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Zhang Zhongjing stated: If a patient presents with cold extremities and a pulse that suddenly becomes tight, the pathogenic factor is constrained in the chest. The patient experiences fullness and irritability in the heart region, feels hungry but cannot eat. The disease is located in the chest and should be treated by inducing vomiting (emesis), for which Gouti San (Melon Seed Powder) is suitable. If a patient presents with cold extremities and a pulse that suddenly becomes knotted, this is due to hostile qi (external pathogen) residing in the chest. There is fullness and irritability below the heart, and food cannot enter. The disease is located in the chest and should be treated by inducing vomiting.

It is also stated: When the symptoms resemble those of Guizhi Tang Syndrome (Taiyang Wind-Strike Exterior Deficiency Syndrome), but there is no headache or stiffness in the neck, and the cun pulse is slightly floating, with a sensation of stuffiness and hardness in the chest, along with qi rushing up to the throat causing difficulty in breathing, this indicates cold pathogen in the chest. It should be treated by inducing vomiting, for which Gouti San (Melon Seed Powder) is suitable. In Shaoyin Disease (disease of the Shaoyin channel), if food is vomited immediately upon entering the mouth, accompanied by a feeling of nausea and desire to vomit without actual expulsion, and initially presenting with cold extremities and a string-tight and slow pulse, this indicates excess in the chest. Purging is contraindicated; instead, emesis should be induced. However, if there is cold fluid retention above the diaphragm causing dry retching, emesis is contraindicated. Urgent warming is required, for which Sini Tang (Frigid Extremity Decoction) is suitable.

Commentary: In the preceding section, "cold in the chest" refers to excess cold pathogen, hence emesis is indicated. In the latter section, "cold fluid above the diaphragm" refers to middle-jiao cold deficiency, hence warming is appropriate. Thus, the "cold" mentioned in the first section refers to the excess nature of cold pathogen, while the "cold" in the second section refers to the deficiency of stomach qi. Although both are termed "cold," they differ in excess and deficiency. Excess conditions are suitable for emesis, which disperses the pathogen; however, applying emesis to deficiency conditions will further deplete stomach qi and exacerbate the illness. These critical points require careful examination.

It is also stated: Regarding various excess patterns in the upper chest, characterized by stifling pain in the chest, inability to eat, a desire for abdominal pressure, yet expectoration of saliva, and diarrhea occurring more than ten times a day with a generally slow pulse but a slightly slippery cun pulse, this condition can be treated by inducing vomiting. After emesis, the diarrhea will cease.

It is also stated: In Taiyang Disease (disease of the Taiyang channel), if emesis is applied, and although Taiyang disease typically presents with aversion to cold, the patient now shows no aversion to cold and even dislikes wearing clothes, this indicates internal heat and irritability caused by the damaging effects of emesis.

Commentary: This occurs because emesis was incorrectly applied to a Taiyang pattern where it was not indicated. Consequently, pathogenic heat enters the stomach through the deficiency created, leading to internal irritability.

1. Food stagnation located in the upper wan (upper epigastrium) should be treated by inducing vomiting.
2. When using emetic drugs, stop as soon as the desired effect is achieved (zhongbing); there is no need to consume the entire dose.
3. If the cun pulse is weak and powerless, emesis is strictly contraindicated.