脉濡而弱弱反在关濡反在巅微反在上涩反在下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
寒阳微则不可下下之则心下痞硬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热烦身上浮冷热汗自泄欲得水自灌动气在下不可下下之
则腹胀满卒起头眩食则清谷心下痞也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诸外实者
不可下下之则发微热亡脉厥者当齐握热诸虚者不可下下之则大渴求水者易愈恶水者剧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
气多入此为除中（一名消中）口虽欲言舌不得前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无血浮为虚
数生热浮为虚自汗出而恶寒数为痛振而寒栗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漓少腹甚硬小便则尿血也脉濡而紧濡则卫气微紧则荣中寒阳微卫中风发
热而恶寒荣紧胃气冷微呕心内烦医谓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栗栗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巅倒不得安手足为微逆身冷而内烦迟欲从后救安可复追还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荣竭血
尽干烦而不眠血薄肉消而成暴（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脉浮而紧浮则为风紧
则为寒风则伤卫寒则伤荣荣卫俱病骨节烦疼当发其汗而不可下也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荣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下下之
必烦利不止少阴病脉微不可发汗亡阳故也阳已虚尺中弱涩者复不可下之脉浮大应发汗医反下之此为大逆也脉浮而大心
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二阳并病太阳初得
病时而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结胸证脉浮大者不可下下之即
死太阳与阳明合病喘而胸满者不可下太阳与少阳合病者心下硬颈项强而眩者不可下诸门逆厥者不可下之虚家亦然病欲
吐者不可下太阳病有外证未解不可下下之为逆病发于阳而反下之热入因作结胸病发于阴而反下之因作痞病脉浮而紧而
复下之紧反入里则作痞夫病阳多者热下之则硬本虚攻其热必哕无阳阴强大便硬者下之必清谷腹满太阴之为病腹满而吐
食不下自利益甚时腹自痛下之必胸下结硬厥阴之为病消渴气上撞心中疼热饥而不欲食食则吐蛔下之利不止少阴病饮食
入口则必吐心中 欲吐复不能吐始得之手足寒脉弦迟者此胸中实不可下也伤寒五六日不结胸腹濡脉虚复厥者不可下
此亡血下之死伤寒发热头痛微汗出发汗则不识人熏之则喘不得小便心腹满下之则短气小便难头痛背强加温针则衄伤寒
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其小便利者可救若
小便难者则危殆矣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目闭贪水者若下之其脉必厥其声嘤咽喉塞若发汗则战栗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得病二三日脉弱无太阳
柴胡证烦躁心下痞至四日虽能食以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虽不大便但头
硬后必溏未定成硬攻之必溏须小便利屎定硬乃可攻之藏结无阳证不往来寒热其人反静舌上苔滑者不可攻也伤寒呕多
虽有阳明证不可攻之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也伤寒中风医反下之其人下利日数十行谷不
化腹中雷鸣心中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
（甘草泻心汤）下利脉大者虚也以强下之故也设脉浮革因尔肠鸣者（当归四逆汤）阳明病身合色赤不可攻之必发热色黄
者小便不利也阳明病心下硬满者不可攻之攻之利遂不止者死利止者愈阳明病自汗出若发汗小便自利者此为津液内竭虽
硬不可攻也须自欲大便宜蜜煎导而通之若土瓜根及猪胆汁皆可为导
云 非阳明之本病不可下阳明本病胃家实故也非痞满燥实不可下非潮热发渴不可下非骂詈亲疏不可下非脉沉数
不可下非弃衣而走登高而歌如见鬼状不可下
活 脉浮者不可下脉虚者不可下恶寒者不可下呕吐者不可下大便失气者不可下（转失气者下泄也）小便清者不
可下大便坚小便数者不可用承气汤（乃脾约丸证也）大便硬小便少者未可攻阳明病自汗出若发汗小便自利者不可下（宜
用蜜煎导之）
