Ke Xue Fang
Do not self-treat with Ke Xue Fang
Practitioner-prepared only. A practitioner writing it as a tea uses daily ranges near these: Qing Dai 3-6 g Zhi Zi 6-9 g Gua Lou Ren 9-15 g Hai Fu Shi 9-15 g He Zi 3-6 g Ready-made granules are dosed to the label.
If this is an emergency
Some reactions to Ke Xue Fang need urgent care. Call your local emergency number or go to an emergency department straight away — do not wait to see whether it passes.
Who should avoid Ke Xue Fang?
- Do not use if you are coughing up blood and have not yet been examined by a doctor — coughing blood can mean tuberculosis, a lung clot, a severe infection or lung cancer
- Do not use if you are coughing up more than streaks of blood, or filling tissues or a cup with blood — call emergency services instead
- Do not use if you have any liver disease, such as hepatitis (inflammation of the liver) or cirrhosis (scarring of the liver), or if your liver blood tests are abnormal
- Do not use if you have pulmonary hypertension (high blood pressure in the arteries of the lungs) or unexplained breathlessness
- Do not use if you take any blood thinner or antiplatelet drug, such as warfarin, apixaban, rivaroxaban, heparin, aspirin or clopidogrel
- Do not use if you have a bleeding disorder such as haemophilia or thrombocytopenia (a low platelet count)
- Do not use if you are pregnant, trying to become pregnant, or breastfeeding
- Do not use if you are considering it for a child or teenager under 18
- Do not use if you have inflammatory bowel disease (long-term inflammation of the gut), such as ulcerative colitis or Crohn's disease
- Do not use if you have long-standing loose stools, a weak appetite or feel cold easily — this is a cooling formula and will make that worse
- Do not use if you drink alcohol regularly or take a medicine known to stress the liver, such as methotrexate, isoniazid or high-dose paracetamol
- Do not use if you cannot arrange liver blood tests while you take it
When should you see a doctor?
Call emergency services now if you cough up more than a streak of blood, cough blood with chest pain or sudden breathlessness, faint, or feel your heart racing.
Stop the formula and see a doctor the same day if your skin or the whites of your eyes turn yellow, your urine goes dark, you get pain under your right ribs, or you feel unusually exhausted. These can be signs of liver injury.
Stop and see a doctor promptly if you become short of breath doing things you used to manage, your ankles swell, or you feel faint when you exert yourself.
See a doctor within a few days if your cough lasts more than three weeks, you are losing weight without trying, you have night sweats or a fever, or you are hoarse for more than three weeks.
- What it is: A fourteenth-century Chinese herbal formula, also called Coughing of Blood Formula, traditionally used for a hot cough with blood-streaked phlegm.
- Active ingredients: Qing Dai (indigo naturalis), Zhi Zi (gardenia fruit), Gua Lou Ren (trichosanthes seed), Hai Fu Shi (pumice), He Zi (chebula fruit)
- Side effects: Stomach upset and loose stools are common; rare but serious liver injury and raised lung artery pressure have been reported with indigo naturalis.
- Pregnancy & breastfeeding: Avoid in pregnancy and while breastfeeding.
Educational information, not medical advice — ask your doctor or midwife.
What is Ke Xue Fang?
Ke Xue Fang is also called Coughing of Blood Formula. It is a classical Chinese herb formula. Its traditional use is for a cough that brings up phlegm streaked with blood.
We handle it here as a single drug (a TCM formula). The herbs come mixed in one fixed recipe. They are not taken one by one.
Trained practitioners give it for what Chinese medicine calls "liver fire scorching the lung". That means a hot, hacking cough with sticky yellow phlegm. Other signs are blood in the phlegm, a red face, a short temper and rib pain.
Some people today try it for blood-streaked phlegm in bronchitis. Others try it in bronchiectasis (widened, damaged airways).
Coughing up blood is never a symptom to treat at home. It can be the first sign of tuberculosis (TB), a lung clot, a serious infection or lung cancer. See a doctor before you even think about a herb.
Here is the evidence verdict. We could not find any human trial of this formula. Its standing rests on about 700 years of recorded Chinese use.
Traditional use is not proof that something works. That point applies to everything below, and we will not repeat it.
How does Ke Xue Fang work?
No one has shown in people how this formula works. So what follows is theory, not proven fact.
In Chinese medicine terms, the formula is said to clear "liver fire" and cool the lung. It is also said to thin sticky phlegm and stop bleeding.
Qing Dai and Zhi Zi are the cooling herbs. Gua Lou Ren and Hai Fu Shi are aimed at the thick phlegm. He Zi is astringent, meaning it draws tissue tight and "holds in" the bleeding.
Lab work on the single herbs shows they can calm swelling and fight germs. Indigo compounds act on a cell receptor that helps the gut lining mend.
None of that has been tested as a treatment for bleeding in the lungs. Lab activity does not predict what happens in a person.
