大法秋宜下。
阳明病，发热不恶寒，汗多者，急下之。
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，心下坚者，或连发汗，已不恶
寒者，或已经下，其脉浮沉按之有力者，宜大承气汤。
大黄（半两） 浓朴（一两） 枳实（一枚） 朴硝（半两）
咀，以水四升，先煮浓朴、枳实至三升，下大黄，煮取一升半，去滓，下朴
硝烊化。每温一盏服，利即止。后服如作煮散煎，每服浓朴、枳实末共三钱，水二盏，煎一盏半，
下大黄末一钱，煎一盏，绞去滓，下朴硝末一钱，烊化服之。
阳明与少阳合病而利，脉不负者，为顺也。负者，失也，互相克为负也。脉滑而数者，有宿食，
当下之。（宜大承气汤。阳明土，其脉大，少阳木，其脉弦，若合病，土被木贼克，更利，为胃已
困。若脉不弦，为土不负。弦者，为土负，必死。）
脉双弦而迟，心下坚，或脉大而紧者，阳中有阴，可下之。病者烦热汗出，如疟状，日晡则发
潮热者，属阳明，其脉必实，当下之而愈。
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，宜下之。
伤寒，若吐下后，不解，不大便五六日以上，至十余日，日晡则发潮热，不恶寒，独语如见鬼
状。若剧者，发则不识人，循衣妄撮，（常见有此撮空候，故改之。）惕而不安，微喘直视，脉弦
者生，脉涩者死；微者，但发热谵语，可下之。一服利，止后服。
过经谵语者，可下之。
病患不大便五六日，绕脐痛，烦躁，发作有时，此有燥屎，故不大便，可下之。（以上并宜大
承气汤。）
太阳病未解，其脉阴阳俱停者，必先振栗汗出而解。阳微者，先汗之而解；阴实者，先下之而
解。下之，宜大柴胡汤。
柴胡（四两） 黄芩 芍药（各一两半） 枳实（二枚） 生姜（二两半） 半夏（一两一分）
大枣（六个） 大黄（一两）
咀，以水六升，煮取三升，去滓，再煎，每温一盏服。
因下之后，潮热而微利者，此医以丸药下之，非其治也。而有表证，仍胸膈满而呕者，先服小
柴胡汤，后服大柴胡汤。（小柴胡汤在和表证中。）
伤寒发热，汗出不解，心中痞硬，呕吐下利者，大柴胡汤主之。
伤寒十余日，结热在里，往来寒热者，宜大柴胡汤。
阳明病，谵语，发潮热，脉滑疾者，小承气汤主之。
大黄（二两） 浓朴（一两） 枳实（二枚）
咀，水二升半，煎至八合，去滓，放温时饮一盏，以利为度。凡大便秘闷，恐有表证者，但
少少饮之，微下为度，不可饮多，恐大泄利也。虚弱人可作煮散煎服。
太阳病，若吐下发汗后，微烦，小便数，大便难者，与小承气汤利之则愈。（此太阳阳明证也。）
下利谵语者，有燥屎也，宜小承气汤。初一服，谵语止；若更衣者，停后服，不尔，尽与之。
（更衣即登厕也，非颜师古注《汉书》更衣之义。《集验方》痔有更衣挺出，颇妨于更衣，更衣出
清血，故以知之。）
阳明病，不吐不下，心烦者，可与调胃承气汤。（方在太阳证中。）
发汗后，恶寒者，虚也；不恶寒，但热者，实也，当和胃气，宜调胃承气汤。
伤寒十三日，过经谵语者，此有热，当以汤下之。若小便利者，大盒饭硬，反下利而脉调和者，
知医以丸药下之，非其治也。若自下利者，脉当微厥；今反和者，
为内实也，宜调胃承气汤。
太阳病，过经十余日，心下温温欲吐而胸中痛，大便反溏，腹微满，郁郁微烦。此时极吐下者，
与调胃承气汤，不尔，可与之。但欲呕，胸中痛，微溏者，此非柴胡证，以呕故知极吐下也，属调
胃承气汤。
伤寒吐后，腹胀满者，属调胃承气汤。
茵陈汤治阳明病，发热汗出者，此为热越，不能发黄也；但头汗出，其身无汗，剂颈而还，
小便不利，渴而饮水者，以瘀热在里，身必发黄。
茵陈蒿（三两） 大黄（一两半） 栀子（二十个，大者七枚）
咀，水二升半，先煮茵陈至一升，内二味，煮取一升二合半，去滓。温饮一盏，日三服。小
