人有饮食入胃而即吐者，此肝木克胃土也，用逍遥散加吴茱萸炒黄连治之，随
手而愈。而无如人以为胃病也，杂用香砂消导之剂，反伤胃气，愈增其吐；又改用
下药不应，复改用寒凉之味，以降其火，不独胃伤而脾亦伤矣；又改用辛热之药，
以救其寒，又不应，始悟用和解之法，解郁散邪，然已成噎膈之症矣。夫胃为肾之
关门，肾中有水，足以给胃中之用，则咽喉之间，无非津液可以推送水谷；肾水不
足，力不能润灌于胃中，又何能分济于咽喉乎？咽喉成为陆地，水干河涸，舟胶不
前，势所必至。且肾水不足，不能下注于大肠，则大肠无津以相养，久必瘦小而至
艰涩；肠既细小艰涩，饮食入胃，何能推送？下既不行，必积而上泛，不特上不能
容而吐，抑亦下不能受而吐也。治法必须大补其肾中之水。方用济艰催 汤∶
熟地（二两） 山茱（一两） 当归（二两） 牛膝（三钱） 玄参（一两） 车前子（一钱）
水煎服。一日一剂，十剂必大顺也。
此方纯补精血，水足而胃中有津，大肠有液，自然上下相通而无阻滞之患。譬
如河漕水浅，舟楫不通，粮糈不能输运，军民莫不 徨而喧哗扰嚷。忽见大雨滂沱，
河渠、沟壑无非汪洋大水，则大舸巨舶，得以装载糗粮，自然人情踊跃，关门大开，
听其转运，而无所留难也。
此症用制肝散亦效甚。
白芍（一两） 吴茱萸（五分） 黄连（一钱） 茯苓（五钱） 水煎服。二剂即愈，何至变成
噎膈哉。
人有朝食暮吐，或暮食朝吐，或食之一日至三日而尽情吐出者，虽同是肾虚之
病，然而有不同者∶一食入而即吐，一食久而始吐也。食入而即吐者，是肾中之无
水；食久而始吐者，乃肾中之无火也。盖脾胃之土，必得命门之火以相生，而后土
中有温热之气，始能发生以消化饮食。倘土冷水寒，结成冰冻，则下流壅积，必返
而上越矣。治法宜急补肾中之火，然而单补其火，则又不可。肾火非肾水不生，肾
火离水则火又亢炎矣。况上无饮食之相济，则所存肾水亦正无多，补火而不兼补其
水，焚烧竭泽，必成焦枯之患，济之以水，毋论火得水而益生，而水亦得火而更生。
水火既济，自然上下流通，何至有翻胃之疾哉。方用两生汤∶
肉桂（二钱） 附子（一钱） 熟地（二两） 山茱萸（一两） 水煎服。一剂而
吐减半，再剂而吐更减，连服四剂则吐止矣，服十剂而全愈也。
此方水火两旺。脾胃得火气而无寒冷之虞，得水气而无干涩之苦，自然上可润
肺而不阻于咽喉，下可温脐而不结于肠腹矣。或谓下寒者多腹痛反胃，既是肾寒，
正下寒之谓也，宜小腹作痛矣，何以食久而吐之病，绝不见腹痛，岂肾寒非欤？不
知寒气结于下焦，则腹必疼痛，今反胃之病，日日上吐，则寒气尽从口而趋出矣，
又何寒结之有？
此症用加味化肾汤亦神效。
熟地（二两） 山茱萸（一两） 肉桂（三钱） 巴戟天（五钱） 水煎服。二剂吐轻，十剂全愈。
人有时而吐，时而不吐，吐则尽情吐出，此症有似于反胃而非翻胃也。此种之
病，妇人居多，男子独少，盖因郁而成之也。夫郁则必伤其肝木之气，肝伤，木即
下克脾胃，肝性最急，其克土之性，亦未有不急者。其所克之势，胃土若不能受，
于是上越而吐。木怒，其土之不顺受也，于是挟其郁结之气卷土齐来，尽祛而出，
故吐之不尽不止。其有时而不吐者，因木气之少平耳。治法不必止吐，而惟在平肝。
方用逍遥散∶
柴胡（一钱） 白芍（五钱） 茯神（三钱） 白术（一钱） 当归（三钱） 陈皮（三分）
甘草（一分） 水煎服。一剂而吐少止，再剂而吐全愈。愈后，仍以济艰催 汤，减半分两调理可
也。
盖逍遥散解郁之后，其木枯渴可知。随用济艰催 汤急救其水，则木得润而滋荣，自然枝
叶敷荣矣，何至拂郁其性而作吐哉。
此症用增减逍遥散亦神效。
白芍（五钱） 茯苓 白术（各三钱） 陈皮 柴胡 神曲（各一钱） 白豆蔻（一粒）水煎服。
四剂愈。
人有胃中嘈杂，腹内微疼，痰涎上涌而吐呕，日以为常，盖虫作祟，非反胃也。
夫人有水湿之气，留注于脾胃之间，而肝木又旺，来克脾胃之土，则土虚而生热，
此热乃肝木之火，虚火也。土得正火而消食，土得虚火而生虫。虫得肝木之气，其
性最急，喜动而不喜静，饥则微动而觅食，饱则大动而跳梁，挟水谷之物，兴波鼓
浪而上吐矣。然但吐水谷而不吐虫者，何故？盖肝木之虫最灵，畏金气之克，居土
则安，入金则死。故但在胃而翻腾，不敢越胃而游乐，祛水谷之出胃，而彼且掉头
而返，恐出于胃为肺金之气所杀也。治法必用杀虫之药，佐以泻肝之味。然而泻肝
杀虫之药，未免寒凉克削，肝未必遽泻而脾胃先已受伤，脾胃受伤而虫亦未能尽杀。
必须于补脾健胃之中，而行其斩杀之术，则地方宁谧，而盗贼难以盘踞，庶几可
尽戮无遗，常静而不再动也。方用健土杀虫汤∶
人参（一两） 茯苓（一两） 白芍（一两） 炒栀子（三钱） 白薇（三钱） 水煎半
碗，加入黑驴溺半碗，和匀饥服。一剂而吐止，不必再剂，虫尽死矣。
