薛立斋曰∶夫疮疡作呕，不可泥于毒瓦斯内攻，而概用败毒等药。如热甚 痛，邪
气实也，仙方活命饮解之。作脓 痛，胃气虚也，托里消毒散。脓熟胀痛，气血虚
也，先用托里散，后用针以泄之。 痛便秘，热蕴于内也，内疏黄连汤导之。若因
寒药伤胃而呕者，托里建中汤。胃寒少食而呕者，托里益中汤。虚寒淫而呕者，托
里温中汤。肝木乘脾而呕者，托里抑青汤。胃脘停痰而呕者，托里清中汤。脾虚自病
而呕者，托里益黄汤。郁结伤脾而呕者，托里越鞠汤。若不得详究其源，而妄用攻毒
之药，则肿者不能溃，溃者不能敛矣。丹溪虽曰肿疡时呕，当作毒瓦斯攻心治之，溃
疡时呕，当作阴虚补之，殊不知此大概之言耳。即《内经》诸痛痒疮，皆属心火之
意。况今之热毒内攻而呕者寡，脾胃虚寒而呕者多，岂可执前圣之言，而药今人之病欤！
刘河间曰∶夫疮疡时呕，当作湿气侵胃，倍用白术。
朱丹溪曰∶诸逆上冲，呕哕，皆属于火。然治呕须分先后，肿疡时，当作毒瓦斯
上攻治之；溃疡后，当作阴虚补之。
冯鲁瞻曰∶夫痈疽呕逆有二∶一因初起失于内托，伏热在心；一因脾气不正，伏
热在脾。在心者则心烦身热， 肿作痛；脾气不正者，则不烦热，但闻秽气便呕。故
治痈疽，多用香药者，盖气血闻香则行，闻臭则逆，疮疡多因营气不从，逆于肉里，郁
结为脓，得香则气血流行。凡疮本腥秽，又闻臭触则愈甚，若毒入胃则呕哕，古人用
之，可谓有理。即如饮食，亦须调令香美，以益脾土，养其真元，可保无虞矣。
申斗垣曰∶夫呕者，有声无物谓之呕，是气病也。有物无声谓之吐，是血病也。凡
疮疡肿痛之时，即有呕声或吐，当诊其脉，如洪数实大，或便秘不喜冷冻饮料者；宜降火
清中，黄连解毒汤。如喜热饮而恶寒者，作呕便利如常，宜养胃调中汤。如脉微细，肠
鸣腹痛，作泄而呕者，托里温中汤、二神丸。再以香砂六君子汤治之，饮食顿进，十
全大补汤亦可。有患疮疡未溃，而作呕及恶心者，乃疮毒之甚内攻，胃气原虚，故
有此证，宜六君子汤加香砂、生姜治之。如疮疡已溃，而作呕作恶心者，或不食痞满，
肠鸣腹痛，大便利，作呕及哕声不绝，不得安眠，昏愦时发，宜托里温中汤治之。
《内经》曰∶寒淫于内，治以辛温，佐以苦温，姜附能温中外阳气，自里之表，故为
君；羌活苦辛温，能透关节耳。
窦汉卿曰∶夫呃逆，乃胃中虚冷之极，宜香、附、丁、沉。
丹溪曰∶内托散性凉，治呕，有降火之理。（即护心丹。）
《精要》云∶呕逆有二证∶一证谓初发不曾服内托散，伏热在心，宜内托；一证
谓气虚，脾气不正，宜嘉禾散。
朱丹溪曰∶治呕须分先后，肿疡时当作毒瓦斯上攻治之，溃后当作阴虚治之，若
年老因疽溃后，呕逆不食者，宜参 白术膏峻补取效。
薛立斋曰∶热毒内攻而呕者寡，脾胃虚寒而呕者多，当脉证辨之。
杨氏曰∶鼻衄初愈，不曾表汗，毒在经络，则背发大疽，自肩下连腰胁，肿硬
如石，其色紫黑，以凉药投之，终夜大呕，连进内托散呕止。
李东垣曰∶呕吐无时，手足厥冷，脏腑之虚也。
娄全善治一男子肿疡，呕，诸药不止，用独参汤一服，呕即止。
薛立斋曰∶喜热恶寒而呕者，宜温养胃气；喜寒恶热而呕者，宜降火。
南院使戴元礼曰∶如恶心者，无声无物，欲吐不吐，欲呕不呕，虽曰恶心，实
非心经之病，皆在胃口，止宜用生姜，盖能开胃豁痰也。
张景岳曰∶予尝饮食少思，吞酸嗳腐，诸药不应，惟服理中汤，及附子理中丸有
效。盖此证，皆因中气虚寒，不能运化郁滞所致，故用温补之剂，使中气温和，自无此证矣。
胡公弼曰∶若气血两虚发呕，而舌尖干燥者，必死。
蒋示吉曰∶脾胃将倾，则饮食作呕，宜六君子汤加木香、砂仁，不应加附子（《说约》）
经曰∶诸吐呕酸水，及水液混浊者，皆属热，诸呕吐涎，澄澈清冷者，皆属寒。如
天寒则水清，天热则水浊之义。又有胃热胃寒之分，辨之以口渴与不渴耳。
薛立斋说：疮疡患者出现呕吐，不能拘泥于“毒瓦斯内攻”这一观点，而一概使用败毒类药物。如果热势严重且疼痛剧烈，这是邪气实盛的表现，可用仙方活命饮来解毒消散。如果脓液形成时疼痛，这是胃气虚弱的表现，应使用托里消毒散。如果脓液成熟后感到胀痛，这是气血虚弱的表现，应先使用托里散，随后用针穿刺排脓。如果伴有便秘，这是热邪蕴结于体内，可用内疏黄连汤导泻清热。如果是因服用寒凉药物损伤胃气而引起的呕吐，应用托里建中汤。如果因胃寒、食欲减退而呕吐，应用托里益中汤。如果是虚寒之邪过盛引起的呕吐，应用托里温中汤。如果是肝木克制脾土引起的呕吐，应用托里抑青汤。如果是胃脘部停聚痰饮引起的呕吐，应用托里清中汤。如果是脾气虚弱自身发病引起的呕吐，应用托里益黄汤。如果是情志郁结损伤脾脏引起的呕吐，应用托里越鞠汤。如果不能详细探究病因根源，而胡乱使用攻毒的药物，那么未溃破的疮肿就不能溃破，已溃破的疮口就不能愈合。朱丹溪虽然说过，在疮疡未溃（肿疡）阶段出现呕吐，应当当作毒瓦斯攻心来治疗；在疮疡已溃（溃疡）阶段出现呕吐，应当当作阴虚来补益，但这殊不知只是大概性的言论罢了。这也就是《内经》所说的各种疼痛、瘙痒、疮疡，都归属于心火的意旨。况且现在因为热毒内攻而引起呕吐的情况很少，因为脾胃虚寒而引起呕吐的情况很多，怎么能固执于前代圣人的言论，去治疗今人的疾病呢！
刘河间说：疮疡患者时常呕吐，应当当作湿气侵犯胃腑来处理，加倍使用白术。
朱丹溪说：各种气逆上冲、呕吐、干呕的症状，都属于火邪。然而治疗呕吐必须分清楚先后阶段，在疮疡未溃（肿疡）时，应当当作毒瓦斯上攻来治疗；在疮疡已溃（溃疡）之后，应当当作阴虚来补益。
冯鲁瞻说：痈疽引起的呕吐和气逆有两种情况：一种是因为初起时未能及时使用内托法，导致伏热留存在心脏；另一种是因为脾气不正，导致伏热留存在脾脏。病位在心的人，会出现心烦、身体发热、局部肿胀作痛；脾气不正的人，则不会感到心烦发热，但只要闻到秽浊气味就会呕吐。所以治疗痈疽时，多用芳香药物，这是因为气血闻到香气就会运行通畅，闻到臭气就会逆乱。疮疡多是因为营气不循常道，逆乱于肌肉纹理之间，郁结而成脓，遇到香气则气血得以流行。凡是疮本身边就带有腥秽之气，如果再闻到臭气刺激，病情就会加重，如果毒气进入胃中，就会导致呕吐和干呕，古人使用香药，可以说是很有道理的。就像饮食一样，也必须调理得香气美味，以补益脾土，养护真元，就可以保证没有忧患了。
