（脉经合下饮病咳嗽为一篇）
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。（脉经曰上。有问字。分为二条。快药。作 药。
咳唾脓血。脉经。千金。分为另条。程本金鉴。接上肺痈为是。）
〔尤〕此设为问答。以辨肺痿肺痈之异。热在上焦二句。见五脏风寒积聚篇。盖师有是语而因之以为问
也。汗出。呕吐。消渴。二便下多。皆足以亡津液。而生燥热。肺虚且热。则为痿矣。口中反有浊唾涎沫者。
肺中津液。为热所迫。而上行也。或云。肺既痿而不用。则饮食游溢之精气。不能分
布诸经。而但上溢口。亦通。（案此徐注。）口中辟辟燥者。魏氏以为肺痈之痰涎脓血。俱蕴蓄结聚于肺脏
之内。故口中反干燥。而但辟辟作空响燥咳而已。然按下肺痈条亦云。其人咳。咽燥不渴。多唾浊沫。则肺
痿肺痈二证多同。惟胸中痛。脉滑数唾脓血。则肺痈所独也。比而论之。痿者萎也。（案巢源。作肺
萎。）如草木之萎。而不荣。为津烁而肺焦也。痈者。壅也。如土之壅而不通。为热聚而肺 也。（案急
就篇颜注。痈之言壅也。气壅痞结。重肿而溃也。是。）故其脉有虚实不同。而其数则一也。
〔徐〕实者。即上滑字。义自见。
案肺痿非此别一病。即是后世所谓劳嗽耳。外台苏游传尸论云。其初得半卧半起。号为 。气急咳者。
名曰肺痿。许仁则论云肺气嗽者。不限老少。宿多上热。后因饮食将息伤热。则常嗽不断。积年累岁。肺气
衰。便成气嗽。此嗽不早疗。遂成肺痿。若此将成。多不救矣。又云。肺气嗽。经久将成肺痿。其状不限四
时冷热。昼夜嗽常不断。唾白如雪。细沫稠粘。喘息气上。乍寒乍热。发作有时。唇口喉舌干焦。
亦有时唾血者。渐觉瘦悴。小便赤。颜色青白毛耸。此亦成蒸。又云。肺气嗽。经久有成肺痈者。其状与
前肺痿不多异。但唾悉成脓出。陈氏妇人良方。劫劳散证治云。劳嗽寒热盗汗。唾中有红线。名曰肺痿。注
家俱为别病。而诠释之者何。快。与 同。梁书姚僧垣曰。大黄快药是也。魏云。辟辟唾
声。恐非。盖辟辟。干燥貌。张氏医通云。言咳者。口中不干燥也。若咳而口中辟辟燥。则是肺已结痈。
火热之毒。出见于口。此说近是。
程氏医径句测云。气虚不能化血。故血干不流。只随火势沸上。火亢乘金。不生气血。而生痰。可知
无血无液。而枯金被火。肺叶安得不焦。故欲退彼之火。须是补我之金。金得补而生液。则水从液滋。火从
液化也。盖肺处脏之最高。叶间布有细窍。此窍名泉眼。凡五脏之蒸溽。从肺 吸入之。
只是气从泉眼呼出之。便成液。息息不穷。以灌溉周身者。皆从此出。此即人身之星宿海也。一受火炎。呼
处成吸。有血即从此眼渗入。碍去窍道。便令人咳。咳则见血。愈咳愈渗。愈渗愈嗽。久则泉眼俱闭。吸时
徒引火升喉间。或痒或呛。呼时并无液出。六叶遂枯遂焦。此肺痿之由也。
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。风则中于卫。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。（多唾浊沫之多字。赵本。作时。脉经。无血为之凝滞之之字。）
〔尤〕此原肺痈之由。为风热蓄结不解也。凡言风脉多浮或缓。此云微者。风入营而增热。故脉不浮而
反微。且与数俱见也。微则汗出者。气伤于热也。数则恶寒者。阴反在外也。呼气不入者。气得风而浮。利出
而艰入也。吸而不出者。血得热而壅。气亦为之不伸也。肺热而壅。故口干而喘满。热在血中。故咽燥而不
渴。且肺被热迫。而反从热化。为多唾浊沫。热盛于里。而外反无气。为时时振寒。由是热蓄不
解。血凝不通。而痈脓成矣。吐如米粥。未必便是死证。至浸淫不已。肺叶腐败。则不可治矣。故曰
始萌可救。脓成则死。
案金鉴云。肺痈之上。当有肺痿二字。不然。本文论肺痿之义。则无着落。必是脱简。盖多唾浊沫。肺
痿肺痈俱有之。而金鉴以为独肺痿有之。而肺痈所无。因为脱文。误甚。又云。脉微之三微字。当是三浮字。
