【纲】仲景曰。下利。日十余行。其脉反迟。寸口脉微滑。此可吐之。利则止。少阴病。饮食
入口即吐。心中温温欲吐。复不能吐者。宜吐之。宿食在上脘者。当吐之。病手足逆冷。脉乍结。
以客气在胸中。心下满而烦。饮食不能食者。病在胸中。当吐之。
【目】吴绶曰。凡病在膈上者。脉大胸满多痰者。食在胃口脉滑者。俱宜吐之。华佗谓伤寒三
四日。邪在胸中者。宜吐之。凡吐用瓜蒂散。或淡盐汤。或温茶汤。如人弱者。人参芦汤亦可。痰
多者。以二陈汤一瓯。乘热与之。以指探喉中。即
吐也。凡老人怯弱劳病内伤虚人。并妇人胎前产后。血虚脉弱小者。皆不可吐。凡药发吐者。如防
风、桔梗、山楂。只用一味煎汤温服之。则吐。若误吐。则损人上焦元气。为患不小。可不慎哉。
王肯堂曰。大法。春宜吐。凡用吐汤。中病即止。不必尽剂也。病如桂枝症。头不疼。项不强。
寸脉微浮。胸中痞硬。气上冲咽喉不得息者。此为有寒。当吐之。或云。此以内有久痰。宜吐之
也。
【纲】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。若得病一二日吐之者。腹中饥。口不能食。三四日吐之者。不喜糜粥。欲食冷食。朝食暮吐。
以医吐之所致也。此为小逆。太阳病。吐之。但太阳病。当恶寒。今反不恶寒。不欲近衣者。此为
吐之内烦也。少阴病。饮食入口即吐。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。若膈上有寒饮。干呕者。不可吐也。当温之。少阳中风。两耳无所闻。目赤。
胸中满而烦者。不可吐下。吐下则悸而惊。
【目】王肯堂曰。四肢厥逆。虚家新产脉微。皆不可吐。
喻昌曰。解肌之法。解肌表风邪。全不伤动脾胃。乃天然不易之法也。若舍此而妄用吐法。吐
虽有发散之义。故不恶寒发热。一二日病在太阳。吐之则腹中饥。口不能食。三四日病在阳明。吐
之则不喜糜粥。欲食冷食。皆胃气受伤之故也。然且朝食暮吐。脾中之真阳亦伤。而不能消谷。是
外感虽除。脾胃内伤。卒未易复。故为小逆。
魏荔彤曰。关上脉细数。方注为细则为虚。数则为热。此脉兼一二日三四日二段言。下方分别
其症。而未出治法。余谓治胸当小陷胸。治胃则桂枝去桂加茯苓甘草汤症也。如胃果虚。则人参、
干姜皆可用矣。次条津液内枯。作烦
发烦。不过虚热二字。热胜于虚者。乃炙甘草汤症也。热大盛。以白虎佐之。至于虚胜于热。则又
建中汤、茯苓甘草汤之症矣。仲景何能预定乎。
[General Principle] Zhang Zhongjing said: In cases of diarrhea (Xialli), occurring more than ten times a day, with a pulse that is surprisingly slow, and the Cun Kou (inch position) pulse appearing slightly slippery, emesis therapy may be applied. Upon inducing vomiting, the diarrhea will cease. In Shaoyin disease, where food or drink is vomited immediately upon entering the mouth, accompanied by a warm sensation in the heart region prompting the urge to vomit but an inability to do so, emesis therapy is appropriate. If retained food stagnates in the Upper Jiao (Upper Epigastrium), emesis should be induced. When a patient presents with cold extremities, a pulse that intermittently knotted, due to pathogenic qi lodged in the chest, accompanied by fullness and irritability in the epigastrium, and an inability to ingest food, the pathology resides in the chest, and emesis therapy is indicated.
