〔薛〕《病机》云∶吐有三∶曰气、积、寒也，皆从三焦论之。上焦吐者从于气，气
者天之阳也，其脉浮而洪，食已暴吐，渴欲饮水，大便燥结，气上冲胸发痛，其治法常
降气和中。中焦吐者从于积，有阴有阳，食与气相假为积而痛，其脉浮而匿，其证或先
痛而后吐，或吐而后作痛，治法当以小毒药去其积，槟榔、木香行其气。下焦吐者从于
寒，地之道也，其脉沉而迟，其证朝食暮吐，暮食朝吐，小便清，大便秘而不通，治法当
以毒药通其秘塞，温其寒气，大便渐通，复以中焦药和之，不令大便秘结而自愈也。王
太仆曰∶食不得入是有火也，食入反出是无火也。又《发明》曰∶噎者六腑之所主，阳
也，气也。塞者五脏之所主，阴也，血也。二者皆由阴中伏火而作也。刘宗浓先生曰∶若
三焦传化失常所致，主于气也。若血亏胃脘干槁所致，因于血也。塞犹填塞不通之义，故
《发明》有治幽门不通、噎塞不便，通幽汤例。盖阳无阴不能通化，阴之失位而阳伏其中，传
化不变而反上行矣。故前证或由饮食起居七情，亏损脾胃，痰饮停滞，中气不运，当以
补中益气汤（杂病劳倦。）为主。若郁结伤脾，用归脾汤（杂病健忘。）加枳壳、桔梗。若恚怒伤肝，
用小柴胡汤（伤寒少阳。）加栀、苓、参、术。脾气虚弱，用六君子（杂病虚劳。）加山栀、枳壳。气
血俱虚，用八珍汤（即杂病八物汤。）加山栀、半夏。若用行气之药，胸膈痞闷，用六君、芎、
归之类。若过用香燥之剂而大便结燥，用四物、（通治。）参、术之类。若饮食不能入，用六
君、山栀、吴茱萸、制黄连。若食入而反出，用六君、炮姜、白豆蔻、黄连、制吴茱萸。若
痰滞而食反出，六君、枳壳、桔梗。若饮食少思，大便不实，胸膈痞闷，吞酸嗳腐，食
反不化，是为脾胃虚寒，用东垣补真丸或八味丸。（杂病虚劳。）若发热烦热，身恶风寒，腹
畏热食，或手足俱冷，胸满腹胀，是内真寒外假热，用神效附子丸，（本条。）或八味丸。大
凡呕吐善食，喜饮冷水，是为有火。呕吐少食，喜饮热汤，是为无火。当审其因而治之。
一妇人患前证，胸腹痞闷，得去后或泄气稍宽。余曰∶此属脾气郁结而虚弱也，当调
补为善。不信，乃别用二陈、枳实、黄连之类，不应；又用香燥破气，前证益甚，形气
愈虚。余用加味归脾汤，（即本方加柴胡、山栀。）调治半载而痊。一妇人患前证，胸胁胀闷，
或小腹不利，或时作痛，小便涩滞。余曰∶此肝火血虚也，当清肝火，生肝血，养脾土，生
肺金。以余言为迂，别服利气化痰等剂，前证益剧，虚证蜂起，余用加味逍遥散，（调经。）
加味归脾汤兼服，寻愈。一妇人患吐痰甚多，手足常冷，饮食少思。余曰∶此肝脾郁
怒，兼命门火衰。不信，另服化痰利气之剂，胸腹愈胀，又服峻利疏道之剂。余曰∶非其
治也，必变脾虚发肿之证，急服《金匮》加减肾气丸，庶有可救。不信，反服沉香化气
等丸，果发肿而殁。
白 散 治妇人翻胃吐食。《千金翼》云∶不特治妇人，男子亦可服。一斤以上为妙。
白 土（以米醋一升， 土令赤，入醋内浸令冷，再 再浸，以醋干为度，取一两研。）
干姜（炮，二钱半）
上为细末，每服一钱，米饮调下，甚者二钱。
白芷散 治妇人翻胃吐食。
上用白芷一两，切作片，瓦上炒令黄，为细末，用猪血二十文切片，以沸汤泡七次，将
血蘸药吃七片。如剩药末，留后次用。
太仓丸 治脾胃虚弱，不进饮食，反胃呕吐。
白豆蔻 缩砂仁（各二两） 丁香（一两） 陈仓米（一升，用黄土炒米赤，去土不用）
上为细末，姜汁法丸梧子大，每服六七十丸，食后淡姜汤下。
青金丹 治呕吐反胃等证。每用三十丸，煎生姜、陈皮汤吞下。（方见前呕吐。）
五苓散 治反胃发渴，加半夏。每四钱，生姜五片煎，温服。（方见伤寒渴。）
东垣补真丸
肉苁蓉（酒浸，焙） 葫芦巴（炒） 附子（炮，去皮） 阳起石（ ） 肉豆蔻（面里煨）
菟丝子（净洗，酒浸蒸） 川乌（炮，去皮） 沉香 五味子（各五钱） 鹿茸（酒浸，炒）
巴戟（去心） 钟乳粉（各一两）
上为细末，用羊腰子两对，治如食法，葱椒酒煮，捣烂入酒，糊丸如梧子大。每服七
十丸，空心米饮，盐汤任下。
神效附子丸 治脾肾虚寒、呕吐，或反胃膈噎。
黑附子重一两四五钱，端正底平尖圆，一枚，灰火炮皮裂，入生姜自然汁内浸润晒干，
仍炮，再入汁浸润，仍晒再炮，用尽姜汁半碗为度，却去皮脐末之，以人参膏和丸如黍
米大。每服数丸，津唾咽下，胃气稍复，饮食稍进，投以温补之剂。
【薛己】在《病机》中说：呕吐有三种类型，分别是气、积、寒，都要从三焦的角度来论述。上焦的呕吐源于气，气属于天之阳，其脉象浮而洪大，进食后立即剧烈呕吐，口渴想喝水，大便干燥结滞，气向上冲撞胸部引发疼痛，治疗原则通常是降气和调中焦。中焦的呕吐源于积滞，有阴有阳，食物与气相互搏结形成积滞并引起疼痛，其脉象浮而沉取无力（匿），症状有的先疼痛后呕吐，有的先呕吐后疼痛，治疗应当用小毒性的药物去除积滞，用槟榔、木香行气。下焦的呕吐源于寒，这是地道之阴，其脉象沉而迟，症状是早晨吃的饭晚上吐出来，晚上吃的饭早晨吐出来，小便清长，大便秘结不通，治疗应当用毒药通开秘塞，温散寒气，待大便逐渐通畅后，再用调理中焦的药物调和它，不让大便再次干结，疾病就会自愈。王太仆说：食物不能咽下是有火邪，食物吃进去反而吐出来是没有火（阳气虚衰）。