大法，秋宜下。
凡可下者，以汤胜丸散，中病便止，不必尽三服。
阳明病，发热汗多者，急下之，属大柴胡汤。
少阴病，得之二、三日，口燥咽干者，急下之，属承气汤。
少阴病六、七日，腹满不大便者，急下之，属承气汤证。
少阴病，下利清水，色青者，心下必痛，口干燥者，可下之，属大柴胡汤、承气汤证。
下利，三部脉皆平，按其心下坚者，可下之，属承气汤证。
阳明与少阳合病而利，脉不负者为顺，负者失也，互相克贼为负。
滑而数者，有宿食，当下之，属大柴胡、承气汤证。
伤寒后脉沉，沉为内实（《玉函》云∶脉沉实，沉实者，下之），下之解，属大柴胡汤证。
伤寒六、七日，目中不了了，睛不和，无表里证，大便难，微热者，此为实。急下之，属大柴胡汤、承气汤证。太
阳病未解，其脉阴阳俱停，必先振，汗出解。但阳微者，先汗之而解；但阴微者，先下之而解。属大柴胡汤证。（阴微一
作尺实）脉双弦迟，心下坚，脉大而紧者，阳中有阴，可下之，属承气汤证。结胸者，项亦强，如柔 状，下之即和。
病者无表里证，发热七、八日，虽脉浮数，可下之，属大柴胡汤证。太阳病六、七日，表证续在，其脉微沉，反不结胸，
其人发狂，此热在下焦，少腹当坚而满，小便自利者，下血乃愈。所以然者，以太阳随经，瘀热在里故也。属抵当汤。
太阳病，身黄，其脉沉结，少腹坚，小便不利，为无血；小便自利，其人如狂者，血证谛。属抵当汤证。伤寒有热
而少腹满，应小便不利，今反利者，此为血，当下之，属抵当丸证。阳明病，发热而汗出，此为热越，不能发黄，但头
汗出，其身无有，齐颈而还，小便不利，渴引水浆，此为瘀热在里，身必发黄，属茵陈蒿汤。阳明证，其人喜忘，必有
畜血。所以然者，本有久瘀血，故令喜忘。虽坚，大便必黑，属抵当汤证。汗出而谵语者，有燥屎在胃中，此风也，过
经乃可下之。下之若早，语言乱，以表虚里实故也。下之则愈，属大柴胡汤、承气汤证。病者烦热，汗出即解，复如疟
状，日晡所发者，属阳明。脉实者，当下之，属大柴胡汤、承气汤证。阳明病，谵语，有潮热，而反不能食者，必有燥
屎五、六枚；若能食者，但坚耳，属承气汤证。太阳中风，下利呕逆，表解，乃可攻之。其人 汗出，发作有时，头
痛，心下痞坚满，引胁下痛，呕则短气，汗出，不恶寒，此为表解里未和，属十枣汤。太阳病不解，热结膀胱，其人如
狂，血自下，下之即愈。其外未解，尚未可攻，当先解外。外解，小腹急结者，乃可攻之，属桃仁承气汤。伤寒七、八
日，身黄如橘，小便不利，少腹微满，属茵陈蒿汤证。伤寒十余日，热结在里，复往来寒热，属大柴胡汤证。但结胸，
无大热，此为水结在胸胁，头微汗出，与大陷胸汤。伤寒六、七日，结胸热实，其脉沉紧，心下痛，按之如石坚，与大
陷胸汤。阳明病，其人汗多，津液外出，胃中燥，大便必坚，坚者则谵语，属承气汤证。阳明病，不吐下而心烦者，可
与承气汤。阳明病，其脉迟，虽汗出而不恶寒，其体（一本作人）必重，短气，腹满而喘，有潮热，如此者，其外为解，
可攻其里。若手足 然汗出者，此大便已坚，属承气汤。其热不潮，未可与承气汤。若腹满大而不大便者，属小承气汤，
微和胃气，勿令至大下。阳明病，谵语，发潮热，其脉滑疾，如此者，属承气汤。因与承气汤一升，腹中转失气者，复
与一升；如不转失气者，勿更与之。明日又不大便，脉反微涩者，此为里虚，为难治，不可更与承气汤。二阳并病，太
阳证罢，但发潮热手足 汗出，大便难而谵语者，下之愈，属承气汤证。病患小便不利，大便乍难乍易，时有微热，
喘冒不能卧者有燥屎也，属承气汤证。
总的原则是，秋季适宜使用攻下法。
凡是适合用攻下法的病证，用汤剂的效果优于丸剂和散剂，只要病情好转就应停药，不必服完三剂。
阳明病，出现发热且汗出较多的症状，应当紧急使用攻下法，适用大柴胡汤。
少阴病，患病两三天后，出现口燥咽干的症状，应当紧急使用攻下法，适用承气汤。
少阴病，患病六七天，出现腹部胀满且大便不通的症状，应当紧急使用攻下法，属于承气汤证。
少阴病，出现泻下清稀水样便，颜色发青，心窝部必定疼痛，口干燥的，可以使用攻下法，属于大柴胡汤或承气汤证。
腹泻，三部脉象都平和，但按压心窝部感觉坚硬的，可以使用攻下法，属于承气汤证。
阳明病与少阳病合病而出现腹泻，脉象没有相克现象的为顺证，脉象相克为逆证（失），相互克制贼害称为负。
脉象滑而数的，说明有积食停滞，应当使用攻下法，属于大柴胡汤或承气汤证。
伤寒病后脉象沉，沉脉主里实（《玉函经》说：脉沉实，沉实者，应用攻下法），通过攻下可以解除病邪，属于大柴胡汤证。
伤寒病六七天，眼睛视物不清，眼球转动不灵活，没有明显的表证或里证，大便困难，仅有轻微发热的，这是实证。应当紧急使用攻下法，属于大柴胡汤或承气汤证。
太阳病未解除，其脉象寸关尺三部皆隐伏不见，病人必先出现寒战，随后汗出而病解。如果仅寸脉微弱的，先使用发汗法而病解；如果仅尺脉微弱的，先使用攻下法而病解。属于大柴胡汤证。（“尺脉微弱”一作“尺脉实”）。脉象双弦且迟，心窝部坚硬，脉象大而紧的，是阳中有阴邪，可以使用攻下法，属于承气汤证。结胸病患者，颈部也僵硬，像柔痉病的样子，使用攻下法即可调和。
病人没有表证和里证，发热七八天，虽然脉象浮数，也可以使用攻下法，属于大柴胡汤证。太阳病六七天，表证依然存在，脉象反而微沉，却没有形成结胸，病人出现发狂的症状，这是热邪在下焦，小腹部应当坚硬胀满，小便自利的，通过泻下瘀血才能痊愈。之所以这样，是因为太阳经邪气随经入里，瘀热在里的缘故。属于抵当汤证。
