【脉】 形状如新卧起。脉弱而呕，小便复利，身有微热，见厥者死。趺阳脉浮
，胃气虚，呕而不食，恐怖死，宽缓生。寒气在上，阴气在下，二气并争，但出不入。呕家
有痈脓者，不可治，脓尽自愈。先呕却渴，此为欲解；先渴却呕，为水停心下，属饮。呕本
渴，今反不渴，有支饮。呕多，虽有阳明证，不可下，盖邪气不在胃口。脉数反吐、汗，令
阳微，膈气空虚，数为客热，不能消谷，胃中虚冷，故吐也。阳紧阴数，食已则吐；阳浮而
数亦然，或浮大。皆阳偏盛，阴不能配之也，为格，主吐逆，无阴故呕。寸口脉紧而芤，紧
为寒，芤为虚，虚寒相搏，脉为阴结而迟，其人则噎。关上脉数则吐。脉弦者，虚也。胃气
无余，朝食暮吐，变为胃反。寸紧尺涩，胸满不能食而吐，吐止者为下之，未止者为胃反也
。趺阳脉微而涩，微则下利，涩则吐逆，谷不得入；或浮而涩，浮则虚，虚伤脾，脾伤则不
磨，朝食暮吐，名胃反。寸口脉微而数，微则血虚，血虚则胸中寒。脉紧而涩者，难治；呕
吐思水者，易解。关上脉浮大，风在胃中，心中澹澹，食欲呕。关上脉微浮，积热在胃中，
呕吐蛔虫。关上脉紧而滑者，蛔动。脉紧而滑者，吐逆。脉小弱而涩，胃反。
【证】 呕吐哕各有所辨。
吐属太阳，有物无声，乃血病也。有食入则吐，食已即吐，食久则吐之别。
呕属阳明，有物有声，气血俱病。
哕属少阳，无物有声，乃气病也。
【治】 因胃口有热，膈上有痰，故呕吐。亦有寒气客于肠胃，厥逆上出，故痛
而呕。因胃中虚，膈上热，故哕。亦有痰水满塞而哕。因胃气虚，阳火上冲，故吃逆。亦有
痰热在胃，中气不降而呃。
李论 寒客胃中，物盛上溢，故呕。清厥甚则痹，食而吐。寒气与新谷气俱还于
胃中，新故相乱，真邪相攻，故哕。三者虽殊，皆因脾胃虚弱，亦因寒气客胃，加之饮食所
伤而致。宜以丁、藿二香、半夏、茯苓、陈皮、生姜之类主之。又有痰饮者，必下之。
又论 皆气冲之火，逆胃之脉，反上而作，治宜降火。呃者，气逆也，阴火炎上
也。气自脐
下为火，直冲上出于口而作声也。又火结痰气而上升，冲出于口也。治宜降火行气导痰而自
安。
刘论 吐有三，气、积、寒也。
上焦吐者，皆从于气。气者，天之阳也。脉浮而洪，其证食已暴吐，渴欲饮水，大便燥
结，气上冲胸而发痛。治宜降气和中。
中焦吐者，皆从于积，食与气相假为积而痛。脉浮而匿，其证或先吐而后痛，或先痛而
后吐。治法，以毒药行其积，木香、槟榔去其积。
下焦吐者，从于寒也。脉沉迟，其证朝食暮吐，暮食朝吐，小便清利，大便不通。治法
，毒药通其闭塞，温其寒气也。
《三因》论 有寒呕、热呕、痰呕、食呕、血呕、气呕。
寒，因胃寒伤食，四肢厥冷，脉弱，宜四逆汤。
热，食入即出，烦躁脉数，柴胡汤。
痰，昔肥今瘦，肠间有声，食与饮并出，宜半夏、人参主之。
食呕因胃虚，寒气在上，暖气在下，朝食暮出，不消，养胃汤主之。
血因瘀蓄，冷血聚于胃口，因忧怒气攻，血随食出，宜茯苓汤主之。
气，胃者阳明，合荣于足，今随气上逆，心膈胀，呕却快，宜茱参汤主之。
方论 呃逆切忌热药，丁香类。病皆胃虚，阴火所乘，宜参、术大补之类。如痰
实者，察其
病因，形气俱实，以人参芦吐之。有伤寒差后呕者，当去余热。有酒家呕，解酒治之。有脚
弱脾疼而呕者，此香港脚内攻，根据香港脚门治。有中毒而呕者，解毒治之。有怀孕恶阻者，根据恶
阻治之。有心中风、心中寒、肝中风、中湿脾痹，有漏气，有走哺。女人患呕吐甚者死，其
阴在上故也。
论皆属于火 呕而心下痞，半夏泻心汤。干呕而利者，黄芩半夏汤。呕吐，谷不得入，
小半
夏汤。呕吐，病在膈上，猪苓汤。食已即吐者，大黄甘草汤。胃反，吐而渴，茯苓泽泻汤。
似呕不呕，如哕不哕，无奈，姜汁半夏汤。哕逆上气者，陈皮竹茹汤，陈皮、参、草、竹茹
。
桔梗汤 治上焦气热所冲，食已暴吐，脉浮而洪。已下出刘。
桔梗 白术（各一两五钱） 半夏 神曲（二两） 陈皮 枳实（炒） 茯苓 浓朴（制，一
两）
水煎，下木香、槟榔末各一两。如大腑燥结，加承气汤。
荆黄汤 治前证热气甚者。
荆芥穗（一两） 人参（五钱） 大黄（三钱） 甘草（二钱五分）
调下木香、槟榔末各二钱。
清镇丸 治前证头痛有汗，脉弦。
柴胡（二两） 黄芩（七钱五分） 半夏 甘草（各五钱） 青黛（二钱五分） 人参（五分
）
上姜汁浸炊饼，丸梧子大。食后姜汤下。
紫沉丸 治中焦吐。食积与寒气相假，故吐而痛。
半夏 神曲 乌梅（去核） 代赭石 缩砂（各三钱） 杏仁（去皮尖） 沉香 木香（各一
钱） 陈皮（半两） 槟榔 丁香（各三钱） 白豆蔻（五分） 白术（一钱） 巴霜（五分，另入）
