名义 尝读成无己《伤寒明理论》有曰∶呕者有声者也，俗谓之 ，吐者吐出其物也，故有干呕而无干吐。
夫呕者，东垣所谓声物兼出者也。吐者，东垣所谓物出而无声者也（按∶东垣言出《试效方》）。至若干呕与哕，
皆声出而无物也。夫仲景以声物兼出而名为呕，以物出而名为吐，以声独出而名为干呕。惟其呕兼声物，故无物而
声空鸣者，乃谓之干，干犹空也。至于吐则是必有物矣，其可谓之干乎。仲景于呕字上加一干字，所以别夫呕为
声物兼出者耳。成氏乃以呕为独有声而同乎干呕，得不有失仲景措辞之本意欤云云。夫 与哕，盖字异而音义俱同
者也。（《溯洄集》）
近世呕吐二字皆通用，然却无甚利害，理亦自不妨。（《要诀》）
病由脾胃虚弱 呕吐者，皆由脾胃虚弱，受于风邪所为也。若风邪在胃则呕。膈间有停饮，胃内有久寒，
则呕而吐。其状长太息，心里澹澹然，或烦满而大便难，或溏泄，并其候。（《病源论》）
呕吐者，胃气上而不下也。譬之通瓶小口，顿溉不入，乃升气所碍。人病呕吐，其理如此。盖脾胃气弱，风冷
干动，使留饮停积，饮食不化，胃气虚胀，心下澹澹，其气上逆，故令呕吐也。（《圣济》）
所因不一 人之阴阳升降，三焦调顺，脾胃和匀，乃能腐熟水谷，变化糟粕，传泻行导，下走肠间。若
脾胃虚冷，水谷不化，则阴阳痞隔，三焦不调，浊阴之气不能下行，奔冲于上，故发为呕吐。然吐逆之病，有得之
于膈实者，有生于中满者，有发于下焦者。种种虽不同，悉本胃气，逆则呕
吐。（《圣济》）
呕吐虽本于胃，然所因亦多端，故有寒热饮食血气之不同，皆使人呕吐。据论云∶寒气在上，忧气在下，
二气并争，但出不入。此亦一涂，未为尽论。且如气属内因，则有七种不同，寒涉外因，则六淫分异，皆作逆，
但郁于胃则致呕，岂拘于忧气而已。况有宿食不消，中满溢出，五饮聚结，随气翻吐，痼冷积热，及瘀血凝闭。
更有三焦漏气走哺，吐利泄血，皆有此证，不可不详辨也。（《三因》）
夫人受天地之中以生，莫不以胃为主。盖胃受水谷，脾主运化，生血生气，以充四体者也。若脾胃无所伤，
则无呕吐之患。其或饮食失节，温凉不调，或喜餐腥脍乳酪，或贪食生冷肥腻，露卧湿处，当风取凉，动扰于胃。
胃既病矣，则脾家停滞，清浊不分，中焦为之痞塞，遂成呕吐之患焉。然此特论饮食过伤，风凉冷湿之所由致者。
又如忧思伤感，宿寒在胃，中脘伏痰，胃受邪热，瘀血停蓄，亦能令人呕吐。（《济生》）
呕吐出于胃气之不和，人所共知也。然有胃寒，有胃热，有痰水，有宿食，有脓血，有气攻，又有所谓风邪
入胃。凡是数者，可不究其所自来哉。（《直指》）
人身以胃为主，赖之以容受五谷。但有所伤，非不能食，且有呕吐之患。胃虚之人，或为寒气所中，或为暑
气所干，或为饮食所伤，或气结而痰聚，皆能令人呕吐。又有瘀血停积胃口，呕吐之间，杂以涎血。当辨其脉证，
施以治法。（《大成》）
冷热二因 许仁则疗呕吐病有两种，一者积热在胃，呕逆不下食；一者积冷在胃，亦呕逆不下食。二事
正反，须细察之。必其食饮寝处将息伤热，又素无冷病，年壮力强，肤
肉充满，此则是积热在胃，致此呕逆。如将息食饮寝处不热，又素有冷病，年衰力弱，肤肉瘦悴，此则积冷在胃，
生此呕逆。若是积冷呕逆经久，急须救之，不尔甚成反胃病。（《外台》）
虚实二因 呕吐一证，最当详辨虚实。实者有邪，去其邪则愈。虚者无邪，则全由胃气之虚也。所谓邪
者，或暴伤寒凉，或暴伤饮食，或因胃火上冲，或因肝气内逆，或以痰饮水气聚于胸中，或以表邪传里，聚于少
阳阳明之间，皆有呕证，此皆呕之实邪也。所谓虚者，或其本无内伤，又无外感，而常为呕吐者，此既无邪，必
胃虚也。或遇微寒，或遇微劳，或遇饮食少有不调，或肝气微逆，即为呕吐者，总胃虚也。凡呕家虚实，皆以胃
气为言。使果胃强脾健，则凡遇饮食，必皆运化，何至呕吐。故虽以寒热饥饱大有所伤，亦不能动，而兹略有所
触，便不能胜，使非胃气虚弱，何以若此。此虚实之原，所当先察，庶不致误治之害。（《景岳》）
胃本属土，非火不生，非暖不化。是土寒者即土虚也。土虚者即火虚也。故曰脾喜暖而恶寒，土恶湿而喜燥。
所以东垣《脾胃论》特着温补之法，盖特为胃气而设也，庸可忽哉。第在河间，则言呕因胃火，是火多实也。兹余
言呕因胃寒，是寒多虚也。一热一寒，皆失中和之论。不知呕因火者，余非言其必无，但因火而呕者少，因寒而
呕者多耳；因胃实而呕者少，因胃虚而呕者多耳。故不得不有此辨。（同上）
脉候 寸口脉数，即为吐，以有热在胃管，熏胸中，宜服药吐之，及针胃管，服除热汤。关脉滑，胃中有
热，滑为热实，以气满故不欲食，食即吐逆，宜服紫菀汤下之，大平胃丸，针胃管泻之。（《脉经》）
关上脉浮而大，风在胃中，张口肩息，心下澹澹，食欲
呕。（同上）
紧而滑者，吐逆。（同上）
趺阳脉浮者，胃气虚，寒气在上，忧气在下，二气并争，但出不入，其人即呕而不得食，恐怖而死，宽缓
即瘥。阳紧阴数，其人食已即吐，阳浮而数亦为吐。寸紧尺涩，其人胸满不能食而吐，吐止者为下之，故不能食。
设言未止者，此为胃反，故尺为之微涩也。寸口脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉为阴结而迟，其
人则噎。关上脉数，其人则吐。趺阳脉微而涩，微则下利，涩则吐逆，谷不得入也。夫吐家，脉来形状如新卧
起。（同上）
诊决难易 滑数为呕，代者霍乱，微滑者生，涩数凶断。（《崔氏脉诀》）
呕吐反胃，浮滑者昌，弦数紧涩，结肠者亡。（《四言举要》）（按∶《续焰》曰∶呕吐有声有物，反出于
胃，上焦之病也。上焦则脉应浮，有物则脉应滑，浮滑为阳，饮食之能纳能运而不反者，阳之力也，故云浮滑
者昌。若得弦数紧涩之脉则逆矣。《必读》曰∶呕吐反胃，脾虚有痰也。浮为虚，滑为痰，是其正象，可以受补，
故曰昌也。若弦数紧涩，则血液枯，遂致粪如羊屎，必死不治矣。《金鉴》取《必读》，作若沉数细数，则为气
少液枯。）
其脉实大者难治，虚细者易愈。（《大成》）（按∶《如宜方》亦曰∶大抵脉宜虚细，不宜实大。）
脉得虚缓易治，紧涩者难治。（《原病集》）
脉宜浮缓而滑，最忌涩脉。（《粹言》）
尺脉不至 奉常梁公（讳克从，鄢陵人）素精岐黄术，任吏部时，暮夜逆予，云夫人病危。至诊脉两寸洪
大，关尺全无。视其床前有吐迹。公曰∶人脉之有尺，如木之有根，
水之有源。今尺绝矣，似难救矣。予曰∶从吐后得乎？曰∶然。曰∶然则可治。问∶何以故？予曰∶凡人大吐
则气上行，是以脉亦上行而不下，下部何由有脉也。所以尺部无脉，在他证言凶，此则无害。用藿香、陈皮、
浓朴、枳实、黄连、半夏、茯苓，加姜煎，连进二剂全愈。（《星海》）（按∶何不引《十四难》为征。）
又有呕吐太甚，胸中气不能降，而尺脉不至者。（《汇补》）
证治总说 盖胃者水谷之海，三焦者水谷之道路。胃气宣通，则上焦如雾，中焦如沤，下焦如渎，命
曰平人。胃既虚弱，水谷停滞，致三焦格拒，升降不匀，其气虚满，得食则呕。而又有朝食暮吐、暮食朝吐者，
有食已即吐者，有呕吐谷不得前者，有但呕而无所出者，有先呕却渴者，有先渴却呕者，有呕家本渴而反不渴者，
其本其治，各各不同。假令内格呕逆，食不得入，是有火也；病呕而吐，食久反出，是无火也。举此二者，乃知
呕吐之名则一，治疗之法各异。虽治法有冷热虚实之别，要当以安其胃气为本，使阴阳升降平匀，呕逆之病顺而
愈矣。（《圣济》）
夫呕吐之疾，非特脾胃虚冷而呕吐也，亦有胃热而呕者，亦有胃中冷、胃口热而吐者，亦有痰盛而呕者，亦
有血弱而呕者，经云无阴则呕是也。不可以一概用药。（《妇人良方》）
呕吐出于胃气之不和，人所共知也。然有胃寒，有胃热，有痰水，有宿食，有脓血，有气攻，又有所谓风邪
入胃，凡是数者，可不究其所自来哉。寒而呕吐，则喜热恶寒，四肢凄清，法当以刚壮温之。热而呕吐，则喜冷
恶热，烦躁中干，法当以温凉解之。痰水证者，唾沫怔忪，先渴后呕，与之消
痰逐水辈。宿食证者，胸腹胀满，醋闷吞酸，与之消食去积辈。腥气燥气，熏炙恶心，此脓血之聚，经所谓呕家
有痈脓，不须治，脓尽自愈是尔。七情内郁，关隔不平，此气攻之证，经所谓诸郁于胃则呕吐是尔。若夫风邪入
胃，人多不审，率用参、术助之，拦住寒邪，于此尤关利害。其或恶闻食臭，汤水不下，粥药不纳，此则翻胃之
垂绝者也。辨之不早，其何以为对治乎。（《直指》）
中寒则脉沉紧，四肢厥冷，饮食不下，当以温暖之药调之。挟暑则脉弦数，烦躁而渴，又当清凉之。停食则消
化之。痰聚则顺气温胃。停积者，多由忧思过度，损伤经络。呕吐之证，名状不一。至若香港脚内攻，妇人怀妊，中
毒困酒，俱有呕吐，又须各从其类以求之。（《大成》）
