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，又被快药下利，重亡津液，故得之。曰∶寸口脉数，其人咳，口中反有
浊唾涎沫者何？师曰∶为肺痿之病。若口中辟辟燥，咳即胸中隐隐痛，脉反滑数，此为肺痈，咳唾脓血。
【注】热在上焦，不咳，不病肺痿也，因热病咳，则为肺痿。肺热致痿之由，非止一端，或从汗
出，或从呕吐，或从消渴，小便数利，或从便难，又被快药下之，重亡津液，故令肺热干痿也。肺热干
痿，则清肃之令不行，水精四布失度。脾气虽散，精液上归于肺，而肺不但不能自滋其干，亦不
能内洒陈于脏腑，外输精于皮毛也。其精液留贮胸中，得热煎熬，变为涎沫，侵肺作咳，唾之不已，
故干者自干，唾者自唾，愈唾愈干，痿病成矣。若口中辟辟干燥，不吐浊唾涎沫，每咳即胸中隐隐
而痛，脉数而滑，不数而虚，则非肺痿乃为肺痈。欠则痈成脓溃，不唾涎沫，而必咳唾脓血矣。
【集注】周扬俊曰∶喻昌云∶行动数武，气即喘鸣，冲击连声，痰始一应。《金匮》治
法，贵得其精意，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，以复肺之清肃，如半身痿废及手足痿软，治之得法，亦能复起。而
肺近在胸中，呼吸所关，可不致力乎？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。故痈为实，误以肺痿治之，是为实实；痿为虚，误以肺痈治之，是
为虚虚。此辩证用药之大略也。然两手寸口之脉，原为手太阴肺脉，此云寸口脉数，云滑数，云数
实，云数虚，皆指左右三部统言，非如气口独主右关之上也。其人咳，口中反有浊唾涎沫，顷之遍地者
为肺痿，言咳而口中不干燥也。若咳而口中辟辟燥，则是肺已结痈，火热之毒，出现于
口，咳声上下，触动其痈，胸中即隐隐而痛，其脉必见滑数有力，正邪气方盛之征也。数虚、数
实之脉，以之分别肺痿肺痈，是则肺痿当补，肺痈当泻也可知矣。又云∶才见久咳，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，血为之凝，痰为之
裹，遂成小痈。所结之形渐长，则肺日胀而胁骨日昂，乃至咳声频并，痰浊如胶，发热畏寒，日晡尤
甚，面红鼻燥，胸生甲错。始先即能辨其脉证，属表属里，极力开提攻下，无不愈者，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。
沈明宗曰∶此肺痿肺痈之辨也。心居上，肾水不足，心火刑金，为热在上焦，肺阴日
消，气逆则咳，故致肺痿。然本经明其始病之因，或从病后阴虚，过汗伤液，呕吐伤津，
消渴，血虚津竭；或利小便，数而伤阴；或大便难，反被快药下利而重亡津液，以致肺
金枯燥，虚热熏蒸，故寸口脉数，其人咳嗽，气弱不振，津液不布，化为浊唾涎沫而成肺
痿。若口中辟辟燥，咳即胸中隐隐痛者，乃风寒侵入肺中，凝滞荣血为痈，故脉滑数而
咳唾脓血。因无形虚热致痿，故脉数虚；因有形气血凝滞成痈，故脉数实。此明肺痈属
实、肺痿属虚也。
脉数虚者为肺痿，数实者为肺痈。
【注】此详申上条肺痿、肺痈之脉也。肺痿得之于热亡津液，虚邪也，故脉数而虚；肺
痈得之于热毒蓄结，实邪也，故脉数而实。
【集注】李 曰∶潘硕甫云∶痿与痈，皆热在上焦，其脉皆数，皆咳，亡津液，未有
异也。但痿属肺气虚而亡津，虽有热亦不烈，故不至燥涸，虽咳而口中有浊唾涎沫，故脉
虽数而虚也。痈则气壅血凝，邪实而热烈，故津液亡而更觉干涸，口中辟辟燥，咳即胸中
隐痛，津液既涸，脉应涩滞而反滑数者，蓄热腐脓，脉故数实也。
尤怡曰∶痿者萎也，如草木之萎而不荣，为津亡而肺焦也；痈者壅也，如土之壅而不
通，为热聚而肺 也。故其脉有虚实不同，而其数则一也。
问曰∶病咳逆，脉之何以知此为肺痈？当有脓血，吐之则死，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，时唾浊
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。
【按】肺痈之上，当有“肺痿”二字，不然本文论肺痿之义，则无着落，必是脱简。脉
微之三“微”字，当是三“浮”字，“微”字文气不属，必是传写之讹。
【注】病咳逆者，何以知为肺痿帅痈也？咳而不渴，浊唾涎沫，脉数而虚，是以脉证
知为肺痿也。口中干燥，胸中隐痛，脉数而实，是以脉证知为肺痈也。至于所以受病之
由，肺痿前已言之，而肺痈则未尝言也，故又取所以致热而病肺痿肺痈之由，互为详悉
发明也。寸口肺脉也，肺脉当浮涩而短；今浮而数，是以知浮则为风，数则为热，初病
风热，外抟皮毛，则荣卫受邪，故汗出而恶寒也。末传风热，内舍于肺，则荣卫分病。病
肺痿者，属风热伤于卫气，气分有津液而无血，津液为之浊，故其力证，咳而不吐脓血，
唾浊涎沫也。病肺痈者，属风热伤于营血，血分有血而无津液，血为之凝蓄，故其为证，咳
而不唾涎休，吐脓血如木粥也。具发热汗出，恶寒恶风，咳而喘满，咽燥不渴，呼气不入，
吸气不出，则为痿、痈互相兼有必然之证也。呼气不入，吸气不出，乃言其呼吸气促，难
出难入，非竟不出入也。始萌可救，谓肺伤尚浅。脓成则死，谓肺已坏矣。盖示人图治
于早，又特为肺痈而谆谆言之也。
肺痈，喘不得卧，葶苈大枣泻肺汤主之。
【注】此承上条，以明急治之义也。肺痈者，谓口中辟辟干燥，胸中隐隐作痛，脉数
实也。而更加喘不得卧，是邪壅肺甚急，故以葶苈大枣泻肺汤，大苦大寒，峻泻肺邪，恐
稍迁延，脓成则死矣。
葶苈大枣泻肺汤方
葶苈（熬令黄色，捣九，如弹子大） 大枣（十二枚）
上先以水三升，煮枣，取二升，去枣，内葶苈，煮取一升，顿服。
【集解】赵良曰∶此治肺痈吃紧之方也。肺中生痈，不泻何待？恐日久痈脓已成，泻
之无益。日久肺气已索，泻之转伤，乘其血结而脓未成，当急以泻之之法夺之，况喘不
得卧，不亦甚乎。
肺痈，胸满胀，一身面目浮肿，鼻塞消涕出，不闻香臭酸辛，咳逆上气，喘鸣迫塞，
