海 秦二母病太阴病三日不解后呕逆恶心而脉不浮与之半硫丸二三服不止复与黄 建中汤脉中极紧无表里病胸
中
大热发渴引饮皆曰阳证欲饮之水予反与姜附等药紧脉反沉细阳犹未生以桂附姜乌之类酒丸与百丸接之二日中十余服病
人身热烦躁不宁欲作汗也又以前丸接之覆以浓衣阳脉方出而作大汗翌日大小便始通下瘀血一盆如猪肝然用胃风汤加桂
附三服血止其寒甚如此亦世所未见也
少阴证口燥舌干而渴尺寸脉俱沉沉迟则四逆汤沉疾则大承气汤 少阴口燥舌干而渴身表凉脉沉细而虚者泻心汤主
之此有形无形药也
人参汤 治伤寒七八日汗后心烦燥渴
人参 黄芩 柴胡 葛根（各一两） 山栀 甘草（炙各半两）上为粗末每服五钱姜枣煎温服
活 阳毒倍常燥盛大渴者黑奴丸主之（方见阳毒）风温如渴甚者宜栝蒌汤（方见风温）中暑伏热屡治不瘥其人
发渴
不已酒蒸黄连丸主之（方见中暑）
脉 热病在肾令人渴口干舌焦黄赤昼夜欲饮水不止腹大而胀尚不厌饮目无精光者死不治
（干呕欲升）
成 呕者声物兼出也俗谓之 非也夫 与哕盖字异而音义俱同吐者但吐出其物而无声故有干呕而无干吐呕有责
为
热者责为寒者至于吐家则悉言虚冷也呕又有停饮者有胃脘有脓者皆当明辨之呕而发热者柴胡汤详具与其呕不止心下急
郁郁微烦大柴胡汤主之者是邪热为呕也膈上有寒饮干呕者不可吐也当温之与其干呕吐涎沫头痛者吴茱萸汤主之是寒邪
为呕也先呕后渴者此为欲解先渴后呕者为水停心下此属饮家是停饮呕者呕家有痈脓不须治脓尽自愈是胃脘有脓而呕也
诸如此者虽有殊别大抵伤寒表邪欲传里里气上逆则为呕也是以半表半里证多云呕也伤寒三日三阳为尽三阴当受邪其人
反能食而不呕此为三阴不受邪是知邪气传里者必致呕也至于干姜附子汤证云不呕不渴为里无热十枣汤证云干呕短气汗
出不恶寒者此表解里未和也即此视之其呕为里热明矣呕家之为病气逆者必散之痰饮者必下之千金曰呕家多服生姜此是
呕家圣药是要散其逆气也金匮要略曰呕家用半夏以去其水水去呕则止是要下其痰饮也呕多虽有阳明证不可攻也谓其气
逆而未收敛为实也其呕而脉弱小便复利身有微热见厥者已为难治盖谓其虚寒之甚也医者必审其邪气之虚实疾证之逆顺
为施药剂治则当矣
太阳 病（汗）或已发热未发热必恶寒体痛呕逆脉阴阳俱紧者名曰伤寒麻黄汤 太阳病过经十余日反二三下之后四
五日柴胡证仍在者先与小柴胡汤呕不止心下急郁郁微烦者为未解也与大柴胡汤下之则愈（按仲景虽曰呕家虽有阳明证不
可攻攻之为逆然阳明伏热熏蒸清道而呕且烦者非以苦寒直折之不可也故用大柴胡下之）伤寒发热汗出不解心下痞硬呕吐
而下利者大柴胡 太阳病过经十余日心下温温欲吐而胸中痛大便反溏腹微满郁郁微烦先此时自极吐下者与调胃承气汤
若不尔者不可与但欲呕胸中痛微溏者此非柴胡证以呕故知极吐下也（成 心下温温欲吐郁郁微烦胸中痛当责邪热客于胸
中大便反溏腹微满则邪热已下于胃也日数虽多若不经吐下止是传邪亦未可下当与柴胡汤以除上中二焦之邪若曾吐下伤
损胃气胃虚而邪乘虚入胃为实非柴胡汤所能去调胃承气汤下胃热以呕知胃气先曾伤动也 按经文温温当作 又以呕
下当有缺文盖呕家正为柴胡证也岂逸微溏字耶）呕而发热者（和）小柴胡汤主之 伤寒六七日发热微恶寒支节烦疼微呕
心下支结外证未去者柴胡加桂枝汤主之 太阳与阳明合病不下利但呕者葛根加半夏汤主之（活人云头疼身热痛肌热目疼
鼻干脉浮而长是也）
葛根半夏汤方
葛根 半夏（各二钱） 麻黄 生姜（各一钱半） 甘草 芍药 桂枝（各一钱） 大枣（十二枚擘） 上 咀以
水一斗先煎麻黄葛根减二升去白沫纳诸药煎取三升温服一升覆取微汗
阳明 伤寒发热无汗呕不能食而反汗出 然者是转属阳明也（大柴胡汤）食谷欲呕者属阳明也吴茱萸汤主之得汤
反剧者属上焦也（葛根半夏汤）伤寒（和）呕多虽有阳明证不可攻之黄芩生姜半夏汤小柴胡汤（活人用桔梗汤）阳明病
胁下硬满不大便而呕舌上白苔者可与小柴胡汤 阳明病（温）反无汗而小便利二三日呕而咳手足厥者必苦头痛（或用真
武汤去茯苓）
少阳 呕而往来寒热胸胁苦满者宜小柴胡若兼下利者乃太阳少阳合病宜黄芩加半夏生姜汤（论见往来寒热及下利太
阳阳明合病自下利为在表当与葛根汤发汗阳明少阳合病自下利者为在里可与承气汤下之此太阳少阳合病自下利为在半
表半里非汗下所宜故与黄芩汤以和解之呕者胃气逆也故加半夏生姜以散逆气）伤寒五六日呕而发热者柴胡汤证具而以他
药下之柴胡证仍在者复与柴胡汤 血弱气尽腠理开邪气因入与正气相搏结于胁下正邪分争往来寒热休作有时默默不欲
饮食脏腑相连其痛必下邪高痛下故使呕也小柴胡汤主之（邪气外甚阳不主里里气不和气下而不上者但下利而不呕里气上
逆而不下者但呕而不下利也与小柴胡汤以解半表半里之邪）渴而饮水呕者柴胡不中与也（活人云宜治膈间水赤茯苓汤主
之方见后）
太阴 太阴之为病腹满而吐食不下自利益甚时腹自痛若下之必胸下结硬
少阴 病下利六七日咳而呕渴心烦不得眠者猪苓汤主之 少阴病下利脉微涩呕而汗出必数更衣反少者当温其上灸
之少阴病二三日不已至四五日腹痛小便不利四肢沉重疼痛自下利者此为有水气其人或咳或小便利或下利或呕者真武
汤去附子加生姜
厥阴 伤寒热少厥微指头寒默默不欲食烦躁数日小便利色白者此热除也欲得食其病为愈若厥而呕胸胁烦满者其后
必便血黄芩芍药汤抵当汤 呕而脉弱小便复利身有微热见厥者难治四逆汤 伤寒本自寒下医复吐下之寒格更逆吐下若
食入口即吐干姜黄连黄芩人参汤（伤寒邪自传表为本自寒下医反吐下损伤正气寒气内为格拒经曰格则吐逆食入口即吐谓
之寒格更复吐下则重虚而死是更逆吐下与干姜黄芩人参汤以通寒格 赵 仲景之意以本因寒下医复吐下因成寒格吐证
经云格则吐逆若更复吐下治之为逆故用干姜以温里黄连黄芩反佐以取之人参补正气也今活人却言关脉迟故用此药何耶
虽然脉迟为胃中虚冷而吐者固也又有脉数为胃中虚冷而吐者仲景尝言之矣病患脉数数为客热当消谷引食而反吐者此以
发汗令阳气微膈气虚脉乃数也数为客热不能消谷以胃中虚冷故吐也今以其脉异证同故引此以为诊视之别）蛔厥者其人当
吐蛔今病者静而复时烦此为脏寒蛔上入膈故烦须臾复上得食而呕又烦者蛔闻食臭出其人当自吐蛔乌梅丸（详吐蛔）
渴 先渴却呕者为水停心下此属饮家（活人云赤茯苓汤主之）先呕却渴者此为欲解候也（金匮云呕思水者急与之）
下利 呕而下利有寒热者为阳宜黄芩汤大柴胡汤无热者为阴宜猪苓汤真武汤（并见吐利门）
烦 呕而心烦若汗吐下后者栀子生姜豉汤若未曾吐汗下后兼咳而渴者宜猪苓汤（详见不得眠）
呕家有痈脓者不必治脓尽自愈 服桂枝呕者酒客病
戴 阳明证具虽显然有可下证者兼之呕多犹属上焦未可遽下宜小柴胡汤若太阳不与少阳阳明合病而独见太阳证
或
吐泻者恐病患膈间素有痰饮停饮伤滞且以二陈汤定之候呕吐定徐进解太阳经药若先呕却渴者宜猪苓汤先渴却呕者宜治
膈间之水小半夏茯苓汤渴欲饮水水入即吐吐已复渴名曰水逆由心经受热而小肠不利也宜五苓散若少阴不渴而吐或干呕
者理中汤去白术加生姜呕而吐涎沫者吴茱萸汤
太阴厥阴间有呕吐太阴宜理中汤厥阴宜四逆汤并加生姜煎以上阴证乃阴中之阴宜用热剂阳入阴者能为利而不为呕
呕属上而近于外也阳之所入者深故利也 又有阳证病新瘥后见呕别无所因此余热在胃脘也宜竹叶石膏汤或橘皮竹茹汤
大凡得之太阳而呕者必是合病呕乃病渐入内非正太阳也曾记有人初得病太阳证有呕吐不住药投暖剂莫能治之知太阳已
汗解固当用冷剂是太阳见呕非合阳明则合少阳其呕为热用暖剂非矣 又记有人初病具太阳证而呕一家少长患状悉类与
养胃汤各服无不立效此时行之气适然如此是为伤寒杂病又非可以正经伤寒律之也