又《发明》说：噎是六腑所主，属阳，属气；塞是五脏所主，属阴，属血。这两种情况都是由阴中伏藏的火邪所致。刘宗浓先生说：如果是三焦传化功能失常导致的，主要在于气；如果是血亏导致胃脘干枯萎缩引起的，主要在于血。“塞”还有填塞不通的意思，所以《发明》中有治疗幽门不通、噎塞不便的通幽汤方例。大概是因为阳没有阴就不能通化，阴失位而阳伏于其中，传化功能不变反而向上逆行。所以前面的病症有的因为饮食起居和七情内伤，亏损了脾胃，痰饮停滞，中气不运，应当以补中益气汤（出自杂病劳倦篇）为主方。如果因郁结损伤脾脏，用归脾汤（出自杂病健忘篇）加枳壳、桔梗。如果因愤怒损伤肝脏，用小柴胡汤（出自伤寒少阳篇）加山栀、茯苓、人参、白术。脾气虚弱，用六君子汤（出自杂病虚劳篇）加山栀、枳壳。气血都虚弱，用八珍汤（即杂病八物汤）加山栀、半夏。如果使用行气的药后出现胸膈痞闷，用六君子汤加川芎、当归之类。如果过用香燥的药物导致大便干结，用四物汤（通用方）加人参、白术之类。如果饮食无法进入，用六君子汤加山栀、吴茱萸、制黄连。如果食物吃进去反而吐出，用六君子汤加炮姜、白豆蔻、黄连、制吴茱萸。如果因痰滞导致食物反出，用六君子汤加枳壳、桔梗。如果饮食减少不想吃，大便不成形，胸膈痞闷，吞酸嗳腐，食物不消化，这是脾胃虚寒，用东垣的补真丸或八味丸（出自杂病虚劳篇）。如果发热烦热，身体怕冷怕风，腹部怕热食，或者手脚都冷，胸闷腹胀，这是内真寒外假热，用神效附子丸（本条所述）或八味丸。大凡呕吐且食欲好，喜欢喝冷水，这是有火。呕吐且食欲差，喜欢喝热汤，这是无火。应当审察病因进行治疗。
有一位妇人患上述病症，胸腹痞闷，排便或排气后稍微宽松一些。我说：这属于脾气郁结而虚弱，应当调理补益为好。她不相信，另外用了二陈汤、枳实、黄连之类的药，无效；又用了香燥破气的药，前面的症状更加严重，形体和气更加虚弱。我用了加味归脾汤（即本方加柴胡、山栀），调理半年后痊愈。另一位妇人患上述病症，胸胁胀闷，有时小腹不适，有时发作疼痛，小便涩滞。我说：这是肝火血虚，应当清肝火，生肝血，养脾土，生肺金。她认为我的话迂腐，另外服用利气化痰等药剂，前面的症状更加剧烈，虚证蜂拥而起，我用了加味逍遥散（出自调经篇）、加味归脾汤兼服，不久痊愈。还有一位妇人呕吐痰液非常多，手脚经常发冷，饮食减少不想吃。我说：这是肝脾郁怒，兼命门火衰。她不相信，另服化痰利气的药剂，胸腹更加胀满，又服用峻烈通利的药剂。我说：这不是正确的治法，一定会变成脾虚浮肿的病症，急服《金匮要略》的加减肾气丸，或许还有救。她不相信，反而服用沉香化气等丸药，果然发生浮肿而死。
白散：治疗妇人翻胃吐食。《千金翼方》说：不仅治疗妇人，男子也可以服用。一斤以上的剂量为妙。
白垩土（用米醋一升，将土烧红，放入醋中浸泡至冷却，再反复浸泡，直到醋被吸干为止，取一两研细。）
干姜（炮制，二钱半）
以上研为细末，每次服用一钱，米汤调下，严重的服用二钱。
白芷散：治疗妇人翻胃吐食。
上面用白芷一两，切成片，在瓦上炒至黄色，研为细末，用猪血二十文（指一定量）切片，用沸水冲泡七次，将血蘸着药粉吃七片。如果剩下药末，留待下次使用。
太仓丸：治疗脾胃虚弱，不进饮食，反胃呕吐。
白豆蔻 缩砂仁（各二两） 丁香（一两） 陈仓米（一升，用黄土炒米至赤色，去掉黄土不用）
以上研为细末，用姜汁泛丸如梧桐子大，每次服用六七十丸，饭后用淡姜汤送下。
青金丹：治疗呕吐反胃等证。每次用三十丸，煎生姜、陈皮汤吞服。（方剂见前呕吐篇。）
五苓散：治疗反胃发渴，加半夏。每次四钱，生姜五片煎煮，温服。（方剂见伤寒渴篇。）
东垣补真丸
肉苁蓉（酒浸，焙干） 葫芦巴（炒） 附子（炮制，去皮） 阳起石（煅） 肉豆蔻（面粉包裹煨熟）
菟丝子（洗净，酒浸蒸） 川乌（炮制，去皮） 沉香 五味子（各五钱） 鹿茸（酒浸，炒）
巴戟天（去心） 钟乳粉（各一两）
以上研为细末，用羊腰子两对，按食用方法处理，用葱椒酒煮烂，捣碎入酒，制成糊丸如梧桐子大。每次服用七十丸，空腹时米汤或盐汤任便送下。
神效附子丸：治疗脾肾虚寒、呕吐，或反胃膈噎。
黑附子重一两四五钱，形状端正底平尖圆，一枚，用灰火炮制至皮裂，放入生姜自然汁中浸润晒干，再炮制，再放入汁中浸润，再晒再炮，直到用完半碗姜汁为止，然后去掉皮脐研成粉末，用人参膏和丸如黍米大。每次服用数丸，用唾液咽下，胃气稍恢复，饮食稍进，再投予温补的药剂。
[Xue Ji] In the *Bingji* (Pathogenesis), it is stated: There are three types of vomiting: Qi, Accumulation, and Cold. All should be discussed from the perspective of the Sanjiao (Triple Burner). Vomiting originating from the Upper Jiao stems from Qi; Qi belongs to the Yang of Heaven. Its pulse is floating and surging (Hong). Food is vomited