盒饭利，尿如皂角沫，一宿腹减，黄从小便出。
十枣汤治太阳病中风，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，胁下痛，干呕短气，汗出不恶寒者，此表和里未和也。
芫花 甘遂 大戟（等分，异杵筛，秤末合之，入臼再杵二三百下。）
先以水一升，煮肥枣十枚，擘碎，煮取半升，去枣，用煎汤少半，调末一钱匕，羸人半钱，再
单饮枣汤送之，平旦服。若下少而病不除，明旦加药一钱半，如前服之。服之必利，利后糜粥自养。
咳而胁下痛，此为有饮，宜十枣汤。
调中汤治夏月及秋初，忽有暴寒，折于盛热，热结四肢，则壮热头痛，寒伤于胃，下利或
血或水，或赤带下，壮热且闷，脉数宜下之。久年肠风，下之亦瘥。
大黄（三分） 葛根 黄芩 芍药 桔梗 茯苓 本 白术 甘草（各半两）
咀，水三升，煎至二升，下大黄，取一升二合，去滓。温温饮一盏，移时勿膈食再服之，得
快下，壮热便歇，其下利亦止。凡秋夏早热积日，或有暴寒折之，热无可散，喜搏着肌中，作壮热
气也。胃为六腑之表，最易为暴寒所折故也，虚人亦不发壮热，但下利或霍乱，不宜用此。实人有
服五石人，喜壮热，
与别药下则加热，喜闷而死矣。是以宜以此下，和其胃气。（调中汤又治阳病因下，遂协热利
不止，及伤寒不因下而自利，表不解，脉浮数者，皆可去大黄，加葛根成一两煎服之，殊验也。）
茵陈丸疗瘴气及黄病 疟。
茵陈 栀子 鳖甲 芒硝（各一两） 大黄（二两半） 豉（二合半） 常山 杏仁（各一两半）
巴豆（半两）
细末，蜜丸梧桐子大。初得时气，三日内平旦米饮服二丸，如人行十里久，或吐或利，或汗出，
不尔，更服一丸，以热粥投之，老少以意加减丸数服。若黄病痰癖，时气伤食 疟，小儿惊热欲发
痫，服之无不瘥者。疗瘴神验，赤白痢服之亦效。春初有宿热，根据上法服之，取吐利，当年不忧热
病。（有性杀药者，每服七丸、五丸。）
抵党汤治太阳病六七日，表证仍在，脉微而沉，反不结胸，其人发狂者，乃热在下焦，小腹
当硬满；小便反利者，下血乃愈。所以然者，以太阳随经，瘀血在里故也。（小腹满而小便不利者，
非血证。）
水蛭 虻虫（各十枚） 桃仁（七枚） 大黄（一两）
咀，以水二升半，煮至一升二合半，去滓，温温分四服。未下，再服。虚人只可作半料服之，
如作煮散，每五钱水一盏半，煎一盏，去滓服之。
桃仁承气汤治太阳病不解，热结在膀胱，其人如狂，血自下者乃愈。其外不解者，尚未可
攻，当先随证行汤解外。外已解，但小腹急结者，乃可攻之。（不恶寒为外解。）
桃仁（二十四个） 大黄（二两） 甘草 桂枝 芒硝（各一两）
咀，以水三升半，煎取一升半，去滓，内芒硝烊化，温服一盏。虚人减作半料，亦可作煮散。
每五钱，水一盏半，煎至一盏，去滓，下芒硝一钱半，烊化服之。
桃仁承气汤又治产后恶露不下，喘胀欲死，服之十瘥十。
庞曰∶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，慎不可下，若下之则烦躁，下利不止而死。凡数脉与皮毛相得，亦不可下也。
合下不下，令病患腹胀满，通身浮肿而死。
The general principle is that purgation (Purgative Method) is suitable in autumn.
In Yangming disease (Disease of the Yangming channel), characterized by fever, aversion to cold absent, and profuse sweating, urgent purgation should be applied.
