本朝八九十年前，越前有奥村良筑者，始阐吐法。而其门人永富凤介着《吐方考》，荻
野元凯着《吐方编》，田中信藏着《医事谈》，皆绍述师说，所裨补不为鲜矣。
汗吐下异法而同归，可吐而不吐，同于可汗下而不汗下，而世医或遗吐之一法，故病处
于不死不起之际者，比比有之。长门独啸庵特得其法，而其所着《吐方考》，皆有征验。
余从奥村先生学吐方，十余年而后行之。年不下数十人，颇知其效验。然至其机变，则
非言
之所能尽，唯考征已明，试验必审，精与识合，胆与信符，而后可庶几焉。凡欲行吐，当审
腹候。按之不得其可吐之候者，虽上下坚实，不可吐之。
凡快吐者必快下，上窍开而下窍通也。而张子和更下之数十行，是宜权其势而斟酌之。
凡行吐法得之于缓病，而后得之于伤寒卒病，则远害矣。
癫痫者，以三圣散吐之，后与铅丹剂佳。
喘息腹满者，不可吐，宜回春紫金丹。若不满者可吐，宜瓜蒂散。
伤寒汗出不解，胸胁苦满，不俗饮食，大便或利或秘，舌上白胎，短气而烦者，当吐之
，瓜蒂散主之。失吐者死。
发汗吐下后，心中懊 结痛者，当吐之，失吐者死。(吐方或指栀子豉汤而言。)
盐汤吐痰，地黄吐蛔，五苓散吐伤寒，葱白头吐头痛。此数方非能吐人，惟在知其义，
对其证而得其法耳。
反胃诸呕，少腹有块动悸冲巨里，心中热痛，饥不能食者，不可吐，吐之必死。
汗出而后蒸蒸发热者，属胃也。若胸胁满而呕者，其热虽潮，未可遽下之。世医不知此
机，多方误投，轻至重，重至危。悲矣!
下利下重，虽脉洪数，当审其腹候。有宜汗，有宜下，有宜和，不可一概下之。下如鱼
脑肝，食饮不下，脉细数者，数日死。能食而下脓血，久不已者，以肠痈药治之。
下利咳逆，痛引胁下，不欲饮食，寒热去来，欲为劳者，急下之，宜十枣汤。
医之临病，犹将之对敌。苟不得其时，不知其机，则一败涂地。思之必精，察之必审
。而误者未之有也。书云∶惟时惟机。天下之事皆然，不止医事也。
中风口眼 斜，或半身不遂者，与瓜蒂散得效，若卒中风者无验。
痿 多由热气上逆，故下焦气血枯燥，而至足痿。此证必小便频数，大便秘，后遗尿
失禁，甚则下血而死。与吐剂而后与白虎汤为得。
耳病用宣明论泻青丸效。
被灸火发壮热喘息者，小柴胡加黑豆、牡蛎尤效。
肠痈经日属阴者，薏苡附子败酱散，加黄 佳。若痛甚者，加没药。
痘疮至贯脓时，烦渴闷乱搐搦者，与风引汤效。盖此证痘科键用满天秋，《活幼心法》
用唇
砂益元散，而不如此方最捷矣。(拙轩曰∶运用自在，虽存于其人。古方之妙也，西土之医
家，或乏此识。药方之日增月加，职斯之由。)
不由邪气而口中干燥者，属血虚，故虚劳多有之。发热亦有属血虚者，不可不知。
生姜发开心胸结邪，干姜温散心胸寒冷，使用虽多，不过此二端。世医无深知生干之别
者，噫!
