Chronic Cough
Cough lasting ≥8 weeks, with no significant abnormalities on chest X-ray and no clear evidence of lung disease, is generally defined as chronic cough. Because it has many possible causes, diagnosis and treatment can sometimes be quite challenging. Four causes are currently considered the most common: cough variant asthma (CVA), upper airway cough syndrome (UACS) [also known as postnasal drip syndrome (PNDS)], eosinophilic bronchitis (EB), and gastroesophageal reflux-related chronic cough (GERC). These account for 70%–95% of chronic cough cases seen in respiratory medicine outpatient clinics. Other causes are less common but wide-ranging; they may be associated not only with respiratory diseases but also with conditions affecting other systems. If treatment is ineffective, further investigations such as high-resolution CT, bronchoscopy, and cardiac examinations may be considered to rule out other conditions, including bronchiectasis, endobronchial tuberculosis, and cardiac insufficiency. In traditional Chinese medicine (TCM), this condition falls under the categories of “cough” and “asthma.” It refers to impaired Lung dispersing and descending functions, with rebellious Lung qi producing a cough and expectoration. Traditionally, a cough without phlegm is called “ke,” while expectoration without a cough is called “sou”; as these are difficult to distinguish clearly, they are commonly referred to together as “cough.”
TCM Pattern Differentiation and Medication Reference
|Common Symptoms
Clinical Description:
Cough; thin, clear-white sputum or foamy sputum; aversion to cold or drafts in the back; no thirst, or a preference for warm drinks when thirsty. Pale tongue, thin white coating, and a floating or wiry-tight pulse.
Plain-Language Explanation:
- Cough
- Thin, clear-white sputum or sputum that looks foamy
- The back feels cold; drafts make you feel worse
- Little thirst, or a preference for warm water
- The tongue looks pale with a thin white coating
- The pulse feels superficial or taut (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Warm the Lung, dispel cold, relieve cough, and resolve phlegm
Plain-Language Explanation:
- Warm the Lung and dispel cold associated with exposure to cold, easing nasal congestion, chills, and aches in the head and body
- Relieve cough and loosen thick phlegm so it is easier to cough up, easing chest tightness, a blocked feeling in the throat, and coughing
|Related Products
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|Common Symptoms
Clinical Description:
Frequent, intense coughing; labored breathing or a hoarse cough; dry, sore throat; difficulty expectorating; sticky or thick yellow sputum; yellow nasal discharge; dry or bitter taste in the mouth. The tongue is somewhat red with a thin yellow coating, and the pulse is rapid or slippery.
Plain-Language Explanation:
- Frequent, severe coughing
- Labored breathing or a hoarse-sounding cough
- Dry, sore throat
- Difficulty coughing up phlegm
- Thick, sticky, yellowish phlegm
- Yellow nasal discharge
- Dry or bitter taste in the mouth
- The tongue looks somewhat red
- A thin yellow coating on the tongue
- The pulse feels fast or slippery (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Clear heat, diffuse Lung qi, transform phlegm, and relieve cough
Plain-Language Explanation:
- Clear heat and reduce what TCM describes as “fire” in the Lung, helping keep the airways open and ease discomfort such as fever, sore throat, and chest tightness
- Loosen thick phlegm so it is easier to cough up, easing coughing, difficulty expectorating, and shortness of breath
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Dry cough with little or no phlegm; dry throat and nose; chest pain with severe coughing; sticky phlegm that is difficult to cough up; dry mouth. The tongue is red and appears dry, with a thin or scant coating; the pulse is thin.
Plain-Language Explanation:
- Dry cough with little or no phlegm
- Dry throat and nose
- Chest pain when coughing severely
- Sticky phlegm that is difficult to cough up
- Dry mouth and a desire to drink
- The tongue looks red and dry, with little saliva
- The tongue coating is very thin or scant
- The pulse feels thin (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Clear the Lung, moisten dryness, and relieve cough
Plain-Language Explanation:
- Clear what TCM describes as “fire” in the Lung and moisten dry airways, easing dry mouth, dry throat, and dry cough with little phlegm
- Ease coughing and help phlegm come up more easily, supporting more comfortable breathing
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Paroxysmal coughing, itchy throat, shortness of breath, spasmodic coughing triggered by odors, smoke, or cold air; expectoration, frequent throat clearing, and a sensation of sticky phlegm in the throat. Pale tongue with a thin white coating; floating or floating-tight pulse.
Plain-Language Explanation:
- Coughing fits that come in bouts
- An itchy throat that can trigger coughing
- Somewhat rapid breathing
- Repeated, forceful coughing that feels almost spasmodic
- Odors, smoke, or cold air can trigger the urge to cough
- Phlegm and a frequent need to clear the throat
- A persistent feeling that phlegm is stuck in the throat
- The tongue looks pale with a thin white coating
- The pulse feels superficial or taut (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Dispel wind, relieve spasm, diffuse Lung qi, and relieve cough
Plain-Language Explanation:
- Dispel what TCM describes as external “wind,” relax airway spasms, and ease coughing fits and throat tightness triggered by irritation
- Promote the flow of Lung qi and help resolve phlegm, easing shortness of breath and labored breathing
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Cough with a deep, muffled sound or a dry cough; abundant phlegm, with coughing easing after phlegm is brought up; sticky phlegm that is difficult to expectorate; nausea or retching; stools sometimes loose. Pale, swollen tongue with teeth marks along the edges, greasy coating, and a slippery pulse.
