甲、概况
杂证咳嗽，咳嗽之属于内外因相杂者。有因哺乳及饮食不慎，误呛气管，气管受伤，以致发为咳嗽者；有
因糖醋冲犯，咸酸过食，或风寒束其外，痰涎塞其内，以致成为哮证者；有因火邪郁肺，痰不得豁，以致发为
干咳者；有因外邪不解，肺气不降，以致成为肺胀，胸高喘咳者；有因感受风寒，未经发越，停
留肺中，蕴发为热，或湿热痰涎垢腻，充塞肺窍，以致成为肺痈，咳吐脓血者。大致不越此数端，惟内外因
相杂之咳嗽，其病证之重，虽不如虚损咳嗽之甚，然原因复杂，究较单属外感者为难治。故哮证一成，往往
终身不除，一遇风寒，即便发作；而肺胀肺痈，虽经治愈，亦往往有遗留之恙。故均号称多变之病证，
医者所宜深切注意者也。
乙、治法
小儿哺乳误呛气管以致咳嗽者，必乳汁过多，不及吞咽所致。哺乳时宜手按乳房，毋使直注而下，不必
服药，咳嗽自可渐已，如为郑重计，可略进甘桔汤，或射干消毒饮之类。饮食不慎，误呛气管，以致气管受
伤，作咳不止者，宜清润之，用射干消毒饮去玄参、荆芥，加蜜炙款冬花、蜜炙冬桑叶、蜜炙枇杷叶
之属。重者喉间作水鸡之声，气道不利，呼吸困难，是为哮证，治宜降其痰而整肃其气道，不可过凉，恐
风邪难解，不可过热，恐痰火易升。遇浓味而发者，用清金丹；遇风寒而发者，用苏子
饮；哮而上气喘急，夜不能卧，用阿胶、马兜铃、甘草、半夏、杏仁、人参、桑白皮煎汤服；寒热夹杂之哮，
先用麻黄、杏仁、苏子、前胡以豁其痰，再用降气之品，或用越婢加半夏汤治之；
胸有停水而哮，酌用十枣汤以行其水；风痰骤升而哮，酌用千缗
导痰汤以疏其痰。凡哮之通治方用千金汤最妥。若汗出如油，气息上奔，出多入少者是谓之喘，其证与哮盖迥
不相同也。干咳者，火邪郁肺，痰不得出，宜先用桔梗、柴胡以开提肺气，再用生地、玉竹、甜杏仁、白蜜
之类以润之，或用逍遥散加苦桔梗以开之。肺胀者，外邪不解，喘咳胀闷，其人上气目如脱状，宜越
婢加半夏汤，心下有水，小青龙加石膏汤主之。痰夹瘀血，阻碍气机者，酌加当归、赤芍、丹皮、桃仁之类
以行其血。肺痈者，初作口中辟辟燥咳，胸中隐隐痛，宜服犀黄丸，或用薏苡仁、淡芩、丝瓜、甘草、川贝、
赤芍、栝蒌仁、桔梗、陈皮、升麻、丹皮以消之，或用金匮皂荚丸以泻之。喘不得卧，面目浮肿者，宜
葶苈大枣泻肺汤。既成之后，咳吐脓血，宜葶苈薏苡泻肺汤或排脓散。肺痈咳吐脓血不止，其势危急者，用陈
芥菜卤汁冲水饮，或用蕺莱煎汤，打鸡蛋食，均效。肺痈初起，未可断定，以生大豆试食不觉腥者是，以甘
草、桔梗各三钱煎服后，稍安者是，宜趁其未伤而泻之，自易挽回，若畏其峻而守王道之方，日久肺叶
朽烂，脓血倾囊吐出，则为难治矣。又杂证咳嗽，虽显有余之象，实为不足之征，故不问内伤外感，为热为
寒，但以人参保定肺气，自可无虑。昔贤曾定有人参清肺、人参泻肺、人参定喘汤三方，以人参之力握其枢而
斡运之，虚实之治，悉寓其中，事实虽不尽然，其理颇有可采，录仍于后，俾备参考。
附方
（一）甘桔汤 见第四章第一节。
（二）射干消毒饮 治麻疹咳嗽声喑，咽喉肿痛。
射干 玄参 连翘 荆芥 鼠粘子 甘草
（三）清金丹 治食积痰壅，哮喘咳嗽，遇浓味即发者。
莱菔子（蒸熟晒干，一两） 猪牙皂角（烧存性，三钱）
共研细末，生姜汁浸蒸饼为丸，如绿豆大。
（四）苏子饮（自制） 治素有哮证，遇风寒则发。
苏子（三钱） 姜汁制竹沥（一两） 法半夏 沉香 川朴（各一钱）
喘逆无汗加麻黄五分。
（五）越婢加半夏汤 治肺胀 咳而上气，其人喘，目如脱状，脉浮大。
麻黄 石膏 半夏 甘草 生姜 大枣
（六）十枣汤 见本章第三节。
（七）千缗导痰汤 治风痰哮。
半夏（七枚） 天南星 陈皮 赤茯苓 枳壳（各一钱） 皂荚（蜜炙） 甘草（蜜炙。各一寸）
加生姜五片，清水煎服。
（八）千金汤 治哮。
麻黄 桑白皮 苏子 杏仁 白果 黄芩 半夏 甘草 款冬花
清水煎服。
（九）逍遥散 治肝气抑郁，血虚火旺，寒热咳嗽，两胁作痛。
柴胡（七分） 白术（蜜水拌蒸） 茯苓 当归 白芍（各钱半） 甘草 陈皮（各八分） 薄荷叶
（五分） 煨姜（三片）
清水煎服。
（十）小青龙加石膏汤 治肺胀咳而上气，烦躁而喘，心下有水气，脉浮者。
麻黄 白芍 细辛 干姜 甘草 桂枝 半夏 五味子 石膏
（十一）犀黄丸 疗痈疽、石疽、乳岩、瘰 、痰核、恶核、横 流注、肺痈、小肠痈，一切腐烂阴疽。
犀黄（三分） 麝香（钱半） 乳香 没药（各一两）
研为细末，用煮烂黄米饭和丸如粟米大。
（十二）皂荚丸 治肺痈初起，咳逆上气，唾浊。
皂荚（刮去皮，酥炙，八两）
研为末，炼蜜和丸，如梧子大，或枣肉和丸，如绿豆大，每服数丸，枣膏和汤送下。
（十三）葶苈大枣泻肺汤 治肺痈喘不得卧，胸满胀，一身面目浮肿，鼻塞清涕出，不闻香臭酸辛，
咳逆上气，喘鸣迫塞，及支饮不得息。
葶苈 大枣
先服小青龙汤一剂，继进此方，服后，即吐脓血。忌食盐、酱等物。
（十四）葶苈薏苡泻肺汤 治肺痈初溃，唾脓血。
葶苈（酒炒研，八分） 薏苡仁（五钱） 贝母（去心，一钱六分） 甘草节（一
钱五分） 陈皮（一钱二分） 黄 （酒拌勿炒） 桔梗 忍冬 白芨（各一钱） 生姜（一片）
清水煎，食后缓缓服。初起去黄 、白芨，加防风；溃后脓尽加人参；久不敛，去葶苈加合欢皮。
（十五）排脓散 治内痈脓从便出。
枳实（十六枚） 芍药（六分） 桔梗（二分）
杵为散，以生鸡子黄一枚，以药散与鸡黄相等，揉和令相得，饮和服之。
（十六）排脓汤 治内痈脓从呕出。
甘草 桔梗 生姜 大枣
（十七）人参清肺汤 治肺胃虚寒，咳嗽喘急，坐卧不安，及久年劳嗽，吐血腥臭。
人参 阿胶 地骨皮 知母 乌梅 罂粟壳 甘草 杏仁 桑白皮（各等分）
清水煎服。
