仲景曰。脉濡而弱。弱反在关。（庞云关下三分也）濡反在巅。
（关上三分也）微反在上。（寸脉也）涩反在下。（尺部也）微则阳气不
足。涩则无血。阳气反微。中风汗出。而反躁烦。涩则无血。厥而且
寒。阳微不可下。下之则心下痞硬。庞氏以气血俱不足。用小建中
汤。常氏云。下后心下痞硬。用增损理中丸。
又曰。动气在右。不可下。下之则津液内竭。咽燥鼻干。头眩心
悸也。庞氏以咽燥鼻干。宜竹叶汤。
又曰。动气在左。不可下。下之则腹内拘急。食不下。动气更剧。
虽有身热。卧则欲蜷。庞常皆云先服干姜甘草汤。后服小建中汤。
又曰。动气在上。不可下。下之则掌握热烦。身上浮冷。热汗自
泄。欲得水自灌。常氏云。宜小建中汤。
又曰。动气在下。不可下。下之则腹胀满。卒起头眩。食则下清
谷。心下痞也。庞氏云。心下痞。宜半夏泻心汤。
又曰。咽中闭塞。不可下。下之则上轻下重。水浆不下。卧则欲
蜷。身急痛。下利日数十行。常氏云。咽中闭塞。可乌扇煎。下利。宜
四逆散。
又曰。诸外实者。不可下。下之则发微热。亡脉厥者。当脐握热。
雍曰。宜服去白术理中汤。以术利腰脐间血故也。
又曰。诸虚者不可下。下之则大渴。求（一作引）水者易愈。恶水
者剧。雍曰。宜小建中汤。
又曰。脉濡而弱。弱反在关。濡反在巅。弦反在上。微反在下。弦
为阳运。微为阴寒。上实下虚。意欲得温。微弦为虚。虚者不可下也。
微则为咳。咳则吐涎。下之则咳止而利因不休。利不休则胸中如虫
啮。粥入则出。小便不利。两胁拘急。喘息为难。颈背相引。臂则不
仁。极寒反汗出。身冷若冰。眼睛不慧。语言不休。而谷气多入。此名
除中。（一云消中）口虽欲言。舌不得前。雍曰。此不治之证。故诸家
无治法。庞氏云。诸脉濡弱微虚细相搏。俱不可下。
又曰。脉濡而弱。弱反在关。濡反在巅。浮反在上。数反在下。浮
为阳虚。数为亡血。浮为虚。数为热。浮为虚。自汗出而恶寒。数为
痛。振寒而 。微弱在关。胸下为急。喘汗而不得呼吸。呼吸之中。痛
在于胁。振寒相搏。形如疟状。医反下之。故令脉数发热。狂走见鬼。
心下为痞。小便淋沥。小腹甚硬。小便则尿血也。常氏云。可小柴胡
汤、鹊石散、延胡索散。
又曰。脉濡而紧。濡则卫气微。紧则营中寒。阳微卫中风。发热
而恶寒。营紧胃气冷。微呕心内烦。医为有大热。解肌而发汗。亡阳
虚烦躁。心下苦痞坚。表里俱虚竭。卒起而头眩。客热在皮肤。怅怏
不得眠。不知胃气冷。紧寒在关元。技巧无所施。汲水灌其身。客热
应时罢。 而振寒。重被而覆之。汗出而冒巅。体惕而又振。小便
为微难。寒气因水发。清谷不容间。呕变反肠出。颠倒不得安。手足
为微逆。身冷而内烦。迟欲从后救。安可复追还。常氏云。可灸关元。
雍曰。仍服通脉四逆汤。
又曰。脉浮而大。浮为气实。大为血虚。血虚为无阴。孤阳独下
阴部者。小盒饭赤而难。胞中当虚。今反小便利而大汗出。法应卫家
当微。今反更实。津液四射。营竭血尽。干烦而不得眠。血暴肉消而
成暴液。（暴液一作黑液）医复以毒药攻其胃。此为重虚。客阳去有
期。必下如污泥而死。常氏云。可小建中汤。已经下者。不治。
又曰。脉浮而紧。浮则为风。紧则为寒。风则伤卫。寒则伤营。营
卫俱病。骨节烦疼。当发其汗。而不可下也。常氏云。可桂枝麻黄各
半汤。雍曰。仲景可汗证中。只用麻黄汤。
又曰。趺阳脉迟而缓。胃气如经也。趺阳脉浮而数。浮则伤胃。
数则动脾。此非本病。医特下之所为也。营卫内陷。其数先微。脉反
但浮。其人必大便硬。气噫而除。何以言之。本以数脉动脾。其数先
微。故知脾气不治。大便硬。气噫而除。今脉反浮。其数改微。邪气独
留。心中则饥。邪热不杀谷。潮热发渴。数脉当迟缓。脉因前后。度数
如法。病者则饥。数脉不时。则生恶疮也。常氏云。可小柴胡汤。恶
疮。漏芦汤。
又曰。脉数者久数不止。止则邪结。正气不能复。正气却结于
脏。故邪气浮之。与皮毛相得。脉数者不可不。下之必烦。利不止。常
氏云。可柴胡桂枝汤。
又曰。少阴病。脉浮。不可发汗。亡阳故也。阳已虚。尺脉弱涩
者。复不可下之。雍曰。宜建中汤。
又曰。脉浮大。应发汗。医反下之。此为大逆。雍曰。误下宜四味
理中丸。误下则中气受伤。故用是汤。
又曰。脉浮而大。心下反硬。有热属脏者。攻之不令发汗。属腑
者。不令溲数。溲数则大便硬。汗多则热愈。汗少则便难。脉迟尚未
可攻。常氏云。可小柴胡汤。雍曰。此一证中有误字。脉经云。攻之不
令微汗。属腑溲数则坚。汗多则愈。汗出小便难。文皆有误。不能通。
又曰。二阳并病。太阳初得病时。发其汗。汗先出不彻。因转属
阳明。续自微汗出。不恶寒。若太阳证不罢者。不可下。下之为逆。常
氏以太阳证不罢。宜柴胡桂枝汤。
又曰。结胸证。脉浮大者。不可下。下之则死。常氏云。可小陷胸
汤、增损理中丸、圣饼灸法。
又曰。太阳与阳明合病。喘而胸满者。不可下。常氏云。可麻黄
杏子甘草石膏汤。
又曰。太阳与少阳并病。心下硬。颈项强而眩者。不可下。常氏
云。可小柴胡汤。雍曰。仲景刺大椎肺俞肝俞。见太阳证中。
又曰。诸四逆厥者。不可下之。虚家亦然。常氏云。可当归四逆
汤。庞氏云。若下证悉见。四逆者。是失下后。气血不通使然。但手足
微厥。掌心常温。时复指稍温。即可下之。勿拘忌也。
又曰。病欲吐者。不可下。常氏云。可半夏加橘皮汤。
又曰。太阳病。有外证未解。不可不。下之为逆。常氏云。可桂枝
