上四味。末之。蜜丸如梧子大。先食饮服一丸。日三服。（小服而频示缓治之意。
）稍增。（大抵可渐增至五丸及十丸。）口中有津液渴者。加芒硝半两。（渴。不应
有津液。今津液多而久渴。故知胃有实热也。加芒硝以下之。所以救胃也。）
（无物曰呕。有物曰吐。病患）卒（然）呕吐。（邪从上越。则心下宜空旷无碍。
乃仍然）心下痞。（是）膈间（停蓄）有水。（水阻阳气不升。则）眩（水凌心主不
安。则）悸者。（宜辛温以开上焦之痞。淡渗以通决渎之壅。以）小半夏加茯苓汤主之。
此言膈间有水之治法。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（四两）
上三味。以水七升。煮取一升五合。分温再服。
假令瘦人。（则不应有水。今乃）脐下有悸。（是水动于下也。）吐涎沫（是水逆
于中也。）而（且头目）颠眩。（是水犯于上也。形体虽瘦。而病实有水。）此水（之
变机）也。（以）五苓散主之。
此言水之犯于上中下之治法。
五苓散方
泽泻（一两六铢） 猪苓 茯苓 白术（各十八铢） 桂枝（半两）
上五味为末。白饮服方寸匕。日三服。多服暖水。汗出愈。（盖欲使表里分消其水。
非挟有表邪而欲两解之谓。）
附方
外台茯苓饮 治心胸中有停痰宿水。自吐出水后。心胸间虚气满。不能食。消
痰气。令能食。
茯苓 人参 白术（各三两） 枳实（二两） 橘皮（二两半） 生姜（四两）
上六味。以水六升。煮取一升八合。分温三服。如人行八九里。进之。
此痰饮善后最稳当之方。
（咳嗽症。表里寒热虚实七情劳伤俱致之。最为虚损大关头。然泛而求之。条绪
纷繁。连编累牍。不能尽也。切而求之。可以不烦言而喻。盖）咳家。其脉弦。为有水。
十枣汤主之。
此提出咳家之大源头。治咳之大手法。俨如云端指示也。后人畏其峻而不敢用。自
二陈汤六安煎治嗽散。以及于宁嗽汤八仙长寿丸六八味丸杏仁酪燕窝粥之类。皆姑息养
奸。引入虚损之门而死。余愿若辈发天良而自问。其亦当知变计矣。
许仁则云、饮食咳者。由所饮之物。停滞在胸。水气上冲。肺得此气。便成咳嗽。经
久不已。渐成水病。其状不限四时昼夜。遇诸动嗽物。即剧。乃至双眼突出。气如欲
断。汗出。大小便不利。吐痰饮涎沫无限。上气喘急。肩息。每旦眼肿。不得平眠。此
即咳家有水之证也。自着有干枣三味丸方亦佳。大枣六十枚。葶苈一升。杏仁一升。
合捣作丸。桑白皮饮下七八丸。日再稍稍加之。以大便通利为度。
按许氏代方。一则胆识不及。一则趋时行道。轻证可以取用。若重证不如三因十枣丸。
犹存古人遗轨。
十枣汤方（见上）
夫有支饮家。（饮气扰乱清道。动肺则）咳（动心则）烦（搏击阳气则）胸中痛者。
（已有死道。犹）不卒死。（延）至一百日。或一岁。（虽虚而元气未竭。医者不可逡
巡畏缩。）宜以十枣汤。（单刀直入以救之。此不恤名不避怨。自尽其道然也。若未至
于一百日及一岁。更不必言矣。）
此承上节而言。十枣汤虽峻。舍此并无良法也。
喻嘉言云、咳嗽必因之痰饮。而五饮之中。独膈上支饮。最为咳嗽根底。外邪入而
合之。固嗽。即无外邪。而支饮渍入肺中。自令人咳嗽不已。况支饮久蓄膈上。其下焦之
气。逆冲而上者。尤易上下合邪也。以支饮之故。而令外邪可内。下邪可上。不去支饮。
其咳终无宁宇矣。去支饮用十枣汤。不嫌其峻。岂但受病之初。即病蓄已久。亦不能
舍此别求良法。其曰咳家其脉弦为有水。十枣汤主之。正谓弦急之脉。必以治饮为急也。
犹易治也。其曰夫有支饮家。咳烦胸中痛。不卒死。至一百日一岁。宜十枣汤。此则
可以死而不死者。仍不外是方去其支饮。不几令人骇且疑乎。凡人胸膈孰无支饮。其害
何以若此之大。其去害何必若此之力。盖膈上为阳气所治。心肺所居。支饮横据其中。
动肺则咳。动心则烦。搏击阳气则痛。逼处其中。荣卫不行。神魄无根据。则卒死耳。至
一百日一年而不死。阳气未散。神魄未离可知。惟急去其邪。则可安其正。所以不嫌于
峻攻也。扫除阴浊。俾清明在躬。较悠悠姑待其死。何得何失耶。
久咳数岁。（缘支饮积肺而咳。饮久不已。则咳亦久而不已也。）其脉弱者。（知
邪不进。为）可治。实大数者（知邪日进。故）死。其脉虚者。（知正衰邪亦衰也。然
邪虽衰。而正不能御
之。亦足以上蔽清阳之气。故）必苦冒。（盖以）其人本有支饮在胸中故也。（十枣汤固
为正法。而病家往往惑于时医之言而弃之。究竟当知其不易之治法。）治属饮家。
此复申言治咳必先治饮。即未定十枣汤之方。总不外十枣汤之意。寓蠲饮于补养之
中也。
（然十枣汤虽为攻饮之良方。但其专主内饮。而不主外寒也。若）咳（而气）逆
倚（几而）息（能俯凭而）不得（仰）卧。（咳逆之甚。何以至此。大抵久病多属水饮。
新病每兼形寒。以）小青龙汤主之。（内饮外寒。兼驱为得。）
此节之上。以水饮为主。而出十枣汤一方。此节之下。以内饮外寒为主。而出小青
龙汤一方。后从青龙而加减之。为咳证立两大法门。
小青龙汤方（见上）
青龙汤（温散。惟有余之人宜之。若误施于下虚之人。其汤）下（咽）已。（即动
其冲气。冲脉起于下焦。挟肾脉上行至喉咙。故）多唾口燥。（厥气上行。而阳气不治。
故）寸脉沉。尺脉微。手足厥逆。（然多唾口燥。尚未显上冲之形也。甚者）气从小
腹上冲胸咽。（手足厥逆。尚未至于痹也。甚者）手足（不用而）痹。（且）其面（色
