脉因证治总说 问曰∶振寒发热，寸口脉滑而数，其人饮食起居如故，此为痈肿病。医反不知，而以伤
寒治之，应不愈也。何以知有脓？脓之所在，何以别知其处？师曰∶假令痛在胸中者，为肺痈，其人脉数，咳唾有
脓血。设脓未成，其脉自紧数；紧去但数。脓为已成也。（《脉经》）
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，腠理则开而受风寒，其气虚者，寒
乘虚伤肺，寒搏于血，蕴结成痈。热又加之，积热不散，血败为脓。肺处胸间，初肺伤于寒则微嗽。肺痈之状，
其人咳，胸内满，隐隐痛而战寒，诊其肺部脉紧为肺痈。（《病源论》）（按∶原此下曰∶又肺病，身当有热，
咳嗽短气，唾出脓血。其脉当短涩而反浮大，其色当白而反赤者，此是火之克金，大逆不治也。此本出《脉经》
肺病证，似与经旨违，仍附注之。）
肺痈证始萌易治，脓成难治。诊其脉数而实，脓已成；微而涩，渐愈。面色白，呕脓而止者，自愈；有脓而
呕食，面色赤，吐脓如糯米粥者，不治。男子以气为主，得之十救二三；妇女以血为主，得之十全七八，历试屡
验。（《得效》）
肺痈者，出于上焦，客热停于肺腑，咳嗽胸膈内痛，致使肺烂成痈，唾脓如败糊臭秽，此为难治。脉关前
紧数，关
后微小，下虚上盛也。（《活法秘方》）
肺痈者，先因感受风寒，未经发越，停留肺中。初则其候毛耸恶风，咳嗽声重，胸膈隐痛，项强不能转侧
者，是其真候也。久则鼻流清涕，咳唾脓痰，黄色腥秽。甚则胸胁胀满，呼吸不利，饮食减少，脉洪自汗。法当
清金，甘桔汤主之（方未考），麦冬清肺饮调之（当是麦冬平肺饮，用参、麦、芍、槟、茯、陈、桔、甘）。
又久嗽劳伤，咳吐痰血，寒热往来，形体消削，咯吐瘀脓，声哑咽痛，其候传为肺痿，如此者百死一生之病也。
又劳力内伤，迎风响叫，外寒侵入，未经解散，致生肺痈者，初起脉浮微数，胸热气粗，寒热往来，咳嗽生痰
者，当以小青龙汤主之，麦冬清肺饮调之，通用金鲤汤、蜡矾丸、太乙膏（当是薛氏原方，用玄参、白芷、归、
桂、芍、地、大黄。）相间服之亦效。（《外科正宗》）
初起风寒相入，头眩恶寒，咳嗽声重者，宜解散风邪。汗出恶风，咳嗽气急，鼻塞项强，胸膈隐痛，实表清
肺。日间多寒，喜覆衣被，夜间发热，多烦去被，滋阴养肺。口干喘满，咽燥而渴，咳嗽身热，脉弦数者，降
火抑阴。胸满喘急，咳吐脓痰，身热气粗，不得安卧，平肺排脓。热退身凉，脉来短涩，精神减少，自汗盗汗，
补肺健脾。（同上）
肺痈危证，乘初起时，极力攻之，庶可救疗。凡咳嗽吐臭稠痰，胸中隐痛，鼻息不闻香臭，项强不能转侧，
咳则遗尿，自汗喘急，呼吸不利，饮食减少，脉数盛而芤，恶风毛耸，便是肺痈之候。盖由感受风寒，未经发
越，停留肺中，蕴发为热，或挟湿热痰涎垢腻，蒸淫肺窍，皆能致此。慎不可用温补保肺药，尤忌发汗伤其肺
气，往往不救。《金匮》皂荚丸、葶苈大枣泻肺汤、《千金》桂枝去芍药加皂荚汤、
苇茎汤、宋人十六味桔梗汤（系桔、甘、薏、贝、归、 、桑白、蒌仁、百合、枳壳、五味、地骨、知母、防己、葶、
杏）俱肺痈专药。初起用苇茎汤，此方大疏肺气，服之使湿瘀悉趋溺孔而去，一二服即应。初起咳逆不利，二
味桔梗汤加贝母、紫菀。溃后唾脓血不止，葶苈薏苡泻肺汤随证加减。平昔劳心思虑，多郁火人，唾臭痰鲜血，
此属阴火，但与生料六味丸加麦冬、紫菀之类。若误投参 补气补火，臭痰转甚者，急宜上法加童便，服之自清。
肺痈溃后，脓痰渐稀，气息渐减，忽然臭痰复甚，此余毒未尽，内气复发，必然之理，不可归咎于调理服食失宜
也。但虽屡发而势渐轻可，可许收功；若屡发而痰秽转甚，脉形转疾者，终成不起也。（《医通》）
轻者煎药可愈，重者脓血已聚，必得清火消毒、提脓保肺等药，方能挽回，否则不治，所以《金匮》云始
萌可救，脓成则死。（《轨范》）
肺痈属肺热极，忌敛涩、补气、升、燥热、酸、咸。宜清热、清痰、降火、解毒散结、甘寒、苦寒、辛寒。
（《本草经疏》）
病有由酒食 肺痈者，由食啖辛热炙 ，或酣饮热酒，燥热伤肺所致，治之宜早。（《纲目》引保）
酒毒留于肺者，缘肺为清虚之脏，酒多则损其清虚之体，由是稠痰浊火，蒸灼其间。轻则外为鼻 准赤，内
为咳嗽痰火；重则肺叶受伤，为胸痛胁胀，咳嗽脓血，痰出腥秽，肺痈溃烂。宜化痰清肺，庶可保全。（《汇
