【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。
【纲】张仲景说：少阴病，出现下利症状。如果腹泻自然停止，伴有怕冷且身体蜷缩卧床，但手脚温暖，这是可以治疗的。
【目】柯琴说：伤寒病以阳气为主。不仅阴证见到阳脉者能生，即使是阴病出现阳证表现者也可以治疗。背部属阳，腹部属阴。阳气盛则发生痉病（肌肉强直、角弓反张），阴气盛则身体蜷缩卧床。如果腹泻但手脚仍然温暖，说明阳气回复，所以可以治疗。
【纲】张仲景说：寸关尺三部脉象都紧的，口中呼出热气，嘴唇和口腔干燥，鼻中流涕，身体蜷缩卧床，脚冷，舌上有苔且口渴，不要胡乱治疗。等到第七天左右，病人轻微发热，手脚温暖，这是病情将要解除的表现。或者到了八天以上，反而发大热的，这是难治。假使伴有怕冷的，必定想呕吐；腹内疼痛的，必定想腹泻。
【目】许叔微说：虽然发热轻微，但手脚自然温暖，这是阴证得到阳气而将要解除的表现。
【纲】张仲景说：少阴病，脉象紧。到了七八天，自行下利，脉象突然变得微弱，手脚反而温暖，脉紧象反而消失，这是病情将要解除。即使有烦躁和下利，也必定自愈。
【目】魏荔彤说：这里进一步解释少阴经邪气有自行解除的原因。大概脏腑之邪属于里证应当温补，经络之邪属于表证应当发散，这已经是定论。然而感受经络之邪，有浅深之分，而人的体质禀赋，有强弱之别。如果正气虚弱而邪气盛，则非用药不能奏效。如果正气旺盛而邪气浅，则经过一个病程周期就可以自行解除。六经都是如此。如本条脉症，并不是少阴脏病的虚寒下利，而是经络中的寒邪将要消散。所以紧脉失去了紧象，忽然变为微脉。微脉是缓、是平，正是紧字的对立面，并非虚弱细微的微脉。而且脏病下利，必定手脚冰冷，如果是腹泻停止后手脚才变温暖。现在是腹泻时手脚就温暖，说明邪气不在脏而在经。明确为将要解除，虽有烦躁但不躁动，这不是阴盛而阳气回复的现象。即使用腹泻未自止，经络之邪也逐渐消除。经络之邪有过经自行解除的道理，所以紧脉去而现微脉。
【纲】张仲景说：少阴病，过了八九天，全身和手脚都发热，是因为热邪在膀胱，必定会出现便血。
【目】魏荔彤说：过了八九天而全身和手脚都发热，看似是太阳病或阳明病的热证。不知道少阴病症既然具备，如此的热，不是阳经发病，仍然是阴经发病。肾与膀胱互为表里，肾热必然旁注于膀胱，这是自然之理。膀胱为太阳腑，于是因腑热而散布到太阳经遍布周身。由此可知病不在阳经，而在阴经，消耗阴津最为迫切，不能说阴病得阳就是容易痊愈。明确其必定便血，是在太阳膀胱本经的热症而言必便血。如今在少阴肾经移注于膀胱经的热症也说必便血。膀胱一腑，与肾互为表里，属下焦血海，皆相互关联，与太阳经同样有便血的机理，就近取其必然性而言。这不是急泄下焦之热，不足以保存少阴之阴。未形成瘀血，则用猪苓汤；已形成瘀血，则用抵当汤，不用这些方法无法挽救。这与太阳病犯水的道理相同。如果已经下血且热随血泄，又须斟酌处理。
【纲】张仲景说：下利之后脉象绝灭，手脚厥冷。如果片刻后脉象恢复，手脚温暖，则生；脉象不恢复的，则死。
【目】沈金鳌按：脉象恢复、手脚温暖，是由医药之力所致。
[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.