Cough is caused by external evil invading the lung system, or dysfunction of the internal organs, internal injury to the lung, unclear lung qi, and loss of publicity and purification. If the cough and cough are said separately, the sound without phlegm is cough, and phlegm without sound is cough. Generally, phlegm and sound are seen together, and it is difficult to separate them, so they are called coughs together.
In cases of upper respiratory tract infection, bronchitis, bronchiectasis, pneumonia, etc. where cough is the main symptom, this evidence can be referred to for identification and treatment.
[Summary of historical and theoretical development]
Cough is one of the main symptoms of lung diseases. According to Yu Jiayan, “Cough is the primary disease of the lung. According to Zhang Jinyue, “although there are many coughing symptoms, they are all lung diseases”. Cough can be caused by external evil attacking the lung guard and causing the lung to fail to declare its qi, or by lesions in other internal organs that are transmitted to the lungs and cause the lungs to lose sufficiency.
The Nei Jing discusses cough in a number of ways. For example, the Su Wen? The Five Qi of Xuanming says: “The five Qi are sick, …… the lungs are coughing.” The Su Wen? The book on coughing also says: “The five viscera and six internal organs all cause coughing, not just the lungs”. It is emphasized that external evil invading the lungs or dysfunction of the internal organs and illnesses in the lungs can cause coughing. As for the classification of coughs, the Treatise on the Origin of Diseases? In addition to the five coughs, there are also wind cough, cold cough, prolonged cough, bile cough, and sympathetic cough. Coughs” says: “The only two evidence of coughs are the two evidence of coughs. One is external sensation, and the other is internal injury and the end of it”.
[Etiology and pathology
There are two main causes of cough: external sensation and internal injury. External coughs are due to the invasion of the lung system by the six external evils; internal coughs are due to the dysfunction of the internal organs and the dryness of the internal evil in the lungs.
The lung is the main organ of the lungs, and it is the lid of the five viscera. It is connected to the throat and opens to the nose, and is responsible for respiration and the outer skin and hair. If the external function of the lung is out of balance, the six evil spirits may enter through the nose and mouth or from the skin and hair, and the lung guard is affected, so that the lung gas is congested and not declared, and the purification order is out of order, affecting the in and out breathing of the lung gas, thus causing a cough. For example, the Six Books on Cough says: “The Six Books on Cough Cough Theory” says: “The six gases of cold, heat, dryness, humidity, wind, and fire all cause coughing”. This is what is meant. The common external coughs are wind-cold, wind-heat and dry-heat. However, as wind is the first of the six mirths, most of the other external evils attack the body along with wind. Therefore, no matter what kind of external cough is present, it is often preceded by wind, or by cold, or by heat, or by dryness, which injures the lung system and causes a cough.
Second, internal evil drying the lungs: internal injury coughs are always caused by dysfunction of the internal organs and internal evil drying the lungs. It can be divided into two types of coughs: those with disease in other organs, involving the lungs, and those with self-inflicted disease in the lungs. For example, if the spleen and stomach produce dampness, gathering dampness and phlegm, phlegm and turbidity offend the lungs, and the loss of suction and descent results in coughing, which is what the ancients called: “The spleen is the source of phlegm, and the lungs are the reservoir of phlegm”. Another example is depression, which causes the liver to lose its control, which causes the qi to become fire, and which causes the lungs to cough. If the kidney is weak and the qi is not properly transformed, the water and qi will overflow and become drink, and the upper ling will become drink, resulting in a cough. This is a “kidney disease and lung”. As for those who develop the disease because of the lung, most of the illnesses are prolonged, the lungs are weak, yin is injured and qi is depleted, the function of the lung as the master of qi is dysfunctional, there is no power to purge and descend, and the qi reverses and becomes a cough.
It is clear from the above that whether the cough is due to an external or internal injury, it is caused by a disease in the lung system and a reversal of lung qi. For example, in the chapter “Three Characters of Medicine? Cough” says, “The lungs are the internal organs of the Huagai, the exhale is deficient, the inhale is full, only the gas of the internal organs, not the external polite, the polite dry, then choking and coughing. According to the theory of deficiency and reality, external coughs are mostly real evidence, while internal coughs are mostly evil real and positive deficiency. However, external sensation and internal injury can affect each other, and if prolonged, the evil will turn into positive deficiency. For example, if an external cough is prolonged and not treated, the evil will injure the lung qi and the positive qi will be internally deficient, gradually turning into a cough with internal injuries. If the lungs are diseased and the external guard is not strong, they are susceptible to invasion by external evil, resulting in a combination of deficiency and reality and internal and external illness. It is clear from this that although coughs are distinguished between external sensations and internal injuries, sometimes the two can be mutually causal.