补》）
试法 肺痈脉数而虚，口燥咽干，胸胁隐痛，二便赤涩，咳唾脓血腥臭，置之水中则沉。（《入门》）
凡人觉胸中隐隐痛，咳嗽有臭痰，吐在水内，沉者是痈
脓，浮者是痰。（《续焰》）
肺痈吐脓腥臭，用黄豆令病患口嚼，不觉豆之气味，是肺痈也。（《寿世》）
初起疑似未真，生大豆绞浆饮之，不觉腥气，便为真候。（《医通》）
难易看法 如手掌皮粗，六脉洪数，气急颧红，污脓白血，呕哕HT 水，鼻煽，不餐饮食者，俱为不治。
此证以身凉脉细，脓血交流，痰色鲜明，饮食知味，脓血渐止者，俱为无妨，反此则死。（《正宗》）
初起，脉浮虚细，身体不热，咳嗽有痰，呼吸调匀者顺。已成，脉浮微数，咳吐脓痰，形色鲜明，语声清
朗者吉。溃后，咯吐脓痰，间吐鲜血，时发时止，饮食知味者顺。吐脓渐渐稀少，胸胁不疼，面色微微带黄，便
调，多稳。初起，脉洪弦数，身热多寒，胸疼气喘，面红多汗，损寿。已成，咯吐脓痰，气味HT 臭，黄痰如胶
粘固，唇反，终亡。咯吐再兼白血，气急多烦，指甲紫而带湾，终归冥路。手掌皮如枯树，面艳颧红，咽痛，音
如鸭声，鼻掀，终死。（《正宗》）
肺痈初起，脉不宜数大，溃后最忌短涩，脉缓滑面白者生，脉弦急面赤者死。（《医通》）
肺痈肺痿之别 详观肺痈、肺痿二证实难治。要之肺痈则间有可愈者，亦须肺未穿故可救。但肺痿罕
有安者，盖其肺枯竭干燥，何由而得润，所以难愈。（《活法秘方》）
肺痈作痛，肺痿不痛，痿甚而痈稍轻也。（《苍生司命》）
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。（《法律》）
初治方法 凡治肺痈病，以清肺热，救肺气，俾其肺叶不致焦腐，其生乃全。故清一分肺热，即存
一分肺气，而清热必须涤其壅塞，分杀其势于大肠，令浊秽脓血日渐下移为妙。若但清解其上，不引之下出，医
之罪也。甚有恶其下利奔迫而急止之，罪加等也。（《法律》）
治咳有微热烦满，胸皮甲错，是为肺痈，黄昏汤方。
黄昏手掌大一片，是合昏皮也， 咀，以水三升，煮取一升，分二服。（《千金》）
又方。
苇茎（切二升以水二斗煮取五升去滓） 薏苡仁（半升） 瓜瓣（半升） 桃仁（三十枚）
上四味 咀，内苇汁中，煮取二升，服一升，当有所见，吐脓血。（同上）《外台》引《古今录验》名苇茎
汤，用苇茎一升。曰∶仲景《伤寒论》云∶苇茎切二升。《千金》范汪同。《圣惠》治肺痈，咳，其声破嗄，
体有微热，烦满，胸前皮甲错，用青苇。
薛立斋治一膏粱之人，寒热作渴，不时咳吐，口内血腥，又五日吐脓血，皮毛错缝，用射干汤（方见胃脘
痈）。四剂脓血已止，但气壅痰多，以甘桔汤二、三剂而愈。（《类案》）
如圣丸，治风热毒瓦斯上攻，咽喉痛痹，肿塞妨闷，及肺痈喘咳唾脓血。
樟脑（另研） 牛黄（另研） 桔梗 甘草（生用各一钱）
上为细末，炼蜜丸，每两作二十丸，每用一丸含化。（《纲目》引梅）
中治诸方《范汪方》治肺痈方。用
薏苡一升 咀，淳苦酒三升，煮得一升，适寒温一服，有脓血当吐之。《葛氏方》同之。（《医心》）
《僧深方》治肺肠痈，经时不瘥，桔梗汤主之方。
桔梗（三两） 甘草 薏苡仁 败酱 干地黄 术（各二两） 当归（一两） 桑根皮（一升）
凡八物切，以水一斗五升，煮大豆四升，取七升汁，去豆，内清酒三升，合药煮取三升半，去滓，服七合，
日三夜再，禁生冷。（同上）
桔梗汤，治肺痈始萌。
桔梗 甘草 薏苡仁（各二两）
上为粗末，每服五钱，水二盏，煎至一盏，去滓服。（《家宝》）
治肺痈吐脓，五心烦热，壅闷咳嗽，四顺汤方。
贝母（去心） 桔梗（炒） 紫菀（去苗土各一两） 甘草（炙锉半两）
上四味粗捣筛，每服三钱匕，水一盏，煎五、七沸去滓，不拘时候稍冷服。如咳嗽甚，入去皮尖杏仁三枚同
煎。（《圣济》）《正宗》有杏仁，曰∶或为末，白汤调服二钱。
玄参清肺饮，治肺痈，咳吐脓痰，胸膈胀满，上气喘急，发热者。
玄参（八分） 银柴胡 陈皮 桔梗 茯苓 地骨皮 麦门冬（各一钱） 薏苡仁（二钱） 人参 甘草（各五分）
槟榔（三分）
水二钟，姜一片，煎八分，临服入童便一杯，食后服。（《正宗》）
肺痈神汤，凡患者右胁按之必痛，但服此汤，未成即
消，已成即溃，已溃即愈，此余新定，屡用屡验者也。
