Objective:To explore the effect and mechanism of Huanglong Zhike Granules in the treatment of cough variant asthma in children based on macrophage polarization.Methods:160 children with cough variant asthma were divided into a con-trol group and an experimental group,with 80 cases in each group.The control group was given montelukast sodium chewable tablets and Huanglong Zhike Granules placebo,and the experimental group was given montelukast sodium chewable tablets and Huanglong Zhike Granules,both groups received continuous treatment for 4 weeks.After treatment,the clinical efficacy was e-valuated by changes in cough severity score,TCM syndrome score,pulmonary function indicators,and airway anatomical indica-tors.The proportions of M1 and M2 macrophages in peripheral blood and the expression levels of macrophage polarization marker genes before and after treatment were compared between the two groups.The occurrence of complications such as drowsiness and diarrhea during the treatment period was statistically analyzed.Results:After treatment,the cough severity score and TCM syndrome score in the experimental group were lower than those in the control group,and FEV1,FVC,FEV1/FVC,and PEF were higher than those in the control group(P<0.05).After treatment,the airway wall thickness,basement mem-brane thickness,and total airway wall area in the experimental group were smaller than those in the control group(P<0.05).After treatment,the proportion of M1 macrophages in the experimental group was lower than that in the control group,and the proportion of M2 macrophages was higher than that in the control group(P<0.05).After treatment,the mRNA expression levels of Arg-1,iNOS,CD80,and CD163 in the experimental group were lower than those in the control group(P<0.05).Dur-ing the treatment period,1 case of headache occurred in the experimental group,with an incidence of adverse reactions of 1.25%,1 case of drowsiness and 1 case of diarrhea occurred in the control group,with an incidence of adverse reactions of 2.50%.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Huanglong Zhike Granules can treat cough variant asthma in children by regulating macrophage polarization,and can reduce cough severity and improve lung function and airway function.