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Pulse appearing at the Yuji (LU10) position indicates counterflow qi and panting. A floating pulse indicates wind, a tight pulse indicates cold, a rapid pulse indicates heat, and a fine pulse indicates dampness; these arise from the struggle with external pathogens. A floating-tight pulse signifies deficiency-cold, a deep-rapid pulse signifies excess-heat, a string-taut (xian) pulse signifies blood deficiency, and a surging-slippery pulse signifies excessive phlegm; all these arise from internal qi stagnation. Furthermore, a string-taut pulse indicates fluid retention; in robust individuals, vomiting can lead to recovery, but those with a deep pulse should not undergo sweating therapy.

Wind-cold pathologies primarily affect the Lung, as the Lung governs the skin and hair and controls the exterior. When injured, the interstices fail to open, allowing wind-cold to stagnate internally within the Lung, obstructing its clear-descending function, thereby generating phlegm and inducing cough. Additionally, when cold food and drink enter the Stomach, they travel up via the Spleen meridian to the Lung, causing Lung cold; the combination of internal and external pathogens leads to cough.

Excessive fire scorching Lung Metal results in stagnation and distension, severely manifesting as dry cough without phlegm, or hemoptysis and expectoration of blood-streaked sputum. Sexual excess damages Kidney Yin; yin deficiency generates internal fire, consuming Lung fluids, causing body fluids, qi, and blood to transform into phlegm. Phlegm causes qi stagnation, obstructing the ascending and descending movements.

Some theories state that cough results from the dysfunction of Defensive Qi (Wei Qi), while panting results from the dysfunction of Nutritive Blood (Ying Blood). External injuries from the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) are treated by observing the affected location and releasing the exterior; internal injuries from the Seven Emotions are primarily received by the Stomach but involve the Lung.

Cough due to Wind Injury: accompanied by worsening aversion to cold, high fever, spontaneous sweating, aversion to wind, dry mouth, and irritability; Ma Huang Tang (Ephedra Decoction) is indicated. If enuresis occurs, Chi Shi Zhi (Halloysitum Rubrum) is used.

Cough due to Cold Damage: fever, absence of sweating, aversion to cold, and no thirst.

Cough due to Summerheat Injury:烦热 (restlessness and heat) with desire for drinking, or vomiting saliva, hoarseness, and hemoptysis.

Cough due to Dampness Injury: painful joints, heavy limbs, and shivering chills.

Cough due to Excess Joy damaging the Heart: sensation of obstruction in the throat as if swollen, severe cases presenting with sore throat and bi-syndrome, along with spontaneous sweating, dry throat, and hemoptysis; this is caused by overwork damaging the Heart, with the Small Intestine receiving the pathogen, leading to cough and loss of qi control; Shao Yao Gan Cao Tang (Peony and Licorice Decoction) is indicated. Alternatively, Gui Zhi Tang (Cinnamon Twig Decoction) may be used for Heart cough.

Cough due to Anger damaging the Liver: pain in both hypochondriac regions, inability to turn or lie on one side, or fullness in both flanks, left-sided flank pain radiating to the lower abdomen; this is anger damaging the Liver. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated; if the Gallbladder receives the pathogen, vomiting bitter fluid occurs, and Huang Qin Ban Xia Tang (Scutellaria and Pinellia Decoction) with added Licorice is used.

Cough due to Overthinking damaging the Spleen: pain in both hypochondriac regions radiating to the shoulder and back, abdominal distension, heart pain, and anorexia; this is injury from irregular eating, and Sheng Ma Tang (Cimicifuga Decoction) is indicated. If the Stomach receives the pathogen, vomiting roundworms occurs, and Wu Mei Tang (Mume Decoction) is used; some say Ren Shen (Ginseng) treats it.

Cough due to Grief damaging the Lung: panting with sound, severe cases presenting with hemoptysis or white frothy sputum, dry mouth, and hoarseness; this is injury from loud calling damaging the Lung; the Large Intestine receives the pathogen, presenting with enuresis, treated similarly to the "Qi Descending" section below, or using Zhi Ke (Aurantii Fructus).

Cough due to Fear damaging the Kidney: pulling pain between waist and back, severe cases presenting with expectoration of saliva, or alternating chills and fever with panting and fullness pulling on the waist and back; this is sexual exhaustion damaging the Kidney, and Ma Huang Xi Xin Fu Zi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) is indicated; if the Bladder receives the pathogen, urinary incontinence occurs, and Fu Ling Gan Cao Tang (Poria and Licorice Decoction) is used.

Chronic cough unrelieved involves the San Jiao (Triple Burner): abdominal fullness and anorexia; these conditions gather in the Stomach and relate to the Lung, causing excessive mucus and saliva, facial edema, and rebellious qi; Yi Gong Bai Zhu San (Yi Gong Atractylodes Macrocephala Powder) is indicated.

Zhang's Theory: Poor people often suffer from external contractions; the Classics state, "Injury by dampness in autumn leads to cough in winter." Also, "Excessive fire in the year injures Lung Metal, resulting in cough pathology." Wealthy people often consume rich flavors, creating heat-phlegm, known as salivary cough.

