Library

Zhou Mengjue stated: The syndrome of vomiting and regurgitation is categorized into three types: cold, heat, and deficiency. In cold syndromes, the pulse is slow; in heat syndromes, the pulse is rapid; in deficiency syndromes, the pulse is weak. Thus, the symptoms can be distinguished by the pulse. The easiest to treat is the cold type. The Yangming Stomach meridian is the site for digesting grains, favoring warmth and disliking cold. Once cold pathogenic factors invade internally, they clash with stomach Qi, causing immediate vomiting upon eating and retching even when not eating. Although herbs such as Banxia (Pinellia Rhizome), Dingxiang (Clove), Ba Dou Kou (Cardamom Fruit), and Sharen (Amomum Fruit) are recorded in materia medica as effective anti-emetics, a bowl of Shengjiang Tang (Fresh Ginger Decoction) acts even faster. This corresponds to the *Neijing* statement: "When cold qi lodges in the intestines and stomach, rebellious Qi rises upward, causing pain and vomiting."

The most prone to misdiagnosis is the heat type. If cold stagnates for too long, it transforms into heat. If physicians fail to recognize the heat and continue treating it as cold with acrid-warm herbs, the vomiting worsens, the heat increases, and the more the heat increases, the worse the vomiting becomes. Books explicitly record the use of Maidong (Ophiopogon Tuber) and Lugen (Reed Rhizome) to stop vomiting, yet some still do not use them, let alone Shigao (Gypsum Fibrosum), which is extremely cold and cooling. It is unknown that Shigao is a premier herb for stopping vomiting. Although the materia medica does not detail its nature, the *Neijing* contains relevant text: "All rebellious upward rushing belongs to fire," and "All vomiting of sour fluid, sudden diarrhea with tenesmus, belongs to heat."

The best to treat is the deficiency type. One should not blame only the Stomach but also consider the Spleen. The Spleen possesses the quiet virtue of Kun (Earth) and the vigorous function of Qian (Heaven). Deficiency leads to failure in transportation and transformation, causing rebellious Qi and vomiting. Regulating the Spleen and Stomach is a long-standing strategy for physicians; Lizhong Tang (Regulate the Middle Decoction) and Liujunzi Tang (Six Gentlemen Decoction) are both effective. The *Neijing* states: "The Foot-Taiyin Spleen meridian runs alongside the throat and connects to the root of the tongue. When the meridian is disturbed, it causes stiffness of the tongue root and vomiting after eating."

Vomiting is a superficial disease, whereas Yige (Dysphagia and food impaction) is a deep-seated disease, making them easy to distinguish. Vomiting has a sudden onset, while Yige develops slowly. Vomiting occurs immediately after eating, or there is a desire to vomit even without eating. Yige involves vomiting only after food enters, with no vomiting when fasting. Vomiting may present with cold, heat, or deficiency signs externally. Yige patients who do not eat appear normal. Vomiting affects people of all ages, while Yige mostly affects the elderly. The pulse in vomiting may be slow, rapid, or weak, whereas the pulse in Yige is slow. Formulary discussions on vomiting often conflate Yige; half of the formulas for Yige are used for vomiting. Why is there confusion and lack of clear judgment?

Once, during a gathering in Xiangzhong Hupan, an old physician said, "I have cured several cases of Yige." Upon examining his prescriptions, they were Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); upon examining the symptoms, they were actually vomiting due to Spleen deficiency. Another old physician said, "I have also cured several cases of Yige." His prescription was Huanglian Faxia Tang (Coptis and Pinellia Decoction); the symptoms were actually vomiting due to Stomach heat. Medicines can cure pseudo-diseases, leading people to acquire pseudo-names; this refers to these two old physicians. Regarding elderly individuals with Qi obstruction who occasionally vomit, one cannot generalize it as simple vomiting nor hastily diagnose it as Yige. This is due to insufficient fluids and Qi deficiency, making transport difficult. Ancients carved doves on walking sticks to wish the elderly freedom from choking, referring to this condition. For pregnant women with vomiting, Faxia (Prepared Pinellia) is not contraindicated and can calm the fetus, as detailed in *Zhunseng*. Furthermore, when women menstruate and are attacked by wind-cold, transmitting to the Liver meridian, blood coagulates in the Liver, causing immediate vomiting upon eating for over a year. Physicians using standard anti-emetic treatments for cold or heat failed. Only by using Jiegeng (Platycodon Root) and Honghua (Safflower) to remove stasis and generate new blood did the patient recover after a few doses. This is another aspect that must not be overlooked.

