夫呕家有痈脓。不可治。呕脓尽自愈。
〔鉴〕呕家呕吐或谷或水。或痰涎。或冷沫。令呕而有脓。此内有痈。脓溃而呕。非呕病也。故曰。不
可治。呕脓尽自愈。赵良曰。此痈之在胃脘上口者也。若过半中。在肺之下者。脓则不从呕出。而从大便
出矣。（详伤寒论辑义厥阴篇。）
先呕却渴者。此为欲解。先渴却呕者。为水停心下。此
属饮家。
呕家本渴。令反不渴者。以心下有支饮故也。此属支饮。
（此属饮家四字。千金作小半夏汤主之。呕家本渴以下。见饮病篇。此属支饮。饮病篇。作
小半夏汤主之。）
〔尤〕呕家必有停痰宿水。先呕却渴者。痰水已去。而胃阳将复也。故曰此为欲解。先渴却呕者。因
热饮水过多。热虽解而饮旋积也。此呕因积饮所致。故曰此属饮家。呕家本渴。水从呕去故也。今反不渴者。
以宿有支饮。在心下。愈动而愈出也。故曰此属支饮。
外台。载呕家本渴以下。而注云。张仲景杂方。此证当用小半夏加茯苓汤。方在支饮门中。
问曰。病患脉数。数为热。当消谷引食。而反吐者何也。师曰。以发其汗。令阳微膈气虚。脉乃数。
数为客热。不能消谷。胃中虚冷故也。脉弦者虚也。胃气无余。朝食暮吐。变为胃反。寒在于上。医反下之。
今脉反弦。故名曰虚。（太阳中篇。阳微作阳气微。故也之间有吐字。无问曰及何也师曰字。）
〔尤〕脉数为热。乃不能消谷引饮。而反吐。以发汗过多。阳微膈虚所致。则其数为客热上浮之数。而
非胃实气热之数矣。客热如客之寄。不久即散。故不能消谷也。脉弦为寒。乃不曰寒。而曰虚者。以寒在
于上。而医反下之所致。故其弦。非阴寒外加之弦。而为胃虚生寒之弦矣。胃虚且寒。阳气
无余。则朝食暮吐。而变为胃反也。读此知数脉弦脉。均有虚候。曰热曰寒。盖浅之乎言脉者耳。
〔鉴〕问
曰病患脉数。至胃中虚冷故也等句。已详伤寒论阳明篇内。错简在此。且与脉弦者虚也。文义不属。
巢源云。夫荣卫俱虚。血气不足。停水积饮。在于胃管。则脏冷。脏冷而脾不磨。脾不磨则宿谷不化。
其气逆而成胃反也。则朝食暮吐。暮食朝吐。心下牢大如 。往来寒热。甚者食已则吐。其脉紧而弦。紧则
为寒。弦则为虚。虚寒相搏。故食已则吐。名为反胃也。圣惠论云。夫反胃者。为食
物呕吐。胃不受食。言胃口翻也。则有因饮酒过伤所致。则有因忧悒怏。蓄怒肠结。胃翻所致。则有宿
滞痼癖。积聚冷痰。久不全除。致成兹疾。其中有才食便吐。有食久乃翻。
不可一概用方。切在仔细体认也。案反翻同。
寸口脉微而数。微则无气。无气则荣虚。荣虚则血不足。血不足则胸中冷。
〔鉴〕按此条文义不属。必是错简。
趺阳脉浮而涩。浮则为虚。虚则伤脾。脾伤则不磨。朝食暮吐。暮食朝吐。宿谷不化。名曰胃反。脉
紧而涩。其病难治。（虚则。脉经。千金。赵本尤本。并作涩则。千金。脉紧上。有趺阳二字。案金鉴云。
虚则伤脾之虚字当是涩字。是传写之讹。未考诸本也。）
〔程〕经曰。趺阳脉浮而涩。知脾气不足。胃气虚也。夫浮为虚。涩为血不足。趺阳得之。必知脾气
不治。华佗曰。脾主消磨水谷。闻声则动。动则磨胃。而主运化。今胃能纳。而脾不能磨。则胃中之谷。必
不能消。是以朝食而暮吐。暮食而朝吐。为胃反之证也。
〔尤〕胃为阳。脾为阴。浮则为虚者。
胃之阳虚也。涩则伤脾者。脾之阴伤也。谷入于胃。而运于脾。脾伤则不能磨。脾不磨。则谷不化。而朝
食者暮当下。暮食者朝当下。若谷不化。则不得下。不得下。必反而上出也。
〔魏〕紧者。寒盛也。涩者。
津亡也。胃中因虚而寒。因寒而燥。因燥而津枯。正不足而邪有余。反胃之病。难治可决矣。欲补阳而津枯。
有妨于补阳。欲生津而阳衰。有碍于补阴。棘手难下者。要在乎失治于早而已。
病患欲吐者。不可下之。
〔尤〕病患欲吐者。邪在上而气方逆。若遽下之。病气必与药气相争。而正乃蒙其祸矣。否则里虚邪入。
病气转深。或痞或利。未可知也。故曰不可下之。
〔程〕欲字。作吐而未吐之义。使人温温欲吐也。
哕而腹满。视其前后。知何部不利。利之即愈。（徐云。哕。恐呕字。案厥阴篇。亦作哕。）
〔沈〕此明实哕之治也。哕者。俗谓呃也。
〔鉴〕赵良曰。腹满为实。实则气上逆。而作哕。故必视其前后。何部不利。而利之则满去。而哕止。
〔魏〕胃气上逆。冲而为哕。治法当视其前后。审大小便调不调
也。前部不利者。水邪之逆也。当利其小便。而哕愈。后部不利者。热邪实也。当利其大便。而哕愈。
活人书云。前部不利。猪苓汤。后部不利。调胃承气汤。
呕而胸满者。茱萸汤主之。
〔尤〕胸中。阳也。呕而胸满。阳不治而阴乘之也。故以吴茱萸。散阴降逆。人参姜枣。补中益阳气。
茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味。以水五升。煮取三升。温服七合。日三服。（详伤寒辑义阳明篇。）
肘后方云。治人食毕噫醋。及醋心。（即本方。外台。引延年。作食讫醋咽多噫。）
三因方云。病者心膈胀满。气逆于胸间。食入即呕。呕尽却快。名曰气呕。胃者足阳明合。荣于足。今
随气上逆。结于胃口。故生呕病也。茱萸人参汤。治气呕胸满不纳食。呕吐涎沫。头疼。（即本方。）
干呕吐涎沫。头痛者。茱萸汤主之。（方见上。）
〔徐〕干呕者。有声无物也。物虽无。而吐涎沫。仲景曰。上焦有寒。其口多涎。上焦既有寒。寒
为阴邪。格阳在上。故头痛。比胸满而呕。似有轻重表里不同。然邪必乘虚。故
亦用茱萸汤。兼补以驱浊阴。谓呕有不同。寒则一也。（详伤寒论辑义厥阴篇。）
呕而肠鸣。心下痞者。半夏泻心汤主之。
〔尤〕邪气乘虚。陷入心中。中气则痞。中气既痞。升降失常。于是阳独上逆而呕。阴独下走而肠鸣。
是虽三焦俱病。而中气为上下之枢。故不必治其上下。而但治其中。黄连黄芩。苦以降阳。半夏干姜。辛
以升阴。阴升阳降。痞将自解。人参甘草。则补养中气。以为交阴阳通上下之用也。
〔徐〕亲见一乳母。吐呕五日。百药不能止。后服干姜黄连二味。立止。即此方之意也。
半夏泻心汤方
半夏（半升洗） 黄芩 干姜 人参（各三两） 黄连（一两） 大枣（十二枚） 甘草（三两炙）
上七味。以水一斗。煮取六升。去滓再煮。取三升。温服一升。日三服。（详伤寒论辑义太阳下编。）
外台。删繁。半夏泻心汤。疗上焦虚寒。肠鸣下利。心下痞坚。
于本方。去大枣。加桂心三两。（出霍乱门。）
干呕而利者。黄芩加半夏生姜汤主之。
〔徐〕伤寒论。芩甘枣芍四味。为黄芩汤。治太阳少阳合病。盖太少之邪合。而内入则协热而利。
故以黄芩为主也。然邪既内入。或有复搏饮者呕多。此其明证矣。故加半夏生姜。
〔程〕干呕者。无物
呕出也。中焦不和。则气逆于上。而作呕。迫于下而为利。故用半夏生姜。入上焦以止呕。甘草
大枣入中焦以和脾。黄芩芍药。入下焦以止利。如是则正气安。而邪气去。三焦和。而呕利止。
巢源云。干呕者。胃气逆故也。但呕而欲吐。吐而无所出。故谓之干呕也。
黄芩加半夏生姜汤方
黄芩（三两） 甘草（二两炙） 芍药（二两） 半夏（半升） 生姜（三两） 大枣（十二个）
上六味。以水一斗。煮取三升。去滓。温服一升。日再。夜一服。
诸呕吐。谷不得下者。小半夏汤主之。（方见痰饮中。）
〔鉴〕赵良曰。呕吐谷不得下者。有寒有热。不可概论也。
食入即吐。热也。朝食暮吐。寒也。此则非寒非热。由中焦停饮气结而逆。故用小半夏汤。
外台。伤寒呕哕门。仲景伤寒论。呕哕。心下悸痞硬不