休息痢属疝者，宜当归四逆汤。
噤口痢不能纳药汁者，鲋鱼为泥，和以吴茱萸，麝香少许，贴之于脐中得效。
食伤不吐下难奈者，升麻、郁金二味煎服捷效。
霍乱转筋甚者，与理中加石膏汤为佳。(古人治转筋以理中汤加石膏，治胞衣不下以平
胃散
加芒硝，其意难晓。盖阴阳相摩，刚柔相济，妙在其中。适所得之于实验，其言非虚矣。)
日本江户时代八九十年前，越前国有一位名叫奥村良筑的医生，开始阐发涌吐法。他的弟子永富凤介撰写了《吐方考》，荻野元凯撰写了《吐方编》，田中信藏撰写了《医事谈》，都继承阐述老师的学说，所做出的补充和贡献是非常多的。
发汗、涌吐、攻下是三种不同的治疗方法，但最终目的相同。该用涌吐法而不用，就像该用发汗或攻下法而不用一样。然而世间的医生往往遗漏了涌吐这一方法，因此处于不死不活边缘的病人，比比皆是。长门国的独啸庵特别精通此法，他所著的《吐方考》中记载的案例都有确切的验证。我跟随奥村先生学习涌吐方剂，十多年后才开始施行。每年诊治不下几十人，很了解其疗效。但是到了运用机变的时候，就不是言语所能完全表达的了，只有考证明确，试验审慎，精湛的技巧与正确的见识相结合，胆识与信心相符，才可以说是差不多了。凡是想要使用涌吐法，应当审查腹部的征候。按压腹部没有出现可涌吐的征象时，即使上下部位坚实，也不可用涌吐法。
凡是能迅速引起呕吐的，必然也会迅速引起腹泻，这是因为上窍打开后下窍也就通畅了。张子和在涌吐之后又用了数十次泻下，这是应该权衡病势并加以斟酌处理的。凡是治疗缓慢性疾病时使用涌吐法，后来在治疗伤寒急症时也使用涌吐法，就可以远离祸害了。
喘息且腹部胀满的患者，不可涌吐，适宜用回春紫金丹。如果腹部不胀满的可以涌吐，适宜用瓜蒂散。
伤寒患者出汗后病邪未解，胸胁部苦闷胀满，饮食不消化，大便有时通利有时秘结，舌苔白，气短且烦躁的，应当涌吐，以瓜蒂散为主治。延误涌吐治疗的会死亡。（注：此处“失吐”指误治或延误涌吐时机。）
发汗、涌吐、攻下之后，心中懊恼郁结疼痛的，应当涌吐，延误涌吐治疗的会死亡。（注：原文括号内提示“吐方”可能指栀子豉汤而言，但根据上下文及仲景原意，此处主要论述涌吐法的适用性。）
盐汤涌吐痰涎，地黄涌吐蛔虫，五苓散涌吐伤寒，葱白头涌吐头痛。这几个方子并不是能让人呕吐的药，关键在于懂得其中的义理，针对证候并掌握正确的方法罢了。
反胃及各种呕吐，少腹部有肿块跳动悸动冲击心下，心中热痛，饥饿但不能进食的，不可涌吐，涌吐必死。
出汗之后出现蒸蒸发热的，属于胃家实热。如果胸胁胀满且呕吐的，虽然发热如潮，不可立即攻下。世间的医生不懂这个机理，多方误投药物，轻症转为重症，重症转为危症，可悲啊！
下利且伴有里急后重，虽然脉象洪数，应当审查腹部征候。有的适宜发汗，有的适宜攻下，有的适宜和解，不可一概攻下。如果大便像鱼脑肝一样稀薄，饮食不下，脉象细数的，几天后会死亡。如果能进食但排出脓血，久治不愈的，用治疗肠痈的药物来治疗。
下利伴咳嗽气逆，疼痛牵引胁下，不想饮食，寒热往来，快要发展为虚劳病的，应当紧急攻下，适宜用十枣汤。
医生面对疾病，就像将领面对敌人。如果不把握时机，不了解机理，就会一败涂地。思考必须精密，观察必须审慎。这样就不会有误诊了。书说：“惟时惟机”。天下的事情都是如此，不仅仅是医学事务。
中风导致口眼歪斜，或者半身不遂的，用瓜蒂散有效，如果是突然中风则没有疗效。
痿证多由热气上逆，导致下焦气血枯燥，从而引起足部痿弱。这种证候必然小便频数，大便秘结，甚至遗尿失禁，严重时会因下血而死。给予涌吐剂后，再给予白虎汤才是得法。
耳部疾病用宣明论中的泻青丸有效。
肠痈经过多日属于阴证的，用薏苡附子败酱散，加入黄芩效果佳。如果疼痛剧烈的，加入没药。
痘疮发展到化脓阶段，出现烦渴、闷乱、抽搐痉挛的，用风引汤有效。大概这个证候是痘科的关键用药，《活幼心法》中使用唇砂益元散，但不如这个方子最快捷。（拙轩评论道：运用自如，虽取决于医者个人，这也是古方的妙处所在。西方医生或许缺乏这种见识。药方日益增加，原因就在这里。）
不是由邪气引起的口中干燥，属于血虚，所以虚劳病多有此症。发热也有属于血虚的，不可不知道。
生姜能发散心胸间的结滞邪气，干姜能温散心胸间的寒冷，虽然使用很多，不过就是这两种功效。世间的医生没有深刻明白生姜和干姜区别的，唉！
噤口痢不能吞咽药汁的，将鲋鱼捣成泥，混合吴茱萸、少许麝香，贴在脐中有效。
食积损伤，难以通过呕吐或排便排出的，用升麻、郁金两味药煎服效果捷速。
霍乱转筋严重的，用理中汤加石膏汤为佳。（古人治疗转筋用理中汤加石膏，治疗胞衣不下用平胃散加芒硝，其中的意思很难理解。大概是因为阴阳相互摩擦，刚柔相互济助，妙处就在其中。这是我通过实验所得到的，这话不是虚言。）
Several decades ago in Japan, a physician named Okamura Ryochiku from Echizen Province began to elucidate the method of inducing vomiting (Yongtu Fa). His disciples, Nagatomi Hoakai, wrote *Kohou Kou* (Examination of Vomiting Formulas), Ogino Genkai wrote *Kohou Hen* (Compilation of Vomiting Formulas), and Tanaka Shinchou wrote *Iji Dan* (Discussions on Medical Affairs); all inherited and expounded upon their master's teachings, making significant contributions.
