钱乙曰。夫嗽者。肺感微寒。八九月肺气大旺。病嗽者必实。非久病也。其症面赤痰盛。或身热。宜葶苈丸下之。
久者不可下也。十一二月嗽者。乃伤风嗽也。风从背脊第三椎肺俞穴入也。宜麻黄汤汗之。有热症面赤饮水涎热。咽喉
不
利者。宜兼甘桔汤。若五七日间身热痰盛唾粘者。褊银丸下之。有肺盛者。咳而后喘。面肿欲饮水。有不饮水者。其身
即热。泻白散。若伤风嗽。五七日无热症而但嗽者。亦可用葶苈丸。后用下痰药。有肺虚者。咳而哽气。时时常出气。
喉中有声。此久病也。阿胶散补之。痰盛者。先实脾。后以褊银丸微下之。痰退。即补肺如上法。盖久嗽者。肺亡津液。
故必用阿胶散。治嗽大法。盛则下之。久即补之。更量虚实。以意为增损。
圣惠方曰。小儿嗽而呀呷作声者。由胸膈痰多嗽动。其痰上搏于咽喉之间。痰与气相击。随嗽动息。呀呷有声。其
咳嗽本体虽同。而于治疗则加消痰破饮之药。以此为异耳。宜圣惠射干散。
罗谦甫曰。小儿 症。本由暑热所侵。未经发散。邪传心肺。变而为热。热生风。风生痰。痰实不化。因循日久。
结为顽块。圆如豆粒。遂成痰母。推本其原。或啼哭未休。遽与乳食。或饲以酸咸。气郁不利。致令生痰。或风寒暑湿
侵袭。或堕水中。水入口鼻。传之于肺。故痰母发动而风随之。风痰潮紧。气促而喘。乃成痼痰。急宜去风化痰。先以
五苓散同宽气饮、宽热饮。稍用姜汁和匀。沸汤调服。次进知母汤、半夏丸治之。
张元素曰。嗽而两胁痛者。属肝经。小柴胡汤。嗽而呕苦者。属胆经。黄芩半夏生姜汤。嗽而喉中如梗者。属心经。
甘桔汤。嗽而失气者。属小肠。芍药甘草汤。嗽而右胁痛者。属脾经。升麻汤。咳而呕长虫者。属胃经。乌梅丸。嗽而
喘息吐血者。属肺经。麻黄汤。咳而遗尿者。属大肠。赤石脂汤。咳而腰背痛。甚则咳涎者。属肾经。麻黄附子细辛汤。
咳而遗溺者。属膀胱。茯苓甘草汤。咳而腹满。不欲食。面肿。气虚者。属三焦。异功散。
曾氏曰。脾虚亦能作嗽。当投补剂。醒脾散、茯苓浓朴汤。令脾气实。然后间与清肺饮。疏解肺经风寒。及藿香饮
助脾养胃。亦救子益母之法也。有一症。咳嗽至极时。顿呕吐。乳食与痰俱出尽。方少定。此名
风痰壅盛。肝木克脾土。用白附饮治之。
薛己曰。咳嗽流涕。外邪伤肺也。参苏饮。咳嗽面赤。心火刑肺也。人参平肺散。嗽而吐青绿水。肝木乘脾也。异
功散加柴胡。嗽而吐痰乳。脾肺气伤也。六君加桔梗。嗽而吐脓痰。热蕴于肺而成肺痈也。桔梗汤。凡风邪外伤。法当
表散而实腠理。其用下药。非邪传于内。及胃有实热者。不宜轻用。面色白。脉短涩者。肺之本症也。易治。面色赤。
脉洪数者。火刑金也。难治。
Qian Yi stated: Cough is caused by the lung being affected by slight cold. In the eighth and ninth lunar months, Lung Qi is flourishing; coughs occurring at this time are necessarily excess patterns and not chronic diseases. The symptoms include a red face and abundant phlegm, or fever. It is appropriate to use Tingli Wan (Thladianthae Fructus Pill) to purge downward.
If it is a chronic cough, purging should not be used. Coughs occurring in the eleventh and twelfth lunar months are wind-cold coughs. The wind pathogen enters through the Feishu (BL13) acupoint located at the third thoracic vertebra on the back. It is appropriate to use Mahuang Tang (Ephedra Decoction) to induce sweating. If there are heat symptoms such as a red face, thirst with drinking, hot saliva, and throat discomfort, it is appropriate to combine with Ganjie Tang (Licorice and Platycodon Decoction). If within five to seven days there is fever, abundant phlegm, and sticky sputum, Pianyin Wan (Bitter Silver Pill) should be used to purge downward. If Lung Qi is excessive, manifesting as cough followed by wheezing, facial edema, and desire to drink water (or no desire to drink but immediate body heat), Xiebai San (Drain White Powder) is indicated. For wind-cold cough without heat symptoms after five to seven days, only coughing present, Tingli Wan may also be used, followed by phlegm-resolving medicines. If Lung Qi is deficient, manifesting as cough with qi obstruction, frequent sighing, and sounds in the throat, this is a chronic disease treated with Ejiao San (Donkey-hide Gelatin Decoction) for tonification. If phlegm is abundant, first strengthen the Spleen, then mildly purge with Pianyin Wan. After phlegm recedes, tonify the Lung using the aforementioned method. Generally, in chronic cough, Lung fluids are depleted, so Ejiao San must be used. The general principle for treating cough is: excess patterns are purged, chronic conditions are tonified, and adjustments are made based on deficiency and excess.
