经义
诸痿喘呕，皆属于上。○诸逆冲上，皆属于火。○太阴所谓食则呕者，物盛满而上溢，故呕也。○少阳所
至，为呕涌。（《素问》）
足厥阴肝所生病者，胸满，呕逆。○善呕，呕有苦，长太息，邪在胆，逆在胃。胆液泄，则口苦，胃气
逆，则呕苦，故曰呕胆。（《灵枢》）
哲言
食刹则吐，谓之呕。食入则吐，谓之暴吐。食已则吐，谓之呕吐。食久则吐，谓之反胃。食再则吐，谓
之翻胃。○呕者声与物俱出；吐者有物无声；哕者有声无物。（李东垣）
恶心者无声无物，但心中兀兀然无奈，欲吐不吐，欲呕不呕，虽曰恶心，实非心经之病，皆在胃口上也。（《活人书》）
身背皆热，肘臂牵痛，气逆不续，膈间厌闷，食入即呕，名曰漏气。○下焦实热，二便不通，气逆不续，
呕逆不禁，名曰走哺。（《准绳》）
呕为火气炎上，特其一耳。有痰隔中焦，食不得下者；有气逆者；有寒气郁于胃口者；有食滞胃脘，则新
食不得下而反出者；有胃中有火与痰而呕者；有久病胃虚，不纳谷者。（朱丹溪）
胃气不和而呕吐，人所共知。然有胃寒胃热，痰饮宿食，及风邪入胃，气逆冲上，数种之异，可不究其所
自来哉。（杨仁斋）
呕吐一证，挟寒则喜热恶寒，肢冷脉小；挟热则喜冷恶热，燥渴脉洪。气滞者胀满不通；痰饮者遇冷即发。
呕苦知邪在胆；吐酸识火入肝。呕涎水虽属痰饮，尚疑虫证；吐酸腐无非食滞，更防火患。吐清水是土之卑监；
吐绿水是木之发生。黑水从胃底翻出；臭水是肠中逆来。（《证治汇补》）
吐清水，其因有五∶身受寒气，口食生冷而作者，胃寒也；食少而吐清水者，气虚也；食后而吐清水者，
宿食也；胸膈间辘辘有声者，痰饮也；心腹间时时作痛者，虫也。宜辨而治之。（徐春甫）
凡胃虚作呕者，其证不一，当知所辨。若胃脘不胀者，非实邪也。胸膈不痛者，非气逆也。内无热躁者，
非火证也。外无寒热者，非表邪也。无食无火，而忽为呕吐者，胃虚也。呕吐无常，而时作时止者，胃虚也。
食无所停，而闻食则呕者，胃虚也。气无所逆，而闻气则呕者，胃虚也。或身背微寒食饮即呕者，胃虚也。或
吞酸嗳腐，时苦恶心，兀兀泛泛，冷咽靡定者，胃虚也。或因病误治，妄用克伐寒凉，本无呕而致呕者，胃虚
也。或朝食暮吐，暮食朝吐，食入中焦而不化者，胃虚也。食入下焦而不化者，土母无阳，命门虚也。凡此虚
证，必皆宜补，是固然矣。然胃土非火不生，非暖不化，是土寒者即土虚也，土虚者即火虚也。故曰脾喜暖而
恶寒，土恶湿而喜燥。所以东垣《脾胃论》特着温补之法，盖特为胃气而设也。（张景岳）
补编
病患欲吐者，不可下之。○呕而胸满者，茱萸汤主之。○干呕，吐涎沫，头痛者，茱萸汤主之。○呕而肠
鸣，心下痞者，半夏泻心汤主之。○干呕而利者，黄芩加半夏生姜汤主之○诸呕吐，谷不得下者，小半夏汤主
之。○呕吐而病在膈上，后思水者解，急与之。思水者，猪苓散主之。○呕而脉弱，小便复利，身有微热，见
厥者难治，四逆汤主之。○呕而发热者，小柴胡汤主之。○胃反，呕吐者，大半夏汤主之。○胃反，吐而渴欲饮
水者，茯苓泽泻汤主之。○食已即吐者，大黄甘草汤主之。○吐后，渴饮得水而贪饮者，文蛤汤主之。○干呕吐
逆，吐涎沫，半夏干姜散主之。○病患胸中似喘不喘，似呕不呕，似哕不哕，彻心中愦愦然无奈者，生姜半夏
汤主之。（《金匮》）
吐有三因∶气、积、寒也。上焦吐者从于气，气者天之阳也。脉浮而洪，头晕不已，气上冲胸，食已即
吐，渴欲饮水，当降气和中。中焦吐者从于积，有阴有阳，气食相假。脉浮而弦，胸中痞闷，或先痛后吐，或
先吐后痛，当祛积和气。下焦吐者从于寒，地道也。脉沉而迟，四肢清冷，朝食暮吐，暮食朝吐，小便清利，
大便不通，当通其闭塞，温其寒气。（张洁古）
上焦之吐，多由气闭，责诸胃阳不能上升也，治在温胃。下焦之吐，多由阴逆，责诸肾阳不能下镇也，
治在纳火。（程郊倩）
仲景云∶病患欲吐不吐者，不可下。又用大黄治食已即吐，何也？曰∶欲吐者，其病在上，因而越之可
也。逆之使下，则必抑塞，愦乱益甚，故禁之。若既吐矣，吐而不已，有升无降，则当逆而折之，引令下行，
无速于大黄，故不禁也。（王宇泰）
呕吐而大小便不秘，利药所当忌也。若大小肠、膀胱热结不通，上为呕吐隔食，若不用利药开通发泄，
则呕吐何由止乎！古人用三乙承气汤，正是此意。○凡呕家，禁服栝蒌、桃仁。一切有油之物，皆犯胃作吐。（朱丹溪）
食入即出，是无水也。盖肾司闭藏之令，肾水既绝，则不能纳气，气不归原，逆于膈上，故呕而食出也，
宜六味丸。食久反出，吐出原物，全不化腐，此肾阳虚不能温养脾土也，宜八味丸。凡寒在上焦，则多为恶心，
或泛泛欲吐者，此胃阳虚也。水到咽喉即呕者，乃脾胃本亏，机关不利也，宜六君子汤加砂仁、炮姜。食后冷
涎不已，随即吐出者，宜六君子汤加丁香、益智仁。○邪在胆经，木乘于胃，吐逆而胆汁上溢，所以呕苦也，
宜吴萸、黄连、茯苓、泽泻、生姜。（《见闻录》）
又有一种肝火之证，呕而不食，所呕酸水、或苦水、或青绿水，亦作心痛，此是木火郁结。木郁达之，火
郁发之，用萸、连浓煎细呷，再服逍遥散，愈后以六味丸调理。（《赵氏医贯》）
呕吐用沉香者，取其沉重下行，使肾纳气，气不泛上，吐自止矣。（查了吾）
理中汤加胡椒，能治胃寒呕吐，胡椒乃胃家药也，若加附子则不验。（方星岩）
凡呕家夹热者，不利于香、砂、橘、半，服干姜黄连黄芩人参汤而晏如。（柯韵伯）
有呕吐诸药不止，乃蛔在胸膈，见药则动，动则不纳，药出而蛔不出。宜于治呕药中，加入川椒，蛔见椒
则伏。（《证治准绳》）
久吐不止，用脾胃药须加姜、枣，盖姜、枣能和脾胃也。（王协中）
呕家圣药是生姜，《千金》之说信矣。气逆作呕，生姜散之。痰水作呕，半夏逐之。然惟治寒呕则佳，若
治热呕不可无乌梅。（《医鉴》）
治呕吐，古方通以半夏、生姜为正剂。独东垣云∶生姜止呕，但治表实气壅。若胃虚谷气不行，惟当补胃
调中，推扬谷气。故服小半夏汤不愈者，服大半夏汤立愈。若吐而诸药不效，必加镇重以坠之；吐而中气久虚，
必借谷食以和之。（《医宗必读》）
胃中虚热，谷气久虚而为呕吐者，但得五谷之阴以和之，则呕吐自止。五谷属阴，其汤皆能止呕，不必用
药。（李东垣）
凡治胃虚呕吐，最须详审气味。盖邪实胃强者，无论气味优劣，皆可容受。惟胃虚气弱者，则有宜否之辨。
盖气虚者，最畏不堪之气，不但腥臊之气不能受，即微香微郁，并饮食之气亦不能受。胃弱者，最畏不堪之味，
非惟苦劣之味不能受，即微咸微苦，并五谷正味亦不能受。此胃虚之呕，所以最重气味。使或略有不投，则入
口便吐。故凡治阳虚呕吐等证，则一切香散咸酸辛味，悉以意测；测有不妥，切不可用。但补其阳，阳回则呕
自止。（《景岳全书》）
呕吐一证，《内经》、《金匮》论之详矣。乃后人但以胃火、胃寒、痰食、气滞立论，不思胃司纳食，
主乎通降，求其所以不降而上逆呕吐者，皆由于肝气冲逆，阻胃之降而然也。故《灵枢》云∶足厥阴肝所生病
者，胸满呕逆。况五行生克，木动则必犯土，胃病治肝，不过隔一之治。试观安胃丸、理中安蛔丸，所用椒、
梅，及胃虚客气上逆之旋复、代赭，此皆胃药乎？抑肝药乎？治法以泄肝安胃为纲领，用药以苦辛为主，以酸
佐之。如肝犯胃，而胃阳不衰有火者，泄肝则用芩、连、楝之苦寒。如胃阳衰者，稍减苦寒而用苦辛酸热，此
其大旨也。若肝阴胃汁皆虚，肝风扰胃呕吐者，则以柔剂，滋液养胃，熄风镇逆。若胃阳虚，浊阴上逆者，则
用辛热通之，微佐苦降。若但胃阳虚，而肝木不甚亢者，则专理胃阳，稍佐椒、梅。若因呕伤，寒郁化热，劫
灼胃津者，则用温胆汤加减。若久呕延及肝肾皆虚，冲气上逆者，则用温通柔润之补下焦。若热邪内结者，则
用泻心法。若肝火冲逆伤肺者，则用养金制木，滋水制火之剂。总之，治胃之法，全在温通。虚则必用人参，
药味皆属和平。治肝之法，药味错杂，或寒热互用，或苦辛酸咸并投。盖因厥阴有相火内寄，治法不得不然耳。
（《临证指南》）
脉候
上部有脉，下部无脉，其人当吐不吐者死。（《难经》）
凡呕吐，见歇至脉者，不治。
选案
王御九仲君，因惊受病，时方晚膳，欲吐不出，遂绝粒不食，向后醇酒膏腴，略无阻碍，惟谷气毫不可犯，
犯之辄呕。吴中名师，不识何病，各逞臆见，补泻杂陈。两三月来，湿面亦得相安，但完谷一试，虽极糜烂，
立时返出。偶遇一人言∶此病非药可治。令用生鹅血乘热饮之，一服即效。此虽未见方书，揆之理无妨碍。遂
宰一鹅取血，热饮下咽， 有声，忍之再三，少顷呕出瘀血升许，中有血块数枚，是夜小试稀糜，竟不吐出。
其后渐能用饭，从少至多，无藉汤药而愈。谛思此病，几不可解，胃既不安稼穑，何反胜任血肉之味？且饮鹅
