【歌】咳嗽多因动湿痰，内因郁火外风寒。阴虚干嗽成劳瘵，肺胀须知疗最难。
【论】夫肺居至高之上，主持诸气，属金而畏火者也。清虚高洁，覆盖五脏，干金之象，外主皮毛，司腠
理开阖，
卫护一身，如天之覆物，体之至轻清者也。或外因六淫之邪相侵，内因七情之气相忤，则肺金受伤，而清纯之
气扰乱妄动，为火为痰，故咳嗽之病从此作矣。故咳嗽有风、寒、暑、湿之邪伤肺者，必显形证于外，此外因
也。有火郁于肺而嗽者，有声而无痰是也。有湿痰嗽者，痰出嗽止是也。有阴虚而嗽者，其气从下而上，多重
于夜分是也。有肺胀而嗽者，动则喘急息重是也。有劳嗽者，干咳声哑，痰中有红丝血点是也。有因嗽而成肺
痿、肺痈者，则云门、中府痛、吐咯脓血，臭秽不可近是也。因外感者，汗之、发之；火者，清之、降之；痰
者，豁之、导之；郁者开之；虚者补之；实者泻之；燥者润之。务令肺气平和，不使火邪乘克，而嗽自止矣。
大抵肺位最高，针石不能及，药饵不能到，惟桔梗能舟辑诸药入肺。药须临卧时细细咽下，则能入肺经也。
【脉】咳嗽所因，浮风紧寒，数热细湿，房劳涩难。右关濡者，饮食伤脾。左关弦短，疲极肝衰。浮短肺
伤，法当咳嗽。五脏之嗽，各视本部。浮紧虚寒，沉数实热。洪滑多痰，弦涩少血。形盛脉细，不足以息。沉
小伏匿，皆是死脉。惟有浮大，而嗽者生。外证内脉，参考秤停。
痰嗽
痰嗽者，嗽动有声有痰，痰出嗽止是也。不可一味苦寒折之，宜千缗汤、坠痰丸、利膈化痰丸之类。积痰
嗽者，非青黛、栝蒌不除。食积痰饮作嗽，半夏、南星、萝卜子、石 、栝蒌之类。痰因火动，逆上作嗽者，
先治火，黄柏、知母、山栀、芩、连之类，后用栝蒌、青黛、贝母、海石、天花粉之类治痰。若郁于肺经作嗽，
胸满涎多，二陈加枳壳、桔梗、栝蒌、黄芩、桑皮、杏仁、前胡、山栀、南星、贝母。
千缗汤（方见喘证条。）
坠痰丸（方见痰证条。）
利膈化痰丸（方见痰证条。）
二陈汤（方见痰证条。）
火嗽
夏月嗽，是火炎上最重，芩、连、山栀治之。上半日嗽，多是胃中有火，贝母、石膏泻胃火。午后嗽，
多是阴虚火盛，四物汤加知母、黄柏、麦门冬、五味子，或六味地黄丸，尤为要药。黄昏嗽，多是火浮于肺，
五味子、五倍子，敛而降之，不宜凉剂。五更嗽，多是胃中火邪并食饮流入于肺，以知母、地骨皮降肺火。火
郁于肺，有声无痰者，用苦梗开之，后以四物汤加山栀、黄芩、竹沥、姜汁。火嗽痰多者，二陈加贝母、栝蒌、
青黛、山栀、黄芩、桑皮，去半夏。
四物汤（方见血证条。）
六味地黄丸（方见虚损条。）
泻白散
治火郁于肺而嗽者。（方见火证条。）
贝母散
治火嗽、痰嗽多日不愈者。
贝母（去心，一钱） 桑白皮（一钱） 五味子（十粒） 甘草（五分） 知母（二分） 款冬花（一钱
五分） 杏仁（一钱，去皮尖。）
上锉，一剂，姜三片，水二盏，煎八分，温服。
外因
冬月嗽，是风寒外来，参苏饮加桑皮、杏仁，取汗后，用半夏等药逐痰，必不再发。寒邪伤肺而嗽者，
二陈汤加麻黄、杏仁、桔梗，或金沸草散。久嗽，风入肺，烟筒吸之。伤风热嗽者，消风百解散。寒热往来而
嗽者，小柴胡汤。
参苏饮（方见伤风。）
金沸草散
治肺经受风，头目昏疼，咳嗽声重，痰吐稠粘。
旋复花（上） 荆芥（中） 前胡（中） 白芍药（中） 甘草（下） 麻黄（下） 半夏（下）
上，姜水煎服。
胸中满闷，加枳壳、桔梗。有热，加黄芩、柴胡。头痛，加川芎。
消风百解散（方见伤风条。）
小柴胡汤（方见疟疾条。）
肺胀
