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1、咳 嗽 【概说】 咳嗽为肺系疾患的主要证候。其发病原因，有外邪侵袭，肺气不得宣畅，因而发生咳嗽；也可由肺脏的病变，或其他脏腑有病，影响肺脏所致。Cough 【Brief Introduction】 Cough, a main symptom of the lung problems, may result either from attack by exogenous pathogenic factors disturbing the dispersion of qi of the lung, or from disorders of the lung itself or other dise

2、ased zang-fu organs affecting the lung.肺的生理功能和特点：肺主气，为五脏之华盖，上连喉咙，开窍于鼻，司呼吸，外合皮毛。Physiological functions and characteristics of lung： Lung dominates qi, known as the “canopy” of the five zang organs. Upward it connects the throat, opens into nose, and controls respiration; externally it dominates the

3、skin and hair.【病因病机】（一）外感咳嗽的病因病机：外邪侵袭，肺卫受邪，肺气壅遏不宣，肺失清肃，因而引起咳嗽。由于人体所感受的外邪不同，因而临床上分为风寒咳嗽，风热咳嗽。【Etiology and pathogenesis】a）Invasion by the exogenous pathogenic factors： When the lung is attacked by the exogenous pathogenic factors, the qi of the lung is blocked and fails to descend, thus resulting in

4、cough. The exogenous pathogenic factors attacking the human body are various, cough therefore is divided into two types: wind cold and wind heat.【病因病机】（二）内伤咳嗽的病因病机：由于脏腑功能失调而致的咳嗽，属于内伤咳嗽。如肺燥阴虚，肺失清肃之咳嗽；或他脏有病， 累及肺脏而致咳嗽。如脾阳不振，聚湿为痰，痰浊上渍于肺，影响气机出入，遂为咳嗽；肝气郁滞， 日久化火，木火上炎，烁肺伤津，亦能发生咳嗽。不论是何脏腑功能失调，一旦影响到肺都可引起咳嗽。临床上

5、常见的内伤咳嗽主要是肺燥阴虚和痰浊阻肺。 【Etiology and pathogenesis】b）Internal injury： Cough resulted from functional impairment of the zang-fu organs falls into the category of cough due to internal injury. Such as cough caused by dryness of the lung with deficiency of yin leading to failure of the qi of the lung to d

6、escend; Or by disorders of the other organs affecting the lung. For example, in case of weakened spleen yang, the accumulated dampness may be turned into phlegm which goes upward to the lung, affecting the normal activities of qi and leading to cough; Stagnation of liver qi may be turned into fire,

7、which flares up and injuries the lung fluid, also resulting in cough; No matter which zang-fu organ is dysfunctioned, cough may occur if the lung is affected. The commonly seen cough caused by internal injury in clinic results from dryness of the lung with deficiency of yin, and blockage of the lung

8、 by phlegm. 【辨证】（一）外感咳嗽 风寒证主证：咳嗽喉痒，痰液稀薄色白， 恶寒发热， 无汗，头痛，鼻塞流涕，舌苔薄白，脉浮。 证候分析：咳嗽喉痒，痰液稀薄色白，鼻塞流涕，为风寒犯肺，郁于气道，肺气不能宣畅所致；头痛，寒热无汗，为风寒兼伤皮毛，外束肌腠，寒主闭塞之故；舌苔薄白，脉浮，主邪在肺在表。【Differentiation】a）Invasion by the exogenous pathogenic factors wind cold type Main manifestations: Cough, itching of the throat, thin and white s

9、putum, chills, fever, anhidrosis, headache, nasal obstruction and discharge, thin, white tongue coating and superficial pulse. Analysis： Cough, itching of the throat, thin and white sputum, nasal obstruction and discharge result from the attack of the lung by pathogenic wind cold, which is stagnated

10、 in the respiratory tract, affecting the dispersion of the qi of the lung； Headache, chills, fever and anhidrosis are due to wind cold affecting the skin and hair, and residing on the body surface； Thin, white tongue coating and superficial pulse indicate the presence of the pathogenic factors stayi

