【纲】仲景曰。伤寒一日。太阳受之。脉若静者为不传。颇欲吐。若躁烦。脉数急者。为传也。
【目】张云岐曰。呕。有声者也。俗谓之 。吐。吐出其物也。故有干呕而无干吐。是以于呕。
则曰食谷欲呕。于吐。则曰饮食入口即吐。则呕吐之有轻重。可知矣。伤寒之呕。有责于热者。
有责于寒者。至于吐。则悉言虚冷。经曰。太阴病。腹满而吐。食不下。自利益甚。时腹自痛。又
曰。胃中虚冷。故吐。可见其概矣。
鳌按。此言寒邪初感。太阳先受第一日也。初受之日。已有吐意。已伏呕逆之机。故兼有烦躁
之症。急数之脉也。将者将然未然之词。
【纲】仲景曰。太阳病。或已发热。或未发热。必恶寒。体痛呕逆。脉阴阳俱紧者。名曰伤寒。
【目】王履曰。呕家之为病。气逆者必散之。痰饮者必下之。千金曰。呕家多服生姜。此是呕
家圣药。是要散其逆气也。
金匮又曰。呕家用半夏以去其水。水去呕则止。是要下其痰饮也。呕多虽有阳明症不可下者。
谓其气逆而未收敛为实也。其呕而脉弱。小便复利。身有微热见厥者。为难治。谓其虚寒之甚也。
宠安常曰。虽有已发未发之分。而症有恶寒体痛呕吐。脉有阴阳俱紧。便可断为太阳伤寒而非
中风也。其体痛者。由寒邪外束也。其呕逆者。寒邪内侵也。
【纲】仲景曰。伤寒六七日。发热微恶寒。肢节烦疼。微呕。心下支结。外症未去者。柴胡桂
枝汤主之。
【目】鳌按。此是内外症俱微。将解未去之候也。故曰微恶寒。见寒之轻。曰肢节烦疼。见非
身腰疼痛。曰微呕。见喜呕之兆。曰支结。见非痞满。只发热而烦。为热多耳。故制此轻剂和解之。
【纲】仲景曰。酒客病。不可与桂枝汤。得汤则呕。以酒客不喜甘故也。凡服桂枝汤吐者。其后必吐脓血也。
【目】魏荔彤曰。酒客脉浮汗自出。似风伤卫。实非风伤卫。然酒客汗自出。脉数而大则有之。
未必浮也。浮则为风伤卫矣。况酒客焉有恶风一症。是虽发热汗出。酒客之常。并无恶风。必伤
风而后恶风。自以酒客伤风为正义也。所以用桂枝汤。必斟酌方效也。湿热家或中风。脉虽浮。必
兼濡涩而带数。于脉可以知其热也。虽头项强痛。必兼身重。骨节烦疼。掣痛不可屈伸。近之则痛
剧。虽汗出。必兼短气。虽恶风。必兼小便不利。于此症可以知其湿也。辨之既明。何至必于吐后。
始知其误服桂枝哉。则湿热之中风。用桂枝之内。必佐以五苓之治法矣。
鳌按。酒客必有湿热。故得甘必吐。不可与桂枝。柯韵伯谓当用葛根芩连解肌之法是也。次条。
乃由酒客推展言之。见一切湿壅于中热淫于内者。俱禁用桂枝。或使湿热涌越。有伤阳络。以致
吐脓血也。旧本俱将脓血条叙在酒客条上。恐义不圆。
【纲】仲景曰。病患有寒。复发汗。胃中冷。必吐蛔。
【目】柯琴曰。有寒。未病时原有寒也。内寒之人。复感外邪。当温中以逐寒。若发其汗。汗
生于谷。谷气外散。胃脘阳虚。无谷气以养其蛔。故蛔动而上从口出也。蛔多。不止者死。吐蛔。
不能食者亦死。
鳌按。韵伯此论。即非伤寒。凡胃虚蛔动者无不然。
【纲】仲景曰。太阳与阳明合病。不下利。但呕者。葛根加半夏汤主之。
【目】柯琴曰。太阳阳明合病。太阳少阳合病。阳明少阳合病。必自下利。则下利似乎合病当
然之症。今不利而呕。又似乎与少阳合病。葛根汤加半夏。兼解少阳半里之邪。便不得为三阳合病。
【纲】仲景曰。伤寒表不解。心下有水气。干呕发热而咳。或渴。或利。或噎。或小便不利少
腹满。或喘者。小青龙汤主之。
【目】李中梓曰。呕者声物俱出。吐者无声出物。哕者有声无物。
鳌按。此条干呕。是水气为患。水气未入于胃。故干呕。
