周梦觉曰∶呕吐之症，一曰寒，一曰热，一曰虚。寒则脉迟，热则脉数，虚则脉虚，即其脉可以分其症。最
易治者寒。阳明为消磨五谷之所，喜温而恶寒。一自寒犯于内，两相龃龉，食入即吐，不食亦呕。彼法夏丁香白蔻
砂仁，本草所注，一派止呕定吐之品，非不神效，不如一碗生姜汤，而其效更速者。经所谓寒气客于肠胃，厥逆上
出，故痛而呕是也。最误治者热。寒之不已，郁而为热。医不知其热，仍以辛热治其寒，愈呕愈热，愈热愈吐。彼
麦冬芦根定吐，书有明文，尚不知用，何况石膏之大寒大凉乎。不知石膏为止呕定吐之上品，本草未注其性，《内
经》实有其文。经曰∶诸逆上冲、皆属于火。诸呕吐酸，暴注下迫，皆属于热是也。最好治者虚。不专责之胃，而
兼责之脾。脾具坤静之德，而有干健之运。虚难转输，逆而呕吐。调理脾胃，乃医家之长策，理中汤六君子汤皆能
奏效。经曰∶足太阴之脉，挟咽连舌本。是动则病舌本强，食则呕是也。夫呕吐，病之最浅者也，噎膈，病之至深
者也，极为易辨。呕吐其来也猝，噎膈其来也缓。呕吐得食则吐，不食则有欲吐之状。噎膈食入方吐，不食不呕。
呕吐或寒或热或虚，外见寒热与虚之形。噎膈不食，亦与平人一般。呕吐不论年之老幼，噎膈多得之老人。呕吐
脉有迟有数有虚，噎膈脉缓。方书所论呕吐，牵扯噎膈之文，噎膈半是呕吐之方，有何疑似之难辨，而茫无定见也。
昔在湘中、壶盘会友，一老医曰∶吾治噎膈，得愈数人。核其药，曰附子理中汤，考其症，乃脾虚之呕吐者。又一
老医曰∶吾治噎膈，得愈数人。核其药，曰黄连法夏汤。考其症，乃胃热之呕吐者。药能医假病，人多得假名，其
即二老之谓欤。至于老人气鲠，时尝呕吐，不可概以呕吐论，亦不可遽以噎膈论。盖津少气虚，难以传送。古人刻
鸠于杖，祝其无噎者，此也。孕妇呕吐，法夏不犯禁例，且能安胎，准绳已详言之。更有妇人天癸来时，为风寒所
袭，传入肝经，血凝于肝，食入即呕，一载有余。医家以寻常治呕吐之法治之，或寒或热，俱不见效。只以桔梗红
花诸药，去瘀生新，数剂而愈，此又不可不知也。
经曰∶寒气客于肠胃，厥逆而出，故痛而呕。陈飞霞曰∶阳明胃气下行为顺，今逆而上行，故作呕吐。其症有
声有物谓之呕，有物无声谓之吐，有声无物谓之哕。又曰∶干呕，久病见此者死。盖小儿呕吐，有寒有热有伤食。
然寒吐热吐，未有不因于伤食者，其病总属于胃。复有溢乳、 乳、呕哕，皆与呕吐相似，而不可以呕吐治之。更
有寒热拒隔之证，又有虫痛而呕者，皆当详其证而治之。凡治小儿呕吐，先宜节其乳食，节者减少之谓也。然呕吐
多渴，不可与之茶水，水入复吐，终不能止，必强忍一二时之久，而后以米汤与之，吐自止矣。
寒吐者，乳片不消，多吐而少出，面白眼慢，气缓神昏，额上汗出，脉息沉微，宜温中消食。轻者，藿香正气
散。不止，理中汤加藿香。又不止，参香散。若再不止，此阴盛格阳，谓之拒格。急以理中汤一剂，用公猪胆汁，
和童便少许，将药润湿炒
熟，煎服即止。此《内经》热因寒用之法。盖阴寒太过，阳热之药，拒而不纳，故以猪胆童便为向导，其始则同，
其终则异。下咽之后，阴体渐消，阳气乃发。
热吐者，面赤唇红，吐次少而出物多，乳片已消，色黄，遍身发热而烦躁。夏月多此症，宜五苓散加藿香；
不止，藿连汤；再不止，用理中汤煎熟，调六一散冷服即止，此寒因热用也。
伤食吐者，眼胞浮肿，面色微黄，足冷，其热夜重日轻，或吐馊酸之气，或吐黄水，或吐清痰，其脉弦实而
滑。此有宿食也，宜下去其积乃止，消积丸治之。伤乳吐者，才乳即吐，或稍停而吐。此因乳食无度，脾胃娇嫩，
不能运化，此满则溢也，名溢乳。但宜节其乳，则吐自止。 乳者，时时吐乳而不多，似吐非吐，皆胃虚所致也，
宜参香散。有乳多而吐者，非真吐也，苟不知禁，即成真吐也。百日内小儿多有之。盖身小身软，必待乳母拥抱之。
苟有倾侧，乳即溢出，此人事也，不须用治。
嗽吐者，儿有咳嗽，必待其嗽定，方可与乳。若嗽未定，以乳哺之，其气必逆，乳不得消化而为痰，痰气壅塞，
