杂病咳嗽。另有方书可查。未及备论。兹所论者。虚痨失血之咳嗽也。失血家。十有九咳。所以然者。肺为华
盖。肺中常有津液。则肺叶腴润。覆垂向下。将气敛抑。使其气下行。气下则津液随之而降。是以水津四布。
水道通调。肝气不逆。肾气不浮。自无咳嗽之病矣。血者火化之阴汁。津者气化之水液。二者本相济相养。
水不济火。则血伤。血不养气。则水竭。水竭则津不润。肺血伤。则火来克金。金被火克。不能行其制节。于是
在下之气。始得逆上。气既逆上。则水津不能随气下布。凝结为痰。在下之水邪。又得随气而升泛为水饮。
皆致咳嗽。吾于咳血门已详论之。兹复条列如下。以便查核。
一肺脏津虚。火气乘之。致成燥咳。气呛痰涩。或带血丝。久成肺痿。清燥救肺汤治之。
一痰火凝结。咳逆发渴。喉中痰滞者。由于津液不散。阻塞气道。治宜清利其痰。滋养其津。紫菀散主之。
一水饮冲肺。咳逆倚息。不得卧者。由于失血之人。肝经风火太盛。激动其水。上冲肺。卧则肺叶张。水饮愈
冲。是以不得卧息。葶苈大枣泻肺汤治之。吾每用二陈汤治饮。加苏子柴胡白芥子黄芩石膏杏仁荆芥
薄荷枇杷叶。风火兼治。尤效。此与杂病咳嗽。因寒动水者有异。因寒动水。以致水饮冲肺者。宜小青龙及
真武汤。血证咳嗽。多是内动风火。激水而上。青龙真武等。又其所忌。医者辨之。
夫虚痨咳嗽。原于火克金。水乘肺。而切究其故。则病皆在于胃。胃为水谷之海。化生津血。血不足则火旺。
津不生则肺燥。水气不化。则饮邪上干。治胃火。宜白虎汤。加生地百合五味子。或玉女煎。治胃痰。宜滚痰
丸。指迷茯苓丸。轻者用豁痰丸。治胃中水饮。宜二陈汤。加苏子白芥子防己枳壳杏仁生姜。若水饮挟火
者。加柴胡黄芩当归白芍。
内经云。五脏六腑。皆有咳嗽。而无不聚于胃关于肺。上条分肺胃。治已详。兹有一方。可以统治肺胃者。则
莫如小柴胡汤。肺火盛。加麦冬。心火盛。加黄连当归。肝火盛。加当归胡黄连。黄昏咳嗽。为火浮于肺。加五
倍子五味子以敛之。五更咳嗽。为食积之火。至寅时流入肺经。加莱菔子。痰凝气滞者。加栝蒌霜旋复花
杏仁桔梗射干川贝母。水饮上冲者。加葶苈子桑白皮细辛五味子。有寒加干姜云茯苓。若兼外感。发热
恶寒。鼻塞头痛。而咳嗽者。宜小柴胡汤。加荆芥紫苏杏仁薄荷。盖小柴胡能通水津。散郁火。升清降浊。左
宜右有。加减合法。则曲尽其妙。
又有痰血作咳。其证咳逆倚息。而不能卧。与水饮冲肺之证相似。盖人身气道。不可有塞滞。内有瘀血。则
阻碍气道。不得升降。是以壅而为咳。气壅即水壅。气即是水故也。水壅即为痰饮。痰饮为瘀血所阻。则益
冲犯肺经。坐立则肺覆。瘀血亦下坠。其气道尚无大碍。故咳亦不甚。卧则瘀血翻转。更为阻塞。肺叶又张。
愈难敛戢。是以倚息不得卧也。若仍照水饮冲肺。用葶苈大枣汤。是得治饮之法。而未得治瘀之法矣。须
知痰水之壅。由瘀血使然。但去瘀血。则痰水自消。宜代抵当丸。加云茯苓法半夏。轻则用血府逐瘀汤。加
葶苈苏子。又有咳嗽侧卧一边。翻身则咳益甚者。诸书皆言侧卧一边。乃失血咳嗽不治之证。而不知仍
是瘀血为病。盖瘀血偏着一边。以一边气道通。一边气道塞。气道通之半边。可以侧卧。气道塞之半边。侧
卧则更闭塞。是以翻身。则愈加咳逆也。宜血府逐瘀汤。加杏仁五味子主之。侧卧左边者。以左边有瘀血。
故不得右卧也。右卧则瘀血翻动。益加壅塞。宜加青皮鳖甲莪术。以去左边之瘀血。侧卧右边者。以右边
有瘀血。故不得左卧也。宜加郁金桑皮姜黄。以去右边之瘀血。凡此瘀血咳嗽之证。诸书少言及者。朱丹