【纲】仲景曰。太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。发作有时。头痛。
心下痞。硬满。引胁下痛。干呕短气。汗出不恶寒者。此表解里未和也。十枣汤主之。
【目】庞安常曰。按此条及干姜附子渴症。不呕不渴。为里无热。可知呕为里热明矣。
鳌按。曰呕逆。曰干呕。细玩通节语气。总以见表之风邪已解。而里之水气不和。
【纲】仲景曰。伤寒汗出解之后。胃中不和。心下痞硬。干呕食臭。胁下有水气。腹中雷鸣。
下利者。生姜泻心汤主之。
【目】柯琴曰。阳邪居胃之上口。故心下痞硬。干呕而食臭。水邪居胃之下口。故腹中雷鸣而
下利。火用不宣则痞硬。水用不宣则干呕。邪热不杀谷则食臭。土虚不能制水故肠鸣。
【纲】仲景曰。太阳病。二日。烦躁。反熨其背。而大汗出。大热入胃。胃中水竭。烦躁。必
发谵语。十余日。振栗。自下利者。此为欲解也。故其汗从腰以下不得汗。欲小便不得。反呕。欲
失溲。足下恶风。大便硬。小盒饭数而反不数。及多。大便已。头卓然而痛。其人足心必热。谷气
下流故也。
【目】楼英曰。此火逆之轻症也。欲小便不得而反呕。欲失溲。此非无小便也。其津液在上焦。
欲还入胃口故也。
【纲】仲景曰。发汗后。水液不得入口。为逆。若更发汗。必吐不止。
【目】柯琴曰。阳重之人。大发其汗。有升无降。故水药拒隔而不得入。若认为中风干呕。伤
寒呕逆。而更汗之。则吐不止。胃气大伤矣。此热在胃口。须用栀子汤。
【纲】仲景曰。中风发热。六七日不解而烦。有表里症。渴欲饮水。水入则吐者。名曰水逆。
五苓散主之。多服暖水。汗出愈。
【目】赵献可曰。水入则吐者。心下有水气。因离中之真水不足。则膻中之火用不宣。邪水凝
结于内。水饮拒绝于外。既不能外输于元府。又不能上输于口舌。亦不能下输于膀胱。此水逆所由
名也。
【纲】仲景曰。伤寒本自汗下。医复吐下之。寒格。若食入口即吐。干姜黄连黄芩人参汤主之。
【目】柯琴曰。治之小误。变症亦轻。故制方用泻心之半。上焦寒格。故用姜、参。心下蓄热。
故用芩、连。呕家不喜甘。故去甘草。不食则不吐。是心下无水气。故不用姜、夏。要知寒热相
阻。则为格症。寒热相结。则为痞症。
【纲】张仲景说：伤寒病第一天，太阳经受邪。如果脉象平静，说明病邪没有传变；如果病人很想呕吐，或者出现烦躁不安、脉搏快而急促的情况，说明病邪已经传变。
【目】张云岐说：呕，是有声音的呕吐；俗称为“哕”。吐，是将胃中之物吐出。所以有干呕而没有干吐。因此，对于呕，我们说“进食后想呕吐”；对于吐，我们说“饮食入口即吐出”。由此可见，呕吐有轻重之分。伤寒引起的呕，有的责之于热邪，有的责之于寒邪。至于吐，则全是因为虚冷。医经说：“太阴病，腹部胀满且呕吐，不能进食，腹泻日益严重，时常腹部自痛。”又说：“胃中虚冷，所以发生呕吐。”由此可以概见其大概了。
沈金鳌按语：这里说的是寒邪初感，第一天太阳先受邪。在初受邪的日子，已有呕吐之意，已潜伏了呕逆的病机，所以兼有烦躁的症状和急数的脉象。“将”字是将然、未然的词义。
【纲】张仲景说：太阳病，有的已经发热，有的尚未发热，但必定恶寒，身体疼痛，呕吐逆气，寸关尺三部脉都紧的，名叫伤寒。
【目】王履说：患呕病的人，气逆者必须用散法治疗；有痰饮者必须用下法治疗。《千金方》说：患呕病的人多服用生姜，这是治呕的圣药，目的是要疏散其逆气。
