〔大法〕
《精要》云∶呕逆有二证，一证谓初发，不曾服内托散，伏热在心；一证谓气虚，脾
气不正，其伏热在心者，与内托散三两帖。气虚者，宜嘉禾散，有寒热宜正气散，兼与山
药丸以补肾。丹溪曰∶诸逆冲上，呕哕，皆属于火。内托散性凉，固有降火之理。若嘉
禾散补力已少，徒温暖以助火耳。山药丸补肾，以壮下焦之阴，粗为近理。然治呕须分
先后，肿疡时当作毒瓦斯上攻治之，溃疡后当作阴虚治之。若年老因疽溃后，呕逆不食者，
宜参 白术膏峻补取效，佐使药，随时随证加减，恐用山药丸缓急，未易得力，河间谓∶
疮疡呕者，湿气侵胃也，药中宜倍加白术。
〔薛〕 疮疡作呕，不可泥于毒瓦斯内攻而概用败毒等药。如热甚 痛，邪气实也，仙
方活命饮解之。作脓 痛胃气虚也，托里消毒散补之。脓热胀痛，气血虚也，先用托里
散；后用针以泄之。 痛便秘，热蕴于内也，内疏黄连汤导之。若因寒药伤胃而呕者，托
里健中汤。胃寒少食而呕者，托里益中汤。中虚寒淫而呕者，托里温中汤。肝木乘脾土而
呕者，托里抑青汤。胃脘停痰而呕者，托里清中汤。脾虚自病而呕者，托里益黄汤。郁
结伤脾而呕者，托里越鞠汤。若不详究其源而妄用攻毒之药，则肿者不能溃，溃者不能
敛矣。丹溪虽曰肿疡当作毒瓦斯攻心治之，溃疡当作阴虚治之，亦大概言耳。今之热毒内
攻而呕者寡，脾胃虚寒而呕者多，岂可胶柱而鼓瑟哉！又曰∶欲呕作呕，或外搽内服寒
凉，或痛甚，或感寒邪、秽气而呕，皆胃气虚也，托里消毒散，去三味，加藿香、倍参
术。
热盛脉数，《精要》与漏芦汤，单煮大黄汤等。若不甚热，脉缓弱，只投五香连翘汤。
丹溪曰∶热盛脉数，若肿疡时，脏腑秘而体实者，犹可与也。若溃疡脓血出多，热盛脉
数，去死为近，岂可下乎！缓弱之脉，古人皆以为邪毒已散，五香之飞走升散，其可用
乎。
李氏云∶痈疽呕逆，是毒瓦斯冲心，非脾胃之冷，当服内托散。杨氏云∶鼻衄初愈，不
曾表汗，毒在经络，则背发大疽，自肩下连腰胁肿硬如石，其色紫黑，以凉药投之，终
夜大呕，连进内托散，呕止疮溃，赤水淋漓，四十日而愈。又有患 者，痛过彻呕，服此
即止。今有病疽不服此药者，故引杨氏之言，以解世人之惑。
丹溪治一老人，年七十，患背疽径尺余已，杂与五香、十宣数十帖，脓血腥秽，呕
逆不食者旬余。病患自服内托散，膈中不安，且素有淋病三十年，今所苦者淋之痛，与呕
吐不得睡而已，急以参 、归术煮膏，以牛膝汤，入竹沥饮之。三日后，尽药一斤半，淋
止思食，七日后，尽药四斤，脓自涌出而得睡，又兼旬而安。一男子，年六十余，性好
酒肉，背疽见脓，呕逆发热，盖其得内托、十宣多矣。医以呕逆，于嘉禾散中加丁香以温
胃行气，时七月大热，脉洪数有力，予因谓∶此脉证在溃疡尤忌。然形气实，只与人参膏
和竹沥饮之，尽药十五斤，竹百余竿而安。予曰∶此病幸安也，不薄味必再作。仍浓味自
若，夏月醉后坐水池中，又年余，左胁傍生一软块如饼，二年后软块为疽，本人见脓血
淋漓而脉洪数有力，又呕逆食少，遂自以人参膏，入竹沥饮之，又十余斤，百余竿而安，
今八十岁强健如旧。此病两以老年气血弱，专服人参、竹沥而愈。若与内托、十宣，恐未
能若是之安全也。娄全善，治一男子肿疡呕，诸药不止，用独参汤一服，呕即愈。
薛新甫治一人，腹痈 痛，烦躁作呕，脉实。河间云∶疮疡者，火之属，须分内外，以
治其本。若脉沉实者，先当疏其内，以绝其源。又云∶呕哕心烦，脉沉而实，肿硬木闷，
或皮肉不变，邪气在内，宜用内疏黄连汤治之，遂用前汤通利二三行，诸证悉去，更以
连翘消毒散而愈。一人患臂毒， 痛作呕，服托里消毒药愈甚，以凉膈散二剂顿退，更以
四物汤，加芩、连，四剂而消。新甫又治一人，年逾四十，患发背已溃，忽呕而疮痛，胃
