（仲景）
治伤寒外证不解，热结膀胱，小腹胀满，大便黑，小便利，躁渴谵语，蓄血发热如狂；
及血瘀胃痛，腹痛，胁痛，疟疾实热夜发，痢疾，蓄血急痛（热邪自太阳不解，传入膀胱之
经，与血相搏。若血自下，则热随血出而愈；不下者血蓄下焦，故小腹急胀，皮见青紫筋；
大便黑者，血瘀也；小便利者，血病而气不病也；小便利而小腹仍急，故知为蓄血。心主血，
邪热上干，心君不宁，故躁烦谵语而如狂；瘀血聚于阳明，则胃痛；在太阴，则腹痛；在厥
阴，则胁痛；疟夜发者，热入血分也。《活人》云∶不当汗而汗之，亡其津液，阳扰之极则
侵阴也，故燥血蓄于胸中也。李 曰∶太阳证则如狂，阳明证则善忘，少阳证则寒热如疟。
伤寒有用大承气不解，反便坚善食者，瘀血也。凡胸中满，心下满者，皆气也；腹中满者，
或燥矢，或宿食；小腹满者，或溺或血，停蓄而胀满也。清阳出上窍，故上满者为气而非物，
浊阴出下窍，故下满者为物而非气，俱是热病；惟冷结膀胱，小腹满一证为寒，有手足厥冷
为可
桃仁（五十枚。去皮尖。研） 大黄（四两） 芒硝 甘草 桂枝（二两。）
此足太阳药也。大黄、芒硝荡热去实，甘草和胃缓中，此调胃承气汤也。热甚搏血，血
聚则
之也（《准绳》曰∶桂枝轻扬上行，此当是桂非枝也。喻嘉言曰∶用桃仁以达血所，加桂枝
以解外邪，亦犹大柴胡汤用柴胡解外相似，益见太阳随经之邪，非桂枝不解耳。昂按∶伤寒
与杂病不同，仲景之书专为伤寒而设，故当用枝。程郊倩曰∶五苓散与桃仁承气均为太阳犯
腑之药，一利前而主气分，一利后而主血分，治各不同。撄宁生曰∶血溢血泄诸蓄妄者，其
始也率以桃仁、大黄行血破瘀之剂折其锐气，然后区别治之。或问失血复下，虚何以当。苏
伊芳举曰∶血既妄行，迷失故道，不去蓄利瘀，则以妄为常，何以御之。且去者自去，生者自
生，何虚
本方加青皮、枳实、当归、芍药、苏木汁、柴胡，名桃仁承气饮子（节庵加青皮、枳实
者，破血必行气也；加当归、芍药，去瘀而生新也；柴胡平肝升清而散表热，苏木助桃仁、
桂心以
（张仲景）
治疗伤寒表证未解，热邪结聚于膀胱经，导致小腹部胀满，大便颜色发黑，小便通畅，烦躁口渴、胡言乱语，蓄血发热且行为如狂；
以及因血瘀引起的胃痛、腹痛、胁痛，疟疾实热型夜间发作，痢疾，蓄血引起的剧烈疼痛。（注：热邪从太阳经不解，传入膀胱之经，与血液相互搏结。如果血液自行排出，则热随血出而病愈；若未排出，则血液蓄积在下焦，所以小腹部急迫胀满，皮肤可见青紫色的筋脉；大便发黑，是血瘀的表现；小便通畅，说明是血分有病而气分无病；小便通畅但小腹部仍然急迫，因此知道是蓄血证。心主血脉，邪热上扰心神，心君不安，所以出现烦躁、谵语且行为如狂；瘀血聚集在阳明经，则引起胃痛；在太阴经，则引起腹痛；在厥阴经，则引起胁痛；疟疾夜间发作的，是热邪深入血分。《活人书》说：不应当发汗却误用发汗法，导致津液耗亡，阳气扰动至极则侵犯阴分，所以燥血蓄积在胸中。李时珍说：太阳病证表现为如狂，阳明病证表现为健忘，少阳病证表现为寒热往来如疟状。伤寒病有用大承气汤治疗无效的，反而出现大便坚硬、食欲好的情况，这是瘀血所致。凡是胸部胀满、胃脘部胀满的，都是气滞；腹部胀满的，或者是燥屎，或者是宿食；小腹部胀满的，或者是尿液，或者是血液，停蓄积聚而导致胀满。清阳之气出于上窍，所以上部胀满是气而非有形之物；浊阴之气出于下窍，所以下部胀满是有形之物而非气，这些大多属于热病；只有冷结膀胱、小腹胀满这一证候属于寒证，伴有手足厥冷。）
桃仁（五十枚，去皮尖，研碎） 大黄（四两） 芒硝 甘草 桂枝（二两）
此方为足太阳经的药物。大黄、芒硝荡涤热邪、攻逐实邪，甘草调和胃气、缓急和中，这是调胃承气汤的底方。热邪炽盛与血相搏，血液聚集则形成瘀血……（此处原文有缺漏或断句，依文意补全逻辑）……（《准绳》说：桂枝轻扬上行，这里应当是用桂枝而非仅指桂皮。喻嘉言说：使用桃仁以通达血分，加入桂枝以解除外邪，也就像大柴胡汤使用柴胡来解外邪一样，更加证明太阳经随经入里的邪气，非桂枝不能解除。汪昂按语：伤寒病与杂病不同，张仲景的书专为伤寒而设，所以应当用桂枝。程郊倩说：五苓散与桃仁承气汤都是治疗太阳经犯及腑证的药物，一个通利前阴主要治理气分，一个通利后阴主要治理血分，治疗方法各不相同。撄宁生说：对于血溢、血泄等各种蓄血妄行的病症，起初通常用桃仁、大黄等行血破瘀的药剂来折其锐气，然后再区别对待进行治疗。有人问：失血之后又用泻下法，虚损如何承受？苏伊芳举说：血液既然妄行，迷失了原来的通道，如果不去除蓄积、利导瘀血，就会把妄行当作常态，用什么来抵御呢？而且去除了旧的，新的自然会生长，怎么会虚损呢？）
本方加入青皮、枳实、当归、芍药、苏木汁、柴胡，名为桃仁承气饮子。（节庵加入青皮、枳实，是因为破血必须行气；加入当归、芍药，是为了祛除瘀血并生成新血；柴胡平肝、升清并疏散表热，苏木辅助桃仁、桂心以……）
(Zhang Zhongjing)
Treats cases where the exterior syndrome of Shanghan (Cold Damage) is not resolved, with heat accumulating in the Bladder meridian, causing fullness and distension in the lower abdomen, black stools, free urination, restlessness, thirst, delirium, fever due to blood stasis, and manic behavior;
as well as stomach pain, abdominal pain, and hypochondriac pain caused by blood stasis; nocturnal onset of excess-heat type malaria; dysentery; and acute pain due to blood stasis. (Note: Heat pathogen fails to resolve from the Taiyang meridian, transmits to the Bladder meridian, and contends with blood. If blood discharges spontaneously, heat exits with the blood and the disease resolves; if it does not discharge, blood accumulates in the Lower Jiao, hence the urgent distension of the lower abdomen and visible cyanotic veins on the skin; black stools indicate blood stasis; free urination indicates pathology in the Blood level while the Qi level remains unaffected; free urination combined with persistent lower abdominal urgency confirms blood accumulation. The Heart governs the blood vessels; when evil heat harasses the upper body, the Heart Spirit becomes unsettled, resulting in restlessness, delirium, and manic behavior; when blood stasis gathers in the Yangming meridian, it causes stomach pain; in the Taiyin meridian, abdominal pain; in the Jueyin meridian, hypochondriac pain. Nocturnal onset of malaria indicates heat entering the Blood level. The *Liu Ren Shu* states: If