熟地黄(八两) 山茱萸 山药(各四两) 牡丹皮 白茯苓 泽泻(各三两) 蜜丸。
阴虚于下,令人多呕者,主此方盐汤吞之。
《脉解篇》曰∶诸阳气浮,无所根据从,故呕、咳、上气喘。此阴虚于下,而令孤阳上浮
尔。是方也,熟地、山萸,质润味浓,可使滋阴。丹皮、泽泻,气味咸寒,可制阳光。山药、
茯
叙曰∶呃逆一也,中下判焉。中焦呃逆其声短,水谷之病也。下焦呃逆其声长,虚邪相
搏也。今考古方三首,辨其上下,察其虚实,则十全之工矣。若呃逆日久而且吞酸,则翻胃
之前驱也,从火治之。
橘皮 竹茹(各一升) 人参 生姜(各半两) 甘草(炙,二两) 大枣(三十枚)
大病后,呃逆不已,脉来虚大者,此方主之。
呃逆者,由下达上,气逆作声之名也。大病后,则中气皆虚,余邪乘虚入里,邪正相搏
,气必上腾,故令呃逆。脉来虚大,虚者正气弱,大者邪热在也。是方也,橘皮平其气,竹
茹清其热,甘草和其逆,人参补其虚,生姜正其胃,大枣益其脾。
丁香(三粒) 柿蒂 竹茹(各三钱) 陈皮(一钱)
大病后,中焦气塞,下焦呃逆,此方主之。
大病后,五脏皆伤,升降失常,故令中焦痞塞,五脏之阴既伤,则少阳之火奋于下,故
令下焦呃逆,直冲清道而上也。是方也,丁香、陈皮,辛温者也,理中气之痞塞。竹茹、柿
蒂,苦寒者也,疗下焦之呃逆。或问∶降逆何以不用栀、柏?余曰∶此少阳虚邪,非实邪也,
故用竹茹、柿蒂之味薄者以主之。若栀、柏味浓,则益戕其中气,痞塞不益盛乎?古人盖亦
深权之矣。
熟地黄(八两) 山茱萸 山药(各四两) 牡丹皮 白茯苓 泽泻(各三两) 炼蜜为丸。
下焦阴虚,导致频繁呕吐的病症,主治此方,用盐开水送服。
《黄帝内经·素问·脉解篇》说:各种阳气浮越于上,没有根基依托,所以出现呕吐、咳嗽、气逆喘息的症状。这是因为下焦阴虚,使得孤立的阳气上浮所致。这个方剂中,熟地黄、山茱萸,质地滋润味道浓厚,能够滋养阴液;牡丹皮、泽泻,气味咸寒,可以制约亢盛的阳热;山药、茯苓……
叙述说:呃逆这一症状,病位有中焦和下焦之分。中焦呃逆,声音短促,属于水谷饮食致病;下焦呃逆,声音悠长,属于虚邪相互搏结所致。如今考证古代三个方剂,辨别其病位在上或在下,察辨其证候属虚或属实,那么就能成为十全十美的良医了。如果呃逆日久且伴有吞酸,这是翻胃(反胃)的先兆,应当从火热证治疗。
橘皮 竹茹(各一升) 人参 生姜(各半两) 甘草(炙,二两) 大枣(三十枚)
大病之后,呃逆不止,脉象虚大的,主治此方。
呃逆,是指气自下向上冲逆发出声音的病名。大病之后,中气全部虚弱,残余的病邪乘虚侵入体内,邪气与正气相互搏结,气机必然上腾,所以导致呃逆。脉象虚大,虚代表正气衰弱,大代表有邪热存在。这个方剂中,橘皮平抑气逆,竹茹清除热邪,甘草调和气逆,人参补益虚弱,生姜温胃止呕,大枣补益脾气。
丁香(三粒) 柿蒂 竹茹(各三钱) 陈皮(一钱)
大病之后,中焦气机阻塞,下焦呃逆,主治此方。
大病之后,五脏都受到损伤,升降功能失常,所以导致中焦痞塞不通;五脏的阴液既然受损,少阳相火就会在下焦躁动,所以导致下焦呃逆,直冲清道而上行。这个方剂中,丁香、陈皮,属于辛温之品,能调理中焦的气机痞塞;竹茹、柿蒂,属于苦寒之品,能治疗下焦的呃逆。有人问:降逆气为什么不用栀子、黄柏?我说:这是少阳的虚性邪热,并非实邪,所以选用药味较薄的竹茹、柿蒂来主治。如果用栀子、黄柏这样药味浓厚的药物,反而会进一步伤害中气,使痞塞更加严重吗?古人确实是经过深思熟虑权衡利弊的。
Prepared Rehmanniae Radix (Shu Dihuang, Prepared Rehmannia Root) (eight liang), Cornus Officinalis Fructus (Shanzhuyu, Dogwood Fruit), Dioscoreae Rhizoma (Shanyao, Yam Rhizome) (each four liang), Moutan Cortex (Mudanpi, Tree Peony Bark), Poria (Baifuling, White Poria), Alisma Rhizoma (Zexie, Water Plantain Rhizome) (each three liang). Formed into pills with honey.
