经义
风者，百病之长也。病入舍于肺，名曰肺痹，发咳上气。○白，脉之至也，喘而浮。上虚下实，惊有积气
在胸中，喘而虚，名曰肺痹，寒热。○肺痹者，烦满，喘而呕。○淫气喘息，痹聚在肺。（《素问》）
哲言
肺为呼吸之橐 ，位居最高，受脏腑上朝之清气，禀清肃之体，性主乎降。又为娇脏，不耐邪侵，六淫
之气一有所着，即能致病。其性恶寒、恶热、恶燥、恶湿，最畏火风，邪着则失其清
肃，降令遂痹塞不通爽矣。治法∶因于风者，则用薄荷、桑叶、牛蒡之属；兼寒则用麻黄、杏仁之类；若温热
壅遏而痹者，则用射干、连翘、山栀、兜铃、竹叶、沙参、象贝；因湿则用通草、滑石、桑皮、苡仁；因燥则
用梨皮、芦根、枇杷叶、紫菀；开气则用蒌皮、香豉、苏子、桔梗、蔻仁。其苇茎汤、葶苈大枣汤，一切药品
总皆主乎轻浮，不用重浊气味。所谓微辛以开之，微苦以降之，适有合乎轻清娇脏之治也。肺主百脉，为病最
多，肺与大肠为表里，又与膀胱通气化，故二便之通闭，肺实有关系焉。（《临证指南》）
肺为清虚之脏，喜通利，恶壅塞，毫发不可干之。今为浊邪阻闭，非清虚通利之药不可。古人治此证，每
用泻白散获效。（方星岩）
（附肺胀、诸内痈）
哲言
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。○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，血为凝滞，蓄结痈脓，吐如米粥。始萌可救，脓
成则死。（《金匮》）
肺叶如草木之花叶，有热之痿，如日炙之则枯；有冷之痿，如霜杀之则干矣。（魏荔彤）
肺痿一证，概属津枯液燥，多由汗下伤正所致。夫痿者，萎也，如草木之萎而不荣，为津亡而气竭也。然
致痿之因，非止一端。《金匮》云∶或从汗出，或从呕吐消渴小便利数，或从便难，又被快药下之，重亡津液，
故令肺热干痿也。肺热干痿，则清肃之令不行，水精四布失度，脾气虽散津液，上归于肺，而肺不但不能自滋
其干，亦不能内洒陈于六腑，外输精于皮毛。其津液留贮胸中，得热煎熬变为涎沫，侵肺作咳，唾之不已。故
干者自干，唾者自唾，愈唾愈干，痿病成矣。（《临证指南》）
肺痿之形象，与肺痈似是而实非。肺痿发在病虚之后；肺痈发在无病之初也。肺痿咳白血而吐涎沫；肺痈
咳臭脓而胸胁痛也。肺痿人肌瘦而神倦；肺痈人体实而强壮也。肺痿病久始洒寒而潮热；肺痈初发则毛耸而恶
风也。肺痿脉芤数而无神；肺痈脉浮数而有力也。种种脉证，不同如是。大约从外因而成肺痈者，急宜调治，
肺虽伤而尚可补救；从内因而成肺痿者，多方培补，肺已枯而百法难疗。（汪蕴谷）
补编
肺痿，吐涎沫而不咳者，其人不渴，必遗尿，小便数。所以然者，以土虚不能制水故也。此名肺中冷，必
眩，多涎唾，甘草干姜汤以温之。○咳而上气，喉中水鸡声，射干麻黄汤主之。○咳逆上气，时时吐浊，但坐不
得眠，皂荚丸主之。○咳而脉浮者，浓朴麻黄汤主之。○脉沉者，泽漆汤主之。○火逆上气，咽喉不利，止逆下
气者，麦门冬汤主之。○肺痈喘不得卧，葶苈大枣泻肺汤主之。○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。○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，烦燥而喘。脉浮者，心下有水，小青龙加石膏汤主之。
○《外台》炙甘草汤，治肺痿涎唾多，心下温温液液者。○《千金》生姜甘草汤，治肺痿咳唾涎沫不止，咽燥
而渴。○《千金》桂枝去芍药加皂荚汤，治肺痿吐涎沫。○《外台》桔梗白散，治咳而胸满，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。○《千金》苇茎汤，治咳有微热，烦满，胸中甲错，是为肺痈。（《金匮》）
师为肺冷干燥将致痿者，立甘草干姜汤一方；为肺热枯焦将致痿者，立麦门冬汤一方，皆预治肺痿之法也。
师为有表邪而肺郁，恐成痿与痈者，立射干麻黄汤一法；为无外邪而气上逆，恐成痈者，立皂荚丸一法；为有
外邪而预理其肺者，立浓朴麻黄汤一法；有外邪而复有内热者，立泽漆汤一法，皆预治肺气不令成痿痈之意也。
又为有外邪而肺胀，急立越婢加半夏汤一法；有外邪而复有内热，肺胀烦燥者，立小青龙加石膏汤一法，亦皆
预治肺气不令成痈痿之意也。治者能选择比属而用之，又何患之可成乎？及肺痈已成，用葶苈大枣泻肺汤；久
久吐脓如米粥，用桔梗汤，皆不得已之婆心也，然已晚矣。观此，知无病不宜预图，况在肺脏元气性命之最关重
要者乎？慎勿失之东隅而来桑榆之悔也。（魏荔彤）
肺为五脏之华盖，位高质清，内主乎气，中主乎音，外司皮毛。人生血气充足于内，水火互藏其根，斯娇
脏无畏火之炎，金水有相生之用，肺气安得受克而萎弱不振者乎？无如先天禀亏，复又房劳不慎，戕贼真元，
根本摇动，致肾水亏而相火炽，上熏肺金。金被火刑，观其证，则咳嗽失血矣；寒热往来矣；盗汗侧眠矣；音
哑咽痛矣；上呕下泄矣。切其脉，或浮大空数；或弦细涩数。病势至此，形体消削，咯吐瘀脓，色如桃花，或
如米粥，此病剧而变肺痿，为百死一生之候，奈之何哉？虽然病固难救，而必欲立法以救之，则责在补肾水以
镇阴火，生津液以润肺燥。更宜参、 、河车之属，填实下元，所谓补其肺者益其气，补其肾
者益其精，庶可起垂危于万一也。○肺痈为病，始萌之时，最难认识。医家误作风寒，见咳治咳，用药不应，
及酝酿成脓，倾囊吐出，方知肺内生痈，已为棘手。其证恶寒发热，咳嗽声重，胸膈隐痛，鼻塞项强。气血稽
留日久，则鼻流清涕，咳唾脓血，腥秽稠浊，甚则胸胁胀满，呼吸不利。其脉∶未溃之先，或浮紧而数，或洪
大而数；既溃之后，或芤大而数，或弦细而数。初起宜甘桔汤、黑豆汤，解毒开提；已成宜百合固金汤，滋水
清金；溃后宜六味汤，补阴保肺，清肺之热，救肺之气，则肺不致焦腐，其生乃全。盖清一分肺热，则存一分
肺气。而清热必须散其火结，涤其壅遏，以分散其势于大肠，令脓血浊沫，日渐下移，因势利导，乃为良法。
夫肺为娇脏，属太阴而体燥，必被火势之毒内攻，致脏伤而脓血外泄。医家不知益肺之虚，救肺之燥，生肺之
液，反恣投燥热之药，其能堪此虚虚之祸乎？（《会心录》）
人身之气禀命于肺，肺气清肃则周身之气，莫不服从而顺行；肺气壅浊则周身之气，易致横逆而犯上。肺
痈者，肺气壅而不通也；肺痿者，肺气萎而不振也。才见久咳上气，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，肺受火热熏灼，即血为之凝，血凝即痰为之裹，遂成小痈。所结之形日长，则肺日
胀，而胁骨日昂，乃至咳声频并，浊痰如胶，发热畏寒，日晡尤甚，面红鼻燥，胸生甲错。始先即能辨其脉证
属表、属里，积力开提攻下，无不愈者。奈何医学无传，但知见咳治咳，冀以解热润燥，迨至血化为脓，肺叶
朽坏，倾囊吐出，始识其证，十死不救。《金匮》治法最精，用力全在未成脓之先。今人施于既成脓之后，其
有济乎？肺痿者，其积渐已非一日，其寒热不止一端，总由胃中津液不输于肺，肺失所养，转枯转燥，然后成
之。盖肺金之生水，精华四布者，全籍胃土津液之富，上供罔缺。医者不知爱护，或腠理素疏，无故而大发其
汗；或中气素馁，频吐以倒倾其囊；或肠枯便秘，强利以求其快，只此上供之津液，坐耗歧途。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，咳痰难于上出，行动数武，气即喘鸣，
冲击连声，痰始一应。《金匮》治法，非不彰明，然混在肺痈一门，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。肺痈属有形之血，血结宜骤攻；
肺痿属无形之气，气伤宜徐理。肺痈为实，误以肺痿治之，是为实实；肺痿为虚，误以肺痈治之，是为虚虚。
此辨证用药之大略也。○再论肺痿、肺痈之病，皆燥病也。肺禀清肃之令，乃金寒水冷之脏。火热熏灼，久久
