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Question: When heat is located in the Upper Jiao (Upper Burner), it leads to Lung Asthma (Fei Wei) due to coughing. How does this disease of Lung Asthma arise? The Master replied: It may arise from excessive sweating, or from vomiting, or from Xiao Ke (Wasting and Thirsting Syndrome) causing frequent urination, or from constipation followed by the mistaken use of drastic purgatives leading to diarrhea, resulting in a severe loss of Body Fluids (Jin Ye). Therefore, one contracts this disease. Question: If the Cun Kou (Inch position at the radial artery) pulse is rapid, the patient coughs, and there is instead turbid saliva and froth in the mouth, what is the reason? The Master replied: This is the disease of Lung Asthma. If the mouth feels dry, and coughing causes a dull pain in the chest, while the pulse is instead slippery and rapid, this is Lung Abscess (Fei Yong), characterized by coughing up pus and blood.

[Commentary] Heat in the Upper Jiao does not cause Lung Asthma unless accompanied by coughing; because heat disease involves coughing, it leads to Lung Asthma. The causes of lung heat leading to atrophy are manifold: either from sweating, or from vomiting, or from Xiao Ke with frequent urination, or from constipation treated with drastic purgatives, causing a severe depletion of Body Fluids, thus resulting in lung heat and dry atrophy. When the lung suffers from heat-induced dry atrophy, its clear and descending function fails, and the distribution of water and essence becomes disordered. Although the Spleen scatters essence and sends fluids up to the Lung, the Lung cannot moisten itself internally, nor can it distribute essence to the Zang-Fu organs internally, nor transport essence to the skin and hair externally. These fluids remain stored in the chest, where they are boiled by heat into saliva and froth, invading the lung and causing coughing. Continuous expectoration leads to a state where the dry remains dry and the expelled fluid continues to be expelled; the more one expects, the drier it becomes, and the disease of Lung Asthma is formed. If the mouth feels parched, without expectorating turbid saliva and froth, and each cough triggers a dull pain in the chest, with a pulse that is rapid and slippery, or rapid and deficient, this is not Lung Asthma but Lung Abscess. When the abscess matures and ruptures, one will no longer expectorate froth but will inevitably cough up pus and blood.

[Collected Commentaries] Zhou Yangjun states: Yu Chang says: Upon moving just a few steps, the patient wheezes audibly, producing continuous sounds upon impact, with phlegm responding to each sound. The treatment principles in the *Jin Gui Yao Lue* emphasize grasping the essential intent: generally, one should proceed slowly, generate Stomach fluids, moisten lung dryness, descend rebellious Qi, resolve accumulated phlegm, stop turbid saliva, tonify true Qi, unblock the small passages of the lung, dissipate fire-heat, and restore the lung's clarity and descending function. Just as flaccidity of half the body or weakness of the limbs can recover if treated correctly, so too must effort be made for the lung, which is close to the chest and vital for respiration. Lung Abscess belongs to tangible blood pathology; blood stasis requires rapid attack. Lung Asthma belongs to intangible Qi pathology; Qi injury requires gradual management. Thus, an abscess is Excess; treating it as Asthma constitutes "treating excess as excess." Asthma is Deficiency; treating it as an Abscess constitutes "treating deficiency as deficiency." This is the general principle of syndrome differentiation and medication. However, the Cun Kou pulse on both hands originally refers to the Hand Taiyin Lung meridian. Here, references to Cun Kou pulse being rapid, slippery-rapid, number-excess, or number-deficient refer collectively to the three positions on both left and right sides, not exclusively to the Qi Kou (radial artery) governing the Right Guan position alone. When a patient coughs and has turbid saliva and froth in the mouth, spreading everywhere shortly after, it is Lung Asthma, indicating the mouth is not dry. If coughing is accompanied by a parched mouth, it indicates the lung has formed an abscess; the toxicity of fire-heat manifests in the mouth. The vibration of coughing touches the abscess, causing dull chest pain, and the pulse must appear slippery, rapid, and forceful, signaling the peak of pathogenic and righteous qi. Using rapid-deficient and rapid-excess pulses to distinguish between Lung Asthma and Lung Abscess reveals that Asthma requires tonification and Abscess requires purgation. Furthermore, upon observing chronic cough, one must first guard against these two conditions. Lung Abscess arises from fire accumulated in the five Zang organs and heat retained in the Stomach, ascending to the lung. The lung is scorched by fire-heat, causing blood to coagulate and phlegm to wrap around it, forming a small abscess. As the formed shape grows, the lung swells daily and the ribs elevate, leading to frequent coughing, thick phlegm like glue, fever and aversion to cold (worse in the afternoon), red face, dry nose, and skin lesions on the chest resembling fish scales. If identified early by pulse and symptoms, determining whether it is exterior or interior, and vigorously applying lifting and purging methods, recovery is assured. However, once blood turns to pus and lung tissue rots, expelling it like an overturned bag, recognition comes too late; ten cases result in death, alas, it is too late.

