仲景曰。大法秋宜下。
又曰。凡服下药。宜用汤。胜丸散。中病便止。不必尽剂也。
又曰。阳明病。发热。汗多者。急下之。宜大柴胡汤。庞氏云。发
热不恶寒。汗多。
又曰。少阴病。得之二三日。口燥咽干者。急下之。宜大承气汤。
又曰。阳明少阳合病。必下利。其脉不负者顺也。负者失也。互
相克贼。名为负也。庞氏曰。阳明土。其脉大。少阳木。其脉弦。若合
病。土被木贼。加之以利。则胃已困矣。若脉不弦。为土不负。弦者为
土负。必死。雍曰。此合病一证下至名为负也而终。按本论原误录。
宿食一证相连。非也。脉经以宿食别作一证。为当。盖脉滑数。有宿
食。故仲景可用承气汤。若胃为木克。困而下利。安有用承气之理。
今根据脉经。离而为二。宿食证。根据仲景用承气汤。惟合病下利。阙治
法。今以负为不治。不负。宜理中丸。厥者。宜四逆汤。仍泻邱虚、阳
陵泉。补三里穴。庞朱二氏依旧本合为一证。疑其非。大抵读仲景
论。仍须以脉经参校之。
又曰。少阴病。下利清水。色纯青。心下必痛。口干燥者。可下
之。宜大柴胡汤、大承气汤。余见少阴本证。更详之。
又曰。下利。三部脉皆平。按之心下硬者。急下之。宜大承气汤。
庞氏曰。凡脉沉细数。为热在里。又兼腹满咽干。或口燥舌干而渴
者。或六七日不大便。小便自如。或目中瞳子不明。无外证者。或汗
后脉沉实者。或下利三部脉皆平。按之心下坚者。或连发汗不恶寒
者。或已经下。其脉浮沉按之有力者。皆宜大承气汤。
又曰。下利。脉浮而滑者。内实也。利未欲止。当下之。宜大承气
汤。
雍曰。常氏疑本论之误。故欲以葛根黄芩治下利。殊不思仲景
以承气下宿食。而合病下利。原无治法也。葛根黄芩汤。以太阳表未
解。误下之利不止者。既有协热下利之表证未退。故可用。今合病下
利。胃气伤困。只当救胃。宜用温药。故雍以四逆理中补其法。胃气
已负。而又加以寒药。则胃谷绝矣。仲景于此一证。特论脉负不负。
盖欲后人当思阳阻少阳土木克贼之理而治之。可谓尽善矣。以是知
合并病之论。虽二阳俱受病。邪气俱当去。又须审二经五行之气。毋
令相克贼。抑强扶衰以致和气。不使复生一秦。助桀为虐也。如是则
胡越可同舟而共济矣。此证和二经。退邪气。与人事不少异。非天下
至精。孰能与于此。然生胃气。制少阳木。亦用金石药。尝见名医治
少阴自汗。自利不止。用金液丹取大效。既非古药。不敢以为然。必
不得已而用。亦须七炼九炼火力重者用之。其一炼火力轻者。复可
下宿食。以虚人老人。不敢用承气也。
仲景问曰。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。
又曰。下利。不欲食者。以有宿食故也。当下之。宜大承气汤。
又曰。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。
又曰。病腹中满痛者。此为实也。当下之。宜大承气汤、大柴胡
汤。
又曰。下利。脉反滑。当有所去。下之乃愈。宜大承气汤。
又曰。腹满不减。减不足言。当下之。宜大柴胡汤、大承气汤。雍
曰。减不足言者。言不甚减也。论言太阳发汗不彻。不足言。与此同
意。俗语所谓不济事者是也。
又曰。伤寒后脉沉。沉者。内实也。下之解。宜大柴胡汤。雍曰。
须沉数有力。可下之。虽沉而微弱迟。皆不可下也。
又曰。伤寒六七日。目中不了了。睛不和。无表里证。大便难。身
微热者。此为实也。急下之。宜大承气汤、大柴胡汤。
又曰。太阳病未解。脉阴阳俱停。必先振 。汗出而解。但阴脉
微（一作尺脉实）者。下之而解。宜大柴胡汤。（一法用调胃承气汤）
脉经云。但阴微者。先下之而解。（庞作阴实）雍曰。文当从脉经及庞
氏。当作但阴脉微而尺脉实者。先下之而解。
又曰。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。
又曰。结胸者。项亦强。如柔 状。下之则和。庞氏云。宜大陷胸
丸。
又曰。病患无表里证。发热七八日。虽脉浮数者。可下之。宜大
柴胡汤。
又曰。太阳病六七日。表证仍在。脉微而沉。反不结胸。其人发
狂者。以热在下焦。少腹当硬满。而小便自利者。下血乃愈。所以然
者。以太阳随经瘀热在里故也。宜下之以抵当汤。
又曰。太阳病。身黄。脉沉结。少腹硬满。小便不利者。为无血
也。小便自利。其人如狂者。血证谛也。属抵当汤。
又曰。伤寒有热。少腹满。应小便不利。今反利者。为有血也。当
下之。宜抵当丸。
又曰。阳明病。发热汗出者。此为热越。不能发黄也。但头汗出。
身无汗。剂颈而还。小便不利。渴饮水浆者。以瘀热在里。身必发黄。
宜下之以茵陈蒿汤。雍曰。先服茵陈五苓散。黄退则不须更下。
又曰。阳明证。其人喜忘者。必有蓄血。所以然者。本有久瘀血。
故令喜忘。屎虽硬。大便反易。其色必黑。宜抵当汤。
又曰。汗出而谵语者。以有燥屎在胃中。此为风也。须下者。过
经乃可下之。下之若早。语言必乱。以表虚里实故也。下之愈。宜大
柴胡汤、大承气汤。