失其清肃而变为燥，肺中生痈，其津液全裹其痈，不溢于口，故口中辟辟然干燥。肺热成痿，则津液之上供者，
悉从燥热化为涎沫浊唾。证多不渴，较胃中津液尽伤，母病累子之痿，又大不同。只是津液之上输者变为唾沫，
肺不沾其惠泽耳。若夫痿病，津液不能灭火，反从火化，累年积岁，肺叶之间酿成一大火聚，以清凉投之，
格不入矣。然虽 格，固无害也，设以燥投之，以火济火，其人有不坐毙者乎？半夏，燥药也，投入肺中，转
增其患，自不待言。但清凉既不能入，惟燥与燥相得，乃能入之，故用半夏之燥，入清凉生津药中，则不但不
燥，转足开燥，其浊沫随逆气下趋，久久，津液之上输者不结为涎沫，而肺得沾其渍润，痿斯起矣。人但知半
夏能燥津液，孰知善用之，即能驱所燥之津液乎？此精蕴也。○凡肺痿多不渴。以其不渴，漫然不用生津之药，
任其肺日枯燥，医之罪也。以其不渴，恣用燥热之药，势必 不救，罪加等也。○凡治肺痿，奄奄不振，故
行峻法，大驱涎沫，图速效，反速毙，医之罪也。○凡治肺痈须与肺痿异治。肺痈为实，肺痿为虚；肺痈为阳实，
肺痿为阴虚。阳实，始宜散邪，次宜下气；阴虚，宜补胃津，兼润肺燥。若不辨而误治，医杀之也。（《医门法律》）
脉候
脉数虚者为肺痿，数实为肺痈。（《金匮》）
肺痈初起，脉不宜数，溃后最忌短涩。脉缓滑，面白者生；脉弦急，面赤者死。（张石顽）
附肺胀
肺胀者，动则喘满，气急息重，左右不得眠者是也。若痰挟瘀血，阻碍气机者，宜行血以流动乎气，降火
以清利其痰，用归、芍、桃仁、枳壳、陈皮、栝蒌、竹沥。若风寒郁于肺中，不得发越，喘咳胀闷者，宜发汗
以祛邪，利肺以顺气，用麻黄越婢加半夏汤。有停水不化，肺气不得下降而胀者，其证水入即吐，宜四苓散加
葶苈、桔梗、桑皮。有肾虚水枯，肺金不得施化而胀者，其证干咳烦冤，宜六味汤加麦冬、五味子。他如气散
而胀者，宜补气；气逆而胀者，宜降气。又肺胀壅遏不得卧，喘急鼻煽者难治。（《证治汇补》）
附诸内痈
黄帝问曰∶人病胃脘痈者，诊当何如？岐伯对曰∶诊此者，当候胃脉。其脉当沉细，沉细者气逆，逆者人
迎甚盛，甚盛则热。人迎者，胃脉也，逆而盛，则热聚于胃口而不行，故胃脘为痈也。（《素问》）
诸浮数脉，应当发热，而反洒淅恶寒，若有痛处，当发其痈。师曰∶诸痈肿，欲知有脓无脓，以手掩肿上，
热者为有脓，不热为无脓。○肠痈之为病，其身甲错，腹皮急，按之濡，如肿状，腹无积聚，身无热，脉数，
此为肠内有痈脓，薏苡附子败酱散主之。○肿痈者，少腹肿痞，按之即痛如淋，小便自调，时时发热，自汗出，
腹恶寒，其脉迟紧者，脓未成，可下之，当有血。脉洪数者，脓已成，不可下也。大黄牡丹汤主之。（《金匮》）
腹内之痈有数证。有肺痈、有肝痈、有胃脘痈、有小肠痈、有大肠痈、有膀胱痈。惟肺痈咳吐腥痰，人犹
易辨。余者，或以为痞结，或以为瘀血，或以为寒痰，或以为食积，医药杂投，及至成脓，治已无及。今先辨
明其状，凡痞结瘀血必有所因，且由
渐而成。寒痰则痛止无定，又必另见痰证；食积则必有受伤之日，便通即散；惟内痈则痛有常所，而迁延益甚。
《金匮》云∶诸脉浮散，应当发热，而反淅淅恶寒，若有痛处，当发其痈。以手按其肿上，热者有脓，不热者
无脓。此数句乃内痈之真谛也。又云∶肠痈之为病，身甲错，腹皮急，按之濡，如肿状，腹无积聚，无热是也。
若肝痈则胁内隐痛，日久亦吐脓血。小肠痈与大肠痈相似，而部位略高。膀胱痈痛在少腹之下，近毛际，着皮
即痛，小便亦艰而痛。胃脘痈有虚、实二种∶实者易消，若成脓，必大吐脓血而愈；惟虚证则多不治，先则胃
中痛胀，久而心下渐高，其坚如石，或有寒热，饮食不进，按之尤痛，形体枯瘦，此乃思虑伤脾之证，不待脓
【背景信息】
书名：医述 作者：程杏轩 朝代：元 章节：肺痹 / 肺痿肺痈(1/2) 类别：医论
【原文翻译】
经义（经典理论）
风邪，是各种疾病的先导。病邪侵入并停留于肺，称为肺痹（肺气闭阻之证），发作时出现咳嗽、气逆上冲。○脉象至而急促且浮，伴有气喘。上部虚而下部实，易受惊扰，胸中有积滞之气，气喘且脉虚，名为肺痹，伴有寒热症状。○肺痹的症状，表现为心烦胀满，气喘且呕吐。○若淫邪导致喘息，则痹证聚集在肺。（出自《素问》）
哲言（名家论述）
肺是呼吸的囊橐（比喻肺如风箱般主持呼吸），位居人体最高处，接受脏腑上行朝会的清气，禀赋清肃的性质，其生理特性主降。肺又是娇脏（娇嫩之脏），不耐受外邪侵袭，六淫（风、寒、暑、湿、燥、火六种外感病邪）之气一旦附着，就能致病。肺的特性厌恶寒冷、厌恶炎热、厌恶干燥、厌恶潮湿，最畏惧火邪和风邪，邪气附着则使其失去清肃之性，肃降的功能遂因闭塞不通而受阻。治疗方法：因风邪所致者，使用薄荷、桑叶、牛蒡子等药物；兼有寒邪则用麻黄、杏仁等药；若温热邪气壅遏导致痹阻，则用射干、连翘、山栀、天竺黄、竹叶、沙参、象贝母；因湿邪所致则用通草、滑石、桑白皮、薏苡仁；因燥邪所致则用梨皮、芦根、枇杷叶、紫菀；开宣肺气则用瓜蒌皮、香豉、苏子、桔梗、蔻仁。苇茎汤、葶苈大枣汤，所有药物总以轻浮为主，不用气味重浊的药物。这就是所谓的微辛以开泄肺气，微苦以降泄肺气，恰好符合治疗轻清娇脏的原则。肺主一身之血脉，患病最多，肺与大肠相表里，又与膀胱相通调气化功能，所以二便的通利与闭塞，肺确实有着密切的关系。（出自《临证指南》）
肺是清虚之脏，喜欢通畅流利，厌恶壅塞阻滞，丝毫不可干扰。如今被浊邪阻闭，非用清虚通利的药物不可。古人治疗此证，常用泻白散获得疗效。（方星岩）
（附肺胀、各种内脏痈肿）
哲言
问：热邪在上焦，因咳嗽导致肺痿。肺痿这个病，是怎么得的？老师说：有的因为出汗过多，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，又被峻下药攻下导致腹泻，重伤津液，所以得此病。○问：寸口脉数，其人咳嗽，口中反而有浑浊的唾液和涎沫，这是为什么？老师说：这是肺痿的病。○如果口中感觉辟辟干燥，咳嗽时胸中隐隐作痛，脉象反而滑数，这是肺痈（肺部化脓性病变），咳嗽吐脓血。○问：病人咳嗽气逆，脉象如何能知道是肺痈？应当有脓血，吐出来就会死，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。风邪伤及卫分，呼气不能深入；热邪过于营分，吸气不能外出。风邪损伤皮毛，热邪损伤血脉。风邪留舍于肺，人就会咳嗽，口干气喘胀满，咽干但不想喝水，多唾浊沫，时时发冷。热邪经过的地方，血液凝滞，蓄结形成痈脓，吐出物像米粥一样。初期还可以救治，脓成之后则难治。（出自《金匮要略》）
肺叶就像草木的花叶，有热邪导致的痿，就像被日晒一样枯萎；有冷邪导致的痿，就像被霜打一样干枯。（魏荔彤）
肺痿这一证候，概属津枯液燥，多由发汗或攻下损伤正气所致。所谓“痿”，就是“萎”，像草木枯萎而不茂盛，是因为津液亡失而气机衰竭。然而导致痿的原因，不止一端。《金匮要略》说：有的因为出汗，有的因为呕吐、消渴、小便频数，有的因为大便困难，又被峻下药攻下，重伤津液，所以导致肺热干痿。肺热干痿，则清肃的功能不行，水精四布失去节制，脾气虽然散布津液，向上归于肺，但肺不但不能滋润自身的干燥，也不能向内洒陈津液于六腑，向外输布精气于皮毛。津液留贮在胸中，受热煎熬变成涎沫，侵扰肺部引起咳嗽，不停地吐涎沫。所以干的自己干，吐的自己吐，越吐越干，痿病就形成了。（出自《临证指南》）
肺痿的形象，与肺痈似是而实非。肺痿发生在疾病虚弱之后；肺痈发生在无病之初。肺痿咳白血而吐涎沫；肺痈咳臭脓而胸胁痛。肺痿病人肌肉消瘦而精神疲倦；肺痈病人身体结实而强壮。肺痿病久才出现洒淅恶寒和潮热；肺痈初发则毫毛竖起而恶风。肺痿脉芤数而无神；肺痈脉浮数而有力。种种脉证，不同如此。大致从外因而成肺痈的，急宜调治，肺虽受伤尚可补救；从内因而成肺痿的，多方培补，肺已枯槁百法难疗。（汪蕴谷）
补编
