【纲】仲景曰。呕而脉弱。小便复利。身有微热。见厥者。难治。四逆汤主之。
【目】张从正曰。既呕而又发热。似乎小柴胡症也。却又脉弱。热又微。内无大热也。所以小
便利。见厥者。表寒也。呕者。膈上有寒饮也。则诸症皆见阳消阴长之兆。何可治乎。
【纲】仲景曰。既吐且利。小便复利。而大汗出。下利清谷。内寒外热。脉微欲绝者。四逆汤
主之。
【目】鳌按。三阴皆有小便自利症。不特少阴也。如太阴伤寒脉浮而缓。手足自温。当发黄。
小便自利。不发黄。至七八日。虽暴烦。下利日十余行。必自止。厥阴伤寒热少厥微。指头寒。嘿
嘿不欲食。烦躁。数日。小便利色白者。此热除也。欲得食。为病愈。是也。太阴厥阴。不另立款。
故附于此。此条小便利。是门户不约也。
（附小便难）
【纲】仲景曰。少阴病。咳而下利。谵语者。被火气劫故也。小便必难。以强责少阴汗故也。
【目】柯琴曰。少阴受邪。复受火侮。枢机无主。大肠清浊不分。膀胱水道不利。故下利而小
便难也。小便利者可治。此阴虚。故小便难也。
【纲】仲景曰。少阴病。二三日不已。至四五日。腹痛。小便不利。四肢沉重疼痛。自下利者。
此为有水气。其人或咳。或小便利。或下利。呕者。真武汤主之。
【目】柯琴曰。小便不利是病根。诸症皆因此而致。然小便不利。实由坎中无阳。坎中火用不宣。
故肾家水体失职。是下焦虚寒不能制水故也。法当壮元阳以消阴翳。三或字。是加减症。不是主
症。
【纲】仲景曰。二三日。至四五日。腹痛。小便不利。下利不止。便脓血者。桃花汤主之。
【目】柯琴曰。少阴病。腹痛下利。是坎中阳虚。故真武有附子。桃花用干姜。不可以小便不
利。作热治。真武是引火归
原法。桃花是升阳散火法。
【纲】仲景曰。少阴病。四逆。其人或咳。或悸。或小便不利。或腹中痛。或泄利下重者。四逆
散主之。
【目】朱肱曰。阴症小便不利。手足厥冷。脉微细者。不宜服利小便冷滑药。但服返阴丹。并取
脐下石门穴灸之。
吴绶曰。太阴腹满自利。小便不利。无热。脉沉者。理中汤合五苓散。更加浓朴、木香。分利
其小便。而大便自止。厥阴便闭。厥冷脉伏。囊缩入腹。小便不利。宜四逆汤加通草、茯苓。或灸
气海石门穴。或以葱熨法治之。
鳌按。朱吴二说。一于少阴病灸石门穴。一于厥阴病灸石门穴。其皆灸石门者。所谓肝肾同一
治也。
【纲】张仲景说：呕吐且脉象微弱，小便反而通利，身体有轻微发热，出现四肢厥冷的症状，属于难治之证。应以四逆汤主治。
【目】张从正说：既然呕吐又伴有发热，看似是小柴胡汤证。但脉象微弱，热势轻微，体内没有大热。所以小便通利，出现四肢厥冷，这是表寒所致。呕吐是因为膈上有寒饮停聚。那么这些症状都呈现出阳气消减、阴气增长的征兆，怎么能治愈呢？
【纲】张仲景说：既呕吐又腹泻，小便反而通利，并且大汗出，泻下未消化的食物（完谷不化），内里寒冷而外表发热，脉象微弱几乎摸不到，应以四逆汤主治。
【目】沈金鳌按语：三阴经（太阴、少阴、厥阴）都有小便自利的症状，不仅限于少阴病。例如太阴伤寒，脉象浮而缓，手足自然温暖，应当发黄；若小便自利，则不发黄。到了七八天，虽然突然烦躁，每天腹泻十几次，必定会自行停止。厥阴伤寒，热少厥微，手指头寒冷，沉默不想吃东西，烦躁。过了几天，小便通利且颜色白，这是热邪已除的表现，想要进食，说明病将痊愈。太阴和厥阴病没有单独设立条目，所以附记在此。这一条中的“小便利”，是指门户（膀胱括约肌功能）不能固摄。
（附注：小便困难）
【纲】张仲景说：少阴病，咳嗽并伴有腹泻，出现谵语（神志不清，胡言乱语），这是因为被火疗强行劫夺津液所致。小便必定困难，这是由于强行要求少阴病发汗造成的。
【目】柯琴说：少阴经受邪，又受到火疗的侵害，枢机失去主宰，大肠清浊不分，膀胱水道不利，所以导致腹泻和小便困难。如果小便通利，尚可治疗。此症因阴虚，所以小便困难。
【纲】张仲景说：少阴病，两三天未愈，发展到四五天，出现腹痛，小便不利，四肢沉重疼痛，自行腹泻，这是有水气停留。其人或有咳嗽，或小便利，或腹泻，或呕吐者，以真武汤主治。
【目】柯琴说：小便不利是病根，各种症状都是由此引发的。然而小便不利，实际上是由于肾中（坎卦之中）缺乏阳气，肾中阳气的温煦功能无法宣通，导致肾脏调节水液的功能失职，这是下焦虚寒不能制约水湿的缘故。治法应当壮补元阳以消除阴寒阴影。文中的三个“或”字，表示加减变化的症状，不是主要症状。
【纲】张仲景说：发病两三天到四五天，腹痛，小便不利，腹泻不止，大便带有脓血，以桃花汤主治。
【目】柯琴说：少阴病，腹痛腹泻，是肾中（坎卦之中）阳气虚弱所致，所以真武汤中使用附子，桃花汤中使用干姜。不可以因为小便不利就当作热证来治疗。真武汤是引火归原的方法，桃花汤是升阳散火的方法。
【纲】张仲景说：少阴病，四肢厥冷，其人或有咳嗽，或心悸，或小便不利，或腹中痛，或泄泻伴肛门重坠感者，以四逆散主治。
【目】朱肱说：阴证出现小便不利，手足厥冷，脉象微细者，不宜服用利尿的寒滑药物。只应服用返阴丹，并灸脐下的石门穴。
吴绶说：太阴病腹部胀满且自利，小便不利，无发热，脉象沉者，用理中汤合五苓散，再加厚朴、木香，分利其小便，大便自然会止住。厥阴病便秘，厥冷脉伏，睾丸收缩入腹，小便不利，宜用四逆汤加通草、茯苓，或者灸气海、石门穴，或用葱熨法治之。
