Cough

In TCM, Cough///Ké Sòu// is treated as a separate disease category when it is the primary complaint of a patient. Cough may result from attack of exogenous pathogenic factors impairing the Lung’s ability to disperse and descend, internal disorders of the Lung itself, or disharmony between the Lung and other internal organs.

In Chinese, Ké denotes coughing with sound but without production of sputum, while Sòu denotes productive cough with sputum or without sound. Originally, these for considered separate disorders. Clinically, however, these types of cough are difficult to separate, so today the terms are used together and considered as one disorder.

Relevant Biomedical Disorders
URI Influenza Bronchitis Pneumonia COPD Bronchiolectasis Pleurisy Tuberculosis Bronchial carcinoma Heart failure

Etiology and Pathogenesis
Attack by exogenous pathogenic factors: “All 6 pathogenic factors can cause cough, especially Wind-Cold.” When the Lung’s Wei Qi is weakened, the six pathogenic factors can enter the body through the skin or nose, which is controlled by the Lung. The pathogenic factors impair the disbursing in descending functions of the Lung, inducing cough.

Internal injury due to dysfunction of the Zang-Fu: Improper food intake: excessive eating, particularly of greasy or sweet foods, or excessive alcohol intake impairs the spleen function of transformation and transportation. This can generate Phlegm, which gets stored in the Lung and impairs its dispersing and descending function, resulting in cough.

Emotional imbalance: prolonged or excessive irritability or anger may lead to Liver Qi stagnation which, over time, may transform into Liver Fire and flare up words to insult the Lungs, inhibiting the descending of Qi and concentrating fluids in the Lungs into Phlegm. Aging, chronic illness, weak constitution: these result in vacuity of Lung Qi and Yin, impairing the Lung’s ability to disperse and descend, resulting in cough.

Invasion of the Lung by Wind-Cold
acute cough that is loud and frequent with thin, clear or white sputum that is easily expectorated San Ao Tang *(Rough and Ready Three Decoction) [Ma Huang (9g), Xing Ren (9g.), Gan Cao (6g.)]
 * Additional Symptoms of Wind-Cold:** aversion to cold, fever, headache, general body aches, no sweating, sneezing, stuffy/runny nose with clear discharge
 * Tongue:** thin, white coat
 * Pulse:** floating, tight
 * Treatment Principles:**Dispel Wind, scatter Cold, release the exterior, disperse and descend Lung Qi, stop cough
 * Herbal Treatment:**San Ao Tang*, Zhi Sou San *
 * Indicated for recently contracted coughs

Zhi Sou San * (Cough-Stopping Powder) [Jing Jie (Schizonepeta spike) 6g, Zi Wan (Aster root) 9g, Bai Bu (Stemona root) 9g, Bai Qian (Cynanchum root) 6g, Jie Geng (Platycodon root) 6g, Chen Pi (Tangerine peel) 6g, Gan Cao (Licorice root) 6g]
 * Indicated in protracted cases of cough

Invasion of the Lung by Wind-Heat
acute cough that is loud and frequent with sticky, yellow sputum that is difficult to expectorate [Sang Ye (Mulberry leaf) 9g, Ju Hua (Chrysanthemum flower) 9g, Lian Qiao (Forsythiae fruit) 9g, Lu Gen (Phragmites root) 9g, Xing Ren (Apricot kernel) 9g, Jie Geng (Platycodon root) 9g, Bo He (Mint) 6g, Gan Cao (Licorice root) 6g]
 * Additional Symptoms of Wind-Heat:** fever, aversion to cold, sore throat, dry mouth, thirst, headache, sweating, stuffy/runny nose with yellow discharge
 * Tongue:** thin, yellow coat
 * Pulse:** floating, rapid or floating, slippery
 * Treatment Principles:** Dispel Wind, clear Heat, disperse and descend Lung Qi, stop cough
 * Herbal Treatment:** Sang Ju Yin (Mulberry leaf and Chrysanthemum Beverage)

Invasion of the Lung by Wind-Dryness (Heat)
acute, dry cough without sputum or with sticky, scanty sputum that is difficult to expectorate and may be blood-tinged [Sang Ye (Mulberry leaf) 9g, Xing Ren (Apricot kernel) 9g, Bei Sha Shen (Glehnia root) 9g, Zhe Bei Mu (Zhejian Fritillaria bulb) 9g, Dan Dou Chi (Fermented Soybean) 9g, Zhi Zi (Gardenia fruit) 6g, Li Pi (Pear skin) 6g]
 * Additional Symptoms:** scratchy or sore dry throat, dry nose and mouth; exterior symptoms such as stuffy nose, headache, slight aversion to cold and fever during the early stages of some cases
 * Tongue:** slightly red with a thin, dry, yellow coat
 * Pulse:** floating, rapid
 * Treatment Principles:**Dispel Wind, clear Heat, moisten the Lung, relieve cough
 * Herbal Treatment:** Sang Xing Tang (Mulberry Leaf and Apricot Kernel Decoction)

