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For heatstroke accompanied by vomiting and diarrhea, cold extremities, and expulsion of roundworms (Ascaris), use Wumei Angwei Wan (Plum Pill to Pacify the Stomach) to harmonize the Liver and Stomach.

Note: Zhang Zhongjing stated that Jueyue (Reversal Cold due to Roundworms) presents without Yang syndromes(1). Furthermore, in the *Jueyin Chapter* it is written: "Qi rushes upward to strike the heart, hunger with no desire to eat, and if one eats, roundworms are expelled." This is also caused by severe damage to the Middle Jiao Yang Qi, leading to the reflux of Jueyin turbid Yin. Therefore, roundworms are present in all normal people; only when Stomach Qi is harmonious do they not surge upward. Moreover, if pathogenic factors do not invade the Jueyin channel, they will not be expelled upward. In this case, due to excessive vomiting and diarrhea and cold extremities, the Yang Qi of the Middle Jiao is severely damaged. The Jueyin turbidity takes advantage of the deficiency to surge upward, causing the roundworms to be expelled. Diseases of the Jueyin channel invariably present with complex and mixed symptoms, making pure and simple medication difficult. Therefore, the bitter-cold properties of Huanglian (Coptidis Rhizoma) and Huangqin (Scutellariae Radix) are used to descend rebellious Qi; the sour-cold properties of Wumei (Mume Fructus) and Baishao (Paeoniae Radix Alba) are used to enter the Liver; combined with the pungent-warm properties of Huajiao (Zanthoxyli Pericarpium) and Shengjiang (Zingiberis Rhizoma Recens) to expel Yin turbidity; and the sweet-warm properties of Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) are used to warm and tonify True Yang.

After heatstroke-induced vomiting and diarrhea, with profuse sweating and cold limbs, a moist black tongue coating, and no thirst or desire to drink, this indicates Water Extremity resembling Fire (Yin Excess repelling Yang). One should use Huiyang Jiujitang (Decoction to Restore Yang and Save from Crisis) to drive out Yin and restore Yang.

This section emphasizes the differentiation of the tongue above all else; one must not hastily conclude extreme Heat solely based on a black tongue. Generally, a black and scorched tongue indicates extreme Heat resembling Water (Heat Extremity resembling Water). However, following vomiting and diarrhea, with profuse sweating and cold limbs, the Yin syndrome is evident. Furthermore, although the tongue is black, it is moist, and there is no thirst or desire to drink, confirming Water Extremity resembling Fire. This represents severe Yin Excess where a thread of Yang Qi is faintly on the verge of collapse. Without relying on Liujunzi Tang (Six Gentlemen Decoction) to tonify the Middle Jiao, along with Ganjiang (Zingiberis Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Danggui (Angelicae Sinensis Radix), and Rougui (Cinnamomi Cortex) to assist Yang and drive out Yin, the condition would hardly avoid being critical.

After heatstroke-induced vomiting and diarrhea, if the body feels hot instead, the tongue is scorched red without coating, and there is thirst but no desire to eat, this indicates that the pathogen has departed but Yin fluids are injured. One should use Maidong Tang (Ophiopogon Decoction) from the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) added with Baishao (Paeoniae Radix Alba), Wumei (Mume Fructus), Guya (Setariae Semen Germinatum), Heye (Nelumbinis Folium), etc., to simultaneously nourish Yin.

Vomiting and diarrhea injure Yin fluids, hence the body feels hot instead. A dry, scorched red tongue without coating, thirst, and no desire to eat are all signs of severe injury to Stomach Jin (fluids), preventing them from transforming and ascending. Since the Stomach is Yang Earth, it requires softening and moistening for relief. Therefore, Maidong Tang (Ophiopogon Decoction) from the *Jin Gui Yao Lue* is used, combined with the sourness of Wumei (Mume Fructus) and Baishao (Paeoniae Radix Alba), and the sweetness of Guya (Setariae Semen Germinatum) and Jingmi (Oryza Sativa Germen), to generate Yin fluids and harmonize Yin and Yang.