按∶冯氏生平多尚温补，如此证，吐血阴虚之后，梦遗而吐，多由龙雷之火下迫上奔。以辛热治其标
则可，若守而不化，则后患不可测也。
孙奉职治赵仪女，忽吐逆，大小便不通，烦乱，四肢渐冷，无脉，凡一日半。大承气汤一剂，至夜半，渐
得大便通，脉渐和，翌日乃安。此关格之病，极为难治，垂死而活者，惟此一人。
卢复曰∶生平闻铜腥臭即恶心，入口鲜不吐者。虽参汤与茶，久在铜铫中者亦然。常思铜青固发吐药，惟
我何独畏之甚，久未晰此疑。辛亥夏卧病，闻铜臭而呕吐，自反为木形人，色常青畏金，故于铜臭为相忤。因
而思子和吐论中，发吐之药，四十有六种，尝读而未能解也，遂将以五形五色定人而施之。若木形人畏金腥而
吐，则火形人畏咸腐水类而吐矣。然畏者必恶，因其恶以激其怒，则用力少而成功多。余三形可例见。噫，岂
惟吐药为然，而下而汗，宁不可乎？（沈抄。）
聂久吾曰∶庚寅季春，别驾夏公至新兴寺放饥谷，予备酒饭款之。正饮间，忽然腹痛，其痛从脐下小腹起，
痛至胃脘即呕，呕讫痛止。半时许，又从下痛，止复呕，呕讫痛止，如是者数次。医作寒治，用藿香、砂仁等
药不效。至申刻，予觉是内热作痛，热气上冲而呕，必须利之。然煎剂不可服，恐反增呕，急制牵牛大黄丸，
服至数钱，利数次而脱然愈矣。黑牵牛四两，半炒半生，磨取头末一两二钱，三棱、莪术醋炒，各六钱。为末，
浓米汤为丸梧子大。服三钱，未利。再服二钱，不俟二三时见效。
魏玉横治鲍渌饮，年二十余，以夏月肩舆反歙，途次受热，鼻衄盈盆，愈后偶啖梨，遂得吐证。盖肝火而
胃寒也，百治无效。闻道吐字，则应声而呕，以故家人咸戒之。后至吴门，就叶氏诊。以其脉沉细，令服附子
理中汤，人参、姜、附俱用三钱。服后出门，行及半里，觉头重目眩，急归寓，及门而仆。幸其尊人，雅谙药
性，谓必中附毒，亟煎甘草汤灌之，良久乃苏。后去附子，仍服三剂，吐转剧。再往诊，仍令服前方，遂不敢
试。改就薛氏，告以故。薛用六君子汤，服四剂无验。再求诊，适薛他往，薛婿令照方加益智仁一钱，再服亦
不应。又求诊于孙某，其方用甘草八钱，不下咽即吐。因不复求治而返。偶以冬月送殡，感寒增咳，缠绵至夏，
余偶访之，则病剧。询知为向患吐，近复二便俱秘，已七八日不食，惟渴饮茶水，更医数人，或令以艾灸脐，
俱不应。请诊之，见其面色青悴，脉弦伏而寸上溢。谓此缘脾阴大亏，木火炽盛。又因久嗽肺虚，肝无所畏，
遂下乘脾而上侮胃，致成关格。（观此论，则前胃寒二字，殊无着落。尽此症本由肝火冲胃，胃中热极，梨
之甘寒不足以胜其热，反激动其猖狂之热。非胃寒也。）幸脉不数，易已也。宜先平肝，俾不上冲而吐止，斯
肺得下降而便行。令以黄连、肉桂各五分，隔汤蒸服。饮下觉吐稍止，即能食糕数块。然二便胀不可支，令以
大田螺一枚，独蒜一枚，捣拦 于丹田，以物系之，不超时，二便俱行，所下皆青色，遂霍然而愈。时甲戌五
月二十七日也。后与六味加减，入沙参、麦冬等，咳嗽亦止。向后常服养荣之剂，吐不作矣。
雄按∶甲戌乾隆十九年也，其时天士已殁，一瓢尚在，所云叶氏，或天士之后人乎。
叶太史古渠，在上江学幕中，患吐证久不愈。凡学使按临之郡，必召其名医延医，两年余更医十数，病日
甚。岁暮旋里，或与二陈加左金，吴萸、川连俱用五六分，服下少顷，吐血碗许。脉之不数，第两寸俱上鱼际，
