（哕，恶心）
有声无物为哕，（于月切。干呕也。又《内经》以哕为呃逆，义别。）有物有声为呕，
无声有物
为吐，病在胃。赵以德则以有声无物（或有水）为呕，有物无声为吐，有物有声为呕吐。
谓胃分三脘∶上脘法天为清阳，属气分，主动。下脘法地，为浊阴，属血分，主静。
虽阳中有阴，阴中有阳，然上脘终是气多血少，下脘终是血多气少，中脘则气血相
半。饮食入胃，亦厘清浊，水饮物之清，谷食物之浊。而清中有浊，故清之清者，
上输于肺，布为津液。清之浊者，下输膀胱，出为便溺。浊中有清，故浊之浊者，
为糟粕，由大肠出。浊之清者，淫精于血脉。若邪在上脘之阳，则气停水积，
饮之清浊混乱，为痰饮涎唾，胸中阻碍不快，清气不升，激而成呕，故呕为气病。
法天之阳，动而有声，与水俱出，犹雷震而雨注也。邪于下脘之阴，则血分滞而食
停。吐法地之阴，静而无声，食从吐出，犹万物之吐于地也。若邪在中脘，则呕吐
并作，饮食皆出矣。（洁古谓∶中焦吐者属积，由食与气相假为积，或先痛而吐，
或先吐而痛，亦清浊相杂
之义，气清食浊也。又谓∶下焦吐属寒，朝食暮吐，则亦属阴之义也。东垣亦谓∶少阳多
气少血，有声无物，
阳明多气多血，有声有物，太阳多血少气，有物无声，皆同此意。但气血多少，不以胃
之三脘分，而以三经分耳。
勿泥也。）然上脘非不吐食也，设阳中之阴亦病，（如上脘有痰血积滞，是有形之
物，即属阴。）则
食入即吐，不得入于胃（见下编），非若中脘之食已而后吐，下脘之食久而后吐也。下
脘非不呕也，设阴中之阳亦病，（如雷龙火上冲。）则吐与呕齐作，但呕少于吐，不若
上脘之呕多于吐也。水谷入胃，若脾气不运，清浊不分，下趋大肠则为泄，上壅
则为吐，故吐与泻对讲，其义便明。水就下，火炎上，知呕吐从于火化，而属热者
为多，则知泻利从于水化，而属寒者为多。且可知小便淋涩，乃为火气所持不得降，
诸义皆明矣。是故外感邪入而呕者，胃阳被郁而上冲也，治宜辛散，生姜所必
用也。不因外感而内热，胃火上冲者，治宜清降，石膏所必用也。痰湿郁滞成热上
逆者，陈皮、半夏、茯苓所必用也。食郁气滞而上逆者，枳实、麦芽等所必用也。
二便热结下不通，而反干乎上者，大黄、滑石等所必用也。此治实热之例也。若夫
胃气虚衰不运，郁热而呕者，则推扬胃气。寒冷不运，压火而呕者，则温中散
寒。胸中虚热，久不食而呕者，但得五谷之阴以和之，则立止。此治虚热之例也。
热固火逆而呕，寒亦郁火上逆而呕，故呕无不本于火者，但不得一概治以寒凉耳。
又若翎钗之探撩，舟车之摇撼，恶臭劣味之触犯，皆能扰动胃气而致呕。夫扰，
动属阳，火之化也，此虽不可以火治，而未始不可云火。若因其不可以火治而谓之
非火，且反谓之寒，则诬矣。一切病证，皆同此论之，不特呕吐为然也。（或问《伤寒
论》、《金匮》明言呕吐为胃寒，而子必归之火，何也？曰∶如但阴寒凝结，而气
不上逆，何以致吐。气即火也，寒
为本，寒郁气致上逆为标，仲景特言其本耳。）热呕，喜冷恶热，烦渴引饮，脉洪
数，二陈汤（见
痰饮。）加黄连、炒栀子、枇杷叶、竹茹、干葛、生姜，入芦根汁服。胃热，恶食
而吐，闻食气即呕，药下亦呕，并用芦根汁。下焦实热，二便不通，气逆不续，呕
逆不禁，病名走哺，人参汤。身背热，臂肋牵痛，膈间厌闷，食入即先呕而后下，
（或作后泻。）病名漏气，此因上焦伤风，郁热入里，麦门冬汤。呕苦水，乃胆热汁泄，
取足三里、阳陵泉。经曰∶诸呕吐酸，皆属于热。平时津液，随上升之气郁积
胃上，湿热不宣，故作酸。（即酒糟热则酸之理。）郁极则上涌而吐，
甚则牙齿酸涩，不能相对，
此为吐酸，平木汤，少用吴萸为从治。若不能吐涌而出，伏于胃中，咯不得上，咽
不得下，此为吞酸。肌表得风寒，则内热愈郁，而酸味刺心。若肌表得暖，腠理开
发，内热得泄，或得香热汤剂，津液行散，亦可暂解。（东垣谓∶酸味为收气，乃
金旺，寒水乃
金子，子能令母实，故用辛热之剂以治寒泻肺。其意亦谓太阳经外感于寒，则皮毛闭
而束热于内耳。太阳属寒水，
皮毛属肺金，故以金水言之。）然热剂终不可过用。丹溪用黄连、吴茱萸各制炒，随时令迭为
佐使，苍术、茯苓为辅，为小丸吞之。黄连汤作丸亦可。有宿食亦酸，如谷肉在器，
湿热则酸也，生料平胃散（见伤食）加麦芽、神曲，有痰者开郁汤。怒气吐逆，胸满膈胀，
不食常饱，食则吐，逍遥散。（见郁。）予尝病干呕，服生姜少止，误以为寒，屡治
不效者十余年。后悟为胃热，用清热生津药而愈。如果胃寒，则必喜热恶冷，
脉迟尿白，理中（见中寒）、吴茱萸等汤自可用。昔人患胃寒吐，用附子理中汤加丁香，
到口即吐，后去干姜、白术，只用参、附加丁香、木香、沉香，立止。盖干姜、
白术滞故耳。又热药有须冷服者，若热服则吐，此热因寒用之法。罗谦甫云∶服诸
热药不愈者，红豆丸神效。呕吐，诸药不效，当用镇重之品，以坠其上逆之气。痰
气结在咽膈间，粥药不得下，到咽即吐，姜苏汤下灵砂丹，俟药可进治之。呕脓，
胃脘痈也，不必治呕，脓尽自愈。呕虫，虫动则恶心，故呕，药入则虫必动，动则
呕，虫不出而药反出，非计也。必于药中入炒川椒十粒，庶虫见椒则伏而不动。泛
泛兀兀，心中怏漾，欲吐不吐，名恶心，气与痰壅，非乌药不开，大半夏汤，或小
半夏茯苓汤。（见痰饮。）仲景云∶欲吐者不可下之，以气方上涌，不可逆之使下，致抑
塞愦乱也。又云∶食已即吐，（火也。）大黄甘草汤下之者，以既吐矣，吐而不已，有升
无降，当引令下行也。呕吐津液既出，必渴，宜生津。呕吐大痛，色如青菜叶者死。
声音发出但没有呕吐物称为“哕”（音yuě，指干呕。另外《内经》中将“哕”解释为呃逆，含义不同）。有呕吐物且有声音称为“呕”，没有声音但有呕吐物称为“吐”，这些病症的病位都在胃。赵以德则认为，有声音没有呕吐物（或有水液）称为“呕”，有呕吐物没有声音称为“吐”，既有呕吐物又有声音称为“呕吐”。他提出胃分为上、中、下三个脘：上脘效法天，属于清阳，归属于气分，主运动；下脘效法地，属于浊阴，归属于血分，主静止。虽然阳中有阴，阴中有阳，但上脘终究是气多血少，下脘终究是血多气少，中脘则是气血各半。饮食进入胃后，也会分离清浊，水饮属于物的清部分，谷物食物属于物的浊部分。而在清之中又有浊，所以清中之清的部分，向上输送到肺，散布成为津液；清中之浊的部分，向下输送到膀胱，排出成为大小便。在浊之中又有清，所以浊中之浊的部分，成为糟粕，由大肠排出；浊中之清的部分，渗入血脉成为精气。如果邪气侵犯上脘的阳气部位，就会导致气停水积，水饮的清浊混乱，形成痰饮涎唾，阻碍胸中使其感到不快，清气不能上升，激荡而引发呕吐，所以“呕”属于气病。它效法天的阳气，动而有声，与水一起吐出，就像雷震雨注一样。如果邪气侵犯下脘的阴气部位，就会导致血分停滞而食物停积。