方书所谓膈气呕吐者，此即《内经》气为上膈之一条也。所谓噎隔呕吐者，即《内经》
三阳结为隔之一条也。仲景《金匮》书，以生姜半夏汤治痰呕，此治膈气方也；又以甘草大
黄汤治呕吐便结者，此治噎隔方也。洁古《家珍》以呕吐分上中下三条，而以气积寒主治
；东垣以辛香温胃立法。此乃膈气呕吐方书，非噎隔呕吐之症也。河间以《内经》诸逆冲上
，诸呕吐酸，诸痿喘呕，正合三阳结热之义，发明气郁不利，胃火上炎，故呕涌溢食不下，
而以三乙承气等方为治。丹溪亦谓噎隔之症，火热上炎，多升少降，更发内伤真阴不足，津
液枯涸，而以四物汤中多加竹沥、荆沥、牛羊乳等为治；又着《局方发挥》，力辨《和剂》
之非，此噎隔呕吐方书，非膈气呕吐胃寒之症也。《内经》明明各是一条，前贤亦各开一面
，今因二者症名相似，膈隔易讹，呕吐难别，遂至辗转差误。不知同一呕吐也，而有热吐寒
吐之分；同一痰涎也，而有湿痰燥痰之别。考之方书，同是治隔也，而有膈气噎隔二条之分
。按之《内经》，同有似论也。而有气为上膈，三阳结为隔之异。夫膈气呕吐者，言饮食之
时，并无阻碍，但食后时或作胀，时或气逆，时或呕吐，然亦时作时止，不比噎隔之症，饮
食之际，即有拒隔不下之患，下咽之后，少顷直涌而上也。《内经》云∶三阳结为隔。注曰
∶三阳者，大小肠、膀胱也。结者，结热也。小肠结热则血脉燥，大肠结热则后不通，膀胱
结热则津液干涸。三阳下结，食必上潮，此阳火上逆，推而不下也
。桢细玩之，曰三阳则与阴经无与，曰结热，则非阴寒可知。夫《千金》诸方，治反胃噎隔
而用姜桂，因气滞清道，用大黄、芒硝、石膏、竹沥、芦根、生地黄汁等一派苦寒，略用姜
桂以为向导，非因胃寒而用也。又按方约之《附余心法》曰∶噎隔之症，因火而成，病源不
一，有因思虑过度而动脾火者；有因忿怒过度而动肝火者；有因饮食太过而生胃火者；有因
淫欲过度而起肾火者。盖火气火上，熏蒸结聚，津液干燥，饮食不得流利，为噎为隔，久则
胃脘结断，饮食虽进，停滞隔间，反而上逆，为呕为吐，此症切不可用香燥之药，若服之必
死，夫证属热燥，又用香燥之药，散气消阴，则助火而烁津矣。又考王宇泰《准绳》书，谓
溢食一症，或伤于酒，或伤于食，或胃风而吐，或胃热而吐，医者不察，火里烧姜，汤中煮
桂，沉香未已，豆蔻继之，砂仁未已，胡椒继之，竟将热药妄施。素热之人，三阳既结，食
必上潮。仓公治用下剂。刘河间治呕吐噎食，遵仲景呕吐门甘草大黄汤，及三乙承气等，独
超近代，但用药之时，累累加服，慎勿顿攻。若咽喉痰阻，微用若酸，轻轻涌出，因而治下
。设或不行，蜜盐下道，始终勾引，两道相通，结散阳消，饮食自顺。余今分别发明曰，膈
气呕吐，与噎隔呕吐，各是一条。膈气呕吐，有寒有热，有痰有气，有燥有湿；噎隔呕吐，
则但热无寒，但燥无湿，惟是三阳结热。《金匮》、《千金》、洁古、东垣之方，治膈气呕
吐者，不可治噎隔症；河间、丹溪之方，治噎隔法也，不可治胃寒膈气。仲景小半夏汤，治湿
痰呕吐者也；大黄甘草汤，治大便燥结，食已即吐者也；其小柴胡汤，治运气外来，少阳所
胜之呕吐也；后洁古加青黛治呕苦，亦同是义。东垣之丁香茱萸汤，治胃寒呕吐者也；《三
因方》麦门冬汤内用竹茹、芦根汁，治燥热漏气呕吐也；河间用承气等下药，治热淫所胜，
膏粱积热，外感有余之噎隔也；丹溪以四物汤加羊牛乳等滋阴，治津竭血燥，内伤不足之噎
隔也；赵氏书独主滋阴而重地黄丸，此治精竭阴耗，肾经真水不足，内伤噎隔之法也。至于
东垣所论噎塞，又有不同。夫曰堵塞喉咙，阳气不得出曰塞，阴气不得降曰噎。夫气逆咽喉
，诸经不行，口开目瞪，气欲绝，当用气味俱阳之药，引胃气以治其本。桢细玩之，词中并
不言及拒格饮食等语，下文反言食消服之，更以美食压之。夫噎塞直至口开气绝，尚能待食
消，更以美食压之乎？此之噎塞，又言膈气不通，阴寒气窒之症，另是气噎一门之症，非言
噎隔溢食，格食不下，三阳结热之噎矣。余读《准绳》书，见以膈气呕吐叙于噎隔呕吐之上
，另立一门，又以噎塞之症，叙于噎隔之下，亦另立一门，则知古人原有分别也。是以一症
之中，亦要分析寒热燥湿诸条。即如《内经》诸呕吐酸，同言热呕也，而为湿热之呕，诸痿
喘呕。同言热呕也，而为燥热之呕，二热同源，湿与燥又分天壤。方书以食久而吐属寒，名
曰翻胃；以食入即吐为热，名曰反胃，不知反与翻同，皆是形容呕吐之义，未可以食入即吐
、食久而吐，以定寒热。王太仆虽有此论，亦言其理之常，难必其症之变也。余常见暴吐多
热，即久吐中亦有热者。脾胃湿热，食久不化，熏蒸结聚，痰涎裹住不消，亦令上逆而吐，
如夏月人感湿热，则食不消化而吐是也。是以噎隔之症，千无一寒，万无一寒，从古到今，
