Cough for Three Weeks – The Problem May Not Be in the Lungs HW02

Your cold is gone, but why is the cough still there three weeks later? The cause may not be limited to the lungs—it may involve the nose, acid reflux, airway hypersensitivity, medicines, or other factors. This book explores persistent cough through modern medicine and Traditional Chinese Medicine, with a practical focus on what you can do: UK OTC options, food therapy for different cough patterns, TCM approaches, and when it is time to see a doctor.

L4 HW02 A Cough That Won’t Go After Three Weeks: The Problem May Not Be in the Lung

What to Do About a Cough: What Modern Medicine Looks For,

and What Chinese Medicine Asks

Fang Tianliang

Health & Wellbeing

 

1. Leo’s Cough Has Now Lasted Three Weeks

The cold is gone, the runny nose is gone, the fever has gone. But Leo’s cough is still there: it starts when he lies down at night, again when he gets up in the morning, and when he has talked for a while his throat tickles and he cannot help coughing for a spell.

A colleague said: “Just drink plenty of hot water.” A friend said: “Take some cough syrup.” His mother posted a box of Chinese patent medicine from China. Leo looked at the pile on the table and did not know which to try first.

Let us put the conclusion first:

If a cough has lasted more than three weeks, stop guessing. It may simply be the aftermath of a cold lingering in the airway, or there may be another cause in the nose, the stomach or the airway. What is worth doing is this: first rule out danger signs, then work out which kind of cough you have, and then choose a direction.

This book is about cough, especially the kind that will not leave. By the end you should be able to answer three questions: What should I do now? When must I see a doctor? And what do modern medicine and traditional Chinese medicine (TCM) each see behind this cough?

 

2. A Cough Is Not a Disease, but a Protective Mechanism

The lining of the airway is full of receptors. When they detect a foreign body, an irritant gas or excess mucus, the signal travels along the vagus nerve to the cough centre in the brainstem and sets off a coordinated sequence: a deep breath in, the glottis closes, the chest and abdominal muscles contract violently, the glottis suddenly opens and a blast of air carries the irritant out. This mechanism exists to protect, not to torment.

Most acute coughs are this mechanism working normally: clearing secretions and damaged tissue left behind after a viral infection. The problem is that in some people the mechanism stays highly sensitive long after the “clearing up” should have finished: a puff of cold air, a whiff of perfume, or simply talking for a long time can trigger a full cough reflex.

How long have you been coughing? Three bands

•         Acute cough: under three weeks; the most common cause is a cold or upper respiratory infection;

•         Subacute cough: three to eight weeks; commonly a post-infectious cough;

•         Chronic cough: more than eight weeks; it needs systematic investigation.

In the UK the NHS’s usual advice is that if a cough has lasted more than three weeks you should contact your GP. Leo is standing right on that line.

When the protective mechanism itself becomes over-sensitive

In recent decades clinical understanding of chronic cough has changed. The earlier mainstream view held that behind a long-lasting cough you would always find one of three “culprits”: asthma, gastro-oesophageal reflux, or “post-nasal drip”. But many patients cannot be neatly fitted into those drawers.

So some researchers proposed a new framework: the afferent nerves in the airway that sense irritation may, after viral infection, acid reflux or environmental irritants, undergo “neuroplastic” change and become abnormally sensitive, triggering excessive coughing at the slightest stimulus. This is called cough hypersensitivity syndrome. It is an important way of understanding refractory chronic cough and cough of unknown cause, but it does not mean that looking for specific causes is outdated; clinicians still need to check one by one for treatable causes.

 

3. For a Chronic Cough, Which Directions Does Modern Medicine Check First?

Assessment usually begins with a few of the commonest directions. This is not a formula applied to everyone, but an order of priority:

•         Upper airway cough syndrome (formerly “post-nasal drip”): secretions from the nose and sinuses run back and irritate the throat. Interestingly, many such patients have no obvious sense of “dripping”; the problem may be that inflammation in the throat itself makes local receptors sensitive;

•         Asthma and cough-variant asthma: for some people with asthma the only symptom is a long-lasting dry cough, without wheeze;

•         Gastro-oesophageal reflux disease: stomach acid can trigger the airway’s cough reflex through nerve reflexes, and tiny amounts may also be inhaled and irritate directly; studies show reflux is quite common among people with chronic cough;

•         Drug side effects: some blood-pressure medicines (ACE inhibitors) cause a dry cough in some people;

•         Eosinophilic bronchitis: symptoms resemble asthma but without airway hyper-reactivity, and it needs a sputum test to confirm.

