（小便数）
成 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证难以概治宜考经条分之可也小便数者三阳
有
在表者有在里者三阴并无小便数之证宜详察之
太阳 病六七日表证仍在脉微而沉反不结胸其人发狂以热在下焦小腹当硬满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证也抵当汤伤寒有热少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
丸伤寒十三日不解过经谵语小便利而大便亦下利脉反和调胃承气证（详谵语）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（详谵语）太阳病小便利者以饮水多必心下悸小便
少者必苦里急小便不利甘草茯苓汤伤寒八九日风湿相搏身体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伤寒发热恶寒大渴欲饮水其腹必满自汗小便利为欲解此肝乘肺名曰横刺期门
阳明 病反无汗而小便利二三日呕而咳手足厥者必苦头痛（详头痛）得病二三日脉弱无太阳柴胡证烦躁心下硬以小
承气微和之不大便六七日小便少者虽不能食但初硬后溏未可攻小便利大承气汤伤寒脉浮而缓手足自温系在太阳当发身
黄若小便自利不能发黄至七八日大便硬为阳明病也大承气汤阳明病自汗更发汗小便自利为津液内竭屎虽硬不可攻之宜
蜜煎导而通之猪胆汁或土瓜根皆可为导
太阳 伤寒脉浮而缓手足自温系在太阴当发黄小便自利不发黄至七八日虽暴烦下利者十余行必自止按以上数条皆
以小便自利为病盖以验病之下与不当下也若小便不利而少腹硬者尿也当渗泄之若小便自利而少腹硬者非血则粪也当通
利之且病之发黄与不发黄及病之死与不死皆可于此而验之焉
少阴 病二三日至四五日腹满小便不利四肢沉重疼痛自下利者为有水气或小便利真武汤（详下利）既吐且利小便复
利而大汗下利清谷内寒外热脉微欲绝者四逆汤
厥阴 伤寒热少厥微指头寒默默不欲食烦躁数日小便利色白者此热除也欲得食为病愈
小便数
伤寒脉浮自汗小便数心烦微恶寒脚挛急者慎不可用桂枝汤（甘草干姜汤芍药甘草汤）
赵 太阳病自汗四肢拘急难以屈伸心烦微恶寒脚挛急若小便数者慎不可用桂枝也宜与甘草干姜汤芍药甘草汤此
虚
寒所致与上文客热等证全不相合又多四肢拘急难以屈伸八字即系前篇小便难之证今却添于此问小便数之下何耶又云伤
寒脉浮便数若胃中不和谵语者少与调胃承气汤盖仲景论中此论专主胃气不和谵语未尝兼治脉浮自汗小便数之证何不曰
若服甘草干姜汤后胃气不和谵语者少与调胃承气汤不亦宜乎
趺阳脉浮而涩浮则胃气强涩则小便数浮涩相搏大便则难其脾为约麻仁丸太阳病汗吐下后微烦小便数大便因硬与小
承气汤和之则愈太阳病寸缓关浮尺弱其人发热汗出恶寒不呕但心下痞者下之早也如其不下病患不恶寒而渴者此转属阳
明小便数者大便必硬
吴 凡小便数者频欲去而不多也太阳阳明治各有条凡肾虚有热小便频数者清心连子饮或人参三白汤加知母黄柏
麦
门石莲肉之类或服滋补丸亦佳或补中益气加知母黄柏生地黄麦门冬主之
（小便频数）
成无己：小便自利（指小便通畅或频数，非病理性的尿失禁，此处结合语境多指尿频或通利异常）的情况，有在表证的，有在里证的；有因热而致通利的，有因寒而致通利的。这是六经病中都会出现的证候，难以一概而论地治疗，应当考察各经的条文进行区分即可。至于小便频数（次数多、量少），三阳经中有在表的、在里的情况，而三阴经并没有小便频数的证候，应当仔细审查辨别。
太阳病：患病六七日，表证仍在，但脉象由浮转微而沉，反而没有形成结胸证。患者出现发狂的症状，这是因为热邪在下焦。如果小腹坚硬胀满，且小便自利（通畅），这是蓄血证，通过攻下瘀血才能痊愈，用抵当汤。
太阳病：身体发黄，脉象沉结，小腹硬满，小便自利，患者神志如狂，这是血证，用抵当汤。
伤寒：发热，少腹满，按理说应该小便不利，现在反而通利，这是有瘀血的表现，应当攻下，不可用其他药物，适宜用抵当丸。
伤寒十三日未解，经过传变出现谵语，小便利，大便也下利，脉象反而调和，这是胃承气汤证（详见“谵语”条）。
太阳中风，用火法劫汗后导致发黄，想要衄血，小便困难，头汗出，腹部胀满，轻微喘息，口干咽烂，或者不大便，时间久了出现谵语，严重的甚至出现哕逆、捻衣摸床等危象。如果小便利的，还可以治疗（详见“谵语”条）。
太阳病：小便利的人，如果饮水过多，必定会出现心下悸动；如果小便少，必定会感到腹部拘急不适。用小便利者饮水量大导致的心下悸，可用甘草茯苓汤。
伤寒八九日，风湿相搏，身体疼痛烦扰，不能翻身转动，不呕吐，不口渴，脉象浮虚而涩，用桂枝附子汤。如果其人小便自利，则去掉桂枝，加白术汤。
伤寒发热恶寒，大渴想喝水，腹部必然胀满，自汗出，小便利，这是病情将要解除的表现。这叫做肝乘肺，名为“横”，针刺期门穴。
阳明病：反而无汗而小便利，过了两三天，出现呕吐和咳嗽，手足厥冷，必定痛苦于头痛（详见“头痛”条）。
得病二三日，脉弱，没有太阳病或少阳病的证候，出现烦躁、心下硬满，用小承气汤轻微调和肠胃。
不大便六七天，如果小便少，虽然不能进食，但初头硬后溏，不可攻下。如果小便利，用大承气汤。
伤寒脉浮而缓，手足自然温暖，病系在太阳，应当发生身黄。如果小便自利，就不会发黄。到了七八天，大便变硬，转为阳明病，用大承气汤。
阳明病，自汗又发汗，小便自利，导致津液内竭，大便虽然硬，不可攻下，适宜用蜜煎导法通便。猪胆汁或土瓜根也可以作为导引剂。
太阳伤寒：脉浮而缓，手足自温，病系在太阴，应当发黄。如果小便自利，就不发黄。到了七八天，虽然突然烦躁并下利十余次，但必定会自行停止。
以上几条，都是以小便自利来判断疾病是否应当使用下法。如果小便不利且少腹硬，是尿液潴留，应当渗湿利水；如果小便自利且少腹硬，不是血就是粪便，应当通利之。而且疾病的发黄与不发黄，以及死与不死，都可以由此来验证。
