火刑肺金，燥痒不能忍因咳。咳因痒，痒因火燥，是咳必有火，然有虚实之分，
不可概用寒凉。嗽因于痰，痰本脾湿，脾热则湿蒸为热痰，脾寒则湿泛为寒痰。热
者挟火作痒，而咳嗽并见；寒者无火不作痒，但嗽出其痰而已。故古人分有声无痰
为咳，（非必无痰也，以咳因于痒，不因于痰，故不言痰也。）有痰无声为嗽，（非必无声也，以嗽本欲出其痰，
非因火逆作声，故不言声也。）有声有痰为咳嗽也。
分外感内伤二证，皆以肺为主。外感邪从皮毛入，皮毛者肺之合也，皮毛受寒
则汗孔为寒所凝闭，而肺气内郁成热；或皮毛受热，亦传入于肺而肺热，此固以肺
为主。若内伤火炎，火性亲上，不论何脏腑之火，皆得上干于肺，故亦以肺为主也。
外感以有咳嗽为轻，盖肺气虽郁，尚能通也，故鼻流清涕，鼻痒而嚏，喉痒而
咳。若郁甚，热壅不能上通，则鼻干且塞，无喷嚏咳嗽之证矣。盖郁不甚者，尚欲
外散与上通；甚则不外散而内攻，不上通而下郁也。内伤以有咳嗽为重，如肝肾之
火，其初止病下焦，未遽上干也。久而炎炽，乃及于肺，则病重矣。（若肺火自盛者，不
在此论。）
伤风，消风宁嗽汤。肺火素盛之人，易于伤风，以肺有火则常汗出腠开，邪易
入。又内火盛，略被遏郁即热也，治宜解表兼清其火。《金匮》咳而上气，喉中水鸡
声，（痰饮与气相触成声。）射干麻黄汤。上气肺胀，喘，目如脱，（谓喘咳之甚，目突欲出也。）脉浮
大，越婢加半夏汤。上气喘而急燥属肺胀，欲作风水，（详肿胀门。）发汗则愈，小
青龙汤（见痰）加石膏。咳而脉浮者，浓朴麻黄汤；（以散外邪。）脉沉者，泽漆汤。（以逐内饮。）
时行咳嗽，发热恶寒，鼻塞气急，初病即伏枕，一二日即轻，俗名虾蟆瘟，参苏饮
（见发热） 加细辛五分。外感风寒，失于解表，久不愈，因而咳血。医误以劳证治之，清
金降火，频进寒凉，外寒未解，内寒又生，缠锦日久，遂致委顿，假劳变成真劳，
（俗云伤风不愈变成劳者，此也。）此最当察。《医贯》云∶肺经受寒，血凝不行，咳嗽随痰而
出，其人必恶寒，其脉必紧，其血必有，或紫或黑数点，（此亦有火证，不可执。）用麻黄桂
枝汤，微汗而愈者数人。盖汗与血一物也，夺血者无汗，夺汗者无血，若作阴虚火
动治，殆矣。感风者鼻塞声重，伤冷者凄清怯寒，挟热则烦躁，受湿则重滞，有血
则膈间腥闷，停水则心下怔忪。夏月火盛，宜滋水清金，黄连必用。感湿者，身体
重痛，小便不利，或有汗，白术酒。（见中湿。）秋燥宜润，杏仁、栝蒌之属。有冷热相兼
者，因增减衣服，寒热俱感，遇乍寒亦咳，遇乍热亦咳，饮热亦咳，饮冷亦咳，（肺
火素盛者亦如此。）宜金沸草散、消风散（见头痛）合煎。或款冬花散，以薄荷叶代麻黄。声暴
哑者寒包火也，宜辛凉解散。有痰壅于肺者，金实则不鸣也，必清肺中邪滞，清
咽宁肺汤。咳而声嘶，杏仁煎、润肺丸、清音丸。有热咳失声咽疼，多进冷剂而声
愈不出者，生姜汁调消风散，（见头痛。）少少与之。然失音非独实证有之，宜审察，佐
以橄榄丸，含化，仍浓煎枇杷叶散，（见中暑。）热服。凡外感风寒，治宜辛散，所谓肺
欲辛也。若发散太过，或形气病气俱虚，即宜补。内伤者，阴虚火旺，治宜甘润，
最忌辛香，所谓气病毋多食辛也。然虚中有实者，亦宜行滞。火郁肺经气分，喘咳
面肿，身热无痰，泻白散。（见发热。）若面赤咳出血，是火郁血分，加黄芩、生地；内
热甚者，加黄连；咳急呕逆胁痛者，肝火也，加青皮、青黛等；若喘而面浮不得
卧者，是有痰饮水气，加苦葶苈以泻之。肺燥宜润，二冬、贝母、阿胶、鸡子清之属。
痰因燥难出，加栝蒌仁；喘，加杏仁。动则喘满气急者，肺胀也。（甚则胸高骨昂。）或左
或右，不得眠，此痰夹瘀血，碍气为病，四物汤（见血）加桃仁、诃子、青皮、竹
沥、姜汁、韭汁之属。壅遏不得眠者，难治。咳久肺胀，宜收敛，诃子为主，佐以
海石、香附、（童便浸三日用。）栝蒌仁、青黛、半夏曲、杏仁、姜汁，蜜调噙之。（初病
外感肺胀，见前《金匮》二条，忌收敛，凡诃子、五味、五倍、乌梅、粟壳等，皆收后之品，初病切勿
用也。）痰嗽，痰出嗽止。痰甚者外作寒热，痰多而清为寒实，多而稠粘为热实，并壅
闭正气。寒实者透罗丹，热实者泻肺丸。痰积非青黛、栝蒌不除。凡咳嗽面赤，胸
腹胁常热，惟足有凉时，脉洪，热痰在胸膈也，小陷胸汤（见胸痛）、礞石滚痰丸（见痰），或
用张子和法吐下之尤快。面白悲嚏，或胁急胀痛，脉沉弦迟细者，寒痰在胸腹也，
半夏温肺汤。食积痰作嗽发热者，半夏、南星为君，栝蒌、莱菔子为臣，青黛、石
减为使。食积人，面青白黄色不常，面上有如蟹爪路，一黄一白者是。治酒嗽，青
黛、栝蒌，蜜丸噙，救肺。饮冷热酒，或冷水伤肺致咳，紫菀饮。饮酒伤肺痰多，
栝蒌、杏仁、青黛、黄连为丸，竹沥煎入韭汁吞之。若虑太寒遏火，先以辛散之，
后以酸收之，甚者吐之，后与五苓、（见伤湿。）甘露（见霍乱）等胜湿去痰之剂。《医贯》谓∶
肺为娇脏，畏热畏寒，火刑金固咳，（肾水虚火上炎者，六味丸。）水冷金寒亦嗽。（若肾火虚，下