血，何以呕出宿瘀顿愈？因考本草言鹅性凉，利五脏。《千金》云∶射工毒虫，鹅能食之。可知其有祛风、杀
虫、解毒、散血之功。故用其血以开其结，确有至理。更推其受病之源，因惊所致，惊则气乱，载血上逆，而
兀兀欲吐，若彼时吐出，却无菀积阻逆之患。今胃气阻逆，谷神得不困惫乎？其血肉可啖者，正赖脂膏以利脏
腑之气耳。然脏腑之气，非谷不安。而安谷全赖乎血，血者神气也。故取善消谷气之血，乘其生气未离，直透
关钥，引领宿积之瘀一涌而胸次荡然，真补中寓泻之良法也。详鹅血可以激发胃中宿瘀，则生鸭血未为不可，
生黄牛血亦未为不可。总取以血攻血，而无峻攻伤胃之虞。（张路玉）
一产妇病呕吐，勺水不入，脉细如丝，手足厥冷，阳将绝矣。而又水逆，奈何？乃用人参、附子为末，煎
陈皮水，和陈米汁作丸，令含口中，俟其自化，化已复含。尽一日之久，吐觉稍定。再进附子理中汤，手足渐
温。第吐不能全止，自觉有物，从少腹上冲咽喉即吐，此肾气上逆也，改用八味汤加人参而愈。（汪广期）
一人患呕吐，诸药不效，但吃井水一口即止，后用白术茯苓
汤治愈。此即《金匮》“呕吐思水者解，急与之”之意也，可信先贤之言不诬。（娄全善）
邻子十岁，从戏台倒跌而下，呕吐苦水，以盆盛之，绿如菜汁。余曰∶此胆倒也。跌翻而下，胆汁倾出，
汁尽死矣。方用温胆汤加枣仁、赭石，正其胆腑，可名正胆汤，一服吐止。忆昔曾见此证，不知其治，遂不救。
（许宣治）
附方
止呕吐方 治胃虚呕吐饮食。用炒陈仓米、伏龙肝二味，长流水煎服。甚者加人参更效。
附∶吐矢
吐矢一证，古书未载。大约其标在胃，其本在肾，幽门失开阖之职也。《经》曰∶饮入于胃，游溢精气，
上输于脾，脾气散精，上归于肺。食气入胃，散精于肝，淫气于筋。食气入胃，浊气归心，淫精于脉。果清者
上升而营运精微，浊者下降而变化糟粕，安得秽浊之物，直逆幽门，反从清道出哉！无如肾水虚，则无形之火
而冲逆者，其常也。无形之火，挟有形秽物而冲逆者，其变也。喻氏有地气加天之说，得毋与此证隐隐有合。
而倒行逆施，于理法之所无而病情之所有者，其为幽门关锁之地为病，胃气亏于中，而肾气亏于下者耶。不然
隔噎之吐，未见吐矢也；反胃之吐，未见吐矢也；脱淤之吐，未见吐矢也；更有呕酸苦汁，痰饮蛔虫，未见吐
矢也。兹则阴阳错乱，清浊混淆，为医家所不及逆料者。洵为幽门无权，胃液空虚，肾火迫之，不足以敌其直
奔之势从小肠入胃，糟粕随之，已可知矣。治非救胃则救肾，非正治则逆治。《经》曰∶肾者胃之关，开窍于
二阴。又曰∶清阳出上窍，浊阴出下窍。必待肾阴回而虚火藏，大便通而机关利，清阳升而浊阴降，此理之所
必然者。（《会心录》）
附案
西商赵谷猷，患吐粪证，医治三年，百药不效。延予时，见
其啖面，余问∶吐否？曰∶面食下咽，觉腹中响动，食自上而下，粪自下而上吐出，不胜其苦。检方皆治气逆
坠下之剂。予曰∶吐证固属气逆，然降下之品，仅降其饮食，而粪仍自上，肠胃中如水车辘轳，何时止息？世
不解肾者胃之关，关门不利，肾实主之；且肾开窍于二阴，顺气之药，徒耗肾阴，恶能有济。方用熟地、山萸、
五味、金樱、芡实镇其中宫，茯苓、白术、巴戟天，肉桂、牛膝行其逆气。服二日吐止，服二十日不再复矣。（程华仲）
【经典论述】
各种痿证、喘证和呕吐，病机都归属于上焦。○各种气逆冲上的症状，病机都归属于火邪。○太阴脾经所说的进食后呕吐，是因为食物充满胃脘而上溢，所以发生呕吐。○少阳胆经受邪所致，会出现呕吐涌出。（《素问》）
足厥阴肝经所生的疾病，包括胸中胀满、呕吐气逆。○容易呕吐，呕吐物味苦，经常长吁短叹，这是邪气在胆，气逆在胃。胆汁外泄，则口苦；胃气上逆，则呕吐苦水，所以称为“呕胆”。（《灵枢》）
【名家言论】
进食时立即吐出，称为呕。食物刚吃进去就吐出来，称为暴吐。吃完饭后才吐出来，称为呕吐。吃下去很久后才吐出来，称为反胃。反复多次呕吐，称为翻胃。○呕的特点是声音和食物一起出来；吐是有食物出来但没有声音；哕（呃逆）是有声音但没有食物出来。（李东垣）
恶心是没有声音也没有食物，只是心中感到烦闷无奈，想吐吐不出，想呕呕不出，虽然叫恶心，实际上并不是心经的病变，都在胃口部位。（《活人书》）
身体背部发热，肘部和手臂牵引疼痛，气逆接续不上，膈间压抑闷塞，食物吃进去就吐出来，这种病叫做漏气。○下焦实热，大小便不通畅，气逆接续不上，呕吐气逆无法控制，这种病叫做走哺。（《准绳》）
呕吐是由于火气炎上，这只是其中一种情况。还有痰湿阻滞中焦，导致食物不能下咽的；有气机上逆的；有寒气郁结在胃口的；有食积停滞在胃脘，导致新吃下的食物不能下行反而反出的；有胃中有火兼有痰浊而呕吐的；有久病导致胃气虚弱，不能受纳食物的。（朱丹溪）
胃气不和导致呕吐，这是大家所共知的。但是有胃寒、胃热、痰饮、宿食，以及风邪侵入胃中，气逆冲上等不同种类的区别，难道可以不探究它们的来源吗？（杨仁斋）
呕吐这一病症，夹带寒邪则喜欢热恶寒，四肢冰冷脉象细小；夹带热邪则喜欢冷恶热，干燥口渴脉象洪大。气机滞涩者会有胀满不通的感觉；痰饮患者遇冷就会发作。呕吐苦水知道邪气在胆；呕吐酸水识别为火邪入肝。呕吐涎水虽然属于痰饮，还要怀疑是否有虫证；呕吐酸腐之物无非是食积，更要防止火热之患。呕吐清水是脾土卑监（湿气过重）的表现；呕吐绿水是肝木发生（肝气过旺）的表现。黑水从胃底翻出；臭水是肠道之气逆行而来。（《证治汇补》）
呕吐清水，原因有五种：感受寒气，食用生冷食物导致的，是胃寒；吃得少而呕吐清水的，是气虚；饭后呕吐清水的，是宿食；胸膈间辘辘有声的，是痰饮；心腹部时时作痛的，是虫证。应当辨别后进行治疗。（徐春甫）
凡是胃虚导致的呕吐，证候不一，应当仔细辨别。如果胃脘不胀，就不是实邪。胸膈不痛，就不是气逆。体内没有热躁，就不是火证。体表没有寒热，就不是表邪。没有食积也没有火邪，却突然发生呕吐的，是胃虚。呕吐无常，时作时止的，是胃虚。食物没有停积，但闻到食物气味就呕吐的，是胃虚。气机没有逆乱，但闻到气味就呕吐的，是胃虚。或者身体背部微寒，饮食入口即呕吐的，是胃虚。或者吞酸嗳腐，时常苦于恶心，心中烦闷泛泛，咽喉发冷不定，是胃虚。或者因病误治，妄用攻伐寒凉药物，本来没有呕吐却导致呕吐的，是胃虚。或者早晨吃晚上吐，晚上吃早上吐，食物进入中焦不能消化的，是胃虚。食物进入下焦不能消化的，是脾土之母无阳，命门虚衰。所有这些虚证，必然都应该用补法，这当然是对的。然而胃土非火不生，非暖不化，所以土寒就是土虚，土虚就是火虚。所以说脾喜欢温暖而厌恶寒冷，土厌恶潮湿而喜欢干燥。因此李东垣在《脾胃论》中特别强调温补的方法，这确实是专门为胃气而设立的。（张景岳）
【补充编录】
病人想要呕吐的，不可使用泻下法。○呕吐且胸中胀满的，用吴茱萸汤主治。○干呕，吐出涎沫，头痛的，用吴茱萸汤主治。○呕吐且肠鸣，心下部痞塞的，用半夏泻心汤主治。○干呕且腹泻的，用黄芩加半夏生姜汤主治。○各种呕吐，谷物不能下咽的，用小半夏汤主治。○呕吐且病位在膈上，后来想喝水的表示病将解，应赶快给他喝水。想喝水的，用猪苓散主治。○呕吐且脉象微弱，小便反而通利，身体有微热，出现四肢厥冷的难治，用四逆汤主治。○呕吐且发热的，用小柴胡汤主治。○胃反病，呕吐的，用大半夏汤主治。○胃反病，呕吐且口渴想喝水的，用茯苓泽泻汤主治。○吃完就吐的，用大黄甘草汤主治。○呕吐后，口渴饮水且贪饮的，用文蛤汤主治。○干呕，气逆，吐涎沫的，用半夏干姜散主治。○病人胸中似喘不喘，似呕不呕，似哕不哕，心中极度烦闷无奈的，用生姜半夏汤主治。（《金匮要略》）
呕吐有三种病因：气、积、寒。上焦呕吐源于气，气属于天之阳。脉象浮而洪，头晕不止，气上冲胸，吃完就吐，口渴想喝水，应当降气和中。中焦呕吐源于积，有阴有阳，气与食相互夹杂。脉象浮而弦，胸中痞闷，或先痛后吐，或先吐后痛，应当祛除积滞调和气机。下焦呕吐源于寒，属于地道。脉象沉而迟，四肢清冷，早晨吃晚上吐，晚上吃早上吐，小便清利，大便不通，应当通其闭塞，温其寒气。（张洁古）
上焦的呕吐，多由气机闭塞引起，责任在于胃阳不能上升，治疗在于温胃。下焦的呕吐，多由阴寒之气上逆引起，责任在于肾阳不能下镇，治疗在于纳火归元。（程郊倩）
仲景说：病人想吐又吐不出来的，不可用泻下法。却又用大黄治疗吃完就吐的病，为什么呢？回答说：想吐的，病位在上，顺应病势使其向上排出是可以的。如果逆势使其向下，则必定会导致抑塞，烦乱更加严重，所以禁止泻下。如果已经吐了，吐个不停，只有升没有降，那么就应当逆势折其势头，引导其下行，没有比大黄更快的，所以不禁用。（王宇泰）