葶苈人枣泻肺汤主之（方见上）。
【注】此承上条互详其证，以同其治也。肺痈胸胀而满，咳逆上气，喘鸣迫塞，一身
面目浮肿，鼻塞清涕出，不闻香臭酸辛，是邪外塞皮毛，内壅肺气，比之喘不得卧，殆
尤甚焉。亦以葶苈大枣泻肺汤者，因其脓未
成故也。
咳而胸满，振寒脉数，咽干不渴，时出浊唾腥臭，久久吐脓如米粥者，为肺痈，桔
梗汤主之。
【注】咳而胸满，振寒脉数，咽干不渴，时出浊唾腥臭，久久吐脓如米粥者，此为肺
痈证也。肺痈尚未成脓实邪也，故以葶苈之剂泻之；今已溃后虚邪也，故以桔梗之苦，甘
草之甘，解肺毒排痈脓也。此治已成肺痈，轻而不死者之法也。
【集注】高世 曰∶吐如米粥亦脓也，何以上文云脓成则死？若谓如米粥者非脓，上
文既曰∶蓄结痈脓，吐如米粥；此又云∶吐脓如米粥，既吐脓矣，奚有始萌脓成之别也？
愚曰∶上文先咳逆，而呼吸不利，后凝滞而血脉成脓，阴阳血气皆伤，故脓成则死。若
上节言肺痈而气机不利，此节言肺痈而经络不和，病阳气者不伤阴，病血脉者不伤阳，故
可治也。如但以“始萌可救，脓成则死”二语尽之，是以辞害志也，奚可乎？
桔梗汤方
桔梗（一两） 甘草（二两）
上二味，以水三升，煮取一升，分温再服，则吐脓血也。
肺痿吐涎沫而不咳者，其人不渴，必遗尿，小便数。所以然者，以上虚不能制下故
也，此为肺中冷，必眩多涎唾，甘草干姜汤以温之。若服汤已渴者，属消渴。
【注】咳而不吐涎沫者，肺燥咳也；咳而吐涎沫者，肺热痿也。若似肺痿之吐涎沫而
不咳者，此为肺中有冷冻饮料，非为肺中成热痿也。肺中冷，则其人必不渴，遗尿小便数，头
眩多涎唾。所以然者，以上焦阳虚，不能约制下焦阴水，下焦之水泛上而唾涎沫，用甘
草干姜汤以温散肺之寒饮也。如服汤已渴者，属消渴，谓始先不渴，服温药即转渴者，不
但非肺中热，亦非肺中冷，乃胃中热也，则不当以属肺中冷寒饮治之，当以属胃中热消
渴治之也。
甘草干姜汤方
甘草（炙，四两） 干姜（炮，二两）
上 咀，以水三升，煮取一升五合，去滓，分温再服。
咳而上气，喉中水鸡声，射干麻黄汤主之。
【注】咳逆上气，谓咳则气上冲逆也。上条发明不咳而吐涎沫者，非为肺痿，是为肺
冷也。此条发明咳而不吐涎沫者，亦非肺痿，亦为肺冷也。上条以不渴，小便数，多唾涎
沫为肺中冷，故以干姜佐甘草，是以温中为主也。此条以气上逆，喉中有水鸡声为肺经
寒，故以生姜佐麻黄，是以散外为主也。病同冷冻饮料，而有在外在内之别；方同辛温，而
有主温主散之异也。水鸡声者，谓水与气相触之声，在喉中连连不绝也。
射干麻黄汤方
射干（三两） 麻黄（四两） 生姜（四两） 细辛 紫菀 款冬花（各三两） 五味
子（半升） 大枣（七枚） 半夏（半升）
上九味，以水一斗二升，先煮麻黄两沸，去上沫，内诸药，煮取三升，分温三服。
【集解】程林曰∶咳而上气，如水鸡声连连不绝者，是汤主之。《内经》曰∶肺苦气上
逆，急食苦以泻之。射干、紫菀之苦，所以泄逆气也。以辛泻之，麻黄、生姜、细辛、半
夏、款冬花之辛，所以泻风邪也。以酸收之，以酸补之，五味子之酸，以补不足。虚则补
其母，大枣之甘，所以补其母也。
大逆上气，咽喉不利，止逆下气者，麦门冬汤主之。
【按】大逆上气之“大”字，当是“火”
字，文义病药始属，必是传写之讹。
【注】咳而上气，咽喉有水鸡声而连连者，是寒饮上逆也。今咳而上气，咽喉无水鸡声
而不利者，是火气上逆也。不利者，谓咽喉若有物相碍，不爽利也。主之以麦门冬汤，止
其火逆，下其上气也。
麦门冬汤方
麦门冬（七升） 半夏（一升） 人参（三两） 甘草（二两） 粳米（三合） 大枣（十
二枚）
上六味，以水一斗二升，煮取六升，温服一升，日三，夜一服。
【集解】周扬俊曰∶喻昌云∶此胃中津液枯燥，虚火上炎之证，麦冬汤乃治本之良法
也。夫用降火之药而火反升，用寒凉之药而热转炽者，不惟无益，而反害之。凡病有胃
气则生，无胃气即死，胃气者，肺之母气也。《本草》有知母之名者，谓肺藉其清凉，知清
凉为肺之母也。有贝母之名者，谓肺藉其豁痰实，豁痰为肺之母也；然屡施于火逆上气，
咽喉不利之证，而屡不应，名不称矣。孰知仲景有此妙法，于麦冬、人参、甘草。粳米
大补中气，大生津液队中，增入半夏之辛温一味，其利咽下气，非半夏之功，实善用半
夏之功，擅古今未有之奇矣。
咳逆上气，时时唾浊，但坐不得眠，皂荚丸主之。
【注】咳逆上气，喉中有水鸡声者，是寒饮冲肺，射干麻黄汤证也。咳逆上气，咽喉
不利者，是火气冲肺，麦门冬汤证也。今咳逆上气，惟时时唾浊，痰涎多也。但坐不得
卧，气逆甚也。此痰气为病，非寒饮亦非火气。主之以皂荚丸者，宣导其痰，通达其气
也；佐枣膏之甘，以药性剽悍缓其势也。
【集注】程林曰∶浊唾壅塞于肺，则不得卧，故时时唾浊也。皂荚味辛咸，辛能散，咸
能软，宣壅导滞，利窍消风，莫过于此。故咳逆上气，时时唾浊，坐不得卧者宜之。然
药性剽悍，佐枣膏之甘，以缓其药势。
魏荔彤曰∶咳逆上气，时时吐浊，但坐不得眠，则较重于喉中水鸡声者矣。声滞者，
挟外感之因；唾浊则内伤之故；但坐不得卧，而肺痈之证将成矣。是上焦有热，痰血包裹，
结聚成患，不可不急为宣通其结聚，而后可津液徐生，枯干获润也，皂荚丸主之，皂荚
驱风理痹，正为其有除瘀涤垢之能也。咳逆上气，时时唾浊，胸膈恶臭之痰血已结，可
不急为涤荡，使之湔洗不留乎？如今用皂荚澡浴以除垢腻，即此理也。用丸俾徐徐润化，
自上而下，而上部方清。若用汤直泻元余，不能治上部之胶凝矣，古人立法诚善哉。此为
预治肺痈将成者主治也。
皂荚丸方
皂荚（刮去皮，用酥炙，八两）
上一味，末之，蜜丸梧子大，以枣膏和汤，服三九，日三，夜一服。
上气，面浮肿，肩息，其脉浮大不治，又加利尤甚。
【注】上气，谓咳逆上气也。面浮肿，谓面目浮肿也。肩息，谓喘也。其脉浮大不治，
