一损损于肾。二损损于肝。三损损于脾。即仲景所言失精之虚劳也。（右节文）念庭之说是也。盖五劳六极七伤。
其目虽殊。要其指归。不出于阳虚阴虚二端。且不啻不出于此二端。而阴虚阳亢者。实为居多。今篇首既冠以男子
二字。而细检各条。大抵莫不属阴虚矣。小建中汤。扶脾之剂也。而其证则亦是上盛下虚。其用此汤。亦取于和阳
就阴。顾脱气一条。犹系于阴虚阳随衰者。酸枣汤。治火亢虚烦。心神不宁者。然则谓仲景所云虚劳者。皆属阴虚
可乎。如大黄 虫丸证。即骨蒸之类。而肺痿一证。是劳嗽之谓。则今之虚损劳瘵者。实不外于仲景所举之数件矣。
（愚撰药治通义。于补法下。以建中肾气二证。对待为辨。然今更考之。其方则为补阳补阴之分。而其证。则不必
胃虚肾虚之别。旧见不免谬。）
论三首 脉证四条（三字。四字。并讹。宜订。） 方十五首（五。当作六。）
问曰。热在上焦者。因咳为肺痿。（脉经。千金。又。作数。）
按喻氏曰。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。徐氏沈氏周氏朱氏皆从此说。
然肺痿之病。必损血液。则以气血立辨者。谬矣。
又按口中反有浊唾涎沫。盖系于该言稠痰白沫者。本经所谓痰者。非今之所谓痰。次条曰。多唾浊沫。皂荚丸
条曰。时时唾浊。桔梗汤条曰。时出浊唾。五脏风寒篇曰。肺中风。吐浊涕之类。皆今之稠痰也。盖肺萎液燥。而
口中有唾涎。故下反字也。（巢源虚劳凝唾候曰。肾液为唾。上焦生热。热冲咽喉。故唾凝结也。此亦稠痰耳。）又
脉反滑数。反字难解。稻叶元熙曰。反于肺痿亡津液之脉。或者。仁存孙氏方曰。详观肺痈肺痿二证。实难治。要
之肺痈则间有可愈者。亦须肺未穿。故可救。但肺痿罕有安者。盖其肺枯竭干燥。何由而得润。所以难愈。
问曰。病咳逆。何以知此为肺痈。（风则之则。原本无之。辑义偶衍。宜删。）
按此条。列呼吸不利。咳口干等候。就风与热。以为分别。然大旨不过云风壅酿热。以为此病耳。
又按热过于荣。热之所过。两过字。注未了。当读如诗江有汜。不我过之过。史记淮阴侯传。信常过樊将军哙。
魏其侯传。灌夫有服。过丞相。扁鹊传。舍客长桑君过之类。亦是。又吕览异宝。五员过于吴。注。过。犹至
也。义殆。相同。辨脉法曰。热之所过。则为痈脓。
又按脉经平肺痿肺痈中所载。出于本经之外者。凡六条。俱似非仲景原文。姑拈一条于左。曰。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。
肺痿吐涎沫。而不咳者。
按稻叶元熙曰。若服汤已渴者。属消渴。是假设之辞。与吴茱萸汤条。得汤反剧者。属上焦也同例。
射干麻黄汤方
按本篇用麻黄者四方。宜为二义看。注家皆谓。其证内饮挟外邪。故用麻黄发其表。是一义。今验肺胀证。多
是宿饮为时令触动者。而不必具表候。则其用麻黄。适取发泄肺中郁饮。亦犹麻杏甘石汤之意。是一义。盖勿拘一
隅可也。
咳逆上气。时时唾浊。
按曾世荣活幼心书曰。肺为五脏华盖。卧开而坐合。所以卧则气促。坐则但宽。盖但坐不得眠。得斯说而其理明矣。
皂荚丸方〔本草。图经云。张仲景治杂病方。咳逆上气。唾浊。得（政和作但）坐不得眠。皂角丸主之。
皂荚。杵末。一物以蜜丸。大如梧子。以枣膏和汤服一丸。日三夜一服。〕
按本草皂荚条黑字云。除咳嗽囊结。又有孙尚药治卒中风涎潮。救急稀涎散。盖胚胎于此方。
千金。治咳嗽胸胁支满。多唾上气方。
白糖（五分） 皂荚（末一方寸匕）
上二味。先微暖糖令消。内皂荚末。合和相得。丸如小豆。先食服二丸。咳而脉浮者。
按水饮上迫。脉必带浮。不必拘表证有无。此二方证。均是上焦蓄饮。而以脉浮沉为别者。盖以势之剧易。及
水饮上迫。与内结之异耳。注家特就邪为分。殆非通论。
浓朴麻黄汤方
按此方证。系寒饮迫肺。而无风寒外候。故于小青龙汤中。去桂枝。以浓朴降逆为君。其佐用杏仁。亦犹桂枝
加浓朴杏子汤之例。况配以石膏。其驱饮之力更峻。
泽漆汤方（千金。五合下。有日三夜一四字。无至夜尽字。本草。图经引。五合下。有日三二字。尽上。
有服字。）
按泽漆。本草白字。称味苦微寒。主大腹水气。四肢面目浮肿。黑字。称利大小肠。盖此方主证。水饮内结。
故有须于利水之品也。
又按陈藏器曰。千里水。及东流水。味平无毒。主病后虚弱。然则此方所用。在熟淡不助内饮已。又煮取五升。
温服五合。至夜尽。是一日十服。他方莫有此例。千金似是。然古之五升。即今之五合。古之五合。即今之五
勺。以今推之。日服五合。未必为多。岂东垣所谓在上者不厌频而少之谓乎。
大逆上气。咽喉不利。（外台无者字。宜从。）
麦门冬汤方（稻叶元熙曰。煎法。据竹叶石膏汤。温服上。恐脱去滓内粳米。煮米熟。汤成去米十二字。）
外台。崔氏疗骨蒸唇干口燥。欲得饮水。止渴。竹叶饮方。于本方。去人参。加竹叶。生姜。
又深师。疗肺气不足。逆满上气。咽喉中闭塞短气。寒从背起。口中如含霜雪。语言失声。甚者吐血。补肺汤
方。
于本方。去人参。半夏。加五味子。干姜。款冬花。桂心。桑根白皮。
肺痈喘不得卧。
按葶苈。下水疏肺壅。故的治肺痈脓未成者也。（金鉴所引赵氏注。据二注本。系于周氏补注。）
医心方。引范汪方云。葶苈熬。令紫色。治令自丸。丸如弹丸。大枣二十枚。以水二升煮枣。令得一升半。去
枣。内药一丸。复煎得一升。尽服之。（出支饮下。）本草图经引。亦作大枣二十枚。
按葶苈。以弹丸为率。故不须举两数。大枣。诸书皆作二十枚。本经疑是错写。（或曰。葶苈。捣之则粘腻。
足以自丸。不必补末蜜二字。）
外台。必效。疗天行病后。因食酒面。肺中热拥。遂成咳不止。
于本方。加桑白皮。桔梗。麻黄。
又崔氏。疗大腹水病。身体肿上气。小便涩赤。云云。