夫驴溺何以能杀虫而止吐也？驴性属金，虫性畏金，故取而用之。世人有单用
此味而亦效者，然而仅能杀虫而不能健土。土弱而肝木仍旺，已生之虫虽死于顷刻，
而未生之虫，不能保其不再生也。健土杀虫汤，补脾胃以扶土，即泻肝以平木，使
木气既平，不来克土，且土旺而正火既足，则虚邪之火无从而犯，虚热不生，而虫
又何从而生乎。况方中栀子、白薇原是杀虫之圣药，同驴溺用之，尤能杀虫于无形。
此拔本塞原之道，不同于单味偏师，取胜于一时者也。
此症用锄种汤亦神效。
楝树根（一两） 槟榔 浓朴 炒栀子 百部（各一钱） 白术 茯苓 使君子肉（各三钱）
水煎服。服后不可用饮食，须忍饥半日，尤不可饮茶水。二剂虫尽死而愈。
人有食后必吐出数口，却不尽出，膈上时作声，面色如平人，人以为脾胃中之
气塞也，谁知是膈上有痰血相结而不散乎。夫膈在胃之上，与肝相连，凡遇怒气，
则此处必痛。以血之不行也，血不行则停积，而血成死血矣。死血存于膈上，必有
碍于气道，而难于升降。气血阻住，津液遂聚而成痰，痰聚而成饮，与血相搏而不
静，则动而成声。本因气而成动，又加食而相犯，势必愈动而难安，故必吐而少快
也。至食已入胃，胃原无病，胃自受也，宁肯茹而复吐乎，此所以既吐而又不尽出
耳。然则治法，但去其膈上之痰血，而吐病不治而自愈也。方用瓜蒂散加味吐之。
瓜蒂（七枚） 萝卜子（三钱） 韭菜汁（一合） 半夏（三钱） 天花粉（三钱） 甘草（三钱）
枳壳（一钱） 人参（一钱） 水煎服。一剂即大吐，去痰血而愈，不必二剂也。
瓜蒂散原是吐药，得萝卜子、枳壳以消食，得半夏、天花粉以荡痰，得韭汁以
逐血。诚恐过于祛除，未免因吐而伤气，又加入人参、甘草以调和之，使胃气无损，
则积滞易扫，何至恶食而再吐哉。此非反胃，因其食后辄吐，有似于反胃，故同反
胃而共论之也。
此症用清膈散甚佳。
天花粉 桑白皮（各三钱） 生地 白芍（各五钱） 红花（三钱） 桃仁（十个） 杏仁（十个）
枳壳（五分） 甘草（一钱） 紫菀（一钱） 水煎服。四剂全愈。
Background Information:
Book: Bian Zheng Lu (Record of Syndrome Differentiation)
Author: Chen Shiduo
Dynasty: Qing
Chapter: Fan Wei Men (Five Cases of Vomiting/Regurgitation)
Category: Comprehensive
Translation:
There are cases where food is vomited immediately after entering the stomach. This is caused by Liver Wood overacting on Stomach Earth. It can be treated with Xiaoyao San (Free and Easy Wanderer Powder) added with Coptidis Rhizoma (Huanglian, 黄连) stir-fried with Evodiae Fructus (Wuzhuyu, 吴茱萸), resulting in immediate recovery. Unfortunately, people mistakenly believe it is a Stomach disease and indiscriminately use aromatic and sand-processed digestive agents, which further damage Stomach Qi, exacerbating the vomiting. Subsequently, purgatives are tried without success, followed by cold-natured herbs to clear fire, damaging not only the Stomach but also the Spleen. Then, acrid-warm herbs are used to rescue from cold, yet again failing. Only then is it realized that a harmonizing method should have been used to resolve depression and disperse pathogens; however, by this time, the condition has evolved into Yige (Dysphagia). The