喘与咳皆肺病，其有肾气逆而为喘咳者，则不得独治肺。五味子敛肺气摄肾气，自是要
药。然但能安正不能逐邪，有邪用之，须防收邪气在内。仲圣以五味伍桂枝，则云下冲气，
去桂加干姜细辛，则云治咳满，可见咳满之任，在姜辛不在五味。然而去桂不去五味，其他
治咳逆诸方，又无不三物并用，其故何也？曰∶足太阳手太阴同为一身之卫，二经之病，往
往相通。小青龙汤，伤寒太阳病也，而杂证肺病亦恒用之。推之苓甘五味姜辛汤、浓朴麻黄
汤，皆肺中有寒饮，皆小青龙出入加减。小青龙系外寒与内饮相搏，故咳逆；若兼外寒，方
中必有麻桂，无外寒者无之。至三物并用，则非分疏不明。肺中冷必眩多涎唾，甘草干姜汤
以温之，此干姜温肺之据。用干姜者，肺寒非干姜不温也。张隐庵之疏细辛也，曰∶气味辛
温，一茎直上，色赤黑，禀少阴泉下之水气而上交于太阳。审乎是而谓细辛不能发汗耶，则
细辛辛温而烈，实能由少阴达表。谓细辛能发汗耶，则细辛细碎之体，那得劲力。所以发少
阴之汗，必与麻黄并用；而散肺中寒饮，则正其所优为。二物一温一散，肺邪已足了之；而
必加以五味，且数多于姜辛，几令人不解。此则治病即以善后，仲圣盖虑之周也。肺苦气上
逆，咳则逆，喘则且至于胀，既张之肺，欲翕不得，有邪虽去而咳犹不止者，谓五味可无乎
不可无乎。或曰∶烦躁而喘者加石膏，胃热熏面者加大黄，得毋三物亦治热咳？不知饮自寒
而挟自热，三物所治仍属寒饮，不得因是致疑。或又曰∶三物治咳，惟细辛关系最重，而小
柴胡汤咳加干姜五味，独不加细辛，岂传写有脱佚耶？夫寒饮迫肺而咳者，可从表解，可从
下泄。少阳在半表半里，间有咳者，殆阳不胜阴而以微寒侵肺耳。无饮可蠲，何需乎细辛。
此伤寒太
尤氏曰∶五味子治嗽，新病惟热伤肺者宜之。若风寒所客，则敛而不去矣。久病气耗者
，非五味子不能收之。然热痰不除，则留固弥坚矣。（见金匮翼）按所论甚是，而不免于语
病。肺为热伤，固非敛不救，如孙真人生脉散之以五味治暑病，然方中必重任人参麦冬生津
止渴之品。即尤氏所引治热咳诸药不效者方，亦何尝无清涤肺热如石膏知母枇杷叶之类，虽
新病不得重
喘证与咳嗽证皆属于肺部的疾病，如果是由肾气上逆导致的喘咳，就不能仅仅治疗肺部。五味子能够收敛肺气、摄纳肾气，这确实是关键药物。然而，它只能安定正气而不能驱逐邪气，如果有邪气存在而使用它，必须防止将邪气收敛在体内。张仲景将五味子与桂枝配伍，说是为了降下冲逆之气；去掉桂枝加入干姜、细辛，说是为了治疗咳嗽和胸满，由此可见，治疗咳嗽和胸满的关键在于干姜和细辛，而不在于五味子。然而，在去掉桂枝却保留五味子的情况下，其他治疗咳逆的方剂中，这三味药（干姜、细辛、五味子）又无不是同时使用的，这是什么原因呢？回答说：足太阳膀胱经和手太阴肺经共同构成人体的卫外功能，这两条经络的病症，往往相互关联。小青龙汤本是治疗伤寒太阳病的方剂，但在杂病中的肺部疾病也常常使用它。推及苓甘五味姜辛汤、厚朴麻黄汤，都是因为肺中有寒饮，都是从小青龙汤加减变化而来。小青龙汤是针对外寒与内饮相互搏结，所以出现咳逆；如果兼有外寒，方中必然有麻黄和桂枝，没有外寒的就没有这两味药。至于三味药（干姜、细辛、五味子）并用，其中的道理如果不分析清楚就不明白。肺中寒冷必定会出现眩晕和多涎唾的症状，甘草干姜汤用来温补肺部，这是干姜温肺的依据。使用干姜的原因在于，肺寒非干姜不能温煦。张隐庵对细辛的注解说：细辛气味辛温，一茎直上，颜色赤黑，禀受少阴肾经泉下的水气而上交于太阳膀胱经。明白了这一点，如果说细辛不能发汗，那是不对的，因为细辛辛温而猛烈，确实能由少阴经达于体表。如果说细辛能发汗，那么细辛细小破碎的质地，哪里会有强劲的力量？所以发少阴经之汗，必须与麻黄并用；而疏散肺中的寒饮，则是它的专长。干姜和细辛一温一散，足以消除肺中的邪气；但一定要加上五味子，而且数量多于干姜和细辛，几乎让人难以理解。这正是治病的同时兼顾善后，张仲景考虑得非常周全。肺脏厌恶气机上逆，咳嗽就是气逆，喘息则甚至导致胸部胀满，已经胀大的肺脏，想要收缩却无法做到，此时即使邪气已去而咳嗽仍不止，能说五味子可有可无吗？有人说：烦躁而喘的加石膏，胃热熏蒸面部的加大黄，难道这三味药也能治疗热咳吗？不知道饮邪源于寒而挟带的热，这三味药所治疗的仍然属于寒饮，不能因此产生怀疑。又有人说：这三味药治疗咳嗽，只有细辛关系最重，而在小柴胡汤治疗咳嗽时加入干姜和五味子，唯独不加细辛，难道是传抄时有遗漏吗？寒饮迫肺导致咳嗽的，可以从表解，也可以从下泄。少阳经位于半表半里之间，偶尔出现的咳嗽，大概是阳气不胜阴气而以微寒侵扰肺部罢了。没有饮邪可以蠲除，哪里需要用到细辛。尤氏说：五味子治疗咳嗽，新发病且只有热邪伤肺的适宜使用。如果是风寒所客，就会收敛邪气而不散去。久病气虚耗损的，非五味子不能收敛。然而如果热痰不除，就会使留滞更加坚固。（见《金匮翼》）我认为他的论述很正确，但不免于有语病。肺被热邪所伤，固然非收敛不能救急，如孙思邈的生脉散用五味子治疗暑病，但是方中必定重用具有生津止渴功效的人参、麦冬。即使是尤氏所引用的治疗热咳诸药无效后的方子，又何尝没有清涤肺热的药物如石膏、知母、枇杷叶之类，即使是新病也不得重用……