sweating is indicated but not performed, or conversely, if sweating is performed when inappropriate, fluids are depleted. Extreme agitation of Yang invades Yin, causing dry blood to accumulate in the chest. Li Shizhen states: Taiyang syndromes present with manic-like behavior; Yangming syndromes present with forgetfulness; Shaoyang syndromes present with alternating chills and fever resembling malaria. In Shanghan, if Da Chengqi Tang is ineffective and the patient presents with hard stools and good appetite, this is due to blood stasis. Fullness in the chest or epigastrium is due to Qi stagnation; fullness in the abdomen may be due to dry feces or retained food; fullness in the lower abdomen may be due to urine retention or blood accumulation. Clear Yang emerges from the upper orifices, so upper fullness is due to Qi rather than tangible matter; turbid Yin emerges from the lower orifices, so lower fullness is due to tangible matter rather than Qi. These are mostly heat diseases; only cold binding in the Bladder with lower abdominal fullness accompanied by cold limbs belongs to cold patterns.)
Taoren (Peach Kernel, 50 seeds, remove skin and tips, grind) Dahuang (Rhubarb Root and Rhizome, 4 liang) Mangxiao (Mirabilite) Gancao (Licorice Root) Guizhi (Cinnamon Twig, 2 liang)
This formula acts on the Foot-Taiyang meridian. Dahuang and Mangxiao purge heat and eliminate excess; Gancao harmonizes the Stomach and moderates the middle. This constitutes the base of Tiaowei Chengqi Tang. When heat is severe and contends with blood, blood aggregates to form stasis... (Text fragment follows)... (*Qunshu Zhengzhi* states: Guizhi is light, ascending, and dispersing; here it should refer to the twig rather than just the bark. Yu Jiayan states: Taoren is used to reach the blood level, and Guizhi is added to release exterior pathogens, similar to using Chaihu in Da Chaihu Tang to release the exterior. This further proves that pathogens following the meridian into the interior in Taiyang cannot be resolved without Guizhi. Wang Ang notes: Shanghan differs from miscellaneous diseases; Zhang Zhongjing's works are specifically for Shanghan, thus Guizhi should be used. Cheng Jiaoqian states: Wuling San and Taoren Chengqi Tang both treat Taiyang pathogen invading the Fu organs; one promotes urination targeting the Qi level, the other promotes bowel movement targeting the Blood level, with different treatments. Yingningsheng states: For conditions such as bleeding or abnormal blood flow due to accumulation, initially use agents like Taoren and Dahuang to move blood and break stasis to curb their sharpness, then differentiate treatment. Question: How can deficiency withstand purgation after hemorrhage? Su Yifangju answers: Since blood has wandered and lost its proper course, if accumulated blood and stasis are not removed and guided out, wandering will become the norm, and how can it be controlled? Moreover, what is removed goes away, and what is generated arises naturally; why would there be deficiency?)
Adding Qingpi (Bitter Orange Peel), Zhishi (Immature Bitter Orange Fruit), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Sumu juice (Sappan Wood Juice), and Chaihu (Bupleurum Root) to this formula creates Tao Ren Cheng Qi Yin Zi. (Jie'an added Qingpi and Zhishi because breaking blood requires moving Qi; adding Danggui and Shaoyao removes stasis and generates new blood; Chaihu soothes the Liver, raises clear Yang, and disperses exterior heat; Sumu assists Taoren and Guixin...)