左尺微不应指。彼欲言病源及所服方药，余曰∶悉知之矣。第服余方，五十剂乃得痊，计熟地当用三斤许。乃
讶然莫喻，问所患究何病？曰∶彼上江名医，不过谓病痰饮耳，所用方不过用四君、六君已耳。遂拍案笑曰∶
一皆如言。但非痰饮，何以多酸苦涎沫？今饮食日减，何以反重用熟地？曰∶此证由于肾虚，肝失其养，木燥生
火，上逆胃络，肺金亦衰。饮食入胃，不能散布通调，致津液停蓄脘中，遇火上冲，则饮食必吐而出也。四君、
二陈、香、砂类皆香燥之品，以之为治，犹抱薪救火，反助之燃。必滋水生木，润肺养金，庶可获效。第阴药
性缓，病既久，非多剂不瘳也，用熟地、杞子、沙参、麦冬、石斛等出入加减，初服吐自若，十剂外吐降序，
食渐增，果至五十剂而愈。
倪首善年未二十，禀赋甚弱，早婚，得吐病。或与二陈、五香等剂转甚。有用桂、附者，服一剂觉不安，
乃止。有教单食猪油者，初颇效，后亦不应。脉之，虚弦略数，与生熟地、沙参、麦冬、川连、蒌仁，四剂后
去连，又三十余剂而痊。
高氏女七八岁时，即病头痛而呕，或酸或苦，百治不效。其父询余，余曰∶此肝火上逆耳。与生地、杞子、
沙参、麦冬，二三剂即愈。后及笄，于春尽病复作。其父已殁，乃兄延数医治之，所用皆二陈、六郁、香、砂、
丁、桂之类，经半年，面杀青，股无肉。其母泣令延余，仍以前方，每剂内熟地一两，二十余剂乃愈。
金氏妇患吐证，盖十余年矣。所服香燥，不可胜计。后左胁渐痛有块，经水不行，脉涩数，善怒。延诊，
辞不治。延不已，勉与六味加减，服之颇有验。然一怒即发，越半年而卒。
福建罗二尹悔斋，久病足痿，于去年春尝呕而头汗大出，医疗无效。乃不药，数月渐可。随于夏间又患不
眠，治亦无效，至秋后乃痊。今年春因公事寓杭，求针科治足疾，又为灸中脘、气海等穴十余壮，步稍良，而
呕证大作，食入即吐，绝粒数日，又不眠，服姜、附、萸、桂、二术、二陈等，觉有烟辣之气上冲。诊之，六
脉大如箸头，两寸皆溢出鱼际，舌瘦小，伸之极尖，且舌颤，黄苔边红瘪，额色赭石，鼻色熏焦，小便清白，
大便常五日一行。谓此营气大亏，肝肾之火，上逆胃络则呕吐，浮入心胞则不眠。与养心汤加川连、牛膝、米
仁。嘱其验小便黄则病退。一剂即不呕能食，小便果黄色。二剂得眠，舌苔淡红瘪消。唯两胁如有物，动辄牵
引，加山栀、川楝，二剂左胁之物即坠下。又加枇杷叶、熟地、蒌仁，去山栀、川楝、黄连、牛膝，二剂右胁
之物亦坠下，脉亦稍敛，大便二日一行，以行期甚迫。嘱其照方服至舌不颤乃可。或足疾再甚，慎进风燥之剂。
所以云者，知其针之得泻而暂愈耳。
章虚谷治一七十岁老人，数年前患疟，病根未除，每至夏秋则发。自去冬至丁亥春，忽病呕吐，战振，筋
脉掣痛，愈后屡发，或见小便黄赤，大便干少，面有红光，谓是肝郁化火，火逆犯胃作呕。胃阴不足，故小便
黄赤，大便干少也。章诊之，脉虚涩少神，舌苔白腐而浓，此中焦虚寒，浊阴聚胃也。以姜制半夏为君，佐参、
苓、附子、干姜、生姜、桂枝、芍药、乌梅、草果仁，一剂即甚效。继去乌梅，加浓朴，连进十余剂。每剂附
子用至三钱，胃口开而病亦愈。
按语：冯氏生平用药多崇尚温补之法。像这种病症，是在吐血且阴虚之后，因梦遗引发呕吐，大多是由于龙雷之火（相火）下迫上奔所致。用辛热药物治其标症是可以的，但如果拘泥守旧不知变通，那么后患将不可预测。