嗽不得转，而吐乳也。枳桔二陈汤。
小儿初生三日内吐乳者，用丁香三粒，陈皮三分，生姜三片，煎服自止。又不若煨姜汤更妙，此余用最多者。
益三四日内，总皆寒吐也。
初起 乳，即当调治。如 不已，即成吐。吐不已，即成呕。呕不已，即成哕。至此胃气大虚，精神渐脱矣。
若呕吐不已，日渐沉困，囟陷颅肿，青筋大露者，并频吐不食，昏沉语塞，喘急大热，常吐腥臭者死。
哕者有声无物，最危之候。凡人久病以后，而见此者，皆为
不治。
凡呕吐不纳药食者，先将姜汤和土作丸，塞其两鼻孔，徐徐灌之。
白虎汤 治热吐。
石膏（一钱） 寸冬（一钱） 粳米（一钱） 炙草（一钱）
梦觉理中汤 治寒吐。
黄 （一钱） 焦术（一钱） 干姜（一钱） 附子（五分） 炙甘草（一钱） 大枣（一枚）
六君子汤（见前咳嗽方内治）虚吐。
《集成》藿香正气散 治内伤脾胃，外感风寒，吐泻霍乱等症。
藿香梗 家苏叶 大腹皮 广陈皮 牙桔梗 法半夏 茯苓 神曲 白芷（各一钱） 川朴 炙甘草（各五分）
生姜（一钱） 大枣（一枚）
上为末，以姜枣汤冲服固可，酌量煎服亦可。
五苓散 （见前咳嗽方内。）
《集成》藿连汤 治热吐。
川黄连 紫油朴 藿香叶 生姜 大枣
《集成》参香散 治胃虚作吐，诸药不止。
人参（切片焙干） 沉香（锉末） 公丁香 藿香根（焙） 广木香（锉屑）
上等分，为细末，木爪煎汤服。
六一散
西滑石（六钱，研末，水飞用） 甘草（一钱）
上共为细末，阴阳水冲服。
《集成》消积丸 治食停胃口作吐。
西砂仁（十三个，酒炒） 公丁香（九粒） 乌梅肉（三个，蒸去核） 巴豆仁（一粒，煨透去净油）
上共为末，米糊为丸，绿豆大，白开水下。
《集成》枳桔二陈汤
枳壳（一钱） 桔梗（一钱） 陈皮（一钱） 半夏（一钱） 茯苓（一钱） 炙甘草（一
钱） 生姜（一钱） 大枣（一枚）
涂蔚生曰∶飞霞此节证论方治，多未稳恰，不如梦觉之精美而纯。如其曰寒吐热吐，未有不因于伤食者，是其
将寒热所以成吐之理，尽行抹煞。未知寒自寒，热自热，而食自食也。纵寒热有因于食，亦断无尽因于食之理。
如其尽因于食，其拟用之理中汤、五苓散等剂，何以竟非消食之药乎？其所拟用之藿香正气散，多系散寒消滞破气
之药。设使人非感寒，内伤食积，与触时疫不正之气者，无不立见偾事。又如其谓热吐，遍身发热而烦躁者，用五
苓散，是犹为以涂糊涂。盖五苓散，为治寒水不化之大剂，其见症虽有发热，烦躁作渴等等，亦确系水停而津不
能散布，始见标热之象也。如桂枝可治热吐，则黄连知母，得勿可治寒吐者乎？故曰不如梦觉之精美而纯。至于少
阴水亏，虚火上犯脾胃而作吐者，则犹为此症不可不知。余曾治一呕吐，多方不效之症，以六味地黄汤，少加桂
附而愈者。可见呕吐之症，不专属于脾胃之虚寒也。然亦可见呕吐之症，不专属于肝肾之虚热也。医者能以举一反三，
方为通权达变。
周梦觉说：呕吐这一病症，分为寒、热、虚三种类型。寒证脉象迟缓，热证脉象数急，虚证脉象虚弱，通过脉象就可以区分症状。最容易治疗的是寒证。阳明胃经是消化五谷的地方，喜欢温暖而厌恶寒冷。一旦寒气侵犯体内，胃气与寒气相互抵触，进食就吐，不吃也会作呕。那些使用半夏、丁香、白豆蔻、砂仁等药物，虽然本草书记载它们是一派止呕定吐的佳品，并非没有神效，但还不如一碗生姜汤，其疗效更迅速。这就是《内经》所说的“寒气客于肠胃，厥逆上出，故痛而呕”。
最容易误治的是热证。寒气郁结久了转化为热。医生不知道这是热证，仍然用辛热的药物治疗寒证，导致呕吐加剧、热气更盛，热气越盛呕吐越厉害。那些使用麦冬、芦根来定吐的书中有明确记载，尚且有人不知道使用，何况是大寒大凉的石膏呢？不知道石膏是止呕定吐的上品，虽然本草书未详细注明其性味，《内经》中确实有相关论述。《内经》说：“各种气逆上冲的病，都归属于火。”“各种呕吐酸水，突然腹泻伴里急后重，都归属于热。”