吴 凡有恶风恶寒腹满时减时满腹胀满可揉可按虚软阴虚劳倦或手足逆冷尺脉弱脉在于表脉沉不实不疾按之无
力亡血虚家以及妇人经水适来适断或热入血室与夫胎前产后崩血小便频数小便清而大便秘等证俱不可下
戴 阳明下证已具其人喘嗽或微恶寒为太阳阳明或往来寒热为少阳阳明于阳明证中而有太阳少阳证未罢此非正
阳明也慎未可遽下所以古注阳明有三当须识此
脉象濡软而微弱，弱脉反而出现在关部，濡脉反而出现在寸部（巅），微脉反而出现在上部，涩脉反而出现在下部。阳气不足则见微脉，无血则见涩脉。阳气反见微弱，中风后出汗反而出现躁动烦乱；涩脉主无血，导致四肢厥冷且寒冷。阳气微弱则不可使用下法，若误用下法，会导致心下痞塞坚硬。
如果脐周搏动感在右侧，不可使用下法，误下则津液内竭，出现咽干、鼻干、头晕、心悸。
如果脐周搏动感在左侧，不可使用下法，误下则腹内拘急挛痛，饮食难下，脐周搏动感更加剧烈，即使身体发热，也想要蜷卧。
如果脐周搏动感在上部，不可使用下法，误下则手掌热烦，身上忽冷忽热，冷汗自出，想要喝水自己浇灌身体。
如果脐周搏动感在下部，不可使用下法，误下则腹胀满，突然站起时头晕，进食完谷不化，心下痞塞。
咽喉中闭塞感，不可使用下法，误下则上轻下重，水浆难以下咽，躺下时想要蜷缩，身体急痛，腹泻一天几十次。
凡是外表实证者，不可使用下法，误下则引发轻微发热，亡失脉气，四肢厥冷者，应当用手握暖肚脐周围。
凡是虚证患者，不可使用下法，误下则大渴欲饮水，想喝水的容易治愈，厌恶喝水的病情加重。
脉象濡软而微弱，弱脉反而出现在关部，濡脉反而出现在寸部（巅），弦脉反而出现在上部，微脉反而出现在下部。弦脉主阳气运行，微脉主阴寒。上实下虚，想要温暖身体。微弦为虚，虚证不可使用下法。微脉则为咳嗽，咳嗽则吐涎沫，若误用下法，咳嗽虽止但腹泻不停，腹泻不止则胸中如虫咬般难受，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，言语不休，但胃气已绝（此为除中，又名消中）。口虽想说话，舌头却僵硬不能前伸。
脉象濡软而微弱，弱脉反而出现在关部，濡脉反而出现在寸部（巅），浮脉反而出现在上部，数脉反而出现在下部。浮脉主阳虚，数脉主无血。浮脉主虚，自汗出且恶寒；数脉主痛，战栗发冷。微弱脉在关部，胸下急迫，喘息出汗且呼吸困难，呼吸时胁肋疼痛，振寒相搏，形体像疟疾一样。医生反而使用下法，导致脉数、发热、狂跑、看见鬼怪，心下痞塞，小便淋漓不尽，少腹非常硬，尿血。
脉象濡软而紧，濡则卫气微弱，紧则营中受寒。卫气微弱，感受风邪，发热而恶寒；营气紧束，胃气寒冷，轻微呕吐，心中烦闷。医生认为有大热，使用解肌发汗法，导致亡阳，虚烦躁，心下苦于痞塞坚硬，表里俱虚竭，突然站起时头晕，客热在皮肤，怅怏不得眠，不知胃气寒冷。紧寒在关元穴处，医家技巧无所施，汲水灌其身，客热随即罢去，战栗振寒，盖上厚被子覆盖，出汗而头目眩晕，身体颤抖又振寒，小便微难，寒气因水而发，完谷不化，不容间断，呕吐变为肠脱肛出，颠倒不得安宁，手足微逆，身冷而内烦。迟来的救治，怎么可以追回呢？
脉象浮而大，浮主气实，大主血虚。血虚为无阴，孤阳独盛，下行至阴部，小便应赤涩难通，胞中空虚。现在反而小便通利且大汗出，法度上卫气应当微弱，现在反而更实，津液四散，营血枯竭，血液耗尽，干燥烦扰而不能睡眠，血薄肉消而成暴病（一作黑液）。医生再用毒药攻伐其胃，这是双重虚弱，客阳离去有期，必定下如污泥而死。
脉象浮而紧，浮则为风，紧则为寒。风伤卫气，寒伤营气，营卫俱病，骨节烦疼，应当发汗而不可使用下法。
趺阳脉迟而缓，说明胃气正常。趺阳脉浮而数，浮则伤胃，数则动脾，这不是本病，是医生误下的结果。营卫内陷，其数脉先变微，脉反而只现浮象，其人必定大便硬，嗳气而除中。为什么这样说？本来因为数脉动脾，其数脉先变微，所以知道脾气不治，大便硬，嗳气而除中。现在脉反而浮，其数改为微，邪气独留，心中则饥，邪热不能消化食物，潮热发渴。数脉应当迟缓，脉因前后度数如法，病者则饥。数脉不时则生恶疮。
脉数者久数不止，止则邪结，正气不能恢复，正气退却结于脏，故邪气浮之与皮毛相得。脉数者不可下，误下必烦，腹泻不止。
少阴病，脉微不可发汗，因为会亡阳。阳气已虚，尺中弱涩者，也不可使用下法。
脉浮大，应当发汗，医生反而下之，这是大逆。
脉浮而大，心下反而硬，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。
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。
结胸证，脉浮大者不可下，下之即死。
太阳与阳明合病，喘而胸满者，不可下。
太阳与少阳合病，心下硬，颈项强而眩者，不可下。
诸门逆厥者，不可下。虚家亦然。
病欲吐者，不可下。
太阳病，有外证未解，不可下，下之为逆。
病发于阳而反下之，热入因作结胸；病发于阴而反下之，因作痞。
病脉浮而紧而复下之，紧反入里则作痞。
夫病阳多者热，下之则硬。本虚攻其热必哕。无阳阴强，大便硬者，下之必清谷，腹满。
太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛，下之必胸下结硬。
厥阴之为病，消渴，气上撞心，心中疼热，饥而不欲食，食则吐蛔，下之利不止。
少阴病，饮食入口则必吐，心中温温欲吐复不能吐，始得之手足寒，脉弦迟者，此胸中实，不可下也。
