治久病呃逆,因于寒者。
丁香 柿蒂(二钱) 人参(一钱) 生姜(五片。)
此足阳明少阴药也。丁香泄肺温胃而暖肾,生姜去痰开郁而散寒,柿蒂苦涩而降
气,人参所以补真气,使得展布也。火呃亦可用者,盖从治之法也。
治久病虚羸,呕逆不已。亦治胃虚呃逆。
橘皮 竹茹 人参 甘草 半夏 麦冬 赤茯苓 枇杷叶 加姜枣煎。
此足阳明药也。胃火上冲,肝胆之火助之,肺金之气,不得下降,故呕。竹茹、枇
杷叶、麦门冬皆清肺而和胃,肺金清则肝气亦平矣。二陈所以散逆气,赤茯所以降心
火,生姜呕家之圣药,久病虚羸,故以人参、甘草、大枣,扶其胃气也。又《金匮》
橘皮竹茹汤,亦治呃逆。
橘皮(二升) 竹茹(二升) 人参(一两) 甘草(五两) 生姜(半斤) 大枣(三十枚。)
又一法,凡呃逆不止,用纸捻刺鼻中,得嚏即止。
东垣曰∶堵塞咽喉,阳气不得出者,曰塞。阴气不得下降者,曰噎。初起七情郁
悒,气不得畅,而胸膈迷闷也。其痞满者,非痞块之痞,痞与否同,乃胸腹炮闷,而不
舒畅也。本皆气病,但噎塞乃气滞初起之端,而痞闷乃久滞不散之象。丹溪曰∶痞满
与胀满不同,胀满内胀,而外亦有形,痞则内觉痞闷,而外无形,盖由阴伏阳畜,气血
不运而成,位于心下填满痞塞耳。有因误下以致里气虚邪,乘虚而入于心之分野者。有
因食饮痰滞,不能营运,而作病者。有因湿热太甚,土乘心下,而为痞者。古法用芩连
枳实之苦以泄之,浓朴半夏生姜之辛以散之,参术甘温以补之,茯苓泽泻之咸淡以渗
之,皆为要药,如脾气虚弱,转运不调,饮食不化,而作痞者,则以补为消,健运一
得,虚痞自除矣。痞挟血而成窠囊,用桃仁红花香附大黄之类。
东垣曰∶痞满皆血症也。下多亡阴,谓脾胃水谷之阴亡也。心主血,心虚而邪陷于
血之分,故致心下痞,宜理脾胃,以血药治之,若全用气药,则痞益甚,而复下之气愈
下降,必变中满鼓胀矣,用气药治痞而不效者,未明此理也。
清阳出上窍,故上满者,为气而非物,浊阴出下窍,故下满者,为物,而非气,俱
是热病,惟冷结膀胱,少腹满一症,为寒,有手足厥冷为可辨。
Treats chronic hiccups caused by cold.
Dingxiang (Clove), Shidi (Persimmon Calyx) (each 2 qian), Renshen (Ginseng Root) (1 qian), Shengjiang (Fresh Ginger Rhizome) (5 slices).
These are herbs acting on the Foot-Yangming Stomach channel and Foot-Shaoyin Kidney channel. Dingxiang (Clove) disperses Lung Qi, warms the Stomach, and warms the Kidney; Shengjiang (Fresh Ginger Rhizome) eliminates phlegm, resolves stagnation, and dispels cold; Shidi (Persimmon Calyx), being bitter and astringent, directs Qi downward; Renshen (Ginseng Root) tonifies True Qi, allowing it to spread and circulate freely. This formula can also be used for hiccups caused by Fire, employing the method of "conforming treatment" (treating according to false symptoms).
Treats chronic weakness and emaciation with persistent vomiting and hiccups. It is also suitable for hiccups due to Stomach deficiency.
Jupi (Tangerine Peel), Zhuru (Bamboo Shavings), Renshen (Ginseng Root), Gancao (Licorice Root), Banxia (Pinellia Tuber), Maimendong (Ophiopogon Tuber), Chifuling (Red Poria), Pipaye (Loquat Leaf), decocted with Shengjiang (Fresh Ginger Rhizome) and Dazao (Jujube Fruit).
