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Prolonged cough that does not heal is due to Lung deficiency with internal fire. The treatment principle should be to clear the Lung and moisten it; astringent, drying, and qi-obstructing medicines are contraindicated. If misused, such as *Yingsuqiao* (Poppy Shell) or *Hezi* (Chebula Fruit), the fire will become congested in the Lung and fail to descend. If combined with *Renshen* (Ginseng), *Baizhu* (Atractylodes Macrocephala Rhizome), and *Banxia* (Pinellia Tuber), death will follow immediately. Physicians of the world often tread this path repeatedly, following each other into disaster, yet none awaken. I briefly write this treatise to warn future practitioners. (From *Guang Biji*.)

Ye Tianshi treated Lu's cough, which was caused by autumn heat and dryness invading from above, first affecting the Lung, leading to cough and fever. This is a clear pathogen attacking the upper jiao. Treatment should employ acrid-cool clearing and moistening methods; sweating should not be induced to damage body fluids. Prescription: *Qingzhuye* (Green Bamboo Leaf), *Lianqiao* (Forsythia Fruit), *Huafen* (Trichosanthes Root), *Xingren* (Apricot Seed), *Xiangbei* (Fritillaria Thunbergii Bulb), *Liuyisan* (Six-Ingredient Powder).

In a subsequent visit for Lu, dampness inevitably transforms into heat, steaming and causing cough. The air passages are not yet clear, and appetite is poor. One must consume bland food and rest quietly to strengthen vitality, preventing the condition from lingering and damaging the body. Prescription: *Feihuasishi* (Calcined Talcum), *Huafen* (Trichosanthes Root), *Xiangbei* (Fritillaria Thunbergii Bulb), *Yiren* (Coix Seed), *Lvdoupi* (Mung Bean Skin), *Tongcao* (Tetrapanax Pith).

Hu, aged sixty-six, had a wiry pulse on the right side. Due to scabies, he frequently bathed in hot water, causing the defensive qi to become loose and susceptible to cold and heat. The skin and hair correspond internally to the Lung, resulting in cough, chest oppression, and profuse phlegm. Over time, food lost its taste, and stool became dry and hard. Stomach fluids were consumed daily, failing to nourish the Lung. Moreover, in autumn and winter, heavenly qi descends, and dryness adds to the condition, gradually presenting signs of phlegm-fire in the elderly. In this situation, clearing qi-level heat to moisten dryness is appropriate. If one fears deficiency and administers cloying tonics daily, the body will only become drier. Prescription: *Shuang Sangye* (Mulberry Leaf frosted by frost), *Tian Xingren* (Sweet Apricot Seed), *Maidong* (Ophiopogon Tuber), *Yuzhu* (Polygonatum Odoratum Rhizome), *Baishashen* (Glehnia Root), *Tianhuafen* (Trichosanthes Root), *Zheganjiang* (Sugarcane Juice), *Tian Lizhi* (Sweet Pear Juice), decocted into an electuary. (Xu Lingtai commented: For the elderly without external contraction cough, *Maidong* and *Yuzhu* can also be used.)

A forty-year-old man presented with a wiry pulse and bi-sensation pain in the chest and diaphragm. Cough accompanied by head distension was due to dryness invading upward and the Lung qi failing to diffuse. Light medicines should be used to clear the upper jiao. Prescription: *Pipaye* (Loquat Leaf), *Sangye* (Mulberry Leaf), *Chuanbeimu* (Fritillaria Cirrhosa Bulb), *Xingren* (Apricot Seed), *Dongguazi* (Winter Melon Seed).

A twenty-seven-year-old man presented with a fine and rapid pulse, prolonged cough with alternating chills and fever, body ache, and sweating. This resulted from essence depletion affecting the Stomach. *Huangqi Jianzhong Tang* (Astragalus Decoction to Build the Middle) was used with ginger removed.

Another twenty-four-year-old man presented with a wiry pulse, larger on the right, prolonged cough with back chills and night sweats. *Xiao Jianzhong Tang* (Minor Decoction to Build the Middle) was used with ginger removed and *Fushen* (Poria with Hostwood) added.