麻黄各半汤。雍曰。根据可汗证中。用桂枝二麻黄一汤。
又曰。病发于阳。而反下之。热入因作结胸。病发于阴。而反下
之。（一作汗之。宫本及脉经皆作下之。）因作痞。常氏云。结胸。可大
陷胸汤、痞。可半夏泻心汤。
又曰。病脉浮而紧。而复下之。紧反入里。则作痞。常氏云。可小
陷胸汤、泻心汤。雍曰。宜半夏泻心汤。
又曰。夫病阳多者热。下之则硬。常氏云。可小柴胡汤。
又曰。其人本虚。攻其热必哕。雍曰。宜半夏生姜汤、类要四味
橘皮汤。
又曰。无阳阴强。大便硬者。下之必清谷腹满。常氏云。可蜜煎
导之。
又曰。太阴之为病。腹满而吐。食不下。自利益甚。时腹自痛。若
下之。必胸下结硬。常氏云。可桂枝加芍药汤。胸下结硬者。增损理
中丸。
又曰。厥阴之为病。消渴。气上撞心。心中疼热。饥不欲食。食则
吐蛔。下之利不止。常氏云。下之利不止。宜四逆汤。余见厥阴本证。
又曰。少阴病。饮食入口则吐。心中温温欲吐。始得之。手足寒。
脉弦迟者。此胸中实。不可下也。常氏云。饮食入口则吐。可瓜蒂散。
余见少阴本证。
又曰。伤寒五六日。不结胸。腹濡脉虚。复厥者。不可下。此亡
血。下之死。常氏云。可小建中汤。已下。不治。
又曰。伤寒发热头痛。微汗出。发汗则不识人。熏之则喘。不得
小便。下之则短气。小便难。头痛背强。加温针则衄。常氏云。可小柴
胡汤。已汗者。桂枝加附子汤。汗出而喘者。麻黄甘草杏子石膏汤。
已下者。五苓散。加温针者。芍药地黄汤。
又曰。伤寒。脉阴阳俱紧。恶寒发热。则脉欲厥。厥者脉初来大。
渐渐小。更来渐大。是其候也。如此者恶寒。甚者翕翕汗出。喉中痛。
若热多者。目赤脉多。睛不慧。医复发之。咽中则伤。若复下之。则两
目闭。寒多便清谷。热多便脓血。若熏之则身发黄。若熨之则咽燥。
若小便利者可救之。若小便难者为危殆。常氏云。初证宜桂枝麻黄
各半汤。喉中痛。桔梗汤。热多。小柴胡汤。便清谷。理中丸。便脓血。
桃花汤。身发黄。茵陈蒿汤。小便难者。猪苓汤。
又曰。伤寒发热。口中勃勃气出。头痛目黄。衄不可制。贪水者
必呕。恶水者厥。若下之。咽中生疮。假令手足温者。必下重便脓血。
头痛目黄者。若下之。则两目闭。贪水者。若下之。其脉必厥。其声
嘤。咽喉塞。若发汗。则战 。阴阳俱虚。恶水者。若下之。则里冷。不
嗜食。大便完谷出。若发汗。则口中伤。舌上白苔。烦躁。脉数实。不
大便。六七日后必便血。若发汗。则小便自利也。常氏曰。若热衄不
可制者。芍药地黄汤。水逆者。五苓散。便脓血。桃花汤。咽中生疮。
白矾甘草散。阴阳俱虚。小建中汤。里冷不嗜食。理中汤。发热身黄。
栀子柏皮汤。余证。小柴胡汤。汗出小便数。甘草干姜汤。
又曰。得病二三日。脉弱。无太阳柴胡证。烦躁。心下硬。至四五
日。虽能食。以小承气汤少少和之。令小安。至六日。与大承气一升。
若不大便六七日。小便少者。虽不能食。但初头硬。后必溏。未定成
硬。攻之必溏。须小便利。屎定硬。乃可攻之。庞氏曰。尺下弱。小便
不利。或尚少。皆未可攻。
又曰。脏结无阳证。不往来寒热。或寒而不热。其人反静。舌上
苔滑者。不可攻也。常氏云。可刺关元穴。在脐下。
又曰。可刺大赫。
在腹部第二行。雍曰。灸尤奇。
又曰。伤寒呕多。虽有阳明证。不可攻之。雍曰。不可攻之。恐厥
逆也。可小半夏加茯苓汤、生姜橘皮汤。
又曰。阳明病。潮热。大便微硬者。可与大承气汤。不硬者。不可
与之。若不大便六七日。恐有燥屎。欲知之法。少与小承气汤。汤入
腹中。转失气者。此有燥屎也。乃可攻之。若不转失气者。此但初头
硬。后必溏。不可攻之。攻之。必胀满不能食也。欲饮水者。与水则
哕。其后发热者。大便复硬而少。宜小承气汤和之。不转失气者。慎
不可攻也。
又曰。伤寒中风。医反下之。其人下利。日数十行。谷不化。腹中
雷鸣。心下痞硬而满。干呕。心烦不得安。医见心下痞。谓病不尽。复
下之。其痞益甚。此非结热。但以胃中虚。客气上逆。故使硬也。属甘
草泻心汤。
又曰。下利。脉大或浮。大者虚也。以强下之故也。设脉浮革。因
尔肠鸣。属当归四逆汤。
又曰。阳明病。面合色赤。不可攻之。攻之。必发热色黄。小便不
利也。常氏云。可五苓散。
又曰。阳明病。心下硬满者。不可攻之。攻之。利遂不止者死。利
止者愈。常氏云。心下硬满者。可半夏泻心汤。已攻而利者。四逆汤。
又曰。阳明病。自汗出。若发汗。小便自利者。此为津液内竭。虽
硬。不可攻之。当须自欲大便。宜蜜导而通之。若土瓜根及猪胆汁。
皆可为导。
庞氏曰。不当下而强下之。令人肠胃洞泄不禁而死。
张仲景说：脉象濡软而微弱，弱脉反而出现在关部。（庞安时注：指关脉下方三分处）濡脉反而出现在巅部（即寸部）。（庞安时注：指关脉上方三分处）微脉反而出现在上部（即寸脉）。涩脉反而出现在下部（即尺部）。微脉表示阳气不足，涩脉表示无血。阳气反而微弱，患中风病会出汗，反而出现躁动烦乱；涩脉表示无血，会导致四肢厥冷且寒。阳气微弱不可攻下，若攻下则会导致心下痞塞坚硬。庞安时认为这是气血俱不足，用小建中汤。常器之说，攻下后心下痞硬，用增损理中丸。
又说：动气在右侧，不可攻下。若攻下则津液内竭，导致咽干鼻燥、头晕心悸。庞安时认为咽干鼻燥，宜用竹叶汤。
又说：动气在左侧，不可攻下。若攻下则腹内拘急，饮食不下，动气症状加剧。即使身体发热，也只想蜷卧。庞氏和常氏都说先服用干姜甘草汤，后服用小建中汤。