吴 初得之呕逆呕哕清水呕吐饮食者皆着寒伤胃也如恶寒拘急未发热而呕逆或吐食者宜加减藿香正气散或人参
养
胃汤若已发热者十味芎苏散发散或葛根汤加生姜半夏若自汗者不可发汗宜正气散去紫苏以和之凡发热口苦脉弦数而呕
心烦而呕胸胁满而呕往来寒热而呕日晡发热而呕皆属少阳并小柴胡倍加半夏生姜主之热少减黄芩口干加葛根栝蒌根心
烦加姜汁炒黄连心下痞满加枳实若潮热内实不大便呕不止心下郁郁微烦者大柴胡下凡呕吐胃家有热脉弦数口苦烦渴胃
有寒脉弦迟逆冷不食有水气先渴后呕腹满怔忡有脓血喉中腥气奔逆上冲不烦治之呕脓尽自愈此四者不可不辨凡太阴腹
满吐食不下或腹痛呕吐脉沉者理中汤加半夏陈皮藿香浓朴生姜之类寒甚加附子凡少阴饮食入口即吐心下温温欲吐复不
能吐手足寒脉沉细者四逆汤加半夏生姜橘皮之类凡厥阴呕吐涎沫逆冷脉沉微者吴茱萸四逆汤加半夏生姜陈皮之类
干呕欲吐
太阳中风阳浮而阴弱阳浮者热自发阴弱者汗自出啬啬恶寒淅淅恶风翕翕发热鼻鸣干呕者桂枝汤 伤寒
表不解心下有水气干呕发热而咳或渴或利或噎或小便不利少腹满或喘者小青龙汤
张 或问小青龙与小柴胡证皆呕而发汗表里之证大概仿佛何故二方用药之不同曰夫伤寒表不解里热未甚而渴欲
饮
水不能多不当与之以腹中热尚少而不能消水饮停蓄故作诸证然水寒作病非温热之剂不能解故用小青龙汤发汗散水原其
理初无里证因水寒以致然也夫小柴胡证系伤寒发热热邪传里在于半表半里之间热气内攻故生诸证缘二证虽曰表里俱病
其中寒热不同故用药有姜桂柴苓之异也
伤寒中风医反下之其人下利日十数行谷不化腹中雷鸣心下痞硬而满干呕心烦不得安医见心下痞谓病不尽复下之其
痞益甚此非热结但以胃中虚客气上逆故便硬也甘草泻心汤 伤寒一日太阳受之脉若静者为不传颇欲吐若躁烦脉数急者
为传也宜与麻黄汤表罢小柴胡白虎汤 伤寒胸中有热胃中有邪气腹中痛欲呕吐者黄连汤太阳中风下利呕逆表解者可攻
之其人 汗出发作有时头痛心下痞硬满引胁下痛干呕短气汗出不恶寒者此表解里未和也十枣汤 太阳病不解转入少
阳者胁下硬满干呕不能食往来寒热尚未吐下脉沉紧者与小柴胡汤（张 或云干呕胁痛小柴胡十枣汤皆有之一和解一攻伐
何也盖小柴胡病在半表半里间外有寒热往来内有干呕诸病所以不可攻下宜和解以散表里之邪夫十枣汤证外无寒热其人
汗出此表已解也但头痛心下痞硬满引胁下痛干呕短气者邪热内蓄而有伏饮是里未和也与十枣汤以下热逐饮以上二
证宜从表证以决有表证而干呕胁痛者乃柴胡汤证也无表证而干呕胁痛即十枣汤证也上文所言头痛者而饮家有此证不可
以常法拘仲景所以述此者恐后学见其头痛以为表不解而不敢用也）食谷欲吐者属阳明也吴茱萸汤得汤反剧者属上焦也小
柴胡汤栀子豉汤黄芩汤（食谷欲吐者胃不受也与吴茱萸汤以温胃得汤反剧者上焦不纳也）少阴病饮食入口即吐心中
欲吐不能吐始得之手足寒脉弦迟者此胸中实不可下当吐之若膈上有寒饮干呕者不可吐也急温之宜四逆汤少阴病下利
不止厥逆无脉干呕烦者白通加猪胆汁汤 少阴病下利清谷里寒外热手足厥冷脉微欲绝身反不恶寒其人面赤色或腹痛或
干呕或咽痛或利止脉不出者通脉四逆汤 少阴病欲吐不吐心烦但欲寐五六日自利而渴者属少阴也 太阴病脉微细沉但
欲卧汗出不烦自欲吐至五六日自利复烦躁不得卧者死病解后虚羸少气欲吐者竹叶石膏汤
附
赤茯苓汤 治伤寒呕哕心下满胸膈有停水头眩心悸
赤茯苓 人参（各一两） 半夏（姜制） 橘红 芎 白术（各半两） 上 咀每服四钱姜五片水煎服
葛根汤 治伤寒干呕不止
葛根 人参 麦门冬（去心） 炙甘草（各一两） 半夏（姜制） 黄 （各七钱半） 白茯苓 白术（各半两）
上咀每服三钱生姜三片枣二枚同煎服
秦景明记载：两位母亲患太阴病，三天后病情未解，出现呕吐、恶心、气逆，且脉象不浮。给予半硫丸服用二三次，症状不止；又给予黄芪建中汤，脉象极紧，无表证也无里证，但胸中大热，发渴引水而饮。众人都说是阳证，想要喝水，我却反而给予姜、附等温热药。紧脉反而变得沉细，阳气尚未生发，于是用桂枝、附子、干姜、乌头之类制成酒丸，每次服用一百丸，连续服用，两天中服用了十多次。病人身体发热，烦躁不安，想要出汗。又以前述药丸接续服用，盖上厚衣，阳脉方才出现，随即大汗出。第二天大小便才通畅，排出一盆如猪肝色的瘀血。后用胃风汤加桂枝、附子，服用三剂，血止。其寒邪之重，如此这般，也是世间所未见的。
少阴证见口燥舌干而渴，尺部和寸部脉象俱来深沉迟缓，则用四逆汤；若脉象沉而疾速，则用大承气汤。少阴病见口燥舌干而渴，身体表面凉爽，脉象沉细而虚者，主方为泻心汤。这是区分有形实邪与无形虚热的用药区别。
人参汤：治疗伤寒七八日，发汗后出现心烦、燥渴。
配方：人参、黄芩、柴胡、葛根（各一两），山栀、甘草（炙，各半两）。以上药物捣成粗末，每次服用五钱，加生姜、大枣煎煮，温服。
李东垣记载：阳毒证倍于常人的燥热盛大、极度口渴者，主方为黑奴丸（方见阳毒条）。风温病如极度口渴者，宜用栝蒌汤（方见风温条）。中暑伏热，屡治不愈，其人发渴不已，主方为酒蒸黄连丸（方见中暑条）。
脉诊：热病在肾，令人口渴，口干舌焦，色黄赤，昼夜想饮水不止，腹部大而胀，尚且不厌恶饮水，目无精光者，死证，不可治。
成无己论述：呕，是声音和食物同时吐出。世俗称之为“哕”，是不对的。“哕”与“干呕”虽然字形不同，但音义相同。吐，只是吐出其中的食物而没有声音，所以有“干呕”而无“干吐”。对于呕，有的责之于热，有的责之于寒。至于吐家，则全说是虚冷。呕又有因停饮所致者，有因胃脘有脓所致者，都应当明确辨别。
呕而发热者，用小柴胡汤（详情见小柴胡汤条）；与其说呕不止、心下急迫、郁郁微烦是大柴胡汤主治的邪热致呕，那么……（此处原文逻辑跳跃，结合上下文意为辨析不同呕证）膈上有寒饮导致干呕者，不可用吐法，当用温法；与其说干呕吐涎沫、头痛是吴茱萸汤主治的寒邪致呕，那么……先呕后渴，这是病欲解除的先兆；先渴后呕，是水停心下，这属于饮家。停饮致呕者，呕家有痈脓，不需要治疗，脓尽则自愈，这是胃脘有脓而致呕。
诸如此类情况，虽然有殊别，大体上伤寒表邪欲传里，里气上逆则为呕。所以半表半里证多说有呕。伤寒三日，三阳经邪气已尽，三阴经当受邪，其人反而能食而不呕，这是三阴不受邪，可知邪气传里者必致呕。至于干姜附子汤证说不呕不渴，是因为里无热；十枣汤证说干呕、短气、汗出、不恶寒，这是表解里未和。由此看来，呕多为里热所致。
呕家之为病，气逆者必散之，痰饮者必下之。《千金方》说呕家多服生姜，这是呕家的圣药，是要散其逆气。《金匮要略》说呕家用半夏以去其水，水去呕则止，是要下其痰饮。呕多，即使有阳明证，也不可攻下。是说其气逆而未收敛成实。其呕而脉弱，小便复利，身有微热，见四肢厥冷者，已经难治。盖谓其虚寒之甚也。医者必须审察邪气的虚实，疾病的逆顺，然后施药剂治疗，就对了。
太阳病（或已发热，或未发热，必恶寒，体痛，呕逆，脉阴阳俱紧者），名曰伤寒，主方麻黄汤。
太阳病过经十余日，反被误下二三下之后，四五天柴胡证仍在者，先与小柴胡汤；呕不止、心下急迫、郁郁微烦者为未解，与大柴胡汤下之则愈。（按：仲景虽曰呕家虽有阳明证不可攻，攻之为逆，然阳明伏热熏蒸清道而呕且烦者，非以苦寒直折之不可也，故用大柴胡汤下之。）
伤寒发热，汗出不解，心下痞硬，呕吐而下利者，主方大柴胡汤。
