有声无物为呕，有物无声为吐，有物有声为呕吐。仲景有干呕条，呕而无物之谓。呕吐症，
以内伤论，皆在阳明胃家；以外感论，有各条分别。若恶寒发热，脉浮而数，初起胸满而
呕，此太阳外感风寒，胃家内有痰饮，以羌活汤散太阳表邪，合保和平胃散加干葛，消胃家
痰饮食滞。若寒热呕而口苦，脉见弦数，此少阳经表邪呕苦之症，小柴胡汤治之。若初起兼
有饱满呕吐，亦是胃家夹食，佐以保和平胃散。若目痛鼻干，先渴后呕，无汗脉浮大，此阳
明外有表邪，内有积热，以干葛清胃法治之。若有汗脉数，呕而消水，此燥火呕吐也，知母
石膏汤冲竹沥芦根汁。若呕而不渴，身不大热，此湿火呕吐也，栀连半夏汤，加白豆蔻、
浓朴、竹茹。若恶心呕吐，六脉滑大不数，发热而口反不渴，此痰饮食积呕吐之症也，平胃
保和散、二陈导痰汤加干葛、竹茹治之。若口臭牙疼，二便赤涩，此积热痰火呕吐也，升麻
清胃汤、二陈汤、竹茹汤、加川连、白豆蔻。若胁肋刺痛呕吐酸水，此肝木火冲之呕，小柴胡
加栀、连、竹茹。总之，无痰涎，不呕吐，故热病呕吐，皆痰饮火邪上冲，用竹茹、半夏化
痰涎，栀、连清胃火。家秘以竹茹半夏汤加栀、连、白豆蔻，其吐立止。若夫时行热病，
汗出不解，足冷耳聋，烦闷咳呕，此疫毒 症呕吐也，羌独败毒散、升麻干葛汤、升麻清胃
汤。若燥邪时疫呕吐，加知母、石膏、竹沥、半夏，冲芦根汁、生梨汁热服。方书云∶呕家
多服生姜，此指胃寒痰饮呕吐而言，若胃热者，不与川连同用宁不增病耶！惟三阴经胃寒呕
吐，乃用理中汤等温剂。此书专为伤寒热病，故三阴不发热呕吐，另具《症因脉治》中也。
太阳中风，阳浮而阴弱，阳浮者热自发，阴弱者汗自出，啬啬恶寒，淅淅恶风，翕翕发热，
鼻鸣干呕，桂枝汤。
脉浮自汗，翕翕发热，此即太阳中风症，故解肌散表，则呕自止。
凡服桂枝汤吐者，其后必吐脓血。
服桂枝而吐者，胃必热。胃热得桂枝后，必吐脓血。
发汗后，水药不得入口为逆，若更发汗，必吐下不止。
太阳热结膀胱，下部症发表为逆，故水药不得入口。若再发汗，必气升而吐利不止。
中风发热，六七日不解而烦，有表里症，渴欲饮水，水入即吐，名曰水逆。五苓散主之。多
服暖水，汗出即愈。
此申明太阳热结膀胱，表里吐逆之症，应用五苓治者。
太阳中风，下利呕逆，表解者乃可攻之。其人 汗出，发作有时，头痛，心下痞硬满，引
胁下痛，干呕短气，汗出不恶寒者，此表解里未和也。十枣汤主之。
太阳中风，下利呕逆，表邪已解，胁下痛，干呕短气，此兼悬饮，宜十枣汤治者。
太阳病或已发热，或未发热，必恶寒体重呕逆，脉阴阳俱紧。
此申明寒伤营之呕逆症，必发热恶寒，身体重痛，呕逆而无汗，脉阴阳俱紧者。
伤寒二三日，心下悸而烦者，小建中汤主之。呕家不可用建中汤，以甜故也。
本言悸烦症治，引出呕家用药，禁忌甘甜泥膈。
伤寒发热，汗出不解，心下痞硬，呕吐而下利者，大柴胡主之。
心下痞而硬，而下利者，通因通用之下症也。尚有发热呕吐，止可用大柴胡汤。
伤寒六七日，发热恶寒，肢节烦疼，微呕，心下支结，外症未去者，柴胡桂枝汤主之。
详注恶寒门。太阳少阳二经，外邪未去而微呕，故用柴胡桂枝汤。
伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐者，黄连汤主之。
胸中有热，胃中有邪，腹中痛，言湿热上冲呕吐，故以黄连汤治火逆。前书皆注邪气为寒
气，误也。
伤寒吐后腹胀满者，与调胃承气汤。
腹胀满虽是下症，但吐后止可用调胃承气汤。
伤寒呕多，虽有阳明症，不可攻之。
呕属上焦病，即有阳明里症，亦不可攻下。
食谷欲呕者，属阳明也，吴茱萸汤主之。得汤反剧者，属上焦。
食谷欲呕，似阳明胃寒。若服温药反剧者，乃是上焦热邪。
伤寒五六日，中风，往来寒热，胸胁若满，默默不欲饮食，心烦喜呕，或胸中烦而不呕，或
渴，或腹中痛，或胁下痞硬，或心下悸，小便不利，或不渴，身有微热，或咳者，小柴胡汤主之。