呕吐且大小便不秘结的，利尿药是应当禁忌的。如果大小肠、膀胱热结不通，向上导致呕吐隔食，如果不使用利尿药开通发泄，那么呕吐怎么能停止呢！古人使用三乙承气汤，正是这个意思。○凡是呕吐的病人，禁止服用瓜蒌、桃仁。一切含有油脂的东西，都会触犯胃气导致呕吐。（朱丹溪）
食物吃进去就出来，这是无水（肾阴亏虚）。因为肾主管闭藏，肾水枯竭，就不能纳气，气不归原，逆乱于膈上，所以呕吐且食物排出，宜用六味丸。食物吃很久反而出来，吐出的原物完全未消化腐熟，这是肾阳虚不能温养脾土，宜用八味丸。凡是寒邪在上焦，多为恶心，或泛泛欲吐的，这是胃阳虚。水到了咽喉就呕吐的，是脾胃本虚，机关不利，宜用六君子汤加砂仁、炮姜。饭后冷涎不断，随即吐出的，宜用六君子汤加丁香、益智仁。○邪气在胆经，木气乘犯胃土，吐逆且胆汁上溢，所以呕吐苦水，宜用吴茱萸、黄连、茯苓、泽泻、生姜。（《见闻录》）
又有一种肝火的证候，呕吐且不进食，所呕吐的是酸水、或苦水、或青绿水，也伴有心痛，这是木火郁结。木郁应当疏达，火郁应当发散，用吴茱萸、黄连浓煎细细呷服，再服用逍遥散，痊愈后用六味丸调理。（《赵氏医贯》）
治疗呕吐使用沉香，是取其性质沉重下行，使肾纳气，气不泛上，呕吐自然停止。（查了吾）
理中汤加胡椒，能治疗胃寒呕吐，胡椒是胃家的药，如果加上附子就不见效。（方星岩）
凡是呕吐夹带热邪的，不利于香燥、砂仁、橘皮、半夏，服用干姜黄连黄芩人参汤则安然无恙。（柯韵伯）
有呕吐诸药无效的情况，是因为蛔虫在胸膈，见到药就动，动了就不能接纳，药出来而蛔虫不出来。应当在治呕药中加入川椒，蛔虫见到花椒就会伏卧不动。（《证治准绳》）
久吐不止，使用脾胃药必须加生姜、大枣，因为姜、枣能调和脾胃。（王协中）
治疗呕吐的圣药是生姜，《千金方》的说法确实可信。气逆作呕，生姜能疏散它。痰水作呕，半夏能驱逐它。然而只有治疗寒呕效果好，如果治疗热呕不可没有乌梅。（《医鉴》）
治疗呕吐，古方通常以半夏、生姜为正剂。唯独李东垣说：生姜止呕，只治疗表实气壅。如果胃虚谷气不行，只应当补胃调中，推扬谷气。所以服用小半夏汤无效的，服用大半夏汤立刻痊愈。如果呕吐且诸药无效，必须加入镇重药物以坠降之；呕吐且中气久虚，必须借助谷食来调和。（《医宗必读》）
胃中虚热，谷气久虚而导致呕吐的，只要得到五谷的阴气来调和它，呕吐自然停止。五谷属阴，其汤汁都能止呕，不必用药。（李东垣）
凡是治疗胃虚呕吐，最须详细审察药物的气味。邪实胃强的病人，无论气味优劣，都可以承受。只有胃虚气弱的病人，才有适宜与否的区别。气虚的人，最畏惧不堪忍受的气味，不但腥臊之气不能接受，即使微香微郁，以及饮食的气味也不能接受。胃弱的人，最畏惧不堪忍受的味道，不但苦劣的味道不能接受，即使微咸微苦，以及五谷的正味也不能接受。这就是胃虚呕吐，之所以最重视气味的原因。如果稍微有不投合，入口就会吐出。所以凡是治疗阳虚呕吐等证，一切香散、咸酸辛味，都要用心推测；推测不妥当，切不可用。只需补其阳气，阳气回复则呕吐自然停止。（《景岳全书》）
呕吐这一病症，《内经》、《金匮要略》论述得很详细了。然而后人只根据胃火、胃寒、痰食、气滞立论，不考虑胃主管受纳食物，主要功能是通降，寻求其不降而上逆呕吐的原因，都是由于肝气冲逆，阻碍胃的降功能所致。所以《灵枢》说：足厥阴肝经所生的疾病，包括胸满呕逆。况且五行生克，木动则必犯土，胃病治肝，不过是隔一脏的治疗。试看安胃丸、理中安蛔丸，所用的花椒、乌梅，以及胃虚客气上逆所用的旋覆花、代赭石，这些是胃药呢？还是肝药呢？治疗方法以泄肝安胃为纲领，用药以苦辛为主，以酸味佐助。如肝气犯胃，而胃阳不衰且有火的，泄肝则用黄芩、黄连、川楝子的苦寒药。如胃阳衰者，稍减苦寒而用苦辛酸热药，这是大概的原则。如果肝阴胃汁都虚，肝风扰胃呕吐的，则用柔剂，滋液养胃，熄风镇逆。如果胃阳虚，浊阴上逆的，则用辛热药通之，微佐苦降药。如果仅胃阳虚，而肝木不甚亢盛的，则专理胃阳，稍佐花椒、乌梅。如果因呕吐损伤，寒郁化热，劫灼胃津的，则用温胆汤加减。如果久呕延及肝肾皆虚，冲气上逆的，则用温通柔润之品补下焦。如果热邪内结的，则用泻心法。如果肝火冲逆伤肺的，则用养金制木、滋水制火的方剂。总之，治胃的方法，全在于温通。虚证必须用人参，药味都属于平和。治肝的方法，药味错杂，或寒热互用，或苦辛酸咸并用。这是因为厥阴肝经有相火内寄，治法不得不如此耳。（《临证指南》）
【脉象候诊】
上部有脉，下部无脉，这个人应当呕吐却不呕吐的，预后不良（死证）。（《难经》）
凡是呕吐，出现歇至脉（间歇脉）的，难以治愈。
【精选医案】
王御九仲君，因惊吓致病，当时正值晚膳，想吐吐不出，于是绝食不吃饭，之后喝醇酒吃肥肉，完全没有阻碍，只有谷物气息丝毫不能触犯，触犯就呕吐。吴中的名医，不知道是什么病，各自逞臆见，补泻药物混杂使用。两三个月来，吃湿面也能相安无事，但只要一试完整谷物，虽然极烂，立刻返吐出来。偶然遇到一个人说：这个病不是药能治好的。让人用生鹅血趁热饮用，一次服药就见效。这虽然没有见于方书，推究其理没有妨碍。于是杀一只鹅取血，趁热饮下，吞咽时有声音，忍耐再三，过了一会儿吐出瘀血约一升，其中有几枚血块，当晚少量尝试稀粥，竟然没有吐出。其后渐渐能吃饭，从少到多，不需要汤药而痊愈。仔细思考这个病，几乎不可理解，胃既然不安于稼穑（谷物），为什么反而胜任血肉的味道？而且饮用鹅血，为什么能吐出宿瘀顿时痊愈？于是考证本草说鹅性凉，利五脏。《千金方》说：射工毒虫，鹅能吃它。可知鹅有祛风、杀虫、解毒、散血的功效。所以用它的血来开其结滞，确有至理。再推究其受病的源头，因惊吓所致，惊则气乱，载血上逆，而心中烦闷欲吐，如果那时吐出来，就没有郁积阻逆的祸患。现在胃气阻逆，谷神能不困惫吗？那血肉可吃的东西，正依赖脂膏来利脏腑之气罢了。然而脏腑之气，没有谷物就不能安宁。而安谷全靠血，血就是神气。所以取善于消谷气的血，趁着其生气未离，直透关钥，引领宿积之瘀血一涌而出而胸次荡然，真是补中寓泻的好方法。详察鹅血可以激发胃中宿瘀，那么生鸭血也未尝不可以，生黄牛血也未尝不可以。总之以血攻血，而没有峻猛攻伐伤胃的忧虑。（张路玉）
一位产妇患呕吐，勺水不进，脉细如丝，手足厥冷，阳气将要断绝了。而又出现水逆，怎么办？于是用人参、附子研末，煎陈皮水，和陈米汁做成丸药，令含在口中，等待其自然融化，化完再含。经过一整天，呕吐觉得稍微安定。再进服附子理中汤，手足渐渐温暖。只是呕吐不能完全停止，自觉有物从少腹上冲咽喉即吐，这是肾气上逆，改用八味汤加人参而痊愈。（汪广期）
一人患呕吐，诸药无效，但吃一口井水就停止，后用白术茯苓汤治愈。这就是《金匮要略》“呕吐思水者解，急与之”的意思，可以相信先贤的话没有虚假。（娄全善）
邻居孩子十岁，从戏台倒跌而下，呕吐苦水，用盆盛放，绿得像菜汁。我说：这是胆倒也。跌翻而下，胆汁倾出，汁尽人就死了。方子用温胆汤加枣仁、赭石，正其胆腑，可以名叫正胆汤，一服呕吐停止。回忆过去曾见过这个证，不知道如何治疗，于是没能救活。（许宣治）
【附方】
止呕吐方 治疗胃虚呕吐饮食。用炒陈仓米、伏龙肝两味药，长流水煎服。严重的加人参效果更好。
【附录：吐矢】
吐矢（呕吐粪便）这一病症，古书没有记载。大约其标在胃，其本在肾，幽门失去了开阖的功能。《内经》说：饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺。食气入胃，散精于肝，淫气于筋。食气入胃，浊气归心，淫精于脉。如果清的上升而营运精微，浊的下降而变化糟粕，怎么会有秽浊之物，直接逆冲幽门，反而从清道（食道）出来的呢！无奈肾水虚，则无形之火冲逆，这是常理。无形之火，挟有形秽物而冲逆，这是变局。喻嘉言有地气加天说的理论，恐怕与此证隐隐相合。而倒行逆施，于理法之所无而病情之所有者，其为幽门关锁之地为病，胃气亏于中，而肾气亏于下者耶。不然，隔噎之吐，未见吐矢；反胃之吐，未见吐矢；脱淤之吐，未见吐矢；更有呕酸苦汁，痰饮蛔虫，未见吐矢。兹则阴阳错乱，清浊混淆，为医家所不及逆料者。确为幽门无权，胃液空虚，肾火迫之，不足以敌其直奔之势从小肠入胃，糟粕随之，已可知矣。治疗非救胃则救肾，非正治则逆治。《内经》说：肾者胃之关，开窍于二阴。又说：清阳出上窍，浊阴出下窍。必须等到肾阴回而虚火藏，大便通而机关利，清阳升而浊阴降，此理之所必然者。（《会心录》）
