痰则涤之。有久病忽咳，病虽久而咳则暴，亦为新咳，必新伤风食也。风则疏之，食则消之即愈矣。久咳者属虚
属郁，有由气虚者，有由血虚者，有由血虚火盛喘咳声嘶者，有气血两虚者，有虚劳嗽痰热渴汗者，有虚劳咳血
痰喘者。有虚劳嗽一二声无痰，夜则发热，过则冷，睡多梦者。有火郁于肺，咳则有声无痰者。有湿痰内郁，痰
出则咳少止，少顷又咳者。而又有咳久伤脾，满面生疮者。有久咳失音者，有久咳失气者，有久咳面目浮肿者，
有久咳成劳者。有久咳经年百药不效，余无他证，与劳嗽异者。有痰郁火邪在中成干咳嗽者，此证极难治，先用开
剂（宜逍遥散重加桔梗），后用补阴之品。（《尊生书》）
新嗽易愈，久嗽难愈。所以难愈者，由病邪传变而入深也。（《苍生司命》）
外感内伤证治（不内外因诸证）外感有嗽，内伤亦有嗽，此一实一虚，治当有辨也。盖外感之嗽，必
因偶受风
寒，故或为寒热，或为气急，或为鼻塞声重，头痛吐痰。邪轻者，脉亦和缓；邪甚者，脉或弦洪微数。但其素
无积劳虚损等证，而陡病咳嗽者，即外感证也。若内伤之嗽，则其病来有渐，或因酒色，或因劳伤，必先有微
嗽而日渐以甚。其证则或为夜热潮热，或为形容瘦减，或两颧常赤，或气短喉干。其脉轻者亦必微数，重者必细
数弦紧。盖外感之嗽其来暴，内伤之嗽其来徐。外感之嗽因于寒邪，内伤之嗽因于阴虚。外感之嗽可温可散，
其治易；内伤之嗽宜补宜和，其治难。此固其辨也。然或其脉证素弱，而忽病外感者有之；或其形体素强，而
病致内伤者亦有之。此中疑似，但于病因脉色中细加权察，自有声应可证。若或认之不真而互谬其治，则吉凶攸
系不浅也，最宜慎之。（《景岳》）
外感咳嗽与阴虚咳嗽，尤宜辨晰。外感咳嗽，则声盛而浊，先缓后急，日夜无度，痰涎稠粘而喘急。阴虚劳
嗽，则声怯而槁，先急后缓，或早甚，或暮甚，清痰少气而喘乏也。（《医通》）
外感以有咳嗽为轻，盖肺气虽郁，尚能通也。故鼻流清涕，鼻痒而嚏，喉痒而咳。若郁甚热壅，不能上通，
则鼻干且塞，无喷嚏咳嗽之证矣。盖郁不甚者，尚欲外散与上通；甚则不外散而内攻，不上通而下郁也。内伤以
有咳嗽为重，如肝肾之火，其初止病下焦，未遽上干也。久而炎炽，乃反于肺，则病重矣。（若肺火自盛者，不在
此论。）（《医碥》）
按咳虽肺病，五脏六腑皆能致之。析其条目，经文尚有漏义；总其纲领，不过内伤外感而已。风寒暑湿伤其
外，则先中于皮毛，皮毛为肺之合，肺邪不解，他经亦病，此自肺而后传于诸脏也。劳欲情志伤其内，则脏气受
伤，先由阴分而病及上焦，此自诸脏而后传于肺也。自表而入者，病在阳，
宜辛温以散邪，则肺清而咳愈。自内而生者，病在阴，宜甘以壮水，润以养金，则肺宁而咳愈。大抵治表者，药
不宜静，静则留连不解，变生他病，故忌寒凉收敛，如《五脏生成篇》所谓肺欲辛是也。治内者，药不宜动，动
则虚火不宁，燥痒愈甚，故忌辛香燥热，如《宣明五气篇》所谓辛走气、气病无多食辛是也。（《必读》）
病者咳嗽，发作寒热，引腰背痛，或复喘满，此因房劳伤肾。病者中满腹胀，抢心痛，不欲食，此因饥饱伤
脾。病者咳嗽，左胁偏疼，引小腹并膝腕疼，此因疲极伤肝。病者咳嗽，吐白涎，口燥声嘶，此因叫呼伤肺。病者
喘嗽，烦热自汗，咽干咯血，此因劳神伤心，并属不内外因。（《三因》）
七情饥饱嗽，无非伤动脏腑正气，致邪上逆，结成痰涎，肺道不理，宜顺气为先，四七汤半帖，加桑白皮、
杏仁、五味子、人参、阿胶各半钱。有嗽吐痰与食俱出者，此盖饮食失节，致肝气不利，而肺又有客邪，肝浊道，
肺清道，清浊相干，宜二陈汤加木香、杏仁、细辛、枳壳各半钱。有饮冷热酒，或饮冷水，伤肺致嗽，俗谓之凑肺，
宜紫菀饮。（《要诀》）（按∶紫菀饮即《济生》紫菀茸汤。）
凡好色之人，元气虚弱，咳嗽不愈者，宜琼玉膏最捷。肺虚甚者，人参膏以生姜、橘红佐之。有痰，加痰药。
（《原理》）
有兼停饮食而咳，须用消化之方，不可用乌梅、粟壳酸涩药。其寒邪未除，宜用发散之剂，不可便用补剂。
（《医通》）
劳嗽（肺中有虫嗽）今之所谓劳嗽者，无所经见，意其华佗所谓邪嗽，真人所谓疰嗽者是已。此病盖酒
色过度，劳极伤肺，损动经络，其重者咯唾脓血，轻者时发时瘥。又有因虚，感邪恶之气，且传疰得之，或先呕
血而后嗽，或先咳
嗽渐就沉羸，此则非特内伤肺经，又挟邪恶传疰之气，所以特甚，病之毒害，无过此也。真人治疰嗽通气丸方，
用蜈蚣四节。又云∶梦与鬼交通及饮食者，全用蜈蚣。《外台》方，四满丸，治五嗽亦用蜈蚣。近世名公能推
原其指意，率用蛤蚧、天灵盖、桃柳枝、麝香、丹砂、雄黄、安息香之类，以通神明之药疗之，高出古人之意
矣。又肺中有虫如蚕，令人喉痒而咳，汤散迳过，针灸不及，以药含化，虫死即嗽止。（《鸡峰》）
至若酒色过度，虚劳少血，津液内耗，心火自炎，遂使燥热乘肺，咯唾脓血，上气涎潮，其嗽连续而不已。
惟夫血不荣肌，故邪在皮毛，皆能入肺，而自背得之尤速，此则人参、芎、归所不可无。（按∶《医通》曰∶
当与炙甘草汤，或黄 建中加丹皮。盖丹皮辛香，调和营气，治无汗骨蒸，故阴虚人解表，以丹皮为向导。）
一种传注，病涉邪恶，五脏受克，毒害尤深，近世率用蛤蚧、天灵盖、桃柳枝、丹砂、雄黄、安息香、苏合香丸
通神之剂。（《直指》）
有劳嗽一证，皆因肺虚，或苦风寒暑湿，及劳逸抑郁，忧思喜怒，饮食饥饱，致脏腑不平，积微至着，以至
渐成肺痿肺痈者。咳嗽有多痰者，有干咳无痰者，甚则失声，咳唾脓血，身体发热，五心烦热，盗汗自出，夜
梦鬼交，日轻夜重，肢体憔悴，皮肤干燥，颊赤如敷胭脂，饮食日少。古人云∶疮一月不愈，则疮中有虫；咳嗽
一月不愈，则肺中有虫。若肺有虫，则药难为功矣。肺虫如蚕，渐致变乱，日将月积，致成劳虫矣。（《治病活
法秘方》）
劳嗽有因久嗽成劳者，有因病劳乃嗽者。其证寒热往来，或独热无寒，咽痛嗌痛，精神疲极。所嗽之痰，或
浓或淡，或时有血，腥臭异常，语声不出者，补肺汤半帖，加杏
仁、贝母、款冬花、阿胶、百合各半钱，煎去滓，调钟乳粉。咽痛者，更加桔梗半钱。热甚者，更加秦艽半钱。
呕者，去地黄，加半夏如其数。气急者，加灵砂丹或二炒丹。（《要诀》）
若饥时胸中大痛，唇面上有白点如粟，咽喉或痒或痛而咳不可忍，脉极数，或忽大忽小，此必肺中有寸白虫，
饥则虫上求食，痛嗽不宁也。一味百部蒸膏，略加槟榔、乌梅。（《医通》）（按∶百部治久咳，出《千金》。）
呷嗽 呷嗽者，犹是咳嗽也。其胸膈痰饮多者，嗽则气动于痰，上搏喉咽之间，痰气相击，随嗽动息，
呼呷有声，谓之呷嗽。其与咳嗽大体虽同，至于投药，则应加消痰破饮之物，以此为异耳。（《病源论》）
瘀血嗽 肺胀而嗽，或左或右不得眠，此痰挟瘀血碍气而病。宜养血以流动乎气，降火疏肝以清痰，四
物汤加桃仁、诃子、青皮、竹沥、姜汁之类。血碍气作嗽者，桃仁去皮尖，大黄酒炒，姜汁丸服。（《丹溪》）
瘀血咳则喉间常有腥臭，轻者泻白散，加生地、山栀、牡丹皮、麦门冬、桔梗，重者桃仁、大黄，姜汁为丸
服。或因打损劳力伤肺，遇风寒则咳，或见血紫黑色者，四物汤去芎，加大黄、苏木为末，酒调服，利去心肺
间瘀血即止，后服人参养荣汤调理。（《入门》）
前后心胀，喉中有血腥气，气口脉涩，此膈间有蓄血也。试法，呷热姜汤作呃者，瘀血也。犀角地黄汤加童便、
桃仁、大黄攻散之，或平胃合越鞠，加韭汁、童便消伐之。气竭肝伤而咳嗽血腥者，四乌 一芦茹丸。（《医
通》）
时行嗽 时行嗽，发热恶寒，头痛鼻塞气急，状如伤冷热，连嗽不已，初得病即伏枕，一两日即轻。
