总括
《病机式要》云∶肺病则咳嗽，谓有痰有声，因肺气受伤，动乎脾湿而然也。若只有声而无痰，是咳之名，肺气伤
而不清也。有痰而无声，谓之嗽，脾湿动而为痰也。二者虽俱属肺之为病。然又有肺寒肺热之分，食积风寒之别，医者
宜详辨之。
肺寒咳嗽
寒嗽者，因平素肺虚喜饮生冷，以致寒邪伤肺，发为咳嗽。其证面色 白，痰多鼻涕清稀。初宜圣惠橘皮散为主之
药；若日久而嗽不愈者，须用补肺阿胶散治之，则顺气化痰而嗽宁矣。
肺热咳嗽
火嗽一证，乃火热熏扰肺金，遂致频频咳嗽，面赤，咽喉干燥，痰黄气秽，多带稠粘也。便软者加味泻白散主
之，便硬，加味凉膈散煎服，则热退气清，而嗽自止矣。
食积咳嗽
食积者，因小儿食积生痰，热气熏蒸，肺气气促痰壅，咳嗽频频也。如便溏者，以曲麦二陈汤治之。便燥者，以苏
亭滚痰丸攻下之。
风寒咳嗽
小儿脱衣，偶为风寒所乘，肺先受邪，使气上逆，冲塞咽喉，发为咳嗽。如常嚏喷流涕，鼻塞声重，多唾痰涎，先
宣疏解风邪，以参苏饮主之，后清其痰嗽，用金沸汤主之。若寒邪壅当散其寒，以加味华盖散治之，则风邪解，而气道
通，气道通而咳嗽痊矣。
总括
喘证者，则呼吸气出急促，外候抬肩欠肚也；哮则喉中有声音也。然致病之原不一，如实热者，则有气粗胸满，痰
稠便 而喘，如虚寒者，则有气乏息微，不能续息而喘。其中有风寒壅闭而喘，又有痰饮壅逆而喘，更有马脾风一证，
最为急候，医者须分别详明而治之。
火热喘急
火邪刑金作喘者，多口干舌燥，作渴，面赤唇红也。因于肺热者，以凉膈散主之。因于胃热者，以白虎汤清之。心
火刑金者，宜用导赤散主之。肾虚火来烁金者，宜用知柏地黄汤治之最灵也。
肺虚作喘
虚喘之证，气乏声音短涩，以洁古黄 汤治之最捷。若虚而夹痰喘促者，百合固金汤治之。若虚而夹热者，以本事
黄汤之剂煎服。
风寒喘急
肺主皮毛，一受风寒，内伤肺气，则气逆不降，呼吸喘急，表热无汗，宜以华盖散之方，汗而散之。若肺气本虚，
复被风邪所伤者，宜紫苏饮补而散之。若肺虚外无风邪所伤，内无痰涎壅塞，惟气逆喘急者，以加减苏子降气汤降其逆
气，其喘自愈。
痰饮喘急
小儿痰饮壅盛，气逆因作喘者，其音如潮响，声如拽锯，须急攻痰饮，宜苏葶滚痰丸从而治之。若停饮喘急，不得
卧者，又当泻饮降逆，用苏葶丸治之。
马脾风
小儿暴喘，俗传其名马脾风。因寒邪客于肺俞，寒化为热，闭于肺经，故胸高气促，肺胀喘满，两胁扇动，陷下作
坑，鼻窍扇动，神气闷乱。初遇之，急服五虎汤，继用一捻金下之。倘得气开，其效最灵。如儿生百日内，见此者，病
多不救。
总括
《病机式要》中说：肺发生病变就会咳嗽，指的是有痰且伴有声音，这是因为肺气受损，触动脾湿所致。如果只有声音而没有痰，这称为“咳”，是肺气受伤而不清肃的表现。如果有痰但没有声音，这称为“嗽”，是脾湿动而生痰的结果。虽然这两者都属于肺的病变，但又有肺寒和肺热之分，以及食积和风寒的区别，医生应当仔细辨别。
肺寒咳嗽
寒性咳嗽，是因为平时肺气虚弱，喜欢饮用生冷食物，导致寒邪伤害肺部，引发咳嗽。其症状表现为面色苍白，痰多鼻涕清稀。初期宜以圣惠橘皮散为主药治疗；如果日久咳嗽不愈，必须使用补肺阿胶散来治疗，这样就能顺气化痰，咳嗽自然平息。
肺热咳嗽
火性咳嗽这一证候，是由于火热之邪熏扰肺金，导致频频咳嗽，面部发红，咽喉干燥，痰液黄稠且气味秽浊，质地粘稠。大便软烂者，以加味泻白散为主治疗；大便干硬者，煎服加味凉膈散，这样热退气清，咳嗽自然停止。
食积咳嗽
食积咳嗽，是因为小儿饮食积滞生痰，热气熏蒸，导致肺气急促、痰液壅盛，频频咳嗽。如果大便溏薄，用曲麦二陈汤治疗。如果大便干燥，用苏亭滚痰丸攻下治疗。
风寒咳嗽
小儿脱去衣物，偶然被风寒邪气侵袭，肺先受邪，使气机上逆，冲塞咽喉，引发咳嗽。如常打喷嚏流涕，鼻塞声重，多唾痰涎，应先宣散疏解风邪，以参苏饮为主治疗；随后清除痰嗽，用金沸汤为主治疗。如果寒邪壅盛应当发散寒气，用加味华盖散治疗，这样风邪解除，气道通畅，气道通畅而咳嗽痊愈。
总括
喘证，是指呼吸气出急促，外在表现是抬肩挺肚；哮证，是指喉中有声音。然而致病的根源不一，如实热证，则有气粗胸满，痰稠便干而喘；如虚寒证，则有气乏息微，不能连续呼吸而喘。其中有因风寒壅闭而喘的，又有因痰饮壅逆而喘的，更有马脾风一证，最为急重，医生必须分别详细明确地治疗。
火热喘急
火邪刑克肺金导致作喘的，多有口干舌燥，口渴，面赤唇红等症状。因肺热引起的，以凉膈散为主治疗。因胃热引起的，用白虎汤清解。心火刑克肺金的，宜用导赤散为主治疗。肾虚之火来灼伤肺金的，宜用知柏地黄汤治疗最为灵验。
肺虚作喘
虚喘证候，气息微弱，声音短促涩滞，用洁古黄芪汤治疗最为快捷。如果是虚证兼夹痰浊导致喘促的，用百合固金汤治疗。如果是虚证兼夹热邪的，用本事方中的黄芪汤剂煎服。
风寒喘急