太阳病过经十余日，心下温温欲吐而胸中痛，大便反溏，腹微满，郁郁微烦。先此时自极吐下者，与调胃承气汤；若不尔者，不可与。但欲呕，胸中痛，微溏者，此非柴胡证，以呕故知极吐下也。（成无己注：心下温温欲吐，郁郁微烦，胸中痛，当责邪热客于胸中；大便反溏，腹微满，则邪热已下于胃也。日数虽多，若不经吐下，止是传邪，亦未可下，当与柴胡汤以除上中二焦之邪。若曾吐下，损伤胃气，胃虚而邪乘虚入胃为实，非柴胡汤所能去，调胃承气汤下胃热。以呕知胃气先曾伤动也。按经文“温温”当作“愠愠”，又以“呕下”当有缺文，盖呕家正为柴胡证也，岂逸“微溏”字耶？）
呕而发热者，主方小柴胡汤。
伤寒六七日，发热微恶寒，支节烦疼，微呕，心下支结，外证未去者，主方柴胡加桂枝汤。
太阳与阳明合病，不下利，但呕者，主方葛根加半夏汤。（活人书云：头疼身热，痛肌热，目疼鼻干，脉浮而长是也。）
葛根加半夏汤方：葛根、半夏（各二钱），麻黄、生姜（各一钱半），甘草、芍药、桂枝（各一钱），大枣（十二枚，擘开）。以上药物切碎，用水一斗，先煎麻黄、葛根，减二升，去白沫，纳诸药，煎取三升，温服一升，覆取微汗。
阳明病：伤寒发热，无汗，呕不能食，而反汗出濈濈然者是转属阳明也，主方大柴胡汤。
食谷欲呕者，属阳明也，主方吴茱萸汤；得汤反剧者，属上焦也，主方葛根加半夏汤。
伤寒呕多，虽有阳明证，不可攻之，主方黄芩生姜半夏汤或小柴胡汤（活人书用桔梗汤）。
阳明病，胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤。
阳明病（温病），反无汗而小便利，二三日呕而咳，手足厥者，必苦头痛（或用真武汤去茯苓）。
少阳病：呕而往来寒热，胸胁苦满者，宜小柴胡汤；若兼下利者，乃太阳少阳合病，宜黄芩加半夏生姜汤（论见往来寒热及下利条：太阳阳明合病自下利为在表，当与葛根汤发汗；阳明少阳合病自下利者为在里，可与承气汤下之；此太阳少阳合病自下利为在半表半里，非汗下所宜，故与黄芩汤以和解之。呕者胃气逆也，故加半夏生姜以散逆气）。
伤寒五六日，呕而发热者，柴胡汤证具，而以他药下之，柴胡证仍在者，复与柴胡汤。
血弱气尽，腠理开，邪气因入，与正气相搏，结于胁下，正邪分争，往来寒热，休作有时，默默不欲饮食，脏腑相连，其痛必下，邪高痛下，故使呕也，主方小柴胡汤。（邪气外甚，阳不主里，里气不和，气下而不上者，但下利而不呕；里气上逆而不下者，但呕而不下利。与小柴胡汤以解半表半里之邪。）
渴而饮水呕者，柴胡不中与也（活人书云：宜治膈间水，赤茯苓汤主之，方见后）。
太阴病：太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛，若下之，必胸下结硬。
少阴病：下利六七日，咳而呕，渴，心烦不得眠者，主方猪苓汤。
少阴病下利，脉微涩，呕而汗出，必数更衣反少者，当温其上，灸之。
少阴病二三日不已，至四五日，腹痛，小便不利，四肢沉重疼痛，自下利者，此为有水气，其人或咳，或小便利，或下利，或呕者，主方真武汤去附子加生姜。
厥阴病：伤寒热少厥微，指头寒，默默不欲食，烦躁，数日小便利，色白者，此热除也，欲得食，其病为愈。若厥而呕，胸胁烦满者，其后必便血，主方黄芩芍药汤或抵当汤。
呕而脉弱，小便复利，身有微热，见厥者，难治，主方四逆汤。
伤寒本自寒下，医复吐下之，寒格更逆吐下，若食入口即吐，主方干姜黄连黄芩人参汤。（伤寒邪自传表，为本自寒下，医反吐下，损伤正气，寒气内为格拒。经曰：格则吐逆。食入口即吐谓之寒格。更复吐下，则重虚而死，是更逆吐下。与干姜黄连黄芩人参汤以通寒格。赵嗣真注：仲景之意，以本因寒下，医复吐下，因成寒格吐证。经云：格则吐逆。若更复吐下，治之为逆。故用干姜以温里，黄连黄芩反佐以取之，人参补正气也。今活人却言关脉迟故用此药，何耶？虽然，脉迟为胃中虚冷而吐者固也，又有脉数为胃中虚冷而吐者，仲景尝言之矣。病患脉数，数为客热，当消谷引食，而反吐者，此以发汗令阳气微，膈气虚，脉乃数也。数为客热，不能消谷，以胃中虚冷故吐也。今以其脉异证同，故引此以为诊视之别。）
蛔厥者，其人当吐蛔。今病者静而复时烦，此为脏寒，蛔上入膈，故烦，须臾复上，得食而呕又烦者，蛔闻食臭出，其人当自吐蛔，主方乌梅丸（详吐蛔条）。
渴：先渴却呕者，为水停心下，此属饮家（活人书云：赤茯苓汤主之）。先呕却渴者，此为欲解候也（金匮云：呕思水者，急与之）。
下利：呕而下利，有寒热者为阳，宜黄芩汤、大柴胡汤；无热者为阴，宜猪苓汤、真武汤（并见吐利门）。
烦：呕而心烦，若汗吐下后者，栀子生姜豉汤；若未曾吐汗下后，兼咳而渴者，宜猪苓汤（详见不得眠条）。
戴元礼论述：阳明证具，虽显然有可下证者，兼之呕多，犹属上焦，未可遽下，宜小柴胡汤。若太阳不与少阳阳明合病，而独见太阳证，或吐泻者，恐病患膈间素有痰饮停饮伤滞，且以二陈汤定之。候呕吐定，徐进解太阳经药。若先呕却渴者，宜猪苓汤；先渴却呕者，宜治膈间之水，小半夏茯苓汤。渴欲饮水，水入即吐，吐已复渴，名曰水逆，由心经受热而小肠不利也，宜五苓散。若少阴不渴而吐，或干呕者，理中汤去白术加生姜。呕而吐涎沫者，吴茱萸汤。
太阴、厥阴间有呕吐，太阴宜理中汤，厥阴宜四逆汤，并加生姜煎。以上阴证乃阴中之阴，宜用热剂。阳入阴者，能为利而不为呕。呕属上而近于外也，阳之所入者深，故利也。
又有阳证病新瘥后见呕，别无所因，此余热在胃脘也，宜竹叶石膏汤或橘皮竹茹汤。
大凡得之太阳而呕者，必是合病，呕乃病渐入内，非正太阳也。曾记有人初得病太阳证，有呕吐不住，药投暖剂莫能治之。知太阳已汗解，固当用冷剂，是太阳见呕，非合阳明则合少阳，其呕为热，用暖剂非矣。
又记有人初病具太阳证而呕，一家少长，患状悉类，与养胃汤，各服无不立效。此时行之气适然如此，是为伤寒杂病，又非可以正经伤寒律之也。
吴崑论述：初得之，呕逆，呕哕清水，呕吐饮食者，皆着寒伤胃也。如恶寒拘急，未发热而呕逆，或吐食者，宜加减藿香正气散或人参养胃汤。若已发热者，十味芎苏散发散，或葛根汤加生姜半夏。若自汗者，不可发汗，宜正气散去紫苏以和之。
凡发热、口苦、脉弦数而呕，心烦而呕，胸胁满而呕，往来寒热而呕，日晡发热而呕，皆属少阳，并小柴胡汤倍加半夏生姜主之。热少减，黄芩口干加葛根、栝蒌根；心烦加姜汁炒黄连；心下痞满加枳实。若潮热内实，不大便，呕不止，心下郁郁微烦者，大柴胡汤下之。
凡呕吐，胃家有热，脉弦数，口苦，烦渴；胃有寒，脉弦迟，逆冷，不食；有水气，先渴后呕，腹满怔忡；有脓血，喉中腥气，奔逆上冲，不烦。治之，呕脓尽自愈。此四者不可不辨。
凡太阴腹满，吐食不下，或腹痛呕吐，脉沉者，理中汤加半夏、陈皮、藿香、浓朴、生姜之类，寒甚加附子。
凡少阴饮食入口即吐，心下温温欲吐复不能吐，手足寒，脉沉细者，四逆汤加半夏、生姜、橘皮之类。
凡厥阴呕吐涎沫，逆冷，脉沉微者，吴茱萸四逆汤加半夏、生姜、陈皮之类。
干呕欲吐：
太阳中风，阳浮而阴弱，阳浮者热自发，阴弱者汗自出，啬啬恶寒，淅淅恶风，翕翕发热，鼻鸣，干呕者，主方桂枝汤。
伤寒表不解，心下有水气，干呕，发热而咳，或渴，或利，或噎，或小便不利，少腹满，或喘者，主方小青龙汤。
张元素论述：或问：小青龙与小柴胡证皆呕而发汗，表里之证大概仿佛，何故二方用药之不同？曰：夫伤寒表不解，里热未甚，而渴欲饮水，不能多，不当与之以腹中热尚少而不能消水，饮停蓄故作诸证。然水寒作病，非温热之剂不能解，故用小青龙汤发汗散水。原其理，初无里证，因水寒以致然也。夫小柴胡证系伤寒发热，热邪传里，在于半表半里之间，热气内攻，故生诸证。缘二证虽曰表里俱病，其中寒热不同，故用药有姜桂柴苓之异也。
甘草泻心汤：伤寒一日，太阳受之，脉若静者为不传；颇欲吐，若躁烦，脉数急者为传也，宜与麻黄汤。表罢，小柴胡汤、白虎汤。
