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The purgative method is the method of attacking and eliminating pathogenic factors. When the disease is in the exterior, use diaphoresis (sweating method); when it is in the half-exterior and half-interior, use harmonization; when it is in the interior, use purgation.

However, there are cases where failing to use purgation when indicated causes harm, and cases where using purgation when not indicated causes harm. There are cases where purgation is indicated but should not be used recklessly, yet reckless purgation causes harm. There are cases where purgation is indicated but should not be used recklessly, yet it must be used, and improper technique causes harm. There are cases where purgation is indicated, but ignorance of depth and degree, failure to distinguish between constipation and blood stasis, and lack of distinction between decoctions and pills cause harm. Furthermore, in treating miscellaneous diseases, failure to differentiate between cold and heat, food stagnation, phlegm, water retention, parasites, blood stasis, abscesses, and pus causes harm. Why is this?

What is meant by "failing to purge when one should" (indications for purgation present but not utilized)? Zhang Zhongjing stated: In Shaoyin disease, if after two or three days there is dryness of the mouth and throat, urgent purgation is required. In Shaoyin disease, if after six or seven days there is abdominal fullness and constipation, urgent purgation is required. If there is diarrhea with a slippery and rapid pulse, anorexia, and hardness upon pressure at the epigastrium, indicating retained food, urgent purgation is required. In Yangming disease, if there is delirium and inability to eat, indicating dry fecal matter in the stomach, purgation may be used. In Yangming disease, if there is fever and profuse sweating, urgent purgation is required. In Shaoyin disease, if there is diarrhea of clear watery stool, purely green in color, pain in the epigastrium, and dry mouth, urgent purgation is required. In Shanghan (Cold Damage) disease, if after six or seven days there is unclear vision and unsteady eyeballs, without exterior symptoms, but with difficult defecation, urgent purgation is required. These are all examples where immediate purgation is indicated. If the opportunity is missed and purgation is not used, body fluids will be exhausted, the body will become like dead wood, and the condition will be irretrievable.

However, there are cases where purgation is not indicated but is used. Why is this? For instance, if the exterior syndrome of Shanghan has not resolved, and the pathogen is still in the Yang channels, using purgation will result in Jie Xiong (Chest Binding). Although the pathogen has entered the interior, if it is scattered among the Three Yin channels and has not yet solidified, hasty purgation will result in Pi Qi (Epigastric Fullness and Obstruction). Moreover, in cases of Yin Constipation, the stool may be hard but moves with warmth, resembling melting ice; additionally, in miscellaneous diseases, there are elderly people with dry blood causing difficulty in defecation, postpartum women with depleted blood causing difficulty in defecation, patients who have lost body fluids due to illness, those who have suffered hemorrhage, and those who have not had a bowel movement for many days but have no abdominal discomfort or other symptoms. If purgation is mistakenly used, various complications will arise. This is what is meant by "purging when one should not."

However, there are cases where purgation is indicated but contraindicated. Why is this? Even if heat pathogens have transmitted to the interior and indications for purgation exist, if there is pulsation (Dong Qi) above, below, to the left, or to the right of the umbilicus, purgation must not be used. The classics state: If Dong Qi is on the right, do not purge, as this will deplete internal fluids, leading to dry throat and nose, dizziness, and palpitations. If Dong Qi is on the left, do not purge, as this will lead to abdominal tension, inability to eat, worsening of pulsation, and even if there is fever, the patient will wish to curl up while lying down. If Dong Qi is above, do not purge, as this will lead to hot palms, edema with sweating, and a desire to pour water over oneself. If Dong Qi is below, do not purge, as this will lead to abdominal distension and dizziness, undigested food in stool, and epigastric obstruction. Furthermore, those with throat closure cannot be purged; doing so leads to lower deficiency and upper excess, inability to take fluids, curling up, body ache, and frequent diarrhea. Those with weak pulses cannot be purged. Those with floating and large pulses that are empty upon pressure cannot be purged. Those with slow pulses cannot be purged. Those with wheezing and chest fullness cannot be purged. Those who feel the urge to vomit cannot be purged. Patients with inherently deficient Yang Qi cannot be purged, as this will cause hiccups. Patients with inherently weak stomachs who cannot eat cannot be purged. Patients who can eat during illness indicate no dry fecal matter in the stomach, so they cannot be purged. Those with clear urine cannot be purged. Patients whose abdominal fullness decreases intermittently but returns cannot be purged. Mistaken purgation will lead to numerous complications. This is what is meant by "purging when one should not, yet doing so recklessly."

