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Vomiting is primarily treated with Banxia (Pinelliae Rhizoma), Jupi (Citri Reticulatae Pericarpium), and Shengjiang (Zingiberis Rhizoma Recens). Hejian (Liu Wansu) considered vomiting to be caused by the upward reversal of Fire Qi, which is merely one aspect. For cases where there is Heat in the Stomach and Phlegm-Dampness on the Diaphragm, Erchen Tang (Two-Cured Decoction) should be added with Chao Shanzhi (Stir-fried Gardenia Fruit), Huanglian (Coptidis Rhizoma), and Shengjiang (Zingiberis Rhizoma Recens). For chronic vomiting due to prolonged illness, it indicates Stomach Deficiency failing to receive food; Ren Shen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Wei Jiang (Prepared Ginger) should be used. For cases where Phlegm obstructs the Middle Jiao preventing food from descending; for cases of rebellious Qi; for cases where Cold Qi is constrained at the Stomach opening; for cases where Qi stagnation occurs between the Heart and Lungs, causing newly ingested food to regurgitate instead of descending; for cases where Stomach Fire combines with Phlegm to cause vomiting; for cases of massive vomiting with thirst desiring water, drinking Tongbian (Child's Urine) is most effective. It is generally contraindicated to use purgatives for vomiting, which refers to the common scenario. However, if Heat accumulation in the Large Intestine, Small Intestine, or Bladder causes obstruction leading to upward vomiting and food blockage, without using purgatives to open and vent the pathogen, how can vomiting cease? Generally, for Excess-Heat in the Upper Jiao, clearing and draining are appropriate; for stagnation in the Middle, resolving and guiding downward are appropriate; for extreme Deficiency causing dizziness and vomiting, tonification is appropriate; for Deficiency-Cold in the Lower Jiao failing to accept food and drink, warming and tonifying are especially crucial and must not be mistaken.

Ancients attributed "Ou" (vomiting with sound) to the Yangming Channel, which has abundant Qi and Blood, hence having both sound and matter, indicating disease in both Qi and Blood. "Tu" (spitting/regurgitation without sound) was attributed to the Taiyang Channel, which has abundant Blood but scarce Qi, hence having matter but no sound, indicating disease in Blood alone. "Yue" (hiccup/belching) was attributed to the Shaoyang Channel, which has abundant Qi but scarce Blood, hence having sound but no matter, indicating disease in Qi alone. Only Dongyuan (Li Gao) believed that Ou, Tu, and Yue all belong to Spleen-Stomach Deficiency, whether caused by Cold Evil invading or dietary injury, leading to upward rebellion and failure to descend. Jiegu Laoren further differentiated the three causes—Qi, Accumulation, and Cold—from the perspective of the Three Jiao. When Evil affects the Yang of the Upper Wan (Upper Epigastrium), Qi stagnates and Water accumulates; the clear and turbid nature of drinks becomes chaotic, transforming into Phlegm, Yin (Fluid Retention), Xian (Saliva), and Tuo (Spittle), eventually becoming Ou. When Evil affects the Yin of the Upper Wan, Blood stagnates and Grain fails to digest; the clear and turbid nature of food is indistinguishable, transforming into Ye (Choking), Han (Cold), Pi (Fullness), Man (Distension), Tong (Pain), and Zhang (Bloating), eventually becoming Tu. When Evil affects the Qi intersection at the Middle Wan (Middle Epigastrium), it encompasses diseases of both Wan regions and should be differentiated by the Three Jiao regarding Qi, Accumulation, and Cold. The Upper Jiao is above the stomach opening, connecting to Heaven Qi, governing reception without expulsion. The Middle Jiao is at the Middle Wan, connecting to Heaven Qi above and Earth Qi below, governing the ripening and rotting of food and drink. The Lower Jiao is below the umbilicus, connecting to Earth Qi, governing expulsion without reception. Therefore, vomiting from the Upper Jiao stems from Qi; Qi is the Yang of Heaven. The pulse is floating and surging; symptoms include immediate vomiting after eating and thirst desiring water; treatment should focus on descending Qi and harmonizing the Middle. Vomiting from the Middle Jiao stems from Accumulation, involving both Yin and Yang, with Qi and Food intermingling; the pulse is floating and wiry; symptoms may include pain before vomiting or vomiting before pain; treatment should focus on removing Accumulation and harmonizing Qi. Vomiting from the Lower Jiao stems from Cold, which is the Earth Path; the pulse is large and slow; symptoms include morning food vomited in the evening or evening food vomited in the morning, with clear urine and constipation; treatment should focus on unblocking obstruction and warming Cold.