Xu Lingtai stated: Taking ginger for cough will certainly cause hematemesis and aphonia; removing it is advisable, though this is unknown to many. For wind-cough complicated by fire, taking *Guizhi* (Cinnamon Twig) will certainly cause hematemesis; this has been verified a hundred times. He further stated: Ye's use of *Jianzhong* methods to treat prolonged cough with middle jiao deficiency follows the principle of "tonifying the mother," which is indeed the orthodox method passed down from ancient sages. However, cough due to yin-deficiency fire and consumptive disease is exactly opposite to the action of *Jianzhong*. Ye applied this method successfully but erred by applying it to consumptive disease due to insufficient differentiation.

Feng Changnian, a xiaolian, suffered from chronic yin-deficiency cough and contracted a seasonal epidemic. *Congbai Xiangchi Tang* (Scallion White and Fermented Soybean Decoction) was used, adding *Renzhonghuang* (Human Excrement Yellow) and *Tongbian* (Child's Urine), resulting in recovery after three days. Another geomancer, who had a history of blood disorders, also contracted a seasonal epidemic. The aforementioned decoction was used, adding *Xijiao* (Rhinoceros Horn) and *Danpi* (Moutan Bark); after ingestion, bloody stool was passed, and he recovered. Wang Gongjun treated a pregnant woman with wind-heat cough. After dispersing methods were applied, the fetus pressed against the heart, causing dyspnea leaning forward, and urinary incontinence during coughing. *Zisu Yin* (Perilla Infusion) was used with *Chuanxiong* (Ligusticum Chuanxiong Rhizome) and *Fupi* (Citrus Peel) removed, adding *Weirui* (Anemarrhena Rhizome) and *Baiwei* (Cynanchum Atratum Root), resulting in fetal stability after one dose. Zhang Danxian treated a young man with yin deficiency injured by autumn dryness. He usually experienced fiery dry cough, five-palm heat, vivid dreams with seminal emission, and urine varying between white and yellow. In late autumn, he suddenly developed severe cough, producing copious clear phlegm while sitting, general aversion to cold, slight surface fever, vomiting when coughing severely, epistaxis resembling a gush during vomiting, dry constipation, and dysuria. First, *Yigong San* (Extraordinary Power Powder) was used with *Baizhu* (Atractylodes Macrocephala Rhizome) removed and *Shanyao* (Dioscorea Rhizome) added. Subsequently, *Liujun Wan* (Six-Ingredient Pill) with *Maidong* (Ophiopogon Tuber) and *Wuweizi* (Schisandra Berry) was given. After half a month, the cough ceased. Analyzing these treatments, whenever yin deficiency is complicated by wind-cold, the focus must invariably be on the root disease. Generally, fiery dry cough is entirely due to yin deficiency. Although ancients discussed treating Kidney and Liver together, careful analysis shows most cases belong to Kidney water exhaustion and Liver fire excess. Therefore, strengthening water to control yang is indicated. Methods to guide fire downward should absolutely not be tried lightly.

Xue Yipiao stated: Prolonged cough transferring pathogens to the Stomach causes the Lung's descending function to lose authority, leading to rebellious qi ascent. Medicines that drain Lung qi should not be used. Water pear, peeled of core but retaining skin, is mashed, filtered through silk cotton for clear juice, and slowly decocted into an electuary. Stored in porcelain bottles, take 5 qian daily with warm water.

The ancients created the character for "consumption" (Lao) using two fires exerting force, hence discussing ministerial and sovereign fires. Warming and tonifying the middle jiao stops the source of phlegm; tonifying the lower jiao benefits the source of water. However, since the disease is deep-seated, it may not be resolved by a single strike. Prescription: *Shudi* (Rehmannia Glutinosa Preparata), *Gouqizi* (Goji Berry), *Yuanshen* (Scrophularia Root), *Niuxi* (Achyranthes Root), *Fuling* (Poria), *Zishiyinqing* (Purple Quartz).

Horizontally, it represents Kan (Water); vertically, it is water. The true yang in the center, when water is deficient, reveals itself as Dragon Fire. The yang below Zhen shares the same source. Rising as Thunder Fire, thunder belongs to Wood, all being fire within yin. Purely yin medicines only intensify the blaze; no herbs can control it. *Yiyuan Dan* (One-Origin Pill) should be used; long-term consumption leads to cure. *Dan Qiushi* (Light Autumn Stone) 5-6 jin, made into pills with red date paste. Take 5-6 qian in the morning and 2-3 qian in the evening, washed down with soup pointed by *Yang Qiushi* (Yang Autumn Stone).

