一、凡内伤之嗽，必皆本于阴分。何为阴分？五脏之精气是也。然五脏皆有精气，而又
惟肾为元精之本，肺为元气之主，故五脏之气分受伤，则病必自上而下，由肺由脾以及于肾
；五脏之精分受伤，则病必自下而上，由肾由脾以极于肺，肺肾俱病，则他脏不免矣。所以
劳损之嗽，最为难治，正以其病在根本，而不易为力也。病在根本，尚堪治不求本乎？故欲
治上者，不在乎上而在乎下；欲治下者，不在乎下而在乎上。知气中有精，精中有气，斯可
以言虚劳之嗽矣。
一、肺属金，为清虚之脏，凡金被火刑则为嗽，金寒水冷亦为嗽，此咳嗽所当治肺也。
然内伤之嗽，则不独在肺。盖五脏之精皆藏于肾，而少阴肾脉从肾上贯肝膈，入肺中，循喉
咙，挟舌本，所以肺金之虚，多由肾水之涸，正以子令母虚也。故凡治劳损咳嗽，必当以壮
水滋阴为主，庶肺气得充，嗽可渐愈，宜一阴煎、左归饮、琼玉膏、左归丸、六味地黄丸之
类择而用之。其有元阳下亏，生气不布，以致脾困于中，肺困于上，而为喘促，为痞满，为
痰涎呕恶，为泄泻畏寒，凡脉见细弱，证见虚寒而咳嗽不已者，此等证候，皆不必治嗽，但
补其阳而嗽自止，如右归饮、右归丸、八味地黄丸、大补元煎、六味回阳饮、理中汤，劫劳
散之类皆当随宜速用，不得因循，以致汲深无及也。
一、内伤咳嗽，凡水亏于下，火炎于上，以致火烁肺金，而为干渴烦热，喉痛口疮，潮
热便结，喜冷，尺寸滑数等证，则不得不兼清火，以存其水，宜四阴煎，或加减一阴煎、人
参固本丸主之。此当与咳血证参酌，其治详见血证门。
一、咳嗽声哑者，以肺本属金，盖金实则不鸣，金破亦不鸣。金实者，以肺中有邪，非
寒邪即火邪也；金破者，以真阴受损，非气虚即精虚也。寒邪者宜辛宜温，火邪者宜甘宜清
，气虚者宜补阳，精虚者宜补阴。大都此证，邪实者，其来暴，其治亦易，虚损者，其来徐
，其治亦难。治损之法，当与后干咳证参酌用之。
一、内伤虚损之嗽，多不宜用燥药及辛香动气等剂，如六安、二陈之类，皆不可轻用。
惟甘润养阴，如乳酥、蜂蜜、百合、地黄、阿胶、麦冬、去皮胡桃肉之类，皆所宜也。
一、外邪证多有误认为劳伤而遂成真劳者，此必其人气体柔弱，而医家望之已有成心，
故见其发热，遂认为火，见其咳嗽，遂认为劳，不明表里，率用滋阴降火等剂。不知寒邪既
已在表，凉药不宜妄投，若外既有寒，而内又得寒，则表里合邪，必致邪留不解，延绵日甚
。俗云∶伤风不愈变成劳。夫伤风岂能变劳？特以庸医误治而日加清削，则柔弱之人能堪几
多清理，久而不愈，不至成劳不已也，此实医之所误耳。故医于此证，最当详察在表在里，
及新邪久病等因，脉色形气等辨，辨得其真，则但以六安煎、金水六君煎，或柴陈煎之类，
不数剂而可愈矣。医之不精，此其一也。
一、干咳嗽证，在丹溪云∶火郁之证，乃痰郁火邪在肺中，用苦梗以开之，下用补阴降
火，不已则成劳，须用倒仓法。此证多是不得志者有之。愚谓丹溪此说，殊不其然，夫既云
不得志，则其忧思内伤，岂痰火病也？又岂苦梗倒仓所宜攻也？盖干咳嗽者，以肺中津液不足
，枯涸而然，此明系内伤亏损，肺肾不交，气不生精，精不化气，所以干涩如此。但其有火
无火，亦当辨治∶若脏平无火者，止因肺虚，故必先补气，自能生精，宜五福饮之类主之；
若脏气微寒者，非辛不润，故必先补阳，自可生阴，宜理阴煎或六君子汤之类主之；若兼内
热有火者，须保真阴，故必先壮水，自能制火，宜一阴煎，或加减一阴煎兼贝母丸之类主之
。若以此证而但知消痰开郁，将见气愈耗，水愈亏，未免为涸辙之鲋矣。
一、凡是内伤引起的咳嗽，必然根源于阴分。什么是阴分？就是五脏的精气。然而五脏都有精气，其中唯独肾是元精的根本，肺是元气的主宰。所以，如果五脏的气分受到损伤，疾病必然从上往下发展，由肺经脾传至肾；如果五脏的阴精分受到损伤，疾病必然从下往上发展，由肾经脾极于肺。当肺和肾都患病时，其他脏腑也就难免受累。因此，劳损导致的咳嗽最为难治，正是因为它病在根本，难以着力。既然病在根本，难道可以不求其本而治疗吗？所以，想要治上部的病，关键不在于上部而在于下部；想要治下部的病，关键不在于下部而在于上部。只有明白了气中有精、精中有气的道理，才可以谈论虚劳咳嗽的治疗了。
二、肺属金，是清虚之脏。凡是被火邪刑克（火克金）就会咳嗽，被寒邪侵袭（金寒水冷）也会咳嗽，这是咳嗽应当治肺的原因。然而内伤咳嗽，则不仅仅在于肺。因为五脏的精气都藏于肾，而足少阴肾脉从肾脏上行穿过肝脏和膈肌，进入肺中，沿着喉咙，夹持舌根。所以肺金的虚弱，多是由于肾水的枯竭所致，这正是“子病及母”（肾为肺之子，肾水亏虚导致肺金失养）的道理。因此，凡是治疗劳损咳嗽，必须以壮水滋阴为主，这样肺气才能充盈，咳嗽才能逐渐痊愈，适宜选用一阴煎、左归饮、琼玉膏、左归丸、六味地黄丸等方剂择而用之。如果有元阳在下部亏损，生气不能布散，导致脾在中焦困顿，肺在上焦困顿，而出现气喘急促、胸脘痞满、痰涎呕吐恶心、腹泻畏寒等症状，凡是脉象细弱，证候表现为虚寒且咳嗽不止的，这些证候都不必专门治咳，只需补益阳气，咳嗽自然停止，如右归饮、右归丸、八味地黄丸、大补元煎、六味回阳饮、理中汤、劫劳散等方剂都应当根据情况迅速使用，不得拖延，以免病情加深无法挽救。
三、内伤咳嗽，凡是下部水液亏虚，上部火炎上亢，导致火邪灼烧肺金，出现口干渴、心烦发热、咽喉疼痛、口舌生疮、潮热、大便干结、喜冷饮、寸关尺脉滑数等证候，则不得不兼用清火之法，以保存阴液，适宜用四阴煎，或加减一阴煎、人参固本丸主治。这应当与咳血证参照斟酌，其治疗方法详见血证门。
