下者，攻也，攻其邪也。病在表，则汗之；在半表半里，则和之；病在里，则下之而已
然有当下不下误人者，有不当下而下误人者。有当下不可下，而妄下之误人者，有当下不
可下，而又不可以不下，下之不得其法以误人者。有当下而下之不知浅深，不分便溺与蓄血
不论汤丸以误人者。又杂症中，不别寒热、积滞、痰、水、虫、血、痈、脓以误人者，是不
何谓当下不下？仲景云∶少阴病，得之二三日，口燥咽干者，急下之。少阴病，六七日
腹满不大便者，急下之。下利，脉滑数，不欲食，按之心下硬者，有宿食也，急下之。阳
明病，谵语，不能食，胃中有燥屎也，可下之。阳明病，发热汗多者，急下之。少阴病，下
利清水，色纯青，心下必痛，口干燥者，急下之。伤寒六七日，目中不了了，睛不和，无表
证，大便难者，急下之。此皆在当下之例，若失时不下，则津液枯竭，身如槁木，势难挽回
然又有不当下而下者何也？如伤寒表证未罢，病在阳也，下之则成结胸。病邪虽已入里
而散漫于三阴经络之间，尚未结实，若遽下之，亦成痞气。况有阴结之症，大便反硬，得
温则行，如开冰解冻之象；又杂症中，有高年血燥不行者，有新产血枯不行者，有病后亡津
液者，有亡血者，有日久不更衣，腹无所苦，别无他症者，若误下之，变症蜂起矣。所谓不
当下而下者此也。
然又有当下不可下者何也？病有热邪传里，已成可下之证，而其人脐之上、下、左、右
或有动气，则不可以下。经云∶动气在右，不可下，下之则津液内竭，咽燥鼻干，头眩心
悸也。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
动气在上，不可下，下之则掌握烦热，身浮汗泄，欲得水自灌。动气在下，不可下，下
之则腹满头眩，食则清谷，心下痞也。又咽中闭塞者不可下，下之则下轻上重，水浆不入，
蜷卧，身疼，下利日数十行。又脉微弱者不可下。脉浮大，按之无力者，不可下。脉迟
者不可下。喘而胸满者不可下。欲吐、欲呕者不可下。病患阳气素微者不可下，下之则呃。
病患平素胃弱，不能食者，不可下。病中能食，胃无燥屎也，不可下。小便清者不可下。病
人腹满时减，复如故者，不可下。若误下之，变症百出矣。所谓当下不可下，而妄下误人者
然有当下不可下，而又不得不下者，何也？夫以羸弱之人，虚细之脉，一旦而热邪乘之
是为正虚邪盛，最难措手。古人有清法焉，有润法焉，有导法焉，有少少微和之法焉，有
先补后攻，先攻后补之法焉，有攻补并行之法焉，不可不讲也。如三黄解毒，清之也。麻仁
梨汁，润之也。蜜煎、猪胆汁、土瓜根导之也。凉膈散、大柴胡，少少和之也。更有脉虚体
弱不能胜任者，则先补之而后攻之，或暂攻之而随补之，或以人参汤，送下三黄枳术丸。又
或以人参、栝蒌、枳实，攻补并行而不相悖。盖峻剂一投，即以参、术、归、芍维持调护于
其中，俾邪气潜消而正气安固，不愧为王者之师矣。又有杂症中，大便不通，其用药之法可
相参者。如老人、久病患、新产妇人，每多大便闭结之症，丹溪用四物汤，东垣用通幽汤，
予尝合而酌之，而加以苁蓉、枸杞、柏子仁、芝麻、松子仁、人乳、梨汁、蜂蜜之类，随手
取效。又尝于四物加升麻，及前滋润药，治老人血枯，数至圊而不能便者，往往有验，此皆
委曲疏通之法。若果人虚，虽传经热邪，不妨借用，宁得猛然一往，败坏真元，至成洞泻，
虽曰天命，岂非人事哉！所谓下之贵得其法者此也。
然又有当下而下，而不知浅深，不分便溺与蓄血，不论汤丸以误人者何也？如仲景大承
气汤，必痞、满、燥、实兼全者，乃可用之。若仅痞满而未燥实者，仲景只用泻心汤。痞满
兼燥而未实者，仲景只用小承气汤。除去芒硝，恐伤下焦阴血也。燥实在下而痞满轻者，仲
