罗夫人七月二十三日腹满胀，转矢气则稍平，夜不安寐。大便行，则血随之而下。以证状论，有似脾虚不能统血。然大便鞕，则决非脾藏之虚，以脾虚者便必塘也。脉弦，宜桃仁承气汤。
【按】病者服二剂后，大便畅而血止矣。
大论曰：太阳病不解，热结膀胱，其人如狂，血自下，下者愈。其外不解者，尚未可攻，当先解其外。外解已，但少腹急结者，乃可攻之，立桃核承气汤。
本条即后人所据，指本汤为太阳府病蓄血之方治也。盖膀胱为太阳之府，本条之首见太阳病三字，条文又在太阳篇中，有此三证，得毋可信？佐景下愚，愿辟其非。
本条条文诸本稍有出入：原注曰：后云解外宜桂枝汤。《玉函》自上有必字，愈上有即字。成氏本解下无其字。《脉经》其外下有属挂枝汤证五字，《千金翼》同。窃意凡此种种出入，皆无关大要。惟条中膀胱二字诸本无异，窃引为大疑。今试先问蓄血证之小便如何？按桃核承气汤条未言，但抵当汤丸三条则已三复言之。曰：以热在下焦，少腹当鞕满，小便自利者，下血乃愈。又曰：少腹鞕，小便不利者，为无血也。小便自利，其人如狂者，血证谛也。又曰：少腹满，应小便不利，今反利者，为有血也。
然则蓄血证之小便利也。夫小便从膀胱出，今小便既利，彼膀胱何病之有？反是，凡膀胧热者，其小便必不利，甚或刺痛，宜猪苓五苓之属，比为任人所知。然则以蓄血证言，膀胱实无热结，而膀胱二字之误，人每熟视不觉者，盖习非成是故耳。膀胱二字既误，反不若下焦二字为妥。下焦，犹言少腹之里也，其义虽太浑涵，假之为代名可也。学者欲知其真切病所，余今尚无辞以答，惟与其谓病所属膀胱，无宁谓属大肠与子宫。盖考诸实例，女子之瘀血有从前阴下者，有从大便下者，男子则悉从大便下。桃核承气汤煎服法中，又曰当微利，亦可以为证。抑谓病所在大肠与子宫,犹未尽妥，未竟之义姑留待高明发之。而热结不在膀胱，要可断言。又大论《厥阴篇》曰：病者手足厥冷，言我不结胸，小腹满，按之痛者，此冷结在膀胱关元也。知膀胱二字原用以代小腹之里，不可过于拘呆，否则，膀胱既属太阳，又何能再属厥阴乎？余今解释桃核承气汤条文，可见文冠以太阳病三字者，汤不必限于太阳方也。本条之意若曰：有人患太阳病，或延不医治，或医不如法，以致太阳病不解。同时其人又作他病，即热结于下焦少腹之里，发为动作如狂。设其人正气旺盛，自能逐下瘀血，如是，血自下者其病得愈。设其人正气不旺，无力逐邪者，当用药以攻之。但此时如其外太阳病依然未解，尚未可攻，当先解外。外解已，但少腹急结者，乃可用桃核承气汤攻之。盖外不解尚未可攻云者，谓太阳未罢，尚未可用阳明攻法也。外解已，但少腹急结者，乃可攻之云者，谓太阳已罢，但存阳明急结，乃可用硝黄攻下也。夫解外宜桂枝汤，人知桂枝汤为太阳方，攻之宜桃核承气汤，人何不知桃核承气汤为阳明方？故本条全文可谓是从太阳说到阳明，奈何前人但见太阳病之冠辞，遂不见阳明病之方治耶？至于本条列在太阳篇中，不妨指本汤为太阳方，又何值一驳？本汤中有桂枝一味，又是前人误解之源，曰桂枝所以解太阳之表者也。不知桂枝汤中之桂枝功在解表，桃核承气汤中之桂枝功在助下。一药二用，有说在乎？曰：我前不云乎，桂枝能活动脉之血者也。动脉之血，自里达表，桂枝助之，可以作汗解表，此桂枝汤中桂枝之功也。动脉之血自心藏出，分作上行下行，然上行者少，下行者多，少腹之热结血瘀，又远居心藏之下，使不有桂枝以助动脉之血下行，瘀何由去？此桃核承气汤中桂枝之功也。夫桂枝为血分药，桃核承气汤证为血分病，以血分药治血分病，何疑之有？其不关太阳事也明矣！曹颖甫曰：胞中蓄血部位，即在膀胱两角。昔年在红卍字会，有男子少腹胀痛，用桃核承气下后，虽未澈底，而少腹渐软。然瘀血则由大便出，将毋服此汤后，胞中瘀血亦能被吸上行，使从大便出耶？太阳病三字，原不可泥，在《太阳篇》中，要不过辨其为蓄水否耳，此其所以当从小便有无为辨也。
桃核承气汤证其二
住毛家弄鸿兴里门人沈石顽之妹，年未二十，体颇羸弱。一日出外市物，骤受惊吓，归即发狂，逢人乱殴，力大无穷。石顽亦被击伤腰部，因不能起。数日后，乃邀余诊。病已七八日矣，狂仍如故。石顽扶伤出见。问之，方知病者经事二月未行。遂乘睡入室诊察，脉沉紧，少腹似胀。因出谓石顽曰，此蓄血证也，下之可愈。遂疏桃核承气汤与之。
桃仁一两生军五钱芒硝二钱炙甘草二钱桂技二钱枳实三钱翌日问之，知服后下黑血甚多，狂止，体亦不疲，且能暖粥，见人羞避不出。乃书一善后之方与之，不复再诊。
【按】狂上体不疲者，以病者体弱不甚，而药复适中病也。即使病者体气过虚，或药量过剂，致下后疲惫者，不妨用补剂以调之。病家至此，慎勿惊惶，反令医者不克竞其技也。
桃核承气汤证其三（附列门人治验）
曹右住林荫路初诊十月二十二日经事六七月不来，鼻衄时作，腹中有块，却不拒按，所以然者，鼻衄宣泄于上故也。阙上痛，周身骨节烘热而咳，此病欲作于血，以其体实，宜桃核承气汤加味，上者下之也。
川桂枝二钱制川军三钱枳实二钱桃仁泥四钱生甘草钱半牛膝二钱全当归二钱大白芍二钱
【按】桃核承气汤亦余所惯用而得效之方也。广益中医院中，每多藜藿之妇女，经停腹痛而乞诊。其甚者更见鼻衄或吐血，所谓倒经是也。余苟察其非孕，悉以本方加减投之，必下黑污之物而愈，本案特其一例耳。
曹右约三十余岁，面目黧黑，一望而知为劳苦之妇人也。妇诉其苦，备如案述：乾咳不得痰。其块在少腹之左，久据不移，腹中痛，却喜按。假令腹中有块而拒按，此为本汤的证，绝无可疑者。今却喜按，一则本汤之中否，实须细考。
余以其鼻衄之宣泄为亡血家，法当导之使下，乃径与本方，盖处方之前，未尝不踌躇审顾也！二诊十月二十三日骨节烘热已减，咳嗽亦除，癥块已能移动，不如向之占据一方矣。服药半日，见效如此，非经方孰能致之？川桂枝三钱枳实三钱当归三钱制川军四钱牛膝三钱白芍三钱桃仁四钱甘草三钱
【按】服药半日云者，盖妇于昨日下午五时服药，迄今日下午五时，方为一日，而今日上午九时妇即来二诊故也。妇谓其块自原处略向上中方向移动，大便畅而未察其色，咳与烘热均减，而夜寐以安。夫不治其咳而咳差，不治其骨蒸而骨蒸减者，何也？所谓治病必求其本，今主病去，而客病随除也。
三日，妇未来。四日，续来，曰：服二诊方后，饭量增，体随舒快。其块更向上中方向移动，渐在腹之中道矣。余曰：若是甚佳，中道犹通衢，其块易下矣。