又说：动气在上部，不可攻下。若攻下则手掌心热烦，身上浮冷，热汗自出，想要用水浇灌自己。常氏说，宜用小建中汤。
又说：动气在下部，不可攻下。若攻下则腹胀满，突然起身则头晕目眩，进食则排泄未消化的食物，心下痞塞。庞氏说，心下痞，宜用半夏泻心汤。
又说：咽喉闭塞不通，不可攻下。若攻下则上轻下重，水浆难进，躺下想蜷缩，身体拘急疼痛，腹泻一天几十次。常氏说，咽喉闭塞，可用乌扇煎。腹泻，宜用四逆散。
又说：各种外实证的病，不可攻下。若攻下则引发轻微发热，亡阳厥逆者，肚脐周围手握感觉发热。郭雍说，宜服用去白术的理中汤，因为白术有利腰脐间血的作用。
又说：各种虚证不可攻下。若攻下则大渴，引水喝的人容易痊愈，厌恶喝水的人病情加重。郭雍说，宜用小建中汤。
又说：脉象濡软而微弱，弱脉反而出现在关部，濡脉反而出现在巅部，弦脉反而出现在上部，微脉反而出现在下部。弦脉代表阳气运行，微脉代表阴寒。上实下虚，意念想要温暖。微弦脉为虚证，虚证不可攻下。微脉则咳嗽，咳嗽则吐涎沫。若攻下则咳嗽停止但腹泻不止。腹泻不止则胸中像被虫咬一样难受，喝粥则吐出，小便不利，两胁拘急，喘息困难，颈背相互牵引，手臂麻木不仁。极寒反而出汗，身体冷如冰，眼睛昏花不明，言语不休，而谷气多入体内。这名叫除中。（一说消中）口虽想说话，舌头却伸不出来。郭雍说，这是不治之证，所以各家没有治疗方法。庞氏说，各种脉象濡弱、微虚、细相搏结的，都不可攻下。
又说：脉象濡软而微弱，弱脉反而出现在关部，濡脉反而出现在巅部，浮脉反而出现在上部，数脉反而出现在下部。浮脉代表阳虚，数脉代表亡血。浮脉为虚，数脉为热。浮脉为虚，自汗出且恶寒；数脉为痛，发冷颤抖而……（原文缺字，据语境推测为寒战或类似症状），微弱脉在关部，胸下急迫，喘促出汗且无法呼吸。呼吸之中，疼痛在胁肋。发冷颤抖相搏结，形体像疟疾发作。医生反而攻下，导致脉数发热，狂跑见鬼，心下痞塞，小便淋沥不尽，小腹非常硬，小便尿血。常氏说，可用小柴胡汤、鹊石散、延胡索散。
又说：脉象濡软而紧，濡则卫气微弱，紧则营中有寒。阳微卫受风邪，发热而恶寒；营紧胃气寒冷，轻微呕吐心中烦闷。医生以为有大热，用解肌法发汗，导致亡阳虚烦躁，心下苦于痞塞坚硬。表里俱虚竭，突然起身则头晕，客热在皮肤，惆怅郁闷不得睡眠。不知道胃气寒冷，紧寒在关元穴处，医术高超者也无处施展。汲水浇其身，客热随即消失，身体颤抖发冷。盖上厚被子覆盖，出汗则头顶冒热气，身体战栗又发抖，小便微难。寒气因冷水激发，完谷不化的腹泻不容间歇，呕吐变为反肠脱出，颠倒不安。手足轻微厥逆，身体冷而内心烦乱。迟了想要从后补救，怎么还能追回呢？常氏说，可灸关元穴。郭雍说，仍服用通脉四逆汤。
又说：脉象浮而大，浮代表气实，大代表血虚。血虚即为无阴，孤阳独自下行至阴部者，小便短赤而困难，胞宫当虚。现在反而小便通利且大汗出，按理应卫气微弱，现在反而更实，津液四散流失，营血枯竭。干燥烦乱而不得睡眠，血液暴脱肌肉消瘦而成暴液。（暴液一作黑液）医生再用毒药攻伐其胃，这是双重虚损。客阳离去有期，必然大便如污泥而死。常氏说，可用小建中汤。已经攻下的，不治。
又说：脉象浮而紧，浮则为风，紧则为寒。风则伤卫，寒则伤营。营卫都生病，骨节烦疼，应当发汗，而不可攻下。常氏说，可用桂枝麻黄各半汤。郭雍说，张仲景在可汗证中，只用麻黄汤。
又说：趺阳脉迟而缓，是胃气正常的表现。趺阳脉浮而数，浮则伤胃，数则动脾。这不是本病，是医生特意攻下所造成的。营卫内陷，其数脉先变微，脉反而只浮，其人必定大便硬，嗳气且呃逆。为什么这样说？本来是因为数脉动脾，其数脉先变微，所以知道脾气不治理，大便硬，嗳气且呃逆。现在脉反而浮，其数脉改微，邪气独留，心中则饥，邪热不能消化谷物，潮热发渴。数脉应当迟缓，脉的前后变化度数合乎法度，病人则感到饥饿。数脉不时出现，则生恶疮。常氏说，可用小柴胡汤。恶疮，用漏芦汤。
又说：脉数的人，久数不止，若停止则邪气结聚，正气不能恢复，正气退却结于脏腑，所以邪气浮越，与皮毛相合。脉数的人不可攻下，若攻下必烦乱，腹泻不止。常氏说，可用柴胡桂枝汤。
又说：少阴病，脉浮，不可发汗，因为亡阳的缘故。阳气已虚，尺脉弱涩的，也不可攻下。郭雍说，宜用建中汤。
又说：脉浮大，应当发汗，医生反而攻下，这是大逆。郭雍说，误下宜用四味理中丸。误下则中气受伤，所以用这个汤。
又说：脉浮而大，心下反而硬，有热属于脏的，攻下不让发汗；属于腑的，不让小便频数。小便频数则大便硬，汗多则热愈甚，汗少则便难。脉迟尚未可攻下。常氏说，可用小柴胡汤。郭雍说，这一证中有错字。《脉经》说：攻下不让微汗，属于腑小便频数则坚，汗多则愈，汗出小便难。文字都有错误，不能通顺理解。
又说：二阳并病，太阳初得病时，发其汗，汗先出不透彻，因而转属阳明，继续自微汗出，不恶寒。如果太阳证不罢休的，不可攻下，攻下为逆。常氏认为太阳证不罢休，宜用柴胡桂枝汤。
又说：结胸证，脉浮大的，不可攻下，攻下则死。常氏说，可用小陷胸汤、增损理中丸、圣饼灸法。
又说：太阳与阳明合病，喘而胸满的，不可攻下。常氏说，可用麻黄杏子甘草石膏汤。
又说：太阳与少阳并病，心下硬，颈项强而眩晕的，不可攻下。常氏说，可用小柴胡汤。郭雍说，张仲景刺大椎、肺俞、肝俞，见于太阳证中。
