巢氏曰∶肺痈者,由风寒伤于肺,其气结聚所成也。肺主气,候皮毛。劳伤血气,腠理开
而受邪,气虚者,邪乘虚伤肺,寒搏于血,蕴结成痈,积热不散,败血为脓。其人咳,胸内满,
隐隐痛而战,咽干,口内辟辟燥
不渴,时时出浊唾腥臭,久久吐脓如米粥者,难治。又云∶风中于卫,呼气不入,数过于荣,
吸而不出。风伤皮毛;热伤血脉。风舍于肺,其人则呕,口干喘满,咽燥不渴,唾而浊沫,
时时战寒。热之所过,血为凝滞,蓄结痈膜,吐如米粒,始萌可救,脓成则死。
肺症证口中辟辟燥,咳则胸中隐隐痛,脉反滑数或数实者,此为肺痈也。肺痈有脓血而呕
者,不须治,其呕脓止自愈。肺痈已破风入者,不治。肺痈不觉,但发寒热,咳亦微,须要按
其右胁而痛者是也。张子和治一小儿,久发寒热,咳亦微,骨蒸,治之半年,病甚。戴人诊之,
两手寸尺脉皆潮于关,关脉独大。戴人曰∶肺痈也,去儿衣,举其两手,按右胁,儿则避缩有
痛,按左胁则不避,故知有肺痈者,右胁必痛也。
肺部脉紧为肺瘫。寸口脉数而实者,为肺痈。寸口脉微而数,微则为风,数者为热。肺痈脉
紧数为脓未成,其脉紧去,但数,脓已成。肺痈病,身常有热,咳嗽短气,吐出脓血,其脉当短
涩而反浮大,其色当白而反赤者,此火之克金,大逆不治也。
Chao Yuanfang stated: Fei Yong (Lung Abscess) is formed by wind-cold injuring the lung, causing the qi to knot and accumulate. The Lung governs qi and corresponds to the skin and hair. When labor and fatigue damage blood and qi, the couli (pores and interstices) open, allowing pathogens to invade. In individuals with qi deficiency, pathogens take advantage of the deficiency to injure the lung; cold condenses with blood, accumulating and forming an abscess. Accumulated heat does not dissipate, and damaged blood transforms into pus. The patient experiences cough, fullness in the chest, dull pain accompanied by shivering, dry throat, a sensation of dryness in the mouth without thirst, frequent expectoration of turbid, foul-smelling saliva, and eventually expectoration of pus resembling rice porridge; this condition is difficult to treat. It is also said that when wind attacks the Wei level, exhalation fails to enter deeply; when wind repeatedly invades the Ying level, inhalation fails to exit smoothly. Wind injures the skin and hair; heat injures the blood vessels. If wind lodges in the lung, the patient will vomit, experience dry mouth, wheezing, and chest fullness, dry throat without thirst, expectorate turbid foam, and suffer from frequent chills. Wherever heat passes, blood becomes stagnant, accumulating and forming an abscess membrane; the expectorant resembles rice grains. If treated at the initial stage, it can be saved; once pus is formed, death ensues.
Symptoms of Fei Yong include a dry sensation in the mouth, dull pain in the chest upon coughing, and a pulse that is slippery and rapid or rapid and excess; this indicates Fei Yong. In cases of Fei Yong where pus and blood are present accompanied by vomiting, no specific treatment is required; once the vomiting of pus ceases, the disease will heal spontaneously. If Fei Yong has ruptured and wind has invaded, it is incurable. If Fei Yong is not obvious, manifesting only as chills and fever with mild cough, one must press the right hypochondrium to check for pain; if painful, it is Fei Yong. Zhang Zihe treated a child who had suffered from recurrent chills and fever for a long time, with mild cough and bone-steaming tidal fever. After half a year of treatment, the condition worsened. Dai Ren (Zhang Zihe's courtesy name) diagnosed the pulse: the Cun and Chi positions on both hands were surging beyond the Guan position, while the Guan pulse alone was large. Dai Ren said, "This is Fei Yong." He asked the child to remove clothes, raised both hands, and pressed the right hypochondrium; the child avoided shrinking and showed pain. Pressing the left hypochondrium caused no avoidance. Thus, he knew that patients with Fei Yong would necessarily have pain in the right hypochondrium.
A tight pulse in the Lung region indicates Fei Wei (Lung Flaccidity). A rapid and excess pulse at the Cun Kou position indicates Fei Yong. A minute and rapid pulse at the Cun Kou position: minute indicates wind, rapid indicates heat. In Fei Yong, a tight and rapid pulse indicates that pus has not yet formed; if the tightness disappears and only rapidness remains, pus has already formed. Patients with Fei Yong disease often have body heat, cough, shortness of breath, and expectorate pus and blood. Their pulse should be short and choppy but is instead floating and large; their complexion should be white but is instead red. This represents Fire overcoming Metal, a great reversal indicating an incurable condition.