痰火为病。恶风发热。脉来弦数。全与伤寒无别。但听其咳嗽气急。可以知其为痰火也。夫痰火之起。由于脾经血
少。胃火太甚。熬煎津液为痰。上传于肺。故令咳嗽气急。然胃火一动。相火翕然从之。所以恶寒发热。宜用舒
中芍药汤三四剂后。脉宜和缓。若弦数不减。数大有力。是为孤阳无阴。多主于死。若脉来微减或细数者。法当
看其痰色。如咳吐黄痰。胸中不快。食积生痰。宜用栝蒌枳实汤。如痰色青白。稀而不稠者。肾虚水沸为痰。宜用
加味地黄汤。滋水以制火。不必拘于治痰也。又有初起之时。外无寒热诸症。内无烦热气急。但见神昏不安。肢体无力。
声音低小。饮食不进。脉来沉细无力者。宜用香砂六君子汤。甚则八味地黄丸。亦可用也。
舒中芍药汤
陈皮 半夏 白茯 甘草 柴胡 黄芩 枳壳 桔梗 白芍 木通 贝母 栝蒌霜 天冬
有食加浓朴。
栝蒌枳实汤
陈皮 白茯 甘草 枳实 栝蒌霜 贝母 当归 桔梗 山栀 黄芩
加味地黄汤
熟地 山药 白茯 丹皮 山萸肉 泽泻 天冬 麦冬 桔梗 甘草 牛膝（倍用）
香砂六君子汤
陈皮 半夏 白茯 甘草 人参 白术 砂仁 香附 藿香
有声无痰。谓之咳。肺气伤而不清也。有痰无声谓之嗽。脾湿动而生痰也。有声有痰。谓之咳嗽。脾生痰而
传于肺也。风寒劳嗽。自有本条。四时咳嗽。不可不辨。丹溪云。春是上升之气。夏是火炎上最重。
秋是湿热伤肺。冬是风寒外束。所谓上升之气者。春天木旺。肝火太甚。乘于肺金。故令咳嗽。宜用清肝宁嗽汤。
脉必弦数可据。久而不止。宜用归芍地黄汤。盖肾水。乃肝木之母。肾水虚弱。无以为发生滋荣之本。故内热而咳。
归芍地黄。是治其本也。所谓火炎上者。夏月心火用事。乘于肺金。有如金被火克。五行相贼。其症极重。若不急治。
直至交秋方止。咳久多成痨怯。亦用归芍地黄汤。或天王补心丹。无不可也。所谓湿热伤肺者。秋分之后。燥金
用事。所起之风。全是一团干燥之气。不比秋分之前。热中有湿也。是以无草不黄。无木不凋。人身应之。肺胃干燥。
津液枯槁。所以作咳。丹溪反言湿热伤肺。当亦传
刻之误。未可执为定论也。亦用归芍地黄汤。所谓风寒外束者。冬月天令严寒。易至伤人。感于风者。
脉来细缓。感于寒者。脉来浮数。自可辨也。大抵四时咳嗽。虽有不同。而东南之地。往往多热多痰。先用清金
化痰之剂。方可各治其本。不可骤用地黄泥药。（名言卓识）极为紧关。又有咳嗽气急。胸中不宽者。治之宜分虚实。实
者
脉来沉滑。可用二陈消食之剂。若脉来弦细微数。微寒微热。大便不甚通畅。欲出不出。极为危险。既不可攻。又不可
补。惟有养血化痰。健脾消食。听天由命而已。此条诸书未有。不得草草忽过（辨论超豁认理真切分四时以用药阐古书
之未发 按咳嗽之源内经有聚于胃关于肺之指示要在细心研究而自得也）
清肝宁嗽汤
柴胡 黄芩 花粉 甘草 陈皮 白茯 当归 白芍 麦冬 丹皮 桔梗 贝母
归芍地黄汤
当归 白芍 麦冬 桔梗 熟地 丹皮 山药 白茯 泽泻 山萸
宁嗽健脾汤
当归 白芍 麦冬 陈皮 山楂 神曲 杏仁 贝母 泽泻 苡仁
胸不宽加浓朴。
痰火致病，表现为怕风、发热，脉象弦而数，这与伤寒病完全相同。但只要听患者咳嗽且气息急促，就可以知道这是痰火引起的。痰火的产生，是由于脾经血少，胃火太盛，煎熬津液形成痰，痰上传于肺，所以导致咳嗽和气息急促。然而，一旦胃火发动，相火也会随之煽动，因此出现恶寒发热的症状。适宜使用舒中芍药汤，服用三四剂后，脉象应当变得和缓。如果脉象仍然弦数不减，或者数大有力，这属于“孤阳无阴”的危重证候，大多主死。如果脉象略微减轻或呈现细数之象，治疗方法应当观察痰的颜色：如咳吐黄痰，胸中不适，这是食积生痰，适宜使用栝蒌枳实汤；如痰色青白，稀薄不稠，这是肾虚水沸成痰，适宜使用加味地黄汤，通过滋补肾水来制约火势，不必拘泥于单纯治痰的方法。又有在发病初期，外部没有寒热等症状，内部没有烦热、气息急促等表现，只见到神志昏沉不安，肢体无力，声音低微，饮食不进，脉象沉细无力的，适宜使用香砂六君子汤，严重时也可使用八味地黄丸。
舒中芍药汤：陈皮、半夏、白茯苓、甘草、柴胡、黄芩、枳壳、桔梗、白芍、木通、贝母、栝蒌霜、天冬。若有食积，加浓朴。
栝蒌枳实汤：陈皮、白茯苓、甘草、枳实、栝蒌霜、贝母、当归、桔梗、山栀、黄芩。
加味地黄汤：熟地黄、山药、白茯苓、丹皮、山萸肉、泽泻、天冬、麦冬、桔梗、甘草、牛膝（加倍使用）。
香砂六君子汤：陈皮、半夏、白茯苓、甘草、人参、白术、砂仁、香附、藿香。
有声音但没有痰，称为“咳”，是肺气受伤而不清利；有痰但没有声音，称为“嗽”，是脾湿动而生痰；既有声音又有痰，称为“咳嗽”，是脾生痰并传于肺所致。风寒劳嗽自有专门条目，四季咳嗽不可不加以辨别。朱丹溪说：春季是上升之气，夏季是火炎上最重，秋季是湿热伤肺，冬季是风寒外束。所谓上升之气，是指春天木气旺盛，肝火太盛，乘袭肺金，所以导致咳嗽，适宜使用清肝宁嗽汤，脉象必定弦数可作为依据。如果久咳不止，适宜使用归芍地黄汤。因为肾水是肝木的母亲，肾水虚弱，就没有了发生滋荣的根本，所以内热而咳。归芍地黄汤是治疗其根本的方法。所谓火炎上，是指夏季心火当令，乘袭肺金，如同金被火克，五行相贼，病情极重，若不紧急治疗，直到立秋才会停止。久咳多变成痨怯，也使用归芍地黄汤，或者天王补心丹，都可以。