喘因血积肝伤者，经曰∶肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆
是也。
《仁斋直指》云∶呕吐出于胃气之不和，人所共知也。然有胃寒，有胃热，有痰水，有
宿食
，有脓血，有气攻，又有所谓风邪干胃。凡是数者，可不究其所自来哉。寒而呕吐，则喜热
恶寒，四肢凄清，法当以刚壮温之。热而呕吐，则喜冷恶热，烦躁中干，法当以清凉解之。
痰水症者，吐沫怔忡，先渴后呕，与之消痰逐水辈。宿食症者，胸腹胀满，醋闷吞酸，与之
消食去积辈。腥气燥气，熏炙恶心，此脓血之聚，经所谓呕家有痈脓，不须治，脓尽自愈是
也。七情内郁，关格不平，此气攻之症，经所谓诸郁干胃则呕吐是也。若夫风邪入胃，人多
不审，率用参、术助之，拦住寒邪，于此犹关利害。其或恶闻食臭，汤水不下，粥药不纳，
此则反胃之垂绝者也。辨之不早，其何以为对治乎。虽然，足阳明之经，胃之络脉也，阳明
之气，下行则顺，今逆而上行，谨不可泄，固也
。然呕吐者，每每大便秘结，上下壅遏，气
不流行，盍思所以区画而利导之。他如汗后水药不入口者，遂呕而脉弱，小便复利，身微热
而手足厥者，虚寒之极也。识者忧焉。
洁古论吐，以气、积、寒，分属上、中、下三焦。大旨元从启元子食不得入，是有火，
食入
反出，是无火来。至中焦吐，则独以积字该之。夫中焦气交之分，主营运上下，和调阴阳，
其病有虚有实，有寒有热，其治亦不拘一法，岂区区毒药去积，槟榔、木香和气所能尽其事
哉。东垣论吐，以呕、吐、哕，分太阳、阳明、少阳，以其经气血多少而为声物有无之别，
未见着实。
For wheezing caused by blood stasis injuring the Liver, the Classics state: "If the Liver pulse is firm and long, but the complexion is not green, it indicates injury from a fall or blow, due to blood accumulating under the hypochondrium, causing wheezing and counterflow." This refers to that condition.
*Ren Zhi Zhi Zhi Fang* (Directing Guide of Renzhai) states: Vomiting arises from disharmony of Stomach Qi, which is common knowledge. However, there are cases due to Cold in the Stomach, Heat in the Stomach, Phlegm-Fluid retention, retained food, pus and blood accumulation, Qi attack, and what is called Wind pathogen invading the Stomach. For these several causes, how can one fail to investigate their origins? If vomiting is due to Cold, the patient prefers warmth and dislikes cold, with limbs feeling chilly and clear; the treatment principle should be to warm using robust, hot-natured agents. If vomiting is due to Heat, the patient prefers coolness and dislikes heat, with restlessness and dryness in the center; the treatment principle should be to resolve using cooling agents. For Phlegm-Fluid syndromes, characterized by spitting foam and palpitations, thirst preceding vomiting, one should administer drugs that eliminate phlegm and drain fluids. For retained food syndromes, characterized by chest and abdominal fullness, stifling sensation, and acid regurgitation, one should administer drugs that digest food and remove stagnation. Foul odors and dry heat from roasting foods causing nausea indicate the accumulation of pus and blood; this refers to the Classic's statement: "In patients with vomiting who have carbuncle pus, there is no need to treat the vomiting specifically; once the pus is exhausted, it will heal itself." Internal depression of the Seven Emotions (Joy, Anger, Worry, Thought, Sadness, Fear, Fright), leading to obstruction and imbalance of Qi dynamics, constitutes the syndrome of Qi attack; this refers to the Classic's statement: "Various types of Qi stagnation invading the Stomach cause vomiting." As for Wind pathogen entering the Stomach, people often fail to examine it carefully, rashly using Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) to tonify, thereby blocking the expulsion of Cold pathogen, which involves significant therapeutic consequences. If the patient detests the smell of food, cannot take soups or liquids, and rejects porridge and medicine, this indicates Fan Wei disease (Regurgitation) at a critical, near-terminal stage. If differentiation is not made early, what remedy can be applied? Although the Foot-Yangming Meridian is the collateral network of the Stomach, and Yangming Qi descending is considered smooth, now that it reverses and ascends, it is indeed inadvisable to use purgative methods. However, patients with vomiting often suffer from constipation, with upper and lower obstruction, and stagnant Qi flow. Why not consider strategies to regulate and guide the Qi? Other cases include those after sweating where water and medicine cannot enter, followed by vomiting, weak pulse, free urination, slight fever, and cold extremities; this represents extreme deficiency-Cold. Those with insight should be concerned.
Li Dongyuan (Jiegu) discussed vomiting, attributing Qi, Accumulation, and Cold to the Upper, Middle, and Lower Jiao respectively. His main idea stems from Qiyuanzi stating: "Food cannot enter due to Fire; food enters but comes back up due to lack of Fire." Regarding Middle Jiao vomiting, he exclusively attributed it to "Accumulation." The Middle Jiao is the junction of Qi interaction, governing the circulation of Ying and Wei, and harmonizing Yin and Yang. Its diseases involve deficiency and excess, Cold and Heat, and its treatments are not limited to a single method. How could simple toxic drugs to remove accumulation, along with Areca Seed (Binglang, 槟榔) and Aucklandia Root (Muxiang, 木香) to harmonize Qi, suffice to handle all matters? Li Dongyuan discussed vomiting, differentiating Oud (nausea/vomiting), Tu (vomiting), and Yueh (hiccup/belching) into Taiyang, Yangming, and Shaoyang meridians, distinguishing based on the presence or absence of sounds and vomitus according to the quantity of Qi and Blood in each meridian. This view lacks substantial accuracy.