“吐”效法地的阴气，静而无声，食物从口中吐出，就像万物从地里生长出来一样。如果邪气在中脘，则呕吐同时发生，饮食都会吐出来。（洁古说：中焦呕吐属于积滞，由食物与气相互结合形成积滞，或者先痛后吐，或者先吐后痛，这也是清浊相杂的道理，即气为清、食为浊。他又说：下焦呕吐属于寒证，早晨吃晚上吐，这也属于阴的性质。东垣也说：少阳经气多血少，表现为有声无物；阳明经气多血多，表现为有声有物；太阳经血多气少，表现为有物无声，这些都与此意相同。只是气血多少的区别，不是以胃的三个脘来划分，而是以三条经脉来划分罢了。不要拘泥于此。）然而上脘并非不吐食物，假如阳中之阴也生病（例如上脘有痰血积滞，这是有形之物，即属于阴），那么食物吃下去就会立即吐出，无法进入胃中（见下文），不像中脘那样食物消化后才吐，也不像下脘那样食物停留很久才吐。下脘也并非不呕，假如阴中之阳也生病（例如雷龙之火上冲），那么吐与呕会同时发生，只是呕少于吐，不像上脘那样呕多于吐。水谷进入胃中，如果脾气不运化，清浊不分，向下流入大肠则为泄泻，向上壅塞则为呕吐，所以呕吐与泄泻是对应的，其道理就明白了。水性就下，火性炎上，知道呕吐是从火化而来，且属热的居多，就知道泄泻是从水化而来，且属寒的居多。并且可以知道小便淋沥涩痛，是因为火气制约导致不得下降，各种道理都阐明了。因此，外感邪气侵入而呕吐的，是胃阳被郁遏而上冲，治疗宜用辛散之法，生姜是必须用的药。不是因为外感而是内热，胃火上冲的，治疗宜用清降之法，石膏是必须用的药。痰湿郁滞化热上逆的，陈皮、半夏、茯苓是必须用的药。食积气滞而上逆的，枳实、麦芽等是必须用的药。二便热结不通于下，反而干扰于上的，大黄、滑石等是必须用的药。这是治疗实热证的法则。如果是胃气虚衰不能运化，郁热而呕吐的，则应推扬胃气。因寒冷导致不运化，压抑火气而呕吐的，则应温中散寒。胸中虚热，长期不进食而呕吐的，只要得到五谷的阴气来调和它，就能立刻停止。这是治疗虚热证的法则。热盛火逆而呕吐，寒邪郁闭火气上逆而呕吐，所以呕吐无不基于火，只是不能一概用寒凉药物治疗罢了。另外，如翎钗探撩、舟车摇撼、恶臭劣味触犯，都能扰动胃气而导致呕吐。这种扰动，动属于阳，是火的性质，这虽然不能直接用火治，但未尝不可以说是火。如果因为不能用火治就说它不是火，甚至反说是寒，那就是诬妄了。一切病证，都遵循这个理论，不仅仅是呕吐如此。（有人问：《伤寒论》、《金匮要略》明确说呕吐是胃寒，为什么您一定要归结为火？回答说：如果只是阴寒凝结，而气不上逆，怎么会引起呕吐。气就是火，寒是本，寒郁气导致上逆是标，张仲景特别说的是本。）热呕，喜欢冷厌恶热，烦躁口渴想喝水，脉象洪数，用二陈汤（见痰饮条）加黄连、炒栀子、枇杷叶、竹茹、干葛、生姜，加入芦根汁服用。胃热，厌恶食物而吐，闻到食物气味就呕，药喝下去也呕，都用芦根汁。下焦实热，二便不通，气逆不止，呕吐剧烈无法控制，病名叫做“走哺”，用人参汤。身体背部发热，手臂和胁肋牵引疼痛，膈间烦闷，食物吃下去先呕然后腹泻（或作后泻），病名叫做“漏气”，这是因为上焦伤风，郁热入里，用麦门冬汤。呕吐苦水，是胆热胆汁外泄，取足三里、阳陵泉穴。经文说：各种呕吐酸水，都属于热证。平时的津液，随着上升的气机郁积在胃上部，湿热不能宣散，所以产生酸味。（这就是酒糟受热变酸的原理。）郁积到极点就向上涌出而呕吐，严重时牙齿酸涩，不能相对说话，这叫“吐酸”，用平木汤，少用吴茱萸作为反佐。如果不能涌吐而出，伏在胃中，咳不出来，咽不下去，这叫“吞酸”。肌表受风寒，则内热更加郁闭，酸味刺心。如果肌表温暖，腠理开发，内热得以宣泄，或者得到香热汤剂，津液运行分散，也可以暂时缓解。（东垣说：酸味具有收敛之气，是金旺的表现，寒水是金的子，子能令母实，所以用辛热药剂来治疗寒泻肺。他的意思也是说太阳经受外寒侵袭，则皮毛闭合而将热束于体内。太阳属寒水，皮毛属肺金，所以用金水关系来论述。）但是热性药剂终究不可过度使用。丹溪用黄连、吴茱萸各制炒，根据时令交替作为佐使，苍术、茯苓为辅，做成小丸吞服。黄连汤做成丸剂也可以。有宿食也会发酸，就像谷物肉类在容器中，湿热就会变酸，用生料平胃散（见伤食条）加麦芽、神曲，有痰的用开郁汤。怒气导致吐逆，胸满膈胀，不想吃东西常觉得饱，吃了就吐，用逍遥散（见郁证条）。我曾经患干呕，服用生姜后稍止，误以为是寒证，多次治疗无效长达十余年。后来醒悟是胃热，用清热生津药而痊愈。如果是胃寒，则一定喜欢热厌恶冷，脉迟尿白，理中汤（见中寒条）、吴茱萸汤等自然可用。以前有人患胃寒呕吐，用附子理中汤加丁香，药到口即吐，后来去掉干姜、白术，只用人参、附子加丁香、木香、沉香，立刻停止。这是因为干姜、白术阻滞的缘故。另外热药有必须冷服的，如果热服则会吐，这是热因寒用的方法。罗谦甫说：服用各种热药无效的，红豆丸有神效。呕吐，各种药物无效时，应当用镇重的药物，来镇压其上逆之气。痰气结在咽喉膈膜之间，粥药无法下咽，到喉咙就吐，用姜苏汤送服灵砂丹，等到药能进后再治疗。呕吐脓液，是胃脘痈，不必治呕，脓排尽自愈。呕吐虫子，虫动则恶心，所以呕吐，药进去则虫必动，动则呕，虫没出来药反而出来了，这不是好办法。必须在药中加入炒川椒十粒，这样虫见到花椒就会潜伏不动。泛泛兀兀，心中怏漾，想吐又吐不出来，名叫恶心，是气与痰壅塞，非乌药不能开通，用大半夏汤，或小半夏茯苓汤（见痰饮条）。张仲景说：想吐的人不可用下法，因为气正向上涌，不可逆势使其下行，导致抑塞混乱。又说：吃完就吐（这是火证），用大黄甘草汤下之，是因为已经吐了，吐个不停，只有升没有降，应当引导其下行。呕吐津液既出，必然口渴，宜生津。呕吐物大痛，颜色像青菜叶的是死证。
(Shuddering, nausea)
