Library

Wang Jiezhai stated: For cough caused by wind-cold injury (Shang Feng), it is appropriate to use acrid-cool methods to release the exterior, such as *Bai Du Zi* (Caulis Cynanchi Atrati), *Fang Feng* (Radix Saposhnikoviae), *Jing Jie* (Herba Schizonepetae), and *Bo He* (Herba Menthae). For cough caused by heat injury (Shang Re), it is appropriate to use cool methods to descend fire, such as *Huang Qin* (Radix Scutellariae), *Sang Bai Pi* (Cortex Mori Radicis), *Zhi Mu* (Rhizoma Anemarrhenae), and *Men Dong* (Tuber Ophiopogonis). For cough caused by damp-heat injury (Shang Shi Re), it is appropriate to promote urination to drain dampness and clear heat, flow moisture to moisten dryness, such as *Sang Pi* (Cortex Mori Radicis), *Shi Gao* (Gypsum Fibrosum), *Huang Bo* (Cortex Phellodendri), *Cang Zhu* (Rhizoma Atractylodis Chinensis), *Hua Shi* (Talcum), and *Gan Cao* (Radix Glycyrrhizae). For cough caused by dryness injury (Shang Zao), it is appropriate to clear Metal and descend fire, moisten the Lung and clear dryness, such as *Shi Gao* (Gypsum Fibrosum), *Zhi Mu* (Rhizoma Anemarrhenae), *Sang Pi* (Cortex Mori Radicis), and *Mai Dong* (Tuber Ophiopogonis). For cough caused by cold damage (Shang Han), it is appropriate to use acrid-dispersing methods to release the exterior, such as Ma Huang Xing Zi Tang (Ephedra and Apricot Kernel Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Yue Bi Tang (Yue Bi Decoction), etc. If there is pre-existing heat in the Lung, add *Zhi Zi* (Fructus Gardeniae), *Huang Qin* (Radix Scutellariae), *Shi Gao* (Gypsum Fibrosum), and *Zhi Mu* (Rhizoma Anemarrhenae). It is also said: The pathology of cough primarily resides in the Lung, as the Lung governs Qi and produces sound. Treatment methods must distinguish between new and old diseases, and deficiency and excess syndromes. For newly contracted wind-cold, disperse it; for fire-heat, clear it; for damp-heat, drain it through urination; for dryness-heat, clear and moisten it. For chronic illness, one must distinguish deficiency from excess. If Qi is deficient, tonify Qi; if Blood is deficient, tonify Blood; if Essence is deficient, tonify Essence. If chronic illness involves stagnation, prioritize resolving stagnation. It is also said: When phlegm arises due to cough, the cough is the primary symptom, and treatment focuses on the Lung. This refers to cases where there was no prior phlegm, but now cough appears, followed by phlegm production. When cough results from phlegm, the phlegm is the primary symptom, and treatment focuses on the Spleen. This refers to cases with pre-existing phlegm-fluids, where cough and wheezing gradually worsen, indicating cough due to damp-phlegm or fluid retention. If food stagnation transforms into phlegm, stubborn phlegm becomes fixed, and phlegm-Qi rises causing cough, treat only the phlegm and eliminate the stagnation; the cough will stop naturally, without needing to specifically treat the Lung. It is also said: For cough caused by excessive alcohol and sexual activity damaging the True Yin of the Lung and Kidney, do not administer *Ren Shen* (Radix Ginseng), lest Yin deficiency with fire hyperactivity be aggravated, further assisting Yang Qi and consuming Yin fluids. First use drugs that strengthen Water (nourish Yin), such as Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), to tonify True Yin, allowing Water to rise and Fire to descend. Subsequently, use *Ren Shen* (Radix Ginseng) and other Lung-tonifying drugs to assist the mother of the Kidney (Earth generating Metal, or Metal-Water mutual generation), so that Yin generates naturally and Yang Fire retreats. Those who use *Ren Shen* (Radix Ginseng) in the world fail to first strengthen Water to suppress Fire, and rashly administer *Ren Shen* (Radix Ginseng) to tonify Yang, which instead makes Yang Fire more vigorous and depletes Metal and Water further. *Zhi Zhi Fang* states: Cough due to wind invasion presents with nasal congestion and heavy voice. Cough due to cold injury presents with a chilly and fearful sensation. Cough due to cold transforming into heat presents with irritability, heat, and anxiety. Heat constrained internally combined with external cold exposure presents with aversion to cold, irritability, heat, and hoarseness. Cough due to damp invasion presents with heavy body and nasal congestion. Cough due to blood stasis presents with stabbing pain in the hypochondrium and chest, and a fishy sensation in the epigastrium/chest. Cough due to water retention presents with palpitations below the heart. If the Lung pulse is floating and tight, it indicates external wind-cold; use dispersing methods to induce sweating. If the Lung pulse is deep, full, and rapid, it indicates internal Lung heat; use clearing and draining methods. If the Lung pulse is soft and scattered, it indicates Lung deficiency; use tonifying methods. The Lung governs skin and hair. If Lung Qi is deficient, the interstices are not dense, and wind pathogens easily enter; the method should first release the exterior, then tonify deficiency. If Lung Qi is excess, the interstices are dense, and pathogens cannot enter. If the Lung has fire, the interstices are not closed, and wind pathogens easily enter; one should release the exterior and clear fire. Once Lung fire is cleared, the interstices close, and pathogens cannot enter. If Lung deficiency cough is treated with Lung-clearing drugs, the interstices become even less dense, making pathogen invasion easier. If Lung fire cough is treated with Lung-tonifying drugs, the interstices become even less closed, making pathogen invasion worse. In summer, wheezing and cough with red face and tidal fever, with a large pulse, are treated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). Irritability and cough are treated with Zhi Zi Tang (Gardenia Decoction). These are treatments for excess fire. Cough with hemoptysis is treated with Mai Dong Tang (Ophiopogon Decoction). Swallowing Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to control Yang fire is a treatment for deficiency fire. Zhang Sanxi stated: Among all diseases, only cough is difficult to treat. Cough with immediate phlegm expulsion is called slippery phlegm, belonging to Spleen dampness; it is appropriate to use *Nan Xing* (Rhizoma Arisaematis Cum Bile) and *Ban Xia* (Rhizoma Pinelliae) to dry it; moistening flavors should be avoided. Cough with several bouts without phlegm expulsion is called dry phlegm, belonging to Lung dryness; it is appropriate to use *Men Dong* (Tuber Ophiopogonis), *Zhi Mu* (Rhizoma Anemarrhenae), *Xing Ren* (Semen Armeniacae Amarum) to moisten it; aromatic-drying drugs should also be avoided.

