吐者，有物无声。哕者，有声无物。呕者；声物俱出，总属于胃。时医以二陈汤加藿香、
砂仁统治之。虽是庸浅活套，尚不碍理，余亦从之。但当分别寒热虚实表里而加减耳。
寒者，口和身冷，或兼腹痛，脉必迟细，吐出如多有冷气，宜再加吴萸、干姜、丁香之类。热
者，或为热渴，或为烦躁，脉必洪数，吐必涌猛，形气声色，必皆壮历，宜再加黄芩、黄连、
麦冬、沙参、竹茹之类。实者，或因食滞，必多胀满，宜再加浓朴、山楂、麦芽、神曲之类
；或因气逆必痛连胁筋，宜再加抚芎、香附、紫苏、连翘之类，或另用左金丸、逍遥散之
类。表者，邪自外至，必头痛发热，宜倍用生姜。里者，邪不在表，兼心下痞者，宜二陈汤
加黄芩、黄连、干姜、人参、大枣，仿半夏泻心汤之意；兼见腹满便硬者，二陈汤加浓朴、
大黄，仿承气汤之意。若在半表半里，必见口苦，寒热往来，宜另用小柴胡汤治之。虚者，
胃气虚也，或命门火气虚也，宜二陈汤加香砂外，重用人参、白术，以补胃气；不愈，更加
干姜、附子、吴萸，以温补命门；或以八味丸汤，直补命门真火，随宜变通。景岳云∶无实
无火而呕吐者，胃虚也。或误服寒凉而呕吐者，胃虚也。食无所停，闻食而呕者，胃虚也。
气无所逆，闻气则呕者，胃虚也。或食入中焦而不化者，胃虚也。食入下焦而不化者，命门
虚也。然胃本属土，非火不生，非暖不化，是土寒即土虚也，土虚即火虚也。脾喜暖而恶
寒，土喜燥而恶湿，故张石顽治虚寒呕吐，每用伏龙肝两许，煮汤澄清，代水煎药，可谓得
治吐之大要矣。治泄泻亦不外此理，而吐呃亦属胃虚，宜于六君子汤去甘草，加黄连、干姜、
蜀椒之类。
次男元犀按∶仲景旋复代赭石汤，本以治心下痞，噫气不除。今于呕吐不止之症，借用
甚效者，取其重以降逆也。干姜黄连黄芩人参汤，本以治寒邪隔热于上焦，今于食入即吐之
症，取用甚效者，以干姜散上焦之寒，芩连清心下之热，人参通格逆之气，而调其寒热，以
至和平。不用生姜、半夏者，胃气虚不堪辛散。不用甘草、大枣者，呕不宜甘也。又吴茱萸
汤，治阳明食谷欲呕，又治少阴病吐利手足逆冷，烦躁欲死，又治干呕、吐涎沫、头痛三症如神。盖取吴茱萸
大热，直入厥阴，能降气而消阴翳。人参扶其生气，姜枣和其胃气，使震坤合德，土木不
害，而呕吐平矣。
哕者，胃中虚冷，及停饮居多。亦有失于攻下，胃中实热而哕者，证必腹满。仲景云∶
哕而腹满，视其前后，知何部不利，利之则愈，承气汤，猪苓汤是也。
哕逆有虚热，橘皮竹茹汤。哕属虚寒，橘皮干姜汤。寒甚去通草，加丁香、附子。寒热
错杂者去甘草，加丁香、柿蒂。
哕声频密相连为实，攻热为主。若半时哕一声者为虚，温补为主。如腹满，不尿，脉散
，头汗，目瞪而哕者，死在旦夕。
呕吐，是指有食物吐出但没有声音。哕（呃逆），是指有声但无食物吐出。呕，是指声音和食物同时吐出，这三种情况总归属于胃的病变。当时的医生用二陈汤加上藿香、砂仁来统管治疗这些病症。这虽然是一种平庸浅显的常规套路，但尚且不违背医理，我也跟随采用这种方法。但是应当分别辨别寒证、热证、虚证、实证、表证、里证而进行加减用药。
寒证，表现为口中和缓不苦、身体发冷，或者兼有腹痛，脉象必定迟而细，吐出的物中多有冷气，适宜再加吴茱萸、干姜、丁香之类的药物。热证，或者是由于热盛口渴，或者是烦躁不安，脉象必定洪大而数，呕吐必定汹涌猛烈，形体气息声色必定都显得壮实有力，适宜再加黄芩、黄连、麦冬、沙参、竹茹之类的药物。实证，或者是由于食积停滞，必定多伴有胀满，适宜再加厚朴、山楂、麦芽、神曲之类的药物；或者是由于气机逆乱，必定疼痛牵连胁肋筋脉，适宜再加抚芎（川芎）、香附、紫苏、连翘之类的药物，或者另外使用左金丸、逍遥散之类的方剂。表证，是邪气从外部侵入，必定伴有头痛发热，适宜加倍使用生姜。里证，是邪气不在体表，兼有心下痞塞感的，适宜用二陈汤加黄芩、黄连、干姜、人参、大枣，仿照半夏泻心汤的意旨；兼见腹部胀满、大便硬结的，用二陈汤加厚朴、大黄，仿照承气汤的意旨。如果在半表半里之间，必定出现口苦、寒热往来的症状，适宜另外用小柴胡汤来治疗。