又说：各种四逆厥冷的病，不可攻下，虚家也是如此。常氏说，可用当归四逆汤。庞氏说，如果下证全部见到，四逆的，是失于攻下后，气血不通使然。只是手足轻微厥冷，掌心常温，时常手指稍温，即可攻下，不要拘泥忌讳。
又说：太阳病，有外证未解，不可攻下，攻下为逆。常氏说，可用桂枝麻黄各半汤。郭雍说，根据可汗证中，用桂枝二麻黄一汤。
又说：病发于阳，而反攻下之，热入因而作结胸。病发于阴，而反攻下之。（一作汗之，宫本及《脉经》皆作下之。）因而作痞。常氏说，结胸，可用大陷胸汤；痞，可用半夏泻心汤。
又说：病脉浮而紧，而复攻下之，紧脉反入里，则作痞。常氏说，可用小陷胸汤、泻心汤。郭雍说，宜用半夏泻心汤。
又说：其人本虚，攻其热必哕逆。郭雍说，宜用半夏生姜汤、类要四味橘皮汤。
又说：无阳阴强，大便硬的，攻下必致清谷腹满。常氏说，可用蜜煎导之。
又说：太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。若攻下之，必胸下结硬。常氏说，可用桂枝加芍药汤。胸下结硬的，用增损理中丸。
又说：厥阴之为病，消渴，气上撞心，心中疼热，饥不欲食，食则吐蛔。攻下之利不止。常氏说，攻下之利不止，宜用四逆汤。其余见厥阴本证。
又说：少阴病，饮食入口则吐，心中温温欲吐，始得病时，手足寒，脉弦迟的，这是胸中实，不可攻下。常氏说，饮食入口则吐，可用瓜蒂散。其余见少阴本证。
又说：伤寒五六日，不结胸，腹部柔软脉虚，又厥冷的，不可攻下。这是亡血，攻下则死。常氏说，可用小建中汤。已经攻下的，不治。
又说：伤寒发热头痛，微汗出。发汗则不识人，熏之则喘，不得小便。攻下则短气，小便难，头痛背强。加温针则衄血。常氏说，可用小柴胡汤。已发汗的，用桂枝加附子汤。汗出而喘的，用麻黄甘草杏子石膏汤。已攻下的，用五苓散。加温针的，用芍药地黄汤。
又说：伤寒，脉阴阳俱紧，恶寒发热，则脉欲厥。厥是指脉初来大，渐渐小，再来渐大，是其征候。如此者恶寒，严重的翕翕汗出，喉中痛。若热多者，目赤脉多，眼睛昏花。医生再发汗，咽中则受伤。若再攻下，则两目闭合。寒多则大便清谷，热多则便脓血。若熏之则身发黄，若熨之则咽燥。若小便利者可救，若小便难者为危殆。常氏说，初证宜用桂枝麻黄各半汤。喉中痛，用桔梗汤。热多，用小柴胡汤。便清谷，用理中丸。便脓血，用桃花汤。身发黄，用茵陈蒿汤。小便难者，用猪苓汤。
又说：伤寒发热，口中勃勃气出，头痛目黄，衄血不可控制。贪水的必呕，恶水的厥冷。若攻下之，咽中生疮。假如手足温的，必下重便脓血。头痛目黄的，若攻下之，则两目闭合。贪水的，若攻下之，其脉必厥，其声嘤嘤，咽喉塞。若发汗，则战栗。阴阳俱虚。恶水的，若攻下之，则里冷，不嗜食，大便完谷出。若发汗，则口中伤，舌上白苔，烦躁，脉数实，不大便，六七日后必便血。若发汗，则小便自利。常氏说，若热衄不可控制的，用芍药地黄汤。水逆者，用五苓散。便脓血，用桃花汤。咽中生疮，用白矾甘草散。阴阳俱虚，用小建中汤。里冷不嗜食，用理中汤。发热身黄，用栀子柏皮汤。其余证，用小柴胡汤。汗出小便数，用甘草干姜汤。
又说：得病二三日，脉弱，无太阳柴胡证，烦躁，心下硬，至四五日，虽能食，以小承气汤少量调和，令小安。至六日，给大承气汤一升。若不大便六七日，小便少的，虽不能食，但初头硬，后必溏，未定成硬，攻之必溏。须小便利，屎定硬，乃可攻之。庞氏说，尺下弱，小便不利，或尚少，都不可攻下。
又说：脏结无阳证，不往来寒热，或寒而不热，其人反静，舌上苔滑的，不可攻下。常氏说，可刺关元穴，在脐下。
又说：伤寒呕多，虽有阳明证，不可攻下。郭雍说，不可攻下，恐厥逆。可用小半夏加茯苓汤、生姜橘皮汤。
又说：阳明病，潮热，大便微硬的，可与大承气汤。不硬的，不可与之。若不大便六七日，恐有燥屎。想知道的方法，少与小承气汤。汤入腹中，转失气的，此有燥屎也，乃可攻之。若不转失气的，此但初头硬，后必溏，不可攻之。攻之，必胀满不能食。欲饮水者，与水则哕。其后发热者，大便复硬而少，宜小承气汤和之。不转失气的，慎不可攻也。
又说：伤寒中风，医生反攻下之。其人下利，日数十行，谷不化，腹中雷鸣，心下痞硬而满，干呕，心烦不得安。医生见心下痞，谓病不尽，复攻下之，其痞益甚。此非结热，但以胃中虚，客气上逆，故使硬也。属甘草泻心汤。
又说：下利，脉大或浮。大者虚也，是强行攻下造成的。设脉浮革，因而肠鸣，属当归四逆汤。
又说：阳明病，面合色赤，不可攻下。攻下之，必发热色黄，小便不利。常氏说，可用五苓散。
又说：阳明病，心下硬满的，不可攻下。攻下之，利遂不止者死。利止者愈。常氏说，心下硬满的，可用半夏泻心汤。已攻而利的，用四逆汤。
又说：阳明病，自汗出，若发汗，小便自利的，此为津液内竭。虽硬，不可攻下。当须自欲大便，宜蜜导而通之。若土瓜根及猪胆汁，皆可为导。