景只用调胃承气汤。除去枳、朴，恐伤上焦阳气也。又有太阳伤风证，误下而传太阴，以致
腹痛者，则用桂枝汤加芍药；大实痛者，桂枝汤加大黄，是解表之中兼攻里也。又有邪从少
阳来，寒热未除，则用大柴胡汤，是和解之中兼攻里也。又结胸证，项背强，从胸至腹硬满
而痛，手不可近者，仲景用大陷胸汤、丸。若不按不痛者，只用小陷胸汤。若寒食结胸，用
三白散热药攻之。又水结胸，头出汗者，用小半夏加茯苓汤。水停胁下，痛不可忍者，则
用十枣汤。凡结胸阴阳二症，服药罔效，《活人》俱用枳实理中丸，应手而愈。又《河间三
书》云∶郁热蓄甚，神昏厥逆，脉反滞涩，有微细欲绝之象，世俗未明造化之理，投以温药
则不可救；或者妄行攻下，致残阴暴绝，势大可危。不下亦危，宜用凉膈散合解毒汤，养
阴退阳，积热借以宣散，则心胸和畅，而脉渐以生。此皆用药浅深之次第也。又如太阳症未
罢，口渴，小便短涩，大便如常，此为溺涩不通之证，治用五苓散。又太阳传本，热结膀胱
其人如狂，少腹硬满而痛，小便自利者，此为蓄血下焦，宜抵当汤、丸。若蓄血轻微，但
少腹急结，未至硬满者，则用桃核承气汤。或用生地四物汤，加酒洗大黄各半下之，尤为稳
当。盖溺涩证，大便如常；燥粪证小便不利；蓄血证小便自利、大便色黑也。此便溺、蓄血
之所由分也。血结膀胱，病势最急，则用抵当汤，稍轻者，抵当丸。结胸恶证悉具，则用大
陷胸汤，稍轻者，大陷胸丸。其他荡涤肠胃，推陈致新之法，则皆用汤。古人有言，凡用下
药攻邪气，汤剂胜丸散。诚以热淫于内。用汤液涤除之，为清净耳。此汤、丸之别也。
然又有杂症中，不别寒热、积滞、痰、水、虫、血、痈脓以误人者何也？东垣治伤食证
腹痛、便闭、拒按者，因于冷食，用见 丸；因于热食，用三黄枳术丸。若冷热互
伤，则以二丸酌其所食之多寡而互用之，应手取效。又实热老痰，滚痰丸；水肿实证，神佑
丸；虫积，剪红丸；血积，花蕊丹、失笑丸；肠痈，牡丹皮散，随症立方，各有攸宜，此杂
近世庸家，不讲于法，每视下药为畏途，病者亦视下药为砒鸩，致令热症垂危，袖手旁
观，委之天数，大可悲耳。昔张子和《儒门事亲》三法，即以下法为补，谓下去其邪而正气
自复，谷、肉、果、菜，无往而非补养之物。虽其说未合时宜，而于治病攻邪之法正未可缺
吾愿学人仰而思之，平心而察之，得其要领，以施救济之方，将以跻斯民于寿域不难矣。
下法，就是攻逐邪气的方法。病邪在表，就用发汗法；在半表半里之间，就用和解法；病邪在里，就用下法而已。
然而，有应当使用下法却没有使用而误人的情况，也有不应当使用下法却使用了而误人的情况。有应当使用下法但不可妄用下法，却胡乱使用下法而误人的情况；有应当使用下法但不可妄用，却又不得不使用，因使用方法不得当而误人的情况。有应当使用下法，但不知道深浅程度，不分是便秘还是蓄血，也不分是用汤剂还是丸剂而误人的情况。还有在治疗杂症时，不辨别寒热、积滞、痰饮、水湿、虫积、瘀血、痈肿、脓疡等病因而误人的情况，这又是为什么呢？
什么叫“当下不下”（应当使用下法却没有使用）呢？张仲景说：少阴病，发病二三天，出现口燥咽干的，要紧急使用下法。少阴病，六七天，腹部胀满且大便不通的，要紧急使用下法。腹泻，脉象滑数，不想吃东西，按压心下部感觉坚硬的，是有宿食停滞，要紧急使用下法。阳明病，胡言乱语，不能进食，胃中有干燥的粪块，可以使用下法。阳明病，发热且出汗多的，要紧急使用下法。少阴病，拉出清水样粪便，颜色纯青，心下部必定疼痛，口干燥的，要紧急使用下法。伤寒病六七天，眼睛视物不清，眼球转动不灵活，没有表证，大便困难的，要紧急使用下法。这些都属于应当立即使用下法的例子，如果错过时机不使用下法，那么津液就会枯竭，身体像枯木一样，病情就难以挽回了。