11、ng in the lung and in the superficial part of the body.【辨证】（一）外感咳嗽风热证主证：咳痰黄稠，咳而不爽，口渴咽痛，身热，或见头疼，恶风，有汗等表证，舌苔薄黄，脉浮数。 证候分析：风热犯肺，肺失清肃，热熬津液为痰，故咳痰黄稠争咳而不爽；肺热伤津，故口渴咽痛；邪客皮毛，正邪相争，故兼有头痛，恶风，有汗，身热等表症；舌苔薄黄，脉浮数，为风热在肺在表之象。【Differentiation】a）Invasion by the exogenous pathogenic factors wind heat type Main manifestati

12、ons：Cough with yellow, thick sputum, choking cough, thirst, sore throat, fever, or headache, aversion to wind, sweating, thin, yellow tongue coating, superficial and rapid pulse. Analysis： In case of the attack of the lung by the pathogenic wind heat, the function of the lung in clarifying the passa

13、ge and sending down the qi is impaired. The fluids are heated and turned into phlegm, and so cough with yellow, thick sputum or choking cough takes place； When the heat in the lung injures body fluid, thirst and sore throat occur； When the pathogenic factors stay in the skin and hair, their conflict

14、 with the body resistance gives rise to headache, aversion to wind, sweating and fever； Thin, yellow tongue coating, and superficial rapid pulse are the signs of wind heat staying in the lung and in the superficial part of the body.【辨证】（二）内伤咳嗽痰浊阻肺证：主证：咳嗽多痰，痰白而粘，胸脘痞闷，胃纳减少，舌苔白腻，脉滑。 证候分析：脾失健运，水湿不化，聚湿为痰

15、，痰浊上渍于肺，阻碍肺气，失于肃降，故咳嗽多痰，咯痰白粘；水湿不化，内停中焦，气机不畅，故胸脘痞闷，胃纳减少；痰湿内阻，故舌苔白腻，脉滑。【Differentiation】b）Internal injury Blockage of the lung by phlegm： Main manifestations：Cough with profuse, white and sticky sputum, stuffiness and depression of the chest, loss of appetite, white, sticky tongue coating and rolling

16、pulse. Analysis： If the spleen fails in its transformation and transportation, the water dampness will no longer be transported and then gathered to form phlegm, which goes upward to the lung, affecting the qi of the lung and causing its failure in descending. The result is cough with profuse sputum

17、 or with white, sticky sputum； If water dampness stays in the middle energizer, impairing its activity, there may be stuffiness and depression of the chest and loss of appetite； White, sticky tongue coating and rolling pulse are due to internal obstruction by the phlegm.【辨证】（二）内伤咳嗽肺燥阴虚证：主证：干咳无痰或痰少，不

18、易咯出，鼻燥咽干或咽疼，或痰中带有血丝甚至咯血，潮热，颧红，舌红苔薄，脉细数。 证候分析：燥胜则干，易伤津液，故燥邪伤肺，肺失清肃，可见干咳，无痰或痰少，不易咯出，鼻燥咽干而痛等症；燥伤肺络，故痰中带有血丝或咯血；肺阴不足，虚热内生， 故见潮热、颧红。舌红苔薄，脉细数，为肺燥阴虚之象。【辨证】b）Internal injury Dryness of the lung with deficiency of yin： Main manifestations：Dry cough without sputum or with scanty sputum, dryness of the nose and

19、 throat, sore throat, spitting blood or even coughing blood, afternoon fever, malar flush, red tongue, thin coating, thready and rapid pulse. Analysis： Dryness is easy to consume the body fluid. If the lung is injured by dryness, the function of the lung will be impaired, manifested by dry cough wit

20、hout sputum or with scanty sputum, dryness of the nose and throat, or sore throat； If the lung vessels are injured by dryness, blood in the sputum or hemoptysis results； If there is deficiency of yin of the lung with endogenous heat, afternoon fever and malar flush may be present; Red tongue, thin c

21、oating, and thready rapid pulse are the signs indicating deficiency of yin and dryness of the lung.【治疗】（一）外感咳嗽 治法：取手太阴、阳明经穴为主。风寒证针灸并用，风热证只针不灸。以宣肺解表。 处方：列缺（肺7） 合谷（大肠4） 肺俞（膀胱13）。 随证配穴：咽喉肿痛：少商(肺11)。发热恶寒：大椎(督14)，外关（三焦5）。 方义：列缺、合谷、肺俞解表，宣肺止咳。少商清热利咽大椎清热外关疏风清热【Treatment】a）Invasion by exogenous pathogenic fa