于本方。加杏仁。各捣。 和合。平旦空腹服八丸。云云。
幼幼新书。简要济众。治小儿水气腹肿。兼下痢脓血。小便赤涩方。
葶苈子半两。以枣肉和。捣为丸。（施圆端效方。名散肿丸。）
鸡峰普济方曰。著作雷道矩病吐痰。顷间已及升余。咳不甚。面色黯郁。精神不快。兆告曰。肺中有痰。胸膈
不利。令服仲景葶苈大枣汤。一服讫已。觉胸中快利。略无痰唾矣。
桔梗汤方（原注血痹。当喉痹。然要是后人所续加。）
按排脓散。用枳实。芍药。桔梗。排脓汤。于本方。加生姜。大枣。是知桔梗有排脓之功。但此间所有。气味
轻淡。不足以抵当大病。彼土古时之品。则恐不如此也。
圣济。治肺痈涕唾涎沫。吐脓如粥。麦门冬汤方。
于本方。加麦门冬。青蒿心叶。
小青龙加石膏汤方
按麻杏甘石汤。浓朴麻黄汤。越婢加半夏汤。小青龙加石膏汤。皆麻黄石膏同用。麻黄发阳。石膏逐水。二味
相藉。而驱饮之力更峻。不必取之于发表清热。盖此四方。紧慢稍异。而其旨趣。则大约相均。要在临证之际。随
其剧易。以为审处耳。
附方
外台。炙甘草汤。（外台。桂枝二两。阿胶三两。炙。大麻子仁半升。大枣四十枚。擘。余同。方后云。上九
味切。以美酒七升。水八升相和。先煎八物。取四升。绞去滓。内胶上微火烊销。温服七合。日三夜一。）
按此方。施之泛泛恶心者。必增呕逆。温温液液。盖别有义。未考。又此方证。与麦门冬汤证相近。俱系滋养
上焦之剂。
千金。甘草汤。
按伤寒类要。以单甘草汤。治炙甘草汤证。其理一致。
千金。生姜甘草汤。
按此方亦治肺冷而萎。犹是甘草干姜汤之变方。沈氏说欠当。又而渴。当作不渴为妥。
千金。桂枝去芍药加皂荚汤。
按此方。桂枝去芍药汤。桂枝甘草汤之意。取之扶胸中阳气。不和调营卫。盖亦属肺冷之痿。
外台。桔梗白散。
按此条与桔梗汤。证一而方异。盖所传之本不同也。然肺痈其脓稍成。正气随衰。峻猛之剂。恐不能堪。王氏
所据。岂得无错乎。
千金。苇茎汤。
按此方主证。盖在虚实之间。
又按苏敬新修本草白瓜条曰。别录云。甘瓜子。主腹内结聚。破溃脓血。最为好。腹肾脾内痈汤要药。本草以
为冬瓜。但用蒂不云子也。又今肠痈汤中之用。俗人或用冬瓜子。非也。又案诸本草。单云瓜子。或云甘瓜子。今
此本误作白字。当改从甘也。（原本。脓。作浓。药。作乐。今从证类本草改。）此说可以确瓜瓣之为甜瓜矣。
医心方。张仲景方。治三十年咳。大枣丸方。
大枣（百枚去核） 杏仁（百枚熬） 豉（百二十枚）
凡三物。豉。杏仁。捣令相得。乃内枣。捣令熟和调。丸如枣核。一丸含之。稍咽汁。日二。渐增之良。（按
此疑杂病论之遗方。仍附于此。）
一损损伤于肾。二损损伤于肝。三损损伤于脾。这就是仲景所说的失精的虚劳病。（右节文）念庭的说法是正确的。大概五劳六极七伤，虽然名目不同，但归根结底，不出阳虚和阴虚两个方面。而且不仅是不出这两个方面，阴虚阳亢的情况，实际上占大多数。现在这篇开头既然冠以“男子”二字，而仔细检查各条内容，大抵都不属于阴虚了。小建中汤，是扶持脾气的方剂，但其证候却是上盛下虚，使用此汤，也是取调和阳气、归于阴分的意思。至于脱气一条，还关系到阴虚且阳气随之衰弱的情况。酸枣汤，治疗火亢盛导致的虚烦、心神不宁。那么，可以说仲景所说的虚劳，都属于阴虚吗？像大黄䗪虫丸的证候，就是骨蒸之类的病症；而肺痿这一证候，就是指劳嗽。那么现在的虚损劳瘵患者，实在没有超出仲景所列举的这几类了。（我撰写《药治通义》时，在补法下面，以建中汤和肾气丸两证作为对待辨析。然而现在再考证，这两方的功效确实是补阳与补阴的区别，但其证候，则不必拘泥于胃虚与肾虚的区别。旧时的见解不免有误。）
论三首 脉证四条（三字、四字，并属讹误，应当订正。） 方十五首（五，当作六。）
问曰：热在上焦的，因咳嗽而成为肺痿。（《脉经》、《千金》，又作“数”。）
按喻氏说：肺痈属于有形的血分，血结聚应当猛烈攻逐；肺痿属于无形的气分，气受伤应当缓慢调理。徐氏、沈氏、周氏、朱氏都遵从这一说法。然而肺痿的病，必定损耗血液，如果仅凭气血来辨别，那是错误的。
又按：口中反而有浊唾涎沫，这大概是针对前面说的稠痰白沫而言。《本经》所说的“痰”，不是现在所说的痰。次条说：“多唾浊沫。”皂荚丸条说：“时时唾浊。”桔梗汤条说：“时出浊唾。”五脏风寒篇说：“肺中风，吐浊涕”之类，都是现在的稠痰。大概肺痿津液干燥，而口中有唾涎，所以下面用了一个“反”字。（巢元方《虚劳凝唾候》说：肾液为唾，上焦生热，热冲咽喉，所以唾凝结。这也是稠痰罢了。）又脉象反而滑数，“反”字难以解释。稻叶元熙说：反于肺痿亡失津液的脉象。或者，仁存孙氏方说：详细观察肺痈和肺痿两证，确实难治。总之肺痈间或有可愈的，也必须肺未穿孔，所以可以救治。但肺痿很少有安好的，大概因为肺枯竭干燥，从哪里得到滋润呢？所以难愈。
问曰：病咳逆，怎么知道这是肺痈？（《风则》之“则”，原本没有，《辑义》偶然衍出，应当删除。）
按此条，列出呼吸不利、咳口干等候症状，就风与热来进行分别。但大意不过说是风邪壅滞酿成热邪，从而形成此病罢了。
又按：热过于荣（营），热之所过。“两过字”，注家解释不清楚。应当读如《诗·江有汜》“不我过”的“过”，《史记·淮阴侯传》“信常过樊将军哙”，《魏其侯传》“灌夫有服，过丞相”，《扁鹊传》“舍客长桑君过”之类，也是这个意思。又《吕览·异宝》“五员过于吴”，注解说：“过，犹至也。”义理大致相同。《辨脉法》说：热之所过，则为痈脓。
又按：《脉经》平肺痿肺痈中所载，出于《本经》之外的，凡六条，都像不是仲景原文。姑且拈出一条放在左边，说：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。医生反而不知道，而以伤寒治之，应该不愈。怎么知道有脓？脓在何处，怎么分别知道它的位置？老师说：假如脓在胸中者，为肺痈，其人脉数，咳唾有脓血。假设脓未成，其脉自紧数；紧去但数，脓为已成也。
