凡病皆有虚实寒热。而呕吐为尤甚。良由治之者。喜温暖而利攻伐。热者
热之无遗。火症临之愈剧。攻者攻之殆尽。胃气因而转伤。于是有呕之不
止。而吐之勿绝。其不至危殆者几希。盖缘寒与实易辨。而虚与热易淆也。
寒与实者。或内伤生冷。或客寒犯胃。或醉饱无度。或饮食失节。脉必沉紧
弦滑。而中焦胀满不安。不有以温之。则寒不除。不有以攻之。则滞不化。宜
乎藿香平胃之属。奏绩易易也。若夫寒郁为热。经曰诸逆冲上。皆属于火。
诸呕吐酸。皆属于热。人咸知之。唯是不察其因。而漫以止吐药投之。往往
喜用香燥。殊不知呕属少阳。木中有火。火性炎上。肋之弥炽。甚至呕绿水
或如菜叶者。则胆中之汁也。使不急与栀连降之。则呕逆何时而止耶。每
见惊伤胆者。其病善呕。先哲立温胆汤。独入竹茹。降气降火。意可识矣。况
乎胃属土。畏木者也。木邪凌土。胃气必伤。水谷不纳。胃中之津液。竭尽无
余。而下焦之气。逆而上攻。比比胸膈痞塞。有似乎实。医者从而伐之。则一
线之气立断矣。故凡遇久吐伤胃。则必于清火中加人参以扶胃气。然后
徐进米饮。方能纳也。尝见古人治虚寒吐逆。用热药恐其捍格。反入黄连
童便为向导。下安阴分。矧在热症。而反以火济火乎。虽其间声物俱出谓
之吐。有声无物谓之呕。声浊恶而长谓之哕。或七情之拂郁。或六气之交
乘。或水土之不和。或关格之不利。种种悬殊。疗非一致。然苟能于虚实寒
热体勘精切。亦可无遗蕴矣。
治验
一女子积劳后。忽发寒热。呕吐不止。三日夜罔间。凡用藿香二陈伏龙肝
之类。皆不效。呕至如菜叶青汁。形神俱疲。余急进山栀人参神曲茯苓
一剂。其呕渐止。后以人参调理而痊。
一女子因惊后。胃脘作疼。呕逆不止。亦越三日矣。胸中时叫饥。但不能纳
谷味耳。且神昏谵妄。面见 疹。及余按其脉则弦。而重取则空。弦者。惊
伤胆之脉也。空者。胃气虚之诊也。 疹者。火炎上之象也。余以远志茯
神枣仁安神养胃。木香陈皮止痛平气。山栀童便降火。稍入柴胡引经。
倍用钩藤止惊。一剂呕止 退。神安思食。再剂而愈。
二陈汤
半夏 茯苓 广皮（各一钱） 甘草（三分）
姜三片。水煎。如脉数烦热呕酸。加黄芩山栀钩藤。甚则入黄连。如停滞。
加浓朴莱菔子枳实。如畏寒。加藿香木香。如因惊。加竹茹。如中气虚。加
人参石斛。虚寒入炮姜熟附。
凡是疾病都有虚、实、寒、热的区别。而呕吐这一病症表现得尤为严重。这往往是因为治疗者喜欢用温补的方法，却滥用攻伐（泻下）的手段。对于热证，如果不彻底清热，火热症状就会更加剧烈；对于实证，如果过度攻下，胃气就会因此受到损伤。于是出现呕吐不止、吐个不停的情况，这种情况下能够不陷入危重状态的寥寥无几。大概是因为寒证和实证容易辨别，而虚证和热证容易混淆。
如果是寒证或实证，可能是因为内伤生冷食物，或者外感寒邪侵犯胃部，或者醉酒饱食无度，或者饮食没有节制。脉象必定表现为沉紧、弦滑，并且中焦（脾胃所在部位）胀满不安。如果不加以温散，寒气就不能去除；如果不加以攻逐，积滞就不能化解。所以适宜使用藿香平胃散之类的方剂，很容易就能见效。
至于寒邪郁结转化为热证，《黄帝内经》说：“各种向上冲逆的症状，都属于火。”“各种呕吐酸水，都属于热。”人们都知道这一点。只是如果不考察病因，随意投止吐药，往往喜欢使用香燥的药物。殊不知呕吐属于少阳病（少阳经受邪），肝胆木气中有火，火性炎上，如果用香燥药物助长火势，会使病情更加炽盛。甚至出现呕吐绿色液体或像菜叶一样的东西，那是胆汁。如果不赶紧用栀子、黄连来降火，呕吐什么时候才能停止呢？
经常见到因惊吓损伤胆气的患者，他们容易呕吐。先哲创立了温胆汤，其中特别加入竹茹，以降气降火，其中的用意是可以理解的。况且胃属土，畏惧木气克制。如果木邪凌犯脾土，胃气必然受损，导致无法进食水谷，胃中的津液枯竭殆尽，而下焦的气逆而上冲，常常导致胸膈痞塞，看起来像是实证。医生如果随之进行攻伐，那么仅存的一丝胃气就会立即断绝。所以凡是遇到久吐伤及胃气的情况，必须在清火药中加入人参来扶持胃气，然后慢慢进服米汤，才能接纳食物。
曾经看到古人治疗虚寒引起的呕吐逆气，因为担心热药与体内虚寒格格不入，反而加入黄连和童便作为向导，以安定阴分。何况是在热证的情况下，怎么能再用火来助火呢？虽然其中声音和物体一起出来的叫做“吐”，只有声音没有物体的叫做“呕”，声音浑浊恶臭且长的叫做“哕”。或者是七情（喜、怒、忧、思、悲、恐、惊）的拂郁，或者是六气（风、寒、暑、湿、燥、火）的交乘，或者是水土的不和，或者是关格（大小便不通）的不利，种种情况悬殊，治疗方法并不一致。但是如果能对虚实寒热仔细辨析，也可以没有遗漏了。
治验案例：
一个女子在积劳之后，突然发作寒热，呕吐不止，三昼夜不间断。凡是使用藿香正气散、二陈汤、伏龙肝之类的药物，都没有效果。呕吐物像菜叶青汁一样，形体和精神都非常疲惫。我急忙给予山栀、人参、神曲、茯苓一剂药，她的呕吐逐渐停止。后来用人参调理而痊愈。
另一个女子因为受惊后，胃脘疼痛，呕吐不止，也超过三天了。胸中时常感到饥饿，但不能吃谷物等食物。而且神志昏沉胡言乱语，面部出现皮疹。等我按摸她的脉象，则脉弦，重按则空虚无根。弦脉，是惊吓损伤胆气的脉象；空脉，是胃气虚弱的诊断表现；皮疹，是火炎上的征象。我用远志、茯神、枣仁来安神养胃，木香、陈皮来止痛平气，山栀、童便来降火，稍微加入柴胡作为引经药，倍用钩藤来止惊。一剂药后呕吐停止，皮疹消退，神志安宁想要进食。再服药一次就痊愈了。
二陈汤
