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Liu XX, aged 32, from Tianjin, contracted a warm-heat disease (Wenbing) in late summer, accompanied by vomiting and an inability to retain food or drink.

Etiology: He was lodging at a school. One day, as the school was empty, his bedding was stolen. After failing to catch the thief, he exerted himself running, sweating profusely throughout his body. Subsequently, while resting and cooling off, he fell ill with this condition.

Symptoms: He experienced mental restlessness and heat sensation, with frequent sweating all over his body. Starting from the second day, he suffered from vomiting and could not retain food. It had been four days since onset; multiple doses of medicine taken previously were all vomited up, and even water drunk when thirsty was frequently vomited. The tongue coating was white and thick/greasy. Bowel movements had not occurred for four days. The pulse was wiry and hard on the left side, and wiry, long, and forceful on the right side, with five breaths per pulse beat (indicating a rapid pulse).

Diagnosis: The wiry and hard pulse on the left indicates blazing fire of the Liver and Gallbladder. The wiry and long pulse on the right indicates Chong Qi (Penetrating Vessel Qi) carrying Stomach Qi upward. The wiry, long, and forceful nature of the pulse indicates that the external pathogenic heat has entered the Yangming Fu organs. This case arose because the theft incident angered the Liver Qi, causing Liver Fire to rush upward, which further agitated the Chong Qi to carry Stomach Qi upward. Meanwhile, the external pathogenic heat blazed in the Stomach, exacerbating the condition. Consequently, there was mental restlessness, sweating, inability to eat, and vomiting of both medicine and water. Treatment should involve administering a formula to clear heat and subdue rebellion (descending adverse Qi).

Prescription: Raw Gypsum Powder (Shi Gao), 2 liang; Raw Hematite Powder (Zhe Shi), 6 qian; Mirror-polished Cinnabar Powder (Zhu Sha), 5 qian. Mix evenly and divide into five packets. Administer one packet first, then another two hours later. Stop administration once the illness resolves; it is not necessary to consume the entire course. The prescription uses powder rather than decoction because powders and pills are superior to decoctions for stopping vomiting.

Outcome: After taking two packets, vomiting ceased, though mental restlessness and heat persisted. After taking four packets, the restlessness and heat completely resolved, and bowel movements became regular.

Explanation: Gypsum is a mineral substance, inherently heavy and cold. In Bai Hu Tang (White Tiger Decoction), Gypsum is the chief herb, moderated by Licorice Root (Gan Cao) and harmonized with Rice (Jing Mi), intending for it to linger in the Stomach after ingestion rather than descending rapidly. Therefore, when using Gypsum, it is contraindicated to combine it with other heavy-sinking herbs, lest its cold nature damage the Lower Jiao; nor should it be combined with dispersing and breaking herbs (Kai Po Zhi Yao), as their action is inherently downward. However, in this case, due to the concurrent upward rushing of Liver Qi and Gallbladder Fire, further agitating the Chong Qi to carry Stomach Qi upward, and aided by external pathogenic heat, the Qi transformation of the Zang-Fu organs became characterized by ascending without descending. Thus, food and medicine entering the Stomach could not be retained. Relying solely on the cold and heavy properties of Gypsum would be insufficient. Hence, Hematite (Zhe Shi), possessing the strongest descending pressure, is specifically used to assist Gypsum. This serves to rotate the Qi transformation within the Zang-Fu organs, restoring normal function. Had the pulse not presented in this specific manner, Gypsum would originally have been contraindicated for simultaneous use with Hematite.