又曰。病患烦热。汗出则解。复如疟状。日晡所发热者。属阳明
也。脉实者。可下之。宜大柴胡汤、大承气汤。
又曰。阳明病。谵语。有潮热。反不能食者。胃中必有燥屎五六
枚也。若能食者。但硬耳。属大承气证。
又曰。下利谵语者。有燥屎也。属小承气汤。初一服。谵语止。若
更衣者。停后服。不尔。尽与之。
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。以小承气汤少少与微和之。令小安。至六日。与承气汤
一升。若不大便。六七日小便少者。虽不能食。但初头硬。后必溏。此
未成硬也。攻之必溏。须小便利。屎定硬。乃攻之。宜大承气汤。
又曰。太阳中风。下利呕逆。表解者。乃可攻之。其人 汗出。
发作有时。头痛。心下痞硬。满引胁下痛。干呕短气。汗出不恶寒者。
此表解里未和也。属十枣汤。
又曰。太阳病不解。热结膀胱。其人如狂。血自下者愈。其外未
解。尚未可攻。当先解其外。外解已。但少腹急结者。乃可攻之。宜桃
核承气汤。庞云。不恶寒。为外解。
又曰。伤寒七八日。身黄如橘子色。小便不利。腹微满者。属茵
陈蒿汤。
又曰。伤寒发热。汗出不解。心下痞硬。呕吐而利者。属大柴胡
汤。
又曰。伤寒十余目。热结在里。复往来寒热者。属大柴胡汤。
又曰。但结胸。无大热者。以水结在胸胁也。但头微汗出者。属
大陷胸汤。
又曰。伤寒六七日。结胸热实。脉沉而紧。心下痛。按之石硬者。
属大陷胸汤。
又曰。阳明病。其人多汗。以津液外出。胃中燥。大便必硬。硬则
谵语。属小承气汤。
又曰。阳明病。不吐不下。心烦者。属调胃承气汤。
又曰。阳明病。脉迟。虽汗出。不恶寒者。其身必重。短气。腹满
而喘。有潮热者。此外欲解。可攻里也。手足 然汗出者。此大便已
硬也。大承气汤主之。若汗出多。微发热恶寒者。外未解也。其热不
潮。未可与承气汤。若腹大满不通者。与小承气汤微和其胃气。勿令
大泄下。
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。大便必复硬而少也。宜小承气汤和之。不转失气
者。慎不可攻之。雍曰。不转失气者。勿服药。待一昼夜。热气不发
泄。定成硬屎。然后可攻。
又曰。阳明病。谵语发热。脉滑而疾者。小承气汤主之。因与承
气汤一升。腹中转失气者。更服一升。若不转失气者。勿更与之。明
日。又不大便。脉反微涩者。里虚也。为难治。不可更与承气汤。常氏
云。可人参黄 建中汤。
又曰。二阳并病。太阳证罢。但发潮热。手足 汗出。大便难
而谵语者。下之则愈。宜大承气汤。
又曰。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。属大承气汤。
又曰。大下后。六七日不大便。烦不解。腹满痛者。此有燥屎也。
所以然者。本有宿食故也。属大承气汤。
庞氏曰。脉朝夕快者。实癖也。可下之。朝平夕快者。非癖也。不
可下。快。谓数脉六七至者也。若脉数一息八九至。切不可下。若下
之。则烦躁下利不止而死。脉数与皮毛相得。亦不可下也。虽数。为
虚客热。
又曰。合下不下。令人腹胀满。通身浮肿而死。雍曰。凡汗下。皆
不宜太过。故汗下后。易将理。若汗下太过。则病患虚。难将理。易劳
复。凡用大承气。亦宜消息。用调胃承气代之。盖仲景自有承气之戒
故也。
又说：凡是服用泻下药，宜用汤剂，胜过丸剂和散剂。药力达到治疗效果就应停药，不必服完全部剂量。
又说：阳明病，出现发热、汗出多的症状，应当紧急使用下法，适宜用大柴胡汤。庞安时认为：发热且不恶寒，汗出多。
又说：少阴病，患病两三天后，出现口燥咽干的，应当紧急使用下法，适宜用大承气汤。
又说：阳明病与少阳病同时发病（合病），必定出现腹泻。脉象没有相克现象的属于顺证；脉象相克的属于逆证。相互克制称为“负”。庞氏说：阳明属土，其脉象大；少阳属木，其脉象弦。如果合病，木克土，再加上腹泻，那么胃气已经困顿。如果脉象不弦，说明土没有被克，即“不负”；如果脉象弦，说明土被克，即“负”，这种情况必然死亡。郭雍说：这段关于合病的论述从“一证”到“名为负”结束。按《伤寒论》原书此处误录了“宿食”一证的内容，这是不对的。《脉经》将宿食单独列为一个证候，这是正确的。因为脉象滑数，是有宿食的表现，所以张仲景可以使用承气汤。如果是胃气被木邪所克，困顿而腹泻，哪里还有使用承气汤的道理？现在根据《脉经》，将两者分开。宿食证，依据张仲景的方法使用承气汤；只有合病导致的下利，原文缺失治法。现在我认为“负”的情况是不治之症，“不负”的情况，适宜用理中丸。如果出现四肢厥冷，适宜用四逆汤。同时针刺泻丘虚穴和阳陵泉穴，补足三里穴。庞安时和朱肱两位先生依然按照旧本将其合并为一个证候，我怀疑这种做法是不对的。大体上阅读张仲景的论述，仍然需要参考《脉经》进行校对。
又说：少阴病，腹泻排出清水，颜色纯青，心下部必定疼痛，口干燥的，可以使用下法，适宜用大柴胡汤、大承气汤。其余内容见少阴病本证，请详细查阅。