The emission of sound without vomitus is called *yue* (shuddering/dry heaving). (Pronounced yuě. It refers to dry heaving. Additionally, in the *Neijing*, *yue* is interpreted as hiccups, which has a different meaning.) The emission of sound with vomitus is called *ou* (vomiting), and the emission of soundless vomitus is called *tu* (regurgitation/spitting out). These diseases are located in the Stomach. Zhao Yi-de, however, considered that having sound but no vomitus (or only water) is *ou*, having vomitus but no sound is *tu*, and having both vomitus and sound is *ou tu*. He proposed that the Stomach is divided into three chambers: the Upper Chamber models Heaven, belongs to Clear Yang, is associated with the Qi level, and governs movement; the Lower Chamber models Earth, belongs to Turbid Yin, is associated with the Blood level, and governs stillness. Although Yang contains Yin and Yin contains Yang, the Upper Chamber ultimately has more Qi and less Blood, the Lower Chamber ultimately has more Blood and less Qi, and the Middle Chamber has an equal balance of Qi and Blood. When food and drink enter the Stomach, they also separate Clear from Turbid. Water and drinks belong to the Clear aspect of substances, while grains and foods belong to the Turbid aspect. Within the Clear, there is Turbid; thus, the Clearer part of the Clear ascends to the Lung and spreads to become Body Fluids. The Turbider part of the Clear descends to the Bladder and exits as urine and feces. Within the Turbid, there is Clear; thus, the Turbider part of the Turbid becomes dregs and exits via the Large Intestine. The Clearer part of the Turbid permeates into the blood vessels to become essence. If pathogenic factors invade the Yang region of the Upper Chamber, Qi stagnation and fluid accumulation occur. The clear and turbid nature of fluids becomes chaotic, forming phlegm-fluids, saliva, and sputum. This obstructs the chest, causing discomfort, prevents Clear Qi from ascending, and agitates to cause vomiting. Therefore, *ou* (vomiting with sound) is a disease of Qi. It models the Yang of Heaven, moves with sound, and exits together with water, similar to thunder shaking and rain pouring. If pathogenic factors invade the Yin region of the Lower Chamber, Blood stasis occurs and food stagnates. *Tu* (regurgitation without sound) models the Yin of Earth, is still and silent, and food is expelled from the mouth, similar to things emerging from the earth. If pathogenic factors are in the Middle Chamber, both *ou* and *tu* occur simultaneously, and all ingested food and drink are expelled. (Jiegu stated: Vomiting from the Middle Jiao belongs to accumulation, formed by the interaction of food and Qi creating stagnation. One may experience pain before vomiting or vomiting before pain, which reflects the mixing of clear and turbid—Qi is clear, food is turbid. He also stated: Vomiting from the Lower Jiao belongs to Cold; morning eating and evening vomiting belongs to the nature of Yin. Dongyuan also stated: The Shaoyang channel has abundant Qi and scarce Blood, manifesting as sound without vomitus; the