[Identification and treatment
Cough is a major symptom of many diseases of the lung system. According to its causes and symptoms, it can be divided into two categories: cough due to external sensation and cough due to internal injury.
I. External cough
(1) Wind-cold attack on the lungs
Clinical symptoms: cough with thin sputum, shortness of breath, nasal congestion, runny nose, itchy throat, headache, aching limbs, cold, fever, no sweating, thin white tongue coating, floating or tight pulse.
Mechanism of treatment: The lung is the master of the whole body’s qi, and the exterior is combined with the skin and hair. Today, the wind-cold evil offends the lung, causing the lung qi not to be promoted, so there is a cough with thin sputum and shortness of breath. As wind-cold attacks the surface, evil and righteousness compete with each other, therefore, there is vicious cold, fever, no sweating, nasal congestion, runny nose, itchy throat, and floating pulse; treatment should be based on dispersing wind and cold, promoting the lung and relieving cough.
Explanation: Aster is bitter-sweet, warm and moist, with the characteristics of warm but not dry, the function of warming the lung and lowering the qi, especially good at expectorant and stopping cough, is a good medicine for lowering phlegm and stopping cough; Bai Bian is warm and moist to stop cough, and aster is used together to enhance the lung and phlegm, lowering the qi and stopping cough effect, together as the monarch. Bai Qian is good at lowering the Qi to resolve phlegm and stop coughing; Radix Platycodon grandiflorus opens the lung Qi, dispels phlegm and relieves the diaphragm; the two together are the subject herbs, and together with the ruling herbs, they can promote and lower the lung Qi, resolve phlegm and stop coughing. Chen Pi is used to regulate the Qi and move the phlegm, so that the Qi is smooth and the phlegm is eliminated. Ginger is used to disperse the wind and cold and dispel the evil, while Chen Pi is used to lower the rebellion and harmonize the middle and resolve the phlegm. Glycyrrhiza glabra harmonizes all the herbs and is used as an adjuvant. The combination of all herbs in this formula is warm but not dry, moistening but not greasy, dispersing cold but not helping heat, relieving symptoms but not harming the right side, which together can dispel wind and cold, promote the lung and stop cough.
(2) Wind-heat offending the lung
Clinical symptoms: Frequent and severe cough, mute cough, unpleasant sputum, sticky and thick sputum, or yellow sputum that is difficult to discharge, thirst and sore throat, often accompanied by fever, slight chill, yellow runny nose, headache, thin yellow tongue coating and floating pulse.
Mechanism of treatment: The wind-heat evil enters through the mouth and nose, injuring the lung channels, resulting in failure to promote the lung qi, resulting in frequent and violent coughing, mute coughing, unpleasant sputum, sticky and thick sputum, or yellow sputum that is difficult to discharge; the wind-heat attacks the surface, the evil is in the lung guard, the evil and the positive are in competition, resulting in body heat and slight chill; the evil heat injures the fluid, resulting in thirst, sore throat, red tongue with thin yellow coating and floating pulse are signs of wind-heat. The disease is located in the lung and cough is the main symptom. Therefore, the treatment should be to remove wind-heat and promote lung-heating to stop coughing, and the formula is Sang Ju Drink plus or minus (mulberry leaf, chrysanthemum, orris, forsythia, rhizome, licorice, north almond, peppermint).
Explanation: Mulberry leaf is used as the ruler in this formula to dispel wind-heat, clear the lung and stop cough, especially good at clearing the evil of wind-heat in the lung complex. Chrysanthemum is pungent, sweet and cool, clearing wind-heat, helping Mulberry leaf to clear the evil of wind-heat in the lung; Radix Platycodon grandiflorus opens the lung qi, resolves phlegm and relieves cough; Almond descends the lung qi and stops cough, matching with Radix Platycodon grandiflorus, one to promote and one to descend, in order to adjust the declination function of the lung. The three herbs are used together as ministerial medicine. Mint pungently cools the exterior and disperses wind-heat; forsythia clears heat and removes evil heat from the upper jiao, and reed root clears heat and generates fluid. The three herbs are used together as adjuvants. Raw licorice is used as an ambassador to harmonize the herbs and clear the throat in combination with orris. This formula is light, clear and transparent, with a pungent, cool and bland taste, so Wu called it “pungent and cool light agent”. Its function is to promote the lung, resolve phlegm and stop coughing. It is suitable for mild cases of wind-heat at the beginning, where the evil is in the lung health and heat injures the lung ligaments.
