人有骤感风寒，一时咳嗽，鼻塞不通，嗽重痰必先清后浊，畏风畏寒，此风寒入于皮毛
，肺经先受之也。夫肺之窍通于鼻，肺受风寒之邪，而鼻之窍不通者，阻隔肺金之气也。肺
窍既不能通，而人身之火即不能流行于经络，而火乃入于肺，以助风寒之党矣。故初起咳嗽
，必须先散风寒，而少佐散火之剂，不可重用寒凉以抑其火，亦不可多用燥热以助其邪，用
和解之法为最妙，如甘桔汤、小柴胡汤是也。然而世人往往以小恙不急治者多矣，久则肺气
虚而难愈，则补母、补子之道宜知也。补母者，补其脾胃也；补子者，补其肾水也，似乎宜
分两治之法，以治久咳久嗽之症。而余实有兼治之方，既有利于子母，而复有益于咳嗽，毋
论新久之嗽，皆可治之以取效也。方用善散汤∶
麦冬（三钱） 苏叶（二钱） 茯苓（三钱） 玄参（三钱） 甘草（一钱） 黄芩（八分） 天门冬（三钱） 款
冬花（五分） 贝母（一钱）
水煎服。
此方用麦冬、天门冬以安肺气，用茯苓、甘草以健脾胃之土，用玄参以润肾经之水，用
苏叶、款冬花以解散其阴阳之风邪，又加黄芩以清其上焦之火，贝母以消其内膈之痰，斟酌
咸宜，调剂皆当，故奏功取胜耳。
此证亦可用宁嗽丹
苏叶 甘草 天花粉 天冬 款冬花（各一钱） 桔梗 生地（各三钱） 麦冬（五钱）
水煎服。二剂愈。
人有风寒已散，而痰气未清，仍然咳嗽气逆，牵引腰腹，俯仰不利，人皆谓必须治痰之
为亟矣。然而治痰而痰愈多，嗽愈急、咳愈重者何也?盖治痰之标，而不治痰之本耳。痰之
标在于肺，痰之本在于肾，不治肾而治肺，此痰之所以不能去，而咳嗽之所以不能愈也。人
生饮食原宜化精而不化痰，惟肾气虚，则胃中饮食所化之津液欲入肾而肾不受，则上泛为痰
矣。盖因胃中所化之津液无多，不足以济肺之干枯，而心火转来相夺，则津液不能滋肺，反
化为痰涎而外越矣。然则治法，宜大补其肾水，使肾水汪洋，既能制心火之有余，更能济肺
金之不足，心火不敢相夺，胃气又复相安，自然津液下润，肾经独受，化精而不化痰矣
。方用∶
熟地（二两） 麦冬（二两） 甘草（一钱） 柴胡（一钱） 白芍（五钱）
水煎服。
此方即子母两富汤加味者也。以熟地大滋其肾水，以麦冬大安其肺金，加芍药、柴胡、
甘草以舒其肝胆之气，使其不来克脾胃之土，则脾胃之气易于升腾，上使救肺，而下可救肾
，且邪亦易散，实有鬼神不测之妙也。
人有久嗽不愈，用补肾滋阴之药不效，反觉饮食少思，强食之而不化，吐痰不已者，人
以为肺经尚有邪留于胃中，而不知乃脾胃虚寒不能生肺，使邪留连于中脘而作嗽也。夫肺金
之母，脾胃二经之土也，土旺则金旺，土衰则金衰，不补母以益金，反泻子以捐土，邪即外
散，肺且受伤，况尚留余邪未散乎!毋怪其久嗽而不愈也。然则治之之法，不可仅散肺之邪
，而当急补肺之气；不可仅补肺之气，而尤当急补脾胃之土矣。然不可徒补脾胃也，盖补胃
必须补心包之火，而补脾必须补命门之火。心包生胃土，命门生脾土，实有不同耳。然而胃
病则脾必病，而脾病则胃亦病也。吾补胃而即兼补脾，补脾而即兼补胃，未尝非肺金之所喜
。肺喜正气之生，自恶邪气之克，不必治嗽而嗽病自已矣。方用补母止嗽汤∶
白术（五钱） 茯苓（五钱） 人参（一钱） 陈皮（三分） 甘草（一钱） 苏子（一钱） 半夏（一钱） 桔
梗（二钱） 麦冬（五钱） 紫苑（一钱） 肉桂（五分）
水煎服。一剂而嗽轻，二剂而嗽更轻，四剂而嗽全止矣。
此方乃补脾胃之圣药，加入肉桂以补心包、命门之二火，一味而两得之也。又恐徒治脾
胃之母，置肺邪于不问，增入补肺散邪之味，则子母两得，而久嗽安得不速愈哉!
此症用助金汤亦佳。
人参（三钱） 甘草 款冬花（各一钱） 白术 百合（各五钱） 茯神（二钱） 肉桂 炮姜 苏叶
百部（各五分） 半夏（三分）
水煎服。四剂愈。
人有咳嗽，长年不愈，吐痰色黄，结成顽块，凝滞喉间，肺气不清，用尽气力始得吐出
于口者，此乃老痰之病也。年老阳虚之人，最多此症。然用消痰清肺之药往往不验者，盖徒
治其痰，而不理其气也。夫痰盛则气闭，气行则痰消。老年之人，孤阳用事，又加气闭而不
伸，则阳火煎熬，遂成黄浊之痰，气虚不能推送，故必咳之久而始能出也。方用六君子汤加
减治之。
人参（五分） 白术（五钱） 茯苓（三钱） 陈皮（五分） 柴胡（五分） 白芍（一两） 白芥子（三钱） 甘
草（一钱） 栀子（一钱）
水煎服。二剂而痰变白矣，四剂而痰易出矣，十剂而咳嗽尽除。
补阳气之虚，开郁气之滞，消痰结之块，祛久闭之火，有资益而无刻削，则老痰易化，
而咳嗽易除也。倘徒用攻痰之药，则阳气必伤，而痰又难化，格格难吐，何日是清快之时乎
!