脉弦紧，彼以为余毒内攻。东垣云∶呕吐无时，手足厥冷，脏腑之虚也。丹溪云∶溃后
发呕不食者，湿气侵于内也。又云∶脓出而反痛，此为虚也，今胃脉弦紧，木乘土位，其
虚明矣，欲以六君子汤用酒炒芍药、砂仁、藿香治之。彼自服护心散，呕愈甚，复邀治，仍
用前药更以补气血药，两月而愈。大抵湿气内侵，或感秽气而作呕者，必喜温而脉弱，热
毒内攻而作呕者，必喜凉而脉数，必须辨认明白。
橘半胃苓汤 治痈疽呕吐不下食，不知味。
橘红 半夏（姜制，各一钱） 苍术（米泔浸炒） 白术（炒） 浓朴（姜制） 甘草（炙）
茯苓 人参 泽泻 茅根（各二钱） 姜汁（数匙）
水二盅，煎一盅，入姜汁，煎一二沸。作十余次饮之。
薛氏曰∶前证七恶中之五恶也。用此方后，胃气将醒，宜用六君子汤兼服之。亦有
烦躁饮冷，不食，脉沉实而呕者，恐不可用此，宜内疏黄连汤。（方见肿疡。）
托里消毒散加减法 治疮疡欲呕作呕，或外搽内服寒凉，或痛甚，或感寒邪秽气而
呕，皆胃气虚也，去白芷、连翘、金银花，加参术、藿香。（方见肿疡内托条）
托里健中汤 治疮疡元气素虚，或因凉药伤胃，饮食少思，或作呕泻等证。
人参 白术 陈皮 茯苓（各二钱） 半夏 炮姜（各一钱） 炙甘草（五分） 黄 （一钱五分）
肉桂（三分）
上姜枣，水煎服。
托里益中汤 治中气虚弱，饮食少思，或疮不消散，或溃而不敛。
人参 白术 陈皮 半夏 茯苓 炮姜（各一钱） 木香 炙甘草（各五分）
上姜枣，水煎服。
托里抑青汤 治脾土虚弱，肝木所侮，以致饮食少思，或胸膈不利等证。
人参 白术 茯苓 半夏（各一钱） 芍药 柴胡 甘草（各五分） 陈皮（一钱）
上姜枣，水煎服。
托里清中汤 治脾胃虚弱，痰气不清，饮食少思等证。
人参 白术 陈皮 茯苓（各一钱） 半夏（八分） 桔梗（七分） 甘草（五分）
上姜枣，水煎服。
托里益黄汤 治脾土虚寒，水反侮土，以致饮食少思，或呕吐泄泻等证。
人参 白术 陈皮 茯苓 半夏（各一钱） 炮姜 丁香 炙甘草（各五分）
上姜枣，水煎服。
托里越鞠汤 治六郁所伤，脾胃虚弱，饮食少思等证。
人参 白术（各二钱） 陈皮 半夏（各一钱） 山栀 川芎 香附米 苍术（各七分） 炙甘草（五分）
上姜枣，水煎服。
人参理中汤 治疮疡脾胃虚寒，呕吐泄泻，饮食少思，肚腹作胀，或胸膈虚痞，饮
食不入。
白术 人参 干姜 甘草（炙，各等分）
上姜枣，水煎服。
【治疗大法】
《外科精要》记载：呕吐逆气有两种证候，一种是初发病时，未曾服用内托散，导致伏热蕴结在心；另一种是气虚，脾气不和。对于伏热在心者，给予内托散，连服三帖。对于气虚者，适宜用嘉禾散；若伴有寒热症状，适宜用正气散，同时配合山药丸以补肾。朱丹溪说：各种向上冲逆的病症，如呕吐、呃逆，都属于火邪。内托散药性凉，确实有降火的功效。然而嘉禾散的补益力量已经很少，只是单纯地温暖身体反而助长火势。山药丸补肾，旨在壮旺下焦之阴，这大致符合医理。但是治疗呕吐必须分清病程阶段，在肿疡期应当当作毒瓦斯上攻来治疗，在溃疡后期应当当作阴虚来治疗。如果老年人因疽疮溃破后，出现呕吐逆气、不能进食的情况，适宜用参术白膏峻猛补益以求见效，辅助药物则根据时间和证候随时加减，恐怕使用山药丸缓不济急，难以奏效。刘河间说：疮疡患者呕吐，是湿气侵犯胃腑所致，用药中应当加倍使用白术。
【薛己按语】