问：热邪位于上焦，因咳嗽而发展为肺痿。肺痿这一疾病，是如何产生的呢？老师回答：有的因为发汗过多，有的因为呕吐，有的因为消渴病导致小便频数，有的因为大便干结，又误用峻下药物导致腹泻，严重耗伤津液，因此患上此病。问：寸口脉象数，病人咳嗽，口中反而有浑浊的唾液和涎沫，这是什么原因？老师回答：这是肺痿的病证。如果口中感觉干燥，一咳嗽就胸中隐隐作痛，脉象反而滑数，这是肺痈，会咳出脓血。
【注】热邪在上焦，如果不咳嗽，就不会得肺痿；因为热病伴随咳嗽，才会导致肺痿。导致肺热致痿的原因不止一种，或者因为发汗，或者因为呕吐，或者因为消渴、小便频利，或者因为大便困难，又被峻下药攻下，严重亡失津液，所以导致肺热干枯萎缩。肺热干枯萎缩，那么清肃的功能就不能正常行使，水谷精微的输布失去节制。虽然脾气散精，将津液上归于肺，但肺不但不能滋润自身的干燥，也不能向内洒陈精微于脏腑，向外输送精微于皮毛。这些精液留存在胸中，受热煎熬，变成涎沫，侵袭肺部引起咳嗽，不停地吐出，所以干燥的依然干燥，吐出的依然吐出，越吐越干，肺痿的病就这样形成了。如果口中感觉干燥，不吐出浑浊的唾液和涎沫，每次咳嗽就胸中隐隐作痛，脉象数而滑，或不数而虚，这就不是肺痿而是肺痈。等到痈脓形成溃破时，就不吐涎沫，而是必然咳出脓血了。
【集注】周扬俊说：喻昌说：病人稍微活动几步，气息就喘息有声，冲击发出连续声音，痰才应声而出。《金匮要略》的治疗法则，贵在领会其精意，大抵要缓慢图治，滋生胃津，润肺燥，降逆气，开积痰，止浊唾，补真气，以通畅肺的小管，散火热，以恢复肺的清肃功能，就像半身痿废及手足痿软一样，治疗得当，也能康复。而肺近在胸中，关乎呼吸，怎能不致力治疗呢？肺痈属于有形的血分病变，血结应当迅速攻逐；肺痿属于无形的气分病变，气伤应当慢慢调理。所以痈是实证，误用治疗肺痿的方法治疗，就是实实之误；痿是虚证，误用治疗肺痈的方法治疗，就是虚虚之误。这是辨证用药的大概原则。然而两手寸口的脉，原本都是手太阴肺脉，这里说寸口脉数，说滑数，说数实，说数虚，都是指左右三部统而言之，不像气口独主右关之上那样。病人咳嗽，口中反而有浑浊的唾液和涎沫，一会儿遍地都是的是肺痿，意思是咳嗽而口中不干燥。如果咳嗽而口中辟辟干燥，那就是肺已经结成痈，火热之毒表现在口，咳嗽的声音上下震动，触动痈处，胸中就隐隐作痛，脉象必定见滑数有力，这是正邪气正盛的征象。用数虚、数实的脉象来分别肺痿和肺痈，那么肺痿应当补益，肺痈应当泻除，就可以知道了。又说：刚见到久咳，先须防备这两种病证，肺痈是由五脏蕴积之火，与胃中停蓄之热，上乘于肺，肺受火热熏灼，血为之凝结，痰为之包裹，遂成小痈。所结成的形状逐渐长大，则肺日渐胀大而胁骨日渐高起，以至于咳嗽声频繁，痰浊如胶，发热畏寒，下午尤其严重，面红鼻燥，胸部皮肤生疮如鳞甲交错。开始如果能辨别其脉证，属表属里，极力开提攻下，没有不愈的，等到血化为脓，肺叶朽坏，倾囊吐出，才开始认识这个病证，十死无救，叹息也来不及了。
沈明宗说：这是肺痿和肺痈的鉴别。心居上，肾水不足，心火刑克肺金，为热在上焦，肺阴日渐消耗，气逆则咳嗽，所以导致肺痿。然而本经明确说明了初病的病因，或者是病后阴虚，过汗伤液，呕吐伤津，消渴，血虚津竭；或者是利小便，频数而伤阴；或者是大便难，反被峻下药攻下而重亡津液，以致肺金枯燥，虚热熏蒸，所以寸口脉数，其人咳嗽，气弱不振，津液不布，化为浊唾涎沫而成肺痿。如果口中辟辟干燥，咳嗽即胸中隐隐作痛，那是风寒侵入肺中，凝滞营血成痈，所以脉滑数而咳唾脓血。因为无形虚热致痿，所以脉数虚；因为有形气血凝滞成痈，所以脉数实。这明确了肺痈属实、肺痿属虚。
【注】这里详细申述上一条关于肺痿、肺痈的脉象。肺痿得之于热盛亡失津液，是虚邪，所以脉数而虚；肺痈得之于热毒蓄结，是实邪，所以脉数而实。
【集注】李 说：潘硕甫说：痿与痈，都是热在上焦，它们的脉象都数，都咳嗽，都亡失津液，没有什么不同。但痿属于肺气虚而亡津，虽然有热也不猛烈，所以不至于燥涸，虽然咳嗽但口中有浊唾涎沫，所以脉虽数而虚。痈则是气壅血凝，邪实而热烈，所以津液亡失而更觉得干涸，口中辟辟干燥，咳嗽即胸中隐痛，津液既已枯竭，脉应该涩滞反而滑数的，是因为蓄热腐脓，脉故数实。
尤怡说：痿就是萎，像草木枯萎而不茂盛，是因为津亡而肺焦；痈就是壅，像泥土壅塞而不通，是因为热聚而肺壅。所以它们的脉有虚实不同，而其数则是一样的。
问：患咳嗽气逆，诊察脉象怎么知道这是肺痈？应当有脓血，吐出来就会死，它的脉象是什么样的？老师回答：寸口脉微而数，微则为风，数则为热；微则汗出，数则恶寒。风邪伤于卫分，呼气不能入内；热邪过于营分，吸气不能外出。风伤皮毛，热伤血脉。风邪舍于肺，病人就会咳嗽，口干，喘满，咽燥不渴，时常吐出浊沫，时时恶寒。热邪所经过的地方，血为之凝滞，蓄结成为痈脓，吐出的像米粥一样，刚开始萌芽时可以救治，脓成则死。
【按】在“肺痈”之上，应当有“肺痿”二字，否则本文论述肺痿的意义就没有着落，必然是脱简。脉微中的三个“微”字，应当是三个“浮”字，“微”字文气不通顺，必然是传写之讹。
【注】患咳嗽气逆的，怎么知道是肺痿还是肺痈呢？咳嗽而不渴，浊唾涎沫，脉数而虚，是根据脉证知道是肺痿。口中干燥，胸中隐痛，脉数而实，是根据脉证知道是肺痈。至于所以患病的缘由，肺痿前面已经讲过了，而肺痈却没有讲过，所以又取所以导致热而患肺痿肺痈的原因，互相详细阐明发明。寸口是肺脉，肺脉应当浮涩而短；现在浮而数，所以知道浮则为风，数则为热，初病风热，外搏皮毛，则营卫受邪，所以汗出而恶寒。末传风热，内舍于肺，则营卫分病。患肺痿的，属于风热伤于卫气，气分有津液而无血，津液为之浊，所以其见证，咳嗽而不吐脓血，唾浊涎沫。患肺痈的，属于风热伤于营血，血分有血而无津液，血为之凝蓄，所以其见证，咳嗽而不唾涎沫，吐脓血如木粥一样。具备发热汗出，恶寒恶风，咳而喘满，咽燥不渴，呼气不入，吸气不出，就是痿、痈互相兼有的必然证候。呼气不入，吸气不出，是说呼吸气促，难出难入，并不是竟不出入。始萌可救，是说肺伤尚浅。脓成则死，是说肺已坏了。大概是告诉人们尽早图谋治疗，又特别为肺痈而谆谆告诫。
