柴胡半斤 黄芩三两 人参三两 甘草三两 半夏半升 生姜三两 大枣十二枚
右七味，以水一斗二升，煮取六升，去滓，再煎取三升，温服一升，日三服。
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呕而脉弱，小便复利，身有微热，见厥者难治，四逆汤主之。
【注】
呕而心烦，心中懊□，内热之呕也。今呕而脉弱，正气虚也，小便复利，中寒盛也。
身有微热而复见厥，曰难治者，此为寒盛格热于外，非呕而发热者比，故以四逆汤胜
阴回阳也。
【集注】
高世栻曰：呕者水去寒犹在上，小盒饭少，今复利者，寒亦在下也。脉弱者，气衰于
内，身微热者，格阳于外。呕证如是，则上下寒而内外虚，若见手足逆冷而厥者，则
表里阴阳之气，不相顺接，故为难治。四逆汤主之，生附子壮火回阳以治厥，干姜温
脾暖胃以治呕，甘草安中调上下以治内外也。
附子（生用）一枚 干姜一两半 甘草（炙）二两
右三味，以水三升，煮取一升二合，去滓，分温再服。强人可大附子 枚，干姜三两
。
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呕而胸满者，茱萸汤主之。
【注】
呕逆之气上冲于胸，胸中气实，则不受邪，必不满也；若胸中气虚，客寒邪气得以留
连，故胸满也。主之吴茱萸汤，补正气，降邪气也。
【集注】
徐彬曰：胸乃阳位，呕为阴邪，使胸之阳气足以御之则不呕，呕亦胸中无恙也，乃呕
而胸满，是胸虚邪客，不但胃不和矣。虚邪属阴，故以吴茱萸之苦辛温，善驱浊阴者
为君，人参补虚为佐，而以姜枣宣发上焦之正气也。
柴胡半斤，黄芩三两，人参三两，甘草三两，半夏半升，生姜三两，大枣十二枚。
以上七味药，用水一斗二升，煎煮至六升，滤去药渣，再次煎煮浓缩至三升，每次温服一升，每日服用三次。
@@@
呕吐且脉象微弱，小便反而通利，身体有轻微发热，出现四肢厥冷的症状属于难治之症，使用四逆汤主治。
【注解】
呕吐伴随心烦、心中烦闷不舒，这是内热引起的呕吐。现在呕吐且脉象微弱，说明正气虚弱；小便反而通利，说明中焦寒邪盛重。
身体有轻微发热却又出现四肢厥冷，称为难治的原因在于：这是寒邪极盛将阳气格拒于外所致，不同于一般的呕吐伴有发热的情况，因此使用四逆汤来战胜阴寒、回复阳气。
【集注】
高世栻说：呕吐是因为水饮去而寒邪仍停留在上部，小柴胡汤本可治疗，现在反而小便通利，说明寒邪也位于下部。脉象微弱，说明内部气机衰败；身体微热，说明阳气被格拒于外部。呕吐证候如此，则上下皆寒、内外皆虚，如果再加上手足逆冷而厥逆，那么表里阴阳之气不能相互顺接，所以难以治疗。使用四逆汤主治，生附子能壮火回阳以治疗厥逆，干姜能温脾暖胃以治疗呕吐，甘草能安和中焦、调和上下以治疗内外病症。
附子（生用）一枚，干姜一两半，甘草（炙）二两。
以上三味药，用水三升，煎煮至一升二合，滤去药渣，分两次温服。体质强壮的人可以使用大附子一枚，干姜三两。
@@@
呕吐且胸部胀满的，使用吴茱萸汤主治。
【注解】
呕逆之气上冲于胸，若胸中气实，则不受邪气侵袭，必然不会感到胀满；如果胸中气虚，客居的寒邪气得以停留，所以会出现胸满。主治使用吴茱萸汤，旨在补益正气、降泄邪气。
【集注】
徐彬说：胸部是阳气所在的位置，呕吐是由阴邪引起，如果胸部的阳气足以抵御它，就不会呕吐，呕吐时胸部也无恙；现在是呕吐且胸部胀满，说明胸中虚损、邪气客居，不仅仅是胃气不和。虚邪属于阴类，所以用吴茱萸的苦辛温之性，善于驱除浊阴作为君药，用人参补虚作为佐药，并用生姜和大枣宣发上焦的正气。
Bupleuri Radix (Chaihu) half a jin, Scutellariae Radix (Huangqin) three liang, Ginseng Radix et Rhizoma (Renshen) three liang, Glycyrrhizae Radix et Rhizoma (Gancao) three liang, Pinelliae Rhizoma Preparatum (Banxia) half a sheng, Zingiberis Rhizoma Recens (Shengjiang) three liang, Jujubae Fructus (Dazao) twelve pieces.