然而又有不应当使用下法却使用了的情况，这是为什么呢？比如伤寒表证还没有解除，病邪还在阳经，如果使用下法，就会形成结胸证。病邪虽然已经入里，但散漫在三阴经络之间，尚未结实，如果匆忙使用下法，也会形成痞气。况且有阴结这种病症，大便反而坚硬，得温则能通行，就像开冰解冻一样的景象；另外在杂症中，有老年人血液枯燥导致排便不畅的，有新产后血液枯竭导致排便不畅的，有病后津液亡失的，有失血的，有长久不大便但腹部没有痛苦，也没有其他症状的，如果误用下法，各种变证就会蜂拥而起。这就是所谓“不当下而下”的情况。
然而又有应当使用下法但实际上不可以使用的情况，这是为什么呢？疾病有热邪传入体内，已经成为可以使用下法的证候，但是患者脐部的上、下、左、右如果有搏动感（动气），就不可以使用下法。医经说：动气在右边，不可使用下法，使用后会导致津液内竭，出现咽干鼻燥、头晕心悸等症状。动气在左边，不可使用下法，使用后会导致腹内拘急，饮食不下，动气更加剧烈，即使身体发热，睡觉时也想要蜷缩。动气在上面，不可使用下法，使用后会导致手掌烦热，身体浮肿出汗，想要喝水浇身。动气在下面，不可使用下法，使用后会导致腹部胀满头晕，吃下去的食物完谷不化，心下部痞塞。另外，咽喉闭塞的人不可使用下法，使用后会导致下虚上实，水浆难进，蜷卧，身体疼痛，腹泻一天几十次。另外，脉象微弱的人不可使用下法。脉象浮大，按之无力的，不可使用下法。脉迟的人不可使用下法。气喘且胸部胀满的人不可使用下法。想吐、想呕的人不可使用下法。病人阳气素来虚弱的人不可使用下法，使用后会出现呃逆。病人平素胃弱，不能进食的，不可使用下法。生病期间能进食的，说明胃中没有燥屎，不可使用下法。小便清长的不可使用下法。病人腹部胀满，有时减轻，过后又恢复原状的，不可使用下法。如果误用下法，各种变证就会层出不穷。这就是所谓“当下不可下，而妄下误人”的情况。
然而又有应当使用下法但实际上不可使用，却又不得不使用的情况，这是为什么呢？对于身体羸弱、脉象虚细的人，一旦受到热邪侵袭，这就是正气虚弱而邪气强盛，最难处理。古人有清热法，有润燥法，有导引法，有轻微调和的方法，有先补后攻、先攻后补的方法，有攻补兼施的方法，这些都是不可不研究的。比如三黄解毒汤，是清热的方法。麻仁配合梨汁，是润燥的方法。蜜煎、猪胆汁、土瓜根，是导引的方法。凉膈散、大柴胡汤，是轻微调和的方法。更有脉虚体弱不能承受峻猛药力的人，就先补益而后攻邪，或者暂时攻邪随后补益，或者用人参汤送服三黄枳术丸。又或者用人参、瓜蒌、枳实，使攻邪与补益并行而不相冲突。大概是在投用峻猛药剂的同时，加入人参、白术、当归、白芍来维持调护，使得邪气悄然消退而正气安稳巩固，不愧为王者之师。另外在杂症中，大便不通，其用药方法可以参考上述原则。比如老人、久病患者、新产妇人，常常有大便闭结的症状，朱丹溪使用四物汤，李东垣使用通幽汤，我曾经将两者结合斟酌，并加入肉苁蓉、枸杞、柏子仁、芝麻、松子仁、人乳、梨汁、蜂蜜之类的药物，随手就能取得疗效。又曾经于四物汤中加入升麻，以及前面的滋润药物，治疗老人血枯，多次想去厕所却无法排便的情况，往往有效，这都是委婉疏通的方法。如果确实人体虚弱，即使是传经的热邪，不妨借用这些温和的方法，宁可不要猛烈地一味攻下，败坏真元，以至于变成洞泄不止，虽然说是天命，难道不是人为造成的吗！这就是所谓“下法贵在得其法度”的意思。
