（女子呕吐甚者死，以其阴在上故也）
总括 面青唇白冷为真，热吐腥酸头额温；停食作痰呕乳逆，不宜尿湿燥红唇。
脉法 脉浮而迟，气少不语者难治。
《内经》曰∶诸呕吐酸，暴注下迫，皆属于火。河间曰∶胃膈热甚则为呕，火气炎上之象也。夫吐谓有物无声，哕
谓有声无物，呕者谓有物有声也，前人以吐为属火，此特其一端耳。吐属太阳，多血少气，乃血病；哕属少阳，多气少
血，乃气病；呕属阳明，多血多气，气血俱病也。
冷吐者，片乳不消，多吐而少出，脉息沉微，面白眼慢，气缓神昏，额上有汗。此因风寒入胃，或食生冷，或伤宿
乳，胃虚不纳而出，宜温胃去寒，理中汤、定吐饮。如不虚，以参香饮治之。
热吐者，面赤唇红，吐次少而出多，乳食不消而色黄，遍体热甚，或因暑气在胃，或食热物，精神不悦而多烦渴躁，
宜服香薷饮。
诸吐者，眼胞浮，面微黄，足冷肚热，昼轻夜重。儿大者，脉沉缓。此宿乳滞胃，故吐黄酸水，或有清痰。脉实而
滑，为食积所伤，吐酸 气，或宿食并出。儿小 乳不化，宜三棱散。
伤风嗽吐，有热生风，有风生痰，痰结胸中，肺气不顺，连嗽不止，和痰吐出，此为嗽吐。痰壅而作，乃为实症，
宜去风化痰，先服小柴胡汤。若泻久脾虚，土不生金，面白唇燥，干嗽干呕，无痰可去，温补为上，用茯苓浓朴汤、惺
惺散。
伤乳吐者，才饮乳后即吐，或少停而吐，此因乳饮无度，脾气虚弱，不能运化，譬之小器盛物，满则溢也。更当节
乳，投三棱散。
呕家多渴，胃之津液干也，欲饮水以自救，宜少与之，不可多也，多则反吐，谓之水逆，宜五苓散。
有时恶心常吐清水，心胃作痛，得食即暂止，饥则甚者，此胃中有蛔虫也，宜槟榔散。大抵呕吐，第一要节乳，徐
徐用药调治。盖节者樽节之节，无过饱也。如不明此理，动辄断一二日，以致馁甚而胃虚，反致不救者多矣，切须知之。
丹溪曰∶胃中有热，膈中有痰，令人时常呕吐清水，作嗳气吞酸等症，用二陈汤，加姜汁、炒黄连、山栀、苍术、
川芎、香附、砂仁、神曲、山楂。少加木香以行滞气，加姜，水煎服。批∶呕家圣药生姜信矣，然气逆作呕，生姜散之；
痰与水作呕，半夏逐之。生姜治寒证最佳，然热呕不可无乌梅也。
凡病呕吐，切不可下，以其逆之故也，此丹溪之论。而东垣乃云∶吐而大便不通，则利大便，上药在所当禁。二说
相反，要当审其通与不通而治耳。
〔附方〕
理中汤 见惊风症内。
定吐饮 见惊风症内。
参香饮 人参 沉香 丁香 藿香 姜汁
香藿饮 香藿 扁豆 浓朴 黄连
三棱散 人参 莪术 三棱 陈皮 枳壳 香附 青皮 益智 神曲 谷芽 半夏 大黄 紫苏 甘草
小柴胡汤 半夏 黄芩 柴胡 人参 薄菏 甘草
茯苓浓朴汤 茯苓 浓朴 半夏 甘草
惺惺散 人参 桔梗 茯苓 白术 防风 川芎 细辛 胆星 天花粉 甘草
五苓散 见惊风症内。
槟榔散 黑锡炒成灰，槟榔末各等分，米饮调服，苦楝汤下亦可。
和中桔梗汤 茯苓（一钱） 半夏（七分） 陈皮（八分） 白术（八分） 生姜（九片） 枳实（八分炒）
浓朴（八分，姜汁炒） 桔梗（八分）
荆黄散 荆芥（二钱） 人参（一钱） 甘草（五分） 大黄（六分） 加槟榔末（一钱） 木香（五分）
二陈汤 茯苓 半夏 陈皮 甘草 白术
(If vomiting in females is severe, death ensues, due to the reversal of Yin Qi.)