又说：腹泻，寸关尺三部脉象都平和，但按压心下部感觉坚硬的，应当紧急使用下法，适宜用大承气汤。庞氏说：凡是脉象沉细数，表示热邪在体内。又兼有腹部胀满、咽喉干燥，或者口燥舌干而口渴的，或者六七天不大便，小便正常的，或者眼睛瞳孔昏暗不清，没有表证的，或者发汗后脉象沉实的，或者腹泻但三部脉象都平和，按压心下部坚硬的，或者连续发汗但不恶寒的，或者已经用过下法，脉象浮沉按之有力的，都适宜用大承气汤。
又说：腹泻，脉象浮而滑的，是内实，腹泻不会停止，当下之，适宜用大承气汤。
郭雍说：常器之怀疑原文有误，所以想用葛根黄芩黄连汤治疗下利，这完全没有考虑到张仲景用承气汤是为了下宿食，而合病下利原本就没有治法。葛根黄芩黄连汤，是因为太阳表证未解，误用下法导致下利不止，既有协热下利的表证未退，所以可以使用。现在的合病下利，胃气受伤困顿，只应当救胃气，适宜用温药。所以我郭雍用四逆汤、理中丸来补充这一治法。如果胃气已经受损，又加上寒凉药物，那么胃气就会断绝。张仲景在这个证候上，专门讨论脉象是否相克，大概是希望后人思考阳气受阻、少阳木邪克制脾胃土气的道理来进行治疗，可以说是尽善尽美了。由此可知，合并病的论述，虽然两阳经同时受病，邪气都应当去除，但也必须审视两经五行之气，不要让它们相互克制，要抑制强盛的一方，扶持衰弱的一方，以达到调和之气，不要再生出一个新的病邪，助纣为虐。像这样就能像胡人和越人同舟共济一样和谐。这个证候调和两经，退去邪气，与人事治理没有什么不同，如果不是天下最精妙的人，谁能做到这一点呢？然而，为了生养胃气，制约少阳木邪，也使用金石类药物。我曾见过名医治疗少阴病自汗、下利不止，使用金液丹取得很大疗效。既然不是古方药物，我不敢苟同。如果迫不得已使用，也必须用火炼七次或九次的重火力药物。其中火炼一次、火力轻的，反而可以下宿食，但对于虚弱的人和老人，不敢使用承气汤。
张仲景问：人有宿食病，如何辨别？老师说：寸口脉浮而大，按下去反而涩，尺中脉也微而涩，所以知道有宿食，当下之，适宜用大承气汤。
又说：腹泻，不想吃东西的，是因为有宿食，当下之，适宜用大承气汤。
又说：腹泻痊愈后，到了原来的年月日时又复发的，是因为病邪未尽，当下之，适宜用大承气汤。
又说：病人腹部胀满疼痛的，这是实证，当下之，适宜用大柴胡汤、大承气汤。
又说：腹泻，脉象反而滑的，说明体内有积滞需排出，下之则愈，适宜用大承气汤。
又说：腹部胀满不减，即使减轻也不值得一提，当下之，适宜用大柴胡汤、大承气汤。郭雍说：“减不足言”，意思是减轻得很少。文中说“太阳发汗不彻，不足言”，与此意思相同。就是俗语所说的“不管用”的意思。
又说：伤寒后脉象沉，沉脉代表内实，下之可解，适宜用大柴胡汤。郭雍说：必须是沉而数且有力，才可以下。虽然沉但微弱迟缓的，都不可下。
又说：伤寒六七天，眼睛视物不清，眼球转动不灵活，没有表证和里证，大便困难，身体微热的，这是实证，紧急下之，适宜用大承气汤、大柴胡汤。
又说：太阳病未解，脉象阴阳俱停，必先战栗，然后出汗而解。如果阴脉微（一说尺脉实）的，下之而解，适宜用大柴胡汤。（另一种方法用调胃承气汤）。《脉经》说：仅阴脉微的，先下之而解。（庞安时作“阴实”）。郭雍说：文字应当遵从《脉经》及庞氏的说法，应当作“仅阴脉微而尺脉实者”，先下之而解。
又说：脉象双弦且迟的，必定心下部坚硬。脉象大而紧的，阳中有阴，可下之，适宜用大承气汤。
又说：结胸证，颈部也强直，像柔痉的样子，下之则和解。庞氏说：适宜用大陷胸丸。
又说：病人没有表证和里证，发热七八天，虽然脉象浮数，也可以下之，适宜用大柴胡汤。
又说：太阳病六七天，表证仍在，脉象微而沉，反而不结胸，其人发狂的，是因为热在下焦，少腹部应当硬满，而小便自利的，下血才痊愈。之所以这样，是因为太阳随经瘀热在里的缘故。适宜用下法，以抵当汤治疗。
又说：太阳病，身体发黄，脉象沉结，少腹硬满，小便不利的，是无血证。小便自利，其人如狂的，是血证确凿无疑，属抵当汤证。
又说：伤寒有热，少腹胀满，应当小便不利，现在反而利，是有瘀血，当下之，适宜用抵当丸。
又说：阳明病，发热汗出的，这是热邪外越，不能发黄。只是头部出汗，身上无汗，齐颈而还，小便不利，渴欲饮水浆的，是因为瘀热在里，身体必定发黄，适宜用下法，以茵陈蒿汤治疗。郭雍说：先服用茵陈五苓散，黄退后就不须再用下法。
又说：阳明证，其人容易健忘的，必定有蓄血。之所以这样，是因为本来就有久瘀血，所以导致健忘。大便虽然硬，排便反而容易，颜色必定黑，适宜用抵当汤。
又说：出汗且说胡话的，是因为胃中有燥屎，这是风邪所致。必须下法的，要等过了经界才可下。下之如果过早，语言必定错乱，因为表虚里实的缘故。下之则愈，适宜用大柴胡汤、大承气汤。
又说：病人烦热，出汗则缓解，又像疟疾发作一样，下午申时发热，属阳明病。脉实的，可下之，适宜用大柴胡汤、大承气汤。
