【纲】仲景曰。太阳病六七日。表症仍在。脉微而沉。反不结胸。其人发狂。以热在下焦。小
腹当硬。小便自利者。下血乃愈。抵当汤。太阳病。身黄。脉沉结。小腹硬。小便自利。其人如狂。
血症也。抵当汤。伤寒有热。小腹满。应小便不利。今反利者。为有血也。当下之。不可余药。
宜抵当丸。
【目】成无己曰。小便自利。有在表者。有在里者。有热而利者。有寒而利者。六经俱有之症。
难以概治。宜随所犯而施药可也。
【纲】仲景曰。太阳中风。火劫。汗后。发黄。欲衄。小便难。头汗出。腹满微喘。口干咽烂。
或不大便。久则谵语。甚者至哕。捻衣摸床。小便利者。可治。
伤寒八九日。风湿相抟。身作疼烦。不能转侧。不呕不渴。脉浮虚而涩者。桂枝附子汤。若其
人小便自利。去桂枝加白术汤。
【目】陶华曰。小便自利者。为津液渗漏。大便必硬。宜以药微下之。其阳明自汗者。复发其
汗。津液内竭。屎虽硬。尤不可攻。纵大便难。蜜煎导之。太阴当发黄。其小便利。则湿热内泄。
不能发黄。惟血症则腹急而如狂。肾与膀胱虚。不能约制水液。二者皆小便自利。若肾与膀胱虚而挟
热。热则水道涩。小便不快。故涩淋而数起也。若自汗而小便数。虽有表症。不可用桂枝。以其亡走
津液也。若误服之。以甘草干姜汤为治可也。若太阳病。小便自利。以饮水多。心下悸。茯苓桂枝甘
草汤。脉浮自汗。小便数。胃不和。谵语者。少与调胃承气汤。
【纲】仲景曰。伤寒脉浮。自汗出。小便数。心烦微恶寒。脚挛急。反与桂枝汤。欲攻其表。此
误也。得之便厥。烦躁吐逆者。作甘草干姜汤与之。以复其阳。若厥愈足温者。更作芍药甘草汤与
之。其脚即伸。若胃气不和。谵语者。少与调胃承气汤。
【目】柯琴曰。小便数者。肾与膀胱俱虚而有客热乘之也。太阳阳明二经既虚。致受于客热。
热则不能制水。故令数。小便热。则水行涩。涩则小便不快。故令数起也。诊其趺阳脉数。胃中热。
即消谷引饮。大便必硬。小便即数也。
鳌按。小便数。或在表。或在里。惟三阳有之。三阴则无此症也。
<translation>
[General Principle] Zhang Zhongjing stated: In Taiyang disease lasting six or seven days, if the exterior syndrome persists, the pulse is faint and deep, and there is no formation of Jie Xiong (chest binding syndrome), but the patient becomes manic, it is due to heat in the Lower Jiao. The lower abdomen should be hard. If urination is normal and free, healing can be achieved by purging blood stasis using Didang Tang (Madder Decoction). In Taiyang disease, if the body is yellow, the pulse is deep and choppy, the lower abdomen is hard, urination is normal and free, and the patient exhibits a manic-like state, this is a Blood Syndrome (Xue Zheng), treated with Didang Tang (Madder Decoction). In Shanghan (Cold Damage) with fever, if the lower abdomen is full, one would expect difficulty in urination; however, if urination is now normal and free, it indicates the presence of blood stasis. It should be purged, and no other medicines are suitable except Didang Wan (Madder Pill).
[Commentary] Cheng Wuji stated: Normal and free urination can occur in exterior syndromes or interior syndromes; it can result from heat causing frequency or cold causing frequency. This symptom appears in all Six Channels, making it difficult to treat uniformly. Medication should be administered according to the specific pathogenic factor and location.
[General Principle] Zhang Zhongjing stated: In Taiyang Wind Strike syndrome, after being subjected to fire therapy to induce sweating, jaundice may develop. There may be a desire for nosebleed, difficulty in urination, sweating only on the head, abdominal fullness with slight wheezing, dry mouth and rotting throat. Or there may be constipation. Over time, delirium may occur. In severe cases, hiccups, picking at clothes, and touching the bed may appear. If urination is normal and free, the condition is treatable.
In Shanghan lasting eight or nine days, if wind-dampness combats each other, causing body pain and restlessness such that the patient cannot turn over, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is used. If the patient has normal and free urination, remove Guizhi (Cinnamon Twig) and add Baizhu (Atractylodes Macrocephala Rhizome).
[Commentary] Tao Hua stated: Normal and free urination indicates leakage of body fluids, so the stool will inevitably be hard. Mild purgation is appropriate. In Yangming syndrome with spontaneous sweating, inducing further sweating will deplete internal fluids. Even if the stool is hard, aggressive purgation is contraindicated. If bowel difficulty persists, honey suppositories should be used. In Taiyin syndrome, jaundice should develop; however, if urination is normal and free, damp-heat is excreted internally, preventing jaundice. Only in Blood Syndromes does abdominal urgency and a manic-like state occur. Deficiency of the Kidney and Bladder fails to control fluid metabolism, also leading to normal and free urination. Both conditions present with normal and free urination. If Kidney and Bladder deficiency is accompanied by heat, the heat causes obstruction in the water passages, leading to difficult and uncomfortable urination, resulting in painful dribbling and frequent urination. If there is spontaneous sweating with frequent urination, even if an exterior syndrome exists, Guizhi Tang (Cinnamon Twig Decoction) must not be used because it consumes fluids. If mistakenly taken, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) can be used for treatment. In Taiyang disease, if urination is normal and free due to excessive water intake causing palpitations in the epigastrium, Fuling Guizhi Gancao Tang (Poria, Cinnamon Twig, and Licorice Decoction) is indicated. For floating pulse, spontaneous sweating, frequent urination, stomach disharmony, and delirium, a small amount of Xiaochengqi Tang (Minor Order the Stomach Decoction) should be given.
[General Principle] Zhang Zhongjing stated: In Shanghan with a floating pulse, spontaneous sweating, frequent urination, mental restlessness, slight aversion to cold, and cramped legs, administering Guizhi Tang (Cinnamon Twig Decoction) to attack the exterior is an error. This leads to cold extremities, irritability, vomiting, and reflux. One should administer Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) to restore Yang Qi. Once the cold extremities resolve and feet become warm, administer Shaoyao Gancao Tang (Peony and Licorice Decoction), which will straighten the legs. If stomach disharmony occurs with delirium, a small amount of Xiaochengqi Tang (Minor Order the Stomach Decoction) should be given.
[Commentary] Ke Qin stated: Frequent urination results from deficiency in both the Kidney and Bladder, allowing guest-heat to invade. Since the Taiyang and Yangming channels are deficient, they are susceptible to guest-heat. Heat fails to control water, causing frequency. Heat in urine causes sluggish flow, leading to discomfort and frequent urges. Palpating the Yuyang (Dazu) pulse as rapid indicates heat in the stomach, leading to digestion of food and increased drinking, hard stools, and frequent urination.
Shen Jin'ao's Note: Frequent urination may be in the exterior or interior, occurring only in the Three Yang channels; it does not occur in the Three Yin channels.
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