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(The distinction between vomiting and retching has been explained in the chapter on Retching. The sensation of wanting to vomit is also included in the section on dry retching; reference should be made there.)

Abdominal fullness, intermittent pain accompanied by vomiting indicates Taiyin Disease (see the discussion on abdominal fullness). *Huoren Shu* states it should be treated with Lizhong Tang.

Shaoyin Disease: If food is vomited immediately upon entering the mouth, the patient feels an urge to vomit but cannot, starts with cold hands and feet, and presents with a wiry and slow pulse, this indicates excess pathogen in the chest. Purging is contraindicated; emesis should be induced. However, if dry retching is caused by cold fluid retention above the diaphragm, emesis is contraindicated. Instead, urgent warming is required, and Sini Tang is indicated. (Cheng Wuji's commentary: When exterior pathogens from Shanghan transmit inward to Shaoyin, since the Shaoyin meridian emerges from the lung, connects with the heart, and enters the chest, pathogenic factors lingering in the chest without dispersing cause immediate vomiting upon ingestion. Qi receives its origin in the chest; when pathogens linger there, Yang Qi cannot diffuse outward, resulting in initial cold extremities and a wiry-slow pulse. This constitutes chest excess, requiring emesis rather than purging. Cold fluid above the diaphragm causes discomfort and cold extremities. Vomiting involves expelling contents, whereas retching does not. Chest excess leads to vomiting with expulsion of food; cold fluid above the diaphragm leads only to dry retching without expulsion. In such cases, do not emese; instead, use Sini Tang to warm the diaphragm.)

Shaoyin Disease: If the patient desires to sleep, lacks irritability, yet vomits, and on the fifth day develops spontaneous diarrhea, irritability, and insomnia, the prognosis is fatal (see "Desire to Sleep").

Dry retching with expulsion of clear saliva/phlegm accompanied by headache is treated with the following formula: Wuzhuyu Tang. It treats vomiting, diarrhea, cold extremities, severe irritability, vomiting with chest fullness.

Wuzhuyu (soaked in water and washed), Shengjiang (each 1.5 liang), Renshen (0.75 liang), Dazao (3 pieces). Coarsely crush the herbs, decoct in water, strain, and divide into two doses. (*Neijing* states: For cold invading internally, treat with sweet-hot agents, assisted by bitter-pungent ones. The pungency of Wuzhuyu and Shengjiang warms the stomach; the sweetness of Renshen and Dazao moderates the spleen.)

Fever, thirst with desire for water, but vomiting immediately after drinking indicates Wuling San.

In Shanghan, if the patient originally had cold-type diarrhea, and the physician erroneously applied emesis or purging, causing cold rejection that worsens vomiting and diarrhea (*Maijing* reads "worsens vomiting," where food is expelled immediately upon entry), and if food is vomited immediately upon entry, Ganjiang Huanglian Huangqin Renshen Tang is indicated. (Note: "Originally cold diarrhea" may be a textual error for "originally vomiting and diarrhea," evidenced by the character "repeatedly." Generally, stomach cold causes vomiting, intestinal cold causes diarrhea. Stomach cold patients should not be emesed; erroneous emesis damages stomach Qi, leading to cold rejection. The text below seems disjointed, suggesting missing passages.)

Ganjiang Huanglian Huangqin Renshen Tang Formula:
Ganjiang, Huanglian, Huangqin, Renshen (each 3 liang). Decoct these four ingredients in 6 sheng of water to obtain 2 sheng, strain, and take half warm, twice daily. (Pungent agents disperse; sweet agents moderate. The sweet-pungent nature of Ganjiang and Renshen tonifies righteous Qi; the bitter nature of Huanglian and Huangqin drains heat/pathogens, thereby opening the cold rejection.)

Taiyang Disease: After vomiting, sweating occurs without aversion to cold, accompanied by fever, fine and rapid Guan pulse, desire for cold food, and evening vomiting of morning food. This is considered a minor deviation (Xiao Ni).

If a patient has a rapid pulse indicating heat, they should digest grain and have an appetite, yet instead vomit, this is due to sweating depleting Yang Qi and weakening Diaphragm Qi, causing the pulse to appear rapid. A rapid pulse with external heat prevents digestion due to deficiency-cold in the stomach. Those who vomit after taking Guizhi Tang will likely vomit pus and blood (Commentary: Patients with internal heat, such as wine drinkers, will vomit after taking Guizhi Tang).

For vomiting accompanied by cold extremities, use Ganjiang Gancao Tang.

Appendix:
*Huoren Shu* categorizes vomiting into cold and heat patterns. Rapid Cun pulse, hot palms, irritability, thirst, and vomiting indicate heat in the stomach cavity, treated with Wuling San. Vomiting with abundant cold signs and no desire for water is treated with Lizhong Tang minus Baizhu plus Shengjiang.

For Yin Syndrome presenting with panting and vomiting/reversal, Fanyin Dan stops symptoms upon ingestion.

Dajupi Tang: Treats "moving Qi" below (palpitations below the umbilicus) where sweating is contraindicated. If mistakenly sweated and no sweat results, accompanied by irritability, bone/joint pain, dizziness, aversion to cold, and vomiting food immediately upon intake, first administer Dajupi Tang. Once vomiting ceases, Jianzhong Tang is appropriate.

Jupi (1.5 liang), Shengjiang (1 liang), Zaozi (8 pieces), Zhigancao (roasted, 0.5 liang), Renshen (1 qian), Zhuru (0.5 liang). Decoct in 3 large bowls of water to obtain 1 bowl, divide into two doses.

If a patient suffers directly from vomiting but presents with weak or painful legs, this is Hongxiangjiao (Beriberi/Foot Qi) and should be treated accordingly (see Beriberi section in Miscellaneous Diseases).