经曰∶诸逆冲上，皆属于火；诸呕吐酸，皆属于热，又曰∶寒气客于肠胃，厥逆而出，故痛而呕。夫呕吐
者，阳明胃气下行则顺，今逆而上行，故作呕吐。其证有声有物谓之呕；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，又有虫痛而吐者，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。凡呕吐多渴，不可与之茶水，水入复吐，终不能止，
必强忍一二时久，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。再若不止，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》热因寒用之法也。盖阴寒太过，阳热之药拒而不纳，故以猪胆汁、童便为向导，其始则同，其
终则异，下咽之后，阴体渐消，阳气乃发也。
热吐者，面赤唇红，吐饮少而出物多，乳片已消，色黄，遍身发热而烦躁。夏月多此证，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，眼泡浮肿，面色微黄足冷，其热日轻夜重，或吐馊酸之气，或吐黄水，或吐青痰，其脉弦实而
滑。此有宿食也，宜下去其积乃止，消积丸。
伤乳吐者，才乳即吐，或少停而吐。此因乳食无度，脾胃娇嫩，不能运化。此满则溢也，名嗌乳。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。
有乳多而吐出者，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，必等乳母拥抱之，
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！此予用最多
者，盖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，囟陷囟肿，青筋大露者；并频吐不食，昏沉语塞，喘急大热，常吐腥臭者，皆死。
哕者，有声无物，最恶之候，凡久病之后而见此者，皆为不治。
予按∶为医者临延医病，贵能体贴病情，能用心法。大凡呕吐不纳药食者，最难治疗。
盖药入即吐，安能有功？又切不可强灌，胃口愈吐愈翻，万不能止。予之治此频多，先将姜汤和黄土作二泥丸，
塞其两鼻，使之不闻药气。然后用对证之药煎好，斟出澄清，冷热得中，止服一口，即停之半时之久，再服
一口，又停之良久，服二口停之，少顷则任服不吐矣。斯时胃口已安，焉能得吐？愚人不知，明见其吐药不纳，
偏以整杯整碗强灌之，则一吐倾囊而出，又何药力之可恃乎？此等之法，不但幼科可用，即方脉亦当识此。倘
临证不体病情，全无心法，即如呕吐一证，虽能识病，虽能用药，其如不纳何哉？
《内经》说：各种气逆冲上的病症，都属于火；各种呕吐酸水的症状，都属于热。又说：寒气侵入肠胃，导致气机厥逆而上出，所以既疼痛又呕吐。所谓呕吐，是阳明胃气应当下行才顺畅，如今反而逆向上行，所以发生呕吐。其症状中，既有声音又有实物吐出称为“呕”；只有实物吐出而没有声音称为“吐”；只有声音而没有实物吐出称为“哕”，也称为干呕。久病出现这种症状的预后不良，主死。大概小儿呕吐，有寒证、热证和伤食证，然而寒吐和热吐，没有不是由伤食引起的，其病总归属于胃。另外还有溢乳、嗌乳（咽乳）、呕哕，这些都与呕吐相似，但不能按呕吐来治疗。更有寒热格拒之证，以及因虫痛而呕吐者，都应当详细辨别证候后进行治疗。凡是治疗小儿呕吐，首先应当节制乳食，节制的含义就是减少喂养量。凡呕吐多伴有口渴，不可立即给予茶水，水喝进去又会吐出来，最终无法止住，必须强忍一段时间，然后再给予米汤，呕吐自然就会停止。
寒性呕吐，表现为乳汁片块不消化，多吐而少出，面色白，眼睑松弛无力，气息缓弱，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，服药后不止吐，用理中汤加藿香，若仍不止吐，用参香散。如果还不停止，这是阴盛格阳，称为拒格，急需服用一剂理中汤，加入少许公猪胆汁和童便，将药物润湿炒熟，煎服即可止吐。这是《内经》中“热因寒用”的方法。因为阴寒之气太过，阳热性质的药物被排斥而不能接纳，所以用猪胆汁、童便作为向导，起初性质相同，最终性质不同，药液咽下之后，阴寒之体逐渐消散，阳气得以发越。
热性呕吐，表现为面红唇赤，吐出的饮水量少而实物多，乳汁片块已经消化，颜色发黄，全身发热且烦躁。夏季多见此证，适宜用五苓散加藿香，若不止吐，用藿连汤，再不止吐，用理中汤，煎熟后调入六一散冷服即可止吐。这是“寒因热用”的方法。
伤食呕吐，表现为眼睑浮肿，面色微黄，足部发冷，发热症状白天轻晚上重，或吐出馊酸气味，或吐出黄水，或吐出青痰，脉象弦实而滑。这是因为体内有宿食停滞，应当攻下积滞才能停止呕吐，方用消积丸。
伤乳呕吐，表现为刚吃奶就吐，或稍停片刻后吐。这是因为哺乳无度，脾胃娇嫩，不能运化。这是满则溢出，名为嗌乳。只应当节制哺乳量，呕吐自然就会停止。
嗌乳，表现为时时吐出少量乳汁，似吐非吐，这都是胃虚所致，适宜用参香散。
有乳汁过多而吐出者，并非真正的呕吐；如果不加以禁忌控制，就会变成真正的呕吐。百日内的小儿多有这种情况，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。这是人为因素造成的，不需要用药治疗。
