芎 当归胶艾汤证曰∶妊娠下血。
白头翁加甘草阿胶汤证，不具。
大黄甘遂汤证曰∶水与血俱结在血室。
上三方，阿胶各二两。
黄连阿胶汤证曰∶心中烦、不得卧。
黄土汤证曰∶下血、吐血、衄血。
上二方，阿胶各三两。
猪苓汤证曰∶心烦、不得眠。
上一方，阿胶一两。
据此诸方，则阿胶主治诸血证，心烦不得眠者明矣。然心烦有数证，不得眠亦有数证。
若无血证，则属他证也。故法无血证者，皆为脱误矣。
芎 当归胶艾汤证曰∶妇人有漏下者（上一证），有半产后，因续下血都不绝者（上一
证），有妊娠下血者（上一证），假令妊娠，腹中痛为胞阻（上一证）。按此条，古来未得其
解。余尝
如此段落，分裁为四章，其义始明，其证亦可得治之。解曰∶妇人有漏下、腹中痛、心烦、
不得眠者，此方主之。上第一章∶妇人有半产后、下瘀血、都不绝、腹中痛、心烦、或不得
眠者，此方主之。上第二章∶妇人有妊娠下血、腹中痛、心烦不得眠、或顿仆失跌、或胎动
不安者，此方主之。上第三章∶妇人有妊娠、腹中痛、漏胞、经水时时来、心烦、不得眠、
或因房室所劳伤胎者，此方主之。上第四章∶以上诸证，皆女人妊娠、或半产、或产后下血、
而心烦腹痛者，此方所宜治也。诸证当须有不得眠之候，然无血证，则非此方所宜也。
白头翁加甘草阿胶汤证，不具，但云产后下利。此方岂惟产后下利治之乎？凡本方证而
下血、心烦、急迫不得眠者，此方主之。由此观之，岂惟妇人乎？虽男子亦有热利下重、大
便血、心烦、急迫不得眠者，则宜用此方。夫下重者，下利重多也？非后世所谓痢病。肛门
下坠、利急后重之谓也。盖利急后重者，下利急迫重多也。古者便为之后，故后重者，下重
也。下重者，下利重多也。是此方所治也。
黄连阿胶汤证曰∶心中烦、不得卧，盖此方治下利腹痛、大便血、心中烦悸、不得眠者。
夫黄芩之于下利，黄连之于心中烦悸，芍药之于腹中痛，主以治之。惟阿胶之于心烦、不得
眠、亦不见血，则无所奏其效。然则此方治下利腹痛、心中烦悸、不得眠而见血者明矣。若
不见血而施此方，岂其谓之得其治法乎？
大黄甘遂汤证曰∶妇人少腹满、如敦状，小便微难而不渴者，是乃此方所主也。《脉经》
敦状作敦敦状，敦音堆，敦敦者，不移不动之谓也。若作敦状，则敦音对，器名。 按∶其
此证谓之有血亦非也。谓之无血亦非也。然谓之小便微难，则谓之非血亦非也。是所谓因法
立略，因略取法，法略相熟。则虽未见其血，亦有此证，则施此方。施此方，则血自下。血
自下，而后其证自差。故仲景曰∶其血当下，其此可谓之略而已。夫略也者，不熟其法，则
不可得此者也。生后者此为水与血，俱结在血室也。此章盖后人所妄添也。生后，产后也。
产后若有前证者，此为水与血，俱结在血室。水血本无二，血是指瘀血，血室谓其分位。义
属想像臆度，今不取焉。夫水血若有二，则仲景何其不谓水与血当下乎？今谓其血当下者，
是水血无二之谓也。医者其思诸。
猪苓汤证曰∶脉浮发热、渴欲饮水、小便不利者主之。又曰∶少阴病，下利六七日、咳
而呕渴、心烦、不得眠者主之。夫少阴病者，脉微细、但欲寐也。又曰∶欲吐不吐、心烦、
但欲寐、五六日、自利而渴者。是虽今见此少阴本证，若其人有血证，则心烦不能眠也。故
见其下血，而后施此方，则未尝有不差者。若不见其血下，则虽屡施此方，亦未尝见奏其功
者，数试数验，不可不知矣。
It primarily treats various blood disorders. Therefore, it also treats symptoms of vexation (Xinfan) and inability to sleep.
The syndrome pattern for Xiong Gui Jiao Ai Tang states: bleeding during pregnancy.
The syndrome pattern for Baitouweng Jia Gancao Ejiao Tang is incomplete.
The syndrome pattern for Dahuang Gansui Tang states: water and blood are jointly bound in the Blood Chamber (Xuèshì).
In the above three formulas, Ejiao is used in amounts of two liang each.
The syndrome pattern for Huanglian Ejiao Tang states: vexation in the heart and inability to lie down.
The syndrome pattern for Huangtu Tang states: lower bleeding, hematemesis, and epistaxis.
In the above two formulas, Ejiao is used in amounts of three liang each.
The syndrome pattern for Zhuling Tang states: vexation and inability to sleep.
In the above one formula, Ejiao is used in an amount of one liang.
