夫（呕吐。或谷或水或痰涎或冷沫。各不相同。今）呕家（因内）有痈脓。（与诸
呕自当另看。切）不可治呕。（俟其痈已）脓尽（则呕）自愈。
此以痈脓之呕撒开。以起下文诸呕也。
（呕家必有停痰宿水。若）先呕却渴者。（痰水已去。而胃阳将复。）此为欲解。
先渴却呕者。（因热而饮水过多。热虽去而饮仍留。此）为水停心下。此属饮家。（新
水之致呕者其一。又）呕家（水从呕去。）本（当作）渴。今（反）不渴者。心下（着）有
支饮（愈动而愈出）故也。此属支饮。（宿水之致呕者又其一。）
此以呕后作渴为欲解。先渴后呕为停饮。呕而不渴为支饮也。
问曰。病患脉数。数为热。（热则）当消谷引饮。而反吐者。何也。师曰。（数不
尽为热也。而虚者亦见数脉。）以（过）发其汗。令阳微膈气虚。（其）脉乃数。（此）
数（不为胃热。而）为客热。（揆其所以）不能消谷。（皆）胃中虚冷故也。（又）脉
弦者。（肝邪之象也。土虚而木乘之。）虚（则受克）也。（今）胃气（匮乏）无余。
朝食暮吐。变为胃反。（推其致病之由。）寒（本）在于上。（而）医反下之。（土气
大伤。）令脉反弦。故名曰虚。
此言误汗而脉数。误下而脉弦。当于二脉中认出虚寒为胃反之本也。
（上言数为客热。今则推言及脉微而数乎。盖）寸口脉微而数。微则（卫虚而）无
气。无气则荣（气随卫气而俱）虚荣。（气随之）虚则血（日见）不足。血不足（虽见阴
火之数脉。而上焦之宗气大虚。）则胸中（必）冷。
此承上节数为客热。而推言脉微而数者为无气。而非有热也。
尤在泾云、合上二条言之。客热固非真热。不可以寒治之。胸中冷亦非真冷。不可
以热治之。是皆当以温养真气为主。真气。冲和纯粹之气。此气浮则生热。沉则生冷。
温之则浮热自收。养之则虚冷自化。若热以寒治。寒以热治。则真气愈虚。寒热内贼。
而其病愈甚矣。
（上言胃气无余。变为胃反。今且由胃而推言及脾乎。盖胃者阳也。脾者阴也。）
趺阳脉浮而涩。浮则为（胃之阳）虚。涩则（为阴虚而）伤（在）脾。脾伤则（胃中所纳之
谷。而）不（能消）磨。（化为糟粕而出）朝食暮吐。暮食朝吐。宿谷不化。（不下行
而上出。）名曰胃反。（若）脉和缓。其土气尚未败也。倘若邪甚而紧（液竭）而
涩。其病难治。
此承上节胃气无余。变为胃反。而推言其病之并在于脾也。
病患欲吐者。（病势在上。）不可（强）下之。
哕（虽在上。）而腹满。（却不在上。是病在下而气溢于上也。当）视其（二阴之在
）前（在）后。知何部不利。（以药）利之（而）愈。
此二节。言病势之欲上欲下。宜顺其势而利导之也。哕病应归橘皮竹茹汤节中。此
特举之。与上节为一上一下之对子。非错简也。
（胸为阳位。呕为阴邪。使胸中阳气足以御邪。则不呕。即呕而胸亦不满。若）呕
而胸满者。（是阳不治。而阴乘之也。以）吴茱萸汤主之。
此言浊阴居阳位。呕而胸满也。
吴茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味。以水五升。煮取三升。温服七合。日三服。
（有声无物。谓之）干呕（无物则所）吐（者尽是）涎沫。（更兼）头痛者。（是寒
气从经上攻于头也。以）吴茱萸汤主之。（温补以驱浊阴。又以折逆冲之势也。）
此承上节而补出吐涎沫头痛。以明此证用此汤之的对也。
李氏云、太阴少阴从足至胸。俱不上头。二经并无头痛证。厥阴经上出额。与督脉
会于巅。故呕吐涎沫者。里寒也。头痛。寒气从经脉上攻也。不用桂附用吴茱萸者。以
其入厥阴经故耳。余皆温补散寒之药。（阳不下交而上逆。则）呕（阴不上交）而（独
走。则）肠鸣。（其升降失常。无非由于）心下痞（所致）者。（以）半夏泻心汤主之。
此为呕证中有痞而肠鸣者。出其方也。此虽三焦俱病。而中气为上下之枢。但治其
中。而上呕下鸣之证俱愈也。
半夏泻心汤方
半夏（半升洗） 黄芩 干姜 人参 甘草（各三两炙） 黄连（一两） 大枣（
十二枚）
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。
（干呕。胃气逆也。若下利清谷。乃肠中寒也。今）干呕而（下）利（浊粘）者。
（是肠中热也。可知呕为热逆之呕。利为挟热之利。以）黄芩加半夏生姜汤主之。
此言热邪入里作利。而复上行而为呕也。与伤寒论大同小异。
黄芩加半夏生姜汤方
黄芩 生姜（各三两） 甘草（二两） 芍药（一两） 半夏（半升） 大枣（十
二枚）
上六味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
（有声有物为呕。有物无声为吐。）诸呕吐（有寒有热。食入即吐。热也。朝食暮吐。
寒也。而此则非寒非热。但觉痰凝于中。食）谷不得下（咽）者。（以）小半夏汤
主之。（祛停饮。散气结。降逆安胃。自效。）
此为呕吐而谷不得下者。而出其总治之方也。
小半夏汤方（见痰饮）
呕吐。而（饮）病在（于）膈上。（饮亦随呕吐而去。故呕吐之）后思水者（知其病已）
解。急（以水少少）与之。（以滋其燥。若未曾呕吐。而先）思水者。（为宿有支饮。
阻其正津而作渴。渴而多饮。则旧饮未去。新饮复生。法宜崇土以逐水。以）猪苓散主
之。
此遥承第二节之意而重申之。并出其方治也。
猪苓散方
猪苓 茯苓 白术（各等分）
上三味。杵为散。饮服方寸匕。日三服。
（呕而心烦心中懊 。内热之呕也。今）呕而脉弱。（正气虚也。）小便复利。（中
寒盛也。）身有微热。见厥者。（正虚邪盛。而阻格其升降之机也。此为表里阴阳之气。
不相顺接。故为）难治。（以）四逆汤主之。
此为虚寒而呕者。出其方治也。阴邪逆则为呕。阳虚而不能摄阴。则小便利。真阴
伤而真阳越。则身有
微热。虚阳又不能布护周身。而见厥脉弱者。此表里阴阳气血俱虚之危候也。此症虚实
并见。治之当求其本矣。
四逆汤方
附子（一枚生用） 干姜（一两半） 甘草（二两炙）
上三味。以水三升。煮取一升二合。去滓。分温再服。强人可大附子一枚。干姜三
两。
（四逆汤。为少阴之专剂。所以救阴枢之折也。然少阴为阴枢。少阳为阳枢。病主
呕。今）呕而（不厥。）发热（不微）者。（是少阳相火之病也。以）小柴胡
汤主之。
此与上节。为一阴一阳之对子。少阴厥而热微。宜回其始绝之阳。少阳不厥而发热。
宜清其游行之火。
小柴胡汤方
柴胡（半斤） 半夏（半升） 黄芩 人参 甘草 生姜（各三两） 大枣（十二
枚）
上七味。以水一斗。煮取六升。去滓再煎。取三升。温服一升。日三服。
（胃主纳谷。其脉本下行。今反挟冲脉之气而上逆。名曰胃反。）胃反呕吐者。（
以）大半夏汤主之。
此为胃反证出其正方也。千金治胃反不受食。食入而吐。外台治呕。心下痞硬者。
可知此方泛应曲当之妙也。俗医但言半夏治痰。则失之远矣。
