桃仁（五十个去皮尖） 桂枝（二两去皮） 大黄（四两） 芒硝（二两） 甘草（二两炙）
上五味。以水七升。煮取二升半。去滓。内芒硝。更上火。微沸。下火先食。温服五合。日三服。当微利。
琥按成注云。甘以缓之。辛以散之。少腹急结。缓以桃仁之甘。夫缓不言甘草。而反言桃仁。殊为不解又云。下
焦蓄血。散以桂枝之辛。夫桂枝非散蓄血之药。上汤中用之者。以其邪自太阳经传来故也。愚以上汤。即调胃承气汤中。
加桃仁桂枝。盖下焦蓄血。无关于胃。故用调胃承气汤。缓。缓下之即上方后云。当微利者是也。成注复云。大热之气。
寒以取之。热甚搏血。故用大黄芒硝。加桃仁者。破血结也。加桂枝者解外邪也。用甘草者。缓腹急也。
或问桃仁承气汤中。用桂枝之义。余答云。喻嘉言有云。太阳随经之余邪。非桂枝不解。所以仲景用桃仁。增入承
气以达血所。仍加桂枝分解外邪。正恐其邪少有未解。则壅热愈甚。血愈蓄积。不能即下。故桃仁承气汤中。用桂枝解
外。与大柴胡汤中。用柴胡解外。其义实相仿也。
（附后例）伤寒八九日下之。胸满烦惊。（云云至）不可转侧者。柴胡加龙骨牡蛎汤主之。（此条系少阳伤寒误下之
证。正文与。注并）
柴胡加龙骨牡蛎汤方。（俱见后第七卷少阳篇中）
伤寒腹满谵语。（云云至）此肝乘脾也。名曰纵。刺期门。
伤寒发热。啬啬恶寒。（云云至）此肝乘肺也。名曰横刺期门。
上二条证（正文与注并穴图。俱见后第十四卷刺热论中）
太阳病二日反躁。凡（当作反）熨其背而大汗出。（云云至）谷气下流故也。太阳病中风以火劫发汗（云云至）小便
利者。其人可治。伤寒脉浮。医以火迫劫之（云云至）起卧不安者。桂枝去芍药。加蜀漆龙骨牡蛎救逆汤主之。
桂枝去芍药。加蜀漆龙骨牡蛎救逆汤方。
形作伤寒。（云云至）被火者必谵语。（云云至）当汗出愈。太阳病以火熏之。（云云至）名为火邪。脉浮热甚。反灸
之（云云至）必咽燥唾血。
微数之脉。慎不可灸。（云云至）焦骨伤筋。血难复也脉浮。宜以汗解。用火灸之。（云云至）名火逆也。欲自解者。
必当先烦。（云云至）故知汗出解也。
烧针令其汗（云云至）与桂枝加桂汤。更加桂二两火逆。下之。因烧针烦躁者。桂枝甘草龙骨牡蛎汤主之。
桂枝甘草龙骨牡蛎汤方
太阳伤寒者。加温针。必惊也。
以上火逆证十一条。方二首。（正文与注。俱见后第十二卷救逆法中）
琥按伤寒一病。内经中只有刺热法。无用火之法。盖伤寒本系热证。复用火以灸之。是以火济火也。所以仲景于
上文云。烦躁谵语。衄血唾血清血。发黄惊狂。身体枯燥。手足躁扰。腰重而痹。口干咽烂。焦骨伤筋等。皆为火逆之
证。垂戒谆谆。后医不可不以此为鉴。然此但为伤寒者说若中寒。不以用火为禁也。
太阳病当恶寒发热。今自汗出。不恶寒发热。关上脉细数者。（云云至）以医吐之所致也。此为小逆。（上条证。乃
不当吐而医误吐之。为逆。正文与注。见后第十二卷救逆法中。）
太阳病吐之。但太阳病当恶寒。今反不恶寒。不欲近衣。此为吐之内烦也。（此条证。虽不宜吐。然吐之亦不为逆。
太阳病吐之者。必病患胸膈之中。挟痰或食也。吐之后。反不恶寒者。即误吐中。亦有发散之义。故不恶寒也。不欲近
衣。此因吐后胃中空虚。邪热乘之。内作烦热。故不欲近衣也。按此条论。仲景无治法。补亡论常器之云。可与竹叶石
膏汤。愚以吐后。胃中虚热而烦者。庶几近之。若吐后。胸中郁热未尽而烦者。宜栀子豉汤。）
病患脉数。数为热当消谷引食。而反吐者。此以发汗令阳气微膈气虚。脉乃数也。数为客热。不能消谷以胃中虚冷。
故吐也。（脉数者。一息六七至是也。数为胃气本热。胃气热。当消谷引食。引。进也。今病反吐者。此以发汗太过。令
阳气外微。阳气受于胸中。故膈中之气亦虚。膈中气虚。则邪热入胃。脉乃数也。数为客热。客热者。即邪热也。邪热