[Commentary] Wu Shou stated: For diseases located above the diaphragm, characterized by a large pulse, chest fullness, and abundant phlegm; or for cases where food is stagnant at the stomach opening resulting in a slippery pulse, emesis therapy is suitable. Hua Tuo asserted that in Shanghan (Cold Damage) disease, after three or four days, if the pathogen is in the chest, emesis is appropriate. Common emetic formulas include Gengdi San (Melon Rind Powder), light salt water, or warm tea. For weak patients, Ren Shen Lu Tang (Ginseng Rhizome Decoction) may also be used. For those with excessive phlegm, one bowl of Erchen Tang (Two-Cured Decoction) should be taken while hot, followed by stimulating the throat with a finger to induce vomiting. Emesis is contraindicated for elderly individuals who are frail, those with chronic internal injury and deficiency, women during pregnancy or postpartum, and anyone with blood deficiency and a weak, small pulse. To induce vomiting pharmacologically without harsh emetics, single herbs such as Fangfeng (Saposhnikoviae Radix), Jiegeng (Platycodonis Radix), or Shanzha (Crataegi Fructus) can be decocted and taken warm. Misapplication of emesis damages the Yuan Qi (Original Qi) of the Upper Jiao, causing significant harm; thus, caution is essential. Wang Kentang stated: The general rule is that spring is the season suitable for emesis. When using emetic decoctions, stop once the therapeutic effect is achieved; there is no need to consume the entire dose. If symptoms resemble Guizhi Tang syndrome but without headache or neck stiffness, with a slightly floating Cun pulse, chest oppression and hardness, and Qi rushing upward to the throat causing breathing difficulty, this indicates cold pathogen retention, warranting emesis. Alternatively, it is said that this results from long-standing phlegm retention within, making emesis appropriate.
[General Principle] Zhang Zhongjing said: Taiyang disease typically presents with aversion to cold and fever. However, if the patient sweats spontaneously and paradoxically lacks aversion to cold and fever, with a fine and rapid pulse at the Guan position, this is an error caused by the physician’s inappropriate use of emesis. If emesis is misapplied one or two days after onset, the patient will feel hungry in the abdomen but unable to eat. If misapplied on the third or fourth day, the patient will dislike congee and crave cold food, resulting in vomiting what was eaten in the morning by evening. This is a consequence of the physician’s erroneous emesis. This constitutes a minor adverse reaction (Xiao Ni). In Taiyang disease, if emesis is used, the typical aversion to cold disappears; instead, the patient feels no aversion to cold and dislikes wearing clothes. This indicates internal irritability (Nei Fan) caused by emesis. In Shaoyin disease, where food is vomited immediately upon entry, with a warm sensation in the heart urging vomiting without success, initial cold extremities, and a string-tight and slow pulse, this indicates excess pathology in the chest. Purging (downward therapy) is contraindicated. If there is cold fluid retention above the diaphragm causing dry retching, emesis is contraindicated; warming therapy should be employed. In Shaoyang wind-stroke, presenting with deafness, red eyes, chest fullness, and irritability, both emesis and purging are contraindicated. Incorrect application of these methods leads to palpitations and fright.
[Commentary] Wang Kentang stated: Limb reversal (Jue Ni), patients with deficiency constitutions, and new postpartum women with a faint pulse are all contraindications for emesis.
Yu Chang stated: The method of resolving the muscle layer (Jie Ji) expels wind-cold pathogens from the exterior without damaging the Spleen and Stomach; this is a natural and unchanging principle. Abandoning this method to recklessly employ emesis is misguided. Although emesis has a dispersing function, misusing it when the disease is in the Taiyang stage (days 1-2) causes hunger without appetite; when misused in the Yangming stage (days 3-4), it causes aversion to warm congee and craving for cold food. These result from damage to Stomach Qi. Furthermore, morning eating and evening vomiting indicate damage to the True Yang of the Spleen, impairing grain digestion. Thus, although external pathogens are removed, internal Spleen-Stomach injury occurs, which is difficult to restore quickly, hence termed "minor adverse reaction."
Wei Litong stated: The fine and rapid pulse at the Guan position is annotated as "fine" indicating deficiency and "rapid" indicating heat. This pulse description covers both the early (1-2 days) and later (3-4 days) stages. The subsequent text details symptoms but omits treatment protocols. I propose that for chest pathology, Xiaoxianxiong Tang (Minor Trapped Chest Decoction) should be used; for Stomach pathology, Guizhi Qu Gui Jia Fuling Gancao Tang (Guizhi Decoction minus Cinnamon Twig plus Poria and Licorice Decoction) is indicated. If Stomach deficiency is confirmed, Renshen (Ginseng Radix et Rhizoma) and Ganjiang (Zingiberis Rhizoma) are applicable. Regarding the second case of internal fluid depletion leading to irritability, this essentially boils down to "deficiency-heat." When heat exceeds deficiency, Zhigancao Tang (Honey-Pounded Licorice Decoction) is indicated; if heat is severe, Baihu Tang (White Tiger Decoction) may be added. If deficiency exceeds heat, Jianzhong Tang (Establish the Middle Decoction) or Fuling Gancao Tang (Poria and Licorice Decoction) are appropriate. How could Zhang Zhongjing have predetermined rigid rules?