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According to *Waike Jingyao* (Essentials of Surgery), there are two patterns for vomiting and regurgitation. One pattern occurs when the disease is in its initial stage and has not yet been treated with *Neituo San* (Internal Support Powder), leading to latent heat accumulating in the heart region. The other pattern arises from Qi deficiency causing dysfunction of the Spleen's transportation. For those with latent heat in the heart, administer *Neituo San* for three doses; for those with Qi deficiency, *Jiahe San* (Harmonizing Grain Powder) is appropriate; if accompanied by alternating chills and fever, *Zhengqi San* (Regulating Qi Powder) is suitable, combined with *Shanyao Wan* (Dioscorea Pill) to tonify the Kidney. Zhu Danxi stated: "All upward rushing and vomiting or hiccups belong to Fire." *Neituo San* is cool in nature, thus possessing the function of descending Fire. As for *Jiahe San*, its tonifying power is minimal, merely providing warmth which may inadvertently assist Fire. *Shanyao Wan* tonifies the Kidney to strengthen the Yin of the Lower Jiao, which is roughly consistent with medical principles. However, treating vomiting requires distinguishing between stages: during the ulcerative stage (swelling without rupture), it should be treated as toxic vapors attacking upward; after the ulceration (rupture), it should be treated as Yin deficiency. If an elderly patient suffers from vomiting, regurgitation, and inability to eat after a carbuncle ruptures, *Shenzhu Gao* (Ginseng and Atractylodes Paste) should be used for vigorous tonification to achieve effect, with adjuvant herbs adjusted according to time and syndrome. It is feared that *Shanyao Wan* would not act quickly enough in urgent cases. Liu Hejian believed that vomiting in sores and ulcers is caused by dampness invading the Stomach, so Bai Zhu (Atractylodis Rhizoma) should be doubled in the prescription.

When sores and ulcers cause vomiting, one must not rigidly adhere to the concept of "toxic vapors attacking inward" and indiscriminately use detoxifying drugs. If heat is severe and painful, indicating excess pathogenic factors, *Xianfang Huoming Yin* (Immortal Formula Preserving Life Decoction) can resolve it. If pain occurs during suppuration, indicating Stomach Qi deficiency, *Tuoli Xiaodu San* (Support Interior and Detoxify Powder) can tonify it. If pus is mature with distending pain, indicating Qi and Blood deficiency, first use *Tuoli San* (Support Interior Powder), then puncture with a needle to drain it. If pain is accompanied by constipation, indicating heat accumulation internally, *Nishu Huanglian Tang* (Draining Internal Coptis Decoction) can guide out the stagnation. If vomiting results from cold-natured drugs injuring the Stomach, use *Tuoli Jianzhong Tang* (Support Interior and Strengthen Middle Decoction); if due to Stomach cold with poor appetite, use *Tuoli Yizhong Tang* (Support Interior and Benefit Middle Decoction); if due to middle Jiao deficiency with cold-damp excess, use *Tuoli Wenzhong Tang* (Support Interior and Warm Middle Decoction); if due to Liver Wood overacting on Spleen Earth, use *Tuoli Yiqing Tang* (Support Interior and Suppress Green Decoction); if due to phlegm retention in the epigastrium, use *Tuili Xiaozhong Tang* (Support Interior and Eliminate Middle Phlegm Decoction); if due to Spleen deficiency itself, use *Tuoli Yihuang Tang* (Support Interior and Benefit Yellow Decoction); if due to constraint injuring the Spleen, use *Tuoli Yueju Tang* (Support Interior and Resolve Depression Decoction). If the root cause is not investigated in detail and toxic-purging drugs are used recklessly, swelling will not suppurate, and open ulcers will not heal (Xue Ji). Although Danxi stated that ulcers should be treated as toxic vapors attacking the Heart, and post-ulceration as Yin deficiency, this is only a general statement. Nowadays, vomiting due to internal attack of heat-toxin is rare, while vomiting due to Spleen and Stomach deficiency-cold is common; how can one stick rigidly to old theories? Furthermore, he said: Vomiting triggered by desire, or caused by external application/internal administration of cold-cooling drugs, or severe pain, or exposure to cold pathogens and foul odors, all indicate Stomach Qi deficiency. Use *Tuoli Xiaodu San*, removing three herbs, adding Huoxiang (Agastache Herba), and doubling Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Rhizoma). (The three removed herbs are: Lianqiao (Forsythiae Fructum), Baizhi (Angelicae Dahuricae Radix), and Yinhua (Lonicerae Japonicae Flos)). For excessive heat and rapid pulse (*Waike Jingyao*), use *Loulu Tang* (Euphorbiae Humifusae Decoction) or decoct Dahuang (Rhei Radix et Rhizoma) alone. If heat is not severe and the pulse is slow and weak, only administer *Wuxiang Lianqiao* (Five-Aromatic Forsythia formula). Excessive heat with rapid pulse indicates imminent death; how can decoctions help? Danxi said: With excessive heat and rapid pulse, if it is during the swelling stage and the viscera are constipated with a strong constitution, purgation may still be applicable. But if pus and blood have flowed during the ulcer stage, can purgation still be used? A slow and weak pulse was considered by ancients as dispersion of evil toxins; since *Wuxiang* formulas contain aromatic and ascending-dispersing herbs, can they still be used? (Above quoted from *Zhunsheng*).

For vomiting caused by sores and ulcers, regardless of whether they have ruptured or not, if the pulse is excess and rapid, and the patient prefers cold drinks, it is toxic vapors attacking inward, and purgation should be used. If the pulse is weak and the patient prefers warmth, it is insufficiency of Yang Qi, and tonification should be used (*Waike Dacheng*).