仲景曰。大法秋宜下。
又曰。凡服下药。宜用汤。胜丸散。中病便止。不必尽剂也。
又曰。阳明病。发热。汗多者。急下之。宜大柴胡汤。庞氏云。发
热不恶寒。汗多。
又曰。少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
又曰。阳明少阳合病。必下利。其脉不负者顺也。负者失也。互
相克贼。名为负也。庞氏曰。阳明土。其脉大。少阳木。其脉弦。若合
病。土被木贼。加之以利。则胃已困矣。若脉不弦。为土不负。弦者为
土负。必死。雍曰。此合病一证下至名为负也而终。按本论原误录。
宿食一证相连。非也。脉经以宿食别作一证。为当。盖脉滑数。有宿
食。故仲景可用承气汤。若胃为木克。困而下利。安有用承气之理。
今根据脉经。离而为二。宿食证。根据仲景用承气汤。惟合病下利。阙治
法。今以负为不治。不负。宜理中丸。厥者。宜四逆汤。仍泻邱虚、阳
陵泉。补三里穴。庞朱二氏依旧本合为一证。疑其非。大抵读仲景
论。仍须以脉经参校之。
又曰。少阴病。下利清水。色纯青。心下必痛。口干燥者。可下
之。宜大柴胡汤、大承气汤。余见少阴本证。更详之。
又曰。下利。三部脉皆平。按之心下硬者。急下之。宜大承气汤。
庞氏曰。凡脉沉细数。为热在里。又兼腹满咽干。或口燥舌干而渴
者。或六七日不大便。小便自如。或目中瞳子不明。无外证者。或汗
后脉沉实者。或下利三部脉皆平。按之心下坚者。或连发汗不恶寒
者。或已经下。其脉浮沉按之有力者。皆宜大承气汤。
又曰。下利。脉浮而滑者。内实也。利未欲止。当下之。宜大承气
汤。
雍曰。常氏疑本论之误。故欲以葛根黄芩治下利。殊不思仲景
以承气下宿食。而合病下利。原无治法也。葛根黄芩汤。以太阳表未
解。误下之利不止者。既有协热下利之表证未退。故可用。今合病下
利。胃气伤困。只当救胃。宜用温药。故雍以四逆理中补其法。胃气
已负。而又加以寒药。则胃谷绝矣。仲景于此一证。特论脉负不负。
盖欲后人当思阳阻少阳土木克贼之理而治之。可谓尽善矣。以是知
合并病之论。虽二阳俱受病。邪气俱当去。又须审二经五行之气。毋
令相克贼。抑强扶衰以致和气。不使复生一秦。助桀为虐也。如是则
胡越可同舟而共济矣。此证和二经。退邪气。与人事不少异。非天下
至精。孰能与于此。然生胃气。制少阳木。亦用金石药。尝见名医治
少阴自汗。自利不止。用金液丹取大效。既非古药。不敢以为然。必
不得已而用。亦须七炼九炼火力重者用之。其一炼火力轻者。复可
下宿食。以虚人老人。不敢用承气也。
仲景问曰。人病有宿食。何以别之。师曰。寸口脉浮而大。按之
反涩。尺中亦微而涩。故知有宿食。当下之。宜大承气汤。
又曰。下利。不欲食者。以有宿食故也。当下之。宜大承气汤。
又曰。下利瘥。至其年月日时复发者。以病不尽故也。当下之。
宜大承气汤。
又曰。病腹中满痛者。此为实也。当下之。宜大承气汤、大柴胡
汤。
又曰。下利。脉反滑。当有所去。下之乃愈。宜大承气汤。
又曰。腹满不减。减不足言。当下之。宜大柴胡汤、大承气汤。雍
曰。减不足言者。言不甚减也。论言太阳发汗不彻。不足言。与此同
意。俗语所谓不济事者是也。
又曰。伤寒后脉沉。沉者。内实也。下之解。宜大柴胡汤。雍曰。
须沉数有力。可下之。虽沉而微弱迟。皆不可下也。
又曰。伤寒六七日。目中不了了。睛不和。无表里证。大便难。身
微热者。此为实也。急下之。宜大承气汤、大柴胡汤。
又曰。太阳病未解。脉阴阳俱停。必先振 。汗出而解。但阴脉
微（一作尺脉实）者。下之而解。宜大柴胡汤。（一法用调胃承气汤）
脉经云。但阴微者。先下之而解。（庞作阴实）雍曰。文当从脉经及庞
氏。当作但阴脉微而尺脉实者。先下之而解。
又曰。脉双弦而迟者。必心下硬。脉大而紧者。阳中有阴也。可
下之。宜大承气汤。
又曰。结胸者。项亦强。如柔 状。下之则和。庞氏云。宜大陷胸
丸。
又曰。病患无表里证。发热七八日。虽脉浮数者。可下之。宜大
柴胡汤。
又曰。太阳病六七日。表证仍在。脉微而沉。反不结胸。其人发
狂者。以热在下焦。少腹当硬满。而小便自利者。下血乃愈。所以然
者。以太阳随经瘀热在里故也。宜下之以抵当汤。
又曰。太阳病。身黄。脉沉结。少腹硬满。小便不利者。为无血
也。小便自利。其人如狂者。血证谛也。属抵当汤。
又曰。伤寒有热。少腹满。应小便不利。今反利者。为有血也。当
下之。宜抵当丸。
又曰。阳明病。发热汗出者。此为热越。不能发黄也。但头汗出。
身无汗。剂颈而还。小便不利。渴饮水浆者。以瘀热在里。身必发黄。
宜下之以茵陈蒿汤。雍曰。先服茵陈五苓散。黄退则不须更下。
又曰。阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。
故令喜忘。屎虽硬。大便反易。其色必黑。宜抵当汤。
又曰。汗出而谵语者。以有燥屎在胃中。此为风也。须下者。过
经乃可下之。下之若早。语言必乱。以表虚里实故也。下之愈。宜大
柴胡汤、大承气汤。
又曰。病患烦热。汗出则解。复如疟状。日晡所发热者。属阳明
也。脉实者。可下之。宜大柴胡汤、大承气汤。
又曰。阳明病。谵语。有潮热。反不能食者。胃中必有燥屎五六
