TCM Principles - Cough
TCM Principles
Cough
By Prof Engin CAN (Enqin Zhang)
Contact e-mail: prof.engincan@hotmail.co.uk
Tel: 0044 078 461 93488
Website: http://sites.google.com/site/drcantreat/home
Cough is a primary symptom of the lung system. In TCM, if cough has sound but without any phlegm, it is termed as ‘Ke’; while if cough is with phlegm but without sound, it is named as ‘Sou’. Clinically, as cough usually occurs with both phlegm and sound almost at the same time, so all the above conditions including ‘Ke’ and ‘Sou’ are simply termed as one term, ‘Kesou’ which has usually been translated as a ‘Cough’ in English.
However, in western medicine cough is just a symptom caused by many different diseases and syndromes, such as common cold, acute and chronic bronchitis, asthma, bronchiectasis, pneumonia, pulmonary tuberculosis, even lung cancer. Therefore it is right for us firstly to find the real reason causing a cough and then start treatment.
In TCM, there are a lot of therapies for treating cough including acupuncture, herbal decoctions, herbal pills, massage, etc. According to our experiences, when you use TCM therapies exactly, most of patients with cough can get well in a very short time.
Aetiology and Pathology
In TCM theory, cough can be caused by 2 types of pathogenic factors, namely exogenous pathogens and endogenous factors:
- Exogenous factors:
According to Chapter 38 Aetiology, Diagnosis and Treatment of Cough of Plain Questions of The Yellow Emperor’s Canon of Internal Medicine (BC475-221), ‘the skin and body hair are external manifestations of the lung. These are the first line of defence against exogenous pathogens. When exogenous pathogens invade the body and cause stagnation of the defensive qi which flows under the skin, this condition will affect the lung’s dispersing function. It is the failure of the lung to disperse that causes the cough’. Clinically, we can often observe that exogenous pathogens such as wind-cold, wind-heat, warm-dryness or cold-dryness invade the exterior and damage the lung system. Furthermore, this condition may develop into the failure of the lung’s dispersing functions, as a result, cough occurs. Additionally, different pathogens produce different clinical patterns of cough. Generally, the cough caused by wind-cold is accompanied by wind-cold exterior symptoms, such as cough with white and thin phlegm, aversion to cold, thin and white fur of the tongue, floating and tight pulse; While the cough due to wind-heat is marked by wind–heat symptoms such as cough with yellowish, think and sticky sputum, fever, aversion to wind and heat, thin and yellowish tongue fur, floating and rapid pulse. The cough resulted from warm-dryness manifests as cough plus warm-dryness type symptoms such as dry cough or with little sputum, dry and sore throat, dry nose and mouth, red tongue tip, thin and yellow tongue fur with little moisture, fine and rapid pulse. The cough due to cool-dryness can be seen as cough plus cool-dryness’s symptoms such as cough with little or without sputum, dry nose and lips, aversion to cold, white and dry tongue fur, floating and tense pulse, etc.
- Endogenous factors:
The description on endogenous factor causing cough can also be seen in the Chapter 38 of Plain Questions of the Yellow Emperor’s Canon of Internal Medicine，it states that, ‘A diet abundant in cold or raw foods will also be a pathogenic factor to cause a cough, as the coldness causes stagnation of the stomach qi. The cold then rises with nutritive qi and spleen qi to the lung, causing coldness, stagnation and cough and an imbalance of the other zang and fu internal organs that result in cough that usually manifest at special times of the year. These factors have nothing to do with the lung being invaded by external pathogens’. From our experiences, endogenous factors mostly include the following aspects: improper diet or hunger causing dysfunction of the spleen and stomach in transportation and transformation and disorder of qi activity leading to stagnation of dampness which can often transform into phlegm or phlegm-heat. Both pathogenic conditions can obstruct the lung system and cause cough; Emotional depression causes stagnation of the liver-qi that may develop into liver-fire which can damage the lung system and causes cough. Long term chronic diseases exhaust yin of the lung-kidney or yang of the spleen and kidney. Both can cause the lung’s dispersing function to weaken, so the lung has not enough ability in normal qi activities, as a result, cough takes place.
Differential Diagnosis
Clinically, we often classify cough as following 8 different patterns:
- Wind-cold cough: cough with thin and white sputum, itching throat, accompanied by aversion to wind or cold, thin and white fur of the tongue, superficial and tight pulse.
- Wind-heat cough: cough with white or yellowish sputum, dry and sore throat, or hoarse voice, accompanied with mild fever with slight aversion to cold or wind, thirst, headache, red tongue tip with thin and yellowish fur, superficial and rapid pulse.
- Warm-dryness cough: dry cough or with little sticky sputum, dry nose and mouth, red tongue with thin whitish and dry fur, and superficial and rapid pulse.
- Cool-dryness cough: dry cough or with little whitish sputum, nasal obstruction and dry throat, accompanied by aversion to cold without sweat, slight headache, thin and whitish fur of the tongue, superficial and taut pulse.
- Damp-phlegm cough: cough with profuse white sticky sputum, aggravated in the morning, full sensation in the chest and abdomen, nausea, poor appetite, lassitude, white and greasy fur of the tongue, taut and slippery pulse.
- Phlegm-heat cough: cough with yellow and thick sputum, fullness and stuffiness in the chest and gastric cavity, yellow and greasy fur of the tongue.
- Cough due to yin-deficiency of the lung and kidney: prolonged cough with scanty sticky sputum, accompanied by dizziness, soreness of the loin, restlessness with feverish sensation in the chest, palms and soles, thirst, dry throat, red tongue with a little fur, thin and rapid pulse.
- Cough due to yang-deficiency of the spleen and kidney: cough with shortness of breath, anorexia, loose stools, aggravated with cold, pale tongue with white fur, deep and weak pulse.