记壬午秋，满
城有此病，继时甲午年夏秋之交，此病又自南而北，得免者少，并呼为虾蟆瘟，用参苏饮加细辛半钱。（《要
诀》）（按∶此证亦出徐应登《医便》，用败毒散。）
两在北方，遇夏秋久雨，天行咳嗽头痛，用古方益元散，姜葱汤调服，应手效，日发数十斤，经以彻夜。此
盖甲己土运湿令，痰壅肺气上窍，但泄其膀胱下窍而已，不在咳嗽例也。（《韩氏医通》）
顿呛 咳嗽俗名曰呛，连咳不已，谓之顿呛。顿呛者，一气连呛二、三十声，少则十数声。呛则头倾
胸曲，甚则手足拘挛，痰从口出，涕泣相随，从膺胸而下应于少腹。大人患此如同哮喘，小儿患此谓之时行顿呛。
顿呛不服药，至一月亦愈。（《医学真传》）（治方出清凉方中，宜参。）
咳嗽短气 肺主气，候皮毛。气虚为微寒客皮毛，入伤于肺则不足，成咳嗽。夫气得温则宣和，得寒
则否涩。虚则气不足而为寒所迫，并聚上肺间，不得宣发，故令咳而短气也。（《病源论》）
咳嗽上气 夫咳嗽上气者，肺气有余也。肺感于寒，微者则成咳嗽。肺主气，气有余则喘咳上气，此为
邪搏于气，气壅不得宣发，是为有余，故咳嗽而上气也。（《病源论》）
久咳嗽上气者，是肺气虚极，风邪停滞，故其病积月累年，久不瘥，则胸背痛面肿，甚则唾脓血。（同上）
咳嗽脓血 咳嗽脓血者，损肺损心故也。肺主气，心主血。肺感于寒，微者则成咳嗽，嗽伤于阴脉则有
血，血与气相随而行，咳嗽极甚，伤血动气，俱乘于肺，肺与津液相搏，蕴结成脓，故咳嗽而脓血也。（《病源
论》）
咳嗽极甚，伤于经络，血液蕴结，故有脓血。气血俱伤，故连滞积久，其血黯瘀，与脓相杂而出。（同上）
咳嗽吐粉红痰，谓之吐白血，仅可绵延岁月。若血色正
赤如朱，浓浓如漆，为守脏血，不治。咳而吐痰，膺乳痛，当看痰色如何。若浓浊如脓，或带血丝而臭，当从肺
痈例治之。（《医通》）
咳嗽声哑 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。（《景岳》）
脉或沉或浮，声不损者，易治；脉来洪数，形瘦面赤，肾脏气衰，不能上循于喉而声哑者，难疗。（按∶此
本于《原病集》。）亦有肺络支塞而声哑者，不在此例。（《医通》）
死证 咳，脱形发热，脉小坚急者死。肌瘦下（一本云不）脱形，热不去者死。咳而呕腹胀且泄。（按∶
此四字《中藏经》作便滑不禁）其脉弦急欲绝者死。（《脉经》）
咳而尿血羸瘦，脉大者死。（《病源论》）
劳嗽，上嗽下泻，用嗽药嗽止则泻甚，服香连丸则泻止复嗽，肺与大肠为表里，此脏腑俱病不可兼治者死。
（《苍生司命》）
阴虚火动，发而为喉痹，音哑者不治。嗽而大便泄者，难治。嗽而发热不止，难冶。（同上）
嗽而喉痛声哑不能药，或嗽而肛门脱，皆所不救也。（《石山医案》）
死证（六名）∶水肿、形脱、热不去、腹胀、呕、泻。（《识病捷法》）
治法要领 治嗽大法∶肺脉浮为风邪所客，以发散取之。肺脉实为气壅内热，以清利行之。脉濡散为肺
虚，以补肺安之。其间久嗽之人曾经解利，以致肺胃俱寒，饮食不进，则用理中助胃加和平治嗽等辈。（按∶此
下原有劳嗽说，既见上。）然则咳嗽证治，于此可以问津索涂矣，抑犹有说焉。肺出气也，肾纳气也。肺为气
之主，肾为气之藏。凡咳嗽暴重，动引百骸，自觉气从脐下逆奔而上者，此肾虚不能收气归元也，当以补骨脂安肾
丸主之，毋徒从事于宁肺（按∶安肾丸不必用，此存其理已），用枳壳为佐，枳壳不惟宽中，又能行其气，气下
痰下，他证自平。（《直指》）
大概以顺气为先，下痰次之，又有停饮而咳者，又须消化之，切不可轻用罂粟壳等药涩之。又有寒邪未除者，
亦不可便用补药。最忌忧思过度，房室劳伤，否则多成瘵疾，谨之谨之。（《大成》）
肺主皮毛，人之无病之时，荣卫周流，内气自皮肤腠理，普达于外。一或风寒外束，则内气不得于外达，便
从中起，所以气升痰上，故咳嗽。宜用辛温辛凉之剂以发散风寒，则邪退正复而嗽止也。又按肺为华盖，凡饥饱
劳役，喜怒忧恐，与夫饮醇醪，食浓味，则火升痰上而伤于肺，亦作咳嗽。宜用降火豁痰之剂，则火降痰消而咳
止也。又按肺主气，营运血液，周流一身。肺金也，受火邪，气从火化，有升无降，为嗽为喘。久而不治，虚极
至损，则不能运化气液，发为烦热惊悸，咳唾粘涎脓血。宜用补虚润燥、开郁散火之剂，则肺得清正而嗽止也。
痰浊应当涤除。如果是久病突然咳嗽，虽然病程长但咳嗽发作急骤，这也属于新发咳嗽，必定是新的伤风或饮食积滞所致。风邪应当疏解，食积应当消导，这样就能痊愈。久咳多属于虚证或郁证，有的由气虚引起，有的由血虚引起，有的因血虚火旺导致气喘、咳嗽、声音嘶哑，有的气血两虚，有的虚劳伴有咳嗽、痰多、发热、口渴、出汗，有的虚劳伴有咳血、痰喘。有的虚劳咳嗽仅一二声且无痰，夜间发热，过后发冷，睡眠多梦。有的火邪郁结于肺，咳嗽有声但无痰。有的湿痰内郁，痰出则咳嗽稍止，片刻后又咳。还有因久咳损伤脾胃，满面生疮的。有久咳失音的，有久咳失气的，有久咳面目浮肿的，有久咳发展为虚劳的。有久咳经年百药不效，没有其他症状，与虚劳咳嗽不同的。有痰郁火邪在中焦形成干咳嗽的，此证极难治疗，先用开郁剂（宜用逍遥散重加桔梗），后用补阴的药物。（《尊生书》）
新发的咳嗽容易治愈，久咳难以治愈。之所以难愈，是因为病邪传变深入所致。（《苍生司命》）
外感与内伤的咳嗽证治（不内外因诸证）：外感会有咳嗽，内伤也会有咳嗽，这是一实一虚两种情况，治疗时应当辨别。大概外感的咳嗽，必定是因为偶然受风寒，所以或者出现寒热往来，或者气急，或者鼻塞声重，头痛吐痰。邪气轻的，脉象也平和舒缓；邪气重的，脉象可能弦、洪、微数。只要平时没有积劳虚损等证，而突然患病咳嗽的，就是外感证。如果内伤的咳嗽，则发病缓慢，或因酒色过度，或因劳累损伤，必定先有轻微咳嗽然后日渐加重。其症状或者夜间潮热，或者形体消瘦，或者两颧常红，或者气短喉干。其脉象轻取必微数，重按必细数弦紧。大概外感咳嗽发病急骤，内伤咳嗽发病徐缓。外感咳嗽因于寒邪，内伤咳嗽因于阴虚。外感咳嗽可用温法或散法，治疗容易；内伤咳嗽宜补益宜调和，治疗困难。这确实是两者的区别。然而也有平时脉证虚弱却突然患外感的；也有平时形体强壮却因病导致内伤的。这种疑似情况，只要在病因、脉象、面色中仔细权衡考察，自然有相应的证据可以验证。如果认识不真切而互相错误地治疗，那么吉凶关系重大，最需谨慎。（《景岳全书》）
外感咳嗽与阴虚咳嗽，尤其需要辨析清楚。外感咳嗽，声音盛大而浑浊，先缓后急，日夜不停，痰涎稠粘且气喘急促。阴虚劳嗽，声音怯弱干枯，先急后缓，或者早晨严重，或者傍晚严重，清稀痰少气短且气喘乏力。（《医学统旨》）
外感以有咳嗽为轻症，因为肺气虽然郁滞，尚能通畅。所以鼻流清涕，鼻痒打喷嚏，喉痒咳嗽。如果郁滞严重热邪壅盛，不能上通，则鼻干且塞，没有喷嚏咳嗽的症状了。大概郁滞不严重的，尚想向外发散和向上通畅；严重时就不向外发散而向内攻伐，不向上通畅而向下郁结。内伤以有咳嗽为重症，如肝肾之火，起初只病在下焦，并未立刻上犯。时间久了火势炽盛，反而反侮于肺，则病情就重了。（若肺火自盛的，不在此讨论范围。）（《医碥》）
