Case Record | Cough with Hiccups
General Information
Patient Li, female, 25 years old.
Date of consultation: May 2, 2026.
Chief Complaint
Recurrent dry cough for one month, accompanied by persistent hiccups.
History of Present Illness
The patient has experienced a cough for one month. It is a dry cough without phlegm and has been protracted and unhealing. Concurrently, she suffers from frequent hiccups. There is no fever, sore throat, chest tightness, or excessive phlegm. Appetite, urination, and defecation are normal.
Four Examinations (Diagnosis)
Pulse: Floating and forceless.
Tongue: Pale tongue body with a white coating. No signs of dryness or phlegm-dampness.
TCM Diagnosis
Cough: Wind-Cold binding the Lungs, chronic cough leading to Lung deficiency.
Hiccups: Rebellious Qi of the Lung and Stomach.
Pattern Differentiation & Analysis
External Wind-Cold pathogens have bound the Lung defense (Wei Qi), impairing the Lung's function of dispersion and depuration, resulting in coughing. Prolonged coughing has consumed Lung Qi, leaving the righteous Qi too weak to expel the pathogen; hence the cough has lingered for a month without phlegm.
The Lungs govern the Qi of the whole body. When the Lungs fail to depurate and descend, it affects the Stomach's harmony and descent. The rebellious Qi of both the Lungs and Stomach concurrently causes hiccups.
The floating pulse indicates residual Wind-Cold pathogens at the exterior. The forceless pulse and pale tongue with white coating suggest inherent deficiency of righteous Qi and weakness of the Lungs and Spleen. The absence of phlegm or heat rules out patterns such as Wind-Heat, Phlegm-Heat, or Yin deficiency with dry cough.
Treatment Principle
Dispel Wind and dissipate Cold; disperse the Lungs and stop coughing; downbear rebellion and stop hiccups; harmonize the Lungs and Stomach.
Prescription
Zi Wan (Tatarian Aster Root): 30g
Shi Di (Persimmon Calyx): 3g
Bai Bu (Stemona Root): 10g
Qian Hu (Hogfennel Root): 10g
Jing Jie (Schizonepeta): 10g
Chen Pi (Tangerine Peel): 10g
Jie Geng (Platycodon Root): 10g
Gan Cao (Licorice Root): 6g
Usage: Decoct in water, one dose per day. Take consecutively for three days.
Formula Analysis
Sovereign (Monarch) Herb: Zi Wanis used in a heavy dosage (30g). It warms, moistens, and disperses the Lungs while dissipating Cold. It specifically targets chronic Wind-Cold cough with no phlegm.
Minister Herbs: Bai Bumoistens the Lungs and stops coughing, alleviating the dryness from chronic cough. Jing Jiedispels Wind and releases the exterior Cold. Qian Hudisperses the Lungs and directs Qi downward.
Assistant Herbs: Jie Gengopens and disperses Lung Qi, guiding the herbs upward. Chen Piregulates Qi and harmonizes the Stomach. Shi Dispecifically downbears rebellious Qi and stops hiccups.
Envoy (Guide) Herb: Gan Caoharmonizes all the herbs and protects the middle burner.
The entire formula disperses Wind-Cold, disperses Lung Qi, downbears the Qi of the Lungs and Stomach, and stops cough and hiccups. It is warming and moistening without being drying, and dispersing without damaging the righteous Qi. This aligns perfectly with the pathogenesis of residual Wind-Cold, rebellious Lung-Stomach Qi, and underlying Qi deficiency.
Follow-up & Efficacy
After taking three doses of the above prescription, follow-up showed that the cough had completely resolved, hiccups ceased, and all symptoms were cured.
Comments
In this case, the key to the chronic dry cough with hiccups was not Heat-Phlegm or Yin deficiency, but rather lingering Wind-Cold in the Lung defense and rebellious Qi of the Lung and Stomach. The treatment did not focus on clearing heat or resolving phlegm, but rather on dispersing Wind, dispersing the Lungs, and downbearing rebellion to harmonize the Stomach. The heavy use of Zi Wantargeted the chronic cough, while the small addition of Shi Dispecifically addressed the hiccups. By treating both the Lungs and Stomach simultaneously and addressing both root and branch, the chronic illness was resolved within three doses.
