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According to the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): A question was asked: "In a patient with cough and rebellious qi, how can one know it is Lung Abscess (Fei Yong) upon palpating the pulse? There should be pus and blood expectorated; if mistaken treatment induces vomiting, death ensues. What does the pulse resemble?" The Master said: "The Cun Kou (inch position at the radial artery) pulse is faint (Wei) and rapid (Shu). Faint indicates Wind, rapid indicates Heat. Faint implies sweating, rapid implies aversion to cold. Wind invades the Wei (Defensive) level, exhalation cannot expel it; Heat overflows into the Ying (Nutritive) level, inhalation cannot retain it. Wind damages the skin and hair pores, Heat damages the blood vessels. Wind lodges in the Lung, causing cough, dry mouth, wheezing and chest fullness, dry throat without thirst, profuse expectoration of turbid froth, and frequent chills. Where Heat passes, blood coagulates and stagnates, accumulating to form an abscess. The expectorant resembles congee made of rice. If treated at the initial stage, it can be saved; once pus is formed, it is fatal."

Regarding the pulse of Lung Abscess, although it is described as slippery and rapid elsewhere, here it is described as faint and rapid. This is not because the pulse itself differs. Slippery and rapid indicate an established abscess, while faint and rapid indicate the etiology at the onset. At the onset, observing the faint pulse in the three positions on both sides indicates that the Wei level is invaded by Wind with spontaneous sweating; the rapid pulse indicates that the Ying level absorbs Heat with aversion to cold. However, when Wind enters the Wei level, it tends to exit with exhalation and cannot penetrate deeply, damaging only the skin and hair pores initially, gradually moving to the Lung Shu points, causing cough, expectoration of turbid fluid, and chills. At this stage, pathogens entering from the exterior can be easily expelled outward. But if Heat overflows into the Ying level, it penetrates deeply with inhalation and cannot exit, thereby damaging the blood vessels. When the Wei level is invaded by Wind and lingers due to Heat in the Ying level, it solidifies between the lung lobes, causing blood stagnation and gradually forming an abscess. Therefore, for such tangible turbid pathogens, one must employ methods to drain the Lung to drive them downward. How could one fail to treat it at the onset and allow the abscess to mature, leading to the rotting of lung tissue?

For cough with rebellious ascending Qi, frequent expectoration of turbid fluid, inability to lie down or sleep, the **Zao Jiao Wan** (Soapberry Pill) is the primary formula.

When toxic Fire-Heat accumulates in the Lung, neither releasing the exterior nor purging the interior, nor clearing Heat nor warming, yields any effect; the condition becomes hard and unassailable. Only Zao Jiao (Gleditsiae Fructus Spina) can penetrate hardness, achieving the effect of thorough cleansing. One should not disregard it because it is a cheap herb. If caused by external contraction, the **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** (Cinnamon Twig Decoction minus Peony plus Soapberry) from *Qian Jin Fang* is best, sufficient to supplement Zhang Zhongjing's earlier omissions.

For cough with chest fullness, chills, rapid pulse, dry throat without thirst, frequent expectoration of foul-smelling turbid saliva, and long-term expectoration of pus resembling congee, this is Lung Abscess. The **Jie Geng Tang** (Platycodon Decoction) is the primary formula.

This is an upward-lifting method. Since the abscess is lodged in the Lung, the sputum is foul. Taking advantage of its new formation and instability, one lifts and expels it. If the pathogen has already entered the interior, one should guide it from the Stomach to the Intestines; this lifting method would then be ineffective. Hence, Song dynasty physicians added the **Shi Liu Wei Jie Geng Tang** (Sixteen-Ingredient Platycodon Decoction), combining the intent of Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung), treating combined external and internal pathogens.

For Lung Abscess with wheezing and inability to lie down, the **Ting Li Da Zao Xie Fei Tang** (Descurainia Seed and Jujube Decoction to Drain the Lung) is the primary formula.

This is a critical formula for treating Lung Abscess. If an abscess forms in the Lung and one does not drain the Lung, what else should one wait for? However, if the disease is prolonged and pus is already formed, draining is useless; if Lung Qi is exhausted after a long time, draining causes further injury. Only when blood is knotted but pus has not yet formed should one urgently use the method of draining the Lung to attack it. If there is generalized edema of the face and body, nasal congestion with clear discharge, indicating the exterior syndrome is not resolved, one should first administer one dose of **Xiao Qing Long Tang** (Minor Green Dragon Decoction), followed by this formula.

Shiwan (Zhang Lu's pseudonym) stated: Lung Abscess is a critical condition. Attacking it vigorously at the onset may save the patient. *Jin Gui Yao Lue* specifically establishes two formulas, each with its own indication. For patients who habitually drink alcohol and eat rich foods, with phlegm-dampness gradually soaking the Lung, **Zao Jiao Wan** is suitable. For those who are obese, asthmatic, full-chested, and have much phlegm, **Ting Li Da Zao Xie Fei Tang** is suitable. *Qian Jin Fang* supplements these by establishing **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** for febrile conditions caused by wind-cold pathogens, and **Wei Jing Tang** (Reed Shoot Decoction) for diseases caused by heart-spleen overwork, failure of Lung Qi transformation, and dysfunction of water passages, which acts fastest. The Song dynasty also introduced **Shi Liu Wei Jie Geng Tang**; although not perfect, it can be used as a reference. If one fears harsh drugs and sticks to mild 'Kingly Way' formulas, one is essentially nurturing the abscess until death. Discerning practitioners should diagnose and treat early.

