Library

Several decades ago in Japan, a physician named Okamura Ryochiku from Echizen Province began to elucidate the method of inducing vomiting (Yongtu Fa). His disciples, Nagatomi Hoakai, wrote *Kohou Kou* (Examination of Vomiting Formulas), Ogino Genkai wrote *Kohou Hen* (Compilation of Vomiting Formulas), and Tanaka Shinchou wrote *Iji Dan* (Discussions on Medical Affairs); all inherited and expounded upon their master's teachings, making significant contributions.

Sweating (Han), inducing vomiting (Tu), and purging (Xia) are different methods that share the same ultimate goal. Failing to induce vomiting when indicated is akin to failing to sweat or purge when indicated. However, physicians of the world often neglect the method of inducing vomiting; consequently, patients who remain in a state between life and death are numerous. Dokushoan from Choshun Province particularly mastered this method, and the cases recorded in his *Kohou Kou* (Examination of Vomiting Formulas) were verified by evidence. I studied vomiting formulas under Master Okamura for over ten years before applying them clinically. Treating dozens of patients annually, I became quite familiar with their efficacy. However, regarding the subtle variations in application, words cannot fully express it. One must rely on clear verification, careful experimentation, combine skill with insight, and align courage with confidence; only then can one approach mastery. When intending to use the vomiting method, one must examine abdominal signs. If pressing the abdomen does not reveal indications suitable for vomiting, even if the upper and lower body feel solid, vomiting should not be induced.

Those who induce rapid vomiting will inevitably experience rapid diarrhea, as opening the upper orifices opens the lower ones. Zhang Hezi administered dozens of purgative doses after inducing vomiting; this requires weighing the condition and exercising discretion. Using the vomiting method for chronic diseases and subsequently for acute Shanghan (Cold Damage) diseases helps avoid harm.

For epilepsy, administer Sansheng San (Three Saints Powder) to induce vomiting, followed by a preparation containing Qian Dan (Lead Oxide) for good results.

For patients with wheezing and abdominal fullness, vomiting is contraindicated; Huichun Zijin Dan (Spring-Returning Purple Gold Pill) is appropriate. If there is no abdominal fullness, vomiting may be induced using Gengdi San (Melon Rind Powder).

In Shanghan disease, if sweating fails to resolve the condition, accompanied by bitter fullness in the chest and hypochondrium, indigestion, alternating loose or constipated stools, a white tongue coating, shortness of breath, and irritability, vomiting should be induced, primarily using Gengdi San (Melon Rind Powder). Failure to induce vomiting when indicated leads to death.

After sweating, vomiting, or purging, if the patient experiences mental restlessness and painful knotting in the heart region, vomiting should be induced; failure to do so leads to death. (Note: The term "vomiting formula" here might refer to Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), but the context emphasizes the vomiting method.)

Salt water induces vomiting for phlegm; Rehmannia induces vomiting for roundworms; Wuling San (Five-Ingredient Powder with Poria) induces vomiting for Shanghan; Scallion White induces vomiting for headache. These formulas do not inherently cause vomiting; the key lies in understanding their principles, matching them to the syndrome, and mastering the correct technique.

For regurgitation and various types of vomiting, if there is a palpable mass with throbbing/palpitations in the lower abdomen impacting the epigastrium, heat and pain in the heart region, hunger but inability to eat, vomiting is contraindicated; inducing vomiting will be fatal.

If sweating is followed by steaming fever, it belongs to the Stomach. If there is chest/hypochondriac fullness and vomiting, despite tidal fever, immediate purging is inadvisable. Physicians ignorant of this mechanism often misprescribe, turning mild conditions severe and severe ones critical. How tragic!

For dysentery with tenesmus, even if the pulse is surging and rapid, one must examine abdominal signs. Some cases require sweating, some purging, some harmonizing; one should not indiscriminately purge. If stool resembles fish brains/liver, food intake is impossible, and the pulse is fine and rapid, death will occur within days. If the patient can eat but passes pus and blood chronically, treat with formulas for intestinal abscess (Chang Yong).

For dysentery with coughing and air reversal, pain radiating to the hypochondrium, anorexia, alternating chills and fever, progressing toward consumptive disease, urgent purging is required, preferably using Shizao Tang (Ten Jujube Decoction).

A physician facing illness is like a general facing an enemy. Without grasping the timing and understanding the mechanism, defeat is certain. Thought must be precise, observation meticulous. Thus, errors are avoided. As the book states: "Only time, only opportunity." This applies to all affairs, not just medicine.

For stroke causing facial deviation or hemiplegia, Gengdi San (Melon Rind Powder) is effective; however, it has no effect for sudden stroke.

Wei Syndrome (Flaccidity Syndrome) is mostly caused by rebellious heat rising, leading to dryness and deficiency of Qi and Blood in the lower jiao, resulting in leg flaccidity. This syndrome necessarily involves frequent urination, constipation, urinary incontinence, and potentially fatal hemorrhage. Administering a vomiting agent followed by Baihu Tang (White Tiger Decoction) is the correct approach.

For ear diseases, Xieqing Wan (Drain Green Pill) from *Xuanming Lun* is effective.

For high fever and asthma induced by moxibustion/fire therapy, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Black Beans and Oyster Shell is particularly effective.

For intestinal abscess persisting for days classified as Yin type, Yiyi Fuzi Baizao San (Coix Seed, Aconite, and Patrinia Powder) added with Huang Qin (Scutellaria Root) is good. For severe pain, add Myrrh.

During the suppuration stage of smallpox/variolae, if there is irritability, thirst, confusion, and convulsions, Fengyin Tang (Wind-Guiding Decoction) is effective. This syndrome is a key point in variolae treatment; while *Huoyou Xinfa* uses Lisha Yi Yuan San (Labradoris Seed and Origin-Preserving Powder), this formula is more rapid. (Zhuoxuan commented: Flexibility depends on the practitioner; this is the subtlety of ancient formulas. Western physicians may lack this insight. The continuous addition of prescriptions stems from this.)

Dry mouth not caused by pathogenic factors indicates Blood deficiency, common in Xu Lao (Consumptive Disease). Fever can also stem from Blood deficiency; this must be known.

Fresh Ginger disperses stagnant pathogens in the chest/heart; Dried Ginger warms and disperses cold in the chest/heart. Despite frequent use, these are their primary functions. Physicians often fail to deeply distinguish between Fresh and Dried Ginger. Alas!

For recurrent dysentery associated with hernia-like symptoms, Danggui Sini Tang (Angelica Decoction for Cold Extremities) is appropriate.

For Jin Kou Li (Lockjaw Dysentery) where oral medication cannot be retained, mash Crucian Carp into a paste, mix with Evodia Fruit and a little Musk, and apply to the umbilicus for effect.

For food stagnation difficult to expel via vomiting or purging, decocting Shengma (Cimicifuga Rhizome) and Yujin (Curcuma Longa Rhizome) yields rapid results.

For severe cholera with muscle cramps/spasms, Lizhong Tang (Regulate the Middle Decoction) added with Gypsum is excellent. (Ancients used Lizhong Tang plus Gypsum for spasms, and Pingwei San (Stomach-Pacifying Powder) plus Mirabilite for retained placenta; the rationale is profound, involving the interaction of Yin-Yang and Hard-Soft. This was derived from clinical practice and is not empty talk.)