@@@
大法春宜吐
【注】
汗、吐、下，治病之大法。谓春宜于吐者，是象天之春气上升以立法也。然凡病有当
吐者则吐之，又不可一概而论也。
【集注】
程应旄曰：吐法从升，有发陈之义，故曰：春宜吐。
@@@
凡用吐汤，中病便止，不必尽剂也。
【注】
凡用吐汤，原以去上焦之邪，中病即止，若病去而过用之，反伤中气，所以不必尽剂
也。
【集注】
程应旄曰：吐以去上焦之邪。上焦为清阳之分，吐之过剂则邪去，而所伤者膻中之阳
，阳固不可不宝惜也。
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，寸口脉惟滑，此可吐之，吐之利则止。
【注】
胸上诸实，谓或痰、或热、或寒之类也。诸实为病，故胸中郁郁而痛，不能食也。欲
使人按之，不但痛不能减，而反有涎唾，知邪在胸中盛满，得按而上溢也。经曰：下
利脉迟而滑者，内实也。今下利日十余行，其脉反迟，寸口惟滑，知寒实在上，水不
下输膀胱而走大肠也，故但吐之利自止也。
【集注】
张璐曰：痛不得食，按之反有涎唾者，知有寒痰在胸中也。下利脉迟，寸口惟滑者，
为膈上实，故吐之则利自止也。
@@@
病手足逆冷，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。
【注】
病人手足厥冷，脉乍结者，以寒邪结气，结在胸中，阳气不能四达也。心下满而烦者
，实结则满，阳郁则烦也。欲食不能食者，是客气病在胸中，故当吐之也。
【集注】
成无己曰：此与瓜蒂散证同。彼云脉乍紧，此云脉乍结，惟此有异。紧为内实，乍紧
则邪在胸中，实而未深也；结为结实，乍结则邪在胸中，结而未深也。虽所治俱同，
但轻之、重之不无别也。
程知曰：脉来缓时一止复来，曰结，结者痰气结滞之名，此与瓜蒂散证同。但彼云脉
乍紧则为寒邪盛 ，此云脉乍结则为痰气实也。
张锡驹曰：病人手足厥冷者，气机内结，不能外达于四肢也。心下满而烦者，邪实则
满，正伤则烦也。
魏荔彤曰：脉乍结，非脉之本然，乃有形之邪，阻碍其胸中宗气，故荣卫之气不能畅
行，非同于气血虚微，不能流布之结也。
@@@
宿食在上脘者，当吐之。
【注】
胃有三脘：宿食在上脘者，痛在胸膈，痛则欲吐，可吐不可下也。宿食在中脘者，痛
在心口，痛欲吐或吐不吐，可吐可下也。宿食在下脘者，痛在脐上，痛不欲吐，不可
吐可下也。故曰：宿食在上脘者，当吐之。此详凡在上者，皆可吐也。
【集注】
成无己曰：宿食在中下脘，则宜下，宿食在上脘，则当吐。『内经』曰：其高者因而
越之，其下者引而竭之。
方有执曰：上脘，谓胃府之口也。
张志聪曰：胃为水谷之海，有上脘、中脘、下脘之分。上主纳，中主化，今食在上脘
，不得腐化，故为宿食，当吐之。
程应旄曰：宗气聚于胸中，升降呼吸出焉。清阳之分，岂容浊物留滞，吐以宣之，使
无障碍也。若属表邪传入无形而有形，则痞满结胸，另有治法，均非宜矣。
【大法春宜吐】
【注】
发汗、涌吐、攻下，是治疗疾病的三大基本法则。说春季适宜使用涌吐法，是效法春天自然界阳气上升的规律来确立治法。然而，凡是疾病应当用涌吐法的才使用涌吐法，不能一概而论。
【集注】
程应旄说：涌吐法顺应气机上升的趋势，有推陈出新的含义，所以说：春季适宜涌吐。
【凡用吐汤，中病便止，不必尽剂也。】
【注】
凡是使用涌吐的汤药，只要达到治疗效果就立即停止，不需要把整副药都喝完。
【注】
使用涌吐汤药，原本是为了祛除上焦的邪气，病情好转即止，如果病邪已去而过度使用，反而会损伤中焦脾胃之气，所以不需要把整副药都喝完。
【集注】
程应旄说：涌吐是为了祛除上焦的邪气。上焦是人体清阳分布的部位，涌吐过度则虽然邪气去了，但会损伤膻中部位的阳气，阳气本来就不应该不加以珍视保护。
【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，寸口脉惟滑，此可吐之，吐之利则止。】
【注】
