问曰。热在上焦者。（因热病咳。）因咳（而）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。
（肺虚且热。）故得之。曰、寸口脉数。（数则为热。热宜口干。乃）其人咳。口中
反有浊唾涎沫者何。师曰。（肺病则津液不能布化。停贮胸中。得热煎熬。变为涎沫。侵
肺作咳。唾之不已。故干者自干。唾者自唾。愈唾愈干。所以成）为肺痿之病。若口中
（不吐浊唾涎沫。而火热之毒上攻。但）辟辟（作空响而发）燥。咳（声上下触动其痈。
）即胸中隐隐（作）痛。脉反滑数。此为肺痈。咳唾脓血。（肺痈之所以别乎肺痿如此。
然二证皆属于热。故其脉皆数。须知）脉数（而）虚者为肺痿。（脉）数（而）实者为
肺痈。（实即滑也。此肺痿肺痈之辨也。）
此言肺痿肺痈。一出于热。但有虚实之分。痿者。萎也。如草木之萎而不荣。为津
涸而肺焦也。痈者。壅也。如土之壅而不通。为热聚而肺溃也。 肺痿。口中反有浊唾
涎沫。肺痈。则口中辟辟燥。二证似当以此分别。然此下肺痈条。亦云其人咳。咽燥不
渴。多唾浊涎。则肺痿肺痈二证多同。惟胸中痛。脉数滑。唾脓血。则肺痈所独也。然又有
可疑者。此言肺痈脉滑。滑者实也。下条又言脉微而数。何其相反乃尔乎。而不知滑数者。
已成而邪盛。微数者。初起而火伏。二说相为表里也。
问曰。（肺痈之）病（必）咳逆。（方其未见痈时而）脉之。何以知此为肺痈。当
有脓血。（往往于既）吐之（后）则死。其脉何类。师曰。（肺痈既成则数滑。当其未
成之初。第见）寸口脉微而数。（盖风脉多浮。而此为热伏于肺。风一入则留恋于内。
其形不显。微者显之对也。故）微则为风。（热为病根。其）数（脉）则为（见出本来
之）热。
微（为风。风性散涣。）则汗出。数（为热。内热而外）则（反）恶寒。风中于卫。呼
气不入。（气得风而浮。利出而难入也。）热过于营。吸而不出。（血得热而壅。气亦
为之不伸也。是）风伤（卫尚属）皮毛。（从卫过营。则）热伤血脉。（夫皮毛者。肺
之合也。）风（从卫入营。而）舍于肺。其人则咳。（肺热而壅。故）口干喘满。（热在
血中。故）咽燥不渴。（热逼肺中之津液而上行。故）多唾浊沫。（热盛于里。而反格
寒于外。故）时时振寒。（由是）热之所过。血为之凝滞。蓄结（肺叶之间。而为）痈
脓。吐如米粥。始萌（尚亦）可救。（至浸淫不已。肺腐）脓成则死。
此原肺痈之由。为风热蓄结不解也。
（上气证。有正气夺与邪气实之不同。如）上气。面浮肿。（摇）肩（出）息。（气但
升而无降矣。又按）其脉浮大。（是元阳之根已拔。）不治又加下利。（则阳脱于上。阴
脱于下。阴阳离决。其证）尤甚。上气喘而躁者。（其喘为风之扇。躁为风之烦。）此
为肺胀。（其逆上之涎沫。将）欲（乘风势而）作风水。（但令）发其汗（风从汗解。）
则（水无风战。自然就下而）愈。
此另提出上气。分二小节。因别虚实以定生死也。前人谓肺痈由风。风性上行而上气。
其实不必拘泥。肺痿肺痈。咳嗽上气。师合为一篇。大有深意。合之可也。分之亦可
也。
肺（不用而）痿。（其饮食游溢之精气。不能散布诸经。而但上溢于口。则时）吐
涎沫。（且邪气之来顺）而不咳者。（痿则冥顽而不灵也。）其人（以涎沫多。而）不
（觉其）渴。（未溺时。）必（自）遗尿。（溺时）小便（短而频）数。所以然者。以
上（焦气）虚不能制（约）下（焦之阴水）故也。此为肺中冷。（盖肺痿皆由于热。何
以忽言其冷。然冷与寒迥别。谓得气则热。不得气则冷。实时俗冷淡冷落之说也。肺为
气主。气虚不能自持于上。则头）必眩。（气虚不能统摄于中。则口）多涎唾。（宜）
甘草干姜汤以温之。（经云。肺喜温而恶寒。又云。肺喜润而恶燥。可知温则润。寒则
燥之理也。且此方辛甘合而化阳。大补肺气。气之所至。津亦至焉。若草木之得雨
露。而痿者挺矣。）若服（此）汤（而反）渴者。属消渴。（又当按法而治之。不在此
例也。）
此申言肺痿证多由肺冷。而出其正治之方也。诸家于冷字错认为寒。故注解皆误。
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。
（上气有咳与不咳之分。不咳者止是风邪上逆。咳者内有水气。外有风邪也。若）
咳而上气。（水与气相触。声在）喉中（连连不绝。作）水鸡声。（以）射干麻黄汤主
之。
此言咳而上气。而出一散邪下水之方也。
徐忠可云、凡咳之上气者。皆有邪也。其喉中水鸡声。乃痰为火所吸不得下。然火
乃风所生。水从风战而作声耳。夫水为润下之物。何以逆上作声。余见近来拔火罐者。
以火入瓶。罨人患处。立将内寒吸起甚力。始悟火性上行。火聚于上。气吸于下。势不
容己。上气水声。亦是此理。此非泻肺邪。何以愈之。故治此以射干为上。白前次之。
能开结下水也。
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） 五味子（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。分温再服。
咳逆上气。时时吐（痰而胶）浊。但坐不得眠。（视水鸡声而更甚。急宜开其壅闭。
涤其污垢。以）皂荚丸主之。
此承上节而言咳而吐浊。坐而不眠之剧证。而出一权宜暂用之方也。
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。
（上气不咳。上既言之矣。咳而上气。亦言之而颇详矣。更有但咳而不上气。病虽
未甚。而在表在里。不可以不辨。若）咳而脉浮者。（为风寒病之在外也。风寒宜表散。
以）浓朴麻黄汤主之。咳而脉沉者。（为痰饮病之里也。痰饮宜荡涤。以）泽漆汤主
之。
此言咳而不上气者。不详见证。但以脉之浮沉。而异其治也。
徐忠可曰、咳而脉浮。则表邪居多。但此非在经之表。乃邪在肺家气分之表也。故
于小青龙去桂芍草三味。而加浓朴以下气。石膏以清热。小麦以辑心火而安胃。若咳而
脉沉。则里邪居多。但此非在腹之里。乃邪在肺家荣分之里也。故君泽漆降肺气。补肾
气。以充腑气。且邪在荣。泽漆兼能调荣也。紫菀能保肺。白前能开结。桂枝能行阳
散邪。故以为佐。若余药。即小柴胡去柴胡大枣。和解其上气而已。（按。泽漆壮肾阴
