[总诀]寒热阴阳细品详,总因气逆呕斯生。降冲安胃开邪拒,气不奔腾呕自平。
呕吐不食,水饮不得入口者,火热相拒隔也。宜人参干姜汤。
人参(三钱) 黄连(三钱) 黄芩(三钱) 干姜(五分)
歌曰∶呕时拒隔水难尝,多用芩连少用姜。
惟有人参能养液,主方重使却无妨。
呕吐能食,食入实时吐出者,两热相争冲也。宜酒蒸大黄汤。
大黄(三钱) 甘草(一钱)
歌曰∶呕吐虽能纳水浆,实时吐出胃脾伤。
只缘两热相争竞,酒水同烹草与黄。
食久乃吐,兼见大腹胀满者,脾经乏火化也。宜姜附六君汤。
人参(二钱) 白术(三钱) 云苓(三钱) 甘草(一钱) 半夏(二钱) 陈皮(一钱) 干姜(一
钱) 附子(二钱)
歌曰∶食饭经时呕吐频,更兼腹满病原真。
人参附片姜和术,半夏云苓甘与陈。
食久乃吐,兼见胸前胀满者,胃府之虚寒也。宜香砂养胃汤。
木香(二钱) 砂仁(二钱) 白术(二钱) 云苓(三钱) 陈皮(一钱) 半夏(二钱)
人参(二钱) 甘草(一钱) 大枣(四枚) 生姜(三片)
歌曰∶食久胸前胀满增,香砂治呕有奇能。
参苓枣夏俱同煮,术草姜陈也共蒸。
食久乃吐,吐出多带水液者,肾部之虚寒也。宜仲景真武汤。
白术(三钱) 云苓(三钱) 白芍(三钱) 生姜(三片) 附子(三钱)
歌曰∶肾寒呕吐水津多,术芍云苓姜附科。
姜附散寒为主药,术苓平胃共调和。
(伯未按∶若呕吐苦水,或酸水,或绿水,而不能饮食者,吴萸,黄连浓煎,缓咽。)
食久乃吐,吐出多带酸水者,肝藏有寒热也。宜仲景乌梅丸。
乌梅(三个) 人参(二钱) 黄柏(二钱) 黄连(二钱) 当归(三钱) 干姜(一钱) 细辛(五
分) 桂枝(一钱) 附子(二钱) 花椒(一钱)
(伯未按∶蜀刻本作“宜吴茱萸原方”,方用吴萸、生姜、人参、大枣。)
歌曰∶食已经时吐带酸,梅连桂附善平肝。
姜辛椒柏当归研,再入人参裹作丸。
单吐痰涎,或兼咳嗽头痛者,胃中有痰饮也。宜加味二陈汤。
陈皮(二钱) 半夏(二钱) 云苓(三钱) 甘草(一钱) 生姜(三片) 竹沥(一勺)
黄芩(三钱)
(伯未按∶蜀刻本无黄芩。)
歌曰∶单吐痰涎用二陈,夏陈苓草竹姜匀。
黄芩加入兼清热,热净痰除效若神。
单吐酸水,或兼头痛如破者,肝寒气上逆也。宜加味左金丸。
吴萸(二钱) 黄连(一钱) 人参(二钱) 云苓(三钱) 细辛(五分) 苡仁(三钱)
歌曰∶单吐酸宜用左金,参苓细苡共连寻。
辛温独取吴萸性,肝气平时病不侵。
(伯未按∶一味吴萸浓煎服亦效,肉桂粉亦佳。)
呕吐不止,兼见腹痛下利者,脾气之虚脱也。宜附子理中汤。
附子(二钱) 白术(三钱) 人参(二钱) 甘草(一钱) 干姜(一钱)
歌曰∶吐兼下利责脾虚,参草和中是急需。
附术干姜仍合用,理中汤服病当除。
呕吐发热,或兼口苦胸满者,少阳之逆气也。宜原方柴胡汤。
黄芩(三钱) 柴胡(一钱) 人参(二钱) 生姜(三片) 半夏(三钱) 甘草(一钱) 大枣(
四枚)
歌曰∶吐兼发热用柴芩,只为三焦逆气侵。
夏草姜参同大枣,长沙旧法细推寻。
卒然呕吐,兼见发闷恶心者,感瘴厉异气也。宜藿香正气散。
白术(三钱) 半夏(三钱) 云苓(三钱) 白芷(二钱) 腹皮(二钱) 生姜(三片) 砂仁(二
钱) 浓朴(一钱) 陈皮(一钱) 桔梗(一钱) 紫苏(一钱) 藿香(一钱) 甘草(一钱) 大