然而又有应当使用下法，却不知道深浅程度，不分是大便不通还是蓄血，也不分是用汤剂还是丸剂而误人的情况，这是为什么呢？比如张仲景的大承气汤，必须痞、满、燥、实四种症状兼备，才可以使用。如果只是痞满而没有燥实，张仲景只用泻心汤。痞满兼有燥但没有实的，张仲景只用小承气汤。去掉芒硝，是恐怕损伤下焦的阴血。燥实在下焦而痞满轻微的，张仲景只用调胃承气汤。去掉枳实、厚朴，是恐怕损伤上焦的阳气。另外又有太阳中风证，误用下法后传入太阴，导致腹痛的，就用桂枝汤加芍药；如果是大实痛，就用桂枝汤加大黄，这是在解表的同时兼以攻里。又有邪气从少阳传来，寒热未除的，就用大柴胡汤，这是在和解的同时兼以攻里。还有结胸证，项背强直，从胸部到腹部硬满而疼痛，手不能触碰的，张仲景用大陷胸汤或丸。如果不按压就不痛的，只用小陷胸汤。如果是寒食结胸，用三白散热药来攻治。又有水结胸，头部出汗的，用小半夏加茯苓汤。水停在胁下，疼痛无法忍受的，就用十枣汤。凡是结胸的阴证和阳证，服药无效，《活人书》都用枳实理中丸，应手而愈。另外《河间三书》说：郁热蓄积严重，神志昏迷，四肢厥逆，脉象反而滞涩，有微细欲绝的迹象，世俗之人不明白造化的道理，投用温药则不可救治；或者胡乱使用攻下法，导致残存的阴气暴绝，形势非常危险。不用下法也危险，应该用凉膈散合解毒汤，养阴退阳，积聚的热邪借此宣散，那么心胸就会和畅，脉象逐渐恢复。这些都是用药深浅的次第。又如太阳证还没有解除，口渴，小便短涩，大便正常，这是小便涩滞不通的证候，治疗用五苓散。又太阳病传入本经，热结膀胱，其人如狂，少腹硬满而疼痛，小便自利的，这是下焦蓄血，宜用抵当汤或丸。如果蓄血轻微，只是少腹急结，未到硬满的程度，就用桃核承气汤。或者用生地四物汤，加酒洗大黄各半量一起服用，更为稳妥。大概小便涩滞证，大便正常；燥屎证小便不利；蓄血证小便自利、大便色黑。这就是区分小便涩滞和蓄血的依据。血结在膀胱，病势最急，就用抵当汤，稍轻的，用抵当丸。结胸恶证全部具备，就用大陷胸汤，稍轻的，用大陷胸丸。其他荡涤肠胃、推陈致新的方法，都使用汤剂。古人有话说，凡是用下药攻逐邪气，汤剂胜过丸散。确实是因为热邪淫溢于内，用汤液来涤除它，最为清净。这就是汤剂和丸剂的区别。
然而又有在杂症中，不辨别寒热、积滞、痰饮、水湿、虫积、瘀血、痈肿脓疡等病因而误人的情况，这是为什么呢？李东垣治疗伤食证，腹痛、便秘、拒按的，如果是因冷食引起的，用见 丸；如果是因热食引起的，用三黄枳术丸。如果冷热互伤，就将这两种丸剂根据所食食物的多少酌情交替使用，应手取效。另外实热老痰，用滚痰丸；水肿实证，用神佑丸；虫积，用剪红丸；血积，用花蕊丹、失笑丸；肠痈，用牡丹皮散，随症状立方的，各有适宜之处，这是杂症中使用下法的原则。近代庸医，不讲求法度，每每把使用下法视为畏途，病人也把使用下法视为毒药，致使热证垂危时，他们袖手旁观，将其归结为天数，这真是大可悲哀啊。昔日张子和在《儒门事亲》中提出的三法，就是把下法当作补法，认为去除了邪气正气自然恢复，谷物、肉类、水果、蔬菜，无处不是补养之物。虽然他的说法不完全符合当时的习俗，但对于治病攻邪的方法却是不可缺少的。我希望学习者仰头思考，平心观察，掌握要领，以此施行救济病人的方术，将使百姓达到长寿的境界并不难啊。
The purgative method is the method of attacking and eliminating pathogenic factors. When the disease is in the exterior, use diaphoresis (sweating method); when it is in the half-exterior and half-interior, use harmonization; when it is in the interior, use purgation.
