洁古曰嗽者秋伤于湿积于脾经曰秋伤于湿冬必咳嗽大抵素秋之气宜清而肃反动之则气必
上冲
而为咳嗽甚则动于湿而为痰也是知脾无留湿虽伤肺气不为痰也有痰者寒少热多各随五脏而治
之假令湿在肝经谓之风痰湿在心经谓之热痰湿在脾经谓之湿痰湿在肺经谓之气痰湿在肾经谓
之寒痰宜随证而治之咳而无痰者以辛甘润其肺咳而嗽者治痰为先故以南星半夏胜其痰而咳嗽
自愈枳壳陈皮利其气而痰自下
按此论咳因湿在于经致痰为咳五脏亦皆有之可谓发内经之秘矣然至气郁津液不降或停水
饮所
致或肾气虚弱火炎水涸津液涌而为痰涎于上此气饮及真脏为病非诸经之留湿致病也故易老云
半夏止能泄痰之标而不能治痰之本是矣详以上所言枳壳等利气下痰恐非易老语也
丹溪曰上半日嗽者属胃中有火午后嗽者属阴虚五更嗽多者此胃中有食积至此时滞肺气不
利诸邪或痰皆然春是春升之气或外感夏是火炎上最重秋是湿热伤肺冬是风寒外来也
原病式曰人瘦者腠理疏通而多汗泄血液衰少而为燥热故多为劳嗽之疾也
丹溪曰咳而无痰者此系火郁之证乃痰郁火邪在中同苦梗以开之下用补阴降火不已则成劳
此证不得志者有之
谨按咳无痰者本肺气伤而不清咳久则痰郁于中不能上出故当用药以开提之实者宣法亦可
施也
凡嗽久亦有痰中兼血有或带血丝者燥热血少者皆当取其化源故曰滋阴降火燥热劳嗽是宜合而
论治
洁古说：咳嗽，是因为秋季感受了湿邪，湿气积聚在脾经。所谓“秋伤于湿，冬必咳嗽”，大体上初秋的气候应当清肃，如果受到反常之气干扰，气机必然上冲，从而引发咳嗽；严重时湿气动而化为痰。由此可知，脾脏如果没有留滞的湿邪，即使损伤肺气，也不会产生痰。有痰的咳嗽，寒证少而热证多，应根据五脏的不同分别治疗。例如，湿邪在肝经，称为风痰；湿邪在心经，称为热痰；湿邪在脾经，称为湿痰；湿邪在肺经，称为气痰；湿邪在肾经，称为寒痰。应当根据具体证候进行治疗。
只有咳嗽而没有痰的，应用辛甘之品滋润肺脏；既有咳嗽又有痰的，治疗应以化痰为先，因此用天南星、半夏来消除痰浊，咳嗽自然痊愈；用枳壳、陈皮来理气，痰自然下行。
按语：这段论述指出咳嗽是因为湿邪停留在经络导致生痰而咳，五脏都可能出现这种情况，可以说是阐发了《内经》的奥秘。然而，如果是因气机郁滞、津液不降，或停聚水饮所致，或是因肾气虚弱、虚火上炎、津液枯竭，导致津液涌泛为痰涎在上，这些属于气机、水饮及真脏病变，并非各经留滞湿邪致病。所以易老（张元素）说：“半夏只能泄除痰的标象，而不能治疗痰的根本。”这是正确的。详细考察上述所言，使用枳壳等药利气下痰，恐怕不是易老的原话。
丹溪说：上半日咳嗽的，属于胃中有火；下午咳嗽的，属于阴虚；五更时分咳嗽多的，是胃中有食积，到了这个时候，食滞阻碍肺气不利，各种邪气或痰都是如此。春季是春升之气的影响，夏季是火炎上最重，秋季是湿热伤肺，冬季是风寒外来。
《原病式》说：身体瘦弱的人，腠理疏松而多汗，血液衰少而导致燥热，所以多为劳嗽的疾病。
丹溪说：咳嗽而没有痰的，这属于火郁的证候，是痰郁结、火邪在中，配合桔梗以开提肺气，下面用补阴降火的药物，如果无效就会变成劳损。这种证候多见于心情不得志的人。
谨按：咳嗽没有痰的，本是肺气受伤而不清利，咳嗽久了则痰郁结在中间不能向上排出，所以应当用药来开提宣散。实证也可以用宣发之法。
凡是咳嗽日久，也有痰中兼带血液，或者带有血丝的，燥热血少的人都应当寻求化源（即调理脾胃生化之源）。所以说滋阴降火治疗燥热劳嗽，应该合而论治。
Jieguo stated: Cough (Ke Sou) results from dampness (Shi) injured in autumn, accumulating in the Splein Meridian. It is said that "autumn injury by dampness leads to cough in winter." Generally, the qi of early autumn should be clear and肃 (solemn/clearing). If disturbed by contrary factors, the qi must rush upward, causing cough; if severe, it moves with dampness to transform into phlegm (Tan). Thus, it is known that if the Spleen has no retained dampness, even if the Lung Qi is injured, phlegm will not be produced. For coughs with phlegm, cold patterns are few while heat patterns are many; treatment should follow the differentiation of the Five Zang Organs. For example, dampness in the Liver Meridian is called Wind-Phlegm (Feng Tan); dampness in the Heart Meridian is called Heat-Phlegm (Re Tan); dampness in the Spleen Meridian is called Damp-Phlegm (Shi Tan); dampness in the Lung Meridian is called Qi-Phlegm (Qi Tan); dampness in the Kidney Meridian is called Cold-Phlegm (Han Tan). Treatment should be adapted to the specific pattern.
For cough without phlegm, acrid-sweet herbs should be used to moisten the Lung. For cough with phlegm, treating phlegm is the priority. Therefore, Tian Nan Xing (Arisaema Rhizoma) and Ban Xia (Pinellia Rhizoma) are used to overcome phlegm, so that cough heals spontaneously; Zhi Qiao (Immature Bitter Orange) and Chen Pi (Tangerine Peel) are used to promote Qi movement, so that phlegm descends naturally.
