咳谓有声，肺气伤而不清；嗽谓有痰，脾湿动而生痰。咳嗽者，因伤肺气而动脾湿也。病本虽分六气五
脏之殊，而其要皆主于肺。盖肺主气而声出也。治法
须分新久虚实。新病风寒则散之，火热则清之，湿热则泻之；久病便属虚属郁，气虚则补气，血虚则补
血，兼郁则开郁。滋之、润之、敛之，则治虚之法也。
主方
杏仁（去皮尖） 白茯苓（各一钱） 橘红（七分） 五味子 桔梗 甘草（炙，各五分）
春多上升之气，宜润肺抑肝，加川芎、芍药、半夏各一钱，麦门冬、黄芩（炒）、知母各五分。
春若伤风，咳嗽鼻流清涕，宜辛凉解散，加防风、薄荷、黄芩（炒）、麦门冬各一钱。
愚按前症若因风寒所伤，咳嗽声重，头痛，用金沸草散；咳嗽声重，身热，头痛，用局方消风散。盖
肺主皮毛，肺气虚则腠理不密，风邪易入，治法当解表兼实肺气；肺有火则腠理不闭，风邪外乘，治宜解
表兼清肺火。邪退即止，若数行解散，则重亡津液，邪蕴而为肺疽、肺痿矣。故凡肺受邪不能输化，而小
便短少，皮肤渐肿，咳嗽日增者，宜用六君子汤以补脾肺，六味丸以滋肾水。
一儒者，素勤苦，恶风寒，鼻流清涕，寒栗，嚏喷，服祛风之药，肢体麻木，倦怠，痰涎自出，殊类
中风。余以为风剂耗散元气，阴火乘其土位也。遂以补中益气汤加麦门、五味治之而安。
一儒者，每至春咳嗽，用参苏饮之类乃愈。后复
发，仍用前药，反喉喑，左尺洪数而无力。余以为肾经阴火刑克肺金，以六味丸料加麦门、五味、炒山栀
及补中益气汤而愈。
夏多火热炎上，最重，宜清金降火，加桑白皮、知母、黄芩（炒）、麦门冬、石膏各一钱。
愚按王太仆云∶壮水之主，以制阳光。前症若喘急而嗽，面赤潮热，其脉洪大者，用黄连解毒汤；热
躁而咳，用栀子仁汤；咳唾有血，用麦门冬汤。俱兼以六味丸，夏月尤当用此，壮肾水以保肺金。
嘉兴周上舍，每至夏患咳嗽，服降火化痰之剂，咳嗽益甚，脾肺肾脉皆浮而洪，按之微细。余曰∶此
脾土虚不能生肺金，肺金不能生肾水，而虚火上炎也。朝用补中益气汤，夕用六味地黄丸而痊。后至
夏，遂不再发。
一男子，夏月唾痰或嗽，用清胃火药，不应。余以为火乘肺金，用麦门冬汤而愈。后因劳复嗽，用补
中益气汤加桔梗、山栀、片芩、麦门、五味而愈。但口干，体倦，小便赤涩，日用生脉散而痊。
秋多湿热伤肺，宜清热泻湿，加苍术、桑白皮各一钱，防风、黄芩、山栀（炒）各五分。
愚按前症若咳而身热，自汗，口干，便赤，脉虚而洪者，用白虎汤；身热而烦，气高而短，心下痞
满，四肢困倦，精神短少者，香薷饮；若病邪既去，
宜用补中益气加干山药、五味子以养元气，柴胡、升麻各二分以升生气。
冬多风寒外感，宜解表行痰，加麻黄、桂枝、半夏、干姜、防风各一钱。肺金素有热者，再加酒炒黄芩、
知母各五分。若发热，头痛，鼻塞声重，再加 本、川芎、前胡、柴胡各一钱。
愚按果系前症，若风寒外感，形气病气俱实者，宜用麻黄之类，所谓从表而入自表而出；若形气病
气俱虚者，宜补其元气，而佐以解表之药，若专于解表，则肺气益虚，腠理益疏，外邪乘虚易入，而其病
愈难治矣。若病日久，或误服表散之剂，以致元气虚而邪气实者，急宜补脾土为主，则肺金有所养而诸病
自愈。若人老弱，或劳伤元气，而患前症，误用麻黄、枳壳、紫苏之类，而汗出亡阳者，多患肺痈、肺
痿，治失其宜，多致不起。
一男子，神劳，冬月患咳嗽，服解散之剂，自以为便。余曰∶此因肺气虚弱，腠理不密，而外邪所感
也。当急补其母，是治本也。始服六君子汤，内去参、术，反加紫苏、枳壳之类，以致元气益虚，生肺
痈而殁。
太守钱东圩，先患肩疽，属足三阴虚，火不归源，用壮水之主以制阳光而愈。余曰∶疮疾虽愈，当
屏去侍女，恐相火一动，其精暗流，金水复竭，必致
变症。后果喘嗽，痰出如涌，面目赤色，小便淋涩，又误认为外感风寒，用麻黄汤表散，汗出不止。迎余
视之，其脉已脱，惟太冲未绝。余曰∶此脾虚不能摄涎，肾虚不能生水，肺虚不能摄气，水泛为痰，虚寒
之症也。辞为难治，勉以益火之源以消阴翳而愈。继又劳伤神思，外邪乘之，仍汗出亡阳，以致不起。
若有痰，加半夏、枳壳；风痰，再加南星（姜汁炒）；湿痰脾困少食，加白术、苍术；有痰而口燥