此症用化老汤亦佳。
人参（三分） 白术（一钱） 生地（二钱） 款冬花（三分） 白芥子 白芍 地骨皮（各三钱） 柴胡（四
分） 甘草（一钱） 麦冬（五钱）
水煎服。四剂轻，十剂愈。
人有阴气素虚，更加气恼，偶犯风邪，因而咳嗽。人以散风祛邪之药治之而愈甚，此不
治其阴虚之故也。然而徒HT 其阴，而肝气未平，则木来侮金，咳亦难已。法宜平肝而益之以
补水之剂，则水能资木，而木气更平也。方用平补汤∶
熟地（一两） 麦冬（一两） 甘草（五分） 白芍（一两） 柴胡（一钱） 人参（五分） 茯苓（三钱） 天
花粉
（二钱） 百合（五钱） 炒黑荆芥（一钱）
水煎服。
此方大补肺、肾、肝、脾之四经，而尤能解肝气之郁。肝经郁解，而肺经风邪亦不必祛
而自散矣。人谓补肾、补肺、平肝足矣，何又兼补脾胃而用人参耶?不知三经之气，非脾胃
之气不行，吾少加人参、茯苓以通之，则津液易生，而肾、肝、肺尤能相益也。
此症用涣邪汤亦效。
白芍 熟地 麦冬（各五钱） 甘草 柴胡 香附（各一钱） 陈皮（三分） 白术 玄参（各三钱）
天花粉（五分） 苏子（一钱）
水煎服。四剂愈。
人有久咳而不愈者，口吐白沫，气带血腥。人以为肺经之湿也，而不知实肺金之燥。苟
肺气不燥，则清肃之令下行，而周身四达，何处非露气之下润乎!不特肾水足以上升而交于
心，亦且心火下降而交于肾，不传于肺矣。心火既不传于肺金，曾何伤燥之虑哉!惟其肺气
先已匮乏，高源之水无有留余之势，而欲下泽之常盈，以上供于肺金之用，此必不得之数也
，治法自宜专润肺金之燥矣。然润肺金之燥，而肾火上冲，则肺且救子之不暇，何能自润?
此肺肾必宜同治也。方用子母两富汤∶
熟地（二两） 麦冬（二两）
水煎服。连服四剂，而肺金之燥除，肾火之干亦解。
譬如滂沱大雨，高低原隰无不沾足，既鲜燥竭之虞，宁有咳嗽之患?倘失此不治，或治
而不补益其肺肾，转盼而毛瘁色弊，筋急爪枯，咳引胸背，吊疼两胁，诸气 郁，诸痿
喘呕，嗌塞血泄，种种危候，相因俱见矣。又用何药以救其焦枯哉!
此症用夜露饮亦妙。
熟地 麦冬 芡实（各一两） 山茱萸（五钱） 贝母（五分）
水煎服。十剂全愈。
人有久病咳嗽，吐痰色红，有似呕血而实非血也，盗汗淋漓，肠鸣作泄，午后发热。人
以为肾经之邪火大盛，将欲肾邪传心也，谁知是脾邪之将传于肾乎?此症初因肾水干枯，肾
经受邪，肾乃传心，故发热而夜重，未几心邪传肺，故咳嗽而汗泄；未几肺邪传肝，故胁痛
而气壅；未几肝邪传脾，故肠鸣而作泄。今既盗汗淋漓，肠鸣作泄，乃肺邪不传肝而传脾也
。邪不入肾肝，尚有可生之机，亟宜平肝滋肾，使邪不再传，则肝平而不与肺为仇，肾滋而
不与心为亢；再益之健脾之品，使脾健而不与肾为耗，自然心火不刑肺而生脾，脾气得养而
肺气更安矣。方用转逆养肺汤∶
白芍（五钱） 麦冬（三钱） 茯苓（三钱） 玄参（二钱） 熟地（五钱） 山茱萸（五钱） 北五味（二钱） 车
前子（二钱） 地骨皮（三钱） 丹皮（三钱） 牛膝（一钱） 破故纸（五分） 贝母（一钱）
水煎服。连服十剂而气转，再服十剂而痰变为白，再服十剂而泄止，肠亦不鸣也。
此方本非止泻之药。盖泄成于阴虚，补其阴而泄自止，阴旺则火息不去烁金；金安则木
平不去克土，所以消痰而化其火炎之色，止泄而撤其金败之声，故肠鸣、盗汗尽除，而咳嗽
亦愈矣。
此症用止传汤亦妙。
熟地（二两） 玄参 百合（各一两） 白芥子（二钱） 荆芥（炒黑，一钱） 茯苓（三钱） 沙参（三钱）
地骨皮（五钱） 桑叶（十五片）
水煎服。十剂轻，三十剂愈。
人有春暖夏热，则安然不嗽，一遇秋凉，即咳嗽不宁，甚至气喘难卧，人以为肌表之疏
泄也，谁知是郁热之难通乎?夫人身之气血，流通于肌肉之内，则风邪不得而入。惟气血闭
塞不通，而邪转来相侮，凝滞而变为热矣。盖春夏之间，皮肤疏泄，内热易于外宣。秋冬之
际，皮肤致密，内热难于外发，所以春夏不咳嗽，而秋冬咳嗽也
。倘不治其郁热之本，而
惟用发散之品，徒虚其外，愈不能当风寒之威，徒耗其中，益转增其郁热之势，均失其治之
之法也。所贵攻补兼施，既舒其内郁之热，而复疏其外入之寒，则本既不伤，而末亦易举也
。方用∶
当归（五钱） 大黄（一钱） 贝母（二钱） 天花粉（三钱） 薄荷（二钱） 荆芥（二钱） 甘草（一钱） 白
术（三钱） 陈皮（三分） 神曲（五分） 黄芩（二钱） 桔梗（二钱）
水煎服。连服四剂，秋冬之时断无咳嗽之症矣。
盖大黄走而不守，用之于祛火消痰之中通郁最速，又得当归之补而不滞，白术之利而不
攻，同队逐群，解纷开结，内外两益矣。
此症用郁金丹亦甚效。
白芍 桔梗（各三钱） 抚芎（二钱） 白芥子 茯苓 生地（各三钱） 甘草 款冬花（各一钱）
水煎服。一剂轻，二剂愈。
【背景信息】
书名：辨证录 作者：陈士铎 朝代：清 章节：咳嗽门（八则） 类别：综合
原文翻译：
有人突然感受风寒，立刻出现咳嗽、鼻塞不通的症状，咳嗽剧烈时痰液先清稀后浑浊，伴有怕风、怕冷的表现。这是风寒侵入皮毛，肺经首先受邪所致。肺的窍道通于鼻，肺受到风寒邪气侵袭，导致鼻窍不通，是因为肺气（肺金之气）被阻隔。肺窍既然不能通畅，人体内的火气就不能在经络中正常运行，火气反而进入肺部，助长风寒之邪。因此，在疾病初起咳嗽时，必须先疏散风寒，并少量配合清散火气的药物。不可重用寒凉药物来压制火气，也不可多用燥热药物来助长邪气，采用和解的方法最为巧妙，例如甘桔汤、小柴胡汤就是此类方剂。然而世人往往因为是小病而不急于治疗，日久则肺气虚弱而难以痊愈，这时就应该懂得“补母”、“补子”的治疗原则。所谓“补母”，是补益脾胃；所谓“补子”，是滋补肾水。这似乎应该分为两种治法，用来治疗久咳久嗽的症状。但我确实有兼顾治疗的方子，既有利于子母两脏，又有益于咳嗽，无论是新发还是久病的咳嗽，都可以用此方取得疗效。方用善散汤：
