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，故脓不自咳出，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。
先呕却渴者，此为欲解；先渴却呕者，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。先渴却呕者，即前痰饮条中，小半夏茯苓汤之证也。
程林曰∶先呕却渴者，为呕后而胃无津液，得水和之即愈；先渴却呕者，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。先呕却渴者，痰水已去，而胃气将复也，故曰∶此为
欲解。先渴却呕者，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。
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FS 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。《饮咳篇》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。
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。
小半夏汤方（见痰饮中）
呕吐而病在膈上，后思水者，解，急与之；思水者，猪苓散主之。
【注】此详申上条饮呕，以明其治也。呕吐病后，则伤膈上津液，若思水者，急与饮
之，不复呕吐者，是病去胃和自解也。思水者，与饮之而仍呕吐者，是病未除而有水饮
也。主之猪苓散者，利水以止呕吐也。
【集注】程林曰∶上章言先呕却渴，此为欲解；今呕吐而病在膈上，后思水者解，亦
与上证不殊，故急与之以和胃。然思水之人，又有得水而贪饮，则胃中热少不能消水，更
与人作病，故思水者，用猪苓散以散水饮。
魏荔彤曰∶呕吐而病在膈上，后思水者，欲解之征也，即论中所言，先呕后渴，此为
欲解之义也。急与之，呕吐后伤津液，水入而津液可复也。若夫未曾呕吐即思水者，即
论中所言，先渴却呕之证也，是为水停心下，应治其支饮，而渴方愈也。主以猪苓散，利
水补土，以治湿邪者，治渴而即以治上逆之呕吐也。
猪苓散方
猪苓 茯苓 白术（各等分）
上三味，杵为散，饮服方寸匕，日三服。
呕而发热者，小柴胡汤主之。
【注】呕而腹满是有里也，主之大柴胡汤，攻里以止呕也；今呕而发热，是有表也，主
之小柴胡汤，和表以止呕也。
【集注】程林曰∶经曰∶呕而发热者，柴胡汤证具。夫呕家未有发热者，以发热属半
表半里，故与小柴胡汤以和之。
李 曰∶伤寒发热者为表证，然邪欲侵里，里气拒而不纳，则逆而作呕，此半表半
里证也。小柴胡为治半表半里，和解之剂。
小柴胡汤方
柴胡（半斤） 黄芩（三两） 人参（三两） 甘草（三两） 半夏（半升） 生姜（三两）
大枣（十二枚）
上七味，以水一斗二升，煮取六升，去滓，再煎取三升，温服一升，日三服。
呕而脉弱，小便复利，身有微热，见厥者难治，四逆汤主之。
【注】呕而心烦，心中懊 ，内热之呕也。今呕而脉弱，正气虚也；小便复利，中寒盛
也。身有微热而复见厥，曰难治者，此为寒盛格热于外，非呕而发热者比，故以四逆汤
胜阴回阳也。
【集注】高世 曰∶呕者水去寒犹在上，小盒饭少，今复利者，寒亦在下也。脉弱者，
气衰于内。身微热者，格阳于外，呕证如是，则上下寒而内外虚，若见手足逆冷而厥者，则
表里阴阳之气，不相顺接，故为难治。四逆汤主之，生附子壮火回阳以治厥，干姜温脾
暖胃以治呕，甘草安中调上下以治内外也。
四逆汤方
附子（生用，一枚） 干姜（一两半） 甘草（炙，二两）
上三味，以水三升，煮取一升二合，去滓，分温再服。强人可大附子一枚，干姜三
两。
呕而胸满者，茱萸汤主之。
【注】呕逆之气上冲于胸，胸中气实，则不受邪，必不满也；若胸中气虚，客寒邪气
得以留连，故胸满也。主之吴茱萸汤，补正气，降邪气也。
【集注】徐彬曰∶胸乃阳位，呕为阴邪，使胸之阳气足以御之则不呕，呕亦胸中无恙
也，乃呕而胸满，是胸虚邪客，不但胃不和矣。虚邪属阴，故以吴茱萸之苦辛温，善驱
浊阴者为君，人参补虚为佐，而以姜、枣宣发上焦之正气也。
茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味，以水五升，煮取三升，温服七合，日三服。
呕而肠鸣，心下痞者，半夏泻心汤主之。
【注】呕而肠鸣，肠虚而寒也。呕而心下痞，胃实而热也。并见之，乃下寒上热，肠
虚胃实之病也，故主之半夏泻心汤，用参、草、大枣以补正虚，半夏以降客逆，干姜以胜中
寒，芩、连以泻结热也。
【集注】程林曰∶呕而肠鸣、心下痞者，此邪热乘虚而客于心下，故用芩、连泄热除
痞，干姜、半夏散逆止呕。《内经》曰∶脾胃虚则肠鸣。又曰∶中气不足，肠为之苦鸣。人
参、大枣、甘草，用以补中而和肠胃。
半夏泻心汤方
半夏（洗，半升） 黄芩 干姜 人参（各三两） 黄连（一两） 大枣（十二枚） 甘
草（炙，三两）
上七味，以水一斗，煮取六升，去滓，再煮取三升，温服一升，日三服。
干呕吐逆，吐涎沫，半夏干姜散主之。
