桃仁（五十个，去皮尖） 大黄（四两） 甘草（二两） 桂枝（二两，去皮） 芒硝（二两） 上五味，以水七
升，煮取二升半，去渣，纳芒硝，更上火微沸，下火。先令温服五合，日三服，当微利。微利仅通大便，不必定下血也。
太阳病，不解，热结膀胱，太阳之邪由经入腑。其人如狂，血自下，下者愈。膀胱多气多血，热甚则血
凝，而上干心包，故神昏而如狂；血得热而行，故能自下，则邪从血出，与阳明之下燥屎同。其外不解者，
尚未可攻，外不解而攻之，则邪反陷入矣。当先解其外，宜桂枝汤。外解已，但小腹急结者，乃可攻之，宜
桃核承气汤。小腹急结，是蓄血现症。
按∶“宜桂枝汤”四字，从《金匮》增入。
水蛭（熬） 虻虫（去翅足熬，各三十个） 大黄（三两，酒浸） 桃仁（二十个，去皮尖） 上四味，以水五
升，煮取三升，去渣，温服一升，不下再服。
太阳病，六、七日，过经。表证仍在，脉微而沉，向里。反不结胸，向下。其人发狂者，以热在下焦，
少腹当硬满，外症。小便自利者，内症。下血乃愈。所以然者，以太阳随经，瘀热在里故也，抵当汤主
之。此亦热结膀胱之症，前桃核承气，乃治瘀血将结之时，抵当乃治瘀血已结之后也。
太阳病，身黄，脉沉结、少腹硬，小便不利者，为无血也；以上皆似血症谛，因小便不利，安知非湿热
不行之故，不可断为有血也。小便自利，其人如狂者，血证谛也，并无湿热而如狂，非蓄血而何？如此审证，
无遁形矣。抵当汤主之。
阳明证，其人喜忘者，必有蓄血。心主血，血凝则心气结，而失其官矣。蓄不甚，故不狂，所以然者，
本有久瘀血，故令喜忘，此乃旧病，非伤寒时所得者。屎虽硬，大便反易，血性滑利。其色必黑，浮血
亦有随便而下者。宜抵当汤下之。
病患无表里证，发热七、八日，过经。虽脉浮数者，可下之。脉虽浮数，而无表里症，则其发热竟属
里实矣，七、八日，故可下。假令已下，脉数不解，合热则消谷善饥。脉数不解，邪本不在大便也，消谷
善饥，蓄血本不在水谷之路，故能食。至六、七日，蓄血更久。不大便者，有瘀血也，宜抵当汤。其脉数
不解而下不止，必协热而便脓血也。此指服汤后之变症，热邪不因下而去。又动其血，则血与便合为一，
而为便脓血之症，又当别有治法。
按∶瘀血，又有但欲漱水，不欲咽之症。盖唇口干燥，而腹中不能容水也。
桃仁（五十个，去皮和尖端） 大黄（四两） 甘草（二两） 桂枝（二两，去皮） 芒硝（二两） 以上五味药，用水七升，煎煮至剩余二升半，滤去药渣，加入芒硝，再次置于火上微沸，然后离火。先让患者温服五合，每日服用三次，应当出现轻微腹泻。轻微腹泻仅指大便通畅，不一定需要排出瘀血。
太阳病（太阳经受邪所致的病证），若未痊愈，热邪结聚于膀胱，这是太阳经的邪气由经络传入腑脏。患者出现神志失常、似狂非狂的症状，如果瘀血能自行排出，病情就会好转。因为膀胱是多气多血的脏腑，热势严重则血液凝滞，并向上干扰心包络，导致神志昏迷且似狂；血液受热则运行加速，所以能够自行排出，这样邪气便随血而出，这与阳明病中通过泻下燥屎祛邪的道理相同。如果表证仍未解除，尚不可使用攻下法，若在表证未解时强行攻里，邪气反而会陷入体内。此时应当先解除表证，适宜用桂枝汤（Cinnamon Twig Decoction）。待表证解除后，如果仅表现为小腹部拘急硬痛，才可以进行攻下治疗，适宜用桃核承气汤（Peach Kernel Decoction to Inherit the Qi）。小腹部拘急硬痛，是蓄血证（Blood Stasis Syndrome）的典型症状。
按语：“宜桂枝汤”这四个字，是从《金匮要略》中增补进去的。
水蛭（熬制） 虻虫（去除翅膀和足后熬制，各三十个） 大黄（三两，用酒浸泡） 桃仁（二十个，去皮和尖端） 以上四味药，用水五升，煎煮至剩余三升，滤去药渣，温服一升，若未见效，再服用一次。
