王节斋曰∶伤风咳嗽，宜辛凉解表，如桑白皮、防风、荆芥、薄荷。伤热咳嗽，宜清凉
降火，如黄芩、桑白皮、知母、门冬。伤湿热咳嗽，宜利湿热，流湿润燥，如桑皮、石膏、
黄柏、苍术、滑石、甘草。伤燥咳嗽，宜清金降火，润肺清燥，如石膏、知母、桑皮、麦冬
。伤寒咳嗽，宜辛散解表，如麻黄杏子汤、小青龙、越婢汤等。若肺素有热者，仍加山栀、
黄芩、石膏、知母。又云∶咳嗽皆主于肺，盖肺主气而作声者也。治法须分新久虚实，新冒
风寒则散之，火热则清之，湿热则渗泄之，燥热则清润之。久病宜分虚实，若气虚则补气，
血虚则补血，精虚则补精。若久而有郁，又宜开郁为主。又云∶因咳而有痰，咳为重，主治
在肺。此言素无痰候，今见咳嗽，后乃有痰而嗽也。因痰而致嗽者，痰为重，主治在脾。此
素有痰涎，今渐加咳嗽喘急之候，即湿痰痰饮之嗽也。若食积成痰，顽痰胶固，痰气上升，
以致咳嗽，只治其痰，消其积，而咳自止，不必治肺。又云∶凡酒色过度，劳伤肺肾真阴，而
咳嗽者，不可服参 ，恐阴虚火旺，反助阳气而阴益消也。先以壮水之药，如六味之类，补
其真阴，使水升火降，随用参 补肺之药，以助肾之母，使金水相生，则阴自生而阳火退。
世之用参 者，不知先壮水以镇火，而遽投参 以补阳，反使阳火愈旺，而金水愈竭矣。《
直指》云∶感风嗽者，鼻塞声重。伤冷嗽者，凄凄清怯。寒伤热嗽者，烦热焦心。热郁于内
，外复冒寒者，恶寒烦热，声哑。感湿嗽者，身重鼻塞。瘀血嗽者，胁肋刺痛，胸膈腥闷。
水停嗽者，心下怔忡。如肺脉浮紧者，为外感风寒，以发散取汗。如肺脉沉实而数，为内伤
肺热，以清利之肺脉濡散者，为肺虚，以补之。肺主皮毛，肺气虚则腠理不密，风邪易入
，法先当解表，后乃补虚，肺气实则腠理密，而邪不入矣。肺有火，则腠理不闭，风邪易入
，当解表清火，肺火清，则腠理闭而邪不入矣。若肺虚咳嗽，而用清肺之药，则腠理愈加不
密，而感邪愈易。肺火而用补肺之药，则腠理愈不闭，而感邪愈甚。夏月喘急而嗽，面赤潮
热，其脉大者，黄连解毒汤。烦躁而咳，栀子汤。此实火之治也。咳唾有血者，麦冬汤。吞
六味丸，以制阳火，此虚火之治也。张三锡曰∶百病惟咳嗽难治。一咳而痰便出者，名滑痰，属脾湿，宜南星与半夏之
类燥之，滋润之味，所当忌也。如连咳数声，痰不出者，名燥痰，属肺燥，宜门冬、知母、杏仁
之类以润之，香燥之药，亦当忌也。
丹溪云∶上半日嗽，多胃中有火；午后嗽，多阴虚火旺；黄昏嗽，多阴火上浮，宜敛而
降之。又曰，五更嗽者，胃中有痰火，伏积于内，至此时火气生养之时，上潮于肺也，宜知
母、石膏、地骨皮、青黛、海石治之。午前嗽者，气分有热，泻白散加知母、石膏。午后嗽
者，血分有热，宜养阴退热，加减四物汤，吞六味丸，合滋肾丸。又云，干咳嗽，乃痰郁火
邪在中，宜先以甘桔汤开之，随加补阴之味。咳嗽声哑，寒包热，不宜骤用寒凉，宜以辛散
桢按∶黄昏嗽，火气上浮肺中，宜敛而降之一法，此敛字，言阴虚火气上升，当养阴滋
阴，敛其火气下降，即滋阴降火之法，今人误认酸寒收敛，大谬矣。
王节斋说：伤风引起的咳嗽，适宜用辛凉的方法解表，例如桑白皮、防风、荆芥、薄荷。伤热引起的咳嗽，适宜用清凉的方法降火，例如黄芩、桑白皮、知母、麦冬。伤湿热引起的咳嗽，适宜利湿清热，流通湿气滋润燥邪，例如桑白皮、石膏、黄柏、苍术、滑石、甘草。伤燥引起的咳嗽，适宜清金降火，润肺除燥，例如石膏、知母、桑白皮、麦冬。伤寒引起的咳嗽，适宜用辛散的方法解表，例如麻杏石甘汤（注：原文“麻黄杏子汤”通常指代含麻黄杏仁的方剂，此处依文意译为麻杏石甘汤或保留原意）、小青龙汤、越婢汤等。如果肺中素有热邪，仍要加入山栀、黄芩、石膏、知母。又说：咳嗽的病机主要在于肺，因为肺主气而发出声音。治疗方法必须区分新病久病、虚证实证。新近感受风寒则发散之，火热则清泻之，湿热则渗泄之，燥热则清润之。久病应当区分虚实，如果是气虚则补气，血虚则补血，精虚则补精。如果久病而有郁结，又应当以开郁为主。又说：因为咳嗽而产生痰的，咳嗽是主要症状，治疗重点在肺。这是说平时没有痰的症状，现在出现咳嗽，后来才产生痰而咳嗽。因为痰而导致咳嗽的，痰是主要症状，治疗重点在脾。这是说平时就有痰涎，现在逐渐加重出现咳嗽喘急的症状，这就是湿痰或痰饮引起的咳嗽。如果是食积形成痰，顽痰胶固，痰气上升，导致咳嗽，只需治疗其痰，消除食积，咳嗽自然停止，不必专门治肺。又说：凡是酒色过度，劳损伤及肺肾真阴，从而引起咳嗽的，不可服用人参，恐怕阴虚火旺，反而助长阳气而使阴液更加消损。先用壮水（滋阴）的药物，如六味地黄丸之类，补益其真阴，使水升火降，随后用人参等补肺的药物，以资助肾之母（土生金，或金水相生之意），使金水相生，那么阴液自然生成而阳火退去。世上使用人参的人，不知道先壮水以镇伏火，就急于投用人参来补阳，反而使阳火更加旺盛，而金水更加枯竭了。《直指方》说：感受风邪引起的咳嗽，鼻塞声音重浊。受冷引起的咳嗽，感觉凄清怯冷。寒邪入里化热引起的咳嗽，烦热焦躁。热邪郁结于内，外面又受寒邪侵袭的，恶寒且烦热，声音嘶哑。感受湿邪引起的咳嗽，身体沉重鼻塞。瘀血引起的咳嗽，胁肋部刺痛，胸膈部腥闷不适。水饮停聚引起的咳嗽，心下悸动不安。如果肺脉浮紧的，是外感风寒，用发散法取汗。如果肺脉沉实而数，是内伤肺热，用清利法。肺脉濡散的，是肺虚，用补法。肺主皮毛，肺气虚则腠理不紧密，风邪容易侵入，法度上应当先解表，然后才补虚，肺气实则腠理紧密，邪气就不能入侵了。肺有火，则腠理不闭合，风邪容易侵入，应当解表清火，肺火清除，则腠理闭合而邪气不能入侵了。如果是肺虚咳嗽，却用清肺的药物，则腠理更加不紧密，而感受邪气更容易。肺有火却用补肺的药物，则腠理更加不闭合，而感受邪气更严重。夏季出现喘急而咳嗽，面色红赤潮热，脉象大的，用黄连解毒汤。烦躁而咳嗽，用栀子汤。这是实火的治疗方法。咳嗽吐血的，用麦冬汤。吞服六味地黄丸，以制约阳火，这是虚火的治疗方法。张三锡说：百种疾病中只有咳嗽难治。一咳嗽痰就出来的，名叫滑痰，属于脾湿，适宜用南星与半夏之类的药物燥湿化痰，滋润的药物应当禁忌。如果连续咳嗽几声，痰出不来的，名叫燥痰，属于肺燥，适宜用麦冬、知母、杏仁之类的药物滋润，香燥的药物，也应当禁忌。
丹溪说：上半日咳嗽，多是胃中有火；午后咳嗽，多是阴虚火旺；黄昏咳嗽，多是阴火上浮，适宜收敛而降逆。又说，五更时分咳嗽的，是胃中有痰火，潜伏积聚在内，到了这个时候火气生养之时，上潮于肺，适宜用知母、石膏、地骨皮、青黛、海浮石治疗。午前咳嗽的，是气分有热，用泻白散加知母、石膏。午后咳嗽的，是血分有热，适宜养阴退热，用加减四物汤，吞服六味地黄丸，配合滋肾丸。又说，干咳，是痰郁火邪在中焦，适宜先用桔梗汤开宣肺气，随后加上补阴的药物。咳嗽声音嘶哑，是寒包热证，不适宜骤然使用寒凉药物，适宜用辛散之法。
按语：黄昏咳嗽，是火气上浮于肺中，适宜收敛而降逆的一种方法，这个“敛”字，是指阴虚火气上升，应当养阴滋阴，收敛其火气下降，即滋阴降火的方法，今人误认为是酸寒收敛，大错特错了。
