治同前证。
莱菔子（生者一两，熟者一两） 共捣碎，煎汤一大茶杯，顿服之。
奉天许××，年二十余。得温病。三四日觉中脘郁结，饮食至其处不下行，仍上逆吐出。来院求为延医。
其脉沉滑而实，舌苔白而微黄。表里俱觉发热，然不甚剧。自言素多痰饮，受外感益甚。因知其中脘之郁结，
确系外感之邪与痰饮相凝滞也。先投以荡胸汤，两点钟后，仍复吐出。为拟此方，一剂结开，可受饮食。继投
以清火理痰之品，两剂全愈。
按∶此证若服荡胸汤，将方中赭石细末留出数钱，开水送下，再服汤药亦可不吐，其结亦必能开。非莱菔
子汤之力胜于荡胸汤也，而试之偶效，尤必载此方者，为药性较荡胸汤尤平易，临证者与病家，皆可放胆用之
而无疑也。若此方不效者，亦可改用荡胸汤，先将赭石细末送下数钱之法。
治寒温阳明府实，大便燥结，当用承气下之，而呕吐不能受药者。
芒硝（六钱） 赭石（二两，研细） 生石膏（二两，捣细） 潞党参（五钱）
上药四味，用水四盅，先煎后三味，汤将成，再加芒硝，煎一两沸。取清汁二盅，先温服一盅。过三点钟，
若腹中不觉转动，欲大便者，再温服余一盅。
一邻妇，年二十余。得温病已过十日，上焦燥热，呕吐，大便燥结，自病后未行。延医数次服药皆吐出。
适愚自他处归，诊其脉，关前甚洪实，一息五至余，其脉上盛于下一倍，所以作呕吐。其至数数者，吐久伤津
液也。为拟此汤，一剂热退呕止，大便得通而愈。
或问∶此证胃腑热实大肠燥结，方中何以复用党参？答曰∶此证多有呕吐甚剧，并水浆不能存者，又有初
病即呕吐，十数日不
止者，其胃气与胃中津液，必因呕吐而大有伤损，故用党参补助胃中元气，且与凉润之石膏并用，大能滋胃中
津液，俾胃中气足液生，自能运转药力下至魄门以通大便也。愚用此方救人多矣，果遇此等证，放胆投之，无
不效者。
一人，年四十许。二便不通，呕吐甚剧，不受饮食。倩人询方。疑系外感之热所致，问其心中发热否？言
来时未尝言及。遂为约略疏方，以赭石二两以止其呕吐，生杭芍一两以通小便，芒硝三钱以通大便。隔日，其
人复来，言服后呕吐即止，二便亦通，此时心中发热且渴如故。既曰如故，是其从前原有热渴之病，阳明之腑
证已实，特其初次遣人未尝详言也。投以大剂白虎加人参汤，一剂而愈。
按∶此证亦镇逆承气汤证，因其证两次始述明，遂致将方中药品前后两次分用之，其病亦即前后两次而愈矣。
治疗与前文所述证候相同。
莱菔子（生用一两，熟用一两） 共同捣碎，煎煮成一大茶杯药汤，一次性服用。
奉天（今辽宁沈阳）许某某，二十多岁。患温病。三四天后感觉中脘部郁结阻滞，饮食到达此处无法下行，反而向上逆出吐出。来院请求我为其诊治。
他的脉象沉滑而实，舌苔白而微黄。表里都感觉发热，但不是很剧烈。他自己说平时痰饮较多，感受外邪后症状更加严重。因此知道其中脘部的郁结，确实是外感邪气与痰饮相互凝滞所致。先给予荡胸汤服用，两个小时后，仍然呕吐。于是为他拟定此方，一剂药后郁结解开，可以接受饮食。随后投以清热降火、理气化痰的药物，两剂药后完全痊愈。
按语：此证如果服用荡胸汤，将方中的赭石细末留出数钱，用开水送服，再服用汤药也可以不呕吐，郁结也一定能解开。并不是莱菔子汤的功效胜过荡胸汤，而是尝试此方偶然有效，特别记载此方的原因，是因为该药性比荡胸汤更为平易温和，临证医生和患者都可以放心大胆使用而没有疑虑。如果此方无效，也可以改用荡胸汤，先将赭石细末送服数钱的方法。
治疗寒温病阳明腑实证，大便燥结，应当用承气汤类攻下，但呕吐严重不能受纳药物的情况。
芒硝（六钱） 赭石（二两，研成细粉） 生石膏（二两，捣碎成细粉） 潞党参（五钱）
以上四味药，用水四盅，先煎煮后三味药，汤药即将煎成时，再加入芒硝，煮沸一两分钟。取澄清药汁二盅，先温热服用一盅。过三个小时，如果腹中没有感觉转动、想要大便的情况，再温热服用剩下的一盅。
一位邻居妇女，二十多岁。患温病已经过了十天，上焦燥热，呕吐，大便燥结，自生病以来未曾排便。多次请医生服药都吐出来了。恰好我从别处回来，诊察她的脉象，关前部位非常洪大有力，一息跳动五次以上，脉象上部盛于下部一倍，所以导致呕吐。脉率快的原因，是因为呕吐久了损伤津液。为她拟定此汤，一剂药后热退呕止，大便通畅而痊愈。
