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Introduction: Pediatric nocturnal cough is often attributed in pattern differentiation to deficiency-cold and food stagnation in the sanjiao. However, the author believes it is caused by lingering pathogens damaging the qi and yin of the spleen and lungs, and clinically effective results have been achieved using the modified Self-Formulated Nocturnal Cough Decoction.

Treatment of 100 Cases of Nocturnal Cough in Children with Self-Formulated Nocturnal Cough Decoction

Quan Shaohua

Pediatric respiratory tract infections are common diseases, and children whose primary symptom is nocturnal cough during respiratory tract infections are often difficult to treat. Since 1990, I have applied the principles of supplementing qi and nourishing yin, resolving phlegm, and relieving cough, and have formulated Night Cough Decoction to treat 100 cases, achieving good results. The summary is as follows.

Clinical Data

All cases in this group were outpatient cases, including 54 males and 46 females. The youngest patient was 6 months old, and the oldest was 13 years old. The longest duration of illness was 4 weeks, and the shortest was 1 week. All patients developed nocturnal cough after treatment with antibiotics and Chinese and Western medicines for resolving phlegm and relieving cough. Among them, 54 cases were bronchopneumonia, 37 cases were bronchial infection, and 9 cases were recurrent respiratory tract infections.

Treatment Methods

Composition of Night Cough Decoction: Anemarrhena (Zhimu) and Fritillaria (Beimu) 5g each; Peucedanum (Qianhu), Coltsfoot Flower (Donghua), Scrophularia (Xuanshen), and Rehmannia (Shengdi) 6g each; Codonopsis (Dangshen) and Astragalus (Huangqi) 10g each; Ophiopogon (Maidong) 9g. Modifications: For excess heat, add Scutellaria (Huangqin) 6g, Honeysuckle (Yinhua) 8g, and Houttuynia (Yuxingcao) 10g; for excess cold, add Ephedra (Marong) 3g and Saposhnikovia (Fangfeng) 6g; for profuse phlegm, add Tangerine Peel (Juhong) and Poria (Fuling) 6g each, and Pinellia (Banxia) 3g. All herbs are stir-fried with honey, then decocted with 300ml of water and taken orally three times a day. All other medications should be discontinued during the treatment period.

Therapeutic Efficacy

Among 100 pediatric cases treated with 2–3 doses, 87 cases were cured, 11 cases showed improvement, and 2 cases were ineffective, yielding a total effective rate of 98%.

Typical Case Report

Zhai, male, 6 years old. Chief complaint: cough for one week. The child developed a cough accompanied by fever (temperature fluctuating around 38°C) one week ago following a cold due to exposure to cold. Physical examination revealed moist rales audible in both lungs, normal cardiac findings (-), liver and spleen not palpable, and no abnormalities in the neurological system. Complete blood count showed elevated white blood cells, and a diagnosis of bronchopneumonia was confirmed at another hospital. Although the condition improved after antibiotic treatment, the child developed severe nocturnal cough, which did not respond to various treatments, prompting a visit to our hospital. Tongue examination showed a pale red tongue with a white coating, and the pulse was deep and weak. The therapeutic principle of boosting qi, nourishing yin, resolving phlegm, and relieving cough was adopted. Modified Nocturnal Cough Decoction was prescribed. The child recovered completely after taking 3 doses.

Experience

Observation of coughing primarily involves understanding its timing, rhythm, and nature, among other aspects. Children have delicate organs, insufficient physical and functional development, and immature yin and yang constitutions. External contraction coughs that persist for a long time can consume and damage qi and yin, leading to patterns of lung yin consumption and lung-spleen qi deficiency. In children, during respiratory tract infections, nighttime coughing emerges as the main clinical feature, with the mechanism being residual pathogens not fully eliminated, damaging the qi and yin of the spleen and lungs.

However, clinical pattern identification and treatment are quite challenging because nighttime coughing is mostly attributed to patterns of deficiency-cold and food stagnation in the triple burner, while afternoon coughing is considered yin deficiency. As stated in *You You Ji Cheng* (A Systematic Compilation of Pediatrics): "In terms of timing, morning cough belongs to phlegm-fire, pre-noon cough belongs to stomach fire, afternoon cough belongs to yin deficiency, and dawn cough is due to food stagnation in the triple burner."

In clinical practice, I have observed that nighttime coughing mostly manifests as paroxysmal, spasmodic coughing at night, with some cases presenting as single coughs, either non-productive or with little phlegm. However, because pediatrics is often called the 'silent specialty,' both the children themselves and their family members often provide unclear descriptions. It is important to determine whether the child is accompanied by symptoms such as vexing heat in the palms and soles, fever, dry and sore throat, fatigue, and lack of strength. Clinical observation does not always show a red tongue or peeling coating. Therefore, in treatment, one should not rigidly adhere to tongue signs or symptoms related to qi and yin deficiency. Instead, the method of boosting qi, nourishing yin, resolving phlegm, and stopping cough should be applied, using the Night Cough Decoction for treatment.

In the formula, Ophiopogonis Radix (mai dong), Rehmanniae Radix (sheng di), and Anemarrhenae Rhizoma (zhi mu) nourish lung yin, clear and resolve residual pathogens, and nourish yin without retaining pathogens. Codonopsis Radix (dang shen) and Astragali Radix (huang qi) supplement the lungs and boost the spleen. Fritillariae Bulbus (bei mu), Farfarae Flos (dong hua), and Peucedani Radix (qian hu) resolve phlegm and stop cough. Honey has the function of strengthening the spleen and moistening the lungs, achieving the effects of boosting qi, nourishing yin, resolving phlegm, and stopping cough. In some cases, the dosage of Codonopsis Radix and Astragali Radix, which strengthen the spleen and boost qi, can be increased for treatment.