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It is said: Various diseases are easy to treat, but cough is difficult to cure. The reason it is difficult to treat is that the root causes of cough are numerous and not limited solely to the Lung (Fei). Nowadays, when encountering a cough, people immediately attribute it to a Lung disease and subsequently use herbs for dispersing (Fasfa), resolving phlegm (Xiaotan), cooling (Qingliang), and moistening the Lung (Runfei). As medicines are administered daily, the cough worsens day by day. The affected meridians do not receive proper treatment, while unaffected meridians suffer in vain. If unresolved after one month, mild syndromes will evolve into deficiency syndromes; if unresolved after two months, deficiency syndromes are established; if prolonged to one hundred days, although life is not yet forfeited, the patient has entered an incurable state. Alas! Diseases that were originally curable are ruined by mediocre physicians. This is common throughout the world, and there is no way to change it. Therefore, I trace back to the origin and summarize briefly. *Suwen: Ke Lun* states: "The five Zang organs and six Fu organs can all cause cough, not just the Lung." Thus, at the onset of cough, some originate from the Kidney (Shen), some from the Liver (Gan), some from the Spleen (Pi), some from the Pericardium (Xinbao), some from the Stomach (Wei), some from the Middle Jiao (Zhongjiao) and Upper Jiao (Shangjiao), and some from the Lung. Treatment should investigate the root cause. The method to investigate the root lies in examining the syndrome pattern (Zheng).

If the throat itches and causes coughing, this indicates the upward rushing of Fire-Heat Qi (Huohuo zhi qi). Just as smoke rises before fire ignites, smoke rushing through the throat causes itching and coughing. In early stages of Wind-Cold invasion (Shangfeng), a slight itch in the throat may be relieved slightly by swallowing hot drinks. This is due to Cold stagnating in the Upper Jiao, causing throat dysfunction and cough. Whether Cold or Heat, treatment should harmonize the Upper Jiao. If itching occurs in the chest, leading to coughing, this is due to internal deficiency of Jin-Ye (Body Fluids) and Blood in the Middle Jiao, caused by either Cold or Heat. The method should be to harmonize the Middle Jiao. Such coughs with throat itching belong to the Upper and Middle Jiao.

If Qi rushes upward causing cough, this indicates deficiency of the Liver and Kidney. The Heart and Lung reside above, while the Liver and Kidney reside below. The Kidney is the Water Organ, paired with the Bladder (Pangguang) Fu organ. Following the Qi of the Taiyang (Greater Yang) meridian, it emerges from the skin pores to connect with the Lung. The Lung represents Heaven, and Water and Heaven form one Qi, circulating endlessly. Now, if the Kidney is internally deficient and cannot coordinate with the Bladder to circulate through the skin pores, Kidney Qi rushes upward from the Earth element (Spleen/Stomach). This upward rush causes cough. Such coughs caused by upward-rushing Qi belong to the Kidney.

Furthermore, the Liver stores Blood. The Chong (Penetrating Vessel) and Ren (Conception Vessel), known as the Sea of Blood, are governed by the Liver. This blood warms muscles, fills the skin, and permeates the hair follicles; during sleep, it returns internally to the Liver. Now, if the Liver is internally deficient and cannot coordinate with the blood of the Chong and Ren vessels to emerge into the skin and pores, Liver Qi rushes upward from the Pericardium. This upward rush causes cough. Such coughs caused by upward-rushing Qi belong to the Liver.

There are cases where hemoptysis (coughing up blood) precedes coughing. Hemoptysis indicates internal injury to the Foot-Jueyin Liver channel, and the Hand-Jueyin Pericardium channel becomes deficient as well, causing Pericardium Fire to attack Metal (Lung). The Pericardium governs Blood and vessels. Internal deficiency of blood vessels leads to fever at night and coughing during the day; severely, both fever and cough occur day and night. This is consumption-type cough (Xu Lao Ke), where Blood is damaged first, then Qi, leading to exhaustion of both Yin and Yang, and deficiency of both Blood and Qi. Taking Yin-nourishing herbs is appropriate, while taking Warm-Tonic herbs is inappropriate. Coughs of this nature are rarely survivable. Such coughs belong to the Pericardium.

Additionally, the Hand-Taiyin Lung channel belongs to Lung Metal, representing Heaven; the Foot-Taiyin Spleen channel belongs to Spleen Earth, representing Earth. In the theory of Five Movements and Six Qi, Earth generates Metal; in Zang-Fu relationships, this represents the interaction between Earth and Heaven. Now, if the Spleen Earth is internally deficient, Earth fails to control Water, causing Phlegm-Saliva to surge upward. Earth Qi does not ascend, and Heaven Qi does not descend, resulting in cough, which must be accompanied by wheezing (Chuan). Such coughs belong to the Spleen.

