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High fever causing thirst and excessive drinking is all termed Yang syndrome. For patients desiring water, I instead administered warm medicines such as Ginger (Shengjiang) and Aconite (Fuzi). The tight pulse (Jinmai) became deep and fine, and Yang Qi had not yet regenerated. Therefore, I prepared wine pills using Cinnamon Twig (Guizhi), Aconite (Fuzi), Dried Ginger (Ganjiang), and Aconite Root (Wutou), administering one hundred pills per dose. Over two days, more than ten doses were taken.

The patient experienced body heat, restlessness, and a desire to sweat. I continued administering the aforementioned pills and covered the patient with thick clothing. Only then did the Yang pulse emerge, followed by profuse sweating. The next day, bowel and bladder movements began to clear, and a basin full of dark red, liver-like blood stasis was discharged. Using Weifeng Tang (Stomach Wind Decoction) added with Cinnamon Twig (Guizhi) and Aconite (Fuzi), three doses stopped the bleeding. Such severe cold manifestations are rarely seen in the world.

Shaoyin syndrome presenting with dry mouth, dry tongue, and thirst: if the Cun, Guan, and Chi pulses are all deep and slow, Sini Tang (Four Reversal Decoction) is indicated; if the pulse is deep and rapid, Dachengqi Tang (Major Order the Yellow Decoction) is indicated. For Shaoyin syndrome with dry mouth, dry tongue, and thirst, accompanied by a cool exterior and a deep, fine, and deficient pulse, Xiexin Tang (Drain the Epigastrium Decoction) is the primary treatment. This distinguishes the use of herbs for tangible pathogens versus intangible deficiencies.

Renshen Tang (Ginseng Decoction): Treats Shanghan (Cold Damage) after seven or eight days, following sweating, resulting in mental irritability, restlessness, and thirst.
Ingredients: Renshen (Radix Ginseng), Huangqin (Scutellariae Radix), Chaihu (Bupleuri Radix), Gegen (Puerariae Lobatae Radix) (each 1 liang); Shanzhi (Gardeniae Fructus), Gancao (Licorice Radix et Rhizoma, processed) (each 0.5 liang). Grind into coarse powder. Take 5 qian per dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), and take warm.

Huorenshu states: For Yang Du (Yang Toxin) syndrome with extreme dryness, heat, and intense thirst, Heinu Wan (Black Slave Pill) is indicated (see Yang Du section). For Fengwen (Wind-Warmth) with severe thirst, Gualou Tang (Trichosanthes Root Decoction) is suitable (see Fengwen section). For Zhongshu (Summerheat) with latent heat that fails to resolve despite repeated treatments, and persistent thirst, Jiuzheng Huanglian Wan (Alcohol-Steamed Coptis Pill) is indicated (see Zhongshu section).

Pulse Diagnosis: Heat disease affecting the Kidney causes thirst, dry mouth, scorched tongue, yellow-red tongue coating, and incessant desire to drink day and night. Abdominal distension and fullness persist despite continuous drinking. If the eyes lack luster, it is a death sign and incurable.

