The cough is one of the chief symptoms of lung disorder, but it may occur in diseases of other organs involving the lungs. Some diseases in modern medicine which have the cough as the major symptom, such as upper respiratory infection, bronchitis, bronchectasis, pneumonia and pulmonary tuberculosis, may be differentiated and treated as discussed in this section.

Etiology and Pathogenesis

A. Invasion of exogenous pathogenic factors

Exogenous pathogenic factors such as wind, cold, heat, dryness, etc., attack the lungs through the mouth, nose, or skin, which leads to dysfunction of the lungs and adverse ascending of lung-qi, thus causing cough. The pathogenic factors may change from one to another if the treatment is improper. For example, wind-cold may change to heat, wind-heat to dryness, thus inducing the production of sputum by heat retained in the lungs. Moreover, when the cough of exogenous origin continues for a long period, other organs may be impaired, and the dysfunction of internal organs becomes the major cause of the cough instead of exogenous factors.

B. Impairment of internal organs

Cough can be caused by the dysfunction of internal organs which may originate from either the lungs or other organs involving the lungs. For example: (1) Emotional upset may impair the liver, causing stagnation of liver-qi with production of fire; as a result, the liver-fire attacks the lungs. (2) Immoderate diet and drinking impair the spleen and lead to the disturbance of food digestion and fluid transportation, and sputum is produced and accumulates in the lungs. (3) Lung disorders consume yin and qi rendering the lungs incapable of keeping lung-qi downward, and deficiency and adverse ascending of qi results. (4) Hypofunction of kidneys which leads to accumulation of fluid in the lungs, or deficiency of the kidney-qi with inability to regulate inspiration may also cause adverse ascending of lung-qi.

In cases due to the impairment of internal organs, phlegm and fire are two agents closely related to the pathogenesis of cough. There are two kinds of sputum, i.e., cold sputum and hot sputum, and two kinds of fire, i.e., asthenic fire and sthenic fire. Prolonged retention of sputum may produce fire, and in turn, fire can produce sputum by acting on the body fluids.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation:

(a) Differentiation between cough of exogenous origin and of endogenous origin. Cough resulting from exogenous evils is usually a newly affected case with a sudden onset and a short duration manifested by superficies-syndrome involving the lungs and weifen and attributed to hyperactivity of evils. That caused by impairment of internal organs is usually a chronic case with an insidious onset and a long duration with repeated recurrences manifested by the symptoms of visceral dysfunction and is attributed to healthy qi deficiency and evil hyperactivity.

(b) Differentiation between cold and heat, asthenia and sthenia syndromes. The characteristics of cough and sputum and the accompanying symptoms may serve as the criteria for syndrome differentiation. Cough with a heavy and weak sound indicates a wind-cold syndrome, that with a harsh and loud sound shows a wind-heat syndrome, which cough with a low weak sound and in difficulty suggests a case due to impairment of internal organs. A large amount of yellow sputum indicates a sthenia-syndrome with fire hyperactivity; a small amount of yellow sputum, an asthenia-syndrome with body fluid consumption; profuse white sputum, a cold-sputum retention syndrome; and scanty white sputum, a wind-cold syndrome. Cases of cough due to exogenous pathogenic factors are usually accompanied by superficies-syndrome and attributed to hyperactivity of evils, and those due to impairment of internal organs are always accompanied by manifestations of visceral deficiency and are attributed to hyperactivity of evils and deficiency of healthy qi.

B. Therapeutic principles The therapy of expelling exogenous evils and releasing lung-qi is generally recommended for cough due to exogenous evils, but early application of greasy drugs, tonics, astringents and antitussives is not advisable. For cough due to impairment of internal organs, regulating zang-fu organs should be the major principle, such as tonifying the spleen, benefiting the lungs and clearing away liver-fire etc. But over-dispersion of qi should be avoid, otherwise the healthy qi may be impaired.

Classification and Treatment

A. Cough due to invasion of exogenous pathogenic factors

(a) Wind-cold

Manifestations: Cough with a heavy sound and thin white sputum, headache, stuffy and runny nose, aching of limbs, chilliness, anhidrosis, thing white tongue coating and floating or floating-tense pulse.

Therapeutic principles: Disperse wind and cold, release lung-qi and relieved cough.