肺痿，吐涎沫而不咳嗽的，病人不口渴，必定遗尿，小便频数。之所以这样，是因为脾土虚弱不能制约水液。这名叫肺中冷，必定头晕，多涎唾，用甘草干姜汤来温补。○咳嗽气逆，喉中有像水鸡叫的声音，用射干麻黄汤主治。○咳嗽气逆上冲，时时吐浊痰，只能坐着不能躺下，用皂荚丸主治。○咳嗽而脉浮的，用浓朴麻黄汤主治。○脉沉的，用泽漆汤主治。○火逆导致气上冲，咽喉不利，止逆下气的，用麦门冬汤主治。○肺痈气喘不能卧，用葶苈大枣泻肺汤主治。○咳嗽而胸满，发冷脉数，咽干不渴，时常吐出浑浊腥臭的痰，久久吐出像米粥一样的脓，这是肺痈，用桔梗汤主治。○咳嗽气逆，这是肺胀。病人喘，眼睛像要脱出一样，脉浮大的，用越婢加半夏汤主治。○肺胀，咳嗽气逆，烦躁而喘。脉浮的，心下有停水，用小青龙加石膏汤主治。
○《外台秘要》的炙甘草汤，治疗肺痿涎唾多，心下温温液液的。○《千金方》生姜甘草汤，治疗肺痿咳唾涎沫不止，咽干而渴。○《千金方》桂枝去芍药加皂荚汤，治疗肺痿吐涎沫。○《外台秘要》桔梗白散，治疗咳嗽胸满，发冷脉数，咽干不渴，时常吐出浑浊腥臭的痰，久久吐出像米粥一样的脓，这是肺痈。○《千金方》苇茎汤，治疗咳嗽有微热，烦满，胸中皮肤甲错，这是肺痈。（出自《金匮要略》）
老师为肺冷干燥将要导致痿的，设立甘草干姜汤一方；为肺热枯焦将要导致痿的，设立麦门冬汤一方，都是预防治疗肺痿的方法。
老师为有表邪而肺郁，恐怕形成痿与痈的，设立射干麻黄汤一法；为无外邪而气上逆，恐怕形成痈的，设立皂荚丸一法；为有外邪而预先调理肺的，设立浓朴麻黄汤一法；有外邪而又内有热的，设立泽漆汤一法，都是预先调理肺气不让其形成痿痈的意思。
又为有外邪而肺胀，紧急设立越婢加半夏汤一法；有外邪而又内有热，肺胀烦躁的，设立小青龙加石膏汤一法，也都是预先调理肺气不让其形成痈痿的意思。治病的人能选择比类归属而使用它们，又有什么担忧会形成疾病呢？等到肺痈已经形成，用葶苈大枣泻肺汤；久久吐出像米粥一样的脓，用桔梗汤，都是不得已的慈悲之心，然而已经晚了。看这些，就知道没有病不宜预先图谋，何况在肺脏元气性命最关键的地方呢？千万不要失去早图的时机而留下晚悔。（魏荔彤）
肺是五脏的华盖（保护伞），位置高质地清，内主气，中主声音，外司皮毛。人生血气充足于内，水火互藏其根，这娇嫩之脏就不畏惧火的炎上，金水有相生之用，肺气怎么会受到克制而萎弱不振呢？无奈先天禀赋亏虚，又房劳不慎，戕害真元，根本摇动，导致肾水亏虚而相火炽盛，向上熏灼肺金。金被火刑，看其症状，则咳嗽失血；寒热往来；盗汗侧卧；音哑咽痛；上呕下泄。切其脉，或浮大空数；或弦细涩数。病势到了这里，形体消瘦，咯吐瘀脓，颜色像桃花，或像米粥，这是病重而变为肺痿，是百死一生的候象，无可奈何呢？虽然病确实难救，但如果一定要立法来救它，那就责在补肾水以镇阴火，生津液以润肺燥。更宜用人参、[缺字]、紫河车之类，填实下元，所谓补其肺就是益其气，补其肾就是益其精，或许可以从垂危中挽救万一。○肺痈这个病，在初期萌芽之时，最难认识。医生误当作风寒，见咳治咳，用药不应，等到酝酿成脓，倾囊吐出，才知道肺内生痈，已经棘手。其症状恶寒发热，咳嗽声重，胸膈隐痛，鼻塞项强。气血稽留日久，则鼻流清涕，咳唾脓血，腥秽稠浊，甚至胸胁胀满，呼吸不利。其脉：未溃破之前，或浮紧而数，或洪大而数；既溃破之后，或芤大而数，或弦细而数。初起宜用甘桔汤、黑豆汤，解毒开提；已成宜用百合固金汤，滋水清金；溃后宜用六味汤，补阴保肺，清肺之热，救肺之气，则肺不至于焦腐，生机才能保全。大概清除一分肺热，就存留一分肺气。而清热必须疏散火结，涤荡壅遏，以分散其势于大肠，令脓血浊沫，日渐下移，因势利导，才是良法。
夫肺为娇脏，属太阴而体燥，必被火势之毒内攻，导致脏伤而脓血外泄。医生不知道益肺之虚，救肺之燥，生肺之液，反而肆意投用燥热之药，这能忍受这种虚虚之祸吗？（出自《会心录》）
人身之气禀命于肺，肺气清肃则周身之气，没有不服从而顺行的；肺气壅浊则周身之气，容易致横逆而犯上。肺痈，是肺气壅塞而不通；肺痿，是肺气萎弱而不振。才见到久咳气逆，先须防备这两个证。肺痈由五脏蕴积之火，与胃中停蓄之热，上乘于肺，肺受火热熏灼，即血为之凝滞，血凝即痰为之包裹，遂成小痈。所结的形状日益长大，则肺日益胀，而胁骨日益昂起，乃至咳嗽声频繁，浊痰如胶，发热畏寒，日晡时尤其严重，面红鼻燥，胸生甲错。起初如果能辨别其脉证属表、属里，积力开提攻下，无不痊愈的。奈何医学无传，只知道见咳治咳，希望以此解热润燥，等到血化为脓，肺叶朽坏，倾囊吐出，才识别其证，十死不救。《金匮要略》治法最精，用力全在未成脓之前。今人施用于已成脓之后，能有济事吗？肺痿，其积累渐进已非一日，其寒热不止一端，总由胃中津液不输送于肺，肺失所养，转枯转燥，然后形成。盖肺金生水，精华四布的，全赖胃土津液的丰富，上供不缺。医生不知道爱护，或腠理素疏，无故而大发其汗；或中气素馁，频繁呕吐以倒倾其囊；或肠枯便秘，强利以求其快，只此上供的津液，坐耗歧途。于是肺火日益炽盛，肺热日益加深，肺中小管日益窒塞，咳嗽声逐渐不扬，胸中脂膜日益干枯，咳痰难于上出，行动几步，气即喘鸣，冲击连声，痰才一应。《金匮要略》治法，并非不彰明，然而混杂在肺痈一门，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。肺痈属有形之血，血结宜骤攻；肺痿属无形之气，气伤宜徐理。肺痈为实，误以肺痿治之，是为实实（实证用补法，使实者更实）；肺痿为虚，误以肺痈治之，是为虚虚（虚证用泻法，使虚者更虚）。这是辨证用药的大略。○再论肺痿、肺痈的病，都是燥病。肺禀清肃之令，乃金寒水冷之脏。火热熏灼，久久失去其清肃而变为燥，肺中生痈，其津液全裹其痈，不溢于口，故口中辟辟然干燥。肺热成痿，则津液之上供者，悉从燥热化为涎沫浊唾。证多不渴，较胃中津液尽伤，母病累子之痿，又大不同。只是津液之上输者变为唾沫，肺不沾其惠泽耳。若夫痿病，津液不能灭火，反从火化，累年积岁，肺叶之间酿成一大火聚，以清凉投之，格不入矣。然虽格拒，固无害也，设以燥投之，以火济火，其人有不坐毙者乎？半夏，燥药也，投入肺中，转增其患，自不待言。但清凉既不能入，惟燥与燥相得，乃能入之，故用半夏之燥，入清凉生津药中，则不但不燥，转足开燥，其浊沫随逆气下趋，久久，津液之上输者不结为涎沫，而肺得沾其渍润，痿斯起矣。人但知半夏能燥津液，孰知善用之，即能驱所燥之津液乎？此精蕴也。○凡肺痿多不渴。以其不渴，漫然不用生津之药，任其肺日枯燥，医之罪也。以其不渴，恣用燥热之药，势必不救，罪加等也。○凡治肺痿，奄奄不振，故行峻法，大驱涎沫，图速效，反速毙，医之罪也。○凡治肺痈须与肺痿异治。肺痈为实，肺痿为虚；肺痈为阳实，肺痿为阴虚。阳实，始宜散邪，次宜下气；阴虚，宜补胃津，兼润肺燥。若不辨而误治，医杀之也。（出自《医门法律》）
脉候
脉数而虚者为肺痿，数而实为肺痈。（出自《金匮要略》）
肺痈初起，脉不宜数，溃后最忌短涩。脉缓滑，面白者生；脉弦急，面赤者死。（张石顽）
附肺胀
肺胀，动则喘满，气急息重，左右不得眠的就是。若痰挟瘀血，阻碍气机的，宜行血以流动乎气，降火以清利其痰，用当归、白芍、桃仁、枳壳、陈皮、瓜蒌、竹沥。若风寒郁于肺中，不得发越，喘咳胀闷的，宜发汗以祛邪，利肺以顺气，用麻黄越婢加半夏汤。有停水不化，肺气不得下降而胀的，其证水入即吐，宜四苓散加葶苈、桔梗、桑白皮。有肾虚水枯，肺金不得施化而胀的，其证干咳烦冤，宜六味汤加麦冬、五味子。其他如气散而胀的，宜补气；气逆而胀的，宜降气。又肺胀壅遏不得卧，喘急鼻煽的难治。（出自《证治汇补》）
附诸内痈
黄帝问：人患胃脘痈的，诊察应当如何？岐伯对曰：诊察这个病，应当候胃脉。其脉应当沉细，沉细则气逆，气逆则人迎脉甚盛，甚盛则热。人迎脉，是胃脉，逆而盛，则热聚于胃口而不行，故胃脘为痈。（出自《素问》）
