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Millwoods Acupuncture Center
102, 2603 Hewes Way
Edmonton AB,   Canada

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肺痿肺痈咳嗽上气病脉证并治第七

Chapter 7, Feiwei, Feiyong, cough, their symptoms, pulse and treatment


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。

Asked: if there is Fire in the Upper Jiao Cavity, cough may cause Feiwei[1]. How the Feiwei comes? Master: it can be due to sweat, to vomiting, to extreme thirsty and heavy urination, to constipation but got strong diarrhea medications, resulting in loss of body Jingye. Asked: if the pulse on the Chun position is frequent, the person has cough but also has sticky saliva in the mouth. How? Master: This is Feiwei disease. If the person feels dry in mouth, feels mild pain in the chest when cough, and if his pulse is smooth and frequent, the condition is called Weiyong. [2]

脉数虚者为肺痿,数实者为肺痈。

For Feiwei (lung withered), the pulse is frequent and weak; for Feiyong (lung abscess), the pulse is frequent and strong.


问曰:病咳逆,脉之何以知此为肺痿肺痈?当有脓血,吐之则死,其脉何类?师曰:寸口脉浮而数,浮则为风,数则为热;浮则汗出,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。

Asked: for a person with cough, how do we know it is Feiwei or Feiyong? Master: if the person has cough with heavy and sticky saliva in mouth but no thirsty, how can we tell if it is Feiwei by his pulse? Master: if the pulse on the Chun position is floating and frequent, the floating means Wind invasion, the frequent mans Fire. Due to the floating pulse, he has sweat, to the frequent pulse, he has chilly. The Wind invades in the Weiqi, the inhalation is difficult; if the Fire is in the Rongqi, the inhalation is difficult. The Wind damages the skin layer of the body, the Fire damages the Blood. The Wind lives in the lung, so the person has cough, dry mouth, asthma and fullness in the chest; feels dry in mouth but not thirsty, spit condensed saliva and has chilly from time to time. If the Fire is too much, it may cause block of the blood to form abscess, so to spit pus-like phlegm. In the early stage, this condition may be reversed, in a later stage, it is hard.

肺痈,喘不得卧,葶苈大枣泻肺汤主之。

For the Feiyong, the person has asthma and hard to lie down, use Tingli Dazao Xiewei Tang

葶苈大枣泻肺汤方

Tingli Dazao Xiefei Tang


葶苈(熬令黄色,捣丸,如弹子大)大枣十二枚

Tinglizi (processed to yellow color, make into pills, as size as 1 cm in diameter), Chinese date 12 badges.


右先以水三升,煮枣,取二升,去枣,内葶苈,煮取一升,顿服。

Add the Chinese date and 750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 500 ml liquid left. Remove the dates, add the Tinglizi in. Continue to boiling until there is 250 ml herbal tea left. Drink half amount of the tea.


 
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,葶苈大枣泻肺汤主之。

For Feiyong disease, the person feels fullness in the chest, swelling in whole body, stiff nose and running nose, no smell ability to any odor or smell, frequent cough as air pushing, asthma and voice in throat. In this case, use Tinglizi Dazao Xiefei Tang.


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。

For Feiyong, the person feels cough and fullness in chest, chilly and dry mouth but no thirsty, spit condensed saliva or phlegm with bad odor, with pus as milk. His pulse can be frequent. In this condition, use Jiegen Tang

桔梗汤方

Jiegen Tang

桔梗  一两,    甘草  二两

Jiegen 15 gram, Gancao 30 gram.

右二味,以水三升,煮取一升,分温再服,则吐脓血也。

Add the herbs and 750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 250 ml liquid left. Collect the herbal tea. Separate it into several parts. Drink each part and repeat once every two to three hours. After drinking, the person may cough out pus and blood.

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。

If the person spit lots of saliva but no cough, no thirsty, he must have urine leak, and frequent urine. This is due to the weakness in the Upper Jiao Cavity that cannot control the Lower Jiao Cavity. The condition is the Cold in the chest.[3] The person feels dizzy and spits lots of saliva or mouth water. Use Gancao Ganjiang Tang. After the drinking, it the person feels thirsty, the condition belongs to Xiaoke.[4] 


甘草干姜
汤方

Gancao Ganjiang Tang


甘草
(炙)四两,干姜(炮)二两

Gancao (processed) 60 gram, Ganjiang (processed) 30 gram.


右咀,以水三升,煮取一升五合,去滓,分温再服。

Add the herbs and 750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml left. Collect the herbal tea. Separate into three parts. Drink one part each time, three times a day.

咳而上气,喉中水鸡声,射干麻黄汤主之。(此为肺冷在经,治以辛散). 

If the person has frequent and urgent cough with water-air noise in the throat[5], use Shegan Mahuang Tang.


