大热发渴引饮皆曰阳证欲饮之水予反与姜附等药紧脉反沉细阳犹未生以桂附姜乌之类酒丸与百丸接之二日中十余服病
人身热烦躁不宁欲作汗也又以前丸接之覆以浓衣阳脉方出而作大汗翌日大小便始通下瘀血一盆如猪肝然用胃风汤加桂
附三服血止其寒甚如此亦世所未见也
少阴证口燥舌干而渴尺寸脉俱沉沉迟则四逆汤沉疾则大承气汤 少阴口燥舌干而渴身表凉脉沉细而虚者泻心汤主
之此有形无形药也
人参汤 治伤寒七八日汗后心烦燥渴
人参 黄芩 柴胡 葛根（各一两） 山栀 甘草（炙各半两）上为粗末每服五钱姜枣煎温服
活 阳毒倍常燥盛大渴者黑奴丸主之（方见阳毒）风温如渴甚者宜栝蒌汤（方见风温）中暑伏热屡治不瘥其人发渴
不已酒蒸黄连丸主之（方见中暑）
脉 热病在肾令人渴口干舌焦黄赤昼夜欲饮水不止腹大而胀尚不厌饮目无精光者死不治
（干呕欲升）
成 呕者声物兼出也俗谓之 非也夫 与哕盖字异而音义俱同吐者但吐出其物而无声故有干呕而无干吐呕有责为
热者责为寒者至于吐家则悉言虚冷也呕又有停饮者有胃脘有脓者皆当明辨之呕而发热者柴胡汤详具与其呕不止心下急
郁郁微烦大柴胡汤主之者是邪热为呕也膈上有寒饮干呕者不可吐也当温之与其干呕吐涎沫头痛者吴茱萸汤主之是寒邪
为呕也先呕后渴者此为欲解先渴后呕者为水停心下此属饮家是停饮呕者呕家有痈脓不须治脓尽自愈是胃脘有脓而呕也
诸如此者虽有殊别大抵伤寒表邪欲传里里气上逆则为呕也是以半表半里证多云呕也伤寒三日三阳为尽三阴当受邪其人
反能食而不呕此为三阴不受邪是知邪气传里者必致呕也至于干姜附子汤证云不呕不渴为里无热十枣汤证云干呕短气汗
出不恶寒者此表解里未和也即此视之其呕为里热明矣呕家之为病气逆者必散之痰饮者必下之千金曰呕家多服生姜此是
呕家圣药是要散其逆气也金匮要略曰呕家用半夏以去其水水去呕则止是要下其痰饮也呕多虽有阳明证不可攻也谓其气
逆而未收敛为实也其呕而脉弱小便复利身有微热见厥者已为难治盖谓其虚寒之甚也医者必审其邪气之虚实疾证之逆顺
为施药剂治则当矣
太阳 病（汗）或已发热未发热必恶寒体痛呕逆脉阴阳俱紧者名曰伤寒麻黄汤 太阳病过经十余日反二三下之后四
五日柴胡证仍在者先与小柴胡汤呕不止心下急郁郁微烦者为未解也与大柴胡汤下之则愈（按仲景虽曰呕家虽有阳明证不
可攻攻之为逆然阳明伏热熏蒸清道而呕且烦者非以苦寒直折之不可也故用大柴胡下之）伤寒发热汗出不解心下痞硬呕吐
而下利者大柴胡 太阳病过经十余日心下温温欲吐而胸中痛大便反溏腹微满郁郁微烦先此时自极吐下者与调胃承气汤
若不尔者不可与但欲呕胸中痛微溏者此非柴胡证以呕故知极吐下也（成 心下温温欲吐郁郁微烦胸中痛当责邪热客于胸
中大便反溏腹微满则邪热已下于胃也日数虽多若不经吐下止是传邪亦未可下当与柴胡汤以除上中二焦之邪若曾吐下伤
损胃气胃虚而邪乘虚入胃为实非柴胡汤所能去调胃承气汤下胃热以呕知胃气先曾伤动也 按经文温温当作 又以呕
下当有缺文盖呕家正为柴胡证也岂逸微溏字耶）呕而发热者（和）小柴胡汤主之 伤寒六七日发热微恶寒支节烦疼微呕
心下支结外证未去者柴胡加桂枝汤主之 太阳与阳明合病不下利但呕者葛根加半夏汤主之（活人云头疼身热痛肌热目疼
鼻干脉浮而长是也）
葛根半夏汤方
葛根 半夏（各二钱） 麻黄 生姜（各一钱半） 甘草 芍药 桂枝（各一钱） 大枣（十二枚擘） 上 咀以
水一斗先煎麻黄葛根减二升去白沫纳诸药煎取三升温服一升覆取微汗
阳明 伤寒发热无汗呕不能食而反汗出 然者是转属阳明也（大柴胡汤）食谷欲呕者属阳明也吴茱萸汤主之得汤
反剧者属上焦也（葛根半夏汤）伤寒（和）呕多虽有阳明证不可攻之黄芩生姜半夏汤小柴胡汤（活人用桔梗汤）阳明病
胁下硬满不大便而呕舌上白苔者可与小柴胡汤 阳明病（温）反无汗而小便利二三日呕而咳手足厥者必苦头痛（或用真
武汤去茯苓）
少阳 呕而往来寒热胸胁苦满者宜小柴胡若兼下利者乃太阳少阳合病宜黄芩加半夏生姜汤（论见往来寒热及下利太
阳阳明合病自下利为在表当与葛根汤发汗阳明少阳合病自下利者为在里可与承气汤下之此太阳少阳合病自下利为在半
表半里非汗下所宜故与黄芩汤以和解之呕者胃气逆也故加半夏生姜以散逆气）伤寒五六日呕而发热者柴胡汤证具而以他
药下之柴胡证仍在者复与柴胡汤 血弱气尽腠理开邪气因入与正气相搏结于胁下正邪分争往来寒热休作有时默默不欲
饮食脏腑相连其痛必下邪高痛下故使呕也小柴胡汤主之（邪气外甚阳不主里里气不和气下而不上者但下利而不呕里气上
逆而不下者但呕而不下利也与小柴胡汤以解半表半里之邪）渴而饮水呕者柴胡不中与也（活人云宜治膈间水赤茯苓汤主
之方见后）
太阴 太阴之为病腹满而吐食不下自利益甚时腹自痛若下之必胸下结硬
少阴 病下利六七日咳而呕渴心烦不得眠者猪苓汤主之 少阴病下利脉微涩呕而汗出必数更衣反少者当温其上灸
之少阴病二三日不已至四五日腹痛小便不利四肢沉重疼痛自下利者此为有水气其人或咳或小便利或下利或呕者真武
汤去附子加生姜
厥阴 伤寒热少厥微指头寒默默不欲食烦躁数日小便利色白者此热除也欲得食其病为愈若厥而呕胸胁烦满者其后
必便血黄芩芍药汤抵当汤 呕而脉弱小便复利身有微热见厥者难治四逆汤 伤寒本自寒下医复吐下之寒格更逆吐下若
食入口即吐干姜黄连黄芩人参汤（伤寒邪自传表为本自寒下医反吐下损伤正气寒气内为格拒经曰格则吐逆食入口即吐谓
之寒格更复吐下则重虚而死是更逆吐下与干姜黄芩人参汤以通寒格 赵 仲景之意以本因寒下医复吐下因成寒格吐证
经云格则吐逆若更复吐下治之为逆故用干姜以温里黄连黄芩反佐以取之人参补正气也今活人却言关脉迟故用此药何耶
虽然脉迟为胃中虚冷而吐者固也又有脉数为胃中虚冷而吐者仲景尝言之矣病患脉数数为客热当消谷引食而反吐者此以
发汗令阳气微膈气虚脉乃数也数为客热不能消谷以胃中虚冷故吐也今以其脉异证同故引此以为诊视之别）蛔厥者其人当
吐蛔今病者静而复时烦此为脏寒蛔上入膈故烦须臾复上得食而呕又烦者蛔闻食臭出其人当自吐蛔乌梅丸（详吐蛔）
渴 先渴却呕者为水停心下此属饮家（活人云赤茯苓汤主之）先呕却渴者此为欲解候也（金匮云呕思水者急与之）
下利 呕而下利有寒热者为阳宜黄芩汤大柴胡汤无热者为阴宜猪苓汤真武汤（并见吐利门）
烦 呕而心烦若汗吐下后者栀子生姜豉汤若未曾吐汗下后兼咳而渴者宜猪苓汤（详见不得眠）
呕家有痈脓者不必治脓尽自愈 服桂枝呕者酒客病
