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The so-called "Ge Qi (Diaphragm Qi) vomiting" in medical formularies refers to the passage in *Nei Jing* (Classic of Internal Medicine) stating that "Qi becomes Upper Ge." The so-called "Ye Ge (Choking and Diaphragm obstruction) vomiting" refers to the passage in *Nei Jing* stating that "The binding of the Three Yang channels causes Ge." Zhang Zhongjing, in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), used Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) to treat phlegm-induced vomiting; this is a formula for treating Ge Qi. He also used Gan Cao Da Huang Tang (Licorice and Rhubarb Decoction) to treat vomiting accompanied by constipation; this is a formula for treating Ye Ge. Li Dongyuan (Jiegu), in *Jia Zhen*, categorized vomiting into upper, middle, and lower types, focusing on Qi accumulation and Cold as the primary pathogenesis; Li Dongyuan further proposed legislation based on acrid-aromatic warming of the Stomach. These belong to the formularies for Ge Qi vomiting, not the syndrome of Ye Ge vomiting. Liu Wansu, citing *Nei Jing* passages such as "All rebellious upward movements belong to Fire," "All vomiting and acid regurgitation belong to Heat," and "All flaccidity, wheezing, and vomiting belong to Heat/Lung," correctly aligned with the meaning of "Three Yang binding with Heat." He elucidated the pathogenesis of Qi stagnation and dysfunction, with Stomach Fire flaming upward causing violent vomiting and inability to swallow food, thus employing San Yi Cheng Qi Tang (Three Yin Modified Cheng Qi Decoction) and similar formulas for treatment. Zhu Danxi also stated that the syndrome of Ye Ge involves Fire-Heat flaming upward, with excessive ascending and insufficient descending, compounded by internal injury leading to deficiency of True Yin and desiccation of body fluids. Therefore, he added Zhu Li (Bamboo Sap), Jing Li (Acanthopanacis Sap), and cattle/sheep milk to Si Wu Tang (Four Substances Decoction) for treatment. He also wrote *Ju Fang Fa Hui* (Elucidation of the Bureau Formulary), vigorously refuting the errors of *Tai Ping Hui Min He Ji Ju Fang* (Formulary of the Public Welfare Pharmacy). These constitute the formularies for Ye Ge vomiting, distinct from the cold-type Ge Qi vomiting. *Nei Jing* clearly treats them as separate entries, and former sages established distinct theoretical frameworks. However, due to the similarity in symptom names, confusion between Ge (diaphragm) and Ge (obstruction), and difficulty distinguishing vomiting types, errors have arisen through transmission. It is unknown that while both are vomiting, there is a distinction between Heat vomiting and Cold vomiting; while both involve phlegm-fluids, there is a difference between Damp Phlegm and Dry Phlegm. Consulting formularies, although both treat "Ge" syndromes, they are divided into Ge Qi and Ye Ge. Comparing with *Nei Jing*, although the discussions appear similar, there is a distinction between "Qi becoming Upper Ge" and "Three Yang binding causing Ge."

Ge Qi vomiting implies no obstruction during eating, but rather occasional bloating after meals, occasional Qi rebellion, or occasional vomiting, which comes and goes intermittently. This differs from Ye Ge, where there is immediate rejection and inability to swallow food upon attempting to eat, followed by direct regurgitation shortly after swallowing. *Nei Jing* states: "The binding of the Three Yang causes Ge." The commentary explains: The Three Yang refer to the Small Intestine, Large Intestine, and Bladder. Binding refers to binding heat. Binding heat in the Small Intestine dries the blood vessels; binding heat in the Large Intestine causes bowel obstruction; binding heat in the Bladder dries up body fluids. With the Three Yang bound at the lower jiao, food must surge upward; this is due to Yang Fire rebelling upward, pushing food down without success. Upon careful examination, mentioning "Three Yang" excludes involvement of the Yin channels; mentioning "binding heat" indicates it is certainly not Yin-Cold. In *Qian Jin Fang* (Thousand Gold Formulas), various prescriptions for Fan Wei (Reverse Stomach) and Ye Ge use Ginger and Cinnamon because Qi stagnates in the clear pathways; thus, bitter-cold herbs like Da Huang (Rhubarb), Mang Xiao (Mirabilite), Shi Gao (Gypsum), Zhu Li (Bamboo Sap), Lu Gen (Reed Rhizome), and Sheng Di Huang Zhi (Fresh Rehmannia Juice) are used, with only slight amounts of Ginger and Cinnamon as guides, not because of Stomach Cold.

Furthermore, Fang Yuezhi’s *Fu Yu Xin Fa* states: The syndrome of Ye Ge is caused by Fire. Etiologies vary: some arise from excessive thinking stirring Spleen Fire; some from excessive anger stirring Liver Fire; some from excessive diet generating Stomach Fire; some from excessive sexual activity raising Kidney Fire. Generally, Fire Qi flaming upward causes steaming and aggregation, drying body fluids, making food flow difficult, resulting in Ye or Ge. Over time, the epigastrium becomes bound and cut off; even if food enters, it stagnates in the diaphragm region, rebels upward, and becomes vomiting. This syndrome must absolutely not be treated with acrid-drying herbs; ingestion will surely lead to death. Since the syndrome belongs to Heat-Dryness, using acrid-drying herbs disperses Qi and consumes Yin, thereby assisting Fire and scorching fluids.

