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[Outline] Zhang Zhongjing stated: In Taiyang disease (Taiyang syndrome), if the exterior pattern is not resolved and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or thirst, or diarrhea, or a sensation of choking in the throat, or difficulty in urination with fullness in the lower abdomen, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated. If fluid retention exists in the epigastrium due to cold damage, presenting with cough and slight wheezing, fever but no thirst, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is indicated. If thirst occurs after taking the decoction, it indicates that the pathogenic factor is departing and the condition is about to resolve. In Shaoyin disease (Shaoyin syndrome), if there is abdominal pain, difficulty in urination, heaviness and pain in the four limbs, and spontaneous diarrhea, this indicates the presence of fluid retention. If the patient also has a cough, Zhen Wu Tang (True Warrior Decoction) added with Wu Wei Zi (Schisandra Fruit), Xi Xin (Asarum Root), and Gan Jiang (Dried Ginger) is indicated.

[Commentary] Zhu Zhenheng stated: Cough associated with Taiyang disease patterns can be treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction) or Xiao Chai Hu Tang (Minor Bupleurum Decoction). Generally, if heat is located in the Upper Jiao (Upper Burner), the person will desire to drink water. When water stagnates in the epigastrium, it causes the Lung Qi to float upward. Since the Lung governs coughing, when fluid qi invades it, cough and slight wheezing result. Both Shaoyang (Lesser Yang) and Shaoyin (Lesser Yin) diseases can present with cough symptoms.

Han Zhihe stated: The previous two clauses refer to cough caused by retained fluid. Although both are caused by fluid retention, Xiao Qing Long Tang (Minor Blue Dragon Decoction) treats cough resulting from the combination of fluid retention and exterior cold, whereas Zhen Wu Tang (True Warrior Decoction) treats cough resulting from the combination of fluid retention and interior cold. This distinction must be understood. Whether it is exterior cold or interior cold, when combined with fluid retention, it inevitably disturbs the Lung, because external cold and cold drinks injure the Lung.

The Lung governs Qi. External cold and cold dietary intake injure the Lung, causing Qi to ascend rather than descend, becoming rebellious and failing to gather. This impacts the diaphragm and pharynx, causing a itching sensation in the throat as if blocked. This induces coughing. Severe cases involve continuous, unceasing coughing, restlessness in sitting and lying, inability to finish speaking, movement affecting the whole body, and audible sounds reaching nearby areas.

Gong Xin stated: Fluid qi refers to the Cold Water Qi of the Taiyang channel. Coughing occurs because fluid qi shoots into the Lung. The skin and hair are the exterior correspondence of the Lung. If the exterior cold is not resolved, cold water remains in its correspondence. Fluid qi in the epigastrium ascends to the Lung, causing Lung cold. The combination of internal and external pathogens results in cough. With fluid qi in the epigastrium, cough is inevitable, while wheezing is possible. This is similar to the criteria for Xiao Chai Hu Tang (Minor Bupleurum Decoction) syndrome, where observing one symptom is sufficient for diagnosis, without needing all symptoms to be present.

[Outline] Zhang Zhongjing stated: After five or six days of cold damage, or wind strike, presenting with alternating chills and fever, bitter distension and fullness in the chest and hypochondrium, silence with lack of appetite, irritability and frequent vomiting, or irritability in the chest without vomiting, or thirst, or abdominal pain, or hardness and fullness under the ribs, or palpitations, or difficulty in urination, or no thirst with slight fever on the body, or cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. In Shaoyin disease (Shaoyin syndrome), presenting with cold extremities, diarrhea with a sensation of rectal heaviness, and if the patient also has cough, palpitations, difficulty in urination, or abdominal pain, Si Ni San (Frigid Extremities Powder) is indicated.

[Commentary] Zhao Sizhen stated: These two clauses describe cough caused by pathogenic factors transmitting from the exterior to the interior. Although both involve transmission to the interior, Xiao Chai Hu Tang (Minor Bupleurum Decoction) treats cough caused by Yang pathogens disturbing the Lung upon transmission, whereas Si Ni San (Frigid Extremities Powder) treats cough caused by Yin pathogens disturbing the Lung upon transmission. This distinction must also be recognized. Whether Yang or Yin pathogens transmit from the exterior to the interior, they inevitably disturb the Lung, because the Zhen Qi (True Qi) of the organs is superior to the Lung.

Cough due to retained fluid and cough due to exterior pathogens transmitting to the interior are already understood. There is also cough due to Lung cold. The Nei Jing states: "Why does the Lung cause cough?" The skin and hair are the exterior correspondence of the Lung. If the skin and hair first receive cold qi, the cold enters through its correspondence. If cold food and drink enter the stomach, the cold travels up via the Lung meridian to the Lung, causing Lung cold. Lung cold leads to the combination of external and internal pathogens, which then lodge in the Lung, resulting in cough. This is cough due to Lung cold.