（十八）人参泻肺汤 治肺经积热上喘，胸膈胀满，痰多，大便涩。
人参 黄芩 栀子 枳壳 薄荷 甘草 连翘 杏仁 桑白皮 大黄 桔梗
清水煎服。
（十九）人参定喘汤 治肺气上逆，喉中有声，坐卧不安，胸膈紧痛。
人参 麻黄 阿胶（蛤粉炒） 半夏曲 五味子 罂粟壳（蜜炙） 甘草（炙，各一钱） 桑白皮（蜜炙，二钱）
加生姜三片，清水煎服。
（二十）姜汁背心 治寒痰壅塞经络，不时发哮。
生姜捣取自然汁，用以浆布背心，贴肉着之，数易即愈。
（二十一）甘草猪胆丸 治醋呛咳嗽。
甘草（去赤皮，二两）
用猪胆汁五枚，浸三日，取出，火上炙干为细末，炼蜜为丸。
A. Overview
Miscellaneous syndrome cough refers to coughs caused by a combination of internal and external factors. Some cases arise from improper breastfeeding or diet, where milk or food is accidentally aspirated into the trachea, injuring it and thereby inducing cough; some result from excessive consumption of sweet, sour, salty, or acidic foods, combined with external constraint by wind-cold and internal obstruction by phlegm-fluid, leading to asthma (a syndrome characterized by rapid breathing and wheezing sounds in the throat); some occur due to heat-fire pathogens stagnating in the lungs, preventing the expulsion of phlegm, resulting in dry cough; some develop into lung distension (a syndrome characterized by chest fullness, tightness, and distension) with high chest and wheezing cough because external pathogens remain unresolved and lung qi fails to descend; some manifest as lung abscess (a syndrome characterized by fever, cough, chest pain, and expectoration of pus and blood) due to retained wind-cold transforming into heat within the lungs, or due to damp-heat phlegm obstructing the lung orifices. Generally, these cover the main categories. However, although mixed internal-external cause coughs are not as severe as deficiency-coughs, their complex etiology makes them more difficult to treat than simple exterior-constraint coughs. Once asthma forms, it often persists for life, recurring upon exposure to wind-cold; lung distension and lung abscess, even after cure, frequently leave residual symptoms. Therefore, they are known as variable syndromes requiring close attention by physicians.
B. Treatment Methods
For infants coughing due to milk aspiration during breastfeeding, the cause is usually excessive milk flow that cannot be swallowed promptly. During feeding, the breast should be held to prevent direct injection of milk; medication is unnecessary, and the cough will gradually cease. For precaution, Ganjie Tang (Licorice and Platycodon Decoction) or Shegan Xiaodu Yin (Belamcanda Detoxification Decoction) may be administered. If cough persists