喘嗽气急胸满者。表散之。
咳嗽发热者。和解之。
咳而胸膈隐痛唾痰腥臭者。宜排脓。
喘急恍惚。疾盛者。宜平肺。
咳脓脉短者。宜补之。
肺痿。寸口脉数而虚肺痿之候久嗽不已。汗出过度。重亡津液便如烂瓜。下如豕脂。小便数
而不渴。渴者自愈。欲饮者瘥。此由多唾涎沫而无脓。
肺疽。寸口脉数而实。肺疽之候。口干喘满。咽噪而渴甚者。四肢微肿。咳唾脓血。或
浊味。胸中隐隐微痛。候始萌则可救。脓成则多死。脉若微紧而数者。未有脓。紧甚而数者
。已有脓。呕脓不止者。难治。久久如粳米粥者。亦难治。
脓自止者。自愈。其脉短而涩者。自痊。浮大者难治。面色常白反赤者。此火克金。皆
内疽皆因饮食之火。七情之火。相郁而发。饮食者阴受之。七情者脏腑受之。宜其发在
腔子而向内。非干肠胃盲膜也。
肺痈先须发表。千金曰。咳唾脓血。其脉数实。或口中咳。胸中隐痛。脉反滑数者为
肺痈。脉紧数为脓未成。紧去但数为脓已成。
要略。先以小青龙汤（百九十五）一贴。以解表之风寒。然后以葶苈大枣泻肺汤、桔
梗汤、苇叶汤、随症用之。以取脓。此治肿疡例也。终以黄昏汤。以补里之阴气。此治溃疡例也。
肺痈已破。入风者不治。或用太乙膏。凡服以搜风汤吐之。吐脓血如肺痈状。口臭。他
方不应者。宜消风散。入男子发灰。清米饮下。两服可除。
一人喘咳。脉紧数。以小青龙汤（百九十五）一剂。表症已解。更以葶苈大枣汤（百九十
六）喘止。乃以桔梗汤愈。（此凭脉症也。）
一人咳嗽气急。胸膈胀满。睡卧不安。以葶苈散二服少愈。更桔梗汤瘥。（此凭症也。）
一人咳嗽。项强气促。脉浮而紧。以参苏饮二剂少愈。更以桔梗汤四剂而安。（此凭脉
一人咳嗽。胁胀满。咽干口燥。咳唾腥臭。以桔梗汤四剂而唾脓。以排脓数服而止。乃
以补阴托里之剂而瘳。（此凭症也。）
一人咳而脓不止。脉不退。诸药不应。甚危。用柘黄丸一服少愈。再服顿退。数服而痊
。溃者尤效。（此凭症也。）
一妇唾脓。五心烦热。口干胸闷。以四顺散（二百一）三剂少止。以排脓散数服而安。（
此凭症也。）
一人面白神劳。咳而胸膈隐痛。其脉滑数。予以为肺痈。欲用桔梗汤。不信。乃服表药
。致
数剂而愈。（此凭脉症也。）
大抵劳伤血气。则腠理不密。风邪乘肺。风热相抟。蕴结不散。必致喘嗽。若误汗下过
则津液重亡。遂成斯症。若寸脉数而虚者为肺痿。数而实者为肺疽。脉微紧而数者未有脓。
紧甚而数者已有脓。唾脓自止者。脉短而面白者。易治。脓不止。脉洪大而面色赤者。不治
。使其治早可救。脓成则无及矣。金匮方论。热在上焦者。因咳为肺痿。得之或从汗出。或
从呕吐。或从渴消。小便不利。或从便难。又被下药快利。重亡津液。故寸口脉数。其人燥
咳。胸中隐隐而痛。脉反滑数。此为肺痈。咳唾脓血。其脉数虚者为肺痿实者为肺痈。
一童气禀不足。患肺痈。唾脓腥臭。皮毛枯槁。脉浮。按之涩更无力。治以钟乳粉汤。
（此凭脉症也。）
一弱人咳脓。日晡发热。夜间盗汗。脉浮数而紧。用人参五味汤数剂顿退。以紫菀茸汤
月余而痊。（此凭症也。）
一仆年逾三十。嗽久不愈。气壅不利睡卧。脓血甚虚。其主已弃矣。予以宁肺散一服少
又服而止大半。乃以宁肺汤数剂而痊。所谓有是病。必用是药。若泥前散。性涩而不利。何
以得愈。（此凭症也。）
一人患肺痿。咳嗽喘急。吐痰腥臭。胸满咽干。脉洪数。用人参平肺散六剂。及饮童便
诸症悉退。更以紫菀茸汤而愈。（此凭脉症也。）
童便虽云专治火虚。常治疮疡肿 疼痛。发热作渴。及肺痿肺痈。发热口渴者尤效。
一妇患肺痿咳嗽。吐痰腥臭。日晡发热。脉数无力。治以地骨皮散。热止。更用人参养
肺汤。月余而安。（此凭脉症也。）
一人咳嗽喘急。发热烦躁。面赤咽痛。脉洪大。用黄连解毒汤（八）二剂少退。更以栀子
汤（二百九）四剂而安。（此凭脉症也。）
一人春间咳嗽。唾脓腥秽。胸满气促。皮肤不泽。项强脉数。此肺疽也。盖肺系在项。
则系伤。故牵引不能转侧。肺主皮毛。为气之本。肺伤不能摄气。故胁胀气促而皮肤纵。东
垣云。肺疮脉微紧而数者未成脓。紧甚而数者已有脓。其脉紧数。脓为已成。以参、 、
归、芎、白芷、贝母、知母、桔梗、防风、甘草、麦门、栝蒌仁。兼以蜡矾丸及太乙膏。脓
尽脉涩而愈。至冬脉复数。经曰。饮食劳倦伤脾。脾伤不能主肺。形寒饮冷伤肺。肺伤不能
主肾。肾水不足则心火炽盛。故脉洪数。经曰。冬见心而莫治。果殁火旺之月。
一人年逾三十患咳嗽。项强气促。右寸脉数。此肺疽也。东垣云。风伤皮毛。热伤血脉
热相抟。血气稽留于肺。变成疮疽。今脉滑疽脓已成。以排脓托里之药。及蜡矾丸。脉渐涩
而愈。（此凭脉症也。）
一人病胸膈壅满。昏不知人。予以杏仁、薏苡之剂灌之。立苏。继以升麻、黄 、桔梗
脓。逾月而愈。予所以知其病者。以阳明脉浮滑。阴脉不足也。浮为风。滑为血聚。始由风
伤肺。故结聚客于肺。阴脉不足。过于宣逐也。诸气本于肺。肺气治则出入顺而菀陈除。故
行其肺气而病自已。（此凭脉也。）
一人肾气素弱。咳唾痰涎。小便赤色。服肾气丸而愈。（此凭症也。）