violently immediately after eating, accompanied by thirst and desire for water, dry and constipated stool, Qi rushing upward to the chest causing pain. The treatment principle is usually to descend Qi and harmonize the Middle Jiao. Vomiting originating from the Middle Jiao stems from Accumulation, which can be Yin or Yang. Food and Qi interact to form an accumulation causing pain. Its pulse is floating but deep upon pressing (Ni). Symptoms may involve pain preceding vomiting or vomiting preceding pain. Treatment should employ slightly toxic drugs to remove the accumulation, using Areca Seed (Binglang) and Costus Root (Muxiang) to move Qi. Vomiting originating from the Lower Jiao stems from Cold, which follows the way of Earth (Yin). Its pulse is deep and slow. Symptoms include morning food vomited in the evening, or evening food vomited in the morning, clear urine, and severe constipation with no passage. Treatment should use toxic drugs to unblock impaction and warm away cold Qi. Once stool gradually passes, medications for the Middle Jiao should be used to harmonize, preventing re-constipation, leading to spontaneous recovery. Wang Taipou said: "Food unable to enter indicates Fire; food entering and then coming out indicates lack of Fire." Furthermore, the *Faming* states: "Ye" (Dysphagia/Choking) is governed by the Six Fu-organs, belonging to Yang and Qi. "Se" (Obstruction) is governed by the Five Zang-organs, belonging to Yin and Blood. Both arise from Fire hidden within Yin. Mr. Liu Zongnong said: If caused by dysfunction of Sanjiao transmission and transformation, it primarily concerns Qi. If caused by Blood deficiency leading to dryness and atrophy of the stomach cavity, it primarily concerns Blood. "Se" implies blockage like filling. Thus, the *Faming* provides the example of Tongyou Tang (Unblocking the幽 Pass Decoction) for treating obstruction of the幽门 (Pylorus) and dysphagia. Generally, Yang cannot transform without Yin; if Yin loses its position and Yang hides within it, transmission becomes abnormal and reverses upward. Therefore, previous symptoms may result from diet, lifestyle, and Seven