素问云。肺之令人咳。何也。五脏六腑。皆令人咳。非独肺也。皮毛者。肺之合也。皮毛先
受邪气。邪气以从其合也。其寒饮食入胃。从肺脉上至于肺则肺寒。肺寒则外内合邪。因而客之。
则为肺咳。肺咳之状。咳则喘息有音。甚则唾血。心咳之状。咳则心痛。喉仲介介如梗状。甚则
咽肿喉痹。肝咳之状。咳则两胁下痛。甚则不可以转。转则两 下满。脾咳之状。咳则右胁下痛。
阴阴引肩背。甚则不可以动。动则咳剧。肾咳之状。咳则腰背相引而痛。甚则咳涎。五脏之久咳。
乃移于六腑。脾咳不已。则胃受之。胃咳之状。咳而呕。呕甚则长虫出。肝咳不已。则胆受之。
胆咳之状。咳呕胆汁。肺
咳不已。则大肠受之。大肠咳状。咳而遗矢。心咳不已。则小肠受之。小肠咳状。咳而失气。气
与咳俱失。肾咳不已。则膀胱受之。膀胱咳状。咳而遗溺。久咳不已。则三焦受之。三焦咳状。
咳而腹满。不欲食饮。此皆聚于胃。关于肺。使人多涕唾而面浮肿气逆也。
岐伯虽言五脏六腑皆令人咳。其所重全在肺胃。而尤重在外内合邪四字。人身有外邪。有内
邪。有外内合邪。此云五脏之久咳乃移于六腑。是指内邪郁发而言。若外邪入伤肺合而咳。原无
脏腑相移之例也。
金匮云。咳逆倚息不得卧。小青龙汤主之。青龙汤下已。多唾口燥。寸脉沉。尺脉微。手足
厥逆。气从小腹上冲胸咽。手足痹。其面翕热如醉状。因复下流阴股。小便难。时复冒者。与桂
苓五味甘草汤治其冲气。冲气即低。而反更咳胸满者。用桂苓五味甘草汤去桂。加干姜、细辛。
以治其咳满。咳满即止。而更复渴。冲气复发者。以细辛、干姜为热药也。服之当遂渴。而渴反
止者。为支饮也。支饮者。法当冒。冒者必呕。呕者。复内半夏以去其水。水去呕止。其人形肿
者。加杏仁主之。其证应内麻黄。以其人遂痹。故不内之。若逆而内之者必厥。所以然者。以其
人血虚。麻黄发其阳故也。若面热如醉。此为胃热上冲熏其面。加大黄以利之。
按金匮治咳。叙之痰饮之下。以咳必因之痰饮。而五饮之中。独膈上支饮。最为咳嗽根底。
外邪入而合之因嗽。即无外邪。而支饮渍入肺中。自足令人咳嗽不已。况支饮久蓄膈上。其下焦
之气。逆冲而上。尤易上下合邪也。夫以支饮之故。而令外邪可内。下邪可上。不去支饮。则咳
终无宁宇矣。其曰咳逆倚息不得卧。小青龙汤主之。明外内合邪之证。惟小青龙汤为的对耳。然
用小青龙汤。其中颇有精义。须防冲气自下而上。重增浊乱。其咳不能堪矣。
伤寒用小青龙汤。无少阴证者可服。杂证用小青龙汤。亦恐少阴肾气素虚。冲任之火易于逆上。
冲任火上。无咳且增烦咳。况久咳不已。顾可动其冲气耶。盖冲任二脉。与肾络同出胞中。肾虚
不能固守于下。则二脉相挟从少腹逆冲而上也。盖肾气本虚之人。即素无痰饮。才感外邪。则冲
任之火便乘势上凌膈上。迫 津液而为痰饮。支塞清道。必至咳逆倚息不得卧也。倚息者。倚伏
而喘息。阴火内应外邪。为证最急。不得不以小青龙为务也。只缘真元素亏。纵有合剂。不能逞
迅扫之力。所以余邪得以久持。致有如下变证也。多唾。饮上溢也。口燥。津液伤也。寸脉沉。
尺脉微。手足逆冷。卫中阳气耗也。气从少腹上冲胸咽。阴火逆也。手足痹。营血虚也。其面翕
热如醉状。阳明胃热也。因复下流阴股。小便难。阴火下流膀胱也。时复冒。太阳余邪未散也。
然证虽屡变。皆为冲气逆上之故。且有时复昏冒一证。即定太阳表证。确守冒家汗出自愈之例。
故反复出入。不离小青龙加减。所以用桂苓五味甘草汤先治冲气。冲气即低。而反更咳胸满。因
水在膈间不散。再变前方。去桂加干姜、细辛以治其咳满。咳满即止。第三变。而更复渴冲气复
发者。以细辛、干姜为热药也。服之当遂渴。而渴反止者。为支饮也。支饮者。法当冒。冒者必
呕。呕者。复纳半夏以去其水。水去呕止。第四变。其人形肿者。以水尚在表也。加杏仁主之。
其证应纳麻黄。以其人遂痹。故不纳之。若逆而纳之必厥。所以然者。以其人血虚。麻黄发其阳