能食。小半夏汤。又呕哕。心下痞硬者。以膈间有水。头眩悸。小半夏加茯苓汤。
呕吐而病在膈上。后思水者解。急与之。思水者猪苓散主之。（外台无而字解字。）
〔程〕上章言先呕却渴。此为欲解。今呕吐而病在膈上。后思水者解。亦与上证不殊。故急与之。以
和胃。然思水之人。又有得水而贪饮。则胃中热少。不能消水更与人作病。故思水者。用猪苓。以散水饮。
〔尤〕呕吐之余。中气未复。不能胜水。设过与之。则旧饮方去。新饮复生。故宜猪苓散。以崇土而逐水也。
兰台轨范云。伤饮恶饮。此乃常理。若胸中有水。则津液下流。反口干思水。但不能多饮耳。
猪苓散方（外台。引仲景伤寒论。）
猪苓 茯苓 白术（各等分○千金云各三两）
上三味。杵为散。饮服方寸匕。日三服。
千金。猪苓散。治呕而膈上寒。（即本方。）
外台。服法后云。欲饮水者。极与之。本虚与水。则哕。攻其热亦哕。
呕而脉弱。小便复利。身有微热。见厥者难治。四逆汤主之。
〔魏〕呕而脉弱者。胃气虚也。小便复利。气不足以统摄之。脱而下泄也。身有微热见厥。内积阴寒。
外越虚阳。阳衰阴盛。其呕为阳浮欲越之机也。见此知为难治。非寻常火邪痰饮之呕也。主之以四逆汤。益
阳安胃。温中止逆。亦大不同于寻常寒热错杂治呕之方也。附子辛热。干姜辛温。甘
草甘平。强人倍用。以急回其阳。勿令飞越。则呕可止也。（详伤寒论辑义厥阴篇。）
四逆汤方（外台。引仲景伤寒论。）
附子（一枚生用） 干姜（一两半） 甘草（二两炙）
上三味。以水三升。煮取一升二合。去滓。分温再服。强人可大附子一枚。干姜三两。
〔程〕神农经曰。疗寒者。以热药。内经云。寒淫于内。
治以甘热。四逆汤者。辛甘大热之剂也。故用附子以回阳散厥。干姜以去寒止呕。甘草以调和血脉。
三因方。四逆汤。治寒厥。或表热里寒。下利清谷。食
入则吐。或干呕。或大汗大吐大下之后。四肢冰冷。五内拘急。举体疼痛不渴。脉沉伏。（即本方。）
呕而发热者。小柴胡汤主之。（亦见厥阴篇。）
〔魏〕呕而皮肤发热者。伤寒病。少阳经证也。合以口苦
咽干目眩。而少阳病全。但见呕而发热。虽非伤寒正病。亦少阳经之属也。主之以小柴胡。表解里和而病愈。
小柴胡汤方
柴胡（半斤） 黄芩（三两） 人参（三两） 甘草（三两） 半夏（半升） 生姜
（三两） 大枣（十二枚）
上七味。以水一斗二升。煮取六升。去滓再煎。取三升。温服一升。日三服。（详伤寒论辑义太阳中篇。）
胃反呕吐者。大半夏汤主之。（〔原注〕千金云。治胃反不受食。食入
即吐。外台云。治呕心下痞硬者。○案今千金。入。作已。即吐。作即呕吐。）
〔鉴〕高世 曰。朝食暮吐。宿谷不化。名曰胃反。胃反但吐不呕。然吐不离乎呕。故曰胃反。呕吐
者用半夏。助燥气以消谷。人参补元气。以安胃。白蜜入水扬之。使甘味散于水中。水得蜜而和缓。蜜得水而
淡渗。庶胃反平而呕吐愈。李升玺曰。呕家不宜甘味。此用白蜜。何也。不知此胃反。自属脾虚。经所谓甘味
入脾。归其所喜是也。况君以半夏。味辛而止呕。佐以人参温气而补中。胃反自立止矣。
大半夏汤方
半夏（二升洗完用） 人参（三两） 白蜜（一升○千金有白术一升生姜三两）
上三味。以水一斗二升。和蜜。扬之二百四十遍。煮药。
取二升半。温服一升。余分再服。（千金云。扬之二三百下。外台云。本论。治反胃支饮。水用泉水。）
三因痰呕门。大半夏汤。治心气不行。郁生涎饮。聚结不散。心下痞硬。肠中沥沥有声。食入即吐。（即本方。）
食已即吐者。大黄甘草汤主之。（〔原注〕外台方。又治吐水。○外台引必效云。疗胃反吐水。及吐食。）
〔鉴〕吐者。有物无声之谓也。朝食暮吐者寒也。食已而吐者火也。以寒性迟。火性急也。故以大黄甘
草汤。缓中泻火。火平自不吐也。王肯堂曰。病患欲吐者。不可下之。又用大黄甘草。治食已即吐何也。曰
欲吐者。其病在上。因而越之可也。而逆之使下。则必抑塞愤乱而益甚。故禁之。若
既已吐矣。吐而不已。有升无降。则当逆而折之。引令下行。
无速于大黄。故取之也。
〔尤〕东垣通幽汤。治幽门不通。上冲吸门者。亦是此意。但有缓急之分耳。
案食入即吐。名回食。出于龚氏回春。当考。
肘后云。治人胃反不受食。食毕辄吐出。
大黄甘草汤方
大黄（四两） 甘草（一两○肘后作二两千金外台同）
上二味。以水三升。煮取一升。分温再服。（千金。味下。有
咀二字。○外台云。如得可则隔两日。更服一剂。神验。千金不传。此本仲景伤寒论方。）
千金翼云。主脾气实。其人口中淡甘。卧愦愦痛无常处。呕吐反胃方。
大黄（六两）
上一味。以水六升。煮取一升。分再服。又主食即吐。
呕吐患者体内有痈脓，不可使用止呕或攻下等常规治法。待脓液排尽，病症自然痊愈。
先出现呕吐随后感到口渴的，这是病情即将解除的征兆；先感到口渴随后发生呕吐的，这是因为水饮停滞在心下（胃脘部）。这种情况属于痰饮病患者。
呕吐患者本来应该感到口渴，现在反而不渴，是因为心下有支饮（支撑于胸膈间的停饮）的缘故。这种情况属于支饮病。
外台秘要记载“呕吐患者本来应该感到口渴”以下条文，并注释说：张仲景的杂病方中，此证应当用小半夏加茯苓汤治疗。该方剂记载在支饮门中。
有人问：病人的脉象数，数脉主热，热能消化食物且使人食欲旺盛，但病人反而呕吐，这是什么原因？医生说：这是因为发汗过度，导致阳气微弱、膈间气虚，脉象才表现为数。这种数脉是客热（浮越之热），不能消化食物，根本原因是胃中虚冷。脉象弦也是虚象，表示胃气已无余存。早晨吃下的食物到晚上吐出，转变为胃反病。寒邪位于上部，医生反而使用攻下法，现在脉象反而变弦，所以称为虚证。（注：太阳中篇中，“阳微”写作“阳气微”，文中还有“吐”字，没有“问曰”和“何也师曰”等字样。）
尤在泾评注：脉数通常主热，但不能消化食物而反呕吐，是因为发汗过多，导致阳气微弱、膈间气虚所致。那么其脉数乃是客热上浮之数，而非胃实气盛之数。客热如同客人寄居，不久即消散，所以不能消化食物。脉弦主寒，这里不说寒而说虚，是因为寒邪在上部，医生反而误用攻下法所致。因此其脉弦，不是阴寒外加之弦，而是胃虚生寒之弦。胃既虚又寒，阳气无余，就会早晨吃下的食物晚上吐出，转变为胃反病。读此可知，数脉和弦脉均有虚候，说它是热或寒，那是浅薄之人谈论脉象罢了。
赵良鉴注：关于“病人脉数……至胃中虚冷故也”等句，已在《伤寒论》阳明篇中详细论述，此处属于错简。且与“脉弦者虚也”文义不连贯。
巢元方说：荣卫俱虚，血气不足，停水积饮在于胃管，则脏腑寒冷。脏腑寒冷则脾不运化，脾不运化则宿食不消化。气机上逆而成胃反病，于是早晨吃晚上吐，晚上吃早上吐，心下坚硬大如盘状，往来寒热，严重的吃完就吐。其脉紧而弦，紧则为寒，弦则为虚，虚寒相搏，所以吃完就吐，名为反胃。
《圣惠方》论说：所谓反胃，是指食物呕吐，胃不受纳食物，言胃口翻转。这有因饮酒过伤所致的，有因忧愁抑郁、蓄怒肠结、胃翻所致的，有因宿食停滞、痼癖积聚、冷痰久未全除，导致形成此疾的。其中有刚吃就吐的，有吃很久才翻吐的。不可一概用同一方药，务必仔细体察辨认。案：“反”与“翻”同义。
寸口脉微而数，微脉表示无气，无气则营气虚弱，营气虚弱则血液不足，血液不足则胸中寒冷。
