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。
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。
越婢加半夏汤方
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）
上六味，以水六升，先煮麻黄，去上沫，内诸药，煮取三升，分温三服。
【集解】李 曰∶脾运水谷，主为胃行津液，职卑如婢也。汤名越婢者，取发越脾气，
通行津液之义也。今治肺胀，则麻黄散表邪，石膏清内热，甘草、大枣养正缓邪，半夏、生
姜散逆下气也。
上气喘而躁者，属肺胀，欲作风水，发汗则愈。
【注】上气咳逆喘而躁急者，属肺胀也。乃风郁于外，水逆于中之候也，故曰∶欲作
风水。当发其汗，故曰∶发汗则愈也。
【集注】徐彬曰∶有邪者，尚可治也。若上气但喘而躁，则喘为风之扇，躁为风之烦，
其逆上之涎沫，将挟风势而为风水。今使先泄于肌表，水无风战，自然顺趋而从下，故
曰∶可汗而愈。
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。
【注】此承上条互详脉证，以明其治也。肺胀，咳而上气，烦躁而喘，脉浮，是外伤
风寒，内有水气，主以小青龙汤，发汗则愈。加石膏者，因多一烦躁证也。
【集注】沈明宗曰∶此互上条，肺胀治法也。风寒之邪，入于营卫，挟饮上逆，则咳
而上气也。烦躁而喘，肺气壅逆，谓之肺胀，即肺痈未成之初也。
尤怡曰∶此亦外邪内饮相搏之证，而兼烦躁，则挟有热邪，麻桂药中必用石膏，如
大青龙之例也。又此条见证与上条颇同，而心下寒饮，则菲温药不能开而去之，故不用
越婢加半夏，而用小青龙加石膏，温寒并进，水热俱捐，于法尤为密矣。
小青龙加石膏汤方
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）
上九味，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。
【集解】李 曰∶心下有水，麻黄、桂枝发汗以泄水于外，半夏、干姜、细辛温中以
散水于内，芍药、五味子收逆气以平肝，甘草益脾土以制水，加石膏以去烦躁，兼能解
肌出汗也。
咳而脉浮者，浓朴麻黄汤主之。脉沉者，泽漆汤主之。
【注】咳，谓咳而不上气也。脉浮者，风寒病外也。主之浓朴、麻黄者，以散外邪为
主也。脉沉者，痰饮病里也。主之泽漆汤，以
逐内饮为主也。
【集解】尤怡曰∶此不详见证，而但以脉之浮沉为辨，而异其治。按浓朴麻黄汤与小
青龙加石膏汤大同，则散邪蠲饮之力居多，而浓朴辛温亦能助表，小麦甘平，五味敛安正
气者也。泽漆汤以泽漆为主，而以白前、黄芩、半夏佐之，则下趋之力较猛，虽生姜、
桂枝之辛，亦只为下气降逆之用而已，不能发表也。仲景之意，盖以咳皆肺邪，而脉浮
者，气多居表，故驱之使从外出为易；脉沉者气多居里，故驱之使从下出为易，亦因势
利导之法也。
浓朴麻黄汤方
浓朴（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）
上九味，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。
泽漆汤方
半夏（半升） 紫参（一作紫菀，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）
上九味， 咀，内泽漆汁中，煮取五升，温服五合，至夜尽。
【集解】李 曰∶咳者，水寒射肺也。脉浮者，停水而又挟风以鼓之也。麻黄去风散
肺逆，与半夏、细辛、干姜、五味子、石膏同用，即前小青龙加石膏，为解表行水之剂
也。然土能制水，而地道壅塞，则水亦不行，故用浓朴疏敦阜之土，使脾气健运，而水自
下泄矣。杏仁下气去逆，小麦入心经能通火气，以火能生土助脾，而共成决水之功也。又
云∶脉沉为水，以泽漆为君者，因其功专于消痰行水也，水性阴寒，桂枝行阳气以导之。
然所以停水者，以脾土衰不能制水，肺气逆不能通调水道，故用人参、紫参、白前、甘
