大意
五脏六腑。皆令人咳。非独肺也。（内经）而其要皆主于肺。盖肺主气而声从此出。故咳之原。皆聚于胃而及
于肺者。情关子母也。（汇补）
内因
肺居至高。主持诸气。体之至清至轻者也。外因六淫。内因七情。肺金受伤。咳嗽之病从兹作矣。（指掌）其火
郁咳者。有声无痰。咳必连声。湿痰咳者。咳动有痰。痰出嗽止。食积痰嗽。面色青黄。五更转甚。吐痰如胶。瘀
血嗽者。胸中窒碍。喉间腥气。或带黑血。胃火嗽者。口渴善饥。面赤脸热。午前尤甚。阴虚嗽者。五心烦热。气
从下升。午重夜甚。劳伤嗽者。干咳无痰。喉痒声哑。痰中见血。停水嗽者。胸满头汗。怔忡吐涎。水逆不入。肺
胀嗽者。喘急气粗。或左或右。则眠不得。有嗽久而成肺痈肺痿者。必云门中府引痛。咯吐脓血。腥秽异常。
外因
咳谓无痰而有声。肺气伤而不清也。嗽谓无声而有痰。脾湿动而生痰也。咳嗽谓有声有痰。因伤肺气复
动脾湿也。（机要）但风伤肺者。咳则鼻塞声重。口干喉痒。语未竟而咳。寒伤肺者。咳则胸紧干哑。凄怆怯寒。
或遇寒则发。暑乘肺者。咳则口燥鼻干。面赤心烦。声嘶吐沫。湿乘肺者。咳则身重首蒙。自汗溺涩。骨节烦
疼。（入门）此皆暴病感邪。必兼头疼身热表症。
五脏劳咳
疲极伤肝。咳而左胁引痛。劳神伤心。咳而咽干咯血。劳力伤脾。咳而气短无力。叫呼伤肺。咳而呕吐白沫。
口燥声嘶。房劳伤肾。咳而腰背引痛。寒热夜发。（汇补）
脉法
咳必先审肺脉虚实。实者浮大有力。若沉而滑。则痰气盛也。虚者弦大无力。若沉细带数。则火郁极也。
（入门）久咳虚羸。脉弱者生。实牢大数者死。浮软者生。沉紧匿者死。
治分肺脾
因咳而有痰者。咳为重。治在肺。因痰而致嗽者。痰为重。治在脾。
治分内外
治表者。药不宜静。静则留连不解。变生他病。忌寒凉收敛。当以辛甘散邪。内虚者。药不宜动。动则虚火不
宁。燥痒愈甚。忌辛香燥热。当以甘寒润肺。（必读）
治分四时
春气上升。润肺抑肝。夏火炎上。清金降火。秋湿热甚。清热泻湿。冬风寒重。解表行痰。（杂着）以上虽分四时。
临症又当从权。
治分新久
新咳有痰者。属外感。随时解散。无痰者。是火热。只宜清之。久咳有痰者。燥脾化痰。无痰者。清金降火。盖外
感久则郁热。内伤久则火炎。俱宜开郁润燥。（入门）今人但知肺主皮毛。一遇外感风寒。疏散之外。牢不可
破。殊不知久则传里。变为郁咳。遂成痨瘵。多由不分内外所因新久之异。夫形寒饮冷。新咳痰稠。固宜温
寒散湿。若夫气动火炎。久咳无痰。当清热润燥。而温寒散湿之剂。又在所禁矣。常见痨症之发。每由咳嗽。
治者不究其源。印定伤风。屡用辛温。发热自汗。食少便稠。卒成不救者有之。（汇补）
火忌发散
有肺伏火邪。腠理不闭。风邪易乘。遇感频发者。当兼清火。若数行解散。则重亡津液。邪蕴而为肺疽肺痈。
不可不慎。（立斋）
邪忌补涩
肺为娇脏。易寒易热。虽参、 、术、草。甘温平补。惟气虚最宜。若肺热有火。及风寒初盛者。不可骤用。至于
乌梅、栗壳、兜铃、五倍。尤不可遽进。恐致缠绵不已。（汇补）
肾虚滋肾
咳嗽烦冤。肾气之逆。以肾为藏气之脏也。凡咳嗽动引百骸。自觉从脐下逆奔而上者。乃肾虚气不归原。
宜所服药中。加补骨脂五味子以敛之。（入门）
脾虚补脾
脾为黄婆。交媾水火。会合金木者也。久咳曾经泻肺。及房劳饥饱。以致脾肺虚而饮食少者。只理脾而咳
自止。（类经）
死候
咳嗽面白。咽疮失音者死。上气喘急。面肿抬肩。身热不眠者危。脉滑手足温者生。脉涩四肢寒者死。咳而
呕。腹满泄泻。脉弦急欲绝者死。咳而脱形。身热脉小坚急以疾为逆。嗽而加汗者死。嗽而下泄上喘者死。（汇补）
用药
有余咳嗽。主以二陈汤。风。加羌活、防风、前胡、紫苏。寒。加麻黄、杏仁、葱白、金沸草。热。加黄芩、山栀、
桑皮。湿。加苍术、防己、赤茯苓。食积嗽者。加山楂、枳壳。气滞咳者。加苏子、桔梗。不足咳嗽。主以二冬二母汤。
火咳。加款冬、玄参、黄芩。痰嗽。加栝蒌、桑皮、苏子。郁。加苦梗、紫菀、枇杷叶。劳嗽。加参、 、芍药。见血。
加阿胶、紫菀。滋阴。加丹皮、黄柏。若夫脾泄者。以异功散。加石斛、五味、百合、苡仁。肾虚者。以六味汤。加麦
冬、五味、枇杷叶。水寒射肺成咳者。五苓散。痰火入肺成咳。面浮者。粉黛散。肺中有虫者。润肺丸。大抵肺位最高。
针石不能及。药饵不能到。惟桔梗能载诸药入肺。须临卧时细细咽下。方能入肺。
【附肺痿】
久嗽肺虚。寒热往来。皮毛枯燥。声音不清。或嗽血线。口中有浊唾涎沫。脉数而虚。为肺痿之病。因津液重
亡。火炎金燥。如草木亢旱而枝叶萎落也。治宜养血润肺。养气清金。初用二地二冬汤以滋阴。后用门冬
清肺饮以收功。（丹溪）
【附肺痈】
久咳不已。浊吐腥臭。咳则胸中隐隐痛。口中辟辟燥。脉实滑数。大小便涩数。振寒吐沫。右胁拒按。为肺痈
