分气血多少而治。胃中有热有痰。胃中有热,膈上有痰,用二陈汤加姜汁炒山栀、黄连、生姜煎服。久病呕吐
者,胃虚不纳谷也。生姜、人参、黄 、白术、香附。注船呕吐大渴,饮水即死,童便好。呕吐若脾胃虚损之人,
或非夏月见者,服理中汤。见其虚甚,庶可用之,亦宜冷与之饮,以顺其性。痰饮为患,或呕或吐恶心,或头眩,或
中脘不快,或发寒热,或食生冷,脾胃不和,二陈汤加丁香、乌梅、生姜七片,痞痛加草豆蔻。胃气虚弱,不能饮食
呕吐,藿香安胃散,藿香、丁香、人参、陈皮、生姜同煎。
肝火出胃,逆上呕吐,抑青丸。痰热呕吐,气盛者,导痰汤加缩砂、姜连、竹茹。痰呕吐不止,陈皮、半夏、姜
汁。夏月呕吐不止,五苓散加姜汁。呕吐煎药,忌栝蒌仁、杏仁、桃仁、莱菔子、山栀,皆要作吐。如药中带香
药,行散不妨。泄泻或呕吐者,生姜汁汤调益元散。一人早呕酒,以栝蒌、贝母、山栀(炒)、石膏( )、香附、
南星、姜制神曲、炒山楂子(各一两)、枳实(炒)、姜黄、莱菔子(蒸)、连翘、石碱(各半两)、升麻(二钱
半) 上末之,姜汁炊饼丸。一人饥饱劳役成呕吐病,时作时止,吐清水,大便或秘或溏,腹痛上攻心背,脉弦∶
白术(一两半) 山栀(一两用茱萸二钱炒,去茱萸不用) 黄连(一两用茱萸二钱炒,去茱萸不用) 神曲 麦
芽桃仁(各一两去皮,用巴豆二十粒炒,去巴豆不用) 姜黄 杏仁(各一两去皮,用巴豆二十粒炒,去
巴豆不用) 蓬术(一两用巴豆二十粒炒,去巴豆不用) 香附(一两) 三棱(一两用巴豆二十粒炒,去巴豆不
用) 白豆蔻 砂仁 木香 莱菔子 陈皮(以上各五钱) 南星(一两姜制) 山楂(一两) 大黄(一两蒸) 青
皮(五钱) 上末之,姜汁饮饼丸,每服二三十丸。朱奉议以半夏、橘皮、生姜为主。孙真人误以哕为咳逆。凡病患
欲吐者,切不可下逆故也。刘河间谓呕者,火气炎上,此特一端耳。有痰隔中焦,食不得下者;又有气逆者;又有寒
气郁于胃中者;又有食滞心肺之分,不得下而反出者;然胃中有火与痰而致呕吐者多;又有久病呕者,此胃虚不纳谷
也。生姜、人参、黄 、白术、香附之类。
根据患者气血的盛衰情况来制定治疗方案。如果胃中有热邪且有痰湿,或者膈间有痰、胃中有热,使用二陈汤(燥湿化痰、理气和中的基础方),加入用姜汁炒过的山栀(栀子)、黄连,以及生姜一起煎煮服用。对于久病呕吐的患者,是因为胃气虚弱无法受纳食物,可用生姜、人参、黄芪、白术、香附治疗。
如果是晕船引起的呕吐且极度口渴,喝水就会死亡,童便(童子尿)是良药。如果是脾胃虚损的人出现呕吐,或者非夏季出现的呕吐,可以服用理中汤(温中散寒、补气健脾)。只有在看到患者虚损非常严重时才可以使用此法,并且应该让药液冷却后饮用,以顺应其虚热的本性。
如果是痰饮为患,表现为或呕或吐、恶心,或者头晕目眩,或者中脘部不适,或者出现寒热往来,或者是吃了生冷食物导致脾胃不和,使用二陈汤加丁香、乌梅、生姜七片;如果有痞块疼痛,加草豆蔻。
如果是胃气虚弱,不能进食并伴有呕吐,使用藿香安胃散,由藿香、丁香、人参、陈皮、生姜共同煎煮。
如果是肝火犯胃,气逆上冲导致呕吐,使用抑青丸。如果是痰热呕吐且气盛者,使用导痰汤(祛痰剂)加缩砂(砂仁)、姜制黄连、竹茹。如果是痰多呕吐不止,使用陈皮、半夏、姜汁。夏季呕吐不止,使用五苓散(利水渗湿剂)加姜汁。
煎煮治疗呕吐的药时,忌用栝蒌仁、杏仁、桃仁、莱菔子、山栀,因为这些药物都有催吐的作用。如果药方中含有香药,具有行散作用,则不妨碍。
如果是泄泻或呕吐,可以用生姜汁调服益元散(滑石、甘草、朱砂)。
有一个案例:一个人早晨饮酒后呕吐,用栝蒌、贝母、山栀(炒)、石膏(煅)、香附、南星、姜制神曲、炒山楂子(各一两)、枳实(炒)、姜黄、莱菔子(蒸)、连翘、石碱(各半两)、升麻(二钱半)研成细末,用姜汁和面做成丸剂。
另有一人因饥饱不均、劳累过度而患上呕吐病,症状时发时止,吐出清水,大便有时便秘有时溏薄,腹痛向上攻冲心背,脉象弦。处方为:白术(一两半)、山栀(一两,用吴茱萸二钱炒,去吴茱萸不用)、黄连(一两,用吴茱萸二钱炒,去吴茱萸不用)、神曲、麦芽、桃仁(各一两,去皮,用巴豆二十粒炒,去巴豆不用)、姜黄、杏仁(各一两,去皮,用巴豆二十粒炒,去巴豆不用)、蓬术(莪术,一两,用巴豆二十粒炒,去巴豆不用)、香附(一两)、三棱(一两,用巴豆二十粒炒,去巴豆不用)、白豆蔻、砂仁、木香、莱菔子、陈皮(以上各五钱)、南星(一两,姜制)、山楂(一两)、大黄(一两,蒸)、青皮(五钱)。研成细末,用姜汁和面做成丸剂,每次服用二三十丸。
朱奉议认为治疗应以半夏、橘皮、生姜为主。孙真人错误地将“哕”(呃逆)当作“咳逆”(咳嗽气喘)。凡是病人想要呕吐的,切不可使用泻下法,因为这是为了排出病邪的缘故。刘河间说呕吐是火气炎上所致,这只是一方面的原因罢了。有的因为痰阻中焦,食物无法下行;有的因为气机逆乱;有的因为寒气郁结在胃中;有的因为食滞在心肺之间,不能下行反而上出;然而大多数呕吐是由胃中有火和痰引起的;还有久病呕吐的,这是因为胃虚不能受纳食物,可用生姜、人参、黄芪、白术、香附之类药物治疗。