Stomach serves as the gatekeeper for the Kidney. If Kidney Water is sufficient to supply the Stomach, then the throat will have ample body fluids to transport food and drink. If Kidney Water is insufficient, its power cannot moisten and irrigate the Stomach, let alone reach the throat. The throat becomes like dry land, rivers run dry, and boats get stuck unable to move forward—a inevitable outcome. Moreover, if Kidney Water is insufficient and cannot flow down to the Large Intestine, the Large Intestine lacks fluid nourishment, eventually becoming shriveled and difficult to pass through. Since the intestines are narrow and obstructed, how can food transported into the Stomach be pushed downward? If the lower pathway is blocked, accumulation must reflux upward. Not only can the upper part not accommodate it leading to vomiting, but the lower part cannot accept it either, also leading to vomiting. The treatment must heavily tonify Kidney Water. The formula is Jijian Cui Tang (Urging Difficult Passage Decoction): Prepared Rehmanniae Radix (Shudi, 熟地) 2 liang, Corni Fructus (Shanzhuyu, 山茱) 1 liang, Angelicae Sinensis Radix (Danggui, 当归) 2 liang, Achyranthis Bidentatae Radix (Niuxi, 牛膝) 3 qian, Scrophulariae Radix (Xuanshen, 玄参) 1 liang, Plantaginis Seed (Cheqianzi, 车前子) 1 qian. Decoct in water and take orally. One dose per day; after ten doses, smoothness will be greatly achieved.
This formula purely tonifies Essence and Blood. When Water is sufficient, there are fluids in the Stomach and liquids in the Large Intestine, naturally allowing free communication between upper and lower parts without obstruction. It is like a shallow canal where boats cannot pass and grain cannot be transported, causing panic and noise among soldiers and civilians. Suddenly, heavy rain falls, filling rivers and ditches with vast waters, allowing large ships to load provisions. Naturally, people become joyful, gates open wide, allowing free transport without hindrance.