戴 阳明证具虽显然有可下证者兼之呕多犹属上焦未可遽下宜小柴胡汤若太阳不与少阳阳明合病而独见太阳证或
吐泻者恐病患膈间素有痰饮停饮伤滞且以二陈汤定之候呕吐定徐进解太阳经药若先呕却渴者宜猪苓汤先渴却呕者宜治
膈间之水小半夏茯苓汤渴欲饮水水入即吐吐已复渴名曰水逆由心经受热而小肠不利也宜五苓散若少阴不渴而吐或干呕
者理中汤去白术加生姜呕而吐涎沫者吴茱萸汤
太阴厥阴间有呕吐太阴宜理中汤厥阴宜四逆汤并加生姜煎以上阴证乃阴中之阴宜用热剂阳入阴者能为利而不为呕
呕属上而近于外也阳之所入者深故利也 又有阳证病新瘥后见呕别无所因此余热在胃脘也宜竹叶石膏汤或橘皮竹茹汤
大凡得之太阳而呕者必是合病呕乃病渐入内非正太阳也曾记有人初得病太阳证有呕吐不住药投暖剂莫能治之知太阳已
汗解固当用冷剂是太阳见呕非合阳明则合少阳其呕为热用暖剂非矣 又记有人初病具太阳证而呕一家少长患状悉类与
养胃汤各服无不立效此时行之气适然如此是为伤寒杂病又非可以正经伤寒律之也
吴 初得之呕逆呕哕清水呕吐饮食者皆着寒伤胃也如恶寒拘急未发热而呕逆或吐食者宜加减藿香正气散或人参养
胃汤若已发热者十味芎苏散发散或葛根汤加生姜半夏若自汗者不可发汗宜正气散去紫苏以和之凡发热口苦脉弦数而呕
心烦而呕胸胁满而呕往来寒热而呕日晡发热而呕皆属少阳并小柴胡倍加半夏生姜主之热少减黄芩口干加葛根栝蒌根心
烦加姜汁炒黄连心下痞满加枳实若潮热内实不大便呕不止心下郁郁微烦者大柴胡下凡呕吐胃家有热脉弦数口苦烦渴胃
有寒脉弦迟逆冷不食有水气先渴后呕腹满怔忡有脓血喉中腥气奔逆上冲不烦治之呕脓尽自愈此四者不可不辨凡太阴腹
满吐食不下或腹痛呕吐脉沉者理中汤加半夏陈皮藿香浓朴生姜之类寒甚加附子凡少阴饮食入口即吐心下温温欲吐复不
能吐手足寒脉沉细者四逆汤加半夏生姜橘皮之类凡厥阴呕吐涎沫逆冷脉沉微者吴茱萸四逆汤加半夏生姜陈皮之类
干呕欲吐
太阳中风阳浮而阴弱阳浮者热自发阴弱者汗自出啬啬恶寒淅淅恶风翕翕发热鼻鸣干呕者桂枝汤 伤寒
表不解心下有水气干呕发热而咳或渴或利或噎或小便不利少腹满或喘者小青龙汤
张 或问小青龙与小柴胡证皆呕而发汗表里之证大概仿佛何故二方用药之不同曰夫伤寒表不解里热未甚而渴欲饮
水不能多不当与之以腹中热尚少而不能消水饮停蓄故作诸证然水寒作病非温热之剂不能解故用小青龙汤发汗散水原其
理初无里证因水寒以致然也夫小柴胡证系伤寒发热热邪传里在于半表半里之间热气内攻故生诸证缘二证虽曰表里俱病
其中寒热不同故用药有姜桂柴苓之异也
伤寒中风医反下之其人下利日十数行谷不化腹中雷鸣心下痞硬而满干呕心烦不得安医见心下痞谓病不尽复下之其
痞益甚此非热结但以胃中虚客气上逆故便硬也甘草泻心汤 伤寒一日太阳受之脉若静者为不传颇欲吐若躁烦脉数急者
为传也宜与麻黄汤表罢小柴胡白虎汤 伤寒胸中有热胃中有邪气腹中痛欲呕吐者黄连汤太阳中风下利呕逆表解者可攻
之其人 汗出发作有时头痛心下痞硬满引胁下痛干呕短气汗出不恶寒者此表解里未和也十枣汤 太阳病不解转入少
阳者胁下硬满干呕不能食往来寒热尚未吐下脉沉紧者与小柴胡汤（张 或云干呕胁痛小柴胡十枣汤皆有之一和解一攻伐
何也盖小柴胡病在半表半里间外有寒热往来内有干呕诸病所以不可攻下宜和解以散表里之邪夫十枣汤证外无寒热其人
汗出此表已解也但头痛心下痞硬满引胁下痛干呕短气者邪热内蓄而有伏饮是里未和也与十枣汤以下热逐饮以上二
证宜从表证以决有表证而干呕胁痛者乃柴胡汤证也无表证而干呕胁痛即十枣汤证也上文所言头痛者而饮家有此证不可
以常法拘仲景所以述此者恐后学见其头痛以为表不解而不敢用也）食谷欲吐者属阳明也吴茱萸汤得汤反剧者属上焦也小
柴胡汤栀子豉汤黄芩汤（食谷欲吐者胃不受也与吴茱萸汤以温胃得汤反剧者上焦不纳也）少阴病饮食入口即吐心中
欲吐不能吐始得之手足寒脉弦迟者此胸中实不可下当吐之若膈上有寒饮干呕者不可吐也急温之宜四逆汤少阴病下利
不止厥逆无脉干呕烦者白通加猪胆汁汤 少阴病下利清谷里寒外热手足厥冷脉微欲绝身反不恶寒其人面赤色或腹痛或
干呕或咽痛或利止脉不出者通脉四逆汤 少阴病欲吐不吐心烦但欲寐五六日自利而渴者属少阴也 太阴病脉微细沉但
欲卧汗出不烦自欲吐至五六日自利复烦躁不得卧者死病解后虚羸少气欲吐者竹叶石膏汤
附
赤茯苓汤 治伤寒呕哕心下满胸膈有停水头眩心悸
赤茯苓 人参（各一两） 半夏（姜制） 橘红 芎 白术（各半两） 上 咀每服四钱姜五片水煎服
葛根汤 治伤寒干呕不止
葛根 人参 麦门冬（去心） 炙甘草（各一两） 半夏（姜制） 黄 （各七钱半） 白茯苓 白术（各半两）
上咀每服三钱生姜三片枣二枚同煎服
大热导致口渴、大量饮水，这都称为阳证。对于想喝水的病人，我反而给予姜、附子等温热药物，紧脉反而变得沉细，阳气尚未恢复，于是用桂枝、附子、干姜、乌头之类的药制成酒丸，每次服用一百丸，连续服用，两天中服用了十多次。
病人身体发热、烦躁不安，想要出汗，我又用前面的药丸接续服用，盖上厚衣服，阳脉才出现，随即大汗出。第二天大小便才开始通畅，排出一盆像猪肝颜色的瘀血。使用胃风汤加桂枝、附子，服用三剂后出血停止。这种寒象之重，也是世间罕见的。
少阴病表现为口燥、舌干而渴，如果寸关尺三部脉象都沉迟，则用四逆汤；如果脉沉而疾速，则用大承气汤。少阴病口燥、舌干而渴，身体表凉，脉沉细而虚的，用泻心汤主治。这是区分有形实邪与无形虚热的用药区别。
人参汤：治疗伤寒七八天，发汗后出现心烦、躁渴。
配方：人参、黄芩、柴胡、葛根（各一两），山栀、甘草（炙，各半两）。以上药材捣成粗末，每次服用五钱，加生姜、大枣煎煮，温服。
活人书观点：阳毒证倍于常人的燥热盛大、极度口渴者，用黑奴丸主治（方见阳毒篇）。风温病如口渴严重的，宜用栝蒌汤（方见风温篇）。中暑伏热，屡治不愈，病人持续口渴不已的，用酒蒸黄连丸主治（方见中暑篇）。
脉诊：热病在肾，令人口渴，口干舌焦，舌色黄赤，昼夜想喝水不止，腹部大而胀满，仍然不厌饮。如果眼睛没有神采，是死证，无法治疗。
（关于干呕欲升的问题）
成无己说：呕吐是指声音和食物同时排出，世俗称之为“哕”是不对的。“哕”与“吐”虽然字形不同，但音义相同。吐只是吐出其中的食物而没有声音，所以有干呕而没有干吐。呕吐的原因，有的责之于热，有的责之于寒。至于吐证，大多说是虚寒。呕吐又有因停饮引起的，有因胃脘有脓引起的，都必须明辨。
