肺主气，其变动为咳嗽者，肺证也。疮疹发热之初便有咳嗽者，肺为五脏之盖，疮疹之火挟君相二火之势上
熏乎肺，肺叶焦举，故气逆而咳也。疮疹既出，其咳更增者，此喉咙有疮，淫淫如痒，习习如梗，故咳
也。疮疹收后而咳者，此卫气虚弱，腠理疏开，风寒外袭，肺气逆而不收，故亦咳也。〔薛〕痘疹未出欲出之际，
乃热毒上熏清道，肺气不宁，宜用惺惺散。若已出之后，则属元气虚弱，不能固卫腠理，
风邪乘虚而袭，宜用五味异功散加桔梗、五味子以补脾肺。
《痘疹方》云∶痘疮未出之先咳嗽，升麻汤（初热）。头疼身热恶寒咳嗽，参苏饮（初热）。呕吐痰涎咳嗽，
白术汤。时气头痛身热咳嗽，惺惺散（初热）。〔万〕如初发热咳嗽甚者，先以参苏饮发之，次以甘桔汤（咽喉）合泻白
散（肺）加牛蒡子治之。
凡痘子出盛咳嗽者，此肺中有火，或咽喉有疮作痒也，只用甘桔汤加牛蒡子，多服良。如涎唾带血，此咽中疮或齿
缝中出也，不须妄治。疮不起发，闷乱喘嗽，手足寒，饮冷者，木香散（泻。）嗽甚，别无他证，五味子汤。如疮
光壮，收靥身热咳甚者，人参清膈散主之。如疮已靥咳嗽者，不问形寒饮冷所致，并宜人参清膈散主之。
若涕唾稠粘，鼻塞不利者，乃风邪伤肺也，亦惺惺散、参苏饮主之（俱初热）。
若痰盛烦躁，痘赤壮热饮冷者，乃脾肺实热也，人参清膈散主之，并饮芹菜汁。
若痰唾稠粘，大便黑色，乃胃经热毒也，用犀角汤（失血）并饮芹菜汁以解之。
病后余毒咳嗽者，升麻汤（初热）。感寒头痛，身热恶寒而嗽者，参苏饮。烦热而嗽者，生地黄散。风热咳嗽，咽膈
不利，甘桔防风汤（咽喉）。兼喘，五味子汤。病后咳嗽胁疼者，盖胁居一身之左右，阴阳二气之所行也，余毒在中，二
气不能升降，故胁痛，用赤茯苓汤、小柴胡汤（发热）加五味子、桔梗、枳壳等解去毒瓦斯，则真气行而所苦自平矣。
〔袁〕若痘交七八之期，而身发火热，恶嗽连声，鼻窍冲出鲜血，金虚则鸣，枭
毒激荡于太阴之络故耳，以杏仁五钱、冬花五钱、门冬五钱、栝蒌仁五钱、与梨汁共煎为膏时取起，再加白蜜人乳，
紧煎数沸，纳于瓷器内，每辰昏进两匙，其效神应。歌曰∶痘中恶嗽冲出血，要识金虚枭毒彻，冬花杏仁与麦门，梨
汁栝蒌仁最切，熬膏投和白蜜中，量数斟加人乳捷，去火紧封瓷器内，晨昏进服嗽声歇。痘中患嗽，极为凶险，但
有感冒风邪于肺络而嗽者，不在此犯论，易治易痊，若元虚气枭，甚宜调养，而男子时迈十七八岁，破阳损精，痘犯于
此，贵宜按方法服治，斯免夭亡矣。
白术汤 治咳嗽呕吐，痰涎气喘通用。
白术（一钱半） 陈皮 白茯苓 五味子 半夏 杏仁（各一钱） 甘草（半钱）
水一盏半，生姜三片，煎六分，分二服。
五味子汤 喘促咳嗽通用。
五味子（二钱） 人参 麦门冬 杏仁 陈皮（各一钱）
上锉散。水一盏，煎六分，空肚温服。儿小者分二服。
人参清膈散
人参 柴胡 当归 芍药 知母 桑白皮 白术 黄 紫菀 地骨皮 茯苓
甘草 桔梗（各一两） 黄芩（半两） 石膏 滑石（各一两半）
上为粗末。每服三钱，水一大盏，生姜三片，同煎至六分，去滓温服，不拘时，量儿大小加减服。
生地黄散 治小儿 疹，身热口干，咳嗽心烦等证。
生地黄（半两） 麦门冬（去心七钱） 杏仁 款冬花 陈皮（各三钱） 甘草（炙，二钱半）
上，每三五钱，水煎，徐徐服。儿大加之。若痰气痘热内作，宜用桔梗甘草防风汤，若痰上壅者，佐以抱龙丸。
赤茯苓汤
赤茯苓 甘草 大青 升麻 枳壳 栀子（各一钱）
上，用水一小盏，苦竹叶七片，豆豉三十粒，煎五分，分为三服。看儿大小加减。
桔梗汤 治久嗽肺气伤，而吐痰有血，痰或腥秽，或咳吐脓血、肺痈等证。
桔梗（炒） 贝母（去心） 知母 桑白皮 枳壳（各一钱） 地骨皮 栝蒌仁 薏苡仁 杏仁
（各五分） 当归 黄 （微炒） 防己（各一钱） 五味子 百合（炒。各一钱五分） 葶苈（炒，五分）
上，每服三五钱，水煎服。
肺主司气，其功能异常表现为咳嗽，这是肺的证候。在疮疹发热初期即出现咳嗽的，是因为肺位于五脏之上，如同华盖，疮疹的热毒挟带君火与相火之势向上熏灼肺部，导致肺叶焦枯上举，因此气机上逆而引发咳嗽。疮疹发出后，咳嗽反而加重的，这是因为喉咙处生有疮疡，感觉瘙痒不适，如有异物梗阻，所以引起咳嗽。疮疹结痂消退后仍咳嗽的，这是由于卫气虚弱，腠理疏松，风寒之邪外袭，导致肺气上逆而不能收敛，因此也发生咳嗽。〔薛己〕认为：痘疹在未出或欲出之际，是热毒上熏清道（呼吸道），肺气不安宁，适宜使用惺惺散。若痘疹已发出之后，则属于元气虚弱，不能固护腠理，风邪乘虚侵袭，适宜使用五味异功散加入桔梗、五味子以补益脾肺。