Zhang Zhongjing said: The pulse is soft and weak (Ru Mai, a soft and weak pulse indicating deficiency); the weak pulse appears at the Guan position. (Pang Anshi notes: three fen below the Guan position). The soft pulse appears at the Dian position (i.e., Cun position). (Pang Anshi notes: three fen above the Guan position). The faint pulse (Wei Mai, a faint pulse indicating severe deficiency) appears at the upper part (i.e., Cun pulse). The choppy pulse (Se Mai, a choppy pulse indicating blood stasis or deficiency) appears at the lower part (i.e., Chi position). A faint pulse indicates insufficient Yang Qi; a choppy pulse indicates lack of Blood. If Yang Qi is faint, Wind-Strike (Zhong Feng) causes sweating and restlessness/agitation. A choppy pulse indicates lack of Blood, leading to cold limbs (Jue) and coldness. Faint Yang Qi should not be purged; purging it leads to epigastric fullness and hardness (Xin Xia Pi Ying). Pang Anshi believes this is due to both Qi and Blood deficiency, and recommends Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Chang Qishi states that for epigastric fullness and hardness after purging, Zeng Sun Li Zhong Wan (Modified Regulate the Middle Pill) should be used.
It is also said: If there is pulsation (Dong Qi) on the right, do not purge. Purging depletes internal fluids, causing dry throat and nose, dizziness, and palpitations. Pang Anshi suggests Zhu Ye Tang (Bamboo Leaf Decoction) for dry throat and nose.
It is also said: If there is pulsation on the left, do not purge. Purging causes abdominal tension, inability to eat, and worsened pulsation. Even if there is body heat, the patient desires to curl up. Both Pang and Chang state to first administer Gan Jiang Gan Cao Tang (Dried Ginger and Licorice Decoction), followed by Xiao Jian Zhong Tang.
It is also said: If there is pulsation in the upper part, do not purge. Purging causes hot and restless palms, floating coldness on the body, spontaneous hot sweating, and a desire to pour water over oneself. Chang Qishi recommends Xiao Jian Zhong Tang.
It is also said: If there is pulsation in the lower part, do not purge. Purging causes abdominal distension and fullness, dizziness upon sudden rising, passage of undigested food after eating, and epigastric fullness. Pang Anshi recommends Ban Xia Xie Xin Tang (Pinellia Drain the Epigastrium Decoction) for epigastric fullness.
