Vomiting as part of Ba Fa (Eight Methods)
Tu Fa (Vomiting Method) is one of the Eight Therapeutic Methods in TCM that uses emetic substances to induce vomiting, expelling phlegm, food stagnation, or toxins lodged in the throat, chest, or upper stomach. It is reserved for acute excess conditions in patients with strong constitutions.
Tǔ Fǎ
Vomiting Method (Emesis)
Educational content · Consult qualified TCM practitioners for diagnosis and treatment
Overview
Tu Fa (Vomiting Method) is one of the Eight Therapeutic Methods (Ba Fa) in Traditional Chinese Medicine—a treatment strategy that uses emetic herbs or physical stimulation to induce vomiting and expel pathogenic substances from the upper body. Think of it as the body's natural "emergency exit" for removing harmful substances that are lodged in the throat, chest, or upper stomach.
This method works on the principle that when pathogens (like food stagnation, phlegm, or toxins) are trapped in the upper regions of the body, the most direct route of elimination is upward through the mouth. As the classical texts describe: "For what is high, draw it out and make it go over" (其高者，引而越之). Tu Fa is considered a powerful but aggressive treatment—effective for acute emergencies but potentially harmful if misused, which is why it's one of the least commonly used methods in modern clinical practice.
Historical Context
The theoretical foundation for Tu Fa was established in the Huangdi Neijing Su Wen, which articulated the principle of expelling pathogens from above. However, it was during the Han Dynasty that Zhang Zhongjing provided the first detailed clinical application in the Shang Han Lun, where he described specific conditions warranting emetic treatment and introduced Gua Di San as the representative formula.
The systematic organization of Tu Fa as one of the Eight Methods occurred during the Qing Dynasty when physician Cheng Zhong-Ling categorized and documented the Ba Fa in his work "Yi Xue Xin Wu" (Medical Revelations, 1732). While Tu Fa was more commonly used in ancient times for conditions like food poisoning and phlegm obstruction, its use has declined significantly in modern practice due to its harsh nature and the availability of gentler alternative treatments.
Comparison
Sweating (Han Fa)
汗法Expels pathogens from the exterior through perspiration. Used when disease is at the surface level (skin and muscles). Tu Fa is for interior conditions in the upper body, not exterior conditions.
Purging (Xia Fa)
下法Expels pathogens downward through the bowels. Used when pathogenic accumulation is in the middle or lower digestive tract. Tu Fa expels upward and is for upper body accumulation—these two methods work opposite directions.
Vomiting (Tu Fa)
吐法Expels pathogens upward through vomiting. Reserved for acute excess conditions where phlegm, food, or toxins are lodged in the throat, chest, or upper stomach. The most violent of the elimination methods and rarely used.
Expel from Above
其高者引而越之The fundamental principle of Tu Fa is that pathogenic substances lodged in the upper body (throat, chest, upper stomach) should be expelled through the most direct route—upward through vomiting. This follows the natural flow principle of TCM: what is high should go higher to leave the body.
Interior Excess Pattern Required
里实证Tu Fa should only be used for interior excess (Shi) conditions where substantial pathogenic material is present—such as thick phlegm blocking the airway, undigested food in the stomach, or recently ingested poisons. It is never used for deficiency conditions.
Emergency Application
急证This method is reserved primarily for acute, urgent situations where rapid expulsion of pathogenic substances is necessary—particularly when phlegm obstructs breathing, food remains lodged in the upper digestive tract, or toxins have been recently ingested and not yet absorbed.
Strong Constitution Required
体实可用Because vomiting is a violent action that can injure Stomach Yin and deplete vital Qi, Tu Fa should only be used on patients with relatively strong constitutions. It is contraindicated in the elderly, weak, pregnant women, and those with deficiency patterns.