桔梗（一钱） 金银花（一钱） 甘草节（一钱二分） 黄 （一钱炒） 贝母（一钱二分） 陈皮（一钱二分）
白芨（一钱） 甜葶苈（八分微炒）
水二钟，姜一片，煎一钟，食后徐徐服。新起，加防风一钱，去 。溃后，加人参一钱。不久敛，加合欢皮
一钱。（《必读》）《医通》葶苈薏苡泻肺汤，治肺痈初溃吐脓血，于本方加薏苡。《心悟》加味桔梗汤，于本
方去黄 ，加薏苡。
世有膏粱子弟，多食浓味燔熬、烹炙煎炒之物，时时吞嚼，或美醪香醪，乘兴酣饮，遂至咽干舌燥，吐痰吐
血，喘急膈痛，不得安卧，是肺痈已成耳。治之法，化毒之中，益之养肺之法，庶几已成者可痊，未成者可散也。
方用枝桑清肺汤，桑叶五钱，紫菀二钱，犀角屑五分，生甘草二钱，款冬花一钱，百合三钱，杏仁七粒，阿胶三
钱，贝母三钱，金银花一两，熟地一两，人参三钱，水煎，将犀角磨末冲服，数剂可奏功也。（《辨证录》）
（按∶此本《济生》紫菀茸汤，今去蒲黄、半夏，加金银花、熟地者。紫菀茸汤见《咳嗽》中。）
一男子因劳伤咳嗽不止，至夜身热尤甚，日久咯吐脓血，诊之脉弦而数，此虚火假证也。先以童子小便，日
饮三、四次。又服紫菀茸汤（方与《济生》同）数剂，至夜身热不发。又间服金鲤汤，月余而渐瘳。此非童便之
力，而阴火岂能得退。尝治疮疡虚热不退者，此极效。（《正宗》）
金鲤汤，治肺痈已成未成，胸中隐痛，咯吐脓血者服之。
金色活鲤鱼（一尾约四两重） 贝母（一钱）
先将鲤鱼连鳞剖去肚肠，勿经水气，用贝母细末渗在鱼肚内，线扎之。用上白童子小便半大碗，将鱼浸童
便内，重汤
顿煮，鱼眼突出为度。少顷取起，去鳞骨，取净鱼肉，浸入童便内顿热，肉与童便作二、三次，一日食尽一枚，
其功效甚捷。（同上）《医通》溃后排脓用。曰∶然不若用薏苡根捣汁，顿热服之，其效最捷，下咽其臭即解，
有虫者虫即死出。薏苡为肺痈专药，然性燥气滞，服之未免上壅，不及根汁之立能下夺，已溃未溃皆可挽回，
诸方皆不及也。
焊肺丹，凡治肺痈，必以此药间而服之，以护膈膜，不致溃透心肺，最为切当。即蜡矾丸，用蜜水送下。
（《寿世》）（方见《肠痈》中）
末治诸方《百济新集方》治肺痈方。
黄 一两，以水三升，煮取一升，分二服，《葛氏方》同之。（《医心》）
排脓散，治肺痈得吐脓后，宜以此药排脓补肺。
绵黄 去芦二两生用。
上为细末，每服二钱，水一中盏，煎至六分，温服不拘时候。（《济生》）
排脓散，理肺痈吐脓后，宜服排脓补肺。
嫩黄 （二两） 川白芷 北五味子（炒） 人参（各一两）
上为末，炼蜜丸如小指大，偃仰入口含化，旋旋咽下，食后服，临卧服。（《得效》）《正宗》每服三钱，
食后蜜汤调服。
加味十奇散，治肺痈已散，不咳不疼，服此去旧生新，内能固消。（同上）（方见《肠痈》内补散下。）
八宝散，治肺痈，咳嗽日久，痰带腥臭，身热虚羸。
白茯苓 桔梗 贝母 人参 北五味 天门冬 胡黄连 熟地（各等分）
水煎，食后服。（《玉案》）
薛立斋治一老妇，素味浓，吐脓已愈，但小便淋沥，用补中益气，加麦冬、五味而愈。膏粱之人，初起清胃
散亦可用。（《类案》）
一妇人素血虚发热咳嗽，或用痰火之剂，后吐脓血而赤，脉数，其势甚危，此脓成而血气虚也。余用八珍汤
以补元气，用桔梗汤以治肺证，脉证全愈。（《外科发挥》）
[General Discussion on Pulse, Etiology, and Symptoms] Question: When there is chills and fever, the pulse at the cunkou (radial artery) is slippery and rapid, yet the patient's diet and daily activities remain normal, this indicates an abscess disease. If the physician fails to recognize this and instead treats it as a Cold Damage (Shanghan), it will likely not heal. How can one know that pus has