Myra* is a spirited woman in her late sixties who I’ve been seeing off and on over the past year for back pain. Every time she comes into my clinic, Myra is coughing. There are some days that it’s so loud, I’m afraid she’d going to expire on the spot. We’ve spent lots of time talking about this cough. Myra’s had it for years, and when it gets really bad, her doctor puts her on a course of the potent anti-inflammatory drug, prednisone; the cough dies down for a month or so, and then it starts rattling around in her chest again.
At every treatment, I do some acupuncture points for the cough, but Myra’s priority is her back pain. I’ve suggested an herbal formula, but Myra isn’t interested. We’ve also talked about the role of diet, and she has stopped drinking her two glasses of milk each day, probably only as a concession to my constant concern (nagging??) about her cough.
Coughs are a little like headaches in that they have their own unique personality. In Chinese medicine, the characteristics and quality of your cough gives up clues as to the underlying pattern to be treated. Things like the sound of your cough, how long you’ve had it, and…ew, the quality and quantity of the phlegm are all signs as to what’s going on in your body that’s causing the cough.
In making a diagnosis, a practitioner of Chinese medicine needs to take a number of variables into consideration. One common method of diagnosis is called the Eight Principle Pattern Diagnosis, which is really a series of four dichotomies: (For more info in diagnosis, check out Simple Steps, pages 133-140.)
- First, is your cough internal or external? In other words, where did that hack come from? If it’s a symptom of a cold or the flu that’s going around at work, it’s considered external. That means it’s pretty superficial and is the result of some outside factor, like your co-worker sneezing on your computer keyboard. An internal cough comes from a disharmony or dysfunction of your internal organs, for example really bad digestion, which can cause you to build up lots of phlegm.
- Another way of diagnosing your cough is by determining if it is from an excess or a depletion. An excess is basically stuff you have to move or get rid of for your cough to go away. Excess coughs are loud with a lot of phlegm rattling around. A depletion means that some kind of weakness is causing your cough, and in order for it to heal, you’ll need to beef up your health. Generally, a cough caused by a deficiency is quiet, sounds weak and forceless, and is generally not productive (not so much phlegm).
- A third way of determining the nature of your cough is to decide if it involves heat or cold. A cough with heat will produce yellow phlegm, may smell bad (this is so gross), and may be accompanied by a fever, thirst or constipation. This kind of cough could be associated with the flu, pneumonia, or a lung infection. The heat involved may also dry out your lungs and cause a loud cough with little phlegm. If cold is involved, then the phlegm you cough up will be white or clear.
- The last thing to consider in diagnosing your cough is whether it is Yin or Yang in nature. A Yang cough is loud, hot, and excess, with yellow phlegm. A Yin cough is basically cooler and wetter. There can be lots of phlegm with a Yin pattern, but it will be clear or white, and generally you won’t have signs of heat or be running a fever.
So, once the nature of your cough has been diagnosed, your practitioner can settle on a course of treatment. The treatment is aimed at resolving the source of your cough. If it’s an external cough from a cold or the flu, then your acupuncturist will generally use acupuncture and an herbal formula short term to speed the course of your cold/flu, resolve the phlegm, and stop your cough.
If your cough is internal, or caused by some imbalance of your internal organs, then your road to recovery will also involve acupuncture and likely an herbal formula for a longer period of time. In many instances, some dietary changes, as well as lifestyle tweaks may be in order. Certainly, if you’re a smoker, quitting will be the first order of business in resolving your cough–and the most beneficial thing you can do to improve your health.
In Myra’s case, I determined that her cough was excess because of the noise she made when she coughed and the amount of phlegm she was coughing up. It was cold and Yin in nature, because the phlegm was white and she was not exhibiting any heat symptoms. And the root cause of the cough was internal. Basically, Myra was a worrier, who let that worry upset her digestion. Her digestion became bogged down to the point where she was not metabolizing food and fluids well, creating dampness and phlegm. She’s quit mainlining milk, but we’re still working on the cough.
*Names and identifying details have been changed.