）翕热如醉状。（自腹而胸而咽而口而面。高之至也。然犹未至于脱。其上浮之阳。）
因复下流阴股。（而不归其源。以行气化。以致）小便（甚）难。（然既已下流。而）
时复（上）冒者。（其故何也。盖以肾邪挟冲大动。而龙雷之火无归。如电光之闪烁无
定也。宜）与茯苓桂枝五味甘草汤治其气冲。
此言误服青龙。动其冲气。特出救逆之方治也。
苓桂五味甘草汤方
桂枝 茯苓（各四两） 五味（半升） 甘草（三两炙）
上四味。以水八升。煮取三升。去滓。分温三服。
（今借苓桂味甘之方。服后）冲气即低。而反更咳。胸满者。（是下焦冲逆之气既
平。而肺中之寒饮续出也。）用桂苓五味甘草汤去桂加干姜细辛。以治其咳满。
此为肺中伏匿之寒饮。而出其方治也。桂气胜而主气。姜味胜而主形。以冲气既降。
而寒饮在胸。寒饮为有形之病。重在形不重在气也。可知古人用药之严。
苓甘五味姜辛汤方
茯苓（四两） 甘草 干姜（三两） 细辛（三两） 五味子（半升）
上五味。以水八升。煮取三升。去滓。温服半升。日三服。
（服前方。）咳满即止。而更复（作）渴。冲气复发者。以细辛干姜为热药（以逼之
）也。服之当遂渴。（若渴而不已。自当另筹甘润咸寒降逆之剂。今者渴病甫增。未治其
渴。）而渴反止者。（火不胜水。）为（有）支饮（故）也。（但有）支饮者。（必有
的据。）法当冒。冒者必呕。呕者。（有水也。）复（用前汤。）内半夏以去其水。
此言咳满得细辛干姜而止。而冲气又因细辛干姜而发者。宜于渴与不渴辨之。若渴
不止者。另治其冲。若渴即止而冒与呕者。惟治其水饮。半夏一味。去水止呕降逆。俱
在其中。审其不渴。则用无不当矣。
苓甘五味姜辛半夏汤方
茯苓（四两） 甘草（二两） 细辛（二两） 干姜（二两） 半夏（半升） 五
味（半升）
上六味。以水八升。煮取三升。去滓。温服半升。日三服。
（水在胃者。为冒为呕。水在肺者。为喘为肿。今）水去呕止。其人形肿者。（胃
气和而肺气未通也。用前方）加杏仁主之。其证应内麻黄。以其人遂痹。故不内之。若
逆而内之者必厥。所以然者。以其人血虚。（阳气无偶。发之最易厥脱。此方以杏仁代
麻黄。因）麻黄发其阳故也。
此为咳家形肿而出其方治也。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两） 甘草 干姜 细辛（各三两） 五味 半夏 杏仁（各半升）
上七味。以水一斗。煮取三升。去滓。温服半升。日三服。
若（兼见）面热如醉。此为胃热上冲熏其面。（即于前方）加大黄以利之。
此为前证面热如醉者。出其方治也。面热如醉。篇中两见。而义各不同。前因冲气。
病发于下。此不过肺气不利。滞于外而形肿。滞于内而胃热。但以杏仁利其胸中之气。
大黄利其胃中之热。则得耳。
尤在泾云、水饮有挟阴之寒者。亦有挟阳之热者。若面热如醉。则为胃热随经上冲
之证。胃之脉上行于面故也。即于消饮药中。加大黄以下其热。与冲气上逆。其面翕热如
醉者不同。冲气上行者。病属下焦阴中之阳。故以酸温止之。此属中焦阳明之阳。故以
苦寒下之也。
愚按咳嗽证。金匮两见。一在肺痈肺痿之下。大抵以润燥为主。一在痰饮之下。大
抵以治饮为先。此仲师咳嗽各证。以此二法。立经权常变之钤法也。然其义蕴。过于深
奥。难与中人以下语之。时传方书。繁
杂不可为训。而张隐 高士宗二家。虽未精粹。尚不支离。姑录之以备参考。
张隐 云、咳者肺病也。有邪在皮毛而为肺咳者。有五脏受邪。各传之于肺而为咳
者。此外因之咳也。有寒饮食入胃。从肺脉上至于肺。则肺寒而咳者。有脏腑之郁热。
上蒸于肺而为咳者。此内因之咳也。盖肺者。五脏之长也。轻清而华盖于上。是以脏腑
之病。皆能相传于肺而为咳。然其未见于肺。而其本在于脏腑之间。故当以本末之法。
兼而行之。治无不应矣。咳论曰。肺咳之状。咳而喘息有音。甚则咯血。心咳之状。咳
则心痛。喉仲介介如梗状。甚则咽肿喉痹。肝咳之状。咳则两胁下痛。甚则不可以转。
转则两 下满。脾咳之状。咳则右胁下痛。阴阴引肩背。甚则不可以动。动则咳剧。肾
咳之状。咳则肩背相引而痛。甚则咳涎。胃咳之状。咳而呕。呕甚则长虫出。胆咳之状。
咳呕苦汁。大肠咳状。咳而遗矢。小肠咳状。咳而矢气。气与咳俱矢。膀胱咳状。咳
而遗溺。三焦咳状。咳而腹满。不欲饮食。
高士宗云、语云、诸病易治。咳嗽难医。夫所以难医者。缘咳嗽根由甚多。不止于
肺。今世遇有咳嗽。即曰肺病。随用发散消痰清凉润肺之药。药日投而咳日甚。有病之
经脉。未蒙其治。无病之经脉。徒受其殃。至一月不愈。则弱证将成。二月不愈。则弱
证已成。延至百日。身命虽未告殂。而此人已归不治之证矣。余因推本而约言之。素问
咳论云。五脏六腑。皆令人咳。非独肺也。是以咳病初起。有起于肾者。有起于肝者。
有起于脾者。有起于心包者。有起于胃者。有起于中上二焦者。有起于肺者。治当察其
原。察原之法。在乎审证。若喉痒而咳。是火热之气上冲也。火欲发而烟先起。烟气
冲喉。故痒而咳。又有伤风初起。
喉中一点作痒。咽热饮则少苏。此寒凝上焦。咽喉不利而咳也。或寒或热。治当和其上
焦。其有胸中作痒。痒则为咳。此中焦津血内虚。或寒或热而为咳。法当和其中焦。此
喉痒之咳。而属于上中二焦也。若气上冲而咳。是肝肾虚也。夫心肺居上。肝肾居下。
