寒 因胃寒伤食,四肢厥冷,脉弱,宜四逆汤。(又云,今吐先觉咽酸,然后吐食,脉
滑小者,是伤寒汗下过多,食久反吐,亦属于冷也。
热 食入即吐,烦躁,脉数,柴胡汤下主之。(又云∶闻谷气则呕,药下则吐,关脉
洪,亦属于热,宜凉药。)
痰 昔肥今瘦,肠间有声,食与饮并出,宜半夏人参汤。(又云∶痰食脉沉伏,宜吐之。)
食 因胃虚,寒气在上,忧气在下,朝食暮吐不消,宜养胃汤。
血 因瘀蓄,冷血聚于胃口,忧怒气攻,血随食出。宜茯苓汤。
气 胃者阳明,合荣于足,今随气上逆,心膈胀满,呕吐却快,宜人参茱萸。
哕 有二证,胃中虚甚,鬲上热也,陈皮竹茹汤主之。
陈皮 竹茹 人参 甘草
痰则半夏汤主之;
呕而心下痞,半夏泻心汤;
呕吐病在鬲上,猪茯苓汤;
干呕而利者,黄芩半夏汤;
胃反,吐而渴者,茯苓泽泻汤;
呕吐谷不得入者,小半夏汤;
似呕不呕,似哕不哕,无奈,姜汁半夏;
食已则吐者,大黄甘草汤;
先吐却渴,为水停心下,五苓主之;
有伤寒瘥后呕者,当去余热;
有酒呕者,当解酒;
有脚弱脾疼而呕者,根据香港脚治;
有中毒而呕者,解毒治之;
有怀孕恶阻者,从痰治。
有漏气 病则身背热,肘臂挛痛,其气不续,鬲间厌闷,食入则先吐而后
下,名曰漏气。此由上焦伤风开其腠理,经气失道,邪气内着,麦门冬汤主之。
麦门冬 生芦根 葳蕤 竹茹 陈皮 甘草 茯苓 参术
有走哺 病者下焦实热,大小便不通,气逆不续,呕逆不禁,名曰走哺,
人参汤主之。前方内去竹茹、麦门冬,加知母、石膏、黄芩、山枝。
有人恶心吐虫数条后,乃屡作,服杀虫药,吐虫愈多,六脉皆细,此非虫
也,乃藏寒而虫不安矣。
有人呕,饮食皆不进,治呕愈呕,此胃风也。
寒证:因胃寒且伤食,导致四肢厥冷,脉象微弱,适宜使用四逆汤。(另一种说法认为,如果先感觉咽部发酸然后呕吐食物,脉象滑而小,这是由于伤寒后发汗或攻下过多,食物停留过久反而吐出,这也属于寒证。)
热证:食物入口即吐,伴有烦躁,脉象数(快),主要使用柴胡汤治疗。(另一种说法认为,闻到谷物气味就呕吐,服药后则吐出,关脉洪大,这也属于热证,适宜使用凉性药物。)
痰证:过去身体肥胖现在消瘦,肠间有水声,食物和饮水一起吐出,适宜使用半夏人参汤。(另一种说法认为,痰食阻滞导致脉象沉伏,适宜采用催吐法治疗。)
食积证:因胃气虚弱,寒气在上焦,忧思之气在下焦,早晨进食晚上呕吐且不消化,适宜使用养胃汤。
血证:因瘀血蓄积,冷血聚集在胃口处,加上忧怒之气冲击,血液随食物一起吐出。适宜使用茯苓汤。
气证:胃属阳明经,与荣气合于足部,如今气随逆上,导致心膈部位胀满,呕吐后感到爽快,适宜使用人参茱萸汤。
哕证(呃逆):有两种证型,一是胃中极度虚寒,二是膈上有热,主要使用陈皮竹茹汤治疗。
陈皮、竹茹、人参、甘草。
若为痰证,则用半夏汤主治;
呕吐且心下部痞塞,用半夏泻心汤;
呕吐病位在膈以上,用猪苓茯苓汤;
干呕且伴有腹泻,用黄芩半夏汤;
胃反病,呕吐且口渴,用茯苓泽泻汤;
呕吐严重至谷物无法进入,用小半夏汤;
似要呕吐又未吐出,似要呃逆又未呃逆,无可奈何,用姜汁半夏;
进食后即呕吐,用大黄甘草汤;
先呕吐随后口渴,这是水饮停聚在心下,用五苓散主治;
有伤寒病愈后出现呕吐的,应当清除余热;
有饮酒引起的呕吐,应当解酒毒;
有下肢软弱、脾脏疼痛且呕吐的,按照香港脚(脚气病)治疗;
有中毒引起呕吐的,解毒治疗;
有怀孕恶阻(妊娠反应)的,从痰论治。
漏气病:症状为身背发热,肘臂拘挛疼痛,气息不接续,膈间压抑闷痛,食物进入后先呕吐而后下行,名为漏气。这是由于上焦受风邪侵袭,腠理开泄,经气运行失常,邪气内着所致,主要使用麦门冬汤治疗。
麦门冬、生芦根、葳蕤(玉竹)、竹茹、陈皮、甘草、茯苓、人参、白术。
走哺病:患者下焦实热,大小便不通,气逆不接续,呕吐逆乱不止,名为走哺,主要使用人参汤治疗。前方中去掉竹茹、麦门冬,加入知母、石膏、黄芩、山栀子。
Cold Syndrome: Caused by cold in the stomach and food retention, leading to cold extremities and a weak pulse. Si Ni Tang (Four Reversals Decoction) is appropriate. (Another view states that if there is a sensation of sourness in the throat followed by vomiting of food, with a slippery and small pulse, this results from excessive sweating or purgation in Taiyang disease, causing food to remain too long and be vomited; this also belongs to Cold.)