之病。因风寒内郁。痰火上凑。邪气结聚。蕴蓄成痈。若风邪内结者。小青龙汤。火邪内灼者。二冬汤。痰火郁
结者。葶苈大枣泻肺汤。溃后收敛疮口。用团参饮子。若入风者。不治。面赤脉浮大者。亦不治。若觉胸膺有
窍。口中所咳脓血。与窍相应而出者。当大补气血。佐以排脓之品。（汇补）
【附肺胀】
肺胀者。动则喘满。气急息重。或左或右。不得眠者是也。如痰挟瘀血碍气。宜养血以流动乎气。降火以清
利其痰。用四物汤。加桃仁、枳壳、陈皮、栝蒌、竹沥。又风寒郁于肺中。不得发越。喘嗽胀闷者。宜发汗以祛邪。
利肺以顺气。用麻黄越婢加半夏汤。有停水不化。肺气不得下降者。其症水入即吐。宜四苓散。加葶苈、桔
梗、桑皮、石膏。有肾虚水枯。肺金不敢下降而胀者。其症干咳烦冤。宜六味丸。加麦冬、五味。又有气散而胀
者。宜补肺。气逆而胀者。宜降气。当参虚实而施治。若肺胀壅遏。不得眠卧。喘急鼻煽者。难治。（汇补）
【附胸痹】
胸痹者。胸中痛引背。喘息咳唾。短气。寸脉沉迟。关上紧数。宜栝蒌半夏薤白汤主之。（准绳）
【附痰火】
有好色作劳之人。相火炽盛。气不归元。腾空而上入于肺叶空隙之间。膜原之内。聚痰凑沫。喘咳烦冤。日
续一日。久久渐成熟路。只俟肾气一动。喘嗽俱发。外症咸痰稠浊。夜卧不眠。或两颐红赤。垒垒发块。或胸
背有疮。如粟如米。皆其验也。治宜清心静养。保肺滋肾。若暴发而痰出如泉。声响如锯。面赤舌胀。喉硬目
突者死。（喻嘉言）
咳嗽选方
二陈汤 治风寒湿痰食积。气滞咳嗽。（方见痰症）
粉黛散 治痰火入肺。肺气上逆。咳而不卧。面浮气促。
真蚌粉新瓦上 红。入青黛少许。用淡 水。滴麻油数点。调服二钱。
润肺丸 治肺中有虫。久嗽不已。渐变痨瘵。
百部 桑皮（各二两） 楝根（三两五钱） 明矾（一两半） 使君子（一两） 鹤虱（一两）
黄连（五钱） 甘草（五钱）
丸如黍米大。米饮下七八十丸。临卧服。上半月用之。
琼玉膏 治肺虚久嗽。气散失音。干咳无痰。或见血线。（方见虚劳）
清宁膏 治咳嗽属火炎热郁。气衰不足者。
生地 麦冬（各十两） 龙眼肉 薏苡仁（各八两） 橘红（三两） 桔梗
甘草 贝母（各二两） 薄荷（五钱）
煎成膏。将苡仁、贝母、簿荷为细末。调入膏中服。
异功散 治咳嗽属土不生金。病兼少食泄泻者。（方见血症）
六味丸 治咳嗽属水衰火炎。病因房劳酒色者。（方见中风）
加味二冬汤 治咳嗽属火盛水亏。痰涎腥秽。将成痈痿者。
天冬 麦冬（各一钱半） 生地 熟地（各二钱） 款冬 桔梗
贝母 紫菀 茯苓 甘草 沙参 栝蒌霜（各一钱）
水煎。
门冬清肺饮 治劳伤气虚。火旺咳嗽。
即生麦散加 紫菀（一钱半） 当归（三分） 黄 白芍 甘草（各一钱）
水煎。
劫劳散 治心肾俱虚。发咳二三声。无痰。遇夜即热。热已即冷。时有盗汗。四肢倦怠。体瘦食少。夜卧恍惚。
或有血丝者。
白芍 茯芩 当归 贝母 黄 （各一钱） 甘草（五分）
熟地（二钱） 枣仁（一钱半） 阿胶（蛤粉炒一钱二分）
合生脉散同煎。
团参饮子 治久嗽肺虚。
紫团参 紫菀茸（各三钱） 款冬花（二钱） 乌梅（一枚）
水煎。
肺痈方 治肺痈未成即消。已成即溃。已溃即愈。
桔梗 金银花 黄 白芨（各一钱） 陈皮 甘草（各一钱二分）
苡仁（五钱） 贝母（一钱半） 甜葶苈（八分）
水姜煎服。初起加防风。去黄 。溃后加人参。久不敛。加合欢皮。
越婢加半夏汤 治肺胀因感风寒。不能发散而成者。
麻黄（六两） 石膏（八两） 生姜（三两） 甘草（一两） 半夏（八两） 大枣（十五枚）
水煎。去麻黄沫。后入诸药。再煎服。
泻白散（方见火症）
参苏饮加减 治冬寒咳嗽。属风寒外束者。
橘红 半夏 桔梗 前胡（各一钱） 枳壳 杏仁 苏叶（各八分）
身热。加柴芩。痰多。加金沸草。
快捷方式方 治久嗽不止。
款冬花二两。于无风处烧之。以笔管吸烟咽下。即用美膳压下。
劫嗽方 治肺气耗散。久咳失音。用此劫之。
诃子 五味子 风化硝 五倍子（各等分） 甘草（减半）
水煎服。稳卧。
【大意】
五脏六腑的疾病，都会导致咳嗽，并非仅仅是肺脏的问题。（《黄帝内经》）但其关键都在于肺。因为肺主管气，声音由此发出，所以咳嗽的根源，多聚集于胃而波及到肺，这是母子相关的关系。（《证治汇补》）
【内因】