【注】这里承接上一条，以说明急治的意义。肺痈，是指口中辟辟干燥，胸中隐隐作痛，脉数实。而又加上喘不得卧，是邪气壅肺非常急迫，所以用葶苈大枣泻肺汤，大苦大寒，峻泻肺邪，恐怕稍加拖延，脓成就死了。
葶苈大枣泻肺汤方
葶苈（熬令黄色，捣碎，如弹子大小） 大枣（十二枚）
以上两味，先用三升水，煮枣，取得二升，去枣，放入葶苈，煮取一升，一次服下。
【集解】赵良说：这是治疗肺痈的关键方剂。肺中生痈，不泻等待什么？恐怕日久痈脓已成，泻之无益。日久肺气已索然，泻之转伤，趁着血结而脓未成，应当急以泻法夺之，何况喘不得卧，不也是很严重吗。
肺痈，胸满胀，一身面目浮肿，鼻塞流清涕，不闻香臭酸辛，咳逆上气，喘鸣迫塞，用葶苈大枣泻肺汤主治（方见上）。
【注】这里承接上一条互详其证，以同其治。肺痈胸胀而满，咳逆上气，喘鸣迫塞，一身面目浮肿，鼻塞清涕出，不闻香臭酸辛，是邪气外塞皮毛，内壅肺气，比之喘不得卧，大概更加严重。也用葶苈大枣泻肺汤，是因为脓尚未形成的缘故。
咳嗽而胸满，振寒脉数，咽干不渴，时常吐出浊唾腥臭，久久吐脓如米粥的，是肺痈，用桔梗汤主治。
【注】咳嗽而胸满，振寒脉数，咽干不渴，时常吐出浊唾腥臭，久久吐脓如米粥的，这是肺痈证。肺痈尚未成脓实邪，所以用葶苈之剂泻之；现在已经溃后虚邪，所以用桔梗之苦，甘草之甘，解肺毒排痈脓。这是治疗已成肺痈，轻而不死者的方法。
【集注】高世栻说：吐如米粥也是脓，为什么上文说脓成则死？如果说如米粥者不是脓，上文既然说：蓄结痈脓，吐如米粥；这里又说：吐脓如米粥，既然吐脓了，哪里还有始萌脓成的区别呢？我说：上文先咳逆，而呼吸不利，后凝滞而血脉成脓，阴阳血气皆伤，所以脓成则死。如果上节言肺痈而气机不利，此节言肺痈而经络不和，病阳气者不伤阴，病血脉者不伤阳，所以可治。如果仅以“始萌可救，脓成则死”两句话概括，是以辞害志，怎么可以呢？
桔梗汤方
桔梗（一两） 甘草（二两）
以上两味，用水三升，煮取一升，分两次温服，则会吐出脓血。
肺痿吐涎沫而不咳嗽的，病人不渴，必然遗尿，小便频数。之所以这样，是因为上虚不能制下，这是肺中冷，必然眩晕多涎唾，用甘草干姜汤以温之。如果服药后感到口渴的，属于消渴。
【注】咳嗽而不吐涎沫的，是肺燥咳；咳嗽而吐涎沫的，是肺热痿。如果像肺痿之吐涎沫而不咳嗽的，这是肺中有冷冻饮料，不是肺中成热痿。肺中冷，那么病人必然不渴，遗尿小便数，头眩多涎唾。之所以这样，是因为上焦阳虚，不能约制下焦阴水，下焦之水泛上而唾涎沫，用甘草干姜汤以温散肺之寒饮。如服药后感到口渴的，属于消渴，谓开始不渴，服温药即转渴的，不但非肺中热，亦非肺中冷，乃胃中热也，则不应当以属肺中冷寒饮治之，当以属胃中热消渴治之。
甘草干姜汤方
甘草（炙，四两） 干姜（炮，二两）
以上两味，切碎，用水三升，煮取一升五合，去滓，分两次温服。
【注】咳逆上气，谓咳嗽则气上冲逆。上一条发明不咳而吐涎沫的，不是肺痿，是为肺冷。这一条发明咳嗽而不吐涎沫的，也不是肺痿，也是肺冷。上一条以不渴，小便数，多唾涎沫为肺中冷，所以用干姜佐甘草，是以温中为主。这一条以气上逆，喉中有水鸡声为肺经寒，所以用生姜佐麻黄，是以散外为主。病同冷冻饮料，而有在外在内之别；方同辛温，而有主温主散之异。水鸡声者，谓水与气相触之声，在喉中连连不绝。
射干麻黄汤方
射干（三两） 麻黄（四两） 生姜（四两） 细辛 紫菀 款冬花（各三两） 五味子（半升） 大枣（七枚） 半夏（半升）
以上九味，用水一斗二升，先煮麻黄两沸，去上沫，内诸药，煮取三升，分三次温服。
【集解】程林说：咳而上气，如水鸡声连连不绝的，用此方主治。《内经》说：肺苦气上逆，急食苦以泻之。射干、紫菀之苦，所以泄逆气。以辛泻之，麻黄、生姜、细辛、半夏、款冬花之辛，所以泻风邪。以酸收之，以酸补之，五味子之酸，以补不足。虚则补其母，大枣之甘，所以补其母。
气逆严重，咽喉不利，止逆下气的，用麦门冬汤主治。
【按】大逆上气的“大”字，应当是“火”字，文义病药始属，必然是传写之讹。
【注】咳而上气，咽喉有水鸡声而连连的，是寒饮上逆。现在咳而上气，咽喉无水鸡声而不利，是火气上逆。不利者，谓咽喉若有物相碍，不爽利。主之以麦门冬汤，止其火逆，下其上气。
麦门冬汤方
麦门冬（七升） 半夏（一升） 人参（三两） 甘草（二两） 粳米（三合） 大枣（十二枚）
以上六味，用水一斗二升，煮取六升，温服一升，日三服，夜一服。
【集解】周扬俊说：喻昌说：这是胃中津液枯燥，虚火上炎之证，麦冬汤乃是治本的良好方法。夫用降火之药而火反升，用寒凉之药而热转炽的，不惟无益，反而有害。凡病有胃气则生，无胃气即死，胃气者，肺之母气。《本草》有知母之名者，谓肺藉其清凉，知清凉为肺之母。有贝母之名者，谓肺藉其豁痰实，豁痰为肺之母；然而屡施于火逆上气，咽喉不利之证，而屡不应，名不称。谁知道仲景有此妙法，于麦冬、人参、甘草、粳米大补中气，大生津液队中，增入半夏之辛温一味，其利咽下气，非半夏之功，实善用半夏之功，擅古今未有之奇。
【注】咳逆上气，喉中有水鸡声的，是寒饮冲肺，射干麻黄汤证。咳逆上气，咽喉不利的，是火气冲肺，麦门冬汤证。现在咳逆上气，只是时时吐浊，痰涎多。只能坐不能卧，气逆甚。此痰气为病，非寒饮亦非火气。主之以皂荚丸，宣导其痰，通达其气；佐枣膏之甘，以药性剽悍缓其势。
【集注】程林说：浊唾壅塞于肺，则不得卧，所以时时吐浊。皂荚味辛咸，辛能散，咸能软，宣壅导滞，利窍消风，莫过于此。所以咳逆上气，时时吐浊，坐不得卧者宜之。然药性剽悍，佐枣膏之甘，以缓其药势。
魏荔彤说：咳逆上气，时时吐浊，只能坐不能眠，则较重于喉中水鸡声者。声滞者，挟外感之因；吐浊则内伤之故；只能坐不能卧，而肺痈之证将成。是上焦有热，痰血包裹，结聚成患，不可不急为宣通其结聚，而后才可以津液徐生，枯干获润，皂荚丸主治，皂荚驱风理痹，正为其有除瘀涤垢之能。咳逆上气，时时吐浊，胸膈恶臭之痰血已结，可不急为涤荡，使之湔洗不留乎？如今用皂荚澡浴以除垢腻，即此理。用丸俾徐徐润化，自上而下，而上部方清。若用汤直泻元余，不能治上部之胶凝，古人立法诚善哉。此为预治肺痈将成者主治。
