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Cough according to Ayurveda and Traditional Chinese Medicine

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Ayurveda

KASA
1. Describe the mechanism of cough.
2. Why is cough not a disease?
3. What are the common causes of kasa?
4. What is difference between transudate and exudate?
5. What are types of kasa?
6. What are doshic manifestations of kasa?
7. What are complications of kaphaja kasa?
8. What is difference between kshataja kasa and kshaya kasa?
9. What is paroxysmal cough?
10. What is brassy cough?
11. What is bovine cough?
12. What are reasons for nocturnal cough?
13. What is hemoptysis?
14. What is purpose of sputum cup? What is observed?
15. What is diagnosis if sputum cup has blood?
16. What is diagnosis if sputum cup has thin watery large amount?
17. What is diagnosis if sputum cup has thin colorless large amount?
18. What is diagnosis if sputum cup has thick scanty sputum?
19. What is diagnosis if sputum cup has green or yellowish sputum?
20. What is diagnosis if sputum cup has yellowish sputum?
21. What is diagnosis if sputum cup has froth on top, clear in middle and thick mucus on bottom?
22. What beverages treat VPK kasa? Which drink is vyadhi pratyanika?
23. What is best compound to treat kshataja kasa?
24. What is best lung tonic?
25. What is best compound for kshayaja kasa?
26. What are dietary remedies for kasa?

Kasa Cough Answers

1.       Describe the mechanism of cough.                                                                                                                                          coughing center in medulla stimulated --> descends prana --> udana vayu ascends in response -->            sudden explosive release of air with sputum or irritant material, voluntary act, pranavahasrotas                   dushti, responds to irritation of respiratory tract - throat, trachea, bronchi

2.       What are the common causes of kasa?                                                                                                                   smoke, dust, dirt, exercise, dry food, sneezing reflex, false entry of foodstuff intro trachea

3.       What is difference between transudate and exudate?                                                                                                      non-inflammatory, only water/  inflammatory, contains dead protein, dead WBC, bacteria, plasma

4.       What are types of kasa?                                                                                                                                                             VPK, kshataja - cavity, kshaya - TB

5.       What are doshic manifestations of kasa?                                                                                                                               V - dry cough, no expectorant, prolonged, acute congestion, pain, palpitations, SOB                   P - inflammation, irritation due to fumes, infection, severe --> hemorrhage                                                                            K -  loose productive cough, profuse exudate, need postural drainage

6.       What are complications of kaphaja kasa?                                                                                                                               bronchiectasis, chronic bronchitis, lung abscess, emphyma

7.       What is difference between kshataja kasa and kshaya kasa?                                                                                             kshataja - cavities, can be TB or non-TB/ kshaya - cough with TB, TB doesn’t have cavity

8.       What is paroxysmal cough?                                                                                                                                                       whooping cough, prolonged, rapid series of cough followed by deep inspiration

9.       What is brassy cough?                                                                                                                                                                metallic, sounds like hitting brass pot

10.    What is bovine cough?                                                                                                                                                               neoplasm presses 10^th cranial nerve --> paralyzes vocal cord --> hoarseness in voice, laryngeal        neoplasm

11.    What are reasons for nocturnal cough?                                                                                                                  L ventricular failure, mitral stenosis, cardiac or bronchial asthma, elongated uvula

12.    What is hemoptysis?                                                                                                                                                                  coughing blood, aka saraktasthiranam, cough precedes hemorrhage, bright red sputum, hx of      respiratory disease

13.    What is purpose of sputum cup? What is observed?                                                                                                           collect expectorant for 24 hours, observe color, smell, amount, consistency

14.    What is diagnosis if sputum cup has blood?                                                                                                                           rakta gata pitta

15.     What is diagnosis if sputum cup has thin watery large amount?                                                                      pulmonary edema (K)

16.     What is diagnosis if sputum cup has thin colorless large amount?                                                                   lung cancer (VPK)

