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Coughing with a tight pulse, or a deep and hidden pulse; coughing with emaciation and a firm, large pulse form; coughing with physical depletion, fever, and a small, firm, and rapid pulse; muscle wasting, lower body atrophy, persistent fever, cough accompanied by vomiting, abdominal distension, diarrhea, and a string-tight and rapid pulse—all these are death signs and are incurable.

Zihe said: *Neijing* (Classic of Internal Canon), "Yin-Yang Yingxiang Dalun" chapter states: "Injury by dampness in autumn leads to cough in winter." The "Wuzang Shengcheng" chapter states: "Cough and upward rushing of qi." The "Zhenyao Jingzhong" chapter states: "If acupuncture is performed in spring during the Autumn Equinox, it causes cough." The "Shi Congrong" chapter states: "Cough with vexation and resentment is due to rebellious Kidney Qi." In these four chapters, "cough" (kesou) is mentioned together; in other chapters, only "ke" (dry cough) is mentioned without "sou" (productive cough). For example, the "Shengqi Tongtian" chapter says: "Injury by dampness in autumn leads to upward rebellion and cough," which has the same meaning as the "Yin-Yang Yingxiang Dalun" but lacks the character "sou." Thus, it is clear that "ke" is equivalent to "sou."

I carefully examine that "ke" and "sou" were originally two distinct characters, but *Neijing* already combined them into one syndrome. Upon detailed analysis, generally speaking, "ke" involves the movement of qi and belongs to Yang; "sou" involves blood and belongs to Yin. Although the root of this syndrome differs, its manifestation is the same, so common people do not doubt it. Only Jiegue (Zhang Yuansu) elucidated the subtle purport of *Neijing*, the principles of which are seen below.

*Bingji Yao* (Essentials of Pathogenesis) states: "Ke" refers to cough with sound but no phlegm, caused by injured Lung Qi failing to be clear; "sou" refers to phlegm production without sound, caused by Spleen dampness stirring up phlegm; "kesou" refers to both sound and phlegm. This occurs because lung injury causes qi to move due to dampness, leading from ke to sou. In summer, cough with fever is called heat-phlegm sou, treated with Xiao Chaihu Tang (Minor Bupleurum Decoction) 4 liang plus Shigao (Gypsum Fibrosum) 1 liang and Zhimu (Anemarrhenae Rhizoma) 0.5 liang. In winter, cough with alternating cold and fever is called cold sou, treated with Xiao Qinglong Tang (Minor Blue Dragon Decoction) plus Xingren (Armeniacae Semen Amarum), taken with honey-fried ginger soup, honey-fried tangerine peel soup, roasted ginger, or walnuts, all treating sou without phlegm. This is the general rule; further modifications should be made according to season and syndrome. If there is phlegm but the patient can eat, use Dachengqi Tang (Major Order the Yellow Decoction) for mild purgation; if there is phlegm but the patient cannot eat, treat with Nongpo Tang (Magnolia Bark Decoction).

Zihe said: *Suwen* (Basic Questions) states: "The skin and hair are the exterior correspondence of the Lung; when pathogens invade, it becomes Lung Ke." Later physicians saw this and concluded that sou is always due to cold, without consulting other chapters. How could they know that all six climatic factors can cause sou? However, their manifestations can be distinguished: Wind invading the Lung causes ceaseless day-and-night coughing, sweating, headache, and difficult expectoration; Heat invading the Lung causes rapid panting and coughing, red face, tidal fever, and cold hands and feet; this also frequently occurs in infants; Cold invading the Lung causes coughing, panting, upper congestion, bloody sputum, and in severe cases, bleeding from the seven orifices; Dryness invading the Lung causes qi stagnation and difficulty, internal pain in all joints, sweating on the head and face, alternating cold and fever, dry skin, fine sores, dry itching, constipation, and thick sticky sputum; Cold invading the Lung may result from external cold exposure, drinking cold liquids, sitting/lying on wet ground in winter, cold Stomach, wind-cold, or water exposure in autumn/winter, causing urgent coughing and panting. Is this not disease caused by the six climatic factors?

Note: This section only describes disease caused by the six climatic factors, thus summarizing the effects of Si Tian (Heavenly Masters) and Sheng Fu (Victory and Repression) on cough, but lacks formulas for Dampness invading the Lung, which appear elsewhere, likely due to missing bamboo slips. However, Danxi Mr. discussed cough caused by overwork, phlegm, Lung distension, food stagnation generating phlegm and fever leading to cough, or hoarseness due to cough, all resulting from blood deficiency and heat invasion. These are internal diseases with different roots. For example, in Shanghan (Cold Damage), Xiao Qinglong Tang treats cough due to fluid retention combining with exterior cold; Zhenwu Tang treats cough due to fluid retention combining with interior cold; Shanghan Zhongfeng (Wind Strike in Cold Damage) with alternating cold and fever, chest fullness, mental restlessness, frequent vomiting, and cough is treated with modified Xiao Chaihu Tang, representing Yang pathogen transmitting to the Lung; Jiawei Sini San (Modified Four Reversal Powder) treats Yin pathogen transmitting inward causing cough. These are examples of external pathogen transmission. They cannot be listed exhaustively. Since the superficial symptoms of cough are similar across individuals, one need not seek the root for each case. Observing Zihe's discussion, it merely inspires the subtle meanings.