（见痉病中）
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下利，脉迟而滑者，实也，利未欲止，急下之，宜大承气汤。
【注】
脉迟不能兼滑，惟浮取之迟，沉取之滑，则有之矣。今下利脉迟而滑，谓浮迟而沉滑
也。浮迟则外和，沉滑则内实。欲止内实之下利，当下之，积去则止，宜大承气汤。
【集注】
尤怡曰：脉迟为寒，然与滑俱见，则不为寒而反为实，以中实有物，能阻其脉迟行。
夫利因实而致者，实不去则利不止，故宜急下。
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下利，脉反滑者，当有所去，下乃愈，宜大承气汤。
【注】
下利脉反滑者，是病脉实，不相宜也。若其人形气如常，饮食如故，乃有当去之积未
去也，下之乃愈，宜大承气汤。
【集注】
赵良曰：下利虚证也，脉滑实脉也，以下利之虚证，而反见滑实之脉，故当有所去也
。
程林曰：经云：滑为有宿食，故当下，去之而利自止矣。
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下利已差，至其年月日时复发者，以病不尽故也，当下之，宜大承气汤。
【注】
下利差后，至其或年、或月、或日而复发其利者，此宿食积病，攻之不尽故也。若其
人形气不衰，饮食尚强，当攻其未尽，自不复发其利也，宜大承气汤。
【集注】
沈明宗曰：此旧积之邪复病也。下利差后，至其年月日时复发者，是前次下利之邪，
隐僻肠间，今值藏府司令期，触动旧邪而复发；无隐僻之根未除，终不能愈，故用大
承气迅除之耳。
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下利谵语者，有燥屎也，小承气汤主之。
【注】
下利里虚证也，谵语里实证也，何以决其有燥屎也？若脉滑数，知有宿食也；其利秽
粘，知有积热也；然必脉证如此，始可知其有燥屎也，宜下之以小承气汤。于此推之
，而燥屎又不在大便□不□也。
【集注】
李□曰：经曰：实则谵语，故知有燥屎宜下。
(See the section on Spasm Diseases)
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In cases of diarrhea with a slow and slippery pulse, it indicates an excess condition. The diarrhea will not cease spontaneously; urgent purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
A slow pulse typically does not coexist with a slippery one. This combination exists only when the pulse feels slow upon superficial palpation (floating) but slippery upon deep palpation (sinking). Thus, "slow and slippery" in this context refers to superficially slow and deeply slippery. Superficial slowness suggests harmony at the exterior, while deep slipperiness indicates internal excess. To stop diarrhea caused by internal excess, purgation should be employed; once the accumulation is removed, the diarrhea will cease. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
You Yi stated: A slow pulse usually indicates cold. However, when seen together with a slippery pulse, it indicates excess rather than cold, because physical matter inside obstructs the flow, causing the pulse to appear slow. Since the diarrhea is caused by excess, if the excess is not removed, the diarrhea will not stop. Therefore, urgent purgation is appropriate.
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In cases of diarrhea where the pulse is surprisingly slippery, there are pathogenic factors that need to be expelled. Healing will occur after purgation, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
Diarrhea with a surprisingly slippery pulse indicates that the disease presents an excess pattern, which is inconsistent with typical deficiency-type diarrhea. If the patient's physique and vital energy remain normal, and their appetite is unchanged, it implies that there are accumulations that should be removed but have not yet been. Purgation will lead to recovery, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
Zhao Liang stated: Diarrhea is generally a deficiency syndrome, whereas a slippery pulse is an excess pulse. Seeing an excess pulse in the context of a deficiency syndrome like diarrhea indicates that there are pathogenic factors to be expelled.
Cheng Lin stated: The Classics state: "Slipperiness indicates retained food." Therefore, purgation is required; once the retention is removed, the diarrhea will stop naturally.
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If diarrhea has resolved but recurs at specific years, months, days, or hours, it is because the pathogen was not completely eradicated. Purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
When diarrhea recurs after resolution, whether at a specific year, month, or day, it is due to incomplete removal of retained food and accumulated pathogens. If the patient's constitution and strength are robust and their diet remains strong, the remaining pathogenic factors should be attacked to prevent recurrence of the diarrhea. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
Shen Mingzong stated: This is a recurrence of illness due to old accumulated pathogens. After the resolution of diarrhea, recurrence at specific times occurs because the pathogens from the previous episode hid in the hidden parts of the intestines. When the governing period of the zang-fu organs arrives, these old pathogens are triggered and cause recurrence. Without removing the hidden root, complete cure is impossible; thus, Da Cheng Qi Tang (Major Order the Qi Decoction) is used to swiftly eliminate them.
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In cases of diarrhea accompanied by delirious speech, there is dry fecal impaction. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is the primary treatment.
[Annotation]
Diarrhea is typically a interior deficiency syndrome, while delirious speech is an interior excess syndrome. How can we determine the presence of dry fecal impaction? If the pulse is slippery and rapid, it indicates retained food; if the excrement is foul and sticky, it indicates accumulated heat. Only when both pulse and symptoms align can we confirm the presence of dry fecal impaction. Purgation is indicated, using Xiao Cheng Qi Tang (Minor Order the Qi Decoction) as the main formula. From this, we can infer that dry fecal impaction does not necessarily manifest as constipation.
[Collected Annotations]
Li [Name obscured] stated: The Classics say: "Excess leads to delirious speech." Therefore, knowing there is dry fecal impaction, purgation is indicated.