刘河间于此方加甘草二钱,名三一承气汤。
大黄(四两,酒洗) 浓朴(半斤,炙去皮) 枳实(五枚,炙) 芒硝(三合) 上四味,以水一斗,先煮浓朴、
枳实,取五升,去渣,纳大黄,更煮取二升,去渣,纳芒硝,更上微火一两沸,分温再服,得下余勿服。
伤寒若吐若下后,不解,坏症。不大便五、六日,上至十余日,日晡时发潮热,不恶寒,独语,如见
鬼状,若剧者,发则不识人,循衣摸床,惕而不安,微喘直视,以上皆阳明危症,因吐下之后,竭其中气,
津液已耗,孤阳独存,胃中干燥,或有燥屎,故现此等恶症。脉弦者生,涩者死。弦则阴气尚存,且能克制胃
实。涩则气血已枯矣。然弦者尚有可生之理,未必尽生,涩者断无不死者也。微者但发热,潮热。谵语者。
恶症皆无。大承气汤主之,若一服利,则止后服。中病即止。
阳明病,谵语有潮热,反不能食者,客热不能消谷。胃中必有燥屎五、六枚也,若能食者,但硬耳。
能食非真欲食,不过粥饮犹可入口耳。不能食,则谷气全不可近,肠胃实极故也。宜大承气汤下之。硬即
可下。
按∶燥屎当在肠中,今云“胃中”,何也?盖邪气结成糟粕,未下,则在胃中,欲下则在肠中。已结者,
即谓之燥屎,言胃则肠已该矣。
汗出谵语者,以有燥屎在胃中,此为风也,阳明本自汗出,然亦有不汗出者,此指明汗出之为风,则
知汗出乃表邪尚存,不汗出者,为火邪内结也。须下者,过经乃可下之。此下之之时。下之若早,语
言必乱,轻于谵语。以表虚里实故也,下早则引表邪入里,故表虚而里实。下之则愈,宜大承气汤。虽已
误下,然见谵语等症,则更下之,亦不因误下而遂不复下也。
二阳并病,同起者为合病,一经未罢,一经又病者,为并病。太阳证罢,但发潮热,手足 汗出,大
便难而谵语者,以上皆阳明现症。下之则愈,宜大承气汤。
阳明病,下之,心中懊 而烦,此乃下之未尽;故有此实烦。胃中有燥屎者,可攻,胃中燥屎,必别有
现症。腹微满,初头硬,后必溏,不可攻之。仅微满则无燥屎,故不可攻。若有燥屎者,宜大承气汤。
病患烦热,汗出则解,又如疟状,日晡所发热者,属阳明也,脉实者宜下之;脉浮虚者,宜发汗。下
之与大承气汤,发汗宜桂枝汤。详解前桂枝汤下。
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。惟有宿食,故虽
大下,而燥屎终未尽。宜大承气汤。
病患不大便五、六日,绕脐痛,正在燥屎之位。烦躁,发作有时者,此有燥屎,故使不大便也。
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。喘冒不卧,燥屎现症,宜大
便有难无易。所以乍易者,以小便不利之故,燥屎不以易便而去也。宜大承气汤。以上三条,皆证阳明
有燥屎之法。
得病二、三日,脉弱无太阳、柴胡证,烦躁,心下硬,邪热入里。至四、五日,又隔二日。虽能食,以
小承气汤,少少与微和之,不必用全方,只通其胃气而已,又用药之一法。令小安,至六日,又隔一日,而病
未除。与大承气汤一升。亦不必用全方。古人用药,虽现症凿凿,而轻方小试,敬慎小心如此。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,小便不利,则水谷未尽分,大便犹湿也。攻
之必溏∶须小便利,屎定硬,乃可攻之,以小便之利否,定宜下、不宜下。又一法。宜大承气汤。
伤寒六、七日,目中不了了,睛不和,皆阳盛之象。无表里证,邪已结在里。大便难,身微热者,此为
实也。邪结为实。急下之,宜大承气汤。
阳明病,此三字,包阳明诸症。发热汗多者,急下之。此重在汗多,恐内热甚而逼阳于外,以致亡阳
也。宜大承气汤。
发汗不解,腹满痛者,不解二字,必兼有阳明症,
加以腹满且痛,则实邪有征矣。急下之,宜大承气汤。
腹满不减,减不足言。虽略减而仍腹满也。当下之,宜大承气汤。以上诸条,举当下之一、二症,即
用下法。然亦必须参观他症,而后定为妥。
阳明、少阳合病,必下利,其脉不负者,顺也;负者,失也。少阳属木,脉当弦紧,阳明属土,脉当洪缓。
若少阳脉胜为负,阳明脉胜为不负也。厥阴篇云∶少阴负趺阳者,为顺也。少阴属水,趺阳属土,土能胜
水,则胃气尚强,故为顺,即此意。但彼处乃手足厥冷之利,故属少阴,此则属少阳为异耳,互相克贼,
名为负也。脉滑而数者,有宿食也,滑数则阳明之脉,独见而过盛,此为实邪,故知有宿食。当下之,宜大
承气汤。
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,有食反微涩,此
气结不通之故。故知有宿食,当下之,宜大承气汤。
少阴病,得之二、三日,阳邪初转入阴。口燥咽干者,急下之,阳邪传阴,肾水欲涸,故当急去其
邪,以保津液。宜大承气汤。
少阴病,自利清水,色纯青,纯青则非寒邪,乃
肝邪入肾也。《难经》云∶从前来者,为实邪。心下必痛,口干燥者,二症尤见非寒邪。急下之,宜大承气
汤。二条俱重口干,知为热邪无疑。
少阴病,六七日,腹胀,不大便者,急下之,不便而胀,为日又久,是以当下。宜大承气汤。