肺主皮毛，一旦受到风寒侵袭，内伤肺气，则气逆不降，呼吸喘急，表热无汗，宜用华盖散的方剂，通过发汗来疏散邪气。如果肺气本虚，又被风邪所伤的，宜用紫苏饮补益并疏散邪气。如果肺虚且外无风邪所伤，内无痰涎壅塞，只是气逆喘急的，用加减苏子降气汤降其逆气，喘证自然自愈。
痰饮喘急
小儿痰饮壅盛，气逆因而作喘的，其声音如潮水响，声如拉锯，必须紧急攻逐痰饮，宜用苏葶滚痰丸顺势治疗。如果是停饮导致喘急，不能平卧的，又当泻除饮邪、降逆气，用苏葶丸治疗。
马脾风
小儿突发气喘，俗称马脾风。因为寒邪客居于肺俞穴，寒邪化为热邪，闭塞于肺经，所以胸部高起，气促，肺胀喘满，两胁扇动，凹陷成坑，鼻翼扇动，神志闷乱。初遇此症，急服五虎汤，继用一捻金攻下。倘若得气开通，疗效最灵。如果婴儿在百日内出现这种情况，病情大多难以救治。
General Overview
The *Bingji Shi Yao* (Essentials of Pathogenesis) states: When the Lung is diseased, coughing occurs, characterized by phlegm and sound, resulting from Lung Qi injury stirring up Spleen dampness. If there is only sound without phlegm, it is termed "Ke" (Cough), indicating Lung Qi injury and lack of clear descending function. If there is phlegm without sound, it is termed "Sou" (Phlegm-rattling), caused by Spleen dampness generating phlegm. Although both belong to Lung diseases, they are differentiated into Lung Cold and Lung Heat, as well as Food Stagnation and Wind-Cold. Physicians must distinguish them carefully.
Lung Cold Cough
Cold-type cough arises because the Lung is inherently deficient and prone to consuming cold/raw foods, leading to Cold Evil injuring the Lung and triggering cough. Symptoms include a pale complexion, abundant phlegm, and thin, clear nasal discharge. Initially, Shenghui Jupi San (Holy Benefit Tangerina Peel Powder) should be used as the primary formula. If the cough persists for a long time, Bufe Ejiao San (Tonify Lung Donkey-Hide Gelatin Powder) is required to regulate Qi, resolve phlegm, and calm the cough.
Lung Heat Cough
Fire-type cough is caused by Fire-Heat harassing the Metal of the Lung, leading to frequent coughing, flushed face, dry throat, yellow and foul-smelling sputum that is thick and sticky. For those with loose stools, Jiawei Xiebai San (Modified Draining White Powder) is the main treatment. For those with hard stools, Jiawei Liangge San (Modified Cooling Diaphragm Decoction) is decocted and taken; this clears heat and purifies Qi, stopping the cough naturally.
