凡吐蛔者，必因病而吐蛔，非因蛔而致吐也，故不必治其蛔，而但治其所以吐，则蛔自
止矣。有因胃火而吐蛔者，以内热之甚，蛔无所容而出也。但清其火，火清而蛔自静，轻者
抽薪饮，甚者万应丸之属是也。有因胃寒而吐蛔者，以内寒之甚，蛔不能存而出也。但温其
胃，胃暖而蛔自安，仲景乌梅丸之属是也。有因胃虚无食而吐蛔者，以仓廪空虚，蛔因求食
而上出也。此胃气大虚之候，速宜补胃温中，以防根本之败，如温胃饮、理中汤、圣术煎之
属也。以上三者，固皆治蛔之法，然蛔有死者，有活者，若吐死蛔，则但治呕如前可也；若
活蛔上出不已，则不得不有以逐之，盖蛔性畏酸、畏苦，但加乌梅为佐使，则蛔自伏也。若
胃实火盛者，可加苦楝根，或黄连亦善。其有未尽者，俱详列诸虫本门，及后条吐蛔治按中
。
凡治胃虚呕吐，最须详审气味。盖邪实胃强者，能胜毒药，故无论气味优劣，皆可容受
；惟胃虚气弱者，则有宜否之辨，而胃虚之甚者，则于气味之间，关系尤重。盖气虚者，最
畏不堪之气，此不但腥臊耗散之气不能受，即微香微郁，并饮食之气亦不能受，而其他可知
矣。胃弱者，最畏不堪之味，此非惟至苦极劣之味不能受，即微咸微苦并五谷正味亦不能受
，而其他可知矣。此胃虚之呕，所以最重气味，使或略有不投，则入口便吐，终无益也。故
凡治阳虚呕吐等证，则一切香散、咸酸，辛味不堪等物，悉当以已意相测，测有不妥，切不
可用，但补其阳，阳回则呕必自止，此最确之法，不可忽也。
余尝见一沈姓者，素业医，极多劳碌，且年及四旬，因患 疝下坠，欲提使上升，自用
盐汤吐法，不知胃虚畏咸，遂致吐不能止，汤水皆呕，如此者一日一夜，忽又大便下黑血一
二碗。而脉则微渺如毛，几如将绝，此盖吐伤胃气，脾虚之极，兼以盐汤走血，故血不能摄
，从便而下。余令其速用人参、姜、附等剂，以回垂绝之阳，庶乎可疗。忽又一医至曰∶诸
逆冲上，皆属火也。大便下血，亦因火也，尚堪用参附乎？宜速饮童便，则呕可愈而血亦止
矣。其人以为有理，及童便下咽即呕，极不堪名状，呕不止而命随继之矣。呜呼！夫以胃强
之人，亦且闻尿欲呕，况呕不能止而复可加以尿乎？此不惟死者堪怜，而妄用若此者尚敢称
医，诚可恶可恨也，故笔之于此，并以征气味之证。又别有气味治按，在小儿门呕吐条中，
所当参酌。
凡是出现吐蛔虫的情况，必定是因为疾病导致呕吐从而排出蛔虫，而不是因为蛔虫本身引起呕吐。因此，不必专门治疗蛔虫，只需治疗引起呕吐的原因，蛔虫自然就会停止吐出。
有的患者因胃火旺盛而吐蛔，这是因为体内热邪极盛，蛔虫无法生存而被迫排出。只要清除胃火，火气消退后蛔虫自然安静。病情较轻的，可用抽薪饮；病情较重的，可用万应丸之类的方剂。
有的患者因胃寒严重而吐蛔，这是因为体内寒气极盛，蛔虫无法存留而被迫排出。只要温补胃部，胃中温暖后蛔虫自然安伏。这类情况可参考张仲景的乌梅丸之类的方剂。
有的患者因胃气虚弱、空腹无食而吐蛔，这是因为脾胃仓廪空虚，蛔虫为了寻找食物而上行吐出。这是胃气大虚的表现，应当迅速补益胃气、温中散寒，以防根本元气败坏。如使用温胃饮、理中汤、圣术煎之类的方剂。
以上三种情况，虽然都是治疗蛔虫的方法，但吐出的蛔虫有死有活。如果吐出的是死蛔虫，则只需像前面所说的那样治疗呕吐即可；如果活蛔虫不断上行吐出，则不得不采取驱除措施。因为蛔虫本性畏惧酸味和苦味，只要在方中加入乌梅作为辅助药物，蛔虫自然会潜伏不动。如果是胃中实火炽盛的患者，可以加用苦楝根，或者黄连也是很好的选择。其余未尽的内容，均详细列在“诸虫”篇的本门以及后面的“吐蛔治验”条中。
大凡治疗胃虚引起的呕吐，必须仔细审察药物的气味（性味）。因为邪气实证、胃气强盛的患者，能够耐受药性猛烈的药物，所以无论药物气味优劣，都可以承受；只有胃气虚弱的人，才需要辨别是否适宜，尤其是胃虚严重的患者，对药物气味的关系尤为重视。
气虚的人，最畏惧难以忍受的气味。这不仅仅是腥臊耗散的气味不能接受，即使是轻微的香气或郁滞之气，以及饮食的气味都不能接受，其他情况可想而知。
胃弱的人，最畏惧难以忍受的味道。这不仅仅是极苦极劣的味道不能接受，即使是微咸、微苦以及五谷的正味都不能接受，其他情况可想而知。
这就是胃虚呕吐之所以最重视药物气味的原因。如果稍微有不合适，药物入口便会立即吐出，终究没有任何益处。
