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Coughing, as a syndrome, has already been discussed in the section on Consumption (Xu Lao). However, the various causes of external contraction were not detailed therein; therefore, it is discussed again here. The lung tissue belongs to Metal, resembling a bell; a bell does not ring unless struck. The six exogenous pathogens—Wind, Cold, Summer-heat, Dampness, Dryness, and Fire—when attacking from the outside, cause it to ring. Similarly, exhaustion, sexual desire, emotional disturbances, improper diet, and the fire generated from roasting or frying foods, when attacking from the inside, also cause it to ring. If a physician fails to remove the cause that makes the bell ring, but instead daily polishes and files the bell itself, the bell will be damaged and its voice hoarse, while the cause of ringing remains unchanged. Can the bell be preserved? I wish those who treat coughing would view it in this manner.

The general principle: When Wind-Cold first arises, accompanied by headache, nasal congestion, fever, aversion to cold, and cough, use Zhisou San (Stop Cough Powder) with added Jingjie (Schizonepetae Herba), Fangfeng (Saposhnikoviae Radix), Ziye (Perillae Folium), and Shengjiang (Zingiberis Rhizoma Recens) to disperse the pathogen. Once the pathogen is dispersed but cough persists, use this formula exclusively to harmonize Lung Qi, or alternatively combine it with Renshen Huta Tang (Ginseng and Walnut Decoction) to moisten; if there is excessive sweating and poor appetite, indicating Spleen deficiency, use Wuyi Yigong San (Five Agents and Four Gentlemen Powder) with added Jiegeng (Platycodonis Radix) to tonify Spleen Earth to generate Lung Metal. If Cold invades the interior causing cough, warming the Middle Jiao will naturally stop the cough. If Summer-heat injures the Lung, presenting with thirst, vexation, and dark urine, the condition is most severe; use Zhisou San with added Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), and Huafen (Trichosanthis Radix) to directly subdue the Fire. If Dampness generates phlegm, with thick and sticky sputum, use Zhisou San with added Banxia (Pinelliae Rhizoma), Fuling (Poria), Sangbaipi (Mori Cortex), Shengjiang, and Dazao (Jujubae Fructus) to dispel Dampness. If Dryness-Fire burns the Metal, causing dry cough without sputum, use Zhisou San with added Gualou (Trichosanthis Fructus), Beimu (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), and Baiziren (Biota Semen) to moisten dryness. These are the treatment methods for exogenous coughs. By adding and subtracting according to the manifestations of the twelve meridians, if the method is correct, cure is assured. The Classic states: "Cough with wheezing and audible sounds, progressing to expectoration of blood, belongs to the Lung organ." This refers to hemoptysis caused by Wind-Cold; add Jingjie, Zisu (Perillae Folium), Chishao (Paeoniae Radix Rubra), and Danshen (Salviae Miltiorrhizae Radix et Rhizoma) to Zhisou San. Cough with pain in both hypochondria, inability to turn the body, belongs to the Liver organ; add Chaihu (Bupleuri Radix), Zhike (Aurantii Fructus), and Chishao to the previous formula. Cough with a sensation of obstruction in the throat, progressing to sore throat and bi-syndrome, belongs to the Heart organ; double the dose of Jiegeng in the previous formula and add Bangzi (Arctii Fructus). Cough with pain in the right hypochondrium, radiating to the shoulder and back, worsening with movement, belongs to the Spleen organ; add Gegen (Puerariae Lobatae Radix), Qinjiao (Gentianae Macrophyllae Radix), and Yujin (Curcumae Longae Radix) to the previous formula. Cough with lower back and waist pain, progressing to expectoration of saliva, belongs to the Kidney organ; add Fuzi (Aconiti Lateralis Radix Praeparata) to the previous formula. Cough with vomiting of bitter fluid belongs to the Gallbladder organ; add Huangqin, Banxia, and Shengjiang to the previous formula. Cough with flatus belongs to the Small Intestine organ; add Shaoyao (Paeoniae Radix Alba) to the previous formula. Cough with vomiting, progressing to expulsion of roundworms, belongs to the Stomach organ; remove Gancao (Glycyrrhizae Radix et Rhizoma) from the previous formula and add Wumei (Mume Fructus), Chuanjiao (Zanthoxyli Pericarpium), Ganjiang (Zingiberis Rhizoma), and add Huanglian if heat signs are present. Cough with fecal incontinence belongs to the Large Intestine organ; add Baizhu (Atractylodis Macrocephalae Rhizoma) and Chishizhi (Halloysitum Rubrum) to the previous formula. Cough with urinary incontinence belongs to the Bladder organ; add Fuling and Banxia to the previous formula. For chronic cough persisting, affecting the San Jiao (Triple Burner), presenting with abdominal fullness, anorexia, excessive mucus and saliva, edema of the face and eyes, and rebellious Qi, combine Zhisou San with Wuyi Yigong San. If the prescription matches the syndrome, the effect is miraculous.