此条历叙少阳中风，邪在半表半里，默默不欲食，心烦喜呕，并以小柴胡汤加减治之。
太阳与阳明合病，不下利但呕者，葛根加半夏汤主之。太阳与阳明合病者，必自下利葛根汤主之。
二条皆是太阳阳明合病，但以不下利呕者，别病在足阳明胃，以不呕下利者，别病在手
阳明大肠。故同用葛根汤，惟以加半夏，以见其和胃止呕；以去半夏，便是升散大肠风邪内陷。
太阳与少阳合病，自下利者，与黄芩汤。若呕者，黄芩加半夏生姜汤。
太阳与少阳合病，同自下利，以不呕，用黄芩汤。若呕吐，黄芩汤中加半夏、生姜。上下
二章，互发呕吐症，半夏、生姜必用者。
太阳之为病，腹满而吐，食不下，自利益甚，时腹自痛，若下之，必胸满结硬。
此条太阳经外有表热里有寒邪而呕利也。若误用下法，则变胸满结硬矣。
伤寒本自寒下利，医复吐下之，寒格更逆吐下，若食入口即吐，干姜黄连黄芩人参汤。
言伤寒则为热病，若阴症自寒下利，吐下之即死矣。岂尚可用芩连乎！因其人表热里寒下
利，医者误认挟热，复吐下之，则寒格而食入口即吐出，故用干姜温其寒，芩、连折其热。
呕而发热者，小柴胡汤主之。
呕吐而发热，阳邪传少阳，故用小柴胡汤。
羌活冲和汤 见发热。
保和平胃散
呕吐有表邪，用前方；有食滞，用此方消导。
小柴胡汤
小柴胡汤有柴胡、黄芩，无竹茹、枳实；清胆汤有竹茹、枳实，无柴胡、黄芩。加二味，
则二方合之。又加藿香、浓朴，以利胃止呕。
干葛清胃汤
干葛 石膏 熟半夏 浓朴 广皮 甘草
干葛解表，石膏清里，加半夏、浓朴、广皮化痰涎，和胃止呕。
羌独败毒散 见发热。
此方散表邪，则疫毒散而呕吐止，故曰败毒散。
升麻葛根汤 见发热。
疫邪 痧，伏于阳明胃经呕吐，用此方升散阳明，则 出吐止。
苍朴导痰汤
痰饮水湿伏于胃家，每多呕吐，故用燥湿化痰。非外感热病，漫用燥药。
栀连二陈汤
前方治有痰无火者，此方加川连、白豆蔻、竹茹、浓朴，治有痰有火者。
竹茹汤
竹茹 干葛 陈皮 半夏 甘草 藿香
呕吐属胃，此方以干葛、竹茹清胃，广皮、甘草和胃。无涎不成呕，故加半夏化痰涎。应
辛散者，加生姜；应清火者，加栀、连、白豆蔻；若带表症，加各经表药；若和中气，加
藿香、浓朴；若饱闷有食滞，加消导之药。
黄连汤 见腹痛。
胃寒而吐，用理中汤、吴茱萸汤。胃热而吐，用黄连汤。若热痰呕吐，栀连二陈汤。食滞
热呕，栀连保和散。口渴热呕，合干葛石膏汤。
黄芩加半夏生姜汤
太阳少阳合病，当用桂枝柴胡黄芩汤。今见呕吐，故加半夏、生姜。
干姜黄连黄芩汤
干姜 黄连 黄芩 人参
此方寒热并用，统治误下致呕者。加广皮、半夏，即合泻心汤方法。
Sound without vomitus is termed "Ou" (retching); vomitus without sound is termed "Tu" (vomiting); both vomitus and sound constitute "Ou Tu" (vomiting). Zhang Zhongjing's text mentions "Gan Ou" (dry retching), which refers to retching without expelling solid matter. Regarding vomiting syndromes, when analyzed from the perspective of internal injury, the pathology resides in the Yangming Stomach; when analyzed from the perspective of external contraction, there are specific clauses for differentiation.
