（附∶龟胸龟背）
总括 咳嗽虽然分冷热，连声因肺感风寒；眼浮痰盛喉中响，戏水多因汗未干。
脉法 关上脉微为咳，浮缓为伤风，脉紧为寒嗽，浮直者生，浮软者死。
《内经》曰∶五脏六腑皆令人咳，非独肺也。盖皮毛者肺之合也，皮毛先受邪气，邪气听从其合也。五脏之咳久乃
移于六腑。
又《病机要》云∶咳谓无痰而有声。肺气伤而不清也。嗽谓无声而有痰，脾湿动而生痰也。咳嗽谓有声有痰，因伤
肺气动于脾湿，故咳而嗽也。
《经》又云∶秋伤于湿，冬必咳嗽。大抵素秋之气宜清而肃，今反动之则气上冲而为咳嗽，甚则动于脾湿而为痰也。
夫肺居至高之上，主持诸气，属金而畏火者也。清虚高洁覆盖五脏，干金之象，外主皮毛，司腠理开合，护卫一身，如
天之覆物体之至轻清者也。或外因六淫之邪相侵，内因七情之气相忤，则肺金受伤，而清纯之气扰乱妄动为火为痰，咳
嗽之病从兹作矣。
小儿日内咳嗽痰壅，睡中不宁，亦因产后感风而得，但不可过用发散之剂，先解表，后服惺惺散。
小儿汗出未干，遽尔戏水，亦至伤风咳嗽。外症眼胞微浮，额陷痰鸣，亦宜疏风化痰、解利邪热，小柴胡汤可也。
钱仲阳曰∶嗽者肺感微寒，八九月间肺气正旺，若面赤身热，其病为实，宜葶苈丸下之。久嗽不宜下。若在冬月，
则伤风嗽，宜麻黄汤汗之。面赤饮水咳嗽吐脓痰，咽喉不利者，以甘桔汤清之。先咳后喘，面肿身热肺气盛也，以泻白
散平之。嗽而吐痰涎乳者，以白饼子下之。
洁古云∶嗽而两胁痛者属肝经，用小柴胡汤。咳而呕苦水者属胆经，用黄芩半夏生姜汤。咳而喉中如梗者属心经，
用甘桔汤。咳而失气者属小肠，用芍药甘草汤。咳而右胁痛者属脾经，用升麻汤。咳而呕大虫者属胃经，用乌梅丸。咳
而喘息吐血者属肺经，用麻黄汤。咳而遗尿者属膀胱经，用茯苓甘草汤。咳而腹满不欲食，面肿气逆者，属三焦，用异
功散。若咳嗽流涕，外邪伤肺也，先用参苏饮。喘嗽面赤，心火刑肺也，用人参平肺散及六味地黄丸。嗽而吐青绿水，
肝木乘脾也，用异功散加柴胡、桔梗。咳而吐痰乳，脾肺气伤也，用六君子汤加桔梗。若嗽吐脓痰者，热蕴于肺而成肺
痈也，用桔梗汤。嗽而涕吐带血，甚则血溢，宜清金降火，此火乘肺也。凡风邪外伤，法当先表散而后实腠理。其用下
药，非邪传于内，及胃有实热者不宜轻用。面色白，脉短涩者，肺之本症也，易治。面色赤，脉洪数者，火刑金也，难
治。
总括：咳嗽虽然分为寒证和热证，但连续不断的咳嗽是因为肺感受了风寒；眼睑浮肿、痰多且喉间有声响，多是因为出汗后立刻戏水所致。
脉法：关部脉象微弱是咳嗽的表现，脉象浮缓是伤风，脉象紧是寒嗽；脉象浮而直挺的预后良好，脉象浮而柔软的预后不良（主死）。
《黄帝内经》说：五脏六腑都能导致咳嗽，不仅仅是肺。因为皮毛是肺的外合部位，皮毛先受到邪气侵袭，邪气就会顺着这种联系传入体内。五脏的咳嗽日久不愈，就会转移影响到六腑。
又《病机要》说：咳是指没有痰但有声音，这是肺气受伤而不清肃的表现。嗽是指没有声音但有痰，这是脾湿扰动而生痰的表现。咳嗽则既有声音又有痰，是因为伤了肺气并动摇了脾湿，所以既咳又嗽。
《内经》又说：秋季受湿气所伤，到了冬天必定会咳嗽。大体上，初秋的气候应当清肃，如果反常导致气机上冲，就会引发咳嗽，严重时触动脾湿而产生痰液。
肺位于人体最高处，主持各种气机，属性为金，畏惧火邪。肺体清虚高洁，覆盖五脏，具有金的象征意义，外部主管皮毛，控制腠理的开合，护卫全身，就像天空覆盖万物一样，性质至轻至清。如果外受六淫邪气的侵犯，内因七情之气相冲突，就会导致肺金受伤，清纯之气扰乱妄动化为火或痰，咳嗽的疾病便由此产生了。
小儿白天咳嗽、痰液壅盛，睡眠中不安宁，也是因为出生后感受风邪所致，但不可以过度使用发散的药物，应当先解表，然后服用惺惺散。
小儿出汗未干时，立刻去戏水，也会导致伤风咳嗽。外在症状表现为眼睑微肿，额头凹陷处痰鸣音明显，也应当疏风化痰、解除邪热，可以使用小柴胡汤。