麦冬（三钱） 苏叶（二钱） 茯苓（三钱） 玄参（三钱） 甘草（一钱） 黄芩（八分） 天门冬（三钱） 款冬花（五分） 贝母（一钱）
用水煎服。
此方用麦冬、天门冬来安定肺气，用茯苓、甘草来健运脾胃之土，用玄参来滋润肾经之水，用苏叶、款冬花来解散阴阳之风邪，又加黄芩来清上焦之火，贝母来消除膈内的痰，斟酌得当，调剂适宜，所以能取得功效。
这种病症也可以用宁嗽丹：
苏叶 甘草 天花粉 天冬 款冬花（各一钱） 桔梗 生地（各三钱） 麦冬（五钱）
用水煎服。服用两剂即可痊愈。
有人风寒已散，但痰气未清，仍然咳嗽气逆，牵引腰腹，俯仰不便。人们都认为必须急治其痰。然而，如果治痰却导致痰更多、咳嗽更急、咳声更重，为什么呢？这是因为只治了痰的标（表象），而没有治痰的本（根源）。痰的标在于肺，痰的本在于肾。不补肾而只治肺，这就是痰去不了、咳嗽好不了的原因。人生下来的饮食原本应该化为精微物质而不是痰，只有当肾气虚弱时，胃中饮食所化的津液想要进入肾脏却被拒绝，于是向上泛溢成为痰。这是因为胃中所化的津液不多，不足以救济肺的干枯，心火转而争夺津液，导致津液不能滋润肺，反而化为痰涎向外溢出。那么治疗方法，应当大补肾水，使肾水充足汪洋，既能制约心火的有余，又能救济肺金的不足。心火不敢再争夺，胃气恢复安宁，自然津液向下滋润，独归于肾经，化为精微而不化为痰。方用：
熟地（二两） 麦冬（二两） 甘草（一钱） 柴胡（一钱） 白芍（五钱）
用水煎服。
此方即是子母两富汤加味而成。用熟地大滋肾水，用麦冬大安肺金，加芍药、柴胡、甘草来舒展肝胆之气，使其不来克制脾胃之土，这样脾胃之气易于升腾，上可救肺，下可救肾，且邪气也容易消散，实有鬼神难测的妙处。
有人久咳不愈，使用补肾滋阴的药物无效，反而觉得饮食减少、不想吃东西，勉强吃下也不消化，吐痰不停。人们以为是肺经还有邪气留在胃中，却不知道这是脾胃虚寒不能生养肺金，使邪气留恋在中脘部位而引发咳嗽。肺金之母，是脾胃二经之土。土旺则金旺，土衰则金衰。如果不补母（脾胃）以益金（肺），反而泻子（肺/或误治伤脾）以损土，即使邪气外散，肺也会受伤，何况还有余邪未散呢！难怪久咳不愈。那么治疗方法，不可仅仅疏散肺的邪气，而应当紧急补益肺气；不可仅仅补肺气，而尤其应当紧急补益脾胃之土。然而不能单纯补脾胃，因为补胃必须补心包之火，而补脾必须补命门之火。心包生胃土，命门生脾土，这确实有所不同。然而胃病则脾必病，脾病则胃亦病。我补胃的同时兼补脾，补脾的同时兼补胃，这并非肺金所不喜欢。肺喜欢正气的生养，厌恶邪气的克制，不必专门治嗽，咳嗽病自然会好。方用补母止嗽汤：
白术（五钱） 茯苓（五钱） 人参（一钱） 陈皮（三分） 甘草（一钱） 苏子（一钱） 半夏（一钱） 桔梗（二钱） 麦冬（五钱） 紫苑（一钱） 肉桂（五分）
用水煎服。一剂咳嗽减轻，二剂咳嗽更轻，四剂咳嗽完全停止。
此方是补脾胃的圣药，加入肉桂以补心包、命门之二火，一味药而两得之。又担心单纯治疗脾胃之母，置肺邪于不顾，增加补肺散邪的药物，这样子母两得，久咳怎么能不迅速痊愈呢！
这种病症用助金汤也很好。
人参（三钱） 甘草 款冬花（各一钱） 白术 百合（各五钱） 茯神（二钱） 肉桂 炮姜 苏叶 百部（各五分） 半夏（三分）
用水煎服。四剂痊愈。
有人咳嗽长年不愈，吐出的痰色黄，结成顽固块状，凝滞在喉间，肺气不清，用尽力气才能吐出到口中，这是老痰的病证。年老阳虚的人，最多患这种症。然而使用消痰清肺的药物往往不灵验，这是因为只治了痰，而没有调理气机。痰盛则气闭，气行则痰消。老年人孤阳用事，再加上气闭不能伸展，阳火煎熬，遂成黄浊之痰，气虚不能推送，所以必须咳很久才能出来。方用六君子汤加减治疗。
人参（五分） 白术（五钱） 茯苓（三钱） 陈皮（五分） 柴胡（五分） 白芍（一两） 白芥子（三钱） 甘草（一钱） 栀子（一钱）
用水煎服。二剂痰变白，四剂痰容易吐出，十剂咳嗽全部消除。
补阳气之虚，开郁气之滞，消痰结之块，祛久闭之火，有益而无刻削，则老痰易化，咳嗽易除。倘若只用攻痰的药物，则阳气必伤，痰又难化，格格难吐，什么时候才是清爽的时候呢！
这种病症用化老汤也很好。
人参（三分） 白术（一钱） 生地（二钱） 款冬花（三分） 白芥子 白芍 地骨皮（各三钱） 柴胡（四分） 甘草（一钱） 麦冬（五钱）
用水煎服。四剂减轻，十剂痊愈。
有人阴气素来虚弱，加上生气恼怒，偶然触犯风邪，因而咳嗽。人们用散风祛邪的药物治疗却加重，这是没有治疗阴虚的缘故。然而如果单纯补阴，而肝气不平，则木来侮金（肝木反克肺金），咳嗽也难以停止。法宜平肝并辅以补水之剂，则水能资木，木气更加平和。方用平补汤：
熟地（一两） 麦冬（一两） 甘草（五分） 白芍（一两） 柴胡（一钱） 人参（五分） 茯苓（三钱） 天花粉（二钱） 百合（五钱） 炒黑荆芥（一钱）
用水煎服。
