Library

In the examination of the Six Qi (Six Excesses), dampness corresponds to the seasonal timing of autumn. Thus, the classics state "injury by dampness in autumn." The qi of damp earth internally corresponds to the Spleen. When Spleen Earth is affected by dampness, it fails to govern transportation and transformation, leading to internal dampness brewing into phlegm-fluids (Tan-Yin). These ascend to invade the Lungs, thereby forming a cough disease. The pathogenic factors of the Six Qi can all cause coughing; it is not limited solely to dampness. This discussion on dampness specifically addresses latent-qi cough (cough caused by pathogens lying dormant within the body until triggered later). Mr. Yu Jiayan from Xichang suspected that the character "dampness" was an error and changed it to "injury by dryness in autumn," expounding upon the theory of autumn dryness. Although this bears the fault of contradicting the classics, it arose from considerations regarding the changes of the Six Qi. Generally speaking, the *Neijing* discusses dampness, likely referring to the times when damp-earth governs the qi, such as Start of Autumn (Liqiu), End of Heat (Chushu), and White Dew (Bailu); whereas Mr. Yu's discussion on dryness likely refers to the periods when dry-metal governs the qi, such as Autumn Equinox (Qiufen), Cold Dew (Hanlu), and Frost Descent (Shuangjiang). In my humble opinion, there are even clearer boundaries: I propose that if one is injured by dampness in early autumn and does not manifest immediately, the dampness brews into phlegm internally, which invades the Lungs causing cough, named Phlegm-Cough (Tan Sou). Treatment should primarily regulate the Spleen, with promoting diuresis to drain dampness as an adjunct. If one is injured by dryness in late autumn and does not manifest immediately, the dryness internally invades the Lungs, causing the Lungs to lose their clear descending function and resulting in cough, named Dry Cough (Gan Ke). Treatment should primarily regulate the Lungs, with moistening dryness as an adjunct. In summary, these do not exceed the treatment principles of the Two Taiyin (Hand-Taiyin Lung Meridian and Foot-Taiyin Spleen Meridian). The coughs mentioned here, caused by injury to dampness or dryness, all arise from latent qi of autumn manifesting in winter. Those that manifest immediately still belong to the categories of injury by dampness or autumn dryness for treatment.

Phlegm-cough is coughing induced by phlegm. Diseases causing cough can be brought about by Wind, Cold, Summerheat, and Heat. Ancient scholars' discussions were numerous and varied; only Mr. Li Yunjian and Mr. Zhang Ruoye summarized them into Internal Injury (Nei Shang) and External Contraction (Wai Gan). Observing their theoretical framework, it was outstanding and unique, yet it had no relevance to the cough described in the *Neijing* as "injury by dampness in autumn." Presuming my own ignorance, I specially supplement this. This illness is indeed caused by being first injured by dampness after Start of Autumn but before Autumn Equinox. Dampness resides internally in the Spleen, brewing over time into phlegm. The phlegm invades the Lungs, causing stagnation in the Qi level, rendering the governance and regulation (Zhi Jie) powerless. One must wait until winter arrives, when slight cold is contracted. Initially, the cold lodges in the skin and hair, gradually entering the Lungs. Lung Qi rebels upward, causing the latent damp-phlegm to rebel along with the Qi, thus forming the disease of Phlegm-Cough. The pulse will necessarily appear wiry and slippery, or slightly tight. The Right Cun and Guan positions will be more discordant than other parts. The tongue coating will be white and moist, the chest feel uncomfortable, the phlegm white and thin, and there is no thirst. These are all manifestations of latent autumn-dampness qi. Treatment should primarily focus on the Spleen, with draining dampness and resolving phlegm as an adjunct. It is appropriate to treat with Modified Er Chen Decoction (Jia Wei Er Chen Tang). If there are aversion to cold and fever, add Perilla Stem (Sugeng) and Peucedani Radix (Qianhu); if there is panting, add Inula Flower (Xuanfu) and Pericarpium Sojae Preparatum (Suzi). Dosages should be increased or decreased according to the specific syndrome.
One might ask: Cough diseases occur in all four seasons. Now, looking at this chapter, it focuses exclusively on onset in winter. Why are coughs in other seasons not discussed? The answer is: Have you not seen the statement in this treatise that Wind, Cold, Summerheat, and Heat can all cause cough? Cough diseases exist in all four seasons. One asks: Why not discuss them separately? The reply is: In the preceding sections on Wind-Warmth, Wind-Heat, Wind-Cold, Wind-Encounter, Summerheat-Cough, and Autumn-Dryness, as well as in the subsequent section on Winter-Warmth, cough syndromes have already been addressed. To repeat them would surely cause boredom. This discussion specifically addresses cough caused by latent qi brewing phlegm; those caused by Wind, Cold, Summerheat, and Heat need not be repeated.