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Chapter 38 of 78
黄帝内经·素问
Overall Meaning Paraphrase
The Yellow Emperor asked: The lungs can cause people to cough—why is this?
Qi Bo replied: All five zang and six fu organs can cause coughing, not just the lungs.
The Yellow Emperor said: I wish to hear about the various manifestations of cough.
Qi Bo said: The skin and body hair are in correspondence with the lungs. When the skin and body hair first encounter external pathogens, the pathogenic qi follows the correspondence relationship between the skin/hair and the lungs, affecting the lungs. When cold food and drink enter the stomach, the cold qi travels upward along the lung meridian to reach the lungs, causing them to be cold-affected; since the lungs are already affected by cold, with external wind-cold and internal cold-fluid retention, the internal and external cold pathogens combine and settle in the lungs, forming a lung cough. The five zang organs each tend to be affected by disease during their governing season; if not in their governing season, the disease may also be transmitted to the lungs from another organ. Humans correspond with heaven and earth and nature, so the five zang organs each contract cold pathogens during their governing seasons and become diseased: in mild cases, this manifests as coughing; in severe cases, it may manifest as diarrhea and pain. When it is autumn, the lungs are affected first; when it is spring, the liver is affected first; when it is summer, the heart is affected first; when it is long summer (late summer, the zhi-yin period), the spleen is affected first; when it is winter, the kidneys are affected first.
The Yellow Emperor asked: How does one distinguish among these coughs?
Qi Bo said: The manifestation of a lung cough is coughing with wheezing and sound; in severe cases, spitting blood. The manifestation of a heart cough is heart pain, a sensation of obstruction in the throat as if something is stuck, and in severe cases, sore and swollen throat, or throat blockage (hou bi). The manifestation of a liver cough is pain beneath both rib-sides when coughing; in severe cases, the body cannot turn, and turning causes distension and fullness beneath both ribs. The manifestation of a spleen cough is pain beneath the right rib-side when coughing, with dull pain drawing toward the shoulder and back; in severe cases, the person cannot move, and movement aggravates the cough. The manifestation of a kidney cough is pain pulling between the lower back and the spine area when coughing; in severe cases, coughing up thin drool and saliva.
The Yellow Emperor asked: What about the coughs of the six fu organs? From where do they receive disease?
Qi Bo said: If the five zang organs' coughs persist without healing, they transfer to the six fu organs. When a spleen cough does not heal, it is transmitted to the stomach, and the stomach cough manifests as vomiting while coughing; in severe cases, roundworms (chang chong) may be vomited out. When a liver cough does not heal, it is transmitted to the gallbladder, and the gallbladder cough manifests as coughing with vomiting of bile. When a lung cough does not heal, it is transmitted to the large intestine, and the large intestine cough manifests as fecal incontinence while coughing. When a heart cough does not heal, it is transmitted to the small intestine, and the small intestine cough manifests as passing gas while coughing, with flatulence and coughing occurring simultaneously. When a kidney cough does not heal, it is transmitted to the urinary bladder, and the urinary bladder cough manifests as involuntary urination while coughing. If the cough persists without healing for a long time, it is transmitted to the san jiao, and the san jiao cough manifests as abdominal distension while coughing, with loss of appetite. All these coughs share a common characteristic: the pathogenic factors accumulate in the stomach and are related to the lungs, causing increased nasal discharge and sputum, facial edema, and counterflow of qi upward.
The Yellow Emperor said: How are these treated?
Qi Bo said: For treating coughs of the five zang organs, select the Shu (transporting) points of their respective meridians. For treating coughs of the six fu organs, select the He (sea) points of their respective meridians. For cases with edema, select the Jing (river) points of their respective meridians. The Yellow Emperor said: Excellent.
Note: Shu, He, and Jing all belong to the Five Transport Points (Jing-well, Ying-spring, Shu-stream, Jing-river, He-sea) classification. Ancient physicians believed that different acupuncture points treat different levels of conditions. This passage is provided purely as an academic and theoretical explanation, not as acupuncture guidance.
Cough Is Not Exclusive to the Lungs—Holistic View
The most central viewpoint of this chapter is that "all five zang and six fu organs can cause coughing, not just the lungs." Although Chinese medicine holds that the lungs govern qi and control respiration, coughing is not solely a disease of the lungs themselves. Dysfunction in other organs can affect the lungs through the meridians and qi movement, leading to cough. This reflects the holistic thinking of "inter-organ correlation" in Chinese medicine, rather than viewing cough in isolation as a local problem of a respiratory organ.
Combined Internal and External Pathogens—Etiological View
Qi Bo points out that the formation of lung cough has two conditions: first, external wind-cold entering through the skin and body hair; second, internal cold from cold food and drink traveling along the lung meridian from the stomach upward to the lungs. Only when external and internal cold combine will the lungs become diseased. This is the pathogenic mechanism of "external and internal pathogens combining," emphasizing that disease is often the result of both external and internal factors working together, rather than a single cause.
