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Question: When heat is located in the upper jiao (upper burner), it leads to Fei Wei (Lung Withering, a disease characterized withering and atrophy of lung tissue) due to coughing. How is the disease of Fei Wei acquired? The Master said: It may result from excessive sweating, or from frequent vomiting, or from Xiao Ke (Wasting-Thirst syndrome) causing frequent urination, or from constipation treated with harsh purgatives leading to diarrhea, resulting in a double loss of body fluids. Thus, this disease arises. Question: If the pulse at the cunkou (radial artery at the wrist) is rapid (shu), the person coughs, and there is instead turbid saliva and froth in the mouth, what is the cause? The Master said: This is the disease of Fei Wei. If the mouth feels parched and dry, and coughing causes a dull pain in the chest, and the pulse is slippery and rapid, this is Fei Yong (Lung Abscess, a suppurative inflammation of the lung), accompanied by coughing up pus and blood.

[Annotation]
Heat in the upper jiao does not cause Fei Wei unless it induces coughing; only when heat illness triggers coughing does it become Fei Wei. The causes of lung heat leading to withering are manifold: excessive sweating, vomiting, Xiao Ke with frequent urination, or constipation treated with harsh purgatives causing severe fluid depletion, all leading to lung heat drying and withering. When lung heat dries and withers, the lung's clear descending function fails, and the distribution of fluids and essences becomes disordered. Although the spleen transports essences upward to the lung, the lung cannot moisten its own dryness, nor can it irrigate the internal zang-fu organs or transport essences outward to the skin and hair. These essences accumulate in the chest, are boiled by heat, transform into froth, invade the lung causing cough, and are continuously expectorated. Thus, the dry remains dry, the expectoration continues, the more one expects, the drier it gets, and the Fei Wei disease is formed. If the mouth feels parched and dry, without expectorating turbid saliva or froth, and each cough causes dull chest pain, with a pulse that is either slippery-rapid or weak-rapid, this is not Fei Wei but Fei Yong. Over time, an abscess forms and ruptures with pus; instead of froth, pus and blood are coughed up.

[Collected Notes]
Zhou Yangjun stated: Yu Chang said: Walking just a few steps causes panting and wheezing, with continuous impact sounds and phlegm resonance. The treatment principles in *Jin Gui Yao Lue* emphasize grasping the essence: generally, proceed slowly. Generate stomach fluids, moisten lung dryness, descend rebellious qi, resolve accumulated phlegm, stop turbid expectoration, tonify true qi, unblock the small passages of the lung, dissipate fire-heat, and restore the lung's clear descending function. Just as hemiplegic withering or flaccidity of limbs can recover with proper treatment, so too can lung diseases. The lung is close to the chest and vital for respiration; how can we neglect it? Fei Yong belongs to tangible blood pathology; blood stasis should be attacked swiftly. Fei Wei belongs to intangible qi pathology; qi injury should be managed gradually. Therefore, Yong is excess; treating it like Wei constitutes "excess reinforcing excess." Wei is deficiency; treating it like Yong constitutes "deficiency weakening deficiency." This is the general principle of syndrome differentiation and medication. However, the cunkou pulse on both hands refers to the Lung Meridian of Hand-Taiyin. Statements regarding rapid, slippery-rapid, excess-rapid, or deficient-rapid pulses refer collectively to the three positions on both sides, not exclusively to the right guan position as in some contexts. Coughing with turbid saliva and froth filling the ground indicates Fei Wei, meaning the mouth is not dry. If coughing accompanies a parched mouth, it indicates lung abscess formation; fire-toxin manifests orally, and coughing vibrations irritate the abscess, causing dull chest pain. The pulse must be slippery-rapid and forceful, a sign of vigorous pathogenic qi. Using deficient-rapid or excess-rapid pulses to distinguish Fei Wei from Fei Yong reveals that Fei Wei requires tonification and Fei Yong requires purgation. Furthermore, upon observing chronic cough, one must guard against these two syndromes. Fei Yong arises from fire accumulating in the five zang organs and heat stagnating in the stomach, ascending to the lung. The lung is scorched by fire-heat, causing blood coagulation and phlegm wrapping, forming a small abscess. As the lesion grows, the lung swells and ribs flare. Symptoms include frequent coughing, thick phlegm like glue, fever, aversion to cold (worse in the afternoon), red face, dry nose, and skin resembling fish scales on the chest. If identified early, distinguishing exterior/interior patterns and using lifting or purging methods ensures recovery. Once blood turns to pus and lung tissue rots, expectorated like an overturned bag, recognition comes too late; ten cases die, and it is futile to sigh.

