（论三首脉证四条方十五首）
〔补注〕嘉言云。金匮于肺痿、肺痈二证。则彻土绸缪。治之于早。然先从脉辨其数
虚数实。欲从口辨其吐沫干燥。然更出一捷要之法。谓咳嗽之初。即见上气喘
急者。乃外受风寒所致。其脉必浮。宜从越婢加半夏之法。及小青龙加石膏之
法。亟为表散。不尔即是肺痈、肺痿之始基。故以咳嗽上气病证。同叙于肺痈、肺
痿之下。而另立痰饮咳嗽本门。原有深意。见咳而至于上气。即是肺中壅塞。逼
迫难安。尚何等待。不急散邪下气以清其肺乎。然亦分表里虚实为治。不当误
施。转增其困矣。
再论肺痈、肺痿之病。皆燥病也。肺禀清肃之令。乃金寒水冷之脏。火热熏灼。久
久失其清肃而变为燥。肺中生痈。其津液全裹其痈。不溢于口。故口中辟辟然
干燥。肺热成痿。则津液之上供者。悉从燥热化为涎沫浊唾。证多不渴。较胃中
津液尽伤。母病累子之痿。又大不同。只是津液之上输者。变为唾沫。肺不沾其
惠泽尔。若夫痿病。津液不能灭火。反从火化。累年积岁。肺叶之间。酿成一大火
聚。以清凉投之。捍格不入矣。然虽捍格。固无害也。设以燥热投之。以火济火。其
人有不坐毙者乎。半夏燥药也。投入肺中。转增其患。自不待言。但清凉既不能
入。惟燥与燥相得。乃能入之。故用半夏之燥。入清凉生津药中。则不但不燥。转
足开燥。其浊沫随逆气下趋。久久津液之上输者。不结为涎沫。而肺得沾其渍
润。痿斯起矣。人但知半夏能燥津液。孰知善用之。即能驱所燥之津液乎。此精蕴也。
总按肺为娇脏。肺气素为形寒饮冷而受伤。久久出汗过多而不瘥。气馁不振。
即为肺痿。其风伤皮毛。无伤血脉。风热相搏。气血稽留。遂为肺痈、肺痿多涎沫。
乃至便下浊沫。肺痈脓血。乃至便下脓积。凡胃强能食而下传者。皆不死也。夫
血热则肉败。营卫不行。必将为脓。是以金匮以通行营卫为第一义。欲治其子。
先健其母。胃中津液。尤贵足以上供而无绝乏。后世诸方。错出不一。不明大意。
今阅金匮十五方。固已用之不尽矣。
问曰。热在上焦者。因咳为肺痿。肺痿之病。从何得之。师曰。或从汗出。或从呕吐。或
从消渴。小便利数。或从便难。又被快药下利。重亡津液。故得之。曰寸口脉数。其人
咳。口中反有浊唾涎沫者何。师曰。为肺痿之病。若口中辟辟燥。咳即胸中隐隐痛。
脉反滑数。此为肺痈。咳唾脓血。脉数虚者为肺痿。数实者为肺痈。
〔补注〕按嘉言云。人身之气。禀命于肺。肺气清肃。则周身之气。莫不服从而顺行。
肺气壅浊。则周身之气。易致横逆而犯上。故肺痈者。肺气壅而不通也。肺痿者。
肺气痿而不振也。才见久咳。先须防此两证。肺痈由五脏蕴崇之火。与胃中停
蓄之热。上乘乎肺。肺受火热熏灼。血为之凝。痰为之裹。遂成小痈。所结之形渐
长。则肺日胀而胁骨日昂。乃至咳声频并。痰浊如胶。发热畏寒。日晡尤甚。面红
鼻燥。胸生甲错。始先即能辨其脉证。属表属里。极力开提攻下。无不愈者。迨至
血化为脓。肺叶朽坏。倾囊吐出。始识其证。十死不救。嗟无及矣。间有痈小气壮。
胃强善食。其脓不从口出。或顺趋肛门。或旁穿胁肋。仍可得生。然不过十中二
三耳。仲景治法最精。用力开提于未成脓之先。今人施于既成脓之后。其有济
乎。肺痿者。其积渐已非一日。其寒热不止一端。总由胃中津液不输于肺。失其
所养。转枯转燥。然后成之。盖肺金之生水。精华四布者。全藉胃。土津液之富。上
供罔缺。但胃中津液暗伤之窦最多。粗工不知爱护。或腠理素疏。无故而大发其汗。或中气
素馁。频吐以倾倒其囊。或痹或消中。饮水而渴不解。泉竭自中。或
肠枯便秘。强利以求其快。漏卮难继。只此上供之津液。坐耗歧途。于是肺火日
炽。肺热日深。肺中小管日窒。咳声以渐不扬。胸中脂膜日干。咳痰艰于上出。行
动数武。气即喘鸣。冲击连声。痰始一应。金匮治法。贵得其精意。大要缓而图之。
生胃津。润肺燥。下逆气。开积痰。止浊唾。补真气。以通肺之小管。散火热。以复肺
之清肃。如半身痿废。及手足痿软。治之得法。亦能复起。而肺近在胸中。呼吸所
关。可不置力乎。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。故痈为实。误以肺痿治之。是为实实。痿为虚。误以肺痈治之。是为虚虚。此
辨证用药之大略也。然两手寸口之脉。原为手太阴肺脉。此云寸口脉数。云滑
数。云数实数虚。皆指左右三部统言。非如气口独主右关之上也。其人咳。口中
反有浊唾涎沫。顷之遍地者为肺痿。言咳而口中不干燥也。若咳而口中辟辟
燥。则是肺已结痈。火热之毒。出现于口。咳声上下。触动其痈。胸中即隐隐而痛。
其脉必见滑数有力。正邪气方盛之征也。数虚数实之脉。以之分别肺痿肺痈。
是则肺痿当补。肺痈当泻明矣。
问曰。病咳逆。脉之何以知此为肺痈。当有脓血。吐之则死。其脉何类。师曰。寸口脉
微而数。微则为风。数则为热。微则汗出。数则恶寒。风中于卫。呼气不入。热过于荣。
吸而不出。风伤皮毛。热伤血脉。风舍于肺。其人则咳。口干喘满。咽燥不渴。多唾浊
沫。时时振寒。热之所过。血为之凝滞。蓄结痈脓。吐如米粥。始萌可救。脓成则死。
〔补注〕按嘉言云。肺痈之脉。既云滑数。此复云微数者。非脉之有不同也。滑数者。
已成之脉。微数者。初起之因也。初起左右三部脉微。知其卫中于风而自汗。左右三部脉数。
