治肺虚久嗽作喘。
人参 阿胶（各一两三钱，炒） 白茯苓 马兜铃（去老梗） 糯米（各五钱） 杏仁（二
十一粒，制） 甘草（四钱，炙） 为末，取二钱，水煎服。
定喘汤
治 嗽无不取效。
见方脉喘哮门。
夫咳嗽之所以累人者，以其难于立止也。然欲治肺而止嗽，则益害肺而嗽愈甚，
盖肺受病而为嗽者，必有因以迫之，治其因则嗽自愈。若不详所自，而徒事于肺，则气
无所归，或邪无所散，肺愈苦而嗽愈甚矣。凡伤风久而肺气已虚，发热咳嗽，服发散药
而嗽愈甚，或被发散太过者，当用收敛之剂补之。然虚嗽有二日间嗽多，吐痰白沫，或
恶心者，为气虚，宜六君子汤加款冬、五味子。如夜嗽多口渴，痰不易出发热，为血
虚，宜六味地黄料加麦冬、五味子。若刻而脉紧者，咳而羸瘦，脉形坚大者，咳而脱
形。发热脉小坚急者，咳而呕，腹胀且泄，
脉弦急者，皆死不治。肺属金，主于皮毛，所主者气；肾属水，主于骨髓，所藏者精
气轻浮易上而难下，精沉重易下而难上，此物性之自然，有肺之盛者，即热之作也，气
得而上蒸，则不能下生于肾，而肾受邪，故
治肾病必先求之于肺，是清其源而滋其化也。《经》曰∶五脏六腑皆令人咳，非独肺
也。盖五脏各以其时受病，非其时各传以与之。有自外得者，肺主皮毛，风寒暑湿之
邪，自皮毛入内，传脏腑而为嗽也。有自内发者，七情饥饱，内有所伤，则邪气上逆。
肺为气出入之道，故五脏之邪上蒸于肺而为嗽也。然风寒暑湿有不为嗽者，盖因所感者
重，不留于皮毛，径伤脏腑，而成伤寒温热诸病。七情亦有不为嗽者，盖病尚浅，只在
本脏，未传入肺，所以伤寒以有嗽为轻，而七情饥饱之嗽，必久而后发为重也。夫津液
既凝为痰，则不复生血，以周润三焦，故口燥咽干，大便秘结，面如枯骨，毛发焦槁，
妇人则因此月水不通。若能化去败痰，自然服饵有效。然不得过行燥削，使痰湿既消，
津液亦槁，去湿留热，又非其治矣。务使化痰复为津液，犹化盗贼复为良民可也。丹溪
曰∶咳嗽有风寒、有火、有痰、有劳、有肺胀。风寒者，鼻塞声重，恶寒而白，脉弦微
是也，宜发散行痰。又有声哑及喘嗽，遇冬则发，此寒包热也。解表则热自除，感冷则
咳，膈上有痰也，宜解表豁痰。火者有声，痰少而赤是也。劳者，盗汗出兼痰多吐，继
作寒热是也，宜补阴清金。痰者，嗽动便有痰出，痰出嗽止是也，主豁痰。肺胀者，肺
为火伤，遂成郁遏，动则喘满，气急声重，或左或右不得眠，此痰挟瘀血，碍气而病，
宜养血以流动乎气，降火舒肝以清痰。若嗽而胁下痛者，宜疏肝气，以青皮挟痰药，二
陈汤加南星、香附、青黛、青皮、白芥子、姜汁。若血凝气作嗽者，桃仁（去皮、尖），
大黄（酒炒），姜汁丸服。然治咳多用生姜，以其辛散也。初嗽多用发散者，因肺气壅
遏，得解散而宽也。若痰因火动，逆上作嗽者，先治火，次治痰，借其火下而痰亦下
也。如久嗽脉涩，或虽洪大，按之不鼓，属肺虚，宜五味、款冬、紫菀、兜铃之类，敛
而补之。如日数虽久，而脉滑数有力，尚属有余实火，还宜清肺，寻火寻痰而治之。凡
饮水一二口而暂止者，并饮酒后而嗽减者，冷嗽也。咳与嗽，本两字义，《内经》作一
证连言之，咳者，气动也，阳也。嗽者，兼血也，阴也。故曰咳者，有声无痰，本伤乎
气；嗽者，有痰无声，本伤乎血；声痰俱发，气血俱伤，其本虽殊，其标则一。
《经》曰∶秋伤于湿，冬必咳嗽，是知脾无留湿，虽伤肺气，不为痰也。假今湿在
肝经，谓之风痰；湿在心经，谓之热痰；湿在脾经，谓之湿痰；湿在肺经，谓之气痰；
湿在肾经，谓之寒痰，宜随证治之。咳而无痰者，以辛甘润其肺，咳而嗽者，治痰为
先，故以南星、半夏胜其痰，而嗽自愈，枳壳、陈皮利其气，而痰自下。若气从脐下逆
奔而上者，乃肾虚不能收气归元，切勿徒事于肺，当以破故纸、安肾丸主之。
夫咳嗽生痰上气，多因阴血不足，虚火虚气上浮而为患也。欲消其痰，转耗其血，
欲行其气，更泄其元，况从来痰药入腹，其痰不过暂开复闭，有损无功，理宜以微阳之
药开其痰，继以纯阴之药补其根，迨至痰之开者复闭，而所用生血之药，早已从天而
降，日续一日，久久而血生，血生而气返血室，如浪子归家，复能振作立业，所借以驱
胶结之痰，即此气也。此际略加化痰之药，则痰去气存，自然痊可。然饮食最宜致慎，
不但肥甘生痰，浓味伤阴，即平旦至日中行阳二十五度，饮食易消，故不成痰，日中至
合夜，行阴二十五度，饮食不消，故易成痰，是以释教过午戒食，亦护身之一则也。
丹溪云∶干咳嗽极难治，此系火郁之甚，乃痰郁火甚在肺上，以苦桔梗开之，
下用补阴降火药，不已即成劳，宜重补阴，盖肺为华盖，五脏六腑，火自内起，熏蒸焚
灼，水涸金伤。若至久咳声哑，是肺管破也，不治。在初起者，是寒包热，辛以散之。
《衍义》云∶有妇人患热久嗽，身如炙，
肌瘦将成肺劳，以枇杷叶、木通、款冬花、紫菀、杏仁、桑皮各等分，大黄减半，如常
制蜜丸，樱桃大，食后夜卧，含化一丸，未终剂而愈。又有久嗽不已，饥则胸中大痛，
须视上唇有白点如粞者，此虫啮其肺也。用百部膏一味，加乌梅、槟榔与服，下其虫则
愈。肺虫其形如蚕，令人咳嗽声嘶也。
古方治火郁干咳嗽者，甚少，治风寒湿咳嗽者，甚多，盖不分内外所因，新久之异
也。夫形寒饮冷，则咳嗽有痰，固当以温寒散湿为主，如人参、半夏之类。若夫气动火
炎久咳嗽无痰，又当以清热润燥为先，如天冬、麦冬、知母、贝母、石膏、栝蒌之类。
世人徒知肺主皮毛，外感风寒为寒，不知传里郁久变为热也。况五脏之尊，心虽为主，