Wheezing (Chuan) and coughing (Ke) are both diseases of the Lung. If wheezing and coughing arise from the rebellion of Kidney Qi, one cannot treat only the Lung. Wuweizi (Schisandrae Fructus), which astringes Lung Qi and secures Kidney Qi, is indeed an essential herb. However, it can only stabilize the righteous Qi but cannot expel pathogenic factors; if used when pathogens are present, one must guard against retaining the pathogens inside. Zhang Zhongjing combined Wuweizi with Guizhi (Cinnamomi Ramulus) to descend rebellious Qi; removing Guizhi and adding Ganjiang (Zingiberis Rhizoma) and Xixin (Asari Radix et Rhizoma) was to treat cough and chest fullness. This shows that the responsibility for treating cough and fullness lies with Ganjiang and Xixin, not Wuweizi. Yet, in formulas where Guizhi is removed but Wuweizi remains, other formulas treating cough and rebellion invariably use all three herbs together. Why is this? The answer is: the Foot-Taiyang Bladder channel and the Hand-Taiyin Lung channel jointly constitute the defensive function of the body. Diseases of these two channels often interconnect. Xiao Qinglong Tang (Minor Green Dragon Decoction) is originally for Taiyang disease in Shanghan (Cold Damage), but it is also frequently used for Lung diseases in miscellaneous disorders. By extension, Linggan Wuwei Jiangxin Tang (Glycyrrhiza, Schisandra, Ginger, and Asari Decoction) and Houpo Mahuang Tang (Magnolia Bark and Ephedra Decoction) both address cold-fluid retention in the Lung and are modifications derived from Xiao Qinglong Tang. Xiao Qinglong Tang addresses the struggle between exterior cold and interior fluid retention, causing cough and rebellion; if exterior cold is present, Mahuang (Ephedrae Herba) and Guizhi are included; if absent, they are not. Regarding the concurrent use of the three herbs (Ganjiang, Xixin, Wuweizi), the rationale must be clarified. Cold in the Lung inevitably causes dizziness and excessive saliva/phlegm; Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) warms the Lung, establishing Ganjiang as the agent for warming the Lung. Ganjiang is used because cold in the Lung cannot be warmed without it. Zhang Yin'an's commentary on Xixin states: "Its flavor is pungent and warm, its stem grows straight upward, its color is red-black, and it inherits the water-qi from the springs of the Shaoyin Kidney to ascend and connect with the Taiyang Bladder." Understanding this, if one claims Xixin cannot induce sweating, that is incorrect, as Xixin is pungent, warm, and potent, truly capable of reaching the exterior from the Shaoyin channel. If one claims Xixin induces sweating, given its small and fragmented nature, where would the strength come from? Therefore, to induce sweat from the Shaoyin channel, it must be used with Mahuang; whereas