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，数被快药下利，重亡津液，故得之。
寸口脉不出，而反发汗，阳脉早索，阴脉不涩，三焦踟蹰，入而不出，阴脉不涩，身体反冷，其内反烦，多唾，唇
燥，小便反难，此为肺痿。伤于津液，便如烂瓜，亦如豚脑，但坐发汗故也。肺痿，其人欲咳不得咳，咳则出干沫，久
久小便不利，甚则脉浮弱。肺痿，吐涎沫而不咳者，其人不渴，必遗溺，小便数。所以然者，以上虚不能制下也，此为
肺中冷，必眩，多涎唾，甘草干姜汤以温其脏。师曰∶肺痿咳唾，咽燥欲饮水者，自愈。自张口者，短气也。咳而口中
自有津液，舌上苔滑，此为浮寒，非肺痿也。
问曰∶寸口脉数，其人咳，口中反有浊唾、涎沫者，何也？师曰∶此为肺痿之病。若口中辟辟燥，咳则胸中隐隐痛，
脉反滑数，此为肺痈。咳唾脓血，脉数虚者，为肺痿；脉数实者，为肺痈。
问曰∶病咳逆，脉之何以知此为肺痈？当有脓血，吐之则死，后竟吐脓死。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；热过于荣，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，畜结痈脓，
吐如米粥。始萌可救，脓成则死。咳而胸满，振寒，脉数，咽干不渴，时时出浊唾腥臭，久久吐脓如粳米粥者，为肺痈，
桔梗汤主之。肺痈，胸满胀，一身面目浮肿，鼻寒清涕出，不闻香鼻酸辛，咳逆上气，喘鸣迫塞，葶苈大枣泻肺汤主之。
寸口脉数，趺阳脉紧，寒热相抟，故振寒而咳。趺阳脉浮缓，胃气如经，此为肺痈。
问曰∶振寒发热，寸口脉滑而数，其人饮食起居如故，此为痈肿病。医反不知，而以伤寒治之，应不愈也。何以知
有脓？脓之所在，何以别知其处？师曰∶假令脓在胸中者，为肺痈。其人脉数，咳唾有脓血。设脓未成，其脉自紧数。
紧去但数，脓为已成也。夫病吐血，喘咳上气，其脉数，有热，不得卧者，死。上气，面浮肿，肩息，其脉浮大，不治。
又加利尤甚。上气燥而喘者，属肺胀，欲作风水，发汗则愈。（一云∶咳而上气，肺胀，其脉沉，心下有水气也。《要略》
《千金》《外台》沉作浮）夫酒客咳者，必致吐血，此坐极饮过度所致也。咳家，脉弦为有水，可与十枣汤下之。咳而脉
浮，其人不咳不食，如是四十日乃已（一云三十日）。咳而时发热，脉卒弦者，非虚也。此为胸中寒实所致也，当吐之。
咳家，其脉弦，欲行吐药，当相人强弱而无热，乃可吐之。其脉沉者，不可发汗。久咳数岁，其脉弱者，可治；实大数
者，不可治。其脉虚者，必苦冒，其人本有支饮在胸中故也，治属饮家。
问曰∶夫饮有四，何谓也？师曰∶有淡饮（一云留饮），有悬饮，有溢饮，有支饮。
问曰∶四饮何以为异？师曰∶其人素盛今瘦，水走肠间，沥沥有声谓之淡饮。饮后水流在胁下，咳唾引痛，谓之悬
饮。饮水流行，归于四肢，当汗出而不汗出，身体疼重，谓之溢饮。咳逆倚息，短气不得卧，其形如肿，谓之支饮。留
饮者，胁下痛引缺盆，咳嗽转盛。（一云辄已）胸中有留饮，其人短气而渴，四肢历节痛，其脉沉者，有留饮。夫心下有
留饮，其人背寒冷大如手。病者脉伏，其人欲自利，利者反快，虽利，心下续坚满，此为留饮欲去故也。甘遂半夏汤主
之。病淡饮者，当以温药和之。心下有淡饮，胸胁支满，目眩，甘草（草一作遂）汤主之。病溢饮者，当发其汗，小青
龙汤主之。支饮，亦喘而不能卧，加短气，其脉平也。膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数
十日，医吐下之，不愈，木防己汤主之。心下有支饮，其人苦冒眩，泽泻汤主之。呕家本渴，渴者为欲解，今反不渴，
