毒火郁遏胃气伤。初热呕吐原无妨。欲吐不吐干霍乱。二者一见最难当。
麻症初起。呕吐亦属常候。而吐泻交作者顺。干霍乱者逆。欲吐不吐者危。夫麻症之有呕吐
者。皆因胃间火毒。不能发泄。而郁于内。致伤胃气而作也。初热而得呕吐之症。此毒未发出。药
宜疏托。以葛根解肌汤（见第五条）去赤芍、甘草。或葛根疏邪汤（见三十三条）主之。正出及正
收时。而见呕吐之症者。是毒未尽。药宜清凉解毒。少加疏散可也。以消毒饮（见二十二条）去甘
草。加枳壳、黄连治之。多痰者加栝蒌霜、贝母治之。收后而仍有呕吐者。乃是余毒留于胃脘所
致。脾胃虚而热滞也。宜用清凉脾胃之药。佐以分利之剂。用石斛清胃散去赤芍、甘草主之。取此
方中之陈皮、扁豆、藿香以止呕吐。若呕一止。而陈皮、藿香叶、扁豆又宜除之。不可过用。恐致燥
害。此症若不间以金石之品。全用轻浮之药。其呕难定。如呕吐不止者。以竹茹汤主之。如热甚呕
吐者。以解毒汤（见二十六条）去桔梗。加竹茹、枇杷叶主之。
朱曰 呕吐与泻。邪有向外之势。或清或散。成法俱在。均无足虑。惟欲吐不吐者危。
石斛清胃散 治麻后呕吐。胃虚不食。热滞。
石斛 茯苓 枳壳 丹皮 扁豆 藿香 陈皮 赤芍（各一钱） 甘草（五分） 生姜引。
竹茹汤
竹茹 陈皮 柿蒂 楂肉 水煎服。
Toxic fire stagnates, damaging the stomach qi. Vomiting at the initial heat stage of measles is originally not a major concern. However, "dry huoluan" (a condition characterized by the urge to vomit or defecate but inability to do so, accompanied by abdominal pain) and alternating vomiting and diarrhea are both difficult to manage upon sight.
At the initial onset of measles, vomiting is also a common manifestation. Among these, alternating vomiting and diarrhea indicates a favorable prognosis (shun); dry huoluan indicates an unfavorable prognosis (ni); and the sensation of wanting to vomit but being unable to do so indicates a critical condition (wei). The occurrence of vomiting in measles cases is generally due to toxic fire in the stomach that cannot be vented outward, instead stagnating internally and injuring the stomach qi.
When vomiting occurs during the initial heat stage, it indicates that the pathogenic factor has not yet been expelled; treatment should focus on dispersing and supporting the exterior. Use Gegen Jieji Tang (Gegen Muscle-Releasing Decoction) [see Article 5], removing Chishao (Radix Paeoniae Rubra) and Gancao (Radix Glycyrrhizae), or use Gegen Shuxie Tang (Gegen Pathogen-Dispersing Decoction) [see Article 33] as the principal formula.
During the active eruption and resolution phases of the rash, if vomiting occurs, it indicates that the toxic factor is not yet fully cleared. Treatment should employ cooling and detoxifying methods with slight dispersing agents. Use Xiaodu Yin (Detoxification Decoction) [see Article 22], removing Gancao (Radix Glycyrrhizae), and adding Zhike (Pericarpium Citri Reticulatae) and Huanglian (Rhizoma Coptidis). For patients with excessive phlegm, add Gualou Shuang (Pulp of Trichosanthis Fructus) and Beimu (Bulbus Fritillariae Cirrhosae).
If vomiting persists after the rash has resolved, it is caused by residual toxicity remaining in the stomach region, resulting in spleen and stomach deficiency with stagnant heat. Treatment should utilize herbs that cool the spleen and stomach, assisted by diuretic and draining agents. Use Shihu Qingwei San (Shihu Stomach-Cooling Powder), removing Chishao (Radix Paeoniae Rubra) and Gancao (Radix Glycyrrhizae). Extract Chenpi (Pericarpium Citri Reticulatae), Bidou (Semen Dolichoris Lablabis), and Huoxiang (Herba Pogostemonis) from this formula to stop vomiting. Once vomiting ceases, Chenpi (Pericarpium Citri Reticulatae), Huoxiang Ye (Folium Pogostemonis), and Bidou (Semen Dolichoris Lablabis) should be removed; they must not be overused, lest they cause damage through dryness. If this condition does not incorporate mineral substances and relies entirely on light, floating, ascending herbs, the vomiting will be difficult to stabilize. If vomiting continues unabated, treat with Zhuru Tang (Bamboo Shavings Decoction). If vomiting is severe due to intense heat, use Jiedu Tang (Detoxification Decoction) [see Article 26], removing Jiegeng (Radix Platycodonis), and adding Zhuru (Caulis Bambusae in Taenia) and Pipaye (Folium Eriobotryae).
Zhu stated: Vomiting and diarrhea indicate that the pathogenic factor has a tendency to move outward. Whether clearing heat or dispersing pathogens, established methods exist, and there is little cause for concern. Only the condition of "wanting to vomit but unable to do so" is critical.
Shihu Qingwei San (Shihu Stomach-Cooling Powder): Treats vomiting after measles, stomach deficiency with loss of appetite, and stagnant heat.
Ingredients: Shihu (Rhizoma Dendrobii), Fuling (Poria), Zhike (Pericarpium Citri Reticulatae), Danpi (Cortex Moutan), Bidou (Semen Dolichoris Lablabis), Huoxiang (Herba Pogostemonis), Chenpi (Pericarpium Citri Reticulatae), Chishao (Radix Paeoniae Rubra) (each 1 qian), Gancao (Radix Glycyrrhizae) (0.5 qian), with Shengjiang (Rhizoma Zingiberis Recens) as a guide.
Zhuru Tang (Bamboo Shavings Decoction):
Ingredients: Zhuru (Caulis Bambusae in Taenia), Chenpi (Pericarpium Citri Reticulatae), Shidi (Calamus Diospyros), Zharon (Sarcotesta Litchi Chinensis), decocted in water and taken orally.