Symptoms indicating Lung Abscess include: cough with expectoration of foul, thick sputum; dull pain in the chest; loss of smell; stiff neck unable to turn; urinary incontinence during coughing; spontaneous sweating, wheezing, and urgency; difficult breathing; reduced appetite; rapid, full, and hollow (Kou) pulse; aversion to wind and piloerection. These arise from contracting wind-cold that was not dispersed, remaining in the Lung, accumulating into Heat, or mixing with damp-heat, phlegm, and turbidity steaming the Lung orifices. One must strictly avoid warm-tonifying Lung herbs and especially avoid sweating methods that damage Lung Qi, as this often leads to untreatable conditions. The **Zao Jiao Wan**, **Ting Li Da Zao Xie Fei Tang** from *Jin Gui*, **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** and **Wei Jing Tang** from *Qian Jin Fang*, and the Song dynasty's **Shi Liu Wei Jie Geng Tang** are all specific medicines for Lung Abscess. At the onset, use **Wei Jing Tang**; this formula greatly disperses Lung Qi, allowing dampness and stasis to exit via the bladder. Improvement occurs within 1-2 doses. For floating pulse and exterior heat, add Cong Bai (Scallion White) and Xiang Chi (Fermented Soybean); for strong pulse at the Qi Kou, add Xi Jiao (Rhinoceros Horn - *note: substitute with Buffalo Horn in modern practice*) and Zhu Ru (Bamboo Shavings); for much phlegm, add Bei Mu (Fritillaria Bulb), Gua Lou Ren (Trichosanthes Seed), and Ge Fen (Armeniac Plaster); for radiating pain, add Zi Wan (Aster Root) and Bai Mi (White Honey); for initial cough with difficulty, use Er Wei Jie Geng Tang plus Bei Mu and Zi Wan; for excessive sweating, add Fang Ji (Stephania Root) and Huang Qi (Astragalus Root); for persistent expectoration of pus and blood after ulceration, modify **Ting Li Yi Yi Xie Fei Tang** according to symptoms. For cough with slight fever, irritability, and chest blockage resembling skin scales (Jia Cuo), *Qian Jin Fang* uses He Huan Pi (Albizia Bark), decocting a palm-sized piece daily. For those prone to mental labor and depression-fire, expectorating foul sputum with fresh blood belongs to Yin Fire; treat with raw Liu Wei Di Huang Wan plus Mai Dong (Ophiopogon Tuber) and Zi Wan. If mistakenly administered Ren Shen (Ginseng) or Huang Qi (Astragalus) tonifying Qi and Fire, worsening the foul sputum, urgently add Tong Bian (Child's Urine) to the above method; self-clearing will occur. For uncertain early cases, drink juice pressed from raw soybeans; if no fishy odor is detected, it confirms the diagnosis. Generally, clear voice, thin and lustrous pus sputum, occasional fresh blood, normal appetite, no chest/flank pain (or slight pain on right side lung lobe during cough), ability to sit/lie comfortably, normal complexion, and regular urination/stool indicate a treatable case. If after ulceration, high fever persists, frequent chills occur, dull pain is in the left short lung lobe, indicating weak Metal Qi, recovery is difficult. Combined with wheezing, sweating, red face, restlessness, anorexia, and incessant foul pus sputum, it is difficult to treat. If wheezing sounds continue, lips retract, expectoration of pus and blood resembles brine with abnormal stench, vital Qi is severely depleted, insensitivity to pain, inability to lie down, difficulty eating, purple curved nails, palms like dry bark, flushed cheeks, hoarse voice, and flaring nostrils indicate an untreatable case. In early Lung Abscess, the pulse should not be rapid and large; after ulceration, a short and choppy pulse is taboo. Slow, slippery pulse with white face indicates survival; wiry, urgent pulse with red face indicates death. If Lung Abscess ruptures and re-contracts Wind, it is untreatable; even frequent consumption of strong Cong Bai and Xiang Chi decoction rarely saves.

Prescriptions for Lung Abscess: For initial foul sputum, drink aged mustard juice, warmed and induced to vomit, which is best. Another prescription: decoct Lotus Leaf strongly, add a little White Honey, take frequently; effective whether ulcerated or not. Another prescription: Remove heart from Pig Lung, scrape off dirt with a bamboo knife, cook with 2 liang of Eucommia Bark (Jie Gu Mu) in a clay pot, eat blandly daily without interruption; effective in 5-7 days. For post-ulceration pus drainage, use Jin Li Tang: remove guts from small live carp, add 3 qian of Bei Mu powder, steam-cook in Child's Urine, consume juice and fish daily; highly effective. However, nothing beats decocting juice from Yi Yi Gen (Coix Root Rhizome), taken hot; it acts fastest, resolving odor immediately upon swallowing, killing parasites if present. Yi Yi Ren (Coix Seed) is specific for Lung Abscess but is drying and stagnant, potentially causing upper jiao obstruction; the root juice acts faster to purge downward. Effective for both pre- and post-ulceration stages, superior to other formulas. After Lung Abscess ulceration, if pus sputum thins and breath decreases, but suddenly foul sputum worsens, this is residual toxin and internal Qi flare-up, a inevitable process, not due to improper diet/care. If episodes lessen over time, recovery is possible. If episodes worsen with increasing turbidity and rapid pulse, death is inevitable.