甲、概况
饮食入胃而上泛回出者谓之吐，吐又有呕吐哕三者之别。呕
者，吐之有声有物者；吐者，吐之无声有物者；哕者，吐之有声无物者。呕与吐常相连属，往往初起为吐，吐
将尽则继之以呕者。其证有虚有实，而哕则常由于虚，纵或挟实，不过挟痰挟火，虚多而实少者也。进而至于
无声无物之干恶心，为胃腑气血两伤，小儿难治之证也。今先言呕，食入即呕，刻不能容，其势疾，其声壮，
呕黄水而味酸苦者热也。盖胃中有火，不能容食，驱逐上行，非倾吐不完不止，因动肝火而气逆犯胃者亦如之。
食入能容，渐泛而作呕，其势缓，其声壮者，虚实参半也。盖胃虚谷气不行，火复乘之上逆有以致之。水到食
管即呕，或呕而由胃底肠中翻出者虚也。盖到咽即呕为气虚不能载物，由肠胃翻出而呕，为脾胃虚弱不能运
化，有以致之。此呕之一类也。次再言吐，吐而食物不化，吐而酸臭触鼻者，是为伤食；吐而出水饮痰
涎，是为停饮蓄痰；吐而面唇青白，清涎夹乳，是为感寒；吐而直冒酸臭，烦怒多啼，是为挟热。此吐之一
类也。然呕吐多相连属，故其因可互相参看也。至于呕吐之起源，多由小儿乳食不化，或露腹受寒，或触秽
感热所致。其有突然呕吐，一起即困倦自汗者，则由胃气久伤，病因早种所致。久吐不愈，若不由于胃
气耗伤，必因痰湿水饮，蓄滞不行，阻其饮食消化之路，郁蒸所致。哕之起源，虽有气滞、痰滞、饮滞、食滞
数因，而其本多由胃虚气弱，不能上达所致。干恶心之起源，多由呕哕经久，胃气益伤所致。乳食亏缺，大病
之后，亦均足致此。总之，胃为后天之本，水谷之海，久病不愈，必至养生之源，竭绝莫挽，固在心
存保赤者之未雨绸缪也。
乙、治法
呕之初起，宜用小半夏汤治之。暴呕挟有胃火者，酌加黄连；挟有痰气者，酌加竹茹；呕而口渴者，酌
加芦根；呕出酸水苦水挟有肝火者，酌加左金丸；呕出清水而口渴，水入又呕者，
酌加五苓散；呕而兼吐食者，酌加陈皮、神曲之属；因虫扰而呕
者，酌加黄连、川椒之属，或用乌梅丸以安之；呕之虚实参半者，其势虽缓，然常时止时作，宜补胃调中，用
大半夏汤和之；胃阳虚而浊阴上逆者，先用逍遥散疏其郁，继用人参、白术、山药之属以补之；脾胃虚弱，不
能运化，致水到咽辄呕，或由胃底肠中倾翻而出，宜六君子汤加砂仁、炮姜或加荜澄茄、肉桂之属；
肝阴胃液，两皆虚耗，服热药呕虽暂止而愈发愈剧，舌苔剥者，宜滋液养胃，熄风镇逆，用六味地黄丸加扁
钗斛、石决明、滁菊、西洋参之属。吐之初起，常由伤食，治宜消积行滞。吐而食
物不化者，宜二陈汤加山楂（消肉积）、麦芽（消米麦积）、神曲（消痰食胶结之积）、枳实、川朴（消痰湿
胶结之积）之属；吐而夹水夹痰者，宜平胃散加半夏、茯苓之属。凡感寒而吐，有腹痛吐清涎等证象者，治
宜祛寒化积，用紫苏、煨姜、橘红、白豆蔻、半夏、木香、白术之类。凡挟热而吐，有恶食、烦怒等证
象者，治宜清热降气，用黄连、生姜、神曲、枳实、青皮、大黄之类。凡触秽而吐，有昏闷、口臭等证象者，
治宜芳香化浊，用藿香、佩兰、浓朴、白芷、菖蒲、神曲、香豆豉之类（夏月胃气疲弱者多见之）。突然呕
吐，困倦自汗，胃气暴伤者，治宜附子理中汤多加白术，此为吐证之重者，宜急救勿缓。至于常年呕吐，
按时而发，谓之反胃，在乳哺之小儿为绝少，童年或间有之。治法大致分寒热虚三种∶寒反胃者呕青手足冷，
宜二陈汤加丁香、附子、干姜、肉桂之属；热反胃者呕酸苦，面红手足热，宜二陈汤加黄芩、黄连之属；虚
反胃者，呕宿食不化，脉软无力，宜四君子汤或四物汤之属，而随证应变，又可合呕吐之治法以参看者
也。哕之治法∶声高有力而连属者，属热，可下；声低力怯而不上达者，属寒，宜温。通治之法，总宜调其
胃气，若偶被冷风所吹而作呃逆者，此属于外因，稍饮热汤，气定自愈，可不必服药。干恶心之治法，宜用
橘红煎服，入姜汁、白蜜，细细呷之，以滋润之。胃热者加川连、竹茹；胃寒者加炮姜；胃虚者加人
参；气逆者加吴萸。总之，凡治呕吐，当其初起泛恶之时，宜引而吐之，以去其滞，吐后方用药安之，则胃
气不伤。久呕不止，必加镇重之药以坠之。中气久虚，必借谷食以和之，或饴糖、白蜜以润之，忌用有油之物
如桃仁、杏仁、栝蒌、莱菔子、山栀（其有不得不用者亦在所不禁）之属。此皆不可不知也。
附方
（一）小半夏汤 治支饮痰积膈上，喘嗽呕哕。
半夏 生姜
（二）左金丸 治肝火燥盛，左胁作痛，吞酸呕吐，筋疝痞
结，一切肝火之证，并治霍乱转筋，火邪内炽，及噤口痢，饮食入口即吐者。
川黄连（六两） 吴茱萸（盐水泡，一两）
共为末，水泛为丸，每服一二钱。
（三）乌梅丸 治蛔厥，吐蛔，久痢。
乌梅 细辛 桂枝 附子 人参 黄柏 干姜 黄连 蜀椒 当归
（四）大半夏汤 治反胃呕吐。
半夏 人参 白蜜
（五）逍遥散 见第六章第四节。
（六）六君子汤 见第五章第三节。
（七）六味地黄丸 见第三章第五节。
（八）二陈汤 见第六章第三节。
（九）平胃散 见第六章第三节。
（十）附子理中汤 见第五章第四节。
（十一）四君子汤 见第三章第五节。
（十二）四物汤 见第三章第五节。
（十三）五苓散 见第三章第五节。
A. Overview
