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[Treatment Principles]
The *Jingyao* (Essentials) states: There are two patterns of vomiting and regurgitation. One pattern occurs at the onset, before taking Neituo San (Internal Support Powder), where latent heat is trapped in the Heart; the other pattern involves Qi deficiency with disharmony of Spleen Qi. 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 rebellions, such as vomiting and hiccups, belong to Fire. Neituo San has a cool nature and indeed possesses the principle of descending Fire. However, Jiahe San has little tonifying power; its mere warmth may only assist the Fire. Shanyao Wan tonifies the Kidney to strengthen the Yin of the Lower Jiao, which is roughly consistent with medical theory. Nevertheless, treating vomiting requires distinguishing between stages: during the abscess stage (swelling without ulceration), it should be treated as toxic vapors attacking upwards; after ulceration, it should be treated as Yin deficiency. If an elderly person suffers from vomiting, regurgitation, and inability to eat after the ulceration of a carbuncle, Shen-Zhu Baigao (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 using Shanyao Wan would be too slow for urgent conditions and difficult to be effective. Liu Hejian stated: Vomiting in patients with sores and ulcers is caused by Dampness invading the Stomach; thus, Bai Zhu (Atractylodis Rhizoma) should be doubled in the prescription.

[Xue Ji's Commentary]
Vomiting caused by sores and ulcers should not be rigidly treated with detoxifying herbs under the assumption of internal attack by toxic vapors. If heat is severe and pain is intense, this indicates excess pathogenic factors; Xianfang Huoming Yin (Immortal Formula for Saving Lives) can be used to resolve it. If pain occurs during suppuration due to deficient Stomach Qi, Tuoli Xiaodu San (Support Interior and Detoxify Powder) should be used to tonify. If there is heat and distending pain after pus discharge, this indicates deficiency of Qi and Blood; first use Tuoli San (Support Interior Powder), then puncture to drain. If pain is accompanied by constipation, heat is accumulated internally; Neishu Huanglian Tang (Drain Internal Coptis Decoction) can be used to guide out stagnation. If vomiting is caused by cold medicines damaging the Stomach, Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) is indicated. For vomiting due to Cold Stomach and poor appetite, Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction) is used. For vomiting due to middle deficiency and excessive Cold, Tuoli Wenzhong Tang (Support Interior and Warm Middle Decoction) is used. For vomiting due to Liver Wood overacting on Spleen Earth, Tuoli Yiqing Tang (Support Interior and Suppress Green Decoction) is used. For vomiting due to phlegm retention in the epigastrium, Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction) is used. For vomiting due to Spleen deficiency itself, Tuoli Yihuang Tang (Support Interior and Benefit Yellow Decoction) is used. For vomiting due to constraint injuring the Spleen, Tuoli Yueju Tang (Support Interior and Resolve Depression Decoction) is used. If the root cause is not investigated in detail and toxic-resolving drugs are used blindly, un-ulcerated swellings will not suppurate, and ulcerated wounds will not heal. Although Danxi stated that the abscess stage should be treated as toxic vapors attacking the Heart and the ulcer stage as Yin deficiency, this was a general statement. Nowadays, vomiting due to internal attack of hot toxins is rare, while vomiting due to Spleen-Stomach deficiency-cold is common. How can one stick to fixed formulas without flexibility? Furthermore, he stated: Vomiting triggered by desire, or caused by external application/internal administration of cold-cooling agents, severe pain, or exposure to cold pathogens and foul odors, all indicate deficiency of Stomach Qi. Tuoli Xiaodu San can be used, removing three ingredients, adding Huoxiang (Patchouli Herba), and doubling Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma).

For abundant heat and rapid pulse, *Jingyao* suggests Lulu Tang (Phlomidos Root Decoction) or boiling Dahuang (Rhei Radix et Rhizoma) alone. If heat is not severe and the pulse is slow and weak, only Wuxiang Liaoqiao Tang (Five-Aromatic and Forsythia Decoction) should be administered. Danxi said: Regarding abundant heat and rapid pulse, if it occurs during the abscess stage with closed organs and a robust constitution, purgatives may still be used. However, if it occurs during the ulcer stage with significant loss of pus and blood, accompanied by abundant heat and rapid pulse, death is near; how can purgatives be used? A slow and weak pulse was considered by ancients as a sign that pathogenic toxins had dispersed; given that Wuxiang Liaoqiao Tang has ascending and dispersing properties, is it appropriate to use it in such cases?

Li Shi stated: Vomiting and regurgitation from carbuncles and ulcers are caused by toxic vapors rushing to the Heart, not by Cold of the Spleen and Stomach; therefore, Neituo San should be taken. Yang Shi stated: After a nosebleed has just healed, without sweating to release the exterior, toxins remain in the meridians, leading to a large carbuncle on the back extending from the shoulder to the waist and hypochondrium, swollen, hard as stone, and purple-black. Using cooling medicines resulted in all-night severe vomiting. Continuous administration of Neituo San stopped the vomiting, allowed the sore to ulcerate, and discharged clear fluid, resulting in recovery after forty days. Another patient with a carbuncle experienced pain so severe it induced vomiting, which ceased upon taking this medicine. Since some carbuncle patients do not take this medicine, Yang Shi's words are cited to dispel worldly confusion.