伤寒五六日，不结胸，腹濡，脉虚，复厥者，不可下，此亡血，下之死。
伤寒发热，头痛，微汗出，发汗则不识人，熏之则喘，不得小便，心腹满，下之则短气，小便难，头痛，背强，加温针则衄。
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。其小便利者可救，若小便难者则危殆矣。
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，若下之则目闭。贪水者，若下之，其脉必厥，其声嘤，咽喉塞。若发汗则战栗，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。
得病二三日，脉弱，无太阳柴胡证，烦躁，心下痞，至四日虽能食，以承气汤少少与，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，虽不大便，但头硬，后必溏，未定成硬，攻之必溏。须小便利，屎定硬，乃可攻之。
藏结无阳证，不往来寒热，其人反静，舌上苔滑者，不可攻也。
伤寒呕多，虽有阳明证，不可攻之。
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，慎不可攻也。
伤寒中风，医反下之，其人下利日数十行，谷不化，腹中雷鸣，心中痞硬而满，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。（甘草泻心汤）
下利脉大者，虚也，以强下之故也。设脉浮革，因尔肠鸣者。（当归四逆汤）
阳明病，身合色赤，不可攻之，必发热色黄者，小便不利也。
阳明病，心下硬满者，不可攻之。攻之利遂不止者死，利止者愈。
阳明病，自汗出，若发汗，小便自利者，此为津液内竭，虽硬不可攻也，须自欲大便，宜蜜煎导而通之。若土瓜根及猪胆汁皆可为导。
云：非阳明之本病，不可下。阳明本病，胃家实故也。非痞满燥实，不可下。非潮热发渴，不可下。非骂詈亲疏，不可下。非脉沉数，不可下。非弃衣而走，登高而歌，如见鬼状，不可下。
活：脉浮者不可下，脉虚者不可下，恶寒者不可下，呕吐者不可下，大便失气者不可下（转失气者下泄也），小便清者不可下，大便坚小便数者不可用承气汤（乃脾约丸证也），大便硬小便少者未可攻。阳明病自汗出，若发汗，小便自利者，不可下（宜用蜜煎导之）。
吴：凡有恶风恶寒，腹满时减，时满腹胀满，可揉可按，虚软阴虚，劳倦或手足逆冷，尺脉弱，脉在于表，脉沉不实，不疾按之无力，亡血虚家，以及妇人经水适来适断，或热入血室，与夫胎前产后崩血，小便频数，小便清而大便秘等证，俱不可下。
戴：阳明下证已具，其人喘嗽或微恶寒，为太阳阳明；或往来寒热，为少阳阳明。于阳明证中而有太阳少阳证未罢，此非正阳明也，慎未可遽下。所以古注阳明有三，当须识此。
The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position (top). The faint (Wei) pulse appears in the upper part, and the choppy (Se) pulse appears in the lower part. A faint pulse indicates insufficiency of Yang Qi; a choppy pulse indicates absence of Blood. If Yang Qi is faint, and after contracting wind-stroke with sweating, restlessness and vexation occur instead; if the choppy pulse indicates absence of Blood, cold limbs and coldness will ensue. When Yang Qi is faint, purgation must not be used. If purgation is wrongly applied, epigastric fullness and hardness will result.
If there is pulsation around the navel on the right side, purgation must not be used. Wrong purgation leads to exhaustion of internal body fluids, causing dry throat, dry nose, dizziness, and palpitations.
If there is pulsation around the navel on the left side, purgation must not be used. Wrong purgation leads to abdominal cramping and tightness, inability to eat, and intensified pulsation around the navel. Even if there is body heat, the patient desires to lie curled up.
