(前人每以有声无痰、有痰无声。细分咳嗽二字，今概不取。无声即不得为咳嗽矣
，且亦安能无痰?但多少、浓薄、难出易出有不同耳!)
《素问》咳论分五脏、六腑、四时，以决其病之吉凶。凡百病皆以自腑入脏者为渐深，
病独以由脏出腑者为日久。盖百病是邪气内侵，咳是真气外脱耳!咳之为病也，五脏皆为之
振动，内气不宁，渐离其根矣。今条析其证之轻重如左∶
卒然咳嗽，连声不可暂止者，此冷风随呼吸而袭肺也。此风袭肺则咳嗽，袭胃则吐逆，
吐逆
更厉于咳嗽，杀人更速，故小儿当风饮食，最所忌也。急宜温散，以桂枝为君，力制风木猖
獗之势。故凡风势之来，其风之头最厉，急入户避之；即卒无可避，亦宜谨护口鼻为佳。
外感风寒，恶寒发热，亦多有咳嗽者。此风寒由经入肺也，宜先表散，久则兼清降。其
咳声
清响，而昼夜相等。经曰∶形寒寒饮则伤肺，咳逆而上气。然饮冷是由胃络入肺也，其声略
重，宜温胃，略兼利湿。
有清晨咳嗽数十声，吐出浓痰碗许而始安者，此胃中湿热蒸肺也。声如在瓮中者，经所
谓声
如从室中言，是中气之湿也。其咳声沉重，治宜宣郁流湿；亦有寒湿致此者，但其痰较清，
其声略急，治宜温健脾土也。
有咳嗽甚重，入夜尤甚，不可伏枕者。此肾水上泛，土弱不能行水，水气冲肺也。声重
而又
急，连连不绝，逼迫万状，气不能续，治用仲景小青龙法、真武汤法，分有无外感而治之。
若水气重甚，目下肿，如新卧起者，十枣汤以泻之，轻则葶苈大枣汤，但必以附子白术汤善
其后，乃无余患也。
有停食嗳腐吞酸而作咳者，其证喉痒，而天明与日晡呛咳较甚，此亦挟风湿而然也。治
宜渗湿化食，温化大肠。其病在胃与大肠之气滞而水停也，宿食不尽，咳必不止。
有因燥而咳者，声干无痰，断续不匀，如为烟所呛，亦无定时，时吐涎沫。治宜降气养
液。
此多由时气亢旱，燥气所伤也，过食爆炙者亦有之。静卧则安，劳动则剧，与水饮昼平夜剧
者相反。有阴火烁肺而咳嗽者，此劳气也。其咳五更黎明，连连不绝，声干少痰，喉中燥痒
，由于肾竭肝虚，火升液耗，肺不能自润也。喉中常觉有一点干结，如树皮草叶，咳咯不出
者，是少阴少精不上潮而脉络燥结者，非肺燥也。急宜滋润肝肾，清宣肺胃，开结行瘀，杀
虫。凡风寒咳嗽，亦喉中作痒，但旋痒即咳，痒甚咳急；劳瘵咳嗽，渐痒始咳，咳缓痒微。
此为异也。
有喉中 然，似有物以梗之，颇碍呼吸，呼吸触之，即偶咳一两声，言语发声多不能
畅，
必先咳一两声，乃能出言。此脾湿不运，浊气上蒸也。治宜健脾行滞，疏利大肠，使浊气下
降即愈矣。更有咽中如炙脔，如桃李核者，其病根亦如此，而甚焉者也。《内经》及《中藏
经》、《脉经》多论此病，或以为肾，或以为胆，或以为肺，或以为大肠，或以为脾，有气
横逆，有气郁结，横逆即湿浊不降，郁结者忧思莫解，大便必秘，经所谓“二阳之病发心脾
”者也。(喉中 一证，《素问·咳论》以此为心咳之证。又曰∶心脉大甚，为喉 。《
金匮》五水篇论此，为寒结关元，肾气上冲。)
若夫肺痈、肺痿，则由肺家燥热太盛，实由脾家湿热熏蒸太久，浊气日增，清气不复，
渐致
液竭血沸而腐败矣。初起可治，宜清热宣郁，养液行瘀。三消、五隔诸证，亦是如此。此血
热之所致也。
陈修园谓∶久咳肺燥，可用人参生津。此必病起风热，素无水饮，日久风去热存故也。
若风
寒久咳，肺气不降，水道不调，愈久而水邪愈盛，不能伏枕，夜无宁刻矣。水饮上射，浮热
逆升，俗每自谓热咳，求用凉药，医亦以肃肺，自求速效，遂令风寒永无出路，而成劳损矣
。故吾谓∶今日咳劳，皆小青龙证也。
（前人往往将“咳”定义为有声无痰，“嗽”定义为有痰无声，对咳嗽二字进行细致区分。现在一概不采用这种观点。如果只有声音而没有痰，那就不称为咳嗽了，况且怎么可能完全没有痰呢？只不过痰的多少、浓稠稀薄、难出易出有所不同罢了！）
《素问·咳论》将咳嗽分为五脏咳、六腑咳以及四时咳嗽，以此来判断疾病的吉凶预后。一般疾病都是由腑传入脏，表示病势逐渐加深；唯独咳嗽是由脏传出腑，表示病程日久。因为一般疾病是邪气向内侵袭，而咳嗽则是真气向外耗脱啊！咳嗽这种疾病，会使五脏都受到震动，内气不得安宁，正气逐渐脱离根本。现将咳嗽证候的轻重条理分析如下：
突然发生咳嗽，连续不断不能暂时停止的，这是冷风随着呼吸侵袭肺脏所致。风气侵袭肺脏则引起咳嗽，侵袭胃腑则引起呕吐逆乱，呕吐逆乱比咳嗽更严重，致死更快，所以小儿在风中饮食是最为忌讳的。应当紧急使用温散法治疗，以桂枝为主药，强力遏制风木猖獗之势。凡是风势来袭，风头最猛烈的时候，应紧急进入屋内躲避；即使突然无法躲避，也应当谨慎保护口鼻为好。
外感风寒，出现恶寒发热症状，也多有咳嗽者。这是风寒由经络传入肺脏所致，应当先解表发散，时间久了则兼用清降法。其咳嗽声音清脆响亮，白天和夜晚程度相等。经书说：“形体受寒或饮用冷水就会伤肺，导致咳嗽气逆。”然而饮用冷水是由胃络传入肺脏的，其咳嗽声音略微沉重，治疗宜温胃，略微兼用利湿法。
有的清晨咳嗽几十声，吐出约一碗浓痰后才感到安稳，这是胃中湿热蒸腾上犯肺脏所致。咳嗽声音像在瓮中一样闷浊，经书中所谓“说话声音从室内传出般沉闷，是中焦湿气阻滞”。其咳嗽声音沉重，治疗宜宣畅郁结、流通湿气；也有因寒湿导致这种情况的，但其痰液较清稀，咳嗽声音略微急促，治疗宜温补健脾土。
