蜜丸加润。酒饮善行。五丸三服。劳伤羸瘦者。攻补俱不能骤胜也。
一条 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。咳吐脓血。
热在上焦二句。当是古医经之文。仲景特借为问答以发其奥耳。从何得之。谓是何因而得此热在上焦。咳
而肺痿也。下文七句。凡四症。正答问词。盖谓或从汗出。则阴伤于外泄。而阳火独亢。一也。或从呕吐。则阴伤
于上涌。而并提其虚热于上。二也。或从消渴。则阳热在上。而逼真阴于下趋。且下焦又以无阳。而不能上蒸
滋润。以供燔炙。三也。或从便难。则太阴脾家既干。而上吸手太阴之肺液。若又以便难之故。而用快乐下利
之。则真阴又大伤于后阴之泄泻。而阳热独亢于上。四也。凡此。皆重亡津液。而孤阳不得与阴为倚附。则浮
动于清虚之府。而肺管作痒。故咳。且咳多。则津液愈伤。而肺金有叶垂花卷之象。故得此肺痿之病也。寸口
脉数三句。因上文言肺痿。得之重亡津液。则肺干者不宜有浊唾涎沫矣。故举此脉症以辨之耳。殊不知寸
口为肺之部位。数为阳热躁疾之应。又脉所来去之空属阴。数者空窄。亡阴之象。合而断之。此正肺家阴虚
阴亢之脉也。阳不得阴为偶。则其气常动。动则火扰清虚。而肺管作痒。故咳。肺中阴阳自和。则下降清华以
应甘露。火气独盛。则炎上而挟其残膏以共升。故口中反有浊唾涎沫。此又肺家阴虚阳亢之症也。故曰。此
脉此症。即为肺痿之病云。口中辟辟五句。及下条二句。又就肺痿而辨肺痈之脉症。以痿与痈之辨甚微。而
其治悬绝故也。辟辟闭塞坚实之声。燥咳对肺痿之浊唾涎沫而言。胸中隐隐痛者。即第四条血为之凝滞。
而肺痈之渐也。脉。亦指寸口而言。滑为气聚血壅之诊。滑而且数。则气聚血壅。由于邪热燔炙所致。谓非肺
痈而何。故咳唾脓血可必也。
二条 脉数虚者为肺痿。数实者为肺痈。
脉。亦就寸口而言。数虚数实。指寸口之浮沉也。真阴不能养阳。故阳自数而阴虚者。为肺痿之脉。邪热内凌
血液。故阳既数而阴实者。为肺痈之脉也。
三条 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
涎吐。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 咀。以水三升。煮取一升五合。去滓。分温再服。
此与前条之痿不同。前条为重亡津液。阳气独胜。故热在上焦。而为肺火自刑之热痿。此则先因肺虚。虚则
气削而生阴翳。譬之花痿春寒。叶垂秋冷之象。而为金寒水冷之痿也。吐涎沫者。肺无呵嘘下润之权。且不
能收摄其津液而上泛也。无邪火以扰其肺管。故不咳。而亦不烦渴也。肺为水之源。且其气象天。尝有提挈
黄泉。传送浊道之妙。肺虚不能提挈。故遗尿。肺寒不能传送。故小便又数也。此非上虚不能制下之故乎。肺
中虚冷。天失阳健之德。地必起而上犯清虚。肝以木气上乘。故眩。肾以水气倒注。故多涎沫。虚则补其母。非
温脾胃之中土以温肺金。无他法也。重用甘以守中之甘草。使之径趋脾胃。佐以辛温之干姜。是直从中土。
升其生金之化。且辛为脾肺所喜之味。温为脾肺所宜之气。明明土息泥香。乘春蒸发。而东风动荡。却化为
太空晴暖矣。至于辛则平肝以降眩。甘则制肾而镇涎。又其余事。两味药中。斡旋造化。烘染阴阳。其妙用乃
如是也。若服汤已而忽然作渴。是肺中素有伏热未发。故见种种不摄不传之症。得辛甘以挑动之。则伏热
顿起而作渴。此属另门之消渴。而非上虚不能制下之肺痿矣。
四条 问曰。肺咳逆。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。
条端、旧本作师曰。当是问曰之讹。今以首条。及他卷之例改正之。首条因辨肺痿而分别肺痈之症。二条
因辨肺痿而分别肺痈之脉。三条又言肺痿之变症。此及下文共四条。才是辨肺痈之脉症治例也。肺痈有
脓血。吐之则死。当是古医经之文。仲景借为问答以申其义。曰。咳嗽气逆。同一肺病。切脉之下。何以知此独
为肺痈。当有脓血。吐之则死。必其脉有确据。方可谨守此禁。其脉是何类乎。师曰。右手寸口。所以候肺。其脉
浮之则体微。沉之则至数。风邪能令真阳飘忽。故微则知其为风。热邪能令真阴消烁。故数则知其为热。真
阳外微。而卫气不摄于皮毛。故微则汗出。数脉内燔。而营阴逼呈于阳分。故数则恶寒。呼吸。指营卫之阖辟
而言。即上文汗出恶寒之义。非口鼻之呼吸也。盖谓疏洞之风邪。中伤卫分。则毛窍张而汗尝出。譬之有呼
