《金匮》云∶病患欲吐者，不可下之。
欲吐者，阴邪在上也。若下之，不惟逆其阳气，反伤无故之阴，变害莫测，岂独反胃而已。
食已即吐者，大黄甘草汤主之。
胃素有热，食复入之，两热相冲，不得停留。用大黄下热，甘草和胃。张石顽云∶仲景
既云欲吐者不可下，又用大黄甘草汤，治食已即吐，何也？曰∶欲吐，病在上，因而越之可
也。逆之使下，则必愦乱益甚，既吐矣。吐而不已，有升无降，当逆折之使下，故用大黄。
大黄甘草汤（方见《金匮》）
治食已即吐。
通草橘皮汤（《千金》） 治伤寒胃热呕吐。
通草（二钱） 橘皮（一钱五分） 粳米（一合） 生芦根汁
水煎热服。去通草、橘皮，加竹茹、生姜汁，《千金》名芦根饮子。治伤寒后呕哕、反胃、干呕。
丹溪云∶凡呕家禁用服栝蒌、桃仁、莱菔子、山栀。一切有油之物，皆犯胃作吐。景
岳云∶呕家亦忌苍术，以其味不醇而动呕也。
茯苓半夏汤
沈芊绿云∶食已心下痛，隐隐不可忍，吐出痛方止，证名食痹。吐食，宜此汤主之。
麦芽 茯苓 半夏 白术 神曲 橘皮 天麻 生姜（各等分） 水煎服。
麦天汤 亦主之。
麦冬 天麻 茯苓 白术 半夏 陈皮 神曲 生姜（各等分）
水煎服。
《金匮要略》中说：病人有想呕吐的感觉时，不可使用泻下法。
想呕吐，是因为阴寒邪气停留在上焦。如果误用泻下法，不仅会违背阳气的正常升发趋势，反而会损伤原本无病的阴液，导致变化莫测的危害，难道仅仅是引起反胃这一种后果吗？
进食后立即呕吐的，应当用大黄甘草汤主治。
这是因为胃中素有积热，食物再次进入后，新旧两股热邪相互冲撞，导致食物无法停留。此时使用大黄来泻除热邪，使用甘草来调和胃气。张石顽说：仲景既然说过“想呕吐的人不可用泻下法”，却又用大黄甘草汤来治疗“进食后立即呕吐”的情况，这是为什么呢？回答说：想呕吐，病位在上焦，顺应病势采用涌吐法是可行的。如果强行逆其病势使其向下，则必然导致病情更加混乱严重，既然已经呕吐了，但呕吐不止，只有上升没有下降，应当逆势折降使其下行，所以使用大黄。
大黄甘草汤（方剂见《金匮要略》）
治疗进食后立即呕吐。
通草橘皮汤（出自《千金方》） 治疗伤寒引起的胃热呕吐。
通草（二钱） 橘皮（一钱五分） 粳米（一合） 生芦根汁
用水煎煮，热服。去掉通草、橘皮，加入竹茹、生姜汁，《千金方》称之为芦根饮子。治疗伤寒后出现的呕吐呃逆、反胃、干呕。
朱丹溪说：凡是呕吐的病人，禁止服用栝蒌、桃仁、莱菔子、山栀。一切含有油脂的食物，都会触犯胃气导致呕吐。
张景岳说：呕吐的病人也忌讳苍术，因为它的味道不纯正且容易引发呕吐。
茯苓半夏汤
沈芊绿说：进食后心窝处疼痛，隐隐作痛难以忍受，吐出食物后疼痛才停止，这种病症名叫食痹。对于吐食的症状，适宜用此汤主治。
麦芽 茯苓 半夏 白术 神曲 橘皮 天麻 生姜（各等分）
用水煎煮服用。
麦天汤 也主治此症。
麦冬 天麻 茯苓 白术 半夏 陈皮 神曲 生姜（各等分）
用水煎煮服用。
The *Jingui Yaolue* states: "When a patient desires to vomit, purgation must not be used."
Desiring to vomit indicates that Yin pathogenic factors are located in the Upper Jiao. If purgation is used, it not only goes against the normal ascending trend of Yang Qi but also damages the healthy Yin fluids, leading to unpredictable and severe complications; does it merely result in regurgitation?
For vomiting immediately after eating, Dahuang Gancao Tang (Rhubarb and Licorice Decoction) is the primary treatment.
This occurs because there is pre-existing heat in the Stomach; when food enters again, the two sources of heat clash, preventing the food from staying in place. Dahuang (Rhei Radix et Rhizoma) is used to purge the heat, while Gancao (Glycyrrhizae Radix) harmonizes the Stomach. Zhang Shiwan stated: "Zhang Zhongjing said that those who desire to vomit should not be purged, yet he uses Dahuang Gancao Tang to treat vomiting immediately after eating. Why?" The answer is: When one desires to vomit, the pathology is in the Upper Jiao, so inducing emesis according to the disease's tendency is appropriate. Forcing downward action against this tendency will cause greater confusion and severity. Since vomiting has already occurred but continues without cessation—having only ascent without descent—one must counteract this by forcing downward movement; hence, Dahuang is used.
Dahuang Gancao Tang (Formula seen in *Jingui Yaolue*)
Treats vomiting immediately after eating.
Tongcao Jupi Tang (from *Qianjin Fang*)
Treats vomiting due to Stomach Heat caused by Cold Damage (Shanghan).
Tongcao (2 qian), Jupi (1.5 qian), Jingmi (1 he), fresh juice of Sheng Lugen (Phragmitis Rhizoma)
Decoct with water and take hot. Removing Tongcao and Jupi, and adding Zhuru (Bambusae Caulis in Taenia) and Shengjiangzhi (Zingiberis Rhizoma Recens Juice), the formula is named Lugan Yinzi in *Qianjin Fang*. It treats vomiting, hiccups, regurgitation, and dry heaving following Cold Damage.
Zhu Danxi stated: "For all patients with vomiting, Gualou (Trichosanthis Fructus), Taoren (Persicae Semen), Laifuzi (Raphani Semen), and Shanzhi (Gardeniae Fructus) are strictly prohibited. All oily substances offend the Stomach Qi and induce vomiting."
Zhang Jingyue stated: "Patients with vomiting should also avoid Cangzhu (Atractylodis Rhizoma) because its flavor is not pure and it tends to provoke vomiting."
Fuling Banxia Tang
Shen Qianlü stated: "Pain in the epigastrium immediately after eating, which is dull and unbearable until the food is vomited out, is known as Shibì (Food Bi Syndrome). For vomiting of food, this decoction is suitable."
Maiya (Hordei Fructus Germinatus), Fuling (Poria), Banxia (Pinelliae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Shenqu (Massa Medicata Fermentata), Jupi (Citri Reticulatae Pericarpium), Tianma (Gastrodiae Rhizoma), Shengjiang (Zingiberis Rhizoma Recens) (equal parts)
Decoct with water and take orally.
Maitian Tang
Also treats this condition.
Maidong (Ophiopogonis Radix), Tianma (Gastrodiae Rhizoma), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Shenqu (Massa Medicata Fermentata), Shengjiang (Zingiberis Rhizoma Recens) (equal parts)
Decoct with water and take orally.