按：咳嗽虽然是肺的病，但五脏六腑都能导致它。分析其条目，经文尚有遗漏的意义；总结其纲领，不过是内伤和外感而已。风寒暑湿伤害体表，先侵犯皮毛，皮毛是肺的合应部位，肺邪不解，其他经络也会生病，这是从肺而后传变到各脏。劳欲情志伤害体内，则脏气受伤，先从阴分发病进而波及上焦，这是从各脏而后传变到肺。从表入里的，病在阳，宜用辛温药以发散邪气，则肺清而咳嗽痊愈。从内生发的，病在阴，宜用甘味药以壮水，润味药以养金，则肺宁而咳嗽痊愈。大抵治疗表证的，药物不宜静守，静守则病邪留恋不解，变生他病，所以忌用寒凉收敛药，如《五脏生成篇》所说“肺喜辛”就是这个道理。治疗里证的，药物不宜动散，动散则虚火不安，燥痒更甚，所以忌用辛香燥热药，如《宣明五气篇》所说“辛走气，气病不要多吃辛”就是这个道理。（《必读》）
病人咳嗽，发作时寒热，牵引腰背痛，或者又气喘胸满，这是因为房劳伤肾。病人中脘胀满腹胀，心痛抢心，不想吃东西，这是因为饥饱伤脾。病人咳嗽，左胁偏疼，牵引小腹及膝腕疼痛，这是因为疲劳过度伤肝。病人咳嗽，吐白涎，口干燥声音嘶哑，这是因为喊叫伤肺。病人气喘咳嗽，烦热自汗，咽干咯血，这是因为劳神伤心，都属于不内外因。（《三因方》）
七情饥饱引起的咳嗽，无非是伤动脏腑正气，导致邪气上逆，结成痰涎，肺道不利，宜以顺气为先，用四七汤半帖，加桑白皮、杏仁、五味子、人参、阿胶各半钱。有咳嗽吐痰与食物一起出来的，这大概是饮食失节，导致肝气不利，而肺又有客邪，肝主浊道，肺主清道，清浊相干扰，宜用二陈汤加木香、杏仁、细辛、枳壳各半钱。有喝冷热酒，或喝冷水，伤肺导致咳嗽的，俗称为凑肺，宜用紫菀饮。（《要诀》）（按：紫菀饮即《济生方》的紫菀茸汤。）
凡是好色之人，元气虚弱，咳嗽不止的，宜用琼玉膏最为快捷。肺虚严重的，用人参膏佐以生姜、橘红。有痰的，加化痰药。（《原理》）
有兼停积饮食而咳嗽的，须用消化的方剂，不可用乌梅、粟壳等酸涩药。其寒邪未除的，宜用发散之剂，不可就用补剂。（《医学统旨》）
劳嗽（肺中有虫引起的咳嗽）：现在所谓的劳嗽，在古籍中没有明确记载，推测就是华佗所说的邪嗽，真人所说的疰嗽。此病大概是酒色过度，极度劳累伤肺，损伤经络，严重的咯吐脓血，轻微的时发时愈。又有因体虚，感受邪恶之气，且传染疰气而得的，或者先呕血而后咳嗽，或者先咳嗽逐渐变得瘦弱，这不仅是内伤肺经，又夹杂邪恶传疰之气，所以特别严重，病的毒害，没有超过这个的了。真人治疗疰嗽通气丸方，用蜈蚣四节。又说：梦见与鬼交通及饮食的，全用蜈蚣。《外台秘要》方，四满丸，治疗五种咳嗽也用蜈蚣。近世名医能推究其旨意，大都用蛤蚧、天灵盖、桃柳枝、麝香、丹砂、雄黄、安息香之类，以通神明之药来治疗，高出古人的心意了。又有肺中有虫像蚕一样，令人喉痒而咳，汤药散剂直接经过无效，针灸也达不到，用药含化，虫死则咳嗽停止。（《鸡峰普济方》）
至于酒色过度，虚劳少血，津液内耗，心火自炎，致使燥热乘袭于肺，咯吐脓血，上气痰涌，咳嗽连续不断。正因为血不能荣养肌肉，所以邪在皮毛，都能入肺，而从背部得之尤为迅速，这时人参、川芎、当归是不可缺少的。（按：《医学统旨》说：应当用炙甘草汤，或黄芪建中汤加牡丹皮。大概牡丹皮辛香，调和营气，治疗无汗骨蒸，所以阴虚人解表，以牡丹皮为向导。）
一种传注病，涉及邪恶，五脏受克，毒害尤深，近世大都用蛤蚧、天灵盖、桃柳枝、丹砂、雄黄、安息香、苏合香丸等通神之剂。（《直指方》）
有劳嗽一证，都是因为肺虚，或者苦于风寒暑湿，以及劳逸抑郁，忧思喜怒，饮食饥饱，导致脏腑不平，积微小至显著，以至逐渐形成肺痿肺痈。咳嗽有多痰的，有干咳无痰的，甚至失声，咳唾脓血，身体发热，五心烦热，盗汗自出，夜梦鬼交，日轻夜重，肢体憔悴，皮肤干燥，脸颊红如敷胭脂，饮食日渐减少。古人说：疮一个月不愈，则疮中有虫；咳嗽一个月不愈，则肺中有虫。如果肺有虫，则药物难以奏功。肺虫像蚕，逐渐导致变乱，日积月累，致成劳虫了。（《治病活法秘方》）
劳嗽有因久咳发展成劳损的，有病劳损才咳嗽的。其症状寒热往来，或者独热无寒，咽痛喉痛，精神极度疲乏。所咳之痰，或者浓或者淡，或者有时带血，腥臭异常，说话不出声的，用补肺汤半帖，加杏仁、贝母、款冬花、阿胶、百合各半钱，煎去渣滓，调钟乳粉。咽痛的，再加桔梗半钱。热重的，再加秦艽半钱。呕吐的，去掉地黄，加半夏同等分量。气急的，加灵砂丹或二炒丹。（《要诀》）
如果在饥饿时胸中大痛，唇面上有白点像粟米，咽喉或者痒或者痛而咳嗽不可忍受，脉极数，或者忽大忽小，这必定是肺中有寸白虫，饥饿时虫子上行求食，痛咳不安。单用百部蒸膏，略加槟榔、乌梅。（《医学统旨》）（按：百部治久咳，出自《千金方》。）
呷嗽：呷嗽，还是咳嗽的意思。其胸膈痰饮多的，咳嗽时气动于痰，上搏喉咽之间，痰气相击，随着咳嗽呼吸，呼呷有声，叫做呷嗽。它与咳嗽大体相同，至于投药，则应加入消痰破饮的药物，以此作为不同之处。（《诸病源候论》）
瘀血嗽：肺胀而咳嗽，或者左边或者右边无法安睡，这是痰挟瘀血阻碍气机而致病。宜养血以流动气机，降火疏肝以清痰，用四物汤加桃仁、诃子、青皮、竹沥、姜汁之类。血碍气作咳嗽的，桃仁去皮尖，大黄酒炒，姜汁为丸服用。（《丹溪心法》）
瘀血咳嗽则喉间常有腥臭味，轻的用泻白散，加生地、山栀、牡丹皮、麦门冬、桔梗，重的用桃仁、大黄，姜汁为丸服。或者因打损伤力伤肺，遇风寒则咳，或者见血紫黑色的，四物汤去川芎，加大黄、苏木为末，酒调服，利下心肺间的瘀血即止，后服人参养荣汤调理。（《医学入门》）
前后心胀，喉中有血腥气，气口脉涩，这是膈间有蓄血。试法，喝热姜汤作呃逆的，是瘀血。犀角地黄汤加童便、桃仁、大黄攻散它，或者平胃散合越鞠丸，加韭汁、童便消伐它。气竭肝伤而咳嗽带血腥气的，用四乌贼骨一芦茹丸。（《医学统旨》）
时行嗽：时行嗽，发热恶寒，头痛鼻塞气急，状如伤冷热，连续咳嗽不止，初得病即伏枕，一两日即减轻。记得壬午年秋天，满城有此病，接着甲午年夏秋之交，此病又从南向北传播，得免的人很少，并称之为虾蟆瘟，用参苏饮加细辛半钱。（《要诀》）（按：此证也出自徐应登《医便》，用败毒散。）
两地在北方，遇到夏秋久雨，天行咳嗽头痛，用古方益元散，姜葱汤调服，应手而效，每天排出数十斤，经过彻夜。这大概是甲己土运湿令，痰壅肺气上窍，只要泄其膀胱下窍即可，不在咳嗽例中。（《韩氏医通》）
顿呛：咳嗽俗名叫呛，连咳不止，叫做顿呛。顿呛者，一气连呛二三十声，少则十数声。呛则头倾胸曲，甚至手足拘挛，痰从口出，涕泪相随，从膺胸而下应于少腹。大人患此如同哮喘，小儿患此谓之时行顿呛。顿呛不服药，到一个月也会痊愈。（《医学真传》）（治方出清凉方中，宜参考。）
咳嗽短气：肺主气，候皮毛。气虚为微寒客于皮毛，入伤于肺则不足，形成咳嗽。气得温则宣和，得寒则否涩。虚则气不足而为寒所迫，并聚于上肺间，不得宣发，所以令咳而短气。（《诸病源候论》）
咳嗽上气：夫咳嗽上气的，是肺气有余。肺感于寒，轻的则成咳嗽。肺主气，气有余则喘咳上气，此为邪搏于气，气壅不得宣发，是为有余，所以咳嗽而上气。（《诸病源候论》）
久咳嗽上气的，是肺气虚极，风邪停滞，所以其病积月累年，久不痊愈，则胸背痛面肿，甚至唾脓血。（同上）
咳嗽脓血：咳嗽脓血的，是损肺损心故也。肺主气，心主血。肺感于寒，轻的则成咳嗽，嗽伤于阴脉则有血，血与气相随而行，咳嗽极甚，伤血动气，俱乘于肺，肺与津液相搏，蕴结成脓，所以咳嗽而脓血。（《诸病源候论》）
咳嗽极甚，伤于经络，血液蕴结，故有脓血。气血俱伤，故连滞积久，其血黯瘀，与脓相杂而出。（同上）
