喘
喘急先分肺实虚，
呼吸急促者，谓之喘；喉中有响声者，谓之哮。虚者，气乏身凉，冷痰如冰；
实者，气壮胸满，身热便硬。
其次当知有火无；
经曰∶诸逆冲上，皆属火。虚火宜滋补降气，实火宜清肺泻胃。
火炎得食喘暂止，
火炎肺胃喘者，乍进乍退，得食则坠下稠痰则止；食已入胃，反助火痰，上喘反
大作，宜降火清金，导痰汤加芩、连、山栀、杏仁、栝蒌。如胃有实火，膈上稠痰者，导水
丸
。
痰喘喉似水鸡吹。
痰喘必有痰声。风痰，千缗汤，或合导痰汤；痰气，苏子降气汤、四磨汤；食积
湿痰，古二母散、神保丸、大萝皂丸。
七情气急无声响，
惊忧气郁，惕惕闷闷，引息鼻张气喘，呼吸急促而无痰声者，四七汤、枳梗汤、
分气紫苏饮、四磨汤。因补药喘者，三拗汤。
外感里逆只气粗；
外感表邪传里，里实不受则气逆上，详见伤寒。寻常感冒，风寒相干，肺胀逆而
喘者，随时令祛散。风喘，金沸草散、麻黄杏仁饮；寒喘，加减三拗汤、藿香正气散加五味
子、杏仁，或苏沉九宝饮；暑月，香葛汤；热证，小柴胡汤、凉膈散。
水喘怔忡或肿胀，
水喘，水气辘辘有声，怔忡者，小青龙汤、古葶枣散、白前汤。水肿、水气胀肺
而喘，然喘必生胀，胀必生喘，二证相因，皆小便不利。肺主气，先喘而后胀者，宜清金降
火，而行水次之；脾主湿，先胀而后喘者，宜燥脾行水，而清金次之。
以上诸喘皆有余。阴虚火从脐下起，
阴虚喘者，血虚则阳无所根据附而上奔，宜四物汤倍芍药，加人参、五味子以收之
；有小腹下火起冲上而喘者，宜降心火，补真阴，四物二陈汤加知、柏、枳壳、黄芩。
气短不能续吸呼。
久病气短不能接续，似喘非喘者，单人参汤、扶脾生脉散、调中益气汤。劳涉过
者，杏参散；饮食热者，葶苈散；痰阻短气者，导痰汤；浊阴在上，清阳陷下，咳喘呕吐者
，加味泻白散。
肾冷元气不能纳，
下元虚冷，肾气不得归元者，九味安肾丸、八味丸；甚者，黑锡丹以镇坠之。烦
躁无脉，身冷神昏者，死。
抬肩撷肚胃衰乎！
胃虚极则气上逆，抬肩撷肚，生脉散加杏仁、陈皮、白术、或理中丸加胡椒救之
。仲景云∶发汗如油，汗出如珠不流，抬肩撷肚，喘而不休及胸前高起，脉络散张，手足厥
冷，脉散及数者，皆死。但妇人喘病尤亟，产后荣竭，卫气无根据，独聚于肺发喘者，死速
。
未发扶正治其本，
血虚补血，气虚补气，兼以清金降火，顺气化痰。
已发辟邪痰火疏。
喘非风寒乘肺，则痰火胀肺。风寒，祛散；痰火，疏导。但火急甚者，亦不可纯
苦药，宜温以劫之，用椒目五七钱为末，姜汤下。喘止后，因痰治痰，因火治火。诸喘不止
者，小萝皂丸、定息饼子、含奇丸、定喘化痰散。久者，人参清肺饮倍粟壳涩之。抑考《内
经》云∶夜行喘出于肾，淫气病肺；有所堕恐，喘出于肝，淫气害脾；有所惊恐，喘出于肺
，淫气伤心；渡水跌仆，喘出于肾，淫气损肝。又云∶邪入六腑，身热喘呼不得卧。此喘之
名同，而所感各异耳。
哮
即痰喘甚，而常发者。
哮促喉中痰作声，吐法必须量体行；
体实者，用紫金丹二十丸，吐去其痰；虚者止服二三丸则不吐，临发时，用此劫
之。丹溪方去豆豉更妙。一法∶用二陈汤加苍术、黄芩，下小胃丹。体虚者，吐、下俱忌，
须带表散之。
挟水挟寒须带表，
水哮者，因幼时被水，停蓄于肺为痰，宜金沸草散、小青龙汤倍防己，或古葶枣
散、导水丸。有寒包热者，麻黄汤加桔梗、紫苏、半夏、黄芩。有风痰者，千缗汤，或用
鸡
子一枚，略敲壳损，勿令膜破，放尿缸中三日夜，取煮食之，效。凡哮须忌燥药，亦不宜纯
凉，须常带表。
断根扶正金宜清。
欲断根者，必先淡滋味，然后服清肺金、扶正气之剂，如定喘汤、黄芩利膈丸是
也。遇浓味发者，清金丸；久不得睡者，兜铃丸。单方∶猫儿头骨烧灰，酒调服二三钱，一
服即止。
恶心
恶心欲吐不得吐，一见饮食心便恶；
二陈汤加白豆蔻、香附、砂仁。
不渴胃虚与胃寒，
胃寒，理中汤加陈皮、半夏、生姜各等分。胃虚，六君子汤，加砂仁；挟火，加
姜
汁炒黄连少许。
烦渴胃家痰火聚。
痰盛者，大、小半夏汤；火盛者，二陈汤加姜汁炒芩、连。船晕恶心，治同。
嘈杂
心嘈似饥又烦杂，
似饥非饥，似痛非痛，或兼暧气、痞满、恶心，渐至胃脘作痛，乃呃逆、翻胃之
由也。
纵食多忧痰火合；
食郁者，枳术丸加山楂、麦芽；有热，更加芩、连。停饮者，曲术丸；胸满者，
大安丸、保和丸。忧郁者，越曲丸、香连丹。湿痰气郁不喜食者，三补丸加苍术，倍香附；
索食者，三圣丸。痰因火动者，治痰为先，二陈汤加姜汁炒芩、连、山栀为君，南星、半夏
为佐；热多，加青黛。火动其痰者，二陈汤加姜炒芩、连、山栀；火郁，更加抚芎、苍术。
痰火
俱盛者，祛痰火丸。
五更嘈者思虑伤，血分稍亏宜补接。
四物汤加香附、贝母、山栀、黄连、甘草。
嗳气
嗳转食气名嗳气，有痰有火滞于胃；
胃中郁火，膈上稠痰，饮食郁成，宜祛痰火丸、润下丸、古萸连丸。
实嗳食罢嗳方形，
气盛实嗳，食罢嗳转腐气，甚则物亦嗳转，多伤食、湿热所致。二陈汤加苍术、
神曲、麦芽、姜炒黄连，或保和丸。
虚嗳浊气填胸次。
不因饮食常嗳者，虚也。盖胃有浊气，膈有湿痰，俱能发嗳，六君子汤加沉香为
君，浓朴、苏子为臣，吴萸为使。久者，匀气丸，或苏合香丸；甚者，灵砂以镇坠之。
呕吐
呕吐须知胃冷热，
大概肥白肉浮多寒湿，瘦黑骨露多燥热，更参脉证。胃冷，面青、手足厥、食
入乃吐，二陈汤加姜、桂；甚，加丁、附，或丁香半夏丸。胃热，面红、手足热、食已即吐
，
二陈汤加姜炒芩、连、山栀；暴甚，略加槟榔、木香；胃口疼，加姜汁，或葛根竹茹汤、加
味橘皮竹茹汤，或小柴胡汤加竹茹。如时常口吐清水冷涎，自下涌上者，此脾热所致也，
二陈汤中白术，白芍，升麻，炒芩、连、山栀，神曲，麦芽，干、生姜等分，或丸或煎服
。
次分三焦有妙括；眩晕不食气上攻，
上焦吐者，气冲胸痛，食已暴吐而渴，治当降气和中，六君子汤加木香、藿香、
桔梗、枇杷叶、或七气汤；热气冲者，古荆防汤加人参、甘草、槟榔。
胸满酸闷食作孽；
中焦吐者，食积与气。或先吐而后痛，或先痛而后吐，治当以木香、槟榔等分为
末
，调服行气紫沉丸。消积，寻常平胃散，二陈汤加青皮、砂仁、白豆蔻、山楂、神曲调之。
厥冷下焦停有寒，
下焦吐者，寒也。朝食暮吐，暮食朝吐，久则小便清利，大便不通，乃阴气偏结
，不与阳和。治当温其寒而通其秘，复以中焦药和之，附子理中汤、木香匀气散合理中汤、
四逆汤、丁胡三建汤、古丁半汤、养正丹、古半硫丸。
三阳热壅大便结。
呕家不可下者，常也。如喜冷烦渴，胸满腹痛，甚而大便闭者，大小肠、膀胱结
也。热者，大柴胡汤下之；虚者，润之。
痰火不已水怔忡，
呕吐，痰火为多，二陈汤加姜炒芩、连，或小调汤主之。肝火出胃者，单黄连
丸，或单人中白，姜汁化服。脾经湿痰郁滞上中二焦，时时恶心，吐出清水，或如豆汁者
，胃苓汤加半夏、槟榔。水呕，心下怔忡，先渴后呕者，赤茯苓汤；先呕后渴者，猪苓汤；
水入即吐者，五苓散。
腥臊熏心多瘀血；
腥气、臊气熏炙，恶心呕吐，杂以涎血，此脓血聚于经中，所谓呕家有痈脓，不
须治，脓尽自愈。四物汤倍赤茯苓、牡丹皮；虚者，八珍汤加陈皮。
客风翻翻暑渴烦，
风邪在胃，翻翻不定，或郁酸水，全不入食者，不换金正气散、麦天汤、安脾丸
，不宜轻用参、术，补住邪气反甚。惟久病肋痛者，木克土也，方敢用六君子汤加青皮、芍
药、柴胡、升麻、川芎、砂仁、神曲。治水热者，小柴胡汤加青黛、姜汁，蒸饼为丸服。暑
吐烦渴，黄连香薷散、六一散加砂仁，或枇杷叶散、钱氏白术散。
气虚痞满虫痛切。
久病胃气虚弱，全不纳食，闻食气则呕者，四味藿叶汤，或四君子汤去茯苓，加