草补脾顺肺，同为制水利水之方也。黄芩苦以泄之，半夏、生姜辛以散之也。
沈明宗曰∶详《金匮》咳嗽病，本于肺则一，大纲有三∶一者，热刑肺金，气弱不
振，咳而唾沫为肺痿；二者，风伤卫分，则病咳上气喘为肺胀；三者，邪传营血，凝而
不行为肺痈。然肺胀之中，又分风、寒、表、里，饮多、风少，风多、饮少之治。故气喘
而躁，脉浮者，为心下有水，欲作风水，当以小青龙两解表里，加石膏以清风热。目如
脱状，乃风寒多而饮少，以越婢驱风，加半夏而下痰逆。风寒外束，火热内郁，喉中水
鸡声者，射干麻黄汤，宣通表里之邪。风热壅逆，津液不布，化而为涎，时时唾浊，但
坐不得眠者，皂荚丸以驱风郁之涎。若咳而脉浮，邪居肺气，以浓朴麻黄汤，俾从表解。
咳而脉沉，邪入于营，将成肺痈，以泽漆而破壅结。火逆上气，咽喉不利，是无外邪，治
当麦门冬汤，清润滋降。若见浮肿肩息，脉浮大而下利，真气上浮下脱，则为不治。以
上皆外邪兼内饮合病，微细之辨，临证又当合《内经》五脏六腑，互相传乘之咳而辨之，
则尽善矣。
如果又出现下利，病情就更为严重。这是因为脉象和症状都显示正气虚弱，已经属于难以治愈的情况；如果再出现下利，就会导致上气喘逆、下利不止，造成阴阳之气双双脱失，脉证表现相互矛盾，所以说“更为严重”。
【集注】徐彬说：这是在论述肺痈的证候，元气衰竭的患者，治疗比较困难。肺痈由风邪引起，风性上行，必然先出现气逆上冲的症状；如果兼见面部浮肿、抬肩呼吸（呼吸困难），说明气机只升不降。此时脉象浮大，元气不能收敛，那么既不能用补法，也不能用汗法；况且内外都是逆乱之气，不像普通的风邪那样可以通过发汗泄解？所以说无法治愈。如果再出现下利，阳气从上焦脱失，阴液从下焦脱失，所以说“更为严重”。
尤怡说：气逆上冲、面部浮肿、抬肩呼吸，说明气机只有上升而没有下降。脉象再次变得浮大，说明阳气有向上越脱的趋势。脉象偏盛，实际上是偏绝的表现。如果再出现下利，说明阴气又从下焦脱失。阴阳离决，所以应当判定为不治之症。“肩息”是指呼吸时肩膀随之摇动。
咳嗽且气逆上冲，这是肺胀病，患者喘息，眼睛突出像要脱落的样子，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，其症状表现为抬肩呼吸而喘，眼球突出像要脱落的状态。现在脉象浮大，就可以知道浮脉主风邪，大脉主实证，所以用越婢加半夏汤主治，以疏散皮毛表邪，内降上逆之气。
【集注】赵良说：咳嗽且气逆上冲，说明气机冲逆而不能下行，可以推知；咳嗽连续不断，也可以推知。这都是因为肺气胀满所致。邪气侵入肺部导致气机壅塞，气机壅塞则必然导致喘息，只有喘息极度严重时，才会出现眼睛像要脱落的样子，这就是肺胀发展到极致的表现。脉浮表示有邪气，兼见大脉则表示邪气实盛。邪气对肺部的危害还没有结束，所以必须用辛热药发散，同时兼用甘寒药佐助，使久积的邪气像冰融化一样消散，难道不快意吗？然而久蓄的饮邪，如何能够排泄出去？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，而消除饮邪的力量少，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，所以利于使用辛寒药物，而不利于使用辛热药物。“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。
越婢加半夏汤方
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）
以上六味药，用水六升，先煮麻黄，去掉上面的泡沫，再加入其他药物，煮取三升药液，分三次温服。
【集解】李 说：脾运化水谷，主要替胃输送津液，职权卑微如同婢女。汤剂名叫“越婢”，是取激发脾气、通行津液的含义。现在治疗肺胀，麻黄散发表邪，石膏清解内热，甘草、大枣扶助正气、缓和邪气，半夏、生姜散逆气、降肺气。
上气喘促且烦躁的，属于肺胀病，将要发展为风水病，通过发汗治疗即可痊愈。
【注】上气喘逆、咳嗽喘息且烦躁急迫的，属于肺胀病。这是风邪郁闭于体表，水气逆乱于体内的征候，所以说“将要发展为风水”。应当采用发汗法，所以说“发汗即可痊愈”。
