当汤。今温疫起无表证。而惟胃实。故肠胃蓄血多。膀胱蓄血少。然抵当汤。行瘀逐蓄之最者。无分前后二便。
并可取用。然蓄血结甚者。在桃仁力所不及。宜抵当汤。盖非大毒猛厉之剂。不足以抵当。故名之。然抵当证。
所遇亦少。
抵当汤方
桃仁（二十个去皮尖○千金。二十三个。翼同本文。有熬字。） 水蛭（熬） 虫虻（各三十个去翅足熬）
大黄（三两酒洗○玉函。成本。酒浸。千金翼。作二两。破六片。）
上四味。以水五升。煮取三升。去滓。温服一升。不下更服。（四味下。玉函。成本。有为末二字。）
〔柯〕蛭。昆虫之巧于饮血者也。虻。飞虫之猛于吮血者也。兹取水陆之善取血者攻之。同气相求耳。
更佐桃仁之推陈致新。大黄之苦寒。以荡涤邪热。〔钱〕抵当者。言瘀血凝聚。固结胶粘。即用桃仁承气。及破
血活血诸药。皆未足以破其坚结。非此尖锐钻研之性。不能抵当。故曰抵当。
张氏医通曰。如无虻蛭。以干漆灰代之。
案抵当。方氏云。抵。至也。亦至当不易之正治也。喻氏汪氏辈皆同。锡驹云。抵拒大敌。四物当之。柯
氏云。抵当者。谓直抵其当攻之所也。
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。
（千金。黄。作重。硬下。有满字。）
〔钱〕此又以小便之利与不利。以别血证之是与非是也。身黄。遍身俱黄也。沉为在里。而主下焦。结则脉
来动而中止。气血凝滞。不相接续之脉也。前云少腹当硬满。此则竟云少腹硬。脉证如此。若犹小便不利者。
终是胃中瘀热郁蒸之发黄。非血证发黄也。故为无血。若小便自利而如狂。则知热邪与气分无涉。故气化无乖。
其邪在阴血矣。此乃为蓄血发黄。〔柯〕湿热留于皮肤而发黄。卫气不行之故也。燥血结于膀胱而发黄。营气
不敷之故也。水结血结。俱是膀胱病。故皆少腹硬满。小便不利是水结。小便自利是血结。如字。助语辞。若
以如字实讲。与发狂分轻重。则谬矣。〔方〕谛。审也。言如此则为血证审实。无复可疑也。
案小便不利者。成氏云。可与茵陈蒿汤。补亡论云。与五苓散。程氏云。属茵陈五苓散。柯氏云。麻黄连
轺赤小豆汤症也。以上宜选而用之。
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。（有热下。玉函。
脉经。外台。有而字。）
〔成〕伤寒有热。少腹满。是蓄血于下焦。若热蓄津液不通。则小便不利。其热不蓄津液。而蓄血不行。
小便自利者。乃为蓄血。当与桃仁承气汤。抵当汤下之。然此无身黄屎黑。又无喜忘发狂。是未至于甚。故不
可余 峻之药也。可与抵当丸。小可下之也。〔柯〕有热。即表证仍在。
抵当丸方
水蛭（二十个熬○周。吴。作二十个。猪脂熬黑。） 桃仁（二十五个去皮尖○玉函。外台。成本。三十个。
千金。二十二个。翼。有熬字） 虻虫（二十个去翅足熬○玉函。二十五个。） 大黄（三两）
上四味。捣分四丸。以水一升。煮一丸。取七合服之。 时当下血。若不下者更服。（千金。作上四味。
为末。蜜和合。分为四丸。）
〔柯〕小其制。而丸以缓之。方变汤为丸。然名虽丸也。犹煮汤焉。〔张〕煮而连滓服之。与大陷胸同意。
陶弘景云。 时者。周时也。从今旦至明旦。
太阳病小便利者。以饮水多。必心下悸。小便少者。必苦里急也。（病源。作太阳病。小便不利者。为多
饮水。心下必悸云云。非也。）
〔成〕饮水多。而小便自利者。则水不内蓄。但腹中水多。令心下悸。金匮要略曰。食少饮多。水停心下。
甚者则悸。饮水多而小便不利。则水蓄于内而不行。必苦里急也。〔钱〕水寒伤胃。停蓄不及即行。必令心下