The Five Zang Organs Contract Disease According to the Seasons—Time Medicine
The text states that "the five zang organs each contract disease in their governing season": in autumn, the lungs are affected first; in spring, the liver is affected first; in summer, the heart is affected first; in long summer, the spleen is affected first; in winter, the kidneys are affected first. This understanding links the body's organs with natural seasons, proposing that different seasons have different susceptible organs. This is an embodiment of the concept that "humans correspond with heaven and earth" in the Huangdi Neijing, and can be viewed as an early form of chronomedicine (time medicine).
Organ-to-Organ Transmission—Prolonged Cough Moves to the Six Fu Organs
When coughs of the five zang organs do not resolve after a long time, they transmit to the six fu organs that are internally-externally paired with them: spleen cough transmits to the stomach, liver cough to the gallbladder, lung cough to the large intestine, heart cough to the small intestine, kidney cough to the urinary bladder, and ultimately the san jiao. This reflects the pattern of disease transmission from zang to fu and from shallow to deep, and also indicates that when a cough lingers indefinitably with other accompanying symptoms, one should not only look at the lungs.
"Accumulating in the Stomach, Relating to the Lungs"—General Pathomechanism
The final summary states that "these all accumulate in the stomach and relate to the lungs," meaning that the shared pathologic mechanism of all these coughs involves both the stomach and the lungs. The stomach governs the reception of water and grains, while the lungs govern qi and regulate water passages. If diet becomes irregular and stomach qi fails to descend, dampness and phlegm fluids tend to invade upward toward the lungs. Later generations of Chinese medicine developed the saying: "The spleen is the source of phlegm production; the lungs are the container that stores phlegm," which is consistent with this line of thought.
Point Selection by Meridian Classification—Acupuncture Principles
In treatment, zang-organ diseases call for the Shu (transporting) points, fu-organ diseases call for the He (sea) points, and edema calls for the Jing (river) points. This embodies the application of the Five Transport Points theory in the Neijing: Shu points are commonly used for zang disorders, He points for fu disorders, and Jing points for impaired qi movement along the meridians. The original text provides only principles without specific acupoints, staying at the level of academic theory.
Diversity of Cough Etiologies Resonates with the Holistic View
Modern medicine also recognizes that cough is a symptom with multiple etiologies. Beyond respiratory infections, asthma, and COPD, conditions such as cardiac insufficiency, gastroesophageal reflux, post-nasal drip, and certain medications can also cause coughing. This parallels the notion that "all five zang and six fu organs can cause coughing," showing that ancient physicians already recognized that cough has relevance to multiple organ systems.
"Combined External and Internal Pathogens" Has Some Observational Basis
Cold air and cold drink stimulation can trigger or aggravate coughs in some individuals, which is partly related to mechanisms such as airway hyperresponsiveness and gastroesophageal reflux. However, the "cold pathogen" described by ancient physicians constitutes a system of traditional pathological terminology that cannot be directly equated to modern pathology.
Referred Pain and Accompanying Symptoms in the Five Zang Organ Coughs
For example, "heart cough" with heart pain and throat obstruction may relate to cardiac, mediastinal, or chronic pharyngitis conditions; "liver cough" with pain beneath both rib-sides may involve pleural irritation or intercostal neuralgia; "kidney cough" with referencing pain between the lower back and spine may be seen in chronic consumptive diseases or lumbar muscle strain. These descriptions carry a degree of clinical observational value, yet they should not be mechanically applied as one-to-one diagnostic correspondences.
Some Manifestations of the Six Fu Organ Coughs Can Be Observed in Modern Clinical Practice
For instance, "cough with involuntary urination" resembles stress urinary incontinence triggered by coughing, often seen in individuals with pelvic floor muscle weakness; "cough with passage of gas" is related to increased intra-abdominal pressure during coughing; "cough with vomiting bile" can be seen in severe coughing episodes accompanied by gastroesophageal reflux. These descriptions demonstrate how carefully ancient physicians observed the accompanying symptoms of cough.
Historical Limitations Should Be Viewed Rationally
The mention of "vomiting roundworms" is linked to Ascaris infection, which has declined with improved sanitary conditions in modern times; it is not something that occurs in every stomach cough. The therapeutic efficacy of acupuncture point selection for cough awaits further validation through evidence-based medical research. Hence, this chapter is best studied as traditional culture and within Chinese medical theory, and should not be directly used for self-diagnosis or self-treatment.
Associated Concepts
Further Reading
This content is based on classic works of traditional Chinese medicine and is provided solely for the study and scholarly reading of traditional culture. It does not constitute any form of medical diagnosis, prescription, or treatment advice. If symptoms arise, please seek professional medical care in a timely fashion.
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