下之攻病，人亦所恶闻也。然积聚陈 于中，留结寒热于内，留之
则是耶？逐之则是耶？《内经》一书，惟以气血通流为贵。世俗庸工，惟以闭塞为贵。又止知下之为泻，
又岂知《内经》之所谓下者，乃所谓补也。陈
去而肠胃洁， 瘕尽而荣卫昌。不补之中，有真补者
存焉。然俗不信下之为补者，盖庸工妄投下药，当寒反热，当热反寒，未见微功，转成大
害，使聪明之士，亦复不信者此也。
所以谓寒药下者，调胃承气汤，泄热之上药也；大、小、
桃仁承气，次也；陷胸汤，又其次也；大柴胡，又其次也。以凉药下者，八正散，泄热兼
利小溲；洗心散，抽热兼治头目；黄连解毒散，治内外上下蓄热而不泄者；四物汤，凉血而
行经者也；神芎丸，解上下蓄热而泄者也。以温药而下者，无忧散，下诸积之上药也；十枣
汤，下诸水之上药也。以热药下者，煮黄丸、缠金丸之类也，急则用汤，缓则用丸，或以汤送
丸，量病之微甚，中病即止，不必尽剂，过而生愆。
仲景曰∶大法秋宜泻。谓秋则阳气在下
，人气与邪气亦在下，故宜下。此仲景言其大概耳。设若春夏有可下之疾，当不下乎？此世上
之庸工局 迁延，误人大病者也。皆曰∶夏月
岂敢用过药泻脱胃气？呜呼！何不达造化之甚也？《内经》称∶土火之郁，发四时之气。以五月
先取化源，泻土补水。又曰∶土郁则夺之。王太仆注曰∶夺，谓下之，令无壅碍也。然则于五月
先防土壅之发，令人下夺，《素问》之言非欤？然随证不必下夺，在良工消息之也。予所以言此
者，矫世俗期不误大病暴病耳。故土郁之为夺，虽大承气汤亦无害也。试举大承气之药论∶大
黄苦寒，通九窍，利大、小便，除五脏六腑积热；芒硝咸寒，破痰散热润肠胃；枳实苦寒为佐使
，散滞气，消痞满，除腹胀；浓朴辛温，和脾胃，宽中通气。此四味虽为下药，有泄有补，
卓然有奇功。刘河间又加甘草以为三一承气，以甘和其中，最得仲景之秘也。余尝以大承气
改作调中汤，加以姜、枣煎之。俗见姜、枣以为补脾胃而喜服，不知其中有大黄、芒硝也。
恶寒喜暖取补，故自古及今，天下皆然。此《内经》之法抑屈而不伸也。此药治中满痞气
不大便者，下五、七行，殊不困乏，次日必神清气快，膈空食进。《内经》曰∶脾为之使，胃为之市。
人之食饮酸咸甘苦百种之味，散列于此，壅而不行，荡其旧而新之，亦脾胃之所望也。况中州之人食
杂而不劳者乎？中州土也，兼载四象，木金水火，皆聚此中。故脾胃之病，奈何中州之医，不
善扫除仓廪，使陈 积而不能去也。犹曰∶我善补。大罪也。此药有奇功，
皆谓服之，便成伤败，乃好丹而非素者也。
或言∶男子不可久泄，妇人不可久吐。何妄论之甚也？可吐则吐
，可下则下，岂问男女乎？大人小儿，一切所伤之物在胃脘，如两手脉迟而滑者，内实也，
宜下之。何以别乎？盖伤宿食者恶食，伤风者恶风，伤寒者恶寒，伤酒者恶酒，至易辨也。故凡宿食
在胃脘，皆可下之，则三部脉平，若心下按之而硬满者，犹宜再下之。如伤寒大汗之后，重
复劳发而为病者，盖下之后热气不尽故也，当再下之。若杂病腹中满痛不止者，此为内实也
。《金匮要略》曰∶痛而腹满，按之不痛为虚，痛者为实。《难经》曰∶痛者为实，腹中满
痛，里壅为实，故可下之。不计杂病、伤寒，皆宜急下之。宜大承气汤，或导水丸，或泄水丸等药，
过十余行。如痛不已，亦可再服，痛已则止。至如伤寒大汗之后，发热，脉沉实，及寒热往来，时
时有涎嗽者，宜大柴胡汤加当归煎服之，下三、五行，立愈。产后慎不可作诸虚不足治之，
必变作骨蒸寒热，饮食不入，肌肤瘦削，经水不行。《经》曰∶寒则衰饮食，热则消肌肉。人
病瘦削，皆粗工以药消烁之故也。呜呼！人之死者，岂为命乎？《难经》曰∶实实虚虚。损不足而
益有余，如此死者，医杀之耳！
至如目黄、九疸、食劳，皆属脾土，可下之，宜茵陈蒿汤。或
用导水丸、禹攻散，泻十余行，次以五苓散、桂苓甘露散、白术丸等药，服之则愈矣。或腰脚胯
痛，可用甘遂粉二、三钱，以 猪腰子薄批七、八片，
掺药在内，以湿纸包数重，文武火烧熟，至临卧细嚼，以温酒或米饮汤调下。至平明见一、
二十行，勿讶，意欲止泻，则饮水或新水顿服之，泻立止。次服通经和气定痛乌金丸、蹁马丹
之类，则愈矣。《内经》有不因气动而病生于外者，太仆以为瘴气贼魅虫毒、蜚尸鬼击、冲薄
坠堕、风寒暑湿、斫射剥割撞扑之类。至如诸落马堕井、打扑闪肭损折、汤沃火烧、车碾犬伤、
肿发 痛、日夜号泣不止者，予寻常谈笑之
间，立获大效。可峻泻三、四十行，痛止肿消，乃以通经散下导水丸等药。如泻水少，则
可再加汤剂泻之，后服和血消肿散毒之药，病去如扫。此法得之睢阳高硕明、侯德和，使外
伤者，不致癃残跛 之患。余非敢掩人之善，意在救人耳！
曾有邻人，杖疮发作肿痛，
及上下，语言错乱，时时呕吐，数日不食，皆曰不
