人身不过表里，气血不过虚实。表实者，里必虚；里实者，表必虚；经实者，络
必虚；络实者，经必虚，病之常也。良工之治病者，先治其实，后治其虚，亦有不治其虚时
。粗工之治病，或治其虚，或治其实，有时而幸中，有时而不中。谬工之治病，实实虚
虚，其误人之迹常着，故可得而罪也。惟庸工之治病，纯补其虚，不敢治其实，举世皆曰平稳，
误人而不见其迹。渠亦自不省其过，虽终老而不悔，且曰∶“吾用补药也，何罪焉？”病患亦曰
∶“彼以补药补我，彼何罪焉？”虽死而亦不知觉。夫粗工之与谬工，非不误人，惟庸工误人最
深，如鲧湮洪水，不知五行之道。夫补者人所喜，攻者人所恶。医者与其逆病患之心而不见用
，不若顺病患之心而获利也，岂复计病者之死生乎？呜呼！世无真实，谁能别之？今余着此
吐汗下三法之诠，所以该治病之法也，庶几来者有所凭借耳。
夫病之一物，非人身素有之
也。或自外而入，或由内而生，皆邪气也。邪气加诸身，速攻之可也，速去之可也，揽而留
之，何也？虽愚夫愚妇，皆知其不可也。及其闻攻则不悦，闻补则乐之。今之医者曰∶“当先
固其元气，元气实，邪自去。”世间如此妄人，何其多也！夫邪之中人，轻则传久而自尽，颇
甚则传久而难已，更甚则暴死。若先论固其元气，以补剂补之，真气未胜，而邪已交驰横骛而
不可制矣。惟脉脱、下虚、无邪、无积之人，始可议补；其余有邪积之人而议补者，皆鲧湮
洪水之徒也。今予论吐、汗、下三法，先论攻其邪，邪去而元气自复也。况予所论之法，谙
练日久，至精至熟，有得无失，所以敢为来者言也。
天
苦、甘、辛、咸、淡。故天邪发病，多在乎上
，地邪发病，多在乎下，人邪发病，多在乎中。此为发病之三也。处之者三，出之者亦三也
。诸风寒之邪，结搏皮肤之间，藏于经络之内，留而不去，或发疼痛走注，麻痹不仁，及四
肢肿痒拘挛，可汗而出之。风痰宿食，在膈或上脘，可涌而出之。寒湿固冷，热客下焦，在
下之病，可泄而出之。《内经》散论诸病，非一状也；流言治法，非一阶也。《至真要大论
》等数篇言运气所生诸病，各断以酸苦甘辛咸淡以总括之。其言补，时见一二；然其补非今之所
谓补也，文具于补论条下，如辛补肝，咸补心，甘补肾，酸补脾，苦补肺。若此之补，
乃所以发腠理，致津液，通血气。至其统论诸药，则曰∶辛甘淡三味为阳，酸苦咸三味为阴。辛
甘发散，淡渗泄。酸苦咸涌泄，发散者归于汗，涌者归于吐，泄者归于下。渗为解表，归于汗
，泄为利小溲，归于下。殊不言补。乃知圣人止有三法，无第四法也。
然则圣人不言补乎？曰∶盖
汗下吐，以若草木治病者也。补者，以谷肉果菜养口体者也。夫谷肉果菜之属，犹君之德教也
；汗下吐之属，犹君之刑罚也。故曰∶德教，兴平之粱肉；刑罚，治乱之药石。若人无病，
粱肉而已；及其有病，当先诛伐有过。病之去也，粱肉补之，如世已治矣，刑措而不用。岂可以
药石为补哉？必欲去大病大瘵，非吐汗下未由也已。然今之医者，不得尽汗下吐法，各立
门墙，谁肯屈己之高而一问哉？且予之三法，能兼众法，用药之时，有按有跷
，有 有导，有减有增，有续有
止。今之医者，不得予之法，皆仰面傲笑曰∶“吐者，瓜蒂而已矣；汗者，麻黄、升麻而已矣
；下者，巴豆、牵牛、朴硝、大黄、甘遂、芫花而已矣。”既不得其术，从而诬之，予固难与
之苦辩，故作此诠。
所谓
三法可以兼众法者，如引涎、漉涎、嚏气、追泪，凡上行者，皆吐法也；炙、蒸、熏、渫、
洗、熨、烙、针刺、砭射、导引、按摩，凡解表者，皆汗法也；催生下乳、磨积逐水、破经
泄气，凡下行者，皆下
法也。以余之法，所以该众法也。然予亦未尝以此三法，遂弃众法，各相其病之所宜而用之。
以十分率之，此三法居其八、九，而众所当才一、二也。或言《内经》多论针而少论药者，
盖圣人欲明经络。岂知针之理，即所谓药之理。即今着吐汗下三篇，各条药之轻重寒温于左
。仍于三法之外，别着《原补》一篇，使不预三法。恐后之医者泥于补，故置之三篇之末，使用药者
知吐中有汗，下中有补，止有三法。《内经》曰∶知其要者，一言而终。是之谓也。
人身不外乎表与里，气血不外乎虚与实。表实证，里必虚；里实证，表必虚；经脉实证，络脉必虚；络脉实证，经脉必虚，这是疾病的常理。高明的医生治病，先治其实证，后治其虚证，也有不治疗虚证的时候。低劣的医生治病，有时治其虚，有时治其实，有时侥幸奏效，有时不能奏效。荒谬的医生治病，使实证更实，虚证更虚（实实虚虚），其误人的痕迹常常明显，因此可以归罪于他。只有平庸的医生治病，纯粹补益其虚，不敢治疗其实，世人都说这样平稳，误人却看不出痕迹。他自己也不反省自己的过错，虽然终老而不后悔，并且说：“我使用的是补药，有什么罪过呢？”病人也说：“他用补药来补我，他有什么罪过呢？”即使死了也不知道觉察。那低劣医生和荒谬医生，并非不误人，只是平庸的医生误人最深，就像鲧用堵塞的方法治理洪水，不懂得五行的道理。补益是受人喜欢的，攻邪是受人厌恶的。医生与其违背病人的心意而不被任用，不如顺从病人的心意而获利，哪里还会考虑病人的生死呢？唉！世间没有真实，谁能辨别它呢？现在我撰写这篇关于吐、汗、下三法的论述，以此来概括治病的方法，希望后来者有所凭借罢了。
疾病这一事物，并不是人体原本就有的。或是从外侵入，或是由内产生，都是邪气。邪气加诸身体，迅速攻逐它是可以的，迅速去除它是可以的，拖延而留滞它，为什么呢？即使是愚笨的男子和妇女，都知道这是不可以的。等到听说要攻邪就不高兴，听说要补益就高兴。现在的医生说：“应当先固护元气，元气充实了，邪气自然去除。”世间像这样狂妄的人，何其多啊！邪气侵犯人，轻则传变日久自行消退，较重则传变日久难以痊愈，更重则突然死亡。如果先论述固护元气，用补剂来补益，真气尚未战胜邪气，而邪气已经纵横驰骋而无法控制了。只有脉象微弱欲绝、下部虚弱、没有邪气、没有积滞的人，才可以讨论补益；其余有邪气积滞的人而议论补益的，都是像鲧堵塞洪水一类的人。现在我论述吐、汗、下三法，先论述攻逐邪气，邪气去除了元气自然恢复。况且我所论述的方法，熟练日久，极其精熟，有得无失，所以敢对后来者言说。