《金匮要略》又说：患呕病的人用半夏来去除水饮，水饮去除了呕吐就会停止，目的是要下行其痰饮。呕吐很多，即使有阳明病的症状，也不可攻下，是说其气逆而未收敛成实邪。那些呕吐且脉弱，小便反而通利，身体有微热并出现四肢厥冷的，属于难治之症，说是因为虚寒非常严重。
庞安常说：虽然有已发热和未发热的区别，但有恶寒、身体疼痛、呕吐等症状，脉象阴阳俱紧，就可以断定为太阳伤寒而不是中风。其身体疼痛，是由于寒邪外束所致；其呕吐逆气，是寒邪内侵所致。
【纲】张仲景说：伤寒六七天，发热轻微恶寒，肢体关节烦疼，轻微呕吐，心下部支撑结聚，外部症状尚未解除的，用柴胡桂枝汤主治。
【目】沈金鳌按语：这是内外症状都轻微，将要解除但尚未完全去除的征候。所以说“微恶寒”，显示寒气轻；说“肢节烦疼”，显示不是身腰疼痛；说“微呕”，显示喜呕的征兆；说“支结”，显示不是痞满，只是发热而烦，是热多罢了。所以制定这种轻剂来和解表里。
【纲】张仲景说：嗜酒之人患病，不可给予桂枝汤，喝了汤就会呕吐，因为嗜酒之人不喜欢甘味。凡是服用桂枝汤后呕吐的，其后必然会出现吐脓血的症状。
【目】魏荔彤说：嗜酒之人脉浮、汗自出，看似风邪伤卫分，实际上并非风邪伤卫。然而嗜酒之人确实会有汗自出、脉数而大的情况，未必脉浮。如果脉浮，才是风邪伤卫。况且嗜酒之人哪里有恶风这一症状？虽然发热汗出是嗜酒之人的常态，并没有恶风，一定是受了风邪之后才恶风，这应当以嗜酒之人伤风为正理。所以使用桂枝汤，必须斟酌得当才能见效。湿热体质的人如果中风，脉虽浮，必兼濡涩而带数，从脉象可以知道有热。虽然头项强痛，必兼身体沉重，骨节烦疼，牵引疼痛不可屈伸，靠近则疼痛加剧。虽然汗出，必兼短气。虽然恶风，必兼小便不利。从这些症状可以知道有湿。辨证既已明确，何至于一定要在呕吐之后，才知道误服了桂枝呢？那么湿热之中风，在使用桂枝汤之内，必须佐以五苓散的治法。
沈金鳌按语：嗜酒之人必有湿热，所以遇到甘味必然呕吐，不可给予桂枝汤。柯韵伯认为应当用葛根芩连汤解肌的方法，是正确的。第二条，是由嗜酒之人推展而言，说明一切湿邪壅滞于中、热邪淫溢于内的情况，都禁用桂枝汤，否则会使湿热涌越，损伤阳络，以致吐脓血。旧版本都将吐脓血的条文叙述在嗜酒之人的条文之上，恐怕文义不圆满。
【纲】张仲景说：病人原有寒证，医生又复发汗，导致胃中寒冷，必然吐出蛔虫。
【目】柯琴说：有寒，是指未生病时原本就有寒证。内有寒邪的人，又感受外邪，应当温中焦以驱逐寒邪。如果发汗，汗生于谷气，谷气向外发散，胃脘阳气虚弱，没有谷气来供养蛔虫，所以蛔虫躁动而上行从口吐出。蛔虫多，不止息的会死；吐出蛔虫，不能进食的也会死。
沈金鳌按语：柯韵伯的这个论述，即使不是伤寒，凡是胃虚导致蛔虫动的情况，没有不是这样的。
【纲】张仲景说：太阳与阳明合病，不下利，只呕吐的，用葛根加半夏汤主治。
【目】柯琴说：太阳阳明合病，太阳少阳合病，阳明少阳合病，必然自下利，所以下利似乎是合病应有的症状。现在不下利而呕吐，又似乎与少阳合病。葛根汤加半夏，兼解少阳半里的邪气，便不得称为三阳合病。
【纲】张仲景说：伤寒表证不解，心下有停饮，干呕、发热而咳嗽，或者口渴，或者下利，或者噎塞，或者小便不利、小腹胀满，或者喘息的，用小青龙汤主治。
【目】李中梓说：呕，是声音和物体一起出来；吐，是没有声音只有物体出来；哕（呃逆），是有声音没有物体出来。
沈金鳌按语：这条文中的干呕，是水气为患。水气尚未进入胃中，所以表现为干呕。
