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Vomiting (Ou) refers to the act accompanied by both sound and expelled matter; Spitting up (Tu) refers to expelling matter without sound. If there is sound but no matter, it is termed Dry Vomiting (Gan Ou); if there is a sensation of nausea and the urge to vomit, it is termed Nausea (E Xin). Li Dongyuan attributed all these conditions to the Spleen and Stomach, which is indeed an insightful conclusion.

The *Classic of Difficult Issues* (*Nanjing*) states: "Diseases of the Foot-Taiyin [Spleen] channel involve vomiting after eating." It further states: "Vomiting after eating occurs because food fills the stomach and overflows upward." From this, we know that the Stomach is the primary organ governing vomiting, while the failure of the Spleen to transform and transport is the root cause. However, the etiologies are not uniform.

As stated in the classics: "All rebellious qi rushing upward belongs to Fire." And again: "All vomiting of sour fluid belongs to Heat." These are caused by heat pathogens.

It is also stated: "When cold qi lodges in the intestines and stomach, causing rebellious qi to rush upward, pain and vomiting occur." These are caused by cold pathogens.

Furthermore: "Diseases generated by the Liver manifest as chest fullness and rebellious vomiting." And: "If gallbladder fluid leaks, bitterness results in the mouth. If Stomach qi rebels, bitter fluid is vomited, termed Gallbladder Vomiting (Dan Ou)." These two descriptions result from Wood pathogen invading the Stomach and causing rebellious qi.

Also: "When various Yang qi float without foundation, leading to vomiting, this is caused by Kidney Yin deficiency resulting in floating isolated Yang."

Additionally, the *Jin Gui Yao Lue* discusses: "Those who frequently vomit should naturally be thirsty; if they are not thirsty now, it is due to the presence of Zhi Yin (branching fluid retention) under the heart." This belongs to vomiting caused by Phlegm-Fluids.

Jiegu (Zhang Yuansu) further proposed vomiting caused by Qi stagnation and Food Retention.

Ancients said: "If vomiting persists despite various medications, heavy-settling drugs must be used to descend it; if vomiting accompanies long-term deficiency of Middle Qi, grain foods must be borrowed to harmonize it." One must carefully distinguish the etiology and prescribe according to symptoms, not adhering rigidly to fixed patterns, to respond to infinite variations.

Zhuru Tang (See Shang Han section). The *Classic* states: "All rebellious qi rushing upward belongs to Fire." This formula is suitable as the main treatment.
Shihu (Dendrobii Caulis, Clearing Stomach Heat) can be added; Su Zi (Perillae Fructus, Descending Qi and stopping vomiting); Fuling (Poria, Guiding Qi and calming Fire). For deficiency, add Renshen (Ginseng Radix, Tonifying Stomach Qi), Baishao (Paeoniae Radix Alba, Astringing Rebellious Qi), and Bidou (Dolichoris Semen, Descending Qi and Harmonizing Middle). If using heavy-settling agents, add Daizheshi (Haematitum, taken as powder mixed with water).

Zuojin Wan (See Xie Tong section). The *Classic* states: "All vomiting of sour fluid belongs to Heat." And again: "Diseases generated by the Liver manifest as chest fullness and rebellious vomiting." This formula is suitable as the main treatment.
Baishao (Paeoniae Radix Alba) and Mugua (Chaenomelis Fructus, Harmonizing Stomach and restraining Liver) can be added; along with Su Zi (Perillae Fructus), Fuling (Poria), Juhong (Citri Reticulatae Pericarpium Rubrum), and Pipaye (Eriobotryae Folium).

These two formulas are excellent remedies for vomiting with Heat; they are effective upon administration. This is because many diseases in the world are caused by Fire and Heat.

Juhong Banxia Tang. The *Jin Gui Yao Lue* states: "Those who frequently vomit should naturally be thirsty; if they are not thirsty now, it is due to the presence of Phlegm-Fluids under the heart." This formula is suitable as the main treatment.
Juhong (Citri Reticulatae Pericarpium Rubrum, Descending Qi and clearing Phlegm); Banxia (Pinelliae Rhizoma, Treating Fluids and stopping vomiting); Shengjiang (Zingiberis Rhizoma Recens, Opening Phlegm and stopping vomiting). Fuling (Poria) can be added. If Phlegm-Fluids are accompanied by Fire, add Huanglian (Coptidis Rhizoma, stir-fried with Ginger Juice). If vomiting is caused by Cold, add Sharen (Amomi Fructus Rotundus) and Doukou (Cardamomi Fructus) to this formula. If accompanied by deficiency, add Renshen (Ginseng Radix).

This is a formula for vomiting caused by Phlegm-Fluids. It is often seen that modern practitioners always use Banxia (Pinelliae Rhizoma) for vomiting, unaware that Dongyuan stated: "Shengjiang (Zingiberis Rhizoma Recens) stops vomiting, but only treats exterior excess and Qi congestion; if Stomach deficiency leads to inability to move Grain Qi, one must tonify the Stomach." Zhongchun stated that if vomiting is caused by Fire rushing and Stomach Heat, rather than Cold-Dampness or Phlegm congestion, Banxia (Pinelliae Rhizoma) is strictly contraindicated. Generally, many people suffer from Yin deficiency, Blood scarcity, and insufficient Body Fluids. Banxia (Pinelliae Rhizoma) is acrid, warm, and slightly toxic, damaging Body Fluids most severely; thus, cases suitable for its use are extremely rare.

Baohe Wan (See Xie Xie section).
This formula is used for vomiting caused by Food Injury, modified as needed.

Chenxiang Jiangqi San
Chenxiang (Aquilariae Lignum Resinatum), Sharen (Amomi Fructus Rotundus), Su Zi (Perillae Fructus), Juhong (Citri Reticulatae Pericarpium Rubrum), Pipaye (Eriobotryae Folium), Fuling (Poria), Maidong (Ophiopogonis Radix) — all are herbs that descend Qi and counteract rebellion. If accompanied by Heat, add Ganshe Jiang (Saccharum officinarum Juice) and Lugenzhi (Phragmitis Rhizoma Juice).
This formula can be used for vomiting caused by Qi stagnation.

Severe vomiting with intense pain, where the vomitus resembles green vegetable leaves, indicates a fatal prognosis.