趺阳脉浮而涩，浮脉则表示虚，虚则损伤脾气。脾气受损则不能磨化水谷，早晨吃下的食物晚上吐出，晚上吃下的食物早上吐出，宿食不消化，名为胃反。脉象紧而涩，此病难治。（注：《脉经》、《千金方》、赵本、尤本中，“虚则”均作“涩则”。《千金方》中“脉紧”上有“趺阳”二字。据《金鉴》云，“虚则伤脾”的“虚”字当是“涩”字，是传写之讹，未考证诸本。）
程知评注：经文说，趺阳脉浮而涩，可知脾气不足，胃气虚。浮为虚，涩为血不足。趺阳脉见此，必知脾气不治。华佗说：脾主消磨水谷，听到声音则动，动则磨胃，而主运化。现在胃能受纳，而脾不能磨化，则胃中的谷物必然不能消化，所以早晨吃晚上吐，晚上吃早上吐，成为胃反的病证。
尤在泾评注：胃属阳，脾属阴。浮则为虚，指胃之阳虚；涩则伤脾，指脾之阴伤。谷物进入胃中，由脾来运化。脾受伤则不能磨化，脾不磨化，则谷物不消化。早晨吃的食物晚上应下行排出，晚上吃的食物早上应下行排出。如果谷物不消化，就不能下行，必然反而向上吐出。
魏念庭评注：紧脉，表示寒盛；涩脉，表示津液亡失。胃中因虚而寒，因寒而燥，因燥而津枯。正气不足而邪气有余，反胃之病，难治是可以确定的。想要补阳而津液枯竭，妨碍补阳；想要生津而阳气衰微，阻碍补阴。棘手难治的原因，在于早期失治而已。
尤在泾评注：病人想呕吐，说明邪气在上部且气机方逆。如果急于攻下，病气必与药气相争，正气反而遭受祸害。否则里虚邪气内入，病气转深，或成痞证或成泄利，都未可知。所以说不可攻下。
程知评注：“欲”字，意为将吐而未吐的样子，使人温温然想吐。
呃逆且腹部胀满，观察前阴和后阴，知道哪一部不利，通利那一部分即可痊愈。（徐灵胎云：哕，恐是“呕”字。案《厥阴篇》中也作“哕”。）
赵良鉴注：赵良说，腹满是实证，实证则气上逆而作哕。所以必须观察前后二阴，哪一部不利，通利它则满去而哕止。
魏念庭评注：胃气上逆，冲激而为哕。治疗方法应当观察前后二阴，审察大小便是否通畅。前部不利，是水邪上逆，应当利小便，哕即愈。后部不利，是热邪实证，应当利大便，哕即愈。
尤在泾评注：胸中属阳，呕吐且胸中胀满，是阳气不治而阴邪乘之。所以用吴茱萸散阴降逆，人参、生姜、大枣补中益阳。
茱萸汤方
吴茱萸（一升） 人参（三两） 生姜（六两） 大枣（十二枚）
以上四味药，用水五升，煮取三升，温服七合，每日三次。（详见《伤寒论辑义》阳明篇。）
《肘后备急方》说：治疗人饭后嗳气吞酸，及醋心。（即本方，《外台秘要》引《延年秘录》作食毕醋咽多嗳气。）
《三因极一病证方论》说：病人心膈胀满，气逆于胸间，食入即呕，呕完却感觉爽快，名为气呕。胃是足阳明经，荣养于足，现在随气上逆，结于胃口，所以产生呕吐病。茱萸人参汤，治疗气呕胸满不纳食，呕吐涎沫，头疼。（即本方。）
徐灵胎评注：干呕，是有声无物。虽然无物，但吐涎沫。张仲景说：上焦有寒，口中多涎。上焦既有寒，寒为阴邪，格拒阳气于上，所以头痛。这与胸满而呕相比，似乎有轻重表里的不同。然而邪气必乘虚而入，所以也用茱萸汤，兼以补益驱除浊阴。谓呕吐虽有不同，但寒邪则一。（详见《伤寒论辑义》厥阴篇。）
尤在泾评注：邪气乘虚陷入心中，中气则痞塞。中气既已痞塞，升降失常，于是阳气独上逆而呕吐，阴气独下走而肠鸣。这虽然是三焦俱病，但中气是上下之枢纽，所以不必治其上下，而只治其中。黄连、黄芩苦寒以降阳，半夏、干姜辛温以升阴。阴升阳降，痞塞自解。人参、甘草补养中气，作为交阴阳、通上下的作用。
徐灵胎评注：亲眼见到一位乳母，呕吐五日，百药不能止。后来服用干姜、黄连两味药，立即停止。即此方之意。
半夏泻心汤方
半夏（半升，洗） 黄芩 干姜 人参（各三两） 黄连（一两） 大枣（十二枚） 甘草（三两，炙）
以上七味药，用水一斗，煮取六升，去滓，再煎，取三升，温服一升，每日三次。（详见《伤寒论辑义》太阳下编。）
《外台秘要》删繁节要版半夏泻心汤，治疗上焦虚寒，肠鸣下利，心下痞硬。
在本方基础上，去大枣，加桂心三两。（出自霍乱门。）
徐灵胎评注：《伤寒论》中，芩、甘、枣、芍四味，组成黄芩汤，治疗太阳少阳合病。盖太少之邪合，内入则协热而利，所以以黄芩为主。然而邪气既已内入，或有再次搏结饮水致呕多的情况，这是明显的证据。所以加半夏、生姜。
程知评注：干呕，是无物呕出。中焦不和，则气逆于上而作呕，迫于下而为利。所以用半夏、生姜入上焦以止呕，甘草、大枣入中焦以和脾，黄芩、芍药入下焦以止利。这样则正气安，邪气去，三焦和，呕利止。
巢元方说：干呕，是胃气逆的缘故。只是呕而想吐，吐而无物，所以叫干呕。
黄芩加半夏生姜汤方
黄芩（三两） 甘草（二两，炙） 芍药（二两） 半夏（半升） 生姜（三两） 大枣（十二个）
以上六味药，用水一斗，煮取三升，去滓，温服一升，每日两次，夜间一次。
食入即吐，是热证；朝食暮吐，是寒证。此证非寒非热，由中焦停饮气结而逆，所以用小半夏汤。
《外台秘要》伤寒呕哕门，张仲景《伤寒论》：呕哕，心下悸痞硬不能食，用小半夏汤。又呕哕，心下痞硬者，以膈间有水，头眩悸，用小半夏加茯苓汤。
呕吐且病位在膈上，后来想喝水的，是病将解除的征兆，赶快给他喝水。想喝水的，用猪苓散主治。（《外台秘要》无“而”字、“解”字。）
程知评注：上一章说先呕却渴，此为欲解。现在呕吐且病在膈上，后来思水者解，也与上证无异，所以急与之水以和胃。然而思水之人，又有得水而贪饮的情况，则胃中热少，不能消水，更会与人作病。所以思水者，用猪苓散以散水饮。
尤在泾评注：呕吐之余，中气未复，不能胜水。如果过量给予，则旧饮方去，新饮复生。所以宜用猪苓散，以崇土而逐水。
《兰台轨范》说：伤饮恶饮，这是常理。若胸中有水，则津液下流，反口干思水，但不能多饮。
猪苓散方（《外台秘要》引张仲景《伤寒论》。）
猪苓 茯苓 白术（各等分○《千金方》云各三两）
以上三味药，捣筛为散，饮服方寸匕，每日三次。
《外台秘要》服法后说：想喝水的人，尽量给他喝。本虚与水，则哕。攻其热亦哕。
呕吐且脉弱，小便反利，身体有微热，出现四肢厥冷的，难治，用四逆汤主治。
魏念庭评注：呕吐且脉弱，是胃气虚。小便反利，是气不足以统摄，脱而下泄。身有微热见厥，是内积阴寒，外越虚阳。阳衰阴盛，其呕为阳浮欲越之机。见此可知为难治，不是寻常火邪痰饮之呕。主之以四逆汤，益阳安胃，温中止逆，也不同于寻常寒热错杂治呕之方。附子辛热，干姜辛温，甘草甘平，强壮之人加倍使用，以急回其阳，勿令飞越，则呕可止。（详见《伤寒论辑义》厥阴篇。）
四逆汤方（《外台秘要》引张仲景《伤寒论》。）
附子（一枚，生用） 干姜（一两半） 甘草（二两，炙）
以上三味药，用水三升，煮取一升二合，去滓，分两次温服。强壮之人可用大附子一枚，干姜三两。
程知评注：《神农本草经》说：疗寒者，以热药。《内经》说：寒淫于内，治以甘热。四逆汤，是辛甘大热的方剂。所以用附子以回阳散厥，干姜以去寒止呕，甘草以调和血脉。
《三因极一病证方论》：四逆汤，治疗寒厥，或表热里寒，下利清谷，食入则吐，或干呕，或大汗大吐大下之后，四肢冰冷，五内拘急，举体疼痛不渴，脉沉伏。（即本方。）
魏念庭评注：呕吐且皮肤发热，是伤寒病，少阳经证。结合口苦、咽干、目眩，则少阳病全备。但只见呕吐且发热，虽非伤寒正病，也属少阳经范畴。主之以小柴胡，表解里和而病愈。
小柴胡汤方
柴胡（半斤） 黄芩（三两） 人参（三两） 甘草（三两） 半夏（半升） 生姜（三两） 大枣（十二枚）
