此数药者。与寒滑之天麦二冬栝蒌仁天花粉知母诸品。时师皆执为治嗽通用之剂。竟不
分表
里虚实之殊。往往误人于死。经曰五脏六腑皆令人咳。又曰五脏各以其时受病。非其时则传
以与之。是非独在肺矣。咳即嗽也。然嗽有内外之殊。故自表而入者。六淫邪气。先客于肺
为外感。宜从前药辛温以散之所谓从表而入者必令从表而出最忌苦寒敛涩之剂。致邪气留连
不去。久必变生他症是犹闭户驱盗也至自里而见者。七情劳欲。脏腑虚损。为内伤。有因嗽
而成痨者。有因痨而致嗽者。其原有四一左肾精伤水亏致火铄金而嗽者则宜甘平静剂以润之
一已土中虚不能生金夹痰而嗽者则宜辛甘温剂以养之一心肺胃三经火郁而嗽者则宜苦甘凉剂
以清之一命门火衰元气素虚肺金寡卫而得者则宜甘热温剂以补之所谓从内而得者虽必传于外
而非可以外治也最忌前药辛散苦寒之品。泄阳降阴。招致外邪是犹启户揖盗也又有初属外感
。
因错治而内外俱伤者。则当补散兼行。以扶中为主。若专于驱散。腠理开泄。转成汗脱。益
觉增剧耳。又有老人痰嗽元气既虚。法难消伐。亦必温养为主。或兼治标。势难全愈。但无
至困殆则得耳。大抵六脉浮缓或兼洪滑。形色如常。饮食不减者可治。若脉弦数细疾。肌肉
渐削。便泄食少。卧难着枕。喘息日增者。计期必死治病本难而治嗽尤难得其窜者十可愈半
。百合乃平润之品。亦无甚功。特伴食中书耳。桔梗性平质轻。载药上升。乃舟楫之用也。
这几味药，与性寒滑利的天冬、麦冬、瓜蒌仁、天花粉、知母等药物一起，当时的医生都固执地认为它们是治疗咳嗽的通用方剂。竟然不分表证、里证、虚证、实证的差异，往往导致病人死亡。《内经》说：“五脏六腑都能使人咳嗽。”又说：“五脏各自在其所主的季节受病，如果不是其主令的季节，则邪气会传给它。”这说明咳嗽并不仅仅在于肺。咳就是嗽。然而嗽有内伤和外感的区别。所以从体表侵入的，是六淫邪气，先客居于肺，称为外感，适宜用前面的辛温药物来发散它。所谓从表而入的病邪，必须让它从表而出，最忌讳使用苦寒收敛涩滞的药物，导致邪气留恋不去，时间久了必然变生其他病症，这就像关着门驱赶盗贼一样（指邪无出路）。至于从体内显现出来的，是七情、劳倦、房欲等因素，导致脏腑虚损，称为内伤。有的因咳嗽而发展成痨病（肺结核类慢性消耗性疾病），有的因痨病而导致咳嗽。其病因主要有四种：一是左肾精伤、水亏，导致火旺灼伤肺金而引起咳嗽的，适宜用甘平滋润的药物来润养；二是脾土中虚，不能生养肺金，夹杂痰湿而引起咳嗽的，适宜用辛甘温的药物来补养；三是心、肺、胃三经火郁结而引起咳嗽的，适宜用苦甘凉的药物来清泄；四是命门火衰、元气素虚，肺金缺乏护卫而受邪引起的，适宜用甘热温的药物来补益。所谓从内部产生的病邪，虽然必然反映在外部，但不能单纯用治外感的方法处理，最忌讳使用前面提到的辛散、苦寒的药物，以免耗泄阳气、下降阴气，招致外邪入侵，这就像开着门邀请盗贼进来一样。又有起初属于外感，因为误治而导致内外俱伤的，应当补益与发散兼用，以扶持中气为主。如果专门用于驱散邪气，导致腠理开泄，反而造成汗出亡阳脱失，病情会更加加重。又有老人痰嗽，元气已经虚弱，法度上难以使用攻伐之药，也必须以温养为主，或者兼顾治标，这种情况很难完全痊愈，但只要不陷入极度困顿危殆的地步就可以了。大抵而言，如果六脉浮缓或兼见洪滑，面色形体如常，饮食没有减少的，可以治疗。如果脉象弦数细疾，肌肉逐渐消瘦，大便泄泻，食量减少，睡觉难以枕卧，喘息日益加重的，按病程推算必定死亡。治病本来很难，而治疗咳嗽尤其难，能掌握其中奥妙的，十个人可以治好一半。百合乃是平和滋润的药物，也没有特别大的功效，只是偶尔在食疗书中提到罢了。桔梗性平质地轻，能载药上行，这是利用它的“舟楫”作用（引药上行）。
These few herbs, along with Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix), Gua Lou Ren (Trichosanthis Semen), Tian Hua Fen (Trichosanthis Radix), and Zhi Mu (Anemarrhenae Rhizoma), which possess cold and slippery properties, are often rigidly regarded by contemporary physicians as universal remedies for cough. They fail to distinguish between exterior and interior, deficiency and excess conditions, often leading to fatal errors. The Classics state: "The five zang organs and six fu organs can all cause cough." It also states: "Each of the five zang organs contracts disease in its respective season; if it is not that season, the pathogenic factor is transmitted to it." This indicates that cough is not solely located in the lung. Cough (ke) and phlegm-rattling (sou) are essentially the same, yet sou has distinctions between internal and external origins. Therefore, when pathogens enter from the exterior, they are the six climatic exuberances (liu yin) that first lodge in the lung, termed external contraction (wai gan). Such cases should be treated with the aforementioned acrid-warm herbs to disperse them. Pathogens entering from the exterior must exit through the exterior; it is most taboo to use bitter-cold, astringent, or binding agents, which cause pathogenic factors to linger and not depart, eventually transforming into