Cough is a common clinical disease that is easy to treat, but there are also many cases that do not work for a long time. It is generally believed that long-standing diseases are treated from the internal organs, but when we review the treatise on cough in the Internal Canon, we are particularly aware that no matter what kind of cough is treated, the four external factors should not be ignored.
The common mechanism of the five visceral coughs described in the Suwen Cough Treatise is generally considered to be the result of evil offending each visceral meridian, causing the Qi and blood of each meridian to revert. The various symptoms are mostly meridian symptoms, for example, the Heart meridian “its branches are from the heart system up to the pharynx”, so there is “coughing causes heart pain”; the Foot Convulsive Yin Liver meridian “spreads out to the ribs”, so there is “Coughing is pain under the two hypochondrium”; foot Taiyin spleen meridian gas up connected to the lung, so coughing is pain under the right hypochondrium, so on and so forth, all due to the imbalance of the meridian gas.
Personally, I believe that the sutra cloud “people and heaven and earth, so each of the five Tibetan to treat the time, feel the cold will be affected by disease, micro is cough, even is the drainage for pain.” It is true that the cough of the five organs is characterized by pain caused by the blockage of qi and blood where the meridians of the five organs pass, such as heart cough, which is characterized by heart pain, and the intermediary of the throat, which is characterized by stems; liver cough, which is characterized by pain under the two hypochondrium; and kidney cough, which is characterized by pain caused by the back of the waist.
However, “each of the five Tibetan coughs should be treated at its own time” cannot be ignored. The heart is fire, and the symptoms of heart cough, such as “swelling of the throat and paralysis of the larynx”, have the meaning of fire evil on inflammation; the spleen is damp earth, and the symptoms of spleen cough, such as “Yin Yin leads to the shoulders and back”, have the meaning of heavy dampness; the kidney is cold water, and the symptoms of kidney cough, such as “pain in the back and waist, and even coughing and salivation”, have the obvious characteristics of cold evil The characteristics of invasion by cold evil.
This is in line with the four times and five Tibetan systems of the Nei Jing. In the Jin Dynasty, Liu Wansu and Zhang Zihe linked cough with the six qi and suggested that “wind, cold, heat, humidity, dryness, and fire all cause cough”, which in fact was a play on the meaning of the sutra, and again reminded that the clinical treatment of cough must pay attention to the influence of climatic factors on the human body.
”The cough of the five viscera moves to the six internal organs after a long period of time” is a summary of the trend of coughs that do not heal. From the relative clinical manifestations of the five visceral coughs and the six visceral coughs, the five visceral coughs are the five major classifications of coughs in the initial stages of the disease, where the external evil is felt, the disease is in the meridians, and the main pathogenic mechanism is the irregularity and rebellion of the meridians. In contrast, cough from the six internal organs is a result of coughing for a long time affecting the body’s qi flow and qi-chemistry activities, and is a further development of the six major classifications of the disease. Therefore, we can see symptoms such as “coughing and vomiting”, which is a kind of stomach qi rebellion, and “coughing and urination”, “coughing and loss of qi”, which is a manifestation of qi deficiency and loss of solidity, so the phase of syncope has already appeared.
One thing must be clear, that is, six-vessel cough is a “pronoun” for the change of the condition centered on the five Tibetan systems, that is, the “five viscera and six internal organs” here is not the same as the meaning we usually express. It takes the relationship between the internal organs and the external organs as the line of disease change, and further explains the law of the development of the disease when the evil of the four seasons affects the five internal organs, and when the disease is not treated and enters the internal organs, it does not mean that the disease goes from the internal organs to the internal organs.
If we think that cough is not cured for a long time, then it is transmitted to the six internal organs, which is the relationship between the internal organs and the treatment from the internal organs is not appropriate. Zhang Lu of the Qing Dynasty also had the assertion that “there is no case of transfer of the internal organs”. It is important to clearly identify the true meaning of “five visceral coughs” and “six internal organs coughs” to name different coughs in later times, and not to be easily confused by the literal meaning, as this will greatly help in clinical diagnosis and treatment.
The sutra says, “If you have a cough for a long time, the three jiao will be affected by it, and the three jiao will cough and have a full abdomen, not wanting to eat or drink, which are all gathered in the stomach and about the lungs, making people snotty and swollen and rebellious. The meaning of this line of sutra has been debated. One is that the six internal organs are collectively referred to as cough, such as Yang Shanshan cloud “six internal organs cough, all with the gas gathered in the stomach, on the lungs, resulting in the face swollen puffy gas rebellion cough.”
Secondly, it is about the internal organs of the lung and stomach, because the lung and stomach are divided into the middle and upper two jiao, so the cloud of the three jiao in the upper two jiao suffer from disease. As Wang Bing notes: “The upper jiao, out of the upper mouth of the stomach, and above the pharynx through the diaphragm, cloth chest go armpit. The middle Jiao is also to the mouth of the stomach, after the upper Jiao, this is subject to the gas, secrete the dregs, steam fluid, transforming its essence, injected in the lung veins, is transformed into blood. Therefore, it is said that all of them are gathered in the stomach and about the lungs.”