【注】有声有物谓之呕，有声无物谓之哕，即干呕也。今有声无物而吐涎沫，故曰干呕。
吐逆，吐涎沫也。干呕吐酸苦，胃中热也；干呕吐涎沫，胃中寒也。主之半夏干姜散，温
中止呕也。
半夏干姜散方
半夏 干姜（等分）
上二味，杵为散，取方寸匕，浆水一升半，煎取七合，顿服之。
干呕，吐涎沫，头痛者，茱萸汤主之。
【注】干呕吐涎沫者，以半夏干姜散，温中止呕也。若更头痛，此属寒气盛而逆之甚
也，故用吴茱萸汤，温寒下气，大折冲逆之势也。
【集注】徐彬曰∶上焦有寒，其口多涎。上焦既有寒邪，格阳在上，故主头痛。用吴
茱萸温补以驱浊阴也。
李 曰∶太阴、少阴经，从足至胸，俱不上头，二经并无头痛证。厥阴经上出额，与
督脉会于巅，故干呕、吐涎沫者，里寒也；头痛者，寒气从经脉上攻也。不用桂、附，用
吴茱萸者，以其入厥阴经故耳！余皆温补散寒之药。
干呕而利者，黄芩加半夏生姜汤主之。
【注】干呕者，胃气逆也，若下利清彻，乃肠中寒也。今下利浊粘，是肠中热也，故
用黄芩汤以治其利，合半夏生姜汤，以治干呕也。
【集注】程林曰∶中焦不和，则气逆于上而作呕，迫于下而为利，故用半夏、生姜，入
上焦而止呕；甘草、大枣，入中焦而和脾；黄芩。芍药，入下焦而止利。如是则正气安而
邪气去，三焦和而呕利止矣。
魏荔彤曰∶此呕为热逆之呕，利为挟热之利。
黄芩加半夏生姜汤方
黄芩（三两） 甘草（炙，二两） 芍药（二两） 半夏（半升） 生姜（三两） 大枣（十二枚）
上六味，以水一斗，煮取三升，去滓，温服一升，日再，夜一服。
食已即吐者，大黄甘草汤主之。
【注】吐者，有物无声之谓也。朝食暮吐者寒也，食己即吐者火也，以寒性迟，火性
急也。故以大黄甘草汤，缓中泻火，火平自不吐也。
【集注】王肯堂曰∶病患欲吐者，不可下之，又用大黄甘草治食已即吐，何也？曰∶欲
吐者，其病在上，因而越之可也，而逆之使下，则必抑塞愤乱而益甚，故禁之。若既已
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，故取之也。
程林曰∶经云∶诸逆冲上，皆属于火。食已即吐，是胃热上逆而不能容食，与反胃寒
呕水饮不同，故用是汤以平胃热。
高世 曰∶食己即吐者，非宿谷不化之胃反，乃火热攻冲之吐逆。
大黄甘草汤方
大黄（四两） 甘草（一两）
上二味，以水三升，煮取一升，分温再服。
病患欲吐者，不可下之。
【注】病患欲吐，上越之势方盛，故不可下之。若病患吐后，其势衰矣，因其衰而济
之，故已吐有可下之法也。
【集注】徐彬曰∶治病之法，贵因势利导，故《内经》曰∶在上者越之，在下者竭之。今
病欲上吐，不可强之使下，凡病皆然，故曰∶病患欲吐者，不可下之。
程林曰∶按“欲”字，乃吐而未吐之义。
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。
【注】此承上条，详申欲吐之状，以明其治也。喘者呼吸气急也，似喘不喘，谓胸中
似喘之不快，而不似喘之气急也。呕者吐物而有声也，似呕不呕，谓似作呕之状，而不
似呕之有物也。哕者干呕也，似哕不哕，谓似乎哕之有声，而不似哕之声连连也。胸彻
心中愦愦然无奈者，总形容似喘不喘，似呕不呕，似哕不哕，心中愦乱无奈，懊 欲吐
之情状也，故以半夏降逆，生姜安胃也。
【集注】沈明宗曰∶似喘不喘，似呕不呕，
似哕不哕，诚不是喘，不是呕，不是哕也。彻者，通也，竟是通心中愦愦然无奈，即泛泛
恶心之义也。
生姜半夏汤方
半夏（半升） 生姜汁（一升）
上二味，以水三升，煮半夏取二升，内生姜汁，煮取一升半，小冷分四服，日三夜
一服。止，停后服。
【集解】李 曰∶生姜、半夏，辛温之气，足以散水饮而舒阳气，然待小冷服者，恐寒
饮固结于中，拒热药而不纳，反致呕逆。今热药冷冻饮料下嗌之后，冷体既消，热性便发，情
且不违，而致大益，此《内经》之旨也。此方与前半夏干姜汤略同，但前温中气，故用
干姜，此散停饮，故用生姜；前因呕吐上逆，顿服之则药力猛峻，足以止逆降气，呕吐立
除；此心中无奈，寒饮内结，难以猝消，故分四服，使胸中邪气徐徐散也。
吐后渴欲得水而贪饮者，文蛤汤主之。兼主微风，脉紧头痛。
【按】“文蛤汤主之”五字，当在头痛之下，文义始属，是传写之讹。兼主之“主”字，
衍文也。
【注】吐后而渴，当少少与饮之，胃和吐自止也。若恣意贪饮，则新饮复停，而吐必
不已也，当从饮吐治之。若兼感微风，脉必紧，头必痛。主之文蛤汤者，是治渴兼治风
水也。故以越婢汤方中盖文蛤。越婢散风水也，文蛤治渴不己也。
【集注】程林曰∶贪饮者，饮水必多，多则淫溢上焦，必有溢饮之患，故用此汤以散
水饮，方中皆辛甘发散之药，故亦主微风，脉紧头痛。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十个） 大枣（十
二枚）
上七味，以水六升，煮取二升，温服一升，汗出即愈。
【集解】李 曰∶文蛤汤，即大青龙汤去桂枝，乃发汗之剂，使水饮从毛窍中泄去，以
散水饮于外。经云∶开鬼门，洁净府。此一方两得之。以内有麻黄、生姜等解表药，故
兼主微风，脉紧头痛。
问曰∶病患脉数，数为热，当消谷，饮食而反吐者，何也？师曰∶以发其汗，令阳
气微，膈气虚，脉乃数，数为客热，不能消谷，胃中虚冷故也。脉弦者，虚也。胃气无
余，朝食暮吐，变为胃反。寒在于上，医反下之，今脉反弦，故名曰虚。
