【纲】仲景曰。少阴病。下利。若利自止。恶寒而蜷卧。手见温者。可治。
【目】柯琴曰。伤寒以阳为主。不特阴症见阳脉者生。即阴病见阳症者亦可治。背为阳。腹为阴。
阳盛则作痉。阴盛则蜷卧。若利而手足仍温。是阳回。故可治。
【纲】仲景曰。脉阴阳俱紧者。口中气出。唇口燥干。鼻中涕出。蜷卧。足冷。舌上胎渴。勿
妄治也。到七日以来。其人微发热。手足温者。此为欲解。或到八日以上。反大发热者。此为难治。
设使恶寒者。必欲呕也。腹内痛者。必欲利也。
【目】许叔微曰。发热虽微。而手足自温。乃阴得阳而欲解也。
【纲】仲景曰。少阴病。脉紧。至七八日。自下利。脉暴微。手足反温。脉紧反去者。为欲解。
虽烦下利。必自愈。
【目】魏荔彤曰。此申解少阴经邪有自解之故。盖脏邪为里症宜温。经邪为表症宜散。固已。
然经邪之感也。有浅深。而人之气禀。有强弱。若其人正弱而邪盛。则非医药不为功。若正旺而邪
浅。则经尽可以自解。六经皆然耳。如本条脉症。并非少阴脏病虚寒下利也。乃在经寒邪欲散也。
所以紧者失其紧。忽变而为微。微者缓也。平也。正紧字之对。非虚微之微也。且脏病下利。必手
足冷。若利止方手足温。今下利而温。其邪不在脏而在经矣。明为欲解。虽烦而不躁。则非阴盛而
见阳回之象矣。即利未自止。经邪渐可消矣。经邪有过经自解之理。故紧去而微。
【纲】仲景曰。少阴病。八九日。一身手足尽热者。以热在膀胱。必便血也。
【目】魏荔彤曰。八九日而一身手足尽热。似为太阳阳明之热矣。不知少阴症既具。而如此之
热。非阳经为病。仍阴经为病也。肾与膀胱表里。肾热必旁注于膀胱。自然之理。膀胱为太阳腑。
遂因腑热而散于太阳经之周身。以此而
知病不在阳经。而在阴经。消耗阴津最迫。不可谓阴病得阳为易愈也。明其必便血。在太阳膀胱本
经之热症言必便血。今在少阴肾经移注于膀胱经之热症亦言必便血。膀胱一腑。与肾表里。下焦血
海。皆相联属。与太阳同有便血之机。就其切近者必之也。此非急泄下焦之热。不足以存少阴之阴
也。未成血。则猪苓。既成血。则抵当。非此无以为救。同于太阳犯水之义也。如已下血热泄。又
须斟酌。
【纲】仲景曰。下利后脉绝。手足厥逆。 时脉还。手足温者生。脉不还者死。
【目】鳌按。脉还手足温。由医药之力也。
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, if diarrhea occurs and then stops spontaneously, accompanied by aversion to cold and a curled-up posture in bed, but the hands and feet remain warm, this condition is treatable.
[Commentary] Ke Qin stated: In Shanghan (Cold Damage) diseases, Yang Qi is paramount. Not only do Yin syndromes with Yang pulses indicate survival, but Yin diseases manifesting Yang symptoms are also treatable. The back belongs to Yang, and the abdomen belongs to Yin. Excess Yang leads to spasm (Jingbing), while excess Yin leads to a curled-up posture. If diarrhea occurs yet the hands and feet remain warm, it indicates the return of Yang Qi; therefore, it is treatable.
[General Principle] Zhang Zhongjing stated: When the pulse is tight at all three positions (Cun, Guan, Chi), with hot breath from the mouth, dry lips and oral cavity, nasal discharge, a curled-up posture, cold feet, coating on the tongue, and thirst, do not treat rashly. After seven days, if the patient has slight fever and warm hands and feet, this indicates the impending resolution of the disease. However, if after eight or more days there is sudden high fever, this is difficult to treat. If accompanied by aversion to cold, vomiting will likely occur; if accompanied by abdominal pain, diarrhea will likely occur.
