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At best an annoying tickle at the back of your throat, coughs can be very unpleasant, straining muscles, disturbing sleep, and leaving you utterly exhausted.
Treating that cough effectively, however, depends on first pinpointing its root cause. Traditional Chinese Medicine (TCM) practitioners believe that coughs can be caused by either external pathogens or internal functional imbalances.
Generally speaking, coughs caused by external pathogens can be recognised by their sudden onset and short duration. Coughs resulting from internal functional imbalances, meanwhile, tend to develop more gradually, last longer, and are more likely to turn chronic.
In both cases, pathogens target the protective qi of the body – its immune system – which is governed by the lungs.
When external pathogens attack
According to TCM, the lungs, which connect to the nose and mouth through the windpipe, are the most vulnerable of the five yin organs to external pathogens. These pathogens fall into six categories – Wind, Cold, Dampness, Dryness, Heat and Fire. Coughs are most likely to be caused by the Wind pathogen, although it is common for it to act together with other pathogens, usually Cold, Heat or Dryness, depending on the time of year.1
In order to treat a cough, TCM physicians first need to determine its root cause, taking into consideration the main characteristics of the cough, such as its sound, the part of the day it is most frequent, and the colour and texture of the sputum. External pathogens tend to cause three main types of cough, each of which has a distinct set of characteristics.
A Wind-Heat cough is generally a loud and harsh cough accompanied by heavy breathing and thick yellow phlegm that is difficult to expectorate. The person usually has a fever, an aversion to cold, a dry mouth or sore throat, yellow nasal discharge, a headache and general aching.
The Wind-Cold cough is characterised by frequent coughing, slight breathlessness, small amounts of thin white phlegm, a runny nose with thin white nasal discharge, a headache, aching limbs and an absence of perspiration. The person may also have a fever and an aversion to cold.
A person with a Wind-Dry cough will have a dry or sore throat and dry or chapped lips, mouth, nose and skin. Phlegm, when present, is scanty and sticky, and difficult to expectorate. They may also experience chest pain when coughing, and may have a fever, stuffy nose, headache, and a slight aversion to cold.
Recognising a cough caused by Internal functional imbalances
Internal functional imbalances in the lungs or closely related systems like the liver, spleen and stomach can also produce a persistent cough. This typically develops over a period of time, and is usually one of the following four types.
The Lung-Yin Deficiency cough is characterised by a short dry cough, sometimes accompanied by scanty white phlegm. Patients with this type of cough often also experience symptoms related to yin deficiency, such as a dry nose, mouth and throat, flushed cheeks, a sore throat and night perspiration.
Those with a Liver Fire cough produce a high-pitched cough that occurs in bursts, feel pain in the chest and rib area, and produce sticky yellow phlegm that is difficult to expectorate. They usually also experience breathlessness, have headaches, dizziness, a flushed face, a dry throat, constant thirst, constipation, and produce scanty urine. A bitter sensation in the mouth is common. The Liver Fire cough is often seen in middle-aged women or those going through menopause, and are affected by emotions.
Generally, a Phlegm-Dampness cough is a continuous cough with a heavy turbid sound that produces profuse quantities of white watery or foamy phlegm. It is aggravated by sweet and oily food. Those with this type of cough usually also complain of indigestion, a feeling of fullness in the chest, poor appetite, fatigue and loose stools.
Finally, Phlegm-Heat coughs are rough, husky coughs accompanied by rapid breathing, thick yellow or blood-tinged phlegm that is difficult to expectorate, and a distension or pain in the chest.
Diagnosis is made on a case-by-case basis, and prescriptions are tailored to the individual’s symptoms and constitution.
The TCM rule of thumb to restoring balance in the body is to remove any excesses and nourish any deficiencies. For a Wind-Heat cough, for example, a TCM physician may prescribe herbs like White Mulberry Leaf (Sang Ye, 桑叶) and Chrysanthemum Flower (Ju Hua, 菊花), and therapies like acupuncture, to dispel Wind and remove Heat.
Your TCM physician can help with advice suited to your precise needs.
A defence strategy
Unfortunately, there are no shortcuts to protecting yourself from coughs, or preventing them from recurring – you have to strengthen your body’s defences and defend yourself from external pathogens in the environment.
Some herbs that can help nourish and strengthen the lungs include Codonopsis Root (Dangshen, 党参), Cordyceps (Dongcongxiacao, 冬虫夏草), Lily Bulb (Baihe, 百合), and Ginseng (Renshen, 人参).
And of course diet and lifestyle play an important role in TCM’s holistic treatment model. A healthy diet, sufficient exercise and rest, and keeping stress to a minimum all help in building up the body’s natural immunity.
Integrated Chinese Medicine. (2005). How Traditional Chinese Medicine Sees Coughing. Retrieved from Shen Nong: http://www.shen-nong.com/eng/exam/cough_sees.html