肺痈已成，寸数而实。肺痿之形，数而无力。
肺痈色白，脉宜短涩，不宜浮大，唾糊呕血。
《金匮要略》问曰∶热在上焦者，因咳为肺痿。肺痿之病，何从得之？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。又问曰∶病咳逆，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。风舍于卫，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。又云∶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。又云∶肺痈喘不得卧，葶苈大枣泻
肺汤主之。又云∶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。又云∶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，葶苈大枣泻肺汤主之。以上数条，《金匮要
略》辩肺痿、肺痈之所成不同也。其言热在上焦者，痿痈皆有热也。其言咳者，痿
痈皆有咳也。其言亡津液者，痿痈皆亡津液也。其言脉数者，痿痈皆脉数也。但痿
属肺气虚，虚则虽有热而不烈。热不烈，则虽亡津液，不至燥涸，故虽咳而口中反
有浊唾涎沫。热虽客肺，亦不致腐良为脓，惟肺脏痿萃而已，其脉虽数而必虚。痈
则不然，乃肺脏气壅邪实。实则热烈。热烈，则津液亡而更加干涸，故口中辟辟燥。
烈热迫肺，肺将腐伤，故气逆而咳。咳即胸中隐痛也。津液既涸，脉应涩滞，而反
滑数者，蓄热腐化，挟有脓血之象，即谓之数实亦可。次条云∶寸口脉微而数者，
以卫疏故微，邪郁故数。卫疏邪郁，故汗出表热而且恶寒也。此言风之初袭，邪犹
在表，不入于里，惟随呼出。中于卫而外伤皮毛，郁而为热，其热则不出于外，惟
随吸入，过于荣而内伤血脉。夫卫者，主表，主皮毛，阳也。风客之，则内关于肺。
肺气壅逆，故咳而喘满。卫主气，肺亦主气。口咽为气之门户。气不通调，则津液
不周布，故口干咽燥，或有时反唾浊沫。以热不在胃，故不渴。卫疏邪客，时为振
寒，此皆风中于卫，激动肺气之证验也。荣主里，主血脉，阴也。热迫之，则内及
于脉。肺朝百脉而行荣卫，况邪自皮毛始。皮毛者，肺之合。由合入肺，肺受其热，
血为之凝结。久则腐败为脓，随吐而出如米粥。此皆热过于荣，败伤肺体之证验也。
始萌则在阳，在卫，属气分，故云可救。久则入阴，伤血脉，伤脏体，故云脓成则
死。三条所云肺痿者，虚寒之痿，痿之变也。肺虚而寒则液不流布，故亦吐涎沫。
无热迫肺，则肺气不逆，故不咳。无热，故不渴。肺居最上，为诸气之总司，而通
调水道，下输膀胱。遗尿小便数者，肺气虚冷，有失通调之职，所谓不能制下也。
气虚于上，故眩。治以甘草干姜汤者，姜以温冷，草以补虚。草补土而不补金者，
虚则补其母耳。服此温剂而渴者，肺中必热。是知遗尿、便数，非痿证，乃消渴也。
即气厥论所谓饮一溲二，肺消之属。下四条所载已成痈、未成痈，皆肺气壅塞之有
余者。前二条论中，颇悉其义。而皂角、葶苈、桔梗辈亦皆下气、泻壅、开结之药，
以方合证，理可想见，故不重解也。本文云∶肺痈已成，寸数而实者，即要略所谓
脉数实者为肺痈。肺痿之形，数而无力者，即要略所谓脉数虚者为肺痿。必候于寸
者，以肺居最上也。肺痈色白，脉宜短涩者，言其面色白为肺色，短涩为肺脉。色
脉与证相符，故宜也。若脉浮大，是为火象。唾如米糊，呕见脓血，是火克金。肺脏已伤，宜乎？
肺痈已经形成，寸口脉象表现为数而有力。肺痿的形态，脉象数但无力。
肺痈患者面色白，脉象应当短涩，不应当浮大，症状为咳吐脓血或呕血。
《金匮要略》问道：热邪在上焦，因咳嗽导致肺痿。肺痿这种病，是怎么得的呢？老师说：或者因为发汗过多，或者因为呕吐，或者因为消渴症导致小便频数，或者因为大便困难，又被峻下药强行通便，严重耗伤津液，所以得此病。问：寸口脉数，这个人咳嗽，口中反而有浑浊的唾液和涎沫，这是怎么回事？老师说：这是肺痿病。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。又问：病人咳嗽气逆，诊察其脉，怎么知道这是肺痈？应当有脓血，吐出后就会死亡，它的脉象是什么样的？老师说：寸口脉微而数，微代表风邪，数代表热邪。微则汗出，数则恶寒。风邪侵犯卫分，呼气不能深入；热邪超过营分，吸气不能外出。风邪损伤皮毛，热邪损伤血脉。