刘××，女，50岁。神经性头痛40多年，每日全靠止痛片减轻痛苦，中药虽进千剂亦不效。邀余诊视。询其头痛而重，吋而头痛如裂，时而晕重恶心。有时眼眶疼痛，视物模糊，脑耳俱鸣，疲乏思睡数月，其后又数日昼夜不眠，记忆力甚差，对外界事物反应迟钝，有时有胃中空虚无物之感，但饭后又痞满不适，心烦心悸，阵阵发作，口苦口干，舌苔薄白，脉沉弦而涩。综合脉证，诊为肝郁气滞，寒饮蕴郁，上热下寒之证。予柴胡加龙骨牡蛎汤，苓桂术甘汤合方治之。连服6剂，头痛减轻，睡眠增加。但继进6剂，证不再减。反复思考，病已40余年，正气虚衰，前方多为治实，而少扶正。细察色脉，面白而神疲，体胖而乏力，口干尤甚于夜间，脉虚而弦滑。乃云：此气阴两虚，痰热阻滞，郁而化火之证也。拟十味温胆汤加减方：黄芪15克，当归9克，党参9克，麦冬9克，五味子9克，竹茹9克，枳壳9克，半夏9克，陈皮9克，茯苓9克，炙甘草9克，菖蒲9克’远志9克，川芎9克，知母9克。刚欲放笔，某医云：头痛如此剧烈，为何不用止痛之全蝎、蜈蚣、僵蚕、蜂房?答曰：全蝎、蜈蚣、僵蚕、蜂房为熄风通络、活血止痛之药，其用于瘀血、风寒入络者，确有宏效，但本证虚多于实，非虫类之能祛。连服6剂诸证俱减，又服两月，其证果愈。为巩固效果，嘱其继续服两月以除根。
高××，女，成。血管神经性头痛3年多，除西药外，曾先后应用过川芎茶调散、丹栀逍遥散、补心丹、上清丸、天麻钩藤饮等500多剂不效。邀治于余。询之，除头痛外，并见五心烦热，心烦心悸，夜间口干，舌苔薄白，脉沉弦而涩．云：“前用诸方，或补或清或散之不效者，乃瘀血阻滞，气血不通，难于濡养筋脉，即王清任所谓血府逐瘀汤所治之病也。”为拟血府逐瘀汤：当归10克，生地1O克，桃仁10克，红花10克，甘草6克，枳壳10克，赤芍10克，柴胡10克，川芎9克，桔梗10克，牛膝15克。药进4剂即愈。
周××，女，51岁。血管神经性头痛20多年。每次性交或劳累时必然发作，其痛如胀如裂，尤甚于巅顶，并伴有恶心呕吐，有时如火烤巅顶，心烦易怒，足手厥冷，曾反复住院治疗，除西药外，中药服用达1000多剂无效。邀余诊视。审其证除以上所述者外，见其常以头低足高之卧位以减轻头痛，心烦肢厥，腰酸微痛，舌暗苔薄白，脉弦而紧。再看其所用药物，除西药中的镇静安眠止痛药外，并配中药芎菊茶调散加减，每日1剂，询其效果，头痛不减反日见加重。脉证与用药效果相互参合，诊为少阴厥阴之上逆头痛。拟用吴萸汤加味：吴茱萸10克，人参10克，甘草10克，大枣10个，枸杞子15克，当归10克。服药7剂后来诊云：头痛已减六七。余云：药已中的，继进14剂。半月后来诊，云：头痛已失八九，但继续用药效果已不明显。再寻其脉细弱无力，此肾督亏损之故尔，为拟右归丸加减：附子10克，肉桂10克，山萸10克，杜仲10克，怀牛膝10克，山药10克，枸杞子10克，龟甲15克，鹿角胶15克(烊化)，白芍15克，当归15克，吴茱萸10克。连服一月头痛消失，两年后来告，云：头痛未作。
高××，女，成。头痛如裂一个月多，前医以祛风散寒、养阴平肝、清热泻火等药而加剧。审之脉弦而紧，舌质暗而苔白，头痛甚于巅顶，时如火灼，或轻或重，严重时恶心呕吐，吐物为涎沫，甚或夹以食物，视物昏眩，足冷，口十小欲饮。综合脉证，诊为厥阴头痛，吴茱萸汤证。乃拟方：吴茱萸15克，人参10克，甘草10克，生姜10克，大枣7个。某医适在旁。问曰：“头热如火，反与吴茱萸之大辛大热，岂不以火助火吗?”余云：“两脉弦紧，舌质暗苔白，此阴寒内盛之象。此虽头热如火，非为真火，乃为阴盛格阳之火，故应以吴茱萸汤之大辛大热，以破阴霾。”服药2剂，痛果大减，继进4剂，痛失而愈。
呕吐
久吐不止，寒热并见者多，虚实并见者亦不少，若病虚甚，非甘缓不能调其脾；水蓄不化者，但予辛散则水逆，非利水而不解。例如：
李××，男，52岁。呕吐4年，前后经上海、北京、太原等医院检查治疗，未发现器质性病变，服中药1000剂及西药治疗不效。查其面色萎黄，舌苔白润，口渴喜饮，饮后则痞满呕吐，吐物如粘涎水沫，少则一痰盂，多则一脸盆，小便少而纳差，疲乏无力，脉见沉紧。细审前方多为止吐之剂。药证相比，诊为脾肾阳虚，水饮不化之水逆证。为拟温阳利水。理中、五苓合方治之。党参10克，白术10克，干姜10克，甘草10克，陈皮10克，桂枝10克，泽泻10克，猪苓10克，茯苓10克。药进2剂呕吐即减，再进20剂呕吐停止，尿量增多，痞满，乏力亦消失。
潘××，女，20岁。呕吐频作4个多月。久进镇静、止吐之中西药物不效。消化道造影无异常发现。审其饮水即吐，口干，尿少，苔薄白，脉弦。证脉合参，诊为脾胃阳虚，水饮停蓄，胃气上逆之水逆证。为拟五苓散加昧：白术10克，茯苓10克，猪苓10克，泽泻10克，肉桂10克，干姜4．5克，附子4．5克，甘草4．5克。药进2剂，五日未吐，10剂后诸证均解。
[按]水饮呕吐初起者，但以小半夏、小半夏加茯苓汤即可止吐。《金匮要略》说：“诸吐，谷不得下者，小半夏汤主之。”“卒呕吐，心下痞，膈间有水，眩悸者，小半夏加茯苓汤主之。”“先渴后呕，为水停心下，此属饮家，小半夏加茯苓汤主之。”但是邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱者，必须化气行水，故《伤寒论》说：“渴欲饮水，水入即吐者，名曰水逆，五苓散主之。”及至真火不足，膻中之火不宣，邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱者，又必温阳利水，故二案均以温阳利水而解。
赵××，男，19岁。胃脘疼痛，呕吐半年。数个医院检查均未确诊。中西药治疗一直不效。细询其吐发于食后，大便秘结数日不行，舌苔白，脉寸尤大于关尺，且上入鱼际。证脉相参，诊为脾胃气逆，为拟重镇降逆止吐。旋覆代赭石汤加减：旋覆花12克，代赭石30克，半夏12克，吴茱萸9克，黄连4．5克，陈皮12克，竹茹9克，生姜3片。药进2剂，呕、痛俱减。某医问：“可否用大黄甘草汤?”答曰：“《金匮要略》云：‘食已即吐者，大黄甘草汤主之。’云其治胃肠实热呕吐，此证大便秘结与胃肠实热者尤相类似，但胃肠实热脉象为沉实，此脉反见上人鱼际，显然不是胃肠实热，而是胃气上逆失降之便秘，故以代赭石之类降逆即可。”再进10剂，痛、呕俱失而愈。
食已即吐，有胃肠实热，食滞不化，脾胃虚寒，肝胃气逆之别，其鉴别方法，除症状外，尤应注意脉象。
