【歌】得食即吐知为火，停久而来却是寒。久病胃虚因不纳，或缘气逆与停痰。食填胃口多生呕，新谷如
何得下关。欲辨寒热虚实候，大微迟数脉中参。
【论】有声有物曰呕，有物无声曰吐，有声无物曰干呕，皆主于脾胃。有胃寒者；有胃热者；有胃虚者；
有痰隔者；有气滞者；有食郁热之不同，在乎参之以脉，验之以证，则
虚实冷热之形无所逃矣。
【脉】呕吐无它，寸紧滑数。微数血虚，单浮胃薄。芤则有瘀，最忌涩数。
胃热
得食即呕，胃火也，脉必数而口渴，二陈加姜炒芩、连。火上冲，食已暴吐，和中桔梗汤，荆黄散调槟榔末。
和中桔梗汤
治气热上冲，食已暴吐，脉洪数。
茯苓（一钱） 半夏（七分，泡） 陈皮（八分） 白术（炒，八分） 生姜（五片） 枳实（炒，八
分） 浓朴（姜炒，八分） 桔梗（八分）
上锉，一剂，水二钟，煎至八分，空心温服。
荆黄散
治上焦气热所冲，暴吐。
荆芥（二钱） 人参（一钱） 甘草（五分） 大黄（六分）
上锉，一剂，水煎，调槟榔末一钱，磨木香五分，温服。
胃寒
食积为寒所逆，停久而吐者，脉必迟，理中汤加半夏、木香、姜汁，或紫沉丸。胃寒呕吐清水者，二陈
汤加丁香、砂仁。
理中汤（方见中寒。）
紫沉丸
沉香（三钱） 槟榔（三钱） 紫苏梗（五钱） 益智（去壳，炒，一两） 神曲（五钱） 麦芽（五
钱） 白术（五钱） 乌药（五钱） 香附（炒，五钱） 陈皮（一两） 浓朴（姜炒，一两） 甘草（炙，三钱）
上为末，水丸，砂仁汤送下三钱。
胃虚
胃虚不能纳食而吐者，脉必微，六君子汤加丁香、砂仁。
饮食伤脾胃而吐者，枳术丸、枳术二陈汤加香附、砂仁。饮酒伤胃，呕吐不止者，葛花解酲汤。
六君子汤（方见伤食。）
枳术丸（方见脾胃。）
枳术二陈汤
即二陈加枳实、白术。（方见痰证。）
葛花解酲汤（方见内伤。）
食郁
停宿食不克化，新壳不化而反出，脉沉，瓜蒂散或保和丸。食郁，饮食不消，填塞胃口而呕吐者，二陈汤
加神曲、山楂、姜炒黄连、浓朴、枳实。
瓜蒂散（方见痰证。）
保和丸（方见伤食。）
痰气
因痰气壅滞胃口，食不下而作呕者，二陈汤加竹沥、姜汁、枳实、栝蒌。脉沉，瓜蒂散。痰在胸中，呕哕，
温胆汤。气逆，枳桔二陈汤。
二陈汤（方见痰证。）
枳桔二陈汤
即二陈加枳壳、桔梗。
温胆汤
即二陈加竹茹、枳壳。
[Song] Vomiting immediately after eating indicates Fire; vomiting after food has remained for a long time indicates Cold. In chronic illness, deficiency of the Stomach leads to an inability to receive and digest food, causing vomiting; alternatively, it may be due to rebellious Qi or retained Phlegm. Food stagnating in the stomach often causes vomiting; how can new grain pass through the贲门 (cardia)? To distinguish between Cold, Heat, Deficiency, and Excess patterns, one must consult the pulse characteristics: subtle, slow, or rapid.