Moreover, the Stomach is the Sea of Water and Grain. Its Qi belongs to Yangming. The Foot-Yangming channel governs the Stomach, and the Hand-Yangming channel governs the Large Intestine. Above the Yangming, Dryness Qi governs, and its Qi descends. Now, if Yangming Qi does not descend properly, either excessive dryness leads to flaming Fire, or loss of dryness leads to retained fluids. Coughing up yellow sputum indicates Stomach Dryness-Heat; accumulation of Phlegm-Fluids internally indicates Stomach Deficiency-Cold. This is cough of the Stomach and Intestines. Although the cough may persist, it will not immediately cause death. Treatment should focus on resolving Phlegm and dispersing Fluid retention. Such coughs belong to the Stomach. Since Phlegm gathers in the Stomach and must exit via cough, *Ke Lun* states: "Phlegm gathers in the Stomach and relates to the Lung." If one does not understand the origin of cough and merely treats it by clearing the Lung, resolving Phlegm, dispersing Wind, and promoting Qi movement, it will only cause harm!

Externally, there is Wind-Cold cough where initial treatment with clearing and dispersing herbs fails. This is called Deficient Wind-Cold (Xu Shang Feng). It strictly contraindicates Cold-Cooling and dispersing methods. With appropriate prescription, gradual recovery is possible. Also, during winter, if Kidney Qi is insufficient, Water fails to generate Wood, causing internal deficiency of Liver Qi. This results in profuse runny nose (Dong Ti) and nasal obstruction, also classified as Deficient Wind-Cold. Dispersing methods are also contraindicated here. With appropriate prescription, when spring arrives and warmth thaws the ice, the runny nose stops, and nasal passages clear.

The general principles of cough are as described above. Grasping their essence and extending them logically would suffice!

Cough is colloquially called "Qiang" (choking/coughing fit). Continuous coughing without pause is called "Dun Qiang" (paroxysmal cough). Dun Qiang involves twenty to thirty consecutive coughing fits per breath, or ten to several dozen for milder cases. During these fits, the head bows and chest curves; severely, limbs become spasmodic. Sputum exits the mouth, accompanied by nasal discharge and tears, radiating from the chest down to the lower abdomen. In adults, this resembles asthma; in children, it is called epidemic paroxysmal cough (Shi Xing Dun Qiang). Paroxysmal cough resolves spontaneously within one month even without medication. The reason is that the 84,000 hair follicles correspond to the Qi of the Taiyang Bladder meridian, connecting to the Lung. Inside the follicles are collateral blood vessels, corresponding to the blood of the Chong Mai (Sea of Blood), connecting to the Liver. If cold invades the follicles, causing blood stasis in the uterus/chambers, the blood cannot permeate the skin and collateral vessels. Qi fails to warm, and Blood fails to moisten, resulting in paroxysmal cough. After one month, the blood in the chambers completes a cycle, hence recovery in one month; if not resolved in one month, it may take two months. Without medication, it does not cause death. However, parents who excessively medicate their children, while physicians only treat Qi and not Blood, only regulate the Lung and not the Liver, may find that paroxysmal cough persists and other diseases arise. Excessive Cold-Cooling herbs lead to vomiting and anorexia; excessive purgatives lead to abdominal fullness and diarrhea; excessive diaphoretic herbs lead to breast swelling and急促喘息 (rapid panting). Many who should not die end up dying. For infant paroxysmal cough at onset, one should only disperse cold in the chambers and harmonize collateral blood. Herbs such as Cyperi Rhizoma (Xiangfu), Carthami Flos (Honghua), Ligusticum Chuanxiong Rhizome (Chuanxiong), Angelica Sinensis Radix (Danggui), and Paeonia Lactiflora Radix Alba (Baishao) can be used. For internal cold with vomiting, dried ginger (Ganjiang) and Evodia Fruit (Wuyu) can be added. For exterior and interior deficiency, Astragali Membranaceus Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), Ginseng Radix (Renshen), and Poria (Fuling) can be used. Modifications depend on the physician's adaptability. If the origin of paroxysmal cough is unknown, and one recklessly uses herbs like Bupleuri Radix (Chaihu - *Note: Text says Qian, likely Qianhu*), Pinelliae Tuber (Banxia - *Text says Xing, likely Xingren*), Perillae Folium (Zisu), Scutellariae Radix (Huangqin), Aurantii Fructus Immaturus (Zhiqiao), Platycodonis Radix (Jiegeng), and Baolong Wan to clear the Lung and resolve Phlegm, it is inadvisable.