以上七味药，用水一斗二升，煮取六升，去滓，再煎，取三升，温服一升，每日三次。（详见《伤寒论辑义》太阳中篇。）
胃反呕吐的，用大半夏汤主治。（〔原注〕《千金方》云：治胃反不受食，食入即吐。《外台秘要》云：治呕心下痞硬。○案今《千金方》，“入”作“已”，“即吐”作“即呕吐”。）
赵良鉴注：高世栻说：朝食暮吐，宿谷不化，名为胃反。胃反但吐不呕。然而吐不离乎呕，所以叫胃反。呕吐者用半夏，助燥气以消谷，人参补元气以安胃，白蜜入水扬之，使甘味散于水中。水得蜜而和缓，蜜得水而淡渗，庶几胃反平而呕吐愈。李升玺说：呕家不宜甘味，此用白蜜，为何？不知此胃反，自属脾虚。经所谓甘味入脾，归其所喜是也。况君以半夏，味辛而止呕，佐以人参温气而补中，胃反自立止矣。
大半夏汤方
半夏（二升，洗完用） 人参（三两） 白蜜（一升○《千金方》有白术一升生姜三两）
以上三味药，用水一斗二升，和蜜，扬之二百四十遍，煮药，取二升半，温服一升，余分再服。（《千金方》云：扬之二三百下。《外台秘要》云：本论，治反胃支饮，水用泉水。）
《三因痰呕门》：大半夏汤，治疗心气不行，郁生涎饮，聚结不散，心下痞硬，肠中沥沥有声，食入即吐。（即本方。）
食已即吐的，用大黄甘草汤主治。（〔原注〕《外台秘要》方，又治吐水。○《外台秘要》引《必效方》云：疗胃反吐水，及吐食。）
赵良鉴注：吐，是有物无声的叫吐。朝食暮吐者是寒，食已而吐者是火。因为寒性迟，火性急。所以用大黄甘草汤，缓中泻火，火平自不吐。王肯堂说：病患想呕吐的，不可攻下。又用大黄甘草汤治食已即吐，为什么呢？回答说：欲吐者，其病在上，因而越之可也。而逆之使下，则必抑塞愤乱而益甚，所以禁止。若已经吐了，吐而不已，有升无降，则当逆而折之，引令下行。没有比大黄更快的，所以取用它。
尤在泾评注：东垣通幽汤，治疗幽门不通，上冲吸门者，也是这个意思，但有缓急之分。
《肘后备急方》说：治疗人胃反不受食，食毕辄吐出。
大黄甘草汤方
大黄（四两） 甘草（一两○《肘后方》作二两，《千金方》《外台秘要》同）
以上两味药，用水三升，煮取一升，分两次温服。（《千金方》味下，有“咀”二字。○《外台秘要》云：如得可则隔两日，更服一剂，神验。《千金方》不传，此本是张仲景《伤寒论》方。）
《千金翼方》云：主脾气实，其人口中淡甘，卧愦愦痛无常处，呕吐反胃方。
大黄（六两）
以上一味药，用水六升，煮取一升，分两次服。又主食即吐。
For a patient with vomiting who has carbuncle pus (carbuncle and suppurative lesions), treatment for vomiting itself is contraindicated. Once the pus is completely vomited out, the condition will heal spontaneously.
If vomiting occurs first followed by thirst, this indicates that the disease is about to resolve. If thirst occurs first followed by vomiting, it is due to fluid retention in the heart region (epigastrium). This type of case belongs to patients with phlegm-fluids (phlegm-water retention).
Patients with vomiting should normally feel thirsty. If they do not feel thirsty now, it is because there is supporting fluid retention (fluid retention supporting in the chest and diaphragm) in the heart region. This case belongs to supporting fluid retention.
The *Wai Tai Mi Yao* records the text following "patients with vomiting should normally feel thirsty" and annotates: In Zhang Zhongjing's miscellaneous formulas, this syndrome should be treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia Decoction plus Poria). The formula is recorded in the Supporting Fluid Retention section.
A question was asked: The patient's pulse is rapid (Shu). A rapid pulse indicates heat, which should digest food and increase appetite, yet the patient vomits instead. What is the reason? The Master said: This is caused by excessive sweating, leading to weak Yang Qi and deficiency of Qi in the diaphragm, resulting in a rapid pulse. This rapid pulse represents guest heat (floating excess heat) and cannot digest food; the root cause is cold deficiency in the stomach. A wiry (Xian) pulse also indicates deficiency, meaning there is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, transforming into Wei Fan (stomach reversal). Cold is located in the upper part, but the physician mistakenly used purgatives. Now the pulse is wiry, hence it is named deficiency. (Note: In the Taiyang Middle Chapter, "Yang Wei" is written as "Yang Qi Wei". There is a character for "vomit" between "Gu Ye", and the phrases "Wen Yue" and "He Ye Shi Yue" are absent.)