Later generations further distinguished: vomiting immediately after eating is called Ou (Sha means a moment; food is vomited out as soon as it enters the mouth). Vomiting upon swallowing is called Bao Tu (Food is vomited out as soon as it goes down the throat). Vomiting after a long time is called Fan Wei (Food stays in the stomach for a long time; the Stomach fails to separate clear from turbid and transform essence, so it reverses and comes out). Vomiting upon re-eating is called Fan Wei (First meal is not vomited; second meal is vomited directly from the lower exit of the Stomach, churning upwards). Morning food vomited in the evening, evening food vomited in the morning (Food accumulates for six hours before being vomited; this is a Lower Jiao disease). Among these symptoms, the faster the vomiting, the higher the lesion; the slower the vomiting, the lower the lesion. Ancient formulas universally used Banxia and Shengjiang as the primary agents. Only Dongyuan stated that Shengjiang stops vomiting, treating only Exterior Excess and Qi congestion. If Stomach Deficiency leads to failed Grain Qi movement, one must only tonify the Stomach and promote Grain Qi. Thus, those who do not improve with Xiao Banxia Tang (Minor Pinellia Decoction) will recover immediately with Da Banxia Tang (Major Pinellia Decoction). Cases with Cold show preference for heat and aversion to cold, with cold limbs and small pulse; cases with Heat show preference for cold and aversion to heat, with dryness, thirst, and surging pulse; cases with Qi stagnation show distension and obstruction; cases with Phlegm-Fluid manifest upon exposure to cold; cases with Food Accumulation require resolution and guidance to find relief. If vomiting persists despite various medicines, heavy sedatives must be borrowed to weigh it down (such as Lingsha Dan or Yangzheng Dan). If vomiting is accompanied by long-term Middle Qi Deficiency, grain foods must be borrowed to harmonize it (use Baizhu stir-fried until black, Chenpi, Fuling, Banxia, Gancao, Chencangmi, Yiyiren, Guyabo, sipping aged rice water frequently). Wind-Evil affecting the Upper Jiao closes the Couli (pores), disrupting Meridian Qi pathways, with Evil lodging internally, causing vomiting followed by diarrhea, body heat, and abdominal stuffiness, named Louqi. Excess-Heat in the Lower Jiao causes obstruction of urination and defecation, rebellious Qi failing to continue, uncontrollable vomiting and counterflow, named Zoubu. Dry heaving with rebellious Qi, nausea with bitter Stomach damage and bitter vomiting, with Evil in the Gallbladder Channel, and sour vomiting, are blamed on Liver Disease. Vomiting clear water often indicates Qi Deficiency. Vomiting roundworms indicates Stomach Cold. One must carefully distinguish the cause before prescribing according to the syndrome.

Vomiting damages Body Fluids to exhaustion; do not mistakenly identify it as a Fire-Heat disease and administer cooling medicines, as the harm is significant. Because Grain Qi has been deficient for a long time, Empty Heat arises in the Chest, triggering vomiting and hiccup; obtaining the Yin of Five Grains to harmonize it will naturally stop the vomiting. Administering Acrid-Warm medicines will increase dryness and heat. Administering strange-flavored medicines will burden the weak Stomach. Only if there is red face, aversion to heat, irritability, desire to drink, surging-slippery pulse, or wiry-rapid pulse, does it belong to Fire Disease. Those prone to vomiting should take more Shengjiang, which is the holy medicine for vomiting. For rebellious Qi, dispersing is necessary, hence Shengjiang is primary. For Stomach Deficiency failing to move Grain Qi, tonify the Stomach with Renshen and Baizhu to promote Grain Qi. Preference for heat, aversion to cold, cold and chilly limbs, and slow-small-weak pulses indicate Cold Injury; use Erchen Tang plus ten Dingxiang (Caryophylli Flos); if severe, Fuzi Lizhong Tang, taken cold. Cold meeting cold allows mutual entry, preventing vomiting. Heat vomiting results in early ejection of food, preference for cold, aversion to heat, irritability, thirst, rapid-surging pulse; use Erchen Tang plus Huanglian stir-fried with ginger, Zhizi stir-fried black, Pipaye roasted, Zhuru, Gegen, Shengjiang, administered with Luzhigen (Reed Rhizome) juice. If smelling grain triggers vomiting and medicine is also vomited up, and the pulse is surging, use Luzhigen juice to treat Heat. Red face, dry mouth, headache, nausea, irritability belonging to Wine Toxicity should be cooled and restrained; use Erchen Tang plus Huanglian