Heat Syndrome: Vomiting immediately after eating, accompanied by irritability and a rapid pulse. Chai Hu Tang (Bupleurum Decoction) is primarily used for treatment. (Another view states that vomiting upon smelling grain odor, and vomiting after taking medicine, with a surging Guan pulse, also belongs to Heat, and cool-natured medicines are appropriate.)
Phlegm Syndrome: The patient was formerly obese but is now emaciated, with sounds in the intestines, and both food and drink are vomited together. Ban Xia Ren Shen Tang (Pinellia and Ginseng Decoction) is appropriate. (Another view states that when phlegm and food obstruction cause a deep and hidden pulse, inducing vomiting is appropriate.)
Food Retention Syndrome: Due to deficiency of Stomach Qi, with Cold Qi above and憂思 (worry/thought) Qi below, morning intake leads to evening vomiting without digestion. Yang Wei Tang (Nourish Stomach Decoction) is appropriate.
Blood Syndrome: Due to blood stasis accumulation, cold blood gathers at the gastric opening, combined with attacks of worry and anger, causing blood to be vomited along with food. Fu Ling Tang (Poria Decoction) is appropriate.
Qi Syndrome: The Stomach belongs to the Yangming channel, combining with Ying Qi (Nutritive Qi) at the feet. Now, Qi rebels upward, causing fullness in the heart and diaphragm, with relief after vomiting. Ren Shen Zhu Yu Tang (Ginseng and Cornus Decoction) is appropriate.
Hiccup Syndrome: There are two syndromes: extreme deficiency-cold in the stomach, and heat above the diaphragm. Chen Pi Zhu Ru Tang (Tangerine Peel and Bamboo Shaving Decoction) is primarily used.
Ingredients: Chen Pi (Citri Reticulatae Pericarpium), Zhu Ru (Bambusae Caulis in Taeniam), Ren Shen (Ginseng Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma).
If it is Phlegm syndrome, Ban Xia Tang (Pinellia Decoction) is primarily used;
For vomiting with epigastric stuffiness, Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) is used;
For vomiting where the pathology is above the diaphragm, Zhu Ling Fu Ling Tang (Polyporus and Poria Decoction) is used;
For dry heaving with diarrhea, Huang Qin Ban Xia Tang (Scutellaria and Pinellia Decoction) is used;
For Wei Fan (Stomantic Reflux) with vomiting and thirst, Fu Ling Ze Xie Tang (Poria and Alisma Decoction) is used;
For severe vomiting where grains cannot enter, Xiao Ban Xia Tang (Minor Pinellia Decoction) is used;
For sensations of wanting to vomit but not doing so, or wanting to hiccup but not doing so, with no way out, Jiang Zhi Ban Xia (Pinellia with Ginger Juice) is used;
For vomiting immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) is used;
For vomiting followed by thirst, indicating water retention in the heart/lower chest, Wu Ling San (Five-Ingredient Powder with Poria) is primarily used;
For vomiting occurring after recovery from Shang Han (Cold Damage), residual heat should be cleared;
For vomiting caused by alcohol, alcohol toxicity should be resolved;
For weakness in the legs, spleen pain, and vomiting, treat according to Jiao Qi (Foot Soreness/Thirsty Disease);
For vomiting caused by poisoning, detoxification treatment is applied;
For E Zu (Morning Sickness/Pregnancy Nausea), treat from the perspective of Phlegm.
Lou Qi (Leaking Qi) Disease: Symptoms include heat in the back and shoulders, spasmodic pain in the elbows and arms, discontinuous breathing, oppression and stuffiness in the diaphragm, and vomiting followed by defecation after eating. This is named Lou Qi. It arises from Wind pathogen injuring the Upper Jiao, opening the Cou Li (pores/skin texture), causing Jing Qi (Meridian Qi) to lose its proper course, and Evil Qi to settle internally. Mai Men Dong Tang (Ophiopogon Decoction) is primarily used.
Ingredients: Mai Men Dong (Ophiopogonis Radix), Sheng Lu Gen (Reed Rhizome), Wei Yu (Polygonati Odorati Rhizoma), Zhu Ru (Bambusae Caulis in Taeniam), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Fu Ling (Poria), Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma).
Zou Bu (Running Breastfeeding/Rebellious Vomiting) Disease: Characterized by excess-heat in the Lower Jiao, blockage of urination and defecation, rebellious Qi failing to continue, and uncontrollable vomiting and regurgitation. This is named Zou Bu. Ren Shen Tang (Ginseng Decoction) is primarily used. In the previous formula, remove Zhu Ru and Mai Men Dong, and add Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), and Shan Zhi Zi (Gardeniae Fructus).
In one case, a person nauseated and vomited several worms, then the condition recurred repeatedly. After taking vermifuge medicines, more worms were vomited, and all six pulses were fine. This was not due to actual parasites, but rather internal organ cold causing the parasites to become restless.
In another case, a person vomited and could not take in any food or drink. Treating the vomiting only worsened it. This is Wei Feng (Wind of the Stomach) syndrome.