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Duxiao'an practiced medicine in Youyi Zhou, specializing in teaching emetic formulas. His initial students were Aowenshu, followed by Huimeininggu. Ninggu also studied ancient formulas alongside Jiyi Dongdong, establishing his own school. His disciples' works, such as *Ninggu Yitan*, *Tufang Silu*, and *Tufang Shuyao*, contain numerous records of emetic methods, demonstrating the prosperity of the ancient formula school.

*Jingxin Jieguan* states: "Among four hundred and four types of diseases, retained food is the root; among the Three Evil Paths and Eight Difficulties, women are the root." Additionally, *Nanhai Jigui Zhuan* records dietary fasting therapies. Based on this, diet is a major source of disease, while emesis is the most rapid method for eliminating disease. (Zhuoxuan commented: Hundred diseases stem from diet. People plan only with their mouths, not their bellies, often leading to disaster. Before eating, ask the mouth if it is acceptable, ask the belly if it is not yet ready, and then stop. Choosing foods suitable for the belly before eating is the first principle of health preservation. This view comes from Guangsi Meidun's *Tushuo*; although not directly related to emesis, the words are meaningful.)

For those with water qi obstructing the airway, presenting with panting, urgency, and swelling, it is appropriate to suppress the water qi in the airway using Yuebi Jia Zhu Ling Tang or Mufangji Jia Ling Tang, combined with Shizhonghuang Wan.

The harm of appetite is greater than that of sexual desire. Yet people only know the harm of sexual desire, ignoring the harm of appetite, which is tragic.

Pediatric gan eye disease and adult nyctalopia (night blindness) are caused by retained toxins in the stomach hindering the circulation of essence and qi. This condition is most common in children who are weaned early into solid food. Palpation of the abdomen will reveal fullness, so removing gastric toxins is key.

In typhoid diseases presenting with gastric excess, differentiation from water retention can be confusing. Water retention cases may require purgatives or aconite-based warming agents; careful consideration of tongue coating and pulse is necessary.

Xiaoke (wasting-thirst) may be caused by latent syphilis, which must not be overlooked.

If oral ulceration occurs due to mingxuan reaction after taking Yanfeng Formula, swallowing strong vinegar drop by drop is advisable. If accompanied by irritability, thirst, and heat, Baihu Tang plus Coptidis Rhizoma (Huanglian) should be used. For pain in the throat and mouth, Ganlian Tang plus Rheum Radix et Rhizoma (Dahuang) and Platycodon Root (Jiegeng) is indicated.

In epidemic febrile diseases, tremors in the hands or on the tongue are ominous signs. (This condition can lead to epilepsy or sudden collapse and death, so it cannot be ignored.)

Hair loss after illness is best treated with applying Puhuang Frost. (Zhuoxuan commented: Applying Fanbi Frost mixed with sesame oil to the affected area is also good for this condition.)

Urinary retention responds well to two qian of dried Gualou Fruit (Trichosanthis Fructus) taken as a powder; the underlying principle is worth pondering.

Kuang (mania), Chuan (asthma/wheezing), and Lao (consumption/deficiency exhaustion) all belong to fetal toxins. Toxin attacking the heart causes Kuang; attacking bones causes Lao; attacking the chest and diaphragm causes Chuan. Their roots are the same, but manifestations differ. If Kuang heals but transforms into Lao, death ensues.

For constipation unresponsive to Croton Seed (Badou) or Rhubarb (Dahuang), adding Aucklandiae Radix (Muxiang) to other prescriptions is effective. (Note: The use of Muxiang in Sanhe San reflects this idea.)

Thirst may arise from water qi, heat, or the resolution phase of an illness; these can be distinguished.

In typhoid disease, spontaneous vomiting is a favorable sign. If no vomiting occurs, it may become Jie Xiong (chest binding); if there is an urge to vomit but inability to do so, Yiwu Gudi San may be given.

