水蛭（熬）三十个 □虫（熬，去头、足）三十个 大黄（去皮，破六片）三两 桃
核（去皮、尖）二十个
右四味，以水五升，煮取三升，去滓，温服一升。不下者更服。
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太阳病，身黄，脉沉结，少腹□满，小便不利者，为无血也；小便自利，其人如狂者
，血证谛，属抵当汤。
【注】
此承上条详其脉证，互发其义也。太阳病，无论中风、伤寒，但身黄脉大，腹满小便
不利兼头汗出者，乃湿热之黄，非瘀血也。今身黄，脉沉结，少腹□，小便自利，其
人如狂者，则是血证，非湿热也，故宜抵当汤以攻其血。
【集注】
方有执曰：谛，审也。言如此为血证审实，无复可疑，必须抵当汤，勉人勿二之意。
程知曰：身黄，脉沉结，少腹□，三者皆下焦畜血之证。然尚与胃热发黄证相近，故
当以小便辨之。其少腹满而小便不利者，则为无形之气病，属茵陈证也；其少腹□而
小便自利者，则为有形之血证，属抵当无可疑矣。
汪琥曰：按本文云：小便不利者之下，仲景不言治法。成注云：可与茵陈汤。『补亡
论』云：与五苓散。后条辨云：属茵陈五苓散。此三方可选而用之。
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伤寒有热，少腹满，应小便不利，今反利者，为有血也，当下之，宜抵当丸。
【注】
此承上条而言证之轻者，以互发其义酌而其治也。伤寒荣病，有热不已，伏于荣中，
其血不随经妄行致□，则必随经下蓄膀胱，少腹者膀胱之室也，故少腹满。若小便不
利，则为病在卫分，有停水也；今小便反利，则为病在荣分，有瘀血也，法当下之，
宜以抵当汤。小其制为丸，缓缓下之，不可过用抵当汤也。
【集注】
方有执曰：上条之方，变汤而为丸。名虽丸也，而犹煮汤焉。汤者荡也，丸者缓也，
丸者缓也，变汤为丸，而犹不离乎汤，盖取欲缓不缓，不荡而荡之意也。
程应旄曰：夫满因热入气分，而蓄及津液者，应小便不利，今反利者，则知其所蓄非
津液也，乃血也。血因热而满结，故用抵当汤，变易为丸，煮而连滓服之，使之直达
血所，以下旧热，荡尽新瘀，乃除根耳！
水蛭（经炮制）三十个，虻虫（经炮制，去除头部和足部）三十个，大黄（去除外皮，破成六片）三两，桃仁（去除外皮和尖端）二十个。
以上四味药，用五升水，煎煮至剩余三升，滤去药渣，温服一升。若服药后瘀血未下，可再服用。
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太阳病（太阳经受邪所致的病证），身体发黄，脉象沉而结滞，小腹部硬满，小便不通利的，属于无瘀血的情况；若小便自利，且患者出现神志狂乱如癫狂状的症状，则是瘀血证的确诊依据，归属于抵当汤的治疗范围。
【注】
此处承接上一条，详细阐述其脉象与症状，互相阐发其中的医理。太阳病，无论是中风还是伤寒，只要出现身体发黄、脉象洪大、腹部胀满、小便不利并伴有头汗出的情况，乃是湿热导致的黄疸，并非瘀血所致。如今身体发黄，脉象沉结，小腹部硬满，小便自利，且患者神志狂乱如癫狂状，这则是瘀血证，而非湿热，因此适宜使用抵当汤来攻逐瘀血。
【集注】
方有执说：“谛”，意为审察、确切。意思是说如此这般确凿无疑地诊断为瘀血证，不再有任何可疑之处，必须使用抵当汤，这是告诫医者不要犹豫不决的意思。
程知说：身体发黄、脉象沉结、小腹部硬满，这三者都是下焦蓄血的证候。然而这些症状尚与胃热发黄证相近，因此应当通过小便情况来辨别。如果小腹胀满且小便不利，则属于无形之气的病变，归属于茵陈汤证；如果小腹部硬满且小便自利，则属于有形之血的病变，归属于抵当汤证，这就无可怀疑了。
汪琥说：按照原文所述，在“小便不利者”之下，张仲景并未提及治法。成无己注释说：可与茵陈汤。“补亡论”说：给予五苓散。后续条辨中说：归属于茵陈五苓散。这三种方剂可供选择使用。
@@@
伤寒病伴有发热，小腹部胀满，按理说应当小便不利，如今反而小便通利，这是因为有瘀血存在，应当采用攻下法治疗，适宜使用抵当丸。
【注】
此处承接上一条，论述病情较轻的情况，以互相阐发医理并斟酌治疗方法。伤寒营分受病，发热持续不退，热邪潜伏于营分之中，血液不随经脉妄行导致出血，那么必然随着经脉下行蓄积于膀胱。小腹部是膀胱所在的部位，所以会出现小腹部胀满。如果小便不利，则说明病在卫分，有水湿停聚；如今小便反而通利，则说明病在营分，有瘀血阻滞，治法应当攻下，适宜使用抵当汤。将剂量缩小制成丸剂，缓缓攻下瘀血，不可过度使用抵当汤。
【集注】
方有执说：上一条的方剂，由汤剂改为丸剂。名称虽然是丸，但实际上仍像煮汤一样煎煮服用。汤剂的作用是涤荡，丸剂的作用是缓和。将汤剂改为丸剂，但仍然不离乎汤剂的作用，大概是取意于既想缓和又不完全迟缓，虽不似汤剂那样猛烈涤荡却能起到涤荡作用的意思。
程应旄说：胀满是因为热邪进入气分，波及津液，应当出现小便不利，如今反而通利，就知道所蓄积的不是津液，而是血液。血液因热邪而胀满结滞，所以使用抵当汤，将其改变为丸剂，煎煮后连同药渣一起服用，使药力直达血分所在，以攻下旧有的热邪，涤尽新形成的瘀血，这样才能除根！
Leech (processed) 30 units, Blue bottle fly larva (processed, remove head and legs) 30 units, Rhubarb (remove peel, break into six pieces) 1.5 taels, Peach Kernel (remove peel and tip) 20 units.