曰：昨以便故，丐他医施诊，顾服药后，今日反觉不舒，块亦不动。阅其案，曰：经闭，腹中痞块，日晡潮热，宿瘀内阻，胞脉不利，宜祛瘀为治。药为桃仁泥六钱，花槟榔三钱，两头尖二钱，大白芍三钱，青陈皮各钱半，川桂枝一钱，醋炒三棱莪术各三钱，紫丹参二钱，泽兰叶三钱。余曰：案甚佳，方亦合，量又不径，安得无效？妇坚请疏方。余曰：服二诊之方可矣，安用多事为？五日，妇竟不复来。阅者将虞其殆乎？余则敢必其向愈。
顾本汤之用，必以病者之体实为前提，假令其人体虚，粗率投之，将得不偿失，而贻后悔。阅者请检前述黄耆建中汤一案，容续陈其经过。其案病者王女士自服治肺之药乏效，坚请设法根治。余曰：根在乾血，当下之。姑试以最轻之量，计桃仁泥三钱，制川军一钱半，元明粉钱半分二次冲，加其他和平扶正之品。二剂后，果下黑如河泥之物。依理，此为病根之拔，正为佳兆，然而病者因是不能起床，胃纳转呆，精神又颓。虽云可用补益之药以善其后，然而病家恐惧，医更难于措手。所谓得不偿失者是也，阅者鉴之。
曹颖甫曰：桃核承气作用正在能攻下耳。二诊后他医所立方治攻而不下，安能奏效？时医畏大黄若蛇蝎，真是不治之痼疾。若王女士既下如污泥之恶物，病根已拔，虽胃呆神倦，不妨再用小建中以调之。即不服药，亦断不至死，可以片言决也！
抵当汤证其一
余尝诊一周姓少女，住小南门，年约十八九，经事三月未行，面色萎黄，少腹微胀，证似干血劳初起。因嘱其吞服大黄麻虫虫虫丸，每服三钱，日三次，尽月可愈。自是之后，遂不复来，意其差矣。越三月，忽一中年妇人扶一女子来请医。顾视此女，面颊以下几瘦不成人，背驼腹胀，两手自按，呻吟不绝。余怪而问之，病已至此，何不早治？妇泣而告曰：此吾女也，三月之前，曾就诊于先生，先生令服丸药，今腹胀加，四肢日削，背骨突出，经仍不行，故再求诊！余闻而骇然，深悔前药之误。然病已奄奄，尤不能不一尽心力。第察其情状，皮骨仅存，少腹胀硬，重按痛益甚。此瘀积内结，不攻其瘀，病焉能除？又虑其元气已伤，恐不胜攻，思先补之。然补能恋邪，尤为不可。于是决以抵当汤予之。
虻虫一钱水蛭一钱大黄五钱桃仁五十粒明日母女复偕来，知女下黑瘀甚多，胀减痛平。惟脉虚甚，不宜再下，乃以生地、黄耆、当归、潞党、川芎、白芍、陈皮、茺蔚子活血行气，导其瘀积。一剂之后，遂不复来。后六年，值于途，已生子，年四五岁矣。
【按】丸药之效否，与其原料之是否道地，修合之是否如法，储藏之是否妥善，在在有关，故服大黄麻虫虫虫丸而未效者，不能即谓此丸竟无用也。
抵当汤证其二
蓄血一证，见于女子者多矣，男子患者甚鲜。某年，余诊一红卍会某姓男子，少腹胀痛，小便清长，且目不识物。论证确为蓄血，而心窃疑之。乃姑投以桃核承气汤，服后片时，即下黑粪，而病证如故。
再投二剂，加重其量，病又依然，心更惊奇。因思此证若非蓄血，服下药三剂，亦宜变成坏病。若果属是证，何以不见少差，此必药轻病重之故也。时门人章次公在侧，曰：与抵当丸何如？余曰：考其证，非轻剂可瘳，乃决以抵当汤下之。服后，黑粪挟宿血齐下。更进一剂，病者即能伏榻静卧，腹胀平，痛亦安。知药已中病，仍以前方减轻其量，计虻虫二钱，水蛭钱半，桃仁五钱，川军五钱。后复减至虻虫水蛭各四分，桃仁川军各钱半。由章次公调理而愈。后更询诸病者，盖尝因劳力负重，致血凝而结成蓄血证也。
抵当汤证其三
丁卯新秋，无锡华宗海之母经停十月，腹不甚大而胀。始由丁医用疏气行血药，即不觉胀满。饮食如常人。经西医考验，则谓腹中有胎，为腐败之物压住，不得长大。欲攻而去之，势必伤胎。宗海邀余赴锡诊之，脉涩不滑，不类妊娠。当晚与丁医商进桃核承气汤，晨起下白物如胶痰。更进抵当汤，下白物更多。胀满悉除，而腹忽大。月余，生一女，母子俱安。孙子云：置之死地而后生，亶其然乎？曹颖甫曰：《金匮 ·妊娠篇》宿有癥病，当下其癥，桂枝茯苓丸主之。方中丹皮桃仁芍药极破血攻瘀之能事。丹皮桃仁为大黄牡丹汤治肠痈之峻药，芍药为痈毒通络之必要，今人之治外证用京赤芍，其明验也。桂枝合芍药能扶统血之脾阳，而疏其瘀结，观太阳病用桂芍解肌，非似脾主肌肉乎。用茯苓者，要不过去湿和脾耳。然方治平近，远不如桃核承气抵当丸之有力。然当时非经西医之考验，及丁医用破血药之有效，亦断然不敢用此。而竟以此奏效，其亦有故无殒，亦无殒也之义乎？
【按】余前表桃核承气汤为阳明攻下之方矣，若抵当汤比前汤更进一步，自亦为阳明之方。盖前汤治血之新瘀者，本汤治血之久热者。故二者见证显分轻重。
彼曰小腹急结，此曰少腹鞕满，鞕满原较急结为重。彼曰如狂，此曰发生，发狂原较如狂为重。彼有血自下者，此则须下其血乃愈，较血能自下者为重。彼不曰脉，当在浮而数之例，此曰脉微而沈，原较前为重。彼用植物性药，此用动物性药，动物性药之功原较植物性药为烈。此皆其彰明较著者也。
本汤条文曰：太阳病，六七日，表证仍在，脉微而沈，反不结胸，其人发狂者，以热在下焦，少腹当鞕满，小便自利，下血乃愈。所以然者，以太阳随经瘀热在里故也，抵当汤主之。试以此与桃核承气汤条文同读，当得一新义，有为前人所未及者。盖二条均属太阳阳明同病，惟前条先治太阳，后治阳明，为经。
本条先治阳明，后治太阳，为权。所以有经权之分者，以血证有缓急之异也。前条血证不过急结如狂而已，故虽属阳明病，犹当先治太阳。本条血证已至鞕满发狂，甚或击人上屋，其候已急，故暂舍太阳，先治阳明，正符急当救里之例。
大论曰：本发汗而复下之，此为逆也。若先发汗，治不为逆。本先下之，而反汗之，为逆。若先下之，治不为逆。此即桃核承气汤及抵当汤二条之提纲也。
罗夫人于七月二十三日出现腹部胀满，排气后症状稍缓解，夜间无法安睡。大便排出时，血液随之而下。从症状来看，似乎属于脾虚不能统摄血液。但是大便干硬，则绝非脾脏虚弱所致，因为脾虚者大便必然稀溏。脉象弦，适宜使用桃仁承气汤。
桃仁泥三钱，生大黄二钱（后下），桂枝三钱，生甘草一钱，芒硝一钱半（冲服）。
【按语】病人服用两剂后，大便通畅且出血停止。
《伤寒论》中说：太阳病不解，热邪结聚在膀胱，病人出现神志狂乱，瘀血自行排出，排出后病就好了。如果表证未解，尚不可攻下，应当先解表。表证解除后，仅见少腹急迫结聚的，才可以攻下，立即设立桃核承气汤。
本条条文即是后人依据此说，认为此方是治疗太阳腑病蓄血的方剂。盖因膀胱为太阳之腑，本条开头见到“太阳病”三字，条文又在太阳篇中，有此三个证据，难道不可以相信吗？佐景愚钝，愿指出其错误。
