东垣曰∶夫呕、吐、哕者，皆属于胃，胃者总司也，以其气血多少为异耳。且
如呕者、阳明也，阳明多血多气，故有声有物，气血俱病也。仲景云∶呕多虽有阳
明症，慎不可下。孙真人曰∶呕家多服生姜，乃呕吐之圣药也。气逆者必散之，故
以生姜为主。吐者、太阳也，太阳多血少气，故有物无声，乃血病也。有食入则吐，
有食已则吐，以陈皮去白主之。哕者、少阳也，少阳多气少血，故有声无物，乃气
病也。以姜制半夏为主。故朱奉议治呕、吐、哕，以生姜、半夏、陈皮之类是也。
究三者之源，皆因脾气虚弱，或因寒气客胃，加之饮食所伤而致也。宜以丁香、藿
香、半夏、茯苓、陈皮、生姜之类主之。若但有内伤而有此疾，宜察其虚实，使内
消之，痰饮者必下之，当分其经，对证用药，不可乱也。《金匮》方，诸呕吐，谷不
得下者，小半夏汤主之。又云∶呕家本渴，渴者为欲解，今反不渴，心下有支饮故
也，小半夏汤主之。用半夏一升，生姜半斤，水七升，煮取一升半，分温再服。又
云∶卒呕吐，心下痞，有水眩悸者，小半夏加茯苓汤主之。即前方加茯苓四两
也。然则生姜、半夏固通治呕吐之正剂矣，然东垣云∶辛药生姜之类治呕吐，但治
上焦气壅表实之病。若胃虚谷气不行，胸中闭塞而呕者，唯宜益胃推扬谷气而已，
勿作表实用辛药泻之。故服小半夏汤不愈者，服大半夏汤立愈，此仲景心法也。寒
而呕吐，则喜热恶寒，四肢凄清，或先觉咽酸，脉弱小而滑，因胃虚伤寒饮食，或
伤寒汗下过多，胃中虚冷所致，当以刚壮温之，宜二陈汤加丁香十粒，或理中汤加
枳实半钱，或丁香吴茱萸汤、藿香安胃散、铁刷汤，不效则温中汤，甚则附子理中
汤，或治中汤加丁香，并须冷服。盖冷遇冷则相入，庶不吐出。（罗谦甫云∶诸药不愈者，红
豆丸神效。）曾有患人用附子理中汤、四逆汤加丁香，到口即吐，后去干姜，只参、附
加丁、木二香，煎熟，更磨入沉香，立吐定。盖虚寒痰气凝结，丁、附既温，佐以
沉、木香则通，干姜、白术则泥耳。热呕，食少则出，喜冷恶热，烦躁引饮，脉数
而洪，宜二陈汤加黄连、炒栀子、枇杷叶、竹茹、干葛、生姜，入芦根汁服。《金匮》
方，呕而发热者，小柴胡汤主之。洁古用小柴胡汤加青黛，以姜汁打糊丸，名清镇
丸，治呕吐脉弦头痛，盖本诸此。胃热而吐者，闻谷气即呕，药下亦呕，或伤寒未
解，胸中有热，关脉洪者是也，并用芦根汁。《金匮》方，呕吐而病在膈上，后思水，
解，急与之，思水者，猪苓散主之。呕而胸满者，吴茱萸汤主之。呕而渴，煮枇杷
叶汁饮之。呕而肠鸣，心下痞者，半夏泻心汤主之。气呕吐，胸满膈胀，关格不通，
不食常饱，食则常气逆而吐，此因盛怒中饮食而然，宜二陈汤加枳实、木香各半钱，
或吴茱萸汤，不效则丁沉透膈汤，及五膈宽中汤。食呕吐，多因七情而得，有外感
邪气，并饮食不节而生，大概治以理中为先，二陈汤加枳实一钱，或加南星七分，
沉香、木香各四分亦好，或只服枳南汤，或导痰汤。又有中脘伏痰，遇冷即发，俗
谓之冷痫，或服新法半夏汤，或挝脾汤。有痰饮，粥药到咽即吐，人皆谓其番胃，
非也，此乃痰气结在咽膈之间，宜先以姜苏汤下灵砂丹，俟药可进，则以顺气之药
继之。外有吐泻及痢疾，或腹冷痛，进热药太骤，以致呕逆，宜二陈汤加砂仁、白
豆蔻各半钱，沉香少许。呕吐诸药不效，当借镇重之药以坠其逆气，宜姜苏汤下灵
砂丹百粒，俟药得止，却以养正丹、半硫丸导之。呕吐津液既去，其口必渴，不可
因渴而遽以为热。若阴虚邪气逆上，窒塞呕哕，不足之病，此地道不通也。正当用
生地黄、当归、桃仁、红花之类，和血、凉血、润血，兼用甘草以补其气，微加大
黄、芒硝以通其闭，大便利，邪气去，则气逆呕哕自不见矣。复有胸中虚热，谷气
久虚，发而为呕哕者，但得五谷之阴以和之，则呕哕自止。
【漏气】身背皆热，肘臂牵痛，其气不续，膈间厌闷，食入即先呕而后下，名曰漏气。
此因上焦伤风，闭其腠理，经气失道，邪气内着，麦门冬汤主之。
【走哺】下焦实热，大小便不通，气逆不续，呕逆不禁，名曰走哺。人参汤主之。
【吐食】上焦气热上冲，食已暴吐，脉浮而洪，宜先降气和中，以桔梗汤调木香散二钱，
隔夜空腹服之，三服后，气渐下，吐渐去，然后去木香散，加芍药二两，黄 一两
半，同煎服之，病愈则止。如大腑燥结，食不尽下，以大承气汤去芒硝微下之，少
利为度，再服前药补之。如大便复结，又根据前微下之。《保命集》用荆黄汤调槟榔散。
中焦吐食，由食积与寒气相格，故吐而疼，宜服紫沉丸。《金匮》大黄甘草汤，治食
已即吐，又治吐水。吐食而脉弦者，由肝胜于脾而吐，乃由脾胃之虚，宜治风安胃，
金花丸、青镇丸主之。《金匮》茯苓泽泻汤，治胃反吐而渴欲饮水者。
【干呕】《金匮》方，干呕哕，若手足厥者，陈皮汤主之。卒干呕不息，取甘蔗汁温服半
升，日三，或入生姜汁。捣葛根绞取汁服。
【恶心】恶心干呕，欲吐不吐，心下映漾，人如畏船，宜大半夏汤，或小半夏茯苓汤，
或理中汤、治中汤皆可用。《金匮》方，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。胃气虚弱，身重有痰，恶心欲吐，是
邪气羁绊于脾胃之间，当先实其脾胃，茯苓半夏汤主之。旧有风证，不敢见风，眼
涩眼黑，胸中有痰，恶心兀兀欲吐，但遇风觉皮肉紧，手足难举动，重如石，若在
暖室，少出微汗，其证随减，再遇风，病复如是，柴胡半夏汤主之。仲景云∶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，则必抑塞愦乱而益以甚，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，无速于大黄者也，故不禁也。兵法曰∶避其锐，
击其惰，此之谓也。丹溪泥之，而曰凡病呕吐，切不可下，固矣夫。
【呕苦】经云∶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。取三里，以下胃气逆，则刺少阳血络，以闭胆逆，却调虚实，
以去其邪。又云∶口苦呕宿汁，取阳陵泉，为胃主呕而胆汁苦，故独取胆与胃也。
阳明在泉，燥淫所胜，病善呕，呕有苦。又云∶阳明之胜，呕苦，治以苦温、辛温。
是运气呕苦，皆属燥也。
【吐酸】（吞酸附）东垣曰∶病机云，诸呕吐酸，皆属于热。辨云，此上焦受外来客邪也，胃气不
