（第十三）
《内经》曰∶五脏六腑皆令人咳，非独肺也。皮毛者，肺之合也。皮毛先受邪气，邪
气听从其令也。五脏之咳，久乃移于六腑，始伤肺气，终动脾湿，故咳而又嗽也。经曰∶秋
伤于湿，冬必咳嗽。大抵素秋之气宜清肃，及动之，则气上冲而为咳嗽，久则动脾湿而为痰
也。大法与大人同。
《脉经》曰∶关上脉微为嗽，脉浮缓者为伤风，脉紧者肺寒咳嗽。脉浮软者生，
弦急者死。
钱氏曰∶嗽者，肺盛微寒。八、九月，肺气大旺，病嗽者，其病必实，非久病也。其
证面赤身热、痰盛，法当以葶苈丸下之。若久者，不可下也。十一月、十二月嗽者，伤风嗽
也。风从背脊第三椎肺俞入也，以麻黄汤汗之。有热证，面赤，便水，涎热，咽喉秘者，甘
桔汤治之。若五、七日之间。其身热，痰盛，涕唾稠粘者，以褊银丸下之。有肺盛者，咳而
后喘，面肿欲饮水者，有不饮水者，其身则热，以泻白散泻之。若伤寒咳嗽五、七日无热证
而但嗽者，亦葶苈丸主之，后用化痰药。而肺虚者，咳而哽气，时时长出气，喉中有声，此
久病也，以阿胶散主之。痰盛者，先实脾，后以褊银丸下之，涎退则补肺为上法，有嗽而吐
水或清绿水者，以百祥丸下之；有嗽而吐痰涎、乳食者，以白饼子下之；有嗽而痰咳脓血者
，乃肺热，食后服甘桔汤，久嗽者，肺亡津液阿胶散补之，咳而痰实，不甚喘而面赤，时饮
水者，褊银丸下之。治嗽大法，盛则下之，久则补之，更量虚实，
以意增减。
伤风发热咳嗽者，宜先发散其表，人参羌活散加麻黄，或金沸草散加桑白皮、惺惺散、
参苏饮皆是发散之药，热不除，解肌汤主之。假如表散风邪，无别证微嗽者，服抱龙丸、泻白散
平肺之剂；痰涎壅盛，玉饼子、金星丸；下痰热，泻白散加人参或辰砂半夏丸、抱龙丸尤良。下
后热不退，作惊风之状，宜以薄荷散服。
感寒发热咳嗽者，服惺惺散加麻黄表散寒邪。微嗽，杏仁膏、人参半夏丸；痰嗽，半夏茯
苓汤。
久嗽曾经解利，肺气虚寒宜补肺，服补肺阿胶散、润肺散。肺中风，肺受寒久不已，灸肺
俞穴三壮，服百部丸，陈皮、罂粟壳、桑根白皮煎汤研化，食后服。
小儿初生百日内咳嗽，肺叶脆弱，最为难治。平常冷热邪入肺中，无能得出，又不堪吐利，
必明病源，消解风寒，化痰顺气，益肺生津，胃开气壮，嗽即渐减，不可强攻。
冷嗽则鼻流清涕，面白痰薄，日轻夜重，或微有邪热。热嗽则面微红，鼻干热，痰稠，脉
浮数。胃热不因风寒而得，以儿啼便乳，壅结心肺不散，即嗽而逆，以玉饼子下。
钱氏治嗽之法，先实脾，脾母得实，肺则和平。
小儿咳嗽者，腠理受风邪感激，脸红喘促，辨虚实，若见唇缩胸前陷，鼻枯干黑，皆为不治。
（第十三）
《黄帝内经》说：五脏六腑都能让人咳嗽，不仅仅是肺。皮毛是肺的外合部位。皮毛先受到邪气侵袭，邪气就会听从肺的指令（影响肺）。五脏的咳嗽，时间久了会传变到六腑，起初损伤肺气，最终扰动脾湿，所以出现咳声和吐痰的症状。经书说：秋季受湿气伤害，冬天必定发生咳嗽。大抵初秋的气候应当清肃，如果受到干扰，气机上冲就会导致咳嗽，时间久了就会扰动脾湿形成痰饮。治疗的大法与成人相同。
《脉经》说：关部脉微细是咳嗽的表现，脉浮缓的是伤风，脉紧的是肺寒咳嗽。脉浮软者预后良好，脉弦急者预后不良（主死）。
钱乙说：咳嗽，是肺气盛而兼有轻微寒邪。八月、九月，肺气正旺盛，此时患咳嗽的病，其病势必然属实，不是久病。症状表现为面红身热、痰多，治法应当用葶苈丸攻下。如果是久病，则不可攻下。十一月、十二月患咳嗽的，是伤风咳嗽。风邪从背部第三椎骨的肺俞穴侵入，治法用麻黄汤发汗。如果有热证，表现为面红、小便通利、涎液热、咽喉闭塞的，用甘桔汤治疗。如果在五、七天之间，身体发热、痰多、鼻涕唾沫稠粘的，用褊银丸攻下。有肺气盛的，咳嗽而后气喘，面部浮肿想喝水的，或者不想喝水的，身体发热，用泻白散清泻肺热。如果是伤寒咳嗽，五、七天没有热证只是咳嗽的，也用葶苈丸主治，之后再用化痰药。而肺虚的，咳嗽时哽气，时常长出气，喉中有声音，这是久病，用阿胶散主治。痰多的，先补益脾气，然后再用褊银丸攻下，涎液消退后补肺是最好的方法。有咳嗽并吐出清水或清绿色水的，用百祥丸攻下；有咳嗽并吐出痰涎、乳食的，用白饼子攻下；有咳嗽并咳出脓血的，是肺热，饭后服用甘桔汤；久咳的，肺中津液枯竭，用阿胶散补益；咳嗽且痰实，不太喘但面红，时常喝水的，用褊银丸攻下。治疗咳嗽的大法，实证则攻下，久病则补益，更要衡量虚实情况，凭意增减药量。