本条条文各版本略有出入：原注说：后面说解表宜用桂枝汤。《玉函经》在“有”字上有“必”字，“愈”字上有“即”字。成无己本在“解”字下没有“其”字。《脉经》在“其外”下有“属桂枝汤证”五字，《千金翼方》相同。我私下认为凡此种种出入，都无关紧要。只有条文中“膀胱”二字各版本没有差异，我对此深感怀疑。现在试着先问蓄血证的小便情况如何？按桃核承气汤条文中未提及，但抵当汤丸三条则反复强调。说：因为热在下焦，少腹应当硬满，小便自利的，下血后病就好。又说：少腹硬，小便不利的，是无血证。小便自利，其人如狂的，是血证的确凿证据。又说：少腹满，应当小便不利，现在反而通利的，是有血证。
那么蓄血证的小便是通利的。小便从膀胱排出，现在小便既通利，那膀胱有什么病呢？反之，凡是膀胱有热的，小便必然不利，甚至刺痛，适宜用猪苓汤、五苓散之类，这是人所共知的。然而以蓄血证而言，膀胱实际上并无热结，而“膀胱”二字的误用，人们往往熟视无睹，大概是习非成是的缘故。“膀胱”二字既然有误，倒不如用“下焦”二字妥当。下焦，犹言少腹之内，其义虽然过于笼统，借作代称是可以的。学者想知道确切的病位，我现在尚无辞可答，与其说是病位在膀胱，不如说是病位在大肠与子宫。考察实例，女子的瘀血有的从前阴排出，有的从大便排出；男子则全部从大便排出。桃核承气汤煎服法中，又说应当微利，也可以作为证据。如果说病位在大肠与子宫，也未尽妥当，未尽之意暂留待高明之士阐发。而热结不在膀胱，是可以断言的。又《伤寒论·厥阴篇》说：病人手足厥冷，说我不结胸，小腹胀满，按压疼痛的，这是冷结在膀胱关元部位。可知“膀胱”二字原本用来代指小腹之内，不可过于拘泥呆板，否则，膀胱既属太阳，又怎能再属厥阴呢？我现在解释桃核承气汤条文，可见文首冠以“太阳病”三字，并不意味着此汤仅限于太阳方。本条的意思若是说：有人患太阳病，或拖延未治，或医治不当，以致太阳病不解。同时他又患其他病，即热结于下焦少腹之内，发作动作狂乱。假如此人正气旺盛，自能驱逐排出瘀血，这样，瘀血自行排出的病就好了。假如此人正气不强，无力驱邪的，应当用药攻下。但此时如果太阳表证依然未解，尚不可攻下，应当先解表。表证解除后，仅见少腹急迫结聚的，才可用桃核承气汤攻下。所谓“外不解尚未可攻”，是说太阳表证未罢，尚不可用阳明攻下法。所谓“外解已，但少腹急结者，乃可攻之”，是说太阳表证已罢，仅存阳明急结，才可用硝黄攻下。解表宜用桂枝汤，人们知道桂枝汤是太阳方，攻下宜用桃核承气汤，人们为何不知桃核承气汤是阳明方？所以本条全文可以说是从太阳说到阳明，奈何前人只见“太阳病”的冠辞，却不见阳明病的方治呢？至于本条列在太阳篇中，不妨称此汤为太阳方，又何值得驳斥？本汤中有桂枝一味，又是前人误解的根源，说桂枝是用来解太阳之表的。不知道桂枝汤中的桂枝功效在于解表，桃核承气汤中的桂枝功效在于助下。一药二用，有说法吗？我说：我以前不是说过吗，桂枝能活动血脉之血。动脉之血，自里达表，桂枝助之，可以作汗解表，这是桂枝汤中桂枝的功效。动脉之血从心脏发出，分作上行下行，然上行者少，下行者多，少腹的热结血瘀，又远居心脏之下，假使没有桂枝以助动脉之血下行，瘀血从何而去？这是桃核承气汤中桂枝的功效。桂枝为血分药，桃核承气汤证为血分病，以血分药治血分病，有什么可疑的呢！这显然与太阳病无关！曹颖甫说：胞中蓄血的部位，就在膀胱两角。昔年在红卍字会，有一男子少腹胀痛，用桃核承气汤攻下后，虽未彻底，但少腹逐渐变软。然而瘀血则由大便排出，莫非服用此汤后，胞中瘀血也能被吸收上行，从而从大便排出呢？“太阳病”三字，原本不可拘泥，在《太阳篇》中，不过是为了辨别其为蓄水证罢了，这就是之所以从小便有无来辨别的道理。
桃核承气汤证其二
住在毛家弄鸿兴里的门人沈石顽的妹妹，年龄不到二十岁，身体颇为瘦弱。一天外出买东西，突然受到惊吓，回家后随即发狂，逢人就打，力气大得无穷无尽。石顽也被击伤腰部，因此不能起身。几天后，才邀请我去诊治。病已七八天了，狂躁依旧。石顽扶着伤出来见我。询问病情，才知道病人月经两个月没来。于是趁她睡着时入室诊察，脉沉紧，少腹似有胀感。于是出来对石顽说，这是蓄血证，攻下即可痊愈。于是开桃核承气汤给她。
桃仁一两，生大黄五钱，芒硝二钱，炙甘草二钱，桂枝二钱，枳实三钱。第二天去问，知道服药后排出大量黑血，狂躁停止，身体也不疲劳，而且能吃热粥，见人害羞躲避不出。于是写了一个善后方给她，不再复诊。
【按语】狂躁停止且身体不疲劳，是因为病人身体虚弱程度不重，且药量适中病机。即使病人正气过虚，或药量过大，导致攻下后疲惫的，不妨用补剂调理。病家到了这一步，千万不要惊慌，反而让医者无法施展医术。
桃核承气汤证其三（附列门人治验）
曹右住在林荫路，初诊十月二十二日。月经六七月不来，鼻衄时常发作，腹中有块，却不拒按，之所以这样，是因为鼻衄在上部宣泄的缘故。印堂上方疼痛，周身骨节烘热而咳嗽，此病欲作于血分，因其体质实，适宜桃核承气汤加味，上部的病从下部治。
川桂枝二钱，制大黄三钱，枳实二钱，桃仁泥四钱，生甘草一钱半，牛膝二钱，全当归二钱，大白芍二钱。
【按语】桃核承气汤也是我惯用且有效的方子。广益中医院里，多有贫苦妇女，停经腹痛而来求诊。严重的更见鼻衄或吐血，所谓倒经。我只要查明她们非怀孕，都用本方加减投予，必定排出黑污之物而痊愈，本案只是其中一例而已。
曹右约三十多岁，面目黧黑，一望而知是劳苦的妇人。妇人诉说痛苦，备如案述：干咳无痰。肿块在少腹左侧，久据不移，腹中痛，却喜欢按压。假令腹中有块而拒按，这才是本汤的确切证候，绝无可疑。现在却喜欢按压，一则本汤是否适用，实在须仔细考证。
我因为她鼻衄宣泄视为亡血之家，法当引导瘀血下行，于是直接给与本方，处方之前并非没有犹豫审视！二诊十月二十三日，骨节烘热已减，咳嗽也除，癥块已能移动，不像以前占据一方了。服药半天，见效如此，非经方谁能做到？川桂枝三钱，枳实三钱，当归三钱，制大黄四钱，牛膝三钱，白芍三钱，桃仁四钱，甘草三钱。
【按语】说服药半天，是因为妇人在昨日下午五时服药，到今日下午五时才是一天，而今日上午九时妇人就来二诊的缘故。妇人说她的肿块从原处略向上中方向移动，大便通畅但未观察颜色，咳嗽与烘热均减轻，而夜寐安宁。为什么不治咳嗽而咳嗽好转，不治骨蒸而骨蒸减轻呢？所谓治病必求其本，现在主病去除，客病随之消除。
第三天，妇人未来。第四天，续来，说：服二诊方后，饭量增加，身体随之舒快。肿块更向上中方向移动，渐渐在腹之中道了。我说：这样很好，中道犹通衢大道，肿块容易下去了。