呕吐且发热的，用小柴胡汤（详情见前文）。
如果呕吐不止，心下急迫，郁郁微烦，这是邪热导致的呕吐，用大柴胡汤主治。
膈上有寒饮，干呕的，不可用吐法，应当温里。
如果干呕，吐涎沫，头痛的，用吴茱萸汤主治，这是寒邪导致的呕吐。
先呕吐后口渴的，这是病情将要解除的表现；先口渴后呕吐的，是水饮停在心下，这属于饮家。
停饮导致的呕吐，以及呕吐家有痈脓的，不需要专门治疗，脓尽自然痊愈，这是胃脘有脓导致的呕吐。
诸如此类情况，虽然有不同，但大体上伤寒表邪欲传入里，里气上逆就会呕吐。所以半表半里证多伴有呕吐。
伤寒三天，三阳经邪气已尽，三阴经当受邪，如果病人反而能进食且不呕吐，这说明三阴经不受邪。由此可知，邪气传里必然导致呕吐。
至于干姜附子汤证说“不呕不渴”，说明里没有热；十枣汤证说“干呕、短气、汗出、不恶寒”，说明表已解而里未和。由此可见，呕吐多为里热所致。
对于呕吐的病，气逆的必须用散法，痰饮的必须用下法。《千金方》说呕吐病人多服生姜，这是治疗呕吐的圣药，目的是散其逆气。《金匮要略》说呕吐病人用半夏以去除水饮，水去则呕吐止，目的是下其痰饮。
呕吐多的人，即使有阳明腑实证，也不可攻下，因为此时气逆而未收敛为实。
如果呕吐且脉弱，小便通利，身体有微热，出现四肢厥冷的，已经难治，这是因为虚寒太甚。
医者必须审察邪气的虚实、疾病的逆顺，才能正确施药治疗。
太阳病（发汗后），或已发热或未发热，必定恶寒，身体疼痛，呕吐逆气，脉阴阳俱紧的，名为伤寒，用麻黄汤。
太阳病经过十余日，反被误下二三次后，四五天了，柴胡证仍在的，先给小柴胡汤。
如果呕吐不止，心下急迫，郁郁微烦，这是病未解，给大柴胡汤，下之则愈。（按：仲景虽说过呕吐家虽有阳明证不可攻，攻之为逆，但如果阳明伏热熏蒸清道而致呕吐且烦的，不用苦寒直折是不行的，所以用大柴胡汤下之。）
伤寒发热，汗出不解，心下痞硬，呕吐而下利的，用大柴胡汤。
太阳病经过十余日，心下温温欲吐而胸中痛，大便反溏，腹微满，郁郁微烦，如果是此前自己进行了剧烈的吐下治疗，给调胃承气汤；如果不是这样，不可给。如果只是欲呕，胸中痛，微溏，这不是柴胡证，是因为剧烈吐下导致的。（成无己认为：心下温温欲吐，郁郁微烦，胸中痛，应责为邪热客于胸中；大便反溏，腹微满，则邪热已下于胃。日数虽多，若不经吐下，只是传邪，也未可下，当与柴胡汤以除上中二焦之邪。若曾吐下，损伤胃气，胃虚而邪乘虚入胃为实，非柴胡汤所能去，应用调胃承气汤下胃热。从呕吐可知胃气先前曾伤动。按经文“温温”当作“愠愠”。又因有“呕”字，下文可能有缺文，盖呕吐正是柴胡证，难道逸去了“微溏”二字吗？）
呕吐且发热的，用小柴胡汤主治。
伤寒六七日，发热微恶寒，肢节烦疼，微呕，心下支结，外证未去的，用柴胡加桂枝汤主治。
太阳与阳明合病，不下利但呕吐的，用葛根加半夏汤主治。（活人书云：头疼身热，痛肌热，目疼鼻干，脉浮而长，是此证。）
葛根加半夏汤方：
葛根、半夏（各二钱），麻黄、生姜（各一钱半），甘草、芍药、桂枝（各一钱），大枣（十二枚，掰开）。以上药材切碎，用水一斗，先煎麻黄、葛根，减去二升，去掉白沫，加入其他药物，煎取三升，温服一升，覆盖衣被取微汗。
阳明病：伤寒发热无汗，呕吐不能食，反而汗出濈然然的，是转属阳明也，用大柴胡汤。
进食就想呕吐的，属阳明病，用吴茱萸汤主治。服药后反而加剧的，属上焦病，用葛根加半夏汤。
伤寒呕吐多的人，即使有阳明证，也不可攻下。可用黄芩生姜半夏汤或小柴胡汤（活人书用桔梗汤）。
阳明病，胁下硬满，不大便而呕吐，舌上白苔的，可与小柴胡汤。
阳明病（温病），反而无汗而小便利，二三日呕吐而咳，手足厥冷的，必苦头痛（或用真武汤去茯苓）。
少阳病：呕吐且往来寒热，胸胁苦满的，宜用小柴胡汤。如果兼有下利的，乃太阳少阳合病，宜用黄芩加半夏生姜汤（论见往来寒热及下利篇）。
太阳阳明合病自下利，为在表，当与葛根汤发汗；阳明少阳合病自下利，为在里，可与承气汤下之；此太阳少阳合病自下利，为在半表半里，非汗下所宜，故与黄芩汤以和解之。呕吐是胃气逆也，故加半夏生姜以散逆气。
伤寒五六日，呕吐且发热的，柴胡证具备，如果用其他药误下，柴胡证仍在的，再给柴胡汤。
血弱气尽，腠理开，邪气因入，与正气相搏，结于胁下，正邪分争，往来寒热，休作有时，默默不欲饮食。脏腑相连，其痛必下，邪高痛下，故使呕也，用小柴胡汤主治。（邪气外甚，阳不主里，里气不和，气下而不上者，但下利而不呕；里气上逆而不下者，但呕而不下利。与小柴胡汤以解半表半里之邪。）
口渴且饮水后呕吐的，柴胡汤不与（活人书云：宜治膈间水，用赤茯苓汤主治，方见后）。
太阴病：太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。如果误下，必胸下结硬。
少阴病：下利六七日，咳而呕，渴，心烦不得眠的，用猪苓汤主治。
少阴病下利，脉微涩，呕吐且汗出，必频繁更衣反而排便少的，当温其上，灸之。
少阴病二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利的，此为有水气。其人或咳，或小便利，或下利，或呕吐的，用真武汤去附子加生姜。
厥阴病：伤寒热少厥微，指头寒，默默不欲食，烦躁数日，小便利，色白的，这是热除也，想吃饭，病将愈。如果厥冷且呕吐，胸胁烦满的，其后必便血，用黄芩芍药汤或抵当汤。
呕吐且脉弱，小便复利，身有微热，见厥冷的，难治，用四逆汤。
伤寒本自寒下，医反吐下之，寒格更逆吐下，若食入口即吐的，用干姜黄连黄芩人参汤。（伤寒邪自传表，为本自寒下，医反吐下，损伤正气，寒气内为格拒。经曰：格则吐逆。食入口即吐谓之寒格。更复吐下则重虚而死，是更逆吐下。与干姜黄芩人参汤以通寒格。赵氏解释仲景之意：本因寒下，医复吐下，因成寒格吐证。经云格则吐逆，若更复吐下，治之为逆，故用干姜以温里，黄连黄芩反佐以取之，人参补正气也。今活人却言关脉迟故用此药，何耶？虽然脉迟为胃中虚冷而吐者固也，又有脉数为胃中虚冷而吐者，仲景尝言之矣。病患脉数，数为客热，当消谷引食而反吐者，此以发汗令阳气微，膈气虚，脉乃数也。数为客热，不能消谷，以胃中虚冷故吐也。今以其脉异证同，故引此以为诊视之别。）
蛔厥者，其人当吐蛔。今病者静而复时烦，此为脏寒，蛔上入膈，故烦，须臾复安。得食而呕又烦者，蛔闻食臭出，其人当自吐蛔，用乌梅丸（详吐蛔篇）。