It is also said: If there is obstruction in the throat, do not purge. Purging leads to a sensation of lightness above and heaviness below, inability to swallow liquids, desire to curl up when lying down, body stiffness and pain, and diarrhea dozens of times a day. Chang Qishi suggests Wu Shan Jian (Black Iris Decoction) for throat obstruction and Si Ni San (Frigid Extremities Powder) for diarrhea.
It is also said: In various Excess patterns outside, do not purge. Purging induces slight fever. In cases of Yang collapse with cold limbs, there is heat around the navel grasped by hand. Guo Yong recommends Li Zhong Tang (Regulate the Middle Decoction) without Bai Zhu, because Bai Zhu promotes the flow of blood in the waist and navel area.
It is also said: In various Deficiency patterns, do not purge. Purging causes severe thirst. Those who seek water recover easily; those who hate water deteriorate. Guo Yong recommends Xiao Jian Zhong Tang.
It is also said: The pulse is soft and weak; the weak pulse appears at the Guan position, the soft pulse at the Dian position, the wiry pulse (Xian Mai) at the upper part, and the faint pulse at the lower part. Wiry indicates Yang movement; faint indicates Yin cold. Upper excess and lower deficiency, desiring warmth. Faint and wiry indicate Deficiency; Deficiency should not be purged. Faint pulse causes cough, which produces saliva. Purging stops the cough but causes persistent diarrhea. Persistent diarrhea causes a sensation like insects biting in the chest, regurgitation of porridge, difficult urination, tension in both hypochondria, difficulty breathing, traction between neck and back, and numbness in arms. Extreme cold with sweating, body cold as ice, dull eyes, incessant speech, yet grain qi enters abundantly. This is called Chu Zhong (Eliminating the Middle). Although the mouth wants to speak, the tongue cannot move forward. Guo Yong states this is an incurable pattern, so no treatment methods are recorded by various authors. Pang Anshi says that pulses that are soft, weak, faint, deficient, fine, and interacting should all not be purged.
It is also said: The pulse is soft and weak; the weak pulse appears at the Guan position, the soft pulse at the Dian position, the floating pulse (Fu Mai) at the upper part, and the rapid pulse (Shu Mai) at the lower part. Floating indicates Yang deficiency; rapid indicates loss of Blood. Floating is Deficiency, rapid is Heat. Floating is Deficiency, causing spontaneous sweating and aversion to cold. Rapid indicates pain, chills, and trembling... (text missing), weak pulse at Guan, urgency below the chest, panting, sweating, and inability to breathe. During respiration, pain is in the hypochondria. Chills and trembling interact, resembling malaria. If the physician purges, it causes rapid pulse, fever, running wildly seeing ghosts, epigastric fullness, dribbling urination, severe hardness in the lower abdomen, and hematuria. Chang Qishi recommends Xiao Chai Hu Tang (Minor Bupleurum Decoction), Que Shi San (Magpie Stone Powder), and Yan Hu Suo San (Corydalis Powder).
It is also said: The pulse is soft and tight. Soft indicates weak Wei Qi; tight indicates Cold in Ying Blood. Yang weak, Wei affected by Wind, causing fever and aversion to cold. Ying tight, Stomach Qi cold, causing slight vomiting and internal irritability. The physician mistakes this for high heat, uses muscle-releasing sweating, causing Yang collapse, deficiency, irritability, and bitter epigastric fullness and hardness. Exterior and Interior are both exhausted. Sudden rising causes dizziness. Guest heat is in the skin, causing melancholy and insomnia. Not knowing the Stomach Qi is cold, and Tight Cold is at Guan Yuan, even skilled physicians have no recourse. Pouring water on the body makes guest heat vanish, but causes trembling and chills. Covering with heavy quilts causes sweating and heat at the crown, body trembling. Urination becomes slightly difficult. Cold Qi is triggered by water, leading to continuous passage of undigested food, vomiting with evisceration, restlessness, slight cold limbs, body coldness, and internal irritability. Delayed rescue cannot restore life. Chang Qishi recommends moxibustion at Guan Yuan. Guo Yong recommends Tong Mai Si Ni Tang (Pulse-Returning Four Reversals Decoction).
It is also said: The pulse is floating and large. Floating indicates Qi excess; large indicates Blood deficiency. Blood deficiency means no Yin. When solitary Yang descends alone into the Yin region, urine is scanty and red with difficulty, and the uterus is deficient. Now, instead, urination is free and sweating is profuse. By law, Wei Qi should be weak, but now it is more solid. Fluids scatter four ways, Ying and Blood are exhausted. Dry irritability and insomnia ensue. Sudden blood loss and muscle wasting lead to Bao Ye (Sudden Fluids). If the physician uses toxic drugs to attack the Stomach, this is double deficiency. Guest Yang will depart within a time; death will come with stool like mud. Chang Qishi recommends Xiao Jian Zhong Tang. If already purged, it is incurable.
It is also said: The pulse is floating and tight. Floating is Wind; tight is Cold. Wind injures Wei; Cold injures Ying. Both Ying and Wei are diseased, causing bone and joint soreness. Sweating should be induced, but purging is contraindicated. Chang Qishi recommends Gui Zhi Ma Huang Ge Ban Tang (Guizhi and Ephedra Half-Dose Decoction). Guo Yong notes Zhang Zhongjing only uses Ma Huang Tang (Ephedra Decoction) in sweat-inducing patterns.
It is said: Fu Yang pulse slow and relaxed indicates normal Stomach Qi. Fu Yang pulse floating and rapid: floating injures Stomach; rapid disturres Spleen. This is not the original disease but caused by physician's purging. Ying and Wei sink inward. The rapid pulse first becomes faint. The pulse reverses to only floating. The person must have hard stool, belching, and hiccuping. Why? Originally, rapid pulse disturbed Spleen, making it faint, indicating Spleen Qi dysfunction, hard stool, belching, and hiccuping. Now pulse floats, rapid becomes faint, pathogenic Qi remains alone. Heart feels hungry, but pathogenic heat cannot digest grain. Tide-like fever and thirst occur. Rapid pulse should become slow and relaxed. If pulse changes follow rules, the patient feels hungry. If rapid pulse appears irregularly, malignant sores arise. Chang Qishi recommends Xiao Chai Hu Tang. For malignant sores, Lu Lu Tang (Ampelopsis Decoction).