咽干，勿用半夏、南星，宜加知母（蜜水拌炒）、贝母、栝蒌仁、黄芩（炒）。
愚按前症若因脾气虚而为湿痰者，宜用补中益气汤；若因肾经虚热而口燥咽干者，宜用六味丸。
若夏月热痰，或素热有痰，加黄芩、黄连、知母、石膏。
愚按前症若心火乘肺，轻则用麦门冬汤，重则用人参平肺散；若上焦实热用凉膈散，虚热用六君子
汤；中焦实热用竹叶石膏汤，虚热用竹叶黄 汤；下焦虚热用六味丸。
一武职，因饮食起居失宜，咳嗽吐痰，用化痰止嗽之药。时仲夏，左尺洪数而无力，胸满，面赤，唾
痰腥臭，自汗。余曰∶肾虚水泛为痰，而反重亡津液，得非肺痈乎？不信，仍服前药。翌日吐脓，脉数，
右寸为甚。用桔梗汤一剂，数脉与脓顷减，又二剂，
将愈，佐以六味丸而痊。
上半日咳者，胃中有火，加贝母、石膏、黄连；五更咳者，同上。
愚按前症若胃中热甚为患者，宜用本方泄之；若胃中微热为患者，当用竹叶石膏汤清之；若胃中虚热
所致者，须用补中益气汤补之；俱少佐以治痰之剂。其五更咳嗽者，当作脾虚宿食为痰治之。
一儒者，咳嗽，用二陈、芩、连、枳壳，胸满气喘，侵晨吐痰，加苏子、杏仁，口出痰涎，口干作
渴。余曰∶清晨吐痰，脾虚不能消化饮食也；胸满气喘，脾虚不能生肺金也；涎沫自出，脾虚不能收摄
也；口干作渴，脾虚不能生津液也。用六君子加炮姜、肉果温补脾胃，更用八味丸以补土母而安。
若咳嗽久肺虚，滋气补血，加人参、黄 、阿胶、当归、生姜、天门冬、款冬花、马兜铃、芍药（酒
炒）之类；肺热喘咳，去人参，用沙参，此兼补血气也。
愚按肺属金，生于脾土。凡肺金受邪，由脾土虚弱，不能生肺，乃所生受病。治者审之！
黄昏咳者，火浮于肺，不可正用寒凉药，宜加五味子、五倍子、诃子皮敛而降之。
愚按前症属脾肺气虚，以致肾经阳虚阴弱，而虚火上炎，或房劳太过，亏损真阴为患。法当补脾肺、
生肾水，不可专主于肺也。
若午后嗽者，属阴虚，即劳嗽也。宜补阴降火，加川芎、当归、芍药、熟地、黄柏、知母、竹沥、
姜汁、天门冬、栝蒌仁、贝母，此专补阴血也。
愚按前症属肾气亏损，火炎水涸，或津液涌而为痰者，乃真脏为患也，须用六味地黄丸壮肾水滋化。
源为主，以补中益气汤养脾土生肺肾为佐。设用清气化痰，则误矣。
司厅陈国华，素阴虚，患咳嗽，自谓知医，用发表化痰之剂，不应，用清热化痰等药，愈甚。余以为
脾肺虚。不信，用牛黄清心丸，反加胸腹作胀，饮食少思。遂朝用六君、桔梗、升麻、麦门、五味补脾土以
生肺金，夕用八味丸补命门火以生脾土，诸症渐愈。
中翰鲍羲伏，患阴虚咳嗽，服清气化痰丸及二陈、芩、连之类，痰益甚，用四物、黄柏、知母之
类，腹胀音哑，右关脉浮弦，左尺洪大。余朝用补中益气汤加山茱、麦门、五味，夕用六味地黄丸加五
味子，三月余，喜其慎疾得愈。
若火郁嗽，为痰郁火邪在中，宜开郁消痰，用诃子皮、香附（童便浸）、栝蒌仁、半夏曲、海石、青黛、
黄芩，为末，蜜调为丸，噙化，仍服前补阴降火药。失治则成劳。
愚按前症若因肺胃蕴热，痰气不利，宜用前药；若因脾肺不清，气郁痰滞，用二陈加山栀、枳壳、桔
梗；若因郁结伤脾，气血虚损，用济生归脾加山栀、桔梗；若因怒动肝火，脾土受克，用四君子加山栀、
柴胡；若劳役失宜，伤损元气，用补中益气加山栀、桔梗。
一妇人不得于姑，患咳，胸膈不利，饮食无味。此脾肺俱伤，痰郁于中。先用归脾汤加山栀、抚芎、
贝母、桔梗，诸症渐愈。
一妇人，咳嗽，胁痛，发热，日晡益甚，用加味逍遥散加熟地治之而愈。后因劳役多怒，前症仍作，
又少阳寒热往来，或咳嗽，遗尿，皆属肝虚火旺，阴挺，痿痹，用前散及地黄丸而痊。
若痰积、食积作咳嗽者，用香附、栝蒌仁、贝母、海石、青黛、半夏曲、软石膏、山楂、枳实、
黄连（姜炒），为末，蜜调噙化。
愚按前症若因饮食停滞胃口湿热所化者，宜用本方；若因脾胃气虚而痰积滞，用六君子加枳壳、木
香；若因脾胃气虚而食积滞，用六君子加神曲、麦芽。夫早间吐痰咳嗽，属食积；喘促咳嗽，属肺气虚
火旺。大抵当助胃壮气为主，不可专攻其痰。
若劳嗽见血，加阿胶、当归、芍药、天门冬、知母、贝母、桑白皮，亦于前肺虚、阴虚二条择用。大抵咳
嗽见血，多是肺受热邪，气得热而变为火，火盛而阴血不宁，从火上升，故治宜泻火滋阴，忌用人参等甘