疮疡引起呕吐，不可拘泥于毒瓦斯内攻而一概使用败毒等药物。如果热势严重且疼痛剧烈，这是邪气实盛，可用仙方活命饮来解毒消散。如果化脓时疼痛且胃气虚弱，应用托里消毒散来补益。如果脓出后仍有热感、胀痛，这是气血虚弱，先用托里散；后用针刺排脓泄热。如果疼痛伴大便秘结，是热邪蕴结于内，可用内疏黄连汤导泻通腑。如果是因服用寒凉药物损伤胃气而导致呕吐，用托里健中汤。胃寒、食欲少而呕吐者，用托里益中汤。中气虚弱、寒邪淫溢而呕吐者，用托里温中汤。肝木乘克脾土而呕吐者，用托里抑青汤。胃脘停聚痰浊而呕吐者，用托里清中汤。脾虚自身病变而呕吐者，用托里益黄汤。郁结伤脾而呕吐者，用托里越鞠汤。如果不详细探究病因根源而妄用攻毒药物，那么未溃的疮疡就不能溃破，已溃的疮疡就不能收敛愈合。丹溪虽然说过肿疡期当作毒瓦斯攻心治疗，溃疡期当作阴虚治疗，但这只是大概而言。如今因热毒内攻而呕吐的很少，因脾胃虚寒而呕吐的很多，怎么能拘泥成法不知变通呢！又说：想要呕吐或正在呕吐，或者外涂内服寒凉药物，或者疼痛剧烈，或者感受寒邪、秽浊之气而呕吐，这些都是胃气虚的表现，可用托里消毒散，去掉其中三味药，加入藿香，加倍人参和白术。
热盛脉数，《精要》主张用漏芦汤，单煮大黄汤等。如果热势不重，脉象缓弱，只投五香连翘汤。丹溪说：热盛脉数，如果在肿疡期，脏腑闭塞而体质壮实的人，还可以使用攻下法。如果在溃疡期，脓血流出过多，热盛脉数，这就离死亡不远了，怎么可以再用攻下法呢！脉象缓弱，古人都认为是邪毒已散，五香连翘汤药性升散走窜，这种情况下还能用吗？
李氏说：痈疽引起的呕吐逆气，是毒瓦斯冲击心脏，并非脾胃寒冷，应当服用内托散。杨氏说：鼻衄刚痊愈，没有经过发汗解表，毒邪留在经络，就会在背部发生大疽，从肩部向下连及腰胁，肿胀坚硬如石头，颜色紫黑，如果用凉药投治，会导致整夜剧烈呕吐，连续服用内托散后，呕吐停止，疮口溃破，流出清澈脓水，四十天后痊愈。又有患背疽的人，疼痛剧烈彻骨并引发呕吐，服用此药即止。现在有病疽患者不服用此药的，所以引用杨氏的话，来解除世人的疑惑。
朱丹溪治疗一位老人，七十岁，患背疽直径一尺多，已经很久了，医生杂乱地使用了五香、十宣等方剂几十帖，导致脓血腥臭污秽，呕吐逆气、不能进食长达十多天。病人自己服用内托散，感到胸膈不安，而且他素有淋病三十年，现在痛苦的是淋病的疼痛，以及呕吐无法入睡。紧急用人参、当归、白术煮成膏状，配合牛膝汤，加入竹沥饮用。三天后，药尽一斤半，淋症停止，开始想吃东西；七天后，药尽四斤，脓液自然涌出，能够安睡；又过了二十多天，病情安定。还有一位男子，六十多岁，喜好酒肉，背疽见脓，呕吐逆气发热，大概是因为他服用了过多的内托散和十宣散。医生因为呕吐，在嘉禾散中加入丁香以温胃行气，当时正值七月大热，脉象洪大数而有力，我认为这种脉证在溃疡期尤其忌讳。然而患者形体气力尚实，只给人参膏和竹沥饮用，药尽十五斤，竹子一百多竿才安定。我说：这个病侥幸痊愈，如果不清淡饮食必定复发。但他依然浓味自若，夏天醉酒后坐在水池中，又过了一年多，左侧胁旁生出一个软块如饼状，两年后软块变成疽疮，本人看到脓血淋漓且脉象洪大数而有力，又出现呕吐逆气、食量减少，于是自己用人参膏，加入竹沥饮用，又用了十余斤药，百余竿竹子才安定，现在八十岁了，身体强健如旧。这个病两次都是因为老年气血虚弱，专门服用人参、竹沥而痊愈。如果给予内托散、十宣散，恐怕不能如此安全治愈。娄全善治疗一名男子，肿疡期呕吐，各种药物无效，用独参汤一服，呕吐立即痊愈。
