倪庆云病膈气十四日。粒米不入咽。始吐清水。次吐绿水。次吐黑水。次吐臭水。呼吸将绝。医已歇手。
余适诊之。许以可救。渠家不信。余曰。尽今一昼夜。先服理中汤六剂。不令其绝。来早转方。一剂全安。
渠家曰。病已至此。滴水不能入喉。安能服药六剂乎。余曰。但得此等甘温入口。必喜而再服。不须过
虑。渠诸子或庠或弁。亦知理折。佥曰。既有妙方。何不即投见效。必先与理中。然后乃用。此何意耶。
余曰。金匮有云。病患噫气不除者。旋复代赭石汤主之。吾于此病。分别言之者有二道。一者以黑水为胃底
之水。臭水为肠中之水。此水且出。则胃中之津液。久已不存。不敢用半夏以燥其胃也。一者以将绝之气。
止存一丝。以代赭堕之。恐其立断。必先以理中分理阴阳。俾气易于降下。然后代赭得以建奇奏绩。一时之深
心。即同千古之已试。何必更疑。及简仲景方。见方中止用煨姜而不用干姜。又谓干姜比半夏更燥。而不敢
用。余曰。尊人所噫者。下焦之气也。所呕者。肠中之水也。阴乘阳位。加以日久不食。诸多蛔虫。
必上居膈间。非干姜之辣。则蛔虫不下转。而上气亦必不下转。妙处正在此。君曷可泥哉。诸子私谓言有大
而非夸者。此公颇似。姑进是药。观其验否。进后果再索药。三剂后。病者能言。云
内气稍接。但恐太急。俟天明再服。后旦转方为妥。至次早未及服药。复请前医参酌。众医交口极沮。渠家
并后三剂不肯服矣。余持前药一盏。勉令服之。曰。吾即于众医前立地转方。顷刻见
效。再有何说。乃用旋复花一味煎汤。调代赭石末。二茶匙与之。才一入口。病者曰好药。吾气已转入丹田
矣。但恐此药难得。余曰易耳。病者十四日衣不解带。目不交睫。惫甚。因图脱衣安寝。冷气一触。复呕。
与前药立止。思粥。令食半盏。渠饥甚。竟食二盏。少顷已食六盏。复呕。与前药立止。又因动怒以物
击婢。复呕。与前药立止。以后不复呕。但困倦之极。服补药二十剂。丸药一斤。将息二月。始能远出。方
悔从前少服理中二剂耳。
胡卣臣先生曰。旋复代赭一方。案中屡建奇绩。但医家未肯信用。熟读前后诸案。自了无疑惑矣。
倪庆云患膈气病已十四天。一粒米都咽不下去。起初吐出清水，接着吐出绿水，然后吐出黑水，最后吐出臭水。呼吸微弱几乎断绝，医生们已经放弃治疗。
我恰好为他诊治，承诺可以救活。但他家人不相信。我说：“请给我整整一天一夜的时间，先服用理中汤六剂，不让病情继续恶化导致死亡，明天早上再调整处方，一剂药就能完全康复。”
他家人说：“病已经到了这种地步，连一滴水都进不了喉咙，怎么能服下六剂药呢？”我说：“只要这些甘温性质的药物能入口，病人一定会喜欢并继续服用，不必过分担忧。”他的几个儿子有的在学校读书，有的已入伍当兵，也都懂得道理，一致说道：“既然有妙方，为什么不立刻投药见效？为什么一定要先用理中汤，然后再用其他药？这是什么意思呢？”
我说：“《金匮要略》中说：‘病人嗳气不止的，用旋复代赭石汤主治。’我对这个病，分别阐述有两个原因。一是认为黑水是胃底的水，臭水是肠中的水。这些水都已经吐出来，说明胃中的津液早已枯竭，所以不敢用半夏来燥湿伤胃。二是认为病人的气息即将断绝，仅存一丝，如果用代赭石这种重镇降逆的药物直接镇压，恐怕会导致气息立即中断。所以必须先使用理中汤来调理阴阳，使气机容易下降，然后代赭石才能发挥奇效。这一时的深思熟虑，与千古以来已被验证的方法相同，何必还要怀疑呢？”等到我翻阅张仲景的方书时，发现原方中只用煨姜而不用干姜，又考虑到干姜比半夏更燥烈，所以不敢使用。我说：“尊父所嗳出的气，来自下焦；所呕吐的水，是肠中的水。阴邪乘袭阳位，加上日久不进食，体内有很多蛔虫，必然上行停留在膈间。如果不是干姜的辛辣之性，蛔虫就不会下行，上逆之气也不会随之下降。奥妙之处就在这里，你们怎么可以拘泥于成见呢？”他的儿子们私下议论说：“言语宏大而非夸大的人，这位先生很像。暂且让他服药，看看是否有效。”服药后果然再次索要药物。服用三剂后，病人能够说话，说：“体内的气息稍微接续上了，但恐怕恢复得太急，等天亮后再服药比较稳妥。”到了第二天早上调整处方才妥当。然而次日清晨还未服药，家属又请之前的医生来斟酌，众医生极力反对。家属连同后面的三剂药也不肯服用了。我拿着前药一盏，勉强让他们喂服，说：“我就在众医生面前立刻转换处方，顷刻间见到疗效，还有什么可说的呢？”于是只用旋复花一味煎汤，调入代赭石末两茶匙给病人服用。刚入口，病人就说：“好药！我的气已经转入丹田了。只是恐怕这药难得。”我说：“很容易得到。”病人十四天衣服都没脱下来睡觉，眼睛也没合过，疲惫至极，因为想脱衣安睡，冷气一接触身体，又发生呕吐，服用前面的药立刻停止。病人想吃粥，让吃半盏，他非常饥饿，竟然吃了两盏，过了一会儿又吃了六盏，随后又呕吐，服用前面的药立刻停止。后来又因为动怒用东西打婢女，又呕吐，服用前面的药立刻停止。此后不再呕吐，只是极度困倦，服用补药二十剂，丸药一斤，调养两个月，才能远行。这时才后悔从前少服了两剂理中汤。
胡卣臣先生说：“旋复代赭一方，在医案中屡次建立奇功。但医生们不肯信任使用。熟读前后的各种医案，自然就没有疑惑了。”
Ni Qingyun suffered from Ge Qi (obstruction in the chest/diaphragm) for fourteen days. He could not swallow a single grain of rice. Initially, he vomited clear water, then green water, followed by black water, and finally foul-smelling water. His breathing was nearly extinct, and other physicians had given up treatment.
