This time, things got physical.
During a commercial break, Perry walked up to Paul's podium, physically grabbed Paul's wrist, and pointed at Paul's face with his other hand (photo below from Reuters).
Perry and Paul were placed next to each other at the center for the Republican debate.
Before the physical exchange, the war of words between Paul and Perry was perhaps even more heated.
When Paul was asked if he supports getting rid of the minimum wage, the doctor briefly answered the question (he supports getting rid of it) and then launched into an attack against Perry.
Rick Perry criticized the Governor of Massachusetts [Mitt Romney] for RomneyCare, but he wrote a really fancy letter supporting HillaryCare, said Paul.
In response, Perry said he didn't know it was going to be the monstrosity that was known as HillaryCare.
Speaking of letters, I was more interested in the one you wrote to Ronald Reagan to say 'I'm going to quit the Party because of the things you believe in,' Perry then said to Paul.
In response to that, Paul said he was one of the few Congressmen to support Reagan in 1976. However, in the 1980s, Reagan deviated from his ideals and spent too much money, said Paul.
Later in the debate, Paul was asked about a letter his campaign wrote that accused Perry of at least 5 sins against conservatism.
Paul zeroed in on the accusation that Perry tried to forcibly vaccinate 12-year-old girls against HPV by executive order.
Perry, in his defense, said there was an opt-out in the order.
Rick Santorum, former U.S. Senator from Pennsylvania and also present at the debate, then countered that the order should be opt-in instead of opt-out.