Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Two ingredients, and the second one is a date. The first is 葶苈子, the seed of Lepidium apetalum or Descurainia sophia; the second is 大枣, jujube fruit. The pairing is the point: a forceful draining seed is given together with a food-fruit that moderates it. This library has met that structure before - in 十枣汤, whose name commemorates the one ingredient that is not doing the draining, the ten dates - and the recurrence is worth noticing, because it means the classical corpus was attentive to force in a way readers routinely skip past.
The indication is stated in physical terms that a modern clinician would recognise at once and would not answer with an oral decoction: 肺痈，喘不得卧 - lung abscess, and breathlessness such that the person cannot lie flat. Jingui Yaolüe gives a longer version elsewhere: 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. A further line applies the same formula to 支饮不得息, retained fluid with inability to breathe.
Breathlessness that prevents lying flat - orthopnoea - is a short differential with a short time frame: acute heart failure, pleural effusion, asthma and COPD exacerbation, pulmonary embolism, aspiration, pneumonia, upper airway obstruction, anaphylaxis, and panic. Pleural effusion today is an imaging question - chest radiograph, ultrasound, computed tomography - followed by diagnostic aspiration with fluid analysis, and then treatment of the cause. Empyema, which is what 肺痈 most closely resembles when pus is involved, is drained and covered with antibiotics; it is not a condition in which any oral formula substitutes for drainage. Lung abscess is managed with prolonged antibiotics and, when it does not resolve, with drainage or surgery. The classical text was describing a state it had no way to see inside; the modern reader can, and that difference is not academic.
The symptom cluster carries its own list. Fever with productive cough, chest pain, breathlessness and weight loss is today a chest radiograph at minimum, and the differential - pneumonia, lung abscess, empyema, infected bronchiectasis, tuberculosis, cavitating malignancy, fungal disease, pulmonary infarction - cannot be separated by pattern reasoning. Haemoptysis anywhere in this picture is a reason to be assessed promptly, and heavy haemoptysis kills by asphyxiation rather than by blood loss.
On the materials. 葶苈子 has reported cardiac glycoside-type activity in pharmacological work; this has not been established in humans, and the uncertainty is a reason for caution rather than reassurance, because an unquantified cardioactive substance alongside diuretics or digoxin is a real problem. It belongs to the Brassicaceae. Jujube fruit is a concentrated sugar load, which matters for anyone managing blood glucose. There are no adequate safety data for pregnancy or breastfeeding. Chinese clinical reports on this formula, largely in pleural effusion and heart failure contexts, are small and methodologically limited; this library records that the research exists, not that benefit has been established.
两味药，第二味是一颗枣。第一味是葶苈子，十字花科独行菜或播娘蒿的种子；第二味是大枣。配伍本身才是重点：一味峻烈的泻肺种子，与一味缓和的食物同用。本库先前已经遇过这个结构 —— 十枣汤，方名纪念的恰恰是唯一不干活的那一味：十枚大枣。这个重复值得留意，它说明古典文献对「峻」是有自觉的，而读者通常跳过。
主治用的是现代医生一眼认得出、且不会用口服汤剂去回答的体征：肺痈，喘不得卧。《金匮要略》另有更长的版本：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。还有一条把同方用于「支饮不得息」。
平卧即喘（端坐呼吸）今天是一张短鉴别表，而且带时间：急性心衰、胸腔积液、哮喘与慢阻肺急性加重、肺栓塞、误吸、肺炎、上气道梗阻、过敏性休克、惊恐发作。胸腔积液今天是影像问题 —— 胸片、超声、CT —— 之后是诊断性穿刺与胸水分析，再之后是病因处理。脓胸（当「肺痈」涉及脓时最接近的对应）要引流并用抗生素覆盖；没有任何口服方能替代引流。肺脓肿靠长程抗生素，不吸收时靠引流或手术。古典在描述一个它无法看到胸腔内部的状态；今天的读者看得见，这个差别不是术语之争。
这组症状自带清单。发热＋咳脓痰＋胸痛＋气短＋体重下降，今天至少是一张胸片；而肺炎、肺脓肿、脓胸、支气管扩张并感染、结核、空洞型恶性肿瘤、真菌病、肺梗死这一串，靠辨证分不开。这组里任何位置出现咯血，都要尽快就诊；大咯血的致死机制是窒息，不是失血。
药物本身：葶苈子在药理工作中有强心苷类活性的报道，**人体证据未建立**；这个不确定是谨慎的理由而不是放心的理由 —— 一味含量不明的强心活性物质，与利尿剂或地高辛同在，是实在的问题。它属十字花科。大枣是浓缩的糖负荷，控糖的人须计入。孕期与哺乳期没有充分的人体安全性数据。中文文献里这方多用于胸腔积液与心衰场景，规模小、方法学质量有限；本库如实记「研究存在」，不记「疗效已被确立」。