微字文气不属。必是传写之讹。虽未知原文果然否。此可以备一说也。
危氏得效方云。始萌易治。脓成难治。诊其脉数而实已成。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。
李氏入门云。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。
潘氏续焰云。试肺痈法。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。案今验果如其言。
又以双箸断之。其断为两段者是脓。其粘着不断者是痰。亦一试法也。
兰台轨范云。肺痈之疾。脓成亦有愈者。全在用药变化。汉时治法。或未全耳。
上气面浮肿肩息。其脉浮大不治。又加利尤甚。
〔魏〕面浮肿。阳衰于中。而气散于上也。肩息者。至人之息。息以踵。今息以肩。气元已铲其根。而
浮游之气。呼吸于胸膈之上也。诊之脉浮大。必浮大而沉微。且欲绝也。
俱为上盛下绝。加以下利。阴又下泄。阳必上越。其死尤速也。此上气之阳虚。气脱之重者。
案上气。诸家不释。考周礼天官疾医职云。嗽上气。郑玄注。上气。逆喘也。此一节。即是肺胀不治之证。
上气喘而躁者。属肺胀。欲作风水。发汗则愈。
〔沈〕此见肺痈当有肺胀之辨也。邪伤于卫后入于营。而为肺痈。此风伤于卫。内挟痰涎。壅逆肺气。
上逆奔迫。故喘而躁。是为肺胀。然有肺气壅逆。不得通调水道。水即泛滥皮肤。故曰欲作风水。治
宜发汗驱风。从表而出。水即下渗。即下条小青龙之证也。
案肺胀一证。诸家未有云后世某证者。考下文云。肺胀咳而上气。又云。咳而上气。此为肺胀。由此
观之。即后世所谓呷嗽哮嗽之属。巢源云。痰气相击。随嗽动息。呼呷有声。谓之呷嗽。本事续方云。哮嗽
如拽锯。是也。
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。（若以下九字。
脉经无。千金作若渴者属消渴法六字。为细注。）
〔魏〕肺痿为虚热之证矣。然又有肺痿而属之虚寒者。则不可不辨也。乃吐涎沫而不咳。其人既不渴。又
遗尿。小便数者。以上虚不能制水故也。肺气既虚。而无收摄之力。但趋脱泄之势。膀胱之阳气下脱。而肺
金益清冷。干燥以成痿也。肺叶如草木之花叶。有热之痿。如日炙之则枯。有冷之痿。如霜杀之则干矣。此
肺冷之所以成痿也。
〔尤〕头眩多涎唾者。经云。上虚则眩。又云上焦有寒。其口多涎也。甘草
干姜。甘辛合用。为温肺复气之剂。服后病不去。而加渴者。
则属消渴。盖小便数而渴者。为消。不渴者。非下虚。即肺冷也。
甘草干姜汤方
甘草（四两炙） 干姜（二两炮）
上 咀。以水三升。煮取一升五合。去滓。分温再服。
（千金注云。集验肘后。有大枣十二枚。）
案此即用伤寒得之便厥者。以复其阳之甘草干姜汤。取理中之半。而回其阳者。此证虽云肺中冷。其
源未曾不由胃阳虚乏。故主以此方。盖与大病瘥后喜唾者。主以理中汤意略同。
咳而上气。喉中水鸡声。射干麻黄汤主之。（外台。引短剧。水上有如字。云。此本仲景伤寒论方。）
〔鉴〕咳逆上气。谓咳则气上冲逆也。水鸡声者。谓水与气相触之声。在喉中连连不绝也。
〔徐〕凡
咳之上气者。皆为有邪也。其喉中水鸡声。乃痰为火所吸不能下。然火乃风所生。水从风战。而作声耳。故以
麻黄细辛。驱其外邪为主。以射干开结热气。行水湿毒。尤善清肺气者为臣。而余皆降
逆消痰。宣散药。唯五味一品。以收其既耗之气。令正气自敛。邪气自去。恐肺气久虚。不堪劫散也。
巢源云。肺病令人上气。兼胸膈痰满。气行壅滞。喘息不调。致咽喉有声。如水鸡之鸣也。案水鸡二
种。本草苏颂云。蛙。即今水鸡是也。又司马相如传颜注。庸渠。一名水鸡。即本草所谓 也。此云水鸡。盖
指蛙而言。取其鸣声连连不绝耳。
射干麻黄汤方
射干（十三枚一法三两） 麻黄（四两） 生姜（四两） 细辛 紫菀 款冬
