伤寒郑声为邪音也。孔子曰。恶郑声之乱雅乐也。又曰。放郑声。远佞人。郑声淫。
人
今
重
数
意
则
气
小便自利。非血证则肾虚也。惟血证则小腹结而如狂。惟肾与膀胱俱虚。则不能约束制
水液
满。
腹虽
自汗
小便
大便
是
谵语者。少与调胃承气汤。太阳自汗。四肢拘急。心烦微恶寒。脚挛急。小便数。误服桂枝
汤
气
歌曰。小便自利血相干。蜜导阳明肾证寒。脾约谵语脚挛急。太阳汗下大便艰。
又云。小便自利者。太阳证下焦有热。小腹必满。小便必不利。而反利者血证也。抵当
汤。
腹必
便自
抵
经
也
急难以
草汤。
大便则
与小
伤寒下利多种。须识别阴阳。勿令差误。三阳下利则身热。太阴下利手足温。少阴厥阴
下利身不热。以此别之。大抵下利挟太阳脉证。不得即用温药。俗医但见下利。便曰阴证。
用温
太阳、阳明合病。必下利。葛根汤主之。下利而头疼腰疼。肌热。目痛鼻干。其脉浮大
而长
太阳、少阳合病。自下利。黄芩汤主之。若呕者。黄芩汤加半夏、生姜。下利而头疼胸
满。
阳明、少阳合病。必下利。其脉不负者顺也。负者逆也。因相克贼。名为负也。下利身
热。
阳属
负者
自利不渴。属太阴。四逆汤。理中汤主之。
自利而渴。属少阴。白通汤。白通加猪胆汤。通脉四逆汤。猪苓汤。真武汤。四逆加人
参汤
其余下利。皆因汗下后证也。大抵伤寒下利。须看脉与外证。下利而脉大者虚也。脉微
弱者
而滑
脐
或下利清谷。湿毒瓦斯盛则下利腹痛。大便如脓血。或如烂肉汁也。下利欲饮水者。以内有热
也。下利谵语者。有燥屎也。寒毒入胃者。四逆汤。理中汤。白通汤加附子。四逆散加薤白
主之。协热利者。黄芩汤。白头翁汤。三黄熟艾汤。薤白汤。赤石脂丸。湿毒下脓血者。桃
花汤
若少
先
生
仲景云。趺阳脉浮涩。少阴脉如经者。其病在脾。法当下利。注云。脾虚不能制水。肾
气平
歌曰。伤寒下利多般数。须辨阴阳勿差误。惟有阳明合少阳。若还克贼名为负。
又云。肾虚下利苦咽干。不识惟知脏有寒。协热胃寒并湿毒。利而谵语下之安。
下利而谵语者。有燥屎也。调胃承气汤。太阳、阳明合病。脉浮大而长。下利者葛根汤。
太
利
或迟而滑者。有宿食也。宜下之。小承气汤。自利不渴属太阴。四逆汤。理中汤。自利而渴
属少阴。脉微者白通汤。厥逆脉不至者。白通猪胆汁汤。通脉四逆汤。咳而呕渴。心烦不得
眠者猪苓汤。三阴下利。法当温之。自利清水。心下痛。口干燥者即宜下。不可不知也。温
之四逆、理中辈。下之大柴胡、承气汤也。三阳下利亦有饮水者。乃有热也。治如肠垢法。
下利心中痞。自有痞而下利条。
大便硬结虽宜下。亦有诸般不可攻。肠垢 溏分冷热。不妨步蹑古人踪。华佗云。寒即
溏。
须根据
丸。鸭
胶汤。
伤寒病中出现的“郑声”，是指患者神志不清时发出的重复、低微且杂乱无章的言语，如同邪气干扰所致。孔子曾说：“厌恶郑声扰乱雅乐。”又说：“摒弃郑声，远离巧言令色之人。因为郑声淫靡不正。”
若小便自利（小便通畅或频数），如果不是血证，就是肾虚。只有血证才会出现小腹硬满结聚且神情如狂的症状。只有肾与膀胱都虚弱时，才能导致水液代谢失常，出现小便频数、腹部胀满等症状。如果是谵语（胡言乱语），应少量给予调胃承气汤以调和胃气。太阳病伴有自汗出，四肢拘急挛缩，心中烦躁，轻微恶寒，脚部挛急，小便频数，这是误服桂枝汤导致的变证。
歌诀说：小便自利多因血分受扰。蜜导法适用于阳明腑实或肾阳虚寒之证。脾约证见谵语、脚挛急，是太阳病误用汗下法后大便艰难所致。
又云：小便自利者，若是太阳病下焦有热，小腹必然胀满，小便应当不利；如果反而通利，则是血证，应用抵当汤治疗。
伤寒下利有多种类型，必须辨别阴阳属性，以免诊断错误。三阳经下利则身体发热；太阴经下利则手足温暖；少阴、厥阴经下利则身体不发热，据此可以鉴别。大抵下利兼有太阳脉证者，不可立即使用温药。世俗医生只见下利，便说是阴证，从而滥用温补。
太阳与阳明合病，必然出现下利，主方为葛根汤。下利伴有头痛、腰痛、肌热、目痛、鼻干，脉象浮大而长，属此类。
太阳与少阳合病，自发下利，主方为黄芩汤。若伴有呕吐，则在黄芩汤基础上加半夏、生姜。下利伴有头痛、胸胁胀满，属此类。
阳明与少阳合病，必然出现下利。脉象不虚者为顺证，脉象虚者为逆证。这是因为五行相克贼害，称为“负”。下利伴身热，属此类。
自利而不口渴，属于太阴病，主方为四逆汤或理中汤。
自利而口渴，属于少阴病，主方可选白通汤、白通加猪胆汤、通脉四逆汤、猪苓汤、真武汤、四逆加人参汤等。
其余的下利，大多是因为发汗或攻下后的变证。大抵伤寒下利，必须观察脉象和外在症状。下利而脉大者，多为虚证；脉微弱者亦为虚；脉滑者可能有宿食。或者下利排出未消化的食物（清谷），若湿毒之气盛，则下利腹痛，大便如脓血，或像烂肉汁一样。下利想喝水的，是因为体内有热。下利出现谵语的，是因为有燥屎内结。寒毒入胃的，可用四逆汤、理中汤、白通汤加附子、四逆散加薤白主治。协热利（表里俱热之下利）的，可用黄芩汤、白头翁汤、三黄熟艾汤、薤白汤、赤石脂丸等。湿毒下脓血的，可用桃花汤等。