【集注】徐彬说：如果有邪气存在，还可以治疗。如果上气喘促且烦躁，喘息是风邪煽动的结果，烦躁是风邪烦扰的表现，那些逆上的涎沫，将挟带风势而形成风水。现在如果能先从肌表发泄，水气没有风邪的鼓动，自然会顺趋向下排出，所以说“可以通过发汗而痊愈”。
肺胀，咳嗽且气逆上冲，烦躁且喘息，脉象浮的，心下有停饮，用小青龙加石膏汤主治。
【注】这是承接上一条详细辨析脉证，以阐明治疗方法。肺胀，咳嗽且气逆上冲，烦躁且喘息，脉象浮，这是外受风寒，内有水气，主治用小青龙汤，发汗后即可痊愈。加入石膏的原因，是因为多了一个烦躁的症状。
【集注】沈明宗说：这是与上一条互相参照，阐述肺胀的治疗方法。风寒邪气侵入营卫，挟带饮邪上逆，就会咳嗽且气逆上冲。烦躁且喘息，肺气壅逆，称为肺胀，也就是肺痈尚未形成的初期阶段。
尤怡说：这也是外邪与内饮相互搏结的证候，而兼见烦躁，说明挟带有热邪，在麻黄、桂枝等药物中必须使用石膏，就像大青龙汤的用法一样。另外这一条的症状与上一条颇为相似，但如果是心下的寒饮，非温热药物不能开通并去除它，所以不用越婢加半夏汤，而用小青龙加石膏汤，温散寒邪与清除热邪并进，水饮与热邪一同消除，在治法上更为严密。
小青龙加石膏汤方
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）
以上九味药，用水一斗，先煮麻黄，去掉上面的泡沫，再加入其他药物，煮取三升药液，体质强壮的人服用一升，体弱的人减量，分二三服服用，小儿服用四合。
【集解】李 说：心下有停饮，麻黄、桂枝发汗以向外排泄水气，半夏、干姜、细辛温中焦以向内消散水气，芍药、五味子收敛逆气以平抑肝气，甘草补益脾土以制约水气，加入石膏以去除烦躁，兼能解肌发汗。
【注】咳嗽，这里指咳嗽但不伴气逆上冲。脉象浮，说明是风寒病在体表。主治用浓朴、麻黄，是以发散外邪为主。脉象沉，说明是痰饮病在体内。主治用泽漆汤，是以驱逐内饮为主。
【集解】尤怡说：这里不详述具体症状，仅以脉象的浮沉作为辨别依据，从而采取不同的治疗方法。按浓朴麻黄汤与小青龙加石膏汤大体相同，则发散邪气、消除饮邪的力量居多，而且浓朴辛温也能帮助解表，小麦甘平，五味子收敛安护正气。泽漆汤以泽漆为主药，而以白前、黄芩、半夏佐助，则下行的力量较为猛烈，虽然也有生姜、桂枝的辛味，也只是用于下气降逆的作用而已，不能发表。张仲景的本意，大概是认为咳嗽都是肺经受邪，脉象浮的，气机多在体表，所以驱除它使其从外出比较容易；脉象沉的，气机多在体内，所以驱除它使其从下出比较容易，这也是顺应趋势加以引导的方法。
浓朴麻黄汤方
浓朴（五两） 麻黄（四两） 石膏（如鸡蛋大小） 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）
以上九味药，用水一斗二升，先煮小麦至熟，去渣，再加入其他药物，煮取三升药液，温服一升，每日三次。
泽漆汤方
半夏（半升） 紫参（一作紫菀，五两） 泽漆（以东流水五斗，煮取一斗五升，取三升汁） 生姜（五两） 白前（五两） 甘草 黄芩 人参 桂枝（各三两）
以上九味药，切碎，放入泽漆汁中，煮取五升药液，温服五合，直到夜间服完。
【集解】李 说：咳嗽，是水寒之气射入肺部所致。脉象浮，是停水又挟带风邪以鼓动所致。麻黄祛风散肺逆，与半夏、细辛、干姜、五味子、石膏同用，就是前面提到的小青龙加石膏汤，属于解表行水的方剂。然而土能制水，如果地道壅塞，水也不能运行，所以用浓朴疏通壅盛的土气，使脾气健运，水气自然向下排泄。杏仁下气去逆，小麦入心经能通火气，因为火能生土助脾，共同完成决水利水的功效。又说：脉沉为水气，以泽漆为君药，是因为它的功效专门在于消痰行水。水性阴寒，桂枝行阳气以引导它。然而之所以停水，是因为脾土衰弱不能制水，肺气逆乱不能通调水道，所以用人参、紫参、白前、甘草补脾顺肺，同为制水利水的方剂。黄芩苦味以泄热，半夏、生姜辛味以散结。