17.    What is diagnosis if sputum cup has thick scanty sputum?                                                                                 asthma (KV)

18.    What is diagnosis if sputum cup has green or yellowish sputum?                                                                     bacterial infection, krumi, eusinophilia

19.    What is diagnosis if sputum cup has yellowish sputum?                                                                                     emphyma = lung abscess

20.    What is diagnosis if sputum cup has froth on top, clear in middle and thick mucus on bottom?                                bronchiectasis (K)

21.    What beverages treat VPK kasa? Which drink is vyadhi pratyanik?                                                                  V - garlic milk + turmeric, P - milk + nutmeg, K - ginger tea + 10 drops mahanarayan oil                                  vyadhi - licorice tea + 10 drops mahanarayan oil - sip every 10 mins

22.    What is best compound to treat kshataja kasa?                                                                                                   rasa sindhur will treat cavity

23.    What is best lung tonic?                                                                                                                                                             chyavanprash + 1 cup milk 30 mins later

24.    What is best compound for kshayaja kasa?                                                                                                                            vanga bhasma - tin ash, specific for TB

25.    What are dietary remedies for kasa?                                                                                                                                      honey + lemon, honey + betel leaves, amalaki + honey + pippali + rock salt

(Durve, 2001: GK 2001 Study, pp. 16-17)

 

Chinese Medicine and Cough

 

HOW WE ASK

It is important to be sensitive when asking questions regarding the chest because people often fear that if we ask about the chest we suspect a heart pathology. Besides this, some typical Chinese expressions are not used by Western patients and we should therefore phrase the question in a way that is understandable to the patient. For example, few patients will actually use the expression 'feeling of oppression of the chest'; they will probably describe a 'feeling of tightness of the chest' or say a feeling was 'like having a weight on the chest'.

'Palpitations' is another example of the importance of asking questions in a way that the patient can understand. Most people think that palpitations are synonymous with tachycardia, that is, the heart beating faster than normal. We should therefore explain to the patient that 'palpitations' simply means an uncomfortable sensation of being aware of one's heartbeat.

Cough

Observation, Chapter 20; Hearing, Chapter 53; Symptoms and Signs, Chapter 63

When a patient presents with a cough, we must first of all establish whether it is an acute or a chronic cough. By 'acute' we mean a cough that had a sudden onset and may continue for a few days or weeks. By 'chronic', we mean either a cough that began insidiously without a previous invasion of Wind and persisted for months or years, or one that began with an exterior invasion of Wind and persisted for months or years.

An acute cough may have any of three causes. First, it may be an acute cough in the very beginning stages of an invasion of Wind, when the pathogenic factor is

still on the Exterior. Secondly, it may be an acute cough with the pathogenic factor (such as Heat or Phlegm-Heat) in the Interior following an external invasion. Thirdly, it may be an acute cough caused by a residual pathogenic factor (such as Dryness or Phlegm) following an external invasion. In the first case the cough will be accompanied by signs of the external invasion such as aversion to cold, fever, sore throat, a runny nose and a Floating pulse. Heat or Phlegm-Heat in the Lungs produces a barking cough with yellow mucus, feelings of heat and thirst, and an Overflowing-Rapid pulse. In residual Dryness with Phlegm in the Lungs, the cough is dry with difficult expectoration of scanty sputum after repeated bouts of coughing, and a tickling sensation in the throat.

A chronic cough is generally due either to chronic retention of Phlegm in the Lungs (which may be combined with Dampness, Heat or Dryness), or to deficiency of Qi or Yin, or both, of the Lungs.

A very common type of chronic cough is one due to Damp-Phlegm in the Lungs, which is characterized by the expectoration of profuse, white sputum which is easy to expectorate, a feeling of oppression of the chest, a Swollen tongue with a sticky coating and a very Slippery pulse. When Phlegm combines with Heat in the Lungs the cough has a louder sound and is characterized by the expectoration of yellow sputum, a feeling of oppression of the chest, a feeling of heat and a Red and Swollen tongue with a sticky yellow coating and a Slippery-Rapid pulse.