大半夏汤方
半夏（二升） 人参（三两） 白蜜（一升）
上三味。以水一斗二升。和蜜扬之二百四十遍。煮药取二升半。温服一升。余分再
服。
（又有阳明有热。大便不通。得食则两热相冲。）食已即吐者。（以）大黄甘草汤主之。
此为食入即吐者出其方治也。东垣谓幽门不通。上冲吸门者。本诸此也。外台治吐
水。可知大黄亦能开脾气之闭。而使散精于肺。通调水道。下输膀胱矣。
大黄甘草汤方
大黄（二两） 甘草（一两）
上二味。以水三升。煮取一升。分温再服。
（胃反病为胃虚挟冲脉而上逆者。取大半夏汤之降逆。更取其柔和以养胃也。今有挟
水饮而病）胃反。（若吐已而渴。则水饮从吐而俱出矣。若）吐（未已）而渴。欲饮水
者。（是旧水不因其得吐而尽。而新水反因其渴饮而增。愈吐愈渴。愈饮愈吐。非从脾
而求输转之法。其吐与渴。将何以宁。以）茯苓泽泻汤主之。
此为胃反之因于水饮者而出其方治也。此方治水饮。人尽知之。而治胃反。则人未
必知也。治渴。更未必知也。然参之本论猪苓散。伤寒论五苓散猪苓汤。可以恍然悟矣。
且外台用此汤治消渴脉绝胃反者。有小麦一升。更得其秘。
李氏云、五苓散治外有微热。故用桂枝。此证无表热。而亦用之者。以桂枝非一于
攻表之药也。乃彻上彻下。可外可内。为通行津液。和阳治水之剂也。
茯苓泽泻汤方
茯苓（半斤） 泽泻（四两） 甘草 桂枝（各二两） 白术（三两） 生姜（四
两）
上六味。以水一斗。煮取三升。内泽泻再煮。取二升半。温服八合。日三服。
（前言先吐却渴为欲解者。以其水与热随吐而俱去。今）吐后渴欲得水。（且以水
不足以止其燥。）而贪饮（不休）者。（是水去而热存也。以）文蛤汤主之。（方中有
麻杏生姜等。除热导水外。）兼主微风脉紧头痛。
此为吐后热渴而出其方治也。
文蛤汤方
麻黄（三两） 杏仁（五十枚） 大枣（十二枚） 甘草 石膏 文蛤（各五两）
生姜（三两）
上七味。以水六升。煮取二升。温服一升。汗出即愈。
干呕吐逆。（胃中气逆也。）吐涎沫。（上焦有寒。其口多涎也。以）半夏干姜散
主之。
此为胃寒干呕者而出其方也。
徐忠可云、此比前干呕吐涎沫头痛条。但少头痛。而增吐逆二字。彼用茱萸汤。此
用半夏干姜散。何也。盖上焦有寒。其口多涎。一也。然前有头痛。是浊阴上逆。格邪
在头为疼。与浊阴上逆。格邪在胸而满相同。故俱用人参姜枣助阳。而以茱萸之苦温。
下其浊阴。此则吐逆。明是胃家寒重。以致吐逆不已。故不
用参。专以干姜理中。半夏降逆。谓与前浊阴上逆者。寒邪虽同。有高下之别。特未至
格邪在头在胸。则虚亦未甚也。
半夏干姜散方
半夏 干姜（各等分）
上二味。杵为散。取方寸匕。浆水一升半。煮取七合。顿服之。
病患（寒邪抟饮。结于）胸中（阻其呼吸往来出入升降之机。其证）似喘不喘。似呕不呕。似
哕不哕。（寒饮与气。相抟互击。逼处心脏。欲却不能。欲受不可。以致）彻心中愦愦
无（可）奈（何之状。而不能明言）者。（以）生姜半夏汤主之。
此为寒邪抟饮。似喘似呕似哕而实非者。出其方治也。
徐忠可云、喘呕哕。俱上出之象。今有其象。而非其实。是膈上受邪。未攻肺。亦
不由胃。故曰胸中。又曰、彻心中愦愦无奈。彻者。通也。谓胸中之邪既重。因而下及
于心。使其不安。其愦愦无可奈何也。生姜宣散之力。入口即行。故其治最高。而能清
膈上之邪。合半夏并能降其浊涎。故主之。与茱萸之降浊阴。干姜之理中寒不同。盖彼
乃虚寒上逆。此惟客邪抟饮于至高之分耳。然此即小半夏汤。彼加生姜煎。此用汁而多。
药性生用则上行。惟其邪高。故用汁而略煎。因即变其汤名。示以生姜为君也。
生姜半夏汤方
半夏（半升） 生姜（汁一升）
上二味。以水三升。煮半夏取二升。内生姜汁。煮取一升半。小冷。分四服。日三
夜一。呕止停后服。
（彼夫初病。形气俱实。气逆胸膈间。以致）干呕（与）哕。若手足厥者。（气逆胸
膈。不复行于四肢也。以）橘皮汤主之。
此为哕之不虚者而出其方治也。古哕证即今之所谓呃也。要知此证之厥。非无阳。
以胃不和。而气不至于四肢也。
橘皮汤方
橘皮（四两） 生姜（半斤）
上二味。以水七升。煮取三升。温服一升。下咽即愈。
（更有胃虚而热乘之。而作）哕逆者。（以）橘皮竹茹汤主之。
此为哕逆之挟虚者。出其方治也。
徐忠可云、此不兼呕言。是专胃虚而冲逆为哕矣。然非真元衰败之比。故以参甘培
胃中元气。而以橘皮竹茹。一寒一温。下其上逆之气。亦由上焦阳气不足以御之。乃呃
逆不止。故以姜枣宣其上焦。使胸中之阳。渐畅而下达。谓上焦固受气于中焦。而中焦
亦禀受于上焦。上焦既宣。则中气自调也。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两）
人参（三两）
上六味。以水一斗。煮取三升。温服一升。日三服。
（总而言之。病证不同。而挈要之道。在气则曰阴阳。在身则曰脏腑。）夫六腑（之
）气（阳也。阳气虚）绝（不温）于外者。手足（无阳以运之。则时觉畏）寒。（胸中
无阳以御下焦之阴。则呕吐哕之类。皆为阴逆）上气。（且）脚（下无阳气之运而生寒。
寒主收引而为）缩。五脏（之）气（阴也。阴气虚）绝（不守）于内者。（则下）利不
禁。下（利之）甚者。（阴脱不随阳气以营运。则）手足不仁。
呕吐，有时吐出食物残渣，有时吐出清水，有时吐出痰涎或冷沫，表现各不相同。对于这类因内有痈脓而导致的呕吐（与一般的呕吐不同），不可单纯止呕，应等待痈脓排尽后，呕吐自然停止。
如果病人先呕吐，之后感到口渴，说明体内的痰饮已去，胃阳即将恢复，这是病情将要好转的迹象。
如果病人先感到口渴，随后发生呕吐，这是因为体内有热而饮水过多，虽然热邪已去但水饮仍停留，这属于水饮停聚在心下（胃脘部）。这种情况属于饮家（特指因水饮致病的人）。这也是导致呕吐的原因之一（新水致呕）。
另外，经常呕吐的病人，由于水饮随呕吐排出，本应当感到口渴；但如果现在反而不渴，是因为心下有支饮（一种悬停的水饮病证）的缘故。这也属于支饮范畴。这也是导致呕吐的另一种原因（宿水致呕）。
这里通过呕吐后口渴判断为欲解，先渴后呕判断为停饮，呕吐而不渴判断为支饮。
问：病人的脉象数（快），数脉主热（热盛），按理应该能消化食物并喜欢喝水，但却反而呕吐，这是什么原因？老师说：数脉并不全代表热证，虚证也会出现数脉。因为之前过度发汗，导致阳气微弱、膈间气虚，脉象才表现为数。这种数脉不代表胃中有实热，而是客热（虚热）。之所以不能消化食物，都是由于胃中虚寒所致。
如果脉象弦（端直而长，如按琴弦），这是肝木乘脾土的征象。脾胃虚弱则受克。如今胃气匮乏，没有余气，早上吃的食物晚上吐出来，变成胃反病（朝食暮吐）。推究其致病原因，原本寒气在上焦，医生反而使用攻下法，严重损伤了脾气，导致脉象反见弦象，所以称为“虚”。
