经义
诸痿喘呕，皆属于上。○诸逆冲上，皆属于火。○太阴所谓食则呕者，物盛满而上溢，故呕也。○少阳所
至，为呕涌。（《素问》）
足厥阴肝所生病者，胸满，呕逆。○善呕，呕有苦，长太息，邪在胆，逆在胃。胆液泄，则口苦，胃气
逆，则呕苦，故曰呕胆。（《灵枢》）
哲言
食刹则吐，谓之呕。食入则吐，谓之暴吐。食已则吐，谓之呕吐。食久则吐，谓之反胃。食再则吐，谓
之翻胃。○呕者声与物俱出；吐者有物无声；哕者有声无物。（李东垣）
恶心者无声无物，但心中兀兀然无奈，欲吐不吐，欲呕不呕，虽曰恶心，实非心经之病，皆在胃口上也。（《活人书》）
身背皆热，肘臂牵痛，气逆不续，膈间厌闷，食入即呕，名曰漏气。○下焦实热，二便不通，气逆不续，
呕逆不禁，名曰走哺。（《准绳》）
呕为火气炎上，特其一耳。有痰隔中焦，食不得下者；有气逆者；有寒气郁于胃口者；有食滞胃脘，则新
食不得下而反出者；有胃中有火与痰而呕者；有久病胃虚，不纳谷者。（朱丹溪）
胃气不和而呕吐，人所共知。然有胃寒胃热，痰饮宿食，及风邪入胃，气逆冲上，数种之异，可不究其所
自来哉。（杨仁斋）
呕吐一证，挟寒则喜热恶寒，肢冷脉小；挟热则喜冷恶热，燥渴脉洪。气滞者胀满不通；痰饮者遇冷即发。
呕苦知邪在胆；吐酸识火入肝。呕涎水虽属痰饮，尚疑虫证；吐酸腐无非食滞，更防火患。吐清水是土之卑监；
吐绿水是木之发生。黑水从胃底翻出；臭水是肠中逆来。（《证治汇补》）
吐清水，其因有五∶身受寒气，口食生冷而作者，胃寒也；食少而吐清水者，气虚也；食后而吐清水者，
宿食也；胸膈间辘辘有声者，痰饮也；心腹间时时作痛者，虫也。宜辨而治之。（徐春甫）
凡胃虚作呕者，其证不一，当知所辨。若胃脘不胀者，非实邪也。胸膈不痛者，非气逆也。内无热躁者，
非火证也。外无寒热者，非表邪也。无食无火，而忽为呕吐者，胃虚也。呕吐无常，而时作时止者，胃虚也。
食无所停，而闻食则呕者，胃虚也。气无所逆，而闻气则呕者，胃虚也。或身背微寒食饮即呕者，胃虚也。或
吞酸嗳腐，时苦恶心，兀兀泛泛，冷咽靡定者，胃虚也。或因病误治，妄用克伐寒凉，本无呕而致呕者，胃虚
也。或朝食暮吐，暮食朝吐，食入中焦而不化者，胃虚也。食入下焦而不化者，土母无阳，命门虚也。凡此虚
证，必皆宜补，是固然矣。然胃土非火不生，非暖不化，是土寒者即土虚也，土虚者即火虚也。故曰脾喜暖而
恶寒，土恶湿而喜燥。所以东垣《脾胃论》特着温补之法，盖特为胃气而设也。（张景岳）
补编
病患欲吐者，不可下之。○呕而胸满者，茱萸汤主之。○干呕，吐涎沫，头痛者，茱萸汤主之。○呕而肠
鸣，心下痞者，半夏泻心汤主之。○干呕而利者，黄芩加半夏生姜汤主之○诸呕吐，谷不得下者，小半夏汤主
之。○呕吐而病在膈上，后思水者解，急与之。思水者，猪苓散主之。○呕而脉弱，小便复利，身有微热，见
厥者难治，四逆汤主之。○呕而发热者，小柴胡汤主之。○胃反，呕吐者，大半夏汤主之。○胃反，吐而渴欲饮
水者，茯苓泽泻汤主之。○食已即吐者，大黄甘草汤主之。○吐后，渴饮得水而贪饮者，文蛤汤主之。○干呕吐
逆，吐涎沫，半夏干姜散主之。○病患胸中似喘不喘，似呕不呕，似哕不哕，彻心中愦愦然无奈者，生姜半夏
汤主之。（《金匮》）
吐有三因∶气、积、寒也。上焦吐者从于气，气者天之阳也。脉浮而洪，头晕不已，气上冲胸，食已即
吐，渴欲饮水，当降气和中。中焦吐者从于积，有阴有阳，气食相假。脉浮而弦，胸中痞闷，或先痛后吐，或
先吐后痛，当祛积和气。下焦吐者从于寒，地道也。脉沉而迟，四肢清冷，朝食暮吐，暮食朝吐，小便清利，
大便不通，当通其闭塞，温其寒气。（张洁古）
上焦之吐，多由气闭，责诸胃阳不能上升也，治在温胃。下焦之吐，多由阴逆，责诸肾阳不能下镇也，
治在纳火。（程郊倩）
仲景云∶病患欲吐不吐者，不可下。又用大黄治食已即吐，何也？曰∶欲吐者，其病在上，因而越之可
也。逆之使下，则必抑塞，愦乱益甚，故禁之。若既吐矣，吐而不已，有升无降，则当逆而折之，引令下行，
无速于大黄，故不禁也。（王宇泰）
呕吐而大小便不秘，利药所当忌也。若大小肠、膀胱热结不通，上为呕吐隔食，若不用利药开通发泄，
则呕吐何由止乎！古人用三乙承气汤，正是此意。○凡呕家，禁服栝蒌、桃仁。一切有油之物，皆犯胃作吐。（朱丹溪）
食入即出，是无水也。盖肾司闭藏之令，肾水既绝，则不能纳气，气不归原，逆于膈上，故呕而食出也，
宜六味丸。食久反出，吐出原物，全不化腐，此肾阳虚不能温养脾土也，宜八味丸。凡寒在上焦，则多为恶心，
或泛泛欲吐者，此胃阳虚也。水到咽喉即呕者，乃脾胃本亏，机关不利也，宜六君子汤加砂仁、炮姜。食后冷
涎不已，随即吐出者，宜六君子汤加丁香、益智仁。○邪在胆经，木乘于胃，吐逆而胆汁上溢，所以呕苦也，
宜吴萸、黄连、茯苓、泽泻、生姜。（《见闻录》）
又有一种肝火之证，呕而不食，所呕酸水、或苦水、或青绿水，亦作心痛，此是木火郁结。木郁达之，火
郁发之，用萸、连浓煎细呷，再服逍遥散，愈后以六味丸调理。（《赵氏医贯》）
呕吐用沉香者，取其沉重下行，使肾纳气，气不泛上，吐自止矣。（查了吾）
理中汤加胡椒，能治胃寒呕吐，胡椒乃胃家药也，若加附子则不验。（方星岩）
凡呕家夹热者，不利于香、砂、橘、半，服干姜黄连黄芩人参汤而晏如。（柯韵伯）
有呕吐诸药不止，乃蛔在胸膈，见药则动，动则不纳，药出而蛔不出。宜于治呕药中，加入川椒，蛔见椒
则伏。（《证治准绳》）
久吐不止，用脾胃药须加姜、枣，盖姜、枣能和脾胃也。（王协中）
呕家圣药是生姜，《千金》之说信矣。气逆作呕，生姜散之。痰水作呕，半夏逐之。然惟治寒呕则佳，若
治热呕不可无乌梅。（《医鉴》）
治呕吐，古方通以半夏、生姜为正剂。独东垣云∶生姜止呕，但治表实气壅。若胃虚谷气不行，惟当补胃
调中，推扬谷气。故服小半夏汤不愈者，服大半夏汤立愈。若吐而诸药不效，必加镇重以坠之；吐而中气久虚，
必借谷食以和之。（《医宗必读》）
胃中虚热，谷气久虚而为呕吐者，但得五谷之阴以和之，则呕吐自止。五谷属阴，其汤皆能止呕，不必用
药。（李东垣）
凡治胃虚呕吐，最须详审气味。盖邪实胃强者，无论气味优劣，皆可容受。惟胃虚气弱者，则有宜否之辨。
盖气虚者，最畏不堪之气，不但腥臊之气不能受，即微香微郁，并饮食之气亦不能受。胃弱者，最畏不堪之味，
非惟苦劣之味不能受，即微咸微苦，并五谷正味亦不能受。此胃虚之呕，所以最重气味。使或略有不投，则入
