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If Lung Abscess (Fei Yong, 肺痈) has already formed, the Cun position pulse is rapid and excess. The manifestation of Lung Flaccidity (Fei Wei, 肺痿) features a rapid but deficient pulse.
In Lung Abscess, the complexion is white; the pulse should be short and choppy, not floating and large; symptoms include coughing up pus or vomiting blood.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) asks: When heat is in the Upper Jiao (Upper Burner), it causes cough leading to Lung Flaccidity. How is this disease of Lung Flaccidity acquired? The Master said: It may result from excessive sweating, vomiting, polydipsia with frequent urination, or constipation treated with harsh purgatives that severely deplete body fluids (Jin Ye, 津液). Questioned further: If the Cun position pulse is rapid, the person coughs, and there is instead turbid saliva and froth in the mouth, what does this indicate? The Master said: This is Lung Flaccidity. If the mouth feels dry, coughing causes hidden pain in the chest, and the pulse is slippery and rapid, this is Lung Abscess, characterized by coughing up pus and blood. A rapid and deficient pulse indicates Lung Flaccidity; a rapid and excess pulse indicates Lung Abscess. Another question: The patient coughs and qi rebels; how do we know this is Lung Abscess based on the pulse? There should be pus and blood; if vomited, death ensues. What kind of pulse is this? The Master said: The Cun position pulse is faint and rapid. Faint indicates Wind, rapid indicates Heat. Faint implies sweating; rapid implies aversion to cold. Wind invades the Defensive Qi (Wei Qi, 卫气), so exhalation cannot draw it in. Heat surpasses the Nutritive Qi (Ying Qi, 营气), so inhalation cannot expel it. Wind damages the skin and hair pores; Heat damages the blood vessels. Wind lodges in the Defensive Qi, causing cough, dry mouth, asthma, and fullness, dry throat without thirst, occasional expectoration of turbid froth, and intermittent chills. Where Heat passes, blood coagulates and stagnates. Accumulating and knotting into an abscess, one coughs up matter like rice porridge. In the initial stage, it can be saved; once pus forms, it leads to death. It is also stated: Lung Flaccidity involves spitting saliva and froth without coughing; the person is not thirsty, must suffer enuresis and frequent urination. The reason is that deficiency in the upper part fails to control the lower part. This is Cold in the Lung, likely accompanied by dizziness and abundant saliva/froth, treated with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to warm it. If after taking the decoction one becomes thirsty, it belongs to Polydipsia (Xiao Ke, 消渴). It is also stated: Lung Abscess with asthma preventing lying down is primarily treated with Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). It is also stated: Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional discharge of turbid saliva with a fishy odor, and long-term expectoration of pus like rice porridge indicates Lung Abscess, primarily treated with Jie Geng Tang (Platycodon Decoction). It is also stated: Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear runny nose, loss of smell for fragrant, foul, sour, or pungent odors, cough with qi rebellion, wheezing, and airway obstruction is primarily treated with Ting Li Da Zao Xie Fei Tang. These several clauses from the *Jin Gui Yao Lue* differentiate the formation of Lung Flaccidity and Lung Abscess. Both involve heat in the Upper Jiao. Both involve coughing. Both involve depletion of fluids. Both feature a rapid pulse. However, Flaccidity belongs to Lung Qi deficiency; deficiency means that although there is heat, it is not fierce. Since the heat is not fierce, even though fluids are depleted, they do not become completely dry; thus, despite coughing, there is turbid saliva and froth in the mouth. Although heat lodges in the Lung, it does not rot healthy tissue into pus, but rather causes the Lung organ to wither; its pulse is rapid but necessarily deficient. Abscess is different; it is caused by Lung Qi stagnation and pathogenic excess. Excess means fierce heat. Fierce heat depletes fluids, causing greater dryness, hence the dry mouth. Fierce heat forces the Lung, damaging it, causing qi rebellion and cough. Coughing causes hidden chest pain. Once fluids are exhausted, the pulse should be choppy, but if it is slippery and