太阳病，身体发黄，脉象沉结，小腹部坚硬，小便不利，这是无瘀血；如果小便自利，病人像发狂一样的，这是瘀血的征象确凿无疑。属于抵当汤证。伤寒病有发热且小腹胀满，应该小便不利，现在反而小便通利的，这是蓄血证，应当使用攻下法，属于抵当丸证。阳明病，发热且汗出，这是热邪向外发散，不会发黄，但如果只有头部出汗，身上无汗，齐颈而止，小便不利，口渴想喝水浆，这是瘀热在里，身体一定会发黄，属于茵陈蒿汤证。阳明病证，病人喜欢忘事，必定有蓄血。之所以这样，是因为原本就有久瘀血，所以导致喜欢忘事。即使大便坚硬，大便颜色必定发黑，属于抵当汤证。出汗且说胡话的，胃中有燥屎，这是风邪所致，经过传变至下一经后才可攻下。如果攻下过早，会导致语言错乱，这是因为表虚里实的缘故。正确攻下后则痊愈，属于大柴胡汤或承气汤证。病人烦热，出汗后暂时缓解，但又像疟疾一样发作，每天傍晚发热的，属于阳明病。脉象实的，应当使用攻下法，属于大柴胡汤或承气汤证。阳明病，说胡话，有潮热，反而不能进食的，必定有五六枚燥屎；如果能进食的，只是大便坚硬罢了，属于承气汤证。太阳中风病，出现腹泻、呕吐逆气，表证解除后，才可以攻里。病人濈然汗出，发作有定时，头痛，心窝部痞塞坚硬胀满，牵引胁下疼痛，呕吐则短气，出汗，不恶寒，这是表证已解而里气未和，属于十枣汤证。太阳病未解除，热邪结聚在膀胱，病人像发狂一样，瘀血自行下行，下行后病即愈。如果表证未解，还不可以攻里，应当先解表。表证解除后，小腹部急迫拘结的，才可以攻里，属于桃仁承气汤证。伤寒七八天，身体黄得像橘子色，小便不利，小腹部微满，属于茵陈蒿汤证。伤寒十多天，热邪结聚在里，又出现往来寒热的症状，属于大柴胡汤证。单纯结胸，没有大热，这是水饮结聚在胸胁，头部微微出汗，给予大陷胸汤。伤寒六七天，结胸证属热实，脉象沉紧，心窝部疼痛，按压像石头一样坚硬，给予大陷胸汤。阳明病，病人汗多，津液外泄，胃中干燥，大便必定坚硬，大便坚硬就会说胡话，属于承气汤证。阳明病，没有经过吐法或下法却心烦的，可以给承气汤。阳明病，脉象迟，虽然出汗但不恶寒，身体必定沉重，短气，腹部胀满且喘，有潮热，像这样的情况，表证已解，可以攻里。如果手脚濈然汗出的，这说明大便已经坚硬，属于承气汤证。如果没有潮热，不可以给承气汤。如果腹部胀满大且不大便的，属于小承气汤证，轻微调和胃气，不要让它导致剧烈攻下。阳明病，说胡话，发潮热，脉象滑疾，像这样的情况，属于承气汤证。因此给予承气汤一升，如果腹中肠鸣转气的，再给一升；如果不转气的，不要再给。第二天又不大便，脉象反而微涩的，这是里虚，难以治疗，不可再给承气汤。二阳并病，太阳证已罢，只发潮热，手足濈然汗出，大便难且说胡话的，攻下则愈，属于承气汤证。病人小便不利，大便时而难时而易，有时有轻微发热，气喘头晕不能卧倒的，是有燥屎，属于承气汤证。
The general principle is that purgation (Purgative Method) is suitable in autumn.
For conditions suitable for purgation, decoctions are more effective than pills and powders. Stop medication once the disease is addressed; it is not necessary to complete three doses.
In Yangming disease (Disease of the Yangming channel), if there is fever with profuse sweating, urgent purgation is required, indicated by Dachaihu Tang (Greater Bupleurum Decoction).
In Shaoyin disease (Disease of the Shaoyin channel), if dry mouth and throat occur two or three days after onset, urgent purgation is required, indicated by Chengqi Tang (Gut-Regulating Decoction).
In Shaoyin disease, if abdominal fullness and constipation occur six or seven days after onset, urgent purgation is required, indicating a Chengqi Tang syndrome.
In Shaoyin disease, if there is diarrhea of clear watery stool with a green color, pain in the epigastrium, and dry mouth, purgation may be used, indicating a Dachaihu Tang or Chengqi Tang syndrome.
If there is diarrhea, the pulse at all three positions (Cun, Guan, Chi) is level, but pressure on the epigastrium reveals hardness, purgation may be used, indicating a Chengqi Tang syndrome.
