脉
呕而脉弱，小便复利，身有微热，厥者难治。
证
夫呕吐者，饮食入胃而复逆出也。有物无声谓之吐，有声无物谓之哕，呕吐谓之有声有物。盖人以
胃气为主，受纳五谷，荣养百骸者也。若胃虚之人，不能摄养，或为寒气所中，或为暑气所干，
或为饮食所伤，或气结而痰聚，皆能令人呕吐。又有恶血停积胃口，呕吐之间，杂以痰血；亦有胃热火邪，冲
上而作呕吐者；有痰隔中焦，食不得下者；有气逆者。又《内经》云，诸呕吐逆冲上，皆
属心火。河间亦曰∶胃膈热甚则为呕，火气炎上之象也，所感不同。
治
治法当以脉辨之∶中寒则脉沉紧，四肢厥冷，饮食不下，当以温暖之药调之；挟暑则脉弦数而虚，烦热
燥渴，法当清凉之；停食痰积者，则当顺气和胃而消导之；积血者化其血；火逆者泻其火，此其治法之大要也。
一呕家圣药是生姜，千金之说信矣。然气逆作呕，生姜散之；
痰与水作呕，半夏逐之。呕有热有寒，生姜于寒证最佳。若遇热呕，不可无乌梅也。
一胃中有热，膈上有痰，令人时常呕吐清水，诈嗳气吞酸等
症，用二陈汤加姜、炒黄连、炒栀子、苍术、川芎、香附、砂仁、神曲、山楂，少加木香，以行滞气。
一时常吐清水，或口干不喜食，冷涎自下而涌上者，此脾热所
致。二陈汤加白术、芍药、升麻、土炒黄连、黄芩、栀子、神曲、麦芽、干姜，或煎或丸，随时制宜。
一时常恶心呕吐清水，胃口作痛，得食暂止，饥则痛甚，此胃
中有蛔也。二陈汤加苦楝根皮、使君子煎服即愈。或用黑锡炒成灰，槟榔等分，米饮调服。
方
煨姜散（西园制） 治呕吐恶心。
生姜一大块，直切薄片，勿令折断，层层渗盐于内，以水湿苎麻密缚，外又用纸包水蘸湿火煨，令熟，去
纸捣烂，和稀米饮服之。
椒茶饼（陈橘轩传）〔批〕（按此方专治呕吐之剂） 止呕吐，治翻胃。
川椒（去目，隔纸焙，三两） 芽茶（一两五钱） 桑白皮（末，一两半） 飞罗面（一两五钱，炒）
上为细末，炼蜜作饼，每重一钱许，细嚼米汤下。
保中汤（云林制）〔批〕（按此方治胃中痰火呕吐之剂） 治呕吐不止，饮食不下。
陈皮（八分） 半夏（姜制，八分） 茯苓（八分） 甘草（三分） 白术（土炒，二钱）
藿香（一钱） 黄连（土炒，二钱） 黄芩（土炒，一钱） 山栀子（姜汁炒，二钱） 砂仁（三分）
上锉一剂，生姜三片，长流水和娇泥澄清水二钟，煎至一钟，
稍冷频服。吐逆甚，加伏龙肝一块同煎。因气，加香附，枳实。心烦，加竹茹。
比和饮〔批〕（按此方治胃虚呕吐之剂） 治水谷不纳，闻食气即呕。
人参（一钱） 白术（一钱） 茯苓（一钱） 藿香（八钱） 陈皮（五分） 砂仁（五分）
神曲（一钱，炒） 甘草（五分）
上锉作一剂，用十年以上陈仓米一合，顺流水二钟，煎沸，泡伏龙肝，研细，搅混，澄清取一钟，生
姜三片，枣二枚，同煎七分，稍冷服。别以陈仓米饮时啜之，日进三服，即止。
枇杷散 治胃虚呕哕不止。
枇杷叶（去毛） 橘红（各一两） 半夏（汤泡） 赤茯苓（去皮） 人参（各五钱） 麦
门冬（去心） 青竹茹（各一两二钱） 甘草（四钱）
上锉，生姜三片，水二盏，煎一盏，空心服。
脉象
呕吐且脉象虚弱，小便反而通畅，身体有轻微发热，四肢厥冷的，属于难治之证。
证候
所谓呕吐，是指饮食进入胃中后，又逆向吐出。有物无声称为吐，有声无物称为哕（呃逆），既有声音又有实物吐出称为呕吐。大概人以胃气为主，胃负责受纳五谷，滋养全身骨骼形体。如果是胃气虚弱的人，不能摄养自身，或者被寒气侵袭，或者被暑气干扰，或者被饮食所伤，或者气机郁结导致痰湿聚集，都能引起人呕吐。又有恶血停滞在胃口处，呕吐时夹杂痰血；也有因胃中有火热邪气，冲逆向上而引发呕吐的；有痰浊阻隔在中焦，导致食物无法下咽的；还有因气机上逆导致的。另外《内经》说，各种呕吐、气逆冲上，都属于心火。刘河间也说：胃膈热盛就会发生呕吐，这是火气炎上的表现，但感受的病邪不同。
