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[Outline] Zhang Zhongjing stated: In Shaoyang disease, if vomiting is frequent, even if Yangming syndrome symptoms are present, purgation (attacking the interior) should not be used. Huangqin Shengjiang Banxia Tang (Scutellaria, Fresh Ginger, and Pinellia Decoction) may be used.

[Commentary] Zhu Gong stated: Without Yang Qi, there will be cold extremities (Jue); without Yin fluids, there will be vomiting. Vomiting is a disorder of the Foot-Yangming Stomach Meridian. The Qi of the Foot-Yangming Stomach naturally descends; now, due to Jue reversal, the Qi ascends instead, leading to rebellious Qi. Rebellious Qi causes vomiting. Zhang Zhongjing said: If vomiting is frequent, even if there is constipation, downward purging should not be employed; Xiao Chaihu Tang (Minor Bupleurum Decoction) may be given. Once the Upper Jiao (Upper Burner) becomes unobstructed, body fluids descend, the Stomach Qi harmonizes, and the patient resolves with slight sweating. Generally, vomiting syndromes vary, each having its own treatment method; however, Xiao Chaihu Tang is generally most appropriate. If there is fullness in the chest and hypochondrium accompanied by vomiting, and tidal fever occurs at dusk (Shen hour), Xiao Chaihu Tang plus Mangxiao (Natrii Sulfas) can be used. If vomiting persists, with urgency in the epigastrium and mild depression/irritability, Da Chaihu Tang (Major Bupleurum Decoction) should be given. If feces are dry and hard, Dahuang (Rhei Radix et Rhizoma) is added. Da Chaihu Tang is excellent for treating vomiting because it contains Zhishi (Aurantii Fructus Immaturus), which removes turbidity and suppresses deficient rebellious Qi. Dahuang must be removed. For the syndrome described in this clause, Guanju Jiegeng Tang (Official Bureau Platycodon Decoction) is best, which also utilizes Zhishi.

Dai Yuanli stated: In Yangming disease, even if there are obvious indications for purgation, if accompanied by frequent vomiting, it still belongs to the Upper Jiao and should not be purged hastily; Xiao Chaihu Tang is suitable. If only Taiyang syndrome symptoms are seen, or if there is vomiting and diarrhea, one should suspect phlegm-fluid retention in the intercostal region; treat initially with Erchen Tang (Two-Aged Decoction) to stabilize it. Wait until vomiting subsides, then slowly administer resolving medicines. If vomiting occurs first followed by thirst, Zhuling Tang (Polyporus Decoction) is indicated. If thirst occurs first followed by vomiting, this indicates water retention in the diaphragm; Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction) is used. If vomiting is accompanied by spitting of saliva and froth, Wuzhuyu Tang (Evodia Decoction) is used. Taiyin and Jueyin diseases occasionally present with vomiting. For Taiyin, Lizhong Tang (Regulate the Middle Decoction) is used; for Jueyin, Sini Tang (Frigid Extremities Decoction) is used, both with added Shengjiang (Fresh Ginger). The above Yin syndromes belong to "Yin within Yin" and require hot-natured formulas. When Yang enters the interior, it manifests as diarrhea rather than vomiting; vomiting belongs to the upper part and is closer to the exterior. Since Yang enters deeply into the interior, it results in diarrhea.

There are cases where Yang syndromes have just healed but vomiting occurs, with no other cause; this is residual heat lingering in the stomach region. Zhuyeshigu Tang (Bamboo Leaf and Meat Bone Decoction) or Jupi Zhuru Tang (Tangerine Peel and Bamboo Shaving Decoction) is appropriate.

Generally, vomiting arising from Taiyang disease implies a combined syndrome, meaning the pathogen is gradually entering the interior, not a pure Taiyang disease. Vomiting in Taiyang disease implies either combination with Yangming or Shaoyang. Such vomiting is due to heat, and warm-toning agents should be avoided.

In some cases, initial illness presents with Taiyang symptoms and vomiting, affecting all ages in a family similarly. Giving Yangwei Tang (Stomach-Nourishing Decoction) yields immediate results. This is due to the prevailing epidemic qi at that time, classifying it as a complicated Shaoyang disease, which cannot be judged solely by the rules of standard Shaoyang disease.

Li Zhongzi stated: Frequent vomiting indicates water-Qi stagnating in the Upper Jiao. Even if there are signs of Stomach excess, only Xiao Chaihu Tang should be used to circulate fluids. Mistakenly using purgation will inevitably lead to incessant diarrhea.

[Outline] Zhang Zhongjing stated: In Shaoyang disease with fever, absence of sweat, vomiting, inability to eat, yet profuse sweating occurs, this indicates the pathogen has transferred to Yangming.