范××，男，38岁。食后即吐四年多，北京、西安等医院诊治为神经性呕吐。久治不效。细审其证，其吐均发于食后，不恶心，不反酸，吐物为食物和粘液，舌苔白，脉弦滑重按无力。再审其原用诸方，多为止吐之剂，或辛或燥或苦无所不投，西药亦种类繁多。两相比较，诊为痰饮阻滞，久吐伤阴之证，若再予辛苦则必伤阴液，重用养阴必助痰饮。宜大半夏汤益气养阴化饮止呕：半夏12克，东参9克，生姜9克，蜂蜜30克。仅进2剂呕吐即止，再进10剂诸证痊愈。
刘××，男，12岁。呕吐2年，近因感冒和吃驱蛔虫药而加重。某院诊为胃痉挛、胃炎。治疗两个多月无效。审其呕吐频作，不恶心，口干纳呆，便干不爽，舌苔薄白，脉象弦滑。云：阴虚痰郁，肝胃气逆之证，予旋覆花9克，代赭石15克，沙参6克，丹参9克，川贝9克，郁金6克，甘草3克，砂仁6克，荷叶6克，麦冬6克，元参15克，川军1．5克，黄芩3克。6剂后吃午饭已不吐，但饮水和吃稀饭时仍吐，食纳稍增，便秘量少，咽喉仍有异物感。综合脉证，诊为痰饮阻滞，乃改予化痰降逆和胃：半夏12克，陈皮9克，厚朴9克，草豆蔻9克，旋覆花9克，吴茱萸9克，黄柏6克，生姜9克，代赭石30克，神曲9克，苏叶6克。药进2剂，反见更甚。细思其证及前后治法，久久呕吐，正气已伤，虽有痰饮已成为正虚邪实，若再单予祛邪必然脾胃更虚而不能运纳水谷。再审其证，面呈皓白，舌尖红而少苔。乃予大半夏汤益气养阴，化饮止呕：半夏12克，人参6克，生姜9克，蜂蜜30克。1剂吐止，6剂而愈。
孙××，男，成。溃疡病8年，近一月来症状日渐加重，疼痛不止，反复呕吐，开始仅吐食物，近来食物粘液一并吐出。先用西药治疗无效，后以中药温中和胃，苦辛通降，重镇止吐等法不但不减，反见加重。消化道造影：胃窦部、十二指肠溃疡、胃窦部溃疡恶性变。再察其面色憔悴无华，脉象虚大而弦滑。云：气阴俱伤，不能受纳，痰饮阻滞之候，为拟大半夏汤：半夏22克，东参9克，生姜9克，蜂蜜30克，麦冬12克。服药1剂呕吐即止，食纳稍进，再进4剂痛止纳增。乃转外科手术切除。
《金匮要略》说：“胃反呕吐者，大半夏汤主之。”林佩琴说：“胃虚谷气不行，呕而液伤，大半夏汤。”张景岳说：“凡治胃虚呕吐，最须详审气味。盖邪实胃强者能胜毒药，故无论气味优劣者皆可容受，惟胃虚气弱者则有宜否之辨。而胃虚之甚者，则于气味之间关系尤重，盖气虚者最畏不堪之气，此不但腥臊耗散之气不能受，即微香微郁并饮食之气亦不能受，而其他可知矣。胃弱者，最畏不堪之味，此非惟至苦极劣之味不能受，即微咸微苦并水谷正味亦不能受而其他可知矣。此胃虚之呕最重气味，使或略有不投，则入胃便吐，终无益也。”范、刘、孙案均呕吐甚久，气阴俱伤，前用诸法，或宗半夏、陈皮、生姜为止呕圣药之说，或以苦辛徒伤胃气，呕吐不但不止，反而更甚。大半夏汤之半夏助燥气以消谷，人参补胃气以安胃，蜂蜜甘而入脾，并抑半夏之辛散，致脾虚得复，呕吐可止。正如李升玺所说：“呕家不宜甘味，此用白蜜何也?不知此胃反自属脾经，经所谓甘味入脾，归其所喜是也；况君以半夏味辛而止呕，佐以人参温气而补中，胃反自可止矣。”
姜××，男，38岁。半年来胃脘痞满，隐隐作痛，食后即吐。某院诊为慢性胃炎、神经性呕吐。中西医久治未效。细察其证，除胃脘疼痛，呕吐外，食纳日减，每日仅能吃50～l0()克左右，消瘦乏力，面色萎黄，舌苔黄白而腻，脉弦滑。证脉合参，诊为脾虚不运，寒热交结，胃气上逆之证。为拟苦辛通降之干姜黄芩黄连人参汤：干姜9克，黄芩9克，黄连9克，党参9克。1剂止，10剂竟诸证俱失。
耿××，男，55岁。溃疡病5年，近一年多来发生反复呕吐。入院诊为十二指肠球部、胃窦部溃疡，慢性胃炎，幽门不全梗阻。曾用中、西药治疗无效，因拒绝手术而邀余治疗。审其证见，胃脘疼痛不止，嘈杂、胃脘满胀，纳呆，食久方吐或朝食暮吐，暮食朝吐，消瘦乏力，口苦口干，面色萎黄、舌苔薄白，脉弦涩不调。证脉合参，正仲景所谓：“胸中有热，胃中有邪气”之寒热夹杂证也。为拟黄连汤加减：黄连9克，半夏9克，干姜9克，肉桂9克，党参9克，甘荦：6克，大枣5个。4剂后呕吐停止，疼痛好转，30剂后诸证全部消失。
寒热夹杂的呕吐甚多，其寒多热少，热多寒少的区别在于脉象．即弦涩者为寒多于热，滑者为热多于寒，故姜案以干姜黄连黄芩人参汤，耿案用黄连汤。
黄疸
刘××，女，50岁。神经性头痛40多年，每日全靠止痛片减轻痛苦，中药虽进千剂亦不效。邀余诊视。询其头痛而重，时而头痛如裂，时而晕重恶心。有时眼眶疼痛，视物模糊，脑耳俱鸣，疲乏思睡数月，其后又数日昼夜不眠，记忆力甚差，对外界事物反应迟钝，有时有胃中空虚无物之感，但饭后又痞满不适，心烦心悸，阵阵发作，口苦口干，舌苔薄白，脉沉弦而涩。综合脉证，诊为肝郁气滞，寒饮蕴郁，上热下寒之证。予柴胡加龙骨牡蛎汤，苓桂术甘汤合方治之。连服6剂，头痛减轻，睡眠增加。但继进6剂，证不再减。反复思考，病已40余年，正气虚衰，前方多为治实，而少扶正。细察色脉，面白而神疲，体胖而乏力，口干尤甚于夜间，脉虚而弦滑。乃云：此气阴两虚，痰热阻滞，郁而化火之证也。拟十味温胆汤加减方：黄芪15克，当归9克，党参9克，麦冬9克，五味子9克，竹茹9克，枳壳9克，半夏9克，陈皮9克，茯苓9克，炙甘草9克，菖蒲9克’远志9克，川芎9克，知母9克。刚欲放笔，某医云：头痛如此剧烈，为何不用止痛之全蝎、蜈蚣、僵蚕、蜂房?答曰：全蝎、蜈蚣、僵蚕、蜂房为熄风通络、活血止痛之药，其用于瘀血、风寒入络者，确有宏效，但本证虚多于实，非虫类之能祛。连服6剂诸证俱减，又服两月，其证果愈。为巩固效果，嘱其继续服两月以除根。
高××，女，成（注：原文“成”疑为“3x”或具体年龄缺失，此处依原文保留）。血管神经性头痛3年多，除西药外，曾先后应用过川芎茶调散、丹栀逍遥散、补心丹、上清丸、天麻钩藤饮等500多剂不效。邀治于余。询之，除头痛外，并见五心烦热，心烦心悸，夜间口干，舌苔薄白，脉沉弦而涩．云：“前用诸方，或补或清或散之不效者，乃瘀血阻滞，气血不通，难于濡养筋脉，即王清任所谓血府逐瘀汤所治之病也。”为拟血府逐瘀汤：当归10克，生地1O克，桃仁10克，红花10克，甘草6克，枳壳10克，赤芍10克，柴胡10克，川芎9克，桔梗10克，牛膝15克。药进4剂即愈。