In combined Yangming and Shaoyang disease presenting with diarrhea, a non-clashing pulse indicates a favorable outcome (Shun); a clashing pulse indicates an unfavorable outcome (Fu/Negative), where mutual overacting leads to deficiency.
A slippery and rapid pulse indicates retained food stagnation, requiring purgation, indicating a Dachaihu Tang or Chengqi Tang syndrome.
After Shanghan (Cold Damage), a deep pulse indicates interior excess (as stated in *Yu Han Jing*: "A deep and solid pulse requires purgation"). Purgation resolves the condition, indicating a Dachaihu Tang syndrome.
Six or seven days into Shanghan, if the eyes appear dull and unresponsive, without obvious exterior or interior signs, but with difficult defecation and slight fever, this is an excess condition. Urgent purgation is required, indicating a Dachaihu Tang or Chengqi Tang syndrome.
If Taiyang disease (Disease of the Taiyang channel) is unresolved and the pulse at all three positions is hidden, the patient will first experience chills, followed by sweating and resolution. If only the Yang position (Cun) pulse is weak, resolve via diaphoresis first; if only the Yin position (Chi) pulse is weak, resolve via purgation first. This indicates a Dachaihu Tang syndrome. (Note: "Chi pulse weak" is alternatively read as "Chi pulse solid"). A double-stringy and slow pulse with epigastric hardness, or a large and tight pulse, indicates Yin within Yang, allowing for purgation, indicating a Chengqi Tang syndrome. In Jie Xiong (Chest Binding), if the neck is stiff like in Rou Ji (Soft Spasm), purgation harmonizes the condition.
If a patient has no exterior or interior signs but has had fever for seven or eight days, purgation may still be used despite a floating and rapid pulse, indicating a Dachaihu Tang syndrome. In Taiyang disease lasting six or seven days, if exterior signs persist, the pulse becomes slightly deep, chest binding does not form, but the patient exhibits mania, this indicates heat in the Lower Jiao (Lower Burner). The lower abdomen should be hard and full, and urination free. Resolution occurs through blood purgation. This is because Taiyang pathogenic factors follow the channels into the interior, causing stasis-heat. This indicates Dangui Tang (Dangui Decoction).
