〔薛〕《病机》云∶吐有三∶曰气、积、寒也，皆从三焦论之。上焦吐者从于气，气
者天之阳也，其脉浮而洪，食已暴吐，渴欲饮水，大便燥结，气上冲胸发痛，其治法常
降气和中。中焦吐者从于积，有阴有阳，食与气相假为积而痛，其脉浮而匿，其证或先
痛而后吐，或吐而后作痛，治法当以小毒药去其积，槟榔、木香行其气。下焦吐者从于
寒，地之道也，其脉沉而迟，其证朝食暮吐，暮食朝吐，小便清，大便秘而不通，治法当
以毒药通其秘塞，温其寒气，大便渐通，复以中焦药和之，不令大便秘结而自愈也。王
太仆曰∶食不得入是有火也，食入反出是无火也。又《发明》曰∶噎者六腑之所主，阳
也，气也。塞者五脏之所主，阴也，血也。二者皆由阴中伏火而作也。刘宗浓先生曰∶若
三焦传化失常所致，主于气也。若血亏胃脘干槁所致，因于血也。塞犹填塞不通之义，故
《发明》有治幽门不通、噎塞不便，通幽汤例。盖阳无阴不能通化，阴之失位而阳伏其中，传
化不变而反上行矣。故前证或由饮食起居七情，亏损脾胃，痰饮停滞，中气不运，当以
补中益气汤（杂病劳倦。）为主。若郁结伤脾，用归脾汤（杂病健忘。）加枳壳、桔梗。若恚怒伤肝，
用小柴胡汤（伤寒少阳。）加栀、苓、参、术。脾气虚弱，用六君子（杂病虚劳。）加山栀、枳壳。气
血俱虚，用八珍汤（即杂病八物汤。）加山栀、半夏。若用行气之药，胸膈痞闷，用六君、芎、
归之类。若过用香燥之剂而大便结燥，用四物、（通治。）参、术之类。若饮食不能入，用六
君、山栀、吴茱萸、制黄连。若食入而反出，用六君、炮姜、白豆蔻、黄连、制吴茱萸。若
痰滞而食反出，六君、枳壳、桔梗。若饮食少思，大便不实，胸膈痞闷，吞酸嗳腐，食
反不化，是为脾胃虚寒，用东垣补真丸或八味丸。（杂病虚劳。）若发热烦热，身恶风寒，腹
畏热食，或手足俱冷，胸满腹胀，是内真寒外假热，用神效附子丸，（本条。）或八味丸。大
凡呕吐善食，喜饮冷水，是为有火。呕吐少食，喜饮热汤，是为无火。当审其因而治之。
一妇人患前证，胸腹痞闷，得去后或泄气稍宽。余曰∶此属脾气郁结而虚弱也，当调
补为善。不信，乃别用二陈、枳实、黄连之类，不应；又用香燥破气，前证益甚，形气
愈虚。余用加味归脾汤，（即本方加柴胡、山栀。）调治半载而痊。一妇人患前证，胸胁胀闷，
或小腹不利，或时作痛，小便涩滞。余曰∶此肝火血虚也，当清肝火，生肝血，养脾土，生
肺金。以余言为迂，别服利气化痰等剂，前证益剧，虚证蜂起，余用加味逍遥散，（调经。）
加味归脾汤兼服，寻愈。一妇人患吐痰甚多，手足常冷，饮食少思。余曰∶此肝脾郁
怒，兼命门火衰。不信，另服化痰利气之剂，胸腹愈胀，又服峻利疏道之剂。余曰∶非其
治也，必变脾虚发肿之证，急服《金匮》加减肾气丸，庶有可救。不信，反服沉香化气
等丸，果发肿而殁。
白 散 治妇人翻胃吐食。《千金翼》云∶不特治妇人，男子亦可服。一斤以上为妙。
白 土（以米醋一升， 土令赤，入醋内浸令冷，再 再浸，以醋干为度，取一两研。）
干姜（炮，二钱半）
上为细末，每服一钱，米饮调下，甚者二钱。
白芷散 治妇人翻胃吐食。
上用白芷一两，切作片，瓦上炒令黄，为细末，用猪血二十文切片，以沸汤泡七次，将
血蘸药吃七片。如剩药末，留后次用。
太仓丸 治脾胃虚弱，不进饮食，反胃呕吐。
白豆蔻 缩砂仁（各二两） 丁香（一两） 陈仓米（一升，用黄土炒米赤，去土不用）
上为细末，姜汁法丸梧子大，每服六七十丸，食后淡姜汤下。
青金丹 治呕吐反胃等证。每用三十丸，煎生姜、陈皮汤吞下。（方见前呕吐。）
五苓散 治反胃发渴，加半夏。每四钱，生姜五片煎，温服。（方见伤寒渴。）
东垣补真丸
肉苁蓉（酒浸，焙） 葫芦巴（炒） 附子（炮，去皮） 阳起石（ ） 肉豆蔻（面里煨）
菟丝子（净洗，酒浸蒸） 川乌（炮，去皮） 沉香 五味子（各五钱） 鹿茸（酒浸，炒）
巴戟（去心） 钟乳粉（各一两）
上为细末，用羊腰子两对，治如食法，葱椒酒煮，捣烂入酒，糊丸如梧子大。每服七
十丸，空心米饮，盐汤任下。
神效附子丸 治脾肾虚寒、呕吐，或反胃膈噎。
黑附子重一两四五钱，端正底平尖圆，一枚，灰火炮皮裂，入生姜自然汁内浸润晒干，
仍炮，再入汁浸润，仍晒再炮，用尽姜汁半碗为度，却去皮脐末之，以人参膏和丸如黍
米大。每服数丸，津唾咽下，胃气稍复，饮食稍进，投以温补之剂。
【薛己】在《病机》中说：呕吐有三种类型，分别是气、积、寒，都要从三焦的角度来论述。上焦的呕吐源于气，气属于天之阳，其脉象浮而洪大，进食后立即剧烈呕吐，口渴想喝水，大便干燥结滞，气向上冲撞胸部并引发疼痛，治疗法则通常是降气和调中焦。中焦的呕吐源于积滞，有阴证和阳证之分，食物与气相互搏结形成积滞而疼痛，其脉象浮而沉取无力（匿），症状或是先疼痛后呕吐，或是先呕吐后疼痛，治疗法则应当用毒性较小的药物去除积滞，使用槟榔、木香来行气。下焦的呕吐源于寒邪，这是地之道的体现，其脉象沉而迟缓，症状是早晨吃的食物晚上吐出来，晚上吃的食物早晨吐出来，小便清长，大便秘结不通，治疗法则应当用药物通导秘结，温散寒气，待大便逐渐通畅后，再用调理中焦的药物调和它，不让大便再次干结，疾病就会自愈。王太仆说：食物不能咽下是因为有火，食物吃进去反而吐出来是因为无火。另外《发明》中说：噎是六腑所主，属阳，属气；塞是五脏所主，属阴，属血。