悸动。心下者。胃之部分也。悸者。水满胃中。气至不得流通。而动惕也。〔程〕若小便少。而欲得水者。此渴。
热在下焦。属五苓散证。强而与之。纵不格拒。而水积不行。必里作急满也。〔汪〕常器之云。可茯苓甘草汤。
又猪苓汤。推常氏之意。小便利者。用茯苓甘草汤。小便少者。猪苓汤。
应当使用抵当汤。如今温疫发作没有表证，而仅有胃家实（胃肠燥热结实），所以肠胃蓄血多，膀胱蓄血少。然而抵当汤是行瘀逐蓄（破除瘀血积滞）最猛烈的方剂，无论病位在前阴还是后阴，都可以取用。但是蓄血结聚严重的，桃仁的力量达不到，适宜用抵当汤。大概如果不是大毒猛烈之剂，不足以抵挡（攻逐）坚结的瘀血，所以名叫抵当。然而抵当汤证，遇到的情况也较少。
抵当汤方
桃仁（二十个，去皮尖○《千金方》用二十三个，其余同本文，有“熬”字。） 水蛭（熬） 虻虫（各三十个，去翅足，熬）
大黄（三两，酒洗○《玉函经》、成本本作酒浸，《千金翼方》作二两，破成六片。）
以上四味药，用水五升，煮取三升，去掉药渣，温服一升。若大便不下，再服。（在四味药之后，《玉函经》、成本本有“为末”二字。）
〔柯琴〕水蛭，是昆虫中善于饮血的；虻，是飞虫中凶猛于吮血的。这里取水陆两种善于吸血的动物来攻逐瘀血，这是同气相求的道理。
再加上桃仁推陈致新，大黄苦寒以荡涤邪热。〔钱潢〕抵当，是说瘀血凝聚，固结胶粘，即使使用桃仁承气汤及破血活血的各种药物，都不足以攻破其坚结，非此尖锐钻研的药性不能抵挡，所以说抵当。
《张氏医通》说：如果没有虻虫、水蛭，可以用干漆灰代替。
按语：抵当，方有执说：抵，就是至（到达）。也是至当不易的正确治法。喻嘉言、汪琥等人也都同意。锡驹说：抵拒大敌，四味药当之。柯琴说：抵当，意思是直抵应当攻逐的部位。
太阳病，身体发黄，脉象沉结，小腹部硬满，小便不利的，是无瘀血。如果小便自利，其人如狂（神志失常，似狂非狂）的，是血证的确凿证据，用抵当汤主治。（《千金方》中，“黄”字作“重”。在“硬”字下，有“满”字。）
〔钱潢〕这里又是通过小便的通利与不通利，来辨别是否为血证。身黄，指遍身俱黄。沉脉主里，且主下焦；结脉则脉来动而中止，是气血凝滞、不相接续的脉象。前文说少腹应当硬满，这里竟只说少腹硬。脉证如此，如果还小便不利，终究是胃中瘀热郁蒸所致的发黄，不是血证发黄，所以说是无血。如果小便自利而且如狂，就知道热邪与气分无关，所以气化功能没有乖违，邪气在阴血了。这就是蓄血发黄。〔柯琴〕湿热留于皮肤而发黄，是卫气不行的缘故；燥血结于膀胱而发黄，是营气不敷布的缘故。水结和血结，都是膀胱的病，所以都见少腹硬满。小便不利是水结，小便自利是血结。“如”字，是助语词。如果把“如”字当作实义讲，用来区分发狂的轻重，那就错了。〔方有执〕谛，就是审（确切）。意思是如此则为血证确凿，再无可疑之处。
按语：对于小便不利的情况，成无己说：可与茵陈蒿汤。《补亡论》说：与五苓散。程郊倩说：属茵陈五苓散证。柯琴说：是麻黄连轺赤小豆汤证。以上宜选而用之。
伤寒发热，小腹胀满，应当小便不利，现在反而通利，是有瘀血。应当攻下，不可用其他药物，适宜用抵当丸。（在“有热”之下，《玉函经》、《脉经》、《外台秘要》有“而”字。）
〔成无己〕伤寒发热，小腹胀满，是蓄血在下焦。如果热邪蓄积导致津液不通，则小便不利；如果热邪不蓄积津液，而是蓄积血液不行，小便自利的，才是蓄血。应当用桃仁承气汤或抵当汤攻下。然而此证没有身黄、大便黑，也没有喜忘、发狂的症状，说明病情尚未到严重程度，所以不能用过于峻猛的药剂。可用抵当丸，轻微攻下。〔柯琴〕有热，即表证仍在。
抵当丸方