这段文字讲述误用汗法导致脉数，误用下法导致脉弦，应当在两种脉象中识别出虚寒是胃反病的根本原因。
上文说数脉是客热，这里进一步推论脉微而数的情况。寸口脉微而数，微脉表示卫气虚弱而无气，无气则营气也随着卫气一同虚弱。营气随之虚弱，血液就会日渐不足。血液不足，虽然会出现阴火导致的数脉，但上焦的宗气大虚，所以胸中必然寒冷。
这里承接上一节数脉为客热的说法，进一步推论脉微而数是因为无气，而不是因为有热。
尤在泾说：结合上面两条来看，客热固然不是真热，不能用寒凉药治疗；胸中冷也不是真冷，不能用温热药治疗。这些都应当以温养真气为主。真气，是指冲和纯粹之气。这股气上浮则生热，下沉则生冷。温养它，上浮的热自然会收敛；滋养它，虚冷的感觉自然会化解。如果用寒治热，用热治寒，那么真气会更加虚弱，寒热之邪内侵，病情反而会加重。
上文说胃气匮乏，变为胃反，这里从胃推论到脾。胃属阳，脾属阴。趺阳脉（足背动脉，候脾胃之气）浮而涩，浮脉表示胃阳虚，涩脉表示阴虚且伤及脾脏。脾脏受伤，则无法磨化胃中摄入的食物，将其转化为糟粕排出。早上吃的食物晚上吐出来，晚上吃的食物早上吐出来，宿食不化，向下不行反而向上吐出，这叫作胃反。如果脉象和缓，说明脾胃土气尚未败坏。倘若邪气很盛，脉象紧而涩，说明津液枯竭，这种病难治。
这里承接上一节胃气匮乏变为胃反，进一步推论病情同时也涉及脾脏。
病人想要呕吐的，病势向上，不可强行使用泻下法。
呃逆（哕），虽然症状表现在上部，但如果腹部胀满，说明病根在下部，是下部气机不利导致气逆溢于上部。应当观察前后二阴（大小便）哪一部不通利，用通利的方法治疗即可痊愈。
这两节讲病势欲上或欲下的情况，应当顺应病势进行引导。呃逆病本应归入橘皮竹茹汤一节，这里特意举出，与上一节构成一上一下的对子，并非错简。
胸为阳位，呕吐为阴邪。如果胸中阳气充足足以抵御邪气，就不会呕吐；即使呕吐，胸部也不会胀满。如果呕吐且胸部胀满，这是阳气不治，阴邪乘虚而入，应用吴茱萸汤主治。
吴茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
以上四味药，用水五升，煮取三升，温服七合，每日三次服用。
有声无物叫干呕，如果没有东西吐出而全是涎沫，再加上头痛，这是寒气从经脉上攻头部所致，应用吴茱萸汤主治（温补以驱散浊阴，并遏制逆冲之势）。
这里承接上一节补充吐出涎沫和头痛的症状，以明确此证使用此方的对症性。
李氏说：太阴经和少阴经从足上行至胸，都不上达头部，这两经都没有头痛证。厥阴经上行出额部，与督脉会于头顶，所以呕吐涎沫是里寒，头痛是寒气从经脉上攻。不用桂枝、附子而用吴茱萸，是因为吴茱萸入厥阴经的缘故。其余药物都是温补散寒的药。（阳气不下交而上逆，则呕吐；阴气不上交而独走，则肠鸣。）升降失常，无非是由于心下痞塞所致，应用半夏泻心汤主治。
这是针对呕吐证中伴有痞塞和肠鸣的情况，给出的方剂。虽然三焦都患病，但中气是上下交通的枢纽，只要治疗中焦，上部的呕吐和下部的肠鸣都会痊愈。
半夏泻心汤方
半夏（半升，洗净） 黄芩 干姜 人参 甘草（各三两，炙） 黄连（一两） 大枣（十二枚）
以上七味药，用水一斗，煮取六升，去渣，再煎取三升，温服一升，每日三次服用。
干呕是胃气上逆。如果下利清谷（拉出不消化的食物），那是肠中寒。现在干呕且下利物浊粘，说明肠中有热。可知这是热逆导致的呕吐，挟热导致的下利，应用黄芩加半夏生姜汤主治。
这段文字讲热邪入里导致下利，又上行导致呕吐。与《伤寒论》大同小异。
黄芩加半夏生姜汤方
黄芩 生姜（各三两） 甘草（二两） 芍药（一两） 半夏（半升） 大枣（十二枚）
以上六味药，用水一斗，煮取三升，去渣，温服一升，每日两次，夜间一次服用。
有声有物为呕，有物无声为吐。各种呕吐，有的因寒，有的因热。食入即吐，属热；朝食暮吐，属寒。而此处既非寒也非热，只是觉得痰凝滞在中焦，食物咽不下去，应用小半夏汤主治（祛除停饮，消散气结，降逆安胃，自有疗效）。
这是针对呕吐且食物咽不下去的情况，给出的通用治疗方剂。
小半夏汤方（见痰饮篇）
呕吐，且病位在膈上，水饮随呕吐而去，所以呕吐后想喝水，说明病已解除，应少量多次给予饮水（以滋润燥热）。如果未曾呕吐，却先想喝水，这是因为素有支饮，阻碍正津生成而作渴。此时若大量饮水，旧饮未去，新饮复生，治法宜健脾崇土以逐水，应用猪苓散主治。
这里遥承第二节的意思并重申，同时给出方治。
猪苓散方
猪苓 茯苓 白术（各等分）
以上三味药，捣碎过筛为散，用米汤送服方寸匕，每日三次服用。
呕吐且心烦、心中懊憹（烦闷不安），这是内热之呕。现在呕吐且脉弱，说明正气虚；小便反而通利，说明中寒盛；身体有微热，出现四肢厥冷，这是正虚邪盛，阻格了升降之机，导致表里阴阳之气不相顺接，所以为难治之证，应用四逆汤主治。
这是针对虚寒呕吐的情况，给出的方治。阴邪上逆则为呕吐，阳虚不能摄阴，则小便通利；真阴伤而真阳外越，则身体微热；虚阳不能布护周身，则见四肢厥冷、脉弱。这是表里阴阳气血俱虚的危重证候。此症虚实并见，治疗当求其根本。
四逆汤方
附子（一枚，生用） 干姜（一两半） 甘草（二两，炙）
以上三味药，用水三升，煮取一升二合，去渣，分两次温服。体质强壮者可加大附子至一枚，干姜至三两。
四逆汤是少阴病的专方，用于挽救阴枢的折损。然而少阴为阴枢，少阳为阳枢。病主呕吐，现在呕吐且不厥冷、发热（不轻微），这是少阳相火的病证，应用小柴胡汤主治。
这与上一节构成一阴一阳的对子。少阴病见厥冷且热微，宜回阳救逆；少阳病不厥冷而发热，宜清解游行之火。
小柴胡汤方
柴胡（半斤） 半夏（半升） 黄芩 人参 甘草 生姜（各三两） 大枣（十二枚）
以上七味药，用水一斗，煮取六升，去渣再煎，取三升，温服一升，每日三次服用。
胃主受纳食物，其脉气本应下行。现在反而挟带冲脉之气上逆，名叫胃反。患胃反呕吐的，应用大半夏汤主治。
这是针对胃反证给出的正方。《千金方》治胃反不受食，食入即吐；《外台秘要》治呕吐、心下痞硬者，可知此方泛应曲当之妙。世俗医生只说半夏治痰，那就失之远矣。
大半夏汤方
半夏（二升） 人参（三两） 白蜜（一升）
以上三味药，用水一斗二升，加入蜂蜜，扬拌二百四十遍，煮药取二升半，温服一升，剩余分次再服。
又有阳明有热，大便不通，进食后两热相冲，食后即吐的，应用大黄甘草汤主治。
这是针对食入即吐的情况给出的方治。东垣认为幽门不通，气上冲吸门，本源于此。《外台秘要》治吐水，可知大黄也能开通脾气之闭，使精微散布于肺，通调水道，下输膀胱。
大黄甘草汤方