天有苦、甘、辛、咸、淡五味。所以天之邪发病，多在上部；地之邪发病，多在下部；人之邪发病，多在中部。这是发病的三种情况。处理邪气的途径有三种，排出邪气的途径也有三种。各种风寒之邪，结聚搏结在皮肤之间，藏匿于经络之内，停留不去，或者引发疼痛走注（游走性疼痛）、麻痹不仁，以及四肢肿痒拘挛，可以用发汗法使其排出。风痰宿食，在膈膜或上脘部位，可以用涌吐法使其排出。寒湿固冷，热邪客居下焦，在下部的病，可以用泻下法使其排出。《内经》散论各种疾病，症状不止一种；流传的说法治疗方法，也不止一个阶段。《至真要大论》等几篇讲述运气所生的各种疾病，分别用酸、苦、甘、辛、咸、淡五味来总括。其中谈到补益时，偶尔见到一两点；然而它的补益不是现在所说的补益，文字记载在补论条目下，如辛味补肝，咸味补心，甘味补肾，酸味补脾，苦味补肺。像这样的补益，正是为了开发腠理，促使津液生成，通畅血气。至于统论各种药物，则说：辛、甘、淡三味属阳，酸、苦、咸三味属阴。辛、甘能发散，淡能渗泄。酸、苦、咸能涌吐和泄下，发散归于汗法，涌吐归于吐法，泄下归于下法。渗泄用于解表，归于汗法；泄下用于利小便，归于下法。完全不谈补益。由此可知圣人只有这三种方法，没有第四种方法。
那么圣人不谈补益吗？回答说：大概汗、下、吐法，是用草木类药物治病的方法。补益，是用谷、肉、果、菜滋养口体和身体的方法。谷肉果菜这类东西，就像君主的德教一样；汗、下、吐这类方法，就像君主的刑罚一样。所以说：德教，是太平盛世的粮食肉类；刑罚，是治理动乱的药石。如果人没有病，只需粮食肉类即可；等到有了病，应当先诛伐有过错的地方。病去之后，再用粮食肉类补益，就像社会已经治理好了，刑罚搁置不用。怎么能把药石当作补益呢？一定要去除大病重病，除了吐、汗、下法别无途径。然而现在的医生，不能完全运用汗、下、吐法，各自树立门户，谁肯降低身份来请教呢？况且我的三法，能兼摄众法，用药之时，有引导、有跷引、有推、有导、有减、有增、有续、有止。现在的医生，不懂我的方法，都仰面傲笑说：“吐法，不过是瓜蒂而已；汗法，不过是麻黄、升麻而已；下法，不过是巴豆、牵牛子、朴硝、大黄、甘遂、芫花而已。”既然得不到其中的技术，反而诬蔑它，我本来难以与他们苦苦争辩，所以写下这篇论述。
所谓三法可以兼摄众法，比如引涎、漉涎、嚏气、追泪，凡是向上的，都是吐法；灸、蒸、熏、渫、洗、熨、烙、针刺、砭射、导引、按摩，凡是解表的，都是汗法；催生下乳、磨积逐水、破经泄气，凡是向下的，都是下法。用我的方法，所以能涵盖众法。然而我也未曾因为这三法，就抛弃众法，各自根据病情适宜之处而使用。以十分比例来看，这三法占八、九分，而众法才占一、二分。有人说《内经》多论述针灸而少论述药物，大概是圣人想要阐明经络。哪里知道针的道理，就是所谓的药的道理。如今撰写吐、汗、下三篇，分别在左侧列出药物的轻重寒温。仍在三法之外，另外撰写《原补》一篇，使其不预在三法之中。担心后来的医生拘泥于补益，所以放在三篇之末，使用药者知道吐中有汗，下中有补，只有这三种方法。《内经》说：懂得要领的人，一句话就能终结。说的就是这个意思。
The human body is nothing but exterior and interior; Qi and Blood are nothing but deficiency and excess. When the exterior is in a state of excess, the interior must be deficient; when the interior is in a state of excess, the exterior must be deficient; when the Jing meridians (primary channels) are in a state of excess, the Luo collaterals must be deficient; when the Luo collaterals are in a state of excess, the Jing meridians must be deficient. This is the normal pattern of disease. Excellent physicians, when treating disease, first treat the excess, then treat the deficiency, though there are times when they do not treat the deficiency. Inferior physicians, when treating disease, sometimes treat the deficiency, sometimes treat the excess; occasionally they succeed by chance, but often they fail. Absurd physicians, when treating disease, exacerbate the excess and further deplete the deficiency (making excess more excessive and deficiency more deficient); their errors are often obvious, so they can be held accountable. Only mediocre physicians, when treating disease, purely tonify deficiency and dare not treat excess. The world calls this "steady," yet they harm