呕者，有声有物;吐者，有物无声；有声无物，则为干呕；泛泛欲吐，则为恶心，东垣俱以属之
脾胃，诚为至论。经言足太阴病，食则呕。又谓食则呕者，物盛满而上溢故呕。则知胃为呕吐之总司，
乃脾失健运之常为本也。然所致之因不一。如经言诸逆冲上，皆属于火。又言诸呕吐酸，皆属于热。此
因热之所致也。又言寒气客于肠胃，厥逆上出，故痛而呕，此因寒之所致也。又言肝所生病，胸满呕
逆。又言胆液泄、则口苦。胃气逆则呕苦、名曰胆呕。此二条，乃木邪乘胃上逆之所致。又言诸阳气
浮无所根据，从而呕者，此肾阴虚而孤阳上浮之所致。又《金匮》论呕家本渴，今反不渴者，以心下有支
饮故也。此属痰饮之呕吐。洁古又有因气滞，因食积所致之呕吐。昔人云∶吐而诸药不效，必假镇重以
坠之，吐而中气久虚，必借谷食以和之，详别其因，对症用药，不胶于一定之迹，方可应无穷之变耳。
竹茹汤〔见伤寒。〕经云∶诸逆冲上，皆属于火。宜此为主。
可加石斛〔清胃除热，〕苏子〔降气除呕。〕茯苓〔导气平火。〕虚者加人参〔
补胃气。〕白芍〔敛逆气。〕扁豆〔下气和中。〕如行镇重，加代赭石〔 末调服。〕
左金丸〔见胁痛。〕经云∶诸呕吐酸，皆属于热。又云∶肝所生病，为胸满呕逆。宜此为主。
可加白芍 木瓜〔和胃制肝。〕苏子 茯苓 橘红枇杷叶之属。
此二方皆挟热呕吐之良剂，投之辄效。以世人之病，因火热者甚多也。
橘红半夏汤《金匮》云∶呕家本渴，今反不渴者，以心下有痰饮故也。宜此为主。
橘红〔下气清痰。〕半夏〔治饮止呕。〕生姜〔开痰止呕。〕可加茯苓。如痰饮而有
火者，加黄连。〔姜汁炒。〕如呕吐因寒者，本方加砂仁、豆蔻。挟虚者再加人参。
此因痰饮呕吐之剂，每见今人治呕，必用半夏，不知东垣云∶生姜止呕，但治表实气壅，若胃虚谷
气不行，惟当补胃。仲淳谓呕吐若由火冲胃热，而不由寒湿痰壅者，切禁半夏，盖世人阴虚血少，津液不
足者多，半夏辛温有毒，最损津液，故相宜者绝少也。
保和丸〔见泄泻。〕
此方因伤食呕吐者，主此加减。
沉香降气散
沉香 砂仁 苏子 橘红 枇杷叶 茯苓 麦冬〔皆下气降逆之品。〕挟热者加甘蔗浆
芦根汁。
此方因气滞呕吐者，可用之。
呕吐大痛，色如青菜叶者死。
呕吐，是指既有声音又有食物吐出；吐，是指只有食物吐出而没有声音；如果只有声音而没有食物吐出，这就称为干呕；如果感到胃中翻腾想要呕吐，这就称为恶心。李东垣将这些症状都归属于脾胃疾病，这确实是精辟的论断。
《内经》说：足太阴脾经发生病变，进食后就会呕吐。又说：进食后呕吐，是因为食物充满胃部而上溢，所以发生呕吐。由此可知，胃是呕吐的主要脏腑，而脾失去健运功能则是其根本原因。然而，导致呕吐的原因并不单一。
如《内经》所说：“各种气逆冲上的病症，都属于火。”又说：“各种呕吐酸水，都属于热。”这是由热邪导致的。
又说：“寒气侵袭肠胃，气机厥逆向上冲出，所以疼痛并呕吐。”这是由寒邪导致的。
又说：“肝脏发生的疾病，会出现胸满、呕吐气逆。”又说：“胆液外泄，就会口苦。胃气上逆则呕吐苦水，称为胆呕。”这两条论述，是由于肝木之邪侵犯胃腑，导致气机上逆所致。
又说：“各种阳气浮越而无根基，随之发生呕吐的，这是由于肾阴虚而孤阳上浮所致。”
另外，《金匮要略》论述说：经常呕吐的人本来应该口渴，现在反而不渴的，是因为心下有支饮（停聚的水饮）的缘故。这属于痰饮引起的呕吐。
古人说：呕吐且服用各种药物无效，必须借助重镇降逆的药物来压制它；呕吐且中气长期虚弱，必须借助谷食来调和它。详细辨别其原因，针对症状用药，不拘泥于固定的模式，才能应对无穷的变化。
竹茹汤（见伤寒章节）。《内经》说：“各种气逆冲上，都属于火。”适宜以本方为主治。
可以加石斛（清胃除热）、苏子（降气除呕）、茯苓（导气平火）。虚证加人参（补胃气）、白芍（敛逆气）、扁豆（下气和中）。如果使用重镇药，加代赭石（研末调服）。
左金丸（见胁痛章节）。《内经》说：“各种呕吐酸水，都属于热。”又说：“肝脏发生的疾病，出现胸满呕吐气逆。”适宜以本方为主治。
可以加白芍、木瓜（和胃制肝）、苏子、茯苓、橘红、枇杷叶等。
这两个方剂都是治疗挟热呕吐的良好药剂，投用往往见效。因为世人的疾病，因火热致病者很多。
橘红半夏汤。《金匮要略》说：“经常呕吐的人本来应该口渴，现在反而不渴的，是因为心下有痰饮的缘故。”适宜以本方为主治。
橘红（下气清痰）、半夏（治饮止呕）、生姜（开痰止呕）。可以加茯苓。如果痰饮兼有火邪，加黄连（姜汁炒）。如果呕吐因寒引起，本方加砂仁、豆蔻。挟有虚证再加人参。
这是治疗因痰饮呕吐的方剂。常见如今人治疗呕吐，必定使用半夏，却不知道李东垣说：生姜止呕，只适用于表实气壅的情况；如果胃虚谷气不行，只应当补胃。仲淳（陈实功或相关医家观点）认为，呕吐如果是由于火冲胃热引起，而不是由寒湿痰壅引起，绝对禁止使用半夏。大概世人阴虚血少、津液不足者很多，半夏辛温有毒，最损伤津液，所以适合使用半夏的情况极少。
保和丸（见泄泻章节）。
这个方剂用于治疗因伤食引起的呕吐，主以此方加减。
沉香降气散