The third assertion is that these two sentences are the successor to “the coughing symptoms of the three jiao”, as in the Suwen Wu Commentary. The fourth assertion is that these two sentences summarize the above coughs, such as Zhang Jiebin’s note: “All coughs are gathered in the stomach and about the lungs, because the stomach is the basis of the five viscera and six internal organs, and the lungs are the combination of the skin and hair, such as the above cloud of the skin and hair first affected by evil and cold food into the stomach, are all lung and stomach symptoms. Yangming pulse starts from the nose, will be in the face, out of the mouth, so that people more snot and spittle and swollen face. The lung is the cover of the internal organs and the main qi, so people cough and rebellious qi.”
The fifth edition of the textbook “Lectures on Internal Medicine” also considers “gathering in the stomach and about the lungs” to be the summary of “coughing for a long time”. There are different opinions. Personally, I think that from the scriptures of the Nei Jing, there is no law of light and heavy cough transmission from the six internal organs, and the ancients added the phrase “coughing for a long time” in front of it in order to systematize it, because the five viscera should respond to the five internal organs, but not to the San Jiao; however, it is one of the six internal organs, so there is a “San Jiao cough”.
I believe that “gathering in the stomach and about the lungs” should be the pathogenesis of “Sanjiao cough”, one of the “six internal organs cough”, because the sutra says “Sanjiao is the official of the decision The main clinical symptom of “Sanjiao cough” is also manifested in the form of the following symptoms The main clinical symptoms of “Sanjiao cough” are also manifested as abdominal fullness, excessive snot and saliva, and puffiness of the face.
In my personal opinion, although the Suwen Cough Theory says: “All five viscera and six internal organs cause coughing, not only the lungs”, the five viscera and six internal organs should not be used as the locus of cough, and the fundamental locus of cough is only the lungs! “All the five internal organs and six internal organs cause coughing” highlights the fact that “man and heaven and earth are involved”, so it is later said that “each of the five internal organs suffers from the disease at its own time, and when it is not the right time, each of them transmits to the other”. This indicates that even though the mechanism of cough is complex, the key disease location is the lung, and the disease of other organs must affect the lung and cause the lung qi to rebel before it will cause coughing.
For example, the Three Character Classic of Medicine – Coughing also says: “But the lungs are the lord of the qi, and all the qi that goes up to the lungs will choke and cough, so the cough is not only in the lungs, but also in the lungs”. The lungs are delicate and clean, so they are susceptible to invasion by evil. If wind and cold attack the lungs, coupled with cold drinks inside, the cold will go up to the lungs, and the external and internal evils will merge, causing the lungs to lose their ability to declare and lower the cough. The five viscera and six internal organs all cause coughing” refers to the five viscera that correspond to the four seasons, and the Internal Canon reminds us to pay attention to the impact of the changes of the four seasons on the human body.
Clinically, it is also meaningful: if a person suffers from cough in spring, he should consider the influence of wind evil, and similarly, if a person with cough sees a windy phase, such as an itchy throat, he can also consider treating it from the liver. From the overall perspective of the doctrine of internal organs, the lungs are closely related to the five viscera and six internal organs. The lungs are the longest of the organs, the cover of the heart, and are subject to all the veins of the heart, so when other internal organs become diseased, they will affect the lungs, causing the lung qi to go up and cough.
Therefore, in addition to the clinical methods of promoting the lung, benefiting the lung, lowering the lung, moistening the lung, and clearing the lung to treat cough, there are also methods such as cultivating the earth to produce gold, pinging the wood with gold, and the method of gold and water, all of which are derived from this theory, but already focus on the internal organs rather than the evil of the time.
From a review of the above scriptures, it can be realized that cough is located in the lungs and should be treated in accordance with the four seasons, and that the symptoms of “cough from the six internal organs” are a serious form of cough, the prognosis of which should be fully considered clinically. The author combines the climatic characteristics of Kunming with those of the four seasons: due to the geographical location of Yunnan, a special climate has developed in the central part of Yunnan, with very significant regional characteristics.
Every year, with the arrival of the south westerly rapids and the withdrawal of the southwest monsoon, the central Yunnan region enters the dry season with sufficient sunshine, strong radiation, low precipitation, low humidity, strong evaporation, high wind speed and large temperature difference between day and night, forming the climate characteristics of dry and cool cloudy days and dry and warm sunny days from November to April. When the south westerly rapids disappear, the rainy season begins, sunshine decreases, radiation weakens, precipitation is high, humidity is high, evaporation is low, wind speed is small, temperature is relatively low, the temperature difference between day and night is small, and a humid and cool climate is formed around May to October.
This is why there is a folk saying that “there is no summer or cold in the four seasons, but when it rains, it becomes winter”. Clinically, the treatment of cough is usually based on the addition of almonds, genkoshen, tannin, and antebellum in the dry season of winter and spring, and patchouli, coix seed, pseudostellaria, and ephedra in the rainy season of summer and autumn, with good results. If the symptoms of “cough from the six internal organs” appear, we treat them according to the seriousness of the disease and increase the power of helping the righteous to dispel the evil, and we have many clinical successes.