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Xu Shugong stated: Cough is a disease with varying causes. Internally, one must distinguish the meridians and zang-fu organs involved; externally, one must differentiate between wind, cold, summerheat, dampness, dryness, and fire pathogens, as well as determine whether the etiology is cold, heat, deficiency, or excess. "Ke" (cough proper) features a heavy sound originating from the Dantian (lower abdomen), occurring continuously, indicating lung qi injury and lack of clarity. "Sou" (phlegm expectoration) features a light sound originating in the Upper Jiao (chest and above), caused by spleen dampness stirring up phlegm. When both occur together ("Ke Sou"), there is both phlegm and sound; the phlegm exits with the sound, and the sound ceases only when the phlegm is expelled.

Treatment should be differentiated based on zang-fu functions, the four seasons, the cause of pathogenic invasion, internal injury from the Seven Emotions (joy, anger, worry, overthinking, grief, fear, fright), and the mutual overcoming relationships among the five zang organs. One must deduce the specific cause and pulse pattern to select appropriate herbs. For instance, if the pulse is floating and moderate (Fu Huan), it indicates Wind; Wind pathogens require dispersing methods. Without herbs such as Ephedrae Herba (Mahuang), Asari Radix (Xixin), Inulae Flos (Xuanjinhua), or Peucedani Radix (Qianhu), or formulas like Jinfei Cao San (Golden Boiling Grass Powder) or Shen Su Yin (Ginseng and Perilla Decoction), the wind pathogen cannot be dispersed.

If the pulse is wiry and tight (Xuan Jin), it indicates Cold; Cold pathogens require warming and resolving methods. Without herbs such as Zingiberis Rhizoma (Ganjiang), Cinnamomi Cortex (Guigui), Dendrobii Caulis (Kudong), or Petasitae Flos (Foercao), or formulas like Lizhong Tang (Regulate the Middle Decoction) or Wen Fei Tang (Warm Lung Decoction), the cold pathogen cannot be warmed away.

If the pulse is deficient and soft (Xu Ruan), it indicates Summerheat; Summerheat requires clearing and resolving. Without herbs such as Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), or Lycii Cortex (Digupi), or adding Ophiopogonis Tuber (Maidong) and Mume Fructus (Wumei) to Liuhe Tang (Six Harmonies Decoction), the summerheat toxin cannot be cleared.

If the pulse is deep and choppy (Chen Se), it indicates Dampness; Dampness requires drying. Without herbs such as Atractylodis Rhizoma (Cangzhu) or Atractylodis Macrocephalae Rhizoma (Baizhu), or formulas like Buhuanjin Zhengqi San (Non-Exchangeable Upright Qi Powder) or Baizhu San (Atractylodes Powder), the dampness cannot be dried.

If the pulse is wiry and slippery (Xuan Hua), appearing at the Stomach meridian or Qikou (pulse position at the radial artery), it indicates Phlegm; Phlegm requires draining and eliminating. Without herbs such as Brassicae Semen Album (Baijiezi), Gleditsiae Sinensis Fructus (Zaojiao), Natron (Shijian), or formulas like Erchen Tang (Two-Cured Decoction) or Daotan Tang (Leading Out Phlegm Decoction), or herbs like Pinelliae Rhizoma (Banxia), Arisaematis Rhizoma (Nanxing), Poria (Fuling), and Citri Reticulatae Pericarpium (Chenpi), the phlegm-fluids cannot be removed.

If the pulse is floating and vigorous at the Qikou, it indicates Qi stagnation; Qi stagnation requires soothing and regulating. Without herbs such as Perillae Folium (Zisu), Cyperi Rhizoma (Xiangfu), Aurantii Fructus (Zhike), or formulas like Xiangsha Erchen Tang (Cyperi and Amomi Two-Cured Decoction), Zi Su Zi Tang (Perilla Seed Decoction), or Jiajian Sanqi Tang (Modified Three Wonders Decoction), the stagnant qi cannot be regulated. If the pulse is weak and gradually thin, it indicates Deficiency; Deficiency requires warming and tonifying. Without Hermodactylis Tubers (Zhongru), Donkey-hide Gelatin (Ejiao), Astragali Radix (Huangqi), or Ginseng Radix et Rhizoma (Renshen), lung deficiency cannot be tonified. If deficiency is extreme and leads to panting and urgency, one must apply warming tonification and sedative/heavy methods targeting the Lower Jiao.