孙奉职治疗赵仪的女儿，突然发生呕吐逆气，大小便不通畅，心烦意乱，四肢逐渐发冷，摸不到脉搏，这种情况持续了一天半。给予大承气汤一剂，到了半夜，大便逐渐通畅，脉搏也逐渐调和，第二天就安稳了。这是关格病，极为难治，濒临死亡而救活的，只有这一例。
卢复说：我生平只要闻到铜器的腥臭味就会恶心，入口几乎没有不吐出来的。即使是参汤和茶，如果在铜壶中放置久了，也是如此。常想铜青确实是催吐药，为什么唯独我对它如此畏惧，长久以来未能理清这个疑惑。辛亥年夏天卧病时，闻到铜臭而呕吐，自我反思认为是木形人，面色常青而畏金，所以与铜臭相抵触。因而想到张子和在论述催吐法中提到，用于发吐的药物有四十多种，曾经读过但未能理解，于是打算以五行五色来定人施治。如果是木形人畏惧金的腥味而呕吐，那么火形人应该畏惧咸腐的水类物质而呕吐了。然而畏惧的一定是厌恶，因为厌恶而激发它的怒气，则用力少而成功多。其余三种形态的人可以类推。唉，岂止是催吐药是这样，攻下法和发汗法难道不可以这样吗？（据沈抄本。）
聂久吾说：庚寅年季春时节，别驾夏公到新兴寺发放救济饥民的谷物，我准备酒饭款待他。正在饮酒之间，忽然腹痛，疼痛从脐下小腹开始，痛至胃脘部就呕吐，呕吐完疼痛停止。半个时辰左右，又从下部起痛，痛止后又呕吐，呕吐完疼痛停止，像这样的情况发生了数次。医生当作寒证治疗，使用藿香、砂仁等药无效。到了申时，我觉得这是内热作痛，热气上冲导致呕吐，必须通利大便。但是煎剂不能服用，恐怕反而增加呕吐，急忙制作牵牛大黄丸，服用数钱后，排便数次而豁然痊愈。黑牵牛四两，一半炒一半生，磨取头末一两二钱，三棱、莪术醋炒，各六钱。研为细末，用浓米汤做成梧桐子大小的丸药。服用三钱，未通便。再服二钱，不到两三个小时见效。
魏玉横治疗鲍渌饮，二十多岁，因为在夏季乘坐轿子往返歙县，途中受热，鼻出血盈盆，病愈后偶然吃梨，于是得了呕吐证。这是肝火而胃寒，各种治疗方法都无效。听到“吐”字，就会应声而呕，因此家人都忌讳提这个字。后来到了吴门，找叶天士诊治。因为他的脉象沉细，让他服用附子理中汤，人参、干姜、附子都用三钱。服药后出门，走了半里路，觉得头重目眩，急忙回住所，刚到门口就晕倒。幸好他的父亲精通药性，认为一定是中了附子的毒，赶紧煎甘草汤灌下去，很久才苏醒。后来去掉附子，仍然服用三剂，呕吐反而加剧。再次去就诊，仍然让服用前方，于是不敢尝试。改求诊于薛氏，告知了前情。薛氏使用六君子汤，服用四剂没有效果。再次求诊，恰逢薛氏外出，薛氏的女婿让照方加益智仁一钱，再服用也不见效。又求诊于孙某，他的方子用甘草八钱，药不下咽即吐。于是不再求治而返回。偶然在冬天送殡，感受寒气加重咳嗽，缠绵至夏天，我偶然拜访他，发现病情严重。询问得知之前患呕吐，最近又大小便俱秘，已经七八天不进食，只口渴喝茶水，换了好几个医生，有的让人艾灸肚脐，都不见效。请我诊治，见其面色青黄憔悴，脉弦伏而寸口溢出鱼际。我说这是因为脾阴大亏，木火炽盛。又因久咳肺虚，肝无所畏，于是下乘脾而上侮胃，导致成关格。（看这个论述，之前的“胃寒”二字，确实没有着落。此症本来是由肝火冲胃，胃中热极，梨的甘寒不足以胜其热，反而激动了其猖狂的热邪。并非胃寒。）幸好脉不数，容易治愈。应当先平抑肝火，使其不上冲而呕吐停止，这样肺得以下降而大便通行。令用黄连、肉桂各五分，隔水蒸服。喝下去觉得呕吐稍止，就能吃几块糕饼。然而二便胀满难以忍受，令用大田螺一枚，独蒜一枚，捣烂敷于丹田，用物体固定住，不超过一个时辰，二便都通了，所下的都是青色粪便，于是霍然而愈。时间是甲戌五月二十七日。后来用六味地黄丸加减，加入沙参、麦冬等，咳嗽也停止了。之后常服养荣之剂，呕吐就不再发作了。