水蛭（二十个，熬○周慎斋、吴谦本作二十个，猪脂熬黑。） 桃仁（二十五个，去皮尖○《玉函经》、《外台秘要》、成本本作三十个，《千金方》二十二个，《千金翼方》有“熬”字） 虻虫（二十个，去翅足，熬○《玉函经》二十五个。） 大黄（三两）
以上四味药，捣碎分成四丸，用水一升，煮一丸，取七合服用。 当时应该下血，如果不下，再服。（《千金方》作：以上四味，为末，蜜和合，分为四丸。）
〔柯琴〕缩小剂量，制成丸剂以缓和药力。方剂由汤变丸，但名义上是丸，实际上还是煮汤喝。〔张璐〕煮后连药渣一起服用，与大陷胸汤的意义相同。陶弘景说：“时”，指一周的时间，从今天早晨到明天早晨。
太阳病，小便通利的，因为饮水过多，必定心下悸动（胃脘部跳动不安）；小便少的，必定苦于里急（小腹拘急不适）。（《诸病源候论》作：太阳病，小便不利者，为多饮水，心下必悸云云，这是不对的。）
〔成无己〕饮水多，而小便自利的，则水不内蓄，只是腹中水多，导致心下悸动。《金匮要略》说：食少饮多，水停心下，严重时则悸。饮水多而小便不利，则水蓄于内而不行，必定苦于里急。〔钱潢〕水寒伤胃，停蓄不及即行，必定令心下悸动。心下，是胃的部位。悸，是水满胃中，气机不得流通，而动惕不安。〔程郊倩〕如果小便少，而想喝水，这是渴，热在下焦，属于五苓散证。强行给水喝，纵然不发生格拒，但水积不行，必定引起里急胀满。〔汪琥〕常器之说：可用茯苓甘草汤，又可用猪苓汤。推究常氏之意，小便利者，用茯苓甘草汤；小便少者，用猪苓汤。
Should use Didang Tang (Cochineal and Leech Decoction). Currently, warm epidemic diseases arise without exterior syndromes, but only with Stomach excess (Gastrointestinal dryness-heat consolidation), so there is much blood stasis in the intestines and stomach, and little in the Bladder. However, Didang Tang is the most potent formula for moving blood stasis and eliminating accumulation (breaking down blood stasis and fluid retention). Regardless of whether the pathology is in the anterior or posterior orifices, it can be used. Nevertheless, when blood stasis is severely knotted, the power of Tao Ren (Peach Kernel) is insufficient, and Didang Tang is appropriate. Generally, unless it is a highly toxic and fierce preparation, it cannot withstand (attack) the solid knotting; hence the name "Didang" (Withstand/Attack). However, cases of Didang syndrome are encountered rarely.