(Regarding Dry Retching)
Cheng Wuji stated: "Ou" (Vomiting) involves both sound and matter being expelled. It is incorrect to colloquially call it "Yue" (Hiccup/Retching). Although "Yue" and "Ou" have different characters, their pronunciation and meaning are similar. "Tu" (Spitting/Vomiting) refers only to expelling matter without sound, hence there is "Gan Ou" (Dry Retching) but no "Gan Tu". Causes of vomiting include Heat and Cold. Vomiting is generally attributed to Deficiency-Cold. Vomiting can also be caused by retained fluids or pus in the stomach. These must be clearly distinguished.
For vomiting with fever, Xiaochaihu Tang (Minor Order the Gallbladder Decoction) is used (details see previous text).
If vomiting persists, epigastric urgency, and mild vexation occur, this is vomiting due to pathogenic heat, treated with Da Chaihu Tang (Major Order the Gallbladder Decoction).
For dry retching due to cold-fluid retention above the diaphragm, emetics are contraindicated; warming is required.
For dry retching with salivary discharge and headache, Wuzhuyu Tang (Evodia Fruit Decoction) is indicated, representing vomiting due to cold pathogens.
Vomiting followed by thirst indicates impending resolution; thirst followed by vomiting indicates fluid retention in the epigastrium, characteristic of Fluid-Dampness syndromes.
For vomiting due to retained fluids, or vomiting associated with abscesses/pus, specific treatment is unnecessary; self-healing occurs when the pus is exhausted. This is vomiting due to pus in the stomach.
Generally, in Shanghan, when exterior pathogens attempt to transmit inward, rebellious Stomach Qi causes vomiting. Thus, half-exterior/half-interior syndromes often feature vomiting.
After three days of Shanghan, if Yang meridians are exhausted and Yin meridians should receive pathogens, but the patient can eat and not vomit, it indicates the Yin meridians are unaffected. Thus, transmission to the interior inevitably causes vomiting.
In Ganjiang Fuzi Tang syndrome, "no vomiting, no thirst" indicates no heat in the interior. In Shizao Tang syndrome, "dry retching, shortness of breath, sweating, no aversion to cold" indicates the exterior is resolved but the interior is disharmonious. Thus, vomiting generally indicates interior heat.
For vomiting diseases, rebellious Qi requires dispersing methods; Phlegm-Fluid requires purging methods. Qianjin Fang states that ginger is the holy medicine for vomiting to disperse rebellious Qi. Jingui Yaolue states that Banxia (Pinelliae Rhizoma) is used to remove water; once water is removed, vomiting stops, aiming to purge Phlegm-Fluid.
Even with Yangming symptoms, if vomiting is frequent, purgatives are contraindicated because Qi is rebellious and has not yet consolidated into excess.
If vomiting occurs with a weak pulse, free urination, slight fever, and cold extremities, it is difficult to treat due to severe Deficiency-Cold.
Physicians must examine the deficiency/excess of pathogens and the smooth/rebellious nature of the disease to prescribe correctly.

Taiyang syndrome (after sweating): Whether fever has appeared or not, there is always aversion to cold, body pain, vomiting/rebellious Qi, and tight pulses at both Yin and Yang positions. This is named Shanghan, treated with Mahuang Tang (Ephedra Decoction).
Taiyang syndrome lasting over ten days, incorrectly purged two or three times: if four or five days pass and Chaihu symptoms remain, administer Xiaochaihu Tang first.
If vomiting persists, epigastric urgency, and mild vexation occur, the disease is unresolved; administer Da Chaihu Tang. Purging will lead to recovery. (Note: Although Zhang Zhongjing stated that purgatives are contraindicated for frequent vomiters even with Yangming symptoms, if latent Yangming heat steams the clear pathways causing vomiting and vexation, bitter-cold direct reduction is necessary, hence Da Chaihu Tang is used.)
Shanghan with fever, sweating without resolution, epigastric stiffness/fullness, vomiting, and diarrhea: Da Chaihu Tang.
Taiyang syndrome lasting over ten days: feeling of nausea wanting to vomit, chest pain, loose stools, mild abdominal fullness, and mild vexation. If the patient previously underwent violent emesis or purgation, Tiaowei Chengqi Tang (Regulate the Stomach Order the Yellow Decoction) is given; otherwise, it is contraindicated. If only nausea, chest pain, and loose stools occur, it is not a Chaihu syndrome but results from prior violent emesis/purgation. (Cheng Wuji argues: Nausea, vexation, and chest pain indicate pathogenic heat in the chest; loose stools and abdominal fullness indicate heat moved to the stomach. If no emesis/purgation occurred, it is merely transmitted pathogen, not suitable for purgation; Chaihu Tang is appropriate. If emesis/purgation damaged Stomach Qi, allowing pathogen to enter as excess, Tiaowei Chengqi Tang is needed to purge Stomach heat. The term "Wenwen" likely means "Yunyun" [discomfort]. There may be missing text regarding "vomiting," which is typical of Chaihu syndromes.)
Vomiting with fever: Xiaochaihu Tang.
Shanghan after six or seven days: slight fever, slight aversion to cold, limb joint pain, slight vomiting, subepigastric constraint, with exterior signs unresolved: Chaihu Jia Guizhi Tang (Bupleurum plus Cinnamon Twig Decoction).
Taiyang and Yangming combined syndrome: no diarrhea but vomiting: Gegen Banxia Tang (Pueraria plus Pinellia Decoction). (Huorenshu notes: headache, body heat, muscle pain, eye pain, nasal dryness, floating and long pulse.)

