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Cough refers to the symptom of coughing. This chapter is named solely after "cough" (Ke, cough) and does not explicitly mention "sputum expectoration" (Sou, expectoration), yet the meaning of Sou is contained within the text; this is a case of elliptical expression. Later generations distinguished between Ke and Sou, defining Sou as cough with sputum and Ke as cough without sputum. There is also what is called "reverse cough" (Ke Ni, cough with rebellious Qi), which occurs due to rebellious upward movement of Qi followed by coughing, and indeed, whenever one coughs, Qi becomes rebellious. However, the manifestations of cough are numerous. The world often attributes all cases to the Lung, failing to realize that all Zang and Fu organs can cause cough. Therefore, this chapter elaborates on this point in detail. In summary, although the initial causes of cough differ among the Zang and Fu organs, once coughing occurs, it invariably involves panting and rebellious exhalation. Thus, the Lung acts as the master of all coughs. Since the Lung governs all Qi, it is natural for the world to attribute all coughs to the Lung.

The Yellow Emperor asked: Why does the Lung cause cough? Qibo replied: All Zang and Fu organs can cause cough, not just the Lung. The Emperor said: I wish to hear about their clinical manifestations. Qibo said: The skin and hair (Pi Mao, integumentary system) are the exterior correspondence of the Lung. When pathogenic factors first invade the skin and hair, they enter the Lung through this correspondence. (Here, "pathogenic factor" refers to cold qi. Note: Entering through its correspondence means entering the Lung Meridian; this describes the Lung receiving cold from the exterior.) If cold food and drink enter the stomach, they travel up along the Lung Meridian to the Lung, causing Lung cold. When the Lung is cold, external and internal cold combine, allowing pathogens to lodge there, resulting in Lung cough. (The Lung meridian originates in the middle Jiao, descends to connect with the Large Intestine, circles back around the stomach opening, ascends through the diaphragm, and belongs to the Lung; hence, it is said to ascend along the Lung meridian to the Lung. Note: This further explains that when the Lung receives cold from both exterior and interior, the combination of internal and external cold leads to cough.) Each Zang organ suffers disease in its respective ruling month. If it is not the ruling month, the disease is transmitted to them by other organs. (...Ruling month refers to the month when an element is prosperous. Note: It is normal for Zang organs not to suffer pathogens during their ruling months. If a Zang organ is deficient, it fails to manifest its ruling nature, allowing pathogens to enter due to deficiency. Thus, Zang organs suffer disease at the time they should be ruling, hence "suffering disease in their respective ruling months." However, this suffering of cold pathogens by the Zang organs does not start directly in the Zang organs. Generally, cold enters the skin and hair, moves from the skin and hair into the Lung, and after the Lung is affected, it transmits to the deficient Zang organs. Let us take the Liver meridian as an example. The Liver corresponds to Wood, which prospers in Spring, its ruling season. If the Lung has received cold and coughing is limited to the Lung, how can it transmit to the Liver? Only if the Liver has pre-existing disease and its meridian is already deficient, even though it is Spring and should be ruling, it fails to do so. Consequently, the cold pathogen entering via the skin and lung is transmitted to the Liver. This transmission to the Liver occurs precisely because it failed to rule during its appropriate time, hence "if not the ruling month, each is transmitted to them." 'Each' refers to the Liver, Heart, Spleen, Kidney, etc. 'Transmit' refers to the Lung transmitting cold pathogens to the Zang and Fu organs. This indicates that coughs of the Zang organs all originate from the Lung, due to their failure to rule at the appropriate time. The previous three paragraphs explain this separately; previous annotations were vague and inaccurate.) The Lung first receives the pathogen. In Spring, the Liver receives it first; in Summer, the Heart receives it first; in Late Summer (Zhi Yin, extreme Yin), the Spleen receives it first; in Winter, the Kidney receives it first. (Note: This specifically details how each Zang organ suffers disease in its ruling season. Originally, before "Lung first receives pathogen," there were three characters "Cheng Qiu Ze" (When Autumn arrives). The New Correction states: "According to the Quan Yuanqi edition and Tai Su, the three characters 'Cheng Qiu Ze' are absent; Wang Bing's edition erroneously added them." This is correct, so we delete them now. Cough always begins in the skin and hair, moving from there to the Lung; thus, the Lung first receives the pathogen. This happens upon exposure, not exclusively in Autumn. 'Cheng' implies lurking or taking advantage of an opportunity; pathogens attacking due to deficiency are like thieves waiting for a gap. The meaning of 'in Spring,' etc., was explained earlier. The Liver, Heart, Spleen, and Kidney are also said to receive it first because if Zang diseases are not cured, they will transfer to the Fu organs. The Spleen rules Late Summer, but here it says 'Zhi Yin' (Extreme Yin); Zhi Yin is where the Spleen resides, and since the Spleen does not rule a specific season alone, this term is used.)