枣(四枚)
歌曰∶卒吐还兼发恶心,瘴乡芷朴急当寻。
术苓夏腹砂陈桔,藿草姜苏枣共斟。
【总诀】寒热阴阳需细细品味详察,呕吐的产生总归是因为气机上逆。通过降冲逆、安胃气、开通邪气阻隔,气机不再奔腾上逆,呕吐自然平息。
呕吐且不能进食,连水饮都无法入口的,是火热之邪相互格拒导致的膈塞。适宜使用人参干姜汤。
人参(三钱) 黄连(三钱) 黄芩(三钱) 干姜(五分)
歌诀说:呕吐时出现格拒,水难以下咽,多用黄连、黄芩,少用干姜。
只有人参能滋养津液,主方中重用也不妨事。
呕吐但能进食,食物吃下去立刻吐出的,是两股热邪相争导致冲逆。适宜使用酒蒸大黄汤。
大黄(三钱) 甘草(一钱)
歌诀说:呕吐虽然能喝下水浆,但立刻吐出说明胃脾受损。
只因为两股热邪相互争斗,用酒水同煮甘草和大黄。
进食很久之后才呕吐,同时伴有腹部胀满的,是脾经缺乏火气运化所致。适宜使用姜附六君汤。
人参(二钱) 白术(三钱) 云苓(三钱) 甘草(一钱) 半夏(二钱) 陈皮(一钱) 干姜(一钱) 附子(二钱)
歌诀说:吃饭过一段时间就频繁呕吐,再加上腹部胀满,病因真实不虚。
人参、附片、干姜和白术,半夏、云苓、甘草和陈皮一起使用。
进食很久之后才呕吐,同时伴有胸前胀满的,是胃腑的虚寒证。适宜使用香砂养胃汤。
木香(二钱) 砂仁(二钱) 白术(二钱) 云苓(三钱) 陈皮(一钱) 半夏(二钱)
人参(二钱) 甘草(一钱) 大枣(四枚) 生姜(三片)
歌诀说:进食很久后胸前胀满加重,木香和砂仁治疗呕吐有奇效。
人参、茯苓、大枣、半夏一同煎煮,白术、甘草、生姜、陈皮也共同蒸煮。
进食很久之后才呕吐,吐出的多为水液的,是肾部的虚寒证。适宜使用张仲景的真武汤。
白术(三钱) 云苓(三钱) 白芍(三钱) 生姜(三片) 附子(三钱)
歌诀说:肾寒引起的呕吐水津多,用白术、白芍、云苓、生姜、附子这组药。
生姜和附子散寒是主要药物,白术和云苓平和胃气共同调和。
(伯未按语:如果是呕吐苦水,或酸水,或绿水,并且不能饮食的,用吴茱萸和黄连浓煎,缓缓咽下。)
进食很久之后才呕吐,吐出的多为酸水的,是肝脏有寒热错杂证。适宜使用张仲景的乌梅丸。
乌梅(三个) 人参(二钱) 黄柏(二钱) 黄连(二钱) 当归(三钱) 干姜(一钱) 细辛(五分) 桂枝(一钱) 附子(二钱) 花椒(一钱)
(伯未按语:蜀刻本写作“适宜吴茱萸原方”,方剂用吴茱萸、生姜、人参、大枣。)
歌诀说:进食过后不久呕吐带酸味,乌梅、黄连、桂枝、附子善于平抑肝气。
生姜、细辛、花椒、黄柏、当归研末,再加入人参包裹做成丸剂。
单独呕吐痰涎,或者兼有咳嗽头痛的,是胃中有痰饮停滞。适宜使用加味二陈汤。
陈皮(二钱) 半夏(二钱) 云苓(三钱) 甘草(一钱) 生姜(三片) 竹沥(一勺)
黄芩(三钱)
(伯未按语:蜀刻本没有黄芩。)
歌诀说:单独呕吐痰涎使用二陈汤,半夏、陈皮、茯苓、甘草、竹沥、生姜用量均匀。
加入黄芩兼以清热,热清痰除效果神奇。
单独呕吐酸水,或者兼有头痛剧烈如破裂感的,是肝寒气上逆所致。适宜使用加味左金丸。
吴萸(二钱) 黄连(一钱) 人参(二钱) 云苓(三钱) 细辛(五分) 苡仁(三钱)
歌诀说:单独呕吐酸水适宜使用左金丸,人参、茯苓、细辛、薏苡仁配合黄连寻找病机。
辛温之性独取吴茱萸,肝气平和则疾病不侵扰。