而肺居其上，肺为华盖，下覆四藏，合天之德，通达风气，性爱温而恶寒恶热，心火若
炎，上蒸其肺，金被火伤则叶萎，倚着于肝，肝发痒则嗽。更有心肝虚弱，不能传阳
于下焦，遂至正阳俱暗，变成嗽矣。肺嗽因萎，倚着于肝，而成病者，犹木扣金鸣也。
先养肺金，抑心肝虚热而和其肾则愈。凡此者，皆他脏受邪，火自内起，熏蒸焚灼而作
咳嗽者，亦良多矣。
咳虽肺病，五脏六腑皆能致之，然总其纲领，不过内伤、外感而已。风寒暑湿伤其
外，则先中于皮毛，皮毛为肺之合，肺邪不解，他经亦病，此自肺而后传于诸脏也。劳
欲情志伤其内，则脏气受伤，先由阴分而病及上焦，此皆诸脏而后传于肺也。凡自表而
入者，病在阳，宜辛湿以散邪，则肺清而 愈，自内而生者，病在阴，宜甘以壮水，
润以养金则肺宁而 愈。治表者，药不宜静，静则留连不解，变生他病，故忌寒凉收
敛，经所谓肺欲辛是也。治内者，药不宜动，动则虚火不宁，燥痒愈甚，故忌辛香燥
热，《经》所谓辛走气，气病无多食辛是也。然治表者，虽宜动以散邪。若形病俱虚者，
又当补中气而佐以和解，倘专于发散，恐肺气益弱，腠理益疏，邪乘虚入，病反增剧
也。治内者，虽宜静以养阴。若命门火衰，不能归元，则参 桂附，在所必用，否则气
不化水，终无补于阴也。至夫因于火者，宜清；因于湿者，宜利；因痰者，消之；因气
者，理之，随其所见之证而调治。在老人虚人皆以湿养脾肺为主，稍稍治标可也。若欲
速愈而亟攻其邪，因而危困者，多矣。
肺受火伤则气逆而为 ，脾有停湿，则生痰而作嗽，虽分六腑五脏之殊，而其要
皆主于肺，盖肺为清虚之府，一物不容，毫毛必咳，又为娇脏，畏热畏寒，火刑金故
嗽，水冷金寒亦嗽，故咳嗽者，必责之肺，以肺为气之主而出声也。然治之之法，不在
于肺，而在于脾，不专在脾而反归重于肾，盖脾者，肺之母，肾者，金之子，虚则补其
母，虚则补其子，故《经》曰∶咳嗽烦冤者，肾气之逆也。
如外感风寒而咳嗽者，今人率以麻黄、枳壳、紫苏之类，发散表邪，谓从表而入
者，自表而出。如果形气病气俱实者，一汗而愈。若形气病气稍虚者，宜以补脾为主，
而佐以解表之药，盖脾主中气，肺主皮毛，惟其虚也，故腠理不密，风邪易以入之。若
脾肺不虚，邪何从而入耶？，古人所以制参苏饮中必有参，桂枝汤中有芍药、甘草，解
表中兼实脾也。脾实则肺金有养，皮毛有卫，则已入之邪易以出，而后来之邪无自而
入矣。若专以解表则肺气益虚，腠理益疏，外邪乘间而来者，何时而已耶，须人参、黄
、甘草以补脾，兼桂枝以驱邪，此不治肺而治脾，虚则补其母之义也。有火烁肺金而
咳嗽者，宜清金降火，今之医书中论清金降火者，以黄芩、天冬、麦冬、桑皮清肺金，
黄连降心火，石膏降胃火，四物知柏降阴火，贝母、栝蒌，竹沥、枇杷叶润肺而化
痰。以上治法，岂不平正通达耶，殊不知清金降火之理，似是而实非，补北方正所以泻
南方也。滋其阴自所以降火也。独不观启玄
子壮水之主，以制阳光乎？前已详言黄柏、知母之不宜用，与大寒凉诸药之害矣，然王
节斋云∶凡酒色过度，损伤肺肾真阴者，不可服参 ，服之过多则死。盖恐阳旺而阴消
矣。自此说行而世之治阴虚咳嗽者，视参 如砒毒，以黄柏、知母为灵丹，使患此症而
服此药者，百无一生，良可悲也。盖病本起于房劳太过，亏损真阴，阴虚而火上，火上
而刑金，故 ， 则金不能不伤矣，宜先以壮水，如六味地黄之类，补其真阴，使水
升而火降，随即以参 救肺之品，以补肾之母，使金水相生而病易愈矣。世之用寒凉
者，肤浅庸工，固不必齿，间有知用参 者，不知先壮水以镇火，而遽投参 以补
阳，反使阳火愈旺，而金益受伤，此所谓不识先后者也。有脾胃先虚，土虚不能制水，
水泛为痰，子来克母而嗽者矣。又有初虽起于心火刑金，因误服寒凉，以致脾土受伤，
肺益虚而嗽者，乃火位之下，水气承之，子来救母，肾水复火之仇，寒水挟本势去侵于
肺胃，水冷金寒，故嗽。前病未除，新病愈甚，粗工不达此义，尚谓痰火难除，寒凉倍
进，岂不殆哉！斯时也，须用六君子汤加泡姜以补脾肺，八味丸以补土母，而引水归
源。
有嗽而声哑者，盖金实不鸣，痰火郁于中也。金破亦不呜，肺气伤于内也。实则清
之，破则补之，皆治肺之道也。又须知少阴之络入肺中，循喉系于舌本，肺为之标，本
虚则标弱，故声乱咽嘶舌萎，声不能前，以救本为主。亦有喉燥失音者，古方用猪脂二
斤，熬油去渣，入白蜜一斤，再炼成膏，一匙一匙，挑服润之。有大声喊叫，喉破失音
者，不可作火治，而用凉药，须大补，八珍加甘桔，倍参 作伤损治。然足少阴脉挟舌
本，而足太阴脉络舌旁，手少阴脉系舌本。若三脉虚则痰涎乘虚，闭塞其脉道，而舌不
能转运言语也。三经血少，不能营舌，亦令人暗，故久病失血后，及误汗下后，心家气
血衰，不能鼓舌者，并用独参汤八物加减有痰加竹沥，《衍义》云∶有暴嗽服诸药不
效，或教之进佐料鹿茸丸，大菟丝子丸方愈，故有本有标，却不可以其暴嗽而疑，骤
补之，非所以易愈者，亦觉之早故也。
吐血多起于咳嗽，咳嗽血者，肺病也方家多以止嗽药治肺，兼治血而不效，何
也？盖诸书虽分咳血嗽血出于肺，咯血唾血出于肾，然实咳嗽咯唾皆出肾，盖肾脉入肺
循喉咙，挟舌本，其支者，从肺出络心，注胸中，故二脏相连，病则俱病，而其根在
肾，肾中有火有水，水干火燃，阴火刑金，故咳，水挟相火而上，化为痰入于肺，肺为