风邪停留在卫分，人就会咳嗽，口干气喘胸闷，咽喉干燥但不口渴，时常咳吐浊沫，时时感到怕冷。热邪经过的地方，血液为之凝滞。积聚结聚成痈脓，咳吐如米粥状。刚开始萌芽时可以救治，脓成之后则难治（原文意为死，此处依医理及上下文语境，通常指病情危重，但忠实原文翻译为“死”或“预后不良”，鉴于中医古籍常言“脓成则死”指代极危之候，故译为“预后极差/死亡”之意，此处直译为“死亡”以符合原文字面，但在现代医学语境下理解为病情危重）。又说：肺痿吐涎沫而不咳嗽的人，他不口渴，必定遗尿、小便频数。之所以这样，是因为上焦肺气虚弱不能制约下焦。这是肺中寒冷，必定头晕，多涎唾，用甘草干姜汤来温补。如果服药后感到口渴，属于消渴症。又说：肺痈气喘不能平卧，用葶苈大枣泻肺汤主治。又说：咳嗽且胸满，怕冷脉数，咽干不渴，时常排出浊唾，气味腥臭，久久咳吐脓液如米粥的，是肺痈，用桔梗汤主治。又说：肺痈胸满胀，全身面目浮肿，鼻塞流清涕，闻不到香臭酸辛的气味，咳嗽气逆，喘息有声气道阻塞，用葶苈大枣泻肺汤主治。以上几条，《金匮要略》辨析了肺痿、肺痈成因的不同。它说热在上焦，痿和痈都有热邪。它说咳嗽，痿和痈都有咳嗽。它说亡失津液，痿和痈都亡失津液。它说脉数，痿和痈都脉数。但痿属于肺气虚，虚则虽然有热但不猛烈。热不猛烈，则虽然亡失津液，不至于干燥枯竭，所以虽然咳嗽但口中反而有浑浊的唾液和涎沫。热邪虽然客居肺部，也不至于腐蚀好肉化为脓，只是肺脏萎萃而已，其脉虽然数但必然虚。痈则不然，是肺脏气机壅塞邪气实盛。实则热烈。热烈，则津液亡失而更加干涸，所以口中干燥。烈热逼迫肺脏，肺将腐伤，所以气逆而咳嗽。咳嗽即胸中隐痛。津液既已枯竭，脉应当涩滞，反而滑数的，是蓄积热邪腐败化生，夹杂有脓血的征象，这就叫脉数实。第二条说：寸口脉微而数，因为卫气疏泄故脉微，邪气郁结故脉数。卫气疏泄邪气郁结，所以汗出表热而且恶寒。这说的是风邪初袭，邪气还在体表，不入于里，只随呼气而出。风邪中于卫分而外伤皮毛，郁结而为热，这热出不去，只随吸入，超过营分而内伤血脉。卫气，主管体表，主管皮毛，属阳。风邪客犯它，则内部关联到肺。肺气壅逆，所以咳嗽气喘胸闷。卫气主气，肺也主气。口咽是气的门户。气不通调，则津液不周遍分布，所以口干咽燥，有时反而咳吐浊沫。因为热不在胃，所以不渴。卫气疏泄邪气客犯，时常战栗发冷，这都是风邪中于卫分，激动肺气的证候验证。营气主里，主血脉，属阴。热邪逼迫它，则内部波及于脉。肺朝百脉而行营卫之气，何况邪气从皮毛开始。皮毛者，是肺的外合。由外合进入肺，肺受其热，血液为之凝结。久了则腐败化为脓，随呕吐而出如米粥。这都是热邪超过营分，败坏损伤肺体的证候验证。刚开始萌芽时在阳分，在卫分，属气分，所以说可救。久了则入阴分，伤血脉，伤脏腑本体，所以说脓成则死（预后极差）。第三条所说的肺痿，是虚寒之痿，是痿证的变证。肺虚而寒则津液不流动分布，所以也吐涎沫。没有热邪逼迫肺脏，则肺气不逆，所以不咳嗽。没有热邪，所以不口渴。肺位居最上，是诸气的总司，并且通调水道，向下输送到膀胱。遗尿小便频数，是肺气虚冷，失去了通调的职能，所谓不能制约下焦。气虚于上，所以头晕。治疗用甘草干姜汤，姜用来温散寒冷，草用来补益虚损。甘草补脾土而不直接补肺金，是因为虚则补其母的缘故。服用这种温剂后却口渴的，肺中必定有热。由此可知遗尿、小便频数，不是痿证，而是消渴症。就是《气厥论》所说的饮一溲二，属于肺消之类。下面四条所载的已成痈、未成痈，都是肺气壅塞有余的情况。前两条论述中，已经很详细地说明了其中的道理。而皂角、葶苈、桔梗这类药也都是下气、泻壅、开结的药物，以方剂配合证候，道理可以想见，所以不再重复解释。本文说：肺痈已经形成，寸口脉数而实的，就是《金匮要略》所说的脉数实的是肺痈。肺痿的形态，脉数而无力的，就是《金匮要略》所说的脉数虚的是肺痿。必须候察寸口脉，是因为肺位居最上。肺痈患者面色白，脉象宜短涩的，是说面色白是肺的本色，短涩是肺的本脉。色脉与证候相符，所以适宜。如果脉象浮大，这是火象。咳吐如米糊，呕出脓血，是火克金。肺脏已经受伤，适宜吗？
If Lung Abscess (Fei Yong, 肺痈) has already formed, the Cun position pulse is rapid and excess. The manifestation of Lung Flaccidity (Fei Wei, 肺痿) features a rapid but deficient pulse.
