一条 夫呕家有痈脓。不可治呕。脓尽自愈。
前人以无物为呕。有物为吐。或云声缓为吐。声急为哕。虽似确当。而愚谓就病因而论。三者俱有虚实寒热
之不同。但因虚、因寒者。十之七。而因实、因热者。十之三。就高下而论。则呕为最高。吐次之。哕则直由极深极
低而迸出者。就脏腑而论。呕、属足之阳明少阳。吐、属手少阳三焦之上部及足太阴。哕、属足之少厥二阴者
也。呕出足阳明者奈何。夫胃脘一寒。欲下趋其腑者势也。胃不受邪。则逆以拒脘。脘即以不下纳而上涌。故
作寒呕者一。伤寒太阳之呕是矣。胃脘犯客热。热为火。火性上炎。而其气闪烁不定。故作热呕者二。内热而
实。中暑及 。并酒客清晨之空呕是矣。所谓阳明脘中之呕。从中路而上逆者。如此。呕出少阳者奈何。少阳
之部在胁。其性善逆。不拘风热寒邪犯之。则其逆气上冲喉咽。故作呕酸、呕苦者。从木化也。凡柴胡汤症之
呕。是矣。所谓少阳胁下之呕。从两旁而上逆者。如此。以其病机在胃之脘。胆之标。而不在胃腑。故呕则无物。
而且曰最高者此也。若夫吐之为病。实在胃中。故其位居呕之次。但脘外及膈中之气。其温暖化被者。实司
消谷之半。（膈气与脾。合司熟谷之化。故曰消谷之半。）此气一虚。则胃中冷而不能消谷。谷停则败。败则
胃不见容而作吐者。一也。下文四条之脉症是矣。又胃虽受谷。而胃外之脾气。虚寒而不能扇运。则迟迟作
吐者。又一也。下文七条之脉症是矣。所谓吐由手少阳三焦之上部。及足太阴脾脏者。此也。至于哕虽亦由
胃家。其实胃气总虚。苟非肝肾之贼阴乘虚上撞。安得从胃底而上迸。声出重浊乎。此二十四条之兼厥。二
十五条之兼逆。谓非肝肾上侮阳明之候耶。故曰哕则极深极低。而发于少厥二阴者。此也。然呕而不吐。吐
而不哕者有之。若吐哕则未有不呕者。以呕高而为吐哕之门户。此十四、十五、十八三条。言吐而皆曰呕吐。
二十五条。言哕而曰呕哕者。可证矣。他如因疑而呕吐者。出于心。因闻秽而呕吐者。出于肺。因饿而嘈杂。以
致惨淡之液。上泛而呕吐者。出于胃。凡种种平人所偶见而非病者。皆不与焉。本条见伤寒厥阴文。注详
其下。但在伤寒。是言厥阴风热。上见少阳之痈脓。因而致呕者。入此。则系泛论痈脓之呕。为微别耳。自此合
下文二、三两条。先提过别症之带呕。而后言呕家之正病正治也。
二条 先呕却渴者。此为欲解。先渴却呕者。为水停心下。此属饮家。
呕属胃脘有寒。故先不渴。呕则寒去。而且能提气于上。使胃阳来复而作渴。故先呕后渴者。知其呕将欲解
也。后三句。见饮门三十五条。注详其下。
三条 呕家本渴。今反不渴者。以心下有支饮故也。此属饮家。
经注俱见饮门二十八条。
四条 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。
此言膈虚胃冷之吐也。仲景设言胃气以温热消谷者。理也。病患脉数。数为内热可知。当消谷引食矣。而反
拒食而吐者。是何理也。答曰。此膈自热。故脉数。胃自冷。故吐也。推原其理。此必因不当汗而发汗。汗乃胸中
胃中之阳气所化出者。阳气既泄于汗。则膈虚胃冷而吐者。宜矣。至其脉数之故。以发表之药不远热。且聚
其气以作汗。汗出而其热势未散。故脉数者。为游行暂托之客热。不主消谷之化。而胃中之真阳。其虚冷者
自若。此脉数与吐互见矣。本条重脉数字。言吐有因于误汗者。其脉如此。
五条 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。令脉反弦。故名曰虚。
此言胃虚之吐也。虚吐冷吐有辨。冷则如酒酝之不沤发而致酸。虚则如舟车之不胜载而致覆之象也。承
上文冷吐而谓吐又有一种脉弦者。弦脉之体状。细削而拘紧。细削、为阳气不能扩充。拘紧、为阳气不能柔
养。皆气虚之诊。故曰虚也。夫胃气无余。则朝食不运。至暮便吐。久而吐机渐熟。变为胃反矣。寒在于上。即上
条膈气虚之义。言此胃反之来由。因其人膈气原虚。不易化食。医误为积滞而攻下之。遂令胃愈虚而脉反
弦。故名曰虚也。本条重脉弦字。言吐有因于误下者。其脉又如此。
六条 寸口脉微而数。微则无气。无气则营虚。营虚则血不足。血不足则胸中冷。