《痘疹方》记载：痘疮未发出之前出现咳嗽，用升麻汤（用于初热阶段）。头痛、身热、恶寒、咳嗽，用参苏饮（用于初热阶段）。呕吐痰涎并伴有咳嗽，用白术汤。时行感冒引起的头痛、身热、咳嗽，用惺惺散（用于初热阶段）。〔万全〕指出：如果初起发热时咳嗽严重，先用参苏饮发散，随后用甘桔汤（针对咽喉）合泻白散（针对肺）加入牛蒡子治疗。
凡是痘疹出得旺盛且咳嗽严重的，这是肺中有火，或者咽喉有疮疡作痒所致，只需使用甘桔汤加入牛蒡子，多服用效果良好。如果唾液中带血，这是咽喉疮疡或齿缝出血所致，不需要胡乱治疗。如果痘疮不起发，伴有烦闷混乱、气喘咳嗽、手足寒冷、想喝冷水的症状，用木香散（用于泻下）。咳嗽剧烈，没有其他症状，用五味子汤。如果痘疮光亮壮盛，结痂后身体发热且咳嗽严重，用人参清膈散主治。如果痘疮已经结痂但仍咳嗽，无论是由形寒饮冷引起还是其他原因，都适宜用人参清膈散主治。
如果鼻涕和唾液粘稠，鼻塞不通利，这是风邪伤肺，也适用惺惺散、参苏饮主治（均用于初热阶段）。
如果痰多烦躁，痘色红赤、壮热、想喝冷水，这是脾肺实热，用人参清膈散主治，并饮用芹菜汁。
如果痰唾粘稠，大便黑色，这是胃经热毒，用犀角汤（用于失血证）并饮用芹菜汁来解毒。
病后余毒引起的咳嗽，用升麻汤（用于初热阶段）。感受寒邪引起头痛、身热、恶寒而咳嗽的，用参苏饮。烦热而咳嗽的，用生地黄散。风热咳嗽，咽喉胸膈不利，用甘桔防风汤（针对咽喉）。兼有喘息的，用五味子汤。病后咳嗽伴胁痛的，因为胁部位于身体左右两侧，是阴阳二气运行的通道，余毒滞留其中，导致二气升降失常，所以胁痛，用赤茯苓汤、小柴胡汤（用于发热）加入五味子、桔梗、枳壳等药物解除毒气，使真气运行，痛苦自然平息。
〔袁氏〕说：如果在痘疹交结的七八天期间，身体发热如火，厌恶咳嗽连声不止，鼻孔冲出鲜血，这是因为金（肺）虚则鸣，枭毒激荡于太阴（肺）之络所致，可以用杏仁五钱、冬花五钱、麦门冬五钱、栝蒌仁五钱，与梨汁共同煎煮成膏，适时取出，再加入白蜜和人乳，快速煮沸数次，装入瓷器内，每天清晨和黄昏各服两匙，疗效神奇。歌诀说：痘中恶嗽冲出血，要识金虚枭毒彻，冬花杏仁与麦门，梨汁栝蒌仁最切，熬膏投和白蜜中，量数斟加人乳捷，去火紧封瓷器内，晨昏进服嗽声歇。痘疹中患咳嗽，极为凶险，但如果是因感冒风邪侵犯肺络而咳嗽的，不在此列讨论，容易治疗痊愈；如果是元气虚弱、气机逆乱，非常适宜调养；而男子到了十七八岁，破阳损精，痘毒犯于此，贵在按照方法服药治疗，这样才能避免夭折。
白术汤 治疗咳嗽呕吐，痰涎气喘通用。
白术（一钱半） 陈皮 白茯苓 五味子 半夏 杏仁（各一钱） 甘草（半钱）
加水一盏半，生姜三片，煎至六分，分两次服用。
五味子汤 治疗喘促咳嗽通用。
五味子（二钱） 人参 麦门冬 杏仁 陈皮（各一钱）
以上药材锉散。加水一盏，煎至六分，空腹温服。幼儿分两次服用。
人参清膈散
人参 柴胡 当归 芍药 知母 桑白皮 白术 黄芪 紫菀 地骨皮 茯苓
甘草 桔梗（各一两） 黄芩（半两） 石膏 滑石（各一两半）
以上药材制成粗末。每次服用三钱，加水一大盏，生姜三片，同煎至六分，去渣温服，不拘时间，根据患儿大小加减服用。
生地黄散 治疗小儿麻疹，身热口干，咳嗽心烦等证候。
生地黄（半两） 麦门冬（去心七钱） 杏仁 款冬花 陈皮（各三钱） 甘草（炙，二钱半）
以上药材，每次取三五钱，水煎，慢慢服用。大孩可加量。如果痰气痘热内生，宜用桔梗甘草防风汤，如果痰液上壅，佐以抱龙丸。
赤茯苓汤
赤茯苓 甘草 大青 升麻 枳壳 栀子（各一钱）
以上药材，用水一小盏，苦竹叶七片，豆豉三十粒，煎至五分，分三次服用。根据患儿大小加减。
桔梗汤 治疗久咳肺气受伤，吐痰带血，痰液腥秽，或咳吐脓血、肺痈等证候。
桔梗（炒） 贝母（去心） 知母 桑白皮 枳壳（各一钱） 地骨皮 栝蒌仁 薏苡仁 杏仁
（各五分） 当归 黄芪（微炒） 防己（各一钱） 五味子 百合（炒。各一钱五分） 葶苈（炒，五分）
以上药材，每次取三五钱，水煎服。
Lung governs Qi, and its pathological change manifests as coughing, which is a syndrome of the Lung. When coughing occurs at the beginning of fever in variola/rubella (chuang zhen), it is because the Lung acts as the canopy over the five Zang organs; the fire of the rash carries the momentum of the Sovereign Fire (Jun Huo) and Ministerial Fire (Xiang Huo) to scorch the Lung upwards, causing the lung lobes to become dry and elevated, thus leading to rebellious Qi and coughing. If the cough increases after the rash has erupted, this is due to sores in the throat that cause itching and a sensation of obstruction, resulting in coughing. If coughing persists after the rash has crusted and healed, this is because the Defensive Qi (Wei Qi) is weak, the interstices (Cou Li) are loose, allowing Wind-Cold to invade from outside, causing Lung Qi to rebel and fail to descend, hence also causing coughing. [Xue] states: At the stage when smallpox is about to erupt, heat-toxin ascends to cloud the clear passages (respiratory tract), disturbing the peace of Lung Qi; Xingxing San should be used. After eruption, it belongs to deficiency of Original Qi, failing to secure the interstices, allowing Wind pathogen to invade through the deficiency; Wuyi Yigong San with Jiegeng and Wuweizi should be used to tonify Spleen and Lung.
The *Douzhen Fang* (Smallpox Formulas) records: Coughing before the eruption of smallpox lesions calls for Shengma Tang (for initial heat stage). Headache, fever, aversion to cold, and coughing call for Shen Su Yin (for initial heat stage). Vomiting of phlegm-saliva with coughing calls for Baizhu Tang. Epidemic headache, fever, and coughing call for Xingxing San (for initial heat stage). [Wan] points out: If coughing is severe during the initial fever, first use Shen Su Yin to disperse, then treat with Ganjie Tang (targeting throat) combined with Xiebai San (targeting Lung) plus Niubangzi.
For cases where coughing is severe while smallpox lesions are abundant, this indicates fire in the Lung or itching caused by sores in the throat; only Ganjie Tang with Niubangzi should be used, taken frequently for good effect. If saliva contains blood, this is due to sores in the throat or bleeding from gum crevices; no arbitrary treatment is needed. If