呕吐之症，一曰寒，一曰热，一曰虚。寒则脉迟，热则脉数，虚则脉虚，即其脉可以分其症。最易治者，
寒，阳明为消磨五谷之所，喜温而恶寒，一自寒犯于内，两相龃龉，食入即吐，不食亦呕。彼法夏、丁香、白蔻
、砂仁，本草所注一派止呕定吐之品，非不神效，不如一碗生姜汤，而其效更速者，经所谓寒气客于肠胃，厥
逆上出，故痛而呕是也。最误治者，热（寒凉燥烈之性，功过参半焉者也。丹溪滋肾
水而清湿热，原补前贤所未备，乃效颦者，肆行寒凉，人之死于寒凉者，非丹溪之罪，实不善读书者之罪。有
明诸儒救寒凉之弊，多为过激之言，二百年中，寒凉之风，一变为燥烈之火，人之死干燥烈者，什倍于寒凉。遇
是症，彼曰宜热，此曰宜热，且曰某书某书，凿凿有凭，又安知症属热乎哉？）。寒之不已，郁而为热，医不
知其热，仍以辛热治其寒，愈呕愈热，愈热愈吐，彼麦冬、芦根，止呕定吐，书有明文，尚不知用，何况石膏
之大凉大寒乎（经验方∶石膏、麦冬、粳米、炙草）？不知石膏为止呕定吐之上品，本草未注其性，《内经》实
有其文。经曰∶“诸逆上冲，皆属于火，诸呕吐酸，暴注下迫，皆属于热”是也。最好治者，虚，不专责之胃，
而兼责之脾，脾具坤静之德，而有干健之运。虚难转输，逆而呕吐，调理脾胃，乃医家之长策，理中汤（人参、
焦术、干姜、附子、炙草、大枣）、六君子汤（人参、焦术、法半夏、茯苓、陈皮、炙草），皆能奏效。经曰
∶足太阴之脉，挟咽连舌本，是动则病舌本强，食则呕是也。夫呕吐，病之最浅者也，噎膈，病之至深者也，
极为易辨。呕吐，其来也猝；噎膈，其来也缓。呕吐，得食则吐，不食亦有欲呕之状；噎膈，食入方吐，不食
不呕。呕吐，或寒或热或虚，外见寒热与虚之形；噎膈，不食亦与平人一般。呕吐不论年之老幼；噎膈多得之老
人。呕吐，脉有迟、有数、有虚；噎膈，脉缓。方书所论呕吐，牵扯噎膈之文，噎膈半是呕吐之方，有何疑
似之难辨而茫无定见也。昔在湘中，壶盘会友，一老医曰∶“吾治噎膈，得愈数人。”核其药，曰附子理中汤，
考其症，乃脾虚之呕吐者。又一老医曰∶“吾治噎膈，得愈数人。”核其药，曰黄连法夏汤，考其症，乃胃
热之呕吐者。谚云∶“药能医假病，人多得假名，”其
即二老之谓欤！至于老人气鲠，时尝呕吐，不可概以呕吐论，亦不可遽以噎膈论，盖津少气虚，难以传送，古
人刻鸠于杖，祝其无噎者，此也。孕妇呕吐，法夏不犯禁例，且能安胎，《准绳》已详言之。更有妇人，天癸
来时，为风寒所袭，传送肺经，血凝于肺，食入即呕，一载有余，医家以寻常治呕吐之法治之，或寒或热，俱
不见效，只以桔梗、红花诸药，去瘀生新，数剂而愈，此又不可不知也。
呕吐这一病症，主要归结为三种类型：寒、热、虚。寒证表现为脉象迟缓，热证表现为脉象急促，虚证表现为脉象虚弱，通过脉象即可区分症状。最容易治疗的是寒证。阳明经是消化五谷的场所，喜欢温暖而厌恶寒冷，一旦寒气侵犯体内，正气与邪气相争，导致食物入口即吐，不进食也会干呕。那些法半夏、丁香、白豆蔻、砂仁等本草书中记载的专门用于止呕定吐的药物，虽然并非没有神效，但效果不如一碗生姜汤迅速，这正是《内经》所说的“寒气客于肠胃，厥逆上出，故痛而呕”的道理。
最容易被误治的是热证（寒凉药性与燥烈药性各有优缺点。朱丹溪主张滋补肾水以清除湿热，这原本弥补了前贤未备之处，但效仿者肆意使用寒凉药物，死于寒凉之弊的人，并非朱丹溪的罪过，实是不善读书者的罪过。明代诸儒为了纠正寒凉之弊，多有过激言论，两百年间，寒凉之风一变而为燥烈之火，死于干燥烈性药物的人数，十倍于死于寒凉者。遇到这种症状，有人说宜用热药，有人说宜用热药，还引经据典，看似确凿有据，又怎知此症属于热证呢？）。如果寒证未愈，郁结而化为热，医生不知道这是热证，仍然用辛热药物治疗其寒，结果越呕吐越热，越热越吐。麦冬、芦根能止呕定吐，书籍中有明确记载，尚且有人不知使用，何况是大凉大寒的石膏呢？（经验方：石膏、麦冬、粳米、炙甘草）？其实石膏是止呕定吐的上品，本草书未注其性味，《内经》中确实有相关论述。经文说：“各种气逆上冲的症状，都归属于火；各种呕吐酸水，以及突然泄泻伴有里急后重的症状，都归属于热。”这就是证据。