射干麻黄
汤方

Shegan Mahuang Tang

射干 三两,麻黄 四两,生姜 四两,细辛,紫苑, 款冬花各三两,五味子 半升,大枣七枚,半夏 半升

Shegan 45 gram, Mahuang 60 gram, fresh ginger 60 gram, Xixin 45 gram, Ziyuan 45 gram, Kuandonghua 45 gram, Wuweizi 25 gram, Chinese date 7 badges, Banxia 124 gram.

右九味,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。

Add Mahuang and 3000 ml in to a herbal pot. Bring to boil and keep in mild boiling for 5 min. Remove the upper floating residue, add the remaining herbs in, continue to boiling until there is 750 ml herbal tea left. Collect the tea. Drink one third of the tea each time, three times a day.

火逆上气,咽喉不利,止逆下气者,麦门冬汤主之。

If Fire pushes up to cause frequent cough, harsh in the throat, use Maimendong Tang. [6]

麦门冬汤方

Maimendong Tang

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

Maimendong 910 gram, Banxia 250 gram, Renshen 45 gram, Gancao 30 gram, Genmi 60 gram, Chinese date 12 badges.

右六味,以水一斗二升,煮取六升,温服一升,日三,夜一服。

Add the herbs and 3000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 1500 ml herbal tea left. Collect the tea, separate it into four parts. Drink one part of the tea each time, three times during the day and once at night.

咳逆上气,时时唾浊,但坐不得眠,皂荚圆主之。

If Phlegm pushes up to cause frequent cough, the person spit lots of phlegm and saliva, hardly to lie down, use Zaojiayuan Tang. [7]

皂荚圆方

Zaojiayuan Tang

皂荚(刮去皮,用酥炙)八两

Zaojia (remove skin, processed) 125 gram.

右一味,末之,蜜丸梧子大,以枣膏和汤,服三丸,日三夜一服。

Prepare the herb into pills (2 cm in diameter) with honey. Drink three pills each time with the help of Chinese date soup, three times during day time, once in the evening.

(肺痈由风则风性上行) 上气,面浮肿,肩息,其脉浮大不治,又加利尤甚。

For Feiyong condition, if the person has frequent cough, swelling in the face, heavy asthma, has floating and big pulse[8], again has diarrhea, the condition is hard to treat.

咳而上气,此为肺胀,其人喘,目如脱状,脉浮大者,越婢加半夏汤主之。

For person with frequent cough, asthma, and it is so severe that the person feels protrusion of the eyes, and the pulse is floating and big, the condition is called Feizhang[9]. Use Yuebi jia Banxia Tang

越婢加半夏汤方

Yuebi jia Banxia Tang

麻黄  六两,石膏  半斤,生姜  三两,大枣  十五枚,甘草  二两,半夏  半斤

Mahuang 90 gram, Shigao 125 gram, fresh ginger 45 gram, Chinese date 15 badges, Gancao 30 gram, Banxia 125 gram.

右六味,以水六升,先煮麻黄,去上沫,内诸药,煮取三升,分温三服。
      

Add Mahuang and 1500 ml in to a herbal pot. Bring to boil and keep in mild boiling for 5 min. Remove the upper floating residue, add the remaining herbs in, continue to boiling until there is 750 ml herbal tea left. Collect the tea. Drink one third of the tea each time, three times a day.

上气喘而躁者,属肺胀,欲作风水,发汗则愈。

If a person has asthma and feels annoyed/impatience, the condition belongs to Feizhang disease. If it is to develop into a swelling in the body (Fengshui condition), use sweat therapy.

肺胀,咳而上气,烦躁而喘,脉浮者,心下有水,小青龙加石膏汤主之。

For person with the Feizhang condition, has cough, asthma, annoyed/impatience, has floating pulse, it suggests he has Shiqi (Water Xieqi) in the stomach. Use Xiao Qinglong jia Shigao Tang.


 
小青龙加石膏汤方

Xiao Qinglong jia Shigao Tang


麻黄
,芍药,桂枝细辛甘草干姜各三两,五味子半夏各半升,石膏  二两

Mahuang 45 gram, Shaoyao 45 gram, Guizhi 45 gram, Xixin 45 gram, Gancao 45 gram, Ganjiang 45 gram, Wuweizi 25 gram, Banxia 62 gram, Shigao 30 gram.

右九味,以水一斗,先煮麻黄,去上沫,内诸药,煮取三升,强人服一升,羸者减之,二、三服,小儿服四合。

Add Mahuang and 2500 ml in to a herbal pot. Bring to boil and keep in mild boiling for 5 min. Remove the upper floating residue, add the remaining herbs in, continue to boiling until there is 750 ml herbal tea left. Collect the tea. Drink one third of the tea each time, three times a day. For skinny person, drink less amount. For children, drink 100 ml each time.

