（论一首脉证二十七条方二十三首）
夫呕家有痈脓。不可治呕。脓尽自愈。
〔衍义〕上卷肺痈证。必先咳而久久吐脓如米粥。桔梗汤白散皆主之。而此不言
痈之所在。知其非肺痈可知。经曰。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。脓亦不似肺痈之如米粥者也。出
胃脘。从湿化而聚结。若如结痰蛤肉者。谓不可治。不必治其呕。呕自脓之瘀。熏
蒸谷气。故呕。若脓出则呕自愈。夫痈之在胃脘上口者则然。若过半中。在肺之
下者。脓则不从呕出。而从大便出矣。
先呕却渴者。此为欲解。先渴却呕者。为水停心下。此属饮家。呕家本渴。今反不渴
者。以心下有支饮故也。此属支饮。
〔衍义〕伤寒言呕多有因。因热因寒因水因饮。皆属胃家病。此独以水饮者。分三
节言之。初一段先呕却渴者。为饮而呕。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。第二段先渴却呕者。即前痰饮条中。小
半夏茯苓汤主之。第三段本渴。今反不渴。亦痰饮条中。小半夏茯苓汤主之。
问曰。病患脉数。数为热。当消谷引食。而反吐者何也。师曰。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。今脉反弦。故名曰虚。
〔衍义〕凡脉以候病。阳盛则数。阴盛则迟。今言阳微而脉数。数而复胃中冷。其理
安在。盖脉病不可以概论也。此数由药之遗热所客。胃中冷。由阳不足而致。何
也。中焦者阴阳之界。汗剂必用辛温发散。不当汗而汗。损其中脘阳分。致令阳
微。膈气虚。药之遗热。从阴分而变。遂成数脉。古云客热。非阳盛也。虽有客热。胃
中之阳气不足。故曰胃中虚冷也。医反以寒剂泻之。复损阴分之阳。故脉变弦。
上下之阳俱不足。虽当日暮行阴之时。阳亦不能入于下。则糟粕不能输。大小
肠不能输将。亦不能安于中。必吐而复出也。故曰胃气无余。朝入而暮吐也。
寸口脉微而数。微则无气。无气则荣虚。荣虚则血不足。血不足则胸中冷。
〔衍义〕此条叙脉不叙证何也。上条以脉数为客热。此独言气血虚又何也。亦承
上条而言也。上条以汗下之过而致病脉之若是。此条以上焦荣卫之不逮。亦
致反胃之证。故不复叙。惟言脉之本象。阳脉动而健。阴脉静而翕。两者和合。不
刚不柔。不疾不迟。今微而数。微乃失阳之象。数乃失阴之体。奚止客热而已。胸
中。荣卫之海。荣卫虚而不充于中。故胸中冷矣。夫荣卫之气。出入脏腑。健运周
身。本生于谷。复消其谷。荣卫非谷不实。谷非荣卫不化。所以胸中冷者。亦必致
胃不纳谷也。王冰释内经曰。食入反出。是无火也。虽然谓之冷。当以正气不足
论之。正气者。阴阳之精。非寒非热。冲和纯粹。不宜以之为冷。与寒邪同治。若以
热治寒。不惟反助客热。且复耗其气。损其阳矣。所谓客热者。不独以上条药之
所遗。若五脏厥阳之火。乘克于中土者。皆足以客之。况多得于七情郁发之所
致欤。夫膏粱之变。皆足成客热。安可复投之以热乎。吁世人治是病。非丁、附则
姜、桂。孰知正气果何如则复也哉。
趺阳脉浮而涩。浮则为虚。涩则伤脾。脾伤则不能磨。朝食暮吐。暮食朝吐。宿谷不
化。名曰胃反。脉紧而涩。其病难治。
〔衍义〕趺阳者。胃脉之所过。故候胃脉必于是焉。脾与胃以膜相连。皆属于土。土
有阴阳。胃为阳土。脾为阴土。阳主气。主动。阴主血。主静。今谓脾伤不能磨。何哉。
此阴阳互为体用之义也。盖阳参于阴。则阴能动而不为凝结。阴参于阳。则阳
能固而不为飞扬。斯脾动则脉不涩。胃固则脉不浮。若浮则胃家虚。而谷不能
腐熟。涩则脾血伤。而谷不得消磨。所以在朝当阳时食入者。至暮行阴时反出。
在暮当阴时食入者。至阳时亦出。以其两虚不能参合。莫得转输于大小肠也。
河间云。趺阳脉紧为难治。胃之上脘血亡。则并膈间皆涩不利。食不下入。脾统
血。血亡。并大小肠皆枯。而糟粕不化。食虽入。必反出也。
病患欲吐者。不可下之。
〔衍义〕欲吐。以其邪在阳也。若下。不惟逆其治阳。又反伤其无过之阴。岂独反胃
而已。其为害可胜言哉。
哕而腹满。视其前后。知何部不利。利之则愈。
〔补注〕哕者。无物有声之谓也。腹满为实。实则气上逆而作哕。故必审其证。视其
前后何部以利之。则满去而哕自止矣。