口便吐。故凡治阳虚呕吐等证，则一切香散咸酸辛味，悉以意测；测有不妥，切不可用。但补其阳，阳回则呕
自止。（《景岳全书》）
呕吐一证，《内经》、《金匮》论之详矣。乃后人但以胃火、胃寒、痰食、气滞立论，不思胃司纳食，
主乎通降，求其所以不降而上逆呕吐者，皆由于肝气冲逆，阻胃之降而然也。故《灵枢》云∶足厥阴肝所生病
者，胸满呕逆。况五行生克，木动则必犯土，胃病治肝，不过隔一之治。试观安胃丸、理中安蛔丸，所用椒、
梅，及胃虚客气上逆之旋复、代赭，此皆胃药乎？抑肝药乎？治法以泄肝安胃为纲领，用药以苦辛为主，以酸
佐之。如肝犯胃，而胃阳不衰有火者，泄肝则用芩、连、楝之苦寒。如胃阳衰者，稍减苦寒而用苦辛酸热，此
其大旨也。若肝阴胃汁皆虚，肝风扰胃呕吐者，则以柔剂，滋液养胃，熄风镇逆。若胃阳虚，浊阴上逆者，则
用辛热通之，微佐苦降。若但胃阳虚，而肝木不甚亢者，则专理胃阳，稍佐椒、梅。若因呕伤，寒郁化热，劫
灼胃津者，则用温胆汤加减。若久呕延及肝肾皆虚，冲气上逆者，则用温通柔润之补下焦。若热邪内结者，则
用泻心法。若肝火冲逆伤肺者，则用养金制木，滋水制火之剂。总之，治胃之法，全在温通。虚则必用人参，
药味皆属和平。治肝之法，药味错杂，或寒热互用，或苦辛酸咸并投。盖因厥阴有相火内寄，治法不得不然耳。
（《临证指南》）
脉候
上部有脉，下部无脉，其人当吐不吐者死。（《难经》）
凡呕吐，见歇至脉者，不治。
选案
王御九仲君，因惊受病，时方晚膳，欲吐不出，遂绝粒不食，向后醇酒膏腴，略无阻碍，惟谷气毫不可犯，
犯之辄呕。吴中名师，不识何病，各逞臆见，补泻杂陈。两三月来，湿面亦得相安，但完谷一试，虽极糜烂，
立时返出。偶遇一人言∶此病非药可治。令用生鹅血乘热饮之，一服即效。此虽未见方书，揆之理无妨碍。遂
宰一鹅取血，热饮下咽， 有声，忍之再三，少顷呕出瘀血升许，中有血块数枚，是夜小试稀糜，竟不吐出。
其后渐能用饭，从少至多，无藉汤药而愈。谛思此病，几不可解，胃既不安稼穑，何反胜任血肉之味？且饮鹅
血，何以呕出宿瘀顿愈？因考本草言鹅性凉，利五脏。《千金》云∶射工毒虫，鹅能食之。可知其有祛风、杀
虫、解毒、散血之功。故用其血以开其结，确有至理。更推其受病之源，因惊所致，惊则气乱，载血上逆，而
兀兀欲吐，若彼时吐出，却无菀积阻逆之患。今胃气阻逆，谷神得不困惫乎？其血肉可啖者，正赖脂膏以利脏
腑之气耳。然脏腑之气，非谷不安。而安谷全赖乎血，血者神气也。故取善消谷气之血，乘其生气未离，直透
关钥，引领宿积之瘀一涌而胸次荡然，真补中寓泻之良法也。详鹅血可以激发胃中宿瘀，则生鸭血未为不可，
生黄牛血亦未为不可。总取以血攻血，而无峻攻伤胃之虞。（张路玉）
一产妇病呕吐，勺水不入，脉细如丝，手足厥冷，阳将绝矣。而又水逆，奈何？乃用人参、附子为末，煎
陈皮水，和陈米汁作丸，令含口中，俟其自化，化已复含。尽一日之久，吐觉稍定。再进附子理中汤，手足渐
温。第吐不能全止，自觉有物，从少腹上冲咽喉即吐，此肾气上逆也，改用八味汤加人参而愈。（汪广期）
一人患呕吐，诸药不效，但吃井水一口即止，后用白术茯苓
汤治愈。此即《金匮》“呕吐思水者解，急与之”之意也，可信先贤之言不诬。（娄全善）
邻子十岁，从戏台倒跌而下，呕吐苦水，以盆盛之，绿如菜汁。余曰∶此胆倒也。跌翻而下，胆汁倾出，
汁尽死矣。方用温胆汤加枣仁、赭石，正其胆腑，可名正胆汤，一服吐止。忆昔曾见此证，不知其治，遂不救。
（许宣治）
附方
止呕吐方 治胃虚呕吐饮食。用炒陈仓米、伏龙肝二味，长流水煎服。甚者加人参更效。
附∶吐矢
吐矢一证，古书未载。大约其标在胃，其本在肾，幽门失开阖之职也。《经》曰∶饮入于胃，游溢精气，
上输于脾，脾气散精，上归于肺。食气入胃，散精于肝，淫气于筋。食气入胃，浊气归心，淫精于脉。果清者
上升而营运精微，浊者下降而变化糟粕，安得秽浊之物，直逆幽门，反从清道出哉！无如肾水虚，则无形之火
而冲逆者，其常也。无形之火，挟有形秽物而冲逆者，其变也。喻氏有地气加天之说，得毋与此证隐隐有合。
而倒行逆施，于理法之所无而病情之所有者，其为幽门关锁之地为病，胃气亏于中，而肾气亏于下者耶。不然
隔噎之吐，未见吐矢也；反胃之吐，未见吐矢也；脱淤之吐，未见吐矢也；更有呕酸苦汁，痰饮蛔虫，未见吐
矢也。兹则阴阳错乱，清浊混淆，为医家所不及逆料者。洵为幽门无权，胃液空虚，肾火迫之，不足以敌其直
奔之势从小肠入胃，糟粕随之，已可知矣。治非救胃则救肾，非正治则逆治。《经》曰∶肾者胃之关，开窍于
二阴。又曰∶清阳出上窍，浊阴出下窍。必待肾阴回而虚火藏，大便通而机关利，清阳升而浊阴降，此理之所
必然者。（《会心录》）
附案
西商赵谷猷，患吐粪证，医治三年，百药不效。延予时，见
其啖面，余问∶吐否？曰∶面食下咽，觉腹中响动，食自上而下，粪自下而上吐出，不胜其苦。检方皆治气逆
坠下之剂。予曰∶吐证固属气逆，然降下之品，仅降其饮食，而粪仍自上，肠胃中如水车辘轳，何时止息？世
不解肾者胃之关，关门不利，肾实主之；且肾开窍于二阴，顺气之药，徒耗肾阴，恶能有济。方用熟地、山萸、
五味、金樱、芡实镇其中宫，茯苓、白术、巴戟天，肉桂、牛膝行其逆气。服二日吐止，服二十日不再复矣。（程华仲）
[Classic Theories]
Various flaccidity syndromes (Wei syndrome), wheezing syndromes, and vomiting syndromes all have pathogenesis belonging to the Upper Jiao. ○ Various symptoms of rebellious Qi rushing upward all have pathogenesis belonging to Fire. ○ What the Taiyin Spleen Meridian describes as vomiting after eating is due to food filling the stomach and overflowing upward, hence vomiting. ○ When Shaoyang Gallbladder Meridian is affected, it results in vomiting and gurgling. (*Su Wen*)
