论痰块壅塞
天师曰∶吐治者，病在胃口之间不能下，则必上越而吐之。如人上焦壅滞痰块，不上不下，塞在
胸间，气喘，欲呕不能，欲吐不肯者是也。法当用阴阳水探吐之，或用瓜蒂、藜芦煎汁，饮之即吐。然
必痰气与火结在胸间作痛者，始可用此法吐之，否则断断不可。盖人之元气，不可一伤，吐一次，则五脏
反复，必损寿元。故必问其人胸痛否，气塞否，喉间有所碍否，痰吐出黄否，有此数种，始可用前药
以吐之。苟或不尽然，即病患自家欲吐，亦须慎之，况行医者乎。此吐治之一法，在人裁度而用之耳。
张公曰∶吐不可轻用，不知禁忌而妄吐之，必致五脏反复不宁，天师之叮咛告诫，真仁人之言也，
汝当敬听。我更有一法教人。宜吐之症，必须看其痰，吐在壁上，有光亮者，放心吐之，余则皆忌。光亮
者，如蜗牛之涎一样光亮也。但看见光亮者，无论其痰在上中下，此光亮之色，必须俟其痰迹干而分辨
之，不可据其湿痰时，而即以为光亮也。
华君曰∶同。
天师曰∶泄治者，汗之也。邪居于腠理之间，不肯自出。必用汗药以疏泄之。方用荆芥一钱，桔
梗一钱，防风一钱，甘草一钱，苏叶一钱，白术五钱，茯苓三钱，陈皮五分，水煎服。此方妙在用白术
为君，而以表汗为佐使。盖人之脾气健，而皮毛腠理始得开合自如，今用白术以健土去湿而利腰脐，邪
已难于久住，况有防风、荆芥、苏叶之品，尽散外邪，何敢再居营卫，又有甘草从中调治，则邪不必攻
而自散矣。此泄治之佳者。
张公曰∶予方泄治最多，无如此方之妙。我方一味主散，天师方妙在健脾而散邪也。此方倘治冬月
之泄汗，或加入桂枝五分乎，或加入麻黄五分乎，亦在人斟酌之耳。
华君曰∶同。
（泄治方用白术，与苏合丸用白术同意，其法甚妙。李子永识。）
陈士铎（号天师）说：吐法，是指病邪位于胃脘部，无法下行，就必须使其向上涌出而呕吐。例如，上焦气机壅滞，有痰块阻滞，不上不下，堵塞在胸膈之间，导致气喘，想呕却呕不出来，想吐又吐不出的情况，就属于此类。治疗应当使用阴阳水（生熟水混合之水）探引催吐，或者用瓜蒂、藜芦煎煮汁液，服用后随即引发呕吐。但是，只有当痰气与火邪结聚在胸间并引起疼痛时，才可以采用这种吐法，否则绝对不可使用。因为人的元气一旦受损便难以恢复，每呕吐一次，五脏的气机就会反复动荡，必然损害寿命和根本元气。所以，必须询问患者是否有胸痛、气塞、喉间异物感、吐出之痰是否为黄色等症状，具备这些指征之一，才可以使用前面的药物进行催吐。如果症状不完全符合，即使患者自己感觉想吐，也必须谨慎对待，何况是行医之人呢？这是吐法的一种应用，关键在于医者根据具体情况裁量使用。
张隐庵（号张公）说：吐法不可轻易使用，如果不了解禁忌症而妄加使用，必然导致五脏气机紊乱不安，天师的谆谆告诫，真是仁德之人的忠言啊，你应当恭敬地听取。我还有另一种方法教给你。适合使用吐法的病症，必须观察其痰液，如果痰液吐在墙壁上，具有光亮色泽的，可以放心使用吐法，其余情况都需忌用。所谓光亮，就像蜗牛爬过留下的涎液一样光亮。但是，看到有光亮特征的，无论痰在上焦、中焦还是下焦，必须等待痰迹干燥后才能分辨其颜色，不能在痰液湿润时就误认为它是光亮的。
华岫云（号华君）说：同意上述观点。
陈士铎（号天师）说：泄法，即通过发汗来驱邪的方法。邪气停留在腠理（皮肤肌肉之间的间隙）之间，不肯自行排出。必须使用发汗的药物来疏解宣泄。方剂组成如下：荆芥一钱，桔梗一钱，防风一钱，甘草一钱，紫苏叶一钱，白术五钱，茯苓三钱，陈皮五分，加水煎服。这个方剂的妙处在于以白术为君药，而以发汗解表的药物为佐使药。因为人的脾气健运，皮毛和腠理才能开合自如。现在使用白术来健脾燥湿，疏通腰脐部位的气机，邪气已经难以久留，况且还有防风、荆芥、紫苏叶等药物，能够全面疏散外邪，邪气怎敢继续盘踞在营卫之间？再加上甘草在中间调和诸药，那么邪气不必强行攻伐就能自然消散。这是泄法中较好的方剂。
张隐庵（号张公）说：我使用泄法治疗的方子很多，没有比这个方子更巧妙的。我的方子通常只用一味主药来发散，而天师的方子妙在健脾的同时疏散邪气。此方如果用于治疗冬季的泄汗证，可以加入桂枝五分，或者加入麻黄五分，这也需要根据具体情况斟酌使用。
华岫云（号华君）说：同意上述观点。
Chen Shiduo (styled Tianshi) stated: The method of inducing vomiting is applied when the pathogenic factor is located in the epigastrium and cannot descend, necessitating its upward expulsion through vomiting. For instance, when there is stagnation in the upper jiao (Upper Burner) with phlegm masses obstructing the flow, neither ascending nor descending, blocking the chest and diaphragm, causing panting, a desire to vomit that fails to materialize, or a reluctance to expectorate, this constitutes such a case. The treatment should employ Yin-Yang water (a mixture of raw and boiled water) to probe and induce vomiting, or decoct seeds of melon (Gua Di) and veratrum (Li Lu), drinking the juice to immediately trigger emesis. However, this method is only applicable when phlegm-qi and fire pathogens are knotted in the chest causing pain; otherwise, it must strictly be avoided. Human primordial qi (Yuan Qi) is delicate and difficult to restore once injured; each episode of vomiting causes turbulence in the five zang organs, inevitably damaging longevity and vital essence. Therefore, one must inquire whether the patient experiences chest pain, qi obstruction, foreign body sensation in the throat, or if the expectorated phlegm is yellow. Only when these indications are present can the aforementioned emetic drugs be used. If the symptoms do not fully align, even if the patient feels an urge to vomit, caution must be exercised, especially by practitioners. This represents one application of the vomiting method, relying on the physician's discretion.