最好治疗的是虚证。不能只责之于胃，还要兼责之于脾。脾具有坤卦静止的德行，同时具备乾卦健运的功能。虚证导致转运无力，气机逆乱而发生呕吐，调理脾胃是医家的良策。理中汤（人参、焦白术、干姜、附子、炙甘草、大枣）、六君子汤（人参、焦白术、法半夏、茯苓、陈皮、炙甘草），都能奏效。经文说：“足太阴脾经的经脉，夹咽部连舌本，发生病变时会出现舌根僵硬，进食则呕吐的症状。”
呕吐是病情最浅表的疾病，噎膈（吞咽困难，胸膈阻塞）是病情最深重的疾病，两者极易辨别。呕吐发病突然；噎膈发病缓慢。呕吐是进食就吐，不进食也有想吐的感觉；噎膈是食物进入后才吐，不进食不吐。呕吐可能由寒、热或虚引起，外在表现出寒、热或虚的形态；噎膈患者即使不进食，也与常人无异。呕吐不分年龄老少；噎膈多见于老年人。呕吐的脉象有迟、数、虚之分；噎膈的脉象缓。方书在论述呕吐时，常牵扯噎膈的内容，噎膈的治疗有一半沿用了呕吐的方剂，有什么值得怀疑难以辨别而没有定见的呢？
过去在湖南地区，聚会交友时，一位老医生说：“我治疗噎膈，治愈了几个人。”核查他的用药，说是附子理中汤，考察其症状，原来是脾虚引起的呕吐。另一位老医生说：“我治疗噎膈，也治愈了几个人。”核查他的用药，说是黄连法夏汤，考察其症状，原来是胃热引起的呕吐。谚语说：“药能医假病，人多得假名”，说的就是这两位老医生的情况吧！至于老年人气机梗塞，时常呕吐，不能一概当作呕吐论治，也不能急于诊断为噎膈，这是因为津液少、气虚，难以传送食物，古人刻鸠鸟于拐杖上，祝愿老人无噎食之患，指的就是这种情况。孕妇呕吐，法半夏不属于禁忌，且能安胎，《准绳》中已有详细说明。还有妇人，在天癸（月经）来潮时，被风寒侵袭，病邪传入肺经，血液凝滞于肺，导致食物入口即吐，持续一年多，医生用寻常治疗呕吐的方法，无论寒热，都不见效，只用桔梗、红花等药物，去瘀生新，几剂药后就痊愈了，这也是不可忽视的情况。
The syndrome of vomiting is primarily categorized into three types: Cold, Heat, and Deficiency. Cold presents with a slow pulse (Chi Mai), Heat with a rapid pulse (Shu Mai), and Deficiency with a deficient pulse (Xu Mai); thus, the pulse allows for differentiation of the symptoms. The easiest to treat is Cold. The Yangming channel is the site for digesting grains and favors warmth while disliking cold. Once cold invades internally, causing conflict between pathogenic factors and healthy qi, food is vomited immediately upon ingestion, and retching occurs even without eating. Although herbs such as Banxia (Pinelliae Rhizoma), Dingxiang (Caryophylli Flos), Baikou (Amomi Fructus Rotundus), and Sharen (Amomi Fructus) are recorded in materia medica as specific anti-emetics and are effective, they are not as swift as a bowl of Shengjiang Tang (Fresh Ginger Decoction). This aligns with the *Neijing* stating: "When cold qi lodges in the stomach and intestines, rebellious qi rises upward, causing pain and vomiting."