When food enters the stomach and regurgitates upwards, it is termed "Tu" (Vomiting). Tu is further differentiated into three types: Ou (Retching/Vomiting with sound), Tu (Vomiting without sound), and Yue (Hiccups/Retching with sound but no substance). "Ou" refers to vomiting accompanied by both sound and expelled matter; "Tu" refers to vomiting with expelled matter but no sound; "Yue" refers to retching or hiccups with sound but no expelled matter. "Ou" and "Tu" are often interconnected; typically, the condition begins as "Tu," and as it subsides, it transitions into "Ou." These syndromes can be either Deficient (Xu) or Excess (Shi). However, "Yue" usually stems from Deficiency; even when complicated by Excess patterns, it is merely due to Phlegm-Dampness or Fire, generally characterized by more Deficiency than Excess. Progressing to dry nausea without sound or substance indicates injury to both Qi and Blood of the Stomach organ, a difficult-to-treat syndrome in children.
First, let us discuss "Ou": Immediate vomiting after eating, where food cannot be retained for even a moment, indicates an urgent condition with loud sounds. Vomiting yellow fluid with a sour and bitter taste signifies Heat. This occurs because Fire in the Stomach cannot accommodate food, forcing it upward until fully expelled. Similar mechanisms apply when Liver Fire moves, causing Qi rebellion invading the Stomach. If food is temporarily retained but gradually rises to cause vomiting, with a slow progression but loud sounds, this represents a mixed pattern of Deficiency and Excess. This results from weak Stomach Qi failing to transport Grain Qi, allowing Fire to ascend and rebel. Vomiting immediately upon water reaching the esophagus, or vomitus surging up from the bottom of the stomach or intestines, indicates Deficiency. Vomiting at the throat suggests Qi Deficiency unable to carry substances; vomiting from the stomach/intestine base suggests Spleen-Stomach weakness failing to transform and transport. This constitutes one category of "Ou."
Next, we discuss "Tu": Vomiting undigested food with a pungent, sour-rotten odor indicates Food Retention (Shang Shi). Vomiting clear fluids, phlegm, and saliva indicates Fluid Retention and Phlegm Accumulation (Ting Yin Xu Tan). Vomiting with cyanotic pale lips and face, mixed with clear saliva and milk, indicates Cold Invasion (Gan Han). Vomiting with direct emission of sour-rotten odors, accompanied by irritability, anger, and excessive crying, indicates Heat Complication (Xie Re). This constitutes one category of "Tu." Since "Ou" and "Tu" are often linked, their etiologies can be cross-referenced.