22、ctors Method：Select the points from the Taiyin and Yangming Meridians of Hand as the principal ones. Both acupuncture and moxibustion are applied in case of wind cold, while only acupuncture is used in case of wind heat to activate the dispersing function of the lung and to relieve the symptoms. Pre

23、scription：Lieque (LU 7), Hegu (LI 4), Feishu (BL 13). Supplementary points：Pain and swelling of the throat: Shaoshang (LU 11). Fever and chills：Dazhui (GV 14), Waiguan (TE 5). Explanation： Lieque (LU 7), Hegu (LI 4), Feishu (BL 13) Eliminate the exogenous pathogenic factors, result in smooth flow of

24、 qi of the lung and the normal dispersing function of the lung, and stop cough; Shaoshang (LU 11) Clear heat, benefit the throat; Dazhui (GV 14) Clear heat; Waiguan (TE 5) Dispel wind and clear heat.【治疗】（二）内伤咳嗽-痰浊阻肺证 治法：取背俞和足阳明经穴为主。针刺补泻兼施，并可加灸。以健脾化痰。 处方：肺俞（膀胱13） 中脘(任12) 尺泽（肺5） 足三里(胃36) 丰隆(胃40)。方义：肺俞

25、、中脘、足三里-以健脾和胃，行湿化痰；尺泽-为肺经合穴，有泻肺止咳的作用；丰隆-为足阳明经的络穴，取之以运中焦脾胃之气，使气行津布，痰湿得化，是去痰除湿之要穴。 【Treatment】b）Internal injury Blockage of the lung by phlegm Method：Select the Back-Shu point and the points of the Yangming Meridian of Foot as the principal points. Both reinforcing and reducing methods should be consi

26、dered in acupuncture treatment, or combined with moxibustion to strengthen the function of the spleen and to resolve phlegm. Prescription：Feishu (BL 13), Zhongwan (CV 12), Chize (LU 5), Zusanli (ST 36), Fenglong (ST 40). Explanation： Feishu (BL 13), Zhongwan (CV 12), Zusanli (ST 36) Strengthen the f

27、unction of the spleen and harmonize the stomach, remove dampness and resolve phlegm; Chize (LU 5) the He-(Sea) point of the Lung Meridian, is able to reduce the pathogenic factors from the lung and relieve cough; Fenglong (ST 40) the Luo-(Connecting) point of the Yangming Meridian of Foot, is select

28、ed to strengthen smooth transport of qi in the spleen and stomach. Thus the body fluids are normally distributed following the free flow of qi and phlegm is resolved. It is key point to eliminate phlegm and dampness.【治疗】（二）内伤咳嗽-肺燥阴虚证 治法：取肺经俞、募穴为主，针刺平补平泻。以益阴润燥，清肃肺气。处方：肺俞（膀胱13） 中府（肺1） 列缺（肺7） 照海（肾6）。随证

29、配穴：咯血加孔最（肺6） 膈俞(膀胱17)。 方义：肺俞、中府-俞募配穴，用以宣调肺道，清肃肺气；列缺、照海列缺是手太阴肺经络穴，通于任脉，照海是足少阴肾经经穴，通阴跷脉，两穴合用，一上一下，为八脉交会配穴法，以益阴润燥，并能清利咽喉，肃降肺气。孔最、膈俞孔最为肺之郄穴，主治肺之急症尤其是止咳血；膈俞是八会穴中的血会，两穴配伍，有止血的作用。【Treatment】b）Internal injury Deficiency of yin with dryness of the lung: Mehod：Select the Back-Shu point and Front-Mu point of t

30、he Lung Meridian as the principal points. Even-movement is applied in acupuncture treatment to nourish yin, eliminate dryness and descend lung qi. Prescription：Feishu (BL 13), Zhongfu (LU 1), Lieque (LU 7), Zhaohai (KI 6). Supplementary：Kongzui (LU 6) and Geshu (BL 17) in case of coughing blood. Exp

31、lanation： Feishu (BL 13), Zhongfu (LU 1) The selection of Feishu (BL 13) and Zhongfu (LU 1) is a method of combining Back-Shu point and Front-Mu point. It is used to regulate the lung passage and descend lung qi; Lieque (LU 7), Zhaohai (KI 6) Lieque (LU 7), the Luo-(Connecting) point of he Lung Meridian of Hand-Taiyin, is connected with the Conception Vessel