这两种情况都是由阴中伏藏的火邪引起的。刘宗浓先生说：如果是三焦传化功能失常所致，主要在于气；如果是血亏导致胃脘干枯萎缩所致，主要在于血。“塞”还有填塞不通的意思，所以《发明》中有治疗幽门不通、噎塞不便的通幽汤案例。大概是因为阳没有阴就不能通化，阴失位而阳伏于其中，传化功能不变反而向上逆行。所以前面的病症有的因为饮食起居、七情内伤，亏损了脾胃，痰饮停滞，中气不运，应当以补中益气汤（见杂病劳倦）为主方。如果因郁结损伤脾脏，用归脾汤（见杂病健忘）加枳壳、桔梗。如果因愤怒损伤肝脏，用小柴胡汤（见伤寒少阳）加栀子、茯苓、人参、白术。脾气虚弱，用六君子汤（见杂病虚劳）加山栀、枳壳。气血都虚弱，用八珍汤（即杂病八物汤）加山栀、半夏。如果使用行气的药后出现胸膈痞闷，用六君子汤加川芎、当归之类。如果过度使用香燥的药物导致大便干结，用四物汤（通治）加人参、白术之类。如果饮食无法进入，用六君子汤加山栀、吴茱萸、制黄连。如果食物吃进去反而吐出，用六君子汤加炮姜、白豆蔻、黄连、制吴茱萸。如果因痰滞导致食物反出，用六君子汤加枳壳、桔梗。如果饮食减少、食欲不振，大便不成形，胸膈痞闷，吞酸嗳腐，食物反不消化，这是脾胃虚寒，用东垣的补真丸或八味丸（见杂病虚劳）。如果出现发热烦热，身体恶风寒，腹部怕吃热食，或者手脚都冷，胸满腹胀，这是内真寒外假热，用神效附子丸（本条）或八味丸。大凡呕吐且食欲好，喜欢喝冷水，这是有火。呕吐且吃得少，喜欢喝热汤，这是无火。应当审察病因进行治疗。
有一位妇人患上述病症，胸腹痞闷，排便或排气后稍微宽松一些。我说：这属于脾气郁结而虚弱，应当调理补益为好。她不相信，于是另用二陈汤、枳实、黄连之类的药物，无效；又用香燥破气的药物，前面的症状更加严重，形体和气更加虚弱。我用加味归脾汤（即本方加柴胡、山栀），调理半年后痊愈。另一位妇人患上述病症，胸胁胀闷，或小腹不适，有时疼痛，小便涩滞。我说：这是肝火血虚，应当清肝火，生肝血，养脾土，生肺金。她认为我的话迂腐，另服利气化痰等药剂，前面的症状更加剧烈，虚证蜂拥而起，我用加味逍遥散（见调经）、加味归脾汤兼服，不久痊愈。还有一位妇人呕吐痰液非常多，手脚经常发冷，饮食减少、食欲不振。我说：这是肝脾郁怒，兼命门火衰。她不信，另服化痰利气的药剂，胸腹更加胀满，又服用峻烈利水疏通的药剂。我说：这不是正确的治疗方法，一定会变成脾虚浮肿的病症，急忙服用《金匮要略》的加减肾气丸，或许还有救。她不信，反而服用沉香化气等丸剂，果然发生浮肿而死。
白散 治疗妇人翻胃吐食。《千金翼方》说：不仅治疗妇人，男子也可以服用。剂量在一斤以上为妙。
白垩土（用米醋一升，将土烧红，放入醋中浸泡至冷却，再反复浸泡，直到醋干为止，取一两研细。）
干姜（炮制，二钱半）
以上研为细末，每次服用一钱，米汤调下，严重的服用二钱。
白芷散 治疗妇人翻胃吐食。
上面用白芷一两，切成片，在瓦上炒至黄色，研为细末，用猪血二十文切片，用沸水冲泡七次，将血蘸着药粉吃七片。如果剩下药末，留作下次使用。
太仓丸 治疗脾胃虚弱，不进饮食，反胃呕吐。
白豆蔻 缩砂仁（各二两） 丁香（一两） 陈仓米（一升，用黄土炒米至赤色，去掉黄土不用）
以上研为细末，用姜汁泛丸如梧桐子大，每次服用六七十丸，饭后用淡姜汤送服。
青金丹 治疗呕吐反胃等证。每次用三十丸，煎生姜、陈皮汤吞服。（方剂见前呕吐章节。）
五苓散 治疗反胃发渴，加半夏。每次四钱，生姜五片煎煮，温服。（方剂见伤寒渴章节。）
东垣补真丸
肉苁蓉（酒浸，焙干） 葫芦巴（炒） 附子（炮制，去皮） 阳起石（煅） 肉豆蔻（面裹煨）
菟丝子（净洗，酒浸蒸） 川乌（炮制，去皮） 沉香 五味子（各五钱） 鹿茸（酒浸，炒）
巴戟天（去心） 钟乳粉（各一两）
以上研为细末，用羊腰子两对，按食用方法处理，用葱、椒、酒煮，捣烂加入酒，制成糊状丸如梧桐子大。每次服用七十丸，空腹时米汤或盐汤任下。
神效附子丸 治疗脾肾虚寒、呕吐，或反胃膈噎。
黑附子重一两四五钱，形状端正底平尖圆，一枚，用灰火炮制至皮裂，放入生姜自然汁中浸润晒干，再炮制，再放入汁中浸润，再晒再炮，用尽姜汁半碗为止，然后去皮脐研成末，用人参膏和丸如黍米大。每次服用数丸，津液吞咽下去，胃气稍复，饮食稍进，再投以温补的药剂。
[Xue Ji] In *Bingji* (Pathogenesis), it is stated: There are three types of vomiting: Qi, Accumulation, and Cold. All should be discussed from the perspective of the Sanjiao (Triple Burner). Vomiting originating in the Upper Jiao stems from Qi; Qi belongs to the Yang of Heaven. Its pulse is floating and surging. Food is vomited violently immediately after eating, accompanied by thirst and a desire to drink