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。
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
但上溢于口。亦通。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。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。故其脉有虚实不同。而其数则一也。
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。风中于卫。呼气不入。热过于营。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。
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。
上气面浮肿。肩息。其脉浮大不治。又加利尤甚。上气喘而躁者。此为肺胀。欲作风水。发汗则
愈。
上气面浮肿。肩息。气但升而不降矣。脉复浮大。则阳有上越之机。脉偏盛者偏绝也。又加下利。
是阴复从下脱矣。阴阳离决。故当不治。肩息、息摇肩也。上气喘而躁者。水性润下。风性上行。水
为风激。气凑于肺。所谓激而行之。可使在山者也。故曰。欲作风水。发汗令风去。则水复其润下之
性矣。故愈。
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。
此举肺痿之属虚冷者。以见病变之不同。盖肺为娇脏。热则气烁。故不用而痿。冷则气沮。故亦
不用而痿也。遗尿、小便数者。肺金不用而气化无权。斯膀胱无制而津液不藏也。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。
咳而上气。喉中水鸡声。射干麻黄汤主之。
咳而上气。肺有邪。则气不降而反逆也。肺中寒饮。上入喉间。为呼吸之气所激。则作声如水鸡。
射干、紫菀、款冬降逆气。麻黄、细辛、生姜发邪气。半夏消饮气。而以大枣安中。五味敛肺。恐劫
散之药。并伤及其正气也。
射干麻黄汤方
射干（三两） 麻黄 生姜（各四两） 细辛 紫菀 款冬花（各三两） 大枣（七枚） 半夏
（半升） 五味（半升）
上九味。以水一斗二升。先煮麻黄两沸。去上沫。内诸药。煮取三升。分温三服。
咳逆上气。时时吐浊。但坐不得眠。皂荚丸主之。
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。
皂荚丸方
皂荚（八两刮去皮酥炙）
上一味。末之。蜜丸梧子大。以枣膏和汤。服三丸。日三夜一服。
咳而脉浮者。浓朴麻黄汤主之。咳而脉沉者。泽漆汤主之。
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。
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（六升） 干姜 细辛
（各二两） 小麦（一升） 五味（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。
泽漆汤方
半夏（半升） 泽漆（三升以东流水五斗煮取一斗五升） 紫参 生姜 白前（各五两） 甘草
黄芩 人参 桂枝（各三两）
上九味。 咀。内泽漆汤中。煮取五升。温服五合。至夜尽。
火逆上气。咽喉不利。止逆下气。麦门冬汤主之。
火热挟饮致逆。为上气。为咽喉不利。与表寒挟饮上逆者悬殊矣。故以麦冬之寒治火逆。半夏之辛治
饮气。人参、甘草之甘。以补益中气。盖从外来者。其气多实。故以攻发为急。从内生者。其气多虚。
则以补养为主也。
麦门冬汤方
麦门冬（七升） 半夏（一升） 人参 甘草（各二两） 粳米（三合） 大枣（十二枚）
上六味。以水一斗二升。煮取六升。温服一升。日三夜一服。
肺痈喘不得卧。葶苈大枣泻肺汤主之。
肺痈喘不得卧。肺气被迫。亦已甚矣。故须峻药顿服。以逐其邪。葶苈苦寒。入肺泄气闭。加大
枣甘温以和药力。亦犹皂荚丸之饮以枣膏也。
葶苈大枣泻肺汤方
葶苈（熬令黄色捣丸如鸡子大） 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。
咳而胸满振寒。脉数。咽干不渴。时出浊唾腥臭。久久吐脓如米粥者。为肺痈。桔梗汤主之。
此条见证。具如前第二条所云。乃肺痈之的证也。此病为风热所壅。故以苦梗开之。热聚则成毒。
故以甘草解之。而甘倍于苦。其力似乎太缓。意者痈脓已成。正伤毒溃之时。有非峻剂所可排击者。
故药不嫌轻耳。后附外台桔梗白散。治证与此正同。方中桔梗、贝母同用。而无甘草之甘缓。且有巴
