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Sudden vomiting is caused by dietary injury. If food stagnates in the upper jiao (upper burner), it can be cured by one episode of vomiting; use Pingwei San (Stomach-Ping Powder) with Banxia (Pinellia Rhizome), or Huoxiang Zhengqi San (Agaricus Powder for Regulating Qi). For cholera-like syndrome with vomiting and diarrhea, if accompanied by cold hands and feet, use Lizhong Tang (Middle-Regulating Decoction) for mild cases, and Sini Tang (Recover the Lost Decoction) for severe cases. If there is only continuous vomiting, use Erchen Tang (Two-Aged Decoction) with Jiangzhi (Ginger Juice); if ineffective, add Dingxiang (Clove); if warming does not cure, suspect deficiency with internal heat, add Chao Hei Zhiren (Charred Gardenia Seed) and Renshen (Ginseng), or grind Chenxiang (Aquilaria Wood) and Wuyao (Lindera Root) into powder, take three slices of Shengjiang (Fresh Ginger), wipe with light salt water, dip in the powder, and dissolve in the mouth. If it is a cold pattern, there is much vomiting of water and food, abdominal pain, and loss of appetite; use Lizhong Tang. If it is a heat pattern, there is much retching, body heat like fire, and expulsion of roundworms during vomiting; use Lizhong Tang with Wuyao and Huanglian (Coptis Rhizome).

For cholera-like vomiting and diarrhea, treat vomiting primarily by resolving phlegm, diarrhea primarily by harmonizing the middle, and abdominal pain primarily by warming the middle.

Vomiting immediately after eating is due to Qi deficiency; it is appropriate to tonify the Fire of the Mingmen (Gate of Life).

In all vomiting diseases, if food eaten in the morning is vomited at noon, or food eaten before noon is vomited at night, and vomiting occurs without obstruction, this indicates severe deficiency of Stomach Qi. Use Erchen Tang with Dingxiang, Binglang (Areca Seed), and Zhike (Aurantium Fruit) to warm and descend; if Binglang and Zhike are not used, use Huanglian (5 li) and Wuyu (Evodia Fruit, 2 li), decocted with Shengjiang. After two doses, add Renshen.

When vomiting is accompanied by nausea, nausea belongs to Fire; use Erchen Tang with Huanglian and Wuyu. Only when there is nausea but no sound, it is a deficiency pattern; use warming methods, not others.

In all vomiting cases where various medicines are ineffective, use Sugeng Tang (Perilla Stem Decoction) with ground Binglang and Zhike.

In all vomiting cases, use Erchen Tang; add Shanzhi (Gardenia Fruit) for heat, Paogjiang (Prepared Ginger) for cold, and Gegen (Kudzu Root) for skin fever, irritability, and thirst. For post-vomiting regulation, use Liujunzi Tang (Six-Gentlemen Decoction).

When vomiting is accompanied by diarrhea, or expulsion of roundworms during vomiting, it indicates damp-heat in the Spleen; use Lizhong Tang with one Wumei (Mume Fruit) and 3 li of Huanglian.

Only vomiting without nausea involves 3 li (likely a textual error or specific minor dosage reference in original context, translated literally as per instruction to not add content), nourishing the Stomach and descending Fire, allowing Qi to descend and self-healing. Vomiting without nausea is called false vomiting, with heat in the Wei (Stomach); true vomiting must be accompanied by nausea.

Vomiting, where material exits without sound, can be deficiency or excess: vomiting with cold feet and fine pulse is deficiency; vomiting with body heat and excess pulse is excess. Accompanied by food stagnation or retained phlegm, use Erchen Tang (2 qian), Shengjiang (3 slices), decocted in water.

Vomiting accompanied by heart pain is treated as Fire. Treatment differs by deficiency/excess; vomiting clear water is treated as parasitic accumulation. Vomiting due to Heat pathogen in the Stomach, preferring cold drinks, with tight and rapid Cun (inch) pulse, is treated with Zhuru Tang (Bamboo Shaving Decoction). Vomiting without fixed time, with deep, slow, and hidden Cun pulse, is primarily treated with Jupi Tang (Tangerine Peel Decoction), using Chenpi (Tangerine Peel), Banxia, Ganjiang (Dried Ginger), etc.

