Library

The human body is nothing but exterior and interior; Qi and Blood are nothing but deficiency and excess. When the exterior is in a state of excess, the interior must be deficient; when the interior is in a state of excess, the exterior must be deficient; when the Jing meridians (primary channels) are in a state of excess, the Luo collaterals must be deficient; when the Luo collaterals are in a state of excess, the Jing meridians must be deficient. This is the normal pattern of disease. Excellent physicians, when treating disease, first treat the excess, then treat the deficiency, though there are times when they do not treat the deficiency. Inferior physicians, when treating disease, sometimes treat the deficiency, sometimes treat the excess; occasionally they succeed by chance, but often they fail. Absurd physicians, when treating disease, exacerbate the excess and further deplete the deficiency (making excess more excessive and deficiency more deficient); their errors are often obvious, so they can be held accountable. Only mediocre physicians, when treating disease, purely tonify deficiency and dare not treat excess. The world calls this "steady," yet they harm people without leaving obvious traces. They themselves do not reflect on their faults; even after a lifetime, they do not repent, saying, "I used tonic medicines; what crime have I committed?" Patients also say, "He used tonics to nourish me; what crime has he committed?" Even if they die, they remain unaware. Neither inferior nor absurd physicians fail to harm people, but mediocre physicians harm people most deeply, like Gun attempting to flood control by blocking, who did not understand the principles of the Five Elements. Tonification is what people like; attacking pathogens is what people dislike. A physician would rather go against the patient's mind and lose employment than conform to the patient's mind to gain profit, let alone consider the patient's life or death. Alas! In a world lacking truth, who can distinguish it? Now I write this treatise on the three methods of vomiting, sweating, and purging, to encompass the methods of treating disease, hoping that future generations will have something to rely upon.

Disease as an entity is not originally inherent in the human body. It either enters from outside or arises from within; all are pathogenic factors (Xie Qi). When pathogenic factors affect the body, it is acceptable to attack them quickly and remove them swiftly. Why delay and retain them? Even foolish men and women know this is unacceptable. Yet when hearing of attacking methods, they are displeased; when hearing of tonifying methods, they are delighted. Today's physicians say, "One should first consolidate Yuan Qi (Original Qi). Once Yuan Qi is solid, pathogens will naturally depart." How many such arrogant people are there in the world! When pathogens invade a person, if mild, they may transmit over time and resolve spontaneously; if moderate, transmission over time makes them difficult to cure; if severe, sudden death occurs. If one first discusses consolidating Yuan Qi and uses tonics to nourish, while True Qi has not yet prevailed, pathogens will already have galloped wildly and become uncontrollable. Only those with pulse depletion, lower deficiency, no pathogens, and no accumulation may be considered for tonification; others with pathogens and accumulations who discuss tonification are akin to Gun blocking floods. Now I discuss the three methods of vomiting, sweating, and purging, first discussing attacking pathogens; once pathogens are removed, Yuan Qi recovers naturally. Moreover, the methods I discuss have been practiced for a long time, becoming extremely refined and familiar, with gains and no losses, which is why I dare to speak to future generations.

