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("Ao" is the ancient variant of "Nao", interchangeable.)

Cheng Wuji's Commentary: A feeling of depression and discomfort in the heart, with a sense of helplessness and restlessness, more severe than simple irritability (Fan), is termed "Ao". This occurs because after purgation, the Yang pathogenic factor from the exterior sinks inward due to deficiency, becoming knotted and stagnant between the heart and chest. The treatment methods involve either emesis or purgation. If purgation is indicated but emesis is mistakenly used, or if cold-natured drugs are employed to treat heat, myriad transformation syndromes may arise. One must be cautious.

In Taiyang disease, if the pulse is floating, active, and rapid, accompanied by headache, fever, slight night sweats, and aversion to cold, the exterior syndrome remains unresolved. An active and rapid pulse indicates emptiness in the stomach; an external pathogen disturbs the diaphragm, causing shortness of breath, agitation, irritability, and "Ao" (heart palpitations with distress). (Zhi Zi Bai Pi Tang [Gardenia and Phellodendron Bark Decoction] is detailed under Spontaneous Sweating.) After sweating, vomiting, or purging, if deficiency-heat causes irritability, insomnia, tossing and turning, and "Ao", use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction).

In Yangming disease, after purgation, if there is heat on the exterior, warmth in the hands and feet, no formation of Jie Xiong (chest binding), "Ao", hunger but inability to eat, and only sweating on the head, use Zhi Zi Chi Tang.

In Yangming disease, if the pulse is floating and tight, with dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to heat rather than cold, and heaviness of the body, erroneous purgation will cause emptiness in the stomach, disturbance of the diaphragm by external pathogens, "Ao", and coating on the tongue. Use Zhi Zi Chi Tang.

In Yangming disease, after purgation, if there is "Ao" and irritability with dry stool accumulation, use Da Cheng Qi Tang (Major Order the Qi Decoction).

In Yangming disease, if there is no sweating, difficulty in urination, and "Ao", jaundice will inevitably develop (Yin Chen Tang [Artemisiae Scopariae Decoction] or Zhi Zi Bai Pi Tang may be used).

(Cough is attached here.)

Cheng Wuji's Commentary: Coughing with sound but no phlegm is called "Ke"; coughing with sound and phlegm is called "Sou". The Lung governs Qi. Cold affecting the body or cold drinks damaging the interior injure the Lung, causing Qi to reverse and fail to disperse. This strikes the throat and diaphragm, causing itching like insects crawling or a sensation of obstruction in the throat, leading to cough. Severe cases may continue without pause, causing restlessness in sitting or lying, interrupted speech, movement involving the whole body, and audible sounds nearby.

Cough can be caused by cold, retained fluid, exterior conditions, interior conditions, or half-exterior half-interior conditions. The etiology differs, so treatments vary. For example: cough due to retained fluid combined with exterior cold is treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction); cough due to retained fluid combined with interior cold is treated with Zhen Wu Tang (True Warrior Decoction); cough due to pathogenic heat in the half-exterior half-interior is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction).

Cough is a Lung disease, usually requiring dispersing methods, but there are contraindications for sweating. The Classics state: If coughing is accompanied by free urination, do not induce sweating, as this leads to cold limbs. Also: If coughing is treated with sweating, resulting in curling up, chest fullness, and abdominal hardness, it is a counter-indication (Ni). Furthermore, if the pulse is rapid, indicating Heart Fire insulting Lung Metal, the prognosis is poor and may lead to death.

In Taiyang Shang Han (Cold Damage), if the exterior is unresolved and there is water retention in the epigastrium, presenting with dry heaves, fever, and cough, or thirst, diarrhea, dysphagia, difficulty urinating with hypogastric fullness, or wheezing, treat with Xiao Qing Long Tang. (Water in the Stomach causes dry heaves and dysphagia; water attacking the Lung causes wheezing and cough; water stagnating in the chest causes thirst; water entering the intestines causes diarrhea; water accumulating in the Lower Jiao causes difficulty urinating and hypogastric fullness. Xiao Qing Long Tang induces sweating to scatter water. As water qi infiltrates internally, transmission varies, creating various potential symptoms; treat according to the specific presentation.)