知为荣吸其热而畏寒。然风初入卫。尚随呼气而出。不能深入。所
伤者不过在于皮毛。皮毛者肺之合也。风由所合以渐舍于肺俞。而咳唾振寒。
兹时从外入者。从外出之易易者。若夫热过于荣。即随吸气所入。不出而伤其
血脉矣。卫中之风。得荣中之热。留恋固结于肺叶之间。乃致血为凝滞。以渐结
为痈脓。是则有形之败浊。必从泻法而下驱之。使其邪毒随驱下移。入胃入腹
入肠。再一驱。即尽去不留矣。安在始萌不救。听其脓成而腐败耶。
上气。面浮肿。肩息。其脉浮大不治。又加利尤甚。
〔补注〕肺为气之总司。主呼吸者也。今云上气至于面浮肿。至为肩息。是其肺气
壅逆。而肩为动摇矣。何也。肺之所畏者。火也。设中焦邪实。阻其升降。而炎上之
性。有加无已。则所呼之气。邪有以助之。而所吸之气不复下达。遂使出入息肩
矣。加以脉浮大。火势方张。本体既衰。而邪削更甚。又何法可令其内还而下趋
乎。故不治也。然犹有可图者。庶几中土尚培。生气未绝耳。若加利为尤甚也。
上气喘而燥者。属肺胀。欲作风水发汗则愈。
〔补注〕同一上气也。此则作喘而不息肩者。正以皮毛乃肺之合。为邪所蔽。遂令
肺气不得外达。故寒伤营者。亦作喘也。彼燥阴也。上气何以复燥。肺气既塞。遂
令下流不化。水既不化。又令木气不疏。此皆以母病而兼及于子也。一发其汗。
则塞者得以外通矣。逆者得以下达矣。故曰愈也。
肺痿。吐涎沫而不咳者。其人不渴。必遗尿。小便数。所以然者。以上虚不能制下故
也。此为肺中冷。必眩。多涎唾。甘草干姜汤以温之。若服汤已。渴者。属消渴。
甘草干姜汤方
甘草（四两炙） 干姜（二两炮）
上二味。以水三升。煮取一升五合。去滓。分温再服。
〔补注〕嘉言云肺热。则膀胱之气化亦热。小便必赤涩而不能多。若肺痿之候。但
吐涎沫而不咳。复不渴。反遗尿而小便数者。何其与本病相反也。必其人上虚
不能制下。以故小便无所收摄尔。此为肺中冷。阴气上巅。侮其阳气。故必眩。阴
寒之气。凝滞津液。故多涎唾。若始先不渴。服温药即转渴者。明是消渴饮一溲
二之证。更当消息之矣。
愚按∶肺寒。上虚也。便数。下虚也。圣人只温其中。岂非以补其母。则子自安。总司
之地温。而膀胱亦温。下泉无洌彼之患矣。
咳而上气。喉中水鸡声。射干麻黄汤主之。
射干麻黄汤方
射干（三两） 麻黄（四两） 生姜（四两） 细辛（三两）
紫菀（三两） 款冬花（三两） 五味子（半升） 大枣（七枚） 半夏（半升洗）
上九味。以水一斗二升。先煮麻黄二沸。去上沫。内诸药。煮取三升。分温三服。
〔补注〕嘉言云。上气声如水鸡。明系痰阻其气尔。阻之务在去之。而仲景不专于
去痰者。以肺受风寒。主气之司。已为邪困而不能自持。莫若主于发表。而佐以
润燥下气开痰四法。聚于一方内。以分解其邪。不使之合。此因证定药之大法也。
咳逆上气。时时唾浊。但坐不得眠。皂荚丸主之。
皂荚丸方
皂荚（八两刮去皮用酥炙）
上一味末之。蜜丸如梧子大。以枣膏和汤服三丸。日三夜一服。
〔补注〕经谓上气者。阴气在下。阳气在上。诸阳气浮。无所根据从也。今咳逆上气。是
浊气上干。清虚之位。反为浊阴所据。故虽时时唾。而浊不为唾减也。皂荚性能
驱浊。其刺又能攻坚。且得直达患处。用意神巧。诚不可思议者。嘉言云。大热之
毒。聚结于肺。表之温之。曾不少应。坚而不可攻者。用此丸豆大三粒。朝三服。暮
一服。吞适病所。如棘针遍刺。四面还攻。如是多日。庶几无坚不入。聿成荡涤之
功。不可以药之微贱而少之也。胸中手不可入。即谓为代针丸可矣。
咳而脉浮者。浓朴麻黄汤主之。
浓朴麻黄汤方
浓朴（五两） 麻黄（四两） 石膏（如鸡子大） 杏仁（半升）
半夏（半升） 干姜（二两） 细辛（二两） 小麦（一升） 五味子（半升）
上九味。以水一斗二升。先煮小麦熟。去滓。内诸药。煮取三升。温服一升。日三服。
〔补注〕嘉言云。若但咳而脉浮。则外邪居多。全以散邪为主。用法即于小青龙汤
中去桂枝、芍药、甘草、加浓朴、石膏、小麦。仍从肺病起见。所以桂枝之热。芍药之
收。甘草之缓。概示不用。而加浓朴以下其气。石膏以清热。小麦引入胃中。助其
升发之气。一举而表解脉和。于以置力于本病。然后破竹之势可成尔。一经裁
酌。直使小青龙载肺病腾空而去。神哉。
咳而脉沉者。泽漆汤主之。
泽漆汤方
半夏（半升） 紫参（五两一作紫菀） 泽漆（三升以东流水五斗煮取一斗五升） 生姜（五两）
白前（五两） 甘草（三两） 黄芩（三两） 人参（三两） 桂枝（三两）
上九味。 咀。内泽漆汁中。煮取五升。温服五合。至夜尽。
〔补注〕浮为在表。沉为在里。表里二字。与伤寒之表里大殊。表者邪在卫。即肺之
表也。里者邪在荣。即肺之里也。热过于荣。吸而不出。其血必结。血结则痰气必
为外裹。故用泽漆之破血为君。加入开痰下气。清热和荣诸药。俾坚垒一空。元气不损。制方之妙若此。
火逆上气。咽喉不利。止逆下气者。麦门冬汤主之。
麦门冬汤方
麦冬（七升） 半夏（一升） 人参（二两） 甘草（二两） 粳米（三合） 大枣（十二枚）
上六味。以水一斗八升。煮取六升。温服一升。日三。夜一服。
〔补注〕嘉言云。胃中津液枯燥。虚火上炎之证。治本之良法也。夫用降火之药而
火反升。用寒凉之药而热转炽者。徒知与火热相争。未思及必不可得之数。不