【附案】
西商赵谷猷，患吐粪证，医治三年，百药无效。请我诊治时，见他吃面，我问：吐吗？他说：面食下咽，觉腹中响动，食自上而下，粪自下而上吐出，不胜其苦。检阅处方都是治气逆坠下之剂。我说：吐证固属气逆，然而降下之品，仅降其饮食，而粪仍自上，肠胃中如水车辘轳，何时止息？世人不懂肾者胃之关，关门不利，肾实主之；且肾开窍于二阴，顺气之药，徒耗肾阴，恶能有济。方用熟地、山萸肉、五味子、金樱子、芡实镇守中宫，茯苓、白术、巴戟天、肉桂、牛膝行其逆气。服用两天呕吐停止，服用二十天不再复发。（程华仲）
[Classic Theories]
Various flaccidity syndromes (Wei syndrome), wheezing syndromes, and vomiting syndromes all have pathogenesis belonging to the Upper Jiao. ○ Various symptoms of rebellious Qi rushing upward all have pathogenesis belonging to Fire. ○ What the Taiyin Spleen Meridian describes as vomiting after eating is due to food filling the stomach and overflowing upward, hence vomiting. ○ When Shaoyang Gallbladder Meridian is affected, it results in vomiting and gurgling. (*Su Wen*)
The diseases generated by the Foot-Jueyin Liver Meridian include chest fullness and rebellious vomiting. ○ Frequent vomiting with bitter taste, frequent deep sighing: this indicates pathogen in the Gallbladder and rebellious Qi in the Stomach. Bile fluid leaking causes bitter mouth; Stomach Qi rebelling upward causes vomiting of bitter water, thus called "Gallbladder Vomiting". (*Ling Shu*)
[Masters' Discourses]
Vomiting when food is bitten/chewed is called Ou (vomit). Vomiting immediately after swallowing is called Bao Tu (sudden vomiting). Vomiting after finishing a meal is called Ou Tu (vomiting). Vomiting long after eating is called Fan Wei (reverse stomach). Repeated vomiting is called Fan Wei (turning stomach). ○ Ou involves both sound and matter coming out; Tu involves matter without sound; Yue (hiccup) involves sound without matter. (Li Dongyuan)
Nausea has no sound or matter, only a feeling of inner restlessness and helplessness, wanting to vomit but unable to, wanting to retch but unable to. Although called nausea, it is actually not a disease of the Heart Meridian, but located at the gastric opening. (*Huo Ren Shu*)
Heat in the body and back, pulling pain in elbows and arms, interrupted Qi flow, oppression and stuffiness in the diaphragm, vomiting immediately after eating: this is named Lou Qi (leaking Qi). ○ Excess-Heat in the Lower Jiao, blockage of urination and defecation, interrupted Qi flow, uncontrollable vomiting and rebellious Qi: this is named Zou Bu (running feeding). (*Zhun Sheng*)
Vomiting due to Fire Qi flaming upward is just one type. There are also cases where Phlegm obstructs the Middle Jiao preventing food descent; cases of Qi rebellion; cases where Cold Qi stagnates at the gastric opening; cases where Food Stagnation in the stomach prevents new food from descending causing reflux; cases of Fire and Phlegm in the Stomach causing vomiting; and cases of chronic illness leading to Stomach deficiency failing to accept food. (Zhu Danxi)
Stomach Qi disharmony causing vomiting is common knowledge. However, there are differences such as Stomach Cold, Stomach Heat, Phlegm-Fluids, retained food, and Wind Pathogen invading the Stomach causing Qi rebellion. One must investigate their origins. (Yang Renzhai)
In vomiting syndromes, if accompanied by Cold, there is preference for heat and aversion to cold, cold limbs, and fine pulse; if accompanied by Heat, there is preference for cold and aversion to heat, dry thirst, and surging pulse. Qi stagnation presents with distension and blockage; Phlegm-Fluids manifest upon exposure to cold. Vomiting bitter water indicates pathogen in the Gallbladder; vomiting sour water indicates Fire entering the Liver. Vomiting saliva/fluid belongs to Phlegm-Fluids but may suggest Parasites; vomiting sour/rotten matter indicates Food Stagnation, watch out for Fire damage. Vomiting clear water indicates Spleen Earth dampness (low monitoring); vomiting green water indicates Liver Wood overactivity. Black water turning up from the stomach bottom; foul-smelling water comes from intestinal reversal. (*Zheng Zhi Hui Bu*)
