王太仆曰∶大寒而甚，热之不热，是无火也，当治其心。大热而甚，寒之不寒，是无水
也，热动夏止，悠忽往来，时动时止，是无水也，当补其肾。故心盛则生热，肾盛则生寒。
肾虚则寒动于中，心虚则热收于内。又热不胜寒，是无火也，寒不胜热，是无水也。夫寒之
不寒，责其无水；热之不热，责其无火。热之不久，责之心虚；寒之不久，责肾之弱。
治者当深味之。
立斋曰∶疮疡发热烦躁，或出血过多，或脓溃大泄，或汗多亡阳，或下多亡阴，以致阴
血耗散，阳无所根据，浮散于肌表之间，而非火也。若发热无寐者，血虚也，用圣愈汤。兼汗
不止，气虚也，急用独参汤。发热烦躁，肉 筋惕，血气俱虚也，用八珍汤。大渴面赤，
脉洪大而虚，阴虚发热也，用当归补血汤。肢体微热，烦躁面赤，脉沉而微，阴盛发躁也，
用四君加姜、附。
立斋曰∶喜热恶寒而呕者，宜温养胃气。脉细，肠鸣腹痛，滑泄而呕者，宜托里温中。
喜寒恶热而呕者，宜降火。脉实便秘而呕者，宜泻火。若不详究其源，而妄用攻毒之药，则
肿者不能溃，溃者不能敛矣。虽丹溪曰，肿疡时呕，当作毒瓦斯攻心治之，溃疡时呕，当作阴
虚补之，殊不知此大概之言耳。况今之热毒内攻而呕者，十才一二，脾胃虚寒或痰气而呕者
，十居八九，故不可执以为言也。又曰∶凡痈疡肿赤痛甚，烦躁脉实而呕者，为有余，当下之
。若肿硬不溃，脉弱而呕者，乃阳气虚弱，当补之。若呕吐食少者，乃胃气虚寒，当温补脾
胃。若痛伤胃气，或感寒邪秽气而呕者，虽在肿疡，当助胃壮气，若妄用攻伐，多致变证不治。
薛氏《枢要》曰∶疮疡作呕，不可泥于热毒内攻，而概用败毒等药。如热甚 痛，邪
气实也，仙方活命饮解之。作脓 痛，胃气虚也，托里消毒散补之。脓熟胀痛，气血虚也
，先用托里散，后用针以泄之。 痛便秘，热壅于内也，内疏黄连汤导之。若因寒药伤胃
而呕者，托里建中汤。胃寒少食而呕者，托里益中汤。中虚寒淫而呕者，托里温中汤。肝木
乘脾而呕者，托里抑青汤。胃脘停饮而呕者，托里清中汤。脾虚自病而呕者，托里益黄汤。
郁结伤脾而呕者，托里越鞠汤。又曰∶大凡诸疮作呕，若饮冷便秘是热毒也，黄连消毒散解
之。饮冷便实是胃火也，竹叶石膏汤清之。懒食饮汤是胃虚也，补中益气汤补之。大便不实
，喜饮热汤是脾胃虚寒也，六君加炮姜以温之。常见脾胃虚弱者，用前散反心膈阴冷致呕，
而喉舌生疮，乃肾水枯涸，虚火炎上也，其证甚恶，急用加减八味丸，亦有得生者。
热毒作呕，证如刘贵患腹痈， 痛烦躁脉实作呕。河间云∶疮疡者，火之属，须分内外
，以治其本。若脉沉实者，先当疏其内，以绝其源。又曰∶呕哕心烦，脉沉而实，肿硬木闷，
或皮肉不变，邪气在内，宜用内疏黄连汤治之。然做呕脉实，毒在内也。遂以前汤通利二三
行，诸证悉去，更以连翘消毒散而愈。
金台王时亨，年逾四十，患臂毒 痛作呕，服托里消毒药愈甚，予用凉膈散二剂顿退
，更以四物汤加芩连，四剂而消。（薛按）
胃寒作呕，证如顾浩室人，年逾四十，患发背，治以托里药而溃。忽呕而疮痛，胃脉弦
紧，彼以为余毒内攻。东垣云∶呕吐无时，手足厥冷，脏腑之虚也。丹溪云∶溃后发呕不
食者，湿气侵于内也。又云∶脓出而反痛，此为虚也，今胃脉弦紧，木乘土位，其虚明矣。
予欲以六君子汤加酒炒芍药、砂仁、藿香治之。彼自服护心散，呕愈甚，复邀治。仍用前药，
更以补气血药，两月而愈。大抵湿气内侵，或感秽气而作呕者，必喜温而脉弱，热毒内攻而
作呕者，必喜凉而脉数。必须辨认明白。亦有大便不实，或腹痛，或膨胀，或呕吐，或吞酸
嗳腐，此皆肠胃虚寒也，以理中汤治之。如不应，加熟附子二三片。予尝饮食少思，吞酸嗳
腐，诸药不应，惟服理中汤及附子理中丸有效。盖此证皆因中气虚寒，不能运化郁滞所致，
故用温补之剂，使中气温和，自无此证矣。张生患漆疮作呕，由中气虚弱，漆毒侵之，予以
六君子汤加砂仁、藿香、酒炒芍药治之，彼不信，另服连翘消毒散，呕果甚。复邀治，仍以
前药，外用麻油调铁锈末涂之而愈。（薛按）
戴氏曰∶如恶心者，无声无物，欲吐不吐，欲呕不呕，虽曰恶心，实非心经之病，皆在
胃口上，宜用生姜，盖能开胃豁痰也。（名元礼南院使）
