呕吐哕 皆属胃 呕字从沤,沤者水也,口中出水而无食也。吐字从土,土者食也,口
中吐食而无水也。呕吐者,水与食并出也。哕者,口中有秽味也,又谓之干呕,口中有秽味
,未有不干呕也。呃逆者,气冲有声,声短而频也。其病皆属于胃。
二陈加 时医贵 二陈汤倍生姜,安胃降逆药也。寒加丁香、砂仁;若热,加黄连、鲜
竹茹、石斛之类。
玉函经 难仿佛 寒热攻补,一定不移。
小柴胡 少阳谓 寒热往来而呕者,属少阳也。
吴茱萸 平酸味 吴茱萸汤治阳明食谷欲呕者,又治少阴症吐利、手足逆冷、烦躁欲死
者,又治干呕吐涎沫者。此症呕吐,多有酸味。
食已吐 胃热沸 食已即吐,其人胃素有热,食复入,两热相冲,不得停留。
黄草汤 下其气 大黄甘草汤治食已即吐。《金匮》云∶欲吐者不可下之。又云∶食已
即吐者,大黄甘草汤下之。何也?曰∶病在上而欲吐,宜因而越之。若逆之使下,则必愦乱
益甚。若既吐矣,吐而不已,是有升无降,当逆折之。
食不入 火堪畏 王太仆云∶食不得入,是有火也。
黄连汤 为经纬 喻嘉言用进退黄连汤,柯韵伯用干姜黄连黄芩人参汤,推之泻心汤亦
可借用,以此数汤为经纬。
若呃逆 代赭汇 代赭旋覆汤治噫气,即治呃逆。若久病呃逆,为胃气将绝,用人参一
两,干姜、附子各三钱,丁香、柿蒂各一钱,可救十中之一。
呕吐、哕,病位皆归属于胃。
“呕”字从“沤”,“沤”意为水,指口中吐出清水而没有食物。
“吐”字从“土”,“土”代表食物,指口中吐出食物而没有水液。
所谓“呕吐”,是指水与食物同时吐出。
“哕”,指口中有秽浊气味,又称为干呕,只要口中有秽味,必然伴随干呕。
“呃逆”,指气冲喉间发出声音,声音短促而频繁。
这些病症的病机都归属于胃。
二陈汤加生姜:当时的医生重视此法。
使用二陈汤并加倍生姜用量,这是安和胃气、降逆止呕的方药。
若属寒证,加入丁香、砂仁;若属热证,加入黄连、鲜竹茹、石斛之类。
《玉函经》之理难以企及:
对于寒证用温法、热证用清法、实证用攻法、虚证用补法,原则是固定不变的。
小柴胡汤对应少阳病:
出现寒热往来且伴有呕吐症状的,属于少阳病(少阳经受邪所致的病证)。
吴茱萸汤平抑酸味:
吴茱萸汤治疗阳明病中进食后想要呕吐的情况;又治疗少阴病(少阴经受邪所致的病证)出现的吐利、手足逆冷、烦躁欲死等症状;还治疗干呕并吐出涎沫的症状。这类呕吐病症,多带有酸味。
食毕即吐,乃胃热沸腾:
进食后立即呕吐,是因为患者胃中素有积热,食物再次进入后,两热相冲,导致食物无法停留。
大黄甘草汤下行其气:
大黄甘草汤用于治疗进食后立即呕吐的情况。《金匮要略》说:“想要呕吐的人,不可使用泻下法。”又说:“进食后立即呕吐的,使用大黄甘草汤泻下。”为什么呢?回答说:病邪在上部且有呕吐趋势时,应当顺应病势使其向上涌出。如果逆势强行使其向下,则病情必定更加混乱严重。如果已经呕吐,但呕吐不止,这是只有上升没有下降,应当逆势折抑其气。
饮食难入,火邪可畏:
王冰(王太仆)说:“饮食不能入口,是因为体内有火邪。”
黄连汤为治疗经纬:
喻嘉言使用进退黄连汤,柯韵伯使用干姜黄连黄芩人参汤,推演开来,泻心汤也可以借用,将这些方剂作为治疗的纲领。
若是呃逆,可用代赭石汇聚:
代赭旋覆汤治疗嗳气,也就是治疗呃逆。如果是久病导致的呃逆,说明胃气即将断绝,应使用人参一两,干姜、附子各三钱,丁香、柿蒂各一钱,或许能挽救十分之一的生机。
Vomiting, retching (Hui), and belching all pertain to the Stomach.
