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The *Jingui Yaolue* asks: When heat is located in the upper jiao, it leads to Lung萎 (Lung Atrophy) due to coughing. (Fire insults Metal; due to coughing, vigorous fire consumes qi, causing Lung heat and withered leaves, resulting in weak and useless limbs, termed Wei/Atrophy.) How is Lung Wei obtained? The Master says: It may arise from excessive sweating, (indicating too much sweat.) or from vomiting, or from Xiao Ke (Wasting-Thirst syndrome) with frequent urination, or from difficulty in defecation, (indicating the blood has dried out.) followed by purgative drugs causing diarrhea, further depleting body fluids. (The above several cases are all causes of fluid depletion, which can be extrapolated.) Thus, the disease is acquired. (When fluids are depleted, Yin cannot assist Yang, and heat becomes severe.) He asks: The pulse at Cun Kou is rapid, the person coughs, yet there is instead turbid saliva and froth in the mouth. Why? (Since fluids are injured, the heat should be dry heat; why is there saliva and froth spit out? Hence the doubt.) The Master says: This is the disease of Lung Wei. (Lung heat impairs the clear descending function; water essence does not distribute widely but stays stored in the chest, transforming into saliva and froth. It not only fails to moisten other organs but also fails to nourish the Lung itself; the dry remains dry, the spit remains spit.) If the mouth feels parched and dry, and coughing brings faint pain in the chest, while the pulse is surprisingly slippery and rapid, this is Lung Abscess (Fei Yong). (Lung Wei disease is in the Qi level, so fluids transform into saliva along with Qi and exit from the mouth. Lung Abscess disease is in the Blood level, so fluids coagulate into pus along with Blood and do not exit from the mouth. However, there are cases of spitting turbid matter; see below for clarification. Slippery indicates phlegm-saliva; if dry without phlegm-saliva, the pulse should be choppy, why slippery? Because of blood heat. Although initially rapid and slippery, later it becomes rapid and excess.) Coughing up pus and blood. (After the abscess ruptures, pus and blood exit via coughing and spitting.) A rapid and deficient pulse indicates Lung Wei, (vigorous fire consumes qi leading to qi deficiency; fluid depletion leads to yin deficiency.) while a rapid and excess pulse indicates Lung Abscess. (Qi stagnation and blood stasis constitute excess.) He asks: The patient has cough and rebellious Qi; how do we know this is Lung Abscess? Answer: The pulse at Cun Kou (referring to all three positions) is faint (The *Yizong Jinjian* states: 'faint' should be 'floating', same below) and rapid. Faint indicates Wind, rapid indicates Heat; faint indicates sweating, rapid indicates aversion to cold. (This discusses external pathogenic factors, hence floating-rapid pulse, fever, sweating, and aversion to cold.) Wind injures the Wei (Defensive) level, Heat penetrates the Ying (Nutritive) level. (Penetrate means enter. External wind-cold, internally constrained into heat, moving from shallow to deep.) Exhalation enters but inhalation does not go out. (Refers to difficult breathing, i.e., the following panting and fullness.) Wind injures skin and hair, Heat injures vessels and blood; Wind lodges in the Lung, (entering from skin/hair to Lung.) the person then coughs, (Fire insults Metal, Lung itch causes cough.) dry mouth, panting and fullness, dry throat but no thirst, (Heat is still at the exterior, not yet injuring fluids, hence no thirst; this refers to early stage.) occasional spitting of turbid froth, (i.e., wind-cold phlegm cough.) periodic chills. (Meaning aversion to wind and cold.) Wherever heat passes, blood coagulates and stagnates. (Periodic chills indicate exterior syndrome unresolved and heat un-dispersed, thus entering deeper day by day, causing blood stasis.) Accumulation forms an abscess and pus, vomiting like rice porridge. (After rupture, pus vomits like rice porridge.) In the initial stage, it can be saved; once pus is formed, death ensues. (There are also survivors; see below. This item cites external contraction, while internal injury causing this can be inferred by analogy.) Cough with chest fullness, chills, rapid pulse, dry throat but no thirst, occasionally discharging turbid, foul-smelling saliva, (showing that Lung Abscess can also involve spitting saliva/froth; inferring from this, Lung Wei must also have cases without spitting saliva/froth. If one rigidly adheres to the previous description for differentiation, would it not lead to error? Furthermore, Lung Wei includes dry-heat and damp-heat, primarily dry-heat. Even if there is saliva/froth, the spitter spits, the dry remains dry; moreover, for those with no saliva/froth to spit, their dehydration is self-evident. Reviewing the Wei section in detail reveals the principle. Heat combined with dampness causes swelling and abscess formation, so Lung Abscess is often damp-heat, hence occasional spitting of turbid matter. Those who do not spit do so because it is condensed internally. Saying Lung Abscess has no dampness is likely unreasonable.) After a long time, vomiting pus like rice porridge indicates Lung Abscess, treated with Jiegeng Tang (Platycodon Decoction). (To resolve toxicity and drain pus. The previous item said death, this one says survival, indicating differences in severity.) Lung Abscess with panting and inability to lie down, treated with Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). (Bitter and cold, severely draining Lung pathogens; slight delay may lead to pus formation and death.) Lung Abscess with chest fullness and distension, edema of the whole body and face, (due to turbid Qi failing to descend.) nasal congestion, clear runny nose, (heat steaming upward transforms into water.) inability to smell fragrant, foul, sour, or pungent odors, (Lung heat attacks the nose, causing sour/pungent sensations; turbid Qi blocks, causing inability to smell.) cough and rebellious Qi, wheezing and obstruction, treated with Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). Lung Wei with spitting saliva/froth but no cough, (Lung Wei with cough and spitting saliva/froth is the standard presentation. Now only spitting saliva/froth without cough suggests it resembles Lung Wei but is not Lung Wei.) the person is not thirsty,必定 experiences enuresis and frequent urination. The reason is that upper deficiency fails to control the lower; this is Cold in the Lung. (Lung cold implies Qi cold, unable to secure fluids, hence spitting froth above and incontinence below.)必定 experiences dizziness, (The Classics state: Upper deficiency causes dizziness.) excessive saliva, treated with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to warm. If after taking the decoction, the person feels thirsty, it belongs to Xiao Ke (Wasting-Thirst). (Frequent urination with thirst is Xiao Ke; frequent urination without thirst is Lung Cold. However, early Xiao Ke may not immediately present thirst; mistaking it for Lung Cold and treating accordingly leads to the appearance of thirst symptoms. This is Zhongjing's method for distinguishing Lung Wei, Lung Cold, and Xiao Ke.)