有的咳嗽非常严重，入夜更加厉害，甚至无法伏枕安睡。这是肾水上泛，脾土虚弱不能运化水湿，水气冲射肺脏所致。咳嗽声音沉重而又急促，连绵不绝，逼迫状极甚，气息不能接续，治疗应用张仲景的小青龙汤法、真武汤法，根据是否有外感分别进行治疗。如果水气特别重，眼下浮肿，像刚睡醒的样子，用十枣汤来泻下攻逐，轻症用葶苈大枣汤，但必须随后用附子白术汤善后调理，才能没有遗留病患。
有的因停食、嗳气腐臭、吞酸而引发咳嗽，证见喉痒，且天亮时和傍晚时分呛咳较为严重，这也是夹杂风湿所致。治疗宜渗湿化食，温化大肠。病位在胃与大肠的气滞和水停，宿食不尽，咳嗽必然不止。
有的因燥邪而咳嗽，声音干燥无痰，断续不均匀，像被烟呛到一样，也没有固定时间，时常吐出涎沫。治疗宜降气养阴生津。这多由时令气候亢旱，燥气所伤所致，过食油炸烧烤食物的人也有此病。静卧则病情缓解，劳动则加重，这与水饮病白天减轻夜间加重的情况相反。
有的因阴火灼烧肺脏而咳嗽，这是劳损之气所致。其咳嗽在五更黎明时分，连绵不绝，声音干燥少痰，喉中干燥发痒，这是由于肾精枯竭、肝血虚少，火升液耗，肺脏不能自我滋润所致。喉中常觉得有一点干结，像树皮草叶一样，咳吐不出来的，这是少阴肾精不足不能上潮而导致脉络燥结，并非单纯的肺燥。应当紧急滋润肝肾，清宣肺胃，开结行瘀，杀虫。凡是风寒咳嗽，也是喉中作痒，但是稍痒即咳，痒得厉害咳嗽就急；劳瘵咳嗽，是渐渐发痒才开始咳，咳嗽缓和时痒感也轻微。这是两者的区别。
有的喉中发出“咯然”的声音，好像有东西梗塞在那里，颇碍呼吸，呼吸触动它，就偶尔咳一两声，言语发声大多不能顺畅，必须先咳一两声，才能说出话来。这是脾湿不运，浊气上蒸所致。治疗宜健脾行滞，疏利大肠，使浊气下降即可痊愈。更有咽喉中感觉像炙肉块、像桃李核一样的，其病根也是如此，但更为严重。《内经》及《中藏经》、《脉经》多论述此病，有的认为是肾，有的认为是胆，有的认为是肺，有的认为是大肠，有的认为是脾，有的是气机横逆，有的是气机郁结。气机横逆则湿浊不降，气机郁结则忧思不解，大便必然秘结，这就是经书所说的“二阳之病发心脾”。（喉中“咯然”一证，《素问·咳论》将其作为心咳的证候。又说：心脉盛大，会导致喉中“咯然”。《金匮要略》五水篇论述此证，认为是寒结关元，肾气上冲。）
至于肺痈、肺痿，则是由于肺家燥热太盛，实际上是由于脾家湿热熏蒸太久，浊气日益增加，清气不再恢复，逐渐导致津液枯竭、血液沸腾而腐败。初起时可治，宜清热宣郁，养阴行瘀。三消、五隔诸证，也是如此。这是血热所致。
陈修园说：久咳肺燥，可用人参生津。这一定是病起于风热，原本没有水饮，日久风去热存的情况。如果是风寒久咳，肺气不降，水道不调，越久水邪越盛，不能伏枕安睡，夜间没有片刻安宁。水饮上射，浮热逆升，世人常自认为是热咳，寻求使用凉药，医生也以肃降肺气自求速效，于是令风寒永远没有出路，从而形成劳损。所以我说是：今日的咳劳，都是小青龙汤证。
(Predecessors often defined "ke" (cough with sound) as having no phlegm, and "sou" (cough with phlegm) as having phlegm but no sound, making a fine distinction between the two characters. This approach is now generally rejected. If there is only sound without phlegm, it cannot be called coughing; moreover, how can there truly be no phlegm? There are merely differences in quantity, consistency (thick or thin), and ease of expectoration!)
The *Suwen* (Basic Questions) chapter on Cough classifies coughs into Zang-coughs, Fu-coughs, and seasonal coughs to determine the prognosis of the disease. Generally, diseases deepen as they transmit from Fu organs to Zang organs; uniquely, coughs manifest as transmitting from Zang to Fu when the condition has persisted for a long time. This is because most diseases involve pathogenic factors invading inward, whereas coughing represents the outward depletion of True Qi! The disease of coughing causes vibration in all five Zang organs, disturbing internal Qi and gradually causing it to lose its root. The severity of cough syndromes is analyzed below:
Sudden onset of coughing, continuous and unceasing, indicates that cold wind invades the Lung following respiration. Wind invading the Lung causes coughing; invading the Stomach causes vomiting and reflux. Vomiting and reflux are more severe than coughing and cause death faster; therefore, children eating or drinking in the wind is strictly contraindicated. Urgent treatment with warming and dispersing methods is required, using Guizhi Tang (Cinnamon Twig Decoction) as the sovereign herb to forcefully restrain the rampant trend of Wind-Wood. When wind strikes, the initial force is most fierce; one should urgently seek shelter indoors. If immediate shelter is unavailable, it is best to carefully protect the mouth and nose.
Exogenous Wind-Cold presenting with aversion to cold and fever often includes coughing. This occurs when Wind-Cold transmits from the meridians into the Lung. Initial treatment should focus on releasing the exterior; if prolonged, clearing and descending methods should be added. The cough sounds clear and resonant, with equal severity day and night. The classics state: "Cold exposure of the body and consumption of cold drinks injure the Lung, leading to cough and rebellious Qi." However, consuming cold drinks affects the Lung via the Stomach collaterals; the cough sound is slightly heavy. Treatment should warm the Stomach and slightly promote dampness drainage.
Morning coughing lasting dozens of bouts, relieved only after expectorating approximately a bowl of thick phlegm, indicates Damp-Heat steaming upward from the Stomach to affect the Lung. A cough sounding muffled, like speaking from within a chamber, corresponds to the classic description of "Dampness in the Middle Jiao." The cough is heavy; treatment should vent stagnation and circulate dampness. In cases caused by Cold-Damp, the phlegm is clearer and the cough slightly more urgent; treatment should warm and strengthen the Spleen Earth.