Dongji (palpitations) can be caused by blood and qi stagnation. Stagnation of blood and qi anywhere can cause palpitations, not just below the heart.

Patients with chronic asthma should not be induced to vomit arbitrarily; Linggui Zhugan Tang plus Perillae Fructus (Suzi) and Apricot Kernel (Xingren) is advisable.

Linggui Zhugan Tang is suitable for hair loss and nyctalopia, as both conditions share the same etiology. Why? Water qi stagnating in the head prevents nourishment of hair follicles, causing hair loss; water qi obstructing the upper body prevents essence from reaching the eyes, causing evening blindness. The principle is the same, so the formula can be applied flexibly. (Zhuoxuan commented: Integrate thoroughly and apply flexible methods.)

Huangpang (yellow puffy syndrome) is mostly due to stomach disharmony. Pale, peeling nails indicate insufficient stomach qi and failure of blood and qi to reach the extremities.

A man suffered from continuous trembling of the head and both hands for two or three years, with a peaceful abdomen and normal diet. I considered this similar to Zhongjing's description of slight tremors in the four limbs and cured him with Fangji Fuling Tang.

Hewei Tang originates from Shaoyao Gancao Tang, making it particularly effective for spasm of the Ren Mai. If ineffective, Jianzhong Tang should be used, as this condition resembles Chaihu Tang syndrome. However, Chaihu Tang focuses on the epigastrium, whereas this formula addresses the entire abdomen.

Shan Xizhang, also known as Tushanmu, treats blood stasis pain, thus curing postpartum limb pain.

For urinary retention, giving Tiaowei Chengqi Tang plus Talcum (Huashi) initially is appropriate. (Note: *Jifeng Fang* uses Dachengqi Tang for severe urinary/fecal obstruction with cold limbs and absent pulse, opening the posterior orifice to open the anterior one. This formula achieves dual relief. However, using it for deficiency-type urinary retention may cause great harm. Reference *Jinkui Yaolue*'s Bawei Wan.)

Yinhu Hernia is difficult to treat, but Huluba Wan can cure it. I obtained this prescription recently from Dao Cun Sanbo, a physician in Jiangdu.

To treat Shegan (tongue gangrene), boil Coconut Oil alone, soak cotton wool in it until yellow, apply to the lesion, and moxa with a heated needle twice daily, stopping when heat becomes unbearable. Internally, take Liangge San plus Gypsum, and periodically administer Douhuang Wan to purge. (Zhuoxuan commented: This is a unique prescription; I will try it later. I have also used heated needles to cauterize the lesion directly, curing 3-4 out of 10 cases.)

Guzhang (drum-like distension), Laozai (consumption), Yinhu Hernia, Ge Ye (dysphagia), Tianxing, Chunxi, and Fei Wei (lung atrophy) are generally incurable, so I dare not intervene.

For Fanwei (regurgitation/vomiting), first use Chaihu Xiexin Tang or Xiongtang Tang to clear the chest and abdomen, then administer an emetic for complete recovery.

Chronic abdominal pain lasting many years can be cured by emesis, or by Anzhong San plus Curcuma Longa (Jianghuang) and Canglong Wan.

Qijiu (lacquer wine) treats blood stasis pain more effectively than Qifei Wan and also treats old abdominal pain. When hitting the target, it inevitably induces vomiting and purging.

Before administering emetics, always examine the abdomen. If the epigastrium is firm, use Xiexin Tang, Xiongtang Tang, or Chaihu Tang variants to control chest/abdominal toxicity for one to five months before attempting emesis. Otherwise, emesis will fail and cause unbearable mingxuan reactions. (Tusheng Chang learned emesis from Ninggu: First give Huanglian Jiedu Tang for six to seven days, then take Gudi San (6 fen) with Fermented Soybean Decoction next morning after drinking hot rice gruel and skipping lunch. Repeat emesis with salt water and paper probe up to four times until the drug reaches the core. Then resume hot gruel and Huanglian Jiedu Tang for several days, possibly adding Guntan Wan. This is the general procedure.)