Diagnosis in Western Medicine
In western medicine, a cough is usually caused by following diseases:
- Bronchitis: It is an inflammation of the trachea or bronchi. Clinically there are 2 main types of bronchitis:
(a) Acute bronchitis: It is mostly caused by the same viruses that causes the common cold, but can also be caused by bacterium, physical or chemical irritations. At the onset, it usually manifests as symptoms similar to a common cold, such as sore throat, runny nose, aversion to cold, fever, general aching, etc, and then starts a dry cough, after 1-2 days it becomes a productive cough with little sticky sputum or thin sputum and gradually changes into purulent or white and sticky sputum. Its course seldom goes beyond one month. Auscultation reveals hoarse breathing sounds and dry or moist rales. Laboratory test reveals a high count of total leucocytes and neutrophils at the acute stage, chest x-ray shows normal or increased broncho-vascular shadows.
(b) Chronic bronchitis: It is one type of COPD (Chronic Obstructive Pulmonary Disease). Chronic bronchitis can be caused by virus, bacterium, physical or chemical irritation, immune disorder or vegetative nerve functional disturbance. Today, many doctors believe that cigarette smoking is the most common cause. However, inhaling fumes and dusts over a long time may also cause chronic bronchitis. Its main clinical manifestations are cough, sputum, and dyspnoea. Chronic bronchitis is a long-tem respiratory condition. Generally speaking, its episodes of attack last at least three months each year for more than 2 years. It is persistent or never goes away completely. On auscultation, moist rales can usually be heard. Wheezes can be heard in patients with asthmatic bronchitis. Chest x-ray shows increased lung markings in the lower lung fields.
- Bronchiectasis: It is a permanent abnormal widening (dilation) in one or more of the bronchi. Extra mucus tends to form and pool in the parts of the bronchi that are widened. Its main symptom is a cough which produces a lot of sputum. The diagnosis is usually based on a compatible clinical history and symptoms, such as a daily cough and viscid sputum production as well as radiographically by characteristic findings, such as bronchial wall thickening and luminal dilatation on CT scan.
- Cough can also be caused by pulmonary tuberculosis, carcinoma and pneumonia and other serious diseases, so for getting an earlier and exact diagnosis you should consult your GP in good time.
TCM Treatments
- Acupuncture
Basic acupoints:
Feishu (B 13)
Lieque (L 7)
Hegu (LI 4)
Tiantu (Ren 22)
Yuji (L10)
Supplementary acupoints:
For wind-cold cough, add Fengchi (G20), Fengmen (B12);
For wind-heat cough, add Shaoshang (L11), Dazhui (Du 14);
For warm-dryness cough, add Quchi (LI11), Sanyinjiao (Sp 6);
For cool-dryness cough, add Chize (Lu5), Taixi (K3);
For damp-phlegm cough, add Fenglong (ST40), Pishu (B20);
For phlegm-heat cough, add Fenglong (ST40), Quchi (LI11);
For yin-deficiency of the lung and kidney, add Shenshu (BL23), Taixi (K3), Zhaohai (K6);
For yang-deficiency of the spleen and kidney, add Zusanli (ST36), Pishu (BL20) and Shenshu (BL23), Mingmen (Du4).
Methods: Use the filiform needles to puncture the above acupoints selected. For wind-cold cough, wind–heat cough, warm-dryness cough, cool-dryness cough and damp-phlegm cough or phlegm-heat cough, you should apply the reducing methods; while for yin-deficiency of the lung and kidney and yang-deficiency of the spleen and kidney, you should use the reinforcing or even movement methods.
- Herbal therapy
(a) Wind-cold cough
Therapeutic principle: dispersing wind-cold to relieve cough.
Formula: Zhisou San/Decoction
Ingredients:
Jingjie (Herba schizonepetae) 9g
Baiqian (Rhizoma cynanchi stauntonii) 9g
Zhigancao (Radix glycyrrhizae praeparatae) 9g
Chenpi (Pericarpium citri reticulatae) 9g
Administration: The original dosage form of Zhisou San was powder, now we often use its decoction form.
All the above ingredients should be decocted in water for 20-25 minutes, then get the decoction for oral use. Drink its half in the morning and then other half in the evening.
(b) Wind-heat cough
Therapeutic principle: dispersing wind and clearing away heat to relieve cough.
Formula: Sang Ju Yin/Decoction
Ingredients:
Xingren (Semen armeniacae amarum) 9g
Lianqiao (Fructus forsythiae) 9g
Shenggancao (Radix glycyrrhizae) 9g
Lugen (Rhizoma phragmitis) 15g
Administration: All the ingredients should be decocted in water for 25-30 minutes, then get the decoction for oral use. Drink its half in the morning and then another half in the evening.
(c) Warm-dryness cough
Therapeutic principle: dispersing heat and moistening dryness to relieve cough.
Formula: Sang Xing Tang/Decoction
Ingredients:
Xingren (Semen armeniacae amarum) 9g
Shashen (Radix adenophorae strictae) 15g
Zhebeimu (Bulbus fritillariae thunbergii) 10g
Dandouchi (Semen sojae praeparatum) 9g
Zhizipi (Pericarpium gardeniae) 9g
Lipi (Exocarpium pyrus) 6g
Administration: All the above ingredients should be decocted in water for 20-25 minutes, then get the decoction for oral use. Drink its half in the morning and then another half in the evening.
(d) Cool-dryness cough
Therapeutic principle: dispersing cold and moistening the lung to relieve cough.
Formula: Xing Su San/Decoction
Ingredients:
Xingren (Semen armeniacae amarum) 9g
Jupi (Exocarpium citri grandis) 9g
Gancao (Radix glycyrrhizae) 9g