下利,三部脉皆平,无外邪症。按之心下硬者,实邪有形。急下之,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。
下利,不欲食者,以有宿食故也。伤食、恶食。凡噤口利亦必因宿食之故。当宜下之,宜大承气汤。
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。
下利,脉反滑,当有所去,脉滑则实邪不留。下之乃愈,宜大承气汤。
病腹中满痛者,此为实也,当下之,宜大承气汤。
脉双弦而迟者,必心下硬,木邪乘土。脉大而紧者,阳中有阴也。大为阳,紧为阴。可以下之,宜大
承气汤。
按∶以上七条,见《伤寒论》可下条内。似指杂症可下法,不入六经治法中。
大黄(四两,用酒清洗) 浓朴(半斤,炙烤后去皮) 枳实(五枚,炙烤) 芒硝(三合) 以上四味药,用水一斗,先煮浓朴、枳实,取药液五升,去渣,加入大黄,再煮取药液二升,去渣,加入芒硝,再用微火煮沸一两沸,分两次温服,如果大便通畅则停止服用剩余的药。
伤寒病经过催吐或泻下治疗后,病情未解,属于坏症。五六天甚至十多天不大便,每天傍晚出现定时发热(日晡潮热),不恶寒,独自说话,像看见鬼怪一样的幻觉;如果病情严重,发作时不认识人,手抓衣被和床沿,惊恐不安,轻微气喘且两眼直视,以上都是阳明病的危重症状。这是因为经过吐下之后,中气耗竭,津液已经消耗,孤阳独存,胃中干燥,可能有燥屎,所以出现这些恶劣症状。脉象弦的有生机,脉象涩的预后不良。脉弦说明阴气尚存,且能克制胃实的邪气。脉涩说明气血已经枯竭。然而脉弦者尚有可生的道理,未必都能生还;脉涩者断无不死之理。病情较轻的只是发热、潮热、说胡话(谵语)。没有上述那些恶症。主治用大承气汤,如果服一次药后大便通畅,就停止后面的服药。中病即止(达到治疗效果就停药)。
阳明病,出现说胡话且有潮热,反而不能进食,这是客热不能消化谷物。胃中一定有五六枚燥屎。如果能进食,仅仅是大便干硬而已。能食并非真正想吃,不过是粥饮还能入口罢了。如果不能进食,则是谷气完全不能接近,肠胃极度充实的缘故。适宜用大承气汤攻下。大便干硬就可以攻下。
按:燥屎应当在肠中,现在说“胃中”,为什么呢?大概邪气与糟粕结聚,尚未下行时,在胃中;想要下行时,则在肠中。已经结聚的,就称为燥屎,说胃中,也就包含了肠中。
出汗且说胡话的,是因为胃中有燥屎,这是风邪所致。阳明病本自汗出,但也有不出汗的情况。这里指明汗出为风邪,则可知汗出是表邪尚存,不出汗的是火邪内结。需要攻下的,必须过了经界才可攻下。这是攻下的时机。攻下如果过早,语言必然错乱,比一般的谵语更重。因为表虚里实的原因,攻下过早会引表邪入里,导致表虚而里实。攻下后痊愈,适宜用大承气汤。虽然已经误下,但见到谵语等症状,则再次攻下,也不会因为之前的误下就不再攻下。
二阳并病,同时起病叫合病,一经病未罢,另一经又发病的叫并病。太阳证已罢,只发潮热,手足出汗,大便困难且说胡话的,以上都是阳明现症。攻下则愈,适宜用大承气汤。
阳明病,经过攻下后,心中烦闷懊恼,这是攻下未尽;所以有此实烦。胃中有燥屎的,可以攻下,胃中的燥屎,必定有其他现症。腹部轻微胀满,大便开头硬,后面必稀溏,不可攻下。仅仅轻微胀满则没有燥屎,所以不可攻下。如果有燥屎的,适宜用大承气汤。
病人烦热,出汗后缓解,又像疟疾一样,每天傍晚发热,属于阳明病。脉实者适宜攻下;脉浮虚者适宜发汗。攻下用大承气汤,发汗宜用桂枝汤。前文详解过桂枝汤。
大泻下后,六七天不大便,烦躁不解,腹部胀满疼痛的,这是有燥屎。为什么会这样?本来就有宿食。只有宿食,所以虽然大泻下,但燥屎终究没有排尽。适宜用大承气汤。
病人五六天不大便,绕脐痛,正在燥屎的位置。烦躁,发作有定时的,这是有燥屎,所以导致不大便。
病人小便不利,大便乍难乍易,有时轻微发热,气喘头昏不能躺卧的,是有燥屎。气喘头昏不能躺卧,是燥屎的现症,适宜大便有难无易。之所以乍易,是因为小便不利的原因,燥屎不因大便变易而排出。适宜用大承气汤。以上三条,都是诊断阳明有燥屎的方法。
得病两三天,脉弱,没有太阳病、柴胡证的迹象,烦躁,心下硬,是邪热入里。到四五天,又隔了两天。虽然能进食,用小承气汤,少量给予以微微调和胃气,不必用全方,只通其胃气而已,这也是用药的一种方法。令病人稍安,到第六天,又隔了一天,而病未除。给大承气汤一升。也不必用全方。古人用药,虽然现症确凿,但轻方小试,敬慎小心如此。如果六七天不大便,小便少的,虽然不能进食,但只要开头硬,后面必稀溏,未确定成硬,小便不利,则水谷未尽分离,大便还是湿的。攻下必致稀溏;须小便通利,屎一定硬,才可攻下,根据小便的通利与否,决定宜下、不宜下。这是又一法。适宜用大承气汤。
伤寒六七天,眼睛看不清楚,眼球转动不灵活,都是阳盛的现象。没有表证里证,邪气已结在里。大便困难,身体轻微发热的,这是实证。邪结为实。急下之,适宜用大承气汤。
