For immune deficiency, add Cordyceps 3 or Immune +.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Cough in general: Lieque (LU 7), Hegu (LI 4), Feishu (BL 13), Chize (LU 5), Taiyuan (LU 9), Taibai (SP 3), Fenglong (ST 40), Yuji (LU 10), Xingjian (LR 2)

* Cough due to external factors (wind-cold or wind-heat): Lieque (LU 7), Hegu (LI 4), Feishu (BL 13). Use strong stimulation for wind-heat. Use regular stimulation plus moxa for wind-cold.

* Cough due to internal causes (heat, phlegm, or yin deficiency): Feishu (BL 13), Taiyuan (LU 9), Zhangmen (LR 13)

 

Classic Master Tung's Points:

* Cough, asthma: Dingke (T 44.28)*, Chongzi (T 22.01), Fugesan (T 44.30)*, Dabai (T 22.04), Tianshi (T 33.15), Dishi (T 33.14), Renshi (T 33.13), Feiqiyi (T 44.25)*, Feiqier (T 44.26)*, Huofuhai (T 33.07), Quling (T 33.16), Zhongjian (T 11.05)

* Common cold: Fugesan (T 44.30)*, Linggu (T 22.05), Hegu (LI 4), Ganmaoyi (T 88.07), Ganmaoer (T 88.08), Huofuhai (T 33.07), Mu (T 11.17)

* Tuberculosis: Feiqier (T 44.26)*, Linggu (T 22.05), Shuijin (T 1010.20), Shuitong (T 1010.19), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Sihuashang (T 77.08), Sihuazhong (T 77.09), Sihuaxia (T 77.11). Bleed the HT and LU area in the back. Bleed before needling for best result.

* Chest stuffiness: Linggu (T 22.05), Dabai (T 22.04), Tianshi (T 33.15), Dishi (T 33.14), Renshi (T 33.13), Zhenjing (T 1010.08), Shangli (T 1010.09)

* Lung cancer/tumor: Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Linggu (T 22.05), Dabai (T 22.04), Shuangling (T 11.28)*, Waisanguan (T 77.27), Xinchang (T 11.19), Zhiwu (T 11.26). Bleed the LU area below the knee. Bleed before needling for best result. The more the blood is let out, the better the effect. Bleed the LU and HT areas on the back (from T3 to T5) with cupping. Bleed before needling for best result.

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Cough: Needle Fenjin (T 44.01), Quchi (LI 11), Sanchasan (T 22.17)*, Chongzi (T 22.01), Chongxian (T 22.02). Bleed Ganmaosan (T DT.12).

 

Balance Method by Dr. Richard Tan:

* Left side: Jingqu (LU 8), Taiyuan (LU 9), Neiguan (PC 6), Xiajuxu (ST 39), Fenglong (ST 40), Jiexi (ST 41)

* Right side: Hegu (LI 4), Yangxi (LI 5), Sanyinjiao (SP 6), Jiaoxin (KI 8)

* Alternate sides with each treatment.

 

Ear Acupuncture:

* Lung, Trachea, Shenmen, Liver, Spleen, Kidney

 

Auricular Medicine by Dr. Li-Chun Huang:

* Cough: Trachea, Bronchus, Lung, Shenmen, Occiput, Stop Asthma, corresponding points of pain. Bleed Ear Apex.

* Cough from common cold: Lung, Internal Nose, Throat (Larynx, Pharynx), Trachea, Bronchus, Stop Asthma

* Cough from bronchiectasis: Bronchus, Lung, Chest, Stop Asthma, Allergic Area, Sympathetic, Adrenal Gland, Spleen

 

NUTRITION

* Individuals with a poor swallowing reflex should consume food and beverages slowly. Aspiration of these contents into the lungs increases the risk of cough and lung infection.

* Pear, loquat, lemon with honey, pineapples, lotus nodes and white radish are excellent foods to help reduce frequency and severity of cough.

* White radish is an excellent food to relieve cough. Take 1 white radish, approximately the size of a fist and cut it into thin slices. Mix it with 1 tablespoon of maltose and 1 cup of water and cook for 20 minutes. Serve the radish and the juice when they cool to room temperature. Another easier method is to mix the slices of white radish with honey. Wait for 30 minutes and drink the fluids that are secreted from the radish.

* Tea made from fresh ginger and honey (1:4 ratio) is also helpful to relieve both acute and chronic cough.

* Avoid drinking cold beverages, as they may constrict the airways and induce cough.

* Avoid foods that are acrid, spicy, aromatic or drying in nature. Do not eat foods that are heavy, greasy, or deep-fried.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Cough

§ Boil tea from watercress and apricot kernels (remove the apex) or almonds. Drink one cup three times daily.

§ Cook banana with a bit of sugar.

§ Drink ginger tea.

§ Mix honey with water and/or almonds.

§ Dice carrots, mix with molasses and leave it overnight; take two teaspoons three times daily.

* Chronic cough: Make tea with about 20 grapefruit seeds, adding a bit of honey; drink three times daily.

* Dry cough

§ Cook four grapefruit slices with either pork or cabbage.

§ Grind pine nuts and walnuts, add honey and slowly cook over low flame until thick; take two teaspoons with warm water.