Emotions damaging the Spleen and Stomach, causing Phlegm-fluid retention and failure of Middle Qi movement. The primary formula should be Buzhong Yiqi Tang (from Miscellaneous Diseases: Fatigue and Weakness). If constrained depression damages the Spleen, use Guipi Tang (from Miscellaneous Diseases: Forgetfulness) plus Magnolia Bark (Zhiqiao) and Platycodon Root (Jiegeng). If anger damages the Liver, use Xiaochaihu Tang (from Shaoyang Syndrome in Cold Damage) plus Gardenia (Zhizi), Poria (Fuling), Ginseng (Renshen), and Atractylodes Macrocephala (Baizhu). For Spleen Qi deficiency, use Liujunzi Tang (from Miscellaneous Diseases: Consumption and Weakness) plus Zhizi and Zhiqiao. For dual deficiency of Qi and Blood, use Bazhen Tang (i.e., Babawu Tang from Miscellaneous Diseases) plus Zhizi and Pinellia (Banxia). If Qi-moving drugs cause chest and diaphragm fullness, use Liujunzi Tang plus Ligusticum Chuanxiong (Xiong) and Angelica Sinensis (Gui). If overuse of aromatic-dry agents causes dry constipation, use Siwu Tang (General Formula) plus Renshen and Baizhu. If food cannot enter, use Liujunzi Tang plus Zhizi, Evodia (Wuzhuyu), and Processed Coptis (Huanglian). If food enters and is regurgitated, use Liujunzi Tang plus Roasted Ginger (Paojiang), Cardamom (Baidoukou), Huanglian, and Processed Wuzhuyu. If Phlegm stagnation causes food regurgitation, use Liujunzi Tang plus Zhiqiao and Jiegeng. If appetite is poor, stool is loose, chest/diaphragm is full, acid regurgitation and belching of rotten food occur, and food is not digested, this is Spleen-Stomach Deficiency-Cold. Use Dongyuan's Bizhen Wan or Bawei Wan (from Miscellaneous Diseases: Consumption and Weakness). If fever and irritability occur, body aversion to wind-cold, abdominal aversion to hot food, or cold hands and feet with chest/full abdomen, this is True Cold inside with False Heat outside. Use Shenxiao Fuzi Wan (this section) or Bawei Wan. Generally, vomiting with good appetite and preference for cold drinks indicates Fire. Vomiting with poor appetite and preference for hot drinks indicates lack of Fire. One must examine the cause and treat accordingly.