申斗垣说：所谓“呕”，是有声音但没有吐出实物，这是气分的病变。所谓“吐”，是有实物吐出但没有声音，这是血分的病变。凡是在疮疡肿痛的时候，如果出现呕吐声或吐出实物，应当诊察脉象，如果脉象洪大、数动、实大，或者便秘、不喜欢喝冷饮的，适宜降火清中，使用黄连解毒汤。如果喜欢喝热饮且怕冷的，呕吐和大便都正常，适宜养胃调中，使用养胃调中汤。如果脉象微细，肠鸣腹痛，腹泻并伴有呕吐的，使用托里温中汤、二神丸。再用香砂六君子汤治疗，饮食会立刻增进，十全大补汤也可以使用。如果有患疮疡尚未溃破，却出现呕吐及恶心的症状，这是疮毒严重内攻，胃气原本虚弱，所以出现这种证候，适宜使用六君子汤加香附、砂仁、生姜治疗。如果疮疡已经溃破，却出现呕吐及恶心，或者食欲不振、痞闷胀满，肠鸣腹痛，大便稀溏，呕吐和干呕声不断，无法安睡，时而昏沉迷糊，适宜使用托里温中汤治疗。
《内经》说：寒邪淫溢于体内，治疗要用辛温的药物，辅以苦温的药物，干姜、附子能够温补内外阳气，由里达表，所以作为君药；羌活味苦辛性温，能够透达关节。
窦汉卿说：呃逆，是胃中虚冷到了极点，适宜使用沉香、香附、丁香、沉水香。
丹溪说：内托散药性偏凉，治疗呕吐，有降火的道理。（即护心丹。）
《精要》说：呕吐和气逆有两种证候：一种证候是说初发时不曾服用内托散，伏热在心，适宜使用内托法；另一种证候是说气虚，脾气不正，适宜使用嘉禾散。
朱丹溪说：治疗呕吐必须分清楚先后阶段，在疮疡未溃（肿疡）时应当当作毒瓦斯上攻来治疗，溃破之后应当当作阴虚来治疗，如果是老年人因为疽疮溃破后，出现呕吐气逆、不能进食的情况，适宜使用人参白术膏峻补以取得疗效。
薛立斋说：因为热毒内攻而引起呕吐的情况很少，因为脾胃虚寒而引起呕吐的情况很多，应当通过脉象和证候来辨别。
杨氏说：鼻出血刚刚痊愈，没有经过发汗解表，毒气留在经络，导致背部发生大疽，从肩膀下连到腰胁，肿胀坚硬像石头一样，颜色紫黑，如果用凉药投治，整夜剧烈呕吐，连续服用内托散后呕吐才停止。
娄全善治疗一名男子患疮疡未溃，出现呕吐，各种药物无效，使用独参汤一剂，呕吐立即停止。
薛立斋说：喜欢热饮、害怕寒冷而呕吐的，适宜温养胃气；喜欢寒饮、害怕炎热而呕吐的，适宜降火。
南院使戴元礼说：如果是恶心，没有声音也没有吐出实物，想吐吐不出来，想呕呕不出来，虽然叫做恶心，实际上并不是心经的疾病，都在胃口部位，只适宜使用生姜，因为它能开胃豁痰。
张景岳说：我曾经饮食减少、思食欲望低，吞酸嗳腐，各种药物都不见效，只有服用理中汤，以及附子理中丸才有效。因为这个证候，都是因为中气虚寒，不能运化郁滞所致，所以使用温补的药剂，使中气温和，自然就没有这种证候了。
蒋示吉说：脾胃即将衰败，则饮食入腹即呕吐，适宜使用六君子汤加木香、砂仁，如果无效再加附子（出自《说约》）。
经典医书说：各种呕吐酸水，以及水液混浊的，都属于热证；各种呕吐涎沫，清澈寒冷的，都属于寒证。这就像天冷则水清，天热则水浊的道理一样。又有胃热和胃寒的区别，通过辨别口渴与不渴来判断。
Xue Lizhai stated: When patients with sores and ulcers experience vomiting, one must not rigidly adhere to the concept of "toxic vapors attacking inward" and indiscriminately use drugs that defeat toxins. If the heat is severe and pain is intense, this indicates an excess of pathogenic qi; Xianfang Huoming Yin (Immortal Life Elixir) should be used to resolve it. If pain occurs during suppuration, this indicates deficiency of stomach qi; Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) should be used. If distending pain occurs when pus is ripe, this indicates deficiency of qi and blood; Tuoli San (Supporting Interior Powder) should be used first, followed by needle drainage. If accompanied by constipation, this indicates heat accumulating internally; Neishu Huanglian Tang (Internal Drainage Coptis Decoction) should be used to guide out the heat. If vomiting is caused by cold medicines damaging the stomach, Tuoli Jianzhong Tang (Supporting Interior and Establishing the Middle Decoction) should be used. If vomiting is caused by stomach cold and reduced appetite, Tuoli Yizhong Tang (Supporting Interior and Benefiting the Middle Decoction) should be used. If vomiting is