Danger signs: a cough accompanied by coughing up blood, marked difficulty breathing, persistent chest pain, unexplained weight loss, repeated fever, difficulty swallowing or a clear change in the voice; or a new persistent cough in someone at high risk (long-term smokers, people with weak immunity or underlying lung disease), should be assessed medically promptly, rather than waited out at home or self-diagnosed.

 

4. What Should I Do Now? (The Most Practical Chapter)

Step one: look for danger signs first

Check against the list above. If any one applies, do not manage it yourself: contact your GP or NHS 111; if breathing worsens, you are coughing up a lot of blood or you have severe chest pain, call 999.

Step two: work out which kind of cough you have

What you notice	What to think of first
The cold is over, but a dry cough and tickly throat remain, set off by cold air, and gradually easing over three to eight weeks	Post-infectious cough
Coughing when lying down or after meals, with acid reflux, heartburn or belching	Gastro-oesophageal reflux
Blocked nose, throat-clearing, a feeling of mucus running down the back of the throat, or allergic rhinitis	Upper airway factors
Mainly dry cough, worse with exercise, cold air or at night, with a history of allergy or asthma	Asthma or cough-variant asthma
A dry cough that began after starting a blood-pressure medicine	A drug cause; contact your GP, and do not stop it yourself
A lot of phlegm, yellow-green or blood-stained, with fever or breathlessness	Possible infection; see a doctor
Clearly worse when tense	Raised sensitivity of the cough reflex linked to stress

This table helps you and your doctor describe the problem clearly. It is not a diagnosis.

Step three: what you can buy at a UK pharmacy

In the UK, common cough-related products are available at pharmacies and supermarkets. Ask the pharmacist which to choose, and tell them your age, whether you are pregnant or breastfeeding, whether you have asthma or high blood pressure, and what else you take.

Type	Common approach or ingredient	Suited to	Notes
Honey and lemon hot drink	Honey and lemon in hot water	Acute cough, throat discomfort; the NHS also lists it as a home measure	Never give honey to babies under one year; people with diabetes should watch the sugar
Simple cough syrups	“Soothing” syrups with glycerol, honey and the like	Dry cough, throat irritation	Mainly soothes the throat; does not deal with the cause
Expectorants	Guaifenesin and similar	When phlegm is sticky and hard to cough up	Evidence of benefit is limited; drinking enough water matters more
Cough suppressants	Dextromethorphan and similar	Dry cough that disturbs sleep	A productive cough should generally not be forcibly suppressed; ask the pharmacist before combining with other medicines
Lozenges	Throat lozenges	Dry, tickly throat	Sugar content and ingredients vary; read the label
Medicines for the cause	Allergy nasal sprays, antacids or alginates and the like	Cough from rhinitis or reflux	If symptoms persist, see a doctor; do not self-treat long term

Children and special groups: UK medicines regulators advise not giving over-the-counter cough and cold medicines to children under six; if you are pregnant or breastfeeding, elderly, taking several medicines or have asthma, ask a pharmacist or doctor first.

Step four: what you can do in daily life

•         Stop smoking and avoid second-hand smoke; this is the most valuable single step for a chronic cough;

•         keep up your fluids, and watch the humidity if the air is very dry;

•         for reflux-related cough: do not eat dinner too late, eat little in the three hours before bed, and raise your upper body if necessary;

•         if you have rhinitis, keep it under control (see our book on allergic rhinitis);

•         keep a cough diary: when it is worst, what triggers it, any acid reflux, the colour of any phlegm. Take it to your doctor, and to a TCM practitioner;

•         if the cough disturbs your sleep, raise your pillow a little, and avoid large cold drinks before bed.

Step five: when should tests be done?

If the cough has lasted more than three weeks, your GP may take a history, listen to your chest and, depending on the picture, arrange a chest X-ray, lung function tests or other investigations, or adjust medicines you are already taking. Bring your cough diary; it is more useful than any description. If the cough does not ease after tests and conventional treatment, referral to a respiratory clinic is possible.