出之气而不返入。燔炙之热邪。传过营分。则血液驰而脉道空。譬之有吸入之势而不推出。风伤皮毛于外。
热伤血络于内。夫皮毛血络。为手太阴肺部之所荣。由表而入里。风热之内舍于肺者可禁乎。肺热。则火邪
熏扰其清虚。故痒而作咳。肺热。则甘泉不升于灵道。故口干而且咽燥也。肺管半贮痰涎。呼吸之游溢肺中
者。不能深入。故满。满故喘也。渴根于胃。胃不病。故但咽燥而不渴也。肺热。则自剥其津液以送邪外出。且肺
热。又不能收摄其津液以分布四旁。故多吐浊沫也。时时振寒。即上文数则恶寒之义。夫皮毛之风热。过于
肺中而舍之。则肺叶之血。因热而凝滞。久久蓄结。则痈而脓矣。色从金化。故稠白如粳米所作之粥。始萌则
真气未伤。而风热之邪。可散可泻。故可救。延至脓成。则肺叶烂而气管已漏。呼吸之游溢者。不能并入气源。
故喘满而死矣。
五条 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。
喘。即上条热舍肺中。血壅气滞。而肺管为之肿塞之候。不得卧。谓不能卧倒。以卧则肺叶横施。而息道更艰
更曲故也。主本汤者。以葶苈味苦气寒。且孟夏凋谢。其性主降阳分之气。而尤能驱水逐湿。夫喘则肺满。苦
以坚之。喘则肺热。寒以敛之。又喘则肺气上浮而痰涎阻塞。则降浮祛沫。又所必需矣。然则舍葶苈其谁属
哉。但苦寒降散之性。其势易于趋下。恐失肺家部位。故以甘浮粘缓之大枣。先作汤液。而纳丸其中。其意欲
抬高葶苈。而使徐徐坚收下散耳。又岂止以甘缓之性。坚制其刻削而已乎。葶苈熬黄捣研。则香同芝麻。投
肺之所好也。纳药枣汤。合煮而连渣顿服。使胃中药满。而易输于肺也。仲景之精意何如哉。
此言肺痈始萌。可救之正治也。
六条 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。
桔梗汤方 桔梗（一两） 甘草（二两）
上二味。以水三升。煮取一升。分温再服。则吐脓血也。
肺在胸中。痈则肺叶肿而肺气满。故但觉胸满耳。振寒、脉数、咽干不渴、浊唾腥臭、脓如米粥等候。注见本篇
首条。及三四条下。桔梗色白。味则苦辛而甘。其性微寒而善开提。色白。故为肺金专药。苦、则泄热。辛、则散热。
甘。则缓热。微寒而善开提。则能解散其热闭之邪。而使之上疏也。然后倍用浮缓之甘草。不特高抬上载。使
桔梗留恋肺中。而得效其熏蒸宣发之用。且得甘草之甘能泻热。缓能舒紧之性。以为后助。则清风荡漾。积
热潜开。王政和平。奸谋自败。其所滞之脓血。有不徐徐渐出而自愈者乎。此言脓成则死之救法也。或谓
本篇四条。一曰吐之则死。又曰脓成则死。夫脓成者既死矣。又何必立桔梗汤之治例。且汤后明缀曰分温
再服。则吐脓血。何以自犯其吐之则死之禁乎。答曰。脓血既成。包藏败浊。溃烂日甚。管漏气泄。息无关锁。呼
吸洞直。一往而散。是脓成曰死者。着意在脓字。盖死于包藏其脓血。而使墙垣有尽坏之势也。若夫苦寒窘
胃。咸寒涌泄。肺气已伤。何堪再责。且吐则耗上焦之气。上空而下阴逆凑。则喘促莫支。吐则亡胸中之阴。阴
伤而阳毒更炎。则烦乱欲绝。是吐之曰死者。着意在吐字。盖死于逼劫其脓血。而致阴阳有立尽之势也。知
此。则本汤之熏蒸开托。既非因循养祸之计。而又与瓜蒂散。及盐矾诸汤之有心责吐。以速倾危者。自不同矣。
七条 肺痈、胸胀满。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。葶苈大枣泻肺
汤主之。
此就前条喘不得卧。而申言肺痈之全症也。胸胀满已见。肺主周身之气。肺肿而治节不行。故一身及面目
浮肿矣。鼻塞。指息道而言。谓肺肿而息道不能从鼻呼吸之义。肺中之阳金属庚。其气常外出。而主提挈运
行之用。清涕出者。失提挈之权也。肺中之阴金属辛。其神常内守。而主感通气味之妙。不闻香臭者。失感通
之应也。酸为肺金之所胜。辛为肺金之所喜。且五味中惟二者之气为触鼻。并此而亦不闻者。甚言之也。声
深而连续者曰嗽。声浮而单见者曰咳。咳者。肺之遁声。逆者。肺之窘气。肺窘而遁。则逆且咳矣。上气与吐衄
血门不同。彼处之言上气。因上焦虚馁。肝肾之下气。乘之而直上。以致阳位逼窄。而炫闷喘急。气上而血亦
随之。是实实有气上冲者。此处之言上气。谓肺叶肿重。肺管不能纳气以下运。如有气上塞之象。犹云气高
气浮之谓。故葶苈大枣泻肺之外。无余药余义及于中下二焦者此也。况后文八条。推开肺痈。单就上气二
