昌着咳嗽论，比类《内经》，未尽底里，窃不自安。再取《金匮》嚼蜡，终日不辍，始得恍然有会，始知《金匮》以
咳嗽叙于痰饮之下，有深意焉。盖以咳嗽必因之痰饮，而五饮之中，独膈上支饮，最为咳嗽根底。外邪入而合之固嗽，
即无外邪，而支饮渍入肺中，自足令人咳嗽不已，况支饮久蓄膈上，其下焦之气逆冲而上者，尤易上下合邪也。夫以支
饮之故，而令外邪可内，下邪可上，不去支饮，其咳终无宁宇矣。去支饮取用十枣汤，不嫌其峻。岂但受病之初，即病
蓄已久，亦不能舍此别求良法。其曰∶咳家其脉弦，为有水，十枣汤主之。正谓急弦之脉，必以去支饮为亟也，犹易知
也。其曰∶夫有支饮家咳烦，胸中痛者不卒死，至一百日一岁，宜十枣汤。此则可以死而不死者，仍不外是方去其支饮，
不几令人骇且疑乎？凡人胸膈间孰无支饮，其害何以若此之大？其去害何必若此之力？盖膈上为阳气所治，心肺所居，
支饮横据其中，动肺则咳，动心则烦，搏击阳气则痛，逼处其中，荣卫不行，神魄无根据，则卒死耳。至一百日一年而不
死，阳气未散，神魂未散可知。惟亟去其邪，可安其正，所以不嫌于峻攻也。扫除阴浊，俾清明在躬，较彼姑待其死，
何得何失耶？其曰∶久咳数岁，其脉弱者可治，实大数者死，其脉虚者必苦冒，其人本有支饮在胸中故也。治属饮家，
夫不治其咳，而治其饮，仲景意中之隐，不觉一言逗出。其实大数为火刑金而无制，故死。其弱且虚为邪正俱衰而易复，
故可愈也。其曰∶咳逆倚息不得卧，小青龙汤主之。明外内合邪之证，惟有小青龙的对一方耳。然而用小青龙汤，其中
颇有精义，须防冲气自下而上，重增浊乱也。冲气重增浊乱，其咳不能堪矣。伤寒证用大青龙汤，无少阴证者可
服，脉微弱者不可服，服之则肉 筋惕而亡阳。杂证用小青龙汤，亦恐少阴肾气素虚，冲任之火易于逆上，冲任火上，
无咳且增烦咳，况久咳不已，顾可动其冲气耶。盖冲任二脉，与肾之大络，同起肾下出胞中，肾虚不得固守于下，则二
脉相挟，从小腹逆冲而上也。于是用桂苓五味甘草汤，先治其冲气，冲气即低，而反更咳胸满者，因水在膈间不散，其病再变，前方去桂加干姜、细辛以治其咳满，咳满即止。第三变而更复渴，冲气复发者，以细辛、干姜为热药也，服之
当遂渴，而渴反止者，为支饮也。支饮者法当冒，冒者必呕，呕者复内半夏以去其水，水去呕止。第四变其人形肿者，
以水尚在表也，加杏仁主之。其证应内麻黄，以其人遂痹，故不内之。若逆而内之者必燥，所以然者，以其人血虚，麻
黄发其阳故也。第五变头面热如醉，此为胃热上冲熏其面，加大黄以利之。嗟夫！仲景治咳，全不从咳起见，去其支饮，
下其冲气，且及下，冲气法，中之法，游刃空虚，全牛划然已解，何其神耶？向也不解作者之意，只觉无阶可升，何期
比类而得，外邪内入，下邪上入之端，因复参之《金匮》，其精蕴始得洞晰，岂非神先告之耶。慰矣！慰矣！
《内经》秋伤于湿，冬生咳嗽，此脱文也。讹传千古，今特正之。曰∶夏伤于暑，长夏伤于湿，秋必 疟。秋伤于
燥，冬生咳嗽。六气配四时之理，灿然明矣。盖湿者水类也，燥者火类也，湿病必甚于春夏，燥病必甚于秋冬。 疟
明是暑湿合邪，然湿更多于暑，何反遗而不言？至于咳嗽，全是火燥见病，何反以为伤湿耶？所以春夏多湿病者，春分
以后，地气上升，天气下降，二气交而湿蒸于中，土膏水溽，础润水津，人身应之，湿病见焉。秋冬多燥病者，秋分
以后，天气不降，地气不升，二气分而燥呈其象，草黄木落，山 水枯，人身应之，燥病见焉。然则咳嗽之为伤燥，岂
不明哉？
六气主病，风、火、热、湿、燥、寒，皆能乘肺，皆足致咳。其湿咳，即分属于风、火、热、燥、寒五气中也。风
乘肺咳，汗出头痛，痰涎不利。火乘肺咳，喘急壅逆，涕唾见血。热乘肺咳，喘急面赤潮热，甚者热盛于中，四末反寒，
热移于下，便泄无度。燥乘肺咳，皮毛干槁，细疮湿痒，痰胶便秘。寒乘肺咳，恶寒无汗，鼻塞身疼，发热躁烦。至于
湿痰内动为咳，又必因风、因火、因热、因燥、因寒，所挟各不相同，至其乘肺则一也。
风寒外束，华盖散，参苏饮。如声音不出，风邪，人参荆芥汤。寒邪，三拗汤。遇冷咳发者，橘皮半夏汤。
火热内燔，加减泻白散，水煮金花丸。如身热如炙，紫菀膏。
伤暑之咳，自汗脉虚，发渴，人参白虎汤、清暑益气汤。
伤湿之咳，身重脉细痰多，五苓散，白术汤。如喘满浮肿，款气丸。湿热素蕴于中，黄连解毒汤、滚痰丸。湿热素
蕴于上，连声迸气不通者，桑白皮散。
伤燥之咳，痰粘气逆，血腥，杏仁萝卜子丸。清金润燥，天门冬丸、牛髓汤。如面目浮肿，蜜酥煎。
内伤之咳，治各不同。火盛壮水；金虚崇土；郁甚舒肝；气逆理肺；食积和中；房劳补下；用热远热，用寒远寒。
内已先伤，药不宜峻。至于上焦虚寒，呕唾涎沫，则用温肺肠。上中二焦俱虚，则用加味理中汤。三焦俱虚，则用加味
三才汤。
伤肾之咳，气逆烦冤，牵引腰腹，俯仰不利，六味地黄汤加五味子。水饮与里寒合作，腹痛下利，真武汤。于中有
燥咳，热移大肠，亦主腹痛下利，毫厘千里，尤宜辨之。
荣卫两虚之咳，荣虚发热；卫虚自汗，或恶寒，宁肺汤。
虚劳之咳，五味黄 散、麦门冬饮。
心火刑肺见血，人参芎归汤。
干咳无痰，火热内壅，用四物桔梗汤开提之。伤酒热积，用琼玉膏滋润之。色欲过度，肾水不升，用八味丸蒸动之。
上半日咳多，火在阳分，宜白虎汤。下半日咳多，火在阴分，宜四物芩连汤。
久咳肺损肺痿，痰中见血，潮热声微，人参养肺汤。血腥喘乏，钟乳补肺汤。久咳宜收涩者，人参清肺汤。如声音
不出，诃子散。
膏粱致咳，比湿热内蕴例治之。如色欲过度，元气虚损，又不可尽攻其痰，辛苦致咳，比风寒外束例治之。如外寒
裹其内热，须分寒热多少，以消息于表里兼治之法。