豆之毒热。似亦以毒攻毒之意。然非病盛气实。非峻药不能为功者。不可侥幸一试也。是在审其形之
肥瘠。与病之缓急而善其用焉。
桔梗汤方
桔梗（一两） 甘草（二两）
上以水三升。煮取一升。分温再服。则吐脓血也。
咳而上气。此为肺胀。其人喘。目如脱状。脉浮大者。越婢加半夏汤主之。
外邪内饮。填塞肺中。为胀为喘。为咳而上气。越婢汤散邪之力多。而蠲饮之力少。故以半夏辅
其未逮。不用小青龙者。以脉浮且大。病属阳热。故利辛寒。不利辛热也。目如脱状者。目睛胀突。如
欲脱落之状。壅气使然也。
越婢加半夏汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 大枣（十五枚） 甘草（二两） 半夏（半升）
上六味。以水六升。先煮麻黄。去上沫。内诸药。煮取三升。分温三服。
肺胀。咳而上气。烦躁而喘。脉浮者心下有水。小青龙加石膏汤主之。
此亦外邪内饮相搏之证。而兼烦躁。则挟有热邪。麻、桂药中。必用石膏。如大青龙之例也。又
此条见证。与上条颇同。而心下寒饮则非温药不能开而去之。故不用越婢加半夏。而用小青龙加石膏。
温寒并进。水热俱捐。于法尤为密矣。
小青龙加石膏汤方
麻黄 芍药 桂枝 细辛 干姜 甘草（各三两） 五味 半夏（各半升） 石膏（二两）
上九味。以水一斗。先煮麻黄。去上沫。内诸药。煮取三升。强人服一升。羸者减之。日三服。小
儿服四合。
附方
外台炙甘草汤 治肺痿涎唾多。心中温温液液者。（方见虚劳）
千金甘草汤方
甘草一味。以水三升。煮减半。分温三服。
千金生姜甘草汤 治肺痿咳唾涎沫不止。咽燥而渴。
生姜（五两） 人参（三两） 甘草（四两） 大枣（十五枚）
上四味。以水七升。煮取三升。分温三服。
千金桂枝去芍药加皂荚汤 治肺痿吐涎沫。
桂枝 生姜（各三两） 甘草（二两） 大枣（十枚） 皂荚（一枚去皮子炙焦）
上五味。以水七升。微火煮取三升。分温三服。
按、以上诸方。俱用辛甘温药。以肺既枯痿。非湿剂可滋者。必生气行气以致其津。盖津生于气。
气至则津亦至也。又方下俱云。吐涎沫多不止。则非无津液也。乃有津液而不能收摄分布也。故非辛
甘温药不可。加皂荚者。兼有浊痰也。
外台桔梗白散 治咳而胸满振寒。脉数。咽干不渴。时出浊唾腥臭。久久吐脓如米粥者。为
肺痈。
桔梗 贝母（各三两） 巴豆（一分去皮熬研如脂）
上三味为散。强人饮服半钱匕。羸者减之。病在膈上者吐脓。在膈下者泻出。若下多不止。饮冷
水一杯则定。
千金苇茎汤 治咳有微热。烦满。胸中甲错。是为肺痈。
苇茎（二升） 薏苡仁（半升） 桃仁（五十粒） 瓜瓣（半升）
上四味。以水一斗。先煮苇茎得五升。去滓。内诸药。煮取二升。服一升。再服。当吐如脓。
按、此方具下热散结通瘀之力。而重不伤峻。缓不伤懈。可以补桔梗汤、桔梗白散二方之偏。亦
良法也。
葶苈大枣泻肺汤 治肺痈胸满胀。一身面目浮肿。鼻塞清涕出。不闻香臭酸辛。咳逆上气。
喘鸣迫塞。（方见上三日一剂可至三四剂先服小青龙汤一剂乃进）
按、此方原治肺痈喘不得卧。此兼面目浮。鼻塞清涕。则肺有表邪宜散。故先服小青龙一剂乃进。
又按、肺痈诸方。其于治效。各有专长。如葶苈、大枣。用治痈之始萌而未成者。所谓乘其未集
而击之也。其苇茎汤。则因其乱而逐之者耳。桔梗汤剿抚兼行。而意在于抚。洵为王者之师。桔梗白
散。则捣坚之锐师也。比而观之。审而行之。庶几各当而无误矣。
Question: When heat is located in the Upper Jiao (Upper Burner), it leads to Lung Flaccidity (Fei Wei, a condition characterized by lung tissue atrophy and weakness) due to coughing. How is this disease of Lung Flaccidity acquired? The Master said: It may arise from excessive sweating, or from vomiting, or from Xiao Ke (Wasting-Thirst syndrome, characterized by polydipsia, polyphagia, and polyuria) with frequent urination; or from constipation followed by purgation with harsh laxatives causing diarrhea, which severely depletes body fluids, thus leading to the disease.