所谓湿热伤肺，是指在秋分之后，燥金当令，所起之风全是一团干燥之气，不像秋分之前热中有湿。因此无草不黄，无木不凋。人体与之相应，肺胃干燥，津液枯槁，所以作咳。丹溪反而说是湿热伤肺，这可能是刻印时的错误，不可固执地作为定论。这种情况也使用归芍地黄汤。所谓风寒外束，是指冬季天气严寒，容易伤人。感于风的，脉象细缓；感于寒的，脉象浮数，自然可以辨别。大致来说，四季咳嗽虽然有所不同，但在东南地区，往往多热多痰，先用清金化痰的药物，然后才可以各自治疗其根本，不可骤用熟地黄等滋腻药物。（名言卓识）极为关键。又有咳嗽气息急促，胸中不宽畅的，治疗应当区分虚实。实证脉象沉滑，可用二陈汤加减消食；若脉象弦细微数，微寒微热，大便不甚通畅，欲出不出，极为危险。此时既不可攻下，又不可进补，唯有养血化痰、健脾消食，听天由命罢了。这一条其他医书未曾记载，不可草率忽略。（辨论超豁认理真切分四时以用药阐古书之未发 按咳嗽之源内经有聚于胃关于肺之指示要在细心研究而自得也）
清肝宁嗽汤：柴胡、黄芩、花粉、甘草、陈皮、白茯苓、当归、白芍、麦冬、丹皮、桔梗、贝母。
Pathogenesis of Phlegm-Fire involves aversion to wind, fever, and a wiry-rapid pulse, which is indistinguishable from Cold Damage (Shanghan). However, by listening to the patient's cough and rapid breathing, one can identify it as caused by Phlegm-Fire. The onset of Phlegm-Fire stems from insufficient blood in the Spleen Meridian and excessive Stomach Fire, which boils down body fluids into phlegm. This phlegm ascends to the Lungs, causing cough and rapid breathing. Once Stomach Fire activates, Ministerial Fire (Xiang Huo) flares up in response, resulting in chills and fever. It is appropriate to use Shuzhong Shaoyao Decoction for three to four doses; thereafter, the pulse should become harmonious and slow. If the pulse remains wiry and rapid, or becomes large and forceful while rapid, this indicates "Solitary Yang without Yin," a critical condition often fatal. If the pulse slightly diminishes or becomes fine and rapid, treatment should depend on observing the sputum color: if yellow sputum is expectorated with chest discomfort due to food stagnation generating phlegm, Gualou Zhishi Decoction is suitable; if the sputum is blue-white, thin and not viscous, indicating Kidney deficiency where water boils to form phlegm, Jiawei Dihuang Decoction is suitable to nourish Water to control Fire, without being confined to merely treating phlegm. In the early stage, if there are no external symptoms like chills or fever, nor internal symptoms like irritability, heat, or rapid breathing, but only mental confusion, restlessness, limb weakness, low voice, poor appetite, and a deep, fine, and forceless pulse, Xiangsha Liujunzi Decoction is suitable; in severe cases, Bawei Dihuang Wan may also be used.