General Summary: A bluish complexion with white and cold lips indicates true cold; heat-type vomiting presents with a fishy and sour odor and a warm forehead; vomiting of milk caused by food stagnation generating phlegm, if accompanied by damp urine and dry red lips, has a poor prognosis.
Pulse Diagnosis: If the pulse is floating and slow, and the patient has scanty breath and reluctance to speak, it is difficult to treat.
The *Neijing* states: All vomiting of acid fluids, sudden diarrhea with tenesmus, belong to Fire. Liu Hejian stated: When heat in the stomach and diaphragm is excessive, vomiting occurs; this is the manifestation of Fire Qi flaring upward. "Tu" (spitting) refers to having material but no sound; "Yue" (hiccuping/belching) refers to having sound but no material; "Ou" (vomiting) refers to having both material and sound. Former physicians considered vomiting to belong to Fire, which is only one aspect. Vomiting belongs to the Taiyang channel, characterized by abundant blood and scarce Qi, thus it is a Blood disease; Yue belongs to the Shaoyang channel, characterized by abundant Qi and scarce blood, thus it is a Qi disease; Ou belongs to the Yangming channel, characterized by abundant blood and abundant Qi, thus it is a disease of both Qi and Blood.
Cold Vomiting: Milk curds are undigested, frequent vomiting with little output, pulse is deep and faint, complexion is pale, eyes are sluggish, Qi is slow, spirit is confused, and sweat appears on the forehead. This is caused by Wind-Cold invading the Stomach, or eating raw/cold foods, or damaging residual old milk; the deficient Stomach cannot retain it, causing expulsion. It is suitable to warm the Stomach and dispel Cold using Lizhong Tang (Regulate the Middle Decoction) or Dingtu Yin (Stop Vomiting Drink). If there is no deficiency, Shenyin Xiang (Ginseng and Agarwood Drink) should be used.
Heat Vomiting: Complexion is red, lips are pink, vomiting frequency is low but volume is high, milk and food are undigested and yellowish, the whole body is very hot, either due to Summer-heat in the Stomach or eating hot-natured foods, mental distress with irritability, thirst, and restlessness. It is suitable to take Xiangru Yin (Elsholtzia Drink).
Various Vomiting: Eyelids are swollen, complexion is slightly yellow, feet are cold while the abdomen is hot, symptoms are lighter during the day and heavier at night. In older children, the pulse is deep and moderate. This is due to residual milk stagnating in the Stomach, hence vomiting yellow acidic fluid or clear phlegm. If the pulse is excess and slippery, it is injured by food accumulation, vomiting acidic gas or mixed with retained food. For infants whose milk is not digested, Sanleng San (Burreed Powder) is suitable.
Wind-Injury Cough with Vomiting: Heat generates Wind, Wind generates Phlegm; Phlegm knots in the chest, Lung Qi is unsmooth, leading to continuous coughing, bringing up sputum along with vomit, termed "Cough-Vomiting." When Phlegm is obstructive and acute, it is an Excess syndrome, suitable for dispersing Wind and resolving Phlegm, first taking Xiaochaihu Tang (Minor Bupleurum Decoction). If prolonged diarrhea leads to Spleen deficiency, Earth fails to generate Metal, with a pale face and dry lips, dry cough and dry retching without phlegm to expel, warming and tonifying is superior, using Fuling Nongpu Tang (Poria and Magnolia Bark Decoction) or Xingxing San (Stupor-Dispelling Powder).
Milk-Injury Vomiting: Vomiting immediately after drinking milk, or after a short pause, is due to unregulated nursing, weak Spleen Qi, and inability to transform and transport, akin to a small vessel overflowing when full. Nursing should be regulated further, and Sanleng San administered.
Those who vomit often feel thirsty because Stomach Jin-Ye (Body Fluids) are dry; they desire water to save themselves. It is suitable to give small amounts, not much, as too much causes reverse vomiting, termed "Water Reversal," suitable for Wuling San (Five-Ingredient Powder with Poria).
Sometimes nausea with frequent spitting of clear fluid, pain in the heart and Stomach, temporarily stopping upon eating, worsening when hungry, indicates Ascaris lumbricoides in the Stomach, suitable for Binglang San (Areca Seed Powder). Generally, for vomiting, the primary step is to regulate milk intake and slowly medicate. "Regulation" means moderation, avoiding overeating. If this principle is not understood, fasting for one or two days leads to extreme hunger and Stomach deficiency, often resulting in untreatable conditions; this must be known.
