（附论）
夫阴阳不和，则三焦隔绝，故津液不利，故令气不调，是以成噎也，此由忧恚所致，忧
恚则
方
木香散（出圣惠方）
治心胸噎塞烦闷。食饮不下。
木香（半两） 赤茯苓（半两） 昆布（三分洗去咸味） 桔梗（三分去芦） 木通（三
分锉）
桑根
两炙）
枳壳
计
时候
芦根散（出圣惠方）
治噎不下食。心胸烦闷。不得眠卧。
芦根（一两锉） 木通（半两锉） 射干（三分） 半夏（三分汤泡七次） 赤茯苓（半
两） 人
参（
入生
姜
诃黎勒皮（出圣惠方）
治噎，心胸烦满，食饮不下，胁腹妨闷。
诃黎勒皮（一两半） 枳壳（麸炒三分去瓤） 桂心（三分） 陈橘皮（一两汤浸去白
瓤） 木
香（
半夏丸（出圣惠方）
治噎，心胸短气，烦闷不能下食。
半夏（二两汤泡七次） 木香（一两） 羚羊角屑（一两） 桂心（一两半） 枳壳（一
两麸炒
微黄
下
生姜汁煎（出圣惠方）
治噎不能下食，咽喉壅塞。\x
生姜汁（五合） 白蜜（五两） 人参（二两去芦捣罗为末） 百合（二两捣罗为末） 牛
酥
上件
一茶
夫吐家、脉来阳紧阴数，其人食已即吐，阳浮而数亦为吐，寸口脉紧而芤，紧即为寒，
芤即
痢，
入，
服汤
消息
心
气
暑
食与饮并出，名曰痰呕。或因涎结气郁于胃口，或因酒食甜冷聚饮之所为也，病者心腹胀闷
，四肢厥冷，恶闻食臭，食入即呕，朝食暮吐，暮食朝吐，名曰食呕。皆因饮食伤脾，宿谷
不化之所为也。病者、心下饱满，食即呕血，名曰血呕。此由瘀蓄冷血，积聚胃口之所为也
。病者、心闷，胸膈胀满，气逆于胸膈间，食入即呕，呕尽却快，名曰气呕。胃者足阳明，
合荣于足，今随上气逆，结于胃口，故生呕病也。病者身背皆热，肘臂挛痛，其气不续，膈
间压闷，食之则先吐而后下，名曰满气。此因上焦伤寒风，开其腠理，上焦之气，剽悍滑疾
，遇开即出，经气失道，邪气内着，故有是证。病者下焦实热，大便不通，气逆不续，呕气
不禁，名曰走哺。此下焦气，起于胃口，下别入回肠，注于膀胱，并与胃传糟粕而下大肠，
令大小便不通，故知下焦实热之所为也。
凡先呕却渴者，此为欲解，先渴却呕者，为水停心下，此属饮家。又伤寒瘥后，余热在
胃，
人怀
之，
药，
所为
满而
食欲
尽自
不渴
令新
折之
吞酸
夫人受天地之气以生，莫不以胃为主，盖胃受水谷，脾主运化，生气以充四体者也。若
脾胃
腻，
遂
脘
霍乱脉大者，可治，微细者，不可治，脉迟气短，劣不欲言者，亦不可治。胃虚之人，或为
寒气所中，或为暑气所干，或为饮食所伤，或气结而痰聚，皆令人呕吐。又有瘀血停于胃口
，呕吐之间，杂以涎血，当辨其脉证，施以治法。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，烦躁而渴，又当清凉之。停食、则消化之。痰聚、则顺
气温胃。停积者，多由忧思过度，损伤经络，其脉实而大者，难治，虚细者，易愈。诸呕吐
酸，皆属于热，此上焦受外来客邪也，胃气不受外邪，故呕。伤寒论云，呕多虽有阳明证，
不可攻之。是未传入里，三阴不曾受邪也，亦可见此证在上也，仲景以生姜半夏治之。以杂
病论之，呕吐酸水者，甚则酸水浸其心，不任其苦，其次则吐出水令上下牙酸，不能相对，
以大辛热剂疗之必减。吐酸水，呕出水酸味者，收气也，西方肺金旺也，寒水乃金之子，子
能令母实，故用大咸热之剂泻其子，以辛热为之佐，而泻肺之实，以病机之法，作热攻之者
，误矣，盖杂病醋心，浊气不降，欲为中满，寒药岂能治之哉。
呕吐，出于胃气之不和，人所共知也。然、有胃寒，有胃热，有痰水，有宿食，有脓血，
有
冷
先
熏
卒
寒
早
可
如
忧
肠
发
本
曰
吐
者
入
各
矣
（附论）
阴阳失调，导致三焦阻隔，因此津液运行不畅，致使气机不调，从而形成噎膈之症。这多由忧愁愤怒所致，忧怒则……
木香散（出自《太平惠民和剂局方》）
治疗心胸噎塞烦闷。饮食无法下咽。
木香（半两） 赤茯苓（半两） 昆布（三分，洗净去除咸味） 桔梗（三分，去芦头） 木通（三分，锉碎）
桑根白皮（三两，炙）
枳壳（……计……时候）
芦根散（出自《太平惠民和剂局方》）
治疗噎膈不能进食。心胸烦闷。无法安睡。
芦根（一两，锉碎） 木通（半两，锉碎） 射干（三分） 半夏（三分，汤泡七次） 赤茯苓（半两） 人参（……入生姜……）
