（论一首 法十三条 律四条）
论曰∶肺痈肺痿之证，谁秉内照，旷然洞悉，请以一得之愚， 为敷陈。人身之气禀命于肺，肺气清肃，则周身之
气，莫不服从而顺行。肺气壅浊，则周身之气，易致横逆而犯上。故肺痈者，肺气壅而不通也。肺痿者，肺气委而不振
也。才见久咳上气，先须防此两证。肺痈由五脏蕴祟之火，与胃中停蓄之热，上乘乎肺，肺受火热熏灼，即血为之凝，
血凝即痰为之裹，遂成小痈。所结之形日长。则肺日胀而胁骨日昂，乃至咳声频并，浊痰如胶，发热畏寒，日晡尤甚，
面红鼻燥，胸生甲错。始先即能辨其脉证属表属里，极力开提攻下，无不愈者。奈何医学无传，尔我形骸，视等隔垣。
但知见咳治咳，或用牛黄、犀角，冀以解热。或用膏子油粘，冀以润燥。或朝进补阴丸。或夜服清胃散。千蹊万径，无
往非杀人之算，病者亦自以为虚劳尸瘵，莫可奈何！迨至血化为脓，肺叶朽坏，倾囊吐出，始识其证，十死不救。嗟无
及矣！间有痈小气壮，胃强善食，其脓不从口出，或顺走肛门，或旁穿胁肋，仍可得生，然不过十中二三耳。《金匮》治
法最精，用力全在未成脓之先。今人施于既成脓之后，其有济乎？肺痿者，其积渐已非一日，其寒热不止一端，总由胃
中津液不输于肺，肺失所养，转枯转燥，然后成之。盖肺金之生水，精华四布者，全借胃土津液之富。上供罔缺，但胃
中津液暗伤之窦最多。医者粗率，不知爱护，或腠理素疏，无故而大发其汗。或中气素馁，频吐以倒倾其囊。或瘅成消
中，饮水而渴不解，泉竭自中，或肠枯便秘，强利以求其快，漏卮难继。只此上供之津液，坐耗歧途。于是肺火日炽，
肺热日深，肺中小管日窒，咳声以渐不扬，胸中脂膜日干，咳痰难于上出，行动数武，气即喘鸣，冲击连声，痰始一
应。《金匮》治法，非不彰明，然混在肺痈一门，况难解其精意。大要缓而图之，生胃津，润肺燥，下逆气，开积痰，止
浊唾，补真气以通肺之小管，散火热以复肺之清肃。如半身痿废及手足痿软，治之得法，亦能复起。虽云肺病近在胸中，
呼吸所关，可不置力乎。肺痈属在有形之血，血结宜骤攻。肺痿属在无形之气，气伤宜徐理。肺痈为实，误以肺痿治之，
是为实实。肺痿为虚，误以肺痈治之，是为虚虚。此辨证用药之大略也。
《金匮》论肺痈肺痿之脉云∶寸口脉数，其人咳，口中反有浊唾涎沫者，为肺痿之病。若口中辟辟燥，咳即胸中隐
隐痛，脉反滑数，此为肺痈。咳唾脓血，脉数虚者为肺痿，数实者为肺痈。
两手寸口之脉，原为手太阴肺脉，此云寸口脉数，云滑数，云数虚数实，皆指左右三部统言，非如气口独主右关之
上也。其人咳，口中反有浊唾涎沫，顷之遍地者为肺痿，言咳而口中不干燥也。若咳而口中辟辟燥，则是肺已结痈，
火热之毒，出现于口。咳声上力，触动其痈，胸中即隐隐而痛，其脉必见滑数有力，正邪气方盛之征也。数虚数实之脉，
以之分别肺痿、肺痈。是则肺痿当补，肺痈当泻，隐然言表。
《金匮》论肺痈，又云∶寸口脉微而数，微则为风，数则为热。微则汗出，数则畏寒。风中于卫，呼气不入。热过
于荣，吸而不出。风伤皮毛，热伤血脉，风舍于肺，其人则咳，口干喘满，燥不渴，时唾浊沫，时时振寒，热之所过，
血为之凝滞，蓄结痈脓，吐如米粥，始萌可救，脓成则死。
肺痈之脉，既云滑数，此复云微数者，非脉之有不同也。滑数者，已成之脉。微数者，初起之因也。初起以左右三
部脉微，知其卫中于风而自汗。左右三部脉数，知为荣吸其热而畏寒。然风初入卫，尚随呼气而出，不能深入，所伤者，
不过在于皮毛。皮毛者，肺之合也。风由所合，以渐舍肺俞，而咳唾振寒。兹时从外入者，从外出之，易易也。若夫热
过于荣，即随吸气深入不出，而伤其血脉矣。卫中之风，得荣中之热，留恋固结于肺叶之间，乃致血为凝滞，以渐结为
痈脓。是则有形之败浊，必从泻肺之法而下驱之，若得其毒随驱下移，入胃入腹入肠，再一驱即尽去不留矣。安在始萌
不救，听其脓成，而致肺叶腐败耶？
《金匮》于二证，用彻土绸缪之法，治之于早。然先从脉辨其数虚数实，次从口辨其吐沫干燥。然更出一捷要之法，
谓咳嗽之初，即见上气喘急者，乃外受风寒所致，其脉必浮，宜从越婢加半夏之法，及小青龙加石膏之法，亟为表散。
不尔即是肺痈、肺痿之始基，故以咳嗽上气病证，同叙于肺痈，肺痿之下，而另立痰饮咳嗽本门，原有深意。见咳而至
于上气，即是肺中壅塞，逼迫难安，尚何等待，不急散邪下气，以清其肺乎？然亦分表里虚实为治，不当误施，转增其
困矣。
《金匮》云，上气面浮肿，有息，其脉浮大不治，又加利尤甚。又云∶上气喘而燥者，属肺胀欲作风水，发汗则愈。
上气之促，至于面目浮肿，鼻有息音，是其肺气壅逼，上而不下，加以其脉浮大，气方外出，无法可令内还而下趋，
故云不治也。加利则上下交争，更何以堪之！肺胀而发其汗者，即《内经》开鬼门之法，一汗而令风邪先泄于肌表。
水无风战，自顺趋而从下出也。若夫面目浮肿，鼻有息音，其痿全在气逆，气可外泄乎？况乎逆上者未已，可尽泄乎？
外不可泄，而内又不能返，故云不治。良工苦心，以渐收摄其气，顺从膀胱之化，尚可得生。故知不治二字原
活，初非以死限之矣。
论《金匮》甘草干姜汤 法云∶肺痿吐涎沫而不咳者，其人不渴，必遗尿，小便数。所以然者，以上虚不能制
下故也。此为肺中冷，必眩、多涎唾，用甘草干姜汤以温之。若服汤已，渴者属消渴。
肺热，则膀胱之气化亦热，小便必赤涩而不能多。若肺痿之候，但吐涎沫而不咳，复不渴，反遗尿而小便数者，何
其与本病相反耶？必其人上虚不能制下，以故小便无所收摄耳。此为肺中冷，阴气上巅，侮其阳气，故必眩。阴寒之气，
凝滞津液，故多涎唾。若始先不渴，服温药即转渴者，明是消渴饮一溲二之证。消渴又与痈疽同类，更当消息之矣。
论《金匮》射干麻黄汤 浓朴麻黄汤 法云∶咳而上气，喉中水鸡声，射干麻黄汤主之。咳而脉浮者，浓朴麻
黄汤主之。
上气而作水鸡声，乃是痰碍其气，气触其痰，风寒入肺之一验耳。发表、下气、润燥、开痰，四法萃于一方，用以
