阳明胃络从头走。气上逆行须便呕。(呕者胃不和也。胃之络从头走足。今气上行而逆。故呕也。)阳明多呕小柴胡。
(仲景云。伤寒五六日。中风。往来寒热。心烦喜呕。或胸中烦而不呕。小柴胡汤。)胸中有热黄连候。(仲景云。伤寒。
胸中有热。胃中有邪气。腹中痛欲呕吐者。黄连汤主之。第二十五。)水停心下茯苓甘。(发汗吐下后。心下逆。满者。
茯苓甘草汤。又方。心下有水气。干呕者。小青龙汤主之。)先呕后渴五苓救。(仲景云。呕而渴者。五苓散主之。)汗后
余热竹叶汤。(汗后虚烦呕逆者。竹叶汤或橘皮汤。)烦虚栀子豉汤授。(烦虚者。栀子豉汤主之。得吐勿服。余者呕而有
脓者。不可治呕。脓尽乃愈。)又有少阴呕证存。真武汤中加减否。(仲景云。少阴病。二三日不已。至四五日。腹痛。
小便不利。四肢沉重。疼痛而利。此为有水气。其人或咳。或小便自利。或下利。或呕者。玄武汤主之。论中有加减之
法。)
吐有冷热两证异。内脉外形当仔细。(吐有胃冷。有胃热者。当以内脉外形辨之。)烦渴脉数手心热。此是胃热之所
致。(孙尚云。脉来数。手心热。烦渴者。胃热也。竹茹汤证。)曾经汗下关脉迟。胃中虚冷理中治。(肝脉迟。胃虚也。
理中丸及汤主之。)膈上寒痰四逆汤。(仲景云。若膈上有寒。欲干呕者。不可吐。当温之。宜四逆汤。)汗后虚烦竹叶已。
(汗后虚烦呕吐者。竹叶并橘皮汤证。)少阴欲吐复不吐。必竟吐之当审记。(仲景云。少阴病。其人饮食入。则心中温
温欲吐。复不得吐。始得之。手足寒。脉弦迟。此胃中实也。不可下。当吐之。)
阳明经的胃络从头部走向足部。如果气机上逆,就必须出现呕吐。(呕吐是因为胃气不和。胃的络脉从头部走向足部。现在气机向上逆行,所以发生呕吐。)阳明病多伴有呕吐,可用小柴胡汤治疗。(张仲景说:伤寒五六天,中风,寒热往来,心烦且喜欢呕吐。或者胸中烦闷但不呕吐,用小柴胡汤。)胸中有热证候,用黄连汤主治。(张仲景说:伤寒,胸中有热,胃中有邪气,腹中疼痛想要呕吐的,用黄连汤主治。见第二十五证。)水饮停聚在心下,用茯苓甘草汤治疗。(发汗、催吐、泻下之后,心下逆满的,用茯苓甘草汤。又方:心下有 water qi(水气),干呕的,用小青龙汤主治。)先呕吐后口渴,用五苓散救治。(张仲景说:呕吐且口渴的,用五苓散主治。)发汗后余热未清导致的虚烦呕吐,用竹叶汤治疗。(发汗后虚烦呕吐的,用竹叶汤或橘皮汤。)虚烦证由栀子豉汤传授(主治)。(虚烦者,用栀子豉汤主治。如果服药后呕吐,不要服用;其余情况是呕吐且有脓液的,不可止呕,待脓液排尽自然痊愈。)还有少阴病的呕吐证候存在,真武汤中加减使用。(张仲景说:少阴病,两三天不好转,到四五日,腹痛,小便不利,四肢沉重疼痛并伴有腹泻。这是有水气。其人如果有咳嗽,或小便利,或腹泻,或呕吐的,用玄武汤(即真武汤)主治。论中有加减的方法。)
呕吐有冷证和热证两种不同表现。内在脉象和外在症状应当仔细辨别。(呕吐有胃冷,有胃热的,应当通过内在脉象和外在症状来辨别。)心烦口渴、脉数、手心发热,这是胃热所致。(孙尚说:脉来快速,手心发热,心烦口渴的,是胃热。对应竹茹汤证。)曾经经过发汗或泻下,关脉迟,这是胃中虚冷,用理中汤治疗。(肝脉迟,表示胃虚。用理中丸及理中汤主治。)膈上有寒痰,用四逆汤。(张仲景说:如果膈上有寒,想要干呕的,不可催吐,应当温阳,适宜用四逆汤。)发汗后虚烦呕吐,用竹叶汤治愈。(发汗后虚烦呕吐的,是竹叶汤和橘皮汤的证候。)少阴病想吐却又吐不出来,最终必须吐出,应当审慎记住。(张仲景说:少阴病,病人饮食入口,则心中温温欲吐,但又吐不出来。刚得病时,手足寒冷,脉弦迟,这是胃中有实邪。不可攻下,应当催吐。)
The stomach collateral of the Yangming channel runs from the head to the foot. If Qi rebels upward, vomiting must occur. (Vomiting is due to disharmony of the Stomach Qi. The Stomach's collateral runs from the head to the foot. Now that Qi rebels upward, vomiting occurs.) Vomiting is common in Yangming disease; Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be used. (Zhang Zhongjing stated: In Shanghan (Cold Damage) for five or six days, with Fengzhong (Wind Strike), there is alternating chills and fever, mental irritability, and a tendency to vomit. Or if there is mental irritability in the chest without vomiting, Xiao Chai Hu Tang is indicated.) For heat in the chest, Huang Lian Tang (Coptis Decoction) is the primary treatment. (Zhang Zhongjing stated: In Shanghan, with heat in the chest and pathogenic factors in the Stomach, accompanied by abdominal pain and a desire to vomit, Huang Lian Tang is the main formula. See Proof 25.) When fluid retention occurs below the heart, Fu Ling Gan Cao Tang (Poria and Licorice Decoction) is used. (After sweating, emesis, or purging, if there is rebellious fullness below the heart, Fu Ling Gan Cao Tang is indicated. Another prescription: If there is fluid-Qi below the heart causing dry retching, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the main treatment.) If vomiting precedes thirst, Wu Ling San (Five-Ingredient Powder with Poria) provides rescue. (Zhang Zhongjing stated: If there is vomiting accompanied