沈明宗说：详细考察《金匮》中的咳嗽病，根源都在肺，大纲有三点：第一，热邪刑克肺金，气弱不振，咳嗽且吐泡沫，这是肺痿；第二，风邪伤及卫分，则病咳、上气、喘息，这是肺胀；第三，邪气传入营血，凝滞不行，这是肺痈。然而在肺胀之中，又分为风、寒、表、里，饮多风少、风多饮少的不同治法。所以气喘且烦躁、脉象浮的，是心下有停水，将要发展为风水，应当用小青龙汤表里双解，加石膏以清风热。眼睛突出像要脱落的样子，是风寒多而饮少，用越婢汤驱风，加半夏以降痰逆。风寒外束，火热内郁，喉中有水鸡叫声的，用射干麻黄汤，宣通表里之邪。风热壅逆，津液不布，化为涎沫，时时唾吐浊物，只能坐着不能躺下的，用皂荚丸以驱除风郁之涎。如果咳嗽且脉象浮，邪气居于肺气，用浓朴麻黄汤，使邪气从表解除。咳嗽且脉象沉，邪气进入营分，将要形成肺痈，用泽漆汤破除壅结。火逆上气，咽喉不利，这是没有外邪，治疗应当用麦门冬汤，清润滋降。如果出现浮肿、抬肩呼吸、脉象浮大且下利，真气上浮下脱，则为不治之症。以上都是外邪兼内饮合病，细微的辨证，临证时还应当结合《内经》五脏六腑互相传乘的咳嗽来进行辨别，那就尽善尽美了。
If diarrhea occurs additionally, the condition becomes even more severe. This is because both the pulse and symptoms indicate deficiency of healthy qi, which already belongs to untreatable cases; if diarrhea occurs additionally, it leads to panting above and diarrhea below, causing a dual loss of yin and yang qi, with pulse and symptoms contradicting each other. Therefore, it is said to be "even more severe."
[Collected Annotations] Xu Bin says: This discusses the syndrome of lung abscess (pulmonary abscess), stating that patients with exhausted yuan qi are difficult to treat. Lung abscess caused by wind pathogen, since wind nature ascends, must first present with qi counterflow upward. If accompanied by facial edema and shoulder breathing (dyspnea with use of accessory muscles), it indicates qi rising but not descending. At this time, the pulse is floating and large, and yuan qi cannot converge. Thus, tonification is contraindicated, and sweating is also contraindicated. Moreover, since both interior and exterior involve rebellious qi, unlike ordinary wind pathogens, can it be fully resolved by sweating? Hence, it is considered untreatable. If diarrhea occurs additionally, yang qi escapes from above, and yin fluids escape from below. Therefore, it is said to be "even more severe."
