咳嗽。微疾也。连绵不已。则又痼疾也。夫岂容渺视哉。然咳则有声无痰。虚
怯者恒见之。或时咳一声。或连咳二三声。日以为常。初不经意。而 羸已
成矣。盖肺出气。肾纳气。升降往来。舒徐不迫。惟纵欲以竭之。以耗散之。而
真气馁。于是假咳而上达。岂可久之道哉。嗽则有声有痰。其因多端。外则
六淫。内则七情。咸足以致之。经谓五脏六腑。皆令人咳。非独肺也。而肺为
之总司。然六淫之中。风寒尤易犯。以肺主皮毛。而开窍于鼻。形寒饮冷则
伤之。留而不去。为寒为热。变迁不一。须审其风则解之。寒则散之。中病即
止。若过于解散。则腠理疏而邪复袭。愈袭愈解。愈解愈袭。脾肺虚而元气
惫。反变成他症而难疗矣。况乎暑湿七情等因。又当随感而施治者哉。窃
思痰者。身之液也。外充皮肤。内滋脏腑。气为之化。血为之辅。相为灌溉而
不可竭者。若久嗽不已。则腑腑精华。肌肉血脉。俱为耗引。消竭于痰。比之
脱气脱血。何多逊焉。独不观久嗽者。始而色瘁。继而肉消。继而骨痿。皆津
液不能敷布乃至此。夫岂容渺视哉。故疗之者。干咳。用地黄丸峻补其肾。
兼进人参以滋化源。痰嗽。风则解以辛凉。寒则散以辛温。暑则清之。湿则
燥之。燥火则润之。七情则随所因而调之。而总以扶脾保肺为首务。幸毋
沾沾于逐痰也。
按痰又有酒湿而生者。六君子加葛粉泽泻之类。有食积而生者。枳术
加半夏曲陈皮甘草之类。有痰火而生者。二陈加栝蒌山栀黄芩之类。
有肺燥而生者。二冬加贝母栝蒌百合之类。有气逆而生者。二陈加苏
子桑皮杜仲之类。此皆治标之治法。随症以投。第不可过甚耳。
咳嗽，本是轻微的病症。但如果连绵不断，就变成了顽固的疾病。这怎么可以轻视呢？然而，只有声音没有痰的咳嗽，体虚怯弱的人经常见到。有时咳一声，有时连续咳两三声，每天习以为常。起初不以为意，但身体已经消瘦衰弱了。因为肺主呼气，肾主纳气，升降往来，舒缓从容而不急促。只有纵欲过度来耗尽它，耗散真气，导致真气虚弱，于是假借咳嗽的声音向上发出，这哪里是长久的办法呢？有声音且有痰的咳嗽，原因有很多方面。外因则是六淫（风、寒、暑、湿、燥、火六种外感病邪），内因则是七情（喜、怒、忧、思、悲、恐、惊七种情志变化），都足以导致这种病。医经说五脏六腑都能让人咳嗽，不仅仅是肺。而肺是总主管。然而在六淫之中，风寒尤其容易侵犯人体，因为肺主皮毛，且开窍于鼻，形体受寒或饮食生冷就会损伤它。邪气停留不去，化为寒证或热证，变化不一。必须审察如果是风邪就用解表法，如果是寒邪就用散寒法，中病即止（见效就停止）。如果过于使用发散解表的方法，就会导致腠理（皮肤毛孔）疏松而邪气再次侵袭，越是侵袭越是发散，越是发散越是侵袭，导致脾肺虚弱而元气疲惫，反而变成其他病症而难以治疗了。何况暑湿、七情等原因，又应当根据感受的不同而施以相应的治疗呢？
我私下认为，痰是身体的津液。向外充盈皮肤，向内滋养脏腑，靠气化推动，靠血液辅助，相互灌溉而不可枯竭。如果久咳不止，那么各脏腑的精华，肌肉血脉，都被消耗牵引，在痰中消竭，比起脱气和脱血，又有什么逊色呢？难道没看到久咳的人吗？开始面色憔悴，继而肌肉消瘦，继而骨骼痿软，都是因为津液不能敷布才到了这一步。这怎么可以轻视呢？所以治疗时，干咳的，用地黄丸（滋阴补肾方剂）峻补其肾，同时进服人参以滋生化之源。有痰的咳嗽，风邪则用辛凉药解表，寒邪则用辛温药散寒，暑邪则清解，湿邪则燥湿，燥火则润燥，七情所致则根据病因调理。总之以扶持脾胃、保护肺脏为首要任务，千万不要仅仅专注于祛除痰液。
按：痰还有因酒湿而产生的，可用六君子汤（健脾益气方剂）加葛粉、泽泻等。有因食积而产生的，可用枳术丸（健脾消痞方剂）加半夏曲、陈皮、甘草等。有因痰火而产生的，可用二陈汤（燥湿化痰方剂）加瓜蒌、山栀、黄芩等。有因肺燥而产生的，可用天冬、麦冬加贝母、瓜蒌、百合等。有因气逆而产生的，可用二陈汤加苏子、桑白皮、杜仲等。这些都是治标的治法，随症状投药，只是不可过于猛烈罢了。
Cough is a minor ailment. However, if it persists continuously, it becomes a chronic disease. How can it be disregarded? Nevertheless, coughing with sound but no phlegm is commonly seen in individuals with deficiency and timidity. Sometimes one coughs once, sometimes two or three times in succession, becoming a daily routine. Initially ignored, the body has already become emaciated. This is because the Lung governs exhalation, and the Kidney governs inhalation; their ascending and descending movements are leisurely and not hurried. Only through excessive indulgence (such as sexual excess) is this energy depleted and scattered, causing the True Qi to weaken. Consequently, false coughing sounds rise upward. Is this a sustainable way of life?
