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All diseases have distinctions of deficiency (Xu), excess (Shi), cold (Han), and heat (Re). Among these, vomiting is particularly severe. This is often because practitioners favor warming methods but abuse purgative (attacking) measures. In cases of heat syndrome, if heat is not thoroughly cleared, the fire symptoms will become more intense; in cases of excess syndrome, if purgation is excessive, the Stomach Qi will thereby be damaged. Consequently, one may experience incessant vomiting without cessation, from which few escape critical danger. This is likely because cold and excess syndromes are easy to distinguish, whereas deficiency and heat syndromes are easily confused.

If it is a cold or excess syndrome, it may be due to internal injury from raw and cold foods, external cold invading the Stomach, excessive drinking and overeating, or irregular diet. The pulse must be deep-tight (Chen Jin) or wiry-slippery (Xian Hua), accompanied by distension and discomfort in the Middle Jiao (the area of the Spleen and Stomach). If not warmed, the cold will not be dispelled; if not purged, the stagnation will not transform. Therefore, formulas such as Huoxiang Pingwei San (Patchouli and Magnolia Bark Decoction for Regulating the Stomach) are suitable and yield results easily.

However, when cold stagnation transforms into heat, as stated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon): "All upward rushing and counterflow symptoms belong to Fire," and "All vomiting and acid regurgitation belong to Heat." Everyone knows this. Yet, failing to investigate the cause and indiscriminately administering anti-emetics, practitioners often prefer aromatic-dry drugs. They fail to realize that vomiting belongs to Shaoyang (Lesser Yang) disease, where Wood contains Fire. Since Fire nature flares upward, using aromatic-dry drugs to assist it will intensify the blaze. It may even lead to vomiting green fluid or substances resembling vegetable leaves, which is bile juice. If Zhi Zi (Gardenia Fruit) and Lian Lian (Coptis Rhizome) are not urgently used to descend fire, when will the vomiting cease?

It is commonly observed that patients whose Gallbladder is injured by fright tend to vomit. Ancient sages established Wendan Tang (Warm the Gallbladder Decoction), specifically adding Zhu Ru (Bamboo Shavings), to descend Qi and fire, an intention that can be understood. Furthermore, the Stomach belongs to Earth and fears the constraint of Wood. If Wood pathogen overwhelms Earth, Stomach Qi must be damaged, leading to the inability to ingest water and food. The fluids in the Stomach will be exhausted completely, while Qi from the Lower Jiao rebels upward, frequently causing stuffiness and obstruction in the chest and diaphragm, which resembles an excess syndrome. If physicians follow this with attacking treatments, the last thread of Qi will be severed immediately. Thus, whenever encountering prolonged vomiting damaging the Stomach, Ginseng must be added to clearing-heat prescriptions to support Stomach Qi. Only then can rice gruel be slowly administered to allow intake.

I have seen ancient practitioners treating vomiting and counterflow due to deficiency-cold. Fearing that hot medicines might clash with the body, they instead added Huang Lian (Coptis Rhizome) and Tong Bian (Child's Urine) as guides to calm the Yin aspect. How much more so in heat syndromes should one avoid adding fire to fire! Although there are distinctions: vomiting sound and matter together is called "Tu" (Vomit); sound only without matter is called "Ou" (Regurgitate); turbid, foul, and long sounds are called "Yue" (Hiccup/Sobbing). These may arise from the depression of Seven Emotions (Qi emotions), the intermingling of Six Qi (pathogenic factors), the disharmony of Water and Earth, or the dysfunction of Guan Ge (Obstruction and Rejection). The conditions vary greatly, and treatments are not uniform. However, if one carefully examines deficiency, excess, cold, and heat, no essence will be left unaddressed.

Clinical Cases:
A young woman, after accumulating fatigue, suddenly developed alternating chills and fever with incessant vomiting, day and night for three nights. Treatments with Huoxiang Zhengqi San (Patchouli Powder for Correcting the Qi), Er Chen Tang (Two-Cured Decoction), and Fulonggan (Stove Soil) were ineffective. She vomited fluid resembling green vegetable juice, becoming physically and mentally exhausted. I urgently administered a single dose of Shan Zhi (Gardenia Fructus), Ren Shen (Ginseng Radix et Rhizoma), Shen Qu (Massa Medicata Fermentata), and Fu Ling (Poria). Her vomiting gradually stopped. She was later convalesced with Ren Shen and recovered.

Another young woman, after suffering fright, experienced epigastric pain and incessant vomiting, lasting over three days. She felt hunger pangs in her chest but could not eat grains. She exhibited delirium and mottled rashes on her face. Upon palpating her pulse, it was wiry (Xian), and heavy pressure revealed emptiness. A wiry pulse indicates Gallbladder injury from fright; an empty pulse indicates Stomach Qi deficiency; rashes indicate the manifestation of flaming-upward fire. I used Yuan Zhi (Polygalae Radix), Fu Shen (Poria with Hostwood), and Suan Zao Ren (Ziziphus Seed) to calm the mind and nourish the Stomach; Mu Xiang (Aucklandiae Radix) and Chen Pi (Citri Reticulatae Pericarpium) to relieve pain and regulate Qi; Shan Zhi and Tong Bian to descend fire; a small amount of Chai Hu (Bupleuri Radix) as a guiding herb; and doubled Gou Teng (Uncariae Ramulus cum Uncis) to stop fright. After one dose, vomiting ceased and rashes faded; her mind calmed and appetite returned. After two doses, she was cured.

Er Chen Tang (Two-Cured Decoction)
Ban Xia (Pinelliae Rhizoma), Fu Ling (Poria), Guang Pi (Citri Reticulatae Pericarpium) (each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma) (0.3 qian).
Add three slices of fresh ginger, decoct in water. If the pulse is rapid with irritability, heat, and acid vomiting, add Huang Qin (Scutellariae Radix), Shan Zhi, and Gou Teng. If severe, add Huang Lian. If there is stagnation, add Hou Po (Magnoliae Officinalis Cortex), Lai Fu Zi (Raphani Semen), and Zhi Shi (Aurantii Fructus Immaturus). If there is aversion to cold, add Huo Xiang (Agastaches Herba) and Mu Xiang. If caused by fright, add Zhu Ru. If Middle Qi is deficient, add Ren Shen and Shi Hu (Dendrobii Caulis). For deficiency-cold, add Pao Jiang (Prepared Zingiberis Rhizoma) and Shu Fu Zi (Prepared Aconiti Lateralis Radix).