四、咳嗽声音嘶哑的，是因为肺本属金，所谓“金实不鸣，金破亦不鸣”。金实，是指肺中有邪气，不是寒邪就是火邪；金破，是指真阴受损，不是气虚就是精虚。寒邪致病宜用辛温药，火邪致病宜用甘清药，气虚宜补阳，精虚宜补阴。大体上这类证候，邪气实盛的，发病急暴，治疗也容易；虚损的，发病缓慢，治疗也困难。治疗虚损的方法，应当与后文的干咳证参照使用。
五、内伤虚损引起的咳嗽，大多不宜使用燥湿药及辛香动气等药剂，如六安煎、二陈汤之类，都不可轻易使用。只有甘润养阴的药物，如乳酥、蜂蜜、百合、地黄、阿胶、麦冬、去皮胡桃肉等，才是适宜的。
六、外感邪气的证候，多有被误认为是劳伤而导致真正变成劳损的，这一定是因为患者体质柔弱，而医生心中已有成见，见到发热就认为是火证，见到咳嗽就认为是劳损，不明辨表里，随意使用滋阴降火等药剂。不知道寒邪既然在体表，就不宜妄投凉药。如果外有寒邪，内又摄入寒凉药物，就会导致表里合邪，必然致使邪气留恋不解，病情日益加重。俗话常说：“伤风不愈变成劳。”难道伤风能变成劳损吗？特因庸医误治，每日加以清泻削弱，那么柔弱的人体能经受得住多少清理呢？久而久之不愈，最终才会变成劳损，这实在是医生的失误。所以医生遇到此类证候，最应当详细察辨是在表还是在里，是新感邪气还是久病，以及脉象、面色、形体、气息等的辨别。辨得其真实情况，则仅用六安煎、金水六君煎，或柴陈煎等方剂，不需多剂即可痊愈。医生医术不精，这就是其中之一。
七、关于干咳证，丹溪说：这是火郁之证，乃痰郁火邪在肺中，用桔梗来开提，下面用补阴降火药，如果不愈则会变成劳损，必须用倒仓法。这种证候多见于不得志的人。我认为丹溪的这种说法，并不完全正确。既然说是不得志，那么他的忧思内伤，难道是痰火病吗？又难道是桔梗、倒仓法所适宜攻伐的吗？大概干咳，是因为肺中津液不足，枯涸所致，这明确属于内伤亏损，肺肾不交，气不能生精，精不能化气，所以出现干涩的症状。但是否有火，也应当辨治：如果脏腑平和无火的，仅仅因为肺虚，所以必须先补气，自然能生精，适宜用五福饮等主治；如果脏腑之气微寒的，非辛温不能滋润，所以必须先补阳，自然可生阴，适宜用理阴煎或六君子汤等主治；如果兼有内热有火的，必须保护真阴，所以必须先壮水，自然能制火，适宜用一阴煎，或加减一阴煎兼贝母丸等主治。如果对此证只知道消痰开郁，将会看到气更加耗散，水更加亏虚，未免成为涸辙之鲋（陷入绝境的人）了。
1. All coughs caused by internal injury must originate from the Yin aspect. What is the Yin aspect? It refers to the essence and Qi of the five Zang organs. Although all five Zang organs possess essence and Qi, the Kidney is the root of primal essence (Yuan Jing), and the Lung is the master of primal Qi (Yuan Qi). Therefore, if the Qi aspect of the five Zang organs is injured, the disease inevitably progresses from top to bottom, spreading from the Lung through the Spleen to the Kidney; if the essence aspect of the five Zang organs is injured, the disease inevitably progresses from bottom to top, spreading from the Kidney through the Spleen to the extreme of the Lung. When both the Lung and Kidney are diseased, other Zang organs cannot escape involvement. Thus, coughs resulting from consumptive diseases (Lao Sun) are the most difficult to treat, precisely because the pathology lies in the root, making it hard to exert therapeutic force. Since the disease is at the root, can one treat it without addressing its root? Hence, to treat disorders above, the key lies not in the upper part but in the lower part; to treat disorders below, the key lies not in the lower part but in the upper part. Only by understanding that Qi contains Essence and Essence contains Qi can one discuss the treatment of consumptive coughs.
