具见六经中。
大法∶秋宜下。
【注】天至秋则气降，物至秋则成实，实则宜下。凡邪在下者，俱宜取法乎此义也。
凡可下者，用汤胜丸散，中病便止，不必尽剂也。
【注】汤者荡也，丸者缓也。下药贵速，故凡服下药用汤，所以胜丸也。中病即止，不必尽剂者，恐尽
剂反伤其正气也。
【集注】程应旄曰∶用汤胜丸，贵活法也。中病即止，示节制也。
下利，三部脉皆平，按之心下硬者，急下之，宜大承气汤。
【注】下利心下硬者，诸泻心汤证也。若寸、关、尺三部脉平实有力，虽下利仍宜攻其硬也。
【集注】方有执曰∶三部脉皆平，血气和可知矣。心下硬实也。所以急下之也。
张锡驹曰∶《本经》云∶若自下利者，脉当微厥。今反和者，此为内实也，宜下之。
下利，脉迟而滑者，内实也。利未欲止，当下之，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，仍当下之，使积去则利自止，宜大承气汤。
【集注】程应旄曰∶迟而滑，滑在下而迟在上，知为物阻之迟，非寒阴之迟，故但下其所阻，则内实去而
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。
【按】尺中“微”字，当是“大”字，若是“微”字，断无当下之理。
【注】寸口脉浮而大，按之反涩，谓按之且大、且涩、且有力也，关上尺中亦然。大涩有力，为实而不利
之诊，故知有宿食也，当下之，宜大承气汤。
【集注】程知曰∶滑为有食，结滞经宿，则脉涩矣。尺以候内，沉以候里，故宿食之脉，按之反涩，尺中
亦大而涩也。
下利不欲食者，以有宿食故也，当下之，宜大承气汤。
【注】初下利不欲食者，是伤食恶食，故不欲食也，若久下利不欲食者，是伤脾，食后饱胀不欲食也。今
初下利即不欲食，故知有宿食也，当下之，宜大承气汤无疑也。
【集注】程应旄曰∶伤食恶食，故不欲食，与不能食者自别。下利有此，更无别样虚证，知非三阴之下
利，而为宿食之下利也，故当下之。
下利瘥，至其年月日时复发者，以病不尽故也，当下之，宜大承气汤。
【注】下利瘥后，至其年月日时而复发其利者，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，自不复发矣，宜大承气汤。
【集注】方有执曰∶其期也，谓周其一年之月日期也。
程应旄曰∶下利瘥后，而余邪之栖于肠胃回折处者未尽，是为伏邪。凡得其候而伏者，仍应其候而伸下，
则搜而尽之矣。
下利脉反滑，当有所去，下乃愈，宜大承气汤。
【注】此承上条互发其义，以详其脉也。下利脉反滑，是证虚脉实，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】程应旄曰∶滑为实，故可行通因通用之法。
病腹中满痛者，此为实也，当下之，宜大承气汤。
【注】腹中不满而痛者，病或属虚，若满而痛，则为实矣，当下之，宜大承气汤。
【集注】张璐曰∶腹中既满且痛，为实结无疑，急须下之。
程应旄曰∶病腹中满痛，虽在阴经，亦可下，不必其为阳明矣。
伤寒后脉沉，沉者，内实也，下之解，宜大柴胡汤。
【注】伤寒后不解，脉沉，沉而有力者，内实也，宜以下解。然其人必午后小有潮热，故取大柴胡两解之也。
脉双弦而迟者，必心下硬，脉大而紧者，阳中有阴也，可下之，宜大承气汤。
【注】双弦，谓左关、右关皆见脉弦也。左关脉弦，肝本脉也；右关脉弦，木刑土也。弦者，饮也；迟者，
寒也。心下硬者，是肝邪挟寒饮而伤胃，故不可下，乃生姜泻心汤证也。若脉大按之紧，是阳有余而阴亦实也，
乃有余之硬，非胃伤者比，故可下之，宜大承气汤也。
这些内容在六经病证中均有体现。
治疗原则：秋季适宜使用下法。
【注】天气到了秋天则气机下降，万物到了秋天则果实成熟，果实成熟则适宜用下法。凡是邪气位于体内的，都应当效法这一原则。
凡是适合使用下法的，使用汤剂优于丸剂和散剂，病情好转即停止用药，不必服完全部剂量。
【注】汤剂的作用是涤荡清除，丸剂的作用是缓慢缓和。下药贵在迅速，所以服用下药时用汤剂，因此优于丸剂。病情好转即止，不必服完全部剂量，是担心服完全部剂量反而损伤人体的正气。
【集注】程应旄说：使用汤剂优于丸剂，贵在灵活变通。病情好转即止，示以节制。
出现下利（腹泻），三部脉象都平和，但按压心下部感觉硬满的，应当紧急使用下法，宜用大承气汤。
【注】下利伴有心下部硬满的，属于诸泻心汤证的范畴。如果寸、关、尺三部脉象平实有力，虽然伴有下利，仍然应当攻逐其硬满之邪。
【集注】方有执说：三部脉象都平和，说明血气和调可知。心下部硬满属实证。所以要紧急使用下法。
张锡驹说：《神农本草经》云：如果是自发性下利，脉象应当微弱或厥冷。现在脉象反而调和，这是体内实邪所致，适宜使用下法。
出现下利，脉象迟而滑的，是体内实邪。下利尚未停止，应当使用下法，宜用大承气汤。
【注】脉象迟通常不能兼见滑象，只有浮取时感到迟，沉取时感到滑，这种情况才存在。现在所说的下利脉迟而滑，是指浮取迟而沉取滑，浮取迟表示外部和缓，沉取滑表示内部实邪。想要止住因内实导致之下利，仍然应当使用下法，使积滞去除则下利自然停止，宜用大承气汤。
【集注】程应旄说：脉迟而滑，滑象在下部而迟象在上部，知道这是被物阻滞导致的迟脉，而非寒阴之迟，所以只要攻下其所阻滞之物，则内实去而下利自然停止！
