呕吐症，胃气失降使然也，而多由肝逆冲胃致之。《灵枢》谓足厥阴所生病者，胸满呕逆是也。夫胃
司纳食，主乎通降，其上逆而呕吐者，乃肝邪犯胃，或胃虚肝乘，故治呕吐，必泄肝安胃。用药主苦降辛通，
佐以酸泄。其肝阳上亢，食入呕吐者，用苦辛降逆，如黄连、川楝子、吴茱萸、半夏、浓朴、姜汁之属。或苦
酸泄热，如乌梅、白芍、木瓜、枳实、左金丸、戊己汤。其胃阳衰，风木乘克，食入不变者，用温胃平肝。
如人参、干姜、丁香、半夏、青皮、白芍，或吴茱萸汤。其脾阳衰，不能运化，腹胀痛呕者，用辛温行滞。
香砂六君子汤加益智、浓朴、神曲。其胃虚客气上逆，噫嗳欲呕者，用咸以软痞，重以镇逆。旋复代赭汤加
二陈。其中阳虚，浊阴犯胃，吐黑绿苦水者，用辛热开浊。理中汤加川椒、半夏、附子、茯苓之属。其肢冷脉
微，时吐清水者，用辛热扶阳。附子理中汤、真武汤。其肝火郁热，吞酸吐酸者，用辛咸苦降。左金丸，或
盐炒吴茱萸汤去枣。其胸痞痰阻，食已漾漾欲吐者，用辛泄。生姜泻心汤，或二陈汤加蔻仁、吴萸、姜汁。
其肝厥上逆，脘痛呕涎者，用辛通，佐以酸泄。如川椒、干姜、桂枝、乌梅、白芍、半夏。其因惊怒动肝，致
胁痛干呕而液虚者，用辛通润补。大半夏加茯神、麦冬、青皮、白芍、当归。其支饮，汤水下咽呕吐者，用
辛泄。小半夏汤。其肝阴胃津两虚，肝风扰胃呕吐者，用柔剂滋液熄风养胃。如人参、白芍、麦冬、阿胶、
小麦、半夏、茯苓、粳米之属。其肝风犯胃，呕吐眩晕者，用苦酸以和阳。如黄连、白芍、乌梅、牡蛎之属。
其呕伤胃津，热邪乘胃，食入即吐者，用辛凉化痰。温胆汤加石斛、山栀。其气冲呛咳吐逆者，肝火上凌，过
胃犯肺，用清肃苦降。如苏子、杏仁、
枇杷叶、前胡、山栀、栝蒌仁、降香末。其气冲心痛，饥不欲食，吐蛔者，用苦辛酸以伏虫。理中安蛔丸。
蛔厥者，脏寒蛔上入膈，口干心烦，手足冷，脉沉迟，宜寒热互用，酸苦杂投。乌梅丸。脏厥者，阳气垂绝，
痛呕不纳，躁扰不安，安胃丸，或半夏泻心汤加枳实。其久呕致伤肝肾，并冲脉上逆者，用温通柔润。如苁
蓉、茯苓、当归、杞子、桂心、沙苑子、鹿角霜。其厥阴浊邪上攻，痛从少腹逆冲为呕者，用辛温泄浊。如
吴萸、小茴、桂枝、韭白汁、茯苓。其呕而绝粒者，取生鹅血热饮。每食必呕者，煮羊血熟食之，皆立止。
呕吐这一病症，是由于胃气不能正常下降所致，而大多由肝气上逆冲犯胃部引起。《灵枢》中提到足厥阴肝经所生的疾病中，胸满、呕逆就是其中的表现。胃负责受纳食物，主要功能在于通畅和下降，如果胃气上逆导致呕吐，这是肝邪侵犯胃腑，或者是胃气虚弱导致肝气乘虚而入的结果。因此治疗呕吐，必须疏泄肝气以安抚胃气。用药主要以苦味药降逆、辛味药通散为主，辅以酸味药泄热。
如果是肝阳上亢，进食后呕吐的，使用苦辛降逆的方法，如黄连、川楝子、吴茱萸、半夏、厚朴、姜汁这类药物。或者使用苦酸泄热的方法，如乌梅、白芍、木瓜、枳实、左金丸、戊己汤。
如果是胃阳衰弱，风木之邪（肝）乘克脾胃，进食后不消化的，使用温补胃阳、平抑肝气的治法。如人参、干姜、丁香、半夏、青皮、白芍，或者吴茱萸汤。
如果是脾阳衰弱，不能运化水谷，出现腹胀、疼痛、呕吐的，使用辛温药物行气导滞。可用香砂六君子汤加益智仁、厚朴、神曲。
如果是胃气虚弱，客气上逆，出现嗳气、想要呕吐的，使用咸味药软坚散结，重镇药降逆止呕。可用旋复代赭汤加二陈汤。
如果是中焦阳气虚衰，浊阴之气犯胃，吐出黑绿色苦水的，使用辛热药物开郁散寒、化浊。可用理中汤加川椒、半夏、附子、茯苓这类药物。
如果是四肢冰冷、脉象微弱，时常吐出清水的，使用辛热药物扶助阳气。可用附子理中汤、真武汤。
如果是肝火郁结化热，出现吞酸、吐酸的，使用辛、咸、苦味药降逆。可用左金丸，或者用盐炒吴茱萸汤去掉大枣。