心下有支饮故也，小半夏汤主之。夫有支饮家，咳烦，胸中痛者，不卒死，至一百日或一岁，可与十枣汤。膈上之病，
满喘咳吐，发则寒热，背痛，腰疼，目泣自出（目泣自出，一作目眩），其人振振身 剧，必有伏饮。夫病患饮水多，必
暴喘满。凡食少饮多，心下水停，甚者则悸，微者短气。脉双弦者，寒也。皆大下后喜虚。脉偏弦者，饮也。肺饮不弦，
但喜喘短气。病患一臂不随，时复转移在一臂，其脉沉细，非风也。必有饮在上焦。其脉虚者为微劳，荣卫气不周故也，
久久自瘥。（一云∶冬自瘥）腹满，口苦干燥，此肠间有水气也，防己椒目葶苈大黄丸主之。假令瘦人脐下悸，吐涎沫而
癫眩者，水也，五苓散主之。先渴却呕，为水停心下，此属饮家，半夏加茯苓汤主之。水在心，心下坚筑短气，恶水不
欲饮。水在肺，吐涎沫欲饮水。水在脾，少气身重。水在肝，胁下支满，嚏而痛。水在肾，心下悸。
问：热邪在上焦，因咳嗽导致肺痿。肺痿这种病，是怎么得的呢？老师说：有的因为发汗过多，有的因为呕吐，有的因为消渴症导致小便频数，有的因为大便困难，多次被峻下药攻下导致腹泻，严重耗伤津液，所以得此病。
寸口脉微弱不出，反而误用发汗法，导致阳脉早衰（索然无力），阴脉不涩滞，三焦气机运行迟缓徘徊，气入而不出。阴脉不涩，身体反而寒冷，体内反而烦热，多唾沫，嘴唇干燥，小便反而困难，这是肺痿。由于津液受损，咳出的痰像烂瓜一样，也像猪脑浆一样，这都是因为误发汗造成的。肺痿病人想咳嗽却咳不出来，咳出时只有干沫，时间久了小便不利，严重时脉象浮弱。肺痿，吐涎沫但不咳嗽的人，口不渴，必然遗尿，小便频数。之所以这样，是因为上焦肺气虚不能制约下焦，这是肺中寒冷，必然头晕，多涎唾，用甘草干姜汤来温补脏腑。老师说：肺痿咳嗽吐唾，咽喉干燥想喝水的，会自愈。张口呼吸的，是短气。咳嗽而口中自有津液，舌苔滑润，这是浮寒，不是肺痿。
问：寸口脉数，人咳嗽，口中反而有浑浊的唾沫、涎沫，这是什么原因？老师说：这是肺痿的病。如果口中极度干燥，咳嗽时胸中隐隐作痛，脉象反而滑数，这是肺痈。咳嗽吐脓血，脉数而虚的，是肺痿；脉数而实的，是肺痈。
问：患咳嗽气逆，通过脉象怎么知道这是肺痈？应当有脓血，吐出就会死，后来果然吐脓而死。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，吸气不能呼出。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，气喘胸闷，咽燥但不口渴，多吐浑浊泡沫，时常发冷颤抖。热邪经过的地方，血液凝滞，积聚结成痈脓，吐出如米粥状。初起阶段可以救治，脓成则死。咳嗽且胸满，发冷颤抖，脉数，咽干不渴，时常吐出浑浊腥臭的唾沫，久而久之吐出如粳米粥样的脓，这是肺痈，用桔梗汤主治。肺痈，胸满胀，全身面目浮肿，鼻塞流清涕，闻不到香味也不觉得酸辛，咳嗽气逆，喘息有声气塞，用葶苈大枣泻肺汤主治。
寸口脉数，趺阳脉紧，寒热相互搏结，所以发冷颤抖且咳嗽。趺阳脉浮缓，胃气正常，这是肺痈。
问：发冷颤抖发热，寸口脉滑而数，人的饮食起居如常，这是痈肿病。医生不知道，却按伤寒治疗，应该治不好。怎么知道里面有脓？脓在什么地方，怎么辨别它的位置？老师说：假如脓在胸中，就是肺痈。病人的脉数，咳嗽吐脓血。假如脓未形成，脉自紧数。紧象消失只余数象，说明脓已经形成了。凡是吐血，气喘咳嗽气逆，脉数，有热，不能安卧的，预后不良（死证）。气逆，面部浮肿，抬肩呼吸，脉浮大，难治。如果再兼腹泻就更严重了。气逆燥喘的，属于肺胀，想要形成风水病，发汗则可痊愈。（另一种说法：咳嗽气逆，肺胀，脉沉，心下有停水。《金匮要略》《千金方》《外台秘要》中“沉”字作“浮”）凡是嗜酒的人咳嗽，必然导致吐血，这是因为饮酒过度所致。咳嗽的病人，脉弦表示有水饮，可以用十枣汤攻下。咳嗽而脉浮，人不咳不食，这样四十天才会好（另一种说法三十天）。咳嗽时而发热，脉突然变弦的，不是虚证。这是胸中寒实所致，应当用涌吐法。咳嗽的病人，脉弦，打算用吐药，应当观察病人的强弱且无热象，才可以吐。脉沉的，不可发汗。久咳数年，脉弱的，可治；脉实大数的，不可治。脉虚的，必然苦于头昏目眩，这是因为病人本来胸中有支饮，治疗属于治饮的方法。
