王太仆曰∶内格呕逆，食不得入，是有火也；病呕而吐，食入反出，是无火也。
《金匮要略》曰∶先呕却渴者，此为欲解。先渴却呕者，为水停心下，此属饮家。呕家
本渴，今反不渴者，以心下有支饮故也，此属支饮。问曰∶病患脉数，数为热，当消谷引食
，而反吐者，何也？曰∶以发其汗，令阳微，膈气虚，脉乃数，数为客热，不能消谷，胃中
虚冷故也。脉弦者，虚也，胃气无余，朝食暮吐，变为胃反。寒在于上，医反下之，今脉反
弦，故名曰虚。病患欲吐者，不可下之。呕而胸满者，茱萸汤主之。呕而吐涎沫，头痛者，
茱萸汤主之。呕而肠鸣，心下痞者，半夏泻心汤主之。干呕而痢者，黄芩半夏生姜汤主之。
诸呕吐谷不得下者，小半夏汤主之。呕吐而病在膈上，后思水者，解，急与之。思水者，猪
苓散主之。呕而脉弱，小便复利，身有微热，见厥者难治，四逆汤主之。呕而发热者，小柴
胡汤主之。胃反呕吐者，大半夏汤主之。食已即吐者，大黄甘草汤主之。胃反吐而渴欲饮水
者，茯苓泽泻汤主之。干呕吐逆，吐涎沫者，半夏干姜散主之。病患胸中似喘不喘，似呕不
呕，似哕不哕，彻心中愦愦然无奈者，生姜半夏汤主之。干呕哕，若手足厥者，橘皮汤主之
。
朱丹溪曰∶胃中有热，膈上有痰者，二陈汤加炒山栀、黄连、生姜。有久病呕者，胃虚
不纳谷也，用人参、生姜、黄 、白术、香附之类。呕吐，朱奉议以半夏、橘皮、生姜为主
。刘河间谓呕者，火气炎上，此特一端耳。有痰膈中焦，食不得下者。有气逆者。有寒气郁
于胃口者。有食滞心肺之分，新食不得下而反出者。有胃中有火与痰而呕者。呕吐药忌栝蒌
、杏仁、桃仁、萝卜子、山栀，皆能作吐。肝火出胃，逆上呕吐者，抑青丸。夏月呕吐
不止，五苓散加姜汁。吐虫，用炒锡灰、槟榔末，米饮服。胃中有热者，二陈汤加姜、苓、
连。恶心有热，有痰，有虚，皆用生姜入药。
薛立斋曰∶若脾胃气虚，而胸膈不利者，用六君子汤壮脾土，生元气。若过服辛热之剂
，而呕吐噎膈者，用六君子加芎、归，益脾土以抑阴火。胃火内格，而饮食不入者，用六君
子加苓、连，清热养胃。若病呕吐，食入而反出者，用六君子加木香、炮姜，温中补脾。若
服耗气之剂，血无所生，而大便燥结者，用四君子加芎、归，补脾生血。若火逆冲上，食不
得入者，用四君子加山栀、黄连，清热养血。若痰饮阻滞，而食不得入者，用六君子加木香
、山栀，补脾化痰。若脾胃虚寒，饮食不入，或入而不化者，用六君子加木香、炮姜，温补
脾胃，更非慎房劳、节浓味、调饮食者，不治，年高无血者，亦不治。
徐东皋曰∶胃虚呕吐，恶食不思食，兼寒者恶寒，或食久还吐，或朝食暮吐，暮食朝吐
，脉迟而微涩，此皆虚寒者也，宜藿香安胃散、理中汤，甚者，丁香煮散温补。胃中郁热，
饮食积滞而呕者，则恶食恶寒，烦闷膈满，或渴喜凉，闻食则吐，服药亦吐，脉洪大而数，
此皆实热者也，宜竹茹汤、麦门冬汤清之。若食积多者，用二陈加神曲、麦芽、黄连，保和
丸之类消导之。
Wang Bing (Wang Taipu) stated: Food rejection with vomiting and regurgitation, where food cannot enter, indicates the presence of Fire; illness presenting with vomiting and expulsion of food, where food is eaten but subsequently vomited out, indicates the absence of Fire (referring to deficiency-cold).