温之药。然亦有气虚而咳血者，则宜用人参、黄 、款冬花等药，但此等症不多耳！
愚按前症亦有劳伤元气，内火妄动而伤肺者；亦有劳伤肾水，阴火上炎而伤肺者；有因过服天门、生
地寒药，损伤脾胃，不能生肺气而不愈者；有因误用黄柏、知母之类，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。须用补中益气汤补脾土而生肺金，用六味地
黄丸滋肾水而生阴精，否则不救。
一武职，素不慎起居，吐痰，自汗，咳嗽，发热。服二陈、芩、连、山栀之类，前症不减，饮食少
思；用四物、二陈、芩、连之类，前症愈甚，反添胸膈不利，食少，晡热；加桑皮、杏仁、紫苏之类，胸
膈膨胀，小便短少，用四苓、枳壳之类，小便不通，饮食不进。余视之，六脉洪数，肺肾二部尤甚。余
曰∶脾土既不能生肺金，而心火乘之，必变肺痈之症也。不信，仍服前药，后吐痰唾脓，复求治。余曰∶
胸膈痞满，脾土败也。已而果殁。
因咳而有痰者，咳为重，主治在肺；因痰而致咳者，痰为重，主治在脾。但是食积成痰，痰气上升，
以致咳嗽，只治其痰，消其积，而咳自止，不必用肺药以治咳也。
愚按前论治法最是。仍分六淫、七情及五脏相
胜、脾肺虚实以治之，否则恐成肺痈之症。
一男子，脾胃不和，服香燥行气之剂，饮食少思，两胁胀闷；服行气破血之药，致饮食不入，右胁
胀痛，喜手按之。余曰∶乃肝木克脾土，而脾土不能生肺金也，用滋化源之药，四剂诸症顿退。余又曰∶
火令在迩，当再补脾土以养肺金。不信，后复作吐脓而殁。
Cough (Ke) refers to the presence of sound, caused by damage to Lung Qi (Lung Energy) leading to turbidity; Sough (Sou) refers to the presence of phlegm, generated by Spleen Dampness (Spleen Moisture Pathology) stirring up fluid retention. The condition of Cough and Sough arises from damaging Lung Qi and disturbing Spleen Dampness. Although the root of the disease may differ among the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and the Five Zang Organs, the key lies in the Lung. This is because the Lung governs Qi and sound originates from it. Treatment methods must distinguish between new and chronic diseases, and deficiency and excess patterns. For new diseases caused by Wind-Cold, disperse them; for those caused by Fire-Heat, clear them; for those caused by Damp-Heat, drain them. Chronic diseases belong to deficiency or stagnation patterns: tonify Qi if Qi-deficient, tonify Blood if Blood-deficient, and resolve stagnation if accompanied by constraint. Nourishing, moistening, and astringing are methods for treating deficiency.