due to dietary indiscretion and tracheal injury, clear and moisten using Shegan Xiaodu Yin, removing Xuan Shen (Scrophulariae Radix) and Jing Jie (Schizonepetae Herba), and adding Mi Zhi Kuan Dong Hua (Honey-fried Farfarae Flos), Mi Zhi Dong Sang Ye (Honey-fried Mori Folium), and Mi Zhi Pi Pa Ye (Honey-fried Eriobotryae Folium). In severe cases presenting with wheezing sounds like a water fowl, airway obstruction, and dyspnea, this is asthma. Treatment should resolve phlegm and regulate the airway; avoid overly cold herbs to prevent trapping wind pathogens, and avoid overly hot herbs to prevent aggravating phlegm-fire. For attacks triggered by rich flavors, use Qingjin Dan (Clear Metal Pill); for wind-cold triggers, use Suzi Yin (Perilla Seed Decoction); for asthma with upper body wheezing and inability to lie flat at night, decoct E Jiao (Donkey-hide Gelatin), Ma Dou Ling (Aristolochiae Fructus), Gan Cao (Glycyrrhizae Radix), Ban Xia (Pinelliae Rhizoma), Xing Ren (Armeniacae Semen), Ren Shen (Ginseng Radix et Rhizoma), and Sang Bai Pi (Mori Cortex). For mixed cold-heat asthma, first use Ma Huang (Ephedrae Herba), Xing Ren, Su Zi (Perillae Fructus), and Qian Hu (Peucedani Radix) to expel phlegm, then use qi-descending agents, or Yingspi Jia Banxia Tang (Yingspi Decoction plus Pinellia). For asthma with fluid retention in the chest, use Shizao Tang (Ten Dates Decoction) to promote diuresis; for sudden rise of wind-phlegm causing asthma, use Qianmin Daotan Tang (Qianmin Phlegm-Resolving Decoction) to disperse phlegm. The general formula for asthma is Qianjin Tang (Thousand Gold Decoction). If sweating is profuse like oil, breath rushes upward, and exhalation exceeds inhalation, this is panting (asthma differs significantly from this). For dry cough due to heat stagnation in lungs, first use Jie Geng (Platycodonis Radix) and Chai Hu (Bupleuri Radix) to raise lung qi, then use Sheng Di Huang (Rehmanniae Radix), Yu Zhu (Polygonati Odorati Rhizoma), Tian Xing Ren (Sweet Apricot Kernel), and white honey to moisten, or Xiaoyao San (Free and Easy Wanderer Powder) plus Ku Jie Geng to open the lungs. For lung distension with unresolved exterior pathogens, wheezing, cough, and chest fullness, where the patient appears to have eyes protruding due to qi rebellion, use Yingspi Jia Banxia Tang; if there is fluid below