呕而胸满者。茱萸汤主之。
茱萸汤方
吴茱萸（一升洗） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味以水五升。煮取三升。温服一升。日三服。
〔衍义〕伤寒以是方治食谷欲呕阳明证。以中焦反寒也。吴茱萸能治内寒降逆。
人参补益阳气。大枣缓脾。生姜发越胃气。且散逆止呕。逆气降。胃之阳行。则腹
痛消矣。此脾脏阴盛逆胃。与夫肾肝下焦之寒。上逆于中焦而致者。即用是方
治之。若不于中焦。其脏久寒者。则以本脏药化之。如厥阴手足厥冷。脉细欲绝。
内有久寒者。于当归四逆加吴茱萸、生姜是也。
干呕吐涎沫。头痛者茱萸汤主之。
〔衍义〕此证伤寒厥阴证中。成注干呕吐涎沫者。里寒是也。头痛者。寒气上攻也。
用是温里散寒。与上条呕而腹满者。病异药同。盖同是厥阴乘于土故也。
呕而肠鸣。心下痞者。半夏泻心汤主之。
半夏泻心汤方
半夏（半升） 黄连（一两） 人参（三两） 干姜
甘草（各三两） 黄芩（三两） 大枣（十二枚）
上七味。以水六升。煮取三升。温服一升。日三服。
〔衍义〕伤寒论。呕而心下痞者。有属半表半里。亦有属里。半表半里者。泻心汤治
属里者。则以十枣汤大柴胡汤。如心下痞。腹中鸣。有水气不利。则以生姜泻心
汤治。有下利完谷不化。则以甘草泻心汤治。治痞恶寒汗出者。用附子。关上脉
浮者。用大黄。心下痞又不独泻心汤治。或用解表。或用和里。或吐或下。或调虚
气。随所宜而施治。自今观之。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。下走则为肠鸣。故用是汤分阴阳。水升火降。而留者
去。虚者实。成注。是方连、芩之苦寒入心。以降阳而升阴也。半夏、干姜之辛热。以
走气而分阴行阳也。甘草、参、枣之甘温。补中而交阴阳。通上下也。
干呕而利者。黄芩加半夏生姜汤主之。
黄芩加半夏生姜汤方
黄芩（三两） 甘草 芍药（各二两） 半夏（半升） 生姜（三两） 大枣（十二枚）
上六味。水六升。煮取三升。温服一升。日三服。
〔衍义〕伤寒论。太阳与少阳合病自下利。若呕。有黄芩加半夏生姜汤主之。成注。
太阳阳明合病。自下利。为在表。与葛根汤发汗。阳明少阳合病自下利。为在里。
可与承气汤下之。太阳少阳合病。为半表半里。则以是汤和解之。论方药主治。
则曰黄芩之苦。芍药之酸。以敛肠胃之气。甘草、大枣之甘。以补肠胃之弱。半夏、生姜散逆也。
诸呕吐。谷不得下者。小半夏汤主之。
〔衍义〕呕吐谷不得下者。有寒有热不可概论也。属热者。王冰所谓谷不得入。是
有火也。此则非寒非热。由中焦停饮气结而逆。故用小半夏汤。
呕吐而病在膈上。后思水者解。急与之。思水者。猪苓散主之。
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。
〔衍义〕伤寒论。太阳病。发汗后。胃中干。欲得水者。少少与之。令胃中和则愈。若小
便不利。微热消渴者。不可与。以汗多胃中燥。猪苓汤复利其小便故也。盖呕吐
犹汗之走津液。膈上犹表也。何用药不同。盖二方以邪内连下焦。故不用泽泻、
滑石、阿胶、猪苓之味淡。从膈上肺部渗其积饮。又防水入停腹。白术和中益津。
使水精四布。去故就新。奚必味多。但用之得其当尔。
呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
四逆汤方
附子（一枚生用） 干姜（一两半） 甘草（二两炙）
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。
〔衍义〕谷入于胃。长养于阳。脉道乃行。今胃不安于谷。以致呕。故其气不充于脉。
则脉弱。下焦虚。则小便自利。迫阳于表则微热。经脉虚则寒厥。夫阳者。一身之
主。内外三焦虚寒如此。诚难治矣。苟有可回之意。必以四逆回阳却阴也。
呕而发热者。小柴胡汤主之。
〔衍义〕伤寒论。出太阳证。又出厥阴证。小柴胡汤。本少阳半表半里药也。何为太
阳厥阴亦治之。盖太阳传里而未尽入。厥阴受传而未尽受。二者俱在半表半
里之间。故呕而发热。病同方亦同也。自此而言。病之半表半里。岂独伤寒有哉。
故更集要略。
胃反呕吐者。大半夏汤主之。
大半夏汤方