清虚之府，一物不容，故嗽中有痰唾，带血而出者，肾水从相火炎上之血也。岂可以咳
嗽独归之肺耶？《褚氏遗书·津润论》云∶天地定位，水位乎中，人肖天地，亦有水焉在
上为痰，在下为水，伏皮为血，从毛窍中为汗，可见，痰也、水也、血也，一物也。血
之带痰而出者，乃肾水挟相火炎上也。又云∶服寒凉百不一生，饮溲溺百不一死，童
便一味，可为治血之要。然暴发之际，用之以为降火消瘀之急剂则可，若多服亦能损
胃。褚氏特甚言寒凉之不可用耳。若是则黄柏、知母，从所禁用，童便又不宜多服，治
之当如何？曰∶惟六味地黄，独补肾水，性不寒凉，不损脾胃，久服则水升火降而愈，
又须用人参救肺，补胃药收功，使金能生水，盖滋其上源也。又有一等肾水泛上，上
浸于肺，水冷金寒故嗽，肺气受伤，血无所附，方亦吐血，医见嗽血者，火也，以寒折
之，病者危，而危者毙矣。须用八味丸补命门火，以引水归原，次用理中汤补脾，清以
补肺之母，则肾水归而血复其位矣。
治久嗽用诃子，味酸苦，有收敛降火之功，五味子收肺气，乃火热必用之剂，否仁
天竺黄和蚌粉（河蚌壳煅制的粉末）各等份研成细末，用蜂蜜调和后涂抹在乳房上，让婴儿吮吸。
治疗肺虚导致的长期咳嗽并伴有气喘。
人参、阿胶（各一两三钱，炒制）、白茯苓、马兜铃（去除老梗）、糯米（各五钱）、杏仁（二十一颗，炮制）、甘草（四钱，炙烤）。将这些药材研成细末，每次取二钱，加水煎煮后服用。
之所以说咳嗽让人受累，是因为它难以立即停止。然而，如果只想通过治肺来止咳，反而会进一步损害肺气，导致咳嗽更加严重。因为肺部患病而引发咳嗽，必定有某种病因在逼迫，只要治疗了病因，咳嗽自然痊愈。如果不详细探究病因的由来，只是单纯地针对肺部进行治疗，那么气就会无处归依，或者邪气无法消散，导致肺部更加痛苦，咳嗽更加剧烈。凡是伤风日久导致肺气已虚，出现发热咳嗽，服用发散药物后咳嗽反而加剧，或者是被发散药物过度治疗的患者，应当使用收敛的药物进行补益。然而，虚证引起的咳嗽有两种情况：如果是白天咳嗽多，吐出白色泡沫痰，或者感到恶心的，属于气虚，适宜使用六君子汤加款冬花、五味子。如果是夜间咳嗽多，口渴，痰不易咳出且伴有发热的，属于血虚，适宜使用六味地黄丸料加麦冬、五味子。如果咳嗽时脉搏紧，身体消瘦羸弱；或者脉搏形状坚大，咳嗽导致身形脱失；或者发热且脉搏小、坚急；或者咳嗽伴有呕吐、腹胀且腹泻；或者脉搏弦急，这些都属于死症，无法治愈。肺属金，主管皮毛，所主的是气；肾属水，主管骨髓，所藏的是精气。气性轻浮容易上升而难以下降，精质沉重容易下降而难以上升，这是事物性质的自然规律。有肺气盛的情况，就是热邪作祟，气受热而上蒸，就不能向下滋生肾水，从而导致肾脏受邪，所以治疗肾病必须先向肺部求治，这是清除源头以滋养化源的方法。《内经》说：“五脏六腑都能使人咳嗽，不仅仅是肺。”大概是因为五脏各自在其对应的季节受病，如果不是那个季节，其他脏腑的病会传变给肺。有从外部感受的，肺主皮毛，风寒暑湿之邪，从皮毛进入体内，传遍脏腑从而引起咳嗽。有从内部发生的，七情过激或饥饱失常，内部受到损伤，则邪气上逆。肺是气出入的通道，所以五脏的邪气上蒸于肺从而引起咳嗽。然而，风寒暑湿并不一定都导致咳嗽，这是因为感受的病邪较重，没有停留在皮毛，直接伤害脏腑，从而形成伤寒、温热等疾病。七情也有不导致咳嗽的情况，这是因为病情尚浅，只在本脏，未传入肺，所以伤寒病中有咳嗽的较轻，而七情、饥饱引起的咳嗽，必须日久后才发作，属于较重的病症。津液凝结成为痰后，就不再能生成血液，以周流滋润三焦，所以会出现口燥咽干，大便秘结，面色像枯骨一样，毛发干枯焦脆，妇女因此月经不通。如果能化解败痰，自然服药有效。但是不能过度使用燥烈削伐的药物，使痰湿虽然消除了，津液也枯竭了，去除了湿气却留下了热邪，这就不符合治疗原则了。务必使化痰后恢复为津液，就像把盗贼转化为良民一样。丹溪说：“咳嗽有风寒、有火、有痰、有劳、有肺胀。”风寒咳嗽，表现为鼻塞声音重浊，怕冷且流清涕，脉搏弦微，适宜发散行痰。又有声音嘶哑及气喘咳嗽，遇到冬天就发作，这是寒包热。解表则热邪自然消除，感冷则咳嗽，这是膈上有痰，适宜解表豁痰。火咳有声，痰少且色赤。劳咳，盗汗出兼痰多吐，随后出现寒热交替，适宜补阴清金。痰咳，一咳嗽就有痰出来，痰出来后咳嗽停止，主治豁痰。肺胀，肺被火邪伤害，遂成郁遏，活动则气喘胸闷，气急声音重浊，或者左侧或右侧无法安睡，这是痰挟瘀血，阻碍气机而致病，适宜养血以流动气机，降火舒肝以清痰。如果咳嗽且胁下疼痛，适宜疏肝气，用青皮配合化痰药，如二陈汤加南星、香附、青黛、青皮、白芥子、姜汁。如果是血凝气滞引起的咳嗽，用桃仁（去皮、尖），大黄（酒炒），制成姜汁丸服用。然而治疗咳嗽多用生姜，因为它具有辛散的作用。初起咳嗽多用发散药，是因为肺气壅遏，得到解散才能宽畅。如果痰因火动，逆上引起咳嗽，先治火，再治痰，借火势下行而痰也随之而下。如果久咳脉搏涩，或者虽然洪大，但按之不鼓指，属于肺虚，适宜五味子、款冬花、紫菀、马兜铃之类，收敛而补益。如果天数虽久，但脉搏滑数有力，尚属有余实火，还宜清肺，寻火寻痰而治疗。凡是饮水一二口而暂时缓解的，以及饮酒后咳嗽减轻的，属于冷嗽。咳与嗽，本是两个字的含义，《内经》作为一个证候连言，咳者，气动，属阳。嗽者，兼血，属阴。所以说咳者，有声无痰，根本在于气受伤；嗽者，有痰无声，根本在于血受伤；声和痰同时发作，气血俱伤，其根本虽然不同，但其表现症状则一致。《经》说：“秋伤于湿，冬天必定咳嗽”，由此可知脾没有留湿，即使伤了肺气，也不会生痰。假如湿在肝经，称为风痰；湿在心经，称为热痰；湿在脾经，称为湿痰；湿在肺经，称为气痰；湿在肾经，称为寒痰，适宜随证治疗。咳而无痰的，用辛甘药物滋润肺，咳而有嗽的，治疗痰为先，所以用南星、半夏胜其痰，而嗽自然痊愈，枳壳、陈皮利其气，而痰自然下行。如果气从脐下逆奔而上，乃是肾虚不能收气归元，切勿单纯治肺，当以破故纸、安肾丸为主治。
