平按∶此篇自篇首至末，见《素问》卷十第三十八《咳论》篇，又见《甲乙经》卷
九第三。
黄帝问于岐伯曰∶肺之令人咳何也？岐伯曰∶五脏六腑皆令人咳，非独肺也。（五
脏六腑皆以肺传与之，称咳为肺咳，然脏腑皆有咳也。）黄帝曰∶愿闻其状。岐伯曰∶皮
毛者肺之合也，毛先受邪，气从其合；其寒饮食，饮食入胃，顺肺脉上注于肺，肺寒，
外内合邪因而客之，□为肺咳。（肺合皮毛，故皮毛受于寒邪，内合于肺。人肺脉手太
阴，起胃中焦，下络大肠，还循胃口上膈□肺。寒饮寒食入胃，寒气循肺脉上入肺中，
内外寒邪相合，肺以恶寒，遂发肺咳之病也。平按∶《素问》、《甲乙》“毛先受邪气
从其合”作“皮毛先受邪气，邪气以从其合”，饮食二字不重，顺肺脉作从肺脉，上注
于肺作上至于肺，“肺寒，外内合”作“则肺寒，肺寒则外内合”。为上缺一字，《素
问》、《甲乙》作则，袁刻作发。注膈下缺一字，袁刻作故，不合，平拟据经文作注字，
与肺字属上读。）五脏各以其时受病，非其时，各传以与之。（五脏各以王时伤寒，肺
先受之，传为五脏之咳。非其时者，又因他脏受寒，传来与之。故肺咳之病，传与余脏，
称五脏咳也。）人与天地相参，故脏各治时，感于寒则受病，微则为咳，甚则为泄为痛。
（各以时者，五脏各以王时也。感于寒者，感伤寒也。感伤寒病有轻有重，轻者为咳，
重者以为泄及痛痹也。平按∶故脏各治时《素问》、《甲乙》作故五脏各以治时。）黄
帝曰∶五脏之咳奈何？岐伯曰∶五脏之久咳，乃移于腑。（以下言肺咳相传为脏腑咳也。
五脏之
咳，近者未虚，久者传为六腑咳也。平按∶《素问》、《甲乙》无此一段，五脏之久咳
二句，在后脾咳不已上。）肺先受邪，乘春则肝先受之，乘夏则心受之，乘至阴则脾受
之，乘冬则肾受之。（肺以恶寒，肺先受寒，乘春肝王时，肝受即为肝咳。若肺先受寒，
乘于至阴，即为脾咳。若肺先受寒，乘冬即为肾咳。平按∶《素问》肺先受邪上有乘秋
则三字，新校正云∶“按全元起本及《太素》无乘秋则三字，疑此文误多也。”）黄帝
曰∶何以异之？（以下言问答五脏咳状也。）岐伯曰∶肺咳之状，咳而喘息有音，甚则
唾血。（言肺咳状也。）心咳之状，咳则心痛，喉仲介介如哽状，甚则咽喉肿。（介介，
喉中气如哽也。平按∶《甲乙》介介作喝喝。哽《素问》、《甲乙》作梗。咽喉肿《素问》、
《甲乙》作咽肿喉痹。）肝咳之状，咳则两 下痛，甚则不可以转，两 下以满。脾咳
之状，咳则在右胁下痛引肩背，甚则不可以动，动则咳。（ ，有本作胁也。平按∶两
下痛《甲乙》作 痛，《素问》作两胁下痛。两 下以满《素问》作转则两 下满，
《甲乙》 作胁。引肩上《素问》、《甲乙》有阴阴二字。则咳下《素问》有剧字。）
肾咳之状，咳则腰背相引而痛，甚则咳演。（音涎，肾液也。谓咳涎出之也。平按∶
演《素问》、《甲乙》作涎。）黄帝曰∶六腑之咳奈何？安所受病？岐伯曰∶脾咳不已，
则胃受之，胃咳之状，咳而欧，欧甚则长虫出。（以下问答，言六腑咳状。六腑之咳，
皆脏咳日久，移入于腑，以为腑咳。腑不为咳移入脏者，以皮肤受寒，内至于肺，肺中
外寒两邪为咳，移于五脏，然后外至于腑，故不从腑移入于脏。所以脾咳日久，移为胃
咳。长虫， 虫也。平按∶《素问》、《甲乙》脾咳不已上有“五脏之久咳，乃移于六
腑”二句。）肝咳不已，则胆受之，胆咳之状，欧欧胆汁。（欧胆
汁者，咳引于胆，故欧胆口苦也。平按∶欧欧胆汁《素问》、《甲乙》作咳呕胆汁。）
肺咳不已，则大肠受之，大肠咳之状，咳而遗矢。（遗矢者，咳引大肠，故遗矢也。平
按∶矢《素问》作失，新校正云∶《甲乙》遗失作遗矢。）心咳不已，则小肠受之，小
肠咳之状，咳而气，气者与咳俱出。（小肠在上，咳引小肠，故气与咳俱发者也。平按∶
“咳而气，气者与咳俱出”《素问》、《甲乙》作“咳而失气，气与咳俱失”。）肾咳
不已，则膀胱受之，膀胱咳之状，咳而遗溺。（咳动膀胱，故尿出也。平按∶《甲乙》
遗溺作遗尿。）久咳不已，三焦受之，三焦咳之状，咳腹满，不欲食饮。（三焦无别属
脏与膀胱合，故膀胱之咳，久而不已，腹病满，不欲食也。）此皆聚于胃管，关于肺，
使人多涕唾而面浮肿气逆。（此六腑咳，皆以气聚胃中，上关于肺，致使面壅浮肿气逆
为咳也。平按∶《素问》、《甲乙》胃下无管字。）黄帝曰∶治之奈何？岐伯曰∶治脏
者治其输，治腑者治其合，浮肿者治其经。黄帝曰∶善。（疗五脏咳，宜疗脏经第三输
也。疗六腑咳者，宜疗脏经第六合也。有浮肿者，不可治络，宜疗经穴也。平按∶输
《素问》、《甲乙》作俞。）
【平按】：本篇从开头到结尾，见于《素问》卷十第三十八篇《咳论》，也见于《甲乙经》卷九第三篇。