【纲】张仲景说：太阳中风，伴有下利、呕吐逆气，表证已解的，才可以攻下。其人濈然汗出，发作有时，头痛，心下痞硬，牵引胁下疼痛，干呕、短气，汗出且不恶寒的，这是表证已解、里气未和的表现，用十枣汤主治。
【目】庞安常说：按此条及干姜附子汤证的渴症，如果不呕不渴，说明里没有热，由此可知呕吐是因为里有热，这是很明显的。
沈金鳌按语：文中说“呕逆”，说“干呕”，仔细玩味整段语气，总归是表明风邪已解，而里部的水气不和。
【纲】张仲景说：伤寒发汗后，表证已解，但胃中不和，心下痞硬，干呕，食物气味臭秽，胁下有停饮，腹中雷鸣般作响，下利的，用生姜泻心汤主治。
【目】柯琴说：阳邪停留在胃的上口，所以心下痞硬，干呕且有食臭味。水邪停留在胃的下口，所以腹中雷鸣而下利。火的功能不宣通则导致痞硬，水的功能不宣通则导致干呕，邪热不能腐熟水谷则产生食臭味，土气虚弱不能制水所以肠鸣。
【纲】张仲景说：太阳病第二天，出现烦躁，反而用熨背的方法发汗，导致大汗出，大热入胃，胃中津液枯竭，烦躁，必然出现谵语。过了十余天，出现振栗，自下利的，这是将要解除病邪的表现。所以他的汗从腰部以下不得出，想小便却解不出，反而呕吐，想失禁小便，脚底怕风，大便硬，小便频数却次数不多，等到小便量多，大便排出后，头部突然感到疼痛，这个人的脚心必然发热，这是因为谷气向下流通的缘故。
【目】楼英说：这是火逆的轻症。想小便却解不出而反呕吐，想失禁小便，这并不是没有小便，而是津液在上焦，想要回流到胃口处的缘故。
【纲】张仲景说：发汗后，水液无法入口，这是逆证。如果再次发汗，必然呕吐不止。
【目】柯琴说：阳盛之人，大发其汗，只有升发没有降敛，所以水药被拒隔而无法进入。如果认为是中风干呕、伤寒呕逆，而再次发汗，则呕吐不止，胃气大伤。这是热在胃口处，须用栀子汤治疗。
【纲】张仲景说：中风发热，六七天未解且烦躁，有表里症状，口渴想喝水，水喝进去就吐出的，名叫水逆，用五苓散主治。多喝暖水，出汗后即可痊愈。
【目】赵献可说：水喝进去就吐出的，是因为心下有停饮，由于离中真水不足，导致膻中火的功能不宣，邪水凝结于内，水饮拒绝于外，既不能外输于毛孔，又不能上输于口舌，也不能下输于膀胱，这就是水逆命名的由来。
【纲】张仲景说：伤寒本来就有自汗或下利，医生又错误地使用了吐法或下法，导致寒热格拒，如果食物入口即吐出的，用干姜黄连黄芩人参汤主治。
【目】柯琴说：治疗的小失误，变证也较轻，所以制方用了一半泻心汤的意思。上焦寒格，所以用干姜、人参；心下蓄热，所以用黄芩、黄连。患呕病的人不喜欢甘味，所以去掉甘草。不吃东西就不呕吐，说明心下无水气，所以不用干姜、半夏。要知道寒热相互阻隔，就形成格证；寒热相互结聚，就形成痞证。
[Outline] Zhang Zhongjing said: On the first day of Shanghan (Cold Damage), the Taiyang channel is affected. If the pulse remains calm, it indicates that the pathogen has not transmitted. If the patient feels a strong urge to vomit, or exhibits restlessness and irritability with a rapid and urgent pulse, it indicates that the pathogen has transmitted.