For this syndrome, Zhigan San (Liver-Calming Powder) is also effective. White Peony Root (Baishao, 白芍) 1 liang, Evodiae Fructus (Wuzhuyu, 吴茱萸) 5 fen, Coptidis Rhizoma (Huanglian, 黄连) 1 qian, Poria (Fuling, 茯苓) 5 qian. Decoct in water and take orally. Recovery occurs in two doses; why did it progress to dysphagia?
Some patients vomit what they ate in the morning at night, or what they ate at night in the morning, or even vomit everything consumed one to three days prior. Although these are all Kidney Deficiency diseases, there are differences: one is vomiting immediately after eating, the other is vomiting after a long delay. Immediate vomiting indicates a lack of Kidney Water; delayed vomiting indicates a lack of Kidney Fire. Spleen and Stomach Earth requires Mingmen Fire to generate warmth, creating a warm environment to digest food. If the Earth is cold and water is icy, forming ice, flow stagnates and reverses upward. Treatment should urgently tonify Kidney Fire. However, tonifying Fire alone is ineffective. Kidney Fire is born from Kidney Water; if Fire separates from Water, it flares up excessively. Furthermore, with no food intake to support it, remaining Kidney Water is scant. Tonifying Fire without tonifying Water is like burning the pond dry, leading to scorching and desiccation. Adding Water allows Fire to benefit from Water, and Water to benefit from Fire. When Water and Fire interact harmoniously, circulation flows freely, preventing Fanwei (regurgitation/vomiting). The formula is Liangsheng Tang (Two Lifegiving Decoction): Cinnamon Twig (Rougui, 肉桂) 2 qian, Aconiti Lateralis Radix Praeparata (Fuzi, 附子) 1 qian, Prepared Rehmanniae Radix (Shudi, 熟地) 2 liang, Corni Fructus (Shanzhuyu, 山茱萸) 1 liang. Decoct in water and take orally. After one dose, vomiting halves; after two doses, it reduces further; after four consecutive doses, vomiting stops; after ten doses, full recovery is achieved.
This formula promotes both Water and Fire. The Spleen and Stomach gain Fire’s warmth avoiding cold, and Water’s moisture avoiding dryness. Naturally, it moistens the Lungs above without blocking the throat, and warms the umbilical region below without stagnating in the intestines. Some ask: Lower Cold often causes abdominal pain and regurgitation. If it is Kidney Cold, shouldn't the lower abdomen hurt? Why is there no abdominal pain in delayed vomiting? Isn't it Kidney Cold? The answer is: If Cold Qi knots in the Lower Jiao, abdominal pain occurs. In regurgitation, daily vomiting expels Cold Qi from the mouth, so there is no knotting of Cold.
For this syndrome, Jiawei Huashen Tang (Modified Kidney-Transforming Decoction) is also miraculous. Prepared Rehmanniae Radix (Shudi, 熟地) 2 liang, Corni Fructus (Shanzhuyu, 山茱萸) 1 liang, Cinnamon Twig (Rougui, 肉桂) 3 qian, Morinda Officinalis Radix (Bajitian, 巴戟天) 5 qian. Decoct in water and take orally. Two doses reduce vomiting; ten doses cure it.