黄帝向岐伯问道：肺导致人咳嗽的原因是什么？岐伯回答说：五脏六腑都能使人咳嗽，并不仅仅是肺。（五脏六腑的病邪都会传给肺，人们因此称咳嗽为肺咳，但实际上脏腑都有咳嗽的症状。）黄帝说：我想听听咳嗽的具体表现。岐伯说：皮毛是肺的外合，皮毛先受到邪气侵袭，病气就顺着其外合之处传入体内；如果吃了寒凉饮食，食物进入胃中，寒气顺着肺脉上行注入肺中，导致肺寒，外感寒邪与内伤寒饮相结合，从而客居于肺，[发]为肺咳。（肺合于皮毛，所以皮毛受寒邪侵袭，内部与肺相合。人的手太阴肺脉，起于胃的中焦，向下联络大肠，回转沿着胃口向上穿过膈膜[故]入肺。寒饮寒食进入胃中，寒气顺着肺脉上行进入肺中，内外寒邪相互结合，肺厌恶寒冷，于是引发肺咳的疾病。【平按】：《素问》、《甲乙经》中“毛先受邪气从其合”写作“皮毛先受邪气，邪气以从其合”，“饮食”二字不重复，“顺肺脉”写作“从肺脉”，“上注于肺”写作“上至于肺”，“肺寒，外内合”写作“则肺寒，肺寒则外内合”。原文此处缺一个字，《素问》、《甲乙经》作“则”，袁刻本作“发”。注释中“膈”下缺一字，袁刻本作“故”，不合逻辑，我推测根据经文应作“注”字，与“肺”字连读。）五脏各自在其当令的时节受病，如果不是当令时节，则是其他脏腑传变而来与之相应。（五脏各自在旺时感受伤寒，肺最先受邪，传变为五脏之咳。如果不是当令时节，则是因其他脏腑受寒，传变而来所致。所以肺咳的病，会传变给其余脏腑，称为五脏咳。）人与天地相互参应，所以各脏各有其主治的时节，感受寒邪就会生病，轻微的就表现为咳嗽，严重的就表现为泄泻或疼痛。（所谓“各以时”，是指五脏各自在其旺时。所谓“感于寒”，是指感受伤寒。感受伤寒病情有轻有重，轻者表现为咳嗽，重者表现为泄泻及痛痹。【平按】：原文“故脏各治时”在《素问》、《甲乙经》中作“故五脏各以治时”。）
黄帝说：五脏的咳嗽是怎样的？岐伯说：五脏的久咳，会转移传变到六腑。（以下讲述肺咳传变为脏腑咳的情况。五脏的咳嗽，病程短的尚未虚损，病程长的会传变为六腑咳。【平按】：《素问》、《甲乙经》中没有这一段，“五脏之久咳”两句，在后文“脾咳不已”之上。）肺先受邪气，遇到春季肝旺之时，肝就先受邪；遇到夏季心旺之时，心就受邪；遇到长夏脾旺之时，脾就受邪；遇到冬季肾旺之时，肾就受邪。（肺厌恶寒冷，肺先受寒，遇到春季肝旺时，肝受邪即为肝咳。如果肺先受寒，遇到长夏，即为脾咳。如果肺先受寒，遇到冬季，即为肾咳。【平按】：《素问》中“肺先受邪”上有“乘秋则”三字，新校正说：“按全元起本及《太素》没有‘乘秋则’三字，怀疑此文多出了。”）
黄帝说：如何区分它们呢？（以下讲述问答五脏咳嗽症状的情况。）岐伯说：肺咳嗽的症状，是咳嗽伴有喘息且有声音，严重的会咳唾带血。（这是描述肺咳的症状。）心咳嗽的症状，是咳嗽时心痛，喉咙中有异物感像被卡住一样，严重的会导致咽喉肿痛。（介介，指喉中气机不畅如哽咽。【平按】：《甲乙经》中“介介”作“喝喝”。哽，《素问》、《甲乙经》作“梗”。咽喉肿，《素问》、《甲乙经》作“咽肿喉痹”。）肝咳嗽的症状，是咳嗽时两胁下疼痛，严重的不能转身，两胁下胀满。脾咳嗽的症状，是咳嗽时右胁下疼痛牵引肩背，严重的不能活动，活动就会加重咳嗽。（“ ”字，有的版本作“胁”。【平按】：两 下痛，《甲乙经》作“ 痛”，《素问》作“两胁下痛”。两 下以满，《素问》作“转则两 下满”，《甲乙经》“ ”作“胁”。引肩上，《素问》、《甲乙经》中有“阴阴”二字。则咳下，《素问》中有“剧”字。）肾咳嗽的症状，是咳嗽时腰背相互牵引而痛，严重的会咳出涎沫。（音同“涎”，指肾液。意思是咳嗽流出涎沫。【平按】：演，《素问》、《甲乙经》作“涎”。）
黄帝说：六腑的咳嗽是怎样的？是从哪里受病的？岐伯说：脾咳日久不愈，则胃受邪，胃咳嗽的症状，是咳嗽并呕吐，严重的会吐出蛔虫。（以下问答，讲述六腑咳的症状。六腑的咳嗽，都是五脏咳嗽日久，移入于腑，成为腑咳。腑不会单独引起咳嗽再移入脏，因为皮肤受寒，内达于肺，肺中外寒两邪导致咳嗽，传变于五脏，然后才外达于腑，所以不从腑移入于脏。因此脾咳日久，移变为胃咳。长虫，即蛔虫。【平按】：《素问》、《甲乙经》在“脾咳不已”上有“五脏之久咳，乃移于六腑”两句。）肝咳嗽日久不愈，则胆受邪，胆咳嗽的症状，是咳嗽并呕吐胆汁。（呕胆汁，是因为咳嗽牵连到胆，所以呕吐胆汁且口苦。【平按】：欧欧胆汁，《素问》、《甲乙经》作“咳呕胆汁”。）肺咳嗽日久不愈，则大肠受邪，大肠咳嗽的症状，是咳嗽并大小便失禁。（遗矢，是因为咳嗽牵连到大肠，所以大小便失禁。【平按】：矢，《素问》作“失”，新校正说：《甲乙经》“遗失”作“遗矢”。）心咳嗽日久不愈，则小肠受邪，小肠咳嗽的症状，是咳嗽并排气，气体随咳嗽一起排出。（小肠在上部，咳嗽牵连小肠，所以气体随咳嗽一起发作。【平按】：“咳而气，气者与咳俱出”在《素问》、《甲乙经》中作“咳而失气，气与咳俱失”。）肾咳嗽日久不愈，则膀胱受邪，膀胱咳嗽的症状，是咳嗽并小便失禁。（咳嗽扰动膀胱，所以尿液流出。【平按】：《甲乙经》“遗溺”作“遗尿”。）久咳不愈，三焦受邪，三焦咳嗽的症状，是咳嗽伴腹部胀满，不想饮食。（三焦没有别属的脏腑，与膀胱相合，所以膀胱的咳嗽，久了不愈，出现腹病胀满，不想吃东西。）这些咳嗽都是因为病气聚集在胃脘，关联于肺，使人多流涕唾沫并且面部浮肿、气机上逆。（这六种腑咳，都是因为气聚积在胃中，向上关联于肺，致使面部壅滞浮肿、气逆而咳嗽。【平按】：《素问》、《甲乙经》“胃”下无“管”字。）