肾为水脏。合膀胱水腑。随太阳之气。出皮毛以合肺。肺者天也。水天一气。营运不息。
今肾脏内虚。不能合水腑而行皮毛。则肾气从中土以上冲。上冲则咳。此上冲之咳而
属于肾也。又肝藏血。而冲任血海之血。肝所主也。其血则热肉充肤。澹渗皮毛。卧则
内归于肝。今肝脏内虚。不合冲任之血。出于肤腠。则肝气从心包以上冲。上冲则咳。
此上冲之咳而属于肝也。又有先吐血。后咳嗽者。吐血则足厥阴肝脏内伤。而手厥阴心
包亦虚。致心包之火。上克肺金。心包主血脉。血脉虚。夜则发热。日则咳嗽。甚则日
夜皆热皆咳。此为虚劳咳嗽。先伤其血。后伤其气。阴阳并竭。血气皆亏。服滋阴之药
则相宜。服温补之药则不宜。如是之咳。百无一生。此咳之属于心包也。又手太阴属肺
金。天也。足太阴属脾土。地也。在运气则土生金。在脏腑则地天交。今脾土内虚。土
不胜水。致痰涎上涌。先脾病。而地气不升。因而肺病。为天气不降。咳必兼喘。此咳
之属于脾与肺也。又胃为水谷之海。气属阳明。足阳明主胃。手阳明主大肠。阳明之上。
燥气治之。其气下行。今阳明之气。不从下行。或过于燥而火炎。或失其燥而停饮。
咳出黄痰。胃燥热也。痰饮内积。胃虚寒也。此为肠胃之咳。咳虽不愈。不即殒躯。治
宜消痰散饮。此咳之属于胃也。夫痰聚于胃。必从咳出。故咳论云。聚胃关肺。使不知
The above four ingredients are ground into powder, mixed with honey, and formed into pills the size of a wu zi (seed of Coknusa obtusifolia). Take one pill with warm water before meals, three times a day. (Taking small doses frequently indicates the intention of slow treatment.) Gradually increase the dose. (Generally, it can be gradually increased to five pills and then ten pills.) If there is an abundance of saliva in the mouth but thirst persists, add Banxia Xiaomai (Mangxiao, 芒硝) half liang. (Thirst should not be accompanied by abundant saliva; the presence of abundant saliva with chronic thirst indicates excess heat in the stomach. Mangxiao is added to purge the heat, thereby saving the stomach.)
(If nothing is vomited, it is called "Ou" (retching); if something is vomited, it is called "Tu" (vomiting). The patient experiences sudden vomiting. (Since the pathogenic factor is expelled from above, the epigastrium should be empty and unobstructed, yet it remains) full and obstructed (Pi). (This indicates that) water has accumulated between the diaphragm. (Water obstruction prevents the ascending of Yang Qi, leading to) dizziness (Xuan), and (water overwhelming the Heart Master causing unrest leads to) palpitations (Ji). (Treatment should employ acrid-warm herbs to open the obstruction in the Upper Jiao, and bland-leaching herbs to unblock the congestion of the San Jiao. Use Xiao Banxia Jia Fuling Tang as the primary formula.)
This section discusses the treatment for water accumulation between the diaphragm.
Formula: Xiao Banxia Jia Fuling Tang (Minor Pinellia plus Poria Decoction)
