桂芍甘草。透微汗以去风。已见伤寒注。加石膏者。因症中之带烦也。余皆肾家治水之药。其意以为肾中不
寒。阴水之气。断不上升。故用干姜、细辛之辛温者。温之所以燥之也。然后以半夏降逆阴之上冲。五味敛黄
泉之倒涌。其悬于肺肾之夹空。而已成雨形者。使麻黄一泄而旁散矣。肺胀而发汗则愈者。此其一也。
十一条 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） 甘草（二两） 生姜（三两） 大枣（十五枚） 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。
此承上文风水之肺胀。而言肺胀一症。又有不因肺风肾水。但以阳明胃气太过。近从中焦上冲肺管。肺受
热闭。又不得从皮毛发越。而肺实胀满者。此但看其咳而上气。无上条之躁症者即是。此为肺胀。犹云此亦
名为肺胀也。肺既无外发之路。胃又以太过之气乘之。两相鼓吹。胃土以母气乘肺子。与肾水以子气乘金
母同义。故亦喘也。手阳明之经。终于鼻旁之迎香穴。足阳明之经。溜于目下之承泣穴。俱与目近。经腑之气
交盛。故其目之外胀。有如欲脱之状也。主越婢加半夏汤者。越婢。君麻黄而加石膏三分之一。其义有三。肺
盛。不得不以麻黄泄之。恐其发越太过。而以重坠之石膏镇之。制麻黄发扬之性。使其和缓柔顺。一也。肺实
由于胃实。则肺热可知。石膏气味辛凉。凉则解热。辛则利气。二也。且其镇坠之余力。犹能衰阳明上冲之热。
三也。以守中之甘草为使。尤有妙义。盖取托住二者之性。令麻黄得石膏留镇之气。而利肺者优柔石膏合
麻黄疏泄之功。而平胃者松泛。然后以辛温之生姜。挑肺胃之真阳。以甘粘之大枣。滋两家之津液。似乎无
弊矣。不知越婢一汤。终是发肺家之汗。假令上焦一空。中焦之气。乘虚袭之。遂同解斗者捆甲之臂。而令乙
殴矣。故加降逆之半夏。而重用之者。使协同石膏。压下麻黄之余性。以疏散胃气。俾不得上干。盖即惊悸条
中。半夏麻黄丸之义也。夫中黄数寸之地。肺胃交争。而咳喘等之诸症杂见。主越婢本汤。则肺家因外泄而
内让。加半夏。则胃家因下退而上让。其文王虞 之化耶。方药云乎哉。
十二条 咳而上气。喉中水鸡声。射干麻黄汤主之。
射干麻黄汤方
射干（三两） 麻黄（四两） 半夏（半斤洗） 细辛 款冬花 紫菀（各三两） 五味子（半斤）
生姜（四两） 大枣（七枚）
上九味。以水一斗二升。先煮麻黄两沸。去上沫。内诸药。煮取三升。分温三服。
此即前二条小青龙。并越婢之兼症也。小青龙一条。为肾中水寒之气上泛。越婢一条。为胃中燥热之气上
蒸。此条却因手太阴之阴阳两虚。合子母而两吸之。遂致肾之浊阴。胃之浊阳。双起而乘肺。水土之邪。交并
于清虚。而成稠粘黄滞之痰。云合于肺胃会通之息道。而呼吸激之。则有声矣。此咳而上气。喉中水鸡声之
应也。咳而上气。当包前条肺胀句在内。与下文咳逆上气条同义。以上气而咳。未有不肺胀者。但有水胀气
胀之异。故省文言之耳。至其主本汤之义。则又另有壶天广大。游览不尽之妙。盖因手太阴之阴阳两虚。故
以凌冬弩芽。从大寒中具生阳之气之款冬花。挑动其阳神。以润软柔宛而善于补血之紫菀。深滋其津液。
因肾家之贼阴上泛。故以细辛、五味。温敛其下焦之逆阴。因胃家之热气上侵。故以半夏、麻黄。降散其中焦
之动气。射干多节。形同肺管。叶则扁生横开。而其性尤专于祛湿。用以名汤。是取其走肺。而令两旁开拓其
痰气之意明矣。再加辛甘发散之姜枣为佐。则肾胃之逆下消。肺中之满外泄。其咳而上气。及喉中之水鸡
声。有不贴然自静者乎。此比前小青龙条无躁症。故去干姜。无风因。故去桂芍及石膏耳。肺胀而发汗则
愈者。又其一也。
十三条 咳逆上气。时时唾浊。但坐。不得眠。皂荚丸主之。
皂荚丸方 皂荚（八两、刮去皮、用酥炙）
上一味。末之。蜜丸梧子大。以枣膏和汤。服三丸。日三服。夜一服。
此条又借咳逆上气。而广言肺痈之治例也。本门第四条曰多唾浊沫。第五条曰喘不得卧。俱肺痈之症。已
见前注。盖谓咳逆上气之人。时唾浊沫。但可靠坐而不能卧倒者。无论痈与未痈。皆属肺叶外肿。肺管内塞
之候。邪气过实。便宜皂荚丸主之。以皂荚之性。外能软坚削形以消肿。内能搜风利窍以通气。蜜丸而兼枣
膏和服。取甘缓者。升浮其性于肺中也。门人问曰。本条皂荚丸。与五条葶苈泻肺汤症颇相同。且俱作丸
子。俱用大枣托起。而取定喘下气之效。敢问二药之同异。并其所以分主之症。一也。又首条言肺痿之症。亦
曰口中反有浊唾涎沫。今于皂荚丸下。夫子但引四条之文。而谓独广肺痈之治例。何以知其不兼肺痿而
言。二也。答曰。葶苈苦寒降散。盖取降以止逆。散以舒气而已。若夫皂荚。其味辛咸。其性犀利。辛咸。则外收内
散。故能削形泄气以消肿。犀利。则裁阳攘阴。故能斩关突入而夺壅。是葶苈之性稍平。而皂荚之性较峻矣。
观方后葶苈服至弹子大一丸。皂荚仅服梧子大三粒。且彼曰顿服。此曰日三夜一服。则当日仲景之意。不
昭然如见乎。大概葶苈泻肺。是主初起之痈。皂荚一丸。是主将脓之候者也。至于浊唾涎沫。痈痿虽同。独不
思痈鼓风邪。痿惟夺液。治痈如驱盗。纵使破财盗去。而余资犹得半全。治痿如救荒。假令纵籴尽粮。而残喘
何能苟活。皂荚削气剥津。惟痈为富家之被盗者。任之可以无虞。彼痿为穷邑之遭荒。当之岂能无弊乎。我
故谓广肺痈之治例。而不兼言肺痿者。非漏也。单是咳逆上气。犹有风水之别症。若又兼浊唾不得眠二
症。则邪实气盛。而为肺痈最急最重之候。故葶苈泻肺。不胜其任也。