如果是胸膈痞闷、痰湿阻滞，进食后感觉恶心欲吐的，使用辛味药宣泄痰湿。可用生姜泻心汤，或者二陈汤加蔻仁、吴茱萸、姜汁。
如果是肝气厥逆上冲，脘腹疼痛、呕吐涎沫的，使用辛通药物，辅以酸味药泄热。如川椒、干姜、桂枝、乌梅、白芍、半夏。
如果是因惊吓、愤怒触动肝气，导致胁痛、干呕且津液亏损的，使用辛通兼润补的方法。可用大半夏汤加茯神、麦冬、青皮、白芍、当归。
如果是支饮（水饮停聚胸胁），喝水时吞咽即呕吐的，使用辛味药宣泄水饮。可用小半夏汤。
如果是肝阴和胃津两虚，肝风扰动胃腑导致呕吐的，使用柔润剂滋养津液、熄风养胃。如人参、白芍、麦冬、阿胶、小麦、半夏、茯苓、粳米这类药物。
如果是肝风犯胃，出现呕吐、眩晕的，使用苦酸药调和阴阳。如黄连、白芍、乌梅、牡蛎这类药物。
如果是呕吐损伤了胃津，热邪乘袭胃腑，进食后立即呕吐的，使用辛凉药物化痰清热。可用温胆汤加石斛、山栀。
如果是气机上冲导致呛咳、吐逆的，这是肝火上凌，经过胃部侵犯肺脏，使用清肃肺气、苦降的方法。如苏子、杏仁、枇杷叶、前胡、山栀、栝蒌仁、降香末。
如果是气机上冲导致心痛，饥饿但不想进食，吐出蛔虫的，使用苦、辛、酸味药安伏蛔虫。可用理中安蛔丸。
如果是蛔厥证，因内脏寒冷导致蛔虫上行进入膈部，出现口干、心烦、手脚冰冷、脉象沉迟的，适宜寒热并用，酸苦杂投。可用乌梅丸。
如果是脏厥证，阳气即将衰竭，疼痛呕吐、无法进食，烦躁不安的，可用安胃丸，或者半夏泻心汤加枳实。
如果是长期呕吐导致肝肾受损，并伴有冲脉之气上逆的，使用温通柔润的方法。如肉苁蓉、茯苓、当归、枸杞子、桂心、沙苑子、鹿角霜。
The syndrome of vomiting and regurgitation is caused by the failure of Stomach Qi to descend, and often results from Liver Qi rebelling upward and rushing into the Stomach. The *Ling Shu* (Spiritual Pivot) states that among the diseases generated by the Foot Jueyin (Liver) meridian, chest fullness and vomiting with reflux are included. The Stomach is responsible for receiving food and its primary function is smooth descent; when rebellious Qi causes vomiting, it is due to pathogenic factors of the Liver invading the Stomach, or Liver Qi taking advantage of Stomach deficiency. Therefore, in treating vomiting and regurgitation, one must drain the Liver and soothe the Stomach. Medications should primarily use bitter agents to direct Qi downward and acrid agents to unblock stagnation, assisted by sour agents to clear heat.