此又推原上条寒在于上之故。而言此种脉症。万勿误行吐下。致成或数或弦之脉。而变为胃反也。如寸口
之脉。所以外诊经络。内诊胸中者也。倘其人脉微而数。数为客热。已见四条。但就微论。则微为气不能鼓之
应。故知其无卫气。夫营卫互相根抱者也。今微而无气。则营虚可知。营阴、又为血中之精华所神化者。营虚、
则周身之大血。其不足又可知。血不足。则宗气无生化之源。而胸中冷矣。倘于此而以阳药汗之。则脉数者
愈数。而为四条之候。以阴药下之。则脉微者变弦。而为五条之候。可不慎乎。
七条 趺阳脉浮而涩。浮则为虚。虚则伤脾。脾伤则不磨。朝食暮吐。暮食朝吐。宿谷不化。名曰胃反。
脉紧而涩。其病难治。
此言脾虚之吐也。趺阳之脉浮而涩。姑且不论涩。即从浮断。夫浮以诊腑。而浮之底面即诊脏。浮脉底虚。趺
阳之底虚。谓非脾气受伤之故乎。脾伤。则胃受谷而脾不磨。于是朝食暮吐。暮食朝吐。宿谷不化。败坏上出。
致成胃反者。又一也。紧者、弦紧之谓。趺阳弦紧。法当下逆为利。上逆为吐之脉。涩者、血不足以生气之诊也。
言浮涩而胃反之脉。渐变紧涩。则紧为无阳。而吐不欲止。涩为无阴。而脾不受温。故难治。合四条、五条及本
条观之。则胃反之症。因于膈虚者一。因于胃中虚寒者二。因于脾伤者三。应病用药。而仲景之旨、不较然乎。
八条 病患欲吐者。不可下之。
此泛论欲吐之禁。不专指胃反也。故曰病患云云。欲吐者。不可下。其义有二。吐则胃寒者居多。下之。则愈寒
而吐益甚者。一也。又吐则气机已在上涌。下之、则又下夺其气。恐致分驰而中绝者。又一也。故禁。
九条 哕而腹满。视其前后。知何部不利。利之则愈。
哕、兼呕吐在内。腹满、指实痛光亮而两言之。非谓按之则软之满也。此承上文吐以下为禁。然间亦有可下。
并可利小便者。又不容不细辨也。如哕而其腹实痛光亮。则为有形之满。而非虚满矣。夫有形之满。又有水
食之别。视其前阴不利。则知蓄水以致满。而其腹光亮。后阴不利。则知积食以致满。而其腹实痛。俱气闭于
下而逆于上。故令哕耳。利之。则下气通而逆自平。故愈。哕深于呕吐。言哕而呕吐者。可例推矣。故曰兼呕吐在内。
十条 呕而胸满者。吴茱萸汤主之。
吴茱萸汤方 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。
自此至十七倏。杂言诸呕之治例也。胸为胃脘所经。及脘外膈分之总名。此处闷满。系虚寒之气。上痞阳位
之应。夫呕虽有寒热之不同。若呕而胸满。则为寒气乘虚之呕无疑。故君苦温降逆之吴茱萸者。盖苦温、所
以除寒。降逆、所以止呕也。然后佐甘温之人参以补其虚。辛温之生姜、以暖其膈。而以甘浮之大枣。上托诸
药而至胸分。则满消而呕自愈矣。此与下条。即所谓胃脘寒而欲下趋其腑。胃不受而还以拒脘之呕也。
十一条 干呕。吐涎沫。头痛者。吴茱萸汤主之。
古人无物曰呕。是无食物之谓。然而或痰或饮。所不能免。若并无痰饮而作空呕者。则曰干呕。吐涎沫者。非
呕而吐出涎沫之谓。盖言呕时无物。而口中尝欲吐清淡之涎沫。此因膈寒遗肺。肺逆而津液不布。以致上
泛之候也。虚寒之气。既已上塞。又得干呕以提之。则其逆气直浮巅顶。而头上之络脉作胀。故痛也。则除寒
降逆。补虚暖膈之吴茱萸汤。所当兼任者矣。夫上条之呕。本条之干呕。同出胃脘之中。上条之胸满。本条之
吐涎沫。又同出脘外之膈。故皆主此汤耳。文见伤寒厥阴。特少头痛一症。但在伤寒。是言厥阴寒热之邪。
假道少阳而上胸膈。其根深。入此。则单言膈寒肺逆之呕。其根浅。而李氏旧注。因厥阴伤寒主此。遂认吴茱
萸为厥阴专药。硬将本条之呕为厥阴症。则大非也。盖本汤为上中二焦。温补降缉之剂。并非厥阴正药。其
治厥阴寒逆之理。以中焦虚寒。不能下御。故肝中木邪。如要荒远寇直从中原穿过。上犯神京之象。故以本
汤之温胸温胃者。为尊攘之义师。而嬴秦荆楚。畏慑窜伏之道也。若本条之主此汤。又以膈自虚而胃自寒。
如前四五两条之候。犹之畿辅凶荒。流离失业。故从就地温补。而为抚绥安缉之法而已。且仲景明明自言
曰。食谷欲呕者。属阳明也。吴茱萸汤主之。夫亦可想见此汤之意旨矣。
十二条 呕而肠鸣。心下痞者。半夏泻心汤主之。
半夏泻心汤方
