大法∶春宜吐。
【注】汗、吐、下，治病之大法。谓春宜于吐者，是象天之春气上升以立法也。然凡病有当吐者则吐之，
又不可一概而论也。
【集注】程应旄曰∶吐法从升，有发陈之义，故曰∶春宜吐。
凡用吐汤，中病便止，不必尽剂也。
【注】凡用吐汤，原以去上焦之邪，中病即止，若病去而过用之，反伤中气，所以不必尽剂也。
【集注】程应旄曰∶吐以去上焦之邪。上焦为清阳之分，吐之过剂则邪去，而所伤者膻中之阳，阳固不可
不宝惜也。
病胸上诸实，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，寸口脉惟滑，
此可吐之。吐之利则止。
【注】胸上诸实，谓或痰、或热、或寒之类也。诸实为病，故胸中郁郁而痛，不能食也。欲使人按之，不
但痛不能减，而反有涎唾，知邪在胸中盛满，得按而上溢也。经曰∶下利脉迟而滑者，内实也。今下利日十余
行，其脉反迟，寸口惟滑，知寒实在上，水不下输膀胱而走大肠也，故但吐之利自止也。
【集注】张璐曰∶痛不得食，按之反有涎唾者，知有寒痰在胸中也。下利脉迟，寸口
惟滑者，为膈上实，故吐之则利自止也。
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。
【注】病患手足厥冷，脉乍结者，以寒邪结气，结在胸中，阳气不能四达也。心下满而烦者，实结则满，
阳郁则烦也。欲食不能食者，是客气病在胸中，故当吐之也。
【集注】成无己曰∶此与瓜蒂散证同。彼云脉乍紧，此云脉乍结，惟此有异。紧为内实，乍紧则邪在胸
中，实而未深也。结为结实，乍结则邪在胸中，结而未深也。虽所治俱同，但轻之、重之不无别也。
程知曰∶脉来缓，时一止复来，曰结。结者，痰气结滞之名。此与瓜蒂散证同。但彼云脉乍紧则为寒邪
盛，此云脉乍结则为痰气实也。正张锡驹曰∶病患手足厥冷者，气机内结，不能外达于四肢也。心下满而烦者，
邪实则满，正伤则烦也。
魏荔彤曰∶脉乍结，非脉之本然，乃有形之邪，阻碍其胸中宗气，故荣卫之气不能畅行，非同于气血虚
微，不能流布之结也。
宿食在上脘者，当吐之。
【注】胃有三脘，宿食在上脘者，痛在胸膈，痛则欲吐，可吐不可下也。在中脘者，痛在心口，痛欲吐
或不吐，可吐可下也。在下脘者，痛在脐上，痛不欲吐，不可吐可下也。故曰∶宿食在上脘者，当吐之。此详
凡在上者，皆可吐也。
【集注】成无己曰∶宿食在中下脘，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。
方有执曰∶上脘，谓胃腑之口也。
张志聪曰∶胃为水谷之海，有上脘、中脘、下脘之分。上主纳，中主化，今食在上脘，不得腐化，故为
宿食，当吐之。
程应旄曰∶宗气聚于胸中，升降呼吸出焉。清阳之分，岂容浊物留滞，吐以宣之，使无障碍也。若属表
邪传入无形而有形，则痞满结胸，另有治法，均非宜矣。
基本原则：春季适宜使用吐法。
【注释】汗法、吐法、下法，是治疗的三大基本原则。说春季适宜用吐法，是取法于春天天气上升的道理来确立治则。然而，凡是疾病应当用吐法的才使用吐法，不能一概而论。
【集注】程应旄说：吐法顺应上升之势，有推陈出新的含义，所以说：春季适宜用吐法。
凡是使用催吐的汤药，达到治疗效果就停止，不必服完全部药量。
【注释】凡是使用催吐的汤药，原本是为了去除上焦的邪气，达到治疗效果就停止，如果病邪已去而过度使用，反而会损伤中气，所以不必服完全部药量。
【集注】程应旄说：吐法是为了去除上焦的邪气。上焦是清阳分布的部位，吐法用药过量则邪气虽去，但会伤害膻中的阳气，阳气本来就不可以不爱惜。
病人胸部以上有各种实邪，胸中郁闷疼痛，不能进食，想要让人按压，反而流出涎唾，腹泻一天十多次，脉象反而迟缓，寸口脉仅见滑象，这是可以使用吐法的。吐后腹泻就会停止。
【注释】胸部以上的各种实邪，指的是痰、热、寒之类的邪气。各种实邪致病，所以胸中郁闷疼痛，不能进食。想要让人按压，不仅疼痛不减，反而流出涎唾，可知邪气在胸中盛满，受到按压而上溢。经书说：腹泻脉迟而滑的，是内有实邪。现在腹泻一天十多次，脉象反而迟缓，寸口脉仅见滑象，可知寒实邪气在上部，水液不能向下输注膀胱而流入大肠，所以只用吐法，腹泻自然停止。
【集注】张璐说：疼痛不能进食，按压反而流出涎唾的，可知有寒痰在胸中。腹泻脉迟，寸口脉仅见滑象的，为膈上有实邪，所以用吐法腹泻自然停止。
病人手足逆冷，脉象突然结滞，因为客气（外邪）停留在胸中，心下部胀满且烦躁，想吃东西却吃不下，病位在胸中，应当使用吐法。
【注释】病人手足厥冷，脉象突然结滞的，是因为寒邪结聚气机，结在胸中，阳气不能通达四肢。心下部胀满且烦躁的，实邪结聚则胀满，阳气郁结则烦躁。想吃东西却吃不下的，是客气病邪在胸中，所以应当使用吐法。
【集注】成无己说：这与瓜蒂散证的病证相同。瓜蒂散证说脉象突然紧，这里说脉象突然结滞，只有这一点不同。紧脉代表内有实邪，突然紧表示邪气在胸中，实而未深。结脉代表结实，突然结滞表示邪气在胸中，结而未深。虽然治疗方剂相同，但轻症与重症还是有所区别的。
程知说：脉来缓慢，偶尔停顿一下再跳动，称为结脉。结脉是痰气结滞的名称。这与瓜蒂散证相同。但瓜蒂散证说脉象突然紧则是寒邪盛，这里说脉象突然结滞则是痰气实。
正张锡驹说：病人手足厥冷的，是气机内部结滞，不能向外通达于四肢。心下部胀满且烦躁的，邪气实则胀满，正气受损则烦躁。
魏荔彤说：脉象突然结滞，不是脉象的本然状态，而是有形之邪阻碍了胸中的宗气，所以营卫之气不能畅行，不同于气血虚微导致不能流布的结滞。
宿食停留在上脘的，应当使用吐法。