分解其邪，不使之合，此因证定药之一法也。若咳而其脉亦浮，则外邪居多，全以外散为主，用法即于小青龙汤中，去
桂枝、芍药、甘草，加浓朴、石膏小麦，仍从肺病起见。以故桂枝之热，芍药之收，甘草之缓，概示不用。而加浓朴以
下气，石膏以清热，小麦引入胃中，助其升发之气，一举而表解脉和，于以置力于本病，然后破竹之势可成耳。一经裁
酌，直若使小青龙载肺病腾空而去，神哉！快哉！
论《金匮》泽漆汤 法云∶咳而脉沉者，泽漆汤主之。
脉浮为在表，脉沉为在里。表里二字，与伤寒之表里大殊，表者邪在卫，即肺之表也。里者邪在荣，即肺之里也。
热过于荣，吸而不出，其血必结。血结则痰气必为外裹，故用泽漆之破血为君，加入开痰下气、清热和荣诸药，俾坚叠
一空，元气不损，制方之意若此。
论《金匮》皂荚丸 法云∶咳逆上气，时时唾浊，坐不得眠，皂荚丸主之。
火热之毒，结聚于肺。表之，里之，清之，温之，曾不少应。坚而不可攻者，又用此丸豆大三粒，朝三服，暮一服，
吞适得所。如棘针遍刺，四面环攻，如是多日，庶几无坚不入，聿成荡洗之功，不可以药之微贱而少之也。胸中手不可
及，即谓为代针丸可矣。
论《金匮》麦门冬汤 法云∶火逆上气，咽喉不利，止逆下气者，麦门冬汤主之。
此胃中津液干枯，虚火上炎之证，治本之良法也。夫用降火之药，而火反升；用寒凉之药，而热转炽者，徒知与火
热相争，未思及必不可得之数，不惟无益，而反害之。凡肺病有胃气则生，无胃气则死。胃气者，肺之母气也。本草有
知母之名者，谓肺借其清凉，知清凉为肺之母也。有贝母之名者，谓肺借其豁痰，实豁痰为肺之母也。然屡施于火逆上
气，咽喉不利之证，而屡不应，名不称矣。孰知仲景有此妙法，于麦冬、人参，甘草、粳米、大枣，大补中气，大生
津液，此中增入半夏之辛温一味，其利咽下气，非半夏之功，实善用半夏之功，擅古今未有之奇矣。
论《金匮》桔梗汤 法云∶咳而胸满，振寒，咽干不渴，时出浊唾腥臭，久久吐脓如米粥者，为肺痈，桔梗汤
主之。
此上提之法也。痈结肺中，乘其新造未固，提而出之。所提之败血，或从唾出，或从便出而可愈。与滋蔓难图，脓
成自溃之死证迥殊。脓未成时，多服此种，亦足以杀其毒势。而坚者渐瑕，壅者渐通也。然用药必须有因，此因胸满，
振寒不渴，病不在里而在表。用此开提其肺气，适为恰当。如其势已入里，又当引之从胃入肠，此法殊不中用矣。
论《金匮》葶苈大枣泻肺汤 法云∶肺痈不得卧，葶苈大枣泻肺汤主之。附方云∶肺痈胸满胀，一身面目浮肿，
鼻塞清涕出，不闻香臭酸辛，咳逆上气，喘鸣迫塞，葶苈大枣泻肺汤主之。三日一服，可服至三四剂，先服小青龙汤一
剂，乃进。
此治肺痈吃紧之方也。肺中生痈，不泻其肺，更欲何待？然日久痈脓已成，泻之无益。日久肺气已索，泻之转伤。
惟血结而脓未成，当亟以泻肺之法夺之。亦必其人表证尽入于里，因势利导，乃可为功。所附之方项下，纯是表证，何
其甘悖仲景而不辞，然亦具有高识远意，必因其里证不能少待，不得不用之耳。其云先服小青龙汤一剂，乃进，情可识
矣。论其常，则当升散开提者，且未可下夺。论其急，则当下夺者，徒牵制于其外，反昧脓成则死之大戒，安得以彼易
此哉！
论《金匮》越婢加半夏汤 小青龙加石膏汤 法云∶咳而上气，此为肺胀，其人喘，目如脱状，脉浮大者，越
婢加半夏汤主之。又云∶肺胀咳而上气，烦躁而喘，脉浮者，心下有水，小青龙加石膏汤主之。
前一方，麻黄汤中以杏仁易石膏，而加姜枣，则发散之力微而且缓。后一方中，以证兼烦躁，宜发其汗，麻桂药中
加入石膏，其力转猛，然监以芍药、五味子、干姜，其势下趋水道，亦不至过汗也。越婢方中有石膏无半夏，小青龙方
中有半夏无石膏，观二方所加之意，全重石膏、半夏二物协力建功。石膏清热，借辛温亦能豁痰。半夏豁痰，籍辛凉亦
能清热。不然，石膏可无虑，半夏在所禁矣。前麦门冬方中，下气止逆，全借半夏入生津药中。此二方，又借半夏
入清热药中，仲景加减成方，无非生心化裁，后学所当神往矣。再论肺痿、肺痈之病，皆燥病也。肺禀清肃之令，乃金
寒水冷之脏。火热熏灼，久久失其清肃，而变为燥。肺中生痈，其津液全裹其痈，不溢于口，故口中辟辟然干燥。肺热
成痿，则津液之上供者，悉从燥热化为涎沫浊唾，证多不渴。较胃中津液尽伤，母病累子之痿，又大不同。只是津液之
上输者，变为唾沫，肺不沾其惠泽耳。若夫痿因津液不能灭火，反从火化，累年积岁，肺叶之间，酿成一大火聚。以清
凉投之， 格不入矣。然虽 格，固无害也。设以燥热投之，以火济火，其人有不坐毙者乎？半夏燥药也，投入肺中，
转增其患，自不待言。但清凉既不能入，惟燥与燥相得，乃能入之，故用半夏之燥，入清凉生津药中，则不但不燥，转
足开燥，其浊沫随逆气下趋。久久津液之上输者，不结为涎沫，而肺得沾其渍润，痿斯起矣。人但知半夏能燥津液，孰
知善用之，即能驱所燥之津液乎？此精蕴也。
附方 六方，系孙奇辈采附《金匮》者，论具本方之下。
《外台》炙甘草汤，治肺痿涎唾多，心中温温液液者。
《千金》甘草汤。
《千金》生姜甘草汤，治肺痿咳涎沫不止，咽燥而渴。
《千金》桂枝去芍药加皂荚汤，治肺痿吐涎沫。
《外台》桔梗白散，治咳而胸满振寒，脉数，咽干不渴，时出浊唾腥臭，久久吐脓如米粥者，为肺痈。
《千金》苇茎汤，治咳有微热，烦满，胸中甲错，为肺痈。
【律四条】
凡肺痿病，多不渴。以其不渴，漫然不用生津之药，任其肺日枯燥，医之罪也。以其不渴，恣胆用燥热之药，势必
不救，罪加等也。
凡治肺痿病，淹淹不振，如鲁哀朝，虽孔圣不讨三家 窃，但扶天常，植人纪，嘿维宗社耳。故行峻法，大驱涎沫，
图速效，反速毙，医之罪也。
凡治肺痈病，须与肺痿分头异治。肺痈为实，肺痿为虚；肺痈为阳实，肺痿为阴虚；阳实始宜散邪，次宜下气。阴
虚宜补胃津，兼润肺燥。若不分辨而误治，医杀之也。
凡治肺痈病，以清肺热，救肺气，俾其肺叶不致焦腐，其金乃生。故清一分肺热，即存一分肺气。而清热必须涤其