半夏（半升洗） 人参 干姜 黄芩（各三两） 黄连（一两） 甘草（二两炙） 大枣（十二枚）
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。
此胃脘虚寒。肠中浮热。因而痞塞致呕之治例也。肠为胃之下口。而丽腹中。脘为胃之上部。而当心下。夫在
天之膈气充周。则胃脘之化机温暖。斯从上制中。从中制下。而营运无弊矣。若呕而肠鸣。是其肠中有走注
之气可知。又心下痞。是其肠中之气。因上虚而倒贯又可知。谓非呕生于痞。痞生于肠鸣。而肠鸣又生于膈
虚脘寒。因而下吸浮热之所致乎。故君降逆之半夏者。所以专责呕逆之由于上痞也。膈虚。故佐益气之人
参以补之。脘寒。故佐暖胃之干姜以温之。肠鸣之气为浮热。故加芩连之苦寒。以坚浮泄热耳。然后托之以
甘草。浮之以大枣。而使诸药直从至高之胸膈。徐徐降下。则痞开而呕自止矣。此条之呕。与四五两条。同
是膈虚胃寒。而方治独异者。以四五两条。为膈胃虚寒之本病。此条尤多一痞症。故专责痞。而带治虚寒也。
十三条 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） 半夏（半升） 生姜（三两） 芍药（二两） 甘草（二两炙） 大枣（十二枚）
上六味。以水一斗。煮取三升。去滓。温服一升。日再服。夜一服。
此上焦虚寒。下焦积热。与上条同。上条为因虚而其热并于上。故痞而单呕。本条系下热不与上虚相并。而
自为奔迫下陷。故寒自呕而热自利也。黄芩、苦寒而直根。为下焦泻热之要药。得酸敛之芍药。甘缓之甘草
为使。则引入肝脾而泻其热。热势缓而奔迫者自平。故利可止。姜半温胃降逆。而以甘浮之大枣为使。则温
降之性。留恋膈间。而寒逆又平。故呕可止也。
十四条 诸呕吐。谷不得下者。小半夏汤主之。（方见痰饮。）
呕吐、勿平看。当重呕一边。以此条言呕症治例故也。犹云诸凡呕甚而致吐之谓。夫呕吐而致谷不得下。则
是寒逆已甚。生姜辛温以散寒者。为治呕之本。半夏辛敛以降逆者。为治呕之标。此小半夏汤之所以可任也。
十五条 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。
呕吐、与上条同是因呕而吐之义。病在膈上。即首条膈气病虚寒之谓也。呕吐之后思水。因呕能提气以实
虚。吐能提火以去寒。故知其解于胸阳之来复耳。但当迎其机而与之以水。使下运之神。借水而利。则上逆
者自平。而呕遂真解矣。急与之义、有二。盖呕吐则液干。不急以水济之。致生烦热懊 之变者。一也。又虚阳
新复。而饮机自动。不急应之。则神机燥涩。而其阳终伏者。二也。然病后饮水。又恐行迟积饮。此渗泄培土之
猪苓散。为不可失矣。
十六条 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（一两五钱） 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。
呕有虚寒、水饮两症。脉充于阳明之精悍。弱则胃无悍气可知。加之小便复利。则非水饮而为虚寒之呕无
疑。虽表有微热。亦是阳热之应。然与厥症同见。则微热为胃中虚寒已甚。而微阳外窜之候也。温之而胃阳
来复则生。不复则死。生死相半。故曰难治。以生附、干姜大辛大热之品。而总托于守中之甘草。正所以温胃
阳而续其残照也。文见伤寒论厥阴篇。但在伤寒。是言厥阴寒逆之气。中凌胃阳。故主此温胃之外。而尤
以味辛者胜木邪也。入此。是言辛甘而温。为阳明本寒之治例而已。其用意不同者。以呕而脉弱诸症。有责
肝责胃之辨故也。
十七条 呕而发热者。小柴胡汤主之。
小柴胡汤方
Article 1: In cases where vomiting is accompanied by pus from an abscess, anti-emetic treatment should not be administered. Once the pus is discharged, the vomiting will cease spontaneously.