Some patients vomit intermittently, vomiting everything when it happens. This resembles Fanwei but is distinct. This condition is more common in women than men, arising from Depression (Yu). Depression injures Liver Wood Qi. When the Liver is injured, Wood attacks Spleen and Stomach Earth. Liver nature is urgent; its attacking nature is equally urgent. If Stomach Earth cannot withstand this attack, it rebels upward causing vomiting. Angered Wood, resentful of Earth's resistance, brings its depressed Qi to purge everything out, hence vomiting continues until nothing remains. When vomiting stops temporarily, it is because Wood Qi has slightly calmed. Treatment does not aim to stop vomiting directly but to calm the Liver. The formula is Xiaoyao San (Free and Easy Wanderer Powder): Bupleuri Radix (Chaihu, 柴胡) 1 qian, White Peony Root (Baishao, 白芍) 5 qian, Poria with Hostwood (Fushen, 茯神) 3 qian, Atractylodes Macrocephala Rhizome (Baizhu, 白术) 1 qian, Angelicae Sinensis Radix (Danggui, 当归) 3 qian, Tangerine Peel (Chenpi, 陈皮) 3 fen, Licorice Root (Gancao, 甘草) 1 fen. Decoct in water and take orally. One dose reduces vomiting; two doses cure it. After recovery, use Jijian Cui Tang (Urging Difficult Passage Decoction) with halved dosages for maintenance.
After Xiaoyao San resolves depression, the Wood is known to be dry and thirsty. Immediately using Jijian Cui Tang rescues Water, moistening and nourishing Wood, allowing branches and leaves to flourish, preventing depression-induced vomiting.
For this syndrome, Zengjian Xiaoyao San (Increased/Decreased Free and Easy Wanderer Powder) is also miraculous. White Peony Root (Baishao, 白芍) 5 qian, Poria (Fuling, 茯苓) and Atractylodes Macrocephala Rhizome (Baizhu, 白术) 3 qian each, Tangerine Peel (Chenpi, 陈皮), Bupleuri Radix (Chaihu, 柴胡), and Medicated Leaven (Shenqu, 神曲) 1 qian each, Cardamom Seed (Baidoukou, 白豆蔻) 1 pod. Decoct in water and take orally. Four doses lead to recovery.
Some patients experience gastric discomfort, mild abdominal pain, surging phlegm-saliva, and vomiting daily. This is likely due to parasites, not Fanwei. Damp-Water Qi stays in the Spleen and Stomach, while vigorous Liver Wood attacks Spleen-Stomach Earth, causing Earth Deficiency and generating Heat. This heat is Liver Wood Fire, a deficient fire. Proper Fire digests food; deficient Fire generates parasites. Parasites acquire Liver Wood Qi, making them urgent, active rather than static. Hungry, they move slightly to seek food; full, they jump wildly, carrying food and drink upward in waves. Why is only food/drink vomited, not parasites? Liver parasites are intelligent, fearing Metal Qi. They feel safe in Earth but die in Metal. Thus, they churn in the Stomach but dare not leave it, fearing destruction by Lung Metal Qi expelled with the vomit. Treatment requires anti-parasitic herbs combined with Liver-draining herbs. However, these are often cold and draining, potentially injuring the Spleen and Stomach before the Liver is drained or parasites killed. Therefore, one must employ killing tactics within Spleen-tonifying and Stomach-strengthening methods. This pacifies the area, making it hard for "bandits" (parasites) to occupy, ensuring their total eradication and silence. The formula is Jiantu Shachong Tang (Earth-Strengthening Anti-Parasitic Decoction): Ginseng Root (Renshen, 人参) 1 liang, Poria (Fuling, 茯苓) 1 liang, White Peony Root (Baishao, 白芍) 1 liang, Stir-fried Gardenia Fruit (Zhizhi, 栀子) 3 qian, Anemarrhenae Rhizome (Baiwei, 白薇) 3 qian. Decoct half a bowl, add half a bowl of Black Donkey Urine, mix well, and take on an empty stomach. One dose stops vomiting; parasites die completely.
Why does donkey urine kill parasites and stop vomiting? Donkeys belong to Metal; parasites fear Metal. Hence, it is used. Some use it alone effectively, but it only kills parasites without strengthening Earth. If Earth is weak and Liver Wood remains vigorous, existing parasites may die, but new ones may arise. Jiantu Shachong Tang tonifies Spleen and Stomach to support Earth, drains Liver to calm Wood. Calmed Wood does not attack Earth. Strong Earth ensures proper Fire is sufficient, preventing deficient evil fire from invading, stopping deficient heat generation, and thus preventing parasite formation. Moreover, Gardenia and Anemarrhenae are holy medicines for killing parasites; combined with donkey urine, they kill parasites invisibly. This addresses the root cause, unlike single-herb approaches that win temporarily.