受外邪故呕。《伤寒论》云∶呕家虽有阳明证，不可攻之，是未传入里，三阴不受邪
也，亦可见此症在外也，仲景以生姜、半夏治之。孙真人云∶呕家多用生姜，是呕
家圣药。以杂病论之。呕吐酸水者，甚则酸水浸其心，不任其苦，其次则吐出酸水，
令上下牙酸涩不能相对，以大辛热剂疗之必减。吐酸，呕出酸水也。酸味者收气
也，西方肺金旺也。寒水乃金之子，子能令母实，故用大咸热之剂，泻其子，以辛
热为之佐，以泻肺之实。以病机之法作热攻之者误矣，盖杂病醋心，浊气不降，欲
为中满，寒药岂能治之乎。丹溪曰∶或问吞酸，《素问》明以为热，东垣又以为寒，
何也？曰吐酸与吞酸不同，吐酸似吐出酸水如醋，平时津液随上升之气郁而成积，
成积既久，湿中生热，故从木化，遂作酸味，非热而何。其有郁积之久，不能自涌
而出，伏于肺胃之间，咯不得上，咽不得下，肌表得风寒则内热愈郁而酸味刺心，
肌表温暖腠理开发，或得香热汤丸，津液得行亦可暂解，非寒而何。《素问》言热者，
言其本也。东垣言寒者，言其末也。但东垣不言外得风寒，而作收气立说，欲泻肺
金之实。又谓寒药不可治酸，而用安胃汤、加减二陈汤，俱犯丁香，且无治热湿郁
积之法，为未合经意。予尝治吞酸，用黄连、茱萸各制炒，随时令迭为佐使，苍术、
茯苓为辅，汤浸蒸饼为小丸吞之，仍教以 食蔬果自养，则病易安。中脘有饮则嘈，
有宿食则酸，故常嗳宿腐，气逆，咽酸水；亦有每晨吐清酸水数口，日间无事者；
亦有膈间常如酸折，皆饮食伤于中脘所致。生料平胃散加神曲、麦芽各一钱，或八
味平胃散，有热则咽醋丸。膈间停饮积久，必吐酸水，神术丸。酒癖停饮吐酸水，
干姜丸。风痰眩冒，头痛恶心，吐酸水，半夏、南星、白附生为末，滴水丸桐子大，
以生面为衣，阴干。每服十丸至二十丸，姜汤送下。参萸丸，可治吞酸，亦可治自
利。酸心，用槟榔四两，陈皮二两，末之。空心生蜜汤下方寸匕。
【呕清水】经云∶太阴之复，呕而密默，唾吐清液，治以甘热。是呕水属湿，一味苍术丸
主之。《金匮》方，心胸中有停痰宿水，自吐出水后，心胸间虚，气满不能食，茯苓饮主
之。能消痰气，令能食。又云∶渴欲饮水，水入则吐者，名曰水逆，五苓散主之。
《千金方》治痰饮，水吐无时节者，其原因冷冻饮料过度，遂令脾胃气羸，不能消于饮食，
饮食入胃则皆变成冷水，反吐不停者，赤石脂散主之。赤石脂捣筛服方寸匕，
酒饮时稍加至三匕，服尽一斤，终身不吐痰水，又不下利。
【吐涎沫】《金匮》方，干呕吐逆，吐涎沫，半夏干姜散主之。半夏、干姜各等分，杵为散，
取方寸匕，浆水一升半，煎至七合，顿服之。干呕，吐涎沫，头痛者，吴茱萸汤主之。
妇人吐涎沫，医反下之，心下即痞，当先治其吐涎沫，小青龙汤主之；涎沫止，乃
治痞，泻心汤主之。
【呕脓】仲景云∶呕家有痈脓，不可治呕，脓尽自愈。《仁斋直指》以地黄丸汤主之。
【呕虫】仲景以吐蛔为胃中冷之故，则成蛔厥，宜理中汤加炒川椒五粒，槟榔半钱，吞
乌梅丸。胃咳之状，咳而呕，呕甚则长虫出，亦用乌梅丸。取胃三里。有呕吐诸药
不止，别无他证，乃蛔在胸膈作呕，见药则动，动则不纳药，药出而蛔不出，虽非
吐蛔之比，亦宜用吐蛔药，或于治呕药中入炒川椒十粒，蛔见椒则头伏故也。
【诊】形状如新卧起。阳紧阴数，其人食已即吐。阳浮而数，亦为吐。（或浮大，皆
阳偏胜阴不能配之也，为格，主吐逆，无阴和之。）寸紧尺涩，其人胸满不能食而吐。寸口脉数，其人则
吐。寸口脉细而数，数则为热，细则为寒，数为呕吐。《金匮》问数为热，当消谷引
食，而反吐者，何也？曰以发其汗，令阳微，膈气虚脉乃数，数为客热，不能消谷，
胃中虚冷故吐也。趺阳脉微而涩，（微则不利，涩则吐逆，谷不得入。）或浮而涩，（浮则虚，
虚伤脾，脾伤则不磨，朝食暮吐名反胃。）寸口脉微而数，（微则血虚，血虚则胃中寒。）脉紧而
涩者，难治。关上脉浮大，风在胃中，心下澹澹，食欲呕。关上脉微浮，积热在胃中，呕吐蛔虫。
关上脉紧而滑者，蛔动。脉紧而滑者，吐逆。脉小弱而涩，胃反。浮而洪为气。浮而匿为
积。沉而迟为寒。趺阳脉浮，胃虚，呕而不食，恐怖者难治，宽缓生。（寒气在上，阴气
在下，二气并争，但出不入。）先呕却渴，此为欲解；先渴却呕，为水停心下，属饮。脉弱而呕，
小便复利，身有微热，见厥者死。呕吐大痛，色如青菜叶者死。
Li Dongyuan stated: Vomiting, retching, and hiccups (hiccough) all belong to the Stomach. The Stomach is the general manager of digestion, differing only in the abundance or scarcity of Qi and Blood. For instance, vomiting belongs to the Yangming channel; Yangming has abundant Blood and Qi, so there is both sound and matter expelled, indicating that both Qi and Blood are diseased. Zhang Zhongjing said: If there is much vomiting even with Yangming syndrome, one must be cautious and absolutely avoid purgation. Sun Simiao said: Patients with vomiting should take fresh ginger frequently; it is the sacred herb for treating vomiting. When Qi rebels, it must be dispersed, hence fresh ginger is used as the principal herb. Retching without vomiting (Tu) belongs to the Taiyang channel; Taiyang has abundant Blood but