黄帝说：如何治疗？岐伯说：治疗五脏咳要针刺其输穴，治疗六腑咳要针刺其合穴，有浮肿的要针刺其经穴。黄帝说：好。（治疗五脏咳，适宜治疗脏经的第三个输穴。治疗六腑咳，适宜治疗脏经的第六个合穴。如果有浮肿，不可治疗络穴，适宜治疗经穴。【平按】：输，《素问》、《甲乙经》作“俞”。）
[Ping An]: This chapter, from beginning to end, is found in Volume 10, Chapter 38 "Treatise on Cough" (Ke Lun) of the *Suwen* (Basic Questions), and also in Volume 9, Chapter 3 of the *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion).
The Yellow Emperor asked Qibo: Why does the Lung cause cough? Qibo replied: All five Zang organs and six Fu organs can cause cough; it is not exclusive to the Lung. (The pathogenic factors of all five Zang and six Fu organs transmit to the Lung, so people call cough "Lung cough," yet every Zang and Fu organ has its own form of cough.) The Yellow Emperor said: I wish to hear about its manifestations. Qibo said: The skin and hair are the exterior correspondence of the Lung. Pathogenic factors first affect the skin and hair, and the Qi follows this correspondence inward; if cold food and drink are consumed, upon entering the Stomach, the coldness follows the Lung meridian upward to inject into the Lung, causing Lung cold. When external and internal pathogenic factors combine and lodge within, [it develops into] Lung cough. (The Lung corresponds to the skin and hair, thus when the skin and hair are affected by cold pathogenic factors, they internally connect with the Lung. The Hand Taiyin Lung Meridian originates in the middle Jiao of the Stomach, descends to connect with the Large Intestine, returns along the stomach opening, ascends through the diaphragm [and enters] the Lung. Cold drinks and food enter the Stomach, and cold Qi ascends via the Lung meridian into the Lung. External