If there is pulsation around the navel above, purgation must not be used. Wrong purgation leads to hot and vexed palms, alternating sensations of cold and heat on the body, spontaneous sweating, and a desire to drink water and pour it over oneself.
If there is pulsation around the navel below, purgation must not be used. Wrong purgation leads to abdominal distension, dizziness upon sudden rising, undigested food in stool after eating, and epigastric stuffiness.
A sensation of obstruction in the throat requires that purgation must not be used. Wrong purgation leads to a feeling of lightness above and heaviness below, inability to swallow liquids, desire to curl up when lying down, abdominal pain, and diarrhea occurring dozens of times a day.
In cases of exterior excess syndromes, purgation must not be used. Wrong purgation induces slight fever.
In cases where the pulse is lost and cold limbs occur, warmth should be applied by holding the area around the umbilicus.
In all deficiency syndromes, purgation must not be used. Wrong purgation leads to intense thirst for water. Thirst for water indicates an easier condition to cure; aversion to water indicates a severe condition.
The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position. The wiry (Xian) pulse appears in the upper part, and the faint (Wei) pulse appears in the lower part. A wiry pulse relates to Yang movement; a faint pulse relates to Yin cold. Upper excess and lower deficiency indicate a desire for warmth. Faint and wiry indicate deficiency; deficiency syndromes must not be treated with purgation.
If a faint pulse causes coughing, leading to expectoration of saliva, wrong purgation may stop the cough but will cause unceasing diarrhea. Unceasing diarrhea feels like insect bites in the chest; drinking gruel causes vomiting; urination is difficult; hypochondriac regions are tight and painful; breathing is labored; neck and back are drawn together; arms are numb. In extreme cold conditions with spontaneous sweating and icy cold body, eyes are dim, speech is incessant, yet grain qi intake is high; this is called "Chu Zhong" (Eliminating Middle), also known as Xiao Zhong. Although the mouth wants to speak, the tongue cannot extend forward.