她说：昨天因为大便的事，乞求其他医生诊治，结果服药后，今天反而觉得不舒服，肿块也不动。看她的医案，说：经闭，腹中痞块，日晡潮热，宿瘀内阻，胞脉不利，宜祛瘀为治。药为桃仁泥六钱，花槟榔三钱，两头尖二钱，大白芍三钱，青陈皮各一钱半，川桂枝一钱，醋炒三棱莪术各三钱，紫丹参二钱，泽兰叶三钱。我说：医案很好，方也合拍，剂量也不偏激，怎么会无效？妇人坚持请我开方。我说：服二诊的方就可以了，何必多事呢？第五天，妇人竟不来了。读者将担心她危险乎？我却敢肯定她向愈。
但是本汤的使用，必须以病人的体质实为前提，假如其人体虚，粗率投予，将得不偿失，而留下后悔。读者请检阅前述黄耆建中汤一案，容我续陈经过。该案病人王女士自服治肺之药无效，坚持请求设法根治。我说：根在干血，当下之。姑且试用最轻的量，计桃仁泥三钱，制大黄一钱半，元明粉一钱半分两次冲服，加其他和平扶正之品。两剂后，果然排出黑如河泥之物。依理，此为病根之拔除，正是佳兆，然而病人因此不能起床，胃纳转呆，精神又颓废。虽说可用补益之药善后，然而病家恐惧，医者更难于措手。所谓得不偿失者是也，读者鉴之。
曹颖甫说：桃核承气作用正在能攻下耳。二诊后他医所立方治攻而不下，怎么能奏效？时医畏大黄若蛇蝎，真是不治之痼疾。若王女士既下如污泥之恶物，病根已拔，虽胃呆神倦，不妨再用小建中汤调理。即不服药，也断不至死，可以片言决也！
抵当汤证其一
我曾诊一位周姓少女，住小南门，年约十八九岁，月经三个月没来，面色萎黄，少腹微胀，证似干血劳初起。于是嘱咐她吞服大黄䗪虫丸，每服三钱，日三次，尽一个月可愈。从此之后，遂不复来，我想她已经好了。过了三个月，忽然一个中年妇人扶着一女子来请医。看这女子，面颊以下瘦得不成人形，背驼腹胀，两手自按，呻吟不绝。我奇怪地问，病已至此，为何不早治？妇人哭着告诉我说：这是我的女儿，三个月前，曾就诊于先生，先生令服丸药，现在腹胀加重，四肢日渐消瘦，背骨突出，月经仍不行，故再来求诊！我听后骇然，深悔前药之误。然而病已奄奄一息，尤不能不一尽心力。只察其情状，皮骨仅存，少腹胀硬，重按痛更甚。这是瘀积内结，不攻其瘀，病怎么能除？又虑其元气已伤，恐不胜攻，思先补之。然而补能恋邪，尤为不可。于是决以抵当汤予之。
虻虫一钱，水蛭一钱，大黄五钱，桃仁五十粒。第二天母女复偕来，知女儿排出大量黑瘀血，胀减痛平。惟脉虚甚，不宜再下，于是用地黄、黄耆、当归、潞党参、川芎、白芍、陈皮、茺蔚子活血行气，导其瘀积。一剂之后，遂不复来。后六年，在路上遇到，已生子，年四五岁了。
【按语】丸药的效果与否，与其原料是否道地，炮制是否如法，储藏是否妥善，处处有关，所以服大黄䗪虫丸而未效的，不能立即谓此丸竟无用也。
抵当汤证其二
蓄血一证，见于女子的很多，男子患者很少。某年，我诊一位红卍会某姓男子，少腹胀痛，小便清长，且目不识物。论证确为蓄血，而我心里窃疑。于是姑且投以桃核承气汤，服后片刻，即下黑粪，而病证如故。
再投两剂，加重其量，病又依然，心里更加惊奇。因而想此证若非蓄血，服下药三剂，也应变成坏病。若果属是证，何以不见少差，这必是药轻病重的缘故。当时门人章次公在旁边，说：与抵当丸何如？我说：考其证，非轻剂可瘳，于是决以抵当汤下之。服后，黑粪挟宿血齐下。再进一剂，病人即能伏榻静卧，腹胀平，痛亦安。知药已中病，仍以前方减轻其量，计虻虫二钱，水蛭一钱半，桃仁五钱，大黄五钱。后复减至虻虫水蛭各四分，桃仁大黄各一钱半。由章次公调理而愈。后来更询诸病人，盖曾因劳力负重，致血凝而结成蓄血证也。
抵当汤证其三
丁卯年新秋，无锡华宗海的母亲月经停十月，腹不甚大而胀。起初由丁医生用疏气行血药，就不觉胀满。饮食如常人。经西医考验，则谓腹中有胎，为腐败之物压住，不得长大。欲攻而去之，势必伤胎。宗海邀我赴锡诊之，脉涩不滑，不类妊娠。当晚与丁医商进桃核承气汤，晨起下白物如胶痰。更进抵当汤，下白物更多。胀满悉除，而腹忽大。月余，生一女，母子俱安。孙子云：置之死地而后生，亶其然乎？曹颖甫说：《金匮要略·妊娠篇》宿有癥病，当下其癥，桂枝茯苓丸主之。方中丹皮桃仁芍药极破血攻瘀之能事。丹皮桃仁为大黄牡丹汤治肠痈之峻药，芍药为痈毒通络之必要，今人之治外证用京赤芍，其明验也。桂枝合芍药能扶统血之脾阳，而疏其瘀结，观太阳病用桂芍解肌，非似脾主肌肉乎。用茯苓者，要不过去湿和脾耳。然方治平近，远不如桃核承气抵当丸之有力。然当时非经西医之考验，及丁医用破血药之有效，亦断然不敢用此。而竟以此奏效，其亦有故无殒，亦无殒也之义乎？
【按语】我之前表述桃核承气汤为阳明攻下之方矣，若抵当汤比前汤更进一步，自亦为阳明之方。盖前汤治血之新瘀者，本汤治血之久热者。故二者见证显分轻重。
彼曰小腹急结，此曰少腹硬满，硬满原较急结为重。彼曰如狂，此曰发狂，发狂原较如狂为重。彼有血自下者，此则须下其血乃愈，较血能自下者为重。彼不言脉，当在浮而数之例，此曰脉微而沉，原较前为重。彼用植物性药，此用动物性药，动物性药之功原较植物性药为烈。此皆其彰明较著者也。
本汤条文说：太阳病，六七日，表证仍在，脉微而沉，反不结胸，其人发狂的，因为热在下焦，少腹应当硬满，小便自利，下血乃愈。之所以这样，是因为太阳随经瘀热在里故也，抵当汤主之。试以此与桃核承气汤条文同读，当得一新义，有为前人所未及者。盖二条均属太阳阳明同病，惟前条先治太阳，后治阳明，为经。
本条先治阳明，后治太阳，为权。所以有经权之分者，以血证有缓急之异也。前条血证不过急结如狂而已，故虽属阳明病，犹当先治太阳。本条血证已至硬满发狂，甚或击人上屋，其候已急，故暂舍太阳，先治阳明，正符急当救里之例。
《伤寒论》说：本发汗而复下之，此为逆也。若先发汗，治不为逆。本先下之，而反汗之，为逆。若先下之，治不为逆。此即桃核承气汤及抵当汤二条之提纲也。
Mrs. Luo experienced abdominal fullness and distension on July 23rd, which eased slightly after passing gas (flatus). She suffered from insomnia at night. When stool was passed, blood followed. Based on the symptoms, it resembles Spleen deficiency failing to control blood (Spleen Qi deficiency failing to maintain blood within vessels). However, since the stool is hard, it is definitely not Spleen organ deficiency, as Spleen deficiency would result in loose stools. The pulse is Wiry (Xian), indicating the suitability of Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi).