一 妇咳而无痰。咽痛。日晡发热。脉浮数。先以甘桔汤少愈。后以地骨皮散而热退。
更以肾气丸。及八珍汤加柴胡地骨皮而愈。（此凭脉症也。）
丹溪云。咳而无痰者。乃火郁之症。及痰郁火邪在中。用苦梗开之。下用补阴降火之剂
。不已。则成劳嗽。此症不得志者多有之。又原病式。瘦人腠理疏通而多汗。血液衰
为燥。故为劳嗽之症也。
一人年前病肺壅。后又患咳嗽。头眩唾沫。饮食少思。小便频数。服解散化痰药不应。
脾肺二脉虚甚。予谓眩晕唾涎。属脾气不能上升。小便无度。乃肺气不得下制。内未成痈。
宜投以加味理中汤。 四剂诸症已退大半。更用钟乳粉汤而安。（此凭脉也。）
河间曰。肺痿属热。如咳久肺痿。声哑声嘶。咯血。此属阴虚热甚然也。本论治肺痿。吐涎
沫而不咳者。其人不渴。必遗尿。小便数。以上虚不能制下故也。此为肺中冷。必眩。多痰
唾。用炙甘草、干姜。此属寒也。肺痿涎唾多心中湿液。湿液者。用炙甘草汤。此补虚劳也
。与补阴大热不同。是皆宜分治。故肺痿又有寒热之异。
一人因劳。咳嗽不止。项强而痛。脉微紧而数。此肺痈也。尚未成脓。欲用托里益气药
。彼不信。仍以发散药。以致血气愈虚。吐脓不止。竟致不救。
经云。肺内主气。外司皮毛。若肺气虚则腠理不密。皮毛不泽。肺受伤则皮毛错纵。故
痈、肺痿、肠痈者。致皮毛如此。以其气不能荣养而然也。亦有服表药见邪不解。仍复发表
。殊不知邪不解者。非邪不能解。多因腠理不密而邪复入也。专用发表。则腠理愈虚。邪愈
易入。反为败症矣。若诊其脉。邪在表者。只当和解而实腠理。乘虚复入者。亦当和解兼实
腠理。故用托里益气之药。若小便赤涩。为肺热所传。短少为肺气虚。盖肺为母。肾为子。
母虚不能生子故也。亦有小便频数者。亦为肺虚不能约制耳。
一人年逾四十。喘咳胁痛。胸满气促。右寸脉大。此风热蕴于肺也。尚未成疮。属有余
。欲用泻白散。（六十）彼谓肺气素弱。自服补药。喘嗽愈盛。两月后复请视。汗出如雨。喘
而不休。此肺气已绝。安用治。果殁夫肺气充实。邪何从袭。邪气既入。则宜散之。故用泻白
散。乃泻肺之邪气。邪气既去。真气自实。一有患此吐脓。面赤脉大。予谓肺病脉宜涩。面
宜白。今面赤脉大。火克金。不可治。果殁。
For wheezing, coughing, rapid breathing, and chest fullness, apply the method of releasing the exterior (releasing the surface).
For coughing accompanied by fever, apply the method of harmonizing.
For coughing with dull pain in the chest and diaphragm, and expectoration of foul-smelling sputum, pus-draining methods are appropriate.
For severe wheezing, mental confusion, and critical illness, calming the Lung Qi is appropriate.
For expectoration of pus and blood with a short pulse, tonification is appropriate.
Lung Wei (Flaccidity Syndrome of the Lung): The pulse at the Cun position is rapid and deficient; this is the sign of Lung Wei. Long-standing cough that does not cease, excessive sweating leading to severe loss of body fluids, stool resembling rotten melon, discharge resembling lard, frequent urination without thirst. If there is thirst, the condition will heal spontaneously; if the patient desires to drink, it will also heal. This is because there is only abundant saliva and froth without pus.