充腑气。非用之破血行水也。）
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（半升）
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。纳诸药。煮取三升。温服一升。日三
服。
泽漆汤方
半夏（半升） 紫参（一本作紫菀） 生姜 白前（各五两） 甘草 黄芩 人参
桂枝（各三两） 泽漆（三升中以东流水五斗煮取一斗五升）
上九味。 咀。内泽漆汤中。煮取五升。温服五合。至夜尽。
（上气不咳。上言正为邪夺者不治。邪盛而正不虚者。宜发汗矣。然此特为外邪而
言也。更有虚火烁金。与风邪挟饮而上逆者。绝不相类。当另分其名曰火逆。）火逆上
气。（无咳逆吐痰水鸡声等证。但觉）咽喉（若有物相碍。而）不（爽）利。（法宜）止逆下气。
（以）麦门冬汤主之。
此言火逆证而出其方也。此证绝无外邪。亦无咳嗽。故用人参。否则人参必不可姑
试也。
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。（在将成未成之初。邪气尽壅于肺。）喘不得卧。（以）葶苈大枣泻肺汤主
之。
此言肺痈始萌。病势渐进。当以此方、乘其未集而击之也。
葶苈大枣泻肺汤方
葶苈（熬令黄色捣丸如弹子大） 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。
（肺痈已成。上已详言其证矣。今且撮举其要。而出其方。）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。（此）为肺痈。（但肺痈未成脓。实
邪也。故以葶苈之逐邪主之。今既成脓。则为虚邪。当以）桔梗汤（之解肺毒排痈脓）
主之。
尤在泾云、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
以桔梗开之。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。
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。上既详其证矣。又有外邪内饮。填塞肺中而为胀者。自当另看）咳而
上气。此（病何以知其）为肺胀。（盖以）其人（大）喘。目（突）如脱（之）状。（
诊其）脉浮（则知其风邪。若浮而且）大者。（则知其风火挟水饮而乘于肺。以）越婢
加半夏汤主之。
此详肺胀证。而出其正治之方也。
越婢加半夏汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 大枣（十二枚） 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。
心下有水。咳而上气。以小青龙汤为的剂。然烦躁则挟有热邪。故加石膏。参用大
青龙之例。寒温并进。两不相碍。
小青龙加石膏汤方
麻黄 芍药 桂枝 细辛 干姜（各三两） 甘草（三两） 五味 半夏（各半升）
石膏（二两，按。宜生用。研末加倍。用之方效。）
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
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（十二枚） 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。
尤在泾云、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（五十枚） 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。
尤在泾云、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。）
尤在泾云、此方原治肺痈喘不得卧。此兼面目浮肿。鼻塞清涕。则肺有表邪宜散。
故先服小青龙一剂乃进。 又云、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), (due to a febrile disease causing cough,) it develops into Lung Flaccidity (Fei Wei, a condition characterized by lung tissue wasting and dryness) due to coughing. How is this disease of Lung Flaccidity acquired? The Master replied: It may arise from excessive sweating; or from vomiting; or from Xiao Ke (Wasting and Thirsting Syndrome, often associated with diabetes-like symptoms) with frequent urination; or from constipation followed by harsh purgatives that cause diarrhea, leading to severe depletion of Body Fluids (Jin Ye). (The lungs are deficient and hot,) thus the disease arises. Question: The pulse at the Cun Kou (Cun position of the radial artery) is rapid. (A rapid pulse indicates heat; heat should cause dry mouth, yet) the patient coughs, but instead has turbid