亦无一寒也；呕吐之症，亦止寒热各半耳。余今以下噎食不下，隔食呕吐之症，直以有热无
寒施治，以呕吐之症，不论食久食已，惟以酸不酸，臭不臭，分别寒热。呕而酸馊，夏热之化
，主火；呕而不酸不臭，冬寒之象，主寒。如造酒者然，热者主酸主臭，冷者不腐不臭是也。
方书中所谓的“膈气呕吐”，就是《内经》中提到的“气为上膈”这一条。所谓“噎隔呕吐”，就是《内经》中“三阳结为隔”这一条。张仲景在《金匮要略》中，用生姜半夏汤治疗痰饮引起的呕吐，这是治疗膈气的方子；又用甘草大黄汤治疗呕吐且大便干结的患者，这是治疗噎隔的方子。李东垣（洁古）在《家珍》中将呕吐分为上、中、下三条，并以气积寒为主要病机进行治疗；李东垣则主张用辛香温胃的方法立法。这些都属于膈气呕吐的方书内容，并非噎隔呕吐的病症。刘河间依据《内经》中“诸逆冲上，皆属于火”、“诸呕吐酸，皆属于热”、“诸痿喘呕，皆属于肺/热”等论述，正符合“三阳结热”的含义，阐发了气机郁滞不利、胃火上炎导致呕吐涌溢、食物无法下咽的病机，因此使用三乙承气汤等方剂进行治疗。朱丹溪也认为噎隔的病症，是火热上炎，升多降少，再加上内伤导致真阴不足，津液枯涸，因此在四物汤中多加竹沥、荆沥、牛羊乳等进行治疗；他又撰写了《局方发挥》，极力辨析《太平惠民和剂局方》的错误，这些属于噎隔呕吐的方书内容，而非膈气呕吐胃寒的病症。《内经》明明是将它们分作两条论述，前贤也各自开辟了一面理论体系。如今因为这两者的症状名称相似，膈与隔容易混淆，呕吐难以区分，从而导致辗转传抄出现差错错误。不知道同样是呕吐，却有热吐和寒吐的区别；同样是痰涎，却有湿痰和燥痰的不同。查阅方书，同样是治疗隔证，却分为膈气和噎隔两条。对照《内经》，虽然有相似的论述，却有“气为上膈”和“三阳结为隔”的差异。
所谓膈气呕吐，是指饮食之时并没有阻碍，只是进食后有时感到腹胀，有时气机上逆，有时发生呕吐，但也是时好时坏，不像噎隔这种病症，在饮食之际就有拒绝阻隔、食物不能下咽的隐患，食物咽下之后，过一会儿就直接向上涌出。《内经》说：“三阳结为隔。”注解说：三阳，指的是小肠、大肠和膀胱。结，指的是结热。小肠结热则血脉干燥，大肠结热则大便不通，膀胱结热则津液干涸。三阳在下部结热，食物必然向上泛潮，这是因为阳火上逆，推挤食物而不能下行。我仔细玩味这句话，说“三阳”就与阴经无关，说“结热”，就知道不是阴寒所致。《千金方》中的各方，治疗反胃噎隔而使用姜、桂（生姜、肉桂），是因为气滞于清道，所以使用大黄、芒硝、石膏、竹沥、芦根、生地黄汁等一派苦寒药物，略微使用姜、桂作为向导，并不是因为胃寒而使用。
我又查阅方约之的《附余心法》说：噎隔的病症，是由火邪造成的，病因不一，有因思虑过度而动脾火的；有因忿怒过度而动肝火的；有因饮食太过而生胃火的；有因淫欲过度而起肾火的。大概火气在上熏蒸结聚，津液干燥，饮食不得流利，形成噎或隔，时间久了胃脘结断，饮食虽然吃进去，停滞在膈间，反而向上逆，形成呕或吐，这种病症切不可使用香燥的药物，如果服用必定致死。既然证候属于热燥，又用香燥的药物，会耗散气机、消烁阴液，从而助长火势、烧灼津液。
我又考证王宇泰的《医学准绳六要》一书，提到溢食一症，有的伤于酒，有的伤于食，有的是胃风而吐，有的是胃热而吐，医生不加以考察，就在火里烧姜，汤中煮桂，沉香还没停，豆蔻接着上，砂仁还没停，胡椒接着加，竟然将热药胡乱施用。素来体热的人，三阳既已结热，食物必然上泛。仓公治疗时使用下法。刘河间治疗呕吐噎食，遵循张仲景呕吐门中的甘草大黄汤，以及三乙承气汤等，独自超越近代医家，但在用药时，屡次增加服药次数，千万不要一次性猛攻。如果咽喉有痰阻塞，轻微使用酸味药物，轻轻催吐排出，然后顺势治疗下部。假如不行，就用蜜盐从肠道引导，始终勾引上下两道相通，结热消散，阳气消退，饮食自然顺畅。
我现在分别阐明：膈气呕吐与噎隔呕吐，各是一条独立的病症。膈气呕吐，有寒有热，有痰有气，有燥有湿；噎隔呕吐，则只有热没有寒，只有燥没有湿，仅仅是三阳结热。《金匮要略》、《千金方》、洁古、东垣的方子，治疗膈气呕吐的，不能治疗噎隔症；河间、丹溪的方子，是治疗噎隔的方法，不能治疗胃寒膈气。张仲景的小半夏汤，治疗的是湿痰呕吐；大黄甘草汤，治疗的是大便燥结、食后即吐的病症；小柴胡汤，治疗的是运气外来、少阳胜复引起的呕吐；后来洁古加入青黛治疗呕吐苦水，也是同样的道理。东垣的丁香茱萸汤，治疗的是胃寒呕吐；《三因极一病证方论》麦门冬汤中使用竹茹、芦根汁，治疗的是燥热漏气引起的呕吐；河间使用承气汤等下药，治疗的是热淫所胜、膏粱积热、外感有余导致的噎隔；丹溪用四物汤加羊牛乳等滋阴，治疗的是津竭血燥、内伤不足导致的噎隔；赵氏的书独自主张滋阴并重用地黄丸，这是治疗精竭阴耗、肾经真水不足、内伤噎隔的方法。