雄按：甲戌年是乾隆十九年，那时叶天士已经去世，一瓢先生还在世，所说的叶氏，或许是叶天士的后人吧。
叶太史古渠，在上江学幕任职期间，患呕吐证长久不愈。凡是学使巡视到的郡县，必定召请名医延医诊治，两年多换了十几个医生，病情日益加重。岁末回乡，有时用二陈汤加左金丸，吴茱萸、黄连都用五六分，服用后不久，吐血一碗左右。脉不数，只是两寸都上达鱼际，左尺微不应指。他想说明病因及所服方药，我说：全知道了。只要服用我的方子，五十剂才能痊愈，计算下来熟地应当用三斤左右。于是惊讶不解，问究竟患的是什么病？我说：那些上江的名医，不过说是痰饮病罢了，所用的方子不过是四君子汤、六君子汤而已。于是拍案笑道：一切如你所说。但这不是痰饮，为什么会有那么多酸苦涎沫？现在饮食日渐减少，为什么反而重用熟地？我说：此证由于肾虚，肝失其养，木燥生火，上逆犯胃络，肺金也衰弱。饮食入胃，不能散布通调，导致津液停蓄在胃脘中，遇到火上冲，则饮食必吐出来。四君子、二陈、香附、砂仁之类都是香燥之品，用来治疗，如同抱薪救火，反而助长火势。必须滋水生木，润肺养金，才可以获效。只是阴药性质缓和，病既已久，非多剂不能痊愈，用熟地、枸杞子、沙参、麦冬、石斛等出入加减，初服时呕吐依旧，十剂外呕吐渐降，饮食逐渐增加，果然到五十剂而痊愈。
倪首善年龄不到二十，禀赋很弱，早婚，得了呕吐病。有人给用二陈汤、五香等剂反而加重。有用桂枝、附子的，服一剂觉得不安，就停止了。有人教单食猪油的，起初颇有效，后来也不见效。诊脉，虚弦略数，给与生熟地、沙参、麦冬、黄连、瓜蒌仁，四剂后去掉黄连，又三十多剂而痊愈。
高氏女七八岁时，就病头痛而呕吐，或酸或苦，各种治疗都无效。她的父亲问我，我说：这是肝火上逆。给与生地、枸杞子、沙参、麦冬，二三剂就痊愈了。后来到了成年，在春末病复发。她父亲已死，乃兄请了几个医生医治，所用皆是二陈汤、六郁汤、香附、砂仁、丁香、肉桂之类，经过半年，面如杀青，大腿无肉。母亲哭着让我去诊治，仍用前方，每剂内熟地一两，二十多剂才痊愈。
金氏妇患呕吐证，大概十几年了。所服的香燥药物，不可胜计。后来左胁渐渐疼痛且有肿块，月经不行，脉涩数，易怒。请我诊治，推辞不治。请求不停，勉强给与六味地黄丸加减，服用颇有验。但是一生气就发作，过了半年就去世了。
福建罗二尹悔斋，久病足痿，在去年春天曾呕吐且头汗大出，医疗无效。于是不吃药，几个月逐渐好转。随后在夏天又患失眠，治疗也无效，到秋天后才痊愈。今年春天因公事寓居杭州，求针灸科治疗足疾，又灸中脘、气海等穴十余壮，走路稍好，但呕吐证大作，食入即吐，绝食数日，又不眠，服用姜、附子、吴茱萸、肉桂、白术、苍术、二陈汤等，觉得有烟辣之气上冲。诊之，六脉大如筷子头，两寸皆溢出鱼际，舌瘦小，伸之极尖，且舌颤，黄苔边红瘪，额色赭石，鼻色熏焦，小便清白，大便常五日一行。我说这是营气大亏，肝肾之火，上逆胃络则呕吐，浮入心包则不眠。给与养心汤加黄连、牛膝、薏苡仁。嘱咐他验小便黄则病退。一剂就不呕能食，小便果黄色。二剂得眠，舌苔淡红瘪消。唯两胁如有物，动辄牵引，加山栀、川楝子，二剂左胁之物即坠下。又加枇杷叶、熟地、瓜蒌仁，去山栀、川楝子、黄连、牛膝，二剂右胁之物亦坠下，脉亦稍敛，大便二日一行，因为行期甚迫。嘱咐他照方服至舌不颤才可。如果足疾再严重，慎用风燥之剂。之所以这样说，是因为知道针法得泻而暂时痊愈罢了。