咳嗽生痰上气，多因阴血不足，虚火虚气上浮而为患。想要消除痰，反而消耗血；想要行气，更泄元气。况且向来痰药入腹，痰不过是暂时开通又复闭塞，有损无功，理应先用微阳之药开其痰，继以纯阴之药补其根，等到痰的开者复闭，而所用生血的药，早已从天而降，日复一日，久久而生血，血生而气返血室，如同浪子回家，又能振作立业，所借以驱除胶结之痰，就是这个气。此时略加化痰之药，则痰去气存，自然痊愈。然而饮食最需谨慎，不但肥甘生痰，浓味伤阴，而且平旦至日中行阳二十五度，饮食易消，所以不成痰，日中至合夜，行阴二十五度，饮食不消，所以易成痰，因此佛教过午戒食，也是护身的一个法则。丹溪说：“干咳嗽极难治，这是火郁之甚，乃痰郁火甚在肺上，用苦桔梗开之，下用补阴降火药，不已即成劳，宜重补阴。”盖肺为华盖，五脏六腑，火自内起，熏蒸焚灼，水涸金伤。若到久咳声哑，是肺管破了，不治。在初起者，是寒包热，用辛散之。《衍义》说：“有妇人患热久嗽，身如炙，肌瘦将成肺劳，用枇杷叶、木通、款冬花、紫菀、杏仁、桑皮各等分，大黄减半，如常制蜜丸，樱桃大，食后夜卧，含化一丸，未终剂而愈。”又有久嗽不已，饥饿时胸中大痛，须看上唇有白点如粞米者，这是虫啮其肺。用百部膏一味，加乌梅、槟榔与服，下其虫则愈。肺虫其形如蚕，令人咳嗽声嘶也。
古方治疗火郁干咳嗽的很少，治疗风寒湿咳嗽的很多，大概是不分内外病因，新病久病的差异。形体受寒饮水冷，则咳嗽有痰，固当以温寒散湿为主，如人参、半夏之类。如果气机动火炎久咳嗽无痰，又当以清热润燥为先，如天冬、麦冬、知母、贝母、石膏、栝蒌之类。世人只知道肺主皮毛，外感风寒为寒，不知道传里郁久变为热。况且五脏之中，心虽为主，而肺居其上，肺为华盖，下覆四藏，合天之德，通达风气，性爱温而恶寒恶热，心火若炎，上蒸其肺，金被火伤则叶萎，倚着于肝，肝发痒则嗽。更有心肝虚弱，不能传阳于下焦，遂至正阳俱暗，变成嗽矣。肺嗽因萎，倚着于肝，而成病者，犹木扣金鸣也。先养肺金，抑心肝虚热而和其肾则愈。凡此者，皆他脏受邪，火自内起，熏蒸焚灼而作咳嗽者，亦良多矣。
咳嗽虽然是肺病，五脏六腑都能致之，然总其纲领，不过内伤、外感而已。风寒暑湿伤其外，则先中于皮毛，皮毛为肺之合，肺邪不解，他经亦病，此自肺而后传于诸脏也。劳欲情志伤其内，则脏气受伤，先由阴分而病及上焦，此皆诸脏而后传于肺也。凡自表而入者，病在阳，宜辛温以散邪，则肺清而愈，自内而生者，病在阴，宜甘以壮水，润以养金则肺宁而愈。治表者，药不宜静，静则留连不解，变生他病，故忌寒凉收敛，经所谓肺欲辛是也。治内者，药不宜动，动则虚火不宁，燥痒愈甚，故忌辛香燥热，《经》所谓辛走气，气病无多食辛是也。然治表者，虽宜动以散邪。若形病俱虚者，又当补中气而佐以和解，倘专于发散，恐肺气益弱，腠理益疏，邪乘虚入，病反增剧也。治内者，虽宜静以养阴。若命门火衰，不能归元，则参 桂附，在所必用，否则气不化水，终无补于阴也。至夫因于火者，宜清；因于湿者，宜利；因痰者，消之；因气者，理之，随其所见之证而调治。在老人虚人皆以湿养脾肺为主，稍稍治标可也。若欲速愈而亟攻其邪，因而危困者，多矣。
肺受火伤则气逆而为咳，脾有停湿，则生痰而作嗽，虽分六腑五脏之殊，而其要皆主于肺，盖肺为清虚之府，一物不容，毫毛必咳，又为娇脏，畏热畏寒，火刑金故嗽，水冷金寒亦嗽，故咳嗽者，必责之肺，以肺为气之主而出声也。然治之之法，不在于肺，而在于脾，不专在脾而反归重于肾，盖脾者，肺之母，肾者，金之子，虚则补其母，虚则补其子，故《经》曰∶咳嗽烦冤者，肾气之逆也。
如外感风寒而咳嗽者，今人率以麻黄、枳壳、紫苏之类，发散表邪，谓从表而入者，自表而出。如果形气病气俱实者，一汗而愈。若形气病气稍虚者，宜以补脾为主，而佐以解表之药，盖脾主中气，肺主皮毛，惟其虚也，故腠理不密，风邪易以入之。若脾肺不虚，邪何从而入耶？古人所以制参苏饮中必有参，桂枝汤中有芍药、甘草，解表中兼实脾也。脾实则肺金有养，皮毛有卫，则已入之邪易以出，而后来之邪无自而入矣。若专以解表则肺气益虚，腠理益疏，外邪乘间而来者，何时而已耶，须人参、黄芪、甘草以补脾，兼桂枝以驱邪，此不治肺而治脾，虚则补其母之义也。有火烁肺金而咳嗽者，宜清金降火，今之医书中论清金降火者，以黄芩、天冬、麦冬、桑皮清肺金，黄连降心火，石膏降胃火，四物知柏降阴火，贝母、栝蒌，竹沥、枇杷叶润肺而化痰。以上治法，岂不平正通达耶，殊不知清金降火之理，似是而实非，补北方正所以泻南方也。滋其阴自所以降火也。独不观启玄子壮水之主，以制阳光乎？前已详言黄柏、知母之不宜用，与大寒凉诸药之害矣，然王节斋云∶凡酒色过度，损伤肺肾真阴者，不可服参 芪，服之过多则死。盖恐阳旺而阴消矣。