Cough

Note: if you are reading this page on cough, please realise that it is not yet finished! It's been developing over the months and may take many more before I'm happy with it.

So it doesn't yet cover all  the descriptions I want to include. The finished article may look very different. But, this being the season for them, I'm busy treating them, and patients have asked for a bit of the theory.

Yes! Chinese medicine treats cough, and upper respiratory tract infections, asthma, bronchitis and so on. After all it's only had 3000 years to think about them.

But it doesn't call them cough. First it works out which syndrome in Chinese medicine is the problem. Once it's worked out the syndrome, it knows how to approach the problem. You'll be amazed to find out that none of the syndromes is called 'cough'!

Read on to discover how this is done. But do remember that coughing is your body's attempt to make itself better. Suppressing your cough with powerful medication may be non-conducive to health. (Not usually good to suppress symptoms - why? Read here)

Chinese medicine tries to understand the 'energy imbalance' behind your cough and, after diagnosing it, to heal the syndromes affected. Success means you feel better, and consequently your cough goes.

What kind of Cough do YOU have?

What a crazy question you may think! After all, with all the OTC (over-the-counter) medicines available, almost none of them talk about the kind of cough.

Instead they talk about 'cough, cold and flu'; or cough suppressant (well, at least they're being honest there!); sometimes you'll see 'baby cough' or 'adult chesty cough' and very occasionally 'tickly, chesty cough'.

But that's about all. They don't go into much more detail.

That's not good enough for Chinese medicine. Let's be more precise!

Acute or Chronic?

Acute Cough

This makes a huge difference to how your cough will be treated.

Usually an acute cough is something that you didn't have until a few days ago. It came on quickly, disrupting your life. Unless you're unlucky, you expect to get rid of it in a few days.

An acute illness is one that attacks fast, produces immediate symptoms which clear soon: otherwise, it becomes chronic.

Acute coughs may come with sore throat and sudden, possibly high,measurable, fever. But not always. They can last a week or two.

Technical stuff - skip, unless you've got time on your hands:

There are two main ways disease - including cough - is considered to invade your body in Chinese medicine.

They are a bit technical so take a little while to get your head round. Not worth the bother if you're interested in a chronic cough, but here they are for reference:

Chronic Cough

A chronic cough is one you've had for a while, and the symptoms of which are much the same all the time.

Any fever you get is fairly steady or predictable in its behaviour. In fact you may have no actual fever, but just feel as if you have - whereas with an acute disease you often do have a measurable fever.

A bit of theory

Acute coughs usually have what is called Wind as part of their picture. 'Wind' is shorthand, and describes something that, like the wind, is changeable and can be very destructive.

Usually Wind comes with either Cold or Heat.

Actually, that's not quite right. It might be hot, cold or neither, but it evokes in your body a reaction that is either Cold or Hot:

  • Wind-Cold describes your symptoms if Cold predominates
  • Wind-Heat describes your symptoms if Heat predominates

In other words, a cold draft that you think is the cause of your cough might produce in you a Wind-Heat reaction. And vice versa.

Which - you may wonder - is the more healthy reaction, Wind-Heat or Wind-Cold, and which is infectious?

Wind-Heat is more acute and generally quicker to appear. I think it usually shows more vigour in your reaction. However, Wind-Heat is often caused by a virus or bacteria. So frequently it's infectious. And some doctors still give antibiotics for them. 

Wind-Cold can come on fast too, and with it you may feel you're going to die (!): it lasts longer and is more generally debilitating. I think it is a less healthy reaction. Wind-Cold reactions are not usually accompanied by a viral or bacterial agent, so aren't usually infectious.

Chronic coughs continue indefinitely. You probably take something for them on an ongoing basis, even if it's just boiled sweets. They probably aren't infectious any longer, even if your phlegm is sometimes a bit green or yellow, which prompts you to visit your doctor for antibiotics.

Antibiotics will probably clear the colour from your phlegm for a while, but leave you open to acute infections again, because they kill off much of your immune system. Read the page on antibiotics.

Full or Empty?

This is the next important distinction to make. To understand this better, read the page on Excess and Deficiency, which means the same as 'full or empty'.