章虚谷治疗一位七十岁老人，数年前患疟疾，病根未除，每到夏秋则发作。自去年冬至丁亥春，忽然病呕吐，战栗振摇，筋脉掣痛，病愈后屡发，有时见小便黄赤，大便干少，面有红光，说是肝郁化火，火逆犯胃作呕。胃阴不足，故小便黄赤，大便干少。章氏诊之，脉虚涩少神，舌苔白腐而浓，这是中焦虚寒，浊阴聚胃。以姜制半夏为君药，佐以人参、茯苓、附子、干姜、生姜、桂枝、芍药、乌梅、草果仁，一剂即甚效。继而去掉乌梅，加厚朴，连进十余剂。每剂附子用至三钱，胃口开而病亦愈。
Note: Feng's lifelong medical practice favored warm and tonifying methods. In such a case, following hematemesis and yin deficiency, with emission dreams leading to vomiting, it is mostly due to the Dragon-Lei Fire (Ministerial Fire) forcing downward and rushing upward. Using acrid-hot herbs to treat the branch symptoms is acceptable; however, if one adheres rigidly without flexibility, the subsequent complications will be immeasurable.
Sun Fenzhi treated the daughter of Zhao Yi, who suddenly experienced vomiting and regurgitation, obstruction of both urination and defecation, restlessness, gradual coldness of the four limbs, and absence of pulse, lasting for one and a half days. One dose of Dachengqi Tang (Major Order the Qi Decoction) was administered. By midnight, bowel movements gradually became unobstructed, the pulse gradually harmonized, and she was at peace the next day. This is Guan Ge disease (Obstruction and Reversal), extremely difficult to treat; among those near death, only this one was saved.