people without leaving obvious traces. They themselves do not reflect on their faults; even after a lifetime, they do not repent, saying, "I used tonic medicines; what crime have I committed?" Patients also say, "He used tonics to nourish me; what crime has he committed?" Even if they die, they remain unaware. Neither inferior nor absurd physicians fail to harm people, but mediocre physicians harm people most deeply, like Gun attempting to flood control by blocking, who did not understand the principles of the Five Elements. Tonification is what people like; attacking pathogens is what people dislike. A physician would rather go against the patient's mind and lose employment than conform to the patient's mind to gain profit, let alone consider the patient's life or death. Alas! In a world lacking truth, who can distinguish it? Now I write this treatise on the three methods of vomiting, sweating, and purging, to encompass the methods of treating disease, hoping that future generations will have something to rely upon.
Disease as an entity is not originally inherent in the human body. It either enters from outside or arises from within; all are pathogenic factors (Xie Qi). When pathogenic factors affect the body, it is acceptable to attack them quickly and remove them swiftly. Why delay and retain them? Even foolish men and women know this is unacceptable. Yet when hearing of attacking methods, they are displeased; when hearing of tonifying methods, they are delighted. Today's physicians say, "One should first consolidate Yuan Qi (Original Qi). Once Yuan Qi is solid, pathogens will naturally depart." How many such arrogant people are there in the world! When pathogens invade a person, if mild, they may transmit over time and resolve spontaneously; if moderate, transmission over time makes them difficult to cure; if severe, sudden death occurs. If one first discusses consolidating Yuan Qi and uses tonics to nourish, while True Qi has not yet prevailed, pathogens will already have galloped wildly and become uncontrollable. Only those with pulse depletion, lower deficiency, no pathogens, and no accumulation may be considered for tonification; others with pathogens and accumulations who discuss tonification are akin to Gun blocking floods. Now I discuss the three methods of vomiting, sweating, and purging, first discussing attacking pathogens; once pathogens are removed, Yuan Qi recovers naturally. Moreover, the methods I discuss have been practiced for a long time, becoming extremely refined and familiar, with gains and no losses, which is why I dare to speak to future generations.