You Yi says: Qi counterflow upward, facial edema, and shoulder breathing indicate that qi only rises and does not descend. The pulse becoming floating and large again indicates an opportunity for yang qi to float away upwards. A pulse that is excessively strong actually indicates extremity of depletion. If diarrhea occurs additionally, it means yin qi is also escaping from below. With the separation of yin and yang, it should be judged as untreatable. "Shoulder breathing" refers to respiration accompanied by the movement of the shoulders.
Cough with qi counterflow upward constitutes Lung Distension (Pulmonary Distension). The patient pants, and the eyes protrude as if about to fall out. If the pulse is floating and large, Yuebi Jia Banxia Tang (Yuebi Decoction plus Pinellia) is the primary treatment.
[Annotation] Cough with qi counterflow upward constitutes Lung Distension. The symptoms include shoulder breathing with panting, and the eyes protruding as if about to fall out. Since the pulse is currently floating and large, we know that floating indicates wind pathogen, and large indicates excess syndrome. Therefore, Yuebi Jia Banxia Tang (Yuebi Decoction plus Pinellia) is used to disperse exterior pathogens in the skin and hair, and internally descend rebellious qi.
[Collected Annotations] Zhao Liang says: Cough with qi counterflow upward indicates that qi rushes upward without descending, which can be inferred; the continuous coughing can also be inferred. All these are caused by Lung Distension. When pathogenic factors enter the lungs, qi becomes congested. Qi congestion inevitably leads to panting. Only when panting reaches its extreme do the eyes appear as if falling out. This represents the culmination of Lung Distension. A floating pulse indicates pathogen; combined with a large pulse, it indicates excess pathogen. The harm to the lungs has not yet ceased. Therefore, acrid-hot herbs must be used to disperse, assisted by sweet-cold herbs, so that long-standing pathogens dissipate like melting ice, which is indeed gratifying. However, how can long-stagnated fluid retention be drained? Thus, Banxia (Pinelliae Rhizoma) is specifically added to Yuebi Tang, which is a fixed method.
You Yi says: Exterior pathogens and interior fluid retention fill the lungs, causing distension, panting, and cough with qi counterflow. Yuebi Tang has strong power to disperse pathogens but weak power to eliminate fluid retention. Therefore, Banxia (Pinelliae Rhizoma) is used to supplement its deficiencies. Xiao Qinglong Tang (Minor Blue Dragon Decoction) is not used because the pulse is floating and large, indicating a yang-heat syndrome. Therefore, acrid-cold herbs are beneficial, while acrid-hot herbs are not. "Eyes protruding as if falling out" refers to dim, swollen, and protruding eyes, resembling a state of impending detachment, caused by congested qi.
**Yuebi Jia Banxia Tang Formula (Yuebi Decoction plus Pinellia)**
Mahuang (Ephedrae Herba, 6 liang), Shigao (Gypsum Fibrosum, 0.5 jin), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Dazao (Jujubae Fructus, 15 pieces), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Banxia (Pinelliae Rhizoma, 0.5 jin).
Take the above six ingredients, add 6 sheng of water, first boil Mahuang (Ephedrae Herba), remove the foam on the surface, then add the remaining herbs. Boil until 3 sheng remains. Divide into three warm doses.
[Collected Annotations] Li says: The Spleen transforms food and grain, primarily transporting body fluids for the Stomach. Its role is humble, like a maid. The name "Yuebi" implies stimulating Spleen qi and promoting the circulation of body fluids. Now, treating Lung Distension: Mahuang (Ephedrae Herba) disperses exterior pathogens, Shigao (Gypsum Fibrosum) clears internal heat, Gancao (Glycyrrhizae Radix et Rhizoma) and Dazao (Jujubae Fructus) support healthy qi and moderate pathogens, while Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) scatter rebellious qi and direct it downward.