字而广言其变症变治。故不可不细认者也。气阻则喘。痰壅则鸣。气道狭则迫。肺管肿则塞。全症如此。葶苈
大枣汤之泻肺。可缓乎哉。
八条 上气。面浮肿。肩息。其脉浮大。不治。又加利。尤甚。
此下。又就上文之上气而推展言之。盖谓上气一症。其候多端。生死悬绝。肺痈固在其中。然不特肺痈为然
也。但凡上气而面浮肿。肩息。脉浮大者。皆不治。盖面者。五脏六腑诸阳之会。阳气最充。浮则气虚。肿则气滞。
是阳气最充之地。而虚且滞矣。脏腑可知也。气促而息道艰。以肩之上下迎导之。则少顺。是肩息者。气机浮
浅。而不能以气海、关元为根蒂矣。加之脉浮。则底无根。脉大。则里无神。皆有出无入。有散无收之象。故皆不
治。又加下利。则阴阳之离绝者更速。故尤甚。此言中下二焦。脱帮脱底而上浮。为上气之最重者。然必三
者全具。方为死候。否则下文三条（即十条）之脉浮。主小青龙汤。七条（即十四条）之脉浮。主浓朴麻
黄汤。四条（即十一条）之脉兼浮大。主越婢半夏汤者。何为又治之耶。岂非以面无浮肿之故乎。
九条 上气、喘而躁者。属肺胀。欲作风水。发汗则愈。
肺不能纳气以归元。故喘。肾将欲蒸湿以为汗。故躁。上气而喘躁并见。是肾欲输水气于肺。将作汗而上蒸。
肺已自受风邪。不能为肾分布以外泄。则肺肾以子母相持。而风水合为一片。肺之胀也宜矣。欲作风水。与
内经水热穴论。及热病论之言风水者不同。盖指肾以水脏之气上熏。肺以风邪盖之。风水相搏。于是肺不
运水。肾不纳水。聚湿成饮。久而溢出经络。致成 肿腹大等候。发汗。则肺之风邪。肾之水气。可两解矣。故愈。
此言肺肾两相排挤。中间无所发越之上气也。
十条 肺胀、咳而上气。烦躁而喘。脉浮者。心下有水气。小青龙加石膏汤主之。
小青龙加石膏汤方
麻黄 桂枝 芍药 甘草 干姜 细辛（各三两） 五味子 半夏（各半斤） 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。
此承上文欲作风水之肺胀。而详其症治。故直接之曰肺胀也。咳而上气。烦躁而喘。为风水之全症。但此五
症中。除却躁之一症。为肾中水寒之气上腾之应。其余四症。俱系肺受风邪。为肾湿所闭。于是不能分布水
饮。肺气欲下而不得下。肾气欲上而不得上。两相挤靠之应也。夫聚水之脉宜沉。今验其脉又反浮。浮为心
肺之应。心下有水气无疑矣。譬诸天地。地气已上而成雨。特悬于太空而未下耳。所以咳者。殷雷也。上气者。
云蒸雾涌也。烦者。郁热也。躁者。础润阶潮也。喘者。气湿风滞。而不能鼓撼万物也。小青龙之轻风疏雨以泄
Honey pills are added with moistening agents. Wine has the property of promoting circulation. Take five pills per dose, three doses daily. For those emaciated and weakened due to labor injury, both attacking pathogens and tonifying deficiency cannot be achieved abruptly.
Article 1: Question: When heat is located in the Upper Jiao (Upper Burner), coughing develops into Lung Flaccidity Disease (Fei Wei). How is Lung Flaccidity Disease acquired? The Master said: It may arise from excessive sweating, or from vomiting, or from Xiao Ke (Wasting-Thirst disease) causing frequent urination, or from constipation followed by the mistaken use of harsh purgatives leading to diarrhea, resulting in severe depletion of body fluids. Question: The