肺胀嗽者，或左或右，不得眠，动则喘急息重，此痰挟瘀血。宜养血以流动乎气，降火疏肝以清其痰，
四物汤加桃仁、红花、诃子、青皮、竹沥、姜汁。肺胀不得卧者难治。
四物汤（方见血证条。）
肺痿（附肺虚、肺燥、劳嗽）
咳嗽有浊唾涎沫，或咳嗽，唾中有红丝脓血，或胸膺间有窍，口中所咳脓血与窍相应而出，名曰肺痿，
其寸脉数而虚涩者是也。治法在乎养血养肺，养气清金，以人参、黄 、当归补气血之剂，佐以退热、排脓等药。
肺虚者，人参款菀膏。发热自汗，肺气喘急，宁肺汤。
肺燥者，桔梗、大力子、知母、鸡子清润之。
劳嗽者，详本条内。
紫菀散（增）
治咳嗽，唾中有脓血，虚劳证，肺痿变痈。
人参（一钱） 紫菀（五分） 知母（一钱五分） 贝母（一钱五分） 桔梗（一钱） 甘草（五分） 五
味子（十粒） 茯苓（一钱） 阿胶（蛤粉炒成珠，五分）
上锉，一剂，水二盏，姜一片，煎八分，温服。
劫劳散（增）
治心肾俱虚，劳嗽二、三声，无痰，遇夜发热，热过即冷，时有盗汗，四肢倦怠，体劣黄瘦，饮食减少，
夜卧恍惚，神气不宁，睡多异梦。此药能治微嗽，唾中有红丝，名曰肺痿，若不治，便成羸劣之疾。
白芍药（钱半） 黄 （一钱） 甘草（一钱） 人参（一钱） 白茯苓（一钱） 熟地黄（一钱） 当
归（一钱半） 五味子（一钱） 阿胶（一钱） 半夏（汤泡，三分）
上锉，一剂，姜三片，枣二枚。水二盏，煎一盏，温服。
人参款菀膏（增）
治劳虚冷嗽。
款冬花（一两） 人参（一两） 北五味（一两） 紫菀（洗，去梗，一两） 桑白皮（一两）
上为末，炼蜜丸，如芡实大，每服细嚼，姜汤送下。
宁肺汤
治荣卫俱虚，发热自汗，喘急咳唾等证。
人参（一钱） 当归（一钱） 白术（八分） 熟地黄（一钱五分） 川芎（三分） 白芍药（一
钱） 甘草（炙，八分） 五味子（十粒） 麦门冬（一钱） 桑白皮（一钱） 白茯苓（八分） 阿胶
（蛤粉炒，一钱）
上锉，一剂，姜三片，水二盏，煎八分，温服。
肺痈
肺痈者，口中辟辟燥，咳即胸中隐隐痛，名曰肺痈，咳伤肺叶而成也。用太乙膏成丸，食后服，或桔梗汤
主之。肺痈已破，入风者不治。《脉诀举要》曰∶寸数而实，肺痈已成。寸数虚涩，肺痿之形。肺痈色白，脉
宜短涩，死者浮大，不白而赤。
桔梗汤
治肺痈咳嗽脓血，咽喉多渴，大、小便赤涩。
桔梗（五分） 贝母（去心，五分） 当归（酒浸，五分） 栝蒌仁（五分） 枳壳（炒，五分） 薏
苡仁（五分） 桑白皮（蜜炙，五分） 防己（五分） 黄 （四分） 甘草节（二分） 杏仁（去皮尖，
炒，二分） 百合（蒸，二分）
大便闭加大黄，小便赤加木通。
上锉，一剂，生姜三片，水二盏煎八分，温服。
一方
治肺痈吐脓。
桔梗（炒，一两） 甘草（炙，半两）
上每服一两，水一钟半，煎八分，空心服，吐尽脓为效，后用黄 散。
黄 散
用黄 蜜炙为末，每服一大匙，食后黄 汤下。
[Song] Cough is mostly caused by dampness stirring up phlegm, internally due to constrained fire and externally from wind-cold. Yin deficiency leading to dry cough evolves into consumptive disease (Lao Zhai), while lung distension indicates the most difficult treatment.
