Differential Diagnosis of Common Symptoms — Vomiting

Vomiting refers to the expulsion of gastric contents through the mouth. It is often caused by external contraction, internal damage, or improper diet. Clinically, it is essential to differentiate between cold, heat, deficiency, and excess types.

• Sudden, acute vomiting accompanied by aversion to cold with fever, headache, or chest oppression and discomfort, epigastric distress, epigastric pain, diarrhea, white tongue coating, and a floating, rapid pulse: this is vomiting due to external pathogen invading the stomach. It is caused by external pathogens attacking the stomach, leading to the stomach failing to harmonize and descend.
• Vomiting of sour, putrid matter, accompanied by epigastric and abdominal distention and fullness, pain that refuses pressure, belching, aversion to food, relief after vomiting, loose or constipated stools, thick slimy tongue coating, and a slippery, forceful pulse: this is food retention vomiting. It is caused by gluttonous overeating and drinking, leading to obstruction of the qi dynamic in the middle burner and upward reversal of stomach qi.
• Vomiting of sour, putrid matter, accompanied by epigastric and abdominal distention and fullness, distention and pain in the hypochondriac region, oppressive discomfort, frequent belching, red tongue with thin slimy coating, and a wiry pulse: this is vomiting due to liver qi invading the stomach. It is caused by liver qi depression assailing the stomach, leading to upward reversal of stomach qi.
• Vomiting of phlegm-drool or clear fluid, accompanied by epigastric stuffiness and fullness, poor appetite, dizziness and palpitations, white or moist tongue coating, and a deep pulse: this is vomiting due to fluid retention in the middle burner. Impaired qi transformation leads to fluid collecting in the middle burner; when ascent and descent lose their normal function, vomiting of phlegm-drool or clear fluid occurs.
• Epigastric discomfort with distention after eating, in severe cases nausea and vomiting, mental fatigue and lack of strength, pale complexion, thirst with a preference for warm drinks, slightly cold extremities, loose stools, pale tongue with white slimy coating, and a weak pulse: this is vomiting due to spleen-stomach deficiency. Spleen-stomach deficiency with impaired transportation and transformation leads to upward reversal of stomach qi, resulting in nausea and vomiting.
• Recurrent episodes of vomiting, or dry retching, with dry mouth and a desire to drink, hunger without a desire to eat, red tongue with scant coating, and a thin, rapid pulse: this is vomiting due to stomach yin deficiency. Stomach yin deficiency leads to the stomach losing its moistening and nourishment, and the ascent-descent qi dynamic of the middle burner becomes impaired, resulting in vomiting.
• Dry retching, vomiting of frothy drool, vertex headache, slightly cold extremities, poor appetite with a preference for warmth, white slimy tongue coating, and a deep pulse: this is vomiting due to liver-stomach deficiency cold. It is caused by liver-stomach deficiency cold, leading to upward reversal of turbid yin.
• Nausea and vomiting, epigastric stuffiness and fullness, borborygmus and diarrhea, red tongue with yellow coating, and a wiry pulse: this is vomiting due to epigastric stuffiness pattern. It is caused by an intermingling of cold and heat, leading to impairment of the ascent-descent qi dynamic in the middle burner.