The diseases generated by the Foot-Jueyin Liver Meridian include chest fullness and rebellious vomiting. ○ Frequent vomiting with bitter taste, frequent deep sighing: this indicates pathogen in the Gallbladder and rebellious Qi in the Stomach. Bile fluid leaking causes bitter mouth; Stomach Qi rebelling upward causes vomiting of bitter water, thus called "Gallbladder Vomiting". (*Ling Shu*)
[Masters' Discourses]
Vomiting when food is bitten/chewed is called Ou (vomit). Vomiting immediately after swallowing is called Bao Tu (sudden vomiting). Vomiting after finishing a meal is called Ou Tu (vomiting). Vomiting long after eating is called Fan Wei (reverse stomach). Repeated vomiting is called Fan Wei (turning stomach). ○ Ou involves both sound and matter coming out; Tu involves matter without sound; Yue (hiccup) involves sound without matter. (Li Dongyuan)
Nausea has no sound or matter, only a feeling of inner restlessness and helplessness, wanting to vomit but unable to, wanting to retch but unable to. Although called nausea, it is actually not a disease of the Heart Meridian, but located at the gastric opening. (*Huo Ren Shu*)
Heat in the body and back, pulling pain in elbows and arms, interrupted Qi flow, oppression and stuffiness in the diaphragm, vomiting immediately after eating: this is named Lou Qi (leaking Qi). ○ Excess-Heat in the Lower Jiao, blockage of urination and defecation, interrupted Qi flow, uncontrollable vomiting and rebellious Qi: this is named Zou Bu (running feeding). (*Zhun Sheng*)
Vomiting due to Fire Qi flaming upward is just one type. There are also cases where Phlegm obstructs the Middle Jiao preventing food descent; cases of Qi rebellion; cases where Cold Qi stagnates at the gastric opening; cases where Food Stagnation in the stomach prevents new food from descending causing reflux; cases of Fire and Phlegm in the Stomach causing vomiting; and cases of chronic illness leading to Stomach deficiency failing to accept food. (Zhu Danxi)
Stomach Qi disharmony causing vomiting is common knowledge. However, there are differences such as Stomach Cold, Stomach Heat, Phlegm-Fluids, retained food, and Wind Pathogen invading the Stomach causing Qi rebellion. One must investigate their origins. (Yang Renzhai)
In vomiting syndromes, if accompanied by Cold, there is preference for heat and aversion to cold, cold limbs, and fine pulse; if accompanied by Heat, there is preference for cold and aversion to heat, dry thirst, and surging pulse. Qi stagnation presents with distension and blockage; Phlegm-Fluids manifest upon exposure to cold. Vomiting bitter water indicates pathogen in the Gallbladder; vomiting sour water indicates Fire