《金匮》所论肺痈、肺痿之证，谁秉内照，旷然洞悉，请以一得之愚，僭为敷陈。人身
之气，禀命于肺，肺气清肃，则周身之气莫不统 而顺行；肺气壅浊，则周身之气易致横逆
而犯上。故肺痈者，肺气壅而不通也；肺痿者，肺气委而不振也。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
则痰为之裹，乃至咳声频并，口中辟辟燥咳，即胸中隐隐痛，浊痰如胶，发热畏寒，日晡尤
甚，面红鼻燥，胸生甲错，寸口脉滑数而实，此肺结之痈，日渐长大，则肺日胀而胁骨日昂
。始先即能辨其证属表属里，极力开提攻下，无不愈者。奈何医者但知见咳治咳，或用牛黄
、犀角冀以解热，或用膏子油粘冀以润燥，或朝进补阴丸，或夜服清胃散。千蹊万径，无往
非杀人之算，病者亦自以为虚劳尸瘵，莫可奈何。迨至血化为脓，肺叶朽坏，倾囊吐出，始
识其证，十死不救，嗟无及矣。间有痈小气壮，胃强善食，其脓不从口出，或顺趋肛门，或
旁穿胁肋，仍可得生，然不过十中二、三耳。《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，全藉胃土津液之
富，上供罔缺。但胃中津液暗伤之窦最多，医者粗豪，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∶或瘅成消中，饮水而渴不解，泉竭自中；或肠枯便闭
，强利以求其快，漏卮难继，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，咳痰艰于上出，行动数武即喘鸣，冲击连声，痰
始一应。寸口脉数而虚，其人咳，口中反有浊唾涎沫者，为肺痿之病。《金匮》治法，非不
彰明，然混在肺痈一门，况难解其精意。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，以复气之清肃。如半身痿废，及手足痿软，治
之得法，亦能复起。虽云肺病近在胸中，呼吸所关，可不置力乎。肺痈属在有形之血，血结
宜骤攻；肺痿属在无形之气，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。
《金匮要略》中论述的肺痈、肺痿病证，谁能像秉烛内照一样，透彻洞察其理？请允许我献上一得之愚，冒昧地加以陈述。
人身之气，禀受于肺，肺气清肃，则周身之气无不统摄而顺行；若肺气壅滞浑浊，则周身之气易致横逆而上犯。所以，肺痈，是肺气壅塞而不通畅；肺痿，是肺气萎弱而不能振奋。刚见到久咳、气逆上冲的症状时，首先必须防备这两种病证。
肺痈是由于五脏蕴积之火，与胃中停蓄之热上乘于肺，肺受到火热熏灼，血液因此凝结，血凝则痰随之包裹，以至于咳嗽声频繁，口中干燥如辟辟作响，胸中隐隐作痛，吐出的浊痰如胶状，发热畏寒，傍晚时分尤为严重，面色红赤，鼻窍干燥，胸部皮肤粗糙如鳞甲（肌肤甲错），寸口脉滑数而实。这是肺部结聚而成的痈肿，日渐长大，则肺日益胀大，胁骨日益高起。如果在初期就能辨别病证属于表证还是里证，极力采用开提或攻下的治法，没有不能治愈的。
奈何医生只知道见咳治咳，有的用牛黄、犀角希望以此清热，有的用膏子油粘之物希望以此润燥，有的早晨服用补阴丸，有的晚上服用清胃散。千条万条路径，无一不是杀人的计谋，病人也自认为是虚劳尸瘵，无可奈何。等到血液化为脓液，肺叶朽坏，倾囊吐出脓血，才认识到这个病证，但已是十死无救，叹息已来不及了。间或有痈肿较小、正气壮盛、胃气强盛善于进食的患者，其脓液不从口而出，而是顺趋肛门排出，或旁穿胁肋流出，仍可得生，但这不过十分之二三罢了。
《金匮要略》的治疗法则最为精妙，用力全在脓液未形成之前。如今医生施治于脓液已成之后，那能有什么帮助呢？
肺痿病，其积累渐成已非一日之功，其寒热表现不止一端，总归是因为胃中津液不能输送到肺，肺失所养，逐渐干枯燥热，然后形成此病。盖因肺金生水，精华四布，全赖胃土津液的丰富，上供无所欠缺。但是，胃中津液暗中受损的途径最多，医生粗疏豪放，不知爱护；有的患者腠理素来疏松，无故而大发其汗；有的患者中气素来虚弱，频繁呕吐以倒空其囊；有的患消渴病（瘅成消中），饮水而口渴不解，源泉枯竭于中；有的肠道干枯便秘，强行利小便以求痛快，漏卮难继，只这上供的津液，白白消耗在歧途。于是肺火日益炽盛，肺热日益加深，肺中小管日益窒塞，咳嗽声音逐渐不响亮，胸中脂膜日益干燥，咳痰艰难难以向上排出，行走几步即喘鸣，冲击连声，痰才应声而出。寸口脉数而虚，其人咳嗽，口中反而有浊唾涎沫的，就是肺痿的病证。
《金匮要略》的治疗法则，并非不彰明，然而混杂在肺痈一门之中，况且难以理解其精意。大抵要缓慢图谋，生津养胃、润肺燥、降逆气、开积痰、止浊唾、补真气，以通利肺之小管；散火热，以恢复气之清肃。即使是半身痿废，及手足痿软，治疗得当，也能康复。虽然说是肺病近在胸中，关乎呼吸，难道可以不着力治疗吗？
肺痈属于有形之血，血结宜迅速攻逐；肺痿属于无形之气，气伤宜徐徐调理。肺痈为实证，误用治疗肺痿的方法去治它，这叫“实实”（使实证更实）；肺痿为虚证，误用治疗肺痈的方法去治它，这叫“虚虚”（使虚证更虚）。这是辨证用药的大略原则。
The discussions on Lung Abscess (Fei Yong) and Lung Withering (Fei Wei) in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), who can illuminate them from within like holding a candle, seeing through them clearly? Please allow me to offer my humble insight and presumptuously elaborate.