王冰（王太仆）说：如果身体极度寒冷，用热药治疗却不见温热效应，这是命门火衰（无火），应当温补心肾之阳。如果身体极度发热，用寒药治疗却不见清凉效果，这是肾阴枯竭（无水）。如果是暑热季节症状时发时止、忽来忽去，这也是肾阴不足（无水），应当滋补肾阴。所以，心火亢盛则产生实热，肾水亢盛则产生实寒。肾气虚弱则寒气内生，心气虚弱则热气内收。另外，如果用热药不能驱散寒邪，是因为体内无火；用寒药不能清除热邪，是因为体内无水。热药见效短暂，责任在于心气虚弱；寒药见效短暂，责任在于肾气衰弱。治疗者应当深刻体会这些道理。
薛己（立斋）说：疮疡患者出现发热烦躁，或者因为出血过多，或者脓液溃破大量流失，或者出汗过多导致阳气亡失，或者泻下过度导致阴液亡失，从而导致阴血耗散，阳气失去依附，浮散在肌表之间，这并非真正的火证。如果发热且无法入睡，是血虚所致，使用圣愈汤。如果兼有汗出不止，是气虚所致，紧急使用独参汤。如果发热烦躁，肌肉跳动、筋脉抽搐，是气血俱虚所致，使用八珍汤。如果极度口渴、面色红赤，脉象洪大但按之空虚，是阴虚发热，使用当归补血汤。如果肢体微热，烦躁面赤，脉象沉而微弱，是阴盛格阳导致的假躁，使用四君子汤加生姜、附子。
薛己说：喜欢热饮、厌恶寒冷并伴有呕吐的，适宜温养胃气。如果脉象细弱，肠鸣腹痛，滑泄并伴有呕吐的，适宜托里温中。喜欢冷饮、厌恶炎热并伴有呕吐的，适宜降火。如果脉象实大、便秘并伴有呕吐的，适宜泻火。如果不详细探究病因根源，而盲目使用攻毒药物，那么未溃破的疮疡就不能溃破，已溃破的疮疡就不能收敛愈合。虽然朱丹溪说，疮疡初期呕吐，当作毒瓦斯攻心来治疗，溃疡期呕吐，当作阴虚来补益，殊不知这只是大概的说法。况且现在因热毒内攻而呕吐的，十人中只有一二人，因脾胃虚寒或痰气上逆而呕吐的，十人中有八九人，所以不可拘泥于这种说法。又说：凡是痈疡红肿疼痛剧烈，烦躁、脉实并伴有呕吐的，属于实证有余，应当用下法。如果肿胀坚硬不溃破，脉弱并伴有呕吐的，是阳气虚弱，应当用补法。如果呕吐、食量减少的，是胃气虚寒，应当温补脾胃。如果疼痛损伤了胃气，或者感受寒邪秽气而呕吐的，即使在疮疡初期，也应当助胃壮气，如果妄用攻伐药物，多会导致变证而无法治愈。
薛氏《枢要》说：疮疡出现呕吐，不可拘泥于热毒内攻，而一概使用败毒等药物。如果热甚且疼痛，是邪气实盛，用仙方活命饮解除。如果成脓期疼痛，是胃气虚弱，用托里消毒散补益。如果脓熟胀痛，是气血虚弱，先用托里散，后用针具排脓。如果疼痛伴便秘，是热邪壅滞于内，用内疏黄连汤导下。如果因寒凉药物损伤胃气而呕吐的，用托里建中汤。胃寒食少而呕吐的，用托里益中汤。中焦虚寒湿盛而呕吐的，用托里温中汤。肝木乘脾而呕吐的，用托里抑青汤。胃脘停饮而呕吐的，用托里清中汤。脾虚自病而呕吐的，用托里益黄汤。郁结伤脾而呕吐的，用托里越鞠汤。又说：大凡各种疮疡出现呕吐，如果喜冷饮、便秘的是热毒，用黄连消毒散解除。如果喜冷饮、大便干结的是胃火，用竹叶石膏汤清解。如果懒于进食喝汤的是胃虚，用补中益气汤补益。如果大便稀溏、喜欢喝热汤的是脾胃虚寒，用六君子汤加炮姜温补。常见脾胃虚弱的人，使用前文提到的清热发散药反而导致心膈阴冷而呕吐，且喉舌生疮，这是肾水枯涸，虚火上炎所致，病情很严重，紧急使用加减八味丸，也有获救的。
热毒引起的呕吐，案例如刘贵患腹痈，局部肿痛、烦躁、脉实而呕吐。刘河间说：疮疡属于火类病症，必须区分内外，以治其本。如果脉象沉实，应当先疏通内部，以断绝病源。又说：呕吐呃逆、心烦，脉象沉而实，疮疡肿胀坚硬麻木，或者皮肉颜色不变，是邪气在内，宜用内疏黄连汤治疗。然而脉实作呕，说明毒邪在内。于是以前方通利大便二三行，所有症状全部去除，再用连翘消毒散而痊愈。
金台人王时亨，年龄超过四十岁，患手臂毒疮肿痛并呕吐，服用托里消毒药后病情加重，我用凉膈散两剂使症状顿退，再用四物汤加黄芩、黄连，四剂后消散。（薛己按语）