十四条 咳而脉浮者。浓朴麻黄汤主之。脉沉者。泽漆汤主之。
浓朴麻黄汤方
浓朴（五两） 麻黄（四两） 石膏（如鸡子大） 杏仁（半升） 五味子（半升） 半夏（半斤）
细辛（二两） 干姜（二两） 小麦（一升）
上九味。以水一斗二升。先煮小麦熟。去渣。内诸药。煮取三升。温服一升。日三服。
泽漆汤方
泽漆（三升、以东流水五斗、煮取一斗三升） 人参 桂枝（各三两） 半夏（半升） 黄芩（三两）
甘草（三两） 生姜 白前 紫参（各五两）
上九味。 咀。内泽漆汁中。煮取五升。温。服五合。至夜尽。
咳字。包前文上气在内。并贯下文脉沉而言。此即十二条射干麻黄汤症。而变言其治例也。十二条之症。
因肺中阴阳两虚。于是胃之浊阳。肾之浊阴。两起而乘之。两浊相搏。则成稠粘黄浊之痰。积于肺胃会通之
地。而呼吸扇之。此喉中水鸡声。及咳而上气矣。故彼方以款冬生阳。紫菀滋阴。使肺中之主人先回。次以平
胃安肾之品佐之。则占住者当避去矣。此条之前症。却又因心之膻中。肺之胸中。其阳气独虚。而胃肾之气
两乘之之候也。夫胸中膻中。为上焦之地。中下之气上乘。故脉浮。脉浮。则知其单在气分。故以小麦为君而
填之。与彼方用生阳之款冬同义。且脉浮。又知其不关血分。故较彼方去滋阴之紫菀者此也。其细辛、干姜、
五味之安肾。半夏、麻黄、石膏之平胃。已见前注。至浓朴之开拓胸中。杏仁之疏通肺窍。明系夺射干之兵符
印玺者也。又咳而上气。于脏为肺。于腑为胸中膻中。其症最高。症高则脉浮者理也。若其脉不浮而反沉。夫
沉为阴象。阴病应水。阴分应血。则咳而上气。又因水寒沉伏血分。而上射其气于肺。肺性恶寒、恶湿之所致
也。故以迅利逐水之泽漆为君。煮以东流者。取益其行性而不与伏水同滞也。又恐峻药多伤。故以补气之
人参。行阳之桂枝。温胃之生姜。培土之甘草佐之者。不特以辛甘之性。赞其行水之功。且以群阳之恺悌仁
人。参谋监制。使强兵悍将。不得纵好杀之手腕。而成王师堂正之旗矣。夫水寒之邪。虽伏根于下焦阴血中。
而其气之已射于肺。致现咳逆者。非半夏之辛燥下降。不足以祛之。用以为臣。犹兵家后军之扫荡也。至于
白前。味则辛甘。形则直长。辛甘走气。直长趋下。一气直行。下焦之大向导耳。紫参色紫入血。性疾逐淤。又借
白前而为下焦阴分之使。殆向导中之精细者乎。此又从欲作风水句。而单言水症。为浓朴、麻黄变中之变
症也。细按前后二汤。蜂房蚁穴。未足比其深微。虹闪霞朱。乌能仿其变幻。而泽漆一汤。尤为奇创。骆宾王
江浦黄帆。匡复之功何远。羞足拟其气象。不意汤液中。有如此之水师也。客有问余者曰。素问以麦为心
之谷属火。郑玄以麦有孚甲。应属木。许慎又谓麦当金王而生。火王而死。宜属金。楚医李时珍辨之。未有确
据。而子注浓朴麻黄汤中之小麦。独遵素问为心之谷者。果有所见耶。答曰。小麦之于八月酉金。止算得胎。
非生也。麦实生于十月之亥耳。夫水火互胎。金木互胎。自有现成至理。诚如许氏之说。以胎酉者为金。则将
以胎午之壬为火。胎子之丙为水乎。况今小麦实生于酉。则又当属丁火矣。许氏属金之说谬也。至若胎酉
养戌。生亥王卯而死午。实系麦之始终。郑玄属木之论近是矣。不知苗死而麦正成。是麦苗死于五月。而麦
实何曾与之俱死耶。则属木之性。以之论麦秸则得。以之论麦实。是亦五十步之止耳。夫天地自然之序。春
残则神气畅为朱明。木终则精华发为光焰。以属木之麦秸一死。而属火之麦实继成。正合生生之序。又岂
止以熟时在午。赤色应离。形圆象心之证乎。故知名为心谷者。真上古圣人之定评。而用为心药者。实中古
神仙之合制也。客为之首肯而退。附记于此。以正高明。
十五条 大逆上气。咽喉不利。止逆下气者。麦门冬汤主之。
麦门冬汤方
麦门冬（七升） 人参（二两） 半夏（一升） 甘草（二两） 大枣（十二枚） 粳米（三合）
上六味。以水一斗六升。煮取六升。温服一升。日三。夜一服。
此虽承前四条越婢加半夏汤。而言肺胃交病之症。然其病机之微妙。章法之变幻。几令人不可寻绎。无怪
乎千古以来。善读金匮者之寥寥也。盖前四条之症。是肺为胃热所蔽。既不能外泄而自为转移。复不能下
临而相为防御。则肺胃之气两实。两实者宜两责之。故主越婢以责肺。加半夏以责胃也。此条之症。是肺液
欲枯。子困而取资于母。故大吸胃液以自救。其如胃中之土液亦干。不能以精汁上供。但悉索其干热之浊
气以奔之。则所应者非所求。而大逆上气矣。咽喉不利者。如有燥物阻滞之状。既液干而浊气乘之之应也。
譬诸天地。太空晴干。下吸大地之灵阴以自润。应则甘露生焉。苟无所应。而渣质乘之。日则浮尘高扬。夜则
黄埃上布。重浊郁冒。阻滞清虚者。此天地之大逆上气。咽喉不利之象。倘非及时甘雨。远被深滋。其能使两
相润泽。各还其清宁之位乎。故以色白补阳液之麦冬为君。而用至七升者。以小水不足以灌溉也。粳米甘
温入胃。以之为佐。欲令麦冬之润。独注中州也。然后以甘草托其下泄。大枣提其上蒸。总交于补气而善行
津脉之人参。以之为龙。而云行雨施之化普矣。独是大滋胃中之津液。且以甘浮之性。提之上润肺金。恐如
水激红炉。气冲灰起。则大逆不更甚乎。故又以降气平胃之半夏。安之缉之耳。是此条为肺胃之阴两虚。两
虚者宜两补之。故以全汤先补胃液。而次补肺液也。所谓病机之微妙者此也。卷中列痿痈上气凡三门。其
上气一门。连本汤共方七道。而主治全矣。肺痈连皂荚丸。虽止方三道。其于痈脓前后。似亦无漏。独肺痿一
门。于寒痿之变症。反出甘草干姜一汤。而于重亡津液。娓娓言之。正经热痿。反无方治。岂以热痿为不药之