焦寒，逼火上浮乘肺，肺热而咳。虽不可云金寒，然是虚热，亦同寒治，八味丸。）有脾胃先虚，不能制水，
水泛为痰，乘肺而嗽者；又有初虽心火刑金，因服寒凉伤脾，肺虚而嗽者，须用六
君子（见气）加炮姜以补脾肺，八味丸（见虚损）以补土母。又谓∶王节斋云，酒色过度损伤
真阴者，不可服参 。此说大是误人。予遇此证，先以六味（见虚损）壮水降火，随以参
救肺，使金水相生而愈。世之用寒凉者固非，知用参 而不知先壮水者亦非，致
阳火旺而阴愈伤，乃不识先后着也。凡咳嗽动引百骸，觉气从脐下逆奔而上者，肾
虚气不归元也，安肾丸等。劳嗽，有因久咳嗽而成劳者，有因病劳而咳嗽者，其证
寒热往来，或独热，潮热盗汗，咽喉干痛，精神疲困，痰或浓或淡，或带血腥，语
言不出，保和汤、滋阴清化丸、五汁膏，并可用。干咳无痰，乃火郁之证，（不得志之
人多有之。）用苦梗开之，（逍遥散更妙。）次用滋补之剂，四物汤（见血）加炒柏、竹沥等。不已则
成劳。经年累月服药不瘥，余无他证，却与劳嗽不同，宜保肺，一味百部膏、桑枝
煎、必效散、噙化丸，并可用。
凡咳嗽上半日多，阳火也，（阳火旺于阳时。）痰稠黄，二陈（见痰）加贝母、石膏、竹茹。
下半日多，阴火也，起于下焦，痰青黑粘滞，四物汤（见血）加炒柏、知母，或知柏八味
丸。黄昏咳多，火气浮于肺也，（肺气当降时而不得降，火浮故也。）不宜凉药，当以五味、五倍等
敛而降之。又黄昏睡熟中，忽嗽痰数口，食积痰也，（睡则脾静不运，故痰停于内而嗽。
前证火咳，此证痰嗽也。）二陈（见痰）、山楂、麦芽，消导自已。五更清晨嗽，亦为痰停。（理详痰
门。）咳亦属火，火空则发也。（每日寅时，气血注肺，其时空心，无所阻碍，故火随气乘空上浮。）二陈加
黄芩、桔梗、桑皮。日轻夜重，属阴虚，二陈加当归。
火邪灼伤肺金，导致肺部燥痒难忍而引发咳嗽。咳嗽源于燥痒，燥痒源于火与燥，因此咳嗽必然伴有火邪，但需区分虚证与实证，不可一概使用寒凉药物。
嗽（有痰无声或声轻）源于痰，痰本由脾湿产生。若脾热，则湿气蒸腾化为热痰；若脾寒，则湿气泛滥化为寒痰。热痰挟带火邪引起燥痒，故咳嗽并见；寒痰无火邪，不引起燥痒，仅表现为咳出痰液而已。因此古人将“有声无痰”称为咳（并非一定没有痰，而是因为咳主要因燥痒引起，而非因痰引起，所以不提痰）；将“有痰无声”称为嗽（并非一定没有声音，而是因为嗽旨在排出痰液，并非因火气上逆发出声音，所以不提声音）；将“有声有痰”合称为咳嗽。
无论外感还是内伤，咳嗽皆以肺为主要病变脏腑。外感病邪从皮毛侵入，皮毛是肺的外合，皮毛受寒则汗孔被寒气凝闭，导致肺气内郁而生热；或者皮毛受热，热邪也传入肺中导致肺热，这确实是以肺为主。若是内伤导致的火炎，火性炎上，不论哪个脏腑的火邪，都会上干于肺，所以也是以肺为主。
外感咳嗽相对较轻，因为肺气虽然郁滞，但尚能通畅，所以会出现流清涕、鼻痒打喷嚏、喉痒咳嗽等症状。如果郁滞严重，热邪壅塞不能向上通达，就会出现鼻干且鼻塞，而没有喷嚏和咳嗽的症状。这是因为郁滞不严重时，正气尚欲向外发散和向上通利；郁滞严重时，就不向外发散而向内攻冲，不向上通利而向下郁结。内伤咳嗽相对较重，如肝肾之火，起初只病在下焦，并未立即上干于肺。时间久了，火势炽盛，才波及到肺，这时病情就重了。（如果是肺火本身自盛的情况，不在此讨论范围内。）
伤风咳嗽，用消风宁嗽汤。肺火素来旺盛的人，容易伤风，因为肺中有火则常出汗、腠理开泄，邪气容易侵入。加上体内火盛，稍微受到遏制郁滞就会发热，治疗宜解表兼清其火。《金匮要略》记载：咳嗽伴气逆上冲，喉中有像水鸡叫一样的声音（这是痰饮与气相互冲击发出的声音），用射干麻黄汤。气逆肺胀，气喘，眼睛突出像要脱出来（形容喘咳非常剧烈，眼球突出），脉象浮大，用越婢加半夏汤。气逆气喘且急促干燥属于肺胀，想要发展为风水肿（详见肿胀门章节），发汗即可痊愈，用小青龙汤（见痰饮门）加石膏。咳嗽且脉象浮的，用浓朴麻黄汤（用以疏散外邪）；脉象沉的，用泽漆汤（用以驱逐内饮）。
时行感冒引起的咳嗽，伴有发热恶寒、鼻塞气急，初起即卧床不起，一二日后症状减轻，俗称虾蟆瘟，用参苏饮（见发热门）加细辛五分。外感风寒，失于解表治疗，久治不愈，进而导致咳血。医生误当作劳损证治疗，频繁使用清金降火的寒凉药物，导致外寒未解，内寒又生，缠绵日久，最终导致身体委顿，假性的劳损变成了真正的劳损（俗话说的伤风不愈变成劳损，指的就是这种情况），这一点最应当仔细考察。《医贯》说：肺经受寒，血液凝滞不行，咳嗽随痰而出，病人必定恶寒，脉象必定紧，咳出的血必有，颜色或紫或黑呈数点状（这也可能有火证，不可固执己见），用麻黄桂枝汤，微微出汗而痊愈的有好几个人。因为汗与血同源，夺血者无汗，夺汗者无血，如果当作阴虚火动来治疗，那就危险了。感受风邪的鼻塞声重，感受冷邪的凄清怕冷，挟热的烦躁，受湿的身体沉重滞涩，有血的膈间腥闷，停水的胃脘部心悸怔忡。夏季火气旺盛，宜滋水清金，必须用黄连。感受湿邪的，身体重痛，小便不利，或有汗，用白术酒（见中湿门）。