沉香、砂仁、苏子、橘红、枇杷叶、茯苓、麦冬（都是下气降逆的药物）。挟热者加甘蔗浆、芦根汁。
这个方剂用于因气滞引起的呕吐，可以使用。
Vomiting (Ou) refers to the act accompanied by both sound and expelled matter; Spitting up (Tu) refers to expelling matter without sound. If there is sound but no matter, it is termed Dry Vomiting (Gan Ou); if there is a sensation of nausea and the urge to vomit, it is termed Nausea (E Xin). Li Dongyuan attributed all these conditions to the Spleen and Stomach, which is indeed an insightful conclusion.
The *Classic of Difficult Issues* (*Nanjing*) states: "Diseases of the Foot-Taiyin [Spleen] channel involve vomiting after eating." It further states: "Vomiting after eating occurs because food fills the stomach and overflows upward." From this, we know that the Stomach is the primary organ governing vomiting, while the failure of the Spleen to transform and transport is the root cause. However, the etiologies are not uniform.
As stated in the classics: "All rebellious qi rushing upward belongs to Fire." And again: "All vomiting of sour fluid belongs to Heat." These are caused by heat pathogens.
It is also stated: "When cold qi lodges in the intestines and stomach, causing rebellious qi to rush upward, pain and vomiting occur." These are caused by cold pathogens.
Furthermore: "Diseases generated by the Liver manifest as chest fullness and rebellious vomiting." And: "If gallbladder fluid leaks, bitterness results in the mouth. If Stomach qi rebels, bitter fluid is vomited, termed Gallbladder Vomiting (Dan Ou)." These two descriptions result from Wood pathogen invading the Stomach and causing rebellious qi.
Also: "When various Yang qi float without foundation, leading to vomiting, this is caused by Kidney Yin deficiency resulting in floating isolated Yang."
Additionally, the *Jin Gui Yao Lue* discusses: "Those who frequently vomit should naturally be thirsty; if they are not thirsty now, it is due to the presence of Zhi Yin (branching fluid retention) under the heart." This belongs to vomiting caused by Phlegm-Fluids.
Jiegu (Zhang Yuansu) further proposed vomiting caused by Qi stagnation and Food Retention.