救。余以通经散三、四钱下神佑丸百余丸，相并而下，间有呕出者，大半已下膈矣！良久，
大泻数行，秽不可近，脓血、涎沫、瘀毒约一、二斗，其病患困睡不醒一日一夜。邻问予
。予曰∶喘息匀停，肿消痛减，故得睡也。来旦语清食进，不数日，痊。救杖疮欲死者，四
十年间二、三百，余追思举世杖疮死者，皆枉死也。自后凡见冤人被责者，急以导水丸、禹
攻散，大作剂料，泻惊涎一、两盆，更无肿发痛
如导水丸、禹攻散泄泻不动，更加之通经散、神佑丸泻之，泻讫，须忌热物，止可吃新汲水
一、二顿，泻止立愈。至如沉积多年羸劣者，不可便服陡攻之药，可服缠积丹、三棱丸之类。《
内经》曰∶重者因而减之。若人年老衰弱，有虚中积聚者，止可五日一服万病无忧散。故凡
积年之患，岂可一药而愈？即可减而去之。
以《本草》考之∶下之寒者，有戎盐之咸，犀角之酸
咸，沧盐、泽泻之甘咸，枳实之苦酸，腻粉之辛，泽漆之苦辛，杏仁之苦甘；下之之微寒者，有猪胆之
苦，下之大寒者，有牙硝之甘，大黄、瓜蒂、牵牛、苦瓠子、兰汁、牛胆、羊蹄苗根之苦，
大戟、甘遂之苦甘，朴硝、芒硝之苦辛；下之温者，有槟榔之辛，芫花之苦辛，石蜜之甘，
皂角之辛咸；下之
热者，有巴豆之辛，下之辛凉者，有猪羊血之咸，下之平者，有郁李仁之酸，桃花萼之苦。
上三十味，惟牵牛、大戟、芫花、皂角、羊蹄苗根、苦瓠子、瓜蒂有小毒，巴豆、甘遂、腻粉
、杏仁之有大毒，余皆无毒。
设若疫气，冒风中酒，小儿疮疹，及产后潮热，中满败血，勿
用银粉、杏仁大毒之药，下之必死，不死即危。且如槟榔、犀角、皂角皆温平，可以杀虫，
透关节，除肠中风火燥结；
大黄、芒硝、朴硝等咸寒，可以治伤寒热病，时气瘟毒，发斑泻血，燥热发狂，大作汤剂，
以荡涤积热；泽泻、羊蹄苗根、牛胆、兰叶汁、苦瓠子亦苦寒，可以治水肿遍身，腹大如鼓，大、
小便不利，及目黄、湿毒、九疸、食痨、疳虫、食土生米等物，分利水湿，通利大小便，荡涤肠胃间宿
谷相搏。又若备急丸，以巴豆、干姜、大黄三味，蜜和丸之，亦是下药。然止可施于辛苦劳
力，贫食粗辣之辈，或心腹胀满，胁肋刺痛，暴痛不住，服五、七丸，或十丸，泻五、七行以救急。若施
之富贵城郭之人则非矣，此药用砒石治疟相类，止可施之于贫食之人。若备急丸，治伤寒风温，
中酒冒风，及小儿疮疹，产后满闷，用之下膈，不死则危。及夫城郭之人，富贵之家，用此
下药，亦不死则危矣！奈何庸人畏大黄而不畏巴豆，粗工喜巴豆而不喜大黄？盖庸人以巴豆
性热而不畏，以大黄性寒而畏之，粗工以巴豆剂小而喜，以大黄剂大而不喜，皆不知理而至是
也。岂知诸毒中，惟巴豆为甚。去油匮之蜡，犹能下后，使人津液涸竭，留毒不去，胸热口
燥，他病转生，故下药以巴豆为禁。
余尝用前十余药，如身之使臂，臂之使手。然诸洞泄寒
中者，不可下，俗谓休息痢也。伤寒脉浮者，不可下。表里俱虚者，不宜下。《内经》中五
痞心证，不宜下。厥而唇青，手足冷，内热深者，宜下。寒者，不宜下，以脉别之。小儿内泻，
转生慢惊，及两目直视，鱼口出气者，亦不宜下。若十二经败甚，亦不宜下，止宜调养，温
以和之，如下则必误人病耳！若其余大积大聚，大病大秘，大涸大坚，下药乃补药也。余尝
曰∶泻法兼补法，良以此夫。
攻下法用于治疗疾病，人们也往往厌恶听到它。然而，如果体内有积聚之物停滞在中焦，寒热邪气留结在内，留着它们是对的吗？驱逐它们是對的吗？《内经》这本书，唯独以气血通畅流动为珍贵。世俗的庸医，唯独以闭塞不通为珍贵。他们又只知道“下”就是泻法，又哪里知道《内经》所说的“下”，其实就是所谓的“补”呢。陈旧的积滞去除后肠胃就洁净了，瘕聚（腹内结块）排尽后营卫之气就昌盛了。在不直接进补的过程中，存在着真正的补益作用。然而世俗之人不相信“下”可以当作“补”来用，大概是因为庸医胡乱投用下药，该用寒凉药时反而用温热药，该用温热药时反而用寒凉药，未见微小的功效，却转变成巨大的危害，使得聪明之士也因此不再相信，原因就在这里。
所以说，用寒性药进行攻下的，调胃承气汤是泄热的上品；大承气汤、小承气汤、桃仁承气汤，次一等；陷胸汤，又次一等；大柴胡汤，再次一等。用凉性药进行攻下的，八正散，既能泄热又能兼利小便；洗心散，能抽提热邪兼治头目疾病；黄连解毒散，治疗内外上下蓄积热邪而不能宣泄的情况；四物汤，能凉血并促进经血运行；神芎丸，能解除上下蓄积的热邪并使之排泄。用温性药进行攻下的，无忧散，是下诸种积滞的上品；十枣汤，是下诸种水饮的上品。用热性药进行攻下的，有煮黄丸、缠金丸之类的药物。急症时用汤剂，缓症时用丸剂，或者用汤剂送服丸剂，根据病情的轻重来决定，中病即止，不必服完整个剂量，过量服用就会产生过失。