秋季燥气当令宜润燥，用杏仁、栝蒌之类。有冷热相兼的，因增减衣服不当，寒热同时感受，遇突然变冷也咳，遇突然变热也咳，喝热水也咳，喝冷水也咳（肺火素盛的人也如此），宜用金沸草散、消风散（见头痛门）合煎。或者用款冬花散，以薄荷叶代替麻黄。声音突然嘶哑的是寒包火，宜用辛凉解散。有痰壅塞在肺中的，是金实不鸣，必须清除肺中的邪气阻滞，用清咽宁肺汤。咳嗽声音嘶哑的，用杏仁煎、润肺丸、清音丸。有热咳导致失音咽痛的，多进冷药反而声音更出不来的，用生姜汁调服消风散（见头痛门），少量多次给予。然而失音不仅仅实证才有，应当审察，佐以橄榄丸含化，仍浓煎枇杷叶散（见中暑门）热服。凡是外感风寒，治疗宜用辛散之法，这就是所说的“肺喜辛”。如果发散太过，或者形体元气和病气都虚弱，就应当补益。内伤者，阴虚火旺，治疗宜甘润，最忌辛香，这就是所说的“气病不要多吃辛味食物”。然而虚证中夹杂实证的，也应当行气导滞。火郁在肺经气分，出现气喘咳嗽面部浮肿，身热无痰，用泻白散（见发热门）。如果面赤咳出血，是火郁在血分，加黄芩、生地；内热严重的，加黄连；咳嗽急迫呕吐逆气胁痛的，是肝火，加青皮、青黛等；如果气喘面部浮肿不能平卧的，是有痰饮水气，加苦葶苈以泻之。肺燥宜润，用天冬、麦冬、贝母、阿胶、鸡蛋清之类。痰因燥难以咳出，加栝蒌仁；气喘，加杏仁。动则气喘胸闷气急的，是肺胀（严重时胸高骨昂）。或左或右，无法入睡，这是痰夹瘀血，阻碍气机致病，用四物汤（见血门）加桃仁、诃子、青皮、竹沥、姜汁、韭汁之类。壅遏严重无法入睡的，难治。咳嗽日久导致肺胀，宜收敛，以诃子为主，佐以海浮石、香附（童便浸泡三日）、栝蒌仁、青黛、半夏曲、杏仁、姜汁，蜂蜜调匀含服。（初病外感肺胀，见前文《金匮》两条，忌用收敛药，凡诃子、五味子、五倍子、乌梅、罂粟壳等，都是收敛后期的药物，初病切勿使用。）痰嗽，痰出则嗽止。痰重的外在表现为寒热往来，痰多而清稀为寒实证，痰多而稠粘为热实证，均会壅闭正气。寒实证用透罗丹，热实证用泻肺丸。痰积非青黛、栝蒌不能消除。凡是咳嗽面赤，胸腹胁部常觉热，只有脚底有时凉，脉象洪大的，是热痰在胸膈，用小陷胸汤（见胸痛门）、礞石滚痰丸（见痰门），或者用张子和的吐下法更为痛快。面白悲泣喷嚏，或胁肋紧急胀痛，脉象沉弦迟细的，是寒痰在胸腹，用半夏温肺汤。食积生痰导致咳嗽发热的，以半夏、南星为君药，栝蒌、莱菔子为臣药，青黛、石决明为使药。食积的人，面色青白黄色不定，脸上有如蟹爪路般的纹路，一黄一白的就是。治疗酒嗽，用青黛、栝蒌，蜜丸含服，救肺。饮用冷热酒，或冷水伤肺致咳，用紫菀饮。饮酒伤肺痰多，用栝蒌、杏仁、青黛、黄连为丸，竹沥煎汤送服韭汁。如果担心过于寒凉遏制火邪，先用辛散药，后用酸收药，严重的用吐法，后再用五苓散（见伤湿门）、甘露散（见霍乱门）等胜湿去痰的方剂。《医贯》说：肺为娇脏，畏热畏寒，火刑金固然导致咳嗽（肾水虚火上炎的，用六味地黄丸），水冷金寒也会嗽（如果肾火虚，下焦寒，逼迫虚火上浮乘肺，肺热而咳。虽然不能说金寒，但是属于虚热，也用寒治法，用八味丸）。又有脾胃先虚，不能制水，水泛为痰，乘肺而嗽的；又有初起虽是心火刑金，因服用寒凉伤了脾，肺虚而嗽的，须用六君子汤（见气门）加炮姜以补脾肺，八味丸（见虚损门）以补土母（补肾阳以暖脾土）。又说：王节斋说，酒色过度损伤真阴的人，不可服人参。这种说法大大误导人。我遇到这种证候，先用六味地黄丸（见虚损门）壮水降火，随后用人参救肺，使金水相生而痊愈。世人用寒凉药固然不对，知道用人参却不知道先壮水滋阴的也不对，导致阳火旺盛而阴液更加受伤，这是不识先后步骤的缘故。凡是咳嗽动作牵动全身，感觉气从脐下逆奔而上冲的，是肾虚气不归元，用安肾丸等。劳嗽，有因久咳而成劳损的，有病后劳损而咳嗽的，其证见寒热往来，或单独发热，潮热盗汗，咽喉干痛，精神疲困，痰或浓或淡，或带血腥，言语不出，保和汤、滋阴清化丸、五汁膏，都可以使用。干咳无痰，是火郁的证候（不得志的人多有此证），用桔梗开之（逍遥散更好），其次用滋补剂，四物汤（见血门）加炒黄柏、竹沥等。不止息则成劳损。经年累月服药不愈，没有其他证候，却与劳嗽不同，宜保肺，一味百部膏、桑枝煎、必效散、噙化丸，都可以使用。
凡是咳嗽上半日多的，是阳火（阳火在阳时旺盛），痰稠黄，用二陈汤（见痰门）加贝母、石膏、竹茹。下半日多的，是阴火，起于下焦，痰青黑粘滞，用四物汤（见血门）加炒黄柏、知母，或知柏八味丸。黄昏时咳嗽多，是火气浮于肺（肺气当降之时不得降，火气上浮所致），不宜用凉药，应当用五味子、五倍子等收敛而降之。又在黄昏睡熟中，忽然咳出几口痰，是食积痰（睡着时脾静不运，故痰停于内而咳。前证是火咳，此证是痰嗽），用二陈汤（见痰门）、山楂、麦芽，消导自愈。五更清晨咳嗽，也是为痰停（原理详痰门）。咳嗽也属火，火空则发（每日寅时，气血注入肺，此时肺部空虚，无所阻碍，故火随气乘空上浮），用二陈汤加黄芩、桔梗、桑白皮。白天轻晚上重的，属阴虚，用二陈汤加当归。
