（干呕 漏气 走哺 呕苦 中酸 吐酸 呕水 吐沫 吐蛔）
经云。诸逆冲上。皆属于火。诸呕吐酸。皆属于热。（胃热则呕。）寒气客于肠胃。厥逆上
出。故痛而呕也。人之哕者。谷入于胃。胃气上注于肺。今有故寒气与新谷气。俱还入于胃。新
故相乱。真邪相攻。气并相逆。复出于胃。故为哕。病深者其声哕。
金匮云。病患欲吐者。不可下之。
欲吐者。阴邪在上也。若下之。不惟逆其阳气。反伤无故之阴。变害莫测。岂独反胃而已。
呕而胸满者。吴茱萸汤主之。
伤寒论用是方。治食谷欲呕之阳明证。以中焦有寒也。茱萸能治内寒。降逆气。人参补中益
阳。大枣缓脾。生姜发
胃气。且散逆止呕。逆气降。胃之阳行。则胸满消矣。此脾藏阴盛逆胃。与夫肝肾下焦之寒上逆
于中焦而致者。即用以治之。故干呕吐涎沫头痛。亦不出是方也。
呕而肠鸣。心下痞者。半夏泻心汤主之。
是证由阴阳不分。塞而不通。留结心下为痞。于是胃中空虚。客气上逆为呕。下走为肠鸣。
故用是汤分解阴阳。水升火降。则留者散。虚者实也。
呕吐而病在膈上。后思水者解。急与之。思水者。猪苓散主之。
呕而思水者。水饮逆于胸中也。故用猪苓之味淡。从膈上渗其所积之饮。更以白术利水生津。
使水精四布。而呕自除矣。
呕而发热者。小柴胡汤主之。
呕而发热。邪在半表半里。逆攻而上也。虽非伤寒之邪。而病势则一。故即以小柴胡汤和之。
食已即吐者。大黄甘草汤主之。
胃素有热。食复入之。两热相冲。不得停留。用大黄下热。甘草和胃。按仲景既云。欲吐者
不可下。又用大黄甘草汤。治食已即吐。何也。曰。欲吐者。病在上。因而越之可也。逆之使下。
则必愦乱而益甚。既吐矣。吐而不已。有升无降。当逆折之。使其下行。故用大黄。丹溪云。凡
病吐者。切不可下。近于困矣。
吐后渴欲得水。而贪饮者。文蛤汤主之。汗出即愈。兼主微风脉紧头痛。
是方即大青龙汤。无桂枝有文蛤。大青龙主发散风寒两感。今是证初不言外邪。而用取汗。
何哉。盖因阳明经中有实热。所以贪饮。故用麻黄、杏仁开发腠理。甘草、姜、枣调和营卫。石
膏解利郁热。文蛤直入少阴。散水止渴。为太阳少阴二经散邪涤饮之圣药。故又主微风脉紧头痛之疾。
干呕哕。若手足厥者。橘皮汤主之。
干呕而哕。手足厥逆。乃胃中阳气。为痰饮阻塞。不得流布四末。故用橘皮、生姜之辛以开
痰利气也。
哕逆者。橘皮竹茹汤主之。
中焦气虚。则下焦之风木得以上乘。谷气因之不宣。变为哕逆。用橘皮升降中气。人参、甘
草补益中焦。生姜、大枣宣散逆气。竹茹以降胆木之风热耳。
干呕吐逆吐涎沫。半夏干姜汤主之。
干呕吐逆吐涎沫者。由客邪逆于肝脾。寒主收引。津液不化。遂聚为涎沫。用半夏。干姜之
辛温中燥湿。浆水之酸收而行之。以下其逆也。
蛔虫之为病。令人吐涎心痛。发作有时。毒药不止。甘草粉蜜汤主之。
徐忠可云。此论蛔病之不因寒者也。故其证独心痛吐涎。而不吐蛔。然其痛发作有时。谓不
恒吐也。则与虚寒之绵绵而痛者远矣。毒药不止。则必治气治血攻寒逐积之药。俱不应矣。故以
甘草粉蜜主之。白粉杀虫。蜜与甘草。既以和胃。又以诱虫也。
呕吐哕。皆属于胃。但有气血多少之异。呕属阳明。多血多气。故有声有物。气血俱病也。
气逆者散之。所以生姜为主。吐属太阳。多血少气。故有物无声。乃血病也。以橘红主之。哕属
少阳。多气少血。故有声无物。乃气病也。以半夏主之。三者皆因脾虚。或寒气客胃。饮食所伤。
致上逆而食不得下也。
治呕吐。以二陈汤为主。如气滞者。加白豆蔻、砂仁。热吐。加黄连。冷涎吐。加丁香。气
升呕。加沉香。气不和。加木香。入姜汁少许。食顷即吐者。半夏、生姜煎服。食入即呕。橘皮、
生姜煎服。食已则吐。橘皮、半夏、生姜煎服。食久而吐为反胃。脉沉无力。理中汤。或三物大
建中汤去干姜。加白术、桂心、橘皮。脉滑而实。旦食暮吐。暮食朝吐。此下焦实。半夏、大黄
等分为末。姜汁和丸。微利之。呕吐谷不得下。小半夏汤。逆气心中烦闷。气满呕吐。千金半夏
汤。即金匮小半夏汤加桂心。少气。加甘草。夫半夏、生姜之辛。但治上焦气壅表实。若胃虚者。
惟宜益胃。推扬谷气而已。忌用辛泻。故服小半夏汤不愈者。服大半夏汤立愈。久寒胸膈逆满不
能食。吴茱萸汤加桂心、半夏、甘草、小麦。酒煎服。寒吐者。喜热恶寒。肢冷。脉细而滑。用
理中汤加枳实。或二陈加丁香、炮姜。并须微温与服。热吐者。喜冷恶热。烦渴小便赤涩。脉洪
而数。二陈加栀、连、竹茹、枇杷叶、葛根、姜汁、芦根汁。怒中饮食呕吐。胸满膈胀。关格不
通。二陈加青皮、木香。未效。丁、沉、木香、砂仁、浓朴、神曲。更不效。有瘀血也。当从蓄
血例治。中脘素有痰积。遇寒即发。俗名冷涎泛。宜丁香、豆蔻、砂仁、干姜、陈皮、半夏、生
姜、白芥子。呕痰而致厥者。乃寒痰逆闷。谓之痰厥。姜附汤加术、半、细辛。痰满胸喉。粥药
到口即吐。先用生姜汤下黑锡丹以镇坠之。候药可进。则以二陈加枳、术、砂仁、浓朴、姜汁。
虚。加人参。有一等肝火逆证。亦呕而不食。但所呕者。或酸水。或苦水。或青蓝水。惟大小便
不秘。亦能作心痛。此是火郁木郁之候。木