因此，凡是治疗阳虚呕吐等证候，一切香燥发散、咸酸、辛烈不堪的药物，都应当根据具体情况谨慎推测。如果推测认为不妥切，绝对不可使用。只需用药补益阳气，阳气恢复则呕吐必然自止，这是最确切的方法，不可忽视。
我曾经见过一位姓沈的人，平时从事医疗行业，非常劳累，且年近四十岁。他患有疝气下坠的症状，想要通过提升气机使其上升，于是自行使用盐汤催吐法。但他不知道胃虚之人畏惧咸味，结果导致呕吐不止，连汤水都呕出，持续了一天一夜。忽然又大便排出一二碗黑血。此时他的脉象微弱渺茫如羽毛，几乎要断绝。这大概是剧烈呕吐损伤了胃气，脾虚到了极点，再加上盐汤具有走血的作用，导致血液无法固摄，从大便而下。我让他迅速服用由人参、生姜、附子等组成的药剂，以挽回即将衰竭的阳气，或许还有救治的希望。
忽然另一位医生来到，说：“各种气逆冲上的症状，都属于火证。大便下血，也是因为火邪所致，哪里还能用人参、附子呢？应当迅速饮用童便（童子尿），这样呕吐可以痊愈，出血也会停止。”
那个人觉得这话很有道理，等到童便咽下后立即呕吐，痛苦不堪，呕吐不止最终导致死亡。唉！即使是胃气强盛的人，闻到尿味都想呕吐，何况是呕吐不止的病人，怎么能再给他喝尿呢？这不仅死者令人怜悯，而且那些妄用此法还敢自称医生的行为，实在可恶可恨。因此我将此事记录下来，以此作为验证药物气味重要性的案例。另外关于气味的治疗案例，在小儿科的呕吐条中有记载，应当参考斟酌。
Any case of vomiting roundworms (Ascaris) is necessarily caused by an underlying disease leading to vomiting, which expels the worms; it is not that the worms themselves cause the vomiting. Therefore, there is no need to treat the worms directly; one should only treat the cause of the vomiting, and the worms will naturally cease to be vomited.
In cases where roundworms are vomited due to Stomach Fire (Stomach Heat), it is because internal heat is excessive, leaving no room for the worms to reside, forcing them out. By clearing the fire, once the heat subsides, the worms will naturally become quiet. For mild cases, Chou Xin Yin (Draw Out the Fire Decoction) may be used; for severe cases, Wan Ying Wan (Ten Thousand Remedies Pill) or similar formulas are appropriate.
In cases where roundworms are vomited due to Stomach Cold, it is because internal cold is excessive, making it impossible for the worms to survive, forcing them out. By warming the Stomach, once the stomach becomes warm, the worms will naturally settle. Formulas such as Wu Mei Wan (Mume Pill) from Zhang Zhongjing are suitable for this.