问：饮邪有四类，是什么？老师说：有痰饮（一种说法叫留饮），有悬饮，有溢饮，有支饮。
问：四种饮邪有什么不同？老师说：病人平时肥胖现在消瘦，水流走于肠间，沥沥有声，叫做痰饮。饮水后水流停留在胁下，咳嗽吐唾牵引疼痛，叫做悬饮。饮水流行，归于四肢，应当出汗却不出汗，身体沉重疼痛，叫做溢饮。咳嗽气逆倚靠呼吸，短气不能平卧，身形如肿，叫做支饮。留饮的病人，胁下疼痛牵引缺盆穴，咳嗽加剧。（一种说法是随即停止）胸中有留饮，人短气且口渴，四肢关节疼痛，脉沉的，是有留饮。心下有留饮，人背部寒冷范围如手掌大小。病人脉伏，想自利，利后反而舒服，虽然利，心下继续坚硬胀满，这是留饮欲去的原因，用甘遂半夏汤主治。患痰饮病的，应当用温药调和。心下有痰饮，胸胁支撑胀满，头晕目眩，用甘草汤主治（草一作遂）。患溢饮病的，应当发汗，用小青龙汤主治。支饮，也气喘不能卧，加上短气，脉象平和。膈间有支饮，人气喘胸满，心下痞硬，面色黧黑，脉沉紧，患病数十日，医生用吐下法治疗无效，用木防己汤主治。心下有支饮，人苦于头昏目眩，用泽泻汤主治。呕吐的人本来口渴，口渴的是病欲解，现在反而不渴，是因为心下有支饮，用小半夏汤主治。凡是支饮病人，咳嗽心烦，胸中痛的，如果不猝死，过一百天或一年，可以用十枣汤。膈上的病，胀满气喘咳嗽吐逆，发作时寒热，背痛，腰疼，眼泪自出（眼泪自出，一作目眩），人身体震颤剧烈，必有伏饮。凡是病人饮水多，必然突发气喘胸满。凡是吃得少喝得多，心下水液停留，严重的则心悸，轻微的则短气。脉双弦的，是寒证。都是大下之后喜欢虚弱。脉偏弦的，是饮邪。肺部的饮邪不弦，只是喜欢气喘短气。病人一只手臂不能随意活动，时常转移到另一只手臂，脉沉细，不是中风。必定是有饮邪在上焦。脉虚的是轻微劳损，营卫之气不周遍的缘故，久了自然痊愈。（一种说法：冬天自然痊愈）腹部胀满，口苦干燥，这是肠间有水气，用防己椒目葶苈大黄丸主治。假如瘦人脐下悸动，吐涎沫且癫痫眩晕的，是水饮，用五苓散主治。先口渴却呕吐，是水停心下，这属于饮家，用半夏加茯苓汤主治。水在心，心下坚硬筑筑跳动短气，厌恶水不想喝。水在肺，吐涎沫想喝水。水在脾，少气身体重。水在肝，胁下支撑胀满，打喷嚏时痛。水在肾，心下悸动。
Question: Heat in the Upper Jiao (Upper Burner) causes lung萎 (Lung Flaccidity) due to coughing. How is Lung Flaccidity contracted? The Master said: It may result from excessive sweating, vomiting, Xiao Ke (Wasting and Thirsting Syndrome) with frequent urination, or constipation treated repeatedly with drastic purgatives causing diarrhea, leading to severe depletion of Jin Ye (Body Fluids).