张仲景说：大法则是秋季适宜用泻下法。这是因为秋季阳气在下，人气与邪气也都在下，所以适宜用下法。这是张仲景说的概略情况。假如春夏季节有可以用下法治疗的疾病，难道就不下吗？这是世上庸医拘泥迁延，误人导致大病的原因。大家都说：夏天怎么敢用过重的药泻脱胃气？唉！这是多么不理解自然造化规律啊！《内经》称：土火之郁，发于四时之气。在五月先取化源，泻土补水。又说：土郁则夺之。王太仆注释说：夺，指用下法，使没有壅塞阻碍。那么在五月先防止土壅的发生，让人用下法夺其邪，《素问》的话不是这样说的吗？然而随证候不一定都要用下法夺邪，在于良医斟酌判断罢了。我之所以说这些，是为了纠正世俗观念，以免延误大病和暴病的救治。所以土郁用夺法，即使是使用大承气汤也没有害处。试着列举大承气汤的药物来论述：大黄苦寒，通利九窍，利大小便，清除五脏六腑的积热；芒硝咸寒，破除痰结散热润肠；枳实苦寒作为佐使药，疏散滞气，消除痞满，除去腹胀；厚朴辛温，调和脾胃，宽中通气。这四味药虽然属于下药，但有泄有补，卓然有奇功。刘河间又加入甘草组成三一承气汤，用甘味药调和其中，最得张仲景的奥秘。我曾将大承气汤改名为调中汤，加入生姜、大枣煎服。俗人见到姜、枣以为是补脾胃而喜欢服用，不知道其中含有大黄、芒硝。厌恶寒冷喜欢温暖以求补益，所以从古至今，天下人都如此。这是《内经》的法度被压抑委屈而不能伸张啊。这种药治疗中满痞气、大便不通的患者，泻下五到七次，身体并不感到困乏，第二天必定精神清爽舒适，膈间空虚食欲增进。《内经》说：脾为之使，胃为之市。人的饮食酸咸甘苦百种味道，分散陈列于此，壅塞而不行，荡涤陈旧而更新，这也是脾胃所期望的。何况中原地区的人饮食混杂而不劳作呢？中原属土，兼载四象，木金水火，都聚集在此中。所以脾胃的疾病，为什么中原的医生不善于扫除仓廪，使陈旧的积滞不能去除呢？还却说：我擅长补益。这是大罪过啊。这种药有奇功，大家都说服用它就会造成损伤败坏，这是喜好丹砂而非素药的人啊。
有人说：男子不可久泄，妇人不可久吐。这是什么荒谬的言论啊！可以吐的就吐，可以下的就下，难道还要问男女吗？大人小孩，一切所伤之物在胃脘，如果两手脉象迟而滑，是内实，适宜用下法。如何辨别呢？大概是伤宿食者厌恶食物，伤风者厌恶风，伤寒者厌恶寒冷，伤酒者厌恶酒，非常容易辨别。所以凡是宿食在胃脘，都可以用下法，直到三部脉象平和，如果心下按压感觉硬满，仍然适宜再用下法。如伤寒大汗之后，反复劳累诱发疾病，这是因为下之后热气未尽的缘故，应当再用下法。如果是杂病腹中满痛不止，这是内实。《金匮要略》说：痛而腹满，按之不痛为虚，痛者为实。《难经》说：痛者为实，腹中满痛，里壅为实，所以可以用下法。不计较是杂病还是伤寒，都适宜急下。适宜用大承气汤，或导水丸，或泄水丸等药，泻下十余次。如果疼痛不停止，也可以再服用，疼痛停止就停药。至于伤寒大汗之后，发热，脉沉实，以及寒热往来，时不时有涎沫咳嗽的，适宜用大柴胡汤加当归煎服，下三五行，立刻痊愈。产后千万不要当作诸虚不足来治疗，否则一定会变成骨蒸寒热，饮食不入，肌肤瘦削，月经不行。《经》说：寒则衰饮食，热则消肌肉。人病瘦削，都是粗工用药消烁的缘故。唉！人的死亡，难道是命运吗？《难经》说：实实虚虚。损不足而益有余，这样的死者，是医生杀死的啊！
至于目黄、九疸、食劳，都属于脾土，可以用下法，适宜茵陈蒿汤。或用导水丸、禹功散，泻下十余次，随后用五苓散、桂苓甘露散、白术丸等药，服用就会痊愈。或者腰脚胯痛，可用甘遂粉二、三钱，将猪腰子薄切七八片，掺药在内，用湿纸包裹数层，文武火烧熟，临睡前细嚼，用温酒或米饮汤送下。到天亮时见泻下一二十次，不要惊讶，如果想止泻，则顿服饮水或新汲水，泻立止。随后服用通经和气定痛乌金丸、蹁马丹之类，就会痊愈。《内经》有不因气动而病生于外的，王太仆认为是瘴气贼魅虫毒、飞尸鬼击、冲薄坠堕、风寒暑湿、斫射剥割撞扑之类。至于各种落马坠井、打扑闪肭损折、汤沃火烧、车碾犬伤、肿发痈痛、日夜号泣不止的，我通常在谈笑之间，立即获得大效。可以峻泻三四十次，痛止肿消，然后用通经散下导水丸等药。如果泻水少，则可以再加汤剂泻之，后服和血消肿散毒的药，病去如扫。这种方法得自睢阳高硕明、侯德和，使外伤者，不至于产生癃残跛足的祸患。我不敢掩盖别人的善行，意在救人罢了！