entering the Liver. Vomiting saliva/fluid belongs to Phlegm-Fluids but may suggest Parasites; vomiting sour/rotten matter indicates Food Stagnation, watch out for Fire damage. Vomiting clear water indicates Spleen Earth dampness (low monitoring); vomiting green water indicates Liver Wood overactivity. Black water turning up from the stomach bottom; foul-smelling water comes from intestinal reversal. (*Zheng Zhi Hui Bu*)
Causes of vomiting clear water include five types: contracting cold or eating raw/cold foods causing Stomach Cold; eating little yet vomiting clear water indicating Qi Deficiency; vomiting clear water after eating indicating retained food; gurgling sounds in chest/diaphragm indicating Phlegm-Fluids; intermittent heart/abdominal pain indicating Parasites. Differentiate and treat accordingly. (Xu Chunfu)
For vomiting caused by Stomach deficiency, signs vary and must be differentiated. If epigastrium is not distended, it is not Excess Pathogen. If chest/diaphragm does not hurt, it is not Qi rebellion. If no internal heat/restlessness, it is not Fire syndrome. If no external cold/heat, it is not Exterior Pathogen. Without food retention or fire, sudden vomiting indicates Stomach deficiency. Irregular vomiting that comes and goes indicates Stomach deficiency. Vomiting upon smelling food without actual retention indicates Stomach deficiency. Vomiting upon smelling odors without Qi rebellion indicates Stomach deficiency. Back chills with immediate vomiting after drinking/eating indicates Stomach deficiency. Acid regurgitation, belching rotten food, frequent nausea, inner restlessness, cold throat sensations indicate Stomach deficiency. Iatrogenic vomiting due to misuse of purgatives/cold herbs indicates Stomach deficiency. Morning eating evening vomiting, evening eating morning vomiting, food not digesting in Middle Jiao indicates Stomach deficiency. Food not digesting in Lower Jiao indicates Mother of Earth (Spleen) lacks Yang, Mingmen Deficiency. All these deficiency syndromes require tonification. However, Earth needs Fire to generate and warmth to transform; thus Earth Cold is Earth Deficiency, Earth Deficiency is Fire Deficiency. Therefore, Spleen likes warmth and dislikes cold; Earth dislikes dampness and likes dryness. Hence Li Dongyuan's *Pi Wei Lun* emphasizes warm tonification, specifically for Stomach Qi. (Zhang Jingyue)
[Supplementary Compilation]