You Zaijing commented: A rapid pulse usually indicates heat. However, if one cannot digest food and instead vomits, it is due to excessive sweating causing weak Yang Qi and deficiency in the diaphragm. Thus, the rapidity is due to guest heat floating upward, not the rapidity of fullness-heat in the Stomach. Guest heat is like a visitor staying temporarily and dissipates soon, so it cannot digest food. A wiry pulse indicates cold. Here, "deficiency" is stated instead of "cold" because the cold was in the upper part and the physician mistakenly purged it. Therefore, the wiriness is not from external yin-cold but from cold generated by Stomach deficiency. With both deficiency and cold in the Stomach, and no surplus of Yang Qi, food eaten in the morning is vomited in the evening, becoming Wei Fan. From this, we know that both rapid and wiry pulses can indicate deficiency states. Calling them heat or cold is a superficial understanding of pulse diagnosis.
Zhao Liangjian noted: The sentences regarding "patient's pulse is rapid... until the root cause is cold deficiency in the Stomach" have been detailed in the Yangming Chapter of the *Shang Han Lun*. Their placement here is likely a textual error (cuojian). Moreover, the meaning does not connect well with "a wiry pulse indicates deficiency."
Chao Yuanfang stated: When Ying and Wei are both deficient, and Blood and Qi are insufficient, retained water and accumulated fluids reside in the stomach tube, causing internal organ coldness. Internal organ coldness leads to Spleen failure to transform. Spleen failure to transform results in undigested old food. Qi rebels upward forming Wei Fan, leading to vomiting food eaten in the morning by evening, and food eaten in the evening by morning. The epigastrium feels hard and large like a plate, with alternating chills and fever. In severe cases, vomiting occurs immediately after eating. The pulse is tight and wiry; tight indicates cold, wiry indicates deficiency. Deficiency and cold contend, causing vomiting after eating, named Fan Wei.
The *Sheng Hui Fang* discusses: Fan Wei refers to vomiting food because the Stomach refuses to accept it, implying the gastric opening flips. Causes include excessive alcohol consumption, sorrow and depression, suppressed anger causing intestinal knotting and Stomach flipping, or long-standing food stagnation, stubborn masses, and cold phlegm that were not fully eliminated. Some vomit immediately after eating; others vomit after a long time. One cannot use a single formula for all cases; careful differentiation is essential. Note: "Fan" (reverse) and "Fan" (flip) are synonymous.
At the Cun Kou (radial artery) position, if the pulse is micro (Wei) and rapid (Shu): Micro indicates lack of Qi; lack of Qi leads to Ying deficiency; Ying deficiency leads to blood insufficiency; blood insufficiency leads to coldness in the chest.