However, there are cases where failing to use purgation when indicated causes harm, and cases where using purgation when not indicated causes harm. There are cases where purgation is indicated but should not be used recklessly, yet reckless purgation causes harm. There are cases where purgation is indicated but should not be used recklessly, yet it must be used, and improper technique causes harm. There are cases where purgation is indicated, but ignorance of depth and degree, failure to distinguish between constipation and blood stasis, and lack of distinction between decoctions and pills cause harm. Furthermore, in treating miscellaneous diseases, failure to differentiate between cold and heat, food stagnation, phlegm, water retention, parasites, blood stasis, abscesses, and pus causes harm. Why is this?
What is meant by "failing to purge when one should" (indications for purgation present but not utilized)? Zhang Zhongjing stated: In Shaoyin disease, if after two or three days there is dryness of the mouth and throat, urgent purgation is required. In Shaoyin disease, if after six or seven days there is abdominal fullness and constipation, urgent purgation is required. If there is diarrhea with a slippery and rapid pulse, anorexia, and hardness upon pressure at the epigastrium, indicating retained food, urgent purgation is required. In Yangming disease, if there is delirium and inability to eat, indicating dry fecal matter in the stomach, purgation may be used. In Yangming disease, if there is fever and profuse sweating, urgent purgation is required. In Shaoyin disease, if there is diarrhea of clear watery stool, purely green in color, pain in the epigastrium, and dry mouth, urgent purgation is required. In Shanghan (Cold Damage) disease, if after six or seven days there is unclear vision and unsteady eyeballs, without exterior symptoms, but with difficult defecation, urgent purgation is required. These are all examples where immediate purgation is indicated. If the opportunity is missed and purgation is not used, body fluids will be exhausted, the body will become like dead wood, and the condition will be irretrievable.
However, there are cases where purgation is not indicated but is used. Why is this? For instance, if the exterior syndrome of Shanghan has not resolved, and the pathogen is still in the Yang channels, using purgation will result in Jie Xiong (Chest Binding). Although the pathogen has entered the interior, if it is scattered among the Three Yin channels and has not yet solidified, hasty purgation will result in Pi Qi (Epigastric Fullness and Obstruction). Moreover, in cases of Yin Constipation, the stool may be hard but moves with warmth, resembling melting ice; additionally, in miscellaneous diseases, there are elderly people with dry blood causing difficulty in defecation, postpartum women with depleted blood causing difficulty in defecation, patients who have lost body fluids due to illness, those who have suffered hemorrhage, and those who have not had a bowel movement for many days but have no abdominal discomfort or other symptoms. If purgation is mistakenly used, various complications will arise. This is what is meant by "purging when one should not."
However, there are cases where purgation is indicated but contraindicated. Why is this? Even if heat pathogens have transmitted to the interior and indications for purgation exist, if there is pulsation (Dong Qi) above, below, to the left, or to the right of the umbilicus, purgation must not be used. The classics state: If Dong Qi is on the right, do not purge, as this will deplete internal fluids, leading to dry throat and nose, dizziness, and palpitations. If Dong Qi is on the left, do not purge, as this will lead to abdominal tension, inability to eat, worsening of pulsation, and even if there is fever, the patient will wish to curl up while lying down. If Dong Qi is above, do not purge, as this will lead to hot palms, edema with sweating, and a desire to pour water over oneself. If Dong Qi is below, do not purge, as this will lead to abdominal distension and dizziness, undigested food in stool, and epigastric obstruction. Furthermore, those with throat closure cannot be purged; doing so leads to lower deficiency and upper excess, inability to take fluids, curling up, body ache, and frequent diarrhea. Those with weak pulses cannot be purged. Those with floating and large pulses that are empty upon pressure cannot be purged. Those with slow pulses cannot be purged. Those with wheezing and chest fullness cannot be purged. Those who feel the urge to vomit cannot be purged. Patients with inherently deficient Yang Qi cannot be purged, as this will cause hiccups. Patients with inherently weak stomachs who cannot eat cannot be purged. Patients who can eat during illness indicate no dry fecal matter in the stomach, so they cannot be purged. Those with clear urine cannot be purged. Patients whose abdominal fullness decreases intermittently but returns cannot be purged. Mistaken purgation will lead to numerous complications. This is what is meant by "purging when one should not, yet doing so recklessly."