曾经有邻居，杖疮发作肿痛，波及上下，语言错乱，时时呕吐，数日不进食，都说救不了。我用通经散三四钱配合神佑丸一百多丸，一起服下，偶尔有呕出的，大部分已经下膈了！许久，大泻数次，秽臭不可近，脓血、涎沫、瘀毒约一、二斗，病患困睡不醒一日一夜。邻居问我。我说：喘息均匀平稳，肿消痛减，所以能睡觉。第二天说话清晰食欲增进，不几天，痊愈。救活杖疮欲死的人，四十年间有二三百，我回想举世杖疮死者，都是枉死。此后凡见冤人被责打者，急忙用导水丸、禹功散，大作剂料，泻出惊涎一两盆，更没有肿发痛。如果导水丸、禹功散泄泻不动，再加上通经散、神佑丸泻之，泻完后，必须忌热物，只可吃新汲水一两顿，泻止立刻痊愈。至于沉积多年羸弱劣弱者，不可立即服用猛烈的攻伐药，可服用缠积丹、三棱丸之类。《内经》说：重者因而减之。如果人年老衰弱，有虚中积聚者，只可五日一次服用万病无忧散。所以凡是积年之患，岂可一药而愈？即可减少而去之。
用《本草》考证：下之寒性的，有戎盐之咸，犀角之酸咸，沧盐、泽泻之甘咸，枳实之苦酸，腻粉之辛，泽漆之苦辛，杏仁之苦甘；下之微寒的，有猪胆之苦，下之大寒的，有牙硝之甘，大黄、瓜蒂、牵牛、苦瓠子、兰汁、牛胆、羊蹄苗根之苦，大戟、甘遂之苦甘，朴硝、芒硝之苦辛；下之温的，有槟榔之辛，芫花之苦辛，石蜜之甘，皂角之辛咸；下之热的，有巴豆之辛，下之辛凉的，有猪羊血之咸，下之平的，有郁李仁之酸，桃花萼之苦。以上三十味药，只有牵牛、大戟、芫花、皂角、羊蹄苗根、苦瓠子、瓜蒂有小毒，巴豆、甘遂、腻粉、杏仁有大毒，其余都无毒。
假设有疫气，冒风中酒，小儿疮疹，及产后潮热，中满败血，不要用银粉、杏仁等大毒之药，下之必死，不死即危。且如槟榔、犀角、皂角皆温平，可以杀虫，透关节，除肠中风火燥结；大黄、芒硝、朴硝等咸寒，可以治伤寒热病，时气瘟毒，发斑泻血，燥热发狂，大作汤剂，以荡涤积热；泽泻、羊蹄苗根、牛胆、兰叶汁、苦瓠子亦苦寒，可以治水肿遍身，腹大如鼓，大小便不利，及目黄、湿毒、九疸、食痨、疳虫、食土生米等物，分利水湿，通利大小便，荡涤肠胃间宿谷相搏。又有备急丸，以巴豆、干姜、大黄三味，蜜和丸之，也是下药。但只可施用于辛苦劳力，贫食粗辣之辈，或心腹胀满，胁肋刺痛，暴痛不住，服五、七丸，或十丸，泻五、七行以救急。若施用于富贵城郭之人则不对了，此药用砒石治疟类似，只可施之于贫食之人。若备急丸，治伤寒风温，中酒冒风，及小儿疮疹，产后满闷，用之下膈，不死则危。以及城郭之人，富贵之家，用此下药，也不死则危矣！为何庸人畏大黄而不畏巴豆，粗工喜巴豆而不喜大黄？大概庸人以巴豆性热而不畏惧，以大黄性寒而畏惧它，粗工以巴豆剂量小而喜欢，以大黄剂量大而不喜欢，都是不知理致此。哪知诸毒中，惟巴豆为甚。去油封之蜡，犹能下后，使人津液涸竭，留毒不去，胸热口燥，他病转生，故下药以巴豆为禁。
我曾经使用前十余种药，如身之使臂，臂之使手。然而诸洞泄寒中的，不可下，俗谓休息痢也。伤寒脉浮的，不可下。表里俱虚的，不宜下。《内经》中五痞心证，不宜下。厥而唇青，手足冷，内热深的，宜下。寒的，不宜下，以脉别之。小儿内泻，转生慢惊，及两目直视，鱼口出气的，也不宜下。若十二经败甚，也不宜下，只宜调养，温以和之，如下则必误人病耳！若其余大积大聚，大病大秘，大涸大坚，下药乃补药也。我曾说：泻法兼补法，良以此夫。
Attacking disease with purgation is something people also dislike hearing about. However, when accumulations and stagnations remain in the center, and cold-heat pathogens linger and knot inside, is it right to retain them? Is it right to expel them? The *Neijing* (Classic of Internal Canon) values only the free flow of Qi and Blood. Secular incompetent physicians value only obstruction and closure. Furthermore, they only know that "purgation" means draining; how could they know that what the *Neijing* calls "purgation" is actually what is called "tonification"? When old accumulations are removed, the intestines and stomach become clean; when masses (abdominal lumps) are exhausted, Ying and Wei (Nutritive and Defensive