(3) Wind-dry injury to the lung
Clinical symptoms: Dry cough with continuous choking, itchy throat, dry and painful throat, dry lips and nose, no sputum or little sticky sputum, or sputum with blood in it, or accompanied by nasal congestion, headache, slight chill, body heat, etc., with thin white tongue coating, red and dry texture and little fluid, and floating pulse.
Mechanism of treatment: This formula treats the light evidence of wind-dryness offending the lung. Wind-dryness injures the lung, consumes fluid and burns liquid, and the lung loses its purification, so dry cough, choking, itching, dry throat, dry lips and nose, no sputum or little sputum and sticky, not easily coughing out, or blood in the sputum. The wind and dryness attack outside and injure the lung guard, and the guard qi is suppressed, thus causing nasal congestion, headache, slight cold, body heat, etc. The tongue is thinly coated with white fur, red and dry with little fluid, and the pulse is floating. The disease is incipient, the evil is in the lung guard, the treatment must be pungent and penetrating and cool and moisten at the same time, so it is appropriate to clear the wind and lung, moisten the dryness and stop the cough, the formula is Sang Xing Tang with addition and subtraction (mulberry leaf, southern almond, pear skin, Zhe Bei Mu, mountain gardenia, southern sage, light black beans).
Explanation: In this formula, mulberry leaf is light, clear and cool, good at entering the lung meridian, which can not only lightly propagate the table, but also clear and stop cough, because its nature is also cool and moist, so it is most appropriate for the evil of warmth and dryness; almond is bitter, pungent and warm, good at lowering the qi and moistening dryness to stop cough, and in combination with mulberry leaf, it can remove dryness and heat, treat cough and gargle, and is the monarch medicine together. Dougu is the “moistening agent for relieving the surface of the body”, and it is said that sweating does not hurt Yin, so it is used to help Mulberry leaf to lightly promote and relieve the surface of the body; Xiang Bei clears heat and dissolves phlegm; Sha Shen moistens the lung and relieves cough, which helps Almond to stop cough and dissolve phlegm, and is the same subject medicine. Gardenia, clearing heat and diarrhea, “internal heat with kernel, surface heat with skin” (“get with the herbs”), this formula with gardenia skin, to heat in the lung guard also; pear skin moisten the lung to stop cough, lowering fire to produce fluid, together to help the ruler, the minister to cool the lung gold, as an adjuvant. The combination of all the drugs, clear appropriate cool and moisten and use, so that the dry heat in addition to the lung and the recovery, the symptoms can be resolved. As stated in the “Warmth and Heat Classic”, “if you take the formula of cooling and moistening, the dryness of the Qi will be calmed and cured”. This is exactly what it means. “Light medicine should not be used repeatedly, and repeated use must be too much for the disease.” (Regulations on Warm Diseases) Therefore, this formula uses a lighter dosage of all medicines.
Cough with internal injuries
(1) Phlegm-dampness offending the lung
Clinical symptoms: Recurrent coughing episodes, heavy coughing sound, white phlegm or grayish phlegm, easy coughing out of phlegm, flattening of phlegm, coughing with more phlegm in the early morning or after eating, often accompanied by chest tightness, abdominal gangrene, vomiting, less food, body fatigue, loose stools, white and greasy tongue coating, moist and slippery pulse.
Mechanism of treatment: phlegm-dampness offending the lung is the main pathogenesis of phlegm-dampness offending the lung and dysfunction of the spleen and lung. Dampness and phlegm are blamed on the spleen, the spleen is not healthy, dampness and phlegm become phlegm, dampness and phlegm accumulate, the qi is obstructed, all the symptoms arise; and “the lung is the storage vessel of phlegm”, dampness and phlegm offend the lung, the lung is not declaring and lowering, then see cough and phlegm, white color is easy to cough; phlegm obstructs the qi, the stomach is not harmonizing and lowering, then see the chest and diaphragm is stuffy, nausea and vomiting; the spleen is trapped by dampness, transportation and transformation is not in order, then the limbs If the spleen is trapped by dampness and there is a failure of transportation, the body will be sleepy, not wanting to eat and drink, and the stools will be loose; the tongue coating is white and greasy, and the pulse is moist and slippery, which are also signs of damp phlegm. The treatment should be to strengthen the spleen and dry dampness, resolve phlegm and stop coughing, with the addition of Er Chen Tang (Fa Han Xia, Chen Pi, Fu Ling, roasted licorice, ginger and Wu Mei).