Fire pathogen scorches Lung Metal, causing dryness and itching that is unbearable, leading to cough. Cough arises from itching, itching arises from fire and dryness; thus, cough must involve fire. However, there are deficiency and excess patterns, so cold-cooling herbs should not be used indiscriminately.
Sputum production (Su) originates from phlegm, which is fundamentally caused by Spleen dampness. If the Spleen is hot, dampness steams into hot phlegm; if the Spleen is cold, dampness overflows into cold phlegm. Hot phlegm carries fire to cause itching, so both coughing and sputum production occur together. Cold phlegm lacks fire and does not cause itching, manifesting only as the expulsion of phlegm. Therefore, ancients distinguished "sound without sputum" as Ke (Cough) (not necessarily devoid of sputum, but because Ke stems from itching rather than sputum, sputum is not mentioned); "sputum without sound" as Su (Phlegmy Cough) (not necessarily silent, but because Su aims to expel sputum rather than producing sound from rebellious fire, sound is not mentioned); and "sound with sputum" as Ke-Sou (Cough).
Both external contraction and internal injury patterns center on the Lung. External pathogens enter via the skin and hair, which are the exterior extensions of the Lung. When the skin and hair are affected by cold, sweat pores are congealed and closed by cold, causing Lung Qi to stagnate internally and generate heat. Alternatively, heat affecting the skin and hair transmits to the Lung, causing Lung heat. This is indeed centered on the Lung. In cases of internal injury with flaming fire, since fire nature flares upward, regardless of which Zang-Fu organ's fire it is, it will harass the Lung upwards; thus, this is also centered on the Lung.