至于东垣所论述的噎塞，又有不同。他说堵塞喉咙，阳气不得出叫做“塞”，阴气不得降叫做“噎”。如果气逆咽喉，诸经气血不行，口开目瞪，气欲绝，应当使用气味俱阳的药物，引胃气以治其本。我仔细玩味他的文字，其中并没有提及拒绝格拒饮食等话语，下文反而说食物消化后服用，再用美食压住它。噎塞严重到口开气绝，还能等待食物消化，再用美食压住吗？这个噎塞，又说是膈气不通，阴寒气窒的病症，另外属于气噎一门的病症，并不是指噎隔溢食、格食不下、三阳结热的噎隔。
我读《医学准绳六要》一书，看到将膈气呕吐叙述在噎隔呕吐之上，另立一门，又将噎塞的病症叙述在噎隔之下，也另立一门，就知道古人原本是有分别的。因此在一症之中，也要分析寒热燥湿各个条目。就像《内经》说的“诸呕吐酸”，同说是热呕，但是湿热之呕；“诸痿喘呕”，同说是热呕，但是燥热之呕，两种热同源，但湿与燥又相差天壤之别。方书认为食物久滞后呕吐属于寒，名叫翻胃；认为食物入即吐属于热，名叫反胃，不知道反与翻是同义，都是形容呕吐的意思，不可以根据食入即吐、食久而吐来定寒热。王冰（王太仆）虽然有此论述，也只是说常理，难以断定病症的变化。我常见突然呕吐多属热，即使久吐中也有热者。脾胃湿热，食物久不消化，熏蒸结聚，痰涎裹住不消，也会令食物上逆而吐，就像夏天人感受湿热，则食物不消化而吐一样。因此噎隔的病症，千无一寒，万无一寒，从古到今，也没有一个是寒的；呕吐的病症，也不过寒热各占一半罢了。我现在对于噎食不下、隔食呕吐的病症，直接以有热无寒来施治；对于呕吐的病症，不论食物久留还是刚吃下，只根据是否发酸、是否发臭，来分别寒热。呕吐而酸馊，是夏季热化的表现，主火；呕吐而不酸不臭，是冬季寒象的表现，主寒。就像酿酒的人一样，热的酿制过程主酸主臭，冷的则不腐不臭。
The so-called "Ge Qi (Diaphragm Qi) vomiting" in medical formularies refers to the passage in *Nei Jing* (Classic of Internal Medicine) stating that "Qi becomes Upper Ge." The so-called "Ye Ge (Choking and Diaphragm obstruction) vomiting" refers to the passage in *Nei Jing* stating that "The binding of the Three Yang channels causes Ge." Zhang Zhongjing, in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), used Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction) to treat phlegm-induced vomiting; this is a formula for treating Ge Qi. He also used Gan Cao Da Huang Tang (Licorice and Rhubarb Decoction) to treat vomiting accompanied by constipation; this is a formula for treating Ye Ge. Li Dongyuan (Jiegu), in *Jia Zhen*, categorized vomiting into upper, middle, and lower types, focusing on Qi accumulation and Cold as the primary pathogenesis; Li Dongyuan further proposed legislation based on acrid-aromatic warming of the Stomach. These belong to the formularies for Ge Qi vomiting, not the syndrome of Ye Ge vomiting. Liu Wansu, citing *Nei Jing* passages such as "All rebellious