水蛭（三十个熬味咸苦寒） 虻虫（三十个熬去翅足味苦微寒） 桃仁（二十个去
皮尖味苦甘平） 大黄（三两酒浸味苦寒）
上四味为末。以水五升。煮取三升。去滓。温服一升。不下。再服。
苦走血。咸胜血。虻虫水蛭之咸苦。以除蓄血。甘缓结。苦泄热。桃仁大黄之苦。以
下结热。
王宇泰云。按玩仍在字。则邪气为不传于里。非犹浅也。膀胱为太阳本经。曰热在
下焦。曰少腹硬满。曰小便自利。皆膀胱之证。故总结曰。随经瘀热也。在里二字。要
看得活。非三阴之里。乃随经膀胱之里也。
成氏云。人之所有。气与血也。气为阳。气留而不行者。则易散。以阳病易治故也。
血为阴。血蓄而不行者。则难散。以阴病难治故也。血蓄于下。非大毒驶剂则不能抵当。
故治蓄血曰抵当汤。
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。
身黄。脉沉结少腹硬。小便不利者。胃热发黄也。可与茵陈汤。身黄脉沉结。少腹
硬小便自利。其人如狂者。非胃中瘀热。为热结下焦。而为蓄血也。与抵当汤以下蓄血。
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。
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。故不可余驶峻之药也。可与抵当丸。小可下之也。
王宇泰云。按身黄屎黑。喜忘发狂。亦是推展之词。若根据上文。只是满而不硬耳。
水蛭（三十个，炒制，味咸、苦，性寒） 虻虫（三十个，炒制，去翅足，味苦，性微寒） 桃仁（二十个，去皮尖，味苦、甘，性平） 大黄（三两，酒浸，味苦，性寒）
以上四味药研成粉末。用水五升，煮取三升药液，滤去药渣。温服一升。若大便未通，再服一次。
苦味入血分，咸味能破血。虻虫和水蛭的咸苦之性，用来消除蓄积之血。甘味能缓和结滞，苦味能泄热。桃仁和大黄的苦味，用来攻下结聚之热。
王宇泰说：按照“仍在”二字来推敲，则邪气并未传入里证，但这并非病位浅表。膀胱是太阳经的本经，文中提到“热在下焦”、“少腹硬满”、“小便自利”，这些都是膀胱的证候。所以总结说是“随经瘀热”。“在里”这两个字要灵活理解，并非指三阴经的里证，而是指随经传入的膀胱之里。
成无己说：人身体拥有的只有气和血。气属阳，气停留而不运行，容易消散，因为阳病容易治疗。血属阴，血蓄积而不运行，难以消散，因为阴病难治。血蓄积在下焦，不用大毒且药势迅猛的方剂就不能抵挡得住。所以治疗蓄血证用抵当汤。
太阳病，身体发黄，脉象沉涩，少腹部坚硬，小便不利的，是无血证。如果小便自利，其人出现如狂的症状，这是血证的确凿证据。用抵当汤主治。
身体发黄，脉象沉涩，少腹坚硬，小便不利的，是胃热发黄。可以用茵陈汤。身体发黄，脉象沉涩，少腹坚硬，小便自利，其人如狂的，不是胃中瘀热，而是热结在下焦，形成蓄血证。用抵当汤来攻下蓄血。
伤寒发热，少腹胀满，应当小便不利，现在反而小便通利，这是有瘀血。应当攻下，但不能用其他药物，适宜用抵当丸。
伤寒发热，少腹胀满，这是蓄血在下焦。如果是热邪蓄积，津液不通，就会小便不利。如果热邪没有蓄积津液，而是蓄积血液导致运行不畅，小便自利的，才是蓄血证。应当给予桃核承气汤或抵当汤攻下。然而此证没有身黄、大便黑，也没有健忘、发狂的症状，说明病情尚未严重，所以不能用过于猛烈峻急的药物。可以给抵当丸，轻微攻下即可。
王宇泰说：按语中提到身黄、大便黑、健忘、发狂，也是推演扩展的说法。如果依据上文，只是少腹胀满而没有坚硬罢了。
Leech (Shuizhi, Hirudo nipponica), thirty pieces, processed; flavor: salty, bitter; nature: cold.