肺痿吐涎沫，而不咳者，
按稻叶元熙说：如果服药后感到口渴的，属于消渴，这是假设的辞句，与吴茱萸汤条“得汤反剧者，属上焦也”同类。
射干麻黄汤方
按本篇使用麻黄的方子有四个，应当从两个意义来看待。注家都说，其证候内有饮邪挟带外邪，所以用麻黄发散表邪，这是一义。现在验证肺胀证，多是宿饮被时令触动所致，而不一定具备表证。那么使用麻黄，恰好取发泄肺中郁积的饮邪之意，也如同麻杏甘石汤的意思，这是另一义。大概不要拘泥于一隅就可以了。
咳逆上气，时时唾浊，
按曾世荣《活幼心书》说：肺为五脏华盖，卧时张开而坐时闭合。所以卧则气促，坐则稍宽。大概只能坐着不能躺下睡觉，有了这个说法，其道理就明白了。
皂荚丸方〔《本草》、《图经》云：张仲景治杂病方，咳逆上气，唾浊，得（政和本作“但”）坐不得眠，皂角丸主之。皂荚，杵末，一物以蜜丸，大如梧子。以枣膏和汤服一丸，日三夜一服。〕
按《本草》皂荚条黑字云：除咳嗽囊结。又有孙尚药治卒中风涎潮的救急稀涎散，大概胚胎于此方。
《千金》治咳嗽胸胁支满，多唾上气方。
白糖（五分） 皂荚（末一方寸匕）
上二味，先微暖糖令消，内皂荚末，合和相得，丸如小豆。先食服二丸。咳而脉浮者，
按水饮上迫，脉必带浮，不必拘泥于有无表证。此二方证候，均是上焦蓄积饮邪，而以脉浮沉来区别。大概是因为病势的轻重缓急，以及水饮上迫与内结的不同罢了。注家特别就邪气来区分，大概不是通达的论述。
浓朴麻黄汤方
按此方证候，系寒饮迫肺，而没有风寒外候。所以在小青龙汤中去掉桂枝，以浓朴降逆为君药。其佐药用杏仁，也如同桂枝加浓朴杏子汤的例子。何况配以石膏，其驱除饮邪的力量更峻猛。
泽漆汤方（《千金》，五合下，有“日三夜一”四字，无“至夜尽”字。《本草》、《图经》引，五合下，有“日三”二字，“尽”上，有“服”字。）
按泽漆，《本草》白字称：味苦微寒，主大腹水气，四肢面目浮肿。黑字称：利大小肠。大概此方主证候，是水饮内结，所以需要用利水的药物。
又按陈藏器说：千里水，及东流水，味平无毒，主病后虚弱。那么此方所用，在于熟淡而不助内饮罢了。又煮取五升，温服五合，至夜尽。是一日十服。其他方子没有这个例子。《千金》似乎是对的。然而古之五升，即今之五合；古之五合，即今之五勺。以今推之，日服五合，未必为多。难道是东垣所谓“在上者不厌频而少之”的意思吗？
大逆上气，咽喉不利。（《外台》无“者”字，宜从。）
麦门冬汤方（稻叶元熙说：煎法，据《竹叶石膏汤》“温服上”，恐怕脱去了“滓内粳米，煮米熟，汤成去米”十二字。）
《外台》，崔氏疗骨蒸唇干口燥，欲得饮水，止渴，竹叶饮方。于本方，去人参，加竹叶、生姜。
又《深师》，疗肺气不足，逆满上气，咽喉中闭塞短气，寒从背起，口中如含霜雪，语言失声，甚者吐血，补肺汤方。于本方，去人参、半夏，加五味子、干姜、款冬花、桂心、桑根白皮。
肺痈喘不得卧，
按葶苈，下水疏肺壅，所以确实治疗肺痈脓未成的病症。（《金鉴》所引赵氏注，据二注本，系于周氏补注。）
《医心方》，引范汪方云：葶苈熬，令紫色。治令自丸，丸如弹丸。大枣二十枚，以水二升煮枣，令得一升半。去枣，内药一丸，复煎得一升。尽服之。（出支饮下。）《本草图经》引，亦作大枣二十枚。
按葶苈，以弹丸为率，所以不需要举两数。大枣，诸书皆作二十枚。《本经》疑是错写。（有人说：葶苈，捣之则粘腻，足以自丸，不必补“末蜜”二字。）
《外台》、《必效》，疗天行病后，因食酒面，肺中热拥，遂成咳不止。于本方，加桑白皮、桔梗、麻黄。
又崔氏，疗大腹水病，身体肿上气，小便涩赤，云云。于本方，加杏仁，各捣，和合，平旦空腹服八丸，云云。
《幼幼新书》、《简要济众》，治小儿水气腹肿，兼下痢脓血，小便赤涩方。
葶苈子半两，以枣肉和，捣为丸。（《施圆端效方》，名散肿丸。）
《鸡峰普济方》说：著作雷道矩病吐痰，顷刻间已及升余，咳不甚，面色黯郁，精神不快。兆告说：肺中有痰，胸膈不利。令服仲景葶苈大枣汤。一服讫已，觉胸中快利，略无痰唾矣。
桔梗汤方（原注血痹，当喉痹，然要是后人所续加。）
按排脓散，用枳实、芍药、桔梗。排脓汤，于本方加生姜、大枣。是知桔梗有排脓之功。但此处所有的桔梗，气味轻淡，不足以抵挡大病。彼土古时之品，则恐怕不如此也。
《圣济》，治肺痈涕唾涎沫，吐脓如粥，麦门冬汤方。于本方，加麦门冬、青蒿心叶。
小青龙加石膏汤方
按麻杏甘石汤、浓朴麻黄汤、越婢加半夏汤、小青龙加石膏汤，皆是麻黄石膏同用。麻黄发阳，石膏逐水，二味相藉，而驱饮之力更峻猛。不必取之于发表清热。大概此四方，紧慢稍异，而其旨趣，则大约相均。要在临证之际，随其剧易，以为审处耳。
附方
《外台》，炙甘草汤。（《外台》，桂枝二两，阿胶三两，炙，大麻子仁半升，大枣四十枚，擘。余同。方后云：上九味切，以美酒七升，水八升相和，先煎八物，取四升，绞去滓，内胶上微火烊销，温服七合，日三夜一。）
按此方，施之泛泛恶心者，必增呕逆。温温液液，盖别有义，未考。又此方证候，与麦门冬汤证相近，俱系滋养上焦之剂。
《千金》，甘草汤。
按《伤寒类要》，以单甘草汤，治炙甘草汤证，其理一致。
《千金》，生姜甘草汤。
按此方亦治肺冷而萎，犹是甘草干姜汤之变方。沈氏说欠当。又“而渴”，当作“不渴”为妥。
《千金》，桂枝去芍药加皂荚汤。
按此方，桂枝去芍药汤、桂枝甘草汤之意，取之扶胸中阳气，不和调营卫。盖亦属肺冷之痿。
《外台》，桔梗白散。
按此条与桔梗汤，证一而方异，盖所传之本不同也。然肺痈其脓稍成，正气随衰，峻猛之剂，恐不能堪。王氏所据，岂得无错乎。
