合四证已具太阳篇中。
大法春宜吐。
春时阳气在上。邪气亦在上。故宜吐。
凡用吐汤。中病即止不必尽剂也。
要在适当。不欲过也。
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。寸口脉微滑。此可吐之。吐之利则止。
胸上诸实。或痰实或热郁。或寒结胸中。郁而痛。不能食。欲使人按之。反有涎唾
者邪在下。按之。气下而无涎唾。此按之反有涎唾者。知邪在胸中。经曰。下利脉迟而滑
者。内实也。今下利日十余行。其脉反迟。寸口脉微滑。是上实也。故可吐之。玉函曰。上盛
不已。吐而夺之。
宿食在上脘者。当吐之。
宿食在中下脘者。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。
病患手足厥冷。脉乍结。以客气在胸中。心中满而烦。欲食不能食者。病在胸中。当
吐之。
此与第六卷。厥阴门瓜蒂散证同。彼云脉乍紧。此云脉乍结。惟此有异。紧为内实。
乍紧则实未深。是邪在胸中。结为结实。乍结则结未深。是邪在胸中。所以证治俱同也。
吴氏云。凡病在膈上者。脉大胸满多痰者。食在胃口脉滑者。俱宜吐之。华佗谓伤
寒三国日。邪在胸中者。宜吐之。凡吐用瓜蒂散。或淡盐汤。或温茶汤与之。如人弱者
以人参芦汤吐之亦可。若痰多者。以二陈汤一瓯。乘热与之。以指探喉中。即吐也。凡
老人怯弱。与病劳内伤虚人。并妇人胎前产后。血虚脉弱小者。皆不可吐。凡药发吐者
如防风桔梗山栀。只用一味煎汤。温服之则吐。盖误吐。则损人上焦元气。为患非轻。
可不慎哉。
这四种证候已在太阳篇中论述完毕。
治疗的大法是春季适宜使用吐法。
春季时阳气上升于上焦，邪气也停留于上焦，因此适宜使用吐法。
凡是使用催吐的汤药，一旦病情缓解就应停止，不必服完全部剂量。
关键在于把握适当的时机和程度，不希望过度。
如果病邪积聚在胸膈以上形成各种实证，患者感到胸中郁闷疼痛，无法进食，想要让人按压胸部，反而吐出涎沫唾液，同时伴有每天腹泻十多次的症状，此时脉象反而迟缓，寸口脉微滑，这是可以使用吐法的指征。通过吐法治疗后，腹泻症状就会停止。
所谓“胸上诸实”，可能是痰实、热郁或寒邪结聚在胸中，导致郁滞而疼痛，不能进食，想要人按压，反而出现涎唾。如果是邪气在下部，按压时气机下沉且没有涎唾吐出；而这里按压后反而有涎唾吐出，由此可知邪气位于胸中。《内经》说：“下利脉象迟而滑的，属于内实。”如今虽然每天腹泻十多次，但脉象反而迟缓，寸口脉微滑，这说明是上部（胸中）有实邪。因此可以使用吐法。《玉函经》说：“上部邪盛不止，应用吐法来祛除它。”
宿食停留在上脘部位的，应当使用吐法。
宿食在中脘和下脘部位的，则适宜使用下法。宿食在上脘，就应当用吐法。《内经》说：“病位在高处的，顺势使其向上涌出；病位在低处的，引导其向下排泄干净。”
病人出现手足厥冷，脉搏突然呈现结象，这是因为客气（外邪）停留在胸中，心中胀满且烦躁，想吃东西却吃不下，病位在胸中，应当使用吐法。
这与第六卷厥阴门瓜蒂散证的条文相同。彼处说脉象乍紧，此处说脉象乍结，只有这一点不同。“紧”代表内部有实邪，“乍紧”说明实邪尚未深重，是邪气在胸中；“结”代表凝结成实，“乍结”说明凝结尚未深重，也是邪气在胸中。所以证候和治疗方法是相同的。
吴氏说：凡是病位在膈以上的，脉象大、胸部胀满、多痰的，或者食物停在胃口、脉象滑的，都适宜使用吐法。华佗认为伤寒三日，邪气在胸中的，适宜使用吐法。凡是用吐法，常用瓜蒂散，或者淡盐水汤，或者温茶汤送服。如果体质虚弱的人，用人参芦煎汤催吐也可以。如果痰多的，喝下一瓯二陈汤，趁热服用，用手指探喉中，即可引发呕吐。凡是老人体弱胆怯，以及患有劳损、内伤等虚证之人，还有妇女怀孕前和产后、血虚脉象弱小者，都不可使用吐法。凡是能引起呕吐的药物如防风、桔梗、山栀，只用一味煎汤，温服后即可引发呕吐。如果误用吐法，会损伤人体上焦的元气，造成的危害不轻，能不谨慎吗？
These four syndromes have already been discussed in the Taiyang chapter.