other syndromes over time. This is akin to locking the door while trying to drive out thieves. Conversely, when symptoms manifest from the interior, they stem from seven emotions, fatigue, or sexual indiscretion causing visceral deficiency, termed internal injury (nei shang). Some develop tuberculosis-like consumption (lao) due to chronic cough, while others suffer cough due to consumption. There are four primary etiologies: First, injury to left kidney essence and water deficiency, leading to fire scorching metal (lung), causing cough; these require sweet-ping (neutral) moistening agents. Second, deficiency of spleen earth failing to generate metal (lung), complicated by phlegm, causing cough; these require acrid-sweet-warm nourishing agents. Third, depression of fire in the heart, lung, and stomach meridians, causing cough; these require bitter-sweet-cool clearing agents. Fourth, decline of ministerial fire (ming men) and inherent deficiency of primordial qi, leaving lung metal unprotected against invasion; these require sweet-hot-warm tonifying agents. Pathogens originating internally, though manifesting externally, cannot be treated merely as external diseases. It is most taboo to use the aforementioned acrid-dispersing and bitter-cold agents, which drain yang and descend yin, inviting external pathogens. This is akin to opening the door to invite thieves. Furthermore, cases initially classified as external contraction may suffer both internal and external damage due to mismanagement; such cases require simultaneous tonification and dispersion, focusing on supporting the middle jiao. If one focuses solely on dispersal, pores open excessively, leading to sweat collapse and worsening condition. Additionally, elderly patients with phlegm-cough and deficient primordial qi cannot tolerate harsh purgative treatments; warm nourishment is essential, possibly combined with symptomatic treatment, though complete cure is difficult. Stability without critical danger is the goal. Generally, if the six pulses are floating and moderate or accompanied by surging and slippery qualities, with normal complexion and form, and unchanged appetite, the prognosis is treatable. However, if the pulse is wiry, rapid, fine, and hurried, with gradual muscle wasting, diarrhea, poor appetite, inability to lie flat, and increasing dyspnea, death is inevitable according to the disease progression. Treating illness is inherently difficult, but treating cough is particularly challenging; those who grasp the nuances may save half of ten cases. Bai He (Lilii Bulbus) is a neutral and moistening herb with no extraordinary efficacy, mentioned only occasionally in dietary texts. Jie Geng (Platycodonis Radix) is neutral in nature and light in quality, capable of carrying medicinal properties upward, serving the function of a "boat and oar" (guiding action upwards).