语云∶诸病易治，咳嗽难医。夫所以难治者，缘咳嗽根本甚多，不止于肺。今世遇有咳嗽，即曰肺病，随
用发散、消痰、清凉、润肺之药，药日投而咳日甚，有病之经脉，未蒙其治，无病之经脉，徒受其殃，至一
月不愈，则弱证将成，二月不愈，则弱证已成，延至百日，身命虽未告殂，而此人已归不治之证矣。呜呼！本
属可治之病，而坏于凡医之手，举世皆然，莫可如何！余因推本而约言之。《素问·咳论》云∶五脏六腑皆
令人咳，非独肺也，是以咳病初起，有起于肾者，有起于肝者，
有起于脾者，有起于心包者，有起于胃者，有起于中、上二焦者，有起于肺者，治当察其原，察原之法，在
乎审证。
若喉痒而咳，是火热之气上冲也，火欲发而烟先起，烟气冲喉，故痒而咳。又有伤风初起，喉中一点作
痒，咽热饮则少苏，此寒凝上焦，咽喉不利而咳也，或寒或热，治当和其上焦。其有胸中作痒，痒则为咳，此
中焦津血内虚，或寒或热而为咳，法当和其中焦。此喉痒之咳，而属于上、中二焦也。
若气上冲而咳，是肝、肾虚也。夫心、肺居上，肝、肾居下。肾为水脏，合膀胱水腑，随太阳之气，出皮毛以
合肺。肺者天也，水天一气，营运不息。今肾脏内虚，不能合水腑而行皮毛，则肾气从中土以上冲，上冲则
咳。此上冲之咳而属于肾也。
又肝藏血，而冲、任血海之血，肝所主也。其血则热肉充肤，澹渗皮毛，卧则内归于肝。今肝脏内虚，不
合冲、任之血，出于肤腠，则肝气从心包以上冲，上冲则咳。此上冲之咳而属于肝也。
又有先吐血，后咳嗽者。吐血则足厥阴肝脏内伤，而手厥阴心包亦虚，致心包之火上克肺金。心包主血、
主脉，血脉内虚，夜则发热，日则咳嗽，甚则日夜皆热，日夜皆咳。此为虚劳咳嗽，先伤其血，后伤其气，阴阳
并竭，血气皆亏，服滋阴之药则相宜，服温补之药则不宜，如是之咳，百无一生。此咳之属于心包也。
又手太阴属肺金，天也；足太阴属脾土，地也。在运气则土生金，在脏腑则地天交。今脾土内虚，土
不胜水，致痰涎上涌，地气不升，天气不降，而为咳，咳必兼喘。此咳之属于脾也。
又胃为水谷海，气属阳明，足阳明主胃，手阳明主大肠。阳明之上，燥气治之，其气下行，今阳明之气不
从下行，或过于燥而火炎，或失其燥而停饮，咳出黄痰，胃燥热也，痰饮内积，胃虚寒也。此为肠胃之咳，咳虽
不愈，不即殒躯。治宜消痰、散饮。此咳之属于胃也。夫痰聚于胃，必从咳出，故《咳论》云聚胃关肺。使不知
咳嗽之原，而但以清肺、消痰、疏风、利气为治，适害也已！
外有伤风咳嗽，初起便服清散药，不能取效者，此为虚伤风也，最忌寒凉发散，投剂得宜，可以渐愈。又有
冬时肾气不足，水不生木，致肝气内虚，洞涕不收，鼻窍不利，亦为虚伤风，亦忌发散，投剂得宜，至春天和冻
解，洞涕始收，鼻窍始利。
咳嗽大略，其义如是，得其意而引伸之，其庶几乎！
咳嗽俗名曰呛，连咳不已，谓之顿呛。顿呛者，一气连呛二三十声，少者十数声，呛则头倾胸曲，甚者手
足拘挛，痰从口出，涕泣相随，从膺胸而下应于少腹。大人患此，如同哮喘，小儿患此，谓之时行顿呛。顿呛不
服药，至一月亦愈。所以然者，周身八万四千毛窍，太阳膀胱之气应之，以合于肺，毛窍之内，即有络脉之血，
胞中血海之血应之，以合于肝∶若毛窍受寒，致胞血凝涩，其血不能澹渗于皮毛络脉之间，气不煦而血不濡，
则患顿呛。至一月，则胞中之血一周环复，故一月可愈；若一月不愈，必至两月。不与之药，亦不丧身。若人
过爱其子，频频服药，医者但治其气，不治其血，但理其肺，不理其肝，顿呛未已，又增他病。或寒凉过多，
而呕吐不食；或攻下过多，而腹满泄泄；或表散过多，而乳肿喘急∶不应死而死者，不可胜计。婴儿顿呛初起，
但当散胞中之寒，和络脉之血，如香附、红花、川芎、归、芍之类可用；其内寒呕吐者，干姜、吴萸可加∶
表里皆虚者， 、术、参、苓可用。因病加减，在医者之神明。苟不知顿呛之原，而妄以前、杏、苏、芩、枳、
桔、抱龙丸辈，清肺化痰，则不可也。