Dragonfly larva (Mengchong, Anisoptera larvae), thirty pieces, processed, wings and feet removed; flavor: bitter; nature: slightly cold.
Peach kernel (Taoren, Prunus persica seed), twenty pieces, skin and pointed ends removed; flavor: bitter, sweet; nature: neutral.
Rhubarb root (Dahuang, Rheum palmatum root), three liang, soaked in wine; flavor: bitter; nature: cold.
The above four ingredients are ground into powder. Add five sheng of water, boil to obtain three sheng of decoction, strain off the dregs. Take one sheng warm. If stool is not passed, take another dose.
Bitter enters the blood level, salty overcomes blood. The salty and bitter properties of Mengchong and Shuizhi are used to eliminate accumulated blood. Sweet moderates stagnation, bitter drains heat. The bitter properties of Taoren and Dahuang are used to purge accumulated heat.
Wang Yutai stated: According to the phrase "still remains," it implies that the pathogenic factor has not transmitted to the interior, yet this is not a superficial condition. The Bladder is the primary channel of Taiyang. The mentions of "heat in the lower jiao," "hardness and fullness in the lower abdomen," and "free urination" are all syndromes of the Bladder. Thus, it is summarized as "stasis-heat following the channel." The term "in the interior" should be understood flexibly; it does not refer to the interior of the Three Yin channels, but rather the interior of the Bladder affected by the channel transmission.
Cheng Wuji stated: What humans possess are Qi and Blood. Qi belongs to Yang; when Qi stagnates and fails to circulate, it easily dissipates because Yang diseases are easy to treat. Blood belongs to Yin; when Blood accumulates and fails to circulate, it is difficult to dissipate because Yin diseases are hard to treat. When Blood accumulates in the lower jiao, only potent and fast-acting agents can withstand it. Therefore, for treating blood accumulation, Dihuang Tang is used.
In Taiyang disease, if there is yellowing of the body, a deep and knotted pulse, hardness in the lower abdomen, and difficulty in urination, it indicates no blood stasis. If urination is free and the patient exhibits manic behavior, this is definitive evidence of a blood syndrome. Dihuang Tang is the principal treatment.
Yellowing of the body, deep and knotted pulse, hardness in the lower abdomen, and difficulty in urination indicate yellowing due to Stomach heat. Yinchen Tang may be administered. Yellowing of the body, deep and knotted pulse, hardness in the lower abdomen, free urination, and manic behavior indicate that this is not stasis-heat in the Stomach, but rather heat binding in the lower jiao causing blood accumulation. Dihuang Tang is given to purge the blood accumulation.
In Shanghan with fever and lower abdominal fullness, urination should be difficult. If it is now free, it indicates the presence of blood stasis. Purging is indicated, but other medicines should not be used; Dihuang Wan is appropriate.
Shanghan with fever and lower abdominal fullness indicates blood accumulation in the lower jiao. If heat accumulates and fluids do not circulate, urination will be difficult. If heat does not accumulate fluids but instead causes blood stasis, resulting in free urination, this is blood accumulation. Tao Ren Cheng Qi Tang or Dihuang Tang should be given to purge. However, since there is no yellowing of the body or black stool, nor amnesia or mania, the condition has not reached a severe stage. Therefore, overly harsh and峻烈 (harsh/forceful) medicines should not be used. Dihuang Wan may be given for mild purging.
Wang Yutai stated: The mention of yellowing of the body, black stool, amnesia, and mania in the commentary is an extrapolation. Based on the preceding text, there is merely fullness without hardness.