寒。阴郁于里也。咽干不渴。阻滞津液也。彼邪热搏聚。固结难散之势。用桔梗开
之以散其毒。甘草解之以消其毒。庶几可图。无使滋蔓。即至久久吐脓之时。亦
仍可用此汤者。一以桔梗可开之使下行。亦可托之俾吐出。一以甘草可以长血肉。更可以益金母也。
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。
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（半升）
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。
〔补注〕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。肺壅则欲不喘不可得。惟喘极故目如
脱。所以状胀与喘之至也。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。
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。
小青龙汤加石膏汤方
麻黄（三两） 细辛（三两） 芍药（三两） 干姜（三两）
甘草（三两） 桂枝（三两） 五味子（半升） 半夏（半升） 石膏（二两）
上九味。以水一斗。先煮麻黄减二升。去上沫。内诸药。煮取三升。去滓。强人服一
升。羸者减之。日三服。小儿服四合。
〔补注〕此条证与上条无异。所异者加躁。脉但浮尔。然前条躁者欲作风水。此条
躁者心下有水。可见躁为阴躁。而水为阴之至也。君主之地。水气上凌。岂细故
耶。故前方于麻黄以杏仁易石膏。加姜、枣。发散之力微且缓。此于麻桂药中加
石膏。其力转猛。然监以芍药、五味、干姜。其势下趋水道。不至过汗也。然后知小
青龙亦能翻江倒海。引水潜藏。不若大青龙之腾云致雨也。夫越婢汤有石膏、
半夏。小青龙方有半夏。无石膏。观二方所加之意。全重此二物协力建功。石膏
清热。藉辛温亦能豁痰。半夏豁痰。藉辛凉亦能清热。不然石膏可无虑。半夏不
在所禁乎。仲景加减一味。已见因心化裁矣。
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。
〔补注〕经云。是动则病肺胀满。膨膨然而喘咳。胃气不升。大肠之气亦不降。则鼻
塞不闻香臭。遂使周身肿浮。有种种之证也。然此表证尚多。岂可专泻。不知肺
痈始因邪由外入。及其成痈。则证复自内显出。故论其常。当升散开提者。且未
可下夺。论其亟当下夺者。倘牵制于外。反昧脓成则死之大戒。安得不审所轻重哉。
寒。这是阴气郁结在体内的表现。咽干但不觉得口渴，是因为津液运行受阻。那些邪热搏结聚集，形成固结难以消散的态势。使用桔梗来开泄以疏散其毒，使用甘草来解毒以消除其毒，这样或许还有希望。不要让病势蔓延滋长，即使到了长久之后吐出脓血的时候，仍然可以使用这个汤剂。一方面，桔梗可以开泄使（脓毒）下行，也可以托举使其吐出；另一方面，甘草可以生长血肉，更可以补益肺金之母（脾土）。
咳嗽且气逆上冲，这属于肺胀。患者气喘，眼睛突出像要脱出一样，脉象浮大的，用越婢加半夏汤主治。
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（半升）
以上六味药，用水六升，先煮麻黄，去掉上浮的泡沫，再加入其他药物，煮取三升药液，分三次温服。
〔补注〕咳嗽且气逆上冲，那么可知其气有冲逆而不能下行的情况。咳嗽接连不断而不停止，也可知。这些都归属于肺胀所致。邪气侵入肺脏则气机壅滞，肺脏壅滞则想要不喘也不可能。只有喘得极其厉害，所以眼睛像要脱出一样，这是胀和喘达到极致的表现。脉浮表示有邪气，兼见大脉则表示邪气实盛，因而对肺脏造成的危害正没有尽头。所以必须用辛热之药发散它，同时也兼用甘寒之药佐助它，使久积合聚的邪气，像冰融化一样消散，难道不快意吗？然而久蓄积的水饮，如何得以排泄？所以特意在越婢汤中加入半夏，这是一定的法则。
肺胀，咳嗽且气逆上冲，烦躁且气喘，脉象浮的，这是心下有停水，用小青龙加石膏汤主治。
小青龙汤加石膏汤方
麻黄（三两） 细辛（三两） 芍药（三两） 干姜（三两）
甘草（三两） 桂枝（三两） 五味子（半升） 半夏（半升） 石膏（二两）
以上九味药，用水一斗，先煮麻黄减少二升，去掉上浮的泡沫，加入其他药物，煮取三升药液，去渣滓。体质强壮的人服用一升，体弱的人减量。每天分三次服用。小儿服用四合。
〔补注〕这一条的症状与上一条没有不同，所不同的是增加了烦躁，脉象只是浮而已。然而前一条中烦躁的是欲发为风水证，这一条中烦躁的是心下有停水。可见烦躁属于阴躁，而水饮是阴邪至极的表现。君主之宫（心），被水气上凌，难道是小事吗？所以前面的方子在麻黄的基础上用杏仁替换石膏，加入姜、枣，发散的力量微弱且缓和。这一条在麻黄、桂枝的药中加入石膏，力量反而猛烈。然而用芍药、五味子、干姜来监制它，其趋势向下趋向水道，不至于导致过汗。然后才知道小青龙汤也能翻江倒海，引导水饮潜藏，不像大青龙汤那样腾云致雨。越婢汤中有石膏、半夏，小青龙方中有半夏，无石膏。观察这两个方子加减的用意，完全重视这两味药协力建功。石膏清热，借助辛温之性也能豁痰；半夏豁痰，借助辛凉之性也能清热。否则，石膏就可以不必担忧，半夏就不在所禁之列了吗？张仲景加减一味药，已经显示出他根据内心悟性进行裁断的智慧了。
肺痈，胸部满闷胀塞，全身面目浮肿，鼻塞流清涕，闻不到香味和臭味，感到酸辛，咳嗽气逆上冲，喘息有声，气道迫塞。用葶苈大枣泻肺汤主治。
