宿食不消当下之。寸口浮大尺中微。（人病有宿食。何以别之。师曰。寸口脉浮大。按之反涩。尺中亦微而涩。当下
之。承气汤主之。）阳明瘀热茵陈证。（仲景云。阳明瘀热在里。身必发黄。宜茵陈蒿汤主之。）谵语柴胡汤最宜。（金匮
云。汗出而谵语者。有燥屎在胃中。此风也。过经乃下之。宜大承气汤。大柴胡汤。）结胸大陷胸丸对。瘀血抵当不可迟。
（结胸。宜大陷胸下之。瘀血。宜抵当丸下之。）大便坚硬惟承气。痞气泻心汤勿疑。（大便坚硬。宜下以承气汤。痞气
虚靳。宜下以泻心汤。）脉若阳微下则痞。（自此以下不可下也。金匮云。阳微不可下。下之则心下痞坚。）或兼虚细更难
之。（仲景云。脉微不可吐。虚细不可下。）结胸浮大下之死。（金匮云。结胸证。其脉浮大者。不可下。下之则死。）四
逆若下命倾危。（金匮云。四逆厥者不可下。下之则死。虚家亦然。）恶寒自是有表证。（恶寒者。表证在。不可下。）呕
吐仍兼胃气亏。（仲景云。病吐者。不可下之。）不转失气必溏利。（仲景云。阳明病。不大便六七日。恐有燥屎。欲知之
法。可与小承气汤。若腹中转失气者。为有燥屎。乃可攻之。若不转失气者。此但头硬后必溏泄。不可下。）阳明自汗下
难为。（阳明自汗。小便利。此为津液内竭。虽坚不可攻。宜用蜜煎导之。）咽中闭塞尤须忌。（玉函经云。咽中闭塞。不
可下。下之则上轻下重。卧则欲蜷身急痛。）趺阳浮数已虚脾。（仲景云。趺阳脉浮而数。浮则伤胃。数则动脾。此非本
病。医特下之所为也。）左右上下有动气。更在调和仔细医。（仲景云。动气在右。下之则津液内竭。咽燥鼻干。头眩心
悸。动气在左。下之则腹满气急。动气在上。下之则掌握热烦。动气在下。下之则腹满卒起头眩。）
宿食停滞不消化，应当使用攻下法。寸口脉浮大，尺中脉微弱。（如果病人有宿食积滞，如何辨别？老师说：寸口脉浮大，重按反而涩滞，尺中脉也微弱而涩滞。此时应当攻下，用承气汤主治。）阳明瘀热发黄证。（张仲景说：阳明病瘀热蕴结在体内，身体必然发黄，适宜用茵陈蒿汤主治。）谵语症状最宜用柴胡汤。（《金匮要略》说：出汗且出现谵语的，胃中有燥屎，这是风邪所致。待经过传变阶段后才可攻下，适宜用大承气汤或大柴胡汤。）结胸证适宜用大陷胸丸治疗。瘀血证用抵当汤不可迟缓。（结胸证，适宜用大陷胸汤攻下；瘀血证，适宜用抵当丸攻下。）大便坚硬只用承气汤。痞满证用泻心汤不要犹豫。（大便坚硬，适宜用承气汤攻下；痞满证因正气虚弱，适宜用泻心汤调理。）脉象若见阳气微弱，误用攻下会导致痞满。（从以下开始讲述不可攻下的情况。《金匮要略》说：阳气微弱者不可攻下，误下则会导致心下痞塞坚硬。）或者兼见虚细脉象更难攻下。（张仲景说：脉微者不可吐，脉虚细者不可攻下。）结胸证若脉浮大，攻下会致死。（《金匮要略》说：结胸证，如果脉象浮大，不可攻下，误下则会死亡。）四逆厥冷证若误攻下，性命危殆。（《金匮要略》说：四肢厥逆者不可攻下，误下则会死亡，体虚之人也是如此。）恶寒说明表证依然存在。（有恶寒症状，说明表证存在，不可攻下。）呕吐仍兼有胃气亏损。（张仲景说：患病呕吐者，不可攻下。）不转矢气必然导致溏泄。（张仲景说：阳明病，六七天不大便，担心有燥屎。想要知道是否有燥屎的方法，可以给予小承气汤。如果腹中转出矢气，说明有燥屎，才可以攻下。如果不转矢气，这仅仅是大便头硬，后面必然溏泄，不可攻下。）阳明病自汗出，攻下难以奏效。（阳明病自汗出，小便通利，这是因为津液在内枯竭，虽然大便坚硬也不可攻下，适宜用蜜煎导法通便。）咽喉闭塞尤其需要禁忌。（《玉函经》说：咽喉闭塞，不可攻下，误下则会导致上虚下实，躺下时想蜷缩身体且急痛。）趺阳脉浮数显示脾气已虚。（张仲景说：趺阳脉浮而数，浮则伤胃，数则动脾，这不是本来的病，是医生误用攻下造成的。）左右上下有动气，更应仔细调和医治。（张仲景说：动气在右侧，攻下则津液内竭，咽干鼻燥，头晕心悸；动气在左侧，攻下则腹胀气急；动气在上部，攻下则手心发热烦躁；动气在下部，攻下则腹胀突然起身头晕。）
Food stagnation that fails to digest requires purgation. The Cun (inch) position pulse is floating and large, while the Chi (cubit) position pulse is faint. (If a patient has retained food, how can it be distinguished? The Master said: The Cun position pulse is floating and large, but feels rough upon deep pressure; the Chi position pulse is also faint and rough. Purgation should be applied at this time, with Chengqi Tang as the primary formula.) Yangming syndrome with stagnant heat causing jaundice. (Zhang Zhongjing stated: When Yangming stagnant heat is trapped in the interior, the body will inevitably turn yellow. Yinchen Hao Tang is appropriate for treatment.) For delirium, Chaihu Tang is most suitable. (The *Jin Gui Yao Lue* states: If there is sweating accompanied by delirium, dry feces are present in the stomach; this is due to wind pathogen. Purging should only be performed after the disease has passed through its stages. Da Chengqi Tang or Da Chaihu Tang are appropriate.) For Jie Xiong (chest binding), Da Xianxiong Wan is indicated. For blood stasis, Didang Tang must not be delayed. (For Jie Xiong, Da Xianxiong Tang is used for purging; for blood stasis, Didang Wan is used for purging.) For hard stool, only Chengqi Tang should be used. For Pi Qi (fullness obstruction), Xiexin Tang should be used without hesitation. (For hard stool, Chengqi Tang