(One treatise, thirteen rules, four prohibitions)
The treatise states: Among the conditions of Lung Abscess (Fei Yong) and Lung Withering (Fei Wei), who can possess inner vision to see through them clearly? Please allow me to expound upon my humble insights. The Qi of the human body is endowed by the Lung. When Lung Qi is clear and肃 (solemn/clear), the Qi of the entire body obeys and flows smoothly. If Lung Qi is obstructed and turbid, the Qi of the entire body easily becomes rebellious and attacks upward. Therefore, Lung Abscess refers to Lung Qi being obstructed and blocked; Lung Withering refers to Lung Qi being depressed and lacking vitality. Upon observing chronic cough and Qi rebellion (Shang Qi), one must first guard against these two conditions. Lung Abscess arises from the accumulated fire of the five Zang organs and the stagnant heat in the Stomach, which ascend to the Lung. The Lung, subjected to the scorching of fire and heat, causes blood to coagulate. Once blood coagulates, it is wrapped by phlegm, thus forming a small abscess. The formed shape grows daily, causing the Lung to swell and the ribs to protrude, leading to frequent coughing, thick sticky sputum, fever and aversion to cold (especially severe in the afternoon), red face, dry nose, and rough skin on the chest like scales. If at the beginning, one can distinguish whether the pulse and symptoms belong to the Exterior or Interior, and strive to use lifting or purgative methods, there will be no case that does not heal. Alas, medical transmission has been lost; we view each other's bodies as if separated by a wall. We only know to treat cough with cough remedies, or use Niuhuang (Calculus Bovis) and Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) hoping to resolve heat. Or use viscous ointments hoping to moisten dryness. Or take Buyin Wan (Tonify Yin Pill) in the morning, and Qingwei San (Clear Stomach Powder) at night. Countless paths lead only to schemes of killing. Patients also consider themselves to suffer from consumptive disease (Xulao) or corpse consumption (Shizhai), helpless! Only when blood turns to pus and lung tissue rots, pouring out like a spilled bag, do they realize the condition, but it is ten deaths without rescue. Alas, it is too late! Occasionally, those with small abscesses and strong Qi, robust stomachs and good appetite, may have pus exit not from the mouth but flowing down the anus or