问：人患病有宿食（停滞不化的食物），如何辨别？老师说：寸口脉浮而大，按之反而涩，尺中脉也微而涩，所以知道有宿食，应当使用下法，宜用大承气汤。
【按】尺中“微”字，应当是“大”字，如果是“微”字，绝对没有应当使用下法的道理。
【注】寸口脉浮而大，按之反而涩，是指按之既大、又涩、且有力，关上和尺中也是如此。大、涩且有力，是实证而不利的脉象，所以知道有宿食，应当使用下法，宜用大承气汤。
【集注】程知说：滑脉主有食，结滞经过一夜，脉象就会变得涩。尺部候内，沉取候里，所以宿食的脉象，按之反而涩，尺中也大而涩。
出现下利且不想吃东西的，是因为有宿食，应当使用下法，宜用大承气汤。
【注】刚开始下利就不想吃东西的，是伤食厌恶食物，所以不想吃；如果是长期下利不想吃东西的，是伤了脾气，饭后饱胀不想吃。现在是刚开始下利就不想吃，所以知道有宿食，应当使用下法，毫无疑问，宜用大承气汤。
【集注】程应旄说：伤食厌恶食物，所以不想吃，这与不能吃的情况自然不同。下利出现这种情况，更没有其他的虚证表现，知道这不是三阴经的下利，而是宿食导致的下利，所以应当使用下法。
下利痊愈后，到了原来的年、月、日、时再次复发的，是因为病邪未除尽，应当使用下法，宜用大承气汤。
【注】下利痊愈后，到了原来的时间再次复发下利的，这是因为宿食积滞的病邪攻伐未尽。如果此人形体气息不衰，饮食依然强盛，应当攻逐其未尽之邪，自然就不会再复发了，宜用大承气汤。
【集注】方有执说：所谓“期”，是指满一年的年月日时周期。
程应旄说：下利痊愈后，残存的邪气潜伏在肠胃回折处未除尽，这称为伏邪。凡是遇到相应的气候条件而潜伏的邪气，仍应顺应其气候特点而施用下法，从而将其搜刮干净。
下利脉象反而滑的，说明体内有当去之积滞，使用下法才能痊愈，宜用大承气汤。
【注】这是承接上一条互发其义，详细阐述脉象。下利脉象反而滑，是证候虚而脉象实，不相适宜。如果此人形体气息如常，饮食如故，乃是应当去除的积滞未去除，使用下法才能痊愈，宜用大承气汤。
【集注】程应旄说：滑脉主实，所以可以运用“通因通用”的治疗方法。
病人腹部胀满疼痛的，这是实证，应当使用下法，宜用大承气汤。
【注】腹部不满而痛的，病可能属虚；如果既满又痛，就是实证了，应当使用下法，宜用大承气汤。
【集注】张璐说：腹部既满且痛，无疑是实邪结聚，急需使用下法。
程应旄说：病在腹部胀满疼痛，即使在阴经，也可以使用下法，不必非要是阳明病。
伤寒后脉象沉，沉脉代表体内实邪，使用下法可解，宜用大柴胡汤。
【注】伤寒后病不解，脉象沉，沉而有力的，是体内实邪，适宜用下法解除。然而此人必定在午后有轻微的潮热，所以选用大柴胡汤表里双解。
脉象左右关部皆弦且迟的，必然心下部硬满；脉象大而紧的，是阳中有阴，可以使用下法，宜用大承气汤。
【注】双弦，是指左关、右关两部脉都见到弦脉。左关脉弦，是肝的本脉；右关脉弦，是木气克制土气。弦脉主饮邪；迟脉主寒。心下部硬满的，是肝邪挟带寒饮伤害胃腑，所以不可使用下法，这是生姜泻心汤的适应证。如果脉大按之紧，是阳气有余而阴气亦实，这是有余之硬满，不是胃气受伤的情况相比，所以可以使用下法，宜用大承气汤。
These manifestations are found throughout the Six Channels (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin).
General Principle: In autumn, purgation is appropriate.
[Annotation] When heaven reaches autumn, Qi descends; when things reach autumn, they become ripe and solid. When solid, purgation is appropriate. For any pathogenic factors located internally, one should follow this principle.
For conditions suitable for purgation, decoctions are superior to pills and powders. Stop medication once the disease is addressed; there is no need to consume the entire dose.
[Annotation] Decoctions act by sweeping and clearing, while pills act slowly. Purgatives require speed; therefore, using decoctions for purgatives is superior to pills. Stopping when the disease is addressed, without consuming the full dose, prevents the risk of damaging healthy Qi by overdosing.
