橘皮二筋 竹茹二升 大枣三十枚 生姜半筋 甘草五两 人参一两
右六味,以水一斗,煮取三升,温服一升,日三服。
【集解】
李□曰:哕有属胃寒者,有属胃热者,此哕逆因胃中虚热,气逆所致。故用人参、甘
草、大枣、补虚,橘皮、生姜散逆,竹茹甘寒,疏逆气而清胃热,因以为君。
尤怡曰:胃虚而热乘之,则作哕逆,橘皮、生姜和胃散逆,竹茹除热止呕哕,人参、
甘草、大枣益虚安中也。
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干呕哕,若手足厥者,橘皮汤主之。
【注】
干呕哕,犹言干呕即哕也。东垣以干呕为轻,哕为重,识仲景措辞之意也。哕而手足
厥,乃胃阳虚,是吴茱萸汤证也。若初病形气俱实,虽手足厥,非阳虚阴盛者比,乃
气闭不达于四肢也。故单以橘皮通气,生姜止哕也。
【集注】
程林曰:干呕哕,则气逆气胸膈间,而不行于四末,故手足为之厥,橘皮能降逆气,
生姜为呕家圣药,小剂以和之也。然干呕非反胃,厥非无阳,故下咽气行即愈。
橘皮四两 生姜半筋
右二味,以水七升,煮取三升,温服一升,下咽则愈。
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哕而腹满,视其前后,知何部不利,利之即愈。
【注】
哕虚邪也。哕而不腹满者,为正气虚,兼有热者,以橘皮竹茹汤主之;兼有寒者,以
吴茱萸汤主之。哕而腹满者为邪气实,当视其二便,大便不利者下之,小便不利者通
之即愈也。
【集注】
朱肱曰:前部不利猪苓汤,后部不利谓胃承气汤。
赵良曰:腹满为实,实则气上逆而作哕,故必视其前后何部不利而利之,则满去而哕
止。
魏荔彤曰:胃气上逆,冲而为哕,治法当视其前后,审大小便调不调也。前部不利者
,水邪之逆也。当利其小便而哕愈;后部不利者,热邪实也,当利其大便而哕愈。
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夫六府气绝于外者,手足寒,上气脚缩;五藏气绝于内者,利不禁;下甚者,手足不
仁。
【注】
气绝非谓脱绝,乃谓虚绝也。六府之气,阳也,阳气虚不温于外,则手足寒缩,阳虚
则阴盛上逆,故呕吐哕也。五藏之气,阴也,阴气虚不固于中,则下利不禁,利甚则
中脱形衰,故手足不仁也。此发明呕吐、下利之原委也。
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下利清谷,里寒外热,汗出而厥者,通脉四逆汤主之。
【注】
下利清谷,里寒也,外热汗出而厥,阳亡也。主之以通脉四逆汤,回阳胜寒,而利自
止也。
Ju Pi (Exocarpium Citri Reticulatae) two jin, Zhu Ru (Bambusa Textilis Caulis in Succo) two sheng, Da Zao (Fructus Jujubae) thirty pieces, Sheng Jiang (Rhizoma Zingiberis Recens) half a jin, Gan Cao (Radix Glycyrrhizae Preparata) five liang, Ren Shen (Radix Ginseng) one liang.
The above six ingredients are decocted with ten dou of water until three sheng remain. Take one sheng warm, three times daily.
[Collected Explanations]
Li [Name obscured] stated: Hiccups (Yue, 哕) may belong to stomach cold or stomach heat. This type of hiccup is caused by deficiency-heat in the stomach and rebellious qi. Therefore, Ren Shen (Radix Ginseng), Gan Cao (Radix Glycyrrhizae Preparata), and Da Zao (Fructus Jujubae) are used to tonify deficiency; Ju Pi (Exocarpium Citri Reticulatae) and Sheng Jiang (Rhizoma Zingiberis Recens) are used to scatter rebellious qi; Zhu Ru (Bambusa Textilis Caulis in Succo) is sweet and cold, capable of dispersing rebellious qi and clearing stomach heat, thus serving as the sovereign herb.
You Yi stated: When stomach deficiency allows heat to invade, hiccups occur. Ju Pi (Exocarpium Citri Reticulatae) and Sheng Jiang (Rhizoma Zingiberis Recens) harmonize the stomach and scatter rebellious qi; Zhu Ru (Bambusa Textilis Caulis in Succo) eliminates heat and stops vomiting and hiccups; Ren Shen (Radix Ginseng), Gan Cao (Radix Glycyrrhizae Preparata), and Da Zao (Fructus Jujubae) benefit deficiency and stabilize the middle jiao.