虚证，是胃气虚弱，或者是命门火气虚弱，适宜在二陈汤加香附、砂仁之外，重用人参、白术，以补益胃气；如果不见效，再加干姜、附子、吴茱萸，以温补命门之火；或者使用八味丸汤，直接补益命门的真火，根据具体情况灵活变通。张景岳说：没有实证、没有火热而呕吐的，是胃虚。或者误服寒凉药物而导致呕吐的，是胃虚。饮食没有停积，闻到食物就呕吐的，是胃虚。气机没有逆乱，闻到气味就呕吐的，是胃虚。或者食物进入中焦而不能消化的，是胃虚。食物进入下焦而不能消化的，是命门虚。然而胃本属土，没有火就不能生化，没有温暖就不能运化，所以土寒就是土虚，土虚就是火虚。脾喜欢温暖而厌恶寒冷，土喜欢干燥而厌恶潮湿，所以张石顽治疗虚寒呕吐，每次使用伏龙肝一两左右，煮汤澄清后，代替水来煎药，可以说是掌握了治疗呕吐的大要领了。治疗泄泻也不外乎这个原理，而吐呃也属于胃虚，适宜在六君子汤去掉甘草的基础上，加黄连、干姜、蜀椒之类的药物。
次子元犀按语：张仲景的旋复代赭石汤，原本是用来治疗心下痞塞、嗳气不止的。现在借用它来治疗呕吐不止的病症，非常有效，是取其重镇之性以降逆气。干姜黄连黄芩人参汤，原本是用来治疗寒邪格拒于上焦的，现在用于“食入即吐”的病症，取用非常有效，是因为干姜能散上焦之寒，黄芩、黄连能清心下之热，人参能通调格逆之气，从而调和寒热，达到平和的状态。不用生姜、半夏的原因，是胃气虚弱不堪受辛散之药；不用甘草、大枣的原因，是呕吐不宜用甘味药。另外，吴茱萸汤，治疗阳明病进食后想呕吐，又治疗少阴病呕吐腹泻、手足逆冷、烦躁欲死，还治疗干呕、吐涎沫、头痛这三种症状，效果如神。大概是取吴茱萸大热之性，直入厥阴经，能降气而消除阴翳。人参扶助其生气，生姜、大枣调和胃气，使震卦（肝/木）与坤卦（脾/土）合德，土木不相害，而呕吐得以平复。
哕（呃逆），多是胃中虚冷，以及水饮停聚所致。也有因为误用攻下法，导致胃中实热而出现哕的，症状必定伴有腹部胀满。张仲景说：哕而且腹部胀满，观察前后二便，知道哪一部不通利，通利它就能痊愈，比如承气汤、猪苓汤等。
哕逆有虚热的，用橘皮竹茹汤。哕属于虚寒的，用橘皮干姜汤。寒邪严重的，去掉通草，加丁香、附子。寒热错杂的，去掉甘草，加丁香、柿蒂。
哕声频繁密集相连的是实证，以攻热为主。如果半个时辰才哕一声的是虚证，以温补为主。如果出现腹部胀满、小便不通、脉象散乱、头部出汗、两眼直视而哕的，预示死亡就在早晚之间。
Vomiting (Ou) refers to the expulsion of material without sound. Hiccups or hiccupping (Yue) refers to sound without expulsion of material. Vomiting with sound and material (Ou, distinct from the first term in some contexts but here grouped as 'Ou' involving both) involves both sound and material being expelled; all these conditions generally belong to the Stomach. Contemporary physicians use Er Chen Tang (Two-Aged Decoction) added with Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit) to treat them universally. Although this is a mediocre and superficial routine method, it does not violate medical principles, so I also follow it. However, one must differentiate between Cold, Heat, Deficiency, Excess, Exterior, and Interior patterns to make additions and subtractions to the prescription.
