大法，秋宜下。
秋时阳气下行，则邪亦在下，故宜下。
凡服下药，（赵本作“凡可下者”）用汤胜丸，（赵本有“散”字）中病即（赵本作“便”）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，悦人皮肤，益
人血气。水能净万物，故胜丸散。中病即止者，如承气汤证云∶若一服，利而（医统本作“则”）止后服。
又曰∶若一服，谵语止，更莫复服。是不尽剂也。
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，而又按之心下硬者，则知
邪甚也，故宜大承气汤下之。
下利，脉迟而滑者，内实也。利未欲止，当下之，宜大承气汤。
经曰∶脉迟者，食干物得之。《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，是致下利者，为内实，若但以温中浓肠之药，利必不（医统本作“未”）止，可与大承气汤，
下去宿食，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。
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，尺中亦微而涩者，胃有宿食里气不和也。与大承气汤，以下宿食。
下利，不欲食者，以有宿食故也，当宜（赵本无“宜”字）下之，与（赵本作“宜”）大承气汤。
伤食则恶食，故不欲食，如伤风恶风、伤寒恶寒之类也。
下利瘥后，（赵本无“后”字）至其年月日（赵本有“时”字）复发者；以病不尽故也，当下之，宜大承气汤。
乘春，则肝先受之；乘夏，则心先受之；乘至阴，则脾先受之；乘秋，则肺先受之。假令春时受病，气
必伤肝，治之难（医统本作“虽”）愈，邪有不尽者，至春时元受月日，内外相感，邪必复动
而痛（医统本作“病”）也。下利为肠胃疾，宿积不尽，故当下去之。
下利，脉反滑，当有所去，下之（赵本无“之”字）乃愈，宜大承气汤。
《脉经》曰∶滑脉者，为病（熊校记∶脉滑者为宿食也。汪本宿误病）食也。下利脉滑，则内有宿食，
故云当有所去，与大承气汤，以下宿食。
病腹中满痛者，此为实也，当下之，宜大承气（赵本有“大柴胡”三字）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，故可下之。
伤寒后，脉沉沉者，内实也，下解之，（赵本作“之解”）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，脉沉实者，以下解之。
脉双弦而迟者，必心下硬；脉大而紧者，阳中有阴也，可以（赵本无“以”字）下之，宜大承气汤。
《金匮要略》曰∶脉双弦者寒也。经曰∶迟为在脏。脉双弦而迟者，阴中伏阳也，必心下硬。大则为阳，
紧则为寒，脉大而紧者，阳中伏阴也，与大承气汤以分阴阳。
治疗原则，秋季适宜使用攻下法。
秋季时阳气下行，邪气也随之位于下部，因此适宜使用攻下法。
凡是服用攻下药，（赵本作“凡可下者”）用汤剂优于丸剂，（赵本有“散”字）药力中病即止，（赵本作“便”）不必服完全部剂量。
汤剂的含义是涤荡，能清洗肠胃，灌溉脏腑，推除陈旧的燥结，清除热邪并驱除寒邪，破除消散邪气疫病，调理疏导以润泽干枯之体，愉悦人的皮肤，补益人的气血。水能净化万物，所以汤剂优于丸剂和散剂。所谓中病即止，如承气汤证的条文所说：如果服一次药后，大便通利就停止后续服药。又说：如果服一次药后，谵语停止，就不再继续服药。这就是不必服完全部剂量。
出现下利症状，三部脉象都平和，按压心下部位感觉坚硬者，需紧急攻下，适宜用大承气汤。
下利的患者，脉象应当微弱或厥逆，现在反而平和，这是因为体内有实邪。下利且三部脉象平和的，已经表明是实证，如果再按压心下部位感觉坚硬，就知道邪气很盛，所以适宜用大承气汤攻下。
下利，脉象迟而滑的，是体内有实邪。下利尚未停止，应当攻下，适宜用大承气汤。
经典说：脉迟，是因为吃了干硬食物所致。《金匮要略》说：脉滑说明谷气充实。下利且脉迟而滑的，是胃中有宿食。脾胃因饮食受伤，不能消化水谷，导致下利，这属于内实，如果只用温中涩肠的药物，下利必定不会停止，可以给予大承气汤，去除宿食，下利自然就会停止。
问：人患有宿食，如何辨别？老师说：寸口脉浮而大，按之反而涩，尺部脉也微而涩，所以知道有宿食，应当攻下，适宜用大承气汤。
寸部脉候察外部，尺部脉候察内部；浮脉候察表证，沉脉候察里证。寸口脉浮大的，是气实血虚；按之反而涩，尺部脉也微而涩的，是胃中有宿食，里气不和。给予大承气汤，以去除宿食。
下利，不想吃东西的，是因为有宿食的缘故，应当攻下，适宜用大承气汤。
伤食则厌恶食物，所以不想吃东西，就像伤风厌恶风、伤寒厌恶寒冷一样。
下利痊愈后，到了原来的年月日又复发的，是因为病邪未除尽的缘故，应当攻下，适宜用大承气汤。
如果是春季发病，肝先受邪；夏季发病，心先受邪；长夏发病，脾先受邪；秋季发病，肺先受邪。假如在春季患病，气必然损伤肝脏，治疗难以痊愈，邪气有未除尽的，等到春季原来患病的年月日，内外相感应，邪气必然再次发动而疼痛。下利是肠胃的疾病，宿积未除尽，所以应当攻下去除它。
