〔鉴〕腹满而痛。脉数而滑者实也。此有宿食。故当下之。李 曰。滑者水谷之气胜也。若滑而兼数。
则实热已入胃腑矣。故云有宿食可下之。
〔魏〕滑与涩相反。何以俱为实宜下。滑者涩之浅。而实邪欲成未成
者。涩者滑之深。而实邪已成者。故不论为滑为涩。兼大而见。则有物积聚。宜施攻治无二理也。
阳明篇云。脉滑而数者。有宿食也。当下之。宜大承气汤。
下利不欲食者。有宿食也。当下之。宜大承气汤。
〔尤〕谷多则伤脾。而水谷不分。谷停则伤胃。而恶闻食臭。故下利不欲食者。知其有宿食。当下也。夫
脾胃者。所以化水谷。而行津气。不可或止者也。谷止则化绝。气止则机息。化绝机息。人事不其顿乎。故必
大承气。速去其停谷。谷去则气行。气行则化续。而生以全矣。若徒事消克。将宿食未去。而生气已消。岂
徒无益而已哉。
〔沈〕骤伤宿食停滞。胃中壅遏。升降之机不转。肠中水谷不分。而下奔则利。宿
食在胃。故不欲食。必当攻去宿食。
程应旄云。伤食恶食。故不欲食。与不能食者自别。下
利有此。更无别样虚证。知非三阴之下利。而为宿食之下利也。故当下之。
大承气汤方（见前 病中。）
宿食在上脘。当吐之。宜瓜蒂散。
〔鉴〕胃有三脘。宿食在上脘者。膈间痛而吐。可吐。不可下也。在中脘者。心中痛而吐。或痛不吐。可
吐可下也。在下脘者。脐上痛而不吐。不可吐。可下也。今食在上脘。故当以瓜蒂散吐之也。
千金云。凡病宿食。在上脘。当吐之。脉数而滑者实也。有宿食不消。下之愈。胃中有 食冷物。即
痛不能食。有热物即欲食。大腹有宿食。寒栗发热如疟。宿食在小腹者。当暮发热。明旦复止。
瓜蒂散方
瓜蒂（一分熬黄） 赤小豆（一分煮○案煮字据伤寒论当删）
上二味。杵为散。以香豉七合。煮取汁。和散一钱匕。温服之。不吐者。少加之。以快吐为度而止。
亡血及虚者。不可与之。（亡血以下九字。原本作细注。今据伤寒论大书。伤寒论。作杵为散。
取一钱匕。以香豉一合。用热汤七合。煮作稀糜。去滓取汁。和散温顿服之。此当改补。）
东垣试效方云。若有宿食而烦者。仲景以栀子大黄汤主之。气口三盛。则食伤太阴。填塞闷乱。极则
心胃大疼。兀兀欲吐。得吐则已。俗呼食迷风是也。经云。上部有脉。下部无脉。其人当吐不吐者死。宜
瓜蒂散之类吐之。经云。高者因而越之。此之谓也。
案宿食在上脘。心腹HT 痛。顿闷欲绝。仓猝之际。药不
及办。以极咸盐汤一盏顿服。立吐。此千金。疗干霍乱之法也。
脉紧如转索无常者。有宿食也。（脉经。索下。有左右二字。）
〔尤〕脉紧如转索无常者。紧中兼有滑象。不似风寒外感
之紧。为紧而带弦也。故寒气所束者。紧而不移。食气所发
者。乍紧乍滑。如以指转索之状。故曰无常。
〔魏〕转索。宿食中阻。气道艰于顺行。曲屈傍行之象。
案据脉经。有左右二字。魏注极是。徐沈以转索无常。为紧脉之象。此袭辨脉法之谬。不可证也。
脉紧。头痛风寒。腹中有宿食不化也。（〔原注〕一云。寸口脉紧。○脉经。作寸口脉紧头上有即字。
腹上有或字。）
〔鉴〕脉紧头痛。是外伤风寒病也。脉紧腹痛。是内伤宿食病也。李 曰。按此脉与证似伤寒。而
非伤寒者。以身不疼腰脊不强故也。然脉紧亦有辨。浮而紧者为伤寒。沉而紧者为伤食。
案头痛。虽有宿食不化。郁滞之气上为头痛者。此则属
外伤于风寒。与腹中有宿食。自是两截。脉经。腹上有或字。义尤明显。
【鉴】腹部胀满且疼痛，脉象数而滑的属于实证。这是因为体内有停滞的食物（宿食），所以应当采用泻下法治疗。李氏说：脉滑是因为水谷之气亢盛。如果脉滑兼见数象，说明实热已经侵入胃腑。所以说有宿食时可以使用下法。
【魏】滑脉与涩脉相反，为什么两者都提示实证且适宜用下法？滑脉是涩脉的浅层表现，代表实邪正在形成但尚未完全成形；涩脉是滑脉的深层表现，代表实邪已经完全形成。因此，无论脉象表现为滑还是涩，只要兼见大脉，就说明体内有积滞之物，适宜采取攻伐治疗，这是毫无疑问的道理。《伤寒论·阳明病篇》说：脉象滑而数的，是有宿食，应当使用下法，适宜用大承气汤。下利（腹泻）而不想进食的，是有宿食，应当使用下法，适宜用大承气汤。
【尤】食物过多会损伤脾脏，导致水谷不能分别消化；食物停滞会损伤胃腑，导致厌恶食物的气味。所以下利且不想进食的人，可知其体内有宿食，应当使用下法。脾胃的功能是运化水谷、运行津液和气机，不能有一刻停止。食物停滞则生化之源断绝，气机停滞则生命机能熄灭。生化断绝、机能熄灭，人的生命岂不顿时终结？所以必须用大承气汤迅速去除停滞的食物。食物去除了，气机才能运行；气机运行了，生化功能才能继续，生命得以保全。如果只是单纯地使用消导克伐的方法，在宿食未去的同时，人体的正气（生气）也会先被消耗，这难道仅仅是没有益处而已吗？
【沈】突然因饮食过量导致宿食停滞，胃中壅塞阻滞，升降的气机无法转动，肠道中水谷不分，向下奔注则发生腹泻。因为宿食停留在胃中，所以不想吃东西。必须攻逐去除宿食。
程应旄说：伤食导致厌恶食物，所以不想吃，这与“不能吃东西”的情况自然不同。下利出现这种情况，更没有其他的虚证表现，可以知道这不是三阴经的下利，而是宿食引起的下利。所以应当使用下法。
大承气汤方（见前文疾病部分）。
宿食停留在上脘（胃的上部），应当采用催吐法治疗，适宜用瓜蒂散。
