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Introduction:

“少阴之为病，脉微细，但欲寐也。” (line 281)

From line 281, we are told that 少阴病 is characterized by a weak and fine pulse. Also the person only feels like sleeping.

“少阴病，欲吐不吐，心烦，但欲寐。” (line 282a)

Next, we are told that the person experiences nausea but cannot vomit. He is vexed, but at the same time, very sleepy.

So far, it sounds like a person who had a little too much to drink and is about to vomit on the streets. ; )

On the diarrhea:

The middle portion of line 282 mentions diarrhea.

“五六日自利而渴者，属少阴也， 虚故引水自救，” (line 282b)

This bloke is having diarrhea for five to six days. And he’s thirsty. This is considered 少阴.

• Takeaway (kidney-yin deficiency): Diarrhea accompanied by thirst is considered to be kidney-related, hence 少阴. Elaborated further, his kidney is deficient, therefore he drinks water to replenish the insufficiency. Kidney deficiency causes you to consume more fluids. Note that if it’s fluid deficiency, it means kidney-yin deficiency. How about kidney yang deficiency? Yes too, if we look at the next snippet in line 282…

”若小便色白者，少阴病形悉具，小便白者，以下焦虚有寒，不能制水，故令色白也。” (line 282c)

• Takeaway (kidney-yang deficiency): The urine is clear and prolonged, a sign of a shaoyin kidney illness. This is because the lower jiao is deficient and cold. It cannot controlled the amount of fluids coming out, and with more coming out, it’s clear and diluted.

Summary:

The presence of thirst categorizes this as a 少阴 (kidney) diarrhea problem.

However, if we look at the original text from another angle, it could be that:

1. The thirst has little to do with 少阴-kidney or otherwise. When you loose fluids and mineral due to diarrhea, of course your thirst center tells you to drink more.
2. The frequent urination may be due to the copious replenishment of fluids.
3. All these considered, this person may actually be suffering from Diabetes Insipidus. It’s the lack of vasopressin that causing frequent urination, and hence thirst.

What say people of the assertion that 附子 in 四逆汤 has a vasopressor effect not to too different than of 真武汤? Or even ADH aka vasopressin since the original doc seems to want to stem the copious urination.