俗名蚂蟥。
味咸苦。气平。有毒。肝经血分药。主逐恶血瘀血。破血症积聚。利水道。治女子月闭
欲成
汤。治
错。
〔论〕 水蛭以蠕动啖血之物。治血之蓄而不行者。与虻虫功用相似。故仲景方往往相
辅
随
化
此物 之。若尚存性。入腹能化原形。啮人肠脏。（性最难死。火炙经年。得水犹活。）
如犯之。
〔修事〕 采得。当展其身令长。腹中有子者去之。以米泔浸一宿。晒干细锉。微火炒
令黄
大如蜜蜂而扁。微黄绿色。好啖牛马血。伺其腹满。掩取干之。
味苦。气微寒。有毒。肝经血分药。主逐瘀血。破血积坚痞。症瘕寒热。通利血脉及九
窍。
苦胜。
虻虫二
〔论〕 用虻之义。与水蛭同。先哲释抵当汤云。血蓄于下。必以咸为主。故水蛭咸寒
为君
血为
中止
凡病患气血虚甚。形质瘦损者。忌之。伤寒发黄。脉沉结。少腹硬。如小便不利者。为
无血
聚。
〔修治〕 入丸散。去翅足。炒熟用。
一名地鳖。生下湿土壤中及屋壁下。大者寸余。形似小鳖而无甲。
味咸。气寒。有小毒。足厥阴经药也。主治心腹寒热洗洗。血积症瘕。下女子月闭。有
子。
行走
经络。
治疟母
二十枚。
取二合。
盏。煎十
跌扑闪挫
麝香少许
杖。
〔论〕 虫性味。盖以化血。俾完其流行相续之用。非一于破决者。是以折伤接骨之用。
观
行
兹
蛴
功
虫
缪氏。无瘀血停留者。不宜服。
〔修治〕 十月取。晒干。炒用。
俗名蚂蟥。
味咸、苦，气平，有毒。归肝经血分，主治驱除恶血、瘀血，破除血积、症瘕积聚，通利水道，治疗女子月经闭止欲成干血痨之证，以及治疗各种错杂病症。
〔论述〕水蛭是依靠蠕动吸血的生物，用于治疗血液蓄积而不流通的病症，其功效与虻虫相似，因此张仲景的方剂中往往两者相辅相成。如果此物在体内仍保持活性，进入腹部能还原其原形，啃食人的肠脏。（其生命力极难消灭，即使火烤多年，遇水仍能复活。）如被其叮咬……
〔炮制〕采集后，应将其身体展开拉直，若腹中有卵者需去除，用米泔水浸泡一夜，晒干后细切，用微火炒至黄色。
体大如蜜蜂而扁平，呈微黄绿色，喜好吸食牛马的血，待其腹部吸饱后捕捉并干燥。
味苦，气微寒，有毒。归肝经血分，主治驱除瘀血，破除坚硬的痞块、症瘕及寒热症状，通利血脉及九窍。
苦味能胜血。
虻虫二
〔论述〕使用虻虫的意义与水蛭相同。先贤解释抵当汤时说：血液蓄积在下焦，必须以咸味药为主，故以咸寒的水蛭为君药。凡气血极度虚弱、形体消瘦的患者，忌用。伤寒发黄，脉象沉结，少腹硬满，若小便不利者，为无瘀血凝聚。
〔炮制〕入丸散剂时，去翅足，炒熟后用。
又名地鳖。生于潮湿土壤及屋壁下，大的有一寸多长，形状像小鳖但没有甲壳。
味咸，气寒，有小毒。归足厥阴肝经，主治心腹寒战发热，血积症瘕，治疗女子月经闭止或有孕，行走经络，治疗疟疾形成的痞块（疟母）。用量二十枚，取二合，一盏水煎十次……跌扑闪挫损伤，加少许麝香。
〔论述〕土鳖虫的性味，主要在于化解瘀血，使其恢复流行相续的功能，并非一味攻破。因此也有用于折伤接骨的功效。缪希雍认为，没有瘀血停留的患者，不宜服用。
〔炮制〕十月采收，晒干，炒用。
Commonly known as leech.
Taste: salty, bitter. Nature: neutral. Toxicity: toxic. Meridian tropism: Liver channel blood level. Actions: Primarily expels malignant blood and stasis, breaks up blood accumulations, masses, and growths, promotes urination, treats amenorrhea in women (potentially leading to dry blood syndrome), and addresses various complex disorders.
[Discussion] The leech is a creature that moves by wriggling and feeds on blood; it is used to treat conditions where blood is stagnant and fails to circulate. Its efficacy is similar to that of the horsefly (Machang). Therefore, in Zhang Zhongjing's formulas, they are often used together to complement each other. If this creature retains its vitality after ingestion, it can revert to its original form within the abdomen and gnaw at the intestines and viscera. (Its nature is extremely difficult to kill; even if roasted by fire for years, it remains alive when exposed to water.) If bitten...
[Processing] After collection, stretch its body to make it long. Remove those with eggs in the abdomen. Soak in rice washing water overnight, sun-dry, cut finely, and stir-fry over low heat until yellow.
Body size like a bee but flat, slightly yellowish-green. Prefers feeding on the blood of cattle and horses. Capture and dry them when their abdomens are full.
Taste: bitter. Nature: slightly cold. Toxicity: toxic. Meridian tropism: Liver channel blood level. Actions: Primarily expels blood stasis, breaks up hard abdominal masses, growths, and alternating chills and fever, unblocks blood vessels and the nine orifices.
Bitter taste overcomes blood.
Horsefly (Machang) 2
[Discussion] The rationale for using the horsefly is the same as for the leech. Ancient scholars explained the Didang Decoction (Thoroughly Resolving Pill): When blood is accumulated in the lower jiao, salty substances must be primary. Thus, the salty-cold leech serves as the sovereign herb. Patients with severe deficiency of qi and blood, or emaciated constitution, should avoid using it. In typhoid fever presenting with jaundice, deep and knotted pulse, hardness in the hypochondrium, and difficulty in urination, this indicates an absence of blood accumulation.
[Processing] For use in pills and powders, remove wings and feet, stir-fry until cooked, and use.
Also known as Earth Beetle (Dibie). Born in wet soil and under house walls. Large specimens are slightly over one cun in length, resembling a small turtle but without a shell.
Taste: salty. Nature: cold. Toxicity: slightly toxic. Meridian tropism: Foot Jueyin Liver Channel. Actions: Primarily treats alternating chills and fever in the heart and abdomen, blood accumulations and growths, treats amenorrhea in women or pregnancy-related issues, regulates meridians, and treats malaria spleen enlargement (malaria mass). Dosage: 20 specimens. Take 2 he, decoct in one cup... For traumatic injuries and sprains, add a small amount of Musk.
[Discussion] The nature and taste of the Earth Beetle primarily function to resolve blood stasis, allowing the normal continuous flow of blood to be restored, rather than merely breaking down obstructions. Hence, it is also used for treating fractures and dislocations. Miao Xiyong stated that patients without stagnant blood should not take it.
[Processing] Harvest in the tenth lunar month, sun-dry, and stir-fry before use.