The *Shenghui Fang* states: When children cough with a rattling sound ("ya xia"), it is due to excessive phlegm in the chest and diaphragm moving during coughing. The phlegm rises and strikes the throat, where phlegm and qi collide, producing rattling sounds synchronized with the cough. Although the nature of the cough is the same, treatment differs by adding herbs that resolve phlegm and break fluid retention. The *Shenghui Fang* Shegan San (Belamcanda Decoction) is indicated.
Luo Qianfu stated: The pediatric convulsion syndrome originates from invasion by summer-heat, which was not dispersed, allowing pathogens to transmit to the Heart and Lung, transforming into heat. Heat generates wind, wind generates phlegm. The phlegm becomes solid and fails to transform. Over time, it knots into stubborn masses, round like bean grains, becoming "phlegm mothers." Tracing the origin, crying without rest followed immediately by feeding, or feeding sour and salty foods, causes qi stagnation and difficulty in flow, leading to phlegm production. Alternatively, invasion by wind, cold, summer-heat, and dampness, or falling into water where water enters the mouth and nose and transmits to the Lung, causes the "phlegm mother" to activate with accompanying wind. Wind-phlegm surges urgently, causing rapid breathing and wheezing, forming stubborn phlegm. Urgent treatment requires dispelling wind and resolving phlegm. First, administer Wuling San (Five-Ingredient Poria Decoction) combined with Kuanqi Yin (Qi-Widening Drink) and Kuanye Yin (Heat-Widening Drink), mixed with a little ginger juice, and taken with boiling water. Subsequently, administer Zhimu Tang (Anemarrhena Decoction) and Banxia Wan (Pinellia Pill) for treatment.
Zhang Yuansu stated: Cough with pain in both hypochondria belongs to the Liver channel; treat with Xiaochaihu Tang (Minor Bupleurum Decoction). Cough with bitter vomiting belongs to the Gallbladder channel; treat with Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction). Cough with a sensation of obstruction in the throat belongs to the Heart channel; treat with Ganjie Tang. Cough with flatus belongs to the Small Intestine channel; treat with Shaoyao Gancao Tang (Peony and Licorice Decoction). Cough with right hypochondriac pain belongs to the Spleen channel; treat with Shengma Tang (Cimicifuga Decoction). Cough with expulsion of long worms belongs to the Stomach channel; treat with Wumei Wan (Mume Pill). Cough with wheezing and hemoptysis belongs to the Lung channel; treat with Mahuang Tang. Cough with enuresis belongs to the Large Intestine channel; treat with Chishizhi Tang (Red Halloysite Decoction). Cough with lower back and waist pain, or severe coughing up of saliva, belongs to the Kidney channel; treat with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction). Cough with urinary incontinence belongs to the Bladder channel; treat with Fuling Gancao Tang (Poria and Licorice Decoction). Cough with abdominal fullness, anorexia, facial edema, and qi deficiency belongs to the Triple Burner; treat with Yigong San (Extraordinary Skill Powder).
Zeng Shi stated: Spleen deficiency can also cause cough. Tonifying agents such as Xingpi San (Spleen-Awakening Powder) and Fuling Niu Bang Tang (Poria and Magnolia Bark Decoction) should be administered to solidify Spleen qi. Then, intermittently administer Qingfei Yin (Lung-Clearing Drink) to disperse wind-cold in the Lung channel, and Huoxiang Yin (Agastache Drink) to assist the Spleen and nourish the Stomach. This is also the method of "saving the child by benefiting the mother." One symptom involves extreme coughing leading to sudden vomiting, expelling milk, food, and phlegm completely, after which the patient calms slightly. This is named excessive wind-phlegm turbidity, where Liver wood overacts on Spleen earth. Treat with Baifu Yin (White Attitude Drink).
Xue Ji stated: Cough with runny nose indicates external pathogens injuring the Lung; treat with Rensu Yin (Ginseng and Perilla Leaf Decoction). Cough with a red face indicates Heart fire punishing Lung metal; treat with Renshen Pingfei San (Ginseng Lung-Pacifying Powder). Cough with vomiting of green or clear water indicates Liver wood invading Spleen earth; treat with Yigong San added with Chaihu (Bupleurum). Cough with vomiting of phlegm-milk mixture indicates injury to Spleen and Lung qi; treat with Liujun Zi Tang (Six-Gentlemen Decoction) added with Jiegeng (Platycodon). Cough with purulent sputum indicates heat accumulating in the Lung forming Lung abscess; treat with Jiegeng Tang. For external wind pathogens, the method should be to release the exterior and consolidate the interstices. Purging medicines should not be used lightly unless pathogens have transmitted internally or there is excess heat in the Stomach. A pale face with short and choppy pulse indicates the primary pattern of the Lung; it is easy to treat. A red face with flooding and rapid pulse indicates fire punishing metal; it is difficult to treat.