瓜蒂（一分熬黄） 赤小豆（一分）
上二味。各别捣。筛为散。已合治之。取一钱匕。以香豉一合。用热（一作熟）汤七合。煮作稀糜。去滓。取汁和
散。温顿服之。不吐者。少少加。得快吐乃止。诸亡血虚家。不可与瓜蒂散。
成氏明理论云。华陀曰。四日在胸。则可吐之。此迎而夺之之法也。千金方曰。气浮上部。填塞心胸。胸中满者。
吐之则愈。此随证治之之法也。大约伤寒四五日。邪气客于胸中之时也。加之。胸中烦满。气上冲咽喉。不得息者。则
为吐证具。乃可投诸吐药。而万全之功有之矣。瓜蒂味苦寒。内经曰。湿气在上。以苦吐之。寒湿之气。留于胸中。以
苦为主。是以瓜蒂为君。赤小豆味酸温。内经曰。酸苦涌泄为阴。分涌膈实。必以酸为佐。是以赤小豆为臣。香豉味苦
寒。苦以涌泄。寒以胜热。去上膈之热。必以苦寒为辅。是以香豉为使。酸苦相合。则胸中痰热。涌吐而出矣。其于亡
血虚家。所以不可与者。以瓜蒂散为驶剂。重亡津液之药。亡血虚家。补养则可。更亡津液。必不可全。用药君子。必
偕究焉。
琥按上方后云。煮作稀糜糜。粥也。又烂也。言以汤七合。煮香豉如糜粥之烂也。方氏条辩以稀糜为另是稀粥。乃
承载瓜蒂赤小豆香豉三物者之舟航。大谬之极。夫胸中痞硬。烦满邪实。反煮糜粥以调药。吾恐必无是理。方氏又云。
用稀糜。为吐虚风虚寒之对药。殊不知仲景法。虚家不可与瓜蒂散。于上方后。言之已明。未尝言虚家用瓜蒂散。当另
煮稀糜粥以调药也。或问云。虚家倘犯上条证。不可与瓜蒂散。当用何药。余答云。仲景方。若栀子豉汤。可以待之。
（重出例）病患胁下素有痞（云云至）入阴筋者。此名藏结死（注见前藏结论下）
（附后例）伤寒病。若吐若下后。七八日不解。热结在里。（云云至）欲饮水数升者。白虎加人参汤主之。
伤寒无大热。口燥渴。心烦。背微恶寒者。白虎加人参汤主之。
伤寒脉浮。发热无汗。其表不解者。不可与白虎汤。渴欲饮水。无表证者。白虎加人参汤主之。
上三条证。（正文与注并汤。俱见后第六卷阳明篇中）太阳少阳并病心下硬。颈项强而眩者。当刺大椎。肺俞。肝俞。
慎勿下之。
上条证。（正文与注。见后第十四卷刺热论中）
太阳与少阳合病。自下利者。与黄芩汤。若呕者。黄芩加半夏生姜汤主之。（此条证。邪在半表半里。虽系太阳病。
实与表无涉也。黄芩汤。亦和解半表半里之药。正文与注并）
黄芩汤方（俱见后第七卷少阳篇中）
伤寒胸中有热。胃中有邪气。腹中痛。欲呕吐者。黄连汤主之。（病属伤寒。表不热而胸中有热。此系寒邪之气。已
传入于里也。胸为阳。为上焦。故易作郁热。胃附乎脾。脾为阴。为中焦。以其人胃气素虚。故其中虽有寒邪之气。不
能作郁热也。腹中痛者。胃有寒也。欲呕吐者。胸有热也。成注云。此伤寒邪气传里。而为下寒上热也。与黄连汤以升
降阴阳之气。又按成注云。阴阳不交。阴不得升而独治于下。为下寒。阳不得降而独治于上。为胸中热。此阴阳者。为
人身真阴真阳之气。阴阳之气不能升降。而独治于上下。斯其中。方挟外来寒热之邪矣。腹中痛。欲呕吐者。此正阴阳
不和。寒热相拒之证。验也。条辩尚论篇。皆以风寒二邪。分阴阳寒热。殊不知风之初来。未必非寒。寒之既入。亦能
成热。不可拘也。）
以上两味药。分别捣碎。筛成细粉。混合均匀后制成散剂。取一钱匕的药粉。用香豉一合，加热水七合。煮成稀粥状。滤去渣滓。取汁液调和药散。温服，一次性服下。若不呕吐，则少量增加剂量。直到引起剧烈呕吐为止。凡是失血患者及体质虚弱者，不可服用瓜蒂散。
成无己在《明理论》中说：华佗说，病邪在胸中四天，就可以用吐法。这是迎头痛击、夺其邪气的治法。《千金方》说：气浮于上部，填塞心胸，导致胸中胀满的，用吐法即可痊愈。这是随证治疗的治法。大约伤寒发病四五日，是邪气客居胸中的时候。如果加上胸中烦闷胀满，气上冲咽喉，呼吸不畅的症状，那么吐证的指征就具备了，这时才可以投用各种涌吐药物，从而获得万无一失的功效。瓜蒂味苦性寒，《内经》说：湿气在上，用苦味药使之吐出。寒湿之气，留滞于胸中，以苦味药为主治。所以用瓜蒂作为君药。赤小豆味酸性温，《内经》说：酸味和苦味能涌泄，属于阴。要分消膈上的实邪，必须以酸味药为佐助。所以用赤小豆作为臣药。香豉味苦性寒，苦味能涌泄，寒性能胜热，去除上膈的热邪，必须以苦寒药为辅佐。所以用香豉作为使药。酸味和苦味相结合，就能将胸中的痰热涌吐出来。对于失血和虚弱的患者，之所以不可使用，是因为瓜蒂散是峻猛之剂，是重伤津液的药物。失血和虚弱的人，应当补养，如果再损伤津液，必然无法痊愈。用药的君子，一定要仔细探究这些道理。