Main Formula: Xingren (Apricot Seed, peeled and tip removed), Baifuran (Poria cocos, each 1 qian), Juhong (Aged Tangerine Peel, 0.7 qian), Wuweizi (Schisandra Berry), Jiegeng (Platycodon Root), Gancao (Licorice Root, honey-fried, each 0.5 qian).
In Spring, when ascending Qi is prevalent, moisten the Lung and suppress the Liver; add Chuanxiong (Ligusticum Rhizome), Shaoyao (Peony Root), Banxia (Pinellia Tuber), each 1 qian, and Maidong (Ophiopogon Tuber), Huangqin (Scutellaria Root, stir-fried), Zhimu (Anemarrhena Rhizome), each 0.5 qian.
If Wind injury occurs in Spring, with cough and clear nasal discharge, use acrid-cool dispersing methods; add Fangfeng (Saposhnikovia Root), Bohe (Mint Herb), Huangqin (Scutellaria Root, stir-fried), Maidong (Ophiopogon Tuber), each 1 qian.
My Commentary: If the aforementioned symptoms are due to Wind-Cold injury, with heavy coughing sound and headache, use Jinfeicao San (Golden Fern Grass Powder); if accompanied by fever and headache, use Ju Fang Xiaofeng San (Bureau Formula Wind-Dispersing Powder). Since the Lung governs the skin and hair, Lung Qi deficiency leads to loose interstices (Cou Li), making it easy for Wind Evil to enter; treatment should release the exterior while strengthening Lung Qi. Lung Heat leads to open interstices, allowing external Wind to invade; treatment should release the exterior while clearing Lung Heat. Stop medication once the pathogen recedes; repeated use of dispersing agents will severely deplete Body Fluids, causing pathogen accumulation leading to Lung Abscess (Fei Yong) or Lung Withering (Fei Wei). Therefore, for cases where the Lung is affected and cannot distribute fluids, resulting in scanty urine, gradual skin edema, and increasing cough, use Liu Junzi Tang (Six Gentlemen Decoction) to tonify Spleen and Lung, and Liuwei Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney Water.
A scholar, accustomed to hard work, suffered from aversion to wind and cold, clear nasal discharge, chills, sneezing. After taking wind-dispelling medicines, he experienced limb numbness, fatigue, and spontaneous salivation, resembling Stroke (Zhong Feng). I believed that wind-dispelling agents had consumed Yuan Qi (Original Qi), allowing Yin Fire to attack the Earth position (Spleen/Stomach). Thus, I treated him with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), resulting in recovery.
Another scholar suffered from cough every spring, recovering only after taking Renshen Su Yin (Ginseng and Perilla Drink) type formulas. Upon recurrence, using the same formula again resulted in hoarseness and a flooding, rapid, yet empty pulse at the left Chi position. I diagnosed this as Kidney channel Yin Fire punishing Metal (Lung). He was cured using Liuwei Wan ingredients added with Maidong, Wuweizi, stir-fried Shanzhi (Gardenia Fruit), and Buzhong Yiqi Tang.
Summer features abundant Fire-Heat rising upwards, which is critical to address. Clear Metal (Lung) and descend Fire; add Sangbaipi (Mulberry Root Bark), Zhimu, Huangqin (stir-fried), Maidong, Shigao (Gypsum Fibrosum), each 1 qian.
My Commentary: Wang Taipu stated: "Strengthen the master of Water to control the sunlight." For symptoms involving panting and cough, red face, tidal fever, and a flooding pulse, use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity); for heat and irritability with cough, use Zhiziren Tang (Gardenia Seed Decoction); for cough with blood in sputum, use Maidong Tang (Ophiopogon Decoction). All should be combined with Liuwei Wan. This is especially important in summer to strengthen Kidney Water to protect Lung Metal.
Zhou Shangshe from Jiaxing suffered from cough every summer. Taking fire-descending and phlegm-resolving agents worsened his cough. His Spleen, Lung, and Kidney pulses were floating and flooding, but fine upon deep pressure. I said: "This is Spleen Earth deficiency failing to generate Lung Metal, and Lung Metal failing to generate Kidney Water, leading to defunct Fire flaming upward." He took Buzhong Yiqi Tang in the morning and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) in the evening, achieving recovery. It did not recur the following summer.
