猪膏半斤 乱发如鸡子大三枚
右二味，和膏中煎之，发消药成，分再服，病从小便出。
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诸黄，腹满而呕者，宜柴胡汤。
【注】
呕而腹痛，胃实热也，然必有潮热便□，始宜大柴胡汤两解之。若无潮热便软，则当
用小柴胡汤去黄芩加芍药和之可也。
【集注】
程林曰：呕而腹满，视其前后，知何部不利，利久则愈。今黄家腹痛而呕，应内有实
邪，当是大柴胡汤以下之。若小柴胡，则可止呕，未可疗腹痛也。
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夫呕家有痈脓，不可治呕，脓尽自愈。
【注】
呕家，呕吐或谷、或水、或痰涎、或冷沫，今呕而有脓，此内有痈，脓溃而呕，非呕
病也，故曰：不可治呕，脓尽自愈。
【集注】
赵良曰：经云：热聚于胃口而不行，胃脘为壅，胃脘属阳明经，阳明气逆则呕，故脓
不自欬出，从呕而出，此痈之在胃脘上口者也。若过半中，在肺之下者，脓则不从呕
出而从大便出矣。
程林曰：夫痈溃则为脓，脓上出必令呕，故不必治其呕，脓尽则呕自止也。
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先呕□渴者，此为欲解；先渴□呕者，为水停心下，此属饮家。
【注】
呕病后渴饮而不呕，为胃气和，此欲解也。因渴而后呕，呕而复渴，为水停心下，此
属饮家之呕，非呕病也。
【集注】
赵良曰：呕则饮去，饮去则阳气回，津液犹未布，故渴耳。虽渴，终以邪去正回而必
解也。先渴□呕者，即前痰饮条中，小半夏茯苓汤之证也。
程林曰：先呕□渴者，为呕后而胃无津液，得水和之即愈；先渴□呕者，本渴而饮水
，水停胃中作呕也，故属水饮。
尤怡曰：呕家必有停痰宿水，先呕□渴者，痰水已去，而胃气将复也，故曰：此为欲
解。先渴□呕者，因热饮水过多，热虽解而饮旋积也，此呕因积饮所致，故曰：此为
饮家。
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呕家本渴，今反不渴者，以心下有支饮故也，此属支饮。
【注】
呕病之人，津液已伤，本应渴也；今反不渴者，以心下素有支饮故也，此属支饮之呕
，非呕病也。
【集注】
徐彬曰：支饮者，偏旁而不中正也。
高世栻曰：支饮者，水气循经，屈曲支行，其形如肿是也。支饮而呕，故曰：此属支
饮。『饮欬篇』云，呕家本渴，渴为欲解，今反不渴，心下有支饮故也，小半夏汤主
之。
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诸呕吐，谷不得下者，小半夏汤主之。
【注】
此详诸呕吐之病，以明其治也。呕者，有声有物之谓也；吐者，有物无声之谓也。凡
诸呕吐，饮食不得下咽者，主之小半夏汤，降逆安胃也。
【集注】
赵良曰：呕吐谷不得下者，有寒有热，不可概论也。食入即吐，热也；朝食暮吐，寒
也。此则非寒非热，由中焦停饮，气结而逆，故用小半夏汤。
沈明宗曰：此痰饮多而致呕之方也。外邪内入而呕，必自饮食稍进；此痰饮多而外邪
少，拒格胸胃之间，气逆而谷不得入，故用生姜散邪，半夏以消痰饮而止呕逆。
Half a jin of pig fat (Zhu Gao), and three pieces of tangled hair roughly the size of a chicken egg.
The above two ingredients are mixed with the pig fat and decocted until the hair is completely dissolved and the medicine is prepared. Divide into two doses for administration; the pathogenic factor will be expelled through urination.
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For various types of jaundice presenting with abdominal fullness and vomiting, Chai Hu Tang (Bupleurum Decoction) is appropriate.
[Annotation]
Vomiting accompanied by abdominal pain indicates excess heat in the Stomach. However, Da Chai Hu Tang (Major Bupleurum Decoction) should only be used to resolve both exterior and interior pathogens if there are tidal fevers and constipation. If there are no tidal fevers and the stool is soft, Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Huang Qin (Scutellariae Radix) removed and Shao Yao (Paeoniae Radix Alba) added should be used to harmonize.
[Collected Annotations]
Cheng Lin stated: In cases of vomiting and abdominal fullness, one should observe the anterior and posterior orifices to determine which part is obstructed; once unobstructed, the disease will heal. Currently, patients with jaundice experiencing abdominal pain and vomiting likely have internal excess pathogens and should be treated with Da Chai Hu Tang to purge. If Xiao Chai Hu Tang is used, it can stop vomiting but cannot treat abdominal pain.
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In cases where vomiting involves pus from an abscess, one should not treat the vomiting directly; the condition will heal spontaneously once the pus is exhausted.
