夫太阳病。恶寒而发热。自汗出。而反不恶寒热。关上脉细数者。不可吐之。
夫少阴病。其人欲食。入则吐。心中温温欲吐复不能吐。手足寒。脉弦迟。干呕。此膈
上有
诸四逆者。不可吐之。
诸虚羸。不可吐之。
新产者。不可吐之。
病者。恶寒而不欲近衣。不可吐之。
大法。春宜吐。
（春时阳气在上。邪气亦在上。故宜吐。）
凡用吐汤。中病即止。不必尽剂也。
（要在适当不欲过也。）
病胸上诸实。胸中郁郁而痛。不能食。欲使人按之。而反有涎唾。下利日十余行。其脉
反迟
（胸上诸实。或痰实。或热郁。或寒结胸中。郁而痛。不能食。欲使人按之。反有涎唾
者。
滑者
上盛不
宿食在上脘者。当吐之。
（宿食在中下脘者。则宜下。宿食在上脘。则当吐。内经曰。其高者。因而越之。其下
者。
病患手足厥冷。脉乍结。以客气在胸中。心下满而烦。欲食不能食者。病在胸中。当吐
之。
大法。春夏宜吐。凡病头不强痛。寸口脉浮。胸中痞满。上冲喉咽。不得息。此为有痰。
当
伤寒胸满痰逆。干呕。热嗽及肺壅唾脓等。宜吐之。
夫宿食在胃脘。宜吐之。
脉濡而弱。弱反在关。濡反在巅。微反在上。涩反在下。微则阳气不足。涩则无血。阳
气反
（阳微下之。阳气已虚。阴气内甚。故心下痞硬。）
动气在右。不可下。下之则津液内竭。咽燥鼻干。头眩心悸也。
（动气在右。肺之动也。下之伤胃。动肺。津液内竭。咽燥鼻干者。肺属金。主燥也。
头眩
动气在左。不可下。下之则腹内拘急。食不下。动气更剧。虽有身热。卧则欲蜷。
（动气在左。肝之动也。下之损脾。而肝气益胜。复行于脾。故腹内拘急。食不下。动
气更
动气在上。不可下。下之则掌握热烦。身上浮冷。热汗自泄。欲得水自灌。
（动气在上。心之动也。下之则伤胃。内动心气。心为火。主热。针经曰。心所生病者。
掌
上
动气在下。不可下。下之则腹胀满。猝起头眩。食则下清谷。心下痞也。
（动气在下。肾之动也。下之则伤脾。肾气则动。寒乘脾。故有腹满头眩。下利。则心
下痞
咽中闭塞。不可下。下之则上轻下重。水浆不下。卧则欲蜷。身急痛。下利日数十行。
（咽中闭塞。胃已不和也。下之。则闭塞之邪。为上轻。复伤胃气。为下重。至水浆不
下。
诸外实者。不可下。下之则发微热。亡脉厥者。当脐握热。
（外实者。表热也。汗之则愈。下之为逆。下后里虚。表热内陷。故发微热。厥深者。
热亦
诸虚者。不可下。下之。则大渴求水者。易愈。恶水者剧。
（金匮玉函曰。虚者十补。勿一泻之。虚家下之为重虚。内竭津液。故令大渴求水者。
阳气
脉濡而弱。弱反在关。濡反在巅。弦反在上。微反在下。弦为阳运。微为阴寒。上实下
虚。
（虚家下之。是为重虚。难经曰。实实虚虚。损不足。益有余。此者。是中工所害也。）
微则为咳。咳则吐涎。下之则咳止。而利因不休。利不休。则胸中如虫啮。粥入则出。
小便
语言
（内经曰。感于寒。则受病。微则为咳。甚则为泄为痛。肺感微寒为咳。则脉亦微也。
下之
便不
者。
者目盲
前。气
脉濡而弱。弱反在关。濡反在巅。浮反在上。数反在下。浮为阳虚。数为亡血。浮为虚。
数
吸
下
（弱在关。则阴气内弱。濡在巅。则阳气外弱。浮为虚。浮在上。则卫不足也。故云阳
虚。
润脏
胁下
热。
腹甚
脉濡而紧。濡则卫气微。紧则营中寒。阳微卫中风。发热而恶寒。营紧胃气冷。微呕心
内烦
热在
栗栗而振寒。重被而覆之。汗出而冒巅。体惕而又振。小便为微难。寒气因水发。清谷不容
间。呕变反肠出。颠倒不得安。手足为微逆。身冷而内烦。迟欲从后救。安可复追还。
（卫冷营寒。阳微中风。发热恶寒。微呕心烦。医不温胃。反为有热。解肌发汗。则表
虚亡
怅怏
以重
寒因
本草曰
脉浮而大。浮为气实。大为血虚。血虚为无阴。孤阳独下阴部者。小盒饭赤而难。胞中
当虚
得眠
（卫为阳。营为阴。卫气强实。阴血虚弱。阳乘阴虚。下至阴部。阴部。下焦也。阳为
热。
出。
射也
污泥
脉数者。久数不止。止则邪结。正气不能复。正气却结于脏。故邪气浮之。与皮毛相得。
脉
（数为热。止则邪气结于经络之间。正气不得复行于表。则却结于脏。邪气独浮于皮毛。
下
脉浮大。应发汗。医反下之。此为大逆。
（浮大属表。故不可下。病欲吐者。不可下。）
呕多。虽有阳明证。不可攻之。
（为邪犹在胸中也。）
太阳病。外证未解。不可下。下之为逆。
（表未解者。虽有里证。亦不可下。当先解外。为顺。若反下之。则为逆也。经曰。本
发汗
夫病阳多者热。下之则硬。
（阳。热证多。则津液少。下之。虽除热。复损津液。必便难也。或谓阳多者。表热也。
下
无阳阴强。大便硬者。下之。则必清谷腹满。
（无阳者。亡津液也。阴强者。寒多也。大便硬。则为阴结。下之虚胃。阴寒内甚。必
清谷
伤寒发热。头痛。微汗出。发汗则不识人。熏之则喘。不得小便。心腹满。下之则短气。
小
（伤寒则无汗。发热头痛。微汗出者。寒邪变热。欲传于里也。发汗则亡阳。增热。故
不识
下之
热
伤寒脉阴阳俱紧。恶寒发热。则脉欲厥。厥者。脉初来大。渐渐小。更来渐渐大。是其
候也
中则
熨之
（脉阴阳俱紧。则清邪中上。浊邪中下。太阳、少阴俱感邪也。恶寒者少阴。发热者太
阳。
咙
则少
邪下
火
而危
伤寒发热。口中勃勃气出。头痛目黄。衄不可制。贪水者必呕。恶水者厥。若下之。咽