香附、参、 ；胸痞短气者，调中益气汤；胃虚寒痰作呕者，增半汤。虫吐，时常恶心，胃
口作痛，口吐清水，得食暂止，饥则甚者，胃中有蛔也，二陈汤加苦楝根、使君子、白术、
乌梅，或用锡灰、槟榔等分，米饮调服亦可。凡吐菜汁者，死。此是乍然呕吐，非翻胃
比也。又船晕大吐，渴饮水者，多死，惟童便饮之最妙。
呃逆
呃逆分不足有余，
不足，因内伤脾胃及大病后胃弱，多面青，肢冷，便软；有余，因外感胃燥及大
怒、太饱，多面红，肢热，便闭。有余可治，不足者危。
不足火炎阴气虚；
火乃元气之贼。人之阴气根据胃气而养，胃土受伤，则木气侵之，阴火所乘，不得
内守，木挟相火，直冲清道而上，乃虚之甚也。膏粱湿热者，十味小柴胡汤，吞单黄柏丸，
或调益元散；胃火善食者，小半夏汤加山栀、黄芩吐之；火盛者，益元散加黄连、黄柏；自
利，更加参、术、白芍、陈皮。久病滞下及妇人产后，从脐下逆上，夜分转甚者，皆属阴虚
，四物汤加知、柏、陈皮、竹茹。
劳役伤脾故有此，
贫苦大劳火动，浊升清陷者，补中益气汤，或合生脉散加黄柏、附子少许；挟
房劳者，琼玉膏；肾气不归元者，九味安肾丸。
久病寒搏火为辜；
极是危证。脉数为火刑金，必死。凡伤寒吐下及杂病久，每呃逆者，皆火欲上行
，
为胃中寒邪所遏，故搏而有声，俱宜丁香柿蒂散、羌活附子汤、理中汤倍参。久者，三香散
，或木瓜根煎汤呷之。中虚昏聩脉结者，炙甘草汤救之。
有余饱食（填寒胸中）失升降，
二陈汤加枳壳、砂仁。
痰郁何由得泰舒？
痰闭于上，火动于下，无别证，忽然发呃从胸中起者，芩连二陈汤，或只陈皮
、半夏，姜煎服，或人参芦煎汤吐之。停痰，或因怒郁瘀热者亦宜。盖参芦泻肺，肺衰气降
，而火土复位矣。七情气郁者，木香匀气散，用萝卜煎汤下，苏子降气汤。
阳证失下多潮热，
地道不通，因而呃逆。宜寒药下之，大柴胡汤。阳极脉微将脱者，宜凉膈散、解
毒汤，养阴退阳，不可大小。
汗吐下后（胃）热未除；
小柴胡加橘皮、竹茹，或橘皮竹茹汤、单泻心汤。
有余涌（吐）泄（平人食物太速
，饮水入肺，
喜笑太多，亦属有余。食呃、笑呃，以纸捻鼻嚏，或久闭气可止。水呃，小陷胸汤、小青龙
汤去麻黄，清之利之而已不足补。）
补有温平凉莫拘。
凡汗、吐、下、服凉药过多者，当温补；脾胃阴火上冲者
，当平补；挟热者，宜凉补。《局方》率用丁、附温暖助火，损不足而益有余，宜乎呃逆之
必死也！
膈噎
三焦枯槁成膈噎，
饮食不下，而大便不通，名膈噎。《疏》云∶膈有拒格意，即隔食反胃也。《玉
机》云∶噎塞大便不通，通幽汤。故以膈噎为题。《局方》以噎近咽，膈近胃，而遗下焦，
又妄分十膈五噎，皆非经旨。病因内伤，忧郁失志及饮食淫欲而动脾胃肝肾之火；或因杂病
，误服辛香燥药，俱令血液衰耗，胃脘枯槁。其槁在上焦贲门者，食不能下，下则胃脘当
心而痛，须臾吐出乃止。贲门，即胃脘上口，言水谷自此奔入于胃，而气则传之于肺也。其
槁在中焦幽门者，食物可下，良久复出。幽门与中脘相近，言其位幽僻，胃中水谷自此而入
小肠也。其槁在下焦阑门者，朝食暮吐，暮食朝吐。阑门脐下，拦约水谷，分入膀胱、大肠
而为粪溺。是大小肠、膀胱，乃气血津液流通之道路也。
阳火上升有虚热；
经曰∶三阳结谓之膈。小肠热结则血脉燥，大肠热结则不能便，膀胱热结则津液
涸。三阳热结，脉必洪数有力，前后闭塞。下既不通，必反而上行，所以噎食不下，纵下复
出，乃阳火上行而不下降也。实火，黄连解毒汤加童便、姜汁，或益元散入姜汁，澄白脚为
小丸，时时服之，温六丸尤妙。甚者，陶氏六一承气汤、人参利膈丸。虚火冲上，食不入者
，枳梗二陈汤加浓朴、白术及木香少许，或古萸连丸；渴者，钱氏白术散；大便闭者，导滞
通幽汤，或参仁丸、麻子仁丸。当噎未至于膈之时，便宜服此防之，膏肓之疾，岂可怠忽！
间有身受寒气，口伤冷物，以脾胃火衰，膈上苦冷，肠鸣，脉必滑微，宜暂用丁香煮散、五
膈汤、五噎汤、单附子散以劫之。若不求其本，偏认为寒，概用辛香燥药，必至烁阴不救。
为痰为积本七情，
古云∶膈噎神思间病，惟内观养之。盖七情火郁，熏蒸津液，为痰为积，积久则
喘急首先要分辨是肺实还是肺虚。
呼吸急促的，称为喘；喉咙里有响声的，称为哮。
虚证的表现是：气力匮乏，身体发凉，冷痰像冰一样；
实证的表现是：气息壮盛，胸部胀满，身体发热，大便干硬。
其次应当知道是否有火邪存在。
《内经》说：“各种向上冲逆的病证，都归属于火。”
虚火适宜用滋补和降气的方法治疗，实火适宜用清肺和泻胃的方法治疗。
如果是火炎上导致的喘，进食后喘息暂时停止，
这是火邪熏蒸肺胃引起的喘，症状时好时坏，进食后稠痰下沉则喘息停止；但食物进入胃中后，反而助长火邪和痰湿，导致上气喘促反而加重，适宜用降火清肺的方法，方用导痰汤加黄芩、黄连、山栀、杏仁、栝蒌。如果胃中有实火，膈上有稠痰的，可用导水丸。
痰喘发作时喉咙里像水鸡叫的声音。
痰喘必然伴有痰鸣声。
如果是风痰，用千缗汤，或者配合导痰汤；
如果是痰气阻滞，用苏子降气汤、四磨汤；
如果是食积湿痰，用古二母散、神保丸、大萝皂丸。
七情（喜、怒、忧、思、悲、恐、惊）引起的气急没有声响，
因惊恐忧虑导致气机郁结，心中惕惕不安、闷闷不乐，吸气时鼻孔张开、气喘吁吁，呼吸急促但没有痰声的，用四七汤、枳梗汤、分气紫苏饮、四磨汤。因为误服补药导致喘息的，用三拗汤。
外感病邪入里或里气上逆只表现为气粗，
外感表邪传入体内，里实而不能受纳则气逆向上，详见伤寒论。寻常感冒，风寒相兼，肺气胀满上逆而喘的，根据时令祛除外邪。
风喘，用金沸草散、麻黄杏仁饮；
寒喘，用加减三拗汤、藿香正气散加五味子、杏仁，或者苏沉九宝饮；
暑天，用香葛汤；
热证，用小柴胡汤、凉膈散。
水饮致喘伴随心悸或肿胀，
水饮致喘，水气辘辘有声，伴有心悸怔忡的，用小青龙汤、古葶枣散、白前汤。水肿、水气胀肺而喘，然而喘必然导致胀，胀必然导致喘，这两种证候互为因果，都伴有小便不利。肺主气，先喘而后出现胀满的，适宜清金降火，其次利水；脾主湿，先胀而后出现喘促的，适宜燥脾行水，其次清金。
以上各种喘证都属于有余（实证）。阴虚火旺从脐下发起，
阴虚喘者，血虚则阳气无所依附而上奔，适宜用四物汤倍加芍药，加入人参、五味子以收敛阳气；有小腹下部火起冲上导致喘的，适宜降心火，补真阴，用四物二陈汤加知母、黄柏、枳壳、黄芩。
气短不能接续吸呼。
久病气短不能接续，似喘非喘的，用单人参汤、扶脾生脉散、调中益气汤。劳倦过度的，用杏参散；饮食辛辣热性的，用葶苈散；痰阻导致短气的，用导痰汤；浊阴在上，清阳陷下，咳嗽气喘呕吐的，用加味泻白散。
肾冷元气不能摄纳，
下元虚冷，肾气不能归元的，用九味安肾丸、八味丸；严重的，用黑锡丹以镇坠之。烦躁无脉，身体冰冷神志昏迷的，为死证。
抬肩撷肚是胃气衰败吗！
胃气极度虚弱则气上逆，出现抬肩撷肚的症状，用生脉散加杏仁、陈皮、白术，或者理中丸加胡椒来救治。张仲景说：“出汗如油，汗出如珠而不流，抬肩撷肚，喘息不止以及胸前高起，脉络散张，手足厥冷，脉散乱及数疾的，都是死证。”但是妇人喘病尤其危急，产后营血枯竭，卫气无所依附，独聚于肺引发喘证的，死亡迅速。
未发作时扶助正气治其本，
血虚补血，气虚补气，兼以清金降火，顺气化痰。
已发作时祛除邪气、痰火疏通。