The general principle is that emesis (inducing vomiting) is suitable in spring.
During spring, Yang Qi ascends to the upper Jiao, and pathogenic factors also reside in the upper Jiao; therefore, emesis is appropriate.
When using emetic decoctions, stop as soon as the disease is alleviated; there is no need to finish the entire dose.
The key lies in appropriateness, avoiding excess.
If various excess patterns exist above the chest, with stifling pain in the chest, inability to eat, a desire for abdominal/chest pressure, yet regurgitation of saliva and phlegm occurs, accompanied by diarrhea occurring more than ten times a day, and the pulse is surprisingly slow with a slightly slippery sensation at the Cun Kou (radial artery), this indicates that emesis may be used. After emesis, the diarrhea will cease.
"Various excess patterns above the chest" may refer to phlegm-excess, heat-stagnation, or cold-binding in the chest, causing stagnation and pain, inability to eat, and a desire for pressure. If the pathogen is below, pressing causes Qi to descend without regurgitating saliva/phlegm. However, if pressing induces regurgitation of saliva/phlegm, it confirms the pathogen is in the chest. The Classic states: "Diarrhea with a slow and slippery pulse indicates internal excess." Although diarrhea occurs more than ten times daily, the pulse is surprisingly slow and the Cun Kou is slightly slippery, indicating upper excess. Thus, emesis is indicated. The *Yu Han Jing* states: "If upper excess persists, use emesis to drain it."
For retained food lodged in the upper Wan (upper stomach), emesis should be employed.
For retained food in the middle or lower Wan, purgation (downward draining) is appropriate. Retained food in the upper Wan requires emesis. The *Nei Jing* states: "Where the pathology is high, induce upward expulsion; where it is low, guide downward evacuation."
Patients presenting with cold extremities, a suddenly knotted pulse (Jie Mai), due to alien Qi residing in the chest, experiencing chest fullness and irritability, desiring to eat but unable to do so, have pathology in the chest and should undergo emesis.
This corresponds to the Gua Di San (Melon Seed Powder) syndrome in the Jueyin chapter of Volume 6. That text mentions a suddenly tight pulse (Jin Mai), whereas this text mentions a suddenly knotted pulse. The difference is minor: "Tight" signifies internal excess; a "suddenly tight" pulse suggests the excess has not deeply penetrated, indicating pathogen in the chest. "Knotted" signifies binding into solidity; a "suddenly knotted" pulse suggests the binding has not deeply penetrated, also indicating pathogen in the chest. Hence, the syndrome and treatment are identical.
Wu Shi stated: For diseases located above the diaphragm, with a large pulse, chest fullness, and abundant phlegm; or for food stuck at the stomach opening with a slippery pulse, emesis is suitable. Hua Tuo said that after three days of Shang Han (Cold Damage), if the pathogen is in the chest, emesis is suitable. Commonly, Gua Di San (Melon Seed Powder), light salt water, or warm tea is used. For weak patients, Ren Shen Lu (Ginseng Rhizome) decoction can be used to induce vomiting. For those with excessive phlegm, drinking one cup of Er Chen Tang (Two-Aged Decoction) while hot, followed by stimulating the throat with a finger, will induce vomiting. Emesis is contraindicated for the elderly who are timid and weak, patients with Lao Sun (consumptive disease) or internal injury constituting deficiency, women before pregnancy and postpartum, and those with blood deficiency and weak/small pulses. Herbs such as Fang Feng (Saposhnikovia Root), Jie Geng (Platycodon Root), and Shan Zhi (Gardenia Fruit) can induce vomiting when taken singly in decoction and consumed warm. Misuse of emesis damages the Yuan Qi (Original Qi) of the Upper Jiao, causing significant harm. One must be cautious.