《金匮》问曰∶热在上焦者，因咳为肺痿，（火刑金，因咳，壮火食气，故肺热叶焦，手足困弱
而不用，曰痿。）肺痿何从得之？师曰∶或从汗出，（言汗出过多也。）或从呕吐，或从消渴小便
利数，或从便难，（血已燥矣。）又被快药下利，重亡津液，（以上数者，皆亡津液之由，可推展之。）
故得之。（津液亡则阴不济阳，而热甚矣。）曰∶寸口脉数，其人咳，口中反有浊唾涎沫者
何？（津液既伤，则热为干热，何故反有唾沫吐出，故疑之。）师曰∶此为肺痿之病。（肺热则清肃之令不行，
水精不四布，留贮胸中化为涎沫，不但不濡他脏，并肺亦不滋，干者自干，唾者自唾也。）若口中
辟辟燥，咳
即胸中隐隐痛，脉反滑数，此为肺痈。（肺痿病在气分，故津液随气分化为涎而出诸口。肺痈病在血
分，故津液随血分凝为脓而不出诸口。然亦有唾浊者，观下文便知。滑为痰涎之诊，既干燥无痰涎，则脉应
涩，何以反滑？以血热也。然初虽数滑，后则数实矣。）咳唾脓血。（痈溃脓血从咳唾出。）
脉数虚者为肺痿，
（壮火食气则气虚，津液亡则阴虚。）数实者为肺痈。（气壅血滞为实。）问曰∶病咳逆，
何以知此为肺
痈？曰∶寸口（通三部言。）脉微（《金鉴》云∶微当作浮，下同）而数，微则为风，数则为热；微则
汗出，数则恶寒。（此以外感言，故脉浮数而身热，有汗，恶寒。）风中于卫，热过于营，（过，入也。
外感风寒，内郁成热，由浅入深。）呼气不入，（句旧在热过于营句上，今移此。）吸而不出。（言呼吸之气，出
入不利也，即下喘满意。）风伤皮毛，热伤血脉，风舍于肺，（由皮毛入肺。）其人则咳，（火刑金，肺
痒故咳。）口干喘满，咽燥不渴，（热尚在表，未遽伤其津液，故不渴，以初病时言。）时唾浊沫，（即伤风
痰嗽也。）时时振寒。（即恶风寒意。）热之所过，血为凝滞，（时时振寒，则表久不解，而热不散，于是日
渐深入，而血凝滞。）蓄结痈脓，吐如米粥，（溃后吐脓如米粥。）始萌可救，脓成则死。（亦有不死者，
观下文便知。此条举外感而言，而内伤之致此者可例矣。）咳而胸满，振寒脉数，咽干不渴，时出浊
唾腥臭，（可知肺痈亦有唾涎沫者矣，由此推之，则肺痿亦必有不吐涎沫者矣。必泥上条所云以辨证，得毋误乎？
再按肺痿有干热，有湿热，而以干热为主。即有涎沫，亦吐者自吐，干者自干，况无涎沫可吐
者，其为干涸，又何待言
乎？合痿门详看，其理自见矣。热得湿而后壅肿成痈，则肺痈多为湿热，故时吐浊。其不唾者，
乃凝结在里之故。
谓肺痈无湿，恐非情理。）久之吐脓如米粥者，为肺痈，桔梗汤主之。（以解毒排脓。上条言死，此条
言不死，盖证有轻重之别也。）肺痈喘不得卧，葶苈大枣泻肺汤主之。（大苦大寒，峻泻肺邪，
恐稍迁延，
脓成则死矣。）肺痈胸满胀，一身面目浮肿，（浊气不得下降之故。）鼻塞，清涕出，（热气上蒸成水也。）
不闻香臭酸辛，（肺热攻鼻，故酸辛，浊气充塞，故不闻香臭。）咳逆上气，喘鸣迫塞，葶苈大枣泻
肺汤主之。肺痿吐涎沫而不咳者，（肺痿咳而吐涎沫，本证也。今止吐涎沫而不咳，则似肺痿而实非肺
痿矣。）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。
（肺冷则气寒，不能摄津液，故上则吐沫，下则小便不禁也。）必眩，（经谓∶上虚则眩是也。）多唾涎，
甘草干姜
汤以温之。若服汤已，渴者，属消渴。（小便多而渴者为消渴，小便多而不渴者为肺冷。然消渴病初起，亦
有不遽渴者，误作肺冷治之，遂见渴证。此仲景教人辨别肺痿、肺冷、消渴之法。）
喻嘉言曰∶才见久咳，先须防此两证。肺痈由五脏蕴崇之火，与胃中停蓄之热
上乘乎肺，肺受熏灼，血为之凝，痰为之裹，遂成小痈，日渐长大，则肺日胀而胁
骨日昂，乃至咳声频并，痰浊如胶，憎寒发热，日晡尤甚，面红鼻燥，胸生甲
错。（甲错谓枯索粗糙，如鳞甲相错也。）始先苟能辨其脉证，属表属里，极力开提攻下，
无不愈者。迨至血化为脓，肺叶朽烂，倾囊吐出，十死不救，嗟无及矣。又云
《金匮》治法，贵得其大要，多方图之，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，亦能复起，可不致力乎？《尊生》肺
痿，举肺汤∶桔梗、甘草、竹茹、二冬、阿胶、沙参、百合、贝母。肺痈，手掌皮
粗，气急颧红，脉数鼻煽，不能饮食，不治。肺痈，清金饮∶刺蒺藜、苡仁、橘叶、
黄芩、花粉、牛蒡、贝母、桑皮、桔梗。咳吐稠痰，胸胀喘急，发热，玄参清肺饮∶
玄参、柴胡、陈皮、桔梗、茯苓、地骨、麦冬、苡仁、甘草、槟榔，煎成入童便一
盏服。重者不能卧，宁肺桔梗汤∶桔梗、贝母、当归、栝蒌仁、黄 、枳壳、甘草
节、桑白、防己、百合、苡仁、五味、甜葶苈、地骨、知母、杏仁。身热加柴胡，
便秘加熟大黄。勿论已成未成，通用金鲤汤∶鲤鱼一个，（重四两，去肠，勿经水。）
贝母（末二钱）
入鱼腹内，线缝，童便一碗浸，重汤煮至鱼眼出为度，去鳞骨，净肉仍浸童便内顿
热，连便服之，日三次，效速。已吐脓后，排脓散∶黄 、白芷、五味、人参各
等分。
