葶苈（熬令黄色，捣丸，如弹子大） 大枣十二枚
右先以水三升，煮枣，取二升，去枣，内葶苈，煮取一升，顿服。
【集解】
赵良曰：此治肺痈吃紧之方也。肺中生痈，不泻何待？恐日久痈脓已成，泻之无益。
日久肺气已索，泻之转伤，乘其血结而脓未成，当急以泻之之法夺之，况喘不得卧，
不亦甚乎。
@@@
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。
【注】
此承上条互详其证，以同其治也。肺痈胸胀而满，咳逆上气，喘鸣迫塞，一身面目浮
肿，鼻塞清涕出，不闻香臭酸辛，是邪外塞皮毛，内壅肺气，比之喘不得卧，殆尤甚
焉。亦以葶苈大枣泻肺汤者，因其脓未成故也。（方见上）
@@@
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。
【注】
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，此为肺痈证也
。肺痈尚未成脓实邪也，故以葶苈之剂泻之；今已溃后虚邪也，故以桔梗之苦，甘草
之甘，解肺毒排痈脓也。此治已成肺痈，轻而不死者之法也。
【集注】
高世栻曰：吐如米粥亦脓也，何以上文云脓成则死？若谓如米粥者非脓，上文既曰；
蓄结痈脓，吐如米粥；此又云：吐脓如米粥，既吐脓矣，奚有始萌脓成之别也？愚曰
：上文先咳逆，而呼吸不利，后凝滞而血脉成脓，阴阳血气皆伤，故脓成则死。若上
节言肺痈而气机不利，此节言肺痈而经络不和，病阳气者不伤阴，病血脉者不伤阳，
故可治也。如但以「始萌可救，脓成则死」二语尽之，是以辞害志也，奚可乎？
以上两味药，先用水三升，煮大枣，取汁二升，去掉枣肉，加入葶苈子，再煮取一升药液，一次性服用。
【集解】
赵良说：这是治疗肺痈的关键方剂。肺中生成痈脓，不泻除还等什么？但恐怕日久之后痈脓已经形成，此时再泻除就无益了。若日久肺气已虚弱，泻除反而会更伤正气。应当在血液凝结而脓液尚未形成时，应当紧急用泻法攻夺病邪，况且患者气喘严重到无法平卧，这难道不是非常危急吗？
@@@
肺痈，胸部胀满，全身及面目浮肿，鼻塞流清涕，闻不到香、臭、酸、辛等气味，咳嗽气逆，喘息有声且气道阻塞，
应当用葶苈大枣泻肺汤主治。
【注】
此条承接上一条互相详述其症状，以统一治疗方法。肺痈导致胸腹胀满，咳嗽气逆，喘息有声且气道阻塞，全身及面目浮肿，鼻塞流清涕，闻不到香、臭、酸、辛等气味，这是邪气外塞皮毛，内壅肺气，比起单纯的喘促不得卧，病情大概更为严重。也使用葶苈大枣泻肺汤，是因为此时脓液尚未形成的缘故。（方剂见上文）
@@@
咳嗽且胸部胀满，发冷战栗，脉象数，咽干但不口渴，时常吐出浑浊腥臭的唾液，久则吐出像米粥一样的脓液，这是肺痈，应当用桔梗汤主治。
【注】
咳嗽且胸部胀满，发冷战栗，脉象数，咽干但不口渴，时常吐出浑浊腥臭的唾液，久则吐出像米粥一样的脓液，这是肺痈的症状。肺痈在尚未成脓时属于实证，所以用葶苈子的药剂来泻除；如今已经溃破后属于虚证，所以用桔梗的苦味和甘草的甘味，来解除肺毒并排出痈脓。这是治疗已成型的肺痈，病情较轻且未致死的方法。
【集注】
高世栻说：吐出的东西像米粥也是脓液，为什么前文说“脓成则死”？如果说像米粥的不是脓液，前文既然说“蓄结痈脓，吐如米粥”，这里又说“吐脓如米粥”，既然已经吐脓了，哪里还有初起和脓成的区别呢？我说：前文先讲咳嗽气逆，呼吸不利，后来凝滞而血脉化为脓液，阴阳气血都受伤，所以说脓成则死。如果上节讲的是肺痈导致气机不利，本节讲的是肺痈导致经络不和，病在阳气者不伤阴，病在血脉者不伤阳，所以是可以治疗的。如果仅仅用“始萌可救，脓成则死”这两句话来概括，那就是因辞害意，怎么可以呢？
Tingli (Stir-fried until yellow, pounded into pills, size of a pellet) Figs (Jujubae Fructus), 12 pieces
Take the above two ingredients. First, boil the figs in three sheng of water, reduce to two sheng, remove the figs, add Tingli, and boil to obtain one sheng of decoction. Take all at once.
