钱仲阳曰∶寒吐者,由乳母当风取凉,或风寒客于乳房,其症面目胀,额汗出,脉沉迟微,
寒气停于胃,故胃不纳而吐出也。哕逆者,由胃气虚甚,过服克伐,使清气不升,浊气不降
,以致气不宣通而作也。风寒在胃者,用理中丸,次服酿乳法。若呕吐清涎夹乳,小便清利
,用大安丸。若因乳母食浓味,用东垣清胃散。若乳母饮醇酒,用葛花解醒汤;饮烧酒,服
冷米醋三五杯。乳母食生冷而致者,用五味异功散。乳母停食者,母服大安丸,子服异功散
。乳母劳役者,子母俱服补中益气汤。乳母怒动肝火者,用加味逍遥散。乳母郁怒伤脾者,
用归脾汤
,仍参热吐霍乱治之。
治验
一小儿因停食腹痛,服疏导之药而愈。后复停食,又用前药,寒热不食,腹胀后重,大便频
而少,此脾气复伤而下陷也,先用异功散加升麻数剂,后重渐愈,再用当归痊愈。后因乳母
恚怒,致见寒热发搐作呕,用六君、柴胡、山栀,以治其母,兼灌其儿并愈。
一小儿因乳母感冒风寒发热,儿患呕吐,身发赤晕,用东垣人参安胃散而愈;又切牙发搐,
呕吐酸腐,待其吐止自安。
一小儿时吐乳食,诊其母有郁怒之症,用加味归脾汤、加味逍遥散治之而愈。
一小儿七岁,身羸兼吐,少食发热面黄,余谓脾脏受伤,用六君、煨姜二剂,而饮食进,去
姜,又数剂而愈。
一小儿吐乳,大便臭秽,目睛缓视,因乳母交感后饮乳所致,用六君、木香、藿香,治之而
安。
一小儿吐乳不食,手足搐搦,痰涎上涌,手足指冷,额黑唇青,此肾水胜心火也,用五味异
功散加木香、炮姜,顿愈;去姜,又数服而愈。
一小儿不时干呕,不乳腹膨,此脾胃虚而将成疳也,用四味肥儿丸以治疳,四君子汤以健中
而痊。后伤食,吐泻完谷,行气困惫,四肢微搐,余曰且勿药,次日吐止,但搐而泻青黄,
此脾土虚而肝木胜也,用六君、钩藤钩而痊。
酿乳法 治婴儿有胎热症,令乳母服之,不可遽用冷药,恐损脾胃。若加呕吐,必成大患。
泽泻(二两五钱) 猪苓(去黑皮) 赤茯苓 天花粉(各一两半) 生地黄(二两) 山茵陈(去梗) 甘草(各
一两)
上每服五钱,水煎,食后捏去旧乳服。
茯苓半夏汤 治呕秽,心下坚痞,膈间有水,痰眩惊悸。
半夏(五钱) 白茯苓(二两)
上每服三钱,姜水煎服。
二陈汤 治痰饮,呕吐恶心,或头眩心悸,或中脘不快,或因食冷物,胃气不和。
半夏 橘红(各五钱) 白茯苓(三钱) 甘草(炙,一钱五分)
上每服二三钱,乌梅一个,姜枣水煎服。
四味肥儿丸 治呕吐不食,腹胀成疳,或作泻不止,或食积脾疳,目生云翳,口舌生疮,牙
龈腐烂,发热瘦怯,遍身生疮。又治小便澄白,腹大青筋,一切疳症。
黄连 芜荑 神曲 麦芽(炒。各等分)
上为末,水糊丸,桐子大。每服一二十丸,空心白滚汤送下。
东垣人参安胃散 治服峻剂,脾胃虚损,或成慢惊,泄泻呕吐,肠胃有热,以致前症。(方见
脾脏)
东垣清胃散(方见内钓)
理中丸(方见咳嗽)
葛花解醒汤(方见热吐)
大安丸(即保和丸加白术)
保和丸
补中益气汤(三方见虚羸)
加味逍遥散
加味归脾丸
清胃散
六君子汤
异功散
四君子汤(六方见内钓)
八珍汤(方见寒热)
人参养胃汤(方见疟症)
钱仲阳说:寒吐,是由于乳母在风中取凉,或者风寒邪气客居于乳房所致。其症状表现为面目肿胀,额头出汗,脉象沉迟而微弱。寒气停滞于胃中,导致胃不能受纳食物,从而引起呕吐。哕逆(呃逆),是由于胃气极度虚弱,过度服用攻伐药物,使得清气不能上升,浊气不能下降,从而导致气机宣通受阻而引发。对于风寒在胃的情况,使用理中丸,随后采用酿乳法。如果呕吐清稀涎沫夹杂乳汁,小便清长通畅,使用大安丸。如果是因乳母食用浓味食物引起,使用东垣清胃散。如果乳母饮用烈性酒,使用葛花解醒汤;如果饮用烧酒,则服用冷米醋三至五杯。如果是因乳母食用生冷食物导致,使用五味异功散。如果是乳母饮食停滞导致,母亲服用大安丸,婴儿服用异功散。如果是乳母劳累过度导致,母子共同服用补中益气汤。如果是乳母愤怒导致肝火亢盛,使用加味逍遥散。如果是乳母忧郁愤怒损伤脾脏,使用归脾汤,并参照热吐和霍乱的治法进行调理。
治疗案例:
一个小孩因为食积腹痛,服用疏导药物后痊愈。后来再次食积,又使用前药,出现寒热交替、食欲不振、腹胀且肛门坠胀感,大便次数多但量少,这是脾气再次受伤而下陷的表现。先用异功散加入升麻数剂,肛门坠胀感逐渐好转,再用当归痊愈。后来因为乳母愤怒,导致小孩出现寒热、抽搐、呕吐,用六君子汤、柴胡、山栀治疗乳母,同时给婴儿灌服,母子均痊愈。
一个小孩因为乳母感冒风寒发热,婴儿患呕吐,身上出现红色晕斑,使用东垣人参安胃散而痊愈;后来又出现咬牙、抽搐,呕吐酸腐食物,等待呕吐停止后自然安宁。
一个小孩时常呕吐乳食,诊察其母亲有忧郁愤怒的症状,使用加味归脾汤、加味逍遥散治疗而痊愈。
一个七岁小孩,身体消瘦兼有呕吐,进食少、发热、面色黄,我认为这是脾脏受伤,使用六君子汤、煨姜两剂,饮食进益,去掉生姜,又服数剂而痊愈。
一个小孩呕吐乳汁,大便气味臭秽,眼睛目光迟缓,是因为乳母性交后喂奶所致,使用六君子汤、木香、藿香治疗而安定。
一个小孩呕吐乳汁不进食,手足抽搐,痰涎上涌,手足指头冰冷,额头发黑嘴唇青紫,这是肾水克制心火的表现,使用五味异功散加入木香、炮姜,顿然痊愈;去掉生姜,又服数剂而痊愈。
一个小孩不时干呕,不吃奶,腹部膨隆,这是脾胃虚弱即将形成疳证的表现,使用四味肥儿丸治疗疳证,四君子汤健运中焦而痊愈。后来伤食,呕吐腹泻完谷不化,气行困倦疲惫,四肢轻微抽搐,我说暂且不要用药,第二天呕吐停止,只是抽搐且泻下青黄色粪便,这是脾土虚弱而肝木亢盛的表现,使用六君子汤、钩藤钩而痊愈。
酿乳法:治疗婴儿有胎热症,让乳母服用此方,不可急于使用寒凉药物,恐怕损伤脾胃。如果加上呕吐,必成大患。
泽泻(二两五钱) 猪苓(去除黑皮) 赤茯苓 天花粉(各一两半) 生地黄(二两) 山茵陈(去除梗) 甘草(各一两)