周××，女，51岁。血管神经性头痛20多年。每次性交或劳累时必然发作，其痛如胀如裂，尤甚于巅顶，并伴有恶心呕吐，有时如火烤巅顶，心烦易怒，足手厥冷，曾反复住院治疗，除西药外，中药服用达1000多剂无效。邀余诊视。审其证除以上所述者外，见其常以头低足高之卧位以减轻头痛，心烦肢厥，腰酸微痛，舌暗苔薄白，脉弦而紧。再看其所用药物，除西药中的镇静安眠止痛药外，并配中药芎菊茶调散加减，每日1剂，询其效果，头痛不减反日见加重。脉证与用药效果相互参合，诊为少阴厥阴之上逆头痛。拟用吴茱萸汤加味：吴茱萸10克，人参10克，甘草10克，大枣10个，枸杞子15克，当归10克。服药7剂后来诊云：头痛已减六七。余云：药已中的，继进14剂。半月后来诊，云：头痛已失八九，但继续用药效果已不明显。再寻其脉细弱无力，此肾督亏损之故尔，为拟右归丸加减：附子10克，肉桂10克，山萸10克，杜仲10克，怀牛膝10克，山药10克，枸杞子10克，龟甲15克，鹿角胶15克(烊化)，白芍15克，当归15克，吴茱萸10克。连服一月头痛消失，两年后来告，云：头痛未作。
高××，女，成。头痛如裂一个月多，前医以祛风散寒、养阴平肝、清热泻火等药而加剧。审之脉弦而紧，舌质暗而苔白，头痛甚于巅顶，时如火灼，或轻或重，严重时恶心呕吐，吐物为涎沫，甚或夹以食物，视物昏眩，足冷，口十小欲饮（注：原文“口十小欲饮”疑为“口干小欲饮”之误，依语境翻译）。综合脉证，诊为厥阴头痛，吴茱萸汤证。乃拟方：吴茱萸15克，人参10克，甘草10克，生姜10克，大枣7个。某医适在旁。问曰：“头热如火，反与吴茱萸之大辛大热，岂不以火助火吗?”余云：“两脉弦紧，舌质暗苔白，此阴寒内盛之象。此虽头热如火，非为真火，乃为阴盛格阳之火，故应以吴茱萸汤之大辛大热，以破阴霾。”服药2剂，痛果大减，继进4剂，痛失而愈。
呕吐
久吐不止，寒热并见者多，虚实并见者亦不少，若病虚甚，非甘缓不能调其脾；水蓄不化者，但予辛散则水逆，非利水而不解。例如：
李××，男，52岁。呕吐4年，前后经上海、北京、太原等医院检查治疗，未发现器质性病变，服中药1000剂及西药治疗不效。查其面色萎黄，舌苔白润，口渴喜饮，饮后则痞满呕吐，吐物如粘涎水沫，少则一痰盂，多则一脸盆，小便少而纳差，疲乏无力，脉见沉紧。细审前方多为止吐之剂。药证相比，诊为脾肾阳虚，水饮不化之水逆证。为拟温阳利水。理中、五苓合方治之。党参10克，白术10克，干姜10克，甘草10克，陈皮10克，桂枝10克，泽泻10克，猪苓10克，茯苓10克。药进2剂呕吐即减，再进20剂呕吐停止，尿量增多，痞满，乏力亦消失。
潘××，女，20岁。呕吐频作4个多月。久进镇静、止吐之中西药物不效。消化道造影无异常发现。审其饮水即吐，口干，尿少，苔薄白，脉弦。证脉合参，诊为脾胃阳虚，水饮停蓄，胃气上逆之水逆证。为拟五苓散加昧（注：原文“加昧”应为“加减”）：白术10克，茯苓10克，猪苓10克，泽泻10克，肉桂10克，干姜4．5克，附子4．5克，甘草4．5克。药进2剂，五日未吐，10剂后诸证均解。
[按]水饮呕吐初起者，但以小半夏、小半夏加茯苓汤即可止吐。《金匮要略》说：“诸吐，谷不得下者，小半夏汤主之。”“卒呕吐，心下痞，膈间有水，眩悸者，小半夏加茯苓汤主之。”“先渴后呕，为水停心下，此属饮家，小半夏加茯苓汤主之。”但是邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱者，必须化气行水，故《伤寒论》说：“渴欲饮水，水入即吐者，名曰水逆，五苓散主之。”及至真火不足，膻中之火不宣，邪水凝结于内，水饮拒绝于外，既不能外输于玄府，又不能上输于口舌，亦不能下输于膀胱者，又必温阳利水，故二案均以温阳利水而解。
赵××，男，19岁。胃脘疼痛，呕吐半年。数个医院检查均未确诊。中西药治疗一直不效。细询其吐发于食后，大便秘结数日不行，舌苔白，脉寸尤大于关尺，且上入鱼际。证脉相参，诊为脾胃气逆，为拟重镇降逆止吐。旋覆代赭石汤加减：旋覆花12克，代赭石30克，半夏12克，吴茱萸9克，黄连4．5克，陈皮12克，竹茹9克，生姜3片。药进2剂，呕、痛俱减。某医问：“可否用大黄甘草汤?”答曰：“《金匮要略》云：‘食已即吐者，大黄甘草汤主之。’云其治胃肠实热呕吐，此证大便秘结与胃肠实热者尤相类似，但胃肠实热脉象为沉实，此脉反见上人鱼际，显然不是胃肠实热，而是胃气上逆失降之便秘，故以代赭石之类降逆即可。”再进10剂，痛、呕俱失而愈。
食已即吐，有胃肠实热，食滞不化，脾胃虚寒，肝胃气逆之别，其鉴别方法，除症状外，尤应注意脉象。
范××，男，38岁。食后即吐四年多，北京、西安等医院诊治为神经性呕吐。久治不效。细审其证，其吐均发于食后，不恶心，不反酸，吐物为食物和粘液，舌苔白，脉弦滑重按无力。再审其原用诸方，多为止吐之剂，或辛或燥或苦无所不投，西药亦种类繁多。两相比较，诊为痰饮阻滞，久吐伤阴之证，若再予辛苦则必伤阴液，重用养阴必助痰饮。宜大半夏汤益气养阴化饮止呕：半夏12克，东参9克，生姜9克，蜂蜜30克。仅进2剂呕吐即止，再进10剂诸证痊愈。
刘××，男，12岁。呕吐2年，近因感冒和吃驱蛔虫药而加重。某院诊为胃痉挛、胃炎。治疗两个多月无效。审其呕吐频作，不恶心，口干纳呆，便干不爽，舌苔薄白，脉象弦滑。云：阴虚痰郁，肝胃气逆之证，予旋覆花9克，代赭石15克，沙参6克，丹参9克，川贝9克，郁金6克，甘草3克，砂仁6克，荷叶6克，麦冬6克，元参15克，川军1．5克，黄芩3克。6剂后吃午饭已不吐，但饮水和吃稀饭时仍吐，食纳稍增，便秘量少，咽喉仍有异物感。综合脉证，诊为痰饮阻滞，乃改予化痰降逆和胃：半夏12克，陈皮9克，厚朴9克，草豆蔻9克，旋覆花9克，吴茱萸9克，黄柏6克，生姜9克，代赭石30克，神曲9克，苏叶6克。药进2剂，反见更甚。细思其证及前后治法，久久呕吐，正气已伤，虽有痰饮已成为正虚邪实，若再单予祛邪必然脾胃更虚而不能运纳水谷。再审其证，面呈皓白，舌尖红而少苔。乃予大半夏汤益气养阴，化饮止呕：半夏12克，人参6克，生姜9克，蜂蜜30克。1剂吐止，6剂而愈。
孙××，男，成。溃疡病8年，近一月来症状日渐加重，疼痛不止，反复呕吐，开始仅吐食物，近来食物粘液一并吐出。先用西药治疗无效，后以中药温中和胃，苦辛通降，重镇止吐等法不但不减，反见加重。消化道造影：胃窦部、十二指肠溃疡、胃窦部溃疡恶性变。再察其面色憔悴无华，脉象虚大而弦滑。云：气阴俱伤，不能受纳，痰饮阻滞之候，为拟大半夏汤：半夏22克，东参9克，生姜9克，蜂蜜30克，麦冬12克。服药1剂呕吐即止，食纳稍进，再进4剂痛止纳增。乃转外科手术切除。