caused by excessive deficiency-cold, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) should be used. If vomiting is caused by liver wood overacting on spleen earth, Tuoli Yiqing Tang (Supporting Interior and Suppressing Greenness Decoction) should be used. If vomiting is caused by phlegm retention in the epigastrium, Tuoli Qingzhong Tang (Supporting Interior and Clearing the Middle Decoction) should be used. If vomiting is caused by spleen deficiency itself, Tuoli Yihuang Tang (Supporting Interior and Benefiting Yellowness Decoction) should be used. If vomiting is caused by emotional constraint injuring the spleen, Tuoli Yueju Tang (Supporting Interior and Resolving Depression Decoction) should be used. If the root cause is not investigated in detail and toxic-draining drugs are used recklessly, un-ulcerated swellings will not suppurate, and ulcerated wounds will not heal. Although Zhu Danxi stated that vomiting during the pre-ulcerative stage (swelling stage) should be treated as toxic vapors attacking the heart, and vomiting during the post-ulcerative stage should be treated as yin deficiency requiring tonification, this is merely a general statement. This aligns with the meaning in *Neijing* (The Classic of Internal Medicine) that all pain, itching, and sores belong to heart fire. Moreover, cases of vomiting due to internal attack of hot toxins are rare nowadays, while those due to deficiency-cold of the spleen and stomach are common. How can one stick to the words of former sages to treat the diseases of contemporary people?
Liu Hejian stated: When patients with sores and ulcers frequently vomit, it should be treated as dampness invading the stomach, using doubled doses of Baizhu (Atractylodis Macrocephalae Rhizoma).
Zhu Danxi stated: All upward rushing rebellions, vomiting, and hiccups belong to fire. However, treating vomiting requires distinguishing between early and late stages. During the pre-ulcerative stage, it should be treated as toxic vapors attacking upward; after ulceration, it should be treated as yin deficiency requiring tonification.
Feng Luzhan stated: There are two types of vomiting and rebellion caused by carbuncles and malignant sores: one is due to failure to use interior-supporting methods at the onset, leaving latent heat in the heart; the other is due to abnormal spleen qi, leaving latent heat in the spleen. Those with heat in the heart experience mental restlessness, body fever, and swelling with pain. Those with