半夏一升 生姜半筋 茯苓三两
右三味,以水七升,煮取一升五合,分温再服。
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呕家本渴,渴者为欲解,今反不渴,心下有支饮故也,小半夏汤主之。
【注】
饮家渴者,是水停气不化生津液而渴也;呕家渴者,是呕吐胃干燥伤津液而渴也,故
曰呕家本应渴也。先呕后渴者,当少少与饮之,以和胃生津,为欲解也;若呕吐后反
不渴者,是必心下素有支饮故也。惟主小半夏汤止呕,而不加茯苓者,以不渴并无新
饮,且呕后已伤津液,不可再行利水,重竭津液也。
【集注】
李□曰:此专以治呕,言呕家渴者,为欲解,以胃气复而津液生也。若心下素有支饮
,则不燥自当不渴,泛溢而呕也。半夏、生姜温能和胃气,辛能散逆气,为呕家圣药
。
半夏一升 生姜半筋
右二味,以水七升,煮取一升半,分温再服。
【集解】
沈明宗曰:此支饮上溢而呕之方也。凡作呕必伤津液,应当作渴,故为呕家本渴,渴
则病从呕去,谓之欲解。若心下有支饮,停蓄胸膈致燥,故呕而不渴,则当治饮,所
以生姜散邪,半夏涤饮,呕自止矣。
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卒呕吐,心下痞,膈间有水,眩悸者,半夏加茯苓汤主之。
【注】
卒然呕吐,虽然不渴而心下痞塞,是膈间有水凝结也。眩者,是水阻阳气不升也;悸
者,是水气上干于心也。即不渴无新饮,而平日饮盛可知,则不必顾及津液,亦必加
茯苓以利水,斯结可开而阻可通也。
【集注】
赵良曰:心下痞,膈间有水,眩悸者,阳气必不宣散也。经云:以辛散之。半夏、生
姜皆味辛,『本草』半夏可治膈上痰。心下坚呕逆眩者,亦上焦阳气虚不能升发,所
以半夏生姜并治之。悸则心受水凌,非半夏可独治,必加茯苓去水,下肾逆以安神,
神安则悸愈也。
尤怡曰:饮气逆于胃则呕吐,滞于气则心下痞,凌于心则悸,蔽于阳则眩,半夏、生
姜止呕降逆,加茯苓去其水也。
Fangji Banxia (Rhizoma Pinelliae) one sheng, Shengjiang (Zingiberis Rhizoma Recens) half jin, Fuling (Poria) three liang.
The above three ingredients are decocted in seven sheng of water until one sheng and five he remain. The resulting liquid is divided into two doses and taken warm.
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Individuals prone to vomiting should naturally feel thirsty; if they feel thirsty, it indicates that the condition is about to resolve. If they do not feel thirsty now, it is due to Zhiyin (fluid retention in the chest and diaphragm). Xiao Banxia Tang (Minor Cinnamon Twig Decoction) is the primary formula for this.
[Annotation]
In individuals with Yin (fluid retention), thirst occurs because fluid stagnation prevents Qi transformation from generating body fluids. In individuals who vomit frequently, thirst occurs because vomiting dries the stomach and damages body fluids; thus, it is said that those prone to vomiting should naturally be thirsty. If vomiting is followed by thirst, small amounts of water should be given to harmonize the Stomach Qi and generate fluids, indicating the condition is resolving. If there is no thirst after vomiting, it is certain that Zhiyin has existed in the epigastrium. Xiao Banxia Tang is used solely to stop vomiting without adding Fuling (Poria) because the absence of thirst implies no new fluid accumulation, and since body fluids have already been damaged by vomiting, diuresis should not be employed again to avoid further exhausting the fluids.
[Collected Annotations]
Li [Name] stated: This formula specifically treats vomiting. Thirst in those prone to vomiting indicates resolution, as Stomach Qi recovers and fluids are generated. If Zhiyin exists in the epigastrium, there is no dryness and thus no thirst; instead, fluid overflow causes vomiting. Banxia (Rhizoma Pinelliae) and Shengjiang (Zingiberis Rhizoma Recens) are warm to harmonize Stomach Qi and pungent to disperse rebellious Qi, making them the "holy medicine" for treating vomiting.
Fangji Banxia (Rhizoma Pinelliae) one sheng, Shengjiang (Zingiberis Rhizoma Recens) half jin.
The above two ingredients are decocted in seven sheng of water until one sheng and a half remain. The resulting liquid is divided into two doses and taken warm.
[Collected Explanations]
Shen Mingzong stated: This is a formula for vomiting caused by Zhiyin overflowing upward. Vomiting inevitably damages body fluids, so thirst should occur; hence, it is said that those prone to vomiting should naturally be thirsty. Thirst indicates that the pathogen is expelled through vomiting, termed "about to resolve." If Zhiyin exists in the epigastrium, stagnating in the chest and diaphragm causing dryness, vomiting occurs without thirst. In such cases, the fluid must be treated; therefore, Shengjiang (Zingiberis Rhizoma Recens) disperses pathogens, and Banxia (Rhizoma Pinelliae) clears fluid, stopping vomiting naturally.
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For sudden vomiting, epigastric fullness and obstruction (Pi), fluid between the diaphragm, dizziness (Xuan), and palpitations (Ji), Banxia Jia Fuling Tang (Banxia Plus Poria Decoction) is the primary formula.
[Annotation]
Sudden vomiting accompanied by epigastric fullness despite the absence of thirst indicates fluid coagulation between the diaphragm. Dizziness results from fluid obstructing Yang Qi from ascending; palpitations result from fluid Qi attacking the Heart. Even if there is no thirst and no new fluid accumulation, it can be inferred that fluid abundance exists normally. Therefore, concern for body fluids is set aside, and Fuling (Poria) must be added to promote diuresis, thereby opening the fluid coagulation and clearing the obstruction.
[Collected Annotations]
Zhao Liang stated: Epigastric fullness, fluid between the diaphragm, dizziness, and palpitations indicate that Yang Qi cannot diffuse freely. The Classics state: "Disperse with pungent substances." Both Banxia (Rhizoma Pinelliae) and Shengjiang (Zingiberis Rhizoma Recens) are pungent. Bencao records that Banxia treats phlegm above the diaphragm. Epigastric hardness, vomiting, rebellious Qi, and dizziness also stem from deficiency of Upper Jiao Yang Qi failing to ascend; thus, Banxia and Shengjiang treat these together. Palpitations indicate the Heart is overwhelmed by Water; Banxia alone cannot treat this. Fuling must be added to remove water, descend rebellious Qi from the Kidney, and calm the Spirit. When the Spirit is calm, palpitations subside.
You Yi stated: Fluid Qi rebelling in the Stomach causes vomiting; stagnating in the Qi mechanism causes epigastric fullness; overwhelming the Heart causes palpitations; obscuring Yang causes dizziness. Banxia and Shengjiang stop vomiting and direct rebellious Qi downward, while added Fuling removes the water.