《金匮要略》说：“胃反呕吐者，大半夏汤主之。”林佩琴说：“胃虚谷气不行，呕而液伤，大半夏汤。”张景岳说：“凡治胃虚呕吐，最须详审气味。盖邪实胃强者能胜毒药，故无论气味优劣者皆可容受，惟胃虚气弱者则有宜否之辨。而胃虚之甚者，则于气味之间关系尤重，盖气虚者最畏不堪之气，此不但腥臊耗散之气不能受，即微香微郁并饮食之气亦不能受，而其他可知矣。胃弱者，最畏不堪之味，此非惟至苦极劣之味不能受，即微咸微苦并水谷正味亦不能受而其他可知矣。此胃虚之呕最重气味，使或略有不投，则入胃便吐，终无益也。”范、刘、孙案均呕吐甚久，气阴俱伤，前用诸法，或宗半夏、陈皮、生姜为止呕圣药之说，或以苦辛徒伤胃气，呕吐不但不止，反而更甚。大半夏汤之半夏助燥气以消谷，人参补胃气以安胃，蜂蜜甘而入脾，并抑半夏之辛散，致脾虚得复，呕吐可止。正如李升玺所说：“呕家不宜甘味，此用白蜜何也?不知此胃反自属脾经，经所谓甘味入脾，归其所喜是也；况君以半夏味辛而止呕，佐以人参温气而补中，胃反自可止矣。”
姜××，男，38岁。半年来胃脘痞满，隐隐作痛，食后即吐。某院诊为慢性胃炎、神经性呕吐。中西医久治未效。细察其证，除胃脘疼痛，呕吐外，食纳日减，每日仅能吃50～l0()克左右，消瘦乏力，面色萎黄，舌苔黄白而腻，脉弦滑。证脉合参，诊为脾虚不运，寒热交结，胃气上逆之证。为拟苦辛通降之干姜黄芩黄连人参汤：干姜9克，黄芩9克，黄连9克，党参9克。1剂止，10剂竟诸证俱失。
耿××，男，55岁。溃疡病5年，近一年多来发生反复呕吐。入院诊为十二指肠球部、胃窦部溃疡，慢性胃炎，幽门不全梗阻。曾用中、西药治疗无效，因拒绝手术而邀余治疗。审其证见，胃脘疼痛不止，嘈杂、胃脘满胀，纳呆，食久方吐或朝食暮吐，暮食朝吐，消瘦乏力，口苦口干，面色萎黄、舌苔薄白，脉弦涩不调。证脉合参，正仲景所谓：“胸中有热，胃中有邪气”之寒热夹杂证也。为拟黄连汤加减：黄连9克，半夏9克，干姜9克，肉桂9克，党参9克，甘荦：6克（注：原文“甘荦”应为“甘草”），大枣5个。4剂后呕吐停止，疼痛好转，30剂后诸证全部消失。
寒热夹杂的呕吐甚多，其寒多热少，热多寒少的区别在于脉象．即弦涩者为寒多于热，滑者为热多于寒，故姜案以干姜黄连黄芩人参汤，耿案用黄连汤。
Liu XX, female, 50 years old. Suffered from neuralgia (neurological headache) for over 40 years, relying daily on analgesic tablets to alleviate pain; despite taking over a thousand doses of Chinese herbal medicine with no effect, she invited me to examine her. Upon inquiry, she reported heavy headaches, sometimes splitting as if cracking, accompanied by dizziness and nausea. Occasionally, she experienced orbital pain, blurred vision, tinnitus in the head and ears, fatigue and sleepiness for months, followed by days of insomnia day and night, poor memory, and sluggish reaction to external stimuli. Sometimes she felt emptiness in the stomach without hunger, but after meals felt distension and discomfort. She suffered from irritability and palpitations, occurring in paroxysms, bitter taste in the mouth, dry mouth, thin white tongue coating, and a deep, wiry, and choppy pulse. Synthesizing the pulse and symptoms, the diagnosis was Liver Qi stagnation, accumulation of cold-fluid retention, with heat above and cold below. I prescribed a combined formula of Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) and Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction). After taking six doses, the headache lessened and sleep increased. However, after another six doses, the symptoms did not decrease further. Reflecting repeatedly, the disease had lasted over 40 years, indicating deficiency of Zheng Qi (healthy energy/antibody resistance), while the previous formulas mainly treated excess conditions and rarely tonified deficiency. Carefully observing the complexion and pulse: pale face with mental fatigue, obese body with weakness, severe dry mouth especially at night, and a deficient, wiry, and slippery pulse. I stated: "This is a syndrome of dual deficiency of Qi and Yin, obstruction by phlegm-heat, and stagnation transforming into fire." I proposed a modified Shiwei Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction): Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 