经义
黄帝问曰∶肺之令人咳，何也？岐伯对曰∶五脏六腑皆令人
咳，非独肺也。帝曰∶愿闻其状。岐伯曰∶皮毛者，肺之合也。皮毛先受邪气，邪气以从其合也。其寒饮食入
胃，从肺脉上至于肺则肺寒，肺寒则外内合邪，因而容之，则为肺咳。五脏各以其时受病，非其时，各传以与
之。○肺咳之状，咳而喘息有音，甚则唾血；心咳之状，咳则心痛，喉仲介介如梗状，甚则咽肿喉痹；肝咳之
状，咳则两胁下痛，甚则不可以转，转则两 下满；脾咳之状，咳则右 下痛，阴阴引肩背，甚则不可以动，
动则咳剧；肾咳之状，咳则腰背相引而痛，甚则咳涎。帝曰∶六腑之咳奈何？岐伯曰∶五脏之久咳，乃移于六
腑。脾咳不已，则胃受之，胃咳之状，咳而呕，呕甚则长虫出；肝咳不已，则胆受之，胆咳之状，咳呕胆汁；
肺咳不已，则大肠受之，大肠咳状，咳而遗矢；心咳不已，则小肠受之，小肠咳状，咳而失气；肾咳不已，则
膀胱受之，膀胱咳状，咳而遗溺；久咳不已，则三焦受之，三焦咳状，咳而复满，不欲食饮。○秋伤于湿，上
逆而咳。○秋伤于湿，冬生咳嗽。○咳嗽烦冤者，是肾气之逆也。○喘咳者，是水气并阳明也。○少阴所谓呕咳
上气喘者，阴气在下，阳气在上，诸阳气浮，无所根据从，故呕咳上气喘也。○咳嗽上气，厥在胸中，过在手阳
明太阴。（《素问》）
哲言
咳嗽诸证，有风嗽、寒嗽、湿嗽、热嗽、郁嗽、劳嗽、食积嗽、气嗽、痰嗽、干嗽、血嗽、酒嗽、久嗽、
火嗽、夜嗽、天行嗽。（《医学入门》）
咳谓无痰而有声，肺气伤而不清也。嗽谓无声而有痰，脾湿动而生痰也。咳嗽谓有声有痰，因伤肺气，复
动脾湿也。（《机要》）
风寒嗽者，鼻塞声重恶寒；火嗽者，有声痰少面赤；劳嗽者，盗汗出多作寒热；肺胀嗽者，动则喘急息
重；湿嗽者，嗽动便有痰声，痰出嗽止。（戴复庵）
《经》言脏腑皆有咳嗽。嗽属肺，何为脏腑皆有之？盖咳嗽为病，有自外而入者，有自内而发者。风寒暑
湿，先自皮毛而入，皮毛者，肺之合，故虽外邪欲传脏，亦必先从其合而为嗽，此自外而入者也；七情郁结，
五脏不和，则邪火逆上，肺为气出入之道，故五脏之邪，上蒸于肺而为嗽，此自内而发者也。然风寒暑湿有不
为嗽者，盖所感者重，竟伤脏腑，不留于皮毛；七情亦有不为嗽者，盖病尚浅，止在本脏，未即上攻。所以伤
寒以有嗽为轻，而七情郁结之嗽，久而后见。（《张氏医通》）
肺为华盖，以覆诸脏，其二十四空窍，虚如蜂窠，吸之则满，呼之则虚，最喜清凉，不耐烦热。今心、
肝、脾、肾四藏之火热上炎，则随所吸之气，入于窍中，则戛戛然而嗽，甚至肺叶干枯，不能振举，水精不能
四布，五经不能并行，而成败证。总缘肺之空窍，只受得脏腑中固有元气，受不得一分邪气耳。○外感见咳嗽
为轻，内伤见咳嗽为重。（《己任编》）
咳嗽一证，诸家立论太繁，以余观之，止惟二证∶一曰外感，一曰内伤，而尽之矣。夫外感之咳，必由皮
毛而入。盖皮毛为肺之合，而凡外邪袭之，则必先入于肺，久而不愈，自肺而传于五脏也。内伤之嗽，必起于
阴分。盖肺属燥金，为水之母，阴损于下，则阳孤于上，水涸金枯，肺苦于燥，肺燥则痒，痒则咳不能已也。
总之，咳证虽多，无非肺病，而肺之为病，亦无非此二者而已，但于二者之中，辨阴阳分虚实耳。（张景岳）
《内经》∶"秋伤于湿，冬生咳嗽"。此脱文也，今特正之。曰∶夏伤于暑，长夏伤于湿，秋必 疟。秋
伤于燥，冬生咳嗽。六气配四时之理，灿然明矣。盖湿者，水类也。燥者，火类也。湿病必甚于春夏，燥病必
甚于秋冬。 疟明是暑湿合邪，然湿更多于暑，何反遗而不言？至于咳嗽，全是火燥见病，何反以为湿耶？（喻嘉言）
五脏劳咳∶疲极伤肝，咳则左胁引痛；劳神伤心，咳则咽干
咯血；劳力伤脾，咳则短气无力；叫呼伤肺，咳则呕吐白沫，口燥声嘶；房劳伤肾，咳则腰背引痛，寒热夜发。
（《证治汇补》）
先嗽后痢，肺虚阳气下陷也；先嗽后疟，金衰不能平木也。（周慎斋）
嗽而复泻者，为肺移热于大肠，脏腑俱病；嗽而发热不止者，为阴虚火炎。皆难治。（《医方集解》）
补编
咳嗽治分四时∶春气上升，润肺抑肝；夏火炎上，清金降火；秋湿热甚，清热泻湿；冬风寒重，解表行
痰。（《明医杂着》）
咳嗽一证，有外感内伤之分，阴阳虚实之别。外感之咳，因偶受风寒，由皮毛而入肺，其证头痛身痛，
恶寒发热，鼻塞声重，鼻涕气急，其脉浮大而紧，或弦大而数，及素无积劳虚咳之证，而忽病咳不已者，即外
感之证也。宜用甘桔汤，升发肺气，使邪从外达，疏通肌腠，使热从表散，此治外感咳嗽之法也。内伤之咳，
凡肝肾阴虚于下而木火刑金者，其证洒寒潮热，形瘦容减，痰多带血，气短喉干，其脉弦大而空，或弦细而数，
及素有酒色劳伤之患，而致咳嗽日增者，即内伤劳损阴亏之证也。宜用六味汤，补阴敛阳，使肺气充实，补水
保元，使虚火归根，此治阴亏咳嗽之法也。又有元阳下亏而水冷金寒者，其证畏寒喘促，呕恶泄泻，水泛痰冷，
腹胀食减，其脉细涩而微，或浮大而迟，及素有下元虚寒之患，而渐至咳嗽日甚者，即内伤阳亏劳损之证也。
宜用八味汤，温补真元，使生气上布，填助真火，使阴寒冰消，此治阳亏咳嗽之法也。且内伤之咳，不独肺金
为患也，《经》谓肾脉从肾上贯肝膈，入肺中，循喉咙，所以肺金之虚，多由肾水之涸，而肾与肺又属子母之脏
，呼吸相应，金水相生，苟阴损于下，阳孤于上，肺苦于燥，不咳不已，是咳虽在肺，而根实在肾。奈何近日庸
工，每遇内伤之咳，惟投清金之药，以为稳当，盖不知肺受他人之侮，我又从而侮之，是以治咳而咳愈甚矣。虽然，
更有说焉，脾为仓廪之官，后天之本，散精与肺，有生金之能，灌溉四旁，有益肺之力。若久咳而滋补无功，
必须培养脾元，补母以及其子。先贤有言，补肾不如补脾。诚知肺属辛金，生于己土，而归脾、四君之属所宜
急进也。总之，外感之咳，实中亦有虚，宜寓攻于补；内伤之咳，虚中或挟实，宜补水兼清。外感之咳，脉数
易治，邪退则脉静；内伤之咳，脉数难治，愈虚则愈数。至于疫后咳嗽，热伤真阴也；疟痢咳嗽，脾胃亏虚也；
肺痈咳嗽，风寒外袭，积热内伤，蓄有脓血也；肺痿咳嗽，金气外泄，肺脏内损，病剧衰靡也；疮闭咳嗽，皮
毛之毒，内攻肺脏，肺受毒害也；支饮咳嗽，脾胃生痰，肺失治节，清肃不行也；胀满咳嗽，土不制水，浸渍
入肺，关门不利也；哮喘咳嗽，内有夙根，痰塞肺窍，太阴屡困也；干咳无痰，气不生精，精不化气，津液枯
涸也。嗽证多端，治法各异，尤必以补元气为上策也。（《会心录》）
咳为气逆，嗽为有痰。内伤外感之因甚多，不离乎肺脏为患。若因于风者，辛平解之；因于寒者，辛温散
之；因于暑者，当与微辛微凉，苦降淡渗；因于湿者，有兼风、兼寒、兼热之不同，以理肺治胃为主；若因秋
燥，则喻氏之义最精；因于火者，以甘寒为主。至于内因为病，有刚亢之威，木扣而金鸣者，当清金制木，佐
以柔肝入络；若土虚而不生金，真气无所禀摄者，有甘凉、甘温二法。又因水虚痰泛，元海竭而诸气上冲者，
则有金水双收，阴阳并补之治，或大剂滋填镇摄，保固先天一气元精。至于饮邪致嗽，另有专门，兼参可也。
（《临证指南》）
外感之嗽，与内伤之嗽，其所本不同，而所治亦异。盖外感之嗽，其来在肺，故必由肺以及他脏，此肺为
本而他脏为标也；内伤之嗽，先因伤他脏，故必由他脏以及肺，此他脏为本而肺为标也。凡治内伤者，使不知
治他脏而单治肺，则真阴何由以复？阴不复则嗽终不愈；治外感者，使不知治阳而妄治阴，则邪气何由以解？
邪不解则嗽终不停。○外感之嗽，其来暴；内伤之嗽，
其来徐。外感之嗽，因于寒邪；内伤之嗽，因于阴虚。外感之嗽，可温可散，其治易；内伤之嗽，宜补宜和，
其治难。此固其辨也。然或其脉证素弱，而忽病外感者有之；或其形体素强，而病致内伤者亦有之。此中疑似，
但于病因脉色中细加详察，自有声应可证也。○内伤之嗽，必皆本于阴分。何为阴分？五脏之精气是也。然五
脏皆有精气，而又惟肾为元精之本。肺为元气之主。故五脏之气分受伤，则病必自上而下，由肺由脾以极于肾；
五脏之精分受伤，则病必自下而上，由肾由脾以极于肺。肺肾俱病，则他脏不免矣。所以劳损之嗽，最为难治，