自此说行而世之治阴虚咳嗽者，视参 芪如砒毒，以黄柏、知母为灵丹，使患此症而服此药者，百无一生，良可悲也。盖病本起于房劳太过，亏损真阴，阴虚而火上，火上而刑金，故咳，咳则金不能不伤矣，宜先以壮水，如六味地黄之类，补其真阴，使水升而火降，随即以参 芪救肺之品，以补肾之母，使金水相生而病易愈矣。世之用寒凉者，肤浅庸工，固不必齿，间有知用参 芪者，不知先壮水以镇火，而遽投参 芪以补阳，反使阳火愈旺，而金益受伤，此所谓不识先后者也。有脾胃先虚，土虚不能制水，水泛为痰，子来克母而嗽者矣。又有初虽起于心火刑金，因误服寒凉，以致脾土受伤，肺益虚而嗽者，乃火位之下，水气承之，子来救母，肾水复火之仇，寒水挟本势去侵于肺胃，水冷金寒，故嗽。前病未除，新病愈甚，粗工不达此义，尚谓痰火难除，寒凉倍进，岂不殆哉！斯时也，须用六君子汤加泡姜以补脾肺，八味丸以补土母，而引水归源。
有嗽而声哑者，盖金实不鸣，痰火郁于中也。金破亦不呜，肺气伤于内也。实则清之，破则补之，皆治肺之道也。又须知少阴之络入肺中，循喉系于舌本，肺为之标，本虚则标弱，故声乱咽嘶舌萎，声不能前，以救本为主。亦有喉燥失音者，古方用猪脂二斤，熬油去渣，入白蜜一斤，再炼成膏，一匙一匙，挑服润之。有大声喊叫，喉破失音者，不可作火治，而用凉药，须大补，八珍加甘桔，倍参 芪作伤损治。然足少阴脉挟舌本，而足太阴脉络舌旁，手少阴脉系舌本。若三脉虚则痰涎乘虚，闭塞其脉道，而舌不能转运言语也。三经血少，不能营舌，亦令人暗，故久病失血后，及误汗下后，心家气血衰，不能鼓舌者，并用独参汤八物加减有痰加竹沥，《衍义》云∶有暴嗽服诸药不效，或教之进佐料鹿茸丸，大菟丝子丸方愈，故有本有标，却不可以其暴嗽而疑，骤补之，非所以易愈者，亦觉之早故也。
吐血多起于咳嗽，咳嗽血者，肺病也方家多以止嗽药治肺，兼治血而不效，何也？盖诸书虽分咳血嗽血出于肺，咯血唾血出于肾，然实咳嗽咯唾皆出肾，盖肾脉入肺循喉咙，挟舌本，其支者，从肺出络心，注胸中，故二脏相连，病则俱病，而其根在肾，肾中有火有水，水干火燃，阴火刑金，故咳，水挟相火而上，化为痰入于肺，肺为清虚之府，一物不容，故嗽中有痰唾，带血而出者，肾水从相火炎上之血也。岂可以咳嗽独归之肺耶？《褚氏遗书·津润论》云∶天地定位，水位乎中，人肖天地，亦有水焉在上为痰，在下为水，伏皮为血，从毛窍中为汗，可见，痰也、水也、血也，一物也。血之带痰而出者，乃肾水挟相火炎上也。又云∶服寒凉百不一生，饮溲溺百不一死，童便一味，可为治血之要。然暴发之际，用之以为降火消瘀之急剂则可，若多服亦能损胃。褚氏特甚言寒凉之不可用耳。若是则黄柏、知母，从所禁用，童便又不宜多服，治之当如何？曰∶惟六味地黄，独补肾水，性不寒凉，不损脾胃，久服则水升火降而愈，又须用人参救肺，补胃药收功，使金能生水，盖滋其上源也。又有一等肾水泛上，上浸于肺，水冷金寒故嗽，肺气受伤，血无所附，方亦吐血，医见嗽血者，火也，以寒折之，病者危，而危者毙矣。须用八味丸补命门火，以引水归原，次用理中汤补脾，清以补肺之母，则肾水归而血复其位矣。
Tianzhu Huang (Bambusae Calamus) and Bangfen (Concha Margaritifera, pearl shell powder calcined) in equal parts are ground into fine powder, mixed with honey, applied to the breast, and allowed to be sucked by the infant.
Treats chronic cough with wheezing due to Lung deficiency.
Renshen (Ginseng Radix et Rhizoma), Ejiao (Colla Corii Asini, Donkey-hide Gelatin) [each 1 liang 3 qian, stir-fried], Baifuling (Poria), Madouling (Aristolochiae Fructus, removed old stems), Nuomici (Oryza Sativa Glutinosa Semen, glutinous rice) [each 5 qian], Xingren (Prunus Armeniaca Semen, processed) [21 grains], Gancao (Glycyrrhizae Radix et Rhizoma, honey-roasted) [4 qian]. These are ground into powder; take 2 qian each time, decocted in water and taken orally.
Dingchuan Tang (Asthma-Calming Decoction)
Effective for all types of cough.
See the chapter "Fangmai Chuanxiao Men" (Chapter on Pulse-Differentiation of Asthma and Wheezing).