渴：先渴却呕的，为水停心下，此属饮家（活人云：赤茯苓汤主之）。先呕却渴的，此为欲解候也（金匮云：呕思水者急与之）。
下利：呕吐而下利，有寒热的为阳，宜黄芩汤、大柴胡汤；无热的为阴，宜猪苓汤、真武汤（并见吐利门）。
烦：呕吐且心烦，若在汗吐下后的，用栀子生姜豉汤；若未曾吐汗下后，兼咳而渴的，宜猪苓汤（详见不得眠篇）。
呕吐家有痈脓的，不必治，脓尽自愈。
服桂枝汤呕吐的，是酒客病。
戴元礼说：阳明证具，虽显然有可下证者，兼之呕吐多，犹属上焦，未可遽下，宜小柴胡汤。如果太阳不与少阳阳明合病而独见太阳证，或吐泻者，恐病患膈间素有痰饮停饮伤滞，暂且用二陈汤定之。候呕吐定，徐进解太阳经药。如果先呕却渴的，宜猪苓汤；先渴却呕的，宜治膈间之水，用小半夏茯苓汤。渴欲饮水，水入即吐，吐已复渴，名曰水逆，由心经受热而小肠不利也，宜五苓散。如果少阴不渴而吐或干呕的，用理中汤去白术加生姜。呕吐而吐涎沫的，用吴茱萸汤。
太阴、厥阴间有呕吐，太阴宜理中汤，厥阴宜四逆汤，并加生姜煎。以上阴证乃阴中之阴，宜用热剂。阳入阴者能为利而不为呕。呕吐属上而近于外也，阳之所入者深，故利也。
又有阳证病新瘥后见呕，别无所因，此余热在胃脘也，宜竹叶石膏汤或橘皮竹茹汤。
大凡得之太阳而呕者，必是合病，呕乃病渐入内，非正太阳。曾记有人初得病太阳证，有呕吐不住，药投暖剂莫能治之。知太阳已汗解，固当用冷剂，是太阳见呕，非合阳明则合少阳，其呕为热，用暖剂非矣。
又记有人初病具太阳证而呕，一家少长患状悉类，与养胃汤各服无不立效，此时行之气适然如此，是为伤寒杂病，又非可以正经伤寒律之也。
吴崑说：初得之，呕逆，呕哕清水，呕吐饮食者，皆着寒伤胃也。如恶寒拘急，未发热而呕逆或吐食的，宜加减藿香正气散或人参养胃汤。若已发热的，用十味芎苏散发散，或葛根汤加生姜半夏。若自汗的，不可发汗，宜正气散去紫苏以和之。凡发热、口苦、脉弦数而呕，心烦而呕，胸胁满而呕，往来寒热而呕，日晡发热而呕，皆属少阳，并用小柴胡汤倍加半夏生姜主治。热少减，黄芩减量；口干加葛根、栝蒌根；心烦加姜汁炒黄连；心下痞满加枳实。若潮热内实，不大便，呕吐不止，心下郁郁微烦的，用大柴胡汤下之。
凡呕吐，胃家有热，脉弦数，口苦，烦渴；胃有寒，脉弦迟，逆冷，不食；有水气，先渴后呕，腹满怔忡；有脓血，喉中腥气，奔逆上冲，不烦。治之，呕脓尽自愈。此四者不可不辨。
凡太阴腹满，吐食不下，或腹痛呕吐，脉沉的，用理中汤加半夏、陈皮、藿香、浓朴、生姜之类。寒甚加附子。
凡少阴饮食入口即吐，心下温温欲吐复不能吐，手足寒，脉沉细的，用四逆汤加半夏、生姜、橘皮之类。
凡厥阴呕吐涎沫，逆冷，脉沉微的，用吴茱萸四逆汤加半夏、生姜、陈皮之类。
干呕欲吐：
太阳中风，阳浮而阴弱。阳浮者热自发，阴弱者汗自出。啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣，干呕的，用桂枝汤。
伤寒表不解，心下有水气，干呕，发热而咳，或渴，或利，或噎，或小便不利，少腹满，或喘的，用小青龙汤。
张景岳问：小青龙与小柴胡证皆呕而发汗，表里之证大概仿佛，何故二方用药之不同？
答：夫伤寒表不解，里热未甚而渴欲饮水不能多，不当与之以腹中热尚少而不能消水，饮停蓄故作诸证。然水寒作病，非温热之剂不能解，故用小青龙汤发汗散水。原其理，初无里证，因水寒以致然也。
夫小柴胡证系伤寒发热，热邪传里在于半表半里之间，热气内攻故生诸证。缘二证虽曰表里俱病，其中寒热不同，故用药有姜桂柴苓之异也。
伤寒中风，医反下之，其人下利日十数行，谷不化，腹中雷鸣，心下痞硬而满，干呕，心烦不得安。医见心下痞，谓病不尽，复下之，其痞益甚。此非热结，但以胃中虚，客气上逆，故便硬也，用甘草泻心汤。
伤寒一日，太阳受之，脉若静者为不传；颇欲吐，若躁烦，脉数急者为传也，宜与麻黄汤。表罢，小柴胡、白虎汤。
伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐的，用黄连汤。
太阳中风，下利，呕逆，表解者可攻之。其人汗出，发作有时，头痛，心下痞硬满，引胁下痛，干呕，短气，汗出，不恶寒者，此表解里未和也，用十枣汤。
太阳病不解，转入少阳者，胁下硬满，干呕不能食，往来寒热，尚未吐下，脉沉紧的，与小柴胡汤。（张氏或云：干呕胁痛，小柴胡、十枣汤皆有之一和解，一攻伐，何也？盖小柴胡病在半表半里间，外有寒热往来，内有干呕诸病，所以不可攻下，宜和解以散表里之邪。夫十枣汤证外无寒热，其人汗出，此表已解也。但头痛，心下痞硬满，引胁下痛，干呕，短气者，邪热内蓄而有伏饮，是里未和也。与十枣汤以下热逐饮。以上二证宜从表证以决，有表证而干呕胁痛者，乃柴胡汤证也；无表证而干呕胁痛，即十枣汤证也。上文所言头痛者，而饮家有此证，不可以常法拘。仲景所以述此者，恐后学见其头痛以为表不解而不敢用也。）
食谷欲吐者，属阳明也，吴茱萸汤。得汤反剧者，属上焦也，小柴胡汤、栀子豉汤、黄芩汤。（食谷欲吐者，胃不受也，与吴茱萸汤以温胃；得汤反剧者，上焦不纳也。）
少阴病，饮食入口即吐，心中欲吐不能吐，始得之，手足寒，脉弦迟者，此胸中实，不可下，当吐之。若膈上有寒饮，干呕者，不可吐也，急温之，宜四逆汤。
少阴病，下利不止，厥逆无脉，干呕，烦者，白通加猪胆汁汤。
少阴病，下利清谷，里寒外热，手足厥冷，脉微欲绝，身反不恶寒，其人面赤色，或腹痛，或干呕，或咽痛，或利止脉不出者，通脉四逆汤。
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也。
太阴病，脉微细沉，但欲卧，汗出不烦，自欲吐，至五六日自利，复烦躁不得卧者，死。病解后，虚羸少气，欲吐者，竹叶石膏汤。
附方：
赤茯苓汤：治伤寒呕哕，心下满，胸膈有停水，头眩心悸。
配方：赤茯苓、人参（各一两），半夏（姜制）、橘红、川芎、白术（各半两）。以上切碎，每服四钱，姜五片，水煎服。
葛根汤（此处方名似有误，应为葛根人参汤或类似变方，依原文翻译）：治伤寒干呕不止。
配方：葛根、人参、麦门冬（去心）、炙甘草（各一两），半夏（姜制）、黄芪（各七钱半），白茯苓、白术（各半两）。以上切碎，每服三钱，生姜三片，枣二枚，同煎服。