《金匮要略》问道：热邪位于上焦，因咳嗽导致肺痿。（火克金，因咳嗽，壮火消耗元气，所以肺热叶焦，手足困弱无法使用，称为痿。）肺痿是如何得的呢？老师说：有的因为出汗过多，（指出汗太多。）有的因为呕吐，有的因为消渴症小便频数，有的因为大便困难，（说明血液已经干燥了。）又被峻下药攻下导致腹泻，再次损伤津液，（以上几种情况，都是损伤津液的原因，可以由此推演其他情况。）因此得病。（津液亡失则阴不能济助阳，而热邪更盛了。）问：寸口脉数，病人咳嗽，口中反而有浑浊的唾沫和涎沫，这是为什么？（津液既然受伤，那么热就是干热，为什么反而有唾沫吐出，所以产生疑问。）老师说：这是肺痿的病。（肺热则清肃的功能不行，水精不能四布，留存在胸中化为涎沫，不仅不能濡养其他脏腑，连肺也不能滋润，干的自己干，吐的自己吐。）如果口中辟辟干燥，咳嗽时胸中隐隐作痛，脉象反而滑数，这是肺痈。（肺痿病在气分，所以津液随气分化为涎而出现在口中。肺痈病在血分，所以津液随血分凝结为脓而不从口中吐出。然而也有吐浊唾的情况，看下文就知道了。滑是痰涎的脉象，既然干燥无痰涎，脉应该涩，为什么反而滑？因为是血热。然而初起虽然数滑，后来则变为数实。）咳嗽吐脓血。（痈溃破后脓血从咳嗽唾出。）脉数而虚的是肺痿，（壮火消耗元气则气虚，津液亡失则阴虚。）脉数而实的是肺痈。（气壅血滞属于实。）问：病人咳嗽气逆，怎么知道这是肺痈？答：寸口（指三部脉而言）脉微（《医宗金鉴》说：微当作浮，下同）而数，微则为风，数则为热；微则汗出，数则恶寒。（这是以外感邪气论述，所以脉浮数而身热，有汗，恶寒。）风邪伤及卫分，热邪深入营分，（过，即入的意思。外感风寒，内郁成热，由浅入深。）呼气吸不进去，（这句话旧本在“热过于营”句之上，现移至此。）吸气呼不出来。（指呼吸之气，出入不利，即下面的喘满。）风邪伤皮毛，热邪伤血脉，风邪舍于肺，（由皮毛传入肺。）病人则咳嗽，（火克金，肺痒所以咳嗽。）口干喘满，咽燥但不口渴，（热邪还在表，没有立刻损伤津液，所以不渴，这是指初病时说的。）时常吐浊沫，（即伤风痰嗽。）时时怕冷。（即恶风寒的意思。）热邪所经过的地方，血液凝滞，（时时怕冷，说明表证久未解除，而热邪不散，于是日渐深入，血液凝滞。）蓄积结成痈脓，吐出像米粥一样的东西，（溃破后吐脓像米粥。）刚开始萌芽时可救治，脓已成则死。（也有不死的情况，看下文就知道。这一条列举外感而言，而内伤导致这种情况的可以以此类推。）咳嗽而胸满，怕冷脉数，咽干不渴，时常排出浑浊腥臭的唾沫，（可知肺痈也有吐涎沫的情况，由此推之，那么肺痿也必然有不吐涎沫的情况。如果死板地拘泥于上一条所说的来辨证，难道不会出错吗？再按肺痿有干热、湿热，而以干热为主。即使有涎沫，也是吐者自吐，干者自干，何况没有涎沫可吐的，它的干涸又何必多说呢？结合痿门详细查看，道理自然明白。热得到湿而后壅肿成痈，那么肺痈多为湿热，所以时常吐浊唾。不吐的，是因为凝结在里面的缘故。说肺痈没有湿，恐怕不合情理。）时间久了吐脓像米粥的，是肺痈，用桔梗汤主治。（以解毒排脓。上一条说死，这一条说不死，大概是因为病情有轻重的区别。）肺痈气喘不能卧，用葶苈大枣泻肺汤主治。（大苦大寒，峻泻肺邪，恐怕稍微拖延，脓成则死了。）肺痈胸满胀，一身面目浮肿，（浊气不得下降的缘故。）鼻塞，流清涕，（热气上蒸化成水。）闻不到香臭酸辛，（肺热攻鼻，所以酸辛，浊气充塞，所以闻不到香臭。）咳嗽气逆，喘息鸣响迫塞，用葶苈大枣泻肺汤主治。肺痿吐涎沫但不咳嗽的，（肺痿咳而吐涎沫，是本证。现在只吐涎沫而不咳嗽，则看似肺痿其实不是肺痿了。）病人不渴，一定遗尿，小便频数，之所以这样，是因为上焦虚不能制约下焦的缘故，这是肺中冷。（肺冷则气寒，不能摄纳津液，所以上面吐沫，下面小便不禁。）一定头晕，（经书说：上虚则眩。）多唾涎，用甘草干姜汤温补。如果服药后，感到口渴的，属于消渴。（小便多且渴的是消渴，小便多但不渴的是肺冷。然而消渴病初起，也有不立刻渴的，误作肺冷治疗，于是出现渴证。这是仲景教人辨别肺痿、肺冷、消渴的方法。）
喻嘉言说：才见到久咳，先须防备这两种证候。肺痈由五脏蕴积之火，与胃中停蓄之热上乘于肺，肺受熏灼，血为之凝，痰为之裹，遂成小痈，日渐长大，则肺日胀而胁骨日昂，乃至咳嗽声频繁，痰浊如胶，憎寒发热，下午尤其严重，面红鼻燥，胸部皮肤生甲错。（甲错指枯索粗糙，如鳞甲相错。）起初如果能辨别其脉证，属表属里，极力开提攻下，没有不愈的。等到血化为脓，肺叶朽烂，倾囊吐出，十死不救，叹息已来不及了。又说《金匮》治法，贵在得其大要，多方图谋，生津养胃，润肺燥，降逆气，开积痰，止浊唾，补真气以通肺之小管，散火热以复肺之清肃，也能治愈，可不致力吗？《尊生》方治肺痿，举肺汤：桔梗、甘草、竹茹、天冬、麦冬、阿胶、沙参、百合、贝母。肺痈，手掌皮粗，气急颧红，脉数鼻煽，不能饮食，不治。肺痈，清金饮：刺蒺藜、薏苡仁、橘叶、黄芩、天花粉、牛蒡子、贝母、桑白皮、桔梗。咳吐稠痰，胸胀喘急，发热，玄参清肺饮：玄参、柴胡、陈皮、桔梗、茯苓、地骨皮、麦冬、薏苡仁、甘草、槟榔，煎成加入童便一盏服用。重者不能卧，宁肺桔梗汤：桔梗、贝母、当归、栝楼仁、黄芪、枳壳、甘草节、桑白皮、防己、百合、薏苡仁、五味子、甜葶苈、地骨皮、知母、杏仁。身热加柴胡，便秘加熟大黄。不论已成未成，通用金鲤汤：鲤鱼一个，（重四两，去肠，勿经水。）贝母（末二钱），放入鱼腹内，线缝，童便一碗浸泡，隔水煮熟至鱼眼突出为度，去鳞骨，净肉仍浸在童便内顿热，连同便一起服用，每日三次，见效快。已吐脓后，排脓散：黄芪、白芷、五味子、人参各等分。
