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(The above content) is recorded in the Six Channels differentiation.

In general treatment principles, purgation (Xia Fa) is suitable in autumn.
[Annotation]
When heaven reaches autumn, the Qi descends; when things reach autumn, they bear fruit. When fruit is ripe, purgation is suitable. For any pathogenic factors located internally, one should follow this principle.
For conditions suitable for purgation, decoctions (Tang) are superior to pills and powders. Stop medication once the disease is addressed; there is no need to consume the entire dose.
[Annotation]
Decoctions act by sweeping away pathogens, while pills act slowly. Purgatives aim for rapid effect, hence decoctions are preferred over pills. "Stop when the disease is addressed" implies avoiding the consumption of the full dose to prevent damage to healthy Qi (Zheng Qi).
[Collected Annotations]
Cheng Yingmao stated: Using decoctions over pills values flexibility. Stopping when the disease is addressed demonstrates restraint.

If diarrhea occurs, and the pulse at the cun, guan, and chi positions on both hands is level/normal, but palpation of the epigastrium reveals hardness/fullness, urgent purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
Diarrhea accompanied by epigastric fullness/hardness typically belongs to the patterns treated by various Xi Xin Tang (Heart-Draining Decoctions). However, if the pulses at the cun, guan, and chi positions are level, solid, and forceful, despite the diarrhea, one should still attack the epigastric excess/fullness.
[Collected Annotations]
Fang Youzhi stated: The pulses at the three positions being level indicates that blood and Qi are harmonious. The epigastric fullness/hardness is an excess condition, hence urgent purgation is required.
Zhang Xiju stated: The classic text says: If there is spontaneous diarrhea, the pulse should be faint or cold. Now that the pulse is harmonious, this indicates internal excess, so purgation is indicated.

If diarrhea occurs, and the pulse is slow and slippery, it indicates internal excess. The diarrhea will not cease until purgation is performed. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
A slow pulse usually does not coexist with a slippery quality. However, superficial palpation may reveal a slow pulse while deep palpation reveals a slippery pulse. Here, "slow and slippery" refers to superficial slowness and deep slipperiness. Superficial slowness suggests external harmony, while deep slipperiness indicates internal excess. To stop diarrhea caused by internal excess, purgation is still required. Once the accumulation is removed, the diarrhea will cease spontaneously. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Cheng Yingmao stated: Slow and slippery, with slipperiness below and slowness above, indicates slowness due to obstruction, not cold-yin slowness. Therefore, only the obstruction needs to be purged. Once the internal excess is removed, the diarrhea will cease!

Q: How can one distinguish food retention (Su Shi) in a patient?
A: The pulse at the cun kou position is floating and large, but becomes choppy upon pressure. The chi position is also faint and choppy. Thus, food retention is known to exist, and purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Commentary]
The character "faint" (wei) in the chi position should likely be "large" (da). If it were "faint," purgation would absolutely be contraindicated.
[Annotation]
The pulse at the cun kou is floating and large, becoming choppy upon pressure, meaning it is large, choppy, and forceful upon pressing. This applies to the guan and chi positions as well. A large, choppy, and forceful pulse is a diagnostic sign of excess and lack of free flow, indicating food retention. Purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Cheng Zhi stated: Slippery pulse indicates food presence. If stagnation persists overnight, the pulse becomes choppy. The chi position reflects the interior, and deep palpation reflects the interior. Thus, the pulse for food retention is choppy upon pressure, and the chi position is large and choppy.

If diarrhea occurs accompanied by loss of appetite, it is due to food retention. Purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
Initial diarrhea with loss of appetite is due to food injury causing aversion to food. Long-term diarrhea with loss of appetite is due to spleen injury, causing postprandial fullness and loss of appetite. Since this case involves initial diarrhea with immediate loss of appetite, food retention is confirmed. Purgation is undoubtedly indicated. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Cheng Yingmao stated: Food injury causes aversion to food, distinguishing it from inability to eat. Diarrhea with this symptom, without other deficiency signs, indicates it is not diarrhea of the Three Yin channels, but diarrhea due to food retention. Hence, purgation is required.

If diarrhea resolves but recurs at the same time of year, month, day, or hour, it is because the pathogen was not fully eliminated. Purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
Recurrence of diarrhea at the specific time after resolution indicates that the food retention and accumulated pathogen were not fully cleared. If the patient's constitution and strength remain robust and appetite is strong, the remaining pathogen should be attacked to prevent recurrence. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Fang Youzhi stated: "Its period" refers to the cycle of one year's months, days, and hours.
Cheng Yingmao stated: After diarrhea resolves, residual pathogens lingering in the folds of the intestines and stomach are not fully cleared; this is called latent pathogen (Fu Xie). Whenever such symptoms appear, the latent pathogen extends accordingly, and purgation should be applied to search out and eliminate it completely.

If diarrhea occurs with a surprisingly slippery pulse, there is something to be expelled. Purging will lead to recovery. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
This elaborates on the previous clause regarding the pulse. A surprisingly slippery pulse during diarrhea indicates a mismatch between deficiency symptoms and excess pulse. If the patient's appearance and qi are normal, and diet is unchanged, it means there is accumulation that needs to be removed. Purging will lead to recovery. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Cheng Yingmao stated: Slippery pulse indicates excess, so the method of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) can be applied.

If abdominal fullness and pain occur, this is an excess condition. Purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
Abdominal pain without fullness may belong to deficiency. However, fullness combined with pain indicates excess. Purgation is required. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Collected Annotations]
Zhang Lu stated: Abdominal fullness and pain undoubtedly indicate excess knotting; urgent purgation is necessary.
Cheng Yingmao stated: Even if abdominal fullness and pain occur in the Yin channels, purgation can be used; it does not have to be Yangming disease.

After Shang Han (Cold Damage), if the pulse is sunken, sunken indicates internal excess. Purging will resolve it. Da Chai Hu Tang (Major Bupleurum Decoction) is indicated.
[Annotation]
If Shang Han remains unresolved with a sunken pulse, and the pulse is sunken and forceful, it indicates internal excess, which should be resolved via purging. However, the patient must have slight tidal fever in the afternoon, hence Da Chai Hu Tang (Major Bupleurum Decoction) is chosen to resolve both exterior and interior simultaneously.

If the pulse is double-string-taut (shuang xian) and slow, there must be epigastric fullness/hardness. If the pulse is large and tight, it indicates yang containing yin. Purgation is possible. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.
[Annotation]
"Double-string-taut" refers to the string-taut (xian) pulse appearing at both the left guan and right guan positions. Left guan string-taut is the liver's native pulse; right guan string-taut indicates wood insulting earth. String-taut indicates fluid retention; slow indicates cold. Epigastric fullness/hardness here is caused by liver pathogen combining with cold-fluid retention to injure the stomach, so purgation is contraindicated; this is a pattern for Sheng Jiang Xi Xin Tang (Fresh Ginger Heart-Draining Decoction). If the pulse is large and tight upon pressure, it indicates excess yang and excess yin. This is excess-type fullness/hardness, distinct from stomach injury, so purgation is permitted. Da Cheng Qi Tang (Major Order the Golden Decoction) is indicated.