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According to *Jiegu Jiazhen* (Treasures from the Home of Jiegu), there are three types of vomiting syndromes: Qi (vital energy), Accumulation (food stagnation), and Cold. These are all analyzed through the lens of the Triple Burner (San Jiao). The Upper Burner is located at the gastric opening, connects upward with the Heaven Qi, and is responsible for receiving but not expelling. The Middle Burner is located at Zhongwan (CV12), connects upward with Heaven Qi and downward with Earth Qi, and is responsible for rotting and ripening food and fluids. The Lower Burner is located below the umbilicus, connects downward with Earth Qi, and is responsible for expelling but not receiving. Therefore, vomiting originating from the Upper Burner is caused by Qi dysfunction. Qi belongs to the Yang of Heaven. Its pulse is floating and surging. Symptoms include sudden violent vomiting after eating, thirst with desire to drink water, dry and constipated stool, Qi rushing upward to the chest causing pain. Treatment should focus on descending Qi and harmonizing the middle. Vomiting originating from the Middle Burner is caused by Accumulation, which can be Yin or Yang type, where food and Qi intertwine to form accumulation causing pain. Its pulse is floating and wiry. Symptoms may present as pain followed by vomiting, or vomiting followed by pain. The method is to use slightly toxic drugs to remove the accumulation, and use Areca Seed (Binglang) and Costus Root (Muxiang) to regulate Qi. Vomiting originating from the Lower Burner is caused by Cold, belonging to the Earthly Dao (Yin). Its pulse is large and slow. Symptoms include vomiting in the evening what was eaten in the morning, and vomiting in the morning what was eaten in the evening; clear and profuse urination, and constipation without passage. The treatment method should use drugs to open blockages and warm the cold Qi. Once the stool gradually passes, use Middle Burner formulas to harmonize, preventing severe constipation of the Large Intestine Fu-organ, leading to spontaneous recovery.

In *Cishi Nan Zhi* (Difficulties in This Matter), it is asked: Do vomiting, retching, and hiccups, which are governed by the Stomach, each have their own meridians? The answer is: The Stomach is the general manager of digestion. Internally, it distinguishes between the Taiyang, Yangming, and Shaoyang meridians. Due to differences in the quantity of Qi and Blood, there are variations in the presence of sound and expelled matter. Specifically, "Tu" (expulsion/vomiting without sound) belongs to the Taiyang meridian, involves matter but no sound, and is a disease of the Blood level. It is further distinguished into immediate expulsion upon eating, expulsion after eating, and delayed expulsion. "Ou" (retching/vomiting with sound) belongs to the Yangming meridian, involves both matter and sound, and indicates disease of both Qi and Blood. Zhang Zhongjing stated: "If there is much retching, even if there are Yangming symptoms, purgation is contraindicated." "Yue" (hiccups/dry heaves) belongs to the Shaoyang meridian, involves sound but no matter, and is a disease of the Qi level. (Here, dry heaves are referred to as Yue.) The general principle of medical practice is: Vomiting immediately after swallowing food is called Ou, treated with Shengjiang Banxia Tang (Fresh Ginger and Pinellia Decoction). Vomiting immediately after food enters is called Baotu (Sudden Vomiting), treated with Shengjiang Chuanpi Tang (Fresh Ginger and Tangerina Peel Decoction). Vomiting immediately after finishing a meal is called Outu, treated with Chuanpi Banxia Tang (Tangerina Peel and Pinellia Decoction). Vomiting after food has stayed for a long time is called Fanwei (Reverse Stomach), treated with Shuizhu Jinhua Wan (Water-Boiled Golden Flower Pill). Vomiting after eating twice is called Fange, treated with Yilao Zichen Wan (Yilao's Purple Sinking Pill). If one cannot eat again in the evening after eating in the morning, accompanied by vomiting and inability to ingest food, with a solid and slippery pulse, treat with Banxia Shengjiang Dahuang Tang (Pinellia, Fresh Ginger, and Rhubarb Decoction) to purge.

