吐者，治上焦也。胸次之间，咽喉之地，或有痰、食、痈脓，法当吐之。经曰∶其高者
因而越之是已。然有当吐不吐误人者，有不当吐而吐以误人者，有当吐不可吐而妄吐之以误
人者，亦有当吐不可吐而又不可以不吐，吐之不得其法以误人者，是不可不辨也。
即如缠喉、锁喉诸症，皆风痰郁火壅塞其间，不急吐之，则胀闭难忍矣。又或食停胸膈
消化弗及，无由转输，胀满疼痛者，必须吐之，否则胸高满闷，变症莫测矣。又有停痰蓄饮
阻塞清道，日久生变，或妨碍饮食，或头眩心悸，或吞酸嗳腐，手足麻痹，种种不齐，宜
用吐法导祛其痰，诸症如失。又有胃脘痈，呕吐脓血者，经云∶呕家有脓，不须治呕，脓尽
自愈。凡此皆当吐而吐者也。
然亦有不当吐而吐者何也？如少阳中风，胸满而烦，此邪气而非有物，不可吐，吐则惊
悸也。又少阴病，始得之，手足厥冷，饮食入口则吐，此膈上有寒饮，不可吐也。病在太阳
不可吐，吐之则不能食，反生内烦。虽曰吐中有散，然邪气不除，已为小逆也。此不当吐
而吐者也。
然又有当吐不可吐者何也？盖凡病用吐，必察其病之虚实；因人取吐，先察其人之性情
不可误也。夫病在上焦可吐之症，而其人病势危笃，或老弱气衰者，或体质素虚，脉息微
弱者，妇人新产者，自吐不止者，诸亡血者，有动气者，四肢厥冷，冷汗自出者，皆不可吐
吐之则为逆候，此因其虚而禁吐也。若夫病久之人，宿积已深，一行吐法，心火自降，相
火必强，设犯房劳，转生虚症，反难救药。更须戒怒凝神，调息静养，越三旬而出户，方为
合法。若其人性气刚暴，好怒喜淫，不守禁忌，将何恃以无恐？此又因性情而禁吐也。所谓当吐不可吐者此也。
然有不可吐，而又不得不吐者何也？病患脉滑大，胸膈停痰，胃脘积食，非吐不除，食
用瓜蒂散与橘红淡盐汤，痰以二陈汤，用指探喉中而出之。体质极虚者，或以桔梗煎汤代之
斯为稳当。而予更有法焉，予尝治寒痰闭塞，厥逆昏沉者，用半夏、橘红各八钱，浓煎
半杯，和姜汁成一杯，频频灌之，痰随药出，则拭之，随灌随吐，随吐随灌，少顷痰开药下
其人即苏。如此者甚众。又尝治风邪中脏将脱之证，其人张口痰鸣，声如曳锯，溲便自遗
者，更难任吐，而稀涎、皂角等药，既不可用，亦不暇用，因以大剂参、附、姜、夏，浓煎
灌之，药随痰出，则拭之，随灌随吐，随吐随灌，久之药力下咽，胸膈流通，参、附大进，
立至数两，其人渐苏，一月之间参药数斤，遂至平复，如此者又众。又尝治风痰热闭之症，
以牛黄丸，灌如前法。颈疽内攻，药不得入者，以苏合香丸，灌如前法。风热不语者，以解
语丹，灌如前法。中暑不醒者，以消暑丸，灌如前法。中恶不醒者，以前项橘、半、姜汁，
灌如前法。魇梦不醒者，以莲须、葱白煎酒，灌如前法。自缢不醒者，以肉桂三钱煎水，灌
如前法。喉闭喉风，以杜牛膝捣汁，雄黄丸等，灌如前法，俱获全安，如此者又众。更有牙
关紧急，闭塞不通者，以搐鼻散，吹鼻取嚏，嚏出牙开，或痰或食，随吐而出，其人遂苏，
如此者尤众。盖因证用药，随药取吐，不吐之吐，其意更深。此皆古人之成法，而予稍为变
通者也。昔仲景治胸痛不能食，按之反有涎吐，下利日数十行，吐之利则止，是以吐痰止利
也。丹溪治妊妇转脬，小便不通，用补中益气汤，随服而探吐之，往往有验，是以吐法通小
便也。华佗以醋蒜吐蛇，河涧以狗油、雄黄同瓜蒂以吐虫而通膈，丹溪又以韭汁去瘀血以治前
症。由此观之，症在危疑之际，古人恒以涌剂，尽其神化莫测之用，况于显然易见者乎！则
近世医者，每将此法置之高阁，亦似汗下之外，并无吐法，以致病中常有自呕、自吐而
为顺症者，见者惊，闻者骇，医家亦不论虚实而亟亟止之，反成坏病，害人多矣。吁，可不
畏哉！
吐法，是治疗上焦疾病的方法。在胸膈之间、咽喉部位，如果有痰浊、食积或痈脓，应当采用吐法。经典记载说：“病位在高处的，顺势使其向上涌出。”这是正确的原则。然而，有该吐而不吐导致误人的，有不该吐却吐而误人的，有该吐但因体质等原因不可吐却妄加施治而误人的，也有该吐但因禁忌不能吐却又不得不吐，且因未掌握正确方法而误人的情况，这些都必须仔细辨别。
就像缠喉风、锁喉风等病症，都是由于风痰郁火壅塞在咽喉之间，如果不紧急使用吐法，就会胀闭难忍。或者食物停滞在胸膈，无法消化和转输，导致胀满疼痛的，必须使用吐法，否则会出现胸部高起、胀闷不适，变证难以预测。又有痰饮停聚阻塞清窍通道，日久产生变化，有的妨碍饮食，有的头晕心悸，有的吞酸嗳腐，有的手足麻木，症状各不相同，适宜用吐法引导祛除痰浊，各种症状就会消失。还有胃脘痈肿，呕吐脓血的，经书说：“呕吐物中有脓液，不需要治疗呕吐本身，脓液排尽自然痊愈。”凡此种种，都是应当使用吐法的情况。
然而也有不该吐却错误地使用了吐法的情况，为什么呢？比如少阳中风，出现胸满心烦，这是邪气侵袭而非有形实邪阻滞，不可使用吐法，如果吐了会导致惊悸。还有少阴病，刚发病时，手足厥冷，饮食入口即吐，这是膈上有寒饮，也不可使用吐法。病在太阳经时不可吐，吐了就不能进食，反而产生内烦。虽然有人说吐法中带有发散之意，但如果邪气未除，就已经造成了轻微的逆乱。这就是不该吐却吐的情况。
然而又有该吐但因某些原因不可吐的情况，为什么呢？大凡使用吐法治病，必须观察病情的虚实；因人施治取吐，先要观察病人的性情，以免出错。凡是病在上焦、适合使用吐法的病症，但如果病人病势危重，或者年老体弱、元气衰微，或者素来体质虚弱、脉象微弱，或者是刚生产完的妇女，或者经常自发性呕吐不止的人，所有失血的人，或者有动气（气机上冲）症状的人，四肢厥冷、冷汗自出的人，都不可使用吐法，如果吐了就是逆证，这是因其虚而禁止使用吐法。如果是患病很久的人，宿积已经很深，一旦使用吐法，心火自然会下降，相火必然亢盛，如果此时犯房事劳累，转而生成虚损之症，反而难以救治。还必须戒除愤怒、凝神静气，调匀呼吸安静休养，过了三十天才能出门活动，这才是合法的做法。如果病人性格刚烈暴躁，喜欢发怒好色，不遵守禁忌，那还有什么可依赖而不必恐惧呢？这又是因其性情而禁止使用吐法。所谓“该吐但不可吐”指的就是这种情况。
