咳血少痰。亦名干嗽。嗽血多痰。随嗽而出。此皆肺受热邪也。吐血者。逐口吐出。呕
血者
。骤然上出。咯血与咳血相似。然失血于口。有咽喉之异。盖咽为胃之上窍。喉为肺之上窍
。呕血咯血出于咽。咳血嗽血出于喉。而血动之由。惟火惟气耳。火盛则血逼而妄行。气逆
则血乱而妄行。凡偶有所伤。而根本未摇者易治。若元气大虚。真阴不守。乃为劳损之症。
凡失血等症。见喘满咳嗽。及左右腔膈间有隐隐胀痛者。病在肺。胸膈膻中之间。觉有
牵痛
如缕如丝或懊 嘈杂。有不可名状者。病在心主包络。胸腹膨膨。不知饥饱。食饮无味。多
涎沫者。病在脾 胁肋牵痛。或躁扰喘息不宁。往来寒热者。病在肝 气短似喘。声哑不出
。骨蒸盗汗。咽干喉痛。动气忡忡者。病在肾。大呕大吐。烦渴头痛。大热不得卧者。病在
胃。肺病宜清降。不宜升浮心病宜养营。不宜耗散。脾病宜温中。不宜酸寒肝病或宜疏利。
或宜甘缓不宜秘滞。肾病宜壮水。宜滋阴。不宜香燥克伐。胃病或宜大泻。或宜大补。当察
兼证虚实而治之。
肺痿之病。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。寸口脉数。其人咳。口中反有浊唾涎沫。若口中辟辟燥。咳即胸中隐隐痛。脉滑数
为肺痈。咳吐脓血。脉数虚者为肺痿。数实者为肺痈。
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。肺失所养。转枯
转燥
。然后成之于是肺火日炽。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。大要生胃津。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。然肺虽燥而多不渴。勿以其不渴而用燥热之药。肺痿咳唾。
咽燥欲饮水者自愈。肺痿六脉沉涩而急。或细数无神。脉口皮肤枯干而气息粗者死。
寸口脉浮而数。浮则为风。数则为热浮则汗出数则畏寒。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。时唾浊沫时
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。(金匮原文作脉
微而数。)
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。即血为之凝。血凝。
即痰
为之裹。遂成小痈所结之形日长。则肺日胀而胁骨日昂。乃至咳声频并。浊痰如胶。发热畏
寒。日晡尤甚。面红鼻燥。胸生甲错。金匮治法最精。全在未成脓之先。今人误作虚劳治之
。迨至血化。为脓。肺叶朽坏。倾囊吐出。始识其症。嗟无及矣间有痈小气壮胃强善食。其
脓不从口出。或顺趣肛门。或旁穿胁肋。仍可得生。然不过十中二三耳。
肺痈初起。疑似未真。用生大豆绞浆饮之。不觉腥气者是也咳则胸胁微痛。痛在右畔肺
之长
叶。而坐卧得宁。形色如常。便溺自调者可治。若溃后大热不止。时时恶寒。胸中隐痛。痛
在左畔肺之短叶。此金气虚。溃后再难平复。而喘汗面赤。脓痰腥秽不已者难治。若喘鸣不
休。咯吐脓血 臭异常。正气大败。而不知痛。不得卧。爪甲紫而带弯。手掌如枯树皮。颧
红唇反。声哑鼻煽者不治。金匮论脉滑数为肺痈。滑数者。已成之脉。又云微而数。微数者
初起之因也。大抵初起脉不宜数大。溃后忌短涩。脉缓滑面白者生脉弦急。面赤者死。(微
当作浮)
Coughing up blood with little sputum. Also known as dry cough (cough without sputum). Coughing up blood with much sputum comes out following the cough. These are all caused by the Lung being affected by heat pathogens. Hematemesis (vomiting blood) is spat out mouthful by mouthful. Regurgitation of blood (ou xue) erupts suddenly upwards. Spitting blood (ke xue) is similar to coughing up blood, but there is a difference in the exit point from the mouth. The pharynx is the upper orifice of the Stomach, and the larynx is the upper orifice of the Lung. Regurgitation of blood and spitting blood originate from the pharynx, while coughing up blood and dry coughing blood originate from the larynx. As for the cause of bleeding, it is solely due to Fire and Qi. When Fire is excessive, it forces blood to act recklessly. When Qi rebels, blood becomes chaotic and acts recklessly. If there is occasional injury but the root vitality remains unshaken, it is easy to treat. However, if primordial Qi is severely deficient and True Yin cannot be maintained, it constitutes a consumptive disease (Lao Sun).
In cases of hemorrhage, if panting, chest fullness, coughing, and hidden distending pain in the left and right hypochondriac/diaphragmatic regions appear, the disease is in the Lung. Between the chest and diaphragm/Shanzhong area, if there is a sensation of pulling pain like threads, or mental restlessness and stomach discomfort indescribable, the disease is in the Pericardium (Xin Bao). If the abdomen is distended, one does not know hunger or satiety, food and drink have no taste, and there is much saliva and froth, the disease is in the Spleen. If there is pulling pain in the hypochondrium, or irritability, restless panting, and alternating chills and fever, the disease is in the Liver. If there is shortness of breath resembling panting, hoarseness with inability to speak, bone-steaming night sweats, dry throat and painful throat, and palpitations triggered by movement, the disease is in the Kidney. If there is severe vomiting, irritability, thirst, headache, high fever, and inability to lie down, the disease is in the Stomach.