scarce Qi, so there is matter expelled without sound, indicating a Blood disease. Cases where food is vomited immediately upon ingestion, or after digestion, are treated primarily with Chenpi (Citri Reticulatae Pericarpium), with the white pith removed. Hiccups (Yue) belong to the Shaoyang channel; Shaoyang has abundant Qi but scarce Blood, so there is sound without matter expelled, indicating a Qi disease. It is treated primarily with Banxia (Pinelliae Rhizoma) prepared with ginger. Therefore, Zhu Fengyi, when treating vomiting, retching, and hiccups, used herbs such as Shengjiang (Zingiberis Rhizoma Recens), Banxia, and Chenpi. Investigating the source of these three conditions, they are all caused by Spleen Qi deficiency, or cold pathogen lodging in the Stomach, compounded by dietary injury. Suitable treatments include Dingxiang (Caryophylli Flos), Huoxiang (Agastaches Herba), Banxia, Fuling (Poria), Chenpi, and Shengjiang. If the condition arises solely from internal injury, one must distinguish between deficiency and excess and promote internal resolution; if it is Phlegm-Fluid, purgation is necessary. One must differentiate by channel and prescribe according to syndrome, avoiding chaos. In the *Jin Gui Yao Lue* formulas, for various types of vomiting where food cannot be retained, Xiaobanxia Tang (Minor Pinellia Decoction) is the primary treatment. It also states: A patient with vomiting who becomes thirsty indicates the disease is resolving; if they do not become thirsty, it is due to Zhiyin (branching fluid retention) in the Heart region, treated with Xiaobanxia Tang. The prescription uses Banxia (Pinelliae Rhizoma) 1 sheng, Shengjiang 0.5 jin, boiled in 7 sheng of water to yield 1.5 sheng, taken warm in two doses. It further states: For sudden vomiting with epigastric fullness (Pi), dizziness, and palpitations due to water qi, Xiaobanxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria) is used, which is the above formula plus Fuling 4 liang. Thus, Shengjiang and Banxia are indeed the standard remedies for vomiting. However, Li Dongyuan noted that pungent herbs like Shengjiang treat vomiting only when there is Qi stagnation in the Upper Jiao and exterior excess. If the Stomach is deficient, Grain Qi fails to move, causing chest obstruction and vomiting, one should only benefit the Stomach and promote Grain Qi, rather than using pungent herbs to drain an exterior excess. Therefore, if Xiaobanxia Tang fails, Dabanxia Tang (Major Pinellia Decoction) brings immediate relief; this is Zhang Zhongjing's key method. Cold-type