Coughing happens when the body feels disagreeable stimuli in the breathing passages. It’s a ‘happening’ rather than a ‘doing’ because it’s involuntary (except when it’s voluntary).

Involuntary, huh? This calls for completely unnecessary example. Enjoy!

Sitting in a crowded lecture hall amidst a glazy-eyed audience you hear nothing but the robotic droning of a presenter paradoxically more bored with his speech than the yawning listeners. You wonder momentarily if a fly on the wall would be able to distinguish this scene from a narcoleptics anonymous support meeting. Then you realize flies are the jackasses of the insect kingdom (especially any fly that would stick around for this miserable lecture), and that it would be better to not drop too many IQ points thinking about flies.

You conveniently inhale the saliva you should have swallowed in a graceful attempt to breath at the wrong moment. Despite your best efforts to the contrary involuntary chaos ensues and you can’t help but cause those in your immediate vicinity to wish that they hadn’t refused the flu shot this year.

Cough physiology:

A cough is the body’s attempt to clear the breathing passages, namely the trachea (windpipe). It is a reflex that results from various events and nonevents stimulating the walls of the trachea, bronchi, or lungs. Events in this case are materials in the breathing passages that need to be cleared to promote normal respiration. Events include liquid, phlegm, dust, and other items inhabiting the breathing passages when they are better suited elsewhere. In this case the cough is not in and of itself pathological as it is necessary for unobstructed respiration.

What is a nonevent and who am I to use this kind of terminology in the discussion of cough? A nonevent is a stimulus in the breathing passages that leads to a cough, but this cough does not really provide a useful purpose other than helping indicate pathology of the lungs and/or respiratory passages.

Nonevents include dryness or damage to the breathing passages and inflammation. A cough in the case of pure dryness, purely damaged breathing passages, or pure inflammation does not actually clear the breathing passages, and can actually exacerbate the aforementioned conditions, in which case both the cough and the reason for coughing are pathological.

Now I say pure(ly) in the last sentence because these issues can sometimes result in phlegm production in the case of dryness or inflammation, and bleeding in the case of damage, in which case you have nonevents leading to events and a mixture of pathological and non-pathological coughing. If that doesn’t make sense read on and I’ll try to confuse you some more.

A non-event results in a cough even though there is nothing in the breathing passages to clear, thus defeating the whole purpose of the cough. Traditional Chinese Medicine (TCM) excels at treating both event and non-event coughing.

Excess vs Deficient Coughing

Health has always been, is currently, and hopefully will always be (or else I’ll need to find a new job, or expand my scope of practice) the result of balance. Any disturbance of health results from either having too much (excess) or not enough (deficient).

In the case of excess, cough can result from oppressive environmental influences, as well as internal accumulations.

Airborne pathogens

Environmental influences disturbing the healthy balance of the lungs are differentiated into two categories; wind heat and wind cold. These both usually result in what we know as the common cold, and in the western sense of looking at pathology usually involve an airborne viral infection. Chinese medicine says wind, western medicine says airborne. Chinese medicine says heat or cold, western medicine says viral or bacterial, you can say whatever is useful to you at the time.

This does not mean that heat and cold are the equivalent of a bacteria or virus, but in this particular instance it is helpful to make this association.

The Chinese medicine perspective, while appearing somewhat pagan, has its uses clinically. Wind can be thought of simply as mechanism of delivery of a pathogen from the environment to the host. So maybe someone coughs in your general direction and you take miscalculated whiff of their exhalation.

Or perhaps you pass the bottle around a room full of people trying to drown their flu symptoms in Kentucky bourbon. Either way, the bugs start outside your body, and find their way inside; that’s wind in the medical sense of the term.

Interaction between pathogen and host

Whether it is heat or cold depends upon the character of the pathogen, the condition of the host, and ultimately the interaction of the two. So certain viruses tend to cause more hot or cold symptoms, and certain hosts are more likely to experience hot or cold symptoms. As a cold spreads through a family or workplace symptoms in some cases are very similar (because caused by same virus or bacteria), but other times manifest as strikingly dissimilar (different host bodies react differently to the same pathogen).