之气。不能消谷。以病患胃中有邪热。则正气必虚。故不能引食而吐也。愚按气本属阳。虚甚则冷。然此胃中既有邪热。
则正气虽虚。未至于冷。正文中冷字。宜从删。按此条论。仲景虽不明言是太阳。然此当是太阳伤寒。发汗太过。而脉
变量。条辩以脉数为温病。误发其汗。因而致吐者。非又按此条论。仲景无治法。补亡论常器之云。可与小半夏汤。此
汤虽系止吐之药。但发汗后。津液必亡。尚宜斟酌用之。又云宜小温中汤。此常氏以吐为胃中虚冷。忘其脉数之为客热
也。倘后学宗之。焉得无误。）
（附后例）太阳病过经十余日。心下温温欲吐。而胸中痛。（云云至）与调胃承气汤。（云云至）以呕。故知极吐下
也。（按此条太阳病。过经十余日。病已不在太阳欲吐。胸中痛。此当是邪传阳明。已入于府。故与调胃承气汤。正文与
注。见后第六卷阳明篇中）
太阳病六七日。表证仍在。脉微而沉。反不结胸。其人发狂者。以热在下焦。少腹当硬满。小便自利者下血乃愈。
所以然者。以太阳随经瘀热在里故也。抵当汤主之。（太阳病六七日。邪气正当传里之时。纵表证仍在。而脉微沉。是徒
有表证。已无表脉也。又脉微沉。为邪气在里。乃结胸之脉。今则反不结胸。知邪不在上焦。其人发狂者。比前桃核承
气汤。如狂证较甚。此热在下焦。而为膀胱府病。无疑矣。 。与硬同。少腹硬满。则其病又甚于急结。小便自利。则
知其热。不结于下焦之气分。而结于下焦之血分也。前如狂证。蓄血轻。故自下而愈。此发狂证。蓄血重。必用药以下
其血。乃愈。所以然者。谓所以少腹硬满之故。以太阳邪热不解。随经入膀胱之府。膀胱热结。血瘀于小腹之里故也。
成注云。与抵当汤。以下蓄血。尚论篇云。此条证。较前条桃核承气证。更重。且六七日表证仍在。曷为不先解其外邪。
又曷为攻药中不兼加桂枝邪。夫蓄血而至于发狂。则热势攻心。桃核承气不足以动其血。桂枝不足以散其邪。非用单刀
直入之将。必不能斩关取胜。故名其汤为抵当。抵者。至也。乃至当不易之良法也。邪结于胸。则用陷胸以涤饮。邪结
少腹。则用抵当以逐血。设非此一法。少腹中所结之血。既不附气而行。更有何药可攻其坚垒哉。所以一峻攻。斯血去。
而邪不留。并无藉桂枝分解之力耳。愚以看病之法。须分表里。假若表里之证兼见。须分轻重而直取其邪。上云。六七
日表证仍在。则表邪已衰。非比一二日之盛矣。况其下文云。脉微而沉。其人发狂。少腹硬满。明系太阳随经瘀热在里。
里证已急。焉得不用峻攻之剂。医人于此。若犹顾虑。夫在表之余邪。是为不知证之轻重。治之缓急。斯时人命。不几
同儿戏邪。噫。今医有以抵当汤丸。为猛厉而不敢下者。其小心适足以害人。而病家反以为把稳。有宁甘就死而不肯服
者。亦大可伤也。）
Peach Kernel (Fifty seeds, skin and tips removed) Cinnamon Twig (Liang Er, bark removed) Rhubarb (Liang Si) Mirabilite (Liang Er) Licorice Root (Liang Er, honey-fried)
The above five herbs. Boil in seven Sheng of water. Reduce to two and a half Sheng. Remove the dregs. Add Mirabilite. Apply heat again until it boils slightly. Remove from heat. Take warm before meals. Each dose is Wu Ge. Three times daily. There should be mild purgation.