症乎。而前后并无难治不治字样。反复思维。神明告我。始知仲景之意。以为重亡津液。有竟成肺痿者。有但
大逆上气咽喉不利者。俱宜此汤。救胃以救肺。故省文互之耳。世之读金匮者。请将首条热痿之症。与本方
药品汤意。细细较之。便见针锋逼对。而知愚鄙之论。非牵强也。所谓章法之变幻者。此也。
桂枝、芍药、甘草。透发微汗以祛除风邪。（此法）已在伤寒注中见到。加入石膏，是因为症状中伴有烦热。其余都是肾脏调节水液的药物。其用意在于认为肾中如果不寒，阴寒水气就不会上升。因此使用干姜、细辛等辛温之品，用温热来燥湿。然后用半夏降逆，平息阴寒之气上冲；用五味子收敛防止津液倒涌。那些悬于肺肾之间的空隙中，已经形成雨状（痰饮）的邪气，让麻黄一泄而旁散。肺胀通过发汗则痊愈，这是其中一种情况。
第十一条 咳嗽且气逆上冲，这称为肺胀。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） 甘草（二两） 生姜（三两） 大枣（十五枚） 半夏（半升）
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，分三次温服。
这是承接上文风水导致的肺胀，来说明肺胀这一病症，又有不是因肺风和肾水引起，而是仅仅因为阳明胃气太过，近从中间焦向上冲入肺管，肺受热邪闭塞，又不能从皮毛发散，导致肺实胀满的情况。这里只要看其咳嗽且气逆上冲，没有上一条那种躁动症状的，就是这种情况。这也称为肺胀。肺既然没有向外发散的路径，胃又以太过之气侵犯它，两者相互鼓吹，胃土以母气乘袭肺金（子病及母/母病及子的五行生克关系），与肾水以子气乘袭肺金（母）意义相同，所以也会气喘。手阳明大肠经，终止于鼻旁的迎香穴；足阳明胃经，流经眼下部的承泣穴，都与眼睛相近。经络和腑的气机交盛，所以眼睛外部肿胀，好像要脱出的样子。主治越婢加半夏汤，越婢汤以麻黄为君药，加上三分之一的石膏，其含义有三点：肺气盛，不得不以麻黄宣泄，但担心其发越太过，所以用沉重下坠的石膏来镇摄，制约麻黄发扬的性质，使其和缓柔顺，这是一。肺实是由于胃实，那么肺热可知。石膏气味辛凉，凉能解热，辛能利气，这是二。况且石膏在镇坠之余力，还能衰减阳明上冲的热气，这是三。用守中的甘草作为使药，尤其有妙义。大概是为了托住两者的性质，令麻黄得到石膏留镇的气息，从而利于肺部；石膏配合麻黄的疏泄之功，从而平复胃部，使之松泛。然后用辛温的生姜，挑动肺胃的真阳；用甘粘的大枣，滋养两家的津液，似乎没有弊端了。不知道越婢汤终究是发肺家的汗。假如上焦空虚，中焦之气乘虚侵袭，就像解斗的人捆住甲的手臂，让乙殴打那样。所以加入降逆的半夏并重用，使其协同石膏，压下麻黄的余性，以疏散胃气，使其不能上犯。这也就是惊悸条中半夏麻黄丸的意义。在中焦数寸之地，肺胃交争，而咳喘等各种症状杂见。主治越婢本汤，则肺家因外泄而内部退让；加半夏，则胃家因下退而上退让。这难道是文王虞舜那样的教化吗？哪里仅仅是方药呢。
第十二条 咳嗽且气逆上冲，喉咙里有像青蛙叫一样的声音，用射干麻黄汤主治。
射干麻黄汤方
射干（三两） 麻黄（四两） 半夏（半升，洗） 细辛 款冬花 紫菀（各三两） 五味子（半斤）
生姜（四两） 大枣（七枚）
以上九味药，用水一斗二升，先煮麻黄两沸，去掉上面的泡沫，再加入其他药物，煮取三升，分三次温服。
这就是前两条小青龙汤和越婢汤的兼症。小青龙汤一条，是肾中水寒之气上泛；越婢汤一条，是胃中燥热之气上蒸。这一条却是由于手太阴肺经阴阳两虚，结合子母关系互相吸引，导致肾的浊阴、胃的浊阳，双双起而乘袭肺脏。水土的邪气，交并在清虚之处，形成稠粘黄滞的痰，云合于肺胃会通的呼吸之道，呼吸激荡它，就有声音了。这就是咳嗽且气逆上冲，喉咙里发出青蛙叫声的应验。咳嗽且气逆上冲，应当包含前条肺胀的意思在内，与下文咳逆上气条意义相同。以上气而咳，没有不导致肺胀的，只是有水胀和气胀的区别，所以省略文字而言。至于主治本汤的意义，则另有广阔天地，游览不尽的妙处。大概因为手太阴肺经阴阳两虚，所以用凌冬弩芽、从大寒中具备生阳之气的款冬花，挑动其阳神；用润软柔宛且善于补血的紫菀，深滋其津液。因为肾家贼阴上泛，所以用细辛、五味子，温敛其下焦的逆阴；因为胃家热气上侵，所以用半夏、麻黄，降散其中焦的动气。射干多节，形状如同肺管，叶子扁生横开，而其性质尤其专于祛湿，用来命名汤剂，是取其走肺，而令两旁开拓痰气的意思很明显了。再加辛甘发散的姜枣作为佐药，那么肾胃的逆气向下消除，肺中的胀满向外发泄，那咳嗽且气逆上冲，以及喉咙中的青蛙叫声，有不贴然自静的吗？这比前条小青龙汤没有躁症，所以去掉干姜；没有风邪原因，所以去掉桂枝、芍药及石膏。肺胀通过发汗则痊愈，又是其中一种情况。
第十三条 咳嗽气逆，时常吐出浑浊之物，只能坐着，不能躺下睡觉，用皂荚丸主治。
皂荚丸方 皂荚（八两，刮去皮，用酥炙）
以上一味药，研成末，蜜丸如梧子大小，用枣膏和汤送服，每次服三丸，白天服三次，晚上服一次。
