仲景曰。太阳病不解。热结膀胱。其人如狂。血自下。下者愈。其
外不解者。尚未可攻。当先解其外。属桂枝汤。外解已。血未下。但少
腹急结者。乃可攻之。宜桃核承气汤。雍曰。小便不利。不可攻也。
又曰。太阳病六七日。表症仍在。脉微而沉。反不结胸。其人发
狂者。以热在下焦。小腹当硬满。而小便自利者。下血乃愈。所以然
者。以太阳随经。瘀热在里故也。宜下之。以抵当汤主之。
又曰。太阳病。身黄。脉沉结。小腹硬满。小便不利者。为无血
也。小便自利。其人如狂者。血证谛也。抵当汤主之。常氏云。小便不
利。无血者。与五苓散。
又曰。伤寒有热。小腹满。应小便不利。今反利者。为有血也。当
下之。不可余药。宜抵当丸。
又曰。阳明症。其人喜忘者。必有蓄血。所以然者。本有久瘀血。
故令喜忘。屎虽硬。大便反易。其色必黑者。宜抵当汤下之。
又曰。病患无表里症。发热七八日。虽脉浮数者。可下之。假令
已下。脉数不解。合热则消谷善饥。至六七日。不大便者。有瘀血。宜
抵当汤。脉经云。若脉数不解。而下不止。必协热而便脓血也。
又曰。少阴病八九日。一身手足尽热者。此热在膀胱。必便血
也。常氏曰。宜用桃核承气汤、芍药地黄汤。雍曰。宜先犀角地黄汤。
又曰。伤寒。热少厥微。指头寒。默默不欲食。烦躁数日。小便利
色白者。此热除也。欲得食。其病可愈。若厥而呕。胸胁烦满者。其后
必便血。常氏云。便血者。可黄芩汤。雍曰。热已除者。畏黄芩。
又曰。淋家不可发汗。发汗必便血。常氏云。可柏皮汤。
又曰。太阳病。以火熏之。不得汗。其人必躁。到经不解。必圊血也。
雍曰。凡病各有轻重。治病用药。亦有轻重。且如瘀血一症。用
抵当汤。根据法如此。不可易也。若其血症轻。或治之早者。亦不须用。
只服犀角地黄汤。血症稍重。及治之瘥迟者。则用桃核承气汤。其重
及治之迟者。方用抵当汤丸。抵当汤丸是十分之药。轻病不宜用也。
用他药仿此。
Zhang Zhongjing stated: When Taiyang disease (disease of the Taiyang channel) is not resolved, heat accumulates in the Bladder. The patient exhibits a manic-like state. If blood discharges spontaneously, the disease will heal. If the exterior syndrome remains unresolved, attack methods should not yet be used; instead, the exterior should first be released, using Guizhi Tang (Cinnamon Twig Decoction). Once the exterior is resolved, if the blood has not discharged but there is only urgency and binding in the lower abdomen, then an attack method may be employed, suitable for Taohao Chengqi Tang (Peach Kernel Decoction to Inherit the Command). Guo Yong noted: If urination is difficult, one must not attack.
He also said: In Taiyang disease after six or seven days, if the exterior syndrome persists, the pulse is faint and deep, and contrary to expectations, Jie Xiong syndrome (chest binding syndrome) does not form, while the patient goes mad, this is because heat is in the Lower Jiao. The lower abdomen should be hard and full, and urination is free and clear. Discharging blood will lead to recovery. This occurs because the Taiyang pathogen follows the channels into the interior, where stasis and heat reside within. An attack method is suitable, primarily using Didang Tang (Diding Decoction).
He also said: In Taiyang disease, if the body is yellow, the pulse is deep and choppy, and the lower abdomen is hard and full, but urination is difficult, this indicates no blood stasis. If urination is free and clear, and the patient exhibits a manic-like state, this confirms the diagnosis of blood stasis, treated primarily with Didang Tang (Diding Decoction). Chang Shi stated: For those with difficult urination and no blood stasis, provide Wuling San (Five-Ingredient Powder with Poria).
He also said: In Shanghan (cold damage) with fever and a full lower abdomen, urination should be difficult; if it is now free, it indicates blood stasis. One should purge, avoiding other medicines, and use Didang Wan (Diding Pill).
He also said: In Yangming disease (disease of the Yangming channel), if the patient suffers from forgetfulness, there must be accumulated blood. This is because long-standing blood stasis exists, causing forgetfulness. Although the stool is hard, defecation is surprisingly easy, and the color must be black; treat by purging with Didang Tang (Diding Decoction).
He also said: If a patient has neither exterior nor interior syndromes but has had fever for seven or eight days, even if the pulse is floating and rapid, one may use an attack method. Suppose purging has already been performed, but the rapid pulse remains unresolved; combined heat causes efficient digestion and frequent hunger. By the sixth or seventh day, if there is no bowel movement, blood stasis is present, suitable for Didang Tang (Diding Decoction). Mai Jing states: If the rapid pulse remains unresolved and diarrhea ensues, heat will surely accompany the discharge of pus and blood.
He also said: In Shaoyin disease (disease of the Shaoyin channel) after eight or nine days, if the whole body and hands and feet are hot, this indicates heat in the Bladder, leading to hematochezia (blood in stool). Chang Shi said: Use Taohao Chengqi Tang (Peach Kernel Decoction to Inherit the Command) or Shaoyao Dihuang Tang (Peony and Rehmannia Decoction). Guo Yong said: Use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) first.
He also said: In Shanghan, with slight heat and mild cold limbs, only the fingertips are cold, silence prevails, and there is no desire to eat. After several days of irritability, if urination is free and white in color, the heat has cleared; desire to eat indicates recovery. If there is cold limbs accompanied by vomiting and chest/hypochondriac fullness and irritability, hematochezia will follow later. Chang Shi said: For hematochezia, Huangqin Tang (Scutellaria Decoction) can be used. Guo Yong said: For those whose heat has cleared, one fears using Huangqin (Scutellariae Radix).
He also said: Linjia (patients with strangury) must not undergo sweating therapy; sweating will inevitably cause hematochezia. Chang Shi said: Bopi Tang (Phellodendron Decoction) can be used.
He also said: In Taiyang disease, if fire moxibustion/fumigation is applied and sweat cannot be obtained, the patient will become agitated. If the disease cycle passes without resolution, Qingxue (defecating blood) will occur.
Guo Yong stated: All diseases have varying degrees of severity, and medicinal treatment must match this gravity. Regarding blood stasis, using Didang Tang (Diding Decoction) follows standard protocol and should not be altered. If the blood syndrome is mild or treated early, Didang Tang is unnecessary; simply服用 Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If the syndrome is slightly severe or treatment is delayed, use Taohao Chengqi Tang (Peach Kernel Decoction to Inherit the Command). Only when the condition is severe and treatment is significantly delayed should one use Didang Tang (Diding Decoction) or Didang Wan (Diding Pill). These are potent medicines and unsuitable for mild cases. Apply similar logic to other medications.