However, there are cases where purgation is indicated but contraindicated, yet it becomes necessary. Why is this? For frail individuals with thin, weak pulses, once attacked by heat pathogens, this represents deficiency of healthy Qi and excess of pathogenic factors, which is difficult to manage. Ancients employed clearing methods, moistening methods, guiding methods, mild harmonizing methods, methods of tonifying before attacking or attacking before tonifying, and methods of simultaneous tonification and purgation. These require study. For example, San Huang Jie Du Tang (Three Yellow Antidote Decoction) clears heat. Hemp seed combined with pear juice moistens dryness. Honey suppositories, pig bile, and Gynostemma rhizome guide accumulation. Liang Ge San (Cool the Upper Jiao Powder) and Da Chai Hu Tang (Major Bupleurum Decoction) provide mild harmonization. For those with weak pulses and bodies too frail to tolerate strong medicines, one may tonify first then attack, or temporarily attack then tonify, or use Ren Shen Tang (Ginseng Decoction) to administer San Huang Zhi Zhu Wan (Three Yellow and Atractylodes Pill). Alternatively, use Ren Shen (Ginseng), Gua Lou (Trichosanthes Fruit), and Zhi Shi (Immature Bitter Orange) to combine attacking and tonifying without conflict. Generally, when administering harsh purgatives, include Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), and Bai Shao (White Peony Root) to support and protect, allowing pathogens to dissipate quietly while healthy Qi remains secure. This is worthy of being called the "army of kings." Regarding miscellaneous diseases with constipation, reference these principles. Elderly people, chronic patients, and postpartum women often suffer from constipation. Zhu Danxi used Si Wu Tang (Four Substance Decoction); Li Dongyuan used Tong You Tang (Unblocking the Lower Orifice Decoction). I have combined and adjusted them, adding Cong Rong (Cistanche Stem), Gou Qi (Goji Berry), Bai Zi Ren (Biota Seed), Sesame, Pine Kernel, Human Milk, Pear Juice, and Honey, achieving immediate results. I have also added Sheng Ma (Cimicifuga Rhizome) to Si Wu Tang along with moistening herbs to treat elderly people with blood depletion who feel the urge to defecate but cannot, often with success. These are gentle unblocking methods. If the person is indeed deficient, even if there is transmitted heat, borrow these mild methods rather than violently attacking and damaging true Yuan Qi, leading to severe diarrhea. Although attributed to fate, is it not human error? This illustrates that "purgation requires proper technique."