这一条又借咳嗽气逆，而广泛论述肺痈的治疗法则。本门第四条说多唾浊沫，第五条说喘不得卧，都是肺痈的症状，已在前注中提到。大概说咳嗽气逆之人，时常吐浊沫，只能靠坐而不能卧倒的，无论是否有痈，都属于肺叶外肿，肺管内堵塞的证候。邪气过实，适宜用皂荚丸主治。因为皂荚的性质，外能软坚削形以消肿，内能搜风利窍以通气。蜜丸并兼用枣膏和服，取甘缓的性质，提升其性于肺中。门人问曰：本条皂荚丸，与第五条葶苈泻肺汤症状颇相同，且都作丸子，都用大枣托起，以求定喘下气的效果。敢问这两种药的同异，以及它们分别主治的症状。其一。另外首条说肺痿的症状，也说口中反而有浊唾涎沫，现在在皂荚丸下，夫子只引用第四条的文字，而说专门广论肺痈的治疗法则，怎么知道它不兼论肺痿呢？其二。回答曰：葶苈苦寒降散，大概取降以止逆，散以舒气而已。至于皂荚，其味辛咸，其性犀利。辛咸，则外收内散，故能削形泄气以消肿；犀利，则裁阳攘阴，故能斩关突入而夺壅。所以葶苈的性质稍平，而皂荚的性质较峻。看方后葶苈服至弹子大一丸，皂荚仅服梧子大三粒，而且前者说顿服，后者说日三夜一服，那么当日张仲景的心意，不昭然可见吗？大概葶苈泻肺，是主治初起的痈；皂荚一丸，是主治将成脓的证候。至于浊唾涎沫，痈和痿虽然相同，但不想想痈鼓动风邪，痿唯独耗夺津液。治痈如驱盗，纵使破财盗去，而余资犹得保全；治痿如救荒，假令纵尽粮购买，而残喘怎能苟活。皂荚削气剥津，只有痈是富家被盗，任由它可以无虞；那痿是穷邑遭荒，当之岂能没有弊端呢？所以我说是广论肺痈的治疗法则，而不兼论肺痿，不是遗漏。单是咳逆上气，还有风水之别症，如果又兼浊唾不得眠两个症状，则是邪实气盛，而为肺痈最急最重的证候。所以葶苈泻肺，不胜任其任务。
第十四条 咳嗽且脉浮者，用浓朴麻黄汤主治；脉沉者，用泽漆汤主治。
浓朴麻黄汤方
浓朴（五两） 麻黄（四两） 石膏（如鸡子大） 杏仁（半升） 五味子（半升） 半夏（半斤）
细辛（二两） 干姜（二两） 小麦（一升）
以上九味药，用水一斗二升，先煮小麦熟，去渣，加入其他药物，煮取三升，温服一升，每天三次。
泽漆汤方
泽漆（三升，以东流水五斗，煮取一斗三升） 人参 桂枝（各三两） 半夏（半升） 黄芩（三两）
甘草（三两） 生姜 白前 紫参（各五两）
以上九味药，切碎，放入泽漆汁中，煮取五升，温服五合，直到夜晚服完。
“咳”字，包含前文“上气”在内，并贯穿下文“脉沉”而言。这就是第十二条射干麻黄汤的症状，而变言其治疗法则。第十二条的症状，是因为肺中阴阳两虚，于是胃的浊阳、肾的浊阴，双双起而乘袭。两浊相搏，则形成稠粘黄浊的痰，积于肺胃会通之地，呼吸扇动它，这就有了喉咙里的青蛙叫声，以及咳嗽且气逆上冲。所以彼方用款冬生阳，紫菀滋阴，使肺中的主人先回，其次用平胃安肾的药物辅助，那么占据者应当避开。这一条的前症，却又因为心之膻中、肺之胸中，阳气独虚，而胃肾之气两相乘袭的证候。夫胸中膻中，为上焦之地，中下之气上乘，所以脉浮。脉浮，则知道其仅在气分，所以用小麦为君药而填补它，与彼方用生阳的款冬意义相同。而且脉浮，又知道其不关血分，所以较彼方去掉滋阴的紫菀，就是这个原因。其细辛、干姜、五味子安肾，半夏、麻黄、石膏平胃，已见前注。至于浓朴开拓胸中，杏仁疏通肺窍，明显是夺取射干的兵符印玺。另外咳而上气，于脏为肺，于腑为胸中膻中，其症状位置最高，症高则脉浮是理所当然。如果其脉不浮反而沉，沉为阴象，阴病应水，阴分应血，那么咳而上气，又是因为水寒沉伏血分，而上射其气于肺，这是肺性恶寒、恶湿所致。所以用迅利逐水的泽漆为君药，煮以东流水，取益其行性而不与伏水同滞。又恐峻药多伤，所以用补气的人参，行阳的桂枝，温胃的生姜，培土的甘草作为佐药，不仅以辛甘的性质，赞助其行水之功，而且以群阳的恺悌仁人，参谋监制，使强兵悍将，不得纵容好杀的手腕，而成王师堂正的旗帜。夫水寒之邪，虽伏根于下焦阴血中，而其气已射于肺，导致出现咳逆的，非半夏的辛燥下降，不足以祛除它，用以为臣，犹如兵家后军的扫荡。至于白前，味道辛甘，形状直长，辛甘走气，直长趋下，一气直行，是下焦的大向导。紫参色紫入血，性质疾速逐瘀，又借白前而为下焦阴分的使者，大概是向导中的精细者吧。这又从欲作风水的句子，而单独言水症，为浓朴、麻黄变中之变症。仔细推敲前后两汤，蜂房蚁穴，不足以比拟其深微，虹闪霞朱，怎么能模仿其变幻。而泽漆一汤，尤为奇创，骆宾王江浦黄帆，匡复之功何远，羞于比拟其气象，没想到汤液中，有如此的水师。客人问我曰：《素问》以麦为心之谷属火，郑玄以麦有孚甲，应属木，许慎又谓麦当金王而生，火王而死，宜属金。楚医李时珍辨析，未有确据，而你注释浓朴麻黄汤中的小麦，独遵《素问》为心之谷，果有所见吗？回答曰：小麦之于八月酉金，只算得胎，非生也。麦实生于十月之亥耳。夫水火互胎，金木互胎，自有现成至理。诚如许氏之说，以胎酉者为金，则将把胎午之壬为火，胎子之丙为水吗？况且今小麦实生于酉，则又当属丁火矣。许氏属金的说法谬误。至于胎酉养戌，生亥旺卯而死午，实系麦的始终，郑玄属木的论断接近正确。不知道苗死而麦正成，是麦苗死于五月，而麦实何曾与之俱死耶？则属木的性质，用来论麦秸则得，用来论麦实，也是五十步笑百步罢了。夫天地自然之序，春残则神气畅为朱明，木终则精华发为光焰，以属木的麦秸一死，而属火的麦实继成，正合生生之序，又岂止以熟时在午，赤色应离，形圆象心的证据乎。所以知名为心谷者，真是上古圣人的定评，而用为心药者，实在中古神仙的合制。客人点头而退，附记于此，以纠正高明之士。
麦门冬汤方
麦门冬（七升） 人参（二两） 半夏（一升） 甘草（二两） 大枣（十二枚） 粳米（三合）
以上六味药，用水一斗六升，煮取六升，温服一升，每天三次，晚上一次。