惟无益。而反害之。凡肺病有胃气则生。无胃气即死。胃气者。肺之母气也。本草
有知母之名者。谓肺藉其清凉。知清凉为肺之母也。有贝母之名者。谓肺藉其
豁痰。实豁痰为肺之母也。然屡施于火逆上气。咽喉不利之证而屡不应。名不
称矣。孰知仲景有此妙法。于麦冬、人参、甘草、粳米大补中气。大生津液队中。增
入半夏之辛温一味。其利咽下气。非半夏之功。实善用半夏之功。擅古今未有之奇矣。
肺痈喘不得卧。葶苈大枣泻肺汤主之。
葶苈大枣泻肺汤方
葶苈（熬令色黄捣丸如弹子大） 大枣（十二枚）
上先以水三升煮枣。取二升。去枣。内葶苈。煮取一升。顿服。
〔补注〕此治肺痈吃紧之方也。肺中生痈。不泻何待。恐日久痈脓已成。泻之无益。
日久肺气已索。泻之转伤。惟血结而脓未成。当急以泻肺之法夺之。况喘不得卧。不云甚乎。
咳而胸满振寒。脉数。咽干不渴。时浊唾腥臭。久久吐脓如米粥者。为肺痈。桔梗汤主之。
桔梗汤方
桔梗（一两） 甘草（一两）
上二味。以水三升。煮取一升。分温再服。
又方（此方系宋人所增并录之以备用）
桔梗 贝母 当归 栝蒌仁 枳壳 薏苡仁 桑白皮 百合（各一钱五分）
五味子 葶苈 地骨皮 甘草节 知母 防己 黄 杏仁（各五分用清水煎服）
〔补注〕肺痈由热结而成。其浊唾腥臭。因热瘀而致。故咳而胸满。是肺不利也。振
(Contains three discussions, four pulse and symptom patterns, and fifteen prescriptions)
[Supplementary Note] Yu Jiayan stated: In the *Jin Gui Yao Lue*, regarding the two conditions of Lung萎 (Lung Flaccidity) and Lung Abscess, it emphasizes consolidating the Earth (Spleen/Stomach) to prepare for contingencies and advocates early treatment. However, one must first differentiate between a rapid-empty (Shu Xu) and rapid-full (Shu Shi) pulse, and attempt to distinguish by oral symptoms whether there is expectoration of froth or dryness. Furthermore, a convenient and crucial method is proposed: if coughing initially presents with upper Qi rebellion and panting, this is caused by external contraction of Wind-Cold. The pulse will certainly be Floating (Fu). It is appropriate to employ the method of Yue Bi Jia Ban Xia Tang (Yuebi Decoction plus Pinellia) or Xiao Qing Long Jia Shi Gao Tang (Minor Blue Green Dragon Decoction plus Gypsum), urgently performing exterior dispersal. If this is not done, it will become the foundation for Lung Abscess or Lung Flaccidity. Therefore, the disease patterns of Cough and Upper Qi Rebellion are narrated under Lung Abscess and Lung Flaccidity, while a separate category for Phlegm-Fluids and Cough is established, which originally holds deep significance. Seeing cough progress to Upper Qi Rebellion indicates congestion in the Lung, forcing discomfort and unrest. What is there to wait for? One must urgently disperse the pathogen and direct Qi downward to clear and purify the Lung. However, treatment must be differentiated by Exterior/Interior and Deficiency/Excess; erroneous application will only increase the patient's distress.
