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Note: Feng's lifelong medical practice favored warm and tonifying methods. In such a case, following hematemesis and yin deficiency, with emission dreams leading to vomiting, it is mostly due to the Dragon-Lei Fire (Ministerial Fire) forcing downward and rushing upward. Using acrid-hot herbs to treat the branch symptoms is acceptable; however, if one adheres rigidly without flexibility, the subsequent complications will be immeasurable.

Sun Fenzhi treated the daughter of Zhao Yi, who suddenly experienced vomiting and regurgitation, obstruction of both urination and defecation, restlessness, gradual coldness of the four limbs, and absence of pulse, lasting for one and a half days. One dose of Dachengqi Tang (Major Order the Qi Decoction) was administered. By midnight, bowel movements gradually became unobstructed, the pulse gradually harmonized, and she was at peace the next day. This is Guan Ge disease (Obstruction and Reversal), extremely difficult to treat; among those near death, only this one was saved.

Lu Fu said: Throughout my life, smelling the metallic odor of copper induces nausea, and almost nothing ingested remains down. Even Ginseng Decoction or tea, if kept long in a copper pot, causes vomiting. I often ponder that Copper Green (Basic Copper Carbonate) is indeed an emetic herb; why do I fear it so much? This doubt remained unresolved for a long time. In the summer of Xinhai, while bedridden, I vomited upon smelling copper. Reflecting on myself, I am a Wood-type person, with a greenish complexion and aversion to Metal; thus, the copper smell clashes with me. This led me to recall Zhang Hezi's discussion on emetics, which lists forty-six emetic herbs. Having read them but not fully understood, I intended to apply treatment based on Five Elements and Five Colors. If Wood-type people vomit due to aversion to the metallic smell of Metal, then Fire-type people should vomit due to aversion to the salty, putrid nature of Water. Since aversion implies disgust, provoking anger through disgust requires less effort but yields greater success. The other three types can be inferred similarly. Alas, is it only emetics that work this way? Could purgatives and diaphoretics not follow the same principle? (According to Shen's manuscript.)

Nie Jiuwu said: In the late spring of Gengyin, Xia Gong, a Vice Prefect, came to Xinxing Temple to distribute grain to the famine victims. I prepared wine and rice to entertain him. While drinking, I suddenly suffered abdominal pain starting from below the navel in the lower abdomen. When the pain reached the epigastrium, vomiting occurred, and ceased after vomiting. Half an hour later, pain started again from below, followed by vomiting upon cessation of pain. This cycle repeated several times. Physicians treated it as Cold, using Huoxiang (Patchouli Herb) and Sharen (Amomum Fruit) without effect. By Shen hour (3-5 PM), I realized it was internal heat causing pain, with heat qi rushing upward inducing vomiting, requiring purgation. However, decoctions could not be taken as they might exacerbate vomiting. I hastily prepared Qianniudahuang Wan (Pharbitis Seed and Rhubarb Pill). After taking a few qian, multiple bowel movements ensued, and I recovered instantly. Black Pharbitis Seed (Pharbitidis Semen) 4 liang, half roasted half raw, ground to take the first extraction powder 1.2 qian; Sanleng (Sparganii Rhizoma) and Ezhu (Curcumae Rhizoma) stir-fried with vinegar, each 6 qian. Ground into powder, formed into pills the size of Sophora seeds using thick rice soup. Taking 3 qian did not induce bowel movement. Taking another 2 qian showed effects within two to three hours.