Heaven possesses bitter, sweet, acrid, salty, and bland flavors. Therefore, pathogenic factors from Heaven causing disease mostly manifest in the upper part; pathogenic factors from Earth causing disease mostly manifest in the lower part; pathogenic factors from Human interaction causing disease mostly manifest in the middle. These are the three origins of disease. There are three ways to manage them, and three ways to expel them. Various wind-cold pathogens, knotting and binding between the skin, hiding within the meridians, lingering without departing, may cause pain radiating along pathways, numbness, and swelling, itching, and spasms of the four limbs; these can be expelled through sweating (Han Fa). Wind-phlegm and retained food stagnation, located in the diaphragm or upper epigastrium, can be expelled through inducing vomiting (Ou Fa). Cold-dampness and fixed cold, or heat lodging in the Lower Jiao (Lower Burner), diseases located below, can be expelled through purging (Xia Fa). The *Nei Jing* (Inner Canon) discusses various diseases separately, noting that symptoms are not uniform; popular sayings on treatment methods are not uniform either. Chapters such as *Zhi Zhen Yao Da Lun* discuss various diseases generated by Six Qi (Yun Qi), summarizing them with sour, bitter, sweet, acrid, salty, and bland flavors. Mentions of tonification appear only occasionally; however, its concept of tonification is not what is meant today. Textual evidence under the "Tonification" section states: Acrid tonifies Liver, Salty tonifies Heart, Sweet tonifies Kidney, Sour tonifies Spleen, Bitter tonifies Lung. Such "tonification" serves to open interstices (Cou Li), promote fluid production, and unblock Qi and Blood. Regarding the general discussion of herbs, it states: Acrid, Sweet, and Bland belong to Yang; Sour, Bitter, and Salty belong to Yin. Acrid and Sweet disperse and diffuse; Bland promotes leaching and draining. Sour, Bitter, and Salty induce vomiting and purging. Dispersing belongs to sweating; vomiting belongs to induced vomiting; purging belongs to downward expulsion. Leaching aids releasing the exterior, belonging to sweating; purging promotes urination, belonging to downward expulsion. There is absolutely no mention of tonification. Thus we know the Sages had only these three methods, no fourth method.