大黄（二两） 甘草（一两）
以上两味药，用水三升，煮取一升，分两次温服。
胃反病是胃虚挟冲脉之气上逆，取大半夏汤降逆，更取其柔和以养胃。现在有挟带水饮而患胃反的，如果呕吐后口渴，说明水饮随呕吐而出；如果呕吐未止而口渴，想喝水，说明旧水未因呕吐而尽去，新水反而因口渴饮水而增加，愈吐愈渴，愈饮愈吐。不从脾脏寻求输转之法，呕吐与口渴如何能平息？应用茯苓泽泻汤主治。
这是针对因水饮导致的胃反给出的方治。此方治水饮，人们都知道，但治胃反，人们未必知道；治渴，更未必知道。然而参照本篇的猪苓散，《伤寒论》的五苓散、猪苓汤，可以恍然大悟。况且《外台秘要》用此汤治消渴脉绝、胃反者，加小麦一升，更得其奥秘。
李氏说：五苓散治外有微热，故用桂枝。此证无表热，也用桂枝，是因为桂枝不是一味单纯攻表的药，而是彻上彻下、可内可外、通行津液、调和阳气治疗水饮的药剂。
茯苓泽泻汤方
茯苓（半斤） 泽泻（四两） 甘草 桂枝（各二两） 白术（三两） 生姜（四两）
以上六味药，用水一斗，煮取三升，放入泽泻再煮，取二升半，温服八合，每日三次服用。
前文说先吐后渴为欲解，是因为水与热随吐而去。现在呕吐后口渴想喝水，且因水量不足以止燥，贪饮不休，这是水去而热存，应用文蛤汤主治（方中有麻黄、杏仁、生姜等，除热导水之外，兼治微风脉紧头痛）。
文蛤汤方
麻黄（三两） 杏仁（五十枚） 大枣（十二枚） 甘草 石膏 文蛤（各五两） 生姜（三两）
以上七味药，用水六升，煮取二升，温服一升，汗出即愈。
干呕伴呕吐逆气，吐出涎沫，这是胃中气逆，上焦有寒，口中多涎，应用半夏干姜散主治。
徐忠可说：此条比前文干呕吐涎沫头痛条，仅少了头痛，增加了吐逆二字。彼处用茱萸汤，此处用半夏干姜散，为什么？因为上焦有寒，口中多涎，这一点相同。但前有头痛，说明浊阴上逆，格拒邪气在头部引起疼痛，与浊阴上逆、格拒邪气在胸部引起胀满相同，所以都用参、姜、枣助阳，而以吴茱萸之苦温，降下浊阴。此处则是吐逆，明显是胃家寒重，导致吐逆不止，所以不用人参，专以干姜理中，半夏降逆。谓与前文浊阴上逆者相比，寒邪虽同，但有高下之别，此处未至于格邪在头在胸，所以虚证也不甚。
半夏干姜散方
半夏 干姜（各等分）
以上两味药，捣碎过筛为散，取方寸匕，用浆水一升半，煮取七合，一次性服下。
病人（寒邪搏结水饮，阻滞于）胸中，阻碍呼吸往来出入升降之机，证候似喘非喘，似呕非呕，似哕非哕。（寒饮与气，相互搏结冲击，逼处心脏，想咳不能，想受不可，以致）心中烦乱无可奈何（的状态，而不能明言），应用生姜半夏汤主治。
徐忠可说：喘、呕、哕，都是气机上出的现象。现在有其象，而非其实，说明邪气受于膈上，未攻肺，也不由胃，所以说胸中。又说“彻心中愦愦无奈”，彻，通也，谓胸中之邪既重，因而下及于心，使其不安，那种烦乱无可奈何的感觉。生姜宣散之力，入口即行，所以其治最高，能清膈上之邪，合半夏并能降其浊涎，故主治此证。与吴茱萸之降浊阴、干姜之理中寒不同。盖前者乃虚寒上逆，此惟客邪抟饮于至高之分耳。然而此方即小半夏汤，彼加生姜煎煮，此用姜汁且量多，药性生用则上行。正因为邪气位置高，所以用姜汁且略煎，因此变其汤名，以示生姜为君药。
生姜半夏汤方
半夏（半升） 生姜（汁一升）
以上两味药，用水三升，煮半夏取二升，加入生姜汁，煮取一升半，稍冷，分四次服用，每日三次，夜间一次。呕吐停止后停服。
那些初病时，形气俱实，气逆于胸膈间，导致干呕与呃逆，如果手足厥冷的，（是气逆胸膈，不复行于四肢也），应用橘皮汤主治。
这是针对不虚的呃逆给出的方治。古之哕证即今之所谓呃逆。要知道此证的厥冷，并非无阳，而是因为胃不和，气不至四肢。
橘皮汤方
橘皮（四两） 生姜（半斤）
以上两味药，用水七升，煮取三升，温服一升，下咽即愈。
这是针对挟虚的呃逆给出的方治。
徐忠可说：此条不兼言呕吐，是专指胃虚而冲逆为呃逆。然非真元衰败之比，故以参、甘培补胃中元气，而以橘皮、竹茹，一寒一温，下其上逆之气。也是因为上焦阳气不足以御之，乃呃逆不止，故以姜、枣宣通其上焦，使胸中之阳，渐畅而下达。谓上焦固受气于中焦，而中焦亦禀受于上焦，上焦既宣，则中气自调也。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（三两）
以上六味药，用水一斗，煮取三升，温服一升，每日三次服用。
总而言之，病证不同，而挈要之道，在气则曰阴阳，在身则曰脏腑。六腑之气属阳，阳气虚绝，不能温煦于外者，手足因无阳以运之，则时常觉得畏寒。（胸中无阳以御下焦之阴，则呕吐哕之类，皆为阴逆上气。）且脚下无阳气之运而生寒，寒主收引而为收缩。五脏之气属阴，阴气虚绝，不能守于内者，则下利不禁。下利甚者，阴脱不随阳气以营运，则手足麻木不仁。
Vomiting may present with different substances, such as undigested food, clear fluid, phlegm-saliva, or cold froth. For patients vomiting due to internal abscess and pus (an abscess causing pus accumulation), which differs from other types of vomiting, one must not simply treat the vomiting. Wait until the pus is completely discharged, and the vomiting will cease spontaneously.
This section sets aside vomiting caused by abscesses to introduce the discussion on various other types of vomiting below.
If a patient vomits first and then feels thirsty, it indicates that the retained phlegm-fluid has been expelled and the Stomach Yang is recovering; this signifies that the condition is about to resolve.
