宜吐法者,邪结中脘,食填太仓,痰饮内伏。胸前作痛,右关脉大,或反沉,或下部有脉,
上部无脉,皆宜吐法。故曰病在膈上,病在胸中,宜吐之。食在上脘,胸满多痰,宜吐之,
华佗云∶伤寒三四日,邪在胸中,宜吐之。凡吐用瓜蒂散,或淡盐汤,或温茶汤,弱者用人
参芦。然终不若家秘吐法,欲散风只用防风一味,欲散结只用枳壳一味,欲解烦用山栀一
味,身痛用羌活一味,头痛用川芎一味,煎汤温服,少顷,即以鸟羽探吐,不伤胃气。
忌吐法者,病不在上,胸无凝滞,不必吐之。仲景云∶关上脉细,以医吐之过也。太阳病吐
之,反不恶寒,不欲近食者,此医吐之内烦也。少阳中风,两耳无所闻,目赤,胸中满而烦
者,不可吐下。故凡老弱虚人,忌吐法。久病虚弱,忌吐法。内伤本元,忌吐法。六脉空
大,忌吐法。脉细无神,忌吐法。胃虚食少,忌吐法。时时眩冒,忌吐法。胎前产后,忌吐
法。痈疽溃后,金疮失血,忌吐法。古人虽以汗吐下三法,以治外感,然吐下二法,亦要小心者也。
仲景于三阴篇,详注温经救里之法。曰∶太阴自利不渴,以其脏有寒故也,当温之,少阴病
吐利,手足厥冷,烦躁欲死者,吴茱萸汤主之。少阴病下利脉微者,少阴病下利清谷,里寒
外热者。通脉四逆汤。少阴病脉沉者,急温之,宜四逆汤。少阴病饮食入口即吐,若膈上有
寒,饮干呕者,不可吐,急温之。少阴病下利脉微涩,呕而汗出,必数更衣,反少者,当温
之。厥阴病手足厥寒,脉细欲绝者,当归四逆汤主之。又伤寒脉促,手足厥逆者,可灸之。
以上皆是三阴经中寒之阴症,故宜温经救里。
宜用吐法的情况是:邪气结聚于中脘,食物填塞太仓(胃),痰饮潜伏体内。胸前疼痛,右关脉大,或者反而沉伏,或者下部有脉而上部无脉,这些情况都适宜使用吐法。所以说,病位在膈上、胸中的,适宜用吐法。食积在上脘,胸部胀满且多痰的,适宜用吐法。华佗说:“伤寒三四天,邪气在胸中,适宜用吐法。”凡是使用吐法,可用瓜蒂散,或淡盐汤,或温茶汤;体质虚弱者用人参芦。然而终究不如家传的吐法好:想要疏散风邪只用防风一味药,想要消散结滞只用枳壳一味药,想要解除烦闷只用山栀一味药,身体疼痛用羌活一味药,头痛用川芎一味药,煎汤温服,过了一会儿,即用鸟羽探喉催吐,这样不损伤胃气。
忌用吐法的情况是:病位不在上部,胸中没有凝滞之物,不必用吐法。张仲景说:“关上脉细,是因为医生误用吐法造成的过失。”太阳病误用吐法后,反而不恶寒,不想吃东西的,这是医生误吐导致内热烦躁。少阳中风,两耳听不见,眼睛红赤,胸中胀满且烦躁的,不可用吐下法。所以凡是年老体弱、正气不足的人,忌用吐法。久病体虚的人,忌用吐法。内伤元气根本的人,忌用吐法。六脉空大而无力的人,忌用吐法。脉象细弱无神的人,忌用吐法。胃气虚弱、饮食减少的人,忌用吐法。时常头晕目眩的人,忌用吐法。怀孕前和产后,忌用吐法。痈疽溃烂之后,刀枪创伤失血过多,忌用吐法。古人虽然用汗、吐、下三法来治疗外感病,但是吐法和下法,也是必须小心使用的。
张仲景在三阴经篇中,详细注释了温经救里的方法。说:“太阴病自利而不口渴,是因为脏腑有寒的缘故,应当温补。”“少阴病呕吐下利,手足厥冷,烦躁欲死的,用吴茱萸汤主治。”“少阴病下利脉微的,”“少阴病下利完谷不化,里寒外热的,用通脉四逆汤主治。”“少阴病脉沉的,急当温补,适宜用四逆汤。”“少阴病饮食入口即吐,若膈上有寒,饮水即干呕的,不可用吐法,急当温补。”“少阴病下利脉微涩,呕吐且出汗,必定频繁上厕所,但排便量反而少的,应当温补。”“厥阴病手足厥冷,脉细欲绝的,用当归四逆汤主治。”又说:“伤寒脉促,手足厥逆的,可以用灸法。”以上这些都是三阴经中受寒的阴证,所以适宜温经救里。
Indications for Emetic Therapy: When pathogenic factors are knotted in the Middle Jiao (Middle Burner), food stagnates in the Tai Cang (Stomach), and phlegm-fluids lie latent within. Pain in the chest region, a large pulse at the Right Guan position, or conversely a deep pulse, or pulses present in the lower part but absent in the upper part, all indicate suitability for emetic therapy. Thus it is said that when the disease is located above the diaphragm or in the chest, emesis is indicated. When food accumulation is in the Upper Jiao (Upper Burner), accompanied by chest fullness and excessive phlegm, emesis is indicated. Hua Tuo stated: "In Shanghan (Cold Damage) after three to four days, when pathogens are in the chest, emesis is indicated." Generally, for emetic therapy, Gengti San (Melon Seed Powder) may be used, or light salt water, or warm tea soup; for those with weak constitutions, Ren Shen Lu (Deer Antler Velvet of Ginseng) is used. However, this is not as effective as the family-secret emetic method: to disperse wind, use only Fang Feng (Saposhnikovia Root); to resolve nodulation, use only Zhi Ke (Bitter Orange); to relieve vexation, use only Shan Zhi (Gardenia Fruit); for body pain, use only Qiang Huo (Notopterygium Rhizome); for headache, use only Chuan Xiong (Ligusticum Rhizome). Decoct these in water, take warm, and after a short while, induce vomiting by tickling the throat with a bird feather. This method does not damage Stomach Qi.