《千金》，苇茎汤。
按此方主证候，盖在虚实之间。
又按苏敬《新修本草》白瓜条曰：别录云：甘瓜子，主腹内结聚，破溃脓血，最为好，腹肾脾内痈汤要药。本草以为冬瓜，但用蒂不云子也。又今肠痈汤中之用，俗人或用冬瓜子，非也。又案诸本草，单云瓜子，或云甘瓜子，今此本误作白字，当改从甘也。（原本，脓，作浓。药，作乐。今从《证类本草》改。）此说可以确瓜瓣之为甜瓜矣。
《医心方》，张仲景方，治三十年咳，大枣丸方。
大枣（百枚去核） 杏仁（百枚熬） 豉（百二十枚）
凡三物，豉、杏仁，捣令相得，乃内枣，捣令熟和调，丸如枣核。一丸含之，稍咽汁，日二，渐增之良。（按此疑《杂病论》之遗方，仍附于此。）
One damage injures the Kidney. Two damages injure the Liver. Three damages injure the Spleen. This is what Zhongjing referred to as Xu Lao (Deficiency Consumption) involving loss of essence. (The text on the right) Nianting's interpretation is correct. Generally speaking, Wu Lao (Five Exhaustions), Liu Ji (Six Extremes), and Qi Shang (Seven Injuries), although their names differ, ultimately do not go beyond the two categories of Yang deficiency and Yin deficiency. Moreover, it is not just limited to these two; cases of Yin deficiency with Yang hyperactivity are actually the majority. Since this chapter begins with the word "Man," and upon careful examination of each clause, most do not belong to Yin deficiency. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is a formula that supports the Spleen, yet its syndrome involves excess above and deficiency below. Its use also aims to harmonize Yang and guide it towards Yin. As for the clause on Tuo Qi (Escaping Qi), it still relates to cases where Yin deficiency causes Yang to decline with it. Suan Zao Ren Tang (Sour Jujube Seed Decoction) treats irritability due to deficiency and restlessness of the Shen (Spirit) caused by hyperactive fire. Then, can we say that all Xu Lao mentioned by Zhongjing belongs to Yin deficiency? The syndrome of Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) is similar to Gu Zheng (Bone-steaming). And Fei Wei (Flaccidity of the Lung) refers to Lao Sou (Consumptive Cough). Therefore, current patients with Xu Sun (Deficiency Damage) and Lao Zhai (Consumption Disease) essentially fall within the few categories listed by Zhongjing. (In my work *Yao Zhi Tong Yi*, under the section on Tonification methods, I differentiated between Jian Zhong (Construct the Middle) and Shen Qi (Kidney Qi) syndromes. However, upon further investigation now, while the formulas indeed distinguish between tonifying Yang and tonifying Yin, the syndromes need not be strictly distinguished as Stomach deficiency versus Kidney deficiency. My previous view was undoubtedly erroneous.)
