仲景曰。太阳病。当恶寒发热。今自汗出。反不恶寒发热。关上
脉细数者。以医吐之过也。若得病一二日吐之。腹中饥。口不能食。
三四日吐之者。不喜糜粥。欲饮冷食。朝食暮吐。以医吐之所致也。
此为小逆。常氏云。可小半夏加橘皮汤、温中汤。
又曰。太阳病吐之者。但太阳病当恶寒。今反不恶寒。不欲近衣
者。此为吐之内烦也。常氏云。可金匮竹皮汤、竹叶石膏汤。雍曰。大
橘皮汤、四味橘皮汤皆可服。
又曰。少阴病。饮食入口则吐。心中温温欲吐。复不能吐。始得
之。手足寒。脉弦迟者。此胸中实。不可下也。当吐之。若膈上有寒
饮。干呕者。不可吐也。急温之。常氏云。可小半夏加橘皮汤、温中
汤。
又曰。诸四逆厥者。不可吐之。虚家亦然。庞氏曰。诸四逆脉微
弱细。或弦迟。虽中满闷。不可吐。宜橘皮汤、枳实散。
又曰。虚家当
吐而不敢吐者。宜以枳实散压气毒痰水。过日毒瓦斯入胃。乃可微下
之。
庞氏曰。不可吐而强之吐。气筑心则死矣。
仲景曰。大法春宜吐。
又曰。凡用吐汤。中病则止。不必尽剂也。
又曰。病如桂枝证。头不痛。项不强。寸脉微浮。胸中痞硬。气上
冲咽喉不得息者。此为胸有寒。当吐之。（一云。此以内有久痰。当吐
之。）常氏云。可瓜蒂散。
又曰。病胸上诸实。（一云作寒）胸中郁郁而痛。不能食。欲使人
按之。而反有涎唾。（一作浊唾）下利日十余行。其脉反迟。寸口脉微
滑。此可吐之。吐之。利则止。常氏云。可瓜蒂散。
又曰。宿食在上脘者。当吐之。常氏云。可瓜蒂散。
又曰。少阴病。饮食入口则吐。心中温温欲吐。复不能吐者。宜
吐之。常氏云。宜瓜蒂散。
又曰。病患手足厥冷。脉乍结。（一作紧）以客气（一作邪结）在
胸中。心下满而烦。欲食不能食者。病在胸中。当吐之。常氏云。可瓜
蒂散。
庞氏曰。胸膈痞闷。痰壅塞碍。脉得浮滑。并宜瓜蒂散吐之。产
后六七日内。下泻。诸药不效。得此脉者。吐之。泻立止。
千金伤寒论曰。得病无热。但狂言烦躁不安。精采言语不与人
相主当者。勿以火迫之。但以猪苓散一方寸匕服之。当逼与新水一
升。若二升。强饮之。令以物刺喉中吐之。病随吐愈。若不能吐者。勿
强与之水。水停则结心下也。当更以余药吐之。若此病辈。不将猪苓
散吐解之者。其死殆速。有水饮膈实者。皆难治。此三死一生也。雍
曰。心下停水。难治之疾。须早吐也。
病源曰。寒多热少。可吐者。此谓痰多也。治疟亦如之。
Zhang Zhongjing said: In Taiyang disease (a syndrome caused by pathogenic factors affecting the Taiyang channel), aversion to cold and fever should be present. Now, if the patient sweats spontaneously but conversely lacks aversion to cold and fever, and the pulse at the Guan position is fine and rapid, this is an error caused by the physician's use of emesis. If emesis is induced one or two days after contracting the disease, the patient will feel hungry in the abdomen but unable to eat; if emesis is induced three or four days after contracting the disease, the patient will dislike congee and desire cold food, vomiting what was eaten in the morning by evening. This is also caused by the physician's improper use of emesis. This constitutes a minor adverse reaction. Chang Shi stated that Xiao Banxia Jia Ju Pi Tang (Minor Pinellia with Tangerine Peel Decoction) or Wen Zhong Tang (Warm the Middle Decoction) could be used.
He further said: When emesis is used for Taiyang disease, since Taiyang disease typically involves aversion to cold, the current absence of aversion to cold and the desire not to wear clothes indicate internal heat agitation (Nei Fan) caused by emesis. Chang Shi stated that Jin Gui Zhu Pi Tang (Golden Cabinet Bamboo Flake Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) could be used. Guo Yong stated that Da Ju Pi Tang (Major Tangerine Peel Decoction) and Si Wei Ju Pi Tang (Four-Ingredient Tangerine Peel Decoction) are both acceptable.
