又曰∶古一妇人二十余岁，胸膺间一窍，口中所咳脓血与窍相应而出，以人参、归、 补气血之剂加退热排脓等药
而愈。
娄金善曰∶肺痿属热，如咳久肺伤，声哑声嘶咯血，此属阴虚火热甚，是本论治。
肺痿吐涎沫而不咳者，其人不渴必遗尿，小便数，以上虚不能制下故也。此为肺中冷，
必眩多涎唾，用炙甘草、干姜此属寒也。肺痿吐涎多，心中温液者，用炙甘草汤以补
虚劳也。亦与补阴虚火热不同，是皆宜厘清之，故肺痿又有寒热之异也。
周文采曰∶其候应乳上下隐隐而痛者，肺疽也。若肉微起者，肺痈也。初起俱可
救，若日久唾脓臭败者，不可治也。但诊其脉微紧而数者，未有脓也。若紧甚而数
者，已有脓也。若脓如粳米粥及呕脓不止，其脉浮大而面色赤者，俱为难治。若脓自
止，其脉短而涩，面色黄白者，皆可治。何以言之？盖脉浮大面赤，此心火克肺金也，
故难治；若脉短涩及面白者，此肺气未损也，故可治。治法当补肺泻火，止嗽定喘
为主。（《集验》）
《圣惠》曰∶中府（穴名，在云门下一寸六分，乳肋间动脉应手陷中者是也。）隐隐而微痛者，肺疽
也。上肉微起者，肺痈也。是以候始萌则可救，脓成则多死。若欲知有脓者，但诊
其脉，若微紧而数者，未有脓也∶紧甚而数者，已有脓也。
申斗垣曰∶其证现于秋冬可救者，何也？肺旺于秋是也。冬寒水旺，子能救母，
子母相生，故云可救为顺。是春夏木旺火胜之时，肺金病再遇火旺之时，烁石流金，
金受火克，此为逆，故难治也。（《启玄》）
李东垣曰∶夫肺者五脏之华盖，处于胸中，主于气，候于皮毛，劳伤血气，腠
理虚而风邪乘之，内感于肺也，则汗出恶风，咳嗽短气，鼻塞项强，胸胁胀满，久
久不瘥，已成肺痿也。肺痿之候，久嗽不已，汗出过度，重亡津液，便如烂瓜，下
如豕脂，小便数而不渴，渴者自愈，欲饮者将瘥，此由肺多唾涎沫而无脓者，肺痿
也。风中于卫，呼气不入；热至于荣，则吸而不出。所以风感皮毛，热伤血脉，风
热相搏，气血稽留，蕴结于肺，变为肺疽。诊其脉候寸口脉数而虚者，肺痿也；数而
实者，肺疽也。其肺疮之候，口干喘满咽燥而渴，甚则四肢微肿，咳嗽脓血，或腥
臭浊沫，胸中隐隐微痛者，肺疽也。
龚居中曰∶经曰，肺伤善痿，痿则火郁邪壅，致金燥烈，肺虚气不能升降，以
充百脉，痈则金体受伤，肺叶焦枯，息亦不利，则火邪无以泄，郁遏熏蒸，致咯咳
嗽血，血渗妄行，必中府、云门隐痛，咳则喉腥，脉洪数而虚，久则腐化而出，遂
成肺痈不治之证。若脓血自止，脉来短涩者，不治自愈。以脉经本部之脉在也。
冯鲁瞻曰∶咳而膺乳痛，即看痰色如何。若浓浊如脓，或黄或赤，口中臭，即
从肺痿、肺痈治。以脉数而虚者为肺痿；脉数而实者为肺痈。
又曰∶肺痿咳吐，咽燥欲饮水者自愈，
张口短气者死。
又说道：古代有一位二十多岁的妇人，胸膺之间有一个孔窍，咳出的脓血与这个孔窍相应而出，用人参、当归等补益气血的药物，加上退热排脓等药治疗而痊愈。
娄金善说：肺痿属于热证，如果咳嗽日久损伤肺部，声音嘶哑甚至失音并咯血，这属于阴虚火旺严重，是本篇论述的治法范围。肺痿患者吐出涎沫却不咳嗽，病人不口渴且必然遗尿，小便频数，这是因为上焦虚寒不能制约下焦的缘故。这是肺中寒冷，必然出现眩晕、多涎唾的症状，应用炙甘草、干姜治疗，这属于寒证。肺痿患者吐涎多，心中感觉温热（指津液不足导致的虚热），应用炙甘草汤来补益虚劳。这也与补益阴虚火旺不同，这些都需要厘清，所以肺痿又有寒证和热证的区别。
周文采说：症状表现为乳房上下隐隐作痛的，是肺疽。如果肌肉微微隆起的，是肺痈。初起时都可以救治，如果日久咳出腥臭败浊的脓液，则不可治。只要诊察其脉象微紧而数的，说明还没有成脓。如果脉紧甚且数，说明已经有脓了。如果脓液像粳米粥一样，或者呕吐脓液不止，脉象浮大且面色赤红的，都属于难治。如果脓液自然停止，脉象短而涩，面色黄白的，都可以治愈。为什么这样说？因为脉浮大面赤，这是心火克制肺金，所以难治；如果脉短涩及面色白，这是肺气未受损，所以可治。治疗方法应当以补肺泻火、止咳定喘为主。（出自《集验》）
《圣惠方》说：中府穴（穴位名，在云门穴下一寸六分，乳肋间动脉应手陷中的位置。）隐隐而微痛的，是肺疽。上方肌肉微微隆起的，是肺痈。所以在病邪刚萌芽时可以救治，脓液形成后大多死亡。如果想确认是否有脓，只需诊察其脉象，如果脉微紧而数，说明没有脓；如果脉紧甚而数，说明已经有脓。
申斗垣说：病症出现在秋冬季节可以救治的，为什么呢？因为肺旺于秋季。冬季寒冷水气旺盛，子能救母，子母相生，所以说可救为顺证。如果是春夏木旺火胜的时候，肺金生病再遇到火旺的时候，如同烁石流金，金受火克，这是逆证，所以难治。（出自《启玄》）