正以其病在根本而不易为力也。故欲治上者，不在乎上而在乎下；欲治下者，不在乎下而在乎上。知气中有精，
精中有气，斯可以言虚劳之嗽矣。○一外邪证，多有误认为劳伤而遂成真劳者，此必其人体气柔弱，医家望之，
已有成心，故见其发热，遂认为火，见其咳嗽，遂认为劳，率用滋阴降火等剂。寒邪在表，凉药妄投，表里合
邪，稽留不解。俗云∶伤风不愈变成劳。夫伤风岂能变劳，特以庸医误治，久而不愈，不至成劳不已也。○干
咳嗽证，在丹溪云乃痰郁火邪在肺中，宜用苦梗开之，下用补阴降火，不已则成劳，须用倒仓法，此证多因不
得志者有之。愚谓此说不然。夫既云不得志，则其忧思内伤，岂痰火病乎？又岂苦梗倒仓所宜攻乎？盖干咳嗽
者，以肺中津液不足枯涸而然。此明系内伤亏损，肺肾不交，气不生精，精不化气，所以干涩如此。但其有火、
无火，亦当辨治。若脏平无火者，止因肺虚，故必先补气，自能生精。若脏气微寒者，非辛不润，故必先补阳，自
可生阴。若兼内热有火者，须保真阴，故必先壮水，自能制火。若但知消痰开郁，将见气愈耗，水愈亏，未免
为涸辙之鲋矣。（张景岳）
一嗽痰即出者，脾湿胜而痰滑也。连嗽十数声痰不即出者，肺燥胜而痰涩也。嗽而无痰者，以甘寒润其肺。
痰多致嗽者，以辛平燥其脾。（张路玉）
肺胃俱寒，郁住皮毛，气道不宣，则痰内生而作嗽。散寒所以治标，温里所以治本，凡形寒饮冷伤肺者，
不出二法范围。若水气射肺而咳者，责之膀胱与肾，是小青龙、真武之事也。（程郊倩）
今人但知肺主皮毛，一遇外感风寒，概行温散，不知久则传里，变为郁咳，遂成劳瘵，多由不分内外所因，
新久之异。夫形寒饮冷，新咳痰稠，固宜温散。若气动火炎，久咳无痰，又当清热润燥，温散在所禁矣。常见
劳证每由咳嗽而起，治者不究其源，印定伤风，屡用辛温，卒成不救者有之。（《证治汇补》）
有肺伏火邪，腠理不闭，风邪易乘，遇感频发者，当兼清火。若数行解散，则重亡津液，邪蕴而为肺痈，
不可不慎。（薛立斋）
虚嗽有二∶日间嗽，多吐咯白沫，或恶心者，为气虚，宜六君汤，加款冬花、五味子。夜嗽多渴，痰不易
出，或发热者，为血虚，宜六味汤，加麦门冬、五味子。（《冯氏锦囊》）
虚火炎上，伤肺咳嗽，该用熟地黄者，先将生地黄代之，二、三服以清其肺，然后用之。不然，则火郁于
肺，有肺痿之患。（罗赤诚）
夜嗽日久，多属肾真亏损，火炎水涸，津液泛而为痰，须用六味丸加二冬以滋化源。（《万病回春》）
肺，出气也；肾，纳气也。肺为气之主，肾乃气之根。凡咳嗽暴重，引动百骸，气从脐下奔逆而上者，此
肾虚不能纳气归原，当以安肾丸主之。毋徒从事于肺，此虚则补子之义也。（杨仁斋）
久嗽，有痰者，燥脾化痰；无痰者，清金降火。盖外感久则郁热，内伤久则火炎，俱须开郁润燥。七情气
逆者，顺气为先；停水宿食者，分导为要。气血虚者，补之敛之，不宜妄用涩剂。（《医方集解》）
凡病患久嗽声哑，乃是元气不足，肺气不滋，宜补元气，养金润燥，其声自亮。若虚劳之人，则宜滋肾水
润肺金为本，诃子百药煎收敛以治其标，标本兼治，此十全也。（徐春甫）
咳嗽，治有敛、散二法∶敛者，谓收敛肺气也；散者，谓解散寒邪也。宜散而敛，则将寒邪敛住，为害非
轻；宜敛而散，则走泄正气，害亦非小。又如感风咳嗽，散后表虚，复感寒邪，虚邪相乘，若欲散风，则愈虚
其肺，若欲收敛，则愈滞其邪。当先轻解，渐次敛之，肺不致虚，邪不致滞，其嗽自止矣。（徐叔拱）
顿嗽之证，大都肺燥津伤，故咳剧痰不易出，宜仿清燥救肺汤大意。其中妙在枇杷叶清肺降气，气下则火
降痰顺，而逆者不逆，斯咳渐平矣。此所谓肺苦气上逆，急食苦以降之，杏仁又在所必需也。（方星岩）
岐伯虽言五脏六腑皆令人咳，然其所重，全在于肺。盖皮毛者，肺之合也。皮毛先受邪气，邪气以从其合，
其寒饮食入胃，从胃脉上至于肺则肺寒，肺寒则内外合邪，因而客之，则为肺咳。此举形寒饮冷伤肺之一端，
[Classic Discourse]
The Yellow Emperor asked: "Why does the Lung organ cause coughing?" Qibo replied: "All five Zang organs and six Fu organs can cause coughing, not just the Lung." The Emperor said: "I wish to hear about its manifestations." Qibo said: "The skin and hair are the external correspondence of the Lung. When pathogenic factors first invade the skin and hair, they transmit internally along this correspondence. If cold food and drink enter the stomach, the cold qi ascends via the Lung meridian to the Lung, causing Lung cold. When the Lung is cold, external and internal pathogenic factors combine, lodging within, resulting in Lung cough. Each of the five Zang organs becomes diseased in its respective season; if it is not that organ's season, pathogenic factors from other organs will transmit to the Lung." ○ The manifestation of Lung cough includes coughing with wheezing and audible sounds; in severe cases, blood may be expectorated. The manifestation of Heart cough includes coughing accompanied by heart pain, a sensation of obstruction in the throat as if something were stuck; in severe cases, sore throat and dysphagia occur. The manifestation of Liver cough includes pain in both hypochondriac regions during coughing; in severe cases, turning the body is impossible, and turning causes fullness in both hypochondriac regions. The manifestation of Spleen cough includes pain in the right hypochondriac region during coughing, dull pain radiating to the shoulder and back; in severe cases, movement is impossible, and movement aggravates the cough. The manifestation of Kidney cough includes pain radiating between the waist and back during coughing; in severe cases, saliva is coughed up. The