[Discussion] "Ou" (vomiting with sound) involves both sound and material expulsion; "Tu" (spitting up without sound) involves material expulsion without sound; "Gan Ou" (dry heaving) involves sound without material. All these are primarily governed by the Spleen and Stomach. Etiologies include: Stomach Cold; Stomach Heat; Stomach Deficiency; Phlegm obstruction; Qi stagnation; and Food stagnation transforming into Heat. These conditions vary significantly. The key lies in correlating the pulse findings with clinical signs, thereby revealing the nature of Deficiency/Excess and Cold/Heat without concealment.
[Pulse Diagnosis] For vomiting, there are no other pulses besides those at the Cun position being Tight, Slippery, or Rapid. A Subtle and Rapid pulse suggests Blood deficiency; a solitary Floating pulse suggests thin Stomach Qi. A Knotted (Kou) pulse suggests blood stasis; a Choppy and Rapid pulse is most contraindicated.
Stomach Heat
Vomiting immediately after eating is caused by Stomach Fire. The pulse will necessarily be Rapid, accompanied by thirst. Use Er Chen Tang (Two-Aged Decoction) added with Ginger-fried Huang Qin (Scutellariae Radix) and Lian Zi (Coptidis Rhizoma). If Fire flares upward causing sudden violent vomiting after eating, use He Zhong Jie Geng Tang (Middle Harmonizing Platycodon Decoction), and administer Jing Huang San (Jingjie and Rhubarb Powder) mixed with Arecae Semen powder.
He Zhong Jie Geng Tang (Middle Harmonizing Platycodon Decoction)
Treats rebellious Qi-Heat from above causing sudden violent vomiting after eating, with a Surging and Rapid pulse.
Fuling (Poria) (1 qian) Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine) (7 fen, soaked) Chenpi (Citri Reticulatae Pericarpium) (8 fen) Baizhu (Atractylodis Macrocephalae Rhizoma) (stir-fried, 8 fen) Shengjiang (Zingiberis Rhizoma Recens) (5 slices) Zhishi (Aurantii Fructus Immaturus) (stir-fried, 8 fen) Houpo (Magnoliae Officinalis Cortex) (Ginger-juice fried, 8 fen) Jiegeng (Platycodonis Radix) (8 fen)
Crush the herbs. For one dose, add two zhong of water, decoct until eight fen remains, and take warm on an empty stomach.
Jing Huang San (Jingjie and Rhubarb Powder)
Treats sudden vomiting caused by Qi-Heat rushing from the Upper Jiao.
Jingjie (Schizonepetae Spica) (2 qian) Renshen (Ginseng Radix et Rhizoma) (1 qian) Gancao (Glycyrrhizae Radix et Rhizoma) (5 fen) Dahuang (Rhei Radix et Rhizoma) (6 fen)
Crush the herbs. For one dose, decoct in water, mix with 1 qian of Arecae Semen powder and 5 fen of ground Muxiang (Aucklandiae Radix), and take warm.
Stomach Cold
When food accumulation is reversed by Cold and vomited after remaining for a long time, the pulse will necessarily be Slow. Use Li Zhong Tang (Regulate the Middle Decoction) added with Banxia (Pinelliae Rhizoma), Muxiang (Aucklandiae Radix), and Jiangzhi (Zingiberis Rhizoma Juice), or Zichen Wan (Purple Sandalwood Pill). For Stomach Cold causing vomiting of clear fluid, use Er Chen Tang (Two-Aged Decoction) added with Dingxiang (Caryophylli Flos) and Sharen (Amomi Fructus Rotundus).
Li Zhong Tang (Regulate the Middle Decoction) (See formula under Middle Cold.)
