帝曰∶肺之令人咳,何也?岐伯曰∶五脏六腑皆令人咳,非独肺也。又曰∶邪在肺,则病皮肤痛,寒热,
上气喘,汗出,咳动肩背。夫肺为华盖,口鼻相通,息之出入,气之升降,必由之路,故专主气。经曰∶形寒
饮冷则伤肺。由儿衣太薄,及冷冻饮料之类,伤于寒也。经曰∶热伤肺。由儿衣太浓,爱养过温,伤于热也。又曰∶
皮毛者,肺之合。皮毛先受邪气,邪气得从其合,使气上而不下,逆而不收,充塞咽嗌,故令咳嗽也。
凡有声无痰谓之咳,肺气伤也;有痰无声谓之嗽,脾湿动也;有声有痰谓之咳嗽,初伤于肺,继动脾湿也。
在小儿由风寒乳食不慎而致病者,尤多矣。经曰∶五脏六腑皆令人咳。然必脏腑各受其邪而与之,要终不离
乎肺也。但因痰而嗽者,痰为重,主治在脾;因咳而动痰者,咳为重,主治在肺。以时而言之,清晨咳者,属痰
火;午前嗽者,属胃火;午后嗽者,属阴虚;黄昏嗽者,火浮于肺;五更嗽者,食积滞于三焦。肺实者,顿嗽抱
首,面赤反食;肺虚者,气逆虚鸣,面白飧泄;肺热者,痰腥而稠,身热喘满,鼻干面红,手捏眉目;肺寒者,
嗽多痰清,面白而喘,恶风多涕。故治者各因其虚实寒热而调之,斯无误矣。
因于寒者则气壅喘促,声浊而无汗,鼻塞声重,宜参苏饮微汗之。
咳而气逆,喘嗽,面白有痰。此肺本经
病,宜清肺饮。咳甚,葶苈丸微利之。
咳而喉仲介介有声,面赤发热心烦,或咽喉痛声哑者,此肺病兼见心证,宜清宁散。咽喉痛,沆瀣丹。
咳而面黄体倦,痰涎壅盛,或吐痰,或吐乳食。此肺病兼见脾证。大抵咳嗽属脾肺者居多,以肺主气,脾
主痰故也,宜橘皮汤。
咳而面青多怒,痰涎壅盛而发搐者,盖因咳嗽声不能转,所以瞪目直视。此肺病兼见肝证,宜集成金粟丹。
咳而面色暗黑,久咳而吐痰水。此肺病而兼见肾证,宜六味地黄丸加麦冬、五味。
咳而声不出,口鼻出血者,此气逆血亦逆也。须顺气宁嗽为主,宜人参冬花膏。
咳而久不止,并无他证,乃肺虚也。只宜补脾为主,人参五味子汤。
咳而胸高骨起,其状如龟者,谓之龟胸。此肺热之极,阳火熏蒸而致也,清燥救肺汤。
咳而日久,胸前疼痛,口吐脓血腥臭者,此肺火壅盛,已成痈也,桔梗汤。治不如法,其证多死。
凡咳嗽痰涎壅塞,逆气冲并而作搐者,多难治。故头摇目上视,及闭目呻吟,手足摆舞,肩息胸突,喉中痰
鸣,口噤不乳,喘而手足冷,皆死证也。
黄帝问道:肺为什么会让人咳嗽呢?岐伯回答说:五脏六腑都能使人咳嗽,并不仅仅是肺的病变。又说:邪气在肺,就会出现皮肤疼痛、怕冷发热、上气喘促、出汗、咳嗽牵引肩背疼痛等症状。肺位于胸腔最高处,像伞盖一样覆盖其他脏腑(华盖),通过口鼻与外界相通,呼吸的出入、气的升降,都必须经过这里,所以肺专门主管气机运行。经书说:形体受寒或饮食生冷就会损伤肺。这是因为婴儿衣服穿得太薄,以及食用冷冻饮料等,被寒气所伤。经书又说:热邪会损伤肺。这是因为婴儿衣服穿得太厚,养育过于温热,被热邪所伤。又说:皮毛是肺的外合部位。皮毛先受到邪气侵袭,邪气便顺着其相合的途径内传,使肺气上逆而不能下行,气机逆乱而不能收敛,充塞咽喉,从而导致咳嗽。
凡是只有声音而没有痰液叫作“咳”,这是肺气受伤;凡是只有痰液而没有声音叫作“嗽”,这是脾湿扰动;既有声音又有痰液叫作“咳嗽”,这是起初损伤了肺,继而影响了脾湿。在小儿中,由于风寒或乳食不慎而致病的情况尤其多。经书说:五脏六腑都能使人咳嗽。然而必定是各个脏腑各自受到邪气侵袭后传给肺,归根结底还是离不开肺。但是因为痰引起的咳嗽,以痰为重,治疗重点在脾;因为咳嗽而引发痰液的,以咳为重,治疗重点在肺。从时间上来说,清晨咳嗽的,属于痰火;午前咳嗽的,属于胃火;午后咳嗽的,属于阴虚;黄昏咳嗽的,是虚火浮越于肺;五更天咳嗽的,是食积停滞在三焦。肺实证的,表现为阵发性剧烈咳嗽、双手抱头、面色发红反而想进食;肺虚证的,表现为气逆虚鸣、面色苍白、完谷不化的腹泻;肺热证的,表现为痰液腥臭且粘稠、身体发热、气喘胸闷、鼻子干燥、面色发红、用手揉搓眉目;肺寒证的,表现为咳嗽多、痰液清稀、面色苍白且气喘、怕风、鼻涕多。所以治疗者应当根据虚实寒热的不同情况进行调理,这样就不会出错了。
因感受寒邪导致的,则气机壅滞、气喘急促、声音浑浊且无汗、鼻塞声音重浊,适宜用参苏饮(Ginseng and Perilla Decoction)使其微微发汗。
咳嗽伴有气逆、气喘咳嗽、面色苍白且有痰。这是肺本经的疾病,适宜用清肺饮(Clear the Lung Decoction)。如果咳嗽严重,可用葶苈丸(Lepidium Seed Pill)轻微通利大便。
咳嗽且喉咙中有介介有声(形容喉间有痰声),面色发红、发热、心烦,或者咽喉疼痛、声音嘶哑的,这是肺病兼见心经证候,适宜用清宁散(Clear and Peaceful Powder)。如果咽喉疼痛,可用沆瀣丹(Huangxie Pill)。