有人问：此证胃腑热实、大肠燥结，方中为什么又用党参？回答说：此证多有呕吐非常剧烈的，甚至水浆都无法存留的，又有初得病就呕吐，十几天不止的，其胃气和胃中津液，必然因为呕吐而受到很大损伤，所以用党参补助胃中元气，并且与凉润的石膏并用，大大能够滋生胃中津液，使得胃中气足液生，自然能运转药力下行至魄门（肛门）以通大便。我使用此方救人很多了，果然遇到此类证候，放心大胆地投药，没有不有效的。
一个人，四十岁左右。大小便不通，呕吐非常剧烈，不接受饮食。托人询问药方。怀疑是外感热邪所致，问他心中是否发热？他说来时未曾提及。于是为他大致开方，用赭石二两来止住呕吐，生杭芍一两来通利小便，芒硝三钱来通导大便。隔日，那人再次前来，说服药后呕吐即止，大小便也通了，此时心中发热且口渴依旧。既然说“依旧”，说明他从前原有热渴的病，阳明腑证已经结实，只是他初次派人时未曾详细陈述。投以大剂量白虎加人参汤，一剂药后痊愈。
按语：此证也是镇逆承气汤的适应证，因为病情两次才叙述清楚，导致将方中的药品分前后两次使用，病情也就分前后两次治愈了。
Treatment is the same as the syndrome described previously.
Radish Seed (Lai Fu Zi) (1 liang raw, 1 liang cooked)
Crush together, decoct in water to make one large teacup of liquid, and take all at once.
Mr. Xu from Fengtian (modern-day Shenyang, Liaoning), in his early twenties, suffered from a Warm Disease (Wen Bing). After three or four days, he felt a sensation of stagnation and fullness in the epigastrium (Zhongwan region). Food reached this area but could not descend, instead regurgitating upwards and being vomited out. He came to the clinic seeking medical attention.
His pulse was deep, slippery, and excess (Chen Hua Shi). His tongue coating was white with a slight yellow tint. Both the exterior and interior felt hot, though not severely so. He stated that he usually had abundant phlegm-fluids (Tan Yin), and contracting an external pathogen exacerbated the condition. Thus, it was known that the stagnation in the epigastrium was indeed caused by the conglomeration of external pathogenic factors and phlegm-fluids. Initially, Dang Xiong Tang (Chest-Scouring Decoction) was administered. Two hours later, vomiting recurred. Therefore, this formula was prescribed. After one dose, the stagnation resolved, allowing him to tolerate food and drink. Subsequently, herbs for clearing heat, purging fire, and resolving phlegm were given. After two doses, he made a complete recovery.