【律六条】
凡治咳不分外感内伤，虚实新久，袭用清凉药，少加疏散者，因仍苟且，贻患实深，良医所不为也。
凡治咳遇阴虚火盛，干燥少痰，及痰咯艰出者，妄用二陈汤，转劫其阴而生大患者，医之罪也。
凡咳而且利，上下交征，而罔顾其人中气者，十无一起。如此死者，医杀之也。此有肺热肾寒两证，水火不同，毋
论用凉用温，总以回护中气为主。
凡邪盛，咳频，断不可用劫涩药。咳久邪衰，其势不脱，方可涩之。误则伤肺，必至咳无休止，坐以待毙，医之罪
也。
凡属肺痿、肺痈之咳，误作虚劳，妄补阴血，转滞其痰，因致其人不救者，医之罪也。
凡咳而渐至气高汗渍，宜不俟喘急痰鸣，急补其本。若仍治标亡本，必至气脱卒亡，医之罪也。
我撰写了《咳嗽论》，虽然参照了《内经》的内容，但未能穷尽其深意，心中暗自不安。于是再次反复研读《金匮要略》，终日不停，这才恍然大悟，明白了张仲景在《金匮要略》中将“咳嗽”叙述在“痰饮”篇下的深意。大概是因为咳嗽必然由痰饮引起，而在五种饮证中，唯独膈上支饮（水饮停聚于胸膈之间），是咳嗽的根本原因。外邪侵入并与之结合固然会导致咳嗽，即使没有外邪，支饮浸渍入肺中，也足以让人咳嗽不止。何况支饮长期蓄积在膈上，下焦逆冲之气更容易与上部的病邪相合。正因为有支饮的缘故，使得外邪可以内侵，下部的邪气可以上逆，如果不去除支饮，咳嗽终究无法安宁。去除支饮应当使用十枣汤（Ten Zao Tang, 大戟、甘遂、芫花大枣汤），不必忌讳药性峻猛。不仅是发病初期，即使病邪蓄积已久，也不能舍弃此方另求良法。文中说：“咳嗽患者脉象弦，说明体内有水饮，用十枣汤主治。”这正是指急弦的脉象，必须急于去除支饮，这还比较容易理解。文中又说：“患有支饮的人，出现咳嗽、心烦、胸痛，如果没有突然死亡，经过一百天或一年，适宜用十枣汤。”这种本来可能致死却未死的情况，仍然不外乎用这个方剂去除支饮，这难道不令人惊骇且怀疑吗？凡人的胸膈间谁没有支饮呢？为什么危害如此之大？为什么祛除危害需要如此强大的力量？因为膈上是阳气所治理、心肺所居住的地方，支饮横亘其中，扰动肺则咳嗽，扰动心则心烦，搏击阳气则疼痛，逼迫正气处于其中，导致营卫运行不畅，神魄无所依托，就会突然死亡。到了第一百天或一年却没有死，说明阳气尚未消散，神魂尚未离散可知。只有急切地去除邪气，才能安护正气，所以不忌讳峻猛攻伐。扫除阴浊之气，使清明之气回归身体，比起姑息等待死亡，得失如何呢？文中说：“久咳数年，脉象弱的可以治疗，脉象实大数的会死亡，脉象虚的必定感到头目昏眩，这是因为病人原本胸中有支饮的缘故。”治疗属于治饮范畴，不治咳嗽而治饮，这是张仲景心中的隐微之意，不经意间就透露出来了。其实脉实大数是火刑克金且无制约，所以死亡。脉弱且虚是邪气与正气都衰弱而容易恢复，所以可以痊愈。文中说：“咳嗽气逆，倚靠呼吸不能平卧，用小青龙汤（Xiao Qing Long Tang, Minor Blue Dragon Decoction）主治。”这是明确外内合邪的证候，只有小青龙汤是对证的方剂。然而使用小青龙汤，其中颇有精义，必须防止冲气从下向上，重新增加浊乱。如果冲气重新增加浊乱，其咳嗽就不能忍受了。伤寒证使用大青龙汤（Da Qing Long Tang, Major Blue Dragon Decoction），没有少阴证的人可以服用，脉微弱者不可服用，服用了就会导致肌肉跳动、筋惕肉瞤而亡阳。杂病使用小青龙汤，也恐怕少阴肾气素来虚弱，冲任之火易于逆上，冲任之火一旦上逆，没有咳嗽也会增加心烦和咳嗽，何况久咳不已，岂可再动其冲气呢？大概冲任二脉，与肾的大络，同起于肾下出于胞中，肾虚不能在下方固守，则二脉相互挟持，从小腹逆冲而上。于是使用桂苓五味甘草汤（Guiling Wuliang Gancao Tang, Cinnamon Twig, Poria, Schisandra and Licorice Decoction），先治疗冲气，冲气降低后，反而又出现咳嗽胸满的症状，这是因为水饮在膈间不散，病情再次变化，前方去掉桂枝，加入干姜、细辛以治疗咳嗽胸满，咳嗽胸满停止后。第三次变化又出现口渴，冲气复发的情况，是因为细辛、干姜是热药，服用了应当随即口渴，但如果口渴反而停止，是因为有支饮。支饮患者依法应当出现头目昏眩，昏眩者必定呕吐，呕吐者再加入半夏以去除水饮，水饮去则呕吐止。第四次变化病人形体浮肿，是因为水气还在体表，加杏仁主治。此证本应加入麻黄，但因为病人肢体麻木痹阻，所以不加入麻黄。如果违背这一原则加入麻黄，必然导致燥热，之所以这样，是因为病人血虚，麻黄会发散其阳气。第五次变化头面发热像喝醉了一样，这是因为胃热上冲熏蒸面部，加大黄以通利之。唉！张仲景治疗咳嗽，完全不是从咳嗽本身入手，而是去除支饮，降下冲气，并且涉及下焦、冲气之法、中焦之法，游刃有余，如同庖丁解牛般自然分解，多么神奇啊！先前我不理解作者的心意，只觉得无路可升，没想到通过比类分析得以领悟，明白了外邪内入、下邪上入的端倪，因此再参究《金匮要略》，其中的精妙蕴藏才得以清晰洞察，这难道不是神明预先告知我吗？欣慰啊！欣慰啊！
《内经》中说“秋伤于湿，冬生咳嗽”，这是脱文（文字脱落或错误）。讹传千古，现在特别纠正它。应当说：“夏伤于暑，长夏伤于湿，秋必疟疾。秋伤于燥，冬生咳嗽。”六气配属四时的道理，就非常明白了。大概湿是水的一类，燥是火的一类，湿病一定在春夏严重，燥病一定在秋冬严重。疟疾明明是暑湿合邪，然而湿多于暑，为什么反而遗漏而不说？至于咳嗽，完全是火燥显现的病证，为什么反而认为是伤湿呢？所以春夏多湿病，是因为春分以后，地气上升，天气下降，二气交争而湿气蒸腾于中间，土壤湿润，石阶出水，人身与之相应，湿病就出现了。秋冬多燥病，是因为秋分以后，天气不降，地气不升，二气分离而燥气呈现其象，草木枯黄凋落，山水干枯，人身与之相应，燥病就出现了。那么咳嗽是由于伤燥所致，难道还不明显吗？