Three Treatises, Four Pulse-Syndrome Clauses (The characters "three" and "four" are errors and should be corrected.) Fifteen Formulas ("Five" should be "Six".)
Question: When heat is in the Upper Jiao (Upper Burner), coughing leads to Fei Wei (Lung Flaccidity). (*Mai Jing*, *Qian Jin*, also read as "Shu" [frequent]).
Commentary: Yu Shi said: Fei Yong (Lung Abscess) pertains to tangible blood; when blood is knotted, it should be attacked vigorously. Fei Wei pertains to intangible Qi; when Qi is injured, it should be managed slowly. Xu Shi, Shen Shi, Zhou Shi, and Zhu Shi all followed this theory. However, the disease of Fei Wei inevitably damages blood and fluids; therefore, distinguishing it solely based on Qi and Blood is incorrect.
Furthermore, the presence of turbid saliva and froth in the mouth seems to refer to the previously mentioned thick phlegm and white foam. The "Tan" (Phlegm) mentioned in the *Ben Jing* (*Shennong Ben Cao Jing*) is not what is meant by phlegm today. The next clause says: "Much spitting of turbid foam." The Zao Ying Wan (Gleditsia Sinensis Pill) clause says: "Often spitting turbid matter." The Jie Geng Tang (Platycodon Decoction) clause says: "Occasionally expelling turbid saliva." The *Wang Zang Feng Han Pian* (Wind-Cold of the Five Viscera Chapter) says: "Lung struck by wind, vomiting turbid mucus," etc., all referring to modern thick phlegm. Generally, Fei Wei involves dryness of lung fluids, yet there is saliva in the mouth, hence the use of the character "Fan" (Reverse/Contrary) below. (*Chao Yuan Fang* in *Xu Lao Ning Tuo Hou* states: Kidney fluid becomes saliva; heat arises in the Upper Jiao, rushing to the throat, causing saliva to coagulate. This is also thick phlegm.) Furthermore, the pulse is contrary to being slippery and rapid; the meaning of "contrary" is difficult to explain. Dao Ye Yuanxi said: It is contrary to the pulse of Fei Wei where body fluids and essence are lost. Alternatively, Sun Shi's prescription in *Ren Cun* states: Observing both Fei Yong and Fei Wei carefully, they are truly difficult to treat. Essentially, Fei Yong may occasionally heal, provided the lung has not perforated, thus it can be saved. But Fei Wei rarely recovers, because the lung is withered and dry, how can it obtain moisture? Hence, it is difficult to heal.