pulse at the Cun Kou (Radial artery at the wrist) is rapid, the patient coughs, yet there is instead turbid saliva and frothy sputum in the mouth. What is the reason? The Master said: This is Lung Flaccidity Disease. If the mouth feels dry and parched ("Pi Pi"), coughing causes a dull pain in the chest, and the pulse is instead slippery and rapid, this is Lung Abscess (Fei Yong), characterized by coughing up pus and blood.
The phrases "Heat in the Upper Jiao" are likely text from ancient medical classics, which Zhang Zhongjing specifically borrowed for Q&A to elucidate their profound meaning. "How is it acquired?" asks what cause leads to this heat in the Upper Jiao, causing cough and Lung Flaccidity. The following seven sentences list four conditions, directly answering the question. Essentially: Or due to sweating, Yin fluids are lost externally, leaving Yang fire hyperactive alone—this is one. Or due to vomiting, Yin fluids are lost upward, dragging deficient heat to the Upper Jiao—this is two. Or due to Xiao Ke (Wasting-Thirst), Yang heat is above, forcing True Yin downward, while the Lower Jiao lacks Yang to steam and moisten upwards to supply the burning heat—this is three. Or due to constipation, the Taiyin Spleen is dry and draws fluid from the Hand-Taiyin Lung; if harsh purgatives are then used for constipation, True Yin is further injured by posterior discharge, and Yang heat remains hyperactive in the Upper Jiao—this is four. All these cases involve severe depletion of body fluids, leaving solitary Yang without Yin support, floating in the clear and empty organ (Lung), causing itching in the bronchial tubes and thus cough. Excessive coughing further injures fluids, leading to the image of drooping lung leaves and curled flowers, hence acquiring Lung Flaccidity Disease.