The origins of vomiting and retching mostly stem from infants' inability to digest breast milk or food, exposure of the abdomen to cold, or contact with turbid pathogens and Heat. Sudden vomiting accompanied by immediate fatigue and spontaneous sweating indicates long-term damage to Stomach Qi, where the pathogenic factor was latent from the beginning. Chronic vomiting that fails to resolve, if not due to Stomach Qi exhaustion, must be caused by Phlegm-Dampness and Fluids accumulating and stagnating, obstructing digestion and causing郁蒸 (stagnant steaming). The origin of "Yue," although involving Qi stagnation, Phlegm stagnation, Fluid stagnation, or Food stagnation, fundamentally stems from weak Stomach Qi and deficiency, preventing Qi from ascending. Dry nausea originates from prolonged "Ou" and "Yue" further injuring Stomach Qi, or from nutritional deficiency and post-major illness states. In summary, the Stomach is the Root of Post-Heaven and the Sea of Water and Grain. Prolonged illness leads to the exhaustion of the source of nourishment, which is irreversible. Therefore, pediatricians must take preventive measures (Wei Yu Chou Mou) to protect the child.
B. Treatment Methods
For early-stage "Ou," Xiao Ban Xia Tang (Minor Pinellia Decoction) is appropriate. For acute vomiting complicated by Stomach Fire, add Huang Lian (Coptis Rhizome); for Phlegm-Qi complication, add Zhu Ru (Bamboo Shavings); for vomiting with thirst, add Lu Gen (Reed Rhizome); for vomiting sour/bitter fluids with Liver Fire, add Zuo Jin Wan (Left Metal Pill); for vomiting clear fluid with thirst, where drinking water triggers immediate vomiting, add Wu Ling San (Five-Ingredient Powder with Poria). For vomiting accompanied by food expulsion, add Chen Pi (Tangerine Peel) and Shen Qu (Medicated Leaven). For vomiting caused by intestinal parasites, add Huang Lian and Chuan Jiao (Sichuan Pepper), or use Wu Mei Wan (Mume Pill) to calm the parasites. For mixed Deficiency-Excess "Ou," which is slow but intermittent, tonify the Stomach and harmonize the Middle using Da Ban Xia Tang (Major Pinellia Decoction). For Stomach Yang Deficiency with Turbid Yin rebelling upward, first use Xiao Yao San (Free and Easy Wanderer Powder) to soothe depression, followed by Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), and Shan Yao (Dioscorea Rhizome) to tonify. For Spleen-Stomach weakness failing to transform, causing vomiting upon water reaching the throat or surging from the stomach base, use Liu Jun Zi Tang (Six-Gentleman Decoction) plus Sha Ren (Amomum Fruit), Pao Jiang (Prepared Ginger), Bi Cheng Qie (Long Pepper Fruit), or Rou Gui (Cinnamon Bark). For simultaneous depletion of Liver Yin and Stomach Fluids, where hot medicines temporarily stop vomiting but worsen the condition, accompanied by peeled tongue coating, nourish fluids, tonify the Stomach, extinguish Wind, and suppress rebellion using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Bian Chai Hu (or similar orchid rhizomes), Shi Jue Ming (Abalone Shell), Chu Ju (Chrysanthemum), and Xi Yang Shen (American Ginseng).
For early-stage "Tu," often caused by Food Retention, treatment should focus on resolving accumulation and promoting stagnation resolution. For vomiting undigested food, use Er Chen Tang (Two-Aged Decoction) plus Shan Zha (Hawthorn Fruit, for meat retention), Mai Ya (Barley Sprout, for grain retention), Shen Qu (for phlegm-food binding), Zhi Shi (Immature Bitter Orange), and Hou Po (Magnolia Bark, for phlegm-damp binding). For vomiting with water-phlegm complications, use Ping Wei San (Peaceful Stomach Powder) plus Ban Xia (Pinellia Tuber) and Fu Ling (Poria). For vomiting due to Cold invasion with abdominal pain and clear saliva, dispel Cold and resolve accumulation using Zi Su (Perilla Leaf), Wei Jiang (Roasted Ginger), Ju Hong (Red Tangerine Peel), Bai Dou Kou (White Cardamom), Ban Xia, Mu Xiang (Aucklandia Root), and Bai Zhu. For vomiting with Heat complications like anorexia and irritability, clear Heat and descend Qi using Huang Lian, Sheng Jiang (Fresh Ginger), Shen Qu, Zhi Shi, Qing Pi (Green Tangerine Peel), and Da Huang (Rhubarb Root). For vomiting due to turbid pathogens with dizziness and foul breath, resolve turbidity with aromatic herbs using Huo Xiang (Patchouli), Pei Lan (Agastache), Nong Po (likely Hou Po), Bai Zhi (Angelica Dahurica), Chang Pu (Acorus Rhizome), Shen Qu, and Xiang Dou Chi (Fermented Soybean). This pattern is common in summer among those with weak Stomach Qi.