薛新甫治疗一人，腹部痈肿疼痛，烦躁作呕，脉象实。刘河间说：疮疡属于火类，必须分清内外，以治其根本。如果脉象沉实，应当先疏通内部，以断绝病源。又说：呕吐呃逆心烦，脉象沉而实，局部肿硬麻木闷痛，或者皮肉颜色不变，这是邪气在内，适宜用内疏黄连汤治疗，于是使用前汤通利大便二三行，所有症状全部去除，再用连翘消毒散而痊愈。另一人患手臂毒疮，肿痛作呕，服用托里消毒药后病情加重，用凉膈散两剂顿时消退，再用四物汤，加入黄芩、黄连，四剂后消散。新甫又治疗一人，年龄超过四十岁，患发背已经溃破，忽然呕吐且疮痛，胃脉弦紧，他认为这是余毒内攻。东垣说：呕吐无定时，手足厥冷，是脏腑虚损。丹溪说：溃破后发作呕吐不能进食，是湿气侵入体内。又说：脓出后反而疼痛，这是虚证，现在胃脉弦紧，是木乘土位，其虚证很明显，打算用六君子汤，加入酒炒芍药、砂仁、藿香治疗。病人自行服用护心散，呕吐更加严重，再次邀请诊治，仍然用前药，更加补气血的药物，两个月后痊愈。大抵湿气内侵，或感受秽浊之气而呕吐的，一定喜欢凉爽而脉象弱；热毒内攻而呕吐的，一定喜欢清凉而脉象数，必须辨认清楚。
橘半胃苓汤 治疗痈疽呕吐、不能进食、不知滋味。
橘红 半夏（姜制，各一钱） 苍术（米泔水浸泡炒） 白术（炒） 浓朴（姜制） 甘草（炙）
茯苓 人参 泽泻 茅根（各二钱） 姜汁（数匙）
用水二盅，煎至一盅，加入姜汁，再煎一二沸。分十几次饮用。
薛氏说：前面的证候属于“七恶”中的五种恶候。使用此方后，胃气将醒，适宜用六君子汤兼服。也有烦躁喜冷饮、不进食、脉沉实而呕吐的，恐怕不可用此方，适宜用内疏黄连汤。（方剂见肿疡篇。）
托里消毒散加减法 治疗疮疡想要呕吐或正在呕吐，或者外涂内服寒凉药物，或者疼痛剧烈，或者感受寒邪秽浊之气而呕吐，这都是胃气虚的表现，去掉白芷、连翘、金银花，加入人参、白术、藿香。（方剂见肿疡篇内托条）
托里健中汤 治疗疮疡元气素来虚弱，或因凉药损伤胃气，饮食少思，或出现呕吐腹泻等证候。
人参 白术 陈皮 茯苓（各二钱） 半夏 炮姜（各一钱） 炙甘草（五分） 黄芪（一钱五分）
肉桂（三分）
以上药物加生姜、大枣，水煎服。
托里益中汤 治疗中气虚弱，饮食少思，或疮疡不消散，或溃破后不收敛。
人参 白术 陈皮 半夏 茯苓 炮姜（各一钱） 木香 炙甘草（各五分）
以上药物加生姜、大枣，水煎服。
托里抑青汤 治疗脾土虚弱，被肝木所克制，以致饮食少思，或胸膈不利等证候。
人参 白术 茯苓 半夏（各一钱） 芍药 柴胡 甘草（各五分） 陈皮（一钱）
以上药物加生姜、大枣，水煎服。
托里清中汤 治疗脾胃虚弱，痰气不清，饮食少思等证候。
人参 白术 陈皮 茯苓（各一钱） 半夏（八分） 桔梗（七分） 甘草（五分）
以上药物加生姜、大枣，水煎服。
托里益黄汤 治疗脾土虚寒，水反侮土，以致饮食少思，或呕吐泄泻等证候。
人参 白术 陈皮 茯苓 半夏（各一钱） 炮姜 丁香 炙甘草（各五分）
以上药物加生姜、大枣，水煎服。
托里越鞠汤 治疗六郁所伤，脾胃虚弱，饮食少思等证候。
人参 白术（各二钱） 陈皮 半夏（各一钱） 山栀 川芎 香附米 苍术（各七分） 炙甘草（五分）
以上药物加生姜、大枣，水煎服。
人参理中汤 治疗疮疡脾胃虚寒，呕吐泄泻，饮食少思，肚腹作胀，或胸膈虚痞，饮食不入。
白术 人参 干姜 甘草（炙，各等分）
以上药物加生姜、大枣，水煎服。
[Treatment Principles]
The *Jingyao* (Essentials) states: There are two patterns of vomiting and regurgitation. One pattern occurs at the onset, before taking Neituo San (Internal Support Powder), where latent heat is trapped in the Heart; the other pattern involves Qi deficiency with disharmony of Spleen Qi. For those with