又说：阳明病，说胡话，有潮热，反而不能吃的，胃中必定有燥屎五六枚。如果能吃的，只是大便硬罢了，属大承气汤证。
又说：腹泻说胡话的，有燥屎，属小承气汤证。第一次服用，胡话停止，如果排便了，停服后面的药。如果不排便，全部服下。
又说：得病二三天，脉弱，没有太阳病和少阳柴胡汤证，烦躁，心下部硬，到了四五天，虽然能吃饭，用小承气汤少量给予，微微调和胃气，令其稍安。到了第六天，给承气汤一升。如果不大便，六七天小便少的，虽然不能吃饭，但大便开头硬，后面必定稀溏，这是未成硬结。攻之必定拉稀。必须小便利，大便一定硬，才攻之，适宜用大承气汤。
又说：太阳中风，腹泻呕吐逆气，表解的，才可以攻里。其人濈然汗出，发作有时，头痛，心下部痞硬，胀满牵引胁下痛，干呕短气，出汗不恶寒的，这是表解里未和，属十枣汤证。
又说：太阳病不解，热结膀胱，其人如狂，瘀血自下的自愈。如果外证未解，尚不可攻，应当先解外证。外证已解，仅少腹急结的，才可以攻之，适宜用桃核承气汤。庞氏说：不恶寒，即为外解。
又说：伤寒七八天，身体黄如橘子色，小便不利，腹部微满的，属茵陈蒿汤证。
又说：伤寒发热，汗出不解，心下部痞硬，呕吐而腹泻的，属大柴胡汤证。
又说：仅结胸，没有大热的，是水饮结在胸胁，仅头部微汗出的，属大陷胸汤证。
又说：伤寒六七天，结胸热实，脉沉而紧，心下部痛，按之像石头一样硬的，属大陷胸汤证。
又说：阳明病，其人汗多，因为津液外出，胃中干燥，大便必定硬，硬则说胡话，属小承气汤证。
又说：阳明病，脉迟，虽然出汗，不恶寒的，身体必定沉重，短气，腹部胀满而喘，有潮热的，这是表证欲解，可以攻里。手足濈然汗出的，这是大便已硬，大承气汤主治。如果汗出多，微发热恶寒的，表未解。其热不潮，不可与承气汤。如果腹部大满不通的，与小承气汤微微调和胃气，不要令其大泄下。
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。如果六七天不大便，恐怕有燥屎，想知道的方法，少量给予小承气汤。汤入腹中，转矢气的，这是有燥屎，才可以攻之。如果不转矢气的，这只是开头硬，后面必定稀溏，不可攻之。攻之，必定胀满不能食。想喝水的，给水则哕。其后发热的，大便必定又硬而少，适宜用小承气汤调和。不转矢气的，千万不可攻之。郭雍说：不转矢气的，不要服药。等待一昼夜，热气不发泄，定成硬屎，然后可攻。
又说：阳明病，说胡话发热，脉滑而疾的，小承气汤主治。因此给承气汤一升，腹中转矢气的，再服一升。如果不转矢气的，不要再给。第二天，又不大便，脉反微涩的，是里虚，为难治，不可再给承气汤。常氏说：可用人参黄芪建中汤。
又说：二阳并病，太阳证罢，仅发潮热，手足濈然汗出，大便难而说胡话的，下之则愈，适宜用大承气汤。
又说：病人小便不利，大便乍难乍易，时有微热，喘冒不能卧的，有燥屎，属大承气汤证。
又说：大下之后，六七天不大便，烦躁不解，腹部胀满痛的，这是有燥屎。之所以这样，是因为本来有宿食，属大承气汤证。
庞氏说：脉象早晨快晚上快的，是实癖，可下之。早晨平晚上快的，不是癖，不可下。快，指一息脉搏六七至。如果脉数一息八九至，切不可下。如果下之，则烦躁下利不止而死。脉数与皮毛相得，也不可下。虽数，也是虚客热。
又说：该下不下，令人腹胀满，通身浮肿而死。郭雍说：凡是汗法和下法，都不宜太过。所以汗下后，容易调理。如果汗下太过，则病人虚，难调理，容易劳复。凡是用大承气汤，也应当斟酌，用调胃承气汤代替。因为张仲景自有对承气汤的告诫。
Zhang Zhongjing said: The general principle is that purgation (下法) is suitable in autumn.
He also said: When administering purgative medicines, decoctions (汤剂) should be used, as they are superior to pills (丸剂) and powders (散剂). Stop medication once the disease is cured; there is no need to finish the entire dose.
He also said: In Yangming disease (阳明病), if fever (发热) and profuse sweating (汗多) occur, urgent purgation is required. Da Chai Hu Tang (Major Bupleurum Decoction) is appropriate. Pang Anshi stated: Fever without aversion to cold (恶寒) and profuse sweating.