Furthermore, both Lung Abscess and Lung Flaccidity are Dryness diseases. The Lung receives the command of clarity and purity; it is an organ of Cold Metal and Cold Water. When scorched by Fire-Heat for a long time, it loses its clarity and purity and transforms into Dryness. When an abscess forms in the Lung, body fluids completely envelop the abscess and do not overflow to the mouth, hence the mouth feels parched and dry (Pi Pi Ran Gan Zao). When Heat causes Lung Flaccidity, the fluids that should ascend to supply the Lung are entirely transformed by Dryness-Heat into saliva and turbid sputum. The condition usually involves no thirst. This is quite different from Flaccidity where stomach fluids are completely damaged, and the Mother disease affects the Child. It is merely that the fluids ascending for transport transform into saliva, and the Lung does not benefit from their nourishment. As for Flaccidity disease, when fluids cannot extinguish Fire, they transform with Fire. Over years, a great accumulation of Fire brews within the lung lobes. If cool/clearing agents are administered, they meet resistance and do not enter. Although resistant, this is inherently harmless. But if Dryness-Heat agents are administered, adding fire to fire, would the person not die sitting down? Ban Xia (Pinelliae Rhizoma) is a drying herb; introducing it into the Lung would naturally increase the harm, as one might expect. However, since cooling agents cannot enter, only Dryness can interact with Dryness to penetrate. Therefore, using the drying nature of Ban Xia within a formula of cooling and fluid-generating herbs not only avoids dryness but actually opens up Dryness. The turbid sputum follows the rebellious Qi downward. Over time, the fluids ascending for transport no longer congeal into saliva, and the Lung receives their moistening infiltration, allowing Flaccidity to recover. People only know that Ban Xia dries body fluids; who knows that skilled use can drive out the dried fluids? This is the profound essence.