【按】问曰∶“病患脉数”至“胃中虚冷故也”等句，己详《伤寒论·阳明篇》内，错
简在此，且与“脉弦者虚也”文义不属。
【注】弦，饮脉也，非虚脉也，病吐者若见之，则为胃气无余也。胃气无余，肝邪乘
之而见弦脉，故名曰虚也。询其所以致弦之由，乃为寒在上，医反下之，使胃气尽而无
余，则不能消化水谷，致令朝食暮吐，暮食朝吐，变为中寒胃反也。
【集注】李 曰∶食不得入，是有火也；食入反出，是无火也。此寒在上者，法当温
In cases where a patient with vomiting has abscess pus, one must not treat the vomiting directly; once the pus is exhausted, it will heal on its own.
[Annotation] "Patient with vomiting" refers to those who vomit food, water, phlegm-fluids, or cold froth. Now, if pus is vomited, this indicates an internal abscess. The pus ruptures and is expelled via vomiting; this is not a primary vomiting disease. Therefore, it is said: do not treat the vomiting; once the pus is exhausted, [the condition] heals spontaneously.
[Collected Annotations] Zhao Liang stated: The Classic says, "Heat gathers at the stomach opening and does not circulate, causing congestion in the epigastrium." The epigastrium belongs to the Yangming channel. When Yangming qi rebels upward, vomiting occurs. Thus, the pus does not come out through coughing but is expelled through vomiting. This indicates the abscess is located at the upper opening of the epigastrium. If the abscess is located past the middle, below the lungs, the pus will not be expelled through vomiting but will exit via the stool.
Cheng Lin stated: When an abscess ruptures, pus forms. Pus exiting upwards inevitably causes vomiting. Therefore, there is no need to treat the vomiting; once the pus is exhausted, the vomiting stops naturally.
If vomiting occurs first and thirst follows, this indicates the condition is about to resolve. If thirst occurs first and vomiting follows, this is due to fluid retention in the heart-epigastrium (lower chest/upper abdomen), which belongs to patients with phlegm-fluids.
[Annotation] After a vomiting illness, if the patient feels thirsty, drinks water, and does not vomit again, it indicates the stomach qi is harmonious, signifying the condition is about to resolve. If the patient becomes thirsty, drinks water, then vomits, and remains thirsty, this is due to fluid retention in the heart-epigastrium. This belongs to the vomiting of phlegm-fluid patients, not a primary vomiting disease.