For cases where Liver Yang is hyperactive and vomiting occurs after eating, employ acrid-bitter methods to direct rebellious Qi downward, such as Huanglian (Coptidis Rhizoma), Chuanlianzi (Toosendan Fructus), Wuzhuyu (Evodiae Fructus), Banxia (Pinelliae Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Jiangzhi (Zingiberis Recens Juice). Alternatively, use bitter-sour methods to clear heat, such as Wumei (Mume Fructus), Baishao (Paeoniae Radix Alba), Mugua (Chaenomelis Fructus), Zhishi (Aurantii Fructus), Zuojin Wan (Left Metal Pill), and Wuji Tang (Wuji Decoction).
For cases where Stomach Yang is deficient and Wood (Liver) overacts on Earth (Spleen/Stomach), resulting in undigested food after eating, employ warming methods to tonify Stomach Yang and calm the Liver. Examples include Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Dingxiang (Caryophylli Flos), Banxia (Pinelliae Rhizoma), Qingpi (Aurantii Fructus Immaturus), Baishao (Paeoniae Radix Alba), or Wuzhuyu Tang (Evodia Decoction).
For cases where Spleen Yang is deficient and fails to transform and transport, leading to abdominal distension, pain, and vomiting, employ acrid-warm methods to move stagnation. Xiangsha Liujunzi Tang (Costus and Amomum Six Gentlemen Decoction) can be used with Yizhi (Alpiniae Oxyphyllae Fructus), Houpo (Magnoliae Officinalis Cortex), and Shenqu (Massa Medicata Fermentata).
For cases of Stomach deficiency with rebellious guest Qi, manifesting as belching and a desire to vomit, employ salty agents to soften hardness and heavy agents to anchor rebellion. Xuanshu Daizhe Tang (Inula and Hematite Decoction) combined with Erchen Tang (Two Aged Substances Decoction) may be used.
For cases of Middle Jiao Yang deficiency with turbid Yin attacking the Stomach, characterized by vomiting black-green bitter fluid, employ acrid-hot agents to open turbidity. Lizhong Tang (Regulate the Middle Decoction) can be added with Chuanjiao (Sichuan Pepper), Banxia (Pinelliae Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), and Fuling (Poria).
For cases with cold limbs and faint pulse, frequently vomiting clear fluid, employ acrid-hot agents to support Yang. Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) or Zhenwu Tang (True Warrior Decoction) may be used.
For cases of stagnant Liver Fire generating heat, manifesting as acid regurgitation, employ acrid-salty-bitter descending methods. Zuojin Wan (Left Metal Pill) or Yan Chao Wuzhuyu Tang (Salt-Fried Evodia Decoction without Jujube) can be used.
For cases of chest stuffiness with phlegm obstruction, feeling nauseous after eating, employ acrid agents to vent. Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) or Erchen Tang (Two Aged Substances Decoction) added with Kouren (Amomi Fructus Rotundus), Wuyu (Evodiae Fructus), and Jiangzhi (Zingiberis Recens Juice) may be used.
For cases of Liver Jue rebellion rushing upward, with epigastric pain and vomiting of saliva, employ acrid-unblocking agents assisted by sour agents to vent. Examples include Chuanjiao (Sichuan Pepper), Ganjiang (Zingiberis Rhizoma), Guizhi (Cinnamomi Ramulus), Wumei (Mume Fructus), Baishao (Paeoniae Radix Alba), and Banxia (Pinelliae Rhizoma).
