瓜蒂（一分熬黄） 赤小豆（一分）
上二味。各别捣。筛为散。已合治之。取一钱匕。以香豉一合。用热（一作熟）汤七合。煮作稀糜。去滓。取汁和
散。温顿服之。不吐者。少少加。得快吐乃止。诸亡血虚家。不可与瓜蒂散。
成氏明理论云。华陀曰。四日在胸。则可吐之。此迎而夺之之法也。千金方曰。气浮上部。填塞心胸。胸中满者。
吐之则愈。此随证治之之法也。大约伤寒四五日。邪气客于胸中之时也。加之。胸中烦满。气上冲咽喉。不得息者。则
为吐证具。乃可投诸吐药。而万全之功有之矣。瓜蒂味苦寒。内经曰。湿气在上。以苦吐之。寒湿之气。留于胸中。以
苦为主。是以瓜蒂为君。赤小豆味酸温。内经曰。酸苦涌泄为阴。分涌膈实。必以酸为佐。是以赤小豆为臣。香豉味苦
寒。苦以涌泄。寒以胜热。去上膈之热。必以苦寒为辅。是以香豉为使。酸苦相合。则胸中痰热。涌吐而出矣。其于亡
血虚家。所以不可与者。以瓜蒂散为驶剂。重亡津液之药。亡血虚家。补养则可。更亡津液。必不可全。用药君子。必
偕究焉。
琥按上方后云。煮作稀糜糜。粥也。又烂也。言以汤七合。煮香豉如糜粥之烂也。方氏条辩以稀糜为另是稀粥。乃
承载瓜蒂赤小豆香豉三物者之舟航。大谬之极。夫胸中痞硬。烦满邪实。反煮糜粥以调药。吾恐必无是理。方氏又云。
用稀糜。为吐虚风虚寒之对药。殊不知仲景法。虚家不可与瓜蒂散。于上方后。言之已明。未尝言虚家用瓜蒂散。当另
煮稀糜粥以调药也。或问云。虚家倘犯上条证。不可与瓜蒂散。当用何药。余答云。仲景方。若栀子豉汤。可以待之。
（重出例）病患胁下素有痞（云云至）入阴筋者。此名藏结死（注见前藏结论下）
（附后例）伤寒病。若吐若下后。七八日不解。热结在里。（云云至）欲饮水数升者。白虎加人参汤主之。
伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水。无表证者。白虎加人参汤主之。
上三条证。（正文与注并汤。俱见后第六卷阳明篇中）太阳少阳并病心下硬。颈项强而眩者。当刺大椎。肺俞。肝俞。
慎勿下之。
上条证。（正文与注。见后第十四卷刺热论中）
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。（此条证。邪在半表半里。虽系太阳病。
实与表无涉也。黄芩汤。亦和解半表半里之药。正文与注并）
黄芩汤方（俱见后第七卷少阳篇中）
伤寒胸中有热。胃中有邪气。腹中痛。欲呕吐者。黄连汤主之。（病属伤寒。表不热而胸中有热。此系寒邪之气。已
传入于里也。胸为阳。为上焦。故易作郁热。胃附乎脾。脾为阴。为中焦。以其人胃气素虚。故其中虽有寒邪之气。不
能作郁热也。腹中痛者。胃有寒也。欲呕吐者。胸有热也。成注云。此伤寒邪气传里。而为下寒上热也。与黄连汤以升
降阴阳之气。又按成注云。阴阳不交。阴不得升而独治于下。为下寒。阳不得降而独治于上。为胸中热。此阴阳者。为
人身真阴真阳之气。阴阳之气不能升降。而独治于上下。斯其中。方挟外来寒热之邪矣。腹中痛。欲呕吐者。此正阴阳
不和。寒热相拒之证。验也。条辩尚论篇。皆以风寒二邪。分阴阳寒热。殊不知风之初来。未必非寒。寒之既入。亦能
成热。不可拘也。）
Citrulli Fructus Semen (Gua Di, one fen, stir-fried until slightly yellow) Vigna angularis Seed (Chi Xiao Dou, one fen)
The above two ingredients. Each separately pounded. Sifted into powder. After mixing and processing together. Take one qian bi (a measure of volume). Use Xiang Chi (Fermented Soybean Paste) one he. Add seven he of hot water. Boil into a thin porridge consistency. Remove the dregs. Take the liquid to mix with the powder. Take warm in one dose. If no vomiting occurs, increase the dose slightly. Stop once vigorous vomiting is achieved. Patients who have lost blood or are constitutionally deficient must not be given Gua Di San.
