具见六经中。
大法∶秋宜下。
【注】天至秋则气降，物至秋则成实，实则宜下。凡邪在下者，俱宜取法乎此义也。
凡可下者，用汤胜丸散，中病便止，不必尽剂也。
【注】汤者荡也，丸者缓也。下药贵速，故凡服下药用汤，所以胜丸也。中病即止，不必尽剂者，恐尽
剂反伤其正气也。
【集注】程应旄曰∶用汤胜丸，贵活法也。中病即止，示节制也。
下利，三部脉皆平，按之心下硬者，急下之，宜大承气汤。
【注】下利心下硬者，诸泻心汤证也。若寸、关、尺三部脉平实有力，虽下利仍宜攻其硬也。
【集注】方有执曰∶三部脉皆平，血气和可知矣。心下硬实也。所以急下之也。
张锡驹曰∶《本经》云∶若自下利者，脉当微厥。今反和者，此为内实也，宜下之。
下利，脉迟而滑者，内实也。利未欲止，当下之，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，仍当下之，使积去则利自止，宜大承气汤。
【集注】程应旄曰∶迟而滑，滑在下而迟在上，知为物阻之迟，非寒阴之迟，故但下其所阻，则内实去而
利自止矣！
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。
【按】尺中“微”字，当是“大”字，若是“微”字，断无当下之理。
【注】寸口脉浮而大，按之反涩，谓按之且大、且涩、且有力也，关上尺中亦然。大涩有力，为实而不利
之诊，故知有宿食也，当下之，宜大承气汤。
【集注】程知曰∶滑为有食，结滞经宿，则脉涩矣。尺以候内，沉以候里，故宿食之脉，按之反涩，尺中
亦大而涩也。
下利不欲食者，以有宿食故也，当下之，宜大承气汤。
【注】初下利不欲食者，是伤食恶食，故不欲食也，若久下利不欲食者，是伤脾，食后饱胀不欲食也。今
初下利即不欲食，故知有宿食也，当下之，宜大承气汤无疑也。
【集注】程应旄曰∶伤食恶食，故不欲食，与不能食者自别。下利有此，更无别样虚证，知非三阴之下
利，而为宿食之下利也，故当下之。
下利瘥，至其年月日时复发者，以病不尽故也，当下之，宜大承气汤。
【注】下利瘥后，至其年月日时而复发其利者，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，自不复发矣，宜大承气汤。
【集注】方有执曰∶其期也，谓周其一年之月日期也。
程应旄曰∶下利瘥后，而余邪之栖于肠胃回折处者未尽，是为伏邪。凡得其候而伏者，仍应其候而伸下，
则搜而尽之矣。
下利脉反滑，当有所去，下乃愈，宜大承气汤。
【注】此承上条互发其义，以详其脉也。下利脉反滑，是证虚脉实，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】程应旄曰∶滑为实，故可行通因通用之法。
病腹中满痛者，此为实也，当下之，宜大承气汤。
【注】腹中不满而痛者，病或属虚，若满而痛，则为实矣，当下之，宜大承气汤。
【集注】张璐曰∶腹中既满且痛，为实结无疑，急须下之。
程应旄曰∶病腹中满痛，虽在阴经，亦可下，不必其为阳明矣。
伤寒后脉沉，沉者，内实也，下之解，宜大柴胡汤。
【注】伤寒后不解，脉沉，沉而有力者，内实也，宜以下解。然其人必午后小有潮热，故取大柴胡两解之也。
脉双弦而迟者，必心下硬，脉大而紧者，阳中有阴也，可下之，宜大承气汤。
【注】双弦，谓左关、右关皆见脉弦也。左关脉弦，肝本脉也；右关脉弦，木刑土也。弦者，饮也；迟者，
寒也。心下硬者，是肝邪挟寒饮而伤胃，故不可下，乃生姜泻心汤证也。若脉大按之紧，是阳有余而阴亦实也，
乃有余之硬，非胃伤者比，故可下之，宜大承气汤也。
These manifestations are found throughout the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin).
General Principle: In autumn, purgation is appropriate.
[Annotation] When heaven reaches autumn, Qi descends; when things reach autumn, they become ripe and solid. When solid, purgation is appropriate. For any pathogenic factors located internally, one should follow this principle.
For conditions suitable for purgation, decoctions 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 and clearing, while pills act slowly. Purgatives require speed; therefore, using decoctions for purgatives is superior to pills. Stopping when the disease is addressed, without consuming the full dose, prevents the risk of damaging healthy Qi by overdosing.
[Collected Annotations] Cheng Yingmao stated: Using decoctions over pills values flexibility. Stopping when the disease is addressed demonstrates moderation.
If diarrhea occurs, and the pulses at the Cun, Guan, and Chi positions are all level, but palpation reveals hardness in the epigastrium, urgent purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Diarrhea accompanied by epigastric hardness typically belongs to the patterns treated by various Xiexin Tang (Drain the Epigastrium Decoctions). However, if the pulses at the Cun, Guan, and Chi positions are level, substantial, and forceful, despite the presence of diarrhea, one should still purge the hardness.