lesions fail to rise, accompanied by restlessness, panting, coughing, cold hands and feet, and desire for cold drinks, Muxiang San (for purging) is indicated. Severe coughing without other symptoms calls for Wuweizi Tang. If lesions are bright and robust, but body heat and severe cough persist after crusting, Renshen Qingge San is the primary formula. If coughing continues after lesions have crusted, regardless of whether caused by exposure to cold or drinking cold fluids, Renshen Qingge San is appropriate.
If nasal discharge and saliva are thick and sticky, with nasal congestion, this is Wind pathogen injuring the Lung; Xingxing San or Shen Su Yin may be used (both for initial heat stage).
If there is profuse phlegm, irritability, red and hot lesions, high fever, and desire for cold drinks, this is Excess-Heat in Spleen and Lung; Renshen Qingge San is indicated, along with drinking celery juice.
If saliva is thick and sticky, and stool is black, this is Heat-Toxin in the Stomach channel; Xijiao Tang (for hemorrhage) should be used, along with celery juice to resolve toxicity.
Coughing due to residual toxins after illness calls for Shengma Tang (initial heat stage). Coughing with headache, fever, and aversion to cold due to Cold invasion calls for Shen Su Yin. Coughing with irritability and heat calls for Shengdihuang San. Wind-Heat coughing with discomfort in the throat and chest calls for Ganjie Fangfeng Tang (targeting throat). Coughing with wheezing calls for Wuweizi Tang. Coughing with hypochondriac pain after illness occurs because the hypochondrium lies on both sides of the body, serving as the pathway for Yin and Yang Qi; residual toxins trapped within prevent the proper ascending and descending of these two Qi types, causing pain; Chifuling Tang and Xiaochaihu Tang (for fever) with Wuweizi, Jiegeng, and Zhike should be used to resolve toxic qi, allowing True Qi to circulate and suffering to cease.