For this syndrome, Chuzhong Tang (Weeding Decoction) is also miraculous. Chinaberry Root (Lianshu Gen, 楝树根) 1 liang, Areca Seed (Binglang, 槟榔), Magnolia Bark (N Hou, 浓朴), Stir-fried Gardenia Fruit (Zhizhi, 栀子), Stemona Root (Baibu, 百部) 1 qian each, Atractylodes Macrocephala Rhizome (Baizhu, 白术), Poria (Fuling, 茯苓), Quisqualis Seed Meat (Shijunzi Rou, 使君子肉) 3 qian each. Decoct in water and take orally. Do not eat or drink afterward; endure hunger for half a day, especially avoiding tea. Two doses kill all parasites and cure the condition.
Some patients vomit a few mouthfuls after eating but not all, with sounds in the diaphragm, normal complexion. People think it is Qi blockage in Spleen-Stomach, but it is actually Phlegm-Blood knotting in the diaphragm. The diaphragm is above the Stomach, connected to the Liver. Anger causes pain here. Blood stasis leads to accumulation and death-blood. Death-blood in the diaphragm obstructs Qi channels, hindering ascent and descent. Blocked Qi and Blood gather fluids into Phlegm, which gathers into Fluids. Struggling with Blood, it moves and makes sounds. Originally caused by Qi movement, aggravated by food, it becomes restless, requiring vomiting for slight relief. Once food enters the Stomach, the Stomach is healthy and accepts it; why vomit again? This explains partial vomiting. Treatment removes Phlegm-Blood in the diaphragm, curing vomiting spontaneously. The formula is Guiti San (Melon Sepal Powder) modified to induce vomiting. Melon Sepal (Guiti, 瓜蒂) 7 pieces, Radish Seed (Luobozhi, 萝卜子) 3 qian, Chinese Chive Juice (Jiucaizhi, 韭菜汁) 1 he, Pinellia Tuber (Banxia, 半夏) 3 qian, Trichosanthes Root (Tianhuafen, 天花粉) 3 qian, Licorice Root (Gancao, 甘草) 3 qian, Aurantium Fruit (Zhiqiao, 枳壳) 1 qian, Ginseng Root (Renshen, 人参) 1 qian. Decoct in water and take orally. One dose induces massive vomiting, removing Phlegm-Blood and curing the condition; a second dose is unnecessary.
Guiti San is originally an emetic. Radish seed and Aurium fruit digest food; Pinellia and Trichosanthes clear phlegm; Chive juice drives out blood. Fearing excessive depletion damages Qi via vomiting, Ginseng and Licorice are added to harmonize, protecting Stomach Qi, facilitating clearance of stagnation, and preventing aversion to food and recurrent vomiting. This is not Fanwei; it resembles it due to postprandial vomiting, hence discussed together.
For this syndrome, Qingge San (Diaphragm-Clearing Powder) is excellent. Trichosanthes Root (Tianhuafen, 天花粉) and Mulberry Root Bark (Sangbaipi, 桑白皮) 3 qian each, Rehmannia Root (Shengdi, 生地) and White Peony Root (Baishao, 白芍) 5 qian each, Safflower (Honghua, 红花) 3 qian, Peach Kernel (Taoren, 桃仁) 10 pieces, Apricot Kernel (Xingren, 杏仁) 10 pieces, Aurantium Fruit (Zhiqiao, 枳壳) 5 fen, Licorice Root (Gancao, 甘草) 1 qian, Aster Root (Ziwan, 紫菀) 1 qian. Decoct in water and take orally. Four doses lead to full recovery.