Cough occurring or becoming more severe just before daybreak (4–6 a.m.) A few coughs just before daybreak usually indicate phlegm-fire. Cough before daybreak with copious phlegm usually indicates spleen vacuity. A daytime cough that is worse in the early morning indicates food accumulation in the stomach.
Medicinal therapy: Treat phlegm-fire patterns with Two Matured Ingredients Decoction (二陈汤èr chén tāng) plus scutellaria (Scutellariae Radix, 黄芩huáng qín), platycodon (Platycodonis Radix, 桔梗jié gěng), and mulberry root bark (Mori Cortex, 桑白皮sāng bái pí). Spleen vacuity patterns are treated with Six Gentlemen Decoction (六君子汤liù jūn zǐ tāng) plus blast-fried ginger (Zingiberis Rhizoma Praeparatum, 炮姜páo jiāng). For food accumulation patterns see food cough.