此方大补肺、肾、肝、脾四经之气，而尤能解肝气之郁。肝经郁结解开，肺经风邪也不必祛除而自然消散。人们说补肾、补肺、平肝就够了，为什么又兼补脾胃用人参呢？不知道三经之气，非脾胃之气不能运行，我少加人参、茯苓以通达之，则津液易生，肾、肝、肺更能相互受益。
这种病症用涣邪汤也有效。
白芍 熟地 麦冬（各五钱） 甘草 柴胡 香附（各一钱） 陈皮（三分） 白术 玄参（各三钱） 天花粉（五分） 苏子（一钱）
用水煎服。四剂痊愈。
有人久咳不愈，口吐白沫，气息带有血腥味。人们以为是肺经有湿，却不知道其实是肺金之燥。如果肺气不燥，则清肃之令下行，周身通达，何处不是露水下润呢！不仅肾水足以上升交于心，而且心火下降交于肾，不传于肺了。心火既不传于肺金，有什么担忧伤燥的呢！只是肺气先已匮乏，高源之水没有留余之势，想要下泽常盈以上供于肺金之用，这是必然做不到的数（理）。治疗方法自然应当专润肺金之燥。然而润肺金之燥，如果肾火上冲，则肺连救子（肾）都来不及，怎么能自润？这是肺肾必须同治。方用子母两富汤：
熟地（二两） 麦冬（二两）
用水煎服。连续服用四剂，肺金之燥除，肾火之干亦解。
譬如滂沱大雨，高低原隰无不沾足，既无干燥枯竭的忧虑，哪里有咳嗽的隐患？如果错过此时不治疗，或者治疗时不补益肺肾，转眼之间毛发憔悴、面色败坏，筋脉拘急、指甲枯槁，咳嗽牵引胸背，吊疼两胁，各种气郁、各种痿证、喘呕、咽喉阻塞、便血等种种危候，相继出现。又用什么药来救治这焦枯的身体呢！
这种病症用夜露饮也很奇妙。
熟地 麦冬 芡实（各一两） 山茱萸（五钱） 贝母（五分）
用水煎服。十剂全愈。
有人久病咳嗽，吐出的痰色红，看似呕血其实不是血，盗汗淋漓，肠鸣作泄，午后发热。人们以为是肾经邪火大盛，将要肾邪传心，谁知道这是脾邪将传于肾呢？此症起初因肾水干枯，肾经受邪，肾乃传心，故发热而夜间加重；不久心邪传肺，故咳嗽而汗泄；不久肺邪传肝，故胁痛而气壅；不久肝邪传脾，故肠鸣而作泄。现在既然盗汗淋漓，肠鸣作泄，乃是肺邪不传肝而传脾。邪气不入肝肾，尚有可生之机，亟宜平肝滋肾，使邪不再传，则肝平而不与肺为仇，肾滋而不与心为亢；再增加健脾之品，使脾健而不与肾为耗，自然心火不刑肺而生脾，脾气得养而肺气更安矣。方用转逆养肺汤：
白芍（五钱） 麦冬（三钱） 茯苓（三钱） 玄参（二钱） 熟地（五钱） 山茱萸（五钱） 北五味（二钱） 车前子（二钱） 地骨皮（三钱） 丹皮（三钱） 牛膝（一钱） 破故纸（五分） 贝母（一钱）
用水煎服。连续服用十剂而气转，再服十剂而痰变为白，再服十剂而泄止，肠也不再鸣响。
此方本不是止泻药。因为泄泻成于阴虚，补其阴而泄自止，阴旺则火息不去烁金；金安则木平不去克土，所以消痰而化其火炎之色，止泄而撤其金败之声，故肠鸣、盗汗尽除，而咳嗽亦愈。
这种病症用止传汤也很妙。
熟地（二两） 玄参 百合（各一两） 白芥子（二钱） 荆芥（炒黑，一钱） 茯苓（三钱） 沙参（三钱） 地骨皮（五钱） 桑叶（十五片）
用水煎服。十剂减轻，三十剂痊愈。
有人春暖夏热时安然不咳嗽，一遇秋凉，即咳嗽不安，甚至气喘难卧。人们以为是肌表疏泄所致，谁知道是郁热难通呢？人身的气血，流通于肌肉之内，则风邪不得而入。只有气血闭塞不通，邪气才反过来相侮，凝滞而变为热。春夏之间，皮肤疏泄，内热易于外宣。秋冬之际，皮肤致密，内热难于外发，所以春夏不咳嗽，而秋冬咳嗽。如果不治其郁热之本，而只用发散之品，徒然虚其外，更不能抵挡风寒之威，徒然耗其中，更加增添其郁热之势，都失去了治疗的方法。可贵的是攻补兼施，既舒其内郁之热，又疏其外入之寒，则本既不伤，而末亦易举。方用：
当归（五钱） 大黄（一钱） 贝母（二钱） 天花粉（三钱） 薄荷（二钱） 荆芥（二钱） 甘草（一钱） 白术（三钱） 陈皮（三分） 神曲（五分） 黄芩（二钱） 桔梗（二钱）
用水煎服。连续服用四剂，秋冬之时断无咳嗽之症。
盖大黄走而不守，用于祛火消痰之中通郁最速，又得当归之补而不滞，白术之利而不攻，同队逐群，解纷开结，内外两益。
这种病症用郁金丹也很有效。
白芍 桔梗（各三钱） 抚芎（二钱） 白芥子 茯苓 生地（各三钱） 甘草 款冬花（各一钱）
用水煎服。一剂减轻，二剂痊愈。
Background Information:
Book: Bian Zheng Lu (Record of Syndrome Differentiation)
Author: Chen Shiduo
Dynasty: Qing Dynasty
Chapter: Cough Section (Eight Cases)
Category: Comprehensive
Translation:
