总括
盖诸逆上冲，皆成呕吐。夫诸逆之因，或以乳食过多，停滞中脘，胃气不能健运而上逆也。或于食时触惊，停积不
化而上逆也。或因痰饮壅盛，阻隔气道，或蛔虫扰乱，懊 不安而上逆也。总之，上逆之因，虽不同，而皆能成呕吐也。
但病有虚有实，有寒有热，治者要分明也。
辨呕吐哕证
吐证有三。古人谓有物有声谓之呕，属阳明，气血俱病也；有物无声，吐证之名，属太阳，血病也；无物有声，为
哕证，属少阳，气病也。独李杲谓呕吐哕俱属脾胃虚弱，洁古老人又从三焦以分气积寒之三因，然皆不外诸逆上冲也。
治者能分虚实，别寒热，医治之，自无不曲中病情矣。
伤乳吐
小儿乳食过饱，停蓄胃中，以致运化不极，吐多片乳，犹如物盛满而上溢也。其证身热面黄，肚腹膨胀，治宜消乳
丸、保和丸，化其宿食，安胃和中，兼节其乳食，自然吐止也。
伤食吐
小儿饮食无节，过食油腻面食等物，以致壅塞中脘，损伤胃气，而成其证。肚腹胀热，恶食口臭，频吐酸粘，眼胞
虚浮，身体潮热，治宜清胃和中为主。须先服三棱丸止其吐，再用和胃汤煎服化其滞，而病愈矣。
夹惊吐
小儿多因饮食之时，忽被惊邪所触而成吐。其证频吐清涎，身体发热，心神烦躁，睡卧不安。宜先截其风，用全蝎
观音散极妙；次止其吐，用定吐丸而病可痊矣。
痰饮吐
小儿饮水过多，以致痰饮壅盛，留在胸中，变而为痰。痰因气逆，呕吐成矣。其候头目眩晕，面青，呕吐涎水痰沫。
宜用香砂二陈汤，虚者用香砂六君子汤治之，可安宁矣。
虫吐
虫吐之证有二，有以胃经热蒸而成，有以胃经寒迫者，皆能令虫不安，扰乱胃中而作吐也。其证唇色必变青色，或
红或白，胃口时疼时止，频呕青涎。属寒属热，当以阴阳之证辨之。热者化虫丸主之，寒者加减理中汤主之，定可痊也。
虚吐
虚吐之证，多因胃气虚弱，不能消纳乳食，致成此证也。其精神倦怠，囟门煽动，睡卧露睛，自利不渴，频频呕吐。
以丁香沉香加四君子汤治之，最灵也。
实吐
小儿平素壮实，偶而停滞，胸腹胀满，二便秘涩不利，痞硬疼痛，口中发渴，思饮寒凉吐多酸臭。宜用三一承气汤
下之，二便利而吐止，可收功矣。
寒吐
此因小儿过食生冷，或乳母当风取凉，使寒气入乳，小儿饮之，则成冷吐。其候朝食而暮吐，乳食不化，吐出之物，
不臭不酸，四肢厥冷，面唇色白。治当温中定吐，胃微寒者，姜橘散主之，寒甚者，丁萸理中汤煎服。
热吐
小儿过食煎爆之物，或乳母过浓味，以致热积胃中，遂成热吐。其候食入而即吐，口渴饮冷，呕吐酸涎，身热唇红，
小便赤色。治宜清热为主，用加味温胆汤可痊也。
总括
凡是各种气机上逆冲上的症状，都会形成呕吐。导致气机上逆的原因，有的是因为吃奶或食物过多，停滞在胃脘部，导致胃气不能正常运化而上逆；有的是因为在进食时受到惊吓，导致食积不化而上逆；有的是因为痰饮壅盛，阻塞气道；有的是因为蛔虫扰乱，使患儿内心烦闷不安而上逆。总之，引起气机上逆的原因虽然不同，但都能导致呕吐。但是疾病有虚证和实证的区别，有寒证和热证的差异，治疗者必须分辨清楚。
辨呕吐哕证
呕吐的证候主要有三种。古人认为：有物有声称为“呕”，属于阳明经，是气血都受病的表现；有物无声，仅称为“吐”，属于太阳经，是血分受病的表现；无物有声，称为“哕”（呃逆），属于少阳经，是气分受病的表现。只有李杲认为呕吐和哕都属于脾胃虚弱所致，洁古老人又从三焦角度区分气、积、寒三种病因，但这些都不外乎气机上逆冲上的范畴。治疗者如果能分清虚实，辨别寒热，进行医治，自然能准确契合病情。
伤乳吐
小儿因吃奶过饱，乳汁停蓄在胃中，导致消化功能不全，吐出多未消化的奶块，就像容器装满而溢出一样。其症状表现为身体发热、面色发黄、肚腹胀满，治疗宜用消乳丸、保和丸，以化解宿食，安和胃气，同时节制乳食，呕吐自然会停止。
伤食吐
小儿饮食没有节制，过量食用油腻、面食等食物，导致中脘部壅塞，损伤胃气，从而形成此证。症状表现为肚腹胀热、厌恶食物、口臭、频繁吐出酸粘物、眼睑虚浮、身体定时发热，治疗应以清胃和中为主。必须先服用三棱丸以止住呕吐，再用和胃汤煎服以化解食滞，病即可痊愈。
夹惊吐
小儿多因在饮食之时，突然被惊恐邪气所触而发生呕吐。其症状表现为频繁吐出清稀涎液、身体发热、心神烦躁、睡眠不安。宜先用全蝎观音散来截断风邪，效果极佳；然后再用定吐丸来止住呕吐，病即可痊愈。
痰饮吐
小儿饮水过多，导致痰饮壅盛，停留在胸中，变生为痰。痰随气逆上冲，呕吐便形成了。其症状表现为头目眩晕、面色发青、呕吐涎水和痰沫。宜用香砂二陈汤治疗，体质虚弱者用香砂六君子汤治疗，即可安宁。
虫吐
虫吐的证候有两种：一种是由胃经热蒸而成，一种是由胃经寒迫所致，这两种情况都能令虫体不安，扰乱胃中而导致呕吐。其症状表现为嘴唇颜色变为青色，或红或白，胃口处时而疼痛时而停止，频繁呕吐青色涎液。属于寒证还是热证，应当通过阴阳证候来辨别。属热证者主用化虫丸，属寒证者主用加减理中汤，定可痊愈。
虚吐
虚吐的证候，多因胃气虚弱，不能消化接纳乳食，从而导致此证。其症状表现为精神倦怠、囟门煽动、睡觉时眼睛半睁（露睛）、自发性腹泻且不口渴、频频呕吐。用丁香沉香加四君子汤治疗，最为灵验。