[Commentary] Zhang Yunqi said: Ou (vomiting with sound) refers to vomiting accompanied by sound; colloquially called "yue". Tu (spitting out/vomiting without sound) refers to expelling the contents of the stomach. Therefore, there is Gan Ou (dry heaving) but no Gan Tu (dry spitting). Thus, for Ou, we say "urge to vomit after eating"; for Tu, we say "food and drink are vomited immediately upon entering the mouth". This shows that Ou and Tu have differences in severity. The Ou caused by Shanghan may be attributed to Heat or Cold. As for Tu, it is entirely due to Deficiency-Cold. The Classics state: "In Taiyin disease, abdominal fullness with vomiting, inability to eat, worsening diarrhea, and spontaneous abdominal pain." It also states: "Deficiency-Cold in the Stomach causes vomiting." From this, the general principle can be understood.
Shen Jin'ao's Note: This passage discusses the initial invasion of Cold pathogen, affecting the Taiyang channel on the first day. On the day of initial invasion, the intention to vomit is already present, indicating a latent mechanism for vomiting and reflux, hence accompanied by symptoms of restlessness and an urgent, rapid pulse. The character "Jiang" (will/soon) implies a state of being about to happen but not yet happened.
[Outline] Zhang Zhongjing said: In Taiyang disease, whether fever has already appeared or not, aversion to cold is inevitable. With body pain, vomiting and reflux, and a tight pulse at both Yin (Cun/Ren) and Yang (Chi) positions, it is named Shanghan (Cold Damage).
[Commentary] Wang Lü said: For patients suffering from vomiting, if the condition is due to rebellious Qi, it must be treated with dispersing methods; if due to Phlegm-Fluids, it must be treated with purging methods. The *Qianjin Fang* states: Patients with vomiting should frequently consume Sheng Jiang (Fresh Ginger Rhizome); this is the sacred medicine for vomiting, intended to disperse rebellious Qi.
The *Jin Gui Yao Lue* further states: Use Ban Xia (Pinellia Tuber) to eliminate Fluids in vomiting patients; once the Fluids are eliminated, vomiting stops. This aims to purge Phlegm-Fluids downward. If vomiting is frequent, even if Yangming syndrome symptoms are present, purgation is contraindicated because the Qi is rebellious and has not yet consolidated into Excess. If vomiting is accompanied by a weak pulse, free urination, slight body heat, and cold extremities, it is difficult to treat, indicating severe Deficiency-Cold.
Pang Anchang said: Although there is a distinction between fever having appeared or not, the presence of aversion to cold, body pain, vomiting, and a tight pulse at both Yin and Yang positions allows one to diagnose Taiyang Shanghan rather than Feng Shang (Wind Strike). Body pain is caused by Cold pathogen binding externally; vomiting and reflux are caused by Cold pathogen invading internally.
[Outline] Zhang Zhongjing said: After six or seven days of Shanghan, with slight fever and aversion to cold, vexing pain in the limbs and joints, slight vomiting, subcostal support and accumulation (Zhi Jie), and unresolving exterior symptoms, Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is the primary treatment.
[Commentary] Shen Jin'ao's Note: This represents a state where interior and exterior symptoms are both mild, indicating the pathogen is about to resolve but has not yet left. Hence, "slight aversion to cold" indicates mild Cold; "vexing pain in limbs/joints" indicates it is not back/waist pain; "slight vomiting" indicates the sign of frequent vomiting; "Zhi Jie" indicates it is not Pi Man (epigastric fullness/stuffiness), but rather heat predominance causing fever and vexation. Therefore, a mild formula is formulated to harmonize the interior and exterior.
[Outline] Zhang Zhongjing said: In patients habitually consuming alcohol, Gui Zhi Tang (Cinnamon Twig Decoction) is contraindicated. Taking it will cause vomiting because alcohol-consumers dislike Sweet flavors. Anyone who vomits after taking Gui Zhi Tang will subsequently vomit pus and blood.
[Commentary] Wei Litong said: Alcohol-consumers presenting with floating pulse and spontaneous sweating resemble Wind damaging the Ying-Wei defense, but it is not actually Wind damaging the Wei. However, alcohol-consumers do exhibit spontaneous sweating and a rapid, large pulse, though not necessarily floating. A floating pulse indicates Wind damaging the Wei. Moreover, alcohol-consumers lack the symptom of aversion to wind. While fever and sweating are common in alcohol-consumers, aversion to wind only occurs after contracting Wind. Thus, Wind strike in alcohol-consumers should be considered the standard case. Therefore, when using Gui Zhi Tang, careful consideration is required for efficacy. If a person with Damp-Heat contracts Wind, although the pulse may be floating, it will likely be soggy and choppy with rapidness, indicating Heat. Although there is stiffness and pain in the head and neck, it will be accompanied by heavy body, vexing pain in bone joints, pulling pain making flexion/extension impossible, and worsened pain upon touch. Although sweating occurs, shortness of breath accompanies it. Although aversion to wind exists, difficulty in urination accompanies it. These symptoms indicate Dampness. Once differentiation is clear, why wait until vomiting to realize the error of taking Gui Zhi Tang? Thus, for Wind strike in Damp-Heat constitutions, Wuling San (Five-Ingredient Poria Powder) methods should be added to Gui Zhi Tang.