Wang Hu notes: Cheng Wuji's annotation states: "Sweet flavor relieves urgency; pungent flavor disperses stagnation. Lower abdominal tension and knotting are relieved by the sweetness of Peach Kernel." It does not mention Licorice Root but instead mentions Peach Kernel, which is puzzling. It further states: "Blood stasis in the lower Jiao is dispersed by the pungency of Cinnamon Twig." However, Cinnamon Twig is not a herb that disperses blood stasis. It is used in the above formula because the pathogen was transmitted from the Taiyang channel. I believe the aforementioned decoction is Tiaowei Chengqi Tang with added Peach Kernel and Cinnamon Twig. Since blood stasis in the lower Jiao has nothing to do with the Stomach, Tiaowei Chengqi Tang is used for gentle purgation, as stated in the post-prescription instructions: "There should be mild purgation." Cheng's annotation also says: "Great heat Qi is controlled by cold. When heat is severe and binds blood, Rhubarb and Mirabilite are used. Peach Kernel is added to break blood knots. Cinnamon Twig is added to resolve external pathogens. Licorice Root is used to relieve abdominal tension."
Someone asks about the rationale for using Cinnamon Twig in Taohao Chengqi Tang. I reply: Yu Jiayan said, "Residual pathogens from Taiyang following the channels cannot be resolved without Cinnamon Twig. Therefore, Zhongjing uses Peach Kernel, adding it to Chengqi Tang to reach the blood level, while still adding Cinnamon Twig to resolve external pathogens. This is precisely to fear that if pathogens remain unresolved, the stagnant heat will become more severe, and blood accumulation will increase, preventing immediate downward movement. Thus, Cinnamon Twig is used in Taohao Chengqi Tang to resolve the exterior, similar to the use of Bupleurum Root in Xiao Chaihu Tang to resolve the exterior; their principles are indeed comparable."
(Attached example) After eight or nine days of Shanghan, mistaken purgation occurred. Chest fullness, irritability, and fright. (Yunyun to) Inability to turn the body due to heaviness. Chaihu Jia Longgu Muli Tang governs this. (This clause pertains to Shaoyang Shanghan complicated by mistaken purgation. The main text and annotations are included.)
Chaihu Jia Longgu Muli Tang Formula. (See Volume 7, Shaoyang Chapter, later.)
Shanghan with abdominal fullness and delirious speech. (Yunyun to) This is Liver overacting on Spleen, named Zong. Stimulate Qimen acupoint.
Shanghan with fever and aversion to cold. (Yunyun to) This is Liver overacting on Lung, named Heng. Stimulate Qimen acupoint.
The above two conditions (Main text, annotations, and acupoint diagrams are all in Volume 14, Ci Re Lun, later.)
Taiyang disease on the second day presents with restlessness contrary to expectation. Generally, back fomentation causing profuse sweating. (Yunyun to) Caused by Grain Qi flowing downward. Taiyang Wind Strike treated with fire to induce sweating. (Yunyun to) If urination is free, the patient can be cured. Shanghan with floating pulse, treated by doctor with fire coercion. (Yunyun to) Restlessness in lying down and sitting up. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang governs this.
Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang Formula.
Symptoms resembling Shanghan. (Yunyun to) Those subjected to fire therapy will certainly have delirium. (Yunyun to) Should recover with sweating. Taiyang disease subjected to fire fumigation. (Yunyun to) Named Fire Pathogen. Floating pulse with intense heat, mistakenly moxibustion applied. (Yunyun to) Will certainly cause dry throat and hemoptysis.