花（各三两） 五味子（半升） 大枣（七枚） 半夏（大者洗八枚一法半升）
上九味。以水一斗二升。先煮麻黄两沸。去上沫。纳诸
药。煮取三升。分温三服。（千金。用射干三两。半夏半升。外台。水上。有东流二字。）
案此治肺胀之方。凡本篇诸条。肺痿肺痈之外。悉属肺胀。读者宜自知耳。
千金麻黄汤 治上气脉浮。咳逆喉中水鸡声。喘急不通。呼吸欲死。（外台。引深师。同。）
于本方内。去生姜细辛紫菀款冬花五味半夏。
圣惠射干散 治小儿咳嗽。心胸痰壅。攻咽喉作呀呷声。
于本方。去大枣细辛款冬五味。加桂心。临用入蜜。
咳逆上气。时时唾浊。但坐不得眠。皂荚丸主之。（唾。赵本。作吐。）
〔徐〕此比水鸡声。乃咳而上气中之逆甚者也。
〔尤〕浊。浊痰也。时时吐浊者。肺中之痰。随上气而
时出也。然痰虽出。而满不减。则其本有固而不拔之势。不迅而扫之不去也。皂荚味辛入肺。除痰之力最猛。
饮以枣膏。安其正也。
〔魏〕皂荚驱风理痹。正为其有除瘀涤垢之能也。如今用皂荚澡浴。
以除垢腻。即此理也。
〔沈〕皂荚能开诸窍。而驱风痰最疾。服三丸者。是取峻药缓散之意也。
皂荚丸方
皂荚（八两刮去皮用酥炙○外台引深师作长大皂荚一挺去皮子炙不用酥炙）
上一味。末之。蜜丸梧子大。以枣膏和汤。服三丸。日
三夜─服。（外台。三丸。作一丸云。千金。经心录。延年同。此本仲景伤寒论方。
一名枣膏丸。○案酥。本草。除胸中客热。）
兰台轨范云。稠痰粘肺。不能清涤。非此不可。
外台。必效。疗病喘息气急。喉中如水鸡声者。无问年月远近方。
肥皂荚（两挺） 好酥（一两）
上二味。于火上炙。去火高一尺许。以酥细细涂之。数翻覆令得所。酥尽止。以刀轻刮去黑皮。然后
破之。去子皮筋脉。捣筛蜜和为丸。每日食后服一丸。如熟豆。日一服讫。
取一行微利。如不利。时细细量。加以微利为度。日止一服。
咳而脉浮者。浓朴麻黄汤主之。脉沉者。泽漆汤主之。
（脉沉上。尤补咳而二字。原本脉沉以下。别列于浓朴麻黄汤方后。今根据徐程诸家注本移于此。）
〔尤〕此不详见证。而但以脉之浮沉为辨。而异其治。按浓朴麻黄汤。与小青龙加石膏汤大同。则散
邪蠲饮之力居多。而浓朴辛温。亦能助表。小麦甘平。则同五味敛安正气者也。
泽漆汤。以泽漆为主。而以白前黄芩半夏佐之。则下趋之力较猛。虽生姜桂枝之辛。亦只为下气降逆之用而
已。不能发表也。仲景之意。盖以咳皆肺邪。而脉浮者气多居表。故驱之使从外出为易。脉沉者气多居里。故
驱之使从下出为易。亦因势利导之法也。
〔鉴〕李 曰。咳者水寒射肺也。脉浮者停水。而又挟风以鼓之也。
麻黄。去风散肺逆。与半夏细辛干姜五味子石膏同用。即前小青龙加石膏。为解表行水之剂
也。然土能制水。而地道壅塞。则水亦不行。故用浓朴。疏
敦阜之土。使脾气健运。而水自下泄矣。杏仁。下气去逆。小麦。入心经。能通火气。以火能生脾。助脾而去
成决水之功也。又云。脉沉为水。泽漆为君者。因其功专于消痰行水也。水性阴寒。桂枝。行阳气以导之。
然所以停水者。以脾土衰不能制水。肺气逆不能通调水道。故用人参紫参白前甘
草。补脾顺肺。同为制水利水之方也。黄芩。苦以泄之。半夏生姜。辛以散之也。
浓朴麻黄汤方
浓朴（五两） 麻黄（四两） 杏仁（半升） 石膏（如鸡子大○千金作三两） 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。纳诸药。煮取三升。温服一升。日三服。
千金浓朴麻黄汤 治咳而大逆上气。胸满喉中不利。如水鸡声。其脉浮者。方与本篇同。案本
篇唯云咳而脉浮。恐是脱遗。千金所载。却是旧文。
(The *Mai Jing* [Classic of Pulse Diagnosis] combines the following content on Yin Pathology and Cough into one chapter.)