Tao Ren Ni (Peach Kernel Paste) 3 qian, Sheng Chuan Jun (Raw Rhubarb) 2 qian (added later), Chuan Gui Zhi (Cinnamon Twig) 3 qian, Sheng Cao (Raw Licorice Root) 1 qian, Mang Xiao (Mirabilite) 1.5 qian (dissolved).
[Note] After taking two doses, the patient had a smooth bowel movement and the bleeding stopped.
The Great Treatise (*Shanghan Lun*) states: If Taiyang disease is not resolved, heat binds in the Bladder, the person becomes manic-like, and if blood comes out spontaneously, they will recover. If the exterior is not yet resolved, attack is not yet indicated; one should first resolve the exterior. Once the exterior is resolved, and only the lower abdomen feels urgent and knotted, then attack is permissible, establishing Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi).
This clause is what later generations relied upon to claim this formula treats Blood Stasis in the Taiyang Fu organ disease. Since the Bladder is the Fu organ of Taiyang, and this clause begins with "Taiyang disease," appearing in the Taiyang chapter, with these three evidences, can it not be believed? Zuo Jing, though foolish, wishes to point out the error.
There are slight variations in this clause among various editions: The original note says: Later it states resolving the exterior is suitable with Gui Zhi Tang (Cinnamon Twig Decoction). *Yu Han Jing* has the character "Bi" (must) before "You" (have); "Ji" (immediately) before "Yu" (recover). Cheng Shi's edition lacks the character "Qi" (its) after "Jie" (resolve). *Mai Jing* adds five characters "Shu Gui Zhi Tang Zheng" (belongs to Gui Zhi Tang syndrome) after "Qi Wai" (the exterior). *Qian Jin Yi Fang* is the same. I privately believe all such variations are irrelevant to the main point. Only the word "Bladder" is identical in all editions, which I find deeply suspicious. Let me first ask: What is the urination like in Blood Stasis syndrome? The Tao He Cheng Qi Tang clause does not mention it, but the three clauses for Di Dang Tang/Wan repeat it three times. It says: Because heat is in the Lower Jiao, the lower abdomen should be hard and full; if urination is free, passing blood leads to recovery. It also says: Lower abdomen hard, urination obstructed means no blood stasis. Urination free, person manic-like, is definitive evidence of blood stasis. It also says: Lower abdomen full, should have obstructed urination, now instead free, indicates blood stasis.