The pulse is soft and weak; the weak pulse appears at the Guan position, while the soft (Ru) pulse appears at the Cun position. The floating (Fu) pulse appears in the upper part, and the rapid (Shu) pulse appears in the lower part. A floating pulse indicates Yang deficiency; a rapid pulse indicates absence of Blood. Floating indicates deficiency; rapid generates heat. Floating with deficiency causes spontaneous sweating and aversion to cold; rapid indicates pain, trembling, and chills. Weakness at the Guan position causes urgency below the chest, panting, sweating, and difficulty breathing; pain occurs in the hypochondrium during respiration; trembling colds clash, resembling malaria. If the physician wrongly uses purgation, it results in a rapid pulse, fever, running wildly, seeing ghosts, epigastric stuffiness, dribbling urination, extreme hardness in the lower abdomen, and hematuria.
The pulse is soft and tight; soft indicates weak Wei Qi (Defensive Qi); tight indicates Cold in Ying Blood (Nutritive Blood). Weak Wei Qi allows wind-stroke, causing fever and aversion to cold; tight Ying Blood causes cold Stomach Qi, slight vomiting, and internal vexation. If the physician mistakes this for excessive heat and uses diaphoresis to release the muscle layer, it leads to loss of Yang, deficiency-induced restlessness, and bitter epigastric stuffiness and hardness. With both interior and exterior exhausted, sudden rising causes dizziness. External heat remains on the skin, causing discomfort and insomnia, unaware that Stomach Qi is cold. Tight cold at the Guan Yuan point renders medical skills useless. Pouring cold water on the body makes external heat cease quickly, but causes shivering and trembling cold. Covering with heavy quilts still results in coldness; sweating reaches the crown; body trembles; urination becomes slightly difficult. Cold Qi triggers undigested stool due to water, vomiting, and intestinal prolapse, causing restlessness. Cold limbs and slight reversal occur; body is cold with internal vexation. How can rescue from behind recover what has passed?
The pulse is floating and large; floating indicates Qi excess, large indicates Blood deficiency. Blood deficiency means lack of Yin, leaving solitary Yang alone. If evil descends to the Yin region, urine should be red and difficult, and the Bladder cavity should be empty. Instead, urination is free and sweating is profuse. According to principles, Wei Qi should be weak, but now it is excess, causing fluids to scatter. Ying Blood is exhausted, Blood is depleted, leading to dryness, vexation, and insomnia. Thin blood and wasting flesh result in acute disease (or black fluid). If the physician uses toxic drugs to attack the Stomach again, this is double deficiency. The departure of external Yang has a deadline; death will come with stool like mud.
The pulse is floating and tight; floating indicates Wind, tight indicates Cold. Wind injures Wei Qi, Cold injures Ying Blood. Both Wei and Ying are diseased, causing bone and joint pain. Sweating should be induced, not purgation.
At the Foot-Yang position, a slow and moderate pulse indicates normal Stomach Qi. A floating and rapid pulse at the Foot-Yang position: floating injures the Stomach, rapid moves the Spleen. This is not the original disease but caused by the physician's erroneous purgation. Ying and Wei sink inward; the rapid pulse first becomes faint. The pulse reverses to only floating; the person will likely have hard stool, belching, and Chu Zhong. Why? Originally, the rapid pulse moved the Spleen; since the rapid pulse became faint, we know Spleen Qi is disordered, causing hard stool, belching, and Chu Zhong. Now the pulse is floating, and the rapid has become faint; evil Qi remains alone. The heart feels hungry, but evil heat cannot digest grain, causing tidal fever and thirst. A rapid pulse should be slow and moderate. If the pulse degrees follow the rules before and after, the patient feels hungry. If the rapid pulse is irregular, sores may arise.
A rapid pulse lasting long without stopping indicates evil knotting. When it stops, Zheng Qi cannot recover; Zheng Qi retreats and knots in the Zang organs, so evil Qi floats to the skin and hair. Rapid pulses must not be purged; purgation causes vexation and unceasing diarrhea.
In Shao Yin disease, if the pulse is faint, sweating should not be induced to avoid loss of Yang. If Yang is already deficient and the Chi position shows weak and choppy pulses, purgation must not be used.
If the pulse is floating and large, sweating should be induced. If the physician wrongly purges, this is a major error.