is used for purging; for Pi Qi caused by deficiency, Xiexin Tang is used for regulation.) If the pulse indicates deficient Yang, purging will lead to fullness obstruction. (From here onwards, conditions where purging is contraindicated are discussed. The *Jin Gui Yao Lue* states: One with deficient Yang cannot be purged; doing so results in epigastric fullness and hardness.) If accompanied by a deficient and thin pulse, purging is even more difficult. (Zhang Zhongjing stated: A faint pulse prohibits emesis; a deficient and thin pulse prohibits purging.) For Jie Xiong with a floating and large pulse, purging leads to death. (The *Jin Gui Yao Lue* states: In Jie Xiong syndrome, if the pulse is floating and large, purging is contraindicated; doing so leads to death.) For Sini (cold extremities) syndrome, purging endangers life. (The *Jin Gui Yao Lue* states: Those with cold extremities cannot be purged; doing so leads to death, and the same applies to those with constitutional deficiency.) Chills indicate that exterior syndrome still exists. (The presence of chills indicates an exterior syndrome, which prohibits purging.) Vomiting still implies stomach Qi deficiency. (Zhang Zhongjing stated: Patients suffering from vomiting cannot be purged.) Failure to pass flatus必然 leads to loose stools. (Zhang Zhongjing stated: In Yangming syndrome, if there is no bowel movement for six or seven days, one may suspect dry feces. To determine this, Xiao Chengqi Tang may be given. If flatus passes in the abdomen, dry feces are present, and attack/purging is permissible. If flatus does not pass, the stool head may be hard, but the remainder will likely be loose; purging is contraindicated.) In Yangming syndrome with spontaneous sweating, purging is difficult to effect. (In Yangming syndrome with spontaneous sweating and free urination, this indicates depletion of body fluids internally. Although the stool is hard, it cannot be attacked/purged; Mi Jian Dao (honey suppository) is appropriate.) Throat blockage is especially contraindicated for purging. (The *Yu Han Jing* states: Throat blockage prohibits purging; doing so leads to upper deficiency and lower excess, with a desire to curl up when lying down and acute pain.) Fuyang floating and rapid pulse indicates spleen deficiency. (Zhang Zhongjing stated: The Fuyang pulse is floating and rapid. Floating injures the Stomach; rapidity disturbs the Spleen. This is not the original disease, but the result of the physician's erroneous purging.) If there is moving Qi on the left, right, upper, or lower, careful harmonization and treatment are required. (Zhang Zhongjing stated: Moving Qi on the right, purging depletes internal fluids, causing dry throat and nose, dizziness, and palpitations. Moving Qi on the left, purging causes abdominal fullness and急促 breathing. Moving Qi in the upper region, purging causes hot palms and irritability. Moving Qi in the lower region, purging causes abdominal fullness and sudden dizziness upon standing.)