The *Jingui Yaolue* asks: When heat is located in the upper jiao, it leads to Lung萎 (Lung Atrophy) due to coughing. (Fire insults Metal; due to coughing, vigorous fire consumes qi, causing Lung heat and withered leaves, resulting in weak and useless limbs, termed Wei/Atrophy.) How is Lung Wei obtained? The Master says: It may arise from excessive sweating, (indicating too much sweat.) or from vomiting, or from Xiao Ke (Wasting-Thirst syndrome) with frequent urination, or from difficulty in defecation, (indicating the blood has dried out.) followed by purgative drugs causing diarrhea, further depleting body fluids. (The above several cases are all causes of fluid depletion, which can be extrapolated.) Thus, the disease is acquired. (When fluids are depleted, Yin cannot assist Yang, and heat becomes severe.) He asks: The pulse at Cun Kou is rapid, the person coughs, yet there is instead turbid saliva and froth in the mouth. Why? (Since fluids are injured, the heat should be dry heat; why is there saliva and froth spit out? Hence the doubt.) The Master says: This is the disease of Lung Wei. (Lung heat impairs the clear descending function; water essence does not distribute widely but stays stored in the chest, transforming into saliva and froth. It not only fails to moisten other organs but also fails to nourish the Lung itself; the dry remains dry, the spit remains spit.) If the mouth feels parched and dry, and coughing brings faint pain in the chest, while the pulse is surprisingly slippery and rapid, this is Lung Abscess (Fei Yong). (Lung Wei disease is in the Qi level, so fluids transform into saliva along with Qi and exit from the mouth. Lung Abscess disease is in the Blood level, so fluids coagulate into pus along with Blood and do not exit from the mouth. However, there are cases of spitting turbid matter; see below for clarification. Slippery indicates phlegm-saliva; if dry without phlegm-saliva, the pulse should be choppy, why slippery? Because of blood heat. Although initially rapid and slippery, later it becomes rapid and excess.) Coughing up pus and blood. (After the abscess ruptures, pus and blood exit via coughing and spitting.) A rapid and deficient pulse indicates Lung Wei, (vigorous fire consumes qi leading to qi deficiency; fluid depletion leads to yin deficiency.) while a rapid and excess pulse indicates Lung Abscess. (Qi stagnation and blood stasis constitute excess.) He asks: The patient has cough and rebellious Qi; how do we know this is Lung Abscess? Answer: The pulse at Cun Kou (referring to all three