It is said: In patients with a rapid pulse lasting long without stopping, if it stops, pathogenic Qi knots, Zheng Qi cannot recover, retreating to knot in Zang organs. Pathogenic Qi floats, merging with skin and hair. Rapid pulse should not be purged; purging causes irritability and unceasing diarrhea. Chang Qishi recommends Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction).
It is said: Sha Yin disease with floating pulse should not be sweated, due to Yang collapse. If Yang is already deficient and Chi pulse is weak and choppy, purging is also contraindicated. Guo Yong recommends Jian Zhong Tang.
It is said: Floating and large pulse should induce sweating; purging is a great reversal. Guo Yong recommends Si Wei Li Zhong Wan (Four-Ingredient Regulate the Middle Pill) for mistaken purging, as it injures Middle Qi.
It is said: Floating and large pulse with reverse epigastric hardness: if heat belongs to Zang, purge without sweating; if belonging to Fu, avoid frequent urination. Frequent urination causes hard stool; much sweating worsens heat; little sweating causes difficult stool. Slow pulse is not yet suitable for purging. Chang Qishi recommends Xiao Chai Hu Tang. Guo Yong notes errors in the text, citing Mai Jing: "Purge without slight sweating," etc., stating the text is corrupted.
It is said: Two Yang combined disease: Tai Yang initial stage, sweating was incomplete, transferring to Yang Ming. Continued slight sweating, no aversion to cold. If Tai Yang signs persist, do not purge; purging is adverse. Chang Qishi recommends Chai Hu Gui Zhi Tang.
It is said: Jie Xiong syndrome with floating and large pulse should not be purged; purging leads to death. Chang Qishi recommends Xiao Xian Xiong Tang (Minor Pinellia Chest-Draining Decoction), Zeng Sun Li Zhong Wan, and Sheng Bing Moxibustion.
It is said: Tai Yang and Yang Ming combined disease with panting and chest fullness should not be purged. Chang Qishi recommends Ma Huang Xing Zi Gan Cao Shi Gao Tang (Ephedra Apricot Kernel Licorice Gypsum Decoction).
It is said: Tai Yang and Shao Yang combined disease with epigastric hardness, stiff neck, and dizziness should not be purged. Chang Qishi recommends Xiao Chai Hu Tang. Guo Yong notes Zhang Zhongjing punctures Da Zhui, Fei Shu, and Gan Shu in Tai Yang patterns.
It is said: Various Si Ni Jue (Frigid Extremities) patterns should not be purged; same for deficient persons. Chang Qishi recommends Dang Gui Si Ni Tang (Angelica Return Frigid Extremities Decoction). Pang Anshi says if purgative signs are present but with Si Ni, it is due to Qi and Blood blockage from missed purging. If hands/feet are slightly cold but palms warm and fingers occasionally warm, purging may be done without hesitation.
It is said: Disease desiring vomiting should not be purged. Chang Qishi recommends Ban Xia Jia Ju Pi Tang (Pinellia plus Tangerine Peel Decoction).
It is said: Tai Yang disease with unresolved exterior signs should not be purged; purging is adverse. Chang Qishi recommends Gui Zhi Ma Huang Ge Ban Tang. Guo Yong recommends Gui Zhi Er Ma Huang Yi Tang (Guizhi Double Ephedra Single-Dose Decoction) based on sweat-inducing patterns.
It is said: Disease starting in Yang, mistakenly purged, heat enters forming Jie Xiong. Disease starting in Yin, mistakenly purged (or sweated, per some texts), forms Pi (fullness). Chang Qishi recommends Da Xian Xiong Tang (Major Pinellia Chest-Draining Decoction) for Jie Xiong and Ban Xia Xie Xin Tang for Pi.
It is said: Disease pulse floating and tight, then purged, tight pulse enters interior forming Pi. Chang Qishi recommends Xiao Xian Xiong Tang and Xie Xin Tang. Guo Yong recommends Ban Xia Xie Xin Tang.
It is said: Diseases with excess Yang cause heat; purging causes hardness. Chang Qishi recommends Xiao Chai Hu Tang.
It is said: If the person is originally deficient, attacking heat causes hiccups. Guo Yong recommends Ban Xia Sheng Jiang Tang (Pinellia and Fresh Ginger Decoction) and Lei Yao Si Wei Ju Pi Tang.
It is said: No Yang, strong Yin, hard stool: purging causes clear stool and abdominal fullness. Chang Qishi recommends Mi Jian Dao (Honey Suppository).
It is said: Tai Yin disease: abdominal fullness, vomiting, inability to eat, worsening diarrhea, occasional abdominal pain. Purging causes lower chest knotting and hardness. Chang Qishi recommends Gui Zhi Jia Shao Yao Tang (Guizhi plus Peony Decoction). For lower chest knotting, Zeng Sun Li Zhong Wan.
It is said: Jue Yin disease: excessive thirst, Qi rushing to heart, heart pain and heat, hunger without desire to eat, vomiting roundworms after eating. Purging causes unceasing diarrhea. Chang Qishi recommends Si Ni Tang for post-purging diarrhea. See Jue Yin original patterns.
It is said: Shao Yin disease: vomiting upon swallowing, feeling of wanting to vomit from the start, cold hands/feet, wiry and slow pulse indicates real pathogen in chest; do not purge. Chang Qishi recommends Gua Di San (Melon Seed Powder) for vomiting upon swallowing. See Shao Yin original patterns.
