脉数故吐（汗令阳微，鬲气空虚；数为客热，不能消 ，胃中虚冷，故使吐也。）
关上脉数，故吐。阳紧阴数，食已即吐，阳浮而数亦然，或浮大（皆阳偏胜，阴
不能配之也，为格，主吐逆，无阴则呕故也。）
脉紧而滑者，吐之。关上浮大，风在胃中，食欲呕。
脉弦者，虚也。胃气无余，朝食暮吐，变为胃反。寸紧尺涩，胸满不食而
吐，吐止者，为下之未止者，为胃反。
趺阳脉微而涩，微则下利，涩则吐逆。或浮而涩，浮则虚，虚伤脾，脾则不
磨，朝食暮吐，名曰胃反。
寸口微而数，微则血虚，血虚则胸中冷。
脉小弱而涩者胃反（血不足也）。
寸口紧而芤（紧为寒，芤为虚，虚寒相搏，脉为阴结而迟，其人则噎。）
脉大而弱，噎鬲（气不足也）。
关上脉微浮，积热在胃中，呕吐蛔虫。关上紧而滑者，蛔动。
盖呕吐因胃口有热，膈上有痰。亦有寒气客于肠胃，故痛而呕也。
哕（吃逆也），因胃中虚，鬲上热，亦有痰水满塞而哕者，必心下坚痞眩悸。
李论 三者皆因脾胃虚弱，客气寒之，加之饮食所伤，治宜二陈汤加丁香、藿香、姜汁主之。
痰饮必下之导之。
火者，二陈汤加芩连降之。
刘论 吐有三，气、积、寒也。
上焦吐者，皆从于气。脉浮而洪，食已暴吐，渴欲食水，大便结燥，气上冲而胸发痛，治宜降气和中。
中焦吐者，皆食，从于积。脉浮而匿，或先吐而后痛，或先痛而后吐，治宜
毒药行积，木香、槟榔去其气。
下焦吐者，从于寒也。脉沉迟，朝食暮吐，暮食朝吐，小便清利，大便不
通，治宜毒药通其闭塞，温其寒气。
治方
安胃散 治呕吐哕胃寒所致。
茱萸 草豆蔻 人参 苍术（各一两） 甘草（炙） 黄 （二钱） 川归（一钱半） 升麻
（七分） 柴胡 丁香 陈皮（五分） 黄柏（五分）
呕吐痰涎痰饮为患，加二陈汤。
二陈汤加黄连、栀子（炒）、姜汁、香附 治痰呕吐。虚加苍术。
桔梗汤 治上焦热气所冲。
半夏面（二两） 陈皮 茯苓 枳壳（炒） 浓朴（制各一两） 白术 桔梗（一两五钱）
上煎调槟榔木香末一钱。
荆黄汤 治前证甚者。
荆芥穗（一两） 人参（五钱） 甘草（炙） 大黄（三钱）
上调下槟榔木香末二钱，大府燥结加承气。
清镇丸 治前证头痛、有汗脉弦。
柴胡（二两） 黄芩（七钱半） 半夏 甘草（一两半） 人参（五分） 青黛（二钱半）
姜汁炊饼丸。
紫沉丸 治中焦积气相假，故吐而哕。
半夏曲 代赭石 乌梅 宿砂（各三钱） 杏仁（去壳皮） 沉香（一钱） 木香（一钱）
槟榔（二钱） 丁香（二钱） 陈皮（五钱） 术（一钱） 白豆蔻（五分） 巴豆霜（五分另入）
醋糊丸米大，姜汤下五十丸。
木香白术散 治前证腹中痛，是脾实击强，宜和之。
木香（一钱） 白术（五钱） 半夏曲（一两） 槟榔（二钱） 茯苓（五钱） 甘草（四钱）
上浓煎，芍药姜汤下，无积者宜之。
附子丸 治下焦吐，大便不通。
附子（炮五钱） 巴豆霜（一钱） 砂（五分另研）
上黄蜡丸，桐子大，每二丸，以利为度，更服紫沉丸，不令再闭。
Pulse rapid, therefore vomiting (Sweating causes Yang Qi to become weak, and Diaphragm Qi becomes empty; a rapid pulse indicates exogenous heat, which cannot digest food; the stomach is cold and deficient, thus causing vomiting.)