abnormal spleen qi do not feel restless or feverish but vomit upon smelling foul odors. Therefore, aromatic herbs are often used in treating carbuncles and malignant sores, because qi and blood flow freely upon smelling fragrance but rebel upon smelling stench. Sores and ulcers often occur because Ying-nutritive qi does not follow its course, rebels within the flesh, and condenses into pus; encountering fragrance allows qi and blood to circulate. Since sores naturally have a fishy/foul odor, further exposure to stench worsens the condition; if toxin enters the stomach, vomiting and retching occur. The ancients' use of aromatic substances was well-reasoned. Similarly, diet should be adjusted to be fragrant and delicious to benefit spleen earth and nourish true yuan, ensuring safety.
Shen Douyuan stated: "Ou" (vomiting with sound but no substance) is a disease of qi. "Tu" (spitting out substance without sound) is a disease of blood. When sores and ulcers are swollen and painful, if there is vomiting sound or spitting, pulse diagnosis is necessary. If the pulse is surging, rapid, full, and large, or if there is constipation and aversion to cold drinks, lowering fire and clearing the middle with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) is appropriate. If there is preference for hot drinks and aversion to cold, with normal vomiting and bowel movements, warming the stomach and regulating the middle with Yangwei Tiaozhong Tang (Stomach-Nourishing and Middle-Regulating Decoction) is appropriate. If the pulse is minute and fine, with borborygmus, abdominal pain, diarrhea, and vomiting, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) and Ershen Wan (Two Divine Pills) are appropriate. Follow up with Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction); dietary intake will immediately improve, and Shiquan Dabu Tang (Ten Complete Tonifying Decoction) may also be used. For patients with non-ulcerated sores experiencing vomiting and nausea, this is due to severe toxin attacking inward and original stomach qi deficiency; Liujunzi Tang (Six Gentlemen Decoction) added with Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), and Shengjiang (Zingiberis Rhizoma Recens) is appropriate. For patients with ulcerated sores experiencing vomiting, nausea, anorexia, fullness, borborygmus, abdominal pain, loose stools, incessant vomiting and hiccups, insomnia, and intermittent confusion, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) is appropriate.