Qi) flourish. Within this non-tonifying approach, true tonification exists. Yet the common people do not believe that purgation can be used as tonification, largely because incompetent physicians recklessly administer purgatives: using heat for cold patterns and cold for heat patterns, failing to achieve even minor efficacy while turning into major harm, causing even intelligent individuals to lose faith. This is the reason.
Therefore, regarding purgation with cold herbs, Tiaowei Chengqi Tang (Regulate the Stomach Decoction) is the superior herb for draining heat; Dachengqi Tang (Major Order the Yellow Decoction), Xiaochengqi Tang (Minor Order the Yellow Decoction), and Tao Ren Chengqi Tang (Apricot Seed Order the Yellow Decoction) are next; Xianxiong Tang (Sunken Chest Decoction) is next again; Da Chaihu Tang (Major Bupleurum Decoction) is yet next. Regarding purgation with cool herbs, Bazheng San (Eight Correctness Powder) drains heat and promotes urination; Xixin San (Washing Heart Powder) extracts heat and treats head and eye conditions; Huanglian Jiedu San (Coptis Detoxification Powder) treats accumulated heat internally and externally, above and below, that cannot vent; Siwu Tang (Four Substances Decoction) cools blood and promotes menstruation; Shenxiong Wan (Spiritual Xiong Pill) resolves accumulated heat above and below and discharges it. Regarding purgation with warm herbs, Wuyou San (Carefree Powder) is the superior agent for descending various accumulations; Shizao Tang (Ten Dates Decoction) is the superior agent for descending various water fluids. Regarding purgation with hot herbs, there are Zhuhuang Wan (Boiled Yellow Pill), Chanjin Wan (Golden Coil Pill), etc. In acute cases, use decoctions; in chronic cases, use pills, or take pills with decoction. Measure the severity of the disease, stop when the disease is addressed, do not necessarily finish the dose; excess leads to error.