呕有声长声短之辨，吐有见痰见食之分，参之以脉证，合之以颜色，问之以从来，始为无失。毋但曰呕吐小
疾而忽之，常见肝实之证，令人呕吐不已而死者。（《方考》）
食积吐，噫酸气秽。寒积吐，清浊混出，不作腥臭，吐汁久澄，清浮浊底。血积吐，汁出色黑，口苦气腥，吐
汁久澄，浊浮清底。（《会解》）
病分三焦 吐有三，气、积、寒也，皆从三焦论之。上焦在胃口，上通于天气，主纳而不出。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，其证食已即吐，渴欲饮水，大便燥结，气上冲而胸发痛，其治也当降气和中。中焦吐者，皆
从于积，有阴有阳，食与气相假为积而痛，其脉浮而弱，其证或先痛而后吐，或先吐而后痛，治法当以毒药去其积，
槟榔木香行其气。下焦吐者，皆从于寒，地道也，其脉沉而迟，其证朝食暮吐，暮
食朝吐，小便清利，大便秘而不通，治法当以毒药通其闭塞，温其寒气，大便渐通，复以中焦药和之，不令大便
秘结而自愈也。（《保命集》）
病分新久 无病之人，卒然而呕吐，定是邪客胃府。在长夏暑邪所干，在秋冬风寒所犯。干暑者，六和汤、
五苓散之类。犯寒者，藿香正气散、理中汤、五积散之类。久病而吐者，胃虚不纳谷也，六君子汤加丁香、豆蔻之
类。常常恶心，呕吐清水，有热而有痰也，宜用二陈汤加苍术、浓朴、黄连、生姜之类是也。（《医统》）
虚呕 凡胃虚作呕者，其证不一，当知所辨。若胃脘不胀者，非实邪也。胸膈不痛者，非气逆也。内无热
躁者，非火证也。外无寒热者，非表邪也。无食无火而忽为呕吐者，胃虚也。呕吐无常而时作时止者，胃虚也。食
无所停而闻食则呕者，胃虚也。气无所逆，闻气则呕者，胃虚也。或身背，或食饮，微寒即呕者，胃虚也。或吞酸，
或嗳腐，时苦恶心，兀兀然，泛泛然，冷咽靡宁者，胃虚也。或因病误治，妄用克伐寒凉，木无呕而致呕者，胃虚也。
或朝食暮吐，暮食朝吐，食入中焦而不化者，胃虚也。食入下焦而不化者，土母无阳，命门虚也。凡此虚证，必皆
宜补。（《景岳》）
凡胃气本虚而或停滞不行者，是又虚中有实，不得不暂从清理，然后可以培补。又或虽有停滞而中气虚困不
支者，是又所急在虚，不得不先顾元气而略兼清理。此中本末先后，自有确然之理，所以贵知权也。（同上）
胃虚呕吐，宜分寒热，忌宜俱同胃虚。（《本草经疏》）
脉细弱或虚大，倦于言动，日久不食而吐者，属胃虚，宜六君子汤加姜汁。久病或服攻伐药，吐涎不止，脉
大无力，属脾虚不能摄涎而涎泛上，六君子加姜、桂凉服，睡觉即止。
（《六要》）
实呕 凡实邪在胃而作呕者，必有所因，必有见证。若因寒滞者，必多疼痛。因食滞者，必多胀满。
因气逆者，必痛胀连于胁肋。因火郁者，必烦热燥渴，脉洪而滑。因外感者，必头身发热，脉数而紧。如无实证
实脉而见呕吐者，切不可以实邪论治。（《景岳》）
寒呕 《医门方》云∶食已吐其食者，胃中虚冷所致。
（《医心》）（按∶此说可疑，姑存之。）
病者胃中寒，心下澹澹，四肢厥冷，食即呕吐，名曰寒呕。或因伤食多，致伤胃气，或因病曾经汗下，致胃
气虚冷之所为也。（《三因》）
如胃冷而呕吐，宜用《局方》人参丁香散、理中丸及许仁则半夏丸、人参七味丸（并见《外台》）。如胃中冷、
胃口热而呕吐者，宜用《局方》藿香正气散，生姜、枣子煎，沉冷服即止。（《妇人良方》）
【名义】
我曾经阅读成无己的《伤寒明理论》，其中有这样的说法：呕，是有声音的呕吐，民间称为“哕”；吐，是吐出胃中的食物，所以有干呕而没有干吐。
所谓呕，是李东垣所说的声音和食物同时排出的情况。所谓吐，是李东垣所说的只有食物排出而没有声音的情况（按：李东垣的话出自《试效方》）。至于像干呕和哕，都是只有声音排出而没有食物。张仲景将声音和食物同时排出命名为“呕”，将只有食物排出命名为“吐”，将只有声音单独排出命名为“干呕”。正因为“呕”兼有声音和食物，所以没有食物而只有声音空鸣的情况，才称之为“干”，“干”就是空的意思。至于“吐”，则一定是有食物的，怎么能称之为“干”呢？张仲景在“呕”字上加一个“干”字，就是为了区分那种声音和食物同时排出的“呕”。成无己却把“呕”当作只有声音而等同于“干呕”，这难道不是违背了张仲景用词的本意吗？等等。至于“哕”与“哕”（注：原文此处可能有误，通常指呃逆或干呕之变称），大概是字形不同但音义都相同的情况。（出自《溯洄集》）
近代“呕”和“吐”两个字通用，但这并没有太大的利害影响，道理上也不妨碍。（出自《要诀》）
【病由脾胃虚弱】
呕吐，都是由脾胃虚弱，受到风邪侵袭所致。如果风邪在胃，就会引起呕。如果膈间有停饮（水液停滞），胃内有久寒，就会既呕又吐。其症状表现为经常叹气，心中悸动不安，或者烦闷且大便困难，或者溏泄，这些都是相应的证候。（出自《诸病源候论》）
呕吐，是胃气向上而不向下运行。就像瓶口小的瓶子，突然灌注水流不进去，是被上升的气所阻碍。人患病呕吐，道理就是这样。大概因为脾胃气弱，风寒冷邪干扰触动，导致留饮停滞积聚，饮食不能消化，胃气虚胀，心下悸动不安，气机上逆，所以导致呕吐。（出自《圣济总录》）
【所因不一】
人的阴阳升降，三焦调顺，脾胃调和均匀，才能腐熟水谷，变化糟粕，传导排泄，向下走于肠道。如果脾胃虚冷，水谷不能消化，就会导致阴阳痞塞阻隔，三焦不调，浊阴之气不能下行，反而奔冲于上，所以发为呕吐。然而吐逆的病，有的是由于膈实引起的，有的是生于中满引起的，有的是发于下焦引起的。虽然种种情况不同，但都本源于胃气，气逆则发生呕吐。（出自《圣济总录》）
呕吐虽然本源于胃，但致病原因也有很多种，所以有寒、热、饮食、血、气的不同，都会使人呕吐。据论述说：寒气在上，忧气在下，二气相互争斗，只出不入。这也是一种情况，但不是全面的论述。况且如气属于内因，则有七种不同，寒邪属于外因，则有六淫之分，都会造成气逆，但只要郁结在胃就会导致呕，哪里仅限于忧气呢？何况还有宿食不消，中满溢出，五饮聚结，随气翻吐，痼冷积热，以及瘀血凝闭。更有三焦漏气走哺（指饮食入口即吐或下利），吐利泄血，都有这种证候，不可不详加辨别。（出自《三因极一病证方论》）
人受天地之气而生，没有不以胃为主的。大概胃受纳水谷，脾主运化，生成气血，以充养四肢。如果脾胃没有受伤，就不会有呕吐的祸患。如果饮食失节，温凉不调，或者喜欢吃腥腻肉类、乳酪，或者贪吃生冷肥腻之物，露天睡在潮湿处，对着风取凉，扰动胃气。胃既然生病了，那么脾家也会停滞，清浊不分，中焦为之痞塞，于是形成呕吐的祸患。然而这仅仅讨论了饮食过伤、风凉冷湿所造成的情况。又如忧思伤感，宿寒在胃，中脘伏痰，胃受邪热，瘀血停蓄，也能令人呕吐。（出自《济生方》）
呕吐出于胃气不和，这是人所共知的。然而有胃寒，有胃热，有痰水，有宿食，有脓血，有气攻，又有所谓的“风邪入胃”。凡是这几类，能不探究它们的来源吗？（出自《直指方》）
人身以胃为主，依赖它来容纳五谷。只要有所损伤，不仅不能进食，而且有呕吐的祸患。胃虚的人，有的被寒气所中，有的被暑气所干，有的被饮食所伤，有的气结而痰聚，都能令人呕吐。又有瘀血停积在胃口，呕吐时夹杂涎血。应当辨别其脉象和证候，施以治疗方法。（出自《医学入门》）
【冷热二因】
许仁则治疗呕吐病有两种情况，一种是积热在胃，呕逆不能进食；一种是积冷在胃，也呕逆不能进食。两件事正好相反，必须仔细察辨。如果是饮食起居调养不当导致受热，而且平时没有冷病，年壮力强，肌肉丰满，这就是积热在胃，导致这种呕逆。如果是饮食起居调养不注意热，而且素有冷病，年老力弱，肌肉瘦弱憔悴，这就是积冷在胃，产生这种呕逆。如果是积冷呕逆时间久了，必须紧急救治，否则会成为严重的反胃病。（出自《外台秘要》）
【虚实二因】
呕吐这一证候，最应当详细辨别虚实。实证是有邪气，去除邪气就好了。虚证没有邪气，完全是由胃气虚弱造成的。所谓邪气，或者是突然受寒凉，或者是突然伤饮食，或者是胃火上冲，或者是肝气内逆，或者是痰饮水气聚于胸中，或者是表邪传入里部，聚于少阳阳明之间，都有呕证，这些都是呕的实邪。所谓虚证，或者是本来没有内伤，又没有外感，而经常呕吐的，这既然没有邪气，必然是胃虚。或者是遇到微寒，或者是遇到微劳，或者是遇到饮食稍有不调，或者是肝气微逆，就发生呕吐的，总归是胃虚。凡是呕家的虚实，都是以胃气来说明的。如果真的胃强脾健，那么凡遇到饮食，必定都能运化，怎么会呕吐呢？所以即使受到寒热饥饱很大的伤害，也不能动摇，而现在稍微有一点触动，就不能承受，如果不是胃气虚弱，怎么会这样呢？这虚实的原因，应当先察辨，以免导致误治的危害。（出自《景岳全书》）