High fever causing thirst and excessive drinking is all termed Yang syndrome. For patients desiring water, I instead administered warm medicines such as Ginger (Shengjiang) and Aconite (Fuzi). The tight pulse (Jinmai) became deep and fine, and Yang Qi had not yet regenerated. Therefore, I prepared wine pills using Cinnamon Twig (Guizhi), Aconite (Fuzi), Dried Ginger (Ganjiang), and Aconite Root (Wutou), administering one hundred pills per dose. Over two days, more than ten doses were taken.
The patient experienced body heat, restlessness, and a desire to sweat. I continued administering the aforementioned pills and covered the patient with thick clothing. Only then did the Yang pulse emerge, followed by profuse sweating. The next day, bowel and bladder movements began to clear, and a basin full of dark red, liver-like blood stasis was discharged. Using Weifeng Tang (Stomach Wind Decoction) added with Cinnamon Twig (Guizhi) and Aconite (Fuzi), three doses stopped the bleeding. Such severe cold manifestations are rarely seen in the world.
Shaoyin syndrome presenting with dry mouth, dry tongue, and thirst: if the Cun, Guan, and Chi pulses are all deep and slow, Sini Tang (Four Reversal Decoction) is indicated; if the pulse is deep and rapid, Dachengqi Tang (Major Order the Yellow Decoction) is indicated. For Shaoyin syndrome with dry mouth, dry tongue, and thirst, accompanied by a cool exterior and a deep, fine, and deficient pulse, Xiexin Tang (Drain the Epigastrium Decoction) is the primary treatment. This distinguishes the use of herbs for tangible pathogens versus intangible deficiencies.
Renshen Tang (Ginseng Decoction): Treats Shanghan (Cold Damage) after seven or eight days, following sweating, resulting in mental irritability, restlessness, and thirst.
Ingredients: Renshen (Radix Ginseng), Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix) (each 1 liang); Shanzhi (Gardeniae Fructus), Gancao (Licorice Radix et Rhizoma, processed) (each 0.5 liang). Grind into coarse powder. Take 5 qian per dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), and take warm.
Huorenshu states: For Yang Du (Yang Toxin) syndrome with extreme dryness, heat, and intense thirst, Heinu Wan (Black Slave Pill) is indicated (see Yang Du section). For Fengwen (Wind-Warmth) with severe thirst, Gualou Tang (Trichosanthes Root Decoction) is suitable (see Fengwen section). For Zhongshu (Summerheat) with latent heat that fails to resolve despite repeated treatments, and persistent thirst, Jiuzheng Huanglian Wan (Alcohol-Steamed Coptis Pill) is indicated (see Zhongshu section).