咳嗽吐粉红痰，叫做吐白血，仅可绵延岁月。若血色正赤如朱，浓浓如漆，为守脏血，不治。咳而吐痰，膺乳痛，当看痰色如何。若浓浊如脓，或带血丝而臭，当从肺痈例治之。（《医学统旨》）
咳嗽声哑：咳嗽声哑的，因为肺本属金，大概金实则不鸣，金破亦不鸣。金实的，因为肺中有邪，非寒邪即火邪。金破的，因为真阴受损，非气虚即精虚。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。大抵此证，邪实者发病急骤，治疗也容易；虚损者发病徐缓，治疗也困难。（《景岳全书》）
脉或沉或浮，声音不损的，易治；脉来洪数，形瘦面赤，肾脏气衰，不能上循于喉而声哑的，难疗。（按：此本于《原病集》。）也有肺络支塞而声哑的，不在此例。（《医学统旨》）
死证：咳，脱形发热，脉小坚急的死亡。肌瘦下（一本说不）脱形，热不去的死亡。咳而呕腹胀且泄。（按：此四字《中藏经》作便滑不禁）其脉弦急欲绝的死亡。（《脉经》）
劳嗽，上嗽下泻，用嗽药嗽止则泻甚，服香连丸则泻止复嗽，肺与大肠为表里，此脏腑俱病不可兼治的死亡。（《苍生司命》）
阴虚火动，发而为喉痹，音哑的不治。嗽而大便泄的，难治。嗽而发热不止的，难治。（同上）
嗽而喉痛声哑不能药，或嗽而肛门脱，皆所不救也。（《石山医案》）
死证（六名）：水肿、形脱、热不去、腹胀、呕、泻。（《识病捷法》）
治法要领：治嗽大法：肺脉浮为风邪所客，以发散取之。肺脉实为气壅内热，以清利行之。脉濡散为肺虚，以补肺安之。其间久嗽之人曾经解利，以致肺胃俱寒，饮食不进，则用理中助胃加和平治嗽等辈。（按：此下原有劳嗽说，既见上。）然则咳嗽证治，于此可以问津索涂矣，抑犹有说焉。肺出气也，肾纳气也。肺为气之主，肾为气之藏。凡咳嗽暴重，动引百骸，自觉气从脐下逆奔而上者，此肾虚不能收气归元也，当以补骨脂安肾丸主之，毋徒从事于宁肺（按：安肾丸不必用，此存其理已），用枳壳为佐，枳壳不惟宽中，又能行其气，气下痰下，他证自平。（《直指方》）
大概以顺气为先，下痰次之，又有停饮而咳的，又须消化之，切不可轻用罂粟壳等药涩之。又有寒邪未除的，亦不可便用补药。最忌忧思过度，房室劳伤，否则多成瘵疾，谨之谨之。（《大成》）
肺主皮毛，人之无病之时，荣卫周流，内气自皮肤腠理，普达于外。一或风寒外束，则内气不得于外达，便从中起，所以气升痰上，故咳嗽。宜用辛温辛凉之剂以发散风寒，则邪退正复而嗽止也。又按肺为华盖，凡饥饱劳役，喜怒忧恐，与夫饮醇醪，食浓味，则火升痰上而伤于肺，亦作咳嗽。宜用降火豁痰之剂，则火降痰消而咳止也。又按肺主气，营运血液，周流一身。肺金也，受火邪，气从火化，有升无降，为嗽为喘。久而不治，虚极至损，则不能运化气液，发为烦热惊悸，咳唾粘涎脓血。宜用补虚润燥、开郁散火之剂，则肺得清正而嗽止也。
Phlegm should be cleared. If a patient with a chronic illness suddenly coughs, although the disease has been long-standing, the sudden onset of coughing is considered a new cough, which must be caused by a recent wind-cold attack or food stagnation. Wind-cold should be dispersed, and food stagnation should be resolved; thus, recovery will occur. Chronic cough generally belongs to deficiency or constraint patterns. Some are caused by Qi deficiency, some by Blood deficiency, some by Blood deficiency with hyperactive fire leading to panting, coughing, and hoarseness, some by dual deficiency of Qi and Blood, some by consumptive diseases accompanied by cough, phlegm, fever, thirst, and sweating, and some by consumptive diseases with hemoptysis, phlegm, and panting. Some consumptive cases involve only one or two coughs without phlegm, night fever followed by chills, and excessive dreaming. Some have fire constrained in the Lung, causing coughing with sound but no phlegm. Some have damp-phlegm internally constrained, where coughing subsides slightly after expectoration but returns shortly after. There are also cases where chronic cough damages the Spleen, causing sores all over the face. There are cases of chronic cough with loss of voice, loss of Qi, facial and ocular edema, and progression to consumptive disease. There are cases of chronic cough lasting years with no effect from various medicines, lacking other symptoms, distinct from consumptive cough. There are cases of dry cough caused by phlegm and fire constraints in the middle Jiao; this condition is extremely difficult to treat. Initially use opening formulas (preferably Xiaoyao San with heavy doses of Jiegeng), followed by Yin-nourishing agents. (*Zunsheng Shu*)
New coughs are easy to cure, while chronic coughs are difficult. The reason for the difficulty lies in the transmission and deepening of the pathogenic factors. (*Cangsheng Siming*)
