大法。秋宜下。
（秋时阳气下行。则邪亦在下。故宜下。）
凡服下药。用汤胜丸。中病即止。不必尽剂也。
（汤之为言荡也。涤荡肠胃。溉灌脏腑。推陈燥结。却热下寒。破散邪疫。理导。润泽
枯槁
利。
下利。三部脉皆平。按之心下硬者。急下之。宜大承气汤。
（下利者。脉当微厥。今反和者。此为内实也。下利三部脉平者。已为实。而久按之。
心下
下利。脉迟而滑者。内实也。利未欲止。当下之。宜大承气汤。
（金匮要略曰。滑则谷气实。下利脉迟而滑者。胃有宿食也。脾胃伤食。不消水谷。是
致下
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
（寸以候外。尺以候内。浮以候表。沉以候里。寸口脉浮大者。气实血虚也。按之反涩。
尺
下利不欲食者。以有宿食故也。当下之。与大承气汤。
（伤食则恶食。故不欲食。如伤风恶风。伤寒恶寒之数也。）
下利瘥后。至其年月日复发者。以病不尽故也。当复下之。宜大承气汤。
（乘春。则肝先受之。乘夏。则心先受之。乘至阴。则心先受之。乘秋。则肺先受之。
假令
而痛也。
下利脉反滑。当有所去。下之乃愈。宜大承气汤。
（脉经曰。脉滑者。为病食也。下利脉滑。则内有宿食。故云当有所去。与大承气汤。
以下
病腹中满痛者。此为实也。当下之。宜大承气汤。
（金匮要略曰。病者腹满。按之不痛为虚。痛为实。可下之。腹中满痛者。里气壅实也。
故
伤寒后。脉沉。沉者。内实也。下解之。宜大柴胡汤。
（伤寒后。为表已解。脉沉为里未和。与大柴胡汤。以下内实。经曰。伤寒瘥以后。更
发热
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。
（金匮要略曰。脉双弦者。寒也。经曰。运为在脏。脉双弦而迟者。阴中伏阳也。必心
下硬
夫少阴病。得之口燥咽干。宜急下之。
夫伤寒病患。腹满不大便者。亦然。
夫伤寒病。腹中满痛者。为寒。当宜下之。
夫伤寒脉数而滑者。有宿食。当下之。则愈。
夫伤寒六七日。目中瞳子不明。无外证。大便难。微热者。此为实。宜急下之。
夫太阳病。七八日。脉微浮者。其人发狂。此下焦有热。小腹当坚而满。小便自利。下
血乃
夫阳明病。但头汗出。其身无汗。小便不利。渴引水浆。此为瘀热在里。身必发黄。宜
急下
夫伤寒有热。而小腹满者。小便反利。此为有蓄血。当宜下之。
夫伤寒病。五六日不大便。绕脐痛。烦躁汗出者。此为有结。汗出后。则暂解。日晡则
复发
夫伤寒。七八日。身黄如橘。小便不利。其腹微满者。宜下之。
夫阳明病。其人多汗。津液越出。胃中有热。大便必坚。宜下之。
夫伤寒大下后。六七日不大便。烦热不解。腹满如痛者。此有宿食。宜下之。
夫伤寒病。小便不利。大便乍难乍易。时有微热。不能卧。此胃中内有结燥故也。宜下
之
General principles. In autumn, purgation is appropriate.
(When Yang qi descends in autumn, pathogens also reside lower, thus purgation is suitable.)
When administering purgatives, decoctions are superior to pills. Stop when the disease is addressed; there is no need to finish the entire dose.
(The term "decoction" implies sweeping away; it cleanses the intestines and stomach, irrigates the zang-fu organs, pushes out old dryness and accumulation, eliminates heat and expels cold, breaks up scattered pathogens, regulates and guides, moistens withered states, and promotes bowel movement.)
In cases of diarrhea (xià lì), if the pulse at all three positions (cun, guan, chi) is peaceful but pressure on the epigastrium reveals hardness, urgent purgation is indicated. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(In diarrhea, the pulse should be faint or wiry-cold; the fact that it is now harmonious indicates internal excess. If the pulse at three positions is peaceful during diarrhea, it signifies an existing excess condition; prolonged pressure on the epigastrium...)
In cases of diarrhea, if the pulse is slow and slippery, it indicates internal excess. The diarrhea will not cease until purgation is applied. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(The Jing Gui Yao Lue states: A slippery pulse indicates substantial grain qi. A slow and slippery pulse during diarrhea indicates retained food in the stomach. Spleen and stomach injury from food retention leads to inability to digest water and grain, resulting in diarrhea.)