When upper qi pants and irritability occurs, it belongs to Lung Distension, and is about to develop into Fengshui (Wind-Water Edema). Sweating will lead to recovery.
[Annotation] Upper qi counterflow, coughing, panting, and irritability belong to Lung Distension. This is a presentation of wind constrained externally and water rebellious internally. Hence, it is said to be "about to develop into Wind-Water Edema." One should induce sweating; hence, it is said that "sweating leads to recovery."
[Collected Annotations] Xu Bin says: If there is a pathogen, it is still treatable. If upper qi merely pants and is irritable, panting is the fan of wind, and irritability is the vexation of wind. The phlegm-fluids rushing upward will carry the momentum of wind to form Wind-Water Edema. If one now vents them through the muscle layer, the water, lacking the battle of wind, will naturally flow downward and exit. Hence, it is said that "it can be cured by sweating."
In Lung Distension, with cough, qi counterflow upward, irritability, and panting, and a floating pulse, there is fluid retention under the heart (epigastric region). Xiaolongdan Jia Shigao Tang (Xiao Qinglong Tang plus Gypsum) is the primary treatment.
[Annotation] This continues from the previous clause to detail pulse and symptoms, clarifying the treatment. Lung Distension, cough, qi counterflow upward, irritability, panting, and floating pulse indicate external contraction of wind-cold and internal presence of fluid qi. The primary treatment is Xiaolongdan Tang (Xiao Qinglong Decoction); inducing sweating leads to recovery. Shigao (Gypsum Fibrosum) is added because of the additional symptom of irritability.
[Collected Annotations] Shen Mingzong says: This cross-references the previous clause, explaining the treatment for Lung Distension. Wind-cold pathogens enter Ying and Wei levels, carrying fluid retention upward and reversing, causing cough and qi counterflow. Irritability and panting, with congested and rebellious Lung qi, are called Lung Distension, which is essentially the initial stage before Pulmonary Abscess forms.
You Yi says: This is also a syndrome of exterior pathogens and interior fluid retention struggling against each other. The addition of irritability indicates the presence of heat pathogens. In formulas containing Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus), Shigao (Gypsum Fibrosum) must be used, following the example of Da Qinglong Tang (Major Blue Dragon Decoction). Furthermore, although the manifestations here are similar to the previous clause, if it is cold-fluid retention under the heart, warm herbs alone cannot open and dispel it. Therefore, Yuebi Jia Banxia Tang is not used, but Xiaolongdan Jia Shigao Tang (Xiao Qinglong Decoction plus Gypsum) is chosen. Warmth and cold are advanced together, eliminating both water and heat, making the method particularly rigorous.
**Xiaolongdan Jia Shigao Tang Formula (Xiao Qinglong Decoction plus Gypsum)**
Mahuang (Ephedrae Herba), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Xixin (Asari Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma, 3 liang each), Wuweizi (Schisandrae Fructus), Banxia (Pinelliae Rhizoma, 0.5 sheng each), Shigao (Gypsum Fibrosum, 2 liang).
Take the above nine ingredients, add 1 dou of water, first boil Mahuang (Ephedrae Herba), remove the foam, then add the other herbs. Boil until 3 sheng remains. Strong individuals take 1 sheng per dose; frail individuals reduce the dose. Take two or three doses. Children take 4 ge.
[Collected Annotations] Li says: Fluid retention under the heart: Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) induce sweating to drain water outward; Banxia (Pinelliae Rhizoma), Ganjiang (Zingiberis Rhizoma), and Xixin (Asari Radix et Rhizoma) warm the middle to dissipate water inward; Shaoyao (Paeoniae Radix Alba) and Wuweizi (Schisandrae Fructus) collect rebellious qi to calm Liver qi; Gancao (Glycyrrhizae Radix et Rhizoma) benefits Spleen earth to control water; adding Shigao (Gypsum Fibrosum) removes irritability and also helps resolve the muscle layer and induce sweating.