这虽然承接前四条越婢加半夏汤，而言肺胃交病的症状，然而其病机的微妙，章法的变幻，几乎令人不可寻绎，难怪千古以来，善于读《金匮》的人寥寥无几。盖前四条的症状，是肺被胃热所蔽，既不能外泄而自为转移，复不能下临而相为防御，则肺胃之气两实，两实者宜两责之，所以主越婢以责肺，加半夏以责胃。这一条的症状，是肺液欲枯，子困而取资于母，故大吸胃液以自救。其如胃中的土液亦干，不能以精汁上供，但悉索其干热之浊气以奔之，则所应者非所求，而大逆上气。咽喉不利，如有燥物阻滞之状，既是液干而浊气乘之的应验。譬诸天地，太空晴干，下吸大地之灵阴以自润，应则甘露生焉。苟无所应，而渣质乘之，日则浮尘高扬，夜则黄埃上布，重浊郁冒，阻滞清虚者，此天地之大逆上气，咽喉不利之象。倘非及时甘雨，远被深滋，其能使两相润泽，各还其清宁之位乎。所以用色白补阳液的麦冬为君药，而用至七升者，因为小水不足以灌溉。粳米甘温入胃，以之为佐，欲令麦冬之润，独注中州。然后用甘草托其下泄，大枣提其上蒸，总交于补气而善行津脉的人参，以之为龙，而云行雨施的化育普及了。独是大滋胃中的津液，且以甘浮的性质，提之上润肺金，恐怕如水激红炉，气冲灰起，则大逆不更甚乎。所以又以降气平胃的半夏，安之缉之。是此条为肺胃之阴两虚，两虚者宜两补之，所以用全汤先补胃液，而次补肺液。所谓病机的微妙者在此。卷中列痿痈上气凡三门，其上气一门，连本汤共方七道，而主治全矣。肺痈连皂荚丸，虽止方三道，其于痈脓前后，似亦无漏。独肺痿一门，于寒痿的变症，反出甘草干姜一汤，而于重亡津液，娓娓言之，正经热痿，反无方治，难道以热痿为不药的症吗？而前后并无难治不治字样，反复思维，神明告我，始知仲景之意，以为重亡津液，有竟成肺痿者，有但大逆上气咽喉不利者，俱宜此汤，救胃以救肺，所以省文互之。世之读《金匮》者，请将首条热痿的症状，与本方药品汤意，细细较之，便见针锋逼对，而知愚鄙之论，非牵强也。所谓章法的变幻者，在此。
Cinnamon Twig (Guizhi), White Peony Root (Baishao), and Licorice Root (Gancao) induce a slight sweat to dispel wind. This method has been seen in the commentary on Cold Damage (Shanghan). The addition of Gypsum (Shigao) is because the symptoms include irritability (fan). The rest are herbs for the Kidney system to manage water metabolism. The intention is that if there is no cold in the Kidney, the Yin water Qi will not rise. Therefore, Dried Ginger (Ganjiang) and Asarum (Xixin), which are acrid and warm, are used; warmth is employed to dry dampness. Then, Pinellia Tuber (Banxia) is used to direct rebellious Qi downward, stopping the upward rush of Yin cold; Schisandra Berry (Wuweizi) is used to astringe and prevent the reflux of fluids. Those pathogens suspended in the empty space between the Lung and Kidney, which have already formed rain-like phlegm-fluids, are dispersed by the purgative action of Ephedra Herb (Mahuang). Pulmonary distension (Feizhang) heals through sweating; this is one case.
Article 11: Cough with rebellious Qi ascending, termed pulmonary distension (Feizhang). The patient wheezes, eyes protrude as if about to fall out, and the pulse is floating and large. Yu Bi Jia Ban Xia Tang (Ephedra Decoction plus Pinellia) is the primary formula.
Yu Bi Jia Ban Xia Tang Formula
Ephedra Herb (Mahuang) (6 liang), Gypsum (Shigao) (0.5 jin), Licorice Root (Gancao) (2 liang), Fresh Ginger (Shengjiang) (3 liang), Jujube (Dazao) (15 pieces), Pinellia Tuber (Banxia) (0.5 sheng).