最好治疗的是虚证。不能只责之于胃，还要兼责之于脾。脾具有坤卦安静顺承的特性，同时具备乾卦刚健运行的功能。脾虚则难以运化转输，气机逆乱而发生呕吐。调理脾胃，是医家长久以来的良策，理中汤和六君子汤都能奏效。《内经》说：“足太阴脾经，挟咽喉连舌本。经脉变动时，会出现舌根僵硬，进食则呕吐的症状。”
呕吐是病情最浅表的疾病，噎膈（吞咽困难，胸膈阻塞）是病情最深重的疾病，极易辨别。呕吐发病突然，噎膈发病缓慢。呕吐是吃了食物就吐，不吃也有想吐的感觉；噎膈是食物吃进去才吐，不吃不吐。呕吐可能表现为寒、热或虚，外表可见寒热或虚弱的形态；噎膈患者即使不进食，也与正常人一样。呕吐不分老人小孩，噎膈多见于老年人。呕吐的脉象有迟、数、虚之分，噎膈的脉象缓。方书中讨论呕吐时，常牵扯噎膈的内容，噎膈的治疗方剂有一半也是治疗呕吐的，有什么疑难难以辨别，从而茫然没有定见呢？
过去在湘中壶盘与朋友聚会时，一位老医生说：“我治疗噎膈，治愈了几个人。”核查他的用药，是附子理中汤；考察他的症状，原来是脾虚引起的呕吐。又一位老医生说：“我治疗噎膈，也治愈了几个人。”核查他的用药，是黄连法夏汤；考察他的症状，原来是胃热引起的呕吐。药物能医治假病，人却得了假名，说的就是这两位老医生吧。至于老年人气机梗塞，时常呕吐，不能一概当作呕吐论治，也不能立刻当作噎膈论治。这是因为津液少、气虚，难以传送食物。古人刻鸠鸟于拐杖上，祝愿老人无噎食之患，指的就是这种情况。孕妇呕吐，法半夏不属于禁忌，而且能安胎，《准绳》中已详细说明。还有妇女月经来潮时，被风寒侵袭，传入肝经，血液凝滞于肝，进食即呕，持续一年多。医生用寻常治疗呕吐的方法，无论是寒证还是热证，都不见效。只用桔梗、红花等药物，去除瘀血、生成新血，几剂药后就痊愈了，这又是不可忽视的情况。
《内经》说：“寒气客于肠胃，厥逆而出，所以疼痛并呕吐。”陈飞霞说：“阳明胃气以下行为顺，现在逆而上行，所以发生呕吐。”有声音有实物吐出叫作呕，有实物无声音吐出叫作吐，有声音无实物吐出叫作哕（干呕）。又说：干呕，如果是久病患者出现此症，预后不良，主死。小儿呕吐，有寒、热、伤食几种情况。然而寒吐和热吐，没有不是因为伤食引起的，其病总属于胃。另外还有溢乳、哺露（喂奶溢出）、呕哕，都与呕吐相似，但不能按呕吐治疗。还有寒热格拒的证候，以及因虫痛而呕吐的，都应当详细辨证后治疗。凡是治疗小儿呕吐，首先应当节制乳食，“节”就是减少的意思。然而呕吐多伴有口渴，不可给患儿喝茶水，水喝进去又会吐出来，始终无法停止，必须强忍一两个小时之久，然后用米汤喂他，呕吐自然就会停止。
寒吐者，乳汁片状不消化，多吐而少出，面色苍白，眼睑松弛，气息微弱，精神昏沉，额头出汗，脉象沉微，适宜温中消食。轻症用藿香正气散。若不止，理中汤加藿香。若仍不止，用参香散。如果再不止，这是阴盛格阳，称为拒格。急需服用一剂理中汤，加入公猪胆汁和少许童便，将药物润湿炒熟，煎服即可停止。这是《内经》“热因寒用”的方法。因为阴寒太过，阳热性质的药物会被拒绝而不被接纳，所以用猪胆和童便作为向导，起初性质相同，最终性质不同。咽下之后，阴寒逐渐消散，阳气得以发散。
热吐者，面红唇赤，呕吐次数少但吐出物多，乳汁片已消化，颜色黄，全身发热且烦躁。夏季多见此症，宜用五苓散加藿香；若不止，用藿连汤；再不止，用理中汤煎熟，调入六一散冷服即可停止，这是“寒因热用”的方法。
伤食吐者，眼睑浮肿，面色微黄，脚冷，热度夜间重白天轻，或吐出馊酸气味，或吐出黄水，或吐出清痰，脉象弦实而滑。这是有宿食停滞，应当攻下积滞才能停止，用消积丸治疗。伤乳吐者，刚吃奶就吐，或者稍停一会儿就吐。这是因为乳食无度，脾胃娇嫩，不能运化，这是满则溢出的现象，名叫溢乳。只需节制乳量，呕吐自然停止。哺露者，时时吐乳但不多，似吐非吐，都是胃虚所致，宜用参香散。有乳汁多而吐出的，不是真正的呕吐，如果不加以禁止，就会变成真吐。百日内的小儿多有此症。因为身体小且软，必须等待乳母拥抱。如果有倾斜侧倒，乳汁就会溢出，这是人为因素，不需要治疗。
