痨症咳嗽，以痨为本，不在咳嗽论。其余咳嗽，但得病源缕晰，无脉不可以治。欲达病源，先分内外。外
感咳嗽，专责之于肺。风寒之来，先入皮毛，皮毛者，肺之合也，风寒郁于肺则咳嗽，肺窍得通，则咳嗽止焉，
故古有外感咳嗽则轻之语。其脉浮而大，散之以葱白，通之以紫苏（参苏饮∶人参 紫苏 葛根 前胡 法
夏茯苓 陈皮 甘草 枳壳 桔梗 木香 葱白）。至于内伤，经曰∶“五脏皆令人咳，不独肺然也。”而要
不离乎肺，其本经咳嗽也，金生在已，形寒金冷，伤其生气，喘息有音，甚则唾血，其脉短而迟，补之以波蔻，
温之以砂仁（经验方∶人参、焦术、云苓、法夏、陈皮、波蔻、砂仁、炙草、姜枣引）；其心脏咳嗽也，火甚
克金，喉中隐隐如梗状，甚则咽肿喉痹，其脉浮而洪，凉之
以黄芩，泻之以山栀（经验方∶生地、赤茯苓、山栀、生甘草、黄芩、桔梗、麦冬、灯芯引），其脾脏咳嗽也，
土不生金，阴阴痛引肩背，甚则不可动，其脉濡而弱，培之以黄 ，燥之以白术（经验方∶人参、秦归、黄 、
焦术、法夏、陈皮、云苓、炙草、大姜枣引）；其肝脏咳嗽也，木燥火发，金被火伤，两胁下痛，甚则不可以
转，其脉沉而弦，制之以鳖甲，和之以柴胡（熟地、鳖甲、秦归、柴胡、酒芍、炙草）；其肾脏咳嗽也，火动水
亏，金少水涵，腰背相引而痛，甚则咳涎，其脉沉而细，滋之以熟地，坚之以黄柏（知柏地黄汤∶熟地、淮药、
枣皮、知母、丹皮、泽泻、茯苓、黄柏）。久咳不已，移于五腑，病则缠绵难愈，治法仍归五脏。彼无痰干咳，
火郁于肺，一言尽之，升提肺气（甘桔汤∶桔梗、甘草），生其津液（八仙长寿丹∶熟地、淮药、枣皮、麦
冬、泽泻、茯苓、丹皮、五味子），斯得之矣。据经分症，即症分脉，凭脉用药，夫固有历历不爽者。经曰∶
秋伤于湿，冬必咳嗽。”经之所言者，主气也，四之气土，正在秋初当权。喻嘉言以为湿字疑燥字之误，只知
岁气之燥，而不知主气之湿。经曰“脾苦湿”，未闻心、肺、肝、肾苦湿。河间《咳嗽》之篇，以为湿在脾可
也，而必分其湿在心、在肺、在肝、在肾何也？丹溪论咳嗽，有风、有寒、有痰、有火、有痨、有虚、有郁、
有肺胀，庶乎近之。降至景岳，所论外感咳嗽，大半内伤之方居多，所谈内伤咳嗽，止知阴虚一语，虽所重者
肾元，四脏亦在内伤之列，何
以曾不之及？内伤外感四字，尚未解透耶（自内而出者，喜、怒、忧、思、悲、恐、惊及房劳、饮食所伤为内
伤；自外而入者，风、寒、暑、湿、燥、火及瘟疫、痢病所感为外感）。夫无痰不作咳，无嗽不有痰，一言咳
嗽而痰在其中，《内经》所以有饮无痰，饮留肠胃，不咳不嗽者。自汉儒添一痰字，方书遂将咳嗽与痰，别为
两门。究竟扯东拽西，两无分别，书之所以日益支离也。
劳损病（痨症）引起的咳嗽，以治疗劳损为本，不应仅仅针对咳嗽症状进行论治。其余类型的咳嗽，只要将病因梳理清晰，就没有不能通过脉诊来治疗的。想要探求病因，首先要区分外感和内伤。
外感咳嗽，责任主要在肺。风寒之邪侵袭，首先侵犯皮毛，而皮毛是肺的外合组织，风寒郁闭于肺则引发咳嗽，肺窍通畅后，咳嗽自然停止，所以古语有“外感咳嗽病情较轻”的说法。其脉象浮大，可用葱白发散，用紫苏疏通（参苏饮：人参、紫苏、葛根、前胡、法半夏、茯苓、陈皮、甘草、枳壳、桔梗、木香、葱白）。
至于内伤咳嗽，《内经》说：“五脏都能让人咳嗽，不仅仅只有肺。”但其根本离不开肺。如果是肺本经的咳嗽，金气生于巳时（夏季末），若形体受寒导致肺金寒冷，损伤了生气，会出现喘息有声，严重时唾血，其脉象短而迟，用人白豆蔻补益，用砂仁温中（经验方：人参、炒白术、茯苓、法半夏、陈皮、白豆蔻、砂仁、炙甘草，生姜大枣为引）；
如果是心脏咳嗽，火气过盛克制肺金，喉咙中有隐隐如异物梗阻的感觉，严重时咽喉肿痛闭塞，其脉象浮而洪大，用黄芩清热，用山栀泻火（经验方：生地、赤茯苓、山栀、生甘草、黄芩、桔梗、麦冬，灯芯草为引）；
如果是脾脏咳嗽，土不生金，身体隐隐作痛并牵引至肩背，严重时无法活动，其脉象濡弱，用黄芪培补脾气，用白术燥湿健脾（经验方：人参、当归、黄芪、炒白术、法半夏、陈皮、茯苓、炙甘草，大姜大枣为引）；
如果是肝脏咳嗽，木燥火发，肺金被火所伤，两胁下疼痛，严重时身体不能转动，其脉象沉弦，用鳖甲制约肝阳，用柴胡调和肝气（熟地、鳖甲、当归、柴胡、酒白芍、炙甘草）；