Gegen Banxia Tang Formula:
Gegen (Puerariae Lobatae Radix), Banxia (Pinelliae Rhizoma) (each 2 qian); Mahuang (Ephedrae Herba), Shengjiang (Zingiberis Rhizoma Recens) (each 1.5 qian); Gancao (Licorice Radix et Rhizoma), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus) (each 1 qian); Dazao (Jujubae Fructus) (12 pieces, split). Cut ingredients. Decoct in 1 dou of water. First boil Mahuang and Gegen, reduce by 2 sheng, skim white foam, add remaining herbs, boil to 3 sheng. Take 1 sheng warm, cover for slight sweating.

Yangming syndrome: Shanghan with fever, no sweat, vomiting, inability to eat, yet sweating profusely: transmission to Yangming. Da Chaihu Tang.
Desire to vomit after eating: belongs to Yangming. Wuzhuyu Tang. If symptoms worsen after taking the decoction, it belongs to the Upper Jiao. Gegen Banxia Tang.
Frequent vomiting in Shanghan: even with Yangming symptoms, do not purge. Use Huangqin Shengjiang Banxia Tang or Xiaochaihu Tang (Huorenshu uses Jiegeng Tang).
Yangming syndrome with hardness/fullness in hypochondrium, constipation, vomiting, and white tongue coating: Xiaochaihu Tang.
Yangming syndrome (Warm disease) with no sweat but free urination: after two or three days, vomiting, coughing, and cold extremities indicate severe headache (or use Zhenwu Tang minus Fuling).

Shaoyang syndrome: Vomiting with alternating chills and fever, hypochondriac fullness: Xiaochaihu Tang. If accompanied by diarrhea, it is Taiyang-Shaoyang combined syndrome: Huangqin Banxia Shengjiang Tang (Bupleurum plus Pinellia and Ginger Decoction). (See Alternating Chills/Fever and Diarrhea sections). Taiyang-Yangming combined diarrhea is exterior, treated with Gegen Tang (diaphoresis). Yangming-Shaoyang combined diarrhea is interior, treated with Chengqi Tang (purging). Taiyang-Shaoyang combined diarrhea is half-exterior/half-interior, not suitable for diaphoresis or purging; Huangqin Tang (Scutellaria Decoction) harmonizes. Vomiting is rebellious Stomach Qi; Banxia and Shengjiang disperse rebellion.
Shanghan after five or six days: vomiting and fever indicate Chaihu syndrome. If incorrectly purged, but Chaihu symptoms persist, re-administer Chaihu Tang.
Weak Blood and Qi, open pores, pathogen enters, struggles with Righteous Qi in hypochondrium, causing alternating chills, silent anorexia. Organs are connected, pain radiates downward, high pathogen causes low pain, leading to vomiting. Xiaochaihu Tang. (If pathogen is external, Yang does not govern interior, Qi sinks: diarrhea without vomiting. If Qi rebels upward: vomiting without diarrhea. Xiaochaihu Tang resolves half-exterior/half-interior pathogens.)
Thirst with water-induced vomiting: Chaihu Tang is contraindicated. (Huorenshu suggests treating inter-diaphragmatic water with Chifuling Tang).

Taiyin syndrome: Abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, periodic abdominal pain. Incorrect purging leads to epigastric knotting/hardness.

Shaoyin syndrome: Diarrhea for six or seven days, cough, vomiting, thirst, irritability, insomnia: Zhuling Tang (Polyporus Decoction).
Shaoyin syndrome with diarrhea, faint/choppy pulse, vomiting, sweating, frequent defecation with little output: Warm the upper part with moxibustion.
Shaoyin syndrome progressing from two to four/five days: abdominal pain, difficult urination, heavy/painful limbs, spontaneous diarrhea: Water-Qi retention. If cough, free urination, diarrhea, or vomiting occurs: Zhenwu Tang minus Fuzi, add Shengjiang.