If the pulse is wiry, fine, and rapid (Xuan Xi Shu), it indicates Consumption (Xu Lao); Consumption requires nourishing blood and qi. Without herbs such as Ginseng Radix et Rhizoma (Renshen), Ophiopogonis Tuber (Tiantong), Schisandrae Fructus (Wuweizi), or Angelicae Sinensis Radix (Danggui), or formulas like Huangqi Biejia San (Astragalus and Turtle Shell Powder) or Qinjiao Biejia San (Gentian and Turtle Shell Powder), Ying and Wei cannot be nourished.

If the pulse is deep, solid, and forceful (Chen Shi Youli), it indicates Excess of Qi; Excess requires purging. Without herbs such as Lepidii Fructus (Tingli) or Morus Cortex Sangbai Pi (Sangpi), or formulas like Xie Bai San (Drain White Powder) or Ping Fei Tang (Calming Lung Decoction), lung excess cannot be purged.

If the pulse is soggy and weak (Ru Ruo), it indicates consumption and dispersion of lung qi; this requires astringing. Without astringent herbs such as Cornus Fructus (Suke), Chebulae Fructus (Hezi), or Mume Fructus (Wumei), or formulas like Tijin San (Extract Gold Powder) or Xixin Wuwei Tang (Asari and Schisandra Decoction), lung qi cannot be astringed.

There are essentially only two methods here: dispersing and astringing. Dispersing aims to resolve cold pathogens, while astringing aims to consolidate lung qi. If dispersing is indicated but astringents are used, the cold pathogen will be trapped, causing significant harm; if astringing is indicated but dispersants are used, healthy qi will leak out, also causing significant harm. For example, in wind-induced cough that has already been treated with dispersants, if the exterior is deficient and re-infected by deficient pathogens, leading to renewed panting and cough, using more dispersants will worsen the condition, while using astringents will retain the pathogen. One should first clear and resolve, then gradually astringe, and the panting and cough will cease naturally.

Yu Jiayan stated: Cough due to internal injury varies in treatment. If fire is excessive, nourish water to control it; if metal (lung) is deficient, strengthen earth (spleen) to generate it; if depression is severe, soothe the liver; if qi is rebellious, regulate the lung; if food stagnation exists, harmonize the middle; if sexual exhaustion occurs, tonify the lower jiao. Since the interior is already injured, medications should not be overly harsh.

Li Shicai stated: Although cough is a lung disease, all zang and fu organs can cause it. Analyzing its details, the classics may still have omitted meanings; summarizing its principles, it boils down to internal injury and external contraction. External pathogens (wind, cold, summerheat, dampness) attack the exterior, first affecting the skin and hair. Skin and hair are the exterior extension of the lung; if lung pathogens are not resolved, other meridians become diseased. This is transmission from the lung to other organs. Internal injury from fatigue or emotions damages organ qi, starting from the yin aspect and affecting the upper jiao. This is transmission from other organs to the lung.

When entering from the exterior, the disease is in yang; it is suitable to use acrid-warm herbs to disperse pathogens, clearing the lung and curing the cough. When arising from within, the disease is in yin; it is suitable to use sweet herbs to nourish water and moistening herbs to nourish metal, calming the lung and curing the cough.

Generally, drugs for treating exterior syndromes should not be static (astringent/cold); if static, pathogens linger unresolved and transform into other diseases. Therefore, cold and astringent herbs are contraindicated, as stated in the *Chapter on Generation of Five Zang Organs*: "The lung desires acridity." Drugs for treating interior syndromes should not be moving (dispersing/drying); if moving, deficient fire becomes unsettled and dryness/itching worsens. Therefore, acrid-aromatic and drying-hot herbs are contraindicated, as stated in the *Chapter on Manifestations of Five Qi*: "Acridity moves qi; in qi disorders, do not consume much acridity."

However, although treating exterior syndromes favors movement to disperse pathogens, if both form and qi are deficient, one must tonify middle qi and assist with harmonizing methods. If one specializes only in dispersing, lung qi may weaken further, pores may loosen, and pathogens may enter through deficiency, worsening the illness. Although treating interior syndromes favors stillness to nourish yin, if Mingmen fire declines and fails to return to its root, Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Cinnamomi Ramulus (Guizhi), and Aconiti Lateralis Radix Praeparata (Fuzi) are essential. Otherwise, qi cannot transform fluids, and there will ultimately be no benefit to yin.

