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Leech (Shuizhi, Hirudo nipponica), thirty pieces, processed; flavor: salty, bitter; nature: cold.
Dragonfly larva (Mengchong, Anisoptera larvae), thirty pieces, processed, wings and feet removed; flavor: bitter; nature: slightly cold.
Peach kernel (Taoren, Prunus persica seed), twenty pieces, skin and pointed ends removed; flavor: bitter, sweet; nature: neutral.
Rhubarb root (Dahuang, Rheum palmatum root), three liang, soaked in wine; flavor: bitter; nature: cold.
The above four ingredients are ground into powder. Add five sheng of water, boil to obtain three sheng of decoction, strain off the dregs. Take one sheng warm. If stool is not passed, take another dose.
Bitter enters the blood level, salty overcomes blood. The salty and bitter properties of Mengchong and Shuizhi are used to eliminate accumulated blood. Sweet moderates stagnation, bitter drains heat. The bitter properties of Taoren and Dahuang are used to purge accumulated heat.
Wang Yutai stated: According to the phrase "still remains," it implies that the pathogenic factor has not transmitted to the interior, yet this is not a superficial condition. The Bladder is the primary channel of Taiyang. The mentions of "heat in the lower jiao," "hardness and fullness in the lower abdomen," and "free urination" are all syndromes of the Bladder. Thus, it is summarized as "stasis-heat following the channel." The term "in the interior" should be understood flexibly; it does not refer to the interior of the Three Yin channels, but rather the interior of the Bladder affected by the channel transmission.
Cheng Wuji stated: What humans possess are Qi and Blood. Qi belongs to Yang; when Qi stagnates and fails to circulate, it easily dissipates because Yang diseases are easy to treat. Blood belongs to Yin; when Blood accumulates and fails to circulate, it is difficult to dissipate because Yin diseases are hard to treat. When Blood accumulates in the lower jiao, only potent and fast-acting agents can withstand it. Therefore, for treating blood accumulation, Dihuang Tang is used.
In Taiyang disease, if there is yellowing of the body, a deep and knotted pulse, hardness in the lower abdomen, and difficulty in urination, it indicates no blood stasis. If urination is free and the patient exhibits manic behavior, this is definitive evidence of a blood syndrome. Dihuang Tang is the principal treatment.
Yellowing of the body, deep and knotted pulse, hardness in the lower abdomen, and difficulty in urination indicate yellowing due to Stomach heat. Yinchen Tang may be administered. Yellowing of the body, deep and knotted pulse, hardness in the lower abdomen, free urination, and manic behavior indicate that this is not stasis-heat in the Stomach, but rather heat binding in the lower jiao causing blood accumulation. Dihuang Tang is given to purge the blood accumulation.
In Shanghan with fever and lower abdominal fullness, urination should be difficult. If it is now free, it indicates the presence of blood stasis. Purging is indicated, but other medicines should not be used; Dihuang Wan is appropriate.
Shanghan with fever and lower abdominal fullness indicates blood accumulation in the lower jiao. If heat accumulates and fluids do not circulate, urination will be difficult. If heat does not accumulate fluids but instead causes blood stasis, resulting in free urination, this is blood accumulation. Tao Ren Cheng Qi Tang or Dihuang Tang should be given to purge. However, since there is no yellowing of the body or black stool, nor amnesia or mania, the condition has not reached a severe stage. Therefore, overly harsh and峻烈 (harsh/forceful) medicines should not be used. Dihuang Wan may be given for mild purging.
Wang Yutai stated: The mention of yellowing of the body, black stool, amnesia, and mania in the commentary is an extrapolation. Based on the preceding text, there is merely fullness without hardness.