Question: When heat is located in the Upper Jiao (Upper Burner), it leads to Lung Asthma (Fei Wei) due to coughing. How does this disease of Lung Asthma arise? The Master replied: It may arise from excessive sweating, or from vomiting, or from Xiao Ke (Wasting and Thirsting Syndrome) causing frequent urination, or from constipation followed by the mistaken use of drastic purgatives leading to diarrhea, resulting in a severe loss of Body Fluids (Jin Ye). Therefore, one contracts this disease. Question: If the Cun Kou (Inch position at the radial artery) pulse is rapid, the patient coughs, and there is instead turbid saliva and froth in the mouth, what is the reason? The Master replied: This is the disease of Lung Asthma. If the mouth feels dry, and coughing causes a dull pain in the chest, while the pulse is instead slippery and rapid, this is Lung Abscess (Fei Yong), characterized by coughing up pus and blood.
[Commentary] Heat in the Upper Jiao does not cause Lung Asthma unless accompanied by coughing; because heat disease involves coughing, it leads to Lung Asthma. The causes of lung heat leading to atrophy are manifold: either from sweating, or from vomiting, or from Xiao Ke with frequent urination, or from constipation treated with drastic purgatives, causing a severe depletion of Body Fluids, thus resulting in lung heat and dry atrophy. When the lung suffers from heat-induced dry atrophy, its clear and descending function fails, and the distribution of water and essence becomes disordered. Although the Spleen scatters essence and sends fluids up to the Lung, the Lung cannot moisten itself internally, nor can it distribute essence to the Zang-Fu organs internally, nor transport essence to the skin and hair externally. These fluids remain stored in the chest, where they are boiled by heat into saliva and froth, invading the lung and causing coughing. Continuous expectoration leads to a state where the dry remains dry and the expelled fluid continues to be expelled; the more one expects, the drier it becomes, and the disease of Lung Asthma is formed. If the mouth feels parched, without expectorating turbid saliva and froth, and each cough triggers a dull pain in the chest, with a pulse that is rapid and slippery, or rapid and deficient, this is not Lung Asthma but Lung Abscess. When the abscess matures and ruptures, one will no longer expectorate froth but will inevitably cough up pus and blood.