六气主病，风、火、热、湿、燥、寒，都能乘袭肺脏，都足以导致咳嗽。其中的湿咳，即分别归属于风、火、热、燥、寒五气之中。风邪乘肺导致的咳嗽，表现为汗出、头痛、痰涎不利。火邪乘肺导致的咳嗽，表现为喘急壅逆、鼻涕唾液中见血。热邪乘肺导致的咳嗽，表现为喘急、面赤、潮热，严重时热盛于中，四肢反而寒冷，热移于下，导致泄泻无度。燥邪乘肺导致的咳嗽，表现为皮毛干枯粗糙、细小疮疡湿痒、痰液胶结便秘。寒邪乘肺导致的咳嗽，表现为恶寒无汗、鼻塞身疼、发热躁烦。至于湿痰内动引起的咳嗽，又必然因风、因火、因热、因燥、因寒的不同夹杂，至其乘袭肺脏则是一样的。
风寒外束，用华盖散（Huagai San）、参苏饮（Shenru Yin）。如果声音不出，风邪所致，用人参荆芥汤（Renshen Jingjie Tang）。寒邪所致，用三拗汤（San'ao Tang）。遇冷发作的咳嗽，用橘皮半夏汤（Jupi Banxia Tang）。
火热内燔，用加减泻白散（Jiajian Xiebai San）、水煮金花丸（Shuizhu Jinhua Wan）。如果身体热得像烤炙一样，用紫菀膏（Ziwan Gao）。
伤暑引起的咳嗽，自汗、脉虚、发渴，用人参白虎汤（Renshen Baihu Tang）、清暑益气汤（Qingshu Yiqi Tang）。
伤湿引起的咳嗽，身体沉重、脉细、痰多，用五苓散（Wuling San）、白术汤（Baizhu Tang）。如果喘满浮肿，用款气丸（Kuanqi Wan）。湿热素来蕴结于中焦，用黄连解毒汤（Huanglian Jiedu Tang）、滚痰丸（Guntan Wan）。湿热素来蕴结于上焦，连声迸气不通的，用桑白皮散（Sangbaipi San）。
伤燥引起的咳嗽，痰粘气逆、血腥味，用杏仁萝卜子丸（Xingren Luobozhi Wan）。清金润燥，用天门冬丸（Tianmendong Wan）、牛髓汤（Niusui Tang）。如果面目浮肿，用蜜酥煎（Misu Jian）。
内伤引起的咳嗽，治疗方法各不相同。火盛则壮水；金虚则崇土；郁甚则舒肝；气逆则理肺；食积则和中；房劳则补下；用热药避开热时，用寒药避开寒时。内伤已先形成，药物不宜峻猛。至于上焦虚寒，呕吐唾液涎沫，则用温肺肠（Wen Fei Chang，此处疑为温肺汤或类似方剂名，原文作温肺肠，保留原名）。上中二焦俱虚，则用加味理中汤（Jiawei Lizhong Tang）。三焦俱虚，则用加味三才汤（Jiawei Sancai Tang）。
伤肾引起的咳嗽，气逆烦冤，牵引腰腹，俯仰不利，用六味地黄汤（Liwei Dihuang Tang）加五味子。水饮与里寒合作，腹痛下利，用真武汤（Zhenwu Tang）。其中有燥咳，热移大肠，也主症见腹痛下利，毫厘千里之差，尤其应当辨别。
荣卫两虚引起的咳嗽，荣虚发热；卫虚自汗，或恶寒，用宁肺汤（Ningfei Tang）。
虚劳引起的咳嗽，用五味黄芪散（Wuweihuangqi San，原文作五味黄 散，推测为五味子黄芪散）、麦门冬饮（Maimendong Yin）。
心火刑肺见血，用人参芎归汤（Renshen Xionggui Tang）。
干咳无痰，火热内壅，用四物桔梗汤（Siwu Jiegeng Tang）开提之。伤酒热积，用琼玉膏（Qiongyu Gao）滋润之。色欲过度，肾水不升，用八味丸（Bawei Wan）蒸动之。
上半日咳嗽多，火在阳分，宜用白虎汤（Baihu Tang）。下半日咳嗽多，火在阴分，宜用四物芩连汤（Siwu Qinlian Tang）。
久咳导致肺损、肺痿，痰中见血，潮热声微，用人参养肺汤（Renshen Yangfei Tang）。血腥喘乏，用钟乳补肺汤（Zhongru Bufei Tang）。久咳宜收涩的，用人参清肺汤（Renshen Qingfei Tang）。如果声音不出，用诃子散（Hezi San）。
膏粱厚味致咳，比照湿热内蕴的病例治疗。如色欲过度，元气虚损，又不可一味攻伐其痰，辛苦致咳，比照风寒外束的病例治疗。如外寒包裹内热，须分辨寒热多少，斟酌于表里兼治的方法。
【律六条】
凡是治疗咳嗽不分外感内伤、虚实新久，沿袭使用清凉药，只稍加疏散药物的，因循苟且，留下的祸患实在很深，这是良医所不为的。
凡是治疗咳嗽遇到阴虚火盛、干燥少痰，以及痰咯艰难而出的，妄用二陈汤（Erchen Tang），转而劫夺其阴液而产生大祸害的，是医生的罪过。
凡是咳嗽而且腹泻，上下同时受征伐，而不顾惜病人中气的，十个没有能救活的。这样死亡的，是医生杀死的。这里有肺热肾寒两种证候，水火不同，不论使用凉药还是温药，总以回护中气为主。
凡是邪气盛，咳嗽频繁，绝对不可用劫涩药（收敛固涩药）。咳嗽日久邪气衰退，病势不再脱失，才可以涩之。误用则会伤肺，必然导致咳嗽无休止，坐以待毙，是医生的罪过。
凡是属于肺痿、肺痈的咳嗽，误作虚劳，妄补阴血，转而阻滞其痰，因而导致病人无法救治的，是医生的罪过。
凡是咳嗽逐渐发展到气息高促、汗出淋漓，应当不等喘急痰鸣，急忙补益其根本。如果仍然治标亡本，必然导致气脱突然死亡，是医生的罪过。