formed? How can the location of the pus be identified? The Master said: Suppose the pain is in the chest; this is Lung Abscess (Fei Yong, a purulent disease of the lung). The patient's pulse is rapid, and they cough up sputum containing pus and blood. If the pus has not yet formed, the pulse is tight and rapid; if the tightness disappears and only rapidness remains, it indicates that the pus has already formed. (From *Mai Jing*)
Lung Abscess arises from Wind-Cold injuring the Lung, causing Qi stagnation and accumulation. The Lung governs Qi and corresponds to the skin and hair. Labor and overexertion damage Qi and Blood, causing the Couli (pores and interstices) to open, allowing Wind-Cold invasion. In those with deficient Qi, Cold exploits the deficiency to injure the Lung. Cold clashes with Blood, accumulating and forming an abscess. Heat adds to this; accumulated heat does not dissipate, causing Blood to rot and transform into pus. The Lung resides in the chest. Initially, when the Lung is injured by Cold, there is slight coughing. The manifestation of Lung Abscess includes cough, fullness in the chest, dull pain, and chills. Palpating the Lung pulse as Tight indicates Lung Abscess. (From *Bing Yuan Lun*) [Note: The original text below states: There is also Lung disease where the body should have fever, cough, shortness of breath, and expectoration of pus and blood. The pulse should be Short and Choppy but is instead Floating and Large; the complexion should be White but is instead Red. This represents Fire overcoming Metal, a major reversal indicating untreatability. This originally comes from the Lung Disease section of *Mai Jing*, which seems contrary to the main intent of the classic, so it is attached here as a note.]