李东垣说：肺是五脏的华盖，位于胸中，主司气，外候于皮毛。因劳伤导致血气亏损，腠理空虚而风邪乘虚而入，内感于肺，就会汗出恶风，咳嗽短气，鼻塞项强，胸胁胀满，久久不愈，就形成了肺痿。肺痿的症状，久嗽不已，出汗过度，再次耗亡津液，大便像烂瓜，下利如猪脂，小便频数而不渴，如果口渴则是自愈之兆，想喝水的是将要痊愈，这是由于肺多唾涎沫而没有脓，称为肺痿。风邪中于卫分，呼气不入；热邪至于营分，则吸气不出。所以风邪感受皮毛，热邪伤害血脉，风热相互搏结，气血稽留，蕴结于肺，变为肺疽。诊察其脉象，寸口脉数而虚的，是肺痿；数而实的，是肺疽。肺疮的症状，口干喘满咽燥而渴，严重时四肢微肿，咳嗽脓血，或腥臭浊沫，胸中隐隐微痛的，是肺疽。
龚居中说：经书说，肺受伤容易患痿，痿则火郁邪壅，导致金燥烈，肺虚气不能升降以充养百脉，痈则是金体受伤，肺叶焦枯，呼吸也不利，那么火邪无法宣泄，郁遏熏蒸，导致咯咳嗽血，血渗妄行，必然在中府、云门处隐痛，咳嗽时喉咙有腥味，脉洪数而虚，久了则腐化而出，遂成肺痈不治之证。如果脓血自止，脉来短涩的，虽说不治但会自愈。这是因为脉经本部之脉的原因。
冯鲁瞻说：咳嗽且胸膺乳房疼痛，就要看痰色如何。如果痰浓浊如脓，或黄或赤，口中发臭，就从肺痿、肺痈治疗。以脉数而虚者为肺痿；脉数而实者为肺痈。
It is also said: In ancient times, a woman in her twenties had an orifice between her chest and diaphragm, from which pus and blood coughed up from her mouth emerged correspondingly. She was cured using decoctions to tonify Qi and Blood, such as Ren Shen (Ginseng Radix) and Dang Gui (Angelicae Sinensis Radix), combined with herbs that clear heat and drain pus.
Lou Jinshan stated: Lung萎 (Lung Atrophy/Withering) belongs to Heat syndromes. If chronic cough damages the Lung, resulting in hoarseness or loss of voice and hemoptysis, this belongs to severe Yin deficiency with hyperactive fire, which falls under the treatment principles discussed in this treatise. When Lung萎 presents with salivation without coughing, the patient is not thirsty and inevitably suffers from enuresis and frequent urination; this is due to upper Jiao deficiency failing to control the lower Jiao. This indicates cold in the Lung, manifesting as vertigo and excessive saliva, treated with Zhi Gan Cao (Honey-fried Licorice Root) and Gan Jiang (Dried Ginger), belonging to Cold syndromes. When Lung萎 presents with excessive salivation and a sensation of warmth in the heart (referring to deficiency heat from fluid depletion), Zhi Gan Cao Tang (Honey-fried Licorice Decoction) should be used to tonify deficiency and exhaustion. This differs from tonifying Yin deficiency with hyperactive fire; all these distinctions must be clarified, hence Lung萎 has both Cold and Heat variations.
