胃气虚寒 素有内寒之人。复感寒邪。当温中散寒。若大发其汗。胃中谷气化汗
外达。则胃气转馁。蛔失谷气以养。则不安而上逆。仲景云。病患有寒。复发汗。胃中
冷。必吐蛔。是也。故凡伤寒吐蛔。虽有大热。忌用寒凉。乃大凶之兆。急用理中汤去甘草。加椒梅主之。
盖蛔闻甘而起。遇酸而伏。见苦则安也。蛔吐不止者死。吐蛔不能食者亦死。（以上述古）
邵评∶中阳虚而受寒。宜温中散寒为治。反大汗之。则胃阳益伤。不能化谷气以养蛔。则蛔
上逆。而从口出也。盖阳虚而有寒邪。复发汗以伤其阳。则胃阳虚而胃中冷。故用椒梅理中汤法温之。
肝邪犯胃 按吐蛔。仲景列于厥阴篇内。则为肝邪犯胃可知。凡伤寒如见寒热。
干呕。心胸格拒。或吐痰涎浊沫。或吐酸苦黄绿之水。或吐蛔下蛔。皆属厥阴乘犯
阳明。治宜泄肝和胃。如川连、桂枝、乌梅、川椒、（炒黑）生白芍、淡吴萸、（盐水炒）黄芩、茯苓
之类。如泄肝和胃不效。乃胃中虚空若谷。客气逆犯上冲。须镇逆安胃。宜人参、
茯苓、半夏、代赭石、炒川椒、乌梅肉、川楝子之类。
邵评∶厥阴属肝木。为至阴之经。阴极则阳生。木中有相火。凡病邪传入厥阴。深沉之至邪。每
挟木火内燔。势必顺阳明而犯胃。伤耗阴津胃液。而见症如此。治宜泄厥阴以安阳明为法。
邪陷厥阴 伤寒暑湿温热之邪。上阻气分。则身热耳聋。入于营分。则舌绛神昏。
治法当清解心营肺卫。如连翘、淡竹叶、滑石粉、川贝母、天竺黄、鲜菖蒲、炒竹茹、绿
豆皮之类。以清上焦。若身热不解。口渴胸痞。耳聋干呕。吐蛔拒纳。此暑湿内蒸。其
邪渐结厥阴之界。乃险症也。宜川连、半夏、枳实、菖蒲、茯苓、黄芩、干姜。苦辛以开内结。
邵评∶温热暑湿之邪。从口鼻吸受。始在上焦气分。或渐入营。与伤寒见症不同。
治法亦异。当宗河间三焦立法。分心营肺卫论治。上焦之邪不解。蔓延中下而
入里。可以治同伤寒。故治温暑与伤寒。始异而终同也。惟药味宜轻清。宣泄上焦。涤痰化热。
邪结气分 如吐蛔与饮。脘闷口渴。舌苔白中带黄。此湿热结于气分。胃中不和而蛔
逆也。宜二陈加干姜、川连。（以上参叶案）
邵评∶此痰饮挟湿热。结于阳明气分。胃热气逆。而蛔上出。胃有痰热。则舌苔白
中带黄。邪内结。则脘闷。用二陈以化痰。姜连以开痞达邪。
胃气虚寒：平素体内有寒的人，又感受了寒邪。应当用温中散寒的方法治疗。如果大发其汗，胃中的水谷之气化为汗液向外发散，那么胃气就会更加虚弱。蛔虫失去水谷之气的滋养，就会不安分而向上逆乱。张仲景说：“病人本有寒证，又误用发汗法，导致胃中寒冷，必定会吐出蛔虫。”正是这种情况。所以凡是伤寒病出现吐蛔症状的，即使有大热，也忌讳使用寒凉药物，这是非常凶险的征兆。应立即使用理中汤去掉甘草，加花椒、乌梅来主治。因为蛔虫闻到甜味就会活动，遇到酸味就会伏下，见到苦味就会安静。如果吐蛔不止的会死，吐蛔且不能进食的也会死。（以上为引述古人的论述）
邵评：中焦阳气虚弱而受寒邪侵袭，适宜用温中散寒的方法治疗。反而用大汗法，则胃阳更加受损，不能化生水谷之气来滋养蛔虫，蛔虫就会上逆而从口中吐出。大概是因为阳气虚弱而有寒邪，又误用发汗法损伤阳气，导致胃阳虚而胃中寒冷，所以用花椒、乌梅配合理中汤的方法来温补。
肝邪犯胃：按吐蛔这一症状，张仲景将其列在厥阴篇内，可知这是肝邪侵犯胃腑所致。凡是伤寒病如果出现恶寒发热、干呕、心胸部位格拒不适，或者吐出痰涎浊沫，或者吐出酸、苦、黄、绿色的液体，或者吐出蛔虫、排出蛔虫，都属于厥阴肝木乘犯阳明胃土。治疗应当疏泄肝邪、调和胃气，如使用黄连、桂枝、乌梅、川椒（炒黑）、生白芍、淡吴茱萸（盐水炒）、黄芩、茯苓之类的药物。如果疏肝和胃无效，则是胃中空虚如同空谷，客气逆乱上冲，必须镇逆安胃，适宜用人参、茯苓、半夏、代赭石、炒川椒、乌梅肉、川楝子之类的药物。
邵评：厥阴经属于肝木，是至阴之经。阴极则阳生，木中藏有相火。凡是病邪传入厥阴，这是深沉至极的病邪，常常挟带木火在内焚烧，势必顺着阳明经侵犯胃腑，耗伤阴津和胃液，从而出现上述症状。治疗应当以疏泄厥阴、安抚阳明为法则。
邪陷厥阴：伤寒、暑湿、温热等邪气，阻滞在上焦气分，则出现身热、耳聋；侵入营分，则出现舌质深红、神志昏迷。治疗方法应当清解心营和肺卫，如使用连翘、淡竹叶、滑石粉、川贝母、天竺黄、鲜石菖蒲、炒竹茹、绿豆皮之类的药物，以清解上焦。如果身热不退，口渴、胸中痞闷、耳聋、干呕、吐蛔、拒绝纳食，这是暑湿在内蒸腾，邪气逐渐结聚于厥阴的边缘，属于险症。适宜使用黄连、半夏、枳实、石菖蒲、茯苓、黄芩、干姜，用苦辛之法以开通内部结滞。
邵评：温热、暑湿等邪气，从口鼻吸入，起初在上焦气分，或者逐渐进入营分，这与伤寒的症状不同。治疗方法也不同。应当遵循刘河间三焦立法的宗旨，分别用心营、肺卫的理论来论治。上焦的邪气不解，蔓延到中下焦而入里，就可以按照治疗伤寒的方法处理。所以治疗温病、暑病与伤寒，开始不同但最终相同。只是药味应当轻清，宣泄上焦，涤除痰浊、化解热邪。