Emperor asked: "What about coughing of the six Fu organs?" Qibo said: "Long-standing cough of the five Zang organs will transfer to the six Fu organs. If Spleen cough persists, the Stomach receives it; Stomach cough manifests as coughing with vomiting, and in severe cases, roundworms may be expelled. If Liver cough persists, the Gallbladder receives it; Gallbladder cough manifests as coughing with vomiting of bile. If Lung cough persists, the Large Intestine receives it; Large Intestine cough manifests as coughing with fecal incontinence. If Heart cough persists, the Small Intestine receives it; Small Intestine cough manifests as coughing with flatus. If Kidney cough persists, the Bladder receives it; Bladder cough manifests as coughing with urinary incontinence. If long-standing cough persists, the San Jiao (Triple Burner) receives it; San Jiao cough manifests as coughing with abdominal fullness and loss of appetite." ○ Injury to dampness in autumn leads to upward rebellion and cough. ○ Injury to dampness in autumn generates cough in winter. ○ Cough accompanied by vexation indicates rebellion of Kidney Qi. ○ Wheezing and cough indicate water qi merging with the Yangming channel. ○ What Shaoyin refers to as vomiting, cough, and upper asthmatic panting is due to Yin qi being below and Yang qi being above, with all Yang qi floating without foundation, thus causing vomiting, cough, and upper asthmatic panting. ○ Cough and rebellious Qi, with stagnation in the chest, relates to the Hand-Yangming and Hand-Taiyin channels. (Su Wen)
[Philosophical Remarks]
Various syndromes of cough include Wind-cough, Cold-cough, Damp-cough, Heat-cough, Stagnation-cough, Labor-cough, Food-stagnation cough, Qi-cough, Phlegm-cough, Dry-cough, Blood-cough, Wine-cough, Chronic-cough, Fire-cough, Night-cough, and Epidemic-cough. (Yixue Rumen)
"Cough" (Ke) refers to sound without phlegm, indicating Lung Qi injury and lack of clarity. "Sobbing/Phlegm-cough" (Sou) refers to phlegm without sound, indicating Spleen dampness stirring and generating phlegm. "Cough and Sobbing" (Kesu) refers to both sound and phlegm, caused by Lung Qi injury combined with Spleen dampness stirring. (Jiyao)
Wind-Cold cough presents with nasal congestion, heavy voice, and aversion to cold. Fire cough presents with sound but little phlegm and red face. Labor cough presents with profuse night sweats and frequent chills and fever. Lung distension cough presents with rapid panting and heavy breathing upon exertion. Damp cough presents with phlegm sounds upon coughing, which cease when phlegm is expelled. (Dai Fuan)
The Classics state that all Zang and Fu organs have cough. Since cough belongs to the Lung, why do all organs exhibit it? Generally, coughing diseases arise either from external invasion or internal generation. Wind, cold, summer-heat, and dampness enter first through the skin and hair; since skin and hair are the Lung's correspondence, even if external pathogens intend to transmit to the Zang organs, they must first affect their correspondence to cause cough; this is external invasion. Seven emotions causing stagnation and disharmony among the five Zang organs lead to rebellious evil fire; since the Lung is the pathway for Qi entry and exit, pathogenic factors from the five Zang organs