Zhongjing said: "The general principle is that autumn suits purging." This means that in autumn, Yang Qi is below, human Qi and pathogenic Qi are also below, so purging is suitable. This is Zhongjing speaking generally. If in spring and summer there are diseases suitable for purging, should one not purge? These are secular incompetent physicians who delay and procrastinate, harming people with serious illness. They all say: "How dare one use heavy drugs to drain Stomach Qi in summer?" Alas! How ignorant of the transformations of Nature they are! The *Neijing* states: "The depression of Earth and Fire manifests in the Qi of the four seasons." In the fifth month, first select the source of transformation, drain Earth and tonify Water. It also says: "When Earth is depressed, seize it." Wang Taipu annotated: "Seize means to purge, to remove obstruction." Then, in the fifth month, to prevent the onset of Earth obstruction, allowing people to undergo purgative seizure, is this not what the *Suwen* says? However, depending on the syndrome, purgative seizure is not always necessary; it depends on the skilled physician's discretion. I speak of this to correct secular views and avoid delaying the treatment of serious and sudden illnesses. Thus, seizing Earth depression, even using Dachengqi Tang causes no harm. Let us discuss the ingredients of Dachengqi Tang: Dahuang (Rhubarb Rhizome) is bitter and cold, opens the nine orifices, benefits large and small urination, removes accumulated heat from the five Zang and six Fu organs; Mangxiao (Mirabilite) is salty and cold, breaks phlegm, dissipates heat, moistens intestines and stomach; Zhishi (Immature Bitter Orange) is bitter and cold, serves as an assistant, disperses stagnant Qi, eliminates fullness and distension, removes abdominal bloating; Houpo (Magnolia Bark) is acrid and warm, harmonizes spleen and stomach, widens the middle and unblocks Qi. Although these four ingredients are purgatives, they have both draining and tonifying effects, possessing remarkable miraculous efficacy. Liu Hejian added Gancao (Licorice Root) to form Sanyi Chengqi Tang, using sweet herbs to harmonize the center, best capturing Zhongjing's secret. I once modified Dachengqi Tang into Tiaozhong Tang, adding Jiang (Ginger Rhizome) and Zao (Jujube Fruit) for decoction. Laypeople see Ginger and Jujube and think they tonify spleen and stomach, so they happily take it, unaware it contains Dahuang and Mangxiao. Disliking cold and liking warmth for tonification, thus from ancient times to now, the world is alike. This is the method of the *Neijing* being suppressed and unable to extend. This medicine treats patients with epigastric fullness, qi stagnation, and constipation; after 5-7 bowel movements, one feels neither tired nor weak; the next day, spirit is clear and pleasant, the chest feels empty, and appetite increases. The *Neijing* says: "Spleen acts as the envoy, Stomach acts as the market." Human food and drink, sour, salty, sweet, bitter, hundred flavors, scatter here, obstructed and not moving; sweeping away the old to renew the new, this is also what the spleen and stomach hope for. Especially considering people in the Central Plains who eat mixed foods and do not labor. The Central Plains is Earth, carrying the Four Symbols; Wood, Metal, Water, Fire all gather here. So for spleen and stomach diseases, why do doctors of the Central Plains not excel at clearing the granaries, leaving old accumulations unable to go? And still say: "I am good at tonifying." This is a great sin. This medicine has miraculous efficacy; everyone says taking it causes damage and ruin; these are those who prefer Dan (cinnabar/alchemy) over Su (plain medicine).
Some say: "Men should not be purged for long; women should not be vomited for long." What absurd论! If vomiting is indicated, vomit; if purging is indicated, purge. Does one ask about gender? For adults and children, whatever harmful substance is in the stomach, if the pulse in both hands is slow and slippery, it is internal excess, suitable for purging. How to distinguish? Those injured by leftover food hate food; those injured by wind hate wind; those injured by cold hate cold; those injured by wine hate wine. It is very easy to distinguish. Therefore, whenever leftover food is in the stomach, one may purge until the three positions of the pulse are level. If pressing the epigastrium feels hard and full, one should still purge. After severe sweating in Shanghan (Cold Damage), if relapse occurs due to repeated exertion, it is because heat was not fully cleared after purging; one should purge again. If miscellaneous diseases present with continuous abdominal fullness and pain, this is internal excess. The *Jingui Yaolue* says: "Pain with abdominal fullness, non-tender on pressure is deficiency, tender is excess." The *Nanjing* says: "Tender indicates excess; abdominal fullness and pain, internal obstruction indicates excess, so purging is suitable." Regardless of whether it is miscellaneous disease or Shanghan, urgent purging is suitable. Use Dachengqi Tang, or Dao Shui Wan (Water Guiding Pill), or Xie Shui Wan (Draining Water Pill), etc., resulting in more than ten bowel movements. If pain persists, one may take it again; stop when pain ceases. As for Shanghan after severe sweating, fever, deep and solid pulse, alternating chills and fever, occasional salivation and cough, use Da Chaihu Tang plus Danggui (Angelica Sinensis) for decoction and ingestion; after 3-5 bowel movements, immediate recovery. Postpartum must never be treated as various deficiencies; otherwise, it will transform into bone-steaming tidal fever, inability to eat, emaciation, and amenorrhea. The Classics say: "Cold decreases appetite; heat consumes muscle." People becoming emaciated are due to crude physicians using drugs to consume and burn. Alas! Do humans die because of fate? The *Nanjing* says: "Reinforce excess and deplete deficiency." Depleting the insufficient and benefiting the surplus—such deaths are killed by physicians!
