《要略》曰：风伤皮毛，热伤血脉，风舍于肺，其人则咳，口乾喘满，咽燥不渴，多唾浊沫，时时振寒，热之所过，血为之凝滞，蓄结痈脓，吐如米粥，始萌可救，脓成则死。由此可知肺痈之病源为热，其病状为先唾浊沫，后吐脓血。浊沫者，肺津为热熏灼所成也。脓血者，津尽甚至肺体腐化也。又曰：咳而胸满，振寒，脉数，咽乾，不渴，时出浊唾腥臭，久久吐脓如米粥者，为肺痈，桔梗汤主之。由此可知桔梗汤之所主者，为肺痈之初成，时出浊唾腥臭，必久而久之，方吐脓如米粥，非初时吐脓如米粥也。又曰：肺痈喘不得卧，葶苈大枣泻肺汤主之。又曰：肺痈，胸满胀，一身面目浮肿，鼻塞，清涕出，不闻香臭酸辛，咳逆上气，喘鸣迫塞者，葶苈大枣泻肺汤主之。后人见此二条无脓血字状，竟以本方专为逐水之剂，非有脓血也，乃失仲圣原旨矣。夫曰胸满胀，试问其所胀者何物，非肺津肺体化为脓血而何？曰喘鸣迫塞，日不得卧，试问其故安在，非肺体腐化不能营其呼吸之工作而何？况仲圣之笔法多有详于彼，而略于此者。故桔梗汤条既曰久久吐脓如米粥者为肺痈，葶苈大枣汤二条即但言肺痈，而隐含吐脓血于其中矣。又曰：《干金》苇茎汤治咳内微热，烦满，胸中甲错，是为肺痈。按烦满，读如烦懑。烦懑者，肺中微热之初生，似尚未灼烁肺津为腥臭之浊唾也。故苇茎汤所主之候，还在桔梗汤之前。由是观之，以上三汤，殊有轻重层次之分。苇茎汤最先而轻，桔梗汤为中，葶苈大枣汤最后而重。姑以方譬方，则苇茎汤犹如白虎汤，桔梗汤犹如调胃承气汤，葶苈大枣汤犹如大承气汤。
今有阳明肠胃病者于此，大便不行，医试以调胃承气，小瘥而未愈，于是与以大承气，遂大下而病瘥，顾胃热未楚，乃以白虎奏全功，此事实所许可者也。故吾师本案先用桔梗，次用葶苈大枣，末用苇茎，其义殆亦犹是。未知吾师之意云何？凡酒客烟徒大便久秘者，最易生肺热。《内经》以肺与大肠相表里，殆千古不刊之论。故治此病总不使其大便秘结，则肺热有下行之路。余尝治前上海晨报馆编辑曹先生夫人，患恙已久，其证每当清晨睡未醒，即盗汗，汗后周身觉冷，踡卧被中，略似桂枝加龙骨牡蛎汤证，然而非是，此乃肺痈条之所谓振寒也。盖详察之，大便燥结，三日一行，小溲觉热，脉弦数，咳吐脓痰，胸中隐隐作痛，经事先期而至，作紫色，日晡必发潮热，五中烦热。夫人自分肺病，疾不可为，愁眉紧锁者多日矣。余曰：毋虑，可治也。用苇茎汤为主方，以治其肺热，加青蒿，白薇，地骨皮，以退其潮热，加丹参，丹皮，益母子，以调其经期。二诊四剂，诸恙均瘳。此即后人之所谓阴虑虚劳，实则要略所云肺痈初起之证也。
更有桔梗白散合桔梗、贝母、巳豆而成，其力更峻。经文虽曰桔梗汤，疑其有误。本散非但可以治重证之肺痈，且可以荡涤一切顽痰壅塞，在膈上者，能使之吐，在膈下者，能使之泻。东人多有用之者，吾不愿国内之大医反弃而勿道之。
曹颖甫曰：肺痈一证，咳吐时，胸中必隐隐作痛，所吐浓厚之痰，杂以如米粥者，至地甚有力，渐乃发酵成气饱，不复平塌地上。盖胸中热如沸汤，蒸烂肺之本体，然后吐出如脓之痰，则所吐之物其中实有蒸气热力，故吐出而发酵也。
肺与大肠为表里，而肺痈用肠痈方治，要不失为仲景遗意。即如痰饮，肺病也，而悬饮内痛，支饮不得息，则用十枣汤以下之。结胸，肺病也，则用甘遂大黄芒硝以下之。要之，燥气在下，则肺藏必受熏灼，非用釜底抽薪之法，不足以清上炎也。
肺痈其二
吴冠明住华成路六号
【按】吴君大镛，余友也。其第二女公子，名冠明，年十岁，肄业小学校中。
本年（二十五年）七月三日，忽感不适，自言胸中痛，约于十日左右，就诊于上海广慈医院。医与内服药，兼用药水揩胸部。续诊一星期许，胸中痛少止，而身热咳嗽仍甚。十七日起，在家自服种种养肺成药，至二十日无效。是日夜间发热更甚，竟夜不能睡，甚且号哭。二十一日上午，重返广慈医院，请检验，医嘱住院疗治。但卒未果，即回家。二十二日就诊中医张君，断为小伤寒。其方案曰：时邪感肺，痰湿交阻，咳呛不爽，肌热颇甚，脉滑数，法拟疏解豁邪，候正。
香豉三钱，嫩前胡钱半，蝉衣八分，木蝴蝶四分，浙贝母去心三钱五分，橘络一钱，生苡米四钱，款冬花一钱八分，鲜佩兰一钱，桑叶钱半，丝瓜络钱半，竹茹钱半。二十三日二诊，方案曰：热势夜甚，咳呛胁痛，夜难安睡，脉数舌绛，时温挟痰湿交阻，再以宣解为治，恐剧，候政。炒香豉三钱，白夕莉二钱，浙贝母去心三钱，蝉衣八分，光杏仁三钱，路路通五个，生苡米四钱，通草一钱，嫩前胡钱半，鸡苏散三钱包，荷梗尺许，竹二青钱半。服后，痰出渐呈臭味。二十四日三诊，方案曰：热势较昨已淡，咳呛颇甚，脉滑数，苔腻，温邪挟痰湿遏肺，再进昨法加减，候政。香豉三钱，鲜佩梗钱半，蝉衣八分，鸡苏散三钱包，浙贝母去心三钱五分，紫苑钱半，光杏仁三钱，白夕莉二钱，木蝴蝶五分，前胡钱半，荷梗尺许，妙竹茹钱半。二十五日四诊，方案散佚，共四诊。至是，热加甚，抚之烙手，咳亦甚，每作则痛剧，澈夜不安，甚至昏厥，乃由伊母手抱竟夜。二十六日，延西医胡先生诊，断为肺炎。用安福消肿膏外涂胸部，又注射药水二种，一以退热度，一以滋营养。如是三日，热略退，顾退后热又高，痛咳未减，不能平卧，但坐，喘鸣迫急，肩动以助呼吸，是为肩息。胡先生恐变急性肺炎，嘱另请高明。八日上午，急送红十字会医院。陈医师诊为肺脓疡，应用手术。