半夏（二升洗） 人参（三两） 白蜜（一升）
右三味。以水一斗二升。和蜜扬之二百四十遍。煮取二升半。分温再服。
〔衍义〕阳明燥金也。与太阴湿土为合。腑脏不和。则湿自内聚。为痰为饮。燥自外
款。为胃脘痈。玄府干涸。而胃之上脘尤燥。故食难入。虽食亦反出也。半夏解湿
饮之聚结。分阴阳。散气逆。人参补正。蜜润燥。以扬水之者。内经云。清上补下。治
之以缓。水性走下。故扬以缓之。佐蜜以润上脘之燥也。
食已即吐者。大黄甘草汤主之。
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。
论曰。胃气生热。其阳则绝。盖胃强则与脾阴相绝。绝则无转运之机。故食入即
吐也。用大黄泻大热。甘草和中耳。
王宇泰先生曰。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。故取之也。
胃反吐而渴欲饮水者。茯苓泽泻汤主之。
茯苓泽泻汤方
茯苓（半斤） 泽泻（四两） 白术（三两） 甘草（二两） 桂枝（二两） 生姜（四两）
上六味。以水一斗。煮取三升。内泽泻再煮。去滓。二升半。温服八合。日三服。
〔衍义〕胃反吐。津液竭而渴矣。斯欲饮水以润之。更无小便不利。而用此汤何哉。
盖阳绝者。水虽入而不散于脉。何以滋润表寒解其燥郁乎。惟茯苓之淡行其
上。泽泻之咸行其下。白术、甘草之甘和其中。桂枝、生姜之辛通其气。用布水精
于诸经。开阳存阴。而洽荣卫也。
吐后渴欲得水而贪饮者。文蛤汤主之。兼主微风脉紧头痛。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十枚） 大枣（十二枚）
上七味。以水六升。煮取二升。温服一升。汗出即愈。
〔衍义〕是汤即大青龙去桂枝盖文蛤也。大青龙主发散风寒两受。此证初无外
邪而用之何哉。夫天地之气。人之饮食之气。分之虽殊。合之总属风寒湿热之
气化耳。足太阳膀胱。本寒水之经也。先因胃热而吐。用竭其津。遂渴欲饮水。饮
多则水气内凝。其寒外应。而腠理闭矣。故将文蛤散水寒。麻黄、杏仁开腠理。利
肺气。甘草、姜、枣发荣卫。石膏解肌表内外之郁热也。而又谓主微风脉紧头痛
者何。盖风热循膀胱。上入巅。覆其清阳。则为头痛。而肾邪亦从而泛溢。故同一主治也。
干呕吐逆。吐涎沫。半夏干姜散主之。
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。煮取七合。顿服之。
〔衍义〕干呕吐涎沫者。由客邪逆于肺。肺主收引。津液不布。遂聚为涎沫也。用半
夏干姜之辛热。温中燥湿。浆水之寒。收而行之。以下其逆。则其病自愈矣。
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。
生姜半夏汤方
生姜汁（一升） 半夏（半升）
上二味。以水三升。煮半夏取二升。内生姜。煮取一升半。小冷。分四服。日三夜一。呕止停后服。
〔衍义〕夫阳受气于胸中。布气息为呼吸。胸中心肺之分。清气之道也。阴邪闭之。
则阻其呼吸往来。令气或促或搏或逆。有似喘呕与哕也。且心舍神者也。聚饮
停痰。则神不宁。故彻心愦愦然无奈也。用半夏之辛温燥其湿饮。生姜之辛热
散寒折逆。则阳得以布。气得以调。斯病可愈耳。○按此方与小半夏汤相同。而
取意少别。小半夏汤宣阳明之气上达。故用半夏为君。生姜为佐。半夏汤通阳
明之经。故用姜汁为君。半夏为佐。取其行于经络。故用汁也。
干呕哕。若手足厥者。橘皮汤主之。
橘皮汤方
橘皮（四两） 生姜（半斤）
(One general discussion, twenty-seven pulse and symptom clauses, and twenty-three formulas)
In cases where a patient with vomiting has abscess pus (pus from an internal abscess), one should not treat the vomiting. Once the pus is discharged, the condition will heal spontaneously.
