吴云。有声之谓咳。连声之谓嗽。不言嗽者。省文也。儒门事亲云。嗽与咳一证也。后人或以嗽为阳。
咳为阴。亦无考据。且内经咳论一篇。纯说咳也。其中无嗽字。由是言之。咳。即嗽也。嗽。即咳也。阴阳应
象大论云。秋伤于湿。冬生咳嗽。又五脏生成篇云。咳嗽上气。又诊要经终论云。春刺秋分。环为咳嗽。又示
从容篇云。咳嗽烦冤者。肾气之逆也。素问惟以四处。连言咳嗽。其余篇中。止言咳
不言嗽。乃知咳嗽一证也。简按释名云。咳。刻也。气奔至出入不平调。若刻物也。嗽。促也。用力急促也。
吴意正与此符矣。刘完素云。咳。谓无痰而有声。嗽。谓无声而有痰。（保命集）李汤卿则辨之云。无考据。
（心印绀珠）大是。
其寒饮食 邪气脏腑病形篇云。形寒寒饮则伤肺。以其两寒相感。中外皆伤。故气逆而上行。汪昂
云。皮毛受寒。为外伤寒。餐寒饮冷。为内伤寒。今人惟知外伤寒。而不知有内伤寒。讹为阴症者。是也。不
读内经。乌能知此。简按内伤寒固有之。然与阴症迥别。
各传以与之 张云。如肝当受病于春。以其时也。然有非木令之时。而肝亦病者。正以肺先受邪。
而能传以与之也。凡诸脏腑之非时受邪者。其义皆然。汪昂云。马注。作肺传邪于五脏而咳。李士材宗之。谬。
观篇首肺之令人咳。篇后关于肺二语。则咳之必由于肺明矣。
为泄为痛 吴云。上文。言外内合邪。故为病亦兼内外。咳。外证也。泄。里证也。寒在表则身痛。
寒在里则腹痛。是兼乎内外者也。简按王注涩痢。恐不必然。
乘秋则 简按据新校正。全本。太素。无此三字。然下文有乘春乘夏等语。则全本。太素。系于脱
遗。马以下诸本并有之。
先受邪 吴云。曰先受之。则次便及乎肺。而为咳矣。
至阴 高云。脾为阴中之至阴。寄王四时。乘至阴。即其王时也。简按痹论。以至阴遇此者。为肌
痹。王注云。至阴。谓戊己月。及土寄月也。
喘息有音 病源。外台。音下。有声字。
喉仲介介如梗状 甲乙介介。作喝喝。（新校正。甲乙。介介如梗状。作喝喝。误。）梗。巢源作
哽。吴云。介介。坚梗而有妨碍之意。
志云。脏腑病形篇曰。心脉大甚为喉 。盖喉乃肺之窍。心火淫金。故喉仲介然如梗状。简按西京赋注。草木
刺人为梗。
不可以转转则 外台。作不可以转侧。似是。
阴阴引肩背 巢源。作 引肩 。○马云。按此事难知。集李东垣治五脏咳方。肺咳。用麻黄汤。
心咳。用桔梗汤。肝咳。用小柴胡汤。脾咳。用升麻汤。肾咳。用麻黄附子细辛汤。虽未尽中病情。姑备此以
俟采择。
长虫 张云。蛔虫也。居肠胃之中。呕甚则随气而上出。简按。巢源云长虫。蛔虫也。长一尺。脏腑
病形篇。云脾脉微滑。为虫毒 蝎。 。 。蛔。并音回。说文。腹中长虫。关尹子云。人之一身。内包蛲蛔。
外蒸虮虱。东方朔神异经云。人腹中蛔虫。其状如蚓。此消谷虫也。多则伤人。少则谷不消。知蛔虫常居肠胃
中也。
呕胆汁 千金。作清苦汁出。四时气篇云。胆液泄则口苦。胃气逆则呕苦。故曰呕胆。
咳而遗失 志云。失。当作矢。廉颇传曰。坐顷三遗矢。简按甲乙作矢。为是。病源作屎。千金作粪。
三焦咳 张云。久咳不已。则上中下三焦俱病。出纳升降。皆失其和。故腹满不能食饮。简按王注。
为上中二焦。马注。为手少阳之三焦。恐非也。
此皆聚于胃关于肺 马云。夫五脏六腑之咳如此。然皆聚之于胃。以胃为五脏六腑之主也。关之于肺。
以肺先受邪。而后传之于别脏别腑也。使人多涕唾。而面浮肿。皆以气逆于上故耳。此乃脏腑咳疾之总语也。
简按此解。胜于王注。张高并仍马义。
治其俞 志云。咳在五脏。当治其俞。五脏之俞。皆在于背。欲知背俞。先度其两乳间。以草度其背。
是谓五脏之。俞。灸刺之度也。简按此据血气形志篇。而诸家并原于本输篇。未详何是。
治其合 志云。合治内腑。故咳在六腑者。取之于合。胃合入于三里。大肠合入于巨虚上廉。小肠
合入于巨虚下廉。三焦合入于委阳。膀胱合入于委中央。胆合入于阳陵泉。高同。简按此据邪气脏腑病形篇。
而诸家并原于本输篇。亦未详何是。
治其经 志云。浮肿者。取肺胃之经脉以治之。简按上文。曰俞。曰合。前注似是。证治准绳。并
张氏医通咳嗽门。载增补素问五脏六腑咳治例。当参看。
