金匮云。问曰。病咳逆。脉之何以知为肺痈。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。
肺痈之脉。既云滑数。此复云微数者。非脉之有不同也。滑数者已成之脉。微数者初起之因
也。初起以左右三部脉微。知卫中于风而自汗。左右三部脉数。为营吸其热而畏寒。然风入卫。
尚随呼气而出。不能深入。所伤者不过在于皮毛。以渐舍肺俞。而咳唾振寒。兹时从外入者。从
外出之易易也。若夫热过于营。即随吸气深入不出而伤其血脉矣。卫中于风。得营中之热留恋。
固结于肺叶之间。乃致血为凝滞。以渐结为痈脓。是则有形之败浊。必从泻肺之法而下驱之。安
在始萌不救。听其脓成。而致肺叶腐败耶。
咳逆上气。时时唾浊。坐不得眠。皂荚丸主之。
火热之毒。结聚于肺。表之里之。清之温之。曾不少应。坚而不可攻。惟此无坚不入。聿成
荡涤之功。不可以药之微贱而忽诸。若因外感所触而成。当取用千金桂枝去芍药加皂荚汤最佳。
足可补仲景之未迨也。
咳而胸满振寒。脉数。咽干不渴。时吐浊唾腥臭。久久吐脓如米粥者。为肺痈。桔梗汤主之。
此上提之法也。痈结肺中。所以浊唾腥臭。乘其新造未固。提而出之。如其势已入里。又当
引之从胃入肠。此法殊不中用矣。所以宋人附以十六味桔梗汤。兼合葶苈泻肺之意。外内合邪之治也。
肺痈喘不得卧。葶苈大枣泻肺汤主之。
此治肺痈吃紧之方也。肺中生痈不泻其肺。更欲何待。然日久痈脓已成。泻之无益。日久肺
气已索。泻之转伤。惟血结而脓未成。当亟以泻肺之法夺之。若一身面目浮肿。鼻塞清涕出。为
表证未罢。当先与小青龙汤一剂。后乃服之。
石顽曰。肺痈危证。乘初起时。极力攻之。庶可救疗。金匮特立二方。各有主见。如患人平
昔善饮嗜啖。痰湿渐渍于肺。宜皂荚丸。肥盛喘满多痰。宜葶苈大枣泻肺汤。千金补所不足。复
立桂枝去芍药加皂荚汤以治风寒客邪感触发热之证。苇茎汤以治心脾过劳。肺气不化。水道不利
之疾。功效最速。宋人又有十六味桔梗汤。虽未尽善。亦可以备诸治之采用。若畏其峻。而守王
道之方。真养痈以待毙耳。明眼者辨治宜早也。
凡咳嗽吐臭稠痰。胸中隐痛。鼻息不闻香臭。项强不能转侧。咳则遗尿。自汗喘急。呼吸不
利。饮食减少。脉数盛而芤。恶风毛耸。便是肺痈之候。盖由感受风寒。未经发越。停留肺中。
蕴发为热。或挟湿热痰涎垢腻。蒸淫肺窍。皆能致此。慎不可用温补保肺药。尤忌发汗伤其肺气。
往往不救。金匮皂荚丸、葶苈大枣泻肺汤、千金桂枝去芍药加皂荚汤、苇茎汤。宋人十六味桔梗
汤。俱肺痈专药。初起用苇茎汤。此方大疏肺气。服之使湿瘀悉趋溺孔而去。一二服即应。脉浮
表热。加葱白、香豉。气口脉盛。加犀角、竹茹。痰多。加贝母、蒌仁。蛤粉。引痛。加紫菀、
白蜜。初起咳逆不利。二味桔梗汤加贝母、紫菀。多汗。加防己、黄 。溃后唾脓血不止。葶苈
薏苡泻肺汤随证加减。咳有微热烦满。胸中块垒甲错者。千金用合欢皮一味。日取掌大一块煎汤
服。平昔劳心思虑多郁火人。唾臭痰鲜血。此属阴火。但与生料六味丸加麦冬、紫菀之类。若误
投参、 补气补火。臭痰转甚者。急宜上法加童便。服之自清。初起疑似未真。生大豆绞浆饮之。
不觉腥气。便为真候。大抵声音清朗。脓痰稀泽。或间有鲜血。饮食知味。胸胁不疼。或咳则微
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。此金气浅薄。溃后最难平复。而喘汗面赤。坐卧不安。饮食无味。
脓痰腥秽不已者难治。若喘鸣不休。唇反。咯吐脓
血。色如败卤。 臭异常。正气大败。而不知痛。坐不得卧。饮食难进。爪甲紫而带弯。手掌如
枯树皮。面艳颧红。声哑鼻煽者不治。肺痈初起。脉不宜数大。溃后最忌短涩。脉缓滑面白者生。
脉弦急面赤者死。肺痈已破。入风者不治。即浓煎葱白香豉汤频服之。然多不救。
肺痈丹方。初起唾臭痰沫。用陈年芥齑汁。温服灌吐最妙。一方。用荷叶浓煎。稍入白蜜。
不时服之。不问已溃未溃皆效。又方。以猪肺去心。竹刀剖去垢沫。取接骨木二两。缶器中煮熟
淡食。日服无间。五七日当效。溃后排脓。用金鲤汤。以小活鲤鱼去肠垢。入贝母末三钱。隔水
童便煮。和汁食之。日服一枚。皆屡验。然不若薏苡根捣汁。炖热服之。其效最捷。下咽其臭即
解。有虫者虫即死出。薏苡为肺痈专药。然性燥气滞。服之未免上壅。不及根汁之立能下夺。已
