气上呛 咳嗽生 《内经》云∶五脏六腑皆令人咳，不独肺也。然肺为气之市，诸气上
逆于肺，则呛而咳。是咳嗽不止于肺而亦不离于肺也。
肺最重 胃非轻 《内经》虽分五脏诸咳，而所尤重者，在聚于胃关于肺六字。盖胃中
水谷之气，不能如雾上蒸于肺，而转溉诸脏，只是留积于胃中，随热气而化为痰，随寒气而
化为饮。胃中既为痰饮所滞，则输肺之气亦必不清，而为诸咳之患矣。
肺如钟 撞则鸣 肺为脏腑之华盖，呼之则虚，吸之则满。只受得本然之正气，受不得
外来之客气。客气干之，则呛而咳矣。亦只受得脏腑之清气，受不得脏腑之病气。病气干之
，亦呛而咳矣。肺体属金，譬若钟然，一外一内，皆所以撞之使鸣也。
风寒入 外撞鸣 经云∶微寒微咳。可见咳嗽多因于风寒也。风从皮毛而入于肺，寒从
背俞而入于肺，皆主乎外也。后注虽言热、言湿、言燥，令不自行，亦必假风寒以为之帅也。
痨损积 内撞鸣 痨伤、咳嗽，主乎内也。二者不治，至于咳嗽失音，是金破不鸣矣。
谁治外 六安行 六安煎虽无深义，却亦平稳。然外感诸咳，当辨风热、风燥二症。如
冬时先伤非节之暖，复加风寒外遏，以致咳嗽、痰结、咽肿、身重、自汗、脉浮者，风热也
，宜萎蕤汤辛润之剂，切勿辛热发散。而风燥一症，辨治尤难。盖燥为秋气，令不独行，必
假风寒之威，而令乃振，咳乃发也。《内经》只言秋伤于湿，何也?以长夏受湿土郁蒸之气
，随秋令收敛，伏于肺胃之间，直待秋深燥令大行，与湿不能兼容，至冬而为咳嗽也。此症
有肺燥、胃湿两难分解之势，唯《千金》麦门冬汤、五味子汤独得其秘，后人以敛散不分，
燥润杂出弃之，昧之甚也。
谁治内 虚痨程 宜于《虚痨门》择其对症之方。审是房痨伤精，则补精；审是思郁伤脾，则养神。
挟水气 小龙平 柯韵伯治咳嗽，不论冬夏，不拘浅深，但是寒嗽，俱用小青龙汤多效
。方中驱风散寒，解肌逐水，利肺暖肾，除痰定喘，攘外安内，各尽其妙。盖以肺家沉寒痼
冷，非麻黄大将不能捣其巢穴，群药安能奏效哉。
兼郁火 小柴清 寒热往来咳嗽者，宜去人参、大枣、生姜，加干姜、五味治之。
姜细味 一齐烹 《金匮》治痰饮咳嗽，不外小青龙汤加减。方中诸味，皆可去取，唯
细辛、干姜、五味不肯轻去。即面热如醉，加大黄以清胃热，及加石膏、杏仁之类，总不去
此三味，学人不可不深思其故也。徐忠可《金匮辨注》有论。
长沙法 细而精 《金匮》痰饮咳嗽治法，宜熟读之。
气机上逆引发咳嗽。《黄帝内经》说：五脏六腑的病变都能导致咳嗽，并不仅仅局限于肺脏。然而，肺是气机汇聚之所，各种气机上逆侵犯肺脏，就会引起呛咳。因此，咳嗽虽然不单纯由肺引起，但也离不开肺的作用。
肺脏的问题至关重要，胃脏的影响也不容轻视。《黄帝内经》虽然分别论述了五脏引起的各种咳嗽，但特别强调的重点在于“聚于胃，关于肺”这六个字。这是因为胃中水谷的精微之气，如果不能像雾露一样向上蒸腾滋养肺脏并灌溉其他脏腑，而是停滞积聚在胃中，遇到热气就会化为痰饮，遇到寒气就会化为水饮。胃中既然被痰饮阻滞，那么输送到肺的气也必然不清澈，从而成为各种咳嗽的隐患。
肺就像一口钟，撞击它就会鸣响。肺是脏腑的华盖（保护伞），呼气时肺内空虚，吸气时肺内充盈。它只能容纳本然的正气，不能容纳外来的邪气。外来邪气干扰肺脏，就会引起呛咳。它也只能容纳脏腑传来的清气，不能容纳脏腑传来的病气。病气干扰肺脏，同样会引起呛咳。肺体五行属金，好比一口钟，无论是外邪还是内伤，都是撞击它使其鸣响的原因。
风寒侵入，属于外部撞击导致的鸣响。医经说：轻微的受寒会导致轻微的咳嗽。可见咳嗽多因风寒引起。风邪从皮毛侵入肺脏，寒邪从背部俞穴侵入肺脏，都属于外感因素。后世注家虽然提到了热、湿、燥等因素，但这些邪气通常不会单独致病，也必须借助风寒作为先导。
痨损积滞，属于内部撞击导致的鸣响。痨伤和咳嗽主要源于内伤。如果这两种情况不治疗，发展到咳嗽失音的地步，就是所谓的“金破不鸣”（肺叶受损无法发声）。
如何治疗外感咳嗽？可以使用六安煎。六安煎虽然理论深意不多，但药性平稳。然而，对于外感引起的各种咳嗽，应当辨别是风热还是风燥两种证型。如果在冬季先感受了不合时令的温暖气候，又加上风寒束表，导致咳嗽、痰结、咽喉肿痛、身体沉重、自汗、脉浮等症状，这是风热证，适宜使用萎蕤汤这类辛润的方剂，切勿使用辛温发散的药物。而风燥这一证型，辨证和治疗尤为困难。因为燥是秋季的主气，它不会单独行动，必须借助风寒的威力，燥令才能盛行，咳嗽才会发作。《黄帝内经》只说“秋伤于湿”，为什么呢？是因为长夏时节受了湿土郁蒸之气，随着秋季收敛之气潜伏在肺胃之间，一直等到深秋燥令大行，燥与湿不能相容，到了冬天就引发咳嗽。这种病症有肺燥和胃湿两难分解的趋势，只有《千金方》中的麦门冬汤、五味子汤独得其妙，后人因为不懂得收敛与发散的区别，认为其燥润并用而弃之不用，这是非常愚昧的。
如何治疗内伤咳嗽？可以参考《虚劳门》的内容。应该选择对症的方剂。如果审查确认是房劳过度损伤精气，就补益精气；如果审查确认是思虑忧郁损伤脾脏，就调养心神。