诃黎勒皮散（出自《太平惠民和剂局方》）
治疗噎膈，心胸烦满，饮食不下，胁腹痞闷。
诃黎勒皮（一两半） 枳壳（麸炒三分，去瓤） 桂心（三分） 陈橘皮（一两，汤浸去白瓤） 木香（……） 半夏（……）
半夏丸（出自《太平惠民和剂局方》）
治疗噎膈，心胸短气，烦闷不能进食。
半夏（二两，汤泡七次） 木香（一两） 羚羊角屑（一两） 桂心（一两半） 枳壳（一两，麸炒微黄……）
生姜汁煎（出自《太平惠民和剂局方》）
治疗噎膈不能进食，咽喉壅塞。
生姜汁（五合） 白蜜（五两） 人参（二两，去芦头，捣罗成末） 百合（二两，捣罗成末） 牛酥（……）
以上药材……一茶匙……
凡是呕吐患者，脉象表现为阳部紧、阴部数，其人进食后即吐；若脉象阳浮而数，也属于呕吐。寸口脉紧且芤，紧即为寒，芤即……痢疾……进入……服用汤药……斟酌调治……心……气……暑……
食物与饮水同时吐出，称为痰呕。或因涎沫凝结、气机郁结于胃口，或因酒食甜冷聚饮所致。患者心腹胀闷，四肢厥冷，厌恶食物气味，食入即呕，早晨吃的晚上吐，晚上吃的早晨吐，称为食呕。这都是因饮食损伤脾胃，宿食不化所致。患者心下饱满，进食即呕血，称为血呕。这是由于瘀积冷血，积聚于胃口所致。患者心闷，胸膈胀满，气逆于胸膈之间，食入即呕，吐尽后感觉爽快，称为气呕。胃属足阳明经，合荣于足，如今随上逆之气，结于胃口，故产生呕吐病症。患者身背皆热，肘臂挛痛，气息不续，膈间压闷，进食则先吐而后下，称为满气。这是因为上焦受风寒侵袭，腠理开泄，上焦之气剽悍滑疾，遇开即出，经气失道，邪气内着，故有此证。患者下焦实热，大便不通，气逆不续，呕吐不止，称为走哺。此乃下焦之气，起于胃口，向下别入回肠，注入膀胱，并与胃传导糟粕而下注大肠，导致大小便不通，故知这是下焦实热所致。
凡是先呕吐随后口渴的，这是病情将要解除的表现；先口渴随后呕吐的，是水饮停聚在心下，这属于饮家。另外伤寒病愈后，余热在胃……人怀……之……药……所为……满而……食欲……尽自……不渴……令新……折之……吞酸……
人禀受天地之气而生，无不以胃为主。盖胃受纳水谷，脾主运化，生气以充养四肢。若脾胃……腻……遂……脘……
霍乱脉大者，可治；脉微细者，不可治；脉迟气短，虚弱不想说话的，也不可治。胃虚之人，或被寒气所中，或被暑气所扰，或被饮食所伤，或气结而痰聚，都会导致呕吐。又有瘀血停于胃口，呕吐时夹杂涎血，应当辨别其脉证，施以治法。中寒，则脉沉紧，四肢厥冷，饮食不下，当用温暖药物调理。挟暑，则脉弦数，烦躁而渴，又当用清凉药物。停食，则消导消化。痰聚，则顺气温胃。停积者，多由忧思过度，损伤经络，其脉实而大的难治，脉虚细的易愈。各种呕吐吞酸，皆属于热，这是上焦感受外来客邪，胃气不受外邪，故呕吐。《伤寒论》说，呕吐多者，即使有阳明证，也不可攻下。这是因为病邪未传入里，三阴未曾受邪，也可看出此证在上焦。张仲景用生姜半夏治疗。从杂病角度论述，呕吐酸水者，严重时酸水浸渍心脏，不堪忍受其苦；其次则吐出酸水使上下牙齿发酸，不能相对，用大辛热剂治疗必能减轻。吐酸水，呕出酸味水，是收气，西方肺金旺盛。寒水是金之子，子能令母实，故用大咸热之剂泻其子，以辛热为之佐，以泻肺之实。按照病机之法，用热药攻之是错误的。大概杂病醋心，浊气不降，欲成中满，寒药怎么能治疗呢？
呕吐，出于胃气不和，这是人所共知的。然而，有胃寒，有胃热，有痰水，有宿食，有脓血，有……冷……先……熏……卒……寒……早……可……如……忧……肠……发……本……曰……吐……者……入……各……矣……
(Attached Treatise)
When Yin and Yang are disharmonious, the Sanjiao (Triple Burner) becomes obstructed, causing fluids to fail in flowing smoothly. This leads to dysfunctional Qi movement, resulting in dysphagia (difficulty swallowing). This condition is caused by sorrow and indignation; sorrow and indignation cause...