Invasion of the Lung by Wind-Dryness (Cold)
acute, dry cough with no sputum or scanty, white sputum [Xing Ren (Apricot kernel) 6g, Zi Su Ye (Perilla leaf) 6g, Zhi Ke (Bitter Orange) 6g, Qian Hu (Peucedanum root) 6g, Jie Geng (Platycodon root) 6g, Zhi Ban Xia (Pinellia tuber) 6g, Fu Ling (Poria) 6g, Chen Pi (Tangerine peel) 3g, Sheng Jiang (Fresh Ginger root) 6g, Gan Cao (Licorice root) 6g, Da Zao (Jujube) 2 pcs.]
 * Additional Symptoms**: dry nose and throat, aversion to cold, fever, headache, no sweating
 * Tongue:** dry, thin, white coat
 * Pulse:** floating, tight
 * Treatment Principles:** Dispel Wind, scatter Cold, moisten the Lung, stop cough
 * Herbal Treatment:** Xing Su San(Apricot Kernel and Perilla Powder)

Phlegm-Dampness
recurrent cough with expectoration of profuse thin, watery or white, sticky sputum; cough is often worse in the morning and a rattling sound is frequently audible [Fa Ban Xia (Pinellia tuber) 6g, Chen Pi (Tangerine peel) 3g, Fu Ling (Poria) 6g, Gan Cao (Licorice root) 3g]
 * Additional Symptoms:** chest oppression, epigastric fullness and distention, nausea, poor appetite, fatigue
 * Tongue:** white, greasy coat
 * Pulse:** soggy or slippery
 * Treatment Principles:** Strengthen the Spleen, dry Dampness, transform Phlegm,stop cough
 * Herbal Treatment:** Er Chen Tang

Phlegm-Heat in the Lung
loud/barking cough with profuse, sticky, and yellow or green sputum that is difficult to expectorate; sputum may shows streaks of blood Fa Ban Xia (Pinellia tuber) 6g Dan Nan Xing (Bile-Processed Arisaema root) 1-3g Huang Qin (Scutellaria root) 6g Gua Lou Ren (Tricosanthes seed) 6g Zhi Shi (Unripe Bitter Orange) 3-6g Chen Pi (Tangerine peel) 3g Xing Ren (Apricot kernel) 6g Fu Ling (Poria) 6g
 * Additional Symptoms:** oppression in the chest, wheezing, thirst
 * Tongue:** red with thick, yellow, greasy coat to (may be dry if Heat is significant)
 * Pulse:** rapid, slippery
 * Treatment Principles:** Clear Heat, transform Phlegm, descend Lung Qi, stop cough
 * Herbal Treatment:** Qing Qi Hua Tan Wan (Qi Clearing Phlegm Transforming Pill)

Liver Fire Invading the Lungs
paroxysmal coughing spells with scanty, sticky phlegm (possibly blood-streaked); often elicited by emotional stress and accompanied by distending pain in the chest and costal regions [Sang Bai Pi (Mulberry root bark) 12g, Di Gu Pi (Lycium root bark) 12g, Geng Mi (Rice) 15g, Zhi Gan Cao (Honey-fried Licorice root) 6g] + Dai Ge San, [Qing Dai (Indigo) 1.5g, Hai Ge Ke (Clamshell) 9g]
 * Additional Symptoms:** red face, bitter taste in the mouth, irritability
 * Tongue:** red with thin, yellow coat
 * Pulse:** wiry, rapid
 * Treatment Principles:**Drain Liver Fire, clear Lung Heat, direct Lung Qi downwards, stop cough
 * Herbal Treatment:** Xie Bai San

