Library

In the spring, when pathogens are vigorous, the vomiting method is appropriate; in summer, the sweating method is appropriate; in autumn, the purgative method is appropriate. Whenever decoctions for sweating, vomiting, or purging are used, they should be stopped as soon as the pathogen is eliminated (Zhongbing Jizhi).

If it is Shaoyang disease (disease of the Shaoyang channel), and the pulse is faint, sweating must not be induced, because it would lead to Yang collapse (Wangyang). In this case, Fuzi Tang (Aconite Decoction) is appropriate. If Yang is already deficient, and the cunian position (Chi) is weak and choppy, purging must not be used either; Xiaochaihu Tang (Minor Bupleurum Decoction) is appropriate.

If there is "moving qi" (abdominal pulsation) on the left, right, above, or below, sweating must not be induced; Chaihu Guizhi Tang (Bupleurum and Cinnamon Twig Decoction) is appropriate. If it is Shaoyin disease (disease of the Shaoyin channel), and the pulse is fine, deep, and rapid, indicating the pathogen is in the interior, sweating must not be induced; Danggui Sini Tang (Angelica Sinensis Decoction for Cold Extremities) is appropriate. If it is Shaoyang disease, sweating must not be induced; Xiaochaihu Tang is appropriate.

If there is throat obstruction and dryness, or if the patient is one who has lost blood (Wangxue), one who frequently suffers from epistaxis (Nujia), one with stranguria (Linjia), or one with sores and ulcers (Chuangjia), sweating must not be induced. All six of these conditions are appropriate for Xiaochaihu Tang.

If there is diarrhea with undigested food (Xialiqinggu), sweating must not be induced; Lizhong Tang (Regulate the Middle Decoction) or Sini Tang (Reverse the Extremities Decoction) and similar formulas are appropriate.

If there are cold extremities (Sini) or the patient is constitutionally weak, vomiting must not be induced. For cold extremities, Danggui Sini Tang is appropriate; for constitutional weakness, Fuzi Tang is appropriate; for those with internal heat, Renshen Jianzhong Tang (Ginseng and Middle-Constructing Decoction) is appropriate. If a constitutionally weak person is treated with heat-clearing attacks, hiccups will inevitably occur; Xiaochaihu Tang is appropriate.

If it is Shaoyin disease with cold in the diaphragm causing dry retching, vomiting must not be induced; Xiaobanxia Ji Juapi Tang (Minor Pinellia with Tangerine Peel Decoction) or Wenzhong Wan (Warm the Middle Pill) is appropriate.

If there is moving qi in the throat, purging must not be induced; if there is throat obstruction, purging must not be induced; Wushan Tang (Black Cockerel Decoction) is appropriate.

If there is an exterior excess syndrome, purging must not be induced. All cases of cold extremities must not be purged, nor should constitutionally weak patients. For cold extremities, Danggui Sini Tang is appropriate; for constitutional weakness, Fuzi Tang is appropriate; for those with heat, Renshen Jianzhong Tang is appropriate.

If the pulse is floating and tight, according to the principles, body pain should be resolved by sweating. However, if the Chi position pulse is slow, sweating must not be induced, because this indicates deficiency of Ying Qi (Nutritive Qi) and blood scarcity; Xiaochaihu Tang is appropriate.

If the pulse is soft (Ru) and tight, Ru indicates weak Wei Qi (Defensive Qi), and tight indicates cold in the Ying level. With weak Yang and wind attacking the Wei level, symptoms include fever and aversion to cold. With tight Ying and cold Wei Qi, there is slight vomiting and internal vexation. This condition cannot be treated with sweating; Xiaochaihu Tang is appropriate.

If the pulse is soft and weak, sweating must not be induced; Xiaochaihu Tang is appropriate.

If the pulse is floating and large, floating indicates Qi excess, and large indicates blood deficiency. Urine should be red and difficult to pass due to emptiness in the Baozhong (Bladder/Uterus region). Now, however, urination is free and there is profuse sweating. According to the method, Xiaojianzhong Tang (Minor Middle-Constructing Decoction) should be given.

If instead the condition becomes more excess-like, fluids scatter, Ying and blood are exhausted, leading to dryness, vexation, and insomnia, purging must not be induced; Xiaochaihu Tang is appropriate.

If the pulse is floating and large, sweating should be induced; Chaihu Guizhi Tang is appropriate.

If the pulse is floating and tight, purging must not be induced. If purging is mistakenly used, it is a major error (Da Ni); Guizhi Mahuang Ban Ge Tang (Cinnamon Twig and Ephedra Half-Dose Decoction) is appropriate.

If the pulse is rapid, purging must not be induced; Chaihu Guizhi Tang is appropriate. If purging is used, it will cause vexation and unceasing diarrhea; Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) is appropriate.

