【纲】仲景曰。尺寸脉微缓者。厥阴受病也。当六七日发。其症少腹烦满。而囊缩。
病者手足厥逆。言我不结胸。小腹满。按之痛者。此冷结在膀胱关元也。胁下素有痞。连在脐
旁。痛引少腹。入阴筋者。名脏结。死。
【目】王肯堂曰。少腹。下焦所治。当膀胱上口。主分别清浊。冷结在膀胱。或用真武汤。
夫胸中满。心下满。皆气也。腹满者。多有燥屎也。少腹满者。有物聚也。盖身半以上。同天
之阳。身半以下。同地之阴。清阳出上窍。浊阴出下窍。故在上满者。气也。在下满者。物也。物
者。溺与血耳。邪结下焦。则津液不通。血气不行。或溺或血。留滞而腹胀也。若小便利者。蓄血
之症。小便不利者。溺涩症也。俱是热病。惟冷结膀胱。少腹满一症。为寒病。有手足厥冷可辨。
【纲】仲景曰。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。
当先解外。外解已。但少腹急结者。乃可攻之。宜桃仁承气汤。
【目】成无己曰。如狂者。热在下焦。必与血相搏。若不蓄。为热迫之。则血自下。下则热随血
出而自愈。不下则血为热搏。蓄积于下。而少腹急结。乃可攻之。以下热散血。内经曰。从外之内
而盛于内者。先治其外。后调其内。此之谓也。
[General Principles] Zhang Zhongjing stated: When the pulse at both the Cun (inch) and Chi (cubit) positions appears slightly slow and mild, it indicates that the Jueyin meridian is affected. This condition typically manifests on the sixth or seventh day of onset. The symptoms include a sense of vexation and fullness in the lower abdomen, along with retraction of the scrotum.
If the patient experiences cold extremities and states, "I do not have chest binding (Jie Xiong)," yet presents with fullness in the lower abdomen and pain upon palpation, this indicates cold binding at the Guanyuan point of the Bladder.
If there has long been a mass (Pi) under the hypochondrium extending to the side of the umbilicus, with pain radiating to the lower abdomen and entering the genitalia (penis), this disease is named Zang Jie (Organ Binding). It carries a fatal prognosis.
[Commentary] Wang Kentang stated: The lower abdomen is governed by the Lower Jiao, located at the upper opening of the Bladder, and its primary function is to separate the clear from the turbid. If cold binds in the Bladder, Zhenwu Tang may be used.
Fullness in the chest and below the heart is due to Qi stagnation. Fullness in the abdomen is mostly caused by dry feces. Fullness in the lower abdomen is caused by the accumulation of tangible matter. Generally, the upper half of the body corresponds to the Yang of Heaven, while the lower half corresponds to the Yin of Earth. Clear Yang emerges from the upper orifices, and turbid Yin exits through the lower orifices. Therefore, fullness in the upper part is due to Qi, whereas fullness in the lower part is due to tangible matter. Such tangible matter consists merely of urine and blood.
When pathogenic factors bind in the Lower Jiao, body fluids become obstructed, and Qi and Blood fail to circulate. Consequently, either urine or blood remains stagnant, leading to abdominal distension. If urination is unobstructed, it is a symptom of Blood Accumulation (Xu Xue); if urination is difficult, it is a symptom of Urinary Retention (Niao Se). Both are classified as Heat diseases. Only the symptom of lower abdominal fullness caused by Cold binding in the Bladder belongs to Cold diseases, which can be distinguished by cold extremities.
[General Principles] Zhang Zhongjing stated: If the Taiyang disease is not resolved, heat binds in the Bladder. The patient will exhibit a manic state resembling madness (Ru Kuang). If blood discharges spontaneously, the disease will heal. If the exterior syndrome is not yet resolved, attack methods should not be employed yet. One must first resolve the exterior. Once the exterior is resolved, if only urgent binding and pain in the lower abdomen remain, then an attack method can be used. Tao Ren Cheng Qi Tang is appropriate.
[Commentary] Cheng Wuji stated: The symptom of "resembling madness" occurs because heat in the Lower Jiao necessarily contends with blood. If blood does not accumulate but is merely forced by heat, it will discharge spontaneously. Upon discharge, the heat dissipates with the blood, and the disease heals. If the blood does not discharge, it is contended by heat and accumulates in the lower part, causing urgent binding in the lower abdomen; only then can an attack method be used to purge heat and dissipate blood.
The Neijing states: "When pathogens enter from the exterior into the interior and become prevalent within, treat the exterior first, then regulate the interior." This refers to such cases.