如果是肾脏咳嗽，相火妄动肾水亏虚，肺金缺乏肾水的涵养，腰背相互牵引而痛，严重时咳出涎沫，其脉象沉细，用熟地黄滋润，用黄柏坚固肾阴（知柏地黄汤：熟地、山药、山茱萸、知母、丹皮、泽泻、茯苓、黄柏）。
久咳不愈，病邪转移至五腑，病情缠绵难愈，但治疗方法仍归结于调理五脏。那些无痰干咳的情况，是火郁结于肺，一句话概括就是升提肺气（甘桔汤：桔梗、甘草），生津液（八仙长寿丹：熟地、山药、山茱萸、麦冬、泽泻、茯苓、丹皮、五味子），这样就对了。依据经典分辨症状，根据症状分辨脉象，凭借脉象用药，这本来就有明确无误的效果。《内经》说：“秋季感受湿气，冬天必定咳嗽。”经文所说的，是指主气，四之气属土，正值秋初当权之时。喻嘉言认为“湿”字可能是“燥”字的误写，只知道岁气的燥，却不知道主气的湿。经文说“脾苦湿”，没听说过心、肺、肝、肾也苦湿。河间在《咳嗽》篇中，认为湿在脾是可以的，但为什么一定要区分湿在心、在肺、在肝、在肾呢？丹溪论述咳嗽，有风、寒、痰、火、劳、虚、郁、肺胀等类型，比较接近真理。到了景岳，他所论述的外感咳嗽，大部分其实是内伤的方剂居多；他所谈论的内伤咳嗽，只知道阴虚这一句话，虽然重视肾元，但其他四脏也在内伤之列，为什么不曾提及？看来对内伤和外感的概念还没有彻底理解（从内部产生的，如喜、怒、忧、思、悲、恐、惊以及房劳、饮食所伤称为内伤；从外部侵入的，如风、寒、暑、湿、燥、火以及瘟疫、痢疾所感称为外感）。
没有痰就不会发生咳嗽，没有咳嗽就不会有痰，一说起咳嗽，痰就在其中，《内经》之所以只说“饮”而不说“痰”，是因为饮邪停留在肠胃，如果不引起咳嗽，就不叫嗽。自从汉代儒者添加了一个“痰”字，方书遂将咳嗽与痰分为两个门类。究竟扯东拉西，两者没有分别，书籍因此日益支离破碎。
Cough caused by consumption (Lao Zheng) should be treated based on the root cause of consumption, rather than focusing solely on the symptom of coughing. For other types of cough, as long as the source of the disease is clearly identified, there is no pulse pattern that cannot guide treatment. To understand the source of the disease, one must first distinguish between external and internal causes.
External contraction coughs are primarily attributed to the Lung. When Wind-Cold invades, it first enters the skin and hair; the skin and hair are the exterior correspondence of the Lung. When Wind-Cold stagnates in the Lung, coughing ensues; once the orifices of the Lung are unblocked, the cough stops. Hence, ancient texts state that "external contraction coughs are mild." The pulse is floating and large; treat with Scallion White (Cong Bai) to disperse, and Perilla Leaf (Zi Su Ye) to unblock (Shen Su Yin: Ginseng, Perilla Leaf, Kudzu Root, Peucedanum Root, Pinellia Rhizome processed with ginger, Poria, Tangerine Peel, Licorice Root, Bitter Orange, Platycodon Root, Aromatic Twig, Scallion White).
