bubble_chart Concept

Vomiting, spitting, and retching (referred to as hiccup in medical texts after the Jin and Yuan dynasties) are all symptoms of stomach qi ascending counterflow. Neijing, "Treatise on Cold Damage Diseases", Jingui Yaolue, and other books have clearly distinguished the three. Yijing Suhui Ji states: "Vomiting, as Dongyuan described, is the simultaneous expulsion of sound and matter. Spitting, as Dongyuan described, is the expulsion of matter without sound (from 'Dongyuan's Experimental Prescriptions'). As for retching and hiccup, both involve the expulsion of sound without matter. Zhongjing named the simultaneous expulsion of sound and matter as vomiting, the expulsion of matter as spitting, and the expulsion of sound alone as retching." Therefore, when speaking of spitting, it includes spitting saliva, spitting turbid sputum (i.e., phlegm), acid regurgitation water, spitting bitter water, etc., none of which necessarily involve the sound of vomiting. When speaking of vomiting, it must involve both sound and matter, and what later generations refer to as retching and vomiting together is also what ancient texts called vomiting, mostly referring to the expulsion of food from the stomach. As for hiccup (retching), it is discussed in a separate chapter.

Vomiting and nausea often occur together clinically, nausea may be an early symptom of vomiting, vomiting is often accompanied by nausea, but nausea does not necessarily lead to vomiting (for nausea, see the relevant entry).

The vomiting discussed in this chapter refers to the symptom of expelling food from the stomach.

bubble_chart Pattern Analysis

1. External Pathogen Invading the Stomach︰Either external contraction wind-cold, or common cold summerheat dampness qi. In cases of external contraction wind-cold, vomiting is accompanied by symptoms such as fever, aversion to cold, headache, body pain, white tongue coating, and floating-tight pulse. In cases of common cold summerheat dampness vomiting, there must be severe fever, aversion to wind or no aversion to wind, headache, heavy body, stuffiness in the epigastrium with nausea, white-greasy or yellow tongue coating, and floating-rapid pulse, among other symptoms. External pathogens refer either to cold pathogens attacking the exterior or summerheat dampness damaging the defensive qi. The former is an exterior cold excess pattern, while the latter is an exterior heat excess pattern. For external contraction of cold pathogens, as stated in the *Treatise on Cold Damage Diseases: Differentiation of Taiyang Disease Pulse Signs and Treatment*: "Whether fever has already developed or not, there must be aversion to cold, body pain, retching, and tight pulse in both yin and yang positions." This retching refers to vomiting, which occurs when cold pathogens externally bind the skin and muscles, preventing defensive yang from dispersing outward, causing qi to surge upward instead of outward. "Stomach qi becomes rebellious when encountering cold" (*Pearl String of Cold Damage Diseases*). Treatment should focus on releasing the exterior with pungent-warm herbs. Once the external cold is resolved, the vomiting will cease. Formulas such as Ephedra Decoction with modifications can be used. For cases where summerheat dampness damages the defensive qi, there is fever with slight aversion to wind and cold. Due to dampness obstructing the middle energizer, in addition to vomiting, there must be symptoms such as stuffiness and fullness in the epigastrium and abdomen, anorexia, heavy body, limb fatigue, sweet and greasy sensation in the mouth, or loose stools, and greasy tongue coating. Treatment should aim to disperse the exterior pathogen, aromatic harmonization of the middle, and resolving dampness. The formula Patchouli Qi-Righting Powder with modifications can be used.
2. Food Retention︰vomiting, epigastric distension and fullness, belching with foul odor, acid regurgitation, aversion to food odor, anorexia, nausea, often relieved by vomiting, tongue coating and pulse manifestation are often normal. In cases of food injury (dyspepsia), the onset is acute, with vomiting and anorexia, relieved by vomiting. Treatment should focus on promoting digestion and removing stagnation, using formulas such as Harmony-Preserving Pill and Immature Orange Fruit Stagnation-Removing Pill with modifications.
3. Stomach Cold︰If the body constitution is middle energizer yang deficiency, there may be frequent vomiting shortly after meals, with a small amount of vomitus, accompanied by stomach stuffiness, stomachache, belching, aversion to cold, emaciation, limb fatigue, a pale tongue, and a weak pulse. If caused by overeating cold or raw food, the stomachache may be severe, and vomiting may initially produce clear fluid followed by ingested food, with relief upon vomiting. The tongue coating and pulse often show no significant changes. For stomach cold: - If due to chronic middle energizer spleen-stomach yang deficiency, the course is long and manifests as a deficiency pattern. - If due to sudden overconsumption of cold or raw food severely damaging stomach yang, the onset is acute, the course is short, and it mostly presents as an excess pattern. Deficiency pattern symptoms include chills, emaciation, stomach pain, reduced appetite, shortage of qi and lack of strength, loose stools, a pale tongue, and a weak pulse—all signs of spleen-stomach weakness. Vomiting is frequent but in small amounts, worsens with cold, and eases with warmth. Excess pattern symptoms include severe stomach pain and intense vomiting, with relief upon expulsion, and few accompanying symptoms. Treatment for both focuses on warming the stomach and dissipating cold to direct qi downward. Prescriptions include Middle-Regulating Decoction, Aconite Middle-Regulating Decoction, and Lesser Galangal and Cyperus Pill, with modifications as needed.
4. Stomach Heat︰Vomiting accompanied by symptoms such as acid swallow and belching of putrid matter, along with fetid mouth odor, epigastric stuffiness, dark urine, constipation, a yellow or greasy tongue coating, and a wiry or slippery and forceful pulse. This condition often arises from consuming rich and greasy foods or excessive alcohol, leading to dampness-heat accumulation in the middle energizer. In addition to vomiting, there may be manifestations of stomach heat such as acid swallow, belching of putrid matter, fetid mouth odor, epigastric stuffiness, constipation, and a yellow tongue coating. It is advisable to use Two Old Ingredients Decoction with added stir-fried Gardenia, Coptis Rhizome, and Fresh Ginger Rhizome.
5. Stomach Yin Deficiency︰The vomiting is severe, initially expelling food, then clear water after the food is exhausted, and finally bile after the clear water is exhausted. The patient cannot eat or drink, and even water is vomited immediately upon ingestion. There is thirst but an inability to drink, along with a dry throat, red tongue, and a fine, weak pulse. This often occurs in the Rebing late stage [third stage], where stomach yin deficiency leads to stomach qi ascending counterflow, causing vomiting. It may also occur after major surgical treatment, when insufficient yin fluids result in deficient heat rising counterflow in the stomach, leading to vomiting. Alternatively, severe vomiting that does not resolve may further damage stomach yin, causing deficient fire to rise counterflow and worsen vomiting, to the point where even a drop of water cannot be retained. In addition to vomiting, symptoms such as dry mouth with a desire to drink and a red tongue with scant moisture are invariably present. Treatment focuses on nourishing stomach yin and descending deficient fire, using Tangerine Peel and Bamboo Shavings Decoction with additions such as Coptis Rhizome and bamboo juice.
6. Liver-stomach Disharmony︰Frequent nausea and belching, chest and gastric stuffiness, vomiting occurs intermittently but with small amounts of vomitus, hypochondriac pain, bitter taste in mouth, yellow tongue coating, and wiry pulse. When emotional fluctuations occur, vomiting symptoms worsen. In cases of liver-stomach disharmony, the course of illness is prolonged due to liver depression and stagnation, which transversely invades the stomach, leading to frequent nausea and vomiting, though the symptoms are not severe. It is accompanied by manifestations of liver qi stagnation such as chest stuffiness, gastric stuffiness, hypochondriac pain, bitter taste in mouth, and knotted pulse. Treatment should focus on soothing the liver and harmonizing the stomach, using Minor Bupleurum Decoction combined with Left Metal Pill with modifications.