“胸上诸实”，指的是痰饮、热邪或寒邪等实证。各种实证致病，所以胸中郁闷疼痛，不能进食。想要让人按压胸部，不仅疼痛不能减轻，反而会有涎液和唾沫涌出，这说明邪气在胸中盛满，受到按压后向上溢出。《内经》说：下利且脉象迟而滑的，是体内有实邪。现在每天腹泻十多次，脉象反而迟，只有寸口脉滑，可知是寒实邪气停留在上部，水液不能向下输布到膀胱而流注于大肠，所以只需使用涌吐法，腹泻自然就会停止。
【集注】
张璐说：疼痛且不能进食，按压反而有涎唾出的，可知胸中有寒痰停滞。腹泻且脉迟，只有寸口脉滑的，是膈上有实邪，所以涌吐后腹泻自然停止。
【病手足逆冷，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。】
【注】
病人手脚冰凉，脉搏偶尔出现结滞现象，是因为外来的邪气停留在胸中，导致胃脘部胀满且心烦，想吃东西却吃不下，这是病邪在胸中，应当使用涌吐法。
【注】
病人手足厥冷，脉搏偶尔结滞，是因为寒邪与气机郁结，阻滞在胸中，阳气不能通达四肢。胃脘部胀满且心烦，是因为实邪阻滞导致胀满，阳气郁结导致心烦。想吃东西却吃不下，是因为外来邪气病位在胸中，所以应当使用涌吐法。
【集注】
成无己说：这与瓜蒂散证的病机相同。瓜蒂散证说的是脉搏突然紧束，这里说的是脉搏突然结滞，仅有这一点不同。紧脉代表内部有实邪，突然紧束说明邪气在胸中，实邪但未深入；结脉代表气血凝结，突然结滞说明邪气在胸中，凝结但未深入。虽然治疗方法相同，但在用药轻重上还是有区别的。
程知说：脉搏来势缓慢，有时停跳一下又恢复跳动，称为结脉，结脉是痰气结滞的名称，这与瓜蒂散证相同。但瓜蒂散证说脉搏突然紧束，那是寒邪盛；这里说脉搏突然结滞，那是痰气实。
张锡驹说：病人手脚厥冷，是气机在内郁结，不能向外达于四肢。胃脘部胀满且心烦，是邪气实导致胀满，正气受损导致心烦。
魏荔彤说：脉搏突然结滞，并非脉搏的本然状态，而是有形之邪阻碍了胸中的宗气，导致营卫之气不能畅行，不同于气血虚弱微小、不能流通导致的结滞。
【宿食在上脘者，当吐之。】
【注】
胃分为上脘、中脘、下脘三部分：宿食停留在上脘的，疼痛部位在胸膈，疼痛时想呕吐，可以使用涌吐法，不可使用攻下法。宿食停留在中脘的，疼痛部位在心口窝，疼痛时想吐或者吐不出来，可以使用涌吐法也可以使用攻下法。宿食停留在下脘的，疼痛部位在肚脐上方，疼痛时不想吐，不可使用涌吐法，可以使用攻下法。所以说：宿食停留在上脘的，应当使用涌吐法。这是详细说明凡是病位在上部的，都可以使用涌吐法。
【集注】
成无己说：宿食在中脘和下脘，适宜使用攻下法；宿食在上脘，应当使用涌吐法。《黄帝内经》说：病位高的，因势利导使其从上越出（涌吐）；病位低的，引导其从下排出（攻下）。
方有执说：上脘，是指胃腑的入口。
张志聪说：胃是水谷汇聚的海，分为上脘、中脘、下脘。上脘主受纳，中脘主消化，现在食物停留在上脘，不能腐熟消化，所以成为宿食，应当使用涌吐法。
程应旄说：宗气聚集在胸中，升降呼吸都由此产生。清阳分布的部位，怎么容许浊物留滞？通过涌吐来宣通，使气道没有障碍。如果属于表邪传入，由无形变为有形，形成痞满或结胸，则有另外的治疗方法，都不适宜使用涌吐法。
[General Principle: Spring is Suitable for Emetic Therapy]
[Annotation]
Diaphoresis (sweating), emesis (vomiting), and purgation (downward draining) are the three major principles of treating diseases. The statement that spring is suitable for emetic therapy is based on establishing treatment methods by imitating the ascending nature of spring Qi in heaven. However, emetic therapy should only be used when indicated by the disease; it cannot be applied indiscriminately.
