声与物俱出为呕。有物无声为吐。有声无物为哕。气自脐下冲逆有声。声短而频。古人
名哕又名咳逆为呃。方书命名各异。今从俗本分名。使人易晓。
脉阳紧阴数为吐。阳浮而数亦吐。寸紧尺涩胸满而吐。寸口脉数者。吐。紧而涩者难治。
紧而滑者吐逆。脉弱而呕。小便复利。身有微热见厥者。难治。 吐出色如青菜者。危。
上四症。皆属气逆。有统治之法。宜二陈汤。随症加减。（八十二）
如为寒气所客。脉迟畏寒。加砂仁藿香干姜○如干呕吐涎沫。加人参一钱。吴茱萸二钱。
大枣三枚。倍生姜。○如食不得入。为火阻于上。加黄连黄芩人参。○如为饮食所伤。吞酸
嗳腐。加苍术藿香砂仁麦芽山楂。○如有声无物。加生竹茹二钱。人参一钱。旋复花三钱。
代赭石一钱五分。大枣二粒。如吐酸水。加吴茱萸一钱。黄连五分。○如脾胃虚弱。运化迟
而呕吐者。加人参白术砂仁木香。○如食已即吐。是胃中有热。食入则两热相冲。不得停留
而吐。若大便秘结。可加大黄三钱。○若寒热往来。胁痛而呕者。为少阳症。加人参黄芩各
一钱。柴胡三钱。大枣二粒。○如骤然发呃者。为胃火上冲。加麦芽石斛麦冬枇杷叶竹茹扁
豆各二钱。○久病发呃。有脾虚肾虚之分。脾虚者。加参术丁香柿蒂。肾虚者。加参附干姜
沉香巴戟天。此症多死。○如吐虫者。去甘草。加川椒人参吴茱萸黄连川楝子乌梅三粒。粳
米一百粒。
When sound and food are expelled simultaneously, it is termed *Ou* (vomiting with sound). When food is expelled without sound, it is termed *Tu* (vomiting without sound). When there is sound but no food expelled, it is termed *Yue* (hiccoughing or retching). When Qi rushes upward from below the navel accompanied by sound, and the sound is short and frequent, ancient texts named this *Yue*, also called *Ke Ni* (coughing against reverse flow), which corresponds to modern *E* (hiccups). Medical books have varied in their naming conventions; today, we follow common usage to distinguish these terms for clarity.
A pulse that is tight in the Yang position and rapid in the Yin position indicates vomiting. A floating and rapid pulse also indicates vomiting. A tight pulse at the Cun (inch) position and a choppy pulse at the Chi (cubit) position, accompanied by chest fullness and vomiting, indicate vomiting. A rapid pulse at the Cun Kou (radial artery) indicates vomiting. A pulse that is tight and choppy is difficult to treat. A pulse that is tight and slippery indicates vomiting and counterflow. A weak pulse with vomiting, clear urination, slight fever, and cold extremities indicates a difficult-to-treat condition. Vomiting material resembling green vegetables signifies a critical condition.
The above four symptoms all belong to rebellious Qi. There is a general treatment principle: Er Chen Tang (Two-Aged Decoction) is appropriate, modified according to specific symptoms. (Article 82)
If caused by invasion of Cold pathogen, with a slow pulse and aversion to cold, add Amomi Fructus Rotundus (Sharen, 砂仁), Agastaches Herba (Huoxiang, 藿香), and Zingiberis Rhizoma Recens (Ganjiang, 干姜). ○ If dry heaving occurs with expulsion of saliva, add Ginseng Radix et Rhizoma (Renshen, 人参) 1 qian, Evodiae Fructus (Wuzhuyu, 吴茱萸) 2 qian, Jujubae Fructus (Dazao, 大枣) 3 pieces, and double the dosage of Zingiberis Rhizoma Recens (Shengjiang, 生姜). ○ If food cannot enter due to Fire pathogen obstructing the Upper Jiao, add Coptidis Rhizoma (Huanglian, 黄连), Scutellariae Radix (Huangqin, 黄芩), and Ginseng Radix et Rhizoma (Renshen, 人参). ○ If injured by diet, with acid regurgitation and belching with a putrid odor, add Atractylodis Macrocephalae Rhizoma (Cangzhu, 苍术), Agastaches Herba (Huoxiang, 藿香), Amomi Fructus Rotundus (Sharen, 砂仁), Malto (Maiya, 麦芽), and Crataegi Fructus (Shanzha, 山楂). ○ If there is sound but no expulsion (hiccups/retching), add Bambusae Caulis in Taeniam (Zhuru, 竹茹) 2 qian, Ginseng Radix et Rhizoma (Renshen, 人参) 1 qian, Inulae Flos (Xuanfuhua, 旋复花) 3 qian, Haematitum (Daizheshi, 代赭石) 1.5 qian, and Jujubae Fructus (Dazao, 大枣) 2 pieces. If vomiting acidic water, add Evodiae Fructus (Wuzhuyu, 吴茱萸) 1 qian and Coptidis Rhizoma (Huanglian, 黄连) 0.5 qian. ○ If vomiting is due to Spleen and Stomach deficiency with sluggish transformation and transportation, add Ginseng Radix et Rhizoma (Renshen, 人参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Amomi Fructus Rotundus (Sharen, 砂仁), and Aucklandiae Radix (Muxiang, 木香). ○ If vomiting occurs immediately after eating, this indicates Heat in the Stomach; food entering clashes with the internal heat, preventing retention and causing vomiting. If constipation is present, add Rheii Radix et Rhizoma (Dahuang, 大黄) 3 qian. ○ If alternating chills and fever occur with hypochondriac pain and vomiting, this is Shaoyang Syndrome; add Ginseng Radix et Rhizoma (Renshen, 人参) and Scutellariae Radix (Huangqin, 黄芩) 1 qian each, Bupleuri Radix (Chaihu, 柴胡) 3 qian, and Jujubae Fructus (Dazao, 大枣) 2 pieces. ○ If hiccups suddenly appear, this indicates Stomach Fire rushing upward; add Malto (Maiya, 麦芽), Dendrobii Caulis (Shihu, 石斛), Ophiopogonis Radix (Maidong, 麦冬), Loquat Leaf (Pipaye, 枇杷叶), Bambusae Caulis in Taeniam (Zhuru, 竹茹), and Dolichoris Semen (Biandou, 扁豆) 2 qian each. ○ Hiccups occurring in chronic illness are differentiated into Spleen deficiency and Kidney deficiency. For Spleen deficiency, add Ginseng Radix et Rhizoma (Renshen, 人参), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Tsaoko Cardamomi Fructus (Dingxiang, 丁香), and Diospyros Fructus (Shidi, 柿蒂). For Kidney deficiency, add Ginseng Radix et Rhizoma (Renshen, 人参), Aconiti Lateralis Radix Praeparata (Fuzi, 附子), Zingiberis Rhizoma Recens (Ganjiang, 干姜), Aquilariae Lignum Resinatum (Chenxiang, 沉香), and Morindae Officinalis Radix (Bajitian, 巴戟天). This condition often proves fatal. ○ If vomiting worms occurs, remove Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), and add Zanthoxyli Fructus (Chuanjiao, 川椒), Ginseng Radix et Rhizoma (Renshen, 人参), Evodiae Fructus (Wuzhuyu, 吴茱萸), Coptidis Rhizoma (Huanglian, 黄连), Akebiae Caulis (Chuanlianzi, 川楝子), Mume Fructus (Wumei, 乌梅) 3 pieces, and Oryza Sativa (Jingsmi, 粳米) 100 grains.