太阳病。发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与饮之。令胃气和则愈。
若脉浮。小便不利。微热消渴者。与五苓散主之。
伤寒之邪。有离太阳之经而入阳明之腑者。有离太阳之标而入太阳之本者。发汗后。汗出胃
干。烦躁饮水者。病去表而之里。为阳明腑热证也。脉浮。小便不利。微热消渴者。病去标而之本
。为膀胱腑热证也。在阳明者。热能消水。与水即所以和胃。在膀胱者。水与热结。利水即所以去
热。多服暖水汗出者。以其脉浮而身有微热。故以此兼彻其表。昔人谓五苓散为表里两解之剂。
非以此耶。
五苓散方 方见权变法。
按古法从经腑言。则太阳为经。而膀胱为腑。从标本言。则太阳为标。膀胱为本。病去太阳
而之膀胱。所以谓之太阳传本也。然膀胱本病。有水结、血结之不同。水结宜五苓散导水泄热。
血结宜桃核承气及抵当汤丸导血除热。具如下文。
发汗已。脉浮数烦渴者。五苓散主之。
伤寒汗出而渴者。五苓散主之。不渴者。茯苓甘草汤主之。
发汗已。脉浮数烦渴者。太阳经病传腑。寒邪变热之候。故与五苓散导水泄热。王宇泰云、
太阳、经也。膀
胱、腑也。膀胱者。溺之室也。故东垣以渴为膀胱经本病。然则治渴者。当泻膀胱之热。泻膀胱之
热者。利小便而已矣。然腑病又有渴与不渴之异。由腑阳有盛与不足之故也。渴者。热盛思水。水与
热得。故宜五苓散导水泄热。不渴者。热虽入里。不与水结。则与茯苓甘草汤行阳化气。此膀胱热
盛热微之辨也。
茯苓甘草汤方
茯苓（二两） 桂枝（二两去皮） 生姜（二两切） 甘草（一两炙）
上四味。以水四升。煮取二升。去滓。分温三服。
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。当先解外。
外解已。但少腹急结者。乃可攻之。宜桃核承气汤。
太阳之邪。不从表出。而内传于腑。与血相搏。名曰蓄血。其人当如狂。所谓蓄血在下。其人
如狂是也。其证当下血。血下则热随血出而愈。所谓血病见血自愈也。如其不愈而少腹急结者。
必以法攻而去之。然其外证不解者。则尚未可攻。攻之恐血去而邪复入里也。是必先解其外之邪。
而后攻其里之血。所谓从外之内而盛于内者。先治其外。而后调其内也。以下三条。并太阳传本、热邪
入血、血蓄下焦之证。与太阳传本、热与水结、烦渴小便不利之证。正相对照。所谓热邪传本者。
有水结、血结之不同也。
桃核承气汤方
桃核（五十枚去皮尖） 桂枝（二两去皮） 芒硝（二两） 甘草（二两炙） 大黄（四两）
上五味。以水七升。煮取二升五合。去滓。纳芒硝。更上火。微沸下火。先食。温服五合
。日三服。当微利。
愚按此即调胃承气汤加桃仁、桂枝。为破瘀逐血之剂。缘此证热与血结。故以大黄之苦寒。
荡实除热为君。芒硝之咸寒。入血 坚为臣。桂枝之辛温。桃仁之辛润。擅逐血散邪之长为使。
甘草之甘。缓诸药之势。俾去邪而不伤正为佐也。
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。
此亦太阳热结膀胱之证。六七日。表证仍在。而脉微沉者。病未离太阳之经。而已入太阳之腑
也。反不结胸。其人发狂者。热不在上而在下也。少腹硬满。小便自利者。不结于气而结于血也。
下血则热随血去。故愈。所以然者。太阳、经也。膀胱、腑也。太阳之邪。随经入里。与血俱结于膀胱
。所谓经邪入腑。亦谓之传本是也。抵当汤中水蛭虻虫食血去瘀之力。倍于芒硝。而又无桂枝之甘辛。
甘草之甘缓。视桃仁承气汤为较峻矣。盖血自下者。其血易动。故宜缓剂。以去未尽之邪。瘀热
在里者。其血难动。故须峻药以破固结之势也。
抵当汤方
水蛭（三十个熬） 虻虫（三十个熬去翅足） 大黄（四两酒浸） 桃仁（三十个去皮尖）
上四味为末。以水五升。煮取三升。去滓。温服一升。不下。更服。
太阳病。身黄。脉沉结。少腹硬。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。
身黄。脉沉结。少腹硬。水病、血病皆得有之。但审其小便不利者。知水与热蓄。为无血而有
水。五苓散证也。若小便自利。其人如狂者。乃热与血结。为无水而有血。抵当汤证也。设更与行
水。则非其治矣。仲景以太阳热入膀胱。有水结、血结之分。故反复明辨如此。
伤寒有热。少腹满。应小便不利。今反利者。为有血也。当下之。不可余药。宜抵当丸。
有热。身有热也。身有热而少腹满。亦太阳热邪传本之证。膀胱者。水溺所由出。其变为小便
不利。今反利者。乃血瘀而非水结。如上条抵当汤下之之例也。云不可余药者。谓非抵当丸不能以治
之耳。
抵当丸方
水蛭（二十个） 虻虫（二十个） 大黄（三两） 桃仁（二十个去皮尖）
上四味。杵分为四丸。以水一升。煮一丸。取七合。服之。 时当下血。若不下者。更服。
愚按此条证治。与前条大同。而变汤为丸。未详何谓。尝考其制。抵当丸中水蛭、虻虫。减汤方
三分之一。而所服之数。又居汤方十分之六。是缓急之分。不特在汤丸之故矣。此其人必有不可不攻
。而又有不可峻攻之势。如身不发黄。或脉不沉结之类。仲景特未明言耳。有志之士。当不徒求之
语言文本中也。
Taiyang disease (Disease of the Taiyang channel), after sweating therapy, if profuse sweating occurs, leading to dryness in the Stomach, restlessness, inability to sleep, and a desire for water, one should give small amounts of water frequently. When the Stomach Qi harmonizes, the patient will recover.
