半夏（洗、浣用）二升 人参三两 白蜜一升
右三味，以水一斗二升，和蜜扬之二百四十遍，煮药取一升半，温服一升，余分再服
。
『千金方』云：大半夏汤治胃反不受食，食入即吐。『外台方』云：大半夏汤治呕心
下痞□者。
【集解】
高世栻曰：朝食暮吐，宿谷不化，名曰胃反；胃反但吐不呕，然吐不离乎呕，故曰：
胃反呕吐者，用半夏助燥气以消谷，人参补元气以安胃，白蜜入水扬之，使甘味散于
水中，水得蜜而和缓，蜜得水而淡渗，庶胃反平而呕吐愈。李升玺曰：呕家不宜甘味
，此用白蜜何也？不知此胃反自属脾虚，经所谓甘味入脾，归其所喜是也。况君以半
夏，味辛而止呕，佐以人参温气而补中，胃反自立止矣。
@@@
胃反，吐而渴欲饮水者，茯苓泽泻汤主之。
【注】
胃反吐而不渴者，寒也。渴欲饮水者，饮也。故以茯苓泽泻汤，补阳利水也。
茯苓半筋 泽泻四两 甘草二两 桂枝二两 白术三两 生姜四两
右六味，以水一斗，煮取三升，内泽泻，再煮取二升半，温服八合，日三服。
『外台方』云：茯苓泽泻汤，治消渴胃反脉绝。
【集解】
李□曰：吐而渴者，津液亡而胃虚燥也。饮水则水停心下，茯苓、泽泻，降气行饮，
白术补生津，此五苓散原方之义也。然胃反因脾气虚逆，故加生姜散逆，甘草和脾。
又五芩散治外有微热，故用桂枝。此胃反无表热，而亦用之者，桂枝非一于攻表药也
，乃彻上彻下，达表里，为通行津液，和阳散水之剂也。
尤怡曰：茯苓泽泻汤，治吐未已，而渴欲饮水者，以吐未已，知邪未去，则宜桂枝、
甘姜散邪气，茯苓、泽泻消水气也。
@@@
哕逆者，橘皮竹茹汤主之。
【注】
哕即干呕也，因其有哕哕之声，而无他物，故不曰干呕，而曰哕逆，属气上逆为病也
。上逆之气，得出上窍，皆能作声，故肺虚气上逆，则作欬，气从喉出而有欬逆之声
，若为邪所阻，则为喘满，故无声也。胃虚气上逆，则作哕，气从咽出而有哕逆之声
，若与物凝结，则为痞痛，故无声也，是知气病也明矣。然邪气所凑，正气必虚，故
用橘皮、竹茹、生姜以清邪气，人参、甘草、大枣，以补正气，则上逆之气自可顺矣
。
半夏（经水洗、漂净后使用）二升，人参三两，白蜜一升。
以上三味药，用水一斗二升，加入蜂蜜并搅拌扬动二百四十次，煎煮药物取汁一升半，温服一升，剩余的药液分两次服用。
《千金方》记载：大半夏汤治疗胃反证，表现为不能受纳食物，吃进去就吐出来。《外台秘要方》记载：大半夏汤治疗呕吐且心下痞塞的患者。
【集解】
高世栻说：早晨吃的东西晚上吐出来，宿食不消化，称为胃反；胃反证只是呕吐而不伴有恶心干呕，然而呕吐往往离不开恶心的机制，所以说：治疗胃反呕吐，用半夏来助燥气以消化谷食，用人参来补元气以安和胃腑，白蜜加入水中搅拌扬动，使甘甜味分散在水中，水得到蜂蜜而变得和缓，蜂蜜得到水而变得淡渗，这样胃反证得以平复，呕吐也就痊愈了。李升玺说：经常呕吐的人不宜使用甘味药，这里为什么使用白蜜呢？不知道这种胃反证属于脾虚，正如经典所说“甘味入脾”，这是顺应脾脏所喜的味道。况且以半夏为君药，味道辛能止呕，佐以人参温补中气，胃反证自然就能停止。
【注】
胃反证呕吐但不口渴的，是寒证。口渴想喝水的，是水饮内停。所以用茯苓泽泻汤，来补阳气、利水湿。
茯苓半筋，泽泻四两，甘草二两，桂枝二两，白术三两，生姜四两。
以上六味药，用水一斗，煎煮取汁三升，再加入泽泻，继续煎煮取汁二升半，温服八合，每天服用三次。
《外台秘要方》记载：茯苓泽泻汤，治疗消渴、胃反证且脉象绝微的患者。
【集解】
李□说：呕吐并且口渴，是因为津液耗亡而胃虚干燥。喝水后水液就会停滞在心下，茯苓、泽泻能降气行水，白术能补气生津，这符合五苓散原方的义理。然而胃反证是由于脾气虚弱逆乱所致，所以加入生姜来散逆气，甘草来调和脾胃。另外五苓散治疗外有轻微发热，所以用桂枝。此处的胃反证没有表热，却也使用桂枝，是因为桂枝不仅仅是一味攻表的药物，它是彻上彻下、通达表里，能够通行津液、调和阳气、消散水气的方剂。
尤怡说：茯苓泽泻汤，治疗呕吐尚未停止，而口渴想喝水的情况，因为呕吐未停，知道邪气未去，所以适宜用桂枝、干姜来散邪气，茯苓、泽泻来消除水气。
@@@
出现呃逆症状的，用橘皮竹茹汤主治。
【注】
哕就是干呕，因为它有哕哕的声音，而没有吐出其他实物，所以不叫干呕，而叫哕逆，属于气机上逆导致的疾病。上逆之气从上部窍道排出，都能发出声音，所以肺虚气机上逆，就会产生咳嗽，气从喉咙出来而有咳嗽逆上的声音，如果被邪气阻滞，就会变成喘满，所以没有声音。胃虚气机上逆，就会产生哕逆，气从咽部出来而有哕逆的声音，如果与有形之物凝结，就会变成痞塞疼痛，所以没有声音。由此可知这是气分的病变。然而邪气聚集之处，正气必然虚弱，所以用橘皮、竹茹、生姜来清除邪气，用人参、甘草、大枣来补益正气，那么上逆的气机自然就可以顺降了。
Banxia (washed and rinsed) 2 sheng, Renshen 3 liang, Baimi (white honey) 1 sheng.