to disperse cold-fluid retention in the Lung, it excels. Ganjiang and Xixin, one warming and one dispersing, suffice to eliminate Lung pathogens; yet Wuweizi is added in quantities greater than Ganjiang and Xixin, which seems puzzling. This reflects treating the disease while considering aftermath; Zhang Zhongjing’s consideration was thorough. The Lung dislikes Qi rebelling upward; coughing is rebellion, and wheezing leads to distension. In a distended Lung that cannot contract, even if pathogens are gone, cough may persist. Can Wuweizi be considered optional or indispensable? Some say: For irritability and wheezing, Shigao (Gypsum Fibrosum) is added; for stomach heat steaming the face, Dahuang (Rhei Radix et Rhizoma) is added. Do these three herbs also treat hot cough? One must understand that fluid retention originates from cold but may be accompanied by heat; the three herbs still treat cold-fluid retention, so doubt should not arise. Others ask: Among the three herbs treating cough, Xixin is most critical. Yet in Xiaochaihu Tang (Minor Bupleurum Decoction) for cough, Ganjiang and Wuweizi are added, but Xixin is omitted. Was there an omission in transcription? When cold-fluid retention forces the Lung causing cough, it can be resolved via the exterior or drained downward. The Shaoyang Gallbladder channel is located at half-exterior and half-interior; occasional coughs here may result from Yang failing to overcome Yin, allowing slight cold to invade the Lung. With no fluid retention to dispel, why is Xixin needed? You Shi stated: "Wuweizi treats cough; for new-onset cases where only heat injures the Lung, it is suitable. If invaded by wind-cold, it will retain pathogens and prevent their expulsion. For chronic cases with Qi depletion, only Wuweizi can secure Qi. However, if hot-phlegm is not eliminated, retention becomes more entrenched." (See *Jinkui Yi*). His discussion is sound but contains logical flaws. If the Lung is injured by heat, astringency alone cannot save it. For instance, Sun Simiao’s Shengmai San (Generate the Pulse Powder) uses Wuweizi for summerheat disease, but heavily relies on Renshen (Ginseng Radix et Rhizoma) and Maidong (Ophiopogonis Radix) to generate fluids and quench thirst. Even in the formulas cited by You Shi where treatments for hot cough failed, did they lack heat-clearing and lung-purging herbs like Shigao, Zhimu (Anemarrhenae Rhizoma), and Pipaye (Loquat Leaf)? Even in new-onset cases, heavy use...