rapid, it indicates accumulated heat rotting and transforming, mixed with pus and blood; this is called a rapid and excess pulse. The second clause states: Cun position pulse faint and rapid. Because Defensive Qi is loose, the pulse is faint; because pathogens are depressed, the pulse is rapid. Loose Defensive Qi and depressed pathogens cause sweating, surface heat, and aversion to cold. This describes the initial invasion of Wind, where pathogens remain on the exterior, not entering the interior, exiting only with exhalation. Invading the Defensive Qi and damaging the exterior skin/hair pores, depression generates heat; this heat cannot exit outwardly but enters with inhalation, surpassing the Nutritive Qi and damaging blood vessels internally. Defensive Qi governs the exterior and skin/hair pores, belonging to Yang. When Wind lodges in it, it affects the Lung internally. Lung Qi stagnates and rebels, causing cough, asthma, and fullness. Defensive Qi governs Qi, and the Lung also governs Qi. The mouth and throat are the portals of Qi. If Qi circulation is unregulated, body fluids do not distribute evenly, causing dry mouth and throat, occasionally spitting turbid froth. Since heat is not in the Stomach, there is no thirst. Loose Defensive Qi and lodged pathogens cause intermittent chills; these are all manifestations of Wind invading the Defensive Qi and agitating Lung Qi. Nutritive Qi governs the interior and blood vessels, belonging to Yin. Heat forces it, affecting the vessels internally. The Lung directs all vessels and circulates Ying and Wei Qi. Since pathogens start at the skin/hair pores, which are the external correspondence of the Lung, entering from the correspondence into the Lung, the Lung receives the heat, and blood coagulates. Over time, it rots into pus, expelled via cough like rice porridge. These are all manifestations of Heat surpassing the Nutritive Qi and damaging the Lung tissue. Initially, it is in Yang, in the Defensive Qi, belonging to the Qi level, so it is savable. Later, it enters Yin, damaging blood vessels and the organ substance, so once pus forms, it leads to death. The third clause's Lung Flaccidity refers to deficiency-cold Flaccidity, a variation of Flaccidity syndrome. Lung deficiency and cold prevent fluid distribution, causing spitting of saliva/froth. Without heat forcing the Lung, Lung Qi does not rebel, so there is no cough. Without heat, there is no thirst. The Lung resides highest, governing all Qi, and regulates water passages, transmitting downward to the Bladder. Enuresis and frequent urination occur because Lung Qi deficiency and cold lose its regulatory function, failing to control the lower. Qi deficiency above causes dizziness. Treatment uses Gan Cao Gan Jiang Tang; Ginger warms the cold, Licorice tonifies deficiency. Licorice tonifies Spleen Earth rather than directly tonifying Lung Metal because "tonify the mother when deficient." If one becomes thirsty after taking this warming agent, there must be heat in the Lung. Thus, enuresis and frequent urination are not Flaccidity syndrome, but Polydipsia. This corresponds to the *Qi Jue Lun* (Treatise on Qi Syncope) mentioning drinking one part and urinating two parts, belonging to Lung Consumption. The following four clauses describe both formed and unformed abscesses, all indicating excess Lung Qi stagnation. The previous two clauses explain this meaning thoroughly. Herbs such as Zao Jiao (Gleditsiae Fructus Spina), Ting Li Zi (Descurainiae Semen), and Jie Geng (Platycodonis Radix) are all herbs that descend Qi, drain stagnation, and resolve knots. Matching formulas to syndromes, the rationale is evident, so no further explanation is repeated. The text states: Lung Abscess formed, Cun position rapid and excess, corresponds to the *Yao Lue* saying "rapid and excess pulse is Lung Abscess." Lung Flaccidity form, rapid but forceless, corresponds to the *Yao Lue* saying "rapid and deficient pulse is Lung Flaccidity." One must examine the Cun position because the Lung resides highest. Lung Abscess with white complexion and short/choppy pulse: White complexion is the color of the Lung; short/choppy is the pulse of the Lung. Color and pulse matching the syndrome are appropriate. If the pulse is floating and large, it is a Fire image. Coughing up paste-like matter and vomiting pus/blood indicates Fire overcoming Metal. Is it appropriate for the Lung organ to be damaged?