[Discussion] The Lung resides at the highest position, governing all Qi in the body. It belongs to Metal and fears Fire. Its nature is clear, empty, high, and pure, covering the five Zang organs, embodying the image of Metal. Externally, it governs the skin and hair, controls the opening and closing of the Cou Li (pores and interstices), and protects the whole body, much like Heaven covers all things; it is the lightest and purest organ in the body. If invaded by external Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire) or disturbed by internal Seven Emotions (Joy, Anger, Worry, Overthinking, Sorrow, Fear, Fright), the Lung Metal is injured, and its pure Qi becomes chaotic and erratic, transforming into Fire or Phlegm. Thus, the disease of Cough arises from this. Therefore, coughs caused by Wind, Cold, Summerheat, or Dampness injuring the Lung will necessarily manifest symptoms on the exterior; these are external causes. Coughs caused by Fire constrained in the Lung present with sound but no phlegm. Coughs caused by Damp-Phlegm stop when the phlegm is expectorated. Coughs caused by Yin deficiency involve Qi rising from below and are often worse at night. Coughs caused by Lung Distension feature rapid panting and heavy breathing upon movement. Consumptive coughs (Lao Sou) present as dry cough with hoarse voice and red threads or blood spots in the sputum. Coughs that evolve into Lung Atrophy (Fei Wei) or Lung Abscess (Fei Yong) present with pain at Yunmen and Zhongfu acupoints, expectoration of pus and blood, and a foul odor that is unbearable. For those caused by external contraction, use sweating methods; for Fire, use clearing and descending methods; for Phlegm, use resolving and guiding methods; for Constraint, use opening methods; for Deficiency, use tonifying methods; for Excess, using draining methods; for Dryness, use moistening methods. Ensure the Lung Qi remains harmonious and prevent Fire Evil from overcoming it, so the cough stops naturally. Generally, because the Lung is located at the highest position, acupuncture and herbal medicine have difficulty reaching it directly; only Jie Geng (Platycodon Root) acts as a boat to carry other herbs into the Lung. Medicines should be swallowed slowly just before bedtime to enter the Lung Meridian effectively.
[Pulse Diagnosis] Regarding the causes of cough: Floating pulse indicates Wind, Tight pulse indicates Cold, Rapid pulse indicates Heat, Fine pulse indicates Dampness, and sexual exhaustion leads to a Choppy and difficult pulse. A Soft pulse at the Right Guan position indicates dietary injury to the Spleen. A Wiry and Short pulse at the Left Guan position indicates extreme fatigue and Liver decline. A Floating and Short pulse indicates Lung injury, which legally corresponds to cough. Coughs of the five Zang organs should be viewed according to their respective organ positions. Floating and Tight pulses indicate Deficient Cold; Deep and Rapid pulses indicate Excess Heat. Surging and Slippery pulses indicate much Phlegm; Wiry and Choppy pulses indicate little Blood. A robust physique with a fine pulse indicates insufficient Qi to sustain respiration. Deep, small, and hidden pulses are all death omens. Only a Floating and Large pulse with cough indicates survival. External symptoms and internal pulses must be referenced and weighed against each other.