阳明病,这三个字,包含阳明诸症。发热汗多的,急下之。这重在汗多,恐怕内热甚而逼迫阳气于外,以致亡阳。适宜用大承气汤。
发汗后病不解,腹部胀满疼痛的,“不解”二字,必定兼有阳明症,加上腹满且痛,则实邪有征象了。急下之,适宜用大承气汤。
腹部胀满不减,即使减轻也不足挂齿。虽然略减但仍然腹满。当下之,适宜用大承气汤。以上诸条,列举当下的一两个症状,就用下法。但也必须参考其他症状,然后定为妥当。
阳明、少阳合病,必下利,脉象不负的,是顺证;负的,是逆证。少阳属木,脉当弦紧,阳明属土,脉当洪缓。若少阳脉胜为负,阳明脉胜为不负。厥阴篇云:少阴负趺阳的,为顺证。少阴属水,趺阳属土,土能胜水,则胃气尚强,故为顺,就是这个意思。但彼处是手足厥冷的下利,所以属少阴,此处则属少阳为异耳,互相克贼,名为负。脉滑而数的,有宿食。滑数则是阳明之脉,独见而过盛,这是实邪,所以知道有宿食。当下之,适宜用大承气汤。
问曰:人病有宿食,如何辨别?师曰:寸口脉浮而大,按之反涩,尺中亦微而涩,有食反微涩,这是气结不通的缘故。所以知道有宿食,当下之,适宜用大承气汤。
少阴病,得病两三天,阳邪初转入阴。口燥咽干的,急下之,阳邪传阴,肾水欲涸,故当急去其邪,以保津液。适宜用大承气汤。
少阴病,自利清水,颜色纯青,纯青则非寒邪,乃肝邪入肾也。《难经》云:从前来者,为实邪。心下必痛,口干燥的,这两个症状尤其可见非寒邪。急下之,适宜用大承气汤。两条都重口干,知道是热邪无疑。
少阴病,六七天,腹胀,不大便的,急下之,不便而胀,日子又久,是以当下。适宜用大承气汤。
下利,三部脉皆平,无外邪症。按之心下硬的,实邪有形。急下之,适宜用大承气汤。
下利,脉迟而滑的,内实也,利未欲止,当下之,适宜用大承气汤。
下利,不欲食的,因为有宿食的缘故。伤食、恶食。凡是噤口利也必因宿食的缘故。应当宜下之,适宜用大承气汤。
下利痊愈后,到了年、月、日复发的,因为病不尽的缘故,当下之,适宜用大承气汤。
下利,脉反滑,当有所去,脉滑则实邪不留。下之乃愈,适宜用大承气汤。
脉双弦而迟的,必心下硬,木邪乘土。脉大而紧的,阳中有阴也。大为阳,紧为阴。可以下之,适宜用大承气汤。
按:以上七条,见于《伤寒论》可下条内。似乎指杂症可下法,不入六经治法中。
Liu Hejian added two qian of Gancao (Licorice Root) to this formula and named it Sanyi Chengqi Tang (Three-One Descending Qi Decoction).
Dahuang (Rhubarb Radix et Rhizoma, four liang, washed with wine), Nongpo (Magnoliae Officinalis Cortex, half jin, roasted and skin removed), Zhishi (Immature Bitter Orange, five pieces, roasted). The above four ingredients are decocted in one dou of water. First, boil Nongpo and Zhishi until the liquid reduces to five sheng, then remove the dregs. Add Dahuang and boil further until the liquid reduces to two sheng, then remove the dregs again. Add Mangxiao (Mirabilite) and boil gently for one or two boils. Divide into two doses and take warm. If bowel movement occurs, stop taking the remaining medicine.
After a Taiyang disease (disease of the Taiyang channel) has been treated with emesis or purgation, if the condition remains unresolved, it is considered a "ruined syndrome" (bad outcome due to improper treatment). If there is no bowel movement for five or six days, extending up to ten or more days, and tidal fever (fever that worsens in the late afternoon) occurs daily without aversion to