按灵枢经脉篇云。足厥阴肝所生病者。胸满呕逆。夫木动必犯土。呕吐出于胃。而
致病之由在肝。胃病治肝。不拘伤寒杂症皆然。不可专以胃火胃寒为治。
邵评∶呕吐为胃气上逆。其胃气之所以上逆。因肝木犯胃所致。夫呕吐之因不
一。有胃阴亏者。有胃阳虚者。有胃火盛而热邪内结者。有胃中寒而浊阴干犯
者。有胃中有痰饮而气不下降者。虽有多因。总因肝火上升。乘虚犯胃。以木土
相仇。肝木克土。而顺乘阳明也。治呕吐者。当两和肝胃为法。
肝火犯胃 凡痞胀。食入即吐。并呕酸水。口渴舌黄。此肝火犯胃。恒因恼怒而得。
宜吴萸、川连、半夏、茯苓、浓朴、枳实、姜汁、竹茹之类主之。
邵评∶此方平肝火而和胃。最效。
胃火冲逆 凡阳明热病。舌苔燥黄。烦渴呕恶。脉来洪滑。米饮入口即呕。惟凉水
可纳者。宜白虎汤。重加活水芦根主之。
邵评∶此方清胃经火热。极效。
肝火冲逆 凡伤寒热盛之时。自觉气自左升。呕吐。勺水不纳。脉弦数。舌燥刺。或
呕吐酸苦黄水。此肝火上乘于胃。宜左金、半夏、陈皮、黑栀、（姜汁炒）茯苓、椒梅等。降之
泄之。或用姜汁炒川连。或用吴萸汤炒川连。治呕最验。
胃脘阳虚 凡食入呕吐。或纳少不变。脉细小而弦。或右脉弦大。脘中满痛。大便
欲解未通。此胃脘阳虚。肝木未亢。治宜专益胃阳。人参、半夏、茯苓、陈皮、干姜、吴萸主之。
胃气不降 夫脾主升。胃主降。若因怫怒动肝。肝木犯胃。胃阳受伤。不能传及小肠。变化失司。
大便不解。纳谷不饥。吞噫酸水。甚至胃底酿积之物。上涌为吐。此胃气不主下行故也。法当温胃阳
制肝逆为治。宜熟附、干姜、白芍、吴萸、枳实、炒白粳米主之。
邵评∶脾以上升为宜。胃以下行为顺。因怒动肝。肝逆乘胃。胃气不得下行。食不
变化。挟肝火上升而呕吐也。此与上条不同。上条只胃脘阳虚。无肝木乘侮。专
理胃阳为治。此则胃阳受伤。因怒而肝火上升犯胃。故吞噫酸水。酸为肝味也。
胃升不降。甚至胃底上泛。涌逆吐出。其胃阳之衰弱已极。肝木之亢逆莫制。几
有胃阳虚脱之变。急当温胃通阳。制肝降逆为治。
肝逆犯肺 凡病气自左升。腹中膨胀。呕吐涎沫酸苦黄水。则咳呛不已。此肝气
逆乘。过胃犯肺。法宜制肝和胃。须陈皮、半夏、茯苓、川椒、乌梅、萸汤炒川连。姜汁炙枇杷叶主之。
邵评∶气自左升者。肝气也。肝气升则为腹胀。犯胃上逆。则吐涎沫酸苦黄水。肝
挟相火。木火刑金。乘肺而作咳呛。已过胃而上升莫制矣。宜平肝和胃治之。
阴浊犯胃 有气从小腹上冲。为呕为胀。所吐皆黑绿苦水。此属下焦阴浊。冲逆
犯胃。厥阴秽气上逆也。宜川椒、乌梅、连制茱萸、茯苓、川楝子、（醋炒）小茴香、（盐水炒）黑
栀子（姜汁炒）等。以制肝逆。胃气虚者加人参。
邵评∶少腹为肝之部分。肝居下焦。其气上冲。则浊阴随之上逆。故呕而且胀。吐
出黑绿苦水。是胃底之浊水。被下焦之阴浊冲逆而上泛也。急当镇胃平肝。通阳泄浊治之。
肝络伏饮 凡气冲偏左。厥逆欲呕。呕尽方适。此伏饮在于肝络也。宜辛以通之。
淡吴萸、（盐水炒）半夏、茯苓、姜汁、旋复花、代赭石主之。
邵评∶肝主一身脉络。从左上冲者。肝气也。肝挟饮邪上逆。入于络中。则厥而呕吐。宜和肝宣络涤饮治之。
热邪内结 痞闷呕浊。不寐不饥。舌黄口渴。治宜苦辛泻心法。黄芩、川连、半夏、枳实、姜汁。
邵评∶热邪痞结阳明。治以苦辛开泄。
暑秽内结 吸入暑秽。先走募原。募原是胃络分布。故上逆而为呕吐。脘闷而痛。
寒热不解。舌黄而渴。宜泻心法。姜制川连、黄芩、半夏、枳实、藿梗、滑石、通草、郁金。
邵评∶暑秽自口鼻吸受。从上直行中道而走膜原。膜原者。脾与胃以膜相联。为
半表半里之界。暑热秽邪。结于膜原。而呕吐寒热。宜苦辛开泄治之。然惟舌黄可用泻心法。
又评∶舌白苔者。不宜陷胸、泻心。宜杏、蔻、桔、橘。苦辛开肺。如邪入膜原。舌苔粉白。
当用吴又可达原饮。舌黄腻浓者。非泻心不可。
湿热相蒸 胃中有火。脾家有湿。湿热相蒸。以致呕吐不纳。时饱时饥。渴不多饮。
舌苔微黄粘腻。此胃热蒸脾湿之验也。治宜寒热兼施。川连、干姜、茯苓、半夏、广皮、黄芩、泽泻、枳实、姜汁。
邵评∶脾湿胃热。蕴结中宫。格拒不开而作呕吐。治以和中开痞。清渗湿热为主。
痰饮兼寒 呕吐不渴。舌苔白滑。或兼咳嗽者。此痰饮兼寒邪也。二陈汤加桂枝、干姜、姜汁。