少阴病：从二三日到四五日，腹部胀满，小便不利，四肢沉重疼痛，自下利，这是有水气，用真武汤（详见“下利”条）。
如果既吐且利，小便反而通利，大汗出，下利清谷，内寒外热，脉微欲绝，用四逆汤。
厥阴病：伤寒热少厥微，仅指头寒冷，默默不欲食，烦躁几天，小便利且颜色白，这是热邪已除，想吃东西，说明病将痊愈。
小便频数（次数多）
伤寒：脉浮，自汗，小便频数，心烦，轻微恶寒，脚部挛急，千万不要用桂枝汤（可考虑甘草干姜汤、芍药甘草汤）。
赵嗣真：太阳病，自汗，四肢拘急难以屈伸，心烦，轻微恶寒，脚部挛急。如果小便频数，千万不要用桂枝汤，适宜给予甘草干姜汤、芍药甘草汤。这是虚寒所致，与上文客热等证完全不同。文中又多出“四肢拘急难以屈伸”八个字，这其实是前篇“小便难”的证候，现在却添加在此处询问小便频数之下，为什么呢？又说伤寒脉浮，如果小便频数，若胃中不和出现谵语，少量给予调胃承气汤。盖仲景论述中，此论专门主治胃气不和导致的谵语，未曾兼治脉浮、自汗、小便频数的证候。为何不说“如果服用甘草干姜汤后，胃气不和出现谵语，少量给予调胃承气汤”，这样不是更合适吗？
趺阳脉浮而涩，浮则胃气强，涩则小便频数。浮涩相搏，大便则难，这是脾约证，用麻仁丸。
太阳病经过汗、吐、下治疗后，出现轻微烦躁，小便频数，大便因此变硬，与小承气汤调和即可痊愈。
太阳病，寸脉缓，关脉浮，尺脉弱，其人发热、汗出、恶寒，不呕吐，但心下痞，这是下之过早。如果病人不下药，不恶寒而口渴，这是转属阳明病。小便频数的人，大便必定硬。
吴崑：凡是小便频数，是指频繁想去厕所但尿量不多。太阳病和阳明病的治疗各有条理。凡肾虚有热导致小便频数的，可用清心莲子饮，或人参三白汤加知母、黄柏、麦门冬、石莲肉之类，或者服用滋补丸也很好，或用补中益气汤加知母、黄柏、生地黄、麦门冬主治。
(Profuse Urination / Frequent Urination)
Cheng Wuji: The condition of "Xiaobian Zili" (smooth or frequent urination, here referring to abnormal frequency or patency rather than pathological incontinence) can be present in exterior syndromes or interior syndromes; it can result from heat causing patency or from cold causing patency. This is a syndrome that can occur in all six meridians and cannot be treated uniformly. One should examine the specific textual clauses of each meridian for differentiation. Regarding "Xiaobian Shu" (frequent urination with small volume), it occurs in the Three Yang meridians (both exterior and interior patterns), but does not occur in the Three Yin meridians; careful examination is required.
Taiyang Disease: After six or seven days of illness, if the exterior pattern persists, but the pulse becomes faint and deep instead of floating, and there is no formation of Jie Xiong (chest binding syndrome), yet the patient exhibits mania, this is due to heat in the Lower Jiao. If the lower abdomen is hard and full, and urination is smooth (Zili), this indicates Blood Accumulation (Yu Xue). It will be cured by purging the blood using Didang Tang.
Taiyang Disease: If the body turns yellow, the pulse is deep and knotted, the lower abdomen is hard, urination is smooth, and the patient's spirit resembles madness, this is a Blood Syndrome, treated with Didang Tang.
Shanghan (Cold Damage): With fever and fullness in the lower abdomen, one would expect difficulty in urination. However, if urination is now smooth, this indicates the presence of blood stasis. It should be purged. Other medicines are not suitable; Didang Wan is appropriate.