Question: If the Cun Kou pulse is rapid, the patient coughs, and there is instead turbid saliva and froth in the mouth, what is the reason? The Master said: This is Lung Flaccidity. If the mouth feels dry, coughing causes a dull pain in the chest, and the pulse is instead slippery and rapid, this is Lung Abscess (Fei Yong, a suppurative inflammation of the lung), accompanied by coughing up pus and blood. A rapid but deficient pulse indicates Lung Flaccidity; a rapid but excess pulse indicates Lung Abscess.
This section uses a question-and-answer format to distinguish between Lung Flaccidity and Lung Abscess. The phrases "Heat in the Upper Jiao" are found in the chapter on Cold Damage and Heat Injury to the Five Zang Organs. It is likely that the Master had previously stated these words, and they were used here as a basis for inquiry. Sweating, vomiting, Xiao Ke, and excessive discharge from the bowels and urine all suffice to deplete body fluids and generate dryness-heat. When the Lung is deficient and hot, Flaccidity occurs. The presence of turbid saliva and froth in the mouth is because the fluids in the Lung are forced upward by heat. Some say that since the Lung is flaccid and non-functional, the essence and qi derived from food and drink cannot be distributed to the meridians, but instead overflow upwards into the mouth; this explanation is also plausible. A feeling of dryness in the mouth: Mr. Wei believed that the phlegm, saliva, pus, and blood of Lung Abscess accumulate and condense within the Lung organ, so the mouth becomes dry, resulting only in an empty, dry cough sound. However, according to the Lung Abscess clause, it also states: "The patient coughs, the throat is dry but there is no desire to drink, and there is much turbid froth." Thus, Lung Flaccidity and Lung Abscess share many similarities. Only chest pain, a slippery-rapid pulse, and coughing up pus and blood are unique to Lung Abscess. Comparatively, "Wei" (Flaccidity) means "Withering," like plants that wither and lose their luster, caused by fluid depletion and scorching of the Lung. "Yong" (Abscess) means "Obstruction," like soil that is blocked and不通 (unblocked), caused by heat accumulation and Lung Qi stagnation. Therefore, their pulses differ in deficiency and excess, but both are rapid.
Question: In cases of coughing and rebellious Qi, how can one diagnose Lung Abscess, which should involve pus and blood, where vomiting leads to death? 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 invades the Wei (Defensive) level, causing exhalation without inward movement; Heat exceeds the Ying (Nutritive) level, causing inhalation without outward movement. Wind damages the skin and hair; Heat damages the blood vessels. Wind lodges in the Lung, causing cough, dry mouth, wheezing, and chest fullness, dry throat without thirst, much turbid froth, and periodic chills. Wherever Heat passes, blood coagulates and stagnates, accumulating to form abscess pus, which is coughed up like rice porridge. If caught in its early stage, it can be saved; if the pus has formed, it is difficult to treat.
