余用六君子加胆星、枳实、香附、沉香二剂。服之。大吐稠痰结垢一二升。因呕势太甚。甲夜渡
湖速往。黎明至暑候之。呕止嗽宁。脉息调匀。不必更进他药矣。
江右督学何涵斋媳。内翰范秋涛女。素常咳嗽不已。痰中间有血点。恒服童真丸不彻。秋涛
殁后。哀痛迫切。咳逆倍常。而痰中杂见鲜血。因与瑞金丹四服。仍以童真丸、乌骨鸡丸调补而安。
又治通政劳书绅太夫人。年五十余。素禀气虚多痰。数日来患风热咳逆。咳甚则厄厄欲吐。
且宿有崩淋。近幸向安。法当先治其咳。因以桔梗汤加葳蕤、白薇、丹皮、橘皮、蜜煎生姜四剂
撤其标证。次与六君子加葳蕤以安其胃气。继进乌骨鸡丸方疗其固疾。而夫人以久不茹腥。不
忍伤残物命。改用大温经汤加麋茸、角 作丸。药虽异而功则一也。
金匮云。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。
两手寸口。原为手太阴肺脉。此云寸口脉数。云滑数。云数虚。云数实。皆左右三部统言也。
其人咳。口中反有浊唾涎沫。顷之遍地者为肺痿。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。咳声上下触动其痈。胸中即隐隐而痛。其脉必见滑数有力。邪
气方盛之征也。数虚数实之脉。以之分别肺痿肺痈。是则肺痿当补。肺痈当泻。隐然言表。
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。
肺热则膀胱之气亦热。小便必赤涩而不能多。若但吐涎沫而不咳。复不渴。反遗尿而小便数
者。明非热在上焦之肺痿。亦非重亡津液之所致。必系上焦虚冷。不能制下。以故小便无所收摄
耳。此为肺中冷。阴气上逆侮其阳气故必眩。阴寒之气凝滞津液故多涎唾。宜与甘草干姜汤之甘
辛以温其脾肺也。若始先不渴。服温药即转渴者。明是消渴饮一溲二之证。消渴又与痈疽同类。
更当消息之矣。
喻嘉言曰。肺痿其积渐。已非一日。其热不止一端。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。冲击连声。痰始一应。金匮治法非不彰明。但混在肺痈一门。
况难解其精意。大要缓而图之。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。如半身痿废。及手足痿软。治之得法。亦能复起。虽云肺病。近
在胸中。呼吸所关。可不置力乎。然肺痈属在有形之血。血结宜骤攻。肺痿属在无形之气。气伤
宜徐理。兼润肺燥。然肺虽燥而多不渴。勿以其不渴而用燥热之药。此辨证用药之大法也。
肺痿涎唾多。心中温温液液者。炙甘草汤主之。此外台法也。肺痿虚寒。羸瘦缓弱战掉。嘘
吸胸满。千金生姜温中汤。肺痿咳唾。涎沫不止。咽燥而渴。千金生姜甘草汤。肺痿咳嗽有痰。
午后热。并声嘶者。古法用人参养肺汤。今改用紫菀散加丹皮、姜、枣。心火克肺。传为肺痿。
咳嗽喘呕。痰涎壅盛。胸膈痞满。咽喉不利者。古法用人参平肺汤。今改用紫菀散加葳蕤、橘红、
姜、枣。肺痿咳嗽不已。往来寒热。自汗烦渴者。古法用知母茯苓汤。今改用紫菀散加知母、银
州柴胡、姜、枣。盖咳嗽声嘶。咽喉不利。皆是火郁痰滞。必用生姜之辛以散之。然须蜜制。藉
甘以润之。此标本兼该之义也。刘默生言。痿本虚燥。总不离壮水清金。滋补气血津液。消痰止
嗽。宜天冬、麦冬、生地、熟地、知母、人参、葳蕤。紫菀为主。痞结。去天冬、生地。加橘红、
苏子。泄泻。去天冬、生地、知母。加山药、茯苓。并用固本丸。不时噙化。肺痿咳嗽。痰中有
红丝。盗汗发热。热过即冷。饮食减少者。劫劳散。虚劳肺痿失音。咳唾腥血稀痰。或面上生疮。
人参蛤蚧散。丹方治肺痿。每日用人参细末一钱。入猪肺管内。砂锅中煮烂。加葱酒服效。肺痿
咳唾。咽燥欲饮水者自愈。