Example:

Everyone at work catches the same bug thanks to the cut-backs on spending for ventilation. Most all infected get a cough and runny nose but for that one guy that always opens his eyes just a little too wide when describing his fish tank. He decides to stage a personal rebellion and gets a headache, nausea and back pain instead. His individual differences caused him to react to the same pathogen differently.

One overlooked fallacy of developing a one size fits all remedy for coughing due to the flu or common cold is the failure to take into account differences in the host. Even if you are dealing with the exact same pathogen, treatment efficacy and success is tantamount upon working with the interaction between the host and the pathogen. If you treat the pathogen as though it is in a closed off system, apart from the host (and if it really was it would eventually just die on its own, no treatment necessary), then success rates fall.

So let’s say you have a hot host (lucky you). There are a lot of ways to tell if a person tends toward running hot. People with a hotter constitution tend to shy away from clothing that is too warm, prefer cold beverages, and have reddish faces. There are more ways than this to infer that someone runs hot, and the absence of these does not necessarily indicate the absence of heat, but these are provided as general indicators. A hot host when invaded by a virus or bacteria that tends toward heat will almost invariably experience wind heat symptoms.

A cold host, which can be shown by the opposites of the above list, will prefer warm clothing, warm beverages, and have a pale face. As a side note, some people make themselves cold by drinking too many cold beverages, so it is important not to get too caught up on any one detail, but examine the whole picture. As you’ve probably guessed, cold person plus cold pathogen equals wind cold symptoms.

When the nature of the pathogen is opposite of the nature of the host the resultant interaction could be heat or cold, depending on whether the pathogenic temperature or the host temperature wins out.

All other factors being equal, a hot person with a hot pathogen will take longer to recover than a cold person with the same hot pathogen. You can probably fill in your own blanks for a cold person versus a hot person when they both encounter the same cold pathogen.

What is the wei qi?

Sorry to take this off on another tangential stream of unconsciousness (sounds like a good name for a band), but Chinese medicine has a elegant method of describing the body’s 1st line of defense, that is not quite the equivalent of what we know as the immune system, but it is close. The defensive qi, or wei qi (pronounced “way chee”) is the energetic firewall that circulates closest to the surface of our body like a bouncer at the door deciding who comes in and who doesn’t.

Some biologic manifestations of wei qi are the skin, mucous membranes, stomach acid, cilia lining respiratory tract, tonsils, and circulatory white blood cells. All of these elements (among others) play a role in preventing pathogens from gaining too strong a foothold in our system.

Back to the interaction between pathogen and host

People that run warm tend to have their defensive qi circulating closer to the surface (because heat rises) than those that run cold. That means they are less likely, all other factors being equal, than those with cold constitutions to get sick during cold season (if your guards are closer to the door it is less likely for someone to get through the door). Most common colds tend towards wind heat, or become that way if you wait long enough (at least in California, I don’t know what’s going on in Antarctica, perhaps there it would be different). The downside to having a constitution that runs hot though is that even though hotter people catch colds less often, when they do get seasonally sick it is typically more severe and lasts longer (hot pathogen plus hot host equals more severe disease).

Before you go wishing for a hot or cold constitution remember that balance beats both of these in the case of a common cold, and also in the case of preventing other illness that can result from tendencies towards heat or cold.

You probably have noticed that some people get sick almost as frequently as a daily commuter curses the traffic. Maybe the office bookie is giving odds on whether Joyce’s sick day will be before or after the 15th this month. Usually Joyce is not too incapacitated when she is sick, but the flip of a coin has more predictive value than Joyce’s pouty face in indicating bad weather or just being under it. On the other hand, there are those of us that can count the number of times we got sick in our entire lives on one hand. But when those from this camp do get sick it is as though the pits of hell have opened up to take residence their lymph nodes and respiratory passages.

There is a misconception that those that get sick more often develop a stronger immune system and so are less uncomfortable when they do get sick. If their immune systems were actually stronger they wouldn’t be getting sick in the first place.