Lu Fu said: Throughout my life, smelling the metallic odor of copper induces nausea, and almost nothing ingested remains down. Even Ginseng Decoction or tea, if kept long in a copper pot, causes vomiting. I often ponder that Copper Green (Basic Copper Carbonate) is indeed an emetic herb; why do I fear it so much? This doubt remained unresolved for a long time. In the summer of Xinhai, while bedridden, I vomited upon smelling copper. Reflecting on myself, I am a Wood-type person, with a greenish complexion and aversion to Metal; thus, the copper smell clashes with me. This led me to recall Zhang Hezi's discussion on emetics, which lists forty-six emetic herbs. Having read them but not fully understood, I intended to apply treatment based on Five Elements and Five Colors. If Wood-type people vomit due to aversion to the metallic smell of Metal, then Fire-type people should vomit due to aversion to the salty, putrid nature of Water. Since aversion implies disgust, provoking anger through disgust requires less effort but yields greater success. The other three types can be inferred similarly. Alas, is it only emetics that work this way? Could purgatives and diaphoretics not follow the same principle? (According to Shen's manuscript.)
Nie Jiuwu said: In the late spring of Gengyin, Xia Gong, a Vice Prefect, came to Xinxing Temple to distribute grain to the famine victims. I prepared wine and rice to entertain him. While drinking, I suddenly suffered abdominal pain starting from below the navel in the lower abdomen. When the pain reached the epigastrium, vomiting occurred, and ceased after vomiting. Half an hour later, pain started again from below, followed by vomiting upon cessation of pain. This cycle repeated several times. Physicians treated it as Cold, using Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit) without effect. By Shen hour (3-5 PM), I realized it was internal heat causing pain, with heat qi rushing upward inducing vomiting, requiring purgation. However, decoctions could not be taken as they might exacerbate vomiting. I hastily prepared Qianniudahuang Wan (Pharbitis Seed and Rhubarb Pill). After taking a few qian, multiple bowel movements ensued, and I recovered instantly. Black Pharbitis Seed (Pharbitidis Semen) 4 liang, half roasted half raw, ground to take the first extraction powder 1.2 qian; Sanleng (Sparganii Rhizoma) and Ezhu (Curcumae Rhizoma) stir-fried with vinegar, each 6 qian. Ground into powder, formed into pills the size of Sophora seeds using thick rice soup. Taking 3 qian did not induce bowel movement. Taking another 2 qian showed effects within two to three hours.
Wei Yuheng treated Bao Luyin, aged over twenty, who contracted heat while traveling by sedan chair between Hui'an and She County in summer, resulting in severe epistaxis filling a basin. After recovery, eating a pear triggered vomiting. This was Liver Fire with Stomach Cold; various treatments failed. Hearing the word "vomit" caused immediate vomiting, so family members avoided mentioning it. Later in Wumen, Ye Tianshi examined him. Due to deep and fine pulse, he prescribed Fuzi Lizhong Tang (Aconite Root and Gastrodia Decoction), with Ginseng, Dried Ginger, and Aconite Root each at 3 qian. After taking the medicine and walking half a li, he felt heavy head and dizziness, rushed back, and collapsed at the door. Fortunately, his father knew herbal properties well, suspected Aconite toxicity, and urgently brewed Licorice Decoction to administer. He revived after a long time. Removing Aconite, he took three more doses, but vomiting worsened. Re-examined, still advised to take the previous formula, so he dared not try. Seeking treatment from Xue Shi, he explained the history. Xue used Liujunzi Tang (Six Gentlemen Decoction); four doses had no effect. Seeking again, Xue was away; Xue's son-in-law advised adding Zhiyiren (Alpinia Oxyphylla Fruit) 1 qian to the prescription, but it also failed. Seeking Sun Mou, whose prescription used Licorice 8 qian, the medicine was vomited out before swallowing. Thus, he returned home without further treatment. Accidentally attending a funeral in winter, he caught cold, worsening cough, lingering until summer. I visited him accidentally and found the condition severe. Inquiring, I learned he previously suffered vomiting, recently with complete obstruction of urination and defecation, fasting for seven to eight days, only drinking tea water. Several doctors tried moxibustion on the umbilicus without success. Upon examination, his complexion was blue-green and haggard, pulse string-like and hidden with overflow at Cun position. I stated this was due to severe depletion of Spleen Yin and flourishing Wood-Fire. Also, chronic cough weakened Lung, leaving Liver unchecked, thus attacking Spleen below and insulting Stomach above, resulting in Guan Ge. (Reading this analysis, the previous mention of "Stomach Cold" lacks basis. This syndrome originates from Liver Fire rushing to Stomach, extreme heat in Stomach. The sweet-cold nature of pear was insufficient to overcome the heat, instead agitating its rampant heat. It is not Stomach Cold.) Fortunately, the pulse was not rapid, indicating ease of treatment. First, soothe Liver to prevent upward rushing and stop vomiting, allowing Lung to descend and bowels to move. Prescribed Huanglian (Coptis Rhizome) and Rougui (Cinnamon Bark) each 0.5 fen, steamed in hot water. After drinking, vomiting slightly stopped, and he could eat a few pieces of cake. However, unbearable distension in bowels and bladder required applying mashed large river snail and single clove garlic to Dantian, secured with cloth. Within an hour, urination and defecation occurred, discharging green stool, and he recovered instantly. Date: May 27, Ji Xu year. Later, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was modified with Shashen (Glehnia Root) and Maidong (Ophiopogon Tuber); cough ceased. Subsequently, regularly taking Yangrong (Nourishing Vigor) formulas prevented recurrence of vomiting.