Banxia (Pinelliae Rhizoma, 1 sheng) Shengjiang (Zingiberis Recensis Rhizoma, 0.5 jin) Fuling (Poria, 4 liang)
Take the above three ingredients, decoct with seven sheng of water, reduce to one sheng and five he, and divide into two warm doses.
Suppose a thin person. (Such a person should not have water retention, yet now there is) palpitation below the umbilicus. (This indicates water moving in the lower part.) Vomiting of saliva and foam (indicates water counterflow in the middle). And (dizziness of the head and eyes) Xuan. (This indicates water invading the upper part. Although the body is thin, the pathology involves actual water retention.) This is the mechanism of water variation. (Use Wuling San as the primary formula.)
This section discusses the treatment for water invading the upper, middle, and lower parts.
Formula: Wuling San (Five-Ingredient Powder with Poria)
Zexie (Alismatis Rhizoma, 1 liang 6 zhu) Zhuling (Polyporus, unspecified amount) Fuling (Poria, unspecified amount) Baizhu (Atractylodis Macrocephalae Rhizoma, 18 zhu each) Guizhi (Cinnamomi Ramulus, 0.5 liang)
Grind the above five ingredients into powder. Take one fang cun bi (square-inch measure) with rice water, three times a day. Drink plenty of warm water afterwards. Recovery occurs with sweating. (The intention is to dissipate water through both exterior and interior, not necessarily to resolve an exterior pathogen simultaneously.)
Attached Formula: Waitai Fuling Yin (Fuling Decoction from Waitai Mi Yao)
Treats retained phlegm and old water in the heart and chest. After vomiting out the water, there is a feeling of empty fullness in the chest and heart, inability to eat. It resolves phlegm and Qi, enabling eating.
Fuling (Poria) Renshen (Ginseng Radix et Rhizoma) Baizhu (Atractylodis Macrocephalae Rhizoma) (each 3 liang) Zhishi (Aurantii Fructus Immaturus, 2 liang) Chupi (Citri Reticulatae Pericarpium, 2.5 liang) Shengjiang (Zingiberis Recensis Rhizoma, 4 liang)
Take the above six ingredients, decoct with six sheng of water, reduce to one sheng and eight he, and divide into three warm doses. Take another dose after walking for about eight or nine li.
