伤寒小便数者,乃小便频来而短少也。肾与膀胱俱虚,客热乘之,虚不能制水也。又有
膀胱积热,则水行涩;涩则小便不快,故涩淋而数起也。若大便难,小便数,是为脾约。约
者,俭也。脾主为胃行其津液,今胃强脾弱,约束不行,致小便数而大便难也。
【下】太阳汗吐下后,小便数而胃不和,谵语者,少与调胃承气汤。大便硬者,小承气
汤。小便数,大便坚,
脾约丸。
【温】太阳自汗,四肢拘急,难以屈伸,心烦微恶寒,脚挛急小便数者,不可
行桂枝,宜与甘草干姜汤、芍药甘草汤。
伤寒发黄证,通身面目皆知如熏黄,如梅如橘。是因当汗不汗而生黄也,当利小便却
不利小便亦生黄也。瘀热在里,身必发黄。胸中水谷不消,太阴脾土应于肌肉湿热所蒸而
致肌黄。治须泄热渗湿为先。有头汗出,齐颈而还,渴饮水浆者,蓄血也。大抵不外表里
郁热所致,其风寒所郁者,间而有之。伤寒至于发黄,为病之已甚也,是以不治者多矣。
寸口近掌无脉,鼻气冷者不治。形体如烟熏,直视摇头者,为心绝,死。环口黧黑,柔汗
发黄,为脾绝,死。
【发汗】发热,一身尽痛,面目俱黄,太阳中湿,麻黄汤、连翘赤小豆汤。脉浮而紧
发黄者,不可下,麻黄各半汤。身热不去,瘀血在里而黄,小便微利,麻黄连翘赤小豆汤。
【和解】往来寒热,一分尽疼,小柴胡加栀子汤。脉浮弦,咳嗽短气,无汗胁痛,鼻
干嗜卧,一身及面目尽潮热,小便不利,柴苓汤。
【分利】发热头汗,渴欲饮水,小便利,大反快而黄者,五苓散加茵陈汤。小便不
利,四肢沉重,似疟,不欲饮,茵陈五苓散。服此而小便如皂荚汁,则黄从小便出也。
【阴黄当温】伤冷中寒,脉弱气虚,小便如常,变为阴黄,理中加茵陈汤。韩 和
云∶因下太过,脾胃
虚,津液竭,饮水自伤。此阴湿伤脾变黄,茵陈茯苓汤、茯苓橘皮汤、小茵陈汤、茵陈四
逆汤、茵陈茱萸汤。
【搐鼻】初觉发黄,以瓜蒂散吹鼻内,口噙水搐之,鼻中出黄水验。
伤寒病中出现小便频数的症状,是指小便频繁但尿量短少。这是因为肾与膀胱都虚弱,外来的热邪趁虚而入,导致正气虚弱无法制约水液。又有因膀胱积热,使得水液运行涩滞;涩滞则小便排出不畅,所以出现涩痛、淋沥且次数增多的情况。如果大便困难而小便频数,这称为“脾约”。“约”的意思是约束、俭省。脾的功能是为胃传输津液,现在胃气强盛而脾气虚弱,脾的传输功能受到约束而不能正常运作,从而导致小便频数而大便困难。
【汗法】太阳病经过发汗、催吐或泻下治疗后,出现小便频数且胃气不和、说胡话(谵语)的情况,应少量给予调胃承气汤。如果大便干硬,给予小承气汤。如果小便频数、大便坚硬,使用脾约丸。
【温法】太阳病自汗出,四肢拘挛紧急,难以屈伸,心中烦躁且轻微怕冷,脚部抽筋且小便频数的情况,不可使用桂枝汤,适宜给予甘草干姜汤和芍药甘草汤。
伤寒发黄证,全身及面目都像被烟熏过的黄色,或者像梅子、橘子那样的颜色。这是因为应当发汗却没有发汗而生出的黄疸,应当利小便却没有利小便也生出的黄疸。瘀热郁结在体内,身体一定会发黄。胸中水谷不消化,太阴脾土对应肌肉,湿热蒸腾而导致肌肤发黄。治疗必须以泄热渗湿为先。如果有头汗出,仅到颈部为止,口渴想喝水饮浆液的,这是蓄血证。大抵黄疸多由表里郁热所致,因风寒郁闭导致的偶尔也有。伤寒发展到发黄阶段,病情已经非常严重了,所以不治而死的很多。寸口脉搏摸不到,鼻气冰冷的,属于不治之症。身体形态像烟熏一样黑黄,眼睛直视且摇头的,是心气绝,会死亡。口唇周围发黑,出冷汗且发黄的,是脾气绝,会死亡。
【发汗】发热,全身疼痛,面目俱黄,属于太阳中湿证,用麻黄汤、连翘赤小豆汤。脉象浮紧且发黄的,不可用泻下法,用麻黄各半汤。身热不退,瘀血在体内导致发黄,小便微利,用麻黄连翘赤小豆汤。
【和解】寒热往来,全身疼痛,用小柴胡加栀子汤。脉象浮弦,咳嗽短气,无汗胁痛,鼻子干燥嗜睡,全身及面目持续潮热,小便不利,用柴苓汤。
【分利】发热且头汗出,口渴想喝水,小便通利,大便反而通畅且色黄,用五苓散加茵陈汤。小便不利,四肢沉重,像疟疾一样忽冷忽热,不想喝水,用茵陈五苓散。服用这些药物后,如果小便像皂荚汁一样颜色深黄,那么黄疸就会从小便排出。
【阴黄当温】受寒冷伤中,脉弱气虚,小便如常,转变为阴黄,用理中加茵陈汤。韩祗和说:因为泻下太过,导致脾胃虚弱,津液枯竭,饮水又损伤自身。这是阴湿伤脾变成的黄疸,可用茵陈茯苓汤、茯苓橘皮汤、小茵陈汤、茵陈四逆汤、茵陈茱萸汤。
In the context of Cold Damage (Shanghan), frequent urination refers to urine that is frequent but scanty. This occurs because both the Kidney and Bladder are deficient, allowing exogenous heat pathogens to take advantage of this weakness; the deficiency prevents the body from controlling water metabolism. Additionally, if there is accumulated heat in the Bladder, water flow becomes obstructed and sluggish; this obstruction leads to difficult and painful urination, resulting in strangury-like symptoms with frequent urges. If constipation accompanies frequent urination, it is termed "Spleen Constraint" (Pi Yue). "Yue" implies restriction or frugality. The Spleen's function is to transport fluids for the Stomach; when Stomach heat is strong but Spleen Qi is weak, the Spleen's transport function is constrained and fails to operate normally, leading to frequent urination and constipation.
