凡胃虚作呕者，其证不一，当知所辨。若胃脘不胀者，非实邪也。胸膈不痛者，非气逆
也。内无热躁者，非火证也。外无寒热者，非表邪也。无食无火而忽为呕吐者，胃虚也。呕
吐无常而时作时止者，胃虚也。食无所停而闻食则呕者，胃虚也。气无所逆而闻气则呕者，
胃虚也。或身背或食饮微寒即呕者，胃虚也。或吞酸，或嗳腐，时苦恶心，兀兀然，泛泛然
，冷咽靡宁者，胃虚也。或因病误治，妄用克伐寒凉，本无呕而致呕者，胃虚也。或朝食暮
吐，暮食朝吐，食入中焦而不化者，胃虚也。食入下焦而不化者，土母无阳，命门虚也。凡
此虚证，必皆宜补，是固然矣。然胃本属土，非火不生，非暖不化，是土寒者，即土虚也，
土虚者，即火虚也，故曰脾喜暖而恶寒，土恶湿而喜燥。所以东垣《脾胃论》特着温补之法
，盖特为胃气而设也，庸可忽哉。第在河间，则言呕因胃火，是火多实也；兹余言呕因胃寒
，是寒多虚也。一热一寒，若皆失中和之论，不知呕因火者，余非言其必无，但因火而呕者
少，因寒而呕者多耳，因胃实而呕者少，因胃虚而呕者多耳，故不得不有此辨。
一、虚呕之治，但当以温胃补脾为主，宜人参理中汤为正治，或温胃饮、圣术煎、参姜
饮之类亦可酌用，或黄芽丸尤为最妙。若胃口寒甚者，宜附子理中汤，或四味回阳饮，或一
气丹主之。若虚在阴分，水泛为痰而呕吐者，宜金水六君煎；虚甚者，宜理阴煎，或六味回
阳饮。若久病胃虚不能纳谷者，俱当以前法酌治之。若胃气微虚而兼痰者，宜六君子汤主之
。
一、凡中毒而吐者，当察其所中者何物。盖中热毒而吐者，宜解以苦寒之剂。中阴寒之
毒而吐泻不止者，宜解以温热之剂。若因吐泻而脾胃致虚者，非大加温补不可。此证有中寒
毒吐泻，治按在后，当并阅之。
凡是因胃气虚弱导致呕吐的，其症状表现多样，应当仔细辨别。如果胃脘部没有胀满感，说明不是实邪阻滞。如果胸膈部位没有疼痛感，说明不是气机逆乱。如果体内没有烦热躁动，说明不是火热证候。如果体表没有恶寒发热的表现，说明不是外感表邪。如果没有饮食停滞也没有火热内扰，却突然发生呕吐，这是胃虚所致。呕吐发作没有规律，时好时坏，这是胃虚所致。食物并没有停积在胃中，但一闻到食物的气味就想吐，这是胃虚所致。气机并没有逆乱，但一闻到异味就想吐，这也是胃虚所致。或者身体背部感到寒冷，或者进食饮水稍凉就引发呕吐，这是胃虚所致。或者出现吞酸水、嗳出腐臭气味，时常感到恶心难受，心中懊恼不安，泛泛欲吐，咽喉间冷感无法安宁，这是胃虚所致。或者因为患病后治疗不当，错误地使用了攻伐或寒凉的药物，原本没有呕吐却导致了呕吐，这是胃虚所致。或者早晨吃的东西晚上吐出来，晚上吃的东西早晨吐出来，食物进入中焦却无法消化，这是胃虚所致。食物进入下焦却无法消化，这是因为脾土之母（肾阳/命门）阳气不足，属于命门火衰之虚证。以上这些虚证，都适宜采用补益法治疗，这当然是正确的。然而，胃本属土，没有火则不能生化，没有温暖则不能运化，所以土寒就是土虚，土虚就是火虚。因此说，脾脏喜欢温暖而厌恶寒冷，土性厌恶潮湿而喜欢干燥。所以李东垣在《脾胃论》中特别强调温补的方法，这确实是专门为调理胃气而设立的，怎么可以忽视呢？只是刘河间认为呕吐是由于胃中有火，那是火多导致的实证；而我这里论述呕吐是由于胃寒，那是寒多导致的虚证。一个讲热，一个讲寒，似乎都偏离了中和的理论。其实，并非我说呕吐由火引起的一定不存在，而是因为火引起的呕吐较少，由寒引起的呕吐较多；因胃实导致的呕吐较少，因胃虚导致的呕吐较多罢了，所以我不得不进行这样的辨析。
第一条：治疗虚呕，只应当以温胃补脾为主要原则，人参理中汤是正治之法，或者温胃饮、圣术煎、参姜饮等方剂也可以酌情使用，其中黄芽丸尤为精妙。如果胃寒严重的，宜用附子理中汤，或者四味回阳饮，或者一气丹来主治。如果病位在阴分，水湿泛滥形成痰饮而导致呕吐的，宜用金水六君煎；虚损严重的，宜用理阴煎，或者六味回阳饮。如果是久病导致胃虚不能受纳食物的，都应当根据上述方法酌情治疗。如果是胃气轻微虚弱且兼有痰湿的，宜用六君子汤主治。
第二条：凡是因中毒而呕吐的，应当观察其所中的是什么毒物。如果是中了热毒而呕吐的，宜用苦寒性质的药物来解毒。如果是中了阴寒之毒而导致呕吐腹泻不止的，宜用温热性质的药物来解毒。如果是因为剧烈的呕吐和腹泻导致脾胃虚弱的，非大力温补不可。此证中有中寒毒导致呕吐腹泻的情况，治疗方法在后面章节，应当一并阅读参考。
In cases of vomiting caused by Stomach deficiency, the symptoms vary, and careful differentiation is required. If there is no distension in the epigastrium, it indicates that pathogenic excess is not present. If there is no pain in the chest and diaphragm, it indicates that Qi rebellion is not the cause. If there is no internal heat and restlessness, it indicates that a Fire syndrome is not present. If there are no exterior signs of aversion to cold and fever, it indicates that an exterior pathogen is not involved. When vomiting occurs suddenly without food retention or internal heat, it is due to Stomach deficiency. When vomiting is irregular, occurring intermittently, it is due to Stomach deficiency. When food does not stagnate in the stomach, yet the smell of food triggers vomiting, it is due to Stomach deficiency. When Qi does not rebel, yet the smell of odors triggers vomiting, it is also due to Stomach deficiency. When one feels coldness in the back or body, or vomits immediately after consuming slightly cool food or drink, it is due to Stomach deficiency. When one experiences acid regurgitation, belching with a putrid odor, frequent nausea, inner discomfort (Wuwuran), and a sensation of rising nausea with unrelenting coldness in the throat, it is due to Stomach deficiency. When improper treatment of illness leads to the erroneous use of purgative or cold-natured herbs, causing vomiting where none existed before, it is due to Stomach deficiency. When morning food is vomited in the evening, or