For Cold patterns: The mouth feels neutral (not bitter or dry), the body is cold, possibly accompanied by abdominal pain, and the pulse is necessarily slow and fine. The vomit often contains cold qi. It is appropriate to add Wuzhuyu (Evodia Fruit), Ganjiang (Dried Ginger), Dingxiang (Clove), etc. For Heat patterns: There may be heat-induced thirst or irritability/restlessness, the pulse is necessarily surging and rapid, vomiting is necessarily violent and gushing, and the physical constitution, breath, voice, and appearance are necessarily robust. It is appropriate to add Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Maidong (Ophiopogon Tuber), Shashen (Glehnia Root), Zhuru (Bamboo Shavings), etc. For Excess patterns: It may be due to food stagnation, necessarily accompanied by distension and fullness; it is appropriate to add Houpo (Magnolia Bark), Shanzha (Hawthorn Fruit), Maiya (Sprouted Barley), Shenqu (Medicated Leaven), etc. Or it may be due to Qi rebellion, necessarily with pain radiating to the hypochondriac tendons; it is appropriate to add Fuxiong (Chuanxiong Rhizome), Xiangfu (Cyperus Rhizome), Zisu (Perilla Leaf), Lianqiao (Forsythia Fruit), etc., or alternatively use Zuojin Wan (Left Metal Pill) or Xiaoyao San (Free and Easy Wanderer Powder). For Exterior patterns: Pathogens come from outside, necessarily accompanied by headache and fever; it is appropriate to double the dosage of Shengjiang (Fresh Ginger). For Interior patterns: The pathogen is not on the exterior, accompanied by epigastric stuffiness; it is appropriate to use Er Chen Tang (Two-Aged Decoction) added with Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Ganjiang (Dried Ginger), Renshen (Ginseng Root), Dazao (Jujube Fruit), imitating the intent of Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium); if accompanied by abdominal fullness and hard stool, use Er Chen Tang (Two-Aged Decoction) added with Houpo (Magnolia Bark) and Dahuang (Rhubarb Root), imitating the intent of Chengqi Tang (Purgative Decoction). If in the Half-Exterior Half-Interior stage, there will necessarily be bitter taste in the mouth and alternating chills and fever; it is appropriate to separately use Xiao Chaihu Tang (Minor Bupleurum Decoction) for treatment.