This explains the origin of Lung Abscess: it is caused by the accumulation and binding of Wind-Heat that does not resolve. Generally, Wind pulses are described as Floating or Slow. Here, "Faint" is used because Wind enters the Ying level and increases Heat, so the pulse is not Floating but Faint, appearing together with Rapid. Faint with sweating indicates Qi damaged by Heat; Rapid with aversion to cold indicates Yin floating outward. "Exhalation without inward movement" means Qi, affected by Wind, floats and moves out easily but enters with difficulty. "Inhalation without outward movement" means Blood, obstructed by Heat, prevents Qi from extending. Lung Heat and obstruction cause dry mouth, wheezing, and chest fullness; Heat in the Blood causes dry throat without thirst. Moreover, the Lung, forced by Heat, transforms according to Heat, producing much turbid froth; Heat excess internally leads to external Qi deficiency, causing periodic chills. Thus, Heat accumulates without resolving, blood coagulates without flowing, and abscess pus forms. Coughing up material like rice porridge is not necessarily fatal; it becomes incurable only when it spreads incessantly and the Lung lobes rot. Hence, it is said that early stages can be saved, but once pus forms, it is difficult to treat.
Rebellious Qi with facial edema and shoulder breathing (using accessory muscles to breathe), with a Floating-Large pulse, is untreatable; if diarrhea is added, the condition worsens further. Rebellious Qi with wheezing and restlessness indicates Lung Distension (Fei Zhang). It is about to develop into Feng Shui (Wind Edema); sweating will cure it.
Rebellious Qi with facial edema and shoulder breathing indicates Qi rising without descending. A Floating-Large pulse suggests Yang has a tendency to float upward; where the pulse is excessively strong, that side becomes depleted. Diarrhea indicates Yin collapsing downward. The separation of Yin and Yang makes it untreatable. "Shoulder breathing" refers to breathing with the shoulders moving. Rebellious Qi with wheezing and restlessness: Water nature is moistening and flows downward; Wind nature moves upward. Water agitated by Wind causes Qi to gather in the Lung, as described: "Agitate and move it, and it can flow over mountains." Thus, it is said to be developing into Feng Shui. Sweating disperses the Wind, allowing Water to resume its downward flow, hence recovery.
Lung Flaccidity presenting with spitting of froth but no coughing, without thirst, inevitably involves enuresis and frequent urination. The reason is that Upper Jiao deficiency fails to control the Lower Jiao. This is Cold in the Lung, accompanied by dizziness and excessive salivation. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) is used to warm it. If thirst develops after taking the decoction, it belongs to Xiao Ke (Wasting-Thirst).
This lists cases of Lung Flaccidity belonging to Deficiency-Cold to show variations in pathology. The Lung is a delicate organ; Heat scorches Qi, causing it to become non-functional and flaccid; Cold inhibits Qi, causing it to become non-functional and flaccid. Enuresis and frequent urination occur because Lung Metal fails to function, Qi transformation lacks authority, and the Bladder loses control, failing to store fluids. Dizziness and excessive salivation occur because, as the Classics state, Upper deficiency causes dizziness, and Upper Jiao Cold causes excessive salivation. Gan Cao (Licorice) and Gan Jiang (Dried Ginger), combined sweet and pungent, constitute a formula to warm the Lung and restore Qi. If the disease persists and thirst increases after administration, it belongs to Xiao Ke. Frequent urination with thirst indicates Xiao Ke; without thirst, it is either Lower deficiency or Lung Cold.
Gan Cao Gan Jiang Tang Formula
Zhi Gan Cao (Prepared Licorice Root, 4 liang) Pao Gan Jiang (Pounded Dried Ginger, 2 liang)
Crush the above two ingredients. Boil in 3 sheng of water to obtain 1.5 sheng. Strain. Divide into two doses and take warm.
Cough with rebellious Qi and a sound in the throat like a water fowl is treated with She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction).
Cough with rebellious Qi indicates Lung pathogenic factors causing Qi to rebel rather than descend. Cold-fluid retention in the Lung rises to the throat and is agitated by respiration, producing a sound like a water fowl. She Gan (Belamcanda Rhizome), Zi Wan (Aster Root), and Kuan Dong Hua (Coltsfoot Flower) direct rebellious Qi downward. Ma Huang (Ephedra Stem), Xi Xin (Asarum Root), and Sheng Jiang (Fresh Ginger) disperse pathogenic factors. Ban Xia (Pinellia Tuber) resolves fluid retention. Da Zao (Jujube Fruit) protects the Middle Jiao. Wu Wei Zi (Schisandra Berry) astringes the Lung, preventing dispersing herbs from damaging righteous Qi.