Zhao Liangjian observed: The logic of this clause is disjointed; it must be a textual error.
At the Fu Yang (dorsalis pedis artery) position, if the pulse is floating (Fu) and choppy (Se): Floating indicates deficiency; deficiency injures the Spleen. Spleen injury leads to failure to grind/transform. Food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited in the morning; old food remains undigested. This is named Wei Fan. If the pulse is tight and choppy, the disease is difficult to treat. (Note: In *Mai Jing*, *Qian Jin*, Zhao Ben, and You Ben, "Xu Ze" is written as "Se Ze". In *Qian Jin*, "Pulse Jin" has "Fu Yang" before it. According to *Jin Jian*, the character "Xu" in "Xu Ze Shang Pi" should be "Se"; this is a transcription error, failing to consult other editions.)
Cheng Zhi commented: The Classic states: At the Fu Yang position, a floating and choppy pulse indicates Spleen Qi insufficiency and Stomach Qi deficiency. Floating indicates deficiency; choppy indicates blood insufficiency. Observing this at Fu Yang confirms Spleen dysfunction. Hua Tuo said: The Spleen governs the grinding of food and drink; it moves upon hearing sound, grinding the Stomach to aid transformation. Now the Stomach can receive, but the Spleen cannot grind. Therefore, grain in the Stomach cannot be digested, leading to vomiting food eaten in the morning by evening, and food eaten in the evening by morning, constituting Wei Fan.
You Zaijing commented: The Stomach is Yang, the Spleen is Yin. Floating indicates deficiency, referring to Stomach Yang deficiency. Choppy indicates Spleen injury, referring to Spleen Yin injury. Grain enters the Stomach and is transported by the Spleen. If the Spleen is injured, it cannot grind. If the Spleen does not grind, grain is not digested. Morning-eaten food should pass down by evening; evening-eaten food should pass down by morning. If grain is not digested, it cannot pass down and must reverse upward.
Wei Nianting commented: Tight indicates severe cold; choppy indicates loss of body fluids. The Stomach becomes cold due to deficiency, dry due to cold, and fluids wither due to dryness. Righteous Qi is insufficient while pathogenic factors are abundant. The difficulty of treating Wei Fan is certain. Attempting to tonify Yang when fluids are withered hinders Yang tonification; attempting to generate fluids when Yang is weak hinders Yin tonification. The棘手 (difficult) nature lies primarily in early mismanagement.
If a patient desires to vomit, purgatives are contraindicated.
You Zaijing commented: When a patient desires to vomit, the pathogen is in the upper part and Qi is rebellious. If purgatives are hastily used, the pathogenic Qi will clash with the medicinal Qi, harming the righteous Qi. Otherwise, interior deficiency allows pathogens to enter, deepening the disease, potentially leading to fullness (Pi) or diarrhea. Hence, purgatives are contraindicated.
Cheng Zhi commented: The character "Yu" (desire/want) implies the state of nearly vomiting but not yet having vomited, making the patient feel nauseous.
If there is hiccup (Yue) accompanied by abdominal fullness, observe the anterior (urinary) and posterior (anal) orifices to determine which is obstructed. Unblocking the obstruction will lead to recovery. (Xu Lingtai notes: Yue might be a typo for Ou. Note: The Jueyin Chapter also uses Yue.)
Shen Mingzong commented: This clarifies the treatment for excess-type hiccup. Yue is commonly known as hiccups.
Zhao Liangjian noted: Zhao Liang said: Abdominal fullness indicates excess. Excess causes Qi to rebel upward, producing hiccup. Therefore, one must observe the anterior and posterior orifices. Unblocking the obstruction removes fullness and stops hiccup.
Wei Nianting commented: Stomach Qi rebelling upward and rushing creates hiccup. The treatment method is to observe the anterior and posterior orifices, examining whether urination and defecation are unobstructed. Obstruction in the anterior part indicates rebellion of water pathogen; benefit urination to cure hiccup. Obstruction in the posterior part indicates excess heat pathogen; benefit defecation to cure hiccup.
The *Huo Ren Shu* states: For anterior obstruction, use Zhu Ling Tang; for posterior obstruction, use Tiao Wei Cheng Qi Tang.
For vomiting accompanied by chest fullness, Zhu Yu Tang (Evodia Decoction) is the primary treatment.
You Zaijing commented: The chest belongs to Yang. Vomiting with chest fullness indicates Yang fails to govern and Yin takes advantage. Therefore, Wu Zhu Yu is used to scatter Yin and direct rebellious Qi downward, while Ren Shen, Sheng Jiang, and Da Zao tonify the center and benefit Yang Qi.
Zhu Yu Tang Formula
Wu Zhu Yu (one sheng), Ren Shen (three liang), Sheng Jiang (six liang), Da Zao (twelve pieces).
These four ingredients are boiled in five sheng of water to obtain three sheng. Take seven ge warm, three times daily. (See *Shang Han Lun Ji Yi*, Yangming Chapter.)
The *Zhou Hou Bei Ji Fang* states: Treat belching with sour taste and acid regurgitation after eating. (This is the same formula. *Wai Tai Mi Yao* cites *Yan Nian* as "sour swallowing and frequent belching after eating.")
The *San Yin Fang* states: Patients experience fullness in the heart and diaphragm, Qi rebelling in the chest, vomiting immediately after eating, feeling relieved only after vomiting. This is named Qi Ou (Qi vomiting). The Stomach is the Foot-Yangming channel, nourishing the foot. Now Qi rebels upward, knotting at the gastric opening, causing vomiting. Zhu Yu Ren Shen Tang treats Qi vomiting with chest fullness, inability to accept food, vomiting of saliva/phlegm, and headache. (This is the same formula.)
For dry heaving (Gan Ou), vomiting of saliva/phlegm, and headache, Zhu Yu Tang is the primary treatment. (Formula seen above.)
Xu Lingtai commented: Dry heaving means sound without material expulsion. Although no material is expelled, saliva/phlegm is vomited. Zhang Zhongjing said: Cold in the Upper Jiao causes excessive salivation. With cold in the Upper Jiao, cold being a Yin pathogen, it blocks Yang in the upper part, causing headache. Compared to chest fullness and vomiting, there seems to be a difference in severity and exterior/interior location. However, pathogens always take advantage of deficiency, so Zhu Yu Tang is also used here to tonify and expel turbid Yin. It is said that although vomiting differs, the cold pathogen is the same. (See *Shang Han Lun Ji Yi*, Jueyin Chapter.)
For vomiting accompanied by borborygmus (intestinal rumbling) and epigastric stuffiness (Pi), Ban Xia Xie Xin Tang (Pinellia Decoction for Draining the Epigastrium) is the primary treatment.
