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Wang Bing (Grand Master Wang) stated: If the body is extremely cold and does not respond to heat therapy, it indicates a deficiency of Mingmen Fire (Mingmen Fire Deficiency), and one should tonify the Yang of the Heart and Kidney. If the body is extremely hot and does not respond to cold therapy, it indicates exhaustion of Kidney Yin (Kidney Yin Exhaustion). If symptoms in summer appear intermittently or come and go suddenly, this also indicates insufficient Kidney Yin, and one should nourish Kidney Yin. Therefore, hyperactivity of Heart Fire generates excess heat, while hyperactivity of Kidney Water generates excess cold. Kidney Qi deficiency leads to internal generation of cold, while Heart Qi deficiency leads to retention of heat internally. Furthermore, if heat drugs fail to dispel cold, it is due to the absence of fire; if cold drugs fail to clear heat, it is due to the absence of water. If the effect of heat drugs is short-lived, the responsibility lies in Heart Qi deficiency; if the effect of cold drugs is short-lived, the responsibility lies in Kidney Qi weakness. Practitioners should deeply comprehend these principles.

Xue Ji (Lizhai) stated: In patients with sores and ulcers, fever and irritability may occur due to excessive bleeding, profuse discharge of pus, excessive sweating leading to loss of Yang Qi, or excessive purgation leading to loss of Yin fluids. This causes consumption of Yin and Blood, leaving Yang Qi without support, floating on the surface of the skin and muscles, which is not a true Fire syndrome. If there is fever accompanied by insomnia, it is due to Blood deficiency, treated with Shengyu Decoction. If accompanied by incessant sweating, it is due to Qi deficiency, requiring urgent administration of Danshen Decoction. If there is fever, irritability, muscle twitching, and tendon tremors, it is due to dual deficiency of Qi and Blood, treated with Bazhen Decoction. If there is extreme thirst, red face, and a flooding pulse that is empty upon pressure, it is Yin-deficiency fever, treated with Danggui Buxue Tang. If there is slight limb heat, irritability, red face, and a deep, faint pulse, it is false restlessness caused by Yin excess repelling Yang, treated with Sijunzi Decoction added with Ginger and Aconite.

Xue Ji stated: For those who prefer warmth, dislike cold, and suffer from vomiting, warming and fortifying Stomach Qi is appropriate. If the pulse is fine, with borborygmus, abdominal pain, slippery diarrhea, and vomiting, reinforcing the interior and warming the middle is appropriate. For those who prefer coolness, dislike heat, and suffer from vomiting, descending Fire is appropriate. If the pulse is excess and solid, with constipation and vomiting, draining Fire is appropriate. If the root cause is not investigated in detail and toxic-clearing drugs are used blindly, un-ulcerated sores will not ulcerate, and ulcerated sores will not heal. Although Zhu Danxi said that vomiting during the early stage of sores should be treated as toxic vapors attacking the Heart, and vomiting during the ulcerative stage should be treated as Yin deficiency, this is merely a general statement. Moreover, cases of vomiting due to internal attack of heat toxicity account for only one or two out of ten, whereas vomiting due to Spleen-Stomach deficiency-cold or phlegm-Qi rebellion accounts for eight or nine out of ten; thus, one should not adhere rigidly to such statements. It is further stated: For any carbuncle or sore with severe redness, swelling, and pain, accompanied by irritability, an excess pulse, and vomiting, it belongs to excess syndromes, and purgation should be used. If the swelling is hard and does not ulcerate, accompanied by a weak pulse and vomiting, it is due to deficiency of Yang Qi, and tonification should be used. If there is vomiting and reduced food intake, it is due to deficiency-cold of Stomach Qi, and warming and tonifying the Spleen and Stomach is required. If pain damages Stomach Qi, or if vomiting occurs due to exposure to cold pathogens or foul odors, even in the early stage of sores, one should assist Stomach Qi and strengthen Qi; blind use of attacking drugs often leads to complications that are incurable.