溃未溃。皆可挽回。诸方皆不及也。肺痈溃后。脓痰渐稀。气息渐减。忽然臭痰复甚。此余毒未
尽。内气复发。必然之理。不可归咎于调理服食失宜也。但虽屡发。而势渐轻可。可许收功。若
屡发而痰秽转甚。脉形转疾者。终成不起也。
《金匮要略》中说：有人问，患咳嗽气逆的病人，诊脉时如何判断是肺痈？应该会有脓血吐出，如果误治吐之则死。这种病的脉象是什么样的？老师说：寸口脉微而数。脉微表示受风邪，脉数表示有热邪。脉微则汗出，脉数则恶寒。风邪侵袭卫分，呼气时邪气不能随之外出；热邪深入营分，吸气时邪气不能随之排出。风邪损伤皮毛，热邪损伤血脉。风邪留舍于肺，病人就会咳嗽、口干、气喘胸闷、咽喉干燥但不想喝水、多唾浑浊泡沫、时常发冷颤抖。热邪经过之处，血液为之凝滞，蓄积结聚成痈脓，吐出的痰像米粥一样。在疾病初起阶段还可以救治，一旦脓液形成则预后不良（原文作“死”，意指危重难治）。
肺痈的脉象，既然说是滑数，这里又说微数，并不是脉象本身有不同。滑数是已经成脓的脉象，微数是初起阶段的病因脉象。初起时通过左右三部脉微，知道卫分被风邪所中且自汗；左右三部脉数，知道营分吸入热邪而畏寒。然而风邪侵入卫分，尚且随着呼气而出，不能深入体内，所伤害的不过在于皮毛，逐渐传入肺俞穴所在部位，出现咳嗽、唾浊沫、发冷颤抖等症状。此时病邪从外而入，从内而外出是比较容易的。如果热邪过于营分，就随着吸气深入体内无法排出，从而损伤血脉。卫分被风邪所中，得到营分中的热邪留恋，固结在肺叶之间，导致血液凝滞，逐渐结聚成痈脓。因此，对于这种有形的败浊之物，必须采用泻肺的方法将其向下驱除。哪里会在初起时不救治，听任其脓成，而导致肺叶腐败呢？
咳嗽气逆上冲，时常吐出浑浊痰液，坐卧不安无法入睡，用皂荚丸主治。
火热毒邪结聚在肺部，无论是解表还是攻里，无论是清热还是温散，都几乎没有效果，病情坚硬不可攻伐。只有皂荚这一味药无坚不入，能够成就荡涤之功，不能因为药物轻微贱价而忽视它。如果是因外感触发的肺痈，应当选用《千金方》中的桂枝去芍药加皂荚汤，效果最佳，足以弥补张仲景未及此处的不足。
咳嗽且胸满、发冷颤抖、脉数、咽干但不渴、时常吐出腥臭的浑浊唾液，久病后吐出如米粥般的脓液，这是肺痈，用桔梗汤主治。
这是上提排脓的方法。痈结聚在肺中，所以浊唾腥臭。趁着痈肿新近形成尚未稳固之时，将其提出排出。如果病势已经深入里部，又应当引导病邪从胃进入肠道，这种方法就不太适用了。所以宋代医家附加了十六味桔梗汤，兼合葶苈子泻肺之意，这是针对内外合邪的治疗方法。
这是治疗肺痈的关键方剂。肺中生痈如果不泻肺，还等待什么呢？然而如果日久脓已成，泻肺则无益；日久肺气已虚损，泻肺反而受伤。只有在血结而脓未成的时候，才应当急切地使用泻肺之法来攻夺。如果全身面目浮肿，鼻塞流清涕，说明表证未罢，应当先服用一剂小青龙汤，然后再服用本方。
石顽（张璐号）说：肺痈是危重病症，在初起时极力攻伐，或许可以救疗。《金匮要略》特别设立两个方剂，各有主见。如果患者平素喜欢饮酒嗜食肥甘，痰湿逐渐浸渍于肺，宜用皂荚丸；形体肥胖壮实、气喘胸闷多痰者，宜用葶苈大枣泻肺汤。《千金方》补充了不足之处，又立桂枝去芍药加皂荚汤以治疗风寒客邪感触发热之证；苇茎汤用于治疗心脾过劳、肺气不化、水道不利的疾病，功效最快。宋代又有十六味桔梗汤，虽然未尽善尽美，也可以备诸治疗方法采用。如果畏惧药性峻猛，而坚守王道平和之方，真是养痈遗患等待死亡罢了。明眼人应当辨别并尽早治疗。
凡是咳嗽吐出腥臭稠痰，胸部隐痛，鼻息闻不到香臭，颈项强直不能转侧，咳嗽时遗尿，自汗喘急，呼吸不利，饮食减少，脉象数盛而芤，恶风毛发竖起，这就是肺痈的征候。大概是由于感受风寒，未经发散，停留于肺中，蕴积化为热邪，或者夹杂湿热痰涎垢腻，蒸淫肺窍，都能导致此病。千万不要使用温补保肺的药物，尤其忌讳发汗损伤肺气，往往会导致不治。《金匮要略》的皂荚丸、葶苈大枣泻肺汤，《千金方》的桂枝去芍药加皂荚汤、苇茎汤，以及宋人的十六味桔梗汤，都是治疗肺痈的专用药物。初起时用苇茎汤，此方能大疏肺气，服用后使湿瘀全部趋向膀胱排出，一二服即可见效。脉浮表热，加葱白、香豉；气口脉盛，加犀角、竹茹；痰多，加贝母、瓜蒌仁、蛤粉；牵引疼痛，加紫菀、白蜜；初起咳逆不利，用二味桔梗汤加贝母、紫菀；多汗，加防己、黄芪；溃后唾脓血不止，用葶苈薏苡泻肺汤随证加减。