Thus, urination is free in Blood Stasis syndrome. Urination exits from the Bladder; now that urination is free, what disease does the Bladder have? Conversely, anyone with Bladder heat will have obstructed urination, even painful urination, suitable for Zhu Ling Tang (Polyporus Decoction) or Wu Ling San (Five-Ingredient Powder with Poria), which is known to everyone. Therefore, regarding Blood Stasis, the Bladder actually has no heat binding. People often overlook the error of the word "Bladder" due to habit. Since "Bladder" is erroneous, it is better to use "Lower Jiao." Lower Jiao refers to the interior of the lower abdomen. Although its meaning is too vague, it can serve as a substitute. Scholars wishing to know the precise location of the disease, I currently have no answer, but rather than saying the disease belongs to the Bladder, it is better to say it belongs to the Large Intestine and Uterus. Examining cases, women's blood stasis exits from the anterior orifice or from the stool; men exit entirely from the stool. The decoction instructions for Tao He Cheng Qi Tang also state "should cause mild diarrhea," which serves as evidence. Saying the disease location is the Large Intestine and Uterus is still not fully accurate; the unfinished meaning is left for experts to clarify. That heat binding is not in the Bladder can be asserted. Furthermore, the *Jueyin Chapter* of the Great Treatise states: The person has cold hands and feet, says "I do not have Jie Xiong (chest knotting)," lower abdomen is full, pressing causes pain; this is Cold Binding at the Bladder Guan Yuan point. Knowing the word "Bladder" originally used to replace the interior of the lower abdomen, one must not be too rigid. Otherwise, if the Bladder belongs to Taiyang, how can it also belong to Jueyin? My explanation of the Tao He Cheng Qi Tang clause shows that although prefixed with "Taiyang disease," the decoction is not limited to Taiyang formulas. The intent of this clause is: Someone suffers Taiyang disease, delays treatment, or receives improper treatment, so Taiyang disease is not resolved. Simultaneously, they develop another disease, i.e., heat binding in the Lower Jiao/lower abdomen interior, manifesting as manic behavior. If their righteous Qi is strong, they can naturally expel blood stasis; thus, if blood comes out spontaneously, the disease heals. If their righteous Qi is weak and unable to expel pathogenic factors, medication should be used to attack. But if the Taiyang exterior remains unresolved, attack is not yet indicated; resolve the exterior first. Once the exterior is resolved, and only the lower abdomen is urgent and knotted, Tao He Cheng Qi Tang can be used to attack. "Exterior unresolved, cannot attack" means Taiyang is not finished, so Yangming attack methods cannot be used. "Exterior resolved, only lower abdomen urgent/knotted, then can attack" means Taiyang is finished, only Yangming urgency remains, so Xiao Huang (Rhubarb and Mirabilite) purgation can be used. Resolving exterior is suitable with Gui Zhi Tang; people know Gui Zhi Tang is a Taiyang formula. Why don't people know Tao He Cheng Qi Tang is a Yangming formula? Thus, the whole clause speaks from Taiyang to Yangming. Why did predecessors only see the "Taiyang disease" prefix and miss the Yangming treatment? As for listing this clause in the Taiyang chapter, calling this formula a Taiyang formula is acceptable, why refute it? The presence of Gui Zhi in this formula is the source of predecessor misunderstanding, claiming Gui Zhi resolves Taiyang exterior. They do not know Gui Zhi in Gui Zhi Tang works to release the exterior, while Gui Zhi in Tao He Cheng Qi Tang works to assist downward movement. One medicine, two uses, is there an explanation? I said before: Gui Zhi can move arterial blood. Arterial blood moves from interior to exterior; Gui Zhi assists it to induce sweating and resolve the exterior—this is Gui Zhi's function in Gui Zhi Tang. Arterial blood exits the Heart, dividing into ascending and descending; ascending is less, descending is more. Heat binding and blood stasis in the lower abdomen are far below the Heart. Without Gui Zhi to assist arterial blood descending, how can stasis go? This is Gui Zhi's function in Tao He Cheng Qi Tang. Gui Zhi is a blood-level medicine; Tao He Cheng Qi Tang syndrome is a blood-level disease. Using blood-level medicine to treat blood-level disease, what is there to doubt? It clearly has nothing to do with Taiyang! Cao Yingfu said: The site of uterine blood stasis is at the two corners of the Bladder. In the past at the Red Cross Society, a man had lower abdominal distension and pain; after using Tao He Cheng Qi Tang to purge, although not thorough, the lower abdomen gradually softened. However, blood stasis exited via stool. Could it be that after taking this decoction, uterine blood stasis is absorbed upward and exits via stool? The words "Taiyang disease" should not be taken literally. In the *Taiyang Chapter*, it merely distinguishes whether it is Water Accumulation, hence distinguishing by the presence or absence of urination.
**Tao He Cheng Qi Tang Syndrome Case Two**
The younger sister of Shen Shiwang, a student living at Hongxing Li, Maojia Nong, was under twenty years old and quite emaciated. One day she went out shopping and was suddenly frightened. Upon returning, she became manic, beating anyone she met with immense strength. Shiwang was also struck in the waist and could not rise. Several days later, he invited me to diagnose. The illness had lasted seven or eight days, and the mania persisted. Shiwang came out to see me supporting his injury. Asking him, I learned the patient's menstruation had been absent for two months. While she slept, I entered to examine her. The pulse was Deep and Tight (Chen Jin); the lower abdomen seemed distended. I came out and told Shiwang: This is Blood Stasis syndrome; purging will cure it. I prescribed Tao He Cheng Qi Tang.
Tao Ren (Peach Kernel) 1 liang, Sheng Jun (Raw Rhubarb) 5 qian, Mang Xiao (Mirabilite) 2 qian, Zhi Gan Cao (Honey-fried Licorice) 2 qian, Gui Zhi (Cinnamon Twig) 2 qian, Zhi Shi (Immature Bitter Orange) 3 qian. The next day I asked, and learned that after taking it, a large amount of black blood was passed, mania stopped, the body was not fatigued, she could eat warm porridge, and she avoided people out of shame. I then wrote a follow-up prescription and did not visit again.
[Note] The cessation of mania and lack of fatigue occurred because the patient's weakness was not severe, and the dosage matched the condition. Even if the patient were overly deficient, or the dose excessive causing post-purge fatigue, one might use tonics to regulate. At this stage, the family must not panic, lest it hinder the physician's ability to complete the treatment.
**Tao He Cheng Qi Tang Syndrome Case Three (Attached Student's Verified Case)**
Cao You lived on Linyin Road. First visit, October 22nd. Menstruation had been absent for six or seven months. Epistaxis (nosebleed) occurred frequently. There was a mass in the abdomen, but it was not tender to pressure. The reason is that epistaxis vents upwards. Pain above the glabella (Yintang area). Generalized bone-joint baking heat and cough. This disease arises from blood levels. Given her robust constitution, Tao He Cheng Qi Tang with modifications is suitable: treating the upper by lowering.
