大意
呕吐哕俱属脾胃虚弱。或寒热所侵。或饮食所伤。致气上逆而食不得下也。（东垣）
内因
有内伤饮食。填塞太阴。新谷入胃。气不宣通而吐者。有久病气虚。胃气衰微。闻食则呕者。有胃中有热。食
入即吐者。有胃中有寒。食久方吐者。有风邪在胃。翻翻不定。郁成酸水。全不入食者。有暑邪犯胃。心烦口
渴。腹痛泄泻而呕者。有胃中有脓。腥臊熏臭而呕者。有胃中有虫。作痛吐水。得食暂止者。有胃中停水。心
下怔忡。口渴欲饮。水入即吐者。有胃中有痰。恶心头眩。中脘躁扰。食入即吐者。（汇补）
外候
挟寒。则喜热恶寒。肢冷脉小。挟热。则喜冷恶热。躁渴脉洪。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。尚疑虫症。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。（汇补）
吐分三焦
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。脉大而迟。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。（洁古）
呕吐哕辨
呕属阳明。气血居多之乡。故有声有物。气血俱病也。吐属太阴多血少气之所。故有物无声。血病也。哕属
少阳。多气少血之部。故有声有物。气病也。（东垣）
呕哕微甚
干呕即哕之微。哕即干呕之甚。呕声轻小而短。哕声重大而长。呕为轻。哕为重。（溯洄）故曰。木陈者其叶落。
病深者其声哕。（经文）
死症
吐如青菜汁者死。船晕大吐不止。渴欲饮水者危。惟童便饮之最效。女子肝气大实。久吐不已者死。呕而
脉弱。小便复利。身有微热。见厥者死。
脉法
寸口脉微者。胃寒。趺阳脉浮者。胃虚。阳紧阴数为吐。阳浮而数亦为吐。寸紧尺涩。胸满而吐。紧而滑者吐
逆。紧而涩者难治。寸口脉紧而芤为噎。关上脉数为吐。寸口脉微数则血不足。胸中冷故吐。又有呕吐太
甚。胸气不能降。而尺脉不至者。（汇补）
治法
古方以半夏、生姜、橘皮为呕家圣药。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。推扬谷气而已。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。（必读）
呕吐忌下
凡呕吐者。切不可下。逆之故也。（丹溪）惟兼胸满腹胀者。视其何部不利。然后利之。（大全）
阴虚成呕
诸阳气浮。无所根据纵。呕咳上气。此阴虚成呕。不独胃家为病。所谓无阴则呕也。地黄汤加石斛、沉香治之。（汇
补）
【附漏气走哺】
先吐后泻。身热腹闷。名曰漏气。漏气者。上焦伤风也。二便不通。气逆不续。名曰走哺。走哺者。下焦实热也。
（准绳）
【附食痹】
食痹者。食已则心下痛。吐出乃止。此因胃脘痰饮恶血留滞于中所致。薤白半夏汤治之。（汇补）
用药
主以二陈汤。加藿香、浓朴。因食者。必嗳气吞酸。加枳实、山楂、麦芽。因气者。必痞满不舒。加枳壳、苏梗、
浓朴。胃热者。必呕苦吐酸。加黄连、姜炒山栀。胃寒者。必呕冷不食。加炮姜、益智。湿痰者。必呕绿水痰涎。加苍
术、香附。虫痛者。必吐清水。能食加楝根、使君。气虚挟热合四君子。气虚挟寒合理中汤。或入糯米共煎。或用
伏龙肝水煎。或煎好调代赭石末服。
呕吐选方
二陈汤 治呕吐诸症。为能安胃气降逆气也。（方见痰症）
六君子汤 治胃气衰微呕吐。（方见中风）
理中汤 治胃气虚寒呕吐。（方见中寒）
竹茹汤 治胃热火炎呕吐。
橘皮 半夏（各三钱） 甘草 竹茹（各一钱） 山栀（七分） 枇杷叶（二片） 姜 枣
左金丸 治肝火上逆呕吐。
黄连 吴茱萸（各等分）
末之。粥丸。煎白术陈皮汤下。
小半夏汤 治胃实呕吐。
半夏 生姜（各三钱）
加橘皮。名橘皮半夏汤。
大半夏汤 治胃虚呕吐。
半夏（五钱） 人参（三钱） 白蜜（三钱）
水扬二百四十遍煎。
半夏生姜大黄汤 治邪实呕吐。便闭可下者。
半夏（二两） 生姜（两半） 大黄（二两）
水煎。分三服。
红豆丸 治胃气久虚。大寒呕吐。
丁香 胡椒 砂仁 红豆（各二十粒）
姜汁糊丸。以大枣去核填药。面裹煨熟。细嚼白滚汤下。
麦冬汤 治漏气。因上焦伤风。邪着不舒。闷而呕吐。
麦冬 芦根 竹茹 白术（各五两） 甘草（三两） 茯苓（三两）
人参 陈皮 葳蕤（各三两） 生姜（五片） 陈皮（一撮）
水煎。分服。
人参汤 治走哺。由大小便不通。下焦实热。
人参 黄芩 知母 萎蕤（各三两） 芦根 竹茹 白术 山栀 陈皮（各半两） 石膏（一两）
每服四钱。水煎。
旋复代赭汤 治呕吐不已。真气逆而不降。用此镇坠。
旋复花（三钱） 代赭石（一钱研）
用旋复花煎。调赭石末服。
General Principles
Vomiting and hiccups both belong to the category of Spleen-Stomach deficiency. They may be caused by invasion of cold or heat pathogens, or by dietary injury, leading to rebellious Qi ascent and the inability of food to descend. (Li Dongyuan)
Internal Causes
There are cases where internal dietary injury causes congestion in the Taiyin Spleen meridian; when new grain enters the Stomach, Qi fails to circulate freely, resulting in vomiting. There are cases where chronic illness leads to Qi deficiency and decline of Stomach Qi, causing nausea upon smelling food. There are cases where heat exists in the Stomach, causing immediate vomiting after eating. There are cases where cold exists in the Stomach, causing vomiting only after food has remained for a long time. There are cases where wind pathogen resides in the Stomach, causing restless retching, stagnation into sour fluid, and complete inability to eat. There are cases where summerheat pathogen invades the Stomach, causing irritability, thirst, abdominal pain, diarrhea, and vomiting. There are cases where pus exists in the Stomach, emitting a fishy, foul odor, causing vomiting. There are cases where parasites exist in the Stomach, causing pain and vomiting of water, which temporarily stops after eating. There are cases where fluid retention exists in the Stomach, causing palpitations below the heart, thirst with desire to drink, but immediate vomiting upon swallowing water. There are cases where phlegm-dampness exists in the Stomach, causing nausea, dizziness, restlessness in the Zhongwan area, and immediate vomiting after eating. (Zhengzhi Huibu)