Sweating (Han), inducing vomiting (Tu), and purging (Xia) are different methods that share the same ultimate goal. Failing to induce vomiting when indicated is akin to failing to sweat or purge when indicated. However, physicians of the world often neglect the method of inducing vomiting; consequently, patients who remain in a state between life and death are numerous. Dokushoan from Choshun Province particularly mastered this method, and the cases recorded in his *Kohou Kou* (Examination of Vomiting Formulas) were verified by evidence. I studied vomiting formulas under Master Okamura for over ten years before applying them clinically. Treating dozens of patients annually, I became quite familiar with their efficacy. However, regarding the subtle variations in application, words cannot fully express it. One must rely on clear verification, careful experimentation, combine skill with insight, and align courage with confidence; only then can one approach mastery. When intending to use the vomiting method, one must examine abdominal signs. If pressing the abdomen does not reveal indications suitable for vomiting, even if the upper and lower body feel solid, vomiting should not be induced.
Those who induce rapid vomiting will inevitably experience rapid diarrhea, as opening the upper orifices opens the lower ones. Zhang Hezi administered dozens of purgative doses after inducing vomiting; this requires weighing the condition and exercising discretion. Using the vomiting method for chronic diseases and subsequently for acute Shanghan (Cold Damage) diseases helps avoid harm.
For epilepsy, administer Sansheng San (Three Saints Powder) to induce vomiting, followed by a preparation containing Qian Dan (Lead Oxide) for good results.
For patients with wheezing and abdominal fullness, vomiting is contraindicated; Huichun Zijin Dan (Spring-Returning Purple Gold Pill) is appropriate. If there is no abdominal fullness, vomiting may be induced using Gengdi San (Melon Rind Powder).
In Shanghan disease, if sweating fails to resolve the condition, accompanied by bitter fullness in the chest and hypochondrium, indigestion, alternating loose or constipated stools, a white tongue coating, shortness of breath, and irritability, vomiting should be induced, primarily using Gengdi San (Melon Rind Powder). Failure to induce vomiting when indicated leads to death.
After sweating, vomiting, or purging, if the patient experiences mental restlessness and painful knotting in the heart region, vomiting should be induced; failure to do so leads to death. (Note: The term "vomiting formula" here might refer to Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction), but the context emphasizes the vomiting method.)
Salt water induces vomiting for phlegm; Rehmannia induces vomiting for roundworms; Wuling San (Five-Ingredient Powder with Poria) induces vomiting for Shanghan; Scallion White induces vomiting for headache. These formulas do not inherently cause vomiting; the key lies in understanding their principles, matching them to the syndrome, and mastering the correct technique.