evening food in the morning, indicating that food entering the Middle Jiao fails to digest, it is due to Stomach deficiency. When food entering the Lower Jiao fails to digest, it is because the Mother of Earth (Kidney Yang/Mingmen) lacks Yang, constituting a deficiency of Mingmen fire. All such deficiency syndromes must be treated with tonification; this is indeed correct. However, the Stomach belongs to Earth, which cannot generate life without Fire, nor transform substances without warmth. Therefore, Cold Earth is equivalent to Deficient Earth, and Deficient Earth is equivalent to Deficient Fire. Thus, it is said that the Spleen prefers warmth and dislikes cold, and Earth dislikes dampness and prefers dryness. For this reason, Li Dongyuan specifically emphasized warm-tonifying methods in his *Treatise on the Spleen and Stomach* (*Piwei Lun*), which was established specifically for regulating Stomach Qi; how can this be ignored? Liu Hejian argued that vomiting is caused by Stomach Fire, representing an excess condition due to excessive Fire. I argue that vomiting is caused by Stomach Cold, representing a deficiency condition due to excessive Cold. One discusses Heat, the other Cold; both seem to deviate from the theory of harmony. It is not that I deny the existence of vomiting caused by Fire, but rather that vomiting caused by Fire is rare, while that caused by Cold is common; vomiting due to Stomach Excess is rare, while that due to Stomach Deficiency is common. Hence, this differentiation is necessary.
First: The treatment of deficiency vomiting should primarily focus on warming the Stomach and tonifying the Spleen. Renshen Lizhong Tang (Ginseng and Atractylodes Macrocephala Decoction) is the standard treatment. Alternatively, Wenwei Yin (Stomach-Warming Drink), Shengzhu Jian (Sage and Atractylodes Decoction), or Shenjiang Yin (Ginseng and Ginger Drink) may be used酌情ly. Among these, Huangya Wan (Yellow Sprout Pill) is particularly excellent. In cases of severe Stomach Cold, Fuzi Lizhong Tang (Aconite and Ginseng Decoction), Siwei Huiyang Yin (Four-Ingredient Decoction to Restore Yang), or Yiqi Dan (Single-Qi Pill) should be used. If the deficiency lies in the Yin aspect, with water flooding to form Phlegm leading to vomiting, Jinshui Liujun Jian (Metal-Water Six-Gentlemen Decoction) is indicated. In cases of severe deficiency, Liyin Jian (Nourishing Yin Decoction) or Liuwei Huiyang Yin (Six-Ingredient Decoction to Restore Yang) should be used. For chronic illness resulting in Stomach deficiency and inability to accept food, the aforementioned methods should be applied酌情ly. If Stomach Qi is mildly deficient and accompanied by Phlegm, Liujunzi Tang (Six-Gentlemen Decoction) is the primary treatment.
Second: In cases of vomiting due to poisoning, one must identify the specific toxin. If vomiting results from Heat toxins, bitter-cold agents should be used to resolve the toxicity. If vomiting and diarrhea persist due to Yin-Cold toxins, warm-hot agents should be used to resolve the toxicity. If the spleen and Stomach become deficient due to severe vomiting and diarrhea, vigorous warm-tonification is essential. This category includes vomiting and diarrhea caused by Cold-toxin poisoning; the treatment for this is described later and should be read in conjunction.