Lung Ju (Abscess of the Lung): The pulse at the Cun position is rapid and excess/full. Signs include dry mouth, wheezing, chest fullness, hoarseness, extreme thirst, slight swelling of the four limbs, expectoration of pus and blood, or turbid fluid with an offensive odor, and dull, slight pain in the chest. It can be saved if treated at the onset; once pus has formed, death is common. If the pulse is slightly tight and rapid, pus has not yet formed. If the pulse is very tight and rapid, pus has already formed. If vomiting of pus continues incessantly, it is difficult to treat. If pus resembling rice gruel porpora is expelled for a long time, it is also difficult to treat. If pus stops naturally, it will heal itself. If the pulse is short and choppy, spontaneous recovery occurs. If the pulse is floating and large, it is difficult to treat. If the complexion is usually white but turns red, this indicates Fire overcoming Metal. All these internal abscesses arise from the fire of diet and the fire of seven emotions, which become stagnant and erupt. Dietary pathogens are received by the Yin aspects, while emotional pathogens are received by the Zang-Fu organs. Thus, they erupt within the thoracic cavity inwardly, not involving the intestines, stomach, or blind membranes.
For Lung Abscess (Fei Yong), one must first release the exterior. *Qianjin Fang* states: Expectoration of pus and blood, rapid and full pulse, or coughing with dull chest pain and a slippery-rapid pulse indicates Lung Abscess. A tight-rapid pulse indicates unformed pus; when tightness disappears leaving only rapidity, pus has formed.
*Jin Gui Yao Lue* states: First use Xiao Qing Long Tang (Minor Blue Dragon Decoction) for one dose to resolve exterior wind-cold. Then use Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung), Jie Geng Tang (Platycodon Decoction), or Ye Yi Tang (Reed Shoot Decoction) according to symptoms to expel pus. This is the principle for treating ulcerated swellings (before rupture). Finally, use Huang Hun Tang (Twilight Decoction) to tonify interior Yin. This is the principle for treating ulcers (after rupture).