胃本属土，没有火就不生发，没有温暖就不能消化。所以土寒就是土虚。土虚就是火虚。所以说脾喜欢温暖而厌恶寒冷，土厌恶湿气而喜欢干燥。所以李东垣的《脾胃论》特别强调温补的方法，这特意为胃气而设的，怎么可以忽视呢？只是在刘河间那里，说呕吐是因为胃火，这是火多实证。我这里说呕吐是因为胃寒，这是寒多虚证。一热一寒，都失去了中和的理论。不知道呕吐因火者，我并非说一定没有，只是因为火而呕的少，因寒而呕的多罢了；因胃实而呕的少，因胃虚而呕的多罢了。所以不得不有此辨析。（同上）
【脉候】
寸口脉数，就会呕吐，因为有热在胃管（胃腑），熏蒸胸中，适宜服药催吐，以及针刺胃俞穴，服用除热汤剂。关脉滑，胃中有热，滑代表热实，因为气满所以不想吃东西，吃了就吐逆，适宜服用紫菀汤泻下，大平胃丸，针刺胃俞穴泻之。（出自《脉经》）
关上脉浮而大，风在胃中，张口耸肩呼吸，心下悸动不安，食欲减退想呕。（同上）
脉紧而滑，吐逆。（同上）
趺阳脉浮，胃气虚，寒气在上，忧气在下，二气并争，只出不入，那人就会呕吐而不能进食，恐惧而死，病情宽缓就会好转。阳脉紧阴脉数，那人吃完就吐，阳脉浮而数也是吐。寸脉紧尺脉涩，那人胸满不能进食而吐，吐止的是用了下法，所以不能进食。如果说吐未止，这是胃反，所以尺脉微涩。寸口脉紧而芤，紧则为寒，芤则为虚，虚寒相搏，脉象为阴结而迟，那人就会噎膈。关上脉数，那人就会吐。趺阳脉微而涩，微则下利，涩则吐逆，谷物不能进入。吐家，脉来形状像刚起床时一样。（同上）
【诊决难易】
脉滑数为呕，脉代者霍乱，脉微滑者生，脉涩数者凶断。（出自《崔氏脉诀》）
呕吐反胃，脉浮滑者昌，脉弦数紧涩，结肠者亡。（出自《四言举要》）（按：《续焰》说：呕吐有声有物，反出于胃，是上焦的病。上焦则脉应浮，有物则脉应滑，浮滑为阳，饮食能纳能运而不反，是阳的力量，所以说浮滑者昌。如果得到弦数紧涩的脉则逆了。《必读》说：呕吐反胃，脾虚有痰。浮为虚，滑为痰，是其正象，可以受补，所以说昌。如果弦数紧涩，则血液枯，导致粪如羊屎，必死不治。《医宗金鉴》取《必读》，作若沉数细数，则为气少液枯。）
脉实大的难治，脉虚细的易愈。（出自《医学入门》）（按：《如宜方》也说：大抵脉宜虚细，不宜实大。）
脉得虚缓易治，脉紧涩的难治。（出自《原病集》）
脉宜浮缓而滑，最忌涩脉。（出自《粹言》）
【尺脉不至】
奉常梁公（名克从，鄢陵人）一向精通岐黄医术，任吏部时，深夜来找我，说夫人病危。我去诊脉，两寸洪大，关尺全无。看他的床前有呕吐的痕迹。梁公说：人脉有尺部，就像树有根，水有源。现在尺脉绝了，似乎难救了。我说：是从呕吐后得到的吗？他说：是的。我说：那就可以治。问：为什么？我说：人大吐则气上行，所以脉也上行而下不去，下部哪里有脉呢。所以尺部无脉，在其他证言中说是凶兆，这里却没有害处。用藿香、陈皮、浓朴、枳实、黄连、半夏、茯苓，加生姜煎服，连进两剂全愈。（出自《星海》）（按：为什么不引用《难经·十四难》作为证据？）
又有呕吐太甚，胸中气不能降，而尺脉不至的情况。（出自《汇补》）
【证治总说】
大概胃是水谷之海，三焦是水谷的道路。胃气宣通，则上焦如雾，中焦如沤，下焦如渎，称为平人。胃既虚弱，水谷停滞，导致三焦格拒，升降不均匀，其气虚满，得食则呕。而且还有朝食暮吐、暮食朝吐的，有食已即吐的，有呕吐谷不得前的，有但呕而无所出的，有先呕却渴的，有先渴却呕的，有呕家本渴而反不渴的，其本源和治疗，各不相同。假设内格呕逆，食不得入，这是有火；病呕而吐，食久反出，这是无火。举这两个例子，就知道呕吐名称虽一，治疗方法各异。虽然治法有冷热虚实之别，但要当以安其胃气为本，使阴阳升降平匀，呕逆之病顺而愈矣。（出自《圣济总录》）
夫呕吐之疾，不仅仅是脾胃虚冷而呕吐，也有胃热而呕的，也有胃中冷、胃口热而吐的，也有痰盛而呕的，也有血弱而呕的，经云无阴则呕是也。不可以一概用药。（出自《妇人良方》）
呕吐出于胃气之不和，人所共知也。然有胃寒，有胃热，有痰水，有宿食，有脓血，有气攻，又有所谓风邪入胃，凡是数者，可不究其所自来哉。寒而呕吐，则喜热恶寒，四肢凄清，法当以刚壮温之。热而呕吐，则喜冷恶热，烦躁中干，法当以温凉解之。痰水证者，唾沫怔忪，先渴后呕，与之消痰逐水辈。宿食证者，胸腹胀满，醋闷吞酸，与之消食去积辈。腥气燥气，熏炙恶心，此脓血之聚，经所谓呕家有痈脓，不须治，脓尽自愈是尔。七情内郁，关隔不平，此气攻之证，经所谓诸郁于胃则呕吐是尔。若夫风邪入胃，人多不审，率用参、术助之，拦住寒邪，于此尤关利害。其或恶闻食臭，汤水不下，粥药不纳，此则翻胃之垂绝者也。辨之不早，其何以为对治乎。（出自《直指方》）
中寒则脉沉紧，四肢厥冷，饮食不下，当以温暖之药调之。挟暑则脉弦数，烦躁而渴，又当清凉之。停食则消化之。痰聚则顺气温胃。停积者，多由忧思过度，损伤经络。呕吐之证，名状不一。至若香港脚内攻，妇人怀妊，中毒困酒，俱有呕吐，又须各从其类以求之。（出自《医学入门》）
呕有声长声短之辨，吐有见痰见食之分，参之以脉证，合之以颜色，问之以从来，始为无失。毋但曰呕吐小疾而忽之，常见肝实之证，令人呕吐不已而死者。（出自《方考》）
食积吐，噫酸气秽。寒积吐，清浊混出，不作腥臭，吐汁久澄，清浮浊底。血积吐，汁出色黑，口苦气腥，吐汁久澄，浊浮清底。（出自《会解》）
【病分三焦】
吐有三，气、积、寒也，皆从三焦论之。上焦在胃口，上通于天气，主纳而不出。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，其证食已即吐，渴欲饮水，大便燥结，气上冲而胸发痛，其治也当降气和中。中焦吐者，皆从于积，有阴有阳，食与气相假为积而痛，其脉浮而弱，其证或先痛而后吐，或先吐而后痛，治法当以毒药去其积，槟榔木香行其气。下焦吐者，皆从于寒，地道也，其脉沉而迟，其证朝食暮吐，暮食朝吐，小便清利，大便秘而不通，治法当以毒药通其闭塞，温其寒气，大便渐通，复以中焦药和之，不令大便秘结而自愈也。（出自《保命集》）
【病分新久】
无病之人，卒然而呕吐，定是邪客胃府。在长夏暑邪所干，在秋冬风寒所犯。干暑者，六和汤、五苓散之类。犯寒者，藿香正气散、理中汤、五积散之类。久病而吐者，胃虚不纳谷也，六君子汤加丁香、豆蔻之类。常常恶心，呕吐清水，有热而有痰也，宜用二陈汤加苍术、浓朴、黄连、生姜之类是也。（出自《医统》）
【虚呕】
凡胃虚作呕者，其证不一，当知所辨。若胃脘不胀者，非实邪也。胸膈不痛者，非气逆也。内无热躁者，非火证也。外无寒热者，非表邪也。无食无火而忽为呕吐者，胃虚也。呕吐无常而时作时止者，胃虚也。食无所停而闻食则呕者，胃虚也。气无所逆，闻气则呕者，胃虚也。或身背，或食饮，微寒即呕者，胃虚也。或吞酸，或嗳腐，时苦恶心，兀兀然，泛泛然，冷咽靡宁者，胃虚也。或因病误治，妄用克伐寒凉，木无呕而致呕者，胃虚也。或朝食暮吐，暮食朝吐，食入中焦而不化者，胃虚也。食入下焦而不化者，土母无阳，命门虚也。凡此虚证，必皆宜补。（出自《景岳全书》）
凡胃气本虚而或停滞不行者，是又虚中有实，不得不暂从清理，然后可以培补。又或虽有停滞而中气虚困不支者，是又所急在虚，不得不先顾元气而略兼清理。此中本末先后，自有确然之理，所以贵知权也。（同上）
胃虚呕吐，宜分寒热，忌宜俱同胃虚。（出自《本草经疏》）
脉细弱或虚大，倦于言动，日久不食而吐者，属胃虚，宜六君子汤加姜汁。久病或服攻伐药，吐涎不止，脉大无力，属脾虚不能摄涎而涎泛上，六君子加姜、桂凉服，睡觉即止。（出自《六要》）
【实呕】
凡实邪在胃而作呕者，必有所因，必有见证。若因寒滞者，必多疼痛。因食滞者，必多胀满。因气逆者，必痛胀连于胁肋。因火郁者，必烦热燥渴，脉洪而滑。因外感者，必头身发热，脉数而紧。如无实证实脉而见呕吐者，切不可以实邪论治。（出自《景岳全书》）
【寒呕】
《医门方》云：食已吐其食者，胃中虚冷所致。（出自《医心方》）（按：此说可疑，姑存之。）
病者胃中寒，心下澹澹，四肢厥冷，食即呕吐，名曰寒呕。或因伤食多，致伤胃气，或因病曾经汗下，致胃气虚冷之所为也。（出自《三因极一病证方论》）
如胃冷而呕吐，宜用《局方》人参丁香散、理中丸及许仁则半夏丸、人参七味丸（并见《外台秘要》）。如胃中冷、胃口热而呕吐者，宜用《局方》藿香正气散，生姜、枣子煎，沉冷服即止。（出自《妇人良方》）
[Nominal Definition]