Jueyin syndrome: Mild heat, slight cold extremities (fingers cold), silent anorexia, irritability. Free pale urine indicates heat removal; desire to eat indicates recovery. If cold extremities with vomiting and hypochondriac vexation: hematochezia follows. Huangqin Shaoyao Tang or Didang Tang.
Vomiting with weak pulse, free urination, slight fever, cold extremities: difficult to treat. Sini Tang.
Shanghan originally involving cold-dysfunction, incorrectly purged/vomited: Cold rejection causes further vomiting/diagnosis. If food is vomited immediately upon entry: Ganjiang Huanglian Huangqin Renshen Tang (Dried Ginger, Coptis, Scutellaria, Ginseng Decoction). (Pathogen transmits to exterior, but original condition was cold-dysfunction. Medical error damages Zheng Qi, causing internal Cold Rejection. Jinggui states: "Rejection causes vomiting." Immediate vomiting is Cold Rejection. Further purging/vomiting causes double deficiency and death. This formula unblocks Cold Rejection. Zhao explains: Original cold-dysfunction worsened by medical error. Jinggui states rejection causes vomiting; further purging is contraindicated. Ganjiang warms interior; Huanglian/Huangqin act as counter-agents; Renshen tonifies Zheng Qi. Huorenshu attributes this to slow Chi pulse indicating Stomach Deficiency-Cold. However, rapid pulse can also indicate Deficiency-Cold vomiting due to weakened Yang Qi from sweating, creating false heat that cannot digest food. Pulse differs, but syndrome is same.)
Hui Jue (Roundworm Revulsion): Patient expectorates roundworms. Patient is quiet but occasionally irritable due to Interior Cold causing worms to ascend to Diaphragm. Irritation subsides briefly. Eating triggers vomiting and irritation as worms smell food and emerge; patient expects worms. Wumei Wan (Mume Pill).

Thirst: Thirst followed by vomiting indicates fluid retention in epigastrium (Fluid-Dampness). Chifuling Tang. Vomiting followed by thirst indicates impending resolution. Jingui states: give water promptly if patient desires it after vomiting.

Diarrhea: Vomiting with diarrhea, with cold/heat signs, is Yang: Huangqin Tang or Da Chaihu Tang. Without heat, it is Yin: Zhuling Tang or Zhenwu Tang.

Vexation: Vomiting with mental irritability after sweating/emesis/purgation: Zhizi Shengjiang Chi Tang (Gardenia, Ginger, Fermented Soybean Decoction). If no prior treatment, with cough and thirst: Zhuling Tang.

Abscess/Pus in Vomiting: No treatment needed; self-resolves when pus is exhausted.
Vomiting after Guizhi Tang: Indicates "Jiu Ke" (Wine Drinker) syndrome.

Dai Yuanli stated: Even with obvious Yangming purgative indications, frequent vomiting suggests Upper Jiao involvement; do not purge hastily. Use Xiaochaihu Tang. If Taiyang syndrome exists alone with vomiting/diarrhea, suspect pre-existing Phlegm-Fluid in Diaphragm. Use Erchen Tang (Two-Chen Decoction) to stabilize. Once stabilized, slowly administer Taiyang resolving herbs. Thirst after vomiting: Zhuling Tang. Vomiting after thirst: Treat inter-diaphragmatic water with Xiao Banxia Fuling Tang (Minor Pinellia and Polyporus Decoction). Thirst, drinking, immediate vomiting, returning thirst: named "Shui Ni" (Water Revulsion), due to Heart Meridian heat affecting Small Intestine. Wuling San (Five-Ling Powder). Shaoyin non-thirsty vomiting or dry retching: Lizhong Tang minus Baizhu, add Shengjiang. Vomiting saliva: Wuzhuyu Tang.
Taiyin/Jueyin vomiting: Taiyin uses Lizhong Tang; Jueyin uses Sini Tang, both with Shengjiang. These Yin syndromes require hot agents. Yang entering Yin causes diarrhea, not vomiting. Vomiting is upper/exterior; Yang entering deeply causes diarrhea.
Post-recovery vomiting in Yang syndromes, without other causes, indicates residual heat in Stomach. Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) or JuPi ZhuRu Tang (Tangerine Peel and Bamboo Shaving Decoction).
Taiyang vomiting implies combined syndrome, indicating disease moving inward. Not pure Taiyang. Case record: Taiyang syndrome with persistent vomiting failed with warm agents. After Taiyang resolved, cold agents were needed. Taiyang vomiting implies Yangming or Shaoyang combination, indicating Heat; warm agents were incorrect. Another case: Family with Taiyang vomiting responded well to Yangwei Tang (Stomach-Nourishing Decoction), suggesting epidemic influence, classifying it as mixed Shanghan/Zabing, not standard Shanghan.