For regurgitation and various types of vomiting, if there is a palpable mass with throbbing/palpitations in the lower abdomen impacting the epigastrium, heat and pain in the heart region, hunger but inability to eat, vomiting is contraindicated; inducing vomiting will be fatal.
If sweating is followed by steaming fever, it belongs to the Stomach. If there is chest/hypochondriac fullness and vomiting, despite tidal fever, immediate purging is inadvisable. Physicians ignorant of this mechanism often misprescribe, turning mild conditions severe and severe ones critical. How tragic!
For dysentery with tenesmus, even if the pulse is surging and rapid, one must examine abdominal signs. Some cases require sweating, some purging, some harmonizing; one should not indiscriminately purge. If stool resembles fish brains/liver, food intake is impossible, and the pulse is fine and rapid, death will occur within days. If the patient can eat but passes pus and blood chronically, treat with formulas for intestinal abscess (Chang Yong).
For dysentery with coughing and air reversal, pain radiating to the hypochondrium, anorexia, alternating chills and fever, progressing toward consumptive disease, urgent purging is required, preferably using Shizao Tang (Ten Jujube Decoction).
A physician facing illness is like a general facing an enemy. Without grasping the timing and understanding the mechanism, defeat is certain. Thought must be precise, observation meticulous. Thus, errors are avoided. As the book states: "Only time, only opportunity." This applies to all affairs, not just medicine.
For stroke causing facial deviation or hemiplegia, Gengdi San (Melon Rind Powder) is effective; however, it has no effect for sudden stroke.
Wei Syndrome (Flaccidity Syndrome) is mostly caused by rebellious heat rising, leading to dryness and deficiency of Qi and Blood in the lower jiao, resulting in leg flaccidity. This syndrome necessarily involves frequent urination, constipation, urinary incontinence, and potentially fatal hemorrhage. Administering a vomiting agent followed by Baihu Tang (White Tiger Decoction) is the correct approach.
For ear diseases, Xieqing Wan (Drain Green Pill) from *Xuanming Lun* is effective.
For high fever and asthma induced by moxibustion/fire therapy, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Black Beans and Oyster Shell is particularly effective.
For intestinal abscess persisting for days classified as Yin type, Yiyi Fuzi Baizao San (Coix Seed, Aconite, and Patrinia Powder) added with Huang Qin (Scutellaria Root) is good. For severe pain, add Myrrh.
During the suppuration stage of smallpox/variolae, if there is irritability, thirst, confusion, and convulsions, Fengyin Tang (Wind-Guiding Decoction) is effective. This syndrome is a key point in variolae treatment; while *Huoyou Xinfa* uses Lisha Yi Yuan San (Labradoris Seed and Origin-Preserving Powder), this formula is more rapid. (Zhuoxuan commented: Flexibility depends on the practitioner; this is the subtlety of ancient formulas. Western physicians may lack this insight. The continuous addition of prescriptions stems from this.)
Dry mouth not caused by pathogenic factors indicates Blood deficiency, common in Xu Lao (Consumptive Disease). Fever can also stem from Blood deficiency; this must be known.
Fresh Ginger disperses stagnant pathogens in the chest/heart; Dried Ginger warms and disperses cold in the chest/heart. Despite frequent use, these are their primary functions. Physicians often fail to deeply distinguish between Fresh and Dried Ginger. Alas!
For recurrent dysentery associated with hernia-like symptoms, Danggui Sini Tang (Angelica Decoction for Cold Extremities) is appropriate.
For Jin Kou Li (Lockjaw Dysentery) where oral medication cannot be retained, mash Crucian Carp into a paste, mix with Evodia Fruit and a little Musk, and apply to the umbilicus for effect.
For food stagnation difficult to expel via vomiting or purging, decocting Shengma (Cimicifuga Rhizome) and Yujin (Curcuma Longa Rhizome) yields rapid results.
For severe cholera with muscle cramps/spasms, Lizhong Tang (Regulate the Middle Decoction) added with Gypsum is excellent. (Ancients used Lizhong Tang plus Gypsum for spasms, and Pingwei San (Stomach-Pacifying Powder) plus Mirabilite for retained placenta; the rationale is profound, involving the interaction of Yin-Yang and Hard-Soft. This was derived from clinical practice and is not empty talk.)