实吐
小儿平时体格壮实，偶尔出现食积停滞，导致胸腹胀满，大小便不通畅，腹部痞硬疼痛，口中发渴，想喝冷饮，呕吐物多带酸臭味。宜用三一承气汤攻下，待大小便通畅后呕吐停止，即可收效。
寒吐
这是因为小儿过食生冷食物，或者乳母在风中乘凉，使寒气进入乳汁，小儿饮用后，形成冷吐。其症状表现为早上吃的东西晚上吐出来，乳食不消化，吐出的东西不臭也不酸，四肢厥冷，面色和嘴唇苍白。治疗应当温中定吐，胃微寒者，主用姜橘散；寒邪严重者，主用丁萸理中汤煎服。
热吐
小儿过食煎炸爆炒的食物，或者乳母饮食过于浓味，导致热邪积聚在胃中，遂成热吐。其症状表现为食物吃进去就吐出来，口渴想喝冷水，呕吐酸水，身体发热，嘴唇红润，小便颜色深赤。治疗应以清热为主，用加味温胆汤即可痊愈。
General Overview
All types of rebellious Qi rushing upward result in vomiting. The causes of such rebellious Qi include: excessive intake of milk or food causing stagnation in the epigastrium, leading to failure of Stomach Qi to transform and move normally, thus rebelling upward; being startled during meals causing food accumulation that fails to digest and rebels upward; excessive phlegm-fluid obstructing the airway; or roundworms disturbing the interior, causing restlessness and rebellion upward. In summary, although the causes of Qi rebellion differ, all can lead to vomiting. However, diseases vary between deficiency and excess, cold and heat patterns; practitioners must distinguish these clearly.
Differentiating Vomiting, Spitting-up, and Hiccups
There are three main types of spitting-up/vomiting syndromes. Ancient texts state: "Ou" (vomiting with sound) involves both substance and sound, belongs to the Yangming channel, and indicates disease affecting both Qi and Blood; "Tu" (spitting up without sound) involves substance but no sound, belongs to the Taiyang channel, and indicates disease affecting Blood; "Yue" (hiccups/belching without substance) involves sound but no substance, belongs to the Shaoyang channel, and indicates disease affecting Qi. Li Gao argued that Ou, Tu, and Yue all stem from Spleen and Stomach deficiency. Jiegu Laoren differentiated the causes into Qi, accumulation, and Cold based on the Triple Burner. Nevertheless, all these fall under the category of rebellious Qi rushing upward. If a practitioner can distinguish between deficiency and excess, and identify cold and heat patterns, treatment will accurately address the condition.