For Deficiency patterns: This is Stomach Qi deficiency, or Mingmen Fire (Gate of Life Fire) deficiency. It is appropriate to add Xiangfu (Cyperus Rhizome) and Sharen (Amomum Fruit) to Er Chen Tang (Two-Aged Decoction), and heavily use Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) to tonify Stomach Qi; if not cured, further add Ganjiang (Dried Ginger), Fuzi (Prepared Aconite Root), and Wuzhuyu (Evodia Fruit) to warm and tonify the Mingmen (Gate of Life); or use Bawei Wan Tang (Eight-Ingredient Pill Decoction) to directly tonify the True Fire of the Mingmen (Gate of Life), adapting flexibly according to circumstances. Zhang Jingyue said: Vomiting without Excess or Fire is due to Stomach Deficiency. Vomiting caused by mistakenly taking cold-cooling herbs is due to Stomach Deficiency. Not having food stagnation but vomiting upon smelling food is due to Stomach Deficiency. Not having Qi rebellion but vomiting upon smelling odors is due to Stomach Deficiency. Food entering the Middle Jiao (Middle Burner) but not digesting is due to Stomach Deficiency. Food entering the Lower Jiao (Lower Burner) but not digesting is due to Mingmen (Gate of Life) Deficiency. However, the Stomach belongs to Earth; without Fire it cannot generate, without warmth it cannot transform. Thus, Cold Earth is Deficient Earth, and Deficient Earth is Deficient Fire. The Spleen likes warmth and dislikes cold; Earth likes dryness and dislikes dampness. Therefore, when Zhang Shiwentreated cold-deficiency vomiting, he often used about one tael of Fulonggan (Dragon's House Mud / Sedimented Clay), boiled it in water, clarified the decoction, and used it instead of water to decoct other medicines. This can be said to have grasped the major essentials of treating vomiting. Treating diarrhea does not go beyond this principle either. Hiccups/Yue also belong to Stomach Deficiency; it is appropriate to use Liujunzi Tang (Six-Gentlemen Decoction) removing Gancao (Licorice Root), and adding Huanglian (Coptis Rhizome), Ganjiang (Dried Ginger), Shujiao (Sichuan Pepper), etc.
My second son Yuanxi notes: Zhongjing's Xuanshu Daizhe Shi Tang (Inula and Hematite Decoction) was originally intended to treat epigastric stuffiness and persistent belching. Now, borrowing it for symptoms of unceasing vomiting is very effective, taking advantage of its heavy nature to descend rebellious Qi. Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) was originally intended to treat cold pathogens blocking the Upper Jiao (Upper Burner). Now, using it for "vomiting immediately after eating" is very effective because Ganjiang (Dried Ginger) disperses Upper Jiao cold, Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) clear Heart/epigastric heat, and Renshen (Ginseng Root) unblocks obstructed Qi, thereby harmonizing cold and heat to achieve peace. We do not use Shengjiang (Fresh Ginger) and Banxia (Pinellia Tuber) because the Stomach Qi is too deficient to withstand acrid-dispersing herbs. We do not use Gancao (Licorice Root) and Dazao (Jujube Fruit) because vomiting should not be treated with sweet herbs. Furthermore, Wuzhuyu Tang (Evodia Decoction) treats Yangming disease where food intake leads to desire to vomit; it also treats Shaoyin disease with vomiting, diarrhea, cold extremities, and severe irritability; and it treats three symptoms like magic: dry retching, vomiting of saliva/froth, and headache. This is because Wuzhuyu (Evodia Fruit) is extremely hot, directly enters the Jueyin (Liver) channel, can descend Qi and eliminate Yin shadows. Renshen (Ginseng Root) supports its generating Qi, Jiang (Ginger) and Zao (Jujube) harmonize Stomach Qi, allowing Zhen (Liver/Wood) and Kun (Spleen/Earth) to act in virtue, preventing Wood from harming Earth, thus calming vomiting.
Yue (Hiccups/Hiccupping) is mostly due to Cold and Deficiency in the Stomach, and retention of fluid-drink. There are also cases where Yue occurs due to Excess Heat in the Stomach resulting from failed purgation; the syndrome must involve abdominal fullness. Zhongjing said: Yue accompanied by abdominal fullness, observe the anterior (urination) and posterior (defecation) orifices, know which part is not free, and promoting its freedom will cure it; examples include Chengqi Tang (Purgative Decoction) and Zhu Ling Tang (Polyporus Decoction).
Yue with Deficiency-Heat uses Jupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction). Yue belonging to Deficiency-Cold uses Jupi Ganjiang Tang (Tangerine Peel and Dried Ginger Decoction). If Cold is severe, remove Tongcao (Tetrapanax Pith), add Dingxiang (Clove) and Fuzi (Prepared Aconite Root). If Cold and Heat are mixed, remove Gancao (Licorice Root), add Dingxiang (Clove) and Shidi (Persimmon Calyx).
Yue sounds that are frequent, dense, and continuous indicate an Excess pattern, primarily attacking Heat. If there is only one Yue every half hour, it indicates a Deficiency pattern, primarily warming and tonifying. If there is abdominal fullness, no urination, scattered pulse, sweating on the head, staring eyes, and Yue, death is imminent (within the day or night).