张仲景说：趺阳脉浮涩，少阴脉如常，其病在脾，法当出现下利。注解说：脾虚不能制约水湿，肾气平和，故病在脾。
歌诀说：伤寒下利种类繁多，必须辨别阴阳勿出差错。唯有阳明合少阳，若发生相克贼害，名为“负”证。
又云：肾虚下利痛苦且咽干，不识此证只知脏腑有寒。协热利、胃寒及湿毒下利，若出现谵语，用攻下法可安。
下利而谵语的，是有燥屎，用调胃承气汤。太阳、阳明合病，脉浮大而长，下利的，用葛根汤。脉迟而滑的，有宿食，宜用攻下法，用小承气汤。自利不渴属太阴，用四逆汤、理中汤。自利而渴属少阴，脉微的用白通汤，厥逆脉不至的用白通加猪胆汁汤、通脉四逆汤。咳嗽而呕吐、口渴、心烦不得眠的，用猪苓汤。三阴经下利，法当用温法。自利清水，心下疼痛，口干燥的，即宜用攻下法，不可不知。温法包括四逆汤、理中汤之类；攻下法包括大柴胡汤、承气汤之类。三阳经下利也有饮水的，那是因为有热，治疗参照肠垢法。下利伴心中痞塞，自有痞证下利的条文可供参考。
大便硬结虽宜攻下，但也有各种情况不可攻伐。肠垢分为冷利和热利，不妨遵循古人的足迹。华佗说：寒性下利则为溏泄……须根据……丸剂、鸭胶汤等辨证施治。
Zhengsheng (repetitive, low-pitched speech due to mental confusion) in Shanghan disease refers to disordered speech caused by pathogenic factors. Confucius said, "I detest Zhengsheng for disrupting Ya Yue (elegant music)." He also said, "Discard Zhengsheng, stay away from flattering people. For Zhengsheng is licentious."
If the urine flows freely (normal or frequent urination), it is not a blood syndrome but rather Kidney deficiency. Only in a blood syndrome will there be hardness and fullness in the lower abdomen accompanied by a manic-like state. Only when both the Kidney and Bladder are deficient can water metabolism be impaired, leading to frequent urination and abdominal fullness. If there is Zhanyu (delirious speech), administer a small amount of Tiaowei Chengqi Tang to harmonize the Stomach. In Taiyang disease with spontaneous sweating, stiffness and spasms of the four limbs, vexation, slight aversion to cold, and calf cramps with frequent urination, this is a complication resulting from the mistaken use of Guizhi Tang.
The verse states: Frequent urination often involves disturbance in the Blood level. Honey suppositories are indicated for Yangming excess or Kidney Yang deficiency cold. Splei-yue syndrome presenting with delirium and leg cramps results from difficulty in defecation after erroneous sweating and purging in Taiyang disease.
It is also stated: In Taiyang disease with heat in the Lower Jiao, if the urine flows freely, there must be lower abdominal fullness; normally, urination should be difficult. If it is instead free, it indicates a blood syndrome, treated with Didang Tang.
