(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 heaves; please refer to it.)

Abdominal fullness, intermittent pain accompanied by vomiting, constitutes a Taiyin disease (for related discussions, see the section on abdominal fullness). *Huoren Shu* states that it should be treated with Lizhong Tang.

In Shaoyin disease, if food is vomited immediately upon entering the mouth, there is a sensation of wanting to vomit but nothing comes out, and at the onset, the hands and feet are cold with a wiry and slow pulse, this indicates excess pathogenic factors in the chest. Purging methods are contraindicated; instead, emetic therapy should be employed. If dry heaves occur due to cold-fluid retention above the diaphragm, emesis is contraindicated. Urgent warming is required, and Sini Tang is appropriate. (Cheng Wuji's commentary: When exterior pathogens from Shanghan transmit inward to reach Shaoyin, the Shaoyin meridian emerges from the lung, connects with the heart, and enters the chest. Once pathogens lodge in the chest and do not dissipate, food intake triggers vomiting and the urge to vomit. Qi receives its origin in the chest; when pathogens stagnate there, Yang qi cannot diffuse outward, resulting in cold extremities and a wiry-slow pulse at onset. This represents an excess condition in the chest, requiring emesis rather than purgation. Cold-fluid retention above the diaphragm causes discomfort and cold extremities. Vomiting expels contents, whereas retching does not. In chest excess, contents are expelled; in diaphragmatic cold-fluid retention, only dry heaves occur without expulsion. Emesis is contraindicated here; Sini Tang should be used to warm the diaphragm.) In Shaoyin disease, if the patient desires to sleep, lacks irritability, yet vomits, and by the fifth day develops spontaneous diarrhea, irritability, and insomnia, the prognosis is fatal (see the section on "Desire to Sleep").

For dry heaves with the expulsion of clear saliva and accompanying headache, the following formula, Wuzhuyu Tang, is indicated.

Wuzhuyu Tang: Treats vomiting, diarrhea, cold extremities, severe irritability, and vomiting with chest fullness.
Ingredients: Evodiae Fructus (Wuzhuyu) [soaked in water and washed] 1.5 liang, Zingiberis Rhizoma Recens (Shengjiang) 1.5 liang, Ginseng Radix et Rhizoma (Renshen) 0.75 liang, Jujubae Fructus (Dazao) 3 pieces. These ingredients are coarsely crushed, decocted in water, strained, and divided into two doses. (*Neijing* states: For excessive cold within, treat with sweet-hot herbs, assisted by bitter-pungent ones. The pungency of Evodiae Fructus and Zingiberis Rhizoma warms the stomach; the sweetness of Ginseng Radix et Rhizoma and Jujubae Fructus moderates the spleen.)

For fever, thirst with desire to drink water, and vomiting immediately after drinking, Wuling San is indicated.

In Shanghan, if the patient originally had cold-type diarrhea, and the physician erroneously applied emetic or purgative methods, causing cold rejection and worsening vomiting and diarrhea (*Maijing* reads "worsening vomiting," where food is expelled immediately upon entry), use Ganjiang Huanglian Huangqin Renshen Tang for cases where food is vomited immediately upon ingestion. (Note: "Originally had cold diarrhea" may be a textual error for "originally had vomiting and diarrhea," as suggested by the character "again/repeatedly." Stomach cold causes vomiting; intestinal cold causes diarrhea. Those with stomach cold should not be subjected to emesis; erroneous emesis damages stomach Qi, leading to cold rejection. The subsequent text lacks coherence, suggesting missing passages.)

Formula for Ganjiang Huanglian Huangqin Renshen Tang:
Ganjiang (Dried Ginger), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix et Rhizoma) [each 3 liang]. Decoct these four ingredients in 6 sheng of water to obtain 2 sheng. Strain and take half warm, then the other half. (Pungent herbs disperse; sweet herbs moderate. The sweet-pungent nature of Ganjiang and Renshen tonifies healthy Qi; the bitter nature of Huanglian and Huangqin drains heat and resolves cold rejection.)

In Taiyang disease, after vomiting, if sweating occurs without aversion to cold but with fever, the Guan pulse is fine and rapid, the patient craves cold food, and morning consumption leads to evening vomiting, this is considered a minor adverse reaction (Xiao Ni).

If a patient presents with a rapid pulse indicating heat, which should normally promote digestion and appetite, yet vomiting occurs, this results from sweating depleting Yang Qi and weakening Diaphragm Qi, causing the pulse to appear rapid. A rapid pulse combined with exogenous heat prevents digestion due to deficiency-cold in the stomach. Generally, if vomiting occurs after taking Guizhi Tang, pus and blood will likely be vomited. (Annotation: Patients with internal heat, such as habitual drinkers, may vomit after taking Guizhi Tang.)

For vomiting accompanied by cold extremities (Jue), Ganjiang Gancao Tang is used.

Appendix:
*Huoren Shu* categorizes vomiting into cold and hot patterns. If the Cun pulse is rapid, palms are hot, accompanied by irritability, thirst, and vomiting, this indicates heat in the epigastrium, treated with Wuling San. If cold predominates, with no desire to drink and vomiting, Lizhong Tang modified by removing Baizhu and adding Shengjiang is indicated.
For Yin-pattern diseases presenting with panting and vomiting/retching, Fanyin Dan stops symptoms upon ingestion.

Da Jupi Tang: Indicated for "moving Qi" in the lower jiao where sweating is contraindicated; if mistakenly induced sweating leads to absence of sweat, irritability, bone/joint pain, dizziness, aversion to cold, and vomiting upon eating preventing food intake, first administer Da Jupi Tang. After vomiting ceases, Jianzhong Tang is appropriate.
Ingredients: Chenpi (Tangerine Peel) 1.5 liang, Shengjiang (Fresh Ginger) 1 liang, Zaizi (Jujubes) 8 pieces, Zhigancao (Prepared Licorice Root) 0.5 liang, Renshen (Ginseng) 1 qian, Zhuru (Bamboo Shavings) 0.5 liang. Decoct these in 3 large bowls of water until reduced to 1 bowl. Divide into two doses.

If a patient suffers primarily from vomiting but exhibits weakness or pain in the legs, this is Hongxiangjiao (Foot Qi/Jamaican Itch), and should be treated according to protocols for Foot Qi (see the Foot Qi section in Miscellaneous Diseases).