Question: How can one distinguish retained food (sù shí)? The Master said: The pulse at Cun Kou is floating and large, but feels choppy upon pressure; the Chi position is also slightly choppy. Thus, retained food is known to exist.
(Cun pulses reflect the exterior, Chi pulses reflect the interior; floating pulses reflect the exterior, deep pulses reflect the interior. A floating and large pulse at Cun Kou indicates Qi excess and Blood deficiency. Feeling choppy upon pressure...)
In cases of diarrhea accompanied by loss of appetite, it is due to retained food. Purgation is indicated. Administer Da Cheng Qi Tang (Great Order the Qi Decoction).
(Food injury causes aversion to food, hence loss of appetite, similar to how wind injury causes aversion to wind, and cold injury causes aversion to cold.)
If diarrhea recurs on the same month, day, or year after recovery, it is because the pathogen was not fully eradicated. Repeat purgation is indicated. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(During spring, the Liver is affected first; during summer, the Heart is affected first; during late summer, the Heart is affected first; during autumn, the Lung is affected first. For example... then pain occurs.)
If diarrhea presents with a surprisingly slippery pulse, it indicates something needs to be removed. Purging will lead to recovery. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(The Mai Jing states: A slippery pulse indicates food pathology. A slippery pulse during diarrhea indicates retained food internally, hence "something must be removed." Administer Da Cheng Qi Tang (Great Order the Qi Decoction). Below...)
If abdominal fullness and pain are present, this is an excess pattern. Purgation is indicated. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(The Jing Gui Yao Lue states: In patients with abdominal fullness, non-tenderness upon pressure indicates deficiency, while tenderness indicates excess; purgation may be used. Abdominal fullness and pain indicate congestion and excess of interior Qi, therefore...)
After Shang Han (Cold Damage), if the pulse is deep, it indicates internal excess. Resolve from the interior. Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate.
(After Shang Han, if the exterior is resolved but the pulse is deep, it indicates interior disharmony. Administer Da Chai Hu Tang (Major Bupleurum Decoction) to purge internal excess. The classics state: After recovery from Shang Han, if fever recurs...)
If the pulse is double-wiry and slow, there will likely be epigastric hardness. If the pulse is large and tight, there is Yin within Yang. Purgation may be used. Da Cheng Qi Tang (Great Order the Qi Decoction) is appropriate.
(The Jing Gui Yao Lue states: A double-wiry pulse indicates Cold. The classics state: Transformation resides in the Zang organs. A double-wiry and slow pulse indicates hidden Yang within Yin, leading to epigastric hardness...)
In Shao Yin disease, if dry mouth and throat occur, urgent purgation is indicated.
In Shang Han patients presenting with abdominal fullness and constipation, the situation is similar (urgent purgation is also indicated).
In Shang Han disease, if abdominal fullness and pain are present, it is due to cold-excess. Purgation is appropriate.
In Shang Han, if the pulse is rapid and slippery, it indicates retained food. Purgation is indicated for recovery.
In Shang Han, after six or seven days, if the eyes appear unclear, without external symptoms, difficulty in defecation, and slight fever are present, this is an excess pattern. Urgent purgation is indicated.
In Tai Yang disease, after seven or eight days, if the pulse is slightly floating, the patient becomes manic, indicating Heat in the Lower Jiao. The lower abdomen should be hard and full, urination is spontaneous, and bleeding [from the rectum] is required for resolution...
In Yang Ming disease, if only the head sweats while the body remains dry, urination is difficult, and thirst drives the intake of fluids, this indicates Stagnant Heat inside the body. Jaundice will inevitably develop. Urgent purgation is indicated...
In Shang Han, if there is fever and lower abdominal fullness, yet urination is surprisingly free, this indicates accumulated blood. Purgation is appropriate.
In Shang Han disease, if there is no defecation for five or six days, periumbilical pain, irritability, and sweating occur, this indicates a knotting/stagnation. Sweating provides temporary relief, but recurrence happens in the afternoon...
In Shang Han, after seven or eight days, if the body is yellow like an orange peel, urination is difficult, and the abdomen is slightly full, purgation is indicated.
In Yang Ming disease, if the patient sweats excessively, causing fluid leakage, and Heat exists in the Stomach, the stool will inevitably become hard. Purgation is indicated.
After severe purgation in Shang Han, if there is no defecation for six or seven days, unresolved irritability and heat, and abdominal fullness resembling pain, this indicates retained food. Purgation is indicated.
In Shang Han disease, if urination is difficult, stool is alternately hard and easy, slight fever occurs intermittently, and sleeplessness ensues, this is due to internal dryness and stagnation in the Stomach. Purgation is indicated...