栀子（十四枚擘） 香豉（四合绵裹）
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。
成氏明理论云。伤寒邪气自表而传里。留于胸中。为邪在高分。则可吐之。是越之之法也。所吐之证。亦自不同。
如不经汗下。邪气蕴郁于膈。则谓之膈实。应以瓜蒂散吐之。瓜蒂散。吐胸中实邪者也。若发汗吐下后。邪气乘虚。留
于胸中。则谓之虚烦。应以栀子豉汤吐之。栀子豉汤。吐胸中虚烦者也。栀子味苦寒。内经曰。酸苦涌泄为阴。涌者。
吐之也。涌吐虚烦。必以苦为主。是以栀子为君。烦为热胜也。涌热者。必以苦。胜热者必以寒。香豉味苦寒。助栀子
以吐虚烦。是以香豉为臣也。
琥按方中栀子十四枚。当是四十枚。否则香豉四合。分两多寡。不相称矣。
琥按栀子豉汤。仲景虽用以吐虚烦之药。余曾调此汤。与病患服之。未必能吐。何也。盖栀子之性苦寒。能清胃火。
润燥。豉性苦寒微甘。能泻热。而兼下气调中。所以其苦未必能使人吐也。医工必欲升散火郁。当于病患喉中。探之使
吐可耳。又用豉法。须陈腐极臭者能使人吐。方中云香豉。恐医工用豉。反取新制而气不臭者。无怪乎其不能使人吐也。
若少气者。栀子甘草豉汤主之。若呕者。栀子生姜豉汤主之。（此承上文而言。发汗吐下后。已见虚烦不眠证矣。若
其人兼少气者。成注云。热伤气也。故加甘草以益之。若兼呕者。热烦而气逆也。故加生姜以散之。）
以上两味药。用水四升。先煮栀子。煮至剩余二升半时。加入香豉。继续煮取一升半药液。滤去药渣。将药液分为两份服用。温服其中一份。如果服药后出现呕吐现象。则停止服用剩下的药。
成无己在《明理论》中说。伤寒邪气从体表传入体内。停留在胸中。属于邪气位于高位的情况。可以采用涌吐法治疗。这就是“越之”的治疗方法。所治疗的证候表现也各不相同。
比如没有经过发汗或攻下治疗。邪气郁结在膈间。就称为“膈实”。应当使用瓜蒂散进行涌吐。瓜蒂散是用于吐出胸中实邪的方剂。如果经过发汗、催吐或攻下治疗后。邪气乘虚而入。停留在胸中。就称为“虚烦”。应当使用栀子豉汤进行涌吐。栀子豉汤是用于吐出胸中虚烦的方剂。栀子味道苦寒。《内经》说。酸味和苦味具有涌泄作用。属于阴的性质。“涌”指的是涌吐。要涌吐虚烦。必须以苦味药为主。因此选用栀子作为君药。烦躁是因为热邪偏盛。要涌泄热邪。必须用苦味药。要克制热邪。必须用寒性药。香豉味道苦寒。辅助栀子来涌吐虚烦。因此选用香豉作为臣药。
琥按：方中的栀子十四枚。应该是四十枚。否则香豉四合的重量与栀子相比。比例不相称。
琥按：栀子豉汤。张仲景虽然将其作为涌吐虚烦的药物使用。但我曾经调配此汤给病人服用。未必能引起呕吐。为什么呢？因为栀子的药性是苦寒。能清胃火。润燥。豉的药性是苦寒微甘。能泻热。兼有下气调中的作用。所以其苦味未必能使人呕吐。医生如果想通过升散的方法解除火郁。应当在病人喉咙处探喉引吐即可。另外使用豉的方法。必须选用陈腐且极臭的豉才能使人呕吐。方中写的是“香豉”。恐怕医生在使用豉时。反而选取新制作的而气味不臭的豉。难怪不能使人呕吐。
如果伴有少气症状的。主治方剂为栀子甘草豉汤。如果伴有呕吐症状的。主治方剂为栀子生姜豉汤。（这是承接上文而言。发汗、催吐、攻下后。已经出现了虚烦不眠的证候。如果其人兼有少气的症状。成无己注解说。热邪损伤了正气。所以加入甘草以补益正气。如果兼有呕吐的症状。是热烦导致气机上逆。所以加入生姜以散除逆气。）
Zhi Zi (Gardeniae Fructus, fourteen pieces, broken) Xiang Chi (Fermented Soybean, four he, wrapped in silk cloth)
Take the above two ingredients. Add four sheng of water. First decoct Zhi Zi until half a sheng remains (two and a half sheng). Then add Xiang Chi. Continue to decoct until one and a half sheng of liquid remains. Strain the dregs. Divide the liquid into two doses. Take one dose warm. If vomiting occurs after taking the medicine, stop taking the remaining dose.
