凡实邪在胃而作呕者，必有所因，必有见证。若因寒滞者，必多疼痛。因食滞者，必多
胀满。因气逆者，必痛胀连于胁肋。因火郁者，必烦热燥渴，脉洪而滑。因外感者，必头身
发热，脉数而紧，如无实证实脉而见呕吐者，切不可以实邪论治。
一、寒邪犯胃而作呕者，其证有三。一以食饮寒凉，或误食性寒生冷等物致伤胃气，因
而作呕。若果寒滞未散而兼胀兼痛者，宜温中行滞，以大小和中饮、神香散，或二陈汤加姜
桂之类主之，或和胃饮亦佳。一以阴寒气令，或雨水沙气及水土寒湿之邪犯胃，因而作呕、
作泄。若寒滞未散而或胀或痛者，宜温中散寒，以平胃散、神香散、加减二陈汤、除湿汤、
《局方》四七汤、大七香丸之类主之。一以风寒外感，或伤寒，或咳疟，凡邪在少阳，
表邪未解而渐次入里，所以外为寒热，内为作呕，盖少阳之经下胸中贯膈而然，此半表半里
证也。治宜解表散寒，以柴陈煎、小柴胡汤、正柴胡饮之类主之。若微呕微吐者，邪在少阳
。若大呕大吐者，此又邪在阳明，胃家病也，宜二陈汤，或不换金正气散、藿香正气散之类
主之。若胃虚兼寒者，惟理中汤、温胃饮之类为宜。
一、饮食伤胃而作呕者，如果留滞未消而兼胀痛等证，宜大和中饮、排气饮、神香散之
类主之，或启脾丸亦可酌用。如食已消而呕未止者，宜温胃饮主之。
一、火在中焦而作呕者，必有火证火脉，或为热渴，或为燥烦，脉必洪数，吐必涌猛，
形气声色必皆壮丽。若察其真有火邪，但降其火，呕必自止。火微兼虚者，宜《外台》黄芩
汤，或半夏泻心汤。火甚者，宜抽薪饮，或大小厘清饮。若暑热犯胃，多渴多呕，气虚烦躁
，而火有不清者，竹叶石膏汤。若热甚呕吐不止，而火在阳明兼头痛者，白虎汤，或太清饮
，或六一散。若冒暑呕吐而火不甚者，宜香薷饮、或五物香薷饮。此有胃火治按在后。
一、痰饮留于胸中，或寒湿在胃，水停中脘而作呕吐者，宜和胃二陈煎，苓术二陈煎，
或小半夏加茯苓汤、橘皮半夏汤之类皆可酌用。
一、气逆作呕者，多因郁怒，致动肝气，胃受肝邪，所以作呕。然胃强者未必易动，而
易动者多因胃虚，故凡治此者，必当兼顾胃气，宜六君子汤或理中汤主之。若逆气未散，或
多胀满者，宜二陈汤或橘皮半夏汤之类主之，或神香散亦佳。
一、疟痢作呕者，其在疟疾，则以表邪内陷。凡邪在少阳、阳明、太阴者，皆能作呕，
但解去表邪，呕必自止。其在痢疾之呕，则多因胃气虚寒。盖表非寒邪无以成疟，里非寒邪
无以成痢，而病不知本，尚何医云。二证方论具载本门。
一、朝食午吐，午食晚吐，或朝食暮吐，详后反胃门。
一方，治呕吐之极，或反胃，粥汤入胃即吐，垂死者，用人参二两，水一升，煮四合，
热服，日再进，兼以人参煮粥食之，即不吐。
凡是实邪在胃导致呕吐的，必定有致病原因，也必定有相应的证候表现。如果是因寒邪停滞引起的，必然伴有疼痛；因食积停滞引起的，必然伴有胀满；因气机逆乱引起的，疼痛和胀满会牵连到胁肋部位；因火邪郁结引起的，必然出现烦热、口干渴，脉象洪大且滑利；因外感邪气引起的，必然头身发热，脉象数而紧。如果没有实证和实脉却出现呕吐症状的，切不可按实邪论治。
一、寒邪侵犯胃部导致呕吐的，其证候有三种情况。一是因为饮食过凉，或误食性寒生冷的食物损伤了胃气，因而引起呕吐。如果确实是寒邪停滞未散，并且兼有胀满和疼痛，适宜用温中散滞的方法治疗，以大小和中饮、神香散，或者二陈汤加生姜、肉桂等药物为主方，或者使用和胃饮也很好。二是因为阴寒气候时令的影响，或雨水湿气以及水土寒湿之邪侵犯胃部，因而引起呕吐、腹泻。如果寒邪停滞未散，并且出现胀满或疼痛，适宜用温中散寒的方法治疗，以平胃散、神香散、加减二陈汤、除湿汤、《局方》四七汤、大七香丸等药物为主方。三是由于风寒外感，或是伤寒，或是咳嗽疟疾，凡是邪气在少阳经，表邪未解并逐渐传入里部，所以外部表现为寒热往来，内部表现为呕吐，这是因为少阳经脉下行穿过胸中、贯通膈肌所致，这属于半表半里的证候。治疗适宜用解表散寒的方法，以柴陈煎、小柴胡汤、正柴胡饮等药物为主方。如果是轻微呕吐，说明邪气在少阳经；如果是剧烈呕吐，说明邪气在阳明经，是胃腑的疾病，适宜用二陈汤，或不换金正气散、藿香正气散等药物为主方。如果是胃虚兼有寒邪，只有理中汤、温胃饮等药物比较适宜。