Question: When heat is in the Upper Jiao (Upper Burner), coughing leads to Lung Wei (Flaccidity Syndrome of the Lung). How is this disease of Lung Wei acquired? The Master replied: It may arise from excessive sweating, from vomiting, from Xiao Ke (Wasting-Thirst Disease) causing frequent urination, or from difficulty in defecation followed by the misuse of drastic purgatives that cause severe diarrhea. These factors severely deplete Body Fluids (Jin Ye), thus leading to the disease. Question: If the Cun (Inch) pulse is rapid, the person coughs, yet the mouth produces turbid saliva and froth instead of dryness, what is the reason? The Master said: This indicates Lung Wei. However, if the mouth feels dry, coughing is accompanied by a dull pain in the chest, and the pulse is slippery and rapid, this is Lung Abscess (Fei Yong), characterized by coughing up pus and blood. A rapid but deficient pulse indicates Lung Wei; a rapid and excess pulse indicates Lung Abscess. (*Note: The "Wen" [Question] character appears above in the Mai Jing, dividing it into two sections. "Kuai Yao" [drastic medicine] is written as "Yao". Coughing up pus and blood are treated as separate items in the Mai Jing and Qian Jin Fang. Cheng Lin and Wu Qian's Yi Zong Jin Jian correctly connect them to the preceding text on Lung Abscess.*)
[You Yujing]: This uses hypothetical questions and answers to distinguish between Lung Wei and Lung Abscess. The phrase "Heat in the Upper Jiao" appears in the chapter on Five Zang Organs, Wind-Cold, Accumulation, and Distension. It seems the Master made such a statement, which was later used as a question. Sweating, vomiting, Xiao Ke, and excessive loss through urination and defecation all suffice to deplete Body Fluids and generate Dryness-Heat. With the Lung both deficient and hot, flaccidity occurs. The presence of turbid saliva and froth in the mouth suggests that Lung fluids are forced upward by Heat. Some argue that since the Lung is flaccid and non-functional, the essence derived from food and drink cannot distribute to the meridians and merely overflows into the mouth; this explanation is also plausible. (Commentary: This is Xu Lingtai's annotation.) A sensation of dryness in the mouth ("Pi Pi Zao") is explained by Wei Liting as due to phlegm, saliva, pus, and blood accumulating within the Lung organ in Lung Abscess, causing oral dryness and only empty, dry coughing sounds. However, checking the Lung Abscess section below, it states: "The person coughs, throat is dry but not thirsty, and produces much turbid froth." Thus, Lung Wei and Lung Abscess share many symptoms. Only chest pain, a slippery-rapid pulse, and coughing up pus and blood are unique to Lung Abscess. Comparatively, "Wei" means "Wilting," like plants losing vitality due to fluid scorching and Lung charring. "Yong" means "Obstruction," like soil blocking flow, caused by Heat aggregation obstructing the Lung. Hence, their pulses differ in deficiency and excess, but both feature a rapid pulse.
[Xu Lingtai]: "Excess" refers to the "slippery" mentioned earlier; the meaning is self-evident.