The three sentences regarding "Cun Kou pulse is rapid..." address the previous statement that Lung Flaccidity results from fluid depletion, implying a dry lung should not have turbid saliva. Thus, these pulse/symptom signs are cited to differentiate. Note that Cun Kou corresponds to the Lung; rapidity indicates Yang heat agitation; the hollow space of the pulse relates to Yin. A rapid pulse with a narrow hollow space indicates Yin depletion. Combined, this is a pulse of Lung Yin deficiency with Yin hyperactivity (deficient heat). Without Yin as a partner, Yang Qi moves constantly; movement generates fire disturbing the clear organs, causing bronchial itching and cough. If Lung Yin and Yang were harmonious, clear Qi would descend like dew; but with dominant fire, it flares upward carrying residual fluids, causing turbid saliva in the mouth. This is a symptom of Lung Yin deficiency and Yang hyperactivity. Thus, these pulse and symptoms indicate Lung Flaccidity Disease.
The five sentences starting with "Mouth feels dry and parched..." and the two sentences in the next article differentiate Lung Abscess from Lung Flaccidity, as their distinction is subtle but treatment is vastly different. "Pi Pi" describes a sound of blockage and firmness; dry cough contrasts with the turbid saliva of Flaccidity. Dull chest pain indicates blood stasis, a precursor to Lung Abscess. The pulse refers to Cun Kou. Slippery indicates Qi accumulation and Blood congestion; slippery and rapid indicates this is caused by pathogenic heat roasting. This must be Lung Abscess, inevitably leading to coughing up pus and blood.
Article 2: A rapid and deficient pulse indicates Lung Flaccidity; a rapid and excess pulse indicates Lung Abscess.
The pulse refers to Cun Kou. Rapid/deficient/excess refers to the superficial/deep quality at Cun Kou. If True Yin cannot nourish Yang, Yang becomes rapid due to Yin deficiency, indicating Lung Flaccidity pulse. If pathogenic heat invades the Blood internally, Yang is rapid and Yin is excess (due to congestion), indicating Lung Abscess pulse.
Article 3: In Lung Flaccidity, if there is spitting of saliva/froth without coughing, the patient is not thirsty, and必定 (must) experience enuresis (bedwetting) 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/spitting. Treat with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to warm it. If after taking the decoction the patient becomes thirsty, it belongs to Xiao Ke (Wasting-Thirst).
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. Remove dregs. Divide into two warm doses.
This differs from the previous article's Flaccidity. That case involved severe fluid loss with dominant Yang heat (Hot Flaccidity). This case involves initial Lung deficiency leading to Qi weakness and Yin shadow, resembling flowers wilting in spring cold or leaves drooping in autumn chill (Cold/Water Flaccidity). Spitting saliva occurs because the Lung lacks the power to moisten downwards and fails to retain fluids, allowing them to float upward. With no pathogenic fire disturbing the bronchi, there is no cough or thirst. The Lung is the source of water and resembles Heaven, capable of lifting fluids and transporting turbidity. Lung deficiency fails to lift, causing enuresis; Lung cold fails to transport, causing frequent urination. Is this not Upper deficiency failing to control Lower? Lung deficiency and cold mean Heaven loses its Yang vigor, allowing Earth Qi to rise and invade the clear organs. Liver Wood Qi attacks upward, causing dizziness; Kidney Water Qi flows backward, causing excessive saliva. Tonify the mother (Earth/Spleen-Stomach) to warm Metal/Lung. Use heavy sweet Gan Cao to stay in the Middle Jiao, assisted by pungent-warm Gan Jiang to raise the generating function of Metal from Earth. Pungency is pleasing to Spleen/Lung; warmth is suitable for them. Like earth yielding fragrance in spring evaporation, turning into clear sky warmth. Pungency soothes Liver to reduce dizziness; sweetness controls Kidney to settle saliva. These are secondary effects. Within these two herbs lies the transformation of creation and balance of Yin-Yang. If thirst suddenly appears after taking the decoction, it indicates latent heat previously present in the Lung was stirred by the pungent-sweet formula, belonging to a separate category of Xiao Ke, not Upper-deficiency Lung Flaccidity.