Wang Jiezhai stated: For cough caused by wind-cold injury (Shang Feng), it is appropriate to use acrid-cool methods to release the exterior, such as *Bai Du Zi* (Caulis Cynanchi Atrati), *Fang Feng* (Radix Saposhnikoviae), *Jing Jie* (Herba Schizonepetae), and *Bo He* (Herba Menthae). For cough caused by heat injury (Shang Re), it is appropriate to use cool methods to descend fire, such as *Huang Qin* (Radix Scutellariae), *Sang Bai Pi* (Cortex Mori Radicis), *Zhi Mu* (Rhizoma Anemarrhenae), and *Men Dong* (Tuber Ophiopogonis). For cough caused by damp-heat injury (Shang Shi Re), it is appropriate to promote urination to drain dampness and clear heat, flow moisture to moisten dryness, such as *Sang Pi* (Cortex Mori Radicis), *Shi Gao* (Gypsum Fibrosum), *Huang Bo* (Cortex Phellodendri), *Cang Zhu* (Rhizoma Atractylodis Chinensis), *Hua Shi* (Talcum), and *Gan Cao* (Radix Glycyrrhizae). For cough caused by dryness injury (Shang Zao), it is appropriate to clear Metal and descend fire, moisten the Lung and clear dryness, such as *Shi Gao* (Gypsum Fibrosum), *Zhi Mu* (Rhizoma Anemarrhenae), *Sang Pi* (Cortex Mori Radicis), and *Mai Dong* (Tuber Ophiopogonis). For cough caused by cold damage (Shang Han), it is appropriate to use acrid-dispersing methods to release the exterior, such as Ma Huang Xing Zi Tang (Ephedra and Apricot Kernel Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Yue Bi Tang (Yue Bi Decoction), etc. If there is pre-existing heat in the Lung, add *Zhi Zi* (Fructus Gardeniae), *Huang Qin* (Radix Scutellariae), *Shi Gao* (Gypsum Fibrosum), and *Zhi Mu* (Rhizoma Anemarrhenae). It is also said: The pathology of cough primarily resides in the Lung, as the Lung governs Qi and produces sound. Treatment methods must distinguish between new and old diseases, and deficiency and excess syndromes. For newly contracted wind-cold, disperse it; for fire-heat, clear it; for damp-heat, drain it through urination; for dryness-heat, clear and moisten it. For chronic illness, one must distinguish deficiency from excess. If Qi is deficient, tonify Qi; if Blood is deficient, tonify Blood; if Essence is deficient, tonify Essence. If chronic illness involves stagnation, prioritize resolving stagnation. It is also said: When phlegm arises due to cough, the cough is the primary symptom, and treatment focuses on the Lung. This refers to cases where there was no prior phlegm, but now cough appears, followed by phlegm production. When cough results from phlegm, the phlegm is the primary symptom, and treatment focuses on the Spleen. This refers to cases with pre-existing phlegm-fluids, where cough and wheezing gradually worsen, indicating cough due to damp-phlegm or fluid retention. If food stagnation transforms into phlegm, stubborn phlegm becomes fixed, and phlegm-Qi