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Question: Heat in the Upper Jiao (Upper Burner) causes lung萎 (Lung Flaccidity) due to coughing. How is Lung Flaccidity contracted? The Master said: It may result from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting Syndrome) with frequent urination, or constipation treated repeatedly with drastic purgatives causing diarrhea, leading to severe depletion of Jin Ye (Body Fluids).

If the Cun Kou (Radial Pulse at the wrist) is faint and unobtainable, yet diaphoresis (sweating-inducing treatment) is wrongly applied, the Yang pulse becomes depleted early, while the Yin pulse remains non-choppy. The Qi of the San Jiao (Triple Burner) lingers and hesitates, entering but not exiting. With a non-choppy Yin pulse, the body feels cold externally, while internally there is vexation. There is excessive salivation, dry lips, and difficulty in urination; this is Lung Flaccidity. Due to injury to Body Fluids, the expectorated sputum resembles rotten melon or pig brain, solely caused by erroneous sweating therapy. In Lung Flaccidity, the patient desires to cough but cannot; when coughing occurs, only dry froth is expelled. Over time, urination becomes difficult, and in severe cases, the pulse is floating and weak. In Lung Flaccidity, if the patient spits saliva and froth without coughing, they are not thirsty, inevitably suffer from urinary incontinence and frequent urination. This is because the deficiency of the Upper Jiao fails to control the Lower Jiao; this is Cold in the Lung, inevitably accompanied by dizziness and excessive saliva/froth. Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be used to warm the Zang organs. The Master said: In Lung Flaccidity with coughing and spitting, if the throat is dry and the patient desires to drink water, the condition will heal spontaneously. If the patient breathes with an open mouth, it indicates shortness of breath. If the patient coughs but has natural saliva in the mouth and a slippery coating on the tongue, this is Floating Cold, not Lung Flaccidity.

Question: The Cun Kou pulse is rapid, the patient coughs, and there is instead turbid saliva and froth in the mouth. What is the cause? The Master said: This is Lung Flaccidity. If the mouth is extremely dry (Pi Pi Zao), and coughing causes dull pain in the chest, while the pulse is slippery and rapid, this is Fei Yong (Lung Abscess). Coughing up pus and blood with a rapid and deficient pulse indicates Lung Flaccidity; a rapid and excess pulse indicates Lung Abscess.

Question: Regarding cough and rebellious Qi, how can one know this is Lung Abscess through pulse diagnosis? One should expect pus and blood; if vomited, death ensues, which indeed happens later when pus is vomited. What does the pulse resemble? The Master said: The Cun Kou pulse is faint and rapid. Faint indicates Wind; rapid indicates Heat. Faint implies sweating; rapid implies aversion to cold. Wind injures the Wei (Defensive) level, so exhalation cannot penetrate inward; Heat overwhelms the Ying (Nutritive) level, so inhalation cannot exit outward. Wind damages skin and hair; Heat damages blood vessels. When Wind lodges in the Lung, the patient coughs, has a dry mouth, wheezing and chest fullness, dry throat without thirst, excessive secretion of turbid froth, and periodic chills. Where Heat passes, blood coagulates and stagnates, accumulating into an abscess and pus, which is vomited like congee. In the initial stage, it can be saved; once pus forms, it is fatal. Cough with chest fullness, chills, rapid pulse, dry throat without thirst, periodic expulsion of turbid foul-smelling sputum, and eventually vomiting pus resembling rice congee indicates Lung Abscess, treated with Jiegeng Tang (Platycodon Decoction). For Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear discharge, loss of smell and sensation to pungency, rebellious cough and Qi, wheezing and airway obstruction, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated.

The Cun Kou pulse is rapid; the Zu Yang (Dorsalis Pedis Pulse) is tight. Cold and Heat contend, causing chills and cough. If the Zu Yang pulse is floating and moderate, indicating normal Stomach Qi, this is Lung Abscess.

Question: Chills and fever with a slippery and rapid Cun Kou pulse, while diet and daily activities remain normal, indicate a carbuncle or swelling. If the physician is unaware and treats it as Tai Yang Shang Han (Cold Damage), it will not heal. How can one know pus exists? How can the location of the pus be identified? The Master said: If the pus is in the chest, it is Lung Abscess. The patient’s pulse is rapid, with coughing up pus and blood. If the pus has not yet formed, the pulse is naturally tight and rapid. When the tightness disappears leaving only rapidity, the pus has formed. For patients vomiting blood, wheezing, coughing, and rebellious Qi, with a rapid pulse, heat, and inability to lie down, the prognosis is fatal. For rebellious Qi with facial edema and shoulder-respiration (accessory muscle breathing), with a floating and large pulse, the condition is difficult to treat. Diarrhea exacerbates it. Rebellious Qi with dryness and wheezing belongs to Fei Zhang (Lung Distension), potentially developing into Feng Shui (Wind Water edema); diaphoresis will cure it. (Another version states: Cough with rebellious Qi and Lung Distension, with a deep pulse, indicates Water Qi in the Heart region. *Jin Gui Yao Lue*, *Qian Jin Fang*, and *Wai Tai Mi Yao* read "floating" instead of "deep".) For wine drinkers who cough, hemoptysis inevitably results, caused by excessive drinking. For chronic coughers, a string-like (Xian) pulse indicates Water Retention; Shizao Tang (Ten Date Pill) may be used to purge it. Cough with a floating pulse, where the patient does not cough or eat, resolves after forty days (another version says thirty days). Cough with intermittent fever and a suddenly string-like pulse is not deficiency; it is caused by Cold Excess in the Chest and requires emesis. For chronic coughers with a string-like pulse, if emetics are intended, one must assess the patient’s strength and ensure no heat signs before inducing vomiting. A deep pulse contraindicates diaphoresis. Chronic cough lasting years with a weak pulse is treatable; an excess, large, and rapid pulse is untreatable. A deficient pulse implies suffering from vertigo/dizziness due to pre-existing Zhi Yin (Piercing/Supporting Fluid Retention) in the chest; treatment falls under managing Fluid Retention.