郁达之。火郁发之。须用萸、连浓煎。细细呷之。再服逍遥散。脾胃本虚。机关不利。不能运化。
而水到咽管辄便呕出者。六君子加砂仁、炮姜。使中央之枢轴转。机关利。自不呕矣。丹溪云。
凡呕家禁服栝蒌实、桃仁、莱菔子、山栀。一切有油之物。皆犯胃作吐。凡药中带香药。行散方效。
哕者。胃中虚冷。或停水饮之故。胃虚宜温胃。理中为主。停水。宜橘皮半夏汤。小便不利。
加桂心、茯苓。胃虚不食。加人参。肺胃有水。喘咳上气。小青龙加减。亦有失于攻下。胃中实
热而哕者。证必腹满。仲景云。哕而腹满。视其前后。知何部不利。利之则愈。承气汤、猪苓汤
是也。哕逆属虚热。橘皮竹茹汤。哕而虚寒。橘皮干姜汤。寒甚。去通草。加丁香、附子。寒热
错杂者。去甘草。加丁香、柿蒂。伤寒后胃热呕哕。千金通草橘皮汤。伤寒后呕哕反胃。干呕食
不下。千金芦根饮子。春夏时行伤寒。寒伤于胃。胃冷变 者。千金用橘皮、桂心、葛根各二两。
白茅根一升。水煎服。有热。去桂心。哕声频密相连为实。攻热为主。若半时哕一声者为虚。温
补为主。如腹满不尿。脉散头汗。目瞪而哕者。死在旦夕。
千金云。凡服汤呕逆不入腹者。先以甘草一两水煎服之。得吐。消息定。然后服余汤。便不
吐也。凡呕者。多食生姜。此是呕家圣药。
〔诊〕上部有脉。下部无脉。其人当吐。不吐者死。脉阳紧阴数为吐。阳浮而数亦吐。寸紧尺
涩。胸满而吐。寸口脉数者吐。紧而涩者难治。紧而滑者吐逆。脉弱而呕。小便复利。身有微热。
见厥者难治。病患欲呕吐者。不可下之。呕吐大痛。吐出色如青菜色者危。
干呕 干呕者。有声无痰。然不似哕声之浊恶而长也。宜橘红煎汤。入姜汁、白蜜少许。细
细呷之。胃虚。加人参。胃寒。加炮姜。胃虚浊气上逆。吴茱萸汤。干呕发热者。黄芩汤。干呕
而利者。黄芩加半夏生姜汤。
漏气 身背热。肘臂牵痛。其气不续。膈间厌闷。食入则先呕而后泻。名曰漏气。此风热闭
其腠理。上焦之气。 悍滑疾。遇开即出。经气失道。邪气内着。故有此证。千金麦冬理中汤主
之。肥盛多痰者。泽泻汤主之。
走哺 下焦实热。其气内结。不下泌糟粕。而淤浊反蒸于胃。故二便不通。气逆不续。呕逆
不禁。名曰走哺。人参汤主之。食已暴吐。脉浮而洪。此上焦火逆也。宜橘、半、枳、桔、浓朴、
槟榔、茯苓、白术。气降则火自清。吐渐止。乃以人参、芍药补之。下闭上呕。亦因火在上焦。
宜枳、桔、陈皮、浓朴、槟榔、大黄、木香微利之。
呕苦 邪在胆经。木善上乘于胃。吐则逆而胆汁上溢。所以呕苦也。宜吴茱萸、黄连、茯苓、
泽泻、生姜。邪在胆。逆在胃。胆液泄则口苦。小柴胡汤。胃气逆则呕苦。吴茱萸汤。
中酸 湿热郁积于肝。肝火逆上。伏于肺胃之间。饮食入胃。被湿郁遏。不得传化。故作中
酸。所谓曲直作酸是也。佐金丸。薛立斋云。吞酸嗳腐。多属脾虚木旺。证多面色痿黄。胸膈不
利举。世好用清气化痰之药。多致大便不实。食少体倦而危。当用六君子加炮姜、木香、吴茱萸。
脾肾俱虚。六君子加肉豆蔻、补骨脂。中气虚弱者。理中汤加吴茱萸。郁火。连理汤。不应。补
中益气加木香、炮姜。送佐金丸。中气虚寒。必加附子。或附子理中汤。无有不愈。凡中酸不宜
食粘滑油腻者。谓气不通畅也。宜食疏淡诸物。使气通利。
吐酸 内经以诸呕吐酸。皆属于热。东垣又以为寒者。何也。若胃中湿气郁而成积。则湿中
生热。从木化而为吐
酸。久而不化。肝木日肆。胃土日衰。当平肝扶胃。逍遥散服佐金丸。若宿食滞于中脘。平胃散
加白豆蔻、藿香、砂仁、神曲。
呕水 渴欲饮水。水入即吐者。名曰水逆。五苓散。气虚。四君子去甘草。加枳、橘、生姜。
不应。六君子换赤茯苓。用伏龙肝煮汤。澄清代水煎药。
吐沫 胃中虚寒不能约束津液。故吐涎沫。宜六君子加益智、生姜。或理中汤加益智以收摄之。
吐蛔（音回） 吐蛔有寒有热。有寒热交错。寒则手足厥逆。吐出之蛔色淡白者。理中汤加
乌梅、黄连、蜀椒。甚则蛔死而形扁者危矣。热则蛔色赤而多。且跳动不已。安蛔丸主之。寒热
交错。则病者静而复时烦。得食而呕。蛔闻食臭出。其人当自吐蛔。乌梅丸主之。大抵吐蛔。寒
热交错者多。方中都用川椒、黄连、乌梅之类。盖蛔闻酸则静。得苦则安。遇辣则伏而不动也。
若误服消克及攻虫诸药。不应。甘草粉蜜汤主之。
石顽曰。夫病有不见经论之异证。则其治亦必有不由绳墨之异法。如王御九仲君。因惊恐受
病。时方晚 。即兀兀欲吐而不得出。遂绝粒不食。而起居自如。半月以来。医祷不灵。举家无
措。向后醇酒膏粱。略无阴碍。惟是谷气毫不可犯。犯之辄呕。吴中名师从未有一识其为何病者。
然各逞臆见。补泻杂陈。丹方迭进。牛黄、狗宝、虎 、猫胞。总无交涉。两三月来。湿面亦得
相安。但完谷一试。虽极糜烂。立时返出。延及八月。莫可谁何。偶遇一人谓言。此病非药可除。
合用生鹅血。乘热饮之。一服便安。此虽未见于方书。揆之于理。谅无妨碍。一阳之夜。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