Whenever the pulse is deep, fine, and rapid, it indicates heat in the interior. If accompanied by abdominal fullness and dry throat, or dry mouth and tongue with thirst, or no bowel movement for six or seven days while urination is normal, or unclear vision in the pupils without exterior symptoms, or a deep and solid pulse after sweating, or diarrhea with all three positions of the pulse (Cun, Guan, Chi) appearing level but hardness at the epigastrium, or continuous sweating followed by absence of aversion to cold, or previous purgation resulting in a pulse that is forceful upon both superficial and deep palpation, Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
Rhubarb Root (Da Huang, 0.5 liang)
Bitter Orange Bark (Niu Pi/Cong Pi, here referred to as Nong Po, 1 liang)
Immature Bitter Orange (Zhi Shi, 1 piece)
Mirabilite (Po Xiao, 0.5 liang)
Crush the herbs, add four sheng of water, first decoct Niu Pi and Zhi Shi until three sheng remain, then add Da Huang, decoct until one and a half sheng remains, strain, and add Po Xiao to dissolve. Take one zhan warm per dose; stop if bowel movement occurs. For subsequent doses prepared as a decoction powder, take three qian of powdered Niu Pi and Zhi Shi together, add two zhan of water, decoct until one and a half zhan remains, add one qian of powdered Da Huang, decoct until one zhan remains, strain, add one qian of powdered Po Xiao, dissolve, and take.
When Yangming and Shaoyang diseases combine with diarrhea, if the pulse does not show "Fu" (defeat/loss of balance), it is a favorable sign. "Fu" means loss; mutual overcoming in Five Elements theory is called Fu. A slippery and rapid pulse indicates retained food, requiring purgation. (Da Cheng Qi Tang is appropriate. Yangming belongs to Earth, its pulse is large; Shaoyang belongs to Wood, its pulse is wiry. In combined disease, if Earth is overcome by Wood, leading to diarrhea, the Stomach Qi is exhausted. If the pulse is not wiry, Earth is not defeated. If wiry, Earth is defeated, indicating death.)
A double-wiry and slow pulse with hardness at the epigastrium, or a large and tight pulse, indicates Yin within Yang, allowing for purgation. If the patient has irritability, heat, sweating, resembling malaria, with tidal fever in the late afternoon, it belongs to Yangming, the pulse must be solid, and purgation will lead to recovery.
If the patient has difficulty urinating, intermittent difficulty in defecation, slight fever, wheezing, dizziness, and inability to lie down, there are dry feces, and purgation is appropriate.
In Shanghan (Cold Damage), if after vomiting or purging the condition persists, no bowel movement for five to ten days, tidal fever in the late afternoon, no aversion to cold, and talking alone as if seeing ghosts: if severe, delirium, unconsciousness, grasping at empty air, restlessness, slight wheezing, fixed gaze; a wiry pulse indicates survival, a choppy pulse indicates death. If mild, only fever and delirium, purgation is appropriate. Stop subsequent doses after one successful bowel movement.
Delirium after passing through meridians allows for purgation.
No bowel movement for five to six days, pain around the umbilicus, irritability, occurring at specific times, indicates dry feces causing constipation; purgation is appropriate. (Da Cheng Qi Tang is appropriate for all above cases.)
If Taiyang disease is unresolved and the pulse shows Yin and Yang both stopping (hiding), shaking and sweating will precede resolution. If Yang is weak, release the exterior first; if Yin is excess, purge the interior first. For purgation, Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate.
Bupleurum Root (Chai Hu, 4 liang)
Scutellaria Root (Huang Qin)
Peony Root (Shao Yao, each 1.5 liang)
Immature Bitter Orange (Zhi Shi, 2 pieces)
Fresh Ginger (Sheng Jiang, 2.5 liang)
Pinellia Tuber (Ban Xia, 1.1 liang)
Jujube Fruit (Da Zao, 6 pieces)
Rhubarb Root (Da Huang, 1 liang)
Crush, add six sheng of water, decoct to three sheng, strain, decoct again, take one zhan warm per dose.
After purgation, if tidal fever and slight diarrhea occur due to the physician using pill-based purgatives (incorrect treatment), and exterior symptoms persist with chest/diaphragm fullness and vomiting, first administer Xiao Chai Hu Tang (Minor Bupleurum Decoction), then Da Chai Hu Tang. (Xiao Chai Hu Tang harmonizes the exterior and interior.)
For Shanghan with fever, sweating without relief, epigastric痞 (fullness/hardness), vomiting, and diarrhea, Da Chai Hu Tang is the primary treatment.
For Shanghan lasting over ten days with heat binding in the interior and alternating chills and fever, Da Chai Hu Tang is appropriate.