故也。第五变。若面热如醉。此为胃热上冲熏其面。加大黄以利之。前四变。随证加减施治。犹
未离本来绳墨。至第五变。其证颇似戴阳。而能独断阳明胃热。乃加大黄以利之。按阳明病面合赤
色。不可攻之。为其肾虚阳气不藏。故以攻下为戒。而此平昔阴亏血虚。反用大黄利之者。以其
证变叠见。虽有面热如醉。脉见寸沉尺微。洵非表邪怫郁。而为胃中热蕴无疑。竟行涤饮攻
热。恬不以阴虚为虑而致扼腕也。嗟夫。仲景治咳。全不从咳起见。治其支饮。下其逆气冲气。
法中之法。游刃有余矣。
咳而上气。喉中水鸡声。射干麻黄汤主之。咳而脉浮者。浓朴麻黄汤主之。咳而脉沉者。泽
漆汤主之。
上气而作水鸡声。乃是痰碍其气。气触其痰。风寒入肺之一验耳。发表下气润燥开痰四法。
萃于一方。用以分解其邪。若咳而脉浮。则外邪居多。全以散邪为主。用法。即于小青龙汤中除
去桂枝、芍药、甘草。加浓朴、石膏、小麦。仍从肺病起见。以桂枝之热。芍药之收。甘草之缓。
概示不用。而加浓朴以下气。石膏以清热。小麦以引入胃中。助其升发之气也。若咳而脉沉。为
邪在营分。即肺之里也。热过于营。吸而不出。其血必结。血结则痰气必外裹。故用泽漆之破血
为君。加入开痰下气。清热和营诸药。俾垒一空。元气不损。制方之妙若此。
火逆上气。咽喉不利者。止逆下气。麦门冬汤主之。
此胃中津液干枯。虚火上炎之证。凡肺病有胃气则生。无胃气则死。胃气者。肺之母气也。
故于竹叶石膏汤中。偏除方名二味。而用麦冬数倍为君。兼参、草、粳米以滋肺母。使水壳之精
微。皆得上注于肺。自然沃泽无虞。当知火逆上气。皆是胃中痰气不清。上溢肺隧。占据津液流
行之道而然。是以倍用半夏。更加大枣。通津涤饮为先。奥义全在乎此。若浊饮不除。津液不致。
虽日用润肺生津之剂。乌能建止逆下气之绩哉。俗以半夏性燥不用。殊失仲景立方之旨。
戴人云。肺为诸咳之门户。每为六气所乘。如风乘肺者。日夜无度。汗出头痛。痰涎不利。热乘肺者。喘急而
嗽。面赤潮热。甚者热甚于中。手足反寒。热移于下。便泄无度。火乘肺者。咳喘上壅出血。甚者七窍血
溢。燥乘肺者。气壅不利。百节内痛。头面汗出。寒热往来。皮肤干枯燥痒。大便秘。痰胶血腥。
寒乘肺者。嗽急而喘。恶寒无汗。鼻塞身疼。发热烦躁。湿乘肺者。痰涎不利。面肿喘急。至于
湿痰内动为咳。又必因风因火因热因寒。所挟各不相同。至于乘肺则一也。咳嗽外感六气郁而成
火。必六淫相合。内伤五脏相胜。必五邪相并。有此不同。而中间又有敛散二法。敛者。谓收敛
肺气也。散者。谓解散寒邪也。宜散而敛。则肺受寒邪。一时敛住。为害非轻。宜敛而散。则肺
气怯弱。一时发散而走泄正气。害亦非小。且如感风咳嗽。已经散后。其表虚。复感寒邪。虚邪
相乘又为喘嗽。若欲散风则愈虚其肺。收敛则愈滞其邪。当先轻解。渐收敛之。肺不致虚。邪不
致滞。咳嗽自止矣。
经言脏腑皆有咳嗽。嗽属肺。何为脏腑皆有之。盖咳嗽为病。有自外而入者。有自内而发者。
风寒暑湿。先自皮毛而入。皮毛者肺之合。故虽外邪欲传脏。亦必先从其合而为嗽。此自外而入
者也。七情郁结。五脏不和。则邪火逆上。肺为气出入之道。故五脏之邪上蒸于肺而为咳。此自
内而发者也。然风寒暑湿有不为嗽者。盖所感者重。竟伤脏腑。不留于皮毛。七情亦有不为嗽者。
盖病尚浅。止在本脏。未即上攻。所以伤寒以有嗽为轻。而七情郁结之嗽久而后见。治法。当审
脉证三因。若外因邪气。止当发散。又须原其虚实冷热。若内因七情。与气口脉相应。当以顺气
为先。下痰次之。
戴复庵云。咳嗽因风寒者。鼻塞声重恶寒者是也。火者。有声痰少面赤者是也。劳者。盗汗
出。兼痰者。多作寒热。肺胀者。动则喘满。气急息重。痰者。嗽动便有痰声。痰出嗽止。五者
大概耳。亦当明其是否也。
赵养葵曰。咳谓无痰而有声。肺受火烁也。嗽是有声而有痰。脾受湿伤也。虽分五脏六腑之