而安。常思此病之不可解者。胃既不安稼涩。何反胜任血肉之味。今饮鹅血。呕出宿瘀顿愈。因
考本草言。鹅性凉。利五脏。千金方云。射工毒虫。鹅能食之。可知其有祛风杀虫。解毒散血之
功也。今用其血以开其结。确有至理。逆推受病之源。原因惊恐所致。惊则气乱。载血上逆。而
兀兀欲吐。若彼时吐出。却无菀积于中。胃气阻逆之患矣。胃气阻逆。谷神得不困惫乎。其血肉
可啖者。正赖脂膏。以攸利脏腑之气也。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。是可直透关钥引领宿积之瘀。一涌而胸次荡然。虽属寻
常食品。而凉利五脏之功。洵不寻常。先是有人患此。绝粒三载。得此顿愈。其后中翰金淳还公
郎。太史韩慕庐东坦。咸赖此霍然。远近相传。凡噎膈呕逆。用之辄效。当知噎膈呕逆。虽属胃
中血枯。若中无瘀结。何致捍格不入。故取同气相感之力。一涌而荡散无余。真补中寓泻之良法。
详鹅血可以激发胃中宿滞。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。昔乔三余治一总戎。患噎膈。百药不应。乔以法激之。呕出瘀积数升而安。喻嘉言治
一血虫。用法激之上涌。然后用药。法皆秘而不宣。由是类推。可以默识其旨。此与劳伤吐血之
日宰鸭血。冲热酒服。同源异 。深得肘后经奥旨。足补夏子益奇方之未逮。
虞恒德治一中年妇。产后伤食。致脾虚不纳谷。四十余日。闻谷气则恶心。闻药气则呕逆。
用异功散加藿香、砂仁、神曲、陈仓米。先以顺流水煎沸。调伏龙肝。搅浑澄清取二盏。加姜、
枣煎服。遂不吐。别以陈仓米煎汤。时时咽之。服前药二三剂渐安。
薛立斋治一妇。年三十余。忽不进饮食。日饮清茶三五碗。少用水果。经三年矣。经水过期
而少。此思虚伤脾。脾气
郁结所致。用归脾汤加吴茱萸。不数剂而饮食如故。
(Dry retching, Leaking Qi, Zoubu [vomiting food upwards], Bitter vomiting, Zhong Suan [sourness in the middle], Spitting acid, Vomiting water, Spitting saliva, Vomiting roundworms)
The *Neijing* states: All rebellious qi rushing upward belongs to Fire. All vomiting and spitting of acid belong to Heat. (This is because stomach heat causes vomiting.) When cold qi invades the intestines and stomach, jue qi rebels and rushes upward, thus causing pain accompanied by vomiting. When a person experiences hiccups (yue), food enters the stomach, and stomach qi flows upward into the lungs. Now, if old cold qi and new grain qi both return to the stomach, the new and old qi confuse each other, righteous qi and pathogenic qi attack each other, qi merges and rebels, and then rushes out from the stomach again, thus causing hiccups. In severe cases, the sound of hiccups becomes heavy.
The *Jingui Yaolue* states: For patients who desire to vomit, purgative methods should not be used.
Desire to vomit indicates that yin pathogenic factors are located in the upper jiao. If purgatives are used, not only will the ascending nature of yang qi be violated, but innocent yin fluids will also be damaged, leading to unpredictable complications, not merely regurgitation.