Wu Kun stated: Initial vomiting, retching clear water, or vomiting food indicates Cold damaging Stomach. With aversion to cold, tension, no fever, vomiting/food expulsion: Jiawei Huoxiang Zhengqi San or Renshen Yangwei Tang. With fever: Shiwei Xiong Su Fa San or Gegen Tang plus Shengjiang/Banxia. With spontaneous sweating: Do not diaphorese; use Zhengqi San minus Zisu to harmonize.
Fever, bitter taste, wiry-rapid pulse, vomiting; mental irritability, vomiting; hypochondriac fullness, vomiting; alternating chills/fever, vomiting; afternoon fever, vomiting: All Shaoyang. Xiaochaihu Tang with doubled Banxia/Shengjiang. Reduce Huangqin as heat lessens; add Gegen/Gualougen for dry mouth; add Jiangzhi Chaidanxin for irritability; add Zhishi for epigastric fullness.
Tidal fever, interior excess, constipation, persistent vomiting, epigastric vexation: Da Chaihu Tang.
Stomach Heat: wiry-rapid pulse, bitter taste, irritability/thirst. Stomach Cold: wiry-slow pulse, cold extremities, anorexia. Water-Qi: thirst before vomiting, abdominal fullness, palpitations. Pus/Blood: foul throat odor, rushing sensation, no irritability. Self-resolves when pus vomited. Distinguish these four.
Taiyin abdominal fullness, vomiting/anorexia, or abdominal pain/vomiting, deep pulse: Lizhong Tang plus Banxia, Chenpi, Huoxiang, Houpo, Shengjiang. Add Fuzi for severe cold.
Shaoyin: food vomited immediately, epigastric discomfort, inability to vomit, cold hands/feet, deep-fine pulse: Sini Tang plus Banxia, Shengjiang, Chenpi.
Jueyin: vomiting saliva, cold extremities, deep-micro pulse: Wuzhuyu Sini Tang plus Banxia, Shengjiang, Chenpi.

Dry Retching:
Taiyang Wind Strike: Floating-Yang/Deficient-Yin pulse. Yang-floating causes spontaneous heat; Yin-deficient causes spontaneous sweating. Aversion to cold/wind, slight fever, nasal congestion, dry retching: Guizhi Tang (Cinnamon Twig Decoction).
Shanghan exterior unresolved, fluid retention in heart/stomach: dry retching, fever, cough, or thirst, diarrhea, dysphagia, urinary difficulty, suprapubic fullness, or wheezing: Xiao Qinglong Tang (Minor Green Dragon Decoction).

Zhang Jingyue asked: Why do Xiao Qinglong Tang and Xiaochaihu Tang differ in herbs despite both treating vomiting with fever and resembling exterior/interior patterns?
Answer: In Shanghan with unresolved exterior and mild interior heat, thirst with limited water intake occurs because interior heat is insufficient to transform fluids, leading to fluid retention and various symptoms. Cold-fluid pathology requires warm-hot agents to resolve via diaphoresis and fluid dispersion. Initially, there is no interior syndrome; it arises from cold-fluid.
Xiaochaihu Tang treats Shanghan fever where heat transmits to half-exterior/half-interior, attacking internally. Although both involve exterior/interior issues, the cold-heat nature differs, necessitating different herbs (Ginger/Cinnamon vs. Bupleurum/Polyporus).