Treatment should follow symptoms. For the elderly and the deficient, the primary approach is warming and nourishing the spleen and stomach, with slight attention to symptomatic relief.

Zhao Yangkui stated: The lung is a pure and hollow organ, tolerating no foreign matter; even slight irritation causes cough. The lung is also a delicate organ, fearing heat and cold. Fire punishing metal causes cough; cold water and cold metal also cause cough. Thus, cough must be attributed to the lung. However, the method of treatment lies not in the lung but in the spleen, and specifically emphasizes the kidney. The spleen is the mother of the lung; the kidney is the son of metal. Therefore, in deficiency, one tonifies the mother and the son. For example, in cough due to external wind-cold, people usually use Ephedrae Herba (Mahuang), Aurantii Fructus (Zhike), or Perillae Folium (Zisu) to release the exterior and disperse pathogens. If both form and qi are substantial, one sweating episode cures it. If form, qi, and pathology are all deficient, one should prioritize tonifying the spleen, assisted by exterior-releasing herbs. This is why Shen Su Yin (Ginseng and Perilla Decoction) contains Ginseng Radix et Rhizoma (Renshen), and Guizhi Tang (Cinnamon Twig Decoction) contains Paeoniae Radix Alba (Shaoyao) and Glycyrrhizae Radix et Rhizoma (Gancao)—to release the exterior while strengthening the spleen. When the spleen is solid, lung metal is nourished, and the skin/hair have protective qi. Existing pathogens exit easily, and new pathogens cannot enter.

Furthermore, *Renzhai Zhizhi* states: The lung exhales qi; the kidney receives qi. The lung is the master of qi; the kidney is the root of qi. In sudden, severe cough that agitates the whole body, with shortness of breath and a sensation of qi rushing upward from below the umbilicus, this is kidney deficiency failing to receive qi and return it to its root. One should treat with Dihuang Wan (Rehmannia Pill) or Anshen Wan (Peace Kidney Pill), rather than focusing solely on the lung. This illustrates the principle of tonifying the son in deficiency.

In cases where fire scorches lung metal causing cough, one should clear metal and descend fire. The principle of clearing metal and descending fire is that tonifying the North (Kidney Water) drains the South (Heart Fire); nourishing yin is the method to descend fire. Since Wang Jiezai discussed how excessive alcohol and sex damage the true yin of the lung and kidney, and that Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) should not be taken, as excessive use leads to death (fearing yang prosperity and yin depletion), this view became prevalent. Consequently, those treating yin-deficiency cough regard Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) as arsenic poison and Anemarrhenae Rhizoma (Zhimu) and Phellodendri Cortex (Huangbai) as spiritual elixirs. It is better to practice moderation and abstain from medicine to prolong life, which is tragic. Since the disease arises from sexual exhaustion damaging true yin, yin deficiency allows fire to punish lung metal, inevitably injuring the lung. One should first use methods to strengthen the source of water to tonify true yin, allowing water to rise and fire to descend, then use Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) to rescue the lung and tonify the mother of the kidney (Earth generates Metal), facilitating the interaction of metal and water, leading to recovery.

In cases where spleen and stomach are initially deficient, earth deficiency fails to control water, water floods and transforms into phlegm, and the "son" (water/kidney) attacks the "mother" (metal/lung) causing cough. Initially, this may stem from heart fire punishing metal, but due to mistaken use of cold-cooling herbs, spleen earth is injured. Cold water, aided by wood, rises and invades the lung and stomach, causing cold water and cold metal. Unskilled physicians, unaware of this, believe phlegm-fire is hard to remove and increase cold-cooling herbs. They fail to realize this syndrome requires Liujunzi Tang (Six Gentlemen Decoction) with Paeoniae Radix Alba Shaoyao (Paojiang - fried ginger) to tonify spleen and lung, and Bawei Wan (Eight-Ingredient Pill) to tonify the earth mother and guide water back to its root; otherwise, it is perilous.

In cough with hoarseness, it is said that "full metal does not ring, broken metal does not ring either." Excess is cleared; deficiency (breakage) is tonified. Also, note that the collateral of Shaoyin enters the lung, follows the throat, and binds to the base of the tongue. The lung is the branch; if the root is deficient, the branch is weak. Thus, voice becomes chaotic, throat hoarse, tongue flaccid, and speech difficult.