[Commentary] In Volume I, regarding lung abscess (Fei Yong), there must first be coughing, followed by spitting up pus like congee after a long time. Jiegeng Tang (Platycodon Decoction) and Baisan (White Powder) both treat this. Here, the location of the abscess is not specified, indicating it is not a lung abscess. The Classics state: "Heat gathers at the stomach opening and does not circulate, causing congestion in the epigastrium." The epigastrium belongs to the Yangming meridian. When Yangming qi rebels upward, vomiting occurs. Therefore, the pus is not expelled through coughing but through vomiting. The nature of the pus also differs from that of lung abscess, which resembles congee. It originates from the epigastrium, transforms from dampness, and aggregates. If it resembles coagulated phlegm or clam meat, as stated here, "do not treat" means one need not specifically treat the vomiting. The vomiting is caused by the stagnation of pus steaming and disturbing the grain qi. Once the pus is discharged, the vomiting will cease naturally. This applies when 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 vomited out but will pass through the stool.
If vomiting occurs first and thirst follows, this indicates the disease is about to resolve. If thirst occurs first and vomiting follows, this is due to fluid retention in the heart-epigastrium region. This belongs to the category of fluid retention diseases. Patients who vomit are typically thirsty; if they are now not thirsty, it is because there is Zhī Yǐn (branching fluid retention) in the heart-epigastrium. This also belongs to branching fluid retention.
[Commentary] In Shanghan Lun, vomiting often has causes: heat, cold, water, or fluid retention, all belonging to stomach disorders. Here, only fluid retention-induced vomiting is discussed in three sections. The first section, "vomiting first then thirst," implies vomiting due to excessive drinking; vomiting removes the fluid, yang qi returns, but fluids have not yet distributed, causing thirst. Although thirsty, recovery is certain as pathogenic factors leave and healthy qi returns. The second section, "thirst first then vomiting," refers to the earlier phlegm-fluid clause, treated with Xiaobanxia Fuling Tang (Pinellia and Poria Decoction). The third section, "originally thirsty, now not," also falls under phlegm-fluid retention, similarly treated with Xiaobanxia Fuling Tang.
Question: A patient has a rapid pulse (Shu Mai). Rapid pulses indicate heat, which should promote digestion and appetite, yet the patient vomits. Why? The Master said: This is due to improper sweating therapy, which weakened yang qi and caused deficiency of qi in the diaphragm, resulting in a rapid pulse. This rapidness represents "guest heat" (temporary external heat), which cannot digest food, due to cold deficiency in the stomach. A wiry pulse (Xian Mai) also indicates deficiency, meaning no surplus stomach qi remains. Morning eating and evening vomiting transform into Wei Fan (stomach reversal). Cold is in the upper jiao, but the physician incorrectly used purgatives. Now the pulse is wiry, hence called deficiency.
[Commentary] Generally, pulse diagnosis reflects disease: excess yang yields rapid pulses, excess yin yields slow pulses. Here, weak yang with a rapid pulse, accompanied by stomach cold, requires explanation. Pulse and disease cannot be generalized. This rapid pulse is caused by residual heat from medication lingering in the body; stomach cold results from insufficient yang. The middle jiao is the boundary of yin and yang. Sweating agents must be acrid-warm and dispersing. Improper sweating damages middle jiao yang, leading to weak yang and deficient diaphragm qi. Residual drug heat transforms from the yin aspect, forming a rapid pulse. Ancient texts call this "guest heat," not true yang excess. Despite guest heat, stomach yang is insufficient, hence "stomach cold deficiency." Physicians wrongly used cold purgatives, further damaging yin yang, changing the pulse to wiry. With insufficient yang above and below, even during evening yin hours, yang cannot enter the lower jiao, preventing waste transport. Intestines cannot excrete, and contents cannot stay in the middle jiao, leading to vomiting. Thus, "no stomach qi surplus," resulting in morning intake and evening ejection.
Cunkou (radial artery) pulse is faint and rapid. Faint indicates lack of qi; lack of qi leads to Ying (nutritive) deficiency; Ying deficiency leads to blood insufficiency; blood insufficiency causes cold in the chest.