vomiting presents with preference for heat and aversion to cold, cold limbs, or initial sour regurgitation, with a weak, small, and slippery pulse. It is caused by Stomach deficiency with cold damage from diet, or excessive sweating/purging in cold damage leading to cold deficiency in the Stomach. It should be warmed with robust warming agents, such as Erchen Tang (Two-Cured Decoction) plus 10 Dingxiang cloves, or Lizhong Tang (Regulate the Middle Decoction) plus 0.5 qian of Zhishi (Aurantii Fructus Immaturus), or Dingxiang Wuzhuyu Tang, Huoxiang Angwei San, or Tieshua Tang. If ineffective, use Wenzhong Tang; if severe, Fuzi Lizhong Tang, or Zhizhong Tang plus Dingxiang. These must be taken cold. The principle is that cold meets cold to penetrate, preventing expulsion. (Luo Qianfu said: For cases unresponsive to other drugs, Hongdou Wan [Red Bean Pill] is miraculous.) There was a case where a patient taking Fuzi Lizhong Tang or Sini Tang plus Dingxiang vomited immediately upon ingestion. Later, Ganjiang (Dried Ginger) was removed, leaving only Renshen (Ginseng) and Fuzi (Aconite) plus Dingxiang and Muxiang (Costi Radix). After decocting, Chenxiang (Aquilariae Lignum) was ground in, stopping the vomiting instantly. This was because deficiency-cold and Phlegm-Qi were congealed; Ding and Fu provided warmth, while Chen and Muxiang promoted circulation, whereas Ganjiang and Baizhu (Atractylodis Macrocephalae Rhizoma) were too cloying. Heat-type vomiting involves small intake followed by expulsion, preference for cold and aversion to heat, irritability, thirst, and a rapid, surging pulse. Erchen Tang plus Huanglian (Coptidis Rhizoma), Chao Zhizi (Gardeniae Fructus stir-fried), Pipa Ye (Loquat Leaf), Zhuru (Bambusae Caulis in Taenia), Gegen (Puerariae Lobatae Radix), and Shengjiang, mixed with Lugen (Reed Rhizome) juice, is suitable. In the *Jin Gui Yao Lue*, vomiting with fever is treated with Xiaochaihu Tang (Minor Bupleurum Decoction). Jiegu used Xiaochaihu Tang plus Qingdai (Indigo Naturalis), made into pills with Ginger Juice paste, named Qingzhen Wan, for vomiting with wiry pulse and headache, based on this principle. Stomach-heat vomiting causes nausea at the smell of grain and rejection of medicine, or unresolved cold damage with heat in the chest and a surging Guan pulse; Reed Rhizome juice is used throughout. In the *Jin Gui Yao Lue*, vomiting with pathology in the upper diaphragm, followed by desire for water indicating resolution, is treated urgently with water; for those desiring water, Zhuling San (Polyporus Powder) is