半夏、茯苓、广皮（各一钱）、甘草（三分）。
生姜三片，水煎服。如果脉数、烦热、呕吐酸水，加黄芩、山栀、钩藤。严重时加入黄连。如果有停滞，加厚朴、莱菔子、枳实。如果畏寒，加藿香、木香。如果因惊吓，加竹茹。如果中气虚弱，加人参、石斛。如果是虚寒证，加入炮姜、熟附子。
All diseases have distinctions of deficiency (Xu), excess (Shi), cold (Han), and heat (Re). Among these, vomiting is particularly severe. This is often because practitioners favor warming methods but abuse purgative (attacking) measures. In cases of heat syndrome, if heat is not thoroughly cleared, the fire symptoms will become more intense; in cases of excess syndrome, if purgation is excessive, the Stomach Qi will thereby be damaged. Consequently, one may experience incessant vomiting without cessation, from which few escape critical danger. This is likely because cold and excess syndromes are easy to distinguish, whereas deficiency and heat syndromes are easily confused.
If it is a cold or excess syndrome, it may be due to internal injury from raw and cold foods, external cold invading the Stomach, excessive drinking and overeating, or irregular diet. The pulse must be deep-tight (Chen Jin) or wiry-slippery (Xian Hua), accompanied by distension and discomfort in the Middle Jiao (the area of the Spleen and Stomach). If not warmed, the cold will not be dispelled; if not purged, the stagnation will not transform. Therefore, formulas such as Huoxiang Pingwei San (Patchouli and Magnolia Bark Decoction for Regulating the Stomach) are suitable and yield results easily.
However, when cold stagnation transforms into heat, as stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "All upward rushing and counterflow symptoms belong to Fire," and "All vomiting and acid regurgitation belong to Heat." Everyone knows this. Yet, failing to investigate the cause and indiscriminately administering anti-emetics, practitioners often prefer aromatic-dry drugs. They fail to realize that vomiting belongs to Shaoyang (Lesser Yang) disease, where Wood contains Fire. Since Fire nature flares upward, using aromatic-dry drugs to assist it will intensify the blaze. It may even lead to vomiting green fluid or substances resembling vegetable leaves, which is bile juice. If Zhi Zi (Gardenia Fruit) and Lian Lian (Coptis Rhizome) are not urgently used to descend fire, when will the vomiting cease?