中生疮。假令手足温者。必下重便脓血。头痛目黄者。若下之。则两目闭。贪水者脉必厥。
其声
谷出
则小
（伤寒发热。寒变热也。口中勃勃气出。热客上膈也。头痛目黄。血不可制者。热蒸于
上也
口中
则
热气内伏。则目闭也。贪水为阴虚。下之。又虚其里。阳气内陷。故脉厥。声嘤。咽喉闭塞
。阴虚发汗。又虚其阳。使阴阳俱虚。而战栗也。恶水为阳虚。下之又虚胃气。虚寒内甚。
故里冷。不嗜食。阳虚发汗。则上焦虚燥。故口中伤烂。舌上白苔而烦躁也。经曰。脉数不
解。合热则消谷喜饥。至六七日不大便者。此有瘀血。此脉数实。不大便六七日。热蓄血于
内也。七日之后。邪热渐解。迫血下行。必便血也。便血发汗。阴阳俱虚。故小便利。）
下利脉大者。虚也。以其强下之故也。设脉浮革。因尔肠鸣者。属当归四逆汤主之。
（脉大为虚。以未应下而下之。利因不休也。浮者。按之不足也。革者。实大而长。微
弦也
夫伤寒脉濡而弱。阳气不足。不可下之。下之。则心下痞。津液内竭。咽燥鼻干也。
夫伤寒脉浮而紧。浮则为风。紧则为寒。风则伤营。寒则伤卫。营卫俱病。骨节烦疼。
当发
夫伤寒脉浮濡弱。不得发汗。无阳故也。阳亡虚。尺中弱涩者。不可下。
夫伤寒结胸证。其脉浮大。不可下。下之即死矣。
夫太阳与阳明合病。喘促胸满。不可下。
夫太阳与少阳合病。心下坚。颈项强而眩。不可下也。
夫四逆病厥者。不可下也。
夫病欲吐者。不可下也。
夫病发于阳。而反下之。热入咽作结胸也。
夫太阴病。其人腹满吐食。不可下。下之益甚。
夫少阴病。当心下坚满。不可下之。后利不止者死。
夫病在里而脉实者。可下。里证悉具。若恶寒。若脉不实。是里犹带表也。未可下之。
伤寒
者水
设或
此救
脉来细小。固不可下。若细小而牢紧。又可下也。脉浮。病在表。不可下。结胸。脉浮
大。
证。
有阳明
但用蜜
脾约证。大便坚。小便清者。热不在里。虽不大便。不可下。桂枝汤汗之。少阴证。小
便白
惟水便如常。乃可下之。
有表证。脉带浮。或恶寒。或犹生寒热。并不可下。不转失气。谓不下泄也。不下泄。
则先
更进
胡汤
头汗
喉
乌
动气
下
汤
Taiyang disease (disease of the Taiyang channel), characterized by aversion to cold and fever, spontaneous sweating. If there is a reversal where the patient no longer feels aversion to cold or heat, and the pulse at the Guan position (middle cun) is fine and rapid, emesis should not be used.
Shaoyin disease (disease of the Shaoyin channel), where the patient desires food but vomits upon eating, feels a warm discomfort in the heart region with an urge to vomit but cannot, has cold hands and feet, a string-taut and slow pulse, and dry retching. This indicates pathogenic factors above the diaphragm, belonging to the category of Sini Tang (Decoction for Reversal Cold). Emesis should not be used.
For all cases of deficiency and emaciation, emesis should not be used.
For women who have just given birth, emesis should not be used.
For patients who are averse to cold but do not desire clothing, emesis should not be used.
The general principle is: Spring is suitable for emesis.
(Because in spring, Yang Qi rises upward, and pathogenic factors also reside in the upper part, so emesis is suitable.)
When using emetic decoctions, stop as soon as the illness is cured; it is not necessary to finish the entire dose.
(The key is appropriateness, avoiding excess.)