当夜住院，九日照X 光一次，审知左肺无恙，右肺因肋膜太厚，不能成影，十一日早，又照X 光一次，下午又照一次，所以在上下午分行者，因清早脓未出，下午脓已吐，冀比较其不同之情形故也。不料所得底片二纸，毫无异状。尔时所吐脓痰之属，积之，每日可得三五小罐。医与鱼肝油等补剂，冀其体力略佳，以为施手术之张本。并经验血二次，似未有结果。小儿科主任陈医师主张用人工气胸术，使肺部压小，以便抽脓。但可否实行，还须先照X 光，决定病灶后再议。乃由肺科主任刘医师重照X 光，所得结果，仍为左肋骨明晰异常，右肋骨部分，底片上全部发白，断为肺与肋膜相接过紧，不可施人工气胸术，终非开刀不可，且须去肋骨一条，以便出脓。但究应取去何条肋骨，仍赖X 光之照取。法用一种颜色油从气管打入肺邹，如是再照X 光时，即易显出肺烂之处，乃可就肺烂最近之处，取去肋骨。据云此种颜色油以后自能吐出，不妨病体。惟动手术前，例须病者家长签字，吴君夫妇筹思再三，终签字与之，时八月十三日下午四时也。六时许，冠明得知次日将受手术，并须吃颜色油，心滋不悦，忧形于面，婉恳勿尔。
吴君夫妇不忍拂其意，乃向医师婉请撒回签字，但仍住院以求别法诊洽，医师勉允之。十五日，值星期六夜，吴君忽闻友人言，肺痈一病，中医亦有办法，但须服药已足，不必动手术，较为安全。十六日为星期日，吴君急早起，奔至医院，婉恳领女回家调治。医院中人惊骇曰：君何突然变策耶？余等为令媛之恙，集会研究者多日，已不知费却几许心血。（注：此言绝非虚语，我实深信，是以该院历来信誉卓著，非幸致也。）所为者何，无非求令媛之速愈耳。今者出院，余等固无从施其技，而令媛亦安得获其救耶？吴君语塞，辞以经济困难何题。医曰：本院原属慈善性质，此节可以通融办理，请勿虑。终以吴君有外交折冲才能，医许之，即于午刻出院。回家时，胸部右方已略觉高肿。下午，急请拙巢师出诊，案曰：初诊夏历六月三十日肺痈已经匝月，咳嗽，咯痰腥臭，夜中热度甚高，内已成脓，当以排泄为主。宜桔梗合《千金》苇茎二汤主治。
苦桔梗五钱生甘草三钱生苡仁一两冬瓜子一两桃仁六钱炙乳没各二钱鲜芦根半斤打汁冲服查入煎犀黄醒消丸每服三钱开水送下
【按】吴小姐服此一剂，咳即减。次早，大便即通。向在医院，大便常闭，医用肥皂水灌洗，方得粪水，不能自下也。本方连服三日，每早大便均畅行，师本瞩连服四剂，八月十九日（佐景注：拙按内悉用农历），又请师二诊。
二诊夏历七月初三日原方去桔梗加葶苈子三钱炒研用黑枣去核包麻扎入煎
【按】吴小姐于下午三时许，服初煎药，三刻钟后，忽然剧痛作，大呼姆妈来抱吾。瞬间，气喘，目上视，四胶厥逆，冷汗出，神识不清，随即昏去。同时有一怪象生，即其右胸患处，约在乳部之上，突隆起如拳大。举家惊惶，不知所措。半小时后，神略清，如醒回。至六时，又剧痛昏厥如前。吴君于晚七时回家，睹状大骇。急请西医胡先生来诊，驾到约夜间十时，主动手术，谓服药无效也，未曾施治而辞。迨夜十二时，病者神志忽然清明，呼啜热粥，果能进一瓯。胸前隆起者依然，而痛却渐定，能安睡。直至次早天明，方醒，热渐退，咳渐减。吴夫人曰：使非昨药之功，安得否极泰来耶？即不畏其峻。清晨八时，复予二煎药。服后不复瞑眩。夫人告余曰：冠明自起病以迄服尊劳大枣前，无一夜得安睡。自服葶苈大枣后，虽病，无一夜不得安睡。余为之惊异。八月二＋日，守服原方，毫无恶化现象。二十一日，三诊。
三诊夏历七月初五日累服桔梗泻肺二汤合《千金》苇茎，病势略轻，仍宜前法加减。
生甘草五钱生白芍五钱生苡仁一两冬瓜子一两桃仁六钱桔梗五钱香白芷一钱炙乳没各二钱轻马勃五分败酱草三钱葶苈子三钱炒研用枣包扎犀黄醒消丸每服二钱
【按】此方连服三日，二十四日，吴君以儿病渐減，拳肿处亦渐平，遂携方至师家，请予加减。师减去白芷、乳没、葶苈、败酱、马勃，余依旧。又连服三日。二十七日，吴君凝轩予药一剂，计生甘草五钱，生白芍五钱，生苡仁一两，冬瓜子八钱，败酱草三钱，桃仁泥三钱，桔梗二钱，川贝母三钱，忍冬藤三钱，炙乳没各钱半，白岌钱半，觉药汁腻甚。八月二十八日，予自乡返申，吴君急邀诊视。案曰：肺痈延已二月，刻诊右肺外部依然隆起，但不如向之如拳矣。咳嗽不爽，咯痰黄绿色，咽中痛，大便二日一行，脉象细数，拟排脓养阴合法，请正。生甘草三钱，苦桔梗二钱，大麦冬去心三钱，天花粉六钱，丝瓜络五钱，光杏仁三钱，象贝母三钱，冬瓜瓣二两，地枯萝三钱，二十九日，承邀续诊。据谓昨方颇效。案曰：服药后，咳时加多，脓痰加多。按此种脓痰蕴积于内，非排去之不为功。刻诊脉象数，肩息未除，咽中痛，大便已行而坚。病清尚在险途，再拟前法加减。鲜芦根三根，西洋参一钱，生苡仁二两，苦桔梗二钱，冬瓜瓣二两，光杏仁四钱，丝瓜络六钱，地枯萝四钱，南沙参三钱，生甘草二钱。三十日，吴君来谓身热又减，臭痰亦少，坚请三诊。余以其脉虽细数，一分钟一百四十余至，不足虑。独息时左肩尚动，思仲圣云：上气，面浮肿，肩息，其脉浮大，不治。此虽非上气病，终不禁踌躇。又以杂务纷集，无暇抽身，仍主请师续诊。九月一日，吴君到师家商议，问吉凶，师慰之。案曰：肺痈业经出险，但咯痰尚浓，兼有微热，仍宜前方加减。生甘草五钱，桔梗五钱，桃仁泥二钱，生白芍五钱，瓜蒌皮仁各三钱，生山梔钱半，另服醒消丸每服二钱。此方服后，又有进步。九月二日，夜中，不知何故，忽云心中剧痛，随呕出鲜红之血，约半小杯，随续吐出数次，吐后，神疲纳呆，又不能安寐。三日，吴君急到师家乞诊。