piercing sideways through the hypochondrium, still surviving, but this is only two or three out of ten. The treatment methods in *Jinkui Yaolue* are most exquisite, exerting effort entirely before the pus forms. Now people apply treatments after pus has already formed; what help can that be? Lung Withering accumulates gradually over days; its cold and heat are not of one type. It generally stems from Stomach fluids failing to transmit to the Lung, causing the Lung to lose nourishment, turning increasingly dry and arid, thus forming. Essentially, Lung Metal generating Water and distributing essence relies entirely on the richness of Stomach Earth fluids. If upper supply is lacking, there are many ways for Stomach fluids to be secretly damaged. Rough physicians, unaware of protection, may induce heavy sweating due to loose interstices without cause. Or due to deficient Middle Qi, frequent vomiting empties the reservoir. Or in cases of Dian Cheng Xiao Zhong (excessive heat causing polydipsia), drinking water fails to quench thirst, exhausting the source from within. Or with dry intestines and constipation, forcing diuresis for relief creates an unfillable leak. Only this upper-supply fluid is wasted on wrong paths. Thus Lung fire intensifies daily, Lung heat deepens, Lung micro-tubes close daily, cough sounds become faint, thoracic membranes dry up, making expectoration difficult. Walking a few steps causes wheezing; impact sounds continue until sputum responds. The treatment methods in *Jinkui Yaolue* are not obscure, yet mixed into the Lung Abscess category, their profound meaning is hard to grasp. Generally, plan slowly: generate Stomach fluids, moisten Lung dryness, descend rebellious Qi, open accumulated phlegm, stop turbid saliva, tonify true Qi to unblock Lung micro-tubes, scatter fire-heat to restore Lung clarity. Even hemiplegic wasting or flaccidity of limbs can recover with proper treatment. Although Lung disease is near the chest, concerning respiration, how can one neglect it? Lung Abscess belongs to tangible Blood; blood stasis requires rapid attack. Lung Withering belongs to intangible Qi; Qi injury requires gradual management. Lung Abscess is Excess; treating it as Withering is "Excess reinforcing Excess." Lung Withering is Deficiency; treating it as Abscess is "Deficiency reinforcing Deficiency." This is the general principle of syndrome differentiation and medication.