the heart, use Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction plus Gypsum). If phlegm is accompanied by blood stasis obstructing qi mechanism, add Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniae Radix Rubra), Mu Dan Pi (Moutan Cortex), and Tao Ren (Persicae Semen) to invigorate blood. For early-stage lung abscess with dry mouth, crisp cough, and dull chest pain, take Xi Huang Wan (Rhino Horn Pill), or use Yi Yi Ren (Coicis Semen), Dan Qin (Scutellariae Radix), Si Gua (Luffae Fructus), Gan Cao, Chuan Bei Mu (Fritillariae Bulbus), Chi Shao, Gua Lou Ren (Trichosanthis Semen), Jie Geng, Chen Pi (Citri Reticulatae Pericarpium), Sheng Ma (Cimicifugae Rhizoma), and Mu Dan Pi to dissipate, or Jin Gui Zao Ying Wan (Golden Cabinet Soap Pod Pill) to purge. For panting with inability to lie flat and facial edema, use Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs). After formation, when expectorating pus and blood, use Ting Li Yi Yi Xie Fei Tang (Descurainia Seed and Coix Seed Decoction to Drain the Lungs) or Pai Nong San (Pus-Expelling Powder). For critical lung abscess with continuous expectoration of pus and blood, drink diluted Chen Jie Cai Lu Zhi (Aged Mustard Greens Brine) or Ji Cai Jian Tang (Houttuynia Decoction) with beaten eggs. To diagnose early lung abscess, have the patient taste raw soybeans; if no fishy smell is detected, it is likely lung abscess. If symptoms alleviate slightly after taking Gan Cao and Jie Geng (each 3 qian), proceed with purging while the damage is minimal for easier recovery. Adhering only to mild formulas due to fear of harsh ones may lead to lung tissue necrosis and massive expectoration of pus and blood, making treatment difficult. Generally, miscellaneous coughs showing excess signs actually indicate deficiency; regardless of internal/external origin or cold/heat nature, using Ren Shen to stabilize lung qi ensures safety. Former sages formulated Ren Shen Qing Fei Tang (Ren Shen Lung-Clearing Decoction), Ren Shen Xie Fei Tang (Ren Shen Lung-Purging Decoction), and Ren Shen Ding Chuan Tang (Ren Shen Panting-Calming Decoction), utilizing Ren Shen to control the pivot and manage both excess and deficiency. Although practical application varies, the theory is valuable and recorded here for reference.
Attached Formulas
(1) Ganjie Tang: See Chapter 4, Section 1.