External contraction coughs are relatively mild because although Lung Qi is stagnant, it can still circulate. Thus, symptoms include clear nasal discharge, nasal itching with sneezing, and throat itching with coughing. If stagnation is severe, heat congestion prevents upward communication, resulting in a dry and stuffy nose, without sneezing or coughing. This is because when stagnation is not severe, the healthy Qi still attempts to disperse outward and communicate upward; when severe, it does not disperse outward but attacks inward, nor does it communicate upward but stagnates downward. Internal injury coughs are relatively severe. For instance, fire from the Liver and Kidneys initially affects the Lower Jiao and does not immediately harass the Lung. After a long time, as the fire becomes blazing, it reaches the Lung, making the condition serious. (If Lung fire itself is excessive, this discussion does not apply.)
For wind-strike cough, use Xiao Feng Ning Sou Tang (Wind-Dispersing and Cough-Calming Decoction). Individuals with inherent Lung fire are prone to wind-strike because Lung fire causes frequent sweating and open interstices, allowing pathogens to enter easily. Additionally, with abundant internal fire, slight constraint leads to heat generation. Treatment should resolve the exterior while clearing the fire. *Jingui Yaolue* states: Cough with rebellious Qi and a voice in the throat like a water frog (sound produced by phlegm-fluid colliding with Qi), use Shegan Mahuang Tang (Belamcanda and Ephedra Decoction). Rebellious Qi, Lung distension, wheezing, eyes protruding as if falling out (describing severe wheezing and coughing where eyes bulge), with a floating and large pulse, use Yuespi Banxia Tang (Mahuang, Poria, Licorice, Ginger, Jujube, and Pinellia Decoction). Rebellious Qi, rapid and dry wheezing belonging to Lung distension, intending to develop into Fengshui edema (see Edema chapter), resolves with sweating; use Xiao Qinglong Tang (Minor Green Dragon Decoction) (see Phlegm-Fluid chapter) plus Shigao (Gypsum Fibrosum). Cough with a floating pulse uses Nongpu Mahuang Tang (Magnolia Bark and Ephedra Decoction) (to disperse external pathogens); a sinking pulse uses Zeqi Tang (Phallus Decoction) (to drive out internal fluids).
