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A patient presented with a yellow tongue coating but no desire to drink. Chronic cough led to nausea and vomiting. Previously, Jinkui Maidong Tang (Cistanche and Ophiopogon Decoction from *Jin Gui Yao Lue*, used to nourish stomach yin) was used to nourish the stomach, yielding slight effect. The patient reported coldness in the back and expectoration of clear phlegm. This indicates that summerheat-damp pathogenic factors have not yet been cleared, combined with a deficient constitution. Treatment should support healthy qi, awaken the spleen, and dispel summerheat.
*Ren Shen* (Ginseng Radix), *Fu Ling* (Poria), Guang Pi (Tangerine Peel), *Ban Xia* (Pinellia Rhizoma), Ginger Juice.

Mr. Guo (58 years old) felt hungry and could eat. Suddenly, there was a sensation of qi rushing upward, with saliva and foam surging up, and rejection in the epigastrium, making it impossible to retain food. *Nei Jing* states that liver disease causes vomiting of saliva and foam. Zhu Danxi said that ascending qi originates from the liver; when wood fire ascends and insults metal, metal is constrained. Coughing and wheezing worsened daily. Treatment focused on nourishing metal to control wood, preventing damage to the earth palace (spleen/stomach); nourishing water to control fire, allowing the lung organ to regain its power of clearing and transforming. These are all injuries caused by chronic fatigue in the elderly. How could attacking the pathogen be effective? (Liver Fire Insulting Metal Syndrome)
*Suzi* (Perilla Fructus), *Mai Dong* (Ophiopogon Tuber), *Pipa Ye* (Loquat Leaf), *Xing Ren* (Apricot Seed), *Bei Sha Shen* (Glehnia Root), *Sang Ye* (Mulberry Leaf), *Dan Pi* (Moutan Cortex), *Xiang Xiang* (Aquilaria Wood), Bamboo Sap.

Mr. Cao (45 years old), due to labor, fatigue, and anger, experienced vomiting and fever. After sweating, the fever resolved, but he had rapid breathing, insomnia, and lack of appetite. This still indicates that pathogenic heat in the qi level has not been cleared. Treatment should first focus on the upper jiao, as the lung governs the qi transformation of the whole body.
*Xing Ren* (Apricot Seed), *Yu Jin* (Curcuma Aromatica Rhizome), *Zhi Zi* (Gardenia Fruit), *Xiang Chi* (Fermented Soybean), Ju Hong (Tangerine Peel), *Gua Lou Pi* (Trichosanthes Peel).

Regarding vomiting, *Nei Jing* and *Jin Gui Yao Lue* discussed it in detail. However, later authors only formulated theories based on stomach fire, stomach cold, phlegm-food retention, and qi stagnation. They failed to consider that the stomach's function is to receive food, relying primarily on descending and unblocking. The reason for failure to descend and instead rising reversely to cause vomiting is all due to rebellious qi from the liver obstructing the stomach's descent. Thus, *Ling Shu: Jing Mai* chapter states: "The diseases generated by the Foot-Jueyin Liver meridian include chest fullness and vomiting/reversal." Moreover, according to the generation and restriction of the Five Elements, when wood moves, it inevitably attacks earth. Treating stomach disease via the liver is merely a treatment separated by one organ (indirect treatment). This principle is shallow and easy to understand, yet people fail to perceive it. Those seeking novelty instead boast of treatments separated by two or three organs. Would they not be laughed at by experts? Consider An Wei Wan (Stomach-Calming Pill) and Li Zhong An Hui Wan (Regulate Middle and Calm Roundworms Pill), which use Zanthoxylum and Mume fruit; and Xuan Fu Dai Zhe Tang (Inula and Hematite Decoction) for stomach deficiency with rebellious guest qi. Are these stomach medicines or liver medicines? One can realize this here. Now, observing Mr.'s treatment method, the guideline is to drain the liver and calm the stomach. Medicines are primarily bitter and acrid, assisted by sour. If liver qi invades the stomach and stomach yang is not deficient but has fire, draining the liver uses bitter-cold herbs like Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizoma), and Chuan Lian Zi (Toosendan Fruit). If stomach yang is deficient, slightly reduce bitter-cold herbs and use bitter, acrid, sour, and hot herbs. This is the general principle. If both liver yin and stomach fluid are deficient, and liver wind disturbs the stomach causing vomiting, then use soft agents to nourish fluids and calm the stomach, extinguish wind, and suppress reversal. If stomach yang is deficient and turbid yin rises reversely, use acrid-hot herbs to unblock, slightly assisting with bitter-descending herbs. If only middle yang is deficient and liver wood is not very hyperactive, specifically regulate stomach yang, or slightly assist with Zanthoxylum and Mume fruit. If injury from vomiting leads to cold stagnation transforming into heat, scorching stomach fluids, then modify Wen Dan Tang (Warm the Gallbladder Decoction). If prolonged vomiting extends to deficiency of both liver and kidney, with chong qi rising reversely, use warm-unblocking and soft-moistening tonification, treating from the lower jiao. If pathogenic heat binds internally, use the Xie Xin method (Drain the Epigastrium method). If liver fire rebels and injures the lung, use methods to nourish metal to control wood and nourish water to control fire. In short, the method of treating the stomach lies entirely in warming and unblocking. For deficiency, Ren Shen (Ginseng Radix) must be used. The medicinal properties are generally mild and peaceful. As for treating the liver, the medicinal ingredients are mixed; sometimes cold and hot are used together, or bitter, acrid, sour, and salty are administered simultaneously. This is because the Jueyin Liver meridian houses ministerial fire internally, so the treatment method must be so. Just observing Zhang Zhongjing's Wu Mei Wan (Mume Pill) rule, one can generally understand. Over sixty case records were compiled, more than half caused by liver pathogenic factors. Without Mr.'s profound insight, how could this principle be fully expounded? (Commented by Hua Xiuyun)

Xu's Commentary: Among the recorded prescriptions, four or five parts belong to Phlegm-Fluid Retention (Chu Yin), and two or three parts belong to Fan Wei (Regurgitation/Vomiting after eating). Fan Wei has its own specific treatment methods, and Chu Yin also has established formulas available. Yet, no distinction is made. Only liver-and-stomach-calming medicines are mixed and matched to form prescriptions. Seven or eight out of ten use Ren Shen (Ginseng Radix) along with Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Preparata Radix). All these contradict the treatment principles for Fan Wei and Chu Yin. Therefore, regarding the symptom of vomiting, this old master has never even dreamed of understanding it. Patients suffering from various diseases are extremely unfortunate.
There was a man surnamed Jin in Dongting who suffered from vomiting for several years. His ancestors were very close friends with this old master. The old master treated him diligently for over a year using such prescriptions, but the patient nearly died. He then sought treatment from me. I said, "This is Phlegm-Fluid Retention. No one in the world understands it." I prescribed a formula, and the illness was cured immediately. That person subsequently became my student. This serves as evidence.