With a wiry and rapid pulse, especially enlarged at the chi position, cough with sore throat and aphonia, occurring years after blood loss, yin deficiency and flaming fire are self-evident. Only items of extreme stillness can guide yang to submerge into yin, approximating the intent of the *Neijing*. However, quiet cultivation is required to ensure yin is dense and yang is solid, achieving the interaction of Kan and Li. Prescription: *Shudi* (Rehmannia Glutinosa Preparata) pounded with *Haishi* (Floating Limestone powder), *Jinshihu* (Dendrobium Stem), *Beishashen* (Glehnia Root), *Fuling* (Poria), *Maidong* (Ophiopogon Tuber), *Sheng Baishao* (Raw White Peony Root), *Gui Fuban* (Turtle Plastron), *Shanyao* (Dioscorea Rhizome).

This illness originated from mental exertion and overwork, coupled with irregular exposure to wind and cold, leading to cough and expectoration, eventually causing internal injury. Internal injury refers to damage to the qi of internal organs. As the ancients called it, consumptive disease, it cannot heal unless one abandons mental exertion and overwork. With no mundane thoughts arising, assisted by medicine, longevity might be extended. Prescription: *Maidong* (Ophiopogon Tuber), *Ejiao* (Donkey-Hide Gelatin), *Jiegeng* (Platycodon Root), *Zhigancao* (Prepared Licorice Root), *Shashen* (Glehnia Root), *Yiren* (Coix Seed), *Fuling* (Poria).

This is a true yin deficiency syndrome, commonly known as Hundred-Day Consumption. Slight latent summerheat makes chills and fever worse; pity that treatment was not earlier. Prescription: *Shudi* (Rehmannia Glutinosa Preparata), *Qiancao* (Rubia Root), *Qinghao* (Artemisia Annua Herba), *Yuanshen* (Scrophularia Root), *Huashi* (Talcum), *Danpi* (Moutan Cortex).

The pulse is rapid and wiry, indicating yin deficiency, not external contraction. Now, headache arises from rising deficient fire, showing a trend of dual injury to Metal (Lung) and Water (Kidney). Quiet cultivation is primary; medication is secondary. Prescription: *Shudi* (Rehmannia Glutinosa Preparata), *Nvzhenzi* (Ligustrum Lucidum Fruit), *Maidong* (Ophiopogon Tuber), *Guiban* (Turtle Plastron), *Yuanshen* (Scrophularia Root), *Dan Qiushi* (Light Autumn Stone), made into pills with jujube paste, taken with boiled water.

Heart yin deficiency causes excessive sweating; Lung yin deficiency causes frequent cough; Liver yin deficiency causes fire rising; Kidney yin deficiency causes fever; Spleen yin deficiency causes loose stools. Is this not one True Yin? It is the beginning of weakness syndromes. Knowing only to treat the head for headache is a good physician; knowing that treading on frost leads to solid ice, the gentleman harbors a mind of vigilance. Prescription: *Chao Baishao* (Stir-fried White Peony Root), *Xiao Shengdi* (Small Raw Rehmannia), *Maidong* (Ophiopogon Tuber), *Zaorou* (Jujube Flesh), *Guizhi Jian* (Cinnamon Twig Tip), *Gancao* (Licorice Root), *Qinghao Geng* (Artemisia Annua Stem), *Yunling* (Poria).

This results from Metal and Water failing to support each other, so cough persists. Do not merely treat the Lung. The Lung is a delicate organ; treating it too much increases deficiency. Nor should one generically nourish yin. Prescription: *Beishashen* (Glehnia Root), *Yuzhu* (Polygonatum Odoratum Rhizome), *Yun Fushen* (Poria with Hostwood), *Chuan Shihu* (Dendrobium Officinale Stem), *Tian Xingren* (Sweet Apricot Seed), *Sheng Bian Dou* (Raw Broad Bean).

Divine prescription for treating cough: Sweet Apricot Seeds 2 liang, remove skins and tips, pound into paste. Divide into three doses. Add 3 qian rock sugar to each dose, mix with boiling water, and ingest including the residue. Twice daily, morning and evening. Three doses constitute a cure. Decoction is ineffective.