[Commentary] This clause describes pulse without symptoms. Why? The previous clause attributed rapid pulse to guest heat; this one attributes it to qi and blood deficiency. It continues from the previous point. The previous clause resulted from errors in sweating and purging; this one results from upper jiao Ying-Wei (defensive-nutritive) insufficiency, also causing stomach reversal. Thus, symptoms are omitted, focusing only on pulse characteristics. Yang pulses move vigorously; yin pulses rest quietly. Harmony between them is neither rigid nor soft, fast nor slow. A faint-rapid pulse shows loss of yang (faint) and loss of yin essence (rapid), exceeding mere guest heat. The chest is the sea of Ying-Wei. Deficient Ying-Wei fails to fill the center, causing chest cold. Ying-Wei qi enters and exits organs, circulating the body, generated from grain, and transforming grain. Without grain, Ying-Wei cannot be filled; without Ying-Wei, grain cannot be transformed. Hence, chest cold leads to stomach refusal to accept food. Wang Bing commented on Neijing: "Food entering and immediately exiting indicates lack of fire." Although termed cold, it should be viewed as healthy qi deficiency. Healthy qi is the essence of yin and yang, neither cold nor hot, harmonious and pure. It should not be treated as cold pathogen. Using heat to treat this would exacerbate guest heat and consume qi and yang. Guest heat arises not only from residual drugs but also from Jueyang fire of the five zang organs attacking the central earth (spleen/stomach), or from emotional stagnation. Rich foods can also generate guest heat; thus, adding heat herbs is inappropriate. Alas! People treating this disease use Ding (Clove), Fu Zi (Aconite), Jiang (Ginger), Gui (Cinnamon), unaware of how to restore healthy qi.
Fuyang (dorsalis pedis artery) pulse is floating and choppy. Floating indicates deficiency; choppy indicates spleen injury. Spleen injury impairs grinding function. Morning eating and evening vomiting, or evening eating and morning vomiting, with undigested food, is called Wei Fan (stomach reversal). A tight and choppy pulse indicates a difficult-to-treat condition.
[Commentary] Fuyang is the passage of the stomach meridian; thus, stomach pulse is examined here. Spleen and stomach are connected by membranes and belong to Earth. Earth has yin and yang: stomach is yang earth, spleen is yin earth. Yang governs qi and movement; yin governs blood and stillness. Why does spleen injury impair grinding? This illustrates the mutual basis and function of yin and yang. Yang participating in yin allows yin to move without stagnation; yin participating in yang allows yang to consolidate without flightiness. Spleen movement prevents choppy pulse; stomach consolidation prevents floating pulse. Floating indicates stomach deficiency, failing to rot and ripen grain; choppy indicates spleen blood injury, failing to digest grain. Thus, food eaten during morning yang hours is vomited during evening yin hours, and vice versa. Due to dual deficiency failing to interact, transport to intestines is blocked. He Jian stated: Tight Fuyang pulse is difficult to treat. Blood loss in the upper stomach causes涩 (choppy/unsmooth) sensation in the diaphragm, preventing food entry. Spleen controls blood; blood loss dries intestines, hindering waste transformation. Food enters but is ejected.
When a patient desires to vomit, do not use purgatives.
[Commentary] Desire to vomit indicates pathogen in the yang level. Purging contradicts treating yang and injures unaffected yin. Harm extends beyond stomach reversal; consequences are severe.
Hiccup (Yue) with abdominal fullness. Examine anterior (urination) and posterior (defecation) orifices to identify obstruction. Relieving the obstruction cures the condition.
[Supplementary Note] Hiccup is sound without matter. Abdominal fullness is excess; excess causes qi rebellion and hiccup. One must assess which orifice is obstructed and relieve it to resolve fullness and stop hiccup.
Vomiting with chest fullness is treated with Zhuyu Tang (Evodia Decoction).
Zhuyu Tang Formula
Wuzhuyu (Evodia Fruit, 1 sheng, washed)
Renshen (Ginseng Root, 3 liang)
Shengjiang (Fresh Ginger, 6 liang)
Dazao (Jujube, 12 pieces)
Boil the four ingredients in 5 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
[Commentary] Shanghan Lun uses this for Yangming syndrome with desire to vomit after eating, due to middle jiao cold. Wuzhuyu treats internal cold and directs rebellious qi downward; Renshen tonifies yang qi; Dazao moderates spleen; Shengjiang promotes stomach qi, disperses rebellion, and stops vomiting. Downward rebellious qi allows stomach yang to circulate, relieving pain. This treats spleen yin excess rebelling against stomach, or kidney/liver lower jiao cold rebelling into middle jiao. For non-middle jiao chronic cold, treat the specific organ. For example, Jueyin cold limbs with fine, nearly imperceptible pulse and internal chronic cold use Danggui Sini Tang plus Wuzhuyu and Shengjiang.