steam upwards into the Lung causing cough; this is internal generation. However, wind, cold, summer-heat, and dampness do not always cause cough because the invading factor is heavy, directly damaging the Zang and Fu organs without lingering in the skin and hair. Similarly, seven emotions do not always cause cough because the disease is shallow, remaining in the original Zang organ without immediately attacking upwards. Therefore, in Cold Damage (Shanghan), cough is considered a mild symptom, whereas cough from seven-emotion stagnation appears only after a long time. (Zhangshi Yitong)
The Lung is the Canopy (Huagai), covering all other organs. It has twenty-four cavities, hollow like a bee's nest; it fills upon inhalation and empties upon exhalation. It prefers coolness and dislikes heat. Currently, if the fire and heat of the Heart, Liver, Spleen, and Kidney ascend, they enter the cavities with inhaled air, causing rattling coughs. In extreme cases, Lung lobes become dry and cannot expand, water essence fails to distribute, and the five meridians fail to function together, leading to a critical syndrome. Ultimately, Lung cavities can only accept the inherent Yuan Qi of the Zang and Fu organs, not a single unit of pathogenic factor. ○ Cough appearing in external contraction is mild; cough appearing in internal injury is severe. (Jiren Bian)
Regarding the cough syndrome, various schools have complex theories. In my view, there are only two types: External Contraction and Internal Injury, which cover all cases. External cough must enter via the skin and hair. Since skin and hair are the Lung's correspondence, external pathogens first enter the Lung; if unresolved, it transmits from the Lung to the five Zang organs. Internal cough originates in the Yin aspect. The Lung belongs to Dry Metal and is the mother of Water. If Yin is damaged below, Yang becomes isolated above; water dries up and metal withers, causing Lung dryness. Lung dryness causes itching, leading to persistent cough. In summary, although cough syndromes are numerous, they are essentially Lung diseases, and Lung diseases are essentially these two types: one must distinguish Yin/Yang and Deficiency/Excess within them. (Zhang Jingyue)
The Neijing states: "Injury to dampness in autumn generates cough in winter." This is a textual error, which I hereby correct. It should read: "Injury to summer-heat in summer, injury to dampness in late summer, malaria occurs in autumn. Injury to dryness in autumn generates cough in winter." The principle of Six Qi matching the Four Seasons becomes clear. Dampness belongs to Water; Dryness belongs to Fire. Damp diseases are severe in Spring/Summer; Dryness diseases are severe in Autumn/Winter. Malaria is clearly Summer-heat and Dampness combining, yet Dampness is more prevalent than Summer-heat, so why omit it? Cough is entirely caused by Fire and Dryness, so why attribute it to Dampness? (Yu Jiayan)
Five Zang Labor Cough: Exhaustion injuring the Liver causes cough with left hypochondriac pain; mental labor injuring the Heart causes cough with dry throat and hemoptysis; physical labor injuring the Spleen causes cough with shortness of breath and weakness; shouting injuring the Lung causes cough with white frothy vomit, dry mouth, and hoarseness; sexual exhaustion injuring the Kidney causes cough with waist/back pain and night chills/fever. (Zhengzhi Huibu)