【鉴】胃分为上、中、下三脘。宿食在上脘的，表现为膈间疼痛并呕吐，可以采用吐法，不可用下法。在中脘的，表现为心中疼痛并呕吐，或者疼痛但不呕吐，可以采用吐法或下法。在下脘的，表现为脐上疼痛且不呕吐，不可用吐法，可以采用下法。现在食积在上脘，所以应当用瓜蒂散来催吐。
《千金方》说：凡是患有宿食的病，如果积滞在上方，应当采用催吐法。脉象数而滑的属于实证，有宿食不消化，用下法可以治愈。胃中有寒冷食物，就会疼痛且不能进食；如果有热性食物，就会想要进食。腹部有大块宿食，会出现寒战发热像疟疾一样的症状。宿食在小腹的，会在傍晚发热，第二天早晨停止。
瓜蒂散方
瓜蒂（一分，炒至微黄） 赤小豆（一分，煮○按：煮字根据《伤寒论》应当删除）
以上两味药，研成细散。用香豉七合，煮取汁液，调和药散一钱匕，温服。如果不呕吐，稍微增加剂量，以快速引起呕吐为度，然后停止。
亡血（失血）及体质虚弱者，不可服用。（关于“亡血及虚者，不可与之”这九个字，原本作为小字注释，现在根据《伤寒论》改为大字正文。《伤寒论》记载：研成细散，取一钱匕，用香豉一合，热汤七合，煮成稀粥状，去渣取汁，调和药散温顿服。此处应当据此修改补充。）
李东垣《试效方》说：如果有宿食且伴有烦闷的，张仲景用栀子大黄汤主治。如果寸口脉比尺脉大三倍，则是饮食损伤太阴脾经，导致胸膈填塞、胸闷混乱，严重时心胃剧烈疼痛，恶心欲吐，吐出后症状缓解，俗称“食迷风”。医经说：上部有脉，下部无脉，病人应当呕吐却不呕吐的，会死亡。适宜用瓜蒂散之类的方法催吐。医经说：病位高的，顺势使其向上越出（通过呕吐排出），说的就是这个道理。
案语：宿食在上脘，心腹剧痛，突然感到极度胸闷欲绝，在紧急情况下，药物来不及准备，可以用极咸的盐汤一盏顿服，立即引发呕吐，这是《千金方》治疗干霍乱的方法。
脉象紧如转索般无常变化的，是有宿食。（《脉经》中，“索”字下有“左右”二字。）
【尤】脉象紧如转索般无常变化，是指紧脉中兼有滑象，不像风寒外感那种紧中带弦的脉象。寒气束缚导致的紧脉，紧而固定不移；饮食积滞引发的紧脉，乍紧乍滑，就像用手指搓动绳索的样子，所以说“无常”。
【魏】转索，形容宿食阻塞中焦，气道难以顺畅运行，呈现曲折旁行的状态。
案语：根据《脉经》，有“左右”二字，魏注非常正确。徐灵胎、沈明宗将“转索无常”解释为紧脉的形象，这是沿袭《辨脉法》的错误观点，不能作为证据。
脉紧，头痛，是风寒外感；腹中有宿食不消化。（〔原注〕一种说法是：寸口脉紧。○《脉经》作：寸口脉紧头上有即字，腹上有或字。）
【鉴】脉紧且头痛，是外伤风寒的病证；脉紧且腹痛，是内伤宿食的病证。李氏说：此处的脉象与症状看似伤寒，但不是伤寒，因为身体不疼痛、腰脊不强硬。然而脉紧也有辨别之处：浮而紧的是伤寒，沉而紧的是伤食。
案语：头痛，虽然宿食不化、郁滞之气上冲也可导致头痛，但此处属于外伤风寒，与腹中有宿食，显然是两个不同的情况。《脉经》中“腹”字前有“或”字，意义更加明显。
[Jian] Abdominal fullness and pain, with a rapid (Shu) and slippery (Hua) pulse, indicate an Excess pattern. This is due to retained food (Su Shi), thus purgation should be applied. Li states: A slippery pulse indicates an abundance of Qi from water and grain. If the pulse is slippery and rapid, it signifies that excess heat has entered the Stomach organ. Therefore, it is stated that when retained food exists, purgation can be used.
[Wei] The slippery pulse and the choppy (Se) pulse are opposites; why are both indications of excess patterns suitable for purgation? The slippery pulse is the superficial manifestation of the choppy pulse, representing excess pathogenic factors that are forming but not yet fully established; the choppy pulse is the deep manifestation of the slippery pulse, representing fully established excess pathogenic factors. Therefore, regardless of whether the pulse is slippery or choppy, if accompanied by a large pulse, it indicates the accumulation