肺位于人体最高处，主持全身之气，是体内最清轻的脏器。外受六淫邪气侵袭，内因七情过度刺激，导致肺金受损，咳嗽之病便由此产生。（《医宗金鉴·指掌》）火郁引起的咳嗽，只有声音没有痰，咳嗽连续不断；湿痰引起的咳嗽，咳嗽时伴有痰液，痰出则咳嗽停止；食积导致的痰嗽，面色青黄，五更时分加重，吐出的痰像胶一样黏稠；瘀血引起的咳嗽，胸中憋闷不畅，喉间有腥臭味，有时带有黑血；胃火引起的咳嗽，口渴且容易饥饿，面部发红发热，上午尤为严重；阴虚引起的咳嗽，手足心热、心胸烦热，气从下向上冲逆，中午重晚上更重；劳伤引起的咳嗽，干咳无痰，喉咙发痒声音嘶哑，痰中带血；停水引起的咳嗽，胸部胀满头部出汗，心悸不安吐涎沫，喝水即吐（水逆）；肺胀引起的咳嗽，喘息急促气息粗大，无论左侧还是右侧疼痛，都无法安睡。有些咳嗽日久会发展成肺痈或肺痿，必然出现云门、中府穴区域牵引性疼痛，咯吐脓血，气味腥臭异常。
【外因】
所谓“咳”，是指没有痰但有声音，是肺气受伤而不清肃的表现。所谓“嗽”，是指没有声音但有痰，是脾湿动而生痰的表现。“咳嗽”则是有声又有痰，是因为损伤了肺气又动摇了脾湿所致。（《医学纲目·机要》）如果是风邪伤肺，咳嗽时鼻塞声音沉重，口干喉痒，话没说完就咳嗽；寒邪伤肺，咳嗽时胸部紧缩干哑，凄惨怕冷，或者遇冷就发作；暑邪侵犯肺脏，咳嗽时口燥鼻干，面红心烦，声音嘶哑吐泡沫；湿邪侵犯肺脏，咳嗽时身体沉重头如裹物，自汗出小便涩滞，骨节烦痛。（《医宗入门》）这些都属于突发疾病感受邪气，必定兼有头痛、身热等表证。
【五脏劳咳】
极度疲劳伤肝，咳嗽时左胁肋部牵引疼痛；思虑过度伤心，咳嗽时咽喉干燥咯血；体力劳动伤脾，咳嗽时气短无力；大声呼叫伤肺，咳嗽时呕吐白沫，口燥声嘶；房事过度伤肾，咳嗽时腰背部牵引疼痛，夜间发作寒热。（《证治汇补》）
【脉法】
诊治咳嗽必须先审察肺脉的虚实。实证表现为浮大有力，如果沉而滑，说明痰气盛实。虚证表现为弦大无力，如果沉细带数，说明火郁极甚。（《医宗入门》）久咳导致身体消瘦虚弱，脉象弱的是可生；脉象实牢大数的则是死证。脉象浮软的可生，脉象沉紧隐匿的死。
【治疗分肺脾】
因为咳嗽而有痰的，以咳为主，治疗重点在肺；因为痰而导致咳嗽的，以痰为主，治疗重点在脾。
【治疗分内外】
治疗表证的药物不宜过于静守，静守则病邪留恋不解，变生其他疾病。忌用寒凉收敛药，应当用辛甘发散的药物来驱散邪气。对于内虚者，药物不宜过于动散，动散则虚火不宁，燥痒更加严重。忌用辛香燥热药，应当用甘寒滋润的药物润肺。（《景岳全书·必读》）
【治疗分四时】
春季阳气上升，宜润肺抑肝；夏季火势炎上，宜清金降火；秋季湿热盛行，宜清热泻湿；冬季风寒严重，宜解表行痰。（《杂著》）以上虽然按四季划分，但临症时应当灵活变通。
【治疗分新久】
新近咳嗽有痰的，属于外感，应随证解散；无痰的，是火热所致，只宜清解。久咳有痰的，宜燥脾化痰；无痰的，宜清金降火。因为外感久了会郁而化热，内伤久了则火炎上炎，都适宜开郁润燥。（《医宗入门》）现在的人只知道肺主皮毛，一遇到外感风寒，除了疏散之外，认为牢固不可破，却不知道日久会传入内脏，变成郁咳，遂成劳瘵。这大多是因为不分内外病因和新旧病程的差异。形体受寒、饮食生冷引起的，新咳痰稠，固然适宜温寒散湿；如果是气动火炎，久咳无痰，应当清热润燥，而温寒散湿的药剂就在禁忌之列了。常见劳症的发生，每由咳嗽引起，医者不探究其本源，认定为伤风，屡次使用辛温药物，导致发热自汗，食少便溏，最终造成无法挽救的后果。（《证治汇补》）
【火邪忌发散】
如果有肺伏火邪，腠理不固，风邪容易乘虚而入，遇感频繁发作的，应当兼清火邪。如果多次使用发散药，则会重伤津液，邪气蕴结成为肺疽肺痈，不可不谨慎。（《医学正传·立斋》）
【邪气忌补涩】
肺是娇脏，易寒易热。虽然人参、白术、甘草等甘温平补之品，只适合气虚者。如果肺热有火，以及风寒初盛时，不可骤然使用。至于乌梅、栗壳、兜铃、五倍子等收敛药，尤其不可急于进服，恐怕导致病情缠绵不已。（《证治汇补》）
【肾虚滋肾】
咳嗽烦冤，是肾气上逆的表现，因为肾是藏气的脏器。凡是咳嗽带动全身，自觉气从脐下逆奔而上，这是肾虚气不归原，应当在所服药物中加入补骨脂、五味子以收敛之。（《医宗入门》）
【脾虚补脾】
脾为黄婆，交媾水火，会合金木。久咳经过泻肺治疗，以及房劳饥饱失调，导致脾肺虚弱而饮食减少的，只需调理脾胃，咳嗽自然停止。（《类经》）
【死候】
咳嗽面白，咽喉生疮失音的，死。上气喘急，面部浮肿抬肩呼吸，身热不眠的，危。脉滑手足温暖的，生。脉涩四肢寒冷的，死。咳嗽伴呕吐，腹部胀满泄泻，脉弦急欲绝的，死。咳嗽形体脱失，身热脉小坚急快速的，为逆证。嗽而加汗出的，死。嗽而下利上喘的，死。（《证治汇补》）
【用药】
有余（实证）咳嗽，主方用二陈汤。风邪加羌活、防风、前胡、紫苏；寒邪加麻黄、杏仁、葱白、金沸草；热邪加黄芩、山栀、桑皮；湿邪加苍术、防己、赤茯苓；食积咳嗽加山楂、枳壳；气滞咳嗽加苏子、桔梗。不足（虚证）咳嗽，主方用二冬二母汤。火咳加款冬、玄参、黄芩；痰嗽加栝蒌、桑皮、苏子；郁证加苦梗、紫菀、枇杷叶；劳嗽加人参、黄芪、芍药；见血加阿胶、紫菀；滋阴加丹皮、黄柏。如果是脾泄，用异功散加石斛、五味子、百合、薏苡仁。肾虚者，用六味丸加麦冬、五味子、枇杷叶。水寒射肺成咳者，用五苓散。痰火入肺成咳，面部浮肿者，用粉黛散。肺中有虫者，用润肺丸。大抵肺位最高，针石不能到达，药饵难以直接送达，只有桔梗能载诸药入肺，必须临睡前细细咽下，才能入肺。