钱乙（钱仲阳）说：嗽是肺感受了轻微寒气，在八九月间肺气正旺盛的时候，如果面色红赤、身体发热，病情属于实证，适宜用葶苈丸攻下。久咳不宜攻下。如果在冬季，则是伤风引起的咳嗽，适宜用麻黄汤发汗治疗。如果面色红赤、想喝水、咳嗽并吐出脓痰、咽喉不利，可以用甘桔汤清热。先咳嗽后气喘，面部肿胀、身体发热，这是肺气盛的表现，可以用泻白散平喘。咳嗽并吐出痰涎乳汁的，可以用白饼子攻下。
张元素（洁古）说：咳嗽并伴有两胁疼痛的，属于肝经病变，用小柴胡汤。咳嗽并呕吐苦水的，属于胆经病变，用黄芩半夏生姜汤。咳嗽并感觉喉咙里有异物梗阻感的，属于心经病变，用甘桔汤。咳嗽并放屁的，属于小肠病变，用芍药甘草汤。咳嗽并右侧胁肋疼痛的，属于脾经病变，用升麻汤。咳嗽并呕吐像虫子一样的东西的，属于胃经病变，用乌梅丸。咳嗽并喘息吐血，属于肺经病变，用麻黄汤。咳嗽并遗尿的，属于膀胱经病变，用茯苓甘草汤。咳嗽并腹部胀满不想吃东西，面部肿胀、气逆的，属于三焦病变，用异功散。如果是咳嗽流鼻涕，是外邪伤肺，先用参苏饮。气喘咳嗽、面色红赤，是心火刑克肺金，用人参平肺散及六味地黄丸。咳嗽并吐出青绿色的水，是肝木乘脾，用异功散加柴胡、桔梗。咳嗽并吐出痰乳，是脾肺之气受伤，用六君子汤加桔梗。如果咳嗽吐出脓痰，是热邪蕴结于肺形成了肺痈，用桔梗汤。咳嗽并鼻涕带血，严重时出血，应当清金降火，这是火邪乘袭肺脏。凡是风邪从外部侵袭，治法应当先解表散邪，然后充实腠理。使用下药，如果不是邪气传入内部，以及胃中有实热的情况，不适宜轻易使用。面色苍白、脉象短涩的，是肺的本症，容易治疗。面色红赤、脉象洪数有力的，是火刑克金，难以治疗。
[Appendix: Tortoise Chest and Tortoise Back]
General Principles: Although cough is divided into cold and heat patterns, continuous coughing occurs due to the Lung being affected by Wind-Cold; eyelid edema, excessive phlegm, and rattling sounds in the throat often result from playing in water while sweat is not yet dry.
Pulse Diagnosis: A faint pulse at the Guan position indicates cough; a floating and moderate pulse indicates Wind injury; a tight pulse indicates Cold cough. A floating and straight pulse suggests a favorable prognosis, whereas a floating and soft pulse suggests an unfavorable prognosis (death).
The *Neijing* states: "All five Zang organs and six Fu organs can cause cough, not just the Lung." This is because the skin and hair are the exterior correspondences of the Lung; when the skin and hair are first invaded by pathogenic factors, the pathogens follow this correspondence to enter the interior. Cough originating from the five Zang organs, if prolonged, will transfer to affect the six Fu organs.