枚也。若能食者。但硬耳。属大承气证。
又曰。下利谵语者。有燥屎也。属小承气汤。初一服。谵语止。若
更衣者。停后服。不尔。尽与之。
又曰。得病二三日。脉弱。无太阳柴胡证。烦躁。心下硬。至四五
日。虽能食。以小承气汤少少与微和之。令小安。至六日。与承气汤
一升。若不大便。六七日小便少者。虽不能食。但初头硬。后必溏。此
未成硬也。攻之必溏。须小便利。屎定硬。乃攻之。宜大承气汤。
又曰。太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。
发作有时。头痛。心下痞硬。满引胁下痛。干呕短气。汗出不恶寒者。
此表解里未和也。属十枣汤。
又曰。太阳病不解。热结膀胱。其人如狂。血自下者愈。其外未
解。尚未可攻。当先解其外。外解已。但少腹急结者。乃可攻之。宜桃
核承气汤。庞云。不恶寒。为外解。
又曰。伤寒七八日。身黄如橘子色。小便不利。腹微满者。属茵
陈蒿汤。
又曰。伤寒发热。汗出不解。心下痞硬。呕吐而利者。属大柴胡
汤。
又曰。伤寒十余目。热结在里。复往来寒热者。属大柴胡汤。
又曰。但结胸。无大热者。以水结在胸胁也。但头微汗出者。属
大陷胸汤。
又曰。伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。
属大陷胸汤。
又曰。阳明病。其人多汗。以津液外出。胃中燥。大便必硬。硬则
谵语。属小承气汤。
又曰。阳明病。不吐不下。心烦者。属调胃承气汤。
又曰。阳明病。脉迟。虽汗出。不恶寒者。其身必重。短气。腹满
而喘。有潮热者。此外欲解。可攻里也。手足 然汗出者。此大便已
硬也。大承气汤主之。若汗出多。微发热恶寒者。外未解也。其热不
潮。未可与承气汤。若腹大满不通者。与小承气汤微和其胃气。勿令
大泄下。
又曰。阳明病。潮热。大便微硬者。可与大承气汤。不硬者。不可
与之。若不大便六七日。恐有燥屎。欲知之法。少与小承气汤。汤入
腹中转失气者。此有燥屎也。乃可攻之。若不转失气者。此但初头
硬。后必溏。不可攻之。攻之。必胀满不能食也。欲饮水者。与水则
哕。其后发热者。大便必复硬而少也。宜小承气汤和之。不转失气
者。慎不可攻之。雍曰。不转失气者。勿服药。待一昼夜。热气不发
泄。定成硬屎。然后可攻。
又曰。阳明病。谵语发热。脉滑而疾者。小承气汤主之。因与承
气汤一升。腹中转失气者。更服一升。若不转失气者。勿更与之。明
日。又不大便。脉反微涩者。里虚也。为难治。不可更与承气汤。常氏
云。可人参黄 建中汤。
又曰。二阳并病。太阳证罢。但发潮热。手足 汗出。大便难
而谵语者。下之则愈。宜大承气汤。
又曰。病患小便不利。大便乍难乍易。时有微热。喘冒不能卧
者。有燥屎也。属大承气汤。
又曰。大下后。六七日不大便。烦不解。腹满痛者。此有燥屎也。
所以然者。本有宿食故也。属大承气汤。
庞氏曰。脉朝夕快者。实癖也。可下之。朝平夕快者。非癖也。不
可下。快。谓数脉六七至者也。若脉数一息八九至。切不可下。若下
之。则烦躁下利不止而死。脉数与皮毛相得。亦不可下也。虽数。为
虚客热。
又曰。合下不下。令人腹胀满。通身浮肿而死。雍曰。凡汗下。皆
不宜太过。故汗下后。易将理。若汗下太过。则病患虚。难将理。易劳
复。凡用大承气。亦宜消息。用调胃承气代之。盖仲景自有承气之戒
故也。
Zhang Zhongjing said: The general principle is that purgation (下法) is suitable in autumn.
He also said: When administering purgative medicines, decoctions (汤剂) should be used, as they are superior to pills (丸剂) and powders (散剂). Stop medication once the disease is cured; there is no need to finish the entire dose.
He also said: In Yangming disease (阳明病), if fever (发热) and profuse sweating (汗多) occur, urgent purgation is required. Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate. Pang Anshi stated: Fever without aversion to cold (恶寒) and profuse sweating.
He also said: In Shaoyin disease (少阴病), if dry mouth and throat (口燥咽干) appear two or three days after onset, urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