伤寒胸中有热，胃中有邪气，腹中痛，欲呕吐者，主方黄连汤。
太阳中风，下利，呕逆，表解者可攻之。其人汗出，发作有时，头痛，心下痞硬满，引胁下痛，干呕，短气，汗出，不恶寒者，此表解里未和也，主方十枣汤。（张元素注：或云干呕胁痛，小柴胡、十枣汤皆有之一，和解一攻伐，何也？盖小柴胡病在半表半里间，外有寒热往来，内有干呕诸病，所以不可攻下，宜和解以散表里之邪。夫十枣汤证，外无寒热，其人汗出，此表已解也。但头痛，心下痞硬满，引胁下痛，干呕，短气者，邪热内蓄而有伏饮，是里未和也。与十枣汤以下热逐饮。以上二证，宜从表证以决。有表证而干呕胁痛者，乃柴胡汤证也；无表证而干呕胁痛，即十枣汤证也。上文所言头痛者，而饮家有此证，不可以常法拘。仲景所以述此者，恐后学见其头痛，以为表不解而不敢用也。）
食谷欲吐者，属阳明也，主方吴茱萸汤；得汤反剧者，属上焦也，主方小柴胡汤、栀子豉汤、黄芩汤（食谷欲吐者，胃不受也，与吴茱萸汤以温胃；得汤反剧者，上焦不纳也）。
少阴病，饮食入口即吐，心中欲吐不能吐，始得之，手足寒，脉弦迟者，此胸中实，不可下，当吐之。若膈上有寒饮，干呕者，不可吐也，急温之，宜四逆汤。
少阴病，下利不止，厥逆无脉，干呕，烦者，主方白通加猪胆汁汤。
少阴病，下利清谷，里寒外热，手足厥冷，脉微欲绝，身反不恶寒，其人面赤色，或腹痛，或干呕，或咽痛，或利止脉不出者，主方通脉四逆汤。
少阴病，欲吐不吐，心烦，但欲寐，五六日自利而渴者，属少阴也。
太阴病，脉微细沉，但欲卧，汗出不烦，自欲吐，至五六日自利，复烦躁不得卧者，死。病解后，虚羸少气，欲吐者，主方竹叶石膏汤。
赤茯苓汤：治伤寒呕哕，心下满，胸膈有停水，头眩心悸。
配方：赤茯苓、人参（各一两），半夏（姜制）、橘红、川芎、白术（各半两）。以上药物切碎，每服四钱，姜五片，水煎服。
葛根汤（此处方名似有误，据内容应为类似竹叶石膏或益气生津之剂，但依原文保留）：治伤寒干呕不止。
配方：葛根、人参、麦门冬（去心）、炙甘草（各一两），半夏（姜制）、黄芪（各七钱半），白茯苓、白术（各半两）。以上切碎，每服三钱，生姜三片，枣二枚，同煎服。
Qin Jingming recorded: Two mothers suffered from Taiyin disease. After three days, the condition did not resolve, and they experienced vomiting, nausea, and counterflow qi. Their pulses were not floating. Banliu Wan (Half-Sulfur Pill) was administered for two or three doses, but the symptoms persisted. Huangqi Jianzhong Tang (Astragalus Decoction to Build the Middle) was then given, and the pulse became extremely tight. There were no exterior or interior signs, yet there was intense heat in the chest, thirst, and a desire to drink water. Everyone said it was a Yang syndrome and that the patient wanted water, but I instead administered warming herbs such as Shengjiang (Fresh Ginger) and Fuzi (Prepared Aconite Root). The tight pulse subsequently became deep and fine, indicating that Yang qi had not yet generated. Therefore, Guizhi (Cinnamon Twig), Fuzi (Prepared Aconite Root), Ganjiang (Dried Ginger), and Wutou (Aconite Root Lateralis Preparata) were made into wine pills. One hundred pills were taken at a time, continuously administered over two days, totaling more than ten doses. The patient's body became hot, and they were restless and irritable, desiring to sweat. The aforementioned pills were continued, and thick clothing was used to cover them. Only then did the Yang pulse emerge, followed by profuse sweating. The next day, urination and defecation finally resumed, and a basin full of dark red, liver-like blood clots was discharged. Weifeng Tang (Stomach Wind Decoction) with added Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) was administered for three doses, stopping the bleeding. The severity of their cold pathogen was thus; such cases are rarely seen in the world.
In Shaoyin syndrome, if there is dryness in the mouth and tongue accompanied by thirst, and both the Cun (inch) and Chi (cubit) pulses are deep and slow, Sini Tang (Frigid Extremities Decoction) should be used. If the pulse is deep and rapid, Dachengqi Tang (Major Order the Golden Decoction) should be used. In Shaoyin syndrome, if there is dryness in the mouth and tongue with thirst, coolness on the body surface, and a deep, fine, and deficient pulse, Xiexin Tang (Drain the Epigastrium Decoction) is the primary formula. This distinguishes the use of medicines for tangible pathogens versus intangible heat.