【附：肺痿】
久嗽肺虚，寒热往来，皮毛枯燥，声音不清，或者咳出血线，口中有浊唾涎沫，脉数而虚，这是肺痿的病。因为津液大量亡失，火炎金燥，就像草木遭受亢旱而枝叶萎落一样。治疗宜养血润肺，养气清金。初期用二地二冬汤以滋阴，后期用门冬清肺饮以收功。（朱丹溪）
【附：肺痈】
久咳不止，吐出浊物腥臭，咳嗽时胸中隐隐作痛，口中辟辟干燥，脉实滑数，大小便涩数，振寒吐沫，右胁拒按，这是肺痈的病。因为风寒内郁，痰火上凑，邪气结聚，蕴蓄成痈。如果是风邪内结，用小青龙汤；火邪内灼，用二冬汤；痰火郁结，用葶苈大枣泻肺汤。溃后收敛疮口，用团参饮子。如果风邪入里，不治。面赤脉浮大的，也不治。如果感觉胸膺有窍，口中所咳脓血与窍相应而出，应当大补气血，佐以排脓之品。（《证治汇补》）
【附：肺胀】
肺胀，动则喘满，气急息重，无论左侧还是右侧不适，无法安睡就是此病。如果是痰挟瘀血碍气，宜养血以流动气机，降火以清利痰液，用四物汤加桃仁、枳壳、陈皮、栝蒌、竹沥。又是风寒郁于肺中，不得发越，喘嗽胀闷的，宜发汗以祛邪，利肺以顺气，用麻黄越婢加半夏汤。有停水不化，肺气不得下降的，其症状是水入即吐，宜四苓散加葶苈、桔梗、桑皮、石膏。有肾虚水枯，肺金不敢下降而胀的，其症状是干咳烦冤，宜六味丸加麦冬、五味。又有气散而胀的，宜补肺；气逆而胀的，宜降气，应当参考虚实而施治。如果肺胀壅遏，不得眠卧，喘急鼻煽的，难治。（《证治汇补》）
【附：胸痹】
胸痹，胸中痛引背，喘息咳唾，短气，寸脉沉迟，关上紧数，宜栝蒌半夏薤白汤主治。（《医学准绳》）
【附：痰火】
有好色作劳之人，相火炽盛，气不归元，腾空而上入于肺叶空隙之间，膜原之内，聚痰凑沫，喘咳烦冤，日复一日，久久渐成熟路，只等肾气一动，喘嗽俱发。外症咸痰稠浊，夜卧不眠，或两颐红赤，垒垒发块，或胸背有疮，如粟如米，都是其征验。治疗宜清心静养，保肺滋肾。如果暴发而痰出如泉，声响如锯，面赤舌胀，喉硬目突的，死。（喻嘉言）
【咳嗽选方】
二陈汤：治风寒湿痰食积，气滞咳嗽。（方见痰症）
粉黛散：治痰火入肺，肺气上逆，咳而不卧，面浮气促。真蚌粉在新瓦上烧至红，入少许青黛，用淡浆水，滴麻油数点，调服二钱。
润肺丸：治肺中有虫，久嗽不已，渐变痨瘵。百部、桑皮（各二两），楝根（三两五钱），明矾（一两半），使君子（一两），鹤虱（一两），黄连（五钱），甘草（五钱）。丸如黍米大，米饮送下七八十丸，临卧服，上半月用之。
琼玉膏：治肺虚久嗽，气散失音，干咳无痰，或见血线。（方见虚劳）
清宁膏：治咳嗽属火炎热郁，气衰不足者。生地、麦冬（各十两），龙眼肉、薏苡仁（各八两），橘红（三两），桔梗、甘草、贝母（各二两），薄荷（五钱）。煎成膏，将苡仁、贝母、薄荷为细末，调入膏中服。
异功散：治咳嗽属土不生金，病兼少食泄泻者。（方见血症）
六味丸：治咳嗽属水衰火炎，病因房劳酒色者。（方见中风）
加味二冬汤：治咳嗽属火盛水亏，痰涎腥秽，将成痈痿者。天冬、麦冬（各一钱半），生地、熟地（各二钱），款冬、桔梗、贝母、紫菀、茯苓、甘草、沙参、栝蒌霜（各一钱）。水煎。
门冬清肺饮：治劳伤气虚，火旺咳嗽。即生麦散加紫菀（一钱半）、当归（三分）、黄芪、白芍、甘草（各一钱）。水煎。
劫劳散：治心肾俱虚，发咳二三声，无痰，遇夜即热，热已即冷，时有盗汗，四肢倦怠，体瘦食少，夜卧恍惚，或有血丝者。白芍、茯苓、当归、贝母、黄芪（各一钱），甘草（五分），熟地（二钱），枣仁（一钱半），阿胶（蛤粉炒一钱二分）。合生脉散同煎。
团参饮子：治久嗽肺虚。紫团参、紫菀茸（各三钱），款冬花（二钱），乌梅（一枚）。水煎。
肺痈方：治肺痈未成即消，已成即溃，已溃即愈。桔梗、金银花、黄芪、白芨（各一钱），陈皮、甘草（各一钱二分），苡仁（五钱），贝母（一钱半），甜葶苈（八分）。水姜煎服。初起加防风，去黄芪。溃后加人参。久不敛，加合欢皮。
越婢加半夏汤：治肺胀因感风寒，不能发散而成者。麻黄（六两），石膏（八两），生姜（三两），甘草（一两），半夏（八两），大枣（十五枚）。水煎。去麻黄沫，后入诸药，再煎服。
泻白散（方见火症）
参苏饮加减：治冬寒咳嗽，属风寒外束者。橘红、半夏、桔梗、前胡（各一钱），枳壳、杏仁、苏叶（各八分）。身热，加柴胡、黄芩。痰多，加金沸草。
快捷方式方：治久嗽不止。款冬花二两，在无风处烧之，以笔管吸烟咽下，即用美膳压下。
