大法。秋宜下。
伤寒。冬病也。若谓可以春宜吐。夏宜汗。秋宜下。为大法。则三法者。其如寒之伤于冬何。
而仲景伤寒之治。大法。实不外乎三者。然则三言之意。岂不与仲景之旨相矛盾乎。嗟乎。仲景
之言。经也。权在其中。三言者。不知为谁。经不经。权不权。 揭三篇条目之首。与伤寒例。
妄六经前之逆同。伤寒例以当简篇前也。故削之。削之则叛经之迹泯。而三言者。以皆揭条册
首。不能削。只得存之。存之亦乱经之罪着。着与泯皆所以为狂妄戒也。后之览者。宜鉴于斯。
凡服下药。用汤胜丸。中病即止。不必尽剂也。
此亦叔和语。
下利。三部脉皆平。按之心下硬者。急下之。宜大承气汤。
三部脉皆平。血气和可知矣。心下硬。实也。所以急也。
下利不欲食者。以有宿食故也。当宜下之。与大承气汤。
不欲。犹恶也。宿。陈久也。犹世俗所谓积也。
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。
此承上文复设问答。言脉以申明之之意。
下利。脉反滑。当有所去。下之乃愈。宜大承气汤。
下利。脉迟而滑者。内实也。利未欲止。当下之。宜大承气汤。
二条亦承上文。又以脉之变者言。以详明之之意。
病。腹中满痛者。此为实也。当下之。宜大承气汤。
实者。邪气甚之谓也。
下利瘥后。至其年月日复发者。以病不尽故也。当下之。宜大承气汤。
其。期也。谓周其一年之月日期也。
伤寒后。脉沉沉者。内实也。下解之。宜大承气汤。
沉以候阴。再言沉者。谓深沉在里阴之意也。
脉双弦而迟者。必心下硬。脉大而紧者。阳中有阴也。可以下之。宜大承气汤。
双弦。谓左右皆然也。弦则为阴。迟则为寒。心下硬者。谓客寒结滞于膈也。大为阳虚。紧
为阴胜。阳以腑言。阴以寒言。谓阴寒之邪。内实于胃腑也。
通用的治疗原则。秋季适宜使用下法。
伤寒，是冬季发生的疾病。如果说“春季适宜用吐法，夏季适宜用汗法，秋季适宜用下法”是通用原则，那么这三种方法，对于在冬季感受寒邪的情况又该如何处理呢？
张仲景治疗伤寒的通用原则，实际上并不超出这三种方法（汗、吐、下）。既然如此，这三种说法的本意，难道不与张仲景的宗旨相矛盾吗？唉！张仲景的话是经典（经），其中包含了权变（权）；而提出这三种说法的人，不知是谁。他们的言论是否属于经典，是否包含权变，尚不可知。
将这三篇条目列在卷首，与《伤寒例》中违背六经辨证顺序的做法相同。《伤寒例》位于简篇之前，所以我将其删去。删去它，则违背经典的痕迹就消失了；但这三种说法因为都列在条册之首，无法删除，只得保留下来。保留它们，也是彰显其扰乱经典的罪过。彰显罪过和消除痕迹，都是为了警示狂妄之人。后来的读者，应当以此为鉴。
凡是服用泻下药，汤剂的效果优于丸剂，药力到达病所即停止服药，不必服完全部剂量。
这也是王叔和的话语。
腹泻，三部脉象都平和，但按压心下部感觉坚硬者，应当紧急使用下法，适宜用大承气汤。
三部脉象都平和，说明气血调和可知。心下部坚硬，属于实证。所以必须紧急攻下。
腹泻且不想吃东西的，是因为有积存的食物所致。应当使用下法，给予大承气汤。
“不欲”，就是厌恶的意思。“宿”，指陈久，就像世俗所说的“积滞”。
问：人患有积食，如何辨别？老师说：寸口脉浮而大，重按反而涩滞，尺部脉也微而涩。因此知道有积食，应当攻下，适宜用大承气汤。
这是承接上文，再次设立问答，通过脉象来申明上述意思。
腹泻，脉象反而滑利，说明体内有积滞需要去除，使用下法才能痊愈，适宜用大承气汤。
腹泻，脉象迟而滑的，属于内实。腹泻尚未停止，应当攻下，适宜用大承气汤。
这两条也是承接上文，通过脉象的变化来详细说明上述意思。
患病，腹部胀满疼痛的，这属于实证，应当攻下，适宜用大承气汤。
“实”，是指邪气盛极。
腹泻病愈后，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。
“其”，指期限，即满一年的月日时间。
伤寒之后，脉象沉伏的，属于内实。应当用下法解除，适宜用大承气汤。
沉脉用来候察阴分，再次提到沉脉，是指深沉在里阴的意思。
脉象左右皆弦且迟缓的，必定心下部坚硬。脉象大而紧的，是阳中有阴，可以使用下法，适宜用大承气汤。
“双弦”，指左右手脉象都是弦脉。弦脉属阴，迟脉属寒。心下部坚硬，是指外来的寒邪结滞于膈膜。脉大为阳气虚，脉紧为阴气胜。阳指腑，阴指寒，意思是阴寒之邪内实在胃腑。
General treatment principles. Autumn is suitable for purgation.