张口短气者危。咳而口中自有津液。舌白苔滑。此为肺寒。甘草干姜汤。肺痿属热。如咳久肺KT 。
喉哑声嘶咯血。此属阴虚。多不可治。肺痿六脉沉涩而急。或细数无神。脉口皮肤枯干。而气高
息粗者死。
金匮云。上气喘而躁者。属肺胀。欲作风水。发汗则愈。
肺胀而发其汗者。即内经开鬼门之法。一汗而令风邪外泄于肌表。水无风战。白顺趋而从下出也。
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。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。
接二方分治肺胀。皆以其脉浮。当从汗解之例。越婢方中有石膏无半夏。小青龙方中有半夏
无石膏。观二方所加之意。全重在半夏、石膏二味协力建功。石膏清热。藉辛温亦能豁痰。半夏
豁痰。藉辛凉亦能清热也。观麦门冬汤方中。下气止逆。全藉半夏入生津药中。此二方又藉半夏
入清热药中。仲景加减成方。无非生心化裁。后学所当神往矣。
上气面浮肿。肩息。其脉浮大。不治。又加利。尤甚。
上气之候。而至面目浮肿。喘息动肩。是肺气壅逼。上而不下。加以脉浮大。气方外出。无
法可令内还而下趋。故云不治也。加利则上下交争。更何以堪。
肺胀而咳。左右不得卧。此痰挟瘀血碍气而胀。当归、丹皮、赤芍、桃仁、枳壳、桔梗、半
夏、甘草、竹沥、姜汁、如外邪去后宜。半夏、海石、香附、栝蒌、甘草为末。姜汁蜜调噙之。
喻嘉言治施眉苍。肺痿喘嗽吐清痰。肢体痿软。不能举动。脉来虚数。以蛤蚧二十枚。酒浸
酥炙。人参、黑参各十两。蜜丸。时噙化。不终剂而痊。
石顽治陆去非。肺痿声飒吐痰。午后发热自汗。左脉细数。右脉虚濡。平昔劳心耽色所致。
先与生脉散合保元汤。次与异功散加黄 。并加姜、枣。与都气丸晨夕兼进。调补半月而热除痰
止。月余方得声清。
又治孙起柏肺胀。服耗气药过多。脉浮大而重按豁然。饮食不入。幸得溺清便坚。与局方七
气。每剂用人参三钱。肉桂、半夏曲、炙甘草各一钱。生姜四片。四剂霍然。盖肺胀实证居多。
此脉虚大。不当以寻常论也。
又治一尼肺胀。喘鸣肩息。服下气止嗽药不应。渐至胸腹胀满。脉得气口弦细而涩。此必劳
力气上。误饮冷水伤肺。肺气不能收敛所致也。遂与越婢汤减麻黄。加细辛、葶苈大泻肺气而安。
又治一酒客。严冬醉卧。渴饮冷茶。肺胀喘嗽。脉得气口沉紧搏指。与小青龙去芍药。加葶
苈、半夏。一剂而痊。则知肺胀喘满。当以葶苈为向导也。
我曾用六君子汤加入胆南星、枳实、香附、沉香，服用两剂。服药后，患者大吐出一二升粘稠的痰垢。因为呕吐势头太猛，我在甲夜渡湖急忙前往（复诊）。黎明时分到达时，患者的呕吐已止，咳嗽也平静了，脉象调匀，不需要再进其他药物了。
江西督学何涵斋的儿媳，是翰林范秋涛的女儿。她平时一直咳嗽不止，痰中偶尔带有血点，长期服用童真丸但未能痊愈。范秋涛去世后，她哀痛迫切，导致咳逆比平时加倍严重，且痰中混杂着鲜血。因此给予瑞金丹服用四次，同时仍用童真丸、乌骨鸡丸进行调补，最终病情安定。
又诊治通政使劳书绅的母亲，五十多岁。素来禀赋气虚多痰。这几天患了风热引起的咳逆，咳嗽剧烈时喉咙里发出“厄厄”的声音想要呕吐。而且她宿有崩漏淋证，近来幸好已经向安。治法应当先治疗咳嗽。因此用桔梗汤加入葳蕤、白薇、丹皮、橘皮、蜜煎生姜，服用四剂以撤除标证。接着用六君子汤加入葳蕤以安抚胃气。随后进服乌骨鸡丸方来治疗其固疾。但是夫人因为长久不吃荤腥，不忍心残害物命，于是改用大温经汤加入麋茸，制成丸药。虽然药物不同，但功效是一致的。