Phlegm-Cough
Phlegm-cough involves sound and phlegm during coughing, stopping when phlegm is expelled. Do not blindly use bitter-cold herbs to suppress it; instead, use formulas such as Qian Min Tang, Zhui Tan Wan, or Li Ge Hua Tan Wan. Coughs due to accumulated phlegm cannot be eliminated without Qing Dai (Indigo Naturalis) and Gua Lou (Trichosanthes Fruit). Coughs caused by food accumulation and fluid retention can be treated with Ban Xia (Pinellia Rhizome), Nan Xing (Arisaema Rhizome), Luo Bo Zi (Radish Seed), Shi [Leng Shi/Meng Shi], and Gua Lou. When Phlegm moves due to Fire and rebels upward causing cough, treat the Fire first with Huang Bai (Phellodendron Bark), Zhi Mu (Anemarrhena Rhizome), Shan Zhi (Gardenia Fruit), Huang Qin (Scutellaria Root), and Lian Qiao (Forsythia Fruit); subsequently treat the Phlegm with Gua Lou, Qing Dai, Bei Mu (Fritillaria Bulb), Hai Shi (Floating Stone), and Tian Hua Fen (Trichosanthes Root). If constrained in the Lung Meridian causing cough with chest fullness and excessive saliva, modify Er Chen Tang with Zhi Ke (Aurantium Fructus), Jie Geng, Gua Lou, Huang Qin, Sang Bai Pi (Mulberry Root Bark), Xing Ren (Apricot Seed), Qian Hu (Peucedanum Root), Shan Zhi, Nan Xing, and Bei Mu.
Qian Min Tang (See Asthma section.)
Zhui Tan Wan (See Phlegm section.)
Li Ge Hua Tan Wan (See Phlegm section.)
Er Chen Tang (See Phlegm section.)
Fire-Cough
Cough in summer is due to the heaviest upward flaming of Fire, treated with Huang Qin, Lian Qiao, and Shan Zhi. Cough in the first half of the day is mostly due to Fire in the Stomach, treated with Bei Mu and Shi Gao (Gypsum). Cough in the afternoon is mostly due to Yin Deficiency with Hyperactive Fire, treated with Si Wu Tang (Four Substances Decoction) plus Zhi Mu, Huang Bai, Mai Men Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Berry), or Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), which are particularly important. Cough at dusk is mostly due to Fire floating in the Lung, treated with Wu Wei Zi and Wu Bei Zi (Galla Chinensis) to astringe and descend; cool agents are inappropriate. Cough at dawn (Wu Geng) is mostly due to Stomach Fire Evil mixed with food and drink flowing into the Lung, treated with Zhi Mu and Di Gu Pi (Lycium Bark) to descend Lung Fire. Fire constrained in the Lung with sound but no phlegm is treated with Ku Jie Geng (Platycodon Root) to open it, followed by Si Wu Tang plus Shan Zhi, Huang Qin, Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice). Fire-cough with much phlegm uses Er Chen Tang plus Bei Mu, Gua Lou, Qing Dai, Shan Zhi, Huang Qin, and Sang Bai Pi, removing Ban Xia.
Si Wu Tang (See Blood section.)
Liu Wei Di Huang Wan (See Consumption section.)
Xie Bai San
Treats Fire constrained in the Lung causing cough. (See Fire section.)
Bei Mu San
Treats persistent Fire-cough or Phlegm-cough lasting many days.
Bei Mu (Heart removed, 1 qian) Sang Bai Pi (1 qian) Wu Wei Zi (10 berries) Gan Cao (0.5 qian) Zhi Mu (0.2 qian) Kuan Dong Hua (1.5 qian) Xing Ren (1 qian, skin and tip removed.)
Chop these ingredients. One dose, add three slices of ginger, two cups of water, decoct to eight-tenths, take warm.