If a patient feels thirsty first and then vomits, it is because excessive drinking occurred due to heat. Although the heat may have subsided, the fluid remains retained. This is "fluid retention in the heart region" (fluid stagnation in the epigastrium). Such cases belong to those suffering from fluid diseases (individuals prone to pathological fluid retention). This is one cause of vomiting induced by new water intake.
Furthermore, chronic vomiters usually lose fluids through vomiting and should therefore feel thirsty. If they do not feel thirsty, it is because there is "branching fluid" (a type of stagnant fluid pathology) in the heart region. This also belongs to branching fluid pathology. This is another cause of vomiting induced by old fluid retention.
Thus, thirst after vomiting suggests resolution; thirst preceding vomiting suggests fluid retention; and vomiting without thirst suggests branching fluid.
Question: A patient has a rapid pulse (Shu Mai). Rapid pulses indicate heat. Heat should promote digestion and increase desire for fluids. Why does the patient instead vomit? The Master said: Not all rapid pulses indicate heat; deficiency patterns can also present with rapid pulses. This occurs because excessive sweating previously depleted Yang Qi, leaving the Diaphragm Qi deficient, resulting in a rapid pulse. This rapidity does not represent Stomach heat but rather "guest heat" (deficiency heat). The inability to digest food is due to Cold-Deficiency in the Stomach.
If the pulse is Wiry (Xian Mai, taut like a guitar string), it reflects Liver Wood overacting on Spleen Earth. Deficiency leads to being overcome. With insufficient Stomach Qi, morning food is vomited in the evening, transforming into "Stomach Reversal" (Gefan, characterized by vomiting undigested food after a long interval). Tracing the etiology, the original pathogen was Cold in the Upper Jiao, but the physician incorrectly used purgatives, severely damaging Spleen Qi and causing the pulse to become wiry. Hence, it is named "Deficiency."
This passage explains that erroneous sweating leads to a rapid pulse, and erroneous purging leads to a wiry pulse. One must recognize within these two pulse presentations that Cold-Deficiency is the root of Stomach Reversal.
The previous section discussed rapid pulse as guest heat; here we further deduce the meaning of a pulse that is both Fine (Wei Mai) and Rapid. A Fine and Rapid pulse at the Cun Kou position indicates that Fineness represents Wei Qi deficiency and lack of Qi. Lack of Wei Qi leads to Ying Qi deficiency as well. As Ying Qi becomes deficient, Blood becomes increasingly insufficient. Insufficient Blood, despite showing a rapid pulse due to Yin Fire, results in Cold in the Chest due to severe deficiency of Zong Qi (Gathering Qi) in the Upper Jiao.