The *Neijing* states: "When cold qi lodges in the intestines and stomach, rebellious Qi emerges, causing pain and vomiting." Chen Feixia stated: "Yangming Stomach Qi moves downward smoothly; now it rebels and moves upward, causing vomiting." Vomiting with sound and matter is called Ou (vomiting); matter without sound is called Tu (regurgitation); sound without matter is called Yue (dry heaving). He added: Dry heaving in chronic illness indicates death. Pediatric vomiting includes cold, heat, and food retention. However, cold and heat vomiting invariably stem from food retention, and the pathology generally belongs to the Stomach. Additionally, milk overflow, spitting up, and dry heaving resemble vomiting but should not be treated as such. There are also patterns of cold-heat rejection and vomiting due to intestinal parasites, all requiring detailed differentiation. When treating pediatric vomiting, one must first regulate milk and food intake ("regulation" means reduction). Vomiting often causes thirst, but tea and water should not be given, as drinking leads to further vomiting. One must endure for one to two hours before giving rice soup, at which point vomiting stops.

In cold vomiting, undigested milk curds are expelled, with frequent vomiting and little output. The face is pale, eyelids are lax, breath is weak, spirit is dull, sweat appears on the forehead, and the pulse is deep and faint. Treatment should warm the middle and digest food. For mild cases, Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) is used. If ineffective, Lizhong Tang plus Huoxiang is prescribed. If still ineffective, Shenxiang San (Ginseng and Agarwood Powder) is used. If vomiting persists, it indicates Yin excess repelling Yang, called "rejection." Urgently administer one dose of Lizhong Tang mixed with bile from a male pig and a small amount of child's urine. Moisten the herbs with this mixture, stir-fry until cooked, decoct, and take to stop vomiting. This follows the *Neijing* principle of "treating heat with cold." Because Yin-cold is excessive, warm Yang herbs are rejected. Pig bile and child's urine act as guides; initially similar, they differ ultimately. After ingestion, Yin-cold dissipates, and Yang Qi emerges.

In heat vomiting, the face is red, lips are crimson, vomiting episodes are infrequent but volume is large, milk curds are digested, vomitus is yellow, and the body is hot with irritability. This is common in summer. Wuling San (Five-Ingredient Poria Powder) plus Huoxiang is indicated. If ineffective, Houxian Tang (Houttuynia and Coptis Decoction) is used. If still ineffective, decoct Lizhong Tang, mix with Liuyi San (Six-to-One Powder), and take cold to stop vomiting. This is "treating cold with heat."

In food retention vomiting, eyelids are puffy, complexion is slightly yellow, feet are cold, fever is worse at night and lighter during the day, vomitus may smell sour/fermented, contain yellow fluid, or clear phlegm. The pulse is wiry, full, and slippery. This indicates retained food; purging the accumulation stops the vomiting. Xiaoji Wan (Eliminate Accumulation Pill) is used. Milk injury vomiting occurs immediately after feeding or after a short pause. This is due to unregulated feeding and delicate Spleen/Stomach failing to transform, resulting in overflow, named "milk overflow." Regulating milk intake stops vomiting. Spitting up (Ru Lu) involves small amounts of milk spit frequently, resembling vomiting but not quite, caused by Stomach deficiency; Shenxiang San is appropriate. Excessive milk expulsion is not true vomiting; if uncontrolled, it becomes true vomiting. Common in infants under 100 days due to small size and softness, requiring maternal support. Tilting causes spillage, which is mechanical and requires no treatment.

Cough-induced vomiting occurs when coughing prevents proper feeding. If fed while coughing, Qi rebels, milk fails to digest and forms phlegm, obstructing Qi flow and causing milk regurgitation. Zhijie Erchen Tang (Bitter Orange and Platycodon Two-Aged Phlegm Decoction) is used.

For infants vomiting within three days of birth, use three cloves (Dingxiang), three fen of Chenpi (Tangerine Peel), and three slices of Shengjiang (Fresh Ginger), decocted and taken. Simmered ginger soup is even better and widely used. Vomiting within three to four days is generally cold vomiting.

Initial spitting up should be regulated. If persistent, it becomes vomiting; if vomiting persists, it becomes retching; if retching persists, it becomes dry heaving. At this stage, Stomach Qi is severely deficient, and spirit fades. Prognosis is poor if vomiting persists with worsening fatigue, sunken fontanelle, swollen skull, prominent veins, frequent vomiting without eating, lethargy, aphasia, panting, high fever, or foul-smelling vomitus. Dry heaving (sound without matter) is critical and untreatable in chronic illness.

For vomiting where medicines/food are rejected, make pills from ginger soup and earth, insert into nostrils, and slowly instill medicine.

Baitu Tang (White Tiger Decoction): Treats heat vomiting.
Shigao (Gypsum Fibrosum, 1 qian), Cundong (Ophiopogon Tuber, 1 qian), Jingmi (Rice Grain, 1 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian).