External Manifestations
When accompanied by cold, there is preference for warmth and aversion to cold, cold limbs, and a thin pulse. When accompanied by heat, there is preference for coolness and aversion to heat, irritability, thirst, and a surging pulse. Qi stagnation presents as distension and obstruction. Phlegm-fluids manifest upon exposure to cold. Vomiting bitter fluid indicates pathogen in the Gallbladder meridian. Vomiting sour fluid identifies fire entering the Liver meridian. Vomiting saliva, although belonging to phlegm-fluids, still requires suspicion of parasitic disease. Vomiting sour-rotten food indicates food stagnation, while also guarding against fire disasters. Vomiting clear water signifies the inferior monitoring of Earth (Spleen dysfunction). Vomiting green water signifies the excessive generation of Wood (Liver hyperactivity). Black water turning over from the bottom of the Stomach, and foul water coming reversely from the intestines. (Zhengzhi Huibu)
Differentiation of Vomiting by Triple Burner
Upper Jiao vomiting stems from Qi. Qi belongs to Heaven's Yang. The pulse is floating and surging, with incessant dizziness, Qi rushing up to the chest, vomiting immediately after eating, and thirst with desire to drink. Treatment should focus on descending Qi and harmonizing the Middle. Middle Jiao vomiting stems from accumulation, involving both Yin and Yang accumulations, where Qi and food interact. The pulse is floating and wiry, with chest stuffiness, either pain preceding vomiting or vomiting preceding pain. Treatment should focus on removing accumulation and harmonizing Qi. Lower Jiao vomiting stems from cold, belonging to the Earthly Way. The pulse is large and slow, with cold limbs, morning food vomited in the evening, evening food vomited in the morning, clear and profuse urination, and constipation. Treatment should focus on unblocking obstruction and warming cold. (Zhang Jiegou)
Differentiation of Vomiting, Spitting, and Hiccups
Vomiting belongs to the Yangming channel, a place abundant in Qi and Blood. Thus, it produces sound and material discharge, indicating disease in both Qi and Blood. Spitting (vomiting without sound) belongs to the Taiyin channel, a place abundant in Blood but deficient in Qi. Thus, it discharges material without sound, indicating Blood disease. Hiccups belong to the Shaoyang channel, a place abundant in Qi but deficient in Blood. Thus, it produces sound and material (rebellious Qi), indicating Qi disease. (Li Dongyuan)
Severity of Vomiting and Hiccups
Dry heaving is mild hiccup; hiccup is severe dry heaving. The sound of vomiting is light, small, and short; the sound of hiccup is heavy and long. Vomiting is mild; hiccup is severe. (Zhu Danxi) Therefore, it is said: When wood is old, its leaves fall; when disease is deep, the voice becomes hiccup. (Classic Text)
Fatal Signs
Vomiting like vegetable juice indicates death. Unstoppable vomiting like seasickness with thirst and desire to drink is critical; drinking child's urine is most effective. Women with excessive Liver Qi stagnation and chronic vomiting will die. Vomiting with a weak pulse, free urination, slight fever, and appearance of cold extremities indicates death.