各种浮数脉，应当发热，反而洒淅恶寒，若有痛处，当发其痈。老师说：各种痈肿，欲知有脓无脓，用手掩在肿上，热的为有脓，不热的为无脓。○肠痈这个病，其身甲错，腹皮急，按之濡，如肿状，腹无积聚，身无热，脉数，此为肠内有痈脓，薏苡附子败酱散主治。○肿痈者，少腹肿痞，按之即痛如淋，小便自调，时时发热，自汗出，腹恶寒，其脉迟紧者，脓未成，可下之，当有血。脉洪数者，脓已成，不可下也。大黄牡丹汤主治。（出自《金匮要略》）
腹内的痈有好几种证。有肺痈、有肝痈、有胃脘痈、有小肠痈、有大肠痈、有膀胱痈。只有肺痈咳吐腥痰，人还容易辨认。其他的，有的以为是痞结，有的以为是瘀血，有的以为是寒痰，有的以为是食积，医药杂投，等到成脓，治已无及。现在先辨明其状，凡是痞结瘀血必有所因，且由渐而成。寒痰则痛止无定，又必另见痰证；食积则必有受伤之日，便通即散；只有内痈则痛有常所，而迁延益甚。《金匮要略》说：诸脉浮散，应当发热，而反而淅淅恶寒，若有痛处，当发其痈。用手按其肿上，热的有脓，不热的无脓。这几句乃是内痈的真谛啊。又说：肠痈之为病，身甲错，腹皮急，按之濡，如肿状，腹无积聚，无热是也。若肝痈则胁内隐痛，日久亦吐脓血。小肠痈与大肠痈相似，而部位略高。膀胱痈痛在少腹之下，近毛际，着皮即痛，小便亦艰而痛。胃脘痈有虚、实二种：实者易消，若成脓，必大吐脓血而愈；惟虚证则多不治，先则胃中痛胀，久而心下渐高，其坚如石，或有寒热，饮食不进，按之尤痛，形体枯瘦，此乃思虑伤脾之证，不待脓
**Classic Theory (Jing Yi)**
Wind pathogen is the leader of all diseases. When a pathogen enters and resides in the Lung, it is called *Fei Bi* (Lung Bi, obstruction of Lung Qi), manifesting as cough and rebellious Qi ascending. ○ If the pulse arrives rapid and floating, accompanied by panting, it indicates deficiency above and excess below, susceptibility to fright, and stagnant Qi accumulating in the chest; this panting with emptiness is named *Fei Bi*, accompanied by alternating cold and fever. ○ Symptoms of *Fei Bi* include vexation and fullness, panting, and vomiting. ○ If excessive fluids cause panting, the Bi syndrome gathers in the Lung. (*Su Wen*)
**Philosophical Discourse (Zhe Yan)**
The Lung is the bellows of respiration, positioned at the highest point, receiving the clear Qi from the viscera that ascends to pay homage. It possesses a nature of clarity and descending, primarily governing descent. As a delicate organ, it cannot withstand pathogenic invasion; once any of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) attaches, disease ensues. The Lung dislikes Cold, Heat, Dryness, and Dampness, and fears Fire and Wind most. When pathogens attach, it loses its clarity and descending function, causing obstruction and blockage. Treatment methods: For cases caused by Wind, use herbs like Bohe (Menthae Haplocalycis Herba), Sangye (Mori Folium), and Niubangzi (Arctii Fructus); if combined with Cold, use Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen Amarum); if obstructed by Warm-Heat, use Shegan (Belamcandae Rhizoma), Lianqiao (Forsythiae Fructus), Shanzhi (Gardeniae Fructus), Tuzhuhuang (Bambusae Concretio Silicea), Zhuye (Bambusae Folium), Shashen (Glehniae Radix), and Xiangbei (Fritillariae Thunbergii Bulbus); for Dampness, use Tongcao (Tetrapanacis Medulla), Huashi (Talcum), Sangpiao (Mori Cortex), and Yiren (Coicis Semen); for Dryness, use Lipi (Pyrifoliae Pericarpium), Lugeng (Phragmitis Rhizoma), Pipaye (Loquati Folium), and Ziwan (Asteris Radix); to open Qi, use Loupi (Trichosanthis Pericarpium), Xiangchi (Sojae Semen Praeparatum), Suzi (Perillae Fructus), Jiegeng (Platycodonis Radix), and Kourén (Amomi Fructus). Weijing Tang (Asparagi Ramulus Decoction) and Tingli Dazao Tang (Descurariae Semen and Jujubae Decoction) all prioritize light and floating properties, avoiding heavy and turbid flavors. This is described as slightly acrid to open and slightly bitter to descend, fitting the treatment of the light, clear, and delicate organ. The Lung governs all vessels and is prone to many diseases. The Lung and Large Intestine are exterior-interior partners, and the Lung communicates with the Bladder to regulate Qi transformation. Thus, the patency or obstruction of urination and defecation is closely related to the Lung. (*Lin Zheng Zhi Nan*)