There are cases where a person suddenly contracts wind-cold, immediately experiencing cough and nasal congestion. The cough is severe, with sputum initially clear and then becoming turbid, accompanied by aversion to wind and cold. This indicates that wind-cold has invaded the skin and hair, and the Lung Meridian is affected first. The orifice of the Lung connects to the nose. When the Lung is attacked by wind-cold pathogens, the nasal orifice becomes blocked because the Qi of Lung Metal is obstructed. Since the Lung orifice cannot open smoothly, the fire within the body cannot circulate freely through the meridians; instead, the fire enters the Lung, assisting the wind-cold pathogens. Therefore, at the onset of cough, one must first disperse wind-cold and slightly add herbs that disperse fire. It is inadvisable to heavily use cold-natured herbs to suppress the fire, nor should hot-drying herbs be used excessively as they may aid the pathogen. The most excellent method is harmonization, such as using Gan Jie Tang (Licorice and Platycodon Decoction) or Xiao Chai Hu Tang (Minor Bupleurum Decoction). However, people often neglect minor ailments and delay treatment. Over time, Lung Qi becomes deficient and difficult to cure. At this stage, one should understand the principles of "tonifying the mother" and "tonifying the child." Tonifying the mother refers to tonifying the Spleen and Stomach; tonifying the child refers to nourishing Kidney Water. Although it seems appropriate to treat these separately for chronic cough, I have a formula that treats both simultaneously, benefiting both the mother and child organs and effectively treating cough regardless of whether it is new or chronic. The formula is Shan San Tang (Excellent Dispersing Decoction):
Ophiopogon Radix (San Qian), Perilla Leaf (Er Qian), Poria (San Qian), Scrophularia Root (San Qian), Licorice Root (Yi Qian), Scutellaria Root (Ba Fen), Anemarrhena Rhizome (San Qian), Farfleur Flower (Wu Fen), Fritillaria Bulb (Yi Qian).
Decoct in water and take orally.
This formula uses Ophiopogon Radix and Anemarrhena Rhizome to calm Lung Qi, Poria and Licorice Root to strengthen Spleen and Stomach Earth, Scrophularia Root to moisten Kidney Water, Perilla Leaf and Farfleur Flower to disperse wind-pathogens of Yin and Yang, Scutellaria Root to clear Upper Jiao Fire, and Fritillaria Bulb to resolve phlegm in the diaphragm. The proportions are well-considered and balanced, thus achieving efficacy.