If the pulse is choppy, weak, floating, and rapid, purging must not be induced; Xiaochaihu Tang is appropriate.

If the pulse is soft, weak, faint, and choppy: faint indicates insufficient Yang Qi, where wind-strike causes sweating but also restlessness; choppy indicates bloodlessness, leading to cold extremities and cold. Purging must not be induced; Guizhi Gancao Muli Longgu Tang (Cinnamon Twig, Licorice, Oyster Shell, and Dragon Bone Decoction) is appropriate.

If it is Jie Xiong (Chest Binding) with a floating and large pulse, purging must not be induced, as it leads to death; Xiao Xianxiong Tang (Minor Chest-Binding Decoction) is appropriate.

If Yang disease involves much heat, purging leads to hardness; Xiaochaihu Tang is appropriate.

If Taiyang disease sweating was incomplete, transferring to Yangming, with slight sweating and no aversion to cold: if Taiyang symptoms have not ceased, purging must not be induced, as it is a counter-action (Ni); Guizhi Mahuang Tang (Cinnamon Twig and Ephedra Decoction) is appropriate.

If Taiyang disease has unresolved exterior symptoms, purging must not be induced, as it is a counter-action; Guizhi Mahuang Tang is appropriate.

If disease originates in Yang channels and is mistakenly purged, heat enters and forms Jie Xiong (Chest Binding); if it originates in Yin channels and is mistakenly purged, Pi (Stagnation) forms. For Jie Xiong, there are three types of Xianxiong Tang/Wan (Chest-Binding Decoction/Pill); for Pi, there are five types of Xiexin Tang (Drain the Epigastrium Decoction).

If Taiyang and Yangming combine, causing wheezing and chest fullness, purging must not be induced; Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is appropriate.

If Taiyang and Shaoyang combine, causing epigastric hardness, neck stiffness, and dizziness, purging must not be induced; Xiaochaihu Tang is appropriate.

If the patient desires to vomit, purging must not be induced; Xiaobanxia Ji Juapi Tang is appropriate.

Taiyin disease presents with abdominal pain, vomiting food, and spontaneous diarrhea. If abdominal pain is treated with purging, it will cause hardness below the chest. Jueyin disease presents with Qi rushing up to the heart, heat in the heart, hunger without desire to eat, and vomiting roundworms after eating. Purging leads to unceasing diarrhea.

If Shaoyin disease presents with immediate vomiting upon swallowing food, warm sensation in the heart with desire to vomit, and abdominal pain: at onset, with cold hands and feet and a string-tight, slow pulse, this is cold-food stagnation in the chest, and purging must not be induced; Wenzhong Tang (Warm the Middle Decoction) or Shengjiang Zhi Banxia Tang (Fresh Ginger and Pinellia Decoction) is appropriate.

If there are no Yang symptoms, strong Yin Qi, and hard stool, purging leads to undigested diarrhea and abdominal fullness; Mi Jian Dao Fa (Honey Suppository Method) should be used.

If Shanghan (Cold Damage) lasts five to six days, without Jie Xiong, with a soft abdomen, deficient pulse, and cold extremities, purging must not be induced, as this indicates blood loss; Danggui Sini Tang is appropriate. Purging leads to death; Sini Tang Jiaren Shen Tang (Reverse Extremities Decoction with Ginseng) is appropriate.

If Zangjie (Organ Knotting) occurs without Yang symptoms, without alternating chills and fever, with the patient remaining quiet and a slippery tongue coating, attacking (purging) must not be induced; Xiaochaihu Tang is appropriate.

If Shanghan causes frequent vomiting, even if Yangming symptoms exist, attacking (purging) must not be induced; Xiaochaihu Tang is appropriate.

If Yangming disease presents with a red face and body, attacking leads to fever; Tiaowei Chengqi Tang (Regulate the Stomach and Direct to the Right Decoction) is appropriate.

If the complexion is yellow, it indicates difficult urination; Wuling San (Five-Ling Powder) is appropriate.

If Yangming disease presents with epigastric hardness and fullness, attacking must not be induced; Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) or Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction) is appropriate. If attacking leads to unceasing diarrhea, death ensues; Sini Tang is appropriate.

The dangers of using sweating, purging, and vomiting methods are significant. Ancients usually listed these after the channel discussions. Generally, medical errors stem first from incorrect medication; once the medication is wrong, complications arise. If sweating or purging fails to cure, conditions such as Yang collapse, jaundice, blood stasis, chest binding, stagnation, dysentery, hypochondriac heat-damp dysentery, spasms, and consumptive diseases may develop. Therefore, these major contraindications are recorded here to prevent physicians from committing these errors at the onset of disease.