Furthermore, discussing these symptoms from the perspective of internal injury: If Qi stagnation due to seven emotions leads to upward surging of constrained Fire, use Zhisou San with added Xiangfu (Cyperi Rhizoma), Beimu, Chaihu, and Heishanzhi (Gardeniae Fructus). If Kidney Yin deficiency results in Water failing to control Fire, leading to internal heat and a fine, rapid pulse, use Dihuang Wan (Rehmannia Pill) in the morning to nourish Kidney Water, and Zhisou San at noon, removing Jingjie and adding Zhimu and Beimu to resolve Fire constraint, still assisted by Weirui Huta Tang (Polygonati Rhizoma and Walnut Decoction). If exogenous pathogens mix and generate deficient heat in the Lung meridian, further assist with Tuanyu Wan (Softshell Turtle Pill). If the disease is deep-seated, transforming into deficiency damage, or if corpse worms enter the Lung causing throat itching and cough, further assist with Yuehua Wan (Moonlight Pill). If internal injury from diet causes dry mouth and chest stuffiness, with worse cough at dawn (5-7 AM), this is Fire from food accumulation flowing into the Lung meridian at this time; use Zhisou San with added Lianqiao (Forsythiae Fructus), Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), and Lopizi (Raphani Semen). If Spleen Qi is weak, with no desire for food, indicating Qi deficiency, use Wuyi Yigong San with added Jiegeng. These are the treatment methods for internal injury coughs.

In general, treating cough requires proper method in the early stages. The Classic states: "Slight cold causes slight cough." Nine out of ten cases of cough are due to Wind-Cold. Therefore, initial treatment must involve dispersing, but not excessively. Failure to disperse leaves the pathogen; excessive dispersing damages Lung Qi. Both lead to lingering difficulty in cure. Xue Lizhai stated: "If the Lung has Fire, Wind pathogens easily enter; treatment should release the exterior and clear Lung Fire simultaneously. If Lung Qi is deficient, the cou li (skin pores) are not secure; treatment should release the exterior and tonify Lung Qi simultaneously." He also said: "Lung belongs to Xin Metal, born from Ji Earth. For chronic cough that does not cease, one must tonify Spleen Earth to generate Lung Metal." This is indeed profound wisdom. However, drugs that clear Fire should not be taken for long. Regardless of whether the pulse is洪大 (surging-large), 滑数 (slippery-rapid), or merely rapid, after a few doses, they should be discontinued. Instead, frequently administer Liuwei Wan (Six-Ingredient Pill with Rehmannia) and assist with white honey and walnuts to moisten; the cough will naturally cease. If Spleen and Lung Qi are deficient, use Wuyi Yigong San, Liujunzi Tang (Six-Gentlemen Decoction), etc., to tonify Earth and generate Lung; success can be achieved quickly, which is the most expedient method. Those treating cough should examine carefully. Patients suffering from cough should observe dietary restrictions and avoid wind. Do not allow chronic cough to remain untreated, evolving into Lung Wei (Flaccidity), Lung Ju (Abscess), deficiency damage, or Lao Zhai (Consumption). Be cautious and vigilant.