If the Cun Kou (Radial Pulse at the wrist) is faint and unobtainable, yet diaphoresis (sweating-inducing treatment) is wrongly applied, the Yang pulse becomes depleted early, while the Yin pulse remains non-choppy. The Qi of the San Jiao (Triple Burner) lingers and hesitates, entering but not exiting. With a non-choppy Yin pulse, the body feels cold externally, while internally there is vexation. There is excessive salivation, dry lips, and difficulty in urination; this is Lung Flaccidity. Due to injury to Body Fluids, the expectorated sputum resembles rotten melon or pig brain, solely caused by erroneous sweating therapy. In Lung Flaccidity, the patient desires to cough but cannot; when coughing occurs, only dry froth is expelled. Over time, urination becomes difficult, and in severe cases, the pulse is floating and weak. In Lung Flaccidity, if the patient spits saliva and froth without coughing, they are not thirsty, inevitably suffer from urinary incontinence and frequent urination. This is because the deficiency of the Upper Jiao fails to control the Lower Jiao; this is Cold in the Lung, inevitably accompanied by dizziness and excessive saliva/froth. Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be used to warm the Zang organs. The Master said: In Lung Flaccidity with coughing and spitting, if the throat is dry and the patient desires to drink water, the condition will heal spontaneously. If the patient breathes with an open mouth, it indicates shortness of breath. If the patient coughs but has natural saliva in the mouth and a slippery coating on the tongue, this is Floating Cold, not Lung Flaccidity.
Question: The Cun Kou pulse is rapid, the patient coughs, and there is instead turbid saliva and froth in the mouth. What is the cause? The Master said: This is Lung Flaccidity. If the mouth is extremely dry (Pi Pi Zao), and coughing causes dull pain in the chest, while the pulse is slippery and rapid, this is Fei Yong (Lung Abscess). Coughing up pus and blood with a rapid and deficient pulse indicates Lung Flaccidity; a rapid and excess pulse indicates Lung Abscess.
Question: Regarding cough and rebellious Qi, how can one know this is Lung Abscess through pulse diagnosis? One should expect pus and blood; if vomited, death ensues, which indeed happens later when pus is vomited. What does the pulse resemble? 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 cannot penetrate inward; Heat overwhelms the Ying (Nutritive) level, so inhalation cannot exit outward. Wind damages skin and hair; Heat damages blood vessels. When Wind lodges in the Lung, the patient coughs, has a dry mouth, wheezing and chest fullness, dry throat without thirst, excessive secretion of turbid froth, and periodic chills. Where Heat passes, blood coagulates and stagnates, accumulating into an abscess and pus, which is vomited like congee. In the initial stage, it can be saved; once pus forms, it is fatal. Cough with chest fullness, chills, rapid pulse, dry throat without thirst, periodic expulsion of turbid foul-smelling sputum, and eventually vomiting pus resembling rice congee indicates Lung Abscess, treated with Jiegeng Tang (Platycodon Decoction). For Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear discharge, loss of smell and sensation to pungency, rebellious cough and Qi, wheezing and airway obstruction, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated.
The Cun Kou pulse is rapid; the Zu Yang (Dorsalis Pedis Pulse) is tight. Cold and Heat contend, causing chills and cough. If the Zu Yang pulse is floating and moderate, indicating normal Stomach Qi, this is Lung Abscess.
Question: Chills and fever with a slippery and rapid Cun Kou pulse, while diet and daily activities remain normal, indicate a carbuncle or swelling. If the physician is unaware and treats it as Tai Yang Shang Han (Cold Damage), it will not heal. How can one know pus exists? How can the location of the pus be identified? The Master said: If the pus is in the chest, it is Lung Abscess. The patient’s pulse is rapid, with coughing up pus and blood. If the pus has not yet formed, the pulse is naturally tight and rapid. When the tightness disappears leaving only rapidity, the pus has formed. For patients vomiting blood, wheezing, coughing, and rebellious Qi, with a rapid pulse, heat, and inability to lie down, the prognosis is fatal. For rebellious Qi with facial edema and shoulder-respiration (accessory muscle breathing), with a floating and large pulse, the condition is difficult to treat. Diarrhea exacerbates it. Rebellious Qi with dryness and wheezing belongs to Fei Zhang (Lung Distension), potentially developing into Feng Shui (Wind Water edema); diaphoresis will cure it. (Another version states: Cough with rebellious Qi and Lung Distension, with a deep pulse, indicates Water Qi in the Heart region. *Jin Gui Yao Lue*, *Qian Jin Fang*, and *Wai Tai Mi Yao* read "floating" instead of "deep".) For wine drinkers who cough, hemoptysis inevitably results, caused by excessive drinking. For chronic coughers, a string-like (Xian) pulse indicates Water Retention; Shizao Tang (Ten Date Pill) may be used to purge it. Cough with a floating pulse, where the patient does not cough or eat, resolves after forty days (another version says thirty days). Cough with intermittent fever and a suddenly string-like pulse is not deficiency; it is caused by Cold Excess in the Chest and requires emesis. For chronic coughers with a string-like pulse, if emetics are intended, one must assess the patient’s strength and ensure no heat signs before inducing vomiting. A deep pulse contraindicates diaphoresis. Chronic cough lasting years with a weak pulse is treatable; an excess, large, and rapid pulse is untreatable. A deficient pulse implies suffering from vertigo/dizziness due to pre-existing Zhi Yin (Piercing/Supporting Fluid Retention) in the chest; treatment falls under managing Fluid Retention.