胃寒引起的呕吐，案例如顾浩的妻子，年龄超过四十岁，患发背疽，用托里药治疗后溃破。突然呕吐且疮痛，胃脉弦紧，她认为是余毒内攻。李东垣说：呕吐无定时，手足厥冷，是脏腑虚损。朱丹溪说：溃后发呕不食，是湿气侵入体内。又说：脓出后反而疼痛，这是虚证，现在胃脉弦紧，是肝木乘脾土之位，其虚证很明显。我想用六君子汤加酒炒芍药、砂仁、藿香治疗。她自己服用护心散，呕吐更严重，再次邀请诊治。我仍用前药，再加补气血药，两个月后痊愈。大抵湿气内侵，或感受秽气而呕吐的，一定喜欢温暖且脉象弱；热毒内攻而呕吐的，一定喜欢凉爽且脉象数。必须辨认清楚。也有大便稀溏，或腹痛，或腹胀，或呕吐，或吞酸嗳腐的，这些都是肠胃虚寒，用理中汤治疗。如果无效，加熟附子二三片。我曾饮食少思、吞酸嗳腐，诸药无效，只有服用理中汤及附子理中丸有效。因为这个证候都是因中气虚寒，不能运化郁滞所致，所以用温补药剂，使中气温和，自然就没有这个证候了。张生患漆疮并呕吐，因中气虚弱，漆毒侵袭，我用六君子汤加砂仁、藿香、酒炒芍药治疗，他不相信，另服连翘消毒散，呕吐果然加重。再次邀请诊治，仍用前药，外用麻油调铁锈末涂抹而痊愈。（薛己按语）
戴元礼（南院使）说：如恶心的情况，没有声音也没有吐出物，想吐吐不出，想呕呕不出，虽然叫恶心，实际上不是心经的疾病，都在胃口上方，适宜用生姜，因为生姜能开胃豁痰。
Wang Bing (Grand Master Wang) stated: If the body is extremely cold and does not respond to heat therapy, it indicates a deficiency of Mingmen Fire (Mingmen Fire Deficiency), and one should tonify the Yang of the Heart and Kidney. If the body is extremely hot and does not respond to cold therapy, it indicates exhaustion of Kidney Yin (Kidney Yin Exhaustion). If symptoms in summer appear intermittently or come and go suddenly, this also indicates insufficient Kidney Yin, and one should nourish Kidney Yin. Therefore, hyperactivity of Heart Fire generates excess heat, while hyperactivity of Kidney Water generates excess cold. Kidney Qi deficiency leads to internal generation of cold, while Heart Qi deficiency leads to retention of heat internally. Furthermore, if heat drugs fail to dispel cold, it is due to the absence of fire; if cold drugs fail to clear heat, it is due to the absence of water. If the effect of heat drugs is short-lived, the responsibility lies in Heart Qi deficiency; if the effect of cold drugs is short-lived, the responsibility lies in Kidney Qi weakness. Practitioners should deeply comprehend these principles.
