Discussion on Coughing in Chapter 38 of the Huangdi Neijing

【Huangdi Neijing】 The Huangdi Neijing is the earliest and most influential comprehensive medical text in China, revered as the “source of medicine” by later generations. It is divided into two parts: Suwen and Ling Shu, and is one of the four classic texts of traditional medicine. Based on the theories of Huang-Lao Daoism, it established the TCM concepts of “Yin-Yang and Five Elements Theory”, “Pulse Theory”, “Zang-Xiang Theory”, “Meridian Theory”, “Etiology”, “Pathogenesis”, “Symptoms”, “Diagnosis”, “Treatment”, as well as “Health Preservation” and “Qi Regulation”, discussing medicine from a holistic perspective and presenting a model of “integrative medicine” that encompasses nature, biology, psychology, and society.【Key Points of This Chapter】1. The pathological changes of coughing are primarily associated with the lungs, but the dysfunction of the other five organs can also affect the lungs, leading to coughing.2. The onset of coughing is significantly related to the four seasons.3. Prolonged coughing can lead to the transfer of disease from the organs to the bowels.4. Treatment principles for coughing are outlined.【Original Text】The Yellow Emperor asked: What causes coughing related to the lungs? Qi Bo replied: All five organs and six bowels can cause coughing, not just the lungs. The Emperor said: I wish to know the symptoms. Qi Bo said: The skin and hair are associated with the lungs. The skin and hair first receive external pathogenic factors, which then affect the lungs. If cold food and drink enter the stomach, the cold travels up the lung meridian to the lungs, causing lung cold. When the lung is cold, the internal and external pathogenic factors combine, leading to coughing. Each of the five organs can be affected by disease at their respective times, not just during the lung’s time.Humans correspond with the natural world, so each organ is affected by cold at its respective time: mild cases lead to coughing, while severe cases can result in diarrhea and pain. In autumn, the lungs are first affected; in spring, the liver; in summer, the heart; in late summer, the spleen; and in winter, the kidneys.The Emperor asked: How can they be differentiated? Qi Bo replied: The symptoms of lung cough include coughing with wheezing and sound, and in severe cases, spitting blood. The symptoms of heart cough include chest pain when coughing, a sensation of obstruction in the throat, and in severe cases, swelling and blockage of the throat. The symptoms of liver cough include pain under the ribs on both sides, and in severe cases, inability to turn, with fullness under the ribs. The symptoms of spleen cough include pain under the right rib, with a pulling sensation in the shoulder and back, and in severe cases, inability to move, with movement exacerbating the cough. The symptoms of kidney cough include pain in the lower back, and in severe cases, coughing up phlegm.The Emperor asked: What about coughing related to the six bowels? How does one receive the disease? Qi Bo replied: If coughing from the five organs persists, it can transfer to the six bowels. If spleen cough persists, the stomach will be affected. The symptoms of stomach cough include coughing and vomiting, and in severe cases, expelling worms. If liver cough persists, the gallbladder will be affected, with symptoms of coughing and vomiting bile. If lung cough persists, the large intestine will be affected, with symptoms of coughing and incontinence. If heart cough persists, the small intestine will be affected, with symptoms of coughing and loss of breath, often occurring simultaneously. If kidney cough persists, the bladder will be affected, with symptoms of coughing and incontinence. If coughing persists, the Sanjiao (Triple Burner) will be affected, with symptoms of coughing and abdominal fullness, leading to a lack of appetite for food and drink. All these conditions are related to the stomach and lungs, causing excessive phlegm and facial swelling with reversed qi.The Emperor asked: How should it be treated? Qi Bo replied: For organ-related coughs, treat the corresponding acupoints; for bowel-related coughs, treat the associated points; for coughs with swelling, treat the relevant meridians. The Emperor said: Good.【Notes】1. Treatment time: Each organ corresponds to its peak season. The liver corresponds to spring, the heart to summer, the spleen to late summer, the lungs to autumn, and the kidneys to winter.2. Sensation of obstruction in the throat: Describes a feeling of something blocking the throat.3. Both sides of the ribs: Refers to the area under the armpits and ribs.4. All these conditions are related to the stomach and lungs: Regardless of which organ or bowel is affected, the cold pathogens accumulate in the stomach and relate to the lungs, indicating that while all five organs and six bowels can cause coughing, the relationship with the stomach and lungs is the closest.

【Translation】

The Yellow Emperor asked: What is the reason that diseases of the lungs can cause coughing? Qi Bo replied: Diseases of all five organs and six bowels can cause coughing, not just lung diseases. The Yellow Emperor said: Please tell me the symptoms of various coughs. Qi Bo said: The skin and hair correspond to the lungs; they first receive external pathogens, which then affect the lungs. If cold food and drink enter the stomach, the cold travels up the lung meridian to the lungs, causing lung cold, which leads to the combination of internal and external cold pathogens, resulting in lung cough. This is the situation of lung cough. As for coughs from the five organs and six bowels, each organ is affected at its respective time, not just during the lung’s time, but rather the diseases of each organ can transmit to the lungs.Humans correspond with nature, so when the five organs are affected by cold at their respective times, they can become ill; if mild, it leads to coughing, and if severe, it can lead to diarrhea and abdominal pain. Therefore, in autumn, the lungs are first affected; in spring, the liver; in summer, the heart; in late summer, the spleen; and in winter, the kidneys.The Yellow Emperor asked: How can these coughs be differentiated? Qi Bo replied: The symptoms of lung cough include coughing with wheezing, audible breathing, and in severe cases, spitting blood. The symptoms of heart cough include chest pain when coughing, a sensation of obstruction in the throat, and in severe cases, swelling and blockage of the throat. The symptoms of liver cough include pain under the ribs on both sides, and in severe cases, pain that prevents turning, with fullness under the ribs. The symptoms of spleen cough include pain under the right rib, with a pulling sensation in the shoulder and back, and in severe cases, inability to move, with movement exacerbating the cough. The symptoms of kidney cough include pain in the lower back, and in severe cases, coughing up phlegm.The Yellow Emperor asked: What are the symptoms of coughing related to the six bowels? How does one receive the disease? Qi Bo replied: If coughing from the five organs persists, it can transfer to the six bowels. For example, if spleen cough persists, the stomach will be affected; the symptoms of stomach cough include coughing and vomiting, and in severe cases, expelling worms. If liver cough persists, the gallbladder will be affected, with symptoms of coughing and vomiting bile. If lung cough persists, the large intestine will be affected, with symptoms of coughing and incontinence. If heart cough persists, the small intestine will be affected, with symptoms of coughing and passing gas, often occurring simultaneously. If kidney cough persists, the bladder will be affected, with symptoms of coughing and incontinence. If coughing persists, the Sanjiao will be affected, with symptoms of coughing and abdominal fullness, leading to a lack of appetite for food and drink. All these coughs, regardless of which organ or bowel is affected, must have the pathogens accumulate in the stomach and affect the lungs, leading to excessive phlegm, facial swelling, and reversed qi.The Yellow Emperor asked: What are the treatment methods? Qi Bo replied: For coughs related to the five organs, treat the corresponding acupoints; for coughs related to the six bowels, treat the associated points; for coughs with swelling, treat the relevant meridians. The Yellow Emperor said: Well said!