Early-stage Lung Abscess is easy to treat; once pus has formed, it is difficult. If the pulse is Rapid and Excess, pus has formed; if it is Fine and Choppy, recovery is gradual. A white complexion with cessation of vomiting after expelling pus indicates spontaneous healing; presence of pus with vomiting of food, red complexion, and expectoration resembling rice gruel indicates untreatability. Men are governed by Qi; two or three out of ten may survive. Women are governed by Blood; seven or eight out of ten may survive. This has been tested repeatedly with consistent results. (From *De Xiao*)
Lung Abscess originates in the Upper Jiao, with pathogenic Heat lingering in the Lung organs, causing cough and pain within the chest and diaphragm, leading to putrefaction of the Lung tissue into an abscess. Expectoration of pus like foul, spoiled paste is difficult to treat. The pulse is Tight and Rapid at the Guan position anteriorly, but Fine and Small posteriorly, indicating Deficiency below and Excess above. (From *Huo Fa Mi Fang*)
Lung Abscess initially results from contracting Wind-Cold, which remains unresolved and lingers in the Lung. Early symptoms include piloerection, aversion to wind, heavy cough, dull chest/diaphragm pain, and neck stiffness preventing turning. These are the true symptoms. Later, clear nasal discharge occurs, followed by expectoration of yellow, foul-smelling purulent sputum. Severe cases present with chest/hypochondriac distension, dyspnea, reduced appetite,洪 (Surging) pulse, and spontaneous sweating. Treatment should clear Metal (Lung Heat), primarily using Ganjie Tang (formula unverified), followed by Modulation with Maidong Qingfei Yin (likely Maidong Pingfei Yin, containing Renshen, Maidong, Shaoyao, Binglang, Fuling, Chenpi, Jiegeng, Gancao). Additionally, chronic cough due to labor injury, with hemoptysis, alternating chills and fever, emaciation, expectoration of stasis/pus, hoarseness, and sore throat, may transmit into Lung萎 (Fei Wei, Lung Withering). Such cases are nearly fatal. Also, internal injury from labor, wheezing upon exposure to wind, external Cold invasion unresolved, leading to Lung Abscess, presents early with Floating, slightly Rapid pulse, chest heat, coarse breathing, alternating chills/fever, and cough with phlegm. Treat primarily with Xiaoqinglong Tang, modulate with Maidong Qingfei Yin, and alternatively use Jinli Tang, Lafan Wan, Taiyi Gao (likely Xue’s original formula: Xuanshen, Baizhi, Danggui, Guizhi, Shaoyao, Dihuang, Dahuang) alternately for efficacy. (From *Waike Zhengzong*)
In early stages with Wind-Cold invasion, dizziness, aversion to cold, and heavy cough require dispersing Wind pathogens. Sweating, aversion to wind, cough with urgency, nasal congestion, neck stiffness, and dull chest pain require consolidating the Exterior and clearing the Lung. Daytime chills preferring blankets, nighttime fever with irritability removing blankets require nourishing Yin and tonifying the Lung. Dry mouth, dyspnea, fullness, dry throat/thirst, cough with fever, and Wiry-Rapid pulse require descending Fire and suppressing Yin. Chest fullness, urgent breathing, expectoration of purulent sputum, fever, coarse breathing, and inability to lie flat require calming the Lung and draining pus. After fever subsides and body cools, with Short-Choppy pulse, reduced spirit, spontaneous/night sweats, tonify the Lung and strengthen the Spleen. (Ibid.)
For critical Lung Abscess, aggressive treatment during the initial stage offers the best chance of survival. Signs include coughing foul thick sputum, dull chest pain, loss of smell, neck stiffness, urinary incontinence upon coughing, spontaneous sweating, dyspnea, reduced appetite, Surging-Hollow pulse, aversion to wind, and piloerection. These indicate Lung Abscess caused by unresolved Wind-Cold lingering in the Lung, transforming into Heat, or mixed with Damp-Heat/phlegm turbidity steaming the Lung orifices. Strictly avoid Warm-Tonifying Lung herbs and especially avoid Diaphoresis which damages Lung Qi, often leading to death. Specialized drugs for Lung Abscess include Zaogao Wan, Tingli Dazao Xiefei Tang (*Jin Gui Yao Lue*), Guizhi Qu Shao Yao Jia Zaogao Tang, Weijing Tang, and Song Dynasty Sixteen-Ingredient Jiegeng Tang (Jiegeng, Gancao, Yiyiren, Beimu, Danggui, [missing], Sangbaipi, Gualouren, Baihe, Zhike, Wuweizi, Digupi, Zhimu, Fangji, Tinglizi, Xingren). Use Weijing Tang initially to vigorously diffuse Lung Qi, allowing damp-stasis to exit via urine; effective within 1-2 doses. For initial cough obstruction, use Erwei Jiegeng Tang plus Beimu and Ziwan. For post-ulceration continuous purulent/bloody expectoration, use Tingli Yiyi Xiefei Tang modified. For chronic mental strain with郁 Fire, expectorating foul bloody sputum (Yin Fire), use Shengli Liuwei Wan plus Maidong and Ziwan. If mistakenly given Renshen/Huangqi tonifying Qi/Fire worsening foul sputum, urgently add Tongbian (child's urine) to the above method. Post-ulceration, if thinning pus suddenly becomes foul again, it is residual toxin and internal Qi flare-up, not dietary mismanagement. Mild recurrences allow recovery; severe/recurrent cases with rapid pulse lead to death. (From *YiTong*)