The "Key Principles" by Xue states: Vomiting in sores and ulcers should not be rigidly attributed to internal attack of heat toxicity, nor should toxic-clearing drugs be used indiscriminately. If heat is severe and painful, indicating excess pathogenic factors, Xianfang Huoming Yin should be used to resolve it. If pain occurs during the suppuration stage, indicating deficiency of Stomach Qi, Tuoli Xiaodu San should be used to tonify. If there is distending pain when pus is ripe, indicating deficiency of Qi and Blood, Tuoli San should be used first, followed by lancing to drain pus. If pain is accompanied by constipation, indicating heat congestion internally, Neishu Huanglian Tang should be used to guide out the stagnation. If vomiting occurs due to damage to the Stomach by cold medicines, Tuoli Jianzhong Tang should be used. If vomiting occurs due to Stomach cold and poor appetite, Tuoli Yizhong Tang should be used. If vomiting occurs due to central deficiency and excess cold-dampness, Tuoli Wenzhong Tang should be used. If vomiting occurs due to Liver Wood overacting on Spleen, Tuoli Qingtang Tang should be used. If vomiting occurs due to fluid retention in the epigastrium, Tuoli Qingzhong Tang should be used. If vomiting occurs due to Spleen deficiency and self-pathology, Tuoli Yihuang Tang should be used. If vomiting occurs due to constraint injuring the Spleen, Tuoli Yueju Tang should be used. It is further stated: Generally, for vomiting in various sores, if the patient prefers cold drinks and has constipation, it is heat toxicity, treated with Huanglian Xiaodu San. If the patient prefers cold drinks and has dry stools, it is Stomach Fire, treated with Zhuye Shigao Tang. If the patient is lazy to eat or drink soup, it is Stomach deficiency, treated with Buzhong Yiqi Tang. If stools are loose and the patient prefers hot drinks, it is Spleen-Stomach deficiency-cold, treated with Liujunzi Decoction added with roasted Ginger to warm. It is common to see that patients with weak Spleen-Stomach, after using the aforementioned dispersing/clearing drugs, develop coldness in the chest and diaphragm leading to vomiting, and sores in the throat and tongue; this is due to exhaustion of Kidney Water and flaming up of deficient Fire. The condition is very serious, and Jiawei Bawei Wan should be administered urgently; some patients survive.

Vomiting due to heat toxicity is exemplified by Liu Gui, who suffered from an abdominal abscess with local swelling and pain, irritability, an excess pulse, and vomiting. Liu Hejian stated: Sores and ulcers belong to the Fire category; one must distinguish between interior and exterior to treat the root. If the pulse is deep and solid, one should first unblock the interior to cut off the source. It is further stated: Vomiting, hiccups, and irritability with a deep and solid pulse, hard and numb swelling of sores, or unchanged skin and flesh color indicate pathogens inside, and Neishu Huanglian Tang is suitable. However, an excess pulse with vomiting indicates toxins inside. Thus, the aforementioned decoction was used to promote bowel movements two or three times, all symptoms disappeared, and the patient recovered with Liaoqiao Xiaodu San.

Wang Shiheng from Jintai, over forty years old, suffered from a toxic sore on his arm with swelling, pain, and vomiting. His condition worsened after taking Tuoli Xiaodu medicine. I used Liangge San for two doses, which rapidly relieved the symptoms, followed by Siwu Tang added with Scutellaria and Coptis for four doses, resulting in resolution. (Note by Xue Ji)

Vomiting due to Stomach cold is exemplified by the wife of Gu Hao, over forty years old, who suffered from a back carbuncle. After treatment with interior-reinforcing medicine, it ulcerated. She suddenly vomited and experienced sore pain; her Stomach pulse was wiry and tight. She believed it was residual toxin attacking internally. Li Dongyuan stated: Vomiting without fixed timing and cold extremities indicate deficiency of the Zang-Fu organs. Zhu Danxi stated: Vomiting and refusal to eat after ulceration indicate dampness invading internally. He further stated: Pain returning after pus discharge indicates deficiency. Now, with a wiry and tight Stomach pulse, it is Liver Wood overacting on Earth position, clearly indicating deficiency. I intended to treat with Liujunzi Decoction added with wine-fried Peony, Amomum, and Agastache. She took Huxin San herself, and vomiting worsened. Upon re-invitation, I used the previous prescription again, adding Qi- and Blood-tonifying herbs, and she recovered in two months. Generally, vomiting due to internal invasion of dampness or foul odors is characterized by preference for warmth and a weak pulse; vomiting due to internal attack of heat toxicity is characterized by preference for coolness and a rapid pulse. One must distinguish them clearly. There are also cases of loose stools, abdominal pain, distension, vomiting, or acid regurgitation and belching, all of which are deficiency-cold of the intestines and stomach, treated with Lizhong Tang. If ineffective, add two or three slices of prepared Aconite. I once suffered from poor appetite, acid regurgitation, and belching; other medicines were ineffective, but Lizhong Tang and Fuzi Lizhong Wan were effective. This condition is caused by deficiency-cold of Middle Qi, failing to transform and transport stagnation; thus, warming and tonifying agents make the Middle Qi harmonious, eliminating the condition. Zhang Sheng suffered from lacquer dermatitis with vomiting due to weak Middle Qi and invasion of lacquer toxin. I treated him with Liujunzi Decoction added with Amomum, Agastache, and wine-fried Peony. He did not believe me and took Liaoqiao Xiaodu San instead, causing vomiting to worsen. Upon re-invitation, I used the previous prescription again, and externally applied iron rust powder mixed with sesame oil, resulting in recovery. (Note by Xue Ji)

Dai Yuanli (Palace Envoy) stated: Nausea, characterized by no sound and no vomitus, where one wants to vomit but cannot, although called nausea, is actually not a disease of the Heart Meridian, but located above the Stomach gate. Fresh Ginger is appropriate, as it can open the Stomach and resolve phlegm.