latent heat in the Heart, administer Neituo San for three doses. For those with Qi deficiency, Jiahe San (Harmonizing Grain Powder) is appropriate; if accompanied by alternating chills and fever, Zhengqi San (Regulating Qi Powder) is suitable, combined with Shanyao Wan (Dioscorea Pill) to tonify the Kidney. Zhu Danxi stated: All upward rushing rebellions, such as vomiting and hiccups, belong to Fire. Neituo San has a cool nature and indeed possesses the principle of descending Fire. However, Jiahe San has little tonifying power; its mere warmth may only assist the Fire. Shanyao Wan tonifies the Kidney to strengthen the Yin of the Lower Jiao, which is roughly consistent with medical theory. Nevertheless, treating vomiting requires distinguishing between stages: during the abscess stage (swelling without ulceration), it should be treated as toxic vapors attacking upwards; after ulceration, it should be treated as Yin deficiency. If an elderly person suffers from vomiting, regurgitation, and inability to eat after the ulceration of a carbuncle, Shen-Zhu Baigao (Ginseng and Atractylodes Paste) should be used for vigorous tonification to achieve effect, with adjuvant herbs adjusted according to time and syndrome. It is feared that using Shanyao Wan would be too slow for urgent conditions and difficult to be effective. Liu Hejian stated: Vomiting in patients with sores and ulcers is caused by Dampness invading the Stomach; thus, Bai Zhu (Atractylodis Rhizoma) should be doubled in the prescription.