If the pulse is floating, urination is difficult, accompanied by slight fever and thirst with excessive drinking, Wuling San (Five-Ingredient Powder with Poria) should be administered as the primary treatment.
The pathogenic factors of Shanghan (Cold Damage) may leave the Taiyang channel and enter the Yangming fu-organs, or leave the Biao (Exterior/Mark) of Taiyang and enter the Ben (Interior/Root) of Taiyang. After sweating therapy, sweating leads to Stomach dryness, causing restlessness and thirst; this indicates the pathogen has moved from the exterior to the interior, constituting a Yangming fu-organ heat syndrome. A floating pulse, difficulty in urination, slight fever, and thirst indicate the pathogen has moved from the Biao to the Ben, constituting a Bladder fu-organ heat syndrome. In the case of Yangming, heat consumes water; providing water serves to harmonize the Stomach. In the case of the Bladder, water and heat bind together; promoting diuresis serves to clear the heat. Drinking warm water after taking Wuling San to induce sweating is because the pulse is floating and there is slight fever on the body; thus, this formula also addresses the exterior. Ancients referred to Wuling San as a formula that resolves both the exterior and interior simultaneously—is this not the reason?
Wuling San Formula: See the section on Rights and Changes Methods.
According to ancient methods, speaking from the perspective of channels and fu-organs, Taiyang is the channel and the Bladder is the fu-organ; speaking from the perspective of Biao and Ben, Taiyang is the Biao and the Bladder is the Ben. The pathogen leaving Taiyang and entering the Bladder is why it is called "Taiyang transmitting to the Ben." However, diseases of the Bladder's root differ between water binding and blood binding. Water binding is suitable for Wuling San to guide water out and drain heat; blood binding is suitable for Taohe Chengqi Tang (Peach Kernel Decoction to Direct the Qi) and Didang Wan (Tiger Pill) to guide blood out and remove heat. Details are as follows.
After sweating therapy, if the pulse is floating and rapid, with irritability and thirst, Wuling San should be administered.
In Shanghan, if sweating leads to thirst, Wuling San should be administered; if there is no thirst, Lingjue Gancao Tang (Poria, Licorice, and Ginger Decoction) should be administered.