Question: There are four types of Yin (Fluid Retention). What are they? The Master said: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Supporting/Piercing Fluid).
Question: How do the four types of Fluid Retention differ? The Master said: If a patient was formerly obese but is now thin, with water moving in the intestines making gurgling sounds, it is called Tan Yin. If fluid accumulates below the hypochondrium after drinking, causing pain upon coughing and spitting, it is called Xuan Yin. If fluid flows to the limbs, should sweat but does not, causing heavy and painful body, it is called Yi Yin. If there is rebellious cough and Qi leaning on support for breathing, shortness of breath preventing lying down, and swelling-like appearance, it is called Zhi Yin. For Liu Yin (Stagnant Fluid), pain in the hypochondrium radiates to the Que Pen (LI 15) acupoint, and cough worsens. (Another version says it stops immediately.) With Liu Yin in the chest, the patient has shortness of breath and thirst, pain in all four joints, and a deep pulse. With Liu Yin under the Heart, the back feels cold over an area the size of a hand. If the patient’s pulse is hidden (Fu), they desire spontaneous diarrhea; relief follows defecation, yet the epigastrium remains hard and full; this indicates Liu Yin attempting to exit, treated with Gansui Banxia Tang (Kansui and Pinellia Decoction). Tan Yin should be harmonized with warming herbs. Tan Yin under the Heart causing chest/hypochondriac fullness and dizziness is treated with Gancao Tang (Licorice Decoction - note: some texts say Sui). Yi Yin requires diaphoresis, treated with Xiao Qinglong Tang (Minor Blue Dragon Decoction). Zhi Yin causes wheezing and inability to lie down, plus shortness of breath, with a normal pulse. Zhi Yin in the Diaphragm causes wheezing, chest fullness, epigastric hardness, dark complexion, and a deep-tight pulse; if untreated for decades by vomiting/purging, Mufangji Tang (Stephania Decoction) is indicated. Zhi Yin under the Heart causing severe vertigo is treated with Zexie Tang (Alisma Decoction). Vomiting patients usually feel thirsty; thirst indicates resolution. Lack of thirst indicates Zhi Yin under the Heart, treated with Xiaobanxia Tang (Minor Pinellia Decoction). For chronic Zhi Yin patients with cough, vexation, and chest pain, if they do not die suddenly, after 100 days or a year, Shizao Tang may be used. Diseases above the Diaphragm involving fullness, wheezing, cough, and vomiting, with onset of chills/fever, back/waist pain, tearing eyes (or dizziness), and violent tremors, indicate Fu Yin (Hidden Fluid Retention). Excessive water intake causes sudden wheezing and chest fullness. Eating little and drinking much leads to water retention under the Heart; severe cases cause palpitations, mild cases shortness of breath. Bilateral string-like pulses indicate Cold, often following harsh purgation leading to deficiency. Unilateral string-like pulses indicate Fluid Retention. Lung Fluid Retention is not string-like but presents with wheezing and shortness of breath. Arm paralysis shifting between arms with a deep-thin pulse is not Wind stroke but Fluid Retention in the Upper Jiao. A deficient pulse indicates minor labor injury due to uneven Ying and Wei Qi, resolving spontaneously over time (or in winter). Abdominal fullness, bitter taste, and dry mouth indicate Water Qi in the intestines, treated with Fangji Jeemu Tingli Dahuang Wan (Stephania, Lepidium, Descurainia, and Rhubarb Pill). In thin persons, subumbilical palpitation, vomiting of saliva/froth, and vertigo/seizure-like symptoms indicate Water, treated with Wuling San (Five-Ingredient Powder with Poria). Thirst followed by vomiting indicates water retention under the Heart, belonging to Fluid Retention syndromes, treated with Banxia Jiashengfu Tang (Pinellia with Added Poria Decoction). Water in the Heart causes epigastric hardness, palpitations, shortness of breath, aversion to water, and lack of desire to drink. Water in the Lung causes vomiting of saliva/froth and desire to drink. Water in the Spleen causes Qi deficiency and heaviness of the body. Water in the Liver causes hypochondriac fullness and pain upon sneezing. Water in the Kidney causes epigastric palpitations.