伤风发热咳嗽的，宜先发散表邪，人参羌活散加麻黄，或者金沸草散加桑白皮、惺惺散、参苏饮都是发散的药物，如果热不退，用解肌汤主治。假如表散风邪后，没有其他症状只有轻微咳嗽的，服用抱龙丸、泻白散等平肺的药剂；如果痰涎壅盛，用玉饼子、金星丸；攻下痰热，用泻白散加人参或者辰砂半夏丸、抱龙丸尤其好。攻下后热不退，出现惊风的迹象，宜服用薄荷散。
感受寒邪发热咳嗽的，服用惺惺散加麻黄以表散寒邪。轻微咳嗽，用杏仁膏、人参半夏丸；痰嗽，用半夏茯苓汤。
久咳曾经经过解表攻下的，肺气虚寒应当补肺，服用补肺阿胶散、润肺散。肺中风，肺受寒久不愈，灸肺俞穴三壮，服用百部丸，用陈皮、罂粟壳、桑根白皮煎汤研化，饭后服用。
小儿出生一百天内咳嗽，肺叶脆弱，最为难治。平常冷热邪气进入肺中，无法排出，又不堪受吐下之法，必须明确病源，消散风寒，化痰顺气，益肺生津，使胃气开、正气壮，咳嗽就会逐渐减轻，不可强行攻伐。
冷嗽则鼻流清涕，面色苍白，痰稀薄，白天轻晚上重，或者微有邪热。热嗽则面色微红，鼻干热，痰稠，脉浮数。胃热不是因为风寒引起的，而是因为婴儿啼哭后立即吃奶，导致壅结在心肺不散，随即咳嗽且气逆，用玉饼子攻下。
(Thirteenth)
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The five zang organs and six fu organs can all cause coughing, not just the lungs. The skin and hair are the exterior correspondence of the lungs. When the skin and hair are first invaded by pathogenic factors, these pathogens follow the command of the lungs [to affect them]. Coughs originating from the five zang organs may, over time, transmit to the six fu organs. Initially, lung qi is injured; ultimately, spleen dampness is disturbed, resulting in both "ke" (coughing sound) and "sou" (expectoration). The classics state: Injury by dampness in autumn leads to coughing in winter. Generally, the qi of early autumn should be clear and肃 (descending/clearing). If disturbed, the qi rushes upward causing coughing; over time, it disturbs spleen dampness to form phlegm. The general treatment principles are the same as for adults.
The *Mai Jing* (Pulse Classic) states: A faint pulse at the guan position indicates coughing; a floating and moderate pulse indicates wind-stroke (wind-cold injury); a tight pulse indicates cold-cough due to lung cold. A floating and soft pulse indicates a favorable prognosis, while a wiry and urgent pulse indicates an unfavorable prognosis (death).
