夫呕家有痈脓。不可治呕。脓尽自愈。
痈脓。胃中有痈。脓从呕出也。是因痈脓而呕。脓尽痈已。则呕自愈。不可概以止吐之药治之也。
先呕却渴者。此为欲解。先渴却呕者。为水停心下。此属饮家。呕家本渴。今反不渴者。心下有
支饮故也。此属支饮。
呕家必有停痰宿水。先呕却渴者。痰水已去。而胃阳将复也。故曰此为欲解。先渴却呕者。因热
饮水过多。热虽解而饮旋积也。此呕因积饮所致。故曰此属饮家。呕家本渴。水从呕去故也。今反不
渴者。以宿有支饮在心下。愈动而愈出也。故曰此属支饮。
问曰。病患脉数。数为热。当消谷引饮。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。令脉
反弦。故名曰虚。
脉数为热。乃不能消谷引饮而反吐者。以发汗过多。阳微膈虚所致。则其数为客热上浮之数。而
非胃实气热之数矣。客热如客之寄。不久即散。故不能消谷也。脉弦为寒。乃不曰寒而曰虚者。以寒
在于上。而医反下之所致。故其弦非阴寒外加之弦。而为胃虚生寒之弦矣。胃虚且寒。阳气无余。则
朝食暮吐而变为胃反也。读此知数脉弦脉。均有虚候。曰热曰寒。盖浅之乎言脉者耳。
寸口脉微而数。微则无气。无气则营虚。营虚则血不足。血不足则胸中冷。
此因数为客热。而推言脉微而数者。为无气而非有热也。气者营之主。故无气则营虚。营者血之
源。故营虚则血不足。营卫俱虚则胸中之积而为宗气者少矣。故胸中冷。
合上二条言之。客热固非真热。不可以寒治之。胸中冷亦非真冷。不可以热治之。是皆当以温养
真气为主。真气、冲和纯粹之气。此气浮则生热。沉则生冷。温之则浮焰自收。养之则虚冷自化。若
热以寒治。寒以热治。则真气愈虚。寒热内贼。而其病益甚矣。
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。宿谷不化。名曰胃反。
脉紧而涩。其病难治。
此因胃气无余。变为胃反。而推言其病之并在于脾也。夫胃为阳。脾为阴。浮则为虚者。胃之阳
虚也。涩
则伤脾者。脾之阴伤也。谷入于胃而运于脾。脾伤则不能磨。脾不磨则谷不化。而朝食者暮当下。暮
食者朝当下。若谷不化。则不得下。不得下。必反而上出也。夫脾胃、土也。土德本缓。而脉反紧。
则肝有余。土气本和。而脉反涩。则血不足。脏真不足。而贼邪有余。故曰难治。
病患欲吐者。不可下之。
病患欲吐者。邪在上而气方逆。若遽下之。病气必与药气相争。而正乃蒙其祸矣。否则里虚邪入。
病气转深。或痞或利。未可知也。故曰不可下之。
哕而腹满。视其前后。知何部不利。利之愈。
哕而腹满者。病在下而气溢于上也。与病患欲吐者不同。故当视其前后二阴。知何部不利而利之。
则病从下出。而气不上逆。腹满与哕俱去矣。
呕而胸满者。吴茱萸汤主之。
胸中、阳也。呕而胸满。阳不治而阴乘之也。故以吴茱萸散阴降逆。人参、姜、枣补中益阳气。
吴茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味。以水五升。煮取三升。温服七合。日三服。
干呕吐涎沫。头痛者。吴茱萸汤主之。
干呕吐涎沫。上焦有寒也。头者诸阳之会。为阴寒之邪上逆而痛。故亦宜茱萸汤。以散阴气而益
阳气。呕而肠鸣。心下痞者。半夏泻心汤主之。
邪气乘虚。陷入心下。中气则痞。中气既痞。升降失常。于是阳独上逆而呕。阴独下走而肠鸣。
是虽三焦俱病。而中气为上下之枢。故不必治其上下。而但治其中。黄连、黄芩苦以降阳。半夏、干
姜辛以升阴。阴升阳降。痞将自解。人参、甘草则补养中气。以为交阴阳通上下之用也。
半夏泻心汤方
半夏（半斤洗） 黄芩 干姜 人参（各三两） 甘草（三两炙） 黄连（一两） 大枣（十二
枚）
上七味。以水一斗。煮取六升。去滓。再煮取三升。温服一升。日三服。
干呕而利者。黄芩加半夏生姜汤主之。
此伤寒热邪入里作利。而复上行为呕者之法。而杂病肝胃之火。上冲下注者。亦复有之。半夏、生
姜。散逆于上。黄芩、芍药。除热于里。上下俱病。中气必困。甘草、大枣合芍药、生姜。以安中而
正气也。
黄芩加半夏生姜汤方
黄芩 生姜（各三两） 甘草（二两） 芍药（一两） 半夏（半升） 大枣（十二枚）
上六味。以水一斗。煮取三升。去滓。温服一升。日再夜一服。
诸呕吐。谷不得下者。小半夏汤主之。
呕吐谷不得下者。胃中有饮。随气上逆。而阻其谷入之路也。故以半夏消饮。生姜降逆。逆止饮
消。谷斯下矣。
小半夏汤方（见痰饮）
呕吐而病在膈上。后思水者解。急与之。思水者。猪苓散主之。
病在膈上。病膈间有痰饮也。后思水者。知饮已去。故曰欲解。即先呕却渴者。此为欲解之义。
夫饮邪已去。津液暴竭。而思得水。设不得。则津亡而气亦耗。故当急与。而呕吐之余。中气未复。
不能胜水。设过与之。则旧饮方去。新饮复生。故宜猪苓散以崇土而逐水也。
猪苓散方
猪苓 茯苓 白术（各等分）
上三味。杵为散。饮服方寸匕。日三服。
呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
脉弱便利而厥。为内虚且寒之候。则呕非火邪。而是阴气之上逆。热非实邪。而是阳气之外越矣。
故以四逆汤救阳驱阴为主。然阴方上冲。而阳且外走。其离决之势。有未可即为顺接者。故曰难治。
或云。呕与身热为邪实。厥利脉弱为正虚。虚实互见。故曰难治。四逆汤舍其标而治其本也。亦通。
四逆汤方
附子（一枚生用） 干姜（一两半） 甘草（二两炙）
上二味。以水三升。煮取一升二合。去滓。分温再服。强人可大附子一枚。干姜三两。
呕而发热者。小柴胡汤主之。
呕而发热。邪在少阳之经。欲止其呕。必解其邪。小柴胡则和解少阳之正法也。
小柴胡汤方
柴胡（半斤） 半夏（一升） 黄芩 人参 甘草 生姜（各三两） 大枣（十二枚）
上七味。以水一斗。煮取六升。去滓。再煎取三升。温服一升。日三服。
胃反。呕吐者。大半夏汤主之。
胃反呕吐者。胃虚不能消谷。朝食而暮吐也。又胃脉本下行。虚则反逆也。故以半夏降逆。人参、
白蜜益虚安中。东垣云。辛药生姜之类治呕吐。但治上焦气壅表实之病。若胃虚谷气不行。胸中闭塞
而呕者。惟宜益胃推扬谷气而已。此大半夏汤之旨也。
大半夏汤方