Furthermore, the *Bingji Yao* states: "Ke" (cough with sound but no phlegm) refers to the impairment of Lung Qi and its failure to descend clearly. "Sou" (phlegm without sound) refers to Spleen dampness stirring up and generating phlegm. "Kesu" (cough with both sound and phlegm) occurs because Lung Qi is injured and Spleen dampness is activated, resulting in both coughing and expectoration.
The Classics also state: "Injury by dampness in autumn leads to cough in winter." Generally, the qi of early autumn should be clear and肃 (descending/clearing); if it moves contrary to this, the qi rushes upward causing cough, and if severe, it disturbs Spleen dampness to produce phlegm.
The Lung resides at the highest position, governs all Qi, belongs to Metal, and fears Fire. It is pure, empty, high, and noble, covering the five Zang organs, embodying the image of Metal. Externally, it governs the skin and hair and controls the opening and closing of the Couli (pores), protecting the whole body, much like the sky covers all things—it is extremely light and clear. If invaded by external Six Evils or conflicted by internal Seven Emotions, Lung Metal is injured, and the pure Qi becomes disturbed and erratic, transforming into Fire or Phlegm, thus giving rise to cough.
When infants and children suffer from daytime cough and phlegm obstruction, with restlessness during sleep, it is also due to contracting Wind after birth. However, dispersing agents should not be overused; one should first release the Exterior, then administer Xingxing San.
If infants and children play in water immediately after sweating, it can lead to Wind injury and cough. External symptoms include slightly swollen eyelids and rattling phlegm in the forehead depression area. One should disperse Wind, resolve Phlegm, and relieve pathogenic Heat; Xiaochaihu Tang may be used.
Qian Zhongyang stated: Sou (cough with phlegm/sound) results from the Lung contracting slight Cold. In the eighth and ninth lunar months, Lung Qi is flourishing. If the face is red and the body is hot, the condition is Excess, and Tingli Wan should be used to purge it. Chronic cough should not be purged. In winter, it is Wind-Cold cough, and Mahuang Tang should be used to induce sweating. If the face is red, there is thirst, cough produces purulent sputum, and the throat is obstructed, Ganjie Tang should be used to clear it. If cough precedes wheezing, accompanied by facial swelling and fever, this indicates abundant Lung Qi; Xiexie San should be used to calm it. If cough produces saliva and milk-like phlegm, Baibing Zi should be used to purge it.
Jiegu stated: Cough with pain in both hypochondria belongs to the Liver Meridian; use Xiaochaihu Tang. Cough with vomiting of bitter fluid belongs to the Gallbladder Meridian; use Huangqin Banxia Shengjiang Tang. Cough with a sensation of obstruction in the throat belongs to the Heart Meridian; use Ganjie Tang. Cough with flatus belongs to the Small Intestine; use Shaoyao Gancao Tang. Cough with right-sided hypochondriac pain belongs to the Spleen Meridian; use Shengma Tang. Cough with vomiting of worm-like substances belongs to the Stomach Meridian; use Wumei Wan. Cough with wheezing and hemoptysis belongs to the Lung Meridian; use Mahuang Tang. Cough with enuresis belongs to the Bladder Meridian; use Fuling Gancao Tang. Cough with abdominal fullness, loss of appetite, facial edema, and rebellious Qi belongs to the Triple Burner; use Yigong San. If cough is accompanied by runny nose, it is external pathogen injuring the Lung; first use Shen Su Yin. Wheezing cough with red face indicates Heart Fire insulting Lung Metal; use Renshen Pingfei San and Liuwei Dihuang Wan. Cough with vomiting of green or blue water indicates Liver Wood invading Spleen; use Yigong San plus Chaihu and Jiegeng. Cough with vomiting of phlegm-milk indicates injury to Spleen and Lung Qi; use Liujunzi Tang plus Jiegeng. If cough produces purulent sputum, it is heat accumulating in the Lung forming Lung Abscess (Fei Yong); use Jiegeng Tang. Cough with bloody nasal discharge, or severe bleeding, requires clearing Metal and descending Fire, as this is Fire insulting the Lung. For external Wind pathogen invasion, the method is to first release the Exterior and then consolidate the Couli. Laxatives should not be used lightly unless the pathogen has transmitted inward or there is excess Heat in the Stomach. A pale complexion with short and choppy pulse indicates the primary symptom of the Lung, which is easy to treat. A red complexion with surging and rapid pulse indicates Fire insulting Metal, which is difficult to treat.