If a patient wants to vomit, do not use purgatives. ○ Vomiting with chest fullness: Zhu Yu Tang (Evodia Decoction) governs. ○ Dry retching, vomiting saliva, headache: Zhu Yu Tang governs. ○ Vomiting with bowel sounds and epigastric stuffiness: Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) governs. ○ Dry retching with diarrhea: Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) governs. ○ Various vomiting where grains cannot pass: Xiao Ban Xia Tang (Minor Pinellia Decoction) governs. ○ Vomiting with pathology above the diaphragm, followed by desire for water indicates resolution; give water promptly. For those desiring water, Zhu Ling San (Polyporus Powder) governs. ○ Vomiting with weak pulse, free urination, slight body heat, and cold extremities is difficult to treat; Si Ni Tang (Four Counterflow Decoction) governs. ○ Vomiting with fever: Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. ○ Wei Fan (Stomantic Reversal) with vomiting: Da Ban Xia Tang (Major Pinellia Decoction) governs. ○ Wei Fan with vomiting and thirst for water: Fu Ling Ze Xie Tang (Poria and Alisma Decoction) governs. ○ Vomiting immediately after eating: Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) governs. ○ After vomiting, excessive thirst and craving for water: Wen Sha Tang (Clam Shell Decoction) governs. ○ Dry retching, rebellious Qi, vomiting saliva: Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) governs. ○ Patient feels like panting but not, like vomiting but not, like hiccuping but not, with profound inner restlessness: Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) governs. (*Jin Gui Yao Lue*)
Three causes of vomiting: Qi, Accumulation, Cold. Upper Jiao vomiting stems from Qi (Heavenly Yang). Pulse floating and surging, persistent dizziness, Qi rushing to chest, vomiting after eating, thirst for water: descend Qi and harmonize middle. Middle Jiao vomiting stems from Accumulation (Yin/Yang, Qi/Food mix). Pulse floating and wiry, epigastric stuffiness, pain before/after vomiting: remove accumulation and harmonize Qi. Lower Jiao vomiting stems from Cold (Earthly Path). Pulse deep and slow, cold limbs, morning eating evening vomiting, clear urine, constipation: open blockage and warm Cold. (Zhang Jiegong)
Upper Jiao vomiting often due to Qi closure, blaming Stomach Yang's failure to ascend; treatment warms Stomach. Lower Jiao vomiting often due to Yin rebellion, blaming Kidney Yang's failure to descend; treatment anchors Fire. (Cheng Jiaoqian)
Jingue says: "Patient wants to vomit but cannot, do not purge." Yet he uses Rhubarb for vomiting after eating. Why? Answer: Wanting to vomit means pathology is upper; inducing emesis is appropriate. Forcing downward causes obstruction and worsens restlessness, hence prohibited. If vomiting persists with no descent, reverse it and guide downward; Rhubarb is fastest, hence permitted. (Wang Yutai)
