("Ao" is the ancient variant of "Nao", meaning distress.)
Cheng Wuji's Commentary: A feeling of depression and discomfort in the heart, a sense of helplessness and confusion, which is more severe than ordinary irritability (Fan), is called "Ao Nao". This occurs because after purgation, the Yang pathogenic factor from the exterior sinks inward due to deficiency, knotting and stagnating between the heart and chest. The treatment method involves either inducing vomiting or purging. If purgation is indicated but emesis is used instead, or if cold-natured herbs are used to treat heat, numerous transformation syndromes may arise. One must be cautious.

In Taiyang disease, with a floating, rapid, and forceful pulse, headache, fever, slight night sweats, and aversion to cold, the exterior syndrome remains unresolved. A rapid and forceful pulse indicates emptiness in the stomach; an invading pathogen disturbs the diaphragm, causing shortness of breath, restlessness, and mental distress (Ao Nao). (Zhi Zi Bai Pi Tang see Self-Sweating section). After sweating, vomiting, or purging, if there is empty irritability preventing sleep, tossing and turning, and mental distress (Ao Nao), use Zhi Zi Chi Tang.

In Yangming disease, after purgation, if there is heat on the exterior, warmth in the hands and feet, no Jie Xiong (chest binding), mental distress (Ao Nao), hunger but inability to eat, and only sweating on the head, use Zhi Zi Chi Tang.

In Yangming disease, with a floating and tight pulse, dry throat, bitter taste, abdominal fullness and panting, fever, sweating, aversion to heat rather than cold, and heavy body. If purged mistakenly, it leads to emptiness in the stomach, disturbance of the diaphragm by invading pathogens, mental distress (Ao Nao), and coating on the tongue. Use Zhi Zi Chi Tang.

In Yangming disease, after purgation, if there is mental distress (Ao Nao) and irritability with hard stool (Zao Shi), use Da Cheng Qi Tang.

In Yangming disease, with no sweat, difficulty in urination, and mental distress (Ao Nao), jaundice will likely develop (use Yin Chen Hao Tang or Zhi Zi Bai Pi Tang).

(Cough and Hoarseness attached)
Cheng Wuji's Commentary: Coughing with sound but no phlegm is called "Ke"; coughing with sound and phlegm is called "Sou". The Lung governs Qi. Cold affecting the body or cold drinks injuring the interior damage the Lung, causing Qi to reverse and fail to disperse. This impacts the throat and diaphragm, causing itching like insects crawling or a sensation of obstruction in the throat, leading to cough. Severe cases continue without pause, causing restlessness in sitting or lying, interrupted speech, movement involving the whole body, and audible sounds nearby. Causes of cough include cold, retained fluid, exterior involvement, interior involvement, and half-exterior half-interior involvement. Diseases differ, so treatments vary. For example: cough combined with retained fluid and exterior cold uses Xiao Qing Long Tang; cough combined with retained fluid and interior cold uses Zhen Wu Tang; cough due to pathogenic heat in the half-exterior half-interior uses Xiao Chai Hu Tang.

Although cough is a Lung disease often treated with dispersing methods, there are contraindications. The Classics state: if coughing with free urination, do not induce sweating, as this causes cold limbs. Also: if coughing and sweating leads to curling up, chest fullness, and abdominal hardness, it is a counter-indication (Ni). Furthermore, if the pulse is rapid, it indicates Heart Fire insulting Lung Metal, which can be fatal.

In Taiyang Shang Han, if the exterior is unresolved and there is water-Qi in the epigastrium, presenting with dry retching, fever, and cough, or thirst, diarrhea, dysphagia sensation, difficulty urinating with lower abdominal fullness, or wheezing, treat primarily with Xiao Qing Long Tang. (Water staying in the Stomach causes dry retching and dysphagia; water attacking the Lung causes wheezing and cough; water stopping in the epigastrium causes thirst; water entering the intestines causes diarrhea; water accumulating in the Lower Jiao causes difficulty urinating and lower abdominal fullness. Xiao Qing Long Tang induces sweating to scatter water. As water-Qi infiltrates internally, transmission varies, causing various optional symptoms; treat according to the specific presentation.)

In Shang Han, if there is water-Qi in the epigastrium, cough with slight wheezing, fever but no thirst, and thirst appears after taking medicine, this indicates the cold has gone and the disease is resolving. Continue using Xiao Qing Long Tang.

Xiao Qing Long Tang Formula:
Mahuang (Ephedrae Herba, remove nodes), Shaoyao (Paeoniae Radix Alba), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma), Guizhi (Cinnamomi Ramulus, remove rough bark), each 3 liang; Wuweizi (Schisandrae Fructus), Banxia (Pinelliae Tuber, each 0.5 sheng, washed with decoction). Eight ingredients. Add 1 dou of water, first boil Mahuang, reduce by 2 sheng, remove foam. Add remaining herbs, boil to obtain 3 sheng. Remove dregs, warm drink 1 sheng.