值师体不豫，乃口报药味，由湘人师兄录之。方曰：嫩射干三钱，白前三钱，桃仁泥二钱，生甘草三钱，生白芍五钱，枳壳一钱，全瓜篓六钱切，桔梗一钱，制香附三钱，生山梔三钱，另服醒消丸每服一钱。下午二时，进初煎，六时进二煎，夜十一时，痛即定。次早起，痛全除。众惊药之速效，竟至于此也。五日，师健步，命驾出诊，案曰：四诊夏历七月廿日肺痈无腥臭之痰，病已出险，但时吐浊痰，胶粘黄厚，当从《千金》皂荚丸法，改汤以治之。盖浊痰不除，咳必不能止也。
牙皂末五分用黑枣去核包煎
《金匮要略》中说：风邪损伤皮毛，热邪损伤血脉，风邪停留于肺，患者就会咳嗽，口干、气喘胸闷，咽喉干燥但不想喝水，多吐浑浊的泡沫痰，时常感到寒战。热邪经过的地方，血液就会凝滞，积聚形成痈脓，咳出的痰像米粥一样。在疾病初起阶段还可以救治，一旦脓液形成则预后不良。由此可知，肺痈的病源是热邪，其症状表现是先吐浊沫，后吐脓血。所谓的浊沫，是肺中津液被热邪熏蒸灼烧而成的。所谓的脓血，是津液耗尽甚至导致肺体腐烂化脓的结果。
《金匮要略》又说：咳嗽且胸满，寒战，脉数，咽干，不渴，不时吐出腥臭的浊唾，时间久了吐出像米粥一样的脓液，这就是肺痈，用桔梗汤主治。由此可知，桔梗汤所主治的是肺痈刚刚形成的阶段，此时只是不时吐出腥臭的浊唾，必须经过很长时间，才会吐出像米粥一样的脓血，并不是在初期就吐出像米粥一样的脓血。
《金匮要略》还说：肺痈气喘得不能躺卧，用葶苈大枣泻肺汤主治。又说：肺痈，胸部胀满，全身面目浮肿，鼻塞，流出清涕，闻不到香、臭、酸、辛的味道，咳嗽气逆上冲，喘息有声且气道阻塞，用葶苈大枣泻肺汤主治。后人看到这两条条文没有“脓血”的字样，竟然认为这个方子专门是用来逐水的，并没有脓血，这是失去了张仲景的原意了。如果说胸满胀，试问胀的是什么东西？不就是肺津和肺体化为脓血吗？如果说喘息有声且气道阻塞，日夜不能安卧，试问原因在哪里？不就是肺体腐烂化脓，无法完成呼吸功能吗？况且张仲景的笔法往往详于此而略于彼。所以桔梗汤条文中既然说了“久久吐脓如米粥者为肺痈”，那么葶苈大枣汤的两条条文就只说“肺痈”，而隐含了吐脓血的情况在其中了。
《金匮要略》又说：《千金方》中的苇茎汤治疗咳嗽伴有轻微发热，烦闷，胸中皮肤粗糙如鳞甲交错，这是肺痈的症状。按，“烦满”读作“烦懑”。烦懑，是指肺中微热刚开始产生，似乎还没有灼烧肺津形成腥臭的浊唾。所以苇茎汤所主治的阶段，还在桔梗汤之前。由此可见，以上三个方剂，确实有轻重层次的区分。苇茎汤最早且最轻，桔梗汤居中，葶苈大枣汤最后且最重。姑且以方剂比喻方剂，那么苇茎汤就像白虎汤，桔梗汤就像调胃承气汤，葶苈大枣汤就像大承气汤。
现在假设有一个阳明肠胃病的患者，大便不通畅，医生尝试用调胃承气汤，病情稍有好转但未痊愈，于是改用大承气汤，结果大量排便后病愈。但是胃热未清，再用白虎汤来收全功，这在事理上是允许的。所以我老师在这个案例中，先用桔梗汤，次用葶苈大枣汤，最后用苇茎汤，其中的道理大概也是如此。不知道我老师的用意是否如此？凡是嗜酒的人和吸烟者，如果长期大便便秘，最容易产生肺热。《黄帝内经》说肺与大肠相表里，这大概是千古不变的真理。所以治疗这种病，总是要防止大便秘结，这样肺热就有下行的出路。
我曾经治疗上海《晨报》馆编辑曹先生的夫人，患病已久。她的症状是在每天清晨睡醒前，就会盗汗，出汗后全身觉得冷，蜷缩躺在被子里，略微有点像桂枝加龙骨牡蛎汤证，但并非如此，这其实是肺痈条文中所说的“振寒”。仔细诊察发现，她大便燥结，三天一次，小便感觉热，脉象弦数，咳嗽吐脓痰，胸中隐隐作痛，月经提前到来，颜色紫暗，每天下午必定发潮热，五心烦热。这位夫人自己认为得了肺病，病不可治，愁眉紧锁了好多天。我说：不要担心，可以治愈。用苇茎汤作为主方，来治疗肺热；加青蒿、白薇、地骨皮，来退潮热；加丹参、牡丹皮、益母草，来调理经期。二诊时服用四剂药，各种病症都痊愈了。这就是后人所说的阴虚虚劳，实际上是《金匮要略》中所说的肺痈初起的证候。
还有桔梗白散配合桔梗、贝母、巴豆组成，药力更加峻猛。经文虽然说是桔梗汤，但我怀疑原文有误。本散不仅可以治疗重症的肺痈，而且可以荡涤一切顽固的痰液壅塞，在膈上的能使它吐出来，在膈下的能使它泻下去。日本人有很多使用此方的，我不希望国内的大医反而抛弃它而不谈论。
曹颖甫说：肺痈这一证候，咳嗽吐痰时，胸中必然隐隐作痛，所吐出的浓稠痰液，混杂着像米粥一样的物质，落地后很有力量，逐渐发酵产生气体鼓起，不再平塌在地上。这是因为胸中热得像沸水一样，蒸煮烂了肺的本体，然后吐出像脓一样的痰，所以吐出的物体中含有蒸汽热力，因此吐出后会发酵。
这是我亲眼所见。至于脉象滑大沉实，以及大便燥结，这些在本证中都具备。
肺与大肠互为表里，而肺痈用治疗肠痈的方剂来治疗，也不失为张仲景的遗意。就拿痰饮来说，肺病，如果是悬饮引起的心下痞硬疼痛，支饮导致呼吸困难，就用十枣汤来攻下。结胸证，也是肺病（涉及胸膈），就用甘遂、大黄、芒硝来攻下。总之，燥气在下，肺脏必然受到熏蒸灼烧，不用釜底抽薪的方法，不足以清除上炎的热邪。
肺痈病例二
吴冠明住在华成路六号
【按语】吴君大镛，是我的朋友。他的第二个女儿，名叫冠明，十岁，正在小学读书。