In summary, the Lung is a delicate organ. Lung Qi is prone to injury from cold exposure and cold drinks. Over time, excessive sweating without recovery leads to deficient Qi and lack of vigor, resulting in Lung Flaccidity. Wind injuring the skin and hair without damaging blood vessels, combined with Wind-Heat struggling, causes Qi and Blood to stagnate, leading to Lung Abscess or Lung Flaccidity with abundant saliva, even passing turbid sputum via stool, or Lung Abscess with pus and blood, even passing pus-like accumulations via stool. Whenever the Stomach is strong enough to eat and transmit downwards, death is avoided. When Blood is hot, flesh rots, and Ying and Wei circulation stops, pus will inevitably form. Thus, the *Jin Gui* regards promoting Ying and Wei circulation as the primary principle. To treat the Child (Lung), one must first strengthen the Mother (Spleen/Stomach). Fluids in the Stomach are especially precious for sufficient upward supply without depletion. Later generations' formulas vary widely, lacking understanding of the main idea. Reading the fifteen formulas in the *Jin Gui* is already more than sufficient.
Q: When Heat is in the Upper Jiao, coughing leads to Lung Flaccidity. From where does the disease of Lung Flaccidity arise? Master said: It arises from sweating, vomiting, Xiao Ke (Wasting-Thirst) with frequent urination, or constipation treated with harsh purgatives causing severe loss of fluids. A: The Cun Kou (Radial Pulse) is rapid. The person coughs and has turbid saliva and froth in the mouth. Why? Master said: This is 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 Lung Abscess, with coughing up pus and blood. A rapid-empty pulse indicates Lung Flaccidity; a rapid-full pulse indicates Lung Abscess.
[Supplementary Note] According to Yu Jiayan: The Qi of the human body derives its mandate from the Lung. When Lung Qi is clear and pure, the Qi of the whole body obeys and flows smoothly. When Lung Qi is congested and turbid, the Qi of the whole body easily becomes rebellious and attacks upward. Therefore, Lung Abscess is Lung Qi congestion and blockage; Lung Flaccidity is Lung Qi flaccidity and lack of vigor. Upon seeing chronic cough, one must first guard against these two conditions. Lung Abscess results from accumulated Fire in the five Zang organs and stagnant Heat in the Stomach rising to the Lung. The Lung suffers scorching 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 rib bones protrude, leading to frequent coughing, thick phlegm like glue, fever and aversion to cold (worse at Shen hour), red face, dry nose, and rough skin on the chest. If identified early by pulse and symptoms, determining Exterior or Interior, and vigorously applying lifting and purging methods, all can be cured. Only when Blood turns to pus and Lung lobes rot, pouring out like a spilled bag, is the condition recognized; ten cases result in death, alas, too late. Occasionally, if the abscess is small, Qi is strong, and the Stomach is robust, allowing pus to exit via the anus or pierce the ribs, survival is possible, but only two or three in ten. Zhang Zhongjing's treatment is most refined, focusing on lifting before pus formation. Today's practitioners apply treatments after pus formation; what good is it? Lung Flaccidity develops gradually over days, involving various colds and heats. It generally stems from Stomach fluids failing to transport to the Lung, losing nourishment, becoming increasingly dry and withered. The Lung (Metal) generates Water, distributing essence, relying entirely on the richness of Stomach (Earth) fluids for uninterrupted supply. However, there are many ways Stomach fluids are secretly damaged. Unskilled doctors fail to protect them: either pores are loose, causing sudden heavy sweating; or Middle Qi is weak, causing frequent vomiting to empty the reservoir; or Bi syndrome or Xiao Zhong, drinking water without relieving thirst, exhausting the spring from within; or dry intestines and constipation, forcibly purging for relief, like a leaking urn hard to replenish. Only this supplying fluid is wasted on wrong paths, causing Lung Fire to blaze daily, Lung Heat to deepen, Lung micro-tubes to obstruct daily, cough voice to fade, chest membranes to dry, difficult to expectorate phlegm, panting upon slight movement, and choking sounds until phlegm responds. The *Jin Gui* treatment values precise intent: primarily plan slowly, generate Stomach fluids, moisten Lung dryness, direct rebellious Qi downward, open accumulated Phlegm, stop turbid saliva, supplement true Qi, unblock Lung micro-tubes, dissipate Fire-Heat, and restore Lung clarity and purity. Even hemiplegic flaccidity or limb weakness can recover with proper treatment. Since the Lung is near the chest, vital for respiration, effort must be made! Lung Abscess belongs to tangible Blood; Blood stasis requires rapid attack. Lung Flaccidity belongs to intangible Qi; Qi injury requires gradual management. Thus, Abscess is Excess; treating it as Flaccidity (Deficiency) is "treating Excess as Excess" (adding to excess). Flaccidity is Deficiency; treating it as Abscess (Excess) is "treating Deficiency as Deficiency" (depleting deficiency). This is the general principle of differentiation and medication. However, the Cun Kou pulse on both hands originally belongs to the Hand-Taiyin Lung Meridian. Here, "Cun Kou pulse rapid," "slippery and rapid," "rapid-full/empty" refer collectively to the three positions on left and right, not just the Qi Kou controlling the Right Guan position alone. Coughing with turbid saliva/froth spreading everywhere indicates Lung Flaccidity, meaning the mouth is not dry during cough. If coughing with a parched mouth, the Lung has formed an abscess; Fire-Heat toxin appears in the mouth; coughing movements trigger the abscess, causing hidden chest pain; the pulse must be slippery, rapid, and forceful, a sign of vigorous pathogenic Qi. Using rapid-empty/full pulses to distinguish Lung Flaccidity/Abscess makes it clear that Flaccidity requires tonification and Abscess requires purging.