[Collected Annotations] Zhao Liang stated: Vomiting expels fluids; when fluids are expelled, yang qi returns. However, body fluids have not yet distributed, so thirst occurs. Although thirsty, because the pathogen is gone and the healthy qi returns, recovery is certain. The case of "thirst first, then vomiting" corresponds to the syndrome treated by Xiao Banxia Fuling Tang mentioned in the previous phlegm-fluid section.
Cheng Lin stated: Vomiting first, then thirst, means the stomach lacks fluids after vomiting; obtaining water to harmonize leads to recovery. Thirst first, then vomiting, means the patient was originally thirsty and drank water, which stayed in the stomach causing vomiting; thus, it belongs to water-fluid pathology.
You Yi stated: Patients with vomiting necessarily have retained phlegm and old water. Vomiting first, then thirst, indicates the phlegm-water has been removed and stomach qi is recovering, hence "this indicates resolution." Thirst first, then vomiting, occurs because excessive drinking due to heat resolves the heat but accumulates water immediately. This vomiting is caused by accumulated fluids, hence "this belongs to phlegm-fluid patients."
Patients with vomiting should normally feel thirsty. If they do not feel thirsty now, it is because there is Zhi Yin (branching fluid) in the heart-epigastrium; this belongs to Zhi Yin.
[Annotation] In patients with vomiting, body fluids are already damaged, so they should normally feel thirsty. If they do not feel thirsty now, it is because Zhi Yin has existed in the heart-epigastrium. This belongs to vomiting caused by Zhi Yin, not a primary vomiting disease.
[Collected Annotations] Xu Bin stated: Zhi Yin refers to fluid distribution that is lateral and not central.
Gao Shishi stated: Zhi Yin refers to water qi following the meridians, curving and branching laterally, resembling swelling. Zhi Yin causing vomiting is why it is said "this belongs to Zhi Yin." The *Chapter on Fluids and Cough* states: "Patients with vomiting should be thirsty; thirst indicates resolution. Now they are not thirsty because there is Zhi Yin in the heart-epigastrium; treat with Xiao Banxia Tang as the main formula."
For various types of vomiting where food cannot go down, Xiao Banxia Tang is the main formula.
[Annotation] This details various vomiting diseases to clarify their treatment. "Ou" (vomiting) refers to symptoms with sound and material; "Tu" (spitting up) refers to symptoms with material but no sound. For all vomiting where food cannot be swallowed, Xiao Banxia Tang is used to descend rebellion and calm the stomach.
[Collected Annotations] Zhao Liang stated: Vomiting where food cannot go down can be cold or hot, and cannot be generalized. Vomiting immediately after eating is heat; morning eating and evening vomiting is cold. This case is neither cold nor hot but results from fluid retention in the middle jiao, qi knotting and rebelling upward, hence Xiao Banxia 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, phlegm-fluids are excessive and external pathogens are few, blocking between the chest and stomach, causing qi rebellion so grain cannot enter. Thus, Shengjiang (Fresh Ginger) disperses pathogens, and Banxia (Pinellia) eliminates phlegm-fluids to stop vomiting and rebellion.
Xiao Banxia Tang Formula (see Phlegm-Fluids section)
When vomiting occurs and the disease is in the upper diaphragm, and the patient subsequently desires water, it indicates resolution; give water immediately. If the patient desires water, Zhuling San is the main formula.
[Annotation] This further elaborates on the above clause regarding fluid-induced vomiting to clarify treatment. After vomiting, the fluids in the upper diaphragm are damaged. If the patient desires water, give water immediately. If vomiting does not recur, the disease is gone, the stomach is harmonious, and it resolves itself. If the patient desires water, is given water, but still vomits, the disease is not eliminated and there is fluid retention. Zhuling San is used to promote urination to stop vomiting.
[Collected Annotations] Cheng Lin stated: The previous chapter said "vomiting first, then thirst" indicates resolution. Now, vomiting with disease in the upper diaphragm, followed by desire for water, also indicates resolution, similar to the previous syndrome, so give water urgently to harmonize the stomach. However, those desiring water may drink greedily upon obtaining it. If stomach heat is insufficient to transform the water, it causes further illness. Thus, for those desiring water, Zhuling San is used to dissipate fluid retention.
Wei Litong stated: Vomiting with disease in the upper diaphragm, followed by desire for water, is a sign of impending resolution, consistent with the meaning of "vomiting first, then thirst, indicates resolution." Give water urgently because vomiting damages fluids, and water intake restores them. If one desires water without having vomited, it corresponds to "thirst first, then vomiting," indicating fluid retention in the heart-epigastrium. One should treat the Zhi Yin, and the thirst will heal. Zhuling San promotes urination and tonifies earth to treat dampness, treating thirst while simultaneously treating the upward-rebelling vomiting.