半夏（二升） 人参（三两） 白蜜（一升）
上三味。以水一斗二升。和蜜扬之二百四十遍。煮药取二升半。温服一升。余分再服。
食已即吐者。大黄甘草汤主之。
经云。清阳出上窍。浊阴出下窍。本乎天者亲上。本乎地者亲下也。若下既不通。必反上逆。所
谓阴阳反作。气逆不从。食虽入胃。而气反出之矣。故以大黄通其大便。使浊气下行浊道。而呕吐自
止。不然。止之降之无益也。东垣通幽汤治幽门不通。上冲吸门者。亦是此意。但有缓急之分耳。
再按、经云。阳气者闭塞。地气者冒明。云雾不精。则上应白露不下。夫阳气、天气也。天气闭。
则地气干矣。云雾出于地。而雨露降于天。地不承。则天不降矣。可见天地阴阳。同此气机。和则俱
和。乖则并乖。人与天地相参。故肺气象天。病则多及二阴脾胃。大小肠象地。病则多及上窍。丹溪
治小便不通。用吐法以开提肺气。使上窍通而下窍亦通。与大黄甘草汤之治呕吐。法虽异而理可通也。
大黄甘草汤方
大黄（四两） 甘草（一两）
上二味。以水三升。煮取一升。分温再服。
胃反。吐而渴欲饮水者。茯苓泽泻汤主之。
猪苓散治吐后饮水者。所以崇土气。胜水气也。茯苓泽泻汤治吐未已。而渴欲饮水者。以吐未已。
知邪未去。则宜桂枝、甘、姜散邪气。苓、术、泽泻消水气也。
茯苓泽泻汤方
茯苓（半斤） 泽泻（四两） 甘草 桂枝（各二两） 白术（三两） 生姜（四两）
上六味。以水一斗。煮取三升。内泽泻。再煮取二升半。温服八合。日三服。
吐后。渴欲得水而贪饮者。文蛤汤主之。兼主微风。脉紧头痛。
吐后水去热存。渴欲得水。与前猪苓散证同。虽复贪饮。亦止热甚而然耳。但与除热导水之剂足
矣。乃复用麻黄、杏仁等发表之药者。必兼有客邪郁热于肺。不解故也。观方下云。汗出即愈。可以
知矣。曰兼主微风脉紧头痛者。以麻、杏、甘、石。本擅驱风发表之长耳。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十粒） 大枣（十二枚）
上七味。以水六升。煮取二升。温服一升。汗出即愈。
干呕吐逆。吐涎沫。半夏干姜散主之。
干呕吐逆。胃中气逆也。吐涎沫者。上焦有寒。其口多涎也。与前干呕吐涎沫头痛不同。彼为厥
阴阴气上逆。此是阳明寒涎逆气不下而已。故以半夏止逆消涎。干姜温中和胃。浆水甘酸。调中引气
止呕哕也。
半夏干姜散方
半夏 干姜（各等分）
上二味。杵为散。取方寸匕。浆水一升半。煮取七合。顿服之。
病患胸中似喘不喘。似呕不呕。似哕不哕。彻心中愦愦然无奈者。生姜半夏汤主之。
寒邪搏饮。结于胸中而不得出。则气之呼吸往来。出入升降者阻矣。似喘不喘。似呕不呕。似哕
不哕。皆寒饮与气。相搏互击之证也。且饮、水邪也。心、阳脏也。以水邪而逼处心脏。欲却不能。欲
受不可。则彻心中愦愦然无奈也。生姜半夏汤。即小半夏汤。而生姜用汁。则降逆之力少。而散结之
力多。乃正治饮气相搏。欲出不出者之良法也。
生姜半夏汤方
半夏（半升） 生姜（汁一升）
上二味。以水三升。煮半夏。取二升。内生姜汁。煮取一升半。小冷分四服。日三夜一。呕止。
停后服。
干呕哕。若手足厥者。橘皮汤主之。
干呕哕非反胃。手足厥非无阳。胃不和。则气不至于四肢也。橘皮和胃气。生姜散逆气。气行胃
和。呕哕与厥自已。未可便认阳虚而遽投温补也。
橘皮汤方
橘皮（四两） 生姜（半斤）
上二味。以水七升。煮取三升。温服一升。下咽即愈。
哕逆者。橘皮竹茹汤主之。
胃虚而热乘之。则作哕逆。橘皮、生姜。和胃散逆。竹茹除热止呕哕。人参、甘草、大枣。益虚
安中也。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
上六味。以水一斗。煮取三升。温服一升。日三服。
夫六腑气绝于外者。手足寒。上气脚缩。五脏气绝于内者。利不禁。下甚者手足不仁。
六腑为阳。阳者主外。阳绝不通于外。为手足寒。阳不外通。则并而上行。为上气脚缩也。五脏
为阴。阴者主内。阴绝不守于内。则下利不禁。甚者不交于阳。而隧道痹闭。为手足不仁也。
下利脉沉弦者下重。脉大者为未止。脉微弱数者为欲自止。虽发热不死。
沉为里为下。沉中见弦。为少阳之气滞于下而不得越。故下重。大为邪盛。又大则病进。故为未
止。徐氏曰。微弱者。正衰邪亦衰也。数为阳脉。于微弱中见之。则为阳气将复。故知利欲自止。虽有
身热。势必自已。不得比于下利热不止者死之例也。
下利手足厥冷。无脉者。灸之不温。若脉不还。反微喘者死。少阴负趺阳者为顺也。
下利厥冷无脉。阴亡而阳亦绝矣。灸之所以引既绝之阳。乃厥不回。脉不还。而反微喘。残阳上
奔。大气下脱。故死。下利为土负水胜之病。少阴负趺阳者。水负而土胜也。故曰顺。
下利有微热而渴。脉弱者令自愈。下利脉数。有微热。汗出。令自愈。设脉紧为未解。下利脉数
而渴者。令自愈。设不瘥。必圊脓血。以有热故也。下利脉反弦。发热身汗者愈。
微热而渴者。胃阳复也。脉弱者。邪气衰也。正复邪衰。故令自愈。脉数、亦阳复也。微热汗出
者。气方振而势外达。亦为欲愈之候。设脉紧则邪尚盛。必能与正相争。故为未解。脉数而渴。阳气
已复。亦下利有微热而渴之意。然脉不弱而数。则阳之复者已过。阴寒虽解。而热气转增。将更伤阴
而圊脓血也。弦脉阴阳两属。若与发热身汗并见。则弦亦阳也。与脉数有微热汗出正同。故愈。
按、上数条。皆是伤寒邪气入里之候。故或热或渴。或汗出。或脉数。阳气既复。邪气得达则愈。
若杂病湿热下利之证。则发热口渴脉数。均非美证。内经云。下利身热者死。仲景云。下利手足不逆
冷。反发热者不死。盖内经所言者。杂病湿热下利之证。仲景所言者。伤寒阴邪内入之证。二者不可
不分也。
下利气者。当利其小便。
呕吐患者若有痈脓，不可治疗其呕吐症状。待脓液排尽，呕吐自然停止。
痈脓，是指胃中有痈肿化脓，脓液随呕吐排出。这是因痈脓引起的呕吐，当脓液排尽、痈肿愈合后，呕吐自然会好，不能一概用止吐药物治疗。
先呕吐而后感到口渴的，这是病情将要解除的表现；先感到口渴而后呕吐的，是因为水饮停聚在心下（胃脘部），这属于痰饮病患者。呕吐的患者本来应该口渴，现在反而不渴，是因为心下有支饮（支撑于胸膈之间的水饮）的缘故，这也属于支饮病。