俗话说：各种疾病容易治疗，但咳嗽难以医治。之所以难治，是因为咳嗽的病因根本很多，并不仅仅局限于肺脏。当今世人遇到咳嗽，就说是肺病，随即使用发散、消痰、清凉、润肺的药物，药物每天服用，咳嗽却日益加重，患病的经脉没有得到治疗，未患病的经脉白白遭受祸殃，如果一个月不愈，轻证将演变成虚弱之证；两个月不愈，虚弱之证已经形成；拖延到一百天，虽然性命尚未终结，但此人已归于无法治疗的境地了。唉！本属于可治的疾病，却被平庸的医生治坏，举世皆是这种情况，无可奈何！我因此追溯本源并简要论述。《素问·咳论》说：五脏六腑都能让人咳嗽，不仅仅只有肺脏。所以咳嗽初起，有起源于肾脏的，有起源于肝脏的，有起源于脾脏的，有起源于心包的，有起源于胃的，有起源于中焦、上焦的，有起源于肺的，治疗应当考察其根源，考察根源的方法，在于审察证候。
如果喉咙发痒而咳嗽，这是火热之气上冲的表现，火欲发作而烟雾先升起，烟气冲击咽喉，所以发痒而咳嗽。又有伤风初起时，喉咙中有一点发痒，咽下热饮则稍微缓解，这是寒邪凝滞于上焦，咽喉不利而导致的咳嗽，无论是寒是热，治疗应当调和上焦。如果有胸中发痒，痒则为咳，这是中焦津液和血液内部亏虚，或寒或热而导致的咳嗽，治法应当调和其中焦。这种喉咙发痒的咳嗽，归属于上、中二焦。
如果气机上冲而咳嗽，这是肝、肾虚损的表现。心、肺位于上部，肝、肾位于下部。肾为水脏，与膀胱水腑相合，随着太阳经之气，出于皮毛而与肺相合。肺属天，水天一气，运行营运不息。现在肾脏内部亏虚，不能配合水腑而行于皮毛，则肾气从中土（脾胃）向上冲逆，上冲则导致咳嗽。这种气机上冲的咳嗽归属于肾。
另外，肝藏血，冲脉、任脉作为血海，其血液由肝所主。这些血液则温热肌肉、充盈皮肤，渗透于皮毛，睡眠时内归于肝。现在肝脏内部亏虚，不能配合冲脉、任脉的血液出于肤腠，则肝气从心包向上冲逆，上冲则导致咳嗽。这种气机上冲的咳嗽归属于肝。
又有先吐血，后咳嗽的。吐血则足厥阴肝脏内部受伤，而手厥阴心包也虚，导致心包之火上克肺金。心包主血、主脉，血脉内部亏虚，夜间发热，白天咳嗽，严重时日夜都发热，日夜都咳嗽。这属于虚劳咳嗽，先损伤其血，后损伤其气，阴阳俱竭，气血皆亏，服用滋阴的药物则适宜，服用温补的药物则不适宜，像这样的咳嗽，百无一活。这种咳嗽归属于心包。
另外，手太阴肺经属肺金，象征天；足太阴脾经属脾土，象征地。在运气学说中土生金，在脏腑关系中则是地天交泰。现在脾土内部亏虚，土不能制水，导致痰涎上涌，地气不升，天气不降，从而产生咳嗽，咳嗽必然兼有气喘。这种咳嗽归属于脾。
另外，胃是水谷之海，气属阳明，足阳明经主胃，手阳明经主大肠。阳明经之上，燥气主治，其气下行，现在阳明经之气不从下行，或者过于干燥而火炎上，或者失去燥性而停聚水饮，咳出黄痰，是胃燥热；痰饮内积，是胃虚寒。这属于肠胃之咳，咳嗽虽然不愈，但不会立即致死。治疗宜消痰、散饮。这种咳嗽归属于胃。痰聚于胃，必然通过咳嗽排出，所以《咳论》说“聚胃关肺”。如果不了解咳嗽的根源，而仅仅以清肺、消痰、疏风、利气为治疗方法，这就有害罢了！
此外有伤风咳嗽，初起就服用清散药，不能取效的，这属于虚伤风，最忌讳寒凉发散，投药得当，可以逐渐痊愈。又有冬季肾气不足，水不生木，导致肝气内部亏虚，鼻涕直流不止，鼻窍不通利，也属于虚伤风，同样忌用发散，投药得当，等到春天暖和冻解时，流涕才会停止，鼻窍才会通利。
咳嗽的大略道理，就是如此，领会其意旨并加以推演，大概就可以了！
咳嗽俗名叫呛，连续咳嗽不停，叫做顿呛。顿呛，是一次气连呛二三十声，少的十数声，呛的时候头低胸曲，严重的四肢拘挛，痰从口出，鼻涕眼泪相随，从膺胸向下应及少腹。大人患此病，如同哮喘，小儿患此病，叫做时行顿呛。顿呛不服药，到一个月也会痊愈。之所以这样，是因为周身八万四千毛窍，由太阳膀胱经之气对应，以合于肺，毛窍之内，就有络脉之血，胞中血海的血液对应，以合于肝：如果毛窍受寒，导致胞血凝涩，其血不能渗透于皮毛络脉之间，气不温暖而血不濡润，则患顿呛。到一个月，则胞中的血液一周环复，所以一个月可愈；如果一个月不愈，必至两个月。不给它服药，也不会丧命。如果有人过分爱惜孩子，频频服药，医生只治其气，不治其血，只调理其肺，不理其肝，顿呛未止，又增加其他疾病。或者寒凉药过多，而导致呕吐不食；或者攻下药过多，而导致腹满泄泻；或者表散药过多，而导致乳房肿胀喘急：本不应死却死了的，不可胜计。婴儿顿呛初起，只应当散胞中之寒，和络脉之血，如香附、红花、川芎、当归、白芍之类可用；其内寒呕吐者，干姜、吴茱萸可加；表里皆虚者，黄芪、白术、人参、茯苓可用。因病加减，在于医生的神明变化。如果不知道顿呛的根源，而妄以前胡、杏仁、苏叶、黄芩、枳实、桔梗、抱龙丸等类，清肺化痰，那就不行了。
