呕吐反胃，浮滑者昌。弦数紧涩，结肠者亡。
呕吐有声有物，反出于胃，上焦之病也。（宜仲景大半夏汤、生姜半夏汤、二陈汤之类。）上焦，
则脉应浮。有物，则脉应滑。浮滑为阳，饮食之能纳能运而不反者，阳之力也。故
云∶浮滑者昌。若得弦数紧涩之脉，则逆矣。盖弦状阴敛，阳运衰微。又弦为肝木
之脉。呕吐属胃，胃者土也。木来乘土，土将夺矣。《金匮要略》云∶脉弦者虚也，
胃气无余。亦惧胃土虚而见肝木之脉也。（宜平肝补脾，如四君子汤、六君子汤加防风白芍之类。）数则
为热，热当消谷。而反吐谷者，乃知数为虚数。虚则不运，数则气促，呕吐不止，
胃将由此而败。《金匮要略》云∶阳气微，膈气虚，脉乃数。（宜补中兼清虚热，如六君子汤加竹
茹、生姜、茱萸、制黄连之类。紧则为寒，寒则无阳以运，故上出而呕吐。宜温中散寒，如理中汤、
藿香安胃散之类。）涩脉枯涩，吐亡津液之所致也。《金匮要略》所谓朝食暮吐，暮食朝吐，
宿谷不化，名曰胃反。脉紧而涩，其病难治者是也。（宜补气而生津，如四君子汤加黄 、五味子
之类。）夫胃为水谷之海，若再加大肠秘结，是全无阴液而水谷之海枯矣。水谷之海
枯而能生者，未之有也。（反胃，粪如羊屎者不治。）
呕吐伴有声音和食物吐出，反自胃中而出，属于上焦的病证。（适宜使用张仲景的大半夏汤、生姜半夏汤、二陈汤等方剂。）病位在上焦，则脉象应当呈现浮象。有实物吐出，则脉象应当呈现滑象。浮滑脉属阳，饮食能够纳入并运化而不反吐，这是阳气的力量所致。所以说：脉象浮滑者预后良好（昌）。如果诊得弦、数、紧、涩的脉象，则为逆证。因为弦脉形态主阴气收敛，阳气运化功能衰微。且弦脉为肝木之脉。呕吐病位在胃，胃属土。肝木克制脾土，脾胃之气将被掠夺。《金匮要略》说：脉弦代表虚证，胃气已无余存。这也是畏惧胃土虚弱而显现肝木之脉的缘故。（适宜平抑肝木、补益脾气，如四君子汤、六君子汤加防风、白芍等药。）数脉主热，热邪应当能消化谷物。反而吐出未消化的谷物，可知此为虚数之脉。虚则不能运化，数则气短急促，呕吐不止，胃气将由此败坏。《金匮要略》说：阳气微弱，膈间气虚，脉象才会呈现数象。（适宜在补益中兼清虚热，如六君子汤加竹茹、生姜、吴茱萸、制黄连等药。）紧脉主寒，寒邪则没有阳气来运化，所以向上溢出而呕吐。适宜温中散寒，如理中汤、藿香安胃散等方剂。）涩脉枯涩，是由于呕吐导致津液亡失所致。《金匮要略》所说的“早晨吃晚上吐，晚上吃早晨吐，宿食不消化”，名为胃反。脉象紧而涩，病情难以治愈，指的就是这种情况。（适宜补气生津，如四君子汤加黄芪、五味子等药。）胃是水谷汇聚的大海，如果再加大肠便秘结滞，就是完全缺乏阴液，水谷之海枯竭了。水谷之海枯竭还能生存的情况，是从未有过的。（若反胃患者大便像羊屎一样干结难下，则属不治之症。）
Vomiting with sound and regurgitation of food from the stomach is a disease of the Upper Jiao (Upper Burner). (Appropriate formulas include Zhang Zhongjing's Banxia Tang Major, Shengjiang Banxia Tang, or Erchen Tang.) When the pathology is in the Upper Jiao, the pulse should be Floating. When there is regurgitated matter, the pulse should be Slippery. A Floating-Slippery pulse indicates Yang; the ability to ingest and transport food without regurgitation is due to the power of Yang. Hence it is said: "Floating and Slippery indicates prosperity." If a Wiry, Rapid, Tight, or Choppy pulse is obtained, it indicates an adverse prognosis. This is because a Wiry pulse shape signifies Yin constriction and declining Yang transportation. Furthermore, the Wiry pulse corresponds to the Liver Wood. Vomiting involves the Stomach, which belongs to Earth. When Wood overacts on Earth, Earth's Qi will be depleted. The *Jingui Yaolue* states: "A Wiry pulse indicates deficiency; there is no surplus of Stomach Qi." This reflects the fear that weak Stomach Earth manifests as a Liver Wood pulse. (Treatment should soothe the Liver and tonify the Spleen, such as Sijunzi Tang or Liujunzi Tang added with Fangfeng and Baishao.) A Rapid pulse indicates Heat, which should digest grain. However, if grain is vomited undigested, this Rapid pulse indicates Deficiency-Rapid. Deficiency leads to failure of transportation; Rapidness leads to shortness of breath. Unceasing vomiting will cause the Stomach Qi to fail. The *Jingui Yaolue* states: "When Yang Qi is minute and Diaphragm Qi is deficient, the pulse becomes Rapid." (Treatment should tonify while clearing Deficient Heat, such as Liujunzi Tang added with Zhuru, Shengjiang, Zhuyu, and Zhi Huanglian.) A Tight pulse indicates Cold; Cold lacks Yang to facilitate transportation, causing upward expulsion and vomiting. Treatment should warm the Middle and dispel Cold, such as Lizhong Tang or Huoxiang Anwei San.) A Choppy pulse is withered and rough, caused by the loss of Body Fluids due to vomiting. The *Jingui Yaolue* describes "morning eating evening vomiting, evening eating morning vomiting, undigested old grain" as Wei Fan (Stomantic Reflux). A Tight and Choppy pulse indicates a difficult-to-treat condition. (Treatment should tonify Qi and generate fluids, such as Sijunzi Tang added with Huangqi and Wuweizi.) The Stomach is the Sea of Water and Grain. If accompanied by constipation of the Large Intestine, it means a complete lack of Yin fluids, leading to the desiccation of the Sea of Water and Grain. There has never been a case where life can be sustained after the Sea of Water and Grain is exhausted. (If the patient with Wei Fan passes stool like sheep dung, it is incurable.)