贝母(一钱五分) 栝蒌(一钱) 花粉 茯苓 橘红 桔梗(各八分
水煎服。
香苏散 (见太阳证。
五皮饮 (见水肿。
小半夏加茯苓汤 (见伤寒咳嗽。
六味丸、十味肾气丸 (即八味丸加车前、牛膝,并见类中门。
呕者,声与物俱出。吐者,有物无声。哕者,有声无物,世俗谓之干呕。东垣以此三者
皆因脾胃虚弱,或寒气所客,或饮食所伤,以致气逆而食不得下也。香砂二陈汤主之。
然呕吐多有属火者,经云∶食不得入。是有火也;食入反出,是有寒也。若拒格饮食,点滴
不入者,必用姜水炒黄连以开之,累用累效。至于食入反出,固为有寒,若大便闭结。须加
血药以润之。润之不去,宜蜜煎导而通之。盖下窍开,上窍即入也。其有因脾胃虚弱而吐者
补中为主,理中汤。其有因痞积滞碍而吐者,消积为主,和中丸。若命门火衰不能生土者
补火为主,八味丸。复有呃逆之症,气自脐下直冲上,多因痰饮所致,或气郁所发,扁
鹊丁香散主之。若火气上冲,橘皮竹茹汤主之。至于大病中见呃逆者,是谓土败木贼,为胃
绝,多难治也。
二陈汤 (见痰饮)
通治呕吐哕,随症加减。
前症若脾胃虚弱,加人参、白术。若寒气所侵,加姜、桂,甚加附子。若饮食所伤,加
山楂、麦芽、神曲、香附、砂仁、藿香。若饮食冲口而出,不得入者,是为有火,加黄连、
山栀。若大便结燥,加当归、黄芩、知母。若有积滞,且兼服和中丸。
理中汤 (见中寒。
和中丸 (见蛊胀。
八味丸 (见类中。
扁鹊丁香散 (见伤寒呃逆。
贝母(一钱五分) 栝蒌(一钱) 花粉 茯苓 橘红 桔梗(各八分)
用水煎服。
香苏散 (见太阳证章节)。
五皮饮 (见水肿章节)。
小半夏加茯苓汤 (见伤寒咳嗽章节)。
六味丸、十味肾气丸 (即八味丸加入车前子、牛膝,并见类中门章节)。
呕吐时,声音与食物同时排出;吐的时候,只有食物排出而没有声音;哕(干呕),只有声音没有食物排出,世俗称之为干呕。李东垣认为这三者都是因为脾胃虚弱,或者寒气客居体内,或者饮食损伤,导致气机上逆而食物无法下行。以香砂二陈汤为主治方剂。
然而呕吐多属于火证,《内经》说:“食物不能入口”,这是有火;“食物吃进去反而吐出”,这是有寒。如果拒绝接受饮食,点滴不进,必须用姜水炒制的黄连来开通,多次使用多次见效。至于食物吃进去反而吐出,固然属于有寒,但如果大便闭结,需要加入血分药物来润燥。如果润燥无效,适宜用蜜煎导法来通便。因为下窍通畅,上窍自然就能受纳。那些因为脾胃虚弱而呕吐的,以补益中气为主,用理中汤。那些因为痞满积滞阻碍而呕吐的,以消积为主,用和中丸。如果命门火衰不能温煦脾土(火不生土)的,以补火为主,用八味丸。又有呃逆这一病症,气从脐下直冲向上,多因痰饮所致,或者因气郁引发,用扁鹊丁香散主治。如果是火气上冲,用橘皮竹茹汤主治。至于在大病中出现呃逆的,这叫做土败木贼(脾虚肝乘),是胃气绝的表现,大多难以治疗。
二陈汤 (见痰饮章节)。
通治呕吐哕,根据症状加减用药。
前述症状如果是因为脾胃虚弱,加入人参、白术。如果是寒气侵袭,加入生姜、肉桂,严重者加入附子。如果是饮食所伤,加入山楂、麦芽、神曲、香附、砂仁、藿香。如果饮食冲口而出,无法进入,这是有火,加入黄连、山栀。如果大便结燥,加入当归、黄芩、知母。如果有积滞,并且兼服和中丸。
理中汤 (见中寒章节)。
和中丸 (见蛊胀章节)。
八味丸 (见类中章节)。
扁鹊丁香散 (见伤寒呃逆章节)。
Fritillariae Thunbergii Bulbus (Beimu, 贝母) [1.5 qian], Trichosanthis Fructus (Gualou, 栝蒌) [1 qian], Trichosanthis Radix (Huafen), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Platycodonis Radix (Jiegeng) [each 0.8 qian].