Danxi stated: Cough in the first half of the day is mostly due to fire in the Stomach; cough in the afternoon is mostly due to Yin deficiency with fire hyperactivity; cough at dusk is mostly due to defluxion of Yin fire, and should be treated by astringing and descending. It is also said: Cough at dawn (5-7 AM) is due to phlegm-fire in the Stomach, latent and accumulated within; at this time, when fire Qi is nourished, it surges upward to the Lung. It should be treated with *Zhi Mu* (Rhizoma Anemarrhenae), *Shi Gao* (Gypsum Fibrosum), *Di Gu Pi* (Cortex Lycii), *Qing Dai* (Indigo Naturalis), and *Hai Shi* (Lapis Calcitae). Cough before noon is due to heat in the Qi level; use Xie Bai San (Drain White Powder) plus *Zhi Mu* (Rhizoma Anemarrhenae) and *Shi Gao* (Gypsum Fibrosum). Cough after noon is due to heat in the Blood level; nourish Yin and retreat heat, using Jia Jian Si Wu Tang (Modified Four Substance Decoction), swallowing Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), combined with Zi Shen Wan (Kidney-Nourishing Pill). It is also said: Dry cough is due to phlegm stagnation and fire pathogens in the middle; first use Gan Jie Tang (Licorice and Platycodon Decoction) to open it, then add Yin-nourishing ingredients. Cough with hoarse voice is due to cold enveloping heat; do not abruptly use cold-cooling drugs; use acrid-dispersing methods.

Commentary: Dusk cough is due to fire Qi floating upward to the Lung; the method of astringing and descending is appropriate. The character "astringe" here means that for rising fire due to Yin deficiency, one should nourish and moisturize Yin, astringing the fire Qi to descend, which is the method of nourishing Yin and descending fire. Modern people mistakenly interpret this as sour-cold astringency, which is a major error.