Sudden vomiting with fatigue and spontaneous sweating, indicating acute Stomach Qi injury, requires Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) with increased Bai Zhu. This is a severe vomiting syndrome requiring urgent rescue. Chronic vomiting occurring at fixed times is termed Fan Wei (Reverse Stomach/Regurgitation). It is rare in nursing infants but occasional in childhood. Treatments are divided into Cold, Heat, and Deficiency types: Cold Fan Wei presents with vomiting green fluid and cold extremities; treat with Er Chen Tang plus Ding Xiang (Clove), Fu Zi (Aconite), Gan Jiang (Dried Ginger), and Rou Gui. Heat Fan Wei presents with sour/bitter vomiting, red face, and warm extremities; treat with Er Chen Tang plus Huang Qin (Scutellaria Root) and Huang Lian. Deficiency Fan Wei presents with vomiting undigested food and a soft, powerless pulse; treat with Si Jun Zi Tang (Four-Gentleman Decoction) or Si Wu Tang (Four-Substance Decoction), adjusting according to symptoms and referencing vomiting treatments.
Treatment for "Yue": Loud, forceful, continuous sounds indicate Heat, suitable for purgation. Low, weak, non-ascending sounds indicate Cold, suitable for warming. The general method always involves regulating Stomach Qi. If hiccups are caused by accidental exposure to cold wind (external factor), sipping hot water may settle the Qi and cure the condition without medication.
Treatment for dry nausea: Use Ju Hong decoction with Jiang Zhi (Ginger Juice) and Bai Mi (White Honey), sipped slowly to moisten. Add Chuan Lian (Huang Lian) and Zhu Ru for Stomach Heat; add Pao Jiang for Stomach Cold; add Ren Shen for Stomach Deficiency; add Wu Zhu Yu (Evodia Fruit) for Qi rebellion.
In summary, for early vomiting with nausea, induce vomiting to remove stagnation, then use medicine to settle the Stomach Qi to prevent injury. For chronic persistent vomiting, add heavy-settling herbs to descend rebellious Qi. For chronic Middle Qi Deficiency, harmonize with grain foods or moisten with Yi Tang (Maltose) and Bai Mi. Avoid oily seeds like Tao Ren (Peach Kernel), Xing Ren (Apricot Kernel), Gua Lou (Trichosanthes Fruit), Lai Fu Zi (Radish Seed), and Shan Zhi (Gardenia Fruit) (unless absolutely necessary). These principles must be known.
Attached Formulas
(1) Xiao Ban Xia Tang (Minor Pinellia Decoction): Treats Branch-Fluid and Phlegm Accumulation above the Diaphragm, causing wheezing, coughing, vomiting, and hiccups.
Ingredients: Ban Xia, Sheng Jiang.
(2) Zuo Jin Wan (Left Metal Pill): Treats excessive Liver Fire causing left hypochondriac pain, acid regurgitation, vomiting, tendon spasms, masses, all Liver Fire syndromes, Cholera with tendon twitching, internal blazing Fire, and Jing Kou Li (Anorexic Dysentery) where food is vomited immediately upon entry.
Ingredients: Chuan Huang Lian (6 liang), Wu Zhu Yu (soaked in salt water, 1 liang).
Preparation: Grind into powder, form pills with water. Dosage: 1-2 qian per dose.
(3) Wu Mei Wan (Mume Pill): Treats Hui Jue (Roundworm Convulsion), vomiting roundworms, and chronic dysentery.
Ingredients: Wu Mei, Xi Xin, Gui Zhi, Fu Zi, Ren Shen, Huang Bo, Gan Jiang, Huang Lian, Shu Jiao, Dang Gui.
(4) Da Ban Xia Tang (Major Pinellia Decoction): Treats Fan Wei and vomiting.
Ingredients: Ban Xia, Ren Shen, Bai Mi.
(5) Xiao Yao San: See Chapter 6, Section 4.
(6) Liu Jun Zi Tang: See Chapter 5, Section 3.
(7) Liu Wei Di Huang Wan: See Chapter 3, Section 5.
(8) Er Chen Tang: See Chapter 6, Section 3.
(9) Ping Wei San: See Chapter 6, Section 3.
(10) Fu Zi Li Zhong Tang: See Chapter 5, Section 4.
(11) Si Jun Zi Tang: See Chapter 3, Section 5.
(12) Si Wu Tang: See Chapter 3, Section 5.
(13) Wu Ling San: See Chapter 3, Section 5.