Based on these formulas, it is clear that Ejiao primarily treats various blood disorders and symptoms of vexation with inability to sleep. However, there are several types of vexation, and several types of inability to sleep.
If there is no blood disorder, it belongs to other patterns. Thus, applying this method to cases without blood disorders is erroneous due to omission or mistake.
The syndrome pattern for Xiong Gui Jiao Ai Tang states: women have metrorrhagia (the aforementioned pattern), post-miscarriage continuous bleeding that does not cease (the aforementioned pattern), bleeding during pregnancy (the aforementioned pattern), and if pregnant, abdominal pain due to uterine obstruction (the aforementioned pattern). Historically, this passage has not been properly interpreted. I once divided this paragraph into four chapters, after which the meaning became clear and the syndromes could be treated. The explanation is as follows: For women with metrorrhagia, abdominal pain, vexation, and inability to sleep, this formula is indicated. Chapter 1: For women with post-miscarriage expulsion of stasis, continuous bleeding, abdominal pain, vexation, or inability to sleep, this formula is indicated. Chapter 2: For women with bleeding during pregnancy, abdominal pain, vexation and inability to sleep, or sudden falls/injuries, or restless fetus, this formula is indicated. Chapter 3: For women who are pregnant, with abdominal pain, leaking amniotic fluid, irregular menstruation, vexation, inability to sleep, or fetal injury due to sexual exertion, this formula is indicated. Chapter 4: All the above conditions involve women during pregnancy, post-miscarriage, or postpartum with bleeding, accompanied by vexation and abdominal pain; this formula is suitable. These conditions must present with inability to sleep; however, without a blood disorder, this formula is not appropriate.
The syndrome pattern for Baitouweng Jia Gancao Ejiao Tang is incomplete, mentioning only postpartum diarrhea. Does this formula only treat postpartum diarrhea? For any case fitting this formula's pattern involving bleeding, vexation, urgency, and inability to sleep, this formula is indicated. From this perspective, is it limited only to women? Even men presenting with heat-type dysentery with heaviness, bloody stools, vexation, urgency, and inability to sleep should use this formula. "Heaviness" here refers to frequent and urgent defecation, not the dysentery described in later generations. It refers to the sensation of anal tenesmus and urgency. Generally, tenesmus implies urgent and frequent defecation. In ancient times, "heaviness" referred to the state after defecation; thus, "post-heaviness" means heavy/frequent defecation. This is what this formula treats.
The syndrome pattern for Huanglian Ejiao Tang states: vexation in the heart and inability to lie down. Presumably, this formula treats diarrhea with abdominal pain, bloody stools, palpitations/vexation, and inability to sleep. Huangqin targets diarrhea, Huanglian targets heart vexation/palpitations, and Shaoyao targets abdominal pain. But does Ejiao alone address vexation and inability to sleep even without visible blood? However, it is clear that this formula treats diarrhea, abdominal pain, heart vexation/palpitations, and inability to sleep when blood is present. If applied without visible blood, can it be said to follow the correct treatment principle?
The syndrome pattern for Dahuang Gansui Tang states: fullness in the lower abdomen of women, resembling a *dun* (vessel), slight difficulty in urination but no thirst; this is the primary indication for this formula. The *Mai Jing* describes it as *dun dun zhuang*, where *dun* sounds like "dui," meaning immovable. If read as *dun zhuang*, *dun* sounds like "dui," referring to a vessel name. Analysis: Calling this condition "having blood" is incorrect; calling it "no blood" is also incorrect. However, given the slight urinary difficulty, calling it "not blood" is incorrect. This illustrates establishing principles from methods and deriving methods from simplified principles. When familiar with both, even if blood is not visibly observed, if the syndrome exists, apply this formula. Applying it causes blood to descend naturally. Once blood descends, the syndrome resolves. Thus, Zhang Zhongjing stated: "The blood should descend." This is a simplification. Simplification requires mastery of the method; otherwise, it cannot be grasped. The phrase "postpartum water and blood jointly bound in the Blood Chamber" was likely added by later authors. "Postpartum" refers to after childbirth. If postpartum patients present with the aforementioned symptoms, it indicates water and blood bound in the Blood Chamber. Water and blood are fundamentally one; "blood" here refers to stasis, and "Blood Chamber" refers to its location. This interpretation is speculative and not adopted here. If water and blood were distinct, why would Zhongjing not say "water and blood should descend"? Saying "blood should descend" implies they are not distinct. Physicians should ponder this.
The syndrome pattern for Zhuling Tang states: floating pulse, fever, thirst desire to drink water, and difficult urination are indicated. It also states: Shaoyin disease, diarrhea for six to seven days, cough, vomiting, thirst, vexation, and inability to sleep are indicated. Shaoyin disease is characterized by a faint and thin pulse and drowsiness. It also states: desire to vomit but unable to, vexation, drowsiness, five to six days duration, spontaneous diarrhea with thirst. Although these are typical Shaoyin patterns, if the patient has a blood disorder, the vexation prevents sleep. Therefore, observing lower bleeding before applying this formula ensures recovery. If bleeding is not observed, repeated application yields no effect. Repeated trials and verification make this indispensable knowledge.