used. Vomiting with chest fullness is treated with Wuzhuyu Tang. Vomiting with thirst is treated with boiled Loquat Leaf juice. Vomiting with borborygmus and epigastric fullness is treated with Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium). Qi-rebellion vomiting with chest/diaphragm fullness, Guan-Ge obstruction, constant satiety without eating, and post-prandial Qi rebellion with vomiting, caused by anger during meals, is treated with Erchen Tang plus Zhishi and Muxiang (0.5 qian each), or Wuzhuyu Tang. If ineffective, use Dingchen Touge Tang or Wuge Kuanzhong Tang. Food-stagnation vomiting often arises from emotional factors, external pathogens, and irregular diet. Treatment prioritizes Lizhong Tang, Erchen Tang plus Zhishi (1 qian), or plus Nanxing (Arisaematis Rhizoma Praeparatum) (0.7 fen), or Chenxiang and Muxiang (0.4 fen each); alternatively, Zhinan Tang or Daotan Tang. Latent Phlegm in Zhongwan flares up with cold,俗称 "Cold Epilepsy"; treat with Xinfa Banxia Tang or Zhuapi Tang. Fluid retention causing immediate vomiting of porridge/medicine at the throat is often mistaken for Fanwei (reversed stomach); it is actually Phlegm-Qi knotting in the throat/diaphragm. Treat first with Jiangsu Tang delivering Lingsha Dan; once medication can be retained, follow with Qi-regulating herbs. External cases of vomiting/diarrhea or dysentery, or cold abdominal pain exacerbated by too-rapid administration of hot medicines, causing rebellious Qi, are treated with Erchen Tang plus Sharen (Amomi Fructus) and Baidoukou (Amomi Rotundus Fructus) (0.5 qian each) and a little Chenxiang. If all vomiting remedies fail, heavy sedatives are needed to descend rebellious Qi; use Jiangsu Tang delivering 100 grains of Lingsha Dan. Once stopped, follow with Yangzheng Dan or Banshu Wan. After vomiting depletes fluids, thirst occurs; do not hastily assume heat. If Yin deficiency allows pathogenic Qi to rebel upward, obstructing vomiting/hiccups, this is a deficiency disease where the lower pathway is blocked. Use Shengdi Huang (Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Taoren (Persicae Semen), Honghua (Carthami Flos) to harmonize, cool, and moisten Blood, combined with Gancao (Licorice Root) to tonify Qi, and slightly add Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas) to open blockage. Once bowels move and pathogen leaves, rebellious Qi and vomiting cease spontaneously. Alternatively, empty heat in the chest and long-term Grain Qi deficiency causing vomiting/hiccups are resolved by nourishing with the Yin of five grains.