殊。而其要皆主于肺。盖肺为清虚之腑。一物不容。毫毛必咳。又肺为娇脏。畏热畏寒。火刑金
烁故嗽。水冷金寒亦嗽。故咳嗽者。必责之肺。而治法不在于肺而在于脾。不专在脾而反归重于
肾。盖脾者肺之母。肾者金之子。故虚则补其母。虚则补其子也。劳嗽见血。有劳伤元气。内火
妄动而伤肺者。亦有劳伤肾水。阴火上炎而伤肺者。有因过服天冬、生地黄等寒药。损伤脾胃。
不能生肺气而不愈者。有因误服知、柏之类。损伤阳气。不能生阴精而不愈者。凡此皆脾肺亏损
而肾水不足。以致虚火上炎真脏为患也。须用异功散加门冬、五味补脾土而生肺金。用六味丸滋
肾水而生阴精。否则不救。凡阴虚火盛。干咳少痰。及痰咯难出之嗽。妄用二陈汤。转劫其阴。
而生大患矣。
张介宾云。大法。咳嗽治表邪者。药不宜静。静则留连不解。变生他病。故忌寒凉收敛。经
所谓肺欲辛者是也。治里证者。药不宜动。动则虚火不宁。燥痒愈甚。故忌辛香燥热。所谓辛走
气。气病无多食辛是也。然治表者。虽宜动以散邪。若形病俱虚者。又当补中气而佐以和解。倘
专于发散。则肺气益弱。腠理益疏。邪乘虚入。病反增剧也。治内者。虽当静以养阴。若命门火
衰不能归元。则参、姜、桂、附在所必用。否则气不化水。终无济于阴也。至若因于火者宜清。
因于湿者宜利。因痰者降其痰。因气者理其气。随其所见之证而兼以调之。大抵风邪胃火。此实
热为患。易治。惟肺肾亏损。此真脏为患。最难治。在老人虚人。皆宜温养脾肺。稍兼治标为当。
石顽曰。经云。劳风法在肺下。其为病也。使人强上冥视。唾出若涕。恶风而振寒。此为劳
风之病。治之以救俯仰。巨阳引。（句）精者三日。中年者五日。不精者七日。咳出青黄涕。其状如
脓。大如弹丸。从口中若鼻中出。不出则伤肺。伤肺则
死也。此段奥义。从无正释。今特明之。夫人劳力则肺气胀满。俞穴大开而汗泄。斯时感冒。风
邪乘其俞穴之开。直入肺下。少顷俞穴仍闭。其邪有入无出。郁闭不通。而生痰聚饮。流入膺胸
肩背经络窍隧之中。故使人强上冥视。强上者。身半以上为风所中。而胸背强戾。但可仰卧而不
能俯。非若肾风之不能正偃也。冥视者。邪害空窍。所以目睛反戾。半开不动。不能视物也。唾
出若涕者。痰饮上溢之征也。恶风振寒者。肺气受困。木邪反肆为虐也。风寒之邪。必由巨阳而
寻出路。今邪在肺下。逼近胃口。既不能从表而解。又非实热燥结。可攻下而除。势必借资膀胱
阳气。上吸胸中。使阴 郁闭之邪。庶得从上解散。本乎天者亲上。故涕从口鼻而出。其色青黄。
其状如脓者。风邪挟肝胆而乘脾胃之候也。大如弹丸者。乃久已支塞肺窍之结痰。见邪蓄之盛也。
设不急治。则伤肺而死矣。故治此证者。当急使巨阳之上引。则肺气清肃下行。而风邪痰涕方得
上出。胸中既空洞无余。自然俯仰无碍矣。又须知此证邪气入深。即使治得其当。虽精壮之人。
亦必服药三日。始得见效。若治中年者。及不精壮者。更须五日七日为期。设遇羸老困惫之人。
胃气浸衰。不能行其药力。何能计日取效哉。治此者。惟金匮桂苓五味甘草汤加姜汁、竹沥。瘥
堪对证。盖桂枝上散肺下邪风。下通膀胱阳气。茯苓先升后降。专祛肺下浊饮。五味约束桂枝辛
散。使津液不随气外泄。而为巨阳之向导。甘草之甘缓。使三味缓留膈上。共成匡济之功。若痰
逆势甚者。又当用桂枝二越婢一汤、小青龙加石膏汤。禀气素虚者。炙甘草汤。皆为合剂。奈何
守真宣明论。特举芎枳丸。专治此证。未审何所见而云然。是予不敢附会也。凡咳嗽。饮水一二
口而暂止者。热嗽也。呷热汤而暂停者。冷嗽也。治热嗽。以小柴胡加桔梗。冷嗽。理中汤加五
味。感风者。鼻塞声重。伤冷者。凄清怯寒。挟热为焦烦。受湿为缠绵。瘀血则膈间腥闷。停水
则心下怔忡。或实或虚。痰之
黄白。唾之稠粘。从可知也。感风而嗽者。脉浮恶风自汗。或身体发热鼻塞。或鼻流清涕。欲语
