Library

Chen Wuzhe stated: Cough caused by wind injury is characterized by aversion to cold with high fever, spontaneous sweating, aversion to wind, dry mouth, and irritability. Cough caused by cold injury is characterized by aversion to cold with fever, absence of sweating, aversion to cold, irritability, but no thirst. Cough caused by summerheat injury is characterized by vexatious heat, desire for drinking, dry mouth, or expectoration of saliva, hoarseness, and hemoptysis. Cough caused by dampness injury is characterized by vexatious pain in the bone joints, heaviness in the four limbs, and chills (Shaxi). These belong to external causes. If cough originating from the five zang organs persists and is not cured, it will transmit to the six fu organs; this belongs to internal causes. For example: cough accompanied by alternating chills and fever with pulling pain in the lower back and abdomen, or panting and chest fullness, is due to kidney injury from sexual exhaustion; or epigastric fullness and abdominal distension, qi rebelling and seizing the heart causing pain, and loss of appetite, is due to spleen injury from irregular eating; or cough with left hypochondriac pain pulling into the lower abdomen and knee/wrist pain, is due to liver injury from extreme fatigue; or expectoration of white saliva, dry mouth, and hoarseness, is due to lung injury from excessive shouting; or cough with vexatious heat, spontaneous sweating, dry throat, and hemoptysis, is due to heart injury from mental overexertion. All these belong to "neither internal nor external causes."

If the chi pulse is floating, choppy, and rapid, it indicates kidney injury; if the right guan pulse is soggy, it indicates spleen injury from diet; if the left guan pulse is wiry and short, it indicates liver injury from extreme fatigue. But if the Renying and Qikou pulses do not show abnormalities, it is a neither internal nor external cause.

Yan Shi stated: Cough initially involves the lung and ultimately gathers in the stomach, causing excessive phlegm and saliva, facial edema, and rebellious qi. The treatment principle should examine the pulse and symptoms to distinguish the three causes. If it is an external pathogenic factor, dispersing and releasing the exterior is appropriate, but one must also investigate deficiency/excess and cold/heat. If it is an internal cause related to the seven emotions, judgment should be made based on the corresponding meridian and Qikou pulse: a floating and tight pulse indicates deficiency-cold, while a surging and slippery pulse indicates abundant phlegm. Regulating qi should come first, followed by resolving phlegm. If cough is caused by retained fluid, it must be transformed and resolved. One must absolutely avoid using astringent and sour medicines such as Cornus Fructus (Wumei) and Poppy Capsule (Suke). When cold pathogens have not been eliminated, tonifying medicines should not be used. Especially, one must avoid excessive worry and thought, and sexual exhaustion, lest it develop into consumptive disease (Zhai Ji).

Commentary: This discussion of cough covers the three causes comprehensively and can be considered detailed. However, the manifestations of external causes differ from Qian Hezi's discussion of the six qi. This is likely because it refers to external contraction of pathogens, which is different from pathogenic factors lodging in the lung. It is a pity that the formulas for various causes are not fully prepared. The discussed pulse, symptom, and treatment methods are extremely subtle and penetrating. The prohibition against casually using astringent and tonifying methods aligns well with the major principles of therapy. Generally, the root of such conditions is often excess, so one should not casually use astringent or tonifying methods. However, those who cannot avoid worry and thought, fail to abstain from sexual activity, have irritable temperaments, or suffer from Tuoying (depletion of essence/blood) are difficult to treat.