Then do the Sages not speak of tonification? I reply: Sweating, purging, and vomiting are methods using herbal substances to treat disease. Tonification is using grains, meats, fruits, and vegetables to nourish the mouth, body, and physique. Grains, meats, fruits, and vegetables are like a ruler's virtue and education; sweating, purging, and vomiting are like a ruler's punishments. Thus it is said: Virtue and education are the fine foods of peace; punishments are the medicinal stones for managing chaos. If a person has no disease, fine foods suffice; once diseased, one must first punish the transgressors. After the disease departs, fine foods restore health, just as when society is governed well, punishments are set aside unused. How can medicinal stones be considered tonification? To certainly eliminate major illnesses and severe consumptive diseases, there is no way other than vomiting, sweating, and purging. However, today's physicians cannot fully apply the sweating, purging, and vomiting methods; each establishes their own school. Who would humble themselves to ask? Furthermore, my three methods can encompass other methods. When using medicine, there is guiding, lifting, pushing, directing, reducing, increasing, continuing, and stopping. Today's physicians, not understanding my methods, look up and laugh arrogantly, saying, "Vomiting is merely Geng Ti (Melon Stalk); sweating is merely Ma Huang (Ephedra) and Sheng Ma (Cimicifuga); purging is merely Ba Dou (Croton), Qian Niu (Pharbitis), Po Xiao (Mirabilite), Da Huang (Rhubarb), Gan Sui (Kansui), and Yuan Hua (Genkwa)." Since they do not grasp the technique, they slander it. I find it difficult to argue bitterly with them, so I wrote this treatise.
What is meant by "the three methods can encompass other methods"? For example, drawing out saliva, filtering saliva, inducing sneezing, and promoting tearing—anything moving upward belongs to the vomiting method; moxibustion, steaming, fumigation, washing, hot compresses, branding, acupuncture, stone needle therapy, Dao Yin (guiding and pulling), and massage—anything resolving the exterior belongs to the sweating method; inducing labor and lactation, grinding accumulations and driving out water, breaking menstruation and venting Qi—anything moving downward belongs to the purging method. Using my methods, therefore, encompasses other methods. However, I have never abandoned other methods because of these three; I use them according to the appropriateness of the condition. By proportion, these three methods account for eight or nine parts, while other methods account for only one or two parts. Some say the *Nei Jing* discusses acupuncture much more than herbs, perhaps because the Sage wished to clarify the meridians. But how could they know that the principle of acupuncture is the same as the principle of herbs? Now, writing the three chapters on vomiting, sweating, and purging, I list the weight, heaviness, cold, and warmth of herbs on the left. Outside these three methods, I separately wrote a chapter titled *Yuan Bu* (On Tonification), keeping it distinct from the three methods. Fearing that future physicians would cling to tonification, I placed it at the end of the three chapters, so that prescribers know that sweating contains elements of vomiting, purging contains elements of tonification, and there are truly only three methods. The *Nei Jing* says: "He who knows the essentials can conclude with a single word." This is what is meant.