治伤寒蓄血, 并治症瘕, 追虫攻毒甚佳.
水蛭 ( 熬 ) 三十个 ?? 虫 ( 熬, 去头足 ) 三十个 大黄三两
桃仁 ( 去皮, 尖 ) 三十个, 右四味为散, 以水五升, 煮三升, 去滓
,温服一升. 不下再服, 利为度. 水蛭 ( 熬 ) 二十个 ?? 虫 ( 熬
,去翅 ) 二十五个 桃仁 ( 去皮, 尖 ) 二十个 大黄三两, 右四
味杵, 分为四丸, 以水一升, 煮一丸, 取七合服. 晬时当下血, 若不
下更服.
【集注】柯琴曰: 膀胱为水腑, 血本无所容蓄者也. 少腹者, 膀胱之
室也, 热结硬满, 当小便不利, 而反利者, 是病不在膀胱内而在少腹
内也. 可知其随经之营血, 因瘀热而结于少腹之里, 而非膀胱之里也
.故小便虽利, 而硬满急结, 蓄血仍瘀于少腹也. 热淫于内, 神魂不
安,故发狂. 血瘀不行, 则营不运, 故脉微而沉, 营不运, 则气不宣
,故沉而结也. 营气不周于身, 则身黄. 消谷善饥者, 胃火炽盛也.
大便反易者, 血之濡也, 色黑者, 蓄血渗入也. 善忘者, 血不荣, 智
不明也. 此皆瘀血之微兆, 非至峻之剂, 不足以抵其巢穴, 而当此重
任,故立抵当汤. 蛭, 虫之善饮血者, 而利于水,??, 虫之善吮血者
,而猛于陆. 并取水陆之善取血者以攻之, 同气相求, 更佐桃仁之苦
甘,推陈致新, 大黄之苦寒, 荡涤邪热, 故名抵当也. 若热虽盛而未
狂,少腹满而未硬, 宜小其制, 为丸以缓治之. 若外证已解, 少腹急
结,其人如狂, 是转属阳明, 用调胃承气加桃仁, 桂枝之行血者于其
中,以微痢之, 胃和则愈矣. 此桃仁承气为治之缓也.
治疗伤寒蓄血证，以及症瘕积聚，驱虫攻毒效果极佳。
水蛭（炒制）三十个 虻虫（炒制，去头足）三十个 大黄三两
桃仁（去皮、尖）三十个，以上四味药研成散剂，用水五升，煮取三升，滤去药渣，温服一升。若未见效再服，以大便通利为度。
水蛭（炒制）二十个 虻虫（炒制，去翅）二十五个 桃仁（去皮、尖）二十个 大黄三两，以上四味药捣碎，分为四丸，用水一升，煮取一丸，煎至七合服用。一昼夜后应排出瘀血，若未排出则继续服用。
【集注】柯琴说：膀胱是水液之腑，血液本无容留之处。少腹是膀胱所在的部位，若有热结导致硬满，应当小便不利，但反而小便通利的，说明病不在膀胱内部而在少腹内部。可知随经脉运行的营血，因瘀热而结聚于少腹之内，而非膀胱之里。所以虽然小便通利，但少腹硬满急结，蓄血仍瘀滞于少腹。热邪淫溢于内，神魂不安，所以发狂。血瘀不行，则营气不能运行，所以脉象微而沉；营气不运行，则气机不畅，所以脉象沉而结。营气不能周流全身，则身体发黄。消谷善饥，是胃火炽盛的表现。大便反而容易排出，是因为血液濡润肠道；颜色黑，是蓄血渗入肠道的表现。健忘，是血不荣养、智力不明朗的表现。这些都是瘀血的细微征兆，非峻猛之剂不足以抵其巢穴，当此重任，所以设立抵当汤。水蛭，是善于吸血的水生昆虫，利于在水中活动；虻虫，是善于吮血陆生昆虫，比水蛭更猛烈。同时选取水陆两种善于取血的昆虫来攻逐瘀血，同气相求，再加上桃仁的苦甘之性，推陈致新，大黄的苦寒之性，荡涤邪热，所以名叫抵当。如果热势虽盛但未发狂，少腹满但未硬，宜减小剂量，制成丸剂以缓治之。如果外证已解，少腹急结，其人如狂，这是转属阳明病，用调胃承气汤加入桃仁、桂枝等行血药物在其中，轻微通下，胃气和顺则痊愈了。这是桃仁承气汤治疗较为缓和的方法。
Treats blood accumulation (Xuè Xù) in Shanghan (Cold Damage), as well as zheng zha (masses and accumulations); it is highly effective for expelling parasites and attacking toxins.