I composed the "Treatise on Cough," referencing the *Neijing* (Inner Canon), yet I felt uneasy that I had not fully penetrated its deepest principles. I then repeatedly chewed over the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) without ceasing all day, until suddenly my understanding clarified. I came to realize the profound intent behind Zhang Zhongjing placing "Cough" under the section of "Phlegm-Fluids" (Tan-Yin, pathological fluid retention). This is because cough invariably arises from phlegm-fluids; among the five types of fluids, only "Branch Fluid" (Zhi-Yin, fluid accumulation in the chest/diaphragm) serves as the root foundation for cough. When external pathogens invade and combine with it, cough certainly results; even without external pathogens, Branch Fluid soaking into the lungs is sufficient to cause incessant cough. Moreover, since Branch Fluid has accumulated long-term in the diaphragm, rebellious Qi from the lower jiao easily combines with pathogenic factors above. Because of Branch Fluid, external pathogens can enter internally, and lower pathogenic factors can rise upward; unless Branch Fluid is removed, cough will never find peace. To remove Branch Fluid, Ten Zao Tang (Shi Zao Tang, Ten Date Pill) should be used, without hesitation regarding its harshness. Not only at the onset of disease, but even if the pathogen has accumulated for a long time, one cannot abandon this formula to seek another good method. The text states: "For patients with cough, a wiry pulse indicates water retention; Ten Zao Tang governs." This precisely refers to the urgent need to remove Branch Fluid indicated by an acute wiry pulse, which is relatively easy to understand. It also states: "For those with Branch Fluid who suffer from cough, irritability, and chest pain, if they do not die suddenly, after one hundred days or a year, Ten Zao Tang is appropriate." For such cases that could have been fatal but were not, relying still on this formula to remove Branch Fluid might seem startling and doubtful? Does everyone not have Branch Fluid in their chest and diaphragm? Why is the harm so great? Why must the removal of harm require such force? Because the area above the diaphragm is governed by Yang Qi and houses the Heart and Lungs. Branch Fluid lies horizontally