Shanghan/Wind Strike, incorrectly purged: Diarrhea ten+ times daily, undigested food, borborygmus, epigastric hardness/fullness, dry retching, irritability, insomnia. Physician sees epigastric fullness, assumes incomplete disease, purges again, worsening fullness. This is not heat accumulation but Stomach Deficiency with rebellious Qi. Gancao Xiexin Tang (Licorice Drain the Epigastrium Decoction).
Shanghan Day 1, Taiyang receives pathogen: Quiet pulse means no transmission. Desire to vomit, irritability, rapid pulse indicates transmission. Ma Huang Tang initially. After exterior resolves, consider Xiaochaihu Tang or Baihu Tang.
Shanghan with heat in Chest, pathogen in Stomach, abdominal pain, desire to vomit: Huanglian Tang (Coptis Decoction).
Taiyang Wind Strike with diarrhea/vomiting: If exterior resolved, attack interior. Sweating, periodic headache, epigastric hardness/fullness radiating to hypochondrium, dry retching, shortness of breath, sweating, no aversion to cold: Exterior resolved, interior disharmony. Shizao Tang (Ten Jujube Decoction).
Taiyang unresolved transmitting to Shaoyang: Hypochondriac hardness, dry retching, anorexia, alternating chills/fever, no prior emesis/purgation, deep-tight pulse: Xiaochaihu Tang. (Zhang notes: Both formulas treat dry retching/hypochondriac pain. Xiaochaihu harmonizes half-exterior/half-interior with alternating chills; Shizao Tang treats interior heat with hidden fluid retention after exterior resolution. Headache in fluid retention should not deter use of Shizao Tang if no exterior signs exist.)
Food-induced vomiting: Yangming. Wuzhuyu Tang. Worsening after ingestion: Upper Jiao. Xiaochaihu Tang, Zhizi Chi Tang, or Huangqin Tang. (Stomach rejects food: warm with Wuzhuyu Tang. Upper Jiao rejects: use others.)
Shaoyin: Food vomited immediately, urge to vomit but cannot, cold hands/feet, wiry-slow pulse: Excess in Chest, do not purge, induce emesis. Cold-fluid above diaphragm with dry retching: Do not emetic, warm urgently with Sini Tang.
Shaoyin: Profuse diarrhea, cold extremities, absent pulse, dry retching, irritability: Baitong Jia Zhuchidan Tang (White Connect Plus Pig Gallbladder Bile Decoction).
Shaoyin: Clear grain diarrhea, interior cold/exterior heat, cold extremities, faint/almost absent pulse, no aversion to cold, flushed face, abdominal pain, dry retching, sore throat, or cessation of diarrhea with absent pulse: Tongmai Sini Tang (Connect to Life Sini Decoction).
Shaoyin: Urge to vomit but cannot, irritability, drowsiness. After five/six days, spontaneous diarrhea with thirst: Shaoyin syndrome.
Taiyin: Faint-fine-deep pulse, drowsiness, sweating, no irritability, desire to vomit. After five/six days, spontaneous diarrhea, irritability, inability to sleep: Death. Post-recovery emaciation, shortness of breath, desire to vomit: Zhuye Shigao Tang.

Appendix Formulas:
Chifuling Tang: Treats Shanghan vomiting/retching, epigastric fullness, inter-diaphragmatic fluid retention, vertigo, palpitations.
Ingredients: Chifuling (Polypori Parvae), Renshen (Radix Ginseng) (each 1 liang); Banxia (Pinelliae Rhizoma, ginger-processed), Juhong (Citri Reticulatae Pericarpium Rubrum), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 4 qian, 5 slices of Shengjiang, decoct in water.

Gegen Tang (Formula Name Discrepancy in Source, likely Ge Gen Ren Shen Tang variant): Treats persistent dry retching in Shanghan.
Ingredients: Gegen (Puerariae Lobatae Radix), Renshen (Radix Ginseng), Maidong (Ophiopogonis Radix, heart removed), Zhigancao (Processed Licorice Radix et Rhizoma) (each 1 liang); Banxia (Pinelliae Rhizoma, ginger-processed), Huangqi (Astragali Radix) (each 7.5 qian); Baifuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma) (each 0.5 liang). Cut. Take 3 qian, 3 slices Shengjiang, 2 dates, decoct together.