A man suffered from expectoration or cough in summer. Taking Stomach-fire-clearing drugs was ineffective. I diagnosed Fire attacking Lung Metal and treated him with Maidong Tang, resulting in recovery. Later, cough recurred due to overwork; he was cured with Buzhong Yiqi Tang added with Jiegeng, Shanzhi, Pian Qin (Scutellaria Root), Maidong, and Wuweizi. However, he still had dry mouth, fatigue, and dark, difficult urination, which resolved with daily use of Shengmai San (Generate the Pulse Powder).
Autumn often features Damp-Heat injuring the Lung. Clear Heat and drain Dampness; add Cangzhu (Atractylodes Rhizome), Sangbaipi, each 1 qian, and Fangfeng, Huangqin, Chao Zhizi (Stir-fried Gardenia Fruit), each 0.5 qian.
My Commentary: For symptoms involving cough with fever, spontaneous sweating, dry mouth, dark urine, and a deficient yet flooding pulse, use Baihu Tang (White Tiger Decoction); for fever with irritability, shortness of breath, epigastric fullness, limb fatigue, and lack of spirit, use Xiangru Yin (Elsholtzia Decoction); if the pathogen has passed, use Buzhong Yiqi Tang added with Gan Shanyao (Dried Chinese Yam) and Wuweizi to nourish Original Qi, and Chaihu (Bupleurum Root), Shengma (Cimicifuga Rhizome), each 2 fen, to raise Sheng Qi (Generating Qi).
Winter often features external Wind-Cold invasion. Release the exterior and move phlegm; add Mahuang (Ephedra Herba), Guizhi (Cinnamon Twig), Banxia, Ganjiang (Dried Ginger), Fangfeng, each 1 qian. If Lung Metal has inherent heat, add Jiuhuangqin (Wine-stir-fried Scutellaria Root) and Zhimu, each 0.5 qian. If accompanied by fever, headache, nasal congestion, and heavy voice, add Gaoben (Ligusticum Wallichii Rhizome), Chuanxiong, Qianhu (Peucedani Radix), Chaihu, each 1 qian.
My Commentary: If these are indeed the aforementioned symptoms, and both physical constitution and pathogenic factor are excess, use Mahuang-type formulas, following the principle of "entering from the exterior, exiting via the exterior." If both constitution and pathology are deficient, tonify Original Qi and assist with exterior-releasing herbs. Solely focusing on releasing the exterior will further weaken Lung Qi, loosen interstices, and allow external pathogens to invade easily, making the disease harder to treat. If the disease has persisted for a long time, or due to mistaken use of dispersing agents leading to Qi deficiency and pathogen excess, urgently focus on tonifying Spleen Earth; then Lung Metal will be nourished and various diseases will heal spontaneously. In elderly or weak individuals, or those with Qi deficiency from overwork, mistaken use of Mahuang, Zhike (Aurantii Fructus), Zisu (Perilla Leaf) leading to sweating and Yang collapse often results in Lung Abscess or Lung Withering; improper treatment frequently leads to death.
A man suffering from mental exhaustion developed cough in winter. He took dispersing agents, believing it appropriate. I said: "This is due to Lung Qi deficiency and loose interstices, allowing external pathogens to invade." One must urgently tonify the Mother organ (Spleen), which is treating the root. Initially, he took Liu Junzi Tang, but人参 (Ren Shen) and Baizhu (Atractylodes Macrocephala Rhizome) were removed, and Zisu, Zhike were added instead, causing further Qi deficiency, leading to Lung Abscess and death.
Governor Qian Dongxu first suffered from shoulder abscess, attributed to deficiency of the three Foot channels, with Fire not returning to its source. He recovered using the method "strengthen the master of Water to control sunlight." I said: "Although the sore has healed, one must avoid sexual activity with concubines. If Ministerial Fire stirs, essence may secretly leak, causing Metal and Water to deplete again, inevitably leading to complications." Indeed, he later developed panting and cough, profuse phlegm, red face and eyes, and dysuria. Mistakenly diagnosed as external Wind-Cold, he took Mahuang Tang for exterior release, resulting in continuous sweating. Upon examination, his pulse had vanished except for the Taichong point. I said: "This is Spleen deficiency failing to control saliva, Kidney deficiency failing to generate water, and Lung deficiency failing to grasp Qi. Water floods forming phlegm; this is a deficiency-cold syndrome." I declined, stating it was difficult to treat, but managed to cure him using "benefit the source of Fire to eliminate Yin shadows." Subsequently, due to mental overwork and external pathogen invasion, he sweated excessively and collapsed Yang, leading to death.