She Gan Ma Huang Tang Formula
She Gan (Belamcanda Rhizome, 3 liang) Ma Huang (Ephedra Stem, 4 liang) Sheng Jiang (Fresh Ginger, 4 liang) Xi Xin (Asarum Root, 3 liang) Zi Wan (Aster Root, 3 liang) Kuan Dong Hua (Coltsfoot Flower, 3 liang) Da Zao (Jujube Fruit, 7 pieces) Ban Xia (Pinellia Tuber, half sheng) Wu Wei Zi (Schisandra Berry, half sheng)
Take the above nine ingredients. Boil in 12 sheng of water. First boil Ma Huang for two boils, remove the foam on top. Add the remaining herbs. Boil to obtain 3 sheng. Divide into three doses and take warm.
Cough with rebellious Qi, frequent expectoration of thick turbid sputum, inability to lie down (only able to sit), is treated with Zao Jiao Wan (Gleditsia Sinensis Pill).
"Turbid" refers to thick sputum. Frequent expectoration of turbid sputum means phlegm in the Lung is expelled with rebellious Qi. However, if chest fullness does not decrease despite expectoration, the root cause has a solid, entrenched nature. Without swift sweeping action, it will not resolve. Zao Jiao (Gleditsia Sinensis Fruit) is pungent and enters the Lung; its phlegm-resolving power is strongest. Taking it with Zao Gao (Jujube Paste) protects righteous Qi.
Zao Jiao Wan Formula
Zao Jiao (Gleditsia Sinensis Fruit, 8 liang, scraped, skin removed, roasted in butter)
Grind the above single ingredient into powder. Form pills the size of Wutong seeds using honey. Take three pills mixed with Jujube Paste and water. Administer three times during the day and once at night.
Cough with a Floating pulse is treated with Hou Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction); cough with a Sinking pulse is treated with Ze Qi Tang (Phytolacca Decoction).
Here, specific symptoms are not detailed; differentiation is made solely based on whether the pulse is Floating or Sinking, guiding different treatments. Hou Po Ma Huang Tang is very similar to Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Plus Gypsum Decoction), possessing strong powers to disperse pathogens and eliminate fluid retention. Hou Po (Magnolia Bark) is pungent-warm and assists the exterior; Xiao Mai (Triticum Aestivum) is sweet-neutral, acting like Wu Wei Zi to astringe and calm righteous Qi. Ze Qi Tang uses Ze Qi (Phytolacca Radix) as the main ingredient, assisted by Bai Qian (Cynanchum Rhizome) and Huang Qin (Scutellaria Root), giving it a stronger downward-purging force. Although Sheng Jiang (Fresh Ginger) and Gui Zhi (Cinnamon Twig) are pungent, they are used only to direct Qi downward and subdue rebellion, not to release the exterior. Zhang Zhongjing's intent seems to be that while cough stems from Lung pathogens, a Floating pulse indicates Qi mostly residing in the Exterior, so driving it out via the exterior is easier; a Sinking pulse indicates Qi mostly residing in the Interior, so driving it out via the lower pathways is easier. This is the method of facilitating the natural trend.
Hou Po Ma Huang Tang Formula
Hou Po (Magnolia Bark, 5 liang) Ma Huang (Ephedra Stem, 4 liang) Shi Gao (Gypsum, size of a chicken egg) Xing Ren (Apricot Seed, half sheng) Ban Xia (Pinellia Tuber, 6 sheng) Gan Jiang (Dried Ginger, 2 liang) Xi Xin (Asarum Root, 2 liang) Xiao Mai (Triticum Aestivum, 1 sheng) Wu Wei Zi (Schisandra Berry, half sheng)
Take the above nine ingredients. Boil in 12 sheng of water. First boil Xiao Mai until cooked, strain. Add the remaining herbs. Boil to obtain 3 sheng. Take 1 sheng warm, three times daily.