However, there are cases where purgation is indicated but contraindicated, yet it becomes necessary. Why is this? For frail individuals with thin, weak pulses, once attacked by heat pathogens, this represents deficiency of healthy Qi and excess of pathogenic factors, which is difficult to manage. Ancients employed clearing methods, moistening methods, guiding methods, mild harmonizing methods, methods of tonifying before attacking or attacking before tonifying, and methods of simultaneous tonification and purgation. These require study. For example, San Huang Jie Du Tang (Three Yellow Antidote Decoction) clears heat. Hemp seed combined with pear juice moistens dryness. Honey suppositories, pig bile, and Gynostemma rhizome guide accumulation. Liang Ge San (Cool the Upper Jiao Powder) and Da Chai Hu Tang (Major Bupleurum Decoction) provide mild harmonization. For those with weak pulses and bodies too frail to tolerate strong medicines, one may tonify first then attack, or temporarily attack then tonify, or use Ren Shen Tang (Ginseng Decoction) to administer San Huang Zhi Zhu Wan (Three Yellow and Atractylodes Pill). Alternatively, use Ren Shen (Ginseng), Gua Lou (Trichosanthes Fruit), and Zhi Shi (Immature Bitter Orange) to combine attacking and tonifying without conflict. Generally, when administering harsh purgatives, include Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), and Bai Shao (White Peony Root) to support and protect, allowing pathogens to dissipate quietly while healthy Qi remains secure. This is worthy of being called the "army of kings." Regarding miscellaneous diseases with constipation, reference these principles. Elderly people, chronic patients, and postpartum women often suffer from constipation. Zhu Danxi used Si Wu Tang (Four Substance Decoction); Li Dongyuan used Tong You Tang (Unblocking the Lower Orifice Decoction). I have combined and adjusted them, adding Cong Rong (Cistanche Stem), Gou Qi (Goji Berry), Bai Zi Ren (Biota Seed), Sesame, Pine Kernel, Human Milk, Pear Juice, and Honey, achieving immediate results. I have also added Sheng Ma (Cimicifuga Rhizome) to Si Wu Tang along with moistening herbs to treat elderly people with blood depletion who feel the urge to defecate but cannot, often with success. These are gentle unblocking methods. If the person is indeed deficient, even if there is transmitted heat, borrow these mild methods rather than violently attacking and damaging true Yuan Qi, leading to severe diarrhea. Although attributed to fate, is it not human error? This illustrates that "purgation requires proper technique."
However, there are cases where purgation is indicated, but ignorance of depth, failure to distinguish between constipation and blood stasis, and lack of distinction between decoctions and pills cause harm. Why is this? For example, Zhang Zhongjing's Da Cheng Qi Tang (Major Order the Qi Decoction) is only used when Pi (stuffy sensation), Man (fullness), Zao (dryness), and Shi (solidity) are all present. If there is only Pi and Man without Zao and Shi, Zhang Zhongjing uses Xie Xin Tang (Drain the Epigastrium Decoction). If there is Pi and Man with Zao but without Shi, he uses Xiao Cheng Qi Tang (Minor Order the Qi Decoction). Removing Mang Xiao (Mirabilite) prevents damage to the Yin blood of the Lower Jiao. If Zao and Shi are in the Lower Jiao with mild Pi and Man, he uses Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction). Removing Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) prevents damage to the Yang Qi of the Upper Jiao. Additionally, if Taiyang Wind Strike is mistakenly purged and transmits to Taiyin, causing abdominal pain, Gui Zhi Tang (Cinnamon Twig Decoction) plus Shao Yao (Peony Root) is used. If there is severe pain, Gui Zhi Tang plus Da Huang (Rhubarb Rhizome) is used, combining exterior release with interior purgation. If pathogens come from Shaoyang with unresolved chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is used, combining harmonization with interior purgation. For Jie Xiong (Chest Binding) with stiff neck and back, hardness and pain from chest to abdomen, and tenderness to touch, Zhang Zhongjing uses Da Xian Xiong Tang/Pill (Major Trap the Chest Decoction/Pill). If there is no pain upon pressure, Xiao Xian Xiong Tang (Minor Trap the Chest Decoction) is used. For Cold-Food Jie Xiong, San Bai San (Three Whites Powder) is used to attack with cooling properties. For Water-Jie Xiong with sweating on the head, Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia Plus Poria Decoction) is used. For water retention in the hypochondrium with unbearable pain, Shi Zao Tang (Ten Jujube Decoction) is used. For both Yin and Yang types of Jie Xiong where medication fails, *Huo Ren* recommends Zhi Shi Li Zhong Wan (Immature Bitter Orange and Gastrodia Pill), which works effectively. *He Jian San Shu* states: Severe郁热 (depressed heat) accumulation causing coma and cold limbs, with stagnant, fine, almost imperceptible pulses, is misunderstood by laypeople who use warming medicines, leading to death; or reckless purgation causes sudden destruction of residual Yin, a critical situation. Neither purging nor not purging is safe; use Liang Ge San (Cool the Upper Jiao Powder) combined with Jie Du Tang (Antidote Decoction) to nourish Yin, retreat Yang, and disperse accumulated heat, restoring comfort and pulse generation. These illustrate the sequence of drug depth. For example, if Taiyang syndrome persists with thirst, scanty dysuria, and normal stool, it is dysuria obstruction, treated with Wu Ling San (Five-Ingredient Powder with Poria). If Taiyang transmits to its interior, heat binds to the Bladder, causing mania-like behavior, lower abdominal hardness/pain, and free urination, this is Lower Jiao Blood Stasis, treated with Di Dang Tang/Pill (Di Dang Decoction/Pill). If blood stasis is mild with only lower abdominal urgency without hardness, Tao He Cheng Qi Tang (Peach Pit Order the Qi Decoction) is used. Or use Sheng Di Si Wu Tang (Rehmannia Four Substance Decoction) with wine-washed Da Huang (Rhubarb Rhizome), which is safer. Dysuria presents with normal stool; dry feces present with difficult urination; blood stasis presents with free urination and black stool. This distinguishes dysuria from blood stasis. Blood binding in the Bladder is most acute, requiring Di Dang Tang; slightly milder cases require Di Dang Pill. Complete Jie Xiong evil signs require Da Xian Xiong Tang; slightly milder cases require Da Xian Xiong Pill. Other methods of cleansing the intestines and stomach, pushing out the old and generating the new, use decoctions. Ancients said: When using purgatives to attack pathogens, decoctions surpass pills and powders. Indeed, for heat rampant within, liquid decoctions cleanse most effectively. This distinguishes decoctions from pills.
However, there are cases in miscellaneous diseases where failure to differentiate cold/heat, stagnation, phlegm, water, parasites, blood, abscesses, and pus causes harm. Why is this? Li Dongyuan treated food injury with abdominal pain, constipation, and refusal of pressure. If caused by cold food, Jian Pi Wan (Spleen-Strengthening Pill) was used; if by hot food, San Huang Zhi Zhu Wan (Three Yellow and Atractylodes Pill) was used. If both cold and heat were injured, the two pills were used alternately based on quantity eaten, achieving immediate effect. For stubborn phlegm with excess heat, Gun Tan Wan (Rolling Phlegm Pill) was used; for excess-type edema, Shen You Wan (Divine Protection Pill) was used; for parasite accumulation, Jian Hong Wan (Cut Red Pill) was used; for blood accumulation, Hua Rui Dan (Flower Nodule Elixir) and Shi Xiao Wan (Instant Pain-Relief Pill) were used; for intestinal abscess, Mu Dan Pi San (Moutan Bark Powder) was used. Prescriptions varied according to symptoms, each having its appropriateness. Modern mediocre physicians ignore these methods, viewing purgation as a fearful path, and patients view it as poison, leaving critical heat syndromes untreated and attributing outcomes to fate, which is tragic. Zhang Zihe in *Ru Men Shi Qin* proposed three methods, equating purgation with tonification, stating that removing pathogens allows healthy Qi to recover naturally, and that grains, meats, fruits, and vegetables are all nourishing. Although his views did not fully align with contemporary customs, the method of attacking pathogens is indispensable. I hope students reflect calmly, grasp the essentials, and apply these remedies to save lives, bringing people to longevity is not difficult.