大法。秋宜下。
伤寒。冬病也。若谓可以春宜吐。夏宜汗。秋宜下。为大法。则三法者。其如寒之伤于冬何。
而仲景伤寒之治。大法。实不外乎三者。然则三言之意。岂不与仲景之旨相矛盾乎。嗟乎。仲景
之言。经也。权在其中。三言者。不知为谁。经不经。权不权。 揭三篇条目之首。与伤寒例。
妄六经前之逆同。伤寒例以当简篇前也。故削之。削之则叛经之迹泯。而三言者。以皆揭条册
首。不能削。只得存之。存之亦乱经之罪着。着与泯皆所以为狂妄戒也。后之览者。宜鉴于斯。
凡服下药。用汤胜丸。中病即止。不必尽剂也。
此亦叔和语。
下利。三部脉皆平。按之心下硬者。急下之。宜大承气汤。
三部脉皆平。血气和可知矣。心下硬。实也。所以急也。
下利不欲食者。以有宿食故也。当宜下之。与大承气汤。
不欲。犹恶也。宿。陈久也。犹世俗所谓积也。
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。
此承上文复设问答。言脉以申明之之意。
下利。脉反滑。当有所去。下之乃愈。宜大承气汤。
下利。脉迟而滑者。内实也。利未欲止。当下之。宜大承气汤。
二条亦承上文。又以脉之变者言。以详明之之意。
病。腹中满痛者。此为实也。当下之。宜大承气汤。
实者。邪气甚之谓也。
下利瘥后。至其年月日复发者。以病不尽故也。当下之。宜大承气汤。
其。期也。谓周其一年之月日期也。
伤寒后。脉沉沉者。内实也。下解之。宜大承气汤。
沉以候阴。再言沉者。谓深沉在里阴之意也。
脉双弦而迟者。必心下硬。脉大而紧者。阳中有阴也。可以下之。宜大承气汤。
双弦。谓左右皆然也。弦则为阴。迟则为寒。心下硬者。谓客寒结滞于膈也。大为阳虚。紧
为阴胜。阳以腑言。阴以寒言。谓阴寒之邪。内实于胃腑也。
General treatment principles. Autumn is suitable for purgation.
Shanghan (Cold Damage) is a disease occurring in winter. If one claims that "spring is suitable for emesis, summer for sweating, and autumn for purgation" as general principles, then how do these three methods apply to cold pathogenic factors contracted in winter?
Zhang Zhongjing's general principles for treating Shanghan actually do not exceed these three methods (sweating, emesis, purgation). In that case, does the intent of these three statements contradict Zhang Zhongjing's original meaning? Alas! Zhang Zhongjing's words are the Canon (Jing), containing within them flexibility/adjustment (Quan); whereas the authors of these three statements are unknown. Whether their words constitute Canon or contain flexibility is unclear.
Placing these three chapters at the beginning of the sections is contrary to the order of the Six Channels, similar to the errors in the *Shanghan Example* (Shanghan Li). Since the *Shanghan Example* precedes the main text, I have deleted it. By deleting it, the traces of deviating from the Canon vanish; however, because these three statements are placed at the head of the volume, they cannot be deleted and must be retained. Retaining them highlights their fault of disrupting the Canon. Both highlighting the fault and erasing the trace serve as warnings against arrogance. Future readers should take this as a lesson.
When administering purgative medicines, decoctions (Tang) are superior to pills. Stop medication once the illness is addressed; there is no need to finish the entire dose.
This is also a statement by Wang Shuhe.
In cases of diarrhea where the pulse at all three positions (Cun, Guan, Chi) is level/normal, but palpation of the epigastrium reveals hardness, urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
Level pulses at all three positions indicate that blood and qi are harmonious. Hardness in the epigastrium indicates excess (Shi). Hence, urgent intervention is necessary.
In cases of diarrhea accompanied by anorexia, it is due to retained food (Su Shi). Purgation is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Not desiring" implies aversion. "Su" refers to something old or long-standing, akin to what is commonly termed "accumulation."
Question: How can one distinguish retained food in a patient? The Master said: If the Cun Kou (radial artery) pulse is floating and large, but feels choppy upon deep pressure, and the Chi position is also faint and choppy, one knows there is retained food. It should be purged. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
This follows the previous context, setting up a Q&A to clarify the point through pulse diagnosis.
In cases of diarrhea where the pulse is surprisingly slippery, there is likely material to be expelled. Purging will lead to recovery. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
In cases of diarrhea where the pulse is slow and slippery, there is internal excess. As the diarrhea has not ceased, purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
These two clauses follow the previous context, elaborating on the matter through variations in pulse presentation.
If a patient suffers from abdominal fullness and pain, this constitutes an excess pattern. Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Excess" refers to the predominance of pathogenic factors.
If diarrhea recurs on the same month and day after recovery, it is because the pathogen was not completely eradicated. Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Qi" here refers to the cycle, specifically the passage of one year's months and days.
After Shanghan, if the pulse is deep (Chen), it indicates internal excess. Purging should be used to resolve it. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
The deep pulse diagnoses Yin conditions. Reiterating "deep" emphasizes that the pathology is profound and located in the interior Yin.
If the pulse is double-string-taut (Shuang Xuan) and slow, there will certainly be hardness in the epigastrium. If the pulse is large and tight, there is Yin within Yang. Purging may be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Double-string-taut" means both left and right pulses are taut. Tautness indicates Yin; slowness indicates Cold. Hardness in the epigastrium signifies exogenous Cold stagnating in the diaphragm region. A large pulse indicates deficiency of Yang; a tight pulse indicates predominance of Yin. Yang refers to the Fu organs; Yin refers to Cold. This describes Cold-Yin pathogens causing internal excess in the Stomach Fu organ.