This is the most prudent and appropriate formula for post-treatment care of phlegm-fluid diseases.
(Cough is caused by exterior/interior, cold/heat, deficiency/excess, Seven Emotions, and overwork. It is a critical juncture for severe deficiency. However, a general search yields complex details that cannot be fully listed. A focused approach makes it clear without much explanation. Generally, for those with chronic cough, if the pulse is Xian (string-like), it indicates water retention. Use Shizao Tang as the primary formula.)
This highlights the root cause of cough and the major method of treatment, like guidance from the clouds. Later generations fear its harshness and dare not use it. Formulas such as Erchen Tang, Liu'an Jian, Zhisou San, Ningsou Tang, Baxian Changshou Wan, Liuba Wei Wan, Xingren Lao, and Yanyan Zhou are merely indulgent and lead to deficiency and death. I wish these practitioners would reflect on their conscience and change their methods.
Xu Renze said: "Dietary cough" arises when ingested substances stagnate in the chest, and water Qi rushes upward. The Lung receives this Qi and becomes cough-prone. If prolonged, it gradually becomes a water disease. Symptoms are not limited by season or time. Exposure to triggers exacerbates it, potentially causing bulging eyes, breathlessness, sweating, difficulty in urination and defecation, excessive vomiting of phlegm and saliva, upper asthma, orthopnea, morning eyelid edema, and inability to lie flat. This is the syndrome of water in chronic coughers. He also proposed Gan Zao San Wei Wan (Three-Ingredient Pill with Dried Dates), which is good: 60 large dates, Tingli (Descurainiae Semen seu Lepidii Semen, 1 sheng), Xingren (Armeniacae Semen Amarum, 1 sheng). Pound together into pills. Take 7-8 pills with Sangbaipi (Mori Cortex) decoction, twice daily, gradually increasing until bowel movements become loose.
Regarding Xu's prescription, it lacks courage and follows contemporary trends. It may be used for mild cases, but for severe cases, Sanyin Shizao Wan is better, preserving ancient traditions.
Formula: Shizao Tang (Ten-Date Pill) (See above)
For those with Zhi Yin (Supporting Fluid), (fluid Qi disturbs the clear pathways, affecting the Lung causes) cough, (affecting the Heart causes) irritability, (and clashing with Yang Qi causes) chest pain. (Although there is a path to death, they do not die suddenly.) They survive for one hundred days or a year. (Although deficient, Yuan Qi is not exhausted; the physician must not hesitate or shrink back.) Use Shizao Tang. (Strike directly to save them. This disregards reputation and avoids resentment, fulfilling the duty. If it has not reached one hundred days or a year, further discussion is unnecessary.)
This continues from the previous section: although Shizao Tang is harsh, there is no other good method besides it.
Yu Jiayan said: Cough is inevitably due to phlegm-fluid. Among the five fluids, only Zhi Yin in the diaphragm is the root of cough. When external pathogens combine with it, cough occurs. Even without external pathogens, Zhi Yin soaking into the Lung causes persistent cough. Moreover, long-standing Zhi Yin in the diaphragm allows Lower Jiao Qi to rush upward, easily combining with upper and lower pathogens. Due to Zhi Yin, external pathogens can enter internally, and lower pathogens can rise upward. Without removing Zhi Yin, the cough will never cease. To remove Zhi Yin, use Shizao Tang; do not fear its harshness. Not only at the beginning of the disease, but even after long accumulation, no other good method exists. When he says "chronic coughers with string-like pulse have water, use Shizao Tang," it means that a string-like pulse urgently requires treating fluid. This is relatively easy to treat. When he says "for those with Zhi Yin, cough, irritability, chest pain, surviving beyond one hundred days or a year, use Shizao Tang," this refers to those who could have died but didn't, still relying on this formula to remove Zhi Yin. Isn't this startling and suspicious? Everyone has Zhi Yin in the chest/diaphragm; why is its harm so great, and why must removal be so forceful? The diaphragm is governed by Yang Qi and houses the Heart and Lung. Zhi Yin occupies it horizontally, affecting the Lung causing cough, affecting the Heart causing irritability, clashing with Yang Qi causing pain. Trapped within, Ying and Wei cannot circulate, Shen and Po have no foundation, leading to sudden death. Surviving a year implies Yang Qi is not scattered and Shen/Po have not left. Only by urgently removing the pathogen can Zheng Qi be secured; hence, harsh purging is acceptable. Clearing yin turbidity restores clarity. Compared to waiting passively for death, what is gained and lost?