Renshen Tang (Ginseng Decoction): Treats Shanghan (Cold Damage) after seven or eight days, where sweating leads to mental restlessness, dryness, and thirst.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix) (each 1 liang); Shanzhi (Gardeniae Fructus), Zhigancao (Prepared Licorice Root) (each 0.5 liang). Grind these into coarse powder. Take 5 qian per dose, decoct with Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), and take warm.
Li Dongyuan recorded: For Yangdu syndrome (Yang Toxin) with燥热 (dry-heat) significantly exceeding normal levels and extreme thirst, Heinu Wan (Black Slave Pill) is the primary formula (see Yangdu section). For Fengwen (Wind-Warmth) with extreme thirst, Gualou Tang (Trichosanthes Root Decoction) is suitable (see Fengwen section). For Zhongshu (Summerheat) with latent heat that fails to heal after repeated treatments, resulting in persistent thirst, Jiuzheng Huanglian Wan (Wine-Steamed Coptis Pill) is the primary formula (see Zhongshu section).
Pulse Diagnosis: In Rebing (Heat Disease) affecting the Kidney, causing thirst, dry mouth, scorched tongue, yellow-red complexion, and an unceasing desire to drink day and night, accompanied by abdominal distension and fullness without aversion to drinking, and eyes lacking luster, this is a death sign and is incurable.
Cheng Wuji discussed: "Ou" (vomiting) involves the simultaneous expulsion of sound and matter. It is commonly misidentified as "Yue" (hiccups/retching). Although "Yue" and "Gan Ou" (dry retching) differ in character, they share the same pronunciation and meaning. "Tu" (spitting up/vomiting) refers only to the expulsion of matter without sound; hence, there is "Gan Ou" (dry retching) but no "Gan Tu" (dry spitting). Regarding vomiting, some cases are attributed to heat, others to cold. However, cases of "Tu" (spitting up) are generally considered due to deficiency-cold. Vomiting can also result from retained fluids or pus in the stomach region, which must be clearly distinguished.
For vomiting accompanied by fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated (details see Xiaochaihu Tang section). For continuous vomiting, epigastric urgency, and mild irritability, this indicates pathogenic heat causing vomiting, treated with Dachengqi Tang (Major Order the Golden Decoction). For dry retching due to cold-fluid retention above the diaphragm, emesis is contraindicated; warming is required. For dry retching with salivary discharge and headache, Wuzhuyu Tang (Evodia Fruit Decoction) is indicated, treating vomiting caused by cold pathogen. Vomiting followed by thirst indicates the disease is resolving. Thirst followed by vomiting indicates water retention in the epigastrium, belonging to fluid-retention syndromes. For vomiting due to retained fluids, if there is abscess-pus in the stomach, treatment is unnecessary as it will resolve spontaneously when the pus is exhausted.