Heaven possesses bitter, sweet, acrid, salty, and bland flavors. Therefore, pathogenic factors from Heaven causing disease mostly manifest in the upper part; pathogenic factors from Earth causing disease mostly manifest in the lower part; pathogenic factors from Human interaction causing disease mostly manifest in the middle. These are the three origins of disease. There are three ways to manage them, and three ways to expel them. Various wind-cold pathogens, knotting and binding between the skin, hiding within the meridians, lingering without departing, may cause pain radiating along pathways, numbness, and swelling, itching, and spasms of the four limbs; these can be expelled through sweating (Han Fa). Wind-phlegm and retained food stagnation, located in the diaphragm or upper epigastrium, can be expelled through inducing vomiting (Ou Fa). Cold-dampness and fixed cold, or heat lodging in the Lower Jiao (Lower Burner), diseases located below, can be expelled through purging (Xia Fa). The *Nei Jing* (Inner Canon) discusses various diseases separately, noting that symptoms are not uniform; popular sayings on treatment methods are not uniform either. Chapters such as *Zhi Zhen Yao Da Lun* discuss various diseases generated by Six Qi (Yun Qi), summarizing them with sour, bitter, sweet, acrid, salty, and bland flavors. Mentions of tonification appear only occasionally; however, its concept of tonification is not what is meant today. Textual evidence under the "Tonification" section states: Acrid tonifies Liver, Salty tonifies Heart, Sweet tonifies Kidney, Sour tonifies Spleen, Bitter tonifies Lung. Such "tonification" serves to open interstices (Cou Li), promote fluid production, and unblock Qi and Blood. Regarding the general discussion of herbs, it states: Acrid, Sweet, and Bland belong to Yang; Sour, Bitter, and Salty belong to Yin. Acrid and Sweet disperse and diffuse; Bland promotes leaching and draining. Sour, Bitter, and Salty induce vomiting and purging. Dispersing belongs to sweating; vomiting belongs to induced vomiting; purging belongs to downward expulsion. Leaching aids releasing the exterior, belonging to sweating; purging promotes urination, belonging to downward expulsion. There is absolutely no mention of tonification. Thus we know the Sages had only these three methods, no fourth method.

Then do the Sages not speak of tonification? I reply: Sweating, purging, and vomiting are methods using herbal substances to treat disease. Tonification is using grains, meats, fruits, and vegetables to nourish the mouth, body, and physique. Grains, meats, fruits, and vegetables are like a ruler's virtue and education; sweating, purging, and vomiting are like a ruler's punishments. Thus it is said: Virtue and education are the fine foods of peace; punishments are the medicinal stones for managing chaos. If a person has no disease, fine foods suffice; once diseased, one must first punish the transgressors. After the disease departs, fine foods restore health, just as when society is governed well, punishments are set aside unused. How can medicinal stones be considered tonification? To certainly eliminate major illnesses and severe consumptive diseases, there is no way other than vomiting, sweating, and purging. However, today's physicians cannot fully apply the sweating, purging, and vomiting methods; each establishes their own school. Who would humble themselves to ask? Furthermore, my three methods can encompass other methods. When using medicine, there is guiding, lifting, pushing, directing, reducing, increasing, continuing, and stopping. Today's physicians, not understanding my methods, look up and laugh arrogantly, saying, "Vomiting is merely Geng Ti (Melon Stalk); sweating is merely Ma Huang (Ephedra) and Sheng Ma (Cimicifuga); purging is merely Ba Dou (Croton), Qian Niu (Pharbitis), Po Xiao (Mirabilite), Da Huang (Rhubarb), Gan Sui (Kansui), and Yuan Hua (Genkwa)." Since they do not grasp the technique, they slander it. I find it difficult to argue bitterly with them, so I wrote this treatise.

What is meant by "the three methods can encompass other methods"? For example, drawing out saliva, filtering saliva, inducing sneezing, and promoting tearing—anything moving upward belongs to the vomiting method; moxibustion, steaming, fumigation, washing, hot compresses, branding, acupuncture, stone needle therapy, Dao Yin (guiding and pulling), and massage—anything resolving the exterior belongs to the sweating method; inducing labor and lactation, grinding accumulations and driving out water, breaking menstruation and venting Qi—anything moving downward belongs to the purging method. Using my methods, therefore, encompasses other methods. However, I have never abandoned other methods because of these three; I use them according to the appropriateness of the condition. By proportion, these three methods account for eight or nine parts, while other methods account for only one or two parts. Some say the *Nei Jing* discusses acupuncture much more than herbs, perhaps because the Sage wished to clarify the meridians. But how could they know that the principle of acupuncture is the same as the principle of herbs? Now, writing the three chapters on vomiting, sweating, and purging, I list the weight, heaviness, cold, and warmth of herbs on the left. Outside these three methods, I separately wrote a chapter titled *Yuan Bu* (On Tonification), keeping it distinct from the three methods. Fearing that future physicians would cling to tonification, I placed it at the end of the three chapters, so that prescribers know that sweating contains elements of vomiting, purging contains elements of tonification, and there are truly only three methods. The *Nei Jing* says: "He who knows the essentials can conclude with a single word." This is what is meant.