He further said: In Shaoyin disease (a syndrome caused by pathogenic factors affecting the Shaoyin channel), food and drink are vomited immediately upon entering the mouth, and there is a sensation of nausea in the heart region without the ability to actually vomit. At the onset, the hands and feet are cold, and the pulse is wiry and slow. This indicates excess in the chest; purgation is contraindicated, and emesis should be employed. However, if there is cold-fluid retention above the diaphragm causing dry heaving, emesis is contraindicated, and urgent warming of Yang Qi is required. Chang Shi stated that Xiao Banxia Jia Ju Pi Tang or Wen Zhong Tang could be used.
He further said: In all cases of Si Ni Jue (Reversal Cold of the Four Extremities), emesis is contraindicated. The same applies to patients with deficiency constitutions. Pang Shi stated that in various cases of Si Ni, where the pulse is weak, minute, fine, wiry, or slow, even if accompanied by fullness and oppression in the middle jiao, emesis is contraindicated. Ju Pi Tang (Tangerine Peel Decoction) and Zhi Shi San (Immature Bitter Orange Powder) are appropriate.
He further said: For patients with deficiency constitutions who require emesis but dare not undergo it, Zhi Shi San should be used to suppress qi stagnation, toxic phlegm, and water retention. After a day or two, once the toxic pathogens have entered the stomach, mild purgation may then be performed.
Pang Shi stated: Forcing emesis when it is contraindicated can cause qi to strike the heart, leading to death.
Zhang Zhongjing said: The general principle is that emesis is suitable in spring.
He further said: Whenever emetic decoctions are used, discontinue administration as soon as the therapeutic effect is achieved; it is not necessary to consume the entire dose.
He further said: If the symptoms resemble those of the Guizhi Tang pattern (Exterior Deficiency Wind Strike Pattern), but there is no headache or stiffness of the neck, and the Cun position of the pulse is slightly floating, with oppression and hardness in the chest, and qi rushing up to the throat causing difficulty in breathing, this indicates cold pathogens in the chest, and emesis should be employed. (Another version states that this is due to long-standing phlegm in the interior, requiring emesis.) Chang Shi stated that Gua Di San (Melon Seed Powder) could be used.
He further said: Regarding various excess conditions in the upper chest (another version reads "cold"), with a feeling of depression and pain in the chest, inability to eat, a desire for someone to press on the area, yet producing saliva (one version reads turbid sputum), and diarrhea occurring more than ten times a day, while the pulse is surprisingly slow and the Cun Kou position is minute and slippery, emesis is indicated. After emesis, the diarrhea will cease. Chang Shi stated that Gua Di San could be used.
He further said: When retained food stagnates in the Upper Wan (upper part of the stomach), emesis should be employed. Chang Shi stated that Gua Di San could be used.
He further said: In Shaoyin disease, where food and drink are vomited immediately upon entry, and there is a sensation of nausea in the heart region without the ability to vomit, emesis is appropriate. Chang Shi stated that Gua Di San is appropriate.
He further said: When patients present with cold extremities and a pulse that suddenly becomes knotted (one version reads tight), because external pathogens (one version reads pathogenic knotting) are lodged in the chest, causing fullness below the heart and irritability, and a desire to eat but inability to do so, the disease is located in the chest, and emesis should be employed. Chang Shi stated that Gua Di San could be used.
Pang Shi stated: For oppression and stuffiness in the chest and diaphragm, obstructed by excessive phlegm, with a floating and slippery pulse, Gua Di San is suitable for inducing emesis. In cases of diarrhea occurring six to seven days postpartum, unresponsive to various medications, if this pulse pattern is observed, emesis will stop the diarrhea immediately.
The Shanghan Lun from Qian Jin Fang stated: When a patient has no fever but exhibits delirium, restlessness, and incoherent speech lacking normal interaction, do not force sweating using fire therapy. Instead, administer one square-cun measure of Zhu Ling San (Polyporus Powder), and forcibly make the patient drink one or two sheng of fresh water, then stimulate the throat to induce vomiting. The disease will resolve with the vomitus. If the patient cannot vomit, do not force water intake, as stagnant water will bind in the epigastrium. Use other emetic agents instead. For such diseases, if not resolved through emesis with Zhu Ling San, death will likely occur rapidly. Patients with water-fluid retention and diaphragmatic excess are difficult to treat; this represents a scenario with three chances of death and one of survival. Guo Yong stated: Water retention in the epigastrium is a difficult-to-treat condition requiring early emesis.
The Bing Yuan Fang Lue stated: Malaria characterized by more cold than heat may be treated with emesis; this refers to cases with excessive phlegm. The treatment for malaria follows this principle.