Shuzhong Shaoyao Decoction: Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Baifu (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Zhiqiao (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Baishao (Paeoniae Radix Alba), Mutong (Akebiae Caulis), Beimu (Fritillariae Bulbus), Gualou Shuang (Trichosanthis Semen), Tiandong (Asparagi Radix). Add Nongpo (Magnoliae Officinalis Cortex) if there is food stagnation.
Gualou Zhishi Decoction: Chenpi, Baifu, Gancao, Zhishi (Aurantii Fructus Immaturus), Gualou Shuang, Beimu, Danggui (Angelicae Sinensis Radix), Jiegeng, Shanzhi (Gardeniae Fructus), Huangqin.
Jiawei Dihuang Decoction: Shudi (Rehmanniae Radix Preparata), Shanyao (Dioscoreae Rhizoma), Baifu, Danpi (Moutan Cortex), Shanyurou (Corni Fructus), Zexie (Alismatis Rhizoma), Tiandong, Maidong (Ophiopogonis Radix), Jiegeng, Gancao, Niuxi (Achyranthis Bidentatae Radix) (use double dose).
Xiangsha Liujunzi Decoction: Chenpi, Banxia, Baifu, Gancao, Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Sharen (Amomi Fructus), Xiangfu (Cyperi Rhizoma), Huoxiang (Agastaches Herba).
Coughing with sound but no phlegm is called "Ke" (cough), indicating Lung Qi injury and lack of clarity. Coughing with phlegm but no sound is called "Sou" (sputtering), indicating Spleen dampness stirring phlegm. Coughing with both sound and phlegm is called "Kesu" (cough and sputtering), indicating phlegm generated by the Spleen transmitted to the Lungs. Wind-Cold and consumptive cough have their own sections; seasonal coughs must be distinguished. Danyu stated: Spring is ascending Qi; Summer is fire blazing upward most severely; Autumn is damp-heat injuring the Lungs; Winter is Wind-Cold constraining externally. The so-called ascending Qi refers to Spring when Wood is prosperous, Liver Fire is excessive, attacking Lung Metal, causing cough. Qinggan Ningsou Decoction is suitable, and the pulse must be wiry and rapid as evidence. If cough persists for a long time, Guishao Dihuang Decoction is suitable. Since Kidney Water is the mother of Liver Wood, weak Kidney Water lacks the root for growth and nourishment, leading to internal heat and cough. Guishao Dihuang Decoction treats the root. The so-called fire blazing upward refers to Summer when Heart Fire dominates, attacking Lung Metal, like Metal being overcome by Fire, a mutual destruction in Five Elements, with extremely severe symptoms. If not treated urgently, it may persist until Autumn. Long-term cough often becomes consumption (Lao Qie); Guishao Dihuang Decoction or Tianwang Buxin Dan may be used. The so-called damp-heat injuring the Lungs refers to after the Autumn Equinox when Dry Metal dominates; the wind arising is entirely dry air, unlike before the equinox where heat contains dampness. Hence grass turns yellow, trees shed leaves. The human body responds with dry Lungs and Stomach, withered fluids, causing cough. Danyu's statement that damp-heat injures the Lungs might be a printing error and should not be taken as definitive theory. In such cases, Guishao Dihuang Decoction is also used. The so-called Wind-Cold constraining externally refers to Winter when cold weather easily harms people. Those affected by Wind have a fine-slow pulse; those affected by Cold have a floating-rapid pulse, which can be distinguished. Generally, although seasonal coughs differ, in Southeast regions, heat and phlegm are common. First use agents to clear Metal and transform phlegm, then treat the root individually. Do not abruptly use cloying medicines like Rehmannia. (Profound insights) are crucial. For cough with rapid breathing and chest tightness, treatment must distinguish excess and deficiency. Excess presents with a deep-slippery pulse; Erchen Tang with food-resolving herbs can be used. If the pulse is wiry-fine-rapid, with slight chills/fever, and stool is difficult to pass, it is extremely dangerous. Neither purging nor tonifying is applicable; only nourishing Blood, transforming phlegm, strengthening Spleen, and resolving food stagnation remain, leaving fate to heaven. This section is absent in other books and should not be overlooked lightly. (Superb discussion, clear understanding, differentiating medications by season, elucidating unpublished ancient texts. Note: The source of cough indicated in Neijing is 'accumulated in Stomach, related to Lungs'; careful study leads to personal comprehension.)
Qingan Ningsou Decoction: Chaihu, Huangqin, Huafen (Trichosanthis Radix), Gancao, Chenpi, Baifu, Danggui, Baishao, Maidong, Danpi, Jiegeng, Beimu.
Guishao Dihuang Decoction: Danggui, Baishao, Maidong, Jiegeng, Shudi, Danpi, Shanyao, Baifu, Zexie, Shanyu (Corni Fructus).
Ningsou Jianpi Decoction: Danggui, Baishao, Maidong, Chenpi, Shanzha (Crataegi Fructus), Shenqu (Medicated Leaven), Xingren (Armeniacae Semen Amarum), Beimu, Zexie, Yiren (Coicis Semen). Add Nongpo if chest is not wide.