He also said: In combined diseases of Yangming and Shaoyang (阳明少阳合病), diarrhea (下利) must occur. If the pulse does not show mutual overcoming (负), it is a favorable condition; if it shows overcoming, it is unfavorable. Mutual overcoming is called "Fu" (negative/overcoming). Pang stated: Yangming belongs to Earth (土), its pulse is large (大); Shaoyang belongs to Wood (木), its pulse is string-like (弦). In combined disease, if Wood overcomes Earth, compounded by diarrhea, the Stomach Qi (胃气) is already exhausted. If the pulse is not string-like, Earth is not overcome ("Bu Fu"); if the pulse is string-like, Earth is overcome ("Fu"), which leads to death. Guo Yong stated: This discussion on combined disease ends at "named Fu". According to the original text of *Shanghan Lun*, the "retained food" (宿食) syndrome was erroneously recorded here, which is incorrect. *Mai Jing* separates retained food into a distinct syndrome, which is correct. Because a slippery and rapid pulse (脉滑数) indicates retained food, Zhang Zhongjing could use Cheng Qi Tang. However, if the Stomach is overcome by Wood and exhausted with diarrhea, what logic would justify using Cheng Qi Tang? Now, based on *Mai Jing*, these are separated. For retained food syndrome, follow Zhang Zhongjing's method of using Cheng Qi Tang. For combined disease causing diarrhea, where the original text lacks treatment methods, I consider "Fu" as untreatable, while "Bu Fu" is suitable for Li Zhong Wan (Regulate the Middle Pill). If cold limbs (厥者) occur, Si Ni Tang (Frigid Extremities Decoction) is appropriate. Additionally, drain Qiuxu (GB24) and Yanglingquan (GB34), and tonify Zusanli (ST36). Pang Anshi and Zhu Hong still merge this into one syndrome according to old texts; I suspect this is incorrect. Generally, when reading Zhang Zhongjing's treatises, one must cross-reference with *Mai Jing*.
He also said: In Shaoyin disease, if there is diarrhea of clear water, purely green in color, pain in the epigastrium (心下必痛), and dry mouth/throat, purgation is permissible. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate. See the main Shaoyin syndrome for details.
