。酸而平者，有铜绿。甘酸而平者，有赤小豆。凡此三十六味，惟常山、胆矾、瓜蒂有小毒
，藜芦、芫花、轻粉、乌附尖有大毒，外二十六味，皆吐药之无毒者。各对证用之，宜先小
服，不吐，积渐加之。
病势剧危，老弱气衰者，不可吐。吐不止，则亡阳。血虚者，不可吐。诸吐血、呕血、
咯血、衄血、嗽血、崩血、失血者，皆不可吐。病患无正性，妄言妄从者，不可吐。主病者
不辨邪正之说，不可吐。性行刚暴，好怒喜淫之人，不可吐。
〔海〕脉尺中按之有力，当吐之。若尺中按之无力，不可吐也。有力则阳气下陷于阴中，
为阴中所遏，故吐之使阳气得上升也。
〔垣〕脾胃虚不可妄用吐药论 六元正纪论曰∶木郁则达之者，盖木性当动荡轩举，是其
本体，今乃郁于地中，无所施为，即是风失其性，人身有木郁之证者，当开通之，乃可用吐
法以助风木，是木郁则达之之义也。又说木郁达之者，盖谓木初失其性，郁于地中，今既开
发行于天上，是发而不郁也，是木复其性而有余也。有余则兼其所胜，脾土受邪，见之于木
郁达之条下，不止此一验也。又厥阴司天，风木旺也。厥阴之胜，亦风木旺也。俱是脾胃受
邪，见于上条，其说一同。或者不悟木郁达之四字之义，反作木郁治之，重实其实，脾胃又
受木制，又复其木，正谓补有余而损不足也。既脾胃之气先已不足，岂不因此而重绝乎。明
胸中窒塞当吐。气口三倍大于人迎，是食伤太阴，上部有脉，下部无脉，其人当吐，不吐则
死。以其下部无脉，知其木郁在下也，塞道不行，而肝气下绝矣。兼肺金主塞而不降，为物
所隔，金能克木，肝木受邪，食塞胸咽，故曰在上者因而越之。仲景曰∶实烦，以瓜蒂散吐
之。如经汗下，谓之虚烦，又名懊 ，烦躁不能眠，知其木郁也，以栀子豉汤吐之。昧
者不知，膈咽不通，上支两胁，腹胀胃虚不足，乃浊气在上，则生 胀之病，猛浪吐之
。况胃虚必怒，风木已来乘凌胃气，《内经》以铁烙镇坠之，岂可反吐助其风木之邪，不宜
吐而吐，其差舛如天地之悬隔。唯窒塞烦闷者，宜吐之耳，治下实，大承气汤，在前表里条。
酸味而性平的药材，有铜绿。甘酸而性平的药材，有赤小豆。以上这三十六味药中，只有常山、胆矾、瓜蒂具有小毒，藜芦、芫花、轻粉、乌附尖（乌头尖端）具有大毒，其余二十六味都是无毒的催吐药。应当根据具体证候选用这些药物，使用时宜先少量服用，若不引起呕吐，再逐渐增加剂量。
病势剧烈危急者，年老体弱、正气衰微者，不可使用催吐法。若呕吐不止，会导致亡阳（阳气脱失）。血虚者，不可使用催吐法。凡是吐血、呕血、咯血、鼻衄（鼻出血）、嗽血（咳血）、崩漏下血、各种失血病症的患者，都不可使用催吐法。患者神志不清、胡言乱语、行为妄动者，不可使用催吐法。主治医生不能辨别邪正虚实之说者，不可使用催吐法。性格刚烈暴躁、易怒且喜好淫欲的人，不可使用催吐法。
〔滑伯仁〕脉象尺部按之有力，应当使用催吐法。如果尺部按之无力，则不可使用催吐法。脉象有力说明阳气下陷于阴分之中，被阴邪所遏制，所以通过催吐使阳气得以升发上升。
〔李东垣〕脾胃虚弱不可妄用催吐药的论述：《素问·六元正纪大论》说：“木郁则达之”，大概是因为木的特性应当动荡高举，这是它的本体属性。现在木气郁结在地中（指人体下部或内部），无法施展作为，这就是风失去了其本性。人体出现木郁证候时，应当开通疏导，这时才可以使用催吐法来助长风木之气，这就是“木郁则达之”的含义。又说“木郁达之”，是指木气刚刚失去本性，郁结在体内，现在既然通过发散使其上行于外（上部），就是发散而不郁结，这是木气恢复了本性而显得有余。木气有余就会克制其所胜的脏腑，导致脾土受邪，这在“木郁达之”的条文下有记载，不仅仅是一个验证例子。另外，厥阴司天之时，风木之气旺盛。厥阴之胜，也是风木旺盛。这两种情况都是脾胃受到邪气侵害，见于上述条文，说法一致。有人不明白“木郁达之”这四个字的含义，反而当作“木郁治之”来处理，加重了实邪，使脾胃再次受到木气的克制，又补益了有余的木气，这正是所谓“补有余而损不足”。既然脾胃之气原本就已经不足，难道不会因此而导致更加衰竭吗？