[Xue Ji's Commentary]
Vomiting caused by sores and ulcers should not be rigidly treated with detoxifying herbs under the assumption of internal attack by toxic vapors. If heat is severe and pain is intense, this indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Formula for Saving Lives) can be used to resolve it. If pain occurs during suppuration due to deficient Stomach Qi, Tuoli Xiaodu San (Support Interior and Detoxify Powder) should be used to tonify. If there is heat and distending pain after pus discharge, this indicates deficiency of Qi and Blood; first use Tuoli San (Support Interior Powder), then puncture to drain. If pain is accompanied by constipation, heat is accumulated internally; Neishu Huanglian Tang (Drain Internal Coptis Decoction) can be used to guide out stagnation. If vomiting is caused by cold medicines damaging the Stomach, Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) is indicated. For vomiting due to Cold Stomach and poor appetite, Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction) is used. For vomiting due to middle deficiency and excessive Cold, Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) is used. For vomiting due to Liver Wood overacting on Spleen Earth, Tuoli Yiqing Tang (Support Interior and Suppress Green Decoction) is used. For vomiting due to phlegm retention in the epigastrium, Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction) is used. For vomiting due to Spleen deficiency itself, Tuoli Yihuang Tang (Support Interior and Benefit Yellow Decoction) is used. For vomiting due to constraint injuring the Spleen, Tuoli Yueju Tang (Support Interior and Resolve Depression Decoction) is used. If the root cause is not investigated in detail and toxic-resolving drugs are used blindly, un-ulcerated swellings will not suppurate, and ulcerated wounds will not heal. Although Danxi stated that the abscess stage should be treated as toxic vapors attacking the Heart and the ulcer stage as Yin deficiency, this was a general statement. Nowadays, vomiting due to internal attack of hot toxins is rare, while vomiting due to Spleen-Stomach deficiency-cold is common. How can one stick to fixed formulas without flexibility? Furthermore, he stated: Vomiting triggered by desire, or caused by external application/internal administration of cold-cooling agents, severe pain, or exposure to cold pathogens and foul odors, all indicate deficiency of Stomach Qi. Tuoli Xiaodu San can be used, removing three ingredients, adding Huoxiang (Patchouli Herba), and doubling Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma).
For abundant heat and rapid pulse, *Jingyao* suggests Lulu Tang (Phlomidos Root Decoction) or boiling Dahuang (Rhei Radix et Rhizoma) alone. If heat is not severe and the pulse is slow and weak, only Wuxiang Liaoqiao Tang (Five-Aromatic and Forsythia Decoction) should be administered. Danxi said: Regarding abundant heat and rapid pulse, if it occurs during the abscess stage with closed organs and a robust constitution, purgatives may still be used. However, if it occurs during the ulcer stage with significant loss of pus and blood, accompanied by abundant heat and rapid pulse, death is near; how can purgatives be used? A slow and weak pulse was considered by ancients as a sign that pathogenic toxins had dispersed; given that Wuxiang Liaoqiao Tang has ascending and dispersing properties, is it appropriate to use it in such cases?
Li Shi stated: Vomiting and regurgitation from carbuncles and ulcers are caused by toxic vapors rushing to the Heart, not by Cold of the Spleen and Stomach; therefore, Neituo San should be taken. Yang Shi stated: After a nosebleed has just healed, without sweating to release the exterior, toxins remain in the meridians, leading to a large carbuncle on the back extending from the shoulder to the waist and hypochondrium, swollen, hard as stone, and purple-black. Using cooling medicines resulted in all-night severe vomiting. Continuous administration of Neituo San stopped the vomiting, allowed the sore to ulcerate, and discharged clear fluid, resulting in recovery after forty days. Another patient with a carbuncle experienced pain so severe it induced vomiting, which ceased upon taking this medicine. Since some carbuncle patients do not take this medicine, Yang Shi's words are cited to dispel worldly confusion.
