栀子（十四枚擘味苦寒） 香豉（四合绵裹寒）
上二味。以水四升。先煮栀子。得二升半。内豉。煮取一升半。去滓。分为二服。
温进一服。得吐者。止后服。
酸苦涌泄为阴。苦以涌吐。寒以胜热。栀子豉汤相合。吐剂宜矣。
成氏云。吐证亦自不同。如不经汗下。邪气蕴郁于膈。则谓之实也。应以瓜蒂散吐
之。瓜蒂散。吐胸中之实邪也。若发汗吐下后邪气乘虚留于胸中。则谓之虚烦。应以栀
子汤吐之。此吐胸中虚烦也。
若少气者。栀子甘草豉汤主之。若呕者栀子生姜豉汤主之。
少气者。热伤气也。加甘草以益气。呕者。热烦而气逆也。加生姜以散气。少气则
气为热搏。散而不收者。甘以补之可也。呕则气为热搏。逆而不散者。辛以散之可也。
于栀子豉汤方内。加生姜五两。余根据前法。得吐。止后服。
发汗。若下之。而烦热。胸中窒者。栀子豉汤主之。
阳受气于胸中。发汗若下。使阳气不足。邪热客于胸中。结而不散。故烦热而胸中窒
塞。与栀子豉汤。以吐胸中之邪。
伤寒五六日。大下之后。身热不去。心中结痛者。未欲解也。栀子豉汤主之。
伤寒五六日。邪气在里之时。若大下后。身热去。心胸空者。为欲解。若大下后。身
热去而心结痛者。结胸也。身热不去心中结痛者。虚烦也。结胸。为热结胸中为实。是
热气已收敛于内。则外身热去。虚烦。为热客胸中。未结为实散漫为烦。是以身热不去。
六七日。为欲解之时。以热为虚烦。故云未欲解也。与栀子豉汤以吐除之。
伤寒下后。心烦、腹满。卧起不安者。栀子浓朴汤主之。
下后。但腹满而不心烦。即邪气入里。为里实。但心烦而不腹满。即邪气在胸中。
为虚烦。既烦且满。则邪气壅于胸腹之间也。满则不能坐。烦则不能卧。故卧起
不安。与栀子浓朴汤。吐烦泄满。
Zhi Zi (Gardeniae Fructus, fourteen seeds, broken, bitter in flavor, cold in nature) Xiang Chi (Fermented Soybean Seed, four he, wrapped in silk cloth, cold in nature)
The above two ingredients. Use four sheng of water. First decoct Zhi Zi. When reduced to two and a half sheng, add Xiang Chi. Decoct until one and a half sheng remains. Strain the dregs. Divide into two doses.
Take one dose warm. If vomiting occurs after taking the medicine, stop taking the remaining dose.
Sour and bitter flavors have the effect of urging discharge, which belongs to Yin. Bitter flavor can urge vomiting. Cold nature can overcome heat. The combination of Zhi Zi and Xiang Chi is suitable as an emetic agent.
Cheng Wuji stated: Emetic syndromes also differ. For instance, if no sweating or purging has been performed, and pathogenic factors are constrained and stagnant in the diaphragm, it is called Excess syndrome. It should be treated with Gua Di San to induce vomiting. Gua Di San expels excess pathogenic factors from the chest. If, after sweating, vomiting, or purging, pathogenic factors remain in the chest due to deficiency, it is called Deficiency vexation. It should be treated with Zhi Zi Tang to induce vomiting. This treats deficiency vexation in the chest.
If there is shortness of breath (Shao Qi), Zhi Zi Gan Cao Chi Tang is indicated. If there is vomiting, Zhi Zi Sheng Jiang Chi Tang is indicated.
Shortness of breath is caused by heat damaging Qi. Adding Gan Cao tonifies Qi. Vomiting is caused by heat-induced vexation leading to rebellious Qi. Adding Sheng Jiang disperses Qi. In cases of shortness of breath, Qi is combated by heat, scattering without gathering; sweet flavor can tonify this. In cases of vomiting, Qi is combated by heat, rebelling without dispersing; pungent flavor can disperse this.
In the Zhi Zi Chi Tang formula, add two liang of Gan Cao. Follow the previous method for preparation. If vomiting occurs after taking the medicine, stop taking the remaining dose.
In the Zhi Zi Chi Tang formula, add five liang of Sheng Jiang. Follow the previous method for preparation. If vomiting occurs after taking the medicine, stop taking the remaining dose.
After sweating or purging, if vexation-heat and a sensation of obstruction in the chest occur, Zhi Zi Chi Tang is indicated.
Yang Qi receives its qi in the chest. Sweating or purging causes Yang Qi deficiency, allowing pathogenic heat to lodge in the chest, knotting without dispersing. Thus, vexation-heat and chest obstruction occur. Administer Zhi Zi Chi Tang to expel pathogenic factors from the chest via vomiting.
In Shaoyang disease lasting five or six days, after severe purging, if body heat persists and there is a knotted pain in the heart region, the disease has not yet resolved. Zhi Zi Chi Tang is indicated.
Five or six days into Shaoyang disease is when pathogenic factors are in the interior. If severe purging leads to the disappearance of body heat and an empty feeling in the chest and heart, resolution is desired. If severe purging leads to the disappearance of body heat but knotted pain in the heart, it is Jie Xiong (Chest Binding). If body heat persists and there is knotted pain in the heart, it is Xu Fan (Deficiency Vexation). Jie Xiong is heat knotting in the chest, constituting an Excess condition; thus, heat has converged internally, and external body heat disappears. Xu Fan is heat lodging in the chest, not yet knotted into excess, scattering to cause vexation; thus, external body heat persists. Six or seven days is the time for resolution. Since this is heat-induced deficiency vexation, it is said that resolution has not occurred. Administer Zhi Zi Chi Tang to expel it via vomiting.
After purging in Shaoyang disease, if vexation, abdominal fullness, and restlessness (unable to lie down or sit up comfortably) occur, Zhi Zi Hou Po Tang is indicated.
After purging, if there is only abdominal fullness without vexation, pathogenic factors have entered the interior, becoming Interior Excess. If there is only vexation without abdominal fullness, pathogenic factors remain in the chest, becoming Deficiency Vexation. If both vexation and fullness exist, pathogenic factors are congested between the chest and abdomen. Fullness prevents sitting comfortably; vexation prevents lying down comfortably. Thus, restlessness occurs. Administer Zhi Zi Hou Po Tang to expel vexation via vomiting and drain fullness.