The Retch is a unique Rustic Sash. Requires Level 44.
The only cap relevant to The Retch is Maximum recovery per Life Leech. This establishes an upper bound on how much life recovery a single instance of leech can have - regardless of whether it is instant or not. The Retch causes damage equal to a percentage of the life leeched by each leech instance, so this cap also limits the amount of damage The Retch can do for each life leech instance.
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It takes 200% of the actual life gained from leech and deals it as chaos damage to enemy that was the target of the leeching. Therefore, by default no damage is dealt if the player is at full health while leeching. This damage is not affected by damage modifiers as it is considered as reflected damage.
With Ghost Reaver modifier the damage is dealt based on energy shield gained from leech.
Using instantaneous life leech modifiers (such as Bloodseeker) causes chaos damage to be dealt instantly as well rather than over time. The damage dealt is based on the life gained before the character is at their maximum life total.
If Brutal Fervour is allocated, then the damage will continue as long as the leech lasts, even once at full life. If combined with instantaneous life leech, then the total amount of potential leech is dealt instantly, including that above the player's maximum life.