[Leaking Qi] Heat over the body and back, pulling pain in elbows/arms, discontinuous Qi, oppression in the diaphragm, vomiting then defecation after eating, named Leaking Qi. Caused by Wind damaging the Upper Jiao, closing Couli (pores), disrupting Jing Qi pathways, and pathogen lodging internally. Maimendong Tang (Ophiopogon Decoction) is used.
[Running Nourishment] Excess heat in the Lower Jiao, obstruction of urination/defecation, discontinuous Qi, uncontrollable vomiting/reversal, named Running Nourishment. Renshen Tang (Ginseng Decoction) is used.
[Vomiting Food] Heat Qi in the Upper Jiao rushing upward, violent vomiting after eating, floating and surging pulse. First, descend Qi and harmonize the Middle using Jiegeng Tang (Platycodon Decoction) mixed with Muxiang San (Costus Powder), 2 qian, taken on an empty stomach overnight. After three doses, Qi descends and vomiting subsides; then remove Muxiang San, add Shaoyao (Paeoniae Radix Alba) 2 liang and Huangqin (Scutellariae Radix) 1.5 liang, decoct together until cured. If large bowel dryness prevents complete evacuation, use Dachengqi Tang (Major Order the Golden Cabinet Decoction) minus Mangxiao for mild purgation, stopping at slight looseness, then replenish with previous herbs. If stool re-hardens, repeat mild purgation. *Baoming Ji* uses Jinghuang Tiao Binglang San. Middle Jiao vomiting food results from food stagnation clashing with cold, causing vomiting and pain; Zichen Wan is suitable. *Jin Gui Yao Lue* Dahuang Gancao Tang treats immediate post-prandial vomiting and vomiting of water. Vomiting food with a wiry pulse indicates Liver overacting on Spleen due to Spleen/Stomach deficiency; treat wind and calm the Stomach with Jinhua Wan and Qingzhen Wan. *Jin Gui Yao Lue* Fuling Zexie Tang treats Wei Fan (Stomach Reversal) with vomiting and thirst for water.
[Dry Heaves] *Jin Gui Yao Lue*: Dry heaves and hiccups with cold extremities are treated with Chenpi Tang. Sudden persistent dry heaves: take warm Sugarcane Juice 0.5 sheng, three times daily, or add Ginger Juice. Crush Gegen (Kudzu Root), wring out juice, and drink.
[Nausea] Nausea and dry heaves, desire to vomit but unable, gurgling in the epigastrium, feeling like seasick, treated with Dabanxia Tang, or Xiaobanxia Fuling Tang, or Lizhong Tang, or Zhizhong Tang. *Jin Gui Yao Lue*: Patient feels like panting but not, like vomiting but not, like hiccuping but not, with inner restlessness and helplessness, treated with Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction). Stomach Qi deficiency with heaviness and Phlegm, nausea and desire to vomit, caused by pathogen entangling Spleen/Stomach; first solidify Spleen/Stomach with Fuling Banxia Tang. Old Wind pattern, fear of wind, dry/black eyes, Phlegm in chest, incessant nausea, skin tightness and limb heaviness upon wind exposure, improving slightly with sweat in warm rooms but recurring with wind, treated with Chaihu Banxia Tang. Zhang Zhongjing said: Patients desiring to vomit should not be purged. Why use Dahuang Gancao for immediate post-prandial vomiting? Answer: Desire to vomit indicates pathology in the Upper Jiao; inducing emesis is appropriate. Forcing downward causes obstruction and worsens the condition, hence prohibited. If vomiting has occurred and is unrestrained (ascending without descending), reverse and subdue it by guiding downward; nothing is faster than Dahuang, hence not prohibited. Military strategy: Avoid sharpness, strike weakness. Danxi rigidly interpreted this, stating vomiting must never be purged, which is correct.
[Bitter Vomiting] Classic says: Frequent vomiting with bitter taste, long sighs, pathogen in Gallbladder, rebellion in Stomach. Gallbladder fluid leakage causes bitter mouth; Stomach Qi rebellion causes bitter vomiting, called Dou Gallbladder. Acupoint Zusanli (ST36) descends Stomach Qi; puncture Shaoyang blood collaterals to close Gallbladder rebellion, adjust deficiency/excess, and eliminate pathogen. Also: Bitter mouth and vomiting old fluid, acupoint Yanglingquan (GB34). Since Stomach governs vomiting and bile is bitter, focus on Gallbladder and Stomach. Yangming ruling, dryness prevailing, disease frequent vomiting with bitter taste. Yangming excess, bitter vomiting, treated with bitter-warm and pungent-warm methods. Etiological bitter vomiting belongs to Dryness.