Article 4: Question: In pulmonary cough and counterflow Qi, how do we know via pulse diagnosis that this is Lung Abscess with 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 penetrates the Defensive (Wei) level; exhalation does not enter deeply. Heat passes through the Nutritive (Ying) level; inhalation does not push out. Wind damages skin and hair; Heat damages vessels and blood. Wind lodges in the Lung, causing cough, dry mouth, wheezing/fullness, dry throat without thirst, abundant turbid froth, and periodic chills. Where Heat passes, Blood coagulates and stagnates, accumulating into an abscess and pus, vomited like rice porridge. Early stage can be saved; once pus forms, it is fatal.
(Note: "Old edition says 'Master said'" is corrected to "Question" based on precedent. Articles 1-3 differentiated Flaccidity/Abscess symptoms/pulses/variations. Articles 4 onwards focus on Abscess pulse/symptoms/treatment. "Vomiting pus leads to death" is ancient text quoted by Zhang Zhongjing. The question asks why we know this specific condition leads to death upon vomiting, requiring definite pulse evidence. The Master explains: Right Cun Hou (inch position) monitors the Lung. Superficial pulse is faint (Wind disperses True Yang); deep pulse is rapid (Heat consumes True Yin). External Yang deficiency leads to Wei Qi failing to secure skin/hair, causing sweating. Internal Heat forces Ying Yin into Yang levels, causing aversion to cold. "Respiration" here refers to the opening/closing of Wei/Ying, not nasal breathing. Wind damaging Wei causes open pores and sweating (like exhaling without inhaling back); Heat damaging Ying causes blood slackening and empty pulses (like inhaling without pushing out). Wind damages exterior skin/hair; Heat damages interior vessels. Since skin/hair/vessels belong to the Lung channel, external wind-heat entering internally is dangerous. Lung heat disturbs the clear organ, causing itching/cough; Lung heat prevents sweet springs from rising, causing dry mouth/throat. Bronchi store phlegm; respiratory qi circulating in Lung cannot penetrate deeply, causing fullness/wheezing. Thirst originates in Stomach; since Stomach is unaffected, there is dry throat but no thirst. Lung heat strips fluids to expel pathogens and fails to distribute them, causing turbid froth. Periodic chills equate to aversion to cold. Wind-heat lodging in Lung causes blood stasis, forming abscess/pus over time. Color transforms according to Metal (white/thick like rice porridge). Early stage: True Qi intact, wind-heat can be dispersed/resolved, so it is salvageable. Late stage: Pus formed, Lung tissue rotted, airways leaked, respiration disconnected, leading to death from wheezing/fullness.
Article 5: 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).
Ting Li Da Zao Xie Fei Tang Formula: Ting Li Zi (Descurainiae Semen, fried until yellow, rolled into pill-sized balls), Da Zao (Jujube, 12 pieces).
Boil Jujubes in 3 sheng of water to obtain 2 sheng. Remove Jujubes. Add Ting Li Zi. Boil to obtain 1 sheng. Take all at once.