劫嗽方：治肺气耗散，久咳失音，用此劫之。诃子、五味子、风化硝、五倍子（各等分），甘草（减半）。水煎服，稳卧。
[General Principle]
Diseases of the five zang organs and six fu organs can all cause cough; it is not solely due to the Lung. (Huangdi Neijing) However, the key lies in the Lung. Since the Lung governs Qi and sound originates from it, the root of cough gathers in the Stomach and affects the Lung, reflecting the mother-son relationship. (Zhengzhi Huibu)
[Internal Causes]
The Lung resides at the highest position, governing all Qi, and is the clearest and lightest organ in the body. External invasion by the Six Excesses (Liu Yin) and internal disturbance by the Seven Emotions damage Metal (the Lung element), causing cough. (Yizong Jinjian: Zhizhang) Cough due to Fire Stagnation presents with sound but no phlegm, occurring in continuous bouts. Cough due to Damp-Phlegm involves phlegm production during coughing, stopping when phlegm is expectorated. Cough due to Food Stagnation shows a greenish-yellow complexion, worsens at dawn (5-7 AM), and produces sticky phlegm like glue. Cough due to Blood Stasis causes chest oppression, a fishy smell in the throat, and sometimes black blood in sputum. Cough due to Stomach Fire features thirst, hunger, facial redness and heat, worsening in the morning. Cough due to Yin Deficiency manifests as heat in the palms, soles, and chest, rising Qi, worsening at noon and night. Cough due to Labor Injury presents as dry cough without phlegm, itchy throat, hoarseness, and blood-streaked sputum. Cough due to Water Retention causes chest fullness, sweating on the head, palpitations, salivation, and vomiting upon drinking water (Water Rebellion). Cough due to Lung Distension involves rapid, coarse breathing, pain on either side, and insomnia. Long-standing cough may develop into Lung Abscess or Lung Flaccidity, characterized by pulling pain in Yunmen and Zhongfu acupoints, expectoration of pus and blood, and extremely foul odor.
