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Cough is a minor ailment. However, if it persists continuously, it becomes a chronic disease. How can it be disregarded? Nevertheless, coughing with sound but no phlegm is commonly seen in individuals with deficiency and timidity. Sometimes one coughs once, sometimes two or three times in succession, becoming a daily routine. Initially ignored, the body has already become emaciated. This is because the Lung governs exhalation, and the Kidney governs inhalation; their ascending and descending movements are leisurely and not hurried. Only through excessive indulgence (such as sexual excess) is this energy depleted and scattered, causing the True Qi to weaken. Consequently, false coughing sounds rise upward. Is this a sustainable way of life?

Coughing with both sound and phlegm has diverse causes. Externally, it arises from the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire); internally, from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). All can induce this condition. The Classics state that all Zang and Fu organs can cause cough, not just the Lung. Yet, the Lung acts as the chief manager. Among the Six Evils, Wind and Cold are particularly prone to invade because the Lung governs the skin and hair and opens into the nose. Physical cold exposure or consuming cold drinks damages the Lung. If pathogenic factors remain and do not dissipate, they transform into Cold or Heat patterns with varying changes. One must examine the pathogen: if Wind, resolve it; if Cold, disperse it. Stop treatment once the disease is addressed. If dispersing methods are overused, the Cou Li (pores and interstices) become loose, allowing pathogens to re-invade. The more invasion occurs, the more dispersion is needed, leading to a cycle where Spleen and Lung deficiency and Yuan Qi exhaustion result, potentially transforming into other difficult-to-treat syndromes. Furthermore, for causes such as Summerheat, Dampness, and Seven Emotions, treatments must be applied according to the specific pathogenic factors.

I ponder that Phlegm is the fluid of the body. It fills the skin externally and nourishes the Zang-Fu organs internally. It is transformed by Qi and assisted by Blood, irrigating each other without being exhausted. However, if chronic cough persists, the essence of the Fu organs, muscles, blood vessels, and meridians are all consumed and drawn away, exhausted within the phlegm. Compared to the loss of Qi or Blood, how does it differ? Have you not observed those with chronic cough? Initially, their complexion becomes sallow; subsequently, muscles waste away; finally, bones become flaccid. This results from the failure of Body Fluids to distribute properly. How can this be disregarded? Therefore, in treatment: for dry cough, use Dihuang Wan (Rehmannia Pill) to strongly tonify the Kidney, and concurrently administer Renshen (Ginseng) to nourish the source of transformation and generation. For cough with phlegm: if Wind, resolve with Acrid-Cool herbs; if Cold, disperse with Acrid-Warm herbs; if Summerheat, clear it; if Dampness, dry it; if Dryness-Fire, moisten it; if caused by Seven Emotions, regulate according to the cause. The primary task is always to support the Spleen and protect the Lung. Do not merely focus on expelling phlegm.

Note: Phlegm may also arise from Wine-Dampness; formulas like Liujunzi Tang (Six Gentlemen Decoction) added with Gegen (Kudzu Root) and Zexie (Alisma) are suitable. It may arise from Food Stagnation; formulas like Zhizhu Wan (Immortelle and Atractylodes Pill) added with Banxia Qu (Pinellia Fermented Paste), Chenpi (Tangerine Peel), and Gancao (Licorice) are suitable. It may arise from Phlegm-Fire; Erchen Tang (Two Aged Herbs Decoction) added with Gualou (Trichosanthes Fruit), Shanzhi (Gardenia Fruit), and Huangqin (Scutellaria Root) are suitable. It may arise from Lung Dryness; Dongtian (Asparagus Tuber) and Dongmai (Ophiopogon Tuber) added with Beimu (Fritillaria Bulb), Gualou, and Baihe (Lily Bulb) are suitable. It may arise from Qi Reversal; Erchen Tang added with Suzi (Perilla Seed), Sangbaipi (Mulberry Bark), and Duzhong (Eucommia Bark) are suitable. These are all symptomatic treatments (treating the branch). Prescribe according to symptoms, but avoid excessive intensity.