The above six ingredients are boiled in 6 sheng of water. First boil Mahuang, remove the foam on top, then add the remaining herbs. Boil until 3 sheng remain, divide into three warm doses.
This follows the previous discussion on pulmonary distension caused by Wind-Water (Fengshui), explaining another type of pulmonary distension not caused by Lung Wind or Kidney Water, but solely due to excessive Yangming Stomach Qi rushing up from the Middle Jiao into the Lung tube. The Lung is heat-closed and cannot vent through the skin and hair, resulting in excess and distension. Here, if one observes cough and rebellious Qi without the agitation mentioned in the previous article, it is this condition. It is also called pulmonary distension. Since the Lung has no outward path for release, and the Stomach attacks it with excessive Qi, they mutually reinforce each other. The Earth of the Stomach (Mother) attacks the Metal of the Lung (Child), similar to how Water of the Kidney (Child) attacks Metal of the Lung (Mother); thus, wheezing occurs. The Hand-Yangming Large Intestine meridian ends at Yingxiang (LI 20) beside the nose; the Foot-Yangming Stomach meridian flows under the eye at Chengqi (ST 1). Both are close to the eyes. When meridian and organ Qi become excessively abundant, the external swelling of the eyes resembles a state of impending prolapse. Yu Bi Jia Ban Xia Tang is indicated. In Yu Bi Tang, Ephedra is the sovereign herb, with one-third added Gypsum. The rationale has three points: Lung excess requires Ephedra to purge, but fear of excessive dispersion leads to using heavy Gypsum to suppress it, moderating Ephedra's rising nature to make it gentle and compliant—this is point one. Lung excess stems from Stomach excess, implying Lung heat. Gypsum is acrid and cool; coolness clears heat, acridity promotes Qi flow—this is point two. Furthermore, Gypsum's residual suppressing power can attenuate the heat rushing up from the Yangming—this is point three. Using neutral Licorice as the envoy has profound meaning, aiming to stabilize both herbs. Let Ephedra receive the stabilizing Qi of Gypsum to benefit the Lung; let Gypsum cooperate with Ephedra's dispersing action to calm the Stomach, making it loose and relaxed. Then, use acrid-warm Fresh Ginger to stimulate the true Yang of Lung and Stomach; use sweet-sticky Jujube to nourish the fluids of both. It seems harmless. However, Yu Bi Tang ultimately induces sweat from the Lung. If the Upper Jiao becomes empty, Middle Jiao Qi may invade via deficiency, akin to tying one arm in a fight so the other strikes freely. Thus, adding descending Pinellia and using it heavily allows it to collaborate with Gypsum to suppress Ephedra's residual properties, dispersing Stomach Qi so it does not harass upwards. This aligns with the principle of Ban Xia Ma Huang Wan (Pinellia and Ephedra Pill) in the palpitations section. In the few inches of the Middle Jiao, Lung and Stomach contend, presenting mixed symptoms of cough and wheezing. Treating with Yu Bi Tang causes the Lung to yield internally due to external release; adding Pinellia causes the Stomach to retreat downwards and yield upwards. Is this not the transformation of King Wen and Shun? Is it merely about formulas and drugs?
Article 12: Cough with rebellious Qi ascending, with a sound in the throat like a frog croaking. She Gan Ma Huang Tang (Belamcanda and Ephedra Decoction) is the primary formula.
She Gan Ma Huang Tang Formula
Belamcanda Rhizome (Shegan) (3 liang), Ephedra Herb (Mahuang) (4 liang), Pinellia Tuber (Banxia) (0.5 sheng, washed), Asarum (Xixin), Farflower (Kuandonghua), Aster Root (Ziwan) (each 3 liang), Schisandra Berry (Wuweizi) (0.5 jin), Fresh Ginger (Shengjiang) (4 liang), Jujube (Dazao) (7 pieces).
The above nine ingredients are boiled in 12 sheng of water. First boil Mahuang for two boils, remove the foam, then add the remaining herbs. Boil until 3 sheng remain, divide into three warm doses.
This corresponds to the combined symptoms of the previous Xiao Qing Long Tang (Minor Green Dragon Decoction) and Yu Bi Tang cases. The Xiao Qing Long Tang article refers to Cold-Dampness from the Kidney rising; the Yu Bi Tang article refers to Dry-Heat from the Stomach steaming upward. This article, however, is due to dual deficiency of Yin and Yang in the Hand-Taiyin Lung, causing mutual attraction between mother and child organs. Consequently, turbid Yin from the Kidney and turbid Yang from the Stomass rise together to attack the Lung. Pathogens of Water and Earth intersect in the clear void, forming thick, sticky, yellow-phlegm. This cloud gathers in the respiratory passage where Lung and Stomach connect; respiration agitates it, producing sound. This explains the cough, rebellious Qi, and frog-like sound in the throat. "Cough with rebellious Qi" includes the concept of pulmonary distension from the previous article, sharing meaning with the following "rebellious Qi and cough" article. Rebellious Qi causing cough invariably leads to pulmonary distension, differing only in water-distension vs. Qi-distension, hence the abbreviated text. The rationale for this formula holds vast profundities. Due to dual deficiency of Yin and Yang in the Lung, Farflower (Kuandonghua), sprouting in winter cold yet possessing generating Yang Qi, is used to stimulate Yang Spirit; Aster Root (Ziwan), moist and soft, good at nourishing blood, deeply nourishes fluids. Because Kidney treacherous Yin rises, Asarum and Schisandra warm and astringe the rebellious Yin of the Lower Jiao. Because Stomach heat invades upward, Pinellia and Ephedra descend and disperse the moving Qi of the Middle Jiao. Belamcanda (Shegan) has many nodes, resembling lung tubes, with flat leaves growing horizontally; its nature specializes in resolving dampness. Naming the decoction after it indicates its action on the Lung to open pathways on both sides for phlegm-Qi. Adding acrid-sweet dispersing Ginger and Jujube as assistants eliminates rebellious Qi from Kidney and Stomach downward and vents Lung fullness outward. Will the cough, rebellious Qi, and frog-like sound not settle quietly? Compared to the previous Xiao Qing Long Tang, this lacks agitation, so Dried Ginger is removed; lacking wind etiology, Cinnamon Twig, White Peony, and Gypsum are removed. Pulmonary distension heals through sweating; this is another case.