If there is aversion to cold and fever, with a floating and rapid pulse, and initially chest fullness accompanied by vomiting, this indicates Taiyang exterior wind-cold invasion with phlegm-fluid retention in the Stomach. Treatment should employ Qianghuo Tang (Notopterygium Decoction) to disperse Taiyang exterior pathogens, combined with Baohe Wan (Preserve Harmony Pill) and Pingwei San (Calm the Stomach Powder) plus Gegen (Kudzu Root), to resolve phlegm-fluid and food stagnation in the Stomach.
If there are alternating chills and fever, vomiting, and bitter taste in the mouth, with a wiry and rapid pulse, this is Shaoyang channel exterior pathogen causing vomiting and bitter taste, treated with Xiaochaihu Tang (Minor Bupleurum Decoction).
If initially accompanied by abdominal distension and vomiting, this also indicates food accumulation in the Stomach, assisted by Baohe Wan and Pingwei San.
If there is eye pain and nasal dryness, thirst preceding vomiting, absence of sweating, and a large floating pulse, this indicates Yangming exterior pathogen with interior accumulated heat, treated with Gegen Qingwei Fa (Kudzu Clearing Stomach Method).
If there is sweating and a rapid pulse, vomiting with polydipsia (or rapid consumption of fluids), this is dryness-fire vomiting, treated with Zhi Mu Shigao Tang (Anemarrhena and Gypsum Decoction) mixed with Zhuli (Bamboo Shavings) and Lugen (Reed Rhizome) juice.
If vomiting occurs without thirst and body temperature is not significantly elevated, this is damp-fire vomiting, treated with Zhilian Banxia Tang (Gardenia and Coptis Pinellia Decoction) added with Baixiandoukou (White Cardamom), Houpo (Magnolia Bark), and Zhuru (Bamboo Shavings).
If nausea and vomiting occur, with six pulses being slippery and large but not rapid, fever present but mouth not thirsty, this is vomiting due to phlegm-fluid and food accumulation, treated with Pingwei Baohe San (Calm Stomach Preserve Harmony Powder) and Erchen Daotan Tang (Two-Aged Phlegm-Expelling Decoction) added with Gegen and Zhuru.
If there is foul breath, toothache, and red, scanty, difficult urination and defecation, this is vomiting due to accumulated heat and phlegm-fire, treated with Shengma Qingwei Tang (Cimicifuga Clearing Stomach Decoction), Erchen Tang, Zhuru Tang, added with Chuanlian (Coptis Rhizome) and Baixiandoukou.
If there is stabbing pain in the hypochondrium and vomiting of sour fluid, this is vomiting caused by Liver Wood fire rushing upward, treated with Xiaochaihu Tang added with Zhizi (Gardenia), Lian (Coptis), and Zhuru.
In summary, without phlegm-fluid, there is no vomiting. Therefore, vomiting in febrile diseases is caused by phlegm-fluid and fire pathogens rushing upward. Use Zhuru and Banxia to transform phlegm-fluid, and Zhizi and Lian to clear Stomach fire. The family secret formula uses Zhuru Banxia Tang (Bamboo Shavings and Pinellia Decoction) added with Zhizi, Lian, and Baixiandoukou, which stops vomiting immediately.