saliva and frothy sputum in the mouth. Why? The Master said: (When the lungs are diseased, body fluids cannot be distributed normally, stagnating in the chest. Heat boils them down, transforming them into frothy sputum, which invades the lungs causing cough. Continuous spitting leads to further dryness; hence, the drier parts become drier, and the spit remains spit. The more one spits, the drier it gets, thereby forming) the disease of Lung Flaccidity. If the mouth (does not spit out turbid saliva and frothy sputum, but rather fire-heat toxin attacks upward, causing only) a crackling sensation (dryness and empty sounds) and coughing (the sound vibrating up and down affecting the abscess,), then there is dull pain in the chest, and the pulse becomes slippery and rapid. This is Lung Abscess (Fei Yong, an accumulation of pus in the lungs). Coughing up pus and blood. (This is how Lung Abscess differs from Lung Flaccidity. However, both conditions belong to heat, so their pulses are both rapid. One must know that) a rapid (and) deficient pulse indicates Lung Flaccidity. A rapid (and) excess pulse indicates Lung Abscess. (Excess here means slippery; this is the distinction between Lung Flaccidity and Lung Abscess.)
This passage discusses Lung Flaccidity and Lung Abscess, both originating from heat, differing only in deficiency and excess. "Wei" (Flaccidity) is synonymous with "Wei" (Withering), like plants withering and losing vigor, caused by exhaustion of body fluids and scorching of the lungs. "Yong" (Abscess) means obstruction, like soil becoming blocked and不通 (uncommunicative), caused by heat aggregation and溃烂 (ulceration/rotting) of the lungs. In Lung Flaccidity, there is turbid saliva and frothy sputum in the mouth; in Lung Abscess, there is a crackling dryness in the mouth. These two conditions seem distinguishable by this sign. However, the subsequent section on Lung Abscess also mentions coughing, dry throat without thirst, and copious turbid saliva, indicating many similarities between Lung Flaccidity and Lung Abscess. Only chest pain, rapid-slippery pulse, and expectoration of pus and blood are unique to Lung Abscess. Yet there is a doubt: here it says Lung Abscess has a slippery pulse, which indicates excess; the next section says the pulse is faint and rapid. Why are they so contradictory? In fact, slippery-rapid indicates the stage where pathogens are abundant, while faint-rapid indicates the initial stage where fire is latent. The two explanations complement each other as exterior and interior.