upward movements belong to Fire," "All vomiting and acid regurgitation belong to Heat," and "All flaccidity, wheezing, and vomiting belong to Heat/Lung," correctly aligned with the meaning of "Three Yang binding with Heat." He elucidated the pathogenesis of Qi stagnation and dysfunction, with Stomach Fire flaming upward causing violent vomiting and inability to swallow food, thus employing San Yi Cheng Qi Tang (Three Yin Modified Cheng Qi Decoction) and similar formulas for treatment. Zhu Danxi also stated that the syndrome of Ye Ge involves Fire-Heat flaming upward, with excessive ascending and insufficient descending, compounded by internal injury leading to deficiency of True Yin and desiccation of body fluids. Therefore, he added Zhu Li (Bamboo Sap), Jing Li (Acanthopanacis Sap), and cattle/sheep milk to Si Wu Tang (Four Substances Decoction) for treatment. He also wrote *Ju Fang Fa Hui* (Elucidation of the Bureau Formulary), vigorously refuting the errors of *Tai Ping Hui Min He Ji Ju Fang* (Formulary of the Public Welfare Pharmacy). These constitute the formularies for Ye Ge vomiting, distinct from the cold-type Ge Qi vomiting. *Nei Jing* clearly treats them as separate entries, and former sages established distinct theoretical frameworks. However, due to the similarity in symptom names, confusion between Ge (diaphragm) and Ge (obstruction), and difficulty distinguishing vomiting types, errors have arisen through transmission. It is unknown that while both are vomiting, there is a distinction between Heat vomiting and Cold vomiting; while both involve phlegm-fluids, there is a difference between Damp Phlegm and Dry Phlegm. Consulting formularies, although both treat "Ge" syndromes, they are divided into Ge Qi and Ye Ge. Comparing with *Nei Jing*, although the discussions appear similar, there is a distinction between "Qi becoming Upper Ge" and "Three Yang binding causing Ge."