木香白术散 治前证腹中痛，是脾实系强，宜和之。
木香（八两） 白术（半两） 半夏 神曲（一两） 槟榔（二钱五分） 茯苓（半两） 甘草（
四钱）
上浓煎，芍药姜汤下二钱。有积而痛，手不可按，无积者宜之。
附子丸 治下焦，朝食暮吐，暮食朝吐，大便不通。
附子（炮，五钱） 巴豆霜（一钱） 砒（五分，另研）
上黄蜡丸，如梧子大，每二丸，冷水下，利为度。更服紫沉丸，不令再闭。
安胃散（李先生） 治呕吐哕以胃寒所致。
丁香（五分） 茱萸 草蔻 人参（各一钱） 炙甘草（五分） 黄 （一钱） 柴胡（五分）
升麻（七分） 黄柏（三钱） 陈皮（五分） 当归（一钱五分） 苍术（一钱） 半夏 茯苓 陈皮
秘方 治痰呕吐。
二陈汤、山栀（炒）、黄连（姜汁炒）、香附。虚，加苍术。
呃逆因，寒则可用。此世俗之劫亦可戒。
丁香 柿蒂（各一钱） 竹茹
煎，热服。
有恶心，吐虫数条后，乃频作。服杀虫药，则吐虫愈多。六脉皆细，非虫脉也，乃脏寒
而不安矣。
有呕，饮食皆不得进。治呕愈呕，此胃风也。
论吐有三证 冷吐，先觉咽酸呕，然后吐食，脉小滑者是。王叔和云∶关，胃寒
不下食。伤寒汗下过多，胃中虚冷，食久反吐，亦属于寒。
胃热而吐者，闻谷气则呕，药下则吐；或伤寒未解，胸中有热，关脉洪，宜凉之。
胸中有宿食，或痰饮，或停水，关沉而伏者，宜吐之。
《三因》论 呕吐出于胃，故有寒、热、食、痰、血、气，同上条。
论呕逆则咳逆也。大率胃实则噫，胃虚则哕。此因胃中虚，膈上热也。故哕至八九声相
连，收气不回惊人者，若伤寒久病得此，甚恶。《内经》所谓坏腑是也。
亦有哕而心下坚痞、眩悸者，以膈间有痰水，非虚危比也。痰，半夏汤主之；哕虚，橘
皮竹茹汤主之。
论漏气 病者身背皆热，肘臂牵痛，其气不续，膈间厌食，食则先吐而后下，名
曰漏气。此由上焦伤风，开其腠理，经气失道，邪气内着，麦门冬汤主之。
麦门冬 生芦根 竹茹 人参 茯苓 白术 甘草 陈皮 葳蕤 姜亦可。
论走哺 病者上焦实热，大小便不通，气逆不续，呕逆不禁，名曰走哺。人参汤
主之。
前方加黄芩、知母、石膏、山栀，去竹茹、麦冬。
【脉象】
脉象形状如同刚睡醒起床时的状态。脉象虚弱且伴有呕吐，小便反而通利，身体有轻微发热，出现四肢厥冷者预后不良（死证）。趺阳脉浮，提示胃气虚弱，呕吐且不能进食，若伴有恐惧感预后不良（死证），若脉象宽缓则预后良好（生证）。寒气在上部，阴气在下部，上下二气相互争斗，导致气只出不进。呕吐患者体内若有痈脓，不可强行治疗，待脓液排尽后自愈。先呕吐而后口渴的，这是病情即将解除的表现；先口渴而后呕吐的，是水饮停聚在心下，属于饮邪。原本应该口渴的呕吐患者，现在反而不渴，说明体内有支饮。呕吐频繁的患者，即使具备阳明病的证候，也不可攻下，因为邪气并不在胃口部位。脉数却反而出现呕吐、出汗，这会导致阳气微弱，膈间气机空虚，脉数是客热所致，不能消化食物，因胃中虚冷，所以发生呕吐。脉象阳部紧而阴部数，进食后即呕吐；脉象阳部浮而数也是如此，或者脉象浮大。这都是阳气偏盛，阴气不能与之相配的结果，称为“格”，主要症状是吐逆，因无阴气制约故呕吐。寸口脉紧而芤，紧脉主寒，芤脉主虚，虚寒相互搏结，脉象表现为阴结而迟，患者会出现噎塞感。关上脉数则呕吐。脉弦者，属虚证。胃气枯竭，早晨吃晚上吐，演变为胃反病。寸口脉紧尺脉涩，胸满不能进食而呕吐，呕吐停止的是误用攻下法所致，呕吐不止的是胃反病。趺阳脉微而涩，微脉主下利，涩脉主吐逆，谷物无法进入；或者脉象浮而涩，浮脉主虚，虚损伤脾，脾受伤则不能磨化水谷，早晨吃晚上吐，名为胃反。寸口脉微而数，微脉主血虚，血虚则胸中寒冷。脉紧而涩者，难治；呕吐且想喝水的，容易治愈。关上脉浮大，风邪在胃中，心中悸动不安，食欲减退且想呕吐。关上脉微浮，积热在胃中，呕吐蛔虫。关上脉紧而滑者，蛔虫扰动。脉紧而滑者，吐逆。脉小弱而涩者，胃反病。
【证候】
呕吐和哕各有其辨别要点。
吐属于太阳经病变，有物吐出但无声响，这是血分病变。其中有食入即吐、食毕即吐、食久方吐的区别。
呕属于阳明经病变，有物有声，这是气血俱病。
哕属于少阳经病变，无物有声，这是气分病变。
【治法】
因胃口有热，膈上有痰，所以发生呕吐。也有寒气客居肠胃，气机厥逆向上冲出，所以疼痛而呕吐。因胃中虚，膈上有热，所以发生哕。也有因痰水满塞而导致哕。因胃气虚，阳火上冲，所以发生呃逆。也有因痰热在胃，中气不降而发生呃逆。