[Commentary] Xu Shuwei stated: Although the fever is slight, the natural warmth of the hands and feet indicates that the Yin syndrome is resolving due to the arrival of Yang Qi.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, if the pulse is tight, and after seven or eight days, spontaneous diarrhea occurs, the pulse suddenly becomes faint, the hands and feet become warm, and the tightness of the pulse disappears, this indicates impending resolution. Even if there is irritability and diarrhea, it will heal spontaneously.
[Commentary] Wei Litong stated: This further explains why pathogenic factors in the Shaoyin meridian may resolve spontaneously. Generally, pathogens in the Zang organs constitute Interior syndromes requiring warming, while pathogens in the Jing meridians constitute Exterior syndromes requiring dispersal. However, the depth of meridian pathogen invasion varies, and individual constitutional strength differs. If Zheng Qi (Upright Qi) is weak and Xie Qi (Pathogenic Qi) is strong, medical intervention is necessary. If Zheng Qi is robust and the pathogen is superficial, the disease may resolve spontaneously after one cycle of the six meridians. This applies to all six meridians. The pulse and symptoms in this passage do not represent deficiency-cold diarrhea of the Shaoyin Zang organs, but rather the dissipation of cold pathogen in the meridian. Thus, the tight pulse loses its tightness and suddenly changes to a faint pulse. "Faint" here means slow and level, the opposite of "tight," not referring to a deficient or minute pulse. Furthermore, Zang organ diarrhea invariably presents with cold hands and feet; if warmth returns only after diarrhea stops, the pathology is different. Here, the hands and feet are warm despite ongoing diarrhea, indicating the pathogen is in the meridian, not the Zang organ. This clearly indicates impending resolution. Although there is irritability, there is no restlessness, which is not the image of Yin excess with returning Yang. Even if diarrhea has not stopped, the meridian pathogen is gradually dissipating. There is a principle that meridian pathogens can resolve spontaneously after passing through the meridian cycle; hence, the tightness disappears and the faint pulse appears.
[General Principle] Zhang Zhongjing stated: In Shaoyin disease, after eight or nine days, if the entire body and hands and feet become hot, it is because the heat is in the Bladder, and hematochezia (blood in stool) or hematuria (blood in urine) will certainly occur.
[Commentary] Wei Litong stated: Heat in the entire body and hands and feet after eight or nine days might seem like heat in the Taiyang or Yangming meridians. However, given that Shaoyin symptoms are present, such heat does not indicate a Yang meridian disease but remains a Yin meridian disease. The Kidney and Bladder are interior-exterior pairs; heat in the Kidney naturally spreads to the Bladder. The Bladder is the Fu organ of Taiyang, so the heat from the Fu organ disperses throughout the body via the Taiyang meridian. This confirms the disease is in the Yin meridian, not the Yang meridian, and consumes Yin fluids urgently. One cannot assume that Yin diseases becoming Yang are easily cured. The certainty of bleeding is stated regarding heat syndromes in the Taiyang Bladder meridian itself. Now, regarding heat syndromes transferring from the Shaoyin Kidney meridian to the Bladder meridian, bleeding is also certain. The Bladder, being interior-exterior to the Kidney and belonging to the Lower Jiao Blood Sea, is closely connected and shares the mechanism for bleeding with the Taiyang meridian. This refers to the most immediate manifestation. Without urgently draining the heat of the Lower Jiao, the Yin of the Shaoyin cannot be preserved. If blood stasis has not formed, Zhu Ling Tang (Polyporus Decoction) should be used; if blood stasis has formed, Di Dang Tang (Resident Beetle Decoction) should be used. Without these, rescue is impossible. This aligns with the principle of Taiyang invading Water. If bleeding has already occurred and heat is discharged with the blood, careful consideration is required.
[General Principle] Zhang Zhongjing stated: After diarrhea, if the pulse vanishes and the hands and feet are cold, but the pulse returns and the hands and feet become warm within a short time, the patient will live; if the pulse does not return, the patient will die.
[Commentary] Shen Jin'ao noted: The return of the pulse and the warming of the hands and feet are results of medical intervention.