I once read Cheng Wuji's *Shanghan Mingli Lun* (Clarifying the Theory of Cold Damage), which states: "Ou" (vomiting with sound) is vomiting accompanied by sound, commonly referred to as "yue" (hiccups or dry heaves in some contexts); "Tu" (vomiting without sound) is expelling the contents of the stomach, hence there is "gan ou" (dry heaving) but no "gan tu" (dry vomiting).
The term "ou" refers to what Li Dongyuan described as the simultaneous expulsion of sound and food. The term "tu" refers to what Li Dongyuan described as the expulsion of food without sound (Note: Li Dongyuan's words are from *Shixiao Fang*). As for "gan ou" (dry heaving) and "yue", both involve the expulsion of sound without food. Zhang Zhongjing named the simultaneous expulsion of sound and food as "ou", the expulsion of food alone as "tu", and the solitary expulsion of sound as "gan ou". Because "ou" involves both sound and food, the case where there is no food but only empty sounding is called "gan" (dry/empty), where "gan" means empty. As for "tu", it must involve food; how could it be called "dry"? Zhang Zhongjing added the character "gan" to "ou" specifically to distinguish the condition where sound and food are expelled together. Cheng Shi (Cheng Wuji), however, equated "ou" with having sound only, thus treating it as equivalent to "gan ou". Is this not a deviation from Zhang Zhongjing's original intent in his terminology? Etc. As for "yue" and "yue" (likely referring to variations in terminology for hiccups or dry heaves), they are characters that differ in form but share the same pronunciation and meaning. (From *Suhui Ji*)
In recent times, the characters "ou" and "tu" are used interchangeably. However, this does not cause significant harm, and theoretically, it is acceptable. (From *Yaojue*)
[Etiology: Spleen and Stomach Deficiency]
Vomiting (*ou tu*) is caused by deficiency and weakness of the Spleen and Stomach, combined with invasion by Wind Pathogen (*Feng Xie*). If Wind Pathogen resides in the Stomach, it causes vomiting. If there is retained fluid (*Ting Yin*) between the diaphragm and cold lingering in the Stomach for a long time, it causes both vomiting and regurgitation. The manifestations include frequent sighing, palpitations in the heart region (*Xin Xia*), irritability and fullness with difficulty in defecation, or loose stools; these are all corresponding signs. (From *Zhubing Yuanhou Lun*)
Vomiting occurs when Stomach Qi ascends instead of descending. It is like trying to pour water into a bottle with a small neck; the flow is obstructed by rising Qi. This is the principle behind human vomiting. Generally, due to weak Qi of the Spleen and Stomach, Wind-Cold disturbs and agitates, causing retained fluids to accumulate. Food fails to digest, leading to Stomach Qi deficiency and distension, palpitations in the heart region, and rebellious Qi ascending, resulting in vomiting. (From *Shengji Zonglu*)
[Various Causes]
The ascending and descending of Human Yin and Yang, the smooth regulation of the San Jiao (Triple Burner), and the harmonious balance of the Spleen and Stomach allow for the rotting and ripening of food and drink, the transformation of waste, and the transmission and guidance downward to the intestines. If the Spleen and Stomach are deficient and cold, food and drink fail to digest, leading to obstruction of Yin and Yang, dysfunction of the San Jiao, and failure of turbid Yin Qi to descend. Instead, it rushes upward, causing vomiting. However, the disease of vomiting and rebellion has various origins: some arise from excess in the Diaphragm, some from fullness in the Middle Jiao, and some from disorders in the Lower Jiao. Although diverse, all originate from Stomach Qi; when Qi rebels, vomiting occurs. (From *Shengji Zonglu*)