I also consulted Wang Yutai’s *Zhun Sheng* (Standard Guidelines), which mentions that the syndrome of overflow vomiting may result from alcohol injury, food injury, Stomach Wind causing vomiting, or Stomach Heat causing vomiting. Physicians failing to examine these conditions burn ginger in fire and boil cinnamon in soup; when Chen Xiang (Aquilaria Wood) stops, Dou Kou (Cardamom) follows; when Sha Ren (Amomum Fruit) stops, Hu Jiao (Pepper) succeeds; they recklessly apply hot medicines. In individuals with inherent heat, once the Three Yang are bound, food must surge upward. Cang Gong treated this using purgatives. Liu Hewen (Wansu) treated vomiting and Ye Ge food obstruction following Zhang Zhongjing’s Gan Cao Da Huang Tang from the Vomiting chapter, as well as San Yi Cheng Qi Tang, surpassing modern practitioners. However, when administering medication, doses should be accumulated gradually; do not attack abruptly. If phlegm obstructs the throat, slightly use sour substances to gently induce vomiting, then treat the lower jiao accordingly. If ineffective, use honey and salt to guide downward, ensuring communication between the upper and lower pathways, dissipating binding and extinguishing Yang, allowing food to flow smoothly.

I now clarify separately: Ge Qi vomiting and Ye Ge vomiting are distinct syndromes. Ge Qi vomiting involves Cold and Heat, Phlegm and Qi, Dryness and Dampness. Ye Ge vomiting involves only Heat, no Cold; only Dryness, no Dampness; it is solely Three Yang binding heat. Formulas from *Jin Gui Yao Lue*, *Qian Jin Fang*, Jiegu, and Dongyuan for treating Ge Qi vomiting cannot treat Ye Ge syndrome. Formulas from Hewen and Danxi for treating Ye Ge cannot treat Stomach Cold Ge Qi. Zhang Zhongjing’s Xiao Ban Xia Tang treats Wet Phlegm vomiting; Da Huang Gan Cao Tang treats constipation with immediate post-prandial vomiting; Xiao Chai Hu Tang treats vomiting caused by external climatic factors and Shaoyang excess. Later, Jiegu added Qing Dai (Indigo Naturalis) to treat bitter vomiting, adhering to the same principle. Dongyuan’s Ding Xiang Zhu Yu Tang treats Stomach Cold vomiting; *San Yin Fang*’s Mai Men Dong Tang uses Zhu Ru (Bamboo Shavings) and Lu Gen juice to treat Dry-Heat leaking Qi vomiting; Hewen uses Cheng Qi decoctions to treat Ye Ge caused by excessive Heat, rich food accumulation, and exterior excess; Danxi uses Si Wu Tang with sheep/cattle milk to nourish Yin, treating Ye Ge caused by fluid exhaustion and Blood dryness from internal injury; Zhao’s book emphasizes nourishing Yin and heavily using Di Huang Wan (Rehmannia Pill), a method for treating internal injury Ye Ge due to essence depletion, Yin consumption, and insufficiency of True Water in the Kidney channel.

Regarding Dongyuan’s discussion of Ye Sai (Choking Obstruction), it differs again. He states that blocking the throat where Yang Qi cannot exit is called "Sai," and where Yin Qi cannot descend is called "Ye." If Qi rebels in the throat, meridians cease functioning, eyes open wide, breath nearly ceases, one should use herbs with strong Yang aroma to guide Stomach Qi to treat the root. Upon careful reading, his text does not mention rejecting food; instead, it says take it after food digestion, pressing it down with good food. Can one wait for food digestion and press with good food when Ye Sai leads to open mouth and breathlessness? This Ye Sai refers to Ge Qi blockage and Yin-Cold qi obstruction, belonging to the Qi Ye category, not the Ye Ge overflow food, rejected food, Three Yang binding heat syndrome.

Reading *Zhun Sheng*, I see Ge Qi vomiting listed above Ye Ge vomiting as a separate category, and Ye Sai listed below Ye Ge as another separate category, indicating ancients originally made distinctions. Thus, within one syndrome, one must analyze Cold, Heat, Dryness, and Dampness. For instance, *Nei Jing*’s "all vomiting and acid regurgitation" speaks of Heat vomiting, specifically Damp-Heat vomiting; "all flaccidity, wheezing, and vomiting" speaks of Heat vomiting, specifically Dry-Heat vomiting. Though both originate from Heat, Damp and Dry differ vastly. Formularies consider late vomiting (food lingering long before vomiting) as Cold, named Fan Wei (Turning Stomach); early vomiting (vomiting immediately after eating) as Heat, named Fan Wei (Reverse Stomach). Not knowing "Fan" and "Reversal" are synonymous, describing vomiting, one cannot determine Cold or Heat solely by timing. Wang Bing (Tai Pu) had this theory but spoke of general principles, hard to apply to variable symptoms. I often observe sudden vomiting is mostly Heat; even prolonged vomiting contains Heat cases. Spleen-Stomach Damp-Heat causes food to fail digestion, steaming and aggregating, phlegm-fluids wrapping and failing to resolve, leading to upward rebellion and vomiting, like summer damp-heat causing indigestion and vomiting. Therefore, among Ye Ge syndromes, none are Cold; among Vomiting syndromes, half are Cold, half Heat. I now treat Ye Ge food obstruction and Ge food vomiting directly as Heat-only, no Cold. For vomiting, regardless of timing, distinguish Cold and Heat by acidity and odor. Vomiting that is sour and rancid reflects Summer Heat transformation, governed by Fire; vomiting that is neither sour nor odorous reflects Winter Cold imagery, governed by Cold. Like brewing wine, hot processes yield sour and odorous results, while cold processes do not rot or smell.