琥按：上述方剂后面说“煮作稀糜”，糜就是粥，又指烂熟的样子。意思是用水七合，煮香豉像糜粥那样烂熟。方有执在《条辩》中将“稀糜”解释为另外煮的稀粥，是用来承载瓜蒂、赤小豆、香豉这三味药的载体，这大错特错。既然胸中痞硬、烦满、邪气实证，反而煮糜粥来调药，我恐怕没有这种道理。方有执又说，用稀糜，是针对吐虚风、虚寒的对药。殊不知张仲景的法度，虚弱之人不可用瓜蒂散，在上述方剂后面已经说得非常明白。从未说过虚弱之人用瓜蒂散时，应当另外煮稀糜粥来调药。有人问：虚弱之人如果犯了上面的证候，不能用瓜蒂散，该用什么药？我回答说：张仲景的方子，如栀子豉汤，可以等待使用。（重出例）病患胁下素有痞块（云云至）进入阴筋的，这叫脏结，死证（注见前藏结论下）
（附后例）伤寒病，如果用吐法或下法后，七八天病情未解，热邪结聚在里。（云云至）想要喝几升水的，用白虎加人参汤主治。
伤寒身体没有大热，口燥渴，心烦，背部微微恶寒的，用白虎加人参汤主治。
伤寒脉浮，发热无汗，表证未解的，不可与白虎汤。口渴想喝水，没有表证的，用白虎加人参汤主治。
以上三条证候。（正文与注释以及汤方，都见于后第六卷阳明篇中）太阳病与少阳病并病，心下硬满，颈项强直且眩晕的，应当针刺大椎穴、肺俞穴、肝俞穴。千万不要用下法。
上一条证候。（正文与注释，见于后第十四卷刺热论中）
太阳病与少阳病合病，出现自发性腹泻的，给予黄芩汤。如果有呕吐症状的，用黄芩加半夏生姜汤主治。（此条证候，邪气在半表半里，虽然属于太阳病，实际上与表证无关。黄芩汤，也是和解半表半里的药物。正文与注释一并列出）
黄芩汤方（都见于后第七卷少阳篇中）
伤寒胸中有热，胃中有邪气，腹中疼痛，想要呕吐的，用黄连汤主治。（病属伤寒，体表不热而胸中有热，这是寒邪之气，已经传入体内了。胸为阳，属于上焦，所以容易形成郁热。胃依附于脾，脾为阴，属于中焦，因为此人胃气素来虚弱，所以其中虽然有寒邪之气，不能形成郁热。腹中疼痛，说明胃有寒。想要呕吐，说明胸中有热。成无己注解说：这是伤寒邪气传入体内，造成下寒上热的情况。给予黄连汤以升降阴阳之气。又按成无己注解说：阴阳不交，阴气不得上升而独治于下，造成下寒；阳气不得下降而独治于上，造成胸中热。这里的阴阳，是指人身真阴真阳之气。阴阳之气不能升降，而独治于上下，这样中间就夹杂了外来的寒热邪气。腹中疼痛，想要呕吐，这正是阴阳不和、寒热相拒的证候验证。方有执的《条辩》和尚论篇，都用风寒二邪来区分阴阳寒热，殊不知风邪初起，未必不是寒，寒邪入体之后，也能化热，不可拘泥。）
Citrulli Fructus Semen (Gua Di, one fen, stir-fried until slightly yellow) Vigna angularis Seed (Chi Xiao Dou, one fen)
The above two ingredients. Each separately pounded. Sifted into powder. After mixing and processing together. Take one qian bi (a measure of volume). Use Xiang Chi (Fermented Soybean Paste) one he. Add seven he of hot water. Boil into a thin porridge consistency. Remove the dregs. Take the liquid to mix with the powder. Take warm in one dose. If no vomiting occurs, increase the dose slightly. Stop once vigorous vomiting is achieved. Patients who have lost blood or are constitutionally deficient must not be given Gua Di San.