If Lung Abscess has ruptured and wind pathogen invades, it is incurable. Alternatively, apply Tai Yi Gao (Great One Ointment). For those taking Sou Feng Tang (Search for Wind Decoction) to induce vomiting, expectorating pus and blood resembling Lung Abscess symptoms with bad breath. If other prescriptions fail, use Xiao Feng San (Wind-Dispersing Powder) mixed with ash from human hair, taken with clear rice water; two doses can eliminate the disease.
Case 1: A person with wheezing and coughing, tight-rapid pulse. Given Xiao Qing Long Tang for one dose, exterior symptoms resolved. Then given Ting Li Da Zao Tang, wheezing stopped. Finally cured with Jie Geng Tang. (Based on pulse and symptoms.)
Case 2: A person with coughing, rapid breathing, chest/diaphragm distension, and restlessness. Given Ting Li San twice, slight improvement. Then cured with Jie Geng Tang. (Based on symptoms.)
Case 3: A person with coughing, stiff neck, rapid breathing, floating-tight pulse. Given Shen Su Yin for two doses, slight improvement. Then stabilized with Jie Geng Tang for four doses. (Based on pulse.)
Case 4: A person with coughing, flank distension, dry throat/mouth, expectoration of foul sputum. Given Jie Geng Tang for four doses, expectorated pus. Stopped after several doses of Pai Nong San (Pus-Expelling Powder). Finally cured with Yin-tonifying and interior-supporting agents. (Based on symptoms.)
Case 5: A person with continuous pus expectoration, non-resolving pulse, unresponsive to various medicines, critically ill. Used Zhe Huang Wan (Catalpa Yellow Pill); one dose brought slight improvement, second dose caused rapid decline, several doses led to recovery. Especially effective for ulcerated cases. (Based on symptoms.)
Case 6: A woman expectorating pus, five-palm heat, dry mouth, chest oppression. Given Si Shun San for three doses, slight cessation. Stabilized after several doses of Pai Nong San. (Based on symptoms.)
Case 7: A person with pale face, mental fatigue, coughing with dull chest pain, slippery-rapid pulse. I diagnosed Lung Abscess and wanted to use Jie Geng Tang. Patient disbelieved, took exterior-releasing drugs instead, causing worsening. Cured after many doses. (Based on pulse and symptoms.)
Generally, labor injury to Qi and Blood makes Cou Li (pores/skin texture) loose, allowing Wind Pathogen to invade the Lung. Wind and Heat combine, stagnate, and cause wheezing/cough. Mistaken use of sweating or purging causes severe fluid loss, leading to this syndrome. Cun pulse rapid and deficient indicates Lung Wei; rapid and full indicates Lung Ju. Pulse slightly tight and rapid means no pus; very tight and rapid means pus formed. Spontaneous cessation of pus expectoration with short pulse and pale face indicates easy treatment. Continuous pus with flooding-large pulse and red face indicates incurability. Early treatment can save; once pus forms, it is too late. *Jin Gui Fang Lun* says: Heat in Upper Jiao causes Lung Wei via cough. Causes include sweating, vomiting, thirst/xiao syndrome, difficult urination, or constipation followed by harsh purgatives causing severe fluid loss. Hence Cun pulse is rapid, patient has irritability/cough, dull chest pain, slippery-rapid pulse—this is Lung Abscess, expectorating pus/blood. Rapid-deficient pulse is Lung Wei; rapid-full is Lung Abscess.
Case 8: A child with insufficient constitution suffers Lung Abscess, expectorates foul pus, withered skin/hair, floating pulse, choppy and weak upon pressure. Treated with Zhong Ru Fen Tang (Stalactite Powder Decoction). (Based on pulse and symptoms.)
Case 9: A weak person expectorates pus, afternoon fever, night sweats, floating-rapid-tight pulse. Ren Shen Wu Wei Zi Tang (Ginseng and Schisandra Decoction) for several doses caused rapid decline. Cured after over a month with Zi Wan Rong Tang (Aster Flos Decoction). (Based on symptoms.)