Generally, in Shanghan, when exterior pathogens attempt to transmit inward, rebellious Qi in the interior causes vomiting. Thus, half-exterior-half-interior syndromes often mention vomiting. After three days of Shanghan, if the Three Yang meridians are exhausted and the Three Yin meridians should receive the pathogen, but the patient can eat and does not vomit, it indicates the Three Yin meridians are not affected. This confirms that transmission of pathogens inward inevitably leads to vomiting. In the case of Ganjiang Fuzi Tang (Dried Ginger and Prepared Aconite Decoction), the absence of vomiting and thirst indicates no heat in the interior. In the case of Shizao Tang (Ten Jujubes Decoction), dry retching, shortness of breath, sweating, and absence of aversion to cold indicate that the exterior is resolved but the interior is not harmonized. From this, it is clear that vomiting is often due to interior heat.
For patients with chronic vomiting, rebellious Qi must be dispersed, and phlegm-fluids must be purged. *Qianjin Fang* states that ginger is the sacred herb for vomiting, intended to disperse rebellious Qi. *Jinkui Yaolue* states that Pinellia is used for vomiting to remove water; once the water is removed, vomiting stops, aiming to purge phlegm-fluids. Even if there are Yangming signs, excessive vomiting contraindicates purgation because the Qi is rebellious and has not yet consolidated into excess. If vomiting is accompanied by a weak pulse, frequent urination, slight fever, and cold extremities, the prognosis is difficult, indicating severe deficiency-cold. Physicians must examine the deficiency or excess of the pathogen and the favorable or unfavorable course of the disease before prescribing medication.
Taiyang disease (whether fever has appeared or not, there must be aversion to cold, body pain, vomiting, counterflow, and tight pulses on both Yin and Yang positions) is named Shanghan. Mahuang Tang (Ephedra Decoction) is indicated.
If Taiyang disease persists beyond its designated period for more than ten days, and after being incorrectly purged two or three times, the Chaihu syndrome remains after four or five days, administer Xiaochaihu Tang (Minor Bupleurum Decoction) first. If vomiting continues, epigastric urgency, and mild irritability persist, indicating the disease is unresolved, administer Dachengqi Tang (Major Order the Golden Decoction) to purge, which will cure it. (Note: Although Zhang Zhongjing stated that excessive vomiting with Yangming signs contraindicates purgation, if latent heat in Yangming steams the clear pathways causing vomiting and irritability, bitter-cold direct draining is necessary; thus, Dachengqi Tang is used.)
In Shanghan, if fever persists despite sweating, with epigastric stiffness/fullness, vomiting, diarrhea, and lower abdominal fullness, Dachengqi Tang (Major Order the Golden Decoction) is indicated.
If Taiyang disease persists beyond its period for more than ten days, with a sensation of warmth in the epigastrium urging vomiting, chest pain, loose stools, mild abdominal fullness, and irritability: if the patient previously underwent extreme emesis or purgation, Tiaowei Chengqi Tang (Regulate the Waistline Order the Golden Decoction) is given; otherwise, it is contraindicated. If there is only a desire to vomit, chest pain, and loose stools, this is not a Chaihu syndrome; the vomiting indicates previous extreme emesis/purgation. (Cheng Wuji notes: Warmth in the epigastrium urging vomiting, irritability, and chest pain suggest heat pathogens in the chest. Loose stools and abdominal fullness suggest heat has moved to the stomach. If no emesis/purgation occurred, it is merely transmitted pathogen, treatable with Chaihu Tang. If emesis/purgation damaged Stomach Qi, allowing pathogen to enter as excess, Tiaowei Chengqi Tang is needed to purge Stomach heat. The text likely has missing characters regarding "vomiting".)
For vomiting with fever, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated.
After six or seven days of Shanghan, with slight fever and aversion to cold, limb pain, slight vomiting, sub-epigastric constraint, and unresolved exterior signs, Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction) is indicated.
In combined Taiyang and Yangming diseases, without diarrhea but with vomiting, Gegen Banxia Tang (Pueraria and Pinellia Decoction) is indicated. (*Huoren Shu* states: Headache, body heat, muscle pain, eye pain, nasal dryness, and floating-long pulse confirm this.)
Gegen Banxia Tang Formula: Gegen (Puerariae Lobatae Radix), Banxia (Pinelliae Rhizoma Preparatum) (each 2 qian); Mahuang (Ephedrae Herba), Shengjiang (Zingiberis Rhizoma Recens) (each 1.5 qian); Gancao (Licorice Root), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus) (each 1 qian); Dazao (Jujubae Fructus) (12 pieces, split). Cut ingredients. Decoct in 1 dou of water. First boil Mahuang and Gegen, reduce by 2 sheng, skim white foam, add remaining herbs, boil to obtain 3 sheng. Take 1 sheng warm, cover to induce slight sweating.
Yangming disease: Shanghan with fever, no sweating, vomiting, inability to eat, but instead profuse sweating indicates transformation into Yangming. Dachengqi Tang (Major Order the Golden Decoction) is indicated.
Desire to vomit upon eating food belongs to Yangming; Wuzhuyu Tang (Evodia Fruit Decoction) is indicated. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao; Gegen Banxia Tang (Pueraria and Pinellia Decoction) is indicated.
Excessive vomiting in Shanghan, even with Yangming signs, contraindicates purgation. Huangqin Shengjiang Banxia Tang (Scutellaria, Fresh Ginger, and Pinellia Decoction) or Xiaochaihu Tang (Minor Bupleurum Decoction) are indicated. (*Huoren Shu* uses Jiegeng Tang).
In Yangming disease, with hardness/fullness under the hypochondrium, constipation, vomiting, and a white coating on the tongue, Xiaochaihu Tang (Minor Bupleurum Decoction) may be given.
In Yangming (Warm) disease, with absence of sweating but free urination, followed by vomiting, cough, and cold extremities after two or three days, severe headache will occur. (Alternatively, Zhenwu Tang (True Warrior Decoction) minus Fuling (Poria) may be used.)
Shaoyang disease: Vomiting with alternating chills and fever, and fullness/hardness in the chest and hypochondrium, suggests Xiaochaihu Tang (Minor Bupleurum Decoction). If accompanied by diarrhea, it is a combined Taiyang and Shaoyang syndrome, treated with Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction). (Discussion on alternating chills/fever and diarrhea: Taiyang-Yangming combined diarrhea is exterior, treated with Gegen Tang (Pueraria Decoction) to induce sweating. Yangming-Shaoyang combined diarrhea is interior, treated with Chengqi Tang (Order the Golden Decoctions) to purge. This Taiyang-Shaoyang combined diarrhea is half-exterior-half-interior, unsuitable for sweating or purging; thus, Huangqin Tang (Scutellaria Decoction) is used to harmonize. Vomiting indicates rebellious Stomach Qi, so Banxia and Shengjiang are added to disperse rebellious Qi.)
After five or six days of Shanghan, with vomiting and fever, if Chaihu syndrome criteria are met but incorrect purgation was performed, and Chaihu syndrome persists, administer Xiaochaihu Tang (Minor Bupleurum Decoction) again.
When blood is weak and Qi exhausted, pores open, and pathogens enter to struggle with healthy Qi, knotting in the hypochondrium, leading to alternating chills/fever, silence, and loss of appetite, connected organs cause pain. Pathogens high, pain low, causing vomiting. Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. (If pathogens are external and Yang cannot govern the interior, Qi descends without ascending, causing diarrhea without vomiting. If interior Qi rebels upward without descending, causing vomiting without diarrhea, Xiaochaihu Tang resolves half-exterior-half-interior pathogens.)