治法
治疗法则应当通过脉象来辨别：如果是中寒，则脉象沉紧，四肢厥冷，饮食不下，应当用温热的药物调理；如果挟带暑邪，则脉象弦数而虚，烦热燥渴，法当用清凉的药物；如果是停食或痰积，则应当顺气和中并消食导滞；如果有瘀血积滞，则化解瘀血；如果是火气上逆，则清泻火邪，这是治疗的大要。
有一条说法认为，生姜是治疗呕吐的圣药，千金方中的说法确实可信。然而如果是气逆引起的呕吐，用生姜发散；如果是痰与水饮引起的呕吐，用半夏驱逐。呕吐有热证和寒证之分，对于寒证，生姜效果最佳。如果遇到热证呕吐，不可不用乌梅。
如果胃中有热，膈上有痰，导致人时常呕吐清水，伴有打嗝、吞酸等症状，使用二陈汤加入生姜、炒黄连、炒栀子、苍术、川芎、香附、砂仁、神曲、山楂，少量加入木香，以行滞气。
如果时常吐清水，或者口干不喜欢吃东西，冷涎自动涌出，这是脾热所致。使用二陈汤加入白术、芍药、升麻、土炒黄连、黄芩、栀子、神曲、麦芽、干姜，可以煎服也可以制成丸剂，根据情况灵活制宜。
如果时常恶心呕吐清水，胃口疼痛，进食后暂时缓解，饥饿时疼痛加剧，这是胃中有蛔虫。使用二陈汤加入苦楝根皮、使君子煎服即可痊愈。或者用黑锡炒成灰，与槟榔等分，用米汤调服。
方剂
煨姜散（西园制） 治疗呕吐恶心。
取生姜一大块，直切成薄片，不要折断，层层在其中渗入盐，用水浸湿苎麻紧密捆绑，外面再用纸包裹蘸水湿润后在火上煨烤，直到熟透，去掉纸捣烂，配合稀米饮服用。
椒茶饼（陈橘轩传）〔批注〕（按此方专门治疗呕吐的药剂） 止住呕吐，治疗翻胃。
川椒（去除椒目，隔纸焙干，三两） 芽茶（一两五钱） 桑白皮（研末，一两半） 飞罗面（一两五钱，炒）
以上研为细末，用炼蜜做成饼，每块重约一钱，细细咀嚼后用米汤送下。
保中汤（云林制）〔批注〕（按此方治疗胃中痰火呕吐的药剂） 治疗呕吐不止，饮食不下。
陈皮（八分） 半夏（姜制，八分） 茯苓（八分） 甘草（三分） 白术（土炒，二钱）
藿香（一钱） 黄连（土炒，二钱） 黄芩（土炒，一钱） 山栀子（姜汁炒，二钱） 砂仁（三分）
以上锉碎为一剂，加生姜三片，长流水和娇泥澄清后的清水两钟，煎至一钟，稍凉后频频服用。如果吐逆严重，加一块伏龙肝同煎。如果是因气滞引起，加香附、枳实。如果心烦，加竹茹。
比和饮〔批注〕（按此方治疗胃虚呕吐的药剂） 治疗水谷不纳，闻到食物气味就呕吐。
人参（一钱） 白术（一钱） 茯苓（一钱） 藿香（八钱） 陈皮（五分） 砂仁（五分）
神曲（一钱，炒） 甘草（五分）
以上锉碎作一剂，用十年以上的陈仓米一合，顺流水两钟，煮沸，浸泡伏龙肝，研细，搅混，澄清取一钟，加生姜三片，大枣二枚，同煎至七分，稍凉后服用。另外用陈仓米饮随时啜饮，每日进服三次，呕吐即止。
枇杷散 治疗胃虚呕哕不止。
枇杷叶（去毛） 橘红（各一两） 半夏（汤泡） 赤茯苓（去皮） 人参（各五钱） 麦门冬（去心） 青竹茹（各一两二钱） 甘草（四钱）
以上锉碎，加生姜三片，水两盏，煎至一盏，空腹服用。
Pulse
When vomiting is accompanied by a weak pulse, frequent urination, slight fever in the body, and cold extremities (Jue), it is difficult to treat.