2. The Lung belongs to Metal and is a clear and empty organ. Cough occurs when Metal is controlled by Fire (Fire insulting Metal) or when Metal is cold and Water is frigid; this is why coughs generally require treatment targeting the Lung. However, internal injury coughs are not solely located in the Lung. The essence of the five Zang organs is stored in the Kidney, and the Foot-Shaoyin Kidney Meridian ascends from the Kidney, passes through the Liver and Diaphragm, enters the Lung, follows the throat, and flanks the base of the tongue. Therefore, deficiency of Lung Metal often results from depletion of Kidney Water, which is the principle of "the child affecting the mother" (Kidney being the child of Lung, Kidney Water deficiency leading to Lung Metal malnourishment). Consequently, treating consumptive coughs must primarily focus on strengthening Water and nourishing Yin, so that Lung Qi becomes sufficient and the cough gradually resolves. Suitable formulas include Yi Yin Decoction (One Yin Decoction), Zuo Gui Yin (Left Restoring Drink), Qiong Yu Gao (Jade Paste), Zuo Gui Wan (Left Restoring Pill), and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), selected according to the condition. If there is deficiency of Primal Yang in the lower jiao with failure of Sheng Qi (vital energy) to circulate, causing stagnation in the middle Jiao (Spleen) and upper Jiao (Lung), manifesting as panting, chest and epigastric fullness, phlegm-saliva vomiting, diarrhea, and aversion to cold, where the pulse is fine and weak, and the syndrome is deficient-cold with persistent cough, such syndromes do not require specific antitussive treatment. Instead, tonifying Yang will stop the cough spontaneously. Formulas such as You Gui Yin (Right Restoring Drink), You Gui Wan (Right Restoring Pill), Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill), Da Bu Yuan Jian (Great Tonifying Source Decoction), Liu Wei Hui Yang Yin (Six-Ingredient Returning Yang Drink), Li Zhong Tang (Regulate the Middle Decoction), and Jie Lao San (Rob Consumptiveness Powder) should be used promptly according to circumstances, without delay, to avoid irreversible deepening of the disease.