For vomiting accompanied by chest fullness, Wuzhuyu Tang (Evodia Decoction) is the primary treatment.
In the *Shanghan Lun*, this formula is used to treat Yangming syndrome characterized by the desire to vomit after eating, due to cold in the middle jiao. Evodia (Wuzhuyu) treats internal cold and directs rebellious qi downward; Ginseng (Renshen) tonifies middle qi and assists yang; Jujube (Dazao) moderates spleen qi; Ginger (Shengjiang) disperses stomach qi, scatters rebellion, and stops vomiting. When rebellious qi descends and stomach yang circulates, chest fullness dissipates. This addresses conditions where spleen yin excess rebels against the stomach, or where cold from the liver/kidney lower jiao rebels upward to the middle jiao. Therefore, it is also applicable for dry retching, spitting of saliva, and headache.
For vomiting accompanied by borborygmus and epigastric stuffiness (pi), Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) is the primary treatment.
This syndrome arises from the failure of yin and yang to harmonize, leading to obstruction and accumulation in the epigastrium forming pi. Consequently, the stomach becomes empty, external qi rebels upward causing vomiting, and moves downward causing borborygmus. Thus, this decoction is used to resolve yin and yang, allowing water to ascend and fire to descend, so that stagnation disperses and deficiency is filled.
For vomiting with pathology above the diaphragm, followed by a desire for water, the disease is resolving; water should be given promptly. For those desiring water, Zhuling San (Polyporus Powder) is the primary treatment.
Vomiting with a desire for water indicates water-fluid retention rebelling in the chest. Therefore, Polyporus (Zhuling), which has a bland taste, is used to leach accumulated fluid from above the diaphragm, along with Atractylodes (Baizhu) to promote urination and generate fluids, allowing fluid essence to distribute throughout the body, thereby stopping vomiting.
For vomiting accompanied by fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment.