Coughing with both sound and phlegm has diverse causes. Externally, it arises from the Six Evils (Wind, Cold, Summerheat, Dampness, Dryness, Fire); internally, from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). All can induce this condition. The Classics state that all Zang and Fu organs can cause cough, not just the Lung. Yet, the Lung acts as the chief manager. Among the Six Evils, Wind and Cold are particularly prone to invade because the Lung governs the skin and hair and opens into the nose. Physical cold exposure or consuming cold drinks damages the Lung. If pathogenic factors remain and do not dissipate, they transform into Cold or Heat patterns with varying changes. One must examine the pathogen: if Wind, resolve it; if Cold, disperse it. Stop treatment once the disease is addressed. If dispersing methods are overused, the Cou Li (pores and interstices) become loose, allowing pathogens to re-invade. The more invasion occurs, the more dispersion is needed, leading to a cycle where Spleen and Lung deficiency and Yuan Qi exhaustion result, potentially transforming into other difficult-to-treat syndromes. Furthermore, for causes such as Summerheat, Dampness, and Seven Emotions, treatments must be applied according to the specific pathogenic factors.
I ponder that Phlegm is the fluid of the body. It fills the skin externally and nourishes the Zang-Fu organs internally. It is transformed by Qi and assisted by Blood, irrigating each other without being exhausted. However, if chronic cough persists, the essence of the Fu organs, muscles, blood vessels, and meridians are all consumed and drawn away, exhausted within the phlegm. Compared to the loss of Qi or Blood, how does it differ? Have you not observed those with chronic cough? Initially, their complexion becomes sallow; subsequently, muscles waste away; finally, bones become flaccid. This results from the failure of Body Fluids to distribute properly. How can this be disregarded? Therefore, in treatment: for dry cough, use Dihuang Wan (Rehmannia Pill) to strongly tonify the Kidney, and concurrently administer Renshen (Ginseng) to nourish the source of transformation and generation. For cough with phlegm: if Wind, resolve with Acrid-Cool herbs; if Cold, disperse with Acrid-Warm herbs; if Summerheat, clear it; if Dampness, dry it; if Dryness-Fire, moisten it; if caused by Seven Emotions, regulate according to the cause. The primary task is always to support the Spleen and protect the Lung. Do not merely focus on expelling phlegm.
Note: Phlegm may also arise from Wine-Dampness; formulas like Liujunzi Tang (Six Gentlemen Decoction) added with Gegen (Kudzu Root) and Zexie (Alisma) are suitable. It may arise from Food Stagnation; formulas like Zhizhu Wan (Immortelle and Atractylodes Pill) added with Banxia Qu (Pinellia Fermented Paste), Chenpi (Tangerine Peel), and Gancao (Licorice) are suitable. It may arise from Phlegm-Fire; Erchen Tang (Two Aged Herbs Decoction) added with Gualou (Trichosanthes Fruit), Shanzhi (Gardenia Fruit), and Huangqin (Scutellaria Root) are suitable. It may arise from Lung Dryness; Dongtian (Asparagus Tuber) and Dongmai (Ophiopogon Tuber) added with Beimu (Fritillaria Bulb), Gualou, and Baihe (Lily Bulb) are suitable. It may arise from Qi Reversal; Erchen Tang added with Suzi (Perilla Seed), Sangbaipi (Mulberry Bark), and Duzhong (Eucommia Bark) are suitable. These are all symptomatic treatments (treating the branch). Prescribe according to symptoms, but avoid excessive intensity.