咳嗽且面色发黄、身体疲倦、痰涎壅盛,或者呕吐痰液、呕吐乳食。这是肺病兼见脾经证候。大抵咳嗽属于脾肺两脏的居多,因为肺主气,脾主生痰的缘故,适宜用橘皮汤(Tangerine Peel Decoction)。
咳嗽且面色发青、易怒、痰涎壅盛并出现抽搐的,大概是因为咳嗽声不能转换,导致瞪眼直视。这是肺病兼见肝经证候,适宜用集成金粟丹(Jicheng Gold and Millet Pill)。
咳嗽且面色暗黑,久咳并吐出痰水。这是肺病兼见肾经证候,适宜用六味地黄丸(Six-Ingredient Rehmannia Pill)加麦冬(Ophiopogon Root)、五味子(Schisandra Fruit)。
咳嗽且声音发不出,口鼻出血的,这是气逆血也随之上逆。必须以顺气宁嗽为主,适宜用人参冬花膏(Ginseng and Kadsura Flower Paste)。
咳嗽日久不止,并没有其他症状,这是肺虚。只适宜以补脾为主,用人参五味子汤(Ginseng and Schisandra Decoction)。
咳嗽且胸部高耸、肋骨外翻,形状像乌龟一样的,叫作龟胸。这是肺热到了极点,阳火熏蒸所致,用清燥救肺汤(Clear Dryness and Rescue the Lung Decoction)。
咳嗽日久,胸前疼痛,口吐脓血腥臭痰的,这是肺火壅盛,已经形成肺痈(lung abscess),用桔梗汤(Platycodon Decoction)。如果治疗不得法,这种病症大多会导致死亡。
凡是咳嗽痰涎壅塞,气逆冲并并引发抽搐的,大多难以治疗。所以出现摇头、眼球上翻,以及闭眼呻吟、手足舞动、抬肩呼吸、胸部突起、喉中痰鸣、牙关紧闭不吃奶、气喘且手脚冰冷,这些都是死证。
The Yellow Emperor asked: Why does the Lung cause coughing? Qibo replied: All five Zang organs and six Fu organs can cause coughing; it is not solely due to the Lung. It is also said: When pathogenic factors are in the Lung, symptoms such as pain in the skin, aversion to cold with fever, upward panting, sweating, and coughing that pulls on the shoulders and back will occur. The Lung is the "Canopy" (Huagai, a metaphor for its position covering other organs), communicating through the mouth and nose. The entry and exit of breath, and the ascending and descending of Qi, all pass through it; thus, the Lung specifically governs Qi. The Classics state: Cold damaging the form and cold drinks injuring the interior will harm the Lung. This is because infants wear too thin clothing or consume frozen drinks, thereby being injured by Cold. The Classics also state: Heat damages the Lung. This is because infants are dressed too warmly or cared for with excessive warmth, thereby being injured by Heat. It is further stated: The skin and hair are the exterior correspondence of the Lung. When the skin and hair first receive pathogenic factors, these factors enter via their correspondence, causing Lung Qi to ascend without descending, becoming rebellious and unable to gather, filling the throat and pharynx, thus causing coughing.