一、饮食损伤胃部导致呕吐的，如果食物停滞未消，并且兼有胀痛等症状，适宜以大和中饮、排气饮、神香散等药物为主方，或者酌情使用启脾丸。如果食物已经消化但呕吐仍未停止，适宜用温胃饮为主方治疗。
一、火邪在中焦导致呕吐的，必然有火证的征象和火脉的表现，或者是热渴，或者是燥烦，脉象必然洪大且数，呕吐必然汹涌猛烈，形体气息声音必然都显得壮盛有力。如果观察确认确实有火邪，只要清降火邪，呕吐自然会停止。如果是火邪轻微兼有虚证，适宜用《外台秘要》的黄芩汤，或者半夏泻心汤。如果火邪严重，适宜用抽薪饮，或者大小厘清饮。如果是暑热侵犯胃部，多口渴多呕吐，气虚烦躁，且火邪未能清除干净的，用竹叶石膏汤。如果热势极重呕吐不止，且火邪在阳明经兼有头痛的，用白虎汤，或者太清饮，或者六一散。如果是中暑呕吐且火邪不严重的，适宜用香薷饮，或者五物香薷饮。这部分关于胃火的治疗法则记载在后面。
一、痰饮停留在胸中，或者寒湿在胃，水液停聚在中脘导致呕吐的，适宜使用和胃二陈煎、苓术二陈煎，或者小半夏加茯苓汤、橘皮半夏汤等药物，皆可酌情选用。
一、气机逆乱导致呕吐的，多因郁怒，导致肝气妄动，胃受到肝邪的侵犯，所以引起呕吐。然而胃气强盛的人未必容易受触动，而容易受触动的多是因为胃虚，所以凡是治疗这种情况的，必须兼顾胃气，适宜用六君子汤或理中汤为主方。如果逆气未消散，或者伴有较多胀满的，适宜用二陈汤或橘皮半夏汤等药物为主方，或者神香散也很好。
一、疟疾和痢疾引起的呕吐，对于疟疾而言，是因为表邪内陷。凡是邪气在少阳、阳明、太阴经的，都能引起呕吐，但只要解除表邪，呕吐自然会停止。对于痢疾引起的呕吐，则多是因为胃气虚寒。因为如果不是寒邪侵袭体表就无法形成疟疾，如果不是寒邪困阻体内就无法形成痢疾，如果不了解疾病的根本，还谈什么医学呢？这两种证候的方剂论述都详细记载在本门相关章节中。
一、早晨吃晚上吐，中午吃晚上吐，或者早晨吃傍晚吐，详细内容参见后面的反胃门。
一方，治疗呕吐极其严重，或者反胃，喝粥汤进入胃里立刻吐出，濒临死亡的患者，用人参二两，水一升，煮取四合，趁热服用，每天进服两次，同时让人参煮粥食用，即可不再呕吐。
Whenever vomiting is caused by excess pathogens in the Stomach, there must be a specific cause and corresponding clinical manifestations. If caused by Cold stagnation, pain will inevitably be present. If caused by Food stagnation, abdominal distension will inevitably be present. If caused by Qi rebellion (rebellious Qi), pain and distension will extend to the hypochondriac region. If caused by Fire depression, irritability, heat sensation, dryness, and thirst will inevitably occur, with a surging and slippery pulse. If caused by external contraction, fever of the head and body will inevitably occur, with a rapid and tight pulse. If vomiting occurs without excess syndrome or excess pulse, it must not be treated as an excess pathogen condition.