Prescription: The Modification of Three Crude Drugs Decoction and Powder of Armeniacae Amarum and Perillae

Herba Ephedrae Praeparata 5 g
Semen Armeniacae Amarum 10 g
Radis Platycodi 9 g
Radix Peucedani 10 g
Radix Glycyrrhizae 6 g
Folium Perillae (decocted later) 10 g
Herba Inulae 10 g
Rhizoma Cynanchi Stauntonii 10 g
Exocarpium Citri Grandis 10 g

Remarks: For serious cases of wind-cold superficies-syndrome, increase the dose of Ephedrae or add Herba Schizonepetae and Rhizoma Zingiberis Recens to strengthen the lung-qi releasing and cold dispersing effects. For cases with profuse sputum, chest oppression and white greasy tongue coating, add Poria, Rhizoma Pinelliae and Cortex Magnoliae Officinalis to dry dampness and eliminate sputum. For cases with interior-heat and exterior-cold syndrome manifested as cough with a husky sound and thick sputum, dyspnea, thirst, high fever, yellowish tongue coating and rapid and smooth or floating pulse, use the modified Decoction of Ephedrae, Armeniacae Amarum, Glycyrrhizae and Gypsum Fibrosum with Radix Scutellariae and Cortex Mori Radicis.

(b) Wind-heat

Main manifestations: Cough with a high husky sound and thick yellow sputum, fever, chilliness, headache, general aching, sore throat, thirst, yellow nasal discharge, thin yellow tongue coating and floating and rapid or smooth pulse.

Therapeutic principles: Clear away heat, disperse wind, release stagnated lung-qi and eliminate sputum.

Prescription: The Modified Decoction of Mori and Chrysanthemi

Folium Mori 10 g
Flos Chrysanthemi 10 g
Radix Platycodi 9 g
Radix Glycyrrhizae 6 g
Semen Armeniacae Amarum 10 g
Rhizoma Phragmitis 15 g
Radix Peucedani 10 g
Bulbus Fritillariae Thunbergii 10 g
Fructus Arctii 10 g

Remarks: For cases with accumulation of lung-heat, add radix Scutellariae and Gypsum Fibrosum to clear away head from the lungs. For cases with difficult expectoration of thick yellow sputum, add Semen Benincasae and Pericarpium Trichosanthis to clear away heat and eliminate sputum. For cases with consumption of lung-fluid by heat, manifested with dryness of mouth and throat and red tongue, add Radix Adenophorae Strictae and radix Trichosanthis to clear away heat and produce body fluids.

(c) Heat-dryness

Main manifestations: Dry choking cough with a husky sound and thick or blood-tinged sputum, itching and dryness of throat, sore throat, dryness of nose and lips, headache, stuffy nose, fever, aversion to wind, redness at the tip of the tongue, dry tongue with thin yellow coating and floating and rapid pulse.

Therapeutic principles: Disperse wind, clear away heat, moisten dryness and relieve cough.

Prescription: The Modified Decoction of Mori and Armeniacae Amarum

Folium Mori 10 g
Radix Adenophorae Strictae 12 g
Folium Eriobotryae Praeparata 10 g
Radix Asteris Praeparata 10 g
Bulbus Fritillariae Thunbergii 10 g
Semen Armeniacae Amarum 10 g
Rhizoma Phragmitis 15 g
Semen Sojae Praeparatum 10 g

Remarks: For cases with predomination of heat, add Gypsum Fibrosum and Phizoma Anemarrhenae to clear away heat from the lungs. For cases with marked consumption of body fluids, add Radix Ophiopogonis and Rhizoma Polygonati Odorati to nourish lung-yin. For cases with blood-tinged sputum, add Rhizoma Imperatae to clear away heat and stop bleeding.

B. Cough due to impairment of internal organs

(a) Attack of sputum-dampness on the lungs.

Manifestations: Cough with a heavy sound and profuse white sputum, fullness and oppressive sensation over the chest and epigastrium, fatigue, poor appetite, nausea, vomiting, diarrhea, white and greasy tongue coating and soft-floating and smooth pulse.

Therapeutic principles: Tonify the spleen, dry dampness, eliminate sputum and relieve cough.

Prescription: The Modification of Erchen Decoction with Three Seeds Decoction for the Aged

Rhizoma Pinelliae 10 g
Pericarpium Citri Reticulatae 10 g
Poria 15 g
Fructus Perillae 10 g
Semen Armeniacae Amarum 10 g
Cortex Magnoliae Officinalis 9 g
Semen Raphani (fried) 10 g
Flos Farfarae 10 g

Remarks: For cases with profuse, white and frothy sputum and aversion to cold, add Rhizoma Zingiberis (dried) and Herba Asari to warm the lungs and eliminate sputum. For cases with spleen deficiency due to prolonged affection, add Radix Codonopsis Pilosulae and Rhizoma Atractylodis Macrocephalae to tonify the spleen and benefit qi.