Do not induce vomiting if there is a small mass below the heart, viral obstruction of the airway, or shortness of breath.

Strong purgatives should be taken at dawn; reduce dinner the night before. If food remains in the stomach, vomiting will occur, negating efficacy. This does not apply to mild purgation.

Gudi San (Gudi 3 parts, Adzuki Bean 3 parts) should also be taken at dawn. As vomiting approaches, one person holds the head, another presses Zhangmen Acupoint to hasten vomiting; the patient should bow slightly. If retching persists, the drug is in the middle jiao; force vomiting or use salt water. Chest oppression indicates impending vomiting. To stop, give sugar water. If unresolved, give Dusheng San (3 fen). (Only skilled practitioners should use this.) Diarrhea after Gudi San indicates successful vomiting. Thirst and black/yellow tongue coating indicate toxin expulsion. Fast for one day post-emesis, then introduce soft porridge. Avoid rich/greasy food to prevent fatal food stagnation.

For Lin Ji (strangury) with difficult urination, boil Can Sha (Silkworm Frass) 2 qian, Huashi 1 qian, and Gancao 5 fen; drink once for immediate cure.

Elderly patients with chronic strangury (4-5 years) dying from accumulated toxins flowing into the bladder should be treated via the chest with Sanhuang Xiexin Tang plus Ejiao and Huashi, combined with Huduan Wan.

For strangury, first apply symptomatic treatment. Externally, steam the lumbar region with a hot towel, insert the penis into a bamboo tube dipped in hot water, and massage the lower abdomen when urination is desired. (This is called Xie Bi technique.) Alternating steaming and rubbing promotes lower jiao qi movement and urination. Without this, drugs act slowly.

In *Qianjin*, Loulu Lianqiao Tang, substituting Chuanxiong for Loulu, is effective. Dahuang Mudan Tang substitutes White Mustard Seed (Baijiezhi) for Melon Seed because White Mustard Seed disperses blood. (Note: *Shengji Zonglu* Dahuang Mudan Tang uses Xiaoshi and Jiezi, named Dahuang Tang, aligning with this view.)

*Waitai* Jiegeng Tang treats early-stage Fei Yong (lung abscess). Even without full symptoms, if there is foul breath, it is highly effective. Baijiang Cao can replace Tingli Zi.

Pediatric Yinhu Hernia is water qi adhering to meridians and flowing into the scrotum. Powdered Fuzi, Huixiang, and Kansui is effective.

Children craving charcoal or wall dirt should be given Qingfen and Sugar powder equal parts, formed into pills with paste. Xiaogan Yin Ziyuan is also effective.

For pediatric ear discharge, apply Dusheng San to the ear canal to drain yellow fluid. Lay the child horizontally to remove toxic fluid.

Mutism is caused by fetal toxin obstructing the upper jiao. It is curable if hearing is intact; deaf muteness is incurable.

Newborns unable to swallow medicine, causing overflow from the nose, present a malignant prognosis.

For pediatric convulsions with opisthotonos approaching death, Honghua and Yujin powder equal parts, taken with fresh well water, is effective.

Newborns with hand tremors like puppets and left-sided hypogastric tension should receive *Qianjin* Xiongtang Tang combined with Ziyuan for rapid effect. Xiongtang Tang treats toxins attaching to the chest.

Huhuanglian resolves fetal toxins, hence its traditional use for pediatric Wugan. Adding it to Ganlian Tang yields special effects. (*Bencao* notes it treats female fetal heat and fruit accumulation. Juzong Xianyuan used it alone as a pill for persistent morning sickness with miraculous results.)

Female leukorrhea (red and white discharge) often stems from the epigastrium. Treat with Sanhuang Xiexin Tang plus Ejiao and Huashi, combined with Huduan Wan.

