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1. All coughs caused by internal injury must originate from the Yin aspect. What is the Yin aspect? It refers to the essence and Qi of the five Zang organs. Although all five Zang organs possess essence and Qi, the Kidney is the root of primal essence (Yuan Jing), and the Lung is the master of primal Qi (Yuan Qi). Therefore, if the Qi aspect of the five Zang organs is injured, the disease inevitably progresses from top to bottom, spreading from the Lung through the Spleen to the Kidney; if the essence aspect of the five Zang organs is injured, the disease inevitably progresses from bottom to top, spreading from the Kidney through the Spleen to the extreme of the Lung. When both the Lung and Kidney are diseased, other Zang organs cannot escape involvement. Thus, coughs resulting from consumptive diseases (Lao Sun) are the most difficult to treat, precisely because the pathology lies in the root, making it hard to exert therapeutic force. Since the disease is at the root, can one treat it without addressing its root? Hence, to treat disorders above, the key lies not in the upper part but in the lower part; to treat disorders below, the key lies not in the lower part but in the upper part. Only by understanding that Qi contains Essence and Essence contains Qi can one discuss the treatment of consumptive coughs.

2. The Lung belongs to Metal and is a clear and empty organ. Cough occurs when Metal is controlled by Fire (Fire insulting Metal) or when Metal is cold and Water is frigid; this is why coughs generally require treatment targeting the Lung. However, internal injury coughs are not solely located in the Lung. The essence of the five Zang organs is stored in the Kidney, and the Foot-Shaoyin Kidney Meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, follows the throat, and flanks the base of the tongue. Therefore, deficiency of Lung Metal often results from depletion of Kidney Water, which is the principle of "the child affecting the mother" (Kidney being the child of Lung, Kidney Water deficiency leading to Lung Metal malnourishment). Consequently, treating consumptive coughs must primarily focus on strengthening Water and nourishing Yin, so that Lung Qi becomes sufficient and the cough gradually resolves. Suitable formulas include Yi Yin Decoction (One Yin Decoction), Zuo Gui Yin (Left Restoring Drink), Qiong Yu Gao (Jade Paste), Zuo Gui Wan (Left Restoring Pill), and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), selected according to the condition. If there is deficiency of Primal Yang in the lower jiao with failure of Sheng Qi (vital energy) to circulate, causing stagnation in the middle Jiao (Spleen) and upper Jiao (Lung), manifesting as panting, chest and epigastric fullness, phlegm-saliva vomiting, diarrhea, and aversion to cold, where the pulse is fine and weak, and the syndrome is deficient-cold with persistent cough, such syndromes do not require specific antitussive treatment. Instead, tonifying Yang will stop the cough spontaneously. Formulas such as You Gui Yin (Right Restoring Drink), You Gui Wan (Right Restoring Pill), Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill), Da Bu Yuan Jian (Great Tonifying Source Decoction), Liu Wei Hui Yang Yin (Six-Ingredient Returning Yang Drink), Li Zhong Tang (Regulate the Middle Decoction), and Jie Lao San (Rob Consumptiveness Powder) should be used promptly according to circumstances, without delay, to avoid irreversible deepening of the disease.

3. In internal injury coughs, when Water is deficient below and Fire flares above, burning Lung Metal, symptoms such as dry mouth and thirst, vexation and heat, sore throat, mouth ulcers, tidal fever, constipation, preference for cold drinks, and slippery-rapid pulses at the Cun, Guan, and Chi positions occur. In such cases, clearing Fire to preserve Yin fluids is necessary. Suitable formulas include Si Yin Decoction (Four Yin Decoction), Jia Jian Yi Yin Decoction (Modified One Yin Decoction), or Ren Shen Gu Ben Wan (Ginseng Root-Securing Pill). This should be considered alongside hemoptysis syndromes; detailed treatments are found in the Blood Syndromes chapter.