Although vomiting originates in the Stomach, the causes are manifold. They differ according to Cold, Heat, diet, Blood, and Qi, all leading to vomiting. According to discussions: Cold Qi above and Worry Qi below contend with each other, leading to expulsion without intake. This is one scenario but not a comprehensive theory. Furthermore, Qi belongs to internal causes, with seven types; Cold relates to external causes, divided into the Six Evils (*Liu Yin*), all causing rebellion. If stagnated in the Stomach, it leads to vomiting, not limited merely to worry Qi. Moreover, there is undigested food, middle-fullness overflow, accumulation of the Five Drinks (*Wu Yin*), turning over and vomiting with Qi, chronic cold and accumulated heat, and blood stasis blocking. There is also leakage of Qi in the San Jiao, vomiting with diarrhea and bleeding. All these conditions require careful differentiation. (From *Sanjin Jingyi Bingzheng Fanglun*)
Humans are born receiving the essence of Heaven and Earth, relying primarily on the Stomach. The Stomach receives food and drink, while the Spleen governs transportation and transformation, generating Blood and Qi to nourish the four limbs. If the Spleen and Stomach are uninjured, there is no risk of vomiting. However, if dietary habits are irregular, temperature regulation is improper, or if one indulges in raw/fatty meats, dairy, cold/raw foods, sleeps in damp places, or seeks coolness facing the wind, the Stomach is disturbed. Once the Stomach is diseased, the Spleen becomes stagnant, clear and turbid Qi mix, and the Middle Jiao becomes blocked, leading to vomiting. This discusses only injuries from excessive diet, wind, coolness, cold, and dampness. Additionally, worry, sorrow, injury, lingering cold in the Stomach, latent phlegm in the Zhongwan area, Stomach pathogenic heat, and accumulated blood stasis can also cause vomiting. (From *Jisheng Fang*)
It is common knowledge that vomiting arises from disharmony of Stomach Qi. However, there are cases of Stomach Cold, Stomach Heat, Phlegm-Fluid, retained food, pus and blood, Qi attack, and so-called Wind Pathogen entering the Stomach. For all these, one must investigate their origins. (From *Zhizhi Fang*)
The human body relies on the Stomach as the primary organ for containing the five grains. Any injury not only prevents eating but also causes vomiting. In persons with Stomach Deficiency, invasion by Cold Qi, Dryness-Heat Qi, dietary injury, or Qi knotting with Phlegm accumulation can all lead to vomiting. Also, blood stasis accumulating at the Stomach opening may result in vomiting mixed with saliva and blood. One must differentiate the pulse and symptoms to apply appropriate treatment. (From *Yixue Rumen*)
[Cold and Heat Etiologies]
Xu Renze treated vomiting based on two types: one is accumulated Heat in the Stomach, causing rebellious vomiting and inability to eat; the other is accumulated Cold in the Stomach, also causing rebellious vomiting and inability to eat. These two are opposite and must be carefully distinguished. If the patient suffered heat from improper diet and lifestyle, has no history of cold diseases, is young and strong with full muscles, this indicates accumulated Heat in the Stomach causing vomiting. If the patient did not suffer heat from lifestyle, has a history of cold diseases, is old and weak with emaciated muscles, this indicates accumulated Cold in the Stomach causing vomiting. If accumulated cold vomiting persists for a long time, urgent rescue is needed, otherwise it may develop into severe Fan Wei (reverse stomach/rebellious vomiting). (From *Waitai Miyao*)