Cough followed by dysentery indicates Lung deficiency with sinking of Yang Qi; cough followed by malaria indicates Metal deficiency failing to control Wood. (Zhou Shenzhai)
Cough with diarrhea indicates Lung transferring heat to the Large Intestine, affecting both Zang and Fu; cough with persistent fever indicates Yin deficiency with flaming fire. Both are difficult to treat. (Yifang Jijie)
[Supplement]
Treatment of cough varies by season: In Spring, Qi rises; moisten the Lung and suppress the Liver. In Summer, Fire flares upward; clear Metal and descend Fire. In Autumn, Damp-Heat is prevalent; clear Heat and drain Dampness. In Winter, Wind-Cold is heavy; release the exterior and move Phlegm. (Mingyi Zazhuo)
Cough is divided into External Contraction and Internal Injury, with distinctions in Yin/Yang and Deficiency/Excess. External cough results from accidental Wind-Cold entering via skin/hair to the Lung. Symptoms include headache, body ache, aversion to cold, fever, nasal congestion, heavy voice, runny nose, and rapid breathing. Pulse is floating-large-tight or string-large-rapid. If there is no history of chronic labor-induced cough and the onset is sudden, it is an External syndrome. Use Ganjie Tang to raise Lung Qi, expel pathogens externally, unblock muscle interstices, and dissipate heat from the surface. Internal cough arises from Liver/Kidney Yin deficiency below, leading to Wood-Fire punishing Metal. Symptoms include chills, tidal fever, emaciation, copious bloody phlegm, shortness of breath, and dry throat. Pulse is string-large-empty or string-thin-rapid. If there is a history of wine/sex/labor injury and cough worsens daily, it is an Internal Labor-Damage Yin-Deficiency syndrome. Use Liuwei Dihuang Wan to nourish Yin and contain Yang, enrich Lung Qi, tonify Water to preserve Yuan Qi, and root deficient fire. Another type involves Yuan Yang deficiency below, causing cold water and cold metal. Symptoms include fear of cold, panting, vomiting, diarrhea, water flooding with cold phlegm, abdominal distension, and poor appetite. Pulse is thin-choppy-micro or floating-large-slow. If there is a history of lower Yuan deficiency-cold and cough worsens gradually, it is an Internal Yang-Deficiency Labor-Damage syndrome. Use Bawei Wan (Jinkui Shenqi Wan) to warm and tonify True Yuan, spread vital Qi, replenish True Fire, and melt ice. Internal cough is not solely a Lung issue. The Classics state the Kidney meridian passes through the Liver/Diaphragm into the Lung and along the throat. Thus, Lung Metal deficiency often stems from Kidney Water depletion. Kidney and Lung are Mother-Son organs, resonating in respiration, with Metal and Water generating each other. If Yin is damaged below and Yang isolated above, Lung dryness causes persistent cough. Although cough is in the Lung, the root is in the Kidney. Regrettably, modern quacks treat internal cough only with Lung-clearing drugs, unaware that attacking the Lung when it is already bullied by other organs exacerbates the condition. Furthermore, the Spleen is the Granary Official and Foundation of Post-Heaven, distributing essence to the Lung to generate Metal. If long-term