A rapid pulse at the Guan position indicates vomiting. A tight pulse in the Yang position and a rapid pulse in the Yin position indicate vomiting immediately after eating; a floating and rapid pulse presents similarly, or a floating and large pulse (all indicate Yang excess, with Yin unable to match it, termed Ge [Rejection], primarily manifesting as vomiting and regurgitation; without Yin, there is retching.)
A tight and slippery pulse indicates vomiting. A floating and large pulse at the Guan position indicates wind in the stomach, with an urge to vomit after eating.
A wiry pulse indicates deficiency. With insufficient Stomach Qi, morning food is vomited in the evening, transforming into Wei Fan [Stomach Reversal]. A tight pulse at the Cun position and a choppy pulse at the Chi position indicate chest fullness, anorexia, and vomiting; if vomiting stops, it is because purgative treatment has not ceased; if it continues, it is Wei Fan [Stomach Reversal].
A faint and choppy pulse at the Zuyang position indicates that faintness leads to diarrhea, and choppy-ness leads to vomiting and regurgitation. Alternatively, a floating and choppy pulse: floating indicates deficiency; deficiency injures the Spleen, causing it to fail to transform food, resulting in morning food vomited in the evening, named Wei Fan [Stomach Reversal].
A faint and rapid pulse at the Cun position indicates blood deficiency; blood deficiency leads to cold in the chest.
A small, weak, and choppy pulse indicates Wei Fan [Stomach Reversal] (due to blood insufficiency).
A tight and hollow pulse at the Cun position (tight indicates cold, hollow indicates deficiency; deficiency and cold combine, causing Yin knotting and slowness in the pulse; the person experiences dysphagia.)
A large and weak pulse indicates Ye Ge [Dysphagia and Food Impaction] (due to Qi insufficiency).
A slightly floating pulse at the Guan position indicates accumulated heat in the stomach, vomiting roundworms. A tight and slippery pulse at the Guan position indicates moving roundworms.
Generally, vomiting occurs due to heat in the stomach opening and phlegm above the diaphragm. There are also cases where cold pathogenic factors lodge in the intestines and stomach, causing pain and vomiting.
Hiccups (E Ni [hiccup]) occur due to stomach deficiency and heat above the diaphragm; there are also cases of hiccups caused by phlegm-fluid retention blocking the area, necessarily accompanied by hardness and distension below the heart, dizziness, and palpitations.
Li’s Discussion: These three conditions all result from Spleen and Stomach weakness, invasion by exogenous cold pathogens, and dietary injury. Treatment should prioritize Er Chen Tang (Two-Aged Decoction) added with Ding Xiang (Clove), Huo Xiang (Patchouli), and Jiang Zhi (Ginger Juice).
Phlegm-fluid retention must be treated with purgatives to guide it out.
Fire pathogen: Use Er Chen Tang (Two-Aged Decoction) added with Huang Qin (Scutellaria Root) and Lian Zi (Lotus Plumule) to descend fire.
Liu’s Discussion: Vomiting has three types: Qi, Accumulation, and Cold.
Upper Jiao vomiting stems from Qi. The pulse is floating and surging; violent vomiting after eating, thirst for water, dry stool, Qi rushing upward causing chest pain. Treatment should focus on descending Qi and harmonizing the Middle.
Middle Jiao vomiting stems from food accumulation. The pulse is floating and hidden, or vomiting precedes pain, or pain precedes vomiting. Treatment should use toxic herbs to move accumulation, and Mu Xiang (Aucklandia Root), Bing Lang (Areca Seed) to remove Qi stagnation.
Lower Jiao vomiting stems from cold. The pulse is deep and slow; morning food vomited in the evening, evening food vomited in the morning, clear urine, constipation. Treatment should use toxic herbs to open blockages and warm away cold.
Prescriptions
An Wei San (Stomach-Anning Powder) treats vomiting and hiccups caused by Stomach cold.
Zhu Yu (Evodia Fruit), Cao Dou Kou (Nutmeg), Ren Shen (Ginseng), Cang Zhu (Atractylodes Rhizome) (each 1 liang), Gan Cao (Licorice Root, honey-fried), Huang Qi (Astragalus Root) (2 qian), Chuan Gui (Angelica Sinensis Root) (1.5 qian), Sheng Ma (Cimicifuga Rhizome) (7 fen), Chai Hu (Bupleurum Root), Ding Xiang (Clove), Chen Pi (Tangerine Peel) (5 fen), Huang Bo (Phellodendron Bark) (5 fen).
