一、痰多咳嗽
甲、概况
内伤咳嗽，咳之属于内因者，或由外感失治，久则转为内伤者亦属之。内伤咳嗽之轻者，十九皆由于痰
多所致，或因小儿为肥胖之体，外观饱满，中气则虚，虚则湿浊滞而不运，以致化痰；或因小儿脾胃薄弱，
加以乳食饮食之不调，宿滞逗留，脾失转运，以致化痰；或因小儿口腹之欲，恣食肥甘，胃中浊气郁
蒸，以致化痰；或因小儿恣食鲜果茶水，水饮停留过多，不及下行，以致化痰；或因小儿屡患感冒，肺气
疲乏，失其开阖之权，以致化痰；或因小儿居处阴湿之地，阳气被困，浊阴弥漫，以致化痰，及其化痰之后，
均须假肺为出路，于是皆发为咳嗽。此轻证内伤咳嗽之来由，所以皆为痰多也。惟痰有热痰、寒痰、燥
痰、湿痰之分，故证状不一，治法各异。热痰之状，多见脉洪面赤，口干唇燥，其痰或浓而色黄，或坚而成
块，饮食不化，肝胃有热，及感冒后余邪化热均足致此；寒痰之状，多见脉沉面黑，口吐清水，其痰或稀而
色白，或间有黑点，脾胃虚寒，肺气怯弱，或水饮停留均足致此；燥痰之状，多见脉涩面白，气上喘
促，其痰涩而难出，或燥如米粒，粘亮而少，时令过燥，肺中有火，或湿邪在肺，从火化而为燥，均足致此；
湿痰之状，多见脉缓面黄，肢体沉重，其痰滑而易出，或色白而多，饮食不化，身体过肥，或水饮停留，居
处阴湿均足致此。此外又有痰饮者，多因热病饮水过多，不加节制，停蓄而致；或寒湿之体，脾阳不
运，饮水不化而成。其状脉偏细弦，不咳而多嗽，日夜吐痰，清而且稀，甚者喘满心悸，渴饮呕水，此各各
不同之见证，而可以一言以蔽之，曰∶痰为之祟也。夫痰之为病，虽不尽为咳嗽，或
为呕为泻，或为痞隔壅塞，或为寒热疟疾，或为眩晕，或为癫狂，或为肿痛，或为结核，或流注于四肢，
其随气升降，遍身上下，无处不到，乘虚而入，停聚则病，原无一定之可言，然内伤咳嗽之属于痰之为病，
盖有可得而言者。若再进究其源，则究其痰之来源，而病情即无不了如指掌，治法亦从可悟到矣。
乙、治法
内伤咳嗽之初起，饮食起居，虽能如常，然往往无端咳呛，或吐清痰，或吐浓痰，继则饮食不为肌肤，
咳嗽时作时止，甚者咳伤肺络，竟至咯血。重者亦有恶寒发热，恶寒者表虚也，发热者内蒸也。此时失于调
治，则病进甚速，若转成虚损之咳嗽，则不易治疗矣。故宜乘其轻浅之时，分别施治。热痰宜用贝母、栝
蒌、二冬、知母、竹沥、天竹黄、猴枣之属，然治热痰非调气下行，则可酌佐陈皮、青皮、苏子之类以行其
气。咳不爽者，亦可略用桔梗以提之。寒痰宜用半夏、陈皮、白术、茯苓、生姜、干姜、肉桂、草果、常山、
附子、硫黄之属，然治寒痰亦宜宣通肺气，则可酌佐薄荷、杏仁、姜制竹沥、白芥子之类以为之导。咳
不爽者，亦可略用桔梗以提之。燥痰宜用贝母、枇杷叶、栝蒌、桑白皮、杏仁、莱菔子、前胡、炙款冬、天
冬、玉竹之属，然治燥痰宜养阴清火以生津，则可酌佐生地、当归、白芍、麻仁、石膏、阿胶、玄参之类以润
其源，间亦须调气为辅，则可酌佐陈皮、青皮、泽泻之类以为之导。咳不爽者，亦可略用桔梗以提
之。湿痰宜用南星、半夏、苍术、白术、陈皮、茯苓、苡米、枳壳、白芥子、槟榔、浓朴、木香，沉香之属，
然湿而挟寒者宜温之，湿而挟热者宜清之，脾胃弱而湿滞者，则可酌佐白豆蔻。肉豆蔻、山药、人参、肉桂
之类以补其气。咳不爽者，亦可略用桔梗以提之。凡内伤咳嗽之初起，大率以二陈汤加减治之。频咳不
已，吐痰多而且稀者，多由于热，宜加竹茹、川贝。栝蒌之属；时咳时止，吐痰少而且稀者，多兼夹寒，宜
加杏仁、苏子、薄
荷、荆芥之属（咳嗽之时，喉间痰声虽似浓稠，而所吐皆为白沫稀涎者，多为虚损咳嗽）。频咳不已，吐
痰多而黄稠者，多由于热，宜加前胡、知母、贝母、冬桑叶、黄菊花之属；时咳时止，吐痰少而黄稠者，
湿而兼热，宜加槟榔、浓朴、苡米、白术之属（咳吐黄痰腥臭者为肺痈证，与寻常咳嗽不同）。其由肠胃积
滞，脾胃不运，以致咳嗽者，宜平胃散加法半夏、贝母、麦芽、神曲之属。其由频患感冒，动辄咳嗽有汗者，
宜玉屏风散加北沙参、百合、马兜铃之属，或合四君子汤治之。其由过饮不化，水停心下，以致咳嗽呕水者，
宜茯苓饮或茯苓桂枝白术甘草汤治之。其由咳伤肺络者，始宜治咳之中加三七、茜草、郁金或桃
仁、大黄以行其瘀，继宜生地、茅根、白芍、丹皮等以凉其血，然后用白芨、沙参、阿胶、冬虫夏草、百合、
麦冬、熟地、归身、燕窝等以补肺养血。咳嗽久而恶寒者，宜治咳之中，加白术、桂枝、黄 等以扶其阳气。
咳嗽久而发热者，宜治咳之中，加桑皮、花粉、知母、淡芩、栀子等以去其内蒸，另有痰饮一
证，多由积饮不化，日久所致，轻者宜小半夏加茯苓汤或茯苓桂枝白术甘草汤，重者宜十枣汤（治实证）、
肾气丸（治虚证）。假令瘦人脐下有悸，吐涎沫而癫眩者，此有水可从小便去之，宜
五苓散。至论痰饮之变化，至为繁复，固当与成人之痰饮同其治法也。
二、虚损咳嗽
甲、概况
虚损咳嗽，乃内伤咳嗽之重者。盖咳嗽经久而不治，未有不转成虚损者，亦有病起甚速，始得即成虚损
者，此必小儿先天太弱，早有预伏之因，或外感误用滋腻之品，泥邪不化所致。虚损咳嗽之来由如此，故其
证之初起，必先肺气已伤，肾气不能上充，水火之升降失调，痰浊之积滞不行，因之脾胃交困，奉生者
少，营养既日以乏，病情自日以进，故虚损咳嗽之为病，其源在
肺，其流所及，则一身全局，莫不有关，脾胃与肾，尤为吃重。又虚损咳嗽，痰未必多，所患者在饮食之