He also said: In Shaoyin disease (少阴病), if dry mouth and throat (口燥咽干) appear two or three days after onset, urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
He also said: In combined diseases of Yangming and Shaoyang (阳明少阳合病), diarrhea (下利) must occur. If the pulse does not show mutual overcoming (负), it is a favorable condition; if it shows overcoming, it is unfavorable. Mutual overcoming is called "Fu" (negative/overcoming). Pang stated: Yangming belongs to Earth (土), its pulse is large (大); Shaoyang belongs to Wood (木), its pulse is string-like (弦). In combined disease, if Wood overcomes Earth, compounded by diarrhea, the Stomach Qi (胃气) is already exhausted. If the pulse is not string-like, Earth is not overcome ("Bu Fu"); if the pulse is string-like, Earth is overcome ("Fu"), which leads to death. Guo Yong stated: This discussion on combined disease ends at "named Fu". According to the original text of *Shanghan Lun*, the "retained food" (宿食) syndrome was erroneously recorded here, which is incorrect. *Mai Jing* separates retained food into a distinct syndrome, which is correct. Because a slippery and rapid pulse (脉滑数) indicates retained food, Zhang Zhongjing could use Cheng Qi Tang. However, if the Stomach is overcome by Wood and exhausted with diarrhea, what logic would justify using Cheng Qi Tang? Now, based on *Mai Jing*, these are separated. For retained food syndrome, follow Zhang Zhongjing's method of using Cheng Qi Tang. For combined disease causing diarrhea, where the original text lacks treatment methods, I consider "Fu" as untreatable, while "Bu Fu" is suitable for Li Zhong Wan (Regulate the Middle Pill). If cold limbs (厥者) occur, Si Ni Tang (Frigid Extremities Decoction) is appropriate. Additionally, drain Qiuxu (GB24) and Yanglingquan (GB34), and tonify Zusanli (ST36). Pang Anshi and Zhu Hong still merge this into one syndrome according to old texts; I suspect this is incorrect. Generally, when reading Zhang Zhongjing's treatises, one must cross-reference with *Mai Jing*.