For deficiency of Yin in the lower jiao causing frequent vomiting, this formula is indicated; it should be taken with salt water.
The *Maijie Pian* (Chapter on Pulse Explanation) states: "When various Yang qi floats upward without a root to rely upon, vomiting, coughing, and wheezing occur." This is due to Yin deficiency in the lower jiao, causing isolated Yang qi to float upward. In this formula, Shudi and Shanzhuyu have moist textures and rich flavors, enabling them to nourish Yin. Mudanpi and Zexie have salty and cold properties, capable of restraining hyperactive Yang. Shanyao and Fuling...
Narration states: Hiccups are categorized by location into the middle and lower jiao. Hiccups originating from the middle jiao have short sounds and are caused by disorders of food and water. Hiccups originating from the lower jiao have long sounds and result from the struggle between deficiency and pathogenic factors. By examining ancient formulas, distinguishing between upper and lower locations, and assessing deficiency or excess, one can become an excellent physician. If hiccups persist for a long time accompanied by acid regurgitation, it is a precursor to Fanwei (Regurgitation); treatment should address Fire.
Citri Reticulatae Pericarpium (Jupi, Tangerine Peel), Bambusae Folium (Zhuru, Bamboo Leaf), each one sheng; Ginseng Radix et Rhizoma (Renshen, Ginseng Root), Zingiberis Rhizoma Recens (Shengjiang, Fresh Ginger Rhizome), each half liang; Glycyrrhizae Radix et Rhizoma (Gancao, Licorice Root) (prepared with honey, two liang); Jujubae Fructus (Dazao, Jujube Fruit) (thirty pieces).
For hiccups persisting after a severe illness, accompanied by a deficient and large pulse, this formula is indicated.
Hiccups refer to the sound produced by Qi reversing from below upwards. After a severe illness, the Middle Qi is entirely deficient; residual pathogens enter the interior taking advantage of the deficiency. The struggle between pathogens and healthy Qi causes Qi to surge upward, resulting in hiccups. A deficient pulse indicates weak healthy Qi, while a large pulse indicates the presence of pathogenic heat. In this formula, Jupi regulates rebellious Qi, Zhuru clears heat, Gancao harmonizes rebellious Qi, Renshen tonifies deficiency, Shengjiang warms the Stomach, and Dazao benefits the Spleen.
Symplocos Fructus (Dingxiang, Clove Bud) (three grains); Diospyroi Fructus (Shidi, Persimmon Calyx); Bambusae Folium (Zhuru, Bamboo Leaf), each three qian; Citri Reticulatae Pericarpium (Chenpi, Aged Tangerine Peel), one qian.
For Qi obstruction in the middle jiao and hiccups in the lower jiao after a severe illness, this formula is indicated.
After a severe illness, the Five Zang organs are injured, and ascending and descending functions are disordered, leading to fullness and obstruction in the middle jiao. Since the Yin of the Five Zang organs is damaged, Shaoyang Ministerial Fire rises vigorously in the lower jiao, causing hiccups that rush directly up the clear pathways. In this formula, Dingxiang and Chenpi are acrid and warm, regulating Qi obstruction in the middle jiao. Zhuru and Shidi are bitter and cold, treating hiccups in the lower jiao. One might ask: Why not use Gardeniae Fructus (Zhizi, Gardenia Fruit) and Phellodendri Cortex (Huangbai, Phellodendron Bark) to direct Qi downward? I reply: This is a deficiency-type pathogen of Shaoyang, not an excess pathogen. Therefore, herbs with lighter flavors like Zhuru and Shidi are used. If heavy-flavored herbs like Zhizi and Huangbai were used, they would further damage Middle Qi, worsening the obstruction, would they not? The ancients indeed weighed these factors deeply.