water, dry and constipated stool, Qi rushing upward to the chest causing pain. The treatment principle is usually to descend Qi and harmonize the Middle Jiao. Vomiting originating in the Middle Jiao stems from Accumulation, which can be Yin or Yang. Food and Qi intertwine to form an accumulation causing pain. Its pulse is floating but deep upon pressing (Ni). Symptoms may involve pain preceding vomiting or vomiting preceding pain. The treatment principle is to use mildly toxic drugs to remove the accumulation, using Areca Seed (Binglang) and Costus Root (Muxiang) to move Qi. Vomiting originating in the Lower Jiao stems from Cold, reflecting the Way of Earth. Its pulse is deep and slow. Symptoms include morning food vomited in the evening, or evening food vomited in the morning, clear urine, and severe constipation. The treatment principle is to use drugs to unblock constipation and warm away cold Qi. Once stool gradually becomes unblocked, use medicines for the Middle Jiao to harmonize it, preventing re-constipation, and the disease will heal spontaneously. Wang Taipu said: Food unable to enter indicates Fire; food entering and then being vomited out indicates lack of Fire. Furthermore, *Faming* states: "Ye" (Dysphagia/Choking) is governed by the Six Fu-organs, belonging to Yang and Qi. "Se" (Obstruction) is governed by the Five Zang-organs, belonging to Yin and Blood. Both conditions arise from latent Fire hidden within Yin. Mr. Liu Zongnong said: If caused by dysfunction of Sanjiao transmission and transformation, it primarily involves Qi. If caused by Blood deficiency leading to dryness and atrophy of the stomach lining, it primarily involves Blood. "Se" implies blockage like filling. Thus, *Faming* provides the example of Tongyou Decoction for treating obstruction of the pylorus and dysphagia. Generally, Yang cannot transform without Yin; if Yin loses its position and Yang lies dormant within, transmission and transformation remain unchanged but reverse direction upwards. Therefore, previous symptoms may result from diet, lifestyle, or Seven Emotions damaging the Spleen and Stomach, causing Phlegm-fluid retention and failure of Middle