喘如果不是风寒乘袭肺脏，就是痰火胀塞肺脏。风寒，用祛散法；痰火，用疏导法。但是火邪急甚者，也不可纯用苦寒药，适宜用温性药物以劫夺火邪，用椒目五七钱研末，姜汤送服。喘止后，因痰治痰，因火治火。各种喘证不止的，用小萝皂丸、定息饼子、含奇丸、定喘化痰散。病程久的，用人参清肺饮倍加罂粟壳以涩之。又考察《内经》说：“夜间行走喘促出于肾，淫气伤害肺；有所堕坠恐惧，喘促出于肝，淫气伤害脾；有所惊恐，喘促出于肺，淫气伤害心；渡水跌仆，喘促出于肾，淫气损伤肝。又说：邪气侵入六腑，身体发热，喘呼不能卧。这些喘的名称相同，但所感受的病因各异罢了。”
即痰喘严重，且经常发作的。
哮促喉中痰作声，吐法必须根据体质施行；
体质实的，用紫金丹二十丸，吐出其痰；体虚的只服用二三丸则不吐，临发作时，用此药劫夺痰邪。丹溪方去掉豆豉更妙。另一种方法：用二陈汤加苍术、黄芩，送服小胃丹。体质虚的，吐法和下法都禁忌，必须带有解表发散的药物。
挟水挟寒须带解表，
水哮者，因幼年时被水惊吓，停蓄于肺化为痰，宜用金沸草散、小青龙汤倍加防己，或者古葶枣散、导水丸。有寒包热的，用麻黄汤加桔梗、紫苏、半夏、黄芩。有风痰的，用千缗汤，或者用鸡蛋一枚，略敲破壳但不令膜破，放入尿缸中三日夜，取出煮食，有效。凡哮必须忌用燥药，也不宜纯用凉药，必须常带解表药。
断根需扶助正气，清润肺金。
想要断根的，必须先清淡饮食，然后服用清肺金、扶正气的药剂，如定喘汤、黄芩利膈丸等。遇到浓味诱发者，用清金丸；久不得睡者，用兜铃丸。单方：猫儿头骨烧灰，酒调服二三钱，一服即止。
恶心
恶心欲吐不得吐，一见饮食心里就厌恶；
用二陈汤加白豆蔻、香附、砂仁。
不渴是胃虚与胃寒，
胃寒，用理中汤加陈皮、半夏、生姜各等分。胃虚，用六君子汤，加砂仁；挟火，加少许姜汁炒黄连。
烦渴是胃家痰火聚。
痰盛者，用大、小半夏汤；火盛者，用二陈汤加姜汁炒黄芩、黄连。船晕恶心，治疗同此。
心嘈似饥又烦杂，
似饥非饥，似痛非痛，或者兼有嗳气、痞满、恶心，逐渐发展到胃脘作痛，这是呃逆、翻胃的原因。
纵食多忧痰火合；
食积郁滞者，用枳术丸加山楂、麦芽；有热，再加黄芩、黄连。停饮者，用曲术丸；胸满者，用大安丸、保和丸。忧郁者，用越曲丸、香连丹。湿痰气郁不喜欢吃东西的，用三补丸加苍术，倍加香附；想吃东西的，用三圣丸。痰因火动者，治痰为先，用二陈汤加姜汁炒黄芩、黄连、山栀为君药，南星、半夏为佐药；热多，加青黛。火动其痰者，用二陈汤加姜炒黄芩、黄连、山栀；火郁，再加抚芎、苍术。
痰火俱盛的，用祛痰火丸。
五更嘈杂者是思虑伤神，血分稍亏适宜补接。
用四物汤加香附、贝母、山栀、黄连、甘草。
嗳转食气名嗳气，有痰有火滞于胃；
胃中郁火，膈上稠痰，饮食郁结而成，宜用祛痰火丸、润下丸、古萸连丸。
实嗳食罢嗳方形，
气盛实嗳，饭后嗳转腐气，甚至将食物也嗳转出来，多由伤食、湿热所致。用二陈汤加苍术、神曲、麦芽、姜炒黄连，或者保和丸。
虚嗳浊气填胸次。
不因饮食常嗳的，是虚证。因为胃有浊气，膈有湿痰，都能引发嗳气，用六君子汤加沉香为君药，浓朴、苏子为臣药，吴茱萸为使药。病程久的，用匀气丸，或者苏合香丸；严重的，用灵砂以镇坠之。
呕吐须知胃冷热，
大概肥白肉浮的多寒湿，瘦黑骨露的多燥热，还要参考脉证。胃冷，面色青、手足厥冷、食入乃吐，用二陈汤加姜、桂；严重的，加丁香、附子，或者丁香半夏丸。胃热，面色红、手足热、食已即吐，用二陈汤加姜炒黄芩、黄连、山栀；暴甚，略加槟榔、木香；胃口疼，加姜汁，或者葛根竹茹汤、加味橘皮竹茹汤，或小柴胡汤加竹茹。如果时常口吐清水冷涎，自下涌上者，这是脾热所致，在二陈汤中加入白术、白芍、升麻、炒黄芩、黄连、山栀、神曲、麦芽、干姜、生姜等分，或者制成丸剂或煎剂服用。
次分三焦有妙括；眩晕不食气上攻，
上焦吐者，气冲胸痛，食已暴吐而渴，治疗应当降气和中，用六君子汤加木香、藿香、桔梗、枇杷叶、或者七气汤；热气冲者，用古荆防汤加人参、甘草、槟榔。
胸满酸闷食作孽；
中焦吐者，食积与气。或者先吐而后痛，或先痛而后吐，治疗应当以木香、槟榔等分为末，调服行气紫沉丸。消积，用寻常平胃散，二陈汤加青皮、砂仁、白豆蔻、山楂、神曲调服。
厥冷下焦停有寒，
下焦吐者，寒也。朝食暮吐，暮食朝吐，久则小便清利，大便不通，乃阴气偏结，不与阳和。治疗应当温其寒而通其秘，再用中焦药调和，用附子理中汤、木香匀气散合理中汤、四逆汤、丁胡三建汤、古丁半汤、养正丹、古半硫丸。
三阳热壅大便结。
呕家不可下者，常理。如果喜欢冷饮烦渴，胸满腹痛，甚至大便闭结的，是大肠、小肠、膀胱结热。热者，用大柴胡汤下之；虚者，润之。
痰火不已水怔忡，
呕吐，痰火居多，用二陈汤加姜炒黄芩、黄连，或者小调汤主治。肝火出胃者，单用黄连丸，或者单人中白，姜汁化服。脾经湿痰郁滞上中二焦，时时恶心，吐出清水，或者如豆汁者，用胃苓汤加半夏、槟榔。水呕，心下怔忡，先渴后呕者，用赤茯苓汤；先呕后渴者，用猪苓汤；水入即吐者，用五苓散。
腥臊熏心多瘀血；
腥气、臊气熏炙，恶心呕吐，杂以涎血，这是脓血聚于经络中，所谓呕家有痈脓，不需要治疗，脓尽自愈。用四物汤倍加赤茯苓、牡丹皮；虚者，用八珍汤加陈皮。
客风翻翻暑渴烦，
风邪在胃，翻翻不定，或者郁积酸水，完全不能进食的，用不换金正气散、麦天汤、安脾丸，不宜轻用参、术，补住邪气反而更重。只有久病肋痛者，是木克土，才敢用六君子汤加青皮、芍药、柴胡、升麻、川芎、砂仁、神曲。治水热者，用小柴胡汤加青黛、姜汁，蒸饼为丸服用。暑吐烦渴，用黄连香薷散、六一散加砂仁，或者枇杷叶散、钱氏白术散。
气虚痞满虫痛切。
久病胃气虚弱，全不纳食，闻食气则呕的，用四味藿叶汤，或者四君子汤去茯苓，加香附、人参、[原文缺字，推测为白术]；胸痞短气的，用调中益气汤；胃虚寒痰作呕的，用增半汤。虫吐，时常恶心，胃口作痛，口吐清水，得食暂止，饥则甚重的，胃中有蛔虫，用二陈汤加苦楝根、使君子、白术、乌梅，或者用锡灰、槟榔等分，米饮调服亦可。凡吐菜汁的，死证。这是乍然呕吐，不是翻胃可比。又船晕大吐，渴饮水的，多死，只有童便饮用最妙。
呃逆分不足有余，
不足，因内伤脾胃及大病后胃弱，多见面青，肢冷，便软；有余，因外感胃燥及大怒、太饱，多见面红，肢热，便闭。有余可治，不足者危。
不足火炎阴气虚；
火乃元气之贼。人的阴气依靠胃气而滋养，胃土受伤，则木气侵之，阴火所乘，不得内守，木挟相火，直冲清道而上，这是虚之甚也。膏粱湿热者，用十味小柴胡汤，吞服单黄柏丸，或者调益元散；胃火善食者，用小半夏汤加山栀、黄芩吐之；火盛者，用益元散加黄连、黄柏；自利，更加人参、白术、白芍、陈皮。久病滞下及妇人产后，从脐下逆上，夜分转甚重的，皆属阴虚，用四物汤加知母、黄柏、陈皮、竹茹。
劳役伤脾故有此，
贫苦大劳火动，浊升清陷的，用补中益气汤，或者合生脉散加黄柏、附子少许；挟房劳的，用琼玉膏；肾气不归元的，用九味安肾丸。
久病寒搏火为辜；
极是危证。脉数为火刑金，必死。凡伤寒吐下及杂病久，每呃逆的，皆是火欲上行，为胃中寒邪所遏，故搏而有声，都适宜用丁香柿蒂散、羌活附子汤、理中汤倍加人参。病程久的，用三香散，或者木瓜根煎汤呷之。中虚昏聩脉结代的，用炙甘草汤救之。
痰郁何由得泰舒？
痰闭于上，火动于下，无别证，忽然发呃从胸中起的，用芩连二陈汤，或者只用陈皮、半夏，姜煎服，或者人参芦煎汤吐之。停痰，或因怒郁瘀热者也适宜。盖参芦泻肺，肺衰气降，而火土复位矣。七情气郁的，用木香匀气散，用萝卜煎汤送服，或者苏子降气汤。
阳证失下多潮热，
地道不通，因而呃逆。适宜用寒药下之，用大柴胡汤。阳极脉微将脱的，适宜用凉膈散、解毒汤，养阴退阳，不可大小便不通。
汗吐下后（胃）热未除；