[Collected Explanations]
Zhao Liang said: This is a crucial formula for treating Lung Abscess (Fei Yong). When an abscess forms in the lungs, why wait without purging it? However, if the disease has persisted for a long time and the pus has already formed, purging will be of no benefit. If lung qi has been depleted over time, purging will further injure it. One should act urgently to purge the pathogen while blood is congealed but pus has not yet formed. Moreover, if the patient suffers from severe asthma so bad that they cannot lie down, is this not extremely critical?
@@@
In cases of Lung Abscess (Fei Yong) with chest fullness and distension, edema of the whole body and face, nasal congestion with clear discharge, loss of smell for fragrant, foul, sour, or pungent odors, cough with rebellious Qi, wheezing with roaring sounds, and airway obstruction,
Tingli Dazao Xiefei Tang (Thladianthi Fructus and Jujube Decoction to Drain the Lungs) is the primary treatment.
[Annotation]
This section elaborates on the symptoms in conjunction with the previous clause to unify the treatment. Lung Abscess (Fei Yong) causing chest fullness and distension, cough with rebellious Qi, wheezing with roaring sounds, and airway obstruction, along with edema of the whole body and face, nasal congestion with clear discharge, and loss of smell, indicates that pathogenic factors are externally blocking the skin and hair follicles and internally obstructing Lung Qi. Compared to simple asthma preventing lying down, this condition is likely even more severe. The use of Tingli Dazao Xiefei Tang (Thladianthi Fructus and Jujube Decoction to Drain the Lungs) is appropriate because the pus has not yet formed. (Formula seen above)
@@@
When there is cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of turbid and foul-smelling saliva, and eventually expectoration of pus resembling rice porridge after a long duration, this is Lung Abscess (Fei Yong), treated primarily with Jiegeng Tang (Platycodon Decoction).
[Annotation]
Cough with chest fullness, chills, rapid pulse, dry throat without thirst, occasional expectoration of turbid and foul-smelling saliva, and eventual expectoration of pus resembling rice porridge constitute the syndrome of Lung Abscess (Fei Yong). When Lung Abscess (Fei Yong) has not yet formed pus, it is an excess syndrome; thus, formulas containing Tingli are used to drain it. Now that it has ulcerated, it becomes a deficiency syndrome; therefore, the bitter nature of Jiegeng (Platycodonis Radix) and the sweet nature of Gancao (Glycyrrhizae Radix et Rhizoma) are used to resolve Lung toxicity and expel the abscess pus. This is the method for treating established Lung Abscess (Fei Yong) where the condition is mild and not fatal.
[Collected Annotations]
Gao Shishi said: Expectorating material resembling rice porridge is also pus. Why did the previous text say "once pus forms, death ensues"? If one argues that material resembling rice porridge is not pus, yet the previous text stated "accumulated and knotted abscess pus, expectorating like rice porridge," and here it says "expectorating pus like rice porridge," since pus is already being expectorated, what distinction remains between early stage and formed pus? I say: The previous text first described cough with rebellious Qi and difficult breathing, followed by stagnation where blood vessels transform into pus, injuring both Yin and Yang and Qi and Blood; hence, "once pus forms, death ensues." If the previous section discussed Lung Abscess (Fei Yong) causing dysfunction of Qi mechanism, and this section discusses Lung Abscess (Fei Yong) causing disharmony of meridians and collaterals, where pathology in Yang Qi does not injure Yin, and pathology in Blood Vessels does not injure Yang, then it is treatable. To summarize everything merely with the phrases "early stage can be saved, once pus forms death ensues" is to let words harm the intent, which is unacceptable.