by thirst, Wu Ling San is the main treatment.) For residual heat after sweating causing deficiency irritability and vomiting, Zhu Ye Tang (Bamboo Leaf Decoction) is used. (For deficiency irritability and vomiting after sweating, Zhu Ye Tang or Ju Pi Tang (Tangerine Peel Decoction) are indicated.) Deficiency irritability is treated with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). (For deficiency irritability, Zhi Zi Chi Tang is the main treatment. If vomiting occurs after taking it, do not administer further; in other cases where vomiting involves pus, stopping vomiting is contraindicated; healing occurs naturally once the pus is exhausted.) There also exists the vomiting syndrome of Shaoyin disease, which can be managed with modifications of Zhen Wu Tang (True Warrior Decoction). (Zhang Zhongjing stated: In Shaoyin disease, if it persists for two or three days and progresses to four or five days, with abdominal pain, difficulty in urination, heavy and painful limbs, and diarrhea, this indicates the presence of fluid-Qi. If the patient has cough, free urination, diarrhea, or vomiting, Xuan Wu Tang (another name for Zhen Wu Tang) is the main treatment. The treatise contains methods for modification.)
Vomiting presents as either cold or heat syndromes, differing in nature. Internal pulse and external symptoms should be carefully distinguished. (Vomiting can stem from Cold Stomach or Heat Stomach; differentiation should be made based on internal pulse and external manifestations.) Mental irritability, thirst, rapid pulse, and heat in the palms indicate that this is caused by Stomach Heat. (Sun Shang stated: A rapid pulse, heat in the palms, mental irritability, and thirst indicate Stomach Heat. This corresponds to the indication for Zhu Ru Tang (Bamboo Shavings Decoction).) If the Guan pulse is slow following previous sweating or purging, it indicates deficiency-cold in the Stomach, treated with Li Zhong Tang (Regulate the Middle Decoction). (A slow Liver pulse indicates Stomach deficiency. Li Zhong Wan (Pill) and Li Zhong Tang are the main treatments.) For cold-phlegm above the diaphragm, Si Ni Tang (Frigid Extremities Decoction) is used. (Zhang Zhongjing stated: If there is cold above the diaphragm causing a desire for dry retching, emesis is contraindicated; warming is required, and Si Ni Tang is appropriate.) For deficiency irritability and vomiting after sweating, Zhu Ye Tang brings cure. (Deficiency irritability and vomiting after sweating correspond to the indications for Zhu Ye Tang and Ju Pi Tang.) In Shaoyin disease, if one desires to vomit but cannot, eventually vomiting must occur; this must be remembered with caution. (Zhang Zhongjing stated: In Shaoyin disease, when food enters the mouth, the person feels warm and nauseous, desiring to vomit but unable to do so. At the onset, with cold hands and feet and a wiry-slow pulse, this indicates excess in the Stomach. Purging is contraindicated; emesis is indicated.)