For men and women over middle age with intestinal masses (hard as stone) or permanent yellow/black tongue coating, if a new acute illness arises, treat the new illness first. Attacking the chronic mass prematurely causes harm. After the new illness resolves, treat the chronic condition. (Zhongjing's principle of treating acute illness first is clear.)

Vaginal parasites respond to mercury preparations. (Likely pubic lice; topical Qingfen cures quickly.)

Severe vulvar swelling responds to Longdan Xiegan Tang.

Menstrual irregularities caused by diet often involve passing white turbid matter; investigate carefully.

A woman with metrorrhagia for over 100 days, unresponsive to other doctors, was cured by Fuling Sini Tang plus Fusui.

Zixian (eclampsia) is mistakenly thought to be a fetal disease. It is often caused by toxic water from delivery agents rushing upward. Inducing vomiting with Gudi San facilitates delivery and rapid recovery. *Qianjin* Xiongtang Tang and Xiongshen Tang are also applicable. This differs significantly from postpartum tetany.

For pregnancy nausea/vomiting where food cannot stay down and other drugs fail, Jiebai Wan is indicated. (Likely made from Jiegeng and Baisan.)

Difficult labor resolves with mild emesis, restoring ascending-descending qi flow. While some doctors use Deer Antler Vegetable or Cloud Mother, I exclusively use Gudi.

A woman with postpartum edema, shortness of breath, wheezing, sweating, urinary retention, and anorexia was deemed incurable. Diagnosing retained fluid, I gave Gansui Banxia Tang. One dose expelled watery fluid and caused profuse diarrhea, resolving all symptoms.

A woman with lifelong constipation, epigastric palpitations, heat intolerance, and itchy nodules behind ears for three years was cured with Fanbi Jiedu Tang and Xionghuang San.

Postpartum retention of the placenta with qi rebellion and vomiting of foul foam is usually fatal.

Postpartum blood fainting may be caused by water qi; do not overlook this.

Postpartum mental confusion/unconsciousness resolves with emesis; Fuzi Xiexin Tang is also indicated.

Ge Ye (dysphagia) is curable in young adults but incurable after age forty.

Ge syndrome with epigastric masses resembling fists or purple spots on the tongue is ominous.

Ge Ye in men over forty results from accumulated toxins condensing in the stomach, compressing the throat, causing gastric atrophy. Palpation from epigastrium to umbilicus feels like a bamboo tube. Incorrect emesis causes fatal mingxuan reactions. Some cases diagnosed as Fei Wei or Fei Yong are actually gastric retained fluid. Emesis expels pus/blood/phlegm through the esophagus; do not treat solely as lung disease.

Generalized rat poison toxicity presents with fever; bleed Weizhong and Chize acupoints.

Arsenic poisoning is treated with Baihu Tang plus Huanglian; drinking cold water is also beneficial.

Jiegeng supports internal drainage of sores and treats sore throat. Dried raw form is effective; sun-dried is not. (*Bencao* calls it Kugeng, likely referring to raw stem.)

Birch bark detoxifies gases; Yongtian Demben and Qu Naisai Daosang used it frequently. (Ninggu's single-use of birch bark is closer to truth. Zhuoxuan noted: Qingzhou's Jingfang Baidu San plus Birch Bark is Ten-Ingredient Baidu San, a standard formula for sores, based on this.)

Xianren Cao specifically treats oral diseases; adding it to Xiexin or Xiongtang formulas is excellent.

Distension/Guzhang develops gradually. Sudden high fever or delirium during resolution marks a critical turning point.

Distension/Guzhang with anorexia responds intermittently to Red Bean and Scallion.

Wubao Dan treats Wei Bi (flaccidity); do not ignore it. (Doctors believe it treats upper jiao clustered toxins.)

Shegan is hard to treat but curable if painful.

Black blood in hematemesis/hematochezia should not be stopped; bright red blood can be stopped. Moxibustion at Mingmen is rapidly effective.

Amnesia due to blood stasis requires Didang Wan.

Excessive head sweating is caused by chest pressure; thus, it is common in Jie Xiong patterns.