cough responds poorly to tonification, one must cultivate Spleen Yuan, tonifying the Mother to benefit the Child. As sages say, tonifying the Spleen is better than tonifying the Kidney. Knowing Lung Metal is born from Ji Earth, Si Jun Zi Tang is urgently indicated. In summary, External cough has Deficiency within Excess; attack while tonifying. Internal cough has Excess within Deficiency; tonify Water while clearing. External cough with rapid pulse is easy to treat; pathogen retreat brings pulse calmness. Internal cough with rapid pulse is hard to treat; more deficiency means faster pulse. Post-epidemic cough indicates Heat injuring True Yin; Malaria/Dysentery cough indicates Spleen/Stomach deficiency; Lung Abscess cough indicates external Wind-Cold and internal accumulated Heat with pus/blood; Lung Withering cough indicates external leakage of Metal Qi and internal Lung damage; Closed sore cough indicates toxin from skin attacking Lung; Branch-fluid cough indicates Spleen/Stomach generating phlegm and Lung losing regulation; Distension cough indicates Earth failing to control Water flooding Lung; Asthma cough indicates latent roots and phlegm blocking Lung orifices; Dry cough without phlegm indicates Qi failing to generate Essence and Essence failing to transform Qi, leading to fluid depletion. Treatment varies, but tonifying Yuan Qi is the supreme strategy. (Huixin Lu)
Cough is Qi rebellion; Sou is having phlegm. Causes are many, but always involve the Lung. For Wind, use Pungent-Ping to resolve; for Cold, use Pungent-Warm to disperse; for Summer-heat, use slightly Pungent-Cool, Bitter-descending, and Light-draining; for Dampness, consider concurrent Wind/Cold/Heat, focusing on regulating Lung and treating Stomach; for Autumn Dryness, Yu's theory is most exquisite; for Fire, use Sweet-Cool. For internal causes: if Wood is hyperactive striking Metal, clear Metal and control Wood, assisting with Softening-Liver entering collaterals; if Earth is deficient failing to generate Metal and True Qi lacks support, use Sweet-Cool or Sweet-Warm methods; if Water is deficient with phlegm flooding and Yuan Sea exhausted causing Qi rushing up, use Dual-Receiving of Metal and Water, simultaneous Yin-Yang tonification, or large doses of Nourishing-Filling and Calming-Subduing to protect Pre-Heaven Qi and Essence. For fluid-pathogen cough, refer to specialized texts. (Linzheng Zhinan)
External and Internal coughs differ in origin and treatment. External cough originates in the Lung, spreading to other organs; Lung is Root, others are Branch. Internal cough originates in other organs, spreading to the Lung; Other organs are Root, Lung is Branch. Treating Internal cough without addressing other organs prevents Yin recovery, so cough persists. Treating External cough by wrongly tonifying Yin prevents pathogen resolution, so cough continues. ○ External cough is acute; Internal cough is chronic. External is due to Cold pathogen; Internal is due to Yin deficiency. External is treated with Warm/Dispersing (easy); Internal is treated with Tonify/Harmonize (difficult). However, weak patients may get External cough; strong patients may develop Internal cough. Careful examination of etiology, pulse, and complexion distinguishes them. ○ Internal cough always roots