*Jinkui Yaolue* discusses the pulses of Lung Abscess and Withering: Cun Kou pulse is rapid, the person coughs, and contrary to expectation, has turbid saliva and froth in the mouth; this is Lung Withering. If the mouth feels parched and dry, and coughing causes hidden pain in the chest, and the pulse is slippery and rapid, this is Lung Abscess. Coughing up pus and blood with a rapid and deficient pulse indicates Lung Withering; a rapid and excess pulse indicates Lung Abscess.
The Cun Kou pulse of both hands originally belongs to the Hand Taiyin Lung meridian. Here, "Cun Kou pulse rapid," "slippery and rapid," "rapid and deficient/excess" all refer collectively to the left and right three positions, not solely the Right Guan position as with Qikou. The person coughs, and contrary to expectation, has turbid saliva and froth in the mouth, spreading everywhere shortly after; this is Lung Withering, indicating coughing without mouth dryness. If coughing brings parched dryness to the mouth, it means the Lung has formed an abscess, and fire-heat toxin manifests in the mouth. Forceful coughing touches the abscess, causing hidden pain in the chest; the pulse must appear slippery, rapid, and forceful, a sign of flourishing pathogenic Qi. Pulses of rapid/deficient and rapid/excess distinguish Lung Withering from Lung Abscess. Thus, Lung Withering should be tonified, Lung Abscess should be drained, implicitly stated.
*Jinkui Yaolue* further discusses Lung Abscess: Cun Kou pulse is faint and rapid. Faint indicates Wind; rapid indicates Heat. Faint implies sweating; rapid implies aversion to cold. Wind injures the Defensive (Wei) level, exhalation does not enter. Heat passes into the Nutritive (Ying) level, inhalation does not exit. Wind injures hair and skin; Heat injures blood vessels. Wind lodges in the Lung, causing cough, dry mouth, wheezing and fullness, dryness without thirst, occasional spitting of turbid froth, and periodic chills. Wherever Heat passes, blood coagulates and stagnates, accumulating into abscess pus, spit resembling rice porridge. In the initial stage, it can be saved; once pus forms, death ensues.
Regarding Lung Abscess pulses, previously mentioned as slippery and rapid, now also faint and rapid: this is not a difference in pulse nature. Slippery and rapid is the pulse of formed pus. Faint and rapid is the cause of the initial onset. Initially, faint pulses in the left and right three positions indicate Wind invading the Defensive level causing spontaneous sweating. Rapid pulses indicate Nutritive level absorbing Heat causing aversion to cold. However, Wind initially entering the Defensive level exits with exhalation and cannot penetrate deeply, injuring only hair and skin. Hair and skin are the exterior of the Lung. Wind enters via this connection, gradually lodging in the Lung Shu points, causing cough, spitting, and chills. At this time, pathogens entering from outside can be expelled outwardly, which is easy. But Heat passing into the Nutritive level penetrates deeply with inhalation and cannot exit, injuring blood vessels. Wind in the Defensive, combined with Heat in the Nutritive, lingers and knots between lung lobes, causing blood stagnation and gradually forming abscess pus. Thus, tangible turbid waste must be driven downward via Lung-draining methods. If the toxin moves downward with the drainage, entering Stomach, abdomen, and intestines, another drive removes it completely. Why let the initial stage go unsaved, allowing pus formation and lung rot?