Li's Theory: All stem from weak Spleen receiving disease, injuring Lung Metal; food stagnates and fails to move, accumulating into phlegm, rushing into the Lung pathway to cause cough.

Liu's Theory: All stem from Spleen deficiency creating phlegm, injuring Lung wind to cause cough.

Regarding four syndromes of phlegm-cough and tidal fever:

Tidal fever due to phlegm-cough: Although generally similar, manifestations differ. Due to deficiency and cold injury, phlegm-cough appears first; chronic cough unrelieved produces blood threads following the sputum, with aversion to cold and fever, right Cun pulse floating and rapid, external signs lighter by day and heavier by night, pale face, and clear phlegm.

Hemoptysis due to sorrow and great anger, followed by phlegm-cough: less cold, more heat, left Cun pulse deep, small, and rapid, external signs of epigastric oppression, dissatisfaction, and inability to eat.

Or conflict between Gu (parasitic) pathogens and death souls: initial hematemesis of unknown origin, slight phlegm-cough, gradual onset of chills and fever, bilateral pulses string-taut, fine, and rapid, external signs of food failing to nourish muscles, restlessness and erratic behavior, body ache and fatigue; long-term cough with spasms and much phlegm, or panting or diarrhea leading to death.

Or previous injury by wind-cold or dampness, incomplete resolution: although illness recedes and person rises, diet decreases, muscles do not grow, body is tired and weak, exertion causes heat, body ache like劳损 (strain), but no hemoptysis or tidal fever; after two or three years, doctors fail to cure; this is residual toxins lurking in meridians, pulse is string-taut, recurrence leads to recovery.

Treatment Theory: Cough and phlegm-cough are divided into two categories.

Cough refers to sound without phlegm, indicating Lung qi injury and lack of clarity, relating to the Lung; pungent moistening herbs are suitable, Qing Pi (Aurantii Fructus Viridis) and Chen Pi (Aurantii Fructus) to disperse San Jiao qi congestion.

Sputtering (Sou) refers to phlegm without sound, indicating Spleen dampness transforming into phlegm, expelled by coughing, accumulating in the Lung. This is because Lung qi injury moves Spleen dampness to cause cough; if the Spleen has no retained dampness, even with Lung qi injury, phlegm does not form. However, cold, summerheat, dryness, dampness, wind, and fire all cause cough; only dampness and phlegm-fluid entering the Stomach remain stagnant, rising to the Lung to become cough. Treatment prioritizes resolving phlegm and descending qi. If dampness is in the Heart Meridian, it is called Heat-Phlegm; in the Liver Meridian, Wind-Phlegm; in the Lung Meridian, Qi-Phlegm; in the Kidney Meridian, Cold-Phlegm.

If able to eat, use purgation; if unable to eat, Hou Po Tang (Magnolia Bark Decoction) is primary.

Phlegm with heat: Chai Hu Tang (Bupleurum Decoction) plus Shi Gao (Gypsum) is primary.

Phlegm with cold: Xiao Qing Long Tang (Minor Blue Dragon Decoction) plus Xing Ren (Apricot Seed) is primary.

Zhang's treatment for Wind-Phlegm: Feng Zheng Tong Sheng San (Wind-Clearing Unblocking Powder) plus Ban Xia (Pinellia).

Summerheat-phlegm: Bai Hu Tang (White Tiger Decoction), Liang Ge San (Cooling Chest Powder).

Fire-phlegm: Huang Lian Jie Du Tang (Coptis Detoxification Decoction).

Damp-phlegm: Wu Ling San (Five-Ingredient Poria Powder) combined with Bai Zhu (Atractylodes Macrocephala).

Dry-cough: Mu Xiang Ting Li San (Costus and Lepidium Powder).

Cold-cough: Ning Shen Ning Fei San (Calming Spirit Calming Lung Powder), further divided into vomiting, sweating, and purging methods.

Additionally, excessive heat and large amounts of drinking condense in the chest to become damp, thus forming phlegm; vomiting is indicated.

Formula: Nan Xing (Arisaema Cum Bile), Ban Xia (Pinellia), Zhi Ke (Aurantii Fructus), Chen Pi (Aurantii Fructus).

Wind-phlegm with string-taut pulse: add Feng Zheng Tong Sheng San.
Heat-phlegm with surging pulse: add Xiao Chai Hu Tang, Qing Dai (Azurite), Huang Lian (Coptis).
Damp-phlegm with slow pulse: add Cang Zhu (Atractylodes Lancea), Fang Ji (Stephania Tetrandra).
Cold-phlegm with deep pulse: add Gui Zhi (Cinnamon Twig), Xing Ren, Xiao Qing Long Tang.
Qi-phlegm with choppy pulse: add Qing Pi, Chen Pi.
Rebellious qi: add Ku Ting Li (Lepidium Fruit).
Shortness of breath: add Ren Shen (Ginseng), Jie Geng (Platycodon).
Fever: add Huang Qin (Scutellaria), Jie Geng.
Severe heat with panting: add Han Shui Shi (Halloysitum Album), Shi Gao.
Fullness: add Zhi Shi (Aurantii Fructus Immaturus); severe cases add Fu Ling (Poria).
Edema: add Yu Li Ren (Prunus Semen), Xing Ren, Ze Xie (Alisma), Fu Ling.
Constipation: add Da Huang (Rhubarb); if able to eat, add Cheng Qi Tang; if unable to eat, add Hou Po (Magnolia Bark).