Once again just to point out that balance wins, those that are truly in balance get sick less frequently, and when they do get sick it’s not that severe. Then there are those that couldn’t even score a 2.0 in the balance department who get frequently severely sick. The model above is useful for cold season however because most common cold sufferers (and most people for that matter) fall into the mildly imbalanced category.

Physiology and manifestation of wind heat and wind cold cough

Wind heat and wind cold both result in coughing. Both disrupt the usual lung function and circulation. The lung is supposed to take in energy from the air, in this case oxygen, and draw it down (if the breather is standing erect) from the nose or mouth through the trachea, through the bronchi, and finally into the lungs. The wind heat or cold disrupts this movement, resulting in the expulsion of air upwards and outwards. Both wind heat and wind cold may result in some inflammation of the throat which the cough will only serve to exacerbate (remember the nonevents I talked about earlier) leading to more coughing. But the two pathologies may also result in the formation of mucous, which the cough will aid in removing from the breathing passages, leading to less coughing.

In the case of wind heat the inflammation in the throat will be more severe and likely to result in soreness. Any phlegm should be thicker and yellow or greenish color. Wind cold has less inflammation and so throat will be more itchy than sore, mucous will be more thin and either clear or whitish colored. Inflammatory processes are usually thought of as hot but in the case of wind cold the inflammation results from the cold constricting or blocking circulation. The restricted circulation irritates the tissues of the throat and produces mild inflammation.

Print this section and put it on your medicine cabinet

So what is the use of all of this information? Well, many over the counter as well as prescription remedies disregard the differentiation between hot and cold. I shouldn’t say the remedies themselves disregard the differentiation; those that recommend or self-prescribe such remedies without regard to the differentiation disregard it.

Yeah, saying those that disregard are those that disregard is like saying green trees are green, but sometimes you don’t notice they’re green until someone points it out. These remedies have a hot or cold nature. So if you don’t know that you actually have wind cold and you take a wind heat remedy, you will actually either make your symptoms worse, or prolong recovery.

Sudafed, Tylenol, Advil, and every cold remedy you can think of have a specific temperature, and so will help in some cases but not others (unfortunately the temperature isn’t usually on the label). Recently a test was run on the over the counter airborne remedy to see if it actually decreases the length of the average cold more than the placebo. It failed to show significant effect. This wasn’t because airborne is necessarily bad, it’s because the maker of airborne, as well as the designer of the experiment never bothered to divide patients up into groups of wind heat and wind cold.

Airborne is basically a modification of a wind heat formula in Chinese medicine called Yin Qiao San (airborne has additional supplements and ingredients which may dilute its effectiveness but that’s a topic for another time).

Since most common colds present as wind heat, airborne should work in a majority of cases, but what happens when someone with wind cold takes it? Airborne may have had a significant effect over the placebo in the cases of wind heat, but all the patients with wind cold would have either gotten worse or had their colds drawn out longer, cancelling out any positive effect and yielding results either equivalent or worse than administration of a mere sugar pill.

Before you say, OK, this is easy, for wind heat take the wind heat medicine, and for wind cold take the wind cold medicine, note that different wind heat formulas will work best for their own specific brand of wind heat, as with wind cold. This means that two patients with wind heat may have symptoms that manifest differently, and be best suited taking formulas that differ from one another.

The prescription will change depending on the length of time you’ve been sick, as well as the predominant symptoms. If cough is the primary symptom then the formula will be different than if sore throat is the primary symptom. And these formulas will look nothing like the formula for predominant headache or body aches accompanying the common cold.

So for a mild cough and sore throat for about 2 days I might use something similar to the airborne formula. I’m going to recommend something entirely different for someone who has had 4 days of a productive cough that’s so severe it makes their already sore throat feels like razor blades are passing through it. Both are wind heat, but to get results each should be treated differently, because in the second case the wind heat has penetrated deeper into the body.

Internal accumulations

These issues sometimes still involve an airborne pathogen in the lungs but a greater emphasis is placed on removing accumulated material or deleterious energy from the lungs.