The Lung is a clear and empty organ, favoring patency and discharging, abhorring stagnation and blockage, which must not be disturbed even slightly. Now blocked by turbid pathogens, only clear, empty, and patent medicines can resolve it. Ancients often used Xiebai San (White Powder Draining Decoction) with success for this condition. (Fang Xingyan)
**(Appendix: Fei Zhang [Lung Distension], Various Internal Abscesses)**
**Philosophical Discourse**
Question: When heat is in the Upper Jiao, it causes cough leading to *Fei Wei* (Lung Flaccidity). How is *Fei Wei* contracted? The Master said: Sometimes from excessive sweating, sometimes from vomiting, sometimes from Xiao Ke (Wasting-Thirst) with frequent urination, or from constipation followed by harsh purgation, leading to severe loss of body fluids, thus contracting the disease. ○ Question: Why does a rapid pulse at the Cun Kou position with cough and copious turbid saliva and froth indicate disease? The Master said: This is *Fei Wei*. ○ If the mouth feels parched and dry, and coughing causes dull pain in the chest with a slippery and rapid pulse, this is *Fei Yong* (Lung Abscess), characterized by coughing up pus and blood. ○ Question: In a patient with cough and rebellious Qi, how can one know it is *Fei Yong* based on the pulse? There should be pus and blood; if vomited, death ensues. What kind of pulse is it? 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 injures the Wei (Defensive) level, so exhalation fails to enter deeply; Heat overwhelms the Ying (Nutritive) level, so inhalation fails to go out. Wind damages the skin and hair; Heat damages the blood vessels. Wind residing in the Lung causes cough, dry mouth, panting, and fullness, dry throat without thirst, copious turbid froth, and periodic chills. Where Heat passes, blood coagulates and stagnates, forming an abscess and pus, expelled like congee. If caught early, it can be saved; once pus forms, it is fatal. (*Jin Gui Yao Lue*)
Lung lobes are like flowers and leaves of plants. *Fei Wei* due to heat is like withering under sun exposure; *Fei Wei* due to cold is like drying after frost damage. (Wei Litong)
*Fei Wei* generally belongs to fluid exhaustion and dryness, mostly caused by injury to healthy Qi through sweating or purging. "Wei" means "wither," like plants losing vigor due to fluid loss and Qi depletion. However, causes of Wei are not limited to one aspect. *Jin Gui* states: Due to sweating, vomiting, Xiao Ke with frequent urination, or constipation treated with harsh purgatives, severe fluid loss leads to Lung Heat and dry Wei. Lung Heat and dry Wei impair the descending and clearing function. Although the Spleen distributes fluids upward to the Lung, the Lung cannot moisten itself nor distribute essence to the Six Fu organs and skin/hair. Fluids accumulate in the chest, are boiled by Heat into froth, invade the Lung causing cough, and are continuously expectorated. Thus, the dry remains dry, the expectoration continues, becoming drier with each expectoration, forming *Fei Wei*. (*Lin Zheng Zhi Nan*)