Cheng Wuji stated in his "Ming Li Lun": Hua Tuo said, if the pathogen has been in the chest for four days, it can be treated by emesis. This is the method of attacking and depriving the pathogen directly. The "Qian Jin Fang" states: When qi floats to the upper part, filling and obstructing the chest and heart, causing fullness in the chest, emesis will cure it. This is the method of treating according to the syndrome. Generally, on the fourth or fifth day of Shang Han, this is when the pathogen lodges in the chest. Adding symptoms of vexation and fullness in the chest, qi rushing up to the throat, and inability to breathe normally, indicates that the indications for emesis are complete. Only then should various emetic drugs be administered, achieving a perfect result. Gua Di is bitter and cold. The "Nei Jing" states: Dampness located in the upper part should be expelled by bitter taste. Cold-dampness qi lingering in the chest should be primarily treated with bitter substances. Therefore, Gua Di is used as the Sovereign drug. Chi Xiao Dou is sour and warm. The "Nei Jing" states: Sour and bitter induce vomiting and purging, belonging to Yin. To drain the excess in the diaphragm, acid must be used as an Assistant. Therefore, Chi Xiao Dou is used as the Minister drug. Xiang Chi is bitter and cold. Bitter induces vomiting and purging; cold overcomes heat. To remove heat from the upper diaphragm, bitter-cold substances must be used as Assistants. Therefore, Xiang Chi is used as the Envoy drug. The combination of sour and bitter causes the phlegm-heat in the chest to be vomited out. Regarding patients with blood loss or deficiency, they cannot be given this because Gua Di San is a harsh agent, a medicine that severely damages body fluids. Patients with blood loss or deficiency require nourishment; further damaging their fluids would certainly prevent recovery. Those who administer medicines carefully must investigate this thoroughly.