Shuizhi (Leech, *Hirudo nipponica*) (stir-fried) 30 pieces; Mengchong (Blue Bottle Fly Larva, *Chrysomya megacephala*) (stir-fried, remove head and feet) 30 pieces; Dahuang (Rhubarb Root and Rhizome, *Rhei Radix et Rhizoma*) 3 liang; Taoren (Peach Seed, *Persicae Semen*) (remove skin and sharp ends) 30 pieces. The above four ingredients are ground into a powder. Add five sheng of water, boil to three sheng, strain the dregs, and take one sheng warm. If no effect, administer again. Stop when bowel movement occurs.
Shuizhi (Leech, *Hirudo nipponica*) (stir-fried) 20 pieces; Mengchong (Blue Bottle Fly Larva, *Chrysomya megacephala*) (stir-fried, remove wings) 25 pieces; Taoren (Peach Seed, *Persicae Semen*) (remove skin and sharp ends) 20 pieces; Dahuang (Rhubarb Root and Rhizome, *Rhei Radix et Rhizoma*) 3 liang. The above four ingredients are pounded and divided into four pills. Add one sheng of water, boil one pill until seven he remains, and take the decoction. Blood should be expelled within twenty-four hours (Zui Shi). If not expelled, administer again.
[Collected Annotations] Ke Qin stated: The Bladder (Pang Guang) is the fu-organ of water, and blood has no place to accumulate therein. The Shaofu (Lower Abdomen) is the chamber of the Bladder. If heat accumulation causes hardness and fullness, urination should be difficult. However, if urination is actually free, it indicates that the disease is not inside the Bladder but within the Shaofu. It can be deduced that the Ying-blood (Nutritive Blood) traveling along the meridians has coagulated due to stasis-heat in the interior of the Shaofu, rather than in the interior of the Bladder. Therefore, although urination is free, the hardness, fullness, and urgency in the Shaofu indicate that accumulated blood remains stasis in the Shaofu. When pathogenic heat floods internally, the Shen-spirit becomes unsettled, leading to mania (Fa Kuang). When blood stasis obstructs flow, Ying-blood cannot circulate, resulting in a pulse that is faint and deep (Wei Er Chen). Since Ying-blood does not circulate, Qi mechanism fails to diffuse, causing the pulse to be deep and knotted (Chen Er Jie). When Ying-Qi fails to circulate throughout the body, jaundice (Huang) may appear. Excessive hunger after eating (Xiao Gu Shan Ji) indicates blazing Stomach-fire (Wei Huo Chi Sheng). Bowel movements being unusually easy suggests lubrication by blood; black stool color indicates that accumulated blood has seeped into the intestines. Forgetfulness (Shan Wang) results from blood failing to nourish and intelligence becoming unclear. These are all subtle signs of blood stasis. Only potent agents are sufficient to reach their nest; thus, Didang Tang (Resist-and-Attack Decoction) was established for this heavy responsibility. Leeches are insects skilled at drinking blood and thrive in water; fly larvae are insects skilled at sucking blood and are fiercer on land. By combining these two creatures skilled at extracting blood from water and land, seeking resonance with similar energies, and assisting with the bitter-sweet nature of Taoren (Peach Seed) to push out the old and generate the new, and the bitter-cold nature of Dahuang (Rhubarb) to cleanse pathogenic heat, the formula is named Didang. If heat is severe but mania has not yet occurred, and the Shaofu is full but not hard, the dosage should be reduced, and pills should be used for slow treatment. If exterior symptoms have resolved, there is urgency and knotting in the Shaofu, and the patient resembles mania, this indicates transformation into Yangming disease. In such cases, Tiaowei Chengqi Tang (Regulate-the-Stomach Purge-Decoction) combined with Taoren (Peach Seed) and Guizhi (Cinnamon Twig) to promote blood circulation is used to induce mild purgation. When Stomach harmony is restored, recovery occurs. This represents the milder approach of Tao Ren Cheng Qi Tang (Peach Kernel Purge-Decoction).