It's important because it tells the person treating you whether first to clear, dissipate your energy, or to support, tonify it. Many medics don't fully understand this: to be fair, diagnosing it is not always easy, being often a combination of both as when someone has Phlegm-Fullness with underlying Kidney Yang deficiency.

How to tell the difference: full/empty

  • Mainly, a LOUD cough is a sign of Fullness
  • A QUIET cough is usually a sign of Emptiness

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External or Internal ?

Coughs 'caught' from the outside of  your body are External, but many coughs arise from ongoing factors inside of your body.

Source - External

  • Caused by Wind: this has symptoms such as dislike of getting cold, probably a fever, runny nose and sore throat, and pulse that is described as 'floating'.
  • Caused by an external invasion, an underlying problem (called a remaining pathogenic factor) is stirred up, such as Lung Dry-Phlegm which produces a dry cough, with repeated attempts to raise phlegm from deep inside - hard to get up.
  • After an invasion from the outside, your body transforms it into an internal pathogenic factor such as Heat or Dryness or Lung Phlegm-Heat: symptoms include thick yellow phlegm, heat and thirst, and the cough is 'barking'. The pulse tends to be rapid (because of the Heat) and 'overflowing'.

Source - Internal

Coughs from internal conditions ('syndromes') may be with you for some time after an acute cough, if not indefinitely.

For example, you might find that after an acute cough, you are left with an occasional dry cough, perhaps with a little phlegm that may be quite deep and hard to raise.

Or, that you never got a cough in the first place, nor even an acute infection, but just found over time that you began to cough - for no apparent reason. What then?

Well, there are lots of possible reasons in Chinese medicine.

However, don't assume your cough will go of its own accord. Why? Because it has become chronic, meaning that your body doesn't know how to throw it out. You're stuck with it.

Of course, if it isn't too bad, a change of environment - perhaps a good holiday and lots of sleep - might fix it.

Should that not work, don't assume the worst and do seek professional help. Chinese medicine has lots of ways to treat syndromes that give rise to internally caused cough.

Type of Cough

It is possible to have more than one kind of a cough at the same time. This means you can have more than one syndrome at a time, eg both a Full and a Deficient syndrome.

NB: the syndromes I suggest below for each condition are only possible diagnoses. They are often the diagnosis, but not always. Don't be surprised if a qualified practitioner comes to a different conclusion, or approaches treatment from a different perspective.