Causes of vomiting clear water include five types: contracting cold or eating raw/cold foods causing Stomach Cold; eating little yet vomiting clear water indicating Qi Deficiency; vomiting clear water after eating indicating retained food; gurgling sounds in chest/diaphragm indicating Phlegm-Fluids; intermittent heart/abdominal pain indicating Parasites. Differentiate and treat accordingly. (Xu Chunfu)
For vomiting caused by Stomach deficiency, signs vary and must be differentiated. If epigastrium is not distended, it is not Excess Pathogen. If chest/diaphragm does not hurt, it is not Qi rebellion. If no internal heat/restlessness, it is not Fire syndrome. If no external cold/heat, it is not Exterior Pathogen. Without food retention or fire, sudden vomiting indicates Stomach deficiency. Irregular vomiting that comes and goes indicates Stomach deficiency. Vomiting upon smelling food without actual retention indicates Stomach deficiency. Vomiting upon smelling odors without Qi rebellion indicates Stomach deficiency. Back chills with immediate vomiting after drinking/eating indicates Stomach deficiency. Acid regurgitation, belching rotten food, frequent nausea, inner restlessness, cold throat sensations indicate Stomach deficiency. Iatrogenic vomiting due to misuse of purgatives/cold herbs indicates Stomach deficiency. Morning eating evening vomiting, evening eating morning vomiting, food not digesting in Middle Jiao indicates Stomach deficiency. Food not digesting in Lower Jiao indicates Mother of Earth (Spleen) lacks Yang, Mingmen Deficiency. All these deficiency syndromes require tonification. However, Earth needs Fire to generate and warmth to transform; thus Earth Cold is Earth Deficiency, Earth Deficiency is Fire Deficiency. Therefore, Spleen likes warmth and dislikes cold; Earth dislikes dampness and likes dryness. Hence Li Dongyuan's *Pi Wei Lun* emphasizes warm tonification, specifically for Stomach Qi. (Zhang Jingyue)
[Supplementary Compilation]
If a patient wants to vomit, do not use purgatives. ○ Vomiting with chest fullness: Zhu Yu Tang (Evodia Decoction) governs. ○ Dry retching, vomiting saliva, headache: Zhu Yu Tang governs. ○ Vomiting with bowel sounds and epigastric stuffiness: Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) governs. ○ Dry retching with diarrhea: Huang Qin Jia Ban Xia Sheng Jiang Tang (Scutellaria Decoction plus Pinellia and Fresh Ginger) governs. ○ Various vomiting where grains cannot pass: Xiao Ban Xia Tang (Minor Pinellia Decoction) governs. ○ Vomiting with pathology above the diaphragm, followed by desire for water indicates resolution; give water promptly. For those desiring water, Zhu Ling San (Polyporus Powder) governs. ○ Vomiting with weak pulse, free urination, slight body heat, and cold extremities is difficult to treat; Si Ni Tang (Four Counterflow Decoction) governs. ○ Vomiting with fever: Xiao Chai Hu Tang (Minor Bupleurum Decoction) governs. ○ Wei Fan (Stomantic Reversal) with vomiting: Da Ban Xia Tang (Major Pinellia Decoction) governs. ○ Wei Fan with vomiting and thirst