呕吐的患者必然有停积的痰饮。先呕吐而后口渴的，说明痰饮已去，胃阳即将恢复，所以说这是病情将要解除。先口渴而后呕吐的，是因为体内有热而饮水过多，虽然热邪解除了，但水饮随即积聚。这种呕吐是由积饮引起的，所以说这属于痰饮病。呕吐的患者本来因为水饮从呕吐而去而应当口渴，现在反而不渴，是因为宿有的支饮在心下，越受扰动越容易涌出，所以说这属于支饮病。
问：病人脉象数，数脉主热，应当能消化食物且多饮，却反而呕吐，这是什么原因？医生说：这是因为发汗过度，导致阳气微弱、膈间气虚，脉象才表现为数。这里的数是客热（假热），不能消化食物，是因为胃中虚寒的缘故。脉象弦也是虚象，表示胃气无余。早晨吃晚饭时吐，变为胃反病。寒邪在上，医生反而用攻下法，导致脉象反见弦，所以名叫虚证。
脉数通常主热，既然不能消化食物反而呕吐，是因为发汗过多，导致阳气微弱、膈间气虚所致。那么这种数脉是客热上浮的数脉，而不是胃实气热的数脉。客热像客人寄居一样，不久就会消散，所以不能消化食物。脉弦主寒，这里不说寒而说虚，是因为寒邪在上，医生反而用攻下法导致的。所以这种弦脉不是阴寒外加之弦，而是胃虚生寒之弦。胃既虚又寒，阳气无余，就会早晨吃晚上吐，变为胃反病。读到这里可知，数脉和弦脉都有虚证的征候，说它是热或寒，只是浅显地谈论脉象罢了。
寸口脉微而数，微脉表示无气，无气则营血虚，营血虚则血液不足，血液不足则胸中寒冷。
这里是因为前面的数脉是客热，进而推论脉微而数的情况，认为是无气而不是有热。气是营的主宰，所以无气则营虚。营是血的源头，所以营虚则血不足。营卫都虚，则胸中积聚而成的宗气就少了，所以胸中寒冷。
结合上面两条来看，客热固然不是真热，不能用寒凉药治疗；胸中冷也非真冷，不能用温热药治疗。这些都应当以温养真气为主。真气，是冲和纯粹之气。这种气浮越则生热，沉潜则生冷。温养它则浮越的热焰自收，滋养它则虚冷自化。如果用寒治热，用热治寒，则真气更虚，寒热内侵，病情会更加严重。
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，早晨吃晚上吐，晚上吃早上吐，宿食不化，名叫胃反。
脉紧而涩，这种病难治。
这是因为胃气无余，变为胃反病，进而推论其病同时也在于脾。胃属阳，脾属阴。浮则为虚，是指胃之阳虚。涩则伤脾，是指脾之阴伤。谷物进入胃而在脾运化，脾受伤则不能磨化。脾不磨化则谷不化，早晨吃的食物晚上应当下行，晚上吃的食物早上应当下行。如果谷不化，就不能下行，不能下行必然反向上吐出。脾胃属土，土德本缓，而脉反紧，则是肝气有余；土气本和，而脉反涩，则是血不足。脏气真元不足，而贼邪有余，所以说难治。
病人想呕吐，说明邪气在上且气机正逆乱，如果立刻用攻下法，病气必与药气相争，正气反而会遭受祸害。否则里气虚而邪气内入，病气转深，变成痞证或下利，都是不可预知的。所以说不可用攻下法。
呃逆且腹部胀满，观察前阴和后阴，知道哪一部分不通利，通利它就好了。
呃逆且腹部胀满，是病在下而气溢于上。这与病人想呕吐的情况不同，所以应当观察前后二阴，知道哪一部分不通利而通利它，病气就从下而出，气就不上逆，腹满与呃逆都会去除。
胸中属阳，呕吐且胸部胀满，是阳气不治而阴邪乘袭。所以用吴茱萸散阴降逆，人参、生姜、大枣补中益气。
吴茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
以上四味药，用水五升，煮取三升，温服七合，每日三次服用。
干呕吐涎沫，是上焦有寒。头是诸阳之会，被阴寒之邪上逆而痛，所以也适宜用茱萸汤，来散阴气而益阳气。
邪气乘虚陷入心下，中气痞塞。中气既已痞塞，升降失常，于是阳气独上逆而呕吐，阴气独下走而肠鸣。虽然三焦都生病，但中气是上下交通的枢纽，所以不必治其上下，只需治其中。黄连、黄芩苦寒以降阳，半夏、干姜辛温以升阴。阴升阳降，痞塞将自然解除。人参、甘草则补养中气，作为交阴阳、通上下的作用。
半夏泻心汤方
半夏（半斤，洗） 黄芩 干姜 人参（各三两） 甘草（三两，炙） 黄连（一两） 大枣（十二枚）
以上七味药，用水一斗，煮取六升，去渣，再煮取三升，温服一升，每日三次服用。
这是伤寒热邪入里导致下利，而又上行导致呕吐的方法。杂病中肝胃之火上冲下注的情况也有。半夏、生姜散上逆之气，黄芩、芍药除里热。上下俱病，中气必困，甘草、大枣合芍药、生姜，以安中气而调正气。
黄芩加半夏生姜汤方
黄芩 生姜（各三两） 甘草（二两） 芍药（一两） 半夏（半升） 大枣（十二枚）
以上六味药，用水一斗，煮取三升，去渣，温服一升，白天两次夜间一次服用。
呕吐且食物无法下咽，是胃中有饮邪，随气上逆，阻碍了食物进入的道路。所以用半夏消饮，生姜降逆。逆气止住，饮邪消除，食物就能下咽了。
呕吐且病位在膈上，后来想喝水的，表示病将解除，赶快给他喝水。想喝水的，用猪苓散主治。
病在膈上，是膈间有痰饮。后来想喝水，说明饮邪已去，所以说欲解。这就是前面说的“先呕却渴者，此为欲解”的意思。
饮邪已去，津液突然枯竭，因而想喝水，如果不给，则津亡而气亦耗，所以应当急给。但在呕吐之后，中气未复，不能承受大量饮水，如果过量给予，则旧饮刚去，新饮又生，所以宜用猪苓散来培土制水。
以上三味药，捣为散，用米汤送服一方寸匕，每日三次服用。
呕吐且脉弱，小便清长，身体有微热，出现四肢厥冷的，难治，用四逆汤主治。
脉弱、便利且厥冷，是内虚且寒的征候。那么呕吐就不是火邪，而是阴气上逆；热也不是实邪，而是阳气外越。所以用四逆汤救阳驱阴为主。然而阴气正上冲，阳气且外走，其离决之势，未必能立即顺接，所以说难治。有人说，呕吐与身热为邪实，厥利脉弱为正虚，虚实互见，所以说难治。四逆汤舍弃标症而治本症，也讲得通。
四逆汤方
附子（一枚，生用） 干姜（一两半） 甘草（二两，炙）
以上两味药（注：原文此处漏写甘草用量或排版错误，通常含甘草，依原文结构列出），用水三升，煮取一升二合，去渣，分两次温服。体质强壮的人可用大附子一枚，干姜三两。
呕吐且发热，邪气在少阳经。要止其呕，必须解其邪。小柴胡汤是和解少阳的正法。
小柴胡汤方
柴胡（半斤） 半夏（一升） 黄芩 人参 甘草 生姜（各三两） 大枣（十二枚）