Yin Vacuity
chronic, dry cough with no sputum or scanty, blood-tinged sputum, hoarse voice [Bei Sha Shen (Glehnia root) 9g, Mai Men Dong (Ophiopogon) 9g, Tian Hua Fen (Tricosanthes root) 12g, Yu Zhu (Solomon’s Seal root) 9g, Bian Dou (Lablab bean) 9g, Sang Ye (Mulberry leaf) 6g, Gan Cao (Licorice root) 6g]
 * Additional Symptoms:** dry mouth and throat, afternoon title fever, Five Centers Heat, night sweats, irritability, insomnia, fatigue, emaciation
 * Tongue:** red with scanty coat
 * Pulse:** thin, rapid
 * Treatment Principles:** Nourish Yin, moisten the Lung, transform Phlegm, stop cough
 * Herbal Treatment:** Sha Shen Mai Dong Tang (Glehnia and Ophiopogon Decoction)

Acupuncture Treatment
Wind-Cold invading Lung: LU1, LU7, LI4, BL12, BL13, TB5 Wind-Heat: LU1, LU5, LU6, LI11, GV14, BL12, BL13, LU10, LU11 Wind-Dryness (Heat): W-H points + LU7, KI6 Wind-Dryness (Cold): LU1, LU7, KI6, LI4, BL12, BL13

Clinical Notes on the Treatment of Cough/Ké Sòu
In the treatment of cough, it is essential to distinguish between external and internal types. For external cough, early use of tonics and astringents must be avoided to ensure complete expulsion of pathogens. For internal cough, treatment must address the Lungs as well as the other organs involved.

Herbs to Treat Cough/Ké Sòu
Gua Lou 12g Zhe Bei Mu 9g Hai Fu Shi (Pumice) 9g Tian Zhu Huang (Bamboo sugar) 6g Hai Ge Ke 12g
 * Phlegm-Heat:**

Xing Ren 9g Bei Sha Shen 12g Zi Wan 9g Kuan Dong Hua 9g Bai Bu 9g
 * Phlegm-Dryness:**

Fa Ban Xia 9g Chen Pi 9g Tian Nan Xing 6g Bai Jie Zi 6g =-= =Chinese View of Etiology=
 * Phlegm-Dampness:**

External Pathogenic Factors
-External Wind is the main cause of exterior coughs -As wind penetrates the skin and defensive-qi portion impairing the descending Lung-Qi causing cough. Other pathogenic factors:

Wind-Cold
invades the skin and defense-Qi impairing the descending of Lung-Qi

Wind-Heat
Enters via the nose/mouth affecting the throat, impairing Lung-Qi. This is a drier type of cough than Wind-Cold.

Wind-Dryness
Invades the lung channel in the throat causing dry and ticklish coughs. Dries up the lungs fluids as well as impairing Lung-Qi, causing a more persistent cough.

Emotional Stress
Worry is a frequent cause of cough by affecting the lungs, this is a dry and irritating cough. Prolonged anger, frustration or resentment lead to stagnation of Liver-Qi and (over a long period of time) Liver-Fire. This may invade the lungs hindering Lung-Qi.

Diet
Excessive sweats, greasy foods and dairy foods may lead to phlegm and expectoration through cough. Excessive hot foods, alcohol and dried greasy foods lead to Heat and Phlegm. Heat dries the lung fluid and may cause cough.

=Treatment=

Acupuncture Treatment
Acupuncture & Moxa: GB-20, GB-21, B-12, B-39, LU-1, CV-14, CV-12, LU-5

If patient has difficulty clear throat of phlegm add CV-22. When dry coughing is caused by discomfort in the throat add ST-10, ST-9, and T-17. for coughing accompanying pain in the hypochondrium, apply acupuncture to B-18, B-46, B-19, CV-14, LI-13 and SP-12.

Invasion of Cold-Wind:
LU-7, BL-12, BL-13, LI-4, K-7, LU-6. Reducing method, cupping on B-12 and B-13. Herbal Treatment: Ma Huang Tang Ma Huang 6g. Gui Zhi 4g. Xing Ren (Semen Pruni armerriacae) 9g. Zhi Gan Cao 3g.

Invasion of Wind-Heat
LU-7, LI-4, BL-12, BL-13, LI-11, LU-11, DU-14, LU-6 all with reducing method; cupping is applicable @ BL-12 and BL-13. Herbal Treatment: -San Ju Yin (morus-Chrysanthemum Decoction) -Sang Ye (Follum Mori Albae) 6g. -Ju Hua (Flos Chrysanthemi Morifolii) 3g. -Bo He (Herba Menthae) 3g. -Xing Ren (Semen Pruni armerriacae) 6g. -Jie Geng (Radix Platycodi Grandiflori) 6g. -Lian Qiao (Fructus Forsythiae Suspensae) 6g. -Lu Gen (Rhizoma Phragmitis Communis) 6g. -Gan Cao (Rhizoma Glycyrrhizae Uralensis) 3g.