If vomiting occurs with unobstructed stool/urine, diuretics are contraindicated. If Large Intestine, Small Intestine, Bladder have Heat binding causing vomiting/blockage, diuretics/openers are needed to stop vomiting. Ancient use of San Yi Cheng Qi Tang reflects this. ○ Vomiting patients forbid Gua Lou (Trichosanthes) and Tao Ren (Peach Seed). Oily substances offend Stomach causing vomiting. (Zhu Danxi)
Food exiting immediately indicates Water Deficiency. Kidney controls closure; Kidney Water exhausted fails to grasp Qi; Qi fails to root, rebels above diaphragm, causing vomiting/food exit; use Liu Wei Wan (Six-Ingredient Pill). Food exits long after eating, undigested, indicates Kidney Yang Deficiency failing to warm Spleen Earth; use Ba Wei Wan (Eight-Ingredient Pill). Cold in Upper Jiao causes nausea/retching, indicating Stomach Yang Deficiency. Water vomiting at throat indicates Spleen/Stomach root deficiency, mechanism dysfunction; use Liu Jun Zi Tang plus Sha Ren, Pao Jiang. Cold saliva after eating indicates Spleen/Stomach deficiency; use Liu Jun Zi Tang plus Ding Xiang, Yi Zhi Ren. Pathogen in Gallbladder Meridian, Wood attacking Stomach, bile reflux causing bitter vomiting; use Yu Zhu, Huang Lian, Fu Ling, Ze Xie, Sheng Jiang. (*Jian Wen Lu*)
Another Liver Fire syndrome: vomiting without eating, vomiting sour/bitter/green water, heart pain, indicates Wood-Fire stagnation. Unblock Wood, vent Fire; use Yu Zhu/Huang Lian decoction sipped slowly, then Xiao Yao San; regulate with Liu Wei Wan post-recovery. (*Zhao Shi Yi Guan*)
Using Chen Xiang (Aquilaria) for vomiting utilizes its heavy descending nature to anchor Kidney Qi, preventing Qi floating upward, stopping vomiting. (Cha Liaowu)
Li Zhong Tang plus Hu Jiao (Pepper) treats Stomach Cold vomiting; Pepper is a Stomach herb. Adding Fu Zi makes it ineffective. (Fang Xingyan)
For vomiting with Heat, aromatic/cardamom/orange/pinellia are unfavorable; Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Ginger, Coptis, Scutellaria, Ginseng Decoction) brings peace. (Ke Yunbo)
If vomiting medicines fail, consider Ascaris in chest/diaphragm reacting to medicine. Add Chuan Jiao (Sichuan Pepper) to subdue worms. (*Zheng Zhi Zhun Sheng*)
For chronic vomiting, add Sheng Jiang and Da Zao to Spleen/Stomach formulas to harmonize them. (Wang Xiezhong)
Sheng Jiang is the holy medicine for vomiting. For Qi rebellion, Sheng Jiang disperses; for Phlegm-Fluids, Ban Xia expels. Sheng Jiang is good for Cold vomiting; for Heat vomiting, Wu Mei (Mume Fruit) is essential. (*Yi Jian*)