Qian Yi stated: Coughing is caused by excess lung qi with slight cold. In the eighth and ninth lunar months, lung qi is vigorous. Coughing during this period indicates an excess condition, not a chronic illness. Symptoms include red face, body heat, and abundant phlegm. The treatment method is to purge using Tingli Wan (Descurainia Seed Pill). If it is a chronic condition, purging is contraindicated. Coughing in the eleventh and twelfth lunar months is due to wind-stroke. Wind enters through Feishu (BL13) at the third thoracic vertebra on the back. The treatment is to induce sweating with Mahuang Tang (Ephedra Decoction). If there are heat signs, such as red face, free urination, hot saliva, and blocked throat, Ganjie Tang (Licorice and Platycodon Decoction) should be used. Within five to seven days, if there is body heat, abundant phlegm, and thick/sticky snot and saliva, Pianyin Wan should be used to purge. For lung excess, characterized by cough followed by wheezing, facial edema, thirst, or lack of thirst, and body heat, Xiebai San (White Powder to Drain) should be used to drain lung heat. For cough due to cold damage, if after five to seven days there are no heat signs but only coughing, Tingli Wan is also indicated, followed by phlegm-resolving medicines. For lung deficiency, characterized by choking sensations during cough, frequent deep sighing, and sounds in the throat (chronic condition), Ejiao San (Donkey-Hide Gelatin Powder) is indicated. If phlegm is abundant, tonify the spleen first, then use Pianyin Wan to purge. After saliva/phlegm recedes, tonifying the lung is the best method. For cough with vomiting of clear water or greenish-clear fluid, Baixiang Wan is used to purge. For cough with vomiting of phlegm-saliva or milk/food, Baibing Zi (White Cake Pill) is used. For cough with pus and blood, indicating lung heat, Ganjie Tang is taken after meals. For chronic cough where lung fluids are depleted, Ejiao San is used to tonify. For cough with solid phlegm, mild wheezing, red face, and occasional drinking, Pianyin Wan is used to purge. The general principle for treating cough is: excess conditions are purged, chronic conditions are tonified, and dosages are adjusted according to excess or deficiency.
For cough with fever due to wind-stroke, the exterior should first be dispersed. Ren Shen Qiang Huo San (Ginseng and Notopterygium Decoction) added with Mahuang, or Jinfeicao San (Boiling Grass Powder) added with Sangbaipi, Xingxing San, or Shensu Yin are all dispersing formulas. If heat persists, Jieji Tang (Muscle-Releasing Decoction) is indicated. If, after dispersing wind pathogens, there are no other symptoms except slight coughing, Baolong Wan (Embracing Dragon Pill) or Xiebai San (White Powder to Drain) for calming the lung may be used. If phlegm-saliva is congested and abundant, Yubing Zi or Jinxing Wan are used. To purge phlegm-heat, Xiebai San added with Ren Shen, or Chen Sha Banxia Wan (Cinnabar and Pinellia Pill), or Baolong Wan are particularly effective. If heat persists after purging and signs of convulsions appear, Bohe San (Mint Powder) should be administered.
For cough with fever due to cold invasion, Xingxing San added with Mahuang is taken to disperse cold from the exterior. For slight coughing, Xingren Gao (Apricot Kernel Paste) or Renshen Banxia Wan (Ginseng and Pinellia Pill) are used. For phlegm-cough, Banxia Fuling Tang (Pinellia and Poria Decoction) is used.
For chronic cough previously treated with resolving methods, if lung qi is deficient and cold, the lung should be tonified. Bufen Ejiao San (Tonify Lung Donkey-Hide Gelatin Powder) or Runfei San (Moisten Lung Powder) are taken. For wind affecting the lungs, or long-standing cold in the lungs that does not resolve, moxibustion is applied to Feishu (BL13) for three moxa cones, and Subai Wan (Stemona Pill) is taken. A decoction of Chenpi (Tangerine Peel), Ying Susuo (Poppy Shell), and Sanggen Baipi (Mulberry Root Bark) is prepared, ground into powder, and taken after meals.
For infants within one hundred days of birth suffering from cough, the lung lobes are fragile, making it the most difficult to treat. Ordinary cold or heat pathogens entering the lungs cannot be expelled easily, and the infant cannot tolerate emetic or purgative therapies. One must clearly identify the source of the disease, dissipate wind-cold, resolve phlegm, regulate qi, benefit the lung, generate fluids, open the stomach, and strengthen qi. Cough will gradually decrease. Strong attacking methods should not be forced.
Cold-cough presents with clear nasal discharge, pale face, thin phlegm, lighter symptoms in the day and heavier at night, or slight pathogenic heat. Heat-cough presents with slightly red face, dry and hot nose, thick phlegm, and floating-rapid pulse. Stomach heat, not caused by wind-cold, results from feeding the infant immediately after crying, causing congestion in the heart and lungs that fails to disperse, leading to cough and counterflow qi. Yubing Zi is used to purge.
Qian Yi’s method for treating cough emphasizes strengthening the spleen first. When the spleen (mother organ) is strengthened, the lung (child organ) becomes harmonious.
In children with cough, the interstices are stimulated by wind pathogens, causing red face and rapid breathing. Differentiate between excess and deficiency. If lips are retracted, chest is sunken, and nose is dry, withered, and black, these are intractable cases.