Hongjiao (beriberi) attacking the heart responds to Kongchuan Dan.

Prolapsed rectum cures instantly after eating turtle; however, subsequent cough leads to consumption and death.

Zihehe stated: Edema with surging pulse is curable. I verified that surging pulse indicates excess and is curable; wiry/slippery pulse indicates sudden change.

Infant spasmodic cough cures with Zuojin Wan; Bat Frost is also effective. (Bat Frost is Dusheng San; Piancang Heling found Vole Frost effective.)

A 30-year-old scholar had stiff neck/back, inability to turn head, back/rib pain, and a hard lump under right rib like an egg, immobile like a puppet. Doctors failed. I diagnosed meat-toxin retention. He admitted eating wild boar in Edo last year. I treated with Xiongtang Tang and Jiegeng Baisan to purge, followed by Guomu Tang plus Tufuling for full recovery. I added Tufuling for meat toxin.

Post-measles pallor and vomiting in infants indicate unresolved upper jiao toxin. Ziyuan (3 pills, 3 times daily) cures.

Jiuyi Yifang uses Snail Water for Xiaoke. I used Snail Frost, finding it faster and more effective, naming it Sanguo San (after Zhuangzi's Ze Yang chapter).

A man with 2-3 year history of severe head/hand tremors, normal abdomen/diet/stool/urine, has pathology in collaterals (Zhongjing's limb tremors). Fangji Fuling Tang is indicated.

Huluan occurs in all seasons, especially in children; Lizhong Tang is primary. (*Waitai* mentions winter huluan.)

Postpartum Wei Bi is hard to treat. Start with Wutou Guizhi Tang, then Jingjie Tang, or intermittent mercury salts.

Breast cancer (Ruyan) is hard to treat. After dreaming of advice to use Danggui Shengyang Roushou Tang, I used it to expel pus/blood, combined with Yanfeng Wan and Plum Meat Wan for cure. (Beef substitutes mutton locally.)

Edema with firm skin and purple-black discoloration is excess; induce sweating. A 50-year-old man cured with Mahuang Jia Zhu Tang in a few days.

Sudden heavy sweating, diarrhea, or rapid reduction of edema in water disease are ominous, leading to death within 4-5 days. Aggressive purging worsens diarrhea. Rapid edema reduction indicates death. Treating water qi is like pouring muddy water: quick pouring leaves mud; slow pouring removes both. Sweat/purge drugs must attack gently; aggressive attack kills the patient despite curing the disease.

Zhongjing said: Water disease with floating pulse indicates death. Like drowning: living sinks, dead floats. Deficient yuan qi floats; robust yuan qi sinks. Thus, floating/slippery pulse is ominous; deep/solid pulse is auspicious. This eternal wisdom applies. Axillary odor and suppurative ears belong to fetal toxins.

Post-alcohol vomiting/pain responds to Gegen Huangqin Huanglian Tang. (Note: *Shanghan Lun* warns against Guizhi Tang for wine drinkers; Ke Qin noted this implies Gegen Huangqin Huanglian for muscle-layer resolution.)

Epigastric hardness/anorexia after purging responds best to Fuling Yin. (Note: Wu Shi explained that lingering pathogen causes hardness; purging should resolve it. Persistent hardness indicates deficiency from prior illness, postpartum state, or weak constitution. Further purging worsens it. Use Shenfu Yiqi Tang instead of Qi-moving drugs to avoid bad transformation. Opposite to Fuling Yin indication.)

Fei Yong with pus/blood hematemesis and chest pain cures with symptomatic drugs plus Bozhou San.

Nyctalopia responds best to Linggui Zhugan Tang plus Plantago Seed (Cheqianzi).

Amomum fruit thrown into wine turns it to water, thus resolving alcohol toxin and aiding digestion.

Pufferfish poisoning is treated by inducing vomiting with Indigofera juice (freshly made by dyers is best). Vomiting is the best antidote for poisoning; Indigo is one option.