〔补注〕《内经》说：经气变动就会发生肺胀满，膨膨胀满而喘咳。胃气不升，大肠之气也不降，就会导致鼻塞闻不到香味和臭味。于是使得周身肿浮，出现种种症状。然而此时表证还很多，怎么能专门攻泻呢？不知道肺痈开始是因为邪气由外而入，等到成痈后，症状又自行从内显现出来。所以论述其常理，应当升散开提的，暂且不可用下法攻夺。论述其紧急时必须用下法攻夺的情况，如果受限于表证牵制，反而违背了“脓成则死”的大戒。怎能不审慎权衡轻重呢？
Cold. This indicates the depression of Yin pathogenic factors within the interior. Dryness in the throat without thirst results from the obstruction of body fluids. The pathogenic heat, clashing and aggregating, forms a solidified state that is difficult to dissipate. Use Jiegeng (Platycodonis Radix) to open and disperse its toxicity, and Gancao (Glycyrrhizae Radix et Rhizoma) to resolve and eliminate its toxicity. Only then might there be hope. Prevent the pathogen from spreading; even when pus is expectorated after a long duration, this decoction can still be used. On one hand, Jiegeng can open the orifices to facilitate downward drainage or upward expulsion of pus; on the other hand, Gancao can nourish flesh and blood, and further tonify the Mother of Metal (Spleen Earth).
Cough with rebellious Qi ascending constitutes Lung Distension (Fei Zhang). The patient wheezes, eyes protruding as if about to fall out, with a floating and large pulse. Yuebi Jia Banxia Tang (Yuebi Decoction plus Pinellia) is the primary treatment.
Formula for Yuebi Jia Banxia Tang (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 sheng).
Take the above six ingredients. Add six sheng of water. First boil Mahuang, remove the foam on the surface, then add the remaining herbs. Boil until three sheng remain. Divide into three warm doses.
[Supplementary Note] Cough with rebellious Qi ascending indicates that the Qi rushes upward rather than descending. The continuous, unceasing cough confirms this. All these symptoms are caused by Lung Distension. When pathogenic factors enter the Lung, Qi becomes congested. Lung congestion inevitably leads to wheezing. Only when wheezing reaches an extreme do the eyes protrude as if falling out, demonstrating the severity of distension and wheezing. A floating pulse indicates external pathogenic factors; combined with a large pulse, it signifies excess pathogenic factors, causing ongoing harm to the Lung. Therefore, acrid-hot herbs must be used to disperse them, assisted by sweet-cold herbs, so that the long-accumulated pathogens melt away like ice. Is this not delightful? However, how can long-stagnant fluid retention be drained? Thus, Banxia is specifically added to Yuebi Tang, which is a fixed principle.