精华，不为养身之用，徒为成痰之源，所患者在痰虽少而易滞不易行，所患者在痰之到处乘虚以酿病，故
虚损咳嗽之为病，常面色不华，身体瘦怯，咳嗽反不如外感之甚，亦不如痰多之剧，咯痰亦少，往往数咳
而一吐，或清晨入晚，略有咳嗽，或低咳数声，或干咳无痰，此津液煎熬所成，盖与其他咳嗽迥异者也。
此时欲攻尽其痰，不啻攻尽其津液，故治法宜补养脾胃以绝其生痰之源。而痰之已成者，仍宜廓而清之以养
肺，庶儿生生之气日长，病可由渐而退也。虚损咳嗽之轻者，饮食尚可，瘦削不甚，略有寒热，未至脾胃俱
伤者，治之尚易，更进则饮食减退，虚热时潮，大便不实，为肺病日进，脾胃俱伤，治之较难。重者潮热似有
似无，火升面颊微红，胃口全败，思食而不能纳，大便溏泻，手足软弱，一举动则喘而汗出，是肺气将竭，
脾胃俱败，虚火妄动，元阳无根，多为不治之证矣。昔有肺损、肺痨、肺痿诸名，在小儿为童痨，其实皆虚
损咳嗽之一类也。至于咳血一症，壮实之人，恒亦有之，未必即为虚损，而虚损咳嗽，亦有至死不咳血者，
故未可以一概论。若咳血因肺体受创，病邪易侵，及精神恐怖，营养减退，转为虚损为
较易，固事理之所应有，则证治当亦相同，而可附论于此也。
乙、治法
虚损咳嗽之初步，常因肺胃失其清肃，以致熏蒸成热，热伤肺阴，以致燥痰结肺，咳吐不爽，治宜川贝、
知母、麦冬、款冬、天花粉、马兜铃之属以养肺清热。肠胃有积，则宜白术、木香、陈皮、神曲之类以行气
化积，忌用麦芽、莱菔等耗气消导之品。其夹外感者，若标急（外邪重）而本缓（虚损浅），则宜就
其标治之（惟忌攻下以伤肠胃）。用药精审者，恒有标病已而本病亦骤愈者。若本急（虚损重）而标缓（外
邪轻），则宜就其本治之，或略顾其标，或竟不必顾其标，此为虚中挟实之治法。迨
虚损病进，则肺阴益损，内热蒸动，每潮热一次，恒数日始已，潮热一次则病进一次，斯时治之合度，可
使其潮热一次，则病减一次，盖不进则退，理有固然，宜用滋阴清化汤、保和汤、滋阴保肺汤之属。凡潮热热
势甚者其病浅，热势微而永不能清者其病深，盖一则正气尚未大耗，而一则正气已属衰微也。干咳无痰者，
宜琼玉膏清之，或本事鳖甲丸加味以补之（火邪郁肺，亦有干咳，不属于虚损咳嗽一类）。又此证出入之关
键，恒在于脾胃之能否鼓舞其正气，倘大便实者，多为可治，倘大便溏薄，多有变端。故虚损之咳嗽，虽发
热之时，宜用川贝、知母、麦冬、生地、地骨皮之属，而一遇便溏，即当用扶胃保脾之品加而进之，
或竟乘其未溏之前，即用之以预为之防者，否则脾阳一败，肾气下竭，更将难于措施，是在临证之随机，用保
肺扶脾汤治之最妥。潮热似有似无，脾伤泄泻者，宜杨氏八味汤加减治之；虚火妄动，元阳无根者，宜金匮
肾气丸加减治之；其有咳嗽之全由虚寒者，宜用附子、干姜、胡芦巴之类；痰气上升，虚而发喘，元
气亏耗，真阳欲脱者，宜用黑锡丹治之；久咳肺气耗散，狂咳无制，身振振动摇者，宜干姜、五味子、五倍子
等收敛之（以上三证，高年患咳嗽者所常有，而小儿患之，恒不多见）。以上为虚损咳嗽之通治，大抵与外感
咳嗽迥乎不同者也。又虚损中有肺痿一证，其特征为肺叶萎缩。原因有二，一因汗下不当，胃气耗
伤，不能上输于肺，肺失所养，日渐枯燥，内不能洒陈于六腑，外不能输津于皮毛，于是肺叶日痿，肺气益
窒，咳声渐以不扬，胸中脂膜日干，治宜生肺津润肺燥，开积痰，下逆气，终则须补真气以开通肺窍。一因肺
为火迫，失其清肃而变干燥，凡脾胃上输之津液，不独不能沾润，转从热化而为涎浊，致肌瘦神疲，咳
吐不已，久之肺热枯燥，虽投清凉，亦扦格不入，治宜以半夏少许，入清凉生津药中，藉半夏为导驱其浊，
而清凉之药力方达于肺。凡此用药之步骤，与上述均可相互参看之。虚损咳嗽至于张
口短气，日久音哑，偏卧一侧，翻身则咳不休，六脉沉涩而急，细数无神者皆不治。至于虚损咳血，初起
先宜化痰行瘀，用紫菀、百部、二冬、甜杏仁、参三七、白茅根之属，服一二剂，继则宜补肺修络以止血，
用保肺归血汤，偏热者去肉桂、干姜，用二冬、藕汁、童便、生地之属以佐之。总之治咳血亦不脱乎标本二
者，急则治其标，缓则治其本，治标者治其横溢之血，宜修补经络，消导血瘀，如牡蛎、龙骨、侧柏炭、地
榆炭、棕榈炭、血余炭、白芨、三七、茜草、蒲黄之类是。治本者治其出血之因，宜顺气止血，各归其经，
如降香、沉香、陈皮、郁金、生地、茅根、梨汁、鲜藕、莲须、丹皮之类是。随证应用，酌加化痰补肺
及培养脾胃之品，固皆可以应手取效者也。
附方
（一）二陈汤 治胃中寒湿痰浊等证。
陈皮 半夏 茯苓（各二钱） 甘草（一钱） 生姜（七片）
一方有乌梅肉一个。清水煎服。
燥痰减半夏、生姜，加麦冬、竹沥；郁痰干咳去半夏，加川贝母；火痰加黄连、竹茹；老痰加蛤粉、海浮石。
（二）平胃散 治湿滞脾胃，不能运化，积饮痞膈，不思饮食，心腹胀痛，口苦短气，反胃恶心，嗳气
吞酸，面黄体瘦，体痛嗜卧，壮热自利，霍乱吐泻。能调气暖胃，化宿食，消痰饮。
浓朴 陈皮 甘草 苍术
（三）玉屏风散 治风邪久留不散，及卫虚自汗不止。
黄 白术 防风 加生姜 大枣
（四）四君子汤 见第三章第五节。
（五）茯苓饮 治胸有停痰宿水，吐出后，心虚气满不能食。
茯苓 人参 白术 枳实 橘皮 生姜
（六）茯苓桂枝白术甘草汤 治伤寒若吐若下后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗
则动经，身为振振摇，及心下有痰饮，胸胁支满，目眩。