Accumulation of heat in lung

Heat can accumulate in the lung as a result of airborne pathogens moving deeper into the body. When called wind heat, you can more or less infer that the pathogen is moving through, inspecting the neighborhood, perhaps pitching a tent or checking into a hotel. In the case of heat accumulation the pathogen has signed an extended lease. Exposure to harsh chemicals or environmental pollutants can also lead to accumulation of heat in the lung (this includes cigarettes), with no involvement of a virus or bacteria. Finally, genetic predispositions can result in heat in the lungs (these can be mitigated by avoidance of the prior heat causes).

The Slobbering Toothless Drunk’s Guide to Traditional Chinese Folk Remedies says, “Wind heat pass through like door to door life insurance salesman. Accumulated heat stay too long, like ungrateful stepson, 35 year old and pee on floor next to toilet, never clean up.”

If the cough has been going on for longer than a month then it’s less likely to be wind. The exception is when coughing due to accumulated heat 1st starts, in which case the doctor needs to look at other factors.

Coughing will be louder than in wind heat, there may be heavier respiration sounds, greater quantities of phlegm, and more persistent coughing (like ungrateful stepson, eat all my damn chips). Cough with blood tinged sputum is almost without exception accumulated heat. Wind heat seldom produces a change in the tongue, but accumulated heat invariably turns the front quarter of the tongue redder than the rest of the tongue (this is the lung area on the tongue in TCM diagnosis).

Treatment of accumulated heat in the lungs requires first the removal of any environmental toxins promoting the imbalance. So find your peace and your center while inhaling succulent fresh air. Hire a ninja to lower themselves quietly from the ceiling like a spider and punch you in the back of the head whenever you’re about to light up a cancer stick. Maybe pay some kid from the neighborhood a quarter to point and laugh every time that happens. Quit your job at the coal mine and go work at a salt mine. Get out of the asbestos office and file a lawsuit while you’re looking for somewhere else to work.

If you really want to quit smoking and can’t afford to hire a ninja then you have the greatest statistical chance of success by quitting cold turkey. You can seek out a TCM practitioner to help you cope with the withdrawal symptoms while your body adjusts. After the withdrawal period TCM can be used to promote detoxification of the body in addition to diet and exercise.

Usually the accumulated heat cough is coupled with copious phlegm (this can change as the condition progresses, more on this later). The more phlegm you can cough out the better because that gets rid of the garbage that has built up in your lungs. You can also take some clear heat and expectorate phlegm herbs from your friendly neighborhood acupuncturist/herbalist.

Accumulation of phlegm in the lung – Wind dampness

I would like there to be only two kinds of wind when it comes to discussing the lungs but I wasn’t included in the committee that voted on what diseases humans would suffer from. There are also viruses and bacteria that have a tendency to cause dampness, fluid accumulations, and phlegm. As you may have guessed, when these pathogens interact with damp people the effect is more severe than when they interact with dry people.

Wind dampness can result from living in damp cool environments like San Francisco and tends to be worse with exposure to mold.

Wind dampness is not too difficult to recognize clinically, usually the nose is dripping clear fluid. Cough is productive but bringing up the phlegm isn’t usually as audible as the phlegm in accumulated heat coughing. Often times you’ll bring up some phlegm without even hearing it, a fun surprise the whole family can enjoy, like that gum that squirts liquid out when you bite into it.

The Exhausted Rice Farmer’s Celestial Pivot on 1000 Cures says, “Wind dampness cough like crow caw, nothing write home about, caw, caw, caw, who care? Learn new song, dumb crow, who ask your opinion? Accumulated heat cough like crazy maniac turkey 4 in morning run by window, gobble, gobble, gobble, every day, 5 year, I shoot you turkey, shoot you in head! Every day give me heart attack, crazy turkey, go wake up hungry wolf.”

Roots of Eastern Medicine Acupuncture Clinic does not support the anti-avian sentiment of the exhausted rice farmer but does sympathize with those who have lost sleep due to being harassed by crazy maniac turkeys.