Regarding internal injury coughs, the Classic states: "The five Zang organs can all cause coughing, not just the Lung." However, it fundamentally remains inseparable from the Lung. If it is a cough originating from the Lung meridian itself, Metal is born at Si (late summer); if the body is chilled causing Lung Metal to become cold, damaging the vital Qi, wheezing with sound occurs, and in severe cases, blood is spat. The pulse is short and slow; tonify with Cardamom Seed (Bo Kou), and warm with Amomum Fruit (Sha Ren) (Empirical Formula: Ginseng, Stir-fried Atractylodes Macrocephala Rhizome, Poria, Pinellia Rhizome processed with ginger, Tangerine Peel, Cardamom Seed, Amomum Fruit, Honey-fried Licorice Root, with Ginger and Jujube as guides);
If it is Heart cough, excessive Fire overacts on Metal, causing a sensation of obstruction in the throat like a lump, and in severe cases, sore throat and bi-syndrome. The pulse is floating and surging; cool with Scutellaria Root (Huang Qin), and drain with Gardenia Fruit (Shan Zhi) (Empirical Formula: Rehmannia Root prepared with wine, Red Poria, Gardenia Fruit, Raw Licorice Root, Scutellaria Root, Platycodon Root, Ophiopogon Tuber, with Barley Grass as a guide);
If it is Spleen cough, Earth fails to generate Metal, causing dull pain radiating to the shoulders and back, and in severe cases, immobility. The pulse is soggy and weak; cultivate with Astragalus Root (Huang Qi), and dry dampness with Atractylodes Macrocephala Rhizome (Bai Zhu) (Empirical Formula: Ginseng, Angelica Sinensis Root, Astragalus Root, Stir-fried Atractylodes Macrocephala Rhizome, Pinellia Rhizome processed with ginger, Tangerine Peel, Poria, Honey-fried Licorice Root, with Ginger and Jujube as guides);
If it is Liver cough, Wood becomes dry and Fire erupts, injuring Metal with Fire, causing pain under both hypochondria, and in severe cases, inability to turn the body. The pulse is deep and wiry; restrain with Turtle Shell (Bie Jia), and harmonize with Bupleurum Root (Chai Hu) (Rehmannia Root prepared with wine, Turtle Shell, Angelica Sinensis Root, Bupleurum Root, Wine-processed Peony Root, Honey-fried Licorice Root);
If it is Kidney cough, Ministerial Fire moves and Water is deficient, leaving Lung Metal without nourishment from Kidney Water, causing pain radiating between the waist and back, and in severe cases, coughing up saliva. The pulse is deep and fine; moisten with Prepared Rehmannia Root (Shu Di Huang), and consolidate with Phellodendron Bark (Huang Bo) (Zhi Bai Di Huang Wan: Prepared Rehmannia Root, Chinese Yam, Cornus Fruit, Anemarrhena Rhizome, Moutan Cortex, Alisma Rhizome, Poria, Phellodendron Bark).
If chronic cough persists, it transfers to the six Fu organs, becoming lingering and difficult to cure, but the treatment method still returns to regulating the five Zang organs. For those dry coughs without phlegm, it is Fire stagnating in the Lung; this can be summarized as lifting Lung Qi (Gan Jie Tang: Platycodon Root, Licorice Root) and generating fluids (Ba Xian Chang Shou Dan: Prepared Rehmannia Root, Chinese Yam, Cornus Fruit, Ophiopogon Tuber, Alisma Rhizome, Poria, Moutan Cortex, Schisandra Berry). This achieves the goal. By classifying symptoms according to classics, distinguishing pulses by symptoms, and prescribing medicines based on pulses, the results are invariably accurate. The Classic says: "Injury by dampness in autumn leads to cough in winter." What the Classic refers to is the Dominant Qi (Zhu Qi); the Fourth Qi belongs to Earth, which holds power in early autumn. Yu Jiayan suspected that "dampness" was a typo for "dryness," knowing only the seasonal Qi's dryness but unaware of the Dominant Qi's dampness. The Classic says "Spleen suffers from dampness"; it has never been heard that Heart, Lung, Liver, or Kidney suffer from dampness. He Jian's chapter on "Cough" argues that dampness in the Spleen is acceptable, but why must one distinguish dampness in the Heart, Lung, Liver, and Kidney? Danxi's discussion on cough includes wind, cold, phlegm, fire, consumption, deficiency, stagnation, and lung distension, which is quite close to the truth. Descending to Jingyue, most of his discussions on external contraction coughs actually use formulas for internal injuries; his discussion on internal injury coughs only mentions yin deficiency. Although he emphasizes Kidney Yuan, the other four Zang organs are also included in internal injuries, yet he does not mention them. Does this mean he has not thoroughly understood the concepts of internal injury and external contraction? (Causes originating from within, such as joy, anger, worry, thought, sorrow, fear, fright, sexual exhaustion, and dietary injury are called internal injuries; factors invading from outside, such as wind, cold, summerheat, dampness, dryness, fire, epidemics, and dysentery are called external contractions).
No cough occurs without phlegm, and no spitting up occurs without phlegm; mentioning cough inherently includes phlegm. The *Neijing* speaks of "fluid retention" (Yin) rather than "phlegm" because fluid retention stays in the stomach and intestines; if it does not cause coughing, it is not termed "sou" (spitting/coughing). Since Han scholars added the character "phlegm," medical books subsequently separated cough and phlegm into two distinct categories. Ultimately, this dragging here and there creates no distinction, leading to increasingly fragmented literature.