Xue Ji (Lizhai) stated: In patients with sores and ulcers, fever and irritability may occur due to excessive bleeding, profuse discharge of pus, excessive sweating leading to loss of Yang Qi, or excessive purgation leading to loss of Yin fluids. This causes consumption of Yin and Blood, leaving Yang Qi without support, floating on the surface of the skin and muscles, which is not a true Fire syndrome. If there is fever accompanied by insomnia, it is due to Blood deficiency, treated with Shengyu Decoction. If accompanied by incessant sweating, it is due to Qi deficiency, requiring urgent administration of Danshen Decoction. If there is fever, irritability, muscle twitching, and tendon tremors, it is due to dual deficiency of Qi and Blood, treated with Bazhen Decoction. If there is extreme thirst, red face, and a flooding pulse that is empty upon pressure, it is Yin-deficiency fever, treated with Danggui Buxue Tang. If there is slight limb heat, irritability, red face, and a deep, faint pulse, it is false restlessness caused by Yin excess repelling Yang, treated with Sijunzi Decoction added with Ginger and Aconite.
Xue Ji stated: For those who prefer warmth, dislike cold, and suffer from vomiting, warming and fortifying Stomach Qi is appropriate. If the pulse is fine, with borborygmus, abdominal pain, slippery diarrhea, and vomiting, reinforcing the interior and warming the middle is appropriate. For those who prefer coolness, dislike heat, and suffer from vomiting, descending Fire is appropriate. If the pulse is excess and solid, with constipation and vomiting, draining Fire is appropriate. If the root cause is not investigated in detail and toxic-clearing drugs are used blindly, un-ulcerated sores will not ulcerate, and ulcerated sores will not heal. Although Zhu Danxi said that vomiting during the early stage of sores should be treated as toxic vapors attacking the Heart, and vomiting during the ulcerative stage should be treated as Yin deficiency, this is merely a general statement. Moreover, cases of vomiting due to internal attack of heat toxicity account for only one or two out of ten, whereas vomiting due to Spleen-Stomach deficiency-cold or phlegm-Qi rebellion accounts for eight or nine out of ten; thus, one should not adhere rigidly to such statements. It is further stated: For any carbuncle or sore with severe redness, swelling, and pain, accompanied by irritability, an excess pulse, and vomiting, it belongs to excess syndromes, and purgation should be used. If the swelling is hard and does not ulcerate, accompanied by a weak pulse and vomiting, it is due to deficiency of Yang Qi, and tonification should be used. If there is vomiting and reduced food intake, it is due to deficiency-cold of Stomach Qi, and warming and tonifying the Spleen and Stomach is required. If pain damages Stomach Qi, or if vomiting occurs due to exposure to cold pathogens or foul odors, even in the early stage of sores, one should assist Stomach Qi and strengthen Qi; blind use of attacking drugs often leads to complications that are incurable.
The "Key Principles" by Xue states: Vomiting in sores and ulcers should not be rigidly attributed to internal attack of heat toxicity, nor should toxic-clearing drugs be used indiscriminately. If heat is severe and painful, indicating excess pathogenic factors, Xianfang Huoming Yin should be used to resolve it. If pain occurs during the suppuration stage, indicating deficiency of Stomach Qi, Tuoli Xiaodu San should be used to tonify. If there is distending pain when pus is ripe, indicating deficiency of Qi and Blood, Tuoli San should be used first, followed by lancing to drain pus. If pain is accompanied by constipation, indicating heat congestion internally, Neishu Huanglian Tang should be used to guide out the stagnation. If vomiting occurs due to damage to the Stomach by cold medicines, Tuoli Jianzhong Tang should be used. If vomiting occurs due to Stomach cold and poor appetite, Tuoli Yizhong Tang should be used. If vomiting occurs due to central deficiency and excess cold-dampness, Tuoli Wenzhong Tang should be used. If vomiting occurs due to Liver Wood overacting on Spleen, Tuoli Qingtang Tang should be used. If vomiting occurs due to fluid retention in the epigastrium, Tuoli Qingzhong Tang should be used. If vomiting occurs due to Spleen deficiency and self-pathology, Tuoli Yihuang Tang should be used. If vomiting occurs due to constraint injuring the Spleen, Tuoli Yueju Tang should be used. It is further stated: Generally, for vomiting in various sores, if the patient prefers cold drinks and has constipation, it is heat toxicity, treated with Huanglian Xiaodu San. If the patient prefers cold drinks and has dry stools, it is Stomach Fire, treated with Zhuye Shigao Tang. If the patient is lazy to eat or drink soup, it is Stomach deficiency, treated with Buzhong Yiqi Tang. If stools are loose and the patient prefers hot drinks, it is Spleen-Stomach deficiency-cold, treated with Liujunzi Decoction added with roasted Ginger to warm. It is common to see that patients with weak Spleen-Stomach, after using the aforementioned dispersing/clearing drugs, develop coldness in the chest and diaphragm leading to vomiting, and sores in the throat and tongue; this is due to exhaustion of Kidney Water and flaming up of deficient Fire. The condition is very serious, and Jiawei Bawei Wan should be administered urgently; some patients survive.