兼夹水气，用小青龙汤可平复。柯韵伯治疗咳嗽，不论冬夏，不拘病情深浅，只要是寒性咳嗽，都使用小青龙汤，大多有效。方中药物能驱风散寒，解肌逐水，利肺暖肾，除痰定喘，攘外安内，各尽其妙。因为肺家有沉寒痼冷，非麻黄这位大将不能捣毁其巢穴，其他群药怎么能奏效呢？
兼夹郁火，用小柴胡汤可清解。出现寒热往来且伴有咳嗽者，适宜去掉人参、大枣、生姜，加入干姜、五味子来治疗。
细辛、干姜、五味子，一齐煎煮。《金匮要略》治疗痰饮咳嗽，不外乎是小青龙汤的加减运用。方中的各种药物，都可以去留，唯独细辛、干姜、五味子不肯轻易去除。即使出现面部发热如醉酒状，加大黄以清胃热，以及加入石膏、杏仁等药物，总也不去掉这三味药，学习的人不可不深思其中的缘故。徐忠可在《金匮辨注》中有相关论述。
Qi ascending and rushing causes cough. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "The diseases of the five zang organs and six fu organs can all cause cough, not limited to the lung alone." However, the lung is the market where qi gathers; when various qi rebelliously ascend into the lung, it triggers choking and coughing. Therefore, cough is not solely caused by the lung, nor can it be separated from the lung.
The condition of the lung is of utmost importance, while that of the stomach is not trivial. Although the *Huangdi Neijing* distinguishes coughs caused by the five zang organs, the particular emphasis lies in the six characters: "gathering in the stomach, relating to the lung." This is because the qi of food and drink in the stomach, if unable to vaporize upwards like mist to nourish the lung and irrigate the other organs, but instead stagnates and accumulates in the stomach, will transform into phlegm with heat or into fluid retention with cold. Once the stomach is obstructed by phlegm and fluid retention, the qi transported to the lung will inevitably be impure, becoming the source of various coughs.
The lung is like a bell; it rings when struck. The lung is the canopy covering the zang and fu organs; it becomes empty upon exhalation and full upon inhalation. It can only accept its inherent righteous qi, but cannot tolerate external pathogenic qi. When external pathogenic qi interferes with it, choking and coughing occur. It can only accept clear qi from the zang and fu organs, but cannot tolerate pathological qi from them. Pathological qi interfering with it also causes choking and coughing. The lung body belongs to Metal in the Five Elements, resembling a bell; both external and internal factors are what strike it to make it ring.
