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A patient presented with vomiting of food during the late summer season, a condition classified as Fan Wei (Reversal Stomach, characterized by delayed vomiting of ingested food). Treatment with Si Jun Zi Tang (Four Gentlemen Decoction) and Yi Gong San (Extraordinary Efficacy Powder), augmented with Pao Jiang (Roasted Ginger), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Root), proved ineffective. I stated that for the Five Zang Organs, preservation is tonification; for the Six Fu Organs, unblocking is tonification. This is an immutable classic principle. Si Jun Zi Tang and Yi Gong San are primarily spleen-regulating formulas, not stomach-regulating ones. The stomach fu organ requires free flow to achieve harmony; employing methods that "guard the center" will inevitably lead to qi stagnation and rebellion. Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Pao Jiang are both "preservative" agents. Furthermore, the Yang Earth (Stomach) prefers softness and abhors harsh, dry substances that consume fluids. Chronic vomiting damages Stomach Yin; therefore, acrid and descending herbs must be used to guide Stomach Qi downward to achieve efficacy. Prescription: Jiu Zi (Allii Tuberosi Semen, stir-fried and powdered), Xing Ren (Prunus Armeniaca Seed), Dou Kou Yi (Cardamomi Fructus Pericarpium), Ban Xia (Pinelliae Rhizoma), Sha Ren (Amomi Fructus), Tai Zi Shen (Pseudostellariae Radix), Jiang Zhi Fen (Ginger Juice Powder), Gua Lou Ren (Trichosanthis Semen). The patient was instructed to avoid grain foods and temporarily consume wheat noodles, as grains are yin in nature and cloying/stagnant, whereas wheat noodles are yang in nature and promoting flow. With careful regulation, recovery is possible.

Patient Bi suffered from Fan Wei due to excessive alcohol consumption. Wheat noodles provided relief, but grain foods resulted in complete vomiting of the previous day's intake overnight. This indicates Spleen-Stomach Yang deficiency, where alcohol and food generate phlegm, and turbid stasis fails to descend. The treatment method was to unblock Yang and drain turbidity. Prescription: Zhi Ban Xia (Prepared Pinelliae Rhizoma), Fu Ling (Poria), Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Gan Jiang (Zingiberis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Wu Zhu Yu (Evodiae Fructus), Sha Ren (Amomi Fructus). Regrettably, the patient could not abstain from alcohol, so the condition relapsed intermittently.

Inability to expel waste from below is called Guan (Obstruction), involving blockage of both urination and defecation. Inability to accept intake from above is called Ge (Refusal), involving regurgitation of liquids. When Guan and Ge occur simultaneously, it signifies failure of the Middle Jiao Qi mechanism to ascend and descend. This is a critical sign of Yin-Yang separation. Zhang Jingyue attributed this to Hyperactive Yang and Exhausted Yin, with the Yuan Sea (Kidney Essence) lacking root. Symptoms include inability to swallow even a grain of rice, thirst for tea or water, vomiting shortly after drinking, repeated cycles of drinking and vomiting, expulsion of hot medicines immediately upon entry, and expulsion of cold medicines after a delay. Both urine and stool are obstructed. Guan has no outlet, Ge has no inlet. Acute conditions cannot be treated slowly. The *Nei Jing* states: Excessive Yin prevents Yang from nourishing, hence Guan; Excessive Yang prevents Yin from nourishing, hence Ge; when both Yin and Yang are excessive and fail to mutually nourish, it is called Guan Ge. Patients with Guan Ge do not survive their natural lifespan because Qi rebels upward while Body Fluids dry up below. Although similar to Ye Ge (Dysphagia) and Fan Wei, the progression is more rapid. Harsh, hot, fluid-consuming herbs are strictly contraindicated. The appropriate method is sweet-moistening to nourish fluids, such as Sheng Mai San (Generate the Pulse Powder) plus Tian Xing Ren (Sweet Apricot Seed) and Yu Zhu (Polygonati Odorati Rhizoma). Alternatively, use sweet-acid to transform into Yin, such as Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Tuber), E Jiao (Donkey-Hide Gelatin), Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Wu Mei (Mume Fructus), Niu Xi (Achyranthis Bidentatae Radix). If the pulse is洪大 (Hóng Dà - Surging and Large), first clear and descend Fire, using Shan Zhi (Gardeniae Fructus), Xi Jiao (Rhinocerotis Cornu), Zhu Ru (Bambusae Caulis in Taenia), Huang Lian (Coptidis Rhizoma). If the pulse is 沉滑 (Chén Huá - Deep and Slippery), first resolve Phlegm, using Da Ban Xia Tang (Major Pinellia Decoction). If accompanied by Xu Xuan (Deficient and Wiry) pulse, first harmonize Yin, using Gan Lu Yin (Sweet Dew Drink) minus Yin Chen (Artemisiae Scopariae Herba) and Huang Qin (Scutellariae Radix). If there is panting and fullness, first direct rebellious Qi downward, using Jiang Qi Tang (Direct Qi Downward Decoction) minus Gui Zhi (Cinnamon Twig). For Yang Knotting, first unblock stagnation, using Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) with modifications. For Fluid Deficiency, prioritize moistening and unblocking, using Yi Yin Jian (First Yin Decoction). For constitutional True Yin Deficiency, nourish the source of transformation, using Da Ying Jian (Great Camp Decoction). For simultaneous Qi and Blood Deficiency, fill the deficiency, using Da Bu Yuan Jian (Great Tonify Origin Decoction). I once treated an elderly man who was vomiting to the point of death and had constipation, presenting with Upper Ge and Lower Guan. He was prescribed Ren Shen (Ginseng Radix), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Shan Yao (Dioscoreae Rhizoma), Niu Xi (Achyranthis Bidentatae Radix), Mai Dong (Ophiopogonis Tuber), Bai He (Lilii Bulbus), etc. After vomiting ceased, he was treated with fried Coix Seed Soup and thickly simmered San Yin Jian (Three Yins Decoction) for regulation. His bowels moved, and he recovered. This illustrates how to examine treatments.