本年（民国二十五年）七月三日，突然感到不适，自述胸中疼痛，大约在十日左右，就诊于上海广慈医院。医生给予内服药，并用药水擦拭胸部。继续诊治约一星期，胸中疼痛稍微停止，但身热咳嗽仍然很严重。从十七日起，在家自行服用各种养肺成药，到二十日无效。当天夜间发热更严重，整夜不能睡觉，甚至大声哭喊。二十一日上午，重返广慈医院，请医生检查，医嘱住院治疗。但最终没有实现，即回家。二十二日就诊中医张君，诊断为小伤寒。其处方方案如下：时邪感染肺部，痰湿交阻，咳嗽呛逆不爽，肌热颇甚，脉滑数，治法拟定疏解豁邪，候正气恢复。
香豉三钱，嫩前胡半钱，蝉衣八分，木蝴蝶四分，浙贝母去心三钱五分，橘络一钱，生苡米四钱，款冬花一钱八分，鲜佩兰一钱，桑叶半钱，丝瓜络半钱，竹茹半钱。二十三日的二诊，方案如下：热势夜间加重，咳嗽呛逆伴胁痛，夜间难以安睡，脉数舌绛，时行温病夹杂痰湿交阻，再以宣解为治，恐怕病情加剧，候正气恢复。炒香豉三钱，白芍二钱，浙贝母去心三钱，蝉衣八分，光杏仁三钱，路路通五个，生苡米四钱，通草一钱，嫩前胡半钱，鸡苏散三钱包，荷梗尺许，竹二青半钱。服药后，痰出逐渐呈现臭味。二十四日的三诊，方案如下：热势较昨天已减轻，咳嗽呛逆颇甚，脉滑数，苔腻，温邪夹杂痰湿遏阻肺部，再进昨天的方法加减，候正气恢复。香豉三钱，鲜佩兰梗半钱，蝉衣八分，鸡苏散三钱包，浙贝母去心三钱五分，紫菀半钱，光杏仁三钱，白芍二钱，木蝴蝶五分，前胡半钱，荷梗尺许，妙竹茹半钱。二十五日的四诊，方案散佚，共四诊。至此，热势加重，触摸起来烫手，咳嗽也厉害，每次发作疼痛剧烈，彻夜不安，甚至昏厥，由母亲抱着度过整夜。二十六日，延请西医胡先生诊治，诊断为肺炎。用安福消肿膏外涂胸部，又注射两种药水，一种用来退热，一种用来补充营养。这样过了三天，热度略微减退，但退后热度又升高，疼痛咳嗽未减，不能平卧，只能坐着，喘息有声且急促，耸肩以辅助呼吸，这就是“肩息”。胡先生担心变为急性肺炎，嘱咐另请高明医生。八月八日上午，急送红十字会医院。陈医师诊断为肺脓肿，主张应用手术。
当夜住院，九日拍X光片一次，得知左肺无恙，右肺因为肋膜太厚，不能成像。十一日早上，又拍X光片一次，下午又拍一次，之所以分上下午进行，是因为清晨脓未排出，下午脓已吐出，希望比较其不同的情形。不料所得的两张底片，毫无异常状况。当时所吐出的脓痰之类，积累起来，每天可得三五小罐。医生给予鱼肝油等补剂，希望其体力稍好，作为施行手术的基础。并经验血两次，似乎没有结果。小儿科主任陈医师主张用人工气胸术，使肺部压力减小，以便抽取脓液。但是否能实行，还需要先照X光，决定病灶后再议。乃由肺科主任刘医师重新照X光，所得结果，仍是左肋骨清晰异常，右肋骨部分，底片上全部发白，断定为肺与肋膜粘连过紧，不可施行人工气胸术，最终非开刀不可，且须去掉一条肋骨，以便排出脓液。但究竟应该取去哪条肋骨，仍依赖X光的照射确定。方法是用一种颜色的油从气管打入肺皱褶，如是再照X光时，就容易显示出肺腐烂之处，就可以就近肺烂处，取去肋骨。据说这种颜色油以后自己能吐出，不妨碍病体。惟动手术前，惯例须病患者家长签字，吴君夫妇筹思再三，终于签了字，时间是八月十三日下午四时。六时许，冠明得知次日将受手术，并须吃颜色油，心里很不高兴，忧虑表现在脸上，委婉恳求不要这样。
吴君夫妇不忍违背她的意愿，乃向医生委婉请求撤回签字，但仍住院以求其他方法诊治，医生勉强同意。十五日，正值星期六夜晚，吴君忽然听到朋友说，肺痈这个病，中医也有办法，只要服药就够了，不必动手术，较为安全。十六日是星期日，吴君急忙早起，奔向医院，委婉恳求领女儿回家调养治疗。医院中人惊骇地说：您为什么突然改变策略呢？我们为了令嫒的病，集会研究了好多天，不知耗费了多少心血。（注：这话绝非虚语，我实在深信，因此该院历来信誉卓著，不是侥幸得来的。）所做的一切，无非是为了令嫒早日康复。现在出院，我们固然无从施展技术，而令嫒又怎能获得救助呢？吴君语塞，借口经济困难问题。医生说：本院原属慈善性质，这一节可以通融办理，请勿担忧。最终因为吴君有外交折冲才能，医生允许了，即在中午时刻出院。回家时，胸部右方已经略微高肿。下午，急忙请拙巢师出诊，案曰：初诊夏历六月三十日，肺痈已经满一个月，咳嗽，咯痰腥臭，夜间热度很高，内部已成脓，应当以排泄为主。宜用桔梗汤合《千金》苇茎汤两方主治。
苦桔梗五钱，生甘草三钱，生苡仁一两，冬瓜子一两，桃仁六钱，炙乳香没药各二钱，鲜芦根半斤打汁冲服，查入犀黄醒消丸每服三钱开水送下。
【按语】吴小姐服用这一剂药，咳嗽即减轻。第二天早晨，大便即通畅。以前在医院，大便常闭结，医生用肥皂水灌洗，才得到粪水，不能自行排出。本方连续服用三天，每天早上大便均畅通，老师本来嘱咐连服四剂，八月十九日（佐景注：拙按内悉用农历），又请老师二诊。
二诊夏历七月初三日，原方去掉桔梗，加葶苈子三钱炒研用黑枣去核包麻扎入煎。
【按语】吴小姐于下午三时许，服用初煎药，三刻钟后，忽然剧烈疼痛发作，大呼妈妈来抱我。瞬间，气喘，眼睛上视，四肢厥冷，出冷汗，神识不清，随即昏去。同时出现一个怪象，就是其右胸患处，大约在乳房之上，突然隆起如拳头大。全家惊慌，不知所措。半小时后，神志稍微清醒，如同醒来。到六点，又剧烈疼痛昏厥如前。吴君于晚上七时回家，看到这种情况大为震惊。急忙请西医胡先生来诊治，医生到达大约夜间十时，主动提出手术，谓服药无效，未曾施治而辞别。等到夜里十二时，病人神志忽然清明，呼喝喝热粥，果然能进一碗。胸前隆起的部分依然，但疼痛却逐渐安定，能安睡。直到第二天早上天亮，才醒来，热度逐渐减退，咳嗽逐渐减少。吴夫人说：如果不是昨天药物的功效，怎么能否极泰来呢？即使不怕药力峻猛。清晨八时，再次给予二煎药。服药后不再出现瞑眩反应。夫人告诉我：冠明自从起病直到服用尊驾的葶苈大枣汤前，没有一夜能安睡。自从服用葶苈大枣汤后，虽然生病，没有一夜不能安睡。我为此感到惊异。八月二十日，守服原方，毫无恶化现象。二十一日，三诊。