溪略引其端。亦未申明。吾于临证有悟。不惜大声疾呼者。正欲起死人而肉白骨。岂敢秘而不传哉。
又有冲气咳逆者。以冲脉起于血海。循行而上丽于阳明。血海受伤。则冲脉气逆。上合阳明。而为火逆燥
咳之证。麦门冬汤主之。玉女煎亦治之。二方皆从阳明。以抑冲气之颠。使不逆也。
又有冲气挟肝经相火。上乘肺金者。其证目眩口苦。呛咳数十声不止。咳牵小腹作痛。发热颊赤。宜四物
汤。合左金丸。再加人尿猪胆汁牡蛎五味治之。盖血室为肝之所司。冲脉起于血室。故肝经之火。得缘冲
气而上。小柴胡汤。加五味子青皮龙骨牡蛎丹皮地骨皮亦治之。重者加胡黄连。
冲脉本属肝经。然其标在阳明。而其根则在于肾。盖冲脉起胞中。而肾气即寄在胞中。肾中之气。上于肺
而为呼吸。亦借冲脉之路。以上循入肺。是以脐旁冲脉之穴。谓之气冲。内经又明言冲为气冲。冲脉之与
肾经交合者如是。是以冲脉每挟肾中之虚火。上逆而咳。喘促咽干。两颧发赤。宜猪苓汤。加五味子知母
牛膝黄柏熟地龟板。或麦味地黄汤以安之。三才汤。加铁落以镇之。或大补阴丸。合磁朱丸。加五味以吸
冲气。使归于肾。则不咳逆矣。又有胞中之水内动。冲气挟水上逆而咳者。其证上热下寒。龙雷火升。面赤
浮肿。头晕咽痛。发热心悸。大便反滑。腰痛遗溺。桂苓甘草五味汤治之。肾气丸亦治之。参看吐血咳血门更详。
咳嗽之病。其标在肺。其本在肾。血家咳嗽。尤多生于肾虚。肾者气之根也。肾经阴虚。则阳无所附。气不归
根。故浮喘咳逆。宜三才汤。加五味子沉香。陈修园用二加龙骨牡蛎汤。加阿胶麦冬五味子。其附子须少
用。只作引导耳。余每用知柏地黄汤。少加五味子肉桂。以为报使。常服都气丸亦佳。又有肾经阳虚。不能
化水。腰痛便短。气喘咳逆者。肾气丸。加五味治之。更有肾水上泛。脾土不制。而为水饮咳嗽者。乃属五饮
杂病。非失血家应有之证。自有各书可查。兹不赘及。
杂病咳嗽，另有方书可供查阅，此处不及详细论述。本文所讨论的，是虚劳失血引起的咳嗽。失血的患者中，十有八九会出现咳嗽。之所以如此，是因为肺为“华盖”（位于五脏六腑之上，覆盖诸脏），肺中常有津液，则肺叶滋润丰满，向下垂覆，能够收敛和抑制气机，使气下行。气下行则津液随之而降，于是水津四布全身，水道通调顺畅，肝气不逆乱，肾气不浮越，自然就不会发生咳嗽的疾病了。
血是由火炼化而成的阴汁，津液是由气化作用产生的水液。这两者原本相互济助、相互滋养。如果水不能济助火，就会损伤血液；如果血不能滋养气，就会导致津液枯竭。津液枯竭则无法滋润肺部，肺血受损则火热之邪来克制肺金（五行中金对应肺）。肺金被火克制，不能行使制约节制的功能，于是下焦的气开始逆乱上行。气既已逆上，水津就不能随气向下布散，凝结成为痰。下焦的水湿邪气，又随着气机上冲泛滥成为水饮。这些都导致咳嗽。我在咳血章节中已经详细论述过，这里再次分条列出如下，以便查阅核对。
一、肺脏津液亏虚，火气乘虚而入，导致燥咳。症状表现为气喘呛咳、痰液涩滞，或痰中带血丝。久病可发展为肺痿。用清燥救肺汤治疗。
二、痰火凝结，咳嗽气逆且口渴，喉中有痰阻滞。这是由于津液不能散布，阻塞气道所致。治疗应当清热利痰，滋养津液。用紫菀散为主方。
三、水饮冲犯肺脏，咳嗽气逆，倚靠物体呼吸，不能平卧。这是由于失血之人，肝经风火太盛，激动体内水液，上冲于肺。平卧时肺叶张开，水饮更加冲逆，所以不能平卧休息。用葶苈大枣泻肺汤治疗。我平时常用二陈汤治疗水饮，加入苏子、柴胡、白芥子、黄芩、石膏、杏仁、荆芥、薄荷、枇杷叶，风火兼治，效果尤其显著。这与杂病咳嗽因寒邪动水不同。因寒邪动水导致水饮冲肺的，适宜用小青龙汤及真武汤。而血证引起的咳嗽，多是内动风火，激惹水液上冲，小青龙汤、真武汤等又是其所禁忌的。医生需仔细辨别。