positions) is faint (The *Yizong Jinjian* states: 'faint' should be 'floating', same below) and rapid. Faint indicates Wind, rapid indicates Heat; faint indicates sweating, rapid indicates aversion to cold. (This discusses external pathogenic factors, hence floating-rapid pulse, fever, sweating, and aversion to cold.) Wind injures the Wei (Defensive) level, Heat penetrates the Ying (Nutritive) level. (Penetrate means enter. External wind-cold, internally constrained into heat, moving from shallow to deep.) Exhalation enters but inhalation does not go out. (Refers to difficult breathing, i.e., the following panting and fullness.) Wind injures skin and hair, Heat injures vessels and blood; Wind lodges in the Lung, (entering from skin/hair to Lung.) the person then coughs, (Fire insults Metal, Lung itch causes cough.) dry mouth, panting and fullness, dry throat but no thirst, (Heat is still at the exterior, not yet injuring fluids, hence no thirst; this refers to early stage.) occasional spitting of turbid froth, (i.e., wind-cold phlegm cough.) periodic chills. (Meaning aversion to wind and cold.) Wherever heat passes, blood coagulates and stagnates. (Periodic chills indicate exterior syndrome unresolved and heat un-dispersed, thus entering deeper day by day, causing blood stasis.) Accumulation forms an abscess and pus, vomiting like rice porridge. (After rupture, pus vomits like rice porridge.) In the initial stage, it can be saved; once pus is formed, death ensues. (There are also survivors; see below. This item cites external contraction, while internal injury causing this can be inferred by analogy.) Cough with chest fullness, chills, rapid pulse, dry throat but no thirst, occasionally discharging turbid, foul-smelling saliva, (showing that Lung Abscess can also involve spitting saliva/froth; inferring from this, Lung Wei must also have cases without spitting saliva/froth. If one rigidly adheres to the previous description for differentiation, would it not lead to error? Furthermore, Lung Wei includes dry-heat and damp-heat, primarily dry-heat. Even if there is saliva/froth, the spitter spits, the dry remains dry; moreover, for those with no saliva/froth to spit, their dehydration is self-evident. Reviewing the Wei section in detail reveals the principle. Heat combined with