Chuan Gui Zhi (Cinnamon Twig) 2 qian, Zhi Chuan Jun (Prepared Rhubarb) 3 qian, Zhi Shi (Immature Bitter Orange) 2 qian, Tao Ren Ni (Peach Kernel Paste) 4 qian, Sheng Gan Cao (Raw Licorice) 1.5 qian, Niu Xi (Achyranthes Root) 2 qian, Quan Dang Gui (Whole Angelica Sinensis) 2 qian, Da Bai Shao (Large White Peony Root) 2 qian.
[Note] Tao He Cheng Qi Tang is a formula I frequently use successfully. In Guangyi Traditional Chinese Medicine Hospital, many poor women present with amenorrhea and abdominal pain. Severe cases show epistaxis or hematemesis, known as "Reverse Menstruation." As long as I confirm they are not pregnant, I prescribe modified versions of this formula, invariably resulting in the passage of black, turbid material and recovery. This case is just one example.
Cao You is about thirty-something, with a dark complexion, obviously a laboring woman. She complained of dry cough without phlegm. The mass was in the left lower abdomen, fixed in place, causing abdominal pain but preferring pressure. If the abdominal mass were tender to pressure, it would be the exact indication for this formula, beyond doubt. Now that she prefers pressure, whether this formula applies requires careful consideration.
I considered her epistaxis as blood loss, so the method should guide it downward. I directly gave her this formula, though I hesitated before prescribing! Second visit, October 23rd. Bone-joint baking heat decreased, cough ceased, the mass moved, no longer occupying one side. Effective after half a day of taking medicine; only classical formulas can achieve this.
Chuan Gui Zhi (Cinnamon Twig) 3 qian, Zhi Shi (Immature Bitter Orange) 3 qian, Dang Gui (Angelica Sinensis) 3 qian, Zhi Chuan Jun (Prepared Rhubarb) 4 qian, Niu Xi (Achyranthes Root) 3 qian, Bai Shao (White Peony Root) 3 qian, Tao Ren (Peach Kernel) 4 qian, Gan Cao (Licorice) 3 qian.
[Note] "Half a day" means she took medicine at 5 PM yesterday, and today is 5 PM, making it one day. She came for the second visit at 9 AM today. She said the mass moved slightly upward and centrally from its original position. Bowels were smooth, color not observed. Cough and baking heat reduced, sleep improved. Why did cough improve without treating it, and bone-steaming heat reduce without treating it? Treating the root causes the branch to disappear.
On the third day, she did not come. On the fourth day, she returned, saying: After taking the second-visit prescription, appetite increased, body felt comfortable. The mass moved further upward and centrally, now in the middle of the abdomen. I said: This is excellent. The middle is like a thoroughfare; the mass can easily pass.
She said: Yesterday, due to bowel issues, I sought another doctor. After taking his medicine, I felt uncomfortable today, and the mass did not move. Reading his case: Amenorrhea, abdominal mass, afternoon tidal fever, old stasis blocking internally, uterine vessels obstructed. Suitable for removing stasis. Prescription: Tao Ren Ni (Peach Kernel Paste) 6 qian, Hua Bin Lang (Areca Seed) 3 qian, Liang Tou Jian (Lonicera Flower Bud) 2 qian, Da Bai Shao (Large White Peony Root) 3 qian, Qing Chen Pi (Green Tangerine Peel) 1.5 qian each, Chuan Gui Zhi (Cinnamon Twig) 1 qian, Cu Chao San Leng (Vinegar-fried Curcuma Zedoaria) 3 qian each, Cu Chao E Zhu (Vinegar-fried Curcuma Phaeocaulis) 3 qian each, Zi Dan Shen (Red Sage Root) 2 qian, Ze Lan Ye (Lycopus Leaf) 3 qian. I said: The case is good, the formula fits, the dosage is moderate, why would it be ineffective? She insisted I prescribe. I said: Take the second-visit formula; why make things complicated? On the fifth day, she did not return. Readers may worry she is in danger? I dare assert she is recovering.
However, the use of this formula presupposes the patient's robust constitution. If the patient is deficient and one prescribes rashly, the loss outweighs the gain, leading to regret. Readers, please check the previous Huang Qi Jian Zhong Tang case for details. That patient, Ms. Wang, took lung medicines with no effect and insisted on radical treatment. I said: The root is Dry Blood; it must be purged. I tentatively tried the lightest dose: Tao Ren Ni (Peach Kernel Paste) 3 qian, Zhi Chuan Jun (Prepared Rhubarb) 1.5 qian, Yuan Ming Fen (Niter) 0.5 qian divided into two doses dissolved. Plus other mild supportive herbs. After two doses, black mud-like material was passed. Logically, this is the removal of the disease root, a good omen. However, the patient could not get out of bed, appetite stagnated, and spirit declined. Although tonic herbs could be used afterwards, the family was terrified, making treatment difficult. This is "loss outweighs gain." Readers beware.
Cao Yingfu said: The action of Tao He Cheng Qi Tang lies precisely in its purgative power. The prescription given by other doctors after the second visit failed to purge; how could it be effective? Physicians' fear of Rhubarb is like fearing snakes and scorpions, an incurable chronic disease. If Ms. Wang passed mud-like foul matter and the root was removed, even with stomach stagnation and fatigue, one might use Xiao Jian Zhong Tang to regulate. Even without medicine, death is impossible; this is certain!
**Di Dang Tang Syndrome Case One**
I once treated a young girl surnamed Zhou, living in Xiao Nan Men, aged eighteen or nineteen. Menstruation had been absent for three months. Complexion was sallow, lower abdomen slightly distended. The syndrome resembled early-stage Dry Blood Labor (Gan Xue Lao). I instructed her to swallow Da Huang E Chong Wan (Rhubarb and Ground Beetle Pill), 3 qian per dose, three times daily. Recovery expected within a month. Afterwards, she never returned, assuming she had recovered. Three months later, a middle-aged woman brought a young woman to seek medical help. Looking at this girl, her face and cheeks below were emaciated to the point of being unrecognizable. Her back was hunched, abdomen distended. She rubbed her hands continuously, groaning incessantly. I asked strangely: Why not treat earlier when the illness reached this state? The woman cried and said: This is my daughter. Three months ago, she consulted you. You ordered pills. Now abdominal distension worsened, limbs wasted daily, back bones protruded, menstruation still absent, so we seek consultation again! I was horrified, deeply regretting the previous prescription. However, the patient was dying, and I could not fail to try my best. Observing her condition, skin and bones remained. Lower abdomen was hard and distended; deep pressure caused severe pain. This is internal accumulation of stasis. Without attacking the stasis, how can the disease be cured? I worried her Yuan Qi (Original Qi) was damaged and feared she could not withstand attack, considering tonifying first. But tonification retains pathogenic factors, which is unacceptable. Thus, I decided to give Di Dang Tang (Mustard Bee and Leech Decoction).