《金匮要略》说：问曰，热在上焦的，因咳嗽而成为肺痿。肺痿这个病，是怎么得的呢？老师说，有的因为发汗过度，有的因为呕吐，有的因为消渴导致小便频数，有的因为大便困难又被峻下药攻下，导致津液再次亡失，所以得此病。问曰，寸口脉数，其人咳嗽，口中反而有浑浊的唾沫涎沫，这是怎么回事？老师说，这是肺痿的病。如果口中干燥，咳嗽时胸中隐隐作痛，脉象反而滑数，这是肺痈，会咳吐脓血。脉数而虚的是肺痿，脉数而实的是肺痈。
两手寸口，原本是手太阴肺经的脉位。这里说寸口脉数、滑数、数虚、数实，都是左右三部脉统而言之。其人咳嗽，口中反而有浑浊的唾沫涎沫，过一会儿流得到处都是，这是肺痿。意思是咳嗽的人口中不干燥。如果咳嗽而口中辟辟干燥，那就是肺已经结成痈，火热之毒显露于口，咳嗽声上下震动触动痈疽，胸中就会隐隐作痛。其脉必然见滑数有力，这是邪气正盛的征象。用数虚和数实的脉象来分别肺痿和肺痈，那么肺痿应当补益，肺痈应当泻实，这隐含在言表之中。
肺痿吐涎沫但不咳嗽的人，他不口渴，必定遗尿，小便频数。之所以这样，是因为上焦虚冷不能制约下焦。这属于肺中冷，必定头晕，多涎唾。用甘草干姜汤来温补它。如果服药后感到口渴的，属于消渴病。
肺热则膀胱之气也热，小便必定赤涩而不能多。如果只是吐涎沫而不咳嗽，又不口渴，反而遗尿且小便频数，明确不是热在上焦的肺痿，也不是重亡津液所致。必定是上焦虚冷，不能制约下焦，所以小便无法收摄。这属于肺中冷，阴气上逆侮犯阳气，所以必定头晕。阴寒之气凝滞津液，所以多涎唾。适宜用甘草干姜汤的甘辛之性来温补脾肺。如果起初不渴，服用温药后即转为口渴的，明确是消渴饮一溲二的证候。消渴又与痈疽同类，更应当仔细斟酌。
喻嘉言说：肺痿的积累，已非一日之功。其热不止一端，总归是由胃中津液不能输送到肺，肺失去滋养，转而干枯燥热，然后形成。于是肺火日益炽盛，肺热日益加深，肺中小管日益阻塞，咳嗽声音逐渐不响亮，胸中脂膜日益干燥，咳痰艰难难以排出，行动几步，气息就喘鸣，冲击连声，痰才应声而出。《金匮》的治疗法则并非不彰明，只是混杂在肺痈一门中，况且难以理解其精意。大要在于缓而图之，生胃津，润肺燥，降逆气，开积痰，止浊唾，补真气，以通利肺的小管，散火热，以恢复肺的清肃功能。就像半身痿废，以及手足痿软，治疗得当，也能康复。虽然是肺病，近在胸中，关乎呼吸，怎能不着力呢？然而肺痈属于有形之血，血结宜迅速攻逐；肺痿属于无形之气，气伤宜慢慢调理，兼润肺燥。然而肺虽燥却大多不口渴，不要因为它不口渴就用燥热的药。这是辨证用药的大法。
肺痿涎唾多，心中温温液液不适的，用炙甘草汤主治。这是《外台秘要》的方法。肺痿虚寒，消瘦无力颤抖，嘘吸胸满的，用《千金方》生姜温中汤。肺痿咳唾，涎沫不止，咽燥而渴的，用《千金方》生姜甘草汤。肺痿咳嗽有痰，午后发热，并伴有声嘶的，古法用人参养肺汤。现在改用紫菀散加丹皮、姜、枣。心火克肺，传变为肺痿，咳嗽喘呕，痰涎壅盛，胸膈痞满，咽喉不利的，古法用人参平肺汤。现在改用紫菀散加葳蕤、橘红、姜、枣。肺痿咳嗽不已，往来寒热，自汗烦渴的，古法用知母茯苓汤。现在改用紫菀散加知母、银州柴胡、姜、枣。大概咳嗽声嘶，咽喉不利，都是火郁痰滞，必须用生姜的辛味来发散它。然而须用蜜制，借甘味来润燥。这是标本兼顾的意义。刘默生说，痿本属虚燥，总离不开壮水清金，滋补气血津液，消痰止咳。宜用天冬、麦冬、生地、熟地、知母、人参、葳蕤、紫菀为主。若有痞结，去掉天冬、生地，加橘红、苏子。若有泄泻，去掉天冬、生地、知母，加山药、茯苓。并用固本丸，不时含化。肺痿咳嗽，痰中有红丝，盗汗发热，热退即冷，饮食减少的，用劫劳散。虚劳肺痿失音，咳唾腥血稀痰，或面上生疮的，用人参蛤蚧散。丹方治肺痿，每日用人参细末一钱，装入猪肺管内，在砂锅中煮烂，加葱酒服用有效。肺痿咳唾，咽燥想喝水的，自愈。
张口短气的危重。咳嗽而口中自有津液，舌苔白滑，这是肺寒，用甘草干姜汤。肺痿属热，如咳嗽日久肺叶枯萎，喉哑声嘶咯血，这属阴虚，大多不可治。肺痿六脉沉涩而急，或细数无神，脉口皮肤枯干，而气高息粗的，死症。