Annotation: Lung Wei is not a distinct disease separate from this context but corresponds to what later generations called "Laborious Cough" (Lao Sou). The *Wai Tai Mi Yao* cites Su You's *Chuan Shi Lun*: Initially, the patient lies half-up, termed "Shi Zhu"; with shortness of breath and cough, it is named Lung Wei. Xu Renze discusses: "Lung Qi Cough" affects young and old alike, often involving upper heat. Improper diet exacerbates heat, causing persistent cough. Over years, Lung Qi declines, becoming Qi Cough. If untreated early, it becomes Lung Wei, which is often incurable at this stage. Furthermore, prolonged Lung Qi Cough leading to Lung Wei presents regardless of season, with day-and-night coughing, white frothy sputum like snow, thick sticky drool, panting, alternating chills and fever, dry lips/throat/tongue, occasional hemoptysis, emaciation, red urine, pale/blue complexion, and erect body hair, indicating steaming heat. Prolonged Lung Qi Cough may also develop into Lung Abscess, similar to Lung Wei but expelling pure pus. Chen Shi's *Fu Ren Liang Fang* describes Laborious Cough with chills, fever, night sweats, and red lines in sputum as Lung Wei. Commentators treat it as a different disease; why? "Kuai" is synonymous with "Xie." The *Book of Liang* mentions Da Huang as a Kuai Yao. Wei argues "Pi Pi" refers to spitting sounds, which is likely incorrect; "Pi Pi" denotes dryness. Zhang Lu's *Zhang Shi Yi Tong* states: In cough, the mouth is usually not dry. If coughing accompanies oral dryness, it indicates Lung Abscess formation where fire-toxicity manifests orally. This view is closer to truth.
Cheng Guopeng's *Yi Xue Xin Wu* explains: Qi deficiency fails to transform blood, leading to dry, stagnant blood rising with fire. Excessive Fire controls Metal (Lung), failing to generate Qi/Blood, instead producing Phlegm. Without blood/fluids, the withered Metal burns, causing Lung leaves to char. To extinguish external fire, one must tonify internal Metal. Tonified Metal generates fluids; fluids nourish Water, and liquid化解 Fire. The Lung sits highest among organs, with fine pores called "Spring Eyes." Steam from Five Zang enters the Lung; Qi exhaled from these eyes becomes fluid, irrigating the body endlessly—this is the "Star River Sea" of the body. Once inflamed by fire, inhalation turns into leakage; blood seeps through these eyes, blocking passages, causing cough and hemoptysis. Persistent coughing worsens leakage until Spring Eyes close. Inhalation draws fire to the throat (itching/choking); exhalation yields no fluid. Six Lung lobes wither and char—this is the origin of Lung Wei.
Question: Regarding cough and rebellious Qi, how can we diagnose Lung Abscess via pulse, knowing pus and blood will appear, and expect death upon expectoration? What does the pulse resemble? The Master said: The Cun pulse is faint and rapid. Faint indicates Wind; Rapid indicates Heat. Faint implies sweating; Rapid implies aversion to cold. Wind attacks the Defensive (Wei) level, making exhalation difficult to retain; Heat penetrates the Nutritive (Ying) level, making inhalation difficult to release. Wind damages skin/hair; Heat damages vessels/blood. Wind lodging in the Lung causes cough, dry mouth, panting/fullness, dry throat without thirst, profuse turbid froth, and periodic chills. Where Heat passes, blood stagnates, accumulating into abscess pus, expelled like rice porridge. Early stages are curable; once pus forms, it is fatal. (Note: "Duo" [much] in "duo tuo zhuo mo" is written as "Shi" [often] in Zhao Ben. The character "Zhi" in "xue wei zhi ning zhi" is absent in Mai Jing.)
[You Yujing]: This traces Lung Abscess etiology to unresolved Wind-Heat accumulation. Wind pulses are typically floating or slow; here "faint" indicates Wind entering Ying increasing Heat, hence not floating but faint, appearing with rapid. Faint sweating results from Qi damaged by Heat. Rapid aversion to cold occurs because Yin floats outward. Difficulty retaining exhalation stems from Wind-floating Qi being easy to exhale but hard to inhale. Difficulty releasing inhalation stems from Heat-stagnated Blood restricting Qi. Lung Heat obstruction causes dry mouth/panting. Heat in Blood causes dry throat/no thirst. Lung forced by Heat transforms into turbid froth. Internal Heat excess with external Qi deficiency causes periodic chills. Unresolved Heat and stagnant Blood form abscess pus. Expelling rice-porridge-like pus isn't immediately fatal; death comes when pus spreads indefinitely, rotting Lung tissue. Hence, early cure is possible; post-pus formation is fatal.