Li Ge Wan (Diaphragm-Opening Pill): Treats chest discomfort, phlegm-cough, and panting.
Ingredients: Mu Xiang (Costus), Bing Lang (Areca Seed) (each 1 qian), Zhi Ke (bran-fried 1 liang), Hou Po (3 liang), Da Huang (wine-processed 1 liang), Dang Gui (Angelica Sinensis), Ren Shen (each 3 qian).

Zi Su Yin Zi (Perilla Infusion): Treats Spleen and Lung cold injury with phlegm-saliva cough.
Ingredients: Zi Su Zi (Perilla Fruit), Sang Bai Pi (Mulberry Root Bark), Qing Pi, Chen Pi, Xing Ren, Ma Huang (Ephedra), Ban Xia, Wu Wei Zi (Schisandra), Zhi Gan Cao (Prepared Licorice), Ren Shen.

Qian Min Tang (Thousand Threads Decoction): Treats phlegm.
Ingredients: Ban Xia (1 liang), Zao Jiao (Tamarix Branch/Soap Pod) (skin and strings removed, half liang), Xiong Huang (Realgar).
Preparation: Boil above ingredients in 3 sheng of water with 8 slices of ginger until reduced to half; rub in a silk bag to extract clear juice for administration.

Secret Recipe: Treats wind-cold, moves phlegm, opens interstices.
Ingredients: Er Chen Tang (Two-Aged Decoction) plus Ma Huang, Xing Ren, Jie Geng.

Treating Fire-Cough: Huang Qin, Huang Lian, Gua Lou (Trichosanthes), Hai Shi (Sea Stone/Floating Stone).

Treating Labor-Cough (Consumption Cough): Si Wu Tang (Four Substance Decoction) plus Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice).

Treating Lung Distension and Fire Stagnation: He Zi (Terminalia Chebula), Xing Ren, Ban Xia, Gua Lou, Qing Dai, Xiang Fu (Cyperus).

Treating Phlegm Accumulation Formula: Nan Xing, Ban Xia, Gua Lou, Qing Dai, Yan Yan (Rock Salt/Mineral Salt).

Liver pain with qi stagnation: add Qing Pi.
Cough in the first half of the day: mostly Stomach fire, add Bei Mu (Fritillaria), Shi Gao.
Cough in the second half of the day: mostly yin deficiency, add Zhi Mu (Anemarrhena), Huang Bo (Phellodendron), Chuan Xiong (Ligusticum), Chuan Gui (Angelica Sinensis); if very deficient and prone to sexual indulgence, add Ren Shen Gao (Ginseng Paste), Chen Pi, Sheng Jiang (Fresh Ginger).

Wine-induced Cough: Bai Fan (Alum) (ground 1 liang), Xing Ren (1 sheng).
Preparation: Boil in 1 sheng of water until dry, spread on tile, expose overnight, stir-fry dry; chew 15 Apricot Seeds after dinner.

E Guan Shi San (Goose Tube Stone Powder): Treats wind entering Lung cavity.
Ingredients: Nan Xing, Xiong Huang, Kuan Dong Hua (Coltsfoot Flower), E Guan Shi (Goose Tube Stone).
Preparation: Grind to powder, mix with Mugwort, place Ginger on tongue, moxa until smoke enters throat; more is better.

Qing Meng Shi Wan (Blue Malachite Pill): Resolves phlegm.

Chen Xiang Wan (Agarwood Pill): Treats phlegm.

Phlegm-Cough Formula: Nan Xing, Ban Xia, Fu Ling, Chen Pi, Feng Hua Xiao (Weathered Nitre), Bei Mu, Huo Shi (Living Stone), Bai Jie Zi (White Mustard Seed).
Heat adds Huang Qin, Qing Dai; Wind adds Zao Jiao; Dampness adds Cang Zhu; Fullness adds Zhi Shi; Dryness adds Gua Lou Ren (Trichosanthes Seed).

Labor-Cough Formula: Si Jun Zi Tang (Four Gentlemen Decoction), Bai He (Lily Bulb), Kuan Hua (Coltsfoot), Xi Xin (Asarum), Gui Zhi (Cinnamon Twig), Wu Wei Zi, E Jiao (Donkey-Hide Gelatin), Tian Men Dong (Asparagus Root), Xing Ren, Ban Xia, Huang Qi (Astragalus), Shao Yao (Peony).
Preparation: Decoct in water and take.