[Collected Annotations] Cheng Yingmao stated: Using decoctions over pills values flexibility. Stopping when the disease is addressed demonstrates moderation.
If diarrhea occurs, and the pulses at the Cun, Guan, and Chi positions are all level, but palpation reveals hardness in the epigastrium, urgent purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Diarrhea accompanied by epigastric hardness typically belongs to the patterns treated by various Xiexin Tang (Drain the Epigastrium Decoctions). However, if the pulses at the Cun, Guan, and Chi positions are level, substantial, and forceful, despite the presence of diarrhea, one should still purge the hardness.
[Collected Annotations] Fang Youzhi stated: Level pulses at all three positions indicate harmonious Blood and Qi. The hardness in the epigastrium indicates excess. Hence, urgent purgation is necessary.
Zhang Xiju stated: *Shennong Bencao Jing* states: If there is spontaneous diarrhea, the pulse should be faint or cold. Since the pulse is now harmonious, this indicates internal excess, and purgation is appropriate.
If diarrhea occurs with a slow and slippery pulse, it indicates internal excess. As the diarrhea has not ceased, purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] A pulse is rarely both slow and slippery simultaneously. This condition exists only when superficial palpation feels slow and deep palpation feels slippery. Here, "slow and slippery" refers to superficial slowness and deep slipperiness. Superficial slowness indicates external harmony, while deep slipperiness indicates internal excess. To stop diarrhea caused by internal excess, purgation is still required. Once the accumulation is removed, the diarrhea will cease spontaneously. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Slow and slippery; the slipperiness is lower and the slowness is upper. This indicates slowness due to obstruction, not cold-Yin slowness. Therefore, purging the obstruction removes the internal excess, and the diarrhea stops naturally.
Q: How can one distinguish a patient suffering from retained food (Su Shi)?