Decoct in water and take orally.
Xiangsu San (Aromatic Elsholtzia Powder) (See Chapter on Taiyang Syndrome).
Wupi Yin (Five-Peel Decoction) (See Chapter on Edema).
Xiao Banxia Jia Fuling Tang (Minor Pinellia Decoction with Added Poria) (See Chapter on Cold Damage Cough).
Liwei Wan (Six-Ingredient Pill with Rehmanniae Root), Shiwei Shenqi Wan (Ten-Ingredient Kidney-Qi Pill) (i.e., Bawei Wan plus Plantaginis Seed [Cheqianzi] and Achyranthis Bidentatae Radix [Niuxi], see Chapter on Stroke-like Syndromes).
"Ou" (vomiting with sound) refers to the simultaneous expulsion of sound and food; "Tu" (spitting/regurgitation) refers to the expulsion of food without sound; "Yue" (hiccups or dry heaving) refers to sound without food, commonly known in secular terms as gan ou (dry vomiting). Li Dongyuan considered these three conditions to result from Spleen-Stomach deficiency, invasion of cold pathogen, or dietary injury, leading to rebellious Qi and inability of food to descend. The primary treatment is Xiangsha Erchen Tang (Aromatic Magnolia Bark and Tuckahoe Two-Aged Decoction).
However, vomiting often belongs to Fire syndromes. The Classics state: "Food cannot enter," indicating Fire; "Food enters but is vomited back," indicates Cold. If there is rejection of food and fluids, with even a drop unable to pass, one must use Huanglian (Coptidis Rhizoma) stir-fried with ginger juice to open the obstruction; repeated use yields repeated efficacy. As for food entering and then being vomited out, this is indeed due to Cold; however, if accompanied by constipation, blood-nourishing herbs should be added to moisten dryness. If moistening fails, honey suppositories (Mi Jian Dao) should be used to unblock the bowels. This is because when the lower orifice opens, the upper orifice naturally accepts. For vomiting caused by Spleen-Stomach deficiency, tonifying the Middle Jiao is primary, using Lizhong Tang (Regulate the Middle Decoction). For vomiting caused by stagnation and accumulation, resolving accumulation is primary, using Hezhong Wan (Harmonize the Middle Pill). For cases where Mingmen Fire (Gate of Life Fire) declines and fails to warm Earth (Spleen), tonifying Fire is primary, using Bawei Wan (Eight-Ingredient Pill). There is also the symptom of Eni (hiccups), where Qi rushes upward directly from below the navel, often caused by Phlegm-Fluids or Qi Stagnation; Bianque Dingxiang San (Bianque's Clove Powder) is the primary treatment. If caused by Fire Qi rushing upward, Chupi Zhuru Tang (Tangerine Peel and Bamboo Shavings Decoction) is used. In severe illnesses, the appearance of hiccups is termed "Earth failing and Wood attacking" (Pi Xu Gan Cheng), indicating exhaustion of Stomach Qi, which is difficult to treat.
Erchen Tang (Two-Aged Decoction) (See Chapter on Phlegm-Fluids).
Generally treats Ou, Tu, and Yue, modified according to symptoms.
For the aforementioned symptoms, if due to Spleen-Stomach deficiency, add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). If invaded by Cold, add Jiang (Zingiberis Rhizoma Recens) and Gui (Cinnamomi Ramulus); in severe cases, add Fuzi (Aconiti Lateralis Radix Praeparata). If injured by diet, add Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Shenqu (Massa Medicata Fermentata), Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), and Huoxiang (Agastaches Herba). If food spurts out and cannot enter, indicating Fire, add Huanglian (Coptidis Rhizoma) and Shanzhi (Gardeniae Fructus). If stool is dry and bound, add Danggui (Angelicae Sinensis Radix), Huangqin (Scutellariae Radix), and Zhimu (Anemarrhenae Rhizoma). If there is stagnation, concurrently administer Hezhong Wan (Harmonize the Middle Pill).
Lizhong Tang (Regulate the Middle Decoction) (See Chapter on Interior Cold).
Hezhong Wan (Harmonize the Middle Pill) (See Chapter on Gu Distension).
Bawei Wan (Eight-Ingredient Pill) (See Chapter on Stroke-like Syndromes).
Bianque Dingxiang San (Bianque's Clove Powder) (See Chapter on Cold Damage Hiccups).