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In cases of vomiting caused by Stomach deficiency, the symptoms vary, and careful differentiation is required. If there is no distension in the epigastrium, it indicates that pathogenic excess is not present. If there is no pain in the chest and diaphragm, it indicates that Qi rebellion is not the cause. If there is no internal heat and restlessness, it indicates that a Fire syndrome is not present. If there are no exterior signs of aversion to cold and fever, it indicates that an exterior pathogen is not involved. When vomiting occurs suddenly without food retention or internal heat, it is due to Stomach deficiency. When vomiting is irregular, occurring intermittently, it is due to Stomach deficiency. When food does not stagnate in the stomach, yet the smell of food triggers vomiting, it is due to Stomach deficiency. When Qi does not rebel, yet the smell of odors triggers vomiting, it is also due to Stomach deficiency. When one feels coldness in the back or body, or vomits immediately after consuming slightly cool food or drink, it is due to Stomach deficiency. When one experiences acid regurgitation, belching with a putrid odor, frequent nausea, inner discomfort (Wuwuran), and a sensation of rising nausea with unrelenting coldness in the throat, it is due to Stomach deficiency. When improper treatment of illness leads to the erroneous use of purgative or cold-natured herbs, causing vomiting where none existed before, it is due to Stomach deficiency. When morning food is vomited in the evening, or evening food in the morning, indicating that food entering the Middle Jiao fails to digest, it is due to Stomach deficiency. When food entering the Lower Jiao fails to digest, it is because the Mother of Earth (Kidney Yang/Mingmen) lacks Yang, constituting a deficiency of Mingmen fire. All such deficiency syndromes must be treated with tonification; this is indeed correct. However, the Stomach belongs to Earth, which cannot generate life without Fire, nor transform substances without warmth. Therefore, Cold Earth is equivalent to Deficient Earth, and Deficient Earth is equivalent to Deficient Fire. Thus, it is said that the Spleen prefers warmth and dislikes cold, and Earth dislikes dampness and prefers dryness. For this reason, Li Dongyuan specifically emphasized warm-tonifying methods in his *Treatise on the Spleen and Stomach* (*Piwei Lun*), which was established specifically for regulating Stomach Qi; how can this be ignored? Liu Hejian argued that vomiting is caused by Stomach Fire, representing an excess condition due to excessive Fire. I argue that vomiting is caused by Stomach Cold, representing a deficiency condition due to excessive Cold. One discusses Heat, the other Cold; both seem to deviate from the theory of harmony. It is not that I deny the existence of vomiting caused by Fire, but rather that vomiting caused by Fire is rare, while that caused by Cold is common; vomiting due to Stomach Excess is rare, while that due to Stomach Deficiency is common. Hence, this differentiation is necessary.

First: The treatment of deficiency vomiting should primarily focus on warming the Stomach and tonifying the Spleen. Renshen Lizhong Tang (Ginseng and Atractylodes Macrocephala Decoction) is the standard treatment. Alternatively, Wenwei Yin (Stomach-Warming Drink), Shengzhu Jian (Sage and Atractylodes Decoction), or Shenjiang Yin (Ginseng and Ginger Drink) may be used酌情ly. Among these, Huangya Wan (Yellow Sprout Pill) is particularly excellent. In cases of severe Stomach Cold, Fuzi Lizhong Tang (Aconite and Ginseng Decoction), Siwei Huiyang Yin (Four-Ingredient Decoction to Restore Yang), or Yiqi Dan (Single-Qi Pill) should be used. If the deficiency lies in the Yin aspect, with water flooding to form Phlegm leading to vomiting, Jinshui Liujun Jian (Metal-Water Six-Gentlemen Decoction) is indicated. In cases of severe deficiency, Liyin Jian (Nourishing Yin Decoction) or Liuwei Huiyang Yin (Six-Ingredient Decoction to Restore Yang) should be used. For chronic illness resulting in Stomach deficiency and inability to accept food, the aforementioned methods should be applied酌情ly. If Stomach Qi is mildly deficient and accompanied by Phlegm, Liujunzi Tang (Six-Gentlemen Decoction) is the primary treatment.

Second: In cases of vomiting due to poisoning, one must identify the specific toxin. If vomiting results from Heat toxins, bitter-cold agents should be used to resolve the toxicity. If vomiting and diarrhea persist due to Yin-Cold toxins, warm-hot agents should be used to resolve the toxicity. If the spleen and Stomach become deficient due to severe vomiting and diarrhea, vigorous warm-tonification is essential. This category includes vomiting and diarrhea caused by Cold-toxin poisoning; the treatment for this is described later and should be read in conjunction.