Yangming channel has abundant Qi and abundant Blood, manifesting as sound with vomitus; the Taiyang channel has abundant Blood and scarce Qi, manifesting as vomitus without sound. All these align with this concept. However, the distinction of abundant or scarce Qi and Blood is not divided by the three chambers of the Stomach, but by the three channels. Do not be rigid about this.) Nevertheless, the Upper Chamber does not fail to expel food. If the Yin within Yang also becomes diseased (e.g., if there is phlegm-blood stagnation in the Upper Chamber, which is a tangible substance and thus belongs to Yin), then food will be vomited immediately upon entry and cannot enter the Stomach (see below), unlike the Middle Chamber where food is vomited after digestion, or the Lower Chamber where food is vomited after a long retention. The Lower Chamber does not fail to produce *ou*. If the Yang within Yin also becomes diseased (e.g., if Fire from the Thunder Dragon rushes upward), then *tu* and *ou* will occur together, but *ou* will be less than *tu*, unlike the Upper Chamber where *ou* exceeds *tu*. When water and grain enter the Stomach, if the Spleen Qi fails to transport and Clear/Turbid are not separated, downward flow into the Large Intestine causes diarrhea, while upward congestion causes vomiting. Thus, vomiting and diarrhea are counterparts, making their logic clear. Water flows downward, Fire flares upward. Knowing that vomiting arises from Fire transformation and is mostly Heat-related, one can know that diarrhea arises from Water transformation and is mostly Cold-related. Furthermore, one can understand that dysuria (scanty, painful urination) occurs because Fire Qi restricts descent. All these principles are clarified. Therefore, when external pathogens invade and cause vomiting, it is due to Stomach Yang being constrained and rushing upward; treatment should employ Acrid-Dispersing methods, and Shengjiang (Fresh Ginger) is essential. When vomiting is caused by internal Heat and Stomach Fire rushing upward (not due to external pathogens), treatment should employ Clearing-Descending methods, and Shigao (Gypsum Fibrosum) is essential. When Phlegm-Dampness stagnates, transforms into Heat, and rebels upward, Chenpi (Citrus Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), and Fuling (Poria) are essential. When Food Stagnation and Qi Stagnation rebel upward, Zhishi (Aurantii Fructus Immaturus) and Maiya (Hordei Fructus Germinatus) etc. are essential. When Heat binding in the Bowels prevents downward flow and interferes upward, Dahuang (Rhei Radix et Rhizoma) and Huashi (Talcum) etc. are essential. This is the protocol for treating Excess-Heat syndromes. If Stomach Qi is deficient and failing to