*Jinkui Yaolue* uses the method of "preparing for rain while the roof is intact" (proactive treatment) for these two conditions, treating early. First differentiate rapid/deficient vs. rapid/excess via pulse; second differentiate spitting froth vs. dryness via mouth. Furthermore, a swift method is presented: at the onset of cough, if Shang Qi (rebellious Qi) and急促 (urgency/wheezing) appear, it is caused by external Wind-Cold invasion, the pulse must be Floating. One should use Yebipro Jia Banxia Tang (Ephedra Decoction Modified with Scutellaria and Pinellia) or Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction Modified with Gypsum). Urgently release the Exterior. Otherwise, it becomes the foundation of Lung Abscess or Withering. Hence, Cough and Shang Qi syndromes are narrated under Lung Abscess and Withering, yet a separate chapter for Phlegm-Fluids and Cough is established, holding deep significance. Seeing cough progressing to Shang Qi indicates Lung obstruction and pressure, leaving no room for waiting. Must one not urgently scatter pathogens and descend Qi to clear the Lung? However, treatment must distinguish Exterior/Interior and Excess/Deficiency to avoid misapplication worsening the condition.
*Jinkui Yaolue* states: Shang Qi with facial edema, breathing sounds (Xi), and a floating-large pulse is untreatable; adding diarrhea makes it worse. Also: Shang Qi with wheezing and dryness belongs to Lung Distension intending to become Feng Shui (Wind Edema); sweating leads to recovery. When Shang Qi urgency reaches facial edema and nasal breathing sounds, it is Lung Qi obstructed and pressing upward, not descending. Coupled with a floating-large pulse, Qi is exiting outwardly, with no method to return it inward and descend. Hence, "untreatable." Adding diarrhea causes struggle between upper and lower, unbearable! Sweating for Lung Distension follows the *Neijing* method of "opening the ghost gate" (diaphoresis), allowing Wind pathogen to escape via muscle-skin surface first. Without Wind fighting, Water naturally flows downward. However, if facial edema and nasal breathing sounds exist, the Withering lies entirely in Qi rebellion; can Qi be vented outwardly? Moreover, if upward rebellion persists, can it be fully exhausted? Unable to vent outwardly and unable to return inwardly, hence "untreatable." Skilled physicians work painstakingly to gradually gather Qi and follow Bladder transformation, still possible to survive. Thus, "untreatable" is flexible, not a death sentence.
Regarding *Jinkui Yaolue* Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction): Lung Withering with salivation but no cough, no thirst, inevitable enuresis, and frequent urination. This occurs because Upper Deficiency cannot control Lower. This is Cold in the Lung, causing dizziness and excessive saliva/phlegm; use Gancao Ganjiang Tang to warm it. If after taking the decoction, thirst appears, it belongs to Xiao Ke (Wasting-Thirst).
Lung Heat causes Bladder Qi transformation to be hot, resulting in red, scanty, difficult urination. In Lung Withering, if there is only salivation without cough, no thirst, but enuresis and frequent urination, why does this contradict the primary disease? It must be Upper Deficiency failing to control Lower, so urine lacks retention. This is Cold in the Lung, Yin Qi ascending to the head, insulting Yang Qi, causing dizziness. Yin-Cold Qi stagnates fluids, causing excessive saliva/phlegm. If initially no thirst, but turning thirsty after warming medicine, it clearly indicates Xiao Ke (drinking much, urinating twice as much). Xiao Ke is similar to carbuncles and sores; further consideration is needed.
Regarding *Jinkui Yaolue* Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) and Nongpo Mahuang Tang (Magnolia Bark and Ephedra Decoction): Cough with Shang Qi and "water-chicken sound" in the throat is treated with Shegan Mahuang Tang. Cough with a floating pulse is treated with Nongpo Mahuang Tang.
Shang Qi with water-chicken sound indicates Phlegm obstructing Qi, and Qi touching Phlegm, a sign of Wind-Cold entering the Lung. Releasing Exterior, descending Qi, moistening dryness, and opening Phlegm—four methods integrated into one formula—to decompose pathogens and prevent combination. This is a method of determining medicine based on syndrome. If coughing with a floating pulse, external pathogens predominate; focus entirely on exterior dispersion. Use Xiao Qinglong Tang, remove Guizhi, Shaoyao, Gancao, add Nongpo, Shigao, Xiaomai, still considering Lung disease. Thus, Guizhi's heat, Shaoyao's astringency, Gancao's slackness are all avoided. Add Nongpo to descend Qi, Shigao to clear Heat, Xiaomai to enter Stomach and assist ascending Qi. One move resolves Exterior and harmonizes Pulse, allowing effort on the root disease, achieving irresistible momentum. Once adjusted, it seems Xiao Qinglong carries Lung disease away into the sky! Divine! Satisfying!
Regarding *Jinkui Yaolue* Zeqi Tang: Cough with a sinking pulse is treated with Zeqi Tang.
