It’s just trickery of the receptors; capsaicin does not do actual damage to humans – not at the levels you’d experience simply by eating spicy food, anyway (EVERYTHING is lethal in sufficient doses).
That said, that trickery of the receptors can cause real physical harm when our body reacts to it. The reason some people get heartburn or vomit is because it irritates nerves inside the body in a similar way as it irritates your taste buds, and some people’s bodies are more sensitive to that. It doesn’t cause damage, but the body does not mess around with that sort of stuff and will do body things to get rid of the thing causing it, and those responses can be “eject everything to get it out,” like vomiting. Or it could promote the creation of more stomach acid than normal which then is more likely to travel up your esophagus a little and cause acid reflux or heartburn. And while capsaicin likely won’t cause the creation of stomach ulcers, the response will certainly aggravate any existing ones. And in the end, whether capsaicin directly causes these problems or just tricks your body into causing them itself is pretty irrelevant, insofar as it sucks for the poor person experiencing them either way.
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