以上七味药，用水一斗，煮取六升，去渣，再煎取三升，温服一升，每日三次服用。
胃反呕吐，是胃虚不能消化食物，早晨吃晚上吐。而且胃脉本应下行，虚则反而上逆。所以用半夏降逆，人参、白蜜益虚安中。东垣说，辛药如生姜之类治疗呕吐，只治疗上焦气壅表实的病。如果是胃虚谷气不行，胸中闭塞而呕吐的，只适宜益胃推扬谷气而已。这就是大半夏汤的宗旨。
以上三味药，用水一斗二升，和蜜扬之二百四十遍，煮药取二升半，温服一升，其余分两次服用。
吃完即吐的，用大黄甘草汤主治。
经文说，清阳出上窍，浊阴出下窍。本乎天的亲上，本乎地的亲下。如果下部不通，必然反向上逆，所谓阴阳反作，气逆不从。食物虽入胃，但气反而出来。所以用大黄通大便，使浊气下行于浊道，而呕吐自然停止。不然，止呕降逆是无益的。东垣的通幽汤治疗幽门不通，上冲吸门，也是这个意思，只不过有缓急之分罢了。
再按：经文说，阳气闭塞，地气冒明。云雾不精，则上应白露不下。夫阳气即天气，天气闭，则地气干矣。云雾出于地，而雨露降于天，地不承，则天不降矣。可见天地阴阳，同此气机，和则俱和，乖则并乖。人与天地相参，所以肺气象天，病则多涉及二阴脾胃；大小肠象地，病则多涉及上窍。丹溪治疗小便不通，用吐法以开提肺气，使上窍通而下窍亦通，与大黄甘草汤治疗呕吐，法虽异而理可通。
以上两味药，用水三升，煮取一升，分两次温服。
猪苓散治疗呕吐后想喝水的，是为了培土气，胜水气。茯苓泽泻汤治疗呕吐未止，而口渴想喝水的，因为呕吐未止，知邪未去，则宜桂枝、甘草、生姜散邪气，茯苓、白术、泽泻消水气。
茯苓泽泻汤方
茯苓（半斤） 泽泻（四两） 甘草 桂枝（各二两） 白术（三两） 生姜（四两）
以上六味药，用水一斗，煮取三升，加入泽泻，再煮取二升半，温服八合，每日三次服用。
呕吐后，口渴想喝水且贪饮的，用文蛤汤主治。兼治微风，脉紧头痛。
呕吐后水去热存，口渴想喝水，与前猪苓散证相同。虽然贪饮，也只是热甚所致。只要给予除热导水的药物即可。乃复用麻黄、杏仁等发表的药物，必定兼有客邪郁热于肺，不解的缘故。看方后说“汗出即愈”，就可以知道了。说兼治微风脉紧头痛，是因为麻黄、杏仁、甘草、石膏，本就擅长驱风发表。
文蛤汤方
文蛤（五两） 麻黄 甘草 生姜（各三两） 石膏（五两） 杏仁（五十粒） 大枣（十二枚）
以上七味药，用水六升，煮取二升，温服一升，汗出即愈。
干呕呃逆，是胃中气逆。吐涎沫，是上焦有寒，口中多涎。这与前面的干呕吐涎沫头痛不同，那是厥阴阴气上逆，这是阳明寒涎逆气不下而已。所以用半夏止逆消涎，干姜温中和胃，浆水甘酸，调中引气止呕哕。
以上两味药，捣为散，取一方寸匕，用浆水一升半，煮取七合，一次性服用。
病人胸中似喘不喘，似呕不呕，似呃逆不呃逆，心中烦闷无奈至极的，用生姜半夏汤主治。
寒邪搏结饮邪，结于胸中而不能出，则气的呼吸往来、出入升降受阻。似喘不喘，似呕不呕，似呃逆不呃逆，都是寒饮与气相互搏结击打的证候。况且饮是水邪，心是阳脏，以水邪逼迫处于心脏，想排除不能，想容纳不可，则心中烦闷无奈。生姜半夏汤，就是小半夏汤，而生姜用汁，则降逆之力少，而散结之力多，正是治疗饮气相搏、欲出不出者的良法。
以上两味药，用水三升，煮半夏，取二升，加入生姜汁，煮取一升半，稍冷时分四次服用，白天三次夜间一次。呕吐停止，停服后面的药。
干呕呃逆不是反胃，手足厥冷不是无阳。胃不和，则气不能到达四肢。橘皮和胃气，生姜散逆气。气行胃和，呕哕与厥冷自然痊愈，不可便认为是阳虚而急于投用温补药。
以上两味药，用水七升，煮取三升，温服一升，下咽即愈。
胃虚而热邪乘之，则发生呃逆。橘皮、生姜，和胃散逆；竹茹除热止呕哕；人参、甘草、大枣，益虚安中。
橘皮竹茹汤方
橘皮（二斤） 竹茹（二升） 大枣（三十枚） 生姜（半斤） 甘草（五两） 人参（一两）
以上六味药，用水一斗，煮取三升，温服一升，每日三次服用。
六腑之气绝于体表，则手足寒冷，气逆脚缩。五脏之气绝于体内，则下利不禁，严重的则手足麻木不仁。
六腑属阳，阳主外。阳绝不通于外，为手足寒冷。阳不外通，则并而上行，为气逆脚缩。五脏属阴，阴主内。阴绝不守于内，则下利不禁。严重的不与阳交，而隧道痹闭，为手足不仁。
下利脉沉弦的，有下重感；脉大的，病未停止；脉微弱而数的，病将自行停止，虽有发热也不死。
沉脉为里为下，沉中见弦，为少阳之气滞于下而不得发散，所以下重。大为邪盛，又大则病进，所以为未止。徐氏说，微弱者，正气衰邪气也衰。数为阳脉，在微弱中见到，则为阳气将复，所以知道下利将自止。虽然有身热，势必自己停止，不能比于下利热不止的死证。
下利手足厥冷，无脉的，灸之不温，如果脉不还，反而微喘的，死。少阴脉负于趺阳脉的为顺。
下利厥冷无脉，阴亡而阳也绝了。灸之所以引导已绝之阳，但厥不回，脉不还，反而微喘，残阳上奔，大气下脱，所以死。下利是土负水胜的病，少阴负于趺阳，是水负而土胜，所以说顺。
下利有微热而渴，脉弱的令其自愈。下利脉数，有微热，汗出，令其自愈。如果脉紧为未解。下利脉数而渴的，令其自愈。如果不愈，必排脓血，因为有热的原因。下利脉反弦，发热身汗的愈。
微热而渴，是胃阳复。脉弱，是邪气衰。正复邪衰，所以令自愈。脉数，也是阳复。微热汗出，是正气振奋而势外达，也是欲愈的征候。如果脉紧则邪尚盛，必能与正相争，所以为未解。脉数而渴，阳气已复，也是下利有微热而渴的意思。然而脉不弱而数，则阳之复者已过，阴寒虽解，而热气转增，将更伤阴而排脓血。弦脉阴阳两属，若与发热身汗并见，则弦亦阳也，与脉数有微热汗出正同，所以愈。
按：上面几条，都是伤寒邪气入里的征候，所以或热或渴，或汗出，或脉数，阳气既复，邪气得达则愈。如果是杂病湿热下利的证候，则发热口渴脉数，均非美证。内经说，下利身热者死。仲景说，下利手足不逆冷，反发热者不死。大概内经所言的是杂病湿热下利的证候，仲景所言的是伤寒阴邪内入的证候，二者不可不分。
If a patient with vomiting has abscess and pus, do not treat the vomiting. Once the pus is exhausted, it will heal on its own.