[External Causes]
"Cough" refers to sound without phlegm, indicating injured Lung Qi failing to clear. "Su" refers to phlegm without sound, indicating Spleen Dampness generating phlegm. "Ke Sou" (Cough) involves both sound and phlegm, resulting from Lung injury combined with Spleen Dampness. (Yixue Gangmu: Jiyao) Wind injuring the Lung causes nasal congestion, heavy voice, dry mouth/throat, and interrupting speech with cough. Cold injuring the Lung causes tight chest, dry/hoarse voice, shivering, fear of cold, or exacerbation upon cold exposure. Summerheat invading the Lung causes dry mouth/nose, red face, irritability, hoarseness, and foamy sputum. Dampness invading the Lung causes heavy body, sensation of head wrapping, spontaneous sweating, difficult urination, and joint pain. These are acute diseases caused by pathogenic invasion, always accompanied by exterior symptoms such as headache and fever.
[Five Zang Exhaustion Cough]
Extreme fatigue injures the Liver, causing cough with pulling pain in the left hypochondrium. Mental overwork injures the Heart, causing cough with dry throat and hemoptysis. Physical labor injures the Spleen, causing cough with shortness of breath and weakness. Loud calling injures the Lung, causing cough with vomiting of white foam, dry mouth, and hoarseness. Sexual excess injures the Kidney, causing cough with pulling pain in the lower back, and night-time chills and fever. (Zhengzhi Huibu)
[Pulse Diagnosis]
One must first examine the Lung pulse for deficiency or excess. Excess pulses are floating, large, and forceful; if deep and slippery, Phlegm-Qi is abundant. Deficient pulses are wiry, large, and weak; if deep, thin, and rapid, Fire stagnation is severe. (Yizong Rumen) In chronic cough with emaciation, a weak pulse indicates survival; a solid, firm, large, and rapid pulse indicates death. A floating and soft pulse indicates survival; a deep, tight, and hidden pulse indicates death.
[Treatment: Differentiating Lung and Spleen]
When cough produces phlegm, cough is predominant, so treatment focuses on the Lung. When phlegm causes cough, phlegm is predominant, so treatment focuses on the Spleen.
[Treatment: Differentiating Exterior and Interior]
For exterior treatments, medicines should not be too static/astringent, as this retains pathogens and causes other diseases. Avoid cold/clearing and astringent herbs; use pungent-sweet dispersing herbs to expel pathogens. For interior deficiency, medicines should not be too dispersing/moving, as this agitates deficient fire and worsens dryness/itching. Avoid pungent-aromatic and hot/drying herbs; use sweet-cold moistening herbs to nourish the Lung. (Jingyue Quanshu: Bidu)
[Treatment: Differentiating Seasons]
In Spring, Yang rises; moisten the Lung and suppress the Liver. In Summer, Fire flares upward; clear Metal and descend Fire. In Autumn, Damp-Heat is prevalent; clear Heat and drain Dampness. In Winter, Wind-Cold is severe; release the exterior and move Phlegm. (Zazhuo) Although divided by seasons, clinical practice requires flexibility.
[Treatment: Differentiating New and Chronic]
New cough with phlegm belongs to external contraction; resolve according to the season. New cough without phlegm is due to Fire/Heat; clear only. Chronic cough with phlegm: dry the Spleen and transform Phlegm. Chronic cough without phlegm: clear Metal and descend Fire. External contractions become stagnant heat over time; internal injuries lead to flaming fire over time. Both require resolving stagnation and moistening dryness. (Yizong Rumen) Modern practitioners often believe the Lung governs skin/hair and that external Wind-Cold is invincible except through dispersal, unaware that long-term cases transmit inward, becoming stagnant cough and consumptive disease. This stems from failing to distinguish between external/internal causes and new/chronic stages. For new cough with thick phlegm due to cold form/diet, warming and dispersing dampness is appropriate. For chronic cough without phlegm due to Qi movement and Fire flaming, clearing Heat and moistening dryness is required, while warming/dispersing agents are contraindicated. Many consumptive diseases originate from cough; physicians who fail to investigate the root, misdiagnosing wind-cold and repeatedly using pungent-warm herbs, may cause fever, spontaneous sweating, poor appetite, loose stools, leading to untreatable conditions. (Zhengzhi Huibu)
[Fire Pathogens Contraindicate Dispersal]
If latent Fire pathogens exist in the Lung with open pores, Wind pathogens easily invade, causing frequent attacks. Treatment must clear Fire simultaneously. Repeated dispersal destroys Body Fluids, allowing pathogens to accumulate into Lung Carbuncle/Abscess. Caution is essential. (Li Zai)
[Pathogens Contraindicate Tonification and Astringency]
The Lung is a delicate organ, susceptible to Cold and Heat. While Ginseng, Atractylodes, and Licorice are sweet-warm and neutral tonics suitable for Qi deficiency, they are contraindicated in Lung Heat/Fire or early-stage Wind-Cold. Astringents like Mume Fructus, Persimmon Calyx, Sinomenine (Stemona), and Chinese Gall are especially unsuitable for immediate use, fearing prolonged illness. (Zhengzhi Huibu)
[Kidney Deficiency: Nourish Kidney]
Cough with vexation is due to rebellious Kidney Qi, as the Kidney stores Qi. If cough moves the whole body and Qi rebels upward from below the navel, it is Kidney deficiency with Qi failing to return to its source. Add Psoralea Fructus and Schisandra Fructus to the prescription to astringe. (Yizong Rumen)