In Shang Han, if there is water retention in the epigastrium causing cough with slight wheezing, fever, and no thirst, and the patient feels thirsty after taking the decoction, this indicates the cold pathogen is departing and the condition is resolving. Continue with Xiao Qing Long Tang.

Xiao Qing Long Tang Formula:
Mahuang (Ephedrae Herba, removed nodes), Shaoyao (Paeoniae Radix Alba), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix), Guizhi (Cinnamomi Ramulus, removed rough bark) - each 3 liang; Wuweizi (Schisandrae Fructus), Banxia (Pinelliae Rhizoma, each 0.5 sheng, washed in boiling water), Gancao (Glycyrrhizae Radix et Rhizoma). These eight ingredients are boiled in one dou of water. First boil Mahuang, reduce by two sheng, remove the foam on top, then add the remaining herbs. Boil until three sheng remain, strain, and take one sheng warm.

Modifications:
If there is mild diarrhea, remove Mahuang and add Raohua (Adenophorae Radix) the size of a chicken egg, roasted until red. Diarrhea patients should not have their exterior attacked; sweating will cause abdominal fullness. Mahuang disperses Yang qi, and water infiltration into the Stomach causes diarrhea. Raohua drains twelve types of water retention; once water is gone, diarrhea stops.
If there is thirst, remove Banxia and add Gualougen (Trichosanthis Radix) 3 liang. Banxia is acrid and drying, unsuitable for those with fluid deficiency; thus, it is removed. Gualou is bitter and generates fluids; thus, it is added.
If there is dysphagia, remove Mahuang and add one Pao Fuzi (Aconiti Lateralis Radix Praeparata). The Classics state: Water combined with cold pathogen creates cold stagnation, causing dysphagia. Add Fuzi to warm and scatter cold-water. If a cold patient undergoes sweating again, Stomach cold may cause vomiting of roundworms; remove Mahuang as it promotes sweating.
If there is difficulty urinating and hypogastric fullness, remove Mahuang and add Fuling (Poria) 4 liang. Water accumulation in the Lower Jiao causes these symptoms. Mahuang disperses fluids outward, which is inappropriate here; Fuling drains water downward, which is appropriate.
If there is wheezing, remove Mahuang and add Xingren (Prunus Semen) 0.5 sheng, removed skin and tips. *Jin Gui Yao Lue* states: If the patient has edema, do not use Mahuang; use Xingzi (Almond) instead, because Mahuang disperses Yang qi. Wheezing and edema are manifestations of water qi. Xiao Qing Long Tang corresponds to the two branches of the Liver, treating dual injuries. Da Qing Long Tang treats dual injury of Ying and Wei; this formula treats exterior unresolved plus water in the chest. Neither Ma Huang Tang nor Gui Zhi Tang can resolve this; only Xiao Qing Long Tang can dispel both exterior and interior pathogens.
Mahuang is the Sovereign herb to sweat the exterior; Guizhi and Gancao assist Mahuang in dispersing as Ministers; cough and wheezing indicate reversed Lung Qi. *Nei Jing* states: The Lung desires astringency; quickly consume sour foods to astringe it. Therefore, Shaoyao (sour-cold) and Wuweizi (sour-warm) are used as Assistants to astringe reversed Qi. Water in the chest prevents fluid circulation, causing Kidney Qi dryness and urgency; consume pungent foods to moisten it. Ganjiang and Xixin are pungent-hot; Banxia is pungent-warm-mildly hot, used as Envoys to scatter cold-water and reversed Qi. When cold-water scatters and fluids circulate, sweating resolves the condition.
Due to varied transmission of water in the chest, modifications are needed. Water accumulation prevents fluid circulation, causing dryness and thirst; removing Banxia allows fluids to recover. Gualougen is bitter-slightly-cool, moistening dryness; adding it circulates fluids and directs water downward into the intestines, causing diarrhea. Diarrhea patients should not have their exterior attacked; Mahuang is purely dispersing and unsuitable for diarrhea, so it is removed. Raohua is bitter-cold, a cathartic agent that drains water; once water is gone, diarrhea stops, so Raohua is added.
For dysphagia, remove Mahuang and add Fuzi. The Classics state: Water meets cold pathogen, creating cold stagnation, causing dysphagia. Dysphagia indicates Stomach Qi exhaustion. Mahuang sweating is unsuitable for Stomach deficiency-cold; thus, it is removed. Fuzi is pungent-hot; heat warms Qi, pungency scatters cold, so it is used as an Assistant to dispel cold.
Generally, pathogens outside the body are treated by sweating; inside by purging; above by emesis; below by leaching. Water in the Lower Jiao causing difficulty urinating and hypogastric fullness should be treated by leaching, not sweating; thus, remove Mahuang and add Fuling. Fuling is sweet-bland, specifically moving fluids. *Nei Jing* states: Dampness invading internally is treated by bland leaching.
For wheezing, remove Mahuang. Wheezing is reversed Qi; Mahuang disperses Yang, so it is removed. Xingren is bitter-sweet-warm, added to drain reversed Qi. *Jin Gui Yao Lue* states: Edematous patients do not use Mahuang but use Almonds because Mahuang disperses Yang, leading to wheezing and edema.