Milk Injury Vomiting
When infants consume too much milk, it accumulates in the Stomach, impairing digestion. They vomit undigested milk curds, resembling an overflowing container. Symptoms include fever, sallow complexion, and abdominal distension. Treatment should employ Xiaoru Wan (Milk-Digesting Pill) and Baohe Wan (Preserve Harmony Pill) to resolve retained food, harmonize the Stomach, and regulate diet. Vomiting will cease naturally.
Food Injury Vomiting
Irregular eating habits, especially overconsumption of greasy foods and wheat products, cause stagnation in the epigastrium and damage Stomach Qi. Symptoms include abdominal distension and heat, aversion to food, foul breath, frequent vomiting of sour sticky matter, puffy eyelids, and tidal fever. Treatment focuses on clearing the Stomach and harmonizing the middle. First, administer Sanleng Wan (Sanleng Pill) to stop vomiting, then use Hewei Tang (Harmonize Stomach Decoction) to resolve stagnation. The illness will resolve.
Startle-Associated Vomiting
Infants may develop vomiting after being startled during feeding. Symptoms include frequent vomiting of clear saliva, fever, mental restlessness, and restless sleep. First, use Quanxie Guanyin San (Scorpion Guanyin Powder) to extinguish wind. Subsequently, use Dingtu Wan (Stop-Vomiting Pill) to arrest vomiting. Recovery is expected.
Phlegm-Fluid Vomiting
Excessive water intake leads to excessive phlegm-fluid retention in the chest, transforming into phlegm. Phlegm follows rebellious Qi, causing vomiting. Symptoms include dizziness, cyanotic complexion, and vomiting of saliva and frothy phlegm. Use Xiangsha Erchen Tang (Aucklandia and Amomum Two-Aged Decoction). For deficiency patterns, use Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction). Peace will be restored.
Worm-Induced Vomiting
There are two types of worm-induced vomiting: one caused by Heat steaming in the Stomach channel, and the other by Cold pressing in the Stomach channel. Both disturb the worms, causing them to agitate the Stomach and induce vomiting. Symptoms include changes in lip color (cyanotic, red, or white), intermittent gastric pain, and frequent vomiting of greenish saliva. Differentiate between Cold and Heat using Yin-Yang principles. For Heat patterns, use Huachong Wan (Worm-Transforming Pill). For Cold patterns, use Jiajian Lizhong Tang (Modified Regulate the Middle Decoction). Recovery is assured.
Deficiency Vomiting
This syndrome arises from weak Stomach Qi unable to digest and accept milk and food. Symptoms include lethargy, pulsating fontanelle, eyes half-open during sleep, spontaneous diarrhea without thirst, and frequent vomiting. Treat with Dingxiang Chenxiang Si Junzi Tang (Clove and Agarwood Four-Gentlemen Decoction) for optimal results.
Excess Vomiting
Normally robust children may experience occasional food stagnation, leading to chest and abdominal fullness, constipation or difficult urination, epigastric hardness and pain, thirst, desire for cold drinks, and vomiting of sour-smelling contents. Administer Sanyi Chengqi Tang (Three-One Purging Decoction) to purge the excess. Once bowel movements and urination normalize, vomiting will cease, and the case will be resolved.
Cold Vomiting
Caused by excessive consumption of raw/cold foods or by the nursing mother exposing herself to wind and cold, allowing cold to enter the milk. The infant ingests this cold milk, resulting in cold vomiting. Symptoms include regurgitation of morning food in the evening, undigested milk/food, non-sour/non-foul vomitus, cold limbs, and pale face/lips. Treatment requires warming the middle to stabilize vomiting. For mild Stomach cold, use Jiangju San (Ginger and Tangerine Peel Powder). For severe cold, use Dingyu Lizhong Tang (Clove and Evodia Regulate the Middle Decoction).
Heat Vomiting
Caused by excessive consumption of fried/fried foods or by the nursing mother consuming rich/spicy flavors, leading to Heat accumulation in the Stomach. Symptoms include immediate vomiting after eating, thirst with desire for cold drinks, vomiting of sour saliva, fever, red lips, and dark red urine. Treatment focuses on clearing Heat. Use Jiawei Wendan Tang (Modified Warm Gallbladder Decoction) for recovery.