Ge Qi vomiting implies no obstruction during eating, but rather occasional bloating after meals, occasional Qi rebellion, or occasional vomiting, which comes and goes intermittently. This differs from Ye Ge, where there is immediate rejection and inability to swallow food upon attempting to eat, followed by direct regurgitation shortly after swallowing. *Nei Jing* states: "The binding of the Three Yang causes Ge." The commentary explains: The Three Yang refer to the Small Intestine, Large Intestine, and Bladder. Binding refers to binding heat. Binding heat in the Small Intestine dries the blood vessels; binding heat in the Large Intestine causes bowel obstruction; binding heat in the Bladder dries up body fluids. With the Three Yang bound at the lower jiao, food must surge upward; this is due to Yang Fire rebelling upward, pushing food down without success. Upon careful examination, mentioning "Three Yang" excludes involvement of the Yin channels; mentioning "binding heat" indicates it is certainly not Yin-Cold. In *Qian Jin Fang* (Thousand Gold Formulas), various prescriptions for Fan Wei (Reverse Stomach) and Ye Ge use Ginger and Cinnamon because Qi stagnates in the clear pathways; thus, bitter-cold herbs like Da Huang (Rhubarb), Mang Xiao (Mirabilite), Shi Gao (Gypsum), Zhu Li (Bamboo Sap), Lu Gen (Reed Rhizome), and Sheng Di Huang Zhi (Fresh Rehmannia Juice) are used, with only slight amounts of Ginger and Cinnamon as guides, not because of Stomach Cold.
Furthermore, Fang Yuezhi’s *Fu Yu Xin Fa* states: The syndrome of Ye Ge is caused by Fire. Etiologies vary: some arise from excessive thinking stirring Spleen Fire; some from excessive anger stirring Liver Fire; some from excessive diet generating Stomach Fire; some from excessive sexual activity raising Kidney Fire. Generally, Fire Qi flaming upward causes steaming and aggregation, drying body fluids, making food flow difficult, resulting in Ye or Ge. Over time, the epigastrium becomes bound and cut off; even if food enters, it stagnates in the diaphragm region, rebels upward, and becomes vomiting. This syndrome must absolutely not be treated with acrid-drying herbs; ingestion will surely lead to death. Since the syndrome belongs to Heat-Dryness, using acrid-drying herbs disperses Qi and consumes Yin, thereby assisting Fire and scorching fluids.
I also consulted Wang Yutai’s *Zhun Sheng* (Standard Guidelines), which mentions that the syndrome of overflow vomiting may result from alcohol injury, food injury, Stomach Wind causing vomiting, or Stomach Heat causing vomiting. Physicians failing to examine these conditions burn ginger in fire and boil cinnamon in soup; when Chen Xiang (Aquilaria Wood) stops, Dou Kou (Cardamom) follows; when Sha Ren (Amomum Fruit) stops, Hu Jiao (Pepper) succeeds; they recklessly apply hot medicines. In individuals with inherent heat, once the Three Yang are bound, food must surge upward. Cang Gong treated this using purgatives. Liu Hewen (Wansu) treated vomiting and Ye Ge food obstruction following Zhang Zhongjing’s Gan Cao Da Huang Tang from the Vomiting chapter, as well as San Yi Cheng Qi Tang, surpassing modern practitioners. However, when administering medication, doses should be accumulated gradually; do not attack abruptly. If phlegm obstructs the throat, slightly use sour substances to gently induce vomiting, then treat the lower jiao accordingly. If ineffective, use honey and salt to guide downward, ensuring communication between the upper and lower pathways, dissipating binding and extinguishing Yang, allowing food to flow smoothly.