for water: Fu Ling Ze Xie Tang (Poria and Alisma Decoction) governs. ○ Vomiting immediately after eating: Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) governs. ○ After vomiting, excessive thirst and craving for water: Wen Sha Tang (Clam Shell Decoction) governs. ○ Dry retching, rebellious Qi, vomiting saliva: Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) governs. ○ Patient feels like panting but not, like vomiting but not, like hiccuping but not, with profound inner restlessness: Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) governs. (*Jin Gui Yao Lue*)
Three causes of vomiting: Qi, Accumulation, Cold. Upper Jiao vomiting stems from Qi (Heavenly Yang). Pulse floating and surging, persistent dizziness, Qi rushing to chest, vomiting after eating, thirst for water: descend Qi and harmonize middle. Middle Jiao vomiting stems from Accumulation (Yin/Yang, Qi/Food mix). Pulse floating and wiry, epigastric stuffiness, pain before/after vomiting: remove accumulation and harmonize Qi. Lower Jiao vomiting stems from Cold (Earthly Path). Pulse deep and slow, cold limbs, morning eating evening vomiting, clear urine, constipation: open blockage and warm Cold. (Zhang Jiegong)
Upper Jiao vomiting often due to Qi closure, blaming Stomach Yang's failure to ascend; treatment warms Stomach. Lower Jiao vomiting often due to Yin rebellion, blaming Kidney Yang's failure to descend; treatment anchors Fire. (Cheng Jiaoqian)
Jingue says: "Patient wants to vomit but cannot, do not purge." Yet he uses Rhubarb for vomiting after eating. Why? Answer: Wanting to vomit means pathology is upper; inducing emesis is appropriate. Forcing downward causes obstruction and worsens restlessness, hence prohibited. If vomiting persists with no descent, reverse it and guide downward; Rhubarb is fastest, hence permitted. (Wang Yutai)
If vomiting occurs with unobstructed stool/urine, diuretics are contraindicated. If Large Intestine, Small Intestine, Bladder have Heat binding causing vomiting/blockage, diuretics/openers are needed to stop vomiting. Ancient use of San Yi Cheng Qi Tang reflects this. ○ Vomiting patients forbid Gua Lou (Trichosanthes) and Tao Ren (Peach Seed). Oily substances offend Stomach causing vomiting. (Zhu Danxi)
Food exiting immediately indicates Water Deficiency. Kidney controls closure; Kidney Water exhausted fails to grasp Qi; Qi fails to root, rebels above diaphragm, causing vomiting/food exit; use Liu Wei Wan (Six-Ingredient Pill). Food exits long after eating, undigested, indicates Kidney Yang Deficiency failing to warm Spleen Earth; use Ba Wei Wan (Eight-Ingredient Pill). Cold in Upper Jiao causes nausea/retching, indicating Stomach Yang Deficiency. Water vomiting at throat indicates Spleen/Stomach root deficiency, mechanism dysfunction; use Liu Jun Zi Tang plus Sha Ren, Pao Jiang. Cold saliva after eating indicates Spleen/Stomach deficiency; use Liu Jun Zi Tang plus Ding Xiang, Yi Zhi Ren. Pathogen in Gallbladder Meridian, Wood attacking Stomach, bile reflux causing bitter vomiting; use Yu Zhu, Huang Lian, Fu Ling, Ze Xie, Sheng Jiang. (*Jian Wen Lu*)
Another Liver Fire syndrome: vomiting without eating, vomiting sour/bitter/green water, heart pain, indicates Wood-Fire stagnation. Unblock Wood, vent Fire; use Yu Zhu/Huang Lian decoction sipped slowly, then Xiao Yao San; regulate with Liu Wei Wan post-recovery. (*Zhao Shi Yi Guan*)