If it is a seasonal febrile disease (epidemic febrile disease), where sweating does not resolve the condition, accompanied by cold feet, deafness, restlessness, cough, and vomiting, this is vomiting due to epidemic toxin, treated with Qiangdu Baidu San (Notopterygium and Angelica Detoxification Powder), Shengma Gegen Tang, or Shengma Qingwei Tang.
If vomiting is caused by dryness-pathogen epidemic, add Zhi Mu, Shigao, Zhuli, Banxia, mixed with Lugen juice and raw pear juice, taken hot.
Formulary texts state: Vomiting patients often consume fresh ginger; this refers specifically to vomiting due to Stomach cold and phlegm-fluid. If the Stomach is hot, failing to use it with Chuanlian (Coptis) would surely exacerbate the disease! Only vomiting due to Stomach cold in the Three Yin channels warrants the use of Warming agents like Lizhong Tang (Regulate the Middle Decoction). This book focuses on Shanghan (Cold Damage) and febrile diseases; thus, non-febrile vomiting in the Three Yin channels is detailed separately in *Zhengyin Maizhi* (Syndrome, Etiology, and Pulse Diagnosis).
Taiyang Wind Strike syndrome presents with a floating yang and weak yin pulse. Floating yang indicates spontaneous heat generation; weak yin indicates spontaneous sweating. Symptoms include severe aversion to cold, chilly aversion to wind, mild fever, nasal congestion with dry retching, treated with Guizhi Tang (Cinnamon Twig Decoction).
Floating pulse with spontaneous sweating and mild fever constitutes Taiyang Wind Strike syndrome; therefore, resolving muscle layer and releasing the exterior will stop vomiting naturally.
Those who vomit after taking Guizhi Tang will subsequently expectorate pus and blood.
Vomiting after taking Guizhi Tang indicates Stomach heat. Stomach heat aggravated by Guizhi Tang leads to expectoration of pus and blood.
After inducing sweating, if water and medicine cannot be kept down, it is a counter-indication (Ni). Further sweating will inevitably lead to continuous vomiting and diarrhea.
When Taiyang heat binds in the Bladder, treating lower-jiao symptoms with exterior-releasing methods is counter-indicated, hence water and medicine cannot enter. Re-sweating will cause Qi to rebel upward, leading to unceasing vomiting and purging.
Wind strike with fever persisting for six to seven days with vexation, presenting both exterior and interior symptoms, thirst desire to drink, but vomiting immediately upon drinking, is named "Shui Ni" (Water Counterflow). It is primarily treated with Wuling San (Five-Ingredient Poria Powder). Drinking warm water frequently induces sweating and cure.
This clause clarifies the application of Wuling San for Taiyang heat binding in the Bladder causing exterior-interior vomiting and counterflow.
Taiyang Wind Strike with diarrhea and vomiting/counterflow can only be attacked internally after the exterior is resolved. If the patient has sweating occurring at intervals, headache, epigastric hardness/fullness radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized. It is treated with Shizao Tang (Ten Jujube Decoction).
Taiyang Wind Strike with diarrhea and vomiting/counterflow, where exterior pathogens are resolved, accompanied by hypochondriac pain, dry retching, and shortness of breath, indicates concurrent Xuan Yin (suspended fluid), suitable for Shizao Tang.
Taiyang disease, whether fever has already appeared or not, must present with aversion to cold, heavy body, vomiting/counterflow, and tight pulses at both Yin and Yang positions.
This clause clarifies the vomiting/counterflow syndrome of Cold damaging the Ying level, characterized by fever, aversion to cold, heavy painful body, vomiting/counterflow without sweating, and tight pulses at both Yin and Yang positions.
In Shanghan, on the second or third day, if there is palpitation and vexation in the heart region, it is treated with Xiaojianzhong Tang (Minor Construct the Middle Decoction). Vomiting patients should not use Jianzhong Tang because sweetness obstructs the diaphragm.