邵评∶寒饮内伏于胃。上升射肺。故呕吐咳嗽。寒邪有饮。则口不渴。白滑苔者。寒痰也。故用涤痰温散之法。
痰饮兼火 呕吐微渴。兼见咳嗽。舌苔淡红而鲜。或带微白者。此痰饮兼胃火也。
温胆汤加枇杷叶、（姜汁炙）黑栀子。（姜汁炒）
邵评∶和胃化痰。宣肺清热。此方极效。
胃中虚寒 纳谷不受。时呕涎沫。舌润不渴。右关濡软。六君子、加砂仁、干姜、呕涎
沫者。加益智仁摄之。吐痰饮者。加桂枝、姜皮和之。
邵评∶寒邪格拒不纳。有寒饮则呕涎沫。无热则舌润不渴。脉濡软。胃虚也。故用补中化痰而温散。
热伤胃津 暑热之邪不解。灼干胃中津液。舌红鲜泽。口渴。食入即呕。当戒腥油
腻物。二陈汤去甘草。加钗斛、姜汁炒竹茹。或温胆汤去枳实、甘草。加栀豉、金斛。
邵评∶湿热暑疫之邪。入于阳明。胃中津液受伤。而呕吐津亏。胃热则舌鲜红而
口渴。故以和胃生津化痰为治。
胃阴虚馁 如大汗后。胃中津液大虚。呕吐不纳。口渴。舌苔白嫩者。宜金水六君
煎。加麦冬、沙参。以和胃阴。
呕吐不已 此有升无降。宜镇逆法。 旋复花、代赭石、半夏、茯苓、会皮。虚者加人
参。
邵评∶胃不下行而上逆。气升呕吐。用镇逆降胃之法。极是。
According to the *Ling Shu: Jing Mai* chapter, diseases occurring in the Foot Jueyin Liver meridian include chest fullness and vomiting with reverse qi. When Wood (Liver) moves, it inevitably invades Earth (Spleen/Stomach). Although vomiting manifests in the Stomach, the root cause of the disease lies in the Liver. Treating Stomach diseases requires addressing the Liver; this applies to both Shanghan (Cold Damage) and miscellaneous diseases. One should not treat solely based on Stomach Fire or Stomach Cold.
Shao's Commentary: Vomiting is the upward reversal of Stomach Qi. The reason Stomach Qi reverses upward is due to Liver Wood invading Stomach Earth. The causes of vomiting are diverse: there are cases of deficient Stomach Yin, deficient Stomach Yang, excessive Stomach Fire with internal binding of heat pathogens, cold in the Stomach with dryness of turbid Yin invading, and phlegm-fluids in the Stomach preventing Qi from descending. Although there are many causes, they generally stem from Liver Fire rising and invading the Stomach when deficiency exists, causing Wood and Earth to conflict, with Liver Wood overacting on Spleen Earth, and subsequently affecting the Yangming Stomach channel. To treat vomiting, one should employ methods to harmonize the Liver and Stomach.