Qi to circulate. The primary formula should be Buzhong Yiqi Tang (see Miscellaneous Diseases: Fatigue). If constrained accumulation damages the Spleen, use Guipi Tang (see Miscellaneous Diseases: Forgetfulness) with added Magnolia Bark (Zhike) and Platycodon Root (Jiegeng). If anger damages the Liver, use Xiaochaihu Tang (see Shaoyang Syndrome of Cold Damage) with added Gardenia (Shanzhi), Poria (Fuling), Ginseng (Renshen), and Atractylodes Macrocephala Rhizome (Baizhu). For Spleen Qi deficiency, use Liujunzi Tang (see Miscellaneous Diseases: Consumption) with added Gardenia and Magnolia Bark. For simultaneous Qi and Blood deficiency, use Bazhen Tang (i.e., Zabing Bayiwu Tang) with added Gardenia and Pinellia Tuber (Banxia). If chest and diaphragm stuffiness occurs after using Qi-moving drugs, use Liujunzi Tang with Chuanxiong Rhizome (Xiong) and Angelica Sinensis Radix (Gui). If excessive use of aromatic-drying agents leads to dry stool, use Siwu Tang (General Treatment) with added Ginseng and Atractylodes Macrocephala Rhizome. If food cannot enter, use Liujunzi Tang with Gardenia, Evodia Fruit (Wuzhuyu), and Processed Coptis Rhizome (Zhi Huanglian). If food enters and is vomited back, use Liujunzi Tang with Processed Ginger (Paojiang), White Cardamom Seed (Baidoukou), Coptis Rhizome, and Processed Evodia Fruit. If food is vomited due to Phlegm stagnation, use Liujunzi Tang with Magnolia Bark and Platycodon Root. If appetite is poor, stool is loose, chest/diaphragm is stuffy, acid regurgitation and belching of rotten food occur, and food fails to digest, this is Spleen-Stomach Deficiency-Cold. Use Dongyuan's Buzhen Wan or Bawei Wan (see Miscellaneous Diseases: Consumption). If feverish irritability, aversion to wind-cold, fear of hot food in the abdomen, or cold hands and feet with chest fullness and abdominal distension occur, this is True Cold inside with False Heat outside. Use Shenxiao Fuzi Wan (this section) or Bawei Wan. Generally, vomiting with good appetite and preference for cold drinks indicates Fire. Vomiting with poor appetite and preference for hot drinks indicates lack of Fire. One must examine the cause and treat accordingly.