Muxiang San (Cumin Powder, from *Taiping Huimin Heji Jufang*)
Treats chest and heart oppression, dysphagia, and vexation. Inability to swallow food and drink.
Muxiang (Lignum Aucklandiae, half liang) Chifuling (Poria with Red Core, half liang) Kunbu (Thallus Laminariae, three fen, washed to remove salty taste) Jiegeng (Radix Platycodonis, three fen, removed rhizome) Mutong (Caulis Akebiae, three fen, sliced)
Sangbaipipi (Cortex Moriradicis, two liang, honey-fried)
Zhike (Fructus Aurantii, ... count ... time)
Lugen San (Reed Rhizome Powder, from *Taiping Huimin Heji Jufang*)
Treats dysphagia with inability to eat. Chest and heart vexation. Inability to sleep.
Lugen (Rhizoma Imperatae, one liang, sliced) Mutong (Caulis Akebiae, half liang, sliced) Shegan (Rhizoma Belamcandae, three fen) Banxia (Rhizoma Pinelliae, three fen, soaked in hot water seven times) Chifuling (Poria with Red Core, half liang) Renshen (Radix Ginseng, ... add fresh ginger ...)
Helilepi San (Pericarpium Terminaliae Chebulae Powder, from *Taiping Huimin Heji Jufang*)
Treats dysphagia, chest and heart fullness and vexation, inability to swallow food and drink, and distension and stuffiness in the hypochondrium and abdomen.
Helilepi (Pericarpium Terminaliae Chebulae, one and a half liang) Zhike (Fructus Aurantii, bran-fried, three fen, removed pith) Guixin (Cortex Cinnamomi, three fen) Chenjupi (Pericarpium Citri Reticulatae, one liang, soaked in hot water, removed white pith) Muxiang (Lignum Aucklandiae, ...) Banxia (Rhizoma Pinelliae, ...)
Banxia Wan (Pinellia Pill, from *Taiping Huimin Heji Jufang*)
Treats dysphagia, shortness of breath in the chest and heart, vexation, and inability to eat.
Banxia (Rhizoma Pinelliae, two liang, soaked in hot water seven times) Muxiang (Lignum Aucklandiae, one liang) Lingyangjiaoxie (Cornu Saigae Tataricae, one liang) Guixin (Cortex Cinnamomi, one and a half liang) Zhike (Fructus Aurantii, one liang, bran-fried until slightly yellow ...)
Shengjiangzhi Jian (Ginger Juice Decoction, from *Taiping Huimin Heji Jufang*)
Treats dysphagia with inability to eat, and pharyngeal obstruction.
Shengjiangzhi (Succus Zingiberis Recens, five he) Baimi (Mel, five liang) Renshen (Radix Ginseng, two liang, removed rhizome, pounded into powder) Baihe (Bulbus Lilii, two liang, pounded into powder) Niusu (Butyrum Bovinum, ...)
The above ingredients ... one tea spoon ...
In cases of vomiting, if the pulse is tight on the Yang position and rapid on the Yin position, the patient vomits immediately after eating. If the pulse is floating and rapid on the Yang position, it also indicates vomiting. If the Cun Kou (inch position) pulse is tight and hollow (Kou), tight indicates cold, and hollow indicates ... dysentery ... entering ... taking herbal decoction ... adjusting carefully ... Heart ... Qi ... Summerheat ...