Wheezing results from heat lodging in Lung, blood congestion, Qi stagnation, and bronchial swelling/inhibition. Inability to lie down occurs because lying compresses the Lung horizontally, making airways more difficult and curved. Ting Li Zi is bitter and cold, shedding in early summer, descending Yang Qi, and driving out water/dampness. Bitter hardens the Lung against fullness; cold contracts the Lung against heat; descending floats and removes foam is necessary for wheezing/phlegm obstruction. Only Ting Li Zi fits. However, its bitter-cold descending nature tends to go too low, missing the Lung location. Therefore, sweet-floating-sticky-slow Da Zao decoction is prepared first, and the Ting Li pill is added. This raises Ting Li Zi to slowly descend and disperse firmly. Also, frying Ting Li Zi makes it fragrant like sesame, pleasing to the Lung. Cooking with Jujube decoction and taking with dregs fills the Stomach, facilitating transmission to the Lung. Zhang Zhongjing's ingenuity is profound!
This describes the standard treatment for early-stage Lung Abscess that is salvageable.
Article 6: Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional foul-smelling turbid saliva, and long-term expectoration of pus like rice porridge indicates Lung Abscess. Treated with Jie Geng Tang (Platycodon Decoction).
Jie Geng Tang Formula: Jie Geng (Platycodonis Radix, 1 liang), Gan Cao (Licorice Root, 2 liang).
Boil both in 3 sheng of water to obtain 1 sheng. Divide into two warm doses. Pus and blood will be expelled.
The Lung resides in the chest; abscess causes Lung tissue swelling and Qi fullness, felt as chest fullness. Symptoms (chills, rapid pulse, etc.) refer to notes in Article 1 and Articles 3-4. Jie Geng is white, bitter-pungent-sweet, slightly cold, and good at raising/opening. White color makes it specific to Lung Metal. Bitter drains heat; pungent disperses heat; sweetness moderates heat. Slightly cold and raising opens heat-blockage and directs Qi upward. Double dose of floating-slow Gan Cao lifts and retains Jie Geng in the Lung for fumigating/dispersing action. Gan Cao's sweetness drains heat and relaxes tension, providing support. Like gentle breeze dissipating accumulated heat, restoring harmony, defeating treachery. Stagnant pus/blood will gradually exit and heal. This is the rescue method for late-stage abscess (previously deemed fatal). Some ask: If "pus formation is fatal" and "vomiting is fatal," why prescribe this decoction? Answer: "Fatal" refers to the danger of pus containment destroying tissue structure. Vomiting forcibly expels pus, depleting Upper Jiao Qi and Chest Yin, leading to immediate collapse. This decoction uses fumigation/opening to gently resolve, unlike drastic emetics (like Gua Di San) that accelerate crisis.
Article 7: Lung Abscess with chest distension/fullness, whole-body and facial edema, nasal congestion, clear runny nose, loss of smell (incense, odor, sour, pungent), cough with counterflow Qi, wheezing, and noisy breathing obstruction is treated with Ting Li Da Zao Xie Fei Tang.
This expands on the full syndrome of Lung Abscess from Article 5. Chest fullness is seen. Lung governs body Qi; swelling impairs regulation, causing generalized edema. Nasal congestion means airways cannot breathe through nose. Lung Yang Metal (Geng) usually exits and regulates; clear runny nose indicates loss of regulatory power. Lung Yin Metal (Xin) usually guards internally and senses odors; loss of smell indicates loss of sensory response. Sour is overcome by Metal; Pungent is pleased by Metal; only these two touch the nose. Not smelling even them emphasizes severity. Deep continuous sound is Sou (cough with phlegm); shallow single sound is Ke (dry cough). Ke is the escape sound of Lung; Ni (counterflow) is the distressed Qi of Lung. Distressed Lung escapes, causing counterflow cough. Shang Qi (Counterflow Qi) here differs from Hematemesis section. There, it was Lower Qi attacking Upper due to deficiency. Here, it is Lung tissue heaviness preventing Qi descent, feeling like Qi blocking upward. Thus, treatment focuses solely on draining Lung, not Middle/Lower Jiao. Later Article 8 expands on Shang Qi variations. Qi obstruction causes wheezing; phlegm congestion causes noise; narrow airway causes pressure; swollen bronchi cause blockage. Full syndrome requires Ting Li Da Zao Tang to drain Lung.
