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Emesis (Tǔ Fǎ) is a method for treating diseases of the Upper Jiao (Upper Burner). In the region between the chest and diaphragm, and in the throat, if there are phlegm, food retention, or abscess pus, the appropriate treatment is emesis. The Classics state: "Where the pathogen is high, induce it to ascend and vomit." This is correct. However, there are cases where failure to vomit when indicated causes harm; there are cases where vomiting is induced when not indicated, causing harm; there are cases where vomiting is contraindicated due to specific conditions yet is recklessly applied, causing harm; and there are cases where vomiting is both indicated and necessary despite contraindications, but mishandled due to lack of proper technique, causing harm. These distinctions must be clearly understood.

For instance, in conditions such as Strangling Throat Wind (Chán Hóu Fēng) and Locking Throat Wind (Suǒ Hóu Fēng), wind-phlegm and stagnant fire obstruct the area. If emesis is not urgently employed, severe distension and closure will become unbearable. Or, if food stagnates in the chest and diaphragm, unable to digest or transform, leading to distension and pain, emesis is mandatory. Otherwise, the chest may become elevated and full, with unpredictable complications arising. Furthermore, if retained phlegm and fluid obstruct the clear pathways, changes may occur over time, hindering diet, causing dizziness and palpitations, acid regurgitation and belching of rotten food, or numbness in the limbs. Symptoms vary widely, but emesis is suitable to guide out the phlegm, after which all symptoms will vanish. In cases of gastric abscess with vomiting of pus and blood, the Classics say: "If there is pus in the vomitus, do not treat the vomiting itself; once the pus is exhausted, health will return naturally." All these are instances where emesis is indicated.

However, there are cases where emesis is inappropriate yet used erroneously. Why? For example, in Shaoyang (Lesser Yang) wind-stroke, with chest fullness and irritability, this is due to pathogenic qi rather than tangible accumulation; emesis is contraindicated, as inducing vomiting would lead to fright and palpitations. In Shaoyin (Lesser Yin) disease, at its onset, with cold extremities and immediate vomiting upon eating, this indicates cold-fluid above the diaphragm; emesis is also contraindicated here. In Taiyang (Greater Yang) disease, emesis is contraindicated; inducing vomiting leads to inability to eat and internal irritability. Although some argue that emesis contains dispersing properties, failing to eliminate the pathogen constitutes a minor deviation. These are cases of inappropriate emesis.

Conversely, there are cases where emesis is indicated but contraindicated. Why? When using emesis, one must assess the deficiency or excess of the disease. When selecting patients for emesis, one must first consider their temperament to avoid error. Even if the disease is in the Upper Jiao and suitable for emesis, if the patient's condition is critical, or they are elderly and weak with depleted Qi, or constitutionally deficient with a faint pulse, or have just given birth, or suffer from spontaneous continuous vomiting, or are among those who have lost blood, or have "moving Qi" (ascending rebellious Qi), or present with cold extremities and spontaneous cold sweat, emesis is strictly forbidden. Inducing vomiting in these cases results in adverse reactions; this is prohibition due to deficiency. For patients with chronic illness and deep-seated accumulation, a single course of emesis may cause Heart Fire to descend while Ministerial Fire rises. If sexual activity or fatigue occurs subsequently, deficiency syndromes may develop, becoming difficult to treat. Such patients must abstain from anger, concentrate their spirit, regulate breathing, and rest quietly. They should not go outdoors for thirty days to follow proper protocol. If a patient has a fierce temper, loves anger and lust, and ignores taboos, what assurance can there be against danger? This is prohibition due to temperament. These are the "indicated but contraindicated" cases.