Zichen Wan (Purple Sandalwood Pill)
Chenxiang (Aquilariae Lignum Resinatum) (3 qian) Binglang (Arecae Semen) (3 qian) Zisugeng (Perillae Caulis) (5 qian) Yizhiren (Alpiniae Oxyphyllae Fructus) (shelled, stir-fried, 1 liang) Shenqu (Massa Medicata Fermentata) (5 qian) Maiya (Hordei Fructus Germinatus) (5 qian) Baizhu (Atractylodis Macrocephalae Rhizoma) (5 qian) Wuyao (Linderae Radix) (5 qian) Xiangfu (Cyperi Rhizoma) (stir-fried, 5 qian) Chenpi (Citri Reticulatae Pericarpium) (1 liang) Houpo (Magnoliae Officinalis Cortex) (Ginger-juice fried, 1 liang) Gancao (Glycyrrhizae Radix et Rhizoma) (roasted, 3 qian)
Grind into fine powder, make into water pills, and take 3 qian with Amomi Fructus Rotundus decoction.
Stomach Deficiency
When Stomach Deficiency prevents receiving food, leading to vomiting, the pulse will necessarily be Subtle. Use Liu Jun Zi Tang (Six Gentlemen Decoction) added with Dingxiang (Caryophylli Flos) and Sharen (Amomi Fructus Rotundus).
For vomiting due to dietary injury to the Spleen and Stomach, use Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) or Zhi Zhu Er Chen Tang (Immature Bitter Orange, Atractylodes, and Two-Aged Decoction) added with Xiangfu (Cyperi Rhizoma) and Sharen (Amomi Fructus Rotundus).
For vomiting that does not cease due to alcohol injuring the Stomach, use Ge Hua Jie Cheng Tang (Flos Hedysari Decoction to Relieve Intoxication).
Liu Jun Zi Tang (Six Gentlemen Decoction) (See formula under Food Injury.)
Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Pill) (See formula under Spleen and Stomach.)
Zhi Zhu Er Chen Tang (Immature Bitter Orange, Atractylodes, and Two-Aged Decoction)
This is Er Chen Tang (Two-Aged Decoction) added with Zhishi (Aurantii Fructus Immaturus) and Baizhu (Atractylodis Macrocephalae Rhizoma). (See formula under Phlegm Syndrome.)
Ge Hua Jie Cheng Tang (Flos Hedysari Decoction to Relieve Intoxication) (See formula under Internal Injury.)
Food Stagnation (Yu)
When retained food cannot be digested, and new intake fails to digest and is regurgitated, the pulse is Deep. Use Gua Di San (Melon Seed Powder) or Bao He Wan (Preserve Harmony Pill). For Food Stagnation where indigestion fills the stomach causing vomiting, use Er Chen Tang (Two-Aged Decoction) added with Shenqu (Massa Medicata Fermentata), Shanzha (Crataegi Fructus), Ginger-fried Huanglian (Coptidis Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Zhishi (Aurantii Fructus Immaturus).
Gua Di San (Melon Seed Powder) (See formula under Phlegm Syndrome.)
Bao He Wan (Preserve Harmony Pill) (See formula under Food Injury.)
Phlegm-Qi
When Phlegm-Qi obstructs and blocks the stomach entrance, preventing food from descending and causing nausea/vomiting, use Er Chen Tang (Two-Aged Decoction) added with Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis Rhizoma Juice), Zhishi (Aurantii Fructus Immaturus), and Gualou (Trichosanthis Fructus). If the pulse is Deep, use Gua Di San (Melon Seed Powder). If Phlegm is in the Chest causing vomiting and hiccups, use Wen Dan Tang (Warm the Gallbladder Decoction). If Qi is rebellious, use Zhi Ju Er Chen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction).
Er Chen Tang (Two-Aged Decoction) (See formula under Phlegm Syndrome.)
Zhi Ju Er Chen Tang (Immature Bitter Orange, Tangerine Peel, and Two-Aged Decoction)
This is Er Chen Tang (Two-Aged Decoction) added with Zhike (Aurantii Fructus) and Jiegeng (Platycodonis Radix).
Wen Dan Tang (Warm the Gallbladder Decoction)
This is Er Chen Tang (Two-Aged Decoction) added with Zhuru (Bambusae Caulis in Taenia) and Zhike (Aurantii Fructus).