This condition can also be treated with Ning Sou Dan (Calm Cough Pill):
Perilla Leaf, Licorice Root, Trichosanthes Root, Anemarrhena Rhizome, Farfleur Flower (each Yi Qian); Platycodon Root, Rehmannia Root (each San Qian); Ophiopogon Radix (Wu Qian).
Decoct in water and take orally. Cure after two doses.
In some cases, wind-cold has dispersed, but phlegm and Qi remain unclarified, resulting in persistent cough with rebellious Qi, pulling pain in the waist and abdomen, and difficulty bending or stretching. People often believe that urgently treating phlegm is necessary. However, if treating phlegm leads to more phlegm, more urgent cough, and heavier wheezing, why is this? It is because only the branch (manifestation) of phlegm is treated, not the root (origin). The branch of phlegm lies in the Lung, while the root lies in the Kidney. Treating the Lung without treating the Kidney explains why phlegm cannot be eliminated and cough cannot heal. Normally, food and drink should transform into essence rather than phlegm. Only when Kidney Qi is deficient does the fluid transformed from food in the Stomach fail to enter the Kidney and instead float upward to become phlegm. Because the fluids transformed in the Stomach are insufficient to nourish the dryness of the Lung, Heart Fire competes for these fluids. Consequently, the fluids fail to moisten the Lung and instead transform into saliva and phlegm that overflow outward. Therefore, the treatment should greatly tonify Kidney Water so that it becomes abundant, capable of restraining excessive Heart Fire and supplementing deficient Lung Metal. Heart Fire will no longer compete, Stomach Qi will recover its peace, and naturally, fluids will descend to moisten, being received solely by the Kidney Meridian, transforming into essence rather than phlegm. The formula is:
Prepared Rehmannia Root (Liang Liang), Ophiopogon Radix (Liang Liang), Licorice Root (Yi Qian), Bupleurum Root (Yi Qian), White Peony Root (Wu Qian).
Decoct in water and take orally.
This formula is a modified version of Zi Mu Liang Fu Tang (Mother and Child Both Abundant Decoction). Prepared Rehmannia Root greatly nourishes Kidney Water, Ophiopogon Radix greatly calms Lung Metal, and adding White Peony Root, Bupleurum Root, and Licorice Root soothes the Qi of the Liver and Gallbladder, preventing them from overacting on Spleen and Stomach Earth. Thus, Spleen and Stomach Qi ascends easily, saving the Lung above and the Kidney below, while pathogens are easily dispersed. This possesses miraculous effects beyond human comprehension.
In cases of chronic cough unresponsive to Kidney-tonifying and Yin-nourishing herbs, patients may experience loss of appetite, indigestion upon forced eating, and continuous expectoration. People assume residual pathogens remain in the Stomach due to Lung pathology, unaware that it is actually Spleen and Stomach deficiency-cold failing to generate Lung Metal, allowing pathogens to linger in the Middle Jiao and cause cough. Lung Metal’s mother is Spleen and Stomach Earth. When Earth is prosperous, Metal is prosperous; when Earth declines, Metal declines. If one fails to tonify the mother (Spleen/Stomach) to benefit Metal (Lung), and instead harms Earth, even if pathogens disperse, the Lung will be injured, let alone if residual pathogens remain. No wonder chronic cough persists. The treatment should not merely disperse Lung pathogens but urgently tonify Lung Qi; nor should it merely tonify Lung Qi but urgently tonify Spleen and Stomach Earth. However, one cannot simply tonify Spleen and Stomach; tonifying the Stomach requires tonifying Pericardium Fire, and tonifying the Spleen requires tonifying Mingmen (Gate of Life) Fire. Pericardium generates Stomach Earth, and Mingmen generates Spleen Earth; there are indeed differences. Yet, Stomach disease affects the Spleen, and Spleen disease affects the Stomach. By tonifying the Stomach while simultaneously tonifying the Spleen, and tonifying the Spleen while simultaneously tonifying the Stomach, this is not displeasing to Lung Metal. The Lung prefers the generation of righteous Qi and abhors the attack of pathogenic Qi. Without specifically treating cough, the cough will heal itself. The formula is Bu Mu Zhi Sou Tang (Tonify Mother Stop Cough Decoction):
Atractylodes Macrocephala Rhizome (Wu Qian), Poria (Wu Qian), Ginseng Root (Yi Qian), Tangerine Peel (San Fen), Licorice Root (Yi Qian), Perilla Seed (Yi Qian), Pinellia Tuber (Yi Qian), Platycodon Root (Er Qian), Ophiopogon Radix (Wu Qian), Aster Root (Yi Qian), Cinnamon Bark (Wu Fen).
Decoct in water and take orally. Cough lightens after one dose, further lightens after two doses, and completely stops after four doses.
This formula is a sacred medicine for tonifying Spleen and Stomach. Adding Cinnamon Bark tonifies both Pericardium and Mingmen Fires with a single herb. Fearing that treating only the mother organ (Spleen/Stomach) would ignore Lung pathogens, herbs that tonify the Lung and disperse pathogens are added. Thus, both mother and child are benefited, and chronic cough cannot fail to heal rapidly!
For this condition, Zhu Jin Tang (Assist Metal Decoction) is also excellent:
Ginseng Root (San Qian), Licorice Root, Farfleur Flower (each Yi Qian); Atractylodes Macrocephala Rhizome, Lily Bulb (each Wu Qian); Spirit of Poria (Er Qian); Cinnamon Bark, Roasted Ginger, Perilla Leaf, Stemona Root (each Wu Fen); Pinellia Tuber (San Fen).