(肺胀)咳而脉浮者,厚朴麻黄汤主之。脉沉者,泽漆汤主之。

If the person has Feizhangcough[10] and floating pulse, use Houpo Mahuang Tang. If his pulse is deep, use Zeqi Tang.[11]

 厚朴麻黄汤方

Houpo Mahuang Tang


厚朴 
五两,麻黄  四两,石膏  如鸡子大,杏仁  半升,半夏  半升,干姜  二两,细辛  二两,小麦  一升,五味子  半升

Houpo 78 gram, Mahuang 60 gram, Shigao 40 gram, Xinren 25 gram, Banxia 124 gram, Ganjiang 30 gram, Xixin 30 gram, Xiaomai 240 gram, Wuweizi 25 gram.


 
右九味,以水一斗二升,先煮小麦熟,去滓,内诸药,煮取三升,温服一升,日三服。

Add Xiaomai and 3000 ml in to a herbal pot. Bring to boil and keep in mild boiling until the Xiaomai is eatable. Remove the residue, add the remaining herbs in, continue to boiling until there is 750 ml herbal tea left. Collect the tea. Drink one third of the tea each time, three times a day.


 泽漆
汤方

Zeqi Tang


半夏 
半升,紫参(一作紫苑)五两,泽漆(以东流水五斗,煮取一斗五升)三升,生姜五两,白前  五两,甘草黄芩,  人参桂枝各三两

Banxia 124 gram, Zishen 78 gram, Ziqi (use flowing water 12500 ml, pre-boiling with the Ziqi until it is 3750 ml) 750 gram, fresh ginger 78 gram, Baiqian 78 gram, Gancao 45 gram, Huangqin 45 gram, Renshen 45 gram, Guizhi 45 gram.


右九味,咀,内 泽漆汁中,煮取五升,温服五合,至夜尽。

Add the herbs into the Ziqi solution (3750 ml). Bring to boil and keep in mild boiling until there is about 1250 ml left. Drink one fifth of the tea each time, finish all of the tea before the night.


[1] Feiwei: Fei here means the lung; wei means atrophy or withered. It refers to lung diseases which is structural problem in the lung, causing reduced effective lung tissue to have oxygen exchange.

[2] Feiyong: Fei means lung, yong means pus-formation infection, e.g. pus mass. In the Feiwei, the person has cough with pus and blood in the phlegm. The pulse should be frequent and strong. In Feiwei, the pulse is frequent and weak. This paragraph distinguishes the Feiwei and Feiyong diseases. For any chronic cough, the first thing in the diagnosis is to exclude these two diseases. In the Feiyong, the accumulated Fire in the any of the five fullness organs mixed with Fire in stomach. The Fire pushes up to the Lung, condenses blood in the lung and folds phlegm inside to form the abscess. The abscess can grow up bigger, the person has more frequent cough, has sticky phlegm, fever and chilly that are more severe in the evening, has red face and dry nose, dry skin in the chest. In this stage, use proper treatment to reduce the Fire, the recover is pretty much possible. If waste time until the abscess is open to broke, spit lots of pus, it is difficult.

[3] If the person has dry cough, no saliva spiting, it may belong to dry cough. If he has cough and spits saliva, it belongs to the Fire Feiwei. If only spit saliva, no cough, it belongs to Cold in the Lung.

[4] Xiaoke: a clinic condition in which the patient feels very thirsty, has very strong hungry feeling, or has too frequent and too much urine. Type I diabetes can have such phenomenon, but it is not the only disease that can have such Xiaoke disease.  After drinking the Gancao Ganjiang Tang, the person feels thirsty, it suggests that the condition does not belong to the Cold lung, but to Fire in stomach (Xiaoke).

[5] The Cold and Water Xieqi push up to cause the cough and water-air bubble noise in the throat.

[6] Cough with water-air noise in the throat: Cold-Water pushes up; cough with harsh feeling in the throat: Fire pushes up.  The Fire upper pushing is due to depletion of Jingye in the stomach.

[7] This condition is not due to Cold-water, or Fire, but to Phlegm. It is much severe than the Cold-water condition in the lung.

[8] The floating and big pulse suggests the Yangqi is to deplete from the upper part of the body. The diarrhea suggests the Yangqi is to deplete from the lower part of the body, so that it said it is a hard condition to solve.

[9] Feizhang: a condition similar to pulmonary emphysema, the term used by western medicine.

[10] Here the cough means scattered cough, not a frequent and urgent cough.

[11] Cough with floating pulse: Wind invasion and the Xieqi is in the outside layer of the body. Use Houpo Mahuang Tang to expel the Xieqi from the body surface. Cough with deep pulse: Water Xieqi in the inside of the body. Use Ziqi Tang to deplete the Xieqi from urine.