大凡虚劳咳嗽，根源在于火克金、水凌肺。但深入探究其病因，病位往往在胃。胃是水谷之海，化生津液和血液。血不足则火旺，津不生则肺燥，水气不化则饮邪上干。治疗胃火，适宜用白虎汤，加生地、百合、五味子；或用玉女煎。治疗胃中痰浊，适宜用滚痰丸、指迷茯苓丸；轻症用豁痰丸。治疗胃中水饮，适宜用二陈汤，加苏子、白芥子、防己、枳壳、杏仁、生姜。若水饮挟带火热，加柴胡、黄芩、当归、白芍。
《内经》说：五脏六腑都有咳嗽，但没有不是汇聚于胃、关联于肺的。上述条款分别论述了肺和胃的治疗，已经很详细了。现在有一方剂，可以统摄治疗肺和胃的病变，那就是小柴胡汤。肺火盛的，加麦冬；心火盛的，加黄连、当归；肝火盛的，加当归、胡黄连。黄昏时咳嗽，是火浮于肺，加五倍子、五味子以收敛之；五更时咳嗽，是食积之火，到了寅时流入肺经，加莱菔子。痰凝气滞的，加瓜蒌霜、旋复花、杏仁、桔梗、射干、川贝母。水饮上冲的，加葶苈子、桑白皮、细辛、五味子。有寒象的，加干姜、云茯苓。若兼有外感，出现发热、恶寒、鼻塞、头痛并伴有咳嗽的，适宜用小柴胡汤，加荆芥、紫苏、杏仁、薄荷。因为小柴胡汤能通调水津，疏散郁火，升清降浊，左右兼顾，加减得当，就能穷尽其妙。
又有痰血作咳的情况，症状表现为咳嗽气逆、倚靠呼吸、不能平卧，与水饮冲肺的症状相似。人体的气道不可有堵塞停滞，体内有瘀血，就会阻碍气道，使气机不得升降，从而壅滞而成咳嗽。气壅即水壅，气即是水的缘故。水壅滞就形成痰饮，痰饮被瘀血阻隔，就更加冲犯肺经。坐立时肺叶覆盖，瘀血也向下坠，此时气道尚没有太大阻碍，所以咳嗽也不严重。平卧时瘀血翻转，更加阻塞，肺叶又张开，更难收敛，所以倚靠呼吸而不能平卧。如果仍然按照水饮冲肺的方法，使用葶苈大枣汤，这是得到了治疗水饮的方法，却没有得到治疗瘀血的方法。必须知道痰水的壅滞，是由瘀血造成的，只要去除瘀血，痰水自然消除。适宜用代抵当丸，加云茯苓、法半夏；轻症用血府逐瘀汤，加葶苈子、苏子。又有咳嗽时侧卧一边，翻身则咳嗽加剧的，各种医书都说侧卧一边是失血咳嗽的不治之证，却不知道这仍然是瘀血致病。因为瘀血偏着在一边，使得一边气道通畅，一边气道闭塞。气道通畅的那半边可以侧卧，气道闭塞的那半边侧卧则更加闭塞，所以翻身时，咳嗽气逆更加厉害。适宜用血府逐瘀汤，加杏仁、五味子为主方。侧卧左边的，是因为左边有瘀血，所以不能向右卧。向右卧则瘀血翻动，更加壅塞，适宜加青皮、鳖甲、莪术，以去除左边的瘀血。侧卧右边的，是因为右边有瘀血，所以不能向左卧，适宜加郁金、桑白皮、姜黄，以去除右边的瘀血。以上这些瘀血咳嗽的证候，各医书很少提及，朱丹溪略微引出端倪，也未明确阐明。我在临证中有感悟，不惜大声疾呼，正是为了起死回生，怎敢秘而不传呢？
又有冲气咳嗽气逆的，因为冲脉起于血海，循行而上连于阳明经。血海受伤，则冲脉气逆，上合阳明，形成火逆燥咳的证候。用麦门冬汤主治。玉女煎也能治疗。这两个方子都从阳明经入手，以抑制冲气的颠狂，使其不致上逆。
又有冲气挟带肝经相火上冲肺金的，症状表现为目眩、口苦、呛咳数十声不止，咳嗽牵引小腹疼痛，发热、脸颊发红。适宜用四物汤，合左金丸，再加人尿、猪胆汁、牡蛎、五味子治疗。因为血室由肝所主管，冲脉起于血室，所以肝经之火，得以顺着冲气而上逆。小柴胡汤，加五味子、青皮、龙骨、牡蛎、丹皮、地骨皮也能治疗。重症加胡黄连。