Article 13: Severe cough with rebellious Qi, frequent expectoration of turbid matter, ability to sit only, inability to lie down. Zao Jiao Wan (Soap Pod Pill) is the primary formula.
Zao Jiao Wan Formula
Soap Pod (Zaojiao) (8 liang, scraped, skin removed, roasted with butter).
Grind the single ingredient into powder, make honey pills the size of Sophora seeds. Take three pills with date paste and water, three times daily, once at night.
This article borrows severe cough and rebellious Qi to broadly discuss treatment principles for Lung Abscess (Feiyong). Article 4 of this chapter mentions profuse turbid saliva; Article 5 mentions wheezing preventing lying down; both are symptoms of Lung Abscess, noted previously. Generally, patients with severe cough and rebellious Qi who frequently spit turbid saliva and can only sit upright belong to the pattern of external swelling of lung lobes and blockage of lung tubes, regardless of whether an abscess exists. When pathogens are excessively strong, Zao Jiao Wan is appropriate. Soap pod's nature externally softens hardness and reduces shape to reduce swelling; internally searches wind and opens orifices to unblock Qi. Honey pills taken with date paste take advantage of sweetness to lift its nature into the Lung. A student asked: The Zao Jiao Wan in this article is quite similar to Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) in Article 5; both are pills, both use Jujube to support, both aim to calm wheezing and direct Qi downward. May I ask the similarities and differences between these two drugs, and their respective indications? One. Also, Article 1 mentions Lung Flaccidity (Feiwei) symptoms, stating "mouth has turbid saliva and froth." Now, under Zao Jiao Wan, Master only cites Article 4 and claims it broadens Lung Abscess treatment principles. How do we know it doesn't also discuss Lung Flaccidity? Two. Answer: Descurainia is bitter and cold, descending and dispersing, taking descent to stop rebellion and dispersion to relieve Qi. Soap pod is acrid and salty, sharp and fierce. Acrid and salty mean external gathering and internal dispersing, thus reducing shape and draining Qi to reduce swelling. Sharp and fierce means controlling Yang and repelling Yin, thus breaking barriers and seizing obstructions. Descurainia's nature is milder, while Soap pod's is more severe. Looking at dosages: Descurainia takes a pill the size of a bullet, taken all at once; Soap pod takes three pills the size of Sophora seeds, taken three times day and once night. Zhang Zhongjing's intent is clearly visible. Generally, Descurainia drains the Lung, treating early-stage abscess; Soap pod treats the stage where pus is about to form. Regarding turbid saliva and froth, both abscess and flaccidity share this, but consider: Abscess stirs wind-pathogen; Flaccidity solely depletes fluids. Treating abscess is like driving away thieves; even if wealth is lost, some remains. Treating flaccidity is like saving from famine; even if grain is bought, survival is hard. Soap pod drains Qi and strips fluids; only abscess is like a rich family robbed, allowing safe use. Flaccidity is like a poor district in famine, making use harmful. Thus, I say it broadens Lung Abscess treatment, excluding Lung Flaccidity, not by omission. Mere cough and rebellious Qi might be Wind-Water; adding turbid saliva and inability to sleep indicates extreme excess and severity, the most critical Lung Abscess presentation. Descurainia cannot handle this burden.
Article 14: Cough with floating pulse, Polyspora and Ephedra Decoction (Nong Po Ma Huang Tang) is indicated; sinking pulse, Ze Qi Tang is indicated.
Nong Po Ma Huang Tang Formula
Magnolia Bark (Nongpo) (5 liang), Ephedra Herb (Mahuang) (4 liang), Gypsum (Shigao) (size of chicken egg), Apricot Seed (Xingren) (0.5 sheng), Schisandra Berry (Wuweizi) (0.5 sheng), Pinellia Tuber (Banxia) (0.5 jin), Asarum (Xixin) (2 liang), Dried Ginger (Ganjiang) (2 liang), Wheat (Xiaomai) (1 sheng).
The above nine ingredients are boiled in 12 sheng of water. First boil wheat until cooked, remove dregs, add remaining herbs. Boil until 3 sheng remain, take 1 sheng warm, three times daily.
Ze Qi Tang Formula
Phytolacca Root (Zeqi) (3 sheng, boiled in 5 dou of east-flowing water until 1.3 sheng remain), Ginseng Root (Renshen), Cinnamon Twig (Guizhi) (each 3 liang), Pinellia Tuber (Banxia) (0.5 sheng), Scutellaria Root (Huangqin) (3 liang), Licorice Root (Gancao) (3 liang), Fresh Ginger (Shengjiang), Bupleurum Root (Baiqian), Purple Ginseng (Zican) (each 5 liang).
The above nine ingredients are chopped, added to Zeqi juice. Boil until 5 sheng remain, take 0.5 sheng warm, finish by night.