Formula: Didang Tang (Cochineal and Leech Decoction)
Tao Ren (Peach Kernel, Semen Persicae, 20 seeds, remove skin and tips ○ *Qianjin Fang* uses 23 seeds, rest same as text, has "roasted" character.) Shui Zhi (Leech, Hirudo, roasted) Meng Chong (Dragonfly Larva, Odonata larva, each 30, remove wings and feet, roasted)
Da Huang (Rhubarb Radix et Rhizoma, 3 liang, washed with wine ○ *Yuhan Jing*, Chengben edition: soaked in wine; *Qianjin Yi Fang*: 2 liang, broken into six pieces.)
The above four herbs, boil in five sheng of water to obtain three sheng, remove dregs, take one sheng warm. If stool does not pass, take again. (After the four herbs, *Yuhan Jing* and Chengben have "make into powder" two characters.)
[Ke Qin] Shui Zhi (Leech) is an insect skilled at drinking blood. Meng Chong (Dragonfly Larva) is a flying insect fierce at sucking blood. Here we use land and water creatures good at taking blood to attack, which is seeking resonance by similar qi.
Additionally assisting with Tao Ren (Peach Kernel) to push out the old and generate the new, and Da Huang (Rhubarb) bitter-cold to sweep away pathogenic heat. [Qian Huang] "Didang" means that blood stasis condenses, firmly knots and sticks. Even using Tao Ren Chengqi Tang and various blood-breaking and blood-moving drugs are insufficient to break its hard knotting. Only this sharp drilling nature can withstand it, hence called Didang.
*Zhang Shi Yi Tong* says: If Meng Chong and Shui Zhi are unavailable, replace with Gan Xi Hui (Dry Lacquer Ash).
Note: Didang, Fang Youzhi says: Di means zhi (arrive/reach). It is also the correct treatment that is unchangeable. Yu Jiaoyan, Wang Hu and others agree. Xiju says: Withstanding a great enemy, the four items stand for it. Ke Qin says: Didang means directly reaching the place where it should be attacked.
Taiyang disease with body yellowing, pulse Chen Jie (Deep and Knotted), hardness in the lower abdomen, and dysuria (difficulty urinating) indicates no blood stasis. If urine flows freely, and the person is like mad (delirious/restless), this is a definitive sign of blood syndrome, treat with Didang Tang. (*Qianjin Fang*: "Huang" written as "Zhong"; under "Hard", there is "Man" fullness.)
[Qian Huang] Here, again, through the freeness or obstruction of urine, it distinguishes whether it is a blood syndrome or not. Body yellowing refers to whole-body jaundice. Chen (Deep) indicates interior location, specifically lower jiao. Jie (Knotted) means the pulse comes, moves, then stops; it is a pulse of qi and blood stagnation, unable to continue. Previously it said lower abdomen should be hard and full, here it merely says lower abdomen is hard. With such pulse and symptoms, if there is still dysuria, it ultimately is yellowing caused by damp-heat and blood stasis steaming in the stomach/intestines, not yellowing from blood syndrome. Hence it is said to be no blood. If urine is free and there is delirium, then one knows the pathogenic heat has nothing to do with the Qi level, so qi transformation is not impaired, and the pathogen is in the Yin-Blood. This is jaundice due to blood stasis accumulation. [Ke Qin] Damp-heat remaining in skin and flesh causes yellowing because Wei Qi (Defensive Qi) does not circulate. Dry blood knotted in the Bladder causes yellowing because Ying Qi (Nutritive Qi) is not distributed. Water knotting and Blood knotting are both Bladder diseases, hence both present with lower abdomen hardness/fullness. Dysuria is water knotting; free urination is blood knotting. "Ru" (Like) is a particle. If "Ru" is interpreted literally to distinguish severity from true madness, it is erroneous. [Fang Youzhi] Di (Di) means Shen (Examine/Confirm). It means thus it is confirmed as blood syndrome, leaving no doubt.