Shen Mingzong said: This distinguishes Fei Wei from Fei Yong. Heart resides superiorly; if kidney water is insufficient, heart fire insults metal (lung), creating heat in the upper jiao. Lung yin declines daily, qi rebels causing cough, leading to Fei Wei. The classic specifies initial causes: post-illness yin deficiency with excessive sweating injuring fluids, vomiting injuring fluids, Xiao Ke with blood deficiency and fluid exhaustion, or diuretics causing frequent urination injuring yin, or constipation treated with harsh purgatives causing double fluid loss. This leads to lung metal dryness, steaming by deficient heat, rapid cunkou pulse, coughing, weak qi, failure of fluid distribution, transforming into turbid saliva and froth, forming Fei Wei. If the mouth is parched and coughing causes dull chest pain, it is wind-cold invading the lung, stagnating nutritive blood to form an abscess, resulting in slippery-rapid pulse and expectoration of pus and blood. Because intangible deficient heat causes withering, the pulse is rapid-deficient. Because tangible qi-blood stagnation forms abscess, the pulse is rapid-excess. This clarifies Fei Yong as excess and Fei Wei as deficiency.

A rapid-deficient pulse indicates Fei Wei; a rapid-excess pulse indicates Fei Yong.

[Annotation]
This elaborates on the pulses for Fei Wei and Fei Yong mentioned previously. Fei Wei results from heat destroying fluids, constituting a deficient pathogen, hence the rapid-deficient pulse. Fei Yong results from heat-toxin accumulation and knotting, constituting an excess pathogen, hence the rapid-excess pulse.

[Collected Notes]
Li [Name obscured] stated: Pan Shuofu said: Both Wei and Yong involve heat in the upper jiao, rapid pulses, coughing, and fluid loss, appearing similar initially. However, Wei involves lung qi deficiency and fluid loss; although heat exists, it is not intense, so it does not reach extreme dryness. Coughing occurs with turbid saliva/froth, so the pulse is rapid-deficient. Yong involves qi stagnation and blood coagulation; pathogenic excess and intense heat cause greater fluid loss and dryness. The mouth feels parched, coughing causes dull chest pain. With fluids exhausted, the pulse should be choppy but is instead slippery-rapid because accumulated heat rots flesh into pus, making the pulse rapid-excess.

You Yi said: Wei means wither, like plants losing vigor due to fluid loss and lung scorching. Yong means blockage, like earth obstructed flow, due to heat aggregation and lung obstruction. Thus, their pulses differ in excess/deficiency, but both are rapid.

Question: In a patient with coughing and rebellious qi, how do we know this is Fei Yong? There should be pus and blood; if expectorated, death ensues. What does the pulse resemble? The Master said: The cunkou pulse is faint and rapid. Faint indicates wind; rapid indicates heat. Faint implies sweating; rapid implies aversion to cold. Wind injures the defensive layer, preventing deep inhalation; heat penetrates the nutritive layer, preventing exhalation. Wind damages the skin and hair; heat damages the vessels and blood. Wind lodging in the lung causes cough, dry mouth, panting and fullness; throat dryness without thirst, occasional expectoration of turbid froth, and intermittent chills. Where heat passes, blood coagulates and stagnates, accumulating into an abscess with pus expectorated like rice porridge. In the early stage, it is treatable; once pus forms, it is fatal.

[Commentary]
The phrase "Fei Wei" likely precedes "Fei Yong" in the original text; otherwise, the discussion of Fei Wei lacks context, suggesting a missing slip. The three instances of "faint" (wei) in the pulse description should likely be "floating" (fu); "faint" disrupts the textual logic, indicating a transcription error.

[Annotation]
How to distinguish Fei Wei from Fei Yong in coughing and rebellious qi? Cough without thirst, expectorating turbid saliva/froth, with a rapid-deficient pulse identifies Fei Wei. Dry mouth, dull chest pain, with a rapid-excess pulse identifies Fei Yong. The causes of Fei Wei were explained earlier; Fei Yong's causes were not. Thus, the mechanisms of heat causing these diseases are detailed. The cunkou is the lung pulse; normally floating-choppy-short. Now it is floating-rapid, indicating wind (floating) and heat (rapid). Initial wind-heat attacks the exterior, affecting Ying and Wei, causing sweating and aversion to cold. If wind-heat enters internally to lodge in the lung, Ying and Wei are affected differently. Fei Wei results from wind-heat injuring Wei Qi; the Qi level has fluids but no blood stasis; fluids become turbid. Symptoms: cough without pus/blood, expectorating turbid froth. Fei Yong results from wind-heat injuring Ying Blood; the Blood level has blood but no fluids; blood coagulates and stagnates. Symptoms: cough without froth, expectorating pus/blood like rice porridge. Fever, sweating, aversion to cold/wind, cough with panting/fullness, throat dryness without thirst, difficult breathing (inhaling/exhaling) are common to both. "Inhaling/exhaling difficulty" refers to shortness of breath, not total cessation. "Early stage treatable" means lung damage is superficial; "pus formed fatal" means lung tissue is destroyed. This warns for early treatment, specifically emphasizing Fei Yong.

In Fei Yong, with panting preventing lying down, Tingli Zaozao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated.

[Annotation]
This follows the previous section to explain the necessity of urgent treatment. Fei Yong is characterized by a parched mouth, dull chest pain, and rapid-excess pulse. If accompanied by panting preventing recumbency, pathogenic stagnation in the lung is extremely urgent. Therefore, Tingli Zaozao Xiefei Tang, being greatly bitter and cold, vigorously drains lung pathogens. Delay risks pus formation and death.