Diseases of the Lung should be treated with descending and clearing methods, not ascending and floating ones. Diseases of the Heart should be treated by nourishing Ying (Nutritive Qi), not by dispersing and consuming. Diseases of the Spleen should be treated by warming the Middle Jiao, not with sour and cold herbs. Diseases of the Liver may require soothing and draining, or sweet and relaxing methods, but not constipating and stagnating ones. Diseases of the Kidney should be treated by strengthening Water and nourishing Yin, not with aromatic and drying herbs that attack and deplete. Diseases of the Stomach may require drastic purgation or drastic tonification; treatment should depend on observing the excess or deficiency of accompanying syndromes.
The disease of Lung萎 (Fei Wei/Lung Atrophy) arises from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting syndrome) with frequent urination, or constipation followed by harsh purgatives that severely deplete body fluids. The Cun Kou pulse is rapid. The person coughs, yet the mouth produces turbid saliva and froth. If the mouth feels parched and dry, and coughing causes hidden pain in the chest, a slippery and rapid pulse indicates Lung Abscess (Fei Yong), characterized by coughing up pus and blood. A rapid and deficient pulse indicates Lung Atrophy (Fei Wei), while a rapid and excess pulse indicates Lung Abscess.
Lung Atrophy accumulates over time, not occurring in a day. Its chills and fevers are not uniform. It generally stems from the failure of Stomach fluids to transport to the Lung, causing the Lung to lose nourishment, gradually becoming dry and arid. Consequently, Lung Fire intensifies daily, Lung Heat deepens, and the small tubes within the Lung become obstructed daily. The cough sound gradually becomes weak. The fatty membranes in the chest dry out daily, making it difficult to expectorate phlegm upward. Walking only a few steps induces wheezing and panting. The general principle is to generate Stomach fluids, moisten Lung dryness, direct rebellious Qi downward, resolve accumulated phlegm, stop turbid saliva, and supplement true Qi to unblock the Lung's small tubes. Disperse fire heat to restore the Lung's clear and descending function. Although the Lung is dry, patients often do not feel thirsty. Do not use drying and heating herbs just because they are not thirsty. In Lung Atrophy with coughing and spitting, if the throat is dry and the patient desires water, they will heal spontaneously. In Lung Atrophy, if the six pulses are deep, choppy, and urgent, or fine and rapid without spirit, and the skin at the pulse site is withered and dry with coarse breathing, the prognosis is fatal.
If the Cun Kou pulse is floating and rapid: floating indicates Wind, and rapid indicates Heat. Floating leads to sweating, and rapid leads to aversion to cold. Wind affects the Wei (Defensive) level, so exhalation does not draw the pathogen in; Heat exceeds the Ying (Nutritive) level, so inhalation does not expel the pathogen out. Wind damages the hair follicles and skin, Heat damages the blood vessels. Wind lodges in the Lung, causing cough, dry mouth, panting, and chest fullness. The throat is dry but not thirsty, with occasional secretion of turbid froth and intermittent chills. Wherever Heat passes, blood coagulates and stagnates, accumulating into an abscess and pus. The vomitus resembles rice porridge. In the early stage, it can be saved; once pus forms, it is fatal. (The original text of *Jin Gui Yao Lue* states "pulse is faint and rapid".)
Lung Abscess arises from the accumulated Fire of the five Zang organs and the stagnant Heat in the Stomach, which ascend to the Lung. The Lung is scorched by Fire and Heat, causing blood to coagulate. Once blood coagulates, it is wrapped by phlegm, forming a small abscess. As it grows day by day, the Lung swells and the ribs elevate. This leads to frequent coughing, thick sticky phlegm, fever, and aversion to cold, especially worse in the afternoon. The face is red, the nose is dry, and the chest skin is rough like fish scales. The treatment method in *Jin Gui Yao Lue* is most exquisite, focusing entirely on the period before pus formation. Modern practitioners mistakenly treat it as Consumptive Disease (Xu Lao). By the time blood transforms into pus and lung tissue rots, expelled in large quantities, the diagnosis is realized, but it is too late. Occasionally, if the abscess is small, Qi is strong, and the Stomach is robust with good appetite, the pus may not exit through the mouth but drain towards the anus or perforate laterally through the hypochondrium, allowing survival. However, this occurs in only two or three out of ten cases.
At the initial stage of Lung Abscess, when doubt exists, drinking juice squeezed from raw soybeans can help diagnose: if there is no fishy smell, it is Lung Abscess. Coughing with slight chest and hypochondriac pain, located in the right long lobe of the Lung, where sitting and lying are comfortable, complexion is normal, and urination/defecation are regular, is treatable. If after ulceration, high fever persists, chills occur frequently, and there is hidden chest pain in the left short lobe of the Lung, this indicates deficiency of Metal Qi, and recovery after ulceration is difficult. If there is wheezing, sweating, flushed face, and incessant foul-smelling purulent sputum, it is difficult to treat. If wheezing continues unabated, coughing up pus and blood with abnormal stench, Zheng Qi is severely defeated, pain is not felt, lying down is impossible, fingernails are purple and curved, palms are withered like tree bark, malar flush occurs, lips retract, voice is hoarse, and nasal flaring appears, it is untreatable. *Jin Gui* discusses that a slippery and rapid pulse indicates Lung Abscess; slippery and rapid is the pulse of established disease. It also mentions faint and rapid; faint and rapid is the cause in the initial stage. Generally, the pulse in the initial stage should not be large and rapid. After ulceration, short and choppy pulses are contraindicated. A slow and slippery pulse with a white face indicates survival; a wiry and urgent pulse with a red face indicates death. ("Faint" should be read as "Floating".)