李氏论述：寒气客居胃中，食物充盛上溢，所以呕吐。清厥严重时则痹阻，进食则吐。寒气与新入胃中的谷气一同返还于胃中，新气与旧气相乱，真气与邪气相攻，所以发生哕。这三种情况虽然表现不同，都是因为脾胃虚弱，加之寒气客胃，以及饮食所伤所致。适宜使用丁香、藿香、半夏、茯苓、陈皮、生姜等药物为主进行治疗。又有痰饮病患者，必须采用攻下法。
又论：这些都是气冲之火，逆乱胃之经脉，反而向上发作，治疗应当降火。呃逆，是气逆的表现，阴火炎上所致。气从脐下化为火，直冲向上出于口而发出声音。另外，火结聚痰气而上升，冲出于口。治疗应当降火、行气、导痰，使气机自然安宁。
刘氏论述：呕吐有三种，分别是气、积、寒。
上焦呕吐，都源于气。气，是天之阳。脉象浮而洪，证候为进食后突然呕吐，口渴想饮水，大便干燥结滞，气上冲胸部并引发疼痛。治疗应当降气和中。
中焦呕吐，都源于积滞，食物与气相互结合形成积滞而疼痛。脉象浮而匿（沉伏），证候有的先呕吐而后疼痛，有的先疼痛而后呕吐。治疗方法，用毒药消除积滞，用木香、槟榔去除积滞。
下焦呕吐，源于寒邪。脉象沉迟，证候为早晨吃晚上吐，晚上吃早上吐，小便清长通利，大便不通。治疗方法，用毒药疏通闭塞，温散寒气。
《三因方》论述：有寒呕、热呕、痰呕、食呕、血呕、气呕。
寒呕，因胃寒伤食，四肢厥冷，脉象虚弱，适宜用四逆汤。
热呕，食物入口即吐出，烦躁，脉数，适宜用柴胡汤。
痰呕，昔日肥胖如今消瘦，肠间有水声，食物与饮水一并吐出，适宜用半夏、人参为主治疗。
食呕因胃虚，寒气在上，暖气在下，早晨吃晚上吐出，不消化，适宜用养胃汤为主治疗。
血呕因瘀血蓄积，冷血聚于胃口，因忧怒气攻，血随食物而出，适宜用茯苓汤为主治疗。
气呕，胃属阳明，合营气于足部，如今随气上逆，心膈胀满，呕吐后感觉爽快，适宜用茱萸人参汤为主治疗。
方剂论述：呃逆切忌使用热药，如丁香类。病皆因胃虚，阴火乘袭，适宜用人参、白术等大补类药物。如果是痰实患者，观察其病因，形体和气机都充实，用人参芦头催吐。有伤寒病愈后呕吐的，应当清除余热。有饮酒者呕吐的，解酒并治疗。有脚弱脾疼而呕吐的，这是香港脚内攻，根据香港脚门的方法治疗。有中毒而呕吐的，解毒并治疗。有怀孕恶阻的，根据恶阻的方法治疗。有心中风、心中寒、肝中风、中湿脾痹，有漏气，有走哺。女性患严重呕吐的会死亡，这是因为阴气在上部的缘故。
论述都属于火：呕吐伴心下痞满，用半夏泻心汤。干呕伴下利的，用黄芩半夏汤。呕吐，食物无法进入，用小半夏汤。呕吐，病位在膈上，用猪苓汤。进食后即呕吐的，用大黄甘草汤。胃反，呕吐且口渴，用茯苓泽泻汤。似呕非呕，似哕非哕，无可奈何，用姜汁半夏汤。哕逆上气的，用陈皮竹茹汤（含陈皮、人参、甘草、竹茹）。
桔梗汤：治疗上焦气热上冲，进食后突然呕吐，脉象浮而洪。此方已收录于刘氏论述中。
组成：桔梗、白术（各一两五钱）、半夏、神曲（二两）、陈皮、枳实（炒）、茯苓、浓朴（制，一两）。
用法：水煎，送服木香、槟榔末各一两。如果大便秘结燥实，加承气汤。
荆黄汤：治疗前述证候热气严重者。
组成：荆芥穗（一两）、人参（五钱）、大黄（三钱）、甘草（二钱五分）。
用法：调服木香、槟榔末各二钱。
清镇丸：治疗前述证候头痛有汗，脉弦。
组成：柴胡（二两）、黄芩（七钱五分）、半夏、甘草（各五钱）、青黛（二钱五分）、人参（五分）。
用法：以上药物用姜汁浸泡炊饼，制成梧子大小的丸药。饭后用姜汤送服。
紫沉丸：治疗中焦呕吐。食积与寒气相互结合，所以呕吐且疼痛。
组成：半夏、神曲、乌梅（去核）、代赭石、缩砂（各三钱）、杏仁（去皮尖）、沉香、木香（各一钱）、陈皮（半两）、槟榔、丁香（各三钱）、白豆蔻（五分）、白术（一钱）、巴霜（五分，另加入）。
木香白术散：治疗前述证候腹中痛，这是脾实系强，适宜调和。
组成：木香（八两）、白术（半两）、半夏、神曲（一两）、槟榔（二钱五分）、茯苓（半两）、甘草（四钱）。
用法：以上药物浓煎，用芍药姜汤送服二钱。有积滞而疼痛，手不可按压；无积滞者适宜使用。
附子丸：治疗下焦呕吐，早晨吃晚上吐，晚上吃早上吐，大便不通。
组成：附子（炮，五钱）、巴豆霜（一钱）、砒（五分，另研）。
用法：以上药物用黄蜡制成梧子大小的丸药，每次二丸，冷水送服，以腹泻为度。再服用紫沉丸，防止再次闭塞。
安胃散（李先生）：治疗因胃寒导致的呕吐哕。
组成：丁香（五分）、吴茱萸、草蔻、人参（各一钱）、炙甘草（五分）、黄芪（一钱）、柴胡（五分）、升麻（七分）、黄柏（三钱）、陈皮（五分）、当归（一钱五分）、苍术（一钱）、半夏、茯苓、陈皮。
秘方：治疗痰致呕吐。
组成：二陈汤、山栀（炒）、黄连（姜汁炒）、香附。体虚者，加苍术。
注：呃逆因寒者可用。此为世俗之见，亦可引以为戒。