Question: In a case of coughing and rebellious Qi, how do we know this is Fei Yong (Lung Abscess)? (The character "Ze" in *Feng Ze* is absent in the original text; *Ji Yi* erroneously added it and should be deleted.)
Commentary: This clause lists symptoms such as difficulty breathing, cough, and dry mouth, differentiating based on Wind and Heat. However, the main idea is simply that wind obstruction generates heat, leading to this disease.
Furthermore, regarding "Heat passes through Ying (Nutritive)," the phrase "heat passes through" is not well explained by commentators. It should be read like the "Guo" (pass/visit) in the *Shi Jing* (*Book of Songs*) line "Bu Wo Guo" (Does not visit me), or in *Shi Ji* (*Records of the Grand Historian*), "Xin often visited General Fan Kuai," "Guan Fu, having mourning clothes, visited the Chancellor," Bian Que's biography mentions "Guest Chang Sang Jun visited." These are similar usages. Also in *Lü Lan* (*Lüshi Chunqiu*), "Wu Yuan passed through Wu," the commentary notes: "Guo means 'to arrive'." The meaning is likely identical. *Bian Mai Fa* (Method of Differentiating Pulses) states: Where heat passes, it becomes abscess and pus.
Furthermore, six clauses recorded in *Mai Jing* regarding Ping Fei Wei Fei Yong (Normal Lung Flaccidity and Lung Abscess) appear outside the *Ben Jing* and seem unlikely to be Zhongjing's original text. I will cite one here: Question: Chills and fever, Cun Kou (Cun position at the wrist) pulse is slippery and rapid. The person's diet and daily activities remain normal. This is an abscess disease. The physician, failing to recognize this, treated it as Shang Han (Cold Damage), which would not heal. How do we know there is pus? How do we distinguish its location? The Master said: If the pus is in the chest, it is Fei Yong. The patient's pulse is rapid, and they cough up pus and blood. If the pus has not yet formed, the pulse is naturally tight and rapid; if the tightness disappears leaving only rapidity, the pus has formed.
Fei Wei involves spitting saliva and foam without coughing,
Commentary: Dao Ye Yuanxi stated: If thirst occurs after taking the decoction, it belongs to Xiao Ke (Wasting-Thirst). This is a hypothetical statement, analogous to the Wuzhuyu Tang clause stating "worsening after taking the medicine indicates pathology in the Upper Jiao."
She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction)
Commentary: There are four formulas in this chapter using Ma Huang (Ephedrae Herba). They should be understood in two ways. Commentators generally state that the syndrome involves internal fluid retention complicated by external pathogens, so Ma Huang is used to release the exterior. This is one interpretation. However, verifying Fei Zhang (Lung Distension) cases, they are mostly triggered by seasonal changes affecting chronic fluid retention, without necessarily presenting exterior signs. Thus, using Ma Huang serves to vent the stagnant fluid in the lungs, similar to the intent of Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). This is the second interpretation. One should not be confined to a single perspective.
Rebellious Qi and coughing, often spitting turbid matter,
Commentary: Zeng Shirong in *Huo You Xin Shu* (*New Book for Saving Children*) stated: The Lung is the canopy of the five viscera; it opens when lying down and closes when sitting. Therefore, lying down causes shortness of breath, while sitting provides relief. Generally, one can sit but cannot lie down to sleep. With this explanation, the rationale becomes clear.
Zao Ying Wan (Gleditsia Sinensis Pill) [According to *Ben Cao* and *Tu Jing*: Zhongjing's formula for miscellaneous diseases, for rebellious Qi, spitting turbid matter, able to sit but unable to sleep, Zao Jiao Wan (Gleditsia Sinensis Pill) governs it. Gleditsia sinensis, pounded into powder, made into pills with honey, size of wu zi (Chinese parasol tree seeds). Take one pill with jujube paste and water, three times a day and once at night.]
Commentary: The black text in *Ben Cao* under Gleditsia sinensis states: Removes cough and scrofula. Additionally, Sun Shang Yao's Jiu Ji Xi Tan San (Emergency Phlegm-Resolving Powder) for sudden stroke with phlegm tide seems to have originated from this formula.
*Qian Jin* Formula for Cough, Chest and Hypochondriac Fullness, Much Spitting, and Rebellious Qi.
Bai Tang (White Sugar, 5 fen) Zao Ying Mo (Gleditsia sinensis powder, 1 fang cun bi)
Mix the two ingredients: first gently warm the sugar until melted, add the Gleditsia powder, mix well, and form pills the size of small beans. Take two pills before meals. In cases of cough with a floating pulse,
Commentary: When fluid retention presses upward, the pulse must carry a floating quality. One should not insist on the presence or absence of exterior signs. Both these formula syndromes involve fluid retention in the Upper Jiao, distinguished by floating versus deep pulses. This is due to the severity of the condition and the difference between fluid pressing upward versus internal knotting. Commentators specifically differentiate based on pathogenic factors, which is likely not a comprehensive theory.
