〔洁〕论曰∶吐有三，气、积、寒也，皆从三焦论之。上焦在胃口，上通天气，主内而不出；中焦在中脘，
上通天气，下通地气，主腐熟水谷；下焦在脐下，下通地气，主出而不纳。是故上焦吐者，皆从于气。气者，
天之阳也，其脉浮而洪，其症食已暴吐，渴欲饮水，大便燥结，气上冲胸而发痛，其治当降气和中。中焦吐者，
皆从于积，有阴有阳，食与气相假为积而痛，其脉浮而弦，其症或先痛而后吐，或先吐而后痛，治法当以小毒
药去其积，槟榔、木香和其气。下焦吐者，皆从于寒，地道也，其脉大而迟，其症朝食暮吐，暮食朝吐，小便
清利，大便秘而不通，治法宜毒药通其闭塞，温其寒气，大便渐通，复以中焦药和之，不令大腑结闭而自安也。
上洁古论三焦吐，其说盖本于黄帝。所谓气为上膈，食饮入而还出为下膈，食 时乃反出之。其上焦食
已暴吐者，今世谓之呕吐也。中下二焦朝食暮吐、暮食朝吐者，今世谓之膈气反胃也。分呕吐膈气为二门。
〔垣〕夫呕、吐、哕者，俱属于胃。胃者，总司也。以其气血多少为异耳。且如呕者，阳明也，阳明多血
多气，故有声有物，气血俱病也。仲景云∶呕多虽有阳明症，慎不可下。孙真人云∶呕家多服生姜，乃呕吐之
圣药也。气逆者必散之，故以生姜为主。吐者太阳也，太阳多血少气，故有物无声，乃血病也。有食入则吐，
有食已则吐，以陈皮去白主之。哕者，少阳也，少阳多气少血，故有声无物，乃气病也。以姜制半夏为主。故
朱奉议治呕吐哕，以生姜、半夏、陈皮之类是也。究其三者之源，皆因其脾虚弱，或因寒气客胃，加之饮食所
伤而致也。宜以丁香、藿香、半夏、茯苓、陈皮、生姜之类主之。（按哕《内经》实指呃逆、今先贤误释为
干呕者，非也。）若但有内伤而有此疾，宜察其虚实，使内消之。痰饮者必下之，当分其经，对证用药，不
可乱也。
【张元素】论述说：呕吐有三种类型，分别是气、积、寒，都应当从三焦的角度来论述。上焦位于胃口，向上通达天气，主要功能是受纳食物而不排出；中焦位于中脘穴部位，向上通达天气，向下通达地气，主要功能是腐熟水谷；下焦位于脐下，向下通达地气，主要功能是排泄废物而不受纳。因此，上焦引起的呕吐，都是由于气机失调所致。气属于天之阳气，其脉象浮而洪大，症状表现为进食后立即剧烈呕吐，口渴想喝水，大便干燥结滞，气机上冲胸部并引发疼痛，治疗应当以降气和胃为主。中焦引起的呕吐，都是由于积滞所致，有阴证和阳证之分，食物与气相互搏结形成积滞从而产生疼痛，其脉象浮而弦，症状表现为或者先疼痛后呕吐，或者先呕吐后疼痛，治疗方法应当使用小毒性的药物去除积滞，用槟榔、木香来调畅气机。下焦引起的呕吐，都是由于寒邪所致，属于地道（阴）的问题，其脉象大而迟滞，症状表现为早晨吃的食物晚上吐出，晚上吃的食物早晨吐出，小便清长通畅，大便秘结不通，治疗方法适宜使用具有泻下作用的药物通开闭塞，温散寒气，待大便逐渐通畅后，再用调理中焦的药物调和，不让大肠腑气结闭，身体自然安宁。以上引用了洁古（张元素）关于三焦呕吐的论述，他的说法大概源于《黄帝内经》。其中所说的“气”导致的是上膈（噎），饮食进入后随即吐出的是下膈（反胃），食物吃下去很久才反吐出来。这里提到的上焦食后即剧烈呕吐的情况，当今称为呕吐。中焦和下焦出现的朝食暮吐、暮食朝吐的情况，当今称为膈气或反胃。将呕吐和膈气分为两个门类。
【李杲】论述说：呕、吐、哕（呃逆/干呕）这三种病症，都归属于胃。胃是总司这些功能的脏腑。只是根据气血多少的不同而有差异。比如呕，属于阳明经，阳明经多血多气，所以既有声音又有实物吐出，这是气血俱病。张仲景说：呕吐频繁者，即使有阳明病的症状，也千万不要攻下。孙思邈说：呕吐患者应多服用生姜，这是治疗呕吐的圣药。气逆必然要疏散，所以以生姜为主药。吐，属于太阳经，太阳经多血少气，所以只有实物吐出而没有声音，这是血分病变。有的食入即吐，有的食毕即吐，以陈皮（去白）为主药。哕，属于少阳经，少阳经多气少血，所以只有声音没有实物吐出，这是气分病变。以姜制半夏为主药。所以朱奉议治疗呕吐哕，使用生姜、半夏、陈皮之类的药物。究其这三者的根源，都是因为脾脏虚弱，或者寒气客居胃中，加上饮食损伤所致。适宜以丁香、藿香、半夏、茯苓、陈皮、生姜等药物为主进行治疗。（按语：哕在《内经》中实际上指的是呃逆，现在的先贤错误地解释为干呕，这是不对的。）如果仅仅是因为内伤而有此疾病，应当辨别虚实，采用内部消导的方法。如果有痰饮，必须使用下法，应当分清经络，对症用药，不可乱用。
[Zhang Yuansu] discusses: There are three types of vomiting, namely Qi (vital energy), accumulation (food stagnation), and Cold. All should be analyzed from the perspective of the Sanjiao (Triple Burner). The Upper Jiao is located at the stomach opening, connects upward with Heaven Qi, and is responsible for receiving but not discharging. The Middle Jiao 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 Jiao is located below the umbilicus, connects downward with Earth Qi, and is responsible for discharging but not receiving. Therefore, vomiting originating from the Upper Jiao is always due to 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 Jiao. Vomiting originating from the Middle Jiao is always due to accumulation, which can be Yin or Yang type. Food and Qi intertwine to form accumulation causing pain. Its pulse is floating and wiry. Symptoms include either pain followed by vomiting, or vomiting followed by pain. Treatment should use mildly toxic drugs to remove the accumulation, and use Areca Seed (Binglang) and Costus Root (Muxiang) to regulate Qi. Vomiting originating from the Lower Jiao is always due to Cold, belonging to the Earthly path (Yin). Its pulse is large and slow. Symptoms include vomiting food eaten in the morning in the evening, or food eaten in the