然而又有不可吐但又不得不吐的情况，为什么呢？如果病人脉象滑大，胸膈有停痰，胃脘有积食，非吐不能去除，可以使用瓜蒂散配合橘红淡盐汤，对于痰浊可以用二陈汤，用手指探喉催吐。体质极虚的人，可以用桔梗煎汤代替催吐药物，这样比较稳妥。而我更有其他方法：我曾经治疗寒痰闭塞导致的厥逆昏沉病人，用半夏、橘红各八钱，浓煎成半杯，混合姜汁成为一杯，频繁灌服，痰随药吐出，就擦拭干净，边灌边吐，边吐边灌，过了一会儿痰开药下，病人立即苏醒。这样的案例很多。又曾经治疗风邪中脏即将脱绝的证候，病人张口痰鸣，声音像拉锯一样，大小便失禁，这种更难承受吐法，而且稀涎散、皂角等药物，既不能用，也来不及用，于是用大剂量的参、附子、干姜、半夏，浓煎后灌服，药随痰吐出，就擦拭干净，边灌边吐，边吐边灌，久而久之药力咽下，胸膈通畅，人参、附子大量进补，立刻达到数两之多，病人逐渐苏醒，一个月内服用人参达数斤，最终恢复健康，这样的案例也很多。又曾经治疗风痰热闭的病症，用牛黄丸，按前面的方法灌服。颈疽内攻，药物无法进入的，用苏合香丸，按前面的方法灌服。风热导致失语的，用解语丹，按前面的方法灌服。中暑昏迷不醒的，用消暑丸，按前面的方法灌服。中恶昏迷不醒的，用前面提到的橘皮、半夏、姜汁，按前面的方法灌服。梦魇昏迷不醒的，用莲须、葱白煎酒，按前面的方法灌服。自缢昏迷不醒的，用肉桂三钱煎水，按前面的方法灌服。喉闭、喉风，用杜牛膝捣汁、雄黄丸等，按前面的方法灌服，都获得了完全康复，这样的案例也很多。更有牙关紧闭、闭塞不通的，用搐鼻散吹鼻取嚏，打喷嚏后牙关张开，痰或食积随之吐出，病人随即苏醒，这样的案例尤其多。这是因为根据证候用药，随药引吐，这种“不吐之吐”，其意蕴更深。这些都是古人的成法，我只是稍作变通罢了。昔日张仲景治疗胸痛不能进食，按压反而有涎沫吐出，腹泻一天几十次，通过吐法使腹泻停止，这是通过吐痰来止利。朱丹溪治疗孕妇转胞，小便不通，用补中益气汤，服药后随即探吐，往往有效，这是通过吐法通利小便。华佗用醋蒜吐蛇，刘河间用狗油、雄黄同瓜蒂以吐虫并通膈，朱丹溪又用韭汁去瘀血来治疗前症。由此看来，病情在危急疑难之际，古人常常使用涌吐剂，发挥其神妙莫测的作用，何况是那些明显容易看到的病症呢！然而近世医生，往往将此法束之高阁，似乎除了汗法和下法之外，并没有吐法，导致病人常有自呕、自吐而成为顺证的，见到的人感到惊讶，听到的人感到骇异，医生也不论虚实而急忙制止，反而造成坏病，害人多矣。唉，能不敬畏吗！
Emesis (Tǔ Fǎ) is a method for treating diseases of the Upper Jiao (Upper Burner). In the region between the chest and diaphragm, and in the throat, if there are phlegm, food retention, or abscess pus, the appropriate treatment is emesis. The Classics state: "Where the pathogen is high, induce it to ascend and vomit." This is correct. However, there are cases where failure to vomit when indicated causes harm; there are cases where vomiting is induced when not indicated, causing harm; there are cases where vomiting is contraindicated due to specific conditions yet is recklessly applied, causing harm; and there are cases where vomiting is both indicated and necessary despite contraindications, but mishandled due to lack of proper technique, causing harm. These distinctions must be clearly understood.
For instance, in conditions such as Strangling Throat Wind (Chán Hóu Fēng) and Locking Throat Wind (Suǒ Hóu Fēng), wind-phlegm and stagnant fire obstruct the area. If emesis is not urgently employed, severe distension and closure will become unbearable. Or, if food stagnates in the chest and diaphragm, unable to digest or transform, leading to distension and pain, emesis is mandatory. Otherwise, the chest may become elevated and full, with unpredictable complications arising. Furthermore, if retained phlegm and fluid obstruct the clear pathways, changes may occur over time, hindering diet, causing dizziness and palpitations, acid regurgitation and belching of rotten food, or numbness in the limbs. Symptoms vary widely, but emesis is suitable to guide out the phlegm, after which all symptoms will vanish. In cases of gastric abscess with vomiting of pus and blood, the Classics say: "If there is pus in the vomitus, do not treat the vomiting itself; once the pus is exhausted, health will return naturally." All these are instances where emesis is indicated.