Earlier scholars distinguished "ou" (vomiting) as having no substance and "tu" (spitting up) as having substance. Some said that slow sounds indicate "tu," while urgent sounds indicate "yue" (hiccups). Although these distinctions seem appropriate, I believe that from the perspective of etiology, all three conditions can present with deficiency, excess, cold, or heat patterns. Among them, seven-tenths are due to deficiency and cold, while three-tenths are due to excess and heat. Regarding the anatomical level, "ou" is the highest, "tu" is intermediate, and "yue" bursts forth from the deepest and lowest levels. Regarding organ involvement, "ou" belongs to the Foot-Yangming Stomach Meridian and Foot-Shaoyang Gallbladder Meridian; "tu" belongs to the Upper Jiao of the Hand-Shaoyang Sanjiao (Triple Burner) Meridian and the Foot-Taiyin Spleen Meridian; "yue" belongs to the Foot-Shaoyin Kidney Meridian and Foot-Jueyin Liver Meridian.
Why is "ou" related to the Foot-Yangming? If the stomach cavity (we wan) is cold, the tendency for pathogenic factors to descend into the bowel is natural. However, if the stomach rejects the pathogen, it reverses upward to resist at the epigastrium. Consequently, the epigastrium fails to receive food downward and instead surges upward, causing cold-type vomiting. This is the first category, exemplified by vomiting in Taiyang Cold Damage syndrome. If the stomach cavity is invaded by exogenous heat, which follows the nature of fire to flare upward and fluctuate, this causes heat-type vomiting. This is the second category, including internal heat excess, summerheat, and empty vomiting in habitual drinkers in the morning. This describes vomiting originating from the Yangming epigastrium, reversing upward along the central pathway.
Why is "ou" related to the Foot-Shaoyang? The Shaoyang region is located in the hypochondrium, and its nature tends toward rebellion. Whether invaded by wind, heat, or cold pathogens, the rebellious qi rushes upward to the throat and pharynx, causing vomiting of sour or bitter fluids, transforming according to the Wood element. Vomiting associated with Chaihu Tang syndrome is an example. This describes vomiting originating from the Shaoyang hypochondrium, reversing upward from the sides. Since the pathogenesis lies in the stomach's epigastrium and the exterior aspect of the gallbladder, rather than the stomach fu-organ itself, vomiting often produces no solid matter and is considered the highest form.
Regarding "tu," the pathology resides firmly in the stomach, placing it below "ou." However, the qi outside the epigastrium and within the diaphragm is responsible for warmth and transformation, actually managing half of the digestion process (the diaphragmatic qi and spleen jointly manage the cooking and transformation of grains). If this qi becomes deficient, the stomach becomes cold and unable to digest grains. Stagnant grains spoil, and the stomach cannot tolerate them, leading to vomiting. This is the first category, corresponding to the pulse and symptoms in Articles 2-4. Furthermore, even if the stomach receives food, if the spleen qi outside the stomach is deficient and cold and cannot transport, delayed vomiting occurs. This is the second category, corresponding to Articles 5-7. Thus, "tu" arises from the upper Jiao of the Hand-Shaoyang Sanjiao and the Foot-Taiyin Spleen.
As for "yue," although it originates from the stomach, it fundamentally involves total deficiency of stomach qi. Unless the yin pathogens of the Liver and Kidneys attack upward upon this deficiency, how could the sound emerge turbidly from the bottom of the stomach? This corresponds to Article 24 accompanying Jue (cold extremities) and Article 25 accompanying Ni (rebellious qi), indicating Liver and Kidney qi rebelling against the Yangming. Thus, "yue" emerges from deep and low levels, originating from the Shaoyin and Jueyin meridians.