Treatment of Exogenous and Endogenous Coughs (Non-internal/External Causes): Exogenous conditions can cause cough, and endogenous conditions can also cause cough; these represent excess and deficiency respectively, requiring differentiation in treatment. Generally, exogenous cough arises from accidental exposure to wind-cold, manifesting as alternating chills and fever, dyspnea, nasal congestion with heavy voice, headache, and expectoration. With mild pathogens, the pulse is harmonious and moderate; with severe pathogens, the pulse may be wiry, surging, or slightly rapid. If there are no prior signs of chronic exhaustion or deficiency, and the cough appears abruptly, it is an exogenous pattern. Conversely, endogenous cough develops gradually, often due to sexual excess or overwork, starting with mild cough that worsens daily. Symptoms include night tidal fever, emaciation, persistent malar flush, shortness of breath, and dry throat. The pulse is slightly rapid on light palpation and fine, rapid, wiry, or tight on heavy pressure. Exogenous cough comes abruptly and is caused by cold pathogens, treatable with warming or dispersing methods, making it easier to cure. Endogenous cough comes slowly and is caused by Yin deficiency, requiring tonification and harmonization, making it harder to cure. This is the fundamental distinction. However, some patients with weak pulses and signs may suddenly contract exogenous diseases; others with strong constitutions may develop endogenous diseases due to illness. In such ambiguous cases, careful examination of etiology, pulse, and complexion provides verification. Misdiagnosis and incorrect treatment carry significant risks, demanding utmost caution. (*Jingyue Quanshu*)
Differentiation between exogenous cough and Yin-deficiency cough is particularly crucial. Exogenous cough features loud and turbid voice, starting slow then becoming urgent, continuous day and night, with thick sticky phlegm and urgent panting. Consumptive cough due to Yin deficiency features a timid and dry voice, starting urgent then becoming slow, worsening in the morning or evening, with thin phlegm, shortness of breath, and fatigue. (*Yitong*)
Exogenous cough is considered mild because although Lung Qi is constrained, it remains patent. Thus, clear nasal discharge, nasal itching with sneezing, and throat itching with coughing occur. If constraint is severe and heat obstructs, preventing upward flow, the nose becomes dry and blocked, without sneezing or coughing. Mild constraint seeks external dispersion and upward unblocking; severe constraint turns inward and downward. Endogenous cough is considered severe. For instance, Liver and Kidney fire initially affects the Lower Jiao without immediately harassing the upper regions. Over time, as fire intensifies, it rebels against the Lung, making the condition severe. (Lung fire originating from within is not discussed here.) (*Yi Que*)