Zhuling San Formula
Zhu Ling (Polyporus), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) (equal parts)
Crush these three herbs into a powder. Take one Fang Cun Bi (square-inch scoop) with liquid, three times daily.
When vomiting is accompanied by fever, Xiao Chai Hu Tang is the main formula.
[Annotation] Vomiting with abdominal fullness indicates interior excess; Da Chai Hu Tang is used to purge the interior to stop vomiting. Now, vomiting with fever indicates exterior involvement (half-exterior half-interior); Xiao Chai Hu Tang is used to harmonize the exterior-interior to stop vomiting.
[Collected Annotations] Cheng Lin stated: The Classic says: "Vomiting with fever indicates the Chai Hu Tang syndrome is complete." Patients with vomiting rarely lack fever; since fever belongs to the half-exterior half-interior, Xiao Chai Hu Tang is given to harmonize.
Li stated: Fever in Shanghan is an exterior syndrome. However, when pathogens attempt to invade the interior, the interior qi rejects them, causing upward rebellion and vomiting. This is a half-exterior half-interior syndrome. Xiao Chai Hu Tang is a harmonizing agent for the half-exterior half-interior.
Xiao Chai Hu Tang Formula
Chai Hu (Bupleuri Radix, 8 liang), Huang Qin (Scutellariae Radix, 3 liang), Ren Shen (Ginseng Radix, 3 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, prepared, 3 liang), Banxia (Pinelliae Rhizoma, prepared, 0.5 sheng), Sheng Jiang (Zingiberis Rhizoma Recens, 3 liang), Da Zao (Jujubae Fructus, 12 pieces)
Boil these seven ingredients in 12 dou of water, reduce to 6 sheng, remove dregs, decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.
When vomiting is accompanied by a weak pulse, frequent urination, slight body heat, and cold extremities, it is difficult to treat; Si Ni Tang is the main formula.
[Annotation] Vomiting with irritability and inner restlessness indicates internal heat vomiting. Now, vomiting with a weak pulse indicates deficient healthy qi; frequent urination indicates abundant middle cold. Slight body heat combined with cold extremities makes it difficult to treat because abundant cold repels yang to the exterior. This differs from vomiting with fever. Thus, Si Ni Tang is used to overcome yin/cold and restore yang.
[Collected Annotations] Gao Shishi stated: Vomiting expels water, but cold remains above; it should be minimal. Now frequent urination indicates cold is also below. A weak pulse indicates qi decline internally. Slight body heat indicates yang repelled externally. With such vomiting, there is cold above and below, deficiency inside and out. If cold extremities and Jue (reversal cold) appear, the yin-yang qi of interior and exterior do not connect smoothly, making it difficult to treat. Si Ni Tang is used: Sheng Fu Zi (Prepared Aconite Lateralis Radix) strengthens fire and restores yang to treat Jue; Gan Jiang (Zingiberis Rhizoma) warms spleen and stomach to treat vomiting; Gan Cao (Licorice Root) stabilizes the middle and harmonizes upper/lower to treat interior/exterior.
Si Ni Tang Formula
Fu Zi (Aconiti Lateralis Radix Preparata, raw use, 1 piece), Gan Jiang (Zingiberis Rhizoma, 1.5 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang)
Boil these three ingredients in 3 sheng of water, reduce to 1.2 sheng, remove dregs. Divide into two warm doses. Strong individuals may use 1 large Fu Zi and 3 liang Gan Jiang.
When vomiting is accompanied by chest fullness, Wu Zhu Yu Tang is the main formula.
[Annotation] Rebellious qi from vomiting rushes upward to the chest. If chest qi is excess, it repels pathogens and will not feel full. If chest qi is deficient, pathogenic cold lingers, causing chest fullness. Wu Zhu Yu Tang is used to tonify healthy qi and descend pathogenic qi.
[Collected Annotations] Xu Bin stated: The chest is a Yang position; vomiting is a Yin pathogen. If chest Yang qi is sufficient to resist it, there is no vomiting, and the chest remains safe. Now, vomiting with chest fullness indicates chest deficiency with pathogen invasion, not just stomach disharmony. Since the pathogenic qi is Yin, Wu Zhu Yu's pungent, bitter, and warm nature, which effectively drives away turbid yin, is used as the sovereign herb. Ren Ginseng tonifies deficiency as the minister herb, while Ginger and Jujube disseminate the Zheng Qi (healthy qi) of the upper jiao.