across it; disturbing the Lung causes cough, disturbing the Heart causes irritability, clashing with Yang Qi causes pain, and forcing its way through obstructs Ying and Wei circulation, leaving Shen and Po without support, leading to sudden death. That they survive to one hundred days or a year indicates that Yang Qi has not dissipated and Shen and Po have not scattered. Only by urgently removing the pathogen can Zheng Qi be secured; thus, there is no objection to harsh purgation. Sweeping away yin turbidity allows clarity to reside in the body; compared to passively waiting for death, what are the gains and losses? The text states: "In chronic cough lasting years, a weak pulse is treatable, a solid, large, and rapid pulse indicates death, and a deficient pulse inevitably brings dizziness, because the patient originally had Branch Fluid in the chest." Treatment belongs to managing fluid disorders. Treating the fluid rather than the cough reveals Zhang Zhongjing's implicit intent, inadvertently expressed. A solid, large, and rapid pulse signifies Fire punishing Metal without restraint, hence death. A weak and deficient pulse indicates both pathogen and healthy Qi are depleted but recoverable, hence curable. The text states: "Cough with rebellion and reliance on breathing, unable to lie flat, is governed by Xiao Qing Long Tang (Minor Blue Dragon Decoction)." This clarifies the syndrome of combined internal and external pathogens, for which Xiao Qing Long Tang is the specific formula. However, using Xiao Qing Long Tang contains subtle principles; one must guard against Chong Qi rising from below, which would re-increase turbid chaos. If Chong Qi increases turbid chaos, the cough becomes unbearable. In Shanghan (Cold Damage) syndromes, Da Qing Long Tang (Major Blue Dragon Decoction) may be taken by those without Shaoyin syndrome; it is contraindicated for those with faint pulses, as administration leads to muscle twitching, sinew palpitations, and loss of Yang Qi. In miscellaneous diseases, using Xiao Qing Long Tang also risks that if Shaoyin Kidney Qi is inherently deficient, Fire of the Chong and Ren meridians easily rebels upward. Once Chong-Ren Fire rises, even without cough, it increases irritability and cough; how much more so if chronic cough persists, could