(2) Shegan Xiaodu Yin: Treats measles-induced hoarse cough and sore throat. Ingredients: Shegan (Belamcandae Rhizoma), Xuan Shen (Scrophulariae Radix), Lian Qiao (Forsythiae Fructus), Jing Jie (Schizonepetae Herba), Niu Bang Zi (Arctii Fructus), Gan Cao (Glycyrrhizae Radix).
(3) Qingjin Dan: Treats food stagnation with phlegm obstruction, asthma/cough triggered by rich foods. Ingredients: Lai Fu Zi (Radish Seed, steamed and dried, 1 liang), Zhu Ya Zao Jiao (Soap Pod, burnt to retain character, 3 qian). Grind to powder, mix with ginger juice and steamed dough, form pills size of mung beans.
(4) Suzi Yin (Self-made): Treats chronic asthma triggered by wind-cold. Ingredients: Su Zi (Perillae Fructus, 3 qian), Jiang Zhi Zhu Li (Ginger-processed Bamboo Sap, 1 liang), Fa Ban Xia (Prepared Pinellia), Chen Xiang (Aquilariae Lignum), Hou Po (Magnoliae Officinalis Cortex, each 1 qian). Add Ma Huang (Ephedrae Herba, 5 fen) if panting without sweat.
(5) Yingspi Jia Banxia Tang: Treats lung distension with cough, qi rebellion, wheezing, protruding eyes, and floating-large pulse. Ingredients: Ma Huang, Shi Gao (Gypsum Fibrosum), Ban Xia, Gan Cao, Sheng Jiang (Zingiberis Rhizoma Recens), Da Zao (Jujubae Fructus).
(6) Shizao Tang: See Chapter 3, Section 3.
(7) Qianmin Daotan Tang: Treats wind-phlegm asthma. Ingredients: Ban Xia (7 pieces), Tian Nan Xing (Arisaematis Rhizoma), Chen Pi, Chi Fu Ling (Poria with Red Wood), Zhi Ke (Aurantii Fructus Immaturus, each 1 qian), Zao Ying (Soap Pod, honey-fried), Gan Cao (honey-fried, each 1 cun). Add 5 slices of Sheng Jiang, decoct in water.
(8) Qianjin Tang: Treats asthma. Ingredients: Ma Huang, Sang Bai Pi, Su Zi, Xing Ren, Bai Guo (Ginkgonis Semen), Huang Qin (Scutellariae Radix), Ban Xia, Gan Cao, Kuan Dong Hua (Farfarae Flos). Decoct in water.
(9) Xiaoyao San: Treats liver qi stagnation, blood deficiency with fire hyperactivity, alternating chills/fever cough, hypochondriac pain. Ingredients: Chai Hu (7 fen), Bai Zhu (Atractylodis Macrocephalae Rhizoma, honey-steamed), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba, each 1.5 qian), Gan Cao, Chen Pi (each 0.8 qian), Bo He (Menthae Haplocalycis Herba, 5 fen), Wei Jiang (Roasted Ginger, 3 slices). Decoct in water.
(10) Xiao Qinglong Jia Shigao Tang: Treats lung distension with cough, qi rebellion, irritability, panting, subcardiac fluid retention, and floating pulse. Ingredients: Ma Huang, Bai Shao, Xi Xin (Asari Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), Gan Cao, Gui Zhi (Cinnamomi Ramulus), Ban Xia, Wu Wei Zi (Schisandrae Fructus), Shi Gao.
(11) Xi Huang Wan: Treats carbuncles, scrofula, breast cancer, lymphadenopathy, phlegm nodules, malignant tumors, buboes, flowing abscesses, lung abscess, intestinal abscess, and all yin abscesses with rotting. Ingredients: Xi Huang (Calculus Bovis, 3 fen), She Xiang (Moschus, 1.5 qian), Ru Xiang (Olibanum), Mo Yao (Myrrha, each 1 liang). Grind to powder, mix with cooked yellow rice, form pills size of millet seeds.
(12) Zao Ying Wan: Treats early lung abscess with cough, qi rebellion, and turbid sputum. Ingredients: Zao Ying (Soap Pod, peeled,酥-baked, 8 liang). Grind to powder, mix with refined honey, form pills size of wu-tong seeds or red dates. Take several pills with date paste soup.