After sweating therapy, if the pulse is floating and rapid, with irritability and thirst, this is a sign that Taiyang channel disease has transmitted to the fu-organs, and cold pathogens have transformed into heat. Therefore, Wuling San is used to guide water out and drain heat. Wang Yutai stated: Taiyang is the channel, and the Bladder is the fu-organ. The Bladder is the chamber of urine; therefore, Dongyuan considered thirst to be the fundamental disease of the Bladder channel. Thus, to treat thirst, one must clear the heat of the Bladder; to clear the heat of the Bladder, one need only promote urination. However, fu-organ diseases differ in whether there is thirst or not, due to the excess or deficiency of Fu-Yang (Yang Qi of the Fu-organs). Thirst indicates excessive heat desiring water; when water meets heat, Wuling San is suitable to guide water out and drain heat. No thirst indicates that although heat has entered the interior, it does not bind with water; thus, Lingjue Gancao Tang is used to move Yang and transform Qi. This distinguishes between excessive heat and mild heat in the Bladder.
Lingjue Gancao Tang Formula:
Fuling (Poria, 2 liang) Guizhi (Cinnamon Twig, 2 liang, peeled) Shengjiang (Fresh Ginger, 2 liang, sliced) Gancao (Licorice Root, 1 liang, honey-fried)
These four ingredients are boiled in 4 sheng of water to obtain 2 sheng. Strain and divide into three warm doses.
If Taiyang disease is unresolved, and heat binds in the Bladder, the person exhibits symptoms resembling madness. If blood passes spontaneously, recovery ensues. If the exterior remains unresolved, attack is not yet appropriate; one must first resolve the exterior. Once the exterior is resolved, if only urgency and binding in the lower abdomen remain, attack can proceed, using Taohe Chengqi Tang.
When Taiyang pathogens do not exit from the exterior but transmit internally to the fu-organs and contend with blood, it is named Blood Accumulation (Xuexue). The person should exhibit symptoms resembling madness, which is what is meant by "Blood accumulation in the lower jiao, the person resembles madness." This syndrome should be treated by inducing bleeding; when blood passes, heat exits with the blood, and recovery occurs. This is what is meant by "blood diseases heal when blood appears." If the condition persists and there is urgency and binding in the lower abdomen, legal attack is necessary to remove the pathogen. However, if external symptoms are unresolved, attack is contraindicated, as attacking might cause blood loss and allow pathogens to re-enter the interior. Therefore, one must first resolve external pathogens, then attack internal blood stasis. This aligns with the principle: "For diseases originating externally and becoming severe internally, treat the exterior first, then regulate the interior." The following three sections all concern Taiyang transmitting to the Ben, heat pathogens entering the blood, and blood accumulating in the lower jiao, contrasting with Taiyang transmitting to the Ben, heat binding with water, irritability, thirst, and difficulty in urination. Heat pathogens transmitting to the Ben differ in having either water binding or blood binding.
Taohe Chengqi Tang Formula:
Taoren (Peach Kernel, 50 pieces, skin and tip removed) Guizhi (Cinnamon Twig, 2 liang, peeled) Mangxiao (Mirabilite, 2 liang) Gancao (Licorice Root, 2 liang, honey-fried) Dahuang (Rhubarb Root, 4 liang)
These five ingredients are boiled in 7 sheng of water to obtain 2.5 sheng. Strain, add Mangxiao, boil briefly over fire, then remove from heat. Take 0.5 sheng warm before meals, three times daily. Slight diarrhea is expected.
My commentary: This formula is Tiaowei Chengqi Tang (Regulate the Stomach Decoction to Direct the Qi) plus Taoren and Guizhi, a formula to break stasis and expel blood. Since this syndrome involves heat binding with blood, Dahuang's bitter-cold nature acts as the Sovereign herb to purge excess and remove heat; Mangxiao's salty-cold nature acts as the Minister herb to enter the blood level and soften hardness; Guizhi's pungent-warm nature and Taoren's pungent-moist nature act as the Assistant-Herald herbs to excel at driving out blood stasis and dispersing pathogens; Gancao's sweet nature acts as the Adjutant herb to moderate the potency of other drugs, ensuring pathogen removal without damaging healthy Qi.