 

5. What TCM Sees: “All Five Zang and Six Fu Organs Can Make One Cough, Not the Lung Alone”

The cough happens in the airway, so why did Chinese physicians more than two thousand years ago say that all the organs can cause cough?

The Huangdi Neijing: Suwen has a chapter devoted to cough, called “Discourse on Cough” (Ke Lun). It opens with the Yellow Emperor asking Qi Bo: “The lung governs cough; why is that?” Qi Bo’s answer is unexpected: “All five zang and six fu organs can make a person cough, not the lung alone.” This sentence set the whole framework of how TCM understands cough: the lung is where the cough “happens”, but the cause may come from any organ. External pathogens first attack the skin and body hair, which connect with the lung, and the pathogen enters the lung along this route. That is the most direct path. Another, more hidden, path is that another organ first becomes disordered and then “passes” the disorder on to the lung.

The lung: dispersing and descending

The TCM “lung” is not just a bag that holds air; it is more like a system of qi movement that must keep flowing up and down, with two core actions, “dispersing” (xuan) and “descending” (jiang). Dispersing is outward and upward diffusion, spreading defensive qi to the body surface and breathing out turbid qi; descending is downward and inward clearing, guiding clear qi downwards and spreading fluids downwards. In health the two coordinate, and qi moves in and out as naturally as breathing.

When lung qi cannot disperse what should be dispersed, or cannot descend what should descend, qi instead surges upward, and cough is the outward expression of this “counterflow of qi”. That is why TCM treatment of cough often includes both “dispersing the lung” and “directing qi downward”, two seemingly opposite directions.

A reminder: “lung qi counterflow” is a traditional language of disease mechanism. It is not the same as bronchospasm, vagal excitation or raised cough-reflex sensitivity, and the two explanatory systems cannot be directly translated into each other.

“The lung is a delicate organ”: why does the cough stay after the cold has gone?

TCM says “the lung is a delicate organ”: of the five zang organs it is relatively the most “tender”, connected to the outside world directly through the nose and throat, and most easily attacked by wind, cold, heat and dryness. Leo’s situation, in traditional pattern differentiation, can be understood as: most of the external pathogen has been cleared, but it is “not completely gone, and the lung’s dispersing and descending has not fully recovered”, so he has a tickly throat, dry cough and triggering by cold wind.

At the level of phenomena this is very like the “post-infectious cough” of modern medicine; both describe “the infection has gone, but the airway is still easily provoked to cough”. But this is only a comparison of phenomena. It does not mean “the lung is a delicate organ” has been proven by neurophysiology, nor can “lingering wind” be translated as “vagal sensitisation”.

The spleen: where does phlegm come from?

Many people think “phlegm” means “the lung produced phlegm”, but TCM does not understand it that way. Traditional theory says: “The spleen is the source of phlegm; the lung is the vessel that stores it.” The TCM “spleen” is responsible for the transformation and distribution of food and fluids; it is a functional-system concept, not the anatomical spleen. When the spleen’s transformation fails, dampness accumulates and gathers into phlegm, and the phlegm shows itself at the lung end. So faced with a long-standing productive cough, TCM does not only think of “clearing the lung”; it may focus on “strengthening the spleen and resolving dampness”: treating the source, not only the end where phlegm appears.

•         Patient A: cough, yellow sticky phlegm, thirst, sore throat; leaning towards “heat”, so the approach leans towards clearing heat and resolving phlegm;

•         Patient B: a long cough with a lot of white phlegm, chest tightness, poor appetite, a heavy body and loose stools; modern medicine looks for infection, asthma and airway inflammation, while TCM may shift the focus to “spleen deficiency with phlegm-dampness”.

The liver: why do emotions pull on the cough?

TCM holds that the liver governs free flow, regulating the movement of qi throughout the body. Long-term emotional suppression and tension can cause “liver qi stagnation”; stagnation lasting long may turn into heat or fire, which rises and disturbs the lung, called “liver fire invading the lung”; the lung loses its descending function and cough follows.

Imagine someone who usually coughs only a few times, but when tense at an important meeting, or after several days of arguments and poor sleep, coughs noticeably more. Modern medicine may understand this through stress-related raised cough sensitivity, throat hypersensitivity and autonomic influence; TCM reads it as liver stagnation and liver fire invading the lung. Both may be observing the same phenomenon with completely different explanations, and we cannot say that “liver fire invading the lung is really just autonomic disturbance”.

