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
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。
【集注】
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、紫苑之苦，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，虚者
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□。
【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。
麦门冬七升 半夏一升 人参三两 甘草二两 粳米三合 大枣十二枚
右六味，以水一斗二升，煮取六升，温服一升，日三，夜一服。
【集注】
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，皂荚圆主之。
【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音矣。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，若用汤直泻无余，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。
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
以上九味药，用水一斗二升，先煮麻黄至沸腾两次，去掉水面上的浮沫，再加入其他药物，煎煮取汁三升，分三次温服。
【集注】
程林说：咳嗽且气逆上冲，喉咙发出像水鸡（青蛙）一样的叫声，连续不断，这是本方主治的症状。《内经》说：肺脏厌恶气机上逆。应当急切地食用苦味药物来泻降肺气。射干、紫菀的苦味，是用来泄降逆气的。用辛味药物来泻之，麻黄、生姜、细辛、半夏、款冬花的辛味，是用来泻除风邪的。用酸味药物来收敛，用酸味药物来补益，五味子的酸味，用来补益不足；根据“虚者补其母”的原则，大枣的甘味，用来补益脾土（脾为肺之母）。
@@@
气机严重上逆，咽喉部感觉不顺畅，需要止逆下气的，由麦门冬汤主治。
【按语】
“大逆上气”中的“大”字，应当是“火”字，这样文义和病机、用药才能相符，这一定是传抄过程中的讹误。
【注解】
咳嗽且气逆上冲，喉咙发出像水鸡一样的叫声并连续不断的，这是寒饮上逆所致。现在咳嗽且气逆上冲，喉咙没有水鸡叫声且不顺畅的，这是火气上逆所致。“不利”是指咽喉部好像有东西阻碍，不爽利。用麦门冬汤为主治，以制止火气上逆，降下其上冲之气。
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
以上六味药，用水一斗二升，煎煮取汁六升，每次温服一升，每日三次，夜间一次。
【集注】
周扬俊说：喻昌认为：这是胃中津液干枯燥热，虚火上炎的证候，麦门冬汤是治本的好方法。凡是使用降火药而火反而上升，使用寒凉药而热势反而加剧的，不仅无益，反而有害。凡是疾病只要有胃气就能生存，没有胃气就会死亡，胃气就是肺的母亲之气。本草中有名为“知母”的药物，是说肺依赖它的清凉特性，知道清凉是肺的母亲；有名为“贝母”的药物，是说肺依赖它豁痰实肺的作用，豁痰是肺的母亲。然而这些药多次用于火逆上气、咽喉不利的证候，却屡次无效，名不副实。谁知道张仲景有这样的妙法，在麦冬、人参、甘草、粳米大队大补中气、大生津液的药物中，加入一味辛温的半夏，它利咽下气的作用，并非单靠半夏的功效，而是善于运用半夏的功效，堪称古今未有之奇效。
@@@
咳嗽气逆，经常吐出浑浊痰涎，只能坐着不能躺卧，由皂荚丸主治。
【注解】
咳嗽气逆，喉中有水鸡叫声的，是寒饮冲犯肺脏，属于射干麻黄汤证。咳嗽气逆，咽喉不顺畅的，是火气冲犯肺脏，属于麦门冬汤证。现在咳嗽气逆，只是经常吐出浑浊痰涎，痰涎很多。只能坐着不能躺卧，说明气逆很严重，这是痰气致病，既不是寒饮也不是火气。用皂荚丸为主治，是为了宣导痰浊，通达气机；佐以枣膏的甘味，以缓和药性的猛烈之势。
【集注】
程林说：浑浊的唾沫壅塞在肺中，导致无法躺卧，所以经常吐出浑浊痰涎。皂荚味道辛咸，辛能发散，咸能软坚，宣通壅滞、疏导积滞、通利窍道、消除风邪，没有比它更好的了。所以咳嗽气逆，经常吐出浑浊痰涎，坐着不能躺卧的适宜使用它。然而药性猛烈，佐以枣膏的甘味，以缓和药势。
魏荔彤说：咳嗽气逆，经常吐出浑浊痰涎，只能坐着不能躺卧，这比喉中有水鸡叫声的情况更重。声音滞涩者，夹杂外感的原因；吐出浑浊痰涎则是内伤的缘故；只能坐着不能躺卧，肺痈的证候即将形成。这是上焦有热，痰血包裹，结聚成患，不可以不急于宣通其结聚，之后津液才能慢慢生成，枯干得以滋润，由皂荚丸主治。皂荚驱风理痹，正是因为它具有祛除瘀血、涤荡污垢的能力。咳嗽气逆，经常吐出浑浊痰涎，胸膈间恶臭的痰血已经结聚，难道可以不急于涤荡清除，使之冲洗干净不留痕迹吗？就像现在用皂荚洗澡以去除污垢油腻一样，就是这个道理。制成丸剂使其慢慢润化，从上往下作用，上部才能清朗，如果用汤剂直接泻下无余，就不能治疗上部的胶凝之症了，古人的立法确实巧妙啊。这是针对肺痈将成时的主治方法。
Shegan Mahuang Decoction (Blackberry Lily and Ephedra Decoction): Shegan (Belamcandae Rhizoma) 3 liang, Mahuang (Ephedrae Herba) 4 liang, Shengjiang (Zingiberis Rhizoma Recens) 4 liang, Xixin (Asari Radix et Rhizoma), Ziwan (Asternis Radix), Kua Donghua (Toddliae Flos) each 3 liang, Wuweizi (Schisandrae Fructus) half sheng, Dazao (Jujubae Fructus) 7 pieces, Banxia (Pinelliae Rhizoma) half sheng.