In cases where roundworms are vomited due to Stomach Deficiency and lack of food, it is because the granary (Spleen and Stomach) is empty, prompting the worms to seek food and move upward. This is a sign of significant Qi deficiency in the Stomach. It is urgent to tonify the Stomach and warm the Middle Jiao to prevent the collapse of the root vitality. Formulas such as Wen Wei Yin (Warm the Stomach Decoction), Li Zhong Tang (Regulate the Middle Decoction), or Sheng Zhu Jian (Holy Atractylodes Decoction) may be used.
Although the above three methods address roundworms, the vomited worms may be dead or alive. If dead worms are vomited, treating the vomiting as described above suffices. However, if live worms continue to ascend and vomit, it becomes necessary to expel them. Since roundworms fear sour and bitter tastes, adding Wu Mei (Fructus Mume) as an assistant drug will cause the worms to subside. In cases of excess Fire in the Stomach, Ku Lian Gen (Cortex Meliae Radicis) or Huang Lian (Rhizoma Coptidis) can be added. Remaining details are listed in the chapter on Various Parasites and the clinical records on vomiting roundworms later in the text.
When treating vomiting due to Stomach Deficiency, one must carefully examine the nature and flavor (Qi and Wei) of the medicines. Patients with Excess pathogens and strong Stomach Qi can tolerate potent drugs, regardless of whether their flavors are superior or inferior. However, for those with weak Stomach Qi, especially severe deficiency, the choice of flavor and aroma is critical.
Those with Qi deficiency most fear unpleasant odors. Not only do they reject fishy, pungent, or dissipating aromas, but even slight fragrances, stagnant smells, or food odors are intolerable. Similarly, those with weak Stomachs most fear unpleasant tastes. They cannot tolerate extremely bitter or poor-tasting substances, nor even slightly salty, slightly bitter, or the natural flavors of grains. Thus, in vomiting due to Stomach Deficiency, the nature and flavor of medicines are paramount; if even slightly incompatible, the medicine will be vomited immediately upon entry, rendering it useless.
Therefore, when treating vomiting due to Yang Deficiency, all aromatic, dispersing, salty, sour, or harsh acrid substances should be carefully evaluated based on judgment. If deemed inappropriate, they must absolutely not be used. One should simply tonify Yang; once Yang returns, the vomiting will stop spontaneously. This is the most reliable method and should not be neglected.
I once observed a patient surnamed Shen, who was a physician by profession, worked very hard, and was nearly forty years old. He suffered from hernia descent and attempted to lift the Qi using a salt water-induced emesis method. Unaware that a deficient Stomach fears salty flavors, he induced uncontrollable vomiting, expelling all liquids for a day and night. Suddenly, he passed one or two bowls of black blood in his stool. His pulse was faint and thread-like, nearly imperceptible. This resulted from vomiting damaging Stomach Qi and extreme Spleen deficiency, compounded by the salt water moving Blood, causing Blood to fail to remain contained and exit through the bowels. I instructed him to quickly take a decoction containing Ren Shen (Radix Ginseng), Sheng Jiang (Rhizoma Zingiberis Recens), and Fu Zi (Radix Aconiti Lateralis Preparata) to restore the failing Yang, which might have saved him.
Suddenly, another physician arrived and stated: "All rebellious Qi rushing upward belongs to Fire. Hematochezia (blood in stool) is also due to Fire. How can you use Ren Shen and Fu Zi? You should quickly administer Tong Bian (Urine of a healthy young boy); this will cure the vomiting and stop the bleeding."
The patient found this reasoning sound. Upon swallowing the urine, he vomited violently in an unbearable manner. The vomiting continued until he died. Alas! Even a person with strong Stomach Qi would feel nauseated by the smell of urine; how could one administer urine to someone already suffering from incessant vomiting? This not only pitied the deceased but also exposed the absurdity of those who dared to call themselves physicians while practicing such reckless methods. I recorded this case to demonstrate the importance of medicinal flavors. Additional case studies on flavors are found in the pediatric section under vomiting, which should be consulted.