Note: Although cough is a Lung disease, all Zang-Fu organs can cause it. Analyzing details reveals omissions in classical texts; summarizing principles, it boils down to endogenous and exogenous causes. External pathogens (wind, cold, summerheat, dampness) first affect the skin and hair, which correspond to the Lung. If Lung pathogens remain unresolved, other meridians become involved, transmitting from the Lung to other organs. Internal injuries (fatigue, desire, emotions) damage Zang Qi, starting from the Yin aspect and affecting the Upper Jiao, transmitting from other organs to the Lung. Diseases entering from the exterior affect Yang; treat with acrid-warm herbs to disperse pathogens, clearing the Lung and stopping cough. Diseases arising from within affect Yin; treat with sweet herbs to nourish Water and moistening herbs to nourish Metal, calming the Lung and stopping cough. Generally, treating exterior patterns requires herbs that do not remain static; static herbs allow pathogens to linger and transform into other diseases, hence avoiding cold, bitter, and astringent herbs, as stated in *Wuzang Shengcheng Pian*: "The Lung desires acridity." Treating interior patterns requires herbs that do not overly disperse; dispersing herbs agitate deficient fire and worsen dryness/itching, hence avoiding acrid-aromatic and drying-hot herbs, as stated in *Xuanming Wuqi Pian*: "Acidity moves Qi; avoid excessive acrid consumption in Qi disorders." (*Bixu*)
If a patient coughs with chills and fever, drawing pain to the lower back, or with panting and fullness, this is due to sexual fatigue damaging the Kidney. If the patient has epigastric fullness, abdominal distension, heart pain, and anorexia, this is due to irregular eating damaging the Spleen. If the patient coughs with left hypochondriac pain radiating to the lower abdomen and knees/ankles, this is due to extreme fatigue damaging the Liver. If the patient coughs, spits white saliva, has dry mouth, and hoarseness, this is due to shouting damaging the Lung. If the patient has panting cough, irritability, fever, spontaneous sweating, dry throat, and hemoptysis, this is due to mental labor damaging the Heart. These all belong to non-internal/external causes. (*Sanyin Fang*)
Cough caused by seven emotions or irregular diet involves injury to the upright Qi of the Zang-Fu, leading to rebellious pathogens forming phlegm and obstructing the Lung pathways. Prioritize regulating Qi using Six Seven Decoction (Siqi Tang) half dose, plus Sangbaipi, Xingren, Wuweizi, Renshen, and Ejiao, each half qian. If coughing expels both phlegm and food, this is likely due to dietary irregularity causing Liver Qi stagnation and invading pathogens in the Lung. Since the Liver governs turbid pathways and the Lung governs clear pathways, their interference requires Erchen Tang plus Muxiang, Xingren, Xixin, and Zhike, each half qian. Drinking cold/hot alcohol or cold water injuring the Lung causes cough,俗称 "Cu Fei" (Gathering in Lung); use Ziwan Yin. (*Yaojue*) (Note: Ziwan Yin is the Ziwan Rong Tang from *Jisheng Fang*.)
