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The *Neijing* states: All rebellious qi rushing upward belongs to Fire; all vomiting and acid regurgitation belong to Heat. It also states: When Cold Qi lodges in the stomach and intestines, causing rebellious qi to exit upwards, pain and vomiting occur. Vomiting refers to the reversal of Yangming Stomach Qi, which should descend smoothly; when it reverses and moves upward, vomiting occurs. In these symptoms, those with both sound and material are called "Ou" (Vomiting); those with material but no sound are called "Tu" (Regurgitation); those with sound but no material are called "Yue" (Hiccups), also known as dry heaving. If this appears in chronic illness, it indicates death. Generally, pediatric vomiting involves Cold, Heat, or Food Stagnation. However, neither Cold nor Heat vomiting occurs without prior food stagnation; the pathology ultimately resides in the Stomach. Additionally, there are conditions like milk overflow (Yiru), swallowing milk (Yilu), and hiccups/vomiting, which resemble vomiting but must not be treated as such. There are also cases of Cold-Heat rejection blockage and vomiting due to worm pain, all of which require detailed differentiation before treatment. In treating pediatric vomiting, one must first regulate milk and food intake, meaning to reduce the quantity. For vomiting accompanied by thirst, do not immediately give tea or water, as drinking will trigger more vomiting that cannot be stopped. One must endure for a period, then offer rice soup, after which vomiting will cease.

Cold-type vomiting presents with undigested milk curds, frequent vomiting with little output, pale face, relaxed eyelids, weak breath, lethargy, sweating on the forehead, and a deep, faint pulse. The treatment should warm the middle and digest food. For mild cases, use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi). If vomiting persists, use Lizhong Tang (Regulate the Middle Decoction) with added Huoxiang. If still persistent, use Shenxiang San (Ginseng and Costus Powder). If it continues, this indicates Yin excess repelling Yang, termed "Juge" (Rejection Blockage). Urgently administer one dose of Lizhong Tang, mixed with a small amount of male pig bile and child's urine. Moisten the herbs, stir-fry until cooked, decoct, and take orally to stop vomiting. This follows the *Neijing* principle of "treating heat with cold methods." Because excessive Yin-Cold repels Yang-warming herbs, pig bile and child's urine act as guides. Initially similar in nature, they differ ultimately; upon ingestion, the Yin pathogen gradually dissipates, allowing Yang Qi to emerge.

Heat-type vomiting presents with a red face, crimson lips, small volume of vomited fluids but large volume of solid matter, digested milk curds that are yellow, generalized fever, and irritability. This is common in summer. Use Wuling San (Five-Ingredient Poria Powder) with added Huoxiang. If persistent, use Houxian Tang (Akebia and Coptis Decoction). If still persistent, use Lizhong Tang, decocted, then mixed with Liuyi San (Six-to-One Powder) and taken cold to stop vomiting. This follows the principle of "treating cold with heat methods."

Food-stagnation vomiting presents with puffy eye lids, slightly yellow complexion, cold feet, fever that is milder during the day and heavier at night, vomiting of sour/fermented odors, yellow water, or green phlegm, with a wiry, full, and slippery pulse. This indicates retained food. One must purge the accumulation to stop vomiting, using Xiaoji Wan (Accumulation-Dissolving Pill).

Milk-injury vomiting occurs immediately after feeding or after a short pause. This is due to unregulated feeding overwhelming the delicate Spleen and Stomach, which cannot transform and transport. This is "overflow due to fullness," named Yilu (Swallowing Milk). Regulation of feeding quantity alone will stop the vomiting.

Yilu (Swallowing Milk) involves frequent spitting of small amounts of milk, appearing as if vomiting but not truly so, caused by Stomach Deficiency. Use Shenxiang San.

Excessive milk discharge is not true vomiting; without dietary restriction, it may become true vomiting. This is common in infants under 100 days old because their bodies are small and soft, requiring maternal support. Tilting causes milk to spill. This is a physical issue, not requiring medical treatment.

Cough-induced vomiting occurs when an infant coughs. Feeding must wait until the cough subsides. Feeding while coughing causes Qi rebellion, preventing milk digestion and transforming it into Phlegm. Phlegm-Qi obstruction prevents cough resolution, leading to milk vomiting. Use Zhijie Erchen Tang (Bitter Orange and Citrus Decoction with Two-Aged Ingredients).

For infants vomiting milk within three days of birth, use three cloves (Dingxiang), three fen of tangerine peel (Chenpi), and three slices of ginger (Shengjiang), decocted and taken orally to stop vomiting. Simmered Ginger Soup (Weijiang Tang) is even better. I use this most frequently, as vomiting within three to four days is generally Cold-type.

Initial Yilu should be regulated early. If Yilu persists, it becomes Tu; if Tu persists, it becomes Ou; if Ou persists, it becomes Yue. At this stage, Stomach Qi is severely deficient, and Spirit is fading. Prognosis is poor if vomiting persists with worsening lethargy, sunken or swollen fontanelles, prominent blue veins, frequent vomiting with refusal to eat, coma, aphasia, rapid breathing, high fever, or foul-smelling vomit. These are fatal signs.

Yue (Hiccups/Dry Heaving) involves sound without material and is a dire sign. Its appearance after chronic illness indicates incurability.

Commentary: Physicians must empathize with the patient's condition and apply clinical wisdom. Vomiting where medication and food are rejected is difficult to treat. If medicine is vomited immediately, how can it work? Forcing administration worsens gastric agitation. I often treat this by plugging the nostrils with clay balls made from ginger soup and loess to block the smell of medicine. Then, prepare the correct formula, clarify it, ensure moderate temperature, and administer one mouthful, pausing for half an hour. Then another mouthful, pausing longer. After two mouthfuls and a brief pause, the infant can drink freely without vomiting. The Stomach Qi stabilizes, preventing further vomiting. Fools, seeing the rejection, force-feed cups of medicine, causing total expulsion and loss of efficacy. This method applies not only to pediatrics but also to internal medicine. Without empathy and clinical wisdom, even accurate diagnosis and prescription are useless if the patient cannot retain the medicine.