Danxi treated an elderly man, aged seventy, who had a dorsal carbuncle over a chi in diameter for a long time. Various doctors had administered dozens of doses of Wuxiang and Shixuan formulas, causing bloody, foul-smelling pus, vomiting, regurgitation, and inability to eat for over ten days. The patient self-administered Neituo San but felt discomfort in the chest and diaphragm. He also suffered from strangury for thirty years. His current suffering was the pain of strangury and vomiting preventing sleep. Urgently, a paste was boiled from Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), administered with Niuxi Tang (Achyranthes Bidentata Decoction) and Zhuli (Bamboo Sap). After three days, having consumed half a jin of medicine, the strangury stopped and appetite returned. After seven days, consuming four jin of medicine, pus gushed out naturally, and he could sleep. After another twenty days, he recovered. Another man, over sixty years old, fond of wine and meat, developed a dorsal carbuncle with pus, vomiting, regurgitation, and fever, likely due to excessive intake of Neituo San and Shixuan. Because of vomiting, the doctor added Dingxiang (Caryophylli Flos) to Jiahe San to warm the Stomach and move Qi. It was mid-summer, very hot, and the pulse was surging, rapid, and forceful. I remarked that this pulse and syndrome are particularly contraindicated in the ulcer stage. However, since his physical constitution was robust, I only gave him Ren Shen Gao (Ginseng Paste) mixed with Zhuli (Bamboo Sap). After consuming fifteen jin of medicine and over a hundred bamboo stalks, he recovered. I said: This disease recovered fortunately; without a bland diet, it would recur. He continued his rich diet and, after sitting in a pool drunk in summer, more than a year later, a soft lump like a cake appeared on his left flank. Two years later, this lump became a carbuncle. Seeing profuse pus and blood, with a surging, rapid, forceful pulse, and again suffering vomiting, regurgitation, and poor appetite, he self-administered Ren Shen Gao with Zhuli, consuming over ten jin and a hundred bamboo stalks before recovering. Now eighty years old, he remains strong as ever. This illness healed twice because of the elderly man's weak Qi and Blood, specifically through the exclusive use of Renshen and Zhuli. Had Neituo San and Shixuan been used, safety might not have been achieved. Lou Quanshan treated a man with vomiting during the abscess stage; various medicines failed, but one dose of Dushen Tang (Single Ginseng Decoction) cured the vomiting immediately.
Xue Xinpu treated a man with an abdominal abscess, painful swelling, irritability, and vomiting, with a solid pulse. Liu Hejian stated: Sores and ulcers belong to Fire; one must distinguish interior and exterior to treat the root. If the pulse is deep and solid, one should first unblock the interior to cut off the source. He also stated: Vomiting, hiccups, irritability, deep and solid pulse, local swelling and hardness with numbness, or unchanged skin color indicate pathogens inside; Neishu Huanglian Tang should be used. Thus, the aforementioned decoction was used to promote defecation two or three times, eliminating all symptoms, followed by Liaoqiao Xiaodu San (Forsythia and Scutellaria Detoxifying Powder) for complete recovery. Another patient with arm toxicity experienced pain, swelling, and vomiting; symptoms worsened after taking Tuoli Xiaodu San. Two doses of Liangge San (Cool the Diaphragm Powder) quickly reduced the condition, followed by Siwu Tang (Four Substances Decoction) with Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) for four doses until resolution. Xinpu also treated a man over forty who had an ulcerated dorsal carbuncle, suddenly developing vomiting and wound pain. The Stomach pulse was wiry and tight. He believed it was residual toxin attacking internally. Dongyuan stated: Vomiting without regularity and cold extremities indicate deficiency of the Zang-Fu organs. Danxi stated: Vomiting and inability to eat after ulceration indicate Dampness invading internally. He also stated: Pain returning after pus discharge indicates deficiency. Now, with a wiry and tight Stomach pulse, Wood is overacting on Earth, clearly indicating deficiency. I intended to treat with Liujunzi Tang (Six Gentlemen Decoction) plus Jiuhao Shaoyao (Wine-fried White Peony Root), Sharen (Amomi Fructus), and Huoxiang (Patchouli Herba). The patient self-administered Huxin San (Heart-Protecting Powder), worsening the vomiting. Upon re-examination, the previous formula was used again, supplemented with Qi and Blood tonics, resulting in recovery after two months. Generally, vomiting caused by internal invasion of Dampness or foul odors prefers coolness and presents with a weak pulse; vomiting caused by internal attack of Hot Toxins prefers cooling and presents with a rapid pulse. These must be clearly distinguished.
Juban Weiling Tang (Tangerina Peel, Pinellia, and Poria Decoction) treats vomiting and inability to eat or taste in carbuncles and ulcers.
