26.少腹满而按之痛, 厥逆尿白冷膀胱, 不厥血蓄小便利, 小便不利
水为殃.
【注】少腹满按之痛, 若四肢厥冷, 小便清白者, 是冷结膀胱, 宜当
归四逆加吴茱萸生姜汤. 不厥冷, 小便自利者, 是血蓄膀胱 , 宜桃
仁承气汤. 小便不利者, 是水蓄膀胱, 宜五苓散. 若大小便不利者,
是水热蓄结, 宜八正散.
27.神昏胃热重阳狂, 三黄三承白解汤. 蓄血发狂小便利, 少腹硬痛
属太阳, 阳明蓄血大便黑, 其人如狂而喜忘, 桃仁承气抵当治, 须识
作汗奄然狂.
【注】神昏胃热, 谓神昏是胃经热极乘心也. 重阳狂, 谓热入于阳则
狂乱也. 三黄, 谓三黄石膏汤, 治神昏狂乱表实无汗者也. 三承, 谓
三承气汤, 治神昏狂乱里实不便者也. 白解汤, 谓白虎解毒汤, 治神
昏狂乱, 无表里证而热极者也. 太阳蓄血发狂, 则少腹硬痛, 小便自
利. 若小便不利, 是水热蓄也, 非血蓄也. 阳明血蓄如狂, 则喜忘,
大便黑. 若大便不黑, 是热极也, 非血蓄也. 蓄血轻者, 桃仁承气汤
,重者抵当汤, 择而用之可也. 然发狂证, 亦有阳盛阴虚之人, 作汗
将解之时, 奄然发狂, 濈然汗出而解者, 当须识之, 不可以药也.
26. 少腹部胀满且按压时疼痛，若四肢厥冷、小便色白清冷，这是寒邪凝结于膀胱；若不出现四肢厥冷、血蓄积于下焦且小便通畅，则是水液代谢失常为害。
【注】少腹部胀满，按压时疼痛，如果伴有四肢厥冷、小便颜色清白，这是寒邪凝结在膀胱，适宜使用当归四逆加吴茱萸生姜汤（Danggui Sini Jia Wuzhuyu Shengjiang Tang）。如果不四肢厥冷、小便自利通畅，这是瘀血蓄积在膀胱，适宜使用桃仁承气汤（Taoren Chengqi Tang）。如果小便不利，这是水湿蓄积在膀胱，适宜使用五苓散（Wuling San）。如果大小便都不利，这是水热互结蓄积，适宜使用八正散（Bazheng San）。
27. 神志昏迷因胃热极盛，重阳之热导致发狂，可用三黄石膏汤（Sanhuang Shigao Tang）、三种承气汤（Three Chengqi Decoctions）或白虎解毒汤（Baihu Jiedu Tang）治疗。瘀血蓄积导致发狂且小便通利，病属太阳经；阳明经瘀血蓄积则大便色黑，患者神情如狂且健忘，可用桃仁承气汤或抵当汤（Didang Tang）治疗。必须识别那种因将要作汗而突然发狂的情况。
【注】“神昏胃热”，是指神志昏迷是由于胃经热邪极盛侵犯心脏所致。“重阳狂”，是指热邪侵入阳分则导致狂乱。“三黄”，指三黄石膏汤，用于治疗神志昏迷、狂乱、表实无汗的证候。“三承”，指三种承气汤，用于治疗神志昏迷、狂乱、里实便秘的证候。“白解汤”，指白虎解毒汤，用于治疗神志昏迷、狂乱，既无表证也无里证但热邪极盛的证候。太阳经瘀血蓄积导致发狂，表现为少腹部硬痛，小便自利通畅。如果小便不利，是水热蓄积，不是瘀血蓄积。阳明经瘀血蓄积导致神情如狂，表现为健忘，大便黑色。如果大便不黑，是热邪极盛，不是瘀血蓄积。瘀血蓄积轻的，用桃仁承气汤；重的，用抵当汤，选择使用即可。然而发狂的证候中，也有阳气盛阴虚的人，在即将出汗解除病邪的时候，突然发狂，随后持续出汗而病愈，这种情况必须识别清楚，不可用药治疗。
26. Fullness in the lower abdomen with pain upon pressure, if accompanied by cold extremities and clear, cold urine, indicates Cold Binding in the Bladder (Lengjie Pangguang); if there are no cold extremities, blood is retained in the lower jiao with free urination, whereas water retention causes harm when urination is obstructed.
[Note] Fullness in the lower abdomen with pain upon pressure: If accompanied by cold extremities and clear, white urine, this is Cold Binding in the Bladder, for which Danggui Sini Jia Wuzhuyu Shengjiang Tang (Cinnamon Twig Decoction plus Evodia and Fresh Ginger) is indicated. If there are no cold extremities and urination is free, this is Blood Retention in the Bladder, for which Taoren Chengqi Tang (Peach Kernel Decoction to Drain the Lower) is indicated. If urination is difficult, this is Water Retention in the Bladder, for which Wuling San (Five-Ingredient Powder with Poria) is indicated. If both stool and urine are obstructed, this is Water-Heat Binding, for which Bazheng San (Eight-Herb Powder for Rectification) is indicated.
27. Confusion due to extreme Stomach Heat, and mania due to Double Yang Heat, may be treated with Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction), the Three Chengqi Decoctions, or Baihu Jiedu Tang (White Tiger Detoxifying Decoction). Mania due to Blood Retention with free urination belongs to the Taiyang (Greater Yang) channel; Yangming (Yang Brightness) Blood Retention presents with black stools, a manic-like state, and forgetfulness, treatable with Taoren Chengqi Tang or Didang Tang (Siege Decoction). One must recognize cases of sudden mania occurring just prior to sweating as a sign of resolution.
[Note] "Confusion due to Stomach Heat" refers to confusion caused by extreme heat in the Stomach channel invading the Heart. "Double Yang Mania" refers to mania resulting from heat entering the Yang aspect. "Sanhuang" refers to Sanhuang Shigao Tang, used for confusion and mania with exterior excess and absence of sweating. "Three Cheng" refers to the three Chengqi Decoctions, used for confusion and mania with interior excess and constipation. "Baijie Tang" refers to Baihu Jiedu Tang, used for confusion and mania where there are neither exterior nor interior signs but extreme heat prevails. Taiyang Blood Retention causing mania presents with hardness and pain in the lower abdomen and free urination. If urination is difficult, it is Water-Heat retention, not Blood Retention. Yangming Blood Retention presenting as manic-like behavior includes forgetfulness and black stools. If stools are not black, it is extreme heat, not Blood Retention. For mild Blood Retention, use Taoren Chengqi Tang; for severe cases, use Didang Tang, choosing appropriately. However, in cases of mania, there are also individuals with excessive Yang and deficient Yin who, at the time of impending sweating for resolution, may suddenly become manic and then resolve with continuous sweating. This pattern must be recognized and should not be treated with medication.