Abscess and pus refer to an abscess in the stomach, where pus is expelled through vomiting. This vomiting is caused by the abscess and pus; once the pus is exhausted and the abscess heals, the vomiting will resolve spontaneously. One should not indiscriminately use anti-emetic drugs to treat it.
If vomiting occurs first followed by thirst, this indicates that the disease is about to resolve. If thirst occurs first followed by vomiting, it is due to fluid retention in the epigastrium (heart below), which belongs to patients with phlegm-fluids (Yin). Patients who vomit usually feel thirsty; if they do not feel thirsty now, it is because there is retained fluid (Zhi Yin) in the epigastrium, which also belongs to Zhi Yin.
Patients who vomit necessarily have retained phlegm and old fluids. If vomiting occurs first followed by thirst, it means the phlegm and fluids have been eliminated, and the Stomach Yang is about to recover. Hence, it is said that this indicates resolution. If thirst occurs first followed by vomiting, it is due to excessive drinking when there was internal heat; although the heat has resolved, the fluids accumulate again. This vomiting is caused by accumulated fluids, hence it belongs to patients with phlegm-fluids. Patients who vomit should naturally be thirsty because water is lost through vomiting. Now, if they are not thirsty, it is because of pre-existing Zhi Yin in the epigastrium, which becomes more active and flows out. Hence, it is said that this belongs to Zhi Yin.
Question: The patient's pulse is rapid (Shu). Rapid pulse indicates heat, so digestion should be enhanced and thirst for drinks increased, yet the patient vomits instead. Why? The Master said: This is due to excessive sweating, which made the Yang Qi weak and the Diaphragm Qi deficient, causing the pulse to appear rapid. This rapidness is "guest heat" (Ke Re), which cannot digest food. It is due to cold deficiency in the Stomach. A wiry (Xian) pulse also indicates deficiency, meaning no surplus of Stomach Qi. Morning eating and evening vomiting transform into Wei Fan (Stomach Reversal). Cold is located above, but the physician mistakenly used purgatives, causing the pulse to become wiry. Thus, it is named deficiency.
A rapid pulse usually indicates heat, yet if digestion is impaired and vomiting occurs, it is caused by excessive sweating leading to weak Yang and deficient Diaphragm Qi. Therefore, the rapidness is due to guest heat floating upward, not the rapidness of excess heat in the Stomach. Guest heat is like a temporary visitor and dissipates soon, so it cannot digest food. A wiry pulse indicates cold. Here, it is called deficiency rather than cold because the cold is above, and the physician mistakenly used purgatives. Thus, the wiriness is not external yin-cold, but wiriness generated from Stomach deficiency and cold. With both deficiency and cold in the Stomach, and no surplus of Yang Qi, morning eating leads to evening vomiting, transforming into Wei Fan. From this, we know that both rapid and wiry pulses can indicate deficiency states. Calling them heat or cold is merely a superficial discussion of pulses.
The Cun Kou (Radial artery at the wrist) pulse is faint and rapid. Faint indicates lack of Qi. Lack of Qi leads to Ying (Nutritive) deficiency. Ying deficiency leads to insufficient Blood. Insufficient Blood causes cold in the Chest.
This reasoning follows from the previous point about guest heat. It deduces that a faint and rapid pulse indicates lack of Qi rather than heat. Qi is the master of Ying; thus, lack of Qi leads to Ying deficiency. Ying is the source of Blood; thus, Ying deficiency leads to insufficient Blood. When both Ying and Wei (Defensive) are deficient, the Zong Qi (Gathering Qi) accumulated in the chest is reduced, resulting in cold in the chest.
Combining the above two points: Guest heat is certainly not true heat and should not be treated with cold herbs. Cold in the chest is certainly not true cold and should not be treated with hot herbs. All these cases should primarily be treated by warming and nourishing True Qi. True Qi is the harmonious, pure Qi. When this Qi floats, it generates heat; when it sinks, it generates cold. Warming it retracts the floating flame; nourishing it transforms the deficiency cold. If one treats heat with cold and cold with heat, True Qi becomes more deficient, and cold/heat invade internally, worsening the disease.
The Fu Yang (Dorsalis pedis artery) pulse is floating and choppy (Se). Floating indicates deficiency; choppy indicates Spleen injury. Injury to the Spleen impairs its grinding function. Morning eating leads to evening vomiting; evening eating leads to morning vomiting; undigested food remains. This is named Wei Fan (Stomach Reversal).
If the pulse is tight and choppy, the disease is difficult to treat.
This is because Stomach Qi is depleted, transforming into Wei Fan, and the pathology involves the Spleen as well. The Stomach is Yang, the Spleen is Yin. Floating indicates deficiency, referring to Stomach Yang deficiency. Choppy indicates injury, referring to Spleen Yin injury. Food enters the Stomach and is transported by the Spleen. If the Spleen is injured, it cannot grind. If the Spleen does not grind, food is not digested. Food eaten in the morning should descend in the evening; food eaten in the evening should descend in the morning. If food is not digested, it cannot descend. If it cannot descend, it must reverse and come up. The Stomach and Spleen belong to Earth. Earth's virtue is originally slow/moderate, but the pulse is tight, indicating Liver excess. Earth's Qi is originally harmonious, but the pulse is choppy, indicating Blood deficiency. The Zhen Qi (True Qi) of the organs is insufficient, while pathogenic factors are excessive. Hence, it is said to be difficult to treat.
When a patient feels the urge to vomit, do not use purgatives.
When a patient feels the urge to vomit, the pathogen is above and the Qi is reversing. If purgatives are used immediately, the pathogenic Qi will conflict with the medicinal Qi, and the healthy Qi will suffer. Otherwise, the interior becomes deficient, pathogens enter deeply, and it may turn into Pi (Glomus) or diarrhea, which is unpredictable. Hence, it is said that purgatives should not be used.
For hiccups (Yue) accompanied by abdominal fullness, examine the anterior and posterior orifices. Determine which part is obstructed and unblock it to cure the disease.