I now clarify separately: Ge Qi vomiting and Ye Ge vomiting are distinct syndromes. Ge Qi vomiting involves Cold and Heat, Phlegm and Qi, Dryness and Dampness. Ye Ge vomiting involves only Heat, no Cold; only Dryness, no Dampness; it is solely Three Yang binding heat. Formulas from *Jin Gui Yao Lue*, *Qian Jin Fang*, Jiegu, and Dongyuan for treating Ge Qi vomiting cannot treat Ye Ge syndrome. Formulas from Hewen and Danxi for treating Ye Ge cannot treat Stomach Cold Ge Qi. Zhang Zhongjing’s Xiao Ban Xia Tang treats Wet Phlegm vomiting; Da Huang Gan Cao Tang treats constipation with immediate post-prandial vomiting; Xiao Chai Hu Tang treats vomiting caused by external climatic factors and Shaoyang excess. Later, Jiegu added Qing Dai (Indigo Naturalis) to treat bitter vomiting, adhering to the same principle. Dongyuan’s Ding Xiang Zhu Yu Tang treats Stomach Cold vomiting; *San Yin Fang*’s Mai Men Dong Tang uses Zhu Ru (Bamboo Shavings) and Lu Gen juice to treat Dry-Heat leaking Qi vomiting; Hewen uses Cheng Qi decoctions to treat Ye Ge caused by excessive Heat, rich food accumulation, and exterior excess; Danxi uses Si Wu Tang with sheep/cattle milk to nourish Yin, treating Ye Ge caused by fluid exhaustion and Blood dryness from internal injury; Zhao’s book emphasizes nourishing Yin and heavily using Di Huang Wan (Rehmannia Pill), a method for treating internal injury Ye Ge due to essence depletion, Yin consumption, and insufficiency of True Water in the Kidney channel.
Regarding Dongyuan’s discussion of Ye Sai (Choking Obstruction), it differs again. He states that blocking the throat where Yang Qi cannot exit is called "Sai," and where Yin Qi cannot descend is called "Ye." If Qi rebels in the throat, meridians cease functioning, eyes open wide, breath nearly ceases, one should use herbs with strong Yang aroma to guide Stomach Qi to treat the root. Upon careful reading, his text does not mention rejecting food; instead, it says take it after food digestion, pressing it down with good food. Can one wait for food digestion and press with good food when Ye Sai leads to open mouth and breathlessness? This Ye Sai refers to Ge Qi blockage and Yin-Cold qi obstruction, belonging to the Qi Ye category, not the Ye Ge overflow food, rejected food, Three Yang binding heat syndrome.
Reading *Zhun Sheng*, I see Ge Qi vomiting listed above Ye Ge vomiting as a separate category, and Ye Sai listed below Ye Ge as another separate category, indicating ancients originally made distinctions. Thus, within one syndrome, one must analyze Cold, Heat, Dryness, and Dampness. For instance, *Nei Jing*’s "all vomiting and acid regurgitation" speaks of Heat vomiting, specifically Damp-Heat vomiting; "all flaccidity, wheezing, and vomiting" speaks of Heat vomiting, specifically Dry-Heat vomiting. Though both originate from Heat, Damp and Dry differ vastly. Formularies consider late vomiting (food lingering long before vomiting) as Cold, named Fan Wei (Turning Stomach); early vomiting (vomiting immediately after eating) as Heat, named Fan Wei (Reverse Stomach). Not knowing "Fan" and "Reversal" are synonymous, describing vomiting, one cannot determine Cold or Heat solely by timing. Wang Bing (Tai Pu) had this theory but spoke of general principles, hard to apply to variable symptoms. I often observe sudden vomiting is mostly Heat; even prolonged vomiting contains Heat cases. Spleen-Stomach Damp-Heat causes food to fail digestion, steaming and aggregating, phlegm-fluids wrapping and failing to resolve, leading to upward rebellion and vomiting, like summer damp-heat causing indigestion and vomiting. Therefore, among Ye Ge syndromes, none are Cold; among Vomiting syndromes, half are Cold, half Heat. I now treat Ye Ge food obstruction and Ge food vomiting directly as Heat-only, no Cold. For vomiting, regardless of timing, distinguish Cold and Heat by acidity and odor. Vomiting that is sour and rancid reflects Summer Heat transformation, governed by Fire; vomiting that is neither sour nor odorous reflects Winter Cold imagery, governed by Cold. Like brewing wine, hot processes yield sour and odorous results, while cold processes do not rot or smell.