Question: There are four types of Yin (Fluid Retention). What are they? The Master said: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Supporting/Piercing Fluid).

Question: How do the four types of Fluid Retention differ? The Master said: If a patient was formerly obese but is now thin, with water moving in the intestines making gurgling sounds, it is called Tan Yin. If fluid accumulates below the hypochondrium after drinking, causing pain upon coughing and spitting, it is called Xuan Yin. If fluid flows to the limbs, should sweat but does not, causing heavy and painful body, it is called Yi Yin. If there is rebellious cough and Qi leaning on support for breathing, shortness of breath preventing lying down, and swelling-like appearance, it is called Zhi Yin. For Liu Yin (Stagnant Fluid), pain in the hypochondrium radiates to the Que Pen (LI 15) acupoint, and cough worsens. (Another version says it stops immediately.) With Liu Yin in the chest, the patient has shortness of breath and thirst, pain in all four joints, and a deep pulse. With Liu Yin under the Heart, the back feels cold over an area the size of a hand. If the patient’s pulse is hidden (Fu), they desire spontaneous diarrhea; relief follows defecation, yet the epigastrium remains hard and full; this indicates Liu Yin attempting to exit, treated with Gansui Banxia Tang (Kansui and Pinellia Decoction). Tan Yin should be harmonized with warming herbs. Tan Yin under the Heart causing chest/hypochondriac fullness and dizziness is treated with Gancao Tang (Licorice Decoction - note: some texts say Sui). Yi Yin requires diaphoresis, treated with Xiao Qinglong Tang (Minor Blue Dragon Decoction). Zhi Yin causes wheezing and inability to lie down, plus shortness of breath, with a normal pulse. Zhi Yin in the Diaphragm causes wheezing, chest fullness, epigastric hardness, dark complexion, and a deep-tight pulse; if untreated for decades by vomiting/purging, Mufangji Tang (Stephania Decoction) is indicated. Zhi Yin under the Heart causing severe vertigo is treated with Zexie Tang (Alisma Decoction). Vomiting patients usually feel thirsty; thirst indicates resolution. Lack of thirst indicates Zhi Yin under the Heart, treated with Xiaobanxia Tang (Minor Pinellia Decoction). For chronic Zhi Yin patients with cough, vexation, and chest pain, if they do not die suddenly, after 100 days or a year, Shizao Tang may be used. Diseases above the Diaphragm involving fullness, wheezing, cough, and vomiting, with onset of chills/fever, back/waist pain, tearing eyes (or dizziness), and violent tremors, indicate Fu Yin (Hidden Fluid Retention). Excessive water intake causes sudden wheezing and chest fullness. Eating little and drinking much leads to water retention under the Heart; severe cases cause palpitations, mild cases shortness of breath. Bilateral string-like pulses indicate Cold, often following harsh purgation leading to deficiency. Unilateral string-like pulses indicate Fluid Retention. Lung Fluid Retention is not string-like but presents with wheezing and shortness of breath. Arm paralysis shifting between arms with a deep-thin pulse is not Wind stroke but Fluid Retention in the Upper Jiao. A deficient pulse indicates minor labor injury due to uneven Ying and Wei Qi, resolving spontaneously over time (or in winter). Abdominal fullness, bitter taste, and dry mouth indicate Water Qi in the intestines, treated with Fangji Jeemu Tingli Dahuang Wan (Stephania, Lepidium, Descurainia, and Rhubarb Pill). In thin persons, subumbilical palpitation, vomiting of saliva/froth, and vertigo/seizure-like symptoms indicate Water, treated with Wuling San (Five-Ingredient Powder with Poria). Thirst followed by vomiting indicates water retention under the Heart, belonging to Fluid Retention syndromes, treated with Banxia Jiashengfu Tang (Pinellia with Added Poria Decoction). Water in the Heart causes epigastric hardness, palpitations, shortness of breath, aversion to water, and lack of desire to drink. Water in the Lung causes vomiting of saliva/froth and desire to drink. Water in the Spleen causes Qi deficiency and heaviness of the body. Water in the Liver causes hypochondriac fullness and pain upon sneezing. Water in the Kidney causes epigastric palpitations.