用小柴胡加橘皮、竹茹，或者橘皮竹茹汤、单泻心汤。
有余涌（吐）泄（平人食物太速，饮水入肺，喜笑太多，亦属有余。食呃、笑呃，以纸捻鼻嚏，或久闭气可止。水呃，小陷胸汤、小青龙汤去麻黄，清之利之而已不足补。）
补有温平凉莫拘。
凡汗、吐、下、服凉药过多的，当温补；脾胃阴火上冲的，当平补；挟热的，宜凉补。《局方》率用丁香、附子温暖助火，损不足而益有余，难怪呃逆必死！
三焦枯槁成膈噎，
饮食不下，而大便不通，名膈噎。《疏》说：膈有拒格意，即隔食反胃也。《玉机》说：噎塞大便不通，用通幽汤。所以以膈噎为题。《局方》认为噎近咽，膈近胃，而遗下焦，又妄分十膈五噎，都不符合经典旨意。病因内伤，忧郁失志及饮食淫欲而动脾胃肝肾之火；或因杂病，误服辛香燥药，都令血液衰耗，胃脘枯槁。其槁在上焦贲门的，食不能下，下则胃脘当心而痛，须臾吐出乃止。贲门，即胃脘上口，言水谷自此奔入于胃，而气则传之于肺也。其槁在中焦幽门的，食物可下，良久复出。幽门与中脘相近，言其位幽僻，胃中水谷自此而入小肠也。其槁在下焦阑门的，朝食暮吐，暮食朝吐。阑门脐下，拦约水谷，分入膀胱、大肠而为粪溺。是大小肠、膀胱，乃气血津液流通之道路也。
阳火上升有虚热；
经曰：三阳结谓之膈。小肠热结则血脉燥，大肠热结则不能便，膀胱热结则津液涸。三阳热结，脉必洪数有力，前后闭塞。下既不通，必反而上行，所以噎食不下，纵下复出，乃阳火上行而不下降也。实火，用黄连解毒汤加童便、姜汁，或者益元散入姜汁，澄白脚为小丸，时时服之，温六丸尤妙。严重的，用陶氏六一承气汤、人参利膈丸。虚火冲上，食不入的，用枳梗二陈汤加浓朴、白术及木香少许，或者古萸连丸；渴的，用钱氏白术散；大便闭的，用导滞通幽汤，或者参仁丸、麻子仁丸。当噎未至于膈之时，便宜服此防之，膏肓之疾，岂可怠忽！间有身受寒气，口伤冷物，以脾胃火衰，膈上苦冷，肠鸣，脉必滑微，适宜暂用丁香煮散、五膈汤、五噎汤、单附子散以劫之。若不求其本，偏认为寒，概用辛香燥药，必至烁阴不救。
Wheezing (Chuan)
In cases of urgent wheezing, one must first distinguish between Lung Excess and Lung Deficiency. Rapid breathing is termed "Wheezing" (Chuan); rattling sounds in the throat are termed "Asthma with Rattling" (Xiao). In deficiency patterns, there is a lack of Qi, coolness of the body, and cold phlegm like ice; in excess patterns, there is robust breath, chest fullness, fever, and hard stool. Secondly, one must determine the presence or absence of Fire. The Classics state: "All upward rushing and counterflow symptoms belong to Fire." For deficient Fire, tonification and descending Qi are appropriate; for excess Fire, clearing the Lung and draining the Stomach are appropriate.
If wheezing is caused by Fire blazing upwards, it may temporarily cease after eating. This is because when Fire blazes in the Lung and Stomach, wheezing comes and goes; after eating, thick phlegm sinks, and wheezing stops. However, once food enters the Stomach, it may instead aggravate Fire and Phlegm, causing upper wheezing to worsen significantly. In such cases, one should descend Fire and clear Metal (Lung), using Dao Tan Tang (Phlegm-Resolving Decoction) added with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), Xing Ren (Armeniacae Semen Amarum), and Gua Lou (Trichosanthis Fructus). If there is excess Fire in the Stomach and thick phlegm above the diaphragm, use Dao Shui Wan (Water-Guiding Pill).
Phlegm-wheezing presents with sounds like a water-fowl blowing. Phlegm-wheezing must have phlegm sounds. For Wind-Phlegm, use Qian Min Tang (Thousand-Min Decoction) or combine with Dao Tan Tang; for Phlegm-Qi obstruction, use Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) or Si Mo Tang (Four-Marrow Decoction); for food stagnation causing damp-phlegm, use Gu Er Mu San (Ancient Two Mothers Powder), Shen Bao Wan (Spirit-Preserving Pill), or Da Luo Zao Wan (Large Radish Soap Pill).
Qi urgency caused by Seven Emotions has no sound. Due to fright, worry, and Qi depression, with feelings of apprehension and gloom, drawing breath with flared nostrils and rapid breathing but without phlegm sounds, use Si Qi Tang (Four-Seven Decoction), Zhi Geng Tang (Immature Bitter Orange and Platycodon Decoction), Fen Qi Zi Su Yin (Separating Qi Perilla Infusion), or Si Mo Tang. If wheezing is caused by tonic medicines, use San Ao Tang (Three Unbinding Decoction).