It is said: Various diseases are easy to treat, but cough is difficult to cure. The reason it is difficult to treat is that the root causes of cough are numerous and not limited solely to the Lung (Fei). Nowadays, when encountering a cough, people immediately attribute it to a Lung disease and subsequently use herbs for dispersing (Fasfa), resolving phlegm (Xiaotan), cooling (Qingliang), and moistening the Lung (Runfei). As medicines are administered daily, the cough worsens day by day. The affected meridians do not receive proper treatment, while unaffected meridians suffer in vain. If unresolved after one month, mild syndromes will evolve into deficiency syndromes; if unresolved after two months, deficiency syndromes are established; if prolonged to one hundred days, although life is not yet forfeited, the patient has entered an incurable state. Alas! Diseases that were originally curable are ruined by mediocre physicians. This is common throughout the world, and there is no way to change it. Therefore, I trace back to the origin and summarize briefly. *Suwen: Ke Lun* states: "The five Zang organs and six Fu organs can all cause cough, not just the Lung." Thus, at the onset of cough, some originate from the Kidney (Shen), some from the Liver (Gan), some from the Spleen (Pi), some from the Pericardium (Xinbao), some from the Stomach (Wei), some from the Middle Jiao (Zhongjiao) and Upper Jiao (Shangjiao), and some from the Lung. Treatment should investigate the root cause. The method to investigate the root lies in examining the syndrome pattern (Zheng).