The phlegm will be white or slightly yellow depending on whether the dampness is more cool (white) or more warm (slight yellow). Yep, most patients are a blend of many factors overlapping, in this case wind and dampness can coexist with both heat and cold. Dark yellow or green phlegm is strictly seen in wind heat and accumulated heat coughing.

Herbs for this condition include expectorants primarily, coupled with those that clear either wind heat or cold depending upon diagnosis.

Deficiency Coughing

The concept of excess coughing is large and ever present in most literature on coughing. Excess coughing means there is too much of something in the body such as too much inflammation, too much mucous, too much bacteria (or virus), too much smoke, etc.

The concept of deficiency however while ever present in Chinese medical texts is not really presented in the average Western medical text discussing the anatomy and physiology of coughing. This is why many cases of chronic cough stay chronic. When doctors attempt to remove things from a system that is already in the negative numbers their efforts are largely futile.

Digestive qi deficiency leading to the accumulation of phlegm in the lungs

Every 1st year TCM student learns that a malfunctioning or weak digestive system produces phlegm which is then contained in the lungs. Weak digestive processes lead to poor fluid metabolism and can result in coughing with phlegm, with a cough quality similar to the wind damp cough. Most TCM books say this cough sounds feebler than wind dampness but clinically this can be difficult to distinguish. Patients with this condition usually have been coughing longer than a month when they visit the doctor (unless they come when the condition has just begun). Wind dampness coughing is more short-lived.

In addition to coughing up phlegm these patients will present with some digestive complaints. These vary, but may include stomach pain or discomfort, poor appetite, nausea, and loose stools or diarrhea. They will also typically feel fatigued and/or cold.

In this case it is OK to use expectorants for short term improvement, but this will never cure the condition, and if this is the only intervention it could actually weaken the digestive system, exacerbate the severity of the coughing, and result in a condition more difficult to treat. Antibiotics are sometimes mistakenly prescribed for this condition due to overlooking digestive complaints. As antibiotics don’t tend to agree well with the digestive system this intervention best case scenario produces no change, but more likely will aggravate the coughing.

To treat qi deficiency coughing appropriately the patient must consume primarily mild, easily digestible foods (rice porridge with scallions and ginger is one good choice, among others, barring any allergies to these items). This should be coupled with warming, energy promoting herbs, as well as digestive stimulants, all of which are completely absent from the Western Pharmacopeia for cough treatment at the time of writing this article. This means you either need to see an herbalist/acupuncturist to get the right ones, or self diagnose and just pick them up from the herbal pharmacy yourself.

Take precaution in self diagnosis in this case because any poor choices could make your digestive system worse and intensify your cough. Warming, tonifying, digestive stimulants can be combined with some mild expectorants to provide faster relief.

Some food allergies such as lactose intolerance can lead to this kind of cough. By appropriate strengthening of the digestive system the TCM practitioner can reduce sensitivity to lactose as well as eliminating the cough. While still coughing it is advisable to avoid dairy products and other allergenic or hard to digest foods.

Qi deficiency coughing is not the only condition whereby the lungs and the digestive system share an intimate bond. The lungs and the large intestine are often paired in Chinese medicine theory. The lung meridian flows directly into the large intestine meridian, both the lungs and the large intestine have orifices that lead to the surface of the body, and both share in expelling wastes from the body.

In the case of accumulated heat lodged in the lungs, sometimes heat will transfer to the large intestine leading to dry stools and or constipation. Note that not every cough coupled with digestive complaints is a qi deficiency cough; you must still examine the nature of the cough and what kind of digestive complaints present before you decide. Admittedly what I just presented was a problem of excretion and not necessarily digestion, but digestion can and will produce changes in excretion so these categories overlap. Some of the herbal and dietary remedies that help with qi deficiency coughing will exacerbate accumulated heat in the lungs. Proper diagnosis is once again the key to successful treatment intervention.

The Outhouse Toilet Paper Salesman’s Intestinal Health Cookbook and Chinese Proverbs says, “Qi deficiency uncork you like many times shake champagne bottle. This no time drive car long trip. Minimum two rolls toilet paper. Accumulated heat in lung dry you up like vast desert wasteland. Better buy newspaper too. You long time sit on toilet maybe fart only.”