The presentation of *Fei Wei* resembles but differs from *Fei Yong*. *Fei Wei* occurs after chronic illness and deficiency; *Fei Yong* occurs at the onset when previously healthy. *Fei Wei* involves coughing white phlegm and saliva; *Fei Yong* involves foul-smelling pus and chest/flank pain. Patients with *Fei Wei* are emaciated and fatigued; patients with *Fei Yong* are robust. *Fei Wei* develops chills and tidal fever late; *Fei Yong* begins with piloerection and aversion to wind. *Fei Wei* pulse is hollow and rapid without spirit; *Fei Yong* pulse is floating and rapid with strength. These differences are significant. Generally, *Fei Yong* caused by external factors requires urgent regulation; although injured, the Lung can still be rescued. *Fei Wei* caused by internal factors requires extensive tonification; since the Lung is withered, few methods work. (Wang Yungu)
**Supplementary Compilation**
*Fei Wei* with expectoration of froth but no cough, non-thirsty, inevitably with enuresis and frequent urination. This is because Spleen Earth deficiency fails to control Water. This is named Cold in the Lung, causing dizziness and copious froth; treat with Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to warm. ○ Cough with rebellious Qi and a sound like a water frog in the throat; treat with Shegan Mahuang Tang (Belamcanda and Ephedra Decoction). ○ Cough with rebellious Qi, frequent expectoration of turbid matter, unable to lie down; treat with Zaojiao Wan (Soapberry Pill). ○ Cough with floating pulse; treat with Nongpo Mahuang Tang (Magnolia Bark and Ephedra Decoction). ○ Pulse sinking; treat with Zeqi Tang (Zeaxia Decoction). ○ Fire rebellion causing ascending Qi and throat discomfort; to stop rebellion and descend Qi, treat with Maimendong Tang (Ophiopogon Decoction). ○ *Fei Yong* with panting preventing lying down; treat with Tingli Dazao Xiefei Tang (Descuraria and Jujube Decoction to Drain the Lung). ○ Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional foul-smelling turbid sputum, long-term expectoration of pus like congee indicates *Fei Yong*; treat with Jiegeng Tang (Platycodon Decoction). ○ Cough with rebellious Qi, this is *Fei Zhang* (Lung Distension). Patient pants, eyes bulge, pulse floating and large; treat with Yeshibi Jia Banxia Tang (Ma Huang and Gypsum plus Pinellia Decoction). ○ *Fei Zhang*, cough with rebellious Qi, irritability, and panting. Pulse floating indicates Water retention below the Heart; treat with Xiao Qinglong Jia Shigao Tang (Minor Green Dragon plus Gypsum Decoction).
○ *Waitai Mi Yao*'s Zhigancao Tang treats *Fei Wei* with copious froth and a warm, liquid sensation in the epigastrium. ○ *Qianjin Fang*'s Shengjiang Gancao Tang treats persistent *Fei Wei* with coughing froth, dry throat, and thirst. ○ *Qianjin Fang*''s Guizhi Qu Shaoyao Jia Zaojiao Tang treats *Fei Wei* with expectoration of froth. ○ *Waitai Mi Yao*'s Jiegeng Baisan treats *Fei Yong* with chest fullness, chills, rapid pulse, dry throat without thirst, foul sputum, and pus like congee. ○ *Qianjin Fang*'s Weijing Tang treats cough with slight fever, vexation, fullness, and crusty skin in the chest, indicating *Fei Yong*. (*Jin Gui Yao Lue*)
The Master established Gancao Ganjiang Tang for Lung Cold and dryness impending *Wei*; and Maimendong Tang for Lung Heat and scorching impending *Wei*, both as preventive measures for *Fei Wei*.