Chronic cough lasting several years. (Due to Zhi Yin accumulating in the Lung causing cough; if fluid persists, cough persists.) If the pulse is weak, (indicating the pathogen is not advancing, it is) treatable. If the pulse is solid, large, and rapid, (indicating the pathogen advances daily, it is) fatal. If the pulse is empty, (indicating both healthy Qi and pathogen are declining. However, although the pathogen declines, healthy Qi cannot resist it, and it still obscures clear Yang Qi, thus) suffering from dizziness (Mao). (Because the person originally had Zhi Yin in the chest.) (Shizao Tang is indeed the correct method, but patients often abandon it due to advice from contemporary physicians. Ultimately, one must know this unchanging treatment.) Treatment belongs to fluid-disease specialists.
This reiterates that treating cough requires treating fluid first. Even without fixing the Shizao Tang formula immediately, the intent remains the same, embedding fluid-resolving within nourishing methods.
(However, although Shizao Tang is an excellent formula for attacking internal fluid, it specifically targets internal fluid and does not address external cold. If) cough (with Qi) counterflow, leaning on furniture to breathe, unable to lie flat (on the back). (Severe cough-counterflow leads here. Generally, chronic illness relates to water-fluid, while acute illness often combines with cold. Use Xiao Qinglong Tang as the primary formula.) (Internal fluid and external cold are treated concurrently for best results.)
The upper part of this section focuses on water-fluid, presenting Shizao Tang. The lower part focuses on internal fluid and external cold, presenting Xiao Qinglong Tang. Later modifications from Qinglong Tang established two major categories for cough treatment.
Formula: Xiao Qinglong Tang (Minor Green Dragon Decoction) (See above)
Qinglong Tang (Warming and dispersing, suitable only for those with excess. If mistakenly administered to those with lower deficiency,) upon swallowing, (it moves Chong Qi. The Chong Mai originates in the Lower Jiao, runs alongside the Kidney Meridian to the throat, thus causing) excessive salivation and dry mouth. (Rebellious Qi rises, and Yang Qi fails to govern, thus) Cun pulse is deep, Chi pulse is faint, with cold extremities. (However, excessive salivation and dry mouth do not yet show signs of upward rushing. In severe cases,) Qi rushes from the lower abdomen to the chest and throat. (Cold extremities are not yet numbness. In severe cases,) extremities become (numb and) bi-syndrome. (And) the face appears flushed and hot like drunkenness. (From abdomen to chest, throat, mouth, to face, reaching the highest point, yet not yet collapse, this floating Yang.) Then flows down to the inner thighs. (Not returning to its source to transform Qi, resulting in) difficult urination. (Yet having flowed down, there is) occasional dizziness. (Why is this? Because Kidney pathogen combined with Chong Qi movement causes Dragon-Lei Fire to have no home, flickering like lightning. Use Ling Gui Wu Wei Gan Cao Tang to treat the Qi rush.)
This explains that mistakenly taking Qinglong Tang moved Chong Qi, presenting a rescue formula.
Formula: Ling Gui Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction)
Guizhi (Cinnamomi Ramulus) Fuling (Poria) (each 4 liang) Wuwei Zi (Schisandrae Chinensis Fructus, 0.5 sheng) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 3 liang)
Take the above four ingredients, decoct with eight sheng of water, reduce to three sheng, strain, and divide into three warm doses.
(Taking the Ling-Gui-Wu-Wei-Gan formula,) the Qi rush subsides, but cough and chest fullness worsen. (This means the rebellious Qi from the Lower Jiao has calmed, but cold-fluid in the Lung continues to emerge.) Use Guiling Wuwei Gancao Tang, remove Guizhi, add Ganjiang and Xixin, to treat the cough and fullness.
This addresses cold-fluid hidden in the Lung. Guizhi is strong in Qi, Ganjiang is strong in Form. Since the Qi rush has subsided and cold-fluid is in the chest, and fluid is a tangible pathology, emphasis is on Form rather than Qi. This shows the strictness of ancient herbal usage.
Formula: Ling Gan Wu Wei Jiang Xin Tang (Poria, Licorice, Schisandra, Ginger, and Asarum Decoction)
Fuling (Poria, 4 liang) Gancao (Licorice) Ganjiang (Zingiberis Rhizoma, 3 liang) Xixin (Asari Radix et Rhizoma, 3 liang) Wuweizi (Schisandrae Chinensis Fructus, 0.5 sheng)
Take the above five ingredients, decoct with eight sheng of water, reduce to three sheng, strain, take half sheng warm, three times a day.