茯苓 桂枝 白术 甘草
（七）小半夏加茯苓汤 治痰饮多汗，小便不利，卒呕吐，心下痞，水停胸膈，眩悸。
半夏 生姜 茯苓
（八）十枣汤 治太阳中风，表解里未和，及悬饮支饮，或因水而咳。
大枣（十枚） 芫花 甘遂 大戟（各等分）
先煮大枣去滓，后纳芫花、甘遂、大戟药末服。以枣肉和丸名十枣丸。
（九）肾气丸 治虚劳不足，消渴小便多。
熟地 山药 山萸肉 茯苓 丹皮 泽泻 附子 桂枝
（十）五苓散 见第三章第五节。
（十一）滋阴清化汤 治痰热。
熟地 生地 天冬 麦冬 当归 鳖甲 阿胶 白芍 茯苓 山药 贝母 天花粉 五味子 甘草
（十二）保和汤 治虚痨咳嗽 肺燥成痿，呕吐脓血。
知母 川贝 天冬（去心） 麦冬（去心） 款冬花（各一钱） 天花粉
苡仁（炒） 杏仁（去皮尖。各五分） 马兜铃 紫菀 桔梗 百合 阿胶（蛤
粉炒） 当归 百部（各六分） 甘草 紫苏 苏薄荷（各四分） 五味子（十二粒）
加生姜三片，入饴糖一匙，清水煎服。痰中带血加蒲黄、生地、小蓟、茜根、藕节。
（十三）滋阴保肺汤 滋阴，保肺。
I. Cough with Excessive Phlegm
A. Overview
Internal injury cough refers to coughing caused by internal factors, or it may result from improper treatment of external contraction diseases that transform into internal injuries over time. Mild cases of internal injury cough are mostly caused by excessive phlegm. This can be due to the child having a fat body; although appearing full externally, the middle Qi is deficient. Deficiency leads to stagnation and failure of transformation of damp-turbidity, thereby generating phlegm. It may also be because the child's spleen and stomach are weak, combined with irregular milk and food intake, causing food retention. The spleen loses its transportation function, thereby generating phlegm. It may also be due to the child's desire for food, indulging in rich and sweet foods, causing turbid Qi in the stomach to stagnate and steam, thereby generating phlegm. Or it may be because the child consumes too much fresh fruit and tea/water, causing water-fluids to stay too long without descending, thereby generating phlegm. Or it may be because the child suffers from repeated colds, exhausting Lung Qi and losing its opening and closing authority, thereby generating phlegm. Or it may be because the child lives in a yin-damp place, where Yang Qi is trapped and turbid Yin spreads, thereby generating phlegm. After phlegm is formed, it must use the Lungs as an outlet, thus all manifest as coughing. This is the origin of mild internal injury cough, hence it is all due to excessive phlegm. However, phlegm is divided into heat-phlegm, cold-phlegm, dry-phlegm, and damp-phlegm, so symptoms vary and treatment methods differ. Heat-phlegm manifests as a surging pulse, red face, dry mouth and lips; the phlegm may be