I. What are postnasal drip syndrome (UACS/PNDS) and upper airway cough syndrome (UACS)? Postnasal drip syndrome (UACS/PNDS): A syndrome in which nasal disease causes secretions to flow backwards from the nose and throat, directly or indirectly stimulating cough receptors, resulting in a cough as the main manifestation is called PNDS. UACS is one of the most common causes of chronic cough. In addition to nasal diseases, UACS is often associated with diseases of the pharynx, such as allergic or non-allergic pharyngitis, laryngitis, pharyngeal neoplasia, and chronic tonsillitis. 1. Clinical manifestations: (1) Symptoms: In addition to cough and sputum, it may manifest as nasal congestion, increased nasal secretion, frequent throat clearing, posterior pharyngeal mucus attachment, and postnasal drip of influenza. Allergic rhinitis manifests as nasal itching, sneezing, running snot, and itchy eyes. Rhino-sinusitis manifests as mucopurulent or purulent snot, and may be associated with pain (facial pain, toothache, headache) and olfactory disturbance. Allergic pharyngitis is characterized by pharyngeal itching and paroxysmal irritating cough. Non-allergic pharyngitis is often characterized by sore throat, foreign body sensation or burning sensation in the pharynx. Inflammation of the larynx and neoplastic organisms are usually accompanied by hoarseness. (2) Signs: The nasal mucosa in allergic rhinitis is mainly pale or edematous, and clear or mucous snot is seen in the nasal passages and the floor of the nasal cavity. In non-allergic rhinitis, the nasal mucosa is mostly characterized by mucosal hypertrophy or congestion-like changes, and in some patients, the mucosa of the oropharynx can be seen to have pebble-like changes or mucopurulent secretions attached to the posterior pharyngeal wall. (3) Auxiliary examination: imaging of chronic sinusitis shows thickening of the sinus mucosa and the presence of fluid planes in the sinuses. When the cough is seasonal or suggests an association with exposure to specific allergens (e.g., pollen, dust mites), allergen testing can help in the diagnosis. 2. Diagnosis: UACS/PNDS involves a variety of underlying diseases such as nose, sinus, pharynx and larynx, and the symptoms and signs vary greatly and many are non-specific. It is difficult to make a clear diagnosis simply by history and physical examination, and a clear diagnosis can only be made when treatment for the underlying disease can effectively relieve the cough, and attention should be paid to the presence of combined lower airway diseases, GERC and other compound causes. What is the treatment of upper airway cough syndrome (UACS/PNDS)? 1. Depending on the underlying disease causing UACS/PNDS. First-generation antihistamines and decongestants are preferred for the following causes: (1) non-allergic rhinitis; (2) common cold. Most patients develop efficacy within a few days to two weeks after initial treatment. Nasal inhaled glucocorticoids and oral antihistamines are the preferred treatment for patients with allergic rhinitis, beclomethasone propionate (50 μg/dose/nostril) or equivalent doses of other inhaled glucocorticoids (e.g., budesonide, mometasone, etc.) once or twice daily. Various antihistamines are effective in the treatment of allergic rhinitis, and second-generation antihistamines without sedative effects, such as loratadine, are preferred. Avoiding or reducing exposure to allergens can help reduce the symptoms of allergic rhinitis. Leukotriene receptor antagonists, short-term nasal or oral decongestants can be added if necessary. Specific allergen immunotherapy may be effective in those with more severe symptoms and poor results with conventional medications, but the onset of action is longer. Bacterial sinusitis is mostly a mixed infection and anti-infection is an important therapeutic measure. The antimicrobial spectrum should cover gram-positive, negative and anaerobic bacteria for not less than 2 weeks for acute and longer for chronic recommended as appropriate. Commonly used drugs are amoxicillin/clavulanic acid, cephalosporins or quinolones. There is evidence that long-term low-dose macrolide antibiotics have a therapeutic effect in chronic sinusitis. Combined with nasal inhalation glucocorticoids for 3 months or more. Decongestants reduce nasal mucosal congestion and edema and facilitate drainage of secretions, and the course of nasal spray is generally <1 week. Combined use of first-generation antihistamines plus decongestants is recommended for a course of 2 to 3 weeks. If the effect of medical treatment is not good, it is recommended to consult a specialist and, if necessary, to undergo nasal endoscopic surgery. 2. Chinese medicine treatment: (1) Main symptoms: In addition to cough and sputum, it can be manifested as nasal congestion, increased nasal secretion, frequent throat clearing, postpharyngeal mucus attachment, and postnasal drip of influenza. Nasal symptoms mainly manifest nasal itching, sneezing, running snot, itchy eyes, etc., or mucopurulent or purulent snot, may have pain (facial pain, toothache, headache), impaired sense of smell, etc. For patients who are prone to colds and are triggered by climate change, and whose symptoms belong to Qi deficiency and lack of consolidation. The treatment is to benefit the Qi and consolidate the surface, and harmonize the Ying and Wei. We use Yu Ping Feng San combined with Cang Er Zi San: Huang Qi, Bai Zhu and Fang Feng to benefit Qi and fix the surface, Bai Zhi, Peppermint, Xin Yi Hua and Cang Er Zi, Xiao Xin and Jing Zhu to disperse wind and dispel cold, and roasted Zi Yuan and roasted Bai Bai to resolve phlegm and stop cough. If the cough sputum is thin and abundant, it is appropriate to add Chen Pi and Panaxia to dry dampness and dissolve phlegm; if the patient has repeated attacks of sinusitis, and the flow of yellow thick mucus is obvious, the treatment is appropriate to clear heat and dampness, dissolve phlegm and clear the orifice. If the headache is severe, with obvious percussion and pressure pain between the eyebrows and cheekbones, or with tinnitus and deafness, red tongue with yellow coating and string pulse, add gentian herb, scutellaria baicalensis, bupleurum, gardenia to clear the biliary heat, and zedoary and carthamus to induce the downward movement of heat. (2) Main symptoms: Itchy pharynx and paroxysmal irritating cough are the main features, often with sore throat, foreign body sensation or burning sensation in the pharynx. Or accompanied by hoarseness. The coating is thin white or thin yellow, and the pulse is floating. The treatment should be to remove wind and heat, sharpen the pharynx and resolve phlegm to relieve cough. The formula for relieving cough in the pharynx is as follows: Thornbush, Bupleurum, Cicadellus, Double Flower, Forsythia, Scutellaria to clear heat and detoxify the toxin, Xuan Shen, Zhe Bei, Mulberry Bark to clear the lung and dissolve phlegm, Burdock, Radix Platycodon, Licorice to disperse nodules and relieve cough, Roasted Zingiber officinale and Roasted Paeonia to dissolve phlegm. If there is any obstruction in the pharynx, Radix et Rhizoma Polygonati, Poria, and Perilla leaf should be used to clear the pharynx and disperse nodules; dry throat, dry mouth, hoarse voice, dry tongue with little coating and thin pulse should be used to nourish yin and clear the lung, produce fluid and moisten dryness, add Mai Dong, Sheng Di, and Dan Pi.