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Jin Gui

Yao Lue -

Essential Prescriptions of the Golden Cabinet


Chapter 7
Lung Wilting, Pulmonary Welling-Abscess,
and Cough with Qi Ascent
OVERVIEW

This chapter discusses lung wilting, welling-abscess of


the lung, and coughing with qi ascent.
Even though these three conditions have different
etiologies and pathomechanisms, they all involve
pathology of the lung. Furthermore, their pathological
interconnections and inter-transformations are also
similar.
Mainly discussed here are lung patterns involving
exterior evils and the internal accumulation of phlegm-
rheum.
Lung Wilting Fei Wei
Wilting
Dictionary:
Plant Pathology
the drying out, drooping, and withering of the leaves of a
plant due to inadequate water supply, excessive
transpiration, or vascular disease.

Bian Bing (differentiation of disease)


Bian Zheng (differentiation of syndrome)
Bronchitis
Whooping cough
Tuberculosis
Lung wilting Fei Wei
Lung wilting is a chronic condition of weakened lung
qi that mainly manifests with coughing, turbid spittle,
drooling, and foaming at the mouth, and shortness
of breath. However, the condition may be further
differentiated into patterns involving deficiency
heat and deficiency cold.
Pulmonary Welling-Abscess Fei Yuan


Dictionary:
abscess. A localized collection of pus in part of the body, formed by
tissue disintegration and surrounded by an inflamed area.

Bian Bing (differentiation of disease)


Bian Zheng (differentiation of syndrome)

Exudative pleurisy
Pneumonia
Pulmonary Welling-Abscess Fei Yuan
It refers to suppurating lesions of LU. Its cause by contraction of
wind evil and heat toxin, cause the blood and flesh to putrefy, and
give rise to pus.
Three Stage:
Exterior Pattern Stage:
characterized by heat effusion, aversion to cold, cough, floating
pulse.
Suppurative Stage:
characterized by shivering, rapid pulse, cough, chest pain, ejection
of fishy-smelling purulent phlegm.
Rupture Stage:
characterized by ejection of phlegm and blood.
In the later stages, pulmonary welling-abscess can convert into
vacuity.
Cough with Qi Ascent
Cough with counterflow ascent of LU Qi. it can be
divided into vacuity and repletion. The vacuity form
is usually due to KD failing to absorb qi. The
repletion form, which is the focus of the present
chapter, it takes the form of pulmonary distension
resulting from a pathomechanism of evil repletion
and qi block that arises when internally collecting
water-rheum is complicated by externally
contracted wind-cold.
SCHEMATIC OVERVIEW

Lung Wilting
1) Vacuity heat type
Causes: Wearing of fluids, yin vacuity with internal
heat
Main Signs: cough, ejection of turbid phlegm, foamy
drool, marked emaciation.
Pulse: Vacuous, Rapid
Treatment Principle: clear and nourish the lung and
stomach Mi Mn Dng Tng(Ophiopogon
Decoction)
Appended formulas:
Zh Gn Cao Tng ( Honey-Fried Licorice Decoction)
to boost qi, engender liquid, and moisten dryness.

Gn Cao Tng (Licorice Decoction)


to enrich dryness and moisten the lung
Lung Wilting
2) Vacuity cold type
Causes: upper burner yang vacuity with cold in the
lung.
Main signs: No cough, no thirst, ejection of foamy
drool, frequent urination, dizzy head, enuresis
Treatment Principle: Warm the lung and disperse
cold
Gn Cao Gn Jing Tng (Licorice and Dried
Ginger Decoction)
Lung Wilting:
Vacuity cold type
Appended formula:
Sheng Jing Gn Cao Tng(Fresh Ginger and Licorice
Decoction) from the Qin Jn Fng (Thousand Gold
Pieces Prescription) to bank up earth and moisten
dryness.
Pulmonary Welling-Abscess

Causes:
Wind striking defense; exhaling prevents [the evil
from] entering furtherwind damaging the skin
and body hair.
Heat encroaching on construction; inhaling prevents
[the evil from] exitingheat damaging the blood
and vessels.
Pulmonary Welling-Abscess
Pathomechanisms:
Wind dwelling in the lung
Heat encroaching, causes of blood to congeal, and
amassing and binding to form a suppurating
welling-abscess
Pulmonary Welling-Abscess
Pulses:
Inch opening
Floating = wind
Rapid = heat
Slippery and rapid
Pulmonary Welling-Abscess
Main Signs:
Exterior pattern stage:

Heat effusion, aversion to cold, cough, fullness in the


chest.
Suppurative stage:

Intensifying chest pain, vigorous fever, quivering with


cold, rapid pulse, frequent spitting of turbid foam.
Rupture stage:

turbid spittle with fishy odor, ejection of pus and blood


that resembles rice gruel.
Pulmonary Welling-Abscess
Treatment
Exterior pattern stage: resolve the exterior with coolness
and acridity while clearing internal heat.
Pus formation stage:
Tng L D Zao Xi Fi Tng(Lepidium/Descurainiae and
Jujube Lung-Draining Decoction) and Wei Jng Tng
(Phragmites Stem Decoction) from the Qin Jn Fng
(Thousand Gold Pieces Prescriptions) to clear heat and
drain lung.
Rupture stage:
Ji Geng Tng (Platycodon Decoction ) to expel pus and
resolve toxin.
Cough and QI Ascent

Causes: Water-rheum collecting internally and wind-


cold fettering the outer body.
Pattern identification
Pulmonary distention
Main Signs: Panting and agitation
Mechanism: Imminent wind swelling. When sweat
effuses, recovery ensues.
Critical signs: Qi ascent, puffy swollen face, raised
shoulder breathing, and a large floating pulse.
Diarrhea means that it is even more severe.
Pattern Identification and Treatment