dampness causes swelling and abscess formation, so Lung Abscess is often damp-heat, hence occasional spitting of turbid matter. Those who do not spit do so because it is condensed internally. Saying Lung Abscess has no dampness is likely unreasonable.) After a long time, vomiting pus like rice porridge indicates Lung Abscess, treated with Jiegeng Tang (Platycodon Decoction). (To resolve toxicity and drain pus. The previous item said death, this one says survival, indicating differences in severity.) Lung Abscess with panting and inability to lie down, treated with Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). (Bitter and cold, severely draining Lung pathogens; slight delay may lead to pus formation and death.) Lung Abscess with chest fullness and distension, edema of the whole body and face, (due to turbid Qi failing to descend.) nasal congestion, clear runny nose, (heat steaming upward transforms into water.) inability to smell fragrant, foul, sour, or pungent odors, (Lung heat attacks the nose, causing sour/pungent sensations; turbid Qi blocks, causing inability to smell.) cough and rebellious Qi, wheezing and obstruction, treated with Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung). Lung Wei with spitting saliva/froth but no cough, (Lung Wei with cough and spitting saliva/froth is the standard presentation. Now only spitting saliva/froth without cough suggests it resembles Lung Wei but is not Lung Wei.) the person is not thirsty,必定 experiences enuresis and frequent urination. The reason is that upper deficiency fails to control the lower; this is Cold in the Lung. (Lung cold implies Qi cold, unable to secure fluids, hence spitting froth above and incontinence below.)必定 experiences dizziness, (The Classics state: Upper deficiency causes dizziness.) excessive saliva, treated with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to warm. If after taking the decoction, the person feels thirsty, it belongs to Xiao Ke (Wasting-Thirst). (Frequent urination with thirst is Xiao Ke; frequent urination without thirst is Lung Cold. However, early Xiao Ke may not immediately present thirst; mistaking it for Lung Cold and treating accordingly leads to the appearance of thirst symptoms. This is Zhongjing's method for distinguishing Lung Wei, Lung Cold, and Xiao Ke.)
