by John Stan –
Cough is the most frequent illness-related reason for patient visits to their primary care physician in the U.S. Chinese herbs offer very effective treatment option for cough.
Etiology and Pathogenesis
The lung is known as the “delicate organ.”
It is extremely sensitive to the external environment and pernicious climatic influences. The lung is especially affected by wind, but also can be damaged by cold, heat, dry, and damp (in excess). External pathogenic influences invade the body, damaging wei qi and may inhibit the lung’s dispersing function, resulting in cough. This type of acute and sudden onset is always considered an excess condition, though there may be underlying deficiencies that precipitate the external invasion. External conditions that don’t resolve and/or if left untreated can become internal, chronic conditions.
Internal conditions can be either deficient or excess in nature and are broken down as such:
1) Deficiency: the lung is too weak to descend qi due to a deficiency of qi and/or yin.
2) Excess: a blockage of qi. This blockage can be due to phlegm or damp accumulation, heat, or stagnant qi. A prime example would be phlegm obstructing the lung’s ability to descend qi. This usually develops gradually and can commonly be due to an underlying deficiency, like damage to the spleen and stomach caused by a poor diet—including the ingestion of excessive cold raw foods, high sugar intake, and greasy or fried foods. The spleen’s transportation and transformation function becomes inhibited leading to damp accumulation, which over time turns to phlegm that is stored in the lung. This obstruction leads to cough.
Organ Patterns Associated with Cough in Oriental Medicine
The etiology of cough is further defined in relation to each organ associated with this condition. The lungs are the primary organ associated with dysfunction resulting in cough. Other organ systems involved include the kidney, spleen, and liver.
The lungs are mainly associated with deficiency patterns when attributed to the primary cause of cough. A sedentary lifestyle including a lack of exercise and feeble breathing can damage lung qi. Excessive or prolonged grief and sadness also damages lung qi. Environmental dryness as well as smoking and inhalation of drugs damage lung yin. Weak lung qi and wei qi make the body vulnerable to external invasions and may allow excess conditions to take hold.
Deficiency of the spleen can contribute to lung deficiency as a weak spleen is unable to support the lung (the “mother/son” relationship). Spleen patterns arise are due to overwork, excessive worrying, and poor diet including overconsumption of cold or raw foods, sugar, dairy, and greasy foods damaging the middle burner, inhibiting the transportation and transformation function, and producing excess phlegm. This excess accumulation is stored in the lungs, resulting in cough.
Cough can also arise from excessive stress and other emotional disharmonies leading to an excess in the liver insulting the lungs through the reverse controlling cycle.
The kidney is associated with deficiency patterns, including kidney qi, yin, and yang deficiencies. The kidney plays an important role in respiration, specifically inhalation. A weak kidney is unable to grasp the qi. The kidney assists the lung during inhalation, grasping and drawing down the qi that is inhaled. This mutual relationship is critical for smooth respiration. If the kidney fails to grasp the qi respiratory issues like cough, wheezing, and shortness of breath occur. Kidney yin deficiency with deficient heat dries up lung yin resulting in a chronic dry cough. Kidney yang, along with spleen yang deficiency, leads to water metabolism issues causing damp and water accumulation in the lung which results in cough.
Oriental medicine has defined effective treatments dependent on the presentation of the cough. There are several key factors to pay attention to:
1) Time—whether the cough is acute, sub-acute, or chronic. An acute cough is considered an excess condition. A chronic cough, defined as cough lasting more than eight weeks, can be either excess or deficient. A post-acute or post-infectious stage includes the time from two to eight weeks. This cough can show attributes that can be classified as either acute or chronic, and generally denotes the pathogen moving internally. Frequency of cough, a subcategory of time, describes the period between episodic bouts of the cough with frequent episodes of severe attacks being excess conditions.
2) Sound quality is another key to categorizing cough. Loud or barking cough is excess and always denotes heat. Weak and feeble cough is deficient.
3) Sputum characteristics include color, quality, quantity, and smell;
4) Other considerations include: if the cough is worse in the morning it indicates a presence of phlegm; if it is worse in the afternoon or evening it is often due to yin deficiency; if it is worse upon exertion or when tired it is due to deficiency; and if the cough is worse with stress then it indicates an excess liver pattern. It is also important to use other general diagnostic tools, like tongue and pulse and accompanying signs andsymptoms when defining or clarifying specific patterns.
Traditional Chinese Medicine patterns for cough are broken down several different ways; acute / chronic, excess / deficient, and interior / exterior. Acute cough is excess and external. It includes wind-cold, wind-heat, warm-dryness, and cool-dryness patterns. Chronic cough is internal and is subdivided into excess and deficient categories. Excess patterns include lung heat, damp-phlegm, lung phlegm-heat, liver fire, and blood stagnation. Lung heat and lung phlegm-heat can also be considered post-acute conditions. Deficient patterns include lung (kidney) qi deficiency, lung (kidney) yin deficiency, and spleen and kidney yang deficiency. The following table provides key identifiers of each pattern.
Acupuncture and Chinese Herbs
For acute conditions acupuncture can be quite effective. For chronic conditions herbal therapies tend to be more effective. A combination approach is suggested for optimal results when treating both acute and chronic stages.