《金匮要略》说：上气喘促而躁动的，属于肺胀，欲作风水病，发汗则愈。
肺胀而发其汗的，就是《内经》开鬼门的方法。一汗出而令风邪外泄于肌表，水随风顺势而下趋从下排出。
咳而上气，这是肺胀。其人喘，眼睛像要脱出的样子，脉浮大的，用越婢加半夏汤主治。肺胀咳而上气，烦躁而喘，脉浮的，心下有水气，用小青龙加石膏汤主治。
接续这两个方子分治肺胀，都是因为脉浮，应当从汗解的法则。越婢方中有石膏无半夏，小青龙方中有半夏无石膏。观察两个方子所加之意，全重在半夏、石膏两味药协力建功。石膏清热，借辛温也能豁痰；半夏豁痰，借辛凉也能清热。看麦门冬汤方中，下气止逆，全藉半夏进入生津药中。这两个方子又藉半夏进入清热药中。张仲景加减成方，无非是用心化裁，后学者应当神往学习。
上气面浮肿，肩息，其脉浮大，不治。如果再加上腹泻，更严重。
上气的证候，到了面目浮肿，喘息动肩，是肺气壅逼，上而不下。加上脉浮大，气方外出，无法令其内还而下趋，所以说不可治。如果加上腹泻，则上下交争，更何以忍受。
肺胀而咳，左右不得卧，这是痰挟瘀血碍气而胀。用当归、丹皮、赤芍、桃仁、枳壳、桔梗、半夏、甘草、竹沥、姜汁，适合在外邪去除后使用。或者用半夏、海浮石、香附、栝蒌、甘草为末，姜汁蜜调含服。
喻嘉言治疗施眉苍，肺痿喘嗽吐清痰，肢体痿软，不能举动，脉来虚数，用蛤蚧二十枚，酒浸酥炙，人参、黑参各十两，蜜丸，时时含化，未服完一剂而痊愈。
石顽治疗陆去非，肺痿声飒吐痰，午后发热自汗，左脉细数，右脉虚濡，平昔劳心耽色所致。先用生脉散合保元汤，次用异功散加黄芪，并加姜、枣，与都气丸晨夕兼进，调补半月而热除痰止，月余方得声音清亮。
又治疗孙起柏肺胀，服用耗气药过多，脉浮大而重按豁然空虚，饮食不入，幸得溺清便坚，用局方七气汤，每剂用人参三钱，肉桂、半夏曲、炙甘草各一钱，生姜四片，四剂霍然痊愈。大概肺胀实证居多，此脉虚大，不应当按寻常论治。
又治疗一位尼姑肺胀，喘鸣肩息，服用下气止嗽药不应，渐至胸腹胀满，脉得气口弦细而涩，这必定是劳力气上，误饮冷水伤肺，肺气不能收敛所致。于是用越婢汤减麻黄，加细辛、葶苈子，大泻肺气而安。
又治疗一位嗜酒者，严冬醉卧，渴饮冷茶，肺胀喘嗽，脉得气口沉紧搏指，用小青龙汤去芍药，加葶苈子、半夏，一剂而痊愈。则知道肺胀喘满，当以葶苈子为向导。
I used Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dan Nan Xing (Arisaema cum Bile), Zhi Shi (Immature Bitter Orange), Xiang Fu (Cyperus Rhizome), and Chen Xiang (Aquilaria Wood). After two doses, the patient vomited vigorously, expelling one or two sheng (approx. 500-1000ml) of thick, sticky phlegm and residue. Because the vomiting was too severe, I crossed the lake in haste during the Jia hour (night watch) to visit again. At dawn, upon arrival, the vomiting had stopped, the cough had calmed, and the pulse was regular. No further medication was needed.