The most prone to misdiagnosis and mistreatment is Heat. (Cold-cooling and drying-hot herbs have pros and cons. Zhu Danxi advocated nourishing Kidney Water to clear damp-heat, which supplemented previous theories; however, blind followers abused cold-cooling agents. Those who died from excessive cold-cooling were victims of poor scholarship, not Zhu Danxi's fault. Ming dynasty scholars, attempting to correct the弊端 of cold-cooling, often made extreme remarks. Over two centuries, the trend shifted from cold-cooling to drying-hot fire. Deaths from drying-hot agents exceeded those from cold-cooling by tenfold. When encountering such cases, some advocate heat therapy, citing various texts as proof, yet fail to recognize that the syndrome may actually be Heat.) If Cold persists, it stagnates and transforms into Heat. If physicians fail to recognize this Heat and continue treating it as Cold with acrid-warm herbs, vomiting and heat will intensify reciprocally. Although Maidong (Ophiopogonis Radix) and Lugen (Phragmitis Rhizoma) are documented to stop vomiting, their use is sometimes overlooked, let alone the use of Shigao (Gypsum Fibrosum), which is extremely cold and cooling. (Empirical Formula: Shigao, Maidong, Jingmi (Oryzae Semen), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata)). Shigao is a premier herb for stopping vomiting. While not explicitly detailed in some materia medica, its efficacy is supported by the *Neijing*: "All rebellious upward rushing belongs to Fire; all vomiting of acid water, sudden diarrhea with tenesmus, belongs to Heat."
The easiest to treat is Deficiency. Treatment should not focus solely on the Stomach but also address the Spleen. The Spleen possesses the stillness of Kun (Earth) and the vigorous movement of Qian (Heaven). Deficiency leads to failed transportation and transformation, causing rebellious qi and vomiting. Regulating the Spleen and Stomach is a superior strategy. Lizhong Tang (Atractylodis Macrocephalae Rhizoma, Ginseng Radix, Zingiberis Rhizoma, Aconiti Lateralis Radix Praeparata, Glycyrrhizae Radix et Rhizoma Preparata, Jujubae Fructus) and Liujunzi Tang (Ginseng Radix, Atractylodis Macrocephalae Rhizoma, Pinelliae Rhizoma Preparatum, Poria, Citri Reticulatae Pericarpium, Glycyrrhizae Radix et Rhizoma Preparata) are both effective. The *Neijing* states: "The Foot-Taiyin Spleen channel runs alongside the pharynx and connects to the root of the tongue. When moved [pathologically], it causes stiffness of the tongue root and vomiting after eating."
Vomiting is a superficial disease, whereas Yige (Dysphagia/Regurgitation) is a deep-seated disease, making them easy to distinguish. Vomiting has an acute onset; Yige has a gradual onset. Vomiting occurs immediately after eating or involves retching when empty; Yige involves regurgitation only after food enters, with no retching when empty. Vomiting may present with external signs of Cold, Heat, or Deficiency; Yige patients appear normal even when not eating. Vomiting affects all ages; Yige is mostly seen in the elderly. Pulses in Vomiting can be Slow, Rapid, or Deficient; the pulse in Yige is Slow. Medical texts often conflate Vomiting and Yige, using formulas for Yige that are essentially for Vomiting, leading to confusion.
In Hunan, an old physician claimed to cure several cases of Yige. His prescription was Fuzi Lizhong Tang, and his diagnosed symptoms were actually Spleen Deficiency Vomiting. Another old physician claimed similar success with Huanglian Banxia Tang, which treated Stomach Heat Vomiting. As the proverb says: "Medicine cures fake diseases, people acquire fake names," referring to these two physicians. For elderly individuals with Qi obstruction and occasional vomiting, one should not generalize it as simple Vomiting nor hastily diagnose Yige, as it may stem from insufficient fluids and Qi deficiency hindering transport. Ancient people carved doves on canes to wish the elderly freedom from choking, illustrating this point. For pregnant women with vomiting, Banxia is not contraindicated and can calm the fetus, as detailed in *Zhunsuo*. Additionally, women whose menstruation (Tian Gui) is disrupted by Wind-Cold, leading to blood stasis in the Lung channel, may experience immediate vomiting after eating for over a year. Standard anti-emetic treatments for Cold or Heat fail here. Only with Jiegeng (Platycodonis Radix) and Honghua (Carthami Flos) to remove stasis and generate new blood does recovery occur in a few doses. This is another aspect that must be understood.