Annotation: Wu Qian's *Yi Zong Jin Jian* argues "Lung Wei" should precede "Lung Abscess" to provide context for the discussion on Lung Wei, suggesting a missing slip. He claims "profuse turbid froth" belongs only to Lung Wei, not Abscess, calling it a textual error. He also suggests three instances of "Faint" (Wei) should be "Floating" (Fu) due to grammatical inconsistency, though original text status is unknown.
Wei Yilin's *De Xiao Fang* states: Early stages easy to treat; pus formation difficult. Rapid/excess pulse indicates established disease; faint/rough pulse indicates recovery. Pale face with stopped pus-vomiting indicates self-healing. Pus with food-vomiting, red face, and rice-porridge-like pus expulsion indicates incurability. Men, governed by Qi, have 20-30% survival; Women, governed by Blood, have 70-80% survival. Tested repeatedly, it holds true.
Li Chan's *Yi Xue Ru Men* notes: Lung Abscess features rapid/deficient pulse, dry mouth/throat, dull chest/hypochondriac pain, red/astringent urination/stool, and foul-smelling pus-blood expectoration that sinks in water.
Pan Ji's *Yi Deng Xu Yan* describes testing for Lung Abscess: Chest dull pain, coughing smelly sputum. Sputum sinking in water indicates abscess pus; floating indicates phlegm. Verified clinically. Another test: Break sputum with chopsticks. Broken segments indicate pus; sticky/unbroken strands indicate phlegm.
Xu Dacun's *Lan Tai Gui Fan* notes: Even with formed pus, Lung Abscess can heal depending on medication adjustment. Han dynasty treatments may have been incomplete.
Rebellious Qi with facial edema and shoulder-respiration (accessory muscle breathing), with a floating-large pulse, is untreatable. Diarrhea makes it worse.
[Wei Liting]: Facial edema indicates Middle Jiao Yang failure and Qi scattering upward. Shoulder-respiration shows Yuan Qi root destroyed, with floating Qi respiring only in the chest/diaphragm. Floating-large pulse implies deep palpation reveals faint/near-extinction pulse. This represents Upper Excess/Lower Extinction. Diarrhea drains Yin downward, forcing Yang upward, accelerating death. This is severe Yang deficiency and Qi collapse in Rebellious Qi.
Annotation: "Shang Qi" [Rebellious Qi] is undefined by commentators. *Zhou Li* defines it as "reverse panting." This section describes untreatable Fei Zhang (Lung Distension).
Panting with irritability belongs to Fei Zhang, intending to become Feng Shui (Wind Edema). Sweating induces recovery.
[Shen Mingzong]: This distinguishes Fei Zhang from Lung Abscess. After Wei damage enters Ying forming Abscess, here Wind damages Wei, carrying Phlegm to obstruct Lung Qi, causing reverse rushing, panting, and irritability—Fei Zhang. Obstructed Lung Qi fails to regulate water passages, flooding skin as Feng Shui. Treatment requires diaphoresis to expel Wind externally, allowing water to drain downward, akin to Xiao Qing Long Tang syndrome.
Annotation: Fei Zhang is not explicitly linked to later syndromes by commentators. Later texts describe "Fei Zhang cough with rebellious Qi" and "Cough with rebellious Qi is Fei Zhang." This corresponds to later "Xia Sou" (Barking Cough) and "Xiao Sou" (Wheezing Cough). Chao Yuanfang defines Xia Sou as phlegm-Qi collision causing barking sounds during respiration. Xue Ji's *Ben Shi Xu Fang* compares Xiao Sou to sawing wood.
Lung Wei with salivation but no cough, non-thirsty, inevitably enuresis and polyuria. Reason: Upper Deficiency fails to control Lower. This is Cold in the Lung, causing dizziness and excessive saliva/phlegm. Treat with Gan Cao Gan Jiang Tang to warm. If thirst develops after taking the decoction, it indicates Xiao Ke. (Note: "Ruo fu tang yi zhe shu Xiao Ke" [If after taking medicine one feels thirsty, it belongs to Xiao Ke] is absent in Mai Jing; Qian Jin Fang lists it as a small note.)
[Wei Liting]: Lung Wei is typically Deficient-Heat, but Deficient-Cold types exist and must be distinguished. Salivation without cough, non-thirsty, enuresis/polyuria result from Upper Deficiency failing to control Water. Lung Qi deficiency lacks grasping power, trending toward collapse. Bladder Yang collapses downward, making Lung Metal colder/drier, forming Wei. Like flowers wilting in sun (Heat) or drying in frost (Cold), Cold Lung causes Wei.
