Lung cancer remains one of the leading causes of morbidity and mortality worldwide, and surgical resection continues to be the mainstay of treatment for early-stage and selected locally advanced disease [1]. Postoperative cough is a common but often underrecognized complication, with reported incidences ranging from 30% to 55% [2]-[4]. It typically presents as an irritative cough that worsens at night and may be accompanied by chest pain or dyspnea, substantially impairing sleep, emotional well-being, and recovery quality [5][6]. Its pathogenesis is multifactorial, involving intraoperative airway traction, inflammatory responses at the bronchial stump, heightened mucosal sensitivity, and stimulation by retained secretions [2][7][8]. Persistent cough may further exacerbate incision pain and impede lung reexpansion, delaying pulmonary rehabilitation [9][10]. Current management mainly relies on expectorants, antitussive agents, and nebulization therapy, yet clinical outcomes remain suboptimal, and symptom recurrence is common, highlighting the need for more effective and safer therapeutic options [11].

Traditional Chinese medicine (TCM), with its multitarget regulatory effects and ability to modulate inflammation, has shown increasing value in postoperative symptom management [12]. Previous studies suggest that TCM interventions can ameliorate cough after lung cancer surgery, reduce airway inflammation, and promote recovery [13][14]. Majing Zhike Granules, composed of Ephedra Herba, Schizonepetae Spica, Cicadae Periostracum, Trichosanthis Fructus, Glehniae Radix, and other herbs, possess the functions of dispersing wind, diffusing the lung, resolving phlegm, and relieving airway spasm [15]. Experimental evidence indicates that this formula may attenuate airway hyperresponsiveness by regulating inflammatory pathways such as TLR4 signaling [16]. However, clinical evidence regarding its efficacy specifically in postoperative cough among lung cancer patients remains insufficient, and its multidimensional effects on symptom severity and cough-related quality of life require further validation. Therefore, this study employed multiple assessment tools—including the Cough Symptom Score (CSS), Visual Analogue Scale (VAS), and the Leicester Cough Questionnaire (LCQ)—to comprehensively evaluate the therapeutic effects of Majing Zhike Granules in this population, aiming to provide updated evidence for integrating TCM into postoperative cough management.

This study showed that Majing Zhike Granules significantly alleviated postoperative cough in lung cancer patients, as demonstrated by reductions in daytime, nighttime, and total CSS scores, along with lower VAS scores. Improvements across all LCQ domains further indicate that the intervention not only reduced symptom severity but also enhanced cough-related quality of life. These multidimensional benefits complement earlier findings that traditional Chinese medicine (TCM) formulations may reduce airway irritation, modulate postoperative discomfort, and promote functional recovery. Collectively, the present results suggest that Majing Zhike Granules may serve as a meaningful adjunctive therapy for postoperative cough, addressing limitations of conventional treatments that often provide incomplete relief.

From the perspective of traditional Chinese medicine (TCM) theory, postoperative cough is primarily attributed to impairment of lung qi and yin caused by surgical trauma, which weakens the lung’s capacity to disperse and descend qi, thereby predisposing patients to persistent irritative cough and throat itching [19]-[21]. Based on the therapeutic principle of supporting the upright qi while dispelling pathogenic factors, Majing Zhike Granules were formulated to regulate qi movement, relieve cough, and restore lung function. Ephedrae Herba (Mahuang) and Schizonepetae Herba (Jingjie) disperse wind and diffuse the lung to facilitate the outward release of pathogenic factors [22], while Inulae Flos (Xuanfuhua) and Tussilaginis Flos cum Melle (Mikuandonghua) descend rebellious qi, moisten the lung, and relieve cough. When used in combination, these herbs create a coordinated ascending-descending effect that helps normalize the movement of lung qi.

In addition, Cicadae Periostracum (Chantui), Cynanchi Paniculati Radix (Xuchangqing), and Arctii Fructus (Niubangzi) further dispel wind, soothe the throat, and alleviate cough and throat itching, whereas Glehniae Radix (Beishashen) and Scrophulariae Radix (Xuanshen) nourish yin, moisten the lung, and benefit the throat, addressing the underlying yin deficiency commonly observed after surgery. Glycyrrhizae Radix et Rhizoma (Gancao) harmonizes the actions of the other herbs, moderates urgency, and exerts antitussive effects, thereby enhancing the overall tolerability and coherence of the formulation. Considering that surgical injury may also lead to blood stasis and qi constraint, Paeoniae Radix Rubra (Chishao) and Trichosanthis Fructus (Gualou) were included to activate blood circulation, regulate qi, and relieve chest stagnation, representing a therapeutic refinement of the formula. Modern pharmacological studies [23]-[25] suggest that Majing Zhike Granules may modulate inflammatory mediators such as TNF-α and IL-6 and attenuate airway hypersensitivity, which is consistent with the clinical improvements observed in the present study. However, it should be noted that inflammatory biomarkers, including TNF-α and IL-6, were not directly measured in the present study; therefore, the proposed mechanistic links are inferred from prior experimental evidence. Future clinical studies incorporating biomarker assessments are warranted to further elucidate the underlying mechanisms of Majing Zhike Granules in postoperative cough.

Majing Zhike Granules also exhibited a favorable safety profile. Only one patient experienced mild, self-limiting diarrhea, and no clinically significant abnormalities were detected in routine laboratory or cardiopulmonary evaluations. These findings suggest that the formula is well tolerated and may enhance postoperative comfort while supporting recovery. Nonetheless, this study was a single-center trial with a modest sample size and a relatively short treatment duration; therefore, the generalizability of the findings should be confirmed through larger, multicenter studies with extended follow-up. Future research should incorporate larger, multicenter cohorts and extended follow-up, along with mechanistic evaluations—such as inflammatory marker profiling, airway mucosal assessment, or imaging—to clarify long-term efficacy and underlying pathways. Such evidence would further strengthen the role of TCM-based interventions in the standardized management of postoperative cough.

This study was supported by the Fujian Provincial Science and Technology Innovation Joint Fund (Grant No. 2024Y9481); the Fujian Provincial Department of Finance Medical and Health Science and Technology Innovation Joint Fund (Grant No. X2024010); the Clinical Research Center for Integrative Medicine on Early Lung Cancer Diagnosis and Treatment of Fujian Province (Grant No. 2022Y201020022); and the Major Science and Technology Innovation “Revealing the List and Taking Command” Special Project of Fujian University of Traditional Chinese Medicine (Grant No. XJB2022002).