旋覆花三两 人参二两 生姜（切）五两 代赭石一两 半夏（洗）半升 甘草（炙
）三两 大枣（擘）十二枚
右七味，以水一斗，煮取六升，去滓再煎，取三升，温服一升，日三服。
【方解】
罗天益曰：汗、吐、下解后，邪虽去而胃气已亏矣。胃气既亏，三焦因之失职，清无
所归而不升，浊无所纳而不降，是以邪气留滞，伏饮为逆，故心下痞□，噫气不除也
。方中以人参、甘草养正补虚，生姜、大枣和脾养胃，所以安定中州者至矣。更以代
赭石之重，使之敛浮镇逆；旋覆花之辛，用以宣气涤饮；佐人参以归气于下，佐半夏
以蠲饮于上，浊降则痞□可消，清升则噫气可除矣。观仲景治少阴水气上凌，用真武
汤镇之；治下焦滑脱不守，用赤石脂禹余粮汤固之，此胃虚气失升降，复用此法理之
，则胸中转否为泰，其为归元固下之法，各极其妙如此。
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伤寒大吐、大下之，极虚，复极汗出者，以其人外气怫郁，复与之水，以发其汗，因
得哕。所以然者，胃中寒冷故也。
【注】
伤寒大吐、大下之后，津液极虚。其人面赤，表气怫郁，渴欲引饮，复与汤水，以助
发其汗，因得哕。所以然者，大吐、下已虚其中，又发其汗，阳从外亡，故曰胃中虚
冷故也。宜以吴茱萸汤，温中降逆可也。
【按】
胃主纳，下通地道。若胃病失职，则不下输大小肠，不纳而反出也。物出无声，谓之
吐；声物并出，谓之呕；声出无物，谓之干呕；干呕者，即哕也，以其有哕哕之声，
故名曰哕也。论中以呕为轻，以哕为重。盖以胃中有物，物与气并逆，所伤者轻；胃
中空虚，惟气上逆，所伤者重故也。哕，与三阴证同见者，为虚为寒；与三阳证同见
者，为实为热。虚寒者，四逆、理中、吴茱萸等汤；实热者，调胃、大小承气等汤，
择而用之，勿谓哕者胃败不可下也。论中云：伤寒哕而腹满，视其前后，知何部不利
，利之则愈是也。又世有谓哕为呃逆、吃逆、噫气者，皆非也。盖哕之声气，自胃出
于口，而有哕哕之声，壮而迫急也；呃逆之声，气自脐下冲上，出口而作格儿之声，
散而不续也。夫所谓呃逆者，即论中平脉篇所谓□□者，气噎结有声也。观呃逆之人
，与冷水实时作格，哕则不然，自可知也。吃逆、噫气者，即今之所谓嗳气也，因饱
食太急，比时作嗳，而不食臭，故名曰吃逆也。因过食伤食，过时作嗳有食臭气，故
名曰噫气也。哕□嗳噫，俱有声无物，虽均属气之上逆，然不无虚实寒热，轻重新久
之别也。甚至以欬逆为呃逆者，殊不知欬逆即今之喘嗽也，兹乃与呃逆混而为一，皆
不考之过，而得失利害系焉！不可以不辨：干呕即哕，欬逆即喘嗽。详在『金匮要略
』中。
【集注】
程应旄曰：哕之一证，有虚有实。虚自胃冷得之，缘大吐大下后，阴虚而阳无所附，
因见面赤，以不能得汗，而外气怫郁也。医以面赤为热气怫郁，复与水而发汗令大出
，殊不知阳从外泄而胃虚，水从内搏而邪格，胃气虚弱矣。安得不哕！
汪琥曰：伤寒既大吐、大下之后，已极虚矣！复极发其汗者何也？以其人外气怫郁，
面上之气，恰如外来之邪怫郁于表也。此系阳明胃府虚极，浮热之气上升于面，医人
认以为邪热胃燥过极，不得汗，复与之水以助其汗，因而得哕。
音切
沫音末 内音纳 合音鸽 见音现 饴音怡 烊音羊 欬溪介切 眩匣绢切 振平声
窒陟力切 暝音冥 □汝六切 蛭音质 □音肓 谛音帝 当去声 瘀影据切 噫
乙介切 濡音软 哕于月切
旋覆花三两，人参二两，生姜（切片）五两，代赭石一两，半夏（洗净）半升，甘草（炙烤）三两，大枣（掰开）十二枚。
以上七味药，用水一斗，煎煮至剩余六升，滤去药渣后再次煎煮，取三升药液，每次温服一升，每日服用三次。
【方解】
罗天益说：经过发汗、催吐、泻下治疗后，病邪虽然已去除，但胃气已经亏损。胃气既然亏虚，三焦因此失职，清气没有归依而不能上升，浊气没有容纳而不能下降，所以邪气留滞，伏饮上逆，导致心下痞塞不通，嗳气不止。方中用人参、甘草来扶正补虚，用生姜、大枣来调和脾胃，以此来安定中焦的作用非常大。再用代赭石的沉重之性，使其收敛浮阳、镇压逆气；用旋覆花的辛散之性，用来宣通气机、涤除痰饮；辅助人参使气归于下，辅助半夏在上部消除痰饮，浊气下降则痞塞可消，清气上升则嗳气可除。看张仲景治疗少阴水气上凌，用真武汤来镇摄；治疗下焦滑脱不固，用赤石脂禹余粮汤来固涩，这是针对胃虚导致气机升降失常，又采用这种方法调理，那么胸中就会由否转为泰，这作为归元固下的方法，各自都达到了极妙的境界。
伤寒经过剧烈的呕吐、剧烈的泻下后，身体极度虚弱，如果再次出现大汗出，是因为患者体表之气郁结不畅，医生又给他喝水以发汗，因此导致呃逆（哕）。之所以这样，是因为胃中寒冷所致。
【注】
伤寒经过剧烈呕吐、剧烈泻下之后，津液极度虚弱。患者面部发红，表气郁结，口渴想饮水，医生又给予汤水，以帮助发汗，因此导致呃逆。之所以这样，是因为剧烈呕吐、泻下已经使中焦虚弱，又通过发汗使阳气从体表耗散，所以说这是因为胃中虚冷所致。适宜使用吴茱萸汤，温中降逆即可。