Ze Qi Tang Formula
Ban Xia (Pinellia Tuber, half sheng) Ze Qi (Phytolacca Radix, 3 sheng, boiled in 5 dou of running east-flowing water to obtain 1.5 dou) Zi Shen (Bistort Root, 5 liang) Sheng Jiang (Fresh Ginger, 5 liang) Bai Qian (Cynanchum Rhizome, 5 liang) Gan Cao (Licorice Root, 3 liang) Huang Qin (Scutellaria Root, 3 liang) Ren Shen (Ginseng Root, 3 liang) Gui Zhi (Cinnamon Twig, 3 liang)
Crush the above nine ingredients. Add to the Ze Qi decoction. Boil to obtain 5 sheng. Take 0.5 sheng warm, finishing by nightfall.
Fire-pathogen rebellion causing Qi uprising and throat discomfort is treated with Mai Men Dong Tang (Ophiopogon Decoction) to stop rebellion and direct Qi downward.
Fire-Heat combined with fluid retention causes Qi rebellion, manifesting as rebellious Qi and throat discomfort. This differs significantly from Cold-Dampness combined with fluid retention causing upward rebellion. Therefore, Mai Men Dong (Ophiopogon Tuber)'s cold nature treats Fire-Rebellion; Ban Xia (Pinellia Tuber)'s pungency treats Fluid-Qi. Ren Shen (Ginseng Root) and Gan Cao (Licorice Root)'s sweetness tonifies Middle Qi. Pathogens coming from outside tend to be Excess, requiring urgent dispersal and attack; pathogens arising from inside tend to be Deficient, requiring nourishment and support.
Mai Men Dong Tang Formula
Mai Men Dong (Ophiopogon Tuber, 7 sheng) Ban Xia (Pinellia Tuber, 1 sheng) Ren Shen (Ginseng Root, 2 liang) Gan Cao (Licorice Root, 2 liang) Jing Mi (Rice, 3 he) Da Zao (Jujube Fruit, 12 pieces)
Take the above six ingredients. Boil in 12 sheng of water to obtain 6 sheng. Take 1 sheng warm, three times during the day and once at night.
Lung Abscess with wheezing and inability to lie down is treated with Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung).
In Lung Abscess with wheezing and inability to lie down, Lung Qi is severely oppressed. Thus, a potent medicine must be taken in a single dose to drive out the pathogen. Ting Li Zi (Descurainia Seed) is bitter-cold, entering the Lung to drain Qi closure. Da Zao (Jujube Fruit) is sweet-warm to harmonize the medicinal strength, similar to using Jujube Paste with Zao Jiao Wan.
Ting Li Da Zao Xie Fei Tang Formula
Ting Li Zi (Descurainia Seed, roasted until yellow, pounded into a pill the size of a chicken egg) Da Zao (Jujube Fruit, 12 pieces)
First boil Da Zao in 3 sheng of water to obtain 2 sheng. Remove the dates. Add Ting Li Zi. Boil to obtain 1 sheng. Take in one dose.
Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of foul-smelling turbid sputum, and long-term expectoration of pus like rice porridge indicates Lung Abscess. It is treated with Jie Geng Tang (Platycodon Decoction).
The symptoms described match those in the second clause above, representing the definitive presentation of Lung Abscess. This disease is caused by Wind-Heat obstruction, so Jie Geng (Platycodon Root) is used to open it. Heat aggregation becomes toxin, so Gan Cao (Licorice Root) is used to resolve it. Since the dosage of Gan Cao is double that of Jie Geng, its power seems too slow. Perhaps when the abscess pus has formed, righteous Qi is injured and toxins are breaking out, situations where potent medicines cannot forcefully expel them. Therefore, mild medicines are acceptable. The externally sourced Jie Geng Bai San (Platycodon and White Powder) treats the same condition. It combines Jie Geng (Platycodon Root) and Bei Mu (Fritillaria Bulb) without the moderating effect of Gan Cao, and includes Ba Dou (Croton Seed), implying a strategy of using toxicity to combat toxicity. However, this should not be attempted lightly unless the disease is severe and Qi is robust, requiring potent drugs for efficacy. One must carefully assess the patient's physique (fat or thin) and the urgency of the illness to apply it properly.
