喘因血积肝伤者，经曰∶肝脉搏坚而长，色不青，当病坠若搏，因血在胁下，令人喘逆
是也。
《仁斋直指》云∶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，又有所谓风邪干胃。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，法当以清凉解之。
痰水症者，吐沫怔忡，先渴后呕，与之消痰逐水辈。宿食症者，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
也。七情内郁，关格不平，此气攻之症，经所谓诸郁干胃则呕吐是也。若夫风邪入胃，人多
不审，率用参、术助之，拦住寒邪，于此犹关利害。其或恶闻食臭，汤水不下，粥药不纳，
此则反胃之垂绝者也。辨之不早，其何以为对治乎。虽然，足阳明之经，胃之络脉也，阳明
之气，下行则顺，今逆而上行，谨不可泄，固也
。然呕吐者，每每大便秘结，上下壅遏，气
不流行，盍思所以区画而利导之。他如汗后水药不入口者，遂呕而脉弱，小便复利，身微热
而手足厥者，虚寒之极也。识者忧焉。
洁古论吐，以气、积、寒，分属上、中、下三焦。大旨元从启元子食不得入，是有火，
食入
反出，是无火来。至中焦吐，则独以积字该之。夫中焦气交之分，主营运上下，和调阴阳，
其病有虚有实，有寒有热，其治亦不拘一法，岂区区毒药去积，槟榔、木香和气所能尽其事
哉。东垣论吐，以呕、吐、哕，分太阳、阳明、少阳，以其经气血多少而为声物有无之别，
未见着实。
因血瘀积滞损伤肝脏而致喘逆的，医经上说：肝脉搏动坚实而长，面色却不发青，这应当是遭受跌坠或搏击外伤所致，因为血液瘀积在胁下，导致人出现喘逆的症状，说的就是这种情况。
《仁斋直指方》说：呕吐是由于胃气不和引起的，这是大家都知道的常识。然而，其中有胃寒导致的，有胃热导致的，有痰饮停聚导致的，有宿食停滞导致的，有脓血积聚导致的，有气机攻冲导致的，还有所谓的风邪侵犯胃腑导致的。对于这些情况，难道可以不探究它们产生的根源吗？如果是胃寒引起的呕吐，患者喜欢热饮、厌恶寒冷，四肢冰凉清冷，治疗法则应当用刚烈温热的药物来温散寒邪。如果是胃热引起的呕吐，患者喜欢冷饮、厌恶炎热，心中烦躁且口干，治疗法则应当用清凉的药物来解除热邪。如果是痰饮水湿证，表现为吐出泡沫、心悸怔忡，先感到口渴随后发生呕吐，应当给予消除痰饮、逐除水湿的药物。如果是宿食停滞证，表现为胸腹部胀满，胸闷想吐、吞酸嘈杂，应当给予消食导滞、去除积滞的药物。腥燥气味熏灼，炙烤食物令人恶心，这是脓血积聚的表现，医经所说的“患有呕吐病的病人如果有痈脓，不需要专门治疗呕吐，待脓液排尽后自然痊愈”指的就是这种情况。七情（喜、怒、忧、思、悲、恐、惊）内郁，导致气机升降失常、阴阳不平，这是气机攻冲的病证，医经所说的“各种郁滞之气干犯胃腑就会引起呕吐”指的就是这种情况。至于风邪侵入胃腑，人们往往不能仔细审察，通常错误地使用人参、白术等补益药物，反而阻碍了寒邪的外散，这里关系着治疗的利害成败。如果患者厌恶食物的气味，汤水无法咽下，粥药也不能接纳，这已经是反胃病到了垂危绝境的阶段。如果不能尽早辨别清楚，又拿什么来进行对治呢？虽然如此，足阳明胃经是胃的络脉，阳明经的气机下行则为顺，现在逆乱而上行，确实不可轻易使用泻法。然而呕吐的病人，常常伴有便秘，上下气机壅塞遏阻，气机不能流通，何不思考一下如何规划疏导以利气机运行呢？其他如发汗之后，水药无法入口，随即呕吐且脉象微弱，小便反而通利，身体微热而手足厥冷的，这是虚寒到了极点的表现。有见识的人对此应感到忧虑。
李东垣（洁古）论述呕吐，将气、积、寒分别归属于上、中、下三焦。其主要观点源自启元子（王好古）所说：“食物不能进入，是因为有火；食物吃进去反而吐出，是因为无火。”到了中焦呕吐，则唯独用“积”字来概括它。中焦是气机交汇的地方，主管营卫的运行和上下交通，调和阴阳，其病症有虚有实，有寒有热，治疗方法也不拘泥于一种，岂能用简单的毒药去积，仅靠槟榔、木香等理气药物就能完全解决问题呢？李东垣论述呕吐，将呕、吐、哕分别归属于太阳、阳明、少阳三经，根据各经脉气血多少的不同来区分声音和呕吐物的有无，这种看法未见得切实可靠。
For wheezing caused by blood stasis injuring the Liver, the Classics state: "If the Liver pulse is firm and long, but the complexion is not green, it indicates injury from a fall or blow, due to blood accumulating under the hypochondrium, causing wheezing and counterflow." This refers to that condition.