组成：丁香、柿蒂（各一钱）、竹茹。
用法：煎煮，热服。
有恶心，吐出几条虫后，反而频繁发作。服用杀虫药，则吐出的虫子更多。六脉皆细，不是虫脉，而是脏寒而不安。
论述呕吐有三证：
冷吐，先觉得咽酸呕吐，然后吐出食物，脉象小滑的是。王叔和说：关脉，胃寒不下食。伤寒汗下过多，胃中虚冷，食物久留反而呕吐，也属于寒。
胃热而吐的，闻到谷气就呕吐，服药就吐；或者伤寒未解，胸中有热，关脉洪大，适宜凉之。
胸中有宿食，或痰饮，或停水，关脉沉而伏的，适宜吐之。
《三因方》论述：呕吐出于胃，所以有寒、热、食、痰、血、气，同上条。
论述呕逆即咳逆。大率胃实则打嗝（噫），胃虚则哕。这是因为胃中虚，膈上有热。所以哕至八九声相连，收气不回令人惊骇的，如果伤寒久病出现此症，非常恶劣。《内经》所谓坏腑就是这种情况。
也有哕伴心下坚痞、眩晕心悸的，因为膈间有痰水，不属于虚危重症。痰证，用半夏汤为主治疗；哕虚证，用橘皮竹茹汤为主治疗。
论述漏气：患者身背皆热，肘臂牵拉疼痛，气息不续，膈间厌食，进食则先吐而后下泄，名叫漏气。这是由于上焦伤风，打开腠理，经气失道，邪气内着，用麦门冬汤为主治疗。
组成：麦门冬、生芦根、竹茹、人参、茯苓、白术、甘草、陈皮、葳蕤。姜也可用。
论述走哺：患者上焦实热，大小便不通，气逆不续，呕吐逆乱不禁，名叫走哺。用人参汤为主治疗。
前方加黄芩、知母、石膏、山栀，去竹茹、麦冬。
[Pulse]
The pulse shape resembles that of a person who has just woken up and risen. A weak pulse accompanied by vomiting, with urination being clear and frequent, slight fever in the body, and cold extremities indicates a fatal prognosis. A floating Fu Yang pulse indicates deficiency of Stomach Qi; vomiting with inability to eat and a sense of terror indicates a fatal prognosis, while a relaxed and slow pulse indicates a favorable prognosis. Cold Qi is above, Yin Qi is below; the contention between these two energies results in expulsion without intake. If a vomiting patient has abscess pus, it should not be forcibly treated; self-healing occurs when the pus is exhausted. Vomiting followed by thirst indicates impending resolution; thirst followed by vomiting indicates fluid retention under the heart, belonging to Fluid Retention (Yin). Vomiting patients who should be thirsty but are not indicate Branch Fluid (Zhi Yin). Frequent vomiting, even if Yang Ming syndrome signs are present, contraindicates purgation because the pathogen is not at the stomach gate. A rapid pulse with vomiting and sweating leads to weakened Yang Qi and emptiness of the Diaphragm Qi; the rapidity indicates guest heat which cannot digest food, causing vomiting due to cold deficiency in the