仲景曰∶病患脉数,数为热,当消谷引食,而反吐者,何也?师曰∶以发其汗,令阳微
,膈气虚,脉乃数,数为客热,不能消谷,胃中虚冷故也。脉弦者,虚也,胃气无余,朝食
暮吐,变为胃反。寒在于上,医反下之,今脉反弦,故名曰虚。趺阳脉浮而涩,浮则为虚,
涩则伤脾,脾伤则不磨,朝食暮吐,暮食朝吐,宿食不化,名曰胃反。脉紧而涩,其病难治
。
《巢氏病源》曰∶营卫俱虚,气血不足,停水积饮在胃脘则脏冷,脏冷则脾不磨,脾不
磨则宿食不化,其气逆而成反胃也。则朝食暮吐,暮食朝吐,心下牢大如杯,往来寒热。甚
者食已即吐,其脉紧而弦,紧则为寒,弦则为虚,虚寒相搏,故食已则吐,名为反胃。
戴原礼曰∶翻胃证,血虚者,脉必数而无力。气虚者,脉必缓而无力。气血俱虚者,则
口中多出沫,但见沫大出者,必死。有热者脉数而有力,有痰者脉滑数,二者可治。血虚者
,四物为主。气虚者,四君子为主。热以解毒为主,痰以二陈为主。
一方 用甘蔗汁二分,姜汁一分,和匀,每服半碗或一碗,日三服,则止。
一方 用人参,见呕吐门。
理中汤(热一) 温胃饮(新热五) 橘皮干姜汤(热五五) 圣术煎(新热二五) 黄芽丸(
新热二一) 五君子煎(新热六) 四味回阳饮(新热一) 六君子汤(补五) 四君子汤(补一)
六味回阳饮(新热二) 右归饮(新补三) 五味异功散(补四) 人参附子理阴煎(新热三)
橘皮汤(热五六) 小半夏汤(和八) 金水六君煎(新和一) 二陈汤(和一) 大半夏汤(和十
)理中化痰丸(热九) 五苓散(和一八二) 平胃散(和十七) 橘皮半夏汤(和十三) 豕膏(
新因二九) 黄芩汤(和一九八) 半夏泻心汤(寒二八) 葛花解酲汤(和一二四) 半夏干姜
散(热五三) 吴茱萸汤(热一三七) 不换金正气散(和二一)
张仲景说:病人脉象数,数脉主热,应当消化食物且食欲旺盛,反而呕吐的,是什么原因呢?医师说:因为发汗,导致阳气微弱,膈部气虚,脉象才表现为数,这里的数是客热(外来的或暂时的热邪),不能消化食物,是因为胃中虚冷。脉象弦的,是虚证,胃气没有余留,早上吃的东西晚上吐出来,转变为胃反病。寒邪在上焦,医生反而用攻下法治疗,现在脉象反而变弦,所以名叫虚证。趺阳脉浮而涩,浮脉表示虚,涩脉表示伤脾,脾受伤则不能磨化水谷,早上吃的东西晚上吐出来,晚上吃的东西早上吐出来,宿食不消化,名叫胃反。脉象紧而涩,这种病难治。
《巢氏病源》说:营卫都虚弱,气血不足,停水和积饮在胃脘部位则脏腑寒冷,脏腑寒冷则脾不能磨化,脾不能磨化则宿食不消化,气机上逆而形成反胃。于是早上吃的东西晚上吐出来,晚上吃的东西早上吐出来,心下坚硬大如杯子,往来寒热。严重的吃完就吐,脉象紧而弦,紧脉主寒,弦脉主虚,虚寒相互搏结,所以吃完就吐,名叫反胃。
戴原礼说:翻胃病证,血虚的人,脉象必然数而无力。气虚的人,脉象必然缓而无力。气血都虚的人,口中多出涎沫,只见涎沫大量涌出的,必死。有热的人脉数而有力,有痰的人脉滑数,这两种情况可以治疗。血虚的,以四物汤为主方。气虚的,以四君子汤为主方。有热的以解毒为主,有痰的以二陈汤为主。
一方:用甘蔗汁两份,姜汁一份,混合均匀,每次服用半碗或一碗,每天三次,症状即可停止。
理中汤(热性一) 温胃饮(新热性五) 橘皮干姜汤(热性五五) 圣术煎(新热性二五) 黄芽丸(新热性二一) 五君子煎(热性六) 四味回阳饮(热性一) 六君子汤(补益五) 四君子汤(补益一) 六味回阳饮(新热性二) 右归饮(新补益三) 五味异功散(补益四) 人参附子理阴煎(新热性三) 橘皮汤(热性五六) 小半夏汤(和剂八) 金水六君煎(新一和剂一) 二陈汤(和一剂) 大半夏汤(和剂十) 理中化痰丸(热性九) 五苓散(和一剂八二) 平胃散(和剂十七) 橘皮半夏汤(和剂十三) 豕膏(新因性二九) 黄芩汤(和一剂九八) 半夏泻心汤(寒性二八) 葛花解酲汤(和一剂一二四) 半夏干姜散(热性五三) 吴茱萸汤(热性一三七) 不换金正气散(和二剂一)
Zhang Zhongjing said: When a patient has a rapid pulse (Shu Mai, rapid pulse), which indicates heat, one would expect efficient digestion and increased appetite. However, if vomiting occurs instead, what is the reason? The physician answered: This results from sweating therapy, which has weakened Yang Qi (Vital Energy) and caused deficiency of Qi in the Diaphragm region. Consequently, the pulse appears rapid; this rapidness represents "Guest Heat" (temporary or external heat), which cannot digest food, due to cold deficiency in the Stomach. A wiry pulse (Xian Mai, wiry pulse) indicates deficiency, meaning there is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, transforming into "Wei Fan" (Gastric Regurgitation). If cold pathogen resides in the Upper Jiao (Upper Burner), but the physician incorrectly uses purgative methods, the pulse may become wiry; thus, it is named deficiency. At the Fuyang pulse position (pulse felt at the dorsum of the foot), if it is floating (Fu Mai, floating pulse) and choppy (Se Mai, choppy pulse), floating indicates deficiency, and choppy indicates Spleen injury. Injury to the Spleen impairs its ability to grind and transform food. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning, with undigested food remaining; this is called "Wei Fan". If the pulse is tight (Jin Mai, tight pulse) and choppy, the disease is difficult to treat.
