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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.