evening in the morning; clear and profuse urination; and constipation without passage of stool. Treatment should appropriately use purgative drugs to open blockages, warm and dispel Cold. Once stool gradually passes, use formulas for the Middle Jiao to harmonize, preventing excessive closure of the Large Intestine so that the body may rest naturally. The above cites Jiegu’s (Zhang Yuansu’s) discussion on Sanjiao vomiting; his theory is likely based on the Huangdi Neijing (Yellow Emperor's Inner Canon). What he calls "Qi" causing Upper Ge (dysphagia/choking), where food enters and immediately returns out, is Lower Ge (regurgitation); food taken in is only regurgitated later. The Upper Jiao case of sudden violent vomiting after eating is what is now called Ou Tu (vomiting). The cases of Morning Food Evening Vomiting and Evening Food Morning Vomiting from the Middle and Lower Jiao are what is now called Ge Qi (diaphragmatic qi stagnation) or Fan Wei (reverse flow of the stomach). Thus, Ou Tu and Ge Qi are divided into two categories.
[Li Dongyuan] states: Ou (retching), Tu (vomiting), and Yue (hiccups/dry heaving) all belong to the Stomach. The Stomach is the general manager of these functions. They differ only in the abundance or scarcity of Qi and Blood. For instance, Ou belongs to the Yangming channel, which has abundant Blood and Qi; thus, there is both sound and material expelled, indicating disease in both Qi and Blood. Zhang Zhongjing said: "If there is frequent vomiting, even if Yangming symptoms exist, one must be cautious and never use purgation." Sun Simiao said: "Patients with vomiting should take fresh ginger frequently; it is the holy medicine for vomiting." When Qi rebels, it must be dispersed; therefore, fresh ginger is used as the chief drug. Tu belongs to the Taiyang channel, which has abundant Blood but scarce Qi; thus, there is material expelled but no sound, indicating disease in the Blood. Some vomit immediately upon eating; some vomit after finishing eating. Tangerine Peel (Chenpi, removed white pith) is used as the chief drug. Yue belongs to the Shaoyang channel, which has abundant Qi but scarce Blood; thus, there is sound but no material expelled, indicating disease in the Qi. Ginger-processed Pinellia Rhizome (Banxia) is used as the chief drug. Therefore, Zhu Fengyi treated Ou, Tu, and Yue using fresh ginger, Banxia, Chenpi, etc. Investigating the source of these three, they all arise because of Spleen deficiency, or Cold pathogen lodging in the Stomach, compounded by dietary injury. It is appropriate to use Clove (Dingxiang), Agastache (Huoxiang), Banxia, Poria (Fuling), Chenpi, fresh ginger, etc., as the main treatment. (Note: In the Neijing, Yue actually refers to hiccupping; modern sages mistakenly interpreted it as dry heaving, which is incorrect.) If this disease arises solely from internal injury, one must examine deficiency or excess and employ internal resolution methods. If there is Phlegm-Fluid retention, purgation must be used; one must differentiate the channel and prescribe medication according to the syndrome, avoiding arbitrary use.