**Liver Fire Invading the Stomach**: Symptoms such as epigastric stuffiness and distension, immediate vomiting after eating, vomiting sour water, thirst, and a yellow tongue coating indicate Liver Fire invading the Stomach. This often arises from anger. It is appropriate to use herbs such as Evodiae Fructus (Wuzhuyu), Coptidis Rhizoma (Chuanlian), Pinelliae Tuber (Banxia), Poria (Fuling), Magnoliae Officinalis Cortex (Houpo), Immature Bitter Orange (Zhishi), Ginger Juice (Jiangzhi), and Bamboo Shavings (Zhuru).
Shao's Commentary: This formula pacifies Liver Fire and harmonizes the Stomach, being most effective.
**Stomach Fire Rushing Upward**: In Yangming Heat diseases, if the tongue coating is dry and yellow, accompanied by irritability, thirst, nausea, and vomiting, with a surging and slippery pulse, and even rice water is vomited immediately upon entry while only cool water can be retained, Baihu Tang (White Tiger Decoction) should be used, heavily supplemented with fresh Reed Rhizome (Lugen).
Shao's Commentary: This formula clears Heat-Fire from the Stomach meridian, being extremely effective.
**Liver Fire Rushing Upward**: During the phase of intense heat in Shanghan, if one feels Qi rising from the left side, accompanied by vomiting, inability to retain even a spoonful of water, a wiry and rapid pulse, a dry and prickly tongue, or vomiting of sour, bitter, and yellow fluids, this indicates Liver Fire ascending to invade the Stomach. Zuojin Wan (Left Metal Pill), Banxia, Chenpi, Gardeniae Fructus (Heizhi, stir-fried with ginger juice), Fuling, and Zhaomei (Pepper Plum) are suitable. Employ descending and purging methods, or use Chuanlian stir-fried with ginger juice, or Chuanlian stir-fried with Wuzhuyu Tang decoction. These are highly verified for treating vomiting.
**Deficiency-Cold of the Epigastrium**: If vomiting occurs after eating, or food intake is low and undigested, with a fine and wiry pulse, or a wiry and large right pulse, epigastric fullness and pain, and a sensation of needing to defecate but failing to do so, this indicates Deficiency-Cold of the Epigastrium without hyperactive Liver Wood. Treatment should focus specifically on tonifying Stomach Yang, using Ginseng Radix et Rhizoma (Renshen), Banxia, Fuling, Chenpi, Zingiberis Rhizoma (Ganjiang), and Evodiae Fructus (Wuzhuyu).
**Failure of Stomach Qi to Descend**: The Spleen governs ascending, and the Stomach governs descending. If anger stirs Liver Qi, causing Liver Wood to invade the Stomach and damage Stomach Yang, transmission to the Small Intestine fails, and transformation and transportation are disrupted. This leads to constipation, lack of appetite, belching with sour taste, and even the upsurge of accumulated matter in the stomach fundus resulting in vomiting. This is because Stomach Qi fails to descend. The method should be to warm Stomach Yang and restrain Liver rebellion, using Prepared Aconite Lateralis Radix (Shufu), Ganjiang, Paeoniae Radix Alba (Baishao), Wuzhuyu, Zhishi, and stir-fried Oryza Sativa Semen (Baijingmi).
Shao's Commentary: Spleen Qi should ascend, and Stomach Qi should descend smoothly. Anger stirs Liver Qi, which rebels and attacks the Stomach, preventing Stomach Qi from descending. Food fails to transform, carrying Liver Fire upward, causing vomiting. This differs from the previous section; the previous case was merely Epigastric Yang Deficiency without Liver Wood overacting, treated by regulating Stomach Yang alone. This case involves damaged Stomach Yang where anger causes Liver Fire to rise and invade the Stomach, leading to sour belching (sourness is the flavor of the Liver). With Stomach Qi rising but not descending, and fundus contents flooding upward, Stomach Yang is extremely weak, and Liver Wood rebellion is unchecked, approaching a state of Stomach Yang collapse. Urgent treatment is required to warm and unblock Stomach Yang, restrain Liver, and descend rebellion.
