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The full text of *Suwen: Treatise on Cough* (Appendix: Treatment Methods for Cough Syndromes)

Huangdi asked, "Why does the Lung cause coughing?" Qibo replied, "All five Zang organs and six Fu organs can cause coughing; it is not exclusive to the Lung." ("Ling" is pronounced with a level tone. "Ke" is pronounced 'Kang-gai'.) Huangdi said, "I wish to hear about its manifestations." Qibo said, "The skin and hair are the exterior correspondence of the Lung. When the skin and hair are first invaded by pathogenic factors, these pathogens follow this correspondence to enter the Lung." (By "pathogenic factors," we mean wind-cold. If the skin and hair are first affected, the disease enters the Lung, thus following its exterior correspondence.) If cold food and drink enter the stomach, the coldness ascends along the Lung meridian to the Lung, causing Lung cold. With Lung cold, external and internal pathogens combine and lodge in the Lung, resulting in Lung cough. (The Lung meridian originates in the middle Jiao, follows the stomach opening, ascends through the diaphragm, and connects to the Lung. Therefore, the coldness from dietary intake in the stomach ascends to the Lung via the Lung meridian. The statement "external cold and cold drinks injure the Lung" precisely refers to this section.) Each of the five Zang organs receives pathogenic influence during its respective season. If illness occurs outside these seasons, it is transmitted from other organs. (For example, the Liver should receive pathology in spring, as that is its ruling season; however, if Liver disease occurs outside the Wood season, it is because the Lung was first invaded by pathogens and subsequently transmitted the disease to the Liver. This principle applies to all Zang and Fu organs receiving pathology out of season. Thus, although all Zang and Fu organs can produce cough, none occur without involvement of the Lung.) Humans correspond with Heaven and Earth; therefore, each Zang organ becomes diseased when exposed to cold during its ruling season. Mild exposure results in cough, while severe exposure leads to diarrhea or pain. ("Zhi shi" refers to the time of the ruling season. The aforementioned combination of external and internal pathogens corresponds to these symptoms. Mild pathogens remain superficial, hence cough; severe pathogens penetrate deeply, hence diarrhea or pain.) In autumn, the Lung is first invaded; in spring, the Liver; in summer, the Heart; during the late summer (extreme Yin period), the Spleen; and in winter, the Kidney. (This refers to receiving pathology during the ruling season. Thus, during its specific season, an organ is inevitably the first to be affected.)

Huangdi asked, "How can they be distinguished?" (Hereinafter, the differences among the five Zang coughs are differentiated.) Qibo said, "The manifestation of Lung cough includes coughing with wheezing and audible sounds; in severe cases, blood is expectorated. (The Lung governs Qi and respiration, hence wheezing with sounds. Expectorating blood differs from vomiting blood as the pathology resides in the Lung.) The manifestation of Heart cough includes cough accompanied by heart pain, a sensation of obstruction in the throat as if something were stuck, and in severe cases, sore throat and throat bi-syndrome. (The Heart meridian originates in the heart, emerges to connect with the heart system, and ascends to flank the throat; thus, pathology manifests as throat obstruction, swelling, and bi-syndrome. 'Jie jie' describes a feeling of obstruction or hindrance.) The manifestation of Liver cough includes pain in both hypochondriac regions upon coughing; in severe cases, turning the body is impossible, and doing so causes fullness in the hypochondriac areas. (The Liver meridian spreads over the costal and hypochondriac regions, hence such pathology. [Character] refers to the area below the armpit and hypochondrium. [Character] is pronounced 'qu' or 'qu'.) The manifestation of Spleen cough includes pain in the lower right abdomen upon coughing, dull pain radiating to the shoulder and back; in severe cases, movement is restricted, and any movement exacerbates the cough. (The Spleen meridian ascends through the diaphragm to flank the throat; its branch diverges from the stomach, ascends through the diaphragm, hence pain in the [area] radiating to the shoulder and back. The Spleen corresponds to Earth, whose nature is static; thus, in severe cases, movement is restricted, and activity aggravates the condition. Note: Spleen cough causing pain in the lower right abdomen occurs because Yin Earth energy corresponds to Kun, emerging from the southwest. As stated in *Ping Ren Qi Xiang Lun*: 'The great collateral of the Stomach is named Xuli, piercing the diaphragm and connecting to the Lung, emerging below the left breast.' Does this not indicate that Yang Earth energy corresponds to Gen, emerging from the northeast? Humans correspond with Heaven and Earth; principles are universally consistent. 'Ju' means extreme.) The manifestation of Kidney cough includes pain in the waist and back that pulls together upon coughing; in severe cases, saliva is coughed up. (The Kidney meridian pierces the spine and ties to the waist and back, hence pulling pain. Its straight branch enters the Lung, follows the throat, hence expectoration of saliva in severe cases. Since the Kidney is the Water organ, it governs saliva and fluids.)