If the pulse is floating and large, but the epigastrium is hard with heat belonging to the Zang, attack it without inducing sweat; if belonging to the Fu, do not induce frequent urination. Frequent urination makes stool hard; profuse sweating increases heat; little sweating makes stool difficult. If the pulse is slow, attack is not yet possible.
When Tai Yang and Yang Ming diseases combine: if Tai Yang was just contracted and sweating was induced but not thorough, it transfers to Yang Ming, continuing with slight sweating and no aversion to cold. If Tai Yang symptoms persist, purgation must not be used; this is adverse.
In Jie Xiong (Chest Binding) syndrome, if the pulse is floating and large, purgation must not be used; purgation leads to death.
In combined Tai Yang and Yang Ming disease with wheezing and chest fullness, purgation must not be used.
In combined Tai Yang and Shao Yang disease with epigastric hardness, stiff neck, and dizziness, purgation must not be used.
In all cases of Ni Jue (Reversal Cold), purgation must not be used. This applies equally to those with deficiency constitutions.
If the patient desires to vomit, purgation must not be used.
In Tai Yang disease, if exterior symptoms are unresolved, purgation must not be used; this is adverse.
If disease originates from Yang and is wrongly purged, heat enters and forms Jie Xiong; if originating from Yin and wrongly purged, Pi (Stagnation) forms.
If the disease pulse is floating and tight, and purgation is wrongly applied, the tightness enters the interior forming Pi.
Diseases with much Yang present involve heat; purgation causes hardness. If originally deficient and heat is attacked, hiccups will occur. Without Yang, with Yin excess and hard stool, purgation causes undigested stool and abdominal fullness.
Tai Yin disease manifests as abdominal fullness, vomiting, inability to eat, worsening spontaneous diarrhea, and periodic abdominal pain. Purgation causes hardness below the chest.
Jue Yin disease manifests as thirst, Qi rushing upward hitting the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms after eating, and unceasing diarrhea if purged.
In Shao Yin disease, if food entering the mouth causes vomiting, and there is a desire to vomit from the heart but inability to do so, with cold hands and feet at onset and a wiry-slow pulse, this indicates excess in the chest; purgation must not be used.
After five or six days of Shang Han, if there is no Jie Xiong, the abdomen is soft, the pulse is weak, and cold limbs recur, purgation must not be used; this indicates loss of Blood, and purgation leads to death.
In Shang Han with fever, headache, and slight sweating, inducing sweating causes delirium; moxibustion causes wheezing and inability to urinate; purgation causes shortness of breath, difficult urination, headache, and stiff back; adding warm needle therapy causes nosebleeds.
In Shang Han, if Yin and Yang pulses are both tight, with aversion to cold and fever, the pulse tends to reverse. Reversal means the pulse starts large, gradually becomes small, then larger again. In such cases, severe aversion to cold, slight sweating, and sore throat occur. If heat is predominant, eyes are red and vision unclear. If the physician induces sweating again, the throat is injured. If purgation is wrongly applied, both eyes close. Cold predominance causes undigested stool; heat predominance causes pus and blood in stool. Moxibustion causes jaundice; ironing causes dry throat. If urination is free, rescue is possible; if difficult, the condition is critical.
In Shang Han with fever, bubbling breath from the mouth, headache, yellow eyes, uncontrollable nosebleeds, craving water leads to vomiting; aversion to water leads to cold limbs. If purged, sores form in the throat. If hands and feet are warm, there is heaviness in the rectum and pus/blood in stool. If head/eyes are yellow and purged, eyes close. If craving water and purged, the pulse becomes reversed, voice is hoarse, and throat is blocked. If sweated, chills occur, and Yin/Yang are both deficient. If aversive to water and purged, interior cold occurs, appetite is lost, and undigested stool passes. If sweated, mouth injuries and white tongue coating occur. Vexation, solid rapid pulse, and constipation for six-seven days lead to bloody stool. If sweated, urination becomes free.