Li Dongyuan's (Jiegu's) discussion on dividing vomiting by the Triple Burner is likely based on the *Huangdi Neijing*. It states that Qi obstruction in the Upper Diaphragm causes food and drink to emerge from far away later (Lower Diaphragm), while food emerging immediately upon eating is the Upper Diaphragm. The case of sudden violent vomiting after eating in the Upper Burner is currently termed "Outu" (Vomiting). The cases of prolonged retention and vomiting in the Middle and Lower Burners, or vomiting after eating twice, are currently termed "Geqi" (Diaphragmatic Qi) or "Fanwei" (Reverse Stomach). Thus, Otu and Geqi are divided into two categories. Zhao Yi-de stated: Yin-Yang, Qi, and Blood have fixed distributions everywhere. Only the Spleen and Stomach embody this distribution, completing the principles of Heaven, Earth, and Man (Three Powers). Therefore, the Stomach has Upper, Middle, and Lower Guan (orifices/chambers). The Upper Guan corresponds to Heaven (Yang), the Lower Guan corresponds to Earth (Yin), and the Middle Guan corresponds to the intersection of Qi. Yang is clear and Yin is turbid; thus, Yang governs Qi, and Yin governs Blood. However, within Yang there is Yin, and within Yin there is Yang. Consequently, the Upper Guan has more Qi and less Blood, reflecting the dynamic changes of the Heavenly Dao. The Lower Guan has more Blood and less Qi, reflecting the static nourishment of the Earthly Dao. The Middle Guan has equal parts Qi and Blood, thus transporting the ascending, descending, moving, and still Qi of the upper and lower regions. Therefore, substances entering the stomach gather according to their nature. Water and drinks are the clear aspect of substances; grains and food are the turbid aspect. Yet, within clarity lies turbidity, and within turbidity lies clarity. Thus, the clear part of drinks must first ascend to the Lung, which governs Qi, and then distribute throughout the body to become Jin-Ye (body fluids). The turbid part of the clear flows downward to the Bladder and exits as urine and feces. The clear part of food must first nourish the Heart and Liver, which govern Blood, to support sinews, bones, and vessels, and further transform into Ying and Wei (Nutritive and Defensive Qi), flowing into the hundred bones. The turbid part of the turbid becomes dregs in the Lower Guan, transmits to the Large Intestine, and exits. If pathogenic factors affect the Yang of the Upper Guan, Qi stagnates; Qi stagnation leads to fluid accumulation. Thus, the clarity and turbidity of drinks mix, transforming into Phlegm, Fluids, Saliva, and Spittle, changing into vomiting. If pathogenic factors affect the Yin of the Lower Guan, Blood stasis occurs; Blood stasis prevents food digestion. Thus, the clarity and turbidity of food are not separated, transforming into Dysphagia, Fullness, Pain, and Distension, changing into vomiting. Pathogenic factors at the Qi intersection of the Middle Guan involve diseases of both the Upper and Lower Guan. Therefore, vomiting arises from Qi disease, corresponding to the Yang of Heaven, moving with sound, exiting with fluids, like thunder bringing rain. Expulsion arises from Blood disease, corresponding to the Yin of Earth, still without sound, exiting with food, symbolizing things emerging from the earth. When both Qi and Blood are diseased, corresponding to the intersection of Yin-Yang Qi, both vomiting and expulsion occur, and food and drink are expelled. However, in the Upper Guan, although food is not vomited, if the Yin within Yang is also diseased, food is expelled immediately upon entry and cannot enter the Stomach. This differs from the Middle Guan, where vomiting occurs after eating, and the Lower Guan, where vomiting occurs after a long delay. In the Lower Guan, although retching does not occur, if the Yang within Yin is also diseased, expulsion and retching occur simultaneously, though retching is less than expulsion, unlike the Upper Guan where retching exceeds expulsion.