I happened to examine him and promised that he could be saved. However, his family did not believe me. I said, "Give me one full day and night. First, administer six doses of Lizhong Tang (Regulate the Middle Decoction) to prevent his condition from deteriorating to death. Tomorrow morning, we will adjust the prescription; one dose will completely restore his health."
His family said, "The illness has reached this point; not even a drop of water can enter the throat. How can he take six doses of medicine?" I replied, "As long as these sweet and warm medicines enter the mouth, the patient will surely accept them willingly without further need for worry." His sons, some of whom were students and others soldiers, understood the reasoning. They collectively asked, "Since there is an excellent prescription, why not administer it immediately to see results? Why must we use Lizhong Tang first and then proceed with other treatments? What is the meaning behind this?"
I explained, "The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) states: 'For patients who suffer from persistent belching, Xuanfu Daizhe Shi Tang (Inula and Hematite Decoction) is the primary treatment.' Regarding this specific case, I have two reasons for my sequential approach. Firstly, the black water represents fluid at the bottom of the stomach, and the foul water represents intestinal fluid. Since these fluids are being expelled, it indicates that the stomach's Yin fluids (body fluids) have been depleted for a long time. Therefore, I dare not use Banxia (Pinellia Rhizome), which is drying, as it would further damage the stomach. Secondly, the patient's vital Qi (vital energy) is on the verge of extinction, with only a thread remaining. If I were to use Daizhe Shi (Hematite), a heavy and descending substance, immediately, it might cause the Qi to cut off abruptly. Thus, I must first use Lizhong Tang to regulate Yin and Yang, facilitating the descent of Qi, so that Daizhe Shi can subsequently achieve its miraculous effect. This momentary profound consideration aligns with methods tested over millennia; why doubt it?"
Upon reviewing Zhang Zhongjing's formulas, I noticed that the original prescription used Wei Jiang (Baked Ginger) rather than Gan Jiang (Dried Ginger). Furthermore, considering that Gan Jiang is more drying than Banxia, I hesitated to use it. However, I reasoned: "The belching originates from Qi rising from the Lower Jiao (Lower Burner); the vomiting involves water from the intestines. Yin pathogens have invaded Yang positions. Given the prolonged lack of food intake, numerous Ascaris (roundworms) likely reside in the diaphragm area. Without the pungent heat of Gan Jiang, the worms would not descend, and the rebellious Qi above would not subside either. The subtlety lies here. Why cling rigidly to conventions?" The sons privately remarked, "Words that are grand yet not exaggerated—this physician resembles such a person. Let us try this medicine and observe if it works."
After administration, they indeed requested more medicine. After three doses, the patient could speak, saying, "My internal Qi has slightly connected, but I fear recovery is too rapid. It is prudent to wait until dawn before taking more." The prescription was adjusted appropriately the next morning. However, before taking the next dose, the family invited previous doctors to consult. All physicians strongly opposed it, and the family refused to administer the subsequent three doses. I held a cup of the previous medicine and urged them to administer it, stating, "I will change the prescription right here in front of all these doctors, and effects will be seen instantly. What else can be said?" I prepared a decoction using only Xuan Fu Hua (Flower of Inula), mixed with two teaspoons of Daizhe Shi powder, and gave it to the patient. Upon entering the mouth, the patient said, "Excellent medicine! My Qi has already turned into the Dantian (Lower Elixir Field). I only fear this medicine is hard to obtain." I replied, "It is easy to get."
The patient had not removed his clothes or closed his eyes for fourteen days due to extreme exhaustion. When he attempted to undress to sleep, exposure to cold air triggered another episode of vomiting. Administration of the previous medicine stopped it immediately. He desired congee. Allowed half a bowl, his intense hunger led him to consume two bowls, and shortly after, six bowls. Vomiting recurred, but stopped immediately upon administering the medicine. Later, anger caused him to strike a maid, triggering another bout of vomiting, which also ceased immediately with the medicine. Thereafter, vomiting ceased entirely. He remained extremely fatigued. He took twenty doses of tonic medicines and one jin (approx. 500g) of pill medicine, recuperating for two months before he could travel far. Only then did he regret having taken fewer than the prescribed two doses of Lizhong Tang earlier.
Mr. Hu Youchen stated: "Xuanfu Daizhe Shi Tang has repeatedly achieved miraculous results in medical cases. Yet, physicians are reluctant to trust and use it. By thoroughly reading the preceding and following cases, one will naturally resolve any doubts."