Commentary: This discussion points out that cough is caused by dampness staying in the meridians leading to phlegm production and cough, which can occur in all five Zang organs. This can be said to have revealed the secrets of the *Neijing* (Inner Canon). However, when cough is caused by Qi stagnation and failure of fluids to descend, or by retained water/fluid retention (Yin), or by Kidney Qi deficiency with fire flaming upward and drying up fluids, causing fluids to surge as phlegm-saliva above, these belong to diseases of Qi/fluid dynamics and True Zang organs, not diseases caused by retained dampness in various meridians. Therefore, Yilao (Zhang Yuansu) said: "Ban Xia can only drain the branch (biao) of phlegm but cannot treat the root (ben) of phlegm." This is correct. Examining the aforementioned statement about using Zhi Qiao etc. to promote Qi and descend phlegm, this is likely not Yilao's original words.
Danxi stated: Cough in the first half of the day belongs to Fire in the Stomach; cough in the afternoon belongs to Yin Deficiency; frequent cough at dawn (Wu Geng) indicates Food Accumulation (Shi Ji) in the Stomach. At this time, food stagnation obstructs Lung Qi, making it unsmooth, affecting various pathogens or phlegm similarly. In Spring, it is due to Spring Ascending Qi; in Summer, Fire flaming upward is most severe; in Autumn, Damp-Heat injures the Lung; in Winter, Wind-Cold comes from outside.
*Yuan Bing Shi* states: People who are thin have loose interstices (Cou Li) and sweat easily, leading to blood deficiency and dryness-heat, thus they often suffer from Laborious Cough (Lao Sou).
Danxi stated: Cough without phlegm is a syndrome of Fire Depression (Huo Yu), where phlegm is depressed and Fire pathogen is in the middle. Combined with Jie Geng (Platycodon Root) to open and lift, and below, use Yin-nourishing and Fire-descending herbs. If this does not work, it becomes Consumption/Laborious Disease. This condition is often seen in those who are frustrated or dissatisfied.
Carefully noted: Cough without phlegm is originally due to Lung Qi injury and lack of clarity. Prolonged cough causes phlegm to depress in the center, unable to emerge upward. Therefore, herbs should be used to open and lift. For Excess patterns, the Dispersion method (Xuan Fa) can also be applied.
In cases of chronic cough, there may also be blood mixed in the phlegm, or streaks of blood. Those with Dryness-Heat and Blood Deficiency should seek the source of transformation (Hua Yuan). Therefore, it is said that Nourishing Yin and Descending Fire for Dryness-Heat Laborious Cough should be discussed and treated together.