You Zaijing commented: Pathogens take advantage of deficiency to sink into the Heart region, causing epigastric stuffiness. Once the Middle Qi is stuffed, ascending and descending functions fail. Yang rebels upward alone causing vomiting, while Yin flows downward alone causing borborygmus. Although the Three Jiaos are all diseased, the Middle Qi is the pivot of ascent and descent. Therefore, there is no need to treat the upper and lower separately, but only the middle. Huang Lian and Huang Qin are bitter and cold to descend Yang; Ban Xia and Gan Jiang are acrid and warm to ascend Yin. As Yin ascends and Yang descends, the stuffiness resolves. Ren Shen and Gan Cao tonify and nourish Middle Qi, serving to harmonize Yin and Yang and connect the upper and lower.
Xu Lingtai commented: I personally saw a wet nurse who vomited for five days, unable to stop despite various medicines. Later, she took Gan Jiang and Huang Lian, and stopped immediately. This illustrates the principle of this formula.
Ban Xia Xie Xin Tang Formula
Ban Xia (half sheng, washed), Huang Qin, Gan Jiang, Ren Shen (each three liang), Huang Lian (one liang), Da Zao (twelve pieces), Gan Cao (three liang, honey-fried).
These seven ingredients are boiled in ten dou of water to obtain six sheng. Remove dregs, boil again to obtain three sheng. Take one sheng warm, three times daily. (See *Shang Han Lun Ji Yi*, Taiyang Lower Compilation.)
*Wai Tai Mi Yao* abridged version of Ban Xia Xie Xin Tang treats Upper Jiao deficiency-cold, borborygmus with diarrhea, and hard epigastric stuffiness.
From this formula, remove Da Zao and add Gui Xin (Cinnamon Bark) three liang. (From the Huoluan Section.)
For dry heaving accompanied by diarrhea, Huang Qin Jia Ban Xia Sheng Jiang Tang (Decoction of Scutellaria plus Pinellia and Fresh Ginger) is the primary treatment.
Xu Lingtai commented: In the *Shang Han Lun*, Huang Qin, Gan Cao, Da Zao, and Bai Shao form Huang Qin Tang, treating combined diseases of Taiyang and Shaoyang. When pathogens of Taiyang and Shaoyang combine and enter internally, they cause heat-associated diarrhea. Thus, Huang Qin is the chief herb. However, once pathogens enter internally, there may be re-aggregation with fluids causing frequent vomiting. This is clear evidence. Hence, Ban Xia and Sheng Jiang are added.
Cheng Zhi commented: Dry heaving means vomiting without material expulsion. Disharmony in the Middle Jiao causes Qi to rebel upward, creating vomiting, and presses downward, causing diarrhea. Therefore, Ban Xia and Sheng Jiang are used in the Upper Jiao to stop vomiting; Gan Cao and Da Zao are used in the Middle Jiao to harmonize the Spleen; Huang Qin and Bai Shao are used in the Lower Jiao to stop diarrhea. In this way, righteous Qi is stabilized, pathogens depart, the Three Jiaos harmonize, and vomiting and diarrhea cease.
Chao Yuanfang stated: Dry heaving is due to Stomach Qi rebellion. It is merely vomiting with the desire to expel, but nothing comes out, hence called dry heaving.
Huang Qin Jia Ban Xia Sheng Jiang Tang Formula
Huang Qin (three liang), Gan Cao (two liang, honey-fried), Bai Shao (two liang), Ban Xia (half sheng), Sheng Jiang (three liang), Da Zao (twelve pieces).
These six ingredients are boiled in ten dou of water to obtain three sheng. Remove dregs. Take one sheng warm, twice daily and once at night.
For various types of vomiting where food cannot go down, Xiao Ban Xia Tang (Minor Pinellia Decoction) is the primary treatment. (Formula seen in Phlegm-Fluids section.)
Zhao Liangjian noted: Zhao Liang said: Vomiting where food cannot go down can be due to cold or heat; it cannot be generalized.
Vomiting immediately after eating indicates heat; vomiting food eaten in the morning by evening indicates cold. This case is neither cold nor heat, but due to retained fluids in the Middle Jiao, Qi knotting, and rebellion. Therefore, Xiao Ban Xia Tang is used.
*Wai Tai Mi Yao*, Shanghan Vomiting/Hiccup Section, Zhang Zhongjing's *Shang Han Lun*: Vomiting/hiccup with palpitations and hard epigastric stuffiness preventing eating, use Xiao Ban Xia Tang. Also, vomiting/hiccup with hard epigastric stuffiness due to water between the diaphragm, dizziness, and palpitations, use Xiao Ban Xia Jia Fu Ling Tang.
For vomiting with pathology above the diaphragm, if the patient later desires water, it indicates resolution. Give water promptly. If the patient desires water, use Zhu Ling San (Polyporus Powder). (*Wai Tai Mi Yao* omits "Er" and "Jie").
Cheng Zhi commented: The previous chapter stated that vomiting first followed by thirst indicates impending resolution. Now, vomiting with pathology above the diaphragm, followed by desire for water, also indicates resolution, similar to the previous syndrome. Hence, give water promptly to harmonize the Stomach. However, those desiring water may greedily drink too much. Since Stomach heat is scant, it cannot transform the water, potentially causing new illness. Therefore, for those desiring water, use Zhu Ling San to disperse fluid retention.
You Zaijing commented: After vomiting, Middle Qi has not recovered and cannot handle water. If given excessively, old fluids may leave, but new fluids will regenerate. Thus, Zhu Ling San is suitable to strengthen Earth (Spleen) and expel water.
*Lan Tai Gui Fan* states: Injury by fluids makes one dislike drinking; this is normal. If there is water in the chest, fluids flow downward, causing dry mouth and desire for water, but one cannot drink much.
Zhu Ling San Formula (*Wai Tai Mi Yao* cites Zhang Zhongjing's *Shang Han Lun*.)
Zhu Ling, Fu Ling, Bai Zhu (equal parts ○ *Qian Jin* says each three liang).
These three ingredients are pounded into powder. Take one cun bi with water, three times daily.
*Qian Jin*: Zhu Ling San treats vomiting with cold above the diaphragm. (This is the same formula.)
*Wai Tai Mi Yao* post-administration note: For those desiring water, give freely. Giving water to the fundamentally deficient causes hiccup. Attacking heat also causes hiccup.
For vomiting with a weak pulse, frequent urination (or clear urine), slight fever, and cold extremities (Jue), the prognosis is poor/difficult. Si Ni Tang (Four Reversals Decoction) is the primary treatment.
Wei Nianting commented: Vomiting with a weak pulse indicates Stomach Qi deficiency. Frequent urination indicates Qi is insufficient to control retention, leading to leakage. Slight fever with cold extremities indicates internal accumulation of Yin cold and external floating of deficient Yang. Yang is weak and Yin is abundant. The vomiting is a sign of floating Yang about to escape. Seeing this indicates a difficult case, not ordinary fire-pathogen or phlegm-fluid vomiting. Si Ni Tang is used to benefit Yang, calm the Stomach, warm the center, and stop rebellion. It is significantly different from formulas for mixed cold-heat vomiting. Fu Zi is acrid-hot, Gan Jiang is acrid-warm, Gan Cao is sweet-neutral. For strong individuals, double the dose to urgently restore Yang and prevent escaping, thus stopping vomiting. (See *Shang Han Lun Ji Yi*, Jueyin Chapter.)