Dry heaving, spitting saliva/froth, and headache are treated with Zhuyu Tang.
[Commentary] In Shanghan Lun Jueyin syndrome, Cheng Wuji notes dry heaving and spitting froth indicate interior cold. Headache results from cold qi attacking upward. This formula warms interior and dispels cold. Different pathology from "vomiting with abdominal fullness" but same formula, as both involve Jueyin attacking Earth.
Vomiting with borborygmus (intestinal rumbling) and epigastric stuffiness (Pi) is treated with Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium).
Banxia Xiexin Tang Formula
Banxia (Pinellia Tuber, half sheng)
Huanglian (Coptis Rhizome, 1 liang)
Renshen (Ginseng Root, 3 liang)
Ganjiang (Dried Ginger, 3 liang)
Gancao (Licorice Root, 3 liang, roasted)
Huangqin (Scutellaria Root, 3 liang)
Dazao (Jujube, 12 pieces)
Boil seven ingredients in 6 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
[Commentary] In Shanghan Lun, vomiting with epigastric stuffiness can be half-exterior/half-interior or interior. Half-exterior/half-interior uses Xiexin Tang. Interior cases use Shizao Tang or Da Chaihu Tang. If epigastric stuffiness involves borborygmus and fluid retention, use Shengjiang Xiexin Tang. If diarrhea with undigested food occurs, use Gancao Xiexin Tang. For stuffiness with aversion to cold and sweating, use Fuzi. If Guan position pulse is floating, use Dahuang. Treatment varies: exterior release, interior harmony, emesis, purgation, or tonifying deficiency, based on suitability. Currently, this syndrome stems from yin-yang disconnection, blockage, and stagnation in the epigastrium. Empty stomach allows guest qi to rebel upward (vomiting) and flow downward (borborygmus). This formula separates yin-yang, raises water, lowers fire, removes stagnation, and fills deficiency. Cheng Wuji notes: Huanglian/Huangqin bitter-cold enters heart to lower yang and raise yin; Banxia/Ganjiang acrid-hot moves qi, separates yin, and promotes yang; Gancao/Renshen/Dazao sweet-warm tonifies middle, connects yin-yang, and unites upper-lower.
Dry heaving with diarrhea is treated with Huangqin Jia Banxia Shengjiang Tang (Scutellia Decoction plus Pinellia and Fresh Ginger).
Huangqin Jia Banxia Shengjiang Tang Formula
Huangqin (Scutellaria Root, 3 liang)
Gancao (Licorice Root, 2 liang)
Shaoyao (Peony Root, 2 liang)
Banxia (Pinellia Tuber, half sheng)
Shengjiang (Fresh Ginger, 3 liang)
Dazao (Jujube, 12 pieces)
Boil six ingredients in 6 sheng of water to obtain 3 sheng. Take 1 sheng warm, three times daily.
[Commentary] Shanghan Lun states Taiyang-Shaoyang combined disease with spontaneous diarrhea, if vomiting, uses this formula. Cheng Wuji notes: Taiyang-Yangming combined disease with diarrhea is exterior, treated with Gegen Tang (sweating); Yangming-Shaoyang combined disease with diarrhea is interior, treated with Chengqi Tang (purging); Taiyang-Shaoyang combined disease is half-exterior/half-interior, treated with this formula for harmonization. Pharmacology: Huangqin bitterness and Shaoyao sourness astringe gastrointestinal qi; Gancao/Dazao sweetness tonifies gastrointestinal weakness; Banxia/Shengjiang disperses rebellion.
Various vomitings where food cannot go down are treated with Xiaobanxia Tang (Minor Pinellia Decoction).
[Commentary] Vomiting with food intolerance can be cold or heat; cannot be generalized. Heat cases, per Wang Bing, mean "fire prevents food entry." Here, it is neither cold nor heat but middle jiao fluid retention and qi knotting causing rebellion. Hence, Xiaobanxia Tang.
Vomiting with pathology above the diaphragm, followed by desire for water, indicates resolution. Give water promptly. If thirsty, use Zhu Ling San (Polyporus Powder).
Zhu Ling San Formula
Zhuling (Polyporus, equal parts)
Fuling (Poria, equal parts)
Baizhu (Atractylodes Macrocephala, equal parts)
Grind three ingredients into powder. Take one cun-bi (measure) with water, three times daily.