Slightly rapid pulse must never be moxibusted. (Yunyun to) Scorched bones and injured sinews, blood difficult to restore. Floating pulse, suitable for sweating resolution, but fire moxibustion applied. (Yunyun to) Named Fire Ni. Spontaneous resolution requires initial irritability. (Yunyun to) Hence known as sweating resolution.
Needle burning to induce sweating. (Yunyun to) Administer Guizhi Jia Gui Tang, add two Liang of Cinnamon Twig. Fire Ni, after purgation, followed by needle burning causing irritability. Guizhi Gancao Longgu Muli Tang governs this.
Guizhi Gancao Longgu Muli Tang Formula.
In Taiyang Shanghan, adding warm needle therapy will certainly cause fright.
Above are eleven cases of Fire Ni syndromes and two formulas. (Main text and annotations are in Volume 12, Jiuni Fa, later.)
Wang Hu notes: In the disease of Shanghan, Neijing only mentions Ci Re method, with no use of fire methods. Presumably, Shanghan is originally a heat syndrome; applying fire moxibustion is using fire to aid fire. Therefore, Zhongjing stated earlier: Irritability, delirium, epistaxis, hemoptysis, jaundice, mania, dry body, restless limbs, heavy and numb waist, dry mouth and rotten throat, scorched bones and injured sinews, etc., are all Fire Ni syndromes. The warnings are earnest. Later physicians must take this as a warning. However, this applies only to Shanghan; for Zhonghan, fire is not prohibited.
Taiyang disease should present with aversion to cold and fever. Now there is spontaneous sweating, no aversion to cold or fever, and the Guan pulse is fine and rapid. (Yunyun to) This is caused by the doctor's mistaken emesis. This is minor Ni. (The above condition arises from mistaken emesis when inappropriate, constituting Ni. Main text and annotations are in Volume 12, Jiuni Fa, later.)
Taiyang disease subjected to emesis. Although Taiyang disease should have aversion to cold, now there is no aversion to cold, and an unwillingness to wear clothes. This is internal irritability caused by emesis. (This condition, although emesis is inappropriate, does not constitute Ni. Emesis in Taiyang disease implies phlegm or food retention in the chest and diaphragm. After emesis, lack of aversion to cold indicates a dispersing effect within the mistake, hence no aversion. Unwillingness to wear clothes results from emptiness in the stomach after emesis, allowing pathogenic heat to enter and cause internal irritability, hence the reluctance to wear clothes. According to this discussion, Zhongjing provides no treatment. Chang Qizhi in Bu Wang Lun suggests Zhu Ye Shi Gao Tang. I believe that for post-emesis stomach deficiency-heat causing irritability, this is close. If post-emesis chest depression-heat remains causing irritability, Zhizi Chi Tang is appropriate.)
Patient has a rapid pulse. Rapid indicates heat, which should digest grain and promote appetite, yet vomiting occurs. This is because sweating made Yang Qi weak and Diaphragm Qi deficient, resulting in a rapid pulse. Rapid indicates guest heat, unable to digest grain, due to stomach deficiency-cold, hence vomiting. (Rapid pulse means six to seven beats per breath. Rapid indicates original stomach Qi heat, which should digest grain. 'Yin' means advance. Now vomiting occurs because excessive sweating made Yang Qi externally weak. Yang Qi resides in the chest, so Diaphragm Qi becomes deficient. Diaphragm deficiency allows pathogenic heat to enter the stomach, making the pulse rapid. Rapid indicates guest heat, i.e., pathogenic heat. Pathogenic heat cannot digest grain because the presence of pathogenic heat implies righteous Qi deficiency, thus inability to ingest food and leading to vomiting. I note: Qi belongs to Yang; extreme deficiency leads to cold. However, since there is pathogenic heat in the stomach, although righteous Qi is deficient, it has not reached cold. The character 'cold' in the main text should be deleted. Regarding this clause, although Zhongjing does not explicitly state Taiyang, it should be Taiyang Shanghan with excessive sweating leading to pulse changes. Some commentaries attribute rapid pulse to Wenbing and mistaken sweating causing vomiting, which is incorrect. Also, Zhongjing provides no treatment here. Chang Qizhi in Bu Wang Lun suggests Xiao Banxia Tang. Although this stops vomiting, post-sweating fluid loss must be considered carefully. He also suggests Xiao Wenzhong Tang. Chang attributes vomiting to stomach deficiency-cold, forgetting that the rapid pulse indicates guest heat. If later scholars follow this, errors will inevitably occur.)