Yu Jiayan said: Upon seeing chronic cough, one must first guard against these two syndromes. Lung Abscess arises from accumulated fire in the five Zang organs and stagnant heat in the Stomach ascending to the Lung. The Lung is scorched, blood coagulates, and phlegm wraps around it, forming a small abscess. Day by day it grows larger, the Lung swells, ribs protrude, coughing becomes frequent, phlegm is turbid and glue-like, aversion to cold and fever occur, worse in the afternoon, face red, nose dry, and skin on the chest becomes rough like fish scales (Jiacuo means dry and rough, interlocking like scales). Initially, if one can differentiate the pulse and symptoms as exterior or interior, and vigorously apply lifting and purging methods, recovery is assured. Once blood transforms to pus and Lung tissue rots, pouring out like an overturned bag, ten die and none are saved; alas, it is too late. He also stated: The treatment methods in *Jingui* value grasping the essentials. Through various approaches, generating Stomach fluids, moistening Lung dryness, descending rebellious Qi, resolving accumulated phlegm, stopping turbid saliva, supplementing true Qi to open Lung bronchioles, and dispersing fire-heat to restore Lung clarity, recovery is possible. One must exert effort! For Lung Wei, *Zunsheng* formula Ju Fei Tang: Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Zhuru (Bambusae Caulis in Taenia), Dongtian (Asparagi Radix), Dongmu (Ophiopogonis Radix), Ejiao (Colla Corii Asini), Shashen (Glehniae Radix), Baihe (Lilii Bulbus), Beimu (Fritillariae Cirrhosae Bulbus). For Lung Abscess, if palms are rough, panting, malar flush, rapid pulse, nasal flaring, inability to eat, it is untreatable. For Lung Abscess, Qingjin Yin (Clear Metal Drink): Cijieli (Tribuli Fructus), Yiren (Coicis Semen), Jiuye (Citri Reticulatae Pericarpium Viride), Huangqin (Scutellariae Radix), Huafen (Trichosanthis Radix), Niubangzi (Arctii Fructus), Beimu (Fritillariae Cirrhosae Bulbus), Sangbai (Mori Cortex), Jiegeng (Platycodonis Radix). For thick phlegm cough, chest distension, panting urgency, fever, Xuanshen Qingfei Yin (Scrophulariae Decoction to Clear the Lung): Xuanshen (Scrophulariae Radix), Chaihu (Bupleuri Radix), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Fuling (Poria), Digupi (Lycii Cortex), Maidong (Ophiopogonis Radix), Yiren (Coicis Semen), Gancao (Glycyrrhizae Radix et Rhizoma), Binglang (Arecae Semen), decocted with one cup of Tongbian (Child Urine) taken with the medicine. For severe cases unable to lie down, Ningfei Jiegeng Tang (Calming Lung Platycodon Decoction): Jiegeng (Platycodonis Radix), Beimu (Fritillariae Cirrhosae Bulbus), Danggui (Angelicae Sinensis Radix), Gualouren (Trichosanthis Semen), Huangqi (Astragali Radix), Zhike (Aurantii Fructus Immaturus), Gancaojie (Glycyrrhizae Radix et Rhizoma cum Nodis), Sangbaipi (Mori Cortex), Fangji (Stephaniae Tetrandrae Radix), Baihe (Lilii Bulbus), Yiren (Coicis Semen), Wuweizi (Schisandrae Chinensis Fructus), Tiantili (Descurainiae Semen seu Lepidii Semen), Digupi (Lycii Cortex), Zhimu (Anemarrhenae Rhizoma), Xingren (Pruni Semen). Add Chaihu (Bupleuri Radix) for fever, add Shu Dahuang (Rhei Radix et Rhizoma Preparata) for constipation. Regardless of whether the abscess is formed or not, use Jinli Tang (Golden Carp Decoction): One carp (4 liang, gutted, not passed through menstruation), 2 qian of Beimu powder placed inside the fish belly, sewn with thread, soaked in one bowl of Tongbian (Child Urine), steamed until fish eyes protrude, remove scales and bones, keep the clean meat soaked in Tongbian, reheat, and take with the urine, three times daily, for rapid effect. After pus has been vomited, use Paion San (Drain Pus Powder): Huangqi (Astragali Radix), Baizhi (Angelicae Dahuricae Radix), Wuweizi (Schisandrae Chinensis Fructus), Renshen (Ginseng Radix) in equal parts.