【纲】仲景曰。呕而脉弱。小便复利。身有微热。见厥者。难治。四逆汤主之。
【目】张从正曰。既呕而又发热。似乎小柴胡症也。却又脉弱。热又微。内无大热也。所以小
便利。见厥者。表寒也。呕者。膈上有寒饮也。则诸症皆见阳消阴长之兆。何可治乎。
【纲】仲景曰。既吐且利。小便复利。而大汗出。下利清谷。内寒外热。脉微欲绝者。四逆汤
主之。
【目】鳌按。三阴皆有小便自利症。不特少阴也。如太阴伤寒脉浮而缓。手足自温。当发黄。
小便自利。不发黄。至七八日。虽暴烦。下利日十余行。必自止。厥阴伤寒热少厥微。指头寒。嘿
嘿不欲食。烦躁。数日。小便利色白者。此热除也。欲得食。为病愈。是也。太阴厥阴。不另立款。
故附于此。此条小便利。是门户不约也。
（附小便难）
【纲】仲景曰。少阴病。咳而下利。谵语者。被火气劫故也。小便必难。以强责少阴汗故也。
【目】柯琴曰。少阴受邪。复受火侮。枢机无主。大肠清浊不分。膀胱水道不利。故下利而小
便难也。小便利者可治。此阴虚。故小便难也。
【纲】仲景曰。少阴病。二三日不已。至四五日。腹痛。小便不利。四肢沉重疼痛。自下利者。
此为有水气。其人或咳。或小便利。或下利。呕者。真武汤主之。
【目】柯琴曰。小便不利是病根。诸症皆因此而致。然小便不利。实由坎中无阳。坎中火用不宣。
故肾家水体失职。是下焦虚寒不能制水故也。法当壮元阳以消阴翳。三或字。是加减症。不是主
症。
【纲】仲景曰。二三日。至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。
【目】柯琴曰。少阴病。腹痛下利。是坎中阳虚。故真武有附子。桃花用干姜。不可以小便不
利。作热治。真武是引火归
原法。桃花是升阳散火法。
【纲】仲景曰。少阴病。四逆。其人或咳。或悸。或小便不利。或腹中痛。或泄利下重者。四逆
散主之。
【目】朱肱曰。阴症小便不利。手足厥冷。脉微细者。不宜服利小便冷滑药。但服返阴丹。并取
脐下石门穴灸之。
吴绶曰。太阴腹满自利。小便不利。无热。脉沉者。理中汤合五苓散。更加浓朴、木香。分利
其小便。而大便自止。厥阴便闭。厥冷脉伏。囊缩入腹。小便不利。宜四逆汤加通草、茯苓。或灸
气海石门穴。或以葱熨法治之。
鳌按。朱吴二说。一于少阴病灸石门穴。一于厥阴病灸石门穴。其皆灸石门者。所谓肝肾同一
治也。
[Outline] Zhang Zhongjing stated: When there is vomiting with a weak pulse, urination is actually free, the body has slight fever, and cold extremities are present, this is difficult to treat. It should be primarily treated with Sini Tang (Four Reversal Decoction).
[Commentary] Zhang Congzheng stated: Since there is vomiting accompanied by fever, it seems to be a Xiaochaihu Tang (Minor Bupleurum Decoction) pattern. However, the pulse is weak, the fever is slight, indicating no significant internal heat. Therefore, urination is free, and cold extremities appear due to exterior cold. Vomiting occurs because of cold-fluid retention above the diaphragm. Thus, all these symptoms manifest as signs of declining Yang and rising Yin; how can they be cured?
[Outline] Zhang Zhongjing stated: When there is both vomiting and diarrhea, urination is actually free, profuse sweating occurs, stool contains undigested food, there is interior cold with exterior heat, and the pulse is faint and almost imperceptible, it should be primarily treated with Sini Tang (Four Reversal Decoction).