三诊夏历七月初五日，累服桔梗泻肺二汤合《千金》苇茎汤，病势略微减轻，仍宜前法加减。
生甘草五钱，生白芍五钱，生苡仁一两，冬瓜子一两，桃仁六钱，桔梗五钱，香白芷一钱，炙乳香没药各二钱，轻马勃五分，败酱草三钱，葶苈子三钱炒研用枣包扎，犀黄醒消丸每服二钱。
【按语】此方连续服用三天，二十四日，吴君因为儿子病情逐渐减轻，拳头肿处也逐渐平复，遂携方到老师家，请求予以加减。老师减去白芷、乳香没药、葶苈、败酱、马勃，其余照旧。又连续服用三天。二十七日，吴君凝轩给予药物一剂，计生甘草五钱，生白芍五钱，生苡仁一两，冬瓜子八钱，败酱草三钱，桃仁泥三钱，桔梗二钱，川贝母三钱，忍冬藤三钱，炙乳香没药各半钱，白及半钱，觉得药汁非常腻。八月二十八日，我从乡下返回上海，吴君急忙邀请诊治。案曰：肺痈拖延已两个月，此刻诊察右肺外部依然隆起，但不像以前那样如拳头大了。咳嗽不爽，咯痰黄绿色，咽中痛，大便两天一次，脉象细数，拟定排脓养阴合法，请指正。生甘草三钱，苦桔梗二钱，大麦冬去心三钱，天花粉六钱，丝瓜络五钱，光杏仁三钱，象贝母三钱，冬瓜瓣二两，地枯萝三钱。二十九日，承邀续诊。据称昨方颇为有效。案曰：服药后，咳嗽时加多，脓痰加多。按此种脓痰蕴积于内，非排出去不能建功。此刻诊脉象数，肩息未除，咽中痛，大便已行而坚。病情尚在险途，再拟前法加减。鲜芦根三根，西洋参一钱，生苡仁二两，苦桔梗二钱，冬瓜瓣二两，光杏仁四钱，丝瓜络六钱，地枯萝四钱，南沙参三钱，生甘草二钱。三十日，吴君来谓身热又减，臭痰亦少，坚请三诊。我认为他脉虽细数，一分钟一百四十余至，不足虑。唯独呼吸时左肩尚动，想到张仲圣说：上气，面浮肿，肩息，其脉浮大，不治。这虽然不是上气病，终究不禁犹豫。又因为杂务纷集，无暇抽身，仍主张请老师续诊。九月一日，吴君到老师家商议，问吉凶，老师安慰他。案曰：肺痈业经出险，但咯痰尚浓，兼有微热，仍宜前方加减。生甘草五钱，桔梗五钱，桃仁泥二钱，生白芍五钱，瓜蒌皮仁各三钱，生山栀半钱，另服醒消丸每服二钱。此方服用后，又有进步。九月二日，夜间，不知何故，忽然说心中剧痛，随即呕出鲜红的血，约半小杯，随后又吐出数次，吐后，神疲纳呆，又不能安寐。三日，吴君急忙到老师家乞诊。
正值老师身体不舒服，乃口报药味，由湘人师兄记录之。方曰：嫩射干三钱，白前三钱，桃仁泥二钱，生甘草三钱，生白芍五钱，枳壳一钱，全瓜篓六钱切，桔梗一钱，制香附三钱，生山栀三钱，另服醒消丸每服一钱。下午二时，进初煎，六时进二煎，夜里十一时，疼痛即定。第二天早起，疼痛全除。众人惊讶药的速度之快，竟达到这种程度。五日，老师健步，命驾出诊，案曰：四诊夏历七月廿日，肺痈无腥臭之痰，病已出险，但时吐浊痰，胶粘黄厚，应当从《千金》皂荚丸法，改汤剂来治疗。盖浊痰不除，咳嗽必不能止也。
牙皂末五分，用黑枣去核包煎。
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: Wind pathogen damages the skin and hair, heat pathogen damages the blood vessels. When wind lodges in the Lung, the patient will cough, experience dry mouth, asthma with chest fullness, dry throat without thirst, produce much turbid saliva, and suffer from intermittent chills. Wherever heat passes, blood becomes stagnant, accumulating to form carbuncle pus; the expectorated sputum resembles rice porridge. If treated at the onset, it can be saved; once pus is formed, death ensues. From this, we know that the etiology of Lung Carbuncle (Fei Yong) is heat, and its symptoms are first expectorating turbid saliva, then expectorating pus and blood. The so-called "turbid saliva" is formed by Lung fluids being scorched by heat. The so-called "pus and blood" results from fluid exhaustion leading to the putrefaction of Lung tissue.