9g, Dangshen (Codonopsis Radix) 9g, Maidong (Ophiopogonis Radix) 9g, Wuweizi (Schisandrae Chinensis Fructus) 9g, Zhuru (Bambusae Caulis in Taenia) 9g, Zhiqiao (Aurantii Fructus) 9g, Banxia (Pinelliae Rhizoma) 9g, Chenpi (Citri Reticulatae Pericarpium) 9g, Fuling (Poria) 9g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 9g, Shichangpu (Acori Tatarinowii Rhizoma) 9g, Yuanzhi (Polygalae Radix) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 9g, Zhimu (Anemarrhenae Rhizoma) 9g. Just as I was about to put down the pen, another doctor said: "With such severe headache, why not use Scorpion (Quanxie), Centipede (Wugong), Silkworm (Jiangcan), or Hornet Nest (Ffang) for pain relief?" I replied: "Scorpion, Centipede, Silkworm, and Hornet Nest are herbs that extinguish wind, unblock collaterals, invigorate blood, and relieve pain. They are indeed highly effective for blood stasis and wind-cold invading the collaterals, but this case is more deficient than excessive, so insect medicines cannot dispel it." After taking six doses, all symptoms decreased. Taking it for another two months, the condition was cured. To consolidate the effect, I advised continuing the medication for two months to eradicate the root cause.
Gao XX, female, [age missing]. Suffered from vasoneuralgia (vascular neurological headache) for over 3 years. Besides Western medicine, she had applied over 500 doses of Chuanxiong Chatiao San (Ligusticum Chariot-Taming Powder), Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder), Buxin Dan (Heart-Nourishing Pill), Shangqing Wan (Upper-Clearing Pill), and Tianma Gouteng Yin (Gastrodia and Uncaria Decoction) with no effect. She sought my treatment. Inquiry revealed that besides headache, she also experienced five-palm heat (heat sensation in palms, soles, and chest), irritability, palpitations, dry mouth at night, thin white tongue coating, and a deep, wiry, and choppy pulse. I said: "The previous formulas, whether tonifying, clearing, or dispersing, failed because they did not address blood stasis obstructing the flow of Qi and Blood, making it difficult to nourish the sinews and vessels. This is the disease treated by Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) as described by Wang Qingren." I prescribed Xuefu Zhuyu Tang: Danggui (Angelicae Sinensis Radix) 10g, Shengdi (Rehmanniae Radix) 10g, Taoren (Persicae Semen) 10g, Honghua (Carthami Flos) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Zhiqiao (Aurantii Fructus) 10g, Chishao (Paeoniae Radix Rubra) 10g, Chaihu (Bupleuri Radix) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 9g, Jiegeng (Platycodonis Radix) 10g, Niuxi (Achyranthis Bidentatae Radix) 15g. The condition was cured after four doses.