冲脉本属于肝经，但其标在阳明，其根则在肾。因为冲脉起于胞中，而肾气也寄居于胞中。肾中的气，上达于肺而形成呼吸，也是借助冲脉的路径，向上进入肺经。所以脐旁冲脉的穴位，称为气冲穴。《内经》又明确说明冲脉即为气冲。冲脉与肾经的交合关系就是这样。因此冲脉常常挟带肾中的虚火上逆而咳，喘促、咽干、两颧发红。适宜用猪苓汤，加五味子、知母、牛膝、黄柏、熟地、龟板；或用麦味地黄汤以安之；或用三才汤，加铁落以镇之；或用大补阴丸，合磁朱丸，加五味子以吸纳冲气，使其归于肾，就不咳嗽气逆了。又有胞中的水液内动，冲气挟水上逆而咳的，症状表现为上热下寒，龙雷之火上升，面赤浮肿，头晕咽痛，发热心悸，大便反而滑泄，腰痛遗尿。用桂苓甘草五味汤治疗。肾气丸也能治疗。参看吐血、咳血章节更为详细。
咳嗽的病，其标在肺，其本在肾。失血患者的咳嗽，大多生于肾虚。肾是气的根本。肾经阴虚，则阳无所依附，气不归根，所以浮喘、咳嗽气逆。适宜用三才汤，加五味子、沉香。陈修园用二加龙骨牡蛎汤，加阿胶、麦冬、五味子，其中的附子须少量使用，只作为引导药罢了。我平时用知柏地黄汤，少加五味子、肉桂，作为引经报使之药。常服都气丸也很好。又有肾经阳虚，不能化水，出现腰痛、小便短少、气喘咳嗽气逆的，用肾气丸，加五味子治疗。更有肾水上泛，脾土不能制约，而成为水饮咳嗽的，这属于五饮杂病，不是失血患者应有的证候，自有各书可查，此处不再赘述。
For coughs arising from miscellaneous diseases, other medical texts are available for reference, so detailed discussion is omitted here. The present text discusses coughs resulting from consumptive diseases (Xulao) and blood loss. Among patients with blood loss, nine out of ten experience coughing. The reason for this is that the Lung acts as the "Canopy" (Huagai), covering all internal organs. Normally, the Lung contains body fluids (Jinye), keeping the lung tissue moist and supple. This allows the lungs to hang downward, restraining and gathering Qi, causing it to descend. When Qi descends, body fluids follow and descend as well, distributing water throughout the body and ensuring the smooth flow of the water passages. In such a state, Liver Qi does not rebel, Kidney Qi does not float, and naturally, no cough occurs.