It is commonly observed that patients whose Gallbladder is injured by fright tend to vomit. Ancient sages established Wendan Tang (Warm the Gallbladder Decoction), specifically adding Zhu Ru (Bamboo Shavings), to descend Qi and fire, an intention that can be understood. Furthermore, the Stomach belongs to Earth and fears the constraint of Wood. If Wood pathogen overwhelms Earth, Stomach Qi must be damaged, leading to the inability to ingest water and food. The fluids in the Stomach will be exhausted completely, while Qi from the Lower Jiao rebels upward, frequently causing stuffiness and obstruction in the chest and diaphragm, which resembles an excess syndrome. If physicians follow this with attacking treatments, the last thread of Qi will be severed immediately. Thus, whenever encountering prolonged vomiting damaging the Stomach, Ginseng must be added to clearing-heat prescriptions to support Stomach Qi. Only then can rice gruel be slowly administered to allow intake.
I have seen ancient practitioners treating vomiting and counterflow due to deficiency-cold. Fearing that hot medicines might clash with the body, they instead added Huang Lian (Coptis Rhizome) and Tong Bian (Child's Urine) as guides to calm the Yin aspect. How much more so in heat syndromes should one avoid adding fire to fire! Although there are distinctions: vomiting sound and matter together is called "Tu" (Vomit); sound only without matter is called "Ou" (Regurgitate); turbid, foul, and long sounds are called "Yue" (Hiccup/Sobbing). These may arise from the depression of Seven Emotions (Qi emotions), the intermingling of Six Qi (pathogenic factors), the disharmony of Water and Earth, or the dysfunction of Guan Ge (Obstruction and Rejection). The conditions vary greatly, and treatments are not uniform. However, if one carefully examines deficiency, excess, cold, and heat, no essence will be left unaddressed.
Clinical Cases:
A young woman, after accumulating fatigue, suddenly developed alternating chills and fever with incessant vomiting, day and night for three nights. Treatments with Huoxiang Zhengqi San (Patchouli Powder for Correcting the Qi), Er Chen Tang (Two-Cured Decoction), and Fulonggan (Stove Soil) were ineffective. She vomited fluid resembling green vegetable juice, becoming physically and mentally exhausted. I urgently administered a single dose of Shan Zhi (Gardenia Fructus), Ren Shen (Ginseng Radix et Rhizoma), Shen Qu (Massa Medicata Fermentata), and Fu Ling (Poria). Her vomiting gradually stopped. She was later convalesced with Ren Shen and recovered.
Another young woman, after suffering fright, experienced epigastric pain and incessant vomiting, lasting over three days. She felt hunger pangs in her chest but could not eat grains. She exhibited delirium and mottled rashes on her face. Upon palpating her pulse, it was wiry (Xian), and heavy pressure revealed emptiness. A wiry pulse indicates Gallbladder injury from fright; an empty pulse indicates Stomach Qi deficiency; rashes indicate the manifestation of flaming-upward fire. I used Yuan Zhi (Polygalae Radix), Fu Shen (Poria with Hostwood), and Suan Zao Ren (Ziziphus Seed) to calm the mind and nourish the Stomach; Mu Xiang (Aucklandiae Radix) and Chen Pi (Citri Reticulatae Pericarpium) to relieve pain and regulate Qi; Shan Zhi and Tong Bian to descend fire; a small amount of Chai Hu (Bupleuri Radix) as a guiding herb; and doubled Gou Teng (Uncariae Ramulus cum Uncis) to stop fright. After one dose, vomiting ceased and rashes faded; her mind calmed and appetite returned. After two doses, she was cured.
Er Chen Tang (Two-Cured Decoction)
Ban Xia (Pinelliae Rhizoma), Fu Ling (Poria), Guang Pi (Citri Reticulatae Pericarpium) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.3 qian).
Add three slices of fresh ginger, decoct in water. If the pulse is rapid with irritability, heat, and acid vomiting, add Huang Qin (Scutellariae Radix), Shan Zhi, and Gou Teng. If severe, add Huang Lian. If there is stagnation, add Hou Po (Magnoliae Officinalis Cortex), Lai Fu Zi (Raphani Semen), and Zhi Shi (Aurantii Fructus Immaturus). If there is aversion to cold, add Huo Xiang (Agastaches Herba) and Mu Xiang. If caused by fright, add Zhu Ru. If Middle Qi is deficient, add Ren Shen and Shi Hu (Dendrobii Caulis). For deficiency-cold, add Pao Jiang (Prepared Zingiberis Rhizoma) and Shu Fu Zi (Prepared Aconiti Lateralis Radix).