[Commentary] Shanghan Lun: After sweating Taiyang disease, stomach dryness causes desire for water; give small amounts to harmonize stomach. If urination is difficult, slight fever, and thirst, do not give, as sweat dehydrated stomach; Zhuling Tang promotes urination, worsening dehydration. Vomiting loses fluids like sweating; diaphragm is like exterior. Why different formulas? These formulas address pathogens connecting to lower jiao, avoiding bland-draining herbs like Zexie, Huashi, Ejiao, Zhuling. Instead, they drain fluid from diaphragm/lungs and prevent abdominal fluid accumulation. Baizhu harmonizes middle and benefits fluids, distributing essence. Appropriateness matters more than quantity.
Vomiting with weak pulse, free urination, slight body heat, and cold extremities is difficult to treat; use Sini Tang (Counterflow Decoction).
Sini Tang Formula
Fuzi (Prepared Aconite Root, one raw piece)
Ganjiang (Dried Ginger, 1.5 liang)
Gancao (Licorice Root, 2 liang, roasted)
Boil three ingredients in 3 sheng of water to obtain 1.2 sheng. Strain, divide into two warm doses. Strong individuals may use larger Fuzi (one piece) and Ganjiang (3 liang).
[Commentary] Grain nourishes yang in stomach, enabling pulse circulation. Stomach unrest causes vomiting, depleting qi in vessels (weak pulse). Lower jiao deficiency causes free urination. Yang forced to surface causes slight heat; vessel deficiency causes cold extremities. Yang is master of body; extensive interior/exterior cold makes treatment difficult. If recovery is possible, Sini Tang restores yang and repels yin.
Vomiting with fever is treated with Xiaochaihu Tang (Minor Bupleurum Decoction).
[Commentary] Shanghan Lun mentions Xiaochaihu Tang for Taiyang and Jueyin syndromes. It is originally for Shaoyang half-exterior/half-interior. Why treat Taiyang/Jueyin? Taiyang transmitting inward is incomplete; Jueyin receiving transmission is incomplete. Both are in half-exterior/half-interior zone. Vomiting and fever share pathology and formula. Thus, half-exterior/half-interior pathology exists beyond Shanghan.
Stomach reversal vomiting is treated with Dabanchen Tang (Major Pinellia Decoction).
Dabanchen Tang Formula
Banxia (Pinellia Tuber, 2 sheng, washed)
Renshen (Ginseng Root, 3 liang)
Baimi (White Honey, 1 sheng)
Mix three ingredients with 12 dou of water and honey, stir 240 times. Boil to obtain 2.5 sheng. Divide into two warm doses.
[Commentary] Yangming Dry Metal combines with Taiyin Damp Earth. Organ dysfunction causes internal dampness (phlegm/fluid) and external dryness (epigastric abscess/dry pores). Upper stomach becomes very dry, preventing food entry or causing immediate ejection. Banxia resolves fluid aggregation, separates yin-yang, disperses qi rebellion; Renshen tonifies healthy qi; Honey moistens dryness. Stirring water slows its descent, per Neijing: "Clear upper, tonify lower, treat with slowness." Water flows down; stirring slows it. Honey moistens upper stomach dryness.
Vomiting immediately after eating is treated with Dahuang Gancao Tang (Rhubarb and Licorice Decoction).
Dahuang Gancao Tang Formula
Dahuang (Rhubarb Root, 4 liang)
Gancao (Licorice Root, 1 liang)
Boil two ingredients in 3 sheng of water to obtain 1 sheng. Divide into two warm doses.
Discussion: Stomach qi generates heat, cutting off yang. Stomach strength cuts off spleen yin; lack of transport mechanism causes immediate ejection. Dahuang clears intense heat; Gancao harmonizes middle.
Mr. Wang Yutai said: "Desire to vomit prohibits purging." Yet Dahuang Gancao Tang treats immediate post-prandial vomiting. Answer: Desire to vomit places pathology above; inducing emesis is appropriate. Forcing downward causes obstruction and worsens condition. Prohibited. However, if vomiting persists with no descent, reverse and curb it by directing downward. No herb acts faster than Dahuang; hence used.
Stomach reversal vomiting with thirst and desire to drink is treated with Fuling Zexie Tang (Poria and Alisma Decoction).
Fuling Zexie Tang Formula
Fuling (Poria, 8 liang)
Zexie (Alisma Rhizome, 4 liang)
Baizhu (Atractylodes Macrocephala, 3 liang)
Gancao (Licorice Root, 2 liang)
Guizhi (Cinnamon Twig, 2 liang)
Shengjiang (Fresh Ginger, 4 liang)
Boil six ingredients in 1 dou of water to obtain 3 sheng. Add Zexie, boil again. Strain, obtain 2.5 sheng. Take 0.8 sheng warm, three times daily.