Treatment should be determined based on the abundance or deficiency of Qi and Blood. If there is heat in the Stomach accompanied by phlegm-dampness, or if there is phlegm above the Diaphragm and heat in the Stomach, use Erchen Tang (Two-Cured Decoction) with Gardeniae Fructus (Shanzhi, 山栀) stir-fried with Ginger Juice, Coptidis Rhizoma (Huanglian, 黄连), and fresh Ginger slices, decocted and taken orally. For patients suffering from chronic vomiting due to prolonged illness, it indicates that the Stomach Qi is deficient and unable to receive food; treat with Zingiberis Rhizoma Recens (Shengjiang, 生姜), Ginseng Radix et Rhizoma (Renshen, 人参), Astragali Radix (Huangqi, 黄芪), Atractodis Rhizoma (Baizhu, 白术), and Cyperi Rhizoma (Xiangfu, 香附).
For motion sickness-induced vomiting accompanied by extreme thirst, where drinking water leads to death, Tongbian (Child's Urine) is an effective remedy. For vomiting occurring in individuals with Spleen-Stomach deficiency and damage, or vomiting not occurring in summer months, Lizhong Tang (Regulate the Middle Decoction) may be administered. This method should only be employed when severe deficiency is evident, and the decoction should be allowed to cool before ingestion to accommodate the patient's nature.
When disorders arise from Phlegm-Fluids, manifesting as vomiting, nausea, dizziness, discomfort in the epigastrium, alternating chills and fever, or spleen-stomach disharmony after consuming raw or cold foods, use Erchen Tang (Two-Cured Decoction) with Tsaoko Fructus Cardamomi (Dingxiang, 丁香 - *Note: Dingxiang usually refers to Eugenius, here likely referring to a specific preparation or context, but standardly Clove*), Mume Fructus (Wumei, 乌梅), and seven slices of fresh Ginger; if palpable masses or pain are present, add Alpiniae Katsumadai Semen (Caodoukou, 草豆蔻).
If Stomach Qi is weak, leading to inability to eat and vomiting, Huoxiang Anwei San (Agastache Powder to Stabilize the Stomach) is used, composed of Agastaches Herba (Huoxiang, 藿香), Eugenii Flos (Dingxiang, 丁香), Ginseng Radix et Rhizoma (Renshen, 人参), Citri Reticulatae Pericarpium (Chenpi, 陈皮), and fresh Ginger, decocted together.
If Liver Fire invades the Stomach, causing rebellious Qi and vomiting, Yiqing Wan (Suppress Blue Pill) is indicated. For vomiting due to Phlegm-Heat with excessive Qi activity, Daotan Tang (Guide Out Phlegm Decoction) is used with Amomi Fructus Rotundus (Suosha, 缩砂), Coptidis Rhizoma stir-fried with Ginger (Jianglian, 姜连), and Bambusae Mesocarpus (Zhuru, 竹茹). For persistent vomiting due to phlegm, use Citri Reticulatae Pericarpium (Chenpi, 陈皮), Pinelliae Rhizoma Preparatum (Banxia, 半夏), and Ginger Juice. For continuous vomiting in summer, Wuling San (Five-Ingredient Powder with Poria) with Ginger Juice is prescribed.
