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I used Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dan Nan Xing (Arisaema cum Bile), Zhi Shi (Immature Bitter Orange), Xiang Fu (Cyperus Rhizome), and Chen Xiang (Aquilaria Wood). After two doses, the patient vomited vigorously, expelling one or two sheng (approx. 500-1000ml) of thick, sticky phlegm and residue. Because the vomiting was too severe, I crossed the lake in haste during the Jia hour (night watch) to visit again. At dawn, upon arrival, the vomiting had stopped, the cough had calmed, and the pulse was regular. No further medication was needed.

The daughter-in-law of Jiang You (Jiangxi) Education Commissioner He Hanzhai, who was the daughter of Hanlin Fan Qiutao, had suffered from persistent cough for a long time, occasionally with blood spots in the sputum. She had taken Tong Zhen Wan (Child's True Pill) continuously but without complete cure. After Fan Qiutao passed away, her grief was intense, causing her cough and rebellious qi to worsen significantly, with fresh blood appearing mixed in the sputum. Therefore, Rui Jin Dan (Rui Gold Pill) was administered four times, while Tong Zhen Wan and Wu Gu Ji Wan (Black Bone Hen Pill) were continued for regulation and tonification, leading to stabilization.

Another case involved the mother of Tong Zheng Lao Shushen, over fifty years old. She naturally had a constitution of qi deficiency with excessive phlegm. Recently, she contracted wind-heat causing cough and rebellious qi; severe coughing produced a choking sound resembling retching. She also had a history of metrorrhagia and leukorrhea, which had recently stabilized. The treatment principle should first address the cough. Thus, Jie Geng Tang (Platycodon Decoction) was used with Wei Rui (Polygonatum Rhizome), Bai Wei (Cynanchum Atratum Root), Dan Pi (Moutan Cortex), Ju Pi (Tangerine Peel), and Honey-fried Ginger, administered for four doses to resolve the exterior/superficial symptoms. Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) with Wei Rui (Polygonatum Rhizome) was given to soothe the stomach qi. Finally, Wu Gu Ji Wan (Black Bone Hen Pill) was advanced to treat the chronic condition. However, the lady had abstained from meat for a long time and could not bear to harm living creatures, so she switched to Da Wen Jing Tang (Major Warming the Menses Decoction) added with Mi Rong (Elk Antler), made into pills. Although the herbs differed, the therapeutic effect was the same.

The *Jin Gui Yao Lue* states: "Question: When heat is in the Upper Jiao, it leads to cough and becomes Fei Wei (Lung Flaccidity). How is this disease acquired? Master said: It may result from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting syndrome) with frequent urination, or constipation treated with harsh purgatives, all leading to repeated loss of body fluids." Question: "When the Cun Kou (radial artery at the wrist) pulse is rapid, the person coughs, and there is instead turbid saliva and froth in the mouth, what is this?" Master said: "This is Fei Wei (Lung Flaccidity). If the mouth is parched and dry, and coughing causes hidden pain in the chest, and the pulse is slippery and rapid, this is Fei Yong (Lung Abscess), characterized by coughing up pus and blood. A rapid and deficient pulse indicates Fei Wei (Lung Flaccidity); a rapid and excess pulse indicates Fei Yong (Lung Abscess)."

The Cun Kou on both hands originally corresponds to the Hand Taiyin Lung meridian. The mentions of rapid, slippery-rapid, rapid-deficient, and rapid-excess pulses here refer collectively to the three positions on both left and right wrists. When a person coughs and has turbid saliva and froth in the mouth, spilling everywhere shortly after, this is Fei Wei (Lung Flaccidity), indicating that the mouth is not dry. If coughing is accompanied by a parched, dry mouth, it means the lung has formed an abscess; toxic fire manifests in the mouth. The vibration of the cough triggers the abscess, causing hidden pain in the chest. The pulse must be slippery, rapid, and forceful, a sign of flourishing pathogenic qi. Using rapid-deficient and rapid-excess pulses to distinguish between Fei Wei (Lung Flaccidity) and Fei Yong (Lung Abscess) implies that Fei Wei (Lung Flaccidity) requires tonification, while Fei Yong (Lung Abscess) requires purging, a meaning implicit in the text.