Cheng Wuji stated in his "Ming Li Lun": Hua Tuo said, if the pathogen has been in the chest for four days, it can be treated by emesis. This is the method of attacking and depriving the pathogen directly. The "Qian Jin Fang" states: When qi floats to the upper part, filling and obstructing the chest and heart, causing fullness in the chest, emesis will cure it. This is the method of treating according to the syndrome. Generally, on the fourth or fifth day of Shang Han, this is when the pathogen lodges in the chest. Adding symptoms of vexation and fullness in the chest, qi rushing up to the throat, and inability to breathe normally, indicates that the indications for emesis are complete. Only then should various emetic drugs be administered, achieving a perfect result. Gua Di is bitter and cold. The "Nei Jing" states: Dampness located in the upper part should be expelled by bitter taste. Cold-dampness qi lingering in the chest should be primarily treated with bitter substances. Therefore, Gua Di is used as the Sovereign drug. Chi Xiao Dou is sour and warm. The "Nei Jing" states: Sour and bitter induce vomiting and purging, belonging to Yin. To drain the excess in the diaphragm, acid must be used as an Assistant. Therefore, Chi Xiao Dou is used as the Minister drug. Xiang Chi is bitter and cold. Bitter induces vomiting and purging; cold overcomes heat. To remove heat from the upper diaphragm, bitter-cold substances must be used as Assistants. Therefore, Xiang Chi is used as the Envoy drug. The combination of sour and bitter causes the phlegm-heat in the chest to be vomited out. Regarding patients with blood loss or deficiency, they cannot be given this because Gua Di San is a harsh agent, a medicine that severely damages body fluids. Patients with blood loss or deficiency require nourishment; further damaging their fluids would certainly prevent recovery. Those who administer medicines carefully must investigate this thoroughly.
Hu notes: The text following the formula says "boil into thin porridge." Mi refers to porridge, and also means soft and rotten. It means using seven he of water to boil Xiang Chi until it is as soft as porridge. Fang Youzhi in his "Tiao Bian" interpreted "thin porridge" as separately cooked thin rice gruel, which serves as a vessel to carry the three ingredients: Gua Di, Chi Xiao Dou, and Xiang Chi. This is extremely erroneous. Given the hardness in the chest, vexation, fullness, and excess pathogen, instead boiling porridge to mix with the medicine, I fear such logic does not exist. Fang Youzhi also claimed that using thin porridge is a counter-agent for vomiting due to empty wind and empty cold. Little did he know that Zhang Zhongjing's method clearly states that deficient persons must not use Gua Di San, as explicitly mentioned after the aforementioned formula. There was never a statement that deficient persons using Gua Di San should separately cook thin porridge to mix with the medicine. One might ask: If a deficient person contracts the syndrome mentioned above and cannot use Gua Di San, what medicine should be used? I answer: Zhang Zhongjing's formulas, such as Zhi Zi Chi Tang, can be considered. (Repeated Example) If a patient has had a mass under the hypochondrium since ancient times... entering the yin sinews, this is called Zang Jie, a fatal condition (Note see previous Zang Jie conclusion below).
(Attached Later Example) In Shang Han disease, if after emesis or purgation, the condition remains unresolved after seven or eight days, with heat knotting inside... (etc.) desiring to drink several sheng of water, Bai Hu Jia Ren Shen Tang is indicated.
In Shang Han, without significant fever, with dry mouth and thirst, mental restlessness, and slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang is indicated.
In Shang Han, with floating pulse, fever, and no sweating, where the exterior is not resolved, Bai Hu Tang must not be given. With thirst desiring water, but no exterior syndrome, Bai Hu Jia Ren Shen Tang is indicated.
The above three syndromes. (Main text and notes and decoction all appear in Volume 6 Yang Ming Chapter later). Tai Yang and Shao Yang concurrent disease, with hardness in the epigastrium, stiffness and rigidity of the neck, and vertigo, should be treated by acupuncture at Da Zhui, Fei Shu, and Gan Shu. Do not use purgation.
The above syndrome. (Main text and notes appear in Volume 14 Ci Re Lun later).
Tai Yang and Shao Yang combined disease, with spontaneous diarrhea, give Huang Qin Tang. If there is vomiting, Huang Qin Jia Ban Xia Sheng Jiang Tang is indicated. (This syndrome involves pathogen in the half-exterior half-interior. Although classified as Tai Yang disease, it is actually unrelated to the exterior. Huang Qin Tang is also a medicine for harmonizing the half-exterior half-interior. Main text and notes included).
Huang Qin Tang Formula (All appear in Volume 7 Shao Yang Chapter later).
Shang Han with heat in the chest, pathogenic qi in the stomach, abdominal pain, and desire to vomit, Huang Lian Tang is indicated. (The disease belongs to Shang Han. The exterior is not hot, but there is heat in the chest. This is cold pathogenic qi that has already transmitted into the interior. The chest is Yang, belonging to the Upper Jiao, so it easily forms stagnant heat. The stomach attaches to the Spleen. The Spleen is Yin, belonging to the Middle Jiao. Because this person's Stomach Qi has always been deficient, although there is cold pathogenic qi within, it cannot form stagnant heat. Abdominal pain indicates cold in the stomach. Desire to vomit indicates heat in the chest. Cheng's commentary states: This is Shang Han pathogen transmitting to the interior, resulting in lower cold and upper heat. Huang Lian Tang is given to ascend and descend the Qi of Yin and Yang. Also according to Cheng's commentary: Yin and Yang do not intersect. Yin fails to ascend and governs alone in the lower, causing lower cold. Yang fails to descend and governs alone in the upper, causing heat in the chest. Here, Yin and Yang refer to the true Yin and true Yang Qi of the human body. When Yin and Yang Qi cannot ascend and descend, governing alone in the upper and lower, the middle becomes mixed with external cold and heat pathogens. Abdominal pain and desire to vomit are exactly the verification of Yin-Yang disharmony and rejection between cold and heat. Fang Youzhi's "Tiao Bian" and Shanglun Pian all distinguish Yin-Yang and cold-heat by Wind-Cold two pathogens. Little did they know that when Wind first arrives, it may not necessarily be Cold; once Cold enters, it can also transform into Heat. One must not be rigid.)