Using Chen Xiang (Aquilaria) for vomiting utilizes its heavy descending nature to anchor Kidney Qi, preventing Qi floating upward, stopping vomiting. (Cha Liaowu)
Li Zhong Tang plus Hu Jiao (Pepper) treats Stomach Cold vomiting; Pepper is a Stomach herb. Adding Fu Zi makes it ineffective. (Fang Xingyan)
For vomiting with Heat, aromatic/cardamom/orange/pinellia are unfavorable; Gan Jiang Huang Lian Huang Qin Ren Shen Tang (Ginger, Coptis, Scutellaria, Ginseng Decoction) brings peace. (Ke Yunbo)
If vomiting medicines fail, consider Ascaris in chest/diaphragm reacting to medicine. Add Chuan Jiao (Sichuan Pepper) to subdue worms. (*Zheng Zhi Zhun Sheng*)
For chronic vomiting, add Sheng Jiang and Da Zao to Spleen/Stomach formulas to harmonize them. (Wang Xiezhong)
Sheng Jiang is the holy medicine for vomiting. For Qi rebellion, Sheng Jiang disperses; for Phlegm-Fluids, Ban Xia expels. Sheng Jiang is good for Cold vomiting; for Heat vomiting, Wu Mei (Mume Fruit) is essential. (*Yi Jian*)
Ancient formulas use Ban Xia and Sheng Jiang as main agents for vomiting. Li Dongyuan notes Sheng Jiang stops vomiting only for Exterior Excess/Qi congestion. For Stomach deficiency/failure of grain Qi, tonify Stomach/harmonize middle. Xiao Ban Xia Tang fails, Da Ban Xia Tang succeeds. If vomiting resists all meds, add heavy descending agents; if Middle Qi deficient, rely on grain food to harmonize. (*Yi Zong Bi Du*)
Stomach Empty Heat/Grain Qi deficiency causing vomiting: nourish with Yin of Five Grains to stop vomiting. Grain soups stop vomiting without drugs. (Li Dongyuan)
Treating Stomach deficiency vomiting requires careful attention to flavor/aroma. Excess/Stomach strength tolerates any flavor. Stomach deficiency fears offensive aromas (even mild fragrance) and flavors (even mild salty/bitter/grain taste). Thus, aroma/flavor is critical. Mismatch causes immediate vomiting. For Yang Deficiency vomiting, avoid aromatic/sour/salty/spicy unless carefully assessed. Tonify Yang; return of Yang stops vomiting. (*Jing Quan Quan Shu*)
Vomiting discussed in *Nei Jing*/*Jin Gui*. Later doctors focus on Stomach Fire/Cold/Phlegm/Food/Qi, ignoring that Stomach governs reception and descending. Non-descending/rebellious vomiting is due to Liver Qi rebellion blocking Stomach descent. *Ling Shu*: Liver Meridian diseases include chest fullness/vomiting. Wood attacks Earth. Treating Stomach via Liver is indirect. An Wei Wan/Li Zhong An He Wan use Pepper/Mume; Xu Fu/Zhe Shi treat rebellious Qi. Are these Stomach or Liver herbs? Principle: Drain Liver to calm Stomach. Meds: Bitter/Acrid primary, Sour assistant. Liver attacking Stomach with Fire: drain Liver with Ku Han (Bitter Cold) like Qin, Lian, Lian Zi. Stomach Yang decline: reduce Ku Han, use Ku Xin Suan Re (Bitter/Acrid/Sour/Warm). Liver Yin/Stomach Juice deficiency with Wind: use soft agents, nourish fluids, extinguish wind. Stomach Yang deficiency with Turbid Yin rising: use Acrid-Warm to open, slightly assist with Bitter descent. Stomach Yang deficiency without strong Liver: manage Stomach Yang, assist with Pepper/Mume. Vomiting injury, Cold transforming to Heat damaging fluids: modify Wen Dan Tang. Chronic vomiting affecting Liver/Kidney with Chong Qi rebellion: warm/unblock/nourish Lower Jiao. Heat binding internally: use Xie Xin method. Liver Fire injuring Lung: nourish Metal/control Wood, nourish Water/control Fire. General: Stomach treatment relies on Warmth/Unblocking. Deficiency uses Ren Shen, mild flavors. Liver treatment uses mixed flavors, hot/cold, bitter/acrid/salty together due to Minister Fire in Jueyin. (*Lin Zheng Zhi Nan*)