太阳病，经过六七天，病已过经（超越本经传变阶段）。表证依然存在，脉象微而沉，说明病势向里发展。反而没有形成结胸证（Fluid and Heat Binding in the Chest Syndrome），说明病位向下。患者出现发狂症状，是因为热邪在下焦，少腹部应当硬满，这是外在症状；小便自利（排尿正常），这是内在症状。若能排出瘀血，病情才会好转。之所以这样，是因为太阳经的邪气随经络内入，瘀热蕴结在体内，应当用抵当汤（Diding Decoction）主治。这也是热结膀胱的症状，前面的桃核承气汤，是治疗瘀血即将凝结时的方剂，而抵当汤则是治疗瘀血已经凝结之后的方剂。
太阳病，身体发黄，脉象沉涩或结代，少腹部硬满，如果小便不利，这是无瘀血的表现；以上这些情况都像是血证的确切证据，但因为小便不利，怎能知道不是湿热阻滞不通的缘故呢？不能断定为有瘀血。如果小便自利，患者出现似狂的症状，这才是血证的确切证据，并没有湿热却出现神志异常，除了蓄血证还能是什么呢？如此仔细辨证，病机就无处遁形了。这种情况应当用抵当汤主治。
阳明病证，患者喜欢遗忘（健忘），必定是有蓄血。心主血脉，血液凝滞则心气郁结，从而失去其主宰功能。由于蓄血程度不重，所以不会发狂，之所以这样，是因为原本就有久存的瘀血，所以导致喜忘，这是旧疾，并非伤寒病期间新得的病症。大便虽然干硬，但排便反而容易，这是因为血液性质滑利。大便颜色必定发黑，浮游之血也有随时排出的情况。适宜用抵当汤攻下。
患者没有表证也没有里证，发热七八天，病已过经。虽然脉象浮数，可以使用下法。脉象虽然浮数，但没有表里症状，那么这种发热完全属于里实证，经过七八天，所以可以攻下。假如已经用过下法，脉数仍然不解，合并热邪则会消谷善饥（食欲亢进，容易饥饿）。脉数不解，说明邪气本不在大肠，消谷善饥，说明蓄血本不在水谷消化的通道，所以患者仍能进食。到了六七天，蓄血时间更久。如果不大便，说明有瘀血，适宜用抵当汤。如果脉数不解而下利不止，必定是协热下利（Heat-collateral Diarrhea）并伴有脓血。这是指服药后的变症，热邪不因攻下而去除，又扰动血液，则血与粪便混合，成为便脓血的症状，这时又应当采用其他治疗方法。
按语：瘀血证，还有只想含水漱口而不想吞咽的症状。这是因为唇口干燥，而腹中不能容纳水分。
Peach Kernel (Fifty seeds, skin and tip removed) Rhubarb (Four liang) Licorice Root (Two liang) Cinnamon Twig (Two liang, bark removed) Mirabilite (Two liang) The above five herbs are boiled in seven sheng of water until reduced to two and a half sheng. Strain out the dregs, add Mirabilite, boil again briefly over fire, then remove from heat. Administer warm dosage of five he initially, three times daily. A slight loose stool is expected. Slight loose stool merely indicates bowel movement, not necessarily the expulsion of blood stasis.