[Deficiency and Excess Etiologies]
In the syndrome of vomiting, differentiating Deficiency (*Xu*) and Excess (*Shi*) is paramount. Excess syndromes involve pathogens; removing the pathogen leads to recovery. Deficiency syndromes have no pathogen and are entirely due to Stomach Qi deficiency. The so-called "pathogen" includes sudden exposure to cold/coolness, sudden dietary injury, Stomach Fire rushing upward, Liver Qi rebelling internally, Phlegm-Fluid-Water-Qi gathering in the chest, or exterior pathogens transmitting inward to gather between Shaoyang and Yangming. All these present with vomiting and are considered Excess pathogens in vomiting. The so-called "deficiency" includes cases where there is no internal injury or external contraction, yet vomiting occurs frequently. Since there is no pathogen, it must be Stomach Deficiency. Or, upon slight cold exposure, slight fatigue, slight dietary irregularity, or slight Liver Qi rebellion, vomiting occurs; this is total Stomach Deficiency. The deficiency and excess of all vomiting cases are defined by Stomach Qi. If the Stomach were strong and the Spleen healthy, any food would be transformed and transported; why would vomiting occur? Thus, even if severely injured by cold, heat, hunger, or satiety, the Stomach would not react; but now, slight contact causes intolerance. If not Stomach Qi deficiency, how could this be? The origin of deficiency and excess must be examined first to avoid the harm of misdiagnosis. (From *Jingyue Quanshu*)
The Stomach belongs to Earth and requires Fire to generate and Warmth to transform. Thus, Cold Earth is Deficient Earth, and Deficient Earth is Deficient Fire. Therefore, the Spleen prefers Warmth and dislikes Cold; Earth dislikes Dampness and prefers Dryness. Hence, Li Dongyuan's *Piwei Lun* (Treatise on the Spleen and Stomach) emphasizes Warmtonic methods, specifically designed for Stomach Qi; how can this be ignored? However, Liu Hejian stated that vomiting is due to Stomach Fire, implying Fire Excess. I state that vomiting is due to Stomach Cold, implying Cold Deficiency. One is Heat, one is Cold; both deviate from the theory of Balance. I do not deny that vomiting can be due to Fire, but Fire-induced vomiting is rare, while Cold-induced vomiting is common; Stomach Excess-induced vomiting is rare, while Stomach Deficiency-induced vomiting is common. Hence, this distinction is necessary. (Ibid.)
[Pulse Signs]
A rapid pulse at the Cun position indicates vomiting, due to Heat in the Stomach channel steaming the chest. Treatment should involve inducing vomiting via medication, needling the Weishu acupoint, and administering decoctions to remove Heat. A slippery pulse at the Guan position indicates Heat in the Stomach; Slippery signifies Heat Excess. Due to Qi fullness, appetite is lost, and eating leads to rebellious vomiting. Treatment should involve Ziwany Tang to purge, Da Pingwei Wan, and needling Weishu to drain. (From *Maijing*)
A floating and large pulse at the Guan position indicates Wind in the Stomach. Symptoms include gasping with shoulders raised, palpitations in the heart region, loss of appetite, and desire to vomit. (Ibid.)