cold, accompanied by talking to oneself as if seeing ghosts, these are critical symptoms of Yangming disease (disease of the Yangming channel/stomach-intestine system). In severe cases, the patient may not recognize others during episodes, clutch at clothing and bedrails, feel terrified and restless, have slight shortness of breath, and fixed staring eyes. These are all critical Yangming symptoms caused by the depletion of middle qi and exhaustion of body fluids after emesis or purgation, leaving isolated yang, dryness in the stomach, and potentially dry feces. A wiry pulse indicates survival potential, while a choppy pulse indicates death. A wiry pulse suggests that yin qi still exists and can restrain the excess in the stomach. A choppy pulse indicates that qi and blood are exhausted. Although a wiry pulse suggests a possibility of survival, it does not guarantee it; a choppy pulse implies certain death. Milder cases present only with fever, tidal fever, and delirium (confused speech), without the aforementioned critical symptoms. The main treatment is Dachengqi Tang (Major Order the Qi Decoction). If one dose results in relief, stop subsequent doses. Stop medication once the illness is addressed.
In Yangming disease, if delirium and tidal fever occur but the patient cannot eat, it indicates exogenous heat failing to digest food. There must be five or six pieces of dry feces in the stomach. If the patient can eat, the stool is merely hard. "Can eat" does not mean true appetite, but rather that porridge or drinks can still be swallowed. Inability to eat means grain qi cannot approach at all due to extreme fullness in the intestines and stomach. Dachengqi Tang should be used to purge. Purging is indicated when the stool is hard.
Note: Dry feces should be in the intestines, yet the text says "stomach." Why? When pathogenic factors bind with waste products before descending, they are in the stomach; when preparing to descend, they are in the intestines. Once bound, they are called dry feces. Mentioning the stomach implies the intestines are included.