吴云：有声音的叫作咳，连续不断的叫作嗽。文中只说“咳”而不提“嗽”，是省略了文字。《儒门事亲》说：嗽和咳是一个病症。后人有的认为嗽属阳，咳属阴，但这都没有考证依据。况且《内经·咳论》这一篇，纯粹讲咳，其中没有“嗽”字。由此而言，咳就是嗽，嗽就是咳。《阴阳应象大论》说：“秋伤于湿，冬生咳嗽。”《五脏生成篇》说：“咳嗽上气。”《诊要经终论》说：“春刺秋分，环为咳嗽。”《示从容篇》说：“咳嗽烦冤者，肾气之逆也。”《素问》中只有这四处连用“咳嗽”二字，其余篇章中，只说“咳”不说“嗽”。由此可知，“咳嗽”是一个病症。简按：《释名》说：咳，刻也。气奔至出入不平调，像刻物一样。嗽，促也，用力急促的意思。吴氏的意思正与此相符。刘完素说：咳，指无痰而有声；嗽，指无声而有痰。（出自《保命集》）李汤卿则辩驳说：没有考证依据。（出自《心印绀珠》）这种观点非常正确。
关于寒凉饮食，《邪气脏腑病形篇》说：形体受寒，喝冷饮料就会损伤肺脏。因为内外两寒相感，内外都受伤，所以气逆而上行。汪昂说：皮毛受寒，称为外伤寒；进食寒饮冷食，称为内伤寒。现在的人只知道外伤寒，而不知道有内伤寒，将其讹传为阴症，这是错误的。不读《内经》，怎么能知道这一点？简按：内伤寒确实存在，然而它与阴症截然不同。
各传以与之：张景岳注：比如肝脏应当在春季受病，因为那是肝木当令的时节。然而也有非木令之时，肝脏却生病的情况，正是因为肺先受了邪气，而能将邪气传给它（肝）。所有其他脏腑在非时令受邪的道理都是这样。汪昂说：马莳的注释，认为是肺将邪气传给五脏而导致咳，李士材遵循了这一说法，这是错误的。看篇首说“肺之令人咳”，篇后有关肺的两句话，那么咳必然由于肺是明确的。
为泄为痛：吴云：上文讲的是外内合邪，所以发病也兼有内外。咳，是外证；泄，是里证。寒在表则身体疼痛，寒在里则腹痛，这是兼有内外症状的表现。简按：王冰注解说这是涩痢，恐怕不一定正确。
乘秋则：简按据林亿等的新校正，全本、《太素》中没有这三个字。然而下文有“乘春”、“乘夏”等语句，那么全本、《太素》应该是脱漏遗失了。马莳以下的版本都有这三个字。
先受邪：吴云：说是“先受之”，那么接着就波及到肺，从而发生咳了。
至阴：高世栻注：脾为阴中之至阴，寄旺于四季。乘至阴，就是它当旺的时节。简按：《痹论》中说，遇到至阴时节的，称为肌痹。王冰注解说：至阴，指的是戊己月，以及土寄旺的月份。
喘息有音：《诸病源候论》、《外台秘要》中，“音”字下多一“声”字。
喉仲介介如梗状：《甲乙经》中“介介”写作“喝喝”。（新校正指出：《甲乙经》中“介介如梗状”写作“喝喝”，是错误的。）“梗”，《诸病源候论》中写作“哽”。吴云：介介，有坚硬阻塞且有妨碍的意思。张志聪注：《邪气脏腑病形篇》说：“心脉大甚为喉啘。”盖因喉乃肺之窍，心火淫盛克制肺金，所以喉咙感觉像被东西梗住一样。简按：《西京赋》注解说，草木刺人叫做梗。
不可以转转则：《外台秘要》中写作“不可以转侧”，似乎更合理。
阴阴引肩背：《诸病源候论》中写作“引肩”。○马云：参考《此事难知》，收集李东垣治疗五脏咳的方子：肺咳，用麻黄汤；心咳，用桔梗汤；肝咳，用小柴胡汤；脾咳，用升麻汤；肾咳，用麻黄附子细辛汤。虽然这些方子未必完全切合病情，暂且备录于此以供采择。
长虫：张景岳注：即蛔虫。居住在肠胃之中，呕吐严重时就会随着气机上逆而出。简按：《诸病源候论》说长虫就是蛔虫，长一尺。《邪气脏腑病形篇》说：“脾脉微滑，为虫毒蝎……蛔。”并注音为“回”。《说文解字》说：腹中长虫。《关尹子》说：人的一身，内包蛲蛔，外蒸虮虱。东方朔《神异经》说：人腹中的蛔虫，形状像蚯蚓，这是消谷虫。多了伤人，少了谷物不消化。由此可知蛔虫常居在肠胃中。
呕胆汁：《千金方》中写作“清苦汁出”。《四时气篇》说：“胆液泄则口苦，胃气逆则呕苦。”所以说“呕胆”。
咳而遗失：张志聪注：失，应当作“矢”。《廉颇传》说：“坐顷三遗矢。”简按：《甲乙经》作“矢”，是正确的。《诸病源候论》作“屎”，《千金方》作“粪”。