in Yin. What is Yin? The essence-Qi of the five Zang organs. All Zang have essence, but Kidney is the root of Primordial Essence. Lung is the master of Vital Qi. Injury to Zang Qi affects自上而下 (top-down): Lung → Spleen → Kidney. Injury to Zang Essence affects自下而上 (bottom-up): Kidney → Spleen → Lung. If Lung and Kidney are diseased, other organs are affected. Thus, Labor-Damage cough is hardest to treat because the disease is at the root. To treat the Upper, look to the Lower; to treat the Lower, look to the Upper. Understanding Qi contains Essence and Essence contains Qi allows discussion of Labor-Damage cough. ○ Some External patterns are mistaken for Labor-Damage, becoming true Labor. This happens in patients with weak constitution where doctors prematurely diagnose Fire/Labor, using Yin-nourishing/Fire-descending herbs. Cold in the exterior meets cold herbs, creating combined pathology. Folk saying "Wind-cold turns to Labor" is false; it is quackery prolonging the disease. ○ Dry cough, according to Danxi, is Phlegm-Stagnation and Fire-Evil in Lung, treated with Platycodon to open, then Yin-nourishing/Fire-descending. If unresolved, it becomes Labor, requiring Dao Cang method. Danxi attributes this to frustration. I disagree. Frustration implies emotional injury, not Phlegm-Fire. Platycodon/Dao Cang are inappropriate. Dry cough is due to Lung fluid depletion. This is clearly Internal Deficiency, Lung-Kidney non-interaction, Qi/Essence failure. Differentiate presence of Fire. If no Fire, tonify Qi to generate Essence. If slight Cold, use Pungent to moisten, tonify Yang to generate Yin. If Internal Heat/Fire, preserve True Yin, strengthen Water to control Fire. Only resolving phlegm/stagnation depletes Qi/Water further, leaving the patient like a fish in a dried rut. (Zhang Jingyue)
Cough with immediate phlegm expulsion indicates Spleen Dampness dominance with slippery phlegm. Cough with multiple bouts but delayed phlegm indicates Lung Dryness dominance with sticky phlegm. Cough without phlegm: use Sweet-Cool to moisten Lung. Cough due to excessive phlegm: use Pungent-Ping to dry Spleen. (Zhang Luyu)
Lung and Stomach Cold, stagnation in skin/hair, unventilated airways generate internal phlegm and cough. Dispersing Cold treats the Branch; Warming Interior treats the Root. For Cold-damaging-Lung from chilling/drinking cold, these two methods suffice. For Water-Qi shooting into Lung causing cough, blame Bladder and Kidney; use Xiao Qing Long Tang or Zhen Wu Tang. (Cheng Jiaoqian)
Modern physicians know Lung governs skin/hair and universally use Warm-Dispersing for external Wind-Cold, ignoring transmission to interior causing Stagnation-Cough and eventually Tuberculosis (Lao Zhai). This stems from failing to distinguish External/Internal causes and New/Old differences. Chilling/drinking cold with new cough/thick phlegm warrants Warm-Dispersing. But if Qi moves with Fire flare and old cough has no phlegm, Clear Heat/Moisten Dryness is needed; Warm-Dispersing is contraindicated. Many Labor cases start with cough; practitioners fixate on Wind-Cold, repeatedly using Pungent-Warm, leading to incurable conditions. (Zhengzhi Huibu)
If Lung harbors hidden Fire-Evil, pores are open, and Wind easily invades causing frequent attacks, clear Fire concurrently. Repeated dispersing destroys fluids, leading to Lung Abscess. Be cautious. (Xue Lizhai)