【按语】
胃主受纳，向下通达地道。如果胃病失职，就不能向下输送到大小肠，不能受纳反而吐出。物体出来没有声音，称为吐；声音和物体一起出来，称为呕；只有声音出来没有物体，称为干呕；干呕，就是呃逆（哕），因为它有“哕哕”的声音，所以名叫哕。医论中以呕为轻症，以哕为重症。大概因为胃中有实物，实物与气并逆，所伤较轻；胃中空虚，只有气上逆，所伤较重。哕，如果与三阴证同时出现，属于虚寒；如果与三阳证同时出现，属于实热。虚寒的，用四逆汤、理中汤、吴茱萸汤等；实热的，用调胃承气汤、大承气汤、小承气汤等，选择而用之，不要认为哕是胃气败坏不可攻下。医论中说：伤寒出现哕且腹部胀满，观察前后二便，知道哪一部分不利，通利它就好了。另外世间有人称哕为呃逆、吃逆、噫气的，都不对。大概哕的声音和气，从胃出于口，而有哕哕的声音，壮盛而迫急；呃逆的声音，气从脐下冲上来，出口发出格儿的声音，散乱而不连续。所谓呃逆，即医论中平脉篇所说的某种情况（原文缺字），气噎结有声。看呃逆的人，喝冷水立刻发出格格声，哕就不是这样，自然可以知晓。吃逆、噫气，就是现在的所谓嗳气，因为饱食太急，当时打嗝，而没有食物臭味，所以名叫吃逆。因为过食导致伤食，过后打嗝有食物臭味，所以名叫噫气。哕、嗳、噫，都有声音没有实物，虽然都属于气之上逆，然而不无虚实寒热、轻重新久之别。甚至有人把欬逆当作呃逆，殊不知欬逆就是现在的喘嗽，这里竟然把欬逆和呃逆混为一谈，都是不考证的过错，得失利害关系重大！不可以不辨别：干呕即哕，欬逆即喘嗽。详细记载在《金匮要略》中。
【集注】
程应旄说：哕这一证候，有虚有实。虚证是从胃冷得来的，源于剧烈呕吐、泻下后，阴虚而阳无所依附，因而见面部发红，因为不能得汗，而体表之气郁结。医生把面部发红当作热气郁结，又给水发汗令其大汗出，却不知道阳气从体外泄而胃虚，水从内搏结而邪气格拒，胃气虚弱了。怎么能不哕！
汪琥说：伤寒既然大吐、大下之后，已经极度虚弱了！为什么还要再次极力发汗呢？是因为患者体表之气郁结，面上的气，恰如外来的邪气郁结在体表一样。这是阳明胃腑极度虚弱，浮热之气上升于面，医生误认为是邪热胃燥过度，不得汗，又给水来帮助发汗，因而导致哕。
音切
沫音末 内音纳 合音鸽 见音现 饴音怡 烊音羊 欬溪介切 眩匣绢切 振平声 窒陟力切 暝音冥 □汝六切 蛭音质 □音肓 谛音帝 当去声 瘀影据切 噫乙介切 濡音软 哕于月切
Inula Flower (Xuanfuhua) 3 liang, Ginseng Root (Renshen) 2 liang, Fresh Ginger Rhizome (Shengjiang, sliced) 5 liang, Hematite (Daizheshi) 1 liang, Pinellia Tuber (Banxia, washed) half sheng, Licorice Root (Gancao, honey-fried) 3 liang, Jujube Fruit (Dazao, torn open) 12 pieces.
The above seven ingredients are decocted with one dou of water to obtain six sheng. The dregs are strained out, and the liquid is decocted again to obtain three sheng. Take one sheng warm, three times a day.
[Formula Analysis]
Luo Tianyi stated: After treatment with sweating, vomiting, or purging, although the pathogenic factors have been eliminated, the Stomach Qi has already become deficient. Since Stomach Qi is deficient, the Sanjiao (Triple Burner) fails in its duties; Clear Qi has no place to return and cannot ascend, while Turbid Qi has no place to be received and cannot descend. Consequently, pathogenic factors remain stagnant, and latent fluid retention rebels upward, causing epigastric fullness and obstruction (Xin Xia Pi), along with persistent belching (Yi Qi). In the formula, Ginseng and Licorice nourish the righteous Qi and tonify deficiency; Fresh Ginger and Jujube harmonize the Spleen and nourish the Stomach, thereby greatly stabilizing the Middle Jiao. Furthermore, the heavy nature of Hematite helps to gather floating Yang and suppress rebellion; the acrid nature of Inula Flower is used to diffuse Qi and wash away fluid retention. Assisting Ginseng to guide Qi downward, and assisting Pinellia to eliminate fluid retention upward, when Turbid Qi descends, epigastric fullness can be resolved; when Clear Qi ascends, belching can be removed. Observing Zhang Zhongjing treating Shaoyin Water-Qi flooding upward with Zhenwu Tang to suppress it; and treating Lower Jiao sliding instability with Chishizhi Yuyuliang Tang to consolidate it, this approach applies similar logic to treat Stomach deficiency leading to dysfunction of Qi ascending and descending. Thus, the chest transforms from obstruction to smoothness. These methods of returning to the origin and consolidating the lower part are each extremely effective.
After severe vomiting and purging in Cold Damage (Shanghan), the body becomes extremely deficient. If excessive sweating occurs subsequently, it is because the exterior Qi was constrained and depressed. If the physician gives water to induce sweating, hiccups (Yue) may result. The reason for this is cold in the Stomach.
[Annotation]
After severe vomiting and purging in Cold Damage, body fluids are extremely deficient. The patient presents with a red face and constrained exterior Qi, feeling thirsty and desiring to drink. If the physician provides soup or water to assist in inducing sweating, hiccups (Yue) may occur. This happens because severe vomiting and purging have already weakened the interior, and subsequent sweating causes Yang Qi to escape from the exterior. Therefore, it is stated that this is due to deficiency-cold in the Stomach. It is appropriate to use Wuzhuyu Decoction (Evodiae Fructus Decoction) to warm the middle and direct rebellious Qi downward.