Mild cases resolve with decoctions; severe cases with established pus/blood require Fire-clearing, detoxifying, pus-draining, and Lung-nourishing herbs to reverse the condition, otherwise untreatable. Thus *Jin Gui* states early stage is salvageable, post-pus formation is fatal. (From *Gui Fan*)
Lung Abscess involves extreme Lung Heat. Contraindicate Astringent, Tonifying-Qi, Ascending, Drying-Hot, Sour, and Salty agents. Indicate Heat-clearing, Phlegm-resolving, Fire-descending, Detoxifying/Dissipating, Sweet-Cold, Bitter-Cold, and Acrid-Cold agents. (From *Bencao Jingshu*)
Dietary Alcohol-induced Lung Abscess results from spicy/roasted foods or hot wine causing Dry-Heat injury to the Lung; treat early. (From *Gangmu* citing Bao)
Alcohol toxicity remaining in the Lung damages its Clear-Empty nature, generating thick turbid phlegm and Fire steaming the interior. Mild cases show red nasal tip and cough/phlegm-fire; severe cases damage Lung lobes, causing chest/hypochondriac pain, cough with pus/blood, foul sputum, and ulceration. Resolve Phlegm and clear the Lung to preserve life. (From *Huib*)
Diagnostic Test: Lung Abscess pulse is Rapid and Deficient, with dry mouth/throat, dull chest/hypochondriac pain, dark/scanty urination/stool, and expectoration of bloody/foul pus. Spitting into water: pus sinks. (From *Rumen*)
If chest dull pain and foul-sputum cough occur, spitting into water: sinking indicates abscess pus; floating indicates phlegm. (From *Xuyan*)
For foul-smelling pus expectoration, have the patient chew raw soybeans; if no bean flavor is perceived, it is Lung Abscess. (From *Shoushi*)
For uncertain early stages, drink raw soybean juice; absence of fishy odor confirms true presentation. (From *YiTong*)
Prognosis: Rough palm skin, Surging-Rapid six pulses, dyspnea, malar flush, foul pus/blood, vomiting clear water, nasal flaring, and anorexia indicate untreatability. Favorable signs: cool body, fine pulse, flowing pus/blood, bright sputum color, return of appetite, and decreasing pus/blood. Opposite signs indicate death. (From *Zhengzong*)
Early stage: Floating-Deficient-Fine pulse, no fever, cough with phlegm, regular breathing = Smooth. Established: Floating-Slightly Rapid pulse, expectoration of bright pus/sputum, clear voice = Auspicious. Post-ulceration: Intermittent fresh blood with pus, return of appetite = Smooth. Decreasing pus, no chest pain, slightly yellow complexion, regular stool = Stable. Unfavorable: Surging-Wiry-Rapid pulse, fever/chills, chest pain/asthma, red face/sweating = Shortened life. Established: Foul-smelling sticky yellow sputum, inverted lips = Fatal. Additional white blood/breathlessness/irritation, purple/curved nails = Death. Palm skin like dead tree, flushed cheeks, sore throat, quacking voice, nasal flaring = Death. (From *Zhengzong*)
Early stage pulse should not be Large-Rapid; post-ulceration, Short-Choppy is taboo. Slow-Smooth pulse with white face = Survival; Wiry-Urgent pulse with red face = Death. (From *YiTong*)
Distinction between Lung Abscess and Lung Withering: Both are hard to treat. Lung Abscess sometimes heals if the Lung is not perforated. Lung Withering rarely heals because the Lung is dried up and cannot be moistened. (From *Huo Fa Mi Fang*)
Lung Abscess causes pain; Lung Withering does not. Withering is generally milder than Abscess. (From *Cangsheng Siming*)
Lung Abscess involves有形 (Form/Blood); Blood stasis requires aggressive attack. Lung Withering involves无形 (Formless/Qi); Qi injury requires gentle management. Abscess is Excess; treating it as Withering (Tonifying) creates Double Excess. Withering is Deficiency; treating it as Abscess (Draining) creates Double Deficiency. This is the general principle of differentiation and medication. (From *Falv*)
Initial Treatment Method: Treating Lung Abscess requires clearing Lung Heat and saving Lung Qi to prevent Lung tissue necrosis. Clearing Heat preserves Qi. Heat clearing must eliminate obstruction and direct the pathogen downward through the Large Intestine to drain turbid pus/blood. Only clearing the upper without guiding downward is medical error. Stopping diarrhea aggressively is even worse. (From *Falv*)
For cough with mild fever, irritability, fullness, and rough chest skin (Jiacuo), this is Lung Abscess. Huanghun Tang Formula:
Huanghun (Albizia bark, large piece), chopped, boiled in 3 sheng water to 1 sheng, divided into two doses. (From *Qianjin*)
Another Formula:
Weijing (Cut 2 sheng, boil in 20 dou water to 5 sheng, strain) Yiyiren (Ban sheng) Guaban (Ban sheng) Taoren (30 seeds)
Chop four ingredients, add to Weijing decoction, boil to 2 sheng, take 1 sheng. Expectoration of pus/blood should occur. (Ibid. *Waitai* cites *Gujin Luyuan* as Weijing Tang, using 1 sheng Weijing. Says Zhang Zhongjing's *Shanghan Lun*: Weijing cut 2 sheng. *Qianjin* Fan Wang agrees. *Shenghui* treats Lung Abscess cough, hoarse voice, slight fever, irritability, chest Jiacuo using Green Reed.)