A) Cold rheum depressing the lung


Main signs:
Caugh and qi ascent; frog rale in the throat.
Formula: Sh Gn M Hung Tng (Belmacanda
and Ephedra Decoction) to disperse cold and flush
rheum.
Cough and QI Ascent
B) Rheum evil being forced upward
Main signs: Cough and counterflow qi ascent,
fullness in the chest, inhibited throat, frog rale,
floating pulse.
Formula: Hu P M Hung Tng(Officinal
Magnolia Bark and Ephedra Decoction) to clear
heat and discharge fullness.
Cough and QI Ascent
C) Water-Rheum binding internally
Main signs: Cough and qi ascent, sunken pulse.
Formula: Z Q Tng(Sun Spurge Decoction) to
expel water and flush rheum.
Cough and QI Ascent
D) Thick phlegm causing obstruction
Main signs:
Cough and counterflow qi ascent, frequently spitting
turbid spittle, only sitting and inability to sleep.
Formula: Zo Ji Wn(Gleditsia Fruit Pill) to flush
turbid phlegm.
Cough and QI Ascent
E) Depressed evil in the outer body with water-
rheum in the inner body
Main signs:
Cough and qi ascent, vexation and agitation,
panting, floating pulse
Formula:
Xiano Qng Lng Ji Shi Go Tng)(Minor Black
Dragon Decoction Pill) to disperse rheum and
eliminate vexation.
Cough and QI Ascent
F)Phlegm-heat depressing the lung
Main signs: Cough and qi ascent with eyes as if fit
to burst from their sockets, floating and large pulse.

Formula: Yu Bi Ji Bn Xi Tng(Spleen-Effusing
Decoction Plus Pinellia) to clear heat and flush
rheum.
SUMMARY

Disease Associated Signs and Principles of Formula


Pattern Pathomechanism Symptoms Treatment
s
Lung Deficiency Fire flaming Cough and Clear lung heat, Mai Men Dong
Wilting heat upward, lung and panting, thick enrich yin, Tang
spleen-stomach sticky phlegm downbear (Ophiopogon
yin deficiency, counterflow Decoction)
fluid damage
Deficiency Lung deficiency Ejection of Warm the lung, Gan Cao Gan
Cold cold, upper foamy drool, return yang Jiang Tang
burner deficiency no coughing, (Licorice and
with failure to frequent Dried Ginger
control the lower, urination, Decoction)
yang deficiency enuresis
SUMMARY
Disease Associated Signs and Principles Formula
Pattern Pathomechanisms Symptoms of
Treatment
Evil excess Phlegm congestion, Severe panting, inability Open the lung, Ting Li Da Zao Xie Fei
Welling-
and qi inhibited lung qi failing to lie flat, chest fullness dispel phlegm Tang (Lepidium and
abscess blockage to govern waterways and distention, puffy rheum, move Jujube Lung-Draining
in the swelling, nasal water Decoction)
lung congestion

Static heat Blood putridity, phlegm- Cough with mild heat Clear the lung, Wei Jing Tang (Reed
brewing in heat, static blood, lung effusion, vexation and resolve phlegm, Rhizome Decoction)
the lung failure of diffusion fullness, expectoration move blood,
of fishy-smelling yellow expel pus
phlegm, encrusted skin
on the chest

Blood Purity Heat-toxin congesting Ulceration with pus and Expel pus, clear Jie Geng Tang
and the lung, lung qi turbid foul-smelling heat, resolve (Platycodon Decoction)
ulceration inhibition sputum, frequent toxin
cough, fullness in the
chest, dry throat,
quivering with cold,
rapid pulses
SUMMARY
Disease Associated Signs and Principles of Formula
Pattern Pathomechanisms Symptoms Treatment
Coughing Cold rheum Lung qi failure to Coughing, Dispel cold, diffuse She Gan Ma
constrained diffuse phlegm-drool rales with a the lung, transform Huang Tang
with qi
in the lung obstructing the croaking phlegm (Belamcanda and
ascent airway sound, airway Ephedra
obstruction, Decoction)
phlegm-drool
Turbid Lung failing to diffuse, Cough, turbid Flush phlegm, open Zao Jia Wan
phlegm airway obstruction phlegm, the lung (Gleditsia Pill)
congesting sitting up with
the lung inability to
sleep, airway
obstruction
Rheum-heat Lung distention, Cough, Diffuse the lung, Yue Bi Jia Ban Xia
constrained phlegm-heat, wind- panting, drain heat, Tang (Maidservant
in the lung heat, evil mingling bulging eye, transform rheum, from Yue
with latent rheum large floating downbear qi Decoction plus
pulses Pinellia)
SUMMARY

Disease Associated Signs and Principles of Formula


Pattern Pathomechanisms Symptoms Treatment
Coughing Cold-rheum Cold rheum Cough, panting, Dispel rheum, Hou Po Ma Huang
with heat transforming into fullness in the drain heat, Tang (Magnolia
with qi
heat chest, vexation, relieve cough Bark and Ephedra
ascent floating pulses Decoction)
Water- Water-qi overflowing Cough, Free yang, Ze Qi Tang (Sun
rheum in the to the fleshy exterior generalized transform Spurge Deoction)
lung and swelling, rheum, suppress
chest inhibited cough, calm
urination, panting
sunken pulses
Exterior Water-rheum in the Cough, panting, Resolve the Xiao Qing Long Jia
wind-cold lung, constrained vexation, exterior, Shi Gao Tang
with heat agitation, chest transform (Minor Blue-Green
collected and rib-side rheum, clear Dragon Decoction
rheum fullness and heat plus Gypsum)
distention