Contraindications for Emetic Therapy: When the disease is not in the upper part, and there is no stagnation in the chest, emesis is unnecessary. Zhang Zhongjing stated: "A fine pulse at the Guan position is due to the physician's error in using emesis." If Taiyang disease is treated with emesis, and the patient instead loses aversion to cold and has no desire for food, this indicates internal heat and vexation caused by the physician's erroneous emesis. In Shaoyang wind-strike, where hearing is lost in both ears, eyes are red, and there is chest fullness and vexation, neither emesis nor purgation should be used. Therefore, emetic therapy is contraindicated for the elderly, the weak, and those with deficiency. It is contraindicated for those with chronic illness and weakness. It is contraindicated for those with internal injury to the Yuan Qi (Original Qi). It is contraindicated for those with empty and large pulses. It is contraindicated for those with fine pulses lacking spirit. It is contraindicated for those with weak Stomach Qi and poor appetite. It is contraindicated for those suffering from frequent dizziness and vertigo. It is contraindicated during pregnancy and postpartum. It is contraindicated after the ulceration of carbuncles and sores, or following traumatic injuries with blood loss. Although ancients used sweating, emesis, and purgation to treat external contraction, emesis and purgation require extreme caution.
Zhang Zhongjing detailed the methods of warming the meridians and rescuing the interior in the chapters on the Three Yin Meridians. He stated: "Taiyin disease with spontaneous diarrhea and no thirst is due to cold in the zang organs; it should be warmed." "For Shaoyin disease with vomiting and diarrhea, cold extremities, and severe restlessness desiring death, Wu Zhu Yu Tang (Evodia Decoction) is the primary treatment." "For Shaoyin disease with diarrhea and a faint pulse..." "For Shaoyin disease with diarrhea passing undigested food, presenting with interior cold and exterior heat, Tong Mai Si Ni Tang (Pulse-Rescuing Cinnamon Twig Decoction) is indicated." "For Shaoyin disease with a deep pulse, urgent warming is required, and Si Ni Tang (Frigid Extremities Decoction) is suitable." "For Shaoyin disease where food is vomited immediately upon entering the mouth, if there is cold above the diaphragm causing dry heaving after drinking water, emesis must not be used; urgent warming is required." "For Shaoyin disease with diarrhea, faint and thin pulses, vomiting, sweating, frequent defecation but scant output, warming is indicated." "For Jueyin disease with cold extremities and a fine pulse nearly imperceptible, Dang Gui Si Ni Tang (Angelica Frigid Extremities Decoction) is the primary treatment." He also stated: "In Shanghan with a rapid pulse and cold extremities, moxibustion may be applied." All the above are Yin syndromes of cold affecting the Three Yin Meridians, thus warranting warming of the meridians and rescue of the interior.