邪结气分：如出现吐蛔与饮水，脘腹闷胀、口渴，舌苔白中带黄，这是湿热结聚在气分，胃气不和而导致蛔虫上逆。适宜使用二陈汤加入干姜、黄连。（以上参考叶天士医案）
邵评：这是痰饮挟带湿热，结聚在阳明气分，胃热气逆，导致蛔虫上出。胃中有痰热，则舌苔白中带黄；邪气内结，则脘腹闷胀。用二陈汤来化痰，用干姜、黄连来开痞散结、透达邪气。
Stomach Qi Deficiency and Cold: Individuals who have chronic internal cold, upon contracting exogenous cold pathogens, should be treated with methods to warm the middle and dissipate cold. If heavy sweating is induced, the grain qi within the stomach transforms into sweat and escapes outward, causing the Stomach Qi to become further depleted. Ascaris lumbricoides (roundworms), deprived of nourishment from grain qi, become restless and rebel upward. Zhang Zhongjing stated, "If a patient has cold syndrome and sweating is erroneously induced, causing cold in the Stomach, vomiting of ascarids will inevitably occur." This is precisely such a case. Therefore, in any case of Taiyang disease presenting with vomiting of ascarids, even if there is significant heat, cold-natured herbs must be contraindicated; this is an ominous sign indicating severe danger. One should immediately administer Lizhong Tang (Cinnamon Twig and Atractylodes Decoction) by removing Gancao (Licorice Root) and adding Chuanjiao (Sichuan Pepper) and Wumei (Mume Fruit). This is because ascarids are aroused by sweetness, subdue themselves with sourness, and remain calm with bitterness. Death ensues if vomiting of ascarids persists without cessation, or if vomiting occurs alongside the inability to ingest food. (The above cites ancient texts.)
Shao's Commentary: When Middle Jiao Yang is deficient and cold pathogens invade, the treatment should be warming the middle and dissipating cold. Instead, inducing heavy sweating injures Stomach Yang further, preventing the transformation of grain qi to nourish ascarids, leading them to rebel upward and exit through the mouth. Generally, when Yang deficiency coexists with cold pathogens, erroneous sweating damages Yang, resulting in Stomach Yang deficiency and cold in the Stomach. Thus, one uses the method of Sichuan Pepper and Mume Fruit combined with Lizhong Tang to warm the interior.