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: Vomiting followed by thirst indicates that the disease is about to resolve. Thirst followed by vomiting indicates water retention in the heart region (epigastrium), which belongs to the category of Fluid Retention disorders. Patients who frequently vomit should naturally feel thirsty; if they do not feel thirsty now, it is due to Branching Fluid Retention (fluid retained in the chest and diaphragm), which belongs to the category of Branching Fluid Retention disorders. Question: A patient has a rapid pulse. Rapid pulses indicate Heat, which should promote digestion and appetite, yet the patient vomits instead. Why? Answer: This is caused by excessive sweating, which weakens Yang Qi and depletes Qi in the Diaphragm, resulting in a rapid pulse. This rapidness represents Guest Heat (transient or external heat), which cannot digest food, due to deficiency-cold in the Stomach. A wiry pulse indicates Deficiency, meaning there is no surplus of Stomach Qi. Food eaten in the morning is vomited in the evening, evolving into Fan Reversal of the Stomach. Cold located in the Upper Jiao, treated incorrectly with purgatives, results in a wiry pulse, hence named Deficiency. If a patient desires to vomit, purgatives must not be used. Vomiting accompanied by chest fullness is primarily treated with Zhuyu Tang (Cornus Decoction). Vomiting with salivation and headache is primarily treated with Zhuyu Tang (Cornus Decoction). Vomiting with borborygmus and epigastric stuffiness is primarily treated with Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium). Dry retching accompanied by dysentery is primarily treated with Huangqin Banxia Shengjiang Tang (Scutellaria, Pinellia, and Fresh Ginger Decoction). Various types of vomiting where grain cannot go down are primarily treated with Xiaobanxia Tang (Minor Pinellia Decoction). Vomiting with pathology above the diaphragm, followed by a desire for water, indicates resolution; give water immediately. For those desiring water, Zhuling San (Polyporus Powder) is primarily used. Vomiting with a weak pulse, free urination, slight body heat, and cold extremities is difficult to treat and is primarily managed with Sini Tang (Frigid Extremities Decoction). Vomiting with fever is primarily treated with Xiaochaihu Tang (Minor Bupleurum Decoction). Fan Reversal of the Stomach with vomiting is primarily treated with Dabanxia Tang (Major Pinellia Decoction). Vomiting immediately after eating is primarily treated with Dahuang Gancao Tang (Rhubarb and Licorice Decoction). Fan Reversal of the Stomach with vomiting and thirst for drinking water is primarily treated with Fuling Zexie Tang (Poria and Alisma Decoction). Dry retching, regurgitation, and spitting saliva are primarily treated with Banxia Ganjiang San (Pinellia and Dried Ginger Powder). When a patient feels as if panting but not panting, as if vomiting but not vomiting, as if hiccoughing but not hiccoughing, and feels profoundly distressed and helpless in the heart region, Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction) is primarily used. Dry retching and hiccoughs, if accompanied by cold extremities, are primarily treated with Ju Pi Tang (Tangerine Peel Decoction).