rises causing cough, treat only the phlegm and eliminate the stagnation; the cough will stop naturally, without needing to specifically treat the Lung. It is also said: For cough caused by excessive alcohol and sexual activity damaging the True Yin of the Lung and Kidney, do not administer *Ren Shen* (Radix Ginseng), lest Yin deficiency with fire hyperactivity be aggravated, further assisting Yang Qi and consuming Yin fluids. First use drugs that strengthen Water (nourish Yin), such as Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), to tonify True Yin, allowing Water to rise and Fire to descend. Subsequently, use *Ren Shen* (Radix Ginseng) and other Lung-tonifying drugs to assist the mother of the Kidney (Earth generating Metal, or Metal-Water mutual generation), so that Yin generates naturally and Yang Fire retreats. Those who use *Ren Shen* (Radix Ginseng) in the world fail to first strengthen Water to suppress Fire, and rashly administer *Ren Shen* (Radix Ginseng) to tonify Yang, which instead makes Yang Fire more vigorous and depletes Metal and Water further. *Zhi Zhi Fang* states: Cough due to wind invasion presents with nasal congestion and heavy voice. Cough due to cold injury presents with a chilly and fearful sensation. Cough due to cold transforming into heat presents with irritability, heat, and anxiety. Heat constrained internally combined with external cold exposure presents with aversion to cold, irritability, heat, and hoarseness. Cough due to damp invasion presents with heavy body and nasal congestion. Cough due to blood stasis presents with stabbing pain in the hypochondrium and chest, and a fishy sensation in the epigastrium/chest. Cough due to water retention presents with palpitations below the heart. If the Lung pulse is floating and tight, it indicates external wind-cold; use dispersing methods to induce sweating. If the Lung pulse is deep, full, and rapid, it indicates internal Lung heat; use clearing and draining methods. If the Lung pulse is soft and scattered, it indicates Lung deficiency; use tonifying methods. The Lung governs skin and hair. If Lung Qi is deficient, the interstices are not dense, and wind pathogens easily enter; the method should first release the exterior, then tonify deficiency. If Lung Qi is excess, the interstices are dense, and pathogens cannot enter. If the Lung has fire, the interstices are not closed, and wind pathogens easily enter; one should release the exterior and clear fire. Once Lung fire is cleared, the interstices close, and pathogens cannot enter. If Lung deficiency cough is treated with Lung-clearing drugs, the interstices become even less dense, making pathogen invasion easier. If Lung fire cough is treated with Lung-tonifying drugs, the interstices become even less closed, making pathogen invasion worse. In summer, wheezing