The *Jin Gui Yao Lue* further states: Cough with chest fullness, chills, rapid pulse, dry throat, no thirst, occasional discharge of foul-smelling turbid saliva, and long-term expectoration of pus resembling rice porridge constitutes Lung Carbuncle, treated with Jiegeng Tang (Platycodon Decoction). Thus, Jiegeng Tang is indicated for the initial formation of Lung Carbuncle, where only foul-smelling turbid saliva is occasionally discharged. It takes a long time before pus resembling rice porridge is expectorated; it does not happen at the very beginning.
It also states: For Lung Carbuncle with asthma preventing lying down, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated. Furthermore: For Lung Carbuncle with chest fullness and distension, edema of the whole body and face, nasal congestion, clear rhinorrhea, loss of smell for fragrant, foul, sour, or pungent odors, cough with rebellious Qi and wheezing causing obstruction, Tingli Dazao Xiefei Tang is indicated. Later generations, seeing these two clauses lack the words "pus and blood," mistakenly believe this formula is solely for draining water and contains no pus or blood, thus missing Zhang Zhongjing's original intent. If there is chest fullness and distension, ask what causes the distension? Is it not Lung fluids and tissue transforming into pus and blood? If there is wheezing and obstruction, day and night inability to lie down, ask the cause? Is it not the putrefaction of Lung tissue impairing respiratory function? Moreover, Zhang Zhongjing's writing style often details one aspect while omitting another. Since the Jiegeng Tang clause mentions "long-term expectoration of pus like rice porridge," the two Tingli Dazao Xiefei Tang clauses simply say "Lung Carbuncle," implicitly including the expectoration of pus and blood within it.
The *Jin Gui Yao Lue* also states: *Qian Jin Fang*'s Weijing Tang treats cough with slight fever, vexation and fullness, and rough skin on the chest (jiacuo), which are signs of Lung Carbuncle. Note: "Fen man" is read as "fen men." Fen men refers to the initial generation of slight heat in the Lung, seemingly not yet scorching Lung fluids into foul-smelling turbid saliva. Therefore, the stage treated by Weijing Tang precedes that of Jiegeng Tang. From this, we see that the above three formulas have distinct levels of severity and hierarchy. Weijing Tang is earliest and mildest, Jiegeng Tang is intermediate, and Tingli Dazao Xiefei Tang is latest and most severe. Comparing formulas to formulas, Weijing Tang is akin to Baihu Tang (White Tiger Decoction), Jiegeng Tang to Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction), and Tingli Dazao Xiefei Tang to Dachengqi Tang (Major Order the Qi Decoction).
Consider a case of Yangming Intestine and Stomach disease where bowel movements are obstructed. If the physician first tries Tiaowei Chengqi Tang, resulting in slight improvement but not cure, and then uses Dachengqi Tang, leading to profuse purgation and recovery, but stomach heat remains unclarified, subsequently using Baihu Tang to complete the treatment is logically permissible. Therefore, my teacher in this case used Jiegeng Tang first, then Tingli Dazao Xiefei Tang, and finally Weijing Tang, following similar logic. I wonder if this aligns with my teacher's intent? Those who consume alcohol or smoke and suffer from chronic constipation are prone to generating Lung Heat. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states that the Lung and Large Intestine are exterior-interior paired, an eternal truth. Thus, treating such conditions always involves preventing constipation, providing a pathway for Lung Heat to descend.
I once treated the wife of Mr. Cao, editor of the Shanghai Morning Post, who had been ill for a long time. Her symptoms included nocturnal sweating just before waking in the early morning, followed by coldness throughout the body, curling up in bed, resembling Guizhi Jia Longgu Muli Tang (Cinnamon Twig plus Dragon Bone and Oyster Shell Decoction) syndrome, but it was not. This was actually the "chills" described in the Lung Carbuncle clause. Detailed examination revealed dry and hard stools, one bowel movement every three days, hot urination, wiry and rapid pulse, cough with purulent sputum, dull pain in the chest, early menstruation with dark purple blood, tidal fever every afternoon, and five-palm heat. She believed her lung disease was incurable and had been frowning in distress for days. I said: Do not worry, it is treatable. I used Weijing Tang as the main formula to clear Lung Heat; added Qinghao (Artemisiae Annuae Herba), Baiwei (Puerariae Radix Alba), and Digupi (Cortici Lycii Cortex) to reduce tidal fever; and Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Mudanpi (Moutan Cortex), and Yimucao (Leonuri Fructus) to regulate the menstrual cycle. At the second visit, after four doses, all ailments resolved. This is what later generations call Yin Deficiency Consumption (Yin Xu Lao), but is actually the initial stage of Lung Carbuncle as described in the *Jin Gui Yao Lue*.
There is also Jiegeng Baisan (Platycodon and White Orpiment Powder) combined with Jiegeng, Beimu, and Bidou (Crotonis Semen), which has a more potent effect. Although the classic text mentions Jiegeng Tang, I suspect an error. This powder can not only treat severe Lung Carbuncle but also purge all stubborn phlegm obstructions. For phlegm above the diaphragm, it induces vomiting; for phlegm below, it induces purgation. Many Japanese physicians use it, and I hope domestic great physicians do not abandon it.
Cao Yingfu stated: In Lung Carbuncle, when coughing and expectorating, there must be dull pain in the chest. The thick sputum mixed with rice-porridge-like material has force upon landing, gradually fermenting and bubbling, rather than flattening. This is because the chest heat is like boiling water, steaming and rotting the Lung tissue, so the expectorated pus contains steam and heat, causing fermentation after expulsion. I witnessed this personally. Regarding the pulse being slippery, large, deep, and solid, along with dry constipation, these are all present in this syndrome.
Since the Lung and Large Intestine are exterior-interior paired, using formulas for Intestinal Carbuncle to treat Lung Carbuncle is consistent with Zhang Zhongjing's legacy. Take Phlegm-Fluid retention: Lung disease, if Xuan Yin (Suspended Fluid) causes subcostal pain, or Zhi Yin (Supporting Fluid) causes breathing difficulty, Shizao Tang (Elaeagnus Decoction) is used to purge. Jie Xiong (Tied Chest) is a Lung disease, treated with Gansui, Dahuang, and Mangxiao to purge. In short, dryness in the lower jiao scorches the Lung; without the method of removing firewood from under the pot (treating the root to clear the branch), upper-rising heat cannot be cleared.
Case 2 of Lung Carbuncle
Wu Guanming resides at No. 6 Huacheng Road.
[Note] Mr. Wu Dayong is my friend. His second daughter, named Guanming, was ten years old and attending elementary school.