Zhu Danxi said: Heat in the Stomach and Phlegm in the Diaphragm cause frequent vomiting of clear fluid, belching, and acid regurgitation. Use Erchen Tang (Two-Aged Decoction), adding Ginger Juice, Stir-fried Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), Cangzhu (Atractylodes Rhizome), Chuanxiong (Sichuan Lovage Rhizome), Xiangfu (Cyperus Rhizome), Sharen (Amomum Fruit), Shenqu (Medicated Leaven), and Shanzha (Hawthorn Fruit). Add a small amount of Muxiang (Aucklandiae Radix) to move stagnant Qi, add Ginger, decoct in water and take. Commentary: Ginger is indeed the holy medicine for vomiting; however, for Qi-reversal vomiting, Ginger disperses it; for Phlegm-and-Water vomiting, Banxia (Pinellia Tuber) drives it out. Ginger is best for Cold syndromes, but for Heat vomiting, Wu Mei (Mume Fruit) is indispensable.
For all vomiting diseases, purgatives must strictly be avoided because it goes against the pathological trend; this is Danxi's view. However, Li Dongyuan stated: If vomiting is accompanied by constipation, then promote bowel movement, and upper-body drugs are prohibited. These two theories contradict each other; treatment depends on examining whether the bowels are open or blocked.
[Attached Formulas]
Lizhong Tang See within Convulsion Syndrome.
Dingtu Yin See within Convulsion Syndrome.
Shenyin Xiang Ren Shen (Ginseng Root), Chen Xiang (Agarwood), Ding Xiang (Clove), Huo Xiang (Patchouli Herb), Jiang Zhi (Ginger Juice).
Xianghuo Yin Huo Xiang (Patchouli Herb), Bian Dou (Hyacinth Bean), Nong Pu (Magnolia Bark), Huang Lian (Coptis Rhizome).
Sanleng San Ren Shen (Ginseng Root), E Zhu (Curcuma Rhizome), San Leng (Burreed Tuber), Chen Pi (Tangerine Peel), Zhi Qiao (Bitter Orange Fruit), Xiang Fu (Cyperus Rhizome), Qing Pi (Green Tangerine Peel), Yi Zhi (Alpinia Oxyphylla Fruit), Shen Qu (Medicated Leaven), Gu Ya (Grain Sprout), Ban Xia (Pinellia Tuber), Da Huang (Rhubarb Root), Zi Su (Perilla Leaf), Gan Cao (Licorice Root).
Xiaochaihu Tang Ban Xia (Pinellia Tuber), Huang Qin (Scutellaria Root), Chai Hu (Bupleurum Root), Ren Shen (Ginseng Root), Bo He (Mint Herb), Gan Cao (Licorice Root).
Fuling Nongpu Tang Fu Ling (Poria), Nong Pu (Magnolia Bark), Ban Xia (Pinellia Tuber), Gan Cao (Licorice Root).
Xingxing San Ren Shen (Ginseng Root), Jie Geng (Platycodon Root), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome), Fang Feng (Saposhnikovia Root), Chuan Xiong (Sichuan Lovage Rhizome), Xi Xin (Asarum Root), Dan Xing (Arisaema Cum Bile), Tian Hua Fen (Trichosanthes Root), Gan Cao (Licorice Root).
Wuling San See within Convulsion Syndrome.
Binglang San Hei Xi (Calcined Lead Oxide) stir-fried to ash, Bing Lang (Areca Seed) powder, equal parts, taken with rice water; also acceptable with Ku Lian Tang (Chinaberry Decoction).
Hezhong Jiegeng Tang Fu Ling (Poria) [1 qian], Ban Xia (Pinellia Tuber) [7 fen], Chen Pi (Tangerine Peel) [8 fen], Bai Zhu (Atractylodes Macrocephala Rhizome) [8 fen], Sheng Jiang (Fresh Ginger) [9 slices], Zhi Shi (Immature Bitter Orange) [8 fen, stir-fried], Nong Pu (Magnolia Bark) [8 fen, stir-fried with ginger juice], Jie Geng (Platycodon Root) [8 fen].
Jinghuang San Jing Jie (Schizonepeta Spike) [2 qian], Ren Shen (Ginseng Root) [1 qian], Gan Cao (Licorice Root) [5 fen], Da Huang (Rhubarb Root) [6 fen], add Bing Lang (Areca Seed) powder [1 qian], Mu Xiang (Aucklandiae Radix) [5 fen].
Erchen Tang Fu Ling (Poria), Ban Xia (Pinellia Tuber), Chen Pi (Tangerine Peel), Gan Cao (Licorice Root), Bai Zhu (Atractylodes Macrocephala Rhizome).