[Annotation]
"Those who vomit" refers to individuals vomiting food, water, phlegm-fluids, or cold saliva. When pus is present in the vomitus, it indicates an internal abscess rupturing and causing vomiting; this is not a primary vomiting disorder. Therefore, it is said that one should not treat the vomiting directly, but wait for the pus to be exhausted for spontaneous healing.
[Collected Annotations]
Zhao Liang stated: The Classics say: "Heat gathers at the stomach opening without circulating, causing congestion in the epigastrium." The epigastrium belongs to the Yangming Meridian; when Yangming Qi rebels upward, vomiting occurs. Thus, the pus does not come out via coughing but via vomiting, indicating the abscess is located at the upper opening of the stomach. If the abscess is lower than the middle section, below the lungs, the pus will exit via the stool rather than vomiting.
Cheng Lin stated: When an abscess ruptures, pus forms. If the pus exits upward, it inevitably causes vomiting. Therefore, there is no need to treat the vomiting; once the pus is exhausted, the vomiting will cease naturally.
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If vomiting is followed by thirst, this indicates the disease is about to resolve; if thirst precedes vomiting, it indicates fluid retention in the heart region, classifying the patient as having a Fluid-Disease (Yin Jia).
[Annotation]
After vomiting, if the patient feels thirsty and drinks water without subsequent vomiting, it indicates harmonious Stomach Qi, suggesting the disease is resolving. If thirst leads to drinking water, which then triggers vomiting, followed by renewed thirst, it indicates fluid retention in the heart region. This belongs to vomiting caused by Fluid-Diseases, not a primary vomiting disorder.
[Collected Annotations]
Zhao Liang stated: Vomiting removes fluids; once fluids are removed, Yang Qi returns, but body fluids have not yet distributed, causing thirst. Although thirsty, the disease will ultimately resolve due to the departure of pathogens and return of healthy Qi. "Thirst preceding vomiting" corresponds to the syndrome described in the Phlegm-Fluid section, treated with Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction).
Cheng Lin stated: "Vomiting preceding thirst" means the Stomach lacks fluids after vomiting; hydration resolves it. "Thirst preceding vomiting" means the patient was originally thirsty, drank water, and the retained water in the Stomach caused vomiting; thus, it belongs to Water-Fluid pathology.
You Yi stated: Those who vomit necessarily have retained phlegm and old fluids. "Vomiting preceding thirst" indicates the phlegm and fluids have been cleared and Stomach Qi is recovering, hence "this indicates resolution." "Thirst preceding vomiting" results from excessive drinking due to heat; although the heat clears, fluids accumulate again. Since this vomiting is caused by accumulated fluids, it is classified as a Fluid-Disease.
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Patients who vomit should normally feel thirsty; if they do not feel thirsty, it is due to Zhi Yin (branch-like fluid retention) in the heart region, classifying them as having Branch-Fluid Retention.
[Annotation]
Patients suffering from vomiting have depleted their body fluids and should normally feel thirsty. If they do not feel thirsty, it is because they have pre-existing Zhi Yin in the heart region. This is vomiting caused by Zhi Yin, not a primary vomiting disorder.
[Collected Annotations]
Xu Bin stated: Zhi Yin refers to fluid retention that is lateral and not central.
Gao Shishi stated: Zhi Yin refers to fluid-Qi traveling along meridians, curving and branching laterally, resembling swelling. Zhi Yin causing vomiting means "this belongs to Zhi Yin." The *Yin Ke Pian* states: "Those who vomit should normally be thirsty; thirst indicates impending resolution. Now, if they are not thirsty, it is due to Zhi Yin in the heart region," and it should be treated with Xiao Ban Xia Tang (Minor Pinellia Decoction).
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For various types of vomiting where food cannot be swallowed, Xiao Ban Xia Tang (Minor Pinellia Decoction) is the principal formula.
[Annotation]
This elaborates on various vomiting disorders to clarify their treatment. "Ou" (vomiting with sound and matter) differs from "Tu" (vomiting matter without sound). For all types of vomiting where food cannot pass down, Xiao Ban Xia Tang is used to descend rebellious Qi and calm the Stomach.
[Collected Annotations]
Zhao Liang stated: Vomiting with inability to swallow food can be due to Cold or Heat and cannot be generalized. Vomiting immediately after eating indicates Heat; morning food vomited in the evening indicates Cold. Here, it is neither Cold nor Heat, but caused by fluid retention in the Middle Jiao leading to Qi stagnation and rebellion; thus, Xiao Ban Xia Tang is used.
Shen Mingzong stated: This is a formula for vomiting caused by excessive phlegm-fluids. When external pathogens enter internally causing vomiting, the patient can usually eat slightly; here, excessive phlegm-fluids and minimal external pathogens block the chest and Stomach, causing Qi rebellion and preventing food intake. Therefore, Sheng Jiang (Zingiberis Rhizoma Recens) is used to disperse pathogens, and Ban Xia (Pinelliae Rhizoma) to eliminate phlegm-fluids and stop vomiting.