He also said: In diarrhea, if the pulses at all three positions (cun, guan, chi) are level/peaceful, but palpation reveals hardness in the epigastrium, urgent purgation is required. Da Cheng Qi Tang is appropriate. Pang stated: A deep, thin, and rapid pulse indicates heat in the interior. Combined with abdominal fullness and dry throat, or dry mouth/tongue with thirst, or constipation for six to seven days with normal urination, or unclear vision/pupils without exterior signs, or a deep and solid pulse after sweating, or diarrhea with level pulses but epigastric hardness upon palpation, or continuous sweating without aversion to cold, or a forceful pulse at both floating and deep levels after purgation, Da Cheng Qi Tang is appropriate in all these cases.
He also said: In diarrhea, if the pulse is floating and slippery, it indicates internal excess (内实). The diarrhea will not stop until purged. Da Cheng Qi Tang is appropriate.
Guo Yong stated: Chang Qizhi suspected an error in the text and proposed Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) for diarrhea. This fails to consider that Zhang Zhongjing uses Cheng Qi Tang to purge retained food, whereas combined disease diarrhea originally had no specified treatment. Ge Gen Huang Qin Huang Lian Tang is used when the Taiyang exterior is unresolved and mistaken purgation causes persistent diarrhea with lingering exterior symptoms of協熱下利 (diarrhea with coordinated heat). In current combined disease diarrhea, Stomach Qi is injured and exhausted; only warming herbs should be used to rescue the Stomach. Thus, I use Si Ni Tang and Li Zhong Wan to supplement this. If Stomach Qi is already compromised and cold herbs are added, Stomach Qi will be severed. Zhang Zhongjing discusses the pulse's "Fu" and "Bu Fu" specifically to teach later generations to consider the obstruction of Yang Qi and the Wood-overcoming-Earth pathology of Shaoyang. This is perfect. Thus, in combined diseases, although both Yang meridians are affected and pathogens must be removed, one must examine the Five Elements interactions to prevent mutual overcoming, suppress the strong, support the weak, and restore harmony, avoiding the creation of new pathogenic factors. This harmonization is akin to managing human affairs. Only the most exquisite minds can achieve this. To generate Stomach Qi and control Shaoyang Wood, metallic/mineral drugs are sometimes used. I have seen famous doctors treat Shaoyin spontaneous sweating and persistent diarrhea with Jin Ye Dan (Golden Liquid Pill) with great effect. Since this is not an ancient drug, I do not fully endorse it. If absolutely necessary, use heavily calcined versions (seven or nine times). Lightly calcined versions can purge retained food but are unsafe for the frail and elderly, who should not take Cheng Qi Tang.
Zhang Zhongjing asked: How to distinguish retained food disease? The Master said: The Cun Kou pulse is floating and large, but feels rough (涩) upon pressure; the Chi position is also slightly rough. This indicates retained food, requiring purgation. Da Cheng Qi Tang is appropriate.
He also said: Diarrhea with loss of appetite indicates retained food. Purge it. Da Cheng Qi Tang is appropriate.
He also said: If diarrhea recurs at the same time/year/day after recovery, it is because the disease is not fully resolved. Purge it. Da Cheng Qi Tang is appropriate.
He also said: Abdominal fullness and pain indicate excess. Purge it. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: Diarrhea with a surprisingly slippery pulse indicates something needs to be expelled. Purge to cure. Da Cheng Qi Tang is appropriate.
He also said: Abdominal fullness that does not decrease, or decreases insignificantly, requires purgation. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate. Guo Yong stated: "Decreases insignificantly" means very little reduction. This aligns with "Taiyang sweating was incomplete, insignificant." It corresponds to the colloquial meaning of "ineffective."
He also said: After Shanghan, a deep pulse indicates internal excess. Purging resolves it. Da Chai Hu Tang is appropriate. Guo Yong stated: The pulse must be deep, rapid, and forceful to purge. If deep but weak, thready, or slow, do not purge.
He also said: After six or seven days of Shanghan, if vision is unclear (不了了) and eyes are unresponsive, without exterior or interior signs, difficulty defecating, and slight body heat, this is excess. Urgent purgation is required. Da Cheng Qi Tang and Da Chai Hu Tang are appropriate.