未竟而咳。宜桂枝汤加香豉、细辛。然火嗽亦有鼻流清涕。语未竟而咳者。但风则一嗽便多稠痰。
火则顿咳无痰。为明辨耳。感寒而嗽者。脉紧恶寒。发热无汗鼻塞。遇寒则咳。内有郁热痰结也。
华盖散。兼喘。九宝汤。暴感风寒。二气相兼而咳嗽。鼻塞声重者。芎苏饮。肺感风寒咳嗽。倚
The *Suwen* (Basic Questions) states: "The lung causes people to cough. Why? All five zang organs and six fu organs can cause coughing; it is not exclusive to the lung." The skin and hair are the exterior correspondence of the lung. When the skin and hair are first invaded by pathogenic factors, these pathogens follow their correspondence and enter the lung. If cold food or drink enters the stomach, the coldness travels up along the lung meridian to the lung, causing lung cold. Once the lung is cold, external and internal pathogens combine. When they lodge in the lung, a lung cough results. The manifestation of a lung cough includes coughing with wheezing and audible sounds; in severe cases, hemoptysis may occur.
The manifestation of a heart cough includes pain in the heart upon coughing, and a sensation of obstruction in the throat as if something were stuck; in severe cases, sore throat and throat bi syndrome occur. The manifestation of a liver cough includes pain under both hypochondria upon coughing; in severe cases, the body cannot turn, and turning causes fullness under both hypochondria. The manifestation of a spleen cough includes pain under the right hypochondrium upon coughing, radiating faintly to the shoulder and back; in severe cases, movement is difficult, and moving aggravates the cough. The manifestation of a kidney cough includes pain between the waist and back upon coughing; in severe cases, salivary fluid is coughed up.