When coughing and the pulse is floating, Nongpo Mahuang Tang (Polygalae Semen Ephedrae Decoction) is the primary treatment. When the pulse is sunken, Zeqi Tang (Phytolaccae Decoction) is the primary treatment.
[Annotation] "Cough" here refers to coughing without qi counterflow upward. A floating pulse indicates Wind-Cold disease at the exterior. Using Nongpo (Magnoliae Officinalis Cortex) and Mahuang (Ephedrae Herba) focuses on dispersing exterior pathogens. A sunken pulse indicates Phlegm-Fluid disease at the interior. Using Zeqi Tang focuses on driving out interior fluid retention.
[Collected Annotations] You Yi says: Here, specific symptoms are not detailed; differentiation is made solely based on whether the pulse is floating or sunken, leading to different treatments. Nongpo Mahuang Tang (Polygalae Semen Ephedrae Decoction) is largely similar to Xiaolongdan Jia Shigao Tang (Xiao Qinglong Decoction plus Gypsum), possessing mostly powers to disperse pathogens and eliminate fluid retention. Nongpo (Magnoliae Officinalis Cortex) is acrid-warm and can assist the exterior; Xiaomai (Tritici Fructus) is sweet-neutral, and Wuweizi (Schisandrae Fructus) collects and stabilizes healthy qi. Zeqi Tang (Phytolaccae Decoction) uses Zeqi (Phytolaccae Radix) as the chief herb, assisted by Baiqian (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), and Banxia (Pinelliae Rhizoma). Its downward-draining power is stronger. Although Ginger (Shengjiang/Zingiberis Rhizoma Recens) and Guizhi (Cinnamomi Ramulus) are acrid, they are only used for directing qi downward and rebelling it, not for releasing the exterior. Zhang Zhongjing's intent seems to be that coughs all stem from Lung pathogens. When the pulse is floating, qi tends to remain at the exterior, so driving it out from the outside is easier. When the pulse is sunken, qi tends to remain at the interior, so driving it out from below is easier. This is the method of facilitating the natural trend.
**Nongpo Mahuang Tang Formula (Polygalae Semen Ephedrae Decoction)**
Nongpo (Magnoliae Officinalis Cortex, 5 liang), Mahuang (Ephedrae Herba, 4 liang), Shigao (Gypsum Fibrosum, size of a chicken egg), Xingren (Armeniacae Semen Amarum, 0.5 sheng), Banxia (Pinelliae Rhizoma, 0.5 sheng), Ganjiang (Zingiberis Rhizoma, 2 liang), Xixin (Asari Radix et Rhizoma, 2 liang), Xiaomai (Tritici Fructus, 1 sheng), Wuweizi (Schisandrae Fructus, 0.5 sheng).
Take the above nine ingredients, add 1.2 dou of water, first boil Xiaomai (Tritici Fructus) until cooked, remove the dregs, then add the other herbs. Boil until 3 sheng remains. Take 1 sheng warm, three times a day.
**Zeqi Tang Formula (Phytolaccae Decoction)**
Banxia (Pinelliae Rhizoma, 0.5 sheng), Zishen (Radix Bupleuri/Pulsatillae? Note: Text says Zishen, usually Zisanzi or Ziwann, here likely Ziwan/Asteris Radix, 5 liang), Zeqi (Phytolaccae Radix, boiled in 5 dou of east-flowing water to obtain 1.5 dou, take 3 sheng of this juice), Shengjiang (Zingiberis Rhizoma Recens, 5 liang), Baiqian (Cimicifugae Rhizoma, 5 liang), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Guizhi (Cinnamomi Ramulus, 3 liang each).
Chop the above nine ingredients, add them to the Zeqi juice, and boil until 5 sheng remains. Take 5 he warm, finishing by nightfall.