Thirst with drinking followed by vomiting contraindicates Xiaochaihu Tang. (*Huoren Shu* states: Treat water between the diaphragm with Chifuling Tang (Red Poria Decoction), see later.)
Taiyin disease: The Taiyin syndrome is characterized by abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, occasional spontaneous abdominal pain. Purging will cause hardness below the chest.
Shaoyin disease: Diarrhea for six or seven days, cough, vomiting, thirst, mental irritability, and insomnia are treated with Zhuling Tang (Polyporus Decoction).
Shaoyin disease with diarrhea, faint and choppy pulses, vomiting, sweating, frequent bowel movements but small amounts, requires warming the upper part and moxibustion.
Shaoyin disease persisting for two to three days, progressing to four or five days with abdominal pain, difficulty urinating, heavy/painful limbs, and spontaneous diarrhea indicates water Qi. If accompanied by cough, free urination, diarrhea, or vomiting, Zhenwu Tang (True Warrior Decoction) minus Fuzi (Prepared Aconite Root) plus Shengjiang (Fresh Ginger) is indicated.
Jueyin disease: In Shanghan with slight heat and mild cold extremities (cold fingertips), silence, loss of appetite, irritability, and free pale urine after several days indicates heat elimination. Desire to eat indicates recovery. If cold extremities are accompanied by vomiting and chest/hypochondriac irritability, hematochezia will follow. Huangqin Shaoyao Tang (Scutellaria and Peony Decoction) or Didang Tang (Should-Reach Decoction) are indicated.
Vomiting with weak pulse, free urination, slight fever, and cold extremities is difficult to treat; Sini Tang (Frigid Extremities Decoction) is indicated.
Shanghan originally involving cold-dysfunction, incorrectly treated with emesis/purgation by physicians, leading to cold rejection and further vomiting/diarrhea, where food is vomited immediately upon entry, is treated with Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction). (Pathogen transmits to exterior, but original condition was cold-dysfunction. Incorrect emesis/purgation damages Zheng Qi, causing internal cold rejection. Classic says: Rejection causes vomiting. Food vomited immediately is cold rejection. Further emesis/purgation causes double deficiency and death. This decoction opens cold rejection. Zhao Sizhen notes: Zhang Zhongjing's intent is to warm the interior with Ganjiang, use Huanglian/Huangqin as counter-agents, and tonify Zheng Qi with Renshen. Some argue Chi pulse delay indicates Stomach deficiency-cold, but rapid pulse can also indicate Stomach deficiency-cold with false heat. Physicians must distinguish based on pulse and syndrome.)
Hui Jue (Roundworm Cold Extremities) involves vomiting roundworms. If the patient is quiet but occasionally irritable, it is due to Zang cold causing roundworms to ascend to the diaphragm. Eating triggers vomiting and irritability as roundworms smell food and emerge. Patient will vomit roundworms spontaneously. Wumei Wan (Mume Pill) is indicated.
Thirst: Thirst followed by vomiting indicates water retention in the epigastrium, belonging to fluid-retention syndromes (*Huoren Shu*: Chifuling Tang). Vomiting followed by thirst indicates resolution (*Jinkui*: If vomiting patient desires water, give it promptly).
Diarrhea: Vomiting with diarrhea involving cold-heat indicates Yang syndrome, treated with Huangqin Tang (Scutellaria Decoction) or Dachengqi Tang (Major Order the Golden Decoction). Absence of heat indicates Yin syndrome, treated with Zhuling Tang (Polyporus Decoction) or Zhenwu Tang (True Warrior Decoction).
Irritability: Vomiting with mental irritability after sweating/emesis/purgation is treated with Zhizi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction). If no prior sweating/emesis/purgation, accompanied by cough and thirst, Zhuling Tang (Polyporus Decoction) is suitable.
Patients with vomiting due to abscess-pus do not require specific treatment; it resolves when the pus is exhausted.
Vomiting after taking Guizhi Tang occurs in habitual wine drinkers.
Dai Yuanli discussed: Even if Yangming syndrome presents obvious indications for purgation, excessive vomiting suggests the pathogen is still in the Upper Jiao, and purgation should not be rushed. Xiaochaihu Tang (Minor Bupleurum Decoction) is appropriate. If Taiyang syndrome exists without combining with Shaoyang/Yangming, presenting with vomiting/diarrhea, suspect pre-existing phlegm-fluid stagnation in the diaphragm. Erchen Tang (Two-Cured Decoction) should stabilize the condition first. Once vomiting subsides, gradually administer Taiyang meridian-resolving herbs. Vomiting followed by thirst suggests Zhuling Tang (Polyporus Decoction). Thirst followed by vomiting suggests treating water in the diaphragm with Xiao Banxia Fuling Tang (Minor Pinellia and Polyporus Decoction). Thirst with immediate vomiting upon drinking, followed by renewed thirst, is named Shui Ni (Water Counterflow), caused by Heart meridian heat affecting Small Intestine function. Wuling San (Five-Ling Powder) is indicated. In Shaoyin, non-thirsty vomiting or dry retching is treated with Lizhong Tang (Regulate the Middle Decoction) minus Baizhu (Atractylodes Macrocephala Rhizome) plus Shengjiang (Fresh Ginger). Vomiting with salivary discharge is treated with Wuzhuyu Tang (Evodia Fruit Decoction).
In Taiyin and Jueyin, vomiting may occur. Taiyin is treated with Lizhong Tang (Regulate the Middle Decoction); Jueyin with Sini Tang (Frigid Extremities Decoction), both with added Shengjiang (Fresh Ginger). These Yin syndromes are Yin within Yin, requiring hot agents. When Yang enters Yin, it causes diarrhea rather than vomiting. Vomiting is upper and near exterior; Yang entering deeply causes diarrhea.
After recovery from Yang syndrome, new-onset vomiting without other causes indicates residual heat in the Stomach. Zhuyegeshao Tang (Bamboo Leaf and Scallop Shell Decoction) or JuPi Zhuru Tang (Tangerine Peel and Bamboo Shaving Decoction) are indicated.
Generally, vomiting arising from Taiyang indicates combined syndrome, suggesting the disease is moving inward. Not pure Taiyang. Recall a case: Initial Taiyang syndrome with persistent vomiting failed to respond to warming agents. Knowing Taiyang exterior was resolved, cooling agents were required. Vomiting in Taiyang implies combination with Yangming or Shaoyang, indicating heat; warming agents were incorrect.
Another case: Initial Taiyang syndrome with vomiting affected a whole family similarly. Yangwei Tang (Stomach-Nourishing Decoction) worked instantly. This was epidemic Qi, classified as Shanghan mixed disease, not strictly following classic Shanghan rules.
Wu Kun discussed: Initial vomiting, retching clear fluid, or vomiting food indicates cold damaging the Stomach. If aversion to cold, stiffness, no fever yet, with vomiting/food regurgitation, use Jiajian Huoxiang Zhengqi San (Modified Evodia and Magnolia Decoction) or Renshen Yangwei Tang (Ginseng Stomach-Nourishing Decoction). If fever has appeared, use Shiwei Xiong Su Fa San (Ten-Ingredient Cyperus and Perilla Dispelling Decoction) or Gegen Tang (Pueraria Decoction) plus Shengjiang/Banxia. If spontaneous sweating, avoid sweating methods; use Zhengqi San minus Zisu (Perilla Leaf) to harmonize.