[Yuan] states: During the seventh or eighth day of smallpox progression, if the body burns with heat, coughing is incessant and distressing, and fresh blood spurts from the nostrils, this is because Metal (Lung) deficiency causes ringing, and Xiao Du (ferocious toxin) agitates the collaterals of Taiyin (Lung). Use Xingren (5 qian), Donghua (5 qian), Menmendong (5 qian), and Gualou Ren (5 qian), decocted with pear juice into a paste. Remove from heat, add white honey and human milk, boil briefly, and store in porcelain. Take two spoons at dawn and dusk; the effect is miraculous. The song says: "Malignant cough in smallpox spurts blood, recognize Metal deficiency and pervasive toxin; Donghua, Xingren, and Maidong, Pear juice and Gualou Ren are most fitting; Boil paste with white honey, adjust dosage with human milk for speed; Seal tightly in porcelain away from fire, take at dawn and dusk to stop cough." Coughing in smallpox is extremely dangerous. However, coughing due to Wind pathogen invading Lung collaterals is not included in this discussion; it is easy to treat and cure. For those with Original Qi deficiency and rebellious Qi, careful nursing is essential. For males aged seventeen or eighteen who have depleted Yang and essence, if smallpox strikes here, strict adherence to treatment methods is crucial to avoid premature death.
Baizhu Tang: General formula for cough, vomiting, phlegm-saliva, and asthma.
Baizhu (1.5 qian), Chenpi, Baifuling, Wuweizi, Banxia, Xingren (each 1 qian), Gancao (0.5 qian).
Add 1.5 cups of water, 3 slices of Shengjiang, decoct to 0.6 cup, divide into two doses.
Wuweizi Tang: General formula for panting and coughing.
Wuweizi (2 qian), Renshen, Maidong, Xingren, Chenpi (each 1 qian).
Crush into coarse powder. Add 1 cup of water, decoct to 0.6 cup, take warm on an empty stomach. Infants divide into two doses.
Renshen Qingge San
Renshen, Chaihu, Danggui, Shaoyao, Zhimu, Sangbaipi, Baizhu, Huangqi, Ziwan, Digupi, Fuling, Gancao, Jiegeng (each 1 liang), Huangqin (0.5 liang), Shigao, Huashi (each 1.5 liang).
Grind into coarse powder. Take 3 qian per dose, add 1 large cup of water, 3 slices of Shengjiang, decoct to 0.6 cup, strain and take warm. No fixed time, adjust dosage according to child's age/size.
Shengdihuang San: Treats pediatric rubella/variolae with fever, dry mouth, cough, and irritability.
Shengdihuang (0.5 liang), Maidong (decored heart, 7 qian), Xingren, Kuandonghua, Chenpi (each 3 qian), Gancao (roasted, 2.5 qian).
Take 3-5 qian per dose, decoct in water, take slowly. Increase dose for older children. If phlegm-Qi and varicella heat arise internally, use Jiegeng Gancao Fangfeng Tang; if phlegm obstructs upward, assist with Baolong Wan.
Chifuling Tang
Chifuling, Gancao, Daqing, Shengma, Zhike, Zhizi (each 1 qian).
Use 1 small cup of water, 7 leaves of Kuzhuye, 30 grains of Douchi, decoct to 0.5 cup, divide into three doses. Adjust according to child's size.
Jiegeng Tang: Treats chronic cough injuring Lung Qi, expectoration of bloody sputum, foul-smelling sputum, hemoptysis, lung abscess, etc.
Jiegeng (fried), Beimu (decored heart), Zhimu, Sangbaipi, Zhike (each 1 qian), Digupi, Gualou Ren, Yiyiren, Xingren (each 0.5 qian), Danggui, Huangqi (lightly fried), Fangji (each 1 qian), Wuweizi, Baihe (fried, each 1.5 qian), Tingli (fried, 0.5 qian).
Take 3-5 qian per dose, decoct in water and take.