嗽吐者，小儿有咳嗽，必须等咳嗽平息后，才可以喂奶。如果咳嗽未平，就喂奶，气机必然逆乱，乳汁不得消化而变为痰，痰气壅塞，咳嗽无法缓解，从而导致吐乳。用枳桔二陈汤。
小儿出生三日内吐乳者，用丁香三粒，陈皮三分，生姜三片，煎服自止。不如煨姜汤更好，这是我使用最多的方法。三四日内的吐乳，总属寒吐。
初起哺露，就应当调治。如果哺露不止，就会变成吐；吐不止，就会变成呕；呕不止，就会变成哕。到了这个阶段，胃气大虚，精神逐渐脱失。如果呕吐不止，日渐沉重困倦，囟门凹陷颅骨肿胀，青筋暴露，频繁呕吐不进食，昏沉不语，喘促急迫高热，经常吐出腥臭之物，这些都属于死证。
哕是有声无物，是最危险的征候。凡人久病之后出现此症，都属于不治之症。
凡呕吐不能接受药物和食物的，先将姜汤和土做成丸药，塞住两个鼻孔，慢慢灌入。
白虎汤：治疗热吐。
石膏（一钱） 寸冬（一钱） 粳米（一钱） 炙甘草（一钱）
梦觉理中汤：治疗寒吐。
黄芪（一钱） 焦术（一钱） 干姜（一钱） 附子（五分） 炙甘草（一钱） 大枣（一枚）
《集成》藿香正气散：治疗内伤脾胃，外感风寒，吐泻霍乱等症。
藿香梗 家苏叶 大腹皮 广陈皮 牙桔梗 法半夏 茯苓 神曲 白芷（各一钱） 川朴 炙甘草（各五分） 生姜（一钱） 大枣（一枚）
以上为末，用姜枣汤冲服固然可以，酌情煎服也可以。
《集成》藿连汤：治疗热吐。
川黄连 紫油朴 藿香叶 生姜 大枣
《集成》参香散：治疗胃虚作吐，诸药不止。
人参（切片焙干） 沉香（锉末） 公丁香 藿香根（焙） 广木香（锉屑）
上等分，研为细末，用木瓜煎汤送服。
六一散
西滑石（六钱，研末，水飞用） 甘草（一钱）
以上共为细末，用阴阳水冲服。
《集成》消积丸：治疗食停胃口作吐。
西砂仁（十三个，酒炒） 公丁香（九粒） 乌梅肉（三个，蒸去核） 巴豆仁（一粒，煨透去净油）
以上共为末，米糊为丸，绿豆大小，白开水送下。
《集成》枳桔二陈汤
枳壳（一钱） 桔梗（一钱） 陈皮（一钱） 半夏（一钱） 茯苓（一钱） 炙甘草（一钱） 生姜（一钱） 大枣（一枚）
涂蔚生说：陈飞霞这一节的证候论述和方剂治疗，大多不够稳妥恰当，不如周梦觉的精妙纯正。比如他说寒吐热吐没有不是因为伤食引起的，这是将寒热导致呕吐的原理全部抹杀了。不知道寒自寒，热自热，而食自食。纵然寒热有因于食引起的，也绝对没有尽是因于食的道理。如果全都因于食，他所拟定的理中汤、五苓散等方剂，为什么竟然不是消食的药物呢？他所拟定的藿香正气散，多是散寒消滞破气的药物。假设病人并非感寒，而是内伤食积，或是触及时疫不正之气的人，无不立即失败。又如他说热吐，全身发热且烦躁者，用五苓散，这简直是糊涂涂。因为五苓散是治疗寒水不化的大方剂，其见证虽然有发热、烦躁作渴等，也确实是因为水停而津液不能散布，才出现标热之象。如果桂枝可以治疗热吐，那么黄连知母，难道不可以治疗寒吐吗？所以说不如周梦觉的精妙纯正。至于少阴肾水亏虚，虚火上犯脾胃而导致呕吐的，则是此症不可不知的。我曾治疗一个多方治疗无效的呕吐病例，用六味地黄汤，少量加入桂枝、附子而痊愈。可见呕吐之症，不专属于脾胃的虚寒。然而也可看出呕吐之症，不专属于肝肾的虚热。医者能够举一反三，才是通权达变。