Hu notes: The text following the formula says "boil into thin porridge." Mi refers to porridge, and also means soft and rotten. It means using seven he of water to boil Xiang Chi until it is as soft as porridge. Fang Youzhi in his "Tiao Bian" interpreted "thin porridge" as separately cooked thin rice gruel, which serves as a vessel to carry the three ingredients: Gua Di, Chi Xiao Dou, and Xiang Chi. This is extremely erroneous. Given the hardness in the chest, vexation, fullness, and excess pathogen, instead boiling porridge to mix with the medicine, I fear such logic does not exist. Fang Youzhi also claimed that using thin porridge is a counter-agent for vomiting due to empty wind and empty cold. Little did he know that Zhang Zhongjing's method clearly states that deficient persons must not use Gua Di San, as explicitly mentioned after the aforementioned formula. There was never a statement that deficient persons using Gua Di San should separately cook thin porridge to mix with the medicine. One might ask: If a deficient person contracts the syndrome mentioned above and cannot use Gua Di San, what medicine should be used? I answer: Zhang Zhongjing's formulas, such as Zhi Zi Chi Tang, can be considered. (Repeated Example) If a patient has had a mass under the hypochondrium since ancient times... entering the yin sinews, this is called Zang Jie, a fatal condition (Note see previous Zang Jie conclusion below).
(Attached Later Example) In Shang Han disease, if after emesis or purgation, the condition remains unresolved after seven or eight days, with heat knotting inside... (etc.) desiring to drink several sheng of water, Bai Hu Jia Ren Shen Tang is indicated.
In Shang Han, without significant fever, with dry mouth and thirst, mental restlessness, and slight aversion to cold on the back, Bai Hu Jia Ren Shen Tang is indicated.
In Shang Han, with floating pulse, fever, and no sweating, where the exterior is not resolved, Bai Hu Tang must not be given. With thirst desiring water, but no exterior syndrome, Bai Hu Jia Ren Shen Tang is indicated.
The above three syndromes. (Main text and notes and decoction all appear in Volume 6 Yang Ming Chapter later). Tai Yang and Shao Yang concurrent disease, with hardness in the epigastrium, stiffness and rigidity of the neck, and vertigo, should be treated by acupuncture at Da Zhui, Fei Shu, and Gan Shu. Do not use purgation.
The above syndrome. (Main text and notes appear in Volume 14 Ci Re Lun later).
Tai Yang and Shao Yang combined disease, with spontaneous diarrhea, give Huang Qin Tang. If there is vomiting, Huang Qin Jia Ban Xia Sheng Jiang Tang is indicated. (This syndrome involves pathogen in the half-exterior half-interior. Although classified as Tai Yang disease, it is actually unrelated to the exterior. Huang Qin Tang is also a medicine for harmonizing the half-exterior half-interior. Main text and notes included).
Huang Qin Tang Formula (All appear in Volume 7 Shao Yang Chapter later).
Shang Han with heat in the chest, pathogenic qi in the stomach, abdominal pain, and desire to vomit, Huang Lian Tang is indicated. (The disease belongs to Shang Han. The exterior is not hot, but there is heat in the chest. This is cold pathogenic qi that has already transmitted into the interior. The chest is Yang, belonging to the Upper Jiao, so it easily forms stagnant heat. The stomach attaches to the Spleen. The Spleen is Yin, belonging to the Middle Jiao. Because this person's Stomach Qi has always been deficient, although there is cold pathogenic qi within, it cannot form stagnant heat. Abdominal pain indicates cold in the stomach. Desire to vomit indicates heat in the chest. Cheng's commentary states: This is Shang Han pathogen transmitting to the interior, resulting in lower cold and upper heat. Huang Lian Tang is given to ascend and descend the Qi of Yin and Yang. Also according to Cheng's commentary: Yin and Yang do not intersect. Yin fails to ascend and governs alone in the lower, causing lower cold. Yang fails to descend and governs alone in the upper, causing heat in the chest. Here, Yin and Yang refer to the true Yin and true Yang Qi of the human body. When Yin and Yang Qi cannot ascend and descend, governing alone in the upper and lower, the middle becomes mixed with external cold and heat pathogens. Abdominal pain and desire to vomit are exactly the verification of Yin-Yang disharmony and rejection between cold and heat. Fang Youzhi's "Tiao Bian" and Shanglun Pian all distinguish Yin-Yang and cold-heat by Wind-Cold two pathogens. Little did they know that when Wind first arrives, it may not necessarily be Cold; once Cold enters, it can also transform into Heat. One must not be rigid.)