Ancient formulas use Ban Xia and Sheng Jiang as main agents for vomiting. Li Dongyuan notes Sheng Jiang stops vomiting only for Exterior Excess/Qi congestion. For Stomach deficiency/failure of grain Qi, tonify Stomach/harmonize middle. Xiao Ban Xia Tang fails, Da Ban Xia Tang succeeds. If vomiting resists all meds, add heavy descending agents; if Middle Qi deficient, rely on grain food to harmonize. (*Yi Zong Bi Du*)
Stomach Empty Heat/Grain Qi deficiency causing vomiting: nourish with Yin of Five Grains to stop vomiting. Grain soups stop vomiting without drugs. (Li Dongyuan)
Treating Stomach deficiency vomiting requires careful attention to flavor/aroma. Excess/Stomach strength tolerates any flavor. Stomach deficiency fears offensive aromas (even mild fragrance) and flavors (even mild salty/bitter/grain taste). Thus, aroma/flavor is critical. Mismatch causes immediate vomiting. For Yang Deficiency vomiting, avoid aromatic/sour/salty/spicy unless carefully assessed. Tonify Yang; return of Yang stops vomiting. (*Jing Quan Quan Shu*)
Vomiting discussed in *Nei Jing*/*Jin Gui*. Later doctors focus on Stomach Fire/Cold/Phlegm/Food/Qi, ignoring that Stomach governs reception and descending. Non-descending/rebellious vomiting is due to Liver Qi rebellion blocking Stomach descent. *Ling Shu*: Liver Meridian diseases include chest fullness/vomiting. Wood attacks Earth. Treating Stomach via Liver is indirect. An Wei Wan/Li Zhong An He Wan use Pepper/Mume; Xu Fu/Zhe Shi treat rebellious Qi. Are these Stomach or Liver herbs? Principle: Drain Liver to calm Stomach. Meds: Bitter/Acrid primary, Sour assistant. Liver attacking Stomach with Fire: drain Liver with Ku Han (Bitter Cold) like Qin, Lian, Lian Zi. Stomach Yang decline: reduce Ku Han, use Ku Xin Suan Re (Bitter/Acrid/Sour/Warm). Liver Yin/Stomach Juice deficiency with Wind: use soft agents, nourish fluids, extinguish wind. Stomach Yang deficiency with Turbid Yin rising: use Acrid-Warm to open, slightly assist with Bitter descent. Stomach Yang deficiency without strong Liver: manage Stomach Yang, assist with Pepper/Mume. Vomiting injury, Cold transforming to Heat damaging fluids: modify Wen Dan Tang. Chronic vomiting affecting Liver/Kidney with Chong Qi rebellion: warm/unblock/nourish Lower Jiao. Heat binding internally: use Xie Xin method. Liver Fire injuring Lung: nourish Metal/control Wood, nourish Water/control Fire. General: Stomach treatment relies on Warmth/Unblocking. Deficiency uses Ren Shen, mild flavors. Liver treatment uses mixed flavors, hot/cold, bitter/acrid/salty together due to Minister Fire in Jueyin. (*Lin Zheng Zhi Nan*)
[Pulse Diagnosis]
Pulse present in upper, absent in lower, patient should vomit but doesn't: death prognosis. (*Nan Jing*)
Vomiting with intermittent pulse: untreatable.
