心下停有水气可作干呕咳喘，然水气仍属无形不至于痞硬也。乃至伤寒或因汗吐下伤其中焦正气，致
冲气肝气皆因中气虚损而上干，迫搏于心下作痞硬，且其外呼之气必噫而后出者，则非小青龙汤所能治矣，
而必须治以旋复花代赭石汤。
《伤寒论》原文∶伤寒发汗，若吐若下解后，心下痞硬，噫气不除者，旋复代赭石汤主之。
【旋复代赫石汤方】旋复花三两，人参二两，生姜五两切，代赭石一两，大枣十二
枚擘，甘草三两炙，半夏半升洗。
上七味，以水一斗煮取六升，去滓再煮取三升，温服一升，日三服。
人之胃气，其最重之责任在传送饮食，故以息息下行为顺。乃此证因汗吐下伤其胃气，则胃
气不能下行，或更转而上逆。下焦之冲脉（为奇经八脉之一），原上隶阳明，因胃气上逆，遂至引动冲气上
冲，更助胃气上逆。且平时肝气原能助胃消食，至此亦随之上逆，团结于心下痞而且硬，阻塞呼吸之气不能
上达，以致噫气不除，噫气者强呼其气外出之声也。此中原有痰涎与气相凝滞，故用旋复花之逐痰水除胁
满者，降胃兼以平肝，又辅以赭石、半夏降胃即以镇冲，更伍以人参、甘草、大枣、生姜以补助胃气之虚，与
平肝降胃镇冲之品相助为理，奏功自易易也。
赭石最善平肝、降胃、镇冲，在此方中当得健将，而只用一
两，折为今之三钱，三分之则一剂中只有一钱，如此轻用必不能见效。是以愚用此方时，轻用则六钱，重用
则一两，盖如此多用，不但取其能助旋复、半夏以平肝、降胃、镇冲也，且能助人参以辅助正气。盖人参
虽善补气，而实则性兼升浮，惟借赭石之重坠以化其升浮，则人参补益之力下行可至涌泉，非然者但知用人参
以补气，而其升浮之性转能补助逆气，而分毫不能补助正气，是用之不如不用也。是以愚从屡次经验以来，知
此方中之赭石，即少用亦当为人参之三倍也。
旋复花，《神农本草经》谓其味咸，主结气、胁下满、惊悸、除水。为其味咸，有似朴硝，故有软坚下
行之功，是以有以上种种之功效。敝邑（盐山）武帝台污所产旋复花，其味咸而且辛，用
以平肝、降胃、开痰、利气诚有殊效。
王姓童子，十二三岁，于晨起忽左半身手足不遂，知其为痰瘀经络，致气血不能流通也。时蓄有自
制半夏若干，及所采武帝台旋复花若干，先与以自制半夏，俾为末徐徐服之，服尽六两病愈弱半，继与以武
帝台旋复花，俾其每用二钱半，煎汤服之，日两次，旬日全愈。盖因其味咸而兼辛，则其利痰开瘀之力当
益大，是以用之有捷效也。夫咸而兼辛之旋复花，原为罕有之佳品，至其味微咸而不甚苦者，药局中容或
有之，用之亦可奏效。若并此种旋复花亦无之，用此方时，宜将方中旋复花减半，多加赭石数钱，如此变通
其方亦权可奏效也。
或问∶人之呼吸惟在肺中，旋复代赭石汤证，其痞硬在于心下，何以妨碍呼吸至噫气不除乎？答曰∶肺
者发动呼吸之机关也，至呼吸气之所及，非仅在于肺也，是以肺管有分支下连于心，再下则透膈连于肝，再下
则由肝连于包肾之脂膜以通于胞室（胞室男女皆有），是以女子妊子其脐带连于胞室，而竟能母呼子亦呼，
母吸子亦吸，斯非气能下达之明征乎？由斯知心下痞硬，所阻之
气虽为呼吸之气，实自肺管分支下达之气也。
心下（胃脘部）停聚水气，可以引起干呕、咳嗽和喘息，然而这种水气仍然属于无形的邪气，不至于导致痞塞坚硬。到了伤寒病，或者因为发汗、催吐、泻下损伤了中焦的正气，导致冲气和肝气都因为中气虚损而上逆侵犯心下，逼迫搏结在心下形成痞塞坚硬，并且呼出的气体必须通过打嗝才能排出的情况，这就不是小青龙汤所能治疗的了，而必须用旋复花代赭石汤来治疗。
《伤寒论》原文：伤寒经过发汗，或者催吐，或者泻下之后，病邪虽解但心下痞塞坚硬，打嗝不止的，主治方剂是旋复代赭石汤。
【旋复代赭石汤方】旋复花三两，人参二两，生姜五两切片，代赭石一两，大枣十二枚掰开，甘草三两炙烤，半夏半升洗净。
以上七味药，用水一斗煮取六升，滤去药渣后再煮取三升，每次温服一升，每天服用三次。
人的胃气，其最重要的责任在于传送饮食，所以胃气以息息向下运行顺畅为正常。而这个病症因为发汗、催吐、泻下损伤了胃气，导致胃气不能下行，反而转向上逆。下焦的冲脉（奇经八脉之一），原本上行隶属阳明胃经，因为胃气上逆，于是引动冲气上冲，更助长胃气上逆。而且平时肝气本来能协助胃消化食物，到此时也随着上逆，纠结在心下造成痞塞且坚硬，阻塞呼吸之气不能上达，以至于打嗝不止。所谓打嗝，就是强行呼气外出的声音。这中间原有痰涎与气相互凝滞，所以使用旋复花来驱逐痰水、消除胁下胀满，它既能降胃又能平肝；又辅以赭石、半夏降胃从而镇摄冲气；再配合人参、甘草、大枣、生姜来补助胃气的虚损，与平肝、降胃、镇冲的药物相助为理，取得疗效自然很容易。
赭石最善于平肝、降胃、镇冲，在这个方子中应当算作健将，但原方只用一两，折合现在的三钱，如果按三分之一计算，一剂药中只有一钱，如此轻重的用量必然不能见效。所以我在使用这个方子时，轻则用六钱，重则用一两。大概如此多用，不仅是取其能帮助旋复花、半夏来平肝、降胃、镇冲，而且能辅助人参来扶持正气。盖因人参虽然善于补气，但实际上性质兼有升浮，只有借助赭石的沉重坠降之性来化解其升浮，那么人参补益的力量才能下行到达涌泉穴，否则只知道用人参补气，而其升浮的性质反而会补助逆气，而不能补助正气，这样用药还不如不用。因此我从屡次经验以来知道，此方中的赭石，即使少用也应当是人参用量的三倍。