[Collected Commentaries] Zhou Yangjun states: Yu Chang says: Upon moving just a few steps, the patient wheezes audibly, producing continuous sounds upon impact, with phlegm responding to each sound. The treatment principles in the *Jin Gui Yao Lue* emphasize grasping the essential intent: generally, one should proceed slowly, generate Stomach fluids, moisten lung dryness, descend rebellious Qi, resolve accumulated phlegm, stop turbid saliva, tonify true Qi, unblock the small passages of the lung, dissipate fire-heat, and restore the lung's clarity and descending function. Just as flaccidity of half the body or weakness of the limbs can recover if treated correctly, so too must effort be made for the lung, which is close to the chest and vital for respiration. Lung Abscess belongs to tangible blood pathology; blood stasis requires rapid attack. Lung Asthma belongs to intangible Qi pathology; Qi injury requires gradual management. Thus, an abscess is Excess; treating it as Asthma constitutes "treating excess as excess." Asthma is Deficiency; treating it as an Abscess constitutes "treating deficiency as deficiency." This is the general principle of syndrome differentiation and medication. However, the Cun Kou pulse on both hands originally refers to the Hand Taiyin Lung meridian. Here, references to Cun Kou pulse being rapid, slippery-rapid, number-excess, or number-deficient refer collectively to the three positions on both left and right sides, not exclusively to the Qi Kou (radial artery) governing the Right Guan position alone. When a patient coughs and has turbid saliva and froth in the mouth, spreading everywhere shortly after, it is Lung Asthma, indicating the mouth is not dry. If coughing is accompanied by a parched mouth, it indicates the lung has formed an abscess; the toxicity of fire-heat manifests in the mouth. The vibration of coughing touches the abscess, causing dull chest pain, and the pulse must appear slippery, rapid, and forceful, signaling the peak of pathogenic and righteous qi. Using rapid-deficient and rapid-excess pulses to distinguish between Lung Asthma and Lung Abscess reveals that Asthma requires tonification and Abscess requires purgation. Furthermore, upon observing chronic cough, one must first guard against these two conditions. Lung Abscess arises from fire accumulated in the five Zang organs and heat retained in the Stomach, ascending to the lung. The lung is scorched by fire-heat, causing blood to coagulate and phlegm to wrap around it, forming a small abscess. As the formed shape grows, the lung swells daily and the ribs elevate, leading to frequent coughing, thick phlegm like glue, fever and aversion to cold (worse in the afternoon), red face, dry nose, and skin lesions on the chest resembling fish scales. If identified early by pulse and symptoms, determining whether it is exterior or interior, and vigorously applying lifting and purging methods, recovery is assured. However, once blood turns to pus and lung tissue rots, expelling it like an overturned bag, recognition comes too late; ten cases result in death, alas, it is too late.
Shen Mingzong states: This distinguishes Lung Asthma from Lung Abscess. The Heart resides superiorly; when Kidney Water is insufficient, Heart Fire insults Metal (Lung), creating heat in the Upper Jiao. Lung Yin is consumed daily, Qi rebels causing cough, thus leading to Lung Asthma. The classic explicitly states the initial causes: either post-illness Yin deficiency with excessive sweating injuring fluids, vomiting injuring Jin Ye, Xiao Ke with blood deficiency and fluid exhaustion; or diuretics causing frequent urination and injuring Yin; or constipation treated wrongly with drastic purgatives causing severe fluid loss. This leads to Dryness of Lung Metal, steaming by deficient heat, resulting in a rapid Cun Kou pulse, coughing, weak Qi, failure of fluid distribution, transformation into turbid saliva and froth, forming Lung Asthma. If the mouth is parched and coughing causes dull chest pain, it is Wind-Cold invading the lung, stagnating Ying-Blood to form an abscess, hence a slippery-rapid pulse and coughing up pus and blood. Because intangible deficient heat causes atrophy, the pulse is rapid-deficient; because tangible Qi-Blood stagnation forms an abscess, the pulse is rapid-excess. This clarifies that Lung Abscess is Excess and Lung Asthma is Deficiency.
A rapid-deficient pulse indicates Lung Asthma; a rapid-excess pulse indicates Lung Abscess.
[Commentary] This elaborates on the pulses for Lung Asthma and Lung Abscess mentioned previously. Lung Asthma arises from heat depleting Body Fluids, representing a Deficient pathogen, hence the pulse is rapid and deficient. Lung Abscess arises from heat-toxin accumulation, representing an Excess pathogen, hence the pulse is rapid and excess.
[Collected Commentaries] Li [Name missing] states: Pan Shuofu says: Both Asthma and Abscess involve heat in the Upper Jiao, rapid pulses, coughing, and loss of Body Fluids, appearing similar. However, Asthma belongs to Lung Qi deficiency and fluid loss; although there is heat, it is not fierce, so it does not reach desiccation. Despite coughing, there is turbid saliva and froth in the mouth, so the pulse is rapid but deficient. Abscess involves Qi congestion and Blood coagulation, with strong pathogens and intense heat; thus, fluid loss leads to greater dryness, a parched mouth, and dull chest pain upon coughing. With fluids exhausted, the pulse should be choppy but is instead slippery and rapid due to accumulated heat rotting into pus, making the pulse rapid and excess.
You Yi states: "Wei" (Asthma/Atrophy) means withering, like plants losing vigor due to fluid loss and lung scorching; "Yong" (Abscess) means obstruction, like earth blocking flow due to heat aggregation and lung congestion. Thus, their pulses differ in deficiency and excess, but both are rapid.
Question: In cases of coughing and rebellious Qi, how do we know this is Lung Abscess? There should be pus and blood; if vomited, death ensues. What does the pulse resemble? The Master replied: 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, preventing exhalation from entering; Heat overcomes the Ying (Nutritive) level, preventing inhalation from exiting. Wind damages the skin and hair; Heat damages the vessels and blood. Wind settles in the Lung, causing cough, dry mouth, wheezing and fullness, dry throat without thirst, occasional expectoration of turbid froth, and periodic chills. Wherever Heat passes, blood coagulates and stagnates, accumulating into an abscess. Expectoration resembles rice porridge. If caught at the萌芽 (germination/early stage), it can be saved; once pus is formed, death occurs.
[Note] Before "Lung Abscess," the characters "Lung Asthma" should likely exist; otherwise, the discussion of Lung Asthma lacks context, suggesting a missing slip. The three instances of "faint" (Wei) in the pulse description should likely be "floating" (Fu); "faint" disrupts the textual logic, likely a transcription error.