Vomiting with fever indicates pathogenic factors in the half-exterior half-interior stage, rebelling upward. Although not necessarily Taiyang cold damage, the pathological trend is similar, so Xiaochaihu Tang is used to harmonize.
For vomiting immediately after eating, Dahuang Gancao Tang (Rhubarb and Licorice Decoction) is the primary treatment.
Chronic stomach heat combined with newly ingested food creates a clash of two heats, preventing retention. Rhubarb (Dahuang) purges heat, and Licorice (Gancao) harmonizes the stomach. Regarding Zhang Zhongjing’s statement that "those desiring to vomit should not be purged," yet using Dahuang Gancao Tang for "vomiting immediately after eating": The former refers to pathology in the upper jiao, where inducing vomiting is appropriate; forcing downward purgation would cause confusion and worsen the condition. The latter involves persistent vomiting with no descent, requiring counter-action to direct qi downward, hence the use of Rhubarb. Zhu Danxi stated: For all vomiting, purgatives must strictly be avoided, as this approaches exhausting the patient.
For vomiting followed by thirst and excessive drinking, Wenli Tang (Clam Shell Decoction) is the primary treatment. Sweating leads to recovery. It also treats mild wind, tight pulse, and headache.
This formula is based on Daqinglong Tang (Major Blue Green Dragon Decoction), replacing Cinnamon Twig (Guizhi) with Clam Shell (Wenge). Daqinglong Tang disperses wind-cold affecting both exterior and interior. Here, although no external pathogen was initially mentioned, sweating is induced because of excess heat in the Yangming channel causing thirst. Ephedra (Mahuang) and Apricot Kernel (Xingren) open the pores; Licorice, Ginger, and Jujube harmonize Ying and Wei; Gypsum (Shigao) clears constrained heat; Clam Shell enters the Shaoyin channel to scatter water and relieve thirst, serving as a supreme herb for dispelling pathogens and eliminating fluid retention in Taiyang and Shaoyin channels. Thus, it treats mild wind, tight pulse, and headache.
For dry retching and hiccups accompanied by cold extremities, Chupi Tang (Tangerine Peel Decoction) is the primary treatment.
Dry retching and hiccups with cold extremities indicate stomach yang qi blocked by phlegm-fluid retention, unable to reach the extremities. Tangerine Peel (Chupi) and Ginger (Shengjiang) are used for their acridity to resolve phlegm and promote qi movement.
For hiccups, Chupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is the primary treatment.
Middle jiao qi deficiency allows wind-wood from the lower jiao to rebel upward, obstructing grain qi transformation into hiccups. Tangerine Peel regulates middle qi; Ginseng and Licorice tonify the middle jiao; Ginger and Jujube disperse rebellious qi; Bamboo Shavings (Zhuru) subdue wind-heat from the Gallbladder wood.
For dry retching, vomiting with rebellious qi, and spitting saliva, Banxia Jiangxin Tang (Pinellia and Dried Ginger Decoction) is the primary treatment.
These symptoms result from pathogenic factors rebelling against the Liver and Spleen. Cold causes contraction, failing to transform fluids, which accumulate as saliva. Pinellia (Banxia) and Dried Ginger (Ganjiang) provide acrid-warmth to dry dampness; Sour Fermented Rice Water (Jiangshui) provides sour-astringency to guide qi downward and subdue rebellion.
For diseases caused by roundworms, presenting with spitting saliva, heart pain, intermittent attacks, and resistance to toxic drugs, Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) is the primary treatment.
Xu Zhongke stated: This discusses roundworm disease not caused by cold. Symptoms are isolated heart pain and spitting saliva without vomiting worms. Pain is intermittent, unlike the continuous pain of deficiency-cold. Resistance to toxic drugs implies that qi-regulating, blood-invigorating, cold-dispelling, and accumulation-purging herbs are ineffective. Thus, Licorice, Flour, and Honey are used. Flour kills parasites; Honey and Licorice harmonize the stomach and lure worms.
Vomiting and hiccups belong to the Stomach, differing in the abundance of qi and blood. Vomiting belongs to Yangming, abundant in blood and qi, producing sound and matter, indicating both qi and blood pathology. Rebellious qi is dispersed using Ginger (Shengjiang). Spitting belongs to Taiyang, abundant in blood but deficient in qi, producing matter without sound, indicating blood pathology, treated with Tangerine Peel Red (Juhong). Hiccups belong to Shaoyang, abundant in qi but deficient in blood, producing sound without matter, indicating qi pathology, treated with Pinellia (Banxia). All three result from Spleen deficiency, cold invading the Stomach, or dietary injury causing upward rebellion and inability to ingest food.