On the second or third day of illness, if the pulse is weak, without Tai Yang or Chai Hu symptoms, but with vexation and epigastric stuffiness: by the fourth day, even if able to eat, give a small amount of Cheng Qi Tang to mildly harmonize and bring slight relief. By the sixth day, give one sheng of Cheng Qi Tang. If no bowel movement for six-seven days but urination is scant, although no bowel movement, only the head is hard, stool will later be loose. Do not attack until hardness is certain. Wait for free urination and confirmed hard stool before attacking.
Zang Jie (Knotting in Zang) without Yang symptoms, no alternating cold and heat, quiet patient, and slippery tongue coating: do not attack.
In Shang Han, if there is much vomiting, even with Yang Ming symptoms, attack must not be used.
In Yang Ming disease, with tidal fever and slightly hard stool, Da Cheng Qi Tang may be given; if not hard, do not give. If no bowel movement for six-seven days and suspecting dry stool, give a small amount of Xiao Cheng Qi Tang. If gas passes after ingestion, dry stool exists, and attack is possible. If no gas passes, only the head is hard and stool is loose later; do not attack. Attacking causes distension and inability to eat. Giving water to one desiring it causes hiccups. Subsequent fever leads to harder, less stool; use Xiao Cheng Qi Tang to harmonize. If no gas passes, strictly do not attack.
In Shang Han Zhong Feng, if wrongly purged, daily diarrhea of dozens of times occurs with undigested food, borborygmus, epigastric hardness/fullness, dry heaves, and vexation preventing peace. Seeing epigastric stuffiness, the physician thinks disease remains and purges again, worsening stuffiness. This is not accumulated heat but Stomach deficiency with rebellious Qi, causing hardness. (Gan Cao Xie Xin Tang)
Diarrhea with a large pulse indicates deficiency caused by strong purgation. If the pulse is floating and thin (Ge), accompanied by borborygmus, (Dang Gui Si Ni Tang) is indicated.
In Yang Ming disease, if the whole body is red, do not attack; it will cause fever and yellowing with difficult urination.
In Yang Ming disease, if the epigastrium is hard and full, do not attack. If attacked and diarrhea continues unceasingly, death ensues; if it stops, recovery occurs.
In Yang Ming disease, with spontaneous sweating, or induced sweating, and free urination, this indicates exhaustion of internal fluids. Even if stool is hard, do not attack. Wait for the desire to defecate and use Honey Suppository to guide passage. Melon root or pig bile can also be used as guides.
Yun: Non-Yang Ming primary diseases must not be purged. Yang Ming primary disease is Stomach Excess. Non-Pi, Fullness, Dryness, and Excess must not be purged. Non-Tidal Fever and Thirst must not be purged. Non-Abusive behavior towards relatives/strangers must not be purged. Non-Sunken-Rapid pulse must not be purged. Non-Discarding clothes, climbing roofs, singing, and seeing ghosts must not be purged.
Huo: Floating pulse: do not purge. Weak pulse: do not purge. Aversion to cold: do not purge. Vomiting: do not purge. Loss of flatus: do not purge (passing gas indicates downward discharge). Clear urine: do not purge. Hard stool with frequent urination: do not use Cheng Qi Tang (this is Pi Yue Wan syndrome). Hard stool with scant urination: do not attack yet. Yang Ming disease with spontaneous sweating, induced sweating, and free urination: do not purge (use Honey Suppository).
Wu: Cases with aversion to wind/cold, abdominal fullness that reduces sometimes, distension that can be rubbed/massed, soft deficiency, Yin deficiency, fatigue, cold extremities, weak Chi pulse, superficial pulse, sunken-ineffective pulse, weak pressure, blood loss, deficiency constitutions, women with regular/interrupted menstruation, Heat entering Blood Chamber, pre/post-natal bleeding, frequent clear urination, and constipation: all must not be purged.
Dai: Although Yang Ming purge indications are present, if the patient has wheezing/cough or slight aversion to cold (Tai Yang-Yang Ming), or alternating cold/heat (Shao Yang-Yang Ming), and Tai Yang/Shao Yang symptoms persist within Yang Ming syndrome, this is not true Yang Ming. Be cautious about immediate purgation. Ancient notes mention three types of Yang Ming; one must recognize this.