This acts on the Foot-Yangming Stomach channel. When Stomach Fire rushes upward, assisted by Liver and Gallbladder Fire, the Qi of Metal (Lung) cannot descend, resulting in vomiting. Zhuru (Bamboo Shavings), Pipaye (Loquat Leaf), and Maimendong (Ophiopogon Tuber) all clear the Lungs and harmonize the Stomach; when Lung Metal is cleared, Liver Qi becomes balanced. Erchen Tang (Two-Aged Decoction - referring here to the phlegm-resolving properties of Banxia etc.) disperses rebellious Qi; Chifuling (Red Poria) drains Heart Fire; Shengjiang (Fresh Ginger Rhizome) is the holy medicine for vomiting. Since the patient suffers from chronic weakness and emaciation, Renshen (Ginseng Root), Gancao (Licorice Root), and Dazao (Jujube Fruit) are used to support Stomach Qi. Additionally, Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) from *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) also treats hiccups.
Jupi (Tangerine Peel) (2 sheng), Zhuru (Bamboo Shavings) (2 sheng), Renshen (Ginseng Root) (1 liang), Gancao (Licorice Root) (5 liang), Shengjiang (Fresh Ginger Rhizome) (0.5 jin), Dazao (Jujube Fruit) (30 pieces).
Another method: For persistent hiccups, stimulate the nasal cavity with a paper wick; inducing sneezing will stop the hiccups.
Li Dongyuan said: When the throat feels blocked and Yang Qi cannot exit, it is called "Se" (Obstruction). When Yin Qi cannot descend, it is called "Ye" (Choking). Initially, this arises from emotional depression causing Qi stagnation and chest/diaphragm confusion. The sensation of "Pi Man" (fullness/stuffiness) is not a palpable mass; "Pi" is synonymous with "Pi" (stagnation/blockage in I Ching), referring to a burning stuffiness in the chest and abdomen without comfort. These are fundamentally Qi disorders. However, "Ye Se" (choking/obstruction) is the initial stage of Qi stagnation, while "Pi Men" (stuffiness) is the manifestation of long-term stagnant Qi that does not disperse. Zhu Danxi said: Pi Man (stuffiness/fullness) differs from Zhang Man (distension). Zhang Man involves internal distension with external visible swelling, whereas Pi Man involves internal feeling of stuffiness without external form. This is caused by latent Yin and accumulated Yang, with impaired Qi and Blood circulation, located at the epigastrium where one feels full and obstructed. Some cases result from improper purging leading to interior deficiency, allowing pathogenic factors to enter the Heart's territory upon deficiency. Some arise from food retention or phlegm stasis failing to circulate. Some occur due to excessive Damp-Heat, where Spleen Earth overacts upon the epigastrium. Ancient methods use bitter herbs like Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Zhishi (Immature Bitter Orange) to drain heat; pungent herbs like Houpo (Magnolia Bark), Banxia (Pinellia Tuber), and Shengjiang (Fresh Ginger Rhizome) to scatter stagnation; sweet-warm herbs like Renshen (Ginseng Root), Baizhu (Atractylodes Rhizome), and Gancao (Licorice Root) to tonify; and salty-light herbs like Fuling (Poria) and Zexie (Alisma Rhizome) to leach out dampness. These are essential medicines. If Pi Man results from Spleen Qi deficiency, poor transport, and undigested food, treatment should focus on tonification combined with mild digestion; once transportation function recovers, deficiency-type Pi Man will resolve. If Pi Man is complicated by blood stasis forming a "nest," herbs like Taoren (Peach Kernel), Honghua (Safflower), Xiangfu (Cyperus Rhizome), and Dahuang (Rhubarb Root) are used.
Li Dongyuan said: Pi Man belongs to Blood disorders. Excessive purging leads to the loss of Yin, specifically the Yin of Water and Grain in the Spleen and Stomach. The Heart governs Blood; if Heart Qi is deficient and pathogens sink into the Blood territory, it causes epigastric Pi Man. Treatment should regulate the Spleen and Stomach and use Blood-invigorating herbs. Using only Qi-regulating herbs will worsen the Pi Man and cause further sinking of Qi, inevitably transforming into abdominal distension and drum-like bloating. Those who fail to treat Pi Man with Qi-regulating herbs do not understand this principle.
Clear Yang exits through the upper orifices, so upper fullness is due to Qi rather than solid matter. Turbid Yin exits through the lower orifices, so lower fullness is due to matter rather than Qi. Both conditions are generally related to Heat diseases. The exception is Cold binding in the Bladder causing lower abdominal fullness, which is a Cold syndrome, distinguishable by cold extremities.