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A surnamed Yang, an elderly woman in Tianjin, over fifty years of age, contracted Warm Disease (Wen Bing) accompanied by vomiting in late spring.

Etiology: Due to a family dispute, the Fire of the Liver and Gallbladder was agitated; subsequently, wind invasion occurred after sweating, leading to this condition.

Symptoms: Severe heat in both the exterior and interior, with violent vomiting that prevented medication intake; even small amounts of food were vomited out. The tongue coating was thick white with a slightly yellow center. Bowel movements had not occurred for three days. The pulse was wiry and long on the left side, and flooding and long on the right side, feeling firm upon heavy pressure.

Diagnosis: This is a combined disease of Shaoyang (Lesser Yang) and Yangming (Greater Yang). Since the external pathogenic heat has entered the Stomach organ of the Yangming channel, there is severe heat in both the exterior and interior, and the tongue coating has turned yellow. Since the agitated fire has accumulated in the Shaoyang Liver and Gallbladder, the fire rushes upward causing frequent vomiting. To treat this condition such that the patient can retain the medicine, the decoction should be changed into a powder, ensuring precise dosage without unnecessary flavors, so as to achieve efficacy.

Prescription: Raw Gypsum Fibrosum (Shi Gao) (one liang, finely powdered); Fresh Pear (two large ones).

Peel the pear, slice it, dip the slices into the gypsum powder, and chew slowly before swallowing.

Second Visit: After chewing and swallowing one and a half portions of the pear slices mixed with gypsum powder, no vomiting occurred. Two hours later, the remainder was consumed. From then on, vomiting ceased, eating became possible, and bowel movement occurred once. Palpation revealed residual heat in the pulse. Inquiry indicated the heart still felt hot, but significantly less than before. It was decided to switch back to a decoction to clear the remaining heat.

Prescription: Raw Gypsum Fibrosum (Shi Gao) (one liang, crushed into fine powder); Raw Paeonia Lactiflora Radix (Sheng Bai Shao) (eight qian); Scrophulariae Radix (Xuan Shen) (three qian); Glehniae Radix (Sha Shen) (three qian); Forsythiae Fructum (Lian Qiao) (two qian); Licorice Root (Gan Cao) (two qian); Fresh Imperata Rhizome (Bai Mao Gen) (three qian).

The seven herbs were processed as follows: The first six were boiled in water for about ten boils. Then, the fresh Imperata Rhizome was added, and boiled for another three or four boils. One large cup of the decoction was obtained and taken warm.

Outcome: After taking one dose according to the method, the fever decreased further, and the pulse approached normalcy. Subsequently, the original prescription was modified: Raw Gypsum Fibrosum was reduced to six qian, and Paeonia Lactiflora Radix to four qian. After taking another dose, the illness was completely cured.

Interrogation: "Gypsum Fibrosum is the primary herb for clearing Yangming heat. In this case, there was excess heat in both Yangming and Shaoyang. Why did clearing only the Yangming heat with Gypsum Fibrosum result in a cure?" The answer is: Once ingested, all medicines circulate throughout the body via Qi and Blood. Although Gypsum Fibrosum excels at clearing Yangming heat, fundamentally, it can clear excess heat harbored in any Zang-Fu organs. Moreover, vomiting is always caused by rebellious Qi ascending. When Gypsum Fibrosum powder is ingested, its heavy and sinking mineral nature effectively suppresses the rebellious Qi, directing it downward. This is aided by the sweet and cool properties of the pear slices, which benefit the stomach and promote appetite. Hence, the effect is swift. If fresh pears are unavailable during the transition between summer and autumn, watermelon can be used as a substitute.