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(Thirteenth)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The five zang organs and six fu organs can all cause coughing, not just the lungs. The skin and hair are the exterior correspondence of the lungs. When the skin and hair are first invaded by pathogenic factors, these pathogens follow the command of the lungs [to affect them]. Coughs originating from the five zang organs may, over time, transmit to the six fu organs. Initially, lung qi is injured; ultimately, spleen dampness is disturbed, resulting in both "ke" (coughing sound) and "sou" (expectoration). The classics state: Injury by dampness in autumn leads to coughing in winter. Generally, the qi of early autumn should be clear and肃 (descending/clearing). If disturbed, the qi rushes upward causing coughing; over time, it disturbs spleen dampness to form phlegm. The general treatment principles are the same as for adults.

The *Mai Jing* (Pulse Classic) states: A faint pulse at the guan position indicates coughing; a floating and moderate pulse indicates wind-stroke (wind-cold injury); a tight pulse indicates cold-cough due to lung cold. A floating and soft pulse indicates a favorable prognosis, while a wiry and urgent pulse indicates an unfavorable prognosis (death).

Qian Yi stated: Coughing is caused by excess lung qi with slight cold. In the eighth and ninth lunar months, lung qi is vigorous. Coughing during this period indicates an excess condition, not a chronic illness. Symptoms include red face, body heat, and abundant phlegm. The treatment method is to purge using Tingli Wan (Descurainia Seed Pill). If it is a chronic condition, purging is contraindicated. Coughing in the eleventh and twelfth lunar months is due to wind-stroke. Wind enters through Feishu (BL13) at the third thoracic vertebra on the back. The treatment is to induce sweating with Mahuang Tang (Ephedra Decoction). If there are heat signs, such as red face, free urination, hot saliva, and blocked throat, Ganjie Tang (Licorice and Platycodon Decoction) should be used. Within five to seven days, if there is body heat, abundant phlegm, and thick/sticky snot and saliva, Pianyin Wan should be used to purge. For lung excess, characterized by cough followed by wheezing, facial edema, thirst, or lack of thirst, and body heat, Xiebai San (White Powder to Drain) should be used to drain lung heat. For cough due to cold damage, if after five to seven days there are no heat signs but only coughing, Tingli Wan is also indicated, followed by phlegm-resolving medicines. For lung deficiency, characterized by choking sensations during cough, frequent deep sighing, and sounds in the throat (chronic condition), Ejiao San (Donkey-Hide Gelatin Powder) is indicated. If phlegm is abundant, tonify the spleen first, then use Pianyin Wan to purge. After saliva/phlegm recedes, tonifying the lung is the best method. For cough with vomiting of clear water or greenish-clear fluid, Baixiang Wan is used to purge. For cough with vomiting of phlegm-saliva or milk/food, Baibing Zi (White Cake Pill) is used. For cough with pus and blood, indicating lung heat, Ganjie Tang is taken after meals. For chronic cough where lung fluids are depleted, Ejiao San is used to tonify. For cough with solid phlegm, mild wheezing, red face, and occasional drinking, Pianyin Wan is used to purge. The general principle for treating cough is: excess conditions are purged, chronic conditions are tonified, and dosages are adjusted according to excess or deficiency.

For cough with fever due to wind-stroke, the exterior should first be dispersed. Ren Shen Qiang Huo San (Ginseng and Notopterygium Decoction) added with Mahuang, or Jinfeicao San (Boiling Grass Powder) added with Sangbaipi, Xingxing San, or Shensu Yin are all dispersing formulas. If heat persists, Jieji Tang (Muscle-Releasing Decoction) is indicated. If, after dispersing wind pathogens, there are no other symptoms except slight coughing, Baolong Wan (Embracing Dragon Pill) or Xiebai San (White Powder to Drain) for calming the lung may be used. If phlegm-saliva is congested and abundant, Yubing Zi or Jinxing Wan are used. To purge phlegm-heat, Xiebai San added with Ren Shen, or Chen Sha Banxia Wan (Cinnabar and Pinellia Pill), or Baolong Wan are particularly effective. If heat persists after purging and signs of convulsions appear, Bohe San (Mint Powder) should be administered.

For cough with fever due to cold invasion, Xingxing San added with Mahuang is taken to disperse cold from the exterior. For slight coughing, Xingren Gao (Apricot Kernel Paste) or Renshen Banxia Wan (Ginseng and Pinellia Pill) are used. For phlegm-cough, Banxia Fuling Tang (Pinellia and Poria Decoction) is used.

For chronic cough previously treated with resolving methods, if lung qi is deficient and cold, the lung should be tonified. Bufen Ejiao San (Tonify Lung Donkey-Hide Gelatin Powder) or Runfei San (Moisten Lung Powder) are taken. For wind affecting the lungs, or long-standing cold in the lungs that does not resolve, moxibustion is applied to Feishu (BL13) for three moxa cones, and Subai Wan (Stemona Pill) is taken. A decoction of Chenpi (Tangerine Peel), Ying Susuo (Poppy Shell), and Sanggen Baipi (Mulberry Root Bark) is prepared, ground into powder, and taken after meals.

For infants within one hundred days of birth suffering from cough, the lung lobes are fragile, making it the most difficult to treat. Ordinary cold or heat pathogens entering the lungs cannot be expelled easily, and the infant cannot tolerate emetic or purgative therapies. One must clearly identify the source of the disease, dissipate wind-cold, resolve phlegm, regulate qi, benefit the lung, generate fluids, open the stomach, and strengthen qi. Cough will gradually decrease. Strong attacking methods should not be forced.

Cold-cough presents with clear nasal discharge, pale face, thin phlegm, lighter symptoms in the day and heavier at night, or slight pathogenic heat. Heat-cough presents with slightly red face, dry and hot nose, thick phlegm, and floating-rapid pulse. Stomach heat, not caused by wind-cold, results from feeding the infant immediately after crying, causing congestion in the heart and lungs that fails to disperse, leading to cough and counterflow qi. Yubing Zi is used to purge.

Qian Yi’s method for treating cough emphasizes strengthening the spleen first. When the spleen (mother organ) is strengthened, the lung (child organ) becomes harmonious.

In children with cough, the interstices are stimulated by wind pathogens, causing red face and rapid breathing. Differentiate between excess and deficiency. If lips are retracted, chest is sunken, and nose is dry, withered, and black, these are intractable cases.