This continues the discussion on guest heat, further explaining that a Fine and Rapid pulse signifies lack of Qi rather than the presence of Heat.
You Zaijing stated: Combining the above two points, guest heat is certainly not true heat and should not be treated with Cold herbs. Chest Cold is certainly not true Cold and should not be treated with Hot herbs. All these conditions require warming and nourishing the True Qi. True Qi is the harmonious and pure Qi. When this Qi floats upward, it generates heat; when it sinks downward, it generates cold. Warming it causes floating heat to subside; nourishing it transforms deficiency cold. If one treats heat with cold and cold with heat, True Qi will become more deficient, and internal invasion by cold and heat will worsen the disease.
The previous section mentioned Stomach Qi deficiency leading to Stomach Reversal; here we extend the discussion to the Spleen. The Stomach is Yang, and the Spleen is Yin. At the Zu Yang (foot dorsalis pedis artery, reflecting Stomach/Spleen status), if the pulse is Floating and Choppy (Se Mai), Floating indicates Stomach Yang deficiency, and Choppy indicates Yin deficiency injuring the Spleen. Spleen injury impairs its ability to grind and transform food ingested by the Stomach into waste. Morning food is vomited in the evening, and evening food in the morning, with undigested food regurgitating upwards instead of descending downwards. This is called Stomach Reversal. If the pulse is Harmonious and Slow, the Earth Qi (Spleen/Stomach function) has not yet collapsed. However, if the pathogen is severe, making the pulse Tight and Choppy, indicating exhaustion of body fluids, the disease is difficult to treat.
This follows up on Stomach Qi deficiency leading to Stomach Reversal, extending the pathology to involve the Spleen.
When a patient desires to vomit, the pathogenic trend is upward; one must not forcibly use purgative methods.
Hiccups (Yue), although manifesting in the upper part, if accompanied by abdominal fullness, indicate that the root pathology is in the lower part, with Qi overflowing upwards due to obstruction below. One should examine the anterior and posterior orifices (urinary and anal openings) to determine which is obstructed, and treat by promoting unobstructed flow, which will lead to recovery.
These two sections discuss顺应ing the pathogenic trend whether it is moving upward or downward. Hiccups should ideally be categorized under the Orange Peel and Bamboo Shave Decoction section; citing it here creates a contrast between upper and lower pathologies, not a textual error.
The Chest is a Yang region, while vomiting is a Yin pathogen. If Chest Yang is sufficient to resist pathogens, vomiting will not occur; even if it does, the Chest will not feel full. If vomiting is accompanied by Chest fullness, it indicates Yang failing to govern and Yin encroaching. Treat with Wu Zhu Yu Tang.
This describes turbid Yin occupying a Yang position, causing vomiting and Chest fullness.
Wu Zhu Yu Tang Formula
Evodia Fruit (Evodiae Fructus, 1 sheng)
Ginseng Root (Ginseng Radix, 3 liang)
Fresh Ginger (Zingiberis Rhizoma Recens, 6 liang)
Jujube (Ziziphi Jujubae Fructus, 12 pieces)
Boil the four ingredients in 5 sheng of water to obtain 3 sheng. Take 7 ge warm, three times daily.
Dry heaving (Gan Ou) refers to sound without substance. If only saliva is expectorated without substance, and headache is present, it indicates Cold Qi attacking the head via the meridians. Treat with Wu Zhu Yu Tang (to warm and tonify, dispelling turbid Yin and restraining rebellious Qi).
This supplements the previous section by adding symptoms of salivary expectoration and headache to clarify the indication for this formula.
Li Shi noted: The Taiyin and Shaoyin meridians ascend from the foot to the chest but do not reach the head; thus, neither meridian typically presents with headache. The Jueyin meridian ascends to the vertex and meets the Du Meridian. Therefore, vomiting saliva indicates interior Cold, and headache indicates Cold attacking from the meridians. Evodia is used instead of Cinnamon Twig or Aconite because it enters the Jueyin meridian. The remaining herbs are for warming, tonifying, and dispersing Cold. When Yang fails to descend and rebels upward, vomiting occurs; when Yin fails to ascend and moves independently, borborygmus occurs. Dysregulation of ascending and descending is caused by Pi (glomus/fullness) in the heart region. Treat with Ban Xia Xie Xin Tang.
This provides the formula for vomiting accompanied by glomus and borborygmus. Although the Triple Burner is involved, the Middle Qi is the pivot. Treating the Middle resolves both upper vomiting and lower borborygmus.
Ban Xia Xie Xin Tang Formula
Pinellia Tuber (Pinelliae Rhizoma, half sheng, washed)
Scutellaria Root (Scutellariae Radix)
Dried Ginger (Zingiberis Rhizoma)
Ginseng Root (Ginseng Radix)
Licorice Root (Glycyrrhizae Radix, 3 liang each, honey-fried)
Coptis Rhizome (Coptidis Rhizoma, 1 liang)
Jujube (Ziziphi Jujubae Fructus, 12 pieces)
Boil the seven ingredients in 1 dou of water to obtain 6 sheng. Remove dregs, boil again to obtain 3 sheng. Take 1 sheng warm, three times daily.
Dry heaving indicates Stomach Qi rebellion. If diarrhea involves undigested food, it indicates Intestinal Cold. Now, dry heaving accompanied by turbid, sticky diarrhea indicates Intestinal Heat. Thus, the vomiting is due to Heat rebellion, and the diarrhea is Heat-complicated. Treat with Huang Qin Jia Ban Xia Sheng Jiang Tang.
This discusses Heat entering the interior causing diarrhea and rising to cause vomiting. It is largely similar to the Shanghan Lun.
Huang Qin Jia Ban Xia Sheng Jiang Tang Formula
Scutellaria Root (Scutellariae Radix)
Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang each)
Licorice Root (Glycyrrhizae Radix, 2 liang)
Peony Root (Paeoniae Radix, 1 liang)
Pinellia Tuber (Pinelliae Rhizoma, half sheng)
Jujube (Ziziphi Jujubae Fructus, 12 pieces)
Boil the six ingredients in 1 dou of water to obtain 3 sheng. Remove dregs. Take 1 sheng warm, twice during the day and once at night.