However, there are cases of only "ou" without "tu," and only "tu" without "yue." But whenever "tu" or "yue" occurs, "ou" must also be present, as "ou" is high and serves as the gateway for "tu" and "yue." Articles 14, 15, and 18 mention vomiting but refer to it as "ou tu"; Article 25 mentions hiccups but refers to it as "ou yue," which confirms this. Other instances, such as vomiting due to anxiety (originating from the Heart), vomiting due to foul odors (originating from the Lungs), or vomiting due to hunger-induced burning sensations causing clear fluids to reflux (originating from the Stomach), are common occurrences in healthy individuals and are excluded here. This article originally appears in the Jueyin chapter of Shanghan Lun, with detailed notes below. In Shanghan Lun, it refers to Jueyin wind-heat rising to the Shaoyang abscess causing vomiting; here, it broadly discusses vomiting caused by abscess pus, marking a slight distinction. Starting from here, combining with Articles 2 and 3 below, we first briefly mention other conditions accompanied by vomiting, before discussing the primary disease and treatment of vomiting.
Article 2: If vomiting is followed by thirst, this indicates the condition is resolving. If thirst precedes vomiting, it indicates water retention in the heart/lower chest area (epigastrium); this belongs to patients with fluid retention syndromes.
Vomiting is due to cold in the stomach cavity, so initially there is no thirst. After vomiting, the cold dissipates, and qi is lifted upward, allowing Stomach Yang to recover and generate thirst. Therefore, vomiting followed by thirst indicates the vomiting is about to resolve. The last three sentences appear in Article 35 of the Fluid Retention section; see notes below.
Article 3: Patients who usually vomit should feel thirsty, but if they do not feel thirsty now, it is because there is Zhi Yin (branching fluid retention) under the heart; this belongs to patients with fluid retention syndromes.
Both the text and notes appear in Article 28 of the Fluid Retention section.
Article 4: Question: A patient has a rapid pulse. Rapidness indicates heat, which should promote digestion and appetite, yet the patient vomits instead. Why? The Master said: This is due to improper sweating therapy, which weakened the Yang qi, causing deficiency of Diaphragm Qi. The pulse is rapid due to "Ke Re" (guest/intermittent heat), which cannot digest food. The root cause is deficiency-cold in the stomach.
This discusses vomiting due to Diaphragm deficiency and Stomach cold. Zhongjing posited that Stomach Qi relies on warmth to digest food. A rapid pulse indicates internal heat, suggesting increased appetite. Yet the patient rejects food and vomits. Why? The answer is that the Diaphragm is internally hot (causing the rapid pulse), while the Stomach is internally cold (causing vomiting). Tracing the origin, this likely resulted from inappropriate sweating. Sweat is transformed from the Yang qi of the chest and stomach. When Yang qi is lost through sweat, Diaphragm deficiency and Stomach cold lead to vomiting. As for the rapid pulse, external-releasing herbs are often warm and gather Qi to produce sweat. After sweating, residual heat remains, causing a rapid pulse. This rapidness is transient guest heat, not capable of digestion, while the true Yang of the Stomach remains deficient and cold. Thus, rapid pulse and vomiting coexist. This article emphasizes the rapid pulse to show that vomiting caused by erroneous sweating presents with this pulse.
Article 5: A wiry pulse indicates deficiency. With insufficient Stomach Qi, food eaten in the morning is vomited in the evening, developing into Wei Fan (Stomach Reversal). Cold is located above; if the physician incorrectly uses purgatives, the pulse becomes wiry, hence named deficiency.
This discusses vomiting due to Stomach deficiency. There is a distinction between deficiency vomiting and cold vomiting. Cold vomiting resembles incomplete fermentation leading to sourness; deficiency vomiting resembles a boat capsizing due to overload. Following the discussion of cold vomiting, a wiry pulse indicates another type. The wiry pulse is thin, sharp, and tense. Thinness indicates Yang Qi cannot expand; tension indicates Yang Qi cannot nourish softly. Both are signs of Qi deficiency, hence "deficiency." With insufficient Stomach Qi, morning food is not transported and is vomited by evening. Over time, the vomiting mechanism becomes habitual, forming Wei Fan. "Cold above" refers to Diaphragm Qi deficiency mentioned in the previous article, explaining the origin of Wei Fan. Due to pre-existing Diaphragm deficiency and difficulty digesting food, if the physician mistakenly treats it as stagnation and purges, the Stomach becomes more deficient and the pulse becomes wiry, hence "deficiency." This article emphasizes the wiry pulse to show that vomiting caused by erroneous purging presents with this pulse.