In Taiyang disease, after six or seven days, if exterior symptoms persist, the pulse is subtle and deep, and there is no chest binding, but the person exhibits mania, it is because heat is in the lower jiao. The lower abdomen should be hard and full, and if urination is normal, passing blood leads to recovery. This is because Taiyang pathogens follow the channel into the interior, where stasis-heat resides. Didang Tang (Tiger Pill Decoction) is indicated.
This is also a syndrome of heat binding in the Bladder. After six or seven days, if exterior symptoms persist but the pulse is subtle and deep, the disease has not left the Taiyang channel but has entered the Taiyang fu-organ. The absence of chest binding and the presence of mania indicate heat is below, not above. Hardness and fullness in the lower abdomen with normal urination indicate binding in blood, not qi. Passing blood removes heat, leading to recovery. This is because Taiyang is the channel and the Bladder is the fu-organ. Taiyang pathogens follow the channel into the interior, binding with blood in the Bladder. This is known as channel pathogens entering the fu-organ, also called transmitting to the Ben. The leeches (Shuizhi) and horseflies (Mengchong) in Didang Tang have twice the blood-breaking power of Mangxiao, and lack the sweet-pungent nature of Guizhi and the sweet-moderating nature of Gancao, making it more potent than Taohe Chengqi Tang. Generally, if blood passes spontaneously, the blood is easier to move, so a milder formula is suitable to remove residual pathogens. If stasis-heat resides in the interior, the blood is difficult to move, requiring a potent formula to break solid binding.
Didang Tang Formula:
Shuizhi (Leech, 30 pieces, processed) Mengchong (Horsefly, 30 pieces, processed, wings and feet removed) Dahuang (Rhubarb Root, 4 liang, wine-soaked) Taoren (Peach Kernel, 30 pieces, skin and tip removed)
Grind these four ingredients into powder. Boil in 5 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm. If no effect, administer again.
In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, and urination is difficult, there is no blood stasis. If urination is normal and the person resembles madness, blood stasis is confirmed. Didang Tang is indicated.
Body yellowing, deep-knotted pulse, and lower abdominal hardness can occur in both water diseases and blood diseases. However, if urination is difficult, it indicates water and heat accumulation without blood stasis, corresponding to Wuling San. If urination is normal and the person resembles madness, it indicates heat binding with blood, without water accumulation, corresponding to Didang Tang. Administering diuretics in such cases would be incorrect treatment. Zhang Zhongjing distinguished between water binding and blood binding when heat enters the Bladder from Taiyang, hence the repeated clarification.
In Shanghan, if there is heat and lower abdominal fullness, urination should be difficult. If it is now normal, there is blood stasis. It should be purged. Do not use other medicines; Didang Wan is suitable.
"Heat" refers to bodily heat. Bodily heat with lower abdominal fullness is also a syndrome of Taiyang heat pathogens transmitting to the Ben. The Bladder is the outlet for urine, typically resulting in difficult urination. If it is now normal, it is blood stasis rather than water binding, similar to the previous example of purging with Didang Tang. "Do not use other medicines" means no medicine other than Didang Wan can treat this.
Didang Wan Formula:
Shuizhi (Leech, 20 pieces) Mengchong (Horsefly, 20 pieces) Dahuang (Rhubarb Root, 3 liang) Taoren (Peach Kernel, 20 pieces, skin and tip removed)
Grind these four ingredients and divide into four pills. Boil one pill in 1 sheng of water to obtain 0.7 sheng. Take orally. Blood should pass at this time. If not, administer again.
My commentary: The syndrome and treatment here are largely similar to the previous section, but the decoction is changed to a pill. The exact reason is unclear. I have examined its preparation: the dosage of Shuizhi and Mengchong in Didang Wan is reduced by one-third compared to the decoction, yet the amount taken per dose is six-tenths of the total decoction dosage. This shows that the distinction between mild and potent effects lies not merely in the form of decoction versus pill. This situation implies that the patient requires attack but cannot withstand a harsh attack, perhaps evidenced by the absence of body yellowing or a non-deep-knotted pulse. Zhang Zhongjing deliberately did not state this explicitly. Those dedicated to learning should not seek answers solely in textual language.