Q: In coughing rebellion, how does pulse diagnosis reveal Lung Abscess with pus and blood, which is fatal upon expectoration? What class is the pulse? 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 enters the Wei (Defensive) level, exhalation does not enter deeply; Heat passes into the Ying (Nutritive) level, inhalation does not exit. Wind injures skin and hair; Heat injures blood vessels. Wind lodges in the Lung, causing cough, dry mouth, panting and fullness, dry throat without thirst, abundant turbid saliva, and intermittent chills. Where Heat passes, Blood coagulates and stagnates, accumulating into abscess pus, vomited like rice porridge. Early stage can be saved; once pus forms, death ensues.
[Supplementary Note] According to Yu Jiayan: Lung Abscess pulse is described as slippery and rapid, yet here also faint and rapid; this is not a difference in pulse but in timing. Slippery/Rapid is the pulse of established disease; Faint/Rapid is the cause of initial onset. Initially, faint pulse in left/right three positions indicates Wei level contracted by Wind with spontaneous sweating; Rapid pulse indicates Ying level absorbing Heat with aversion to cold. However, Wind initially entering Wei exits with exhalation, cannot penetrate deeply, injuring only skin and hair. Skin and hair are the exterior of the Lung. Wind gradually lodges in Lung Shu points through this connection, causing cough, saliva, and chills. At this time, pathogens entering from outside can easily exit outward. If Heat passes into Ying, it enters with inhalation, does not exit, and injures blood vessels. Wind in Wei combined with Heat in Ying lingers and knots in lung lobes, causing Blood coagulation and gradual formation of abscess pus. Thus, tangible corrupt matter must be driven down via purging methods, moving pathogenic toxins downward into Stomach, abdomen, and intestines, then purged again until completely removed. How can one say early stage is unsavable, waiting for pus to rot?
Upper Qi rebellion, facial edema, shoulder breathing, with Floating-Large pulse is untreatable; if accompanied by diarrhea, it is even worse.
[Supplementary Note] The Lung is the master of Qi, governing respiration. Now, Upper Qi rebellion reaching facial edema and shoulder breathing indicates Lung Qi congestion and rebellion, causing shoulders to move. Why? What the Lung fears is Fire. If Middle Jiao pathogenic excess blocks ascent and descent, and the flaming nature increases endlessly, the exhaled Qi is aided by pathogen, and inhaled Qi fails to descend, causing breathing with shoulder movement. Added with Floating-Large pulse, Fire energy is flourishing, constitution is depleted, and pathogen is stronger. What method can return it inward and downward? Hence, untreatable. Yet there is hope if Middle Earth is still cultivated and vital Qi not extinct. If accompanied by diarrhea, it is even worse.
Upper Qi rebellion with panting and dryness belongs to Lung Distension. Desiring to induce sweating for Feng Shui (Wind-Water) will lead to recovery.
[Supplementary Note] Same Upper Qi rebellion, but here panting without shoulder movement. Precisely because skin/hair is the exterior of the Lung, obscured by pathogen, preventing Lung Qi from extending outward. Thus, Cold injuring Ying also causes panting. That Dryness is Yin; why does Upper Qi rebellion present with Dryness? Once Lung Qi is blocked, downward flow fails to transform. Water fails to transform, and Wood Qi fails to diffuse. These are Mother disease affecting Child. Inducing sweating allows blockage to open outward and rebellion to descend downward, hence "recovery."
Lung Flaccidity, expectorating saliva/froth without coughing, person is not thirsty, must have enuresis and frequent urination. The reason is Upper Deficiency failing to control Lower. This is Cold in the Lung,必然 dizziness, and abundant saliva/sputum. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) warms it. If after taking the decoction, the person becomes thirsty, it belongs to Xiao Ke (Wasting-Thirst).