Sound with substance is vomiting; substance without sound is spitting/regurgitation. Various vomitings have Cold or Heat causes. Vomiting immediately after eating indicates Heat; vomiting in the evening what was eaten in the morning indicates Cold. Here, neither Cold nor Heat is primary; rather, Phlegm stagnates in the Middle, preventing food from passing down. Treat with Xiao Ban Xia Tang (to remove retained fluid, dissipate Qi knotting, and calm the Stomach).
This provides a general formula for vomiting where food cannot pass down.
Xiao Ban Xia Tang Formula (See Fluid Retention Chapter)
In vomiting where the pathology is above the Diaphragm, fluid is expelled with the vomit. Thirst after vomiting indicates resolution. Provide small amounts of water frequently to moisten dryness. If thirst precedes vomiting without prior emesis, it suggests pre-existing branching fluid obstructing normal Jin-Ye production. Drinking excessively here would retain old fluid and generate new fluid. The treatment should strengthen the Spleen to drain water. Treat with Zhu Ling San.
This reiterates the second section's intent and provides the formula.
Zhu Ling San Formula
Polyporus (Polypori Umbilicati Sclerotium)
Poria (Poria cocos)
Atractylodes Macrocephala Rhizome (Atractylodis Macrocephalae Rhizoma) (Equal parts)
Pulverize the three ingredients. Take one cun-bi measure with rice broth, three times daily.
Vomiting with irritability and mental restlessness (Ao Nao) indicates Internal Heat vomiting. Now, vomiting with a Weak pulse indicates Righteous Qi deficiency. Frequent urination indicates severe Interior Cold. Slight fever and cold extremities indicate that Deficient Righteous Qi and Excess Pathogen block the mechanism of ascent and descent, preventing communication between Exterior/Interior and Yin/Yang. This is difficult to treat. Treat with Si Ni Tang.
This provides the formula for Deficiency-Cold vomiting. Yin pathogen rebelling causes vomiting; Yang deficiency failing to control Yin causes frequent urination; True Yin damage and True Yang floating cause slight fever; failure of deficient Yang to protect the body causes cold extremities and weak pulse. This is a critical state of total deficiency of Exterior/Interior Yin/Yang and Qi/Blood. Since deficiency and excess coexist, treatment must address the root.
Si Ni Tang Formula
Aconite Lateral Root (Aconiti Lateralis Radix Praeparata, one piece, raw)
Dried Ginger (Zingiberis Rhizoma, 1.5 liang)
Licorice Root (Glycyrrhizae Radix, 2 liang, honey-fried)
Boil the three ingredients in 3 sheng of water to obtain 1.2 sheng. Remove dregs. Divide into two warm doses. Strong individuals may use one large Aconite piece and 3 liang of Dried Ginger.
Si Ni Tang is the specific formula for Shaoyin disease, rescuing the collapse of the Yin pivot. However, Shaoyin is the Yin pivot, and Shaoyang is the Yang pivot. Vomiting with no cold extremities and fever (not mild) indicates a Shaoyang Minister Fire pathology. Treat with Xiao Chai Hu Tang.
This forms a Yin-Yang pair with the previous section. Shaoyin with cold extremities and mild heat requires restoring departing Yang; Shaoyang without cold extremities but with fever requires clearing wandering Fire.
Xiao Chai Hu Tang Formula
Bupleurum Root (Bupleuri Radix, 8 jin)
Pinellia Tuber (Pinelliae Rhizoma, half sheng)
Scutellaria Root (Scutellariae Radix)
Ginseng Root (Ginseng Radix)
Licorice Root (Glycyrrhizae Radix)
Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang each)
Jujube (Ziziphi Jujubae Fructus, 12 pieces)
Boil the seven ingredients in 1 dou of water to obtain 6 sheng. Remove dregs and decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.
The Stomach receives food, and its Qi normally descends. Now, Qi rebels upward carrying Chong Mai energy, named Stomach Reversal. For Stomach Reversal with vomiting, treat with Da Ban Xia Tang.
This provides the correct formula for Stomach Reversal. Qianjin Fang treats Stomach Reversal where food is rejected and vomited immediately; Waitai Mi Yao treats vomiting with epigastric hardness. This shows the versatility of this formula.俗医 (vulgar physicians) claiming Pinellia only treats Phlegm are far off the mark.
Da Ban Xia Tang Formula
Pinellia Tuber (Pinelliae Rhizoma, 2 sheng)
Ginseng Root (Ginseng Radix, 3 liang)
White Honey (Mel, 1 sheng)
Mix the three ingredients with 1.2 dou of water and honey, stirring vigorously 240 times. Decoct to obtain 2.5 sheng. Take 1 sheng warm, divide remaining doses.
In cases of Yangming Heat with constipation, eating causes conflicting heats, leading to immediate vomiting after eating. Treat with Da Huang Gan Cao Tang.
This provides the formula for immediate post-prandial vomiting. Dong Yuan attributed pyloric obstruction causing reflux to this principle. Waitai Mi Yao notes Dahuang can open Spleen closure, allowing essence to disperse to the Lung, regulate water passages, and transmit to the Bladder.
Da Huang Gan Cao Tang Formula
Rhubarb Root (Rhei Radix et Rhizoma, 2 liang)
Licorice Root (Glycyrrhizae Radix, 1 liang)
Boil the two ingredients in 3 sheng of water to obtain 1 sheng. Divide into two warm doses.
Stomach Reversal is Stomach deficiency with Chong Qi rebellion, treated with Da Ban Xia Tang to descend rebellion and nourish the Stomach gently. If Stomach Reversal is complicated by fluid retention, thirst after vomiting indicates fluid expulsion. If vomiting persists with thirst and desire to drink, old fluid remains, and new fluid increases due to drinking. This cycle of vomiting-thirst-drinking-vomiting requires Spleen transport regulation. Treat with Fu Ling Ze Xie Tang.
This provides the formula for Stomach Reversal due to fluid retention. While known for treating fluid retention, its use for Stomach Reversal and thirst is less known. Comparing with Zhu Ling San, Wu Ling San, and Zhu Ling Tang clarifies its mechanism. Waitai Mi Yao uses this with Wheat for diabetes and Stomach Reversal, revealing its secret.
Li Shi stated: Wu Ling San uses Cinnamon Twig for exterior mild heat. Here, despite no exterior heat, Cinnamon Twig is used because it is not merely an exterior-releasing herb but promotes fluid circulation and harmonizes Yang to treat water.
Fu Ling Ze Xie Tang Formula
Poria (Poria cocos, 8 liang)
Alisma Rhizome (Alismatis Rhizoma, 4 liang)
Licorice Root (Glycyrrhizae Radix)
Cinnamon Twig (Cinnamomi Ramulus, 2 liang each)
Atractylodes Macrocephala Rhizome (Atractylodis Macrocephalae Rhizoma, 3 liang)
Fresh Ginger (Zingiberis Rhizoma Recens, 4 liang)
Boil the six ingredients in 1 dou of water to obtain 3 sheng. Add Alisma and boil again to obtain 2.5 sheng. Take 8 ge warm, three times daily.