we disturb Chong Qi? The Chong and Ren meridians originate together from below the Kidneys, emerging from the Baozhong (uterus/pelvic cavity); when Kidney deficiency fails to secure them below, these two meridians accompany each other, rebelling upward from the lower abdomen. Therefore, Guiling Wuliang Gancao Tang (Cinnamon Twig, Poria, Schisandra, and Licorice Decoction) is used first to treat Chong Qi. Once Chong Qi subsides, but cough and chest fullness recur, it is because water remains undissipated in the diaphragm, causing a secondary change. Remove Cinnamon Twig from the previous formula, add Gan Jiang (Dried Ginger) and Xi Xin (Asarum) to treat cough and fullness; once cough and fullness cease... On the third change, if thirst recurs and Chong Qi relapses, it is because Xi Xin and Gan Jiang are hot herbs; consumption should lead to immediate thirst, but if thirst stops instead, it indicates Branch Fluid. Branch Fluid patients legally experience dizziness; dizzy patients vomit; upon vomiting, add Ban Xia (Pinellia) to remove water; once water is gone, vomiting stops. On the fourth change, if the person's body swells, it is because water remains in the exterior; add Xing Ren (Apricot Seed) to govern. This syndrome should include Ma Huang (Ephedra), but because the person has numbness/bi syndrome, Ma Huang is omitted. If administered contrary to this, dryness will result; this is because the person has Blood deficiency, and Ma Huang disperses Yang Qi. On the fifth change, if the head and face feel hot like drunkenness, this is Stomach Heat rushing upward to熏 (smoke/steam) the face; add Da Huang (Rhubarb) to drain it. Alas! Zhang Zhongjing’s treatment of cough does not start from the cough itself, but removes Branch Fluid, lowers Chong Qi, and addresses methods of the lower and middle jiao, moving freely through emptiness, resolving the whole ox like a skilled butcher—how miraculous! Previously, I did not understand the author's intent, feeling there was no ladder to climb; unexpectedly, through comparative analysis, I grasped the beginnings of external pathogens entering internally and lower pathogens rising upward. By further consulting the *Jingui*, the profound essence became clearly visible. Is this not divine guidance? Comforting! Comforting!