Plain-Language Explanation:
- Cough with a deep, rough sound, or a dry cough
- Abundant phlegm; coughing may ease temporarily after bringing some up
- Sticky phlegm that is difficult to clear, with a feeling of congestion in the chest
- Nausea or an urge to vomit, sometimes with vomiting
- Loose stools or occasional diarrhea
- The tongue looks pale and slightly swollen, with tooth marks along the edges
- The tongue coating feels thick and sticky
- The pulse feels slippery (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Strengthen the Spleen, transform phlegm, diffuse Lung qi, and relieve cough
Plain-Language Explanation:
- Support digestive function and reduce what TCM describes as “damp-phlegm,” helping loosen sticky phlegm and reduce its formation
- Promote the flow of Lung qi so phlegm is easier to cough up, easing coughing, chest tightness, and shortness of breath
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Cough, often triggered by irritating odors; scant, sticky phlegm; dry, sticky feeling in the mouth; itchy throat. The tongue is red or dusky, with a yellow-white, greasy coating; the pulse is soggy.
Plain-Language Explanation:
- Cough
- Irritating odors (such as smoke, perfume, or paint fumes) can trigger coughing
- Scant, sticky phlegm that is difficult to cough up
- Dry mouth and a sticky, unpleasant feeling in the mouth
- Itchy throat
- The tongue looks red or dusky
- The tongue coating is yellowish-white and somewhat thick and sticky
- The pulse feels soft (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Diffuse Lung qi, clear heat, transform dampness, and relieve cough
Plain-Language Explanation:
- Promote the flow of Lung qi and reduce internal heat, easing discomfort such as fever, sore throat, and chest tightness
- Reduce excess dampness and loosen sticky phlegm, easing coughing and helping phlegm come up more easily
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Paroxysmal, choking cough and shortness of breath; severe coughing may cause regurgitation of sour or bitter fluid; upward surging qi triggers coughing; pain in the flanks; accompanied by belching with a sour taste, acid reflux, and burning behind the breastbone. Symptoms worsen while eating or after meals. Pale-red tongue with a thin white coating; wiry pulse.
Plain-Language Explanation:
- Coughing fits that come in bouts and may cause choking
- Rapid breathing or shortness of breath
- Severe coughing may bring up sour or bitter fluid
- A sensation of qi surging upward during coughing
- A dull ache along the sides of the torso
- Frequent belching, acid reflux, and a burning sensation behind the breastbone
- Symptoms become more noticeable while eating or after meals
- The tongue looks pale red with a thin white coating
- The pulse feels taut (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Soothe the Liver, harmonize the Stomach, direct counterflow downward, and relieve cough
Plain-Language Explanation:
- Promote emotional ease and relieve what TCM describes as “stagnation,” while supporting digestive function to ease discomfort such as chest or flank distension, acid reflux, and stomach bloating
- Encourage qi to move downward and reduce the sensation of it surging upward, thereby easing irritating cough, hiccups, and nausea
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
|Common Symptoms
Clinical Description:
Weak cough with expectoration and a prolonged course, or frequent susceptibility to colds; symptoms are easily triggered by external factors; weak voice and shortness of breath. Pale tongue with a thin white coating; thin, weak pulse.
Plain-Language Explanation:
- Weak cough with a quiet voice
- Phlegm can be coughed up
- Symptoms persist for a long time or keep recurring
- Prone to colds; exposure to wind, cold, or changes in temperature can trigger symptoms
- Quiet voice and a tendency to become short of breath
- The tongue looks pale with a thin white coating
- The pulse feels thin and weak (as described by a clinician during examination)
|Treatment Approach
Clinical Description:
Strengthen the Spleen and benefit the Lung, supporting the body’s defensive qi to help manage cough
Plain-Language Explanation:
- Support digestive function, energy, and appetite, and reduce what TCM describes as “damp-phlegm,” helping ease coughing and leave the airways feeling clearer
- Support Lung function and the body’s “defenses,” with the aim of reducing recurrent colds and coughing episodes and supporting easier breathing
|Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a physician or pharmacist.
References
- Respiratory Disease Committee of the Internal Medicine Branch, China Association of Chinese Medicine. Expert Consensus on the Diagnosis and Treatment of Cough (2011 Edition) [J]. Journal of Traditional Chinese Medicine, 2011, 52(10): 896–899.
- Zhang Hongchun. Annotations to the TCM Clinical Diagnosis and Treatment Guidelines: Respiratory Diseases [M]. Beijing: China Press of Traditional Chinese Medicine, 2015.
- Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China: Clinical Medication Guide—Chinese Patent Medicines [M]. Beijing: China Medical Science Press, 2010.
- Chinese Pharmacopoeia Commission. National Drug Standards: Standards for New Drugs Approved for Production [S]. Beijing: People’s Medical Publishing House, 2006.