Side note – Cystic Fibrosis

Western medical literature hints at the relationship between the digestive system and the lungs in the pathology of cystic fibrosis. This condition presents as a more severe version of qi deficiency coughing and should be treated in a similar albeit more aggressive manner. The western pathology of this disease is a genetic defect whereby a protein that controls water and salt movement is either defective or insufficient. This results in accumulation of phlegm which reduces digestive function and lung function leading to coughing with phlegm, wheezing, loose and greasy stools, fatigue, and other symptoms related to digestion and respiration.

The current Western medical intervention does not provide a cure for this condition but rather seeks to mitigate the symptoms through mucolytics (dissolve mucous), bronchodilators to widen the air passageways, decongestants to further widen air pathways, and antibiotics in the case of infections. At the time of writing this article research is being done to treat the affected gene.

The current treatment while necessary and helpful in treating the effects of this condition would be enhanced through coupling the therapy with Chinese medicine techniques. First and foremost the digestive system must be promoted through the techniques discussed in digestive qi deficiency coughing. Secondly any genetic pattern of disease should include treatment of the kidneys. The kidney system in Chinese medicine is the closest phenomenon in Chinese medicine to the DNA as it is believed the kidney system is inherited from the parents and accounts for 50% of our development. In TCM the other 50% comes from environmental stimulus which is most dependent upon the digestive system.

Kidney Qi Def Cough

This type of coughing is rarer and is typically only seen in older or very weak patients. This cough will have some white mucous production like the qi deficient cough. When the patient coughs they may experience urinary incontinence. Additionally the patient will most likely feel cold, take frequent trips to the bathroom to urinate, have low libido, and feel fatigued.

Patients like this should practice Qi Gong mediation (so should most patients, but these especially), restrain from sexual activity, and take warming herbs to promote kidney function in addition to some herbs to help clear phlegm from the lungs.

So we finally come to the most misdiagnosed and poorly treated cough by standard techniques (but getting better as more people utilize TCM, let’s spread the word). Most patients that come to my office with this cough were either told or inferred on their own that it was due to postnasal dripping. This is when watery mucous dropping from the back of the nasal passages into the throat causes random coughing fits. Actual post nasal drip though will not present with a dry nose, some will drip from the pre nasal area as well. This means there will be a runny nose in addition to coughing. The cough from true post nasal nasal drip has a similar character and etiology to qi deficiency coughing and wind dampness coughing.

What is actually happening in yin deficiency coughing (not post nasal drip) is the purest case of non-event coughing that I will present in this article. The lungs, bronchioles, and trachea in this case are so dry that it creates an itching sensation in the throat just like dry skin can feel itchy. Unfortunately moisturizing hand cream is does not sell as an inhalant, and the standard version of this product is not recommended for this particular usage.

Any external stimulus, the finest particle of dust, or pollen, or cat dander will create an unbearable itchiness in the already sensitive breathing passages that serves to send the unsuspecting breather into a fit of dry coughing which further dries out the air passages and the cough reproduces itself like rabbits after the spring equinox.

This cough can be the result of various factors but the most common I see are poor sleeping habits, perimenopause and menopause, living in a dry climate, overindulgence in coffee and/or spicy foods, genetic predisposition, and the transition from phlegm to dryness from long term heat accumulated in lungs. What happens in most of these cases is either heat or dryness damages the fluids of the lungs. If this continues for too long it can result in tissue damage as well.

The damage begins with the cilia which are hair like particles in the respiratory passages which filter out particles from the breath. Without cilia more environmental debris are present to irritate the respiratory lining and cause coughing.

Lung Yin Deficiency and Allergies

The dryness and possible tissue damage to the respiratory tract results in hyper sensitivity to environmental stimuli and is a major factor in many respiratory allergies. Any of the lung pathologies discussed previously in this article can result in sensitivity to environmental stimuli not normally considered pathological but a great majority of the allergy cases linked to coughing I see are due to lung yin deficiency.