[Pulse Diagnosis]
Pulse present in upper, absent in lower, patient should vomit but doesn't: death prognosis. (*Nan Jing*)
Vomiting with intermittent pulse: untreatable.
[Selected Cases]
Wang Yujiu suffered from shock illness. At dinner, wanted to vomit but couldn't, stopped eating grains. Alcohol/fat passed easily, but grains caused vomiting. Famous doctors used mixed tonifying/purging methods. Wet noodles tolerated, whole grains vomited immediately. Someone suggested drinking hot goose blood. One dose effective. Goose blood opens stagnation, dispels wind/toxins/blood stasis. Shock causes Qi chaos, blood rebellion. Vomiting would have prevented stagnation. Now Stomach Qi blocked, Grain Spirit exhausted. Blood nourishes organs; goose blood stimulates old stasis, clearing chest. A method of tonifying while purging. Raw duck/beef blood also usable. (*Zhang Luyu*)
Postpartum woman vomiting, spoonful of water refused, thread-like pulse, cold limbs, Yang near extinction. Water rebellion present. Used Ren Shen, Fu Zi powder, Chen Pi water, rice juice pills held in mouth. Vomiting subsided. Then Fu Zi Li Zhong Tang warmed limbs. Still vomiting, sensation of mass rising from lower abdomen to throat: Kidney Qi rebellion. Changed to Ba Wei Tang plus Ren Shen, cured. (Wang Guangqi)
Man with vomiting, all meds failed. One sip of well water stopped it. Cured with Bai Zhu Fu Ling Tang. Matches *Jin Gui*: "Vomiting with desire for water resolves, give water." (Lou Quanshan)
Neighbor's son fell from stage, vomited bitter green liquid. Diagnosed as Gallbladder reversal. Used Wen Dan Tang plus Suan Zao Ren, Zhe Shi (named Zheng Dan Tang). One dose stopped vomiting. (*Xu Xuanzhi*)
[Attached Formulas]
Stop Vomiting Formula: For Stomach deficiency vomiting. Stir-fried Chen Cang Mi (aged rice) + Fu Long Gan (Dried Dragon Bone/Clay), decoct in running water. Add Ren Shen for severe cases.
[Appendix: Vomiting Feces]
Vomiting feces (Tu Shi) is rare in classics. Mark in Stomach, Root in Kidney, Pylorus dysfunction. *Jing*: Fluids enter Stomach, essence ascends to Spleen/Lung. Food enters Stomach, essence to Liver/Heart. Clear rises, turbid descends. How can waste reverse through Pylus to esophagus? Kidney Water deficiency allows Fire rebellion (normal). Fire carrying waste rebels (abnormal). Metaphor: Earth Qi adding to Heaven Qi. Pyloric lock, Stomach Qi deficiency middle, Kidney Qi deficiency lower. Unlike Ge Ye (regurgitation) or Fan Wei (reversal), this is Yin/Yang confusion, Clear/Turbid mixing. Pylorus powerless, Stomach fluid empty, Kidney Fire forcing waste from Small Intestine to Stomach. Treatment: Save Kidney or Stomach, direct or reverse therapy. Kidney is Stomach gate, opens to two yin. Clear Yang exits upper orifices, Turbid Yin exits lower. Wait for Kidney Yin return,虛火 hidden, stool通畅, mechanisms free, Clear Yang rises, Turbid Yin descends. (*Hui Xin Lu*)
[Attached Case]
Merchant Zhao Guyou vomited feces for 3 years, meds failed. Ate noodles, felt rumbling, food down, feces up. Prescriptions were Qi-descending. I said: Descending meds only move food, not feces. Intestines like waterwheel. People don't know Kidney is Stomach gate. Qi meds consume Kidney Yin. Formula: Shu Di, Shan Yu, Wu Wei, Jin Ying, Qian Shi (anchor middle); Fu Ling, Bai Zhu, Ba Ji Tian, Rou Gui, Niu Xi (guide rebellious Qi). 2 days vomiting stopped; 20 days recurrence ceased. (Cheng Huazhong)