(伯未按语:单味吴茱萸浓煎服用也有效,肉桂粉也很好。)
呕吐不止,同时伴有腹痛腹泻的,是脾气虚脱证。适宜使用附子理中汤。
附子(二钱) 白术(三钱) 人参(二钱) 甘草(一钱) 干姜(一钱)
歌诀说:呕吐兼腹泻责之于脾虚,人参、甘草和中是急需。
附子、白术、干姜仍然合用,服用理中汤病应当消除。
呕吐发热,或者兼有口苦胸满的,是少阳经逆气所致。适宜使用原方柴胡汤。
黄芩(三钱) 柴胡(一钱) 人参(二钱) 生姜(三片) 半夏(三钱) 甘草(一钱) 大枣(四枚)
歌诀说:呕吐兼发热使用柴胡、黄芩,只因为三焦逆气侵扰。
半夏、甘草、生姜、人参同大枣一起,仔细推求长沙旧法(指张仲景之法)。
突然呕吐,同时伴有发闷恶心的,是感受瘴厉异气所致。适宜使用藿香正气散。
白术(三钱) 半夏(三钱) 云苓(三钱) 白芷(二钱) 腹皮(二钱) 生姜(三片) 砂仁(二钱) 浓朴(一钱) 陈皮(一钱) 桔梗(一钱) 紫苏(一钱) 藿香(一钱) 甘草(一钱) 大枣(四枚)
歌诀说:突然呕吐还兼有发闷恶心,在瘴气之乡急切当寻白芷、厚朴。
白术、茯苓、半夏、腹皮、砂仁、陈皮、桔梗,藿香、甘草、生姜、紫苏、大枣共同斟酌使用。
[General Principle] Cold and heat, yin and yang must be carefully examined; vomiting arises fundamentally from the rebellion of qi. By descending the rebellious qi, stabilizing the stomach, and opening the obstruction caused by pathogens, when the qi ceases to surge upward, vomiting will naturally subside.
Vomiting accompanied by inability to eat, where even water and fluids cannot enter the mouth, is due to mutual rejection between fire and heat causing a blockage in the diaphragm. Ren Shen Gan Jiang Tang (Ginseng and Dried Ginger Decoction) is suitable.
Ren Shen (San Qian) Huang Lian (San Qian) Huang Qin (San Qian) Gan Jiang (Wu Fen)
The song states: During vomiting with rejection, water is hard to taste; use more Huang Qin and Huang Lian, less Gan Jiang.
Only Ren Shen can nourish body fluids; using it heavily in the main formula is not harmful.