明确胸中窒塞应当使用催吐法。寸口脉（气口）三倍大于人迎脉，这是饮食损伤太阴脾经所致；上部有脉，下部无脉，病人应当催吐，不催吐则会死亡。因为下部无脉，可知是木气郁结在下部，气道阻塞不通，肝气在下部断绝了。兼有肺金主司闭塞而不降，被实物阻隔，金能克木，肝木受到邪气侵害，食物堵塞胸咽，所以说“在上者因而越之”（位于上部的病邪，因势利导使其从上面排出）。张仲景说：实证烦闷，用瓜蒂散催吐。如果经过发汗或攻下治疗后，称为虚烦，又名懊憹（ào náo，心中烦乱不安），烦躁不能入睡，这是木气郁结的表现，用栀子豉汤催吐。愚昧的人不知道，膈膜咽喉不通，向上支撑两胁，腹胀且胃气虚弱不足，这是浊气停留在上部，从而产生胀满的病证，却鲁莽地使用催吐法。况且胃虚必然导致肝气愤怒，风木之气已经来乘袭凌犯胃气，《内经》主张用铁烙等重镇之物来压制它，怎么可以反而使用催吐法来助长风木的邪气呢？不宜催吐而催吐，这种错误就像天地一样悬殊隔绝。只有那些确实存在窒塞烦闷症状的，才适宜使用催吐法。治疗下焦实证，使用大承气汤，详见前文表里相关条目。
Sour and neutral in nature are *Tonglü* (Vitriol Green). Sweet, sour, and neutral in nature are *Chixiaodou* (Adzuki Bean). Among these thirty-six herbs, only *Changshan* (Dichroa Root), *Danfan* (Alum), and *Gua Di* (Melon Stalk) possess slight toxicity; *Lilu* (Veratrum Root), *Yuanhua* (Genkwa Flower), *Qingfen* (Calomel), and *Wufu Jian* (Aconite Tip) possess major toxicity. The remaining twenty-six herbs are non-toxic emetics. They should be selected according to the specific syndrome. Initially, a small dose should be administered; if vomiting does not occur, the dosage should be gradually increased.
Emesis is contraindicated in cases of severe and critical disease progression, in the elderly and weak with depleted vital energy (*Zheng Qi*), as prolonged vomiting may lead to *Wang Yang* (collapse of Yang Qi). Emesis is contraindicated in patients with blood deficiency. It is also contraindicated in patients presenting with hematemesis, hemoptysis, epistaxis, coughing up blood, metrorrhagia, or any form of hemorrhage. Emesis is contraindicated in patients who lack mental stability, exhibiting delirious speech and erratic behavior. It is contraindicated when the attending physician cannot distinguish between pathogenic factors and healthy Qi. Emesis is contraindicated in individuals with a rigid and violent temperament, prone to anger and licentiousness.
