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[Appendix: Tortoise Chest and Tortoise Back]

General Principles: Although cough is divided into cold and heat patterns, continuous coughing occurs due to the Lung being affected by Wind-Cold; eyelid edema, excessive phlegm, and rattling sounds in the throat often result from playing in water while sweat is not yet dry.

Pulse Diagnosis: A faint pulse at the Guan position indicates cough; a floating and moderate pulse indicates Wind injury; a tight pulse indicates Cold cough. A floating and straight pulse suggests a favorable prognosis, whereas a floating and soft pulse suggests an unfavorable prognosis (death).

The *Neijing* states: "All five Zang organs and six Fu organs can cause cough, not just the Lung." This is because the skin and hair are the exterior correspondences of the Lung; when the skin and hair are first invaded by pathogenic factors, the pathogens follow this correspondence to enter the interior. Cough originating from the five Zang organs, if prolonged, will transfer to affect the six Fu organs.

Furthermore, the *Bingji Yao* states: "Ke" (cough with sound but no phlegm) refers to the impairment of Lung Qi and its failure to descend clearly. "Sou" (phlegm without sound) refers to Spleen dampness stirring up and generating phlegm. "Kesu" (cough with both sound and phlegm) occurs because Lung Qi is injured and Spleen dampness is activated, resulting in both coughing and expectoration.

The Classics also state: "Injury by dampness in autumn leads to cough in winter." Generally, the qi of early autumn should be clear and肃 (descending/clearing); if it moves contrary to this, the qi rushes upward causing cough, and if severe, it disturbs Spleen dampness to produce phlegm.

The Lung resides at the highest position, governs all Qi, belongs to Metal, and fears Fire. It is pure, empty, high, and noble, covering the five Zang organs, embodying the image of Metal. Externally, it governs the skin and hair and controls the opening and closing of the Couli (pores), protecting the whole body, much like the sky covers all things—it is extremely light and clear. If invaded by external Six Evils or conflicted by internal Seven Emotions, Lung Metal is injured, and the pure Qi becomes disturbed and erratic, transforming into Fire or Phlegm, thus giving rise to cough.

When infants and children suffer from daytime cough and phlegm obstruction, with restlessness during sleep, it is also due to contracting Wind after birth. However, dispersing agents should not be overused; one should first release the Exterior, then administer Xingxing San.

If infants and children play in water immediately after sweating, it can lead to Wind injury and cough. External symptoms include slightly swollen eyelids and rattling phlegm in the forehead depression area. One should disperse Wind, resolve Phlegm, and relieve pathogenic Heat; Xiaochaihu Tang may be used.

Qian Zhongyang stated: Sou (cough with phlegm/sound) results from the Lung contracting slight Cold. In the eighth and ninth lunar months, Lung Qi is flourishing. If the face is red and the body is hot, the condition is Excess, and Tingli Wan should be used to purge it. Chronic cough should not be purged. In winter, it is Wind-Cold cough, and Mahuang Tang should be used to induce sweating. If the face is red, there is thirst, cough produces purulent sputum, and the throat is obstructed, Ganjie Tang should be used to clear it. If cough precedes wheezing, accompanied by facial swelling and fever, this indicates abundant Lung Qi; Xiexie San should be used to calm it. If cough produces saliva and milk-like phlegm, Baibing Zi should be used to purge it.

Jiegu stated: Cough with pain in both hypochondria belongs to the Liver Meridian; use Xiaochaihu Tang. Cough with vomiting of bitter fluid belongs to the Gallbladder Meridian; use Huangqin Banxia Shengjiang Tang. Cough with a sensation of obstruction in the throat belongs to the Heart Meridian; use Ganjie Tang. Cough with flatus belongs to the Small Intestine; use Shaoyao Gancao Tang. Cough with right-sided hypochondriac pain belongs to the Spleen Meridian; use Shengma Tang. Cough with vomiting of worm-like substances belongs to the Stomach Meridian; use Wumei Wan. Cough with wheezing and hemoptysis belongs to the Lung Meridian; use Mahuang Tang. Cough with enuresis belongs to the Bladder Meridian; use Fuling Gancao Tang. Cough with abdominal fullness, loss of appetite, facial edema, and rebellious Qi belongs to the Triple Burner; use Yigong San. If cough is accompanied by runny nose, it is external pathogen injuring the Lung; first use Shen Su Yin. Wheezing cough with red face indicates Heart Fire insulting Lung Metal; use Renshen Pingfei San and Liuwei Dihuang Wan. Cough with vomiting of green or blue water indicates Liver Wood invading Spleen; use Yigong San plus Chaihu and Jiegeng. Cough with vomiting of phlegm-milk indicates injury to Spleen and Lung Qi; use Liujunzi Tang plus Jiegeng. If cough produces purulent sputum, it is heat accumulating in the Lung forming Lung Abscess (Fei Yong); use Jiegeng Tang. Cough with bloody nasal discharge, or severe bleeding, requires clearing Metal and descending Fire, as this is Fire insulting the Lung. For external Wind pathogen invasion, the method is to first release the Exterior and then consolidate the Couli. Laxatives should not be used lightly unless the pathogen has transmitted inward or there is excess Heat in the Stomach. A pale complexion with short and choppy pulse indicates the primary symptom of the Lung, which is easy to treat. A red complexion with surging and rapid pulse indicates Fire insulting Metal, which is difficult to treat.