**Liver Rebellion Invading the Lung**: If Qi rises from the left, abdominal distension occurs, and vomiting of saliva, sour/bitter/yellow fluids leads to incessant coughing and wheezing, this is Liver Qi rebelling and attacking, passing through the Stomach to invade the Lung. The method should restrain the Liver and harmonize the Stomach, using Chenpi, Banxia, Fuling, Zanthoxyli Fructus (Chuanjiao), Mume Fructus (Wumei), Chuanlian stir-fried with Wuzhuyu Tang, and Loquat Leaf (Pipaye) roasted with ginger juice.
Shao's Commentary: Qi rising from the left is Liver Qi. Rising Liver Qi causes abdominal distension; invading the Stomach and reversing upward causes vomiting of saliva and sour/bitter/yellow fluids. The Liver carries Ministerial Fire, and Wood-Fire insults Metal, attacking the Lung to cause coughing. This has passed the Stomach and risen uncontrollably. Pacify the Liver and harmonize the Stomach.
**Yin Turbidity Invading the Stomach**: If Qi rushes upward from the lower abdomen causing vomiting and distension, and the vomitus is black-green bitter fluid, this belongs to Lower Jiao Yin Turbidity rushing up to invade the Stomach, representing Jueyin foul Qi reversing upward. Use Zanthoxyli Fructus, Wumei, Processed Evodiae Fructus (Zhi Zhuyu), Fuling, Toosendan Fructus (Chuanlianzi), stir-fried Cuminum Cyminum Seed (Xiaohuixiang with vinegar), and stir-fried Gardeniae Fructus (Heizhi with salt water and ginger juice) to restrain Liver rebellion. Add Ginseng if Stomach Qi is deficient.
Shao's Commentary: The lower abdomen is part of the Liver's domain. The Liver resides in the Lower Jiao; its Qi rushing upward causes turbid Yin to reverse upward, resulting in vomiting and distension. Vomiting black-green bitter fluid indicates turbid water from the stomach fundus being flushed up by Lower Jiao Yin Turbidity. Urgently calm the Stomach, pacify the Liver, unblock Yang, and drain turbidity.
**Hidden Fluids in Liver Collaterals**: If Qi rushes to the left, extremities are cold and one desires to vomit, feeling comfortable only after vomiting, this indicates hidden fluids residing in the Liver collaterals. Use acrid substances to unblock them. Use mild Evodiae Fructus (Dan Wuzhuyu), stir-fried Banxia, Fuling, Jiangzhi, Inulae Flos (Xuanfuhua), and Haematitum (Daizheshi).
Shao's Commentary: The Liver governs the body's collaterals. Qi rushing up from the left is Liver Qi. Liver carrying fluid pathogens reverses upward into the collaterals, causing coldness and vomiting. Harmonize the Liver, open the collaterals, and eliminate fluids.
**Internal Binding of Heat Pathogens**: Epigastric stuffiness, vomiting of turbid matter, insomnia, lack of appetite, yellow tongue coating, and thirst. Treat with the Acrid-Bitter Heart-Purging method. Use Scutellariae Radix (Huangqin), Coptidis Rhizoma (Chuanlian), Banxia, Zhishi, and Jiangzhi.
Shao's Commentary: Heat pathogens bind in Yangming; treat with Acrid-Bitter opening and draining.
**Internal Binding of Summer-Heat Filth**: Inhalation of summer-heat filth first travels to the Mouyuan (Membrane Source). The Mouyuan is where Stomach collaterals distribute, so it reverses upward causing vomiting, epigastric stuffiness and pain, unresolved chills and fever, yellow tongue coating, and thirst. Use the Xixin Fa (Heart-Purging Method). Use ginger-processed Coptidis Rhizoma, Huangqin, Banxia, Zhishi, Agastache Herba (Huogeng), Talcum (Huashi), Akebia Caulis (Tongcao), and Curcumae Longae Rhizoma (Yujin).
Shao's Commentary: Summer-heat filth enters via mouth and nose, traveling straight down the middle path to the Membrane Source. The Membrane Source is the boundary between exterior and interior where the Spleen and Stomach connect via membranes. Summer-heat filth binds here, causing vomiting, chills, and fever. Treat with Acrid-Bitter opening and draining. However, the Xixin Fa is only applicable when the tongue coating is yellow.
Additional Commentary: If the tongue coating is white, Xianxiong Tang (Chest-Sinking Decoction) and Xixin Fa are contraindicated; use Apricot Kernel (Xingren), Amomum Fruit (Kouren), Platycodon Root (Jiegeng), and Tangerine Peel (Jupi) to open the Lung with Acrid-Bitter methods. If pathogens enter the Membrane Source and the coating is powdery white, use Wu Youke's Daoyin Yin (Origin-Reaching Decoction). If the coating is yellow, greasy, and thick, the Xixin Fa is indispensable.