A woman suffered from the above symptoms, with chest and abdominal stuffiness, feeling slightly relieved after defecation or passing gas. I said: This belongs to Spleen Qi constraint and deficiency; regulation and tonification are best. She did not believe me, used Erchen Tang, Immature Bitter Orange (Zhishi), and Coptis Rhizome instead, with no effect; then used aromatic-drying Qi-breaking agents, worsening the symptoms and further depleting her form and Qi. I used Jiawei Guipi Tang (i.e., this formula with added Bupleurum Root (Chaihu) and Gardenia), regulating and treating for half a year until recovery. Another woman suffered from the above symptoms, with chest and hypochondriac distension, lower abdominal discomfort, occasional pain, and scanty, difficult urination. I said: This is Liver Fire and Blood deficiency. Clear Liver Fire, generate Liver Blood, nourish Spleen Earth, and generate Lung Metal. She considered my words pedantic, took Qi-promoting and Phlegm-resolving agents instead, worsening the condition and bringing forth numerous deficiency syndromes. I used Jiawei Xiaoyao San (see Menstrual Disorders) and Jiawei Guipi Tang concurrently, and she recovered soon. Another woman vomited copious phlegm, had constantly cold hands and feet, and poor appetite. I said: This is Liver-Spleen constraint and anger, combined with Declining Fire of the Gate of Vitality (Mingmen). She did not believe me, took Phlegm-resolving and Qi-promoting agents, increasing abdominal distension, then took harsh diuretic and purgative agents. I said: This is incorrect treatment; it will surely turn into Spleen-deficiency edema. Urgently take Jin Gui Jian Shenqi Wan, perhaps there is hope. She did not believe me, took Chenxiang Huaqi pills instead, indeed developed edema and died.
Bai San treats women's Fanwei (Reverse Flow of Stomach) and vomiting. *Qianjin Yi Fang* states: It is not only for women; men may also take it. A dose of one jin or more is excellent.
White Kaolin (Boil one sheng of rice vinegar, heat the earth until red, immerse in vinegar until cool, repeat immersion until vinegar is dry, take one liang and grind.)
Dried Ginger (Processed, two qian and half)
Grind into fine powder. Take one qian per dose, mixed with rice drink. For severe cases, take two qian.
Baizhi San treats women's Fanwei and vomiting.
Take one liang of Angelica Dahurica Root (Baizhi), slice it, stir-fry on tile until yellow, grind into fine powder. Take twenty slices of pig blood, soak in boiling water seven times, dip the blood slices in the medicine powder and eat seven slices. Reserve remaining powder for next use.
Taicang Wan treats Spleen-Stomach weakness, inability to eat, and Fanwei vomiting.
White Cardamom Seed (Suandoukou) and Amomum Fruit (Suosharen) (each two liang), Clove (Dingxiang) (one liang), Stored Grain Rice (Chencangmi) (one sheng, stir-fry with yellow loess until rice turns red, remove loess).
Grind into fine powder. Make pills the size of wutong seeds using ginger juice. Take 60-70 pills per dose after meals, washed down with light ginger soup.
Qingjin Dan treats vomiting and Fanwei etc. Take thirty pills per dose, swallowed with decoction of Fresh Ginger and Tangerine Peel (Chenpi). (Formula seen in previous Vomiting section.)
Wuling San treats Fanwei with thirst, add Pinellia Tuber (Banxia). Take four qian per dose, decoct with five slices of fresh ginger, take warm. (Formula seen in Cold Damage Thirst section.)
Dongyuan Buzhen Wan
Cistanche Stem (Roucongrong) (soaked in wine, baked), Trigonella Foenum-graecum Seed (Huluba) (stir-fried), Prepared Aconite Root (Fuzi) (processed, peeled), Activated Halloysite (Yangqishi) (calcined), Nutmeg (Roudoukou) (baked in flour wrapper), Dodder Seed (Tusizi) (cleanly washed, soaked in wine and steamed), Prepared Sichuan Aconite Root (Chuanwu) (processed, peeled), Agarwood (Chenxiang), Schisandra Fruit (Wuweizi) (each five qian), Deer Antler Lu Rong (Lu Rong) (soaked in wine, fried), Morinda Officinalis Root (Baji) (decored), Calcined Stalactite Powder (Zhongru Fen) (each one liang).
Grind into fine powder. Treat two pairs of sheep kidneys as food, boil with scallion, pepper, and wine, mash, add wine, make paste pills the size of wutong seeds. Take seventy pills per dose when empty stomach, washed down with rice drink or salt water as desired.
Shenxiao Fuzi Wan treats Spleen-Kidney Deficiency-Cold, vomiting, or Fanwei and Ge Ye (Diaphragmatic Obstruction).
Black Aconite Root (Hei Fuzi) weighing one liang, four qian, five qian, upright with flat base and round tip, one piece. Process in ash fire until skin cracks, soak in fresh ginger juice, dry, process again, soak again, dry and process again. Use half a bowl of ginger juice completely. Then peel and remove navel, grind to powder. Mix with Ginseng Paste to make pills the size of millet grains. Swallow several pills with saliva. When Stomach Qi recovers slightly and food intake improves, administer warming and tonifying agents.