When coughs from the five zang organs persist for a long time, the pathology transfers to the six fu organs. If a spleen cough persists, the stomach becomes affected, resulting in a stomach cough. The manifestation of a stomach cough includes coughing with vomiting; in severe cases, roundworms may be vomited. If a liver cough persists, the gallbladder becomes affected, resulting in a gallbladder cough. The manifestation of a gallbladder cough includes coughing and vomiting bile. If a lung cough persists, the large intestine becomes affected, resulting in a large intestine cough. The manifestation of a large intestine cough includes coughing with fecal incontinence. If a heart cough persists, the small intestine becomes affected, resulting in a small intestine cough. The manifestation of a small intestine cough includes coughing with flatus, where gas escapes simultaneously with the cough. If a kidney cough persists, the bladder becomes affected, resulting in a bladder cough. The manifestation of a bladder cough includes coughing with urinary incontinence.
If chronic cough persists, the Sanjiao (Triple Burner) becomes affected, resulting in a Sanjiao cough. The manifestation of a Sanjiao cough includes coughing with abdominal fullness and loss of appetite. These conditions all involve phlegm-fluid retention gathering in the stomach and relating to the lung, causing excessive nasal discharge and saliva, facial edema, and rebellious qi.
Although Qibo stated that all five zang and six fu organs can cause coughing, his emphasis lies entirely on the lung and stomach, particularly stressing the concept of "external and internal combined pathogens." The human body has external pathogens, internal pathogens, and combined external-internal pathogens. The statement that chronic cough of the five zang organs transfers to the six fu organs refers to the eruption of internal pathogens due to stagnation. If external pathogens invade and damage the lung's exterior correspondence, causing cough, there is originally no precedent for transmission among the zang-fu organs.
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: "Cough with rebellious qi, leaning forward to breathe, unable to lie flat, is primarily treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). After administering Xiao Qing Long Tang, if symptoms such as excessive salivation, dry mouth, deep pulse at the cun position, faint pulse at the chi position, cold extremities, qi rushing upward from the lower abdomen to the chest and throat, numbness of the hands and feet, facial flushing resembling intoxication, followed by heat flowing downward to the inner thighs, difficulty urinating, and occasional dizziness occur, Gui Ling Wu Wei Gan Cao Tang (Decoction of Atractylodes Macrocephala, Poria, Schisandra, and Licorice) should be given to treat the rebellious qi.
Once the rebellious qi subsides, but cough and chest fullness recur, Gui Ling Wu Wei Gan Cao Tang should be modified by removing Gui Zhi (Cinnamon Twig) and adding Gan Jiang (Dried Ginger) and Xi Xin (Asarum) to treat the cough and fullness. Once the cough and fullness cease, but thirst recurs and the rebellious qi reappears, this is because Xi Xin and Gan Jiang are hot herbs; ingestion should normally cause immediate thirst. If thirst instead ceases, it indicates Zhi Yin (Pendent Fluid), a type of fluid retention. Patients with Zhi Yin typically experience dizziness, and those who are dizzy often vomit. In cases of vomiting, Ban Xia (Pinellia Tuber) should be added to eliminate water retention. Once the water is eliminated and vomiting stops, if the patient presents with edema, Xing Ren (Apricot Seed) should be added as the principal herb. Although Ma Huang (Ephedra) should theoretically be added for this presentation, it is omitted because the patient already suffers from numbness. Forcing its use would lead to cold limbs, as Ma Huang disperses yang qi in patients with blood deficiency.
If the face appears flushed like intoxication, this indicates stomach heat rushing upward to flush the face; Da Huang (Rhubarb Root) should be added to drain it.
Commentary: The treatment of cough in the *Jingui Yaolue* is discussed under Phlegm-Fluid Retention because cough is invariably caused by phlegm-fluid. Among the five types of fluid retention, Zhi Yin (Pendent Fluid) in the epigastrium is the most fundamental root of cough. External pathogens combining with it cause cough; even without external pathogens, Zhi Yin infiltrating the lung is sufficient to cause persistent cough. Moreover, long-standing Zhi Yin in the epigastrium causes lower jiao qi to rush upward, easily creating combined upper-lower pathology. Therefore, unless Zhi Yin is removed, cough will never cease. The phrase "cough with rebellious qi, leaning forward to breathe, unable to lie flat, treated with Xiao Qing Long Tang" clearly identifies this as an external-internal combined pathogen pattern, for which Xiao Qing Long Tang is the specific remedy. However, using Xiao Qing Long Tang requires caution to prevent rebellious qi from rising further, which would worsen the cough.