Wu Zhu Yu Tang Formula
Wu Zhu Yu (Evodiae Fructus, 1 sheng), Ren Shen (Ginseng Radix, 3 liang), Sheng Jiang (Zingiberis Rhizoma Recens, 6 liang), Da Zao (Jujubae Fructus, 12 pieces)
Boil these four ingredients in 5 sheng of water, reduce to 3 sheng. Take 7 ge warm, three times daily.
When vomiting is accompanied by borborygmus (intestinal rumbling) and epigastric stuffiness (Pi), Banxia Xiexin Tang is the main formula.
[Annotation] Vomiting with borborygmus indicates intestinal deficiency and cold. Vomiting with epigastric Pi indicates stomach excess and heat. Their coexistence represents lower cold and upper heat, intestinal deficiency and stomach excess. Banxia Xiexin Tang is used: Ren Shen, Gan Cao, and Da Zao tonify deficiency; Banxia descends rebellious qi; Gan Jiang overcomes middle cold; Huang Qin and Huang Lian drain constrained heat.
[Collected Annotations] Cheng Lin stated: Vomiting with borborygmus and epigastric Pi indicates pathogenic heat invading the heart-epigastrium due to deficiency. Huang Qin and Huang Lian drain heat and remove Pi; Gan Jiang and Banxia disperse rebellion and stop vomiting. The *Neijing* states: "Spleen and stomach deficiency causes borborygmus." It also states: "Insufficient middle qi causes painful borborygmus." Ren Shen, Da Zao, and Gan Cao tonify the middle and harmonize the stomach and intestines.
Banxia Xiexin Tang Formula
Banxia (Pinelliae Rhizoma, washed, 0.5 sheng), Huang Qin (Scutellariae Radix), Gan Jiang (Zingiberis Rhizoma), Ren Shen (Ginseng Radix) (each 3 liang), Huang Lian (Coptidis Rhizoma, 1 liang), Da Zao (Jujubae Fructus, 12 pieces), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 liang)
Boil these seven ingredients in 1 dou of water, reduce to 6 sheng, remove dregs, decoct again to obtain 3 sheng. Take 1 sheng warm, three times daily.
Dry heaving with rebellious vomiting and expulsion of saliva/phlegm is treated with Banxia Ganjiang San.
[Annotation] Sound with material is Ou (vomiting); sound without material is Yue (hiccup/dry heave). Now, there is sound but no material, only expulsion of saliva/phlegm, so it is called dry heaving. Rebellious vomiting refers to expelling saliva/phlegm. Dry heaving with sour/bitter taste indicates stomach heat; dry heaving with saliva/phlegm indicates stomach cold. Banxia Ganjiang San is used to warm the middle and stop vomiting.
Banxia Ganjiang San Formula
Banxia (Pinelliae Rhizoma), Gan Jiang (Zingiberis Rhizoma) (equal parts)
Crush these two herbs into a powder. Take one Fang Cun Bi, decoct in 1.5 sheng of Jiangshui (fermented grain liquid) to obtain 0.7 sheng. Take all at once.
Dry heaving, expulsion of saliva/phlegm, accompanied by headache is treated with Wu Zhu Yu Tang.
[Annotation] For dry heaving with expulsion of saliva/phlegm, Banxia Ganjiang San is used to warm the middle and stop vomiting. If headache is added, this indicates severe cold and intense upward rebellion. Wu Zhu Yu Tang is used to warm cold, direct qi downward, and strongly suppress the rebellious momentum.
[Collected Annotations] Xu Bin stated: Cold in the upper jiao causes excessive salivation. With cold pathogens in the upper jiao repelling yang upward, headache is the main symptom. Wu Zhu Yu is used to warm and tonify, driving away turbid yin.
Li stated: The Taiyin and Shaoyin channels run from foot to chest and do not ascend to the head; these two channels do not present with headache. The Jueyin channel ascends to the forehead and meets the Du vessel at the vertex. Thus, dry heaving and expulsion of saliva/phlegm indicate interior cold; headache indicates cold attacking from the channels. Guizhi and Fuzi are not used; instead, Wu Zhu Yu is used because it enters the Jueyin channel. The rest are warming, tonifying, and cold-dispersing herbs.
Dry heaving accompanied by diarrhea is treated with Huangqin Jia Banxia Shengjiang Tang.
[Annotation] Dry heaving indicates stomach qi rebellion. If diarrhea is clear and thin, it is intestinal cold. Now, diarrhea is turbid and sticky, indicating intestinal heat. Huangqin Tang is used to treat the diarrhea, combined with Banxia Shengjiang Tang to treat dry heaving.
[Collected Annotations] Cheng Lin stated: Disharmony in the middle jiao causes qi to rebel upward leading to vomiting and press downward leading to diarrhea. Banxia and Shengjiang enter the upper jiao to stop vomiting; Gan Cao and Da Zao enter the middle jiao to harmonize the spleen; Huang Qin and Shaoyao enter the lower jiao to stop diarrhea. Thus, healthy qi is secured, pathogens are expelled, the three jiao are harmonized, and vomiting and diarrhea cease.