[You Yujing]: Dizziness and salivation stem from Upper Deficiency causing dizziness and Upper Jiao Cold causing salivation. Gan Cao + Gan Jiang (Sweet-Pungent combination) warms Lung and restores Qi. If illness persists and thirst increases post-medication, it indicates Xiao Ke. Polyuria+thirst = Xiao Ke; Non-thirsty = Lower Deficiency or Lung Cold.
Gan Cao Gan Jiang Tang Formula
Gan Cao (4 liang, honey-fried) Gan Jiang (2 liang, roasted)
Crush ingredients. Decoct in 3 sheng water to yield 1.5 sheng. Strain. Divide into two warm doses.
(*Qian Jin* note: *Ji Yan* and *Zhou Hou* add 12 Da Zao.)
Annotation: This adapts the *Shang Han Lun* formula for reversing cold limbs to restore Yang, using half the *Li Zhong Tang* concept. Though labeled "Cold in Lung," the root is Stomach Yang deficiency. Similar to treating post-illness salivation with *Li Zhong Tang*.
Cough with rebellious Qi, throat sound like a water-frog, treated with She Gan Ma Huang Tang. (*Wai Tai* cites *Duan Ju*, adding "Ru" [like], noting this originates from Zhang Zhongjing's *Shang Han Lun*.)
[Wu Qian]: "Ke Ni Shang Qi" means cough with Qi rushing upward. "Shui Ji Sheng" [Water-frog sound] is the noise of water and Qi colliding continuously in the throat.
[Xu Lingtai]: Cough with rebellious Qi always involves pathogenic factors. The frog-sound arises from Phlegm trapped by Fire unable to descend; Fire is generated by Wind, Water battles Wind creating sound. Ma Huang and Xi Xin expel exterior pathogens primarily. She Gan opens heat-nodes and clears Lung Qi as Minister herbs. Others descend Qi and resolve Phlegm. Wu Wei Zi alone consolidates depleted Qi, preventing further depletion from harsh dispersants.
Chao Yuanfang: Lung disease causes rebellious Qi, chest/phlegm fullness, obstructed Qi flow, irregular panting, and throat sounds like frogs. Note: "Shui Ji" refers to frogs (or possibly toads), chosen for their continuous croaking.
She Gan Ma Huang Tang Formula
She Gan (13 pieces, ~3 liang) Ma Huang (4 liang) Sheng Jiang (4 liang) Xi Xin Zi Wan Kun Dong Hua (each 3 liang) Wu Wei Zi (0.5 sheng) Da Zao (7 pieces) Ban Xia (8 large pieces, washed, ~0.5 sheng)
Nine ingredients. Decoct in 12 sheng water. Boil Ma Huang first (two boils), skim foam. Add remaining herbs. Cook to 3 sheng. Divide into three warm doses.
(*Qian Jin*: She Gan 3 liang, Ban Xia 0.5 sheng. *Wai Tai*: Adds "East-flowing" to water instruction.)
Annotation: This treats Fei Zhang. All chapters in this section, except Lung Wei/Abscess, relate to Fei Zhang.
Qian Jin Ma Huang Tang: Treats rebellious Qi, floating pulse, cough/frog-sound, severe panting, respiratory distress. (*Wai Tai* cites *Shen Shi*, identical.*)
Formula: Remove Sheng Jiang, Xi Xin, Zi Wan, Kun Dong Hua, Wu Wei Zi, Ban Xia from the base formula.
Sheng Hui She Gan San: Treats pediatric cough, chest/phlegm obstruction, throat obstruction sounds.
Formula: Remove Da Zao, Xi Xin, Kun Dong, Wu Wei Zi; add Gui Xin. Add honey before use.
Cough with rebellious Qi, frequent expectoration of turbid matter, inability to lie down, treated with Zao Jiao Wan. (Zhao Ben writes "Tu" [vomit] instead of "Tuo" [spit].)
[Xu Lingtai]: Compared to frog-sound, this is more severe rebellious Qi in cough.
[You Yujing]: "Zhuo" is turbid phlegm. Frequent expectoration means Lung phlegm exits with rebellious Qi. However, fullness remains, indicating stubborn phlegm requiring forceful clearance. Zao Jiao (Soap Pod) is pungent, enters Lung, and has potent phlegm-resolving power. Dates paste protects healthy Qi.
