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（赵本作“便”）止，不必尽剂也。
要在适当，不欲过也。
按∶赵本此处有∶“病如桂枝证，头不痛，项不强，寸脉微浮，胸中痞硬，
气上撞咽喉，不得息者，此为有寒，当吐之。”注∶“一云∶此以内有久痰，宜吐之。”一条。
病胸上诸实，（赵本注∶“一作寒”）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。
按∶赵本此处有∶“少阴病，饮食入口则吐，心中温温，欲吐复不能吐者，宜吐之。”一条。
宿食，在上脘（赵本作“管”）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，（赵本作“病手足逆冷”）脉乍结，以客气在胸中；心下满而烦，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。
综合上述四种证候，已在《太阳病篇》中详细论述。
治疗原则是：春季适宜使用吐法。
因为春季阳气上升于体表，邪气也停留在上部，所以适宜用吐法。
凡是使用催吐的汤药，一旦病情好转（中病）就应停止，不需要把药全部喝完。
关键在于掌握适当的时机，不希望过度治疗。
按语：赵本在此处有一条记载：“症状类似桂枝汤证，但头部不痛，项部不强硬，寸脉微微浮起，胸中痞塞坚硬，气向上冲撞咽喉，呼吸不畅的，这是体内有寒，应当用吐法。”注释说：“另一种说法认为：这是因为体内有久积的痰饮，适宜用吐法。”
凡是胸膈部位的各种实证（赵本注：一作寒），患者胸中郁闷疼痛，不能进食，想要让人按压胸部，反而吐出涎沫和唾液的，虽然每天腹泻十多次，但脉象反而迟缓，寸口脉微滑，这种情况可以用吐法。用了吐法后，腹泻就会停止。
所谓胸膈部位的实证，可能是痰实、热郁结，或者是寒邪结聚在胸中，导致郁滞而疼痛，不能进食，想要让人按压，反而出现涎唾。如果病邪在下焦，按压时气机下行且没有涎唾；现在按压反而有涎唾，这说明病邪在胸中。经典说：“腹泻脉象迟而滑的，是内有实邪。”如今腹泻一天十多次，脉象反而迟，寸口脉微滑，这是上焦实证，所以可以用吐法。《玉函经》说：“上焦盛实不止，应用吐法以祛除邪气。”
按语：赵本在此处还有一条记载：“少阴病，饮食入口即吐，心中泛泛不适，想吐又吐不出来的，适宜用吐法。”
宿食停滞在上脘（赵本作“管”）的，应当用吐法。
宿食在中下脘的，则适宜用泻下法；宿食在上脘的，则应当用吐法。《内经》说：“病位在高处的，顺势使其从上而出（越之）；病位在低处的，引导其从下排出（竭之）。”
患者手足厥冷（赵本作“病手足逆冷”，指四肢寒冷至肘膝），脉象突然涩滞不畅，是因为客气（外邪或病理产物）停留在胸中；胃脘部胀满且烦躁，想吃东西却吃不下，病位在胸中，应当用吐法。
这与第六卷厥阴门瓜蒂散证的条文相同。彼处说脉象突然紧束，此处说脉象突然涩滞，仅此不同。紧脉主内实，突然紧说明实邪未深，病在胸中；结脉主结实，突然结说明结聚未深，病也在胸中。所以证候和治疗方法是相同的。
The four syndromes mentioned above have already been fully discussed in the *Taiyang Chapter*.
The general principle is that vomiting therapy is suitable in spring.
During spring, yang qi ascends to the upper part of the body, and pathogenic factors also reside in the upper part; therefore, vomiting is appropriate.
When using a decoction for vomiting, stop as soon as the condition improves (zhong bing); there is no need to consume the entire dose.
The key lies in appropriateness, avoiding excessive treatment.
Note: Zhao's edition includes the following passage here: "If the symptoms resemble those of the Guizhi Tang syndrome, but the head does not hurt, the neck is not stiff, the cun pulse is slightly floating, the chest feels obstructed and hard, qi rushes up to strike the throat, and breathing is difficult, this indicates cold in the interior, and vomiting should be induced." The annotation states: "Another version says: This is due to long-standing phlegm in the interior, and vomiting is appropriate."
For various excess conditions in the chest/epigastrium (Zhao's edition notes: one version reads 'cold'), if the patient experiences depression and pain in the chest, cannot eat, desires someone to press on the area, yet instead produces saliva and sputum, and suffers from diarrhea more than ten times a day, while the pulse is surprisingly slow and the cun position pulse is slightly slippery, vomiting may be indicated. After vomiting, the diarrhea will cease.
"Various excess conditions in the chest" refer to either phlegm-excess, heat-stagnation, or cold-binding in the chest, causing stagnation and pain, inability to eat, and a desire for pressure, which paradoxically induces saliva and sputum. If the pathogen were in the lower jiao, pressing would cause qi to descend without producing saliva/sputum. Since pressing here induces saliva/sputum, it confirms the pathogen is in the chest. The Classics state: "In cases of diarrhea with a slow and slippery pulse, there is internal excess." Now, with diarrhea occurring more than ten times a day, a surprisingly slow pulse, and a slightly slippery cun pulse, this indicates upper excess; thus, vomiting is appropriate. The *Yu Han Jing* states: "If upper excess persists, use vomiting to drain it."
Note: Zhao's edition also includes the following passage here: "In Shaoyin disease, if food intake immediately causes vomiting, the heart feels uncomfortable, and there is an urge to vomit but inability to do so, vomiting is appropriate."
For retained food in the upper jiao (Zhao's edition reads 'guan'), vomiting is indicated.
For retained food in the middle or lower jiao, purgation is appropriate; for retained food in the upper jiao, vomiting is indicated. The *Nei Jing* states: "Where the pathology is high, induce evacuation from above (yue zhi); where it is low, guide it out from below (jie zhi)."
If a patient presents with cold limbs (Zhao's edition reads "bing shou ni leng", meaning coldness extending to elbows and knees), a suddenly knotted pulse, due to alien qi residing in the chest; epigastric fullness and irritability, desire to eat but inability to do so, the pathology is in the chest, and vomiting is indicated.
This corresponds to the Genti San syndrome described in Volume 6, Jueyin Chapter. That text mentions a suddenly tight pulse, whereas this text mentions a suddenly knotted pulse; this is the only difference. A tight pulse indicates internal excess; a sudden tightness suggests the excess is not deep, indicating the pathogen is in the chest. A knotted pulse indicates solidification; a sudden knotting suggests the solidification is not deep, also indicating the pathogen is in the chest. Therefore, the syndromes and treatments are identical.