Library

Sour and neutral in nature are *Tonglü* (Vitriol Green). Sweet, sour, and neutral in nature are *Chixiaodou* (Adzuki Bean). Among these thirty-six herbs, only *Changshan* (Dichroa Root), *Danfan* (Alum), and *Gua Di* (Melon Stalk) possess slight toxicity; *Lilu* (Veratrum Root), *Yuanhua* (Genkwa Flower), *Qingfen* (Calomel), and *Wufu Jian* (Aconite Tip) possess major toxicity. The remaining twenty-six herbs are non-toxic emetics. They should be selected according to the specific syndrome. Initially, a small dose should be administered; if vomiting does not occur, the dosage should be gradually increased.

Emesis is contraindicated in cases of severe and critical disease progression, in the elderly and weak with depleted vital energy (*Zheng Qi*), as prolonged vomiting may lead to *Wang Yang* (collapse of Yang Qi). Emesis is contraindicated in patients with blood deficiency. It is also contraindicated in patients presenting with hematemesis, hemoptysis, epistaxis, coughing up blood, metrorrhagia, or any form of hemorrhage. Emesis is contraindicated in patients who lack mental stability, exhibiting delirious speech and erratic behavior. It is contraindicated when the attending physician cannot distinguish between pathogenic factors and healthy Qi. Emesis is contraindicated in individuals with a rigid and violent temperament, prone to anger and licentiousness.

[Slip Bowu] If the pulse at the Chi position (cubital fossa/wrist) is forceful upon palpation, emesis should be employed. If the Chi pulse is feeble, emesis is contraindicated. A forceful pulse indicates that Yang Qi has sunk into the Yin aspect and is constrained by Yin pathogens; therefore, emesis is used to facilitate the ascending movement of Yang Qi.

[Li Dongyuan] Discussion on the improper use of emetics in Spleen-Stomach deficiency: The *Suwen: Liuyuan Zhengji Dalun* states, "When Wood is depressed, it should be dispersed." This implies that the intrinsic nature of Wood is dynamic and uplifting. When Wood Qi is depressed within the body (analogous to being buried in the earth) and unable to function, it signifies a loss of its Wind nature. In cases of Wood depression in the human body, unblocking and dredging methods should be applied; thus, emesis can be used to assist the Wind-Wood Qi, which embodies the meaning of "Wood depression, disperse it." Furthermore, "disperse" here means that when Wood initially loses its nature and becomes depressed internally, using emesis to induce upward expulsion allows it to rise without stagnation, thereby restoring its nature with surplus energy. This surplus may then overact upon its controlling element, causing pathology in Spleen Earth, as documented under the section on "Wood depression, disperse it," serving as more than just a single verification. Additionally, during periods governed by Jueyin, Wind-Wood Qi is prosperous. Similarly, "Jueyin victory" also indicates prosperous Wind-Wood. Both scenarios result in pathological invasion of the Spleen-Stomach, consistent with the previous discussion. Those who fail to comprehend the meaning of "Wood depression, disperse it" might mistakenly treat it as "treating Wood depression," thereby reinforcing excess and subjecting the Spleen-Stomach further to Wood constraint, effectively tonifying the excess and damaging the deficient. Since Spleen-Stomach Qi is already insufficient, would this not lead to further exhaustion?

Clear indications for emesis include chest oppression and blockage. If the Qi Kou (radial artery at the wrist) pulse is three times larger than the Ying Shou (carotid artery) pulse, it indicates dietary injury to the Taiyin Spleen. If there is a pulse in the upper positions but none in the lower positions, the patient requires emesis; failure to do so may result in death. The absence of a lower pulse indicates Wood depression in the lower jiao, obstruction of the pathways, and severance of Liver Qi. Accompanied by Lung Metal's tendency to obstruct and fail to descend due to physical blockage, Metal overacts on Wood, causing Liver Wood pathology. Food impaction in the chest and throat illustrates the principle: "Those located above should be expelled upwards." Zhang Zhongjing stated: For excessive heat causing vexation, use *Gua Di San* (Melon Stalk Powder) to induce emesis. If vexation persists after sweating or purgation, it is termed "deficiency vexation" or *Ao Nao* (profound restlessness), characterized by irritability and insomnia, indicating Wood depression; *Zhi Zi Chi Tang* (Gardenia and Fermented Soybean Decoction) should be used to induce emesis. Ignorant practitioners fail to recognize that when the diaphragm and throat are blocked, pain radiates to both hypochondria, abdominal distension occurs, and the Stomach is deficient, this constitutes turbid Qi stagnating in the upper jiao, leading to distension diseases. Indiscriminate use of emesis in such cases is erroneous. Moreover, Stomach deficiency often leads to Liver anger, where Wind-Wood invades the Stomach Qi. The *Neijing* advocates using heavy, sedative measures (like iron weights) to suppress this; how can one instead use emesis to aid the Wind-Wood pathogen? Using emesis when it is contraindicated creates an error as vast as the separation between heaven and earth. Only cases of genuine obstruction and vexation are suitable for emesis. For excess conditions in the lower jiao, *Da Cheng Qi Tang* (Major Order the Qi Decoction) is indicated, as detailed in the preceding sections on exterior-interior relationships.