[Collected Annotations]
Cheng Yingmao stated: Emesis follows the ascending movement, possessing the meaning of discarding the old to bring forth the new; therefore, it is said that spring is suitable for emesis.
[When using an emetic decoction, stop as soon as the disease is cured; there is no need to consume the entire dose.]
[Annotation]
When administering an emetic decoction, one should stop immediately once the therapeutic effect is achieved; it is unnecessary to finish the entire prescription.
[Annotation]
The purpose of using emetic decoctions is originally to eliminate pathogenic factors in the Upper Jiao (Upper Burner). Stopping upon cure prevents excessive use, which would otherwise damage the Middle Qi (Qi of the Spleen and Stomach); hence, finishing the full dose is not required.
[Collected Annotations]
Cheng Yingmao stated: Emesis eliminates pathogenic factors in the Upper Jiao. The Upper Jiao is the region where Clear Yang distributes. Over-emesis, while expelling pathogens, damages the Yang Qi of the Danzhong (Chest Center). Since Yang Qi must certainly be cherished and protected, caution is needed.
[In cases of various excess conditions in the upper chest, with a feeling of oppression and pain in the chest, inability to eat, desire for someone to press on the area, yet producing saliva and phlegm upon pressing, accompanied by diarrhea occurring more than ten times a day, with a pulse that is surprisingly slow, and only the Cun Kou (radial artery at the wrist) pulse appearing slippery, this condition is suitable for emesis. After emesis, the diarrhea will cease.]
[Annotation]
"Various excess conditions in the upper chest" refers to exuberant Phlegm, Heat, or Cold. These excess pathogens cause oppression and pain in the chest and an inability to eat. The desire for abdominal/chest pressure, which fails to relieve pain but instead induces salivation and phlegm production, indicates that pathogens are abundant and full in the chest, overflowing upward upon pressure. The Classic states: "Diarrhea with a slow and slippery pulse indicates internal excess." Now, with diarrhea occurring over ten times daily, a surprisingly slow pulse, and only a slippery Cun Kou pulse, it is known that Cold-Excess resides in the upper part, preventing water fluids from descending to the Bladder and causing them to flow into the Large Intestine. Therefore, simply using emesis will naturally stop the diarrhea.
[Collected Annotations]
Zhang Lu stated: Pain, inability to eat, and the production of saliva/phlegm upon pressure indicate the presence of Cold-Phlegm in the chest. Diarrhea with a slow pulse and only a slippery Cun Kou pulse indicates Excess above the diaphragm; thus, emesis will naturally stop the diarrhea.
[In cases where the patient experiences coldness in the hands and feet, a pulse that occasionally becomes knotted (Jie Mai), due to alien Qi residing in the chest, epigastric fullness and vexation, and a desire to eat but inability to do so, the disease is located in the chest and should be treated with emesis.]