A tight and slippery pulse indicates rebellious vomiting. (Ibid.)
A floating Douyang pulse indicates Stomach Qi deficiency. Cold Qi is above, Worry Qi is below; the two contend, leading to expulsion without intake. The patient vomits and cannot eat, dies in fear, but recovers if the condition relaxes. Yang Tight and Yin Rapid pulses indicate vomiting immediately after eating. Floating and Rapid Yang pulses also indicate vomiting. Cun Tight and Chi Choppy pulses indicate chest fullness, inability to eat, and vomiting. If vomiting stops, it was due to purging, hence the inability to eat. If vomiting does not stop, it is Fan Wei (rebellious stomach), hence the Chi pulse is faint and choppy. Cun Tight and Kou (scalloped/hollow) pulses: Tight indicates Cold, Kou indicates Deficiency. Deficiency and Cold combine, creating Yin Knotting and Slowness, leading to dysphagia. Guan Rapid pulses lead to vomiting. Douyang Faint and Choppy pulses: Faint indicates diarrhea, Choppy indicates rebellious vomiting, preventing grain entry. Patients with vomiting often have a pulse shape resembling that of someone who just woke up. (Ibid.)
[Determining Difficulty of Prognosis]
Slippery and Rapid pulses indicate vomiting; Dai (moderate/interrupted) pulses indicate Huoluan (cholera-like disorder); Faint and Slippery pulses indicate survival; Choppy and Rapid pulses indicate ominous prognosis. (From *Cui Shi Maijue*)
For vomiting and Fan Wei, Floating and Slippery pulses indicate prosperity/recovery; String, Rapid, Tight, and Choppy pulses, especially with colon obstruction, indicate death. (From *Siyan Juyao*) (Note: *Xuyan* states: Vomiting with sound and matter, reversing from the Stomach, is a disease of the Upper Jiao. Upper Jiao pulses should be Floating; presence of matter implies Slippery. Floating-Slippery is Yang, indicating the ability to receive and transport food without reversal, hence "prosperous." String-Rapid-Tight-Choppy pulses are rebellious. *Bidu* states: Vomiting and Fan Wei are due to Spleen Deficiency with Phlegm. Floating is Deficiency, Slippery is Phlegm, representing the correct image, allowing for tonification, hence "prosperous." String-Rapid-Tight-Choppy indicates blood exhaustion, leading to sheep-dung-like stool, inevitably fatal. *Yizong Jinjian* adopts *Bidu*, stating that Deep-Rapid or Fine-Rapid pulses indicate Qi and Fluid exhaustion.)
Pulses that are Excess and Large are difficult to treat; Deficient and Fine pulses are easy to cure. (From *Yixue Rumen*) (Note: *Ruyi Fang* also states: Generally, pulses should be Deficient and Fine, not Excess and Large.)
Pulses that are Deficient and Slow are easy to treat; Tight and Choppy pulses are difficult to treat. (From *Yuanbing Ji*)
Pulses should be Floating, Slow, and Slippery; Choppy pulses are most taboo. (From *Cuiyan*)
[Absent Chi Pulse]
Fangchang Lord Liang (courtesy name Kecong, from Yanling) was proficient in traditional medicine. While serving as a Ministry official, he visited me at night, saying his wife was critically ill. Upon pulse diagnosis, the Cun positions were洪大 (Huge and Large), while Guan and Chi were completely absent. Seeing vomit traces before the bed, Lord Liang said: "The Chi pulse in humans is like the root of a tree or the source of water. Now the Chi pulse is severed; it seems incurable." I asked: "Did you obtain this pulse after vomiting?" He replied: "Yes." I said: "Then it is treatable." He asked: "Why?" I explained: "After severe vomiting, Qi ascends, so the pulse also ascends and does not descend downward. How can there be a pulse in the lower part? Therefore, the absence of the Chi pulse, while ominous in other contexts, is harmless here." Prescription: Huoxiang, Chenpi, Houpo, Zhishi, Huanglian, Banxia, Fuling, added with Ginger, decocted. Two doses resulted in complete recovery. (From *Xinghai*) (Note: Why not cite *Nan Jing Chapter 14* as evidence?)
There are also cases of excessive vomiting where Qi in the chest cannot descend, resulting in an absent Chi pulse. (From *Huibu*)
[General Discussion on Syndromes and Treatment]
The Stomach is the Sea of Water and Grain; the San Jiao are the pathways for Water and Grain. When Stomach Qi is unobstructed, the Upper Jiao is like mist, the Middle Jiao like foam (fermentation), and the Lower Jiao like a ditch (drainage); this is called a healthy person. If the Stomach is weak, water and grain stagnate, causing rejection in the San Jiao and uneven ascending/descending. Qi becomes deficient and full; upon eating, vomiting occurs. There are cases of morning food evening vomiting, evening food morning vomiting, immediate vomiting after eating, vomiting without material expulsion, vomiting followed by thirst, thirst followed by vomiting, and vomiting patients who are thirsty but paradoxically not thirsty. Their origins and treatments vary. For example, internal blockage with rebellious vomiting and inability to eat indicates Fire; vomiting and regurgitation of food after a long time indicates lack of Fire. From these two examples, we see that although the name "vomiting" is the same, treatment methods differ. Although treatments vary by Cold, Heat, Deficiency, and Excess, the fundamental goal is to calm Stomach Qi, balancing Yin and Yang ascending and descending, so that rebellious vomiting subsides and heals. (From *Shengji Zonglu*)
Vomiting is not only caused by Spleen-Stomach deficiency and cold; there are also cases of Stomach Heat vomiting, Stomach Cold with Stomach Opening Heat vomiting, Phlegm-Excess vomiting, and Blood-Deficiency vomiting. The Classic states: "Without Yin, there is vomiting." Medication cannot be applied uniformly. (From *Furen Liangfang*)
Vomiting arises from Stomach Qi disharmony, which is common knowledge. However, there are Stomach Cold, Stomach Heat, Phlegm-Fluid, Retained Food, Pus-Blood, Qi Attack, and Wind Pathogen entering the Stomach. One must investigate their sources. Cold vomiting presents with preference for warmth and aversion to cold, cold and clear limbs; treatment should use strong warming agents. Heat vomiting presents with preference for coolness and aversion to heat, irritability and dryness in the center; treatment should use cool-warm resolving agents. Phlegm-Fluid syndrome presents with salivation and palpitations, thirst preceding vomiting; use phlegm-resolving and fluid-draining agents. Retained Food syndrome presents with chest/abdominal fullness, acid regurgitation; use food-digesting and accumulation-removing agents. Fishy/dry odors, roasting nausea, indicate accumulation of pus-blood. The Classic says: "For vomiting patients with carbuncle-pus, do not treat directly; self-heals when pus is exhausted." Seven Emotions internal depression, obstruction imbalance, indicate Qi Attack syndrome. The Classic says: "All depressions in the Stomach cause vomiting." Regarding Wind Pathogen entering the Stomach, people often fail to examine carefully, rashly using Ginseng and Atractylodes to assist, trapping Cold Pathogens; this is particularly critical. If one dislikes the smell of food, cannot take liquids or porridge/medicine, this is terminal Fan Wei. Early differentiation is crucial for counter-treatment. (From *Zhizhi Fang*)
