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These four syndromes have already been discussed in the Taiyang chapter.

The general principle is that emesis (inducing vomiting) is suitable in spring.
During spring, Yang Qi ascends to the upper Jiao, and pathogenic factors also reside in the upper Jiao; therefore, emesis is appropriate.
When using emetic decoctions, stop as soon as the disease is alleviated; there is no need to finish the entire dose.
The key lies in appropriateness, avoiding excess.

If various excess patterns exist above the chest, with stifling pain in the chest, inability to eat, a desire for abdominal/chest pressure, yet regurgitation of saliva and phlegm occurs, accompanied by diarrhea occurring more than ten times a day, and the pulse is surprisingly slow with a slightly slippery sensation at the Cun Kou (radial artery), this indicates that emesis may be used. After emesis, the diarrhea will cease.

"Various excess patterns above the chest" may refer to phlegm-excess, heat-stagnation, or cold-binding in the chest, causing stagnation and pain, inability to eat, and a desire for pressure. If the pathogen is below, pressing causes Qi to descend without regurgitating saliva/phlegm. However, if pressing induces regurgitation of saliva/phlegm, it confirms the pathogen is in the chest. The Classic states: "Diarrhea with a slow and slippery pulse indicates internal excess." Although diarrhea occurs more than ten times daily, the pulse is surprisingly slow and the Cun Kou is slightly slippery, indicating upper excess. Thus, emesis is indicated. The *Yu Han Jing* states: "If upper excess persists, use emesis to drain it."

For retained food lodged in the upper Wan (upper stomach), emesis should be employed.
For retained food in the middle or lower Wan, purgation (downward draining) is appropriate. Retained food in the upper Wan requires emesis. The *Nei Jing* states: "Where the pathology is high, induce upward expulsion; where it is low, guide downward evacuation."

Patients presenting with cold extremities, a suddenly knotted pulse (Jie Mai), due to alien Qi residing in the chest, experiencing chest fullness and irritability, desiring to eat but unable to do so, have pathology in the chest and should undergo emesis.

This corresponds to the Gua Di San (Melon Seed Powder) syndrome in the Jueyin chapter of Volume 6. That text mentions a suddenly tight pulse (Jin Mai), whereas this text mentions a suddenly knotted pulse. The difference is minor: "Tight" signifies internal excess; a "suddenly tight" pulse suggests the excess has not deeply penetrated, indicating pathogen in the chest. "Knotted" signifies binding into solidity; a "suddenly knotted" pulse suggests the binding has not deeply penetrated, also indicating pathogen in the chest. Hence, the syndrome and treatment are identical.

Wu Shi stated: For diseases located above the diaphragm, with a large pulse, chest fullness, and abundant phlegm; or for food stuck at the stomach opening with a slippery pulse, emesis is suitable. Hua Tuo said that after three days of Shang Han (Cold Damage), if the pathogen is in the chest, emesis is suitable. Commonly, Gua Di San (Melon Seed Powder), light salt water, or warm tea is used. For weak patients, Ren Shen Lu (Ginseng Rhizome) decoction can be used to induce vomiting. For those with excessive phlegm, drinking one cup of Er Chen Tang (Two-Aged Decoction) while hot, followed by stimulating the throat with a finger, will induce vomiting. Emesis is contraindicated for the elderly who are timid and weak, patients with Lao Sun (consumptive disease) or internal injury constituting deficiency, women before pregnancy and postpartum, and those with blood deficiency and weak/small pulses. Herbs such as Fang Feng (Saposhnikovia Root), Jie Geng (Platycodon Root), and Shan Zhi (Gardenia Fruit) can induce vomiting when taken singly in decoction and consumed warm. Misuse of emesis damages the Yuan Qi (Original Qi) of the Upper Jiao, causing significant harm. One must be cautious.