[Commentary] Wang Kentang stated: Da Chaihu Tang is appropriate.

Tao Hua stated: "Ou" (vomiting/reflux) involves sound and matter being expelled simultaneously; "Tu" (spitting/vomiting forcefully) involves matter being expelled suddenly without sound. Comparing severity, Ou is worse than Tu. Mostly, exterior pathogens transmit to the interior, causing interior Qi to rebel upward, resulting in vomiting and inability to retain food and drink. If there is Stomach heat, with wiry-rapid pulse, bitter taste, irritability, thirst, and vomiting; if there is Stomach cold, with wiry-slow pulse, cold extremities, anorexia, free urination, and vomiting; if there is water-Qi retained in the diaphragm, with palpitations, thirst preceding vomiting; if there is pus and blood, with fishy odor in the throat, and Qi rushing upward—if untreated, spontaneous recovery occurs after expelling pus and blood. These four conditions must be distinguished.

Shen Jin'ao noted: The vomiting in this clause accompanies the inability to eat, indicating the Stomach was originally robust, differing from dry heaving (gan ou).

[Outline] Zhang Zhongjing stated: After sweating, vomiting, or purging, deficiency vexation (Xu Fan) occurs, leading to insomnia. If severe, the patient tosses and turns restlessly with inner annoyance (Ao Nan). Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) governs this. If there is shortness of breath, Zhi Zi Gancao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) governs. If there is vomiting, Zhi Zi Shengjiang Chi Tang (Gardenia, Fresh Ginger, and Fermented Soybean Decoction) governs.

[Commentary] Zhu Gong stated: Ancients often used Banxia (Pinelliae Rhizoma) and Shengjiang (Fresh Ginger) to treat vomiting. Sun Simiao said: "Shengjiang is the holy medicine for vomiting." Zhang Zhongjing uses it for all vomiting treatments. *Jin Gui Yao Lue* treats various vomitings where food cannot stay down; Xiaobanxia Tang (Minor Pinellia Decoction), Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction), and Xiaobanxia Jupi Tang (Minor Pinellia and Tangerine Peel Decoction) are selectable options. For vomiting with fever, Xiao Chaihu Tang is used. For vomiting with thirst, Zhuling Tang is used. For thirst preceding vomiting, it is water retention below the heart; Fuling Tang is used. If Shaoyin syndrome presents with vomiting, Zhenwu Tang (True Warrior Decoction) with Fuzi (Aconiti Lateralis Radix Praeparata) removed and Shengjiang added is used. For vomiting after Shaoyang disease resolution, with residual heat in the stomach, Zhuye Tang (Bamboo Leaf Decoction) with Shengjiang is used. If a patient suffers directly from vomiting accompanied by weak or painful legs, this is Hongxiangjiao (Hong Kong Foot / Beriberi), and should be treated as such.

Ke Qin stated: Deficiency vexation is a deteriorated state of Yangming disease. Shortness of breath and vomiting arise from deficiency vexation. Vexation injures Qi; add Gancao (Licorice Root) to tonify Qi. Deficient heat combats, likely causing vomiting; add Shengjiang to disperse pathogens.

[Outline] Zhang Zhongjing stated: In Yangming disease, hardness and fullness under the ribs, constipation, and vomiting, with a white coating on the tongue, indicate Xiao Chaihu Tang may be given. Once the Upper Jiao is unobstructed, fluids descend, Stomach Qi harmonizes, and the patient resolves with slight sweating. In Yangming disease, if there is paradoxical absence of sweat but free urination, and after two or three days, vomiting and coughing occur with cold extremities, headache will surely be severe. If there is no coughing or vomiting, and extremities are not cold, the head will not hurt.

[Commentary] Wei Litong stated: Hardness and fullness under the ribs are milder compared to the "chest and hypochondriac fullness persisting" mentioned in other clauses. Constipation with vomiting and a white tongue coating indicate Yangming Stomach excess, yet the pathogen has transferred to Shaoyang. Among these symptoms, only constipation represents pure Yangming; the rest are symptoms of Shaoyang-Yangming combination. However, they all represent a transition toward Shaoyang that is not yet fully formed. Administering Xiao Chaihu Tang employs harmonization, allowing the pure Yang pathogen to exit via Shaoyang, preventing Stomach excess and resolving the Yangming condition.

After two or three days, Cold pathogen lingers briefly in Yangming before transforming into Heat, rising counterflow like Yang pathogen, causing vomiting and coughing. However, it lacks the intensity of pure Yang pathogen, so there is coughing without sore throat. It carries the stagnation of Yin pathogen, hence the vomiting.