For cases triggered by fright or anger disturbing the Liver, leading to hypochondriac pain, dry retching, and fluid deficiency, employ acrid-unblocking and moistening-tonifying methods. Dabanzhi Tang (Major Pinellia Decoction) can be added with Fushen (Poria with Hostwood), Maidong (Ophiopogonis Radix), Qingpi (Aurantii Fructus Immaturus), Baishao (Paeoniae Radix Alba), and Danggui (Angelicae Sinensis Radix).
For cases of Zhi Yin (Branchal Fluid Retention) where drinking water triggers immediate vomiting, employ acrid agents to vent fluid. Xiaobanxia Tang (Minor Pinellia Decoction) may be used.
For cases where both Liver Yin and Stomach Fluids are deficient, with Liver Wind disturbing the Stomach causing vomiting, employ soft agents to nourish fluids, extinguish wind, and nourish the Stomach. Examples include Renshen (Ginseng Radix et Rhizoma), Baishao (Paeoniae Radix Alba), Maidong (Ophiopogonis Radix), Ejiao (Asini Corii Colla), Xiaomai (Tritici Fructus), Banxia (Pinelliae Rhizoma), Fuling (Poria), and Jingmi (Oryza Sativa Germen).
For cases where Liver Wind attacks the Stomach, causing vomiting and vertigo, employ bitter-sour agents to harmonize Yang. Examples include Huanglian (Coptidis Rhizoma), Baishao (Paeoniae Radix Alba), Wumei (Mume Fructus), and Muli (Ostreae Concha).
For cases where vomiting damages Stomach Fluids and Heat pathogens invade the Stomach, causing immediate vomiting after eating, employ acrid-cool agents to resolve phlegm. Wendan Tang (Warm Gallbladder Decoction) can be added with Shihu (Dendrobii Caulis) and Shanzhi (Gardeniae Fructus).
For cases where Qi rushes upward causing coughing and violent vomiting, indicating Liver Fire harassing the Lung via the Stomach, employ clearing-descent and bitter-descending methods. Examples include Suzi (Perillae Fructus), Xingren (Armeniacae Semen Amarum), Pipaye (Loquat Folium), Qianhu (Peucedani Radix), Shanzhi (Gardeniae Fructus), Gualouren (Trichosanthis Semen), and Jiangxiangmo (Aquilariae Lignum Resinatum Pulvis).
For cases where Qi rushing upward causes heart pain, hunger without desire to eat, and expulsion of roundworms, employ bitter-acrid-sour agents to subdue parasites. Lizhong Anhui Wan (Regulate the Middle Roundworm-Calming Pill) may be used.
For Hui Jue (Roundworm Jue), where internal cold causes roundworms to ascend into the diaphragm, presenting with dry mouth, irritability, cold hands and feet, and a deep-slow pulse, employ simultaneous cold-heat therapy and mixed sour-bitter administration. Wumei Wan (Mume Pill) is indicated.
For Zang Jue (Viscera Jue), where Yang Qi is nearly exhausted, presenting with painful vomiting, inability to ingest, and restlessness, Anwei Wan (Stomach-Calming Pill) or Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction) added with Zhishi (Aurantii Fructus) may be used.
For chronic vomiting damaging the Liver and Kidney, accompanied by rebellious Qi of the Chong Mai (Penetrating Vessel), employ warming-unblocking and soft-moistening methods. Examples include Congrong (Cynomorii Herba), Fuling (Poria), Danggui (Angelicae Sinensis Radix), Qizi (Lycii Fructus), Guixin (Cinnamomi Cortex), Shayuanzi (Astragali Complanati Semen), and Lujiaoshuang (Cornu Cervi Pantotrichum Cum Osse).
For cases where Jueyin turbid pathogens attack upward, with pain rushing from the lower abdomen causing vomiting, employ acrid-warm agents to vent turbidity. Examples include Wuyu (Evodiae Fructus), Xiaohui (Foeniculi Fructus), Guizhi (Cinnamomi Ramulus), Jiubai Zhi (Allii Tuberosi Bulbus Juice), and Fuling (Poria).
For vomiting so severe that no food can be taken, drink hot goose blood. For vomiting occurring with every meal, cooked sheep blood may be consumed, which will stop the symptoms immediately.