Severe coughing, worsening at night to the point of inability to rest on a pillow, indicates Kidney Water floating upward due to weak Spleen Earth failing to control water, with Water Qi rushing against the Lung. The cough is heavy and urgent, continuous and extremely distressing, with shortness of breath. Treatment applies Zhang Zhongjing's Xia Qing Long Tang (Minor Blue Dragon Decoction) method or Zhen Wu Tang (True Warrior Decoction) method, differentiated by the presence or absence of exogenous pathogens. If Water Qi is severe, presenting with periorbital edema resembling post-sleep puffiness, Shi Zao Tang (Ten Date Decoction) is used to purge; for mild cases, Ting Li Da Zao Tang (Descuraria Seed and Jujube Decoction) is used. Crucially, Fu Zi Bai Zhu Tang (Aconite and Atractylodes Macrocephala Decoction) must follow to consolidate recovery and prevent residual pathology.
Cough triggered by food stagnation, belching of rotten smells, and acid regurgitation presents with throat itching, worse at dawn and late afternoon. This involves concurrent Wind-Damp. Treatment should promote dampness leaching and food transformation, warming and transforming the Large Intestine. The pathology lies in Qi stagnation and water retention in the Stomach and Large Intestine; until old food residue is cleared, the cough will not cease.
Dry cough presents with dry voice, no phlegm, irregular intervals, sensation of smoke irritation, no fixed timing, and occasional expectoration of saliva. Treatment should descend Qi and nourish fluids. This is often caused by climatic drought injuring Dryness Qi, or excessive consumption of fried/roasted foods. Rest alleviates symptoms, while exertion aggravates them, contrasting with Water-Fluid diseases that improve by day and worsen by night.
Cough due to Yin Fire scorching the Lung indicates consumptive Qi deficiency. Coughing occurs continuously around dawn (Wu Geng), with dry voice and scant phlegm, and dry, itchy throat. This results from Kidney exhaustion and Liver deficiency, with rising fire and depleted fluids preventing Lung self-lubrication. A sensation of dry knotting in the throat, like bark or leaves, difficult to expectorate, indicates Shaoyin (Kidney) essence failing to ascend, causing collateral dryness and knotting, rather than simple Lung dryness. Urgent treatment should moisten and nourish the Liver and Kidney, clear and ventilate the Lung and Stomach, resolve knots, move blood stasis, and eliminate parasites. In Wind-Cold cough, throat itching triggers immediate coughing; in consumptive cough (Lao Zhai), itching precedes coughing, and cough relief correlates with reduced itching. These are distinguishing features.
A "ge" (gurgling/rattling) sound in the throat, feeling like an obstruction hindering respiration, causing occasional cough upon breathing movement, and requiring coughing before speech, indicates Spleen dampness failing to transport, with turbid Qi steaming upward. Treatment should strengthen the Spleen, move stagnation, and regulate the Large Intestine to allow turbid Qi to descend. A sensation of a roasted meat lump or plum pit in the throat shares this root cause but is more severe. The *Neijing*, *Zhongzang Jing*, and *Maijing* discuss this condition, attributing it variously to the Kidney, Gallbladder, Lung, Large Intestine, or Spleen, involving either rebellious Qi or constrained Qi. Rebellious Qi prevents turbid dampness descent; constrained Qi stems from unresolved worry/thought, leading to constipation, corresponding to the classic statement: "Diseases of the Two Yangs originate in the Heart and Spleen." (The "ge" symptom in the throat is described in *Suwen·Ke Lun* as a Heart Cough sign. It also states: Excessively large Heart pulse leads to throat "ge". *Jingui Yaolue* discusses this in the Five Fluids chapter as Cold knotting at Guanyuan with Kidney Qi rushing upward.)
Fei Yong (Lung Abscess) and Fei Wei (Lung Flaccidity) result from excessive Dry-Heat in the Lung, actually caused by prolonged steaming of Damp-Heat in the Spleen. Turbid Qi increases daily, Clear Qi fails to return, gradually leading to fluid exhaustion and boiling blood causing corruption. Early stages are treatable with clearing heat, venting stagnation, nourishing fluids, and moving blood stasis. San Xiao (Three Consumptions) and Wu Ge (Five Obstructions) syndromes arise similarly from Blood Heat.
Chen Xiuyuan stated: For chronic cough with Lung dryness, Renshen (Ginseng Radix et Rhizoma) can generate fluids. This applies only when the disease originated from Wind-Heat, with no prior fluid retention, where Wind dissipates but Heat remains over time. In chronic Wind-Cold cough, Lung Qi fails to descend, water passages become disordered, and Water Pathogens increase over time, preventing supine rest and causing sleepless nights. Upward-shooting Water Fluids and counter-rising floating heat lead laypeople to mistakenly identify this as "Heat Cough," seeking cooling herbs. Physicians, seeking quick effects by suppressing Lung Qi, inadvertently trap Wind-Cold with no exit, resulting in consumptive damage. Therefore, I assert: Modern cases of coughing consumptive disease are essentially Xiao Qing Long Tang (Minor Blue Dragon Decoction) patterns.