Shen Mingzong states: This distinguishes Lung Asthma from Lung Abscess. The Heart resides superiorly; when Kidney Water is insufficient, Heart Fire insults Metal (Lung), creating heat in the Upper Jiao. Lung Yin is consumed daily, Qi rebels causing cough, thus leading to Lung Asthma. The classic explicitly states the initial causes: either post-illness Yin deficiency with excessive sweating injuring fluids, vomiting injuring Jin Ye, Xiao Ke with blood deficiency and fluid exhaustion; or diuretics causing frequent urination and injuring Yin; or constipation treated wrongly with drastic purgatives causing severe fluid loss. This leads to Dryness of Lung Metal, steaming by deficient heat, resulting in a rapid Cun Kou pulse, coughing, weak Qi, failure of fluid distribution, transformation into turbid saliva and froth, forming Lung Asthma. If the mouth is parched and coughing causes dull chest pain, it is Wind-Cold invading the lung, stagnating Ying-Blood to form an abscess, hence a slippery-rapid pulse and coughing up pus and blood. Because intangible deficient heat causes atrophy, the pulse is rapid-deficient; because tangible Qi-Blood stagnation forms an abscess, the pulse is rapid-excess. This clarifies that Lung Abscess is Excess and Lung Asthma is Deficiency.

A rapid-deficient pulse indicates Lung Asthma; a rapid-excess pulse indicates Lung Abscess.

[Commentary] This elaborates on the pulses for Lung Asthma and Lung Abscess mentioned previously. Lung Asthma arises from heat depleting Body Fluids, representing a Deficient pathogen, hence the pulse is rapid and deficient. Lung Abscess arises from heat-toxin accumulation, representing an Excess pathogen, hence the pulse is rapid and excess.

[Collected Commentaries] Li [Name missing] states: Pan Shuofu says: Both Asthma and Abscess involve heat in the Upper Jiao, rapid pulses, coughing, and loss of Body Fluids, appearing similar. However, Asthma belongs to Lung Qi deficiency and fluid loss; although there is heat, it is not fierce, so it does not reach desiccation. Despite coughing, there is turbid saliva and froth in the mouth, so the pulse is rapid but deficient. Abscess involves Qi congestion and Blood coagulation, with strong pathogens and intense heat; thus, fluid loss leads to greater dryness, a parched mouth, and dull chest pain upon coughing. With fluids exhausted, the pulse should be choppy but is instead slippery and rapid due to accumulated heat rotting into pus, making the pulse rapid and excess.

You Yi states: "Wei" (Asthma/Atrophy) means withering, like plants losing vigor due to fluid loss and lung scorching; "Yong" (Abscess) means obstruction, like earth blocking flow due to heat aggregation and lung congestion. Thus, their pulses differ in deficiency and excess, but both are rapid.

Question: In cases of coughing and rebellious Qi, how do we know this is Lung Abscess? There should be pus and blood; if vomited, death ensues. What does the pulse resemble? The Master replied: 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, preventing exhalation from entering; Heat overcomes the Ying (Nutritive) level, preventing inhalation from exiting. Wind damages the skin and hair; Heat damages the vessels and blood. Wind settles in the Lung, causing cough, dry mouth, wheezing and fullness, dry throat without thirst, occasional expectoration of turbid froth, and periodic chills. Wherever Heat passes, blood coagulates and stagnates, accumulating into an abscess. Expectoration resembles rice porridge. If caught at the萌芽 (germination/early stage), it can be saved; once pus is formed, death occurs.

[Note] Before "Lung Abscess," the characters "Lung Asthma" should likely exist; otherwise, the discussion of Lung Asthma lacks context, suggesting a missing slip. The three instances of "faint" (Wei) in the pulse description should likely be "floating" (Fu); "faint" disrupts the textual logic, likely a transcription error.