The daughter-in-law of Jiang You (Jiangxi) Education Commissioner He Hanzhai, who was the daughter of Hanlin Fan Qiutao, had suffered from persistent cough for a long time, occasionally with blood spots in the sputum. She had taken Tong Zhen Wan (Child's True Pill) continuously but without complete cure. After Fan Qiutao passed away, her grief was intense, causing her cough and rebellious qi to worsen significantly, with fresh blood appearing mixed in the sputum. Therefore, Rui Jin Dan (Rui Gold Pill) was administered four times, while Tong Zhen Wan and Wu Gu Ji Wan (Black Bone Hen Pill) were continued for regulation and tonification, leading to stabilization.
Another case involved the mother of Tong Zheng Lao Shushen, over fifty years old. She naturally had a constitution of qi deficiency with excessive phlegm. Recently, she contracted wind-heat causing cough and rebellious qi; severe coughing produced a choking sound resembling retching. She also had a history of metrorrhagia and leukorrhea, which had recently stabilized. The treatment principle should first address the cough. Thus, Jie Geng Tang (Platycodon Decoction) was used with Wei Rui (Polygonatum Rhizome), Bai Wei (Cynanchum Atratum Root), Dan Pi (Moutan Cortex), Ju Pi (Tangerine Peel), and Honey-fried Ginger, administered for four doses to resolve the exterior/superficial symptoms. Subsequently, Liu Jun Zi Tang (Six Gentlemen Decoction) with Wei Rui (Polygonatum Rhizome) was given to soothe the stomach qi. Finally, Wu Gu Ji Wan (Black Bone Hen Pill) was advanced to treat the chronic condition. However, the lady had abstained from meat for a long time and could not bear to harm living creatures, so she switched to Da Wen Jing Tang (Major Warming the Menses Decoction) added with Mi Rong (Elk Antler), made into pills. Although the herbs differed, the therapeutic effect was the same.
The *Jin Gui Yao Lue* states: "Question: When heat is in the Upper Jiao, it leads to cough and becomes Fei Wei (Lung Flaccidity). How is this disease acquired? Master said: It may result from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting syndrome) with frequent urination, or constipation treated with harsh purgatives, all leading to repeated loss of body fluids." Question: "When the Cun Kou (radial artery at the wrist) pulse is rapid, the person coughs, and there is instead turbid saliva and froth in the mouth, what is this?" Master said: "This is Fei Wei (Lung Flaccidity). If the mouth is parched and dry, and coughing causes hidden pain in the chest, and the pulse is slippery and rapid, this is Fei Yong (Lung Abscess), characterized by coughing up pus and blood. A rapid and deficient pulse indicates Fei Wei (Lung Flaccidity); a rapid and excess pulse indicates Fei Yong (Lung Abscess)."
The Cun Kou on both hands originally corresponds to the Hand Taiyin Lung meridian. The mentions of rapid, slippery-rapid, rapid-deficient, and rapid-excess pulses here refer collectively to the three positions on both left and right wrists. When a person coughs and has turbid saliva and froth in the mouth, spilling everywhere shortly after, this is Fei Wei (Lung Flaccidity), indicating that the mouth is not dry. If coughing is accompanied by a parched, dry mouth, it means the lung has formed an abscess; toxic fire manifests in the mouth. The vibration of the cough triggers the abscess, causing hidden pain in the chest. The pulse must be slippery, rapid, and forceful, a sign of flourishing pathogenic qi. Using rapid-deficient and rapid-excess pulses to distinguish between Fei Wei (Lung Flaccidity) and Fei Yong (Lung Abscess) implies that Fei Wei (Lung Flaccidity) requires tonification, while Fei Yong (Lung Abscess) requires purging, a meaning implicit in the text.