[Commentary] Regarding coughing and rebellious Qi, how do we distinguish Asthma from Abscess? Coughing without thirst, with turbid saliva and froth, and a rapid-deficient pulse identifies Lung Asthma. A dry mouth, dull chest pain, and rapid-excess pulse identify Lung Abscess. The causes of illness were explained for Asthma previously but not for Abscess; thus, the reasons for heat causing these diseases are detailed here. Cun Kou is the Lung pulse; normally floating, choppy, and short. Now it is floating and rapid; thus, floating indicates Wind, rapid indicates Heat. Initially, Wind-Heat attacks the exterior, affecting Ying and Wei, causing sweating and aversion to cold. Later, Wind-Heat moves inward to the Lung, affecting Ying and Wei separately. Lung Asthma results from Wind-Heat injuring Wei-Qi; the Qi level has fluids but no blood pathology, so fluids become turbid. Hence, symptoms include coughing without pus/blood, but with turbid froth. Lung Abscess results from Wind-Heat injuring Ying-Blood; the Blood level has blood but no fluid pathology, so blood coagulates. Hence, symptoms include coughing without froth, but with pus/blood resembling rice porridge. Symptoms including fever, sweating, aversion to cold/wind, coughing with wheezing/fullness, dry throat without thirst, difficulty exhaling/inhaling, indicate combined Asthma and Abscess. "Difficulty exhaling/inhaling" refers to急促 breathing, not complete cessation. "Early stage saveable" means lung injury is shallow; "Pus formed fatal" means lung tissue is destroyed. This warns patients to seek treatment early, specifically emphasizing Lung Abscess.
For Lung Abscess with wheezing and inability to lie down, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated.
[Commentary] This follows the previous section to explain the necessity of urgent treatment. Lung Abscess is defined by a parched mouth, dull chest pain, and rapid-excess pulse. Added with wheezing and inability to lie down, it indicates severe lung congestion by pathogens. Therefore, Ting Li Da Zao Xie Fei Tang, bitter and cold, strongly drains lung pathogens, fearing that delay will lead to pus formation and death.
Ting Li Da Zao Xie Fei Tang Formula
Ting Li Zi (Descurainiae Semen, fried until yellow, pounded, size of a bullet) - 1 portion
Da Zao (Jujubae Fructus, 12 pieces)
Boil Jujubes in 3 sheng of water to obtain 2 sheng. Remove Jujubes. Add Ting Li Zi. Boil to obtain 1 sheng. Take all at once.
[Collected Explanation] Zhao Liang says: This is the critical formula for Lung Abscess. An abscess in the lung demands draining. One must fear that if delayed until pus forms, draining is useless. If lung Qi is depleted, draining causes further harm. One must act while blood is congealed but pus has not yet formed, using draining methods to seize the pathogen. Especially with wheezing and inability to lie down, the condition is severe.
For Lung Abscess with chest fullness and distension, edema of the whole body and face, nasal congestion with clear discharge, loss of smell for fragrant/foul/sour/spicy odors, coughing and rebellious Qi, wheezing and choking, Ting Li Da Zao Xie Fei Tang (see above) is indicated.
[Commentary] This elaborates on the symptoms from the previous section to unify the treatment. Chest fullness, coughing/rebellious Qi, wheezing/choking, edema, nasal congestion, and anosmia indicate pathogens obstructing the exterior skin/hair and congesting the lung internally. This is worse than mere wheezing/inability to lie down. Ting Li Da Zao Xie Fei Tang is used because pus has not yet formed.
For coughing with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of turbid foul-smelling sputum, and long-term expectoration of pus resembling rice porridge, this is Lung Abscess. Jie Geng Tang (Platycodon Decoction) is indicated.
[Commentary] These symptoms constitute Lung Abscess. Since the abscess has not yet fully formed into solid excess, Ting Li formulas drain it. Now that it has ulcerated, becoming a deficient pathogen, Jie Geng's bitterness and Gan Cao's sweetness resolve lung toxicity and expel abscess pus. This treats established Lung Abscess that is mild and non-fatal.
[Collected Commentaries] Gao Shishi asks: Expectorating rice-porridge-like substance is also pus. Why did the text earlier say "pus formed means death"? If rice-porridge-like substance is not pus, why did the earlier text say "accumulated abscess pus, expectorating rice porridge"? And here "expectorating pus like rice porridge"? If pus is expectorated, what distinction remains between early stage and formed pus? I answer: The earlier section describes coughing/rebellious Qi with breathing difficulty, followed by blood coagulation and pus formation, injuring both Yin-Yang and Qi-Blood, hence "pus formed means death." The current section discusses Lung Abscess with Qi mechanism dysfunction versus Meridian dysfunction. Disease affecting Yang Qi does not injure Yin; disease affecting Blood vessels does not injure Yang, hence it is treatable. Relying solely on "early stage saveable, pus formed fatal" misinterprets the intent.
Jie Geng Tang Formula
Jie Geng (Platycodonis Radix, 1 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, 2 liang)
Boil these two ingredients in 3 sheng of water to obtain 1 sheng. Divide into two warm doses. Pus and blood will be expectorated.
For Lung Asthma with expectoration of froth but no coughing, where the patient is not thirsty, inevitably experiencing enuresis and frequent urination: This occurs because the upper deficiency cannot control the lower. This is Cold in the Lung, characterized by vertigo and abundant saliva/froth. Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) is used to warm it. If the patient feels thirsty after taking the decoction, it belongs to Xiao Ke (Wasting and Thirsting).
[Commentary] Coughing without froth indicates Lung Dryness Cough; coughing with froth indicates Lung Heat Asthma. If one expects froth like Asthma but does not cough, this is "Cold Drink" (Frozen Beverage) in the Lung, not Heat Asthma. Lung Cold implies no thirst, enuresis, frequent urination, vertigo, and abundant froth. This happens because Upper Jiao Yang deficiency fails to constrain Lower Jiao Yin Water, allowing Lower Jiao water to flood upward as froth. Gan Cao Gan Jiang Tang warms and disperses Lung Cold-Fluid. If thirst develops after taking warming medicine, it indicates Stomach Heat (Xiao Ke), not Lung Heat or Lung Cold, and should be treated accordingly.
Gan Cao Gan Jiang Tang Formula
Gan Cao (Licoricae Radix et Rhizoma, roasted, 4 liang)
Gan Jiang (Zingiberis Rhizoma, processed, 2 liang)
Crush these ingredients. Boil in 3 sheng of water to obtain 1.5 sheng. Remove dregs. Divide into two warm doses.
For coughing with rebellious Qi and a "water-chicken" sound in the throat, She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction) is indicated.
[Commentary] "Coughing and rebellious Qi" means Qi rushes upward with coughing. The previous section clarified that non-coughing froth-expectoration is Lung Cold. This section clarifies that coughing without froth is also Lung Cold. The previous section used Gan Jiang assisting Gan Cao for internal warming (due to no thirst, frequent urination, froth). This section uses Sheng Jiang assisting Ma Huang for external dispersion (due to rebellious Qi and water-chicken sound in the throat). Both involve Cold-Fluid, but one is internal and one external; both use Acrid-Warm formulas, but one focuses on warming and the other on dispersing. "Water-chicken sound" refers to the sound of water and Qi interacting continuously in the throat.