Jie Geng Tang Formula
Jie Geng (Platycodon Root, 1 liang) Gan Cao (Licorice Root, 2 liang)
Boil in 3 sheng of water to obtain 1 sheng. Divide into two doses and take warm. Pus and blood will then be vomited/coughed up.
Cough with rebellious Qi, indicating Lung Distension. The patient wheezes, eyes appear bulging (as if protruding), and the pulse is Floating-Large. It is treated with Yue Bi Jia Ban Xia Tang (Yue Bi Plus Pinellia Decoction).
External pathogens and internal fluid retention fill the Lung, causing distension, wheezing, and cough with rebellious Qi. Yue Bi Tang (Yue Bi Decoction) has strong pathogen-dispersing power but weak fluid-resolving power, so Ban Xia (Pinellia Tuber) is added to supplement this deficiency. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is not used because the Floating-Large pulse indicates Yang-Heat, favoring pungent-cold over pungent-warm. "Eyes like protruding" means the eyeballs bulge as if falling out, caused by obstructed Qi.
Yue Bi Jia Ban Xia Tang Formula
Ma Huang (Ephedra Stem, 6 liang) Shi Gao (Gypsum, half jin) Sheng Jiang (Fresh Ginger, 3 liang) Da Zao (Jujube Fruit, 15 pieces) Gan Cao (Licorice Root, 2 liang) Ban Xia (Pinellia Tuber, half sheng)
Take the above six ingredients. Boil in 6 sheng of water. First boil Ma Huang, remove the foam. Add the remaining herbs. Boil to obtain 3 sheng. Divide into three doses and take warm.
Lung Distension with cough, rebellious Qi, irritability, wheezing, and a Floating pulse, indicating water retention below the Heart, is treated with Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Plus Gypsum Decoction).
This is also a pattern of External Pathogen and Internal Fluid Retention interacting, complicated by irritability indicating Heat. Shi Gao (Gypsum) must be added to Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig), following the example of Da Qing Long Tang (Major Blue Dragon Decoction). Furthermore, although the symptoms resemble the previous clause, the Cold-Fluid retention below the Heart requires warm medicines to open and dispel it. Therefore, Yue Bi Jia Ban Xia Tang is not used; instead, Xiao Qing Long Jia Shi Gao Tang is chosen. Warmth and Cold are addressed simultaneously, removing both Water and Heat, making the treatment method particularly rigorous.
Xiao Qing Long Jia Shi Gao Tang Formula
Ma Huang (Ephedra Stem, 3 liang) Bai Shao (White Peony Root, 3 liang) Gui Zhi (Cinnamon Twig, 3 liang) Xi Xin (Asarum Root, 3 liang) Gan Jiang (Dried Ginger, 3 liang) Gan Cao (Licorice Root, 3 liang) Wu Wei Zi (Schisandra Berry, half sheng) Ban Xia (Pinellia Tuber, half sheng) Shi Gao (Gypsum, 2 liang)
Take the above nine ingredients. Boil in 10 sheng of water. First boil Ma Huang, remove the foam. Add the remaining herbs. Boil to obtain 3 sheng. Strong individuals take 1 sheng; frail individuals reduce the dose. Take three times daily. Children take 4 he.
Attached Formulas
Waitai Zhi Gan Cao Tang (External Cabinet Prepared Licorice Decoction): Treats Lung Flaccidity with excessive salivary froth and a warm, liquid sensation in the heart. (Formula see Xu Lao Chapter)
Qian Jin Gan Cao Tang Formula (Thousand Gold Licorice Decoction)
Gan Cao (Licorice Root, single ingredient)
Boil in 3 sheng of water until reduced by half. Divide into three doses and take warm.
Qian Jin Sheng Jiang Gan Cao Tang Formula (Thousand Gold Fresh Ginger and Licorice Decoction): Treats Lung Flaccidity with incessant coughing and spitting of froth, dry throat, and thirst.
Sheng Jiang (Fresh Ginger, 5 liang) Ren Shen (Ginseng Root, 3 liang) Gan Cao (Licorice Root, 4 liang) Da Zao (Jujube Fruit, 15 pieces)
Take the above four ingredients. Boil in 7 sheng of water to obtain 3 sheng. Divide into three doses and take warm.
