天津杨姓媪，年过五旬，于季春得温病兼呕吐。
病因 家庭勃溪，激动肝胆之火，继因汗出受风，遂得此证。
证候 表里壮热，呕吐甚剧，不能服药，少进饮食亦皆吐出。舌
苔白浓，中心微黄。大便三日未行。其脉左部弦长，右部洪长，重按皆实。
诊断 此少阳阳明合病也。为其外感之热已入阳明胃府，是以表里俱壮热，而舌苔已黄，为其激
动之火积于少阳肝胆，是以其火上冲频作呕吐。治此证者欲其受药不吐，当变汤剂为
散，且又分毫无药味，庶可奏效。
处方 生石膏（一两细末） 鲜梨（两大个）
将梨去皮，切片，蘸石膏末，细细嚼服。
复诊 将梨片与石膏末嚼服一强半未吐，迟两点钟又将所余者服完，自此不复呕吐，可进饮食，大
便通下一次。诊其脉犹有余热，问其心中亦仍觉热，而较前则大轻减矣。拟改用汤剂。以清其未尽之热。
处方 生石膏（一两捣细） 生杭芍（八钱） 玄参（三钱） 沙参（三钱）
连翘（二钱） 甘草（二钱） 鲜白茅根（三钱）
药共七味，先将前六味水煎十余沸，入鲜白茅根再煎三四沸，取汤一大盅，温服。
效果 将药如法煎服一剂，热又减退若干，脉象已近和平，遂即
原方将石膏改用六钱，芍药改用四钱，又服一剂，病遂全愈。
或问 石膏为清阳明之主药，此证原阳明少阳均有实热，何以用石膏但清阳明之热而病即可愈？答
曰∶凡药服下，原随气血流行无处不到。石膏虽善清阳明之热，究之，凡脏腑间蕴有
实热，石膏皆能清之。且凡呕吐者皆气上逆也，石膏末服，其石质之重坠大能折其上逆之气使之
下行，又有梨片之甘凉开胃者以辅之，所以奏效甚捷也。若当秋夏之交无鲜梨时，可以西瓜代之。
天津一位杨姓老妇人，年龄超过五十岁，在晚春时节患上了温病并伴有呕吐。
病因：因家庭争吵，激惹了肝胆之火，随后又因出汗后受风，从而得了这个病症。
证候：身体表里都有高热，呕吐非常剧烈，无法服药，即使少量进食也会全部吐出。舌苔白厚，中心部位微微发黄。大便三天没有排出。脉象左侧弦而长，右侧洪大而长，重按感觉坚实有力。
诊断：这是少阳病与阳明病合病。因为外感的热邪已经传入阳明胃腑，所以表里都出现壮热，且舌苔已经变黄；因为被激惹的火气积聚在少阳肝胆，导致火气上冲，频繁发生呕吐。治疗此证，为了让患者服药后不呕吐，应当将汤剂改为散剂，并且药味要分毫不差（指精准控制剂量或简化），这样才能见效。
将梨去皮，切成片，蘸取石膏末，细细咀嚼服用。
复诊：将梨片和石膏末嚼服了一强半（约1.5倍量或特定计量单位，此处指大部分）后没有呕吐，过了两个小时将剩下的也服完，从此不再呕吐，可以进食，大便通畅排了一次。诊察脉象仍有余热，询问患者心中仍然觉得热，但比之前大大减轻了。打算改用汤剂，以清除未尽的余热。
处方：生石膏（一两，捣碎成细粉） 生杭芍（八钱） 玄参（三钱） 沙参（三钱） 连翘（二钱） 甘草（二钱） 鲜白茅根（三钱）
药物共七味，先将前六味用水煎煮十余沸，加入鲜白茅根再煎煮三四沸，取药汁一大盅，温服。
效果：按照方法煎服一剂后，热度又减退了一些，脉象已接近平和，随即在原方基础上将石膏改为六钱，芍药改为四钱，又服用一剂，病就完全痊愈了。
有人问：石膏是清解阳明经热的主药，此证原本阳明和少阳都有实热，为什么只用石膏清解阳明之热病就能好？回答说：凡是药物服下，原本就会随着气血流行，无处不到。石膏虽然善于清解阳明之热，但究其根本，凡脏腑间蕴含有实热的，石膏都能清解。而且凡是呕吐都是气机上逆，石膏末服用时，其石质的沉重坠降特性能大大折抑其上逆之气使其下行，又有梨片的甘凉开胃作用来辅助，所以见效很快。如果在夏秋之交没有鲜梨时，可以用西瓜代替。
A surnamed Yang, an elderly woman in Tianjin, over fifty years of age, contracted Warm Disease (Wen Bing) accompanied by vomiting in late spring.