He also said: In Shaoyin disease, if there is diarrhea of clear water, purely green in color, pain in the epigastrium (心下必痛), and dry mouth/throat, purgation is permissible. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate. See the main Shaoyin syndrome for details.
He also said: In diarrhea, if the pulses at all three positions (cun, guan, chi) are level/peaceful, but palpation reveals hardness in the epigastrium, urgent purgation is required. Da Cheng Qi Tang is appropriate. Pang stated: A deep, thin, and rapid pulse indicates heat in the interior. Combined with abdominal fullness and dry throat, or dry mouth/tongue with thirst, or constipation for six to seven days with normal urination, or unclear vision/pupils without exterior signs, or a deep and solid pulse after sweating, or diarrhea with level pulses but epigastric hardness upon palpation, or continuous sweating without aversion to cold, or a forceful pulse at both floating and deep levels after purgation, Da Cheng Qi Tang is appropriate in all these cases.
He also said: In diarrhea, if the pulse is floating and slippery, it indicates internal excess (内实). The diarrhea will not stop until purged. Da Cheng Qi Tang is appropriate.
Guo Yong stated: Chang Qizhi suspected an error in the text and proposed Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction) for diarrhea. This fails to consider that Zhang Zhongjing uses Cheng Qi Tang to purge retained food, whereas combined disease diarrhea originally had no specified treatment. Ge Gen Huang Qin Huang Lian Tang is used when the Taiyang exterior is unresolved and mistaken purgation causes persistent diarrhea with lingering exterior symptoms of協熱下利 (diarrhea with coordinated heat). In current combined disease diarrhea, Stomach Qi is injured and exhausted; only warming herbs should be used to rescue the Stomach. Thus, I use Si Ni Tang and Li Zhong Wan to supplement this. If Stomach Qi is already compromised and cold herbs are added, Stomach Qi will be severed. Zhang Zhongjing discusses the pulse's "Fu" and "Bu Fu" specifically to teach later generations to consider the obstruction of Yang Qi and the Wood-overcoming-Earth pathology of Shaoyang. This is perfect. Thus, in combined diseases, although both Yang meridians are affected and pathogens must be removed, one must examine the Five Elements interactions to prevent mutual overcoming, suppress the strong, support the weak, and restore harmony, avoiding the creation of new pathogenic factors. This harmonization is akin to managing human affairs. Only the most exquisite minds can achieve this. To generate Stomach Qi and control Shaoyang Wood, metallic/mineral drugs are sometimes used. I have seen famous doctors treat Shaoyin spontaneous sweating and persistent diarrhea with Jin Ye Dan (Golden Liquid Pill) with great effect. Since this is not an ancient drug, I do not fully endorse it. If absolutely necessary, use heavily calcined versions (seven or nine times). Lightly calcined versions can purge retained food but are unsafe for the frail and elderly, who should not take Cheng Qi Tang.
Zhang Zhongjing asked: How to distinguish retained food disease? The Master said: The Cun Kou pulse is floating and large, but feels rough (涩) upon pressure; the Chi position is also slightly rough. This indicates retained food, requiring purgation. Da Cheng Qi Tang is appropriate.
He also said: Diarrhea with loss of appetite indicates retained food. Purge it. Da Cheng Qi Tang is appropriate.
He also said: If diarrhea recurs at the same time/year/day after recovery, it is because the disease is not fully resolved. Purge it. Da Cheng Qi Tang is appropriate.
He also said: Abdominal fullness and pain indicate excess. Purge it. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: Diarrhea with a surprisingly slippery pulse indicates something needs to be expelled. Purge to cure. Da Cheng Qi Tang is appropriate.
He also said: Abdominal fullness that does not decrease, or decreases insignificantly, requires purgation. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate. Guo Yong stated: "Decreases insignificantly" means very little reduction. This aligns with "Taiyang sweating was incomplete, insignificant." It corresponds to the colloquial meaning of "ineffective."