Shanghan (Cold Damage) is a disease occurring in winter. If one claims that "spring is suitable for emesis, summer for sweating, and autumn for purgation" as general principles, then how do these three methods apply to cold pathogenic factors contracted in winter?
Zhang Zhongjing's general principles for treating Shanghan actually do not exceed these three methods (sweating, emesis, purgation). In that case, does the intent of these three statements contradict Zhang Zhongjing's original meaning? Alas! Zhang Zhongjing's words are the Canon (Jing), containing within them flexibility/adjustment (Quan); whereas the authors of these three statements are unknown. Whether their words constitute Canon or contain flexibility is unclear.
Placing these three chapters at the beginning of the sections is contrary to the order of the Six Channels, similar to the errors in the *Shanghan Example* (Shanghan Li). Since the *Shanghan Example* precedes the main text, I have deleted it. By deleting it, the traces of deviating from the Canon vanish; however, because these three statements are placed at the head of the volume, they cannot be deleted and must be retained. Retaining them highlights their fault of disrupting the Canon. Both highlighting the fault and erasing the trace serve as warnings against arrogance. Future readers should take this as a lesson.
When administering purgative medicines, decoctions (Tang) are superior to pills. Stop medication once the illness is addressed; there is no need to finish the entire dose.
This is also a statement by Wang Shuhe.
In cases of diarrhea where the pulse at all three positions (Cun, Guan, Chi) is level/normal, but palpation of the epigastrium reveals hardness, urgent purgation is required. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
Level pulses at all three positions indicate that blood and qi are harmonious. Hardness in the epigastrium indicates excess (Shi). Hence, urgent intervention is necessary.
In cases of diarrhea accompanied by anorexia, it is due to retained food (Su Shi). Purgation is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Not desiring" implies aversion. "Su" refers to something old or long-standing, akin to what is commonly termed "accumulation."
Question: How can one distinguish retained food in a patient? The Master said: If the Cun Kou (radial artery) pulse is floating and large, but feels choppy upon deep pressure, and the Chi position is also faint and choppy, one knows there is retained food. It should be purged. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
This follows the previous context, setting up a Q&A to clarify the point through pulse diagnosis.
In cases of diarrhea where the pulse is surprisingly slippery, there is likely material to be expelled. Purging will lead to recovery. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
In cases of diarrhea where the pulse is slow and slippery, there is internal excess. As the diarrhea has not ceased, purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
These two clauses follow the previous context, elaborating on the matter through variations in pulse presentation.
If a patient suffers from abdominal fullness and pain, this constitutes an excess pattern. Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Excess" refers to the predominance of pathogenic factors.
If diarrhea recurs on the same month and day after recovery, it is because the pathogen was not completely eradicated. Purging is indicated. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Qi" here refers to the cycle, specifically the passage of one year's months and days.
After Shanghan, if the pulse is deep (Chen), it indicates internal excess. Purging should be used to resolve it. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
The deep pulse diagnoses Yin conditions. Reiterating "deep" emphasizes that the pathology is profound and located in the interior Yin.
If the pulse is double-string-taut (Shuang Xuan) and slow, there will certainly be hardness in the epigastrium. If the pulse is large and tight, there is Yin within Yang. Purging may be employed. Da Cheng Qi Tang (Major Order the Qi Decoction) is appropriate.
"Double-string-taut" means both left and right pulses are taut. Tautness indicates Yin; slowness indicates Cold. Hardness in the epigastrium signifies exogenous Cold stagnating in the diaphragm region. A large pulse indicates deficiency of Yang; a tight pulse indicates predominance of Yin. Yang refers to the Fu organs; Yin refers to Cold. This describes Cold-Yin pathogens causing internal excess in the Stomach Fu organ.