Article 6: The Cun Kou (radial artery at the wrist) pulse is faint and rapid. Faintness indicates lack of Qi; lack of Qi leads to Ying (Nutrient) deficiency; Ying deficiency leads to Blood insufficiency; Blood insufficiency leads to cold in the chest.
This further explores the cause of "cold above" mentioned in Article 5 and warns against using emetics or purgatives, which could change the pulse to rapid or wiry, leading to Wei Fan. The Cun Kou pulse diagnoses meridians externally and the chest internally. A faint and rapid pulse: rapidness is guest heat (see Article 4). Faintness indicates Qi cannot pulse vigorously, showing a lack of Wei (Defensive) Qi. Ying and Wei are interdependent. Lack of Wei Qi implies Ying deficiency. Ying Yin is the spiritual transformation of essence in Blood; Ying deficiency implies systemic Blood insufficiency. Insufficient Blood means Zong (Pectoral) Qi lacks a source of generation, leading to chest cold. Using Yang herbs to sweat would worsen the rapid pulse (Article 4 pattern); using Yin herbs to purge would change the faint pulse to wiry (Article 5 pattern). One must be cautious.
Article 7: The Fu Yang pulse is floating and choppy. Floating indicates deficiency; deficiency injures the Spleen. Spleen injury impairs grinding/digestion. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. Undigested old food is expelled, named Wei Fan. If the pulse is tight and choppy, the disease is difficult to treat.
This discusses vomiting due to Spleen deficiency. A floating and choppy Fu Yang pulse: focusing on floating, floating diagnoses Fu organs, but the base diagnoses Zang organs. A floating pulse with a deficient base at the Fu Yang position indicates injured Spleen Qi. Spleen injury means the Stomach receives food but the Spleen cannot grind it, leading to morning food vomited in the evening, etc., forming Wei Fan. Tightness refers to wiry-tightness. Fu Yang wiry-tightness suggests downward reversal for diarrhea or upward reversal for vomiting. Choppy indicates Blood insufficient to generate Qi. If the floating-choppy pulse of Wei Fan gradually becomes tight-choppy, tightness indicates lack of Yang (vomiting persists), and choppy indicates lack of Yin (Spleen cannot accept warmth), making it difficult to treat. Comparing Articles 4, 5, and 7, Wei Fan arises from Diaphragm deficiency (one case), Stomach deficiency-cold (two cases), and Spleen injury (three cases). Treating according to the disease reveals Zhongjing's principles clearly.
Article 8: If a patient feels the urge to vomit, do not use purgatives.
This generally prohibits purging when there is an urge to vomit, not just for Wei Fan. The reasons are twofold: First, vomiting is mostly due to Stomach cold; purging increases cold and worsens vomiting. Second, during vomiting, Qi mechanisms surge upward; purging drains Qi downward, risking separation and interruption of Qi flow. Hence, it is prohibited.
Article 9: Hiccups accompanied by abdominal fullness. Examine the anterior (urination) and posterior (defecation) orifices to determine which is obstructed. Unblocking it will cure the condition.
"Yue" includes vomiting. "Abdominal fullness" refers to solid pain and distension, not soft fullness on palpation. While purging/emesis are generally contraindicated, sometimes purging or promoting urination is necessary and requires careful differentiation. If hiccups accompany solid, painful, shiny abdominal distension, it is solid fullness, not deficiency fullness. Solid fullness differs by water or food retention. Obstruction of the anterior orifice indicates water retention causing shiny distension; obstruction of the posterior orifice indicates food retention causing solid painful distension. In both cases, Qi is blocked below and rebels upward, causing hiccups. Unblocking allows lower Qi to flow and rebellion to subside, curing the condition. Hiccups are deeper than vomiting; mentioning hiccups implies vomiting is also involved.
Article 10: Vomiting with chest fullness is treated with Wu Zhu Yu Tang.
Wu Zhu Yu Tang Formula: Wu Zhu Yu (Evodia Fruit, 1 sheng), Ren Shen (Ginseng Root, 3 liang), Sheng Jiang (Fresh Ginger, 6 liang), Da Zao (Jujube, 12 pieces).
Boil the four ingredients in 5 sheng of water to obtain 3 sheng. Take 7 he warmed, three times daily.