Zhou XX, female, 51 years old. Suffered from vasoneuralgia for over 20 years. Attacks inevitably occurred during intercourse or exertion, with pain feeling like distension or splitting, especially severe at the vertex. Accompanied by nausea and vomiting, sometimes feeling as if the vertex were roasted by fire, irritability, cold hands and feet. She had been hospitalized repeatedly; besides Western medicine, she took over 1000 doses of Chinese medicine with no effect. I examined her. Besides the above symptoms, she often lay with her head low and feet high to relieve headache, had irritability and limb coldness, sore and slightly painful lower back, dark tongue with thin white coating, and a wiry and tight pulse. Reviewing her medications, besides Western sedatives, hypnotics, and analgesics, she used modified Xiongju Chatiao San (Ligusticum and Chrysanthemum Chariot-Taming Powder) once daily. Her headache worsened instead of improving. Combining pulse/symptoms with treatment effects, the diagnosis was rebellious headache of Shaoyin and Jueyin channels. I prescribed modified Wuzhuyu Tang (Evodia Decoction): Wuzhuyu (Euodiae Fructus) 10g, Renshen (Ginseng Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Dazao (Ziziphi Jujubae Fructus) 10 pieces, Gouqizi (Lycii Fructus) 15g, Danggui (Angelicae Sinensis Radix) 10g. After seven doses, she reported headache reduced by 60-70%. I said: "The medicine hit the target; continue for 14 doses." Half a month later, she reported headache reduced by 80-90%, but further medication showed little effect. Re-examining the pulse, it was fine, weak, and powerless, indicating deficiency of Kidney and Du Mai (Governing Vessel). I prescribed modified Yougui Wan (Right-Restoring Pill): Fuzi (Aconiti Lateralis Radix Praeparata) 10g, Rougui (Cinnamomi Cortex) 10g, Shanzhuyu (Corni Fructus) 10g, Duzhong (Eucommiae Cortex) 10g, Huainiuxi (Achyranthis Bidentatae Radix) 10g, Shanyao (Dioscoreae Rhizoma) 10g, Gouqizi (Lycii Fructus) 10g, Guijia (Testudinis Carapax et Plastrum) 15g, Lu jiao jiao (Cervi Cornus Colla) 15g (melted), Baishao (Paeoniae Radix Alba) 15g, Danggui (Angelicae Sinensis Radix) 15g, Wuzhuyu (Euodiae Fructus) 10g. After one month of continuous intake, the headache disappeared. Two years later, she reported no recurrence.
Gao XX, female, [age missing]. Headache like splitting for over a month. Previous doctors aggravated it with wind-dispelling, cold-scattering, Yin-nourishing, liver-calming, heat-clearing, and fire-draining herbs. Pulse was wiry and tight, tongue dark with white coating, headache severe at vertex, sometimes burning like fire, varying in intensity. Severe cases involved nausea and vomiting of saliva, sometimes mixed with food, blurred vision, cold feet, dry mouth with slight desire to drink. Synthesizing pulse and symptoms, diagnosed as Jueyin headache, Wuzhuyu Tang syndrome. Prescribed: Wuzhuyu (Euodiae Fructus) 15g, Renshen (Ginseng Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Shengjiang (Zingiberis Rhizoma Recens) 10g, Dazao (Ziziphi Jujubae Fructus) 7 pieces. Another doctor present asked: "Head feels hot like fire, yet you use Wuzhuyu, which is extremely pungent and hot? Does this not add fire to fire?" I replied: "Both pulses are wiry and tight, tongue dark with white coating, indicating abundant internal Yin-cold. Although the head feels hot like fire, it is not true fire, but fire repelled outward by abundant Yin (Yin-sheng Ge-Yang). Therefore, we must use the extreme pungency and heat of Wuzhuyu Tang to break through the Yin gloom." After two doses, pain greatly decreased. After four more doses, pain vanished and she was cured.
Vomiting
Long-standing vomiting often presents with both cold and heat, and deficiency and excess. If deficiency is severe, only sweet and緩缓 (gentle/modulating) herbs can regulate the Spleen; if water accumulates and fails to transform, using only pungent dispersants causes Water Rebellion (Shui Ni), and only diuresis can resolve it. For example:
Li XX, male, 52 years old. Vomiting for 4 years. Checked and treated in Shanghai, Beijing, Taiyuan hospitals; no organic lesions found. Took 1000 doses of Chinese medicine and Western medicine with no effect. Complexion sallow, tongue coating white and moist, thirsty and preferring to drink, but drinking leads to distension and vomiting. Vomit resembles sticky saliva and foam, ranging from one chamber pot to a large basin. Urine output scanty, poor appetite, fatigue, pulse deep and tight. Careful review of previous prescriptions showed mostly anti-emetics. Comparing medicine and syndrome, diagnosed as Spleen-Kidney Yang deficiency, Water Rebellion syndrome due to failure to transform fluid retention. Prescribed warming Yang and promoting diuresis: Lizhong Tang (Regulate the Middle Decoction) combined with Wuling San (Five-Ingredient Powder with Poria). Dangshen (Codonopsis Radix) 10g, Baizhu (Atractodis Macrocephalae Rhizoma) 10g, Ganjiang (Zingiberis Rhizoma) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Guizhi (Cinnamomi Ramulus) 10g, Zexie (Alismatis Rhizoma) 10g, Zhuling (Polyporus) 10g, Fuling (Poria) 10g. After two doses, vomiting decreased. After 20 more doses, vomiting stopped, urine volume increased, distension and fatigue disappeared.
Pan XX, female, 20 years old. Frequent vomiting for over 4 months. Long-term use of sedative and anti-emetic Chinese and Western medicines ineffective. Gastrointestinal angiography normal. Drinking immediately triggers vomiting, dry mouth, scanty urine, thin white coating, wiry pulse. Synthesizing syndrome and pulse, diagnosed as Spleen-Stomach Yang deficiency, fluid retention, rebellious Stomach Qi causing Water Rebellion. Prescribed modified Wuling San (Five-Ingredient Powder with Poria): Baizhu (Atractodis Macrocephalae Rhizoma) 10g, Fuling (Poria) 10g, Zhuling (Polyporus) 10g, Zexie (Alismatis Rhizoma) 10g, Rougui (Cinnamomi Cortex) 10g, Ganjiang (Zingiberis Rhizoma) 4.5g, Fuzi (Aconiti Lateralis Radix Praeparata) 4.5g, Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g. After two doses, no vomiting for five days. After 10 doses, all symptoms resolved.