thick and yellow, or hard and clumped; food is not digested; Liver-Stomach heat, or residual pathogens after a cold transforming into heat, are sufficient to cause this. Cold-phlegm manifests as a deep pulse, dark face, spitting clear saliva; the phlegm may be thin and white, or have black spots; Spleen-Stomach deficiency-cold, weak Lung Qi, or water-fluid retention are sufficient to cause this. Dry-phlegm manifests as a choppy pulse, pale face, upward rushing Qi and panting; the phlegm is sticky and difficult to expectorate, or dry like rice grains, shiny but scanty; seasonal excessive dryness, fire in the Lungs, or damp-pathogens in the Lungs transforming from fire into dryness are sufficient to cause this. Damp-phlegm manifests as a slow pulse, yellow face, heavy limbs; the phlegm is slippery and easy to expectorate, or white and abundant; food is not digested; being overweight, water-fluid retention, or living in a yin-damp place are sufficient to cause this. Additionally, there is fluid-retention (Tan-Yin), often caused by drinking too much water during febrile diseases without restraint, leading to accumulation; or in individuals with cold-damp constitutions, where Spleen Yang fails to transform fluids, causing water to accumulate. Symptoms include a fine and wiry pulse, frequent retching rather than coughing, day and night expectoration of clear and thin phlegm; severe cases involve panting, chest fullness, palpitations, thirst with drinking, and vomiting water. These different manifestations can be summarized in one word: it is Phlegm that causes the disaster. Although Phlegm disease does not always cause coughing, it can cause vomiting, diarrhea, epigastric fullness and obstruction, chills and fever/malaria, dizziness, mania, swelling and pain, tuberculosis, or flow into the four limbs. It rises and falls with Qi, reaching everywhere in the body, entering when deficiency exists, and causing illness when stagnant, originally having no fixed pattern. However, internal injury cough caused by Phlegm has patterns that can be discussed. Further investigating its source, tracing the origin of Phlegm, allows one to understand the condition clearly and deduce treatment methods.