Si Ni Tang Formula (*Wai Tai Mi Yao* cites Zhang Zhongjing's *Shang Han Lun*.)
Fu Zi (one piece, raw), Gan Jiang (one and a half liang), Gan Cao (two liang, honey-fried).
These three ingredients are boiled in three sheng of water to obtain one sheng two he. Remove dregs. Divide into two warm doses. Strong individuals may use one large Fu Zi and three liang Gan Jiang.
Cheng Zhi commented: The *Shen Nong Ben Cao Jing* states: To treat cold, use hot herbs. The *Nei Jing* states: When cold invades internally, treat with sweet-hot methods. Si Ni Tang is an acrid-sweet, greatly hot formula. Thus, Fu Zi is used to restore Yang and dissipate cold reversals; Gan Jiang to dispel cold and stop vomiting; Gan Cao to harmonize vessels and blood.
*San Yin Fang*: Si Ni Tang treats cold reversals, or exterior heat with interior cold, diarrhea with undigested food, vomiting after eating, or dry heaving, or after massive sweating, vomiting, or purging, with cold limbs, internal cramping, whole-body pain without thirst, and deep-hidden pulse. (This is the same formula.)
For vomiting accompanied by fever, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the primary treatment. (Also seen in Jueyin Chapter.)
Wei Nianting commented: Vomiting with skin fever indicates Shanghan disease, a Shaoyang channel syndrome. Combined with bitter taste in the mouth, dry throat, and vertigo, the Shaoyang disease is complete. Even seeing only vomiting and fever, though not the typical Shanghan presentation, it still belongs to the Shaoyang channel. Xiao Chai Hu is used to resolve the exterior and harmonize the interior, curing the disease.
Xiao Chai Hu Tang Formula
Chai Hu (half jin), Huang Qin (three liang), Ren Shen (three liang), Gan Cao (three liang), Ban Xia (half sheng), Sheng Jiang (three liang), Da Zao (twelve pieces).
These seven ingredients are boiled in twelve dou of water to obtain six sheng. Remove dregs, decoct again to obtain three sheng. Take one sheng warm, three times daily. (See *Shang Han Lun Ji Yi*, Taiyang Middle Chapter.)
For Wei Fan (Stomach Reversal) with vomiting, Da Ban Xia Tang (Major Pinellia Decoction) is the primary treatment. ([Original Note] *Qian Jin* says: Treats Wei Fan refusing food, vomiting immediately after eating. *Wai Tai Mi Yao* says: Treats vomiting with hard epigastric stuffiness. ○ Note: Current *Qian Jin* writes "Ru" as "Yi", and "Ji Tu" as "Ji Ou Tu".)
Zhao Liangjian noted: Gao Shishi said: Vomiting food eaten in the morning by evening, undigested old food, is named Wei Fan. Wei Fan involves only vomiting, not retching. However, vomiting is inseparable from retching, hence called Wei Fan. For vomiting, Ban Xia is used to assist drying Qi to digest food; Ren Shen tonifies primal Qi to calm the Stomach; Bai Mi (white honey) is mixed with water and shaken, dispersing its sweet flavor into the water. Water becomes gentle with honey; honey becomes light and penetrating with water. Thus, Wei Fan levels out and vomiting heals. Li Shengxi said: Vomiting patients should avoid sweet flavors. Why use white honey here? Unknown that this Wei Fan naturally belongs to Spleen deficiency. The Classic states: Sweet flavor enters the Spleen, returning to what it likes. Moreover, with Ban Xia as the chief herb, acrid in taste to stop vomiting, assisted by Ren Shen warming Qi and tonifying the center, Wei Fan will stop on its own.
Da Ban Xia Tang Formula
Ban Xia (two sheng, washed and prepared), Ren Shen (three liang), Bai Mi (one sheng ○ *Qian Jin* has Bai Zhu one sheng and Sheng Jiang three liang).
These three ingredients are mixed with ten dou two sheng of water and honey, shaken two hundred forty times, then decocted. Obtain two sheng five he. Take one sheng warm, divide the remainder for another dose. (*Qian Jin* says shake two or three hundred times. *Wai Tai Mi Yao* says: This theory treats Fan Wei and supporting fluids; use spring water.)
*San Yin Tan Ou Men*: Da Ban Xia Tang treats Stomach Qi stagnation,郁 (depression) generating saliva/fluids, gathering and not dispersing, hard epigastric stuffiness, gurgling sounds in intestines, and vomiting immediately after eating. (This is the same formula.)
For vomiting immediately after eating, Da Huang Gan Cao Tang (Rhubarb and Licorice Decoction) is the primary treatment. ([Original Note] *Wai Tai Mi Yao* formula also treats vomiting water. ○ *Wai Tai Mi Yao* cites *Bi Xiao* saying: Treats Fan Wei vomiting water and food.)
Zhao Liangjian noted: "Tu" (vomiting/expelling) refers to expelling material without sound. Vomiting food eaten in the morning by evening is cold; vomiting immediately after eating is fire/heat. Because cold nature is slow, fire/heat nature is urgent. Therefore, Da Huang Gan Cao Tang is used to moderate the center and purge fire/heat. Once fire/heat calms, vomiting stops. Wang Kentang said: For patients desiring to vomit, purgatives are contraindicated. Why use Da Huang Gan Cao Tang for vomiting immediately after eating? Answer: When desiring to vomit, the pathology is in the upper part, so inducing emesis is appropriate. Opposing it by forcing downward causes suppression, frustration, and worsening. Hence, it is prohibited. If vomiting has already occurred and continues incessantly, with only ascending and no descending, one must oppose and break it, guiding it downward. Nothing is faster than Da Huang, hence it is chosen.
You Zaijing commented: Dong Yuan's Tong You Tang, treating obstruction at the幽门 (pylorus) with rebellion up to the吸门 (glottis), shares this intent, differing only in urgency.
Note: Vomiting immediately after eating is named Hui Shi (returning food), originating from Gong's *Hui Chun*, which should be verified.
*Zhou Hou Bei Ji Fang* states: Treats Fan Wei refusing food, vomiting immediately after finishing a meal.
Da Huang Gan Cao Tang Formula
Da Huang (four liang), Gan Cao (one liang ○ *Zhou Hou* says two liang, *Qian Jin* and *Wai Tai* agree).
These two ingredients are boiled in three sheng of water to obtain one sheng. Divide into two warm doses. (*Qian Jin* has the character "Ju" under the ingredients. ○ *Wai Tai* says: If effective, wait two days and administer another dose; it is miraculous. *Qian Jin* does not transmit this; this original is from Zhang Zhongjing's *Shang Han Lun*.)
*Qian Jin Yi Fang* states: Mainly treats Spleen Qi excess, where the person has a bland-sweet taste in the mouth, restlessness in lying down, unpredictable pain, vomiting, and Fan Wei.
Da Huang (six liang).
This single ingredient is boiled in six sheng of water to obtain one sheng. Divide into two doses. Also for vomiting immediately after eating.