Nong Po Ma Huang Tang (Magnolia Bark and Ephedra Decoction)
Commentary: This formula syndrome involves cold-fluid pressing on the Lung, without external wind-cold signs. Therefore, Gui Zhi (Cinnamon Twig) is removed from Xiao Qing Long Tang (Minor Green Dragon Decoction), and Nong Po (Magnolia Bark) is used as the sovereign herb to direct rebellious Qi downward. The assistant use of Xing Ren (Apricot Kernel) follows the example of Gui Zhi Jia Nong Po Xing Zi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel). Moreover, combined with Shi Gao (Gypsum), the power to drive out fluid retention is even more intense.
Ze Qi Tang (Euphorbia Lathyris Decoction) (*Qian Jin* has "San Ri Yi Ye Yi" [Three times a day, once at night] under "Wu He" [Five he], lacking "Zhi Ye Jin" [Finish by night]. *Ben Cao* and *Tu Jing* quote "San Ri" [Three times a day] under "Wu He", and "Fu" [Take] above "Jin" [Finish].)
Commentary: Ze Qi (Euphorbiae Thunbergianae Herba), according to the white text of *Ben Cao*, is bitter and slightly cold, governing large abdominal water qi, edema of limbs, face, and eyes. The black text states it promotes urination in the Large and Small Intestines. Presumably, the main syndrome of this formula involves internal knotting of fluid retention, hence the need for diuretic herbs.
Furthermore, Chen Cangqi stated: Qian Li Shui (Thousand-Mile Water) and Dong Liu Shui (East-Flowing Water) are neutral and non-toxic, governing post-illness weakness. Thus, the water used in this formula serves to be bland and cooked, avoiding aiding internal fluid retention. Boil to obtain five sheng, take five he warm, finishing by night. This amounts to ten doses a day. No other formula has this example. *Qian Jin* seems correct. However, ancient Wu Sheng equals modern Wu He; ancient Wu He equals modern Wu Shao. Estimating from modern standards, taking five he per day is not excessive. Is this what Dong Yuan meant by "For pathology in the upper, frequent and small doses are not tiresome"?
Severe rebellious Qi, unsmooth throat. (*Wai Tai* lacks the character "Zhe", which should be adopted.)
Mai Men Dong Tang (Ophiopogon Decoction) (Dao Ye Yuanxi noted: Regarding the decoction method, based on *Zhu Ye Shi Gao Tang* "Warm take", it is feared that the twelve characters "Remove dregs, add Coicis Semen, boil until rice is cooked, remove rice, finish soup" were omitted.)
*Wai Tai*, Cui Shi's treatment for Bone-steaming, dry lips and mouth, desire to drink water, stopping thirst, Zhu Ye Yin (Leaf Decoction). Remove Ren Shen (Ginseng Radix) from this formula, add Zhu Ye (Bambusae Folium) and Sheng Jiang (Zingiberis Rhizoma Recens).
Also *Shen Shi*, treatment for Lung Qi insufficiency, rebellious fullness and Qi, blockage and shortness of breath in the throat, cold rising from the back, mouth feeling like holding frost and snow, loss of voice, severe hemoptysis, Bu Fei Tang (Tonify Lung Decoction). Remove Ren Shen and Ban Xia (Pinelliae Rhizoma) from this formula, add Wu Wei Zi (Schisandrae Fructus), Gan Jiang (Zingiberis Rhizoma), Kuan Dong Hua (Farfarae Flos), Gui Xin (Cinnamomi Ramulus), and Sang Bai Pi (Morus Cortex).
Fei Yong causing wheezing and inability to lie down,
Commentary: Ting Li (Descurainiae Semen seu Lepidii Semen) drains water and clears Lung congestion, thus effectively treating Fei Yong before pus formation. (Zhao Shi's commentary cited in *Jin Jian*, based on the two-commentary edition, is attributed to Zhou Shi's supplementary notes.)
*Yi Xin Fang* cites Fan Wang's formula: Ting Li, roasted until purple color. Process to make self-formed pills, size of a bullet. Twenty Da Zao (Jujubae Fructus). Boil dates in two sheng of water until one and a half sheng remains. Remove dates, add one pill, boil again until one sheng remains. Take all. (From Zhi Yin section.) *Ben Cao Tu Jing* citation also uses twenty dates.
Commentary: Ting Li is standardized to bullet-sized pills, so specific numbers are not needed. Dates are listed as twenty in various texts. *Ben Jing* might contain a writing error. (Some say: Ting Li becomes sticky when pounded, sufficient to form pills itself, no need to add "powder" or "honey" characters.)
*Wai Tai* and *Bi Xiao*, treatment for epidemic disease aftermath, caused by eating wine and wheat products, heat congestion in the Lung, resulting in incessant cough. Add Sang Bai Pi, Jie Geng, and Ma Huang to this formula.
Also Cui Shi, treatment for large abdominal water disease, body swelling and rebellious Qi, scanty dark urine, etc. Add Xing Ren to this formula, pound each, mix, take eight pills on an empty stomach at dawn, etc.
*You You Xin Shu* and *Jian Yao Ji Zhong*, formula for pediatric water qi abdominal swelling, accompanied by dysentery with pus and blood, red and scanty urine.
Ting Li Zi (Descurainiae Semen seu Lepidii Semen) half liang, mixed with Da Rou (Jujubae Mesocarp), pounded into pills. (*Shi Yuan Duan Xiao Fang* calls it San Zhong Wan).
*Ji Feng Pu Ji Fang* states: Author Lei Daoju suffered from vomiting phlegm, accumulating over a sheng in moments, slight cough, dark complexion, and low spirits. Zhao Gao said: There is phlegm in the Lung, discomfort in the chest and diaphragm. Ordered to take Zhongjing's Ting Li Da Zao Tang (Descurainia and Jujube Decoction). After one dose, felt immediate relief in the chest, with almost no phlegm or saliva remaining.