[Commentary] Stomach reversal vomiting depletes fluids, causing thirst. Desire to drink aims to moisten. Why use this formula without urinary difficulty? Yang cutoff prevents water distribution in vessels, failing to moisten exterior cold and resolve dryness. Fuling's blandness drains upper; Zexie's saltiness drains lower; Baizhu/Gancao sweetness harmonizes middle; Guizhi/Shengjiang acridity unblocks qi. Distribute water essence to meridians, open yang, preserve yin, and nourish Ying-Wei.
After vomiting, thirst with greedy drinking is treated with Wenli Tang (Clam Shell Decoction). Also treats mild wind, tight pulse, and headache.
Wenli Tang Formula
Wenli (Clam Shell, 5 liang)
Mahuang (Ephedra Stem, 3 liang)
Gancao (Licorice Root, 3 liang)
Shengjiang (Fresh Ginger, 3 liang)
Shigao (Gypsum, 5 liang)
Xingren (Apricot Seed, 50 pieces)
Dazao (Jujube, 12 pieces)
Boil seven ingredients in 6 sheng of water to obtain 2 sheng. Take 1 sheng warm. Cure upon sweating.
[Commentary] This is Da Qinglong Tang minus Guizhi plus Wenli. Da Qinglong disperses wind-cold. Why use here without external pathogen? Heaven/earth and dietary qi combine into wind-cold-damp-heat transformations. Bladder meridian is cold-water channel. Stomach heat caused vomiting, depleting fluids, leading to thirst and drinking. Excess drinking causes internal water condensation and external cold response, closing pores. Wenli dissipates water-cold; Mahuang/Xingren open pores and benefit lung qi; Gancao/Jiang/Zao promote Ying-Wei; Shigao clears muscle-surface internal-external郁 heat. Why treat mild wind/tight pulse/headache? Wind-heat follows bladder meridian to vertex, covering clear yang, causing headache. Kidney pathogen overflows. Same treatment applies.
Dry heaving, retching, and spitting froth are treated with Banxia Ganjiang San (Pinellia and Dried Ginger Powder).
Banxia Ganjiang San Formula
Banxia (Pinellia Tuber, equal parts)
Ganjiang (Dried Ginger, equal parts)
Grind two ingredients into powder. Take one cun-bi. Boil in 1.5 sheng of Jiangshui (fermented grain water) to obtain 0.7 sheng. Take in one dose.
[Commentary] Dry heaving and spitting froth result from guest pathogen rebelling in lung. Lung governs contraction; fluids fail to distribute, aggregating into froth. Acrid-hot Banxia/Ganjiang warm middle and dry dampness. Cold Jiangshui collects and guides downward, subduing rebellion. Disease heals.
Patient feels chest discomfort:似喘不喘 (like panting but not panting), 似呕不呕 (like vomiting but not vomiting), 似哕不哕 (like hiccup but not hiccup), with profound mental distress and helplessness. Treat with Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction).
Shengjiang Banxia Tang Formula
Shengjiangzhi (Fresh Ginger Juice, 1 sheng)
Banxia (Pinellia Tuber, half sheng)
Boil Banxia in 3 sheng water to obtain 2 sheng. Add Ginger Juice, boil to obtain 1.5 sheng. Cool slightly. Divide into four doses: three daytime, one nighttime. Stop after vomiting ceases.
[Commentary] Yang receives qi in chest, distributing breath. Chest houses heart/lung, pathway for clear qi. Yin pathogen blocks breathing, causing急促 (rapid), 搏 (pounding), or rebellious qi, mimicking panting/vomiting/hiccup. Heart houses spirit; fluid/phlegm accumulation disturbs spirit, causing profound distress. Acrid-warm Banxia dries damp-fluid; acrid-hot Ginger disperses cold and curbs rebellion. Yang distributes, qi regulates, disease heals. Note: Similar to Xiaobanxia Tang but intent differs. Xiaobanxia Tang promotes Yangming qi upward (Banxia chief, Ginger assistant). This formula unblocks Yangming meridian (Ginger Juice chief, Banxia assistant), utilizing juice for meridian penetration.
Dry heaving and hiccup with cold extremities are treated with Jupi Tang (Tangerine Peel Decoction).
Jupi Tang Formula
Jupi (Tangerine Peel, 4 liang)
Shengjiang (Fresh Ginger, 8 liang)