Gan Cao Gan Jiang Tang Formula
Gan Cao (4 liang, roasted) Gan Jiang (2 liang, processed)
These two ingredients, with 3 sheng of water, boil to obtain 1.5 sheng, remove dregs, divide into two warm doses.
[Supplementary Note] Jiayan said: Lung Heat causes Bladder Qi transformation to be hot, urine must be red/astringent and not abundant. If Lung Flaccidity presents with only saliva/froth expectoration without coughing, no thirst, but enuresis and frequent urination, why opposite to the main disease? It must be Upper Deficiency failing to control Lower, so urine lacks retention. This is Cold in the Lung, Yin Qi rising to the head, insulting Yang Qi, hence dizziness. Yin-Cold Qi congeals fluids, hence abundant saliva/sputum. If initially not thirsty, but becomes so after warming medicine, it clearly indicates Xiao Ke "drink one, urinate two" syndrome, requiring further consideration.
I observe: Lung Cold is Upper Deficiency; frequent urination is Lower Deficiency. The Sage only warms the Middle, isn't this strengthening the Mother so the Child rests? When the central hub is warm, the Bladder is warm, avoiding the danger of cold lower springs.
Cough with Upper Qi rebellion, sound of water chickens in the throat, She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction) governs it.
She Gan Ma Huang Tang Formula
She Gan (3 liang) Ma Huang (4 liang) Sheng Jiang (4 liang) Xi Xin (3 liang)
Zi Wan (3 liang) Kuan Dong Hua (3 liang) Wu Wei Zi (0.5 sheng) Da Zao (7 pieces) Ban Xia (0.5 sheng, washed)
Nine ingredients, with 12 sheng of water, first boil Ma Huang for two boils, remove foam on top, add other herbs, boil to obtain 3 sheng, divide into three warm doses.
[Supplementary Note] Jiayan said: Upper Qi rebellion with sound like water chickens clearly indicates Phlegm blocking Qi. Blocking must be removed. Zhang Zhongjing does not focus solely on removing Phlegm because the Lung,受 Wind-Cold, has its Qi-mastering function trapped by pathogen and unable to sustain itself. Better to focus on exterior release, assisted by four methods: moistening dryness, directing Qi downward, opening Phlegm. Gathering these in one formula to decompose the pathogen, preventing combination, this is the major principle of prescribing based on syndrome.
Coughing rebellion with Upper Qi, constantly spitting turbid matter, only able to sit, unable to sleep, Zao Jiao Wan (Soap Pod Pill) governs it.
Zao Jiao Wan Formula
Zao Jiao (8 liang, scraped, skin removed, roasted with butter)
Grind this single ingredient into powder, honey-pill like wu zi size, take three pills mixed with date paste and water, three times day, one time night.
[Supplementary Note] Classics state Upper Qi means Yin Qi below, Yang Qi above, all Yang Qi floats without basis. Now coughing rebellion with Upper Qi is turbid Qi attacking upward, clear void position occupied by turbid Yin. Hence, although constantly spitting, turbidity is not reduced by spitting. Zao Jiao nature drives turbidity; its thorns break hardness, reaching the lesion directly, ingenious intention, truly inconceivable. Jiayan said: Great Heat toxin gathers in Lung, exterior/warming methods fail, hard and unbreakable. Use this pill, bean-sized three grains, three times morning, one time night, swallowing to the disease site, like thorns piercing everywhere, attacking from four sides. For many days, hopefully nothing hard remains, achieving cleansing merit. Do not despise the cheapness of the drug. If the chest is inaccessible by hand, call it an acupuncture substitute pill.
Cough with Floating pulse, Nong Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction) governs it.
Nong Po Ma Huang Tang Formula
Nong Po (5 liang) Ma Huang (4 liang) Shi Gao (size of chicken egg) Xing Ren (0.5 sheng)
Ban Xia (0.5 sheng) Gan Jiang (2 liang) Xi Xin (2 liang) Xiao Mai (1 sheng) Wu Wei Zi (0.5 sheng)
Nine ingredients, with 12 sheng of water, first boil Xiao Mai until cooked, remove dregs, add other herbs, boil to obtain 3 sheng, warm dose 1 sheng, three times day.
[Supplementary Note] Jiayan said: If only coughing with Floating pulse, exterior pathogen predominates, focusing entirely on dispersing pathogen. Method is derived from Xiao Qing Long Tang removing Gui Zhi, Shao Yao, Gan Cao, adding Nong Po, Shi Gao, Xiao Mai, still considering Lung disease. Thus Gui Zhi's heat, Shao Yao's astringency, Gan Cao's slackness are generally unused. Instead, Nong Po directs Qi downward, Shi Gao clears Heat, Xiao Mai enters Stomach to assist ascending Qi. One move resolves exterior and harmonizes pulse, allowing effort on the root disease, then bamboo-splitting momentum forms. Once adjusted, it makes Xiao Qing Long carry Lung disease away into the sky, miraculous.