[Selected Cases]
Wang Yujiu suffered from shock illness. At dinner, wanted to vomit but couldn't, stopped eating grains. Alcohol/fat passed easily, but grains caused vomiting. Famous doctors used mixed tonifying/purging methods. Wet noodles tolerated, whole grains vomited immediately. Someone suggested drinking hot goose blood. One dose effective. Goose blood opens stagnation, dispels wind/toxins/blood stasis. Shock causes Qi chaos, blood rebellion. Vomiting would have prevented stagnation. Now Stomach Qi blocked, Grain Spirit exhausted. Blood nourishes organs; goose blood stimulates old stasis, clearing chest. A method of tonifying while purging. Raw duck/beef blood also usable. (*Zhang Luyu*)
Postpartum woman vomiting, spoonful of water refused, thread-like pulse, cold limbs, Yang near extinction. Water rebellion present. Used Ren Shen, Fu Zi powder, Chen Pi water, rice juice pills held in mouth. Vomiting subsided. Then Fu Zi Li Zhong Tang warmed limbs. Still vomiting, sensation of mass rising from lower abdomen to throat: Kidney Qi rebellion. Changed to Ba Wei Tang plus Ren Shen, cured. (Wang Guangqi)
Man with vomiting, all meds failed. One sip of well water stopped it. Cured with Bai Zhu Fu Ling Tang. Matches *Jin Gui*: "Vomiting with desire for water resolves, give water." (Lou Quanshan)
Neighbor's son fell from stage, vomited bitter green liquid. Diagnosed as Gallbladder reversal. Used Wen Dan Tang plus Suan Zao Ren, Zhe Shi (named Zheng Dan Tang). One dose stopped vomiting. (*Xu Xuanzhi*)
[Attached Formulas]
Stop Vomiting Formula: For Stomach deficiency vomiting. Stir-fried Chen Cang Mi (aged rice) + Fu Long Gan (Dried Dragon Bone/Clay), decoct in running water. Add Ren Shen for severe cases.
[Appendix: Vomiting Feces]
Vomiting feces (Tu Shi) is rare in classics. Mark in Stomach, Root in Kidney, Pylorus dysfunction. *Jing*: Fluids enter Stomach, essence ascends to Spleen/Lung. Food enters Stomach, essence to Liver/Heart. Clear rises, turbid descends. How can waste reverse through Pylus to esophagus? Kidney Water deficiency allows Fire rebellion (normal). Fire carrying waste rebels (abnormal). Metaphor: Earth Qi adding to Heaven Qi. Pyloric lock, Stomach Qi deficiency middle, Kidney Qi deficiency lower. Unlike Ge Ye (regurgitation) or Fan Wei (reversal), this is Yin/Yang confusion, Clear/Turbid mixing. Pylorus powerless, Stomach fluid empty, Kidney Fire forcing waste from Small Intestine to Stomach. Treatment: Save Kidney or Stomach, direct or reverse therapy. Kidney is Stomach gate, opens to two yin. Clear Yang exits upper orifices, Turbid Yin exits lower. Wait for Kidney Yin return,虛火 hidden, stool通畅, mechanisms free, Clear Yang rises, Turbid Yin descends. (*Hui Xin Lu*)
[Attached Case]
Merchant Zhao Guyou vomited feces for 3 years, meds failed. Ate noodles, felt rumbling, food down, feces up. Prescriptions were Qi-descending. I said: Descending meds only move food, not feces. Intestines like waterwheel. People don't know Kidney is Stomach gate. Qi meds consume Kidney Yin. Formula: Shu Di, Shan Yu, Wu Wei, Jin Ying, Qian Shi (anchor middle); Fu Ling, Bai Zhu, Ba Ji Tian, Rou Gui, Niu Xi (guide rebellious Qi). 2 days vomiting stopped; 20 days recurrence ceased. (Cheng Huazhong)