Stomach. A tight pulse in the Yang position and rapid in the Yin position causes vomiting immediately after eating; a floating and rapid pulse, or even a large floating pulse, similarly indicates excessive Yang Qi unable to match with Yin, termed "Ge" (Gridlock), characterized by regurgitation and vomiting due to lack of Yin. A tight and hollow (Kou) pulse at the Cun Kou position: tight indicates cold, hollow indicates deficiency; the combination of deficiency and cold creates Yin knotting and slowness, leading to dysphagia (Ye). A rapid pulse at the Guan position causes vomiting. A wiry pulse indicates deficiency. Exhaustion of Stomach Qi leads to morning eating and evening vomiting, evolving into Stomach Reversal (Wei Fan). Tight pulse at Cun and choppy pulse at Chi cause chest fullness, inability to eat, and vomiting; cessation of vomiting after purgation indicates iatrogenic injury, while persistent vomiting indicates Stomach Reversal. A faint and choppy Fu Yang pulse: faint indicates diarrhea, choppy indicates vomiting and regurgitation with inability to ingest grain; or a floating and choppy pulse: floating indicates deficiency, damaging the Spleen; Spleen damage impairs grinding, leading to morning eating and evening vomiting, named Stomach Reversal. A faint and rapid Cun Kou pulse: faint indicates blood deficiency, blood deficiency leads to cold in the chest. A tight and choppy pulse is difficult to treat; vomiting with desire for water is easy to resolve. A large and floating Guan pulse indicates Wind in the Stomach, palpitations, loss of appetite, and desire to vomit. A slightly floating Guan pulse indicates accumulated heat in the Stomach, vomiting roundworms. A tight and slippery Guan pulse indicates moving roundworms. A tight and slippery pulse indicates vomiting and regurgitation. A small, weak, and choppy pulse indicates Stomach Reversal.