Zhou Mengjue stated: The syndrome of vomiting and regurgitation is categorized into three types: cold, heat, and deficiency. In cold syndromes, the pulse is slow; in heat syndromes, the pulse is rapid; in deficiency syndromes, the pulse is weak. Thus, the symptoms can be distinguished by the pulse. The easiest to treat is the cold type. The Yangming Stomach meridian is the site for digesting grains, favoring warmth and disliking cold. Once cold pathogenic factors invade internally, they clash with stomach Qi, causing immediate vomiting upon eating and retching even when not eating. Although herbs such as Banxia (Pinellia Rhizome), Dingxiang (Clove), Ba Dou Kou (Cardamom Fruit), and Sharen (Amomum Fruit) are recorded in materia medica as effective anti-emetics, a bowl of Shengjiang Tang (Fresh Ginger Decoction) acts even faster. This corresponds to the *Neijing* statement: "When cold qi lodges in the intestines and stomach, rebellious Qi rises upward, causing pain and vomiting."
The most prone to misdiagnosis is the heat type. If cold stagnates for too long, it transforms into heat. If physicians fail to recognize the heat and continue treating it as cold with acrid-warm herbs, the vomiting worsens, the heat increases, and the more the heat increases, the worse the vomiting becomes. Books explicitly record the use of Maidong (Ophiopogon Tuber) and Lugen (Reed Rhizome) to stop vomiting, yet some still do not use them, let alone Shigao (Gypsum Fibrosum), which is extremely cold and cooling. It is unknown that Shigao is a premier herb for stopping vomiting. Although the materia medica does not detail its nature, the *Neijing* contains relevant text: "All rebellious upward rushing belongs to fire," and "All vomiting of sour fluid, sudden diarrhea with tenesmus, belongs to heat."