Exterior contraction and interior counterflow present only with coarse breathing. When exterior pathogenic factors transmit inward and the interior excess cannot accept them, Qi counters upward; see Treatise on Cold Damage for details. For common colds where Wind-Cold interferes, causing Lung distension and counterflow leading to wheezing, dispel pathogens according to the season. For Wind-wheezing, use Jin Fei Cao San (Boiling Water Herb Powder); for Cold-wheezing, use Modified San Ao Tang, Huo Xiang Zheng Qi San (Agaricus Rectifying Qi Powder) added with Wu Wei Zi (Schisandrae Fructus) and Xing Ren, or Su Chen Jiu Bao Yin (Perilla and Amber Nine-Treasures Infusion); in summer heat, use Xiang Ge Tang (Pueraria and Costus Root Decoction); for Heat patterns, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Liang Ge San (Cooling the Diaphragm Powder).
Water-wheezing involves palpitations or swelling. For water-wheezing, where water qi gurgles and is accompanied by palpitations, use Xiao Qing Long Tang (Minor Green Dragon Decoction), Gu Ting Zao San (Ancient Tinglizi and Jujube Powder), or Bai Qian Tang (Cynanchum Atratum Decoction). Edema and water qi distending the Lung cause wheezing; however, wheezing generates distension, and distension generates wheezing; these two conditions are interdependent, both involving difficulty in urination. The Lung governs Qi; if wheezing precedes distension, clear Metal and descend Fire, followed by promoting water metabolism; the Spleen governs Dampness; if distension precedes wheezing, dry the Spleen and promote water metabolism, followed by clearing Metal.
The aforementioned wheezings are all Excess. Wheezing from Yin Deficiency with Fire rising from below the navel occurs because Blood deficiency leaves Yang without attachment, causing it to rush upward. Use Si Wu Tang (Four Substances Decoction) with doubled Shao Yao (Paeoniae Radix Alba), added with Ren Shen (Ginseng Radix) and Wu Wei Zi to astringe. If fire rises from the lower abdomen and rushes upward causing wheezing, descend Heart Fire and tonify True Yin, using Si Wu Er Chen Tang (Four Substances and Two Aged Ingredients Decoction) added with Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Zhi Ke (Aurantii Fructus Immaturus), and Huang Qin.
Shortness of Qi unable to continue inhalation/exhalation. In chronic illness, shortness of Qi that cannot connect, resembling wheezing but not quite, use Dan Ren Shen Tang (Single Ginseng Decoction), Fu Pi Sheng Mai San (Spleen-Supporting Pulse-Nourishing Powder), or Tiao Zhong Yi Qi Tang (Regulating Middle and Boosting Qi Decoction). Caused by overexertion, use Xing Shen San (Apricot and Ginseng Powder); caused by hot diet, use Ting Li San (Descurainiae Seed Powder); caused by Phlegm obstruction, use Dao Tan Tang; due to Turbid Yin above and Clear Yang sinking, with cough, wheezing, and vomiting, use Jia Wei Xie Bai San (Modified White Powder Draining Decoction).