B. Treatment Methods
At the onset of internal injury cough, diet and daily life may seem normal, but often there is unprovoked choking cough, or spitting clear phlegm, or thick phlegm. Subsequently, food nutrients fail to nourish the muscles and skin, coughing comes and goes. Severe cases damage Lung collaterals, even leading to hemoptysis. Heavy cases may also have aversion to cold and fever; aversion to cold indicates exterior deficiency, fever indicates internal steaming. If treatment is neglected at this stage, the disease progresses rapidly. If it transforms into deficiency-cough, it becomes difficult to treat. Therefore, treatment should be applied separately while the condition is mild and superficial. For heat-phlegm, use Fritillariae Bulbus (Beimu), Trichosanthis Fructus (Gualou), Asparagi Radix et Ophiopogonis Radix (Er Dong), Anemarrhenae Rhizoma (Zhimu), Bamboo Juice (Zhuli), Tianshu Huang, and Monkey Seed (Houzao). However, treating heat-phlegm requires regulating Qi to descend; if not, one may add Tangerine Peel (Chenpi), Green Tangerine Peel (Qingpi), or Perilla Seed (Suzi) to move Qi. For unsatisfactory cough, Euphorbiae Hirtae Herba (Jiegeng) may be slightly used to lift Qi. For cold-phlegm, use Pinelliae Rhizoma (Banxia), Tangerine Peel (Chenpi), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Fresh Ginger (Shengjiang), Dried Ginger (Ganjiang), Cinnamon Twig (Rougui), Tsaoko Fructus (Caoguo), Swallowwort Root (Changshan), Aconiti Lateralis Radica Praeparata (Fuzi), and Sulfur (Liuhuang). However, treating cold-phlegm also requires venting Lung Qi; one may add Mint (Bohe), Apricot Kernel (Xingren), Ginger-processed Bamboo Juice, or White Mustard Seed (Baijiezi) as guides. For unsatisfactory cough, Jiegeng may be slightly used to lift Qi. For dry-phlegm, use Beimu, Loquat Leaf (Pipaye), Gualou, Mulberry Root Bark (Sangbaipi), Xingren, Radish Seed (Laifuzi), Peucedani Radix (Qianhu), Honey-fried Coltsfoot Flower (Zhikuandong), Tiandong, and Polygonati Odorati Rhizoma (Yuzhu). Treating dry-phlegm requires nourishing Yin and clearing fire to generate fluids; one may add Rehmanniae Radix (Shengdi), Angelicae Sinensis Radix (Danggui), White Peony Root (Baishao), Hemp Seed (Maren), Gypsum (Shigao), Donkey-hide Gelatin (Ejiao), and Scrophulariae Radix (Xuanshen) to moisten the source. Sometimes Qi regulation is needed as assistance; Chenpi, Qingpi, or Alisma Rhizoma (Zexie) may be added as guides. For unsatisfactory cough, Jiegeng may be slightly used to lift Qi. For damp-phlegm, use Arisaema Cum Bile (Nanxing), Banxia, Atractylodis Rhizoma (Cangzhu), Baizhu, Chenpi, Fuling, Coix Seed (Yimi), Aurantii Fructus (Zhike), Baijiezi, Areca Seed (Binglang), Magnoliae Officinalis Cortex (Nongpu/Houpo), Costus Root (Muxiang), and Aquilaria Wood (Chenxiang). If dampness combines with cold, warm it; if dampness combines with heat, clear it; if Spleen-Stomach is weak with damp stagnation, add White Cardamom (Baidoukou), Nutmeg (Roudoukou), Dioscoreae Rhizoma (Shanyao), Ginseng (Renshen), or Rougui to tonify Qi. For unsatisfactory cough, Jiegeng may be slightly used to lift Qi. Generally, the early stage of internal injury cough is treated with Erchen Tang (Two-Cured Decoction) modified. Frequent coughing with abundant thin phlegm is mostly due to heat; add Bamboo Shavings (Zhuru), Chuan Beimu, and Gualou. Intermittent coughing with scanty thin phlegm often involves cold; add Xingren, Suzi, Bohe, and Schizonepeta Spike (Jingjie) (Note: If throat sounds suggest thick phlegm but only white foam and thin saliva are expectorated, it is mostly deficiency-cough). Frequent coughing with abundant yellow-thick phlegm is mostly due to heat; add Qianhu, Zhimu, Beimu, Mulberry Leaf (Dongsangye), and Chrysanthemi Flos (Huangjuhua). Intermittent coughing with scanty yellow-thick phlegm indicates dampness combining with heat; add Binglang, Houpo, Yimi, and Baizhu (Note: Expectoration of foul-smelling yellow phlegm indicates Lung Abscess, different from ordinary cough). For cough caused by intestinal/ gastric stagnation and Spleen-Stomach failure to transport, use Pingwei San (Flat Stomach Powder) with Banxia, Beimu, Malt (Maiya), and Medicated Leaven (Shenqu). For cough caused by frequent colds with sweating, use Yupingfeng San (Jade Windscreen Powder) with Glehniae Radix (Beishashen), Lily Bulb (Baihe), and Aristolochiae Manshuriensis