As for yellow eyes, Jiudan (Nine Jaundices), and Shi Lao (Food Labor Disease), all belong to Spleen Earth, suitable for purging; use Yinchen Hao Tang (Artemisia Capillaris and Horsetail Decoction). Or use Dao Shui Wan, Yu Gong San (Yu Gong Powder), purging more than ten times, then follow with Wuling San (Five Ling Powder), Guiling Ganlu San (Cassia Twig and Poria Sweet Dew Powder), Baizhu Wan (Atractylodes Macrocephala Pill), etc.; taking them leads to cure. Or for waist, leg, and hip pain, use Gansui powder 2-3 qian, slice pig kidney thinly 7-8 pieces, mix medicine inside, wrap in wet paper several layers, cook with mild fire until done, chew finely before sleep, swallow with warm wine or rice soup. At dawn, seeing 10-20 bowel movements, do not be surprised; if wanting to stop diarrhea, drink water or fresh well water in one gulp, diarrhea stops immediately. Then take Tongjing Heshi Dingtong Wu Jin Wan (Meridian Unblocking, Qi Harmonizing, Pain-Stopping Black Gold Pill), Pianma Dan, etc., and it will heal. The *Neijing* mentions diseases arising externally not due to Qi movement; Taipu considers them miasma, evil spirits, insect poison, Feishi (Flying Corpse), ghost strike, impact, falling, wind-cold-warmth-dampness, cutting, shooting, peeling, cutting, bumping, striking, etc. As for falling from horses, falling into wells, beating, spraining, fractures, scalding, burning, cart crushing, dog bites, swelling and painful abscesses, crying day and night without stopping, I usually achieve great effect in casual conversation. One can severely purge 30-40 times, pain stops, swelling subsides, then use Tongjing San with Dao Shui Wan, etc. If water discharge is little, add decoction to purge, then take blood-harmonizing, swelling-reducing, detoxifying medicines; disease removed like sweeping. This method was obtained from Gao Shuoming and Hou Dehe of Suiyang, preventing external injuries from leading to disability and lameness. I dare not cover others' goodness; my intent is only to save lives!
Once a neighbor had a beating wound erupting with swelling and pain, spreading up and down, confused speech, frequent vomiting, not eating for days; all said incurable. I used Tongjing San 3-4 qian with Shenyou Wan over 100 pills, taken together; some were vomited out, but most passed the diaphragm! After a while, severe diarrhea several times, foul smell unbearable, pus, blood, saliva, phlegm, stasis toxin about 1-2 dou; the patient slept deeply unconscious for a day and night. Neighbor asked me. I said: Breathing is uniform and steady, swelling reduced, pain decreased, so he sleeps. Next morning, speech clear, appetite returned, healed in a few days. Saving those dying from beating wounds, between forty years two or three hundred; I recall all neighbors dying from beating wounds died in vain. Since then, whenever seeing unjustly punished people, urgently use Dao Shui Wan, Yu Gong San, make large doses, purge惊涎 (frightened saliva) one or two basins, no more swelling and pain. If Dao Shui Wan, Yu Gong San do not induce diarrhea, add Tongjing San, Shenyou Wan to purge. After purging, must avoid hot foods, only drink fresh well water one or two times; once diarrhea stops, immediately cured. As for those emaciated and weak from deposits for many years, do not suddenly use harsh attacking drugs; can take Chanji Dan, Sanleng Wan, etc. The *Neijing* says: "For heavy conditions, reduce gradually." If an elderly person is weak, with deficiency-center accumulation, only take Wanbing Wuyou San every five days. Thus, how can a disease of years be cured by one drug? It can be reduced and removed.