Wei Litong stated: Here, the vomiting is heat-rebellion vomiting, and the diarrhea is heat-associated diarrhea.
Huangqin Jia Banxia Shengjiang Tang Formula
Huang Qin (Scutellariae Radix, 3 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 2 liang), Shaoyao (Paeoniae Radix Alba, 2 liang), Banxia (Pinelliae Rhizoma, prepared, 0.5 sheng), Sheng Jiang (Zingiberis Rhizoma Recens, 3 liang), Da Zao (Jujubae Fructus, 12 pieces)
Boil these six ingredients in 1 dou of water, reduce to 3 sheng, remove dregs. Take 1 sheng warm, twice daily, once at night.
Vomiting immediately after eating is treated with Dahuang Gancao Tang.
[Annotation] Tu (spitting up) is material without sound. Morning eating and evening vomiting is cold; vomiting immediately after eating is fire/heat, because cold is slow and fire/heat is urgent. Dahuang Gancao Tang is used to soothe the middle and drain fire; once fire is pacified, vomiting stops naturally.
[Collected Annotations] Wang Kentang stated: When a patient wants to vomit, purgatives are contraindicated. Yet here, Dahuang Gancao treats vomiting immediately after eating. Why? Answer: When wanting to vomit, the disease is in the upper part, and inducing emesis is appropriate. Forcing downward counteracts this, causing obstruction and worsening the condition, hence it is prohibited. If vomiting has already occurred and continues incessantly, rising without descending, one must counteract and break the trend, guiding it downward. Nothing is faster than Dahuang, hence it is selected.
Cheng Lin stated: The Classic says: "All rebellious upward rushing belongs to fire." Vomiting immediately after eating is stomach heat rebelling upward, unable to retain food. This differs from Fanwei (reverse stomach) cold vomiting of water/fluids. Thus, this formula is used to pacify stomach heat.
Gao Shishi stated: Vomiting immediately after eating is not Fanwei (retention of undigested food) but vomiting/rebellion caused by fire-heat attacking.
Dahuang Gancao Tang Formula
Da Huang (Rhei Radix et Rhizoma, 4 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 liang)
Boil these two ingredients in 3 sheng of water, reduce to 1 sheng. Divide into two warm doses.
When a patient wants to vomit, purgatives are contraindicated.
[Annotation] When a patient wants to vomit, the upward-expelling momentum is strong, so purgatives are contraindicated. If the patient has already vomited, the momentum has declined. One can assist the treatment based on this decline; thus, after vomiting, there are cases where purgatives can be used.
[Collected Annotations] Xu Bin stated: The method of treating disease values guiding according to the momentum. The *Neijing* says: "Those in the upper are expelled upwards; those in the lower are drained downwards." Now the disease wants to vomit upward; one must not force it downward. This applies to all diseases, hence "when a patient wants to vomit, purgatives are contraindicated."
Cheng Lin stated: The character "Yu" (want/wish) implies vomiting has not yet occurred.
When a patient feels like panting but isn't panting, like vomiting but isn't vomiting, like hiccuping but isn't hiccuping, and feels thoroughly confused and helpless in the heart/mind, Shengjiang Banxia Tang is the main formula.
[Annotation] This continues the previous clause, detailing the state of wanting to vomit to clarify treatment. Panting is rapid breathing. "Like panting but not panting" means chest discomfort resembling panting, but not the rapid breathing of actual panting. Vomiting is expelling material with sound. "Like vomiting but not vomiting" means the posture of wanting to vomit, but without expelling material. Yue (hiccup) is dry heaving. "Like Yue but not Yue" means seeming to have the sound of Yue, but not the continuous sound of actual Yue. "Thoroughly confused and helpless in the heart" summarizes the state of "like panting but not panting, like vomiting but not vomiting, like Yue but not Yue," describing the confusion, helplessness, restlessness, and desire to vomit. Banxia is used to descend rebellion, and Shengjiang to calm the stomach.
[Collected Annotations] Shen Mingzong stated: Like panting but not panting, like vomiting but not vomiting, like Yue but not Yue—indeed, it is not panting, not vomiting, not Yue. "Che" (thorough/pervade) means penetrating. It is a thorough feeling of confusion and helplessness in the heart, i.e., general nausea.
Shengjiang Banxia Tang Formula
Banxia (Pinelliae Rhizoma, prepared, 0.5 sheng), Sheng Jiang Zhi (Zingiberis Rhizoma Recens Juice, 1 sheng)
Boil Banxia in 3 sheng of water to obtain 2 sheng. Add Sheng Jiang Zhi, boil to obtain 1.5 sheng. Take slightly cool, divided into four doses. Three times during the day, once at night. Stop subsequent doses if symptoms cease.