*Neijing* states: When cold excesses internally, treat with pungent-warm herbs, assisted by bitter-warm herbs. Jiang (Zingiberis Rhizoma) and Fu (Aconiti Lateralis Radix Praeparata) warm yang qi inside and outside, from interior to exterior, thus serving as sovereign herbs. Qianghuo (Notopterygii Rhizoma et Radix) is bitter, pungent, and warm, penetrating joints and ears.
Dou Hanqing stated: Hiccups represent extreme deficiency-cold in the stomach; Chenxiang (Aquilariae Lignum Resinatum), Xiangfu (Cyperi Rhizoma), Ding (Eugeniae Flos), and Chenshi (Citri Reticulatae Pericarpium) are appropriate.
Danxi stated: Neituo San (Interior-Supporting Powder) is cool in nature and treats vomiting through the principle of lowering fire. (i.e., Huxin Dan (Heart-Protecting Pill)).
*Jingyao* (Essentials) states: There are two syndromes of vomiting and rebellion: one syndrome occurs when interior-supporting powder was not taken at the onset, leaving latent heat in the heart, requiring interior support; the other syndrome is due to qi deficiency and abnormal spleen qi, requiring Jiahe San (Grain-Benefiting Powder).
Zhu Danxi stated: Treating vomiting requires distinguishing stages. During the pre-ulcerative stage, treat as toxic vapors attacking upward; after ulceration, treat as yin deficiency. For elderly patients who, after ulceration of a malignant sore, experience vomiting, rebellion, and inability to eat, Shen Bai Zhu Gao (Ginseng and Atractylodes Paste) should be used for vigorous tonification to achieve efficacy.
Xue Lizhai stated: Vomiting due to internal attack of hot toxins is rare; vomiting due to deficiency-cold of the spleen and stomach is common. It must be differentiated by pulse and symptoms.
Yang Shi stated: After initial healing of epistaxis, if sweating was not induced and toxin remains in the meridians, a large carbuncle may erupt on the back, extending from the shoulder down to the waist and hypochondrium, swollen and hard like stone, purple-black in color. If cool medicines were administered, violent vomiting occurred throughout the night; continuous administration of Neituo San stopped the vomiting.
Li Dongyuan stated: Vomiting occurring at any time with cold extremities indicates deficiency of the zang-fu organs.
Lou Quanshan treated a male patient with a pre-ulcerative sore experiencing vomiting, which did not respond to various medicines. One dose of Dushen Tang (Single Ginseng Decoction) stopped the vomiting immediately.
Xue Lizhai stated: Vomiting with preference for heat and aversion to cold requires warming and nourishing stomach qi; vomiting with preference for cold and aversion to heat requires lowering fire.
Dai Yuanli, Southern Hospital Envoy, stated: Nausea involves no sound and no substance, with a desire to vomit but inability to do so. Although called nausea, it is not a disease of the heart meridian but resides in the stomach opening. Only Shengjiang (Zingiberis Rhizoma Recens) is appropriate, as it opens the stomach and resolves phlegm.
Zhang Jingyue stated: I once experienced reduced appetite and desire to eat, acid regurgitation, and belching of rotten food, unresponsive to various medicines. Only Lifu Tang (Regulate the Middle Decoction) and Fuzi Lifu Wan (Aconite Regulate the Middle Pills) were effective. This syndrome is caused by deficiency-cold of middle qi failing to transform and transport stagnation. Thus, warm-tonifying agents make the middle qi harmonious, eliminating the syndrome.
Hu Gongbi stated: If vomiting occurs due to dual deficiency of qi and blood, and the tip of the tongue is dry, death is certain.
Jiang Shiji stated: When spleen and stomach are on the verge of collapse, food intake causes vomiting. Liujunzi Tang (Six Gentlemen Decoction) added with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus) is appropriate; if ineffective, add Fu (Aconiti Lateralis Radix Praeparata) (*Shuoyue*).
The Classics state: All vomiting of sour water and turbid fluids belongs to heat; all vomiting of saliva that is clear and cold belongs to cold. This is like the principle that water is clear in cold weather and turbid in hot weather. There is also a distinction between stomach heat and stomach cold, differentiated by thirst or lack thereof.