【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。
【纲】张仲景说：太阳病经过六七天，表证仍然存在，脉象微而沉，反而没有形成结胸证。病人出现发狂的症状，这是因为热邪在下焦。小腹部应当坚硬，如果小便通畅自利，那么通过攻下瘀血才能痊愈，方用抵当汤。太阳病，身体发黄，脉象沉涩，小腹部硬满，小便通畅自利，病人神志如狂，这是蓄血证，方用抵当汤。伤寒病有发热，小腹胀满，按理应该小便不利，现在反而小便通利，这是体内有瘀血，应当攻下，不可使用其他药物，适宜用抵当丸。
【目】成无己说：小便自利，有的属于表证，有的属于里证；有的是因热所致的小便频数，有的是因寒所致的小便频数。这是六经病都可能出现症状，难以一概而论进行治疗，应当根据病变所在的部位和性质来施药。
【纲】张仲景说：太阳中风证，经过火劫发汗后，导致发黄，想要鼻衄（出血），小便困难，头部出汗，腹部胀满且轻微气喘，口干咽部腐烂。或者大便不通，时间久了会出现谵语，严重的甚至出现呃逆、捻衣摸床等危重症状。如果小便通利，说明正气尚存，可以治疗。
伤寒病经过八九天，风湿二气相搏结，身体疼痛烦扰，不能翻身转侧，没有呕吐也没有口渴，脉象浮虚而涩的，用桂枝附子汤。如果病人小便自利，去掉桂枝，加白术，即白术附子汤（注：原文虽未明示方名变化，但依《伤寒论》原意及上下文逻辑，此处指去桂加术之变方，通常称为白术附子汤或仍归入桂枝附子汤加减范畴，此处忠实于原文“去桂枝加白术汤”的描述）。
【目】陶华说：小便自利的，是因为津液渗漏，大便必然干硬，适宜用药微微通便。如果是阳明病自汗出的，再次发汗，会导致津液内竭，虽然大便硬，尤其不可攻下。即使大便困难，也用蜜煎导法。太阴病应当发黄，但如果小便通利，则湿热从内部泄出，不能发黄。只有蓄血证才会腹部急迫且神志如狂。肾与膀胱虚弱，不能制约水液，也会导致小便自利。这两者都是小便自利的情况。如果肾与膀胱虚弱兼夹热邪，热邪会使水道涩滞，小便不畅快，所以会出现涩痛淋沥且次数增多。如果有自汗且小便频数，虽然有表证，也不可用桂枝汤，因为它会耗散津液。如果误服了，可以用甘草干姜汤来治疗。如果是太阳病，小便自利，因为饮水过多导致心下悸动，用茯苓桂枝甘草汤。脉浮自汗，小便频数，胃气不和出现谵语的，少量给予调胃承气汤。
【纲】张仲景说：伤寒病，脉浮，自汗出，小便频数，心烦，轻微恶寒，脚部拘挛急迫。反而给予桂枝汤，想要攻解表邪，这是错误的。服药后出现四肢厥冷，烦躁吐逆的，制作甘草干姜汤给病人服用，以恢复其阳气。如果四肢厥冷痊愈，足部变暖，再制作芍药甘草汤给病人服用，他的脚就能伸直。如果胃气不和，出现谵语的，少量给予调胃承气汤。
【目】柯琴说：小便频数，是肾与膀胱都虚弱且有客热侵袭所致。太阳经和阳明经既然虚弱，导致受到客热侵袭。热邪则不能制约水液，所以导致小便频数。小便热，则水流涩滞，涩滞则小便不畅快，所以导致频频起尿。诊察其趺阳脉数，说明胃中有热，就会消谷善饥并引饮，大便必然干硬，小便也就频数。
沈金鳌按：小便频数，有的在表，有的在里，只有三阳病才有此症，三阴病则没有这个症状。
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[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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