For excess conditions in the chest and epigastrium, presenting with depression and pain in the chest, inability to eat, a desire for someone to press on the chest, and the presence of saliva/phlegm, accompanied by diarrhea more than ten times a day, and a pulse that is surprisingly slow (or slippery indicating excess above and deficiency below), if retained food is in the upper Jiao (upper stomach), emesis should be used.
(Retained food in the middle or lower Jiao is suitable for purgation; retained food in the upper Jiao requires emesis. The *Neijing* states: "Where the pathology is high, induce vomiting to disperse it; where it is low, guide it downward.")
If a patient has cold extremities, a knotted pulse intermittently, because external pathogenic factors are in the chest, causing fullness and irritability in the epigastrium, and a desire to eat but inability to do so, the pathology is in the chest, and emesis should be used.
The general principle is: Spring and Summer are suitable for emesis. For any patient whose head does not have strong pain, with a floating pulse at the Cun position, chest oppression and fullness, Qi rushing up to the throat, and difficulty breathing, this indicates phlegm, and emesis should be used.
For Shanghan (cold damage) causing chest fullness, rebellious phlegm-Qi, dry retching, hot cough, and lung congestion with pus-like sputum, emesis is suitable.
For retained food in the stomach, emesis is suitable.
A pulse that is soggy and weak, with weakness reversed at the Guan position, soggy reversed at the Dian (Cun) position, faint reversed at the upper position, and choppy reversed at the lower position. Faint indicates insufficiency of Yang Qi; choppy indicates lack of Blood. Yang Qi is reversed...
(Fainting [Yang deficiency] treated with purgation depletes Yang Qi, which is already deficient, while Yin Qi becomes excessive internally, resulting in epigastric stiffness and fullness.)
Moving Qi (pulsation around the umbilicus) on the right side indicates the Lung's movement. Purgation should not be used. Purgation will exhaust internal fluids, leading to dry throat and nose, dizziness, and palpitations.