In Fei Wei (Lung Flaccidity), if there is salivation and froth without coughing, the person is not thirsty and will inevitably have urinary incontinence and frequent urination. This is because the upper jiao is cold and cannot control the lower jiao. This belongs to Cold in the Lung, likely accompanied by dizziness and excessive saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) should be used to warm it. If thirst occurs after taking the decoction, it belongs to Xiao Ke (Wasting and Thirsting syndrome).

If the lung is hot, the qi of the Bladder is also hot, resulting in dark, scanty, and difficult urination. However, if there is only salivation and froth without coughing, no thirst, but rather urinary incontinence and frequent urination, it is clearly not Fei Wei (Lung Flaccidity) due to heat in the upper jiao, nor due to severe fluid loss. It must be upper jiao deficiency-cold, unable to control the lower jiao, leading to unregulated urination. This is Cold in the Lung, where yin qi rebels upward and harasses yang qi, causing dizziness. Yin-cold stagnating fluids causes excessive saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) with sweet and pungent properties should be used to warm the Spleen and Lung. If initially not thirsty but becoming thirsty after taking warming medicines, it is clearly Xiao Ke (Wasting and Thirsting syndrome) with drinking one part and urinating two parts. Xiao Ke (Wasting and Thirsting syndrome) is similar to carbuncles and sores, requiring careful consideration.

Yu Jiayan stated: Fei Wei (Lung Flaccidity) accumulates gradually over time. Its heat arises from various sources, primarily because stomach fluids fail to transport to the lung, causing the lung to lose nourishment, become dry, and eventually form. Lung fire intensifies daily, lung heat deepens, and small tubes in the lung become obstructed. Cough sounds gradually weaken, chest membranes dry out, making expectoration difficult. Walking a few steps causes wheezing and gasping. Sputum is hard to expel. The treatment methods in *Jin Gui* are clear but often mixed with Fei Yong (Lung Abscess), making the essence hard to grasp. The general principle is to proceed slowly: generate stomach fluids, moisten lung dryness, descend rebellious qi, open accumulated phlegm, stop turbid saliva, tonify true qi, unblock small lung tubes, dissipate heat/fire, and restore lung clarity and descending function. Just as hemiplegic flaccidity or limb weakness can recover with proper treatment, although lung disease is near the chest and vital for respiration, effort must be exerted. However, Fei Yong (Lung Abscess) involves tangible blood; blood stasis should be attacked rapidly. Fei Wei (Lung Flaccidity) involves intangible qi; qi injury should be managed slowly, combined with moistening lung dryness. Although the lung is dry, patients are rarely thirsty; do not use drying-hot herbs just because they are not thirsty. This is the major principle of syndrome differentiation and medication.

