bubble_chart Concept

Cough, also known as 咳, Suwen．The Cough Treatise specifically discusses cough and proposes the idea that "the five zang-organs and six fu-organs can all lead to cough, not just the lung." Sometimes referred to as cough, it is often mentioned alongside abnormal rising of qi, as in Suwen．The chapter on the generation of the five zang-organs states "cough abnormal rising of qi," and in the book Jingui Yaolue, sometimes "cough abnormal rising of qi" is mentioned together, and other times "phlegm-fluid retention cough" is mentioned together. Jingui Yaolue and "Han Dynasty Wuwei Medical Bamboo Slips" also refer to "cough" and "cough abnormal rising of qi." It can be seen that before the Han Dynasty, 咳, cough, and cough were synonymous, and cough was particularly closely related to abnormal rising of qi (喘) and phlegm-fluid retention, hence they were often mentioned together.

Zhubing Yuanhou Lun clearly distinguishes between cough, abnormal rising of qi, and phlegm-fluid retention, discussing each in separate sections. Among them, "Cough Disease Princes．Fifteen Discussions" points out that "cough is caused by the lung being affected by cold, and a mild case results in cough." If caused by warm and hot pathogens, it is discussed separately under "seasonal epidemic cough" and "warm disease cough." If caused by internal damage, it is discussed under "deficiency fatigue cough." Suwen Bingji Qiyi Baomingji states: "咳 refers to having sound without phlegm, caused by lung qi being injured and not clear. 嗽 refers to having phlegm without sound, caused by spleen dampness moving to produce phlegm. Cough refers to having both phlegm and sound, caused by injury to lung qi and movement of spleen dampness, resulting in cough and 嗽."

Clinically, there is no need to distinguish between 咳, 嗽, and cough, and they can be collectively referred to as cough. Cough is a clinical manifestation of lung phlegm disease. If it is phlegm-fluid retention cough, it is mostly a disease of the lung and spleen. If it is cough abnormal rising of qi, it is mostly a disease of the lung and kidney (for abnormal rising of qi and phlegm-fluid retention, see the discussions under panting and 咳痰 sections).