Blood is Yin fluid transformed by Fire, while body fluids are water liquids generated by Qi transformation. These two originally support and nourish each other. If Water fails to control Fire, Blood is damaged; if Blood fails to nourish Qi, Body Fluids become exhausted. Exhaustion of fluids leads to lack of lubrication in the Lungs. Damage to Lung Blood allows Fire to overact upon Metal (the element corresponding to the Lung). When Metal is controlled by Fire, it loses its ability to regulate and restrain. Consequently, Qi from the lower Jiao begins to rebel and ascend. Once Qi rebels upward, body fluids cannot descend with it, condensing into Phlegm. Meanwhile, pathogenic water-dampness from below rises with the rebellious Qi, flooding as Water-Fluids (Shuiyin). Both conditions lead to coughing. I have discussed this in detail in the section on Hemoptysis. Here, I list the points again for easy reference.
1. Deficiency of Lung Yin fluids allows Fire to invade, resulting in Dry Cough. Symptoms include wheezing, dry throat, thick or sticky sputum, or sputum streaked with blood. Prolonged cases may develop into Lung Atrophy (Fei Wei). Treatment: Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction).
2. Condensation of Phlegm-Fire causes coughing with rebellion of Qi, thirst, and phlegm obstruction in the throat. This results from body fluids failing to disperse and blocking the airways. Treatment should focus on clearing and draining Phlegm and nourishing fluids. Primary Formula: Ziwan San (Aster Powder).
3. Water-Fluids rushing against the Lung cause coughing with Qi rebellion, requiring the patient to lean forward to breathe (Yixi), preventing lying flat. This occurs because in patients with blood loss, Wind-Fire in the Liver Meridian is excessive, agitating body water and forcing it upward against the Lung. Lying flat expands the lungs, allowing water-fluids to rush up further, hence the inability to lie down. Treatment: Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). I often use Erchen Tang (Two-Aged Decoction) to treat fluid retention, adding Su Zi (Perilla Fruit), Chai Hu (Bupleurum Root), Baijiezi (White Mustard Seed), Huangqin (Scutellaria Root), Shigao (Gypsum), Xingren (Apricot Seed), Jingjie (Schizonepeta), Bohe (Mint), and Pipaye (Loquat Leaf) to treat both Wind and Fire, which is particularly effective. This differs from miscellaneous disease coughs caused by Cold moving water. For coughs where Cold moves water leading to water-fluids rushing the Lung, Xiaoqinglong Tang (Minor Green Dragon Decoction) and Zhenwu Tang (True Warrior Decoction) are appropriate. However, coughs in blood disorders are mostly due to internal Wind-Fire agitating water to rise; thus, Xiaoqinglong Tang and Zhenwu Tang are contraindicated. Physicians must distinguish between these.
Generally, consumptive coughs originate from Fire overcoming Metal and Water overwhelming the Lung. However, upon thorough investigation, the pathology often lies in the Stomach. The Stomach is the Sea of Grain and Water, transforming fluids and blood. Insufficient blood leads to hyperactive Fire; lack of fluid generation leads to Lung dryness; failure to transform water-Qi leads to pathogenic fluids rising. To treat Stomach Fire, use Baihu Tang (White Tiger Decoction) added with Shengdi (Rehmannia Root), Baihe (Lily Bulb), and Wuweizi (Schisandra Berry); or Yunnv Jian (Lady's Jade Elixir). To treat Stomach Phlegm, use Guntan Wan (Rolling Phlegm Pill), Zhimi Fuling Wan (Pointing to Mystery Poria Pill); for mild cases, Huotan Wan (Expelling Phlegm Pill). To treat Stomach water-fluids, use Erchen Tang added with Su Zi, Baijiezi, Fangji (Stephania Root), Zhike (Aurantii Fructus), Xingren, and Shengjiang (Fresh Ginger). If water-fluids carry heat, add Chai Hu, Huangqin, Danggui (Angelica Sinensis), and Baishao (White Peony Root).