In Lung Abscess, the complexion is white; the pulse should be short and choppy, not floating and large; symptoms include coughing up pus or vomiting blood.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) asks: When heat is in the Upper Jiao (Upper Burner), it causes cough leading to Lung Flaccidity. How is this disease of Lung Flaccidity acquired? The Master said: It may result from excessive sweating, vomiting, polydipsia with frequent urination, or constipation treated with harsh purgatives that severely deplete body fluids (Jin Ye, 津液). Questioned further: If the Cun position pulse is rapid, the person coughs, and there is instead turbid saliva and froth in the mouth, what does this indicate? The Master said: This is Lung Flaccidity. If the mouth feels dry, coughing causes hidden pain in the chest, and the pulse is slippery and rapid, this is Lung Abscess, characterized by coughing up pus and blood. A rapid and deficient pulse indicates Lung Flaccidity; a rapid and excess pulse indicates Lung Abscess. Another question: The patient coughs and qi rebels; how do we know this is Lung Abscess based on the pulse? There should be pus and blood; if vomited, death ensues. What kind of pulse is this? The Master said: The Cun position pulse is faint and rapid. Faint indicates Wind, rapid indicates Heat. Faint implies sweating; rapid implies aversion to cold. Wind invades the Defensive Qi (Wei Qi, 卫气), so exhalation cannot draw it in. Heat surpasses the Nutritive Qi (Ying Qi, 营气), so inhalation cannot expel it. Wind damages the skin and hair pores; Heat damages the blood vessels. Wind lodges in the Defensive Qi, causing cough, dry mouth, asthma, and fullness, dry throat without thirst, occasional expectoration of turbid froth, and intermittent chills. Where Heat passes, blood coagulates and stagnates. Accumulating and knotting into an abscess, one coughs up matter like rice porridge. In the initial stage, it can be saved; once pus forms, it leads to death. It is also stated: Lung Flaccidity involves spitting saliva and froth without coughing; the person is not thirsty, must suffer enuresis and frequent urination. The reason is that deficiency in the upper part fails to control the lower part. This is Cold in the Lung, likely accompanied by dizziness and abundant saliva/froth, treated with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) to warm it. If after taking the decoction one becomes thirsty, it belongs to Polydipsia (Xiao Ke, 消渴). It is also stated: Lung Abscess with asthma preventing lying down is primarily treated with Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). It is also stated: Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional discharge of turbid saliva with a fishy odor, and long-term expectoration of pus like rice porridge indicates Lung Abscess, primarily treated with Jie Geng Tang (Platycodon Decoction). It is also stated: Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear runny nose, loss of smell for fragrant, foul, sour, or pungent odors, cough with qi rebellion, wheezing, and airway obstruction is primarily treated with Ting Li Da Zao Xie Fei Tang. These several clauses from the *Jin Gui Yao Lue* differentiate the formation of Lung Flaccidity and Lung Abscess. Both involve heat in the Upper Jiao. Both involve coughing. Both involve depletion of fluids. Both feature a rapid pulse. However, Flaccidity belongs to Lung Qi deficiency; deficiency means that although there is heat, it is not fierce. Since the heat is not fierce, even though fluids are depleted, they do not become completely dry; thus, despite coughing, there is turbid saliva and froth in the mouth. Although heat lodges in the Lung, it does not rot healthy tissue into pus, but rather causes the Lung organ to wither; its pulse is rapid but necessarily deficient. Abscess is different; it is caused by Lung Qi stagnation and pathogenic excess. Excess means fierce heat. Fierce heat depletes fluids, causing greater dryness, hence the dry mouth. Fierce heat forces the Lung, damaging it, causing qi rebellion and cough. Coughing causes hidden chest pain. Once fluids are exhausted, the pulse should be choppy, but if it is slippery and rapid, it indicates accumulated heat rotting and transforming, mixed with pus and blood; this is called a rapid and