Explanation: In this formula, Panaxia is pungent, warm and dry, and belongs to the spleen, lung and stomach meridians, which is best at drying dampness and resolving phlegm, and can lower the rebellion and stomach to stop vomiting, as the ruler. Orange Red aromatically awakens the spleen, regulates qi and harmonizes the middle, regulates qi to eliminate phlegm, and can also dry dampness and dissolve phlegm. The spleen is the source of phlegm, so Fu Ling Gan light to strengthen the spleen and permeate damp, so that the damp is not gathered, there is no phlegm from the source of phlegm, to treat its source of phlegm; ginger a help half summer, orange red to lower the phlegm, one can control the poison of half summer; and a little umeboshi to astringent lung gas, and half summer together, scattered in the collection, the opposite of each other, so that the expectoration of phlegm and not hurt, are adjuvant drugs. Roasted licorice harmonizes the middle and dispels phlegm, and harmonizes all the medicines, which is the complementary medicine. The combination of these two medicines can help to dry dampness, resolve phlegm and harmonize qi and the middle. In the formula, the two medicines of Panaxia and Orange Red, which are valuable in aging for a long time, are not overly dry, so they have the name of “Two Chan”. This formula is a famous formula for treating phlegm, and is known as the general remedy for phlegm.
(2) Phlegm-heat congestion of the lung
Clinical symptoms: Coughing and asthma, or phlegm in the throat, yellow and sticky phlegm, unpleasant coughing and vomiting, or phlegm with hot fishy smell, or vomiting blood phlegm, chest pain when coughing, red face, or body heat, dry mouth with desire to drink, thin yellowish greasy moss, red tongue, and slippery pulse.
Mechanism of treatment: This is caused by the evil of phlegm and heat congestion in the lung. The heat is lewd in the lung, burning the fluid into phlegm, phlegm and heat are intertwined, the lung loses its clearness, so the phlegm is yellow and sticky, coughing and vomiting, or the phlegm has a hot fishy smell, or vomiting blood phlegm; the phlegm and heat are knotted in the lung, and the qi is blocked, so the chest pain is seen; the lung heat is strong, burning the yin and fluid, so the face is red, or the body is hot, and the mouth is dry and wants to drink; the tongue is red, the moss is yellow and greasy, and the pulse is slippery, which are also signs of phlegm and heat. The treatment is to clear heat and resolve phlegm, regulate Qi and stop cough. Wang Ang has a cloud: “If there is excess qi, it is fire, and if there is excess liquid, it is phlegm, so the person who treats phlegm must first lower its fire, and the person who treats fire must smooth its qi” (Medical Formula Collection of Waiting). This formula is based on the formula of Qing Qi and Phlegm Pill with addition and subtraction (Gua Gua Ren, Chen Pi, Scutellaria Baicalensis, North Almond, Citrus Aurantium, Poria Cocos, Bile South Star, Semi-Xia).
Explanation: In this formula, Bile South Star is bitter and cool in taste, and it enters the lung through the meridian. It is good at clearing phlegm-heat, treating phlegm-heat congestion in the lung, and is the ruling herb. Scutellaria baicalensis clears lung fire; Guadua piperita clears heat and dissolves phlegm, the two together help the ruler to enhance the power of clearing lung heat and dissolving phlegm; treating phlegm requires regulating qi, so it also uses Citrus aurantium to move qi and eliminate phlegm, dispersing nodules and clearing lumps; Chen Pi is aromatic, can move and lower, regulate qi and eliminate stagnation, dry dampness and dissolve phlegm, the two together move qi and lower rebellion, eliminate phlegm and dissolve nodules, so that qi is smooth and phlegm disappears, the four drugs together are the minister. The spleen is the source of phlegm, the lung for the storage of phlegm, it is also used Poria to strengthen the spleen and permeate dampness, to treat the source of phlegm; almond to lower the lung to help eliminate phlegm and stop cough; half ansia dry damp phlegm, eliminating gangrene and disperse nodules, lowering the rebellion and stopping vomiting, the three flavors together for the spleen and lung as an adjuvant. The combination of the three herbs works together to clear heat, resolve phlegm and regulate qi to stop cough.
(3) Liver fire offending the lung
Clinical symptoms: Cough caused by Qi rebellion, redness of the face when coughing, cough leading to pain in the throat, dryness of the throat and bitterness of the mouth, little phlegm of sticky quality, often stagnating in the throat, cough increasing with mood swings, thin yellow tongue coating with little fluid, and stringiness of the pulse.