[Diaphoresis Method] After Taiyang disease has been treated with sweating, vomiting, or purging methods, if the patient presents with frequent urination, disharmony of the Stomach, and delirium (Zhenyu), administer a small dose of Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction). If the stool is hard, administer Xiao Chengqi Tang (Minor Order the Qi Decoction). If there is frequent urination and hard stool, use Pi Yue Wan (Spleen Constraint Pill).
[Warming Method] In Taiyang disease with spontaneous sweating, spasticity and stiffness of the four limbs making flexion and extension difficult, irritability, slight aversion to cold, foot cramps, and frequent urination, Guizhi Tang (Cinnamon Twig Decoction) should not be used. Instead, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) and Shaoyao Gancao Tang (Peony and Licorice Decoction) are appropriate.
Jaundice in Cold Damage is characterized by the whole body and face appearing yellow like smoked meat, or resembling the color of plums or oranges. This jaundice arises from failing to sweat when sweating was indicated, or from failing to promote diuresis when diuresis was indicated. When stagnant heat resides within, the body will inevitably turn yellow. If food and fluid stagnate in the chest, and damp-heat steams the muscles corresponding to the Taiyin Spleen Earth, jaundice of the skin results. Treatment must prioritize clearing heat and leaching out dampness. If there is sweating only on the head up to the neck, accompanied by thirst for drinking liquids, this indicates Blood Accumulation (Xue Yu). Generally, jaundice is caused by stagnant heat in the interior and exterior, though cases due to constraint by Wind-Cold occasionally occur. Jaundice in Cold Damage represents a severe stage of illness, and thus many cases prove fatal. If the pulse at the Cun Kou position near the wrist is imperceptible and breath from the nose is cold, it is incurable. If the body appears dark yellow like smoke, with fixed staring gaze and head shaking, it indicates the exhaustion of Heart Qi and death. If the area around the mouth is blackish, accompanied by soft sweating and jaundice, it indicates the exhaustion of Spleen Qi and death.
[Diaphoresis Method] For fever, generalized body pain, and yellowing of the face and eyes due to Dampness affecting the Taiyang channel, use Mahuang Tang (Ephedra Decoction) or Lianqiao Chixiaodou Tang (Forsythia and Red Bean Decoction). For jaundice with a floating and tight pulse, purgation is contraindicated; use Mahuang Geban Tang (Mahuang Half-Dose Decoction). For persistent fever and yellowing due to blood stasis in the interior with slightly free urination, use Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction).
[Harmonizing Method] For alternating chills and fever with generalized pain, use Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhi Zi (Gardenia Fructus). For a floating and wiry pulse, cough, shortness of breath, absence of sweating, hypochondriac pain, dry nose, drowsiness, continuous tidal fever of the whole body and face, and difficulty in urination, use Chai Ling Tang (Bupleurum and Poria Decoction).
[Promoting Diuresis] For fever with head sweating, thirst for water, free urination, and loose, bright yellow stools, use Wuling San (Five-Ingredient Powder with Poria) added with Yin Chen (Artemisiae Scopariae Herba). For difficulty in urination, heavy sensation in the four limbs, malaria-like symptoms, and lack of desire for water, use Yinchen Wuling San (Artemisiae Scopariae and Five-Ingredient Powder with Poria Decoction). After taking these formulas, if the urine resembles soap pod juice, the jaundice will exit through the urine.
[Yin Jaundice Requires Warming] When cold damages the interior, presenting with a weak pulse and deficient Qi, while urination remains normal, transforming into Yin Jaundice, use Lizhong Tang (Regulate the Middle Decoction) added with Yin Chen (Artemisiae Scopariae Herba). Han Zhihe stated: Excessive purging leads to Spleen and Stomach deficiency, depletion of body fluids, and further injury from drinking water. This is Yin-Dampness injuring the Spleen causing jaundice; suitable formulas include Yinchen Fuling Tang (Artemisiae Scopariae and Poria Decoction), Fuling Jupi Tang (Poria and Tangerine Peel Decoction), Xiao Yinchen Tang (Minor Artemisiae Scopariae Decoction), Yinchen Sini Tang (Artemisiae Scopariae and Counterflow Toxin Decoction), and Yinchen Zhuyu Tang (Artemisiae Scopariae and Cornus Decoction).
[Nasal Irritation] At the initial sign of jaundice, blow Gudi San (Melon Spore Powder) into the nasal cavity. Hold water in the mouth and stimulate the nose; the appearance of yellow fluid from the nose confirms efficacy.