bubble_chart Syndrome Analysis

1. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
2. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
3. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
4. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
5. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
6. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
7. Phlegm Drink︰Symptoms include cough, white sputum, coughing that stops immediately after the phlegm comes out, accompanied by chest and epigastrium swelling and tightness, decreased diet; or nausea, vomiting, or facial swelling. The tongue coating is white and greasy, and the pulse is moist and slippery. phlegm-dampness means that the cough is caused by phlegm, so it has the characteristic that the cough stops immediately after the phlegm comes out. It is a comprehensive manifestation of phlegm-dampness and dysfunction of spleen in transportation (reduced diet, chest distension, or vomiting). To treat invigorating spleen and drying dampness, resolving phlegm and relieving cough, choose Two Old Ingredients Decoction combined with Stomach-Calming Powder addition and subtraction. If phlegm-dampness accumulates and turns into heat, you will see yellow and thick phlegm, yellow and greasy fur, slippery and rapid pulse, etc. This is phlegm-heat cough. To treat it, clearing heat and resolving phlegm should be treated with Phragmites Stem Decoction TogetherMinor Chest Bind Decoction adds and subtracts. If there is phlegm-fluid retention or internal accumulation of water and vapor, combined with cold evil, resulting in internal stasis of cold drinks, or cough with external evils that have not been purified, coughing up white thin phlegm, fullness and tightness in the chest and diaphragm, and even vomiting Cold shape etc. To treat with warming lung and resolving fluid retention, choose Minor Green-Blue Dragon Decoction plus or minus.
8. Spleen Qi Deficiency︰Symptoms include cough, multi-colored white phlegm that is easy to cough up, black end swallowwort root swelling, shortage of qi, physical fatigue, cold sensitivity, abdominal distention, loss of appetite, and bland taste in mouth. The tongue coating is thin and white, and the pulse is thin. Mainly due to weak spleen qi deficiency, lack of power in transportation and transformation, accumulation of dampness and phlegm, phlegm-dampness blocking the lungs and cough, so the phlegm is white and multi-colored and easy to be coughed up. This disease also has the symptoms of weak spleen qi deficiency (shortage of qi, face and face). blackend swallowwort root swelling, lack of food, loose stool, etc.). To treat the spleen and replenishing qi, drying dampness and resolving phlegm, choose Six Gentlemen Decoction addition and subtraction.
9. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
10. Wind-heat Attacks the Lungs︰Symptoms include unpleasant cough and yellow or yellow-white phlegm that is thick and thick. Dry mouth, sore throat, headache, nasal congestion, body heat aversion to wind sweating, or slight aversion to wind cold, thin yellow tongue coating, floating pulse. Wind-heat pathogenic qi invades the lungs, lung qi fails in purification, and heat burns body fluids, so the cough is uncomfortable, the phlegm is thick and yellow, and it is thick and sore, and the throat is sore; wind-heat disturbs the clearing, and the blood counterflow in the head is disordered, causing headache. ; healthy qi and pathogenic qi are in conflict, and the function is excited, so the body temperature rises and fever is seen; pathogenic qi attacks the outside, and the function of the outside of the body is abnormal, then aversion to wind; wind-heat evil is responsible for the rise and release, causing striae and interstice opening and discharging and sweating. To treat dispersing wind, ventilating lung and relieving cough, choose Mulberry Leaf and Chrysanthemum Decoction plus or minus. Wind-heat attacks lung cough and cough may also appear to be superficially resolved or unresolved but the lung heat has become inflamed.
11. Kidney Yang Deficiency︰Symptoms include cough, with clear and thin phlegm in a foamy state. If the cough is severe, there will be nausea and shortness of breath, which will be aggravated by exertion. blackend swallowwort root swelling, or swelling of the limbs. The fur is white and light, and the pulse is heavy and thin. It is caused by multifactorial body yang deficiency or old age and frailty, persistent cough, and kidney disease. The kidney governs the bones, stores essence and receives qi. If kidney yang deficiency is insufficient, it will not be able to receive qi, so there will be frequent coughing and wheezing, or it may often cause cough and difficulty breathing, or even feeling that the qi rushes up from under the navel. After exertion, All symptoms will be aggravated; the kidney governs water, and if kidney yang deficiency occurs, the water and dampness will turn into phlegm, and the phlegm will have a salty taste. There is insecurity of kidney qi, so if the cough is severe, there will be drowning. To treat warming and tonifying kidney yang, choose Kidney Qi Pill plus Schisandra Fruit, Psoralea, etc. If you have severe cough and asthma, and the phlegm is heavy and salty, you should nourish the kidneys and resolving phlegm, then choose Jian Six Gentiemen Metal and Water Decoction.
12. Liver Fire Invading Lung︰Symptoms include cough qi counterflow, where the phlegm is not clear, either like plum cores, or like broken flocculation, which is difficult to cough up. Coughing may cause flushing and hypochondriac pain. Dry throat, dysphoria and irritability. The tip of the tongue is red, the fur is thin, yellow and dry, and the pulse is stringy and rapid. This syndrome is mostly caused by stagnation of anger damaging the liver, failure of the liver to relieve diarrhea, excessive liver damage to the lungs, and lung qi ascending counterflow. The symptoms are characterized by symptoms of liver depression (suffocation or gushing in the chest and ribs, depressed mood, dysphoria, irritability, etc.) and ascending counterflow symptoms (cough counterflow or wheezing due to coughing, etc.), as well as phlegm accumulation in qi depression. The symptoms (unpleasant discharge of phlegm, or phlegm such as plum cores, loose flocculation, etc.) are common. To treat soothing the liver and resolving phlegm, regulating qi and resolving phlegm, choose Peripatetic Powder combined with Pinellia and Magnolia Bark Decoction plus or minus. If the fire turns into depression, bitter taste in the mouth, yellow phlegm, red tongue, stringy and rapid pulse, it is advisable to clear the liver and draining fire, moistening dryness and resolving phlegm, and then choose clearing the lung and resolving phlegm decoction combined with Dai Ha powder.