The above three ingredients are decocted with 12 dou of water mixed with honey, stirred and splashed two hundred and forty times. The decoction is reduced to obtain 1.5 sheng. Take 1 sheng warm; the remainder is divided into two doses for subsequent administration.
*Qianjin Fang* states: Banxia Decoction (Dabanchang Tang) treats Wei Fan (gastric reflux), characterized by the inability to retain food and immediate vomiting after ingestion. *Waitai Mi Yao Fang* states: Banxia Decoction (Dabanchang Tang) treats patients with vomiting and epigastric fullness/stuffiness.
[Collected Commentaries]
Gao Shishi stated: When morning intake is vomited in the evening, and undigested food remains, it is named Wei Fan (gastric reflux); Wei Fan involves vomiting without retching, yet vomiting is inherently linked to the mechanism of retching. Therefore, for treating Wei Fan and vomiting, Banxia is used to assist drying qi to digest grains, Renshen is used to tonify primordial qi to stabilize the stomach, and Baimi (white honey) is added to water and stirred vigorously so that its sweet flavor disperses in the water. Water becomes mild when combined with honey, and honey becomes light and penetrating when combined with water. Thus, Wei Fan is pacified, and vomiting ceases. Li Shengxi stated: Patients prone to vomiting should generally avoid sweet flavors. Why use Baimi here? It is unknown that this type of Wei Fan belongs to Spleen deficiency. As the classics state, "sweet flavor enters the Spleen," which accords with what the Spleen prefers. Moreover, with Banxia as the sovereign herb, its pungent flavor stops vomiting, assisted by Renshen to warm qi and tonify the middle, causing Wei Fan to cease spontaneously.
@@@
When Wei Fan (gastric reflux) presents with vomiting and thirst desire to drink water, Fuling Zexie Tang (Poria and Alisma Decoction) is the primary treatment.
[Annotation]
Wei Fan with vomiting but no thirst indicates cold. Thirst desire to drink water indicates fluid retention. Therefore, Fuling Zexie Tang is used to tonify yang and promote diuresis.
Fuling 0.5 jin, Zexie 4 liang, Gancao 2 liang, Guizhi 2 liang, Baizhu 3 liang, Shengjiang 4 liang.
The above six ingredients are decocted with 10 dou of water until 3 sheng remain. Then add Zexie and continue decocting until 2.5 sheng remain. Take 8 ge warm, three times a day.
*Waitai Mi Yao Fang* states: Fuling Zexie Tang treats Xiao Ke (wasting-thirst) and Wei Fan with absent pulse.
[Collected Commentaries]
Li [Name obscured] stated: Vomiting accompanied by thirst indicates loss of body fluids and dryness due to Stomach deficiency. Drinking water leads to fluid stagnation in the heart region. Fuling and Zexie descend qi and move fluids, while Baizhu tonifies qi and generates fluids; this aligns with the principle of the original Wuling San (Five-Ingredient Powder with Poria). However, since Wei Fan arises from deficient and rebellious Spleen qi, Shengjiang is added to scatter rebellion, and Gancao harmonizes the Spleen. Furthermore, Wuling San is used when there is slight external heat, hence the use of Guizhi. Although this case of Wei Fan lacks exterior heat, Guizhi is still used because Guizhi is not merely an exterior-releasing agent; it penetrates from top to bottom, connects interior and exterior, promotes the circulation of body fluids, harmonizes yang, and dissipates water.
You Yi stated: Fuling Zexie Tang treats cases where vomiting has not yet ceased, accompanied by thirst and desire to drink. Since vomiting persists, it indicates pathogenic factors have not been expelled; thus, Guizhi and Ganjiang (dried ginger) are suitable to scatter pathogenic qi, while Fuling and Zexie eliminate fluid accumulation.
@@@
For Suo Ni (hiccups/belching with upward reversal), Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary treatment.
[Annotation]
Suo refers to dry heaving. Because it produces a "suo suo" sound without expelling other substances, it is termed Suo Ni rather than Gan Ou (dry heaving). It belongs to diseases caused by upward reversal of qi. Qi reversing upward and exiting through upper orifices can produce sound. For instance, Lung deficiency with upward reversing qi causes coughing; qi exiting the throat produces coughing sounds. If obstructed by pathogens, it becomes panting and fullness, resulting in no sound. Stomach deficiency with upward reversing qi causes Suo; qi exiting the pharynx produces Suo sounds. If condensed with tangible matter, it becomes distension and pain, resulting in no sound. Thus, it is clear this is a disease of qi. Wherever pathogenic factors gather, righteous qi must be deficient. Therefore, Jupi, Zhuru, and Shengjiang are used to clear pathogenic qi, while Renshen, Gancao, and Dazao are used to tonify righteous qi, allowing the upward-reversing qi to naturally descend smoothly.