Wind and cold entering cause ringing from external striking. The classics state: "Slight cold leads to slight cough." Thus, cough is often due to wind and cold. Wind enters the lung from the skin and hair, and cold enters the lung from the back shu points; both are external factors. Although later annotations mention heat, dampness, and dryness, these pathogens do not act independently but must rely on wind and cold as their leaders.
Tuberculous damage and accumulation cause ringing from internal striking. Tuberculous injury and cough are primarily internal. If these two conditions are not treated, progressing to cough and loss of voice, this is known as "broken metal does not ring" (damage to the lung tissue preventing sound production).
Who treats external cases? Liu'an Decoction is used. Although Liu'an Decoction lacks profound theoretical depth, it is stable and mild. However, for coughs caused by external pathogens, one must distinguish between wind-heat and wind-dryness syndromes. For instance, if in winter one first suffers from unseasonable warmth, followed by external constraint of wind and cold, resulting in cough, phlegm nodules, swollen throat, heavy body, spontaneous sweating, and floating pulse, this is wind-heat. It is suitable to use Weirui Tang (Polygonatum Decoction), a pungent-moistening formula, and absolutely avoid pungent-warm dispersing agents. The syndrome of wind-dryness is particularly difficult to differentiate and treat. Dryness is the qi of autumn; it does not act alone but must borrow the might of wind and cold for its command to prevail and for cough to arise. Why does the *Huangdi Neijing* only say "autumn injury by dampness"? Because during late summer, one receives the qi of damp-earth stagnation and steaming, which, following autumn's收敛 (convergence), lies latent between the lung and stomach. It waits until deep autumn when dryness commands prevail; dryness and dampness become incompatible, leading to cough in winter. This syndrome presents a dilemma of lung dryness and stomach dampness that are hard to separate. Only Maidong Tang (Ophiopogon Decoction) and Wuweizi Tang (Schisandra Decoction) from the *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) capture the secret essence. Later generations, failing to distinguish between astringency and dispersion, discarded them for mixing drying and moistening properties, which was very ignorant.
Who treats internal cases? Follow the protocol for deficiency consumption. Select appropriate formulas from the "Deficiency Consumption Chapter." If examined to be kidney essence injury due to sexual excess, tonify essence; if examined to be spleen injury due to worry and depression, nourish the spirit.
Accompanied by water qi, Xiao Qinglong Tang calms it. Ke Yunbo treated cough regardless of season or depth; for any cold-type cough, Xiao Qinglong Tang (Minor Blue Dragon Decoction) was effective in most cases. The formula expels wind and dissipates cold, resolves the muscle layer and drives out water, benefits the lung and warms the kidney, eliminates phlegm and stabilizes wheezing, repelling the exterior and securing the interior, each function working exquisitely. Since the lung house harbors chronic cold and stubborn cold, only Mahuang (Ephedrae Herba), the general, can destroy its stronghold; how could other herbs achieve efficacy?
Accompanied by constrained fire, Xiao Chaihu Tang clears it. For cough accompanied by alternating chills and fever, it is suitable to remove Renshen (Ginseng Radix et Rhizoma), Dazao (Jujubae Fructus), and Shengjiang (Zingiberis Rhizoma Recens), and add Ganjiang (Zingiberis Rhizoma) and Wuweizi (Schisandrae Chinensis Fructus) for treatment.
Xixin (Asari Radix et Rhizoma), Ganjiang, and Wuweizi are cooked together. The treatment of phlegm-fluid and cough in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) does not go beyond modifications of Xiao Qinglong Tang. Among the ingredients in the formula, most can be added or removed, but Xixin, Ganjiang, and Wuweizi are never lightly discarded. Even if the face appears hot like drunkenness, requiring Dashuang (Rhei Radix et Rhizoma) to clear stomach heat, or adding Shigypsum (Gypsum Fibrosum) and Xingren (Armeniacae Semen Amarum), these three herbs are always retained. Students of medicine must deeply ponder the reason. Xu Zhongke has discussions in his *Jingui Bianzhu*.
The methods of Changsha (referring to Zhang Zhongjing, who served as Prefect of Changsha) are detailed and refined. The treatment methods for phlegm-fluid and cough in the *Jingui Yaolue* should be studied thoroughly.