Pulse Diagnosis: Heat disease affecting the Kidney causes thirst, dry mouth, scorched tongue, yellow-red tongue coating, and incessant desire to drink day and night. Abdominal distension and fullness persist despite continuous drinking. If the eyes lack luster, it is a death sign and incurable.
(Regarding Dry Retching)
Cheng Wuji stated: "Ou" (Vomiting) involves both sound and matter being expelled. It is incorrect to colloquially call it "Yue" (Hiccup/Retching). Although "Yue" and "Ou" have different characters, their pronunciation and meaning are similar. "Tu" (Spitting/Vomiting) refers only to expelling matter without sound, hence there is "Gan Ou" (Dry Retching) but no "Gan Tu". Causes of vomiting include Heat and Cold. Vomiting is generally attributed to Deficiency-Cold. Vomiting can also be caused by retained fluids or pus in the stomach. These must be clearly distinguished.
For vomiting with fever, Xiaochaihu Tang (Minor Order the Gallbladder Decoction) is used (details see previous text).
If vomiting persists, epigastric urgency, and mild vexation occur, this is vomiting due to pathogenic heat, treated with Da Chaihu Tang (Major Order the Gallbladder Decoction).
For dry retching due to cold-fluid retention above the diaphragm, emetics are contraindicated; warming is required.
For dry retching with salivary discharge and headache, Wuzhuyu Tang (Evodia Fruit Decoction) is indicated, representing vomiting due to cold pathogens.
Vomiting followed by thirst indicates impending resolution; thirst followed by vomiting indicates fluid retention in the epigastrium, characteristic of Fluid-Dampness syndromes.
For vomiting due to retained fluids, or vomiting associated with abscesses/pus, specific treatment is unnecessary; self-healing occurs when the pus is exhausted. This is vomiting due to pus in the stomach.
Generally, in Shanghan, when exterior pathogens attempt to transmit inward, rebellious Stomach Qi causes vomiting. Thus, half-exterior/half-interior syndromes often feature vomiting.
After three days of Shanghan, if Yang meridians are exhausted and Yin meridians should receive pathogens, but the patient can eat and not vomit, it indicates the Yin meridians are unaffected. Thus, transmission to the interior inevitably causes vomiting.
In Ganjiang Fuzi Tang syndrome, "no vomiting, no thirst" indicates no heat in the interior. In Shizao Tang syndrome, "dry retching, shortness of breath, sweating, no aversion to cold" indicates the exterior is resolved but the interior is disharmonious. Thus, vomiting generally indicates interior heat.
For vomiting diseases, rebellious Qi requires dispersing methods; Phlegm-Fluid requires purging methods. Qianjin Fang states that ginger is the holy medicine for vomiting to disperse rebellious Qi. Jingui Yaolue states that Banxia (Pinelliae Rhizoma) is used to remove water; once water is removed, vomiting stops, aiming to purge Phlegm-Fluid.
Even with Yangming symptoms, if vomiting is frequent, purgatives are contraindicated because Qi is rebellious and has not yet consolidated into excess.
If vomiting occurs with a weak pulse, free urination, slight fever, and cold extremities, it is difficult to treat due to severe Deficiency-Cold.
Physicians must examine the deficiency/excess of pathogens and the smooth/rebellious nature of the disease to prescribe correctly.
Taiyang syndrome (after sweating): Whether fever has appeared or not, there is always aversion to cold, body pain, vomiting/rebellious Qi, and tight pulses at both Yin and Yang positions. This is named Shanghan, treated with Mahuang Tang (Ephedra Decoction).
Taiyang syndrome lasting over ten days, incorrectly purged two or three times: if four or five days pass and Chaihu symptoms remain, administer Xiaochaihu Tang first.
If vomiting persists, epigastric urgency, and mild vexation occur, the disease is unresolved; administer Da Chaihu Tang. Purging will lead to recovery. (Note: Although Zhang Zhongjing stated that purgatives are contraindicated for frequent vomiters even with Yangming symptoms, if latent Yangming heat steams the clear pathways causing vomiting and vexation, bitter-cold direct reduction is necessary, hence Da Chaihu Tang is used.)
Shanghan with fever, sweating without resolution, epigastric stiffness/fullness, vomiting, and diarrhea: Da Chaihu Tang.
Taiyang syndrome lasting over ten days: feeling of nausea wanting to vomit, chest pain, loose stools, mild abdominal fullness, and mild vexation. If the patient previously underwent violent emesis or purgation, Tiaowei Chengqi Tang (Regulate the Stomach Order the Yellow Decoction) is given; otherwise, it is contraindicated. If only nausea, chest pain, and loose stools occur, it is not a Chaihu syndrome but results from prior violent emesis/purgation. (Cheng Wuji argues: Nausea, vexation, and chest pain indicate pathogenic heat in the chest; loose stools and abdominal fullness indicate heat moved to the stomach. If no emesis/purgation occurred, it is merely transmitted pathogen, not suitable for purgation; Chaihu Tang is appropriate. If emesis/purgation damaged Stomach Qi, allowing pathogen to enter as excess, Tiaowei Chengqi Tang is needed to purge Stomach heat. The term "Wenwen" likely means "Yunyun" [discomfort]. There may be missing text regarding "vomiting," which is typical of Chaihu syndromes.)
Vomiting with fever: Xiaochaihu Tang.
Shanghan after six or seven days: slight fever, slight aversion to cold, limb joint pain, slight vomiting, subepigastric constraint, with exterior signs unresolved: Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction).
Taiyang and Yangming combined syndrome: no diarrhea but vomiting: Gegen Banxia Tang (Pueraria plus Pinellia Decoction). (Huorenshu notes: headache, body heat, muscle pain, eye pain, nasal dryness, floating and long pulse.)
Gegen Banxia Tang Formula:
Gegen (Puerariae Lobatae Radix), Banxia (Pinelliae Rhizoma) (each 2 qian); Mahuang (Ephedrae Herba), Shengjiang (Zingiberis Rhizoma Recens) (each 1.5 qian); Gancao (Licorice Radix et Rhizoma), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus) (each 1 qian); Dazao (Jujubae Fructus) (12 pieces, split). Cut ingredients. Decoct in 1 dou of water. First boil Mahuang and Gegen, reduce by 2 sheng, skim white foam, add remaining herbs, boil to 3 sheng. Take 1 sheng warm, cover for slight sweating.
Yangming syndrome: Shanghan with fever, no sweat, vomiting, inability to eat, yet sweating profusely: transmission to Yangming. Da Chaihu Tang.
Desire to vomit after eating: belongs to Yangming. Wuzhuyu Tang. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao. Gegen Banxia Tang.
Frequent vomiting in Shanghan: even with Yangming symptoms, do not purge. Use Huangqin Shengjiang Banxia Tang or Xiaochaihu Tang (Huorenshu uses Jiegeng Tang).
Yangming syndrome with hardness/fullness in hypochondrium, constipation, vomiting, and white tongue coating: Xiaochaihu Tang.
Yangming syndrome (Warm disease) with no sweat but free urination: after two or three days, vomiting, coughing, and cold extremities indicate severe headache (or use Zhenwu Tang minus Fuling).