The stomach: coughing as soon as you lie down

Nothing in the day, but a cough soon after a full meal or soon after lying down at night, sometimes with acid reflux and heartburn. The modern explanation is that stomach acid refluxes and, through nerve reflexes or tiny aspirations, triggers cough. TCM’s route is: stomach qi should keep “harmonious descent”; if the stomach loses harmonious descent and stomach qi counterflows upward, this too can affect the lung’s descending function, so lung qi flows upward with it and one coughs.

The two arrows look tidy: modern medicine is “reflux → nerve or chemical stimulation → cough”; TCM is “stomach fails to descend → stomach qi counterflow → lung fails to descend → cough”. But because they look alike we must not conclude that “stomach qi counterflow” equals “acid reflux”: the first is a theoretical language describing the direction of qi movement, the second is a physiological and chemical process measurable with instruments, and what overlaps is only the phenomenon that “the source is in the stomach and it affects the lung”.

The kidney: why ask an older person about the lower back, knees and night-time urination?

Tradition says “the lung governs exhalation; the kidney governs the grasping of qi”: the lung is responsible for dispersing and expelling qi, and the kidney is thought to “receive” it, helping to hold the inhaled qi firmly and sink it downward. After long illness, old age or weakness the kidney’s receiving function may weaken, giving breathlessness on exertion, more out-breath than in-breath and a lingering cough and wheeze, called “kidney failing to receive qi”.

Imagine a 72-year-old who has coughed for half a year, is especially breathless on stairs, with an aching lower back and knees and getting up more often at night. Besides asking about phlegm, a TCM practitioner will ask “How many times do you get up at night?”, “Do your lower back and knees ache?” and “When you walk, is it the cough that is bad, or do you feel you cannot get your breath?” These questions that seem unconnected with cough are judging whether, behind this cough, the kidney’s receiving function is also involved.

A safety boundary: an older person with a long-term cough and breathlessness must first have modern medical investigations to rule out heart disease, lung disease, cancer, infection and other causes that need priority. “Kidney failing to receive qi” is a supplementary view, used after those are excluded, for understanding and caring for the body’s state. It cannot replace investigation.

Long-standing cough and “transmission”: TCM noticed chronicity early

Ke Lun also describes the accompanying features of lung cough, heart cough, liver cough, spleen cough and kidney cough, and discusses how a long-lasting cough is “transmitted”: a cough of the five zang organs that does not clear goes on to affect the paired fu organs. For example, a long spleen cough passes to the stomach, with cough and vomiting; a long liver cough passes to the gallbladder, with coughing up bitter fluid; a long kidney cough passes to the bladder, with urine leaking when coughing; longer still it involves the triple burner, with abdominal fullness and no wish to eat. What is most valuable to read today is a kind of “chronic” thinking: the longer the cough, the wider the involvement tends to be. This echoes what modern medicine has observed, that chronic cough often coexists with reflux, sinus problems and emotional factors and seldom has a single cause, even though the theoretical language is entirely different.

 

6. The Same Cough: Why Does TCM Make Different Judgements?

Suppose four people each go to a TCM practitioner because of “cough”:

•         The first: cough, itchy throat, thin white phlegm, afraid of cold; fits wind-cold;

•         The second: a heavier cough, thick yellow phlegm, sore throat, thirst; fits wind-heat or lung heat;

•         The third: a lingering cough, a lot of white phlegm, chest tightness, poor appetite, a heavy body; fits phlegm-dampness;

•         The fourth: dry cough with little phlegm, a dry throat, worse at night, already two or three months; fits yin-deficient dry cough.

The point is not for you to match yourself to one, but to explain: why does a TCM practitioner ask a dozen questions that “have nothing to do with cough”? Because TCM does not ask the yes-or-no question “do you have a cough?”, but “in what kind of bodily state is this cough occurring?” This is the method that runs through the whole of this series. The above are simplified teaching scenarios; real patients often have several features at once, and the actual pattern differentiation must be done by a qualified TCM practitioner after a full consultation.

After a long cough, why does the treatment approach change?