Liver Pathogen Invading the Stomach: According to Zhang Zhongjing, vomiting of ascarids is listed in the Jueyin Chapter, indicating that this condition arises from Liver pathogenic factors invading the Stomach. In cases of Taiyang disease, if symptoms such as aversion to cold and fever, dry retching, oppression or rejection in the chest and epigastrium, vomiting of phlegm-saliva or turbid froth, vomiting of acidic, bitter, yellow, or green fluids, or vomiting/passing ascarids appear, these all belong to Jueyin Wood overacting on Yangming Earth. The treatment should involve purging the Liver and harmonizing the Stomach, using herbs such as Huanglian (Coptis Rhizome), Guizhi (Cinnamon Twig), Wumei (Mume Fruit), Chuanjiao (Sichuan Pepper, stir-fried until black), Sheng Baishao (Raw White Peony Root), Dan Wuzhuyu (Evodia Fruit, stir-fried with salt water), Huangqin (Scutellaria Root), and Fuling (Poria). If purging the Liver and harmonizing the Stomach proves ineffective, it indicates that the Stomach is empty like a valley, allowing rebellious Qi to rush upward. One must suppress rebellion and stabilize the Stomach, using herbs such as Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Banxia (Pinellia Tuber), Daizheshi (Ochre), Chuanjiao (Sichuan Pepper, stir-fried), Wumei Rou (Mume Fruit Flesh), and Chuanlianzi (Toosendan Fruit).
Shao's Commentary: The Jueyin channel belongs to Liver Wood and is the most Yin channel. When Yin reaches its extreme, Yang is born; within Wood resides Ministerial Fire. When pathogenic factors transmit to Jueyin, they represent deep-seated pathogens often carrying Wood-Fire that burns internally. These inevitably follow the Yangming channel to invade the Stomach, consuming Yin fluids and Stomach essence, resulting in the aforementioned symptoms. The treatment should focus on purging Jueyin to pacify Yangming.
Pathogens Trapped in Jueyin: When Taiyang, Summerheat-Dampness, or Warm-Heat pathogens obstruct the Qi level in the Upper Jiao, symptoms include fever and deafness. If they enter the Ying (Nutritive) level, symptoms include crimson tongue and mental confusion. The treatment method should clear and resolve the Heart Ying and Lung Wei, using herbs such as Lianqiao (Forsythia Fruit), Dan Zhuye (Lophatherum Leaf), Huashi (Talcum), Chuanbeimu (Fritillaria Bulb), Tianzhuhuang (Calamus Tuber), Xian Changpu (Fresh Acorus Rhizome), Chao Zhuru (Bamboo Shavings, stir-fried), and Ludoupi (Mung Bean Skin), to clear the Upper Jiao. If fever persists, accompanied by thirst, chest fullness, deafness, dry retching, vomiting of ascarids, and refusal to eat, this indicates internal steaming of Summerheat-Dampness, with pathogens gradually binding at the boundary of Jueyin. This is a critical condition. One should use Huanglian (Coptis Rhizome), Banxia (Pinellia Tuber), Zhishi (Immature Bitter Orange), Changpu (Acorus Rhizome), Fuling (Poria), Huangqin (Scutellaria Root), and Ganjiang (Dried Ginger), employing bitter and acrid methods to open internal binders.
Shao's Commentary: Warm-heat and Summerheat-Dampness pathogens are inhaled through the nose and mouth, initially affecting the Qi level of the Upper Jiao, or gradually entering the Ying level. This differs from Taiyang disease symptoms and requires different treatments. One should follow Liu Hejian’s San Jiao legislation, treating according to Heart Ying and Lung Wei theories. If Upper Jiao pathogens do not resolve, they spread to the Middle and Lower Jiao and enter the interior, at which point treatment can align with Taiyang disease protocols. Thus, the treatment of Warm diseases and Summerheat differs initially but converges ultimately. However, herbal ingredients should be light and pure to vent the Upper Jiao, eliminate phlegm, and transform heat.
Pathogens Binding in the Qi Level: Symptoms such as vomiting of ascarids while drinking, epigastric stuffiness, thirst, and a white tongue coating with yellow tinges indicate Damp-Heat binding in the Qi level, with disharmony in the Stomach causing ascarid rebellion. One should administer Erchen Tang (Two-Aged Phlegm Resolving Decoction) added with Ganjiang (Dried Ginger) and Huanglian (Coptis Rhizome). (Referencing Ye Tianshi’s medical cases.)
Shao's Commentary: This involves Phlegm-Fluids complicated by Damp-Heat binding in the Yangming Qi level. Stomach Heat causes Qi rebellion, leading to the expulsion of ascarids. Phlegm-Heat in the Stomach manifests as a white tongue coating with yellow tinges; internal pathogen binding causes epigastric stuffiness. Erchen Tang is used to resolve phlegm, while Ganjiang and Huanglian are used to open palpitations and expel pathogens.