Article 8: Counterflow Qi, facial edema, shoulder breathing, floating-large pulse is untreatable. If accompanied by diarrhea, it is even worse.
Expanding on Shang Qi: Many presentations, life/death distinct. Lung Abscess is included, but not exclusive. Any Shang Qi with facial edema, shoulder breathing, floating-large pulse is untreatable. Face is meeting point of Yang Qi; floating indicates Qi deficiency; edema indicates Qi stagnation. Vital area is deficient/stagnant, implying internal organs are affected. Shoulder breathing indicates shallow Qi mechanism lacking root in Qi Sea/Guan Yuan. Floating pulse lacks root; large pulse lacks spirit. Both show exiting without entering, scattering without gathering. Untreatable. Diarrhea accelerates Yin-Yang separation. Worse. This describes Middle/Lower Jiao detachment floating upward, the heaviest Shang Qi. Must have all three signs for death prognosis. Otherwise, other articles treat floating pulses (e.g., Xiao Qing Long Tang for Article 10, Ma Huang Hou Po Tang for Article 14, Yue Bi Ban Xia Tang for Article 11). Why? Because they lack facial edema.
Article 9: Counterflow Qi, wheezing, and restlessness belong to Lung Distension (Fei Zhang), intending to become Feng Shui (Wind Edema). Sweating will cure it.
Lung fails to receive Qi to return to Origin, causing wheezing. Kidney prepares to steam dampness into sweat, causing restlessness. Shang Qi + wheezing/restlessness shows Kidney trying to send water Qi to Lung to sweat upward. Lung already has Wind pathogen, cannot distribute outward for Kidney. Lung-Kidney (Mother-Child) conflict, Wind-Water merge, causing Lung Distension. "Intending to become Feng Shui" differs from Nei Jing definitions. Here, Kidney Water steams up, Lung Wind covers it. Wind-Water clash, Lung fails to move water, Kidney fails to receive water. Dampness gathers into drink, overflows meridians, causing edema/ascites. Sweating resolves both Lung Wind and Kidney Water. Cure. This describes Shang Qi where Lung-Kidney squeeze each other with no outlet.
Article 10: Lung Distension, cough with counterflow Qi, irritability, wheezing, floating pulse, with water-fluids below the Heart, is treated with Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Gypsum).
Xiao Qing Long Jia Shi Gao Tang Formula: Ma Huang (Ephedrae Herba), Gui Zhi (Cinnamomi Ramulus), Bai Shao (Paeoniae Radix Alba), Gan Cao (Glycyrrhizae Radix), Gan Jiang (Zingiberis Rhizoma), Xi Xin (Asari Radix et Rhizoma) [each 3 liang], Wu Wei Zi (Schisandrae Fructus), Ban Xia (Pinelliae Rhizoma) [each 0.5 jin], Shi Gao (Gypsi Fibrosus) [2 liang].
Boil nine ingredients in 1 dou of water. First boil Ma Huang, remove scum. Add others. Boil to obtain 3 sheng. Strong adults take 1 sheng; weak reduce dose. Three times daily. Children take 4 ge.
Continuing from Article 9's Lung Distension/Feng Shui intent. Cough, counterflow Qi, irritability, wheezing are full Feng Shui symptoms. Except restlessness (Kidney cold-water steaming), the other four result from Lung Wind blocked by Kidney dampness. Water cannot distribute; Lung Qi wants to descend but cannot; Kidney Qi wants to ascend but cannot. Mutual squeezing. Water-retention pulse should be deep; but it is floating, indicating Heart-Lung involvement and water-fluids below Heart. Like rain suspended in sky. Cough is thunder; counterflow Qi is cloud vapor; irritability is depressed heat; restlessness is damp steps; wheezing is Qi-damp-wind stagnation failing to stir things. Xiao Qing Long...