夫小儿诸淋者，肾与膀胱热也。二经相为表里，俱主水道，水入小肠，下行于胞则为溺。若
膀胱热，则津液内涸，水道不通。肾气热，则小便淋沥，或少腹引脐而痛。夫淋有五∶石淋
者，肾热化石，内塞水道，痛引膀胱；气淋者，肺气壅热，小腹胀满，小便涩滞；热淋者，
三焦有热，传入肾、膀胱，流入于胞，小便赤涩；血淋者，心热血散失其常经，溢渗入胞；
寒淋者，膀胱气冷，与正气交争，寒战气解是也。亦有因妊母肝热，及乳母恚怒者，当分五
脏蓄热治之。若心脏有热者，导赤散加黄连。肝脏有热者，柴胡栀子散；大便不通，泻青丸
。脾脏有热者，泻黄散；脾气不足，异功散；脾气下陷，补中益气汤。肺脏有热者，泻白散
；肺气虚热，异功散加炒黑山栀。肾脏有热者，地黄丸。或因乳母肝经热者，用栀子清肝散；恚怒者
，用柴胡清肝散。乳母浓味者，用加味清胃散；心小肠热者，用清心莲子饮。或儿早近色欲
，小便涩滞或作痛，及更去后大小便牵痛者，皆属肝肾不足也，用六味地黄丸、补中益气汤
加牛膝、车前、肉桂。未应，当参五脏所胜，不可轻用渗泄寒凉之药，大损胃气，仍参前小便不通症览
之。
治验
一小儿小便不通，服五苓之类不应，颏间及左腮色赤，乃肝肾虚热也，用四物、山栀及地黄
丸而愈。后因感冒误汗，小便仍不利，余用补中益气汤加麦门、五味而安。
一小儿小便不利，茎中涩痛，时或尿血，此禀父胃热为患也，先用五淋散以疏导，又用滋肾
丸、地黄丸补肝肾，渐愈。后出痘色紫，小便短赤，颏间右腮或赤或白，用补中益气汤、六
味地黄丸，前症并愈。
一小儿小便不利，衄血、鼻色赤，属脾肺有热也，用济生犀角地黄汤而愈。后颏间常赤，作
渴有痰，此禀赋肾气不足，用地黄丸而诸症瘥。
一小儿十五岁，所赋虚怯，且近女色，小便滴沥，误服五苓散之类，大小便牵痛，几至不起
，用六味丸而愈。
金砂散 治小便淋沥不通。
郁金 海金砂 滑石 甘草（各等分）
上为末，每服一钱，煎地肤子汤调下，灯心、木通亦可。
又方 冬瓜最治实热，小便不通，内热口渴。
立效散 治小儿诸淋不通，茎中作痛。
木通 甘草 王不留行 胡荽 滑石 海金砂 山栀子 槟榔（各等分）
上每服一钱，水煎。
五淋散 治膀胱有热，水道不通，或小腹肿胀。
赤茯苓 赤芍药（各五分） 山栀（炒） 当归（各三分） 甘草（二分）
上用灯心十根水煎。
木通散（方见小便不通）
导赤散（方见心脏）
泻青丸（方见肝脏）
泻黄散（方见脾脏）
四物汤（方见急惊）
清胃散
异功散（二方见内钓）
补中益气汤（方见虚羸）
泻白散（方见肺脏）
地黄丸（方见肾脏）
柴胡清肝散
栀子清肝散（二方见发热，即柴胡栀子散）
滋肾丸（方见腹胀）
清心莲子饮
茯苓散（二方见白浊）
五淋散（方见五淋）
圣济犀角地黄汤（方见尿血便血）
小儿的各种淋证，是由于肾与膀胱有热所致。这两经互为表里，都主管水道。水进入小肠后，向下流入胞宫（此处指膀胱/尿室）则成为尿液。如果膀胱有热，津液就会在内枯竭，导致水道不通。肾气有热，就会出现小便淋漓不尽，或者少腹牵引肚脐疼痛。
淋证分为五种：石淋，是肾热使尿液凝结成石，堵塞水道，疼痛牵引至膀胱；气淋，是肺气壅滞生热，导致小腹胀满，小便涩滞不畅；热淋，是三焦有热，传入肾和膀胱，流入胞中，导致小便红赤涩痛；血淋，是心热血散，失去正常的运行规律，溢出并渗入胞中；寒淋，是膀胱气冷，与人体正气相互抗争，表现为寒战、出汗后症状缓解。
也有因为怀孕母亲肝热，以及哺乳母亲愤怒导致的，应当根据五脏蓄热的情况分别治疗。如果心脏有热，用导赤散加黄连。肝脏有热，用柴胡栀子散；如果大便不通，用泻青丸。脾脏有热，用泻黄散；脾气不足，用异功散；脾气下陷，用补中益气汤。肺脏有热，用泻白散；肺气虚热，用异功散加炒黑山栀。肾脏有热，用地黄丸。如果是由于乳母肝经有热，用栀子清肝散；因愤怒致病，用柴胡清肝散。乳母饮食厚味者，用加味清胃散；心与小肠有热者，用清心莲子饮。
如果孩子过早接触色欲，出现小便涩滞或疼痛，以及大小便排出后牵拉疼痛的，都属于肝肾不足，用六味地黄丸、补中益气汤加牛膝、车前子、肉桂。如果无效，应当参考五脏相克的理论进行治疗，不可轻易使用渗利泄下的寒凉药物，以免严重损伤胃气。仍应参考前面关于小便不通的症候进行综合考察。
治验案例：
有一个小孩小便不通，服用五苓散之类的药物无效，下巴及左腮颜色发红，这是肝肾虚热，用四物汤、山栀及地黄丸而痊愈。后来因感冒误用发汗法，小便仍然不利，我用补中益气汤加麦门冬、五味子而使其安定。
有一个小孩小便不利，尿道涩痛，有时尿血，这是禀受父亲胃热所致，先用五淋散疏导，又用滋肾丸、地黄丸补益肝肾，逐渐痊愈。后来出痘疹颜色紫暗，小便短赤，下巴及右腮有时红有时白，用补中益气汤、六味地黄丸，之前的病症全部痊愈。
有一个小孩小便不利，流鼻血、鼻子颜色红，属于脾肺有热，用济生犀角地黄汤而痊愈。后来下巴常发红，口渴有痰，这是禀赋肾气不足，用地黄丸而诸症消退。
有一个十五岁的小孩，先天禀赋虚弱怯懦，且近女色，小便滴沥，误服五苓散之类的药物，大小便牵拉疼痛，几乎无法起身，用六味地黄丸而痊愈。
金砂散：治疗小便淋漓不通。
郁金、海金砂、滑石、甘草（各等分）。
以上研为细末，每次服用一钱，用地肤子煎汤调服，灯心草、木通煎汤亦可。
立效散：治疗小儿各种淋证不通，尿道作痛。
木通、甘草、王不留行、胡荽、滑石、海金砂、山栀子、槟榔（各等分）。
以上每次服用一钱，水煎服。
五淋散：治疗膀胱有热，水道不通，或小腹肿胀。
赤茯苓、赤芍药（各五分）、山栀（炒）、当归（各三分）、甘草（二分）。
以上用灯心草十根，水煎服。
木通散（方见“小便不通”条下）
导赤散（方见“心脏”条下）
泻青丸（方见“肝脏”条下）
泻黄散（方见“脾脏”条下）
四物汤（方见“急惊”条下）
清胃散
异功散（二方见“内钓”条下）
补中益气汤（方见“虚羸”条下）
泻白散（方见“肺脏”条下）
地黄丸（方见“肾脏”条下）