[Syndromes]
Vomiting and Hiccups have distinct differentiations.
Tu (Spitting/Vomiting without sound) belongs to Tai Yang; it involves ejection of matter without sound, indicating a Blood pathology. It is differentiated into immediate vomiting upon ingestion, vomiting immediately after eating, and delayed vomiting.
Ou (Vomiting with sound) belongs to Yang Ming; it involves ejection of matter with sound, indicating both Qi and Blood pathology.
Yue (Hiccups/Involuntary diaphragmatic spasm) belongs to Shao Yang; it involves sound without matter, indicating a Qi pathology.
[Treatment]
Vomiting occurs due to heat in the Stomach gate and phlegm above the Diaphragm. It can also occur due to Cold invading the intestines and stomach, causing rebellious Qi to rush upward, resulting in pain and vomiting. Yue occurs due to Stomach deficiency and heat above the Diaphragm, or due to obstruction by phlegm and fluids. E Ni (Hiccups) occurs due to Stomach Qi deficiency and upward rushing of Yang Fire, or due to Phlegm-Heat in the Stomach preventing the descent of Middle Qi.
Li's Discussion: Cold invading the Stomach causes food to overflow upwards, leading to vomiting. Severe cold reversal leads to bi-obstruction and vomiting upon eating. When Cold Qi mixes with new grain Qi in the Stomach, the new and old confuse each other, and true and evil Qi attack each other, causing Yue. Although these three differ, they all stem from Spleen and Stomach weakness, Cold invasion, and dietary injury. Treatment should prioritize Ding Xiang (Clove), Huo Xiang (Patchouli), Ban Xia (Pinellia), Fu Ling (Poria), Chen Pi (Tangerine Peel), and Sheng Jiang (Fresh Ginger). For patients with Phlegm-Fluid, purgation is necessary.
Further Discussion: These are fires driven by rebellious Qi, counter-flowing along the Stomach meridian and rising up; treatment should focus on descending fire. E Ni is rebellious Qi caused by Yin Fire flaring upward. Qi transforms into fire below the umbilicus, rushing straight up out of the mouth to make sound. Additionally, fire knots with phlegm-Qi and rises, rushing out of the mouth. Treatment should descend fire, move Qi, and guide out phlegm to restore peace.
Liu's Discussion: There are three types of vomiting: Qi, Accumulation, and Cold.
Upper Jiao vomiting stems from Qi. Qi is Heaven's Yang. The pulse is floating and surging; symptoms include sudden vomiting after eating, thirst with desire for water, dry and constipated stool, Qi rushing to the chest causing pain. Treatment should descend Qi and harmonize the Middle.
Middle Jiao vomiting stems from Accumulation, where food and Qi combine to form accumulation and pain. The pulse is floating and hidden; symptoms may include vomiting before pain or pain before vomiting. Treatment uses toxic drugs to move accumulation, and Mu Xiang (Aucklandia) and Bing Lang (Areca Nut) to remove accumulation.
Lower Jiao vomiting stems from Cold. The pulse is deep and slow; symptoms include morning eating and evening vomiting, evening eating and morning vomiting, clear and frequent urination, and constipation. Treatment uses toxic drugs to open blockages and warm the Cold.
San Yin Fang Discussion: There are Cold, Heat, Phlegm, Food, Blood, and Qi vomiting.
Cold: Due to Stomach Cold and food injury, cold limbs, weak pulse; use Si Ni Tang (Frigid Extremities Decoction).
Heat: Vomiting immediately after eating, irritability, rapid pulse; use Chai Hu Tang (Bupleurum Decoction).
Phlegm: Once fat now thin, sounds in intestines, food and drink expelled together; use Ban Xia (Pinellia) and Ren Shen (Ginseng).
Food: Due to Stomach deficiency, Cold above, Warmth below, morning eating and evening expulsion, indigestion; use Yang Wei Tang (Nourish Stomach Decoction).
Blood: Due to blood stasis, cold blood gathering at the stomach gate, aggravated by worry and anger, blood expelled with food; use Fu Ling Tang (Poria Decoction).
Qi: Stomach is Yang Ming, combining Ying with the foot; now rebellious Qi ascends, causing chest/diaphragm distension, relief after vomiting; use Zhu Yu Shen Tang (Evodia and Ginseng Decoction).