stir-fried with ginger, Zhizi, Ziye, Gegen, taken hot for efficacy. Vomiting roundworms due to severe Stomach Cold causes Hui Jue (Roundworm Colic) leading to vomiting; if various medicines fail and there are no other symptoms, it is because roundworms disturb between the Chest and Diaphragm, moving upon seeing medicine, thus rejecting medicine while the worm remains; treatment should focus on expelling roundworms, adding Chuanjiao to subdue them or Wumei to pacify them. Vomiting sour or green water with wiry-tight pulse extending to the Cun position indicates Liver Fire rebelling upward; use Erchen Tang plus Wuzhuyu, Huanglian stir-fried, Chaihu. No sound, no matter, feeling like vomiting but unable to, feeling like retching but unable to, though called Nausea, is actually not a Heart Channel disease, but Phlegm-Fluid pathology at the Stomach opening; use Erchen Tang or Liujunzi Tang, ensuring ample Shengjiang to open the Stomach, descend Qi, and resolve Phlegm. For severe cases, Lizhong Tang. To treat acidity, Wuzhuyu (steeped in decoction for half a day after removing stem) must be the Sovereign herb, assisted by Erchen Tang or Pingwei San. For Qi Depression, add Xiangfu; for Heat Accumulation, add Huanglian and Zhizi stir-fried; strictly avoid rich flavors, rely on vegetable diet for self-nourishment, then the disease will easily settle; this disease should be treated by following its nature, not with Cold-Cooling herbs. Dongyuan used entirely Warm medicines; Danxi used Huanglian but also combined it with Wuzhuyu and Cangzhu, because Heat promotes movement, Fire prosperity strengthens Spleen transportation. Those prone to vomiting should avoid Gualou (Trichosanthis Fructus), Xingren (Armeniacae Semen Amarum), Laifuzi (Raphani Semen), Zhizi, Suzi; all oily medicines can offend the Stomach and induce vomiting, except in pills where aromatic-warm dispersing agents are acceptable. Weak pulse with vomiting, free urination, slight body heat, and appearance of Jue (cold extremities) indicates death. Vomiting with severe pain, material resembling green vegetable leaves, indicates death.

Regarding the symptom of Yue, ancient identifications varied. Some identified Ke Ni (coughing against reverse flow) as Yue; some identified E Ni (hiccup) as Yue; some identified Gan Ou (dry heaving) as Yue; none are accurate diagnoses. Ke Ni is a Lung disease where Fire attacks Metal. E Ni, commonly known as Leng Ye, involves head shaking and shoulder shrugging when sound occurs; it belongs to Stomach Cold blocking Yang Qi preventing dissemination, or Phlegm on the Diaphragm constrained by Anger, where Phlegm-Heat struggle prevents Qi descent; both are Stomach diseases. It can also belong to Extreme Cold in the Lower Jiao forcing Fire upward, with Qi rushing straight from below the umbilicus to between the Chest and Throat; this is a Yin Syndrome. Gan Ou involves opening the mouth loudly, caused by Dry-Heat Qi rushing into Yangming, with rebellious Qi ascending. As for Yue itself, it produces a repetitive sound, resembling nausea with sound, or dry heaving with smaller sound; it mostly occurs in critical conditions of chronic illness where Yin and Yang separate. Thus, the Classics state: deep disease inevitably manifests Yue; it mostly belongs to Stomach Deficiency-Cold, occasionally Phlegm or Heat, but more often arises when Yin Qi is exhausted. Yang Fire lacks root, floating in the Chest; Upper Jiao Yang Qi is insufficient to defend, allowing Dragon-Lei Yin Fire to rush and rebel, thus its manifestation belongs to the Stomach, but its origin lies in the Kidney. Middle Jiao Yue-Ni has short sounds, indicating Grain-Water disease, Stomach Fire, easy to treat. Lower Jiao Yue-Ni has long sounds, indicating Deficient Evil disease, Yin Fire, difficult to treat. Frequent, continuous Yue sounds indicate Excess, treatable. One Yue sound every ten hours indicates Deficiency, difficult to treat. Sudden onset of Yue in acute disease must be due to Phlegm, Food, or Blood disturbance, or Anger interference; these are easy-to-treat diseases. Gradual onset of Yue in chronic disease, such as Shanghan (Cold Damage), Xiali (Dysentery), Postpartum, or Xulao (Consumption), are difficult-to-treat diseases. Between Excess/Deficiency and Cold/Heat, treatment methods differ significantly. Why do ancient formulas generally use Dingxiang Shidi San (Cloves and Date Pit Powder) as the main formula for treating Yue? This medicine cannot clear Qi and benefit Phlegm, cannot tonify Deficiency and descend Fire, and lacks strong power; how can it uniformly govern this disease?