Danxi treated an elderly man, aged seventy, who had a dorsal carbuncle over a chi in diameter for a long time. Various doctors had administered dozens of doses of Wuxiang and Shixuan formulas, causing bloody, foul-smelling pus, vomiting, regurgitation, and inability to eat for over ten days. The patient self-administered Neituo San but felt discomfort in the chest and diaphragm. He also suffered from strangury for thirty years. His current suffering was the pain of strangury and vomiting preventing sleep. Urgently, a paste was boiled from Renshen (Ginseng Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma), administered with Niuxi Tang (Achyranthes Bidentata Decoction) and Zhuli (Bamboo Sap). After three days, having consumed half a jin of medicine, the strangury stopped and appetite returned. After seven days, consuming four jin of medicine, pus gushed out naturally, and he could sleep. After another twenty days, he recovered. Another man, over sixty years old, fond of wine and meat, developed a dorsal carbuncle with pus, vomiting, regurgitation, and fever, likely due to excessive intake of Neituo San and Shixuan. Because of vomiting, the doctor added Dingxiang (Caryophylli Flos) to Jiahe San to warm the Stomach and move Qi. It was mid-summer, very hot, and the pulse was surging, rapid, and forceful. I remarked that this pulse and syndrome are particularly contraindicated in the ulcer stage. However, since his physical constitution was robust, I only gave him Ren Shen Gao (Ginseng Paste) mixed with Zhuli (Bamboo Sap). After consuming fifteen jin of medicine and over a hundred bamboo stalks, he recovered. I said: This disease recovered fortunately; without a bland diet, it would recur. He continued his rich diet and, after sitting in a pool drunk in summer, more than a year later, a soft lump like a cake appeared on his left flank. Two years later, this lump became a carbuncle. Seeing profuse pus and blood, with a surging, rapid, forceful pulse, and again suffering vomiting, regurgitation, and poor appetite, he self-administered Ren Shen Gao with Zhuli, consuming over ten jin and a hundred bamboo stalks before recovering. Now eighty years old, he remains strong as ever. This illness healed twice because of the elderly man's weak Qi and Blood, specifically through the exclusive use of Renshen and Zhuli. Had Neituo San and Shixuan been used, safety might not have been achieved. Lou Quanshan treated a man with vomiting during the abscess stage; various medicines failed, but one dose of Dushen Tang (Single Ginseng Decoction) cured the vomiting immediately.

Xue Xinpu treated a man with an abdominal abscess, painful swelling, irritability, and vomiting, with a solid pulse. Liu Hejian stated: Sores and ulcers belong to Fire; one must distinguish 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. He also stated: Vomiting, hiccups, irritability, deep and solid pulse, local swelling and hardness with numbness, or unchanged skin color indicate pathogens inside; Neishu Huanglian Tang should be used. Thus, the aforementioned decoction was used to promote defecation two or three times, eliminating all symptoms, followed by Liaoqiao Xiaodu San (Forsythia and Scutellaria Detoxifying Powder) for complete recovery. Another patient with arm toxicity experienced pain, swelling, and vomiting; symptoms worsened after taking Tuoli Xiaodu San. Two doses of Liangge San (Cool the Diaphragm Powder) quickly reduced the condition, followed by Siwu Tang (Four Substances Decoction) with Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma) for four doses until resolution. Xinpu also treated a man over forty who had an ulcerated dorsal carbuncle, suddenly developing vomiting and wound pain. The Stomach pulse was wiry and tight. He believed it was residual toxin attacking internally. Dongyuan stated: Vomiting without regularity and cold extremities indicate deficiency of the Zang-Fu organs. Danxi stated: Vomiting and inability to eat after ulceration indicate Dampness invading internally. He also stated: Pain returning after pus discharge indicates deficiency. Now, with a wiry and tight Stomach pulse, Wood is overacting on Earth, clearly indicating deficiency. I intended to treat with Liujunzi Tang (Six Gentlemen Decoction) plus Jiuhao Shaoyao (Wine-fried White Peony Root), Sharen (Amomi Fructus), and Huoxiang (Patchouli Herba). The patient self-administered Huxin San (Heart-Protecting Powder), worsening the vomiting. Upon re-examination, the previous formula was used again, supplemented with Qi and Blood tonics, resulting in recovery after two months. Generally, vomiting caused by internal invasion of Dampness or foul odors prefers coolness and presents with a weak pulse; vomiting caused by internal attack of Hot Toxins prefers cooling and presents with a rapid pulse. These must be clearly distinguished.