of material substances within the body, warranting attack therapy without doubt. The Yangming Chapter of Shanghan Lun states: "A slippery and rapid pulse indicates retained food; purgation should be applied, preferably Da Cheng Qi Tang." Diarrhea with loss of appetite indicates retained food; purgation should be applied, preferably Da Cheng Qi Tang.
[You] Excessive intake damages the Spleen, leading to the failure to separate water and grain. Retention of food damages the Stomach, leading to aversion to the smell of food. Thus, diarrhea with loss of appetite indicates retained food, requiring purgation. The Spleen and Stomach transform water and grain and circulate fluids and Qi; they cannot cease functioning even momentarily. If food retention occurs, the source of transformation ceases; if Qi stagnates, physiological mechanisms halt. With cessation of transformation and halting of mechanisms, human life would abruptly end. Therefore, Da Cheng Qi Tang must be used to rapidly eliminate retained food. Once food is removed, Qi moves; once Qi moves, transformation continues, preserving life. Merely employing digestive and reducing methods would consume the vital energy (Sheng Qi) before the retained food is eliminated, which is not merely ineffective but harmful.
[Shen] Sudden overeating causes retained food to stagnate, blocking the Stomach and preventing the rotation of ascending and descending mechanisms. Water and grain in the intestines fail to separate, rushing downward causing diarrhea. Because retained food resides in the Stomach, there is no desire to eat. It is necessary to attack and remove the retained food.
Cheng Yingmao states: Food injury leads to aversion to food, hence the lack of desire to eat, which differs from the inability to eat. When diarrhea presents this way, without other deficiency signs, it is known not to be Jueyin/Yangyin/Yin Yin diarrhea, but rather diarrhea caused by retained food. Therefore, purgation should be applied.
Da Cheng Qi Tang Formula (see previous section on diseases).
When retained food is located in the Upper Wan (upper part of the stomach), emesis should be induced, preferably using Gua Di San.