Floating pulse indicates Exterior; sinking pulse indicates Interior. These differ greatly from Shanghan's Exterior/Interior. Exterior means pathogen in Wei (Defensive), i.e., Lung's Exterior. Interior means pathogen in Ying (Nutritive), i.e., Lung's Interior. Heat passing into Ying, inhalation not exiting, causes blood knotting. Blood knotting causes Phlegm-Qi to be wrapped externally. Thus, Zeqi (Phytolacca Root) breaking blood is used as Sovereign herb, added with herbs opening Phlegm, descending Qi, clearing Heat, and harmonizing Ying, so that hard accumulations are emptied, Yuan Qi undamaged. Such is the intent of formulating.
Regarding *Jinkui Yaolue* Zaojiao Wan (Ziziphus Jujuba Pill): Coughing, rebellious Qi, frequent spitting of turbid matter, inability to sleep sitting, treated with Zaojiao Wan.
Fire-heat toxin knots in the Lung. Exterior-releasing, Interior-purging, Clearing, Warming—all fail slightly. For hardness unyielding to attack, use this pill, bean-sized, three doses morning, one dose evening, swallowed appropriately. Like thorns piercing, attacking from all sides for many days, penetrating all hardness, achieving cleansing effect. Do not despise the cheapness of the drug. Chest is unreachable by hand; call it an "Acupuncture-Replacement Pill."
Regarding *Jinkui Yaolue* Maimendong Tang (Ophiopogon Decoction): Fire-rebellion causing Shang Qi, throat discomfort, stopping rebellion and descending Qi is treated with Maimendong Tang.
This is a syndrome of dried Stomach fluids and defluxing Deficient Fire, a good method for treating the root. Using fire-descending drugs while fire rises; using cooling drugs while heat intensifies—merely knowing to fight fire-heat without realizing impossibility harms rather than helps. Lung diseases live with Stomach Qi, die without it. Stomach Qi is the Mother Qi of Lung. Herbs named Zhimu (Anemarrhena Rhizome) imply Lung borrows coolness, knowing coolness is Lung's Mother. Herbs named Beimu (Fritillaria Bulb) imply Lung borrows phlegm-resolving, knowing phlegm-resolving is Lung's Mother. Yet repeatedly applied to fire-rebellion Shang Qi and throat discomfort without success, names do not match reality. Who knew Zhang Zhongjing had this wonderful method: in Maimodong, Renshen, Gancao, Jingmi, Dazao, greatly tonifying Middle Qi and generating fluids, adding Banxia (Pinellia Tuber) pungent-warm. Its benefit to throat and descending Qi is not Banxia's merit alone, but the skillful use of Banxia, possessing unprecedented wonder.
Regarding *Jinkui Yaolue* Jiegeng Tang (Platycodon Decoction): Cough with chest fullness, chills, dry throat without thirst, occasional spitting of foul-smelling turbid sputum, long-term spitting of pus like rice porridge is Lung Abscess, treated with Jiegeng Tang.
This is an uplifting method. Abscess knotted in Lung,趁 (taking advantage of) new formation not solid, lift and extract it. Extracted bad blood exits via spit or stool, healing. Far different from spreading difficulty and self-rupturing pus death syndrome. Before pus forms, frequent use kills toxic momentum. Hardness gradually cracks, obstruction gradually clears. However, medication must have cause. This cause is chest fullness, chills, no thirst; disease is not Interior but Exterior. Using this to uplift Lung Qi is appropriate. If trend enters Interior, guide via Stomach to Intestine; this method is useless.
Regarding *Jinkui Yaolue* Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Lung-Draining Decoction): Lung Abscess preventing lying down is treated with Tingli Dazao Xiefei Tang. Supplementary Formula: Lung Abscess with chest fullness/swelling, whole-body facial edema, nasal congestion with clear discharge, loss of smell/taste, coughing/rebellious Qi, wheezing/blockage, treated with Tingli Dazao Xiefei Tang. Take every three days, up to 3-4 doses. Take one dose of Xiao Qinglong Tang first, then proceed.
This is a critical formula for Lung Abscess. Abscess born in Lung, if not draining Lung, what else to wait for? However, long-standing abscess pus formed, draining is useless. Long-standing Lung Qi exhausted, draining injures. Only when blood knots and pus not formed, urgently drain Lung. Must also ensure Exterior signs fully enter Interior, guiding according to trend to succeed. The supplementary formula items are purely Exterior signs; how dare they blatantly violate Zhongjing? Yet they possess high insight and far-reaching intent, likely because Interior signs cannot wait, necessitating use. Saying "take one dose of Xiao Qinglong Tang first, then proceed" reveals the situation. Discussing normalcy, lifting/scattering should not be purged. Discussing urgency, purging should not be hindered externally, ignoring the great taboo "pus formed equals death." How can one substitute one for the other?