[Commentary] For early-stage fluid-retention vomiting, Xiaobanxia Tang (Minor Pinellia Decoction) or Xiaobanxia Ji Fuling Tang (Minor Pinellia Decoction plus Poria) can stop vomiting. *Jingui Yaolue* states: "For all vomiting where food cannot go down, Xiaobanxia Tang governs it." "For sudden vomiting, epigastric fullness, water between diaphragm, dizziness and palpitations, Xiaobanxia Ji Fuling Tang governs it." "Thirst first then vomiting indicates water stopping under the heart, belonging to drinkers, governed by Xiaobanxia Ji Fuling Tang." However, when pathogenic water condenses internally and fluid retention rejects externally, unable to transport out via pores, up to mouth/tongue, or down to bladder, one must transform Qi and move water. Thus, *Shanghan Lun* states: "Desiring to drink water, but vomiting immediately upon ingestion, named Water Rebellion, governed by Wuling San." When True Fire is insufficient, Mingmen Fire (Fire of the Gate of Life) does not disseminate, pathogenic water condenses internally, fluid retention rejects externally, unable to transport out via pores, up to mouth/tongue, or down to bladder, one must warm Yang and promote diuresis. Hence, both cases were resolved by warming Yang and promoting diuresis.
Zhao XX, male, 19 years old. Epigastric pain and vomiting for half a year. Multiple hospital checks undiagnosed. Chinese and Western medicine ineffective. Inquiry revealed vomiting after eating, severe constipation for several days, white tongue coating, Cun (Inch) pulse significantly larger than Guan (Bar) and Chi (Cubit) pulses, extending into the fish-mouth area. Synthesizing pulse and syndrome, diagnosed as Spleen-Stomach Qi rebellion. Prescribed heavy-settling, descending, and anti-emetic modified Xuanfu Daizhe Shi Tang (Inula and Hematite Stone Decoction): Xuanfuhua (Inulae Flos) 12g, Daizheshi (Hematitum) 30g, Banxia (Pinelliae Rhizoma) 12g, Wuzhuyu (Euodiae Fructus) 9g, Huanglian (Coptidis Rhizoma) 4.5g, Chenpi (Citri Reticulatae Pericarpium) 12g, Zhuru (Bambusae Caulis in Taenia) 9g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices. After two doses, vomiting and pain decreased. Another doctor asked: "Can Dahuang Gancao Tang (Rhubarb and Licorice Decoction) be used?" I replied: "*Jingui Yaolue* says: 'Vomiting immediately after eating, governed by Dahuang Gancao Tang.' It treats gastrointestinal excess-heat vomiting. This case's constipation resembles excess-heat, but the pulse for excess-heat is deep and solid. Here, the pulse extends to the fish-mouth, clearly not gastrointestinal excess-heat, but constipation due to rebellious Stomach Qi failing to descend. Thus, settling rebellion with Daizheshi suffices." After 10 more doses, pain and vomiting vanished and she was cured.
Vomiting immediately after eating differs in gastrointestinal excess-heat, food stagnation, Spleen-Stomach deficiency-cold, and Liver-Stomach Qi rebellion. Differentiation, besides symptoms, particularly requires attention to the pulse.
Fan XX, male, 38 years old. Vomiting immediately after eating for over 4 years. Diagnosed as neurogenic vomiting in Beijing and Xi'an hospitals. Long-term treatment ineffective. Careful examination: vomiting always after eating, no nausea, no acid regurgitation, vomit contains food and mucus, white tongue coating, wiry-slippery pulse, powerless on deep pressure. Reviewing original formulas, mostly anti-emetics, pungent, drying, or bitter, various Western medicines also used. Comparing, diagnosed as phlegm-fluid obstruction, long-term vomiting injuring Yin. Further pungent-bitter herbs would injure Yin fluids; heavy Yin-tonification would aid phlegm-fluid. Suitable for Banxia Tang (Major Pinellia Decoction) to tonify Qi, nourish Yin, transform fluid, and stop vomiting: Banxia (Pinelliae Rhizoma) 12g, Dongshen (Codonopsis Radix) 9g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Fengmi (Mel) 30g. Only two doses stopped vomiting. Ten more doses cured all symptoms.
Liu XX, male, 12 years old. Vomiting for 2 years, aggravated recently by cold and anthelmintic drugs. Diagnosed as gastric spasm and gastritis. Treatment for over two months ineffective. Frequent vomiting, no nausea, dry mouth, poor appetite, dry and unsatisfactory stool, thin white coating, wiry-slippery pulse. I said: "Yin deficiency with phlegm-stagnation, Liver-Stomach Qi rebellion." Prescribed: Xuanfuhua (Inulae Flos) 9g, Daizheshi (Hematitum) 15g, Shashen (Glehniae Radix) 6g, Danshen (Salviae Miltiorrhizae Radix) 9g, Chuanbei (Fritillariae Cirrhosae Bulbus) 9g, Yujin (Curcumae Radix) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Sharen (Amomi Fructus) 6g, Heye (Nelumbinis Folium) 6g, Maidong (Ophiopogonis Radix) 6g, Xuanshen (Scrophulariae Radix) 15g, Chuanjun (Rhei Radix et Rhizoma) 1.5g, Huangqin (Scutellariae Radix) 3g. After 6 doses, lunch no longer vomited, but drinking water and eating porridge still caused vomiting. Appetite slightly increased, constipation volume decreased, foreign body sensation in throat remained. Synthesizing pulse and symptoms, diagnosed as phlegm-fluid obstruction. Changed to resolving phlegm, descending rebellion, harmonizing Stomach: Banxia (Pinelliae Rhizoma) 12g, Chenpi (Citri Reticulatae Pericarpium) 9g, Houpo (Magnoliae Officinalis Cortex) 9g, Caodoukou (Amomi Fructus Rotundus) 9g, Xuanfuhua (Inulae Flos) 9g, Wuzhuyu (Euodiae Fructus) 9g, Huangbai (Phellodendri Cortex) 6g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Daizheshi (Hematitum) 30g, Shenqu (Massa Medicata Fermentata) 9g, Zhusu (Perillae Folium) 6g. After 2 doses, symptoms worsened. Reflecting on syndrome and treatments, long-term vomiting injured Zheng Qi (healthy energy); although phlegm-fluid exists, it became deficiency of Zheng Qi with excess of Pathogen. Further single expulsion of pathogen would make Spleen-Stomach more deficient, unable to transport and receive water and grain. Re-examining syndrome: face bright white, tip of tongue red with scanty coating. Prescribed Banxia Tang (Major Pinellia Decoction) to tonify Qi, nourish Yin, transform fluid, and stop vomiting: Banxia (Pinelliae Rhizoma) 12g, Renshen (Ginseng Radix) 6g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Fengmi (Mel) 30g. One dose stopped vomiting, six doses cured.