Cold Kidney failing to grasp Yuan Qi. With deficiency-cold in the lower origin and Kidney Qi failing to return to its root, use Jiu Wei An Shen Wan (Nine-Ingredient Calming Kidney Pill) or Ba Wei Wan (Eight-Ingredient Pill); in severe cases, use Hei Xi Dan (Black Tin Elixir) to anchor and sink. If there is irritability, absent pulse, cold body, and coma, it is fatal.
Shoulder lifting and belly pulling indicate Stomach decline? Extreme Stomach deficiency causes Qi to counter upward, leading to shoulder lifting and belly pulling. Use Sheng Mai San (Generate the Pulse Powder) added with Xing Ren, Chen Pi (Citri Reticulatae Pericarpium), and Bai Zhu (Atractylodis Macrocephalae Rhizoma), or Li Zhong Wan (Regulate the Middle Pill) added with Hu Jiao (Piperis Longi Fructus). Zhang Zhongjing said: "Sweating like oil, sweat droplets not flowing, shoulder lifting and belly pulling, continuous wheezing, chest prominence, scattered vessels, cold extremities, scattered and rapid pulse—all indicate death." However, wheezing in women is particularly urgent; postpartum Ying blood exhaustion, with Wei Qi having no foundation, gathering solely in the Lung to cause wheezing, leads to rapid death.
Before onset, support Righteousness to treat the root. Tonify Blood if deficient, tonify Qi if deficient, combined with clearing Metal, descending Fire, regulating Qi, and resolving Phlegm.
After onset, expel Evil, resolve Phlegm and Fire. Wheezing is either Wind-Cold invading the Lung or Phlegm-Fire distending the Lung. For Wind-Cold, disperse; for Phlegm-Fire, guide out. However, if Fire is extremely urgent, pure bitter-cold drugs should not be used exclusively; use warm methods to seize it. Use Jiao Mu (Zanthoxyli Semen) 5-7 qian as powder, taken with Ginger Decoction. After wheezing stops, treat Phlegm for Phlegm, treat Fire for Fire. For persistent wheezing, use Xiao Luo Zao Wan, Ding Xi Bing Zi, Han Qi Wan, or Ding Chu Hua Tan San. For chronic cases, use Ren Shen Qing Fei Yin with doubled Ying Su Ke (Papaveris Capsulum) to astringe. Examining the *Nei Jing*: "Night walking wheezing originates from the Kidney, excessive Qi harms the Lung; falling/fright wheezing originates from the Liver, excessive Qi harms the Spleen; fear/shock wheezing originates from the Lung, excessive Qi harms the Heart; wading/falling wheezing originates from the Kidney, excessive Qi damages the Liver." It also states: "Pathogens entering the Six Fu organs cause fever, wheezing, calling, and inability to lie down." These wheezings share the same name but have different etiologies.
Asthma with Rattling (Xiao)
This is severe phlegm-wheezing that recurs frequently.
Asthma with rattling sounds requires emesis based on constitution. For strong constitutions, use Zijin Dan (Purple Gold Elixir) 20 pills to vomit out phlegm; for weak constitutions, take only 2-3 pills to avoid vomiting, using this to seize the pathogen at onset. Danxi's formula removing Dou Chi (Fermented Soybean) is better. Another method: use Er Chen Tang (Two Aged Ingredients Decoction) added with Cang Zhu (Atractylodis Rhizoma) and Huang Qin, administered with Xiao Wei Dan (Small Stomach Pill). Weak constitutions contraindicate emesis and purgation; surface-dispelling methods must be included.
Accompanying Water and Cold requires surface dispersion. Water-asthma, caused by childhood water-dampness retained in the Lung transforming into Phlegm, uses Jin Fei Cao San, Xiao Qing Long Tang with doubled Fang Ji (Stephaniae Tetrandrae Radix), or Gu Ting Zao San, Dao Shui Wan. Cold-enveloping-Heat uses Ma Huang Tang (Ephedra Decoction) added with Jie Geng (Platycodonis Radix), Zi Su (Perillae Folium), Ban Xia (Pinelliae Rhizoma), and Huang Qin. Wind-Phlegm uses Qian Min Tang, or an egg cracked slightly (membrane intact) placed in a urine chamber for three days, then boiled and eaten—effective. Asthma must avoid drying herbs and pure cooling herbs; surface dispersion should always be included.
Root elimination supports Righteousness and clears Lung Metal. To eliminate the root, first maintain a bland diet, then take formulas clearing Lung Metal and supporting Righteousness, such as Ding Chuan Tang (Stabilizing Wheezing Decoction) or Huang Qin Li Ge Wan (Scutellaria Clearing Diaphragm Pill). If triggered by rich foods, use Qing Jin Wan; if insomnia persists, use Dou Ling Wan (Loquat Leaf Pill). Single remedy: Cat Head Bone (Mao Er Tou Gu) burnt to ash, taken with wine 2-3 qian, stops immediately upon one dose.
Nausea
Nausea with urge to vomit but inability, aversion to food sight. Use Er Chen Tang added with Bai Dou Kou (Amomi Fructus Rotundus), Xiang Fu (Cyperi Rhizoma), and Sha Ren (Amomi Fructus).
No thirst indicates Stomach Deficiency and Cold. Stomach Cold uses Li Zhong Tang (Regulate the Middle Decoction) added with Chen Pi, Ban Xia, and Sheng Jiang (Zingiberis Rhizoma Recens) in equal parts. Stomach Deficiency uses Liu Jun Zi Tang (Six Gentlemen Decoction) added with Sha Ren; if accompanied by Fire, add small amount of Jiang Zhi Chao Huang Lian (Ginger-processed Coptis Rhizoma).
Irritable thirst indicates Phlegm-Fire accumulation in the Stomach. Severe Phlegm uses Da/Xiao Ban Xia Tang (Major/Minor Pinellia Decoction); severe Fire uses Er Chen Tang added with Jiang Zhi Huang Qin and Huang Lian. Motion sickness nausea is treated similarly.
Clamoring (Zao Ce)
Heart clamoring resembles hunger yet is irritable. Resembling hunger but not quite, resembling pain but not quite, possibly accompanied by belching, fullness, and nausea, gradually progressing to epigastric pain; this is the precursor to hiccup and regurgitation.
Overeating and worry combine Phlegm and Fire. Food stagnation uses Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) added with Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus); if Heat, add Huang Qin and Huang Lian. Fluid retention uses Qu Zhu Wan (Medicated Leaven and Atractylodes Pill); chest fullness uses Da An Wan (Great Peace Pill) or Bao He Wan (Preserve Harmony Pill). Depression uses Yue Qu Wan or Xiang Lian Dan. Damp-Phlegm and Qi depression with loss of appetite uses San Bu Wan added with Cang Zhu and doubled Xiang Fu; craving food uses San Sheng Wan. Phlegm moved by Fire treats Phlegm first: Er Chen Tang added with Jiang Zhi Huang Qin, Huang Lian, Zhi Zi as Sovereign, Nan Xing (Arisaematis Rhizoma) and Ban Xia as Ministers; if more Heat, add Qing Dai (Indigo Naturalis). Fire moving Phlegm uses Er Chen Tang added with Jiang Chao Huang Qin, Huang Lian, Zhi Zi; Fire depression adds Fu Xiong (Ligustici Chuanxiong Rhizoma) and Cang Zhu. Phlegm-Fire both excess uses Qu Tan Huo Wan.
Five-watch clamoring indicates Mind injury; slight Blood deficiency requires tonification. Use Si Wu Tang added with Xiang Fu, Bei Mu (Fritillariae Bulbus), Zhi Zi, Huang Lian, Gan Cao (Glycyrrhizae Radix et Rhizoma).