A woman suffered from the above symptoms, with chest and abdominal fullness, feeling somewhat relieved after defecation or passing gas. I said: This belongs to Spleen Qi constraint and deficiency; regulation and tonification are best. She did not believe me and used Erchen Tang, Zhashi, and Huanglian, which was ineffective. Then she used aromatic-dry Qi-breaking agents, worsening the symptoms and further depleting her Form and Qi. I used Jiawei Guipi Tang (Guipi Tang plus Bupleurum [Chaihu] and Zhizi), regulating and treating for half a year until recovery. Another woman suffered from the above symptoms, with chest and hypochondriac distension, occasional lower abdominal discomfort or pain, and dribbling urine. I said: This is Liver Fire and Blood deficiency. One should clear Liver Fire, generate Liver Blood, nourish Spleen Earth, and generate Lung Metal. Deeming my advice pedantic, she took Qi-promoting and Phlegm-resolving agents instead, making the symptoms worse and triggering numerous deficiency signs. I used Jiawei Xiaoyao San (from Menstrual Disorders) and Jiawei Guipi Tang concurrently, and she recovered soon. Another woman vomited excessive phlegm, had cold hands and feet, and poor appetite. I said: This is Liver-Spleen constraint and anger, combined with Decline of Mingmen Fire. Disbelieving, she took phlegm-resolving and Qi-promoting agents, increasing abdominal distension, and then took harsh purgative agents. I said: This is incorrect treatment; it will surely turn into Spleen-deficiency edema. Urgently take Jin Gui's Jiashen Shenqi Wan, or there might be hope. Disbelieving, she took Chenxiang Huaqi pills instead, and indeed developed edema and died.
Bai San: Treats women's Fanwei (Reverse Stomach) and vomiting. Qianjin Yi Fang states: It treats men as well. A dose of one jin or more is excellent.
Bai E Tu (White Halloysite): Take one sheng of rice vinegar, heat the earth until red, immerse in vinegar until cool. Repeat immersion until vinegar is absorbed. Take one liang and grind finely.
Gan Jiang (Dried Ginger): Processed, two qian and half.
Grind both into fine powder. Take one qian each time, mixed with rice drink. For severe cases, take two qian.
Baizhi San: Treats women's Fanwei and vomiting.
Take one liang of Bai Zhi (Angelica Dahurica), slice it, stir-fry on a tile until yellow, and grind into fine powder. Take twenty slices of pig blood, soak in boiling water seven times. Dip the blood slices in the powder and eat seven slices. Reserve remaining powder for next use.
Tai Cang Wan: Treats Spleen-Stomach weakness, inability to eat, reverse vomiting.
Bai Dou Kou (Cardamom Fruit) and Suo Sha Ren (Amomum Fruit): Two liang each.
Ding Xiang (Clove): One liang.
Chen Cang Mi (Stored Rice): One sheng, stir-fried with yellow earth until red, discard earth.
Grind into powder. Make pills with ginger juice the size of wutong seeds. Take 60-70 pills after meals, washed down with light ginger soup.
Qing Jin Dan: Treats vomiting and Fanwei. Take thirty pills each time, swallowed with decoction of Sheng Jiang (Fresh Ginger) and Chen Pi (Tangerine Peel). (Formula see Vomiting section previously.)
Wu Ling San: Treats Fanwei with thirst. Add Ban Xia (Pinellia). Take four qian each time, decoct with five slices of Sheng Jiang, take warm. (Formula see Cold Damage Thirst section.)
Dongyuan Bizhen Wan
Rou Cong Rong (Cistanche): Wine-soaked, baked.
Hu Lu Ba (Trigonella Foenum-graecum): Stir-fried.
Fu Zi (Prepared Aconite): Processed, skin removed.
Yang Qi Shi (Leiolite): Calcined.
Rou Dou Kou (Nutmeg): Baked in flour paste.
Tu Si Zi (Cuscuta Seed): Cleaned, wine-soaked, steamed.
Chuan Wu (Processed Aconite): Processed, skin removed.
Chen Xiang (Agarwood).
Wu Wei Zi (Schisandra): Five qian each.
Lu Rong (Deer Antler Velvet): Wine-soaked, fried.
Ba Ji Tian (Morinda Root): Heart removed.
Zhong Ru Fen (Stalactite Powder): One liang each.
Grind into powder. Prepare two pairs of sheep kidneys according to culinary methods. Boil with scallion, pepper, and wine until soft. Mash, add wine, and make paste pills the size of wutong seeds. Take seventy pills on an empty stomach, washed down with rice drink or salt water as preferred.
Shenxiao Fuzi Wan: Treats Spleen-Kidney Deficiency-Cold, vomiting, or Fanwei and Ge Ye (Diaphragmatic Dysphagia).
Hei Fu Zi (Black Prepared Aconite): Weighing one liang, four qian, five qian. Shape should be upright, flat bottom, round tip. One piece. Process with ash fire until skin cracks. Immerse in fresh ginger juice, sun-dry. Process again, immerse again, sun-dry, process again. Continue until half a bowl of ginger juice is consumed. Remove skin and navel, grind to powder. Mix with Renshen Gao (Ginseng Paste) to make pills the size of millet grains. Take several pills each time, swallow with saliva. When Stomach Qi recovers slightly and intake improves, administer warming and tonifying agents.