Question: (In Lung Abscess,) the disease (must involve) coughing and rebellious Qi. (Before the abscess manifests,) how do we diagnose it by pulse? We should expect pus and blood. (Often after) expectorating (it,) death occurs. What does the pulse resemble? The Master said: (Once Lung Abscess is formed, the pulse is rapid and slippery. In its early stage before formation,) the Cun Kou pulse is faint and rapid. (Generally, wind pulses are floating, but here heat is latent in the lungs. Once wind enters, it lingers inside, making the manifestation indistinct. "Faint" is relative to "manifest." Thus,) faint indicates wind. (Heat is the root of the disease, and its) rapid (pulse) indicates (the underlying) heat.
Faint (indicates wind, and wind's nature is dispersing.) leading to sweating. Rapid (indicates heat, internal heat but external) then (contrary) aversion to cold. Wind damages the Wei (Defensive) level, exhalation fails to enter. (Qi becomes floating due to wind, easy to exhale but hard to inhale.) Heat exceeds the Ying (Nutritive) level, inhalation fails to exit. (Blood is congested by heat, and Qi is also constrained.) Thus, wind damaging (Wei still belongs to) skin and hair. (From Wei passing to Ying,) heat damages blood vessels. (Skin and hair are the exterior correspondence of the lungs.) Wind (from Wei entering Ying, and) lodging in the lungs causes coughing. (Lung heat and congestion lead to) dry mouth, wheezing, and fullness. (Heat in the blood leads to) dry throat without thirst. (Heat forces lung fluids upward, leading to) copious turbid froth. (Heat excess internally, yet repelling cold externally, leads to) occasional chills. (Wherever) heat passes, blood coagulates and stagnates, accumulating and knotting (between lung lobes, forming) abscess pus. Expectoration resembles rice porridge. In the early germination stage (it can still be saved.) (But when it spreads incessantly, rotting the lungs,) once pus is fully formed, death ensues.
This traces the origin of Lung Abscess to unresolved accumulation of wind-heat.
(Upper Rebellious Qi syndrome differs in whether Zheng Qi (Upright Qi) is depleted or Xie Qi (Pathogenic Qi) is excess. For example,) Upper Rebellious Qi with facial edema, shoulder-lifting breathing, (Qi rises but does not descend. Also, observing) a floating-large pulse, (indicates the root of Yuan Yang (Primal Yang) has been uprooted.) This is untreatable. If diarrhea is added, (Yang collapses above, Yin collapses below, Yin and Yang separate, and the condition) becomes even worse. Upper Rebellious Qi with wheezing and restlessness, (wheezing is fanned by wind, restlessness is troubled by wind.) This is Lung Distension (Fei Zhang). (The rebellious phlegm-fluids will) tend (to follow the wind's momentum and) form Feng Shui (Wind-Water edema). (Simply induce) sweating (wind resolves with sweat.) then (water, no longer battling wind,) naturally descends and heals.
Here, Upper Rebellious Qi is separately presented in two subsections to distinguish deficiency and excess for prognosis. Predecessors claimed Lung Abscess stems from wind, and since wind moves upward, it causes Upper Rebellious Qi; however, one need not be rigidly bound by this. The Master combined Lung Flaccidity, Lung Abscess, Cough, and Upper Rebellious Qi into one chapter, implying profound meaning. They can be viewed together or separately.