transport, leading to constrained Heat and vomiting, one must promote and raise Stomach Qi. If Cold prevents transport, suppressing Fire and causing vomiting, one must Warm the Middle and Dispel Cold. If there is Deficient Heat in the Chest, and prolonged fasting leads to vomiting, providing the Yin of the Five Grains to harmonize it will stop it immediately. This is the protocol for treating Deficient-Heat syndromes. Whether vomiting is due to Excess Fire rebellion or Cold constraining Fire leading to rebellion, vomiting fundamentally stems from Fire, though one cannot uniformly treat it with Cold-Cooling herbs. Additionally, stimuli such as probing with feathers/ornaments, rocking from boats/carts, or exposure to foul odors can disturb Stomach Qi and cause vomiting. Disturbance involves movement, which belongs to Yang and is a transformation of Fire. Although this cannot be treated directly with Fire therapy, it can still be described as related to Fire. To claim it is not Fire, or even to call it Cold, because it cannot be treated with Fire therapy, would be false. This theory applies to all diseases, not just vomiting. (Someone asked: The *Shanghan Lun* and *Jinkui Yaolue* explicitly state that vomiting is due to Stomach Cold, why do you attribute it to Fire? I replied: If there were merely Yin-Cold coagulation without Qi rebelling upward, how could vomiting occur? Qi is Fire. Cold is the root; Cold constraining Qi to rebel upward is the branch. Zhang Zhongjing specifically addressed the root.) For Heat-induced vomiting, characterized by preference for cold and aversion to heat, irritability, thirst with desire to drink, and a surging-rapid pulse, use Erchen Tang (see Phlegm-Fluids) added with Huanglian (Coptidis Rhizoma), Chao Zhizi (Gardeniae Fructus stir-fried), Pipaye (Loquat Leaf), Zhuru (Bambusa Textilis Caulis in succo), Genge (Puerariae Radix), and Shengjiang (Zingiberis Rhizoma Recens), taken with Luzhigen juice (Reed Rhizome Juice). For Stomach Heat, characterized by aversion to food and vomiting, vomiting at the smell of food, and vomiting even after taking medicine, use Luzhigen juice alone. For Lower Jiao Excess Heat, characterized by obstruction of urination and defecation, rebellious Qi unable to continue, and uncontrollable violent vomiting, a condition named "Zoubu" (Running Nourishment), use Renshen Tang (Ginseng Decoction). For fever in the body and back, pulling pain in arms and costal regions, oppression in the diaphragm, and vomiting followed by diarrhea after eating (or subsequent diarrhea), a condition named "Louqi" (Leaking Qi), caused by Wind-Heat invading the Upper Jiao and constrained Heat entering the interior, use Maimendong Tang (Ophiopogonis Decoction). For vomiting bitter