If the throat itches and causes coughing, this indicates the upward rushing of Fire-Heat Qi (Huohuo zhi qi). Just as smoke rises before fire ignites, smoke rushing through the throat causes itching and coughing. In early stages of Wind-Cold invasion (Shangfeng), a slight itch in the throat may be relieved slightly by swallowing hot drinks. This is due to Cold stagnating in the Upper Jiao, causing throat dysfunction and cough. Whether Cold or Heat, treatment should harmonize the Upper Jiao. If itching occurs in the chest, leading to coughing, this is due to internal deficiency of Jin-Ye (Body Fluids) and Blood in the Middle Jiao, caused by either Cold or Heat. The method should be to harmonize the Middle Jiao. Such coughs with throat itching belong to the Upper and Middle Jiao.
If Qi rushes upward causing cough, this indicates deficiency of the Liver and Kidney. The Heart and Lung reside above, while the Liver and Kidney reside below. The Kidney is the Water Organ, paired with the Bladder (Pangguang) Fu organ. Following the Qi of the Taiyang (Greater Yang) meridian, it emerges from the skin pores to connect with the Lung. The Lung represents Heaven, and Water and Heaven form one Qi, circulating endlessly. Now, if the Kidney is internally deficient and cannot coordinate with the Bladder to circulate through the skin pores, Kidney Qi rushes upward from the Earth element (Spleen/Stomach). This upward rush causes cough. Such coughs caused by upward-rushing Qi belong to the Kidney.
Furthermore, the Liver stores Blood. The Chong (Penetrating Vessel) and Ren (Conception Vessel), known as the Sea of Blood, are governed by the Liver. This blood warms muscles, fills the skin, and permeates the hair follicles; during sleep, it returns internally to the Liver. Now, if the Liver is internally deficient and cannot coordinate with the blood of the Chong and Ren vessels to emerge into the skin and pores, Liver Qi rushes upward from the Pericardium. This upward rush causes cough. Such coughs caused by upward-rushing Qi belong to the Liver.
There are cases where hemoptysis (coughing up blood) precedes coughing. Hemoptysis indicates internal injury to the Foot-Jueyin Liver channel, and the Hand-Jueyin Pericardium channel becomes deficient as well, causing Pericardium Fire to attack Metal (Lung). The Pericardium governs Blood and vessels. Internal deficiency of blood vessels leads to fever at night and coughing during the day; severely, both fever and cough occur day and night. This is consumption-type cough (Xu Lao Ke), where Blood is damaged first, then Qi, leading to exhaustion of both Yin and Yang, and deficiency of both Blood and Qi. Taking Yin-nourishing herbs is appropriate, while taking Warm-Tonic herbs is inappropriate. Coughs of this nature are rarely survivable. Such coughs belong to the Pericardium.
Additionally, the Hand-Taiyin Lung channel belongs to Lung Metal, representing Heaven; the Foot-Taiyin Spleen channel belongs to Spleen Earth, representing Earth. In the theory of Five Movements and Six Qi, Earth generates Metal; in Zang-Fu relationships, this represents the interaction between Earth and Heaven. Now, if the Spleen Earth is internally deficient, Earth fails to control Water, causing Phlegm-Saliva to surge upward. Earth Qi does not ascend, and Heaven Qi does not descend, resulting in cough, which must be accompanied by wheezing (Chuan). Such coughs belong to the Spleen.