However, there are cases where emesis is inappropriate yet used erroneously. Why? For example, in Shaoyang (Lesser Yang) wind-stroke, with chest fullness and irritability, this is due to pathogenic qi rather than tangible accumulation; emesis is contraindicated, as inducing vomiting would lead to fright and palpitations. In Shaoyin (Lesser Yin) disease, at its onset, with cold extremities and immediate vomiting upon eating, this indicates cold-fluid above the diaphragm; emesis is also contraindicated here. In Taiyang (Greater Yang) disease, emesis is contraindicated; inducing vomiting leads to inability to eat and internal irritability. Although some argue that emesis contains dispersing properties, failing to eliminate the pathogen constitutes a minor deviation. These are cases of inappropriate emesis.
Conversely, there are cases where emesis is indicated but contraindicated. Why? When using emesis, one must assess the deficiency or excess of the disease. When selecting patients for emesis, one must first consider their temperament to avoid error. Even if the disease is in the Upper Jiao and suitable for emesis, if the patient's condition is critical, or they are elderly and weak with depleted Qi, or constitutionally deficient with a faint pulse, or have just given birth, or suffer from spontaneous continuous vomiting, or are among those who have lost blood, or have "moving Qi" (ascending rebellious Qi), or present with cold extremities and spontaneous cold sweat, emesis is strictly forbidden. Inducing vomiting in these cases results in adverse reactions; this is prohibition due to deficiency. For patients with chronic illness and deep-seated accumulation, a single course of emesis may cause Heart Fire to descend while Ministerial Fire rises. If sexual activity or fatigue occurs subsequently, deficiency syndromes may develop, becoming difficult to treat. Such patients must abstain from anger, concentrate their spirit, regulate breathing, and rest quietly. They should not go outdoors for thirty days to follow proper protocol. If a patient has a fierce temper, loves anger and lust, and ignores taboos, what assurance can there be against danger? This is prohibition due to temperament. These are the "indicated but contraindicated" cases.