For external pathogens causing Lung depression risking *Wei* and *Yong*, he established Shegan Mahuang Tang; for internal Qi rebellion without external pathogens risking *Yong*, he established Zaojiao Wan; for external pathogens requiring preemptive Lung regulation, he established Nongpo Mahuang Tang; for external pathogens with internal Heat, he established Zeqi Tang. All aim to prevent Qi stagnation from forming *Wei* or *Yong*.
For external pathogens causing *Fei Zhang*, he urgently established Yeshibi Jia Banxia Tang; for external pathogens with internal Heat causing *Fei Zhang* and irritability, he established Xiao Qinglong Jia Shigao Tang. These also aim to prevent Qi stagnation from forming *Yong* or *Wei*. If practitioners select and apply these appropriately, what worry would there be of disease formation? Once *Fei Yong* has formed, using Tingli Dazao Xiefei Tang; or long-term pus expectoration treated with Jiegeng Tang, are measures of last resort, yet already too late. Observing this, we know prevention is crucial, especially for the Lung, which is vital to Qi and life. Do not miss the opportunity early and regret it late. (Wei Litong)
The Lung is the canopy of the Five Viscera, high and clear, governing Qi internally, voice centrally, and skin/hair externally. When Blood and Qi are sufficient internally, and Water and Fire root each other, the delicate organ fears no Fire inflammation, and Metal and Water generate each other, so why would Lung Qi be constrained and wither? Alas, congenital deficiency combined with reckless sexual activity damages True Yuan, shaking the root, causing Kidney Water deficiency and Ministerial Fire flourishing, steaming Lung Metal. Metal punished by Fire manifests as cough and hemoptysis; alternating cold and fever; night sweats; hoarseness and sore throat; upper vomiting and lower diarrhea. Pulses may be floating, large, empty, and rapid; or wiry, fine, choppy, and rapid. At this stage, the body wastes away, coughing up stasis and pus like peach blossoms or congee. This severe disease transforming into *Fei Wei* is a critical prognosis. Although difficult to save, if one must legislate a cure, the focus is tonifying Kidney Water to suppress Yin Fire, generating fluids to moisten Lung dryness. Further, use Renshen (Ginseng Radix et Rhizoma), [Missing Character], and Heche (Placentae Humanæ) to fill the Lower Yuan. Tonifying the Lung benefits Qi; tonifying the Kidney benefits Essence. Only then might one recover from the brink of death. ○ *Fei Yong* is hardest to recognize in its initial stage. Physicians mistake it for Wind-Cold, treating only the cough, failing with medication. By the time pus matures and is expectorated, they realize the Lung Abscess is intractable. Symptoms include aversion to cold and fever, heavy cough, dull chest pain, nasal congestion, and neck stiffness. Prolonged Qi and Blood stagnation leads to clear nasal discharge, coughing pus and blood, foul and thick sputum, chest/flank distension, and breathing difficulty. Pulses before rupture: floating-tight-rapid or flooding-rapid; after rupture: hollow-large-rapid or wiry-fine-rapid. Initial stage: Ganjie Tang (Licorice and Platycodon Decoction) or Douko Tang (Black Soybean Decoction) to detoxify and lift; formed stage: Baihe Gujin Tang (Lily Bulb to Secure the Metal Decoction) to nourish Water and clear Metal; post-rupture: Liuwei Dihuang Tang (Six Ingredient Pill with Rehmannia) to tonify Yin and protect the Lung, clearing Heat and saving Qi, preventing Lung corruption. Clearing Lung Heat preserves Lung Qi. Clearing Heat must dissipate Fire knots and drain stagnation, directing the pathogen to the Large Intestine, allowing pus and turbid matter to move downward. This is the good method.
The Lung is a delicate organ, belonging to Taiyin and having a dry constitution. It must not be attacked by Fire toxicity, causing organ damage and pus/blood leakage. Physicians who fail to tonify Lung deficiency, rescue Lung dryness, and generate Lung fluids, instead recklessly administering drying-hot drugs, subject the patient to the disaster of "tonifying excess." (*Huixin Lu*)
Human Qi derives its command from the Lung. If Lung Qi is clear and descending, all Qi obeys and flows smoothly; if Lung Qi is turbid and stagnant, Qi easily rebels and attacks upward. *Fei Yong* is Lung Qi obstruction and blockage; *Fei Wei* is Lung Qi flaccidity and lack of vigor. Upon seeing chronic cough and rebellious Qi, one must first guard against these two conditions. *Fei Yong* arises from accumulated Fire in the Five Viscera and retained Heat in the Stomach ascending to the Lung. Lung scorched by Fire causes blood coagulation; coagulated blood is wrapped by Phlegm, forming a small abscess. As the mass grows, the Lung distends, ribs elevate, cough becomes frequent, sputum becomes glue-like, fever and chills worsen at dusk, face turns red, nose dries, and chest skin becomes crusty. If identified early as Exterior or Interior and treated with lifting and purging, recovery is certain. Regrettably, medical transmission is lost; doctors only see cough and treat cough, hoping to clear Heat and moisten dryness. By the time blood turns to pus and Lung lobes rot, expectorating copiously, they recognize the condition, but ten out of ten die. *Jin Gui* treatment is exquisite, focusing on the pre-pus stage. Modern application post-pus formation is futile. *Fei Wei* accumulates gradually over days, with various causes of cold and heat, ultimately due to Stomach fluids failing to reach the Lung, causing malnourishment, desiccation, and dryness. Lung Metal generates Water, distributing essence, relying entirely on abundant Stomach Earth fluids. Physicians fail to protect these; some induce massive sweating in those with loose pores; some cause frequent vomiting in those with weak Middle Qi; some forcibly purge constipation. These actions deplete the fluids meant for the Lung. Lung Fire intensifies, Heat deepens, Lung micro-tubes obstruct, cough becomes muffled, chest membranes dry, sputum is hard to expel, panting occurs after short walks, and wheezing sounds accompany expectoration. *Jin Gui* methods are clear but often confused with *Fei Yong*. The key is gradual management: generate Stomach fluids, moisten Lung dryness, descend rebellious Qi, open accumulated Phlegm, stop turbid froth, tonify True Qi to unblock Lung tubes, and dissipate Fire to restore Lung clarity. *Fei Yong* involves tangible Blood clots, requiring aggressive attack; *Fei Wei* involves intangible Qi injury, requiring gentle regulation. *Fei Yong* is Excess; treating it as Deficiency (*Wei*) is "Excess reinforcing Excess." *Fei Wei* is Deficiency; treating it as Excess (*Yong*) is "Deficiency