Belching (Ai Qi)
Belching of food gas is called Belching; Phlegm and Fire stagnate in the Stomach. Stomach郁 Fire and thick Phlegm above the diaphragm, formed by food stagnation, use Qu Tan Huo Wan, Run Xia Wan, or Gu Yu Lian Wan (Ancient Cornus and Coptis Pill).
Excess belching occurs after meals. Robust Qi excess belching, belching putrid gas after meals, even regurgitating food, mostly caused by food injury and Damp-Heat. Use Er Chen Tang added with Cang Zhu, Shen Qu (Medicated Leaven), Mai Ya, Jiang Chao Huang Lian, or Bao He Wan.
Deficiency belching fills the chest with Turbid Qi. Frequent belching unrelated to food indicates Deficiency. Stomach Turbid Qi and Diaphragm Damp-Phlegm cause belching. Use Liu Jun Zi Tang added with Chen Xiang (Aquilariae Lignum Resinatum) as Sovereign, Hou Po (Magnoliae Officinalis Cortex) and Su Zi (Perillae Fructus) as Ministers, Wu Zhu Yu (Evodiae Fructus) as Guide. Chronic cases use Yun Qi Wan or Su He Xiang Wan (Liquidamber and Styrax Pill); severe cases use Ling Sha (Cinnabar and Native Sulphur Elixir) to anchor.
Vomiting (Ou Tu)
Vomiting requires knowing Stomach Heat or Cold. Generally, fat/pale/flabby flesh indicates Cold-Damp; thin/dark/bony frames indicate Dry-Heat; consult pulse and symptoms. Stomach Cold: pale face, cold extremities, vomiting after eating; use Er Chen Tang added with Sheng Jiang and Gui Zhi (Cinnamomi Ramulus); severe, add Ding Xiang (Caryophylli Flos) and Fu Zi (Aconiti Lateralis Radix Praeparata), or Ding Xiang Ban Xia Wan. Stomach Heat: red face, hot extremities, vomiting immediately after eating; use Er Chen Tang added with Jiang Chao Huang Qin, Huang Lian, Zhi Zi; severe, add Bing Lang (Arecae Semen) and Mu Xiang (Aucklandiae Radix); gastric pain, add Jiang Zhi, or Ge Gen Zhu Ru Tang (Pueraria and Bamboo Shavings Decoction), Jia Wei Ju Pi Zhu Ru Tang, or Xiao Chai Hu Tang added with Zhu Ru (Bambusae Caulis in Taenia). Frequent spitting of clear cold saliva rising from below indicates Spleen Heat; use Er Chen Tang with Bai Zhu, Bai Shao (Paeoniae Radix Alba), Sheng Ma ( Cimicifugae Rhizoma), Jiang Chao Huang Qin, Huang Lian, Zhi Zi, Shen Qu, Mai Ya, Gan Jiang (Zingiberis Rhizoma), Sheng Jiang in equal parts, pill or decoction.
Next, differentiate Three Jiao; dizziness and anorexia with Qi attacking upward. Upper Jiao vomiting: Qi rushing to chest pain, violent vomiting after eating with thirst; treat by descending Qi and harmonizing Middle, use Liu Jun Zi Tang added with Mu Xiang, Huo Xiang (Agastaches Herba), Jie Geng, Pi Pa Ye (Loquat Leaf), or Qi Qi Tang; Heat Qi rushing uses Gu Jing Fang Tang added with Ren Shen, Gan Cao, Bing Lang.
Chest fullness, sour oppression, food as culprit. Middle Jiao vomiting: food stagnation and Qi. Vomiting then pain, or pain then vomiting; treat with Mu Xiang and Bing Lang powdered equally, mixed with Xing Qi Zi Chen Wan. Resolve stagnation: Ping Wei San, or Er Chen Tang added with Qing Pi (Citri Reticulatae Pericarpium Viride), Sha Ren, Bai Dou Kou, Shan Zha, Shen Qu.
Cold extremities indicate Cold retention in Lower Jiao. Lower Jiao vomiting is Cold. Morning food evening vomit, evening food morning vomit; long-term clear urine and constipation, indicating Yin Qi aggregation without Yang harmony. Treat by warming Cold and unblocking constipation, harmonize with Middle Jiao meds: Fu Zi Li Zhong Tang, Mu Xiang Yun Qi San combined with Li Zhong Tang, Si Ni Tang (Frigid Extremities Decoction), Ding Hu San Jian Tang, Gu Ding Ban Xia Tang, Yang Zheng Dan, Gu Ban Shou Wan.
Three Yang Heat obstruction causes constipation. Vomiting patients generally should not be purged. If preferring cold, irritable thirst, chest/abdominal fullness/pain, severe constipation, it is Large Intestine, Small Intestine, Bladder obstruction. Heat: purge with Da Chai Hu Tang (Major Bupleurum Decoction); Deficiency: moisten.
Persistent Phlegm-Fire causes Water Palpitations. Vomiting often due to Phlegm-Fire: Er Chen Tang added with Jiang Chao Huang Qin, Huang Lian, or Xiao Tiao Tang. Liver Fire exiting Stomach: single Huang Lian Wan or Ren Zhong Bai (Human Midsection Ash), dissolved in Jiang Zhi. Spleen Damp-Phlegm stagnating Upper/Middle Jiao, frequent nausea, spitting clear water or bean-soup-like fluid: Wei Ling Tang added with Ban Xia, Bing Lang. Water vomiting, subcardiac palpitations, thirst then vomiting: Chi Fu Ling Tang; vomiting then thirst: Zhu Ling Tang (Polypori Decoction); vomiting immediately after drinking: Wu Ling San (Five-Ingredient Powder with Poria).
Fishy/musk odors steaming Heart indicate Blood Stasis. Fishy/musk odors causing nausea/vomiting mixed with salivous blood indicates pus/blood accumulating in channels ("vomiting patient with carbuncle pus"); do not treat, self-heals when pus exhausted. Use Si Wu Tang with doubled Chi Fu Ling (Poria Cum Rosa) and Mu Dan Pi (Moutan Cortex); Deficiency: Ba Zhen Tang (Eight-Treasure Decoction) added with Chen Pi.
Guest Wind tossing, Summerheat thirst irritability. Wind Pathogen in Stomach, tossing不定, or郁 Acid Water, unable to eat: Bu Huan Jin Zheng Qi San, Mai Tian Tang, An Pi Wan; avoid easily using Ren Shen/Bai Zhu as tonification traps Evil. Only for chronic rib pain (Wood overcoming Earth), dare use Liu Jun Zi Tang added with Qing Pi, Shao Yao, Chai Hu (Bupleuri Radix), Sheng Ma, Chuan Xiong (Ligustici Chuanxiong Rhizoma), Sha Ren, Shen Qu. Water-Heat: Xiao Chai Hu Tang added with Qing Dai, Jiang Zhi, steamed biscuit pills. Summer vomiting/thirst: Huang Lian Xiang Ru San (Coptis and Elsholtzia Powder), Liu Yi San (Six-to-One Powder) added with Sha Ren, or Pi Pa Ye San, Qian Shi Bai Zhu San (Child Master's Atractylodes Powder).
Qi Deficiency fullness, Worm pain cutting. Chronic Stomach Qi weakness, unable to eat, vomiting at smell of food: Si Wei Huo Ye Tang, or Si Jun Zi Tang (Four Gentlemen Decoction) minus Fu Ling, added with Xiang Fu, Ren Shen, [missing character]; chest fullness/shortness of Qi: Tiao Zhong Yi Qi Tang; Stomach Deficiency Cold-Phlegm vomiting: Zeng Ban Tang. Worm vomiting: frequent nausea, gastric pain, spitting clear water, relief after eating, worse on hunger, indicates stomach roundworms: Er Chen Tang added with Ku Liu Gen (Meliae Radix), Shi Jun Zi (Quisqualis Fructus), Bai Zhu, Wu Mei (Mume Fructus), or Xi Hui (Tin Ash) and Bing Lang equally, rice drink. Vomiting vegetable juice is fatal. This is acute vomiting, not regurgitation. Severe motion sickness vomiting with thirst for water is often fatal; child urine is best.