Etiology: Due to a family dispute, the Fire of the Liver and Gallbladder was agitated; subsequently, wind invasion occurred after sweating, leading to this condition.
Symptoms: Severe heat in both the exterior and interior, with violent vomiting that prevented medication intake; even small amounts of food were vomited out. The tongue coating was thick white with a slightly yellow center. Bowel movements had not occurred for three days. The pulse was wiry and long on the left side, and flooding and long on the right side, feeling firm upon heavy pressure.
Diagnosis: This is a combined disease of Shaoyang (Lesser Yang) and Yangming (Greater Yang). Since the external pathogenic heat has entered the Stomach organ of the Yangming channel, there is severe heat in both the exterior and interior, and the tongue coating has turned yellow. Since the agitated fire has accumulated in the Shaoyang Liver and Gallbladder, the fire rushes upward causing frequent vomiting. To treat this condition such that the patient can retain the medicine, the decoction should be changed into a powder, ensuring precise dosage without unnecessary flavors, so as to achieve efficacy.
Prescription: Raw Gypsum Fibrosum (Shi Gao) (one liang, finely powdered); Fresh Pear (two large ones).
Peel the pear, slice it, dip the slices into the gypsum powder, and chew slowly before swallowing.
Second Visit: After chewing and swallowing one and a half portions of the pear slices mixed with gypsum powder, no vomiting occurred. Two hours later, the remainder was consumed. From then on, vomiting ceased, eating became possible, and bowel movement occurred once. Palpation revealed residual heat in the pulse. Inquiry indicated the heart still felt hot, but significantly less than before. It was decided to switch back to a decoction to clear the remaining heat.
Prescription: Raw Gypsum Fibrosum (Shi Gao) (one liang, crushed into fine powder); Raw Paeonia Lactiflora Radix (Sheng Bai Shao) (eight qian); Scrophulariae Radix (Xuan Shen) (three qian); Glehniae Radix (Sha Shen) (three qian); Forsythiae Fructum (Lian Qiao) (two qian); Licorice Root (Gan Cao) (two qian); Fresh Imperata Rhizome (Bai Mao Gen) (three qian).
The seven herbs were processed as follows: The first six were boiled in water for about ten boils. Then, the fresh Imperata Rhizome was added, and boiled for another three or four boils. One large cup of the decoction was obtained and taken warm.
Outcome: After taking one dose according to the method, the fever decreased further, and the pulse approached normalcy. Subsequently, the original prescription was modified: Raw Gypsum Fibrosum was reduced to six qian, and Paeonia Lactiflora Radix to four qian. After taking another dose, the illness was completely cured.
Interrogation: "Gypsum Fibrosum is the primary herb for clearing Yangming heat. In this case, there was excess heat in both Yangming and Shaoyang. Why did clearing only the Yangming heat with Gypsum Fibrosum result in a cure?" The answer is: Once ingested, all medicines circulate throughout the body via Qi and Blood. Although Gypsum Fibrosum excels at clearing Yangming heat, fundamentally, it can clear excess heat harbored in any Zang-Fu organs. Moreover, vomiting is always caused by rebellious Qi ascending. When Gypsum Fibrosum powder is ingested, its heavy and sinking mineral nature effectively suppresses the rebellious Qi, directing it downward. This is aided by the sweet and cool properties of the pear slices, which benefit the stomach and promote appetite. Hence, the effect is swift. If fresh pears are unavailable during the transition between summer and autumn, watermelon can be used as a substitute.