In Fei Wei (Lung Flaccidity), if there is salivation and froth without coughing, the person is not thirsty and will inevitably have urinary incontinence and frequent urination. This is because the upper jiao is cold and cannot control the lower jiao. This belongs to Cold in the Lung, likely accompanied by dizziness and excessive saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) should be used to warm it. If thirst occurs after taking the decoction, it belongs to Xiao Ke (Wasting and Thirsting syndrome).
If the lung is hot, the qi of the Bladder is also hot, resulting in dark, scanty, and difficult urination. However, if there is only salivation and froth without coughing, no thirst, but rather urinary incontinence and frequent urination, it is clearly not Fei Wei (Lung Flaccidity) due to heat in the upper jiao, nor due to severe fluid loss. It must be upper jiao deficiency-cold, unable to control the lower jiao, leading to unregulated urination. This is Cold in the Lung, where yin qi rebels upward and harasses yang qi, causing dizziness. Yin-cold stagnating fluids causes excessive saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) with sweet and pungent properties should be used to warm the Spleen and Lung. If initially not thirsty but becoming thirsty after taking warming medicines, it is clearly Xiao Ke (Wasting and Thirsting syndrome) with drinking one part and urinating two parts. Xiao Ke (Wasting and Thirsting syndrome) is similar to carbuncles and sores, requiring careful consideration.
Yu Jiayan stated: Fei Wei (Lung Flaccidity) accumulates gradually over time. Its heat arises from various sources, primarily because stomach fluids fail to transport to the lung, causing the lung to lose nourishment, become dry, and eventually form. Lung fire intensifies daily, lung heat deepens, and small tubes in the lung become obstructed. Cough sounds gradually weaken, chest membranes dry out, making expectoration difficult. Walking a few steps causes wheezing and gasping. Sputum is hard to expel. The treatment methods in *Jin Gui* are clear but often mixed with Fei Yong (Lung Abscess), making the essence hard to grasp. The general principle is to proceed slowly: generate stomach fluids, moisten lung dryness, descend rebellious qi, open accumulated phlegm, stop turbid saliva, tonify true qi, unblock small lung tubes, dissipate heat/fire, and restore lung clarity and descending function. Just as hemiplegic flaccidity or limb weakness can recover with proper treatment, although lung disease is near the chest and vital for respiration, effort must be exerted. However, Fei Yong (Lung Abscess) involves tangible blood; blood stasis should be attacked rapidly. Fei Wei (Lung Flaccidity) involves intangible qi; qi injury should be managed slowly, combined with moistening lung dryness. Although the lung is dry, patients are rarely thirsty; do not use drying-hot herbs just because they are not thirsty. This is the major principle of syndrome differentiation and medication.
For Fei Wei (Lung Flaccidity) with excessive saliva/froth and a sensation of warmth and fluidiness in the heart, Zhi Gan Cao Tang (Honey-fried Licorice Decoction) is the primary formula. This is the method from *Wai Tai Mi Yao*. For Fei Wei (Lung Flaccidity) with deficiency-cold, emaciation, weakness, trembling, and chest fullness during inhalation/exhalation, *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) recommends Sheng Jiang Wen Zhong Tang (Fresh Ginger Warming the Middle Decoction). For Fei Wei (Lung Flaccidity) with coughing up sputum, incessant saliva/froth, dry throat, and thirst, *Qian Jin Fang* recommends Sheng Jiang Gan Cao Tang (Fresh Ginger and Licorice Decoction). For Fei Wei (Lung Flaccidity) with cough, phlegm, afternoon fever, and hoarseness, ancient methods use Ren Shen Yang Fei Tang (Ginseng Nourishing Lung Decoction). Now, Zi Wan San (Aster Powder) added with Dan Pi (Moutan Cortex), Ginger, and Jujube is used. If Heart Fire attacks the Lung, transmitting to Fei Wei (Lung Flaccidity), with cough, wheezing, vomiting, abundant phlegm-saliva, chest/epigastric stuffiness, and throat obstruction, ancient methods use Ren Shen Ping Fei Tang (Ginseng Calming Lung Decoction). Now, Zi Wan San (Aster Powder) added with Wei Rui (Polygonatum Rhizome), Ju Hong (Red Tangerine Peel), Ginger, and Jujube is used. For Fei Wei (Lung Flaccidity) with persistent