Cold invasion presents with Deep-Tight pulses, cold limbs, inability to eat; treat with warming medicines. Summerheat complication presents with String-Rapid pulses, irritability, and thirst; treat with cooling agents. Retained food requires digestion-promoting agents. Phlegm aggregation requires smoothing Qi and warming the Stomach. Accumulation is often due to excessive worry/thought damaging meridians. Vomiting syndromes have various names and appearances. Additionally, beriberi attacking inward, pregnancy in women, poisoning, and alcohol intoxication all present with vomiting; each must be sought according to its category. (From *Yixue Rumen*)
Differentiate vomiting by whether the sound is long or short; differentiate spitting by whether phlegm or food is seen. Combine with pulse and symptoms, observe complexion, and inquire about the history to ensure accuracy. Do not dismiss vomiting as a minor illness; I have often seen Liver Excess syndromes causing endless vomiting leading to death. (From *Fangkao*)
Food-accumulation vomiting: belching with sour, foul odor. Cold-accumulation vomiting: clear and turbid mixed, no fishy smell; after settling, clear floats and turbid sinks. Blood-accumulation vomiting: fluid is dark black, bitter taste, fishy odor; after settling, turbid floats and clear sinks. (From *Huijie*)
[Classification by San Jiao]
Vomiting is categorized into three types: Qi, Accumulation, and Cold, analyzed through the San Jiao. The Upper Jiao is at the Stomach opening, connecting to Heaven Qi, governing reception without expulsion. The Middle Jiao is at Zhongwan, connecting to Heaven Qi above and Earth Qi below, governing rotting and ripening of food. The Lower Jiao is below the umbilicus, connecting to Earth Qi, governing expulsion without reception. Thus, Upper Jiao vomiting stems from Qi (Heavenly Yang); pulse is Floating-Huge; symptoms include immediate vomiting after eating, thirst for water, dry stool, Qi rushing up causing chest pain; treatment should descend Qi and harmonize the Middle. Middle Jiao vomiting stems from Accumulation (Yin and Yang); food and Qi combine to form accumulation and pain; pulse is Floating-Weak; symptoms include pain preceding vomiting or vomiting preceding pain; treatment should use toxic drugs to remove accumulation and Areca/Burdock to move Qi. Lower Jiao vomiting stems from Cold (Earthly Way); pulse is Deep-Slow; symptoms include morning food evening vomiting, evening food morning vomiting, clear urine, constipation; treatment should use toxic drugs to open blockages, warm Cold Qi, gradually pass stool, then harmonize with Middle Jiao herbs to prevent constipation and achieve self-healing. (From *Baoming Ji*)
[Classification by New and Old Disease]
In previously healthy individuals, sudden vomiting indicates pathogen invading the Stomach Fu. In late summer, it is caused by Summerheat; in autumn/winter, by Wind-Cold. Summerheat invasion: Liuhe Tang, Wuling San. Cold invasion: Huoxiang Zhengqi San, Lizhong Tang, Wuji San. Chronic vomiting indicates Stomach Deficiency failing to accept grain: Liujunzi Tang plus Dingxiang (Clove) and Doukou (Cardamom). Frequent nausea and vomiting of clear water, with Heat and Phlegm: Erchen Tang plus Cangzhu, Houpo, Huanglian, Shengjiang. (From *Yitong*)
[Deficiency Vomiting]
When Stomach Deficiency causes vomiting, symptoms vary and must be differentiated. If the epigastrium is not distended, it is not Excess Pathogen. If the chest/diaphragm is not painful, it is not Qi rebellion. If there is no internal heat/restlessness, it is not Fire syndrome. If there is no exterior cold/heat, it is not Exterior Pathogen. Vomiting without food or fire causes is Stomach Deficiency. Irregular, intermittent vomiting is Stomach Deficiency. Vomiting upon smelling food without food retention is Stomach Deficiency. Vomiting upon smelling Qi without Qi rebellion is Stomach Deficiency. Vomiting upon slight cold exposure on the back or after eating/drinking is Stomach Deficiency. Sour swallowing, belching rotten food, frequent nausea, feeling unsettled and giddy, cold throat discomfort is Stomach Deficiency. Vomiting caused by erroneous treatment using harsh/cold-purging drugs when there was no Wood-related vomiting is Stomach Deficiency. Morning food evening vomiting, food not transforming in the Middle Jiao, is Stomach Deficiency. Food not transforming in the Lower Jiao indicates Earth Mother lacks Yang, Mingmen Deficiency. All these deficiency syndromes require tonification. (From *Jingyue Quanshu*)
If Stomach Qi is fundamentally deficient and stagnates, this is Deficiency with Excess; temporary clearing is necessary before tonification. If there is stagnation but Middle Qi is too deficient to support, the urgency lies in Deficiency; protecting Yuan Qi while slightly clearing is required. The priority and sequence have definite principles, hence the value of flexibility. (Ibid.)
Stomach Deficiency vomiting should be differentiated by Cold and Heat; contraindications and indications are the same as for Stomach Deficiency. (From *Bencao Jing Shulou*)
Fine-Weak or Empty-Large pulses, fatigue in speech/movement, vomiting after prolonged fasting belong to Stomach Deficiency; use Liujunzi Tang with Ginger Juice. Prolonged disease or post-purging medication, continuous saliva vomiting, Large-ineffective pulse belongs to Spleen Deficiency failing to control saliva; use Liujunzi Tang with Ginger/Cinnamon, taken cool, stopping upon waking. (From *Liuyao*)
[Excess Vomiting]
When Excess Pathogen in the Stomach causes vomiting, there must be a cause and signs. Cold stagnation causes pain. Food stagnation causes fullness. Qi rebellion causes pain/fullness radiating to hypochondriums. Fire depression causes irritability, heat, thirst,洪-Slippery pulse. Exterior contraction causes head/body fever, Rapid-Tight pulse. If vomiting occurs without Excess signs/pulses, do not treat as Excess Pathogen. (From *Jingyue Quanshu*)
[Cold Vomiting]
*Yimen Fang* states: Vomiting food immediately after eating is caused by Stomach deficiency-cold. (From *Yixin Fang*) (Note: This statement is questionable; preserved tentatively.)
Patient has Cold in Stomach, palpitations in heart region, cold limbs, vomiting after eating; named Cold Vomiting. Caused by excessive food injury damaging Stomach Qi, or by previous sweating/purging therapies causing Stomach Qi deficiency-cold. (From *Sanjin Jingyi Bingzheng Fanglun*)
For Cold Stomach vomiting, use *Ju Fang* Renshen Dingxiang San, Lizhong Wan, or Xu Renze Banxia Wan, Renshen Qiwei Wan (all in *Waitai Miyao*). For Cold Stomach with Hot Stomach Opening vomiting, use *Ju Fang* Huoxiang Zhengqi San decocted with Ginger and Jujube, taken cold to stop vomiting. (From *Furen Liangfang*)