Library

Inula Flower (Xuanfuhua) 3 liang, Ginseng Root (Renshen) 2 liang, Fresh Ginger Rhizome (Shengjiang, sliced) 5 liang, Hematite (Daizheshi) 1 liang, Pinellia Tuber (Banxia, washed) half sheng, Licorice Root (Gancao, honey-fried) 3 liang, Jujube Fruit (Dazao, torn open) 12 pieces.
The above seven ingredients are decocted with one dou of water to obtain six sheng. The dregs are strained out, and the liquid is decocted again to obtain three sheng. Take one sheng warm, three times a day.

[Formula Analysis]
Luo Tianyi stated: After treatment with sweating, vomiting, or purging, although the pathogenic factors have been eliminated, the Stomach Qi has already become deficient. Since Stomach Qi is deficient, the Sanjiao (Triple Burner) fails in its duties; Clear Qi has no place to return and cannot ascend, while Turbid Qi has no place to be received and cannot descend. Consequently, pathogenic factors remain stagnant, and latent fluid retention rebels upward, causing epigastric fullness and obstruction (Xin Xia Pi), along with persistent belching (Yi Qi). In the formula, Ginseng and Licorice nourish the righteous Qi and tonify deficiency; Fresh Ginger and Jujube harmonize the Spleen and nourish the Stomach, thereby greatly stabilizing the Middle Jiao. Furthermore, the heavy nature of Hematite helps to gather floating Yang and suppress rebellion; the acrid nature of Inula Flower is used to diffuse Qi and wash away fluid retention. Assisting Ginseng to guide Qi downward, and assisting Pinellia to eliminate fluid retention upward, when Turbid Qi descends, epigastric fullness can be resolved; when Clear Qi ascends, belching can be removed. Observing Zhang Zhongjing treating Shaoyin Water-Qi flooding upward with Zhenwu Tang to suppress it; and treating Lower Jiao sliding instability with Chishizhi Yuyuliang Tang to consolidate it, this approach applies similar logic to treat Stomach deficiency leading to dysfunction of Qi ascending and descending. Thus, the chest transforms from obstruction to smoothness. These methods of returning to the origin and consolidating the lower part are each extremely effective.

After severe vomiting and purging in Cold Damage (Shanghan), the body becomes extremely deficient. If excessive sweating occurs subsequently, it is because the exterior Qi was constrained and depressed. If the physician gives water to induce sweating, hiccups (Yue) may result. The reason for this is cold in the Stomach.

[Annotation]
After severe vomiting and purging in Cold Damage, body fluids are extremely deficient. The patient presents with a red face and constrained exterior Qi, feeling thirsty and desiring to drink. If the physician provides soup or water to assist in inducing sweating, hiccups (Yue) may occur. This happens because severe vomiting and purging have already weakened the interior, and subsequent sweating causes Yang Qi to escape from the exterior. Therefore, it is stated that this is due to deficiency-cold in the Stomach. It is appropriate to use Wuzhuyu Decoction (Evodiae Fructus Decoction) to warm the middle and direct rebellious Qi downward.

[Commentary]
The Stomach governs reception and connects downward to the "earthly pathway." If the Stomach loses its function, it fails to transport contents to the Large and Small Intestines; instead of receiving, it expels. Expulsion of matter without sound is called vomiting (Tu); expulsion of both sound and matter is called retching (Ou); expulsion of sound without matter is called dry retching (Gan Ou). Dry retching is equivalent to hiccups (Yue), named so because of the "yue yue" sound. In medical discussions, retching (Ou) is considered mild, while hiccups (Yue) are considered severe. This is because when there is matter in the Stomach, the matter and Qi rebel together, causing lighter injury; whereas when the Stomach is empty, only Qi rebels upward, causing heavier injury. When Yue accompanies Shaoyin syndromes, it indicates deficiency-cold; when it accompanies Yangming syndromes, it indicates excess-heat. For deficiency-cold, formulas such as Sini Tang (Frigid Extremities Decoction), Lizhong Tang (Regulate the Middle Decoction), and Wuzhuyu Tang are used; for excess-heat, formulas such as Tiaoweichengqi Tang (Regulate the Stomach and Direct Downward Decoction), Dachengqi Tang (Major Direct Downward Decoction), and Xiao Chengqi Tang (Minor Direct Downward Decoction) are selected. Do not assume that Yue indicates Stomach failure and prohibits purgation. The text states: "In Cold Damage, if Yue is accompanied by abdominal fullness, observe the anterior and posterior orifices to determine which is obstructed; unblocking it will lead to recovery." Additionally, some people mistakenly equate Yue with hiccup (E Ni), burping (Chi Ni), or belching (Yi Qi), which is incorrect. The sound and Qi of Yue originate from the Stomach and exit the mouth with a vigorous, urgent "yue yue" sound. In contrast, the sound of E Ni originates from below the navel, rushes upward, exits the mouth making a "ge er" sound, and is scattered and discontinuous. The term E Ni refers to what is described in the Ping Mai Pian (Chapter on Plain Pulse Diagnosis) as Qi stagnation with sound. One can observe that those with E Ni make a "ge" sound immediately upon drinking cold water, whereas those with Yue do not, which distinguishes them. Chi Ni and Yi Qi refer to what is currently known as belching (Ai Qi). Belching occurring immediately after eating too quickly, without a food odor, is called Chi Ni. Belching occurring later after overeating and damaging digestion, accompanied by a food odor, is called Yi Qi. Although Yue, Ai, and Yi all involve sound without matter and belong to upward rebellion of Qi, they differ in terms of deficiency/excess, cold/heat, severity, and duration. Some even confuse Ke Ni (cough-reversal) with E Ni. However, Ke Ni is actually asthma and coughing (Chuan Sou). Confusing these is due to lack of investigation and has significant consequences. It is crucial to distinguish them: Gan Ou is equivalent to Yue, and Ke Ni is equivalent to Chuan Sou. Details are found in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet).

[Collected Annotations]
Cheng Yingmao stated: The syndrome of Yue can be either deficiency or excess. Deficiency arises from Stomach cold, following severe vomiting and purging, where Yin is deficient and Yang has no attachment, resulting in a red face and constrained exterior Qi due to inability to sweat. Physicians mistake the red face for heat constraint and give water to induce profuse sweating, unaware that Yang escapes outward causing Stomach deficiency, and water clashes inward causing pathogenic rejection. With weak Stomach Qi, how can Yue not occur?
Wang Hu stated: After severe vomiting and purging in Cold Damage, the body is already extremely deficient. Why induce further sweating? Because the exterior Qi is constrained, resembling external pathogens constraining the surface. This represents extreme deficiency of the Yangming Stomach Fu organ, with floating heat rising to the face. Physicians misidentify this as extreme Stomach heat and dryness preventing sweating, and give water to aid sweating, thereby causing Yue.

Phonetics
Mo sounds like Mo. Nei sounds like Na. He sounds like Ge. Jian sounds like Xian. Yi sounds like Yi. Yang sounds like Yang. Kai is pronounced Xi-Jie. Xuan is pronounced Huan-Juan. Zhen is level tone. Zhi is pronounced Zhi-Li. Ming sounds like Ming. [Character missing] is pronounced Ru-Liu. Zhi sounds like Zhi. [Character missing] sounds like Huang. Di sounds like Di. Dang is departing tone. Yu is pronounced Ying-Ju. Yi is pronounced Yi-Jie. Ru sounds like Ruan. Yue is pronounced Yu-Yue.