and internal cold pathogenic factors combine; since the Lung dislikes cold, a disease of Lung cough arises. [Ping An]: In the *Suwen* and *Jiayi Jing*, "Mao xian shou xie qi cong qi he" is written as "Pimao xian shou xie qi, xie qi yi cong qi he"; the word "yinshi" (food and drink) is not repeated; "shun feimai" is written as "cong feimai"; "shang zhu yu fei" is written as "shang zhi yu fei"; "fei han, wai nei he" is written as "ze fei han, fei han ze wai nei he". One character is missing here in the text; the *Suwen* and *Jiayi Jing* use "ze", while Yuan's edition uses "fa". Below "ge" (diaphragm) in the commentary, one character is missing; Yuan's edition uses "gu", which is inconsistent. I speculate that based on the classic text, it should be "zhu" (inject/flow), read together with "fei" (Lung).) Each of the five Zang organs contracts disease during its respective ruling season; if it is not the ruling season, the disease is transmitted from other organs to correspond with it. (Each Zang organ contracts cold damage during its prosperous season; the Lung is affected first, transmitting to become cough of the five Zang organs. If it is not the ruling season, it is because another Zang organ contracted cold, which then transmits to it. Thus, the disease of Lung cough transmits to the remaining organs, called cough of the five Zang organs.) Humans correspond with Heaven and Earth, so each Zang organ governs a specific time. Contracting cold leads to disease; mild cases result in cough, while severe cases result in diarrhea or pain. ([Regarding] "each governs a time," it means each Zang organ during its prosperous season. [Regarding] "contracting cold," it means contracting cold damage. Contracting cold damage varies in severity; mild cases manifest as cough, severe cases as diarrhea and painful obstruction. [Ping An]: "Gu zang ge zhi shi" in the *Suwen* and *Jiayi Jing* is written as "Gu wu zang ge yi zhi shi".)