On July 3rd of this year (Republic of China Year 25), she suddenly felt unwell, complaining of chest pain. Around the 10th, she visited Guangci Hospital in Shanghai. The doctor prescribed internal medicine and applied medicinal lotion to the chest. After about a week of follow-up visits, chest pain subsided slightly, but fever and cough remained severe. From the 17th, she self-medicated at home with various lung-nourishing patent medicines, which were ineffective by the 20th. That night, fever intensified, causing insomnia and even crying out. On the morning of the 21st, she returned to Guangci Hospital for examination and was advised to be hospitalized, but this did not happen, and she went home. On the 22nd, she saw Traditional Chinese Medicine (TCM) practitioner Dr. Zhang, who diagnosed "Minor Cold Damage" (Xiao Shanghan). The prescription was: Pathogenic factor affecting the Lung, phlegm-dampness obstructing, cough with discomfort, significant muscle fever, slippery and rapid pulse. Method: Disperse and resolve pathogens, await Zheng Qi recovery.
Fermented Soybean (Xiang Chi) 3 qian, Tender Peucedanum Root (Qianhu) 0.5 qian, Cicada Slough (Chan Yi) 8 fen, Butterfly Flower (Mutiehu) 4 fen, Zhejiang Fritillary Bulb (Zhe Beimu) de-heartened 3.5 qian, Tangerine Network (Juluo) 1 qian, Raw Coix Seed (Sheng Yimi) 4 qian, Winter Flower (Kuandonghua) 1.8 qian, Fresh Mint (Xian Peilan) 1 qian, Mulberry Leaf (Sangye) 0.5 qian, Loofah Network (Sigualuo) 0.5 qian, Bamboo Rhus (Zhuru) 0.5 qian.
Second visit on the 23rd: Heat worsens at night, cough with rib pain, difficulty sleeping at night, rapid pulse, crimson tongue. Seasonal warm pathogen complicated by phlegm-dampness obstruction. Continue with dispersing and resolving methods, fearing aggravation. Fried Fermented Soybean 3 qian, White Peony Root (Baishao) 2 qian, Zhejiang Fritillary Bulb de-heartened 3 qian, Cicada Slough 8 fen, Apricot Kernel (Guang Xingren) 3 qian, All-Way Through (Lulutong) 5 pieces, Raw Coix Seed 4 qian, Tongcao 1 qian, Tender Peucedanum Root 0.5 qian, Jisu San 3 qian wrapped, Lotus Stem (Hegeng) approx. 1 chi, Zhu Er Qing 0.5 qian. After taking, sputum gradually developed a foul odor.
Third visit on the 24th: Heat slightly reduced compared to yesterday, cough still severe, slippery and rapid pulse, greasy coating. Warm pathogen with phlegm-dampness obstructing Lung. Continue previous method with modifications. Fermented Soybean 3 qian, Fresh Mint Stem 0.5 qian, Cicada Slough 8 fen, Jisu San 3 qian wrapped, Zhejiang Fritillary Bulb de-heartened 3.5 qian, Aster Root (Ziyuan) 0.5 qian, Apricot Kernel 3 qian, White Peony Root 2 qian, Butterfly Flower 5 fen, Peucedanum Root 0.5 qian, Lotus Stem approx. 1 chi, Stir-fried Bamboo Rhus 0.5 qian.
Fourth visit on the 25th: Prescription lost. Total four visits. By now, heat increased, feeling burning to touch, cough severe, excruciating pain during attacks, sleepless all night, even fainting, held by mother all night. On the 26th, Western Doctor Hu was consulted, diagnosing Pneumonia. Anfu Anti-swelling Plaster was applied externally to the chest, and two injections were given, one for fever reduction and one for nutrition. Over three days, fever slightly subsided, but rebounded high, pain and cough unchanged, unable to lie flat, sitting only, with wheezing urgency and shoulder breathing (Jian Xi). Dr. Hu feared acute pneumonia and suggested consulting another specialist. On the morning of August 8th, rushed to Red Cross Hospital. Dr. Chen diagnosed Lung Abscess, recommending surgery.
Hospitalized that night. X-ray on the 9th showed left lung normal, right lung invisible due to thick pleura. Another X-ray on the 11th morning and afternoon to compare pre- and post-expectorant states. Surprisingly, both films showed no abnormalities. The expectorated pus accumulated to 3-5 small jars daily. Cod liver oil and other tonics were given to improve strength for surgery. Blood tests twice yielded inconclusive results. Pediatric Director Chen proposed artificial pneumothorax to compress the lung for drainage. However, feasibility required prior X-ray localization. Pulmonary Director Li repeated the X-ray: Left ribs clear, right ribs completely white on film, indicating tight adhesion between lung and pleura, making artificial pneumothorax impossible. Surgery was deemed necessary, requiring removal of a rib for drainage. The specific rib to remove depended on X-ray guidance using a colored oil injected via trachea to highlight necrotic areas. The oil would eventually be expectorated. Parental consent was required. After deliberation, Mr. and Mrs. Wu signed on August 13th at 4 PM. At 6 PM, Guanming learned of the next day's surgery and the colored oil ingestion, became distressed and pleaded against it.
Unwilling to upset her, Mr. and Mrs. Wu requested withdrawal of consent but wished to stay hospitalized for alternative treatment, which the doctor reluctantly agreed to. On Saturday night the 15th, Mr. Wu heard from a friend that TCM could treat Lung Carbuncle with herbs alone, avoiding surgery safely. On Sunday the 16th, Mr. Wu rushed to the hospital to request discharge for home care. Hospital staff were shocked: "Why change plans suddenly? We have studied your daughter's case for days, investing immense effort..." (Note: This is not empty talk; I firmly believe this dedication explains the hospital's excellent reputation.) "All for her speedy recovery. Now discharging, we cannot treat her, nor can she receive help." Mr. Wu cited financial difficulties. The doctor replied the hospital is charitable and could accommodate. Due to Mr. Wu's diplomatic skills, the doctor agreed, and they discharged at noon. Upon returning home, the right chest was slightly swollen. In the afternoon, urgently invited my teacher, Zhuochao, for consultation. Record: First visit, Lunar June 30th. Lung Carbuncle has lasted a month. Cough, foul-smelling sputum, high night fever, internal pus formation. Priority: Drainage. Use Jiegeng Tang combined with Qian Jin Weijing Tang.
Bitter Platycodon Root (Ku Jiegeng) 5 qian, Raw Licorice Root (Sheng Gancao) 3 qian, Raw Coix Seed (Sheng Yiren) 1 liang, Winter Melon Seed (Donggua Zi) 1 liang, Peach Kernel (Taoren) 6 qian, Roasted Frankincense and Myrrh (Zhi Ru Mo) 2 qian each, Fresh Reed Rhizome (Xian Lugeng) half jin, juice extracted and taken with decoction. Also take Xihuang Xingxiao Wan (Calculus Bovis and Musk Pill) 3 qian with boiled water.