In Taiyang disease (Disease of the Taiyang channel), if unresolved, heat binds in the Bladder, meaning the pathogenic factor of the Taiyang channel has entered the fu-organ from the jing-channel. The patient exhibits manic-like behavior. If blood discharges spontaneously, the condition improves. The Bladder is rich in qi and blood; severe heat causes blood coagulation, which disturbs the Pericardium upwards, leading to mental confusion and manic-like symptoms. Blood moves when heated, thus it can discharge spontaneously, allowing the pathogen to exit with the blood, similar to purging dry feces in Yangming disease. If the exterior syndrome remains unresolved, attack should not be attempted yet. Attacking while the exterior is unresolved causes the pathogen to sink inward. One should first resolve the exterior, using Guizhi Tang (Cinnamon Twig Decoction). Once the exterior is resolved, if only the lower abdomen feels urgent and knotted, attack may proceed, using Taohao Chengqi Tang (Peach Kernel Decoction to Inherit the Qi). Urgency and knotting in the lower abdomen are presenting symptoms of Blood Stasis Syndrome (Xue Yu Zheng).
Note: The phrase "using Guizhi Tang" was added from *Jingui Yaolue*.
Leech (Processed) Dragonfly Larva (Wings and legs removed, processed, thirty each) Rhubarb (Three liang, soaked in wine) Peach Kernel (Twenty seeds, skin and tip removed) The above four herbs are boiled in five sheng of water until reduced to three sheng. Strain out the dregs, administer one sheng warm. If no effect, administer another dose.
In Taiyang disease, after six or seven days, the pathogen has passed beyond the original channel. Exterior symptoms persist, but the pulse is faint and deep, indicating progression inward. There is no formation of Jie Xiong (Binding in the Chest Syndrome), indicating the pathology moves downward. The patient becomes manic because heat is located in the Lower Jiao, resulting in hardness and fullness in the lower abdomen (external symptom); urination is normal (internal symptom). Expulsion of blood leads to recovery. This occurs because the Taiyang pathogen follows the channels inward, causing stasis and heat to accumulate internally; Diding Tang (Diding Decoction) is indicated. This is also a case of heat binding in the Bladder. Previously, Taohao Chengqi Tang treats the stage where blood stasis is about to form, whereas Diding Tang treats the stage where blood stasis has already formed.
In Taiyang disease, if the body is yellow, the pulse is deep and knotted, and the lower abdomen is hard, but urination is difficult, this indicates absence of blood stasis. Although these signs resemble definitive blood stasis, due to difficult urination, one cannot rule out damp-heat obstruction. It cannot be concluded as blood stasis. However, if urination is normal and the patient exhibits manic-like symptoms, this is definitive evidence of blood stasis. Without damp-heat but with manic behavior, what else could it be but Blood Stasis Syndrome? Such careful differentiation leaves no room for concealment. Diding Tang (Diding Decoction) is indicated.
In Yangming syndrome, if the patient suffers from forgetfulness, there must be blood stasis. The Heart governs blood; blood coagulation causes Heart qi to stagnate, impairing its function. Since the stasis is mild, mania does not occur. This happens because there is pre-existing long-standing blood stasis, causing forgetfulness; this is an old condition, not acquired during the Shanghan (Cold Damage) episode. Although stool is hard, defecation is surprisingly easy because blood has a slippery nature. The stool color will definitely be black; floating blood may also pass down easily. Diding Tang (Diding Decoction) is indicated to purge.
If a patient presents with neither exterior nor interior symptoms, but has fever for six or seven days, passing beyond the channel stage. Even if the pulse is floating and rapid, purgation may be used. Although the pulse is floating and rapid, the absence of exterior/interior symptoms suggests the fever belongs entirely to interior excess. After six or seven days, purgation is appropriate. If purgation has been administered but the rapid pulse persists, combined heat causes excessive hunger and digestion. The persistent rapid pulse indicates the pathogen is not in the large intestine. Excessive hunger indicates blood stasis is not in the digestive tract, hence appetite remains. By the sixth or seventh day, stasis has persisted longer. Constipation indicates blood stasis; Diding Tang (Diding Decoction) is indicated. If the rapid pulse persists accompanied by unceasing diarrhea, it must be Heat-collateral Diarrhea (Xie Re Li) with pus and blood. This refers to post-medication complications where heat is not expelled by purgation and further disturbs blood, mixing blood with stool to cause dysentery-like symptoms, requiring different treatment.
Note: Another symptom of blood stasis is the desire to rinse the mouth with water without swallowing. This is due to dryness of the lips and mouth, while the abdomen cannot tolerate water intake.