三焦咳：张景岳注：久咳不止，则上、中、下三焦都生病，出纳升降，都失去了和谐，所以腹部胀满，不能饮食。简按：王冰注解说是指上、中二焦，马莳注解说是指手少阳之三焦，恐怕都不对。
此皆聚于胃关于肺：马云：五脏六腑的咳如此，然而都汇聚于胃，因为胃是五脏六腑的主宰。关联于肺，是因为肺先受了邪气，然后才传送给其他脏腑。使人多涕唾，并且面部浮肿，都是因为气逆于上的缘故。这是关于脏腑咳疾的总体论述。简按：这种解释胜过王冰的注解。张景岳、高世栻仍然沿袭马莳的观点。
治其俞：张志聪注：咳在五脏，应当治疗其俞穴。五脏的俞穴都在背部。想要知道背俞，先测量两乳之间的距离，用草量度背部，这就是五脏俞穴灸刺的尺度。简按：这是依据《血气形志篇》，而各家都原本于《本输篇》，不清楚究竟哪个是对的。
治其合：张志聪注：合治内腑，所以咳在六腑的，取用合穴。胃合入于三里，大肠合入于巨虚上廉，小肠合入于巨虚下廉，三焦合入于委阳，膀胱合入于委中央，胆合入于阳陵泉。高世栻观点相同。简按：这是依据《邪气脏腑病形篇》，而各家都原本于《本输篇》，也不清楚究竟哪个是对的。
治其经：张志聪注：浮肿的，取肺、胃的经脉来治疗。简按：上文提到了俞穴、合穴，前人的注解似乎是正确的。《证治准绳》和张氏《医通》咳嗽门中，载有增补《素问》五脏六腑咳治例，应当参考查看。
Wu Yun: That which produces sound is called "ke" (cough); that which involves continuous, connected sounds is called "sou" (phlegm-rattling cough). The text mentions only "ke" and omits "sou"; this is a textual ellipsis. *Rumen Shiqin* states that sou and ke are the same syndrome. Later scholars sometimes classified sou as Yang and ke as Yin, but there is no evidentiary basis for this. Furthermore, the chapter "Ke Lun" (Treatise on Cough) in the *Neijing* discusses only ke, without using the character sou. Therefore, ke is equivalent to sou, and sou is equivalent to ke. *Yinyang Yingxiang Dalun* states: "Injury by dampness in autumn generates coughing in winter." *Wuzang Shengcheng Pian* states: "Cough with rebellious Qi." *Zhenyao Jingzhong Lun* states: "If acupoints corresponding to autumn are needled in spring, it leads to coughing." *Shicongrong Pian* states: "Cough accompanied by vexation indicates rebellion of Kidney Qi." In the *Suwen*, the term "kesou" (cough) appears together only in these four passages; in other chapters, only "ke" is used, not "sou". Thus, "kesou" refers to a single syndrome.