  • Afternoon cough: Lung Yin deficiency.
  • Barking - loud - phlegm expectorated is yellow and thick, you feel hot, may have a fever, will be thirsty, chest may hurt when coughing: pulse is rapid, over-flowing. Often Lung Phlegm-Heat (might be whooping cough if comes in violent bouts, especially with whooping in-breaths between coughs). If it has persisted for some time, may also have Lung Yin deficiency and even Kidney Yin deficiency if severe.
  • Caused by Cold or anxiety or heavy exertion, coughing to catch breath, difficulty breathing, tight chest, possibly better in warm climates or weather, or in summer: Lung Yin deficiency and/or Kidney Yang deficiency. (Probably diagnosed as asthma by your doctor.)
  • Caused by stress or emotional upsets: chest probably feels stuffy, distended: may have pain in hypochondria. Liver Qi stagnation interferes with action of Lungs
  • Dry and loud - short - frequent - persistent, sometimes bringing up a little phlegm that may be lightly coloured, ticklish throat: often Lung Dry-Phlegm continuing after an acute attack of Wind-Heat or early signs of attack by Wind-Heat
  • Dry and weak - persistent (ie chronic: old people often have this kind of cough) with sometimes a little phlegm which is hard to raise, probably white, clear or tinged with yellow first thing in the morning, throat feels dry, tongue swollen and dry covering: Lung Phlegm-Dryness 
  • Dry, tickly, chronic - sometimes with phlegm that is very hard to raise, and which is possibly bloody, or has a little redness in it. If your throat and mouth feel dry through the night, and you are generally easily or always tired, even by speaking, and you also tend to perspire during sleep at night, and may even look healthier in the evening with a slight flush then  (as opposed to your more usual pasty face) and even a sense of slight fever, you could have Lung Yin Deficiency with, additionally, Empty Heat. In this case, your tongue will be red, with very little or no coating, and your pulse will be fast and empty and/or floating. 
  • Dry, often with ticklish throat - weak - persistent (ie chronic) - quiet or low sound, throat dry particularly in later afternoon and evening, tends to sweat in sleep, (often after 3am), pulse floating, empty, tongue without coating, and may have small lines at front of tongue on either side of the central line - probably Lung Yin deficiency
  • Dry, with ticklish throat - weak - persistent, often worse from cold or exertion: runny nose, with shortness of breath eg on walking, talking or climbing stairs, with frequent sweating for no obvious reason, frequent tendency to catch colds. Pulse empty especially in Lung position: tongue pale. Lung Qi deficiency
  • Irritating - hard - from throat; redness and heat in the face; aggravated by deep breathing, exertion or lying down; chest feels oppressed and hot; difficulty breathing; tongue red with yellow coating; pulse rapid-overflowing: Wind-Heat, producing Lung-Heat
  • Loose, phlegmy, 'rattly' - loud - often Lung Damp-Phlegm, which has easy expectoration of white mucus up from your chest which feels blocked and heavy or compressed: your tongue here is swollen with sticky white mucus on it: pulse slippery
  • Loose, with sound or feeling of fluids plashing around in chest - Lung Phlegm-Cold
  • Loud - acute onset, with hoarse voice - Wind-Heat 
  • Loud, with expectoration of profuse yellow or green phlegm, you feel hot, may have a fever, your chest feels oppressed and your tongue is red and swollen with covering that is yellow and sticky, pulse rapid and slippery: Lung-Phlegm-Heat
  • Morning cough: Stomach Fire, Spleen deficiency or Cold/Damp in the Large Intestine
  • Painful chest when coughs: breathlessness, red face, warm hands: Lung Heat
  • Phlegmy, chronic: either Lung Phlegm-Damp, or Lung Phlegm-Heat or Lung Dry-Phlegm. These syndromes have a background of Spleen deficiency: the Spleen is said in Chinese medicine to be responsible for allowing Phlegm to collect, but the Lungs store it.
  • Productive cough with runny clear or white mucus, runny nose: invasion of Wind-Cold
  • Sudden onset, loud - probably  Wind-Heat
  • Sudden onset, with runny nose, dislike of cold, a fever, sore throat: pulse floating = invasion of Wind. For treatment, your acupuncturist would ask questions to discover if it was more Wind-Heat or Wind-Cold, because it makes a difference to how he treats you, not just with acupuncture but herbs too.
  • Throat-clearing cough before speaking, often worse after eating: Stomach and/or Spleen Yang deficiency, with easy production of Phlegm. (The solution here is eat smaller amounts per mouthful, and chew them well before swallowing; also to eat warm food, and avoid raw, cold, chilled, sweet or dairy foods. Read up on Cold Foods and Hot foods.) May also be Lung Cold Phlegm or Lung Damp Phlegm.
  • Tickling - rather like being tickled by a feather in your throat or chest, or like dust there - sometimes producing a hacking cough - often worse during or after food - Lung-Phlegm-Heat with Lung Qi deficiency (+Spleen and Stomach Qi deficiency)
  • Violent - spasmodic; throat raw, increasing amounts of phlegm; probably Wind-Heat
  • Weak, chronic cough: soft or weak voice, an effort to talk loudly or for too long; sighing: runny nose, generally worse for exertion or cold, frequent sweating, many colds. Pulse empty especially in Lung position: tongue pale. Lung Qi deficiency

What about that Phlegm?

That phlegm - mucus - which you cough up and should, preferably, spit out, tells you a lot about what's going on inside.

Read more here or read my book on phlegm, which suggests the herbs you need to clear your kind of phlegm.

Lung syndromes - a list of the main ones

Most coughs occur because the Lung function' of descending energy is blocked, leading to the energy ascending, as cough. Here is a list of Lung syndromes.

Deficiency syndromes:

Full or Excess syndromes:

Interior syndromes of the Lungs

Shared syndromes

Click to read about acupuncture points along the Lung channel.


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