以上每服五钱,水煎煮,饭后挤去旧乳后服用。
茯苓半夏汤:治疗呕吐秽物,心下坚硬痞块,膈间有水饮,痰眩惊悸。
半夏(五钱) 白茯苓(二两)
以上每服三钱,姜水煎煮服用。
二陈汤:治疗痰饮,呕吐恶心,或头晕心悸,或中脘不适,或因吃冷物,胃气不和。
半夏 橘红(各五钱) 白茯苓(三钱) 甘草(炙,一钱五分)
以上每服二三钱,乌梅一个,姜枣水煎煮服用。
四味肥儿丸:治疗呕吐不食,腹胀成疳,或腹泻不止,或食积脾疳,眼睛生云翳,口舌生疮,牙龈腐烂,发热瘦弱怯懦,遍身生疮。又治疗小便澄澈色白,腹部大且有青筋暴露,一切疳证。
黄连 芜荑 神曲 麦芽(炒。各等分)
以上研为末,水糊为丸,如梧桐子大。每服一二十丸,空腹白开水送下。
东垣人参安胃散:治疗服用峻猛药物,脾胃虚损,或形成慢惊风,泄泻呕吐,肠胃有热,以致上述病症。(方剂见脾脏章节)
理中丸(方剂见咳嗽章节)
葛花解醒汤(方剂见热吐章节)
补中益气汤(三方见虚羸章节)
清胃散
Qian Zhongyang stated: Cold vomiting arises from the wet nurse cooling off in the wind or from wind-cold pathogenic factors lodging in the breasts. The symptoms include swelling of the face and eyes, sweating on the forehead, and a deep, slow, and faint pulse. Cold qi stagnates in the Stomach, causing it to fail to receive food, leading to vomiting. Hiccups (Yue Ni) arise from extreme deficiency of Stomach Qi, excessive use of purgative drugs, which prevents Clear Qi from ascending and Turbid Qi from descending, resulting in impaired circulation of Qi. For cases where wind-cold is in the Stomach, Lizhong Wan (Regulate the Middle Pill) is used, followed by the Nurturing Milk Method. If clear saliva mixed with milk is vomited, and urination is clear and free, Da'an Wan (Great Peace Pill) is used. If caused by the wet nurse consuming rich flavors, Dongyuan Qingwei San (Stomach-Clearing Powder by Dongyuan) is used. If the wet nurse drinks strong wine, Gehua Jie Xing Tang (Pueraria Flower Decoction for Resolving Intoxication) is used; if she drinks distilled spirits, cold rice vinegar three to five cups is taken. If caused by the wet nurse consuming raw and cold foods, Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) is used. If caused by food stagnation in the wet nurse, the mother takes Da'an Wan, and the infant takes Yigong San. If caused by the wet nurse's overwork, both mother and child take Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If caused by the wet nurse's anger stirring Liver Fire, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is used. If caused by the wet nurse's depression and anger injuring the Spleen, Guipi Tang (Restore the Spleen Decoction) is used, and treatment should also refer to that for heat vomiting and cholera-like disease.
Clinical Cases:
An infant suffered from abdominal pain due to food stagnation and recovered after taking promoting digestion drugs. Later, food stagnation recurred, and the same drugs were used again, resulting in alternating chills and fever, loss of appetite, abdominal distension with a sensation of heaviness in the rectum, and frequent but scanty stools. This indicated that the Spleen Qi was injured again and sinking. Initially, Yigong San with added Shengma (Cimicifugae Rhizoma) was administered for several doses, alleviating the rectal heaviness gradually. Subsequently, Danggui (Angelicae Sinensis Radix) cured the condition. Later, due to the wet nurse's anger, the infant developed chills, fever, convulsions, and vomiting. Liu Jun Zi Tang (Six Gentlemen Decoction), Chaihu (Bupleuri Radix), and Zhizi (Gardeniae Fructus) were used to treat the mother, while the infant was also fed the medicine, resulting in recovery for both.
An infant suffered from vomiting because the wet nurse had a cold with fever due to wind-cold invasion, and the infant developed red rashes on the body. Dongyuan Renshen Anwei San (Dongyuan's Ginseng Stomach-Calming Powder) cured the condition. Later, teeth grinding and convulsions occurred, accompanied by vomiting of sour and putrid matter; the infant calmed down naturally after the vomiting stopped.
An infant frequently vomited milk and food. Examination revealed the mother had symptoms of depression and anger. Jiawei Guipi Wan (Modified Restore the Spleen Pills) and Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) cured the condition.
A seven-year-old child was emaciated and vomiting, with poor appetite, fever, and sallow complexion. I diagnosed this as injury to the Spleen organ. Liu Jun Zi Tang (Six Gentlemen Decoction) with Wei Jiang (Roasted Ginger) for two doses improved food intake. After removing the ginger, several more doses cured the condition.
An infant vomited milk, had foul-smelling stools, and slow eye movements. This was caused by breastfeeding immediately after sexual intercourse with the mother. Liu Jun Zi Tang (Six Gentlemen Decoction) with Muxiang (Aucklandiae Radix) and Huoxiang (Pogostemonis Herba) brought relief.
An infant vomited milk, refused food, had convulsions of hands and feet, surging phlegm-saliva, cold fingers and toes, black forehead, and blue lips. This indicated Kidney Water overcoming Heart Fire. Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) with added Muxiang (Aucklandiae Radix) and Pao Jiang (Prepared Ginger) cured it instantly. After removing the ginger, several more doses completed the cure.