"Cough" encompasses "rebellious Qi" from earlier and connects to "sinking pulse" below. This varies the treatment for the She Gan Ma Huang Tang syndrome in Article 12. In Article 12, dual deficiency of Yin and Yang in the Lung allowed turbid Yang from Stomach and turbid Yin from Kidney to attack. Two turbidities clashed, forming thick yellow phlegm in the Lung-Stomach junction, agitated by respiration, causing frog sounds and cough/rebellious Qi. That formula used Kuandonghua to generate Yang and Ziwan to nourish Yin, restoring the Lung's master first, then assisting with Stomach-calming and Kidney-peaceful herbs. This article's preceding symptoms arise from isolated deficiency of Yang in Pericardium (Shanzhong) and Chest (Xiongzho ng), attacked by Stomach and Kidney Qi. The Chest and Pericardium are Upper Jiao; when Middle/Lower Qi ascends, the pulse floats. Floating pulse indicates pathology in Qi level only, so Wheat is used as sovereign to fill it, same logic as Kuandonghua. Floating pulse also indicates no Blood involvement, hence Ziwan (Yin-nourishing) is removed compared to the previous formula. Asarum, Dried Ginger, and Schisandra calm the Kidney; Pinellia, Ephedra, and Gypsum calm the Stomach, as noted before. Magnolia bark opens the chest; Apricot seed unblocks lung orifices, effectively replacing Belamcanda. Cough and rebellious Qi involve Lung (Zang) and Chest/Pericardium (Fu); high symptoms naturally cause floating pulses. If pulse sinks instead, sinking is Yin image, Yin disease relates to Water, Yin level relates to Blood. Cough and rebellious Qi here stem from Cold-Water hiding in Blood level, shooting Qi upward to Lung, due to Lung's aversion to Cold and Dampness. Phytolacca (Zeqi), swift and water-draining, is used as sovereign. East-flowing water is used to enhance movement and avoid stagnation with hidden water. Fearing harsh drugs cause damage, Ginseng (tonifies Qi), Cinnamon Twig (moves Yang), Fresh Ginger (warms Stomach), and Licorice (supports Earth) are used as assistants. Not only do acrid-sweet natures aid water-draining, but benevolent Yang herbs act as advisors to restrain aggressive generals, forming a righteous army. Although Cold-Water roots in Lower Jiao Blood, its Qi shoots to Lung causing cough; only acrid-dry descending Pinellia can dispel it, used as minister, like rear-guard sweeping. Baiqian is acrid-sweet, straight and long; acrid-sweet moves Qi, straight-long descends; it acts as a guide to the Lower Jiao. Zican is purple, enters Blood, swiftly removes stasis, aided by Baiqian as messenger to Lower Jiao Yin, a precise guide. This discusses water pathology alone, a variation within Nong Po Ma Huang Tang. Comparing these two formulas, their depth rivals ant hills; their variability rivals rainbow clouds. Ze Qi Tang is particularly innovative, like Luo Binwang's naval victory, unmatched in grandeur. Who said herbal liquids lack such naval forces? A guest asked: Suwen says Wheat is Heart Grain, Fire element; Zheng Xuan says Wheat has husk, Wood element; Xu Shen says Wheat grows in Metal, dies in Fire, Metal element. Li Shizhen debated this without certainty. Why do you follow Suwen calling Wheat Heart Grain in Nong Po Ma Huang Tang? Answer: Wheat in August You month is only embryo, not born. Wheat fruit matures in October Hai month. Water/Fire and Metal/Wood embryonize each other. If Xu Shen is right, You-embryo is Metal, then Wu-embryo Ren is Fire, Zi-embryo Bing is Water? But current Wheat matures in You, belonging to Ding Fire. Xu Shen's Metal theory is wrong. Zheng Xuan's Wood theory is closer, as Wheat embryos in You, nourishes Xu, births Hai, prospers Mao, dies Wu. But Wheat stalk dies in May while grain forms; stalk death doesn't mean grain death. Wood nature applies to stalk, not grain. Heaven and Earth order: Spring ends, Spirit flows as Zhu Ming (Fire); Wood ends, Essence emits as Guang Yan (Fire). Wood-stalk death leads to Fire-grain formation, fitting generative order. It's not just ripening in Wu, red color matching Li, round shape matching Heart. Thus, "Heart Grain" is indeed ancient sage's verdict, and using it as Heart medicine is medieval immortal's prescription. Guest nodded and left. Recorded here to correct experts.
Article 15: Severe rebellious Qi, throat discomfort, directing Qi downward to stop rebellion. Mai Men Dong Tang (Ophiopogon Decoction) is indicated.
Mai Men Dong Tang Formula
Ophiopogon Tuber (Maimendong) (7 sheng), Ginseng Root (Renshen) (2 liang), Pinellia Tuber (Banxia) (1 sheng), Licorice Root (Gancao) (2 liang), Jujube (Dazao) (12 pieces), Rice (Jingmi) (0.3 he).
The above six ingredients are boiled in 16 sheng of water until 6 sheng remain. Take 1 sheng warm, three times daily, once at night.
Although following Yu Bi Jia Ban Xia Tang, this addresses Lung-Stomach interrelated disease. Its subtle pathology and complex structure explain why few masters read Jingui well. Previous articles' symptoms: Lung obscured by Stomach Heat, unable to vent externally or defend downward, leading to excess in both Lung and Stomach. Yu Bi targets Lung; Pinellia targets Stomach. This article's symptoms: Lung fluid drying up, Child suffering and seeking Mother's resource, sucking Stomach fluid to save itself. But Stomach Earth fluid is also dry, unable to supply essence upward, only sending dry-hot turbid Qi. What responds is not what is sought, causing severe rebellious Qi. Throat discomfort feels like dry obstruction, response to fluid dryness and turbid Qi invasion. Like sky being dry, sucking Earth's Yin to moisten; if responded, sweet dew forms. If not, dregs invade, dust rises by day, yellow haze by night, heavy turbidity blocks clarity. This is heaven-earth's severe rebellious Qi and throat discomfort. Unless timely rain nourishes deeply, how can both moisten and return to peace? Ophiopogon, white and tonifying Yang-fluid, is sovereign, used heavily (7 sheng) because small water cannot irrigate. Rice is sweet-warm entering Stomach, used as assistant to direct Ophiopogon's moisture to Central Earth. Licorice supports downward drainage; Jujube lifts upward steaming. All converge on Ginseng, tonifying Qi and moving fluids, acting as dragon bringing rain. Tonifying Stomach fluid with sweet-floating nature to moisten Lung Metal risks water hitting red furnace, ash rising, worsening rebellion. Thus, descending Pinellia calms and stabilizes. This article involves dual deficiency of Lung and Stomach Yin; dual deficiency requires dual tonification. Full formula first tonifies Stomach fluid, then Lung fluid. This is the subtlety of pathology. Chapter lists Flaccidity, Abscess, and Rebellious Qi. Rebellious Qi section has seven formulas including this one, covering treatments fully. Abscess has three formulas including Zao Jiao Wan, covering pre/post-pus stages. Only Flaccidity section uses Gan Jiang Gan Cao Tang for cold-flaccidity variations, discussing severe fluid loss extensively, but lacks formula for hot-flaccidity. Is hot-flaccidity untreatable? No difficult/easy tags appear. Thinking deeply, inspiration reveals Zhongjing's intent: severe fluid loss leads either to Flaccidity or merely severe rebellious Qi/throat discomfort. Both suit this formula, saving Stomach to save Lung. Hence abbreviated text. Readers comparing Article 1 hot-flaccidity symptoms with this formula's ingredients and intent will see precise correspondence, proving my argument is not forced. This is the complexity of structure.