Note: If this syndrome were treated with Dang Xiong Tang, leaving out several qian of fine Ochre powder (Zhe Shi) from the formula, taking it with boiled water, and then consuming the decoction would also prevent vomiting and resolve the stagnation. This does not imply that Radish Seed Decoction is superior to Dang Xiong Tang; rather, it was recorded because this formula happened to be effective upon trial, and its properties are milder and more accessible than those of Dang Xiong Tang. Physicians and patients can use it boldly without hesitation. If this formula proves ineffective, one may switch to Dang Xiong Tang, first administering several qian of fine Ochre powder with water.
For Cold Damage or Warm Diseases presenting with Yangming Fu-organ excess syndrome, characterized by dry and hard stool requiring purgation via Cheng Qi Decoction-type formulas, but where severe vomiting prevents the retention of medication:
Magnesium Sulfate (Mang Xiao) (6 qian)
Ochre (Zhe Shi) (2 liang, ground into fine powder)
Raw Gypsum Sheng Shi Gao) (2 liang, crushed into fine powder)
Codonopsis Root Lu Dang Shen) (5 qian)
Take these four ingredients, add four zhong of water, and first decoct the latter three ingredients. When the decoction is nearly ready, add Mang Xiao and boil for one or two minutes. Strain to obtain two zhong of clear liquid. First, take one zhong warm. After three hours, if there is no sensation of abdominal movement or urge to defecate, take the remaining one zhong warm.
A neighbor's wife, in her early twenties, had suffered from a Warm Disease for over ten days. She experienced upper jiao dryness and heat, vomiting, and dry, hard stool. Since the onset of illness, she had not had a bowel movement. Several doctors had been consulted, but all medications were vomited up. I happened to return from elsewhere and examined her pulse. The pulse at the Guan position (middle position) was very surging and excess, beating more than five times per respiration cycle. The pulse was twice as strong in the upper positions compared to the lower positions, which caused the vomiting. The rapid rate was due to fluid damage from prolonged vomiting. I prescribed this decoction. After one dose, the heat subsided, vomiting stopped, and her bowels moved freely, leading to recovery.
Someone asked: In this syndrome, there is heat-excess in the Stomach organ and dryness-excess in the Large Intestine, why is Codonopsis (Dang Shen) used in the formula? I replied: In such cases, vomiting is often severe, sometimes preventing even water from staying down. In other instances, vomiting begins immediately upon illness onset and persists for ten-plus days. Consequently, the Stomach Qi and fluids within the Stomach must have suffered significant damage due to vomiting. Therefore, Dang Shen is used to supplement the primordial Qi of the Stomach. Combined with the cooling and moistening properties of Raw Gypsum (Shi Gao), it greatly helps generate fluids in the Stomach. When Stomach Qi is sufficient and fluids are generated, it naturally facilitates the transport of medicinal power downward to the Po Men (anus) to unblock the bowels. I have saved many people using this formula. Indeed, when encountering such syndromes, prescribe it boldly, and it will invariably be effective.
A man, around forty years old, suffered from obstruction of both urination and defecation, severe vomiting, and inability to accept food or drink. He sent someone to inquire about a prescription. Suspecting it was caused by exogenous heat, I asked if he felt heat in his heart/chest. He said he had not mentioned this initially. So, I roughly prescribed: Zhe Shi (2 liang) to stop vomiting, Raw Paeonia Root Bai Shao) (1 liang) to promote urination, and Mang Xiao (3 qian) to promote defecation. The next day, he returned, stating that after taking the medicine, vomiting ceased, and both urination and defecation resumed. However, the heat and thirst in his chest remained as before. Since he said "remained as before," it indicated he originally had a condition of heat and thirst. The Yangming Fu-organ syndrome was already established, but he had failed to detail this during the initial inquiry. I prescribed a large dose of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). After one dose, he recovered.
Note: This case also falls under the indications for Zhen Ni Cheng Qi Tang (Rebellious-Normalizing Cathartic Decoction). Because the symptoms were clarified only in two stages, the ingredients of the formula were utilized in two separate administrations, and the illness was cured in two corresponding stages.