That which has sound but no phlegm is called "Ke" (cough), indicating injury to Lung Qi; that which has phlegm but no sound is called "Sou" (saliva/phlegm production), indicating disturbance of Spleen dampness; that which has both sound and phlegm is called "Kesou" (cough with phlegm), indicating initial injury to the Lung followed by disturbance of Spleen dampness. In children, illness caused by wind-cold or improper nursing/diet is particularly common. The Classics state: All five Zang organs and six Fu organs can cause coughing. However, each organ must receive its own pathogenic factor and transmit it to the Lung; ultimately, it cannot depart from the Lung. But when coughing is caused by phlegm, phlegm is the primary aspect, and treatment focuses on the Spleen; when coughing generates phlegm, coughing is the primary aspect, and treatment focuses on the Lung. Speaking in terms of time: Coughing in the early morning belongs to Phlegm-Fire; coughing before noon belongs to Stomach Fire; coughing after noon belongs to Yin Deficiency; coughing at dusk belongs to Floating Fire in the Lung; coughing at wu geng (3-5 AM) belongs to Food Stagnation in the San Jiao. Lung Excess presents as paroxysmal severe coughing, holding the head, reddish face, and desire to eat; Lung Deficiency presents with rebellious Qi and empty wheezing, pale face, and undigested stool in diarrhea; Lung Heat presents with fishy-smelling and thick phlegm, body heat, panting and chest fullness, dry nose, red face, and rubbing the eyebrows and eyes; Lung Cold presents with frequent coughing, clear and thin phlegm, pale face, panting, aversion to wind, and excessive nasal discharge. Therefore, practitioners should regulate according to excess/deficiency and cold/heat, and there will be no errors.
When caused by Cold, Qi becomes obstructed leading to panting, turbid voice, absence of sweat, nasal congestion, and heavy voice; Shen Su Yin (Ginseng and Perilla Decoction) should be used to induce slight sweating.
Coughing with rebellious Qi, panting and coughing, pale face, and phlegm. This is a disease of the Lung meridian itself; Qing Fei Yin (Clear the Lung Decoction) should be used. If coughing is severe, Ting Li Wan (Lepidium Seed Pill) should be used to slightly promote bowel movement.
Coughing with a rattling sound in the throat, reddish face, fever, irritability, or sore throat and hoarseness. This is Lung disease accompanied by Heart syndrome; Qing Ning San (Clear and Peaceful Powder) should be used. For sore throat, Hang Xie Dan (Huangxie Pill) should be used.
Coughing with yellowish face, fatigue, abundant saliva and phlegm, or vomiting phlegm/milk/food. This is Lung disease accompanied by Spleen syndrome. Generally, most coughs belong to the Spleen and Lung because the Lung governs Qi and the Spleen governs Phlegm; Ju Pi Tang (Tangerine Peel Decoction) should be used.
Coughing with bluish face, anger, abundant saliva and phlegm, and convulsions. This is likely because the coughing sound cannot transform, leading to staring eyes. This is Lung disease accompanied by Liver syndrome; Ji Cheng Jin Su Dan (Jicheng Gold and Millet Pill) should be used.
Coughing with dark complexion, chronic coughing with expectoration of watery phlegm. This is Lung disease accompanied by Kidney syndrome; Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) added with Mai Dong (Ophiopogon Root) and Wu Wei Zi (Schisandra Fruit) should be used.
Coughing with inability to speak and bleeding from mouth and nose. This is Qi rebellion causing Blood rebellion. The main treatment must be to soothe Qi and calm coughing; Ren Shen Dong Hua Gao (Ginseng and Kadsura Flower Paste) should be used.
Chronic coughing that does not stop, with no other symptoms, indicates Lung Deficiency. Treatment should focus primarily on tonifying the Spleen; Ren Shen Wu Wei Zi Tang (Ginseng and Schisandra Decoction) should be used.
Coughing with high chest and protruding bones, resembling a turtle, is called "Tortoise Chest" (Guixiong). This is extreme Lung Heat caused by Yang Fire steaming; Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lung Decoction) should be used.
Chronic coughing with anterior chest pain and expectoration of purulent, bloody, foul-smelling sputum. This is excessive Lung Fire obstruction, having formed a Lung Abscess (Fei Yong); Jie Geng Tang (Platycodon Decoction) should be used. If treated improperly, this condition often leads to death.
Whenever coughing is accompanied by abundant phlegm-saliva obstruction, rebellious Qi rushing together, and convulsions, it is difficult to treat. Therefore, shaking of the head, upward rolling of the eyes, closing eyes while groaning, waving of limbs, shoulder breathing, protrusion of the chest, rattling phlegm in the throat, clenched jaw refusing milk, panting with cold hands and feet, are all signs of death.