Case 10: A servant over thirty, chronic cough, Qi stagnation, sleep disturbance, severe pus/blood loss, considered hopeless by master. I gave Ning Fei San (Lung-Calming Powder) for one dose, slight improvement; repeated dose stopped most symptoms. Then Ning Fei Tang for several doses cured him. "Where there is disease, there must be medicine." If one sticks to previous powders which are astringent and obstructive, how could one recover? (Based on symptoms.)
Case 11: Person with Lung Wei, coughing/wheezing, foul sputum, chest fullness, dry throat, flooding-rapid pulse. Ren Shen Ping Fei San (Ginseng Lung-Calming Powder) for six doses, plus drinking Tong Bian (Child Urine), all symptoms receded. Then cured with Zi Wan Rong Tang. (Based on pulse and symptoms.)
Tong Bian is said to specifically treat Fire deficiency, often used for sores/swellings/pain, fever/thirst, and especially effective for Lung Wei/Abscess with fever/thirst.
Case 12: Woman with Lung Wei cough, foul sputum, afternoon fever, rapid-weak pulse. Treated with Di Gu Pi San (Bark of Groundcherry Root Powder), heat stopped. Then Ren Shen Yang Fei Tang (Ginseng Lung-Nourishing Decoction) for over a month brought stability. (Based on pulse and symptoms.)
Case 13: Person with coughing/wheezing, fever/irritability, red face, sore throat, flooding-large pulse. Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) for two doses reduced symptoms slightly. Then Zhi Zi Tang (Gardenia Decoction) for four doses brought peace. (Based on pulse and symptoms.)
Case 14: Spring cough, expectoration of foul pus, chest fullness, rapid breathing, dull skin, stiff neck, rapid pulse. This is Lung Ju. Lung channels connect to the neck; thus lung channel injury causes牵引 (traction) preventing turning. Lung governs skin/hair and is the root of Qi. Lung injury fails to control Qi, causing flank distension, rapid breathing, and loose skin. Dong Yuan said: Lung sores with slightly tight-rapid pulse have unformed pus; very tight-rapid pulse means pus formed. With tight-rapid pulse, pus is formed. Use Ren Shen, [Missing Character], Dang Gui, Chuan Xiong, Bai Zhi, Mu Li, Zhi Mu, Jie Geng, Fang Feng, Gan Cao, Mai Men Dong, Gua Lou Ren. Also La Fan Wan (Beeswax Alum Pill) and Tai Yi Gao. When pus is exhausted and pulse becomes choppy, it heals. In winter, pulse becomes rapid again. Classics say: Diet/labor injures Spleen; Spleen injury fails to govern Lung. Cold exposure/cold drinks injure Lung; Lung injury fails to govern Kidney. Kidney Water deficiency leads to Heart Fire flourishing, hence flooding-rapid pulse. Classics say: Winter appearance of Heart pulse implies no cure. Indeed died in the month of Fire prosperity.
Case 15: Person over thirty with cough, stiff neck, rapid breathing, rapid Right Cun pulse. This is Lung Ju. Dong Yuan said: Wind injures skin/hair, Heat injures vessels. Wind-Heat combine, Blood/Qi stagnates in Lung, becoming sores/abscesses. Now pulse is slippery, abscess pus has formed. Use Pus-expelling and Interior-supporting drugs, plus La Fan Wan. Pulse gradually became choppy and healed. (Based on pulse and symptoms.)
Case 16: Person with chest/diaphragm fullness, coma/unconsciousness. I administered Xing Ren and Yi Yi Ren agents, immediate revival. Followed by Sheng Ma, Huang Qin, Jie Geng... to expel pus. Healed after over a month. I knew the disease because Yang Ming pulse was floating-slippery, Yin pulse was insufficient. Floating indicates Wind, Slippery indicates Blood accumulation. Initially Wind injured Lung, causing accumulation lodging in Lung. Yin insufficiency led to excessive dispersing/draining. All Qi originates in Lung; when Lung Qi is regulated, entry/exit is smooth and stagnation removed. Thus, regulating Lung Qi cures the disease. (Based on pulse.)
Case 17: Person with inherent weak Kidney Qi, expectorating phlegm/saliva, red urine. Cured with Shen Qi Wan (Kidney Qi Pill). (Based on symptoms.)