For treating vomiting, Erchen Tang (Two-Aged Decoction) is the main formula. For qi stagnation, add White Cardamom (Baidoukou) and Amomum (Sharen); for heat vomiting, add Coptis (Huanglian); for cold-phlegm vomiting, add Clove (Dingxiang); for qi-rising vomiting, add Agarwood (Chenxiang); for disharmonious qi, add Costus (Muxiang), with a little Ginger Juice (Jiangzhi). For vomiting shortly after eating, decoct Pinellia and Ginger. For vomiting immediately upon ingestion, decoct Tangerine Peel and Ginger. For vomiting after eating, decoct Tangerine Peel, Pinellia, and Ginger. For delayed vomiting (regurgitation) with deep, weak pulse, use Lizhong Tang (Regulate the Middle Decoction) or Sanwu Dajianzhong Tang minus Dried Ginger, adding Atractylodes (Baizhu), Cinnamon Heart (Guixin), and Tangerine Peel. For slippery, excess pulse with morning/evening vomiting, indicating lower jiao excess, use equal parts Pinellia and Rhubarb powder, formed into pills with Ginger Juice, to mildly purge. For vomiting grain without passage, use Xiaobanxia Tang (Minor Pinellia Decoction). For rebellious qi, mental distress, and fullness vomiting, use Qianjin Banxia Tang (Golden Thousand Pinellia Decoction), i.e., Jingui Xiaobanxia Tang plus Cinnamon Heart. For shortness of breath, add Licorice. The acridity of Pinellia and Ginger treats upper jiao qi congestion and exterior excess; for stomach deficiency, only tonifying the stomach and promoting grain qi is suitable, avoiding acrid purgation. Thus, if Xiaobanxia Tang fails, Dabanxia Tang (Major Pinellia Decoction) works immediately. For chronic cold causing chest/diaphragm rebellion and anorexia, use Wuzhuyu Tang plus Cinnamon Heart, Pinellia, Licorice, and Wheat, decocted in wine. For cold vomiting (preferring heat, aversion to cold, cold limbs, fine slippery pulse), use Lizhong Tang plus Immature Bitter Orange (Zhishi), or Erchen Tang plus Clove and Fried Ginger, taken warm. For heat vomiting (preferring cold, aversion to heat, irritability/thirst, red/scanty urine, surging rapid pulse), use Erchen Tang plus Gardenia (Zhizi), Coptis, Bamboo Shavings, Loquat Leaf (Pipaye), Kudzu Root (Gegen), Ginger Juice, and Reed Rhizome Juice (Lugen汁). For vomiting during anger with chest fullness and blockage, use Erchen Tang plus Green Tangerine Peel (Qingpi) and Costus. If ineffective, add Clove, Agarwood, Costus, Cardamom, Magnolia Bark (Houpo), and Medicated Leaven (Shenqu). If still ineffective, consider blood stasis, treating according to Blood Accumulation protocols. For phlegm accumulation in the epigastrium triggered by cold (commonly called cold saliva overflow), use Clove, Cardamom, Amomum, Dried Ginger, Tangerine Peel, Pinellia, Ginger, and White Mustard Seed (Baijiezi). For vomiting-phlegm leading to syncope (phlegm syncope), use Jiangfu Tang (Ginger and Aconite Decoction) plus Atractylodes, Pinellia, and Asarum (Xixin). For phlegm filling chest/throat causing immediate rejection of food/medicine, first use Black Tin Pill (Heixi Dan) with Ginger Juice to anchor and sink; once tolerable, use Erchen Tang plus Immature Bitter Orange, Atractylodes, Cardamom, Magnolia Bark, and Ginger Juice. For deficiency, add Ginseng. For Liver Fire rebellion causing vomiting without intake, vomiting sour/bitter/blue-green fluids with unobstructed bowels/bladder and heart pain, indicating Fire and Wood constraint, apply "Wood constraint requires dispersion, Fire constraint requires venting." Use concentrated Evodia and Coptis, sipped slowly, followed by Xiaoyao San (Free and Easy Wanderer Powder). For Spleen/Stomach deficiency with poor transformation causing immediate vomiting upon swallowing, use Liujunzi Tang (Six Gentlemen Decoction) plus Cardamom and Fried Ginger to rotate the central pivot. Danxi stated: Vomiting patients must avoid Trichosanthes Fruit (Gualou Shi), Peach Kernel (Taoren), Radish Seed (Laifuzi), and Gardenia (Shanzhi), and all oily substances, as they offend the stomach and induce vomiting. Herbs with aromatic properties facilitate dispersion and efficacy.