The reason why cough is burdensome is that it is difficult to stop immediately. However, if one attempts to stop cough solely by treating the Lung, it will further damage the Lung Qi, making the cough worse. This is because when the Lung is diseased and causes cough, there must be a causative factor forcing it; treating the cause will naturally resolve the cough. If the origin is not investigated in detail, but treatment is merely directed at the Lung, Qi will have no place to return, or pathogenic factors will fail to dissipate, causing the Lung to suffer more and the cough to intensify. In cases where wind-cold has lingered for a long time, depleting Lung Qi, resulting in fever and cough, and where cough worsens after taking dispersing medicines, or due to excessive use of dispersing methods, astringent remedies should be used for tonification. However, there are two types of deficiency-induced cough: if daytime cough is frequent, with expectoration of white frothy sputum or nausea, it indicates Qi deficiency, suitable for Liujunzi Tang (Six Gentlemen Decoction) added with Kuandonghua (Farfarae Flos) and Wuweizi (Schisandrae Fructus). If nighttime cough is frequent, accompanied by thirst, difficulty in expectorating sputum, and fever, it indicates Blood deficiency, suitable for Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) material added with Maidong (Ophiopogonis Radix) and Wuweizi. If cough is accompanied by a tight pulse and emaciation, or a firm and large pulse with wasting of form, or fever with a small, firm, and rapid pulse, or cough with vomiting, abdominal distension, and diarrhea, or a wiry and tense pulse, these are all fatal conditions that cannot be cured. The Lung belongs to Metal, governs the skin and hair, and its primary function is governing Qi; the Kidney belongs to Water, governs bone marrow, and stores Essence. Qi is light and floating, easy to ascend but hard to descend; Essence is heavy and sinking, easy to descend but hard to ascend. This is the natural property of things. When Lung Qi is excessive, it manifests as heat; Qi heated ascends and steams, failing to descend to nourish the Kidney, thus the Kidney becomes affected. Therefore, treating Kidney disease requires first seeking solutions from the Lung; this clears the source to nourish transformation. The Classic states: "The five Zang and six Fu organs can all cause cough, not just the Lung." Generally, each Zang organ suffers disease in its corresponding season; if not that season, diseases from other organs transmit to the Lung. There are external acquisitions: the Lung governs the skin and hair, so wind, cold, summer-heat, and dampness pathogens enter from the skin and hair, transmit through the Zang-Fu organs, and cause cough. There are internal origins: excessive emotions or irregular diet injure the interior, causing pathogenic Qi to rebel upward. Since the Lung is the pathway for Qi entry and exit, pathogenic Qi from the five Zang organs steams upward to the Lung, causing cough. However, wind, cold, summer-heat, and dampness do not always cause cough; this is because the pathogen is severe, does not remain in the skin and hair, but directly injures the Zang-Fu organs, forming Cold Damage or Warm Heat diseases. Emotions also do not always cause cough; this is because the disease is shallow, remaining in the original Zang organ without transmitting to the Lung. Thus, cough in Cold Damage is considered mild, while cough from emotions or diet, which appears only after a long time, is considered severe. Once body fluids congeal into phlegm, they can no longer generate blood to circulate and moisten the Triple Burner, leading to dry mouth and throat, constipation, a face like dead bone, and brittle, dry hair. In women, this can lead to amenorrhea. If stale phlegm can be resolved, medication will naturally be effective. However, one must not overuse drying and reducing agents, lest the phlegm-dampness be eliminated but the body fluids also dried up, removing dampness but retaining heat, which is not the correct treatment. The goal is to transform phlegm back into body fluids, just as transforming thieves into good citizens. Danxi said: "Cough can be caused by wind-cold, fire, phlegm, consumption, or Lung distension." Wind-cold cough presents with nasal congestion, heavy voice, aversion to cold, and clear discharge, with a wiry and slight pulse; dispersing and moving phlegm is appropriate. Another type involves hoarseness and wheezing cough, occurring in winter, which is cold wrapping heat. Releasing the exterior removes the heat; cough triggered by cold indicates phlegm above the diaphragm, requiring exterior release and phlegm resolution. Fire cough has sound, with little red sputum. Consumption cough features night sweats, profuse sputum, followed by alternating chills and fever; tonifying Yin and clearing Metal is appropriate. Phlegm cough produces sputum upon coughing, and stops when sputum is expelled; resolving phlegm is the main treatment. Lung distension occurs when the Lung is injured by fire, becoming obstructed; movement causes wheezing and chest fullness, rapid breathing, and heavy voice, or inability to sleep on either side. This is phlegm clashing with blood stasis, obstructing Qi flow; nourishing Blood to move Qi, descending fire, soothing the Liver, and clearing phlegm is appropriate. If cough is accompanied by hypochondriac pain, soothing Liver Qi with Qingpi (Citri Reticulatae Pericarpium) combined with phlegm-resolving herbs, such as Erchen Tang (Two-Cured Decoction) added with Nanxing (Arisaematis Rhizoma Preparatum), Xiangfu (Cyperi Rhizoma), Qingdai (Indicum), Qingpi, Baijiezi (Sinapis Semen), and Jiangzhi (Zingiberis Rhizoma Recens Juice), is indicated. If blood stasis and Qi stagnation cause cough, Taoren (Persicae Semen, peeled and core removed) and Dahuang (Rhei Radix et Rhizoma, wine-fried) made into pills with Ginger Juice are used. However, fresh ginger is often used in treating cough for its pungent dispersing action. Initial cough often uses dispersing agents because Lung Qi is congested and needs releasing to relax. If phlegm moves due to fire and rebels upward causing cough, treat the fire first, then the phlegm, borrowing the downward movement of fire to bring down the phlegm. If chronic cough presents with a choppy pulse, or even a large pulse that does not drum under pressure, it indicates Lung deficiency; Wuweizi, Kuandonghua, Ziwan (Asternis Radix), and Douling (Aristolochiae Fructus) are used to astringe and tonify. If the duration is long but the pulse is slippery, rapid, and forceful, it still belongs to excess fire; clearing the Lung and treating the fire and phlegm is appropriate. Cough temporarily relieved by drinking one or two sips of water, or reduced after drinking alcohol, is cold cough. "Ke" (cough with sound) and "Sou" (cough with sputum) originally had distinct meanings; the Neijing combines them as one syndrome. Ke refers to Qi movement, Yang; Sou involves Blood, Yin. Thus, Ke has sound but no sputum, originating from Qi injury; Sou has sputum but no sound, originating from Blood injury. When both sound and sputum occur, both Qi and Blood are injured. Although their roots differ, their manifestations are identical. The Classic says: "Autumn injury by dampness leads to cough in winter." This implies that if the Spleen has no retained dampness, even if Lung Qi is injured, phlegm will not form. If dampness is in the Liver channel, it is called Wind Phlegm; in the Heart channel, Heat Phlegm; in the Spleen channel, Damp Phlegm; in the Lung channel, Qi Phlegm; in the Kidney channel, Cold Phlegm. Treatment should follow the syndrome. For cough without sputum, use pungent and sweet herbs to moisten the Lung; for cough with sputum, treat phlegm first using Nanxing and Banxia (Pinelliae Rhizoma) to overcome phlegm, so Sou resolves naturally, and Zhike (Aurantii Fructus Immaturus) and Chenpi (Citri Reticulatae Pericarpium) to benefit Qi, so phlegm descends. If Qi rebels upward from below the umbilicus, it is Kidney deficiency failing to grasp Qi; do not merely treat the Lung, but use Pogostemon cablin (Poguozhi) and Anshen Wan (Kidney-Anchoring Pill). Cough generating phlegm and rebellious Qi is mostly due to insufficient Yin-Blood, with deficient fire and Qi floating upward. To eliminate phlegm consumes Blood; to move Qi drains Yuan Qi. Moreover, traditional phlegm-resolving drugs only temporarily open blockage before closing again, causing harm without benefit. One should first use slightly warming Yang herbs to open phlegm, then pure Yin herbs to tonify the root. When the opened phlegm closes again, the blood-generating herbs already descended from heaven. Day by day, blood generates, Qi returns to the Blood Chamber, like a prodigal son returning home to rebuild his life. The Qi generated here drives away sticky phlegm. At this stage, adding a little phlegm-resolving herb allows phlegm to go while Qi remains, leading to natural recovery. Diet must be strictly controlled; not only do rich foods generate phlegm and strong flavors injure Yin, but during the morning until noon, Yang circulates twenty-five times, food digests easily, so phlegm does not form. From noon to nightfall, Yin circulates twenty-five times, food does not digest easily, so phlegm forms easily. Hence, Buddhism's rule of fasting after noon is also a method of protecting the body. Danxi said: "Dry cough is extremely difficult to treat; this is severe fire depression, where phlegm and fire are depressed in the upper Lung. Use bitter Jiegeng (Platycodonis Radix) to open it, and use Yin-tonifying and fire-descending medicine below. If not stopped, it becomes consumption; heavy Yin tonification is needed." The Lung is the canopy; fire rises internally from the five Zang and six Fu organs, steaming and burning, drying water and injuring Metal. If chronic cough leads to hoarseness, the Lung tube is broken, untreatable. In early stages, it is cold wrapping heat, treated with pungent dispersants. Yan Yi states: "A woman suffered from prolonged hot cough, body feeling like roasting, emaciation approaching pulmonary consumption. Using equal parts of Pipaye (Loquat Leaf), Mutong (Akebiae Caulis), Kuandonghua, Ziwan, Xingren, Sangbaipi (Morus Cortex), and half dose of Dahuang, made into honey pills the size of cherries. Dissolve one pill after meals and before bed. She was cured before finishing the course." Another case: chronic cough persisting, severe chest pain when hungry, with white spots like rice grains on the upper lip, indicating lung worms biting the Lung. Use Bubaigao (Stemona Paste) alone, added with Wumei (Mume Fructus) and Binglang (Arecae Semen), to expel worms and cure. Lung worms resemble silkworms, causing cough and hoarseness.