Yet, there are situations where emesis is technically contraindicated but absolutely necessary. For example, if a patient has a slippery and large pulse, with phlegm retention in the chest and food stagnation in the stomach, which cannot be removed without emesis, one may use Geng Ti San (Melon Seed Powder) with orange peel and light salt water. For phlegm, Er Chen Tang (Two-Aged Decoction) may be used, combined with finger-induced gagging. For extremely deficient constitutions, decoction of Platycodon Root (Jie Geng) may substitute for emetic agents, which is safer. I have further methods: I once treated a case of cold-phlegm obstruction causing syncope and cold limbs by decocting Pinellia Tuber (Ban Xia) and Exocarpium Citri Reticulatae (Ju Hong), each 8 qian, concentrated to half a cup, mixed with ginger juice to make one cup, administered frequently. As phlegm was expelled with the medicine, it was wiped away; the cycle of administering and vomiting continued until, after a short while, the phlegm cleared, the medicine descended, and the patient regained consciousness. There were many such cases. I once treated a case of wind-pathogen affecting the Zang organs approaching collapse, characterized by open-mouthed rattling respiration like sawing wood and involuntary urination/defecation. Emesis was too taxing, and medicines like Xi Xian San (Thin Saliva Powder) or Sichuan Bulb Fritillary (Zao Jiao) were unavailable or impractical. Instead, I used a large dose of Ginseng Radix et Rhizoma (Ren Shen), Aconite Lateralis Radix Praeparata (Fu Zi), Zingiberis Rhizoma (Sheng Jiang), and Pinellia Tuber (Ban Xia), decocted strongly and administered. Medicine came out with phlegm, which was wiped away; administration and vomiting continued cyclically. Eventually, the medicinal force reached the stomach, the chest and diaphragm became unobstructed, and large doses of Ginseng and Aconite could be tolerated, reaching several taels immediately. The patient gradually recovered, consuming several jin of Ginseng within a month until fully restored. There were many such cases. I also treated wind-phlegm-heat obstruction using Niuhuang Wan (Calculus Bovis Pill); neck carbuncle invading inward where medicine could not enter, using Suhe Xiang Wan (Styrax Pill); aphasia due to wind-heat, using Jieyu Dan (Unblocking Speech Powder); heatstroke coma, using Xiaoshu Wan (Summerheat Relief Pill); sudden evil invasion coma, using the aforementioned orange peel, Pinellia, and ginger juice mixture; nightmare coma, using Lotus Stamen (Lian Xu) and Scallion White (Cong Bai) decocted in wine; and hanging/coma, using Cinnamon Bark (Rou Gui) 3 qian decocted in water. All were administered via the same frequent-gavage-and-vomit method, resulting in complete recovery. There were many such cases. Furthermore, for trismus (lockjaw) and complete obstruction, Chubi San (Nose-Snuffing Powder) was blown into the nose to induce sneezing. Sneezing opened the jaw, allowing phlegm or food to be expelled, and the patient revived. Such cases were particularly numerous. This approach—medicating according to syndrome and inducing emesis through medication—represents a deeper meaning of "emesis without active vomiting." These are established ancient methods, slightly modified by me.

Previously, Zhang Zhongjing treated chest pain with inability to eat, where pressing elicited salivation, accompanied by diarrhea dozens of times daily; he used emesis to stop the diarrhea by expelling phlegm. Zhu Danxi treated pregnant women with retroverted bladder (Zhuan Pao) and urinary retention by administering Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) followed by induced vomiting, often with success, thereby using emesis to promote urination. Hua Tuo used vinegar and garlic to expel snakes; Liu Wansu used dog oil and Realgar (Xiong Huang) with Melon Seeds (Gua Di) to expel parasites and unblock the diaphragm; Zhu Danxi used leek juice to remove blood stasis for similar conditions. From this, we see that in critical and doubtful situations, ancients frequently employed emetics to achieve miraculous and unfathomable effects, let alone in obvious cases! Yet modern physicians often relegate this method to obscurity, acting as if no emetic method exists beyond sweating and purging. Consequently, patients often experience spontaneous vomiting, which becomes a favorable sign, but observers are startled, and doctors, regardless of deficiency or excess, hastily suppress it, turning favorable signs into disastrous complications, harming many people. Alas, how can one not revere this method?