1. Vomiting caused by Cold Evil invading the Stomach presents in three patterns. First, due to consumption of cold food and drinks, or accidental ingestion of cold and raw substances that damage Stomach Qi, leading to vomiting. If Cold stagnation has not dissipated and is accompanied by distension and pain, treatment should warm the Middle and dissipate stagnation, using Da Zhong He Yin (Large Harmonizing Decoction), Shen Xiang San (Aromatic Powder), or Er Chen Tang (Two-Cured Decoction) added with Sheng Jiang (Zingiberis Rhizoma Recens, Fresh Ginger) and Rou Gui (Cinnamomi Cortex, Cinnamon Bark); He Wei Yin (Stomach-Harmonizing Decoction) is also excellent. Second, due to Yin-Cold climatic conditions, or invasion of Rain/Water dampness and Water/Earth cold-damp pathogens into the Stomach, causing vomiting and diarrhea. If Cold stagnation has not dissipated and causes distension or pain, treatment should warm the Middle and dispel Cold, using Ping Wei San (Peace the Stomach Powder), Shen Xiang San, Jia Jian Er Chen Tang (Modified Two-Cured Decoction), Chu Shi Tang (Dampness-Expelling Decoction), Si Qi Tang (Four-Sevens Decoction from *Ju Fang*), or Da Qi Xiang Wan (Great Aromatic Pill). Third, due to Wind-Cold external contraction, or Shang Han (Cold Damage), or cough/malaria, where the pathogen is in the Shaoyang channel, the exterior pathogen has not resolved and gradually enters the interior; thus, exteriorly presenting as alternating chills and fever, and internally as vomiting. This occurs because the Shaoyang channel descends through the chest, pierces the diaphragm, and constitutes a half-exterior, half-interior syndrome. Treatment should release the exterior and disperse Cold, using Chai Chen Jian (Bupleurum and Two-Cured Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), or Zheng Chai Hu Yin (Correct Bupleurum Decoction). If vomiting is mild, the pathogen is in the Shaoyang. If vomiting is severe, the pathogen is in the Yangming, indicating a disease of the Stomach organ; treat with Er Chen Tang, Bu Huan Jin Zheng Qi San (Golden Replacement Upright Qi Powder), or Huo Xiang Zheng Qi San (Agastache Upright Qi Powder). If Stomach deficiency accompanies Cold, Li Zhong Tang (Regulate the Middle Decoction) or Wen Wei Yin (Warm Stomach Decoction) are appropriate.
2. Vomiting caused by dietary injury to the Stomach: if food stagnation remains undigested and is accompanied by distension and pain, treat with Da Zhong He Yin, Pai Qi Yin (Qi-Discharging Decoction), or Shen Xiang San; Qi Pi Wan (Spleen-Initiating Pill) may also be considered. If food has digested but vomiting persists, treat primarily with Wen Wei Yin.
3. Vomiting caused by Fire in the Middle Jiao: there must be Fire signs and Fire pulses, such as heat-thirst or dry irritability, with a surging and rapid pulse, violent projectile vomiting, and robust physical constitution, breath, and voice. If true Fire evil is confirmed, clearing the Fire alone will stop the vomiting. If Fire is mild and accompanied by deficiency, use Huang Qin Tang (Scutellaria Decoction from *Wai Tai*) or Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction). If Fire is severe, use Chou Xin Yin (Fire-Draining Decoction) or Da/Xiao Li Qing Yin (Large/Small Clearing Decoctions). If Summerheat-Heat invades the Stomach, causing excessive thirst and vomiting, Qi deficiency, irritability, and unclear Fire, use Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). If Heat is extreme with incessant vomiting, Fire is in the Yangming, and headache is present, use Bai Hu Tang (White Tiger Decoction), Tai Qing Yin (Supreme Clarity Decoction), or Liu Yi San (Six-to-One Powder). If vomiting is caused by Summerheat exposure with mild Fire, use Xiang Ru Yin (Elsholtzia Decoction) or Wu Wu Xiang Ru Yin (Five-Ingredient Elsholtzia Decoction). The treatment principles for Stomach Fire are detailed later.
4. Vomiting caused by Phlegm-Fluid retention in the chest, or Cold-Damp in the Stomach, with water accumulation in the Zhongwan (Conception Vessel CV12) area: treat with He Wei Er Chen Jian (Stomach-Harmonizing Two-Cured Decoction), Ling Zhu Er Chen Jian (Poria and Atractylodes Two-Cured Decoction), or Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia Added Poria Decoction), Ju Pi Ban Xia Tang (Tangerine Peel and Pinellia Decoction), selected as appropriate.
5. Vomiting caused by Qi rebellion: often due to emotional depression and anger, stirring Liver Qi, which invades the Stomach, causing vomiting. However, a strong Stomach is not easily disturbed; those easily disturbed usually have Stomach deficiency. Therefore, treatment must simultaneously support Stomach Qi, using Liu Jun Zi Tang (Six-Gentlemen Decoction) or Li Zhong Tang. If rebellious Qi has not dissipated or is accompanied by significant distension, use Er Chen Tang or Ju Pi Ban Xia Tang, or Shen Xiang San.
6. Vomiting associated with Malaria and Dysentery: In malaria, this is due to exterior pathogens sinking inward. Pathogens in the Shaoyang, Yangming, or Taiyin channels can all cause vomiting; resolving the exterior pathogen will stop the vomiting. In dysentery, vomiting is mostly due to Stomach Qi deficiency and Cold. Without Cold pathogens on the exterior, malaria cannot form; without Cold pathogens in the interior, dysentery cannot form. Ignoring the root cause renders medical practice meaningless. Formulas and discussions for these two conditions are recorded in their respective sections.
7. Vomiting after morning meals at noon/evening, or noon meals at evening: see the section on Fan Wei (Reversal Regurgitation) for details.
8. Formula for extreme vomiting or Fan Wei, where even gruel and soup are vomited immediately upon entering the Stomach, in critical condition: Use Ren Shen (Ginseng Radix et Rhizoma) 2 liang, boiled in 1 sheng of water to yield 4 he, taken hot. Administer twice daily. Additionally, consume gruel cooked with Ren Shen to stop vomiting.