Decoct in water and take orally. Cure after four doses.
Some patients suffer from chronic cough lasting years, expecting yellow sputum that forms stubborn clumps, stagnating in the throat. Lung Qi is unclear, requiring great effort to expectorate. This is a disease of old phlegm. Elderly individuals with Yang deficiency are most prone to this. However, phlegm-resolving and Lung-clearing herbs often fail because they treat only the phlegm without regulating Qi. Excessive phlegm causes Qi blockage; when Qi moves, phlegm dissipates. In the elderly, solitary Yang dominates, and combined with Qi blockage, Yang fire simmers fluids, forming yellow-turbid phlegm. Deficient Qi cannot push it out, so it takes prolonged coughing to expel it. The formula is Liu Jun Zi Tang (Six Gentlemen Decoction) modified:
Ginseng Root (Wu Fen), Atractylodes Macrocephala Rhizome (Wu Qian), Poria (San Qian), Tangerine Peel (Wu Fen), Bupleurum Root (Wu Fen), White Peony Root (Yi Liang), White Mustard Seed (San Qian), Licorice Root (Yi Qian), Gardenia Fruit (Yi Qian).
Decoct in water and take orally. Phlegm turns white after two doses, becomes easy to expectorate after four doses, and cough disappears completely after ten doses.
Tonifying deficient Yang, opening stagnant Qi, resolving phlegm nodules, and dispelling long-standing closed fire, this approach benefits without damaging, making old phlegm easy to dissolve and cough easy to remove. If one merely uses attacking phlegm herbs, Yang Qi will be damaged, phlegm will be hard to resolve, expectoration will be obstructed, and when will relief come?
For this condition, Hua Lao Tang (Resolve Old Phlegm Decoction) is also good:
Ginseng Root (San Fen), Atractylodes Macrocephala Rhizome (Yi Qian), Rehmannia Root (Er Qian), Farfleur Flower (San Fen), White Mustard Seed, White Peony Root, Cortex Lycii Radicis (each San Qian); Bupleurum Root (Si Fen), Licorice Root (Yi Qian), Ophiopogon Radix (Wu Qian).
Decoct in water and take orally. Lightens after four doses, cures after ten doses.
Some patients have inherent Yin deficiency, exacerbated by anger, contracting wind pathogens and causing cough. Treatment with wind-dispelling herbs worsens the condition because Yin deficiency was not addressed. However, merely tonifying Yin without calming Liver Qi allows Wood to insult Metal (Liver overacting on Lung), making cough difficult to stop. The method should calm the Liver and supplement with water-nourishing agents, so Water nourishes Wood, and Wood Qi becomes peaceful. The formula is Ping Bu Tang (Leveling and Tonifying Decoction):
Prepared Rehmannia Root (Yi Liang), Ophiopogon Radix (Yi Liang), Licorice Root (Wu Fen), White Peony Root (Yi Liang), Bupleurum Root (Yi Qian), Ginseng Root (Wu Fen), Poria (San Qian), Trichosanthes Root (Er Qian), Lily Bulb (Wu Qian), Stir-fried Black Schizonepeta Head (Yi Qian).
Decoct in water and take orally.
This formula greatly tonifies the Qi of the Lung, Kidney, Liver, and Spleen meridians, especially resolving Liver Qi depression. Once Liver depression is resolved, Lung wind-pathogens disperse spontaneously without needing specific expulsion. One might ask: isn't tonifying Kidney, Lung, and leveling Liver enough? Why add Ginseng to tonify Spleen and Stomach? It is unknown that the Qi of these three meridians cannot circulate without Spleen and Stomach Qi. By adding small amounts of Ginseng and Poria to facilitate circulation, fluids are easily generated, and Kidney, Liver, and Lung mutually benefit.
For this condition, Huan Xie Tang (Dispel Pathogen Decoction) is also effective:
White Peony Root, Prepared Rehmannia Root, Ophiopogon Radix (each Wu Qian); Licorice Root, Bupleurum Root, Cyperus Rhizome (each Yi Qian); Tangerine Peel (San Fen), Atractylodes Macrocephala Rhizome, Scrophularia Root (each San Qian); Trichosanthes Root (Wu Fen), Perilla Seed (Yi Qian).
Decoct in water and take orally. Cure after four doses.
Some patients have chronic cough with white froth and bloody breath. People attribute this to Dampness in the Lung, not realizing it is actually Dryness of Lung Metal. If Lung Qi were not dry, its clearing and descending function would proceed downward, permeating the whole body like dew. Not only would Kidney Water rise to interact with Heart, but Heart Fire would descend to interact with Kidney, not transmitting to the Lung. With Heart Fire not transmitting to Lung Metal, what worry of dryness injury remains? Only because Lung Qi is initially deficient, high-source water lacks surplus to constantly replenish the Lung. This is impossible. Thus, treatment should focus on moistening Lung Dryness. However, if moistening Lung Dryness triggers Kidney Fire rushing upward, the Lung cannot save itself, let alone moisten itself. Therefore, Lung and Kidney must be treated together. The formula is Zi Mu Liang Fu Tang (Mother and Child Both Abundant Decoction):
Prepared Rehmannia Root (Liang Liang), Ophiopogon Radix (Liang Liang).
Decoct in water and take orally. After four consecutive doses, Lung Metal dryness is removed, and Kidney Fire dryness is resolved.
Like heavy rain, high and low lands are all sufficiently moistened, eliminating dryness anxiety and preventing cough. If this opportunity is missed, or if treatment fails to tonify Lung and Kidney, soon hair will wither, complexion deteriorate, sinews tighten, nails wither, cough pulls chest and back, flanks ache, various Qi stagnations, flaccidity syndromes, wheezing, vomiting, throat obstruction, and bleeding occur. What medicine can save such scorched and dried bodies?