Practical Application
In practice, Tu Fa is used primarily in emergency situations. Common applications include: (1) Food poisoning or toxic ingestion when the material is still in the stomach and not yet absorbed—vomiting can quickly expel the harmful substance; (2) Phlegm obstructing the throat causing breathing difficulty or inability to speak; (3) Severe food stagnation in the upper stomach causing chest fullness, distention, and difficulty breathing; (4) Conditions like manic psychosis (dian kuang) caused by phlegm-fire obstructing the Heart orifices.
Modern clinical use is rare, as gastric lavage and other medical interventions have largely replaced emetic treatment. When Tu Fa is employed, practitioners must ensure the patient has a strong constitution, monitor carefully for excessive vomiting, and be prepared to stop the emesis if it becomes uncontrolled (traditionally done with cloves or musk). The method should never be used if the pathogen has already moved to the intestines, as this would make purging (Xia Fa) more appropriate.
Clinical Relevance
Tu Fa has limited use in contemporary TCM practice but remains clinically relevant for specific emergency scenarios. It may be considered when: acute poisoning has occurred and the toxic substance remains in the stomach; thick phlegm obstructs the airway causing respiratory distress; food is severely impacted in the upper stomach causing acute chest fullness and difficulty breathing; or in certain psychiatric emergencies involving phlegm-fire obstruction.
The practitioner must carefully assess whether the patient's constitution can tolerate the treatment. Key contraindications include: pregnancy, advanced age, weak constitution, patients with bleeding disorders, those with deficiency patterns, and situations where the pathogenic substance has already passed into the intestines. If used, vomiting should be induced to the point of expelling the pathogenic substance but not excessively, as prolonged vomiting damages Stomach Yin and depletes Qi.
Common Misconceptions
"Tu Fa is simply about making someone vomit" - While vomiting is the mechanism, Tu Fa is a carefully considered therapeutic strategy. It's not about inducing vomiting for its own sake, but about using the body's natural expulsion mechanism to remove specific pathogenic substances that are lodged in the upper body. Random vomiting without proper indication can cause significant harm.
"Tu Fa can be used whenever there's nausea" - Nausea is actually a symptom of rebellious Stomach Qi, which is treated differently—typically by descending Stomach Qi rather than encouraging more upward movement. Tu Fa is only used when substantial pathogenic material needs to be expelled, not for general digestive discomfort.
"This method is obsolete and no longer relevant" - While rarely used, Tu Fa principles still inform emergency treatment decisions. Understanding when emesis is appropriate versus contraindicated remains clinically valuable, even if modern practitioners typically refer such cases to emergency medicine.
Classical Sources
Huangdi Neijing Su Wen (Yellow Emperor's Inner Classic)
Chapter 5 - Yin Yang Ying Xiang Da Lun其高者，引而越之
For what is high (in the body), draw it out and make it go over (expel it through vomiting)
Yi Xue Xin Wu (Medical Revelations)
Yi Men Ba Fa (Eight Methods of Medicine)论治病之方，则又以汗和下消清温补八法尽之
In discussing methods of treating disease, they can all be encompassed by the eight methods: sweating, harmonizing, purging, reducing, clearing, warming, vomiting, and tonifying
Shang Han Lun (Treatise on Cold Damage)
Line 166病如桂枝证，头不痛，项不强，寸脉微浮，胸中痞硬，气上冲咽喉不得息者，此为胸有寒也，当吐之，宜瓜蒂散
When there is a condition resembling Gui Zhi pattern but with no headache, no stiff neck, slightly floating inch pulse, hardness in the chest, and Qi rushing up to the throat causing breathing difficulty, this indicates cold in the chest. It should be treated with vomiting—Gua Di San is appropriate.
Modern References
Chinese Herbal Formulas and Applications
Comprehensive reference covering emetic prescriptions including Gua Di San and their modern clinical applications
Chinese Herbal Medicine: Formulas & Strategies
Classic English-language text on TCM formulas with detailed discussion of the Eight Methods framework
The Traditional Chinese Medicine Formula Study Guide
Educational text covering Ba Fa theory and formula categorization according to therapeutic methods