柴胡清肝散
栀子清肝散（二方见“发热”条下，即柴胡栀子散）
滋肾丸（方见“腹胀”条下）
清心莲子饮
茯苓散（二方见“白浊”条下）
五淋散（方见“五淋”条下）
圣济犀角地黄汤（方见“尿血便血”条下）
Various types of stranguria (Lin syndrome) in children are caused by heat in the Kidney and Bladder. These two meridians are exterior-interiorly related and both govern the water passages. Water enters the Small Intestine, descends into the Bao (uterus/bladder), and becomes urine. If there is heat in the Bladder, body fluids dry up internally, causing obstruction of the water passages. If there is heat in the Kidney Qi, urination becomes dribbling, or there is pain radiating from the lower abdomen to the umbilicus.
There are five types of stranguria:
Shi Lin (Stone Stranguria): Heat in the Kidney causes stones to form, blocking the water passages, with pain radiating to the Bladder.
Qi Lin (Qi Stranguria): Lung Qi is congested and hot, causing distension and fullness in the lower abdomen, with astringent and stagnant urination.
Re Lin (Heat Stranguria): Heat in the San Jiao (Triple Burner) transmits to the Kidney and Bladder, flowing into the Bao, causing red, astringent, and painful urination.
Xue Lin (Blood Stranguria): Heart blood is hot and scattered, losing its normal course, overflowing and seeping into the Bao.
Han Lin (Cold Stranguria): Bladder Qi is cold, clashing with healthy Qi, manifesting as chills and sweating after which symptoms relieve.
Some cases arise from liver heat in the pregnant mother or anger in the nursing mother; these should be treated according to heat accumulation in the Five Zang organs.
If there is heat in the Heart, use Dao Chi San (Coptis Decoction) added with Huang Lian (Coptis Rhizome).
If there is heat in the Liver, use Chai Hu Zhi Zi San (Bupleurum and Gardenia Powder); if stool is unsmooth, use Xie Qing Wan (Drain Green Pill).
If there is heat in the Spleen, use Xie Huang San (Drain Yellow Powder); if Spleen Qi is deficient, use Yi Gong San (Yi Gong's Powder); if Spleen Qi sinks, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
If there is heat in the Lung, use Xie Bai San (Drain White Powder); if Lung Qi is deficient and hot, use Yi Gong San added with charred Zhi Zi (Gardenia Fruit).
If there is heat in the Kidney, use Di Huang Wan (Rehmannia Pill).
If due to Liver Meridian heat in the nursing mother, use Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder); if due to anger, use Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder).