Xue Lizhai treated a rich person with chills/fever, thirst, intermittent coughing, bloody taste, then pus/blood after 5 days, rough skin. Used Shegan Tang (see Stomach Abscess). After 4 doses, bleeding stopped, but Qi stagnation/phlegm remained. Cured with Ganjie Tang for 2-3 doses. (From *Lei An*)
Rusheng Wan: Treats Wind-Heat-Toxin attacking throat, causing pain/swelling/blockage, and Lung Abscess asthma/cough with pus/blood.
Zhangnao (separately ground) Niuhuang (separately ground) Jiegeng Gancao (Raw, each 1 qian)
Grind to fine powder, honey pills, 20 pills per liang. Dissolve one pill in mouth. (From *Gangmu* citing Mei)
Middle Stage Formulas: *Fan Wang Fang* for Lung Abscess: Yiyiren 1 sheng, chopped, boiled in 3 sheng strong vinegar to 1 sheng. Take warm. Expel pus/blood. *Ge Shi Fang* same. (From *Yixin*)
*Seng Shen Fang* for Lung/Intestinal Abscess persisting: Jiegeng Tang.
Jiegeng (3 liang) Gancao Yiyiren Baijiang Shengdihuang Zhu (each 2 liang) Danggui (1 liang) Sanggenpi (1 sheng)
Chop 8 items, boil in 15 sheng water with 4 sheng soybeans to get 7 sheng juice. Remove beans, add 3 sheng clear wine, boil medicine to 3.5 sheng. Strain, take 7 ge, 3x day/2x night. Avoid cold/raw. (Ibid.)
Jiegeng Tang for early Lung Abscess:
Jiegeng Gancao Yiyiren (each 2 liang)
Coarse powder, 5 qian dose, 2 zhan water, boil to 1 zhan. Strain and take. (From *Jiabao*)
Sishun Tang for Lung Abscess pus, five-center heat, oppression/cough:
Beimu (core removed) Jiegeng (fried) Ziwan (roots/soil removed, each 1 liang) Gancao (honey-fried/crushed, ban liang)
Coarse sieve, 3 qian dose, 1 zhan water, boil 5-7 times. Strain, take lukewarm anytime. If severe cough, add 3 peeled/apricot kernels. (From *Shengji*) *Zhengzong* adds Xingren: or powder, mix with hot water, 2 qian.
Xuanshen Qingfei Yin for Lung Abscess, pus/sputum, chest fullness, asthma, fever:
Xuanshen (8 fen) Yinchaihu Chenpi Jiegeng Fuling Digupi Maidong (each 1 qian) Yiyiren (2 qian) Renshen Gancao (each 5 fen) Binglang (3 fen)
Boil 2 zhong water with 1 slice ginger to 8 fen. Add 1 cup Tongbian before taking. Take after meals. (From *Zhengzong*)
Shen Tang for Lung Abscess: Right hypochondriac tenderness. Prevents formation, promotes rupture of formed, heals ruptured. Newly formulated, verified.