(Taking the previous formula,) cough and fullness stop, but thirst recurs, and Chong Qi re-emerges. This is because Xixin and Ganjiang are hot herbs (forcing heat). Taking them should cause thirst. (If thirst persists, sweet-moistening, salty-cold, descending agents should be considered. Now thirst has just increased, not yet treated.) But if thirst stops instead. (Fire cannot overcome Water.) It is due to (Zhi) fluid. (But where there is Zhi fluid,) there must be evidence. Methodologically, dizziness should occur. Those with dizziness must vomit. Vomiting indicates (water). Repeat (the previous formula,) add Banxia to remove water.
This explains that although cough/fullness stopped with Xixin/Ganjiang, Chong Qi re-emerged due to them. One must distinguish based on thirst. If thirst persists, treat Chong Qi separately. If thirst stops and dizziness/vomiting occur, treat only the fluid. Banxia alone removes water, stops vomiting, and descends rebellion. If one confirms no thirst, its use is appropriate.
Formula: Ling Gan Wu Wei Jiang Xin Ban Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction)
Fuling (Poria, 4 liang) Gancao (Licorice, 2 liang) Xixin (Asari Radix et Rhizoma, 2 liang) Ganjiang (Zingiberis Rhizoma, 2 liang) Banxia (Pinelliae Rhizoma, 0.5 sheng) Wuwei (Schisandrae Chinensis Fructus, 0.5 sheng)
Take the above six ingredients, decoct with eight sheng of water, reduce to three sheng, strain, take half sheng warm, three times a day.
(Water in the Stomach causes dizziness and vomiting; water in the Lung causes asthma and swelling. Now) water is gone, vomiting stopped, but the person has bodily swelling. (Stomach Qi harmonized, but Lung Qi not yet unblocked. Use the previous formula) add Xingren as primary treatment. This syndrome should include Mahuang, but because the person has numbness/bi, it is not included. If forced inclusion, it would definitely cause syncope/cold extremities. The reason is blood deficiency. (Yang Qi has no companion, dispersing easily leads to collapse. This formula uses Xingren instead of Mahuang because) Mahuang disperses Yang Qi.
This addresses bodily swelling in chronic coughers.
Formula: Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang (Poria, Licorice, Schisandra, Ginger, Asarum, Pinellia, and Apricot Seed Decoction)
Fuling (Poria, 4 liang) Gancao (Licorice) Ganjiang (Zingiberis Rhizoma) Xixin (Asari Radix et Rhizoma) (each 3 liang) Wuwei (Schisandrae Chinensis Fructus) Banxia (Pinelliae Rhizoma) Xingren (Armeniacae Semen Amarum) (each 0.5 sheng)
Take the above seven ingredients, decoct with one dou of water, reduce to three sheng, strain, take half sheng warm, three times a day.
If (accompanied by) face hot like drunkenness, this is Stomach Heat rushing upward steaming the face. (Add Dahuang to the previous formula) to drain it.
This addresses the facial flushing like drunkenness. Facial flushing appears twice in the chapter with different meanings. Previously, it was due to Chong Qi rising from below. Here, it is simply Lung Qi dysfunction, stagnating externally causing swelling, and internally causing Stomach Heat. Using Xingren to benefit Qi in the chest and Dahuang to drain Heat in the Stomach resolves it.
You Zaijing said: Water-fluid can carry Yin-Cold or Yang-Heat. Facial flushing like drunkenness indicates Stomach Heat rushing upward along the meridian. Because the Stomach meridian ascends to the face. Adding Dahuang to fluid-resolving drugs drains the heat. This differs from Chong Qi counterflow with facial flushing like drunkenness. Chong Qi rising belongs to Yang within Yin of the Lower Jiao, so sour-warm herbs stop it. This belongs to Yang of the Middle Jiao Yangming, so bitter-cold herbs drain it.
I note that cough appears twice in *Jinkui Yaolue*: once under Lung Abscess and Lung Flaccidity, primarily focusing on moistening dryness; once under Phlegm-Fluid, primarily focusing on treating fluid. These two methods establish the constant and variable principles for cough. However, the profound meaning is too deep for average practitioners. Contemporary prescription books are complex and unteachable. Zhang Yinyan and Gao Shizong, though not perfect, are not disjointed. I record them for reference.