[Commentary] Regarding coughing and rebellious Qi, how do we distinguish Asthma from Abscess? Coughing without thirst, with turbid saliva and froth, and a rapid-deficient pulse identifies Lung Asthma. A dry mouth, dull chest pain, and rapid-excess pulse identify Lung Abscess. The causes of illness were explained for Asthma previously but not for Abscess; thus, the reasons for heat causing these diseases are detailed here. Cun Kou is the Lung pulse; normally floating, choppy, and short. Now it is floating and rapid; thus, floating indicates Wind, rapid indicates Heat. Initially, Wind-Heat attacks the exterior, affecting Ying and Wei, causing sweating and aversion to cold. Later, Wind-Heat moves inward to the Lung, affecting Ying and Wei separately. Lung Asthma results from Wind-Heat injuring Wei-Qi; the Qi level has fluids but no blood pathology, so fluids become turbid. Hence, symptoms include coughing without pus/blood, but with turbid froth. Lung Abscess results from Wind-Heat injuring Ying-Blood; the Blood level has blood but no fluid pathology, so blood coagulates. Hence, symptoms include coughing without froth, but with pus/blood resembling rice porridge. Symptoms including fever, sweating, aversion to cold/wind, coughing with wheezing/fullness, dry throat without thirst, difficulty exhaling/inhaling, indicate combined Asthma and Abscess. "Difficulty exhaling/inhaling" refers to急促 breathing, not complete cessation. "Early stage saveable" means lung injury is shallow; "Pus formed fatal" means lung tissue is destroyed. This warns patients to seek treatment early, specifically emphasizing Lung Abscess.

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

[Commentary] This follows the previous section to explain the necessity of urgent treatment. Lung Abscess is defined by a parched mouth, dull chest pain, and rapid-excess pulse. Added with wheezing and inability to lie down, it indicates severe lung congestion by pathogens. Therefore, Ting Li Da Zao Xie Fei Tang, bitter and cold, strongly drains lung pathogens, fearing that delay will lead to pus formation and death.

Ting Li Da Zao Xie Fei Tang Formula
Ting Li Zi (Descurainiae Semen, fried until yellow, pounded, size of a bullet) - 1 portion
Da Zao (Jujubae Fructus, 12 pieces)
Boil Jujubes in 3 sheng of water to obtain 2 sheng. Remove Jujubes. Add Ting Li Zi. Boil to obtain 1 sheng. Take all at once.

[Collected Explanation] Zhao Liang says: This is the critical formula for Lung Abscess. An abscess in the lung demands draining. One must fear that if delayed until pus forms, draining is useless. If lung Qi is depleted, draining causes further harm. One must act while blood is congealed but pus has not yet formed, using draining methods to seize the pathogen. Especially with wheezing and inability to lie down, the condition is severe.

For Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear discharge, loss of smell for fragrant/foul/sour/spicy odors, coughing and rebellious Qi, wheezing and choking, Ting Li Da Zao Xie Fei Tang (see above) is indicated.

[Commentary] This elaborates on the symptoms from the previous section to unify the treatment. Chest fullness, coughing/rebellious Qi, wheezing/choking, edema, nasal congestion, and anosmia indicate pathogens obstructing the exterior skin/hair and congesting the lung internally. This is worse than mere wheezing/inability to lie down. Ting Li Da Zao Xie Fei Tang is used because pus has not yet formed.

For coughing with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of turbid foul-smelling sputum, and long-term expectoration of pus resembling rice porridge, this is Lung Abscess. Jie Geng Tang (Platycodon Decoction) is indicated.

[Commentary] These symptoms constitute Lung Abscess. Since the abscess has not yet fully formed into solid excess, Ting Li formulas drain it. Now that it has ulcerated, becoming a deficient pathogen, Jie Geng's bitterness and Gan Cao's sweetness resolve lung toxicity and expel abscess pus. This treats established Lung Abscess that is mild and non-fatal.

[Collected Commentaries] Gao Shishi asks: Expectorating rice-porridge-like substance is also pus. Why did the text earlier say "pus formed means death"? If rice-porridge-like substance is not pus, why did the earlier text say "accumulated abscess pus, expectorating rice porridge"? And here "expectorating pus like rice porridge"? If pus is expectorated, what distinction remains between early stage and formed pus? I answer: The earlier section describes coughing/rebellious Qi with breathing difficulty, followed by blood coagulation and pus formation, injuring both Yin-Yang and Qi-Blood, hence "pus formed means death." The current section discusses Lung Abscess with Qi mechanism dysfunction versus Meridian dysfunction. Disease affecting Yang Qi does not injure Yin; disease affecting Blood vessels does not injure Yang, hence it is treatable. Relying solely on "early stage saveable, pus formed fatal" misinterprets the intent.

Jie Geng Tang Formula
Jie Geng (Platycodonis Radix, 1 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, 2 liang)
Boil these two ingredients in 3 sheng of water to obtain 1 sheng. Divide into two warm doses. Pus and blood will be expectorated.