She Gan Ma Huang Tang Formula
She Gan (Belamcandae Rhizoma, 3 liang)
Ma Huang (Ephedrae Herba, 4 liang)
Sheng Jiang (Zingiberis Rhizoma Recens, 4 liang)
Xi Xin (Asari Radix et Rhizoma, 3 liang)
Zi Wan (Stemonae Radix, 3 liang)
Kuan Dong Hua (Farfarae Flos, 3 liang)
Wu Wei Zi (Schisandrae Fructus, 0.5 sheng)
Da Zao (Jujubae Fructus, 7 pieces)
Ban Xia (Pinelliae Rhizoma Preparatum, 0.5 sheng)
Boil these nine ingredients in 12 sheng of water. First boil Ma Huang for two boils, remove foam. Add remaining herbs. Boil to obtain 3 sheng. Divide into three warm doses.
[Collected Explanation] Cheng Lin says: For coughing with rebellious Qi and continuous water-chicken sounds, this formula is indicated. The *Nei Jing* states: "The Lung dislikes Qi rebellion; urgently use Bitter to drain it." She Gan and Zi Wan are bitter to drain rebellious Qi. Use Acrid to drain: Ma Huang, Sheng Jiang, Xi Xin, Ban Xia, Kuan Dong Hua are acrid to drain Wind-Pathogens. Use Sour to astringe and tonify: Wu Wei Zi is sour to tonify deficiency. Tonify the Mother when deficient: Da Zao is sweet to tonify the Mother (Earth generates Metal).
For severe rebellious Qi and unsmooth throat, use Mai Men Dong Tang (Ophiopogon Decoction) to stop rebellion and descend Qi.
[Note] The character "Da" (Great) in "Da Ni Shang Qi" (Severe Rebellious Qi) should likely be "Huo" (Fire); this makes the text, disease, and medicine consistent, suggesting a transcription error.
[Commentary] Coughing with rebellious Qi and water-chicken sounds indicates Cold-Fluid rebelling upward. Current coughing with rebellious Qi but no water-chicken sound, only unsmoothness, indicates Fire-Qi rebelling upward. "Unsmooth" means a sensation of obstruction in the throat. Mai Men Dong Tang stops Fire-Rebellion and descends Qi.
Mai Men Dong Tang Formula
Mai Men Dong (Ophiopogonis Radix, 7 sheng)
Ban Xia (Pinelliae Rhizoma Preparatum, 1 sheng)
Ren Shen (Ginseng Radix, 3 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang)
Jing Mi (Oryza Sativa, 3 he)
Da Zao (Jujubae Fructus, 12 pieces)
Boil these six ingredients in 12 sheng of water to obtain 6 sheng. Take 1 sheng warm, three times daily, once at night.
[Collected Commentaries] Zhou Yangjun states: Yu Chang says: This is a syndrome of Dry Stomach Fluids with Deficient Fire flaming upward. Mai Men Dong Tang is the fundamental treatment. Using Fire-Descending drugs causes Fire to rise; using Cold-Cool drugs intensifies Heat, doing harm rather than good. Life depends on Stomach Qi; death follows its absence. Stomach Qi is the Mother of Lung Qi. The *Ben Cao* names Zhi Mu (Anemarrhenae Rhizoma) implying the Lung relies on its coolness, knowing coolness is the Lung's mother. Bei Mu (Fritillariae Bulbus) implies the Lung relies on resolving phlegm, knowing phlegm-resolution is the Lung's mother. Yet these often fail for Fire-Rebellion and unsmooth throat. Who knew Zhang Zhongjing had this brilliant method? By combining Mai Men Dong, Ren Shen, Gan Cao, and Jing Mi to greatly tonify Middle Qi and generate fluids, adding Ban Xia (Acrid-Warm), the benefit of smoothing the throat and descending Qi lies not in Ban Xia itself, but in the masterful use of Ban Xia, achieving a uniqueness unseen before.
For coughing and rebellious Qi, frequent expectoration of turbid matter, and inability to lie down (only sitting possible), Zao Ying Wan (Soapberry Pill) is indicated.
[Commentary] Coughing/rebellious Qi with water-chicken sound is Cold-Fluid attacking the Lung (She Gan Ma Huang Tang pattern). Coughing/rebellious Qi with unsmooth throat is Fire-Attacking the Lung (Mai Men Dong Tang pattern). Current coughing/rebellious Qi with only frequent turbid expectoration (abundant phlegm-saliva) and inability to lie down (severe Qi rebellion) indicates Phlegm-Qi pathology, neither Cold-Fluid nor Fire. Zao Ying Wan guides out phlegm and unblocks Qi; assisted by Jujube Paste's sweetness to moderate the harsh nature of the drug.
[Collected Commentaries] Cheng Lin says: Turbid saliva obstructing the Lung prevents lying down, hence frequent expectoration. Zao Ying (Soapberry) is Acrid-Salty; Acrid disperses, Salty softens. It opens congestion, guides stagnation, benefits orifices, and eliminates wind/phlegm better than any other herb. Thus, it suits coughing/rebellious Qi with frequent turbid expectoration and inability to lie down. Its harsh nature is moderated by Jujube Paste.
Wei Litong says: Coughing/rebellious Qi with frequent turbid expectoration and inability to lie down is more severe than the water-chicken sound. The latter involves external contraction; the former involves internal injury. Inability to lie down suggests impending Lung Abscess. This indicates Upper Jiao Heat with Phlegm-Blood wrapping and knotting. Urgent resolution of this knotting allows fluids to regenerate and dryness to moisten. Zao Ying Wan drives Wind and resolves Bi, possessing the ability to remove stasis and cleanse filth. Coughing/rebellious Qi with foul Phlegm-Blood knots in the chest/diaphragm requires urgent cleansing. Like using soapberry for bathing to remove grease, pills allow slow dissolution from top to bottom, clearing the upper part. Decoctions would purge too directly to treat upper sticky congestion. Ancient legislation is truly excellent. This is the primary treatment for pre-empting Lung Abscess.
Zao Ying Wan Formula
Zao Ying (Gleditsiae Spina, scraped, processed with butter, 8 liang)
Grind into powder. Form pills the size of Wuzi (Chinese parasol tree seeds) with Honey. Take 3 pills mixed with Jujube Paste decoction, three times daily, once at night.
Rebellious Qi, facial edema, shoulder-respiration (using accessory muscles to breathe), with a Floating-Large pulse is untreatable; if accompanied by Diarrhea, it is even worse.
[Commentary] "Rebellious Qi" refers to coughing and Qi rebellion. "Facial edema" refers to swelling of the face and eyes. "Shoulder-respiration" refers to wheezing/labored breathing. A Floating-Large pulse indicates untreatability; diarrhea exacerbates the prognosis.