For Fei Wei (Lung Flaccidity) with excessive saliva/froth and a sensation of warmth and fluidiness in the heart, Zhi Gan Cao Tang (Honey-fried Licorice Decoction) is the primary formula. This is the method from *Wai Tai Mi Yao*. For Fei Wei (Lung Flaccidity) with deficiency-cold, emaciation, weakness, trembling, and chest fullness during inhalation/exhalation, *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) recommends Sheng Jiang Wen Zhong Tang (Fresh Ginger Warming the Middle Decoction). For Fei Wei (Lung Flaccidity) with coughing up sputum, incessant saliva/froth, dry throat, and thirst, *Qian Jin Fang* recommends Sheng Jiang Gan Cao Tang (Fresh Ginger and Licorice Decoction). For Fei Wei (Lung Flaccidity) with cough, phlegm, afternoon fever, and hoarseness, ancient methods use Ren Shen Yang Fei Tang (Ginseng Nourishing Lung Decoction). Now, Zi Wan San (Aster Powder) added with Dan Pi (Moutan Cortex), Ginger, and Jujube is used. If Heart Fire attacks the Lung, transmitting to Fei Wei (Lung Flaccidity), with cough, wheezing, vomiting, abundant phlegm-saliva, chest/epigastric stuffiness, and throat obstruction, ancient methods use Ren Shen Ping Fei Tang (Ginseng Calming Lung Decoction). Now, Zi Wan San (Aster Powder) added with Wei Rui (Polygonatum Rhizome), Ju Hong (Red Tangerine Peel), Ginger, and Jujube is used. For Fei Wei (Lung Flaccidity) with persistent cough, alternating chills and fever, spontaneous sweating, and vexatious thirst, ancient methods use Zhi Mu Fu Ling Tang (Anemarrhena and Poria Decoction). Now, Zi Wan San (Aster Powder) added with Zhi Mu (Anemarrhena Rhizome), Yin Zhou Chai Hu (Bupleurum from Yinzhou), Ginger, and Jujube is used. Generally, cough with hoarseness and throat obstruction are due to constrained fire and stagnant phlegm, requiring the pungency of Ginger to disperse it. However, it must be honey-processed to borrow sweetness for moistening. This embodies the principle of treating both root and branch. Liu Mosheng said: Flaccidity is fundamentally deficiency-dryness, never departing from strengthening water to clear metal, tonifying qi-blood and fluids, resolving phlegm, and stopping cough. Main herbs include Tian Dong (Asparagus Tuber), Mai Dong (Ophiopogon Tuber), Sheng Di Huang (Rehmannia Root), Shu Di Huang (Prepared Rehmannia Root), Zhi Mu (Anemarrhena Rhizome), Ren Shen (Ginseng Root), Wei Rui (Polygonatum Rhizome), and Zi Wan (Aster Root). For palpable knots, remove Tian Dong and Sheng Di Huang, add Ju Hong (Red Tangerine Peel) and Su Zi (Perilla Seed). For diarrhea, remove Tian Dong, Sheng Di Huang, and Zhi Mu, add Shan Yao (Dioscorea Rhizome) and Fu Ling (Poria). Use Gu Ben Wan (Root-Fixing Pill), taken intermittently by holding in the mouth. For Fei Wei (Lung Flaccidity) with cough, red threads in sputum, night sweats, fever followed by cold, and reduced appetite, Jie Lao San (Depletion-Expelling Powder) is indicated. For consumptive Fei Wei (Lung Flaccidity) with loss of voice, coughing up fishy-smelling thin sputum with blood, or facial sores, Ren Shen Ge Jie San (Ginseng and Gecko Powder) is indicated. A folk prescription for Fei Wei (Lung Flaccidity) uses one qian of fine Ginseng powder inserted into a pig lung, boiled until soft in a clay pot, then taken with scallion and wine. Fei Wei (Lung Flaccidity) with coughing sputum and dry throat desiring water will heal spontaneously.

Opening the mouth with shortness of breath is critical. Coughing with natural saliva in the mouth and a white, slippery tongue coating indicates Lung Cold; Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) is used. Fei Wei (Lung Flaccidity) belonging to heat, such as long-term cough leading to lung withering, hoarse voice, and hemoptysis, belongs to yin deficiency and is mostly incurable. Fei Wei (Lung Flaccidity) with six pulses being deep, choppy, and urgent, or fine and rapid without spirit, with dry skin at the radial artery and high breathing with coarse breath, is fatal.

The *Jin Gui Yao Lue* states: "Upper qi rushing upward with restlessness belongs to Fei Zhang (Lung Distension), intending to become Feng Shui (Wind Edema). Sweating will lead to recovery."

Sweating for Fei Zhang (Lung Distension) follows the *Nei Jing* method of 'opening the ghost gate' (sweating). One sweat allows wind-pathogen to escape to the muscle surface; water follows the wind smoothly and exits downward.

Cough with upper qi rushing upward is Fei Zhang (Lung Distension). The person wheezes, eyes bulge as if protruding, and the pulse is floating and large; Yue Bi Jia Ban Xia Tang (Yuebi Decoction plus Pinellia) is the primary formula. Fei Zhang (Lung Distension) with cough and upper qi rushing upward, irritability, wheezing, and a floating pulse indicates water-qig under the heart; Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum) is the primary formula.

These two formulas treat Fei Zhang (Lung Distension) separately, both based on the principle that floating pulses require resolution via sweating. Yue Bi Tang contains Shi Gao (Gypsum) but no Ban Xia (Pinellia); Xiao Qing Long Tang contains Ban Xia (Pinellia) but no Shi Gao (Gypsum). Observing the intent of these additions, the key lies in the synergy of Ban Xia (Pinellia) and Shi Gao (Gypsum). Shi Gao (Gypsum) clears heat and, borrowing pungent-warmth, can resolve phlegm; Ban Xia (Pinellia) resolves phlegm and, borrowing pungent-coolness, can clear heat. In Mai Men Dong Tang (Ophiopogon Decoction), descending qi and stopping rebellion relies entirely on Ban Xia (Pinellia) entering fluid-generating herbs. These two formulas similarly rely on Ban Xia (Pinellia) entering heat-clearing herbs. Zhang Zhongjing's modifications of established formulas are nothing but creative adaptation; later scholars should aspire to this.