In Yangming disease, with delirium, tidal fever, and slippery-rapid pulse, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is indicated.
Rhubarb Root (Da Huang, 2 liang)
Bitter Orange Bark (Nong Po, 1 liang)
Immature Bitter Orange (Zhi Shi, 2 pieces)
Crush, add two and a half sheng of water, decoct to eight he, strain, drink one zhan when warm, stopping when bowel movement occurs. For constipation with suspected exterior symptoms, drink sparingly to achieve slight purgation; do not drink much to avoid severe diarrhea. Weak patients may use decoction powder.
After vomiting, purging, or sweating in Taiyang disease, if there is slight irritability, frequent urination, and difficult defecation, give Xiao Cheng Qi Tang to relieve it, leading to recovery. (This is a Taiyang-Yangming syndrome.)
Diarrhea with delirium indicates dry feces; Xiao Cheng Qi Tang is appropriate. After the first dose, if delirium stops, or if bowel movement occurs, stop subsequent doses. ("Geng Yi" refers to using the toilet, not changing clothes.)
In Yangming disease, without prior vomiting or purging, if there is mental agitation, Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) can be given. (Formula recorded in Taiyang section.)
After sweating, aversion to cold indicates deficiency; heat without aversion to cold indicates excess. To harmonize Stomach Qi, Tiao Wei Cheng Qi Tang is appropriate.
On the thirteenth day of Shanghan, delirium after passing through meridians indicates heat, requiring decoction purgation. If urination is clear, stool should be hard; if diarrhea occurs with a harmonious pulse, it indicates incorrect pill purgation by the physician. Natural diarrhea would present with a faint/cold pulse; a harmonious pulse indicates interior excess, so Tiao Wei Cheng Qi Tang is appropriate.
In Taiyang disease, after more than ten days, if there is nausea, chest pain, loose stools, slight abdominal fullness, and slight irritability, following drastic vomiting/purging, Tiao Wei Cheng Qi Tang is appropriate. If only vomiting, chest pain, and slight looseness occur, it is not Chai Hu syndrome but results from drastic vomiting/purging, fitting Tiao Wei Cheng Qi Tang.
After Shanghan vomiting, if abdominal fullness occurs, it fits Tiao Wei Cheng Qi Tang.
Yin Chen Tang (Artemisia Capillaris Decoction) treats Yangming disease with fever and sweating, indicating heat dispersing outward, preventing jaundice. However, if only head sweats, body has no sweat up to the neck, urination is difficult, and thirst with drinking occurs, stagnant heat in the interior will cause jaundice.
Artemisia Capillaris Herb (Yin Chen Hao, 3 liang)
Rhubarb Root (Da Huang, 1.5 liang)
Gardenia Fruit (Zhi Zi, 20 pieces, 7 large ones)
Crush, add two and a half sheng of water, first decoct Yin Chen Hao to one sheng, add other two herbs, decoct to one and a half sheng, strain. Drink one zhan warm, three times daily. Bowel movement will occur, urine like soap suds, abdominal reduction overnight, yellow pigment exits via urine.
Shi Zao Tang (Ten Jujubes Decoction) treats Taiyang wind-stroke with diarrhea and retching. Only after exterior resolution can attack be used. Symptoms include sweating at intervals, headache, epigastric痞-hard-fullness, hypochondriac pain, dry retching, shortness of breath, sweating without aversion to cold. This indicates exterior resolved but interior unharmonized.
Kansui Root (Yuan Hua)
Kansui Rhizome (Gan Sui)
Euphorbia Root (Da Ji) (Equal parts, pounded/sifted separately, mixed, pounded 200-300 times).
Boil ten fat jujubes in one sheng of water until half sheng remains, remove jujubes, use remaining juice to mix one qian bi of powder (half qian for weak persons), take on an empty stomach at dawn. If slight purgation fails to resolve disease, increase to one and a half qian next morning. Purging will occur; nourish with millet porridge afterwards.
Cough with hypochondriac pain indicates fluid retention; Shi Zao Tang is appropriate.
Tiao Zhong Tang (Regulate the Middle Decoction) treats sudden cold in summer/early autumn suppressing intense heat, binding heat in limbs causing high fever/headache, cold injuring Stomach causing diarrhea/blood/water discharge or bloody leukorrhea, high fever/chest oppression, rapid pulse requiring purgation. Chronic intestinal wind also improves with purgation.