When preparing decoctions for vomiting, avoid Trichosanthis Semen (Gualouren, 栝蒌仁), Armeniacae Semen Amarum (Xingren, 杏仁), Persicae Semen (Taoren, 桃仁), Raphani Semen (Laifuzi, 莱菔子), and Gardeniae Fructus (Shanzhi, 山栀), as these tend to induce vomiting. However, aromatic herbs that promote circulation and dispersion are permissible.
For diarrhea or vomiting, Yiyuan San (Benefit Origin Powder) can be mixed with Ginger Juice and water.
Case 1: A patient vomited after morning wine consumption. Prescription: Trichosanthis Fructus (Gualou, 栝蒌), Fritillariae Bulbus (Beimu, 贝母), Gardeniae Fructus (Shanzhi, 山栀, stir-fried), Gypsum Fibrosum (Shigao, 石膏, calcined), Cyperi Rhizoma (Xiangfu, 香附), Pinelliae Rhizoma (Nanxing, 南星), Massae Fermentatae Medicinalis Preparated with Ginger (Jiangzhi Shenqu, 姜制神曲), Crataegi Fructus Stir-fried (Chaohuaizi, 炒山楂子) (each 1 liang), Zizyphi Fructus Stir-fried (Zhishi, 枳实, stir-fried), Curcumae Longae Rhizoma (Jianghuang, 姜黄), Raphani Semen Steamed (Laifuzi, 莱菔子, steamed), Forsythiae Fructus (Lianqiao, 连翘), Natron (Shijian, 石碱) (each 0.5 liang), Cimicifugae Rhizoma (Shengma, 升麻) (2.5 qian). Grind into powder, form pills with Ginger Juice and steamed dough.
Case 2: A patient developed vomiting due to irregular diet and overexertion, characterized by intermittent episodes, vomiting clear fluid, alternating constipation and loose stools, abdominal pain radiating to the heart and back, and a wiry pulse. Prescription: Atractodis Rhizoma (Baizhu, 白术) (1.5 liang), Gardeniae Fructus (Shanzhi, 山栀) (1 liang, stir-fried with 2 qian of Evodiae Fructus, discard Evodiae), Coptidis Rhizoma (Huanglian, 黄连) (1 liang, stir-fried with 2 qian of Evodiae Fructus, discard Evodiae), Massae Fermentatae Medicinalis (Shenqu, 神曲), Saccharomyces (Maiya, 麦芽), Persicae Semen (Taoren, 桃仁) (each 1 liang, peeled, stir-fried with 20 seeds of Ephedrae Semen? No, Baodou Dou/Brassicae Semen? Text says Baodou, likely Brassicae Semis Mustardae or similar emetic/purgative seed, discard after frying), Curcumae Longae Rhizoma (Jianghuang, 姜黄), Armeniacae Semen Amarum (Xingren, 杏仁) (each 1 liang, peeled, stir-fried with 20 Baodou, discard), Curcuma Zedoariae Rhizoma (Pengzhu, 蓬术) (1 liang, stir-fried with 20 Baodou, discard), Cyperi Rhizoma (Xiangfu, 香附) (1 liang), Sparganii Rhizoma (Sanleng, 三棱) (1 liang, stir-fried with 20 Baodou, discard), Amomi Fructus Rotundus (Baidoukou, 白豆蔻), Amomi Fructus (Sharen, 砂仁), Aquilariae Lignum Resinatum (Muxiang, 木香), Raphani Semen (Laifuzi, 莱菔子), Citri Reticulatae Pericarpium (Chenpi, 陈皮) (each 5 qian), Pinelliae Rhizoma Preparated with Ginger (Nanxing, 南星) (1 liang), Crataegi Fructus (Shanzha, 山楂) (1 liang), Rheoi Radix et Rhizoma (Dahuang, 大黄) (1 liang, steamed), Aurantii Fructus Immaturus (Qingpi, 青皮) (5 qian). Grind into powder, form pills with Ginger Juice and dough, take 20-30 pills per dose.
Zhu Fengyi advocated using Pinelliae Rhizoma Preparatum (Banxia, 半夏), Citri Reticulatae Pericarpium (Jupi, 橘皮), and fresh Ginger (Shengjiang, 生姜) as the main components. Sun Simiao mistakenly identified Hiccups (Yue, 哕) as Coughing and Wheezing (Keni, 咳逆). In cases where a patient desires to vomit, purgatives must strictly be avoided, as vomiting serves to expel pathogenic factors. Liu Wansu stated that vomiting is caused by the flaming upward of Fire Qi; however, this is only one aspect. Other causes include: Phlegm obstructing the Middle Jiao preventing food descent; Rebellious Qi; Cold Qi stagnating in the Stomach; Food stagnation between the Heart and Lungs preventing descent and causing reverse expulsion. Nevertheless, most vomiting results from Fire and Phlegm in the Stomach. Chronic vomiting is due to Stomach deficiency failing to receive food, treated with Zingiberis Rhizoma Recens (Shengjiang, 生姜), Ginseng Radix et Rhizoma (Renshen, 人参), Astragali Radix (Huangqi, 黄芪), Atractodis Rhizoma (Baizhu, 白术), and Cyperi Rhizoma (Xiangfu, 香附).