Hiccups (E Ni)
Hiccups differentiate Deficiency and Excess. Deficiency: internal injury to Spleen/Stomach or post-major illness Stomach weakness, pale face, cold limbs, soft stool; Excess: exterior contracting Stomach Dryness, great anger, overeating, red face, hot limbs, constipation. Excess is treatable; Deficiency is critical.
Deficiency: Fire blazing, Yin Qi Deficient. Fire is the thief of Yuan Qi. Human Yin Qi relies on Stomach Qi for nourishment; Stomach Earth injured, Wood Qi invades, Yin Fire attacks, unable to stay inside, Wood carries Ministerial Fire straight up the Clear Path, extreme Deficiency. Rich/Damp-Heat: Shi Wei Xiao Chai Hu Tang, swallow Dan Huang Bo Wan, or tune Yi Yuan San; Stomach Fire with good appetite: Xiao Ban Xia Tang added with Zhi Zi, Huang Qin to induce vomiting; Fire excess: Yi Yuan San added with Huang Lian, Huang Bo; spontaneous diarrhea: add Ren Shen, Bai Zhu, Bai Shao, Chen Pi. Chronic dysentery/postpartum, counterflow from navel worsening at night: all Yin Deficiency, Si Wu Tang added with Zhi Mu, Huang Bo, Chen Pi, Zhu Ru.
Labor injures Spleen thus causing this. Poverty/great labor Fire movement, Turbid rising/Clear sinking: Bu Zhong Yi Qi Tang, or combine Sheng Mai San with small Huang Bo, Fu Zi; sexual fatigue: Qiong Yu Gao (Jade Jade Paste); Kidney Qi not returning to root: Jiu Wei An Shen Wan.
Long illness Cold clashing Fire is guilty. Extremely critical. Rapid pulse indicates Fire punishing Metal, fatal. Post-cold damage vomiting/purging or chronic disease hiccups: Fire wanting to go up, obstructed by Stomach Cold Pathogen, clashing making sound. All use Ding Xiang Shi Di San (Clove and Persimmon Sepal Powder), Qiang Huo Fu Zi Tang, Li Zhong Tang doubled Ren Shen. Chronic: San Xiang San, or Papaya Root decoction sip. Middle Deficiency confusion/knotted pulse: Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) saves.
Excess: Full eating (filling Chest with Cold) loses ascending/descending. Er Chen Tang added with Zhi Ke, Sha Ren.
How can Phlegm Depression be soothed? Phlegm closed above, Fire moving below, no other symptoms, sudden hiccup from chest: Qin Lian Er Chen Tang, or only Chen Pi, Ban Xia, Ginger decoction, or Ren Shen Lu (Ginseng Stalk) decoction to vomit. Retained Phlegm, or anger-depression stasis-Heat also suitable. Ren Shen Lu drains Lung, Lung declines Qi descends, Fire/Earth reset. Seven Emotions Qi depression: Mu Xiang Yun Qi San with Radish decoction, Su Zi Jiang Qi Tang.
Yang Syndrome missed purging causes tidal fever. Earthly Path blocked, hence hiccups. Purge with cold meds: Da Chai Hu Tang. Yang extreme, pulse faint about to collapse: Liang Ge San, Jie Du Tang, nourish Yin retreat Yang, size not large/small.
After sweating/vomiting/purging, Stomach Heat not removed. Xiao Chai Hu added with Ju Pi, Zhu Ru, or Ju Pi Zhu Ru Tang, Dan Xie Xin Tang.
Excess vomiting/diarrhea (Plain people eat too fast, water enters Lung, laughing too much also Excess. Food/Hiccup: paper twist nose sneeze, or hold breath stop. Water Hiccup: Xiao Xian Xiong Tang, Xiao Qing Long Tang minus Ma Huang, clear/drain only. Deficiency supplement.) Supplement: Warm/Flat/Cold do not拘. Sweating/vomiting/purging/excess cold meds: warm supplement; Spleen/Stomach Yin Fire rushing up: flat supplement; accompanied by Heat: cool supplement. *Ju Fang* uses Ding/Fu warming assisting Fire, damaging Deficiency increasing Excess, hence hiccups fatal!
Diaphragmatic Obstruction (Ge Ye)
Three Jiao withered forms Diaphragmatic Obstruction. Unable to eat, bowel不通, named Ge Ye. Commentary: Ge implies rejection, i.e., food blockage/regurgitation. *Yu Ji*: Obstruction/bowel不通, Tong You Tang. Hence title Ge Ye. *Ju Fang* says Ye near throat, Ge near Stomach, omitting Lower Jiao, wrongly dividing Ten Ges and Five Yes, not Classic intent. Etiology: Internal injury, depression/frustration, diet/lust moving Spleen/Stomach/Liver/Kidney Fire; or misc diseases, wrong use of pungent/drying meds, all deplete Blood, wither Stomach cavity. Withered at Upper Jiao Fen Men (Cardia): food cannot go down, if goes down, epigastric pain center heart, vomit shortly after stops. Fen Men is Stomach opening, water/grain enter Stomach, Qi transmits to Lung. Withered at Middle Jiao You Men (Pylorus): food can go down, returns after long time. You Men near Zhong Wan,幽僻, water/grain enter Small Intestine. Withered at Lower Jiao Lan Men (Intestinal Valve): morning food evening vomit, evening food morning vomit. Lan Men below navel, blocks water/grain, divides into Bladder/Large Intestine for feces/urine. Large/Small Intestines, Bladder are pathways for Blood/Qi/JinYe.
Yang Fire rising has Deficiency Heat. Classics: Three Yang knotting named Ge. Small Intestine Heat knotting makes Blood vessels dry; Large Intestine Heat knotting makes stool impossible; Bladder Heat knotting makes JinYe dry. Three Yang Heat knotting, pulse Hong/Shu/strong, front/back blocked. Down不通, must reverse up, hence food stuck, if goes down returns, Yang Fire going up not down. Excess Fire: Huang Lian Jie Du Tang added with Tong Bian (Child Urine), Jiang Zhi, or Yi Yuan San with Jiang Zhi, clarified white foot small pills, frequent intake, warm 6 pills excellent. Severe: Tao Shi Liu Yi Cheng Qi Tang, Ren Shen Li Ge Wan. Deficiency Fire rushing up, food not entering: Zhi Geng Er Chen Tang added with Hou Po, Bai Zhu, small Mu Xiang, or Gu Yu Lian Wan; thirsty: Qian Shi Bai Zhu San; constipated: Dao Zhi Tong You Tang, or Ren Shen Ren Wan, Ma Zi Ren Wan. When Ye not yet Ge, take this to prevent; incurable disease, how can neglect! Occasionally body Cold, mouth Cold injury, Spleen/Stomach Fire decline, Diaphragm bitter cold, bowel sounds, pulse Slippery/Micro, temporarily use Ding Xiang Zhu San, Wu Ge Tang, Wu Ye Tang, Dan Fu Zi San to seize. If seeking root, bias to Cold, general pungent/drying meds, will scorch Yin unsaveable.
Phlegm/Accumulation root is Seven Emotions. Ancients say: Ge Ye spirit-mind disease, only inner observation nourishes. Seven Emotions Fire郁, steaming JinYe, becomes Phlegm/Accumulation, accumulates long...