After thirteen days of Shanghan without resolution, passing into another stage with delirium, if urination is smooth and diarrhea also occurs, but the pulse is harmonious, this is a Weichengqi Tang syndrome (see "Delirium").
In Taiyang Wind Strike, after coercing sweat with fire therapy leading to jaundice, desire for nasal bleeding, difficult urination, sweating on the head, abdominal fullness, slight wheezing, dry mouth, and rotting throat, or constipation leading to delirium over time, or even severe cases with hiccups, picking at bedclothes, and touching clothes: if urination is smooth, it is treatable (see "Delirium").
In Taiyang Disease: In patients with smooth urination who drink excessively, palpitations in the epigastrium will inevitably occur. In those with little urine, abdominal urgency and discomfort will be suffered. For palpitations caused by excessive water intake in patients with smooth urination, Gancao Fuling Tang is used.
After eight or nine days of Shanghan, where Wind-Dampness combats, causing body pain and restlessness preventing turning over, without vomiting or thirst, and with a floating, deficient, and choppy pulse, Guizhi Fuzi Tang is used. If the patient has smooth urination, remove Guizhi and add Baizhu Tang.
In Shanghan with fever, aversion to cold, intense thirst for drinking water, and inevitable abdominal fullness, spontaneous sweating, and smooth urination, this indicates the disease is about to resolve. This is called Liver invading Lung, named "Heng". Puncture Qimen (LR14).
Yangming Disease: If there is no sweat but smooth urination, and after two or three days, vomiting and coughing occur with cold extremities, headache will surely be suffered (see "Headache").
Two or three days after onset, if the pulse is weak, without Taiyang or Shaoyang patterns, but with irritability and hardness in the epigastrium, Xiaochengqi Tang is used to mildly harmonize the stomach.
If constipation lasts six or seven days, but urine is scanty, although food intake is poor, if the stool is hard at the beginning but loose later, do not purge. If urine is smooth, Dachengqi Tang is used.
In Shanghan with a floating and slow pulse, warm hands and feet, indicating the disease is in Taiyang, jaundice should develop. If urination is smooth, jaundice will not develop. By the seventh or eighth day, if the stool becomes hard, it transforms into Yangming Disease, treated with Dachengqi Tang.