The Emperor asked: How can they be distinguished? Qibo said: The manifestation of Lung cough is coughing with wheezing and audible sounds; severely, it may involve spitting blood. (The Lung stores Qi and governs respiration, so coughing leads to panting and sounds in the throat. Note: Severe spitting blood occurs because prolonged Qi rebellion causes blood to move, and blood follows Qi.) The manifestation of Heart cough is coughing accompanied by heart pain, a sensation of obstruction in the throat as if something were stuck; severely, it leads to sore throat and Bi syndrome of the throat. (The Pericardium Meridian of Hand-Jueyin originates in the chest and belongs to the Pericardium. The Kidney Meridian of Foot-Shaoyin originates in the heart and belongs to the Heart Tie (connection). Its branch ascends from the Heart Tie and flanks the throat. Hence the symptoms.) The manifestation of Liver cough is coughing with pain under both hypochondria; severely, the body cannot turn, and turning causes fullness under both hypochondria. (The Liver Meridian of Foot-Jueyin penetrates the diaphragm, spreads over the hypochondria, and follows the posterior aspect of the throat. Hence the symptoms. 'Xia' also refers to the hypochondrium.) The manifestation of Spleen cough is coughing with pain under the right hypochondrium, radiating faintly to the shoulder and back; severely, movement is difficult, and movement exacerbates the cough. (Spleen Qi connects with the Lung, so pain radiates to the shoulder and back. Note: The right side is the domain governed by the Lung. The Lung governs Qi, and the Spleen is the mother of Qi. Spleen disease affects the Lung, causing pain under the right hypochondrium. The shoulder and back are governed by the Lung. Movement increases Qi rebellion, worsening the cough. The annotation claiming the Spleen governs the right side is incorrect.) The manifestation of Kidney cough is coughing with pulling pain between the waist and back; severely, it involves coughing up saliva/phlegm. (The Kidney Meridian of Foot-Shaoyin ascends along the posterior medial aspect of the thigh, penetrates the spine, belongs to the Kidney, and connects with the Bladder. Its main trunk ascends from the Kidney, penetrates the Liver and diaphragm, enters the Lung, follows the throat, and flanks the root of the tongue. Additionally, the Bladder Meridian passes through the medial shoulder, descends alongside the spine to the middle of the waist, enters the paraspinal muscles, and connects with the Kidney. Hence the symptoms. Note: The Kidney governs the five fluids, transforming them into dampness. Dampness enters the Spleen to become saliva. Prolonged cough leads to Kidney deficiency and water flooding; the Spleen cannot transport the dampness, which returns to the Kidney, causing coughing up of saliva.)

The Emperor asked: What about coughs of the Fu organs? From where do they arise? Qibo said: Chronic coughs of the Zang organs transfer to the Fu organs. (Note: Zang and Fu organs are paired. With chronic illness, transmission occurs; the longer the duration, the more complex and severe it becomes. 'Transfer' implies spreading, meaning Zang disease spreads to Fu organs.) If Spleen cough persists, the Stomach receives it. The manifestation of Stomach cough is coughing with vomiting; severely, roundworms may be expelled. (Stomach cold causes vomiting; severe vomiting causes intestinal Qi to rebel upward, expelling worms.) If Liver cough persists, the Gallbladder receives it. The manifestation of Gallbladder cough is coughing with vomiting of bile. (Note: Liver and Gallbladder belong to Wood. Wood prefers harmony. Cold causes Qi stagnation; extreme stagnation leads to vomiting. Bile is bitter fluid.) If Lung cough persists, the Large Intestine receives it. The manifestation of Large Intestine cough is coughing with loss of stool and urine. (Note: The Large Intestine is the exterior correspondence of the Lung. The Lung governs Qi; prolonged cough depletes Qi, leading to inability to secure, causing lower collapse and incontinence of stool and urine. The *Jia Yi Jing* writes "yi shi" (loss of feces), referring only to stool, which is biased; Wang Bing's "yi shi" (loss of stool and urine) is more accurate.) If Heart cough persists, the Small Intestine receives it. The manifestation of Small Intestine cough is coughing with passage of flatus, where Qi escapes simultaneously with the cough. (Note: The Small Intestine is the Fu organ of the Heart and belongs to Fire. Excess Fire and heat cause blockage and urinary retention; excess Cold and Qi deficiency cause sliding diarrhea and loss of control over Water and Fire. Here, Cold affects the Heart and transfers to its Fu organ. Cold is Water Qi; Fire is extinguished by Water, leading to passage of flatus. 'Loss of Qi' means dissipation of Qi. 'Qi escaping with cough' means that since Qi dissipates, one cannot produce sound even when trying to cough. This is because prolonged cough scatters Qi, leading to exhaustion and inability to continue.) If Kidney cough persists, the Bladder receives it. The manifestation of Bladder cough is coughing with urinary incontinence. (Note: The Bladder stores body fluids. Prolonged cough depletes Qi, preventing fluid retention; Cold Qi flows downward, causing incontinence.) If chronic cough persists, the San Jiao (Triple Burner) receives it. The manifestation of San Jiao cough is coughing with abdominal fullness and lack of appetite. These conditions all involve pathogenic accumulation in the Stomach and involvement of the Lung, causing excessive phlegm/saliva, facial edema, and rebellious Qi. (Note: This summarizes the harm of chronic cough. Prolonged cough affects not just one Zang or Fu but all aspects of the body; thus, chronic cough leads to San Jiao involvement. The San Jiao covers the upper and lower, encompassing the whole body, functioning through Qi. When cough affects the San Jiao, Qi becomes obstructed and stagnant, causing abdominal fullness and anorexia. The Lung belongs to the Upper Jiao, and the Stomach to the Middle Jiao. 'Accumulation' means congestion, and '關' (guan) means closure; this describes Qi congested and closed in the Lung and Stomach. However, Qi is congested in the Middle and Upper Jiao precisely because prolonged cough depletes Qi, preventing it from descending to the Lower Jiao. Unable to exit downward, it congests in the Lung and Stomach, causing phlegm, facial edema, and rebellious Qi upward. This is Qibo's further explanation of abdominal fullness. Previous annotations claiming the disease stops in the Middle and Upper Jiao are shallow.) The Emperor asked: How should it be treated? Qibo said: For Zang coughs, treat their Shu (Stream) points; for Fu coughs, treat their He (Sea) points; for edema, treat their Jing (River) points. The Emperor said: Excellent! (Note: The *Ling Shu* states: "Where Qi pours in is Shu, where it flows is Jing, where it enters is He.")