The Yellow Emperor asked: What is the nature of cough of the five Zang organs? Qibo said: Long-standing cough of the five Zang organs will transfer to the Fu organs. (The following discusses how Lung cough transmits to become Zang and Fu cough. Cough of the five Zang organs, if recent, has not yet caused deficiency; if long-standing, it transmits to become cough of the six Fu organs. [Ping An]: The *Suwen* and *Jiayi Jing* do not contain this paragraph; the two sentences "Wu zang zhi jiu ke, nai yi yu liu fu" appear above "Pi ke bu yi" later in the text.) The Lung is affected first by pathogenic factors. In Spring, when Liver Qi is prosperous, the Liver is affected first; in Summer, when Heart Qi is prosperous, the Heart is affected; in Late Summer (Zhi Yin), when Spleen Qi is prosperous, the Spleen is affected; in Winter, when Kidney Qi is prosperous, the Kidney is affected. (The Lung dislikes cold; if the Lung first contracts cold, and encounters the Spring season when Liver Qi is prosperous, the Liver is affected, resulting in Liver cough. If the Lung first contracts cold and encounters Late Summer, it results in Spleen cough. If the Lung first contracts cold and encounters Winter, it results in Kidney cough. [Ping An]: In the *Suwen*, the phrase "Cheng qiu ze" (In Autumn, then...) appears before "Fei xian shou xie". The New Correction states: "According to Quan Yuanqi's edition and the *Taisu*, there are no three characters 'Cheng qiu ze'; it is suspected that this text erroneously added them.")
The Yellow Emperor asked: How can they be distinguished? (The following discusses the symptoms of cough of the five Zang organs.) Qibo said: The manifestation of Lung cough is cough accompanied by wheezing and audible sounds; in severe cases, blood is expectorated. (This describes the symptoms of Lung cough.) The manifestation of Heart cough is cough accompanied by heart pain, a sensation of something stuck in the throat like a foreign body, and in severe cases, swelling of the throat and tongue. ("Jiejie" refers to the feeling of Qi stagnation in the throat as if choked. [Ping An]: In the *Jiayi Jing*, "jiejie" is written as "hehe". "Geng" (choked) is written as "geng" (blockage) in the *Suwen* and *Jiayi Jing*. "Yan hou zhong" (swelling of throat) is written as "yan zhong hou bi" (swollen throat and throat obstruction) in the *Suwen* and *Jiayi Jing*.) The manifestation of Liver cough is cough accompanied by pain in both hypochondriac regions; in severe cases, turning the body is impossible, and the hypochondriac regions feel full. The manifestation of Spleen cough is cough accompanied by pain under the right hypochondrium radiating to the shoulder and back; in severe cases, movement is impossible, and movement exacerbates the cough. (" " is written as "xie" (hypochondrium) in some editions. [Ping An]: "Liang xia tong" is written as " Tong" in the *Jiayi Jing* and "Liang xie xia tong" in the *Suwen*. "Liang xia yi man" is written as "Zhuan ze Liang Tong man" in the *Suwen*, and "Tong" is written as "xie" in the *Jiayi Jing*. "Yin jian shang" has the characters "yinyin" in the *Suwen* and *Jiayi Jing*. "Ze ke xia" has the character "ju" (severe) in the *Suwen*.) The manifestation of Kidney cough is cough accompanied by pulling pain between the waist and back; in severe cases, profuse saliva is coughed up. ("Yan" sounds like "xian" (saliva), referring to Kidney fluid. It means coughing up saliva. [Ping An]: "Yan" is written as "xian" in the *Suwen* and *Jiayi Jing*.)