A: The Cun Kou pulse is floating and large, but upon pressure, it feels choppy. The Chi position is also slightly large and choppy. Thus, retained food is known to exist, and purgation is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Commentary] The character "faint" (Wei) in "Chi position is faint" should likely be "large" (Da). If it were "faint," there would absolutely be no rationale for purgation.
[Annotation] The Cun Kou pulse being floating and large, yet choppy upon pressure, means that upon pressing, it is large, choppy, and forceful. The same applies to the Guan and Chi positions. Large, choppy, and forceful is a pulse of excess without free flow, indicating retained food. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Zhi stated: Slippery pulses indicate food retention. After lingering overnight, the pulse becomes choppy. The Chi position reflects the interior, and deep palpation reflects the interior. Thus, for retained food, the pulse is choppy upon pressure, and the Chi position is large and choppy.
If diarrhea occurs with an aversion to eating, it is due to retained food. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Initial diarrhea with an aversion to eating indicates food injury causing disgust for food. Long-term diarrhea with an aversion to eating indicates Spleen injury causing postprandial fullness. Here, initial diarrhea accompanied by an aversion to eating indicates retained food. Purging is undoubtedly required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Food injury causes disgust for food, which differs from inability to eat. Diarrhea presenting this way, without other deficiency signs, indicates it is not a Three-Yin diarrhea but a diarrhea due to retained food. Therefore, purging is required.
If diarrhea resolves but recurs at the specific year, month, day, or hour, it is because the pathogen was not completely eliminated. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Recurrence of diarrhea at the original time after resolution indicates that the pathogenic factor of retained food accumulation was not fully eradicated. If the patient's physical constitution and appetite remain strong, one should purge the remaining pathogen to prevent recurrence. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Fang Youzhi stated: "Period" refers to the annual cycle.
Cheng Yingmao stated: After diarrhea resolves, residual pathogens may linger in the folds of the intestines and stomach, termed latent pathogens. When the corresponding climatic conditions arise, these latent pathogens extend. Applying purgation at such times searches them out completely.
If diarrhea presents with a surprisingly slippery pulse, there is accumulation to be expelled. Purging leads to recovery. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] This elaborates on the previous clause regarding the pulse. A slippery pulse during diarrhea indicates a mismatch between deficiency symptoms and excess pulses. If the patient's physique and diet remain normal, it implies unremoved accumulation. Purging is required for recovery. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Cheng Yingmao stated: Slippery pulses indicate excess, so the method of "treating obstruction with draining methods" (Tong Yin Tong Yong) can be applied.
If abdominal fullness and pain occur, this is excess. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] Abdominal pain without fullness may belong to deficiency. Fullness combined with pain indicates excess. Purging is required. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Collected Annotations] Zhang Lu stated: Abdominal fullness and pain undoubtedly indicate excess stagnation; urgent purging is necessary.
Cheng Yingmao stated: Abdominal fullness and pain can be treated with purgation even in Yin channels, not limited to Yangming channel diseases.
After Shanghan (Cold Damage), if the pulse is Chen (Deep), it indicates internal excess. Purging resolves it. Dachaihu Tang (Major Bupleurum Decoction) is indicated.
[Annotation] Unresolved Shanghan with a Deep pulse that is forceful indicates internal excess, resolvable by purging. However, the patient likely experiences mild tidal fever in the afternoon. Therefore, Dachaihu Tang (Major Bupleurum Decoction) is chosen to resolve both exterior and interior.
If the pulses at both Guan positions are Xuan (Wiry) and Chi (Slow), there must be epigastric hardness. If the pulse is Da (Large) and Jin (Tight), there is Yang containing Yin. Purging is possible. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.
[Annotation] "Double Xuan" means the Left Guan and Right Guan pulses are both Wiry. Left Guan Wiry is the Liver's native pulse; Right Guan Wiry indicates Wood insulting Earth. Xuan pulses indicate fluid retention; Chi pulses indicate Cold. Epigastric hardness here is caused by Liver pathogen combining with cold-fluid to injure the Stomach, so purging is contraindicated; this is a pattern for Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction). If the pulse is Large and tight upon pressure, it indicates excess Yang and excess Yin. This is hardness due to excess, distinct from Stomach injury, so purging is permissible. Da Chengqi Tang (Major Order the Qi Decoction) is indicated.