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A patient suffering from *Lao Shang* (consumption/chronic debility) experiences a daily decline in Spleen Qi, which fails to generate Lung Metal. Whenever coughing occurs, tonifying the Middle Jiao Earth will cure all diseases. The appropriate prescription is Liu Jun Zi Tang (Six Gentlemen Decoction), with Gan Jiang (Dried Ginger) added at 1.5 qian, and Wu Wei Zi (Schisandra Fruit) and Xi Xin (Asarum) each at 0.8 fen, decocted in water for oral administration. Although Ren Shen (Ginseng Root) is included in the formula, it is not contraindicated for patients with chronic cough and Lung dryness. (2)

Another patient suffers from persistent chronic cough accompanied by occasional panting and shortness of breath. This indicates deficiency of both Lung and Kidney, a syndrome of failure of Heaven (Lung/Metal) and Water (Kidney/Water) to interact. The appropriate prescription is Fu Zi Li Zhong Tang (Aconite Decoction for Regulating the Middle), with Fu Ling (Poria) added at 4 qian, Xi Xin (Asarum) and Wu Wei Zi (Schisandra Fruit) each at 0.8 fen, and E Jiao (Donkey-hide Gelatin) and Tian Men Dong (Asparagus Root) each at 3 qian. (107)

Although cough is considered a Lung disease, its branch manifestation is in the Lung, while its root lies in the Kidney. The Kidney possesses both Water and Fire. If Kidney Water is deficient, it should be nourished; the appropriate prescription is Zhu Ling Tang (Polyporus Decoction). After taking four or five doses, one should then take Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), adding Ge Jie (Gecko), Mai Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Fruit). If Kidney Fire is deficient, it should be warmed; the appropriate prescription is Zhen Wu Tang (True Warrior Decoction), removing Sheng Jiang (Fresh Ginger), and adding Gan Jiang (Dried Ginger), Xi Xin (Asarum), and Wu Wei Zi (Schisandra Fruit). After four or five doses, one should then take Gui Fu Di Huang Wan (Cinnamon and Aconite Pill with Rehmannia). All these formulas primarily focus on promoting urination to drain dampness. Scholars who read Zhang Jingyue’s works would certainly argue that tonifying the Kidney should not involve draining water, citing the metaphor of a "leaking vessel" (*Lou Zhi*) from his book *Qiu Zheng Lu*. However, they fail to realize that cough inevitably involves the retention of fluid pathogens (*Yin Xie*). The branch is in the Lung, but the root is in the Kidney; just as Heaven connects to the earth via water rather than directly, once the water passages are cleared, the fluid retention in the Upper Jiao must descend downward. With both source and flow purified, the cough heals spontaneously. The Classic states: "The Upper Jiao is like mist," "the Middle Jiao is like maceration," and "the Lower Jiao is like a ditch." As long as the Qi transformation of the Three Jiao is normal and the water passages are open and regulated, clouds will move and rain will fall, presenting a new scene in the universe.

The Classic states: "The Lung dislikes cold." It also states: "Exposure to cold and consumption of cold drinks damage the Lung." Zhang Zhongjing did not use Ren Shen (Ginseng Root) for acute illnesses because Ren Shen has a slightly cold nature. However, this applies to new-onset diseases. For patients with chronic cough, the Lungs are necessarily dry, and frequent coughing draws upon various Fires to oppress Lung Metal; thus, Ren Shen remains an essential herb. If the pathology resides in the Metal Zang (Lung), Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lung Decoction) is appropriate. If the pathology resides in the Water Zang (Kidney), Qiong Yu Gao (Jade Paste) is appropriate.

Patients with Excess syndromes must not recklessly use formulas for Deficiency syndromes, lest the pathogenic factors remain and cause complications. Conversely, patients with Deficiency syndromes must absolutely not discard formulas for Excess syndromes, because cough invariably arises from underlying causes that may involve excess conditions.