He also said: After Shanghan, a deep pulse indicates internal excess. Purging resolves it. Da Chai Hu Tang is appropriate. Guo Yong stated: The pulse must be deep, rapid, and forceful to purge. If deep but weak, thready, or slow, do not purge.
He also said: After six or seven days of Shanghan, if vision is unclear (不了了) and eyes are unresponsive, without exterior or interior signs, difficulty defecating, and slight body heat, this is excess. Urgent purgation is required. Da Cheng Qi Tang and Da Chai Hu Tang are appropriate.
He also said: If Taiyang disease is unresolved, and Yin/Yang pulses both stop, shivering followed by sweating indicates resolution. If the Yin pulse is slightly weak (or Chi pulse is solid), purging resolves it. Da Chai Hu Tang is appropriate (alternatively, Tiao Wei Cheng Qi Tang). *Mai Jing* states: If only the Yin pulse is weak, purge first to resolve. (Pang reads "Yin solid"). Guo Yong stated: Text should follow *Mai Jing* and Pang: "If Yin pulse is weak and Chi pulse is solid," purge first to resolve.
He also said: A double-stringy and slow pulse indicates epigastric hardness. A large and tight pulse indicates Yin within Yang. Purging is possible. Da Cheng Qi Tang is appropriate.
He also said: In Jie Xiong (Chest Binding), neck stiffness resembling Rou Ji (Soft Spasm) occurs. Purging brings harmony. Pang stated: Da Xian Xiong Wan (Major Draining the Chest Pill) is appropriate.
He also said: Patients without exterior or interior signs, febrile for seven to eight days, even with a floating and rapid pulse, may be purged. Da Chai Hu Tang is appropriate.
He also said: In Taiyang disease for six or seven days, if exterior signs persist, pulse is micro and deep, but no Jie Xiong occurs, and the patient is manic (发狂), it is due to heat in the Lower Jiao. The lower abdomen should be hard and full, yet urination is free. Hematochezia (下血) cures it. This is because Taiyang follows the meridian, trapping stasis-heat in the interior. Purge with Di Dang Tang (Di Dang Decoction).
He also said: In Taiyang disease, jaundice (身黄), deep and knotted pulse, hard/full lower abdomen, and difficult urination indicate no blood stasis. Free urination and mania-like behavior confirm blood stasis. Di Dang Tang is appropriate.
He also said: In Shanghan with heat, lower abdominal fullness usually implies difficult urination. If urination is now free, it indicates blood stasis. Purge with Di Dang Wan (Di Dang Pill).
He also said: In Yangming disease, fever and sweating indicate heat venting outward, preventing jaundice. If only the head sweats, body has no sweat up to the neck, urination is difficult, and thirst for fluids exists, stasis-heat in the interior causes jaundice. Purge with Yin Chen Hao Tang (Artemisia Capillaris Decoction). Guo Yong stated: First take Yin Chen Wu Ling San; once jaundice recedes, further purgation is unnecessary.
He also said: In Yangming syndrome, forgetfulness (喜忘) indicates blood retention (蓄血) due to long-standing stasis. Stool may be hard but passage is easy, and color is black. Di Dang Tang is appropriate.
He also said: Sweating with delirium (谵语) indicates dry stool (燥屎) in the Stomach, caused by Wind. Purging is required only after the pathogen has passed through the meridians (过经). Premature purging causes confused speech due to exterior deficiency and interior excess. Purging cures it. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: Patients with vexation and heat resolve with sweating, then resemble malaria with afternoon fever (日晡所发热), indicating Yangming. If the pulse is solid, purge. Da Chai Hu Tang and Da Cheng Qi Tang are appropriate.
He also said: In Yangming disease, delirium with tidal fever (潮热) and inability to eat indicates five or six pieces of dry stool in the Stomach. Ability to eat suggests only hardness, fitting Da Cheng Qi Tang syndrome.
He also said: Diarrhea with delirium indicates dry stool. Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is appropriate. After the first dose, if delirium stops and bowel movement occurs, stop subsequent doses. Otherwise, administer fully.
He also said: On days 2-3 of illness, with weak pulse, no Taiyang or Chai Hu signs, restlessness, and epigastric hardness: By day 4-5, even if eating, give small amounts of Xiao Cheng Qi Tang to mildly harmonize Stomach Qi. By day 6, give one Sheng of Cheng Qi Tang. If no bowel movement by day 6-7 and urine is scant, even if unable to eat, initial stool hardness with loose posterior indicates unformed hardness. Attacking will cause loose stools. Wait for free urination and definite hardness before attacking with Da Cheng Qi Tang.