An infant occasionally dry heaved, refused milk, and had a distended abdomen. This indicated Spleen and Stomach deficiency progressing toward Infantile Malnutrition (Gan Syndrome). Siwei Fei'er Wan (Four-Ingredient Fattening Infant Pill) was used to treat Gan Syndrome, and Sijun Zi Tang (Four Gentlemen Decoction) strengthened the Middle Jiao, leading to recovery. Later, food injury caused vomiting and diarrhea of undigested food, with lethargy and slight convulsions of the limbs. I advised against medication temporarily. The next day, vomiting stopped, but convulsions persisted with greenish-yellow diarrhea. This indicated Spleen Earth deficiency and Liver Wood excess. Liu Jun Zi Tang (Six Gentlemen Decoction) with Goutenggou (Uncariae Ramulus cum Uncis) cured the condition.
Nurturing Milk Method: Treats infants with fetal heat syndrome. The wet nurse should take this formula. Do not abruptly use cold-natured drugs, as they may damage the Spleen and Stomach. Adding vomiting would lead to serious complications.
Zexie (Alismatis Rhizoma, 2 liang 5 qian) Zhuling (Polypori Umbellati, skin removed) Chi Fuling (Red Poria) Tianhuafen (Trichosanthis Radix, 1.5 liang each) Sheng Dihuang (Rehmanniae Radix, 2 liang) Shan Yinchen (Artemisiae Scopariae Herba, stems removed) Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang each)
Take 5 qian per dose, decoct in water, and consume after meals, squeezing out old milk first.
Fuling Banxia Tang (Poria and Pinellia Decoction): Treats vomiting of foul matter, hardness and fullness below the heart, fluid retention between the diaphragm, dizziness due to phlegm, palpitations, and fright.
Banxia (Pinelliae Rhizoma, 5 qian) Bai Fuling (White Poria, 2 liang)
Take 3 qian per dose, decoct in ginger water.
Er Chen Tang (Two Aged Ingredients Decoction): Treats phlegm-fluid retention, vomiting, nausea, dizziness, palpitations, epigastric discomfort, or disharmony of Stomach Qi due to consuming cold foods.
Banxia (Pinelliae Rhizoma) Juhong (Citri Reticulatae Pericarpium Rubrum, 5 qian each) Bai Fuling (White Poria, 3 qian) Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 1.5 qian)
Take 2-3 qian per dose, with one Wumei (Mume Fructus), decoct in ginger and jujube water.
Siwei Fei'er Wan (Four-Ingredient Fattening Infant Pill): Treats vomiting, anorexia, abdominal distension leading to Gan Syndrome, persistent diarrhea, food stagnation Spleen Gan Syndrome, corneal opacity, mouth and tongue ulcers, gingival rot, fever, emaciation, generalized sores. Also treats clear white urine, abdominal distension with visible veins, and all types of Gan Syndrome.
Huanglian (Coptidis Rhizoma) Wuyi (Toosendan Fructus) Shenqu (Massa Medicata Fermentata) Maiya (Hordei Fructus Germinatus, stir-fried, equal parts)
Grind into powder, make pills with water paste, size of Torreya seeds. Take 10-20 pills per dose, swallowed with warm boiled water on an empty stomach.
Dongyuan Renshen Anwei San (Dongyuan's Ginseng Stomach-Calming Powder): Treats damage to Spleen and Stomach from harsh drugs, slow convulsive disease, diarrhea, vomiting, and internal heat causing these symptoms. (Formula see Spleen Organ chapter)
Dongyuan Qingwei San (Stomach-Clearing Powder by Dongyuan) (Formula see Internal Hook chapter)
Lizhong Wan (Regulate the Middle Pill) (Formula see Cough chapter)
Gehua Jie Xing Tang (Pueraria Flower Decoction for Resolving Intoxication) (Formula see Heat Vomiting chapter)
Da'an Wan (Great Peace Pill) (Is Baohe Wan with added Baizhu)
Baohe Wan (Harmonize the Stomach Pill)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (Three formulas see Emaciation chapter)
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder)
Jiawei Guipi Wan (Modified Restore the Spleen Pills)
Qingwei San (Stomach-Clearing Powder)
Liu Jun Zi Tang (Six Gentlemen Decoction)
Yigong San (Extraordinary Merit Powder)
Sijun Zi Tang (Four Gentlemen Decoction) (Six formulas see Internal Hook chapter)
Bazhen Tang (Eight Treasures Decoction) (Formula see Cold and Heat chapter)
Renshen Yangwei Tang (Ginseng Nourishing Stomach Decoction) (Formula see Malaria chapter)