External Causes
Cough in winter is due to external Wind-Cold, treated with Shen Su Yin (Ginseng and Perilla Decoction) plus Sang Bai Pi and Xing Ren. After inducing sweat, use Ban Xia etc. to expel phlegm, ensuring no recurrence. Cough caused by Cold Evil injuring the Lung uses Er Chen Tang plus Ma Huang (Ephedra Herb), Xing Ren, and Jie Geng, or Jin Fei Cao San (Boilweed Powder). Chronic cough with Wind entering the Lung is likened to smoke inhalation through a pipe. Wind-Heat cold cough uses Xiao Feng Bai Jie San. Cough with alternating chills and fever uses Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Shen Su Yin (See Wind Injury section.)
Jin Fei Cao San
Treats Lung Meridian affected by Wind, with dizziness, headache, heavy cough, and thick sticky sputum.
Xuan Fu Hua (Superior grade) Jing Jie (Medium grade) Qian Hu (Medium grade) Bai Shao Yao (Medium grade) Gan Cao (Inferior grade) Ma Huang (Inferior grade) Ban Xia (Inferior grade)
Decoct with ginger water.
For chest fullness, add Zhi Ke and Jie Geng. For heat, add Huang Qin and Chai Hu (Bupleurum Root). For headache, add Chuan Xiong (Szechwan Lovage Rhizome).
Xiao Feng Bai Jie San (See Wind Injury section.)
Xiao Chai Hu Tang (See Malaria section.)
Lung Distension
Lung distension cough, occurring on either left or right side, preventing sleep, with rapid panting and heavy breathing upon movement, is Phlegm combined with Blood Stasis. Nourish Blood to move Qi, descend Fire and soothe the Liver to clear Phlegm. Use Si Wu Tang plus Tao Ren (Peach Kernel), Hong Hua (Carthamus Flower), He Zi (Chebula Fruit), Qing Pi (Aged Tangerine Peel), Zhu Li, and Jiang Zhi. Lung distension preventing lying down is difficult to treat.
Si Wu Tang (See Blood section.)
Lung Atrophy (Attached: Lung Deficiency, Lung Dryness, Consumptive Cough)
Cough with turbid saliva and foam, or coughing with red threads and pus-blood in sputum, or cavities between the chest and hypochondrium where expelled pus-blood corresponds to the cavity, is named Lung Atrophy (Fei Wei). The Cun pulse is Rapid, Empty, and Choppy. Treatment lies in nourishing Blood and Lung, nourishing Qi and clearing Metal. Use Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), and Dang Gui (Angelica Sinensis) to tonify Qi and Blood, assisted by herbs that reduce fever and drain pus.
For Lung Deficiency, use Ren Shen Kuan Wan Gao (Ginseng and Kuan Dong Honey Paste). For fever, spontaneous sweating, and Lung Qi panting, use Ning Fei Tang.
For Lung Dryness, use Jie Geng, Da Li Zi (Arctium Seed), Zhi Mu, and Ji Zi Qing (Egg White) to moisten.
For Consumptive Cough, see the main section.
Zi Wan San (Added)
Treats cough with pus-blood in sputum, consumptive disease, and Lung Atrophy transforming into abscess.
Ren Shen (1 qian) Zi Wan (0.5 qian) Zhi Mu (1.5 qian) Bei Mu (1.5 qian) Jie Geng (1 qian) Gan Cao (0.5 qian) Wu Wei Zi (10 berries) Fu Ling (1 qian) E Jiao (Stir-fried with蛤粉/Cocci Meliae to pearl shape, 0.5 qian)
Chop these ingredients. One dose, add two cups of water and one slice of ginger, decoct to eight-tenths, take warm.
Jie Lao San (Added)
Treats Heart and Kidney dual deficiency, consuming cough of two or three sounds, no phlegm, night fever followed by cold, occasional night sweats, limb fatigue, emaciated yellow thin body, reduced appetite, vague sleep at night, restless spirit, and vivid dreams. This medicine treats slight cough with red threads in sputum, named Lung Atrophy. If untreated, it becomes a debilitating disease.