Shaoyang Shang Han on the sixth day, Wind Strike, with alternating chills and fever, fullness and distress in the chest and hypochondrium, silence with lack of appetite, irritability, frequent vomiting, slight fever, or cough, is treated with Xiao Chai Hu Tang, removing Renshen, adding Wuweizi and Ganjiang.

Yangming disease: Cough with resolved exterior and excess in the Stomach belongs to Yangming. If there is unexpectedly no sweating, free urination, vomiting, and cold limbs, headache will occur. If there is only dizziness, no aversion to cold, and ability to eat, sore throat will occur (see Excess in Stomach).

Shaoyin disease: Cough with diarrhea, delirium, and difficult urination results from fire therapy劫夺 (robbing/stealing) of Qi (see Diarrhea). Shaoyin disease with Si Ni pattern and cough is treated with Si Ni San adding Wuweizi and Ganjiang, each 5 fen. Shaoyin disease with diarrhea for six to seven days, cough, vomiting, thirst, irritability, and insomnia is treated with Zhu Ling San. Shaoyin disease lasting two to three days, progressing to four to five days with abdominal pain, difficulty urinating, heavy/painful limbs, and spontaneous diarrhea indicates water qi; if coughing occurs, treat with Zhen Wu Tang adding Wuweizi 0.5 sheng, Xixin, and Ganjiang, each 1 liang.

Shang Han with cough, reversal of Qi, and scattered pulse indicates death due to physical depletion. Cough with urinary incontinence should not be treated with sweating, as this leads to cold limbs (see Urinary Incontinence).

Attached Formulas

Yun Qizi's Formula: For post-sweating persistent cough/wheezing fearing progression to Lung萎 (Flaccidity), use Bu Fei San (Lung Tonifying Powder).
Renshen (Ginseng Radix et Rhizoma) 1 liang, Wuweizi 5 qian, Sangbaipi (Mori Cortex) 2 liang, Kua Donghua (Farflos Flos), Gejie (Gecko). Grind to fine powder. Take 5 qian mixed with one cup of boiling water.