咳嗽伴有微热烦闷，胸中块垒状如肌肤甲错者，《千金方》用合欢皮一味，每日取手掌大一块煎汤服用。平素劳心思虑多郁火之人，吐出臭痰带鲜血，这属于阴火，只给予生料六味丸加麦冬、紫菀之类。如果误投人参、黄芪补气补火，导致臭痰加重，急需在上法中加入童便，服用后自然清净。初起疑似而未确诊时，饮生大豆绞汁，不觉腥气，便是真候。大抵声音清朗，脓痰稀薄润泽，或间有鲜血，饮食知味，胸胁不疼，或咳嗽时微痛，痛在右侧肺之长叶，而坐卧安宁，形色如常，大小便调畅者可治。如果溃后大热不止，时时恶寒，胸部隐痛，痛在左侧肺之短叶，这是金气浅薄，溃后最难平复，加上喘汗面赤，坐卧不安，饮食无味，脓痰腥秽不已者难治。如果喘鸣不休，唇反，咯吐脓血，颜色如败卤，气味异常臭秽，正气大败而不知痛，坐不得卧，饮食难进，爪甲紫而弯曲，手掌如枯树皮，面色艳红颧骨红，声哑鼻煽者不治。肺痈初起，脉不宜数大，溃后最忌短涩。脉缓滑面白者生，脉弦急面赤者死。肺痈已破，复感风邪者不治，即使浓煎葱白香豉汤频服，大多也不救。
肺痈丹方：初起唾臭痰沫，用陈年芥齑汁，温服灌吐最好。一方，用荷叶浓煎，稍加白蜜，不时服用，无论已溃未溃皆有效。又一方，以猪肺去心，用竹刀剖去垢沫，取接骨木二两，在瓦罐中煮熟淡食，每日不间断服用，五七日当见效。溃后排脓，用金鲤汤，用小活鲤鱼去肠垢，入贝母末三钱，隔水用童子小便煮，和汁食用，每日服一枚，都屡验有效。然而不如薏苡根捣汁，炖热服用，其效最捷，下咽后臭味即解，有虫者虫即死出。薏苡为肺痈专药，然性燥气滞，服用未免上部壅塞，不及根汁之立即能下夺。已溃未溃，皆可挽回，其他方剂都不如它。肺痈溃后，脓痰渐稀，气息渐减，忽然臭痰又严重，这是余毒未尽，内气复发，是必然的道理，不可归咎于调理服食失宜。但只要虽屡发而势渐轻，可许收功。若屡发而痰秽转甚，脉形转疾者，终成不起也。
According to the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): A question was asked: "In a patient with cough and rebellious qi, how can one know it is Lung Abscess (Fei Yong) upon palpating the pulse? There should be pus and blood expectorated; if mistaken treatment induces vomiting, death ensues. What does the pulse resemble?" The Master said: "The Cun Kou (inch position at the radial artery) pulse is faint (Wei) and rapid (Shu). Faint indicates Wind, rapid indicates Heat. Faint implies sweating, rapid implies aversion to cold. Wind invades the Wei (Defensive) level, exhalation cannot expel it; Heat overflows into the Ying (Nutritive) level, inhalation cannot retain it. Wind damages the skin and hair pores, Heat damages the blood vessels. Wind lodges in the Lung, causing cough, dry mouth, wheezing and chest fullness, dry throat without thirst, profuse expectoration of turbid froth, and frequent chills. Where Heat passes, blood coagulates and stagnates, accumulating to form an abscess. The expectorant resembles congee made of rice. If treated at the initial stage, it can be saved; once pus is formed, it is fatal."
