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Xue Lizhai stated: When patients with sores and ulcers experience vomiting, one must not rigidly adhere to the concept of "toxic vapors attacking inward" and indiscriminately use drugs that defeat toxins. If the heat is severe and pain is intense, this indicates an excess of pathogenic qi; Xianfang Huoming Yin (Immortal Life Elixir) should be used to resolve it. If pain occurs during suppuration, this indicates deficiency of stomach qi; Tuoli Xiaodu San (Supporting Interior and Detoxifying Powder) should be used. If distending pain occurs when pus is ripe, this indicates deficiency of qi and blood; Tuoli San (Supporting Interior Powder) should be used first, followed by needle drainage. If accompanied by constipation, this indicates heat accumulating internally; Neishu Huanglian Tang (Internal Drainage Coptis Decoction) should be used to guide out the heat. If vomiting is caused by cold medicines damaging the stomach, Tuoli Jianzhong Tang (Supporting Interior and Establishing the Middle Decoction) should be used. If vomiting is caused by stomach cold and reduced appetite, Tuoli Yizhong Tang (Supporting Interior and Benefiting the Middle Decoction) should be used. If vomiting is caused by excessive deficiency-cold, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) should be used. If vomiting is caused by liver wood overacting on spleen earth, Tuoli Yiqing Tang (Supporting Interior and Suppressing Greenness Decoction) should be used. If vomiting is caused by phlegm retention in the epigastrium, Tuoli Qingzhong Tang (Supporting Interior and Clearing the Middle Decoction) should be used. If vomiting is caused by spleen deficiency itself, Tuoli Yihuang Tang (Supporting Interior and Benefiting Yellowness Decoction) should be used. If vomiting is caused by emotional constraint injuring the spleen, Tuoli Yueju Tang (Supporting Interior and Resolving Depression Decoction) should be used. If the root cause is not investigated in detail and toxic-draining drugs are used recklessly, un-ulcerated swellings will not suppurate, and ulcerated wounds will not heal. Although Zhu Danxi stated that vomiting during the pre-ulcerative stage (swelling stage) should be treated as toxic vapors attacking the heart, and vomiting during the post-ulcerative stage should be treated as yin deficiency requiring tonification, this is merely a general statement. This aligns with the meaning in *Neijing* (The Classic of Internal Medicine) that all pain, itching, and sores belong to heart fire. Moreover, cases of vomiting due to internal attack of hot toxins are rare nowadays, while those due to deficiency-cold of the spleen and stomach are common. How can one stick to the words of former sages to treat the diseases of contemporary people?

Liu Hejian stated: When patients with sores and ulcers frequently vomit, it should be treated as dampness invading the stomach, using doubled doses of Baizhu (Atractylodis Macrocephalae Rhizoma).

Zhu Danxi stated: All upward rushing rebellions, vomiting, and hiccups belong to fire. However, treating vomiting requires distinguishing between early and late stages. During the pre-ulcerative stage, it should be treated as toxic vapors attacking upward; after ulceration, it should be treated as yin deficiency requiring tonification.

Feng Luzhan stated: There are two types of vomiting and rebellion caused by carbuncles and malignant sores: one is due to failure to use interior-supporting methods at the onset, leaving latent heat in the heart; the other is due to abnormal spleen qi, leaving latent heat in the spleen. Those with heat in the heart experience mental restlessness, body fever, and swelling with pain. Those with abnormal spleen qi do not feel restless or feverish but vomit upon smelling foul odors. Therefore, aromatic herbs are often used in treating carbuncles and malignant sores, because qi and blood flow freely upon smelling fragrance but rebel upon smelling stench. Sores and ulcers often occur because Ying-nutritive qi does not follow its course, rebels within the flesh, and condenses into pus; encountering fragrance allows qi and blood to circulate. Since sores naturally have a fishy/foul odor, further exposure to stench worsens the condition; if toxin enters the stomach, vomiting and retching occur. The ancients' use of aromatic substances was well-reasoned. Similarly, diet should be adjusted to be fragrant and delicious to benefit spleen earth and nourish true yuan, ensuring safety.

Shen Douyuan stated: "Ou" (vomiting with sound but no substance) is a disease of qi. "Tu" (spitting out substance without sound) is a disease of blood. When sores and ulcers are swollen and painful, if there is vomiting sound or spitting, pulse diagnosis is necessary. If the pulse is surging, rapid, full, and large, or if there is constipation and aversion to cold drinks, lowering fire and clearing the middle with Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) is appropriate. If there is preference for hot drinks and aversion to cold, with normal vomiting and bowel movements, warming the stomach and regulating the middle with Yangwei Tiaozhong Tang (Stomach-Nourishing and Middle-Regulating Decoction) is appropriate. If the pulse is minute and fine, with borborygmus, abdominal pain, diarrhea, and vomiting, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) and Ershen Wan (Two Divine Pills) are appropriate. Follow up with Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction); dietary intake will immediately improve, and Shiquan Dabu Tang (Ten Complete Tonifying Decoction) may also be used. For patients with non-ulcerated sores experiencing vomiting and nausea, this is due to severe toxin attacking inward and original stomach qi deficiency; Liujunzi Tang (Six Gentlemen Decoction) added with Xiangfu (Cyperi Rhizoma), Sharen (Amomi Fructus), and Shengjiang (Zingiberis Rhizoma Recens) is appropriate. For patients with ulcerated sores experiencing vomiting, nausea, anorexia, fullness, borborygmus, abdominal pain, loose stools, incessant vomiting and hiccups, insomnia, and intermittent confusion, Tuoli Wenzhong Tang (Supporting Interior and Warming the Middle Decoction) is appropriate.