Food Stagnation Cough
This condition results from food stagnation in children generating phlegm, with Heat steaming upward, causing rapid Lung Qi and phlegm obstruction, leading to frequent coughing. If stools are loose, Qumai Erchen Tang (Qu Mai Erchen Decoction) is used. If stools are dry, Sutting Guntan Wan (Suting Rolling Phlegm Pill) is used to purge downward.
Wind-Cold Cough
When children expose themselves to cold by removing clothes, Wind-Cold invades, affecting the Lung first. This causes Qi to rebel upward, blocking the throat and inducing cough. Symptoms include sneezing, runny nose, nasal congestion with heavy voice, and excessive salivary phlegm. First, disperse and release Wind-Evil using Shenru Yin (Ginseng and Perilla Drink). Subsequently, clear phlegm and cough using Jinfei Tang (Golden Boiling Decoction). If Cold Evil is obstructive, dispel the Cold using Jiawei Huagai San (Modified Huagai Powder); once Wind-Evil is resolved and the Qi pathway is unobstructed, the cough heals.
General Overview on Asthma/Wheezing
Asthma/Wheezing (Chuan Zheng) is characterized by急促 breathing and outward signs such as raising shoulders and protruding abdomen. Wheezing (Xiao) is characterized by sounds in the throat. However, the origins of disease vary. In Excess-Heat cases, there is coarse breathing, chest fullness, thick phlegm, constipation, and wheezing. In Deficiency-Cold cases, there is weak Qi, faint breath, inability to sustain respiration, and wheezing. There are also cases of asthma due to Wind-Cold obstruction, phlegm-fluid rebellion, and Ma Pi Feng (Horse Spleen Wind), which is the most critical emergency. Physicians must treat these distinctly and clearly.
Fire-Heat Asthma/Wheezing
When Fire Evil attacks Lung Metal causing wheezing, symptoms include dry mouth and tongue, thirst, flushed face, and red lips. If caused by Lung Heat, Liangge San (Cooling Diaphragm Powder) is the main treatment. If caused by Stomach Heat, Baihu Tang (White Tiger Decoction) clears it. If Heart Fire attacks Lung Metal, Daochi San (Guiding Red Powder) is appropriate. If Kidney Deficiency Fire scorches Lung Metal, Zhibo Dihuang Tang (Anemarrhena and Rehmannia Decoction) is the most effective treatment.
Lung Deficiency Asthma/Wheezing
In Deficiency Asthma/Wheezing, Qi is weak and voice is short and rough. Jiegu Huangqi Tang (Jiegu Astragalus Decoction) treats this most swiftly. If deficiency is complicated by phlegm causing panting, Baihe Gujin Tang (Lily Preserving Metal Decoction) is used. If deficiency is complicated by Heat, Ben Shi Fang Huangqi Tang (Ben Shi Formula Astragalus Decoction) is decocted and taken.
Wind-Cold Asthma/Wheezing
The Lung governs skin and hair. Once invaded by Wind-Cold, internal Lung Qi is injured, causing Qi rebellion and failure to descend, leading to急促 breathing, exterior heat, and anhidrosis. Huagai San (Huagai Powder) should be used to induce sweating and dissipate the pathogen. If Lung Qi is originally deficient and further injured by Wind-Evil, Zisu Yin (Perilla Drink) tonifies and dissipates. If Lung is deficient but free from external Wind-Evil and internal phlegm-fluid obstruction, with only Qi rebellion and急促 breathing, Jiajian Suzi Jiangqi Tang (Modified Perilla Seed Descending Qi Decoction) descends the rebellious Qi, and the wheezing resolves spontaneously.
Phlegm-Fluid Asthma/Wheezing
When children have excessive phlegm-fluids causing Qi rebellion and wheezing, the sound resembles tidal waves or sawing wood. Urgent attack on phlegm-fluids is needed using Sutong Guntan Wan (Sutong Rolling Phlegm Pill). If retained fluids cause急促 breathing and inability to lie flat, fluids must be drained and Qi descended using Sutong Wan (Perilla and Thladiantha Pill).
Ma Pi Feng (Horse Spleen Wind)
Sudden severe wheezing in children is commonly known as Ma Pi Feng. It occurs when Cold Evil lodges in Feishu (BL13), transforms into Heat, and blocks the Lung Meridian. Symptoms include elevated chest,急促 breathing, Lung distension and fullness, flaring costal margins creating depressions, alar flaring, and confused spirit. Upon initial encounter, administer Wuhu Tang (Five Tigers Decoction) urgently, followed by Yiniang Jin (One Finger Gold) to purge. If Qi opens, the effect is most potent. If infants under 100 days present this, the prognosis is mostly poor.