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Vomiting (Ou) refers to a symptom where both sound and matter are expelled simultaneously. Spitting (Tu) refers to expelling matter without sound. Therefore, Zhang Zhongjing used "gan" (dry/empty) to distinguish them, making it clear that ou involves the expulsion of actual matter. "Gan" is akin to "empty," referring merely to empty retching without any substance being expelled. However, since both vomiting and spitting involve the expulsion of matter, comparing their severity, ou is more severe than tu. This occurs because exterior pathogens transmit inward, causing rebellious qi in the interior, leading to vomiting and an inability to retain food or fluids.

If there is stomach heat, the pulse is wiry and rapid, accompanied by irritability and thirst in the mouth and tongue. If there is stomach cold, the pulse is wiry and slow, accompanied by cold extremities, loss of appetite, and free urination. If there is fluid retention, one experiences thirst followed by vomiting, and palpitations in the epigastric region. If there is pus and blood, there is a fishy odor in the throat and a rushing sensation of qi moving upward; this requires no specific treatment, as it will resolve spontaneously once the pus and blood are vomited out. These four conditions must be carefully differentiated. Generally, when pathogens are half-exterior and half-interior, vomiting often occurs. When interior heat leads to vomiting, this also happens. Thus, the classics state: "Frequent vomiting, even if Yangming syndrome patterns are present, should not be treated with purgation," because the qi is rebellious and has not yet consolidated into excess. If vomiting is accompanied by a weak pulse, free urination, fever only, and cold extremities, it is difficult to treat due to severe deficiency-cold.

In combined Taiyang and Shaoyang disease, with spontaneous diarrhea and vomiting, use Huangqin Jia Banxia Shengjiang Tang (Decoction of Scutellaria with Pinellia and Fresh Ginger).
In combined Taiyang and Yangming disease, spontaneous diarrhea should occur; if there is no diarrhea but only vomiting, use Gegen Jia Banxia Tang (Kudzu Root with Pinellia Decoction).
In Shanghan (Cold Damage), with heat in the chest, pathogenic factors in the stomach, abdominal pain, and rebellious qi causing a desire to vomit, use Huanglian Tang (Coptis Decoction).
In Taiyang disease, with fever, sweating, mental restlessness and oppression in the epigastrium, fullness and hardness with difficult defecation, and vomiting, use Daxiehu Tang (Major Bupleurum Decoction).
For fever and rebellious vomiting involving the three yang channels, use Xiaochaihu Tang (Minor Bupleurum Decoction); for vomiting with thirst, use Zhuling Tang (Polyporus Decoction) and Wuling San (Five-Ingredient Powder with Poria).
Vomiting followed by thirst indicates the condition is resolving; provide water to quench thirst. Thirst followed by vomiting with fluid retention in the heart/lower chest area indicates Chifuling Tang (Red Poria Decoction).
In Shaoyin disease, with vomiting, drowsiness, occurring after five to six days, with spontaneous diarrhea, thirst, and white urine, use Sini Tang (Counterflow Decoction) added with fresh ginger.
For shortness of breath, or cough, or palpitations, body pain, and spontaneous diarrhea, use Zhenwu Tang (True Warrior Decoction) removing Fuzi (Aconite) and adding fresh ginger. For cold-fluid retention above the diaphragm, dry heaving, and spitting of saliva/froth, use Sini Tang (Counterflow Decoction).
If vomiting and diarrhea occur with cold extremities and severe irritability, use Wuzhuyu Tang (Evodia Decoction).
Desire to vomit upon eating grain belongs to Yangming disease, treated as above. If symptoms worsen after taking the decoction, it belongs to the upper jiao; use Jupi Tang (Tangerine Peel Decoction) and Xiaochaihu Tang (Minor Bupleurum Decoction).
Symptoms resembling vomiting, hiccups, or asthma, with a confused and uncomfortable feeling in the epigastrium, use Dajupi Tang (Major Tangerine Peel Decoction).
After sweating or purging treatments, if the guan pulse is slow and vomiting occurs, it is stomach cold; use Lizhong Wan (Regulate the Middle Pill). For post-illness deficiency-heat irritability and vomiting, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) added with fresh ginger juice. After repeated sweating and purging, if cold qi blocks the diaphragm and food is vomited immediately upon ingestion, use Ganjiang Huangqin Huanglian Renshen Tang (Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction).
If water and medicine cannot be retained after sweating, use Sini Tang (Counterflow Decoction) and Banxia Fuling Tang (Pinellia and Polyporus Decoction). The *Jingui Yaolue* states: For various types of vomiting where food cannot be retained, use Banxia Tang (Pinellia Decoction). For vomiting with a slippery-rapid or surging pulse, accompanied by fever, use Maogen Tang (Imperata Root Decoction).