Fever, bitter taste, string-taut-rapid pulse with vomiting; mental irritability with vomiting; hypochondriac fullness with vomiting; alternating chills/fever with vomiting; afternoon tidal fever with vomiting—all belong to Shaoyang. Treat with Xiaochaihu Tang (Minor Bupleurum Decoction) doubling Banxia and Shengjiang. If heat decreases and mouth is dry, add Gegen and Gualougen (Trichosanthes Root). If irritable, add Jiangzhi Chuhuanglian (Ginger-juiced Fried Coptis). If epigastric fullness, add Zhishi (Immature Bitter Orange). If tidal fever, interior excess, constipation, continuous vomiting, and epigastric irritability, use Dachengqi Tang (Major Order the Golden Decoction) to purge.
Differentiate four types of vomiting: Stomach heat (string-taut-rapid pulse, bitter taste, irritability/thirst); Stomach cold (string-taut-slow pulse, cold extremities, anorexia); Water Qi (thirst before vomiting, abdominal fullness, palpitations); Pus/Blood (foul odor in throat, rushing upward, no irritability). Pus/blood vomiting resolves spontaneously.
Taiyin abdominal fullness, vomiting food, inability to eat, or abdominal pain with vomiting and deep pulse: Lizhong Tang (Regulate the Middle Decoction) plus Banxia, Chenpi, Huoxiang, Houpo, Shengjiang. Add Fuzi for severe cold.
Shaoyin: Food vomited immediately upon entry, epigastric warmth urging vomiting but inability to spit, cold hands/feet, deep-fine pulse: Sini Tang (Frigid Extremities Decoction) plus Banxia, Shengjiang, Chenpi.
Jueyin: Vomiting saliva, cold extremities, deep-micro pulse: Wuzhuyu Sini Tang (Evodia and Frigid Extremities Decoction) plus Banxia, Shengjiang, Chenpi.
Dry retching/desire to vomit:
Taiyang Wind Strike: Floating-yang and deficient-yin pulses. Yang-floating causes spontaneous heat; Yin-deficient causes spontaneous sweating. Aversion to cold/wind, slight fever, nasal congestion, and dry retching are treated with Guizhi Tang (Cinnamon Twig Decoction).
Shanghan with unresolved exterior and fluid retention in the heart region: Dry retching, fever, cough, thirst, diarrhea, choking, difficulty urinating, lower abdominal fullness, or asthma are treated with Xiao Qinglong Tang (Minor Green Dragon Decoction).
Zhang Yuansu discussed: Question: Both Xiao Qinglong Tang and Xiaochaihu Tang treat vomiting with sweating, appearing similar in exterior/interior patterns. Why the difference? Answer: In Shanghan with unresolved exterior and mild interior heat, thirst with inability to drink much indicates insufficient interior heat to transform fluids, leading to fluid retention. Cold-water pathology requires warm-hot agents to disperse fluid via sweating; thus, Xiao Qinglong Tang is used. Originally, there was no interior syndrome, only cold-water induced. Conversely, Xiaochaihu Tang treats Shanghan fever where heat transmits to the half-exterior-half-interior, attacking internally. Although both involve exterior/interior issues, the cold-heat nature differs, justifying the use of Ginger/Cinnamon vs. Bupleurua/Poria.
Gancao Xiexin Tang (Licorice Drain the Epigastrium Decoction): On the first day of Shanghan, if the pulse is quiet, no transmission; if prone to vomiting, irritability, and rapid pulse, transmission is occurring. Use Mahuang Tang (Ephedra Decoction) initially. Once exterior resolves, use Xiaochaihu Tang or Baihu Tang (White Tiger Decoction).
Shanghan with heat in the Chest and pathogenic Qi in the Stomach, abdominal pain, and desire to vomit:黄连汤 (Coptis Decoction).
Taiyang Wind Strike with diarrhea and vomiting: If exterior resolves, attack the interior. Sweating, periodic headache, epigastric hardness/fullness radiating to hypochondrium, dry retching, shortness of breath, sweating, no aversion to cold: Exterior resolved, interior unharmonized. Shizao Tang (Ten Jujubes Decoction) is indicated. (Zhang Yuansu note: Dry retching and hypochondriac pain appear in both Xiaochaihu and Shizao Tangs. One harmonizes, one attacks. Xiaochaihu is for half-exterior-half-interior with alternating chills/fever and dry retching; purgation is contraindicated. Shizao Tang is for resolved exterior (no chills/fever, sweating) with internal heat and latent fluid causing headache, epigastric hardness, dry retching, shortness of breath. Differentiate by presence of exterior signs: with exterior signs, use Chaihu Tang; without, use Shizao Tang. Zhang mentions headache in fluid retention to prevent students from fearing exterior involvement.)
Desire to vomit upon eating belongs to Yangming: Wuzhuyu Tang (Evodia Fruit Decoction). Worsening after intake indicates Upper Jiao rejection: Xiaochaihu Tang, Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), or Huangqin Tang (Scutellaria Decoction).
Shaoyin disease: Food vomited upon entry, urge to vomit but inability, cold hands/feet, string-taut-slow pulse at onset: Excess in Chest, do not purge, induce emesis. If cold-fluid above diaphragm causing dry retching, do not emetic; urgently warm with Sini Tang (Frigid Extremities Decoction).
Shaoyin disease: Unstopping diarrhea, cold extremities, absent pulse, dry retching, irritability: Baitong Jia Zhuchidan Tang (White Connective plus Pig Gallbladder Bile Decoction).
Shaoyin disease: Clear grain diarrhea, interior cold with exterior heat, cold extremities, micro pulse nearing extinction, no aversion to cold, flushed face, abdominal pain, dry retching, sore throat, or stopped diarrhea with absent pulse: Tongmai Sini Tang (Connect to Frigid Extremities Decoction).
Shaoyin disease: Urge to vomit but nothing comes, irritability, drowsiness. After five-six days, spontaneous diarrhea with thirst belongs to Shaoyin.
Taiyin disease: Micro-fine-deep pulse, desire to sleep, sweating without irritability, desire to vomit. Progressing to five-six days with spontaneous diarrhea, renewed irritability, and inability to sleep is fatal. Post-recovery, weakness, shortness of breath, and desire to vomit: Zhuyegeshao Tang (Bamboo Leaf and Scallop Shell Decoction).
Chifuling Tang (Red Poria Decoction): Treats Shanghan vomiting/retching, epigastric fullness, fluid retention in chest/diaphragm, dizziness, palpitations.
Ingredients: Chifuling (Red Poria), Renshen (Ginseng Radix et Rhizoma) (each 1 liang); Banxia (Pinelliae Rhizoma Preparatum, ginger-processed), Juhong (Citri Reticulatae Pericarpium Rubrum), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 4 qian per dose with 5 slices of Shengjiang (Fresh Ginger), decoct in water.
Gegen Tang (Pueraria Decoction - Note: Formula content resembles a tonic/resolving fluid formula, possibly misnamed in source text relative to standard Mahuang-based Gegen Tang): Treats persistent dry retching in Shanghan.
Ingredients: Gegen (Puerariae Lobatae Radix), Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix, heart removed), Zhigancao (Prepared Licorice Root) (each 1 liang); Banxia (Pinelliae Rhizoma Preparatum, ginger-processed), Huangqi (Astragali Radix) (each 0.75 liang); Baifuling (White Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 3 qian per dose with 3 slices of Shengjiang (Fresh Ginger) and 2 Jujubes, decoct together.