Jiegeng (1 qian) Jinyinhua (1 qian) Gancao Jie (1.2 qian) Huangqi (1 qian fried) Beimu (1.2 qian) Chenpi (1.2 qian) Baiji (1 qian) Tiantili (8 fen lightly fried)
Boil 2 zhong water with 1 ginger slice to 1 zhong. Take slowly after meals. New onset: add Fangfeng 1 qian, remove Huangqi. Post-ulceration: add Renshen 1 qian. If slow closure: add Hehuanpi 1 qian. (From *Bidu*) *YiTong* Tingli Yiyi Xiefei Tang adds Yiyiren to this base. *Xinwu* Jiawei Jiegeng Tang removes Huangqi, adds Yiyiren.
Rich youths eating rich/fried foods and drinking heavily may develop dry throat, hemoptysis, dyspnea, chest pain, insomnia—established Lung Abscess. Treatment: Detoxify while nourishing Lung. May cure established, disperse early. Formula: Zhisang Qingfei Tang. Sangye 5 qian, Ziwan 2 qian, Xijiao 5 fen, Sheng Gancao 2 qian, Kuandonghua 1 qian, Baihe 3 qian, Xingren 7 grains, Ejiao 3 qian, Beimu 3 qian, Jinyinhua 1 liang, Shudi 1 liang, Renshen 3 qian. Decoct. Grind Xijiao powder, mix in. Several doses effective. (From *Bianzheng Lu*) [Note: Based on *Jisheng* Ziwan Rong Tang, removing Puhuang/Banxia, adding Jinyinhua/Shudi.]
A man with labor-induced chronic cough, worse night fever, long-term pus/blood expectoration, Wiry-Rapid pulse, indicated Deficient Fire false syndrome. First, Tongbian 3-4x daily. Then Ziwan Rong Tang several doses; night fever ceased. Intermittently Jinli Tang; recovered after a month. Not just Tongbian's power, but Yin Fire retreated. Effective for chronic ulcer deficiency heat. (From *Zhengzong*)
Jinli Tang for established/unformed Lung Abscess, chest pain, pus/blood expectoration:
Golden Live Carp (~4 liang) Beimu (1 qian)
Scale/gut carp, avoid water contact. Stuff Beimu powder inside, tie. Soak in half bowl Tongbian. Steam-boil until eyes protrude. Remove scales/bones, meat. Re-soak/warm in Tongbian. Eat meat and drink urine in 2-3 portions, one fish per day. Very effective. (Ibid.) *YiTong* uses for post-ulceration drainage: Better to use Yiyi root juice, hot. Most effective, odor resolves instantly, worms die/excrete. Yiyiren is specific for Lung Abscess but drying/stagnant; root juice drains immediately, effective for pre/post-ulceration, superior to other formulas.
Hanfei Dan: For Lung Abscess, alternate use to protect diaphragm, prevent perforation of Heart/Lung. Is Lafan Wan, taken with honey water. (From *Shoushi*) [See Intestinal Abscess]
Late Stage Formulas: *Baiji Xinji Fang*: Huangqi 1 liang, boil 3 sheng water to 1 sheng, 2 doses. *Ge Shi Fang* same. (From *Yixin*)
Pain Drain Powder (Painong San): Post-Lung Abscess pus expectoration, to drain pus and tonify Lung.
Huangqi (Remove roots, 2 liang raw)
Fine powder, 2 qian dose, 1 zhan water, boil to 6 fen. Warm take anytime. (From *Jisheng*)
Pain Drain Powder: Post-Lung Abscess pus, to drain and tonify.
Tender Huangqi (2 liang) Chuan Baizhi Beiweizi (Fried) Renshen (each 1 liang)
Powder, honey pills finger-sized. Dissolve in mouth, swallow slowly. After meals, before bed. (From *De Xiao*) *Zhengzong*: 3 qian, honey water after meal.
Jiawei Shiqi San: For resolved Lung Abscess, no cough/pain, removes old generates new, solidifies internally. (See Intestinal Abscess Neibu San)
Babao San: Chronic Lung Abscess cough, foul sputum, fever/emaciation.
Baifuling Jiegeng Beimu Renshen Beiweizi Tianmendong Huhuanglian Shudi (Equal parts)
Decoct, take after meals. (From *Yu An*)
Xue Lizhai treated elderly woman, rich diet history, cured pus vomiting, but dribbling urine. Used Buzhong Yiqi plus Maidong/Wuweizi. Cured. Rich patients early stage may use Qingwei San. (From *Lei An*)
Woman with chronic Blood Deficiency fever/cough, used Phlegm-Fire herbs, then bloody pus, Rapid pulse, critical. Pus formed, Qi/Blood deficient. Used Bazhen Tang to tonify Yuan Qi, Jiegeng Tang for Lung. Pulse/Symptoms fully resolved. (From *Waike Fahui*)