Wei Yuheng treated Bao Luyin, aged over twenty, who contracted heat while traveling by sedan chair between Hui'an and She County in summer, resulting in severe epistaxis filling a basin. After recovery, eating a pear triggered vomiting. This was Liver Fire with Stomach Cold; various treatments failed. Hearing the word "vomit" caused immediate vomiting, so family members avoided mentioning it. Later in Wumen, Ye Tianshi examined him. Due to deep and fine pulse, he prescribed Fuzi Lizhong Tang (Aconite Root and Gastrodia Decoction), with Ginseng, Dried Ginger, and Aconite Root each at 3 qian. After taking the medicine and walking half a li, he felt heavy head and dizziness, rushed back, and collapsed at the door. Fortunately, his father knew herbal properties well, suspected Aconite toxicity, and urgently brewed Licorice Decoction to administer. He revived after a long time. Removing Aconite, he took three more doses, but vomiting worsened. Re-examined, still advised to take the previous formula, so he dared not try. Seeking treatment from Xue Shi, he explained the history. Xue used Liujunzi Tang (Six Gentlemen Decoction); four doses had no effect. Seeking again, Xue was away; Xue's son-in-law advised adding Zhiyiren (Alpinia Oxyphylla Fruit) 1 qian to the prescription, but it also failed. Seeking Sun Mou, whose prescription used Licorice 8 qian, the medicine was vomited out before swallowing. Thus, he returned home without further treatment. Accidentally attending a funeral in winter, he caught cold, worsening cough, lingering until summer. I visited him accidentally and found the condition severe. Inquiring, I learned he previously suffered vomiting, recently with complete obstruction of urination and defecation, fasting for seven to eight days, only drinking tea water. Several doctors tried moxibustion on the umbilicus without success. Upon examination, his complexion was blue-green and haggard, pulse string-like and hidden with overflow at Cun position. I stated this was due to severe depletion of Spleen Yin and flourishing Wood-Fire. Also, chronic cough weakened Lung, leaving Liver unchecked, thus attacking Spleen below and insulting Stomach above, resulting in Guan Ge. (Reading this analysis, the previous mention of "Stomach Cold" lacks basis. This syndrome originates from Liver Fire rushing to Stomach, extreme heat in Stomach. The sweet-cold nature of pear was insufficient to overcome the heat, instead agitating its rampant heat. It is not Stomach Cold.) Fortunately, the pulse was not rapid, indicating ease of treatment. First, soothe Liver to prevent upward rushing and stop vomiting, allowing Lung to descend and bowels to move. Prescribed Huanglian (Coptis Rhizome) and Rougui (Cinnamon Bark) each 0.5 fen, steamed in hot water. After drinking, vomiting slightly stopped, and he could eat a few pieces of cake. However, unbearable distension in bowels and bladder required applying mashed large river snail and single clove garlic to Dantian, secured with cloth. Within an hour, urination and defecation occurred, discharging green stool, and he recovered instantly. Date: May 27, Ji Xu year. Later, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was modified with Shashen (Glehnia Root) and Maidong (Ophiopogon Tuber); cough ceased. Subsequently, regularly taking Yangrong (Nourishing Vigor) formulas prevented recurrence of vomiting.

Xiong Note: Ji Xu corresponds to the 19th year of Qianlong. Ye Tianshi had passed away, while Yipiao was still alive. The mentioned "Ye Shi" might refer to Ye Tianshi's descendants.

Ye Taishi Guqu, serving in the Jiangsu education bureau, suffered from chronic vomiting. Whenever the Education Commissioner inspected prefectures, famous doctors were summoned. Over two years, more than ten physicians treated him, yet the condition worsened. Returning home at year-end, sometimes Erchen Tang plus Zuojin Wan was used, with Evodia Fruit and Coptis Rhizome at 5-6 fen. Shortly after ingestion, he vomited about a bowl of blood. Pulse was not rapid, but both Cun positions extended to Yuji. Left Chi position was faint and barely palpable. He wanted to explain the etiology and previous prescriptions. I said: I know all. Take my prescription for fifty doses to recover, requiring approximately three jin of Shudi (Prepared Rehmannia Root). He was surprised and asked the diagnosis. I said: Those Jiangsu physicians attributed it to Phlegm-Fluid retention, using Sijunzi Tang or Liujunzi Tang. I laughed and slapped the table: All correct. But if not Phlegm-Fluid, why so much sour-bitter saliva? Why increase food intake reduction lead to heavy use of Shudi? I replied: This syndrome stems from Kidney deficiency, Liver losing nourishment, Wood drying generating Fire, rushing upward invading Stomach collaterals, and Lung Metal also declining. Food entering Stomach cannot distribute and regulate, causing fluids to accumulate in the epigastrium. Meeting Fire rushing up, food must be vomited. Sijunzi, Erchen, Xiangfu, Sharen are aromatic-drying substances. Treating with them is like carrying firewood to save a fire, aiding combustion. Must nourish Water to generate Wood, moisten Lung to tonify Metal. Only then can efficacy be achieved. Yin-nourishing drugs act slowly; for chronic illness, many doses are needed. Using Shudi, Gouqi (Wolfberry Fruit), Shashen, Maidong, Shihu (Dendrobium Stem) with modifications. Initially, vomiting persisted. After ten doses, vomiting decreased sequentially, food intake increased, and recovery occurred at fifty doses.