Formula Discussion: E Ni strictly contraindicates hot herbs like Ding Xiang. The disease is due to Stomach deficiency and Yin Fire invasion; use large tonics like Ren Shen and Bai Zhu. For phlegm-excess cases where constitution and Qi are robust, induce vomiting with Ren Shen Lu (Ginseng Rhizome). Post-typhoid vomiting requires clearing residual heat; alcoholic vomiting requires resolving alcohol; leg weakness/spleen pain with vomiting indicates Hong Kong Foot (Gout/Beriberi) attacking internally, treat according to Hong Kong Foot protocols; poisoning vomiting requires detoxification; pregnancy nausea treats according to E Zu protocols. Severe vomiting in women is fatal due to Yin Qi being above.
Discussion on Fire: Vomiting with epigastric fullness uses Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium). Dry vomiting with diarrhea uses Huang Qin Ban Xia Tang (Scutellaria and Pinellia Decoction). Vomiting with inability to ingest food uses Xiao Ban Xia Tang (Minor Pinellia Decoction). Vomiting with pathology above the diaphragm uses Zhu Ling Tang (Polyporus Decoction). Vomiting immediately after eating uses Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction). Stomach Reversal with vomiting and thirst uses Fu Ling Ze Xi Tang (Poria and Silverling Decoction). Indecisive vomiting/hiccups uses Jiang Zhi Ban Xia Tang (Ginger Juice Pinellia Decoction). Hiccups with rebellious Qi uses Chen Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction).
Jie Geng Tang: Treats Upper Jiao Qi-Heat rushing up, sudden vomiting after eating, floating and surging pulse.
Ingredients: Jie Geng (Platycodon), Bai Zhu (Atractylodes Macrocephala) [1.5 liang each], Ban Xia (Pinellia), Shen Qu (Medicated Leaven) [2 liang], Chen Pi (Tangerine Peel), Zhi Shi (Immature Bitter Orange, stir-fried), Fu Ling (Poria), Nong Po (Magnolia Bark, processed) [1 liang].
Preparation: Decoct in water, take with powdered Mu Xiang and Bing Lang [1 liang each]. If severe constipation, add Cheng Qi Tang.
Jing Huang Tang: Treats severe heat in the aforementioned conditions.
Ingredients: Jing Jie Sui (Schizonepeta Spike) [1 liang], Ren Shen (Ginseng) [0.5 liang], Da Huang (Rhubarb) [0.3 liang], Gan Cao (Licorice) [0.25 liang].
Preparation: Take with powdered Mu Xiang and Bing Lang [0.2 liang each].
Qing Zhen Wan: Treats headache with sweating and wiry pulse.
Ingredients: Chai Hu (Bupleurum) [2 liang], Huang Qin (Scutellaria) [0.75 liang], Ban Xia (Pinellia), Gan Cao (Licorice) [0.5 liang each], Qing Dai (Indigo Naturalis) [0.25 liang], Ren Shen (Ginseng) [0.05 liang].
Preparation: Soak ingredients in ginger juice with steamed wheat cake, pill to size of paulownia seeds. Take after meals with ginger water.
Zi Chen Wan: Treats Middle Jiao vomiting. Food accumulation combined with Cold causes vomiting and pain.
Ingredients: Ban Xia (Pinellia), Shen Qu (Medicated Leaven), Wu Mei (Mume Fruit, pitted), Dai Zhe Shi (Hematite), Su Sha (Amomum Villosum) [3 qian each], Xing Ren (Apricot Seed, peeled), Chen Xiang (Aquilaria), Mu Xiang (Aucklandia) [1 qian each], Chen Pi (Tangerine Peel) [0.5 liang], Bing Lang (Areca Nut), Ding Xiang (Clove) [3 qian each], Bai Dou Kou (Cardamom) [0.5 fen], Bai Zhu (Atractylodes Macrocephala) [1 qian], Ba Shuang (Croton Seed Frost) [0.5 fen, added separately].
Mu Xiang Bai Zhu San: Treats abdominal pain from the aforementioned condition, indicating Spleen excess/stiffness, requiring harmonization.
Ingredients: Mu Xiang (Aucklandia) [8 liang], Bai Zhu (Atractylodes Macrocephala) [0.5 liang], Ban Xia (Pinellia), Shen Qu (Medicated Leaven) [1 liang], Bing Lang (Areca Nut) [0.25 liang], Fu Ling (Poria) [0.5 liang], Gan Cao (Licorice) [0.4 liang].
Preparation: Decoct strongly, take 2 qian with Shaoyao (Peony) and ginger water. Suitable for pain without palpable mass; avoid if mass is present.
Fu Zi Wan: Treats Lower Jiao vomiting, morning eating/evening vomiting, evening eating/morning vomiting, constipation.