The *Neijing* states "Autumn injury by Dampness, Winter generates Cough"; this is a textual error (tuo wen). Misinterpreted for millennia, I now correct it. It should read: "Summer injury by Summerheat, Late Summer injury by Dampness, Autumn必然 (necessarily) brings Malaria. Autumn injury by Dryness, Winter generates Cough." The principle of Six Qi matching Four Seasons becomes brilliantly clear. Dampness is a category of Water; Dryness is a category of Fire. Damp diseases are severe in Spring and Summer; Dryness diseases are severe in Autumn and Winter. Malaria is clearly Summerheat-Damp combined pathogen, yet Damp exceeds Summerheat; why omit it? As for cough, it manifests entirely as Fire-Dryness pathology; why attribute it to Damp injury? Thus, Spring-Summer damp diseases occur because after Spring Equinox, Earth Qi rises, Heaven Qi descends; the two Qi interact, steaming Dampness in the middle; soil moistens, stone steps sweat; the human body responds, and Damp diseases appear. Autumn-Winter Dryness diseases occur because after Autumn Equinox, Heaven Qi does not descend, Earth Qi does not rise; the two Qi separate, presenting Dryness; grass yellows, trees fall, mountains and waters dry up; the human body responds, and Dryness diseases appear. Then, cough being caused by Dryness injury is obvious.
Six Qi governing diseases: Wind, Fire, Heat, Dampness, Dryness, Cold—all can attack the Lung and cause cough. The Damp-Cough is sub-categorized into Wind, Fire, Heat, Dryness, and Cold. Wind attacking Lung cough: sweating, headache, difficult expectoration. Fire attacking Lung cough: asthma, oppression, blood in sputum. Heat attacking Lung cough: asthma, red face, tidal fever; severely, heat excess in center causes cold extremities; heat shifts downward causing profuse diarrhea. Dryness attacking Lung cough: dry/coarse skin/hair, small sores/itching, sticky sputum, constipation. Cold attacking Lung cough: aversion to cold, no sweat, nasal congestion, body ache, fever, restlessness. Regarding cough caused by internal movement of Damp-Phlegm, it must be due to Wind, Fire, Heat, Dryness, or Cold; the accompanying factors differ, but attacking the Lung is the same.
Wind-Cold exterior constraint: Huagai San (Canopy Powder), Shenru Yin (Ginseng and Perilla Drink). If voice is lost due to Wind Pathogen: Renshen Jingjie Tang (Ginseng and Schizonepeta Decoction). Due to Cold Pathogen: San'ao Tang (Three Unbinding Decoction). Cough triggered by cold: Jupi Banxia Tang (Tangerine Peel and Pinellia Decoction).
Internal blazing of Fire-Heat: Jiajian Xiebai San (Modified Draining White Powder), Shuizhu Jinhua Wan (Water-Boiled Golden Flower Pill). If body heat feels like roasting: Ziwan Gao (Astera Ointment).
Cough from Summerheat injury: spontaneous sweating, deficient pulse, thirst: Renshen Baihu Tang (Ginseng White Tiger Decoction), Qingshu Yiqi Tang (Clearing Summerheat and Boosting Qi Decoction).
Cough from Dampness injury: heavy body, fine pulse, profuse phlegm: Wuling San (Five-Ling Powder), Baizhu Tang (Atractylodes Decoction). If asthma/fullness and edema: Kuanqi Wan (Relieving Qi Pill). If Damp-Heat historically accumulates in Middle Jiao: Huanglian Jiedu Tang (Coptis Detoxification Decoction), Guntan Wan (Rolling Phlegm Pill). If Damp-Heat historically accumulates in Upper Jiao, with continuous gasping and blocked breath: Sangbaipi San (Mulberry Bark Powder).
Cough from Dryness injury: sticky sputum, rebellious Qi, bloody taste: Xingren Luobozhi Wan (Apricot Seed and Radish Seed Pill). Clearing Metal and moistening Dryness: Tianmendong Wan (Asparagus Fern Pill), Niuisui Tang (Ox Marrow Decoction). If face/eyes swell: Misu Jian (Honey and Butter Fritter).