Juban Weiling Tang (Tangerina Peel, Pinellia, and Poria Decoction) treats vomiting and inability to eat or taste in carbuncles and ulcers.
Chenhong (Tangerina Peel), Banxia (Pinelliae Rhizoma prepared with ginger, each 1 qian); Cangzhu (Atractylodis Rhizoma soaked in rice water and fried); Baizhu (Atractylodis Macrocephalae Rhizoma fried); Houpo (Magnoliae Officinalis Cortex prepared with ginger); Gancao (Licorice Root roasted); Fuling (Poria); Renshen (Ginseng Radix et Rhizoma); Zexie (Alismatis Rhizoma); Maogen (Imperatae Rhizoma, each 2 qian); Jiangzhi (Ginger Juice, several spoons).
Boil with two cups of water until one cup remains, add Ginger Juice, boil for one or two boils. Drink in over ten portions.

Mr. Xue stated: The preceding syndrome belongs to five of the "Seven Evils." After using this formula, when Stomach Qi begins to awaken, Liujunzi Tang (Six Gentlemen Decoction) should be taken concurrently. For those with irritability, craving cold drinks, anorexia, deep solid pulse, and vomiting, this formula is likely inappropriate; Neishu Huanglian Tang (Drain Internal Coptis Decoction) is preferred. (Formula see Abscess Section.)

Tuoli Xiaodu San Modification treats vomiting or regurgitation in sores and ulcers, or vomiting caused by external application/internal administration of cold-cooling agents, severe pain, or exposure to cold pathogens and foul odors, all indicating deficiency of Stomach Qi. Remove Baizhi (Angelicae Dahuricae Radix), Liaoqiao (Forsythiae Fructus), and Jinyinhua (Lonicerae Japonicae Flos); add Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Huoxiang (Patchouli Herba). (Formula see Abscess Section, Neituo Item.)

Tuoli Jianzhong Tang (Support Interior and Strengthen Middle Decoction) treats sores and ulcers in patients with originally deficient Yuan Qi, or Stomach damage from cooling medicines, poor appetite, or symptoms such as vomiting and diarrhea.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria, each 2 qian); Banxia (Pinelliae Rhizoma), Paojiang (Prepared Ginger, each 1 qian); Zhigancao (Roasted Licorice Root, 0.5 qian); Huangqi (Astragali Radix, 1.5 qian); Rougui (Cinnamomi Cortex, 0.3 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Tuoli Yizhong Tang (Support Interior and Benefit Middle Decoction) treats deficiency of Middle Qi, poor appetite, non-resolution of sores, or failure of ulcerated wounds to close.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Banxia (Pinelliae Rhizoma), Fuling (Poria), Paojiang (Prepared Ginger, each 1 qian); Muxiang (Aucklandiae Radix), Zhigancao (Roasted Licorice Root, each 0.5 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Tuoli Yiqing Tang (Support Interior and Suppress Green Decoction) treats weakness of Spleen Earth oppressed by Liver Wood, leading to poor appetite or discomfort in the chest and diaphragm.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma, each 1 qian); Shaoyao (Paeoniae Radix Alba), Chaihu (Bupleuri Radix), Gancao (Licorice Root, each 0.5 qian); Chenpi (Tangerina Peel, 1 qian).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Tuoli Qingzhong Tang (Support Interior and Clear Middle Decoction) treats weakness of Spleen and Stomach, turbid Phlegm-Qi, and poor appetite.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria, each 1 qian); Banxia (Pinelliae Rhizoma, 0.8 fen); Jiegeng (Platycodonis Radix, 0.7 fen); Zhigancao (Roasted Licorice Root, 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Tuoli Yihuang Tang (Support Interior and Benefit Yellow Decoction) treats deficiency-cold of Spleen Earth, Water counter-acting Earth, leading to poor appetite, vomiting, or diarrhea.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Tangerina Peel), Fuling (Poria), Banxia (Pinelliae Rhizoma, each 1 qian); Paojiang (Prepared Ginger), Dingxiang (Caryophylli Flos), Zhigancao (Roasted Licorice Root, each 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Tuoli Yueju Tang (Support Interior and Resolve Depression Decoction) treats injury from Six Depressions, weakness of Spleen and Stomach, and poor appetite.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma, each 2 qian); Chenpi (Tangerina Peel), Banxia (Pinelliae Rhizoma, each 1 qian); Shanzhi (Gardeniae Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xiangfumi (Cyperi Rhizoma), Cangzhu (Atractylodis Rhizoma, each 0.7 fen); Zhigancao (Roasted Licorice Root, 0.5 fen).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.

Renshen Lizhong Tang (Ginseng and Immortelle Decoction) treats deficiency-cold of Spleen and Stomach in sores and ulcers, vomiting, diarrhea, poor appetite, abdominal distension, empty fullness in the chest and diaphragm, or inability to ingest food.
Baizhu (Atractylodis Macrocephalae Rhizoma), Renshen (Ginseng Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Zhigancao (Roasted Licorice Root, equal parts).
Add Shengjiang (Fresh Ginger) and Dazao (Jujubae Fructus), decoct with water and take orally.