(b) Retention of heat-sputum in the lungs

Manifestations: Rapid breathing with harsh voice, cough with difficult expectoration of thick yellow sputum, or odorous or bloody sputum, chest pain, dry mouth, constipation, red tongue with yellow or yellow and greasy coating and rapid and smooth pulse.

Therapeutic principles: Clear away heat, eliminate sputum and relieve cough.

Prescription: The Modified Decoction for Clearing Lung-Heat and Dispersing Phlegm

Cortex Mori Radicis 12 g
Radix Scutellariae 10 g
Fructus Trichosanthis 20-30 g
Bulbus Fritillariae Thunbergii 10 g
Semen Benincasae 15 g
Semen Coicis 15-30 g
Herba Houttuyniae 30 g
Fructus Aurantii Immaturus 5-10 g
Lumbricus 10 g

(c) Attack of liver-fire on the lungs

Manifestations: Dry and paroxysmal cough, pain over the chest and hypochondrium, redness of eyes and face, bitter taste in the mouth, dry throat, reddishness at the margin of the tongue with thin yellow coating and rapid and wiry pulse.

Therapeutic principles: Clear away lung-heat, calm the liver, keep the adverse qi downward and suppress fire.

Prescription: The Modified Powder for Expelling Lung-Heat and Powder of Indigo Naturalis and Concha Meretricis seu Cyclinae

Cortex Mori Radicis 12 g
Cortex Lycii Radicis 10 g
Radix Scutellariae 10 g
Fructus Gardeniae 10 g
Cortex Moutan Radicis 10 g
Herba Inulae 10 g
Folium Eriobotryae Praeparata 10 g
Radix Curcumae 10 g
Fructus Aurantii 10 g
Powder of Indigo Naturalis and Concha Meretricis
seu Cyclinae (decocted after wrapped with cloth) 10 g

(d) Consumption of the lung-yin

Manifestations: Longstanding cough with a little amount of white mucous or bloody sputum, dry throat, hoarseness, flushed cheeks, afternoon fever, feverish sensation over the palms, soles and the chest, insomnia, night sweating, fatigue, emaciation, red tongue with a little coating and thready and rapid pulse.

Therapeutic principles: Nourish yin, moisturize the lungs, eliminate sputum and relieve cough.

Prescription: The Modified Decoction of Adenophorae Strictae and Ophiopongonis

Radix Adenophorae Strictae 12 g
Radix Ophiopogonis 10 g
Radix Trichosanthis 10 g
Cortex Lycii Radicis 12 g
Radix Asteris Praeparata 10 g
Bulbus Fritillariae Cirrhosae 10 g
Folium Eriobotryae Praeparata 10 g
Semen Armeniacae Amarum 10 g
Cortex Mori Radicis 10 g

Remarks: For cases with dyspneic cough, add Fructus Schisandrae to astringe lung-qi. For cases with flushed cheeks and hectic fever, add Radix Stellariae and Herba Artemisiae Annuae to clear away asthenic heat. For cases with blood-tinged sputum, add Rhizoma Imperatae, Cortex Moutan Radicis and Fructus Gardeniae to clear away heat and arrest bleeding.

Experiential Prescriptions

A. Cook a certain amount of honey and mix with the juices of pear, ginger and turnip; 1 to 2 tablespoons of the mixture to be taken 3 times a day; applicable to cases with chronic cough.

B. Herba Ephedrae (30 g) and Radix Stemonae (90 g) prepared as concentrated decoction, then boiled with honey (500 g) for a short period; 1 to 2 tablespoons to be taken 3 times a day; applicable to mild cases of chronic dry cough.

C. Equal amounts of Bulbus Fritillariae Cirrhosae and Rhizoma Anemarrhenae prepared as fine powder; 3-6 grams taken twice daily; applicable to cough due to yin-deficiency.

D. A piece of human placenta taken orally after simmering, or Pulvis Placenta Hominis 1.5-3.0 grams 2 to 3 times daily; applicable to cough caused by deficiency of lungs and kidneys.

E. Appropriate amount of Semen Juglandis crushed and mixed with Crystallized sugar; 10 grams of the mixture to be taken several times a day; indicated for chronic cough due to kidney-deficiency.

Copyright 1995 Hopkins Technology