The Qi of the human body is endowed by the Lung. When Lung Qi is clear and descending, the Qi of the entire body is governed and flows smoothly; when Lung Qi is obstructed and turbid, the Qi of the entire body easily becomes rebellious and attacks upward. Therefore, Lung Abscess refers to Lung Qi being obstructed and not flowing freely; Lung Withering refers to Lung Qi being withered and failing to rise. Upon observing chronic cough and Qi rebelling upward, one must first guard against these two conditions.
Lung Abscess arises from the accumulated fire of the five Zang organs and the stagnant heat in the Stomach ascending to the Lung. The Lung is scorched by this fire-heat, causing blood to coagulate. Once blood coagulates, phlegm wraps around it. This leads to frequent coughing, a dry sensation in the mouth as if crackling, hidden pain in the chest, thick turbid phlegm resembling glue, fever and aversion to cold (which are worse in the late afternoon), red face, dry nose, rough skin on the chest resembling armor scales (Ji Cuo), and a slippery, rapid, and full pulse at the Cun Kou position. This is an abscess formed by congestion in the Lung. As it grows day by day, the Lung swells, and the ribs protrude. If one can distinguish whether the syndrome belongs to the Exterior or Interior at the beginning, and vigorously employ methods to raise and release or purge downward, there will be no case that cannot be cured.
Alas, physicians only know to treat cough when they see cough. Some use Niuhuang (Calculus Bovis) and Xijiao (Rhinoceros Horn) hoping to resolve heat; some use sticky pastes or oils hoping to moisten dryness; some administer Buyin Wan (Nourish Yin Pill) in the morning, and Qingwei San (Clear Stomach Powder) at night. Countless paths, none but schemes for killing. Patients also consider themselves to suffer from consumptive disease (Shi Zhai), helpless. Only when blood transforms into pus and lung tissue rots, vomiting out the contents like emptying a bag, do they realize the nature of the disease, but it is already ten deaths without hope. Sigh, it is too late. Occasionally, those with small abscesses and strong Qi, or strong Stomach Qi and good appetite, may have pus exit not from the mouth, but flow down to the anus or pierce sideways through the hypochondrium, still surviving, but this accounts for only two or three out of ten.
The treatment principles in the *Jin Gui Yao Lue* are most exquisite, exerting effort entirely before the pus forms. Today, physicians apply treatments after pus has already formed; what benefit can there be?
Lung Withering accumulates gradually over days and months. Its cold and heat manifestations are not limited to one aspect. It generally results from Stomach fluids failing to transmit to the Lung, causing the Lung to lose nourishment, turning withered and dry, thus forming the disease. The generation of water by Lung Metal and the distribution of its essence rely entirely on the abundance of Stomach Earth fluids to supply upwards without deficiency. However, there are many ways for Stomach fluids to be secretly damaged. Physicians, being coarse and bold, fail to protect them; or patients have loose interstices (Cou Li) and induce excessive sweating without cause; or patients have deficient Middle Qi and frequent vomiting empties their reserves; or they suffer from diabetes-like thirst (Dan Cheng Xiao Zhong), drinking water yet thirst remains unquenched, with the spring drying up from within; or intestines are dry with constipation, forcing diuresis for relief, like a leaking vessel hard to replenish. These upper-supplying fluids are wasted on wrong paths. Thus, Lung fire intensifies daily, Lung heat deepens, small tubes in the Lung become obstructed daily, cough sounds become fainter, mediastinal membranes dry out, expectoration becomes difficult, panting and wheezing occur after walking a few steps, gasping continues, and phlegm finally responds. The Cun Kou pulse is rapid and deficient. The patient coughs, and instead of clear sputum, there is turbid saliva and froth in the mouth; this is the disease of Lung Withering.
The treatment methods in the *Jin Gui Yao Lue* are not unclear, but they are mixed under the category of Lung Abscess, making it difficult to grasp their profound meaning. Generally, one should plan slowly: generate Stomach fluids, moisten Lung dryness, descend rebellious Qi, open accumulated phlegm, stop turbid saliva, supplement true Qi, to unblock the small tubes of the Lung; dissipate fire-heat to restore the clarity and descending function of Qi. Even hemiplegic flaccidity and flaccidity of limbs, if treated correctly, can recover. Although Lung disease is close in the chest, concerning respiration, how can one neglect treating it?
Lung Abscess pertains to tangible Blood; blood stasis should be attacked rapidly. Lung Withering pertains to intangible Qi; Qi injury should be managed gradually. Lung Abscess is Excess; treating it with Lung Withering methods constitutes "Excess reinforcing Excess" (Shi Shi). Lung Withering is Deficiency; treating it with Lung Abscess methods constitutes "Deficiency reinforcing Deficiency" (Xu Xu). This is the general principle of syndrome differentiation and medication.