Sweating accompanied by delirium indicates dry feces in the stomach, caused by wind pathogen. Yangming disease naturally involves sweating, but some cases do not sweat. Here, sweating indicates wind pathogen, meaning exterior pathogenic factors remain. Lack of sweating indicates internal binding of fire pathogen. Purging is permissible only after the pathogen has passed through the meridians. This defines the timing for purging. If purging is done too early, speech will become chaotic, worse than simple delirium, because the exterior is deficient and the interior is excessive. Premature purging draws exterior pathogens inward, causing exterior deficiency and interior excess. Purging will cure the condition; Dachengqi Tang is appropriate. Even if purging was previously mistaken, if delirium and other symptoms persist, purging should be repeated; a previous mistake does not preclude future purging.
When two yang channels are involved simultaneously, it is called combined disease (Hebing); when one channel's disease is not resolved and another channel becomes diseased, it is called concurrent disease (Bingbing). If Taiyang symptoms have ceased, presenting only with tidal fever, sweating on hands and feet, difficult defecation, and delirium, these are current Yangming symptoms. Purging will cure the condition; Dachengqi Tang is appropriate.
After purging Yangming disease, if the patient feels heart vexation and restlessness (Aonao), it indicates incomplete purging, resulting in real vexation. If there are dry feces in the stomach, purging is indicated. Dry feces in the stomach must present with other specific symptoms. If the abdomen is slightly full, and stool is hard at the beginning but loose later, purging is contraindicated. Slight fullness alone indicates no dry feces, so purging is contraindicated. If dry feces are present, Dachengqi Tang is appropriate.
If a patient suffers from vexation and heat, which resolves with sweating, but resembles malaria with evening fever, it belongs to Yangming. A solid pulse indicates purging is suitable; a floating and deficient pulse indicates sweating is suitable. For purging, use Dachengqi Tang; for sweating, use Guizhi Tang (Cinnamon Twig Decoction). See the detailed explanation of Guizhi Tang earlier.
After severe purging, if there is no bowel movement for six or seven days, persistent vexation, and abdominal fullness and pain, this indicates dry feces. The reason is pre-existing retained food. Because of retained food, even after severe purging, dry feces may not be fully expelled. Dachengqi Tang is appropriate.
If a patient has not had a bowel movement for five or six days, experiences periumbilical pain (the location of dry feces), and has vexation that comes and goes at specific times, this indicates dry feces causing constipation.
If a patient has difficulty urinating, intermittent difficulty and ease in defecation, occasional slight fever, and shortness of breath with vertigo preventing lying down, this indicates dry feces. Shortness of breath, vertigo, and inability to lie down are signs of dry feces. Ideally, defecation should be difficult without ease. The intermittent ease is due to difficulty urinating; dry feces do not pass easily with loose stool. Dachengqi Tang is appropriate. The above three clauses describe methods for diagnosing dry feces in Yangming disease.
On the second or third day of illness, if the pulse is weak, with no Taiyang or Chaihu (Bupleurum) symptoms, but with vexation and hardness below the heart, indicating pathogenic heat entering the interior. By the fourth or fifth day (two days later), even if the patient can eat, administer Xiaochengqi Tang (Minor Order the Qi Decoction) in small amounts to gently harmonize the stomach qi, without using the full formula. This is a method of medication to provide slight relief. By the sixth day (one day later), if the illness persists, administer one sheng of Dachengqi Tang, also possibly not the full formula. Ancient physicians, despite clear symptoms, would test with mild formulas cautiously. If there is no bowel movement for six or seven days and urine output is low, even if the patient cannot eat, if the stool is hard at the beginning but loose later, and it is not confirmed to be hard, and urine is insufficient, meaning water and grain are not fully separated and stool is still damp, purging will cause loose stool. One must wait for free urination and confirmed hard stool before purging. Whether to purge depends on the sufficiency of urination. This is another method. Dachengqi Tang is appropriate.
On the sixth or seventh day of Shanghan (Cold Damage), if the eyes appear unclear and pupils are unresponsive, these are signs of excessive yang. With no exterior or interior symptoms, the pathogen is bound in the interior. Difficulty in defecation and slight body heat indicate an excess condition. Pathogen binding creates excess. Urgent purging is required; Dachengqi Tang is appropriate.