TCM has sayings such as “a long cough injures the lung” and “long illness reaches the kidney”. The core idea is simple: early in illness the main aim is to “expel the pathogen”, to drive out wind, cold and heat quickly; when it drags on it often becomes “the pathogen not yet gone while the body’s upright qi is already injured”, with qi or yin fluids used up in the process. At first it is fear of cold, blocked nose, itchy throat and cough; a few weeks later, if it lingers, it may turn into dry cough, easy tiredness, coughing when talking a lot and a dry throat at night. The approach then shifts from dispersing wind and opening the lung towards boosting qi, nourishing yin and moistening the lung. For the same person’s cough, at different stages the TCM prescribing approach may point in opposite directions: “dispersing” early, “nourishing” later.

 

7. Food Care in the Kitchen: Start with the Food-Medicine Substances

China’s regulations recognise “substances that are traditionally both food and Chinese medicinal materials” (food-medicine substances for short), which may be used as food, and quite a few are everyday ingredients. Below, by several tendencies, are ingredients traditionally used for everyday nourishment. This is not a diagnosis; it is a traditional way of thinking about dietary care and does not replace necessary medical examination and treatment.

Tendency	Daily direction	Ingredients traditionally used	Home preparations
Wind-cold leaning: itchy throat, thin white phlegm, afraid of cold	Warming	Fresh ginger, perilla (zisu), red dates	Ginger and red date tea; perilla and ginger tea
Heat-leaning: thick yellow phlegm, sore throat, thirst	Light, leaning cool	Mulberry leaf, chrysanthemum, mint, luo han guo (monk fruit)	Mulberry leaf and chrysanthemum tea; luo han guo tea
Dry cough: little phlegm, dry throat, worse at night	Moistening	Lily bulb (baihe), ophiopogon root (maidong; newly listed in 2024), honey, sweet almond	Lily bulb and white fungus congee; ophiopogon and honey water (smaller amounts for those with cold, weak digestion)
Phlegm-damp: lots of white phlegm, chest tightness, poor appetite, heavy body	Strengthen the spleen, resolve dampness	Tangerine peel (chenpi), poria (fuling), coix seed, Chinese yam	Tangerine peel and poria tea; yam and coix seed congee

A few reminders:

•         Bitter almonds contain harmful compounds; do not eat them freely or steep them in water. Guidance generally says to use sweet almonds and follow the pack instructions;

•         Fritillaria (chuanbei) is not on the food-medicine list, so it cannot be used as an ordinary ingredient; it appears only in patent medicines or prescriptions used after pattern differentiation;

•         honey contains sugar and must never be given to babies under one; people with diabetes should watch total sugar;

•         for older people with a long cough and breathlessness, see a doctor first, then talk about dietary care;

•         traditionally, large amounts of icy, fried, spicy and very sweet foods are discouraged during an attack, but this is experience, not a universal rule: observe for a week yourself, and eat less of whatever clearly makes you worse;

•         people with allergic tendencies should try new ingredients in small amounts first.

Everyday dietary-care foods mentioned in this book: fresh ginger, red dates, perilla, mulberry leaf, chrysanthemum, mint, luo han guo, lily bulb, ophiopogon root, tangerine peel (chenpi), poria, coix seed, Chinese yam, honey.

[HONGDAHEALTH dietary-care food link: to be added]

Please remember: in the UK, foods may not claim to treat or prevent disease. Be wary of any food or supplement claiming to “stop a cough in a few days” or “cure a long-standing cough”.

 

8. After Pattern Differentiation: Two Chinese Cough Patent Medicines on the Shelf

Walk into a Chinese pharmacy and you may find Orange Red Phlegm-Cough Granules and honey-prepared Fritillaria and Loquat Syrup side by side. Both say they relate to cough, so why are the formulas so different?

This part is not “see a cough, buy it yourself”; it needs a qualified TCM practitioner to judge, one to one, after pattern differentiation, whether it suits you.