and cough with red face and tidal fever, with a large pulse, are treated with Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). Irritability and cough are treated with Zhi Zi Tang (Gardenia Decoction). These are treatments for excess fire. Cough with hemoptysis is treated with Mai Dong Tang (Ophiopogon Decoction). Swallowing Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to control Yang fire is a treatment for deficiency fire. Zhang Sanxi stated: Among all diseases, only cough is difficult to treat. Cough with immediate phlegm expulsion is called slippery phlegm, belonging to Spleen dampness; it is appropriate to use *Nan Xing* (Rhizoma Arisaematis Cum Bile) and *Ban Xia* (Rhizoma Pinelliae) to dry it; moistening flavors should be avoided. Cough with several bouts without phlegm expulsion is called dry phlegm, belonging to Lung dryness; it is appropriate to use *Men Dong* (Tuber Ophiopogonis), *Zhi Mu* (Rhizoma Anemarrhenae), *Xing Ren* (Semen Armeniacae Amarum) to moisten it; aromatic-drying drugs should also be avoided.
Danxi stated: Cough in the first half of the day is mostly due to fire in the Stomach; cough in the afternoon is mostly due to Yin deficiency with fire hyperactivity; cough at dusk is mostly due to defluxion of Yin fire, and should be treated by astringing and descending. It is also said: Cough at dawn (5-7 AM) is due to phlegm-fire in the Stomach, latent and accumulated within; at this time, when fire Qi is nourished, it surges upward to the Lung. It should be treated with *Zhi Mu* (Rhizoma Anemarrhenae), *Shi Gao* (Gypsum Fibrosum), *Di Gu Pi* (Cortex Lycii), *Qing Dai* (Indigo Naturalis), and *Hai Shi* (Lapis Calcitae). Cough before noon is due to heat in the Qi level; use Xie Bai San (Drain White Powder) plus *Zhi Mu* (Rhizoma Anemarrhenae) and *Shi Gao* (Gypsum Fibrosum). Cough after noon is due to heat in the Blood level; nourish Yin and retreat heat, using Jia Jian Si Wu Tang (Modified Four Substance Decoction), swallowing Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), combined with Zi Shen Wan (Kidney-Nourishing Pill). It is also said: Dry cough is due to phlegm stagnation and fire pathogens in the middle; first use Gan Jie Tang (Licorice and Platycodon Decoction) to open it, then add Yin-nourishing ingredients. Cough with hoarse voice is due to cold enveloping heat; do not abruptly use cold-cooling drugs; use acrid-dispersing methods.
Commentary: Dusk cough is due to fire Qi floating upward to the Lung; the method of astringing and descending is appropriate. The character "astringe" here means that for rising fire due to Yin deficiency, one should nourish and moisturize Yin, astringing the fire Qi to descend, which is the method of nourishing Yin and descending fire. Modern people mistakenly interpret this as sour-cold astringency, which is a major error.