半夏一升 生姜半筋 茯苓三两
右三味,以水七升,煮取一升五合,分温再服。
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呕家本渴,渴者为欲解,今反不渴,心下有支饮故也,小半夏汤主之。
【注】
饮家渴者,是水停气不化生津液而渴也;呕家渴者,是呕吐胃干燥伤津液而渴也,故
曰呕家本应渴也。先呕后渴者,当少少与饮之,以和胃生津,为欲解也;若呕吐后反
不渴者,是必心下素有支饮故也。惟主小半夏汤止呕,而不加茯苓者,以不渴并无新
饮,且呕后已伤津液,不可再行利水,重竭津液也。
【集注】
李□曰:此专以治呕,言呕家渴者,为欲解,以胃气复而津液生也。若心下素有支饮
,则不燥自当不渴,泛溢而呕也。半夏、生姜温能和胃气,辛能散逆气,为呕家圣药
。
半夏一升 生姜半筋
右二味,以水七升,煮取一升半,分温再服。
【集解】
沈明宗曰:此支饮上溢而呕之方也。凡作呕必伤津液,应当作渴,故为呕家本渴,渴
则病从呕去,谓之欲解。若心下有支饮,停蓄胸膈致燥,故呕而不渴,则当治饮,所
以生姜散邪,半夏涤饮,呕自止矣。
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卒呕吐,心下痞,膈间有水,眩悸者,半夏加茯苓汤主之。
【注】
卒然呕吐,虽然不渴而心下痞塞,是膈间有水凝结也。眩者,是水阻阳气不升也;悸
者,是水气上干于心也。即不渴无新饮,而平日饮盛可知,则不必顾及津液,亦必加
茯苓以利水,斯结可开而阻可通也。
【集注】
赵良曰:心下痞,膈间有水,眩悸者,阳气必不宣散也。经云:以辛散之。半夏、生
姜皆味辛,『本草』半夏可治膈上痰。心下坚呕逆眩者,亦上焦阳气虚不能升发,所
以半夏生姜并治之。悸则心受水凌,非半夏可独治,必加茯苓去水,下肾逆以安神,
神安则悸愈也。
尤怡曰:饮气逆于胃则呕吐,滞于气则心下痞,凌于心则悸,蔽于阳则眩,半夏、生
姜止呕降逆,加茯苓去其水也。
半夏一升,生姜半斤,茯苓三两。
以上三味药,用水七升,煎煮至剩余一升五合,分两次温服。
@@@
经常呕吐的人本来应该口渴,如果感到口渴,说明病情即将好转;现在反而不渴,是因为心下有支饮(水饮停聚于胸膈)的缘故,用小半夏汤主治。
【注】
有痰饮病的人感到口渴,是因为水液停聚导致气机不化生津液而口渴;经常呕吐的人感到口渴,是因为呕吐导致胃干燥、损伤津液而口渴,所以说经常呕吐的人本应口渴。先呕吐后感到口渴的,应当少量给予饮水,以调和胃气、生津液,这是病情即将好转的表现;如果呕吐后反而不渴,那一定是因为心下素有支饮的缘故。只主治小半夏汤来止呕,而不加茯苓的原因,是因为不渴且没有新产生的水饮,况且呕吐后已经损伤了津液,不可再进行利水治疗,以免进一步枯竭津液。
【集注】
李□说:此方专门用于治疗呕吐,说经常呕吐的人感到口渴,是病情即将好转的表现,因为胃气恢复而津液生成。如果心下素有支饮,那么就不会干燥,自然也不会感到口渴,而是水饮泛溢导致呕吐。半夏和生姜性温能调和胃气,味辛能散逆气,是治疗呕吐的圣药。
半夏一升,生姜半斤。
以上两味药,用水七升,煎煮至剩余一升半,分两次温服。
【集解】
沈明宗说:这是治疗支饮上溢导致呕吐的方剂。凡是发生呕吐必然损伤津液,应当感到口渴,所以说是经常呕吐的人本应口渴,如果感到口渴,说明病邪从呕吐中排出,称为病情即将好转。如果心下有支饮,停蓄在胸膈导致燥热,所以呕吐但不感到口渴,则应当治疗水饮,所以用生姜散邪,半夏涤除水饮,呕吐自然停止。
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突然呕吐,心下痞塞,膈间有水,出现眩晕和心悸的,用半夏加茯苓汤主治。
【注】
突然呕吐,虽然不渴但心下痞塞,这是膈间有水凝结所致。眩晕,是因为水阻遏阳气不能上升;心悸,是因为水气上犯于心。即使不渴且无新产生的水饮,也可知平日体内水饮旺盛,则不必顾及津液,也必须加入茯苓以利水,这样水结才能打开,阻滞才能通畅。
【集注】
赵良说:心下痞塞,膈间有水,出现眩晕和心悸,阳气必然不能宣散。经书说:用辛味药发散它。半夏和生姜都味辛,《本草》记载半夏可治疗膈上的痰。心下坚硬、呕吐、逆气、眩晕,也是上焦阳气虚弱不能升发,所以半夏和生姜共同治疗。心悸则是心受到水气凌犯,不是半夏能单独治疗的,必须加入茯苓去水,降下肾中逆气以安神,神安则心悸痊愈。
尤怡说:饮气逆乱于胃则呕吐,停滞于气分则心下痞塞,凌犯于心则心悸,遮蔽阳气则眩晕,半夏和生姜止呕降逆,加入茯苓去除水饮。
Fangji Banxia (Rhizoma Pinelliae) one sheng, Shengjiang (Zingiberis Rhizoma Recens) half jin, Fuling (Poria) three liang.