reinforcing Deficiency." This is the general principle of differentiation and medication. ○ Furthermore, both *Fei Wei* and *Fei Yong* are Dryness diseases. The Lung receives clear and descending commands, being a Metal-Water organ. Prolonged Fire scorching destroys clarity, creating Dryness. In *Fei Yong*, fluids surround the abscess and do not overflow, causing mouth dryness. In *Fei Wei*, fluids transform into froth due to Heat, often without thirst, differing from Stomach fluid exhaustion affecting the Child (Lung). Here, fluids transform into froth, depriving the Lung of nourishment. In *Wei*, fluids fail to extinguish Fire, turning into Fire, creating a fire cluster in the Lung lobes over years. Cooling agents cannot penetrate. Although rejection occurs, it is harmless; however, administering drying-hot drugs adds Fire to Fire, leading to death. Banxia (Pinelliae Rhizoma) is a drying herb; adding it to the Lung increases harm. But since cooling agents cannot enter, only Dryness matches Dryness. Thus, using Banxia's dryness within cooling-fluid-generating herbs allows entry, opening dryness, driving turbid froth downward with rebellious Qi. Over time, fluids no longer form froth, and the Lung gains moisture, recovering *Wei*. People know Banxia dries fluids, but few know skilled use drives dried fluids. This is the profound essence. ○ Generally, *Fei Wei* patients are non-thirsty. Using this to neglect fluid-generating herbs, letting the Lung dry daily, is the physician's fault. Using this to recklessly administer drying-hot herbs, ensuring untreatability, is a greater fault. ○ Treating *Fei Wei* with weak vitality using harsh methods to drive froth for quick results accelerates death; this is the physician's fault. ○ Treating *Fei Yong* must differ from *Fei Wei*. *Fei Yong* is Excess; *Fei Wei* is Deficiency. *Fei Yong* is Yang-Excess; *Fei Wei* is Yin-Deficiency. Yang-Excess requires dispersing pathogens then descending Qi; Yin-Deficiency requires tonifying Stomach fluids and moistening Lung dryness. Misdiagnosis and mistreatment kill the patient. (*Yi Men Fa Lv*)
**Pulse Diagnosis**
Rapid and deficient pulse indicates *Fei Wei*; rapid and excess pulse indicates *Fei Yong*. (*Jin Gui Yao Lue*)
In early *Fei Yong*, rapid pulse is unfavorable; after rupture, short and choppy pulses are taboo. Slow and slippery pulse with pale face indicates survival; wiry and urgent pulse with red face indicates death. (Zhang Shiwang)
**Appendix: Fei Zhang (Lung Distension)**
*Fei Zhang* is characterized by panting and fullness upon movement,急促 breathing, heavy sighing, and inability to sleep on either side. If Phlegm and Blood Stasis obstruct Qi mechanism, promote Blood circulation to move Qi, and descend Fire to clear Phlegm, use Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Taoren (Persicae Semen), Zhike (Aurantii Fructus), Chenpi (Citri Reticulatae Pericarpium), Gualou (Trichosanthis Fructus), and Zhuli (Bambusae Succus). If Wind-Cold stagnates in the Lung, causing panting, cough, and distension, induce sweating to dispel pathogens and benefit the Lung to smooth Qi, use Mahuang Yeshibi Jia Banxia Tang (Ma Huang, Gypsum, and Pinellia Decoction). If retained Water fails to transform, preventing Lung Qi descent and causing distension, with symptoms of vomiting immediately after drinking, use Siling San (Four Ling Powder) plus Tingli, Jiegeng, and Sangpiao. If Kidney Water deficiency and dryness prevent Lung Metal transformation, causing dry cough and distress, use Liuwei Dihuang Tang plus Maidong and Wuweizi. Other types: Qi dispersion causing distension requires tonifying Qi; Qi rebellion causing distension requires descending Qi. *Fei Zhang* with obstruction preventing lying down,急促 panting, and nasal flaring is difficult to treat. (*Zhengzhi Huibu*)
**Appendix: Various Internal Abscesses**
Yellow Emperor asked: How to diagnose Stomach Epigastrium Abscess? Qibo replied: Examine the Stomach pulse. It should be deep and fine. Deep and fine indicates Qi rebellion. Rebellion causes the Renying pulse to be very full. Fullness indicates Heat. Renying is the Stomach pulse. Rebellion and fullness mean Heat gathers at the stomach opening and cannot flow, causing Stomach Epigastrium Abscess. (*Su Wen*)
Various floating and rapid pulses usually indicate Fever. If accompanied by shivering aversion to cold and a painful area, an Abscess will develop. The Master said: To determine if an Abscess has pus, press on the swelling. Heat indicates pus; no heat indicates no pus. ○ Intestinal Abscess presents with crusty skin, tight abdominal wall, soft upon pressure, swollen appearance, no abdominal masses, no fever, and rapid pulse. This is intestinal pus; treat with Yiyi Fuzi Baijiang San (Coix Seed, Aconite, and Patrinia Powder). ○ Swollen Abscess: Swelling and痞 in the lower abdomen, painful upon pressure resembling strangury, normal urination, periodic fever, spontaneous sweating, abdominal aversion to cold. Delayed and tight pulse indicates unformed pus; purgation is indicated, expecting blood. Flooding and rapid pulse indicates formed pus; purgation is contraindicated. Treat with Dahuang Mudan Tang (Rhubarb and Moutan Decoction). (*Jin Gui Yao Lue*)
Internal Abcesses have several types: Lung, Liver, Stomach Epigastrium, Small Intestine, Large Intestine, Bladder. Only Lung Abscess with foul sputum is easily identified. Others are mistaken for痞结 (Stagnation), Blood Stasis, Cold Phlegm, or Food Retention. Mixed treatments lead to missed opportunities once pus forms. Differentiate clearly: Stagnation and Stasis have causes and develop gradually. Cold Phlegm has shifting pain and other Phlegm signs. Food Retention has a history of injury and resolves with bowel movement. Internal Abscesses have fixed pain that worsens over time. *Jin Gui* states: Floating and scattered pulses with Fever but shivering aversion to cold and pain indicate Abscess. Pressing heat confirms pus. This is the truth of internal Abscesses. Also: Intestinal Abscess with crusty skin, tight abdomen, soft pressure, swollen look, no masses, no fever. Liver Abscess has hidden flank pain and eventual pus/blood expectoration. Small Intestine Abscess resembles Large Intestine but is higher. Bladder Abscess pain is in the lower lower abdomen near the pubis, tender to touch, with difficult/painful urination. Stomach Epigastrium Abscess has Excess and Deficiency types. Excess resolves easily; if pus forms, copious pus/blood expulsion cures it. Deficiency is often untreatable: initial stomach pain/fullness, gradually rising hardness below the heart like stone, alternating cold/fever, anorexia, extreme tenderness, emaciation. This is Spleen injury from overthinking, not waiting for pus...