Vomiting is one of the common clinical symptoms that can occur in various diseases. Acute cases are often due to excess, while chronic cases are often due to deficiency. Clinically, it is observed that "nine out of ten cases are due to stomach cold, and only one or two out of ten are due to internal heat" (Jingyue Quanshu). Therefore, the treatment should generally focus on warming the stomach and stopping vomiting. Fresh Ginger Rhizome is traditionally known as the holy medicine for vomiting and is frequently used. Additionally, there are cases of vomiting caused by phlegm-fluid retention, which should be treated by warming yang and resolving retained fluid, and the vomiting will naturally cease. The prescription used is Inula and Hematite Decoction. There are also cases of vomiting caused by static blood obstruction, which should be treated by invigorating blood and resolving stasis. The prescription used is Infradiaphragmatic Stasis-Expelling Decoction with modifications.

bubble_chart Documentation

1. 《Shen's Zunsheng Book．Vomiting Hiccup Origin》: "Vomiting bitter water is caused by evil in the gallbladder, the gallbladder overcomes the stomach, hence the reverse and vomiting of gall fel, resulting in the vomit being bitter water (appropriate are Evodia, Coptis Rhizome, Dried Ginger, Poria, Skullcap Root). Vomiting clear water is due to thirst and desire to drink water, but water is vomited upon intake, known as water counterflow (appropriate are Shenzhu Pill, Five Ingredients with Poria Powder). Spitting saliva and foam is due to spleen deficiency unable to restrain body fluids, hence saliva and foam come out on their own (appropriate are Six Gentlemen Decoction with Sharpleaf Galangal Fruit, Fresh Ginger Rhizome, or Pineilia, Dried Ginger in equal parts as powder). ... However, there is a general treatment method for vomiting (appropriate is Cardamon Fruit soup)."
2. Danxi Xinfa．Vomiting》: "Great vomiting, those who are thirsty and drink water will die, drinking child's urine is the best."