(Moving Qi on the right reflects Lung activity. Purgation damages Stomach Qi and disturbs the Lung, exhausting fluids. Dry throat and nose occur because the Lung belongs to Metal and governs dryness. Dizziness...)
Moving Qi on the left side indicates the Liver's movement. Purgation should not be used. Purgation leads to abdominal cramping, inability to eat, and intensified moving Qi. Even if there is body heat, the patient wishes to curl up when lying down.
(Moving Qi on the left reflects Liver activity. Purgation damages Spleen Qi, allowing Liver Qi to become excessive and invade the Spleen, causing abdominal cramping, inability to eat, and intensified moving Qi...)
Moving Qi in the upper area indicates the Heart's movement. Purgation should not be used. Purgation leads to heat and irritability in the palms, floating coldness on the body, spontaneous cold sweating, and a desire to pour water over oneself.
(Moving Qi in the upper area reflects Heart activity. Purgation damages Stomach Qi and internally disturbs Heart Qi. The Heart belongs to Fire and governs heat. The *Zhenjing* states: Diseases generated by the Heart... palms... upper...)
Moving Qi in the lower area indicates the Kidney's movement. Purgation should not be used. Purgation leads to abdominal fullness, sudden dizziness upon rising, passage of undigested food after eating, and epigastric stuffiness.
(Moving Qi in the lower area reflects Kidney activity. Purgation damages the Spleen, causing Kidney Qi to move. Cold attacks the Spleen, resulting in abdominal fullness, dizziness, diarrhea, and epigastric stuffiness...)
Closure in the throat indicates the Stomach Qi is already disharmonious. Purgation should not be used. Purgation causes the obstructing pathogen to become light above but heavy below, leading to inability to take fluids, a desire to curl up when lying down, body stiffness and pain, and diarrhea dozens of times a day.
(Closure in the throat means Stomach Qi is disharmonious. Purgation makes the obstructing pathogen light above, further damaging Stomach Qi, making it heavy below. Eventually, fluids cannot enter...)
All exterior excess conditions should not be purged. Purgation induces slight fever. In cases of Yang collapse and cold limbs, there is heat grasped at the navel.
(Exterior excess refers to exterior heat. Sweating cures it; purgation is contraindicated. After purgation, interior deficiency allows exterior heat to sink inward, causing slight fever. The deeper the cold limbs, the more intense the heat...)
All deficiency conditions should not be purged. Purgation leads to extreme thirst for water; those who desire water recover easily, while those who reject water worsen.
(*Jinkui Yufang Jing* states: For deficiency, tonify ten times, do not purge once. Purging the deficient causes double deficiency and internal exhaustion of fluids, leading to extreme thirst for water... Yang Qi...)
Pulse is soggy and weak, with weakness at the Guan position, soggy at the Dian position, wiry at the upper position, and faint at the lower position. Wiry represents Yang movement; faint represents Yin cold. Upper excess and lower deficiency...
(Purging the deficient causes double deficiency. *Nanjing* states: Making excess more excess and deficiency more deficient, damaging what is insufficient and adding to what is surplus, is harm caused by mediocre physicians.)
Faint pulse indicates coughing, which produces saliva. Purgation stops the cough but causes continuous diarrhea. Continuous diarrhea leads to a sensation like insects biting in the chest; ingested porridge is vomited out, and urination... speech...
(*Neijing* states: Contracting cold causes disease; mild cases result in cough, severe cases in diarrhea and pain. Lung contracting mild cold causes cough, and the pulse becomes faint. Purgation... stool not... those... those blind... anterior. Qi...)
Pulse is soggy and weak, with weakness at the Guan position, soggy at the Dian position, floating at the upper position, and rapid at the lower position. Floating indicates Yang deficiency; rapid indicates loss of Blood. Floating is deficiency; rapid... inhalation... lower...
(Weakness at Guan means internal Yin Qi is weak; soggy at Dian means external Yang Qi is weak. Floating is deficiency; floating at the upper position means Wei Qi is insufficient. Thus, Yang deficiency... moistens Zang... hypochondrium... heat... abdomen very...)