Moreover, the Stomach is the Sea of Water and Grain. Its Qi belongs to Yangming. The Foot-Yangming channel governs the Stomach, and the Hand-Yangming channel governs the Large Intestine. Above the Yangming, Dryness Qi governs, and its Qi descends. Now, if Yangming Qi does not descend properly, either excessive dryness leads to flaming Fire, or loss of dryness leads to retained fluids. Coughing up yellow sputum indicates Stomach Dryness-Heat; accumulation of Phlegm-Fluids internally indicates Stomach Deficiency-Cold. This is cough of the Stomach and Intestines. Although the cough may persist, it will not immediately cause death. Treatment should focus on resolving Phlegm and dispersing Fluid retention. Such coughs belong to the Stomach. Since Phlegm gathers in the Stomach and must exit via cough, *Ke Lun* states: "Phlegm gathers in the Stomach and relates to the Lung." If one does not understand the origin of cough and merely treats it by clearing the Lung, resolving Phlegm, dispersing Wind, and promoting Qi movement, it will only cause harm!
Externally, there is Wind-Cold cough where initial treatment with clearing and dispersing herbs fails. This is called Deficient Wind-Cold (Xu Shang Feng). It strictly contraindicates Cold-Cooling and dispersing methods. With appropriate prescription, gradual recovery is possible. Also, during winter, if Kidney Qi is insufficient, Water fails to generate Wood, causing internal deficiency of Liver Qi. This results in profuse runny nose (Dong Ti) and nasal obstruction, also classified as Deficient Wind-Cold. Dispersing methods are also contraindicated here. With appropriate prescription, when spring arrives and warmth thaws the ice, the runny nose stops, and nasal passages clear.
The general principles of cough are as described above. Grasping their essence and extending them logically would suffice!
Cough is colloquially called "Qiang" (choking/coughing fit). Continuous coughing without pause is called "Dun Qiang" (paroxysmal cough). Dun Qiang involves twenty to thirty consecutive coughing fits per breath, or ten to several dozen for milder cases. During these fits, the head bows and chest curves; severely, limbs become spasmodic. Sputum exits the mouth, accompanied by nasal discharge and tears, radiating from the chest down to the lower abdomen. In adults, this resembles asthma; in children, it is called epidemic paroxysmal cough (Shi Xing Dun Qiang). Paroxysmal cough resolves spontaneously within one month even without medication. The reason is that the 84,000 hair follicles correspond to the Qi of the Taiyang Bladder meridian, connecting to the Lung. Inside the follicles are collateral blood vessels, corresponding to the blood of the Chong Mai (Sea of Blood), connecting to the Liver. If cold invades the follicles, causing blood stasis in the uterus/chambers, the blood cannot permeate the skin and collateral vessels. Qi fails to warm, and Blood fails to moisten, resulting in paroxysmal cough. After one month, the blood in the chambers completes a cycle, hence recovery in one month; if not resolved in one month, it may take two months. Without medication, it does not cause death. However, parents who excessively medicate their children, while physicians only treat Qi and not Blood, only regulate the Lung and not the Liver, may find that paroxysmal cough persists and other diseases arise. Excessive Cold-Cooling herbs lead to vomiting and anorexia; excessive purgatives lead to abdominal fullness and diarrhea; excessive diaphoretic herbs lead to breast swelling and急促喘息 (rapid panting). Many who should not die end up dying. For infant paroxysmal cough at onset, one should only disperse cold in the chambers and harmonize collateral blood. Herbs such as Cyperi Rhizoma (Xiangfu), Carthami Flos (Honghua), Ligusticum Chuanxiong Rhizome (Chuanxiong), Angelica Sinensis Radix (Danggui), and Paeonia Lactiflora Radix Alba (Baishao) can be used. For internal cold with vomiting, dried ginger (Ganjiang) and Evodia Fruit (Wuyu) can be added. For exterior and interior deficiency, Astragali Membranaceus Radix (Huangqi), Atractylodis Macrocephalae Rhizoma (Baizhu), Ginseng Radix (Renshen), and Poria (Fuling) can be used. Modifications depend on the physician's adaptability. If the origin of paroxysmal cough is unknown, and one recklessly uses herbs like Bupleuri Radix (Chaihu - *Note: Text says Qian, likely Qianhu*), Pinelliae Tuber (Banxia - *Text says Xing, likely Xingren*), Perillae Folium (Zisu), Scutellariae Radix (Huangqin), Aurantii Fructus Immaturus (Zhiqiao), Platycodonis Radix (Jiegeng), and Baolong Wan to clear the Lung and resolve Phlegm, it is inadvisable.