Ingredients: Fu Zi (Aconite Root, processed) [5 qian], Ba Dou Shuang (Croton Seed Frost) [1 qian], Pi (Arsenic) [0.5 fen, ground separately].
Preparation: Pill with yellow wax to paulownia seed size. Take 2 pills with cold water until diarrhea occurs. Follow with Zi Chen Wan to prevent re-obstruction.
An Wei San (Mr. Li): Treats vomiting/hiccups due to Stomach Cold.
Ingredients: Ding Xiang (Clove) [0.5 fen], Zhu Yu (Evodia), Cao Kou (Black Cardamom), Ren Shen (Ginseng) [1 qian each], Zhi Gan Cao (Honey-fried Licorice) [0.5 fen], Huang Qi (Astragalus) [1 qian], Chai Hu (Bupleurum) [0.5 fen], Sheng Ma (Cimicifuga) [0.7 fen], Huang Bo (Phellodendron) [3 qian], Chen Pi (Tangerine Peel) [0.5 fen], Dang Gui (Angelica Sinensis) [1.5 qian], Cang Zhu (Atractylodes Lancea) [1 qian], Ban Xia (Pinellia), Fu Ling (Poria), Chen Pi (Tangerine Peel).
Secret Formula: Treats Phlegm-induced vomiting.
Ingredients: Er Chen Tang (Two-Cured Decoction), Shan Zhi (Gardenia, fried), Huang Lian (Coptis, ginger-juice fried), Xiang Fu (Cyperus). For deficiency, add Cang Zhu. Note: For hiccups due to Cold. This secular view serves as a warning.
Ingredients: Ding Xiang (Clove), Shi Di (Persimmon Calyx) [1 qian each], Zhu Ru (Bamboo Shavings).
Preparation: Decoct, take hot.
Nausea followed by expelling several worms, then frequent recurrence. Anti-parasitic drugs increase worm expulsion. All six pulses are fine, not a worm pulse, but Cold in the Zang organs causing unrest.
Vomiting where food and drink cannot enter. Treating vomiting worsens it; this is Stomach Wind.
Discussion on Three Types of Vomiting:
Cold Vomiting: Sensation of sourness in throat before vomiting food, small slippery pulse. Wang Shuhe says: Guan pulse indicates Stomach Cold failing to accept food. Excessive sweating/purging in typhoid causes Stomach Cold deficiency, delayed vomiting, also Cold.
Stomach Heat Vomiting: Vomiting at smell of grain, vomiting medicine; or unresolved typhoid with chest heat, surging Guan pulse, treat with cooling.
Epigastric Food Retention, Phlegm-Fluid, or Water Retention: Deep and hidden Guan pulse, induce vomiting.
San Yin Fang Discussion: Vomiting originates in the Stomach, involving Cold, Heat, Food, Phlegm, Blood, Qi, as above.
Discussion on Rebellious Vomiting/Cough: Generally, Stomach excess causes belching, Stomach deficiency causes Yue. This is due to Stomach deficiency and Diaphragm heat. Yue repeating 8-9 times without returning breath is alarming; in chronic typhoid, it is ominous, termed "Ruined Zang" in Nei Jing.
Yue with epigastric hardness/fullness and vertigo/palpitations is due to Phlegm-Fluid in the Diaphragm, not critical deficiency. Phlegm uses Ban Xia Tang; Deficient Yue uses Ju Pi Zhu Ru Tang.
Discussion on Lou Qi (Leaking Qi): Patient has hot back/arms, elbow/arm牵引 pain, discontinuous Qi, anorexia, vomiting then defecating after eating. Named Lou Qi. Caused by Upper Jiao Wind damaging pores, losing meridian pathway, pathogen lodging internally. Use Mai Men Dong Tang (Ophiopogon Decoction).
Ingredients: Mai Men Dong (Ophiopogon), Sheng Lu Gen (Reed Rhizome), Zhu Ru (Bamboo Shavings), Ren Shen (Ginseng), Fu Ling (Poria), Bai Zhu (Atractylodes), Gan Cao (Licorice), Chen Pi (Tangerine Peel), Wei Rui (Polygonatum). Ginger is optional.
Discussion on Zou Bu (Running Feeding): Upper Jiao excess heat, constipation/urinary retention, discontinuous rebellious Qi, uncontrollable vomiting. Named Zou Bu. Use Ren Shen Tang (Ginseng Decoction).
Modification of previous formula: Add Huang Qin (Scutellaria), Zhi Mu (Anemarrhena), Shi Gao (Gypsum), Shan Zhi (Gardenia); remove Zhu Ru (Bamboo Shavings), Mai Men Dong (Ophiopogon).