In Chinese medicine the tissue associated to the lungs is the skin because the lungs are the organ that most closely interacts with the external world and the skin is the tissue that does the same. This may help explain why treating the lungs with TCM intervention often helps with allergy symptoms even in the presence of a positive scratch test. A scratch test is a method whereby the suspected allergen is placed on the skin and the skin is pricked to see if there is any unusual reaction or inflammation thereby evaluating the body’s sensitivity to that substance.

Symptoms of Lung Yin Deficiency

In lung yin deficiency coughing the cough will usually be dry. There may be very minimal phlegm production but it will be extremely viscous and scanty, no watery fluid coming from the nose. TCM explains the presence of phlegm in this case through the interaction of heat or dryness with the body fluids. The heat or dryness evaporates the fluids (which are normally secreted by the mucosal lining of the respiratory tract) leaving behind a residue of the constituent solids present in the body fluids. This process gradually thickens the fluids into a viscous substance that results in untimely vocal mishaps in karaoke bars across the country.

The phlegm in lung deficiency cough is almost not worth mentioning though. The cough will either be completely dry or mostly dry with periodic highlights of scanty phlegm expectoration during which time the cough sounds slightly productive.

The Limping Sage’s Discussions on the Development of Hard Qi through Boulder Kicking says, “When cultivating the breath clarity of flow is tantamount. Recognize salivations. Swallow clear and sweet fluids, this is the nectar of angels. Thick and dirty fluids are like the soil after a heavy rain that would invite the gathering of many swine. These should be quickly expelled. Dry and sparse secretions like deep desert clay should remain buried. No, Mao Mei Li, my foot was gored by a possessed bull during the great bovine exorcism of BC 166. Speak out of turn again and your tongue will find its resting place among the ashes of our fathers.”

Most likely the dry and sparse secretions he speaks of are pointing to the character of the miniscule phlegm that can develop with lung yin deficiency. He says to allow this to stay where it is because when you are dealing with dryness it is best to keep as much fluid is possible. But this was written in ancient China where provisions may have been unavailable for treatment. These days it doesn’t really hurt to spit this stuff out if you bring it up; any dryness can be moistened by the techniques that follow.

Some other factors that may help point to lung yin deficiency condition are night sweats, feeling hot at night, easily waking up at night, frequent thirst, and the front quarter of the tongue appearing red with scanty or no lingual coating. Lung Yin Deficiency like accumulated heat may result in dry stools or constipation.

Treatment of Lung Yin Deficiency Coughing

Treatment for this condition is relatively straightforward. As before the patient must be removed from any environmental stimuli that exacerbate the condition if possible. After that a diet and herbal remedy that cools heat, moistens dryness, and promotes respiratory tract repair should be recommended according to your specific case of lung yin deficiency. A good herbalist will be able to narrow down a good regimen for your specific case of lung yin deficiency.

As far as I know there is no intervention at the time of writing this article in the Western Pharmacopeia that performs this function. Sometimes doctors may recommend sitting in a steam room, but the effects of this methodology are only temporary. This works better for thick copious phlegm that won’t come up.

In the case of dry cough often times Western treatment involves a cough suppressant that attempts to interfere with the cough reflex itself. But because we are so hard wired to cough when the body perceives deleterious substances in the respiratory tract (which is important because our very survival depends on this reflex) these medications rarely work. Traditional Chinese medicine intervention is the way to go for this one.

Lung Yin Deficiency vs Accumulated Heat in the Lungs – COPD

It is helpful to examine these two together because for one they provide a good model for the explanation of the development of chronic obstructive pulmonary disease (COPD) for chronic smokers and the dichotomy between emphysema and chronic bronchitis.

When smoking remains at the stage of accumulated heat it usually eventually leads to chronic bronchitis. When the smoker has a genetic predisposition to dryness, or the when the heat overwhelms the body fluids so much that the phlegm dries up the result is lung yin deficiency. If smoking persists in this case emphysema develops.