What forms does Ke Xue Fang come in?
You will meet it in a few forms.
Raw herbs, weighed out and simmered into a decoction (a strong tea) by a practitioner.
A honey pill or lozenge. This is the classical form. The powder was bound with honey and ginger juice, then dissolved slowly in the mouth.
Granules or capsules of a strong extract, sold as a ready-made formula.
Strength varies a lot between makers. Imported herbal products are not checked for contamination as closely as medicines are.
Where it comes from:
The formula first appears in Dan Xi Xin Fa. That book collects the teachings of the physician Zhu Danxi. It comes from fourteenth-century China, in the Yuan dynasty.
It has stayed in the standard Chinese formula course ever since. It is still taught as the model prescription for blood-streaked cough from lung heat.
Its use sits within Chinese medicine only. It has no separate history in other traditions.
What does Ke Xue Fang help with?
- Blood-streaked phlegm with a hot, dry cough: This is the use the formula was written for, and the tradition behind it is strong and consistent. There is no human trial showing it reduces bleeding. Blood in phlegm always needs a doctor first, so this is at best something a practitioner adds after a cause has been found and treated.
- Cough with thick yellow or green phlegm: Traditionally the trichosanthes seed and mineral ingredients are aimed at loosening sticky phlegm. No trial has tested the formula for cough. Thick coloured phlegm with fever may mean a chest infection that needs antibiotics.
- Chest and rib pain with coughing: Classical texts describe rib-side pain as part of the "liver fire" pattern this formula treats. There is no measured evidence of pain relief. New chest pain, especially with breathlessness, needs urgent medical assessment rather than a herb.
- Dry, sore throat with hoarseness: The lozenge form was designed to be dissolved slowly so it coats the throat. Any soothing effect is likely shared with any honey lozenge. Hoarseness lasting more than three weeks should be checked by a doctor.
- Irritability and flushed face alongside cough: These are signs a Chinese medicine practitioner uses to pick this formula, not conditions it has been proven to treat. Treat them as pattern clues rather than health claims.
What are the side effects of Ke Xue Fang?
- Nausea and stomach ache
- Loose stools or diarrhoea
- Blue or green staining of the stool from the indigo (harmless in itself)
- Constipation or a dry mouth from the astringent chebula fruit
- Headache
- Liver injury: yellow skin or eyes, dark urine, deep tiredness, pain under the right ribs
- Rising pressure in the lung arteries: new or worsening breathlessness, ankle swelling, fainting on exertion
- Severe stomach pain with vomiting, which has been reported with long-term indigo use
Good to know:
Stomach upset and loose stools are the common problems and settle when you stop.
The serious problems are rare but real, and both come mainly from long-term use of indigo naturalis: liver injury, and raised pressure in the lung arteries. Both have been reported in people taking indigo daily for months for bowel disease, which is a heavier exposure than a short herbal course, but the risk is why this formula is rated high-risk here.
Stop taking it and get checked the moment yellow skin, dark urine or new breathlessness appears.
Options to discuss with a clinician
Better-studied routes exist for each of the problems this formula is reached for, and every one of them is a conversation to have with a doctor, pharmacist or qualified herbalist rather than a straight swap.
**Coughing up blood-streaked phlegm.** This is the one that needs a clinician the same week, not a remedy. Blood in phlegm can come from infection, clotting problems, or something in the lung, and the cause has to be identified first. Ask for a chest examination and imaging before anything else is considered.
**Dry, sore throat and hoarseness.** Honey has good trial evidence, and Marshmallow Root, Slippery Elm (Ulmus rubra) and Licorice root (Glycyrrhiza glabra) are demulcents (things that coat and soothe a raw throat) a pharmacist can tell you whether they suit you — Licorice root in particular interacts with blood pressure and heart medicines.
**Cough with thick yellow or green phlegm.** Steam Inhalation, Eucalyptus Oil and Umckaloabo come up in this situation; Andrographis and Black Elderberry have some trial support for respiratory infections. Worth asking whether this needs antibiotics instead.
**Chest or rib pain when coughing.** Pain on breathing deserves examination to rule out pleurisy, clot or fracture — raise it directly with a clinician.
Graded pages for the options named above:
- Licorice root (Glycyrrhiza glabra) — evidence grade B, traditional tier T3
- Slippery Elm (Ulmus rubra) — evidence grade C, traditional tier T2
- Black Elderberry — evidence grade B, traditional tier T2
- Marshmallow Root — evidence grade C, traditional tier T3
- Steam Inhalation — evidence grade C, traditional tier T3
- Eucalyptus Oil — evidence grade A, traditional tier T2
- Andrographis — evidence grade A, traditional tier T3
- Umckaloabo — evidence grade A, traditional tier T2
- Honey — evidence grade A, traditional tier T3
Review status
This page has not been signed off by a pharmacist and is not published. It is shown here for a policy decision only.