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For dry retching or hiccups accompanied by coldness of the hands and feet, Ju Pi Tang (Orange Peel Decoction) is the primary treatment.
[Annotation]
"Dry retching and hiccups" implies that dry retching here refers to hiccups. Dong Yuan considered dry retching mild and hiccups severe, recognizing Zhang Zhongjing's precise wording. Hiccups with cold extremities indicate stomach yang deficiency, which is the indication for Wu Zhu Yu Tang (Evodia Decoction). However, if it is an initial illness where both form and qi are excess, even with cold extremities, it differs from yin excess due to yang deficiency; rather, it is caused by qi closure preventing circulation to the four limbs. Therefore, only Ju Pi (Exocarpium Citri Reticulatae) is used to unblock qi, and Sheng Jiang (Rhizoma Zingiberis Recens) to stop hiccups.
[Collected Annotations]
Cheng Lin stated: Dry retching and hiccups indicate rebellious qi stagnating in the chest and diaphragm, failing to reach the extremities, hence the coldness of the hands and feet. Ju Pi (Exocarpium Citri Reticulatae) can descend rebellious qi, and Sheng Jiang (Rhizoma Zingiberis Recens) is the sage medicine for vomiting. A small dose is used to harmonize. However, dry retching is not regurgitation, and coldness does not imply loss of yang; thus, upon swallowing, qi flows and recovery occurs.
Ju Pi (Exocarpium Citri Reticulatae) four liang, Sheng Jiang (Rhizoma Zingiberis Recens) half a jin.
The above two ingredients are decocted with seven sheng of water until three sheng remain. Take one sheng warm; recovery follows immediately upon swallowing.
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In cases of hiccups accompanied by abdominal fullness, observe the anterior and posterior orifices to determine which part is obstructed; unblocking it will lead to recovery.
[Annotation]
Hiccups generally belong to deficiency pathogens. Hiccups without abdominal fullness indicate righteous qi deficiency; if accompanied by heat, Ju Pi Zhu Ru Tang (Orange Peel and Bamboo Sheath Decoction) is indicated; if accompanied by cold, Wu Zhu Yu Tang (Evodia Decoction) is indicated. Hiccups with abdominal fullness indicate excess pathogens. One must examine the bowel and urinary movements: if stool is difficult, purgation is used; if urination is difficult, diuresis is used, leading to recovery.
[Collected Annotations]
Zhu Gong stated: Obstruction in the anterior part (urine) is treated with Zhu Ling Tang (Polyporus Decoction); obstruction in the posterior part (stool) is treated with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction).
Zhao Liang stated: Abdominal fullness indicates excess; excess causes qi to rebel upward resulting in hiccups. Therefore, one must identify which of the anterior or posterior orifices is obstructed and unblock it, thereby removing fullness and stopping hiccups.
Wei Litong stated: Rebellious stomach qi surges upward causing hiccups; the treatment method requires observing the anterior and posterior orifices to assess whether urination and defecation are smooth. Obstruction in the anterior part (urine) indicates water pathogen rebellion; promoting urination cures the hiccups. Obstruction in the posterior part (stool) indicates heat pathogen excess; promoting defecation cures the hiccups.
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When the qi of the six fu organs fails externally, there is coldness of the hands and feet, rebellious qi ascending, and retraction of the legs; when the qi of the five zang organs fails internally, there is uncontrollable diarrhea; in severe cases, there is numbness of the hands and feet.
[Annotation]
"Qi failure" does not mean complete extinction, but extreme deficiency. The qi of the six fu organs is yang; when yang qi is deficient and cannot warm the exterior, the hands and feet become cold and retracted. Yang deficiency leads to yin excess and rebellion, causing vomiting and hiccups. The qi of the five zang organs is yin; when yin qi is deficient and cannot secure the interior, uncontrollable diarrhea occurs. Severe diarrhea leads to central collapse and physical decline, resulting in numbness of the hands and feet. This section elucidates the origins of vomiting and diarrhea.
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In cases of diarrhea with undigested food, internal cold with external heat, sweating, and cold extremities, Tong Mai Si Ni Tang (Pulse-Unblocking Four Reversal Decoction) is the primary treatment.
[Annotation]
Diarrhea with undigested food indicates internal cold. External heat, sweating, and cold extremities indicate the collapse of yang qi. Tong Mai Si Ning Tang (Pulse-Unblocking Four Reversal Decoction) is used to restore yang and overcome cold, thereby stopping the diarrhea.