Hiccups result from stomach deficiency-cold or retained water-fluids. Stomach deficiency requires warming with Lizhong Tang; retained water requires Chupi Banxia Tang; if urination is difficult, add Cinnamon Heart and Poria (Fuling); if stomach deficiency prevents eating, add Ginseng. For Lung/Stomach water retention with wheezing/cough, modify Xiaoqinglong Tang. For hiccups due to missed purgation causing stomach excess heat with abdominal fullness, follow Zhongjing: check anterior/posterior obstructions and clear them using Chengqi Tang or Zhuling Tang. Hiccups due to deficiency-heat use Chupi Zhuru Tang; deficiency-cold use Chupi Ganjiang Tang; severe cold removes Tongcao, adds Clove and Aconite (Fuzi); mixed cold-heat removes Licorice, adds Clove and Persimmon Calyx (Shidi). Post-Taiyang cold damage stomach heat vomiting/hiccups use Qianjin Tongcao Chupi Tang; post-cold damage vomiting/regurgitation/dry retching/anorexia use Qianjin Lugan Yinzi (Reed Rhizome Drink). For seasonal cold damaging the stomach causing cold-induced hiccups in spring/summer, Qianjin uses Tangerine Peel, Cinnamon Heart, and Kudzu Root (2 liang each) and White Imperata Rhizome (1 sheng), decocted in water. Add heat, remove Cinnamon Heart. Frequent, connected hiccups indicate excess, treat with heat-clearing; hiccups every half hour indicate deficiency, treat with warming-tonifying. Abdominal fullness, anuria, scattered pulse, head sweat, staring eyes, and hiccups indicate imminent death.
Qianjin states: For patients rejecting herbal decoctions, first decoct 1 liang of Licorice in water, induce vomiting, observe, then administer remaining decoction to prevent vomiting. Ginger is the sacred herb for vomiting.
[Diagnosis] Pulse present at upper position, absent at lower position indicates impending vomiting; absence of vomiting implies death. Tight Yang, rapid Yin pulse indicates vomiting; floating and rapid Yang pulse indicates vomiting. Tight Cun, choppy Chi pulse with chest fullness and vomiting; rapid Cun Kou pulse indicates vomiting; tight and choppy pulse is difficult to treat; tight and slippery pulse indicates vomiting/rebellion. Weak pulse with vomiting, free urination, slight fever, and cold extremities is difficult to treat. Patients desiring to vomit should not be purged. Severe vomiting pain with green vegetable-colored emesis is critical.
Dry Retching: Dry retching produces sound without phlegm, distinct from the turbid, long sound of hiccups. Use Tangerine Peel decoction with Ginger Juice and Honey, sipped slowly. For stomach deficiency, add Ginseng; for stomach cold, add Fried Ginger. For stomach deficiency with turbid qi rebellion, use Wuzhuyu Tang. For dry retching with fever, use Huangqin Tang (Scutellaria Decoction). For dry retching with diarrhea, use Huangqin Jia Banxia Shengjiang Tang (Scutellaria plus Pinellia and Ginger Decoction).
Leaking Qi: Heat in back/arms,牵引 pain, interrupted qi, diaphragmatic oppression, vomiting then diarrhea after eating. Named Leaking Qi. Caused by wind-heat closing pores, allowing vigorous upper jiao qi to escape through openings, losing its pathway, with pathogenic factors lodging internally. Treat with Qianjin Maidong Lizhong Tang (Ophiopogon Regulate-Middle Decoction). For obese patients with much phlegm, use Zexie Tang (Alisma Decoction).
Zoubu: Lower jiao excess heat with internal knotting, failure to excrete waste, turbidity steaming into stomach, blocking bowel/bladder, rebellious qi, uncontrollable vomiting. Named Zoubu. Treat with Renshen Tang (Ginseng Decoction). Sudden vomiting after eating with floating/surging pulse indicates upper jiao fire rebellion. Use Tangerine Peel, Pinellia, Immature Bitter Orange, Platycodon, Magnolia Bark, Areca Seed, Poria, Atractylodes. Descending qi clears fire, stopping vomiting, then tonify with Ginseng and Peony. Upper closure with lower vomiting due to upper fire, use Immature Bitter Orange, Platycodon, Tangerine Peel, Magnolia Bark, Areca Seed, Rhubarb, Costus to mildly purge.
Bitter Vomiting: Pathogen in Gallbladder channel, Wood overacting on Stomach, bile reflux causing bitter vomiting. Use Evodia, Coptis, Poria, Alisma, Ginger. Pathogen in Gallbladder, rebellion in Stomach, bile leakage causes bitterness; treat with Xiaochaihu Tang. Stomach qi rebellion causes bitter vomiting; treat with Wuzhuyu Tang.