The best to treat is the deficiency type. One should not blame only the Stomach but also consider the Spleen. The Spleen possesses the quiet virtue of Kun (Earth) and the vigorous function of Qian (Heaven). Deficiency leads to failure in transportation and transformation, causing rebellious Qi and vomiting. Regulating the Spleen and Stomach is a long-standing strategy for physicians; Lizhong Tang (Regulate the Middle Decoction) and Liujunzi Tang (Six Gentlemen Decoction) are both effective. The *Neijing* states: "The Foot-Taiyin Spleen meridian runs alongside the throat and connects to the root of the tongue. When the meridian is disturbed, it causes stiffness of the tongue root and vomiting after eating."
Vomiting is a superficial disease, whereas Yige (Dysphagia and food impaction) is a deep-seated disease, making them easy to distinguish. Vomiting has a sudden onset, while Yige develops slowly. Vomiting occurs immediately after eating, or there is a desire to vomit even without eating. Yige involves vomiting only after food enters, with no vomiting when fasting. Vomiting may present with cold, heat, or deficiency signs externally. Yige patients who do not eat appear normal. Vomiting affects people of all ages, while Yige mostly affects the elderly. The pulse in vomiting may be slow, rapid, or weak, whereas the pulse in Yige is slow. Formulary discussions on vomiting often conflate Yige; half of the formulas for Yige are used for vomiting. Why is there confusion and lack of clear judgment?
Once, during a gathering in Xiangzhong Hupan, an old physician said, "I have cured several cases of Yige." Upon examining his prescriptions, they were Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction); upon examining the symptoms, they were actually vomiting due to Spleen deficiency. Another old physician said, "I have also cured several cases of Yige." His prescription was Huanglian Faxia Tang (Coptis and Pinellia Decoction); the symptoms were actually vomiting due to Stomach heat. Medicines can cure pseudo-diseases, leading people to acquire pseudo-names; this refers to these two old physicians. Regarding elderly individuals with Qi obstruction who occasionally vomit, one cannot generalize it as simple vomiting nor hastily diagnose it as Yige. This is due to insufficient fluids and Qi deficiency, making transport difficult. Ancients carved doves on walking sticks to wish the elderly freedom from choking, referring to this condition. For pregnant women with vomiting, Faxia (Prepared Pinellia) is not contraindicated and can calm the fetus, as detailed in *Zhunseng*. Furthermore, when women menstruate and are attacked by wind-cold, transmitting to the Liver meridian, blood coagulates in the Liver, causing immediate vomiting upon eating for over a year. Physicians using standard anti-emetic treatments for cold or heat failed. Only by using Jiegeng (Platycodon Root) and Honghua (Safflower) to remove stasis and generate new blood did the patient recover after a few doses. This is another aspect that must not be overlooked.
The *Neijing* states: "When cold qi lodges in the intestines and stomach, rebellious Qi emerges, causing pain and vomiting." Chen Feixia stated: "Yangming Stomach Qi moves downward smoothly; now it rebels and moves upward, causing vomiting." Vomiting with sound and matter is called Ou (vomiting); matter without sound is called Tu (regurgitation); sound without matter is called Yue (dry heaving). He added: Dry heaving in chronic illness indicates death. Pediatric vomiting includes cold, heat, and food retention. However, cold and heat vomiting invariably stem from food retention, and the pathology generally belongs to the Stomach. Additionally, milk overflow, spitting up, and dry heaving resemble vomiting but should not be treated as such. There are also patterns of cold-heat rejection and vomiting due to intestinal parasites, all requiring detailed differentiation. When treating pediatric vomiting, one must first regulate milk and food intake ("regulation" means reduction). Vomiting often causes thirst, but tea and water should not be given, as drinking leads to further vomiting. One must endure for one to two hours before giving rice soup, at which point vomiting stops.