[Collected Annotations] Fang Youzhi stated: Level pulses at all three positions indicate harmonious Blood and Qi. The hardness in the epigastrium indicates excess. Hence, urgent purgation is necessary.
Zhang Xiju stated: *Shennong Bencao Jing* states: If there is spontaneous diarrhea, the pulse should be faint or cold. Since the pulse is now harmonious, this indicates internal excess, and purgation is appropriate.
If diarrhea occurs with a slow and slippery pulse, it indicates internal excess. As the diarrhea has not ceased, purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] A pulse is rarely both slow and slippery simultaneously. This condition exists only when superficial palpation feels slow and deep palpation feels slippery. Here, "slow and slippery" refers to superficial slowness and deep slipperiness. Superficial slowness indicates 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 Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Slow and slippery; the slipperiness is lower and the slowness is upper. This indicates slowness due to obstruction, not cold-Yin slowness. Therefore, purging the obstruction removes the internal excess, and the diarrhea stops naturally.
Q: How can one distinguish a patient suffering from retained food (Su Shi)?
A: The Cun Kou pulse is floating and large, but upon pressure, it feels choppy. The Chi position is also slightly large and choppy. Thus, retained food is known to exist, and purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Commentary] The character "faint" (Wei) in "Chi position is faint" should likely be "large" (Da). If it were "faint," there would absolutely be no rationale for purgation.
[Annotation] The Cun Kou pulse being floating and large, yet choppy upon pressure, means that upon pressing, it is large, choppy, and forceful. The same applies to the Guan and Chi positions. Large, choppy, and forceful is a pulse of excess without free flow, indicating retained food. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Zhi stated: Slippery pulses indicate food retention. After lingering overnight, the pulse becomes choppy. The Chi position reflects the interior, and deep palpation reflects the interior. Thus, for retained food, the pulse is choppy upon pressure, and the Chi position is large and choppy.
If diarrhea occurs with an aversion to eating, it is due to retained food. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Initial diarrhea with an aversion to eating indicates food injury causing disgust for food. Long-term diarrhea with an aversion to eating indicates Spleen injury causing postprandial fullness. Here, initial diarrhea accompanied by an aversion to eating indicates retained food. Purging is undoubtedly required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Food injury causes disgust for food, which differs from inability to eat. Diarrhea presenting this way, without other deficiency signs, indicates it is not a Three-Yin diarrhea but a diarrhea due to retained food. Therefore, purging is required.
If diarrhea resolves but recurs at the specific year, month, day, or hour, it is because the pathogen was not completely eliminated. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Recurrence of diarrhea at the original time after resolution indicates that the pathogenic factor of retained food accumulation was not fully eradicated. If the patient's physical constitution and appetite remain strong, one should purge the remaining pathogen to prevent recurrence. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Fang Youzhi stated: "Period" refers to the annual cycle.
Cheng Yingmao stated: After diarrhea resolves, residual pathogens may linger in the folds of the intestines and stomach, termed latent pathogens. When the corresponding climatic conditions arise, these latent pathogens extend. Applying purgation at such times searches them out completely.
If diarrhea presents with a surprisingly slippery pulse, there is accumulation to be expelled. Purging leads to recovery. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] This elaborates on the previous clause regarding the pulse. A slippery pulse during diarrhea indicates a mismatch between deficiency symptoms and excess pulses. If the patient's physique and diet remain normal, it implies unremoved accumulation. Purging is required for recovery. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Slippery pulses indicate excess, so the method of "treating obstruction with draining methods" (Tong Yin Tong Yong) can be applied.
If abdominal fullness and pain occur, this is excess. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Abdominal pain without fullness may belong to deficiency. Fullness combined with pain indicates excess. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Zhang Lu stated: Abdominal fullness and pain undoubtedly indicate excess stagnation; urgent purging is necessary.
Cheng Yingmao stated: Abdominal fullness and pain can be treated with purgation even in Yin channels, not limited to Yangming channel diseases.
After Shanghan (Cold Damage), if the pulse is Chen (Deep), it indicates internal excess. Purging resolves it. Dachaihu Tang (Major Bupleurum Decoction) is indicated.
[Annotation] Unresolved Shanghan with a Deep pulse that is forceful indicates internal excess, resolvable by purging. However, the patient likely experiences mild tidal fever in the afternoon. Therefore, Dachaihu Tang (Major Bupleurum Decoction) is chosen to resolve both exterior and interior.
If the pulses at both Guan positions are Xuan (Wiry) and Chi (Slow), there must be epigastric hardness. If the pulse is Da (Large) and Jin (Tight), there is Yang containing Yin. Purging is possible. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] "Double Xuan" means the Left Guan and Right Guan pulses are both Wiry. Left Guan Wiry is the Liver's native pulse; Right Guan Wiry indicates Wood insulting Earth. Xuan pulses indicate fluid retention; Chi pulses indicate Cold. Epigastric hardness here is caused by Liver pathogen combining with cold-fluid to injure the Stomach, so purging is contraindicated; this is a pattern for Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction). If the pulse is Large and tight upon pressure, it indicates excess Yang and excess Yin. This is hardness due to excess, distinct from Stomach injury, so purging is permissible. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.