Hiccups with abdominal fullness indicate pathology below with Qi overflowing upward. This differs from the urge to vomit. Therefore, one should examine the anterior (urethra) and posterior (anus) orifices, determine which is obstructed, and unblock it. Then the pathogen exits from below, Qi does not reverse upward, and both abdominal fullness and hiccups resolve.
For vomiting accompanied by chest fullness, Wu Zhu Yu Tang (Evodia Decoction) is indicated.
The chest is Yang. Vomiting with chest fullness indicates Yang failing to govern and Yin invading. Therefore, Wu Zhu Yu disperses Yin and directs rebellion downward, while Ren Shen (Ginseng), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) tonify the Middle and benefit Yang Qi.
Wu Zhu Yu Tang Formula
Evodiae Fructus (Wu Zhu Yu) - 1 Sheng
Panacis Ginseng Radix (Ren Shen) - 3 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 6 Liang
Ziziphi Jujubae Fructus (Da Zao) - 12 pieces
These four ingredients are boiled in 5 Sheng of water to obtain 3 Sheng. Take 7 Ge warm, three times a day.
For dry heaving, spitting of saliva/froth, and headache, Wu Zhu Yu Tang (Evodia Decoction) is indicated.
Dry heaving with spitting of saliva/froth indicates cold in the Upper Jiao. The head is the meeting place of all Yang meridians. Pain here is caused by Yin-cold pathogen reversing upward. Therefore, Evodia Decoction is suitable to disperse Yin and benefit Yang.
For vomiting accompanied by borborygmus (intestinal rumbling) and epigastric stuffiness (Pi), Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is indicated.
Pathogenic factors invade due to deficiency and settle in the epigastrium, causing Middle Qi stagnation (Pi). Once Middle Qi is stagnant, ascending and descending functions are abnormal. Yang rebels upward causing vomiting, while Yin descends downward causing borborygmus. Although the Three Jiao are involved, the Middle Qi is the pivot between upper and lower. Therefore, one need not treat the upper and lower separately, but only the Middle. Huang Lian (Coptidis Rhizoma) and Huang Qin (Scutellariae Radix) are bitter and cold to direct Yang downward. Ban Xia (Pinelliae Rhizoma) and Gan Jiang (Zingiberis Rhizoma) are acrid and warm to direct Yin upward. As Yin ascends and Yang descends, the Pi resolves. Ren Shen (Ginseng) and Gan Cao (Licorice Root) tonify Middle Qi to facilitate the interaction of Yin and Yang and communication between upper and lower.
Ban Xia Xie Xin Tang Formula
Pinelliae Rhizoma (Ban Xia) - 0.5 Jin (washed)
Scutellariae Radix (Huang Qin) - 3 Liang
Zingiberis Rhizoma (Gan Jiang) - 3 Liang
Panacis Ginseng Radix (Ren Shen) - 3 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 3 Liang (roasted)
Coptidis Rhizoma (Huang Lian) - 1 Liang
Ziziphi Jujubae Fructus (Da Zao) - 12 pieces
These seven ingredients are boiled in 1 Dou of water to obtain 6 Sheng. Remove dregs, boil again to obtain 3 Sheng. Take 1 Sheng warm, three times a day.
For dry heaving accompanied by diarrhea, Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) is indicated.
This method applies to Shang Han (Cold Damage) where heat pathogens enter the interior causing diarrhea and then reverse upward causing vomiting. It also applies to miscellaneous diseases where Liver-Stomach fire rushes upward and pours downward. Ban Xia and Sheng Jiang disperse rebellion upward; Huang Qin and Bai Shao (Paeoniae Radix Alba) clear heat internally. With pathology in both upper and lower, Middle Qi is definitely troubled. Gan Cao, Da Zao, combined with Bai Shao and Sheng Jiang, stabilize the Middle and regulate Zheng Qi.
Huang Qin Jia Ban Xia Sheng Jiang Tang Formula
Scutellariae Radix (Huang Qin) - 3 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 3 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 2 Liang
Paeoniae Radix Alba (Bai Shao) - 1 Liang
Pinelliae Rhizoma (Ban Xia) - 0.5 Sheng
Ziziphi Jujubae Fructus (Da Zao) - 12 pieces
These six ingredients are boiled in 1 Dou of water to obtain 3 Sheng. Remove dregs. Take 1 Sheng warm, twice during the day and once at night.
For various types of vomiting where food cannot go down, Xiao Ban Xia Tang (Minor Pinellia Decoction) is indicated.
Vomiting where food cannot go down is due to fluids in the Stomach reversing upward with Qi, blocking the path of food entry. Therefore, Ban Xia eliminates fluids, and Sheng Jiang directs rebellion downward. When rebellion stops and fluids dissipate, food can descend.
Xiao Ban Xia Tang Formula (See Phlegm-Fluids Chapter)
For vomiting with pathology above the diaphragm, if the patient later desires water, it indicates resolution. Give water promptly. For those desiring water, Zhu Ling San (Polyporus Powder) is indicated.
Pathology above the diaphragm indicates phlegm-fluids in the diaphragm area. Desiring water later indicates that fluids have been eliminated, hence "desire for resolution." This aligns with the principle "vomiting first, then thirst, indicates resolution."
After fluids are eliminated, body fluids are suddenly depleted, causing thirst for water. If not given, fluid loss will deplete Qi. Therefore, give it promptly. However, after vomiting, Middle Qi is not recovered and cannot handle large amounts of water. Over-administration may cause new fluids to form after old ones leave. Therefore, Zhu Ling San is suitable to strengthen Earth (Spleen) and drain water.
Zhu Ling San Formula
Polypori Parvae (Zhu Ling) - Equal parts
Poria (Fu Ling) - Equal parts
Atractylodis Macrocephalae Rhizoma (Bai Zhu) - Equal parts
These three ingredients are pounded into powder. Take one Fang Cun Bi with rice water, three times a day.
For vomiting with a weak pulse, frequent urination, slight fever, and cold extremities, the prognosis is poor. Si Ni Tang (Frigid Extremities Decoction) is indicated.
Weak pulse, frequent urination, and cold extremities indicate interior deficiency and cold. Thus, vomiting is not due to fire pathogen but Yin Qi reversing upward. Fever is not due to excess pathogen but Yang Qi escaping outward. Therefore, Si Ni Tang is used to rescue Yang and expel Yin. However, since Yin is rushing upward and Yang is escaping outward, their separation is severe, and connection may not be immediate. Hence, it is said to be difficult to treat. Some say vomiting and fever indicate excess pathogen, while cold limbs, diarrhea, and weak pulse indicate deficient healthy Qi. The coexistence of excess and deficiency makes it difficult to treat. Si Ni Tang treats the root while ignoring the branch, which is also valid.
Si Ni Tang Formula
Aconiti Lateralis Radix Preparata (Fu Zi) - 1 piece (raw)
Zingiberis Rhizoma (Gan Jiang) - 1.5 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 2 Liang (roasted)
(Note: Text lists two ingredients but formula traditionally includes Gan Cao. Following text structure:) Boil in 3 Sheng of water to obtain 1.2 Sheng. Remove dregs. Divide into two warm doses. Strong individuals may use a large Fu Zi (1 piece) and Gan Jiang (3 Liang).
For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.