In Shaoyin disease patterns, Xiao Qing Long Tang can be used if there are no Shaoyin signs. In miscellaneous diseases, one must fear that the patient's inherent Kidney Qi is deficient, allowing Fire of the Chong and Ren vessels to rebel upward. This fire, even without cough, increases irritability and coughing; thus, in chronic cough, disturbing the rebellious qi is contraindicated. The Chong and Ren vessels originate from the Bao Zhong (Uterus/Pelvic Cavity) alongside the Kidney collaterals. Kidney deficiency fails to secure the lower jiao, allowing these vessels to rebel from the lower abdomen. Even without prior phlegm-fluid, external pathogens trigger this fire to overwhelm the epigastrium, forcing fluids into phlegm-fluid, blocking the clear orifices, and causing inability to lie flat due to coughing and dyspnea. "Leaning forward to breathe" describes supporting the body while panting; internal Yin fire responding to external pathogens creates an urgent condition requiring Xiao Qing Long Tang. However, due to inherent Yuan Qi deficiency, even correct formulas lack swift efficacy, allowing residual pathogens to linger and cause variations.
Variations include: excessive salivation (fluid overflowing upward); dry mouth (yin fluid injury); deep cun/faint chi pulses and cold extremities (consumption of Wei Yang qi); qi rushing from lower abdomen to throat (rebellion of Yin fire); numbness (deficiency of Ying Blood); facial flushing (Yangming Stomach heat); heat flowing to inner thighs and dysuria (Yin fire flowing to Bladder); occasional dizziness (residual Taiyang pathogen). Despite variations, all stem from rebellious qi. Dizziness confirms Taiyang exterior syndrome; adhering to the principle that sweating resolves dizziness, the treatment revolves around modifying Xiao Qing Long Tang. First, Gui Ling Wu Wei Gan Cao Tang treats rebellious qi. Upon subsidence, if cough/fullness returns due to fluid in the diaphragm, remove Gui Zhi and add Gan Jiang/Xi Xin. Upon cessation, if thirst/rebellion returns due to hot herbs, and thirst ceases indicating Zhi Yin, add Ban Xia for vomiting. Fourth variation: edema indicates fluid in the exterior; add Xing Ren. Omit Ma Huang due to numbness/blood deficiency. Fifth variation: facial flushing indicates Stomach heat; add Da Huang. The first four variations follow standard modifications. The fifth, resembling Dai Yang (Floating Yang), is correctly identified as Stomach heat, justifying Da Huang. Unlike Yangming disease where red face prohibits purgation due to Kidney deficiency, here, despite superficial signs of deficiency, the pattern is clearly Stomach heat accumulation, warranting drainage without fear of yin damage. Zhang Zhongjing’s approach treats the root (Zhi Yin and rebellious qi) rather than the symptom (cough), demonstrating masterful flexibility.
"Cough with rebellious qi and a sound like a water fowl in the throat is treated with She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction)." "Cough with a floating pulse is treated with Nong Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction)." "Cough with a deep pulse is treated with Ze Qi Tang (Phytolacca Decoction)."
The "water fowl" sound indicates phlegm obstructing qi and qi stirring phlegm, a sign of Wind-Cold invading the lung. This formula combines releasing the exterior, directing qi downward, moistening dryness, and resolving phlegm. If the pulse is floating, external pathogens predominate; the strategy focuses on dispersing them. This is achieved by modifying Xiao Qing Long Tang: removing Gui Zhi (hot), Shao Yao (astringent), and Gan Cao (harmonizing/slowing), and adding Nong Po (Magnolia Bark) to direct qi downward, Shi Gao (Gypsum) to clear heat, and Xiao Mai (Wheat) to guide into the Stomach and assist ascending qi. If the pulse is deep, the pathogen is in the Ying (Nutritive) level (interior of the Lung). Heat stasis in Ying leads to blood coagulation, which traps phlegm-qi externally. Ze Qi (Phytolacca Root) breaks blood stasis as the chief herb, combined with agents to resolve phlegm, direct qi, clear heat, and harmonize Ying, emptying the obstruction without damaging Yuan Qi.