Regarding the pulse of Lung Abscess, although it is described as slippery and rapid elsewhere, here it is described as faint and rapid. This is not because the pulse itself differs. Slippery and rapid indicate an established abscess, while faint and rapid indicate the etiology at the onset. At the onset, observing the faint pulse in the three positions on both sides indicates that the Wei level is invaded by Wind with spontaneous sweating; the rapid pulse indicates that the Ying level absorbs Heat with aversion to cold. However, when Wind enters the Wei level, it tends to exit with exhalation and cannot penetrate deeply, damaging only the skin and hair pores initially, gradually moving to the Lung Shu points, causing cough, expectoration of turbid fluid, and chills. At this stage, pathogens entering from the exterior can be easily expelled outward. But if Heat overflows into the Ying level, it penetrates deeply with inhalation and cannot exit, thereby damaging the blood vessels. When the Wei level is invaded by Wind and lingers due to Heat in the Ying level, it solidifies between the lung lobes, causing blood stagnation and gradually forming an abscess. Therefore, for such tangible turbid pathogens, one must employ methods to drain the Lung to drive them downward. How could one fail to treat it at the onset and allow the abscess to mature, leading to the rotting of lung tissue?
For cough with rebellious ascending Qi, frequent expectoration of turbid fluid, inability to lie down or sleep, the **Zao Jiao Wan** (Soapberry Pill) is the primary formula.