沈金鳌按语：朱肱和吴绶两人的说法，一个是在少阴病时灸石门穴，一个是在厥阴病时灸石门穴。他们都灸石门穴，这就是所谓的肝肾同治的道理。
[Outline] Zhang Zhongjing stated: When there is vomiting with a weak pulse, urination is actually free, the body has slight fever, and cold extremities are present, this is difficult to treat. It should be primarily treated with Sini Tang (Four Reversal Decoction).
[Commentary] Zhang Congzheng stated: Since there is vomiting accompanied by fever, it seems to be a Xiaochaihu Tang (Minor Bupleurum Decoction) pattern. However, the pulse is weak, the fever is slight, indicating no significant internal heat. Therefore, urination is free, and cold extremities appear due to exterior cold. Vomiting occurs because of cold-fluid retention above the diaphragm. Thus, all these symptoms manifest as signs of declining Yang and rising Yin; how can they be cured?
[Outline] Zhang Zhongjing stated: When there is both vomiting and diarrhea, urination is actually free, profuse sweating occurs, stool contains undigested food, there is interior cold with exterior heat, and the pulse is faint and almost imperceptible, it should be primarily treated with Sini Tang (Four Reversal Decoction).
[Commentary] Shen Jin'ao noted: The Three Yin channels (Taiyin, Shaoyin, Jueyin) all have patterns of spontaneous free urination, not limited to Shaoyin disease. For example, in Taiyin Cold Damage, if the pulse is floating and slow, and hands and feet are naturally warm, jaundice should develop; however, if urination is free, jaundice does not occur. By the seventh or eighth day, even if there is sudden irritability and diarrhea more than ten times a day, it will surely stop on its own. In Jueyin Cold Damage, with little heat and mild cold extremities, only the fingertips are cold, the patient is silent, desires no food, and is irritable. After several days, if urination is free and white in color, this indicates the heat has been eliminated; desire for food signifies recovery. Since Taiyin and Jueyin diseases do not have separate sections, they are attached here. In this passage, "free urination" refers to the failure of the gate (bladder sphincter function) to retain.