Vomiting due to heat toxicity is exemplified by Liu Gui, who suffered from an abdominal abscess with local swelling and pain, irritability, an excess pulse, and vomiting. Liu Hejian stated: Sores and ulcers belong to the Fire category; one must distinguish between 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. It is further stated: Vomiting, hiccups, and irritability with a deep and solid pulse, hard and numb swelling of sores, or unchanged skin and flesh color indicate pathogens inside, and Neishu Huanglian Tang is suitable. However, an excess pulse with vomiting indicates toxins inside. Thus, the aforementioned decoction was used to promote bowel movements two or three times, all symptoms disappeared, and the patient recovered with Liaoqiao Xiaodu San.
Wang Shiheng from Jintai, over forty years old, suffered from a toxic sore on his arm with swelling, pain, and vomiting. His condition worsened after taking Tuoli Xiaodu medicine. I used Liangge San for two doses, which rapidly relieved the symptoms, followed by Siwu Tang added with Scutellaria and Coptis for four doses, resulting in resolution. (Note by Xue Ji)
Vomiting due to Stomach cold is exemplified by the wife of Gu Hao, over forty years old, who suffered from a back carbuncle. After treatment with interior-reinforcing medicine, it ulcerated. She suddenly vomited and experienced sore pain; her Stomach pulse was wiry and tight. She believed it was residual toxin attacking internally. Li Dongyuan stated: Vomiting without fixed timing and cold extremities indicate deficiency of the Zang-Fu organs. Zhu Danxi stated: Vomiting and refusal to eat after ulceration indicate dampness invading internally. He further stated: Pain returning after pus discharge indicates deficiency. Now, with a wiry and tight Stomach pulse, it is Liver Wood overacting on Earth position, clearly indicating deficiency. I intended to treat with Liujunzi Decoction added with wine-fried Peony, Amomum, and Agastache. She took Huxin San herself, and vomiting worsened. Upon re-invitation, I used the previous prescription again, adding Qi- and Blood-tonifying herbs, and she recovered in two months. Generally, vomiting due to internal invasion of dampness or foul odors is characterized by preference for warmth and a weak pulse; vomiting due to internal attack of heat toxicity is characterized by preference for coolness and a rapid pulse. One must distinguish them clearly. There are also cases of loose stools, abdominal pain, distension, vomiting, or acid regurgitation and belching, all of which are deficiency-cold of the intestines and stomach, treated with Lizhong Tang. If ineffective, add two or three slices of prepared Aconite. I once suffered from poor appetite, acid regurgitation, and belching; other medicines were ineffective, but Lizhong Tang and Fuzi Lizhong Wan were effective. This condition is caused by deficiency-cold of Middle Qi, failing to transform and transport stagnation; thus, warming and tonifying agents make the Middle Qi harmonious, eliminating the condition. Zhang Sheng suffered from lacquer dermatitis with vomiting due to weak Middle Qi and invasion of lacquer toxin. I treated him with Liujunzi Decoction added with Amomum, Agastache, and wine-fried Peony. He did not believe me and took Liaoqiao Xiaodu San instead, causing vomiting to worsen. Upon re-invitation, I used the previous prescription again, and externally applied iron rust powder mixed with sesame oil, resulting in recovery. (Note by Xue Ji)
Dai Yuanli (Palace Envoy) stated: Nausea, characterized by no sound and no vomitus, where one wants to vomit but cannot, although called nausea, is actually not a disease of the Heart Meridian, but located above the Stomach gate. Fresh Ginger is appropriate, as it can open the Stomach and resolve phlegm.