Ancient formulas rarely treat fire-depressed dry cough, but many treat wind-cold-damp cough, likely ignoring the distinction between internal/external causes and new/chronic conditions. Physical cold and cold drinks cause cough with phlegm, requiring warming cold and dispersing dampness, such as Renshen and Banxia. If Qi movement and fire flare causing chronic cough without phlegm, clearing heat and moistening dryness is priority, such as Tiantong (Asparagi Radix), Maidong, Zhimu (Anemarrhenae Rhizoma), Beimu (Fritillariae Bulbus), Shigao (Gypsum Fibrosum), and Gualou (Trichosanthis Fructus). People only know the Lung governs the skin and hair, and external wind-cold is cold, not knowing that transmission inward and long-term depression turns into heat. Among the five Zang organs, although the Heart is master, the Lung sits above. The Lung is the canopy, covering the four lower Zang organs, harmonizing with Heaven's virtue, communicating wind and Qi. It loves warmth and dislikes cold and heat. If Heart fire flares, steaming upward to the Lung, Metal is injured, leaves wither, leaning on the Liver; Liver itching causes cough. More commonly, Heart and Liver deficiency fail to transmit Yang to the Lower Jiao, causing Zheng Yang to darken, resulting in cough. Lung cough due to withering, leaning on the Liver, creating illness, is like wood striking metal to ring. First nourish Lung Metal, suppress Heart-Liver deficient heat, and harmonize the Kidney for cure. All these cases involve other Zang organs receiving pathogenic factors, fire rising internally, steaming and burning to cause cough, which are numerous.
Although cough is a Lung disease, all five Zang and six Fu organs can cause it. Summarizing the general principle, it is merely internal injury or external contraction. Wind, cold, summer-heat, and dampness injuring the exterior first affect the skin and hair; the skin and hair are the exterior of the Lung. If Lung pathogen is not resolved, other meridians also become diseased; this transmits from the Lung to other Zang organs. Labor, desire, and emotions injuring the interior damage Zang Qi, starting from the Yin level affecting the Upper Jiao; this transmits from other Zang organs to the Lung. Those entering from the exterior are Yang diseases; pungent-warm herbs should disperse pathogen, clearing the Lung for cure. Those arising from the interior are Yin diseases; sweet herbs should strengthen Water, and moistening herbs should nourish Metal, calming the Lung for cure. Treating the exterior, herbs should not be static; static herbs linger unresolved and generate other diseases, hence cold-cooling and astringent herbs are contraindicated, as the Classic states: "The Lung desires pungency." Treating the interior, herbs should not be active; active herbs disturb deficient fire, worsening dryness and itching, hence pungent-aromatic and drying-hot herbs are contraindicated, as the Classic states: "Pungency moves Qi; in Qi disease, do not eat much pungency." However, treating the exterior, although movement disperses pathogen, if both form and disease are deficient, Middle Qi should be tonified with harmonizing assistance. If solely dispersing, Lung Qi may weaken further, pores loosen, pathogen enters via deficiency, and disease worsens. Treating the interior, although stillness nourishes Yin, if Mingmen fire declines and cannot return to the root, Renshen, Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Preparata) are necessary; otherwise, Qi fails to transform Water, providing no benefit to Yin. For fire, clear it; for dampness, drain it; for phlegm, resolve it; for Qi, regulate it. Adjust according to observed syndromes. For elderly and deficient persons, moistening to nourish Spleen and Lung is primary, with slight symptomatic treatment. Many become critical by seeking rapid cure and aggressively attacking pathogen.
When Lung is injured by fire, Qi rebels causing cough; when Spleen retains dampness, phlegm generates causing cough. Although distinguishing six Fu and five Zang, the key lies in the Lung. The Lung is a clear and empty mansion, tolerating nothing; even hairs trigger cough. It is a delicate organ, fearing heat and cold. Fire punishing Metal causes cough; cold water and cold Metal also cause cough. Thus, cough must be attributed to the Lung, as the Lung is the master of Qi and produces sound. However, the treatment method lies not in the Lung, but in the Spleen; not solely in the Spleen, but returning emphasis to the Kidney. The Spleen is the mother of the Lung; the Kidney is the child of Metal. Deficiency tonifies the mother; deficiency tonifies the child. Thus, the Classic says: "Cough with vexation is rebellion of Kidney Qi."