Regarding *Jinkui Yaolue* Yebipro Jia Banxia Tang (Ephedra Decoction Modified with Scutellaria and Pinellia) and Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction Modified with Gypsum): Cough with Shang Qi, this is Lung Distension, person wheezes, eyes bulge like popping out, floating-large pulse, treated with Yebipro Jia Banxia Tang. Also: Lung Distension cough with Shang Qi, irritability and wheezing, floating pulse, water below Heart, treated with Xiao Qinglong Jia Shigao Tang.
First formula: replace Shigao with Xingren in Mahuang Tang, add Jiang and Zao, dispersing power becomes weak and slow. Second formula: syndrome includes irritability, suitable for sweating; add Shigao to Ma-Gui herbs, power becomes fierce, but monitored by Shaoyao, Wuweizi, Ganjiang, trend descends via water pathways, avoiding excessive sweating. Yebipro formula has Shigao but no Banxia; Xiao Qinglong formula has Banxia but no Shigao. Observing additions, both emphasize Shigao and Banxia cooperating. Shigao clears Heat, borrowing pungent-warmness to resolve Phlegm. Banxia resolves Phlegm, borrowing coolness to clear Heat. Otherwise, Shigao needs no worry, Banxia is prohibited. In previous Maimendong formula, descending Qi stops rebellion relying on Banxia entering fluid-generating herbs. In these two formulas, Banxia enters heat-clearing herbs. Zhongjing's modified formulas are all creative adaptations, worthy of admiration by later learners. Further discussing Lung Withering and Abscess, both are Dryness diseases. Lung receives clear-and-solemn command, a cold-metal-water-cold organ. Fire-heat scorching, losing clarity over time, becomes Dryness. Abscess in Lung, fluids wrap abscess, not overflowing mouth, hence mouth parched dry. Lung Heat causing Withering, upper-supplied fluids turn to saliva/phlegm via dry-heat, syndrome mostly no thirst. Compared to Stomach fluid exhaustion, mother disease affecting child Withering, greatly different. Only upper-transmitted fluids turn to saliva, Lung not benefiting. If Withering because fluids cannot extinguish fire, instead transforming by fire, year after year, between lung lobes brews a large fire gathering. Cooling agents rejected. Though rejected, harmless. If dry-heat agents used, fire aiding fire, would person not sit and die? Banxia is dry herb, putting into Lung increases harm, needless to say. But since cooling cannot enter, only dry matches dry to enter, thus using Banxia's dryness in cooling-fluid-generating herbs, not only not drying, but opening dryness. Turbid froth descends with rebellious Qi. Over time, upper-transmitted fluids do not knot into saliva, Lung gets moistened, Withering rises. People only know Banxia dries fluids; who knows skilled use drives dried fluids? This is the essence.
Supplementary Formulas: Six formulas, collected by Sun Qi et al. from *Jinkui*, discussions below respective formulas.
*Waitai Mi Yao* Zhi Gancao Tang treats Lung Withering with excessive saliva/froth, warm liquid feeling in heart.
*Qianjin Fang* Gancao Tang.
*Qianjin Fang* Shengjiang Gancao Tang treats Lung Withering with incessant cough/saliva, dry throat/thirst.
*Qianjin Fang* Guizhi Qu Shaoyao Jia Zaojiao Tang treats Lung Withering with spitting saliva/froth.
*Waitai Mi Yao* Jiegeng Bai San treats cough/chest fullness/chills, rapid pulse, dry throat/no thirst, occasional foul sputum, long-term pus like rice porridge, Lung Abscess.
*Qianjin Fang* Weijing Tang treats cough with slight heat, irritability/fullness, rough chest skin, Lung Abscess.
[Four Prohibitions]
1. Lung Withering syndrome mostly involves no thirst. Because of no thirst, casually avoiding fluid-generating herbs, letting Lung dry daily, is physician's fault. Because of no thirst, recklessly using dry-hot herbs, inevitably fatal, fault increased.
2. Treating Lung Withering lethargically, like Lu Aichao, though Confucius wouldn't attack Three Families, supporting heaven's constant, planting human ethics, silently maintaining ancestral temple. Thus using harsh methods, driving saliva heavily, seeking quick effect, causing quick death, is physician's fault.
3. Treating Lung Abscess must differ from Withering. Abscess is Excess, Withering is Deficiency; Abscess is Yang-Excess, Withering is Yin-Deficiency. Yang-Excess first suitable for scattering pathogens, then descending Qi. Yin-Deficiency suitable for tonifying Stomach fluids, moistening Lung dryness. Not distinguishing and mistreating kills patient.
4. Treating Lung Abscess must clear Lung Heat, save Lung Qi, ensuring Lung lobes do not burn and rot, so Metal generates. Clearing one part Lung Heat saves one part Lung Qi. Clearing Heat must cleanse...