"Rebellious qi due to Fire, with unsmooth throat, is treated with Mai Men Dong Tang (Ophiopogon Decoction) to stop rebellion and direct qi downward." This pattern involves dried Stomach fluids and defluxion of Deficient Fire. Lung health depends on Stomach Qi (the Mother of Lung Metal). Modifying Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) by removing Zhu Ye and Shi Gao, and greatly increasing Mai Men Dong (Ophiopogon Tuber) as the chief herb, supplemented by Ren Shen, Gan Cao, and Jing Mi (Rice) to nourish the Lung Mother, ensures fluids ascend to moisten the Lung. Rebellious qi stems from unclear Stomach phlegm-qi flooding the Lung passages. Thus, Ban Xia (Pinellia) and Da Zao (Jujube) are used to clear fluids and phlegm first. Without removing turbid fluid, moistening herbs fail. Using Ban Xia due to its drying nature contradicts common practice but aligns with Zhang Zhongjing’s intent.
Dai Ren stated: The lung is the gateway for all coughs, frequently invaded by the Six Qi. Wind invading the lung causes day-and-night coughing, sweating, headache, and difficult expectoration. Heat invading causes rapid panting, coughing, facial flushing, and tidal fever; severe cases show central heat with cold extremities and diarrhea. Fire invading causes coughing, panting, hematemesis, and bleeding from seven orifices. Dryness invading causes qi stagnation, joint pain, head/face sweating, alternating chills/fever, dry/itchy skin, constipation, and sticky bloody sputum. Cold invading causes urgent coughing/panting, aversion to cold, anhidrosis, nasal congestion, body ache, fever, and irritability. Dampness invading causes difficult expectoration, facial edema, and rapid panting. Wet-phlegm coughing always involves accompanying Wind, Fire, Heat, or Cold. Exogenous coughs result from Six Evils郁 transforming into Fire; endogenous coughs result from Five Zang mutual overcoming. Treatment involves either "Astringing" (consolidating Lung Qi) or "Dispersing" (expelling Cold). Incorrect application harms the Lung. For post-dispersal deficiency with new Cold invasion, gentle release followed by gradual astringency prevents Lung weakness and pathogen stagnation.
Classics state all organs cause coughing, yet cough belongs to the Lung. Exogenous pathogens (Wind, Cold, Summer-Heat, Dampness) enter via skin/hair (Lung correspondence), affecting the Lung before reaching organs. Endogenous coughs arise from Seven Emotions stagnating the Five Zang, causing Fire to rebel upward to the Lung. Not all exogenous/endo-genous patterns cause cough; severity determines organ involvement. Exogenous cough is mild in Cold Damage; emotional cough appears later. Treatment examines pulse/syndrome/causes: Exogenous requires dispersal based on deficiency/excess/cold-heat; Endogenous requires regulating Qi first, then resolving phlegm.
Dai Fu’an noted: Wind-Cold cough features nasal congestion, heavy voice, aversion to cold. Fire cough features audible cough, scant sputum, red face. Labor-induced cough features night sweats. Phlegm-cough features alternating chills/fever. Lung distension features exertional panting/fullness. Phlegm-cough features sound upon coughing, stopping after expectoration.
Zhao Yangkui distinguished: "Ke" (Cough) is sound without phlegm (Lung scorched by Fire); "Sou" (Expectoration) is sound with phlegm (Spleen injured by Dampness). Though differing by organ, all center on the Lung. The Lung is delicate, fearing heat/cold. Treatment targets the Spleen (Mother) and Kidney (Child). Labor cough with blood may stem from Yuan Qi injury/Internal Fire, Kidney Water injury/Yin Fire, or overuse of cold herbs (Tian Dong, Di Huang) damaging Spleen/Stomach Qi production. Or misuse of Zhi Mu/Bai Pi damaging Yang/Qi production. All result in Spleen/Lung deficiency and Kidney Water insufficiency, causing Deficient Fire to harass True Organs. Treat with Yi Gong San plus Mai Men Dong/Wu Wei Zi to tonify Spleen/Lung; Liu Wei Di Huang Wan to nourish Kidney/Water. Otherwise, incurable. Deficient Yin/Fire excess with dry cough/thick sputum should not use Er Chen Tang, which damages Yin.