The above three ingredients are decocted in seven sheng of water until one sheng and five he remain. The resulting liquid is divided into two doses and taken warm.
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Individuals prone to vomiting should naturally feel thirsty; if they feel thirsty, it indicates that the condition is about to resolve. If they do not feel thirsty now, it is due to Zhiyin (fluid retention in the chest and diaphragm). Xiao Banxia Tang (Minor Cinnamon Twig Decoction) is the primary formula for this.
[Annotation]
In individuals with Yin (fluid retention), thirst occurs because fluid stagnation prevents Qi transformation from generating body fluids. In individuals who vomit frequently, thirst occurs because vomiting dries the stomach and damages body fluids; thus, it is said that those prone to vomiting should naturally be thirsty. If vomiting is followed by thirst, small amounts of water should be given to harmonize the Stomach Qi and generate fluids, indicating the condition is resolving. If there is no thirst after vomiting, it is certain that Zhiyin has existed in the epigastrium. Xiao Banxia Tang is used solely to stop vomiting without adding Fuling (Poria) because the absence of thirst implies no new fluid accumulation, and since body fluids have already been damaged by vomiting, diuresis should not be employed again to avoid further exhausting the fluids.
[Collected Annotations]
Li [Name] stated: This formula specifically treats vomiting. Thirst in those prone to vomiting indicates resolution, as Stomach Qi recovers and fluids are generated. If Zhiyin exists in the epigastrium, there is no dryness and thus no thirst; instead, fluid overflow causes vomiting. Banxia (Rhizoma Pinelliae) and Shengjiang (Zingiberis Rhizoma Recens) are warm to harmonize Stomach Qi and pungent to disperse rebellious Qi, making them the "holy medicine" for treating vomiting.
Fangji Banxia (Rhizoma Pinelliae) one sheng, Shengjiang (Zingiberis Rhizoma Recens) half jin.
The above two ingredients are decocted in seven sheng of water until one sheng and a half remain. The resulting liquid is divided into two doses and taken warm.
[Collected Explanations]
Shen Mingzong stated: This is a formula for vomiting caused by Zhiyin overflowing upward. Vomiting inevitably damages body fluids, so thirst should occur; hence, it is said that those prone to vomiting should naturally be thirsty. Thirst indicates that the pathogen is expelled through vomiting, termed "about to resolve." If Zhiyin exists in the epigastrium, stagnating in the chest and diaphragm causing dryness, vomiting occurs without thirst. In such cases, the fluid must be treated; therefore, Shengjiang (Zingiberis Rhizoma Recens) disperses pathogens, and Banxia (Rhizoma Pinelliae) clears fluid, stopping vomiting naturally.
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For sudden vomiting, epigastric fullness and obstruction (Pi), fluid between the diaphragm, dizziness (Xuan), and palpitations (Ji), Banxia Jia Fuling Tang (Banxia Plus Poria Decoction) is the primary formula.
[Annotation]
Sudden vomiting accompanied by epigastric fullness despite the absence of thirst indicates fluid coagulation between the diaphragm. Dizziness results from fluid obstructing Yang Qi from ascending; palpitations result from fluid Qi attacking the Heart. Even if there is no thirst and no new fluid accumulation, it can be inferred that fluid abundance exists normally. Therefore, concern for body fluids is set aside, and Fuling (Poria) must be added to promote diuresis, thereby opening the fluid coagulation and clearing the obstruction.
[Collected Annotations]
Zhao Liang stated: Epigastric fullness, fluid between the diaphragm, dizziness, and palpitations indicate that Yang Qi cannot diffuse freely. The Classics state: "Disperse with pungent substances." Both Banxia (Rhizoma Pinelliae) and Shengjiang (Zingiberis Rhizoma Recens) are pungent. Bencao records that Banxia treats phlegm above the diaphragm. Epigastric hardness, vomiting, rebellious Qi, and dizziness also stem from deficiency of Upper Jiao Yang Qi failing to ascend; thus, Banxia and Shengjiang treat these together. Palpitations indicate the Heart is overwhelmed by Water; Banxia alone cannot treat this. Fuling must be added to remove water, descend rebellious Qi from the Kidney, and calm the Spirit. When the Spirit is calm, palpitations subside.
You Yi stated: Fluid Qi rebelling in the Stomach causes vomiting; stagnating in the Qi mechanism causes epigastric fullness; overwhelming the Heart causes palpitations; obscuring Yang causes dizziness. Banxia and Shengjiang stop vomiting and direct rebellious Qi downward, while added Fuling removes the water.