Pulse is soggy and tight. Soggy indicates微弱 Wei Qi; tight indicates cold in Ying. Yang微弱 leads to Wei being struck by wind, causing fever and aversion to cold; Ying tight indicates cold Stomach Qi, slight vomiting, and internal irritability... heat in... shivering and chills, covering with heavy quilts still cold, sweating with wind penetrating the crown, body trembling, slight difficulty in urination. Cold pathogen arises from water-dampness, clear grains cannot be tolerated, vomiting changes to intestinal prolapse, tossing and turning without peace, slight cold limbs, body cold with internal irritability. Slow pulse seeks rescue from behind, how can it be追回?
(Wei cold and Ying cold, Yang微弱 with wind striking Wei, fever and aversion to cold, slight vomiting and irritability. The physician does not warm the Stomach but treats it as heat, using muscle-relieving sweating, leading to exterior deficiency and loss... dissatisfaction... with heavy... cold cause... Bencao says...)
Pulse is floating and large. Floating indicates Qi excess; large indicates Blood deficiency. Blood deficiency is Yin absence. Solitary Yang descends alone into the Yin region, causing urine to be red and difficult, and the uterus/baozhong is deficient... ability to sleep...
(Ying is Yin, Wei is Yang. Wei Qi is strong and solid, Yin Blood is weak. Yang exploits Yin deficiency, descending to the Yin region. The Yin region is the Lower Jiao. Yang is heat... exit... shooting... mud...)
Pulse is rapid. Long-term rapidity without stopping, if it stops, pathogenic factors knot, and Zheng Qi cannot recover. Zheng Qi retreats and knots in the Zang organs, so pathogenic factors float, associating with the skin and hair.
(Rapid indicates heat. Stopping means pathogenic factors knot in the meridians, Zheng Qi cannot return to the surface, thus retreating to knot in the Zang. Pathogenic factors float solely on the skin and hair... lower...)
Pulse is floating and large, indicating sweating is required. If the physician uses purgation instead, this is a major contraindication.
(Floating and large belong to the exterior, so purgation is forbidden. For patients desiring to vomit, purgation is forbidden.)
Frequent vomiting, even with Yangming syndrome, prohibits attack/purgation.
(Because the pathogen is still in the chest.)
Taiyang disease, if exterior symptoms are unresolved, purgation is forbidden. Purgation is contraindicated.
(If the exterior is unresolved, even with interior symptoms, purgation is forbidden. One must first resolve the exterior, which is correct. If purgation is used in reverse, it is contraindicated. The classics state: Originally intended to sweat...)
Diseases with abundant Yang (heat syndromes) treated with purgation lead to hardness.
(Yang, meaning many heat syndromes, implies less fluids. Purgation removes heat but damages fluids, inevitably causing difficult defecation. Or some say abundant Yang refers to exterior heat; purgation...)
No Yang, Yin strength, hard stool: Purgation leads to passage of undigested food and abdominal fullness.
(No Yang means loss of fluids. Yin strength means much cold. Hard stool is Yin knotting. Purgation empties the Stomach, Yin-cold becomes severe internally, inevitably... undigested food...)
Shanghan with fever, headache, slight sweating: Sweating leads to inability to recognize people; fumigation leads to asthma, inability to urinate, and heart/abdominal fullness. Purgation leads to shortness of breath... small...
(Shanghan usually has no sweat. Fever and headache with slight sweating indicate cold pathogen transforming into heat, intending to transmit inward. Sweating causes Yang collapse and increased heat, thus... not recognizing... purging... heat...)
Shanghan with Yin-Yang pulses both tight, aversion to cold and fever, the pulse desires Jue. Jue means the pulse starts large, gradually becomes smaller, then comes again gradually becoming larger; this is its sign... middle then... ironing...
(Yin-Yang pulses both tight mean clear pathogen strikes the upper, turbid pathogen strikes the lower. Taiyang and Shaoyin both contract pathogens. Aversion to cold is Shaoyin, fever is Tai... throat... then Shaoyin... pathogen lower... fire... and danger...)
Shanghan with fever, bubbling Qi exiting the mouth, headache, yellow eyes, uncontrollable epistaxis. Those craving water will vomit; those fearing water will have Jue. If purged, ulcers form in the throat. If hands and feet are warm, there will be heaviness below and pus-blood in stool. Headache and yellow eyes: if purged, both eyes close. Craving water, the pulse will be Jue, its voice... grain exit... then small...