Modifications:
If slight diarrhea, remove Mahuang, add Raohua (Adenophorae Radix) the size of a chicken egg, roasted until red. Diarrhea patients should not attack the exterior; sweating will cause abdominal fullness. Mahuang disperses Yang; water infiltrating the Stomach causes diarrhea. Raohua drains water from twelve channels; once water is drained, diarrhea stops.
If thirsty, remove Banxia, add Gualougen (Trichosanthis Radix) 3 liang. Banxia is acrid and drying, unsuitable for those with damaged fluids and thirst. Gualou is bitter and generates fluids, hence added.
If dysphagia sensation, remove Mahuang, add one Pao Fuzi (Aconiti Lateralis Radix Praeparata). The Classics state: Water meets cold Qi, they clash, causing dysphagia. Add Fuzi to warm and scatter cold-water. If a cold patient is wrongly sweated, Stomach cold causes vomiting of roundworms. Since sweating is disliked, remove Mahuang.
If difficulty urinating and lower abdominal fullness, remove Mahuang, add Fuling (Poria) 4 liang. Water accumulation in Lower Jiao causes these symptoms. Mahuang disperses fluids outward, which is inappropriate here. Fuling drains accumulated water downward, which is appropriate.
If wheezing, remove Mahuang, add Xingren (Armeniacae Semen Amarum) 0.5 sheng (remove skin and tips). *Jin Gui Yao Lue* states: If the person has edema, do not use Mahuang, use Apricot Kernel instead, because Mahuang disperses Yang. Wheezing and edema are root and branch issues of water-Qi. Qing Long Tang resembles the two branches of the Liver, treating dual injuries. Da Qing Long Tang treats dual injury of Ying and Wei; this formula treats exterior unresolved plus water-Qi in epigastrium, which neither Ma Huang Tang nor Gui Zhi Tang can resolve. Only Xiao Qing Long Tang can dispel exterior and interior pathogens. Exterior unresolved: Mahuang induces sweating as Sovereign herb; Guizhi and Gancao assist Mahuang as Minister herbs. Cough and wheezing indicate reversed Lung Qi. *Nei Jing* states: Lung desires astringency, urgently eat sour to astringe. Thus, Shaoyao (sour-cold) and Wuweizi (sour-warm) are Assistant herbs to astringe reversed Qi. Water in epigastrium blocks fluids, causing Kidney Qi dryness and urgency; eat acrid to moisten. Ganjiang and Xixin (acrid-hot), Banxia (acrid-warm) are Envoy herbs to scatter cold-water and reversed Qi. Once cold-water scatters and fluids circulate, sweating resolves the disease. Due to variable transmission of water in epigastrium, modifications exist. Water accumulation blocks fluids, causing dryness and thirst; removing Banxia restores fluids easily. Gualougen is bitter-cool, moistens dryness; adding it circulates fluids and directs water downward into intestines, causing diarrhea. Diarrhea patients should not attack exterior; Mahuang disperses, unsuitable for diarrhea, so remove. Raohua is bitter-cold, a draining agent; water removal stops diarrhea. Raohua drains water, so add. Dysphagia: remove Mahuang, add Fuzi. Classics: Water meets cold, clashes, causing dysphagia. Dysphagia indicates Stomach Qi exhaustion; Mahuang sweating is unsuitable for Stomach deficiency/cold. Fuzi is acrid-hot; heat warms Qi, acrid scatters cold. Use as Assistant to scatter cold. Pathogens outside: sweat them; inside: purge them; upper: vomit them; lower:渗 (percolate/drain) them. Water in Lower Jiao, difficulty urinating, lower abdominal fullness: percolation is suitable, not sweating. Remove Mahuang, add Fuling. Fuling is sweet-bland, moves fluids. *Nei Jing*: Dampness within, drain with blandness. Wheezing: remove Mahuang. Wheezing is Qi reversal; Mahuang disperses Yang, so remove. Combine with Xingren (bitter-sweet-warm) to drain reversed Qi. *Jin Gui Yao Lue*: Edema excludes Mahuang, uses Xingzi because Mahuang disperses Yang, causing wheezing/edema.

Shaoyang disease: Six days of Shang Han or Feng Zhong, alternating chills and fever, chest/hypochondriac fullness, silent desire not to eat, irritability, frequent retching, slight fever or cough. Use Xiao Chai Hu Tang, remove Renshen, add Wuweizi and Jiangye.