For post-sweating/purgation cough with Lung deficiency and hoarse voice, use E Jiao San (Donkey-Hide Gelatin Decoction).
Shuyu (Dioscoreae Rhizoma), E Jiao (Colla Corii Asini, fried), Wuweizi, Maidong (Ophiopogonis Radix, heart removed), Baizhu (Atractylodis Macrocephalae Rhizoma) - each 1 liang; Ganjiang (roasted), Guizhi - each 2 qian; Xingren (removed skin/tips) 3 qian. Cut finely. Take 7 qian with two cups of water and one qian of Wumei (Mume Fructus) flesh, decoct and take.

For post-sweating/purgation wheezing/cough with irritability, Qi stagnation, and rebellious pathogenic Qi, use Jie Geng Tang (Platycodon Decoction).
Jiegeng (Platycodonis Radix), Sangbaipi - each 1 liang; Gancao, Beimu (Fritillariae Bulbus), Helile (Terminaliae Fructus) - each 5 qian. Grind to powder. Take 5 qian with one qian each of Wuweizi and Wumei flesh, two cups of water, decoct and take.

Renshen Shigao Tang: Treats persistent Shang Han cough, irritability, wind-heat headache, mental fatigue, and confusion.
Renshen (rhizome removed) 0.5 qian, Shigao (Gypsum Fibrosum) 1 liang, Banxia (washed in boiling water), Zhizi Ren (Gardeniae Semen), Huangqin (Scutellariae Radix) - each 1 qian; Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhu, Fuling (removed skin), Zhimu (Anemarrhenae Rhizoma) - each 1.5 qian; Gancao (roasted) 2 qian. One dose, two cups of water, three slices of Shengjiang (Zingiberis Rhizoma Recens), decoct to one cup, take at any time.

Wu Shi's Advice: For exterior cold cough with floating pulse, aversion to cold, body ache/stiffness, and no sweating, use Ma Huang Tang or San Ao Tang to induce sweating. For sticky phlegm, use Jin Fei Cao San to induce sweating. If heat is present, use Shen Su Yin removing Muxiang, adding Renshen, Sangbaipi, Xingren, and Mahuang to induce sweating; adjust based on season and condition. For weak individuals contracting wind-cold with cough/phlegm, aversion to wind, headache, or dry heaving, use Renshen Xingren Tang. For Shang Han transmitting to Shaoyang on day 2-3, with wiry pulse, bitter taste, fever, and cough, use Xiao Chai Hu Tang removing Renshen, Dazao, and Shengjiang, adding Wuweizi and Ganjiang. If fever, chest irritability/fullness, and cough occur, add fried Gualou. If hypochondriac fullness, fever, and cough occur, add Zhike and Jiegeng. For Yin patterns with cold limbs, deep/thin pulse, and cough, use Si Ni Tang adding Wuweizi. Generally, Shang Han cough differs from miscellaneous diseases. Following Zhang Zhongjing's examples, cough is treated with Wuweizi and Ganjiang regardless of Yin/Yang differentiation. Wuweizi astringes Lung Qi to stop cough; Ganjiang's acrid-warm nature disperses reversed Qi in the Lung meridian.

Hoarseness (Loss of Voice)

She Gan Tang: Treats early autumn heavy rain/cold or epidemic sudden cold, where heat hides internally, causing difficult breathing, hoarseness/loss of voice, dry cough without phlegm, and throat obstruction sensation.
Shegan (Belamcandae Rhizoma), Ziwan (Asteri Radix), Danggui (Angelicae Sinensis Radix), Duhuo (Angelicae Pubescentis Radix), Mahuang, Gancao - each 1 liang; Shengjiang (roasted), Ju pi (Citri Reticulatae Pericarpium), Rougui (Cinnamomi Cortex, removed rough bark), Zhishi (Aurantii Fructus Immaturus, roasted) - each 2 liang; Banxia (washed) 2.5 liang; Xingren (removed skin/tips, roasted) 1.5 liang. Coarsely crush. Take 5 qian with one and a half cups of water, decoct to 0.8 cups, strain, and take warm.