In cold vomiting, undigested milk curds are expelled, with frequent vomiting and little output. The face is pale, eyelids are lax, breath is weak, spirit is dull, sweat appears on the forehead, and the pulse is deep and faint. Treatment should warm the middle and digest food. For mild cases, Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi) is used. If ineffective, Lizhong Tang plus Huoxiang is prescribed. If still ineffective, Shenxiang San (Ginseng and Agarwood Powder) is used. If vomiting persists, it indicates Yin excess repelling Yang, called "rejection." Urgently administer one dose of Lizhong Tang mixed with bile from a male pig and a small amount of child's urine. Moisten the herbs with this mixture, stir-fry until cooked, decoct, and take to stop vomiting. This follows the *Neijing* principle of "treating heat with cold." Because Yin-cold is excessive, warm Yang herbs are rejected. Pig bile and child's urine act as guides; initially similar, they differ ultimately. After ingestion, Yin-cold dissipates, and Yang Qi emerges.
In heat vomiting, the face is red, lips are crimson, vomiting episodes are infrequent but volume is large, milk curds are digested, vomitus is yellow, and the body is hot with irritability. This is common in summer. Wuling San (Five-Ingredient Poria Powder) plus Huoxiang is indicated. If ineffective, Houxian Tang (Houttuynia and Coptis Decoction) is used. If still ineffective, decoct Lizhong Tang, mix with Liuyi San (Six-to-One Powder), and take cold to stop vomiting. This is "treating cold with heat."
In food retention vomiting, eyelids are puffy, complexion is slightly yellow, feet are cold, fever is worse at night and lighter during the day, vomitus may smell sour/fermented, contain yellow fluid, or clear phlegm. The pulse is wiry, full, and slippery. This indicates retained food; purging the accumulation stops the vomiting. Xiaoji Wan (Eliminate Accumulation Pill) is used. Milk injury vomiting occurs immediately after feeding or after a short pause. This is due to unregulated feeding and delicate Spleen/Stomach failing to transform, resulting in overflow, named "milk overflow." Regulating milk intake stops vomiting. Spitting up (Ru Lu) involves small amounts of milk spit frequently, resembling vomiting but not quite, caused by Stomach deficiency; Shenxiang San is appropriate. Excessive milk expulsion is not true vomiting; if uncontrolled, it becomes true vomiting. Common in infants under 100 days due to small size and softness, requiring maternal support. Tilting causes spillage, which is mechanical and requires no treatment.
Cough-induced vomiting occurs when coughing prevents proper feeding. If fed while coughing, Qi rebels, milk fails to digest and forms phlegm, obstructing Qi flow and causing milk regurgitation. Zhijie Erchen Tang (Bitter Orange and Platycodon Two-Aged Phlegm Decoction) is used.
For infants vomiting within three days of birth, use three cloves (Dingxiang), three fen of Chenpi (Tangerine Peel), and three slices of Shengjiang (Fresh Ginger), decocted and taken. Simmered ginger soup is even better and widely used. Vomiting within three to four days is generally cold vomiting.
Initial spitting up should be regulated. If persistent, it becomes vomiting; if vomiting persists, it becomes retching; if retching persists, it becomes dry heaving. At this stage, Stomach Qi is severely deficient, and spirit fades. Prognosis is poor if vomiting persists with worsening fatigue, sunken fontanelle, swollen skull, prominent veins, frequent vomiting without eating, lethargy, aphasia, panting, high fever, or foul-smelling vomitus. Dry heaving (sound without matter) is critical and untreatable in chronic illness.
For vomiting where medicines/food are rejected, make pills from ginger soup and earth, insert into nostrils, and slowly instill medicine.
Baitu Tang (White Tiger Decoction): Treats heat vomiting.
Shigao (Gypsum Fibrosum, 1 qian), Cundong (Ophiopogon Tuber, 1 qian), Jingmi (Rice Grain, 1 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian).
Mengjue Lizhong Tang: Treats cold vomiting.
Huangqi (Astragalus Root, 1 qian), Jiaozhu (Charred Atractylodes Macrocephala Rhizome, 1 qian), Ganjiang (Dried Ginger, 1 qian), Fuzi (Prepared Aconite Lateral Root, 0.5 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian), Dazao (Jujube, 1 piece).
Liujunzi Tang (See previous cough formula): Treats deficiency vomiting.