Cheng Wuji stated in *Ming Lilun* (Theory of Clarification): In Shanghan (Cold Damage), pathogenic factors transmit from the exterior to the interior and remain in the chest. This indicates that the pathogen is located at a high position, and thus emesis (vomiting therapy) can be employed. This is the method of "Yue" (lifting and dispersing). The syndromes treated also vary.
If no sweating or purging has been performed, and pathogenic factors are constrained and stagnant in the diaphragm, it is called "Ge Shi" (Diaphragmatic Excess). One should use Gua Di San (Melon Seed Powder) to induce vomiting. Gua Di San is used to expel excess pathogens from the chest. However, if after sweating, vomiting, or purging, pathogenic factors take advantage of the deficiency and remain in the chest, it is called "Xu Fan" (Deficiency Irritability). One should use Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) to induce vomiting. Zhi Zi Chi Tang is used to expel deficiency irritability from the chest. Zhi Zi has a bitter and cold nature. The *Neijing* states: "Sour and bitter flavors have the effect of涌泄 (upward discharge and downward evacuation), belonging to Yin." "Yong" refers to inducing vomiting. To induce vomiting for deficiency irritability, bitter herbs must be primary. Therefore, Zhi Zi is used as the Jun (Monarch) herb. Irritability is caused by excessive heat. To discharge heat via vomiting, bitter herbs are necessary. To overcome heat, cold herbs are necessary. Xiang Chi has a bitter and cold nature with slight sweetness. It assists Zhi Zi in expelling deficiency irritability. Therefore, Xiang Chi is used as the Chen (Minister) herb.
Hu notes: The fourteen pieces of Zhi Zi in the formula should likely be forty pieces; otherwise, the weight ratio between four he of Xiang Chi and the Zhi Zi would be disproportionate.
Hu notes: Although Zhang Zhongjing used Zhi Zi Chi Tang as an emetic for deficiency irritability, I have prepared this decoction for patients, and it did not necessarily induce vomiting. Why? Because Zhi Zi's nature is bitter and cold, capable of clearing Stomach fire and moistening dryness. Chi's nature is bitter, cold, and slightly sweet, capable of draining heat and directing Qi downward while harmonizing the middle. Thus, its bitterness may not necessarily induce vomiting. If physicians wish to disperse Fire stagnation through ascending and dispersing methods, they can simply stimulate the patient's throat to induce vomiting. Furthermore, regarding the use of Chi, only aged, rotten, and extremely foul-smelling Chi can induce vomiting. The formula specifies "Xiang Chi" (Fragrant Chi). It is feared that physicians might use newly processed Chi which lacks the foul odor, explaining why it fails to induce vomiting.
If accompanied by shortness of breath (Shao Qi), Zhi Zi Gan Cao Chi Tang (Gardenia, Licorice, and Fermented Soybean Decoction) is indicated. If accompanied by vomiting, Zhi Zi Sheng Jiang Chi Tang (Gardenia, Ginger, and Fermented Soybean Decoction) is indicated. (This follows the preceding text. After sweating, vomiting, or purging, symptoms of deficiency irritability and insomnia have already appeared. If the patient additionally presents with shortness of breath, Cheng's commentary states that heat damages Qi, so Gan Cao (Licorice Root) is added to tonify Qi. If accompanied by vomiting, it indicates heat irritability causing rebellious Qi, so Sheng Jiang (Fresh Ginger Rhizome) is added to disperse the rebellion.)