[Annotation]
Coldness in the extremities and an occasionally knotted pulse result from Cold Pathogens and Qi stagnation knotting in the chest, preventing Yang Qi from reaching the four limbs. Epigastric fullness and vexation arise because actual stagnation causes fullness, and constrained Yang causes vexation. The desire to eat but inability to do so indicates that alien Qi is pathologically located in the chest; therefore, emesis should be employed.
[Annotation]
The patient's cold extremities and occasional knotted pulse are caused by Cold Pathogens and Qi binding in the chest, obstructing the circulation of Yang Qi to the limbs. Fullness and vexation in the epigastrium occur due to real stagnation causing fullness and constrained Yang causing vexation. The desire to eat but inability to swallow indicates the disease of alien Qi is in the chest, so emesis is indicated.
[Collected Annotations]
Cheng Wuji stated: This shares the same pattern as the Gengti San (Melon Stalk Powder) syndrome. That text mentions a suddenly tight pulse, whereas this mentions a suddenly knotted pulse; this is the only difference. A tight pulse indicates internal excess; a sudden tightness suggests the pathogen is in the chest, excess but not deep. A knotted pulse indicates knotting/stagnation; a sudden knottedness suggests the pathogen is in the chest, knotted but not deep. Although the treatment is the same, there is a distinction in the heaviness or lightness of the approach.
Cheng Zhi stated: A pulse that comes slowly and stops occasionally before resuming is called a Knotted Pulse (Jie Mai), named for the knotting and stagnation of Phlegm-Qi. This aligns with the Gengti San syndrome. However, a sudden tight pulse in the other case indicates盛 (exuberance) of Cold Pathogens, whereas a sudden knotted pulse here indicates Excess of Phlegm-Qi.
Zhang Xiju stated: Coldness in the hands and feet results from Qi mechanism knotting internally and failing to reach the extremities externally. Fullness and vexation in the epigastrium occur because pathogenic excess causes fullness, and righteous Qi injury causes vexation.
Wei Litong stated: A sudden knotted pulse is not the natural state of the pulse but rather the obstruction of Zong Qi (Pectoral Qi) in the chest by tangible pathogens. This prevents the smooth circulation of Ying (Nutritive) and Wei (Defensive) Qi, differing from knotting caused by deficiency and weakness of Qi and Blood preventing distribution.
[For retained food lodged in the Upper Wan (upper stomach), emesis should be used.]
[Annotation]
The Stomach is divided into the Upper, Middle, and Lower Wan. When retained food lodges in the Upper Wan, pain occurs in the chest and diaphragm; when painful, the patient desires to vomit, making emesis appropriate and purgation inappropriate. When retained food lodges in the Middle Wan, pain occurs at the heart's pit; whether the patient desires to vomit or not, both emesis and purgation may be considered. When retained food lodges in the Lower Wan, pain occurs above the umbilicus; the patient does not desire to vomit, making emesis inappropriate and purgation appropriate. Thus, it is said that for retained food in the Upper Wan, emesis should be used. This elaborates that generally, anything located in the upper regions can be treated with emesis.
[Collected Annotations]
Cheng Wuji stated: For retained food in the Middle and Lower Wan, purgation is suitable; for retained food in the Upper Wan, emesis is appropriate. The Neijing states: "Where the pathology is high, induce vomiting to let it rise out; where the pathology is low, guide it to drain out."
Fang Youzhi stated: The Upper Wan refers to the opening of the Stomach organ.
Zhang Zhicong stated: The Stomach is the sea of water and grain, divided into Upper, Middle, and Lower Wan. The Upper Wan receives, the Middle Wan transforms. If food remains in the Upper Wan without being decomposed and transformed, it becomes retained food, and emesis is indicated.
Cheng Yingmao stated: Zong Qi gathers in the chest, governing ascent, descent, inhalation, and exhalation. How can the region of Clear Yang tolerate the stagnation of turbid substances? Emesis disperses and unblocks, removing obstacles. If the condition arises from exterior pathogens transmitting inward, transforming from formless to tangible, resulting in Pi (glomus) or Jie Xiong (chest binding), there are separate treatment methods; emesis is not suitable in those cases.