Jian An notes: *Shiming* explains: Ke means "carving"; when Qi rushes in and out unevenly, it resembles carving. Sou means "hasty"; it implies forceful and rapid action. Wu’s interpretation aligns with this. Liu Wansu stated: Ke refers to sound without phlegm; sou refers to phlegm without sound (*Baoming Ji*). Li Tangqing refuted this, stating there is no evidence (*Xinyin Gan Zhu*). This view is correct.
Regarding cold food and drink: *Xieqi Zangfu Bingxing Pian* states: "Exposure to cold in form and ingestion of cold drinks injures the Lung. Because internal and external cold interact, both interior and exterior are injured, causing Qi to rebel and move upward." Wang Ang stated: Cold affecting the skin and hair is external cold injury; consuming cold drinks and food is internal cold injury. Modern people only know of external cold injury and ignore internal cold injury, erroneously classifying it as Yin Syndrome. This is incorrect. Without reading the *Neijing*, how could one know this? Jian An notes: Internal cold injury indeed exists, but it is distinct from Yin Syndrome.
"Transmitted to each according to its time": Zhang Jiebin annotated: For example, the Liver should be diseased in Spring, as it is the season of Wood. However, the Liver may also be diseased outside the Wood season because the Lung first received the pathogen and transmitted it to the Liver. The principle applies similarly to other Zang-Fu organs receiving pathogens out of season. Wang Ang noted: Ma Shi’s annotation suggests the Lung transmits pathogens to the Five Zang organs causing cough; Li Shicai followed this, which is erroneous. Given the opening statement "The Lung causes people to cough" and the concluding remarks regarding the Lung, it is clear that cough originates from the Lung.
"For diarrhea and pain": Wu Yun explained: The preceding text discusses combined internal and external pathogens, so the disease manifestations involve both interior and exterior. Cough is an exterior syndrome; diarrhea is an interior syndrome. Cold in the exterior causes body pain; cold in the interior causes abdominal pain. This represents symptoms involving both interior and exterior. Jian An notes: Wang Bing’s annotation interpreting this as "astringent dysentery" is likely incorrect.
"Cheng Qiu Ze" (When encountering Autumn): Jian An notes: According to Lin Yi’s new corrections, the complete edition and *Taisu* do not contain these three characters. However, since the following text mentions "encountering Spring," "encountering Summer," etc., the complete edition and *Taisu* likely suffered from textual loss. Versions from Ma Shi onwards include these characters.
"First Received Pathogen": Wu Yun stated: Being "first affected" implies that subsequently the Lung is involved, leading to cough.
"Zhi Yin" (Extreme Yin): Gao Shishi annotated: The Spleen is the Extreme Yin among the Yin organs,寄旺 (residing and flourishing) through the four seasons. Encountering Zhi Yin refers to its time of flourishing. Jian An notes: *Bi Lun* states that those encountering Zhi Yin suffer from Muscle Bi. Wang Bing annotated: Zhi Yin refers to the months of Wu and Ji, and the months where Earth resides.
"Wheezing with Sound": *Zhoubing Yuanhou Lun* and *Waitai Miyao* add the character "Sheng" (sound) after "Yin" (sound).
"Throat feels obstructed like a blockage": *Jiayi Jing* writes "Jiejie" as "Hehe" (New Corrections state that *Jiayi Jing* writing "Jiejie ru geng zhuang" as "Hehe" is an error). "Geng" is written as "Geng" in *Zhoubing Yuanhou Lun*. Wu Yun stated: Jiejie implies a hard obstruction causing hindrance. Zhang Zhicong annotated: *Xieqi Zangfu Bingxing Pian* states: "Excessively large Heart pulse indicates throat obstruction." Since the throat is the orifice of the Lung, excessive Heart Fire insulting Metal (Lung) causes the sensation of blockage in the throat. Jian An notes: The commentary on *Xijing Fu* states that plants piercing humans is called "geng".
"Cannot turn or roll": *Waitai Miyao* writes "cannot turn or side-lean," which seems more plausible.