The above seven ingredients are boiled with one dou and two sheng of water until six sheng remain. The dregs are removed, and the liquid is further decocted to obtain three sheng. Take one sheng warm each time, three times a day.
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Vomiting accompanied by a weak pulse, frequent urination, slight fever in the body, and cold extremities constitute a difficult-to-treat condition; Si Ni Tang (Four Counterflow Decoction) is the primary treatment.
[Annotation]
Vomiting accompanied by mental restlessness and inner vexation indicates vomiting due to internal heat. Now, vomiting with a weak pulse indicates deficiency of healthy qi; frequent urination indicates excess cold in the middle jiao.
Slight fever combined with cold extremities is termed difficult to treat because this represents extreme cold repelling yang qi to the exterior, which differs from vomiting accompanied by fever. Therefore, Si Ni Tang (Four Counterflow Decoction) is used to overcome yin cold and restore yang qi.
[Collected Notes]
Gao Shishi stated: Vomiting occurs when fluid retention leaves but cold remains in the upper part; Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated, but now frequent urition implies cold also resides in the lower part. A weak pulse indicates衰竭 of qi internally; slight fever indicates yang qi repelled externally. With such vomiting symptoms, there is cold in both upper and lower parts and deficiency in both interior and exterior. If cold extremities and jue syndrome appear, the yin and yang qi of the interior and exterior fail to connect smoothly, making it difficult to treat. Si Ni Tang (Four Counterflow Decoction) is used as the main treatment: Raw Fuzii Radix (Fuzi, 附子) strengthens fire and restores yang to treat jue; Dried Zingiberis Rhizoma (Ganjiang, 干姜) warms the spleen and warms the stomach to treat vomiting; Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) stabilizes the middle and harmonizes upper and lower to treat interior and exterior conditions.
Raw Fuzii Radix (Fuzi, 附子) one piece, Dried Zingiberis Rhizoma (Ganjiang, 干姜) one liang and half, Prepared Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) two liang.
The above three ingredients are boiled with three sheng of water until one sheng and two he remain. The dregs are removed, and the decoction is divided into two warm doses. For robust individuals, a large Fuzii Radix (Fuzi, 附子) one piece and Dried Zingiberis Rhizoma (Ganjiang, 干姜) three liang may be used.
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Vomiting accompanied by chest fullness is primarily treated with Wuzhuyu Tang (Evodiae Fructus Decoction).
[Annotation]
Rebellious qi from vomiting rushes upward to the chest. If the chest qi is substantial, it resists pathogenic factors and will not feel full; if the chest qi is deficient, invading cold pathogenic factors can linger, causing chest fullness. Wuzhuyu Tang (Evodiae Fructus Decoction) is used to tonify healthy qi and descend pathogenic qi.
[Collected Notes]
Xu Bin stated: The chest is a position of yang qi, while vomiting is caused by yin pathogens. If the chest's yang qi is sufficient to resist them, vomiting will not occur, and the chest remains unharmed. However, vomiting with chest fullness indicates chest deficiency with pathogen invasion, implying not only stomach disharmony. Since deficient pathogens belong to yin, Evodiae Fructus (Wuzhuyu, 吴茱萸), with its bitter, acrid, and warm properties, is used as the sovereign herb for its ability to drive away turbid yin. Ginseng Radix et Rhizoma (Renshen, 人参) is used as an assistant to tonify deficiency, while Fresh Zingiberis Rhizoma (Shengjiang, 生姜) and Jujubae Fructus (Dazao, 大枣) are used to disseminate the healthy qi of the upper jiao.