In chronic bronchitis the primary symptoms are inflamed respiratory passages and copious phlegm production. This results in frequent coughing with phlegm and difficulty breathing. Frequent infections will result because bacteria are easily trapped in the copious mucus of the respiratory passages. The infections can result in some damage to the trachea and formation of scar tissue known as bronchiectasis, which further obstructs breathing and traps bacteria causing more inflammation, more phlegm production, and more frequent infections.

In emphysema symptoms are dry in comparison to chronic bronchitis. Eventually dryness causes the lung tissue to break down. The alveoli, which are the functional unit of the lungs where oxygen is exchanged for carbon dioxide, become damaged. This reduces the elasticity of the lungs so air becomes trapped inside. This results in less space for new air to come in during each inhalation and shortness of breath.

Both emphysema and chronic bronchitis can result in poor oxygenation of the blood, pulmonary hypertension, fatigue, headaches, and general nihilistic misery. If you are a smoker currently and you periodically get a productive cough (in general or just when you are sick) chances are you will develop chronic bronchitis if you continue to smoke. If you tend more towards wheezing and dry cough however you will probably get emphysema if you continue to smoke. Most smokers develop a combination of emphysema and chronic bronchitis, but the respiratory ailments they have prior to this development shed some light on whether they will have a tendency towards one or the other.

To help ameliorate some of the malcontented despondency that is COPD the TCM practitioner should utilize same treatments for lung yin deficiency and accumulated heat in the lungs. If emphysema is more prevalent the treatment should focus more on nourishing the yin and moistening the lungs. If chronic bronchitis is more prevalent then treatment should focus on clearing heat and dissolving phlegm.

General Tips for Coughing Conditions

In almost every lung pathology the upper back and neck should be treated with acupuncture and/or tui na medical massage. One route of communication between the lungs and the brain is through the spinal nerves which exit the spinal cord and innervate the lungs through the upper back. Any impingements here can both lead to lung malfunction (an impinged nerve sends inappropriate signals and can lead to inappropriate responses) and be exacerbated by coughing (when coughing causes the muscles in these areas to tighten and spasm).

Treatment of the upper back also improves circulation to tissues surrounding the lungs enhancing the efficiency of the immune system to fight off infection as well as the ability of the blood (by virtue of its enhanced circulation) to moisten dryness and repair tissue damage.

This technique also aids to dislodge phlegm through two mechanisms. The first is local stimulation (the neck being local to the trachea and the upper back local to the lungs) will help jostle phlegm loose so it can be coughed out. The second is that loosening tight muscles around the lungs will increase air flow during relaxed breathing (increased air flow loosens phlegm by agitating it).

It is very rare to see pure lung pathology in the case of a chronic cough. In acute coughing due to upper respiratory tract infections it’s usually appropriate to treat the lungs alone. Chronic lung conditions however both arise from and cause problems in other organs. Usually the digestive system is the affecter/effected system in chronic lung pathology but there can also be related issues in the kidneys, heart, or liver.

These concurrent pathologies can be discovered in addition to lung pathology during diagnostic questioning, palpation, and visual examination, and should usually be treated concurrently with the appropriate acupuncture, acupressure/massage, herbs, exercise, and dietary recommendations. If the lungs are treated alone progress can and will plateau especially when the concurrent pathology is the primary cause of the coughing.

It is of utmost importance to avoid environment stimuli that are adding to the burden of the lungs. The cougher must avoid hazardous inhalants as well as causative dietary factors. In the case of phlegm production it’s useful to avoid dairy (even if you’re not lactose intolerant, just while the cough persists), oily greasy foods, and sugary foods. For any of the heat conditions (wind heat, accumulated heat, and yin deficiency) eating spicy foods is equivalent to fighting fire with gasoline. Overindulgence in spicy foods is often sufficient to cause accumulated heat or yin deficiency apart from other factors.

The Door to Door Life Insurance Salesman’s Tips on Surviving Public Transport says, “Exuberant projectile coughing directed at other passengers is a tried and true way to create space on a crowded bus. It’s also a great way to get thrown off the bus.”

Roots of Eastern Medicine Acupuncture Clinic

www.acuroots.com