fluid, indicating Gallbladder Heat and bile leakage, select Zusanli (ST36) and Yanglingquan (GB34). The Classic states: All vomiting and acid regurgitation belong to Heat. Normally, Body Fluids, following ascending Qi, accumulate in the upper Stomach. Due to Damp-Heat failing to disperse, acidity forms. (This is the same principle as wine lees turning sour when heated.) When constrained to the extreme, it surges upward and is vomited. In severe cases, teeth feel sour and numb, preventing speech. This is called "Tu Suan" (Vomiting Acid). Use Pingmu Tang, adding a small amount of Wuzhuyu (Evodiae Fructus) as a counter-agent. If the acid cannot be vomited out but remains lodged in the Stomach, unable to be coughed up or swallowed down, it is called "Tun Suan" (Swallowing Acid). When the body surface is exposed to Wind-Cold, internal Heat becomes more constrained, and the sour sensation pierces the heart. If the body surface is warm, pores open, and internal Heat dissipates, or if aromatic-hot decoctions are taken to disperse Body Fluids, temporary relief may occur. (Dongyuan stated: Sour taste has a contracting nature, indicating strong Metal. Cold Water is the child of Metal. The child makes the mother full, so acrid-hot agents are used to treat Cold draining the Lung. His intent was also that when the Taiyang channel is externally attacked by Cold, skin and hair close, trapping Heat inside. Taiyang belongs to Cold Water, skin and hair belong to Lung Metal, hence the discussion in terms of Metal and Water.) However, hot agents should never be overused. Danxi used Huanglian (Coptidis Rhizoma) and Wuzhuyu (Evodiae Fructus), each processed by stir-frying, alternating as assistants according to seasons, with Cangzhu (Atractylodis Rhizoma) and Fuling (Poria) as supports, made into small pills to swallow. Huanglian Tang made into pills is also acceptable. Food retention can also cause acidity, like grain and meat turning sour in containers due to Damp-Heat. Use Shengliao Pingwei San (see Food Retention) added with Maiya (Hordei Fructus Germinatus) and Shenqu (Massa Medicata Fermentata); for Phlegm, use Kaiyu Tang (Open Depression Decoction). Anger causing vomiting and rebellion, chest fullness and diaphragmatic distension, lack of appetite with constant fullness, and vomiting after eating, use Xiaoyao San (see Depression). I once suffered from dry heaving. Taking a little Shengjiang provided slight relief. Mistaking this for Cold, I underwent multiple ineffective treatments for over ten years. Later, I realized it was Stomach Heat and cured myself using Heat-Clearing and Fluid-Nourishing herbs. If it were truly Stomach Cold, one would prefer heat and dislike cold, have a slow pulse and white urine, and