Note: For dysuria, Cheng Wuji says: Can use Yinchen Hao Tang (Artemisia Capillaris Decoction). *Buwang Lun* says: Use Wuling San (Five-Ingredient Powder with Poria). Cheng Jiaoqian says: Belongs to Yinchen Wuling San syndrome. Ke Qin says: It is Mahuang Lianqiao Chixiaodou Tang syndrome. Above, select and use appropriately.
Shanghan (Cold Damage) with fever, lower abdominal fullness, should have dysuria, now conversely has free urination, indicating presence of blood stasis. Should purge, do not use other medicines,适宜 (suitable) is Didang Wan (Cochineal and Leech Pill). (Under "You Re" (Has Fever), *Yuhan Jing*, *Maijing*, *Waitai* have "Er" (And) character.)
[Cheng Wuji] Shanghan with fever, lower abdominal fullness, is blood stasis accumulating in the lower jiao. If heat accumulates causing fluids to not flow, then dysuria occurs. If heat does not accumulate fluids, but accumulates blood causing it not to move, and urine is free, this is blood stasis. Should use Tao Ren Chengqi Tang or Didang Tang to purge. However, this case lacks body yellowing, black stools, nor forgetfulness/madness, meaning it has not reached severity. Thus, harsh medicines should not be used. Can use Didang Wan, mild purgation. [Ke Qin] "Has fever" means exterior syndrome still exists.
Formula: Didang Wan (Cochineal and Leech Pill)
Shui Zhi (Leech, Hirudo, 20, roasted ○ Zhou Shenzhai, Wu Qian: 20, roasted in pig fat until black.) Tao Ren (Peach Kernel, Semen Persicae, 25, remove skin and tips ○ *Yuhan Jing*, *Waitai*, Chengben: 30; *Qianjin*: 22; *Qianjin Yi Fang*: has "roasted") Meng Chong (Dragonfly Larva, 20, remove wings and feet, roasted ○ *Yuhan Jing*: 25.) Da Huang (Rhubarb Radix et Rhizoma, 3 liang)
The above four herbs, pound and divide into four pills. Boil one pill in one sheng of water, obtain seven she, take orally. Blood should pass at that time. If not, take again. (*Qianjin*: Make the above four herbs into powder, mix with honey, divide into four pills.)
[Ke Qin] Reduce the dosage, make into pills to slow the action. The formula changes from decoction to pill, but although named pill, it is still boiled as decoction. [Zhang Lu] Boil and take with dregs, same intent as Daxiexiong Tang. Tao Hongjing says: "Shi" (Time) means a cycle, from today morning to tomorrow morning.
Taiyang disease with free urination, due to drinking too much water, must cause palpitations in the epigastrium (Xin Xia); with less urine, must suffer from internal urgency (lower abdominal tension/discomfort). (*Bingyuan* says: Taiyang disease, those with dysuria drink too much water, heart must palpitate etc., this is incorrect.)
[Cheng Wuji] Drinking much water, while urination is free, then water does not accumulate internally, but simply much water in the abdomen causes epigastric palpitations. *Jingui Yaolue* says: Eat little, drink much, water stops in Xin Xia, severe cases then palpitate. Drink much water but dysuria, then water accumulates internally and does not move, must suffer from internal urgency. [Qian Huang] Cold-damage to Stomach, water stops and fails to move immediately, must cause epigastric palpitation. Xin Xia is the region of the Stomach. Ji (Palpitation) is water filling the Stomach, Qi failing to circulate smoothly, leading to trembling/movement. [Cheng Jiaoqian] If urine is little, and desiring water, this is thirst, heat in lower jiao, belongs to Wuling San syndrome. Forcefully giving water, even if no rejection, water accumulates and does not move, must cause internal urgency and fullness. [Wang Hu] Chang Qizhi says: Can use Fuling Jiangzhi Tang (Poria, Ginger, and Licorice Decoction), also Zhuling Tang (Polyporus Decoction). Inferring Chang's intent: Free urination, use Fuling Jiangzhi Tang; Less urine, use Zhuling Tang.