When toxic Fire-Heat accumulates in the Lung, neither releasing the exterior nor purging the interior, nor clearing Heat nor warming, yields any effect; the condition becomes hard and unassailable. Only Zao Jiao (Gleditsiae Fructus Spina) can penetrate hardness, achieving the effect of thorough cleansing. One should not disregard it because it is a cheap herb. If caused by external contraction, the **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** (Cinnamon Twig Decoction minus Peony plus Soapberry) from *Qian Jin Fang* is best, sufficient to supplement Zhang Zhongjing's earlier omissions.
For cough with chest fullness, chills, rapid pulse, dry throat without thirst, frequent expectoration of foul-smelling turbid saliva, and long-term expectoration of pus resembling congee, this is Lung Abscess. The **Jie Geng Tang** (Platycodon Decoction) is the primary formula.
This is an upward-lifting method. Since the abscess is lodged in the Lung, the sputum is foul. Taking advantage of its new formation and instability, one lifts and expels it. If the pathogen has already entered the interior, one should guide it from the Stomach to the Intestines; this lifting method would then be ineffective. Hence, Song dynasty physicians added the **Shi Liu Wei Jie Geng Tang** (Sixteen-Ingredient Platycodon Decoction), combining the intent of Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung), treating combined external and internal pathogens.
For Lung Abscess with wheezing and inability to lie down, the **Ting Li Da Zao Xie Fei Tang** (Descurainia Seed and Jujube Decoction to Drain the Lung) is the primary formula.
This is a critical formula for treating Lung Abscess. If an abscess forms in the Lung and one does not drain the Lung, what else should one wait for? However, if the disease is prolonged and pus is already formed, draining is useless; if Lung Qi is exhausted after a long time, draining causes further injury. Only when blood is knotted but pus has not yet formed should one urgently use the method of draining the Lung to attack it. If there is generalized edema of the face and body, nasal congestion with clear discharge, indicating the exterior syndrome is not resolved, one should first administer one dose of **Xiao Qing Long Tang** (Minor Green Dragon Decoction), followed by this formula.
Shiwan (Zhang Lu's pseudonym) stated: Lung Abscess is a critical condition. Attacking it vigorously at the onset may save the patient. *Jin Gui Yao Lue* specifically establishes two formulas, each with its own indication. For patients who habitually drink alcohol and eat rich foods, with phlegm-dampness gradually soaking the Lung, **Zao Jiao Wan** is suitable. For those who are obese, asthmatic, full-chested, and have much phlegm, **Ting Li Da Zao Xie Fei Tang** is suitable. *Qian Jin Fang* supplements these by establishing **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** for febrile conditions caused by wind-cold pathogens, and **Wei Jing Tang** (Reed Shoot Decoction) for diseases caused by heart-spleen overwork, failure of Lung Qi transformation, and dysfunction of water passages, which acts fastest. The Song dynasty also introduced **Shi Liu Wei Jie Geng Tang**; although not perfect, it can be used as a reference. If one fears harsh drugs and sticks to mild 'Kingly Way' formulas, one is essentially nurturing the abscess until death. Discerning practitioners should diagnose and treat early.