Chenhong (Tangerina Peel), Banxia (Pinelliae Rhizoma prepared with ginger, each 1 qian); Cangzhu (Atractylodis Rhizoma soaked in rice water and fried); Baizhu (Atractylodis Macrocephalae Rhizoma fried); Houpo (Magnoliae Officinalis Cortex prepared with ginger); Gancao (Licorice Root roasted); Fuling (Poria); Renshen (Ginseng Radix et Rhizoma); Zexie (Alismatis Rhizoma); Maogen (Imperatae Rhizoma, each 2 qian); Jiangzhi (Ginger Juice, several spoons).
Boil with two cups of water until one cup remains, add Ginger Juice, boil for one or two boils. Drink in over ten portions.
Mr. Xue stated: The preceding syndrome belongs to five of the "Seven Evils." After using this formula, when Stomach Qi begins to awaken, Liujunzi Tang (Six Gentlemen Decoction) should be taken concurrently. For those with irritability, craving cold drinks, anorexia, deep solid pulse, and vomiting, this formula is likely inappropriate; Neishu Huanglian Tang (Drain Internal Coptis Decoction) is preferred. (Formula see Abscess Section.)
Tuoli Xiaodu San Modification treats vomiting or regurgitation in sores and ulcers, or vomiting caused by external application/internal administration of cold-cooling agents, severe pain, or exposure to cold pathogens and foul odors, all indicating deficiency of Stomach Qi. Remove Baizhi (Angelicae Dahuricae Radix), Liaoqiao (Forsythiae Fructus), and Jinyinhua (Lonicerae Japonicae Flos); add Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Huoxiang (Patchouli Herba). (Formula see Abscess Section, Neituo Item.)
Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) treats sores and ulcers in patients with originally deficient Yuan Qi, or Stomach damage from cooling medicines, poor appetite, or symptoms such as vomiting and diarrhea.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria, each 2 qian); Banxia (Pinelliae Rhizoma), Paojiang (Prepared Ginger, each 1 qian); Zhigancao (Roasted Licorice Root, 0.5 qian); Huangqi (Astragali Radix, 1.5 qian); Rougui (Cinnamomi Cortex, 0.3 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction) treats deficiency of Middle Qi, poor appetite, non-resolution of sores, or failure of ulcerated wounds to close.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Banxia (Pinelliae Rhizoma), Fuling (Poria), Paojiang (Prepared Ginger, each 1 qian); Muxiang (Aucklandiae Radix), Zhigancao (Roasted Licorice Root, each 0.5 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Tuoli Yiqing Tang (Support Interior and Suppress Green Decoction) treats weakness of Spleen Earth oppressed by Liver Wood, leading to poor appetite or discomfort in the chest and diaphragm.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma, each 1 qian); Shaoyao (Paeoniae Radix Alba), Chaihu (Bupleuri Radix), Gancao (Licorice Root, each 0.5 qian); Chenpi (Tangerina Peel, 1 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction) treats weakness of Spleen and Stomach, turbid Phlegm-Qi, and poor appetite.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria, each 1 qian); Banxia (Pinelliae Rhizoma, 0.8 fen); Jiegeng (Platycodonis Radix, 0.7 fen); Zhigancao (Roasted Licorice Root, 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Tuoli Yihuang Tang (Support Interior and Benefit Yellow Decoction) treats deficiency-cold of Spleen Earth, Water counter-acting Earth, leading to poor appetite, vomiting, or diarrhea.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria), Banxia (Pinelliae Rhizoma, each 1 qian); Paojiang (Prepared Ginger), Dingxiang (Caryophylli Flos), Zhigancao (Roasted Licorice Root, each 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Tuoli Yueju Tang (Support Interior and Resolve Depression Decoction) treats injury from Six Depressions, weakness of Spleen and Stomach, and poor appetite.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, each 2 qian); Chenpi (Tangerina Peel), Banxia (Pinelliae Rhizoma, each 1 qian); Shanzhi (Gardeniae Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xiangfumi (Cyperi Rhizoma), Cangzhu (Atractylodis Rhizoma, each 0.7 fen); Zhigancao (Roasted Licorice Root, 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.
Renshen Lizhong Tang (Ginseng and Immortelle Decoction) treats deficiency-cold of Spleen and Stomach in sores and ulcers, vomiting, diarrhea, poor appetite, abdominal distension, empty fullness in the chest and diaphragm, or inability to ingest food.
Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Zhigancao (Roasted Licorice Root, equal parts).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.