In Taiyang disease, if jaundice occurs with a deep and knotted pulse, hard lower abdomen, and dysuria, there is no blood stasis; however, if urination is free and the patient resembles mania, blood stasis is confirmed. This indicates Dangui Tang syndrome. In Shanghan with fever and lower abdominal fullness, if urination is unexpectedly free, this indicates blood stasis requiring purgation, indicating Dangui Wan (Dangui Pill).
In Yangming disease, fever with sweating indicates heat dispersing outward, preventing jaundice. However, if only the head sweats (stopping at the neck), with no body sweat, dysuria, and thirst for fluids, this is stasis-heat in the interior leading to jaundice, indicated by Yinchenshao Tang (Artemisiae Scopariae Decoction). In Yangming syndrome, forgetfulness indicates retained blood due to long-standing stasis. Even if the abdomen is hard, stools will be black, indicating Dangui Tang syndrome. Sweating with delirium indicates dry feces in the Stomach due to wind pathogens; purgation should only be performed after the pathogen has passed to the next stage. Premature purgation causes speech confusion due to exterior deficiency and interior excess. Proper purgation cures the condition, indicating Dachaihu Tang or Chengqi Tang syndrome.
If a patient has irritability and heat, resolving temporarily with sweat, then recurring like malaria with afternoon fever, this is Yangming disease. A solid pulse requires purgation, indicating Dachaihu Tang or Chengqi Tang syndrome. In Yangming disease, delirium with tidal fever and inability to eat indicates five or six pieces of dry feces; if eating is possible, only hard stools exist, indicating Chengqi Tang syndrome.
In Taiyang Wind Strike with diarrhea and vomiting, purgation is permitted only after the exterior is resolved. If the patient has continuous sweating occurring at specific times, headache, epigastric stiffness and fullness radiating to the hypochondrium, shortness of breath upon vomiting, sweating without aversion to cold, this indicates resolved exterior and unresolved interior, indicated by Shizao Tang (Ten Jujube Decoction).
If Taiyang disease is unresolved and heat binds in the Bladder, causing mania, spontaneous bleeding resolves the condition. If the exterior remains unresolved, do not attack the interior yet; resolve the exterior first. Once the exterior is resolved and the lower abdomen feels urgent and knotted, attack the interior, indicated by Taoren Chengqi Tang (Peach Kernel Gut-Regulating Decoction).
In Shanghan lasting seven or eight days, yellow skin like orange peel, dysuria, and mild lower abdominal fullness indicate Yinchenshao Tang syndrome. In Shanghan lasting ten-plus days, heat bound in the interior with alternating chills and fever indicates Dachaihu Tang syndrome. Pure Jie Xiong without significant heat indicates water binding in the chest and hypochondrium with slight head sweating, treated with Daxiexiong Tang (Great Chest-Binding Decoction). In Shanghan six or seven days later, heat-real Jie Xiong with a deep-tight pulse, epigastric pain, and stone-hard palpation is treated with Daxiexiong Tang.
In Yangming disease, profuse sweating depletes fluids, drying the Stomach and hardening stools, leading to delirium, indicated by Chengqi Tang syndrome. In Yangming disease, restlessness without prior emesis or purgation allows for Chengqi Tang administration. In Yangming disease, a slow pulse with sweating but no aversion to cold, heavy body, shortness of breath, abdominal fullness with wheezing, and tidal fever indicates resolved exterior and actionable interior. Hand-foot sweating confirms hardened stools, indicated by Chengqi Tang. Without tidal fever, Chengqi Tang is contraindicated. For abdominal fullness and constipation, Xiaochengqi Tang (Minor Gut-Regulating Decoction) is used to mildly harmonize Stomach Qi, avoiding severe purgation. In Yangming disease, delirium with tidal fever and a slippery-rapid pulse indicates Chengqi Tang syndrome. Administer one sheng of Chengqi Tang; if intestinal gas passes, administer another sheng. If no gas passes, withhold further doses. If constipation persists the next day with a faint and choppy pulse, this indicates interior deficiency and difficulty in treatment; do not administer Chengqi Tang again.
In concurrent Taiyang and Yangming diseases, if Taiyang signs cease and only tidal fever, hand-foot sweating, difficult defecation, and delirium remain, purgation cures the condition, indicated by Chengqi Tang syndrome. If a patient has dysuria, alternating difficulty and ease in defecation, slight fever, wheezing, dizziness, and inability to lie down, this indicates dry feces, indicated by Chengqi Tang syndrome.