咳嗽伴随呕吐，小儿有咳嗽时，必须等到咳嗽平息后，才可以喂奶。如果咳嗽未平息就喂奶，气机必然逆乱，乳汁不能消化而变为痰，痰气壅塞，导致咳嗽无法缓解而吐出乳汁，方用枳桔二陈汤。
小儿出生三日内吐乳的，用丁香三粒、陈皮三分、生姜三片，煎服即可自止。不如煨姜汤效果更好！这是我使用最多的方法，因为三四日内的吐乳总属寒吐。
初起嗌乳，就应当调治。如果嗌乳不止就会变成吐，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，囟门凹陷或肿胀，青色筋脉大露；或者频繁呕吐且不进食，神志昏沉、言语障碍，气喘急促、高热，经常吐出腥臭之物，这些都是死证。
哕，是有声无物，是最凶恶的症状，凡是久病之后出现这种症状的，都是不治之症。
我按语：做医生的在延请医生治病时，贵在能体贴病情，能运用心法。大凡呕吐不能纳受药食的情况，最难治疗。因为药物一入口就吐出来，怎么能有疗效呢？又切不可强行灌药，胃口会越灌越翻腾，万不能止住。我治疗这种情况很多，先将姜汤和黄土做成两个泥丸，塞住患儿的两鼻孔，使其闻不到药味。然后用对症的药物煎好，斟出澄清部分，温度冷热适中，先喂一口，随即停止半小时左右，再喂一口，又停止很长时间，喂两口后停止，过一会儿就可以随意服用而不吐了。此时胃口已经安定，怎么能还会吐呢？愚昧的人不知道这一点，明明看到患儿吐药不纳，却偏要整杯整碗地强行灌入，结果一吐就将所有药物倾囊而出，又哪里还有药力可依靠呢？这种方法，不但儿科可以使用，即内科诊疗也应当知晓此理。如果在临证时不体贴病情，完全没有心法，就像呕吐这一证候，虽然能识别疾病，虽然能用对药物，但患者不纳受，又能有什么办法呢？
The *Neijing* states: All rebellious qi rushing upward belongs to Fire; all vomiting and acid regurgitation belong to Heat. It also states: When Cold Qi lodges in the stomach and intestines, causing rebellious qi to exit upwards, pain and vomiting occur. Vomiting refers to the reversal of Yangming Stomach Qi, which should descend smoothly; when it reverses and moves upward, vomiting occurs. In these symptoms, those with both sound and material are called "Ou" (Vomiting); those with material but no sound are called "Tu" (Regurgitation); those with sound but no material are called "Yue" (Hiccups), also known as dry heaving. If this appears in chronic illness, it indicates death. Generally, pediatric vomiting involves Cold, Heat, or Food Stagnation. However, neither Cold nor Heat vomiting occurs without prior food stagnation; the pathology ultimately resides in the Stomach. Additionally, there are conditions like milk overflow (Yiru), swallowing milk (Yilu), and hiccups/vomiting, which resemble vomiting but must not be treated as such. There are also cases of Cold-Heat rejection blockage and vomiting due to worm pain, all of which require detailed differentiation before treatment. In treating pediatric vomiting, one must first regulate milk and food intake, meaning to reduce the quantity. For vomiting accompanied by thirst, do not immediately give tea or water, as drinking will trigger more vomiting that cannot be stopped. One must endure for a period, then offer rice soup, after which vomiting will cease.