Xiong Note: Ji Xu corresponds to the 19th year of Qianlong. Ye Tianshi had passed away, while Yipiao was still alive. The mentioned "Ye Shi" might refer to Ye Tianshi's descendants.
Ye Taishi Guqu, serving in the Jiangsu education bureau, suffered from chronic vomiting. Whenever the Education Commissioner inspected prefectures, famous doctors were summoned. Over two years, more than ten physicians treated him, yet the condition worsened. Returning home at year-end, sometimes Erchen Tang plus Zuojin Wan was used, with Evodia Fruit and Coptis Rhizome at 5-6 fen. Shortly after ingestion, he vomited about a bowl of blood. Pulse was not rapid, but both Cun positions extended to Yuji. Left Chi position was faint and barely palpable. He wanted to explain the etiology and previous prescriptions. I said: I know all. Take my prescription for fifty doses to recover, requiring approximately three jin of Shudi (Prepared Rehmannia Root). He was surprised and asked the diagnosis. I said: Those Jiangsu physicians attributed it to Phlegm-Fluid retention, using Sijunzi Tang or Liujunzi Tang. I laughed and slapped the table: All correct. But if not Phlegm-Fluid, why so much sour-bitter saliva? Why increase food intake reduction lead to heavy use of Shudi? I replied: This syndrome stems from Kidney deficiency, Liver losing nourishment, Wood drying generating Fire, rushing upward invading Stomach collaterals, and Lung Metal also declining. Food entering Stomach cannot distribute and regulate, causing fluids to accumulate in the epigastrium. Meeting Fire rushing up, food must be vomited. Sijunzi, Erchen, Xiangfu, Sharen are aromatic-drying substances. Treating with them is like carrying firewood to save a fire, aiding combustion. Must nourish Water to generate Wood, moisten Lung to tonify Metal. Only then can efficacy be achieved. Yin-nourishing drugs act slowly; for chronic illness, many doses are needed. Using Shudi, Gouqi (Wolfberry Fruit), Shashen, Maidong, Shihu (Dendrobium Stem) with modifications. Initially, vomiting persisted. After ten doses, vomiting decreased sequentially, food intake increased, and recovery occurred at fifty doses.
Ni Shoushan, under twenty, constitutionally weak, married early, developed vomiting. Erchen Tang and Wuxiang formulas aggravated it. Gui Zhi (Cinnamon Twig) and Fuzi (Aconite Root) caused discomfort after one dose, so stopped. Eating pure lard initially helped, later ineffective. Pulse was deficient, string-like, slightly rapid. Prescribed Raw and Prepared Shudi, Shashen, Maidong, Huanglian (Coptis Rhizome), Louren (Trichosanthes Seed). After four doses, Huanglian removed, continued for thirty-plus doses until cured.