If there is phlegm, add Banxia, Zhike; for Wind-phlegm, add Nanxing (Arisaema Cum Bile, stir-fried with ginger juice); for Damp-phlegm with Spleen distress and poor appetite, add Baizhu, Cangzhu; if there is phlegm with dry mouth and throat, do not use Banxia or Nanxing; instead, add Zhimu (stir-fried with honey water), Beimu (Fritillaria Bulb), Gualou Ren (Trichosanthes Seed), Huangqin (stir-fried).
My Commentary: If the aforementioned symptoms are due to Spleen Qi deficiency causing Damp-phlegm, use Buzhong Yiqi Tang; if due to Kidney channel deficiency heat causing dry mouth and throat, use Liuwei Wan.
For Summer Heat-phlegm, or inherent heat with phlegm, add Huangqin, Huanglian (Coptis Rhizome), Zhimu, Shigao.
My Commentary: If Heart Fire attacks the Lung, use Maidong Tang for mild cases, and Renshen Pingfei San (Ginseng Lung-Pacifying Powder) for severe cases; for Upper Jiao Excess Heat, use Liangge San (Cool the Diaphragm Powder), for Deficiency Heat, use Liu Junzi Tang; for Middle Jiao Excess Heat, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), for Deficiency Heat, use Zhuye Huanglian Tang (Bamboo Leaf and Coptis Decoction); for Lower Jiao Deficiency Heat, use Liuwei Wan.
A military officer, due to improper diet and lifestyle, suffered from cough and expectoration. He took phlegm-resolving and cough-stopping drugs. In mid-summer, his left Chi pulse was flooding, rapid, and empty; he had chest fullness, red face, foul-smelling sputum, and spontaneous sweating. I said: "Kidney deficiency causes water to flood forming phlegm, while simultaneously severely depleting fluids; could this be Lung Abscess?" He did not believe me and continued previous medications. The next day, he expectorated pus, with a rapid pulse, particularly strong at the right Cun position. One dose of Jiegeng Tang (Platycodon Decoction) reduced the rapid pulse and pus; two more doses nearly cured him, assisted by Liuwei Wan.
Cough occurring in the first half of the day indicates Fire in the Stomach; add Beimu, Shigao, Huanglian. Cough occurring at dawn (5-7 AM) follows the same pattern.
My Commentary: If stomach heat is severe, use the above formula to purge; if stomach heat is mild, use Zhuye Shigao Tang to clear; if caused by Stomach deficiency heat, use Buzhong Yiqi Tang to tonify; all should have a small amount of phlegm-resolving agents added. Dawn cough should be treated as Spleen deficiency with retained food transforming into phlegm.
A scholar suffered from cough. Using Erchen Tang (Two-Aged Decoction), Huangqin, Huanglian, Zhike led to chest fullness and panting. Adding Suzi (Perilla Seed) and Xingren led to salivation, dry mouth, and thirst. I said: "Expectorating phlegm in the early morning indicates Spleen deficiency failing to digest food; chest fullness and panting indicate Spleen deficiency failing to generate Lung Metal; spontaneous salivation indicates Spleen deficiency failing to secure fluids; dry mouth and thirst indicate Spleen deficiency failing to generate body fluids." Treat with Liu Junzi Tang added with Paojiang (Roasted Ginger) and Rougu (Nutmeg) to warm and tonify Spleen and Stomach, followed by Bawei Wan (Eight-Ingredient Pill) to tonify the Mother of Earth (Kidney).
If chronic cough leads to Lung deficiency, nourish Qi and tonify Blood; add Renshen (Ginseng Root), Huangqi (Astragalus Root), Ejiao (Donkey-hide Gel), Danggui (Angelica Sinensis Root), Shengjiang (Fresh Ginger), Tiandong (Asparagus Tuber), Kuandonghua (Farfara Flower), Maduling (Aristolochia Root), Shaoyao (Peony Root, wine-fried). For Lung Heat with panting and cough, remove Renshen and use Shashen (Glehnia Root), which also tonifies Blood and Qi.
My Commentary: Lung belongs to Metal, born from Spleen Earth. Whenever Lung Metal is affected, it is due to Spleen Earth weakness failing to generate Lung, meaning the "generated" element suffers. Practitioners must examine this carefully!
Cough occurring at dusk indicates Fire floating in the Lung. Do not strictly use cold/cooling drugs; instead, add Wuweizi, Wubeizi (Galla Chinensis), Hepizi (Persimmon Sepal) to astringe and descend.