[Slip Bowu] If the pulse at the Chi position (cubital fossa/wrist) is forceful upon palpation, emesis should be employed. If the Chi pulse is feeble, emesis is contraindicated. A forceful pulse indicates that Yang Qi has sunk into the Yin aspect and is constrained by Yin pathogens; therefore, emesis is used to facilitate the ascending movement of Yang Qi.
[Li Dongyuan] Discussion on the improper use of emetics in Spleen-Stomach deficiency: The *Suwen: Liuyuan Zhengji Dalun* states, "When Wood is depressed, it should be dispersed." This implies that the intrinsic nature of Wood is dynamic and uplifting. When Wood Qi is depressed within the body (analogous to being buried in the earth) and unable to function, it signifies a loss of its Wind nature. In cases of Wood depression in the human body, unblocking and dredging methods should be applied; thus, emesis can be used to assist the Wind-Wood Qi, which embodies the meaning of "Wood depression, disperse it." Furthermore, "disperse" here means that when Wood initially loses its nature and becomes depressed internally, using emesis to induce upward expulsion allows it to rise without stagnation, thereby restoring its nature with surplus energy. This surplus may then overact upon its controlling element, causing pathology in Spleen Earth, as documented under the section on "Wood depression, disperse it," serving as more than just a single verification. Additionally, during periods governed by Jueyin, Wind-Wood Qi is prosperous. Similarly, "Jueyin victory" also indicates prosperous Wind-Wood. Both scenarios result in pathological invasion of the Spleen-Stomach, consistent with the previous discussion. Those who fail to comprehend the meaning of "Wood depression, disperse it" might mistakenly treat it as "treating Wood depression," thereby reinforcing excess and subjecting the Spleen-Stomach further to Wood constraint, effectively tonifying the excess and damaging the deficient. Since Spleen-Stomach Qi is already insufficient, would this not lead to further exhaustion?
Clear indications for emesis include chest oppression and blockage. If the Qi Kou (radial artery at the wrist) pulse is three times larger than the Ying Shou (carotid artery) pulse, it indicates dietary injury to the Taiyin Spleen. If there is a pulse in the upper positions but none in the lower positions, the patient requires emesis; failure to do so may result in death. The absence of a lower pulse indicates Wood depression in the lower jiao, obstruction of the pathways, and severance of Liver Qi. Accompanied by Lung Metal's tendency to obstruct and fail to descend due to physical blockage, Metal overacts on Wood, causing Liver Wood pathology. Food impaction in the chest and throat illustrates the principle: "Those located above should be expelled upwards." Zhang Zhongjing stated: For excessive heat causing vexation, use *Gua Di San* (Melon Stalk Powder) to induce emesis. If vexation persists after sweating or purgation, it is termed "deficiency vexation" or *Ao Nao* (profound restlessness), characterized by irritability and insomnia, indicating Wood depression; *Zhi Zi Chi Tang* (Gardenia and Fermented Soybean Decoction) should be used to induce emesis. Ignorant practitioners fail to recognize that when the diaphragm and throat are blocked, pain radiates to both hypochondria, abdominal distension occurs, and the Stomach is deficient, this constitutes turbid Qi stagnating in the upper jiao, leading to distension diseases. Indiscriminate use of emesis in such cases is erroneous. Moreover, Stomach deficiency often leads to Liver anger, where Wind-Wood invades the Stomach Qi. The *Neijing* advocates using heavy, sedative measures (like iron weights) to suppress this; how can one instead use emesis to aid the Wind-Wood pathogen? Using emesis when it is contraindicated creates an error as vast as the separation between heaven and earth. Only cases of genuine obstruction and vexation are suitable for emesis. For excess conditions in the lower jiao, *Da Cheng Qi Tang* (Major Order the Qi Decoction) is indicated, as detailed in the preceding sections on exterior-interior relationships.