cough, alternating chills and fever, spontaneous sweating, and vexatious thirst, ancient methods use Zhi Mu Fu Ling Tang (Anemarrhena and Poria Decoction). Now, Zi Wan San (Aster Powder) added with Zhi Mu (Anemarrhena Rhizome), Yin Zhou Chai Hu (Bupleurum from Yinzhou), Ginger, and Jujube is used. Generally, cough with hoarseness and throat obstruction are due to constrained fire and stagnant phlegm, requiring the pungency of Ginger to disperse it. However, it must be honey-processed to borrow sweetness for moistening. This embodies the principle of treating both root and branch. Liu Mosheng said: Flaccidity is fundamentally deficiency-dryness, never departing from strengthening water to clear metal, tonifying qi-blood and fluids, resolving phlegm, and stopping cough. Main herbs include Tian Dong (Asparagus Tuber), Mai Dong (Ophiopogon Tuber), Sheng Di Huang (Rehmannia Root), Shu Di Huang (Prepared Rehmannia Root), Zhi Mu (Anemarrhena Rhizome), Ren Shen (Ginseng Root), Wei Rui (Polygonatum Rhizome), and Zi Wan (Aster Root). For palpable knots, remove Tian Dong and Sheng Di Huang, add Ju Hong (Red Tangerine Peel) and Su Zi (Perilla Seed). For diarrhea, remove Tian Dong, Sheng Di Huang, and Zhi Mu, add Shan Yao (Dioscorea Rhizome) and Fu Ling (Poria). Use Gu Ben Wan (Root-Fixing Pill), taken intermittently by holding in the mouth. For Fei Wei (Lung Flaccidity) with cough, red threads in sputum, night sweats, fever followed by cold, and reduced appetite, Jie Lao San (Depletion-Expelling Powder) is indicated. For consumptive Fei Wei (Lung Flaccidity) with loss of voice, coughing up fishy-smelling thin sputum with blood, or facial sores, Ren Shen Ge Jie San (Ginseng and Gecko Powder) is indicated. A folk prescription for Fei Wei (Lung Flaccidity) uses one qian of fine Ginseng powder inserted into a pig lung, boiled until soft in a clay pot, then taken with scallion and wine. Fei Wei (Lung Flaccidity) with coughing sputum and dry throat desiring water will heal spontaneously.
Opening the mouth with shortness of breath is critical. Coughing with natural saliva in the mouth and a white, slippery tongue coating indicates Lung Cold; Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) is used. Fei Wei (Lung Flaccidity) belonging to heat, such as long-term cough leading to lung withering, hoarse voice, and hemoptysis, belongs to yin deficiency and is mostly incurable. Fei Wei (Lung Flaccidity) with six pulses being deep, choppy, and urgent, or fine and rapid without spirit, with dry skin at the radial artery and high breathing with coarse breath, is fatal.
The *Jin Gui Yao Lue* states: "Upper qi rushing upward with restlessness belongs to Fei Zhang (Lung Distension), intending to become Feng Shui (Wind Edema). Sweating will lead to recovery."
Sweating for Fei Zhang (Lung Distension) follows the *Nei Jing* method of 'opening the ghost gate' (sweating). One sweat allows wind-pathogen to escape to the muscle surface; water follows the wind smoothly and exits downward.
Cough with upper qi rushing upward is Fei Zhang (Lung Distension). The person wheezes, eyes bulge as if protruding, and the pulse is floating and large; Yue Bi Jia Ban Xia Tang (Yuebi Decoction plus Pinellia) is the primary formula. Fei Zhang (Lung Distension) with cough and upper qi rushing upward, irritability, wheezing, and a floating pulse indicates water-qig under the heart; Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum) is the primary formula.
These two formulas treat Fei Zhang (Lung Distension) separately, both based on the principle that floating pulses require resolution via sweating. Yue Bi Tang contains Shi Gao (Gypsum) but no Ban Xia (Pinellia); Xiao Qing Long Tang contains Ban Xia (Pinellia) but no Shi Gao (Gypsum). Observing the intent of these additions, the key lies in the synergy of Ban Xia (Pinellia) and Shi Gao (Gypsum). Shi Gao (Gypsum) clears heat and, borrowing pungent-warmth, can resolve phlegm; Ban Xia (Pinellia) resolves phlegm and, borrowing pungent-coolness, can clear heat. In Mai Men Dong Tang (Ophiopogon Decoction), descending qi and stopping rebellion relies entirely on Ban Xia (Pinellia) entering fluid-generating herbs. These two formulas similarly rely on Ban Xia (Pinellia) entering heat-clearing herbs. Zhang Zhongjing's modifications of established formulas are nothing but creative adaptation; later scholars should aspire to this.
