〔洁〕论曰∶吐有三，气、积、寒也，皆从三焦论之。上焦在胃口，上通天气，主内而不出；中焦在中脘，
上通天气，下通地气，主腐熟水谷；下焦在脐下，下通地气，主出而不纳。是故上焦吐者，皆从于气。气者，
天之阳也，其脉浮而洪，其症食已暴吐，渴欲饮水，大便燥结，气上冲胸而发痛，其治当降气和中。中焦吐者，
皆从于积，有阴有阳，食与气相假为积而痛，其脉浮而弦，其症或先痛而后吐，或先吐而后痛，治法当以小毒
药去其积，槟榔、木香和其气。下焦吐者，皆从于寒，地道也，其脉大而迟，其症朝食暮吐，暮食朝吐，小便
清利，大便秘而不通，治法宜毒药通其闭塞，温其寒气，大便渐通，复以中焦药和之，不令大腑结闭而自安也。
上洁古论三焦吐，其说盖本于黄帝。所谓气为上膈，食饮入而还出为下膈，食 时乃反出之。其上焦食
已暴吐者，今世谓之呕吐也。中下二焦朝食暮吐、暮食朝吐者，今世谓之膈气反胃也。分呕吐膈气为二门。
〔垣〕夫呕、吐、哕者，俱属于胃。胃者，总司也。以其气血多少为异耳。且如呕者，阳明也，阳明多血
多气，故有声有物，气血俱病也。仲景云∶呕多虽有阳明症，慎不可下。孙真人云∶呕家多服生姜，乃呕吐之
圣药也。气逆者必散之，故以生姜为主。吐者太阳也，太阳多血少气，故有物无声，乃血病也。有食入则吐，
有食已则吐，以陈皮去白主之。哕者，少阳也，少阳多气少血，故有声无物，乃气病也。以姜制半夏为主。故
朱奉议治呕吐哕，以生姜、半夏、陈皮之类是也。究其三者之源，皆因其脾虚弱，或因寒气客胃，加之饮食所
伤而致也。宜以丁香、藿香、半夏、茯苓、陈皮、生姜之类主之。（按哕《内经》实指呃逆、今先贤误释为
干呕者，非也。）若但有内伤而有此疾，宜察其虚实，使内消之。痰饮者必下之，当分其经，对证用药，不
可乱也。
[Zhang Yuansu] discusses: There are three types of vomiting, namely Qi (vital energy), accumulation (food stagnation), and Cold. All should be analyzed from the perspective of the Sanjiao (Triple Burner). The Upper Jiao is located at the stomach opening, connects upward with Heaven Qi, and is responsible for receiving but not discharging. The Middle Jiao is located at Zhongwan (CV12), connects upward with Heaven Qi and downward with Earth Qi, and is responsible for rotting and ripening food and fluids. The Lower Jiao is located below the umbilicus, connects downward with Earth Qi, and is responsible for discharging but not receiving. Therefore, vomiting originating from the Upper Jiao is always due to Qi dysfunction. Qi belongs to the Yang of Heaven; its pulse is floating and surging. Symptoms include sudden violent vomiting after eating, thirst with desire to drink water, dry and constipated stool, Qi rushing upward to the chest causing pain. Treatment should focus on descending Qi and harmonizing the Middle Jiao. Vomiting originating from the Middle Jiao is always due to accumulation, which can be Yin or Yang type. Food and Qi intertwine to form accumulation causing pain. Its pulse is floating and wiry. Symptoms include either pain followed by vomiting, or vomiting followed by pain. Treatment should use mildly toxic drugs to remove the accumulation, and use Areca Seed (Binglang) and Costus Root (Muxiang) to regulate Qi. Vomiting originating from the Lower Jiao is always due to Cold, belonging to the Earthly path (Yin). Its pulse is large and slow. Symptoms include vomiting food eaten in the morning in the evening, or food eaten in the evening in the morning; clear and profuse urination; and constipation without passage of stool. Treatment should appropriately use purgative drugs to open blockages, warm and dispel Cold. Once stool gradually passes, use formulas for the Middle Jiao to harmonize, preventing excessive closure of the Large Intestine so that the body may rest naturally. The above cites Jiegu’s (Zhang Yuansu’s) discussion on Sanjiao vomiting; his theory is likely based on the Huangdi Neijing (Yellow Emperor's Inner Canon). What he calls "Qi" causing Upper Ge (dysphagia/choking), where food enters and immediately returns out, is Lower Ge (regurgitation); food taken in is only regurgitated later. The Upper Jiao case of sudden violent vomiting after eating is what is now called Ou Tu (vomiting). The cases of Morning Food Evening Vomiting and Evening Food Morning Vomiting from the Middle and Lower Jiao are what is now called Ge Qi (diaphragmatic qi stagnation) or Fan Wei (reverse flow of the stomach). Thus, Ou Tu and Ge Qi are divided into two categories.
[Li Dongyuan] states: Ou (retching), Tu (vomiting), and Yue (hiccups/dry heaving) all belong to the Stomach. The Stomach is the general manager of these functions. They differ only in the abundance or scarcity of Qi and Blood. For instance, Ou belongs to the Yangming channel, which has abundant Blood and Qi; thus, there is both sound and material expelled, indicating disease in both Qi and Blood. Zhang Zhongjing said: "If there is frequent vomiting, even if Yangming symptoms exist, one must be cautious and never use purgation." Sun Simiao said: "Patients with vomiting should take fresh ginger frequently; it is the holy medicine for vomiting." When Qi rebels, it must be dispersed; therefore, fresh ginger is used as the chief drug. Tu belongs to the Taiyang channel, which has abundant Blood but scarce Qi; thus, there is material expelled but no sound, indicating disease in the Blood. Some vomit immediately upon eating; some vomit after finishing eating. Tangerine Peel (Chenpi, removed white pith) is used as the chief drug. Yue belongs to the Shaoyang channel, which has abundant Qi but scarce Blood; thus, there is sound but no material expelled, indicating disease in the Qi. Ginger-processed Pinellia Rhizome (Banxia) is used as the chief drug. Therefore, Zhu Fengyi treated Ou, Tu, and Yue using fresh ginger, Banxia, Chenpi, etc. Investigating the source of these three, they all arise because of Spleen deficiency, or Cold pathogen lodging in the Stomach, compounded by dietary injury. It is appropriate to use Clove (Dingxiang), Agastache (Huoxiang), Banxia, Poria (Fuling), Chenpi, fresh ginger, etc., as the main treatment. (Note: In the Neijing, Yue actually refers to hiccupping; modern sages mistakenly interpreted it as dry heaving, which is incorrect.) If this disease arises solely from internal injury, one must examine deficiency or excess and employ internal resolution methods. If there is Phlegm-Fluid retention, purgation must be used; one must differentiate the channel and prescribe medication according to the syndrome, avoiding arbitrary use.