*Jicheng* Huoxiang Zhengqi San: Treats internal Spleen/Stomach damage, external wind-cold, vomiting, diarrhea, cholera-like syndromes.
Huoxiang Geng (Agastache Stem), Jiayelu (Perilla Leaf), Dafupi (Areca Peel), Guang Chenpi (Broad-leaved Tangerine Peel), Ya Jiegeng (Platycodon Root), Faxia (Prepared Pinellia Rhizome), Fuling (Poria), Shenqu (Medicated Leaven), Baizhi (Angelica Dahurica Root) (each 1 qian), Chuanpu (Magnolia Bark), Zhi Gancao (Honey-fried Licorice Root) (each 0.5 qian), Shengjiang (Fresh Ginger, 1 qian), Dazao (Jujube, 1 piece).
Grind to powder, take with ginger-date decoction or decoct as needed.
Wuling San (See previous cough formula).
*Jicheng* Houxian Tang: Treats heat vomiting.
Chuan Huanglian (Coptis Rhizome), Ziyoupu (Magnolia Bark), Huoxiang Ye (Agastache Leaf), Shengjiang (Fresh Ginger), Dazao (Jujube).
*Jicheng* Shenxiang San: Treats Stomach deficiency vomiting unresponsive to other drugs.
Renshen (Ginseng Root, sliced and dried), Chenxiang (Agarwood, powdered), Gong Dingxiang (Male Clove), Huoxiang Gen (Agastache Root, roasted), Guang Muxiang (Costus Root, shredded).
Equal parts, grind to fine powder, take with Chaomua (Papaya) decoction.
Liuyi San
Xihuaishi (Western Talcum, 6 qian, powdered, water-floted), Gancao (Licorice Root, 1 qian).
Grind to fine powder, take with Yin-Yang Water.
*Jicheng* Xiaoji Wan: Treats vomiting due to food stagnation in the epigastrium.
Xisharen (Western Amomum Fruit, 13 pieces, wine-fried), Gong Dingxiang (Male Clove, 9 pieces), Wumei Rou (Dark Plum Flesh, 3 pieces, steamed and pitted), Badou Ren (Croton Seed Kernel, 1 piece, roasted to remove oil).
Grind to powder, bind with rice paste into pills the size of mung beans, take with plain boiled water.
*Jicheng* Zhijie Erchen Tang
Zhike (Bitter Orange Fruit, 1 qian), Jiegeng (Platycodon Root, 1 qian), Chenpi (Tangerine Peel, 1 qian), Banxia (Pinellia Rhizome, 1 qian), Fuling (Poria, 1 qian), Zhi Gancao (Honey-fried Licorice Root, 1 qian), Shengjiang (Fresh Ginger, 1 qian), Dazao (Jujube, 1 piece).
Tu Weisheng commented: Chen Feixia’s discussion on syndromes and treatments in this section is largely imprecise, inferior to Zhou Mengjue’s elegance and purity. For instance, stating that cold and heat vomiting always stem from food retention erases the principles of how cold and heat cause vomiting. Cold is cold, heat is heat, and food is food. Even if cold/heat stems from food, it is not exclusively so. If it were exclusively food-related, why are his prescribed Lizhong Tang and Wuling San not digestive formulas? Huoxiang Zhengqi San primarily disperses cold, eliminates stagnation, and moves Qi. If a patient is not affected by cold but has internal food retention or seasonal pestilence Qi, these formulas would fail. Regarding heat vomiting with whole-body heat and irritability, prescribing Wuling San is confusing. Wuling San treats failure to transform cold-water; although symptoms include heat and thirst, these are marked heat signs due to water retention preventing fluid distribution. If Guizhi (Cinnamon Twig) can treat heat vomiting, could Huanglian (Coptis Rhizome) and Zhimu (Anemarrhena Rhizome) treat cold vomiting? Thus, Zhou Mengjue is superior. However, one must know that Kidney Water deficiency with deficient fire attacking the Spleen/Stomach can cause vomiting. I once treated a refractory vomiting case with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) with added Guizhi and Fuzi, achieving recovery. This shows vomiting is not solely due to Spleen/Stomach deficiency-cold, nor solely due to Liver/Kidney deficiency-heat. Physicians must apply reasoning flexibly.