For those indulging in sex with weak Yuan Qi and persistent cough, Qiongyu Gao is most effective. For severe Lung deficiency, Ren Shen Gao supplemented with Shengjiang and Juhong is used. Add phlegm-resolving herbs if phlegm is present. (*Yuanli*)
If cough is accompanied by food stagnation, use digestive formulas; avoid sour/astringent herbs like Wumei and Susu Ke. If cold pathogens remain, use dispersing agents; do not use tonics prematurely. (*Yitong*)
Consumptive cough (cough with worms in the Lung): The current concept of consumptive cough is not explicitly found in ancient texts; it is presumed to be the "Evil Cough" described by Hua Tuo or the "Zhù Cough" described by Zhenren. This disease results from sexual/dietary excess and extreme fatigue damaging the Lung and collaterals. Severe cases expectorate pus and blood; mild cases fluctuate. It can also arise from deficiency combined with evil Qi transmission (Zhù). Symptoms include hemoptysis preceding cough, or gradual wasting from cough. This involves not only internal Lung injury but also evil transmitted Qi, making it particularly toxic. Zhenren’s Tongqi Wan for Zhù Cough uses four segments of Wugong. It is also said that dreams of intercourse with ghosts require full doses of Wugong. The *Waitai Mi Yao* formula Siman Wan for five types of coughs also uses Wugong. Recent physicians, understanding the intent, mostly use Gejie, Tianlinggai, Taoliuzhi, Shexiang, Dansha, Xionghuang, and Anxi Xiang—spirit-unblocking herbs—to treat this, surpassing ancient methods. Additionally, worm-like entities in the Lung cause throat itching and cough; decoctions pass through ineffective, and acupuncture cannot reach them. Using lozenges kills the worms, stopping the cough. (*Jifeng Puji Fang*)
Regarding sexual excess, consumptive Blood deficiency, internal depletion of fluids, and self-flaring Heart fire causing dry-heat to harass the Lung, resulting in hemoptysis, upper Qi rebellion, and phlegm tides, the cough is continuous. Because Blood fails to nourish muscles, pathogens in the skin/hair easily enter the Lung, especially via the back. In such cases, Renshen, Xiong, and Gui are indispensable. (Note: *Yitong* suggests Zhi Gancao Tang or Huangqi Jianzhong Tang plus Mudanpi. Mudanpi is acrid-aromatic, harmonizes Ying-Qi, treats bone-steaming fever without sweat, and serves as a guide for releasing the exterior in Yin-deficient patients.)
Transmitted diseases involving evil Qi, overcoming the Five Zang, are deeply toxic. Recent practitioners mostly use Gejie, Tianlinggai, Taoliuzhi, Dansha, Xionghuang, Anxi Xiang, and Suhexiang Wan—spirit-unblocking agents. (*Zhizhi Fang*)
Consumptive cough arises from Lung deficiency, exacerbated by wind/cold/summerheat/dampness, irregular work/rest, emotional depression, worry/thought/anger, or dietary irregularities, leading to Zang-Fu imbalance, accumulating from subtle to manifest, eventually forming Lung萎 (Flaccidity) or Lung Abscess. Cough may produce much phlegm or be dry without phlegm, even progressing to aphonia, expectoration of pus/blood, fever, five-palm heat, night sweats, nocturnal emissions/dreams, diurnal improvement/nocturnal worsening, emaciation, dry skin, and malar flush resembling rouge, with decreasing appetite. Ancients said: "Ulcers unhealed for a month harbor worms; coughs unhealed for a month harbor worms in the Lung." If worms exist in the Lung, drugs struggle to work. Lung worms resemble silkworms, causing chaos, accumulating over months/years to form consumptive worms. (*Zhibing Huofang Mifang*)
Consumptive cough may result from chronic cough developing into consumptive disease, or from consumptive disease causing cough. Symptoms include alternating chills/fever, isolated fever, sore throat, and extreme fatigue. Sputum varies in thickness/color, sometimes bloody, exceptionally foul-smelling, with aphonia. Use Bufei Tang half dose, plus Xingren, Beimu, Kuandonghua, Ejiao, and Baihe, each half qian. Decoct, strain, and mix with Zhongru Fen. For sore throat, add Jiegeng half qian. For high fever, add Qinjiao half qian. For vomiting, remove Dihuang, add Banxia in equal amount. For dyspnea, add Lingsha Dan or Erchao Dan. (*Yaojue*)
If chest pain occurs during hunger, with millet-sized white spots on lips/face, and unbearable cough with throat itching/pain, and pulse is extremely rapid or fluctuating, this indicates Ascaris lumbricoides (Cunbai Chong) in the Lung seeking food during hunger, causing painful cough. Use single-ingredient Baibu steamed paste, slightly adding Binglang and Wumei. (*Yitong*) (Note: Baibu treats chronic cough, cited from *Qianjin Fang*.)
Ha Cough (Gasping Cough): Ha cough is essentially coughing. When there is abundant phlegm-fluid in the chest/diaphragm, coughing moves the phlegm, striking the throat/pharynx. Phlegm and Qi collide, producing gasping sounds synchronized with breathing, called Ha Cough. While similar to general cough, treatment differs by adding phlegm-resolving and fluid-breaking herbs. (*Zhubing Yuanhou Lun*)
Blood Stasis Cough: Lung distension with cough, inability to sleep on either side, is caused by phlegm and blood stasis obstructing Qi. Nourish Blood to move Qi, descend Fire, soothe Liver, and clear Phlegm. Use Siwu Tang plus Tao Ren, Hezi, Qingpi, Zhuli, and Jiangzhi. For blood-stasis-induced cough, peel Tao Ren, stir-fry Dahuang with ginger juice, and make pills. (*Danxi Xinfa*)
Blood stasis cough presents with a fishy/foul odor in the throat. Mild cases use Xiebai San plus Shengdi, Zhizi, Mudanpi, Maidong, and Jiegeng. Severe cases use Tao Ren and Dahuang, made into pills with ginger juice. If cough triggered by trauma/labor injury, worsened by wind/cold, or with purple-black blood, use Siwu Tang minus Xiong, plus Dahuang and Sumu powder, taken with wine. Expel blood stasis from Heart/Lung to stop symptoms, then regulate with Renshen Yangrong Tang. (*Rumen*)
Distension in front/back of chest, fishy odor in throat, and choppy pulse at Qi Kou indicate retained blood in the diaphragm. Test: hiccuping after drinking hot ginger soup indicates blood stasis. Attack with Xijiao Dihuang Tang plus Tongbian, Tao Ren, and Dahuang, or Pingwei San combined with Yueju Wan plus Jiuzhi and Tongbian. For Qi exhaustion and Liver injury with bloody cough, use Si Wu Mei Yi Lu Ru Wan. (*Yitong*)
Epidemic Cough: Epidemic cough presents with fever, chills, headache, nasal congestion, dyspnea, resembling cold/heat injury, with continuous coughing. Patients bedridden initially, improving within 1-2 days. Recalling autumn of Renwu year, this disease swept Mancheng. Later, summer-autumn of Jiawu year, it spread south to north, sparing few, called "Toad Plague." Treat with Shen Su Yin plus Xixin half qian. (*Yaojue*) (Note: Also in Xu Yengdeng's *Yi Bian*, using Baidu San.)