Epidemic cough with fever, aversion to cold, nasal congestion, and rapid breathing, starting with bedridden state and improving after one to two days, commonly known as "Toad Plague," uses Shen Su Yin (Ginseng and Perilla Infusion) (see Fever chapter) plus 5 fen of Xixin (Asarum). External cold-wind contraction neglected with exterior-resolving treatment, persisting for a long time leading to hemoptysis. Physicians mistakenly treated it as consumptive disease, frequently administering cold-cooling herbs to clear Lung metal and descend fire. The external cold was not resolved, and internal cold arose, lingering for years, leading to physical collapse, turning false consumption into true consumption (the common saying that unresolved wind-strike turns into consumption refers to this). This requires careful observation. *Yi Guan* states: When the Lung channel is affected by cold, blood coagulates and fails to circulate. Cough brings up blood with sputum. The patient must have aversion to cold, a tight pulse, and the blood expelled may be purple or black in small spots (this may also involve fire signs, do not adhere rigidly). Use Mahuang Guizhi Tang (Ephedra and Cinnamon Twig Decoction); several people recovered with mild sweating. Sweat and blood share the same origin; those who lose blood have no sweat, and those who lose sweat have no blood. Treating this as Yin deficiency with fire agitation would be disastrous. Wind sensation causes nasal congestion and heavy voice; cold sensation causes shivering and fear of cold; heat involvement causes irritability; dampness involvement causes heaviness and stagnation; blood stasis causes stifling and fishy sensation in the chest; fluid retention causes palpitations in the epigastrium. In summer, when fire is abundant, nourish Water to clear Metal; Huanglian (Coptidis Rhizoma) is essential. Dampness sensation causes body heaviness and pain, difficult urination, possibly with sweat; use Baizhu Jiu (Atractylodes Macrocephala Wine) (see Middle Jiao Dampness chapter). Autumn dryness requires moistening; use Xingren (Armeniacae Semen Amarum) and Gualou (Trichosanthis Fructus). Mixed cold and heat, due to improper clothing adjustment, contracting both cold and heat, causes cough upon sudden cold, sudden heat, drinking hot liquids, or drinking cold liquids (also applies to those with inherent Lung fire); use Jin Fei Cao San (Boiling Herb Powder) and Xiao Feng San (Wind-Dispersing Powder) (see Headache chapter) decocted together. Or use Kuantonghua San (Adenophora Flower Powder), replacing Mahuang with Bohe Ye (Menthae Haplocalycis Folium). Sudden hoarseness indicates cold wrapping fire; use acrid-cool dispersants. Phlegm congestion in the Lung causes "Metal solid does not ring"; must clear Lung pathogenic stagnation; use Qingyan Ningfei Tang (Throat-Clearing and Lung-Calming Decoction). Cough with hoarse voice uses Xingren Jian (Almond Decoction), Runfei Wan (Lung-Moistening Pill), and Qingyin Wan (Voice-Clearing Pill). Heat cough causing loss of voice and sore throat, worsened by cold medicines, uses Shengjiang Zhi (Fresh Ginger Juice) to mix Xiao Feng San (see Headache chapter), administered in small amounts. However, aphonia occurs in non-excess patterns too; examine carefully, assist with Ganlan Wan (Olive Pill) for sucking, and concurrently decoct Pipaye San (Loquat Leaf Powder) (see Summerheat chapter) to take warm. All external cold-wind contractions should be treated with acrid dispersion, as "Lung desires acrid." If dispersion is excessive, or if constitution and pathogenic Qi are both deficient, tonification is indicated. For internal injuries with Yin deficiency and fire hyperactivity, treatment should be sweet and moistening; acrid-aromatics are strictly forbidden, as "Qi diseases should not consume much acrid." However, if deficiency contains excess, moving stagnation is appropriate. Fire depression in Lung Qi level, with wheezing, cough, facial swelling, and body heat without phlegm, uses Xiebai San (Drain White Powder) (see Fever chapter). If face is red, coughing blood, fire depresses in Blood level; add Huangqin (Scutellariae Radix) and Shengdi (Rehmanniae Radix). Severe internal heat adds Huanglian (Coptidis Rhizoma). Urgent cough, vomiting, reverse Qi, and hypochondriac pain