The character "Ou" (Vomit) derives from "Ou" (soak/bubble), where "Ou" means water; it refers to spitting out clear fluid without food.
The character "Tu" (Eject/Vomit) derives from "Tu" (Earth), where "Earth" represents food; it refers to ejecting food without fluid.
"Ou Tu" (Vomiting) implies that both water and food are expelled together.
"Hui" (Retch/Convulsive hiccup) refers to a foul odor in the mouth, also known as dry heaves; whenever there is a foul odor in the mouth, dry heaves invariably occur.
"E Ni" (Hiccup) refers to air rushing up producing sound, characterized by short and frequent noises.
The pathology of these conditions all belongs to the Stomach.
Er Chen Tang with added Ginger: Contemporary physicians value this approach.
Using Er Chen Tang (Two-Aged Peel Decoction) with doubled fresh ginger is a formula that stabilizes the Stomach and directs rebellious Qi downward.
If the pattern is Cold, add Ding Xiang (Clove) and Sha Ren (Amomum Fruit); if Heat, add Huang Lian (Coptis Rhizome), Xian Zhu Ru (Fresh Bamboo Shavings), Shi Hu (Dendrobium Stem), and similar herbs.
The principles of the *Yu Han Jing* are difficult to approximate:
For Cold patterns use warming methods, for Heat patterns use clearing methods, for Excess patterns use purging methods, and for Deficiency patterns use tonifying methods; these principles remain fixed and unchanging.
Xiao Chai Hu Tang corresponds to Shaoyang:
When alternating chills and fever occur accompanied by vomiting, the condition pertains to Shaoyang disease (disease resulting from pathogenic invasion of the Shaoyang channel).
Wu Zhu Yu Tang neutralizes sourness:
Wu Zhu Yu Tang (Evodia Decoction) treats cases of Yangming disease where one desires to vomit after eating grain; it also treats Shaoyin disease (disease resulting from pathogenic invasion of the Shaoyin channel) presenting with vomiting, diarrhea, cold extremities, and severe restlessness desiring death; and it treats dry heaves with expulsion of saliva. In such vomiting cases, a sour taste is often present.
Vomiting immediately after eating indicates boiling Stomach Heat:
Vomiting immediately after finishing a meal indicates that the patient has pre-existing heat in the Stomach; when new food enters, the two heats clash, preventing retention.
Da Huang Gan Cao Tang directs Qi downward:
Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) treats vomiting immediately after eating. The *Jin Gui Yao Lue* states: "Those who desire to vomit should not be treated with purgatives." It further states: "Those who vomit immediately after eating should be treated with Da Huang Gan Cao Tang to purge." Why? The answer is: When the pathogen is in the upper jiao and vomiting is desired, one should follow the trend and induce emesis. If one opposes this by forcing downward movement, the confusion will worsen significantly. If vomiting has already occurred but continues incessantly, this indicates rising without descending; one must oppose this trend to subdue it.
Inability to ingest food reveals Fire, which is to be feared:
Wang Bing (Grand Master Wang) stated: "Inability to take in food is due to the presence of Fire."
Huang Lian Tang serves as the warp and weft [guiding principle]:
Yu Jiayan used Jin Tui Huang Lian Tang (Advance-Retreat Coptis Decoction), Ke Yunbo used Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction); extending this logic, the Xin Xie Tang (Drain the Epigastrium Decoctions) can also be borrowed, using these several formulas as guiding principles.
Regarding E Ni (Hiccup), Dai Zhe (Magnetite) converges:
Dai Zhe Xuan Fu Tang (Magnetite and Inula Decoction) treats eructation, which is synonymous with treating hiccup. If hiccup persists in chronic illness, it indicates that Stomach Qi is about to exhaust; use Ren Shen (Ginseng Root) 1 liang, Gan Jiang (Dried Ginger) and Fu Zi (Prepared Aconite Root) each 3 qian, Ding Xiang (Clove) and Shi Di (Persimmon Calyx) each 1 qian; this may save one in ten patients.