Lungs (losing function) become flaccid. (The essence from food and drink cannot distribute to the meridians, but overflows upward to the mouth, causing frequent) expectoration of saliva and froth. (And when pathogenic qi arrives,) without coughing. (Flaccidity implies dullness and lack of responsiveness.) The person (due to excessive saliva,) does not (feel) thirsty. (Before urinating.) there will inevitably be (spontaneous) enuresis. (During urination,) urine is (short and frequent) polyuria. The reason is that Upper (Jiao Qi) deficiency cannot control Lower (Jiao Yin water). This is Cold in the Lungs. (Generally, Lung Flaccidity results from heat; why mention cold now? However, cold differs significantly from chill. It means getting Qi brings warmth, lacking Qi brings coldness, akin to the modern colloquial sense of "cold/distant." The Lungs govern Qi. Qi deficiency cannot sustain itself above, leading to) vertigo. (Qi deficiency cannot regulate itself in the middle, leading to) excessive saliva and froth. (Use) Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to warm it. (The Classic states: The Lungs prefer warmth and dislike cold; they prefer moisture and dislike dryness. This shows that warmth brings moisture, while cold brings dryness. Moreover, this formula combines acrid and sweet to generate Yang, greatly tonifying Lung Qi. Where Qi goes, fluids follow, just as plants thrive with rain and dew, and the flaccid ones stand upright.) If taking (this) decoction (causes) thirst, it belongs to Xiao Ke (Wasting-Thirst). (It should be treated according to method, not included in this category.)
This elaborates that Lung Flaccidity syndromes often stem from Lung Cold and provides the primary treatment formula. Various commentators mistakenly interpreted "cold" as "chill," leading to erroneous annotations.
Gan Cao Gan Jiang Tang Formula
Zhi Gan Cao (Prepared Licorice Root, 4 liang) Pao Gan Jiang (Pounded Dried Ginger, 2 liang)
Crush the herbs. Boil in 3 sheng of water to obtain 1.5 sheng. Strain. Divide into two warm doses.
(Upper Rebellious Qi distinguishes between coughing and non-coughing. Non-coughing is merely rebellious wind pathogen; coughing involves internal fluid retention and external wind pathogen. If) coughing with Upper Rebellious Qi, (water and qi collide, producing a sound in) the throat (continuously, resembling) a waterfowl's croak. (Treat with) She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction).
This discusses cough with Upper Rebellious Qi and presents a formula to disperse pathogens and drain fluids.
Xu Zhongke stated: All cases of cough with Upper Rebellious Qi involve pathogens. The waterfowl sound in the throat is phlegm sucked by fire, unable to descend. Fire is generated by wind, and water makes noise battling wind. Water is naturally descending; why does it rebel upward? I observed cupping therapy: fire is placed in a jar, applied to the affected area, forcefully sucking internal cold upward. I realized fire nature ascends; fire gathers above, Qi is drawn from below, inevitably rising. The water sound in Upper Rebellious Qi follows this logic. Without draining Lung pathogens, how can it heal? Therefore, treat this with She Gan (Belamcanda Rhizome) as chief, Bai Qian (Cynanchum Stauntonii Stem) as deputy, capable of opening knots and draining downward.
She Gan Ma Huang Tang Formula
She Gan (Belamcanda Rhizome, 3 liang) Ma Huang (Ephedra Stem) Sheng Jiang (Fresh Ginger, 4 liang each) Xi Xin (Asarum) Zi Wan (Aster Root) Kuan Dong Hua (Coltsfoot Flower, 3 liang each) Da Zao (Jujube, 7 pieces) Ban Xia (Pinellia Tuber, half sheng) Wu Wei Zi (Schisandra Berry, half sheng)
Nine ingredients. Boil in 12 sheng of water. First boil Ma Huang for two boils, remove foam. Add remaining herbs. Boil to obtain 3 sheng. Divide into two warm doses.
Rebellious Qi with coughing, frequent expectoration of (sticky turbid) phlegm, sitting only and unable to sleep. (More severe than waterfowl sound, urgently open obstruction and cleanse filth using) Zao Ying Wan (Soap Pod Pill).
This continues the previous section regarding severe symptoms of cough with turbid expectoration and inability to lie down, presenting a temporary expedient formula.
Zao Ying Wan Formula
Zao Ying (Soap Pod, 8 liang, scraped, skin removed, roasted with酥)
Grind the single ingredient into powder. Make pills with honey the size of wutong seeds. Take three pills mixed with jujube paste and water, three times daily, one dose at night.