Zhou Wencai stated: Symptoms presenting as dull pain above and below the breasts indicate Lung Ju (Lung Abscess). If there is slight swelling of the flesh, it is Lung Yong (Lung Carbuncle). Both are curable in the early stages; however, if purulent, foul-smelling sputum is expectorated after a long duration, it is incurable. Upon pulse diagnosis, if the pulse is slightly tight and rapid, pus has not yet formed. If the pulse is very tight and rapid, pus has already formed. If the pus resembles rice gruel, or if vomiting of pus continues unceasingly, accompanied by a floating, large pulse and red complexion, all are difficult to treat. If the pus stops spontaneously, and the pulse is short and choppy with a yellowish-white complexion, they are all curable. Why? Because a floating, large pulse with a red complexion indicates Heart Fire overcoming Lung Metal, making it difficult to treat; whereas a short, choppy pulse with a white complexion indicates that Lung Qi is undamaged, making it curable. The treatment method should focus on tonifying the Lung, draining fire, stopping cough, and calming wheezing. (From *Ji Yan*)
*Sheng Hui Fang* states: Dull, slight pain at Zhongfu (Acupoint, located 1.5 cun below Yunmen, in the depression where the intercostal artery beats between the ribs) indicates Lung Ju. Slight elevation of the flesh above indicates Lung Yong. Therefore, if detected at the initial stage, it can be saved; once pus forms, death is common. To determine if pus exists, one need only diagnose the pulse: if slightly tight and rapid, no pus has formed; if very tight and rapid, pus has formed.
Shen Douyuan stated: Cases presenting in autumn and winter are curable because the Lung is prosperous in autumn. In winter, when Water is prosperous due to cold, the Child rescues the Mother (Kidney Water nourishes Lung Metal), following the principle of mutual generation among parent and child, thus considered favorable. However, in spring and summer, when Wood is prosperous and Fire prevails, a Lung Metal disease encountering strong Fire creates a situation akin to melting stone and flowing metal; Metal being overcome by Fire constitutes an unfavorable pattern, making it difficult to treat. (From *Qi Xuan*)
Li Dongyuan stated: The Lung is the canopy of the five Zang organs, located in the chest, governing Qi, and reflecting on the skin and hair. Labor and injury deplete Qi and Blood, causing the pores to become deficient, allowing Wind pathogen to invade and affect the Lung internally. This results in sweating, aversion to wind, cough, shortness of breath, nasal congestion, neck stiffness, and distension/fullness in the chest and hypochondrium. If prolonged and unresolved, it becomes Lung萎. The symptoms of Lung萎 include chronic cough, excessive sweating, further depletion of body fluids, stools resembling rotten melons, diarrhea resembling pig fat, frequent urination without thirst. If thirst occurs, it indicates self-healing; desire to drink indicates impending recovery. This condition, characterized by excessive saliva and phlegm without pus, is called Lung萎. Wind invading the Wei level prevents exhalation from entering; Heat reaching the Ying level prevents inhalation from exiting. Thus, Wind affects the skin and hair, Heat damages the vessels and blood; Wind and Heat contend, causing Qi and Blood to stagnate and accumulate in the Lung, transforming into Lung Ju. Pulse diagnosis shows: if the Cun Kou pulse is rapid and deficient, it is Lung萎; if rapid and excess, it is Lung Ju. Symptoms of Lung sores include dry mouth, wheezing, fullness, dry throat with thirst, mild swelling of limbs, coughing up pus and blood, or foul-smelling turbid froth, and dull pain in the chest, indicating Lung Ju.
Gong Juzhong stated: The Classics say, "Lung injury leads to ease of萎." With萎, Fire stagnates and pathogens obstruct, causing Metal to become dry and fierce. Lung deficiency prevents Qi from ascending and descending to nourish the hundred vessels. With Yong, the structure of Metal is damaged, Lung leaves become scorched and withered, breathing becomes difficult, and Fire pathogens cannot be vented. Stagnation and steaming lead to coughing up blood, hemorrhage, and wandering bleeding. There will inevitably be dull pain at Zhongfu and Yunmen, and a fishy smell in the throat upon coughing. A洪 (Surging) and rapid but deficient pulse indicates that over time, tissue rots and discharges, leading to an incurable case of Lung Yong. If pus and blood stop spontaneously and the pulse becomes short and choppy, although termed incurable, it may heal itself due to the nature of the pulse in its own section.
Feng Luzhan stated: Cough with pain in the chest and breasts requires examining the sputum color. If thick and turbid like pus, yellow or red, with a foul odor in the mouth, treat according to Lung萎 or Lung Yong patterns. A rapid but deficient pulse indicates Lung萎; a rapid and excess pulse indicates Lung Yong.
It is also said: In Lung萎 with cough and expectoration, if the throat is dry and the patient desires water, self-healing will occur; if the patient opens their mouth for shortness of breath, death ensues.