For Lung Asthma with expectoration of froth but no coughing, where the patient is not thirsty, inevitably experiencing enuresis and frequent urination: This occurs because the upper deficiency cannot control the lower. This is Cold in the Lung, characterized by vertigo and abundant saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) is used to warm it. If the patient feels thirsty after taking the decoction, it belongs to Xiao Ke (Wasting and Thirsting).

[Commentary] Coughing without froth indicates Lung Dryness Cough; coughing with froth indicates Lung Heat Asthma. If one expects froth like Asthma but does not cough, this is "Cold Drink" (Frozen Beverage) in the Lung, not Heat Asthma. Lung Cold implies no thirst, enuresis, frequent urination, vertigo, and abundant froth. This happens because Upper Jiao Yang deficiency fails to constrain Lower Jiao Yin Water, allowing Lower Jiao water to flood upward as froth. Gan Cao Gan Jiang Tang warms and disperses Lung Cold-Fluid. If thirst develops after taking warming medicine, it indicates Stomach Heat (Xiao Ke), not Lung Heat or Lung Cold, and should be treated accordingly.

Gan Cao Gan Jiang Tang Formula
Gan Cao (Licoricae Radix et Rhizoma, roasted, 4 liang)
Gan Jiang (Zingiberis Rhizoma, processed, 2 liang)
Crush these ingredients. Boil in 3 sheng of water to obtain 1.5 sheng. Remove dregs. Divide into two warm doses.

For coughing with rebellious Qi and a "water-chicken" sound in the throat, She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction) is indicated.

[Commentary] "Coughing and rebellious Qi" means Qi rushes upward with coughing. The previous section clarified that non-coughing froth-expectoration is Lung Cold. This section clarifies that coughing without froth is also Lung Cold. The previous section used Gan Jiang assisting Gan Cao for internal warming (due to no thirst, frequent urination, froth). This section uses Sheng Jiang assisting Ma Huang for external dispersion (due to rebellious Qi and water-chicken sound in the throat). Both involve Cold-Fluid, but one is internal and one external; both use Acrid-Warm formulas, but one focuses on warming and the other on dispersing. "Water-chicken sound" refers to the sound of water and Qi interacting continuously in the throat.

She Gan Ma Huang Tang Formula
She Gan (Belamcandae Rhizoma, 3 liang)
Ma Huang (Ephedrae Herba, 4 liang)
Sheng Jiang (Zingiberis Rhizoma Recens, 4 liang)
Xi Xin (Asari Radix et Rhizoma, 3 liang)
Zi Wan (Stemonae Radix, 3 liang)
Kuan Dong Hua (Farfarae Flos, 3 liang)
Wu Wei Zi (Schisandrae Fructus, 0.5 sheng)
Da Zao (Jujubae Fructus, 7 pieces)
Ban Xia (Pinelliae Rhizoma Preparatum, 0.5 sheng)
Boil these nine ingredients in 12 sheng of water. First boil Ma Huang for two boils, remove foam. Add remaining herbs. Boil to obtain 3 sheng. Divide into three warm doses.

[Collected Explanation] Cheng Lin says: For coughing with rebellious Qi and continuous water-chicken sounds, this formula is indicated. The *Nei Jing* states: "The Lung dislikes Qi rebellion; urgently use Bitter to drain it." She Gan and Zi Wan are bitter to drain rebellious Qi. Use Acrid to drain: Ma Huang, Sheng Jiang, Xi Xin, Ban Xia, Kuan Dong Hua are acrid to drain Wind-Pathogens. Use Sour to astringe and tonify: Wu Wei Zi is sour to tonify deficiency. Tonify the Mother when deficient: Da Zao is sweet to tonify the Mother (Earth generates Metal).

For severe rebellious Qi and unsmooth throat, use Mai Men Dong Tang (Ophiopogon Decoction) to stop rebellion and descend Qi.

[Note] The character "Da" (Great) in "Da Ni Shang Qi" (Severe Rebellious Qi) should likely be "Huo" (Fire); this makes the text, disease, and medicine consistent, suggesting a transcription error.

[Commentary] Coughing with rebellious Qi and water-chicken sounds indicates Cold-Fluid rebelling upward. Current coughing with rebellious Qi but no water-chicken sound, only unsmoothness, indicates Fire-Qi rebelling upward. "Unsmooth" means a sensation of obstruction in the throat. Mai Men Dong Tang stops Fire-Rebellion and descends Qi.