(Non-coughing Upper Rebellious Qi was discussed above. Coughing with Upper Rebellious Qi was discussed in detail. There are cases of only coughing without significant Upper Rebellious Qi. Though not severe, differentiation between exterior and interior is necessary. If) coughing with a floating pulse, (indicates exterior Wind-Cold. Wind-Cold should be released via sweating, use) Nong Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction). Coughing with a sinking pulse, (indicates interior Phlegm-Fluid. Phlegm-Fluid should be purged, use) Ze Qi Tang (Sedge Decoction).
This discusses cough without significant Upper Rebellious Qi, distinguishing treatment based on pulse floating or sinking rather than detailed symptoms.
Xu Zhongke said: Cough with floating pulse indicates mostly exterior pathogens, but not in the meridians; rather, pathogens are in the Qi aspect of the Lungs. Thus, remove Gui Zhi, Shao Yao, and Gan Cao from Xiao Qing Long Tang, add Nong Po to direct Qi downward, Shi Gao to clear heat, and Xiao Mai to calm Heart fire and harmonize Stomach. Cough with sinking pulse indicates mostly interior pathogens, but not in the abdomen; rather, pathogens are in the Ying aspect of the Lungs. Thus, use Ze Qi as chief to descend Lung Qi, tonify Kidney Qi, and fill Fu organs. Since pathogens are in Ying, Ze Qi also regulates Ying. Zi Wan protects Lungs, Bai Qian opens knots, Gui Zhi promotes Yang and disperses pathogens, used as assistants. Remaining herbs are Xiao Chai Hu Tang minus Chai Hu and Da Zao, to harmonize Upper Rebellious Qi. (Note: Ze Qi strengthens Kidney Yin and fills Fu organs; it is not used for breaking blood or moving water.)
Nong Po Ma Huang Tang Formula
Nong 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, half sheng) Gan Jiang (Dried Ginger) Xi Xin (Asarum, 2 liang each) Xiao Mai (Wheat, 1 sheng) Wu Wei Zi (Schisandra Berry, half sheng)
Nine ingredients. Boil in 12 sheng of water. First cook wheat until soft, strain. Add other herbs. Boil to obtain 3 sheng. Warm dose of 1 sheng, three times daily.
Ze Qi Tang Formula
Ban Xia (Pinellia Tuber, half sheng) Zi Shen (Bupleurum Root, some texts say Zi Wan/Aster Root) Sheng Jiang (Fresh Ginger) Bai Qian (Cynanchum Stauntonii Stem, 5 liang each) Gan Cao (Licorice Root) Huang Qin (Scutellaria Root) Ren Shen (Ginseng) Gui Zhi (Cinnamon Twig, 3 liang each) Ze Qi (Phytolacca Acinosa Root, 3 sheng boiled with 5 dou of flowing eastward water to obtain 1.5 sheng)
Nine ingredients. Crush. Add to the Ze Qi decoction. Boil to obtain 5 sheng. Warm dose of 0.5 sheng, finish by night.
(Non-coughing Upper Rebellious Qi: previously stated that depletion of Zheng Qi by Xie Qi is untreatable. If Xie Qi is excess and Zheng Qi is not deficient, sweating is indicated. However, this refers only to exterior pathogens. There are also cases of Deficient Fire scorching Metal, and Wind Pathogen carrying Fluids rebelling upward, which are completely different, named Huo Ni (Fire Rebellion).) Fire Rebellion with Upper Rebellious Qi, (without coughing, expectorating phlegm/water, or waterfowl sounds, only feeling) the throat (as if obstructed, and) unsmooth/uncomfortable. (Method should) stop rebellion and direct Qi downward, (use) Mai Men Dong Tang (Ophiopogon Decoction).
This discusses Fire Rebellion syndrome and provides its formula. This syndrome has no exterior pathogens nor cough, hence Ren Shen is used; otherwise, Ren Shen should not be tried casually.
Mai Men Dong Tang Formula
Mai Men Dong (Ophiopogon Tuber, 7 sheng) Ban Xia (Pinellia Tuber, 1 sheng) Ren Shen (Ginseng) Gan Cao (Licorice Root, 2 liang each) Jing Mi (Rice, 3 he) Da Zao (Jujube, 12 pieces)
Six ingredients. Boil in 12 sheng of water to obtain 6 sheng. Warm dose of 1 sheng, three times daily, one dose at night.
Lung Abscess, (in the initial stage of formation, pathogens congest the lungs,) wheezing and inability to lie down, (treat with) Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs).