There are many types of Li (diarrhea/dysentery) in Shanghan disease; one must distinguish between Yin and Yang to avoid diagnostic errors. In San Yang (Taiyang, Yangming, Shaoyang) diarrhea, the body is hot. In Taiyin diarrhea, the hands and feet are warm. In Shaoyin and Jueyin diarrhea, the body is not hot; this distinguishes them. Generally, if diarrhea accompanies Taiyang pulse and symptoms, warming herbs should not be used immediately. Common physicians, seeing only diarrhea, label it as a Yin syndrome and indiscriminately use warming tonics.
In combined Taiyang and Yangming disease, diarrhea inevitably occurs, primarily treated with Gegen Tang. Diarrhea accompanied by headache, back pain, muscle fever, eye pain, dry nose, and a floating, large, and long pulse belongs to this category.
In combined Taiyang and Shaoyang disease, spontaneous diarrhea occurs, primarily treated with Huangqin Tang. If vomiting is present, add Banxia and Shengjiang to Huangqin Tang. Diarrhea accompanied by headache and chest fullness belongs to this category.
In combined Yangming and Shaoyang disease, diarrhea inevitably occurs. A pulse that does not show deficiency is a favorable sign (Shun); a deficient pulse is an unfavorable sign (Ni). This is due to mutual overcoming (Ke Ze), termed "Fu" (Defeat/Negative). Diarrhea accompanied by fever belongs to this category.
Spontaneous diarrhea without thirst belongs to Taiyin disease, primarily treated with Sini Tang or Lizhong Tang.
Spontaneous diarrhea with thirst belongs to Shaoyin disease, primarily treated with Baitong Tang, Baitong Zhu Dan Tang, Tongmai Sini Tang, Zhuling Tang, Zhenwu Tang, or Sini Jia Renshen Tang.
The remaining cases of diarrhea are mostly complications after sweating or purging. Generally, in Shanghan diarrhea, one must observe the pulse and external symptoms. Diarrhea with a large pulse indicates deficiency; a faint and weak pulse also indicates deficiency; a slippery pulse suggests retained food. Or, diarrhea with undigested food (Qinggu); if damp-toxic qi is abundant, there is painful diarrhea with stool resembling pus and blood, or like rotten meat juice. Desire to drink water during diarrhea indicates internal heat. Delirium during diarrhea indicates dry feces (Zaoshi) accumulation. Cold toxin entering the Stomach is treated with Sini Tang, Lizhong Tang, Baitong Tang plus Fuzi, or Sini San plus Xiebai. Heat-collateral diarrhea is treated with Huangqin Tang, Baitouweng Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, or Chishizhi Wan. Damp-toxic diarrhea with pus and blood is treated with Taohua Tang.
Zhang Zhongjing said: If the Yuyang pulse is floating and choppy, and the Shaoyin pulse is normal, the disease lies in the Spleen, and diarrhea is expected. The annotation states: Spleen deficiency fails to control water; Kidney Qi is balanced, so the disease is in the Spleen.
The verse states: There are many types of Shanghan diarrhea; one must distinguish Yin and Yang to avoid error. Only in Yangming-Shaoyang combination, if mutual overcoming occurs, it is named "Fu".
It is also said: Kidney deficiency causing diarrhea brings bitter dryness in the throat; failing to recognize this, one only knows of organ cold. Heat-collateral, Stomach cold, and damp-toxic diarrhea, if accompanied by delirium, are settled by purging.
Delirium with diarrhea indicates dry feces, treated with Tiaowei Chengqi Tang. Combined Taiyang-Yangming disease with floating, large, long pulse and diarrhea is treated with Gegen Tang. A slow and slippery pulse indicates retained food, suitable for purging with Xiao Chengqi Tang. Spontaneous diarrhea without thirst belongs to Taiyin, treated with Sini Tang and Lizhong Tang. Spontaneous diarrhea with thirst belongs to Shaoyin; a faint pulse uses Baitong Tang; cold extremities with absent pulse use Baitong Zhu Dan Tang and Tongmai Sini Tang. Cough, vomiting, thirst, vexation, and insomnia are treated with Zhuling Tang. San Yin diarrhea should generally be treated with warming methods. Clear water diarrhea with epigastric pain and dry mouth requires purging; this must not be ignored. Warming methods include Sini and Lizhong categories; purging methods include Dachaihu and Chengqi categories. San Yang diarrhea may also involve drinking water due to heat, treated according to the Changgou method. Diarrhea with epigastric stagnation has its own sections on stagnation and diarrhea.
Although hard stool usually requires purging, there are various conditions where attack is contraindicated. Changgou (intestinal mucus) is divided into cold and heat types; one need not fear following the footsteps of the ancients. Hua Tuo said: Cold causes loose stools... One must select pills or Ya Jiao Tang based on differentiation.