旋复花，《神农本草经》说它味道咸，主治结气、胁下胀满、惊悸、去除水气。因为它味道咸，类似于朴硝，所以有软坚下行的功效，因此具有上述种种功效。我家乡（盐山）武帝台污所产的旋复花，味道咸而且辛，用来平肝、降胃、化痰、利气确实有特殊的疗效。
有一个姓王的童子，十二三岁，早晨起来突然左半身手足不能随意运动，我知道这是痰瘀阻滞经络，导致气血不能流通。当时我有自制的半夏若干，以及采集的武帝台旋复花若干，先给他服用自制的半夏，让他研成粉末慢慢服用，服完六两后病情减轻了一半，接着给他服用武帝台的旋复花，让他每次用二钱半，煎汤服用，每天两次，十天后完全痊愈。大概是因为它味道咸而兼辛，那么它利痰开瘀的力量应当更大，所以使用它有迅速的效果。那咸味兼辛味的旋复花，原本是罕见的佳品，至于那些味道微咸而不怎么苦的，药局中或许会有，使用它们也可以奏效。如果连这种旋复花也没有，使用此方时，应该将方中的旋复花减半，多加几钱赭石，像这样变通方剂也可以权宜地奏效。
有人问：人的呼吸只在肺中，旋复代赭石汤证，其痞硬位于心下，为什么妨碍呼吸到打嗝不止的地步呢？回答说：肺是发动呼吸的机关，但是呼吸之气所到达的地方，不仅仅在肺，所以肺管有分支向下连接于心，再向下穿透膈膜连接于肝，再向下则由肝连接于包裹肾脏的脂膜以通达胞室（男女都有胞室），所以女子怀孕时脐带连接于胞室，竟然能母亲呼气孩子也呼气，母亲吸气孩子也吸气，这难道不是气能下达的明显证据吗？由此可知心下痞硬，所阻碍的气虽然是呼吸之气，实际上是自肺管分支下达的气。
The retention of water qi (pathogenic moisture and energy) in the epigastrium can cause dry retching, coughing, and wheezing. However, this water qi remains formless and does not lead to a sensation of fullness and hardness. In cases of Cold Damage (Shanghan), or when the healthy qi of the middle jiao is damaged by sweating, vomiting, or purging, the Chong Qi (Penetrating Vessel Qi) and Liver Qi may ascend due to the deficiency of Middle Qi, pressing and clashing in the epigastrium to cause a sensation of fullness and hardness. Furthermore, if exhaled air must be released through belching, this condition cannot be treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). Instead, it must be treated with Xuan Fu Dai Zhe Shi Tang (Inula and Hematite Decoction).
Original text from *Shanghan Lun* (Treatise on Cold Damage): After sweating, vomiting, or purging for Cold Damage, if the pathogen is resolved but there remains a sensation of fullness and hardness in the epigastrium accompanied by persistent belching, Xuan Fu Dai Zhe Shi Tang should be administered.
[Xuan Fu Dai Zhe Shi Tang Formula] Xuan Fu Hua (Inula Flower) 3 liang, Ren Shen (Ginseng Root) 2 liang, Sheng Jiang (Fresh Ginger Rhizome) 5 liang sliced, Dai Zhe Shi (Hematite) 1 liang, Da Zao (Jujube Fruit) 12 pieces split open, Gan Cao (Licorice Root) 3 liang honey-fried, Ban Xia (Pinellia Tuber) half sheng washed.