Gao's daughter, aged seven or eight, suffered headache and vomiting, sour or bitter taste, unresponsive to various treatments. Her father asked me. I said: Liver Fire rushing upward. Prescribed Shengdi (Rehmannia Root), Gouqi, Shashen, Maidong. Cured in two to three doses. At adulthood, relapsed in late spring. Father deceased, brother consulted several physicians using Erchen Tang, Liuyu Tang, Xiangfu, Sharen, Dingxiang (Caryophylli Flos), Rougui. After half a year, face turned greenish, thighs wasted. Mother wept, begged me to treat. Used previous formula with Shudi 1 liang per dose. Cured in twenty-plus doses.
Jin's wife suffered vomiting for over ten years. Ingested countless aromatic-drying herbs. Later, left hypochondriac pain with mass, amenorrhea, pulse choppy and rapid, irritability. Consulted me, declined treatment. Persistently requested, reluctantly prescribed modified Liuwei Dihuang Wan. Effective, but relapsed upon anger. Died six months later.
Luo Er Yin Huizhai from Fujian, suffered chronic flaccidity of legs. Last spring, vomited with profuse head sweating; medical treatment failed. Stopped medication, improved gradually over months. Summer brought insomnia, treatment failed, recovered in autumn. Spring this year, stayed in Hangzhou for official business, sought acupuncture for leg ailment. Moxibustion on Zhongwan (CV12) and Qihai (CV6) improved walking, but vomiting intensified, immediate regurgitation after eating, fasting for days, insomnia. Took Ginger, Aconite, Evodia, Cinnamon, Atractylodes, Pinellia, Erchen Tang, feeling pungent smoke rising. Pulse: Six positions large as chopsticks, Cun positions overflowing Yuji. Tongue: Thin, small, pointed tip, trembling, yellow coating, red depressed edges. Forehead: Hematite color. Nose: Smoky scorched color. Urine: Clear white. Bowel: Once every five days. Diagnosis: Severe depletion of Ying Qi, Liver-Kidney Fire rushing upward to Stomach collaterals causing vomiting, floating to Pericardium causing insomnia. Prescribed Yangxin Tang (Heart-Nourishing Decoction) plus Huanglian, Niuxi (Achyranthes Root), Yiyiren (Coix Seed). Advised monitoring urine color for improvement. One dose: Vomiting stopped, appetite returned, urine yellow. Two doses: Sleep restored, tongue coating faded. Distension in hypochondria pulling sensation: Added Zhizi (Gardenia Fruit) and Chuanlianzi (Evodia Fruit). Two doses: Mass in left hypochondrium descended. Added Pipaye (Loquat Leaf), Shudi, Louren; removed Zhizi, Chuanlianzi, Huanglian, Niuxi. Two doses: Mass in right hypochondrium descended, pulse收敛 (gathered), bowel movement every two days. Due to urgent travel, advised continuing prescription until tongue tremor ceases. Caution against wind-drying agents if leg weakness recurs. Reason: Acupuncture provided temporary relief via draining.
Zhang Xugu treated a seventy-year-old man. Malaria years ago left root cause untreated, recurring in summer-autumn. From last winter to Dinghai spring, sudden vomiting, shivering, tendon spasm pain, recurrent remissions. Sometimes yellow-red urine, dry scant stool, facial red glow. Diagnosed as Liver Depression transforming into Fire, Fire insulting Stomach causing vomiting. Stomach Yin deficiency causing yellow-red urine and dry stool. Zhang's pulse: Deficient, choppy, lacking spirit. Tongue: White, rotten, thick coating. Diagnosis: Middle Jiao Deficient Cold, Turbid Yin accumulating in Stomach. Principal herb: Ginger-processed Banxia (Pinellia Tuber). Assistants: Renshen (Ginseng Root), Fuling (Poria), Fuzi (Aconite Root), Ganjiang (Dried Ginger), Shengjiang (Fresh Ginger), Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Wumei (Mume Fruit), Caoguoren (Areca Seed). One dose highly effective. Removed Wumei, added Houpo (Magnolia Bark), continued ten-plus doses. Each dose contained 3 qian of Fuzi. Appetite opened, disease cured.