§ Mash strawberries with brown sugar; steam and eat three times daily.

* Dry cough with yellow sputum: Take warm daikon and water chestnut juice with one teaspoon honey.

* Productive cough: Juice raw turnip, and mix with honey and warm water. Drink 2 to 3 cups a day.

* Cough with yellow sputum: Drink apple juice.

* Cough with yellow phlegm: Core Asian pear and fill with 3 grams of Chuan Bei Mu (Bulbus Fritillariae Cirrhosae) and a little rock sugar or brown sugar; steam about 30 minutes and eat completely.

 

LIFESTYLE INSTRUCTION

* Airway irritation (smoke, dust and fumes) is a very common cause of cough. Try to avoid exposure to these environments as much as possible. If necessary, install an air filter to clean the air.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Respitrol (CF) is an empirical therapy for the symptomatic relief of cough. It contains many herbs with antitussive effects to suppress cough, expectorant effects to eliminate phlegm and reduce congestion, bronchodilating effects to relieve wheezing and dyspnea, and antibiotic effects to treat cough from infection.

        Many herbs in Respitrol (CF) have excellent antitussive effects to suppress cough, such as Ku Xing Ren (Semen Armeniacae Amarum), Tian Zhu Zi (Fructus Nandina) and Gan Cao (Radix et Rhizoma Glycyrrhizae). Ku Xing Ren (Semen Armeniacae Amarum) suppresses cough via an inhibitory effect on the respiratory center in the brain, thereby exerting its antitussive effect.[5] Tian Zhu Zi (Fructus Nandina) has been used to treat various types of cough, including but not limited to acute bronchitis, whooping cough, and cough in children.[6] Gan Cao (Radix et Rhizoma Glycyrrhizae) has marked antitussive and expectorant effects, and the mechanism of action has been attributed to its effect on the central nervous system.[7]

        Respitrol (CF) also incorporates many herbs to treat symptoms commonly associated with coughing, such as phlegm, chest congestion, wheezing, and dyspnea. For example, Jie Zi (Semen Sinapis) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have expectorant effects to eliminate phlegm and relieve congestion.[8] Zi Su Ye (Folium Perillae) promotes bronchodilation to relieve bronchospasm. It also reduces secretions from the bronchioli.[9] Furthermore, Gan Cao (Radix et Rhizoma Glycyrrhizae) has an anti-inflammatory effect to reduce swelling and relieve chest congestion.[10] The mechanism of this action is attributed in part to the effect of Gan Cao (Radix et Rhizoma Glycyrrhizae) to stimulate the production of glucocorticoids by the adrenal glands and to delay their metabolism by the liver.[11]

        Furthermore, because cough is often a symptom of respiratory tract infection, many herbs with antibiotic effects are used in Respitrol (CF), including Zi Su Ye (Folium Perillae),[12],[13] Sheng Jiang (Rhizoma Zingiberis Recens),[14] Mai Dong (Radix Ophiopogonis),[15] and Wu Mei (Fructus Mume).[16]^,[17]

        Postnasal drip is a common cause of both acute and chronic cough. Therefore, Zi Su Ye (Folium Perillae) is used for its antiallergic effect to dry up nasal discharge and ameliorate allergic inflammatory reactions. The mechanisms of the antiallergic and anti-inflammatory effects include decreased mast cell and eosinophil infiltration, reduced histamine levels, and inhibited expressions of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α.[18]

        In summary, Respitrol (CF) is an empirical formula that treats cough and its associated conditions. It is formulated with herbs that suppress cough, eliminate phlegm, reduce chest congestion, relieve wheezing and dyspnea, and treat infection.

 

COMPARATIVE ANALYSIS

Cough is a symptom that has many causes, such as infection, pre-existing diseases, airway irritation, and aspiration. Because cough is a natural reaction to eliminate foreign or harmful substance from the lungs, mild to moderate coughing is generally not treated. However, in cases where severe or constant cough interferes with resting and recovery, drugs and herbs should be used together to treat the symptom (cough) and the cause (numerous).

        Cough is usually treated with opioids, such as dextromethorphan and narcotic antitussives (such as codeine). These drugs have a respiratory depressant effect to suppress cough. Though these drugs are effective, they may cause side effects such as hypersensitivity, tachycardia or bradycardia, syncope, respiratory depression, circulatory depression, nausea, vomiting, constipation, urinary retention, and in severe cases, tolerance and dependence.

        Cough is usually treated with herbs that eliminate sputum, relieve chest congestion, and regulate the flow of Lung qi. In other words, herbs do not just suppress cough, but rather, they open up the airways and unblock chest congestion to relieve cough. Nonetheless, some herbs that relieve cough may have side effects, such as described above under Cautions & Contraindications.

        It is generally not necessary to treat cough, as it is a natural defensive and desirable reaction. However, if treatment is deemed necessary, both the symptom and the cause must be addressed at the same time. In this case, both drugs and herbs are effective to treat cough. Drugs tend to “suppress” cough by depressing the respiratory tract. Herbs tend to “relieve” cough by opening the airways and unblocking obstruction. Both medicines have side effects, and must be carefully evaluated in choosing the most suitable therapy for the patient.