The original text discusses treatment for palpitation and vexation, introducing medication contraindications for vomiting patients, avoiding sweet substances that clog the diaphragm.
In Shanghan with fever, sweating that does not resolve, epigastric hardness, vomiting, and diarrhea, Dachaihu Tang (Major Bupleurum Decoction) is used.
Epigastric hardness with diarrhea indicates a downward-draining indication using the method of "treating obstruction with draining agents." However, with concurrent fever and vomiting, only Dachaihu Tang is applicable.
In Shanghan lasting six to seven days, with fever, aversion to cold, limb joint irritability/pain, slight vomiting, subcostal support/congestion, and unresolved exterior symptoms, Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is used.
See detailed notes under Aversion to Cold. For Taiyang and Shaoyang channels where exterior pathogens remain with slight vomiting, Chaihu Guizhi Tang is employed.
In Shanghan, with heat in the chest and pathogenic factors in the Stomach, abdominal pain, and desire to vomit, Huanglian Tang (Coptis Decoction) is used.
"Heat in the chest, pathogen in the Stomach, abdominal pain" describes damp-heat rushing upward causing vomiting; thus, Huanglian Tang treats fire counterflow. Previous texts incorrectly annotated "pathogen" as cold qi.
After vomiting in Shanghan, if abdominal distension and fullness occur, Tiaowei Chengqi Tang (Regulate the Intestines and Descend Qi Decoction) is given.
Although abdominal distension is an indication for purgation, after vomiting, only Tiaowei Chengqi Tang is appropriate.
In Shanghan with frequent vomiting, even if Yangming symptoms exist, purgation must not be used.
Vomiting belongs to Upper Jiao pathology; even with Yangming interior symptoms, purgation is contraindicated.
Desire to vomit after eating grain indicates Yangming disease, treated with Wuzhuyu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, the pathology is in the Upper Jiao.
Desire to vomit after eating resembles Stomach cold in Yangming. If symptoms worsen after taking warming medicines, it indicates Upper Jiao heat pathogen.
In Shanghan or wind strike after five to six days, with alternating chills and fever, fullness in the chest and hypochondrium, silent desire not to eat, vexation and preference for vomiting, or chest vexation without vomiting, or thirst, or abdominal pain, or hypochondriac hardness, or palpitation in the heart region, inadequate urination, or no thirst with slight body heat, or cough, Xiaochaihu Tang is used.
This clause details Shaoyang wind strike, where pathogen is half-exterior half-interior, silent lack of appetite, vexation, and preference for vomiting, treated with modified Xiaochaihu Tang.
In simultaneous Taiyang and Yangming disease, if there is no diarrhea but only vomiting, Gegen Banxia Tang (Kudzu and Pinellia Decoction) is used. In simultaneous Taiyang and Yangming disease, if there is spontaneous diarrhea, Gegen Tang (Kudzu Decoction) is used.
Both clauses involve simultaneous Taiyang-Yangming disease. Differentiation lies in vomiting without diarrhea indicating pathology in Foot Yangming Stomach, while diarrhea without vomiting indicates pathology in Hand Yangming Large Intestine. Both use Gegen Tang; adding Banxia demonstrates harmonizing the Stomach and stopping vomiting; removing Banxia allows ascending and dispersing Large Intestine wind pathogen sinking inward.
In simultaneous Taiyang and Shaoyang disease with spontaneous diarrhea, Huangqin Tang (Scutellaria Decoction) is given. If vomiting occurs, Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction) is used.
Simultaneous Taiyang-Shaoyang disease with diarrhea: if no vomiting, Huangqin Tang is used. If vomiting, Banxia and Shengjiang are added to Huangqin Tang. These two chapters mutually elaborate on vomiting syndromes, emphasizing the necessity of Banxia and Shengjiang.
Taiyang disease manifests as abdominal fullness and vomiting, inability to eat, worsening spontaneous diarrhea, intermittent abdominal pain. If purgation is mistakenly used, chest fullness and knotting/hardness will result.
This clause describes Taiyang channel with exterior heat and interior cold causing vomiting and diarrhea. Mistaken purgation leads to chest fullness and knotting.