[Commentary]
The Stomach governs reception and connects downward to the "earthly pathway." If the Stomach loses its function, it fails to transport contents to the Large and Small Intestines; instead of receiving, it expels. Expulsion of matter without sound is called vomiting (Tu); expulsion of both sound and matter is called retching (Ou); expulsion of sound without matter is called dry retching (Gan Ou). Dry retching is equivalent to hiccups (Yue), named so because of the "yue yue" sound. In medical discussions, retching (Ou) is considered mild, while hiccups (Yue) are considered severe. This is because when there is matter in the Stomach, the matter and Qi rebel together, causing lighter injury; whereas when the Stomach is empty, only Qi rebels upward, causing heavier injury. When Yue accompanies Shaoyin syndromes, it indicates deficiency-cold; when it accompanies Yangming syndromes, it indicates excess-heat. For deficiency-cold, formulas such as Sini Tang (Frigid Extremities Decoction), Lizhong Tang (Regulate the Middle Decoction), and Wuzhuyu Tang are used; for excess-heat, formulas such as Tiaoweichengqi Tang (Regulate the Stomach and Direct Downward Decoction), Dachengqi Tang (Major Direct Downward Decoction), and Xiao Chengqi Tang (Minor Direct Downward Decoction) are selected. Do not assume that Yue indicates Stomach failure and prohibits purgation. The text states: "In Cold Damage, if Yue is accompanied by abdominal fullness, observe the anterior and posterior orifices to determine which is obstructed; unblocking it will lead to recovery." Additionally, some people mistakenly equate Yue with hiccup (E Ni), burping (Chi Ni), or belching (Yi Qi), which is incorrect. The sound and Qi of Yue originate from the Stomach and exit the mouth with a vigorous, urgent "yue yue" sound. In contrast, the sound of E Ni originates from below the navel, rushes upward, exits the mouth making a "ge er" sound, and is scattered and discontinuous. The term E Ni refers to what is described in the Ping Mai Pian (Chapter on Plain Pulse Diagnosis) as Qi stagnation with sound. One can observe that those with E Ni make a "ge" sound immediately upon drinking cold water, whereas those with Yue do not, which distinguishes them. Chi Ni and Yi Qi refer to what is currently known as belching (Ai Qi). Belching occurring immediately after eating too quickly, without a food odor, is called Chi Ni. Belching occurring later after overeating and damaging digestion, accompanied by a food odor, is called Yi Qi. Although Yue, Ai, and Yi all involve sound without matter and belong to upward rebellion of Qi, they differ in terms of deficiency/excess, cold/heat, severity, and duration. Some even confuse Ke Ni (cough-reversal) with E Ni. However, Ke Ni is actually asthma and coughing (Chuan Sou). Confusing these is due to lack of investigation and has significant consequences. It is crucial to distinguish them: Gan Ou is equivalent to Yue, and Ke Ni is equivalent to Chuan Sou. Details are found in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet).
[Collected Annotations]
Cheng Yingmao stated: The syndrome of Yue can be either deficiency or excess. Deficiency arises from Stomach cold, following severe vomiting and purging, where Yin is deficient and Yang has no attachment, resulting in a red face and constrained exterior Qi due to inability to sweat. Physicians mistake the red face for heat constraint and give water to induce profuse sweating, unaware that Yang escapes outward causing Stomach deficiency, and water clashes inward causing pathogenic rejection. With weak Stomach Qi, how can Yue not occur?
Wang Hu stated: After severe vomiting and purging in Cold Damage, the body is already extremely deficient. Why induce further sweating? Because the exterior Qi is constrained, resembling external pathogens constraining the surface. This represents extreme deficiency of the Yangming Stomach Fu organ, with floating heat rising to the face. Physicians misidentify this as extreme Stomach heat and dryness preventing sweating, and give water to aid sweating, thereby causing Yue.
Phonetics
Mo sounds like Mo. Nei sounds like Na. He sounds like Ge. Jian sounds like Xian. Yi sounds like Yi. Yang sounds like Yang. Kai is pronounced Xi-Jie. Xuan is pronounced Huan-Juan. Zhen is level tone. Zhi is pronounced Zhi-Li. Ming sounds like Ming. [Character missing] is pronounced Ru-Liu. Zhi sounds like Zhi. [Character missing] sounds like Huang. Di sounds like Di. Dang is departing tone. Yu is pronounced Ying-Ju. Yi is pronounced Yi-Jie. Ru sounds like Ruan. Yue is pronounced Yu-Yue.