Zhong Suan (Sourness in Middle): Damp-heat stagnating in Liver, Liver fire rebelling upward, lodged between Lung/Stomach. Food entering stomach is constrained by dampness, failing to transform, causing sourness ("curved and straight makes sour"). Use Zuojin Wan (Assist Metal Pill). Xue Lizhai stated: Acid regurgitation and burping often belong to Spleen deficiency and Wood hyperactivity, with sallow complexion and chest oppression. Clearing heat/phlegm herbs often cause loose stools, anorexia, and fatigue. Use Liujunzi Tang plus Fried Ginger, Costus, Evodia. For Spleen/Kidney dual deficiency, add Nutmeg (Roudoukou) and Psoralea (Buguzhi). For middle qi weakness, use Lizhong Tang plus Evodia. For constrained fire, use Lianli Tang. If ineffective, use Buzhong Yiqi Tang plus Costus and Fried Ginger, delivering Zuojin Wan. For middle qi deficiency-cold, add Aconite or use Fuzi Lizhong Tang. Avoid sticky/greasy foods; eat light foods to promote qi flow.
Spitting Acid: *Neijing* attributes vomiting/spitting acid to Heat. Dongyuan attributed it to Cold. Why? If stomach dampness stagnates and transforms into heat, following Wood transformation, it causes acid spitting. Over time, Liver Wood flourishes, Stomach Earth declines. Pacify Liver, support Stomach; use Xiaoyao San with Zuojin Wan. For retained food in epigastrium, use Pingwei San plus Cardamom, Patchouli, Amomum, Medicated Leaven.
Vomiting Water: Thirst for water, vomiting immediately upon ingestion, named Water Rebellion. Use Wuling San. For qi deficiency, use Sijunzi Tang minus Licorice, add Immature Bitter Orange, Tangerine Peel, Ginger. If ineffective, use Liujunzi Tang replacing Poria with Red Poria, decocted in clarified Longgu (Dragon Bone/Vermilion Tile Sediment) water.
Spitting Saliva: Stomach deficiency-cold failing to constrain fluids causes spitting saliva. Use Liujunzi Tang plus Alpinia Oxyphylla (Yizhi) and Ginger. Or Lizhong Tang plus Alpinia to astringe.
Vomiting Roundworms: Can be cold, heat, or mixed. Cold presents with cold extremities and pale roundworms; treat with Lizhong Tang plus Phytolacca Berry (Wumei), Coptis, Sichuan Pepper (Shuzhao). Severe cases with flat/dead worms are critical. Heat presents with red, numerous, moving worms; treat with Anqi Wan (Calming Worm Pill). Mixed cold-heat presents with quietness alternating with irritability, vomiting after eating, worms emerging from food odor; treat with Wumei Wan. Most roundworm vomiting is mixed cold-heat. Formulas use Sichuan Pepper, Coptis, Phytolacca Berry. Worms calm with sour, settle with bitter, remain still with pungent. If vermifuges fail, use Gancao Fenmi Tang.
Shiwan stated: Diseases with atypical presentations require unconventional treatments. Example: Wang Yujiuzhong contracted illness from fright, experiencing incessant retching without emission, fasting for half a month while maintaining daily activities. Medical prayers failed. Alcohol and rich foods were tolerated, but grains induced vomiting. Famous physicians could not diagnose. Various tonics/purgatives and folk remedies (Bezoar, Dog Gallstone, Tiger Eye, Cat Placenta) failed. Wet noodles were tolerated, but whole grains caused immediate regurgitation after eight months. A stranger suggested drinking hot goose blood. One dose brought relief. Goose blood is cool, benefits five zang organs, and eats venomous insects (per *Qianjin Fang*), possessing wind-dispelling, parasite-killing, detoxifying, and blood-resolving properties. Drinking hot blood opened the knot, expelling stagnant blood clots, allowing gradual resumption of diet without medicine. This suggests blood can resolve blood stasis without harsh purgation. Similar cases include Qiao Sanyu treating a General with dysphagia by inducing vomiting of blood stasis, and Yu Jiayan treating blood parasites. These methods, though secret, align with *Neijing* principles and supplement Xia Zi Yi's unique prescriptions.
Yu Hengde treated a middle-aged woman with postpartum food stagnation and Spleen deficiency failing to accept grain for 40 days. Nausea at grain smell, vomiting at medicine smell. Used Yigong San plus Patchouli, Amomum, Medicated Leaven, and aged rice. Decocted smooth-flowing water, mixed with Vermilion Tile Sediment (Fulonggan), filtered, added Ginger/Jujube, and administered. Vomiting stopped. Aged rice water was sipped frequently. Gradual recovery after 2-3 doses.
Xue Lizhai treated a 30-year-old woman who ceased eating for 3 years, drinking tea and fruit. Menstruation was late and scant. Diagnosed as thought-wounding Spleen with qi constraint. Used Guipi Tang plus Evodia. Recovery after few doses.