Meng Chong (Blue Bottle Fly) 1 qian, Shui Zhi (Leech) 1 qian, Da Huang (Rhubarb) 5 qian, Tao Ren (Peach Kernel) 50 grains. The next day, mother and daughter returned. The girl passed a large amount of black stasis. Distension reduced, pain subsided. However, the pulse was very deficient; further purging was unsuitable. So I used Sheng Di Huang (Rehmannia Root), Huang Qi (Astragalus Root), Dang Gui (Angelica Sinensis), Lu Dang Shen (Codonopsis Root), Chuan Xiong (Ligusticum Rhizome), Bai Shao (White Peony Root), Chen Pi (Tangerine Peel), Chong Wei Zi (Eclipta Fruit) to invigorate blood and move Qi, guiding the stasis out. After one dose, she did not return. Six years later, I met her on the road. She had borne a child, aged four or five.
[Note] Whether the pill is effective depends on whether the raw materials are authentic, processing is standard, and storage is proper. Therefore, failure of Da Huang E Chong Wan does not mean the pill is useless.
**Di Dang Tang Syndrome Case Two**
Blood Stasis syndrome appears often in women, rarely in men. One year, I treated a male patient surnamed [Name Omitted] from the Red Cross Society. He had lower abdominal distension and pain, clear and profuse urination, and blindness. The diagnosis confirmed Blood Stasis, but I secretly doubted it. I tentatively prescribed Tao He Cheng Qi Tang. After taking it, black stool was passed shortly, but the syndrome remained unchanged.
I prescribed two more doses, increasing the quantity, but the illness persisted. I was more surprised. I thought: If this were not Blood Stasis, three doses of purgatives should have caused a bad transformation. If it truly is this syndrome, why no slight improvement? This must be due to light medicine and heavy disease. At that time, my student Zhang Cigong was present. He said: How about Di Dang Wan (Mustard Bee and Leech Pill)? I said: Examining the syndrome, light medicine cannot cure it. I decided to use Di Dang Tang to purge. After taking it, black stool mixed with old blood was passed together. One more dose allowed the patient to lie quietly on the couch. Abdominal distension flattened, pain ceased. Knowing the medicine hit the target, I reduced the dosage of the previous formula: Meng Chong (Blue Bottle Fly) 2 qian, Shui Zhi (Leech) 1.5 qian, Tao Ren (Peach Kernel) 5 qian, Chuan Jun (Rhubarb) 5 qian. Later reduced to Meng Chong and Shui Zhi 0.25 qian each, Tao Ren and Chuan Jun 1.5 qian each. Zhang Cigong regulated the patient until recovery. Later inquiry revealed the patient had lifted heavy loads, causing blood coagulation and forming Blood Stasis.
**Di Dang Tang Syndrome Case Three**
In early autumn of the Dingmao year, Mrs. Hua Zonghai from Wuxi had missed menstruation for ten months. Her abdomen was not very large but distended. Initially, Doctor Ding used Qi-regulating and Blood-moving herbs, and the distension disappeared. Diet was normal. Western medical examination suggested a fetus in the abdomen, suppressed by corrupt matter, preventing growth. To attack and remove it would inevitably harm the fetus. Zonghai invited me to Wuxi to diagnose. The pulse was Choppy (Se) and not Slippery (Hua), unlike pregnancy. That evening, I discussed with Doctor Ding to administer Tao He Cheng Qi Tang. In the morning, white substance like gelatinous phlegm was passed. Further administration of Di Dang Tang resulted in more white substance. Distension completely resolved, but the abdomen suddenly enlarged. Over a month later, she gave birth to a daughter. Mother and child were safe. Sunzi said: Place in death ground, then live. Is this true? Cao Yingfu said: In *Jin Gui Yao Lue · Pregnancy Chapter*: If there is an existing mass disease, purge the mass; Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) governs it. Danshen, Tao Ren, and Bai Shao in the formula maximize breaking blood and attacking stasis. Dan Pi and Tao Ren are harsh drugs in Da Huang Mu Dan Tang for treating intestinal abscess; Bai Shao is necessary for opening collaterals in abscess toxicity. Modern use of Jing Chi Shao (Beijing Red Peony) for external conditions is clear proof. Gui Zhi combined with Bai Shao supports the Spleen Yang that controls blood and disperses stasis knots. Observing Taiyang disease using Gui Zhi and Bai Shao to resolve muscle layer, does it not resemble Spleen governing muscles? Using Fu Ling (Poria) is merely to remove dampness and harmonize the Spleen. However, the treatment is mild and close, far inferior to the power of Tao He Cheng Qi Tang and Di Dang Wan. Yet, without Western medical examination and the effectiveness of Doctor Ding's blood-breaking herbs, I would not have dared to use this. That it succeeded implies the principle: "If there is a cause, no harm occurs; if no harm occurs, no harm results."
[Note] I previously stated Tao He Cheng Qi Tang is a Yangming purgative formula. Di Dang Tang goes a step further, thus also being a Yangming formula. The former treats fresh blood stasis; this one treats long-standing heat in blood. Hence, the manifestations clearly differ in severity.
The former says "lower abdomen urgent and knotted"; this says "lower abdomen hard and full." Hard and full is heavier than urgent and knotted. The former says "manic-like"; this says "mania." Mania is heavier than manic-like. The former has spontaneous blood discharge; this requires purging blood to heal, which is heavier than spontaneous discharge. The former does not specify pulse, implying Floating and Rapid; this says "pulse Micro and Deep," which is heavier. The former uses plant-based medicines; this uses animal-based medicines. Animal-based medicines are more potent than plant-based ones. These are obvious differences.
The clause for this formula states: Taiyang disease, six or seven days, exterior syndrome remains, pulse is Micro and Deep, contrary to Jie Xiong (chest knotting). The person is manic. Because heat is in the Lower Jiao, the lower abdomen should be hard and full. Urination is free. Passing blood leads to recovery. The reason is that Taiyang follows the channels, and stasis-heat is inside. Di Dang Tang governs it. Reading this together with the Tao He Cheng Qi Tang clause yields a new meaning, surpassing predecessors. Both clauses involve simultaneous Taiyang and Yangming disease. The former treats Taiyang first, then Yangming, representing the Norm (Jing).
This clause treats Yangming first, then Taiyang, representing the Expedient (Quan). The distinction between Norm and Expedient exists because blood syndromes vary in urgency. The former blood syndrome is merely urgent/knotted and manic-like. Thus, although it involves Yangming, Taiyang should be treated first. This blood syndrome has progressed to hard/full and mania, even hitting people or climbing roofs. The situation is urgent. Thus, temporarily abandoning Taiyang to treat Yangming first conforms to the principle of urgently saving the Interior.
The Great Treatise states: Originally intended to sweat, but purged instead; this is incorrect. If sweating is done first, treatment is not incorrect. Originally intended to purge, but sweated instead; this is incorrect. If purging is done first, treatment is not incorrect. This is the outline for both Tao He Cheng Qi Tang and Di Dang Tang clauses.