Syndrome
Vomiting refers to food entering the stomach and then regurgitating upwards. Vomiting with matter but without sound is called "Tu" (emesis); retching with sound but without matter is called "Yue" (hiccups or dry heaving); both sound and matter indicate "Ou Tu" (vomiting). Generally, the human body relies on Stomach Qi as its foundation; the Stomach receives and digests the five grains to nourish the entire skeletal structure. If a person has deficient Stomach Qi and fails to maintain it properly, they may be invaded by Cold pathogenic factors, affected by Summer-heat, injured by dietary irregularities, or suffer from Qi stagnation leading to Phlegm accumulation, all of which can cause vomiting. Additionally, stagnant blood accumulating at the gastric opening may result in vomiting mixed with Phlegm and blood; excessive Heat and Fire in the Stomach rushing upward can also induce vomiting; Phlegm obstructing the Middle Jiao can prevent food from descending; and rebellious Qi can also be a cause. Furthermore, the *Neijing* states that various forms of vomiting and rebellious Qi rushing upward belong to Heart Fire. Liu Hejian also stated: "Excessive Heat in the Stomach and Diaphragm leads to vomiting, which is the manifestation of Fire blazing upward." However, the specific pathogens contracted differ.
Treatment Principles
The treatment principle should be determined by differentiating the pulse: If Cold invades, the pulse will be deep and tight, accompanied by cold extremities and inability to retain food/drink; warm herbs should be used to regulate. If Summer-heat is involved, the pulse will wiry, rapid, and empty, accompanied by irritability, heat, dryness, and thirst; cooling methods should be employed. For retained food or Phlegm accumulation, methods to harmonize Qi, strengthen the Stomach, and promote digestion should be used. For blood stasis, resolve the blood; for rebellious Fire, purge the Fire. These are the general principles of treatment.
It is said that Fresh Ginger (Shengjiang) is the holy medicine for treating vomiting, and the assertion in the *Qianjin Fang* is indeed credible. However, for vomiting caused by rebellious Qi, use Fresh Ginger to disperse it; for vomiting caused by Phlegm and fluid retention, use Pinellia (Banxia) to expel it. Vomiting can be due to Heat or Cold; for Cold syndromes, Fresh Ginger is optimal. For Heat-induced vomiting, Mume Fruit (Wumei) must not be omitted.
If there is Heat in the Stomach and Phlegm in the Diaphragm, causing frequent vomiting of clear fluid, along with belching and acid regurgitation, use Er Chen Tang (Two-Aged Decoction) added with Fresh Ginger, stir-fried Coptis Rhizome (Huanglian), stir-fried Gardenia Fruit (Zhizi), Atractylodes Macrocephala Rhizome (Cangzhu), Ligusticum Chuanxiong Rhizome (Chuanxiong), Cyperi Rhizoma (Xiangfu), Amomum Fructus (Sharen), Medicated Leaven (Shenqu), and Hawthorn Fruit (Shanzha), with a small amount of Costus Root (Muxiang) to move stagnant Qi.
If one frequently vomits clear fluid, or experiences dry mouth and aversion to eating, with cold saliva surging upward spontaneously, this is caused by Spleen Heat. Use Er Chen Tang (Two-Aged Decoction) added with Atractylodes Macrocephala Rhizome (Baizhu), Peony Root (Shaoyao), Cimicifuga Rhizome (Shengma), earth-fried Coptis Rhizome (Huanglian), Scutellaria Root (Huangqin), Gardenia Fruit (Zhizi), Medicated Leaven (Shenqu), Hordeum Vulgare Sprout (Maiya), and Dried Ginger (Ganjiang). It can be decocted or made into pills, adjusted according to circumstances.
If one frequently feels nauseous and vomits clear fluid, with pain in the epigastrium that temporarily stops after eating but worsens when hungry, this indicates Ascaris lumbricoides (roundworms) in the Stomach. Use Er Chen Tang (Two-Aged Decoction) added with bark of Toosendan Root (Kouliangenpi) and Quisqualis Indica Fruit (Shijunzi), decocted and taken orally, which will lead to recovery. Alternatively, use Pyrum Ash (Heixi) calcined to ash, equal parts of Areca Seed (Binglang), mixed and taken with rice water.