**Steaming of Damp-Heat**: Fire in the Stomach and Dampness in the Spleen steam each other, causing vomiting, anorexia, alternating satiety and hunger, thirst with little desire to drink, and a slightly yellow, sticky tongue coating. This verifies Stomach Heat steaming Spleen Dampness. Treat with simultaneous Cold and Hot methods. Use Chuanlian, Ganjiang, Fuling, Banxia, Guangpi, Huangqin, Alisma Rhizoma (Zexie), Zhishi, and Jiangzhi.
Shao's Commentary: Spleen Dampness and Stomach Heat accumulate in the Middle Jiao, blocking and refusing to open, causing vomiting. Treat by harmonizing the center, resolving stuffiness, and clearing/drainage of Damp-Heat.
**Phlegm-Fluids Accompanied by Cold**: Vomiting without thirst, white and slippery tongue coating, possibly with coughing. This is Phlegm-Fluids combined with Cold pathogens. Use Erchen Tang (Two-Aged Decoction) plus Guizhi Tang (Cinnamon Twig Decoction) components (Guizhi), Ganjiang, and Jiangzhi.
Shao's Commentary: Cold fluids hide in the Stomach, rising to shoot into the Lung, causing vomiting and coughing. With Cold pathogens and fluids, there is no thirst. A white-slippery coating indicates Cold Phlegm. Therefore, use methods to eliminate phlegm and disperse cold.
**Phlegm-Fluids Accompanied by Fire**: Vomiting with slight thirst, accompanied by coughing, pale red and bright tongue coating, or slightly white. This is Phlegm-Fluids combined with Stomach Fire. Use Wendan Tang (Warm the Gallbladder Decoction) plus Pipaye (roasted with ginger juice) and Heizhi (stir-fried with ginger juice).
Shao's Commentary: Harmonize the Stomach, resolve phlegm, ventilate the Lung, and clear Heat. This formula is extremely effective.
**Deficiency-Cold in the Stomach**: Inability to receive food, occasional vomiting of saliva, moist tongue without thirst, soft and soggy right Guan pulse. Use Liujunzi Tang (Six-Gentlemen Decoction) plus Amomi Fructus (Sharen) and Ganjiang. For vomiting saliva, add Alpinia Oxyphylla Fructus (Yizhiren) to secure. For vomiting phlegm-fluids, add Guizhi and Zingiberis Pericarpium (Jiangpi) to harmonize.
Shao's Commentary: Cold pathogens block and refuse intake; with cold fluids, saliva is vomited. Without heat, the tongue is moist and there is no thirst. A soft pulse indicates Stomach deficiency. Therefore, tonify the center, resolve phlegm, and disperse cold.
**Heat Damaging Stomach Fluids**: Unresolved summer-heat pathogens scorch and dry Stomach fluids, resulting in a bright red tongue, thirst, and immediate vomiting after eating. Avoid greasy and oily foods. Use Erchen Tang minus Licorice Root (Gancao), plus Dendrobii Caulis (Chahu/Dendrobium) and stir-fried Zhuru. Alternatively, use Wendan Tang minus Zhishi and Gancao, plus Gardeniae Fructus (Zhizi) and Fermented Soybean (Chidouchi) and Jinhu.
Shao's Commentary: Damp-heat and summer-plague pathogens enter Yangming, damaging Stomach fluids, leading to vomiting and fluid depletion. Stomach Heat causes a bright red tongue and thirst. Therefore, treat by harmonizing the Stomach, generating fluids, and resolving phlegm.
**Deficiency of Stomach Yin**: After profuse sweating, if Stomach fluids are greatly depleted, causing vomiting, anorexia, thirst, and a tender white tongue coating, use Jinshui Liu Jun Jian (Golden Water Six-Gentlemen Decoction) plus Ophiopogonis Radix (Maidong) and Glehniae Radix (Shashen) to harmonize Stomach Yin.
**Incessant Vomiting**: This is rising without descending. Use the Suppressing Rebellion Method. Use Xuanfuhua, Daizheshi, Banxia, Fuling, and Chenpi. Add Renshen for deficiency.
Shao's Commentary: Stomach Qi does not descend but reverses upward; Qi rises causing vomiting. Using methods to suppress rebellion and descend Stomach Qi is very correct.