The above four ingredients are decocted with five sheng of water until three sheng remain. Strain the dregs and take one sheng warm. If the blood stasis is not expelled, administer again.
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In Taiyang disease (a syndrome caused by pathogenic factors invading the Taiyang channel), if there is yellowing of the body, a deep and knotted pulse, fullness and hardness in the lower abdomen, and dysuria (difficulty urinating), this indicates the absence of blood stasis; however, if urination is normal and the patient exhibits manic-like mental restlessness, this confirms a blood stasis syndrome, which falls under the indication for Dishui Tang (Leech Decoction).
[Note]
This passage follows the previous one to detail the pulse and symptoms, mutually elucidating the underlying principles. In Taiyang disease, whether Wind-stroke or Cold damage, if there is yellowing of the body, a large pulse, abdominal fullness, dysuria, accompanied by sweating only on the head, this is jaundice due to Damp-Heat, not Blood Stasis. Now, with yellowing of the body, a deep and knotted pulse, fullness and hardness in the lower abdomen, normal urination, and manic-like mental restlessness, this is indeed a Blood Stasis syndrome, not Damp-Heat, thus requiring Dishui Tang (Leech Decoction) to purge the blood stasis.
[Collected Notes]
Fang Youzhi states: "Di" means precise examination. It implies that such presentation constitutes a definitive diagnosis of Blood Stasis, leaving no room for doubt, necessitating the use of Dishui Tang (Leech Decoction); this serves as an admonition to physicians not to hesitate.
Cheng Zhi states: Yellowing of the body, a deep and knotted pulse, and fullness and hardness in the lower abdomen are all signs of Blood Accumulation in the Lower Jiao. However, these resemble the syndrome of Jaundice due to Stomach Heat, so differentiation must be made via urination. If there is lower abdominal fullness with dysuria, it is a disorder of formless Qi, belonging to Yinchen Tang (Artemisia Capillaris Decoction); if there is lower abdominal fullness and hardness with normal urination, it is a disorder of formed Blood, belonging to Dishui Tang (Leech Decoction), beyond doubt.
Wang Hu states: According to the main text, below "dysuria," Zhang Zhongjing does not specify a treatment method. Cheng Wuji's commentary suggests: Yinchen Tang (Artemisia Capillaris Decoction) may be given. "Bu Wang Lun" suggests: Wuling San (Five-Ingredient Powder with Poria). Subsequent commentaries suggest: Yinchen Wuling San (Yinchen Five-Ingredient Powder with Poria). These three formulas can be selected for use.
@@@
In Shanghan (Cold Damage) with fever and lower abdominal fullness, dysuria should occur; however, if urination is now normal, this indicates the presence of Blood Stasis. Purging is indicated, and Dishui Wan (Leech Pill) is appropriate.
[Note]
This follows the previous paragraph to discuss milder cases, mutually elucidating principles and adjusting treatment. In Shanghan affecting the Ying (Nutritive) level, persistent heat lurks within the Ying. If the blood does not follow the channels and bleed recklessly, it will likely descend along the channels and accumulate in the Bladder. The lower abdomen is the residence of the Bladder, hence the lower abdominal fullness. If dysuria occurs, the pathology is in the Wei (Defensive) level with retained Water; if urination is now normal, the pathology is in the Ying level with Blood Stasis. The method requires purging, and Dishui Tang (Leech Decoction) is suitable. By reducing the dosage and forming pills, the purging action is gradual; excessive use of Dishui Tang (Leech Decoction) should be avoided.
[Collected Notes]
Fang Youzhi states: The formula from the previous paragraph is changed from a decoction to a pill. Although named a pill, it is still boiled like a decoction. A decoction acts vigorously (dang), while a pill acts slowly (huan). Changing from decoction to pill, yet retaining the nature of a decoction, aims for an effect that is neither too slow nor fully vigorous, achieving a purging effect without the harshness of a standard decoction.
Cheng Yingmao states: Fullness arises when heat enters the Qi level and affects fluids, leading to dysuria. If urination is now normal, it is known that the accumulation is not fluid but Blood. Blood becomes full and knotted due to heat, so Dishui Tang (Leech Decoction) is used, altered into pills, boiled and taken with the dregs, allowing the medicine to reach the blood directly, purging old heat and sweeping away new stasis, thereby eliminating the root cause!