Bai Shao Yao (1.5 qian) Huang Qi (1 qian) Gan Cao (1 qian) Ren Shen (1 qian) Bai Fu Ling (1 qian) Shu Di Huang (1 qian) Dang Gui (1.5 qian) Wu Wei Zi (1 qian) E Jiao (1 qian) Ban Xia (Soaked in boiling water, 0.3 qian)
Chop these ingredients. One dose, add three slices of ginger and two dates. Add two cups of water, decoct to one cup, take warm.
Ren Shen Kuan Wan Gao (Added)
Treats consumptive deficiency cold cough.
Kuan Dong Hua (1 liang) Ren Shen (1 liang) Bei Wu Wei (1 liang) Zi Wan (Washed, stem removed, 1 liang) Sang Bai Pi (1 liang)
Grind into powder, refine honey into pills the size of芡实/Euryale Seed. Chew thoroughly per dose, swallow with Ginger Water.
Ning Fei Tang
Treats Ying and Wei dual deficiency, fever, spontaneous sweating, panting, and coughing with sputum.
Ren Shen (1 qian) Dang Gui (1 qian) Bai Zhu (0.8 qian) Shu Di Huang (1.5 qian) Chuan Xiong (0.3 qian) Bai Shao Yao (1 qian) Gan Cao (Roasted, 0.8 qian) Wu Wei Zi (10 berries) Mai Men Dong (1 qian) Sang Bai Pi (1 qian) Bai Fu Ling (0.8 qian) E Jiao (Stir-fried with 蛤粉, 1 qian)
Chop these ingredients. One dose, add three slices of ginger and two cups of water, decoct to eight-tenths, take warm.
Lung Abscess
Lung Abscess presents with dry mouth, and hidden pain in the chest upon coughing, named Lung Abscess, caused by cough damaging the Lung lobes. Use Tai Yi Gao made into pills, taken after meals, or primarily use Jie Geng Tang. If Lung Abscess has ruptured and Wind enters, it is untreatable. *Mai Jue Ju Yao* states: Cun pulse Rapid and Excess indicates Lung Abscess is formed. Cun pulse Rapid, Empty, and Choppy indicates the form of Lung Atrophy. Lung Abscess with white complexion should have a Short and Choppy pulse; if Floating and Large, death occurs. If not white but Red, death occurs.
Jie Geng Tang
Treats Lung Abscess cough with pus-blood, excessive throat thirst, and red/bitter urination/defecation.
Jie Geng (0.5 qian) Bei Mu (Heart removed, 0.5 qian) Dang Gui (Soaked in wine, 0.5 qian) Gua Lou Ren (0.5 qian) Zhi Ke (Stir-fried, 0.5 qian) Yi Yi Ren (Coix Seed, 0.5 qian) Sang Bai Pi (Honey-roasted, 0.5 qian) Fang Ji (0.5 qian) Huang Qi (0.4 qian) Gan Cao Jie (0.2 qian) Xing Ren (Skin and tip removed, stir-fried, 0.2 qian) Bai He (Steamed, 0.2 qian)
For constipation, add Da Huang (Rhubarb Root). For red urine, add Mu Tong (Akebia Stem).
Chop these ingredients. One dose, add three slices of fresh ginger and two cups of water, decoct to eight-tenths, take warm.
Another Formula
Treats Lung Abscess vomiting pus.
Jie Geng (Stir-fried, 1 liang) Gan Cao (Roasted, 0.5 liang)
Take one liang per dose, add one and a half zhong of water, decoct to eight-tenths, take on an empty stomach. Vomiting out all pus indicates efficacy, followed by Huang Qi San.
Huang Qi San
Use Huang Qi (Astragalus Root) roasted with honey, ground into powder. Take one large spoon per dose, swallow with Huang Qi Decoction after meals.