Orange Red Phlegm-Cough Granules (橘红痰咳颗粒) usually contain huajuhong (a citrus peel), honey-fried baibu, bitter almond, poria, processed pinellia, schisandra, baiqian and liquorice. The manufacturer’s leaflet usually gives the indication as “regulating qi and dispelling phlegm, moistening the lung and relieving cough”, for what tradition calls phlegm-damp cough, typically a cough that recurs, sounds heavy and turbid, with a lot of phlegm that is white or greyish. Huajuhong leans towards regulating qi, drying dampness and resolving phlegm and is the centre of the whole approach; processed pinellia dries dampness and resolves phlegm, linking exactly to the line “spleen fails to transform → dampness gathers into phlegm → phlegm stored in the lung”; poria does not directly “press down” the cough but works from strengthening the spleen and draining dampness; baibu, baiqian and bitter almond lean towards directing qi downwards, relieving cough and resolving phlegm; schisandra is traditionally thought to astringe the lung; liquorice often harmonises the other ingredients. The whole chain is: spleen fails to transform → dampness gathers → much phlegm → phlegm blocks the lung → lung qi does not descend → cough. It does not aim for “eight herbs together to destroy the bacteria causing cough” but a whole traditional method of resolving phlegm, regulating qi, descending lung qi and relieving cough. The manufacturer’s leaflet also advises: stop and seek medical advice if there is no improvement after a week of use, and also seek medical advice promptly if there is a high fever above 38°C, wheezing and breathlessness, worsening cough or markedly increased phlegm.

Honey-prepared Fritillaria and Loquat Syrup (蜜炼川贝枇杷膏) is a different line of thinking. Taking the Nin Jiom honey-prepared fritillaria and loquat syrup commonly seen on the UK market as an example, the formula includes fritillaria (chuanbei), loquat leaf, platycodon, huajuhong, processed pinellia and others, made into a syrup with honey. Fritillaria has a traditional history of use for clearing heat, moistening the lung and resolving phlegm, closer to a cough with “sticky phlegm, leaning to heat” than the wind-cold cough with “thin white phlegm”; loquat leaf traditionally clears the lung and sends counterflow down, also involving descending stomach qi, linking exactly the “lung qi counterflow” and “stomach qi counterflow” we met earlier; platycodon disperses the lung and eases the throat; honey provides the texture and, traditionally, soothes the throat. A reminder: the sugar content of such honey syrups is often not low, and anyone who needs to control sugar should not overlook it just because it is “herbal”.

Put the two products side by side and you find that both relate to cough and share huajuhong and pinellia, but the emphasis differs: Orange Red Phlegm-Cough Granules focus on the phlegm-damp cough with “a lot of phlegm and a heavy, turbid sound”; the honey-prepared Fritillaria and Loquat Syrup stresses moistening the lung and throat and is closer to sticky, heat-leaning phlegm or throat discomfort. “Cough” is only the name of a symptom and is not the same as the outcome of pattern differentiation. No single “Chinese cough medicine” suits every cough: someone with lots of phlegm differs from someone with almost none, white thin phlegm differs from yellow sticky phlegm, and two days after catching cold differs from two months of dry cough.

The steps of evidence

With such patent medicines we must use our usual steps of evidence: record of traditional use → laboratory research on single herbs → pharmacological mechanism studies of the formula → human clinical studies of the finished product → high-quality randomised controlled trials → independent replication → long-term safety. A herb showing antitussive, anti-inflammatory or expectorant activity in cell or animal experiments does not mean the whole formula on the shelf has been shown by high-quality human trials to be equally effective; conversely, a product with a long traditional history is not therefore worthless, since it carries experience worth verifying further. Traditional experience and clinical evidence should be stated separately.

If you want to know which pattern you belong to and whether a certain type of patent medicine suits you, the safest route is: first rule out danger signs, then book a full pattern differentiation consultation with a qualified TCM practitioner, who will decide, in light of your circumstances and the medicines you take, whether to use it.

[HONGDAHEALTH Chinese medicine consultation entry: to be added]

 

9. Is Stopping the Cough Really the Goal?

A cough is a protective reflex to begin with. That is why, faced with a recurrent cough, modern medicine’s first question is never “how do I make it stop at once?” but “why is it happening?”

TCM does not simply suppress a cough on sight either: if wind caused it, the approach is to disperse; if phlegm-dampness, to resolve phlegm; if lung dryness, to moisten; if weak upright qi, to tonify; if counterflow of qi, to guide it downward. What they share is that the aim is not to “eliminate the act of coughing” but to deal with the deeper cause that makes the act keep recurring.

What really needs dealing with is often not “this one cough”, but the reason the cough will not retreat.