[Spleen Deficiency: Tonify Spleen]
The Spleen acts as the mediator, balancing Water and Fire, integrating Metal and Wood. For chronic cough after Lung-draining therapies, or due to sexual excess/starvation/fullness imbalances, leading to Spleen-Lung deficiency and poor appetite, regulating the Spleen alone will stop the cough. (Leijing)
[Death Signs]
Cough with pale face, throat ulcers, and loss of voice: Death. Upper asthma, rapid breathing, facial edema, shoulder lifting, fever, and insomnia: Critical. Slippery pulse and warm hands/feet: Survival. Choppy pulse and cold limbs: Death. Cough with vomiting, abdominal fullness, diarrhea, and wiry/tight pulse nearing extinction: Death. Cough with emaciation, fever, small/firm/rapid pulse: Adverse prognosis. Cough with excessive sweating: Death. Cough with lower diarrhea and upper asthma: Death. (Zhengzhi Huibu)
[Medication]
For Excess (Shi) cough, the main formula is Er Chen Tang. Add Qianghuo, Fangfeng, Qianhu, Zisu for Wind; Mahuang, Xingren, Congbai, Jinfeicao for Cold; Huangqin, Shanzhi, Sangpi for Heat; Cangzhu, Fangji, Chifuling for Dampness; Shanzha, Zhike for Food Stagnation; Suizi, Jiegeng for Qi Stagnation. For Deficiency (Xu) cough, the main formula is Er Dong Er Mu Tang. Add Kuidong, Xuanshen, Huangqin for Fire cough; Gualou, Sangpi, Suizi for Phlegm cough; Jiegeng, Ziwan, Pipaye for Stagnation cough; Renshen, Huangqi, Shaoyao for Labor cough; Ejiao, Ziwan for Hemoptysis; Danpi, Huangbai for Yin nourishment. For Spleen diarrhea, use Yigong San plus Shihu, Wuweizi, Baihe, Yiren. For Kidney deficiency, use Liuwei Wan plus Maidong, Wuweizi, Pipaye. For Water-Cold attacking the Lung, use Wuling San. For Phlegm-Fire entering the Lung with facial edema, use Fendai San. For worms in the Lung, use Runfei Wan. Generally, the Lung is high; acupuncture cannot reach it, and medicine struggles to arrive. Only Jiegeng carries drugs to the Lung; swallow slowly before bed to ensure entry.
[Appendix: Lung Flaccidity]
Chronic cough with Lung deficiency, alternating chills/fever, dry skin/hair, unclear voice, blood streaks in sputum, turbid saliva/phlegm in mouth, rapid/deficient pulse: Lung Flaccidity. Due to severe loss of Body Fluids and Fire scorching Metal, like plants withering in drought. Treatment: Nourish Blood and moisten Lung, nourish Qi and clear Metal. Initially use Erdi Erdong Tang to nourish Yin; later use Mendong Qingfei Yin to conclude treatment. (Zhu Danxi)
[Appendix: Lung Abscess]
Unrelenting chronic cough, expectoration of foul-smelling turbid matter, dull chest pain on coughing, dry mouth, solid/slippery/rapid pulse, difficult urination/defecation, chills, foamy sputum, right hypochondriac tenderness: Lung Abscess. Due to internal stagnation of Wind-Cold, accumulation of Phlegm-Fire, pathogen condensation, and abscess formation. For internal Wind stagnation: Xiao Qinglong Tang. For internal Fire burning: Er Dong Tang. For Phlegm-Fire stagnation: Tingli Dazao Xiefei Tang. After ulceration, use Tuanshen Yinzi to heal wounds. Internal Wind invasion: Untreatable. Red face/floating-large pulse: Untreatable. Sensation of chest cavity opening with pus/blood matching the opening: Greatly tonify Qi and Blood, assist with pus-expelling agents. (Zhengzhi Huibu)
[Appendix: Lung Distension]
Lung Distension: Asthma/fullness on exertion, rapid/heavy breathing, discomfort on either side, inability to sleep. If Phlegm and Blood Stasis obstruct Qi: Nourish Blood to move Qi, descend Fire to clear Phlegm. Use Siwu Tang plus Taoren, Zhike, Chenpi, Gualou, Zhuli. If Wind-Cold stagnates in Lung without venting, causing asthma/cough/distension: Release exterior to expel pathogens, benefit Lung to smooth Qi. Use Mahuang Yuespi Jia Banxia Tang. If Water retention fails to transform, Lung Qi fails to descend, vomiting immediately after drinking: Siling San plus Tingli, Jiegeng, Sangpi, Shigao. If Kidney deficiency leads to Water/Dryness, Lung Metal fails to descend causing distension, dry cough/vexation: Liuwei Wan plus Maidong, Wuweizi. If Qi scattering causes distension: Tonify Lung. If Qi rebellion causes distension: Descend Qi. Treat based on deficiency/excess. If Lung Distension blocks respiration, insomnia, rapid asthma, nasal flaring: Difficult to treat. (Zhengzhi Huibu)
[Appendix: Chest Bi]
Chest Bi: Chest pain radiating to back, asthma/cough/spitting, shortness of breath, deep-slow Chi pulse, tight-rapid Guan pulse. Treat with Gualou Banxia Xiebai Tang. (Yixue Zhunsheng)
[Appendix: Phlegm-Fire]
Individuals with sexual excess/labor have blazing Ministerial Fire, Qi failing to return to origin, rising into Lung interstices and Membrane Source, gathering Phlegm/Foam, causing asthma/cough/vexation. Over time, pathways mature; once Kidney Qi moves, asthma/cough erupts. External signs: Thick turbid salty phlegm, insomnia, red cheeks, lumps, or chest/back sores like millet grains. Treatment: Clear Heart, calm mind, protect Lung, nourish Kidney. Sudden eruption with gushing phlegm, saw-like sound, red face/swollen tongue, stiff throat/protruding eyes: Death. (Yu Jiayan)
[Cough Selected Formulas]
Er Chen Tang: Treats Wind-Cold-Damp-Phlegm-Food Stagnation Qi Stagnation Cough. (See Phlegm Syndrome)
Fendai San: Treats Phlegm-Fire entering Lung, rebellious Qi, cough preventing lying down, facial edema, shortness of breath. Calcined Pearl Powder with Indigo Naturalis, mixed with dilute grain water and sesame oil, 2 qian per dose.