[Vomiting Sourness] (Including Swallowing Sourness) Li Dongyuan said: *Bingji* states all vomiting/sourness belongs to Heat. Commentary states this is external pathogen affecting Upper Jiao; Stomach rejects external pathogen causing vomiting. *Shanghan Lun* says: Even with Yangming syndrome, vomiting patients must not be attacked/purged, indicating pathogen is not yet interior, Three Yin not affected, thus exterior syndrome. Zhang Zhongjing treats with Shengjiang and Banxia. Sun Simiao said: Ginger is the sacred herb for vomiting. Discussing miscellaneous diseases: Vomiting sour water severely soaks the Heart with bitterness; mildly, teeth feel sour/astringent. Great pungent-hot agents reduce this. Vomiting sourness is expelling sour water. Sour flavor relates to gathering Qi; West Lung Metal is prosperous. Cold Water is the child of Metal; child makes mother full. Hence use great salty-hot agents to drain the child, assisted by pungent-hot to drain Lung excess. Treating as Heat per *Bingji* is error; miscellaneous disease sour heart involves turbid Qi failing to descend, potential fullness; how can cold herbs treat this? Zhu Danxi asked: *Suwen* says Heat, Dongyuan says Cold, why? Answer: Vomiting sourness differs from swallowing sourness. Vomiting sourness resembles spitting vinegar-like fluid; normal fluids rise with Qi, stagnate and accumulate; long accumulation generates heat from dampness, transforms to Wood, becoming sour—how is this not Heat? Long stagnation, unable to surge out, lies between Lung/Stomach, cannot be coughed up or swallowed down; wind/cold on surface increases internal heat depression and sour piercing; warmth opens pores, fragrant-hot pills allow fluid movement and temporary relief—how is this not Cold? *Suwen* speaks of Heat as the root; Dongyuan speaks of Cold as the branch. But Dongyuan ignores external wind/cold, bases theory on gathering Qi to drain Lung excess. Says cold herbs cannot treat sourness, uses Angwei Tang and Modified Erchen Tang containing Dingxiang, lacking method for heat-damp stagnation, inconsistent with classics. I treated swallowing sourness with Huanglian (Coptidis Rhizoma) and Zhuyu (Evodiae Fructus) stir-fried separately, alternating assistant/enemy roles by season, Cangzhu (Atractylodis Rhizoma) and Fuling as auxiliaries, steamed pill with rice cake dough, swallowed. Advised vegetarian diet/vegetables/fruits for recovery, disease easily calms. Zhongwan fluid retention causes hunger-pain; residual food causes sourness, hence belching rotten gas, Qi rebellion, swallowing sour water; some spit clear sour water morning-only, fine daytime; some feel sour breaking in diaphragm, all due to dietary injury in Zhongwan. Shengliao Pingwei San plus Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus) (1 qian each), or Bawei Pingwei San; if heat, swallow Cu Wan (Vinegar Pill). Diaphragmatic fluid retention long-standing causes sour vomiting; Shenzhu Wan. Wine-related fluid retention sour vomiting; Ganjiang Wan. Wind-Phlegm dizziness/headache/nausea/sour vomiting: Banxia, Nanxing, Baifuzi (Typhonii Rhizoma) raw powder, drop-water pills size tung seed, raw flour coating, shade dry. Take 10-20 pills with Ginger Tea. Canyu Wan treats swallowing sourness and spontaneous diarrhea. Acid Heart: Binglang (Arecae Semen) 4 liang, Chenpi 2 liang, powdered. Empty stomach, honey water delivers 1 cun bi.
[Vomiting Clear Fluid] Classic says: Taiyang reversal, vomiting and silence, spitting clear fluid, treat with sweet-hot. Vomiting water belongs to Dampness; Yiwu Cangzhu Wan (Single Herb Atractylodes Pill) is used. *Jin Gui Yao Lue*: Phlegm/fluid retention in chest/heart, self-vomiting fluid, leaving chest empty/full with inability to eat, Fuling Yin (Poria Drink) is used. Eliminates Phlegm-Qi, enables eating. Also: Thirst for water, vomiting upon drinking, named Shui Ni (Water Rebellion), Wuling San (Five-Ingredient Powder with Poria) is used. *Qianjin Fang* treats Phlegm-fluid vomiting without timing, caused by excessive cold drinks weakening Spleen/Stomach Qi, inability to digest food, food turning to cold water in Stomach, continuous vomiting; Chishizhi San (Halloysit Rubra Powder) is used. Halloysit rubbed fine, 1 cun bi dose, wine helps increase to 3 bi, finish 1 jin, lifelong no phlegm-water vomiting or diarrhea.