This discusses early-stage Lung Abscess with progressive severity, advising this formula to strike before the abscess matures.
Ting Li Da Zao Xie Fei Tang Formula
Ting Li (Descurainia Seed, roasted yellow, pounded into pill size of a bullet) Da Zao (Jujube, 12 pieces)
First boil jujubes in 3 sheng of water to obtain 2 sheng. Remove jujubes. Add Ting Li. Boil to obtain 1 sheng. Take all at once.
(Lung Abscess is formed; symptoms were detailed earlier. Now summarizing key points and providing formula.) Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of turbid foul-smelling sputum, long-term expectoration of pus resembling rice porridge, (this) is Lung Abscess. (However, before pus forms, it is Excess pathogen, so Ting Li is used to purge pathogens. Now that pus is formed, it is Deficient pathogen, so use) Jie Geng Tang (Platycodon Decoction) to resolve Lung toxicity and expel abscess pus.
You Zaijing said: The symptoms in this paragraph match those in Article 2, representing the definitive signs of Lung Abscess. This disease is congested by Wind-Heat, so Jie Geng opens it. Heat aggregation becomes toxin, so Gan Cao resolves it. Gan Cao is double the amount of Jie Geng, seeming too slow. Perhaps because pus is formed, Zheng Qi is injured and Du (Toxin) is溃散 (scattered), requiring gentle rather than harsh agents. Hence, light herbs are preferred.
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 warm doses. Pus and blood will be expelled.
(Cough with Upper Rebellious Qi: symptoms detailed earlier. Another case involves exterior pathogens and interior fluids filling the lungs causing distension, requiring separate consideration.) Cough with Upper Rebellious Qi, how to know (this) is Lung Distension? (Because) the person (severely) wheezes, eyes (protruding) as if popping out. (Palpating the) pulse floating (indicates wind pathogen; if floating and) large, (indicates Wind-Fire carrying Fluids attacking the Lungs, treat with) Yue Bi Jia Ban Xia Tang (Mahuang Decoction plus Pinellia).
This details Lung Distension syndrome and provides the primary treatment formula.
Yue Bi Jia Ban Xia Tang Formula
Ma Huang (Ephedra Stem, 6 liang) Shi Gao (Gypsum, 0.5 jin) Sheng Jiang (Fresh Ginger, 3 liang) Da Zao (Jujube, 12 pieces) Gan Cao (Licorice Root, 2 liang) Ban Xia (Pinellia Tuber, half sheng)
Six ingredients. Boil in 6 sheng of water. First boil Ma Huang, remove foam. Add other herbs. Boil to obtain 3 sheng. Divide into three warm doses.
Lung Distension, cough with Upper Rebellious Qi, irritability and wheezing, floating pulse, fluid under the Heart (Epigastrium), Xiao Qing Long Jia Shi Gao Tang (Minor Blue Green Dragon Decoction plus Gypsum) treats this.
Fluid under the Heart with cough and Upper Rebellious Qi is properly treated with Xiao Qing Long Tang. However, irritability indicates accompanying Heat, so add Shi Gao. Following the example of Da Qing Long Tang, Cold and Heat advance together without conflict.
Xiao Qing Long Jia Shi Gao Tang Formula
Ma Huang (Ephedra Stem) Shao Yao (Peony Root) Gui Zhi (Cinnamon Twig) Xi Xin (Asarum) Gan Jiang (Dried Ginger, 3 liang each) Gan Cao (Licorice Root, 3 liang) Wu Wei Zi (Schisandra Berry) Ban Xia (Pinellia Tuber, half sheng each) Shi Gao (Gypsum, 2 liang; Note: Raw, ground to powder, doubled dose for efficacy.)
Nine ingredients. Boil in 10 sheng of water. First boil Ma Huang, remove foam. Add other herbs. Boil to obtain 3 sheng. Strong adults take 1 sheng, weak adults reduce dose. Three times daily. Children take 0.4 sheng.
Attached Formulas
Waitai Zhi Gan Cao Tang (External Platform Prepared Licorice Decoction) treats Lung Flaccidity with excessive saliva/froth and a warm, liquid sensation in the heart. (Formula see Xu Lao/Wasting and Thirsting Chapter)
Qian Jin Gan Cao Tang (Thousand Gold Licorice Decoction)
Single herb Gan Cao. Boil in 3 sheng of water until reduced by half. Divide into three warm doses.