The *Neijing* states: "All five Zang and six Fu organs can produce cough, but none do so without gathering at the Stomach and relating to the Lung." The previous sections detailed treatments for the Lung and Stomach separately. Now, there is one formula that can govern both Lung and Stomach pathologies: Xiaochaihu Tang (Minor Bupleurum Decoction). For excess Lung Fire, add Maidong (Ophiopogon Tuber); for excess Heart Fire, add Huanglian (Coptis Rhizome) and Danggui; for excess Liver Fire, add Danggui and Huhuanglian (Coptis chinensis var. angustipetala). Coughing at dusk indicates Fire floating in the Lung; add Wubeizi (Chinese Gall) and Wuweizi to astringe. Coughing at dawn (Wugeng) indicates Fire from food stagnation flowing into the Lung Meridian at the Yin hour; add Laifuzi (Radish Seed). For Phlegm condensation and Qi stagnation, add Gualou Shuang (Trichosanthes Frost), Xinfuluo (Inula Flower), Xingren, Jiegeng (Platycodon Root), Shegan (Belamcanda Rhizome), and Chuanbeimu (Fritillaria Cirrhosa Bulb). For rushing water-fluids, add Tinglizi (Descurainia Seed), Sangbaipi (Mulberry Root Bark), Xixin (Asarum), and Wuweizi. For Cold patterns, add Ganjiang (Dried Ginger) and Yunfuling (Poria). If accompanied by external contraction with fever, aversion to cold, nasal congestion, headache, and cough, use Xiaochaihu Tang added with Jingjie, Zisu (Perilla Leaf), Xingren, and Bohe. Xiaochaihu Tang can unblock water fluids, dissipate constrained Fire, raise clear Yang, and descend turbid Yin. With proper modifications, it achieves perfect efficacy.
Another type is cough caused by Phlegm-Blood stasis. Symptoms include coughing with Qi rebellion, leaning to breathe, and inability to lie flat, resembling water-fluids rushing the Lung. The body's airways must not be obstructed. Internal blood stasis blocks the airways, preventing Qi descent and ascent, leading to congestion and cough. Qi congestion equals water congestion, as Qi and Water are closely related. Water congestion forms Phlegm-Fluids; when blocked by blood stasis, they more severely assault the Lung Meridian. Sitting or standing allows the lungs to cover downward and blood stasis to settle, causing less obstruction and milder cough. Lying flat causes blood stasis to shift, increasing blockage, while the lungs expand, making them harder to constrain, leading to orthopnea. Treating this solely with Tingli Dazao Tang addresses the fluid retention but misses the blood stasis. It must be understood that Phlegm-Fluid congestion is caused by blood stasis; removing the stasis resolves the Phlegm-Fluids. Use Daidsidang Wan (Great Eliminating Stasis Pill) added with Yunfuling and Banxia (Pinellia Tuber); for mild cases, Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) added with Tinglizi and Su Zi. Another presentation is coughing worse when turning over while lying on one side. Many texts claim unilateral lateral decubitus in blood-loss cough is incurable, unaware it is still due to blood stasis. Stasis localizes to one side, blocking the airway there while leaving the other open. Lying on the open side is comfortable; lying on the blocked side worsens obstruction, causing severe cough upon turning. Use Xuefu Zhuyu Tang added with Xingren and Wuweizi. For left-side preference (due to left-sided stasis), add Qingpi (Aurantii Fructus Pericarpium), Biejia (Tartar Shell), and Ezhu (Curcuma Rhizome) to remove left-sided stasis. For right-side preference (due to right-sided stasis), add Yujin (Curcuma Aromatica Rhizome), Sangbai Pi, and Jianghuang (Turmeric Rhizome) to remove right-sided stasis. Such blood-stasis coughs are rarely mentioned in older texts; Zhu Danxi hinted at them but did not clarify. My clinical insights compel me to share this openly to save lives, not to keep secrets.