Vomiting with the ability to eat, where food is vomited immediately after ingestion, is due to the contention of two heats causing a surge. Jiu Zheng Da Huang Tang (Wine-Steamed Rhubarb Decoction) is suitable.
Da Huang (San Qian) Gan Cao (Yi Qian)
The song states: Although vomiting allows intake of water and grain, immediate vomiting indicates injury to the stomach and spleen.
It is merely because two heats contend; cook Gan Cao and Da Huang together with wine and water.
Vomiting long after eating, accompanied by abdominal distension and fullness, is due to the deficiency of fire in the Spleen channel affecting transformation. Jiang Fu Liu Jun Tang (Ginger and Aconite Six-Gentlemen Decoction) is suitable.
Ren Shen (Er Qian) Bai Zhu (San Qian) Yun Ling (San Qian) Gan Cao (Yi Qian) Ban Xia (Er Qian) Chen Pi (Yi Qian) Gan Jiang (Yi Qian) Fu Zi (Er Qian)
The song states: Vomiting frequently after a meal, plus abdominal fullness reveals the true origin of the disease.
Ren Shen, Fu Pian, Gan Jiang, and Bai Zhu; Ban Xia, Yun Ling, Gan Cao, and Chen Pi are used together.
Vomiting long after eating, accompanied by chest and epigastric distension, is due to deficiency-cold in the Stomach fu. Xiang Sha Yang Wei Tang (Aucklandia and Amomum Nourishing Stomach Decoction) is suitable.
Mu Xiang (Er Qian) Sha Ren (Er Qian) Bai Zhu (Er Qian) Yun Ling (San Qian) Chen Pi (Yi Qian) Ban Xia (Er Qian)
Ren Shen (Er Qian) Gan Cao (Yi Qian) Da Zao (Si Mei) Sheng Jiang (San Pian)
The song states: Chest fullness increases long after eating; Mu Xiang and Sha Ren have miraculous efficacy in treating vomiting.
Ren Shen, Fu Ling, Da Zao, and Ban Xia are boiled together; Bai Zhu, Gan Cao, Sheng Jiang, and Chen Pi are steamed together.
Vomiting long after eating, where the vomitus consists mostly of fluid, is due to deficiency-cold in the Kidney region. Zhong Jing's Zhen Wu Tang (True Warrior Decoction by Zhang Zhongjing) is suitable.
Bai Zhu (San Qian) Yun Ling (San Qian) Bai Shao (San Qian) Sheng Jiang (San Pian) Fu Zi (San Qian)
The song states: Vomiting with excessive saliva due to Kidney cold uses the combination of Bai Zhu, Bai Shao, Yun Ling, Sheng Jiang, and Fu Zi.
Sheng Jiang and Fu Zi disperse cold as the primary drugs; Bai Zhu and Yun Ling harmonize the stomach.
(Bai An's Note: If vomiting bitter water, sour water, or green water, and unable to eat, decoct Wu Zhu Yu and Huang Lian strongly and swallow slowly.)
Vomiting long after eating, where the vomitus contains much sour fluid, is due to cold and heat mixed in the Liver zang. Zhong Jing's Wu Mei Wan (Mume Pill by Zhang Zhongjing) is suitable.
Wu Mei (Three) Ren Shen (Er Qian) Huang Bo (Er Qian) Huang Lian (Er Qian) Dang Gui (San Qian) Gan Jiang (Yi Qian) Xi Xin (Wu Fen) Gui Zhi (Yi Qian) Fu Zi (Er Qian) Hua Jiao (Yi Qian)
(Bai An's Note: The Shu edition states "Suitable for Wu Zhu Yu Original Formula," using Wu Zhu Yu, Sheng Jiang, Ren Shen, and Da Zao.)
The song states: Vomiting with sour taste long after eating; Wu Mei, Huang Lian, Gui Zhi, and Fu Zi effectively calm the Liver.
Sheng Jiang, Xi Xin, Hua Jiao, Huang Bo, and Dang Gui are ground; then mixed with Ren Shen and formed into pills.