He also said: In Taiyang Wind Strike with diarrhea and vomiting, if the exterior is resolved, attack the interior. Symptoms include continuous sweating, intermittent headache, epigastric痞硬 (fullness/hardness), flank pain, dry heaves, shortness of breath, sweating without aversion to cold. This is exterior resolved, interior unharmonized. Shi Zao Tang (Ten Date Pill) is appropriate.
He also said: If Taiyang disease is unresolved and heat binds to the Bladder, mania-like behavior occurs. Spontaneous bleeding cures it. If exterior remains, do not attack; resolve exterior first. Once exterior is resolved and only lower abdominal urgency/clumping (急结) remains, attack with Tao He Cheng Qi Tang (Peach Kernel Order the Qi Decoction). Pang stated: No aversion to cold indicates exterior resolution.
He also said: After seven to eight days of Shanghan, orange-yellow jaundice, difficult urination, and mild abdominal fullness fit Yin Chen Hao Tang.
He also said: Shanghan fever with unresolved sweating, epigastric痞硬, vomiting, and diarrhea fits Da Chai Hu Tang.
He also said: After ten-plus days of Shanghan, heat bound in the interior with alternating chills and fever fits Da Chai Hu Tang.
He also said: Pure Jie Xiong without high heat indicates water binding in chest/flanks. Slight head sweating fits Da Xian Xiong Tang (Major Draining the Chest Decoction).
He also said: After six or seven days of Shanghan, hot Jie Xiong with deep, tight pulse, epigastric pain, and stone-hard palpation fits Da Xian Xiong Tang.
He also said: In Yangming disease, excessive sweating depletes fluids, drying the Stomach and hardening stool, leading to delirium. Xiao Cheng Qi Tang is appropriate.
He also said: In Yangming disease,心烦 (vexation) without vomiting or purging fits Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).
He also said: In Yangming disease, slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness with wheezing, and tidal fever indicate exterior resolving and interior ready for attack. Continuous hand/foot sweating indicates hardened stool. Da Cheng Qi Tang governs. If sweating is profuse with slight fever/aversion to cold, exterior is unresolved. Without tidal fever, do not give Cheng Qi Tang. If severe abdominal fullness/blockage, give Xiao Cheng Qi Tang to mildly harmonize Stomach Qi, avoiding drastic purgation.
He also said: In Yangming disease, tidal fever with slightly hard stool allows Da Cheng Qi Tang. If not hard, do not give. If no bowel movement for 6-7 days and suspicion of dry stool exists, give a small amount of Xiao Cheng Qi Tang. If gas passes after ingestion, dry stool exists, and purging is allowed. If no gas passes, initial hardness with loose posterior indicates non-purgable state. Attacking causes bloating and anorexia. Thirst with water intake causes hiccups. Subsequent fever leads to hard, scant stool; harmonize with Xiao Cheng Qi Tang. Do not attack if no gas passes. Guo Yong stated: If no gas passes, withhold medicine for 24 hours. If heat does not dissipate, hard stool forms, then purge.
He also said: In Yangming disease, delirium with fever and slippery/rapid pulse is governed by Xiao Cheng Qi Tang. Give one Sheng. If gas passes, give another Sheng. If no gas passes, do not give more. Next day, if no bowel movement and pulse becomes micro/thready, interior deficiency makes it difficult to treat; do not give Cheng Qi Tang again. Chang stated: Ren Shen Huang Qi Jian Zhong Tang (Ginseng and Astragalus Middle-Building Decoction) may be used.
He also said: In Two-Yang combined disease, if Taiyang signs cease, only tidal fever, continuous hand/foot sweating, difficult defecation, and delirium occur, purging cures it. Da Cheng Qi Tang is appropriate.
He also said: Patients with difficult urination, alternating hard/loose stool, slight fever, wheezing/dizziness unable to lie down, have dry stool. Da Cheng Qi Tang is appropriate.
He also said: After severe purgation, if no bowel movement for 6-7 days, persistent vexation, and abdominal fullness/pain occur, dry stool exists due to prior retained food. Da Cheng Qi Tang is appropriate.
Pang stated: Pulse fast morning and night indicates excess accumulation (实癖); purging is allowed. Pulse calm morning/fast night is not accumulation; do not purge. "Fast" means 6-7 beats per breath. If pulse is 8-9 beats per breath, do not purge; purging causes fatal烦躁 (restlessness) and diarrhea. Pulse fast matching skin texture also prohibits purging; rapidity indicates deficient guest-heat.
He also said: Failure to purge when indicated causes abdominal fullness, generalized edema, and death. Guo Yong stated: Sweating and purging should not be excessive. Post-treatment care is easier if moderate. Excessive treatment causes deficiency, making care difficult and prone to relapse from exertion. When using Da Cheng Qi Tang, exercise caution; substitute with Tiao Wei Cheng Qi Tang if needed, following Zhang Zhongjing's warnings.