Internal injury cough: treatments vary. Excess Fire nourishes Water; Metal deficiency supports Earth; severe stagnation soothes Liver; rebellious Qi regulates Lung; food stasis harmonizes Middle; sexual exhaustion tonifies Lower; use Hot herbs avoiding Hot seasons, use Cold herbs avoiding Cold seasons. Since internal injury has already occurred, drugs should not be harsh. For Upper Jiao deficiency-cold with vomiting of saliva/phlegm: Wenfei Chang (Warm Lung Intestine [Formula Name]), likely referring to a warming lung formula. For simultaneous Upper and Middle Jiao deficiency: Jiawei Lizhong Tang (Modified Regulating the Center Decoction). For Triple Burner deficiency: Jiawei Sancai Tang (Modified Three Capabilities Decoction).
Kidney-injury cough: rebellious Qi, vexation, pulling sensation in waist/abdomen, difficulty bending/stretching: Liwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Wuweizi (Schisandra). Water-Fluid combining with Interior Cold, abdominal pain and diarrhea: Zhenwu Tang (True Warrior Decoction). Note: Dry-Cough within this context, with Heat shifting to Large Intestine, also presents with abdominal pain and diarrhea; the difference is minute yet vast, requiring careful differentiation.
Ying-Wei dual deficiency cough: Ying deficiency causes fever; Wei deficiency causes spontaneous sweating or aversion to cold: Ningfei Tang (Calming Lung Decoction).
Consumption (Xu Lao) cough: Wuwei Huangqi San (Schisandra and Astragalus Powder), Maimendong Yin (Ophiopogon Drink).
Heart Fire punishing Lung with bleeding: Renshen Xionggui Tang (Ginseng, Ligusticum and Angelica Decoction).
Dry cough without phlegm, internal obstruction of Fire-Heat: Siwu Jiegeng Tang (Four Substances and Plume Poppy Root Decoction) to lift and open. Alcohol-induced Heat accumulation: Qiongyu Gao (Jade Pearl Ointment) to moisten. Sexual excess causing Kidney Water failure to ascend: Bawei Wan (Eight-Ingredient Pill) to steam and activate.
Cough mostly in the first half of the day: Fire in Yang division, suitable for Baihu Tang (White Tiger Decoction). Cough mostly in the second half: Fire in Yin division, suitable for Siwu Qinlian Tang (Four Substances, Scutellaria and Coptis Decoction).
Chronic cough causing Lung damage/Fei Wei (Lung Atrophy), blood in sputum, tidal fever, faint voice: Renshen Yangfei Tang (Ginseng Nourishing Lung Decoction). Bloody sputum, asthma, fatigue: Zhongru Bufei Tang (Cloudstone Tonifying Lung Decoction). Chronic cough requiring astringency: Renshen Qingfei Tang (Ginseng Clearing Lung Decoction). If voice is lost: Hezi San (Chebula Powder).
Cough from rich/greasy diet: treat similarly to internal Damp-Heat accumulation. Cough from sexual excess and Yuan Qi deficiency: do not solely attack phlegm. Cough from bitter/spicy foods: treat similarly to Wind-Cold exterior constraint. If Exterior Cold wraps Internal Heat: distinguish the degree of Cold vs. Heat, employing simultaneous exterior-interior treatment methods.
[Six Laws]
1. Treating cough without distinguishing external/internal injury, deficiency/excess, or new/chronic nature, and blindly applying cooling herbs with slight dispersants is negligent and causes deep harm; good physicians do not do this.
2. Treating cough in cases of Yin deficiency with Fire excess, dryness with little phlegm, or difficult expectoration, and recklessly using Erchen Tang (Two-Aged Decoction) depletes Yin and causes major disaster; this is the physician's fault.
3. Cough accompanied by diarrhea, attacking both upper and lower while ignoring the Middle Qi (Spleen/Stomach), rarely saves the patient ("ten out of ten die"). Such deaths are caused by the physician. There are patterns of Lung Heat and Kidney Cold; Water and Fire differ. Regardless of using cool or warm herbs, the primary goal must be protecting Middle Qi.
4. When pathogen is strong and cough frequent, absolutely do not use astringent/herding herbs. Only when cough is chronic, pathogen is weak, and the condition is stable, may astringents be used. Mistaken use injures the Lung, leading to endless cough and sitting awaiting death; this is the physician's fault.
5. Cough due to Fei Wei (Lung Atrophy) or Fei Yong (Lung Abscess) mistaken for Consumption (Xu Lao), with reckless tonification of Yin/Blood, blocking phlegm, leading to untreatable conditions; this is the physician's fault.
6. Cough progressing to high-pitched breathing and profuse sweating requires urgent tonification of the Root before asthma/wheezing occurs. If treating the branch destroys the root, Qi collapse and sudden death will follow; this is the physician's fault.