Mengjue Lizhong Tang: Treats cold vomiting.
Huangqi (Astragalus Root, 1 qian), Jiaozhu (Charred Atractylodes Macrocephala Rhizome, 1 qian), Ganjiang (Dried Ginger, 1 qian), Fuzi (Prepared Aconite Lateral Root, 0.5 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian), Dazao (Jujube, 1 piece).

Liujunzi Tang (See previous cough formula): Treats deficiency vomiting.

*Jicheng* Huoxiang Zhengqi San: Treats internal Spleen/Stomach damage, external wind-cold, vomiting, diarrhea, cholera-like syndromes.
Huoxiang Geng (Agastache Stem), Jiayelu (Perilla Leaf), Dafupi (Areca Peel), Guang Chenpi (Broad-leaved Tangerine Peel), Ya Jiegeng (Platycodon Root), Faxia (Prepared Pinellia Rhizome), Fuling (Poria), Shenqu (Medicated Leaven), Baizhi (Angelica Dahurica Root) (each 1 qian), Chuanpu (Magnolia Bark), Zhi Gancao (Honey-fried Licorice Root) (each 0.5 qian), Shengjiang (Fresh Ginger, 1 qian), Dazao (Jujube, 1 piece).
Grind to powder, take with ginger-date decoction or decoct as needed.

Wuling San (See previous cough formula).

*Jicheng* Houxian Tang: Treats heat vomiting.
Chuan Huanglian (Coptis Rhizome), Ziyoupu (Magnolia Bark), Huoxiang Ye (Agastache Leaf), Shengjiang (Fresh Ginger), Dazao (Jujube).

*Jicheng* Shenxiang San: Treats Stomach deficiency vomiting unresponsive to other drugs.
Renshen (Ginseng Root, sliced and dried), Chenxiang (Agarwood, powdered), Gong Dingxiang (Male Clove), Huoxiang Gen (Agastache Root, roasted), Guang Muxiang (Costus Root, shredded).
Equal parts, grind to fine powder, take with Chaomua (Papaya) decoction.

Liuyi San
Xihuaishi (Western Talcum, 6 qian, powdered, water-floted), Gancao (Licorice Root, 1 qian).
Grind to fine powder, take with Yin-Yang Water.

*Jicheng* Xiaoji Wan: Treats vomiting due to food stagnation in the epigastrium.
Xisharen (Western Amomum Fruit, 13 pieces, wine-fried), Gong Dingxiang (Male Clove, 9 pieces), Wumei Rou (Dark Plum Flesh, 3 pieces, steamed and pitted), Badou Ren (Croton Seed Kernel, 1 piece, roasted to remove oil).
Grind to powder, bind with rice paste into pills the size of mung beans, take with plain boiled water.

*Jicheng* Zhijie Erchen Tang
Zhike (Bitter Orange Fruit, 1 qian), Jiegeng (Platycodon Root, 1 qian), Chenpi (Tangerine Peel, 1 qian), Banxia (Pinellia Rhizome, 1 qian), Fuling (Poria, 1 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian), Shengjiang (Fresh Ginger, 1 qian), Dazao (Jujube, 1 piece).

Tu Weisheng commented: Chen Feixia’s discussion on syndromes and treatments in this section is largely imprecise, inferior to Zhou Mengjue’s elegance and purity. For instance, stating that cold and heat vomiting always stem from food retention erases the principles of how cold and heat cause vomiting. Cold is cold, heat is heat, and food is food. Even if cold/heat stems from food, it is not exclusively so. If it were exclusively food-related, why are his prescribed Lizhong Tang and Wuling San not digestive formulas? Huoxiang Zhengqi San primarily disperses cold, eliminates stagnation, and moves Qi. If a patient is not affected by cold but has internal food retention or seasonal pestilence Qi, these formulas would fail. Regarding heat vomiting with whole-body heat and irritability, prescribing Wuling San is confusing. Wuling San treats failure to transform cold-water; although symptoms include heat and thirst, these are marked heat signs due to water retention preventing fluid distribution. If Guizhi (Cinnamon Twig) can treat heat vomiting, could Huanglian (Coptis Rhizome) and Zhimu (Anemarrhena Rhizome) treat cold vomiting? Thus, Zhou Mengjue is superior. However, one must know that Kidney Water deficiency with deficient fire attacking the Spleen/Stomach can cause vomiting. I once treated a refractory vomiting case with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) with added Guizhi and Fuzi, achieving recovery. This shows vomiting is not solely due to Spleen/Stomach deficiency-cold, nor solely due to Liver/Kidney deficiency-heat. Physicians must apply reasoning flexibly.