肺痿者津枯叶悴,因热在上焦,咳久伤肺,始则寒热自汗,口吐浊沫,或吐红丝脓血,脉数而虚者是也。
肺痈者,咽干吐脓,因风热客肺,蕴毒成痈,始则恶寒毛耸,喉间燥咳,胸前隐痛,痰脓腥臭,按右胁必痛,
着左卧则喘,脉滑数有力者是也。肺痿伤在无形之气,气伤者调其元。肺痈毒结有形之血,血结者排其毒,
此治法之概也。分而论之,肺痿由津液枯燥,至肺管日窒,咳声不扬,动即气喘,治在补气血,生津液,佐以
止嗽消痰。宜人参、玉竹、五味、阿胶、白芍、麦冬、当归、熟地、紫菀、川贝、杏仁等。其肺劳成痿,虚热
咳血者,人参固本丸,不时噙化。肺虚喘急自汗者,安肺汤。往来寒热,自汗烦渴者,紫菀散加银柴胡,姜
用蜜制。咳脓血,发热盗汗者,劫劳散。涎唾多,心中
温温液液者,炙甘草汤。痰嗽午热声嘶者,紫菀散加丹皮、姜、枣。喘咳失音咯血者,人参蛤蚧散。其虚寒羸
瘦,嘘吸胸满者,千金生姜温中汤。凡肺痿症,咳唾咽燥,欲饮水者,自愈。张口短气者,危。肺伤咯血喉
哑者,不治。肺痈由热蒸肺窍,至咳吐臭痰,胸胁刺痛,呼吸不利,治在利气疏痰,降火排脓,宜安肺桔梗汤。
初起肺受风寒喘嗽者,小青龙汤散解之。喘不得卧,胸胀者,葶苈大枣泻肺汤泻之。肺气不化,水道不利者,
苇茎汤疏利之。苇茎汤大疏肺气,使湿浊悉从溺孔去。咳逆上气,时时唾浊者,皂荚丸涤之。皂荚丸荡涤痰
浊,无坚不入。咳脓腥秽者,桔梗汤开提之。咳而短气溺少者,参 补肺汤调之。体倦食少脾虚者,参术补脾
汤养之。脓已 者,排脓散,或金鲤汤,或薏苡根煎汁饮,大效。痰中带血胸痛者,枯梗杏仁煎,或肺痈神汤
主之。吐脓咽痛者,甘桔汤加杏仁、贝母。痈久不敛者,川槿汤。如思虑劳心致动阴火,痰臭转甚者,六味丸
加麦冬、紫菀。二症溃后,宜补脾肺,滋肾水,不宜专攻其疮。凡肺痈症初起,痰觉腥臭,用陈腌芥卤温服,
或浓煎荷叶汁加白蜜服效。咳则微痛,痛在胸右,为肺之长叶,坐卧如常,饮食知味者,易治;若溃后寒热胁
痛,痛在胸左,为肺之短叶,或坐卧不安,饮食无味者,难治;若喘鸣不休,坐不得卧,咯吐脓血,色如败卤,
饮食艰进。声哑鼻扇者,不治。肺痈已破入风者,浓煎葱白香豉汤频服。然多不救。
肺痿,是指津液枯竭、肺叶枯萎憔悴的病证。这是由于热邪位于上焦,久咳损伤肺气所致。初期表现为寒热往来、自汗,口吐浑浊泡沫,或吐出带有红丝及脓血,脉象数而虚弱的就是这种病。
肺痈,是指咽喉干燥、吐出脓液,这是由于风热之邪客居于肺,蕴结毒气形成痈肿。初期表现为恶寒、毫毛竖起,喉间燥咳,胸前隐痛,痰液呈脓状且气味腥臭,按压右侧胁部必然疼痛,向左侧卧位则气喘加重,脉象滑数有力的就是这种病。肺痿损伤的是无形之气,气伤则需要调理元气;肺痈毒结于有形的血分,血结则需要排出毒邪,这是治疗原则的大概概要。
分别论述如下:肺痿由津液枯燥引起,导致肺管日益闭塞,咳嗽声音不响亮,稍微活动就气喘吁吁,治疗在于补益气血、生津液,辅以止咳消痰。适宜使用人参、玉竹、五味子、阿胶、白芍、麦冬、当归、熟地黄、紫菀、川贝母、杏仁等药物。如果是肺劳导致成痿,伴有虚热咳血的,用人参固本丸,随时含化服用。肺虚导致喘急、自汗的,用安肺汤。出现往来寒热、自汗、心烦口渴的,在紫菀散基础上加银柴胡,生姜用蜜制。咳嗽吐脓血、发热盗汗的,用劫劳散。涎唾多、心中感觉温温不适(恶心欲呕感)的,用炙甘草汤。痰嗽、午后发热、声音嘶哑的,在紫菀散基础上加牡丹皮、生姜、大枣。喘咳失音、咯血的,用人参蛤蚧散。如果是虚寒消瘦、呼吸时胸部胀满的,用千金生姜温中汤。凡是肺痿症状,如果咳嗽吐沫、咽干想喝水的,会自愈。如果张口短气的,病情危重。肺损伤导致咯血、喉咙哑的,无法治愈。