Zhang Jiebin stated: Treating exterior cough requires non-stagnant herbs; avoid cold/astringent herbs ("Lung desires pungency"). Treating interior cough requires non-moving herbs; avoid pungent/dry-hot herbs ("Pungency moves Qi; avoid pungency in Qi disorders"). Exterior treatment uses dispersal; if deficiency exists, tonify Middle Jiao and harmonize. Pure dispersal weakens Lung Qi and opens pores, inviting pathogens. Interior treatment uses stillness to nourish Yin; if Ming Men Fire declines, Ren Shen/Gan Jiang/Rou Gui/Fu Zi are essential to transform Qi into fluid. Fire requires clearing; Dampness requires draining; Phlegm requires descending; Qi requires regulating. Wind/Stomach Heat (Excess) is easy; Lung/Kidney Deficiency (True Organ) is difficult. Elderly/weak patients need warming/nourishing Spleen/Lung with slight symptomatic relief.
Shi Wen commented on Lao Feng (Labor Wind): Pathology lies below the Lung, causing stiff neck, blurred vision, thick sputum, aversion to wind/chills. Treatment relies on guiding Ju Yang (Taiyang) to rescue flexion/extension. Recovery takes 3 days (vigorous), 5 days (middle-aged), 7 days (weak). Expectoration of green/yellow pus-like sputum (size of a pellet) from mouth/nose is crucial; retention damages Lung and causes death. Labor expands Lung Qi, opening acupoints and sweating. Wind enters open points, stagnates when they close, generating phlegm-fluid in chest/back meridians. "Stiff neck" implies Wind striking upper body, preventing bending (unlike Kidney Wind). "Blurred vision" implies pathogen affecting orifices, fixing eyes. Thick sputum indicates fluid overflow. Chills indicate Lung constraint and Wood pathogen aggression. Wind-Cold seeks exit via Ju Yang. Since pathogen is below Lung near Stomach, it cannot be released via exterior or purged internally. It must borrow Bladder Yang to absorb Chest Qi, allowing expulsion upwards. Green/yellow pus indicates Wind combining with Liver/Gallbladder attacking Spleen/Stomach. Large pellets indicate long-standing phlegm blocking Lung orifices. Urgent treatment guides Ju Yang upward, clearing Lung Qi downward, expelling wind/phlegm. Vigorous patients improve in 3 days; others in 5-7 days. Frail elderly with declining Stomach Qi respond slowly. Gui Ling Wu Wei Gan Cao Tang plus Jiang Zhi (Ginger Juice) and Zhu Li (Bamboo Sap) is appropriate. Gui Zhi disperses Lung Wind and connects Bladder Yang; Fu Ling raises/lowers and clears turbid fluid; Wu Wei Zi constrains Gui Zhi to preserve fluids and guide Ju Yang; Gan Cao slows action in the epigastrium. For severe phlegm-rebellion, Gui Zhi Er Yue Bi Yi Tang or Xiao Qing Long Tang plus Shi Gao; for inherent deficiency, Zhi Gan Cao Tang. Xiong Zhi Wan is unsuitable.
Differentiation: Cough pausing after drinking water indicates Heat Cough; pausing after hot soup indicates Cold Cough. Heat Cough: Xiao Chai Hu Tang plus Jie Geng. Cold Cough: Li Zhong Tang plus Wu Wei Zi. Wind: nasal congestion/heavy voice. Cold: chilliness. Heat: irritability. Damp: lingering. Blood Stasis: chest stuffiness. Fluid Retention: palpitations. Pulse/sputum characteristics confirm excess/deficiency. Wind cough: floating pulse, aversion to wind, sweating, fever, nasal congestion, clear discharge, interrupting speech to cough. Treat with Gui Zhi Tang plus Dou Chi/Xi Xin. Differentiate from Fire cough (also clear discharge/interrupted speech) by noting Wind causes thick sputum immediately, while Fire causes sudden dry cough. Cold cough: tight pulse, aversion to cold, fever, anhidrosis, nasal congestion, worsening with cold, internal stagnant heat/phlegm. Hua Gai San for cough; Jiu Bao Tang for cough with panting. Xiong Su Yin for acute Wind-Cold with nasal congestion. Lung Wind-Cold cough...