For this condition, Ye Lu Yin (Night Dew Drink) is also wonderful:
Prepared Rehmannia Root, Ophiopogon Radix, Euryale Seed (each Yi Liang); Cornus Fruit (Wu Qian), Fritillaria Bulb (Wu Fen).
Decoct in water and take orally. Cure after ten doses.
Some patients with chronic cough expectorate red sputum resembling hematemesis but not blood, with night sweats profuse, borborygmus with diarrhea, and afternoon fever. People think it is excessive Fire in the Kidney Meridian about to transmit to the Heart. Who knows it is Spleen Pathogen about to transmit to the Kidney? Initially, Kidney Water was dry, and Kidney Meridian was attacked. Kidney transmitted to Heart, causing fever worse at night. Soon Heart Pathogen transmitted to Lung, causing cough and sweating. Then Lung Pathogen transmitted to Liver, causing hypochondriac pain and Qi oppression. Then Liver Pathogen transmitted to Spleen, causing borborygmus and diarrhea. Now, with profuse night sweats and borborygmus with diarrhea, Lung Pathogen transmits to Spleen instead of Liver. As pathogens do not enter Kidney and Liver, there is still hope. Urgently level Liver and nourish Kidney to stop transmission. Then Liver levels and does not enmity Lung; Kidney nourishes and does not antagonize Heart. Add Spleen-strengthening herbs so Spleen strengthens and does not deplete Kidney. Naturally, Heart Fire does not punish Lung but generates Spleen; Spleen Qi is nourished, and Lung Qi is safer. The formula is Zhuan Ni Yang Fei Tang (Reverse-Turning Lung-Nourishing Decoction):
White Peony Root (Wu Qian), Ophiopogon Radix (San Qian), Poria (San Qian), Scrophularia Root (Er Qian), Prepared Rehmannia Root (Wu Qian), Cornus Fruit (Wu Qian), Schisandra Berry (Er Qian), Plantago Seed (Er Qian), Cortex Lycii Radicis (San Qian), Moutan Bark (San Qian), Achyranthes Root (Yi Qian), Psoralea Fruit (Wu Fen), Fritillaria Bulb (Yi Qian).
Decoct in water and take orally. After ten consecutive doses, Qi transforms; after another ten doses, sputum turns white; after another ten doses, diarrhea stops, and borborygmus ceases.
This formula is not primarily an antidiarrheal. Diarrhea arises from Yin deficiency; tonifying Yin stops diarrhea. When Yin prospers, Fire rests and does not scorch Metal; when Metal is safe, Wood levels and does not overcome Earth. Thus, phlegm is resolved, fire color changes, diarrhea stops, metal decline sound withdraws. Borborygmus and night sweats disappear, and cough heals.
For this condition, Zhuan Chuan Tang (Stop Transmission Decoction) is also wonderful:
Prepared Rehmannia Root (Liang Liang), Scrophularia Root, Lily Bulb (each Yi Liang), White Mustard Seed (Er Qian), Stir-fried Black Schizonepeta Head (Yi Qian), Poria (San Qian), Glehnia Root (San Qian), Cortex Lycii Radicis (Wu Qian), Mulberry Leaf (Fifteen Leaves).
Decoct in water and take orally. Lightens after ten doses, cures after thirty doses.
Some patients are fine during warm spring and hot summer but cough restlessly upon autumn coolness, even to the point of asthma and inability to lie down. People attribute this to surface laxity, not realizing it is difficult-to-unblock depressed heat. Body Qi and Blood circulate within muscles, preventing wind invasion. Only when Qi and Blood are blocked do pathogens invade, stagnate, and transform into heat. In spring and summer, skin pores are open, allowing internal heat to vent externally. In autumn and winter, skin pores are tight, making internal heat difficult to emit. Hence, no cough in spring/summer, but cough in autumn/winter. If one does not treat the root of depressed heat but only uses dispersing herbs, one vainly weakens the exterior, unable to withstand wind-cold, and vainly consumes the interior, increasing depressed heat. This misses the treatment principle. The value lies in combining attack and tonification: soothing internal depressed heat and dispersing external invading cold. Thus, the root is not harmed, and the branch is easily managed. The formula is:
Angelica Sinensis Root (Wu Qian), Rhubarb (Yi Qian), Fritillaria Bulb (Er Qian), Trichosanthes Root (San Qian), Mint (Er Qian), Schizonepeta Head (Er Qian), Licorice Root (Yi Qian), Atractylodes Macrocephala Rhizome (San Qian), Tangerine Peel (San Fen), Medicated Leaven (Wu Fen), Scutellaria Root (Er Qian), Platycodon Root (Er Qian).
Decoct in water and take orally. After four consecutive doses, there will be absolutely no cough in autumn and winter.
Rhubarb moves without staying; it rapidly unblocks depression among fire-dispersing and phlegm-resolving herbs. Combined with Angelica Sinensis Root (tonifying without stagnation) and Atractylodes Macrocephala Rhizome (draining without attacking), they work together to resolve conflicts and knots, benefiting both interior and exterior.
For this condition, Yu Jin Dan (Depressed Heat Pill) is also very effective:
White Peony Root, Platycodon Root (each San Qian), Ligusticum Chuanxiong Rhizome (Er Qian), White Mustard Seed, Poria, Rehmannia Root (each San Qian), Licorice Root, Farfleur Flower (each Yi Qian).
Decoct in water and take orally. Lightens after one dose, cures after two doses.