皂荚（刮去皮，用酥炙）八两
右一味，末之，蜜丸梧子大，以枣膏和汤，服三丸，日三夜一服。
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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，又加
利尤甚，谓脉证两虚，已属不治，又加利，则上喘下利，阴阳两脱，脉证相反，故曰
：尤甚也。
【集注】
徐彬曰：此言肺痈之证，元气惫者，为难治也。谓肺痈由风则风性上行，必先上气，
若兼面浮肿，肩息，气升不降也。又脉浮大，元气不能复敛，则补既不可，汗又不可
，况内外皆逆气，非风之比，可尽汗泄乎？故云不治。加利则阳从上脱，阴从下脱，
故曰尤甚。
尤怡曰：上气，面浮肿，肩息，气但升而不降矣。脉复浮大，则阳有上越之机。脉偏
盛者，偏绝也。又加下利，是阴复从下脱矣。阴阳离决，故当不治。肩息息，摇肩也
。
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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。
【注】
咳而上气，此为肺胀，其证肩息而喘，目突如脱之状。今脉浮大，则可知浮则为风，
大则为实，故以越婢加半夏汤主之，外疏皮毛，内降气逆也。
【集注】
赵良曰：咳而上气，则其气之有冲而不下，可知矣；其咳之相连而不已，可知矣，此
皆属肺之胀使之也。邪入于肺则气壅，气壅则欲不喘不可得，惟喘极，故目如脱，所
以肺胀与喘之至也。脉浮邪也。兼大则邪实，而所以遗害于肺，正未有已，故必以辛
热发之，亦兼以甘寒佐之，使久合之邪，涣然冰释，岂不快乎？然久蓄之饮，何由得
泄，故特加半夏于越婢汤中，一定之法也。
尤怡曰：外邪内饮，填塞肺中，为胀、为喘、为咳而上气，越婢汤散邪之力多，而蠲
饮之力少，故以半夏辅其未逮。不用小青龙者，以脉浮且大，病属阳热，故利辛寒，
不利辛热也。目如脱状者，目暗胀突，如欲脱落之状，壅气然也。
皂荚（刮去外皮，用酥油炙烤）八两
以上一味药，研成细末，用蜂蜜制成梧桐子大小的丸剂，用大枣膏调和汤水送服，每次服用三丸，每日三次，夜间一次。
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气逆上冲，面部浮肿，呼吸时耸肩，脉象浮大者属难治之证，如果又加上腹泻则病情更加严重。
【注】
所谓“上气”，是指咳嗽气逆向上。所谓“面浮肿”，是指面目浮肿。所谓“肩息”，是指喘息时耸肩。脉象浮大属于难治之证，如果再加上腹泻，则更为严重，这是因为脉象与症状都显示虚损，已经属于难以救治的情况，再加上腹泻，导致上面气喘、下面泄利，阴阳之气双重脱失，脉象与症状相违背，所以说“更加严重”。
【集注】
徐彬说：这里论述的是肺痈的证候，元气极度疲惫的患者，属于难治之症。肺痈由风邪引起，风性上行，必然先出现气逆上冲，如果兼有面部浮肿、耸肩喘息，说明气机只升不降。脉象浮大，说明元气不能收敛恢复，此时既不能用补法，也不能用发汗法，况且内外都是逆乱之气，不像普通的风邪，能完全通过发汗宣泄吗？所以说是难治。如果加上腹泻，阳气从上脱失，阴气从下脱失，所以说“更加严重”。
尤怡说：气逆上冲，面部浮肿，耸肩喘息，说明气机只有上升而没有下降。脉象又见浮大，说明阳气有上越的趋势。脉象偏盛，意味着偏绝。如果再加上腹泻，说明阴气也从下脱失。阴阳离决，所以应当是难治之症。“肩息”中的“息”，指摇动肩膀。
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咳嗽且气逆上冲，这是肺胀病，患者喘息，眼睛像要脱出一样，脉象浮大的，用越婢加半夏汤主治。
【注】
咳嗽且气逆上冲，这是肺胀病，其症状表现为耸肩喘息，眼睛突出像要脱落的样子。现在脉象浮大，可知浮主风邪，大主实证，所以用越婢加半夏汤主治，以疏散皮毛之风邪，降逆体内之气。
【集注】
赵良说：咳嗽且气逆上冲，可知气机冲逆而不能下行；咳嗽连续不断，可知这是肺气胀满所致。邪气侵入肺脏则气机壅滞，气机壅滞则必然导致喘息，只有喘息到了极点，才会出现眼睛像要脱出的样子，这就是肺胀和喘息的极致表现。脉浮表示有邪气，兼见脉大则表示邪气实盛，对肺脏的危害还没有停止，所以必须用辛热药物发散，同时兼用甘寒药物佐助，使久积的邪气如冰消融散，难道不快意吗？然而久积的水饮，如何得以排泄，所以在越婢汤中特别加入半夏，这是一定的法则。
尤怡说：外邪和内饮，填塞在肺中，导致肺胀、喘息、咳嗽气逆，越婢汤发散邪气的力量多，而祛除水饮的力量少，所以用半夏来弥补其不足。不用小青龙汤的原因，是因为脉象浮且大，病属阳热性质，所以利于辛寒药物，不利于辛热药物。“目如脱状”，是指眼睛昏暗肿胀突出，像要脱落的样子，这是气机壅滞造成的。
Saponariae Fructus (scraped of skin, roasted with suet) 8 liang.