In northern regions during prolonged summer/autumn rains, epidemic cough with headache can be treated with ancient Yiyuan San mixed in ginger/scallion soup, yielding immediate results, expelling dozens of jin of sputum overnight. This is due to Earth transport dampness, phlegm obstructing Lung Qi orifices; draining the Bladder orifice suffices, excluding it from standard cough categories. (*Hanshi Yitong*)
Dun Qiang (Paroxysmal Cough): Colloquially called "Qiang," continuous coughing is Dun Qiang. One breath triggers 20-30 coughs, or at least ten. Head tilts forward, chest curves, limbs may spasm, phlegm exits mouth, tears/nasal discharge follow, sensation extending from chest to lower abdomen. In adults, it resembles asthma; in children, it is epidemic Dun Qiang. Untreated, it resolves in a month. (*Yixue Zhenchuan*) (See Qingliang Fang for formulas.)
Cough with Shortness of Breath: Lung governs Qi and corresponds to skin/hair. Qi deficiency allows mild cold to invade skin/hair, damaging Lung Qi, causing insufficiency and cough. Qi warms and flows smoothly; cold makes it stagnant. Deficiency leads to insufficient Qi forced by cold, gathering in upper Lung, unable to diffuse, causing cough and shortness of breath. (*Zhubing Yuanhou Lun*)
Cough with Rebellious Qi: Cough with rebellious Qi indicates Lung Qi excess. Cold invasion causes mild cough. Lung governs Qi; excess Qi leads to panting, cough, and rebellious Qi. Pathogens contend with Qi, causing obstruction and lack of diffusion, resulting in excess, hence cough and rebellious Qi. (*Zhubing Yuanhou Lun*)
Chronic cough with rebellious Qi indicates extreme Lung Qi deficiency with stagnant wind pathogens. Persisting for months/years without cure, it causes chest/back pain, facial swelling, and expectoration of pus/blood. (Ibid.)
Cough with Pus and Blood: Caused by damage to Lung and Heart. Lung governs Qi, Heart governs Blood. Cold invasion causes mild cough; injury to Yin vessels causes bleeding. Blood and Qi travel together; severe cough injures Blood and agitates Qi, both assaulting the Lung. Lung fluids clash, fermenting into pus, causing cough with pus/blood. (*Zhubing Yuanhou Lun*)
Severe cough injures collaterals, causing blood accumulation and pus/blood. Dual injury to Qi and Blood leads to chronic stagnation, dark瘀 blood mixing with pus. (Ibid.)
Coughing pink-red sputum is called "expectorating white blood," allowing survival for years. Bright red blood, thick like lacquer, is "organ-retaining blood," untreatable. Cough with sputum and chest/breast pain: examine sputum color. Thick/turbid like pus or bloody/foul indicates Lung Abscess; treat accordingly. (*Yitong*)
Hoarse Voice from Cough: Lung corresponds to Metal. "Metal solid does not ring; metal broken does not ring." Solid Metal implies pathogens in Lung (cold or fire). Broken Metal implies true Yin damage (Qi or Essence deficiency). Cold pathogens require acrid/warm; fire pathogens require sweet/clear. Qi deficiency requires Yang tonification; Essence deficiency requires Yin tonification. Generally, excess pathogens come abruptly and are easier to treat; deficiency comes slowly and is harder to treat. (*Jingyue Quanshu*)
Pulse floating or sinking with intact voice is easy to treat. Surging/rapid pulse, emaciation, red face, and Kidney Qi failure failing to ascend to larynx causing hoarseness is difficult to treat. (Based on *Yuanbing Ji*). Lung collateral blockage causing hoarseness is excluded. (*Yitong*)
Death Signs: Cough with emaciation and fever, small/firm/urgent pulse indicates death. Emaciation with persistent fever indicates death. Cough with vomiting, abdominal distension, and diarrhea (or incontinence per *Zhongzang Jing*), with pulse wiry/urgent nearing extinction indicates death. (*Maijing*)
Cough with hematuria, emaciation, and large pulse indicates death. (*Zhubing Yuanhou Lun*)
Consumptive cough with upper cough and lower diarrhea: Stopping cough stops diarrhea but worsens it; stopping diarrhea restarts cough. Lung and Large Intestine are exterior-interior paired; simultaneous Zang-Fu disease untreatable jointly indicates death. (*Cangsheng Siming*)
Yin deficiency with fire agitation causing throat bi and hoarseness is untreatable. Cough with diarrhea is difficult. Cough with persistent fever is difficult. (Ibid.)
Cough with sore throat/hoarseness preventing medication, or prolapsed anus with cough, are incurable. (*Shishan Yi'an*)
Death Signs (Six Types): Edema, emaciation, persistent fever, abdominal distension, vomiting, diarrhea. (* Shibing Jiefang*)
Key Treatment Principles: General method for cough: Floating Lung pulse indicates wind-pathogen; treat with dispersion. Excess Lung pulse indicates Qi stagnation/internal heat; treat with clearing/draining. Soft/scattered pulse indicates Lung deficiency; treat with tonifying/calming Lung. For chronic coughers previously treated with purgatives leading to Lung/Stomach cold and anorexia, use Lizhong to assist Stomach plus mild cough remedies. (Consumptive cough section omitted as seen above). Thus, one can navigate cough treatment here, yet further explanation is needed. Lung exhales Qi; Kidney grasps Qi. Lung is master of Qi; Kidney is storehouse of Qi. If cough is violent, moving the whole body, with Qi rushing up from below navel, this is Kidney deficiency failing to grasp Qi. Treat with Buguzhi Anshen Wan. Do not merely focus on calming Lung (Anshen Wan need not be used; principle preserved). Use Zhike as assistant; it expands middle and moves Qi. Downward movement of Qi and Phlegm resolves other symptoms. (*Zhizhi Fang*)
Generally, prioritize regulating Qi, then resolving phlegm. For cough with retained fluids, use digestion aids. Strictly avoid astringents like Ying Su Ke. If cold pathogens remain, avoid tonics. Most taboo: excessive worry/thought and sexual fatigue, otherwise consuming diseases often result. Be cautious! (*Dacheng*)
Lung governs skin/hair. In health, Ying-Wei circulate, internal Qi reaches exterior via skin/collaterals. If wind/cold binds exterior, internal Qi cannot reach exterior, rising from within, causing Qi ascent and Phlegm elevation, hence cough. Use acrid-warm/cool herbs to disperse wind/cold; pathogens retreat, Zheng recovers, cough stops. Note: Lung is the Canopy. Irregular diet, labor, emotions, rich food/alcohol cause Fire ascent and Phlegm elevation, injuring Lung, causing cough. Use Fire-descending and Phlegm-resolving agents; Fire descends, Phlegm clears, cough stops. Note: Lung governs Qi, circulates Blood throughout body. Lung is Metal; receiving Fire pathogens, Qi transforms with Fire, ascending without descending, causing cough/panting. Untreated long-term, extreme deficiency leads to inability to transform Qi/fluids, causing irritability, palpitations, sticky/foul sputum/pus/blood. Use deficiency-tonifying, dryness-moistening, constraint-opening, and Fire-dispersing agents; Lung regains purity/clarity, cough stops.