Fructus (Madouling), or combine with Sijunzi Tang (Four Gentlemen Decoction). For cough and vomiting caused by excessive undigested drinking and water retention under the heart, use Fuling Yin or Fuling Guizhi Baizhu Gancao Tang. For cough damaging Lung collaterals, initially add Notoginseng Radix (Sanqi), Rubia Cordifolia Radix (Qiancao), Curcuma Aromatica Rhizoma (Yujin), or Peach Kernel (Taoren) and Rheum Palmatum Radix et Rhizoma (Dahuang) to move blood stasis; subsequently use Shengdi, Imperata Rhizome (Maogen), Baishao, and Moutan Cortex (Danpi) to cool blood; finally use Bletillae Rhizoma (Baiji), Glehniae Radix (Shashen), Ejiao, Cordyceps (Dongchongxiacao), Baihe, Ophiopogonis Radix (Maidong), Prepared Rehmanniae Radix (Shudi), Danggui Body (Guishen), and Bird's Nest to tonify Lung and nourish blood. For chronic cough with aversion to cold, add Baizhu, Guizhi, and Astragali Radix (Huangqi) to support Yang Qi. For chronic cough with fever, add Sangbaipi, Trichosanthis Radix (Huafen), Zhimu, Scutellariae Radix (Danqin), and Gardenia Fruit (Zhizi) to remove internal steaming. Another syndrome is fluid-retention (Tan-Yin), often caused by accumulated fluids failing to transform over time. Mild cases use Xiaobanxia Jiafuling Tang or Fuling Guizhi Baizhu Gancao Tang; severe cases use Shizao Tang (for excess syndromes) or Shenqi Wan (for deficiency syndromes). If a thin person has palpitations below the umbilicus, spits saliva/drool, and experiences vertigo, this indicates water pathogen removable via urination; use Wuling San. Changes in Tan-Yin are complex and should be treated similarly to adults.
II. Deficiency-Cough
A. Overview
Deficiency-cough is a severe form of internal injury cough. Chronic untreated cough inevitably transforms into deficiency-cough. Some develop rapidly into deficiency-cough upon onset, usually due to congenital weakness in children with latent causes, or misuse of cloying/nourishing herbs for external contractions, trapping pathogens. Thus, deficiency-cough originates here. At onset, Lung Qi is damaged, Kidney Qi cannot ascend to fill, Water-Fire ascending-descending is disordered, and phlegm-turbidity stagnates. Spleen-Stomach become distressed, providing less nourishment. Nutrition dwindles daily, and the condition worsens daily. The source of deficiency-cough is the Lung, affecting the whole body, with Spleen-Stomach and Kidneys being critical. In deficiency-cough, phlegm may not be abundant; the key issue is that dietary essence fails to nourish the body, becoming the source of phlegm. The phlegm is scanty but sticky and hard to move. Phlegm travels everywhere, causing illness by exploiting deficiency. Patients often have a sallow complexion, emaciated and frail bodies. Coughing is less severe than in external contraction or excessive phlegm coughs. Expectoration is scarce, often coughing several times before spitting once, or slight coughing in morning/evening, low coughs, or dry cough without phlegm. This results from fluid consumption, distinct from other coughs. Attempting to eliminate all phlegm here would deplete fluids. Thus, treatment should tonify Spleen-Stomach to cut off the phlegm source. Existing phlegm should be cleared to nourish the Lung, allowing vital Qi to grow and the disease to recede. Mild deficiency-cough allows normal diet, slight emaciation, slight chills/fever, and undamaged Spleen-Stomach; treatment is easier. Progression leads to reduced appetite, tidal fever, loose stools, indicating advancing Lung disease and damaged Spleen-Stomach; treatment is harder. Severe cases have vague tidal fever, rising fire with flushed cheeks, complete loss of appetite, inability to eat despite desire, loose stools, weak limbs, panting and sweating upon movement. This indicates impending Lung Qi exhaustion, Spleen-Stomach failure, wild deficiency-fire, and rootless Yuan-Yang; mostly untreatable. Past names include Lung Damage, Lung Tuberculosis, Lung Withering; in children called "Childhood Tuberculosis," all belonging to deficiency-cough. Hemoptysis occurs in robust people and is not necessarily deficiency; deficiency-cough patients may never hemoptysis until death. Thus, generalization is inappropriate. If hemoptysis results from lung trauma, pathogen invasion, mental terror, and nutritional decline leading to deficiency, the pathology aligns, and treatment is similar, discussed here.