[Collected Annotations] Li says: Cough is caused by cold-water shooting into the Lungs. A floating pulse indicates stagnant water driven by wind. Mahuang (Ephedrae Herba) dispels wind and scatters Lung rebellion. Used together with Banxia (Pinelliae Rhizoma), Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Wuweizi (Schisandrae Fructus), and Shigao (Gypsum Fibrosum), it forms the previously mentioned Xiaolongdan Jia Shigao Tang (Xiao Qinglong Decoction plus Gypsum), a formula for resolving the exterior and promoting water metabolism. However, Earth controls Water. If the earthly pathways are blocked, water cannot flow. Therefore, Nongpo (Magnoliae Officinalis Cortex) is used to dredge the piling-up Earth, strengthening Spleen transportation so that water drains downward. Xingren (Armeniacae Semen Amarum) directs qi downward and removes rebellion. Xiaomai (Tritici Fructus) enters the Heart channel to circulate fire qi. Since Fire generates Earth and assists the Spleen, they jointly achieve the function of draining water. It is also said: Sunken pulse indicates water. Zeqi (Phytolaccae Radix) is the sovereign herb because its efficacy specializes in resolving phlegm and promoting water metabolism. Water nature is yin-cold; Guizhi (Cinnamomi Ramulus) moves yang qi to guide it. However, the reason for water stagnation is Spleen Earth deficiency failing to control water, and Lung qi rebellion failing to regulate water passages. Therefore, Renshen (Ginseng Radix), Zishen (Asteris Radix), Baiqian (Cimicifugae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) are used to tonify the Spleen and smooth the Lungs, forming a formula for controlling and draining water. Huangqin (Scutellariae Radix) is bitter to drain; Banxia (Pinelliae Rhizoma) and Shengjiang (Zingiberis Rhizoma Recens) are acrid to disperse.
Shen Mingzong says: Detailed examination of the Cough diseases in *Jinkui Yaolue* shows that the root is always in the Lungs, with three main categories: First, Heat punishing Lung Metal, with weak qi unable to振奋 (rise), causing cough and spitting froth—this is Feiwei (Lung萎/Flaccidity). Second, Wind injuring the Wei level, causing cough, qi counterflow, and panting—this is Feizhang (Lung Distension). Third, Pathogens transmitting to Ying and Blood, condensing and failing to move—this is Fei Yong (Lung Abscess). Within Lung Distension, treatments differ for Wind, Cold, Exterior, Interior, and varying ratios of Fluid vs. Wind. Thus, panting with irritability and a floating pulse indicates fluid retention under the heart, about to become Wind-Water Edema; treat with Xiaolongdan Tang (Xiao Qinglong Decoction) to resolve both exterior and interior, adding Shigao (Gypsum Fibrosum) to clear wind-heat. Eyes protruding as if falling out indicates excessive wind-cold and little fluid retention; treat with Yuebi Tang to drive wind, adding Banxia (Pinelliae Rhizoma) to descend phlegm-rebellion. Wind-cold binding the exterior with internal fire depression, and a sound like a water-frog in the throat, indicates Shegan Mahuang Tang (Belamcandae Rhizoma Ephedrae Decoction) to vent exterior-interior pathogens. Wind-heat congestion and rebellion, with fluids not distributing, transforming into saliva, frequent spitting of turbid matter, and inability to lie down, indicates Zaojiao Wan (Gleditsiae Sinensis Fruit Pill) to drive wind-congested saliva. If coughing with a floating pulse, pathogen resides in Lung qi; use Nongpo Mahuang Tang (Polygalae Semen Ephedrae Decoction) to allow release from the exterior. If coughing with a sunken pulse, pathogen enters Ying level, potentially forming Lung Abscess; use Zeqi Tang to break congestion. Fire rebellion causing upper qi and throat discomfort, without exterior pathogens, indicates Maimendong Tang (Ophiopogonis Decoction) for clearing, moistening, nourishing, and descending. If edema, shoulder breathing, floating-large pulse, and diarrhea appear, true qi floats up and escapes down, constituting untreatable cases. All the above are exterior pathogens combined with interior fluid retention, requiring subtle differentiation. In clinical practice, one must also combine the *Neijing*'s principles of mutual transmission among the Five Zang and Six Fu organs regarding coughs to achieve perfection.