Previously, thirst after vomiting indicated resolution as water and heat were expelled. Now, thirst after vomiting with insatiable drinking indicates water is gone but heat remains. Treat with Wen Sha Tang (containing Ephedra, Apricot Kernel, Fresh Ginger, etc., to clear heat and guide water; also treats mild wind with tight pulse and headache).
This provides the formula for heat and thirst after vomiting.
Wen Sha Tang Formula
Ephedra Stem (Ephedrae Herba, 3 liang)
Apricot Seed (Armeniacae Semen Amarum, 50 pieces)
Jujube (Ziziphi Jujubae Fructus, 12 pieces)
Licorice Root (Glycyrrhizae Radix)
Gypsum (Gypsum Fibrosum)
Clam Shell (Meretrix Concha, 5 liang each)
Fresh Ginger (Zingiberis Rhizoma Recens, 3 liang)
Boil the seven ingredients in 6 sheng of water to obtain 2 sheng. Take 1 sheng warm. Recovery occurs with sweating.
Dry heaving with retching and expectoration of saliva indicates Stomach Qi rebellion and Upper Jiao Cold causing excessive salivation. Treat with Ban Xia Gan Jiang San.
This provides the formula for Stomach Cold dry heaving.
Xu Zhongke stated: Compared to the previous section on dry heaving, salivary expectoration, and headache, this lacks headache but adds retching. The former used Wu Zhu Yu Tang; this uses Ban Xia Gan Jiang San. Both involve Upper Jiao Cold and salivation. However, headache in the former indicates turbid Yin rebelling to the head; chest fullness indicates rebelling to the chest. Both used Ginseng, Ginger, and Jujube to support Yang, with Evodia to descend turbid Yin. Here, retching indicates severe Stomach Cold. Thus, Ginseng is omitted; Dried Ginger regulates the Middle, and Pinellia descends rebellion. Although the Cold pathogen is similar, the location differs (head/chest vs. stomach), and deficiency is less severe.
Ban Xia Gan Jiang San Formula
Pinellia Tuber (Pinelliae Rhizoma)
Dried Ginger (Zingiberis Rhizoma) (Equal parts)
Pulverize the two ingredients. Take one cun-bi measure. Boil in 1.5 sheng of fermented grain liquid to obtain 7 ge. Take all at once.
Patients with Cold-Difficulty binding fluid in the Chest obstructing respiration and Qi movement present with pseudo-dyspnea, pseudo-vomiting, and pseudo-hiccups. Cold-fluid and Qi struggle against the Heart, causing indescribable distress ("Kui Kui"). Treat with Sheng Jiang Ban Xia Tang.
This provides the formula for Cold-Difficulty binding fluid mimicking dyspnea/vomiting/hiccups.
Xu Zhongke stated: Dyspnea, vomiting, and hiccups are upward movements. Here, the sign exists without the reality, indicating pathogen in the Upper Diaphragm, not affecting the Lung or Stom directly. "Kui Kui" implies distress spreading from Chest to Heart. Fresh Ginger disperses quickly, treating high pathogen; combined with Pinellia, it descends turbid saliva. Unlike Evodia (descending turbid Yin) or Dried Ginger (warming Middle), this addresses external pathogen binding fluid at the highest level. It is essentially Xiao Ban Xia Tang but uses Ginger Juice in larger quantity and less decoction time because raw properties ascend. The name change highlights Ginger as the Sovereign herb.
Sheng Jiang Ban Xia Tang Formula
Pinellia Tuber (Pinelliae Rhizoma, half sheng)
Fresh Ginger Juice (Zingiberis Rhizoma Recens Sucus, 1 sheng)
Boil Pinellia in 3 sheng of water to obtain 2 sheng. Add Ginger Juice and boil to obtain 1.5 sheng. Cool slightly. Divide into four doses: three times daily, once at night. Stop after vomiting ceases.
In early disease with excess form and Qi, Qi rebellion in Chest/Diaphragm causes dry heaving and hiccups. If accompanied by cold extremities (Qi failing to reach limbs), treat with Ju Pi Tang.
This provides the formula for non-deficiency hiccups. Ancient "Yue" corresponds to modern hiccup. This cold extremity is not Yang absence but Stomach disharmony preventing Qi distribution.
Ju Pi Tang Formula
Tangerine Peel (Citri Reticulatae Pericarpium, 4 liang)
Fresh Ginger (Zingiberis Rhizoma Recens, 8 liang)
Boil the two ingredients in 7 sheng of water to obtain 3 sheng. Take 1 sheng warm. Relief occurs upon swallowing.
For hiccups caused by Stomach deficiency with Heat encroachment, treat with Ju Pi Zhu Ru Tang.
This provides the formula for deficiency-complex hiccups.
Xu Zhongke stated: This focuses solely on Stomach deficiency causing rebellious hiccups, not true Yuan Qi collapse. Ginseng and Licorice tonify Middle Qi; Tangerine Peel and Bamboo Shave (one cold, one warm) descend rebellious Qi. Upper Jiao Yang insufficiency fails to control, causing persistent hiccups. Ginger and Jujube diffuse Upper Jiao, allowing Chest Yang to descend smoothly. Upper Jiao receives Qi from Middle, and Middle from Upper; diffusing Upper regulates Middle.
Ju Pi Zhu Ru Tang Formula
Tangerine Peel (Citri Reticulatae Pericarpium, 2 jin)
Bamboo Shave (Bambusae Lamina in Culmo) (2 sheng)
Jujube (Ziziphi Jujubae Fructus, 30 pieces)
Fresh Ginger (Zingiberis Rhizoma Recens, 8 liang)
Licorice Root (Glycyrrhizae Radix, 5 liang)
Ginseng Root (Ginseng Radix, 3 liang)
Boil the six ingredients in 1 dou of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
In summary, while syndromes differ, the key lies in Qi (Yin/Yang) and Body (Zang-Fu). Six Fu Organs' Qi is Yang. If Yang Qi is deficient and fails to warm the exterior, hands and feet feel cold due to lack of Yang movement. Without Yang in the Chest to guard against Lower Jiao Yin, vomiting, hiccups, etc., result from Yin rebelling upward. Cold in the feet causes contraction due to Cold's contracting nature. Five Zang Organs' Qi is Yin. If Yin Qi is deficient and fails to secure the interior, uncontrollable diarrhea occurs. Severe diarrhea leads to Yin depletion failing to circulate with Yang, causing numbness in hands and feet.