下利，脉象反而滑的，应当有所去泄，攻下之后才能痊愈，适宜用大承气汤。
《脉经》说：滑脉，是宿食造成的病。（熊校记：脉滑为宿食。汪本将“宿”误作“病”）。下利且脉滑，说明内有宿食，所以说应当有所去泄，给予大承气汤，以去除宿食。
病人腹部胀满疼痛的，这是实证，应当攻下，适宜用大承气汤（赵本有“大柴胡”三字）。
《金匮要略》说：病人腹部胀满，按之不痛的是虚证，痛的则是实证，可以攻下。腹部胀满疼痛的，是里气壅滞实证，所以可以攻下。
伤寒之后，脉象沉伏的，是内实，需要解下，适宜用大柴胡汤。
伤寒之后，表证已解，脉沉说明里气未和，给予大柴胡汤，以攻下内实。经典说：伤寒痊愈后再次发热，脉象沉实的，用攻下法解除。
脉象双弦且迟的，一定心下坚硬；脉象大而紧的，是阳中有阴，可以攻下，适宜用大承气汤。
《金匮要略》说：脉双弦是寒证。经典说：迟脉主脏病。脉双弦且迟的，是阴中伏阳，一定心下坚硬。大脉属阳，紧脉属寒，脉大而紧的，是阳中伏阴，给予大承气汤以调和阴阳。
General principles indicate that purgation is suitable in autumn.
In autumn, yang qi descends, and pathogens also reside in the lower part; therefore, purgation is appropriate.
For those taking purgatives, (Zhao's edition reads "those who can be purged") decoctions are superior to pills, (Zhao's edition includes the character for "powder") treatment should cease once the disease is addressed, (Zhao's edition reads "then") without necessarily completing the full dosage.
The term "decoction" implies sweeping away; it cleanses the intestines and stomach, irrigates the viscera, pushes out old dry accumulations, eliminates heat and expels cold, breaks up and disperses pathogenic epidemics, regulates and guides to moisten withered states, benefits the skin, and nourishes blood and qi. Water can purify all things, thus decoctions surpass pills and powders. Ceasing treatment upon addressing the disease is exemplified by the Chengqi Tang syndrome: "If after one dose, bowel movement occurs, stop subsequent doses." It also states: "If after one dose, delirium ceases, do not take more." This illustrates not completing the full dosage.
In cases of diarrhea where pulses at the three positions are all level, but pressure on the epigastrium reveals hardness, urgent purgation is required, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
Diarrhea typically presents with a faint or knotted pulse; if the pulse is instead harmonious/level, this indicates internal excess. Diarrhea accompanied by level pulses at the three positions already suggests excess; combined with hardness upon pressing the epigastrium, it confirms severe pathogenic factors, warranting purgation with Da Chengqi Tang (Major Order the Qi Decoction).