[Jian] The Stomach is divided into Upper, Middle, and Lower Wan. When retained food is in the Upper Wan, it causes pain in the diaphragm region and vomiting; emesis is indicated, while purgation is contraindicated. In the Middle Wan, it causes epigastric pain with or without vomiting; both emesis and purgation may be considered. In the Lower Wan, it causes pain above the umbilicus without vomiting; emesis is contraindicated, while purgation is indicated. Since the food retention is currently in the Upper Wan, Gua Di San should be used to induce vomiting.
Qianjin Fang states: For all cases of retained food located in the upper region, emesis should be induced. A rapid and slippery pulse indicates excess; retained food that does not digest can be cured by purgation. Cold food in the Stomach causes pain and inability to eat; hot food induces a desire to eat. Large amounts of retained food in the abdomen cause chills and fever resembling malaria. Retained food in the lower abdomen causes fever at dusk, resolving by morning.
Gua Di San Formula
Gua Di (1 fen, fried until yellow) Chi Xiao Dou (1 fen, boiled [Note: 'boiled' should be deleted according to Shanghan Lun])
The above two ingredients are pounded into a powder. Mix with juice extracted from boiling Xiang Chi (7 he) with the powder (one qian bi). Take warm. If vomiting does not occur, slightly increase the dose. Stop when vigorous vomiting is achieved.
Contraindicated in patients with blood loss or deficiency. ([Note]: The nine characters "Contraindicated in patients with blood loss or deficiency" were originally small print notes; now enlarged as main text according to Shanghan Lun. Shanghan Lun records: Pounded into powder, take one qian bi, mix with juice from boiling Xiang Chi (1 he) in hot water (7 he) until a thin porridge consistency is reached, strain, and take warm in one dose. This section should be revised accordingly.)
Li Dongyuan's Shixiao Fang states: If retained food is accompanied by vexation, Zhang Zhongjing uses Zhi Zi Da Huang Tang. If the Cun (inch) position pulse is three times stronger than the Chi (cubit) position, it indicates dietary injury to the Taiyin Spleen, causing chest filling, oppression, and confusion, potentially leading to severe heart and stomach pain, nausea, and vomiting, which resolves after vomiting. This is commonly called "food intoxication wind." The Classics state: If there is a pulse in the upper body but none in the lower body, and the patient should vomit but cannot, death ensues. Emesis with formulas like Gua Di San is appropriate. The Classics state: "For pathogens high up, induce them to exit upwards via emesis." This refers to this principle.
Case Note: When retained food is in the Upper Wan, causing severe heart and abdominal pain and sudden extreme chest oppression, if emergency medication is unavailable, drink a cup of extremely salty salt water immediately to induce vomiting. This is the method for treating Gan Huo Luan (dry cholera) in Qianjin Fang.
A pulse tight like a turning rope, changing unpredictably, indicates retained food. (Mai Jing adds "left and right" after "rope".)
[You] A pulse tight like a turning rope, changing unpredictably, means the tightness is combined with slipperiness, unlike the tightness with wiriness seen in external wind-cold contraction. Tightness due to cold qi constraint is fixed and unchanging; tightness due to food qi fluctuates between tight and slippery, resembling the sensation of fingers twisting a rope, hence described as "unpredictable."
[Wei] "Turning rope" describes the obstruction of retained food in the middle jiao, where the Qi pathway is difficult to traverse smoothly, presenting a tortuous and lateral movement image.
Case Note: According to Mai Jing, "left and right" are present. Wei's annotation is very accurate. Xu Lingtai and Shen Mingzong interpret "turning rope unpredictability" as the image of a tight pulse, which follows the error of Bian Mai Fa and cannot serve as evidence.
Tight pulse with headache indicates external wind-cold; tightness with abdominal pain indicates internal retained food indigestion. ([Original Note]: One version says: Cun Kou pulse is tight. ○ Mai Jing reads: Cun Kou pulse is tight, head has 'ji' character, abdomen has 'huo' character.)
[Jian] Tight pulse with headache is an external wind-cold disease; tight pulse with abdominal pain is an internal retained food disease. Li states: Although the pulse and symptoms resemble Taiyang Shang Han, it is not Shang Han because there is no body ache or stiff spine. However, tight pulses require differentiation: floating and tight indicates Shang Han; sinking and tight indicates food injury.
Case Note: Headache, although it can be caused by stagnant Qi rising from undigested retained food, here belongs to external wind-cold contraction, distinct from retained food in the abdomen. The presence of the character "or" (huo) before "abdomen" in Mai Jing makes the meaning clearer.