Huangdi asked, "What about coughs of the six Fu organs? From where do they receive pathology?" (Hereinafter, the differences among the six Fu coughs are differentiated.) Qibo said, "Prolonged cough of the five Zang organs shifts to the six Fu organs. (If prolonged cough of the five Zang organs persists, the disease extends to the Fu organs, transferring between interior and exterior based on their pairings.) If Spleen cough persists, the Stomach is affected; the manifestation of Stomach cough includes coughing with vomiting; in severe cases, roundworms are expelled. (The Spleen and Stomach are paired; thus, persistent Spleen cough inevitably affects the Stomach. If the Stomach cannot accommodate, Qi rebels upward causing vomiting. Chang chong refers to roundworms, residing in the intestines and stomach; severe vomiting expels them upward. 'Hui' is the pronunciation.) If Liver cough persists, the Gallbladder is affected; the manifestation of Gallbladder cough includes coughing with vomiting of bile. (Bile is bitter sweat.) If Lung cough persists, the Large Intestine is affected; the manifestation of Large Intestine cough includes coughing with fecal incontinence. ('Yi shi', written as 'yi shi' in *Jia Yi Jing*, refers to Large Intestine pathology. 'Shi' is synonymous with stool.) If Heart cough persists, the Small Intestine is affected; the manifestation of Small Intestine cough includes coughing with flatus, where gas is expelled simultaneously with coughing. (Below the Small Intestine lies the Large Intestine. Qi of the Large Intestine derives from transformation by the Small Intestine; thus, when the Small Intestine is invaded and causes cough, Qi rushes downward causing incontinence.) If Kidney cough persists, the Bladder is affected; the manifestation of Bladder cough includes coughing with urinary incontinence. (The Bladder is the reservoir of fluids; thus, when pathogens reside there, coughing accompanies incontinence.) If prolonged cough persists, the San Jiao is affected; the manifestation of San Jiao cough includes coughing with abdominal fullness and loss of appetite. (Persistent cough affects the Upper, Middle, and Lower San Jiao; excretion, intake, ascending, and descending functions lose harmony, causing abdominal fullness and inability to eat or drink.) All these coughs gather in the Stomach and relate to the Lung, causing excessive phlegm and saliva, facial edema, and rebellious Qi. (Hereinafter, various cough syndromes are summarized, touching upon treatment. All coughs gather in the Stomach and relate to the Lung because the Stomach is the root of the Zang and Fu organs, and the Lung is the exterior correspondence of the skin and hair. As mentioned earlier, external invasion of skin/hair and cold drinks entering the Stomach are signs of Lung and Stomach pathology. The Yangming meridian originates at the nose, meets at the face, and emerges at the mouth, hence causing excessive phlegm/saliva and facial edema. The Lung covers the Zang and Fu organs and governs Qi, hence causing cough and rebellious Qi.) Huangdi asked, "How should they be treated?" Qibo said, "To treat Zang disorders, select Shu (Stream) points; to treat Fu disorders, select He (Sea) points; for edema, select Jing (River) points." Huangdi said, "Excellent." (Points where Qi flows are Shu points; points where Qi enters are He points; points where Qi travels are Jing points; this applies to all Zang and Fu organs. See Meridians Class, chapters 14 and 16. My commentary: Cough syndromes necessarily involve the Lung, yet this chapter states 'all Zang and Fu organs cause cough,' and 'each Zang receives pathology in its season, transmitting to others if not in season,' indicating pathology is not limited to the Lung. Generally, cough has distinctions between internal injury and external contraction. Pathology may transmit from the Lung to the five Zang organs, or from the five Zang organs to the Lung. For instance, wind, cold, summer-heat, and dampness invading externally first affect the skin and hair. Since skin and hair are the Lung's exterior correspondence, unresolved pathogens transmit from the Lung to other Zang organs. Conversely, labor, desire, and emotional injuries internally damage Zang Qi, starting from the Yin aspect affecting the Upper Jiao, transmitting from other Zang organs to the Lung. External invasions affect Yang; thus, treatment must release from the exterior using acrid and warm methods to disperse pathogens, clearing Lung Qi and resolving cough. Internal injuries damage Yin; deficiency of Yin below causes floating Yang above, drying Water and Withering Metal, making the Lung dry and itchy, leading to persistent cough. Treatment requires sweet flavors to nourish Yin and moistening agents to nourish the Lung, restoring Water and Qi to calm the Lung. Generally, treating exterior pathogens requires herbs that do not stagnate; stagnation prevents resolution and may generate further pathology, hence cold and astringent formulas are contraindicated, as stated in *Wu Zang Sheng Cheng Pian*: 'The Lung desires acridity.' Treating interior syndromes requires herbs that do not scatter excessively; scattering unsettles deficient fire and fails to restore True Yin, worsening dryness and itching, aggravating the disease. Hence, acrid and aromatic Yang-assisting formulas are contraindicated, as stated in *Xuan Ming Wu Qi Pian*: 'Acridity moves Qi; avoid excessive acrid consumption in Qi disorders.' However, while exterior treatments favor dispersion, if both constitutional Qi and pathogenic Qi are deficient, one must tonify Middle Qi and assist with warm-releasing herbs. Exclusive dispersion may weaken Lung Qi further, loosen interstices, allow easier pathogen entry, and worsen the condition. While interior treatments favor stillness to nourish Yin, if Mingmen Yang is deficient and fails to grasp Qi, herbs like Ginseng, Dried Ginger, Cinnamon Twig, and Aconite Root are necessary; otherwise, Qi fails to transform fluids, failing to aid Yin nourishment. For heat pathogens, clear heat; for damp pathogens, promote diuresis; for phlegm, resolve phlegm; for Qi stagnation, regulate Qi. Although medical texts list many categories, seeking the root reveals that wind-cold and exhaustion account for eight or nine out of ten cases. Wind-cold is attributed to excess Yang; exhaustion is attributed to Yin deficiency. This is the guideline for cough syndromes. Other symptomatic treatments merely adjust based on observed signs and are not root-treating methods. For elderly patients with chronic cough, since Yuan Qi is already deficient, complete cure is difficult. Warm-tonification of Spleen and Lung, possibly combined with symptomatic treatment, is preferred, aiming only to prevent emaciation and debility. Seeking miraculous effects through aggressive attack is inadvisable. Treating disease is inherently difficult, and treating cough is particularly challenging due to lack of key principles. I have outlined the general approach here; readers should not dismiss it as insufficiently detailed.)