Sun XX, male, [age missing]. Peptic ulcer for 8 years, symptoms worsening for a month, unremitting pain, repeated vomiting. Initially vomited only food, recently vomited food mixed with mucus. Western medicine ineffective. Chinese medicine methods of warming and harmonizing Stomach, bitter-pungent descending, heavy-settling anti-emetic did not reduce symptoms but aggravated them. Gastrointestinal angiography: antral ulcer, duodenal ulcer, malignant transformation of antral ulcer. Complexion haggard and lusterless, pulse deficient-large, wiry, and slippery. I said: "Qi and Yin both injured, unable to receive, sign of phlegm-fluid obstruction." Prescribed Banxia Tang (Major Pinellia Decoction): Banxia (Pinelliae Rhizoma) 22g, Dongshen (Codonopsis Radix) 9g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Fengmi (Mel) 30g, Maidong (Ophiopogonis Radix) 12g. One dose stopped vomiting, appetite slightly improved. Four more doses stopped pain and increased appetite. Then transferred to surgical excision.
*Jingui Yaolue* states: "For stomach reversal vomiting, Banxia Tang (Major Pinellia Decoction) governs it." Lin Peiqin said: "Stomach deficiency, grain Qi not moving, vomiting with fluid injury, Banxia Tang (Major Pinellia Decoction)." Zhang Jingyue said: "When treating stomach deficiency vomiting, one must carefully examine flavor and aroma. Since pathogenic excess and strong Stomach can withstand toxic drugs, any flavor quality is acceptable. But for deficient and weak Stomach, there is a distinction of suitability. Especially for severe stomach deficiency, the relationship between flavors is crucial. Qi-deficient patients fear unbearable aromas most; not only fishy/foul dissipating aromas are unacceptable, even slight fragrance/stagnation and food aromas are unacceptable. Weak Stomachs fear unbearable tastes most; not only extremely bitter/inferior tastes are unacceptable, even slight salty/bitter and natural food tastes are unacceptable. This stomach deficiency vomiting heavily relies on flavor; if slightly incompatible, it enters the Stomach and is vomited, ultimately useless." Cases Fan, Liu, and Sun all had long-term vomiting with Qi and Yin injury. Previous methods either relied on Banxia, Chenpi, Shengjiang as holy anti-emetics, or used bitter-pungent harming Stomach Qi, causing vomiting to not stop but worsen. In Banxia Tang (Major Pinellia Decoction), Banxia aids dryness to digest grain, Renshen tonifies Stomach Qi to calm Stomach, Fengmi is sweet entering Spleen, suppressing Banxia's pungent dispersion, restoring Spleen deficiency, stopping vomiting. As Li Shengxi said: "Vomiters should avoid sweet taste, why use white honey here? Unknown that this stomach reversal belongs to Spleen channel; classics say sweet taste enters Spleen, returning to its preference; moreover, with Banxia pungent stopping vomiting as sovereign, Renshen warming Qi tonifying middle as assistant, stomach reversal can stop."
Jiang XX, male, 38 years old. Epigastric fullness and dull pain for half a year, vomiting after eating. Diagnosed as chronic gastritis and neurogenic vomiting. Long-term Chinese and Western medicine ineffective. Careful examination: besides epigastric pain and vomiting, appetite decreasing daily, able to eat only ~50-100g, emaciated and fatigued, sallow complexion, yellow-white greasy tongue coating, wiry-slippery pulse. Synthesizing syndrome and pulse, diagnosed as Spleen deficiency failing to transport, cold-heat interlocking, rebellious Stomach Qi. Prescribed bitter-pungent descending Ganjiang Huangqin Huanglian Renshen Tang (Ginger, Scutellaria, Coptis, and Ginseng Decoction): Ganjiang (Zingiberis Rhizoma) 9g, Huangqin (Scutellariae Radix) 9g, Huanglian (Coptidis Rhizoma) 9g, Dangshen (Codonopsis Radix) 9g. One dose stopped it, ten doses cured all symptoms.
Geng XX, male, 55 years old. Peptic ulcer for 5 years, repeated vomiting for over a year. Hospitalized diagnosed as duodenal bulb ulcer, antral ulcer, chronic gastritis, incomplete pyloric obstruction. Chinese and Western medicine ineffective, refused surgery, sought my treatment. Symptoms: unremitting epigastric pain, acid regurgitation, epigastric fullness, poor appetite, vomiting after long time or morning food evening vomit/evening food morning vomit, emaciated and fatigued, bitter and dry mouth, sallow complexion, thin white coating, irregular wiry-choppy pulse. Synthesizing syndrome and pulse, exactly matches Zhongjing's description: "Heat in chest, pathogenic Qi in Stomach," a cold-heat complex syndrome. Prescribed modified Huanglian Tang (Coptis Decoction): Huanglian (Coptidis Rhizoma) 9g, Banxia (Pinelliae Rhizoma) 9g, Ganjiang (Zingiberis Rhizoma) 9g, Rougui (Cinnamomi Cortex) 9g, Dangshen (Codonopsis Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Dazao (Ziziphi Jujubae Fructus) 5 pieces. After 4 doses, vomiting stopped, pain improved. After 30 doses, all symptoms disappeared.
There are many cold-heat complex vomiting cases. Distinction between more cold/less heat and more heat/less cold lies in pulse: wiry-choppy indicates more cold than heat, slippery indicates more heat than cold. Hence, Jiang case used Ganjiang Huanglian Huangqin Renshen Tang, Geng case used Huanglian Tang.
Jaundice