Upper qi rushing upward with facial edema, shoulder breathing, and a floating-large pulse is untreatable. If diarrhea is added, it is even worse.
In the presentation of upper qi rushing upward, reaching facial edema and shoulder breathing indicates lung qi congestion forcing upward without descending. Coupled with a floating-large pulse, the qi is exiting outward, with no way to return inward and descend. Hence, it is deemed untreatable. Adding diarrhea means struggle between upper and lower, which is unbearable.
Fei Zhang (Lung Distension) with cough, unable to lie on either side, is caused by phlegm binding with blood stasis obstructing qi, leading to distension. Use Dang Gui (Angelica Sinensis), Dan Pi (Moutan Cortex), Chi Shao (Red Peony Root), Tao Ren (Peach Kernel), Zhi Qiao (Bitter Orange), Jie Geng (Platycodon Root), Ban Xia (Pinellia), Gan Cao (Licorice), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice), suitable after exterior pathogens are removed. Alternatively, Ban Xia (Pinellia), Hai Shi (Calcitum), Xiang Fu (Cyperus Rhizome), Gua Lou (Trichosanthes Fruit), and Gan Cao (Licorice) powdered, mixed with ginger juice and honey, held in the mouth.
Yu Jiayan treated Shi Meicang with Fei Wei (Lung Flaccidity), wheezing, coughing, clearing phlegm, limb flaccidity, inability to move, and a deficient-rapid pulse. He used twenty Ge Jie (Geckos), soaked in wine and fried with butter, along with ten liang each of Ren Shen (Ginseng Root) and Hei Shen (possibly referring to a specific preparation or herb, contextually linked to tonification), made into pills with honey, held in the mouth intermittently. Recovery occurred before finishing one dose.
Shi Wan treated Lu Qufei with Fei Wei (Lung Flaccidity), raspy voice, phlegm expectoration, afternoon fever, spontaneous sweating, fine-rapid left pulse, and deficient-soft right pulse, caused by mental labor and sexual indulgence. First, Sheng Mai San (Generate Pulse Powder) combined with Bao Yuan Tang (Protect Origin Decoction) was given. Next, Yi Gong San (Benefit the Worker Powder) added with Huang Qi (Astragalus Root), plus Ginger and Jujube, was administered alongside Du Qi Wan (Eight Ingredients Pill) morning and evening. After half a month of regulation, fever ceased and phlegm stopped. After more than a month, the voice cleared.
He also treated Sun Qibai with Fei Zhang (Lung Distension). Excessive consumption of qi-depleting drugs resulted in a floating-large pulse that vanished upon heavy pressure, inability to eat, though urine was clear and stool firm. Ju Fang Qi Qi Tang (Seven Qi Decoction from the Bureau Formulary) was used, with three qian of Ren Shen (Ginseng Root), one qian each of Rou Gui (Cinnamon Bark), Ban Xia Qu (Pinellia Fermented), and Zhi Gan Cao (Honey-fried Licorice), plus four slices of Ginger per dose. Four doses led to sudden recovery. Generally, Fei Zhang (Lung Distension) cases are mostly excess; this deficient-large pulse should not be treated ordinarily.
He also treated a nun with Fei Zhang (Lung Distension), wheezing, shoulder breathing. Medications for descending qi and stopping cough failed, leading to chest and abdominal distension. The pulse at the Qi Kou (radial artery) was string-taut, fine, and choppy. This was likely due to strenuous labor ascending, mistakenly drinking cold water injuring the lung, causing lung qi to fail to converge. Thus, Yue Bi Tang (Yuebi Decoction) with reduced Ma Huang (Ephedra Stem), added with Xi Xin (Asarum Root) and Ting Li (Descurainia Seed), was used to strongly drain lung qi, resulting in peace.
He also treated a wine drinker who slept drunk in deep winter and drank cold tea when thirsty, developing Fei Zhang (Lung Distension), wheezing, and cough. The pulse at the Qi Kou was deep, tight, and striking. Xiao Qing Long Tang (Minor Green Dragon Decoction) without Shao Yao (Peony Root), added with Ting Li (Descurainia Seed) and Ban Xia (Pinellia), cured him in one dose. Thus, it is known that for Fei Zhang (Lung Distension) with wheezing and fullness, Ting Li (Descurainia Seed) should serve as the guide.