Jie Geng Tang (Platycodon Decoction) (Original note: Xue Bi should be Hou Bi [Throat Bi], but this seems to be a later addition.)
Commentary: Pai Nong San (Drain Pus Powder) uses Zhi Shi (Aurantii Fructus), Shao Yao (Paeoniae Radix Alba), and Jie Geng. Pai Nong Tang (Drain Pus Decoction) adds Sheng Jiang and Da Zao to this formula. Thus, we know Jie Geng has the function of draining pus. However, the Jie Geng available here has light and mild properties, insufficient to combat severe illness. Ancient products from that land might not have been like this.
*Sheng Ji*, treatment for Fei Yong with runny nose, spitting saliva and foam, vomiting pus like porridge, Mai Men Dong Tang. Add Mai Men Dong and Qing Hao Xin Ye (Artemisiae Annuae Cordifolia Folium).
Xiao Qing Long Jia Shi Gao Tang (Minor Green Dragon Decoction plus Gypsum)
Commentary: Ma Xing Gan Shi Tang, Nong Po Ma Huang Tang, Yue Bi Jia Ban Xia Tang, and Xiao Qing Long Jia Shi Gao Tang all use Ma Huang and Shi Gao together. Ma Huang releases Yang, Shi Gao drives out water. The combination intensifies the power to drive out fluid retention. It is not merely for releasing the exterior or clearing heat. Although these four formulas vary slightly in urgency and slowness, their general purport is similar. The key lies in clinical judgment, adjusting according to the severity of the condition.
Attached Formulas
*Wai Tai*, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction). (*Wai Tai*: Gui Zhi 2 liang, E Jiao 3 liang, fried, Da Ma Zi Ren 0.5 sheng, Da Zao 40 pieces, split. Rest same. Post-formula note: Cut nine ingredients, mix with 7 sheng fine wine and 8 sheng water. First boil eight ingredients to obtain 4 sheng, strain, remove dregs, add gelatin, melt over low fire, take 7 he warm, three times a day and once at night.)
Commentary: Applying this formula to general nausea will likely increase vomiting. "Wen Wen Ye Ye" implies a different meaning, not yet verified. Also, this formula's syndrome is similar to Mai Men Dong Tang syndrome; both are agents nourishing the Upper Jiao.
*Qian Jin*, Gan Cao Tang (Licorice Decoction).
Commentary: *Shang Han Lei Yao* uses single Gan Cao Tang to treat Zhi Gan Cao Tang syndrome; the principle is consistent.
*Qian Jin*, Sheng Jiang Gan Cao Tang (Ginger and Licorice Decoction).
Commentary: This formula also treats Lung cold leading to flaccidity, still a variation of Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction). Shen Shi's comment is inadequate. Also, "Er Ke" (and thirsty) should likely be "Bu Ke" (not thirsty) for accuracy.
*Qian Jin*, Gui Zhi Qu Shao Yao Jia Zao Ying Tang (Cinnamon Twig Decoction minus Peony plus Gleditsia Sinensis).
Commentary: This formula draws from the intent of Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction minus Peony) and Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) to support Yang Qi in the chest, rather than harmonizing Ying and Wei. It presumably also belongs to Lung cold-induced flaccidity.
*Wai Tai*, Jie Geng Bai San (Platycodon White Powder).
Commentary: This clause and Jie Geng Tang share the same syndrome but different formulas, likely due to different transmitted versions. However, in Fei Yong, as pus forms slightly, righteous Qi declines with it. Harsh and potent agents may not be tolerated. Could Wang Shi's basis be erroneous?
*Qian Jin*, Wei Jing Tang (Reedmace Root Decoction).
Commentary: The main syndrome of this formula lies between deficiency and excess.
Furthermore, Su Jing's *Xin Xiu Ben Cao* under Bai Gua (White Melon) states: Bie Lu says: Gan Gua Zi (Sweet Melon Seed) governs abdominal knotting, breaks down and discharges pus and blood, being very good, a key herb for abdominal, kidney, and spleen internal abscesses. *Ben Cao* considers it Dong Gua (Winter Melon), but only uses the stem end, not the seed. Also, in current Chang Yong Tang (Intestinal Abscess Decoction), laypeople sometimes use Dong Gua Zi, which is incorrect. Furthermore, examining various *Ben Cao* texts, they simply say Gua Zi or Gan Gua Zi. This version mistakenly writes Bai (White) instead of Gan (Sweet); it should be corrected to Gan. (Original text: Nong written as Nong, Yao written as Le. Corrected from *Zheng Lei Ben Cao*.) This statement confirms that Gua Ban (Melon Seeds) are Sweet Melon Seeds.
*Yi Xin Fang*, Zhongjing's formula, treating thirty-year cough, Da Zao Wan (Jujube Pill).
Da Zao (100 pieces, pitted) Xing Ren (100 pieces, roasted) Chi Dou (Fermented Soybean, 120 pieces)
These three ingredients: Pound Chi Dou and Xing Ren until well combined, then add dates, pound thoroughly until mixed, form pills the size of date pits. Hold one pill in the mouth, swallow the juice gradually, twice a day, increasing gradually is beneficial. (Note: This is suspected to be a lost formula from *Za Bing Lun*, attached here nonetheless.)