The Yellow Emperor asked: What is the nature of cough of the six Fu organs? From where does the disease originate? Qibo said: If Spleen cough persists, the Stomach becomes affected. The manifestation of Stomach cough is cough accompanied by vomiting; in severe cases, roundworms are expelled. (The following Q&A describes the symptoms of Fu cough. Cough of the six Fu organs all result from long-standing Zang cough transferring into the Fu organs to become Fu cough. The Fu organs do not initiate cough and then transfer to the Zang organs; rather, skin contraction of cold pathogens reaches the Lung internally, where external and internal cold pathogens in the Lung cause cough, which then transfers to the five Zang organs, and only subsequently reaches the Fu externally. Therefore, it does not transfer from Fu to Zang. Thus, long-standing Spleen cough transfers to become Stomach cough. Changchong refers to roundworms. [Ping An]: The *Suwen* and *Jiayi Jing* have the two sentences "Wu zang zhi jiu ke, nai yi yu liu fu" before "Pi ke bu yi".) If Liver cough persists, the Gallbladder becomes affected. The manifestation of Gallbladder cough is cough accompanied by vomiting of bile. (Vomiting bile occurs because cough affects the Gallbladder, leading to bitter taste in the mouth. [Ping An]: "Ou ou dan zhi" is written as "Ke ou dan zhi" (cough and vomit bile) in the *Suwen* and *Jiayi Jing*.) If Lung cough persists, the Large Intestine becomes affected. The manifestation of Large Intestine cough is cough accompanied by involuntary defecation. (Yishi occurs because cough affects the Large Intestine, leading to loss of bowel control. [Ping An]: "Shi" is written as "shi" (loss) in the *Suwen*; the New Correction notes that the *Jiayi Jing* writes "yi shi" as "yi shi".) If Heart cough persists, the Small Intestine becomes affected. The manifestation of Small Intestine cough is cough accompanied by flatus, which is expelled along with the cough. (The Small Intestine is located superiorly; cough affects the Small Intestine, so flatus is emitted with the cough. [Ping An]: "Ke er qi, qi zhe yu ke ju chu" is written as "Ke er shi qi, qi yu ke ju shi" in the *Suwen* and *Jiayi Jing*.) If Kidney cough persists, the Bladder becomes affected. The manifestation of Bladder cough is cough accompanied by urinary incontinence. (Cough disturbs the Bladder, leading to urine leakage. [Ping An]: In the *Jiayi Jing*, "yi ni" is written as "yi niao".) If long-standing cough persists, the Sanjiao (Triple Burner) becomes affected. The manifestation of Sanjiao cough is cough accompanied by abdominal fullness and lack of appetite. (The Sanjiao has no separate Zang organ association but combines with the Bladder; thus, persistent Bladder cough leads to abdominal disease and fullness, and loss of desire for food and drink.) All these conditions gather at the Wei Guan (Stomach opening/esophagus) and relate to the Lung, causing excessive phlegm and drool, facial edema, and rebellious Qi. (These six types of Fu cough all result from Qi gathering in the Stomach, affecting the Lung superiorly, causing facial congestion and edema, rebellious Qi, and cough. [Ping An]: The *Suwen* and *Jiayi Jing* do not have the character "guan" after "wei".)
The Yellow Emperor asked: How should they be treated? Qibo said: To treat cough of the Zang organs, treat their Shu (Transport) points; to treat cough of the Fu organs, treat their He (Sea) points; for edema, treat their Jing (River) points. The Yellow Emperor said: Excellent. (To treat cough of the five Zang organs, it is appropriate to treat the third Shu point of the Zang meridians. To treat cough of the six Fu organs, it is appropriate to treat the sixth He point of the Zang meridians. For those with edema, one should not treat the Luo (Connecting) points, but rather the Jing points. [Ping An]: "Shu" is written as "Yu" in the *Suwen* and *Jiayi Jing*.)