The above nine ingredients are decocted with one dou two sheng of water. First, boil Mahuang for two boiling cycles, remove the foam on the surface, then add the remaining herbs. Decoct until three sheng of liquid remains. Divide into three doses and take warm.
[Collected Annotations]
Cheng Lin stated: Cough accompanied by rebellious Qi rising, with a continuous sound in the throat resembling that of a water chicken (frog), is the indication for this decoction. The *Neijing* states: "The Lung dislikes rebellious Qi." One should urgently consume bitter substances to drain it. The bitterness of Shegan and Ziwan serves to drain rebellious Qi. Using pungent substances to drain it, the pungency of Mahuang, Shengjiang, Xixin, Banxia, and Kua Donghua serves to drain wind pathogens. Using sour substances to astringe, and using sour substances to tonify, the sourness of Wuweizi serves to tonify deficiency. According to the principle of "tonifying the mother in cases of deficiency," the sweetness of Dazao serves to tonify the mother (Spleen Earth, which is the mother of Lung Metal).
@@@
Severe rebellious Qi rising, with an unsmooth sensation in the throat, requiring the cessation of rebellion and descent of Qi, is treated with Maidong Tang (Ophiopogon Decoction).
[Commentary]
The character "Da" (Great) in "Da Ni Shang Qi" (Great Rebellious Qi Rising) should likely be "Huo" (Fire). Only then do the textual meaning, pathology, and medication align; this is certainly a transcription error.
[Annotation]
Cough with rebellious Qi rising and a continuous sound in the throat resembling a water chicken indicates cold-fluid retention rebelling upward. Currently, cough with rebellious Qi rising, without the water chicken sound but with an unsmooth sensation in the throat, indicates Fire Qi rebelling upward. "Unsmooth" refers to a sensation in the throat as if obstructed by something, lacking smoothness. Maidong Tang is used as the primary treatment to stop the rebellious Fire Qi and descend its upward movement.
Maidong (Ophiopogonis Radix) 7 sheng, Banxia (Pinelliae Rhizoma) 1 sheng, Renshen (Ginseng Radix) 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang, Jingmi (Oryza Sativa) 3 he, Dazao (Jujubae Fructus) 12 pieces.
The above six ingredients are decocted with one dou two sheng of water until six sheng of liquid remains. Take one sheng warm per dose, three times during the day and once at night.