(Shanghan fever, cold transforms to heat. Bubbling Qi exiting the mouth indicates heat lodging in the upper Diaphragm. Headache and yellow eyes, blood uncontrolled, indicates steaming heat upward... mouth... then... Heat Qi internal伏, thus eyes close. Craving water indicates Yin deficiency; purging further empties the interior, Yang Qi sinks inward, thus pulse Jue, voice ying, throat closure. Yin deficiency with sweating further empties Yang, causing Yin-Yang dual deficiency and tremors. Fearing water indicates Yang deficiency; purging further empties Stomach Qi, internal empty-cold becomes severe, thus interior cold, no appetite. Yang deficiency with sweating leads to Upper Jiao empty-dryness, thus mouth injuries and rot, white tongue coating with irritability. Classics state: Pulse rapid unresolved, combined heat consumes grain and promotes hunger. By 6-7 days without stool, this is Blood stasis. This pulse is rapid and solid, no stool for 6-7 days, heat accumulates Blood internally. After 7 days, pathogenic heat gradually resolves, forcing Blood downward, inevitably bloody stool. Bloody stool with sweating causes Yin-Yang dual deficiency, thus free urination.)
Diarrhea with a large pulse indicates deficiency, due to forced purgation. If the pulse is floating and革 (leather-like), with intestinal rumbling, it belongs to Danggui Sini Tang (Angelica Decoction for Reversal Cold) as the main treatment.
(Large pulse indicates deficiency, because purgation was used when it should not have been, causing continuous diarrhea. Floating means insufficient upon pressure. Ge means solid, large, long, slightly wiry...)
Shanghan with soggy and weak pulse indicates Yang insufficiency; purgation is forbidden. Purgation leads to epigastric stuffiness, internal exhaustion of fluids, dry throat and nose.
Shanghan with floating and tight pulse: Floating is Wind, Tight is Cold. Wind injures Ying, Cold injures Wei. Ying and Wei both diseased, bone joints painful, should induce sweating.
Shanghan with floating, soggy, and weak pulse: Cannot induce sweating due to lack of Yang. Yang collapse deficiency, Rchi position weak and choppy: Purgation is forbidden.
Shanghan Jie Xiong (Chest Knotting) syndrome with floating and large pulse: Purgation is forbidden. Purgation leads to death.
Taiyang and Yangming He Bing (combined disease) with panting and chest fullness: Purgation is forbidden.
Taiyang and Shaoyin He Bing with epigastric hardness, neck stiffness, and dizziness: Purgation is forbidden.
Sini disease with Jue (reversal cold): Purgation is forbidden.
Disease desiring to vomit: Purgation is forbidden.
Disease originating in Yang, treated with purgation, leads to heat entering the throat forming Jie Xiong.
Taiyin disease with abdominal fullness and vomiting food: Purgation is forbidden. Purgation worsens it.
Shaoyin disease with epigastric hardness and fullness: Purgation is forbidden. If followed by continuous diarrhea, death ensues.
Pathology in the interior with a solid pulse: Purgation is permissible. Interior symptoms complete, but if there is aversion to cold or the pulse is not solid, the interior still carries exterior signs; purgation is not yet permitted.
Shanghan... water... Suppose or... This rescue...
Pulse coming small and thin: Definitely cannot purge. If small, thin, firm, and tight, purgation may be used. Pulse floating, pathology in the exterior: Purgation is forbidden. Jie Xiong, pulse floating and large... syndrome... Has Yangming... Only use honey...
Pi Yue Syndrome (Spleen Confinement), hard stool, clear urine: Heat is not in the interior. Although no stool, purgation is forbidden. Guizhi Tang (Cinnamon Twig Decoction) to induce sweating. Shaoyin syndrome, white urine... Only if urine is normal can purgation be used.
Exterior syndrome present, pulse floating, or aversion to cold, or alternating chills and fever: Purgation is forbidden. No passing of gas (farting), meaning no downward discharge. No downward discharge, then first... advance more... Hu Tang... Head sweat... Throat... Wu... Moving Qi... Lower... Tang