（见痉病中）
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下利，脉迟而滑者，实也，利未欲止，急下之，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，当下之，积去则止，宜大承气汤。
【集注】
尤怡曰：脉迟为寒，然与滑俱见，则不为寒而反为实，以中实有物，能阻其脉迟行。
夫利因实而致者，实不去则利不止，故宜急下。
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下利，脉反滑者，当有所去，下乃愈，宜大承气汤。
【注】
下利脉反滑者，是病脉实，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】
赵良曰：下利虚证也，脉滑实脉也，以下利之虚证，而反见滑实之脉，故当有所去也
。
程林曰：经云：滑为有宿食，故当下，去之而利自止矣。
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下利已差，至其年月日时复发者，以病不尽故也，当下之，宜大承气汤。
【注】
下利差后，至其或年、或月、或日而复发其利者，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，自不复发其利也，宜大承气汤。
【集注】
沈明宗曰：此旧积之邪复病也。下利差后，至其年月日时复发者，是前次下利之邪，
隐僻肠间，今值藏府司令期，触动旧邪而复发；无隐僻之根未除，终不能愈，故用大
承气迅除之耳。
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下利谵语者，有燥屎也，小承气汤主之。
【注】
下利里虚证也，谵语里实证也，何以决其有燥屎也？若脉滑数，知有宿食也；其利秽
粘，知有积热也；然必脉证如此，始可知其有燥屎也，宜下之以小承气汤。于此推之
，而燥屎又不在大便□不□也。
【集注】
李□曰：经曰：实则谵语，故知有燥屎宜下。
（此条文参见痉病章节中）
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出现下利，脉象迟而滑的，属于实证。下利不会自行停止，应当紧急使用攻下法，适宜用大承气汤。
【注】
脉象迟通常不能兼见滑象，只有在轻取（浮取）时感到迟，重取（沉取）时感到滑，这种情况才存在。现在所说的下利脉迟而滑，是指轻取迟而重取滑。轻取迟说明体表和气机相对平和，重取滑说明体内有实邪积聚。想要止住因内实引起的下利，应当采用攻下法，积滞去除后下利自然停止，适宜用大承气汤。
【集注】
尤怡说：脉迟主寒，但如果与滑脉同时出现，就不是寒证反而成了实证，因为中间有实物阻滞，导致脉行迟缓。这种下利是因为实邪导致的，实邪不去则下利不止，所以应当紧急攻下。
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出现下利，脉象反而滑利的，说明体内有当去之邪物，通过攻下治疗才能痊愈，适宜用大承气汤。
【注】
下利而脉象反而滑利，这是病邪呈现实象，与虚证的下利不相宜。如果患者形体和元气如常，饮食也正常，那就是有应当去除的积滞尚未去除，通过攻下治疗才能痊愈，适宜用大承气汤。
【集注】
赵良说：下利多属虚证，而滑脉是实脉，以下利的虚证反而见到滑实的脉象，所以应当有当去之邪物。
程林说：经典记载：滑脉主有宿食，所以应当攻下，去除积滞后下利自然停止。
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下利已经好转，到了特定的年、月、日、时又复发的，是因为病邪未除尽的缘故，应当攻下，适宜用大承气汤。
【注】
下利痊愈后，到了某年、某月或某日复发下利的，这是因为宿食积滞的病根攻伐不彻底所致。如果患者形气不衰，饮食依然旺盛，就应当攻伐未尽的病邪，这样下利自然不再复发，适宜用大承气汤。
【集注】
沈明宗说：这是旧有的积滞邪气再次发病。下利好转后，到了特定的年月日时复发，是因为前次下利的邪气隐匿在肠间偏僻之处，如今正值脏腑当令之时，触动旧邪而复发；如果没有清除隐匿的病根，终究不能痊愈，所以用大承气汤迅速祛除它。
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出现下利并伴有谵语（神志不清，胡言乱语）的，是有燥屎内结，用小承气汤主治。
【注】
下利通常是里虚证，谵语是里实证，凭什么判断有燥屎呢？如果脉象滑数，就知道有宿食；如果排泄物秽浊粘稠，就知道有积热；但必须脉证如此，才能知道有燥屎，适宜用攻下法，以小承气汤为主治方剂。由此推断，燥屎并不一定表现为大便干结不通。
【集注】
李□说：经典记载：实证会出现谵语，所以知道有燥屎应当攻下。
(See the section on Spasm Diseases)
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In cases of diarrhea with a slow and slippery pulse, it indicates an excess condition. The diarrhea will not cease spontaneously; urgent purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
A slow pulse typically does not coexist with a slippery one. This combination exists only when the pulse feels slow upon superficial palpation (floating) but slippery upon deep palpation (sinking). Thus, "slow and slippery" in this context refers to superficially slow and deeply slippery. Superficial slowness suggests harmony at the exterior, while deep slipperiness indicates internal excess. To stop diarrhea caused by internal excess, purgation should be employed; once the accumulation is removed, the diarrhea will cease. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
You Yi stated: A slow pulse usually indicates cold. However, when seen together with a slippery pulse, it indicates excess rather than cold, because physical matter inside obstructs the flow, causing the pulse to appear slow. Since the diarrhea is caused by excess, if the excess is not removed, the diarrhea will not stop. Therefore, urgent purgation is appropriate.