From here to Article 17, various treatments for vomiting are discussed. The chest is the pathway of the epigastrium and the general term for the area outside the epigastrium and the diaphragm. Fullness here is a response to deficiency-cold qi blocking the Yang region. Although vomiting varies by cold/heat, vomiting with chest fullness is undoubtedly cold qi invading deficiency. Thus, Wu Zhu Yu (bitter-warm, descending/rebellious) is used as the sovereign herb to dispel cold and stop vomiting. It is assisted by sweet-warm Ren Shen to tonify deficiency, pungent-warm Sheng Jiang to warm the diaphragm, and sweet-floating Da Zao to lift the herbs to the chest. Then fullness subsides and vomiting stops. This corresponds to the cold epigastrium rejecting food upward described earlier.
Article 11: Dry heaving, spitting saliva/froth, and headache are treated with Wu Zhu Yu Tang.
"Ou" without substance refers to empty vomiting without food, phlegm, or fluid. Spitting saliva/froth means the mouth constantly desires to expel clear saliva during dry heaving. This is due to Diaphragm cold affecting the Lungs, causing Lung rebellion and failure to distribute fluids, leading to reflux. Deficiency-cold blocks above, and dry heaving lifts it, sending rebellious qi to the vertex, distending head collaterals and causing headache. Wu Zhu Yu Tang, which dispels cold, descends rebellion, tonifies deficiency, and warms the diaphragm, is indicated. The vomiting in the previous article and dry heaving in this one both originate from the epigastrium; chest fullness and spitting saliva both relate to the diaphragm outside the epigastrium, hence the same formula. The text appears in the Jueyin chapter of Shanghan Lun, lacking the headache symptom. In Shanghan Lun, it refers to Jueyin cold-heat pathogens passing through Shaoyang to the chest/diaphragm (deep root); here, it refers solely to Diaphragm cold and Lung rebellion (shallow root). Li's old commentary mistakenly identified Wu Zhu Yu as exclusive to Jueyin because it treats Jueyin Cold Damage, forcing this vomiting into Jueyin syndrome, which is incorrect. This formula warms and tonifies the Upper and Middle Jiaos and descends rebellion; it is not a specific Jueyin drug. Its mechanism for treating Jueyin cold rebellion is that Middle Jiao deficiency-cold fails to control downward, allowing Liver Wood pathogens to invade like distant barbarians attacking the capital. The formula acts as a righteous army to protect the center. For this article, however, it treats Diaphragm deficiency and Stomach cold like famine relief in border regions—local warming and tonification. Zhongjing explicitly stated: "Food desired to be vomited belongs to Yangming; Wu Zhu Yu Tang treats it." This clarifies the formula's intent.
Article 12: Vomiting with borborygmus (intestinal rumbling) and epigastric stuffiness (Pi) is treated with Ban Xia Xie Xin Tang.
Ban Xia Xie Xin Tang Formula: Ban Xia (Pinellia Tuber, half sheng, washed), Ren Shen (Ginseng Root), Gan Jiang (Dried Ginger), Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome) (each 3 liang), Huang Lian (1 liang), Gan Cao (Licorice Root, roasted, 2 liang), Da Zao (Jujube, 12 pieces).
Boil the seven ingredients in 1 dou of water to obtain 6 sheng, remove dregs, boil again to obtain 3 sheng. Take 1 sheng warmed, three times daily.
This treats vomiting caused by Pi (stuffiness) due to Stomach deficiency-cold and floating heat in the intestines. The intestine is the lower outlet of the Stomach; the epigastrium is the upper part of the Stomach. If Diaphragm Qi is abundant, Stomach transformation is warm, regulating the middle and lower parts. Vomiting with borborygmus indicates wandering Qi in the intestines; epigastric Pi indicates intestinal Qi reversing upward due to upper deficiency. Vomiting arises from Pi, Pi from borborygmus, and borborygmus from Diaphragm deficiency/Stomach cold absorbing floating heat. Ban Xia (descending/rebellious) is sovereign to treat vomiting from upper Pi. Ren Shen (tonifying Qi) assists Diaphragm deficiency. Gan Jiang (warming Stomach) assists Stomach cold. Huang Qin and Huang Lian (bitter-cold) assist in clearing floating heat. Gan Cao and Da Zao support and float the herbs, allowing them to descend slowly from the chest/diaphragm, opening Pi and stopping vomiting. Unlike Articles 4-5 which treat fundamental Diaphragm-Stomach deficiency-cold, this article focuses on Pi with concurrent deficiency-cold.
Article 13: Dry heaving with diarrhea is treated with Huang Qin Jia Ban Xia Sheng Jiang Tang.