Shaoyang syndrome: Vomiting with alternating chills and fever, hypochondriac fullness: Xiaochaihu Tang. If accompanied by diarrhea, it is Taiyang-Shaoyang combined syndrome: Huangqin Banxia Shengjiang Tang (Bupleurum plus Pinellia and Ginger Decoction). (See Alternating Chills/Fever and Diarrhea sections). Taiyang-Yangming combined diarrhea is exterior, treated with Gegen Tang (diaphoresis). Yangming-Shaoyang combined diarrhea is interior, treated with Chengqi Tang (purging). Taiyang-Shaoyang combined diarrhea is half-exterior/half-interior, not suitable for diaphoresis or purging; Huangqin Tang (Scutellaria Decoction) harmonizes. Vomiting is rebellious Stomach Qi; Banxia and Shengjiang disperse rebellion.
Shanghan after five or six days: vomiting and fever indicate Chaihu syndrome. If incorrectly purged, but Chaihu symptoms persist, re-administer Chaihu Tang.
Weak Blood and Qi, open pores, pathogen enters, struggles with Righteous Qi in hypochondrium, causing alternating chills, silent anorexia. Organs are connected, pain radiates downward, high pathogen causes low pain, leading to vomiting. Xiaochaihu Tang. (If pathogen is external, Yang does not govern interior, Qi sinks: diarrhea without vomiting. If Qi rebels upward: vomiting without diarrhea. Xiaochaihu Tang resolves half-exterior/half-interior pathogens.)
Thirst with water-induced vomiting: Chaihu Tang is contraindicated. (Huorenshu suggests treating inter-diaphragmatic water with Chifuling Tang).
Taiyin syndrome: Abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, periodic abdominal pain. Incorrect purging leads to epigastric knotting/hardness.
Shaoyin syndrome: Diarrhea for six or seven days, cough, vomiting, thirst, irritability, insomnia: Zhuling Tang (Polyporus Decoction).
Shaoyin syndrome with diarrhea, faint/choppy pulse, vomiting, sweating, frequent defecation with little output: Warm the upper part with moxibustion.
Shaoyin syndrome progressing from two to four/five days: abdominal pain, difficult urination, heavy/painful limbs, spontaneous diarrhea: Water-Qi retention. If cough, free urination, diarrhea, or vomiting occurs: Zhenwu Tang minus Fuzi, add Shengjiang.
Jueyin syndrome: Mild heat, slight cold extremities (fingers cold), silent anorexia, irritability. Free pale urine indicates heat removal; desire to eat indicates recovery. If cold extremities with vomiting and hypochondriac vexation: hematochezia follows. Huangqin Shaoyao Tang or Didang Tang.
Vomiting with weak pulse, free urination, slight fever, cold extremities: difficult to treat. Sini Tang.
Shanghan originally involving cold-dysfunction, incorrectly purged/vomited: Cold rejection causes further vomiting/diagnosis. If food is vomited immediately upon entry: Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, Ginseng Decoction). (Pathogen transmits to exterior, but original condition was cold-dysfunction. Medical error damages Zheng Qi, causing internal Cold Rejection. Jinggui states: "Rejection causes vomiting." Immediate vomiting is Cold Rejection. Further purging/vomiting causes double deficiency and death. This formula unblocks Cold Rejection. Zhao explains: Original cold-dysfunction worsened by medical error. Jinggui states rejection causes vomiting; further purging is contraindicated. Ganjiang warms interior; Huanglian/Huangqin act as counter-agents; Renshen tonifies Zheng Qi. Huorenshu attributes this to slow Chi pulse indicating Stomach Deficiency-Cold. However, rapid pulse can also indicate Deficiency-Cold vomiting due to weakened Yang Qi from sweating, creating false heat that cannot digest food. Pulse differs, but syndrome is same.)
Hui Jue (Roundworm Revulsion): Patient expectorates roundworms. Patient is quiet but occasionally irritable due to Interior Cold causing worms to ascend to Diaphragm. Irritation subsides briefly. Eating triggers vomiting and irritation as worms smell food and emerge; patient expects worms. Wumei Wan (Mume Pill).
Thirst: Thirst followed by vomiting indicates fluid retention in epigastrium (Fluid-Dampness). Chifuling Tang. Vomiting followed by thirst indicates impending resolution. Jingui states: give water promptly if patient desires it after vomiting.
Diarrhea: Vomiting with diarrhea, with cold/heat signs, is Yang: Huangqin Tang or Da Chaihu Tang. Without heat, it is Yin: Zhuling Tang or Zhenwu Tang.
Vexation: Vomiting with mental irritability after sweating/emesis/purgation: Zhizi Shengjiang Chi Tang (Gardenia, Ginger, Fermented Soybean Decoction). If no prior treatment, with cough and thirst: Zhuling Tang.
Abscess/Pus in Vomiting: No treatment needed; self-resolves when pus is exhausted.
Vomiting after Guizhi Tang: Indicates "Jiu Ke" (Wine Drinker) syndrome.
Dai Yuanli stated: Even with obvious Yangming purgative indications, frequent vomiting suggests Upper Jiao involvement; do not purge hastily. Use Xiaochaihu Tang. If Taiyang syndrome exists alone with vomiting/diarrhea, suspect pre-existing Phlegm-Fluid in Diaphragm. Use Erchen Tang (Two-Chen Decoction) to stabilize. Once stabilized, slowly administer Taiyang resolving herbs. Thirst after vomiting: Zhuling Tang. Vomiting after thirst: Treat inter-diaphragmatic water with Xiao Banxia Fuling Tang (Minor Pinellia and Polyporus Decoction). Thirst, drinking, immediate vomiting, returning thirst: named "Shui Ni" (Water Revulsion), due to Heart Meridian heat affecting Small Intestine. Wuling San (Five-Ling Powder). Shaoyin non-thirsty vomiting or dry retching: Lizhong Tang minus Baizhu, add Shengjiang. Vomiting saliva: Wuzhuyu Tang.
Taiyin/Jueyin vomiting: Taiyin uses Lizhong Tang; Jueyin uses Sini Tang, both with Shengjiang. These Yin syndromes require hot agents. Yang entering Yin causes diarrhea, not vomiting. Vomiting is upper/exterior; Yang entering deeply causes diarrhea.
Post-recovery vomiting in Yang syndromes, without other causes, indicates residual heat in Stomach. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or JuPi ZhuRu Tang (Tangerine Peel and Bamboo Shaving Decoction).
Taiyang vomiting implies combined syndrome, indicating disease moving inward. Not pure Taiyang. Case record: Taiyang syndrome with persistent vomiting failed with warm agents. After Taiyang resolved, cold agents were needed. Taiyang vomiting implies Yangming or Shaoyang combination, indicating Heat; warm agents were incorrect. Another case: Family with Taiyang vomiting responded well to Yangwei Tang (Stomach-Nourishing Decoction), suggesting epidemic influence, classifying it as mixed Shanghan/Zabing, not standard Shanghan.
Wu Kun stated: Initial vomiting, retching clear water, or vomiting food indicates Cold damaging Stomach. With aversion to cold, tension, no fever, vomiting/food expulsion: Jiawei Huoxiang Zhengqi San or Renshen Yangwei Tang. With fever: Shiwei Xiong Su Fa San or Gegen Tang plus Shengjiang/Banxia. With spontaneous sweating: Do not diaphorese; use Zhengqi San minus Zisu to harmonize.