Upper qi rushing upward with facial edema, shoulder breathing, and a floating-large pulse is untreatable. If diarrhea is added, it is even worse.

In the presentation of upper qi rushing upward, reaching facial edema and shoulder breathing indicates lung qi congestion forcing upward without descending. Coupled with a floating-large pulse, the qi is exiting outward, with no way to return inward and descend. Hence, it is deemed untreatable. Adding diarrhea means struggle between upper and lower, which is unbearable.

Fei Zhang (Lung Distension) with cough, unable to lie on either side, is caused by phlegm binding with blood stasis obstructing qi, leading to distension. Use Dang Gui (Angelica Sinensis), Dan Pi (Moutan Cortex), Chi Shao (Red Peony Root), Tao Ren (Peach Kernel), Zhi Qiao (Bitter Orange), Jie Geng (Platycodon Root), Ban Xia (Pinellia), Gan Cao (Licorice), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice), suitable after exterior pathogens are removed. Alternatively, Ban Xia (Pinellia), Hai Shi (Calcitum), Xiang Fu (Cyperus Rhizome), Gua Lou (Trichosanthes Fruit), and Gan Cao (Licorice) powdered, mixed with ginger juice and honey, held in the mouth.

Yu Jiayan treated Shi Meicang with Fei Wei (Lung Flaccidity), wheezing, coughing, clearing phlegm, limb flaccidity, inability to move, and a deficient-rapid pulse. He used twenty Ge Jie (Geckos), soaked in wine and fried with butter, along with ten liang each of Ren Shen (Ginseng Root) and Hei Shen (possibly referring to a specific preparation or herb, contextually linked to tonification), made into pills with honey, held in the mouth intermittently. Recovery occurred before finishing one dose.

Shi Wan treated Lu Qufei with Fei Wei (Lung Flaccidity), raspy voice, phlegm expectoration, afternoon fever, spontaneous sweating, fine-rapid left pulse, and deficient-soft right pulse, caused by mental labor and sexual indulgence. First, Sheng Mai San (Generate Pulse Powder) combined with Bao Yuan Tang (Protect Origin Decoction) was given. Next, Yi Gong San (Benefit the Worker Powder) added with Huang Qi (Astragalus Root), plus Ginger and Jujube, was administered alongside Du Qi Wan (Eight Ingredients Pill) morning and evening. After half a month of regulation, fever ceased and phlegm stopped. After more than a month, the voice cleared.

He also treated Sun Qibai with Fei Zhang (Lung Distension). Excessive consumption of qi-depleting drugs resulted in a floating-large pulse that vanished upon heavy pressure, inability to eat, though urine was clear and stool firm. Ju Fang Qi Qi Tang (Seven Qi Decoction from the Bureau Formulary) was used, with three qian of Ren Shen (Ginseng Root), one qian each of Rou Gui (Cinnamon Bark), Ban Xia Qu (Pinellia Fermented), and Zhi Gan Cao (Honey-fried Licorice), plus four slices of Ginger per dose. Four doses led to sudden recovery. Generally, Fei Zhang (Lung Distension) cases are mostly excess; this deficient-large pulse should not be treated ordinarily.

He also treated a nun with Fei Zhang (Lung Distension), wheezing, shoulder breathing. Medications for descending qi and stopping cough failed, leading to chest and abdominal distension. The pulse at the Qi Kou (radial artery) was string-taut, fine, and choppy. This was likely due to strenuous labor ascending, mistakenly drinking cold water injuring the lung, causing lung qi to fail to converge. Thus, Yue Bi Tang (Yuebi Decoction) with reduced Ma Huang (Ephedra Stem), added with Xi Xin (Asarum Root) and Ting Li (Descurainia Seed), was used to strongly drain lung qi, resulting in peace.

He also treated a wine drinker who slept drunk in deep winter and drank cold tea when thirsty, developing Fei Zhang (Lung Distension), wheezing, and cough. The pulse at the Qi Kou was deep, tight, and striking. Xiao Qing Long Tang (Minor Green Dragon Decoction) without Shao Yao (Peony Root), added with Ting Li (Descurainia Seed) and Ban Xia (Pinellia), cured him in one dose. Thus, it is known that for Fei Zhang (Lung Distension) with wheezing and fullness, Ting Li (Descurainia Seed) should serve as the guide.