Yet, there are situations where emesis is technically contraindicated but absolutely necessary. For example, if a patient has a slippery and large pulse, with phlegm retention in the chest and food stagnation in the stomach, which cannot be removed without emesis, one may use Geng Ti San (Melon Seed Powder) with orange peel and light salt water. For phlegm, Er Chen Tang (Two-Aged Decoction) may be used, combined with finger-induced gagging. For extremely deficient constitutions, decoction of Platycodon Root (Jie Geng) may substitute for emetic agents, which is safer. I have further methods: I once treated a case of cold-phlegm obstruction causing syncope and cold limbs by decocting Pinellia Tuber (Ban Xia) and Exocarpium Citri Reticulatae (Ju Hong), each 8 qian, concentrated to half a cup, mixed with ginger juice to make one cup, administered frequently. As phlegm was expelled with the medicine, it was wiped away; the cycle of administering and vomiting continued until, after a short while, the phlegm cleared, the medicine descended, and the patient regained consciousness. There were many such cases. I once treated a case of wind-pathogen affecting the Zang organs approaching collapse, characterized by open-mouthed rattling respiration like sawing wood and involuntary urination/defecation. Emesis was too taxing, and medicines like Xi Xian San (Thin Saliva Powder) or Sichuan Bulb Fritillary (Zao Jiao) were unavailable or impractical. Instead, I used a large dose of Ginseng Radix et Rhizoma (Ren Shen), Aconite Lateralis Radix Praeparata (Fu Zi), Zingiberis Rhizoma (Sheng Jiang), and Pinellia Tuber (Ban Xia), decocted strongly and administered. Medicine came out with phlegm, which was wiped away; administration and vomiting continued cyclically. Eventually, the medicinal force reached the stomach, the chest and diaphragm became unobstructed, and large doses of Ginseng and Aconite could be tolerated, reaching several taels immediately. The patient gradually recovered, consuming several jin of Ginseng within a month until fully restored. There were many such cases. I also treated wind-phlegm-heat obstruction using Niuhuang Wan (Calculus Bovis Pill); neck carbuncle invading inward where medicine could not enter, using Suhe Xiang Wan (Styrax Pill); aphasia due to wind-heat, using Jieyu Dan (Unblocking Speech Powder); heatstroke coma, using Xiaoshu Wan (Summerheat Relief Pill); sudden evil invasion coma, using the aforementioned orange peel, Pinellia, and ginger juice mixture; nightmare coma, using Lotus Stamen (Lian Xu) and Scallion White (Cong Bai) decocted in wine; and hanging/coma, using Cinnamon Bark (Rou Gui) 3 qian decocted in water. All were administered via the same frequent-gavage-and-vomit method, resulting in complete recovery. There were many such cases. Furthermore, for trismus (lockjaw) and complete obstruction, Chubi San (Nose-Snuffing Powder) was blown into the nose to induce sneezing. Sneezing opened the jaw, allowing phlegm or food to be expelled, and the patient revived. Such cases were particularly numerous. This approach—medicating according to syndrome and inducing emesis through medication—represents a deeper meaning of "emesis without active vomiting." These are established ancient methods, slightly modified by me.
Previously, Zhang Zhongjing treated chest pain with inability to eat, where pressing elicited salivation, accompanied by diarrhea dozens of times daily; he used emesis to stop the diarrhea by expelling phlegm. Zhu Danxi treated pregnant women with retroverted bladder (Zhuan Pao) and urinary retention by administering Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) followed by induced vomiting, often with success, thereby using emesis to promote urination. Hua Tuo used vinegar and garlic to expel snakes; Liu Wansu used dog oil and Realgar (Xiong Huang) with Melon Seeds (Gua Di) to expel parasites and unblock the diaphragm; Zhu Danxi used leek juice to remove blood stasis for similar conditions. From this, we see that in critical and doubtful situations, ancients frequently employed emetics to achieve miraculous and unfathomable effects, let alone in obvious cases! Yet modern physicians often relegate this method to obscurity, acting as if no emetic method exists beyond sweating and purging. Consequently, patients often experience spontaneous vomiting, which becomes a favorable sign, but observers are startled, and doctors, regardless of deficiency or excess, hastily suppress it, turning favorable signs into disastrous complications, harming many people. Alas, how can one not revere this method?