【纲】仲景曰。阳明病。自汗出。若发汗。小便自利。此为津液内竭。大便虽硬。不可攻之。
当须自欲大便。宜蜜煎导而通之。若土瓜根。及与大猪胆汁。皆可为导。
【目】柯琴曰。本自汗。更发汗。则上焦之液已外竭。小便自利。则下焦之液又内竭。
【纲】仲景曰。伤寒脉浮缓。手足自温者。系在太阴。太阴者。身自发黄。若小便自利者。不
能发黄。至七八日大便硬者。为阳明病。阳明病。反无汗而小便利。二三日呕而咳。手足厥者。必
苦头痛。
【目】柯琴曰。首条。小便自利。是津液越出。故燥土受病。病在胃也。次条。小便利则里无
瘀热可知矣。
【纲】仲景曰。太阳病。若吐。若下。若发汗。微烦。小便数。大便因硬者。小承气汤和之。
愈。
【目】王肯堂曰。阳明皆以小便自利为病。盖以验病之下与不当下也。若小便不利而少腹硬者。
屎也。当渗泄之。若小便自利而少腹硬者。非血则粪也。当通利之。且病之发黄与不发黄。及病
之死与不死。皆可于此验之。
吴绶曰。小便数者。频欲去而不多也。太阳阳明。治各有条。凡肾虚有热。小便频数者。清心
莲子饮。或人参三白汤加知、柏、麦冬、石莲之类。或滋补丸。补中益气汤加知、柏、麦冬、生地。
柯琴曰。此用小承气以润燥。是亦和剂。不专是下剂。
[Outline] Zhang Zhongjing stated: In Yangming disease, with spontaneous sweating, if diaphoresis (sweating therapy) is applied again, resulting in free urination (profuse and uncontrolled urination), this indicates exhaustion of body fluids internally. Although the stool is hard, purgation should not be used. One must wait for the natural urge to defecate; then, honey suppositories are suitable to guide and relieve the obstruction. Alternatively, Trichosanthes root (Tugua Gen) or large pig bile can also be used as guiding agents.
[Commentary] Ke Qin stated: Since there was already spontaneous sweating, applying diaphoresis again exhausts the fluids of the Upper Jiao outwardly. Free urition indicates that the fluids of the Lower Jiao are exhausted inwardly.
[Outline] Zhang Zhongjing stated: In Cold Damage disease, with a floating and moderate pulse, and naturally warm hands and feet, the condition is associated with the Taiyin channel. In Taiyin disease, jaundice naturally appears; however, if there is free urination, jaundice cannot develop. After seven or eight days, if the stool becomes hard, it transforms into Yangming disease. In Yangming disease, if there is paradoxically no sweat but free urination, and after two or three days vomiting and coughing occur along with cold extremities, severe headache will inevitably ensue.
[Commentary] Ke Qin stated: In the first case, free urination indicates fluids leaking outwards, causing dry earth to be affected, with the pathology located in the Stomach. In the second case, free urination indicates that there is no stagnant heat within, which can be deduced.
[Outline] Zhang Zhongjing stated: In Taiyang disease, if emesis, purgation, or diaphoresis has been applied, leading to slight irritability, frequent urination, and consequently hard stool, Xiao Chengqi Tang should be used to harmonize the condition, leading to recovery.
[Commentary] Wang Kentang stated: Yangming diseases all take free urination as a pathological sign, to verify whether the disease requires purgation. If urination is obstructed and the lower abdomen is hard, it is fecal impaction, requiring diuresis and drainage. If urination is free and the lower abdomen is hard, it is either blood stasis or dry stool, requiring unblocking and draining. Furthermore, whether jaundice develops or not, and the prognosis of life or death, can all be verified through this.
Wu Shou stated: Frequent urination refers to the frequent desire to void but with small volume. For Taiyang and Yangming diseases, treatments have specific guidelines. For cases of frequent urination due to Kidney deficiency with heat, Qingxin Lianzi Yin may be used, or Renshen Sanbai Tang added with Zhi Mu, Huang Bai, Mai Dong, Shi Lian Zi, etc., or Buzhi Wan, or Buzhong Yiqi Tang added with Zhi Mu, Huang Bai, Mai Dong, Sheng Di Huang.
Ke Qin stated: The use of Xiao Chengqi Tang here is to moisten dryness; it is also a harmonizing formula, not exclusively a purgative one.