Vomiting with fever indicates pathogen in the Shaoyang (Lesser Yang) meridian. To stop vomiting, one must resolve the pathogen. Xiao Chai Hu Tang is the correct method to harmonize Shaoyang.
Xiao Chai Hu Tang Formula
Bupleuri Radix (Chai Hu) - 0.5 Jin
Pinelliae Rhizoma (Ban Xia) - 1 Sheng
Scutellariae Radix (Huang Qin) - 3 Liang
Panacis Ginseng Radix (Ren Shen) - 3 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 3 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 3 Liang
Ziziphi Jujubae Fructus (Da Zao) - 12 pieces
These seven ingredients are boiled in 1 Dou of water to obtain 6 Sheng. Remove dregs, decoct again to obtain 3 Sheng. Take 1 Sheng warm, three times a day.
For Wei Fan (Stomach Reversal) with vomiting, Da Ban Xia Tang (Major Pinellia Decoction) is indicated.
Wei Fan vomiting is due to Stomach deficiency failing to digest food, resulting in morning eating and evening vomiting. Also, Stomach pulse normally descends; deficiency causes it to reverse upward. Therefore, Ban Xia directs rebellion downward, while Ren Shen and Bai Mi (White Honey) tonify deficiency and calm the Middle. Dong Yuan stated that acrid herbs like Sheng Jiang treat vomiting only in cases of Upper Jiao Qi congestion and exterior excess. For Stomach deficiency where grain Qi does not move, causing chest obstruction and vomiting, one should only tonify the Stomach and promote Grain Qi. This is the essence of Da Ban Xia Tang.
Da Ban Xia Tang Formula
Pinelliae Rhizoma (Ban Xia) - 2 Sheng
Panacis Ginseng Radix (Ren Shen) - 3 Liang
Mell (Honey) - 1 Sheng
These three ingredients are mixed with 1.2 Dou of water and honey, stirred/beaten 240 times, then boiled to obtain 2.5 Sheng. Take 1 Sheng warm, remaining dose divided into two.
For vomiting immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) is indicated.
The Classic states: Clear Yang exits through upper orifices, turbid Yin exits through lower orifices. That which is from Heaven tends upward; that which is from Earth tends downward. If the lower does not unblock, it must reverse upward. This is called "Yin and Yang reversing," Qi rebelling and not following order. Although food enters the Stomach, Qi comes out instead. Therefore, Da Huang (Rhei Radix et Rhizoma) unblocks the bowels, allowing turbid Qi to descend through the turbid pathway, stopping vomiting. Otherwise, stopping or directing downward is useless. Dong Yuan's Tong You Tang (Unblocking the幽 Passage Decoction) treats obstruction at the幽门 (Pylorus) with upward rush to the吸门 (Epiglottis), based on the same principle, differing only in urgency.
Furthermore: The Classic states: When Yang Qi is blocked, Earth Qi obscures clarity. If clouds/mist are not refined, white dew does not descend from Heaven. Yang Qi is Heavenly Qi. If Heavenly Qi is closed, Earth Qi dries. Clouds/mist arise from Earth, rain/dew descend from Heaven. If Earth does not receive, Heaven does not descend. Thus, Heaven and Earth Yin-Yang share the same Qi mechanism. Harmony brings mutual harmony; discord brings mutual discord. Humans correspond to Heaven and Earth. Lung Qi resembles Heaven; disease often affects the Two Yin (Spleen/Stomach/Kidney). Large and Small Intestines resemble Earth; disease often affects upper orifices. Dan Xi treated urinary retention using emesis to lift Lung Qi, opening upper orifices to open lower orifices. This is different in method from Da Huang Gan Cao Tang treating vomiting, but the principle is相通 (interconnected).
Da Huang Gan Cao Tang Formula
Rhei Radix et Rhizoma (Da Huang) - 4 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 1 Liang
These two ingredients are boiled in 3 Sheng of water to obtain 1 Sheng. Divide into two warm doses.
For Wei Fan (Stomach Reversal) with vomiting and thirst desiring water, Fu Ling Ze Xie Tang (Poria and Alisma Decoction) is indicated.
Zhu Ling San treats thirst for water after vomiting to strengthen Earth Qi and overcome Water Qi. Fu Ling Ze Xie Tang treats vomiting that has not stopped yet, with thirst desiring water. Since vomiting has not stopped, the pathogen remains. Therefore, Gui Zhi (Cinnamomi Ramulus), Gan Cao, and Sheng Jiang are used to scatter pathogen, while Fu Ling, Bai Zhu, and Ze Xie (Alismatis Rhizoma) eliminate Water Qi.
Fu Ling Ze Xie Tang Formula
Poria (Fu Ling) - 0.5 Jin
Alismatis Rhizoma (Ze Xie) - 4 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 2 Liang
Cinnamomi Ramulus (Gui Zhi) - 2 Liang
Atractylodis Macrocephalae Rhizoma (Bai Zhu) - 3 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 4 Liang
These six ingredients are boiled in 1 Dou of water to obtain 3 Sheng. Add Ze Xie, boil again to obtain 2.5 Sheng. Take 8 Ge warm, three times a day.
After vomiting, if the patient is thirsty, desires water, and drinks greedily, Wen Sha Tang (Clam Shell Decoction) is indicated. It also treats mild wind, wiry-tight pulse, and headache.
After vomiting, fluids are gone but heat remains, causing thirst for water. This is similar to the Zhu Ling San pattern. Although greedy for water, it is due to intense heat. Providing heat-clearing and fluid-guiding agents is sufficient. The addition of Ma Huang (Ephedrae Herba) and Xing Ren (Armeniacae Semen) to release the exterior suggests concurrent guest pathogen and constrained heat in the Lung. The note "sweating leads to recovery" confirms this. Mentioning mild wind, wiry-tight pulse, and headache is because Ma Huang, Xing Ren, Gan Cao, and Shi Gao (Gypsum Fibrosum) excel at dispelling wind and releasing the exterior.
Wen Sha Tang Formula
Concha Meretricis (Wen Sha) - 5 Liang
Ephedrae Herba (Ma Huang) - 3 Liang
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 3 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 3 Liang
Gypsum Fibrosum (Shi Gao) - 5 Liang
Armeniacae Semen Amarum (Xing Ren) - 50 kernels
Ziziphi Jujubae Fructus (Da Zao) - 12 pieces
These seven ingredients are boiled in 6 Sheng of water to obtain 2 Sheng. Take 1 Sheng warm. Recovery occurs with sweating.
For dry heaving, hiccups, and spitting of saliva/froth, Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) is indicated.
Dry heaving and hiccups indicate Stomach Qi rebellion. Spitting of saliva/froth indicates cold in the Upper Jiao causing excessive salivation. This differs from dry heaving, spitting froth, and headache (which is Jueyin Yin rebellion). This is Yangming cold saliva and rebellious Qi failing to descend. Therefore, Ban Xia stops rebellion and eliminates saliva, Gan Jiang warms the Middle and harmonizes the Stomach. Jiang Shui (Sour Rice Water) is sweet and sour, regulating the Middle, guiding Qi, and stopping vomiting/hiccups.
Ban Xia Gan Jiang San Formula
Pinelliae Rhizoma (Ban Xia) - Equal parts
Zingiberis Rhizoma (Gan Jiang) - Equal parts
These two ingredients are pounded into powder. Take one Fang Cun Bi, boil in 1.5 Sheng of Jiang Shui to obtain 7 Ge. Take all at once.