Wind-cold fettering exterior and wind-heat invading the lung are both caused by external pathogens, hence both exhibit exterior syndrome/pattern. The key points for differentiation between these two patterns lie in the characteristics of the cough, the nature of the phlegm, and the accompanying exterior syndrome/pattern.

Dryness pathogen damaging the lung and summerheat dampness are also caused by external pathogens, hence they also exhibit exterior syndrome/pattern. However, their onset is seasonal. Due to the different nature of the pathogens, the clinical manifestations also differ, which can be used to differentiate them from wind-cold fettering exterior and wind-heat invading the lung.

Lung heat and lung dryness, heat being the gradual form of fire, and fire always being dry, hence the disease cause of cough in these two patterns, although one is pathogenic heat and the other is dryness pathogen, their symptoms have similarities (such as cough causing chest and rib pain), and should be differentiated based on their accompanying symptoms.

Phlegm-fluid retention and spleen deficiency both have phlegm-dampness as the pathogen, but their disease cause and mechanism of disease are different.

For the symptom of cough, the first step is to differentiate whether it is cough due to external contraction or cough due to internal damage. Generally speaking, cough due to external contraction often has a clear pathogenic cause, a rapid onset, and a short course, characterized by the presence of exterior syndrome/pattern, mostly belonging to excess syndrome/pattern. Cough due to internal damage often has no obvious trigger, a slow onset, and a long course, especially lung yin deficiency and kidney yang deficiency cough, often lasting for a long time without healing, or recurring, mostly belonging to deficiency syndrome/pattern.

In the differentiation of cough, it is important to grasp the characteristics of the cough and the phlegm. For example, cough that is worse during the day is often due to heat or dryness, while cough that is worse at night is mostly due to kidney deficiency, spleen deficiency, or phlegm-dampness. In terms of differentiating phlegm, clear and thin phlegm belongs to dampness, while sticky and thick phlegm belongs to heat or dryness; white phlegm belongs to wind, cold, or dampness, while yellow phlegm belongs to heat; a large amount of phlegm belongs to phlegm-dampness or spleen and kidney deficiency, while a small amount of phlegm is mostly due to wind-cold fettering exterior or yin deficiency. Dry cough with little phlegm that is difficult to expectorate, or even no phlegm at all.

bubble_chart Documentation

1. Danxi Xinfa．cough》：「In the morning, frequent coughing indicates stomach fire, use Fritillaria Bulb、Gypsum to reduce stomach fire; frequent coughing in the afternoon indicates yin deficiency, must use Four Ingredients Decoction plus fried Phellodendron、Anemarrhena to reduce fire; coughing at dusk is due to fire qi floating in the lungs, should not use cooling herbs, but Schisandra Fruit、Chinese Gall to astringe and descend it; frequent coughing at dawn indicates food accumulation in the stomach, at this time, fire qi flows into the lungs, use Anemarrhena、Chinese Wolfberry Root-bark to reduce lung fire.」
2. Jingyue Quanshu．cough》：「Cough, if it occurs every autumn and winter, it is cold wrapping heat. Just resolve the cold, the heat will dissipate on its own, suitable are Liu'an Decoction、Two Old Ingredients Decoction、Jian Six Gentiemen Metal and Water Decoction three formulas, observe the deficiency and excess, use appropriately according to age and condition, if internal heat is severe, may assist with Skullcap Root、Anemarrhena and the like.」
3. Zabing Yuanliu Xizhu．cough asthma origin》：「Sound without phlegm is called cough, not without phlegm, but phlegm is not easily expelled, the disease is in the lungs, the lungs govern sound, so sound comes first and phlegm follows. Phlegm without sound is called expectoration, not without sound, but phlegm comes out with expectoration, the sound is not very loud, the disease is in the spleen, the spleen stores phlegm, so phlegm comes out and expectoration stops.」