3. In internal injury coughs, when Water is deficient below and Fire flares above, burning Lung Metal, symptoms such as dry mouth and thirst, vexation and heat, sore throat, mouth ulcers, tidal fever, constipation, preference for cold drinks, and slippery-rapid pulses at the Cun, Guan, and Chi positions occur. In such cases, clearing Fire to preserve Yin fluids is necessary. Suitable formulas include Si Yin Decoction (Four Yin Decoction), Jia Jian Yi Yin Decoction (Modified One Yin Decoction), or Ren Shen Gu Ben Wan (Ginseng Root-Securing Pill). This should be considered alongside hemoptysis syndromes; detailed treatments are found in the Blood Syndromes chapter.
4. Hoarseness in cough arises because the Lung belongs to Metal: "Metal solid does not sound; Metal broken also does not sound." "Metal solid" indicates pathogenic factors in the Lung, either Cold or Fire pathogens; "Metal broken" indicates damage to True Yin, either Qi deficiency or Essence deficiency. For Cold pathogens, acrid-warm herbs are indicated; for Fire pathogens, sweet-clear herbs are indicated; for Qi deficiency, Yang tonification is indicated; for Essence deficiency, Yin tonification is indicated. Generally, in these conditions, excess pathogens present abruptly and are easier to treat, while deficiency-consumption presents insidiously and is harder to treat. Methods for treating consumption should be referenced against the subsequent section on dry cough.
5. Coughs due to internal deficiency-consumption generally should not use drying herbs or acrid-aromatic qi-moving agents, such as Liu An Decoction (Anhui Decoction) or Er Chen Tang (Two-Cured Decoction), which should not be used lightly. Instead, sweet-moistening Yin-nourishing substances like milk butter, honey, Lily Bulb, Rehmannia, Donkey-hide Gelatin, Ophiopogon, and peeled Walnut Meat are appropriate.
6. Exterior pathogen syndromes are often mistaken for consumptive injuries, leading to true consumptive disease. This usually happens in patients with weak constitution, where the physician has preconceived notions: seeing fever, they assume Fire; seeing cough, they assume Consumption, without distinguishing between exterior and interior, and arbitrarily using Yin-nourishing and Fire-descending agents. They fail to realize that if Cold pathogens are on the exterior, cooling herbs should not be recklessly administered. If exterior Cold is combined with internal Cold from medication, exterior-interior pathogens combine, causing pathogenic retention and progressive worsening. The common saying goes, "Wind-cold unrelieved turns into Consumption." Can wind-cold truly turn into consumption? It is merely that incompetent physicians misdiagnose and daily apply clearing and draining methods, exhausting the weak body until it eventually becomes consumption. This is truly medical error. Therefore, physicians must carefully distinguish whether the pathogen is in the exterior or interior, whether it is a new acquisition or chronic illness, and differentiate based on pulse, complexion, form, and Qi. Once the truth is identified, using only Liu An Decoction, Jin Shui Liu Jun Decoction (Metal-Water Six-Gentleman Decoction), or Chai Chen Decoction (Bupleurum-Chenpi Decoction) for a few doses can lead to recovery. Lack of medical precision is one cause of such errors.
7. Regarding dry cough, Danxi stated: "This is a Fire-stagnation syndrome, where phlegm-stagnant Fire pathogens reside in the Lung. Use Platycodon to open them up, and below use Yin-tonifying and Fire-descending herbs. If unresolved, it becomes consumption, requiring the Dao Cang method (purging therapy)." This syndrome is mostly seen in those who are frustrated/unfulfilled. I argue that Danxi's view is not entirely accurate. If it is due to frustration, then the internal injury from worry and thought—is it really a Phlegm-Fire disease? Is it suitable for attack by Platycodon or purging? Dry cough is essentially due to insufficient fluids in the Lung, leading to desiccation. This clearly belongs to internal injury and depletion, with non-interaction between Lung and Kidney, Qi failing to generate Essence, and Essence failing to transform Qi, resulting in dryness. However, the presence or absence of Fire must be differentiated: If the Zang organs are balanced without Fire, and it is merely Lung deficiency, first tonify Qi to naturally generate Essence; Wu Fu Yin (Five Blessings Decoction) is suitable. If the Zang Qi is slightly cold, non-acrid-warm cannot moisten; thus, first tonify Yang to naturally generate Yin; Li Yin Jian (Nourish Yin Decoction) or Liu Jun Zi Tang (Six-Gentleman Decoction) is suitable. If accompanied by internal heat and Fire, True Yin must be protected; thus, first strengthen Water to control Fire; Yi Yin Decoction or Jia Jian Yi Yin Decoction combined with Bei Mu Wan (Fritillaria Pill) is suitable. If one only knows how to resolve phlegm and relieve stagnation in this condition, Qi will be further depleted, Water further exhausted, leaving the patient like a fish in a dried-up rut (in a desperate situation).