Lung Distension, characterized by cough with rebellious Qi ascending, irritability, wheezing, and a floating pulse, indicates fluid retention below the Heart (Xin Xia You Shui). Xiaoqinglong Jia Shigao Tang (Xiaoqinglong Decoction plus Gypsum) is the primary treatment.
Formula for Xiaoqinglong Tang plus Shigao (Xiaoqinglong Decoction plus Gypsum)
Mahuang (Ephedrae Herba, 3 liang), Xixin (Asari Radix et Rhizoma, 3 liang), Shaoyao (Paeoniae Radix Alba, 3 liang), Ganjiang (Zingiberis Rhizoma, 3 liang),
Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang), Guizhi (Cinnamomi Ramulus, 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng), Banxia (Pinelliae Rhizoma, 0.5 sheng), Shigao (Gypsum Fibrosum, 2 liang).
Take the above nine ingredients. Add one dou of water. First boil Mahuang until reduced by two sheng, remove the foam, then add the remaining herbs. Boil until three sheng remain. Strain. Strong individuals take one sheng per dose; weak individuals reduce the dose. Administer three times daily. Children take four he.
[Supplementary Note] The syndrome in this clause is identical to the previous one, differing only by the addition of irritability and a merely floating pulse. In the previous clause, irritability indicated a tendency toward Wind-Water edema; here, irritability indicates fluid retention below the Heart. This shows that irritability is "Yin irritability," and fluid retention represents the extremity of Yin pathogens. When Water Qi invades the Palace of the Sovereign (Heart), is this a trivial matter? Therefore, in the previous formula, Xiren (Almond) replaced Shigao in relation to Mahuang, adding Jiang and Zao, resulting in a mild and slow dispersing force. In this formula, Shigao is added to Mahuang and Guizhi, making the force more potent. However, it is restrained by Shaoyao, Wuweizi, and Ganjiang, directing the action downward through the water pathways, preventing excessive sweating. Thus, we understand that Xiaoqinglong Tang can also overturn rivers and seas, guiding water to hide, unlike Daqinglong Tang which raises clouds and brings rain. Yuebi Tang contains Shigao and Banxia; Xiaoqinglong Fang contains Banxia but no Shigao. Observing the rationale behind these additions highlights the collaborative efficacy of these two herbs. Shigao clears heat and, aided by acrid-warm properties, can resolve phlegm; Banxia resolves phlegm and, aided by acrid-cool properties, can clear heat. Otherwise, why would Shigao need concern, or Banxia be prohibited? Zhang Zhongjing’s adjustment of a single herb demonstrates his wisdom in adapting prescriptions according to internal understanding.
Lung Abscess (Fei Yong) presents with chest fullness and distension, generalized edema of the face and body, nasal congestion with clear discharge, loss of smell (olfactory dysfunction), sour and pungent sensations, cough with rebellious Qi ascending, wheezing with rhonchi, and airway obstruction. Tingli Dazao Xiefei Tang (Descurainiae Semen cum Jujuba Decoction to Drain the Lung) is the primary treatment.
[Supplementary Note] The Classic states: "When the meridian moves abnormally, disease manifests as Lung Distension and fullness, bloating with wheezing and cough." If Stomach Qi fails to ascend and Large Intestine Qi fails to descend, nasal congestion and loss of smell occur. Consequently, generalized edema arises, presenting various symptoms. However, since exterior syndromes are still prominent, how can one solely employ purgation? One must realize that Lung Abscess initially stems from external pathogens invading; once the abscess forms, symptoms manifest internally. Discussing the general rule, lifting and dispersing methods should be considered first, and purgation should not be used hastily. Discussing the urgent necessity of purgation, if constrained by exterior signs, one violates the major prohibition that "once pus forms, death ensues." How can one fail to carefully weigh the priorities?