(Attached example) Taiyang disease passed its stage for over ten days. Epigastric nausea and chest pain. (Yunyun to) Administer Tiaowei Chengqi Tang. (Yunyun to) Due to vomiting, we know extreme emesis and purgation occurred. (Note: This Taiyang case, having passed stages for over ten days, is no longer Taiyang. Nausea and chest pain suggest pathogen transmitted to Yangming, entering the Fu organ, hence Tiaowei Chengqi Tang is given. Main text and annotations are in Volume 6, Yangming Chapter, later.)
Taiyang disease for six or seven days. Exterior symptoms persist. Pulse is faint and deep. Contrary to not having Jie Xiong. The person is manic. Because heat is in the lower Jiao, the lower abdomen should be hard and full. If urination is normal, bleeding resolves it. The reason is that Taiyang pathogens followed the channels, and stasis-heat is in the interior. Dandang Tang governs this. (At six or seven days of Taiyang disease, pathogens are transmitting inward. Even if exterior symptoms persist, a faint and deep pulse indicates exterior symptoms exist but exterior pulses do not. Faint and deep pulses indicate interior pathogens, typical of Jie Xiong. Here, Jie Xiong is absent, indicating pathogens are not in the upper Jiao. Mania is more severe than the 'like-manic' state in Taohao Chengqi Tang. Heat is in the lower Jiao, affecting the Bladder Fu organ, undoubtedly. Hardness is synonymous with hardness. Lower abdominal hardness and fullness indicate severity greater than tension/knotting. Normal urination indicates heat is bound in the blood level of the lower Jiao, not the Qi level. The previous 'like-manic' state involved light blood stasis, resolving spontaneously. This 'manic' state involves heavy blood stasis, requiring medication to purge blood for recovery. The reason for lower abdominal hardness/fullness is that Taiyang pathogenic heat did not resolve, followed channels into the Bladder Fu. Bladder heat binding causes blood stasis in the lower abdomen. Cheng's annotation says: Dandang Tang purges blood stasis. Shanglun Pian says: This condition is heavier than the previous Taohao Chengqi condition. With exterior symptoms persisting at six or seven days, why not resolve external pathogens first? Why not add Cinnamon Twig to the attacking herbs? When blood stasis reaches mania, heat attacks the Heart. Taohao Chengqi is insufficient to move blood, and Cinnamon Twig is insufficient to disperse pathogens. Only a general striking straight in can win the battle. Hence named Dandang. 'Di' means reaching. It is the unchangeable good method. Pathogens bound in the chest use Xianxiong to wash away fluids; pathogens bound in the lower abdomen use Dandang to drive out blood. Without this method, blood bound in the lower abdomen does not follow Qi, so what other medicine can attack this fortress? Thus, one strong purge removes blood, leaving no pathogens, without relying on Cinnamon Twig's dispersing power. I believe medical practice must distinguish exterior and interior. If both are present, distinguish severity and directly target pathogens. The text says: Six or seven days, exterior symptoms persist, meaning exterior pathogens have declined, unlike the intensity of one or two days. Furthermore, the text says: Faint and deep pulse, mania, lower abdominal hardness/fullness clearly indicate Taiyang pathogens following channels, stasis-heat in the interior. Interior condition is urgent. Why not use strong purging agents? Physicians hesitating here regarding residual exterior pathogens show ignorance of condition severity and treatment urgency. Human life at such times is like child's play! Alas! Modern physicians dare not use Dantang Pills/Decoction considering them too fierce. Their caution harms people, while patients think it safe, preferring death to taking it. This is greatly harmful.)