B. Treatment Methods
Early deficiency-cough often stems from Lung-Stomach losing clarity and purity, causing steaming heat, damaging Lung Yin, forming dry-phlegm in Lungs, causing unsatisfactory expectoration. Use Chuan Beimu, Zhimu, Maidong, Kuandong, Huafen, Madouling to nourish Lung and clear heat. If intestinal/gastric stagnation exists, use Baizhu, Muxiang, Chenpi, Shenqu to move Qi and resolve stagnation; avoid Maiya and Laifuzi which consume Qi. If complicated by external contraction: if branch is urgent (heavy pathogen) and root is slow (light deficiency), treat the branch (avoid purgatives damaging intestines/stomach). Precise medication often resolves branch and root simultaneously. If root is urgent (heavy deficiency) and branch is slow (light pathogen), treat the root, briefly address branch, or ignore branch; this is treating deficiency with excess complication. As deficiency advances, Lung Yin damages further, internal heat steams. Each tidal fever episode lasts days; each episode advances disease. Proper treatment can make each episode reduce disease ("advance means retreat"). Use Ziyin Qinghua Tang, Baohe Tang, or Ziyin Baofei Tang. Severe tidal fever indicates shallow disease; faint, persistent fever indicates deep disease (vital Qi not greatly consumed vs. vital Qi exhausted). Dry cough without phlegm uses Qiongyu Gao to clear, or Ben Shi Biejia Wan modified to tonify (Fire pathogen stagnating in Lung causes dry cough, not deficiency-cough). The key to this condition lies in whether Spleen-Stomach can boost vital Qi. Solid stool indicates treatability; loose stool indicates complications. During fever, use Chuan Beimu, Zhimu, Maidong, Shengdi, Digan Pi. Upon loose stool, immediately use Spleen-Stomach supporting herbs, or preemptively use them before stool loosens. Otherwise, Spleen Yang failure and Kidney Qi depletion will be hard to manage. Adapt clinically; Baofei Fupi Tang is most appropriate. Vague tidal fever with Spleen injury/diarrhea uses Yangshi Bawei Tang modified. Wild deficiency-fire/rootless Yuan-Yang uses Jin Gui Shenqi Wan modified. Cough entirely due to deficiency-cold uses Fuzi, Ganjiang, Halysidota Tartarea (Huluba). Rising phlegm-Qi, deficiency-panting, depleted Yuan Qi, impending True-Yang collapse uses Heixi Dan. Chronic cough dissipating Lung Qi, uncontrollable violent cough, body trembling uses Ganjiang, Wuweizi, Myrobalan (Wubeizi) to astringe (These three are common in elderly, rare in children). These are general treatments for deficiency-cough, distinct from external contraction cough. Lung Withering (Fei Wei) in deficiency features withered lung lobes. Causes: 1. Improper sweating/purging damages Stomach Qi, unable to transmit to Lung, Lung loses nourishment, becomes dry. Internally cannot moisten six fu-organs, externally cannot transmit fluids to skin/hair. Lung lobes wither, Lung Qi obstructs, cough sound fades, chest membrane dries. Treat by generating Lung fluids, moistening dryness, resolving phlegm, directing rebellious Qi down, finally tonifying True Qi to open Lung orifices. 2. Lung forced by fire, losing clarity, becoming dry. Fluids from Spleen-Stomach do not moisten but transform from heat into turbid saliva. Emaciation, fatigue, continuous coughing. Long-term Lung heat/dryness makes cooling herbs ineffective. Use small amount of Banxia in cooling/fluid-generating herbs to guide turbidity out, allowing cooling power to reach Lung. Medication steps refer to above. Untreatable signs: gasping, hoarseness, sleeping on one side, coughing upon turning, deep/choppy/rapid/thin-numerous soulless pulses. For deficiency-hemoptysis, initially resolve phlegm and move stasis using Ziwan, Tuberculous Stemona (Baibu), Er Dong, Sweet Apricot Kernel, Sanqi, Maogen for 1-2 doses. Then tonify Lung and repair collaterals to stop bleeding using Baofei Guixue Tang. For heat, remove Rougui/Ganjiang, add Er Dong, Lotus Rhizome Juice (Ou Zhi), Child's Urine (Tong Bian), Shengdi. Treating hemoptysis follows root/branch principles: urgent treats branch (overflowing blood), slow treats root (cause of bleeding). Branch treatment repairs collaterals, resolves stasis using Oyster Shell (Muli), Dragon Bone (Longgu), Platycladi Cacumen Carbonized (Cebotao), Sanguisorbae Radix Carbonized (Diyttao), Palmyra Palm Spadix Carbonized (Zonglutao), Human Hair Carbonized (Xuyutao), Baiji, Sanqi, Qiancao, Polumen (Puhuang). Root treatment directs Qi, stops bleeding, returns blood to meridians using Xiangliang, Chenxiang, Chenpi, Yujin, Shengdi, Maogen, Pear Juice, Fresh Lotus Root, Nelumbinis Stamen (Lianxu), Danpi. Apply according to syndrome, adding phlegm-resolving, Lung-tonifying, and Spleen-Stomach-nourishing herbs for effective results.