My Commentary: These symptoms belong to Spleen-Lung Qi deficiency, leading to Kidney channel Yang deficiency and Yin weakness, with defunct Fire flaming upward, or excessive sexual activity damaging True Yin. Treatment should tonify Spleen and Lung, generate Kidney Water, and not focus solely on the Lung.
Cough occurring in the afternoon belongs to Yin deficiency, i.e., Laborious Cough (Lao Sou). Nourish Yin and descend Fire; add Chuanxiong, Danggui, Shaoyao, Shudi (Prepared Rehmannia Root), Huangbai (Phellodendron Bark), Zhimu, Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice), Tiandong, Gualou Ren, Beimu. This specifically tonifies Yin and Blood.
My Commentary: These symptoms belong to Kidney Qi depletion, with Fire flaming and Water drying up, or fluids surging to form phlegm. This is a disorder of the True Organ. Use Liuwei Dihuang Wan to strengthen Kidney Water and nourish the source as the primary method, with Buzhong Yiqi Tang to nourish Spleen Earth and generate Lung-Kidney as an assistant. Using Qingqi Huatan (Clear Qi and Resolve Phlegm) would be a mistake.
Chen Guohua, a department director, had inherent Yin deficiency and suffered from cough. Believing himself knowledgeable in medicine, he used exterior-releasing and phlegm-resolving agents without effect, then heat-clearing and phlegm-resolving agents, worsening the condition. I diagnosed Spleen-Lung deficiency. Disbelieving me, he used Niuhuang Qingxin Wan (Calculus Bovis Heart-Clearing Pill), which aggravated abdominal distension and loss of appetite. Thus, he took Liu Junzi Tang, Jiegeng, Shengma, Maidong, Wuweizi in the morning to tonify Spleen Earth and generate Lung Metal, and Bawei Wan in the evening to tonify Mingmen Fire (Gate of Life) to generate Spleen Earth. Symptoms gradually improved.
Bao Xifu, a Hanlin Academician, suffered from Yin-deficiency cough. Taking Qingqi Huatan Wan and Erchen Tang with Huangqin, Huanglian worsened phlegm. Taking Siwu Tang (Four Substance Decoction) with Huangbai, Zhimu caused abdominal distension, hoarseness, floating-wiry pulse at right Guan, and flooding pulse at left Chi. I prescribed Buzhong Yiqi Tang added with Shanzhuyu (Cornus Fruit), Maidong, Wuweizi in the morning, and Liuwei Dihuang Wan added with Wuweizi in the evening. After more than three months, he recovered due to careful management.
If Fire-Stagnation Cough, where phlegm stagnates Fire-Evil in the middle, resolve stagnation and resolve phlegm. Use Hepingzi (Persimmon Sepal), Xiangfu (Cyperi Rhizoma, soaked in child's urine), Gualou Ren, Banxia Qu (Pinellia Fermented Paste), Haishi (Calcitrum), Qingdai (Indigo Naturalis), Huangqin. Grind into powder, mix with honey to make pills, hold in mouth to dissolve. Continue taking previous Yin-nourishing and Fire-descending drugs. Failure to treat properly leads to Consumption (Lao).
My Commentary: If due to Lung-Stomach accumulated heat and obstructed phlegm-Qi, use the above formula; if due to unclear Spleen-Lung, Qi stagnation and phlegm obstruction, use Erchen Tang added with Zhizi, Zhike, Jiegeng; if due to emotional constraint injuring Spleen, Qi-Blood deficiency, use Jisheng Guipi Tang (Jisheng Restore the Spleen Decoction) added with Zhizi, Jiegeng; if due to anger stirring Liver Fire suppressing Spleen Earth, use Sijunzi Tang (Four Gentlemen Decoction) added with Zhizi, Chaihu; if due to improper labor damaging Original Qi, use Buzhong Yiqi Tang added with Zhizi, Jiegeng.
A woman, distressed by her mother-in-law, suffered from cough, chest/diaphragm oppression, and tasteless food. This is dual injury to Spleen and Lung, with phlegm stagnating in the middle. First use Guipi Tang (Restore the Spleen Decoction) added with Zhizi, Fuxiong (Ligusticum Chuanxiong Rhizome), Beimu, Jiegeng. Symptoms gradually improved.
A woman suffered from cough, hypochondriac pain, fever, worsening at sunset. Treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Shudi, resulting in recovery. Later, due to labor and anger, symptoms recurred, accompanied by alternating cold and heat of Shaoyang, cough, enuresis. All belong to Liver deficiency with hyperactive Fire. For genital prolapse and flaccidity/numbness, use the previous powder and Dihuang Wan, resulting in recovery.