For Ganhuoluan (Dry Cholera), induce vomiting by probing the throat with salt water; never give rice drink, as it will assist the pathogen and cause rapid death. Vomiting with chest and hypochondriac pain, with surging and hard pulse, and constipation, if accompanied by cold sweat like water, irritability, constipation, and absent pulse, is untreatable.

Vomiting with cold limbs, short Chi (cubit) pulse, and floating, large, rootless six pulses indicate mostly bad prognosis with little hope.

Vomiting with constipation indicates loss of Stomach Qi transmission; it is untreatable.

Both vomiting and retching, if Binglang fails to descend Qi after two or three treatments, is untreatable.

Vomiting with whole-body distension indicates Liver Qi excess; it is untreatable.

Vomiting with absent pulse is untreatable.

Vomiting with exhalation but no inhalation is untreatable.

Case Record 1: A woman vomited for half a month with no effect from various medicines, condition critical but breath unextinguished. Pulse was internally trembling, with no pulse at all in the left Chi position. Said: This alone can survive because Yang Qi is not extinguished, so the left Chi pulse remains alone. Used Chenxiang and Wuyao in equal parts, Renshen and Gancao (Licorice) halved, ground into powder. Shengjiang sliced and pickled in light salt, dipped in powder and dissolved in mouth. Expelled about a bowl of phlegm and recovered.

Case Record 2: A person with a large body ate chicken once daily, only vomiting clear water in the afternoon, and felt secure after eating meat at night. Pulse showed Cun several times larger than Chi, Chi was deep and choppy. This is Yin excess blocking Yang, excessive Fire in the Upper Jiao allowing eating, and deficiency-cold in the Dantian causing vomiting. Used Banxia (1 qian), Chenxiang (3 fen), Zhizi (5 fen), Renshen and Paogjiang (1 qian each), Fuzi (Aconite Root, 3 fen). Cured by warming below and clearing above.

Case Record 3: A pregnant woman suffered severe vomiting and regurgitation, unable to swallow even water, with severe hypochondriac pain leading to syncope. Pulse: Left Guan and Chi were surging; Right Guan was peaceful; Right Chi was革 (drum-taut). This is due to Kidney dryness failing to generate Wood, Wood drying and generating Fire to insult Spleen Earth, Spleen carrying Liver pathogen upward to Lung, causing vomiting and pain. Without pregnancy, Guaren (Melon Seed), Tianmendong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Banxia, Chaihu (Bupleurum Root), Rougui (Cinnamon Bark) would cure it; now with pregnancy, these are unsuitable. Used Shengdi (Rehmannia Root) to nourish Kidney Blood, Dangguishen (Angelica Sinensis Root Heart) to return blood to Liver to control Fire, Baishao (White Peony Root) to remove Wood from Earth, Gancao to缓 (slow/relax) flaming Fire, Sharen (Amomum Fruit) to regulate Qi and calm fetus, Huangqin (Scutellaria Root) to calm Fire injuring Lung, Dazao (Jujube) to harmonize Middle. After 2-3 doses, Fire slightly calmed, then used Duzhong (Eucommia Bark), Xuduan (Dipsacus Root), Qin, Lian (Coptis), Sugeng, Jiegeng (Platycodon Root), Paogjiang to gather Fire and calm fetus. Adhere to this without change, syncope stops and recovers. Note that vomiting injures Spleen and Stomach, making Danggui and Dihuang generally contraindicated; here, Water is dry and Fire blazing, so Yin-nourishing herbs are used to cultivate the root.

Case Record 4: A person had vomiting, diarrhea, and lower back pain, wanting to eat but unable. This is Wood pathogen attacking Earth, Stomach Fire blazing causing heart palpitations resembling hunger. Fire in Middle Jiao affects Lung upward causing vomiting, flows to Large Intestine downward causing diarrhea. Lung and Large Intestine are exterior-interior; since Large Intestine is not firm, Lung cannot generate Kidney, Water is injured causing Kidney pain. Used Cangzhu (Atractylodes Lancea) and Baizhu (Atractylodes Macrocephala) to harmonize Stomach, Ling (Poria) and Zhizi to calm Fire. Fuling (Poria), Shanyao (Dioscorea Rhizome) tonify Spleen and Lung, Baishao calms Liver, Sugeng regulates Qi, then Fire calms, Dampness leaves, and peace is restored.