Zhang Yinzhan (styled Zhang Gong) stated: The vomiting method should not be used lightly. Ignoring contraindications and using it recklessly will inevitably cause unrest and disorder in the five zang organs. Tianshi’s earnest warnings are indeed the words of a benevolent person; you should heed them respectfully. I have another method to teach you. For conditions suitable for vomiting, observe the sputum: if it adheres to the wall with a glossy sheen, the vomiting method may be safely employed; all other cases are contraindicated. "Glossy" refers to a shine similar to the slime left by a snail. However, even if such glossiness is observed, regardless of whether the phlegm originates from the upper, middle, or lower jiao, one must wait for the sputum trace to dry before distinguishing its color. One must not mistake the wet appearance of fresh phlegm for glossiness.
Hua Xiuyun (styled Hua Jun) stated: I agree with the above views.
Chen Shiduo (styled Tianshi) stated: The method of "xie" (draining/venting) refers to sweating to expel pathogens. When pathogens reside in the cou-li (interstices between skin and muscle) and refuse to exit spontaneously, herbs that induce sweating must be used to disperse and vent them. The prescription consists of: Jing Jie (Schizonepetae Herba) 1 qian, Jie Geng (Platycodonis Radix) 1 qian, Fang Feng (Saposhnikoviae Radix) 1 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 qian, Zi Su Ye (Perillae Folium) 1 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 5 qian, Fu Ling (Poria) 3 qian, Chen Pi (Citri Reticulatae Pericarpium) 0.5 qian. Decoct in water and take orally. The brilliance of this formula lies in using Bai Zhu as the sovereign herb, while employing exterior-releasing herbs as minister and envoy. When the spleen qi is robust, the pores and cou-li can open and close freely. Here, Bai Zhu strengthens the spleen, dries dampness, and benefits the waist and umbilical region, making it difficult for pathogens to remain. Furthermore, Fang Feng, Jing Jie, and Zi Su Ye thoroughly scatter external pathogens, preventing them from lingering in the Ying (Nutritive) and Wei (Defensive) levels. With Gan Cao harmonizing the middle, the pathogens dissipate naturally without forceful attack. This is an excellent example of the draining method.
Zhang Yinzhan (styled Zhang Gong) stated: I have used many formulas for the draining method, none more exquisite than this one. My formulas typically rely on a single sovereign herb for dispersion, whereas Tianshi’s formula excels in strengthening the spleen while dispersing pathogens. If treating winter sweating syndromes with this formula, one might consider adding Gui Zhi (Cinnamomi Ramulus) 0.5 qian or Ma Huang (Ephedrae Herba) 0.5 qian, depending on clinical judgment.
Hua Xiuyun (styled Hua Jun) stated: I agree with the above views.
(Note: The use of Bai Zhu in the draining formula shares the same principle as its use in Su He Wan (Styrax Pill); the method is highly ingenious. Recorded by Li Ziyong.)