Yangming disease: Cough with resolved exterior, Stomach excess belongs to Yangming. If conversely no sweat, free urination, vomiting, and cold limbs, headache is certain. If only vertigo, no aversion to cold, able to eat, throat pain is certain. (See Stomach Excess).

Shaoyin disease: Cough with diarrhea, delirium, difficulty urination, caused by fire coercion. (See Diarrhea). Shaoyin disease, Si Ni, coughing: Si Ni San add Wuweizi and Jiangye each 5 fen. Shaoyin disease, diarrhea 6-7 days, cough, vomiting, thirst, irritability, insomnia: Zhu Ling San. Shaoyin disease 2-3 days unrelieved, progressing to 4-5 days, abdominal pain, difficulty urination, heavy/painful limbs, spontaneous diarrhea: this is water-Qi, coughing: Zhen Wu Tang add Wuweizi 0.5 sheng, Xixin and Jiangye each 1 liang.

Shang Han cough with reversed Qi, scattered pulse: death, indicating form depletion. Cough with urinary incontinence: do not sweat, sweating causes cold limbs. (See Enuresis).

Attached Formulas:
Yun Qizi says: After Shang Han sweating, persistent cough/wheeze fears transmission to Fei Wei (Lung萎). Use Bu Fei San.
Renshen (1 liang), Wuweizi (5 qian), Sangbaipi (2 liang), Kundonghua, Gejie (1 pair). Powder, take 5 qian mixed with boiling water.

After Shang Han sweating/purging, cough with Lung deficiency and hoarse voice: E Jiao San.
Shuyu, E Jiao (fried), Wuweizi, Maidong (remove heart), Baizhu (each 1 liang), Ganjiang (roasted), Guizhi (each 2 qian), Xingren (remove skin/tips 3 qian). Cut fine, take 7 qian with 2 lamps of water and 1 qian Wumei flesh, decoct and drink.

After Shang Han sweating/purging, cough/wheeze, irritability, Qi stagnation/reversal: Jie Geng Tang.
Jiegeng, Sangbaipi (each 1 liang), Gancao, Beimu, Helile (each 5 qian). Powder, take 5 qian with 1 qian Wuweizi and Wumei flesh, 2 bells of water, decoct.

Ren Shen Shi Gao Tang: Treats persistent Shang Han cough, irritability, wind-heat headache, mental dullness.
Renshen (remove rhizome 0.5 qian), Shigao (1 liang), Banxia (soaked in water), Zhizi Ren, Huangqin (each 1 qian), Chuanxiong, Baizhu, Fuling (remove peel), Zhimu (each 1.5 qian), Gancao (roasted 2 qian). One dose, 2 bells water, 3 slices ginger, decoct to 1 bell, take anytime.

Wu Shi says: Exterior cold cough, floating pulse, aversion to cold, body ache/stiffness, no sweat: Ma Huang Tang or San Ao Tang to sweat. Phlegm like glue: Jin Fei Cao San to sweat. With heat: Shen Su Yin remove Muxiang, add Renshen, Sangbaipi, Xingren, Ma Huang to sweat (good, adjust for weather/condition). Weak person catching wind-cold, cough/phlegm, aversion to wind/headache/dry retch: Ren Shen Xing Ren Tang. Shang Han day 2-3 transmitting to Shaoyang, string-taut pulse, bitter taste, fever, cough: Xiao Chai Hu Tang remove Renshen, Dazao, Shengjiang, add Wuweizi, Jiangye. Fever/chest irritability/fullness/cough: add fried Gualou. Chest/hypochondriac fullness/fever/cough: add Zhike, Jiegeng. Yin syndrome, cold limbs, deep/thin pulse, cough: Si Ni Tang add Wuweizi. Generally, Shang Han cough differs from miscellaneous diseases. Zhang Zhongjing treats cough regardless of Yin/Yang with Wuweizi and Jiangye. Wuweizi astringes Lung Qi to stop cough; Jiangye acrid-warm scatters reversed Qi in Lung meridian.

Hoarseness:
She Gan Tang: Treats early autumn rain/cold epidemic sudden cold, heat hiding inside, tortuous cough, difficult breathing, hoarse voice/aphonia, dry cough/no phlegm, throat obstruction.
Shegan, Ziwan, Danggui, Duhuo, Mahuang, Gancao (each 1 liang), Shengjiang (roasted), Juapi, Rougui (remove bark), Zhishi (roasted each 2 liang), Banxia (washed 2.5 liang), Xingren (remove skin/tips fried 1.5 liang). Cut coarse, take 5 qian with 1.5 lamps water, decoct to 0.8 lamps, remove dregs, warm drink.