However, there are cases where purgation is indicated, but ignorance of depth, failure to distinguish between constipation and blood stasis, and lack of distinction between decoctions and pills cause harm. Why is this? For example, Zhang Zhongjing's Da Cheng Qi Tang (Major Order the Qi Decoction) is only used when Pi (stuffy sensation), Man (fullness), Zao (dryness), and Shi (solidity) are all present. If there is only Pi and Man without Zao and Shi, Zhang Zhongjing uses Xie Xin Tang (Drain the Epigastrium Decoction). If there is Pi and Man with Zao but without Shi, he uses Xiao Cheng Qi Tang (Minor Order the Qi Decoction). Removing Mang Xiao (Mirabilite) prevents damage to the Yin blood of the Lower Jiao. If Zao and Shi are in the Lower Jiao with mild Pi and Man, he uses Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction). Removing Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) prevents damage to the Yang Qi of the Upper Jiao. Additionally, if Taiyang Wind Strike is mistakenly purged and transmits to Taiyin, causing abdominal pain, Gui Zhi Tang (Cinnamon Twig Decoction) plus Shao Yao (Peony Root) is used. If there is severe pain, Gui Zhi Tang plus Da Huang (Rhubarb Rhizome) is used, combining exterior release with interior purgation. If pathogens come from Shaoyang with unresolved chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is used, combining harmonization with interior purgation. For Jie Xiong (Chest Binding) with stiff neck and back, hardness and pain from chest to abdomen, and tenderness to touch, Zhang Zhongjing uses Da Xian Xiong Tang/Pill (Major Trap the Chest Decoction/Pill). If there is no pain upon pressure, Xiao Xian Xiong Tang (Minor Trap the Chest Decoction) is used. For Cold-Food Jie Xiong, San Bai San (Three Whites Powder) is used to attack with cooling properties. For Water-Jie Xiong with sweating on the head, Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia Plus Poria Decoction) is used. For water retention in the hypochondrium with unbearable pain, Shi Zao Tang (Ten Jujube Decoction) is used. For both Yin and Yang types of Jie Xiong where medication fails, *Huo Ren* recommends Zhi Shi Li Zhong Wan (Immature Bitter Orange and Gastrodia Pill), which works effectively. *He Jian San Shu* states: Severe郁热 (depressed heat) accumulation causing coma and cold limbs, with stagnant, fine, almost imperceptible pulses, is misunderstood by laypeople who use warming medicines, leading to death; or reckless purgation causes sudden destruction of residual Yin, a critical situation. Neither purging nor not purging is safe; use Liang Ge San (Cool the Upper Jiao Powder) combined with Jie Du Tang (Antidote Decoction) to nourish Yin, retreat Yang, and disperse accumulated heat, restoring comfort and pulse generation. These illustrate the sequence of drug depth. For example, if Taiyang syndrome persists with thirst, scanty dysuria, and normal stool, it is dysuria obstruction, treated with Wu Ling San (Five-Ingredient Powder with Poria). If Taiyang transmits to its interior, heat binds to the Bladder, causing mania-like behavior, lower abdominal hardness/pain, and free urination, this is Lower Jiao Blood Stasis, treated with Di Dang Tang/Pill (Di Dang Decoction/Pill). If blood stasis is mild with only lower abdominal urgency without hardness, Tao He Cheng Qi Tang (Peach Pit Order the Qi Decoction) is used. Or use Sheng Di Si Wu Tang (Rehmannia Four Substance Decoction) with wine-washed Da Huang (Rhubarb Rhizome), which is safer. Dysuria presents with normal stool; dry feces present with difficult urination; blood stasis presents with free urination and black stool. This distinguishes dysuria from blood stasis. Blood binding in the Bladder is most acute, requiring Di Dang Tang; slightly milder cases require Di Dang Pill. Complete Jie Xiong evil signs require Da Xian Xiong Tang; slightly milder cases require Da Xian Xiong Pill. Other methods of cleansing the intestines and stomach, pushing out the old and generating the new, use decoctions. Ancients said: When using purgatives to attack pathogens, decoctions surpass pills and powders. Indeed, for heat rampant within, liquid decoctions cleanse most effectively. This distinguishes decoctions from pills.

However, there are cases in miscellaneous diseases where failure to differentiate cold/heat, stagnation, phlegm, water, parasites, blood, abscesses, and pus causes harm. Why is this? Li Dongyuan treated food injury with abdominal pain, constipation, and refusal of pressure. If caused by cold food, Jian Pi Wan (Spleen-Strengthening Pill) was used; if by hot food, San Huang Zhi Zhu Wan (Three Yellow and Atractylodes Pill) was used. If both cold and heat were injured, the two pills were used alternately based on quantity eaten, achieving immediate effect. For stubborn phlegm with excess heat, Gun Tan Wan (Rolling Phlegm Pill) was used; for excess-type edema, Shen You Wan (Divine Protection Pill) was used; for parasite accumulation, Jian Hong Wan (Cut Red Pill) was used; for blood accumulation, Hua Rui Dan (Flower Nodule Elixir) and Shi Xiao Wan (Instant Pain-Relief Pill) were used; for intestinal abscess, Mu Dan Pi San (Moutan Bark Powder) was used. Prescriptions varied according to symptoms, each having its appropriateness. Modern mediocre physicians ignore these methods, viewing purgation as a fearful path, and patients view it as poison, leaving critical heat syndromes untreated and attributing outcomes to fate, which is tragic. Zhang Zihe in *Ru Men Shi Qin* proposed three methods, equating purgation with tonification, stating that removing pathogens allows healthy Qi to recover naturally, and that grains, meats, fruits, and vegetables are all nourishing. Although his views did not fully align with contemporary customs, the method of attacking pathogens is indispensable. I hope students reflect calmly, grasp the essentials, and apply these remedies to save lives, bringing people to longevity is not difficult.