If cough is caused by Phlegm Accumulation or Food Accumulation, use Xiangfu, Gualou Ren, Beimu, Haishi, Qingdai, Banxia Qu, Ruang Shigao (Soft Gypsum), Shanzha (Hawthorn Fruit), Zhishi (Immature Bitter Orange), Huanglian (stir-fried with ginger). Grind into powder, mix with honey, hold in mouth to dissolve.
My Commentary: If due to dietary stagnation transforming into damp-heat in the Stomach, use this formula; if due to Spleen-Stomach Qi deficiency with phlegm stagnation, use Liu Junzi Tang added with Zhike, Muxiang (Aucklandia Root); if due to Spleen-Stomach Qi deficiency with food stagnation, use Liu Junzi Tang added with Shenqu (Medicated Leaven), Maiya (Sprouted Barley Grain). Morning expectoration and cough belong to food stagnation; panting and cough belong to Lung Qi deficiency with hyperactive Fire. Generally, assist Stomach and strengthen Qi is primary; do not solely attack phlegm.
If Laborious Cough with blood, add Ejiao, Danggui, Shaoyao, Tiandong, Zhimu, Beimu, Sangbaipi. Select from previous Lung deficiency and Yin deficiency categories. Generally, cough with blood is mostly due to Lung receiving Heat Evil; Qi transforms into Fire under heat influence; excessive Fire disturbs Yin Blood, rising with Fire. Thus, treatment should purge Fire and nourish Yin; avoid sweet-warm drugs like Renshen. However, some cases of Qi deficiency with hemoptysis require Renshen, Huangqi, Kuandonghua, etc., though such cases are rare!
My Commentary: Previous symptoms may also result from labor damaging Original Qi, causing internal Fire to move recklessly and injure Lung; or labor damaging Kidney Water, causing Yin Fire to flare upward and injure Lung; or overuse of cold drugs like Tiandong, Shengdi (Rehmannia Root) damaging Spleen-Stomach, failing to generate Lung Qi; or misuse of Huangbai, Zhimu damaging Yang Qi, failing to generate Yin Essence. All these are Spleen-Lung depletion and Kidney Water insufficiency, leading to defunct Fire flaming upward and affecting the True Organ. Must use Buzhong Yiqi Tang to tonify Spleen Earth and generate Lung Metal, and Liuwei Dihuang Wan to nourish Kidney Water and generate Yin Essence; otherwise, rescue is impossible.
A military officer, careless with lifestyle, suffered from expectoration, spontaneous sweating, cough, fever. Taking Erchen Tang, Huangqin, Huanglian, Zhizi did not reduce symptoms, leading to poor appetite. Taking Siwu Tang, Erchen Tang, Huangqin, Huanglian worsened symptoms, adding chest oppression, poor eating, afternoon fever. Adding Sangpi, Xingren, Zisu caused chest distension and scanty urine. Taking Siling San (Four Poria Powder), Zhike led to urinary retention and inability to eat. Examination showed flooding-rapid pulses in all six positions, especially in Lung and Kidney areas. I said: "Spleen Earth fails to generate Lung Metal, and Heart Fire attacks; this must transform into Lung Abscess." He did not believe me, continued previous meds, and later expectorated pus-like sputum, seeking treatment again. I said: "Epigastric fullness indicates Spleen Earth failure." He subsequently died.
When cough produces phlegm, cough is predominant; treatment focuses on Lung. When phlegm causes cough, phlegm is predominant; treatment focuses on Spleen. However, if food stagnation forms phlegm, and phlegm-Qi rises causing cough, only treat the phlegm and dissipate the stagnation; cough will stop spontaneously. There is no need to use Lung-targeting drugs to treat cough.
My Commentary: The previous discussion on treatment methods is most accurate. Still differentiate among Six Excesses, Seven Emotions, mutual overcoming of Five Zang, and Spleen-Lung deficiency/excess to treat accordingly; otherwise, fear of developing Lung Abscess.
A man with Spleen-Stomach disharmony took aromatic-dry Qi-moving drugs, leading to poor appetite and bilateral hypochondriac distension. Taking Qi-moving and Blood-breaking drugs led to inability to eat, right hypochondriac distending pain, relieved by pressure. I said: "This is Liver Wood suppressing Spleen Earth, and Spleen Earth failing to generate Lung Metal." Used drugs to nourish the Source of Transformation. Four doses led to sudden retreat of all symptoms. I added: "Fire season is approaching; must tonify Spleen Earth again to nourish Lung Metal." He did not believe me, later recurred with expectoration of pus and death.