Examining the *Bencao*: Cold purgatives include Rongyan (Rock Salt) salty, Xijiao (Rhinoceros Horn) sour-salty, Cangyan (Blue Rock Salt), Zexie (Alisma) sweet-salty, Zhishi (Immature Bitter Orange) bitter-sour, Nifen (Calomel) acrid, Zeqi (Euphorbia Lathyris) bitter-acrid, Xingren (Apricot Seed) bitter-sweet; slightly cold purgatives include Zhudan (Pig Gallbladder) bitter; greatly cold purgatives include Yaxiao (Saltpeter) sweet, Dahuang (Rhubarb), Guali (Melon Tip), Qianniu (Pharbitis Seed), Ku Huazi (Bitter Bottle Gourd), Lan Zhi (Orchid Juice), Niudan (Cow Gallbladder), Yangtimiaogen (Shepherd's Purse Root) bitter, Daji (Euphorbia Pekinensis), Gansui (Kansui Root) bitter-sweet, Puxiao (Mirabilite), Mangxiao (Mirabilite) bitter-acrid; warm purgatives include Binglang (Areca Nut) acrid, Yuanhua (Genkwa Flower) bitter-acrid, Shimii (Honey) sweet, Zaojiao (Gleditsia Sinensis) acrid-salty; hot purgatives include Badou (Croton Seed) acrid; acrid-cool purgatives include Zhu Yangxue (Pig and Sheep Blood) salty; neutral purgatives include Yuliren (Prunus Armeniaca Kernel) sour, Taohua E (Peach Blossom Epicalyx) bitter. Of the above thirty items, only Qianniu, Daji, Yuanhua, Zaojiao, Yangtimiaogen, Ku Huazi, Guali have slight toxicity; Badou, Gansui, Nifen, Xingren have great toxicity; the rest are non-toxic.
If epidemic Qi, wind-strike, alcohol intoxication, pediatric rash, postpartum tidal fever, epigastric fullness, blood stasis, do not use Yinfen (Silver Powder), Xingren (Apricot Seed) great toxic drugs; purging will cause death, or critical condition. Take Binglang (Areca Nut), Xijiao (Rhinoceros Horn), Zaojiao (Gleditsia Sinopsis) as warm and neutral, can kill parasites, penetrate joints, remove wind-fire dryness in intestines; Dahuang (Rhubarb), Mangxiao (Mirabilite), Puxiao (Mirabilite) salty-cold, treat Shanghan heat disease, seasonal epidemic plague toxin, macules, bloody stool, dry heat mania; make large decoctions to sweep accumulated heat; Zexie (Alisma), Yangtimiaogen (Shepherd's Purse Root), Niudan (Cow Gallbladder), Lane Ye Zhi (Orchid Leaf Juice), Ku Huazi (Bitter Bottle Gourd) also bitter-cold, treat edema all over body, abdomen large as drum, difficult urination and defecation, yellow eyes, damp toxin, Jiudan (Nine Jaundices), Shi Lao (Food Labor Disease), Ganchong (Childhood Malnutrition Parasites), eating soil/raw rice, separate and benefit water-dampness, unblock large and small urination, sweep old grain fighting in intestines. Also Beiji Wan (Emergency Aid Pill), made of Badou (Croton Seed), Ganjiang (Dried Ginger), Dahuang (Rhubarb), honey-pilled, is also a purgative. But only applicable to hard laborers, poor people eating coarse/spicy food, or epigastric fullness, stabbing costal pain, sudden unceasing pain; take 5-7 or 10 pills, purge 5-7 times to save emergency. If applied to wealthy city dwellers, it is wrong; this drug treating malaria with Ashi Stone (Realgar/Arsenic) is similar, only for poor eaters. If Beiji Wan treats Shanghan wind-warmth, alcohol/wind strike, pediatric rash, postpartum fullness, taken below diaphragm, death or critical. And city dwellers, wealthy families, using this purgative, death or critical too! Why do mediocre physicians fear Dahuang (Rhubarb) but not Badou (Croton Seed)? Crude physicians like Badou but dislike Dahuang? Mediocre physicians do not fear Badou because it is hot, fear Dahuang because it is cold; crude physicians like Badou because dose is small, dislike Dahuang because dose is large; all due to ignorance of principle. Who knows among all toxins, Badou is the worst. Removing oil and sealing with wax, it still causes purging, drying up body fluids, retaining toxin, chest heat, mouth dryness, other diseases arise; thus Badou is forbidden in purgatives.
I once used the first ten-plus drugs as easily as the body uses the arm, the arm uses the hand. However, for various hole-diarrhea and cold-middle, do not purge; commonly called Xiuxi Li (Resting Dysentery). For Shanghan with floating pulse, do not purge. For exterior and interior both deficient, not suitable to purge. For Wupi Xin Syndrome in *Neijing*, not suitable to purge. For Jue with blue lips, cold hands and feet, deep internal heat, suitable to purge. For cold, not suitable to purge, distinguish by pulse. For children with internal diarrhea transforming into Slow Convulsion, staring eyes, fish-mouth breathing, also not suitable to purge. If twelve meridiments are severely damaged, not suitable to purge, only suitable to nourish and regulate, warm to harmonize; purging will surely harm the patient! For the rest, large accumulations and masses, major diseases with major constipation, major dryness and hardness, purgatives are tonics. I once said: Purging method combines tonifying method, precisely for this reason.