Another type is cough with Qi rebellion due to Chong Mai (Penetrating Vessel) disturbance. The Chong Mai originates from the Blood Sea (Chong Mai/Blood Chamber) and ascends to connect with the Yangming Stomach Meridian. Injury to the Blood Sea causes Chong Qi to rebel, merging with Yangming, resulting in Fire-rebellion dry cough. Treat with Maimendong Tang (Ophiopogon Decoction) or Yunnv Jian. Both formulas act on the Yangming to suppress the rebellious Chong Qi.
If Chong Qi carries Liver Ministerial Fire to assault Lung Metal, symptoms include vertigo, bitter taste, incessant hacking cough, abdominal pain radiating from coughing, fever, and flushed cheeks. Use Siwu Tang (Four Substances Decoction) combined with Zuojin Wan (Left Metal Pill), plus human urine, pig bile, Muli (Oyster Shell), and Wuweizi. Since the Blood Chamber is governed by the Liver and the Chong Mai originates from it, Liver Fire follows Chong Qi upward. Xiaochaihu Tang added with Wuweizi, Qingpi, Longgu (Dragon Bone), Muli, Mudanpi (Moutan Cortex), and Digupi (Lycium Bark) is also effective. Severe cases add Huhuanglian.
Although the Chong Mai belongs to the Liver Meridian, its manifestation is in Yangming, and its root is in the Kidney. Originating in the Uterus (Baozhong), where Kidney Qi resides, Kidney Qi ascends to the Lung for respiration via the Chong Mai pathway. Hence, the acupoint near the navel on the Chong Mai is called Qichong. The *Neijing* explicitly links Chong with Qi Chong. Thus, the Chong Mai often carries Kidney Deficient Fire upward, causing cough, panting, dry throat, and malar flush. Use Zhuling Tang (Polyporus Decoction) added with Wuweizi, Zhimu (Anemarrhena Rhizome), Niuxi (Achyranthes Root), Huangbai (Phellodendron Bark), Shudi (Prepared Rehmannia Root), and Guiban (Turtle Shell); or Maiwei Dihuang Tang (Ophiopogon and Schisandra Rehmannia Pill) to calm it; or Santang Tang (Three Immortals Decoction) with Tielpuo (Iron Filings) to anchor it; or Dabu Yin Wan (Great Tonify Yin Pill) combined with Cizhu Wan (Magnetite and Alumen Pill) with Wuweizi to draw Chong Qi back to the Kidney, stopping the cough. If water in the Uterus moves internally, carrying Chong Qi and water upward, symptoms include upper heat/lower cold, rising Dragon-Lei Fire, facial flushing and edema, dizziness, sore throat, fever, palpitations, loose stools, lower back pain, and urinary incontinence. Treat with Guiling Gancao Wuwei Tang (Cinnamon Twig, Poria, Licorice, and Schisandra Decoction) or Shenqi Wan (Kidney Qi Pill). See the Hematemesis and Hemoptysis sections for details.
Cough has its branch in the Lung and its root in the Kidney. Cough in blood-loss patients often stems from Kidney deficiency. The Kidney is the root of Qi. Kidney Yin deficiency leaves Yang unanchored, causing Qi to fail to return to its root, resulting in floating panting and cough. Use Santang Tang added with Wuweizi and Chenxiang (Aquilaria Wood). Chen Xiuyuan used Erjia Longgu Muli Tang (Two-Sided Dragon Bone and Oyster Shell Decoction) added with Ejiao (Donkey-Hide Gelatin), Maidong, and Wuweizi, using only a small amount of Fuzi (Aconite Root) as a guide. I often use Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Pill) with small amounts of Wuweizi and Rougui (Cinnamon Bark) as guiding agents. Changfu Duqi Wan (Duqi Pill) is also good. For Kidney Yang deficiency failing to transform water, presenting with lower back pain, short urine, and asthmatic cough, use Shenqi Wan added with Wuweizi. If Kidney water floods upward and Spleen Earth fails to control it, causing water-fluid cough, this belongs to the Five Fluids miscellaneous diseases, not typical of blood-loss patients, and is covered in other texts.