[Collected Annotations]
Zhou Yangjun stated: Yu Chang said: This is a syndrome of dryness and lack of fluids in the Stomach, with deficient Fire flaming upward. Maidong Tang is an excellent method for treating the root cause. If drugs that lower Fire cause Fire to rise further, and cooling drugs cause Heat to intensify, not only is there no benefit, but harm ensues. Any disease can survive if there is Stomach Qi, and will die if there is none. Stomach Qi is the mother Qi of the Lung. In materia medica, the herb Zhi Mu (Anemarrhenae Rhizoma) implies that the Lung relies on its cooling nature, knowing that cooling is the mother of the Lung. Bei Mu (Fritillariae Bulbus) implies that the Lung relies on its ability to resolve phlegm and solidify the Lung, knowing that resolving phlegm is the mother of the Lung. However, when repeatedly applied to syndromes of rebellious Fire Qi and unsmooth throat, they often fail, making their names misleading. Who would have known that Zhang Zhongjing possessed such a brilliant method? By adding one portion of pungent-warm Banxia to the large group of Maidong, Renshen, Gancao, and Jingmi—which greatly tonify Middle Qi and generate fluids—its ability to soothe the throat and descend Qi is not merely due to the efficacy of Banxia itself, but rather the skillful application of Banxia, a marvel unprecedented in ancient and modern times.
@@@
Cough with rebellious Qi rising, frequent expectoration of turbid saliva, and inability to lie down (only able to sit), is treated with Zao Jiao Wan (Soap Fruit Pill).
[Annotation]
Cough with rebellious Qi rising and a water-chicken-like sound in the throat indicates Cold-Fluid rushing to the Lung, which is the indication for Shegan Mahuang Tang. Cough with rebellious Qi rising and an unsmooth throat indicates Fire Qi rushing to the Lung, which is the indication for Maidong Tang. Currently, cough with rebellious Qi rising, characterized only by frequent expectoration of turbid saliva and abundant phlegm-saliva, along with an inability to lie down (only able to sit), indicates severe Qi rebellion. This is a disease caused by Phlegm-Qi, neither Cold-Fluid nor Fire Qi. Zao Jiao Wan is used to guide and disperse the Phlegm and unblock the Qi. It is assisted by the sweetness of Jujube Paste to moderate the fierce nature of the drug.
[Collected Annotations]
Cheng Lin stated: Turbid saliva obstructing the Lung prevents lying down, hence the frequent expectoration of turbid matter. Zao Jiao (Gleditsiae Sinensis Fructus) tastes pungent and salty; pungency disperses, and salinity softens. Nothing surpasses it in unblocking congestion, guiding stagnation, benefiting orifices, and eliminating wind. Therefore, it is suitable for cough with rebellious Qi rising, frequent expectoration of turbid saliva, and inability to lie down. However, since the drug's nature is fierce, it is assisted by the sweetness of Jujube Paste to moderate its action.
Wei Litong stated: Cough with rebellious Qi rising, frequent expectoration of turbid saliva, and inability to lie down (only able to sit) is more severe than having a water-chicken sound in the throat. A滞 (stagnant) sound involves external contraction, while expectorating turbid saliva indicates internal injury. Inability to lie down suggests that Lung Abscess (Fei Yong) is about to form. This is Heat in the Upper Jiao, where Phlegm and Blood wrap around and accumulate into a lesion. It is imperative to promptly unblock this accumulation so that body fluids may slowly regenerate and dryness may be moistened. Zao Jiao Wan is indicated. Zao Jiao dispels wind and resolves bi-syndrome precisely because it has the ability to remove stasis and cleanse filth. When rebellious Qi rises and turbid saliva is frequently expectorated, and foul-smelling phlegm-blood has accumulated in the chest and diaphragm, must we not urgently cleanse and wash it away completely? It is like using Zao Jiao for bathing to remove grease and dirt. Formulating it as a pill allows for slow melting and action from top to bottom, clearing the upper part. If a decoction were used to purge everything directly, it could not treat the sticky coagulation in the upper part. The legislative wisdom of the ancients is truly excellent. This is the primary treatment for preventing the formation of Lung Abscess.