(Attached: Difficulty in Urination)
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if there is coughing with diarrhea and delirium, it is caused by the forcible seizure of fluids via fire therapy. Urination will certainly be difficult, resulting from the forced induction of sweating in Shaoyin disease.
[Commentary] Ke Qin stated: When the Shaoyin channel is invaded by pathogenic factors and further insulted by fire therapy, the pivot mechanism loses control, leading to the inability of the Large Intestine to separate clear from turbid, and the bladder's water passages becoming obstructed. Hence, diarrhea and difficulty in urination occur. If urination is free, it is treatable. This condition involves Yin deficiency, hence the difficulty in urination.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, if after two or three days it persists into the fourth or fifth day, abdominal pain, difficulty in urination, heavy and painful limbs, and spontaneous diarrhea occur, this indicates the presence of water qi (fluid retention). The patient may also have coughing, or free urination, or diarrhea, or vomiting. In such cases, Zhenwu Tang (True Warrior Decoction) should be used.
[Commentary] Ke Qin stated: Difficulty in urination is the root of the disease, and all other symptoms arise from it. However, difficulty in urination is actually due to the lack of Yang energy in the Kidney (the center of Kan trigram), where the warming function of Fire in Kan fails to circulate. Consequently, the Kidney's responsibility to regulate water is impaired, which is due to lower jiao deficiency-cold failing to control water. The treatment method should be to strengthen Yuan Yang to dispel Yin shadows. The three "or" characters in the text indicate variable symptoms for modification, not main symptoms.
[Outline] Zhang Zhongjing stated: From the second or third day to the fourth or fifth day, if there is abdominal pain, difficulty in urination, unceasing diarrhea, and pus and blood in the stool, Taohua Tang (Peach Blossom Decoction) should be used.
[Commentary] Ke Qin stated: In Shaoyin disease, abdominal pain and diarrhea indicate deficiency of Yang in the Kidney (Kan center). Therefore, Fuzi (Aconite Root) is used in Zhenwu Tang, and Ganjiang (Dried Ginger) in Taohua Tang. One must not treat difficulty in urination as a Heat pattern. Zhenwu Tang employs the method of guiding fire back to its source, while Taohua Tang employs the method of raising Yang and dispersing fire.
[Outline] Zhang Zhongjing stated: In Shaoyin disease, with cold extremities, if the patient also has coughing, palpitations, difficulty in urination, abdominal pain, or diarrhea with a sensation of heaviness in the rectum, Sini San (Four Reversal Powder) should be used.
[Commentary] Zhu Gong stated: In Yin patterns with difficulty in urination, cold extremities, and a faint, thin pulse, one should not administer cold and slippery diuretic drugs. Instead, only Fan Yin Dan (Return to Yin Pill) should be administered, and moxibustion should be applied to the Shimen (Stone Gate) acupoint below the navel.
Wu Shou stated: In Taiyin disease with abdominal fullness and spontaneous diarrhea, difficulty in urination, absence of heat, and a deep pulse, Lizhong Tang (Regulate the Middle Decoction) combined with Wuling San (Five Ling Powder) should be used, plus Houpo (Magnolia Bark) and Muxiang (Aucklandia Root), to separate and drain the urine, so that the stool will naturally stop. In Jueyin disease with constipation, cold extremities, hidden pulse, and retraction of the testicles into the abdomen, with difficulty in urination, Sini Tang (Four Reversal Decoction) added with Tongcao (Tetrapanax Pith) and Fuling (Poria) should be used, or moxibustion applied to Qihai (Sea of Qi) and Shimen (Stone Gate) acupoints, or treated with scallion ironing therapy.
Shen Jin'ao noted: Zhu Gong and Wu Shou both recommended moxibustion on the Shimen acupoint, one for Shaoyin disease and the other for Jueyin disease. Their common use of Shimen illustrates the principle that Liver and Kidney share the same treatment approach.