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[General Principle: Spring is Suitable for Emetic Therapy]
[Annotation]
Diaphoresis (sweating), emesis (vomiting), and purgation (downward draining) are the three major principles of treating diseases. The statement that spring is suitable for emetic therapy is based on establishing treatment methods by imitating the ascending nature of spring Qi in heaven. However, emetic therapy should only be used when indicated by the disease; it cannot be applied indiscriminately.
[Collected Annotations]
Cheng Yingmao stated: Emesis follows the ascending movement, possessing the meaning of discarding the old to bring forth the new; therefore, it is said that spring is suitable for emesis.

[When using an emetic decoction, stop as soon as the disease is cured; there is no need to consume the entire dose.]
[Annotation]
When administering an emetic decoction, one should stop immediately once the therapeutic effect is achieved; it is unnecessary to finish the entire prescription.
[Annotation]
The purpose of using emetic decoctions is originally to eliminate pathogenic factors in the Upper Jiao (Upper Burner). Stopping upon cure prevents excessive use, which would otherwise damage the Middle Qi (Qi of the Spleen and Stomach); hence, finishing the full dose is not required.
[Collected Annotations]
Cheng Yingmao stated: Emesis eliminates pathogenic factors in the Upper Jiao. The Upper Jiao is the region where Clear Yang distributes. Over-emesis, while expelling pathogens, damages the Yang Qi of the Danzhong (Chest Center). Since Yang Qi must certainly be cherished and protected, caution is needed.

[In cases of various excess conditions in the upper chest, with a feeling of oppression and pain in the chest, inability to eat, desire for someone to press on the area, yet producing saliva and phlegm upon pressing, accompanied by diarrhea occurring more than ten times a day, with a pulse that is surprisingly slow, and only the Cun Kou (radial artery at the wrist) pulse appearing slippery, this condition is suitable for emesis. After emesis, the diarrhea will cease.]
[Annotation]
"Various excess conditions in the upper chest" refers to exuberant Phlegm, Heat, or Cold. These excess pathogens cause oppression and pain in the chest and an inability to eat. The desire for abdominal/chest pressure, which fails to relieve pain but instead induces salivation and phlegm production, indicates that pathogens are abundant and full in the chest, overflowing upward upon pressure. The Classic states: "Diarrhea with a slow and slippery pulse indicates internal excess." Now, with diarrhea occurring over ten times daily, a surprisingly slow pulse, and only a slippery Cun Kou pulse, it is known that Cold-Excess resides in the upper part, preventing water fluids from descending to the Bladder and causing them to flow into the Large Intestine. Therefore, simply using emesis will naturally stop the diarrhea.
[Collected Annotations]
Zhang Lu stated: Pain, inability to eat, and the production of saliva/phlegm upon pressure indicate the presence of Cold-Phlegm in the chest. Diarrhea with a slow pulse and only a slippery Cun Kou pulse indicates Excess above the diaphragm; thus, emesis will naturally stop the diarrhea.

[In cases where the patient experiences coldness in the hands and feet, a pulse that occasionally becomes knotted (Jie Mai), due to alien Qi residing in the chest, epigastric fullness and vexation, and a desire to eat but inability to do so, the disease is located in the chest and should be treated with emesis.]
[Annotation]
Coldness in the extremities and an occasionally knotted pulse result from Cold Pathogens and Qi stagnation knotting in the chest, preventing Yang Qi from reaching the four limbs. Epigastric fullness and vexation arise because actual stagnation causes fullness, and constrained Yang causes vexation. The desire to eat but inability to do so indicates that alien Qi is pathologically located in the chest; therefore, emesis should be employed.
[Annotation]
The patient's cold extremities and occasional knotted pulse are caused by Cold Pathogens and Qi binding in the chest, obstructing the circulation of Yang Qi to the limbs. Fullness and vexation in the epigastrium occur due to real stagnation causing fullness and constrained Yang causing vexation. The desire to eat but inability to swallow indicates the disease of alien Qi is in the chest, so emesis is indicated.
[Collected Annotations]
Cheng Wuji stated: This shares the same pattern as the Gengti San (Melon Stalk Powder) syndrome. That text mentions a suddenly tight pulse, whereas this mentions a suddenly knotted pulse; this is the only difference. A tight pulse indicates internal excess; a sudden tightness suggests the pathogen is in the chest, excess but not deep. A knotted pulse indicates knotting/stagnation; a sudden knottedness suggests the pathogen is in the chest, knotted but not deep. Although the treatment is the same, there is a distinction in the heaviness or lightness of the approach.
Cheng Zhi stated: A pulse that comes slowly and stops occasionally before resuming is called a Knotted Pulse (Jie Mai), named for the knotting and stagnation of Phlegm-Qi. This aligns with the Gengti San syndrome. However, a sudden tight pulse in the other case indicates盛 (exuberance) of Cold Pathogens, whereas a sudden knotted pulse here indicates Excess of Phlegm-Qi.
Zhang Xiju stated: Coldness in the hands and feet results from Qi mechanism knotting internally and failing to reach the extremities externally. Fullness and vexation in the epigastrium occur because pathogenic excess causes fullness, and righteous Qi injury causes vexation.
Wei Litong stated: A sudden knotted pulse is not the natural state of the pulse but rather the obstruction of Zong Qi (Pectoral Qi) in the chest by tangible pathogens. This prevents the smooth circulation of Ying (Nutritive) and Wei (Defensive) Qi, differing from knotting caused by deficiency and weakness of Qi and Blood preventing distribution.

[For retained food lodged in the Upper Wan (upper stomach), emesis should be used.]
[Annotation]
The Stomach is divided into the Upper, Middle, and Lower Wan. When retained food lodges in the Upper Wan, pain occurs in the chest and diaphragm; when painful, the patient desires to vomit, making emesis appropriate and purgation inappropriate. When retained food lodges in the Middle Wan, pain occurs at the heart's pit; whether the patient desires to vomit or not, both emesis and purgation may be considered. When retained food lodges in the Lower Wan, pain occurs above the umbilicus; the patient does not desire to vomit, making emesis inappropriate and purgation appropriate. Thus, it is said that for retained food in the Upper Wan, emesis should be used. This elaborates that generally, anything located in the upper regions can be treated with emesis.
[Collected Annotations]
Cheng Wuji stated: For retained food in the Middle and Lower Wan, purgation is suitable; for retained food in the Upper Wan, emesis is appropriate. The Neijing states: "Where the pathology is high, induce vomiting to let it rise out; where the pathology is low, guide it to drain out."
Fang Youzhi stated: The Upper Wan refers to the opening of the Stomach organ.
Zhang Zhicong stated: The Stomach is the sea of water and grain, divided into Upper, Middle, and Lower Wan. The Upper Wan receives, the Middle Wan transforms. If food remains in the Upper Wan without being decomposed and transformed, it becomes retained food, and emesis is indicated.
Cheng Yingmao stated: Zong Qi gathers in the chest, governing ascent, descent, inhalation, and exhalation. How can the region of Clear Yang tolerate the stagnation of turbid substances? Emesis disperses and unblocks, removing obstacles. If the condition arises from exterior pathogens transmitting inward, transforming from formless to tangible, resulting in Pi (glomus) or Jie Xiong (chest binding), there are separate treatment methods; emesis is not suitable in those cases.