indicate Liver fire; add Qingpi (Citri Reticulatae Pericarpium Viride) and Qingdai (Indigo Naturalis). Wheezing with facial edema and inability to lie flat indicates phlegm-fluid-water Qi; add Ku Tingli (Koelreuteriae Fructus) to drain. Lung dryness requires moistening; use Donghua (Donggu and Mugu), Beimu (Fritillariae Bulbus), Ejiao (Colla Corii Asini), and Jiziqing (Egg White). Phlegm difficult to expectorate due to dryness adds Gualou Ren (Trichosanthis Semen); wheezing adds Xingren (Armeniacae Semen Amarum). Wheezing and fullness upon movement indicate Lung distension (severe cases show elevated chest and prominent bones). Left or right side, unable to sleep, indicates phlegm mixed with blood stasis obstructing Qi; use Siwu Tang (Four Substances Decoction) (see Blood chapter) plus Taoren (Persicae Semen), Hezi (Terminalia Chebulae Fructus), Qingpi (Citri Reticulatae Pericarpium Viride), Zhuli (Bambusa Textilis Caulis Succus), Jiangzhi (Zingiberis Recensis Succus), and Jiuzhi (Allii Tuberosi Succus). Obstruction preventing sleep is difficult to treat. Chronic cough with Lung distension requires astringency; Hezi (Terminalia Chebulae Fructus) is primary, assisted by Haishi (Lapis Marmoratus), Xiangfu (Cyperi Rhizoma) (soaked in Child's Urine for three days), Gualou Ren (Trichosanthis Semen), Qingdai (Indigo Naturalis), Banxiaqu (Pinelliae Fermentatum), Xingren (Armeniacae Semen Amarum), Jiangzhi (Zingiberis Recensis Succus), mixed with honey for sucking. (Initial external contraction Lung distension, see previous *Jingui* two entries, avoid astringents. All astringents like Hezi, Wuweizi, Wubeizi, Wumei, and Yingsuke are late-stage products; never use in initial illness.) Phlegm-cough stops when phlegm is expelled. Severe phlegm presents externally as alternating chills and fever. Abundant clear phlegm indicates cold excess; abundant sticky phlegm indicates heat excess; both obstruct healthy Qi. Cold excess uses Touluo Dan; heat excess uses Xiefei Wan (Lung-Draining Pill). Phlegm accumulation cannot be removed without Qingdai (Indigo Naturalis) and Gualou (Trichosanthis Fructus). Cough with red face, constant heat in chest/abdomen/hypochondrium, cool feet occasionally, and flooding pulse indicates hot phlegm in chest-diaphragm; use Xiaoxianxiong Tang (Minor Stagnant Chest Decoction) (see Chest Pain chapter) or Mengshi Gun Tan Wan (Lead Ore Rolling Phlegm Pill) (see Phlegm chapter). Zhang Hezi's purgative/vomiting methods are even more effective. Pale face, sadness, sneezing, or hypochondriac urgency/pain/swelling, with sinking, wiry, slow, fine pulse indicates cold phlegm in chest/abdomen; use Banxia Wenfei Tang (Pinellia Warming Lung Decoction). Food stagnation generating phlegm causing cough and fever uses Banxia (Pinelliae Rhizoma) and Nanxing (Arisaematis Rhizoma) as sovereign, Gualou (Trichosanthis Fructus) and Laifuzi (Raphani Semen) as minister, Qingdai (Indigo Naturalis) and Shijue (Haliotidis Concha) as envoy. Food stagnation patients have varying green-white-yellow faces, with crab-claw-like lines on the face, alternating yellow and white. Treat wine-induced cough with Qingdai (Indigo Naturalis) and Gualou (Trichosanthis Fructus) honey pills for sucking to save the Lung. Drinking cold/hot wine or cold water injuring Lung causing cough uses Ziwan Yin (Sinosenecionis Root Infusion). Alcohol injuring Lung with abundant phlegm uses Gualou (Trichosanthis Fructus), Xingren (Armeniacae Semen Amarum), Qingdai (Indigo Naturalis), Huanglian (Coptidis Rhizoma) pills, swallowed with Zhuli (Bambusa Textilis Caulis Succus) decoction and Jiuzhi (Allii Tuberosi Succus). If concerned about excessive cold suppressing fire, first use acrid dispersants, then sour astringents; severe cases use vomiting, followed by Wuling San (Five Ling Powder) (see Dampness Injury chapter) or Ganlu San (Sweet Dew Powder) (see Cholera Disorder chapter) to overcome dampness and remove phlegm. *Yi Guan* states: Lung is a delicate organ, fearing heat and cold. Fire scorching Metal causes cough (Kidney Water deficiency with flaming fire uses Liuwei Wan/Six Ingredient Pill with Rehmannia); Cold water freezing Metal causes cough (Kidney Fire deficiency, Lower Jiao cold forcing fire upward to harass Lung, causing Lung heat cough. Though not strictly "Metal