Mechanism of treatment: Liver fire is internalized, resulting in redness of the face, drowsiness, dryness of the throat, bitterness of the mouth, and stringiness of the pulse; liver fire offends the lung and the lung qi is unfavorable, resulting in coughing with qi rebellion, redness of the face when coughing, coughing leading to drowsiness, little sputum and sticky quality, often stagnating in the throat, and coughing increasing with mood swings. Treatment should be to clear the lung, calm the liver, lower the fire and smooth the Qi. This formula uses Dai Clam San (Qing Dai and sea clam shells) combined with Di Bai San (Mulberry Bark, Ground Bone Bark, round-grained rice and licorice).
Explanation: In this formula, Qing Dai and Hai Clam Shell clear the liver and resolve phlegm, while Mulberry Bark clears lung heat, stops cough and calms asthma. Ground Bone Bark is sweet, slightly bitter and cold in nature, clearing the fire in the lung, and is good at reducing Yin deficiency fever, and is the subject medicine. The combination of the ruler and the minister enhances the power of clearing and purifying lung qi. Roasted licorice and round-grained rice nourish the stomach to benefit the lung, and are adjuvant medicines.
(4) Loss of lung yin
Clinical symptoms: Dry cough, short coughing sound, sputum with little sticky white, or blood in the sputum, or hoarseness, dry mouth and throat, hot flushes, heat in the hands and feet, lethargy and night sweating, red tongue with little coating, thin pulse.
Mechanism of treatment: deficiency of lung yin and loss of lung function, resulting in dry cough, short cough, white sputum, blood in sputum, hoarse voice, dry mouth and throat; deficiency of yin tends to produce internal heat, resulting in red flushes, fever in the hands and feet and heart, thinning and night sweating, red tongue with little fur and fine pulse. Treatment is to nourish Yin and moisten the lung, resolve phlegm and stop cough. The formula is based on Sha Shen Mai Dong Tang with addition and subtraction (Sha Shen, Mai Dong, Yu Zhu, Lentil, Smallpox Powder, Mulberry Leaf and Licorice).
Explanation: In this formula, Sha Shen and Mai Dong are the ruling herbs to clear heat, nourish Yin and moisten the lung; Mulberry leaf clears lung heat, Yu Zhu and Smallpox powder nourish Yin and lung Yin, the three herbs together are the subjects to help the ruling herbs to strengthen the function of nourishing Yin and moistening dryness, clearing heat and relieving cough; Lentil strengthens the spleen and resolves dampness, Glycyrrhiza glabra nourishes the spleen and harmonizes the middle.
[Summary of clinical evidence]
1. Cough is the main symptom of lung diseases, and there are two types of coughs: external and internal.
2. For cough due to external sensation, most of the coughs are due to actual evil, so the main focus should be on eliminating evil and promoting lung circulation so that the cough will stop. For internal coughs, we should identify the deficiency of the symptoms and treat them by removing phlegm, clearing heat and nourishing Yin.
[Excerpts from the medical case]
(Journal of Beijing University of Traditional Chinese Medicine, 1995.18(3): 53-53): Zheng, male, 17 years old, was first diagnosed on December 1, 1993. He complained of coughing for more than a month and was diagnosed as bronchitis by Western medicine, and his treatment with Chinese and Western drugs was ineffective. At that time, the patient had a continuous cough with white mucous sputum, chest tightness and head heaviness, tiredness and laziness, accompanied by swelling in the ears, yellow exudate from the ears, red tongue, white greasy coating, and floating moist pulse. He was asked about the cause of his illness, which was due to the entrance examination, heavy homework, impatience, poor sleep, and the onset of the flu. Liu Lao observed that his tongue was white and thick, and his pulse was floating and moist, so he identified it as damp cough and heat from Qi depression in Sanjiao. The prescription: 10g of Cardamom, 10g of Patchouli, 15g of Yin Chen, 15g of Slippery Rock, 10g of Tong Cao, l0g of Ge Pu, 8g of Scutellaria, l0g of Forsythia, 14g of Zhe Bei, 10g of Radix et Rhizoma, 2g of Peppermint (later), 10g of Radix Platycodon, 10g of Almond, l0g of Qian Hu. After taking 7 doses, the cough was significantly reduced, and the chest tightness and body fatigue were also greatly improved. Now the end of the sputum all clean, the stool is dry, suggesting that there are signs of dampness and heat, the above minus Qian Hu, Radix et Rhizoma, plus 10g of bamboo leaves, 10g of water saffron seeds, dampness and heat from the three jiao to drive out the evil. At the time of the third consultation, the cough was basically cured, Yi eliminated ear not flowing, see its moss is still white greasy, is the use of dampness and the formula, consolidate the effect of treatment and cured.