Two types of Deficient Cough: Daytime cough with white froth or nausea indicates Qi Deficiency; use Liu Jun Zi Tang plus Kuandonghua and Wuweizi. Night cough with thirst, difficult phlegm, or fever indicates Blood Deficiency; use Liuwei Dihuang Wan plus Maidong and Wuweizi. (Fengshi Jinnang)
For Deficient Fire flaming up injuring Lung causing cough, substitute Shu Dihuang with Sheng Dihuang initially for 2-3 doses to clear Lung, then use Shu Dihuang. Otherwise, Fire stagnates in Lung, risking Lung Withering. (Luo Chicheng)
Long-standing night cough usually indicates Kidney True Deficiency, Fire flaming, Water drying, fluids flooding as phlegm. Use Liuwei Wan plus Erdong (Tiandong/Maidong) to nourish the source. (Wanbing Huichun)
Lung exhales; Kidney inhales. Lung is Master of Qi; Kidney is Root of Qi. Severe acute cough with Qi rushing up from below navel indicates Kidney failing to grasp Qi. Use Anshen Wan. Do not just treat Lung; this follows "Tonify Child when Deficient" (Kidney is Child of Lung? Note: Metal generates Water, so Kidney is Child of Lung. Wait, Zhang Jingyue says "Xu Ze Bu Zi" - Tonify Child. Lung is Metal, Kidney is Water. Metal generates Water. So Kidney is Child. Correct.). (Yang Renzhai)
Old cough with phlegm: Dry Spleen, transform phlegm. Old cough without phlegm: Clear Metal, descend Fire. External old cough leads to Stagnant Heat; Internal old cough leads to Flaming Fire; both require Opening Stagnation and Moistening Dryness. For Seven Emotions Qi rebellion, regulate Qi first. For retained water/food, separate and guide. For Qi/Blood deficiency, tonify and astringe; do not misuse Astringents. (Yifang Jijie)
For long cough with hoarseness, it is Yuan Qi insufficiency and Lung Qi lack of nourishment. Tonify Yuan Qi, nourish Metal, moisten Dryness; voice will brighten. For Labor-Damage patients, nourish Kidney Water and moisten Lung Metal as Root, use Hezi and Baiyaojian to astringe as Branch. Treating Root and Branch together ensures success. (Xu Chunfu)
Cough treatment has Astringing and Dispersing methods. Astringing gathers Lung Qi; Dispersing resolves Cold. Dispersing when Astringing is needed traps Cold; Astringing when Dispersing is needed leaks Zheng Qi. For Wind-cough, if Exterior is deficient after dispersing and re-invaded by Cold, dispersing further harms Lung, while astringing traps Pathogen. First lightly resolve, then gradually astringe. Lung remains sufficient, Pathogen does not stagnate, cough stops. (Xu Shugong)
Dun Ke (Whooping Cough) is mostly Lung Dryness and Fluid Injury, causing severe cough with difficult phlegm. Follow Qing Zao Jiu Fei Tang principles. Loquat leaf clears Lung and descends Qi; descending Qi lowers Fire and smooths Phlegm, stopping rebellion. This aligns with "Lung dislikes Qi rebellion, urgently eat Bitter to descend it." Apricot kernel is essential. (Fang Xingyan)
Although Qibo stated all Zang/Fu cause cough, emphasis is on Lung. Skin/hair are Lung's correspondence. External pathogens enter here. Cold drinks ascend to Lung causing Cold. External/Internal Cold combines, lodging in Lung, causing Lung cough. This illustrates one aspect of Chilling and Cold Drinking injuring Lung.