Mai Men Dong Tang Formula
Mai Men Dong (Ophiopogonis Radix, 7 sheng)
Ban Xia (Pinelliae Rhizoma Preparatum, 1 sheng)
Ren Shen (Ginseng Radix, 3 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang)
Jing Mi (Oryza Sativa, 3 he)
Da Zao (Jujubae Fructus, 12 pieces)
Boil these six ingredients in 12 sheng of water to obtain 6 sheng. Take 1 sheng warm, three times daily, once at night.

[Collected Commentaries] Zhou Yangjun states: Yu Chang says: This is a syndrome of Dry Stomach Fluids with Deficient Fire flaming upward. Mai Men Dong Tang is the fundamental treatment. Using Fire-Descending drugs causes Fire to rise; using Cold-Cool drugs intensifies Heat, doing harm rather than good. Life depends on Stomach Qi; death follows its absence. Stomach Qi is the Mother of Lung Qi. The *Ben Cao* names Zhi Mu (Anemarrhenae Rhizoma) implying the Lung relies on its coolness, knowing coolness is the Lung's mother. Bei Mu (Fritillariae Bulbus) implies the Lung relies on resolving phlegm, knowing phlegm-resolution is the Lung's mother. Yet these often fail for Fire-Rebellion and unsmooth throat. Who knew Zhang Zhongjing had this brilliant method? By combining Mai Men Dong, Ren Shen, Gan Cao, and Jing Mi to greatly tonify Middle Qi and generate fluids, adding Ban Xia (Acrid-Warm), the benefit of smoothing the throat and descending Qi lies not in Ban Xia itself, but in the masterful use of Ban Xia, achieving a uniqueness unseen before.

For coughing and rebellious Qi, frequent expectoration of turbid matter, and inability to lie down (only sitting possible), Zao Ying Wan (Soapberry Pill) is indicated.

[Commentary] Coughing/rebellious Qi with water-chicken sound is Cold-Fluid attacking the Lung (She Gan Ma Huang Tang pattern). Coughing/rebellious Qi with unsmooth throat is Fire-Attacking the Lung (Mai Men Dong Tang pattern). Current coughing/rebellious Qi with only frequent turbid expectoration (abundant phlegm-saliva) and inability to lie down (severe Qi rebellion) indicates Phlegm-Qi pathology, neither Cold-Fluid nor Fire. Zao Ying Wan guides out phlegm and unblocks Qi; assisted by Jujube Paste's sweetness to moderate the harsh nature of the drug.

[Collected Commentaries] Cheng Lin says: Turbid saliva obstructing the Lung prevents lying down, hence frequent expectoration. Zao Ying (Soapberry) is Acrid-Salty; Acrid disperses, Salty softens. It opens congestion, guides stagnation, benefits orifices, and eliminates wind/phlegm better than any other herb. Thus, it suits coughing/rebellious Qi with frequent turbid expectoration and inability to lie down. Its harsh nature is moderated by Jujube Paste.

Wei Litong says: Coughing/rebellious Qi with frequent turbid expectoration and inability to lie down is more severe than the water-chicken sound. The latter involves external contraction; the former involves internal injury. Inability to lie down suggests impending Lung Abscess. This indicates Upper Jiao Heat with Phlegm-Blood wrapping and knotting. Urgent resolution of this knotting allows fluids to regenerate and dryness to moisten. Zao Ying Wan drives Wind and resolves Bi, possessing the ability to remove stasis and cleanse filth. Coughing/rebellious Qi with foul Phlegm-Blood knots in the chest/diaphragm requires urgent cleansing. Like using soapberry for bathing to remove grease, pills allow slow dissolution from top to bottom, clearing the upper part. Decoctions would purge too directly to treat upper sticky congestion. Ancient legislation is truly excellent. This is the primary treatment for pre-empting Lung Abscess.

Zao Ying Wan Formula
Zao Ying (Gleditsiae Spina, scraped, processed with butter, 8 liang)
Grind into powder. Form pills the size of Wuzi (Chinese parasol tree seeds) with Honey. Take 3 pills mixed with Jujube Paste decoction, three times daily, once at night.

Rebellious Qi, facial edema, shoulder-respiration (using accessory muscles to breathe), with a Floating-Large pulse is untreatable; if accompanied by Diarrhea, it is even worse.

[Commentary] "Rebellious Qi" refers to coughing and Qi rebellion. "Facial edema" refers to swelling of the face and eyes. "Shoulder-respiration" refers to wheezing/labored breathing. A Floating-Large pulse indicates untreatability; diarrhea exacerbates the prognosis.