Tao Hua stated: Cough involves clearing the throat; commonly called 'sou'. The Lung governs Qi. When the Lung is invaded by pathogens, Qi rebels and fails to descend, causing cough. There is cough due to Lung cold, cough due to retained fluid, and cough due to pathogens in the Half-Exterior Half-Interior. Treatments differ. The three types of water-induced cough must be distinguished. Xiao Qing Long Tang (Minor Blue Dragon Decoction) treats surface water of the Taiyang channel; Shi Zao Tang (Ten Date Pill) treats interior water of the Taiyang channel; Zhen Wu Tang (True Warrior Decoction) treats fluid qi in water-patterns. Generally, when water combines with exterior cold, use Xiao Qing Long Tang (Minor Blue Dragon Decoction) to induce sweating; when water combines with interior cold, use Zhen Wu Tang (True Warrior Decoction) to warm; when interior accumulation combines with water to disturb the Lung causing cough, use Shi Zao Tang (Ten Date Pill) to purge. For Taiyang disease with fever, cough, dry retching, wheezing, and diarrhea, use Xiao Qing Long Tang (Minor Blue Dragon Decoction); for aversion to cold and body pain, follow the base formula; for cool body, cough, dry retching, mild diarrhea, epigastric fullness, and pain radiating to the hypochondrium, use Shi Zao Tang (Ten Date Pill); for heavy limbs, abdominal pain, diarrhea, cough, or vomiting, use Zhen Wu Tang (True Warrior Decoction).

[Outline] Zhang Zhongjing stated: If coughing is accompanied by free urination, sweating therapy should not be used. If sweating is induced, it will lead to cold reversal in the four limbs.

[Commentary] Cheng Wuji stated: Cough is a disease of the Lung, and treatment requires dispersing methods. However, sweating therapy must absolutely be avoided, as stated in this clause.

Wu Shou stated: For exterior cold cough with floating pulse, aversion to cold, body ache, stiffness, and absence of sweat, use Ma Huang Tang (Ephedra Decoction) or San Ao Tang (Three Unbinding Decoction) to induce sweating. If sputum is like glue, use Jin Fei Cao San (Golden Whorlwort Powder) to induce sweating. If there is heat, use Shen Su Yin (Ginseng and Perilla Drink) removing Mu Xiang (Aucklandia Root) and Ren Shen (Ginseng Root), adding Ma Huang (Ephedra Stem), Sang Bai Pi (Mulberry Root Bark), and Xing Ren (Apricot Seed) to induce sweating. For weak individuals suffering from cold damage with cough and phlegm, or aversion to wind, headache, and dry retching, use Ren Shen Xing Ren Tang (Ginseng and Apricot Seed Decoction). If cold damage transmits to the Shaoyang channel within two to three days, presenting with wiry pulse, bitter taste, fever, and cough, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Ren Shen (Ginseng Root), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube Fruit), adding Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger). If there is fever, chest irritability, and cough, add fried Gua Lou (Trichosanthes Fruit). If there is chest and hypochondriac fullness, fever, and cough, add Zhi Ke (Bitter Orange) and Jie Geng (Platycodon Root). For any Yin pattern with cold extremities, deep and fine pulse, and cough, use Si Ni Tang (Frigid Extremities Decoction) added with Wu Wei Zi (Schisandra Fruit). Generally, cough in cold damage differs from miscellaneous diseases. According to Zhang Zhongjing's principles, for cough regardless of Yin or Yang patterns, Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger) are always used. Wu Wei Zi (Schisandra Fruit) astringes Lung Qi to stop cough, while Gan Jiang (Dried Ginger) enters the Lung meridian to disperse rebellious Qi. In early autumn, following heavy rain and cold, or during epidemic severe cold, heat tends to hide internally. Symptoms include cough, difficult breathing, hoarseness, loss of voice, dry cough, and a sensation of blockage in the throat; She Gan Tang (Belamcanda Decoction) is indicated.

Li Zhongzi stated: Cough with sound but no phlegm is called 'Ke'; cough with sound and phlegm is called 'Sou'.

Zhu Danxi stated: Cough and Sou are essentially one disease. Some say Ke has sound but no phlegm, while Sou has phlegm but no sound. Others say Ke is Yang and Sou is Yin. These claims lack evidence. Cough is not solely caused by cold; the Six Qi (Six Excesses) can all cause cough. Wind cough presents with dizziness and vertigo, and difficult expectoration; treat with Tong Sheng San (Universal Salvation Powder) to induce sweating, and Sou Feng Wan (Wind-Searching Pill) to clear. Fire cough presents with dry mouth and tongue, wheezing, and hemoptysis; treat with Liang Ge San (Cool the Diaphragm Powder) added with Dang Gui (Angelica Sinensis Root) and Jie Geng (Platycodon Root), and Jie Du with Da Jin Hua Wan (Great Golden Flower Pill). Summerheat cough presents with red face, cold hands, and spontaneous sweating on the head; treat with Bai Hu Tang (White Tiger Decoction) to eliminate. Dampness cough presents with facial edema and upper wheezing; treat with Da Ju Pi Tang (Large Tangerine Peel Decoction) to stop cough; severe cases use San Hua Shen Wan (Three Flowers Divine Pill) to purge. Dryness cough presents with alternating chills and fever, and thick sticky nasal discharge and sputum; treat with Chai Hu Yin Zi (Bupleurum Drink). Cold cough presents with cold extremities; treat with Ning Fei San (Lung-Calming Powder) to astringe. Erroneous physicians fail to distinguish the Six Qi, stubbornly treating everything as cold, and abruptly using Kun Fan (Alum) and Su Qiao (Poppy Shell); even in old age, they remain unaware of their error.

Shen Jin'ao noted: Zhu's theory on the Six Qi causing cough applies generally to miscellaneous diseases. However, the etiology of cough in cold damage also includes causes related to the Six Qi, so the treatment methods can certainly be referenced.