Fever, bitter taste, wiry-rapid pulse, vomiting; mental irritability, vomiting; hypochondriac fullness, vomiting; alternating chills/fever, vomiting; afternoon fever, vomiting: All Shaoyang. Xiaochaihu Tang with doubled Banxia/Shengjiang. Reduce Huangqin as heat lessens; add Gegen/Gualougen for dry mouth; add Jiangzhi Chaidanxin for irritability; add Zhishi for epigastric fullness.
Tidal fever, interior excess, constipation, persistent vomiting, epigastric vexation: Da Chaihu Tang.
Stomach Heat: wiry-rapid pulse, bitter taste, irritability/thirst. Stomach Cold: wiry-slow pulse, cold extremities, anorexia. Water-Qi: thirst before vomiting, abdominal fullness, palpitations. Pus/Blood: foul throat odor, rushing sensation, no irritability. Self-resolves when pus vomited. Distinguish these four.
Taiyin abdominal fullness, vomiting/anorexia, or abdominal pain/vomiting, deep pulse: Lizhong Tang plus Banxia, Chenpi, Huoxiang, Houpo, Shengjiang. Add Fuzi for severe cold.
Shaoyin: food vomited immediately, epigastric discomfort, inability to vomit, cold hands/feet, deep-fine pulse: Sini Tang plus Banxia, Shengjiang, Chenpi.
Jueyin: vomiting saliva, cold extremities, deep-micro pulse: Wuzhuyu Sini Tang plus Banxia, Shengjiang, Chenpi.
Dry Retching:
Taiyang Wind Strike: Floating-Yang/Deficient-Yin pulse. Yang-floating causes spontaneous heat; Yin-deficient causes spontaneous sweating. Aversion to cold/wind, slight fever, nasal congestion, dry retching: Guizhi Tang (Cinnamon Twig Decoction).
Shanghan exterior unresolved, fluid retention in heart/stomach: dry retching, fever, cough, or thirst, diarrhea, dysphagia, urinary difficulty, suprapubic fullness, or wheezing: Xiao Qinglong Tang (Minor Green Dragon Decoction).
Zhang Jingyue asked: Why do Xiao Qinglong Tang and Xiaochaihu Tang differ in herbs despite both treating vomiting with fever and resembling exterior/interior patterns?
Answer: In Shanghan with unresolved exterior and mild interior heat, thirst with limited water intake occurs because interior heat is insufficient to transform fluids, leading to fluid retention and various symptoms. Cold-fluid pathology requires warm-hot agents to resolve via diaphoresis and fluid dispersion. Initially, there is no interior syndrome; it arises from cold-fluid.
Xiaochaihu Tang treats Shanghan fever where heat transmits to half-exterior/half-interior, attacking internally. Although both involve exterior/interior issues, the cold-heat nature differs, necessitating different herbs (Ginger/Cinnamon vs. Bupleurum/Polyporus).
Shanghan/Wind Strike, incorrectly purged: Diarrhea ten+ times daily, undigested food, borborygmus, epigastric hardness/fullness, dry retching, irritability, insomnia. Physician sees epigastric fullness, assumes incomplete disease, purges again, worsening fullness. This is not heat accumulation but Stomach Deficiency with rebellious Qi. Gancao Xiexin Tang (Licorice Drain the Epigastrium Decoction).
Shanghan Day 1, Taiyang receives pathogen: Quiet pulse means no transmission. Desire to vomit, irritability, rapid pulse indicates transmission. Ma Huang Tang initially. After exterior resolves, consider Xiaochaihu Tang or Baihu Tang.
Shanghan with heat in Chest, pathogen in Stomach, abdominal pain, desire to vomit: Huanglian Tang (Coptis Decoction).
Taiyang Wind Strike with diarrhea/vomiting: If exterior resolved, attack interior. Sweating, periodic headache, epigastric hardness/fullness radiating to hypochondrium, dry retching, shortness of breath, sweating, no aversion to cold: Exterior resolved, interior disharmony. Shizao Tang (Ten Jujube Decoction).
Taiyang unresolved transmitting to Shaoyang: Hypochondriac hardness, dry retching, anorexia, alternating chills/fever, no prior emesis/purgation, deep-tight pulse: Xiaochaihu Tang. (Zhang notes: Both formulas treat dry retching/hypochondriac pain. Xiaochaihu harmonizes half-exterior/half-interior with alternating chills; Shizao Tang treats interior heat with hidden fluid retention after exterior resolution. Headache in fluid retention should not deter use of Shizao Tang if no exterior signs exist.)
Food-induced vomiting: Yangming. Wuzhuyu Tang. Worsening after ingestion: Upper Jiao. Xiaochaihu Tang, Zhizi Chi Tang, or Huangqin Tang. (Stomach rejects food: warm with Wuzhuyu Tang. Upper Jiao rejects: use others.)
Shaoyin: Food vomited immediately, urge to vomit but cannot, cold hands/feet, wiry-slow pulse: Excess in Chest, do not purge, induce emesis. Cold-fluid above diaphragm with dry retching: Do not emetic, warm urgently with Sini Tang.
Shaoyin: Profuse diarrhea, cold extremities, absent pulse, dry retching, irritability: Baitong Jia Zhuchidan Tang (White Connect Plus Pig Gallbladder Bile Decoction).
Shaoyin: Clear grain diarrhea, interior cold/exterior heat, cold extremities, faint/almost absent pulse, no aversion to cold, flushed face, abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse: Tongmai Sini Tang (Connect to Life Sini Decoction).
Shaoyin: Urge to vomit but cannot, irritability, drowsiness. After five/six days, spontaneous diarrhea with thirst: Shaoyin syndrome.
Taiyin: Faint-fine-deep pulse, drowsiness, sweating, no irritability, desire to vomit. After five/six days, spontaneous diarrhea, irritability, inability to sleep: Death. Post-recovery emaciation, shortness of breath, desire to vomit: Zhuye Shigao Tang.
Appendix Formulas:
Chifuling Tang: Treats Shanghan vomiting/retching, epigastric fullness, inter-diaphragmatic fluid retention, vertigo, palpitations.
Ingredients: Chifuling (Polypori Parvae), Renshen (Radix Ginseng) (each 1 liang); Banxia (Pinelliae Rhizoma, ginger-processed), Juhong (Citri Reticulatae Pericarpium Rubrum), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 4 qian, 5 slices of Shengjiang, decoct in water.
Gegen Tang (Formula Name Discrepancy in Source, likely Ge Gen Ren Shen Tang variant): Treats persistent dry retching in Shanghan.
Ingredients: Gegen (Puerariae Lobatae Radix), Renshen (Radix Ginseng), Maidong (Ophiopogonis Radix, heart removed), Zhigancao (Processed Licorice Radix et Rhizoma) (each 1 liang); Banxia (Pinelliae Rhizoma, ginger-processed), Huangqi (Astragali Radix) (each 7.5 qian); Baifuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 3 qian, 3 slices Shengjiang, 2 dates, decoct together.