It is said: Cold damage five to six days, no Jie Xiong, soft abdomen, deficient pulse, again cold limbs: do not purge. This is blood loss; purging leads to death. Chang Qishi recommends Xiao Jian Zhong Tang. Already purged is incurable.
It is said: Cold damage with fever, headache, slight sweating. Sweating causes confusion. Smoking causes panting, inability to urinate. Purging causes shortness of breath, difficult urination, headache, stiff back. Warm needle causes nosebleed. Chang Qishi recommends Xiao Chai Hu Tang. For already sweated, Gui Zhi Jia Fu Zi Tang (Guizhi plus Aconite Decoction). For sweating with panting, Ma Huang Gan Cao Xing Zi Shi Gao Tang. For already purged, Wu Ling San (Five Ingredient Powder). For warm needle, Shao Yao Di Huang Tang (Peony and Rehmannia Decoction).
It is said: Cold damage, Yin-Yang pulses both tight, aversion to cold and fever, pulse欲 Jue (reversal). Jue means pulse starts large, gradually small, then large again. Such patients have aversion to cold; severe cases have slight sweating and sore throat. If heat is dominant, red eyes, many vessels, dull eyes. Further sweating injures throat. Further purging closes eyes. Cold dominant causes clear stool; heat dominant causes pus/blood in stool. Smoking causes jaundice; ironing causes dry throat. If urination is free, curable; if difficult, critical. Chang Qishi recommends Gui Zhi Ma Huang Ge Ban Tang for initial signs, Jie Geng Tang for sore throat, Xiao Chai Hu Tang for heat, Li Zhong Wan for clear stool, Tao Hua Tang (Peach Blossom Decoction) for pus/blood, Yin Chen Hao Tang (Artemisia Decoction) for jaundice, Zhu Ling Tang (Polyporus Decoction) for difficult urination.
It is said: Cold damage with fever, bubbling Qi from mouth, headache, yellow eyes, uncontrollable nosebleed. Those craving water vomit; those hating water have cold limbs. Purging causes ulcers in throat. If hands/feet warm, tenesmus and pus/blood in stool. Headache/yellow eyes: purging closes eyes. Craving water: purging causes Jue pulse, humming sound, throat obstruction. Sweating causes shivering. Yin-Yang both deficient. Hating water: purging causes interior cold, anorexia, undigested stool. Sweating causes mouth injury, white tongue coating, irritability, rapid-solid pulse, constipation; bloody stool after 6-7 days. Sweating causes free urination. Chang Qishi recommends Shao Yao Di Huang Tang for uncontrollable heat/nosebleed, Wu Ling San for water rebellion, Tao Hua Tang for pus/blood, Bai Fan Gan Cao San (Alum and Licorice Powder) for throat ulcers, Xiao Jian Zhong Tang for Yin-Yang deficiency, Li Zhong Tang for interior cold/anorexia, Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction) for fever/jaundice, Xiao Chai Hu Tang for other signs, Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) for sweating/frequent urination.
It is said: Disease two to three days, weak pulse, no Tai Yang/Chai Hu signs, irritability, epigastric hardness. To fourth-fifth day, though able to eat, give small amount of Xiao Cheng Qi Tang to harmonize. To sixth day, give one sheng of Da Cheng Qi Tang. If no stool for 6-7 days and little urine, though unable to eat, if head is hard but tail loose, not yet hardened, purging causes loose stool. Wait for free urination and definite hard stool before purging. Pang Anshi says weak Chi pulse and difficult/scarce urine mean purging is contraindicated.
It is said: Zang Jie (Organ Knotting) without Yang signs, no alternating chills/fever, or cold without heat, patient quiet, slippery tongue coating: do not attack. Chang Qishi recommends puncturing Guan Yuan.
It is said: Can puncture Da He. Located in second row of abdomen. Guo Yong says moxibustion is particularly effective.
It is said: Cold damage with much vomiting, even with Yang Ming signs, do not attack. Guo Yong says caution against Jue Ni; recommend Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) and Sheng Jiang Ju Pi Tang (Fresh Ginger and Tangerine Peel Decoction).
It is said: Yang Ming disease with tide-like fever and slightly hard stool: may give Da Cheng Qi Tang. If not hard, do not give. If no stool for 6-7 days, suspect dry stool. Test by giving small amount of Xiao Cheng Qi Tang. If passing gas after ingestion, dry stool exists, may purge. If no gas, head hard but tail loose, do not purge. Purging causes distension and anorexia. Thirsty for water causes hiccups. Later fever, hard but less stool: use Xiao Cheng Qi Tang to harmonize. If no gas, strictly avoid purging.
It is said: Cold damage/Wind Strike, physician purges. Patient has diarrhea dozens of times daily, undigested food, borborygmus, epigastric fullness/hardness, dry heaving, irritability. Physician sees fullness, thinks disease persists, purges again, worsening fullness. This is not heat knotting but Stomach deficiency with rebellious Qi. Belongs to Gan Cao Xie Xin Tang (Licorice Drain the Epigastrium Decoction).
It is said: Diarrhea with large or floating pulse. Large indicates deficiency from forced purging. If pulse is floating and leather, with borborygmus, belongs to Dang Gui Si Ni Tang.
It is said: Yang Ming disease with reddish face, do not attack. Attack causes fever, yellow complexion, difficult urination. Chang Qishi recommends Wu Ling San.
It is said: Yang Ming disease with epigastric fullness/hardness, do not attack. Attack with unceasing diarrhea leads to death; stopping diarrhea leads to recovery. Chang Qishi recommends Ban Xia Xie Xin Tang for epigastric fullness; Si Ni Tang for post-attack diarrhea.
It is said: Yang Ming disease with spontaneous sweating, or sweating, with free urination: this is internal fluid exhaustion. Though hard, do not attack. Wait for desire to defecate; use honey suppository. Tu Gua Gen (Trichosanthes Root) and pig bile can also be used as suppositories.
Pang Anshi says: Forcing purging when inappropriate causes intestinal leakage and death.