4. Hoarseness in cough arises because the Lung belongs to Metal: "Metal solid does not sound; Metal broken also does not sound." "Metal solid" indicates pathogenic factors in the Lung, either Cold or Fire pathogens; "Metal broken" indicates damage to True Yin, either Qi deficiency or Essence deficiency. For Cold pathogens, acrid-warm herbs are indicated; for Fire pathogens, sweet-clear herbs are indicated; for Qi deficiency, Yang tonification is indicated; for Essence deficiency, Yin tonification is indicated. Generally, in these conditions, excess pathogens present abruptly and are easier to treat, while deficiency-consumption presents insidiously and is harder to treat. Methods for treating consumption should be referenced against the subsequent section on dry cough.

5. Coughs due to internal deficiency-consumption generally should not use drying herbs or acrid-aromatic qi-moving agents, such as Liu An Decoction (Anhui Decoction) or Er Chen Tang (Two-Cured Decoction), which should not be used lightly. Instead, sweet-moistening Yin-nourishing substances like milk butter, honey, Lily Bulb, Rehmannia, Donkey-hide Gelatin, Ophiopogon, and peeled Walnut Meat are appropriate.

6. Exterior pathogen syndromes are often mistaken for consumptive injuries, leading to true consumptive disease. This usually happens in patients with weak constitution, where the physician has preconceived notions: seeing fever, they assume Fire; seeing cough, they assume Consumption, without distinguishing between exterior and interior, and arbitrarily using Yin-nourishing and Fire-descending agents. They fail to realize that if Cold pathogens are on the exterior, cooling herbs should not be recklessly administered. If exterior Cold is combined with internal Cold from medication, exterior-interior pathogens combine, causing pathogenic retention and progressive worsening. The common saying goes, "Wind-cold unrelieved turns into Consumption." Can wind-cold truly turn into consumption? It is merely that incompetent physicians misdiagnose and daily apply clearing and draining methods, exhausting the weak body until it eventually becomes consumption. This is truly medical error. Therefore, physicians must carefully distinguish whether the pathogen is in the exterior or interior, whether it is a new acquisition or chronic illness, and differentiate based on pulse, complexion, form, and Qi. Once the truth is identified, using only Liu An Decoction, Jin Shui Liu Jun Decoction (Metal-Water Six-Gentleman Decoction), or Chai Chen Decoction (Bupleurum-Chenpi Decoction) for a few doses can lead to recovery. Lack of medical precision is one cause of such errors.

7. Regarding dry cough, Danxi stated: "This is a Fire-stagnation syndrome, where phlegm-stagnant Fire pathogens reside in the Lung. Use Platycodon to open them up, and below use Yin-tonifying and Fire-descending herbs. If unresolved, it becomes consumption, requiring the Dao Cang method (purging therapy)." This syndrome is mostly seen in those who are frustrated/unfulfilled. I argue that Danxi's view is not entirely accurate. If it is due to frustration, then the internal injury from worry and thought—is it really a Phlegm-Fire disease? Is it suitable for attack by Platycodon or purging? Dry cough is essentially due to insufficient fluids in the Lung, leading to desiccation. This clearly belongs to internal injury and depletion, with non-interaction between Lung and Kidney, Qi failing to generate Essence, and Essence failing to transform Qi, resulting in dryness. However, the presence or absence of Fire must be differentiated: If the Zang organs are balanced without Fire, and it is merely Lung deficiency, first tonify Qi to naturally generate Essence; Wu Fu Yin (Five Blessings Decoction) is suitable. If the Zang Qi is slightly cold, non-acrid-warm cannot moisten; thus, first tonify Yang to naturally generate Yin; Li Yin Jian (Nourish Yin Decoction) or Liu Jun Zi Tang (Six-Gentleman Decoction) is suitable. If accompanied by internal heat and Fire, True Yin must be protected; thus, first strengthen Water to control Fire; Yi Yin Decoction or Jia Jian Yi Yin Decoction combined with Bei Mu Wan (Fritillaria Pill) is suitable. If one only knows how to resolve phlegm and relieve stagnation in this condition, Qi will be further depleted, Water further exhausted, leaving the patient like a fish in a dried-up rut (in a desperate situation).