If the nursing mother consumes rich flavors, use Jia Wei Qing Wei San (Modified Stomach-Clearing Powder); if there is heat in the Heart and Small Intestine, use Qing Xin Lian Zi Yin (Heart-Clearing Lotus Seed Decoction).
If a child has early exposure to sexual desires, resulting in astringent or painful urination, and pulling pain during/after defecation/urination, this belongs to deficiency of the Liver and Kidney. Use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Bu Zhong Yi Qi Tang added with Niu Xi (Achyranthes Root), Che Qian (Plantago Seed), and Rou Gui (Cinnamon Bark). If ineffective, refer to the theory of the overcoming relationship among the Five Zang organs for treatment. Do not lightly use diuretic, draining, or cold-cooling herbs, as they severely damage Stomach Qi. Still, refer to the previous section on symptoms of urinary obstruction for comprehensive examination.
Clinical Cases:
One child had urinary retention; Wu Ling San (Five-Ingredient Powder with Poria) was ineffective. The chin and left cheek were red, indicating deficient heat in the Liver and Kidney. He was cured using Si Wu Tang (Four Substances Decoction), Zhi Zi (Gardenia), and Di Huang Wan (Rehmannia Pill). Later, due to mistaken sweating treatment for a cold, urination remained difficult. I used Bu Zhong Yi Qi Tang added with Mai Men Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Fruit) to stabilize him.
One child had difficult urination, astringent pain in the urethra, and occasional hematuria. This was caused by inheriting stomach heat from the father. Initially, Wu Lin San (Five-Stranguria Powder) was used to dredge and guide, followed by Zi Shen Wan (Kidney-Nourishing Pill) and Di Huang Wan to tonify the Liver and Kidney, leading to gradual recovery. Later, when chickenpox appeared with purple color, short red urine, and variable redness/whiteness on the chin and right cheek, Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan were used, curing all previous symptoms.
One child had difficult urination, epistaxis (nosebleed), and a red nose, indicating heat in the Spleen and Lung. He was cured using Ji Sheng Xi Jiao Di Huang Tang (Ji Sheng Rhinoceros Horn Rehmannia Decoction). Later, persistent redness on the chin, thirst, and phlegm indicated congenital insufficiency of Kidney Qi. He recovered using Di Huang Wan.
A fifteen-year-old child, constitutionally weak and having engaged in sexual activity, suffered from dribbling urination. Mistakenly taking Wu Ling San caused pulling pain in both bowel and bladder movements, nearly leading to collapse. He was cured using Liu Wei Di Huang Wan.
Jin Sha San (Gold Sand Powder): Treats dribbling and obstructed urination.
Yu Jin (Turmeric Tuber), Hai Jin Sha (Lygodium Spore), Hua Shi (Talcum), Gan Cao (Licorice Root) (equal parts).
Grind into powder. Take one qian per dose, mixed with decoction of Di Fu Zi (Kochia Fruit). Decoction of Deng Xin Cao (Juncus Effusus) or Mu Tong (Akebia Stem) is also acceptable.
Another Formula: Winter melon is best for treating excess heat causing urinary obstruction, internal heat, and thirst.
Li Xiao San (Instant Effect Powder): Treats various types of stranguria in children with obstruction and urethral pain.
Mu Tong (Akebia Stem), Gan Cao (Licorice Root), Wang Bu Liu Xing (Vaccaria Seed), Hu Sui (Coriander), Hua Shi (Talcum), Hai Jin Sha (Lygodium Spore), Shan Zhi Zi (Gardenia Fruit), Bing Lang (Areca Seed) (equal parts).
Take one qian per dose, decocted in water.
Wu Lin San (Five-Stranguria Powder): Treats Bladder heat, obstruction of water passages, or lower abdominal swelling.
Chi Fu Ling (Red Poria), Chi Shao Yao (Red Peony Root) (each 5 fen), Shan Zhi Zi (Gardenia Fruit, stir-fried), Dang Gui (Angelica Sinensis) (each 3 fen), Gan Cao (Licorice Root) (2 fen).
Decoct with ten stalks of Deng Xin Cao (Juncus Effusus) in water.
Mu Tong San (see "Urinary Obstruction" section)
Dao Chi San (see "Heart" section)
Xie Qing Wan (see "Liver" section)
Xie Huang San (see "Spleen" section)
Si Wu Tang (see "Acute Convulsion" section)
Qing Wei San (Stomach-Clearing Powder)
Yi Gong San (see "Internal Hook" section) [Note: Two formulas mentioned here]
Bu Zhong Yi Qi Tang (see "Emaciation" section)
Xie Bai San (see "Lung" section)
Di Huang Wan (see "Kidney" section)
Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder)
Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder) [See "Fever" section, i.e., Chai Hu Zhi Zi San]
Zi Shen Wan (see "Abdominal Distension" section)
Qing Xin Lian Zi Yin (Heart-Clearing Lotus Seed Decoction)
Fu Ling San (see "White Turbidity" section) [Note: Two formulas mentioned here]
Wu Lin San (see "Five Strangurias" section)
Sheng Ji Xi Jiao Di Huang Tang (see "Hematuria and Hematochezia" section)