肺痈由热邪蒸腾肺窍引起,导致咳嗽吐出臭痰,胸胁刺痛,呼吸不畅,治疗在于利气疏痰、降火排脓,适宜使用安肺桔梗汤。初起时肺受风寒导致喘嗽的,用小青龙汤发散解表。喘促不能平卧、胸部胀满的,用葶苈大枣泻肺汤泻下。肺气不化、水道不利的,用苇茎汤疏通利导。苇茎汤能大力疏通肺气,使湿浊全部从小便排出。咳嗽气逆、时常吐出浊液的,用皂荚丸涤除。皂荚丸能荡涤痰浊,无坚不摧。咳嗽吐脓腥秽物的,用桔梗汤开提排脓。咳嗽且短气、小便少的,用参补肺汤调理。身体疲倦、食少脾虚的,用参术补脾汤滋养。脓已排出后,用排脓散,或者金鲤汤,或者薏苡根煎汁饮用,效果显著。痰中带血、胸痛严重的,用枯梗杏仁煎,或者肺痈神汤主治。吐脓、咽痛的,用甘桔汤加杏仁、贝母。痈肿日久不愈合的,用川槿汤。如果是思虑劳心导致阴火妄动,痰液臭味更严重的,用六味丸加麦冬、紫菀。这两种病症溃破之后,适宜补益脾肺、滋补肾水,不宜专门攻伐疮疡。
凡是肺痈初起,感觉痰液腥臭,用陈年腌制的芥菜卤温热服用,或者浓煎荷叶汁加白蜜服用有效。咳嗽时轻微疼痛,疼痛在胸部右侧,这是肺的长叶,坐卧如常,饮食知味的,容易治疗;如果溃破后寒热往来、胁痛,疼痛在胸部左侧,这是肺的短叶,或者坐卧不安,饮食无味的,难以治疗;如果喘息鸣响不止,坐不得卧,咯吐脓血,颜色像败坏的卤水,饮食艰难进食,声音嘶哑、鼻翼扇动的,无法治愈。肺痈已经破溃并感受风邪的,用浓煎的葱白香豉汤频繁服用。然而大多无法挽救。
Fei Wei (Lung Atrophy) refers to a condition characterized by the depletion of body fluids and the withering of lung tissue. It is caused by heat pathogenic factors residing in the Upper Jiao (Upper Burner), where prolonged coughing damages the Lung Qi. The initial stage presents with alternating chills and fever, spontaneous sweating, expectoration of turbid saliva, or spitting out blood-streaked sputum and pus, accompanied by a rapid and deficient pulse.
Fei Yong (Lung Abscess) is characterized by dryness of the throat and expectoration of pus. It arises from Wind-Heat pathogens lodging in the Lung, where toxic heat accumulates to form an abscess. The initial stage presents with aversion to cold, piloerection (goosebumps), dry cough in the throat, dull pain in the chest, purulent sputum with a foul odor, tenderness upon pressing the right hypochondrium, worsening panting when lying on the left side, and a slippery, rapid, and forceful pulse. Fei Wei injures the Formless Qi; when Qi is damaged, one must regulate the Yuan Qi (Primal Qi). Fei Yong involves toxic accumulation in the Formless Blood; when Blood is congealed, one must expel the toxin. This summarizes the general treatment principles.