In Shanghan originally suffering from cold-type diarrhea, if the physician erroneously applies vomiting and purgation, cold rejection causes further counterflow of vomiting and purging. If food is vomited immediately upon entering the mouth, Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is used.
Shanghan implies febrile disease; if Yin syndrome involves spontaneous cold diarrhea, vomiting and purgation would be fatal. How could one use Huangqin and Huanglian? Since the patient has exterior heat and interior cold with diarrhea, and the physician mistakenly recognizes it as heat-binding, applying vomiting and purgation again causes cold rejection and immediate vomiting of food. Thus, Ganjiang warms the cold, while Huangqin and Huanglian curb the heat.
Vomiting with fever is treated with Xiaochaihu Tang.
Vomiting with fever indicates Yang pathogen transmitting to Shaoyang, hence Xiaochaihu Tang is used.
Qianghuo Chonghe Tang See Fever.
Baohe Pingwei San
For vomiting with exterior pathogens, use the previous formula; for food stagnation, use this formula for digestion and guidance.
Xiaochaihu Tang
Xiaochaihu Tang contains Chaihu and Huangqin, but lacks Zhuru and Zhishi; Qingdan Tang contains Zhuru and Zhishi, but lacks Chaihu and Huangqin. Adding these two ingredients combines the two formulas. Adding Huoxiang and Houpo benefits the Stomach and stops vomiting.
Gegen Qingwei Tang
Gegen, Shigao, Prepared Banxia, Houpo, Guangpi, Gancao
Gegen releases the exterior, Shigao clears the interior. Added Banxia, Houpo, and Guangpi transform phlegm-fluid, harmonize the Stomach, and stop vomiting.
Qiangdu Baidu San See Fever.
This formula disperses exterior pathogens; once epidemic toxins are dispersed, vomiting stops, hence it is called Baidu San (Detoxification Powder).
Shengma Gegen Tang See Fever.
Epidemic pathogen and Sha (scarlet fever/toxin) lying dormant in Yangming Stomach channel causing vomiting; this formula ascends and disperses Yangming, allowing Sha to emerge and vomiting to cease.
Cangpu Daotan Tang
Phlegm-fluid and water-dampness lurking in the Stomach often cause vomiting; thus, drying dampness and transforming phlegm is used. Do not casually use drying herbs for non-external febrile diseases.
Zhilian Erchen Tang
The previous formula treats phlegm without fire; this formula adds Chuanlian, Baixiandoukou, Zhuru, and Houpo to treat phlegm with fire.
Zhuru Tang
Zhuru, Gegen, Chenpi, Banxia, Gancao, Huoxiang
Vomiting belongs to the Stomach. This formula uses Gegen and Zhuru to clear the Stomach, Guangpi and Gancao to harmonize the Stomach. Without phlegm-fluid, vomiting does not occur; thus, Banxia is added to transform phlegm-fluid. For pungent dispersion, add Shengjiang; for clearing fire, add Zhizi, Lian, and Baixiandoukou; if exterior symptoms are present, add exterior-releasing herbs for respective channels; for harmonizing Middle Qi, add Huoxiang and Houpo; for fullness and food stagnation, add digestive and guiding herbs.
Huanglian Tang See Abdominal Pain.
Stomach cold with vomiting uses Lizhong Tang and Wuzhuyu Tang. Stomach heat with vomiting uses Huanglian Tang. Heat-phlegm vomiting uses Zhilian Erchen Tang. Food-stagnation heat vomiting uses Zhilian Baohe San. Thirsty heat vomiting combines with Gegen Shigao Tang.
Huangqin Banxia Shengjiang Tang
For simultaneous Taiyang-Shaoyang disease, Guizhi Chaihu Huangqin Tang should be used. Since vomiting is present, Banxia and Shengjiang are added.
Ganjiang Huanglian Huangqin Tang
Ganjiang, Huanglian, Huangqin, Renshen
This formula uses cold and heat together, universally treating vomiting caused by mistaken purgation. Adding Guangpi and Banxia aligns with the method of Xiexin Tang (Drain the Epigastrium Decoction).