Cough with Sinking pulse, Ze Qi Tang (Euphorbia Lathyris Decoction) governs it.
Ze Qi Tang Formula
Ban Xia (0.5 sheng) Zi Can (5 liang, alternatively Zi Wan) Ze Qi (3 sheng, boiled with 5 dou east-flowing water to obtain 1.5 dou) Sheng Jiang (5 liang)
Bai Qian (5 liang) Gan Cao (3 liang) Huang Qin (3 liang) Ren Shen (3 liang) Gui Zhi (3 liang)
Nine ingredients, chop, add to Ze Qi juice, boil to obtain 5 sheng, warm dose 0.5 sheng, finish by night.
[Supplementary Note] Floating indicates Exterior, Sinking indicates Interior. These terms differ greatly from Shang Han's Exterior/Interior. Exterior means pathogen in Wei, i.e., Lung's exterior; Interior means pathogen in Ying, i.e., Lung's interior. Heat passes into Ying, inhalation does not exit, Blood must knot. Blood knotting means Phlegm-Qi must be wrapped externally. Thus use Ze Qi to break Blood as chief, adding herbs to open Phlegm, direct Qi downward, clear Heat, harmonize Ying, making fortresses empty, Yuan Qi undamaged. Such is the subtlety of formula making.
Fire rebellion causing Upper Qi, throat discomfort, stopping rebellion and directing Qi downward, Mai Men Dong Tang (Ophiopogon Decoction) governs it.
Mai Men Dong Tang Formula
Mai Dong (7 sheng) Ban Xia (1 sheng) Ren Shen (2 liang) Gan Cao (2 liang) Jing Mi (0.3 he) Da Zao (12 pieces)
Six ingredients, with 18 sheng of water, boil to obtain 6 sheng, warm dose 1 sheng, three times day, one time night.
[Supplementary Note] Jiayan said: Stomach fluid dryness with deficient Fire flaming upward, this is a good method for treating the root. Using fire-descending drugs while Fire rises, using cold-cooling drugs while Heat intensifies, knowing only to contend with Fire-Heat, ignoring the impossibility, brings no benefit, only harm. Lung disease with Stomach Qi lives, without Stomach Qi dies. Stomach Qi is Lung's Mother Qi. Materia Medica has Zhi Mu named for Lung borrowing its coolness, knowing coolness is Lung's mother; Bei Mu named for Lung borrowing its phlegm-resolving power, actually resolving phlegm is Lung's mother. Yet repeatedly applied to Fire rebellion Upper Qi/throat discomfort with little effect, names don't match. Who knew Zhongjing had this wonderful method: in Mai Dong, Ren Shen, Gan Cao, Jing Mi team greatly supplement Middle Qi and generate fluids, adding one dose of Ban Xia's acrid-warm nature. Its throat-soothing and Qi-directing is not Ban Xia's merit, but the merit of skillfully using Ban Xia, possessing unprecedented wonder.
Lung Abscess panting unable to lie down, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Date Decoction to Drain the Lung) governs it.
Ting Li Da Zao Xie Fei Tang Formula
Ting Li (roasted until yellow, pounded into pill like bullet size) Da Zao (12 pieces)
First boil dates in 3 sheng water, obtain 2 sheng, remove dates, add Ting Li, boil to obtain 1 sheng, take in one dose.
[Supplementary Note] This is a critical formula for treating Lung Abscess. Abscess in Lung, why wait not to drain? Fear that long days mean pus formed, draining useless; long days mean Lung Qi exhausted, draining harms. Only when Blood knots and pus not formed, urgently drain Lung method to seize it. Moreover, panting unable to lie down, isn't this severe?
Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional turbid foul-smelling sputum, long-term vomiting pus like rice porridge, is Lung Abscess. Jie Geng Tang (Platycodon Decoction) governs it.
Jie Geng Tang Formula
Jie Geng (1 liang) Gan Cao (1 liang)
Two ingredients, with 3 sheng of water, boil to obtain 1 sheng, divide into two warm doses.
Another Formula (Added by Song people, recorded for reference)
Jie Geng Bei Mu Dang Gui Gua Lou Ren Zhi Ke Yi Yi Ren Sang Bai Pi Bai He (each 1.5 qian)
Wu Wei Zi Ting Li Di Gu Pi Gan Cao Jie Zhi Mu Fang Ji Huang Qin Xing Ren (each 0.5 qian, decoct in clear water)
[Supplementary Note] Lung Abscess forms from Heat knotting, turbid foul sputum caused by Heat stasis, hence cough with chest fullness indicates Lung dysfunction. Chills...