Yu Jiayan said: Upon seeing chronic cough, one must first guard against these two syndromes. Lung Abscess arises from accumulated fire in the five Zang organs and stagnant heat in the Stomach ascending to the Lung. The Lung is scorched, blood coagulates, and phlegm wraps around it, forming a small abscess. Day by day it grows larger, the Lung swells, ribs protrude, coughing becomes frequent, phlegm is turbid and glue-like, aversion to cold and fever occur, worse in the afternoon, face red, nose dry, and skin on the chest becomes rough like fish scales (Jiacuo means dry and rough, interlocking like scales). Initially, if one can differentiate the pulse and symptoms as exterior or interior, and vigorously apply lifting and purging methods, recovery is assured. Once blood transforms to pus and Lung tissue rots, pouring out like an overturned bag, ten die and none are saved; alas, it is too late. He also stated: The treatment methods in *Jingui* value grasping the essentials. Through various approaches, generating Stomach fluids, moistening Lung dryness, descending rebellious Qi, resolving accumulated phlegm, stopping turbid saliva, supplementing true Qi to open Lung bronchioles, and dispersing fire-heat to restore Lung clarity, recovery is possible. One must exert effort! For Lung Wei, *Zunsheng* formula Ju Fei Tang: Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuru (Bambusae Caulis in Taenia), Dongtian (Asparagi Radix), Dongmu (Ophiopogonis Radix), Ejiao (Colla Corii Asini), Shashen (Glehniae Radix), Baihe (Lilii Bulbus), Beimu (Fritillariae Cirrhosae Bulbus). For Lung Abscess, if palms are rough, panting, malar flush, rapid pulse, nasal flaring, inability to eat, it is untreatable. For Lung Abscess, Qingjin Yin (Clear Metal Drink): Cijieli (Tribuli Fructus), Yiren (Coicis Semen), Jiuye (Citri Reticulatae Pericarpium Viride), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), Niubangzi (Arctii Fructus), Beimu (Fritillariae Cirrhosae Bulbus), Sangbai (Mori Cortex), Jiegeng (Platycodonis Radix). For thick phlegm cough, chest distension, panting urgency, fever, Xuanshen Qingfei Yin (Scrophulariae Decoction to Clear the Lung): Xuanshen (Scrophulariae Radix), Chaihu (Bupleuri Radix), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Fuling (Poria), Digupi (Lycii Cortex), Maidong (Ophiopogonis Radix), Yiren (Coicis Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Binglang (Arecae Semen), decocted with one cup of Tongbian (Child Urine) taken with the medicine. For severe cases unable to lie down, Ningfei Jiegeng Tang (Calming Lung Platycodon Decoction): Jiegeng (Platycodonis Radix), Beimu (Fritillariae Cirrhosae Bulbus), Danggui (Angelicae Sinensis Radix), Gualouren (Trichosanthis Semen), Huangqi (Astragali Radix), Zhike (Aurantii Fructus Immaturus), Gancaojie (Glycyrrhizae Radix et Rhizoma cum Nodis), Sangbaipi (Mori Cortex), Fangji (Stephaniae Tetrandrae Radix), Baihe (Lilii Bulbus), Yiren (Coicis Semen), Wuweizi (Schisandrae Chinensis Fructus), Tiantili (Descurainiae Semen seu Lepidii Semen), Digupi (Lycii Cortex), Zhimu (Anemarrhenae Rhizoma), Xingren (Pruni Semen). Add Chaihu (Bupleuri Radix) for fever, add Shu Dahuang (Rhei Radix et Rhizoma Preparata) for constipation. Regardless of whether the abscess is formed or not, use Jinli Tang (Golden Carp Decoction): One carp (4 liang, gutted, not passed through menstruation), 2 qian of Beimu powder placed inside the fish belly, sewn with thread, soaked in one bowl of Tongbian (Child Urine), steamed until fish eyes protrude, remove scales and bones, keep the clean meat soaked in Tongbian, reheat, and take with the urine, three times daily, for rapid effect. After pus has been vomited, use Paion San (Drain Pus Powder): Huangqi (Astragali Radix), Baizhi (Angelicae Dahuricae Radix), Wuweizi (Schisandrae Chinensis Fructus), Renshen (Ginseng Radix) in equal parts.