Zhang Yinyan said: Cough is a Lung disease. Pathogens in the skin/hair cause Lung cough; pathogens in the Five Zang organs transmit to the Lung causing cough. This is external-cause cough. Cold food entering the Stomach, traveling up the Lung meridian to the Lung, causing Lung cold and cough; organ heat steaming upward to the Lung causing cough. This is internal-cause cough. The Lung is the chief of the Five Zang organs, light and pure, covering the top. Thus, diseases of all organs can transmit to the Lung causing cough. Although symptoms appear in the Lung, the root lies in the organs. Therefore, treating both root and branch is necessary for success. *Ke Lun* states: Lung cough presents with cough, wheezing, and sounds; severe cases expectorate blood. Heart cough presents with cough and heart pain, throat feeling obstructed; severe cases throat swelling and obstruction. Liver cough presents with cough and hypochondriac pain; severe cases inability to turn, turning causes fullness. Spleen cough presents with cough and right hypochondriac pain radiating to shoulder/back; severe cases inability to move, moving worsens cough. Kidney cough presents with cough and pulling pain in shoulder/back; severe cases expectorate saliva. Stomach cough presents with cough and vomiting; severe cases roundworms exit. Gallbladder cough presents with cough and vomiting bitter juice. Large Intestine cough presents with cough and fecal incontinence. Small Intestine cough presents with cough and passing gas with cough. Bladder cough presents with cough and urinary incontinence. San Jiao cough presents with cough and abdominal fullness, loss of appetite.
Gao Shizong said: It is said that various diseases are easy to treat, but cough is difficult. The difficulty arises because cough has many roots, not just the Lung. Today, encountering cough, people say it is a Lung disease, using dispersing, phlegm-resolving, cooling, and moistening drugs. As drugs are administered daily, cough worsens. Affected meridians receive no treatment, unaffected meridians suffer harm. If unresolved in one month, weakness develops; in two months, weakness is established; extending to one hundred days, life is not lost, but the case is deemed untreatable. I trace the root and summarize: *Suwen·Ke Lun* states: All Zang and Fu organs cause cough, not just the Lung. Thus, early cough may originate from Kidney, Liver, Spleen, Pericardium, Stomach, Middle/Upper Jiao, or Lung. Treatment must examine the origin, determined by symptom assessment. Throat itching with cough indicates Fire-Heat Qi rushing upward. Fire emits smoke first; smoke hitting the throat causes itching and cough. Wind-cold initial stage causes throat itching, relieved slightly by hot drinks; this is Cold congealing in the Upper Jiao, throat dysfunction causing cough. Cold or Heat, treat by harmonizing the Upper Jiao. Chest itching causing cough indicates Middle Jiao fluid/blood deficiency, Cold or Heat causing cough, treat by harmonizing the Middle Jiao. These are throat-itching coughs belonging to Upper/Middle Jiao. Qi rushing upward causing cough indicates Liver/Kidney deficiency. Heart/Lung reside above, Liver/Kidney below. Kidney is Water organ, paired with Bladder, following Taiyang Qi exiting skin to connect with Lung. Lung is Heaven, Water and Heaven are one Qi, circulating endlessly. Now Kidney interior is deficient, unable to connect with Bladder and exit skin, so Kidney Qi rushes upward from Central Earth, causing cough. This is Qi-rushing cough belonging to Kidney. Liver stores Blood, governing Chong/Ren sea blood. Blood warms flesh, permeates skin, returns to Liver during sleep. Now Liver interior is deficient, unable to release Chong/Ren blood to skin, so Liver Qi rushes upward from Pericardium, causing cough. This is Qi-rushing cough belonging to Liver. Hemoptysis followed by cough indicates Foot-Jueyin Liver injury and Hand-Jueyin Pericardium deficiency, causing Pericardium Fire to attack Lung Metal. Pericardium governs blood vessels; vessel deficiency causes night fever and day cough, or both day and night fever/cough. This is deficiency-consumption cough, injuring Blood first, then Qi, exhausting Yin/Yang and Blood/Qi. Yin-nourishing drugs are suitable; Yang-tonifying drugs are unsuitable. Such coughs rarely survive. This is cough belonging to Pericardium. Hand-Taiyin is Lung Metal (Heaven), Foot-Taiyin is Spleen Earth (Earth). In Yunqi, Earth generates Metal; in Zang-Fu, Earth and Heaven interact. Now Spleen Earth is deficient, unable to control Water, causing phlegm/saliva to surge. Spleen disease first, Earth Qi fails to ascend, causing Lung disease, Heaven Qi fails to descend, cough accompanied by asthma. This is cough belonging to Spleen and Lung. Stomach is Sea of Water/Grain, Qi belongs to Yangming. Foot-Yangming governs Stomach, Hand-Yangming governs Large Intestine. Above Yangming, Dryness Qi governs, Qi descends. Now Yangming Qi does not descend, either too dry causing Fire flare-up or losing dryness causing fluid stagnation. Coughing yellow sputum indicates Stomach dry-heat; internal fluid accumulation indicates Stomach deficiency-cold. This is Gastrointestinal cough. Cough may persist without immediate death; treatment should resolve phlegm and dissipate fluid. This is cough belonging to Stomach. Phlegm gathers in Stomach, must exit via cough. Thus *Ke Lun* states: Phlegm gathers in Stomach, closes Lung...