Rhubarb Root (Da Huang, 3 fen)
Kudzu Root (Ge Gen)
Scutellaria Root (Huang Qin)
Peony Root (Shao Yao)
Platycodon Root (Jie Geng)
Poria (Fu Ling)
Ligusticum Rhizome (Ben)
Atractylodes Rhizome (Bai Zhu)
Licorice Root (Gan Cao) (Each 0.5 liang)
Crush, add three sheng of water, decoct to two sheng, add Da Huang, take one and a half sheng, strain. Drink one zhan warm, wait before eating, repeat. Successful purgation stops high fever and diarrhea. Summer/Autumn heat accumulation suppressed by cold causes heat binding in muscles; Stomach is easily affected by cold. Weak persons do not get high fever but diarrhea/Huoluan; this formula is unsuitable. Excess persons taking Five Minerals Pills who prefer high fever might die from heat/miasma if purged with other drugs; thus, this formula purges to harmonize Stomach Qi. (Also treats Yangming post-purgation協熱利 [collateral heat diarrhea] or spontaneous diarrhea with floating-rapid pulse; remove Da Huang, add Ge Gen to 1 liang, effective.)
Yin Chen Wan (Artemisia Capillaris Pill) treats miasma, jaundice, and malaria.
Artemisia Capillaris Herb (Yin Chen)
Gardenia Fruit (Zhi Zi)
Turtle Shell (Bie Jia)
Mirabilite (Mang Xiao) (Each 1 liang)
Rhubarb Root (Da Huang, 2.5 liang)
Fermented Soybean (Chi, 2.5 he)
Dichroa Root (Chang Shan)
Apricot Seed (Xing Ren) (Each 1.5 liang)
Croton Seed (Ba Dou, 0.5 liang)
Powder finely, honey-pill size of tung tree seeds. For early seasonal disease, take two pills at dawn with rice drink. After walking ten li, expect vomiting, diarrhea, or sweating. If none, take one more pill with hot porridge. Adjust dosage by age/strength. Effective for jaundice, phlegm-mass, seasonal disease, food stagnation malaria, pediatric convulsion fever. Also effective for dysentery. Spring residual heat treated similarly induces vomiting/purging, preventing summer heat disease. (Potent drugs: take 5-7 pills.)
Di Dang Tang (Resist Blood Decoction) treats Taiyang disease day 6-7, exterior symptoms persist, pulse micro-deep, no chest binding, maniacal behavior, heat in lower jiao, lower abdomen hard/full, urination normal, bloodletting cures. Reason: Taiyang pathogen follows meridian, blood stasis in interior. (Lower abdomen fullness with urinary difficulty is not blood syndrome.)
Leech (Shui Zhi)
Dragonfly Larva (Meng Chong) (Each 10 pieces)
Peach Kernel (Tao Ren, 7 pieces)
Rhubarb Root (Da Huang, 1 liang)
Crush, add two and a half sheng of water, decoct to one and a half sheng, strain, divide into four warm doses. If no purgation, repeat. Weak persons take half dose. As powder: 5 qian, 1.5 zhan water, decoct to 1 zhan, strain, take.
Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) treats unresolved Taiyang disease, heat binding in Bladder, maniacal behavior, self-blood discharge cures. If exterior unresolved, treat exterior first. Once exterior resolved, only lower abdominal urgency/clumping allows attack. (No aversion to cold = exterior resolved.)
Peach Kernel (Tao Ren, 24 pieces)
Rhubarb Root (Da Huang, 2 liang)
Licorice Root (Gan Cao)
Cinnamon Twig (Gui Zhi)
Mirabilite (Mang Xiao) (Each 1 liang)
Crush, add three and a half sheng of water, decoct to one and a half sheng, strain, add Mang Xiao to dissolve, take one zhan warm. Weak persons halve dose. As powder: 5 qian, 1.5 zhan water, decoct to 1 zhan, strain, add 1.5 qian Mang Xiao, dissolve, take.
Also treats postpartum lochia retention, wheezing/distension nearing death; ten cures out of ten.
Pang Anshi says: Pulse varying rapidly between morning/evening indicates excess mass, purgable. Morning calm/evening rapid is not mass, not purgable. Rapid means 6-7 beats per breath. If 8-9 beats per breath, strictly avoid purgation; purging causes irritability, endless diarrhea, death. Rapid pulse with skin/hair signs also contraindicates purgation. Failure to purge when needed causes abdominal fullness, generalized edema, death.