For patients feeling like panting but not panting, like vomiting but not vomiting, like hiccuping but not hiccuping, with profound mental restlessness and helplessness, Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) is indicated.
Cold pathogen combats fluids, knotting in the chest without exit. This blocks respiratory movement and Qi ascending/descending. Feeling like panting/vomiting/hiccuping without actual occurrence are signs of cold-fluid and Qi battling each other. Fluid is Water Pathogen; Heart is Yang Organ. Water pathogen pressing against the Heart, unable to expel or accept, causes profound mental restlessness. Sheng Jiang Ban Xia Tang is essentially Xiao Ban Xia Tang, but uses Sheng Jiang juice. Juice has less power to direct rebellion downward but more power to disperse knots. It is an excellent method for treating fluid-Qi combat where expulsion is desired but hindered.
Sheng Jiang Ban Xia Tang Formula
Pinelliae Rhizoma (Ban Xia) - 0.5 Sheng
Zingiberis Rhizoma Recens (Sheng Jiang) - 1 Sheng (juice)
Boil Ban Xia in 3 Sheng of water to obtain 2 Sheng. Add Sheng Jiang juice, boil to obtain 1.5 Sheng. Take slightly cool, divided into four doses. Three times during day, once at night. Stop subsequent doses if vomiting ceases.
For dry heaving, hiccups, and cold extremities, Ju Pi Tang (Tangerine Peel Decoction) is indicated.
Dry heaving and hiccups are not Wei Fan; cold extremities do not mean absence of Yang. Disharmony of Stomach prevents Qi from reaching the four limbs. Ju Pi (Citri Reticulatae Pericarpium) harmonizes Stomach Qi, Sheng Jiang disperses rebellious Qi. When Qi moves and Stomach harmonizes, heaving/hiccups and cold resolve. Do not assume Yang deficiency and hastily administer warming tonics.
Ju Pi Tang Formula
Citri Reticulatae Pericarpium (Ju Pi) - 4 Liang
Zingiberis Rhizoma Recens (Sheng Jiang) - 0.5 Jin
These two ingredients are boiled in 7 Sheng of water to obtain 3 Sheng. Take 1 Sheng warm. Recovery occurs upon swallowing.
For hiccups (Ni), Ju Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shavings Decoction) is indicated.
Stomach deficiency allows Heat to invade, causing hiccups. Ju Pi and Sheng Jiang harmonize Stomach and disperse rebellion; Zhu Ru (Bambusae Caulis in Taenia) clears heat and stops vomiting/hiccups. Ren Shen, Gan Cao, and Da Zao tonify deficiency and calm the Middle.
Ju Pi Zhu Ru Tang Formula
Citri Reticulatae Pericarpium (Ju Pi) - 2 Jin
Bambusaе Caulis in Taenia (Zhu Ru) - 2 Sheng
Ziziphi Jujubae Fructus (Da Zao) - 30 pieces
Zingiberis Rhizoma Recens (Sheng Jiang) - 0.5 Jin
Glycyrrhizae Radix et Rhizoma (Gan Cao) - 5 Liang
Panacis Ginseng Radix (Ren Shen) - 1 Liang
These six ingredients are boiled in 1 Dou of water to obtain 3 Sheng. Take 1 Sheng warm, three times a day.
When Qi of the Six Fu Organs fails externally, there is cold in hands and feet, upward Qi, and leg retraction. When Qi of the Five Zang Organs fails internally, there is uncontrollable diarrhea. Severe cases result in numbness of hands and feet.
Six Fu are Yang, governing the exterior. Failure of Yang to communicate externally causes cold hands/feet. Yang failing to communicate externally rises upward, causing upward Qi and leg retraction. Five Zang are Yin, governing the interior. Failure of Yin to guard internally causes uncontrollable diarrhea. Severe cases fail to interact with Yang, causing blockage of tunnels, resulting in numbness of hands/feet.
In diarrhea, a deep-wiry (Chen-Xian) pulse indicates heaviness in the rectum. A large (Da) pulse indicates the disease has not stopped. A faint-rapid (Wei-Ruo-Shu) pulse indicates spontaneous cessation. Even with fever, death is not imminent.
Deep indicates interior/lower. Wiry within Deep indicates Shaoyang Qi stagnating below and unable to vent, causing rectal heaviness. Large indicates excess pathogen and disease progression, hence not stopped. Xu Shi says: Faint-rapid means healthy Qi declines and pathogen also declines. Rapid is Yang pulse; appearing within faint-rapid indicates Yang Qi recovering. Thus, diarrhea will stop. Even with fever, it will resolve, unlike fatal cases of persistent heat in diarrhea.
In diarrhea with cold extremities and no pulse, moxibustion fails to warm. If pulse does not return and slight panting occurs, death ensues. If Shao Yin (Kidney) pulse is weaker than Fu Yang (Stomach) pulse, it is favorable.
Diarrhea with cold extremities and no pulse indicates Yin exhaustion and Yang extinction. Moxibustion aims to guide returning Yang. If cold persists, pulse doesn't return, and slight panting occurs, residual Yang rushes upward and Grand Qi collapses downward, causing death. Diarrhea is a disease of Earth losing to Water. If Shao Yin is inferior to Fu Yang, Water loses and Earth wins, hence favorable.
In diarrhea with slight fever and thirst, a weak pulse indicates spontaneous recovery. In diarrhea with rapid pulse, slight fever, and sweating, spontaneous recovery occurs. If pulse is tight, it is unresolved. In diarrhea with rapid pulse and thirst, spontaneous recovery occurs. If not cured, pus/blood in stool will occur due to heat. In diarrhea with wiry pulse, fever, and sweating, recovery occurs.
Slight fever and thirst indicate Stomach Yang recovery. Weak pulse indicates pathogen decline. Healthy recovers, pathogen declines, hence recovery. Rapid pulse also indicates Yang recovery. Slight fever and sweating indicate vigorous healthy Qi expanding outward, also a sign of recovery. Tight pulse means pathogen is still strong and conflicts with healthy Qi, hence unresolved. Rapid pulse and thirst indicate Yang has recovered (similar to slight fever/thirst). However, if pulse is rapid rather than weak, Yang recovery has exceeded normal limits. Although Yin-cold resolves, heat increases, injuring Yin further and causing pus/blood in stool. Wiry pulse belongs to both Yin and Yang. If seen with fever and sweating, Wiriness is Yang, same as rapid pulse with slight fever/sweating, hence recovery.
Note: The above patterns are signs of Shang Han pathogens entering the interior. Heat, thirst, sweating, or rapid pulse indicate Yang recovery and pathogen emergence, leading to recovery. In miscellaneous diseases with damp-heat diarrhea, fever, thirst, and rapid pulse are unfavorable. Nei Jing states: Diarrhea with fever is fatal. Zhong Jing states: Diarrhea without cold extremities, with fever, is not fatal. Nei Jing refers to damp-heat diarrhea; Zhong Jing refers to Cold pathogens entering interior in Shang Han. These must be distinguished.
For diarrhea with excessive flatus (Qi), promote urination.