Pulse Diagnosis
A faint pulse at the Cun position indicates Stomach cold. A floating pulse at the Yuyang position indicates Stomach deficiency. Tight Yang and rapid Yin indicate vomiting. Floating and rapid Yang pulse also indicates vomiting. Tight Cun and choppy Chi indicate chest fullness and vomiting. Tight and slippery pulse indicates vomiting and rebellion. Tight and choppy pulse is difficult to treat. Tight and knotted pulse at Cun indicates dysphagia. Rapid pulse at Guan indicates vomiting. Faint and rapid pulse at Cun indicates insufficient Blood and cold in the chest causing vomiting. Also, excessive vomiting may prevent Chest Qi from descending, resulting in an imperceptible Chi pulse. (Zhengzhi Huibu)
Treatment Methods
Ancient formulas regard Banxia (Pinellia Rhizome), Shengjiang (Fresh Ginger), and JuPi (Tangerine Peel) as holy medicines for vomiting. However, Li Dongyuan stated that Shengjiang stops vomiting only for exterior excess and Qi congestion. If Stomach deficiency prevents Grain Qi from moving, one must only tonify Stomach Qi, regulate the Middle, and promote Grain Qi. If vomiting persists despite various medications, heavy-settling agents must be added to sink the rebellion. If vomiting occurs with long-term Middle Qi deficiency, grain food must be borrowed to harmonize. (Yixue Rumen)
Contraindication of Purging in Vomiting
In all cases of vomiting, purgatives must absolutely not be used, as this opposes the pathological trend. (Zhu Danxi) Only when accompanied by chest fullness and abdominal distension should one observe which part is obstructed and then apply draining methods. (Yizong Bidu)
Vomiting Caused by Yin Deficiency
When all Yang Qi floats without foundation, causing vomiting, coughing, and rebellious Qi, this is vomiting due to Yin deficiency. It is not merely a Stomach disease; it is what is called "no Yin leads to vomiting." Treat with Dihuang Tang (Rehmannia Decoction) plus Shihu (Dendrobium Stem) and Chenxiang (Aquilaria Wood). (Zhengzhi Huibu)
[Appendix: Leaking Qi and Zoubu]
Vomiting followed by diarrhea, with body heat and abdominal stuffiness, is named Leaking Qi. Leaking Qi is wind injury to the Upper Jiao. Obstruction of both urination and defecation with rebellious Qi unable to continue is named Zoubu. Zoubu is excess heat in the Lower Jiao. (Yixue Zhunsheng)
[Appendix: Shi Bi]
Shi Bi (Food Impediment) is pain below the heart after eating, which stops only after vomiting. This is caused by phlegm-fluids and evil blood stagnating in the Stomach region. Treat with Xiebai Banxia Tang (Allium Macrostemon and Pinellia Decoction). (Zhengzhi Huibu)
Medication
The primary formula is Erchen Tang (Two-Cured Decoction), added with Huoxiang (Patchouli Herb) and Houpo (Magnolia Bark). For food stagnation, characterized by belching and acid regurgitation, add Zhishi (Immature Bitter Orange), Shanzha (Hawthorn Fruit), and Maiya (Germinated Hordeum). For Qi stagnation, characterized by stuffiness and discomfort, add Zhike (Bitter Orange Peel), Sugeng (Perilla Stem), and Houpo. For Stomach heat, characterized by bitter vomiting and sour regurgitation, add Huanglian (Coptis Rhizome) and Jiang Chao Shanzhi (Gardenia Fruit stir-fried with ginger). For Stomach cold, characterized by vomiting cold substances and anorexia, add Paojiang (Prepared Ginger) and Yizhi (Alpinia Oxyphylla Fruit). For damp-phlegm, characterized by vomiting green water and sputum, add Cangzhu (Atractylodes Rhizome) and Xiangfu (Cyperus Rhizome). For parasitic pain, characterized by vomiting clear water, if appetite remains, add Lian Gen (Melia Root Bark) and Shijunzi (Quisqualis Fruit). For Qi deficiency with heat, combine with Sijunzi Tang (Four Gentlemen Decoction); for Qi deficiency with cold, combine with Lizhong Tang (Regulate the Middle Decoction). Alternatively, decoct together with Nuomi (Glutinous Rice). Or decoct using Fulonggan Water (Dried Mud from Cooking Pot Bottom). Or decoct well and mix with Daizheshi Powder (Hematitum) before taking.