Take the above seven ingredients, boil in one dou (approx. 10 liters) of water until reduced to six sheng (approx. 6 liters), remove the dregs, and boil again until reduced to three sheng (approx. 3 liters). Take one sheng (approx. 300ml) warm at a time, three times daily.
The most critical responsibility of Stomach Qi is the transportation of food and drink; thus, its smooth downward movement is the norm. In this syndrome, damage to Stomach Qi by sweating, vomiting, or purging prevents downward movement, causing it to rebel upward. The Chong Mai (Penetrating Vessel) of the lower jiao, which originally ascends to connect with the Yangming Stomach channel, is drawn upward by the rebellious Stomach Qi, further exacerbating the upward rebellion. Additionally, while Liver Qi normally assists the Stomach in digestion, it too rebels upward in this state, clustering in the epigastrium to cause fullness and hardness. This obstructs respiratory Qi from ascending, resulting in persistent belching. Belching is the sound of forcibly exhaling air. Phlegm-fluids and Qi stagnate together within. Therefore, Xuan Fu Hua is used to expel phlegm-fluids and relieve hypochondriac fullness, descending Stomach Qi and soothing the Liver. It is assisted by Dai Zhe Shi and Ban Xia to descend Stomach Qi and calm the Chong Qi. Ren Shen, Gan Cao, Da Zao, and Sheng Jiang are added to tonify the deficiency of Stomach Qi. Assisting these descending, liver-soothing, and Chong-calming agents, therapeutic efficacy is readily achieved.
Dai Zhe Shi is most effective in soothing the Liver, descending Stomach Qi, and calming the Chong Qi, acting as a key general in this formula. However, the original prescription uses only 1 liang (approx. 3 qian modern weight). If calculated as one-third, a single dose contains only 1 qian. Such a light dosage is unlikely to be effective. Therefore, I use this formula with a light dosage of 6 qian or a heavy dosage of 1 liang. Using such larger amounts not only aids Xuan Fu Hua and Ban Xia in soothing the Liver, descending Stomach Qi, and calming the Chong Qi, but also assists Ren Shen in supporting healthy Qi. Although Ren Shen is excellent for tonifying Qi, its nature tends to ascend and float. Only by borrowing the heavy, descending property of Dai Zhe Shi to neutralize this ascent can the tonifying power of Ren Shen reach down to the Yongquan point (KI-1). Otherwise, merely using Ren Shen to tonify Qi allows its ascending nature to support rebellious Qi rather than healthy Qi, rendering its use ineffective. Thus, based on repeated experience, I know that in this formula, even in small doses, Dai Zhe Shi should be used in three times the amount of Ren Shen.
*Xun Fu Hua* (Inula Flower), according to *Shennong Bencao Jing* (Divine Farmer's Materia Medica), has a salty taste and treats constrained Qi, hypochondriac fullness, palpitations, and removes water. Due to its salty taste, resembling Po Xiao (Mirabilite), it possesses the function of softening hardness and promoting downward movement, thereby achieving the aforementioned effects. The *Xuan Fu Hua* produced in Wudi Taiwu, my hometown (Yanshan), has a salty and pungent taste. It is indeed highly effective in soothing the Liver, descending Stomach Qi, resolving phlegm, and promoting Qi flow.
A boy surnamed Wang, aged twelve or thirteen, suddenly suffered paralysis of the left side of his body upon waking in the morning. I determined this was due to phlegm and blood stasis blocking the collaterals, preventing the free flow of Qi and Blood. At that time, I had some self-made Ban Xia and collected *Xuan Fu Hua* from Wudi Taiwu. I first gave him the self-made Ban Xia, ground into powder to be taken slowly. After consuming 6 liang, his weakness decreased by half. Subsequently, I gave him the Wudi Taiwu *Xuan Fu Hua*, instructing him to take 2.5 qian per dose, decocted in water, twice daily. He recovered completely after ten days. This is likely because its salty and pungent taste enhances its ability to resolve phlegm and unblock stasis, yielding rapid results. *Xuan Fu Hua* with a salty and pungent taste is a rare and superior quality. Those with a slightly salty and not very bitter taste, possibly found in pharmacies, can also be effective. If even this type is unavailable, when using this formula, reduce the dosage of *Xuan Fu Hua* by half and add several qian more of Dai Zhe Shi. Such modification can also yield temporary effectiveness.
Someone asked: Respiration occurs only in the Lungs. In the syndrome of Xuan Fu Dai Zhe Shi Tang, the fullness and hardness are located in the epigastrium. How does this interfere with respiration to the extent of causing persistent belching? I answer: The Lungs are the organ initiating respiration. However, the reach of respiratory Qi extends beyond the Lungs. The Lung tubes have branches connecting downward to the Heart, then penetrating the diaphragm to connect with the Liver, and further connecting via the Liver to the fatty membrane surrounding the Kidneys, leading to the Bao Shi (Uterus/Womb, present in both sexes). For instance, when a woman is pregnant, the umbilical cord connects to the Bao Shi, allowing the fetus to inhale and exhale along with the mother. Is this not clear evidence that Qi can descend? From this, we understand that the Qi blocked by epigastric fullness and hardness, although related to respiration, is actually the Qi descending from the branches of the Lung tubes.