Shen Jin'ao's Note: Alcohol-consumers inevitably have Damp-Heat; thus, they vomit upon encountering Sweet flavors, and Gui Zhi Tang is contraindicated. Ke Yunbo suggested using Ge Gen Qin Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) to release the muscle layer, which is correct. The second clause extends from alcohol-consumers to illustrate that all cases of Dampness obstructing the Interior and Heat flooding the Interior strictly prohibit Gui Zhi Tang. Otherwise, Damp-Heat may surge upward, damaging the Yang collaterals, leading to vomiting pus and blood. Old editions placed the clause on vomiting pus and blood before the alcohol-consumer clause, which may lack logical coherence.
[Outline] Zhang Zhongjing said: If a patient with existing Cold syndrome undergoes diaphoresis again, causing Cold in the Stomach, they will inevitably vomit Ascaris (roundworms).
[Commentary] Ke Qin said: "Existing Cold" means the patient had Cold prior to illness. In individuals with Internal Cold who contract external pathogens, the Middle Jiao should be warmed to expel Cold. If diaphoresis is induced, sweat is generated from Grain Qi; as Grain Qi scatters outward, the Yang Qi of the Stomach epigastrium becomes deficient. Without Grain Qi to nourish the Ascaris, they become agitated and move upward, exiting through the mouth. If many Ascaris are vomited and do not stop, death ensues. If Ascaris are vomited and the patient cannot eat, death also ensues.
Shen Jin'ao's Note: Ke Yunbo's argument applies not only to Shanghan but to any condition where Stomach Deficiency causes Ascaris agitation.
[Outline] Zhang Zhongjing said: In concurrent diseases of Taiyang and Yangming, if there is no diarrhea but only vomiting, Ge Gen Jia Ban Xia Tang (Kudzu Decoction with Added Pinellia) is the primary treatment.
[Commentary] Ke Qin said: Concurrent diseases of Taiyang-Yangming, Taiyang-Shaoyang, and Yangming-Shaoyang typically present with spontaneous diarrhea; thus, diarrhea seems inherent to concurrent diseases. Now, without diarrhea but with vomiting, it resembles Shaoyang concurrent disease. Ge Gen Tang with Ban Xia simultaneously resolves the semi-interior pathogen of Shaoyang, so it cannot be classified as concurrent disease of the Three Yang channels.
[Outline] Zhang Zhongjing said: In Shanghan, if the Exterior is unresolved and there is Fluid retention in the Heart (Epigastrium), presenting with dry heaving, fever, and cough, or alternatively thirst, diarrhea, dysphagia/choking sensation, difficulty in urination with hypogastric fullness, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary treatment.
[Commentary] Li Zhongzi said: Ou (vomiting with sound) involves both sound and matter; Tu (spitting out) involves matter without sound; Yue (hiccups/belching) involves sound without matter.
Shen Jin'ao's Note: The dry heaving in this clause is caused by Fluid retention. Since the Fluids have not entered the Stomach, it presents as dry heaving.
[Outline] Zhang Zhongjing said: In Taiyang Wind Strike with diarrhea and vomiting/reflux, if the Exterior is resolved, purgation may proceed. If the patient has continuous sweating occurring at intervals, headache, epigastric stuffiness and hardness, pain radiating to the hypochondrium, dry heaving, shortness of breath, sweating without aversion to cold, this indicates the Exterior is resolved but the Interior is disharmonious. Shi Zao Tang (Ten Date Powder) is the primary treatment.
[Commentary] Pang Anchang said: Regarding this clause and the thirst in Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction) cases, the absence of vomiting and thirst indicates no Heat in the Interior. Therefore, the presence of vomiting clearly indicates Heat in the Interior.
Shen Jin'ao's Note: The text mentions "vomiting/reflux" and "dry heaving." Carefully analyzing the tone throughout, it ultimately indicates that the Wind pathogen of the Exterior has resolved, while the Fluids in the Interior are disharmonious.