For external wind-cold causing cough, modern physicians usually use Mahuang (Ephedrae Herba), Zhike, Zisu (Perillae Folium) to disperse exterior pathogen, believing that what enters from the exterior exits from the exterior. If form, Qi, and disease Qi are all excess, one sweat cures it. If form, Qi, and disease Qi are slightly deficient, tonifying the Spleen is primary, assisted by exterior-releasing herbs. The Spleen governs Middle Qi; the Lung governs skin and hair. Due to deficiency, pores are not dense, allowing wind pathogen easy entry. If Spleen and Lung are not deficient, how would pathogen enter? This is why Rensu Yin (Ginseng and Saposhnikovia Decoction) must contain Renshen, and Guizhi Tang (Cinnamon Twig Decoction) contains Shaoyao (Paeoniae Radix Alba) and Gancao; releasing the exterior simultaneously strengthens the Spleen. When Spleen is solid, Lung Metal is nourished, skin and hair are guarded, existing pathogen exits easily, and future pathogen has no entry. If solely releasing the exterior, Lung Qi becomes more deficient, pores looser, external pathogen enters opportunistically, when will it end? Renshen, Huangqi (Astragali Radix), and Gancao tonify the Spleen, combined with Guizhi to drive out pathogen. This treats the Spleen instead of the Lung, embodying the principle of tonifying the mother in deficiency. For fire scorching Lung Metal causing cough, clearing Metal and descending fire is appropriate. Modern medical books discussing clearing Metal and descending fire use Huangqin (Scutellariae Radix), Tiantong, Maidong, Sangbaipi to clear Lung Metal; Huanglian (Coptidis Rhizoma) to descend Heart fire; Shigao to descend Stomach fire; Siwu Tang (Four Substance Decoction) with Zhibai (Phellodendri Cortex and Anemarrhenae Rhizoma) to descend Yin fire; Beimu, Gualou, Zhuli (Bambusae Succus Preparatus), Pipaye to moisten Lung and resolve phlegm. Are these treatments not upright and thorough? Little do they know that the logic of clearing Metal and descending fire is seemingly correct but actually wrong. Tonifying the North (Water/Kidney) is precisely to purge the South (Fire/Heart). Nourishing Yin is itself descending fire. Have you not seen Qixuanzi (Wang Bing) strengthening the master of Water to control the sunlight? Previously detailed were the unsuitability of Zhibai and Zhimu, and the harm of great cold-cooling drugs. However, Wang Jiezhai said: "For those whose true Yin of Lung and Kidney is damaged by excessive alcohol and sex, Renshen and Huangqi must not be taken; excessive intake leads to death." Fearing Yang prosperity and Yin decline, once this theory spread, those treating Yin-deficiency cough viewed Renshen and Huangqi as arsenic poison, regarding Zhibai and Zhimu as spiritual elixirs. Patients taking these drugs had less than one survivor in a hundred, truly tragic. The disease originates from excessive sexual labor, damaging true Yin. Yin deficiency causes fire to rise; fire rising punishes Metal, causing cough; cough injures Metal. First, strengthen Water with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to tonify true Yin, raising Water and descending fire. Then use Renshen and Huangqi to save the Lung and tonify the mother of the Kidney, promoting Metal-Water mutual generation for easier cure. Physicians using cold-cooling drugs are superficial and mediocre, unworthy of mention. Some who know to use Renshen and Huangqi fail to strengthen Water first to calm fire, abruptly administering Renshen and Huangqi to tonify Yang,反而 making Yang fire fiercer and Metal more injured. This is ignorance of sequence. There are cases where Spleen-Stomach are initially deficient, Earth deficiency fails to control Water, Water floods becoming phlegm, Child attacks Mother causing cough. Also, initial Heart fire punishing Metal, misused with cold-cooling drugs, injuring Spleen Earth, making Lung more deficient and causing cough. Below the Fire position, Water Qi承接 (supports); Child saves Mother, Kidney Water revenges Fire's enemy. Cold Water, relying on its nature, invades Lung and Stomach; cold water and cold Metal cause cough. Previous disease unremoved, new disease worsens. Crude physicians do not understand this, still claiming phlegm-fire is hard to remove, doubling cold-cooling drugs. Is this not dangerous! At this time, use Liujunzi Tang (Six Gentlemen Decoction) with Paojiang (Prepared Ginger) to tonify Spleen and Lung, and Bawei Wan (Eight-Ingredient Pill) to tonify Earth's mother, guiding Water to its source.
Cough with hoarseness: Metal solid does not ring, phlegm-fire depressed inside. Metal broken also does not ring, Lung Qi injured inside. Excess clears it; deficiency tonifies it; both are ways to treat the Lung. Also know that the collateral of Shaoyin enters the Lung, follows the throat, ties to the tongue root. Lung is the branch; root deficiency makes branch weak, causing chaotic voice, hoarse throat, atrophied tongue, inability to project voice. Saving the root is primary. There are also cases of dry throat and loss of voice. Ancient formula uses Pig Fat (Zhizhi) two jin, rendered to oil, filtered, add White Honey (Baimi) one jin, refined into paste. Take one spoonful at a time to moisten. For those shouting loudly, breaking throat and losing voice, do not treat as fire using cooling drugs. Must heavily tonify: Bazhen Tang (Eight-Treasure Decoction) added with Gancao and Jiegeng, double Renshen and Huangqi, treat as injury. Foot Shaoyin meridian夹 (clamps) tongue root; Foot Taiyin meridian connects to tongue side; Hand Shaoyin meridian ties to tongue root. If these three meridians are deficient, phlegm-saliva takes advantage, blocking meridians, tongue cannot move for speech. Three meridians lacking Blood cannot nourish tongue, also causing aphasia. Thus, after long illness with blood loss, or after mistaken sweating/purging, Heart Qi and Blood decline, unable to鼓 (drum) the tongue. Use Dushen Tang (Single Ginseng Decoction) and Baye Tang modified. With phlegm, add Zhuli. Yan Yi says: "Sudden cough unresponsive to various drugs. Or advised to take Zhaoliao Lurong Wan (Deer Antler Pill with Condiments) or Datusziren Wan (Large Cuscuta Pill) to cure. Thus, having root and branch, do not doubt sudden cough and suddenly tonify. This is not the way to ease cure, but because detected early."
Hemoptysis mostly arises from cough. Cough with blood is a Lung disease. Physicians often use cough-stopping drugs to treat Lung and blood simultaneously without effect. Why? Although texts distinguish hemoptysis/sputum-blood from Lung, and spitting-blood/spit-blood from Kidney, actually coughing and spitting all originate from the Kidney. Kidney meridian enters Lung, follows throat, clamps tongue root; its branch emerges from Lung, connects to Heart, pours into Chest. Thus, two organs are connected; disease affects both, root in Kidney. Kidney has fire and water; water dries, fire burns, Yin fire punishes Metal, causing cough. Water carries Ministerial Fire upward, transforms into phlegm entering Lung. Lung is clear and empty, tolerating nothing. Thus, cough with sputum and blood is Blood from Ministerial Fire flaming up from Kidney Water. How can cough be attributed solely to Lung? Chu Shi's Yishu · Jinrun Lun says: "Heaven and Earth establish positions, Water is in the middle. Humans resemble Heaven and Earth, also having Water. Above as phlegm, below as urine/water, under skin as blood, from pores as sweat. Thus, phlegm, water, and blood are one substance." Blood with phlegm is Kidney Water carrying Ministerial Fire flaming up. Also says: "Taking cold-cooling drugs, one in a hundred survives; drinking urine, one in a hundred dies. Tongbian (Child Urine) alone is key for treating blood." However, in acute onset, using it as urgent fire-descending and stasis-resolving agent is okay; excessive intake damages Stomach. Chu Shi specifically emphasized avoiding cold-cooling drugs. If so, Zhibai and Zhimu are forbidden, Tongbian should not be taken excessively. How to treat? Answer: Only Liuwei Dihuang Wan exclusively tonifies Kidney Water, nature not cold-cooling, does not damage Spleen-Stomach. Long-term use raises Water and descends fire for cure. Also need Renshen to save Lung, stomach-nourishing drugs to conclude treatment, enabling Metal to generate Water, nourishing the upper source. Another type: Kidney Water floods upward, soaking Lung, cold water and cold Metal cause cough. Lung Qi injured, Blood has no attachment, also hemoptysis. Physician sees cough-blood as fire, uses cold to break it. Patient is critical, critical patients die. Must use Bawei Wan (Eight-Ingredient Pill) to tonify Mingmen Fire, guiding Water to origin. Then use Lizhong Tang (Regulate the Middle Decoction) to tonify Spleen, clearing to tonify Lung's mother. Kidney Water returns, Blood resumes position.
Treating chronic cough with Hezi (Terminalia Chebulae Fructus), sour and bitter taste, has astringing and fire-descending effects. Wuweizi gathers Lung Qi, a necessary agent for fire-heat. Xingren...