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The *Jingyao* (Essentials) states: There are two types of syndromes. One refers to the initial onset where the *Neituo San* (Internal Support Powder) was not administered, leading to latent heat accumulating in the Heart. The other refers to Qi deficiency with dysfunctional Spleen Qi. For those with latent heat in the Heart, administer *Neituo San*; for those with Qi deficiency, *Jiahe San* (Harmonizing Grain Powder) is appropriate. If accompanied by aversion to cold and fever, *Zhengqi San* (Regulating Qi Powder) is suitable, supplemented with *Shanyao Wan* (Dioscorea Pill) to tonify the Kidney.

Zhu Danxi stated: All rebellious upward movements, including vomiting and hiccups, belong to Fire. *Tuoli San* (Support Interior Powder) has a cool nature and indeed possesses the principle of descending Fire. However, *Jiahe San* merely provides warmth to assist Yang, and *Shanyao Wan* tonifies the Kidney to strengthen the Yin of the Lower Jiao; these explanations are crude but close to reason. Nevertheless, treating vomiting requires distinguishing between stages. During the ulceration stage (before rupture), it should be treated as toxic vapors attacking upwards; after the ulcer has ruptured, it should be treated as Yin deficiency requiring supplementation. For elderly patients who experience vomiting and inability to eat after the rupture of a carbuncle, *Shenzhu Baigu Gao* (Ginseng and Atractylodes Paste) should be used as an adjunctive medicine, adjusted according to time and syndrome. There are also cases cured using *Dushen Tang* (Single Ginseng Decoction). *Shanyao Wan* acts slowly and is not easy to use for acute conditions. Liu Hejian believed that vomiting and hiccups in sores are caused by dampness invading the Stomach, suggesting doubling the dosage of *Baizhu* (Atractylodis Rhizoma) in the prescription. Haiyun stated: Vomiting with material but no sound indicates a Blood disease; hiccupping without material but with sound indicates a Qi disease; vomiting with both sound and material indicates a disease affecting both Qi and Blood. Zhang Zhongjing said: Even if a patient with vomiting presents with Yangming syndrome, purgatives should not be used. Hiccups (Ke Ni) are sounds produced by Fire rushing upward from below to strike the stomach opening, often resulting from post-illness Stomach deficiency and severe Yin deficiency. Conditions reaching this stage are often critical; skilled practitioners certainly do not speak generally of vomiting without distinction.

If heat is abundant and the pulse is rapid, *Jingyao* recommends *Lulu Tang* (Phlomis Decoction) or decocting *Dahuang* (Rhei Radix et Rhizoma) alone. If the heat is not severe and the pulse is slow and weak, only *Wuxiang Liaoqiao Tang* (Five-Aromatic Forsythia Decoction) should be administered.

Zhu Danxi stated: In cases of abundant heat and rapid pulse, if during the pre-ulceration stage the internal organs are blocked and the constitution is strong, purgatives may still be used. However, if after ulceration there is excessive loss of pus and blood, yet heat remains abundant and the pulse rapid, death is near; how can purgatives be used? A slow and weak pulse is considered by ancients as a sign that pathogenic toxins have dissipated; since *Wuxiang* formulas have ascending and dispersing properties, can they still be used?

I have observed treating cold with heat, yet the cold becomes more severe; treating heat with cold, yet the heat becomes more intense. Why? If excess Heat arises from the Heart, one should benefit the Kidney water to nourish Yin, and the heat will naturally subside. If Cold arises from Kidney deficiency, one should tonify the Heart fire; as Heart fire descends, the cold will naturally recede. This is what is meant by "treating heat with cold medicines, if ineffective, treat from the Yin"; and "treating cold with hot medicines, if ineffective, treat from the Yang." There are also principles of "using heat due to cold" and "using cold due to heat," which rely on understanding the underlying logic. It is also heard that mild diseases are treated oppositely (Ni Zhi), while severe diseases are treated similarly (Cong Zhi). Generally, when using hot medicines to treat cold, they must be taken cool (counter-assistance); when using cold medicines to treat heat, they must be taken warm (counter-assistance). This is intended to harmonize. Among these, there are standard treatments (Zheng) and flexible adaptations (Quan). Since diseases vary in severity, mild cases are treated oppositely, which is the orthodox principle; severe cases are treated similarly, which is the adaptive principle.