Qian Jin Sheng Jiang Gan Cao Tang (Thousand Gold Fresh Ginger and Licorice Decoction) treats Lung Flaccidity with incessant coughing/spitting of froth, dry throat, and thirst.
Sheng Jiang (Fresh Ginger, 5 liang) Ren Shen (Ginseng, 3 liang) Gan Cao (Licorice Root, 4 liang) Da Zao (Jujube, 15 pieces)
Four ingredients. Boil in 7 sheng of water to obtain 3 sheng. Divide into three warm doses.
Qian Jin Gui Zhi Qu Shao Yao Jia Zao Ying Tang (Thousand Gold Cinnamon Twig Decoction minus Peony plus Soap Pod) treats Lung Flaccidity with expectoration of froth.
Gui Zhi (Cinnamon Twig) Sheng Jiang (Fresh Ginger, 3 liang each) Gan Cao (Licorice Root, 2 liang) Da Zao (Jujube, 12 pieces) Zao Ying (Soap Pod, 1 piece, skin/seeds removed, roasted until charred)
Five ingredients. Boil in 7 sheng of water over low heat to obtain 3 sheng. Divide into three warm doses.
You Zaijing said: All the above formulas use acrid, sweet, and warm herbs. Since the Lungs are withered and dry, moistening agents cannot nourish them. One must generate and move Qi to produce fluids. Fluids are born from Qi; where Qi goes, fluids follow. Also, the formulas state "excessive froth expectoration," implying fluids exist but cannot be retained or distributed. Thus, acrid-sweet-warm herbs are essential. Adding Zao Ying addresses turbid phlegm.
Waitai Jie Geng Bai San (External Platform Platycodon and White Powder) treats cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional turbid foul sputum, long-term expectoration of pus like rice porridge, indicating Lung Abscess.
Jie Geng (Platycodon Root) Bei Mu (Fritillaria Bulb, 3 liang each) Ba Dou (Croton Seed, 1 fen, peeled, roasted, ground to paste)
Three ingredients made into powder. Strong adults take half a qian bi (measure) with water; weak adults reduce dose. Disease above diaphragm causes vomiting of pus; below diaphragm causes purging. If purging is excessive and uncontrolled, drink one cup of cold water to stop it.
Qian Jin Wei Jing Tang (Thousand Gold Reed Shoot Decoction) treats cough with slight fever, irritability, fullness, rough skin on chest, indicating Lung Abscess.
Wei Jing (Reed Shoot, 2 sheng) Yi Yi Ren (Coix Seed, half sheng) Tao Ren (Peach Kernel, 50 pieces) Gua Ban (Melon Seeds, half sheng)
Four ingredients. Boil in 10 sheng of water. First boil Wei Jing to obtain 5 sheng, strain. Add other herbs. Boil to obtain 2 sheng. Take 1 sheng; second dose should expel pus like material.
You Zaijing said: This formula has power to drain heat, dissipate knots, and unblock stasis, heavy yet not harsh, slow yet not lax. It can correct the biases of Jie Geng Tang and Jie Geng Bai San. It is indeed a good method.
Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) treats Lung Abscess with chest fullness/distension, edema of face/body, nasal congestion with clear discharge, loss of smell/taste, cough with Upper Rebellious Qi, wheezing and choking. (See above. One dose every three days, up to 3-4 doses. First take one dose of Xiao Qing Long Tang, then proceed.)
You Zaijing said: This formula originally treats Lung Abscess with wheezing and inability to lie down. Here accompanied by facial edema and nasal congestion, indicating exterior pathogens in the Lungs should be dispersed. Hence, take one dose of Xiao Qing Long first, then proceed. He also said: Among Lung Abscess formulas, each has specific expertise. Ting Li Da Zao treats early-stage abscess before formation, striking while unformed. Wei Jing Tang clears chaos and expels pathogens. Jie Geng Tang combines suppression and pacification, focusing on pacification, truly a king's army. Jie Geng Bai San is a sharp vanguard breaking fortifications. Compare and observe, act prudently, and errors will be avoided.