[Outline] Zhang Zhongjing said: After Shanghan is resolved by sweating, if the Stomach is disharmonious, presenting with epigastric stuffiness and hardness, dry heaving, foul food odor, Fluid retention under the costal region, borborygmus (rumbling in abdomen), and diarrhea, Sheng Jiang Xie Xin Tang (Fresh Ginger Drain the Epigastrium Decoction) is the primary treatment.
[Commentary] Ke Qin said: Yang pathogens residing at the upper opening of the Stomach cause epigastric stuffiness and hardness, dry heaving, and food odor. Water pathogens residing at the lower opening of the Stomach cause borborygmus and diarrhea. Failure of Fire function to circulate leads to stuffiness and hardness; failure of Water function to circulate leads to dry heaving. Pathogenic Heat failing to digest food leads to food odor; Spleen Earth deficiency failing to control Water leads to intestinal rumbling.
[Outline] Zhang Zhongjing said: In Taiyang disease on the second day, if restlessness appears and the back is mistakenly moxibusted/heated to induce profuse sweating, great Heat enters the Stomach, depleting Stomach fluids. Restlessness will lead to delirious speech. After more than ten days, if chills and shaking occur followed by spontaneous diarrhea, this indicates the disease is about to resolve. Consequently, sweating may not occur below the waist, the urge to urinate may be present but unsuccessful, vomiting may occur instead, urge to lose stool may arise, feet may feel aversive to wind, stools may become hard, urination frequency may increase but volume small, and finally, when urine volume increases and stool passes, sudden head pain may occur, and the soles of the feet will feel hot. This is because Grain Qi flows downward.
[Commentary] Lou Ying said: This is a mild case of Fire Reversal. The urge to urinate fails accompanied by vomiting, and the urge to lose stool arises; this does not mean there is no urine, but rather that Body Fluids are in the Upper Jiao and attempting to return to the Stomach area.
[Outline] Zhang Zhongjing said: After inducing sweating, if fluids cannot enter the mouth, it is a reversal pattern. If sweating is induced again, vomiting will not cease.
[Commentary] Ke Qin said: In individuals with excessive Yang, excessive sweating leads to ascending without descending, causing rejection of water and medicine. If mistaken for Wind Strike dry heaving or Shanghan vomiting/reflux and sweating is induced again, vomiting will persist, severely damaging Stomach Qi. This indicates Heat at the Stomach opening, requiring Zhi Zi Tang (Gardenia Decoction).
[Outline] Zhang Zhongjing said: In Wind Strike with fever, if unresolved after six or seven days with restlessness, presenting with Exterior and Interior symptoms, thirst wanting to drink, and vomiting immediately after drinking water, it is named Shui Ni (Water Reversal). Wu Ling San (Five-Ingredient Powder with Poria) is the primary treatment. Drinking plenty of warm water induces sweating and cures the disease.
[Commentary] Zhao Xianke said: Vomiting immediately after drinking water is due to Fluid retention in the Heart (Epigastrium). Due to insufficiency of True Water in the Li (Heart/Fire), the Fire function in Dan Zhong (Chest) fails to circulate. Evil Water condenses internally, rejecting external fluids. It cannot transport outward to the pores, upward to the mouth/tongue, or downward to the Bladder. This is the origin of the name "Water Reversal."
[Outline] Zhang Zhongjing said: In Shanghan originally presenting with spontaneous sweating or diarrhea, if the physician erroneously uses emesis or purgation, causing Cold-Heat Gridlock, where food is vomited immediately upon entering the mouth, Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) is the primary treatment.
[Commentary] Ke Qin said: A minor treatment error results in mild transformation. The formula uses half the principles of Xie Xin Tang (Drain the Epigastrium Decoction). For Cold Gridlock in the Upper Jiao, Gan Jiang (Dried Ginger) and Ren Shen (Ginseng) are used; for Heat accumulation in the Heart (Epigastrium), Huang Qin (Scutellaria Root) and Huang Lian (Coptis Rhizome) are used. Vomiting patients dislike Sweet flavors, so Gan Cao (Licorice Root) is removed. No vomiting without eating indicates no Fluid retention in the Heart, so Gan Jiang and Ban Xia are omitted. One must know that Cold and Heat blocking each other forms a Ge (Gridlock) syndrome; Cold and Heat knotting together forms a Pi (Stuffiness) syndrome.