 

10. A Cough Action Map: “If This Is Me, Where Do I Start?”

In the past we told readers how two medicines understand cough; now we want these two bodies of knowledge to help you decide what to do next. Find the row that looks most like you:

My cough	First thing	Pharmacy and daily care	Dietary direction	Next step
Dry cough and tickly throat after a cold, no danger signs	Observe the course; keep a cough diary	Honey and lemon hot drink (over one year old), soothing syrup; ask the pharmacist	Lily bulb, honey and other moistening ingredients	See your GP if beyond three weeks
Yellow sticky phlegm, sore throat, thirst	Check for infection; see a doctor if fever or breathlessness	Ask the pharmacist; drink plenty	Mulberry leaf, chrysanthemum, luo han guo	See your GP if it will not go
A lot of white phlegm, chest tightness, bloating and tiredness	Rule out lung problems first	Treat according to the cause; do not only suppress the cough	Tangerine peel, poria, Chinese yam, coix seed	TCM pattern differentiation
Cough after meals or when lying down, with acid reflux and heartburn	Think of reflux	Adjust dinner time and sleeping position; ask the pharmacist about alginates, antacids and the like	Plain, regular meals	See your GP if it persists
Rhinitis, throat-clearing, mucus running down the throat, with cough	Deal with the rhinitis first	Nasal spray, nasal rinse; ask the pharmacist	Choose according to constitution	GP or TCM practitioner
Dry cough with little phlegm, dry throat, worse at night, for two or three months	Look for chronic causes; do not just suppress	See your GP first	Lily bulb, ophiopogon and other moistening ingredients	GP plus TCM practitioner
Older person with a long cough, breathlessness, frequent night-time urination	Get checked first	Do not suppress the cough yourself long term	Talk about dietary care after tests	GP first
Any danger sign at any time	Seek help at once	NHS 111; call 999 if severe	Not applicable	Do not wait

Need a TCM practitioner to differentiate your pattern according to your constitution? If you are not sure which type you are, or want to know whether a certain type of patent medicine suits you, you can book a HONGDAHEALTH Chinese medicine consultation, where a practitioner will judge according to your overall condition.

[HONGDAHEALTH Chinese medicine consultation entry: to be added]

 

11. Two Systems, One Cough

Modern medicine understands chronic cough by first assuming there is a neural reflex mechanism in the airway that may have become over-sensitive, then checking in turn the commonest triggers in the upper airway, lower airway and digestive tract; TCM understands cough from the whole framework of “all five zang and six fu organs can make one cough”, treating the disorders of lung, heart, liver, spleen and kidney each as possible routes to the one common exit of “cough”.

What we really want to show readers is not “ancient Chinese doctors discovered cough hypersensitivity syndrome two thousand years ago”, nor “modern medicine has finally proved that all the organs can cause cough”, but: through long clinical observation ancient Chinese physicians built a model that understands cough from the relationships among whole-body symptoms; modern medicine, through anatomy, physiology, neuroscience, immunology and clinical trials, has built another. Some clinical phenomena overlap interestingly, but their theoretical explanations and systems of evidence are completely different, and they can neither replace each other nor be simply equated.

 

12. Closing: Why It Is Worth Asking One More “Why”

Leo’s cough in the end faded as the aftermath of his cold settled, which is the natural outcome of the great majority of post-cold coughs. But what this book wants to say is that behind the same “cough lasting more than three weeks” there may stand very different causes: it may be the sensitivity of the airway nerves that have not yet recovered from an infection; it may be stomach acid quietly climbing the gullet at night; it may be a “fire” born of stress and emotional stagnation; it may be a pool of phlegm gathered after the spleen’s transformation failed; and in the traditional TCM framework, it may also be an expression of the “kidney failing to receive qi” after old age and weakness.

A cough looks like a matter of the throat and lung, but in either system of medicine it reminds us of the same thing: a symptom that keeps coming back and will not retreat is worth one more “why”, rather than hurrying to find a pill that stops it at once.

The dietary-care content in this book is traditional dietary knowledge and does not replace diagnosis or necessary medical treatment. For a persistent cough, difficulty breathing, coughing up blood and similar situations, seek professional medical help promptly.

For more information, please visit our website at theFTL.org — For Truth & Life. Thank you and see you next time.