Zhu Danxi stated: For Heat in the Stomach and Phlegm above the Diaphragm, Erchen Tang (Two-Cured Decoction) is modified with stir-fried Gardenia, Coptis, and Fresh Ginger. For chronic vomiting due to Stomach Deficiency failing to receive grain, Ren Shen, Fresh Ginger, Astragalus, Atractylodes, and Cyperus are used. Regarding vomiting, Zhu Fengyi emphasized Pinellia, Tangerine Peel, and Fresh Ginger as main herbs. Liu Hejian considered vomiting as Fire Qi flaring upward, which is only one aspect. Other cases include Phlegm obstructing the Middle Jiao preventing food descent, Qi rebellion, Cold Qi stagnating at the Stomach opening, Food Stagnation between the Heart and Lungs preventing new food from descending and causing regurgitation, and vomiting due to Fire and Phlegm in the Stomach. Medications for vomiting should avoid Trichosanthes Root, Apricot Seed, Peach Kernel, Radish Seed, and Gardenia, as all can induce vomiting. For Liver Fire invading the Stomach and rebelling upward causing vomiting, Yiqing Wan (Suppress Blue Pill) is used. For continuous vomiting in summer, Wuling San (Five-Ingredient Powder with Poria) with Ginger Juice is used. For vomiting worms, Stir-fried Tin Ash and Areca Seed powder taken with Rice Drink are used. For Heat in the Stomach, Erchen Tang (Two-Cured Decoction) is modified with Ginger, Poria, and Coptis. For nausea with Heat, Phlegm, or Deficiency, Ginger is always included in the prescription.
Xue Lizhai stated: For Spleen and Stomach Qi Deficiency with discomfort in the chest and diaphragm, Liujunzi Tang (Six-Gentlemen Decoction) is used to strengthen Spleen Earth and generate Original Qi. For vomiting and dysphagia caused by overuse of acrid-hot agents, Liujunzi Tang (Six-Gentlemen Decoction) is modified with Ligusticum and Angelica to nourish Spleen Earth and suppress Yin Fire. For internal blockage by Stomach Fire preventing food intake, Liujunzi Tang (Six-Gentlemen Decoction) is modified with Poria and Coptis to clear Heat and nourish the Stomach. For vomiting where food is eaten but expelled, Liujunzi Tang (Six-Gentlemen Decoction) is modified with Aucklandia and Roasted Ginger to warm the Middle and tonify the Spleen. For blood generation failure and dry stool constipation due to agents that consume Qi, Sijunzi Tang (Four-Gentlemen Decoction) is modified with Ligusticum and Angelica to tonify the Spleen and generate Blood. For rebellious Fire rushing upward preventing food intake, Sijunzi Tang (Four-Gentlemen Decoction) is modified with Gardenia and Coptis to clear Heat and nourish Blood. For obstruction by Phlegm-Fluid preventing food intake, Liujunzi Tang (Six-Gentlemen Decoction) is modified with Aucklandia and Gardenia to tonify the Spleen and transform Phlegm. For Spleen and Stomach Deficiency-Cold preventing food intake or causing indigestion, Liujunzi Tang (Six-Gentlemen Decoction) is modified with Aucklandia and Roasted Ginger to warm and tonify the Spleen and Stomach. Without careful regulation of sexual activity, moderation of rich flavors, and dietary adjustment, treatment will fail; likewise, elderly patients without Blood cannot be cured.
Xu Donggao stated: Stomach Deficiency vomiting with aversion to food and lack of appetite, combined with Cold signs like aversion to cold, or delayed vomiting of food, or morning food vomited in the evening, evening food vomited in the morning, with a slow and slightly choppy pulse, are all Deficiency-Cold patterns. Huoxiang Anwei San (Agastache Stomach-Anchoring Powder) and Lizhong Tang (Regulate the Middle Decoction) are appropriate; severe cases require Dingxiang Zhusan (Clove Boiled Powder) for warming and tonifying. Stomach郁 Heat with Food Stagnation causing vomiting presents with aversion to food and cold, irritability and chest fullness, thirst preferring cool drinks, vomiting upon smelling food or taking medicine, and a surging and rapid pulse; these are Excess-Heat patterns, treated with Zhuru Tang (Bamboo Shave Decoction) or Maidong Tang (Ophiopogon Decoction) to clear Heat. For significant Food Stagnation, Erchen Tang (Two-Cured Decoction) is modified with Medicated Leaven, Malt, and Coptis, or Baohe Wan (Preserve Harmony Pill) is used to guide out stagnation.