For vomiting of phlegm-saliva and phlegm-fluid, add Er Chen Tang (Two-Aged Decoction).
Er Chen Tang (Two-Aged Decoction) added with Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit, stir-fried), Jiang Zhi (Ginger Juice), Xiang Fu (Cyperus Rhizome) treats phlegm-induced vomiting. Add Cang Zhu (Atractylodes Rhizome) for deficiency.
Jie Geng Tang (Platycodon Decoction) treats upper Jiao heat rushing upward.
Ban Xia Mian (Pinellia Paste) (2 liang), Chen Pi (Tangerine Peel), Fu Ling (Poria), Zhi Ke (Bitter Orange, stir-fried), Hou Po (Magnolia Bark, processed) (each 1 liang), Bai Zhu (Atractylodes Macrocephala Rhizome), Jie Geng (Platycodon Root) (1.5 liang).
Decoct together, mix with 1 qian of Bing Lang (Areca Seed) and Mu Xiang (Aucklandia Root) powder.
Jing Huang Tang (Schizonepeta and Rhubarb Decoction) treats severe cases of the above conditions.
Jing Jie Sui (Schizonepeta Spike) (1 liang), Ren Shen (Ginseng) (5 qian), Gan Cao (Licorice Root, honey-fried), Da Huang (Rhubarb Root) (3 qian).
Mix with 2 qian of Bing Lang (Areca Seed) and Mu Xiang (Aucklandia Root) powder. If stool is dry and hard, add Cheng Qi Tang (Descending the Qi Decoction).
Qing Zhen Wan (Clearing and Settling Pill) treats headache, sweating, and wiry pulse from previous conditions.
Chai Hu (Bupleurum Root) (2 liang), Huang Qin (Scutellaria Root) (7.5 qian), Ban Xia (Pinellia Tuber), Gan Cao (Licorice Root) (1.5 liang), Ren Shen (Ginseng) (5 fen), Qing Dai (Indigo Naturalis) (2.5 qian).
Make pills using steamed wheat cake dough mixed with Jiang Zhi (Ginger Juice).
Zi Chen Wan (Purple Sandalwood Pill) treats middle Jiao accumulated Qi causing vomiting and hiccups.
Ban Xia Qu (Pinellia Fermented Curd), Dai Zhe Shi (Magnetite), Wu Mei (Mume Fruit), Sha Ren (Amomum Fruit) (each 3 qian), Xing Ren (Apricot Seed, peeled), Chen Xiang (Aquilaria Wood) (1 qian), Mu Xiang (Aucklandia Root) (1 qian), Bing Lang (Areca Seed) (2 qian), Ding Xiang (Clove) (2 qian), Chen Pi (Tangerine Peel) (5 qian), Bai Zhu (Atractylodes Macrocephala Rhizome) (1 qian), Bai Dou Kou (White Cardamom) (5 fen), Ba Dou Shuang (Croton Seed Frost) (5 fen, added separately).
Make pills with vinegar paste, size of rice grains. Take 50 pills with Ginger Decoction.
Mu Xiang Bai Zhu San (Aucklandia and Atractylodes Powder) treats abdominal pain from previous conditions, indicating Spleen excess striking strongly; harmonization is appropriate.
Mu Xiang (Aucklandia Root) (1 qian), Bai Zhu (Atractylodes Macrocephala Rhizome) (5 qian), Ban Xia Qu (Pinellia Fermented Curd) (1 liang), Bing Lang (Areca Seed) (2 qian), Fu Ling (Poria) (5 qian), Gan Cao (Licorice Root) (4 qian).
Decoct strongly, take with Shao Yao (Peony Root) and Ginger Decoction. Suitable for cases without accumulation.
Fu Zi Wan (Aconite Pill) treats lower Jiao vomiting with constipation.
Fu Zi (Prepared Aconite Root) (5 qian), Ba Dou Shuang (Croton Seed Frost) (1 qian), Sha Ren (Amomum Fruit) (5 fen, ground separately).
Make pills with yellow beeswax, size of wisteria seeds. Take 2 pills per dose, stopping when bowel movement occurs. Follow with Zi Chen Wan (Purple Sandalwood Pill) to prevent re-obstruction.