Symptoms indicating Lung Abscess include: cough with expectoration of foul, thick sputum; dull pain in the chest; loss of smell; stiff neck unable to turn; urinary incontinence during coughing; spontaneous sweating, wheezing, and urgency; difficult breathing; reduced appetite; rapid, full, and hollow (Kou) pulse; aversion to wind and piloerection. These arise from contracting wind-cold that was not dispersed, remaining in the Lung, accumulating into Heat, or mixing with damp-heat, phlegm, and turbidity steaming the Lung orifices. One must strictly avoid warm-tonifying Lung herbs and especially avoid sweating methods that damage Lung Qi, as this often leads to untreatable conditions. The **Zao Jiao Wan**, **Ting Li Da Zao Xie Fei Tang** from *Jin Gui*, **Gui Zhi Qu Shao Yao Jia Zao Jiao Tang** and **Wei Jing Tang** from *Qian Jin Fang*, and the Song dynasty's **Shi Liu Wei Jie Geng Tang** are all specific medicines for Lung Abscess. At the onset, use **Wei Jing Tang**; this formula greatly disperses Lung Qi, allowing dampness and stasis to exit via the bladder. Improvement occurs within 1-2 doses. For floating pulse and exterior heat, add Cong Bai (Scallion White) and Xiang Chi (Fermented Soybean); for strong pulse at the Qi Kou, add Xi Jiao (Rhinoceros Horn - *note: substitute with Buffalo Horn in modern practice*) and Zhu Ru (Bamboo Shavings); for much phlegm, add Bei Mu (Fritillaria Bulb), Gua Lou Ren (Trichosanthes Seed), and Ge Fen (Armeniac Plaster); for radiating pain, add Zi Wan (Aster Root) and Bai Mi (White Honey); for initial cough with difficulty, use Er Wei Jie Geng Tang plus Bei Mu and Zi Wan; for excessive sweating, add Fang Ji (Stephania Root) and Huang Qi (Astragalus Root); for persistent expectoration of pus and blood after ulceration, modify **Ting Li Yi Yi Xie Fei Tang** according to symptoms. For cough with slight fever, irritability, and chest blockage resembling skin scales (Jia Cuo), *Qian Jin Fang* uses He Huan Pi (Albizia Bark), decocting a palm-sized piece daily. For those prone to mental labor and depression-fire, expectorating foul sputum with fresh blood belongs to Yin Fire; treat with raw Liu Wei Di Huang Wan plus Mai Dong (Ophiopogon Tuber) and Zi Wan. If mistakenly administered Ren Shen (Ginseng) or Huang Qi (Astragalus) tonifying Qi and Fire, worsening the foul sputum, urgently add Tong Bian (Child's Urine) to the above method; self-clearing will occur. For uncertain early cases, drink juice pressed from raw soybeans; if no fishy odor is detected, it confirms the diagnosis. Generally, clear voice, thin and lustrous pus sputum, occasional fresh blood, normal appetite, no chest/flank pain (or slight pain on right side lung lobe during cough), ability to sit/lie comfortably, normal complexion, and regular urination/stool indicate a treatable case. If after ulceration, high fever persists, frequent chills occur, dull pain is in the left short lung lobe, indicating weak Metal Qi, recovery is difficult. Combined with wheezing, sweating, red face, restlessness, anorexia, and incessant foul pus sputum, it is difficult to treat. If wheezing sounds continue, lips retract, expectoration of pus and blood resembles brine with abnormal stench, vital Qi is severely depleted, insensitivity to pain, inability to lie down, difficulty eating, purple curved nails, palms like dry bark, flushed cheeks, hoarse voice, and flaring nostrils indicate an untreatable case. In early Lung Abscess, the pulse should not be rapid and large; after ulceration, a short and choppy pulse is taboo. Slow, slippery pulse with white face indicates survival; wiry, urgent pulse with red face indicates death. If Lung Abscess ruptures and re-contracts Wind, it is untreatable; even frequent consumption of strong Cong Bai and Xiang Chi decoction rarely saves.
Prescriptions for Lung Abscess: For initial foul sputum, drink aged mustard juice, warmed and induced to vomit, which is best. Another prescription: decoct Lotus Leaf strongly, add a little White Honey, take frequently; effective whether ulcerated or not. Another prescription: Remove heart from Pig Lung, scrape off dirt with a bamboo knife, cook with 2 liang of Eucommia Bark (Jie Gu Mu) in a clay pot, eat blandly daily without interruption; effective in 5-7 days. For post-ulceration pus drainage, use Jin Li Tang: remove guts from small live carp, add 3 qian of Bei Mu powder, steam-cook in Child's Urine, consume juice and fish daily; highly effective. However, nothing beats decocting juice from Yi Yi Gen (Coix Root Rhizome), taken hot; it acts fastest, resolving odor immediately upon swallowing, killing parasites if present. Yi Yi Ren (Coix Seed) is specific for Lung Abscess but is drying and stagnant, potentially causing upper jiao obstruction; the root juice acts faster to purge downward. Effective for both pre- and post-ulceration stages, superior to other formulas. After Lung Abscess ulceration, if pus sputum thins and breath decreases, but suddenly foul sputum worsens, this is residual toxin and internal Qi flare-up, a inevitable process, not due to improper diet/care. If episodes lessen over time, recovery is possible. If episodes worsen with increasing turbidity and rapid pulse, death is inevitable.