Process the single herb into a fine powder, form pills the size of wu zi (Cocculus trilobus seeds) using honey, and administer with jujube paste mixed in decoction. Take three pills per dose, three times daily and once at night.
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Qi rebellion upward, facial edema, breathing with shoulder movement (shoulder breathing), and a floating and large pulse indicate a difficult-to-treat condition; if accompanied by diarrhea, the condition is even more severe.
[Annotation]
"Qi rebellion upward" refers to coughing with rebellious Qi moving upward. "Facial edema" refers to swelling of the face and eyes. "Shoulder breathing" refers to panting accompanied by shrugging the shoulders. A floating and large pulse indicates a difficult-to-treat state. If diarrhea is added, it becomes even more severe because both the pulse and symptoms indicate deficiency, rendering it incurable. The combination of upper panting and lower diarrhea signifies the depletion of both Yin and Yang, with the pulse and symptoms contradicting each other, hence described as "even more severe."
[Collected Annotations]
Xu Bin states: This passage discusses the syndrome of Lung Abscess (Fei Yong) where the Yuan Qi (Original Qi) is exhausted, making it difficult to treat. Lung Abscess caused by Wind pathogen involves the upward nature of Wind, leading initially to Qi rebellion. If accompanied by facial edema and shoulder breathing, it indicates that Qi rises but does not descend. A floating and large pulse suggests that Yuan Qi cannot converge and recover; thus, tonification is contraindicated, as is diaphoresis. Moreover, since there is rebellious Qi inside and outside, unlike simple Wind, can it be fully resolved by sweating? Hence, it is deemed difficult to treat. Diarrhea implies Yang depleting from above and Yin depleting from below, hence "even more severe."
You Yi states: Qi rebellion, facial edema, and shoulder breathing indicate that Qi ascends without descending. A floating and large pulse suggests a tendency for Yang to float upward. An excessive pulse indicates partial exhaustion. If diarrhea is added, Yin also depletes from below. The separation of Yin and Yang leads to an incurable prognosis. "Shoulder breathing" refers to the shaking of the shoulders during respiration.
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Coughing with Qi rebellion upward constitutes Lung Distension (Fei Zhang). The patient pants, with eyes appearing as if protruding or about to fall out, and a floating and large pulse. Yuebi Jia Banxia Tang (Yuebi Decoction plus Pinellia Rhizome) is the primary treatment.
[Annotation]
Coughing with Qi rebellion upward indicates Lung Distension. Symptoms include shoulder breathing and panting, with eyes protruding as if falling out. A floating and large pulse indicates that floating corresponds to Wind and large corresponds to Excess. Therefore, Yuebi Jia Banxia Tang is used to disperse Wind from the exterior skin and hair follicles and to direct rebellious Qi downward internally.
[Collected Annotations]
Zhao Liang states: Coughing with Qi rebellion upward indicates that Qi rushes but does not descend; continuous coughing indicates this is caused by Lung Distension. When pathogens enter the Lung, Qi becomes congested. Congestion inevitably leads to panting. Only when panting reaches its extreme do the eyes appear to protrude. This represents the culmination of Lung Distension and panting. A floating pulse indicates pathogenic presence; combined with a large pulse, it indicates substantial pathogenic excess, causing ongoing harm to the Lung. Thus, acrid-hot herbs must be used to disperse, assisted by sweet-cold herbs, so that long-standing pathogens melt away like ice, which is gratifying. However, how are long-stagnated fluids discharged? Therefore, Banxia Rhizoma (Pinelliae Rhizoma) is specifically added to Yuebi Tang, which is a fixed method.
You Yi states: Exterior pathogens and interior fluid retention fill the Lung, causing distension, panting, and coughing with Qi rebellion. Yuebi Tang has strong power to disperse pathogens but weak power to eliminate fluid retention; thus, Banxia is used to supplement this deficiency. Xiao Qinglong Tang is not used because the floating and large pulse indicates a Yang-Heat pathology, favoring acrid-cold herbs over acrid-hot ones. "Eyes appearing as if protruding" refers to dim, swollen, and bulging eyes, resembling a state of falling out, caused by Qi congestion.