Formulas
Wei Jiang San (Roasted Ginger Powder) [Prepared by Xiyuan] Treats vomiting and nausea.
Take a large piece of Fresh Ginger, slice it straight into thin slices without breaking them. Layer salt inside, bind tightly with ramie hemp soaked in water, wrap externally with paper dipped in water, and roast over fire until cooked. Remove the paper, mash the ginger, and take with thin rice gruel.
Jiao Cha Bing (Pepper and Tea Cake) [Passed down by Chen Juxuan] [Comment: This formula specifically treats vomiting.] Stops vomiting, treats Fan Wei (reverted gluttony/regurgitation).
Sichuan Pepper (Chuanjiao) (remove eyes, bake between papers, 3 liang) Bud Tea (Yacha) (1.5 qian) Mulberry Root Bark (Sangbaipi) (powder, 1.5 liang) Fine Flour (Feiluo mian) (1.5 qian, stir-fried)
Grind all into fine powder, make cakes with refined honey, each weighing about 1 qian. Chew thoroughly and swallow with rice soup.
Bao Zhong Tang (Protect the Middle Decoction) [Prepared by Yunlin] [Comment: This formula treats vomiting due to Phlegm-Fire in the Stomach.] Treats persistent vomiting and inability to eat.
Tangerine Peel (Chenpi) (8 fen) Pinellia Tuber (Banxia) (processed with Ginger, 8 fen) Poria (Fuling) (8 fen) Licorice Root (Gancao) (3 fen) Atractylodes Macrocephala Rhizome (Baizhu) (earth-fried, 2 qian)
Agastache Herba (Huoxiang) (1 qian) Coptis Rhizome (Huanglian) (earth-fried, 2 qian) Scutellaria Root (Huangqin) (earth-fried, 1 qian) Gardenia Fruit (Zhizi) (stir-fried with Ginger juice, 2 qian) Amomum Fructus (Sharen) (3 fen)
Cut into pieces for one dose. Add 3 slices of Fresh Ginger and 2 zhong of clear water clarified from long-flowing water and Jiao mud. Decoct to 1 zhong. Take frequently when slightly cool. If vomiting is severe, add a piece of Long Gu (Fulonggan/Dragon Bone - note: traditionally Huolongtan/Fired Earth) and decoct together. If due to Qi stagnation, add Cyperi Rhizoma (Xiangfu) and Immature Bitter Orange (Zhishi). If irritable, add Bamboo Shavings (Zhuru).
Bi He Yin [Comment: This formula treats vomiting due to Stomach deficiency.] Treats inability to accept food and drink, vomiting upon smelling food.
Ginseng Radix (Renshen) (1 qian) Atractylodes Macrocephala Rhizome (Baizhu) (1 qian) Poria (Fuling) (1 qian) Agastache Herba (Huoxiang) (8 qian) Tangerine Peel (Chenpi) (5 fen) Amomum Fructus (Sharen) (5 fen)
Medicated Leaven (Shenqu) (1 qian, stir-fried) Licorice Root (Gancao) (5 fen)
Cut into pieces for one dose. Use 1 he of aged stored rice (over 10 years old) and 2 zhong of smooth-flowing water. Boil, soak Huolongtan (Fired Earth), grind finely, mix, clarify, and take 1 zhong of the liquid. Add 3 slices of Fresh Ginger and 2 Jujubes (Zao). Decoct together to 0.7 portion. Take when slightly cool. Additionally, sip aged rice water occasionally throughout the day. Take three doses daily, and vomiting will cease.
Pi Pa San [Comment: Treats persistent vomiting and hiccups due to Stomach deficiency.]
Loquat Leaf (Pipaye) (de-hair) Exocarpium Citri Reticulatae (Juhong) (each 1 liang) Pinellia Tuber (Banxia) (soaked in boiling water) Red Poria (Chifuling) (peeled) Ginseng Radix (Renshen) (each 5 qian) Ophiopogon Tuber (Maimendong) (de-heart) Green Bamboo Shavings (Qingzhuru) (each 1.2 liang) Licorice Root (Gancao) (4 qian)
Cut into pieces. Add 3 slices of Fresh Ginger and 2 zhan of water. Decoct to 1 zhan. Take on an empty stomach.