[Wei Liting]: Zao Jiao expels Wind and resolves bi-syndrome by removing stasis/dirt, similar to using it for bathing grease.
[Shen Mingzong]: Zao Jiao opens orifices and rapidly expels Wind-Phlegm. Taking three pills reflects the strategy of using harsh medicine slowly.
Zao Jiao Wan Formula
Zao Jiao (8 liang, scraped skin, fried in su [animal fat] ○ *Wai Tai* cites *Shen Shi*: Large pod, skinned, roasted without su)
Grind into powder. Honey-pill size of wu zi (walnut seed). Take three pills mixed with date paste decoction, three times day, once night.
(*Wai Tai*: One pill. *Qian Jin*, *Jing Xin Lu*, *Yan Nian* agree. Originates from *Shang Han Lun*, also called Zao Gao Wan. ○ Annotation: Su removes chest heat per *Ben Cao*.)
*Xu Dacun*: For thick phlegm adhering to Lung, this is essential.
*Wai Tai Bi Xiao Fang*: For panting/rebellious Qi with frog-sound, regardless of duration.
Soap Pods (2 large) Hao Su (1 liang)
Roast pods over fire (1 chi high), coat thinly with Su, flip until absorbed. Scrape black skin, remove seeds/membranes, grind, mix with honey into pills. Take one pill post-meal (size of cooked bean), once daily. Induce mild diarrhea; adjust dosage if ineffective. Stop after one daily dose.
Cough with floating pulse: Niu Po Ma Huang Tang. Cough with sinking pulse: Ze Qi Tang.
(Note: You Yi adds "Ke Er" [And cough] before "Mai Chen". Originally placed after Niu Po Ma Huang Tang formula; moved here per Xu/Cheng annotations.)
[You Yujing]: Diagnosis relies solely on pulse floating/sinking. Niu Po Ma Huang Tang resembles Xiao Qing Long Jia Shi Gao Tang, focusing on expelling pathogens and draining fluid. Niu Po aids exterior; Xiao Mai calms Zheng Qi like Wu Wei Zi. Ze Qi Tang uses Ze Qi as sovereign, Bai Qian/Huang Qin/Ban Xia as ministers, strongly directing downward. Ginger/Cinnamon only assist descending Qi, not releasing exterior. Zhang Zhongjing's intent: Cough is Lung pathogen. Floating pulse (Qi in exterior) → expel outward. Sinking pulse (Qi in interior) → expel downward. This follows the principle of guiding according to trend.
[Wu Qian]: Li Zhongzi says: Cough is Cold-Water attacking Lung. Floating pulse indicates retained water aggravated by Wind. Ma Huang expels Wind/resolves Lung rebellion. Combined with Ban Xia/Xi Xin/Gan Jiang/Wu Wei Zi/Shi Gao, it acts as Xiao Qing Long Jia Shi Gao Tang (releasing exterior/draining water). Earth controls Water; if Earth is blocked, Water stagnates. Niu Po unblocks Earth, strengthening Spleen transport to drain Water. Xing Ren descends Qi. Xiao Mai enters Heart, conducts Fire to generate Spleen Earth, aiding water metabolism. Sinking pulse indicates Water. Ze Qi is sovereign for resolving phlegm/water. Water is Yin-Cold; Gui Xing guides Yang Qi. Stagnation occurs due to Spleen weakness and Lung rebellion. Ren Shen/Zi Can/Bai Qian/Gan Cao tonify Spleen/smooth Lung. Huang Qin drains bitterness; Ban Xia/Sheng Jiang disperses pungency.
Niu Po Ma Huang Tang Formula
Niu Po (5 liang) Ma Huang (4 liang) Xing Ren (0.5 sheng) Shi Gao (size of chicken egg, ~3 liang in *Qian Jin*) 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. Decoct in 12 sheng water. Boil Xiao Mai until cooked, strain. Add other herbs. Cook to 3 sheng. Warm dose 1 sheng, three times daily.
Qian Jin Niu Po Ma Huang Tang: Treats severe cough/rebellious Qi, chest fullness, throat obstruction, frog-sound, floating pulse. Formula same as main text. Annotation: Main text only says "Cough with floating pulse," likely missing text. *Qian Jin* preserves older text.