Huang Qin Jia Ban Xia Sheng Jiang Tang Formula: Huang Qin (Scutellaria Root, 3 liang), Ban Xia (Pinellia Tuber, half sheng), Sheng Jiang (Fresh Ginger, 3 liang), Shao Yao (Peony Root, 2 liang), Gan Cao (Licorice Root, roasted, 2 liang), Da Zao (Jujube, 12 pieces).
Boil the six ingredients in 1 dou of water to obtain 3 sheng, remove dregs. Take 1 sheng warmed, twice daily and once at night.
This involves Upper Jiao deficiency-cold and Lower Jiao accumulated heat, similar to the previous article. In the previous article, heat combines with deficiency above, causing Pi and isolated vomiting. Here, Lower heat does not combine with Upper deficiency but rushes downward, causing cold-induced vomiting and heat-induced diarrhea. Huang Qin (bitter-cold, rooting) clears Lower Jiao heat. Combined with Shao Yao (sour-astringent) and Gan Cao (sweet-slowing), it enters Liver/Spleen to drain heat, calming urgency and stopping diarrhea. Ginger and Ban Xia warm the Stomach and descend rebellion; Da Zao keeps the warming/descending action in the diaphragm, calming cold rebellion and stopping vomiting.
Article 14: Various types of vomiting where food cannot go down are treated with Xiao Ban Xia Tang. (Formula seen in Phlegm-Fluids section.)
"Ou Tu" should not be viewed lightly; emphasis is on "Ou" as this article addresses vomiting patterns. It implies severe vomiting leading to spitting up. When vomiting prevents food intake, cold rebellion is severe. Sheng Jiang (pungent-warm) disperses cold (root of treating vomiting); Ban Xia (pungent-astringent) descends rebellion (branch of treating vomiting). Thus, Xiao Ban Xia Tang is suitable.
Article 15: Vomiting with pathology in the upper diaphragm, followed by desire for water, indicates resolution. Give water immediately. Desire for water after vomiting is treated with Zhu Ling San.
Zhu Ling San Formula: Zhu Ling (Polyporus), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) (equal parts).
Grind the three ingredients into powder. Take one cun bi (measure) with water, three times daily.
Similar to Article 14, this is vomiting due to severe "Ou." Pathology in the upper diaphragm refers to Diaphragm Qi deficiency-cold from Article 1. Thirst after vomiting indicates resolution because vomiting lifts Qi to fill deficiency and lifts Fire to dispel cold, restoring Chest Yang. Water should be given promptly to aid downward transport via fluid, calming upward rebellion and truly resolving vomiting. "Give immediately" has two reasons: 1) Vomiting depletes fluids; delaying water risks irritability and restlessness. 2) Newly recovered Yang may fail if thirst is not addressed promptly, leading to dryness and hidden Yang. However, post-illness drinking might cause fluid retention; thus, Zhu Ling San (promoting urination and strengthening Earth) is essential.
Article 16: Vomiting with a weak pulse, free urination, slight fever, and cold extremities is difficult to treat. Use Si Ni Tang.
Si Ni Tang Formula: Fu Zi (Aconite Root, raw, 1 piece), Gan Jiang (Dried Ginger, 1.5 liang), Gan Cao (Licorice Root, roasted, 2 liang).
Boil the three ingredients in 3 sheng of water to obtain 1.2 sheng, remove dregs. Divide into two warm doses. Strong individuals may use 1 large Fu Zi and 3 liang Gan Jiang.
Vomiting can be deficiency-cold or fluid-retention. A strong pulse reflects Yangming Jing-Han (vigorous Qi); a weak pulse indicates lack of vigorous Stomach Qi. Free urination rules out fluid retention, confirming deficiency-cold vomiting. Slight fever with cold extremities indicates severe Stomach deficiency-cold with floating Yang escaping outward. Warming restores Stomach Yang (life); failure results in death. Hence "difficult to treat." Si Ni Tang uses raw Fu Zi and Gan Jiang (pungent-hot) supported by Gan Cao (central-stabilizing) to warm Stomach Yang and sustain remaining light. In Shanghan Lun, this treats Jueyin cold rebellion attacking Stomach Yang, using pungent herbs to overcome Wood pathogens. Here, it treats Yangming constitutional cold with pungent-sweet-warm herbs. The difference lies in distinguishing Liver vs. Stomach responsibility in weak-pulse vomiting.
Article 17: Vomiting with fever is treated with Xiao Chai Hu Tang.
Xiao Chai Hu Tang Formula