Ni Shoushan, under twenty, constitutionally weak, married early, developed vomiting. Erchen Tang and Wuxiang formulas aggravated it. Gui Zhi (Cinnamon Twig) and Fuzi (Aconite Root) caused discomfort after one dose, so stopped. Eating pure lard initially helped, later ineffective. Pulse was deficient, string-like, slightly rapid. Prescribed Raw and Prepared Shudi, Shashen, Maidong, Huanglian (Coptis Rhizome), Louren (Trichosanthes Seed). After four doses, Huanglian removed, continued for thirty-plus doses until cured.

Gao's daughter, aged seven or eight, suffered headache and vomiting, sour or bitter taste, unresponsive to various treatments. Her father asked me. I said: Liver Fire rushing upward. Prescribed Shengdi (Rehmannia Root), Gouqi, Shashen, Maidong. Cured in two to three doses. At adulthood, relapsed in late spring. Father deceased, brother consulted several physicians using Erchen Tang, Liuyu Tang, Xiangfu, Sharen, Dingxiang (Caryophylli Flos), Rougui. After half a year, face turned greenish, thighs wasted. Mother wept, begged me to treat. Used previous formula with Shudi 1 liang per dose. Cured in twenty-plus doses.

Jin's wife suffered vomiting for over ten years. Ingested countless aromatic-drying herbs. Later, left hypochondriac pain with mass, amenorrhea, pulse choppy and rapid, irritability. Consulted me, declined treatment. Persistently requested, reluctantly prescribed modified Liuwei Dihuang Wan. Effective, but relapsed upon anger. Died six months later.

Luo Er Yin Huizhai from Fujian, suffered chronic flaccidity of legs. Last spring, vomited with profuse head sweating; medical treatment failed. Stopped medication, improved gradually over months. Summer brought insomnia, treatment failed, recovered in autumn. Spring this year, stayed in Hangzhou for official business, sought acupuncture for leg ailment. Moxibustion on Zhongwan (CV12) and Qihai (CV6) improved walking, but vomiting intensified, immediate regurgitation after eating, fasting for days, insomnia. Took Ginger, Aconite, Evodia, Cinnamon, Atractylodes, Pinellia, Erchen Tang, feeling pungent smoke rising. Pulse: Six positions large as chopsticks, Cun positions overflowing Yuji. Tongue: Thin, small, pointed tip, trembling, yellow coating, red depressed edges. Forehead: Hematite color. Nose: Smoky scorched color. Urine: Clear white. Bowel: Once every five days. Diagnosis: Severe depletion of Ying Qi, Liver-Kidney Fire rushing upward to Stomach collaterals causing vomiting, floating to Pericardium causing insomnia. Prescribed Yangxin Tang (Heart-Nourishing Decoction) plus Huanglian, Niuxi (Achyranthes Root), Yiyiren (Coix Seed). Advised monitoring urine color for improvement. One dose: Vomiting stopped, appetite returned, urine yellow. Two doses: Sleep restored, tongue coating faded. Distension in hypochondria pulling sensation: Added Zhizi (Gardenia Fruit) and Chuanlianzi (Evodia Fruit). Two doses: Mass in left hypochondrium descended. Added Pipaye (Loquat Leaf), Shudi, Louren; removed Zhizi, Chuanlianzi, Huanglian, Niuxi. Two doses: Mass in right hypochondrium descended, pulse收敛 (gathered), bowel movement every two days. Due to urgent travel, advised continuing prescription until tongue tremor ceases. Caution against wind-drying agents if leg weakness recurs. Reason: Acupuncture provided temporary relief via draining.

Zhang Xugu treated a seventy-year-old man. Malaria years ago left root cause untreated, recurring in summer-autumn. From last winter to Dinghai spring, sudden vomiting, shivering, tendon spasm pain, recurrent remissions. Sometimes yellow-red urine, dry scant stool, facial red glow. Diagnosed as Liver Depression transforming into Fire, Fire insulting Stomach causing vomiting. Stomach Yin deficiency causing yellow-red urine and dry stool. Zhang's pulse: Deficient, choppy, lacking spirit. Tongue: White, rotten, thick coating. Diagnosis: Middle Jiao Deficient Cold, Turbid Yin accumulating in Stomach. Principal herb: Ginger-processed Banxia (Pinellia Tuber). Assistants: Renshen (Ginseng Root), Fuling (Poria), Fuzi (Aconite Root), Ganjiang (Dried Ginger), Shengjiang (Fresh Ginger), Guizhi (Cinnamon Twig), Shaoyao (Peony Root), Wumei (Mume Fruit), Caoguoren (Areca Seed). One dose highly effective. Removed Wumei, added Houpo (Magnolia Bark), continued ten-plus doses. Each dose contained 3 qian of Fuzi. Appetite opened, disease cured.