黄芩三两 甘草(炙)二两 芍药二两 半夏半升 生姜三两 大枣十二枚
右六味,以水一斗,煮取三升,去滓,温服一升,日再,夜一服。
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食已即吐者,大黄甘草汤主之。
【注】
吐者,有物无声之谓也。朝食暮吐者寒也,食已即吐者火也,以寒性迟,火性急也。
故以大黄甘草汤,缓中泻火,火平自不吐也。
【集注】
王肯堂曰:病人欲吐者,不可下之,又用大黄甘草治食已即吐,何也?曰:欲吐者,
其病在上,因而越之可也,而逆之使下,则必抑塞愤乱而益甚,故禁之。若既已吐矣
,吐而不已,有升无降,则当逆而折之,引令下行,无速于大黄,故取之也。
程林曰:经云:诸逆冲上,皆属于火。食已即吐,是胃热上逆而不能容食,与反胃寒
呕水饮不同,故用是汤以平胃热。
高世栻曰:食已即吐者,非宿谷不化之胃反,乃火热攻冲之吐逆。
大黄四两 甘草一两
右二味,以水三升,煮取一升,分温再服。
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病人欲吐者,不可下之。
【注】
病人欲吐,上越之势方盛,故不可下之。若病人吐后,其势衰矣,因其衰而济之,故
已吐有可下之法也。
【集注】
徐彬曰:治病之法,贵因势利导,故「内经」曰:在上者越之,在下者竭之。今病欲
上吐,不可强之使下,凡病皆然。故曰:病人欲吐者,不可下之。
程林曰:按「欲」字,乃吐而未吐之义。
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病人胸中似喘不喘,似呕不呕,似哕不哕,彻心中愦愦然无奈者,生姜半夏汤主之。
【注】
此承上条,详申欲吐之状,以明其治也。喘者呼吸气急也,似喘不喘,谓胸中似喘之
不快,而不似喘之气急也。呕者吐物而有声也,似呕不呕,谓似作呕之状,而不似呕
之有物也,哕者干呕也,似哕不哕,谓似乎哕之有声,而不似哕之声连连也。胸彻心
中愦愦然无奈者,总形容似喘不喘,似呕不呕,似哕不哕,心中愦乱无奈,懊□欲吐
之情状也,故以半夏降逆,生姜安胃也。
【集注】
沈明宗曰:似喘不喘,似呕不呕,似哕不哕,诚不是喘,不是呕,不是哕也。彻者,
通也,竟是通心中愦愦然无奈,即泛泛恶心之义也。
Huangqin (Scutellariae Radix) 3 liang, Gancao (Glycyrrhizae Radix et Rhizoma, roasted) 2 liang, Shaoyao (Paeoniae Radix Alba) 2 liang, Banxia (Pinelliae Rhizoma) half sheng, Shengjiang (Zingiberis Rhizoma Recens) 3 liang, Dazao (Jujubae Fructus) 12 pieces.
The above six herbs are boiled in one dou of water until reduced to three sheng. The dregs are removed, and the liquid is taken warm, one sheng per dose, twice during the day and once at night.
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For vomiting immediately after eating, Da Huang Gancao Tang (Rhubarb and Licorice Decoction) is the primary treatment.
[Annotation]
Vomiting refers to the expulsion of contents without sound. Vomiting food eaten in the morning but expelled in the evening indicates Cold; vomiting immediately after eating indicates Fire, because Cold nature is slow while Fire nature is urgent.
Therefore, Da Huang Gancao Tang is used to moderate the middle jiao and purge Fire; once the Fire is pacified, vomiting ceases naturally.
[Collected Annotations]
Wang Kentang stated: When a patient desires to vomit, purgative methods should not be used. Why, then, is Da Huang Gancao Tang used for vomiting immediately after eating? The answer is: When the desire to vomit exists, the pathology is located superiorly, and it is appropriate to follow this tendency by inducing emesis. If one opposes this tendency by forcing downward purgation, it will inevitably cause qi stagnation, oppression, and agitation, exacerbating the condition; hence, it is prohibited. However, if vomiting has already occurred and continues incessantly, with upward movement only and no downward descent, one must oppose and curb this trend, guiding the qi downward. Nothing acts faster than Da Huang (Rhei Radix et Rhizoma) for this purpose, hence its selection.
Cheng Lin stated: The classics say: "All rebellious upward movements belong to Fire." Vomiting immediately after eating results from Stomach Heat rebelling upward, preventing the retention of food. This differs from cold retching of water and fluids seen in Fanwei (Regurgitation). Therefore, this decoction is used to pacify Stomach Heat.
Gao Shishi stated: Vomiting immediately after eating is not Wei Fan (Stomach Regurgitation) caused by undigested old grain, but rather vomiting and rebellion caused by attacking and thrusting Fire-Heat.
Da Huang (Rhei Radix et Rhizoma) 4 liang, Gancao (Glycyrrhizae Radix et Rhizoma) 1 liang.
The above two herbs are boiled in three sheng of water until reduced to one sheng. Divide into two doses and take warm.
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When a patient desires to vomit, purgative methods must not be used.
[Annotation]
When a patient desires to vomit, the momentum of upward expulsion is vigorous; therefore, purgative methods must not be used. If the patient has already vomited, this momentum has subsided. One may then assist the body's recovery due to this decline; thus, there are indications for purgation in cases where vomiting has already occurred.
[Collected Annotations]
Xu Bin stated: The method of treating disease values following the momentum and guiding it accordingly. Thus, the *Neijing* states: "For pathologies in the upper, use emesis; for pathologies in the lower, use exhaustion (purgation)." Now that the disease tends upward toward vomiting, one must not force it downward. This applies to all diseases. Hence it is said: When a patient desires to vomit, do not use purgatives.
Cheng Lin stated: According to the character "yu" (desire/want), it implies the state of wanting to vomit but not yet having done so.
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When a patient feels as if they need to pant but does not, as if they need to retch but do not, as if they need to hiccup but do not, and feels a pervasive sense of restlessness and helplessness throughout the chest and heart region, Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction) is the primary treatment.
[Annotation]
This follows the previous clause to detail the manifestations of desiring to vomit, thereby clarifying the treatment. Panting (Chuan) refers to rapid breathing. "As if panting but not panting" means discomfort in the chest resembling panting, but without the rapid breathing characteristic of true panting. Retching (Ou) involves expelling contents with sound. "As if retching but not retching" means appearing to have the posture of retching, but without expelling any substance. Hiccup/Dry heave (Yue) refers to dry heaving. "As if hiccuping but not hiccuping" means seeming to have the sound of hiccupping, but without the continuous sound characteristic of true hiccups. "Tong che xin zhong kui kui ran wu nai" describes a pervasive feeling of restlessness and helplessness in the chest and heart, summarizing the state of being like panting but not, like retching but not, like hiccuping but not—feeling mentally troubled, helpless, and distressed with a desire to vomit. Therefore, Banxia (Pinelliae Rhizoma) is used to direct rebellious qi downward, and Shengjiang (Zingiberis Rhizoma Recens) is used to calm the Stomach.
[Collected Annotations]
Shen Mingzong stated: "As if panting but not, as if retching but not, as if hiccuping but not"—these are indeed not panting, not retching, and not hiccuping. "Che" means through or pervasive. It refers to a pervasive feeling of restlessness and helplessness within the heart/chest, which is synonymous with a general sensation of nausea.