He also said: If Taiyang disease is unresolved, and Yin/Yang pulses both stop, shivering followed by sweating indicates resolution. If the Yin pulse is slightly weak (or Chi pulse is solid), purging resolves it. Da Chai Hu Tang is appropriate (alternatively, Tiao Wei Cheng Qi Tang). *Mai Jing* states: If only the Yin pulse is weak, purge first to resolve. (Pang reads "Yin solid"). Guo Yong stated: Text should follow *Mai Jing* and Pang: "If Yin pulse is weak and Chi pulse is solid," purge first to resolve.
He also said: A double-stringy and slow pulse indicates epigastric hardness. A large and tight pulse indicates Yin within Yang. Purging is possible. Da Cheng Qi Tang is appropriate.
He also said: In Jie Xiong (Chest Binding), neck stiffness resembling Rou Ji (Soft Spasm) occurs. Purging brings harmony. Pang stated: Da Xian Xiong Wan (Major Draining the Chest Pill) is appropriate.
He also said: Patients without exterior or interior signs, febrile for seven to eight days, even with a floating and rapid pulse, may be purged. Da Chai Hu Tang is appropriate.
He also said: In Taiyang disease for six or seven days, if exterior signs persist, pulse is micro and deep, but no Jie Xiong occurs, and the patient is manic (发狂), it is due to heat in the Lower Jiao. The lower abdomen should be hard and full, yet urination is free. Hematochezia (下血) cures it. This is because Taiyang follows the meridian, trapping stasis-heat in the interior. Purge with Di Dang Tang (Di Dang Decoction).
He also said: In Taiyang disease, jaundice (身黄), deep and knotted pulse, hard/full lower abdomen, and difficult urination indicate no blood stasis. Free urination and mania-like behavior confirm blood stasis. Di Dang Tang is appropriate.
He also said: In Shanghan with heat, lower abdominal fullness usually implies difficult urination. If urination is now free, it indicates blood stasis. Purge with Di Dang Wan (Di Dang Pill).
He also said: In Yangming disease, fever and sweating indicate heat venting outward, preventing jaundice. If only the head sweats, body has no sweat up to the neck, urination is difficult, and thirst for fluids exists, stasis-heat in the interior causes jaundice. Purge with Yin Chen Hao Tang (Artemisia Capillaris Decoction). Guo Yong stated: First take Yin Chen Wu Ling San; once jaundice recedes, further purgation is unnecessary.
He also said: In Yangming syndrome, forgetfulness (喜忘) indicates blood retention (蓄血) due to long-standing stasis. Stool may be hard but passage is easy, and color is black. Di Dang Tang is appropriate.
He also said: Sweating with delirium (谵语) indicates dry stool (燥屎) in the Stomach, caused by Wind. Purging is required only after the pathogen has passed through the meridians (过经). Premature purging causes confused speech due to exterior deficiency and interior excess. Purging cures it. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: Patients with vexation and heat resolve with sweating, then resemble malaria with afternoon fever (日晡所发热), indicating Yangming. If the pulse is solid, purge. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: In Yangming disease, delirium with tidal fever (潮热) and inability to eat indicates five or six pieces of dry stool in the Stomach. Ability to eat suggests only hardness, fitting Da Cheng Qi Tang syndrome.
He also said: Diarrhea with delirium indicates dry stool. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is appropriate. After the first dose, if delirium stops and bowel movement occurs, stop subsequent doses. Otherwise, administer fully.
He also said: On days 2-3 of illness, with weak pulse, no Taiyang or Chai Hu signs, restlessness, and epigastric hardness: By day 4-5, even if eating, give small amounts of Xiao Cheng Qi Tang to mildly harmonize Stomach Qi. By day 6, give one Sheng of Cheng Qi Tang. If no bowel movement by day 6-7 and urine is scant, even if unable to eat, initial stool hardness with loose posterior indicates unformed hardness. Attacking will cause loose stools. Wait for free urination and definite hardness before attacking with Da Cheng Qi Tang.
He also said: In Taiyang Wind Strike with diarrhea and vomiting, if the exterior is resolved, attack the interior. Symptoms include continuous sweating, intermittent headache, epigastric痞硬 (fullness/hardness), flank pain, dry heaves, shortness of breath, sweating without aversion to cold. This is exterior resolved, interior unharmonized. Shi Zao Tang (Ten Date Pill) is appropriate.