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In cases of diarrhea where the pulse is surprisingly slippery, there are pathogenic factors that need to be expelled. Healing will occur after purgation, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
Diarrhea with a surprisingly slippery pulse indicates that the disease presents an excess pattern, which is inconsistent with typical deficiency-type diarrhea. If the patient's physique and vital energy remain normal, and their appetite is unchanged, it implies that there are accumulations that should be removed but have not yet been. Purgation will lead to recovery, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
Zhao Liang stated: Diarrhea is generally a deficiency syndrome, whereas a slippery pulse is an excess pulse. Seeing an excess pulse in the context of a deficiency syndrome like diarrhea indicates that there are pathogenic factors to be expelled.
Cheng Lin stated: The Classics state: "Slipperiness indicates retained food." Therefore, purgation is required; once the retention is removed, the diarrhea will stop naturally.
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If diarrhea has resolved but recurs at specific years, months, days, or hours, it is because the pathogen was not completely eradicated. Purgation is required, and Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Annotation]
When diarrhea recurs after resolution, whether at a specific year, month, or day, it is due to incomplete removal of retained food and accumulated pathogens. If the patient's constitution and strength are robust and their diet remains strong, the remaining pathogenic factors should be attacked to prevent recurrence of the diarrhea. Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations]
Shen Mingzong stated: This is a recurrence of illness due to old accumulated pathogens. After the resolution of diarrhea, recurrence at specific times occurs because the pathogens from the previous episode hid in the hidden parts of the intestines. When the governing period of the zang-fu organs arrives, these old pathogens are triggered and cause recurrence. Without removing the hidden root, complete cure is impossible; thus, Da Cheng Qi Tang (Major Order the Qi Decoction) is used to swiftly eliminate them.
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In cases of diarrhea accompanied by delirious speech, there is dry fecal impaction. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is the primary treatment.
[Annotation]
Diarrhea is typically a interior deficiency syndrome, while delirious speech is an interior excess syndrome. How can we determine the presence of dry fecal impaction? If the pulse is slippery and rapid, it indicates retained food; if the excrement is foul and sticky, it indicates accumulated heat. Only when both pulse and symptoms align can we confirm the presence of dry fecal impaction. Purgation is indicated, using Xiao Cheng Qi Tang (Minor Order the Qi Decoction) as the main formula. From this, we can infer that dry fecal impaction does not necessarily manifest as constipation.
[Collected Annotations]
Li [Name obscured] stated: The Classics say: "Excess leads to delirious speech." Therefore, knowing there is dry fecal impaction, purgation is indicated.