Runfei Wan: Treats Lung worms, chronic cough progressing to consumption. Stemona, Mulberry Bark (2 liang each), Toosendan Root (3.5 liang), Alum (1.5 liang), Quisqualis Seed (1 liang), Pyrethrum Root (1 liang), Coptis (0.5 liang), Licorice (0.5 liang). Pill size of millet seeds, 70-80 pills with rice water before bed, used in the first half of the lunar month.
Qiongyu Gao: Treats Lung deficiency chronic cough, Qi scattering/loss of voice, dry cough/no phlegm, blood streaks. (See Consumptive Disease)
Qingning Gao: Treats cough due to Fire/Heat/Stagnation with Qi deficiency. Rehmannia, Ophiopogon (10 liang each), Longan Aril, Coix Seed (8 liang each), Tangerine Peel (3 liang), Platycodon, Licorice, Fritillaria (2 liang each), Mint (0.5 liang). Decoct into paste, mix with fine powder of Coix Seed, Fritillaria, Mint.
Yigong San: Treats cough due to Earth failing to generate Metal, with poor appetite/diarrhea. (See Blood Syndrome)
Liuwei Wan: Treats cough due to Water deficiency/Fire flaming, caused by sexual excess/alcohol. (See Stroke)
Jiawei Erdong Tang: Treats cough due to Fire excess/Water deficiency, foul phlegm, impending abscess/flaccidity. Asparagus, Ophiopogon (1.5 qian each), Rehmannia (Raw/Cooked, 2 qian each), Kolanther Flower, Platycodon, Fritillaria, Aster, Poria, Licorice, Glehnia, Trichosanthes Powder (1 qian each). Decoct in water.
Mendong Qingfei Yin: Treats labor-induced Qi deficiency, Fire-flaring cough. Based on Shengmai San plus Aster (1.5 qian), Angelica Sinensis (0.3 qian), Astragalus, White Peony, Licorice (1 qian each). Decoct in water.
Jielao San: Treats Heart/Kidney dual deficiency, brief cough, no phlegm, night fever/chills, night sweats, limb fatigue, emaciation, poor appetite, restlessness, blood streaks. White Peony, Poria, Angelica Sinensis, Fritillaria, Astragalus (1 qian each), Licorice (0.5 qian), Cooked Rehmannia (2 qian), Sour Jujube Seed (1.5 qian), Donkey-hide Gelatin (1.2 qian, stir-fried with shell powder). Decoct with Shengmai San.
Tuanshen Yinzi: Treats chronic cough with Lung deficiency. Purple Codonopsis, Aster Root (3 qian each), Kolanther Flower (2 qian), Mume Fruit (1 piece). Decoct in water.
Fei Yong Fang (Lung Abscess Formula): Prevents formation, promotes rupture, heals after rupture. Platycodon, Honeysuckle, Astragalus, Bletilla (1 qian each), Tangerine Peel, Licorice (1.2 qian each), Coix Seed (5 qian), Fritillaria (1.5 qian), Sweet Descurainia Seed (0.8 fen). Decoct with Ginger/Water. Add Fangfeng at onset, remove Astragalus. Add Ginseng after rupture. Add Albizia Bark if non-healing.
Yuespi Jia Banxia Tang: Treats Lung Distension from unvented Wind-Cold. Ephedra (6 liang), Gypsum (8 liang), Ginger (3 liang), Licorice (1 liang), Pinellia (8 liang), Jujube (15 pieces). Decoct in water. Skim Ephedra foam, add remaining herbs, decoct again.
Xiebai San (See Fire Syndrome)
Rensu Yin Modified: Treats winter Wind-Cold cough. Tangerine Peel, Pinellia, Platycodon, Peucedanum (1 qian each), Aurantium, Apricot Seed, Perilla Leaf (0.8 fen each). Add Bupleurum/Coptis for fever; add Jinfeicao for excessive phlegm.
Quick Method Formula: Treats unrelenting chronic cough. Burn 2 liang Kolanther Flower in windless place, inhale smoke via pen tube, swallow with food.
Jiesou Fang: Treats Lung Qi dispersion, chronic cough/loss of voice. Chebula, Schisandra, Weathered Nitre, Chinese Gall (equal parts), Licorice (half amount). Decoct in water, take while resting.