Discussing them separately: Fei Wei results from the dryness of body fluids, leading to the gradual obstruction of the bronchial tubes, hoarse coughing, and panting upon slight exertion. Treatment focuses on tonifying Qi and Blood, generating body fluids, and assisting with stopping cough and eliminating phlegm. Suitable herbs include Renshen (Ginseng Root), Yuzhu (Polygonatum Odoratum Rhizome), Wuweizi (Schisandra Fruit), Ejiao (Donkey-hide Gelatin), Baishao (White Peony Root), Maimendong (Ophiopogon Tuber), Danggui (Angelica Sinensis Root), Shudihuang (Prepared Rehmannia Root), Ziwan (Aster Root), Chuanbeimu (Fritillaria Cirrhosa Bulb), and Xingren (Apricot Seed). If Fei Lao (Lung Consumption) leads to Wei, accompanied by deficiency-heat and hemoptysis, Renshen Guben Wan (Ginseng Root-Solidifying Pill) should be held in the mouth and dissolved as needed. For Lung deficiency causing panting and spontaneous sweating, Anfei Tang (Lung-Calming Decoction) is indicated. For alternating chills and fever, spontaneous sweating, irritability, and thirst, Ziwang San (Aster Powder) with Yin Chaihu (Stellaria Root) added, and honey-processed Ginger, is used. For coughing up pus and blood, fever, and night sweats, Jie Lao San (Labor-Exhausting Powder) is prescribed. For excessive saliva and a sensation of warmth and discomfort in the heart (nausea/epigastric fullness), Zhigancao Tang (Licorice Decoction) is used. For phlegm-cough, afternoon fever, and hoarseness, Ziwang San with Mudanpi (Tree Peony Bark), Ginger, and Jujube added is suitable. For panting, cough, loss of voice, and hemoptysis, Ren Shen Hejie San (Ginseng and Gecko Powder) is indicated. For deficiency-cold, emaciation, and chest fullness during respiration, Qianjin Shengjiang Wenzhong Tang (Thousand-Gold Ginger Middle-Warming Decoction) is used. Generally, if Fei Wei symptoms involve coughing and spitting with dry throat and desire for water, the condition will heal spontaneously. If there is gaping mouth and shortness of breath, it is critical. If Lung injury causes hemoptysis and hoarseness, it is incurable.
Fei Yong arises from heat steaming the Lung orifices, leading to coughing up foul-smelling sputum, stabbing pain in the chest and hypochondrium, and difficult breathing. Treatment focuses on promoting Qi movement, dispersing phlegm, descending fire, and draining pus. Anfei Jiegeng Tang (Lung-Calming Platycodon Decoction) is suitable. In the early stage, if Wind-Cold affects the Lung causing panting and cough, Xiao Qinglong Tang (Minor Blue Dragon Decoction) is used to disperse and resolve. If panting prevents lying down and the chest is distended, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is used to purge. If Lung Qi fails to transform and water passages are obstructed, Weijing Tang (Reed Stem Decoction) is used to dredge and promote flow. Weijing Tang vigorously unblocks Lung Qi, allowing damp-turbidity to exit through the urine pores. For coughing with rebellious Qi and frequent expectoration of turbid matter, Zhaojiao Wan (Soap Pod Pill) is used to cleanse. Zhaojiao Wan sweeps away phlegm-turbidity, penetrating all hardness. For coughing up pus and foul matter, Jiegeng Tang (Platycodon Decoction) is used to open and lift. For cough with shortness of breath and scanty urine, Shen Bu Fei Tang (Ginseng Lung-Tonifying Decoction) is used to regulate. For fatigue, poor appetite, and Spleen deficiency, Shen Zhu Tuo Pi Tang (Ginseng and Atractylodes Spleen-Tonifying Decoction) is used to nourish. After pus has drained, Pai Nong San (Pus-Draining Powder), Jin Li Tang (Golden Carp Decoction), or decocted Yi Yi Gen (Coix Seed Root) juice can be drunk, showing great efficacy. For phlegm with blood and severe chest pain, Kugeng Xingren Jian (Bitter Platycodon and Apricot Seed Decoction) or Fei Yong Shen Tang (Lung Abscess Divine Decoction) is administered. For vomiting pus and sore throat, Ganjie Tang (Licorice and Platycodon Decoction) with Xingren and Beimu added is used. For abscesses that do not heal after a long time, Chuanjin Tang (Chuanjin Decoction) is prescribed. If mental worry and overwork stir up Deficiency Fire, causing worsened foul sputum, Liuwei Wan (Six-Ingredient Pill) with Maimendong and Ziwan added is used. After both conditions ulcerate, it is appropriate to tonify the Spleen and Lung and nourish Kidney Water, rather than specifically attacking the wound.
Generally, in the early stage of Fei Yong, if sputum smells foul, warm old pickled mustard brine can be taken, or concentrated Lotus Leaf Juice with white honey added, which is effective. If coughing causes mild pain located in the right chest (the Long Lobe of the Lung), with normal sitting/lying posture and preserved taste/appetite, it is easy to treat. If, after ulceration, there are alternating chills, fever, and hypochondriac pain located in the left chest (the Short Lobe of the Lung), with restlessness and loss of appetite, it is difficult to treat. If wheezing continues without cease, inability to lie down, expectoration of pus and blood resembling spoiled brine, difficulty eating, hoarseness, and nasal flaring occur, it is incurable. If Fei Yong has ruptured and Wind pathogen has entered, frequent consumption of strongly boiled Congbai Xiachi Tang (Scallion White and Fermented Soybean Decoction) may be attempted, but most cases are not salvageable.