[Collected Commentary] Li stated: Shengjiang and Banxia have pungent-warm qi sufficient to dissipate fluid retention and relieve yang qi. However, taking it slightly cool is to prevent cold fluids firmly knotted in the middle from rejecting hot medicine, which would cause vomiting. By taking hot medicine cold, after swallowing, the cold nature dissipates, and the hot nature activates. This complies with the mind and brings great benefit, following the principle of the *Neijing*. This formula is slightly similar to the previous Banxia Ganjiang Tang. The former warms middle qi, using Gan Jiang; this one dissipates retained fluids, using Sheng Jiang. The former involves vomiting rebellion, taken in one dose for potent effect to stop rebellion and vomiting immediately; this case involves heart confusion and internal knotted cold fluids, hard to dissolve suddenly, so divided into four doses to slowly dissipate chest pathogens.
After vomiting, if the patient is thirsty, desires water, and drinks greedily, Wenli Tang is the main formula. It also treats mild wind, tight pulse, and headache.
[Note] The five characters "Wenli Tang zhu zhi" (Wenli Tang is the main formula) should be placed after "headache" for logical coherence; this is a transcription error. The character "Zhu" (main/treat) in "Jian zhu zhi" is a superfluous character.
[Annotation] After vomiting, if thirsty, water should be given in small amounts. When stomach qi harmonizes, vomiting stops. If one drinks greedily, new fluids accumulate, and vomiting continues. Treatment should follow fluid-vomiting protocols. If accompanied by mild wind, the pulse will be tight, and headache will occur. Wenli Tang treats thirst and wind-water simultaneously. Thus, Wenli Shell is added to the Yuebi Tang formula. Yuebi San treats wind-water; Wenli Shell treats persistent thirst.
[Collected Annotations] Cheng Lin stated: Those who drink greedily drink much. Excess spills into the upper jiao, causing Yi Yin (overflowing fluid). Thus, this formula dissipates fluid retention. All herbs in the formula are pungent-sweet and dispersing, hence it also treats mild wind, tight pulse, and headache.
Wenli Tang Formula
Wen Li (Arcae Concha, 5 liang), Ma Huang (Ephedrae Herba), Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Jiang (Zingiberis Rhizoma Recens) (each 3 liang), Shi Gao (Gypsum Fibrosum, 5 liang), Xing Ren (Prunus Armeniacae Semen, 50 pieces), Da Zao (Jujubae Fructus, 12 pieces)
Boil these seven ingredients in 6 sheng of water, reduce to 2 sheng. Take 1 sheng warm. Recovery occurs with sweating.
[Collected Commentary] Li stated: Wenli Tang is Da Qing Long Tang minus Guizhi. It is a sweating agent, allowing fluid retention to escape through hair pores, dissipating external fluids. The Classic says: "Open the ghost gate (pores), cleanse the clean府 (bladder)." This single formula achieves both. Because it contains exterior-resolving herbs like Ma Huang and Sheng Jiang, it also treats mild wind, tight pulse, and headache.
Question: The patient's pulse is rapid (Shu). Rapid indicates heat, which should digest food. Why does the patient vomit after eating?
Master said: Because sweating was induced, yang qi became slight, diaphragm qi became deficient, and the pulse became rapid. This rapid pulse indicates guest heat, which cannot digest food. The root is cold deficiency in the stomach. A string-like (Xian) pulse indicates deficiency. When stomach qi is exhausted, morning eating and evening vomiting occurs, transforming into Fanwei (reverse stomach). Cold is in the upper part, but the doctor incorrectly used purgatives. Now the pulse is string-like, hence named deficiency.
[Note] The passage from "The patient's pulse is rapid" to "root is cold deficiency in the stomach" is detailed in the *Yangming Chapter* of the *Shanghan Lun*. It is misplaced here (cuojian) and does not logically connect with "string-like pulse indicates deficiency."
[Annotation] Xian (string-like) is a fluid-retention pulse, not a deficiency pulse. If seen in vomiting patients, it indicates exhausted stomach qi. With exhausted stomach qi, liver pathogen invades, producing a string-like pulse, hence named deficiency. Asking the cause of the string-like pulse: cold was in the upper part, but the doctor incorrectly used purgatives, exhausting stomach qi completely. Thus, digestion fails, leading to morning eating/evening vomiting or evening eating/morning vomiting, transforming into middle-cold Fanwei.
[Collected Annotations] Li stated: Food cannot enter indicates fire; food enters and comes back out indicates no fire. For cold in the upper part, the method should be warming.