He also said: If Taiyang disease is unresolved and heat binds to the Bladder, mania-like behavior occurs. Spontaneous bleeding cures it. If exterior remains, do not attack; resolve exterior first. Once exterior is resolved and only lower abdominal urgency/clumping (急结) remains, attack with Tao He Cheng Qi Tang (Peach Kernel Order the Qi Decoction). Pang stated: No aversion to cold indicates exterior resolution.
He also said: After seven to eight days of Shanghan, orange-yellow jaundice, difficult urination, and mild abdominal fullness fit Yin Chen Hao Tang.
He also said: Shanghan fever with unresolved sweating, epigastric痞硬, vomiting, and diarrhea fits Da Chai Hu Tang.
He also said: After ten-plus days of Shanghan, heat bound in the interior with alternating chills and fever fits Da Chai Hu Tang.
He also said: Pure Jie Xiong without high heat indicates water binding in chest/flanks. Slight head sweating fits Da Xian Xiong Tang (Major Draining the Chest Decoction).
He also said: After six or seven days of Shanghan, hot Jie Xiong with deep, tight pulse, epigastric pain, and stone-hard palpation fits Da Xian Xiong Tang.
He also said: In Yangming disease, excessive sweating depletes fluids, drying the Stomach and hardening stool, leading to delirium. Xiao Cheng Qi Tang is appropriate.
He also said: In Yangming disease,心烦 (vexation) without vomiting or purging fits Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).
He also said: In Yangming disease, slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness with wheezing, and tidal fever indicate exterior resolving and interior ready for attack. Continuous hand/foot sweating indicates hardened stool. Da Cheng Qi Tang governs. If sweating is profuse with slight fever/aversion to cold, exterior is unresolved. Without tidal fever, do not give Cheng Qi Tang. If severe abdominal fullness/blockage, give Xiao Cheng Qi Tang to mildly harmonize Stomach Qi, avoiding drastic purgation.
He also said: In Yangming disease, tidal fever with slightly hard stool allows Da Cheng Qi Tang. If not hard, do not give. If no bowel movement for 6-7 days and suspicion of dry stool exists, give a small amount of Xiao Cheng Qi Tang. If gas passes after ingestion, dry stool exists, and purging is allowed. If no gas passes, initial hardness with loose posterior indicates non-purgable state. Attacking causes bloating and anorexia. Thirst with water intake causes hiccups. Subsequent fever leads to hard, scant stool; harmonize with Xiao Cheng Qi Tang. Do not attack if no gas passes. Guo Yong stated: If no gas passes, withhold medicine for 24 hours. If heat does not dissipate, hard stool forms, then purge.
He also said: In Yangming disease, delirium with fever and slippery/rapid pulse is governed by Xiao Cheng Qi Tang. Give one Sheng. If gas passes, give another Sheng. If no gas passes, do not give more. Next day, if no bowel movement and pulse becomes micro/thready, interior deficiency makes it difficult to treat; do not give Cheng Qi Tang again. Chang stated: Ren Shen Huang Qi Jian Zhong Tang (Ginseng and Astragalus Middle-Building Decoction) may be used.
He also said: In Two-Yang combined disease, if Taiyang signs cease, only tidal fever, continuous hand/foot sweating, difficult defecation, and delirium occur, purging cures it. Da Cheng Qi Tang is appropriate.
He also said: Patients with difficult urination, alternating hard/loose stool, slight fever, wheezing/dizziness unable to lie down, have dry stool. Da Cheng Qi Tang is appropriate.
He also said: After severe purgation, if no bowel movement for 6-7 days, persistent vexation, and abdominal fullness/pain occur, dry stool exists due to prior retained food. Da Cheng Qi Tang is appropriate.
Pang stated: Pulse fast morning and night indicates excess accumulation (实癖); purging is allowed. Pulse calm morning/fast night is not accumulation; do not purge. "Fast" means 6-7 beats per breath. If pulse is 8-9 beats per breath, do not purge; purging causes fatal烦躁 (restlessness) and diarrhea. Pulse fast matching skin texture also prohibits purging; rapidity indicates deficient guest-heat.
He also said: Failure to purge when indicated causes abdominal fullness, generalized edema, and death. Guo Yong stated: Sweating and purging should not be excessive. Post-treatment care is easier if moderate. Excessive treatment causes deficiency, making care difficult and prone to relapse from exertion. When using Da Cheng Qi Tang, exercise caution; substitute with Tiao Wei Cheng Qi Tang if needed, following Zhang Zhongjing's warnings.