【注释】胃分为上脘、中脘、下脘三部分，宿食停留在上脘的，疼痛部位在胸膈，疼痛则想吐，可以用吐法，不可以用下法。宿食在中脘的，疼痛部位在心口，疼痛时想吐或不想吐，可以用吐法也可以用下法。宿食在下脘的，疼痛部位在脐上，疼痛时不想吐，不可以用吐法，可以用下法。所以说：宿食停留在上脘的，应当使用吐法。这详细说明了凡是病邪在上部的，都可以使用吐法。
【集注】成无己说：宿食在中脘和下脘，则适宜用下法；宿食在上脘，则应当用吐法。《内经》说：病位高的，因而使其向上涌越；病位低的，引导其向下竭尽。
方有执说：上脘，是指胃腑的口部。
张志聪说：胃是水谷汇聚的海，分为上脘、中脘、下脘。上脘主受纳，中脘主消化，现在食物停留在上脘，不能腐熟消化，所以称为宿食，应当使用吐法。
程应旄说：宗气聚集在胸中，升降呼吸由此产生。清阳分布的部位，岂能容许浊物留滞，用吐法宣通，使没有障碍。如果属于表邪传入，由无形变为有形，形成痞满或结胸，则有另外的治疗方法，都不适宜用吐法了。
General Principle: In spring, the emetic method is appropriate.
[Annotation] Sweating (Han), vomiting (Tu), and purging (Xia) are the three major principles of treatment. The statement that vomiting is appropriate in spring establishes the therapeutic principle by analogy with the ascending nature of spring Qi in heaven. However, vomiting should only be employed when indicated by the disease; it cannot be applied indiscriminately.
[Collected Annotations] Cheng Yingmao stated: The emetic method follows the principle of ascending, possessing the meaning of discarding the old to bring forth the new; therefore, it is said that vomiting is appropriate in spring.
When using an emetic decoction, stop administering once the desired effect is achieved; there is no need to consume the entire dose.
[Annotation] Emetic decoctions are originally intended to eliminate pathogenic factors from the Upper Jiao (Upper Burner). Once the treatment hits the mark (Zhong Bing), administration should cease. If overused after the pathogen has been expelled, it will damage Middle Qi (Spleen/Stomach Qi); thus, it is unnecessary to finish the full dosage.
[Collected Annotations] Cheng Yingmao stated: The emetic method eliminates pathogenic factors from the Upper Jiao. The Upper Jiao is the domain of Clear Yang. Overuse of emetics expels the pathogen but damages the Yang Qi of Danzhong (Pericardium/Center of Chest). Yang Qi must certainly be cherished.
When a patient presents with various excess conditions above the chest, feeling stifled and painful in the chest, inability to eat, desiring someone to press upon the area, yet producing excessive saliva/phlegm, accompanied by diarrhea occurring more than ten times a day, with a pulse that is surprisingly slow (Chi), while the Cun Kou (Radial artery at the wrist) pulse is merely slippery (Hua), this condition is suitable for emesis. Vomiting will cause the diarrhea to cease.