Attached Formulas
(1) Erchen Tang: Treats cold-damp phlegm-turbidity in Stomach.
Chenpi, Banxia, Fuling (2 qian each), Gancao (1 qian), Shengjiang (7 slices).
Alternative: Add one Wumei flesh. Decoct in clear water.
For dry-phlegm: halve Banxia/Shengjiang, add Maidong/Zhuli.
For constrained dry-cough: remove Banxia, add Chuan Beimu.
For fire-phlegm: add Huanglian/Zhuru.
For old-phlegm: add Ge Fen/Haifushi.
(2) Pingwei San: Treats damp-stagnation in Spleen-Stomach, failure to transform, retained fluids, epigastric fullness, loss of appetite, abdominal distension/pain, bitter taste, shortness of breath, regurgitation, nausea, belching, acid reflux, sallow face/emaciation, body pain, lethargy, high fever with spontaneous diarrhea, cholera/vomiting-diarrhea. Regulates Qi, warms Stomach, transforms old food, eliminates phlegm-fluids.
Houpo, Chenpi, Gancao, Cangzhu.
(3) Yupingfeng San: Treats lingering wind-pathogen and Wei-deficiency spontaneous sweating.
Huangqi, Baizhu, Fangfeng. Add Shengjiang, Dazao.
(4) Sijunzi Tang: See Chapter 3, Section 5.
(5) Fuling Yin: Treats retained phlegm/fluids in chest. After expectoration, emptiness and fullness prevent eating.
Fuling, Renshen, Baizhu, Zhishi, JuPi, Shengjiang.
(6) Fuling Guizhi Baizhu Gancao Tang: Treats post-Shanghan vomiting/purging with subcardiac fullness/reversal, Qi rushing to chest, dizziness upon standing, deep-wiry pulse. Sweating moves channels causing body tremors. Also treats subcardiac fluid-retention, hypochondriac fullness, dizziness.
Fuling, Guizhi, Baizhu, Gancao.
(7) Xiaobanxia Jiafuling Tang: Treats fluid-retention with profuse sweating, difficult urination, sudden vomiting, subcardiac fullness, water stopping in chest/diaphragm, dizziness/palpitations.
Banxia, Shengjiang, Fuling.
(8) Shizao Tang: Treats Taiyang wind-stroke with resolved exterior/unharmonized interior, hanging fluid, supporting fluid, or cough due to water.
Dazao (10 pieces), Yuanhua, Gansui, Daji (equal parts).
Boil Dazao first, remove dregs, add powders of Yuanhua, Gansui, Daji. Mix with date flesh into pills named Shizao Wan.
(9) Shenqi Wan: Treats deficiency-labor insufficiency, Xiao Ke (wasting-thirst) with polyuria.
Shudi, Shanyao, Shanzhuyu, Fuling, Danpi, Zexie, Fuzi, Guizhi.
(10) Wuling San: See Chapter 3, Section 5.
(11) Ziyin Qinghua Tang: Treats phlegm-heat.
Shudi, Shengdi, Tiandong, Maidong, Danggui, Biejia, Ejiao, Baishao, Fuling, Shanyao, Beimu, Huafen, Wuweizi, Gancao.
(12) Baohe Tang: Treats deficiency-labor cough, Lung dryness causing withering, vomiting pus/blood.
Zhimu, Chuan Beimu, Tiandong (decored), Maidong (decored), Kuandonghua (1 qian each), Huafen.
Yiren (stir-fried), Xingren (skin/kernel removed, 5 fen each), Madouling, Ziwan, Jiegeng, Baihe, Ejiao (fried with Ge Fen), Danggui, Baibu (6 fen each), Gancao, Zisu, Suhoupo (4 fen each), Wuweizi (12 grains).
Add 3 slices Shengjiang, 1 spoon Yitang, decoct in clear water. Add Puhuang, Shengdi, Xiaoji, Qigen, Ou Jie if blood in phlegm.
(13) Ziyin Baofei Tang: Nourishes Yin, protects Lung.