"Yin Yin draws to shoulders and back": *Zhoubing Yuanhou Lun* writes "draws to shoulders." ○ Ma Zhen noted: Referencing *Ci Shi Nan Zhi*, collecting Li Dongyuan’s formulas for Five Zang Coughs: Lung Cough uses Mahuang Tang; Heart Cough uses Jiegeng Tang; Liver Cough uses Xiaochaihu Tang; Spleen Cough uses Shengma Tang; Kidney Cough uses Mahuang Fuzi Xixin Tang. Although these may not fully match every clinical presentation, they are recorded here for reference.
"Chang Chong" (Long Worms): Zhang Jiebin annotated: These are roundworms (Ascaris), residing in the intestines. Severe vomiting causes them to exit upwards with the Qi. Jian An notes: *Zhoubing Yuanhou Lun* states Chang Chong are roundworms, about one chi long. *Xieqi Zangfu Bingxing Pian* states: "Slightly slippery Spleen pulse indicates worm poison... Hui (roundworm)." Pronounced "Hui". *Shuowen* states: Long worms in the abdomen. *Guanyanzi* states: Inside the human body are pinworms and roundworms; outside are lice and nits. Dongfang Shuo’s *Shenyi Jing* states: Roundworms in the abdomen resemble earthworms; these are grain-consuming worms. Too many harm the person; too few prevent proper digestion of grain. Thus, roundworms commonly reside in the intestines.
"Vomiting Bile": *Qianjin Fang* writes "clear bitter fluid exits." *Sishiqi Pian* states: "When Gallbladder fluid leaks, the mouth tastes bitter; when Stomach Qi rebels, bitter vomit occurs." Hence it is called "vomiting gallbladder."
"Cough with involuntary defecation": Zhang Zhicong annotated: "Shi" should be read as "Shi" (feces). *Lian Po Zhuan* states: "Sat for a moment and passed stool three times." Jian An notes: *Jiayi Jing* writes "Shi," which is correct. *Zhoubing Yuanhou Lun* writes "Shi" (feces); *Qianjin Fang* writes "Fen" (excrement).
"Sanjiao Cough": Zhang Jiebin annotated: If chronic cough persists, the Upper, Middle, and Lower Sanjiao all become diseased. Ingestion, excretion, ascending, and descending functions lose harmony, resulting in abdominal fullness and inability to eat or drink. Jian An notes: Wang Bing interpreted this as referring to the Upper and Middle Sanjiao; Ma Shi interpreted it as the Hand-Taiyang Sanjiao. Both are likely incorrect.
"All these gather at the Stomach and relate to the Lung": Ma Zhen stated: The coughs of the Five Zang and Six Fu organs are thus, yet they all gather at the Stomach because the Stomach is the master of the Five Zang and Six Fu. They relate to the Lung because the Lung first receives the pathogen and then transmits it to other organs. This causes excessive saliva and facial edema, all due to Qi rebelling upward. This is the general summary of Zang-Fu cough diseases. Jian An notes: This explanation surpasses Wang Bing’s annotation. Zhang Jiebin and Gao Shishi still follow Ma Shi’s meaning.
"Treat their Shu points": Zhang Zhicong annotated: Cough located in the Five Zang should be treated via their Shu points. The Shu points of the Five Zang are all on the back. To locate the Back-Shu points, first measure the distance between the two nipples, then use grass to measure across the back; this determines the location for moxibustion and needling of the Five Zang Shu points. Jian An notes: This is based on *Xueqi Xingzhi Pian*, whereas various commentators attribute it to *Benshu Pian*; it is unclear which is correct.
"Treat their He points": Zhang Zhicong annotated: He points treat interior Fu organs. Therefore, cough located in the Six Fu organs should be treated using He points. Stomach He point enters Zusanli; Large Intestine He point enters Shangliao (Upper Leg Three Empty); Small Intestine He point enters Xialiao (Lower Leg Three Empty); Sanjiao He point enters Weiyang; Bladder He point enters Weizhong; Gallbladder He point enters Yanglingquan. Gao Shishi agrees. Jian An notes: This is based on *Xieqi Zangfu Bingxing Pian*, whereas various commentators attribute it to *Benshu Pian*; it is unclear which is correct.
"Treat their Jing points": Zhang Zhicong annotated: For edema, treat using the Jing-River meridians of the Lung and Stomach. Jian An notes: The preceding text mentioned Shu and He points; previous annotations seem appropriate. *Zhengzhi Zhunsheng* and Zhang’s *Yitong* (Cough section) contain supplemented treatment examples for Five Zang and Six Fu Coughs from the *Suwen*; these should be consulted.