[Commentary] Shen Jin'ao noted: The Three Yin channels (Taiyin, Shaoyin, Jueyin) all have patterns of spontaneous free urination, not limited to Shaoyin disease. For example, in Taiyin Cold Damage, if the pulse is floating and slow, and hands and feet are naturally warm, jaundice should develop; however, if urination is free, jaundice does not occur. By the seventh or eighth day, even if there is sudden irritability and diarrhea more than ten times a day, it will surely stop on its own. In Jueyin Cold Damage, with little heat and mild cold extremities, only the fingertips are cold, the patient is silent, desires no food, and is irritable. After several days, if urination is free and white in color, this indicates the heat has been eliminated; desire for food signifies recovery. Since Taiyin and Jueyin diseases do not have separate sections, they are attached here. In this passage, "free urination" refers to the failure of the gate (bladder sphincter function) to retain.
(Attached: Difficulty in Urination)
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if there is coughing with diarrhea and delirium, it is caused by the forcible seizure of fluids via fire therapy. Urination will certainly be difficult, resulting from the forced induction of sweating in Shaoyin disease.
[Commentary] Ke Qin stated: When the Shaoyin channel is invaded by pathogenic factors and further insulted by fire therapy, the pivot mechanism loses control, leading to the inability of the Large Intestine to separate clear from turbid, and the bladder's water passages becoming obstructed. Hence, diarrhea and difficulty in urination occur. If urination is free, it is treatable. This condition involves Yin deficiency, hence the difficulty in urination.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if after two or three days it persists into the fourth or fifth day, abdominal pain, difficulty in urination, heavy and painful limbs, and spontaneous diarrhea occur, this indicates the presence of water qi (fluid retention). The patient may also have coughing, or free urination, or diarrhea, or vomiting. In such cases, Zhenwu Tang (True Warrior Decoction) should be used.
[Commentary] Ke Qin stated: Difficulty in urination is the root of the disease, and all other symptoms arise from it. However, difficulty in urination is actually due to the lack of Yang energy in the Kidney (the center of Kan trigram), where the warming function of Fire in Kan fails to circulate. Consequently, the Kidney's responsibility to regulate water is impaired, which is due to lower jiao deficiency-cold failing to control water. The treatment method should be to strengthen Yuan Yang to dispel Yin shadows. The three "or" characters in the text indicate variable symptoms for modification, not main symptoms.
[Outline] Zhang Zhongjing stated: From the second or third day to the fourth or fifth day, if there is abdominal pain, difficulty in urination, unceasing diarrhea, and pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) should be used.
[Commentary] Ke Qin stated: In Shaoyin disease, abdominal pain and diarrhea indicate deficiency of Yang in the Kidney (Kan center). Therefore, Fuzi (Aconite Root) is used in Zhenwu Tang, and Ganjiang (Dried Ginger) in Taohua Tang. One must not treat difficulty in urination as a Heat pattern. Zhenwu Tang employs the method of guiding fire back to its source, while Taohua Tang employs the method of raising Yang and dispersing fire.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, with cold extremities, if the patient also has coughing, palpitations, difficulty in urination, abdominal pain, or diarrhea with a sensation of heaviness in the rectum, Sini San (Four Reversal Powder) should be used.
[Commentary] Zhu Gong stated: In Yin patterns with difficulty in urination, cold extremities, and a faint, thin pulse, one should not administer cold and slippery diuretic drugs. Instead, only Fan Yin Dan (Return to Yin Pill) should be administered, and moxibustion should be applied to the Shimen (Stone Gate) acupoint below the navel.
Wu Shou stated: In Taiyin disease with abdominal fullness and spontaneous diarrhea, difficulty in urination, absence of heat, and a deep pulse, Lizhong Tang (Regulate the Middle Decoction) combined with Wuling San (Five Ling Powder) should be used, plus Houpo (Magnolia Bark) and Muxiang (Aucklandia Root), to separate and drain the urine, so that the stool will naturally stop. In Jueyin disease with constipation, cold extremities, hidden pulse, and retraction of the testicles into the abdomen, with difficulty in urination, Sini Tang (Four Reversal Decoction) added with Tongcao (Tetrapanax Pith) and Fuling (Poria) should be used, or moxibustion applied to Qihai (Sea of Qi) and Shimen (Stone Gate) acupoints, or treated with scallion ironing therapy.
Shen Jin'ao noted: Zhu Gong and Wu Shou both recommended moxibustion on the Shimen acupoint, one for Shaoyin disease and the other for Jueyin disease. Their common use of Shimen illustrates the principle that Liver and Kidney share the same treatment approach.