excess pulse. The second clause states: Cun position pulse faint and rapid. Because Defensive Qi is loose, the pulse is faint; because pathogens are depressed, the pulse is rapid. Loose Defensive Qi and depressed pathogens cause sweating, surface heat, and aversion to cold. This describes the initial invasion of Wind, where pathogens remain on the exterior, not entering the interior, exiting only with exhalation. Invading the Defensive Qi and damaging the exterior skin/hair pores, depression generates heat; this heat cannot exit outwardly but enters with inhalation, surpassing the Nutritive Qi and damaging blood vessels internally. Defensive Qi governs the exterior and skin/hair pores, belonging to Yang. When Wind lodges in it, it affects the Lung internally. Lung Qi stagnates and rebels, causing cough, asthma, and fullness. Defensive Qi governs Qi, and the Lung also governs Qi. The mouth and throat are the portals of Qi. If Qi circulation is unregulated, body fluids do not distribute evenly, causing dry mouth and throat, occasionally spitting turbid froth. Since heat is not in the Stomach, there is no thirst. Loose Defensive Qi and lodged pathogens cause intermittent chills; these are all manifestations of Wind invading the Defensive Qi and agitating Lung Qi. Nutritive Qi governs the interior and blood vessels, belonging to Yin. Heat forces it, affecting the vessels internally. The Lung directs all vessels and circulates Ying and Wei Qi. Since pathogens start at the skin/hair pores, which are the external correspondence of the Lung, entering from the correspondence into the Lung, the Lung receives the heat, and blood coagulates. Over time, it rots into pus, expelled via cough like rice porridge. These are all manifestations of Heat surpassing the Nutritive Qi and damaging the Lung tissue. Initially, it is in Yang, in the Defensive Qi, belonging to the Qi level, so it is savable. Later, it enters Yin, damaging blood vessels and the organ substance, so once pus forms, it leads to death. The third clause's Lung Flaccidity refers to deficiency-cold Flaccidity, a variation of Flaccidity syndrome. Lung deficiency and cold prevent fluid distribution, causing spitting of saliva/froth. Without heat forcing the Lung, Lung Qi does not rebel, so there is no cough. Without heat, there is no thirst. The Lung resides highest, governing all Qi, and regulates water passages, transmitting downward to the Bladder. Enuresis and frequent urination occur because Lung Qi deficiency and cold lose its regulatory function, failing to control the lower. Qi deficiency above causes dizziness. Treatment uses Gan Cao Gan Jiang Tang; Ginger warms the cold, Licorice tonifies deficiency. Licorice tonifies Spleen Earth rather than directly tonifying Lung Metal because "tonify the mother when deficient." If one becomes thirsty after taking this warming agent, there must be heat in the Lung. Thus, enuresis and frequent urination are not Flaccidity syndrome, but Polydipsia. This corresponds to the *Qi Jue Lun* (Treatise on Qi Syncope) mentioning drinking one part and urinating two parts, belonging to Lung Consumption. The following four clauses describe both formed and unformed abscesses, all indicating excess Lung Qi stagnation. The previous two clauses explain this meaning thoroughly. Herbs such as Zao Jiao (Gleditsiae Fructus Spina), Ting Li Zi (Descurainiae Semen), and Jie Geng (Platycodonis Radix) are all herbs that descend Qi, drain stagnation, and resolve knots. Matching formulas to syndromes, the rationale is evident, so no further explanation is repeated. The text states: Lung Abscess formed, Cun position rapid and excess, corresponds to the *Yao Lue* saying "rapid and excess pulse is Lung Abscess." Lung Flaccidity form, rapid but forceless, corresponds to the *Yao Lue* saying "rapid and deficient pulse is Lung Flaccidity." One must examine the Cun position because the Lung resides highest. Lung Abscess with white complexion and short/choppy pulse: White complexion is the color of the Lung; short/choppy is the pulse of the Lung. Color and pulse matching the syndrome are appropriate. If the pulse is floating and large, it is a Fire image. Coughing up paste-like matter and vomiting pus/blood indicates Fire overcoming Metal. Is it appropriate for the Lung organ to be damaged?