When food and drink are vomited out together, it is called Phlegm-Vomiting (Tan Ou). This may be due to saliva condensation and Qi stagnation at the stomach gate, or caused by the accumulation of wine, food, sweets, and cold drinks. The patient experiences abdominal distension and stuffiness, cold limbs, aversion to the smell of food, immediate vomiting after eating, morning food vomited in the evening, and evening food vomited in the morning. This is called Food-Vomiting (Shi Ou). All these are caused by dietary injury to the Spleen and Stomach, leading to undigested retained food. If the patient feels fullness below the heart and vomits blood immediately after eating, it is called Blood-Vomiting (Xue Ou). This is caused by the accumulation of cold blood stasis at the stomach gate. If the patient feels chest distress, distension and fullness in the chest and diaphragm, Qi counterflow in the chest and diaphragm, immediate vomiting after eating, and relief only after complete vomiting, it is called Qi-Vomiting (Qi Ou). The Stomach belongs to the Foot-Yangming Meridian, harmonizing with the foot. Now, following the counterflowing Qi, it knots at the stomach gate, thus generating vomiting disease. If the patient's back and body are hot, spasmodic pain in the elbows and arms, discontinuous Qi, pressure and stuffiness in the diaphragm, and vomiting followed by defecation after eating, it is called Fullness-Qi (Man Qi). This is because the Upper Jiao was injured by wind-cold, opening the couli (pores). The Qi of the Upper Jiao is fierce, swift, and slippery; upon opening, it exits. The meridian Qi loses its path, and pathogenic Qi attaches internally, hence this syndrome. If the patient has excess-heat in the Lower Jiao, constipation, counterflowing Qi that cannot continue, and uncontrollable vomiting of Qi, it is called Walking-Breast (Zou Bu). This Qi originates from the stomach gate, descends separately into the ileum, pours into the bladder, and together with the Stomach transmits dregs down to the Large Intestine, causing blockage of both urine and stool. Thus, we know this is caused by excess-heat in the Lower Jiao.
If vomiting occurs first followed by thirst, this indicates the condition is about to resolve. If thirst occurs first followed by vomiting, this indicates fluid retention below the heart, belonging to the category of Fluid-Disease (Yin Jia). Furthermore, after recovery from Cold Damage, residual heat remains in the Stomach... people harbor... of... medicine... caused by... fullness and... appetite... completely self... no thirst... make new... subdue it... acid regurgitation...
Humans receive Qi from Heaven and Earth to generate life, none without the Stomach as the master. The Stomach receives water and grain, the Spleen governs transportation and transformation, generating Qi to fill the four limbs. If the Spleen and Stomach... greasy... then... epigastric...
In Huoluan (Stomach-Intestine Turmoil), if the pulse is large, it is treatable; if minute and fine, it is untreatable. If the pulse is slow with shortness of Qi, weak and unwilling to speak, it is also untreatable. People with deficient Stomach Qi may be struck by cold Qi, disturbed by summerheat Qi, injured by diet, or have Qi knotting with phlegm accumulation, all leading to vomiting. There is also blood stasis stopping at the stomach gate, where vomiting mixes with saliva and blood. One must distinguish the pulse and symptoms to apply treatment methods. For internal cold, the pulse is deep and tight, limbs are cold, and food cannot be swallowed; warm medicines should be used to regulate. With summerheat, the pulse is wiry and rapid, with irritability and thirst; cooling medicines should be used. For retained food, digestion-promoting methods are used. For phlegm accumulation, Qi-smoothing and Stomach-warming methods are used. Retained accumulation is mostly due to excessive worry and thought damaging meridians; if the pulse is solid and large, it is difficult to treat; if empty and fine, it is easy to heal. Various types of vomiting and acid regurgitation belong to Heat. This is because the Upper Jiao receives external invading pathogens, and the Stomach Qi does not accept external pathogens, hence vomiting. The *Shanghan Lun* states: "If there is much vomiting, even if there are Yangming syndromes, do not purge." This is because the pathogen has not entered the interior, and the Three Yin meridians have not been invaded, showing this syndrome is located in the Upper Jiao. Zhang Zhongjing treats it with Shengjiang (Fresh Ginger) and Banxia (Pinellia). Discussing from the perspective of miscellaneous diseases, those who vomit acid water, when severe, have acid water soaking the heart, unbearable bitterness; secondarily, vomiting acid water makes the upper and lower teeth sour, unable to face each other; treating with major acrid-hot agents will surely reduce symptoms. Vomiting acid water, vomiting out sour-tasting water, represents the Gathering Qi, where Metal of the West Lung is prosperous. Cold Water is the child of Metal; the child can make the mother solid. Therefore, use major salty-hot agents to drain the child, using acrid-hot as assistants to drain the excess of the Lung. According to the method of *Bingji*, attacking with heat agents is an error. Generally, miscellaneous disease with vinegar-heart involves turbid Qi failing to descend, intending to form Middle-Jiao fullness; how can cold medicines treat this?
Vomiting arises from the disharmony of Stomach Qi, which is commonly known. However, there is Stomach-Cold, Stomach-Heat, Phlegm-Fluid, Retained Food, Pus-Blood, Cold... First... Smoke... Suddenly... Cold... Early... Can... Like... Worry... Intestine... Erupt... Root... Say... Vomit... Enter... Each... Thus...