[Note] After one dose, Ms. Wu's cough decreased. Next morning, bowels moved. Previously in hospital, bowels were constipated, requiring enemas. Taking this formula for three days resulted in smooth daily bowel movements. Teacher originally instructed four doses. On August 19th (Lunar calendar), second visit requested.
Second visit, Lunar July 3rd: Original formula minus Jiegeng, add Tingli Zi (Descurainia Seed) 3 qian, stir-fried and ground, wrapped in black date.
[Note] Ms. Wu took the first decoction at 3 PM. Fifteen minutes later, severe pain erupted, screaming for her mother. Instantly, gasping, eyes rolling back, cold extremities, cold sweat, confusion, then unconsciousness. Simultaneously, a strange phenomenon occurred: the affected area on the right chest, above the breast, suddenly bulged like a fist. Family panicked. Half an hour later, consciousness partially returned. At 6 PM, severe pain and fainting recurred. Mr. Wu returned at 7 PM, horrified. Urgently called Western Doctor Hu, who arrived around 10 PM, proposed surgery citing drug failure, but left without treating. At midnight, patient's consciousness suddenly cleared, asked for hot porridge, drank a bowl. Chest bulge remained, but pain settled, allowing sleep. Woke at dawn next day, fever subsided, cough decreased. Mrs. Wu said: "If not for yesterday's medicine, how could things turn for the better? Even harsh drugs are acceptable." At 8 AM, second decoction given. No adverse reaction (Mingxuan). Mrs. Wu reported: "Guanming slept poorly until taking Tingli Dazao Tang. Since then, despite illness, she sleeps well every night." I was amazed. August 20th, continued original formula, no worsening. August 21st, third visit.
Third visit, Lunar July 5th: Cumulative use of Jiegeng/Lung-Draining formulas and Qian Jin Weijing Tang reduced severity slightly. Continue previous method with modifications.
Raw Licorice Root 5 qian, Raw White Peony Root 5 qian, Raw Coix Seed 1 liang, Winter Melon Seed 1 liang, Peach Kernel 6 qian, Platycodon Root 5 qian, Angelica Dahurica (Baizhi) 1 qian, Roasted Frankincense and Myrrh 2 qian each, Light Marshallia (Mabo) 5 fen, Patrinia (Baijiangcao) 3 qian, Tingli Zi 3 qian stir-fried/ground/wrapped in date, Xihuang Xingxiao Wan 2 qian per dose.
[Note] Taken for three days. On the 24th, since condition improved and swelling subsided, Mr. Wu brought the formula for modification. Teacher removed Baizhi, Ru/Mo, Tingli, Baijiangcao, Mabo. Continued for three days. On the 27th, Mr. Ningxuan gave a formula: Raw Licorice 5 qian, Raw White Peony 5 qian, Raw Coix 1 liang, Winter Melon Seed 8 qian, Patrinia 3 qian, Peach Kernel Paste 3 qian, Platycodon 2 qian, Sichuan Fritillary 3 qian, Honeysuckle Vine 3 qian, Roasted Frankincense/Myrrh 0.5 qian each, Bletilla 0.5 qian. Medicine tasted very cloying. On August 28th, I returned from countryside. Mr. Wu urgently sought consultation. Record: Lung Carbuncle persisted two months. Right lung external bulge remains but less than fist-sized. Cough uncomfortable, yellow-green sputum, sore throat, bowel movement every two days, fine and rapid pulse. Plan: Drain pus and nourish Yin.
Raw Licorice 3 qian, Bitter Platycodon 2 qian, Large Ophiopogon Root (Da Maidong) de-heartened 3 qian, Trichosanthes Root (Tianhuafen) 6 qian, Loofah Network 5 qian, Apricot Kernel 3 qian, Elephant Fritillary (Xiang Beimu) 3 qian, Winter Melon Peel (Donggua Ban) 2 liang, Radish Root (Dikulo) 3 qian. September 1st, follow-up consultation. Previous formula effective. Record: After medication, cough and purulent sputum increased. Accumulated internal pus must be expelled. Pulse rapid, shoulder breathing persists, sore throat, bowels moved but hard. Condition still critical. Continue previous method. Fresh Reed Rhizome 3 roots, American Ginseng 1 qian, Raw Coix Seed 2 liang, Bitter Platycodon 2 qian, Winter Melon Peel 2 liang, Apricot Kernel 4 qian, Loofah Network 6 qian, Radish Root 4 qian, Southern Schisandra (Nanshashen) 3 qian, Raw Licorice 2 qian. September 30th, Mr. Wu reported reduced fever and foul sputum, insisted on third visit. I noted pulse fine/rapid at 140 bpm, not concerning. Only left shoulder moved during respiration. Recalling Zhang Zhongjing: "Rebellious Qi, facial edema, shoulder breathing, floating/large pulse, untreatable." Though not exactly rebellious Qi, I hesitated. Busy with affairs, recommended teacher continue.
September 1st, Mr. Wu consulted teacher regarding prognosis. Teacher comforted him. Record: Lung Carbuncle passed danger phase, but sputum still thick with slight fever. Continue previous formula. Raw Licorice 5 qian, Platycodon 5 qian, Peach Kernel Paste 2 qian, Raw White Peony 5 qian, Trichosanthes Peel/Kernel 3 qian each, Raw Gardenia 0.5 qian, take Xingxiao Wan 2 qian separately. Formula showed progress. September 2nd night, sudden severe chest pain, vomiting fresh red blood (~half small cup), several times. Post-vomit: fatigue, poor appetite, insomnia. September 3rd, Mr. Wu urgently sought teacher.
Teacher was unwell, dictated ingredients recorded by Hunan senior colleague. Formula: Tender Belamcanda Root (Shegan) 3 qian, Bupleurum Root (Qianjinzi/Baiqian) 3 qian, Peach Kernel Paste 2 qian, Raw Licorice 3 qian, Raw White Peony 5 qian, Aurantium Fruit (Zhiqiao) 1 qian, Whole Trichosanthes Fruit (Quangualou) sliced 6 qian, Platycodon 1 qian, Processed Cyperus (Zhixiangfu) 3 qian, Raw Gardenia 3 qian, take Xingxiao Wan 1 qian separately. First decoction at 2 PM, second at 6 PM. Pain stopped at 11 PM. Next morning, pain completely gone. Everyone astonished by speed. September 5th, teacher visited. Record: Fourth visit, Lunar July 20th. Lung Carbuncle no longer foul-smelling, passed danger phase, but occasional thick yellow sticky sputum. Follow *Qian Jin* Zaojiao Wan method, convert to decoction. Turbid phlegm must be removed to stop cough.
Tooth Soap Powder (Ya Sao) 5 fen, wrapped in pitted black date for decoction.