A common type of chronic cough in the elderly is that due to Dry-Phlegm in the Lungs which is characterized by a chronic, dry cough with a weak sound and the occasional, difficult expectoration of scanty sputum, a dry throat and a Swollen tongue with a dry coating.

A chronic cough due to a deficiency of Lung-Qi or Lung-Yin is characterized by a slight, dry cough with a weak sound, dry throat in the evening accompanied by the signs of Qi or Yin deficiency, such as night sweating, and a tongue without coating.

Case history 38.1 illustrates a pattern underlying chronic cough.

Chapter 38: CHEST AND ABDOMEN 323

Case history 38.1

A 48-year-old woman had been suffering from a persistent cough for 6 months: she felt she had some phlegm in the throat but this was difficult to expectorate so that the cough was often dry. When she did expectorate some sputum, this was thick, sticky and white. She also complained of breathlessness and a feeling of tightness and oppression of the chest. A chest specialist had diagnosed bronchiectasis.

She was thin and slightly built and she had experienced loss of weight for the past 2 years. Her complexion was very dull and sallow. She also suffered from a general cold feeling, cold hands and feet, constipation and a yellow vaginal discharge.

Her tongue-body color was normal but the tongue body was Swollen, the back of the tongue had a rootless, yellow coating but no 'spirit'. Her pulse was Weak in general, especially in both the Rear positions, but also slightly Slippery.

Diagnosis: The cough with expectoration of thick, sticky white sputum, together with the breathlessness and feeling of tightness and oppression of the chest, indicate the presence of Damp-Phlegm in the Lungs, which is confirmed by the swelling of the tongue body and the Slippery pulse. The general cold feeling, cold hands and feet, constipation and Weak Rear pulse positions also indicate Kidney-Yang deficiency, which obviously contributed to the formation of Phlegm. The Kidney deficiency is also evidenced by the absence of 'spirit' on the root of the tongue. Besides Damp-Phlegm in the Lungs, there is also Damp-Heat in the Lower Burner, which causes the yellow vaginal discharge.

The loss of weight which occurred in the previous 2 years and the rootless tongue coating point to the beginning of a situation of Kidney-Yin deficiency, which may sometimes develop from Kidney-Yang deficiency.

The treatment should concentrate first on resolving Damp-Phlegm and stimulating the descending of Lung-Qi and secondly on tonifying the Kidneys.

　

BOX 38.1 COUGH

Box 38.1 summarizes the patterns underlying cough.

Acute

External invasion of Wind: acute cough, aversion to cold, fever, sore throat, runny nose, Floating pulse

Heat or Phlegm-Heat in the Lungs: acute, barking cough with expectoration of yellow mucus, feeling of heat, thirst, Overflowing-Rapid pulse

Residual dryness and Phlegm in the Lungs: acute, dry cough with difficult expectoration of scanty sputum after repeated bouts of dry coughing, tickling sensation in throat.

Chronic

Damp-Phlegm in the lungs: chronic cough with easy expectoration of profuse, white sputum, feeling of oppression of the chest, Swollen tongue with sticky coating. Slippery pulse

Phlegm-Heat in the Lungs: loud chronic cough with expectoration of profuse yellow or greenish sputum, feeling of heat, feeling of oppression of the chest. Red and Swollen tongue with sticky yellow coating, Slippery-Rapid pulse

Dry-Phlegm in the Lungs: chronic dry cough with occasional, difficult expectoration of scanty sputum, dry throat, Swollen tongue with a dry coating

Lung-Qi deficiency: chronic, slight cough with weak sound, weak voice, Empty pulse

Lung-Yin deficiency: chronic, dry cough, dry throat in the evening, night sweating, tongue without coating

(Source: Maciocia, TCM Diagnosis, 2004: pp. 322-323)

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See Lungs for detailed Ayurvedic - Chinese - Western comparisons.