The *Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang) states: When Ying and Wei (Defensive and Nutritive Qi) are both deficient, and Qi and Blood are insufficient, retained water and accumulated fluids in the Epigastrium cause Cold in the Zang organs. Cold in the Zang organs leads to the Spleen's inability to grind and transform food. Inability of the Spleen to transform food results in undigested food. The rebellious upward movement of Qi forms Fan Wei (Reverse Stomach/Regurgitation). Thus, food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning. There is hardness below the heart, large as a cup, accompanied by alternating chills and fever. In severe cases, vomiting occurs immediately after eating. The pulse is tight and wiry; tight indicates Cold, and wiry indicates Deficiency. Deficiency and Cold contend with each other, causing vomiting after eating, named Fan Wei.
Dai Yuanli stated: In Fan Wei syndrome, patients with Blood Deficiency will have a rapid but forceless pulse. Patients with Qi Deficiency will have a slow but forceless pulse. Patients with both Qi and Blood Deficiency will produce excessive saliva/phlegm in the mouth; if large amounts of saliva are seen spurting out, death is inevitable. Those with Heat will have a rapid and forceful pulse; those with Phlegm will have a slippery and rapid pulse. Both conditions are treatable. For Blood Deficiency, Si Wu Tang (Four Substances Decoction) is the primary formula. For Qi Deficiency, Si Jun Zi Tang (Four Gentlemen Decoction) is the primary formula. For Heat, detoxification is the primary method; for Phlegm, Er Chen Tang (Two Aged Decoction) is the primary method.
Prescription 1: Use two parts sugarcane juice and one part ginger juice, mix evenly. Take half a bowl or one bowl per dose, three times a day, until symptoms cease.
Prescription 2: Use Ren Shen (Ginseng Radix et Rhizoma); see the section on Vomiting.
Acupoints: Shangwan (CV13), Zhongwan (CV12), Xiawan (CV10) (each moxibustion 14 cones/moxa units); Tianshu (ST25) (moxybustion 21 cones/moxa units).
Li Zhong Tang (Warming Middle Decoction) [Heat property 1] Wen Wei Yin (Stomach Warming Drink) [New Heat property 5] Ju Pi Gan Jiang Tang (Tangerine Peel and Dried Ginger Decoction) [Heat property 55] Sheng Zhu Jian (Holy Artisan Decoction) [New Heat property 25] Huang Ya Wan (Yellow Sprout Pill) [New Heat property 21] Wu Jun Zi Jian (Five Gentlemen Decoction) [Heat property 6] Si Wei Hui Yang Yin (Four Ingredients Restoring Yang Drink) [Heat property 1] Liu Jun Zi Tang (Six Gentlemen Decoction) [Tonify property 5] Si Jun Zi Tang (Four Gentlemen Decoction) [Tonify property 1] Liu Wei Hui Yang Yin (Six Ingredients Restoring Yang Drink) [New Heat property 2] You Gui Yin (Right Restoration Drink) [New Tonify property 3] Wu Wei Yi Gong San (Five Flavors Extraordinary Power Powder) [Tonify property 4] Ren Shen Fu Zi Li Yin Jian (Ginseng and Aconite Nourishing Yin Decoction) [New Heat property 3] Ju Pi Tang (Tangerine Peel Decoction) [Heat property 56] Xiao Ban Xia Tang (Minor Pinellia Decoction) [Harmonize property 8] Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction) [New Harmonize property 1] Er Chen Tang (Two Aged Decoction) [Harmonize property 1] Da Ban Xia Tang (Major Pinellia Decoction) [Harmonize property 10] Li Zhong Hua Tan Wan (Warming Middle Resolving Phlegm Pill) [Heat property 9] Wu Ling San (Five Ingredient Powder with Poria) [Harmonize property 182] Ping Wei San (Peaceful Stomach Powder) [Harmonize property 17] Ju Pi Ban Xia Tang (Tangerine Peel and Pinellia Decoction) [Harmonize property 13] Shi Gao (Pork Fat) [New Etiological property 29] Huang Qin Tang (Scutellaria Decoction) [Harmonize property 198] Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) [Cold property 28] Ge Hua Jie Cheng Tang (Kudzu Flower Relieving Intoxication Decoction) [Harmonize property 124] Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) [Heat property 53] Wu Zhu Yu Tang (Evodia Decoction) [Heat property 137] Bu Huan Jin Zheng Qi San (Non-Exchanging Metal Upright Qi Powder) [Harmonize property 21]