[Annotation] "Various excess conditions above the chest" refers to pathogens such as phlegm, heat, or cold. These excess pathogens cause illness, resulting in stifling pain in the chest and inability to eat. The desire for pressure relief, which instead induces salivation/phlegm, indicates that pathogens are abundant and full in the chest, overflowing upward upon pressure. The Classics state: "Diarrhea with a slow and slippery pulse indicates internal excess." Now, with diarrhea occurring more than ten times daily, a surprisingly slow pulse, and a Cun Kou pulse that is merely slippery, it is known that cold-excess pathogens reside in the upper part, causing fluids to fail to transport downward to the Bladder and instead flow into the Large Intestine. Therefore, employing only emesis will naturally stop the diarrhea.
[Collected Annotations] Zhang Lu stated: Pain preventing eating, and producing saliva/phlegm upon pressure, indicates cold-phlegm in the chest. Diarrhea with a slow pulse and a Cun Kou pulse that is merely slippery indicates excess above the diaphragm; thus, emesis will naturally stop the diarrhea.
When a patient presents with cold extremities (Ni Leng), a pulse that suddenly becomes knotted (Jie), due to rebellious Qi (Ke Qi/Exogenous pathogens) lodged in the chest, epigastric fullness accompanied by vexation, and a desire to eat but inability to do so, the disease is located in the chest and should be treated with emesis.
[Annotation] Cold extremities and a suddenly knotted pulse occur because cold pathogens bind Qi, lodging in the chest and preventing Yang Qi from reaching the four limbs. Epigastric fullness and vexation arise because excess binding causes fullness, and constrained Yang causes vexation. The desire to eat but inability to do so indicates that rebellious pathogenic Qi is in the chest; therefore, emesis should be employed.
[Collected Annotations] Cheng Wuji stated: This corresponds to the syndrome of Gengti San (Melon Stalk Powder). That text mentions a suddenly tight (Jin) pulse, whereas this mentions a suddenly knotted pulse; this is the only difference. A tight pulse indicates internal excess; a sudden tightness means the pathogen is in the chest, excess but not deep. A knotted pulse indicates solidity; a sudden knotting means the pathogen is in the chest, bound but not deep. Although the treatment is the same, there is a distinction between mild and severe cases.
Cheng Zhi stated: A pulse that comes slowly and occasionally stops before resuming is called a knotted pulse. "Jie" refers to the stagnation of phlegm and Qi. This corresponds to the Gengti San syndrome. However, a sudden tight pulse indicates abundant cold pathogens, whereas a sudden knotted pulse indicates solid phlegm-Qi.
Zheng Zhang Xiju stated: Cold extremities indicate internal binding of Qi mechanism, preventing its outward reach to the four limbs. Epigastric fullness and vexation occur because excess pathogens cause fullness, and damage to righteous Qi causes vexation.
Wei Litong stated: A suddenly knotted pulse is not the natural state of the pulse but rather caused by tangible pathogens obstructing the Zong Qi (Gathering Qi) in the chest, preventing the smooth circulation of Ying and Wei (Nutritive and Defensive) Qi. This differs from knotting caused by deficiency of Qi and Blood preventing distribution.
When retained food resides in the Upper Wan (Upper Stomach), it should be treated with emesis.
[Annotation] The stomach is divided into Upper, Middle, and Lower Wan. When retained food is in the Upper Wan, pain occurs in the chest and diaphragm; pain induces the urge to vomit, making emesis appropriate and purgation inappropriate. When retained food is in the Middle Wan, pain occurs at the heart's opening; the urge to vomit may or may not be present, making both emesis and purgation potentially appropriate. When retained food is in the Lower Wan, pain occurs above the umbilicus; there is no urge to vomit, making emesis inappropriate and purgation appropriate. Thus, it is said: When retained food resides in the Upper Wan, emesis should be used. This elaborates that any pathology located superiorly can be treated with emesis.
[Collected Annotations] Cheng Wuji stated: Retained food in the Middle and Lower Wan is suitable for purgation; retained food in the Upper Wan requires emesis. The *Neijing* states: "For those high up, induce upward expulsion; for those low down, guide downward exhaustion."
Fang Youzhi stated: The Upper Wan refers to the mouth/opening of the stomach organ.
Zhang Zhicong stated: The stomach is the sea of water and grain, divided into Upper, Middle, and Lower Wan. The Upper Wan receives, the Middle Wan transforms. Since food remains in the Upper Wan without rotting or transforming, it is termed retained food and should be treated with emesis.
Cheng Yingmao stated: Zong Qi gathers in the chest, and ascent/descent and respiration emerge from it. How can the domain of Clear Yang tolerate the stagnation of turbid substances? Emesis disperses them, removing obstructions. If the condition involves exterior pathogens transmitting inward, transforming from formless to tangible, resulting in Pi Man (Stagnant Fullness) or Jie Xiong (Knotted Chest), there are separate treatments; emesis would be inappropriate.