cold," it is deficient heat, treated similarly with cold methods, using Bawei Wan/Eight Ingredient Pill). Also, Spleen/Stomach deficiency failing to control water, causing water overflow into phlegm harassing Lung; or initial Heart fire scorching Metal, but damaged Spleen by cold herbs causing Lung deficiency cough. These require Liujunzi Tang (Six Gentlemen Decoction) (see Qi chapter) plus Paojiang (Prepared Ginger) to tonify Spleen/Lung, and Bawei Wan (Eight Ingredient Pill) (see Deficiency Consumption chapter) to tonify Earth mother. Furthermore, Wang Jiezhai stated that those damaging True Yin through excessive alcohol and sex should not take Renshen (Ginseng Radix et Rhizoma). This view greatly misleads people. I encounter such cases, first using Liuwei Wan (Six Ingredient Pill with Rehmannia) (see Deficiency Consumption chapter) to strengthen Water and descend fire, then using Renshen (Ginseng Radix et Rhizoma) to save the Lung, allowing Metal and Water to generate each other for recovery. Using cold-cooling herbs is wrong; knowing to use Renshen (Ginseng Radix et Rhizoma) but not knowing to first strengthen Water is also wrong, leading to flourishing Yang fire and further Yin damage, showing ignorance of priority steps. Cough moving all limbs, feeling Qi rushing upward from below the navel, indicates Kidney deficiency with Qi failing to return to its source; use Anshen Wan (Kidney-Anchoring Pill) etc. Labor cough includes those becoming consumptive from chronic cough, or coughing due to consumptive disease. Symptoms include alternating chills and fever, or isolated fever, tidal fever, night sweats, dry painful throat, mental fatigue, phlegm thick or pale, possibly bloody, inability to speak. Baohe Tang (Preserve Harmony Decoction), Ziyin Qinghua Wan (Nourish Yin Clear Transform Pill), and Wuzhi Gao (Five Juices Paste) are applicable. Dry cough without phlegm is fire depression pattern (common in frustrated people); use Jiegeng (Platycodonis Radix) to open (Xiaoyao San is better), followed by tonics like Siwu Tang (Four Substances Decoction) (see Blood chapter) plus Chao Bai (Stir-fried Phellodendri Cortex) and Zhuli (Bambusa Textilis Caulis Succus). Unresolved, it becomes consumption. Chronic medication failure without other symptoms differs from labor cough; preserve Lung using Yibai Bu Gao (Single Stemona Paste), Sangzhi Jian (Mulberry Twig Decoction), Bixiao San (Certain Efficacy Powder), and Qinhua Wan (Sucking Pill).
Cough predominant in the first half of the day is Yang fire (Yang fire flourishes during Yang hours); phlegm is thick and yellow; use Erchen Tang (Two Aged Ingredients Decoction) (see Phlegm chapter) plus Beimu (Fritillariae Bulbus), Shigao (Gypsum Fibrosum), and Zhuru (Bambusa Textilis Caulis Succus). Predominant in the second half is Yin fire, originating from Lower Jiao; phlegm is blue-black and sticky; use Siwu Tang (Four Substances Decoction) (see Blood chapter) plus Chao Bai (Stir-fried Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), or Zhibai Bawei Wan (Anemarrhena, Phellodendron, and Eight Ingredient Pill). Cough predominant at dusk indicates fire floating in Lung (Lung Qi should descend at this time but fails, causing fire to float); cold medicines are inappropriate; use Wuweizi (Schisandrae Chinensis Fructus) and Wubeizi (Galla Chinensis) to astringe and descend. Waking suddenly from sleep at dusk coughing up phlegm indicates food stagnation phlegm (Spleen静止 during sleep fails to transport, causing phlegm retention and cough. Previous case was fire cough, this is phlegm cough); use Erchen Tang (Two Aged Ingredients Decoction) (see Phlegm chapter), Shanzha (Crataegi Fructus), and Maiya (Hordei Fructus Germinatus) for digestion and resolution. Cough at dawn (Wugeng) is also due to phlegm retention (principles detailed in Phlegm chapter). Cough also belongs to fire; fire erupts when empty (At Yin hour daily, Qi and Blood flow into Lung; the Lung is empty, unobstructed, so fire follows Qi floating upward); use Erchen Tang (Two Aged Ingredients Decoction) plus Huangqin (Scutellariae Radix), Jiegeng (Platycodonis Radix), and Sangbai Pi (Mori Cortex). Lighter by day, heavier by night indicates Yin deficiency; use Erchen Tang (Two Aged Ingredients Decoction) plus Danggui (Angelicae Sinensis Radix).