Selected Formulas for Vomiting
Erchen Tang: Treats various symptoms of vomiting, as it can calm Stomach Qi and descend rebellious Qi. (Formula seen in Phlegm Disease chapter)
Liu Junzi Tang: Treats vomiting due to decline of Stomach Qi. (Formula seen in Stroke chapter)
Lizhong Tang: Treats vomiting due to Stomach Qi deficiency and cold. (Formula seen in Cold Damage chapter)
Zhuru Tang: Treats vomiting due to Stomach fire and blazing heat.
JuPi (Tangerine Peel), Banxia (Pinellia Rhizome) (3 qian each), Gancao (Licorice Root), Zhuru (Bamboo Shavings) (1 qian each), Shanzhi (Gardenia Fruit) (7 fen), Pipaye (Loquat Leaf) (2 pieces), Jiang (Ginger), Zao (Jujube).
Zuojin Wan: Treats vomiting due to Liver Fire rebelling upward.
Huanglian (Coptis Rhizome), Wuzhuyu (Evodia Fruit) (equal parts).
Grind into powder, make pills with congee, and take with Baizhu Chenpi Tang (Atractylodes Macrocephala and Tangerine Peel Decoction).
Xiao Banxia Tang: Treats vomiting due to Stomach excess.
Banxia (Pinellia Rhizome), Shengjiang (Fresh Ginger) (3 qian each).
Add JuPi to name Jupi Banxia Tang.
Da Banxia Tang: Treats vomiting due to Stomach deficiency.
Banxia (Pinellia Rhizome) (5 qian), Ren Shen (Ginseng Radix et Rhizoma) (3 qian), Baimi (White Honey) (3 qian).
Decoct water that has been tossed 240 times.
Banxia Shengjiang Dahuang Tang: Treats vomiting due to pathogenic excess, applicable when constipation allows purging.
Banxia (Pinellia Rhizome) (2 liang), Shengjiang (Fresh Ginger) (1.5 liang), Dahuang (Rhubarb Radix et Rhizoma) (2 liang).
Decoct in water, divide into three doses.
Hongdou Wan: Treats vomiting due to long-term Stomach Qi deficiency and extreme cold.
Dingxiang (Caryophylli Flos), Hujiao (Piperis Longi Fructus), Sharen (Amomi Fructus), Hongdou (Adzuki Bean) (20 grains each).
Make pills with Ginger Juice paste. Fill dates (pitted) with medicine, wrap in flour, roast until cooked, chew finely, and swallow with plain boiled water.
Maidong Tang: Treats Leaking Qi. Due to Upper Jiao wind injury, pathogen adheres causing discomfort, stuffiness, and vomiting.
Maidong (Ophiopogonis Radix), Lugen (Phragmitis Rhizoma), Zhuru (Bamboo Shavings), Baizhu (Atractylodis Macrocephalae Rhizoma) (5 liang each), Gancao (Licorice Root) (3 liang), Fuling (Poria) (3 liang).
Renshen (Ginseng Radix et Rhizoma), Chenpi (Tangerine Peel), Weirui (Polygonati Odorati Rhizoma) (3 liang each), Shengjiang (Fresh Ginger) (5 slices), Chenpi (Tangerine Peel) (a pinch).
Decoct in water, divide into doses.
Renshen Tang: Treats Zoubu. Caused by obstruction of urination and defecation, excess heat in Lower Jiao.
Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), Weirui (Polygonati Odorati Rhizoma) (3 liang each), Lugen (Phragmitis Rhizoma), Zhuru (Bamboo Shavings), Baizhu (Atractylodis Macrocephalae Rhizoma), Shanzhi (Gardenia Fruit), Chenpi (Tangerine Peel) (0.5 liang each), Shigao (Gypsum Fibrosum) (1 liang).
Take 4 qian per dose, decoct in water.
Xuanfu Daizhe Tang: Treats persistent vomiting where True Qi rebels and fails to descend, using this formula to settle and sink.
Xuanfuhua (Inulae Flos) (3 qian), Daizheshi (Hematitum) (1 qian, ground).
Decoct Xuanfuhua, mix with Daizheshi powder, and take.