In cases of diarrhea with a slow and slippery pulse, there is internal excess. Since the diarrhea has not ceased, purgation is indicated, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
Classics state: A slow pulse results from consuming dry foods. *Jingui Yaolue* states: A slippery pulse indicates substantial grain qi. Diarrhea with a slow and slippery pulse indicates retained food in the stomach. Spleen and stomach injury from food stagnation leads to an inability to digest water and grains, causing diarrhea; this constitutes internal excess. If only warming and astringent intestinal medicines are used, the diarrhea will likely not cease. Da Chengqi Tang (Major Order the Qi Decoction) may be administered to remove the retained food, after which the diarrhea will naturally stop.
Question: How can retained food be distinguished in patients? The Master said: The cunkou pulse is floating and large; upon pressure, it feels choppy, and the chi position is also slightly choppy. Thus, retained food is known to exist, requiring purgation, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
The cun position inspects the exterior; the chi position inspects the interior. Floating pulses inspect the exterior; deep pulses inspect the interior. A floating and large cunkou pulse indicates excess qi and deficient blood. Choppy upon pressure and slightly choppy at the chi position indicates retained food in the stomach and disharmony of interior qi. Da Chengqi Tang (Major Order the Qi Decoction) is given to purge the retained food.
In cases of diarrhea with loss of appetite, it is due to retained food; purgation is indicated, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
Food injury causes aversion to food, hence the lack of appetite, similar to wind injury causing aversion to wind or cold injury causing aversion to cold.
If diarrhea recurs on the same month, day, or year after recovery, it is because the pathogen was not fully eliminated; purgation is indicated, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
If contracted in spring, the liver is affected first; in summer, the heart; during the late summer transition, the spleen; in autumn, the lung. For instance, if illness occurs in spring, qi inevitably injures the liver, making treatment difficult to cure. If pathogens remain unresolved, when the time arrives corresponding to the original onset in spring, internal and external resonance causes the pathogen to reactivate, leading to pain. Diarrhea is a gastrointestinal disorder; since retained accumulation is incomplete, it must be purged.
In cases of diarrhea with a surprisingly slippery pulse, something needs to be expelled; purgation leads to recovery, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
*Mai Jing* states: A slippery pulse indicates disease caused by retained food. (Xiong's correction notes: Slippery pulse indicates retained food. Wang's edition mistakenly writes 'disease' for 'retained'). Diarrhea with a slippery pulse indicates internal retained food; thus, it is said that something must be expelled. Da Chengqi Tang (Major Order the Qi Decoction) is given to purge the retained food.
Abdominal fullness and pain indicate excess; purgation is required, preferably using Da Chengqi Tang (Major Order the Qi Decoction) (Zhao's edition adds "Da Chaihu").
*Jingui Yaolue* states: Abdominal fullness that is non-tender upon pressure is deficiency; tender/fullness is excess, allowing for purgation. Abdominal fullness and pain indicate interior qi congestion and excess, permitting purgation.
After Shanghan, a deep pulse indicates internal excess; resolution via purgation is needed, preferably using Da Chaihu Tang (Minor Order the Qi Decoction).
Post-Shanghan, with the exterior resolved, a deep pulse indicates unharmonized interior. Da Chaihu Tang (Minor Order the Qi Decoction) is given to purge internal excess. Classics state: After Shanghan recovery, if fever recurs with a deep and solid pulse, purgation resolves it.
A double-string-like and slow pulse indicates epigastric hardness; a large and tight pulse indicates yin within yang, allowing for purgation, preferably using Da Chengqi Tang (Major Order the Qi Decoction).
*Jingui Yaolue* states: Double-string-like pulses indicate cold. Classics state: Slow pulses indicate zang organ involvement. A double-string-like and slow pulse indicates hidden yang within yin, resulting in epigastric hardness. Large pulses belong to yang; tight pulses belong to cold. A large and tight pulse indicates hidden yin within yang. Da Chengqi Tang (Major Order the Qi Decoction) is given to differentiate and harmonize yin and yang.