Ancients said: "If vomiting persists despite various medications, heavy-settling drugs must be used to descend it; if vomiting accompanies long-term deficiency of Middle Qi, grain foods must be borrowed to harmonize it." One must carefully distinguish the etiology and prescribe according to symptoms, not adhering rigidly to fixed patterns, to respond to infinite variations.
Zhuru Tang (See Shang Han section). The *Classic* states: "All rebellious qi rushing upward belongs to Fire." This formula is suitable as the main treatment.
Shihu (Dendrobii Caulis, Clearing Stomach Heat) can be added; Su Zi (Perillae Fructus, Descending Qi and stopping vomiting); Fuling (Poria, Guiding Qi and calming Fire). For deficiency, add Renshen (Ginseng Radix, Tonifying Stomach Qi), Baishao (Paeoniae Radix Alba, Astringing Rebellious Qi), and Bidou (Dolichoris Semen, Descending Qi and Harmonizing Middle). If using heavy-settling agents, add Daizheshi (Haematitum, taken as powder mixed with water).
Zuojin Wan (See Xie Tong section). The *Classic* states: "All vomiting of sour fluid belongs to Heat." And again: "Diseases generated by the Liver manifest as chest fullness and rebellious vomiting." This formula is suitable as the main treatment.
Baishao (Paeoniae Radix Alba) and Mugua (Chaenomelis Fructus, Harmonizing Stomach and restraining Liver) can be added; along with Su Zi (Perillae Fructus), Fuling (Poria), Juhong (Citri Reticulatae Pericarpium Rubrum), and Pipaye (Eriobotryae Folium).
These two formulas are excellent remedies for vomiting with Heat; they are effective upon administration. This is because many diseases in the world are caused by Fire and Heat.
Juhong Banxia Tang. The *Jin Gui Yao Lue* states: "Those who frequently vomit should naturally be thirsty; if they are not thirsty now, it is due to the presence of Phlegm-Fluids under the heart." This formula is suitable as the main treatment.
Juhong (Citri Reticulatae Pericarpium Rubrum, Descending Qi and clearing Phlegm); Banxia (Pinelliae Rhizoma, Treating Fluids and stopping vomiting); Shengjiang (Zingiberis Rhizoma Recens, Opening Phlegm and stopping vomiting). Fuling (Poria) can be added. If Phlegm-Fluids are accompanied by Fire, add Huanglian (Coptidis Rhizoma, stir-fried with Ginger Juice). If vomiting is caused by Cold, add Sharen (Amomi Fructus Rotundus) and Doukou (Cardamomi Fructus) to this formula. If accompanied by deficiency, add Renshen (Ginseng Radix).
This is a formula for vomiting caused by Phlegm-Fluids. It is often seen that modern practitioners always use Banxia (Pinelliae Rhizoma) for vomiting, unaware that Dongyuan stated: "Shengjiang (Zingiberis Rhizoma Recens) stops vomiting, but only treats exterior excess and Qi congestion; if Stomach deficiency leads to inability to move Grain Qi, one must tonify the Stomach." Zhongchun stated that if vomiting is caused by Fire rushing and Stomach Heat, rather than Cold-Dampness or Phlegm congestion, Banxia (Pinelliae Rhizoma) is strictly contraindicated. Generally, many people suffer from Yin deficiency, Blood scarcity, and insufficient Body Fluids. Banxia (Pinelliae Rhizoma) is acrid, warm, and slightly toxic, damaging Body Fluids most severely; thus, cases suitable for its use are extremely rare.
Baohe Wan (See Xie Xie section).
This formula is used for vomiting caused by Food Injury, modified as needed.
Chenxiang Jiangqi San
Chenxiang (Aquilariae Lignum Resinatum), Sharen (Amomi Fructus Rotundus), Su Zi (Perillae Fructus), Juhong (Citri Reticulatae Pericarpium Rubrum), Pipaye (Eriobotryae Folium), Fuling (Poria), Maidong (Ophiopogonis Radix) — all are herbs that descend Qi and counteract rebellion. If accompanied by Heat, add Ganshe Jiang (Saccharum officinarum Juice) and Lugenzhi (Phragmitis Rhizoma Juice).
This formula can be used for vomiting caused by Qi stagnation.
Severe vomiting with intense pain, where the vomitus resembles green vegetable leaves, indicates a fatal prognosis.