In Yangming Disease, with spontaneous sweating followed by induced sweating and smooth urination, leading to internal depletion of fluids, even if the stool is hard, do not purge. Use Honey Suppository (Mijian Dao) to guide it out. Pig bile or Gynostemma pentaphyllum root (Tugua Gen) can also be used as suppositories.
Taiyang Shanghan: With a floating and slow pulse and warm hands and feet, the disease is associated with Taiyin, and jaundice should develop. If urination is smooth, jaundice will not develop. By the seventh or eighth day, even if there is sudden irritability and diarrhea more than ten times, it will stop spontaneously.
The above clauses all use smooth urination to determine whether purgation is indicated. If urination is difficult and the lower abdomen is hard, it is urine retention, requiring diuresis. If urination is smooth and the lower abdomen is hard, it is either blood or feces, requiring unblocking and purging. Whether jaundice develops or not, and whether the prognosis is fatal or not, can all be verified through this.
Shaoyin Disease: From the second or third day to the fourth or fifth day, if there is abdominal fullness, difficult urination, heavy and painful limbs, and spontaneous diarrhea, this indicates Water Qi, treated with Zhenwu Tang (see "Diarrhea").
If there is both vomiting and diarrhea, yet urination is surprisingly smooth, accompanied by profuse sweating, diarrhea with undigested food, internal cold with external heat, and a faint pulse nearly disappearing, Sini Tang is used.
Jueyin Disease: In Shanghan with slight heat and mild cold limbs (only cold fingertips), silence, anorexia, and irritability for several days: if urination is smooth and white, this indicates the heat has cleared. Desire for food indicates recovery.
Frequent Urination (High Frequency)
Shanghan: With a floating pulse, spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, and leg cramps, Guizhi Tang must absolutely not be used (consider Gancao Ganjiang Tang or Shaoyao Gancao Tang).
Zhao Sizhen: In Taiyang Disease with spontaneous sweating, limb stiffness and difficulty in flexion/extension, heart vexation, slight aversion to cold, and leg cramps: if urination is frequent, Guizhi Tang must absolutely not be used. Instead, Gancao Ganjiang Tang and Shaoyao Gancao Tang are appropriate. This is caused by deficiency-cold, completely different from the excess-heat patterns mentioned earlier. The addition of "limb stiffness and difficulty in flexion/extension" seems to belong to the previous section on "difficult urination," yet it is added here under "frequent urination." Why? It also states that in Shanghan with a floating pulse and frequent urination, if stomach disharmony causes delirium, a small amount of Tiaowei Chengqi Tang is given. Zhang Zhongjing's discussion here specifically targets delirium due to stomach disharmony, not the combination of floating pulse, sweating, and frequent urination. Would it not be more appropriate to say, "If after taking Gancao Ganjiang Tang, stomach disharmony causes delirium, then give a small amount of Tiaowei Chengqi Tang"?
Fuyang Pulse: Floating and choppy. Floating indicates strong Stomach Qi; choppy indicates frequent urination. The interaction of floating and choppy leads to difficult defecation. This is Pi Yue (Spleen Constriction), treated with Mahuang Wan.
After sweating, vomiting, or purging in Taiyang Disease, if slight vexation occurs, urination is frequent, and the stool becomes hard due to this, Xiaochengqi Tang is used to harmonize, leading to recovery.
In Taiyang Disease, with a slow Cun pulse, floating Guan pulse, and weak Chi pulse, if the patient has fever, sweating, aversion to cold, no vomiting, but epigastric fullness, this is due to premature purgation. If the patient is not purged, does not have aversion to cold, but has thirst, this transforms into Yangming Disease. Patients with frequent urination will inevitably have hard stools.
Wu Kun: Frequent urination refers to the frequent urge to void with little output. Treatment for Taiyang and Yangming diseases follows specific principles. For frequent urination due to Kidney deficiency with heat, Qingxin Lianzi Yin or Renshen Sanbai Tang added with Zhimu, Huangbai, Maidong, and Shilianrou can be used. Alternatively, Zibu Wan is good, or Buzhong Yiqi Tang added with Zhimu, Huangbai, Shengdihuang, and Maidong.