[Vomiting Saliva/Froth] *Jin Gui Yao Lue*: Dry heaves/reversal, vomiting saliva/froth, Banxia Ganjiang San (Pinellia and Dried Ginger Powder) is used. Banxia and Ganjiang equal parts, powdered. 1 cun bi dose, boiled in 1.5 sheng Jiangshui (Grain Water) to 0.7 sheng, taken at once. Dry heaves, vomiting saliva/froth, headache: Wuzhuyu Tang is used. Woman vomiting saliva/froth, doctor wrongly purged, epigastric fullness results; first treat saliva/froth with Xiaoqinglong Tang (Minor Green Dragon Decoction); once froth stops, treat fullness with Xiexin Tang (Drain the Epigastrium Decoction).
[Vomiting Pus] Zhang Zhongjing said: Patient vomiting pus from abscess should not be treated for vomiting; when pus is exhausted, it heals itself. *Ren Zhi Zhi Zhi Fang* uses Dihuang Wan Tang (Rehmannia Pill Decoction).
[Vomiting Worms] Zhang Zhongjing attributes vomiting roundworms to Cold in Stomach, causing Hui Jue (Roundworm Collapse); treat with Lizhong Tang plus 5 stir-fried Chuanjiao (Sichuan Pepper) and 0.5 qian Binglang, swallowing Wu Mei Wan (Mume Pill). Stomach Cough: cough with vomiting, severe vomiting expels long worms; also use Wu Mei Wan. Acupoint Zusanli (ST36). If all vomiting drugs fail, no other symptoms, worms in chest/diaphragm cause vomiting, moving upon seeing medicine, rejecting medicine, medicine exits but worm does not; though not typical worm vomiting, use worm-expelling drugs, or add 10 stir-fried Chuanjiao to anti-emetic drugs; worms bow head upon seeing pepper.
[Diagnosis] Appearance like newly risen from bed. Yang pulse tight, Yin pulse rapid, patient vomits immediately after eating. Yang pulse floating and rapid, also indicates vomiting. (Or floating-large, Yang excess Yin cannot match, Ge [blocking], main vomiting/reversal, no Yin to harmonize.) Cun tight Chi choppy, chest full, unable to eat, vomiting. Cun Kou pulse rapid, patient vomits. Cun Kou pulse thin and rapid: rapid is Heat, thin is Cold, rapid indicates vomiting. *Jin Gui Yao Lue* asks: Rapid is Heat, should digest grain and attract food, but instead vomits? Why? Answer: Caused by sweating, making Yang weak, Diaphragm Qi deficient, pulse rapid; rapid is guest Heat, cannot digest grain, Stomach middle cold deficiency causes vomiting. Fu Yang pulse faint and choppy: (faint implies constipation, choppy implies vomiting/reversal, grain cannot enter.) Or floating and choppy: (floating implies deficiency, deficiency injures Spleen, Spleen injury fails to grind, morning food evening vomit named Fan Wei [Stomach Reversal].) Cun Kou pulse faint and rapid: (faint implies Blood deficiency, Blood deficiency implies Stomach cold.) Pulse tight and choppy: difficult to treat. Guan pulse floating-large: Wind in Stomach, epigastric palpitations, appetite but desire to vomit. Guan pulse faint-floating: accumulated heat in Stomach, vomiting worms. Guan pulse tight-slippery: worms moving. Pulse tight-slippery: vomiting/reversal. Pulse small-weak-choppy: Stomach Reversal. Floating-large is Qi. Floating-hidden is Accumulation. Deep-slow is Cold. Fu Yang pulse floating: Stomach deficiency, vomiting without eating, fearfulness: difficult to treat, loose/warm leads to survival. (Cold Qi above, Yin Qi below, two Qi struggle, only exit not entry.) First vomit then thirst: desire to resolve; first thirst then vomit: water retention in Heart, belongs to Yin (Fluid). Pulse weak with vomiting, urination free, slight body heat, cold extremities: death. Vomiting severe pain, color like green vegetable leaves: death.