*Ren Zhi Zhi Zhi Fang* (Directing Guide of Renzhai) states: Vomiting arises from disharmony of Stomach Qi, which is common knowledge. However, there are cases due to Cold in the Stomach, Heat in the Stomach, Phlegm-Fluid retention, retained food, pus and blood accumulation, Qi attack, and what is called Wind pathogen invading the Stomach. For these several causes, how can one fail to investigate their origins? If vomiting is due to Cold, the patient prefers warmth and dislikes cold, with limbs feeling chilly and clear; the treatment principle should be to warm using robust, hot-natured agents. If vomiting is due to Heat, the patient prefers coolness and dislikes heat, with restlessness and dryness in the center; the treatment principle should be to resolve using cooling agents. For Phlegm-Fluid syndromes, characterized by spitting foam and palpitations, thirst preceding vomiting, one should administer drugs that eliminate phlegm and drain fluids. For retained food syndromes, characterized by chest and abdominal fullness, stifling sensation, and acid regurgitation, one should administer drugs that digest food and remove stagnation. Foul odors and dry heat from roasting foods causing nausea indicate the accumulation of pus and blood; this refers to the Classic's statement: "In patients with vomiting who have carbuncle pus, there is no need to treat the vomiting specifically; once the pus is exhausted, it will heal itself." Internal depression of the Seven Emotions (Joy, Anger, Worry, Thought, Sadness, Fear, Fright), leading to obstruction and imbalance of Qi dynamics, constitutes the syndrome of Qi attack; this refers to the Classic's statement: "Various types of Qi stagnation invading the Stomach cause vomiting." As for Wind pathogen entering the Stomach, people often fail to examine it carefully, rashly using Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) to tonify, thereby blocking the expulsion of Cold pathogen, which involves significant therapeutic consequences. If the patient detests the smell of food, cannot take soups or liquids, and rejects porridge and medicine, this indicates Fan Wei disease (Regurgitation) at a critical, near-terminal stage. If differentiation is not made early, what remedy can be applied? Although the Foot-Yangming Meridian is the collateral network of the Stomach, and Yangming Qi descending is considered smooth, now that it reverses and ascends, it is indeed inadvisable to use purgative methods. However, patients with vomiting often suffer from constipation, with upper and lower obstruction, and stagnant Qi flow. Why not consider strategies to regulate and guide the Qi? Other cases include those after sweating where water and medicine cannot enter, followed by vomiting, weak pulse, free urination, slight fever, and cold extremities; this represents extreme deficiency-Cold. Those with insight should be concerned.
Li Dongyuan (Jiegu) discussed vomiting, attributing Qi, Accumulation, and Cold to the Upper, Middle, and Lower Jiao respectively. His main idea stems from Qiyuanzi stating: "Food cannot enter due to Fire; food enters but comes back up due to lack of Fire." Regarding Middle Jiao vomiting, he exclusively attributed it to "Accumulation." The Middle Jiao is the junction of Qi interaction, governing the circulation of Ying and Wei, and harmonizing Yin and Yang. Its diseases involve deficiency and excess, Cold and Heat, and its treatments are not limited to a single method. How could simple toxic drugs to remove accumulation, along with Areca Seed (Binglang, 槟榔) and Aucklandia Root (Muxiang, 木香) to harmonize Qi, suffice to handle all matters? Li Dongyuan discussed vomiting, differentiating Oud (nausea/vomiting), Tu (vomiting), and Yueh (hiccup/belching) into Taiyang, Yangming, and Shaoyang meridians, distinguishing based on the presence or absence of sounds and vomitus according to the quantity of Qi and Blood in each meridian. This view lacks substantial accuracy.