Case 18: Woman with cough without phlegm, sore throat, afternoon fever, floating-rapid pulse. First Gan Jie Tang (Licorice and Platycodon Decoction) brought slight improvement. Then Di Gu Pi San reduced heat. Then Shen Qi Wan, plus Ba Zhen Tang added Chai Hu and Di Gu Pi, cured her. (Based on pulse and symptoms.)
Dan Xi said: Cough without phlegm is Fire Stagnation syndrome, or Phlegm-Stagnant Fire in the middle. Use Jie Geng to open it, below use Yin-tonifying and Fire-descending agents. If unceasing, it becomes Labor Cough. This syndrome is common among those frustrated. *Yuan Bing Shi* says: Thin people have loose Cou Li and sweat much; Blood deficiency leads to Dryness, hence Labor Cough.
Case 19: Person had Lung Obstruction last year, now cough, dizziness, salivation, poor appetite, frequent urination. Dispersing/phlegm-resolving drugs failed. Spleen/Lung pulses very deficient. I reasoned dizziness/saliva belongs to Spleen Qi failing to ascend; frequent urination belongs to Lung Qi failing to descend/control internally. Internal abscess not yet formed. Should give Jia Wei Li Zhong Tang (Modified Center-Regulating Decoction). Four doses reduced symptoms by half. Then Zhong Ru Fen Tang brought peace. (Based on pulse.)
He Jian said: Lung Wei belongs to Heat. Long-term cough Lung Wei, hoarse voice, hemoptysis, belongs to Yin deficiency with severe Heat. This treatise treats Lung Wei: expectorating froth without cough, no thirst, enuresis, frequent urination, due to Upper Deficiency failing to control Lower. This is Cold in Lung, causing dizziness, profuse phlegm/saliva. Use Zhi Gan Cao, Gan Jiang; this belongs to Cold. Lung Wei with profuse saliva/froth and damp fluid in heart: use Zhi Gan Cao Tang; this tonifies deficiency/labor. Different from Yin-tonifying with Great Heat. All should be treated separately; thus Lung Wei has Cold/Heat differences.
Case 20: Person due to labor, continuous cough, stiff/painful neck, slightly tight-rapid pulse. This is Lung Abscess, not yet formed. Wanted to use Interior-supporting/Qi-tonifying drugs. Patient disbelieved, took dispersing drugs instead, causing further Qi/Blood deficiency, continuous pus expectoration, ultimately fatal.
Classics say: Lung governs Qi internally, Skin/Hair externally. Lung Qi deficiency makes Cou Li loose, skin dull. Lung injury causes skin disorder. So Carbuncle, Lung Wei, Intestinal Abscess cause such skin changes because Qi cannot nourish. Some take exterior drugs, pathogen not resolved, still use exterior release. Not knowing that unresolved pathogen is not because it cannot be released, but often because loose Cou Li allows re-entry. Solely using exterior release makes Cou Li more deficient, pathogen enters easier, becoming disastrous syndrome. If diagnosing pulse, pathogen in Exterior should only be Harmonized and Cou Li fortified. Those entering via deficiency should also be Harmonized and Cou Li fortified. Thus use Interior-supporting/Qi-tonifying drugs. Red/scanty urine indicates Lung Heat transmission; short/scarce urine indicates Lung Qi deficiency. Lung is Mother, Kidney is Child; Mother deficiency fails to generate Child. Frequent urination is also Lung deficiency failing to constrain.
Case 21: Person over forty, wheezing/cough, flank pain, chest fullness, rapid breathing, large Right Cun pulse. Wind-Heat accumulating in Lung, not yet forming sore, Excess type. Wanted to use Xie Bai San (Drain White Powder). Patient claimed inherent weak Lung Qi, self-administered tonics, wheezing/cough worsened. Two months later consulted again, sweating like rain, continuous wheezing. Lung Qi exhausted, what treatment? Indeed died. If Lung Qi were full, how would pathogen invade? Once pathogen enters, it should be dispersed. Thus use Xie Bai San to drain Lung pathogen. Once pathogen leaves, True Qi becomes full. Another case: Vomiting pus, red face, large pulse. I said Lung disease pulse should be choppy, face white. Now red face/large pulse, Fire overcoming Metal, incurable. Indeed died.