Vomiting only phlegm-saliva, or accompanied by cough and headache, is due to phlegm-fluid retention in the Stomach. Jia Wei Er Chen Tang (Modified Two-Aged Decoction) is suitable.
Chen Pi (Er Qian) Ban Xia (Er Qian) Yun Ling (San Qian) Gan Cao (Yi Qian) Sheng Jiang (San Pian) Zhu Li (Yi Shao)
Huang Qin (San Qian)
(Bai An's Note: The Shu edition lacks Huang Qin.)
The song states: For vomiting only phlegm-saliva, use Er Chen Tang; Ban Xia, Chen Pi, Ling, Gan Cao, Zhu, and Jiang are balanced.
Adding Huang Qin clears heat; once heat is cleared and phlegm removed, the effect is miraculous.
Vomiting only sour water, or accompanied by severe headache like bursting, is due to Liver cold with qi rebelling upward. Jia Wei Zuo Jin Wan (Modified Left Metal Pill) is suitable.
Wu Yu (Er Qian) Huang Lian (Yi Qian) Ren Shen (Er Qian) Yun Ling (San Qian) Xi Xin (Wu Fen) Yi Yi Ren (San Qian)
The song states: For vomiting only sour water, Zuo Jin Wan is suitable; Ren Shen, Ling, Xi Xin, and Yi Yi seek out Huang Lian.
Taking the acrid-warm nature of Wu Yu alone calms Liver qi, preventing disease invasion.
(Bai An's Note: Decocting single Wu Zhu Yu strongly is also effective; Rou Gui powder is also excellent.)
Unremitting vomiting, accompanied by abdominal pain and diarrhea, is due to deficiency collapse of Spleen qi. Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) is suitable.
Fu Zi (Er Qian) Bai Zhu (San Qian) Ren Shen (Er Qian) Gan Cao (Yi Qian) Gan Jiang (Yi Qian)
The song states: Vomiting with diarrhea blames Spleen deficiency; Ren Shen and Gan Cao harmonizing the middle is urgent.
Fu Zi, Bai Zhu, and Gan Jiang are still combined; taking Li Zhong Tang should eliminate the disease.
Vomiting with fever, or accompanied by bitter taste and chest fullness, is due to rebellious qi of the Shaoyang channel. Yuan Fang Chai Hu Tang (Original Formula Bupleurum Decoction) is suitable.
Huang Qin (San Qian) Chai Hu (Yi Qian) Ren Shen (Er Qian) Sheng Jiang (San Pian) Ban Xia (San Qian) Gan Cao (Yi Qian) Da Zao (Si Mei)
The song states: Vomiting with fever uses Chai Hu and Huang Qin, merely because rebellious qi invades the San Jiao.
Ban Xia, Gan Cao, Sheng Jiang, Ren Shen, and Da Zao together; carefully explore the old methods of Changsha (referring to Zhang Zhongjing).
Sudden vomiting, accompanied by stuffiness and nausea, is due to contracting miasma and abnormal qi. Huo Xiang Zheng Qi San (Agastache Rectifying Qi Powder) is suitable.
Bai Zhu (San Qian) Ban Xia (San Qian) Yun Ling (San Qian) Bai Zhi (Er Qian) Fu Pi (Er Qian) Sheng Jiang (San Pian) Sha Ren (Er Qian) Hou Po (Yi Qian) Chen Pi (Yi Qian) Jie Geng (Yi Qian) Zi Su (Yi Qian) Huo Xiang (Yi Qian) Gan Cao (Yi Qian) Da Zao (Si Mei)
The song states: Sudden vomiting with stuffiness and nausea; in miasma regions, urgently seek Bai Zhi and Hou Po.
Bai Zhu, Ling, Ban Xia, Fu Pi, Sha, Chen, Jie; Huo Xiang, Gan Cao, Sheng Jiang, Zi Su, and Da Zao are weighed together.