"Yangming disease" encompasses various Yangming symptoms. If there is fever and profuse sweating, urgent purging is required. The emphasis is on profuse sweating, fearing that intense internal heat will force yang outward, leading to yang collapse. Dachengqi Tang is appropriate.
If sweating fails to resolve the condition, and abdominal fullness and pain occur, "unresolved" implies accompanying Yangming symptoms. Added abdominal fullness and pain confirm excess pathogen. Urgent purging is required; Dachengqi Tang is appropriate.
Abdominal fullness that does not decrease, or decreases insignificantly, requires purging. Although slight reduction occurs, fullness remains. Purging is required; Dachengqi Tang is appropriate. The above clauses list one or two symptoms requiring purging. However, other symptoms must be consulted to ensure appropriateness.
In combined Yangming and Shaoyang disease, diarrhea is inevitable. A pulse that does not show "defeat" (negative indication) is favorable; a "defeated" pulse is unfavorable. Shaoyang corresponds to Wood, with a wiry-tight pulse; Yangming corresponds to Earth, with a surging-slow pulse. If Shaoyang pulse dominates, it is defeat; if Yangming pulse dominates, it is non-defeat. The Jueyin chapter states: "Shaoyin defeating Zuyang is favorable." Shaoyin corresponds to Water, Zuyang to Earth; Earth overcoming Water indicates strong stomach qi, hence favorable. This principle applies here, though Shaoyin involves cold limbs and diarrhea, whereas this case involves Shaoyang. Mutual overcoming is called defeat. A slippery and rapid pulse indicates retained food. Slippery-rapid represents the Yangming pulse appearing exclusively and excessively, indicating excess pathogen and retained food. Purging is required; Dachengqi Tang is appropriate.
Question: How to distinguish retained food in patients? Master said: If the Cun-kou pulse is floating and large, but feels choppy upon pressure, and the Chi position is also faint and choppy, this indicates qi stagnation and blockage due to food retention. Thus, retained food is confirmed, and purging is required; Dachengqi Tang is appropriate.
In Shaoyin disease, on the second or third day, as yang pathogen initially transfers to yin, dry mouth and throat indicate urgent purging. As yang pathogen transfers to yin, kidney water is about to dry up, so the pathogen must be urgently removed to preserve body fluids. Dachengqi Tang is appropriate.
In Shaoyin disease, spontaneous diarrhea of clear water, purely green in color, indicates liver pathogen entering the kidney, not cold pathogen. The Nan Jing states: "Coming from the source is excess pathogen." Pain below the heart and dry mouth confirm it is not cold pathogen. Urgent purging is required; Dachengqi Tang is appropriate. Both clauses emphasize dry mouth, confirming heat pathogen.
In Shaoyin disease, on the sixth or seventh day, abdominal fullness and constipation require urgent purging. Constipation with fullness lasting long necessitates purging. Dachengqi Tang is appropriate.
In diarrhea, if the pulses in all three positions are level and there are no exterior symptoms, but pressing reveals hardness below the heart, this indicates tangible excess pathogen. Urgent purging is required; Dachengqi Tang is appropriate.
In diarrhea, if the pulse is slow and slippery, it indicates internal excess. Diarrhea has not stopped; purging is required; Dachengqi Tang is appropriate.
In diarrhea, if there is loss of appetite, it is due to retained food. Food injury and aversion to food. Even "closed-mouth" diarrhea is caused by retained food. Purging is indicated; Dachengqi Tang is appropriate.
If diarrhea recurs in the same year, month, or day after recovery, it is because the illness was not fully resolved. Purging is required; Dachengqi Tang is appropriate.
In diarrhea, if the pulse is unexpectedly slippery, there is something to eliminate. A slippery pulse indicates excess pathogen does not remain. Purging leads to recovery; Dachengqi Tang is appropriate.
Abdominal fullness and pain indicate excess. Purging is required; Dachengqi Tang is appropriate.
A double-wiry and slow pulse indicates hardness below the heart, with wood pathogen attacking earth. A large and tight pulse indicates yang containing yin. Large is yang, tight is yin. Purging is permissible; Dachengqi Tang is appropriate.
Note: The above seven clauses appear in the "Purgative Clauses" of the Shanghan Lun. They seem to refer to purgative methods for miscellaneous diseases, not strictly within the Six Channels treatment framework.