(13) Ting Li Da Zao Xie Fei Tang: Treats lung abscess with panting, inability to lie flat, chest fullness, generalized edema, nasal congestion, loss of smell/taste, cough, wheezing, and fluid retention causing dyspnea. Ingredients: Ting Li (Descurainiae Semen seu Fructus), Da Zao. Take one dose of Xiao Qinglong Tang first, then this formula; expectoration of pus/blood follows. Avoid salt and soy sauce.
(14) Ting Li Yi Yi Xie Fei Tang: Treats early ruptured lung abscess with expectoration of pus/blood. Ingredients: Ting Li (wine-fried, 0.8 fen), Yi Yi Ren (Coicis Semen, 5 qian), Bei Mu (Fritillariae Cirrhosae Bulbus, dehearted, 1.6 qian), Gan Cao Jie (Licorice Joint, 1.5 qian), Chen Pi (1.2 qian), Huang Qi (Astragali Radix, wine-mixed, uncooked), Jie Geng, Ren Dong Jin (Lonicerae Japonicae Caulis), Bai Ji (Bletillae Rhizoma, each 1 qian), Sheng Jiang (1 slice). Decoct in water, take slowly after meals. Early stage: remove Huang Qi, Bai Ji, add Fang Feng (Saposhnikoviae Radix). After rupture when pus is gone: add Ren Shen. If non-healing long-term: remove Ting Li, add He Huan Pi (Albiziae Cortex).
(15) Pai Nong San: Treats internal abscess with pus discharging via stool. Ingredients: Zhi Shi (Immature Bitter Orange, 16 pieces), Shao Yao (Paeoniae Radix, 0.6 fen), Jie Geng (0.2 fen). Pound to powder, mix with one raw egg yolk equally, knead well, take with water.
(16) Pai Nong Tang: Treats internal abscess with pus discharging via vomiting. Ingredients: Gan Cao, Jie Geng, Sheng Jiang, Da Zao.
(17) Ren Shen Qing Fei Tang: Treats lung/stomach deficiency-cold, cough/panting, restlessness, chronic劳嗽 (labor cough) with bloody/foul sputum. Ingredients: Ren Shen, E Jiao, Di Gu Pi (Lycii Cortex), Zhi Mu (Anemarrhenae Rhizoma), Wu Mei (Mume Fructus), Ying Su Qiao (Papaveris Capsicum), Gan Cao, Xing Ren, Sang Bai Pi (equal parts). Decoct in water.
(18) Ren Shen Xie Fei Tang: Treats lung meridian accumulated heat causing panting, chest/diaphragm fullness, profuse phlegm, constipation. Ingredients: Ren Shen, Huang Qin, Zhi Zi (Gardeniae Fructus), Zhi Ke, Bo He, Gan Cao, Lian Qiao, Xing Ren, Sang Bai Pi, Da Huang (Rhei Radix et Rhizoma), Jie Geng. Decoct in water.
(19) Ren Shen Ding Chuan Tang: Treats rebellious lung qi, stridor, restlessness, chest tightness/pain. Ingredients: Ren Shen, Ma Huang, E Jiao (fried with clam powder), Ban Xia Qu (Pinellia Fermented Curd), Wu Wei Zi, Ying Su Qiao (honey-fried), Gan Cao (roasted, each 1 qian), Sang Bai Pi (honey-fried, 2 qian). Add 3 slices of Sheng Jiang, decoct in water.
(20) Jiang Zhi Bei Xin: Treats cold-phlegm blocking meridians causing intermittent asthma. Crush fresh ginger to extract juice, soak cotton vest in it, wear against skin, change frequently until cured.
(21) Gan Cao Zhu Dan Wan: Treats cough from vinegar aspiration. Ingredients: Gan Cao (deprived of red skin, 2 liang). Soak in 5 pig gallbladders for 3 days, remove, roast dry on fire, grind to powder, mix with refined honey to form pills.