*Neijing* states: When cold excesses internally, treat with pungent-warm herbs, assisted by bitter-warm herbs. Jiang (Zingiberis Rhizoma) and Fu (Aconiti Lateralis Radix Praeparata) warm yang qi inside and outside, from interior to exterior, thus serving as sovereign herbs. Qianghuo (Notopterygii Rhizoma et Radix) is bitter, pungent, and warm, penetrating joints and ears.

Dou Hanqing stated: Hiccups represent extreme deficiency-cold in the stomach; Chenxiang (Aquilariae Lignum Resinatum), Xiangfu (Cyperi Rhizoma), Ding (Eugeniae Flos), and Chenshi (Citri Reticulatae Pericarpium) are appropriate.

Danxi stated: Neituo San (Interior-Supporting Powder) is cool in nature and treats vomiting through the principle of lowering fire. (i.e., Huxin Dan (Heart-Protecting Pill)).

*Jingyao* (Essentials) states: There are two syndromes of vomiting and rebellion: one syndrome occurs when interior-supporting powder was not taken at the onset, leaving latent heat in the heart, requiring interior support; the other syndrome is due to qi deficiency and abnormal spleen qi, requiring Jiahe San (Grain-Benefiting Powder).

Zhu Danxi stated: Treating vomiting requires distinguishing stages. During the pre-ulcerative stage, treat as toxic vapors attacking upward; after ulceration, treat as yin deficiency. For elderly patients who, after ulceration of a malignant sore, experience vomiting, rebellion, and inability to eat, Shen Bai Zhu Gao (Ginseng and Atractylodes Paste) should be used for vigorous tonification to achieve efficacy.

Xue Lizhai stated: Vomiting due to internal attack of hot toxins is rare; vomiting due to deficiency-cold of the spleen and stomach is common. It must be differentiated by pulse and symptoms.

Yang Shi stated: After initial healing of epistaxis, if sweating was not induced and toxin remains in the meridians, a large carbuncle may erupt on the back, extending from the shoulder down to the waist and hypochondrium, swollen and hard like stone, purple-black in color. If cool medicines were administered, violent vomiting occurred throughout the night; continuous administration of Neituo San stopped the vomiting.

Li Dongyuan stated: Vomiting occurring at any time with cold extremities indicates deficiency of the zang-fu organs.

Lou Quanshan treated a male patient with a pre-ulcerative sore experiencing vomiting, which did not respond to various medicines. One dose of Dushen Tang (Single Ginseng Decoction) stopped the vomiting immediately.

Xue Lizhai stated: Vomiting with preference for heat and aversion to cold requires warming and nourishing stomach qi; vomiting with preference for cold and aversion to heat requires lowering fire.

Dai Yuanli, Southern Hospital Envoy, stated: Nausea involves no sound and no substance, with a desire to vomit but inability to do so. Although called nausea, it is not a disease of the heart meridian but resides in the stomach opening. Only Shengjiang (Zingiberis Rhizoma Recens) is appropriate, as it opens the stomach and resolves phlegm.

Zhang Jingyue stated: I once experienced reduced appetite and desire to eat, acid regurgitation, and belching of rotten food, unresponsive to various medicines. Only Lifu Tang (Regulate the Middle Decoction) and Fuzi Lifu Wan (Aconite Regulate the Middle Pills) were effective. This syndrome is caused by deficiency-cold of middle qi failing to transform and transport stagnation. Thus, warm-tonifying agents make the middle qi harmonious, eliminating the syndrome.

Hu Gongbi stated: If vomiting occurs due to dual deficiency of qi and blood, and the tip of the tongue is dry, death is certain.

Jiang Shiji stated: When spleen and stomach are on the verge of collapse, food intake causes vomiting. Liujunzi Tang (Six Gentlemen Decoction) added with Muxiang (Aucklandiae Radix) and Sharen (Amomi Fructus) is appropriate; if ineffective, add Fu (Aconiti Lateralis Radix Praeparata) (*Shuoyue*).

The Classics state: All vomiting of sour water and turbid fluids belongs to heat; all vomiting of saliva that is clear and cold belongs to cold. This is like the principle that water is clear in cold weather and turbid in hot weather. There is also a distinction between stomach heat and stomach cold, differentiated by thirst or lack thereof.