Lizhong Tang (see Middle Cold) or Wuzhuyu Tang would naturally be applicable. Previously, someone with Stomach Cold vomiting used Fuzi Lizhong Tang added with Dingxiang (Caryophylli Flos). The medicine was vomited immediately upon reaching the mouth. Later, Ganjiang (Zingiberis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma) were removed, using only Renshen (Ginseng), Fuzi (Aconiti Lateralis Radix Praeparata), Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix), and Chenxiang (Aquilariae Lignum Resinatum), and the vomiting stopped immediately. This was because Ganjiang and Baizhu were cloying/stagnating. Additionally, some hot medicines must be taken cold; if taken hot, they induce vomiting. This is the method of "Treating Heat with Cold Administration." Luo Qianfu said: For those who do not respond to various hot medicines, Hongdou Wan (Red Bean Pill) is miraculous. For vomiting unresponsive to various drugs, heavy-settling substances should be used to suppress the rebellious Qi. If Phlegm-Qi knots in the throat and diaphragm, preventing porridge and medicine from passing, causing immediate vomiting upon reaching the throat, administer Lingsha Dan (Cinnabar Pill) with Jiangsu Tang (Ginger and Perilla Decoction), and treat further once medicine can be retained. Vomiting pus indicates a gastric abscess (*Weiyuan Yong*). There is no need to treat the vomiting; it will heal spontaneously once the pus is exhausted. Vomiting worms: Worm movement causes nausea and vomiting. Medicine intake causes worm movement, which triggers vomiting. If worms are not expelled but the medicine is, this is not a good strategy. One must add ten stir-fried Chuanjiao (Sichuan Pepper) grains to the medicine, so that worms see the pepper and lie dormant. A feeling of floating unease, inner agitation, wanting to vomit but unable to, is called "Enxin" (Nausea). This is Qi and Phlegm congestion, which cannot be opened without Wayao (Linderae Radix). Use Banxiahua Tang (Pinellia and Pinellia Decoction) or Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction) (see Phlegm-Fluids). Zhang Zhongjing said: Those who want to vomit should not be purged, because Qi is surging upward; forcing it downward causes suppression and confusion. He also said: Vomiting immediately after eating (Fire syndrome) can be treated with Dahuang Gancao Tang (Gastrodia and Licorice Decoction) to purge, because since vomiting has already occurred and continues incessantly, with ascent but no descent, it is necessary to guide it downward. After vomiting depletes Body Fluids, thirst inevitably ensues;生津 (generating fluids) is appropriate. Vomiting accompanied by severe pain, with vomitus resembling green vegetable leaves, indicates a fatal prognosis.