Qian Jin Gui Zhi Qu Shao Yao Jia Zao Jiao Tang Formula (Thousand Gold Cinnamon Twig Decoction Removing Peony Plus Gleditsia): Treats Lung Flaccidity with spitting of froth.
Gui Zhi (Cinnamon Twig, 3 liang) Sheng Jiang (Fresh Ginger, 3 liang) Gan Cao (Licorice Root, 2 liang) Da Zao (Jujube Fruit, 10 pieces) Zao Jiao (Gleditsia Sinensis Fruit, 1 piece, skin and seeds removed, roasted until charred)
Take the above five ingredients. Boil in 7 sheng of water over low heat to obtain 3 sheng. Divide into three doses and take warm.
Note: All the above formulas use Pungent-Sweet-Warm medicines. Since the Lung is withered and flaccid, it cannot be moistened by damp-nourishing agents. One must generate Qi and move Qi to produce fluids. Fluids are born from Qi; where Qi arrives, fluids arrive. Also, the formulas state "incessant excessive spitting of froth," indicating that fluids are not absent, but rather cannot be retained and distributed. Therefore, Pungent-Sweet-Warm medicines are essential. Adding Zao Jiao (Gleditsia) addresses concurrent turbid phlegm.
Waitai Jie Geng Bai San (External Cabinet Platycodon White Powder): Treats cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of foul-smelling turbid sputum, and long-term expectoration of pus like rice porridge, indicating Lung Abscess.
Jie Geng (Platycodon Root, 3 liang) Bei Mu (Fritillaria Bulb, 3 liang) Ba Dou (Croton Seed, 1 fen, skin removed, roasted and ground into paste)
Grind the above three ingredients into powder. Strong individuals take half a qian bi (measure) with water; frail individuals reduce the dose. If the disease is above the diaphragm, pus is vomited; if below, it is discharged via stool. If diarrhea is excessive and uncontrolled, drinking one cup of cold water will stop it.
Qian Jin Wei Jing Tang Formula (Thousand Gold Reed Shoot Decoction): Treats cough with slight fever, irritability and fullness, and rough skin on the chest, indicating Lung Abscess.
Wei Jing (Reed Shoot, 2 sheng) Yi Yi Ren (Coix Seed, half sheng) Tao Ren (Peach Kernel, 50 grains) Gua Ban (Melon Seeds, half sheng)
Take the above four ingredients. Boil in 10 sheng of water. First boil Wei Jing until 5 sheng remain. Strain. Add the remaining herbs. Boil to obtain 2 sheng. Take 1 sheng, then take again. Pus-like material should be vomited.
Note: This formula possesses powers to purge Heat, dissipate nodules, and unblock stasis, yet is heavy without being harsh, and slow without being ineffective. It can compensate for the biases of Jie Geng Tang and Jie Geng Bai San, making it an excellent method.
Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung): Treats 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, or pungent odors, cough with rebellious Qi, and wheezing with obstruction. (See above: One dose every three days, up to 3-4 doses. First take one dose of Xiao Qing Long Tang before proceeding.)
Note: This formula originally treats Lung Abscess with wheezing and inability to lie down. Now, with facial edema and nasal congestion with clear discharge, it indicates External Pathogens in the Lung that should be dispersed. Therefore, take one dose of Xiao Qing Long Tang first, then proceed with this formula.
Furthermore, among the various formulas for Lung Abscess, each has specialized effects. Ting Li Zi (Descurainia Seed) and Da Zao (Jujube) are used when the abscess is just beginning and not yet formed, striking while it is not yet gathered. Wei Jing Tang (Reed Shoot Decoction) drives it out when it is chaotic. Jie Geng Tang (Platycodon Decoction) combines suppression and pacification, with an emphasis on pacification, truly acting as the army of a king. Jie Geng Bai San (Platycodon White Powder) is the sharp vanguard for breaking fortifications. Comparing and observing them, and practicing them prudently, ensures appropriate application without error.