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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.