Cold-type vomiting presents with undigested milk curds, frequent vomiting with little output, pale face, relaxed eyelids, weak breath, lethargy, sweating on the forehead, and a deep, faint pulse. The treatment should warm the middle and digest food. For mild cases, use Huoxiang Zhengqi San (Agastache Powder to Rectify the Qi). If vomiting persists, use Lizhong Tang (Regulate the Middle Decoction) with added Huoxiang. If still persistent, use Shenxiang San (Ginseng and Costus Powder). If it continues, this indicates Yin excess repelling Yang, termed "Juge" (Rejection Blockage). Urgently administer one dose of Lizhong Tang, mixed with a small amount of male pig bile and child's urine. Moisten the herbs, stir-fry until cooked, decoct, and take orally to stop vomiting. This follows the *Neijing* principle of "treating heat with cold methods." Because excessive Yin-Cold repels Yang-warming herbs, pig bile and child's urine act as guides. Initially similar in nature, they differ ultimately; upon ingestion, the Yin pathogen gradually dissipates, allowing Yang Qi to emerge.
Heat-type vomiting presents with a red face, crimson lips, small volume of vomited fluids but large volume of solid matter, digested milk curds that are yellow, generalized fever, and irritability. This is common in summer. Use Wuling San (Five-Ingredient Poria Powder) with added Huoxiang. If persistent, use Houxian Tang (Akebia and Coptis Decoction). If still persistent, use Lizhong Tang, decocted, then mixed with Liuyi San (Six-to-One Powder) and taken cold to stop vomiting. This follows the principle of "treating cold with heat methods."
Food-stagnation vomiting presents with puffy eye lids, slightly yellow complexion, cold feet, fever that is milder during the day and heavier at night, vomiting of sour/fermented odors, yellow water, or green phlegm, with a wiry, full, and slippery pulse. This indicates retained food. One must purge the accumulation to stop vomiting, using Xiaoji Wan (Accumulation-Dissolving Pill).
Milk-injury vomiting occurs immediately after feeding or after a short pause. This is due to unregulated feeding overwhelming the delicate Spleen and Stomach, which cannot transform and transport. This is "overflow due to fullness," named Yilu (Swallowing Milk). Regulation of feeding quantity alone will stop the vomiting.
Yilu (Swallowing Milk) involves frequent spitting of small amounts of milk, appearing as if vomiting but not truly so, caused by Stomach Deficiency. Use Shenxiang San.
Excessive milk discharge is not true vomiting; without dietary restriction, it may become true vomiting. This is common in infants under 100 days old because their bodies are small and soft, requiring maternal support. Tilting causes milk to spill. This is a physical issue, not requiring medical treatment.
Cough-induced vomiting occurs when an infant coughs. Feeding must wait until the cough subsides. Feeding while coughing causes Qi rebellion, preventing milk digestion and transforming it into Phlegm. Phlegm-Qi obstruction prevents cough resolution, leading to milk vomiting. Use Zhijie Erchen Tang (Bitter Orange and Citrus Decoction with Two-Aged Ingredients).
For infants vomiting milk within three days of birth, use three cloves (Dingxiang), three fen of tangerine peel (Chenpi), and three slices of ginger (Shengjiang), decocted and taken orally to stop vomiting. Simmered Ginger Soup (Weijiang Tang) is even better. I use this most frequently, as vomiting within three to four days is generally Cold-type.
Initial Yilu should be regulated early. If Yilu persists, it becomes Tu; if Tu persists, it becomes Ou; if Ou persists, it becomes Yue. At this stage, Stomach Qi is severely deficient, and Spirit is fading. Prognosis is poor if vomiting persists with worsening lethargy, sunken or swollen fontanelles, prominent blue veins, frequent vomiting with refusal to eat, coma, aphasia, rapid breathing, high fever, or foul-smelling vomit. These are fatal signs.
Yue (Hiccups/Dry Heaving) involves sound without material and is a dire sign. Its appearance after chronic illness indicates incurability.
Commentary: Physicians must empathize with the patient's condition and apply clinical wisdom. Vomiting where medication and food are rejected is difficult to treat. If medicine is vomited immediately, how can it work? Forcing administration worsens gastric agitation. I often treat this by plugging the nostrils with clay balls made from ginger soup and loess to block the smell of medicine. Then, prepare the correct formula, clarify it, ensure moderate temperature, and administer one mouthful, pausing for half an hour. Then another mouthful, pausing longer. After two mouthfuls and a brief pause, the infant can drink freely without vomiting. The Stomach Qi stabilizes, preventing further vomiting. Fools, seeing the rejection, force-feed cups of medicine, causing total expulsion and loss of efficacy. This method applies not only to pediatrics but also to internal medicine. Without empathy and clinical wisdom, even accurate diagnosis and prescription are useless if the patient cannot retain the medicine.