癃闭似淋点滴无，只求利水法全迂，柴升（补中益气汤服后，以手探吐）探吐针机转，麻黄
杏（仁加入五淋汤）行阳阴气濡，肾气（丸）龙腾泽自沛，通关（丸，又名滋肾丸）云合雨时敷，二冬杏
菀参桑白（此李士材医案，从高原以导之之法，）海蜇（一名水母）荸荠亦可需。
浊病皆湿热之病。湿胜热则为白，热胜湿则为赤。初起宜二陈汤加苍术、白术、黄柏、
萆主之，赤浊再加丹参。如若未效，宜固其精道，利其水道，用萆 厘清饮。或久而
不愈
，宜补其心气，用四君子汤加远志二钱。或水虚火旺而为浊，宜六味丸加黄柏、苍术、益智
仁之类。或火衰气不摄精，宜桂附八味丸加菟丝、车前之类。浊出精窍，与淋出溺窍不同。
总以治肾为主。然初起多由于湿热，故列于热证。
（经义）《至真要大论》曰∶“诸转反戾，水液混浊，皆属于热。”“太阳之胜，阴中乃疡
，隐曲不利，互引阴股。”《痿论》曰∶“思想无穷，所愿不得，意淫于外，入房太甚，宗
筋驰纵，发为筋痿，及为白淫。”《口问》曰∶“中气不足，溲便为之变。”《玉机真论
》曰∶“冬脉不及，则令人小腹满，小便变。”按∶宜参癃闭、遗溺各章文。
浊由湿热二陈（汤）加（味），苍白丹参柏 夸，坊本（萆 ）厘清（饮）通水道，全书（景岳）远志（四
君子
汤加此）入心家，火衰肾气丸为主，水阙（六味）地黄汤可嘉，借用遗精封髓（丹）法，时方却不悖长
沙。
呕者，呕字从沤，沤者水也，口中出水而无食也。吐者，吐字从土，土者食也，口中吐
食而无水也。呕吐者，水与食并出也。哕者，口中有秽味也，又谓之干呕者，口中有秽味，
未有不干呕也。呃逆者，气冲有声，声短而频也，昔人亦谓之哕，时书分别多误，今特正之
。统用二陈汤倍半夏加生姜为主，以统治之。热加黄连、鲜竹茹、鲜芦根；寒加吴茱萸、人
参、大枣；食积加六神曲、炒山楂、麦芽、干姜；哕加旋复花、人参、代赭石；呃逆加竹茹
四钱，倍用橘皮。如久病发呃，为脾肾之气将绝，用人参一两，干姜、附子各三钱，丁香、
沉香、柿蒂各一钱，可救十中之一。以上诸证，皆阳明气逆之病，故一方可以统治。惟吐虫
宜去甘草，加川椒、人参、吴茱萸、黄连、黄柏、干姜、乌梅肉各一钱治之。此症不尽属热
，缘《内经》有∶“诸逆上冲，皆属于火”之训，故列于热证。
癃闭（小便不通）的症状表现为点滴难出，看似淋证（小便频数短涩、滴沥刺痛），若只采用利水的方法治疗则过于迂腐。通过服用补中益气汤后探吐以激发气机升降，或用麻黄、杏仁加入五淋汤中以通阳化气使阴液滋润；肾气丸能如龙腾般温补肾阳使津液充沛，通关丸（又名滋肾丸）能如云合雨施般通利小便；此外，也可使用天冬、麦冬、杏仁、桔梗、人参、桑白皮（这是李士材的医案，运用“提壶揭盖”即从上游疏导下游的方法），海蜇（一名水母）和荸荠也可以使用。
浊病（尿液浑浊或精浊）都是湿热引起的疾病。湿邪胜过热邪则尿色发白，热邪胜过湿邪则尿色发红。初起时适宜用二陈汤加苍术、白术、黄柏、萆薢来治疗，赤浊（尿色红）再加丹参。如果无效，应当固摄精道，通利水道，使用萆薢分清饮。或者病程长久不愈，应当补益心气，使用四君子汤加远志二钱。或者是肾水亏虚、火旺导致的浊病，适宜用六味地黄丸加黄柏、苍术、益智仁之类。或者是命门火衰、气不能固摄精微导致的浊病，适宜用桂附八味丸加菟丝子、车前子之类。浊病是从精窍排出，与淋证从小便溺窍排出不同。总体以治疗肾脏为主。然而初起多由于湿热，所以将其列在热证章节中。
（经典依据）《黄帝内经·素问·至真要大论》说：“各种筋脉拘挛抽搐、屈伸不利，以及小便混浊，都归属于热邪。”“太阳寒水之气偏胜，阴部就会生疮疡，隐蔽部位的功能障碍，牵引大腿内侧疼痛。”《素问·痿论》说：“思虑无穷，愿望不得满足，意念外驰，房事过度，导致宗筋弛纵，发为筋痿，以及出现白淫（指男子滑精、女子带下等症）。”《灵枢·口问》说：“中气不足，大小便就会发生异常。”《素问·玉机真脏论》说：“冬季脉象不及，就会使人小腹胀满，小便异常。”按语：应当参考癃闭、遗溺各章的内容。
浊病由湿热引起，可用二陈汤加味，重用苍术、白术、丹参、黄柏加以夸耀其效；坊间版本推崇萆薢分清饮以通利水道；全书（指张景岳著作）主张在四君子汤中加入远志以入心家；火衰者以肾气丸为主治；水亏者用地黄汤（六味地黄丸）值得称赞；借用治疗遗精的封髓丹方法，时方（后世医家的方剂）并不违背长沙学派（张仲景）的原则。
呕字从沤，沤意为水泡，指口中出水而没有食物吐出。吐字从土，土代表食物，指口中吐出食物而没有水。呕吐则是水和食物一起吐出。哕（干呕声）是指口中有秽臭味，又被称为干呕，有秽臭味就没有不干呕的。呃逆是指气冲有声，声音短促而频繁，古人也称之为哕，当时的书籍区分多有错误，现在特意纠正它。统用二陈汤加倍半夏加生姜作为主方，来统领治疗这些病症。热证加黄连、鲜竹茹、鲜芦根；寒证加吴茱萸、人参、大枣；食积加六神曲、炒山楂、麦芽、干姜；哕加旋复花、人参、代赭石；呃逆加四钱竹茹，加倍橘皮。如果是久病出现呃逆，是脾肾之气即将断绝的表现，用人参一两，干姜、附子各三钱，丁香、沉香、柿蒂各一钱，可以挽救十分之一的患者。以上诸证，都是阳明胃气上逆的疾病，所以一个方子可以统领治疗。只有吐虫症应当去掉甘草，加川椒、人参、吴茱萸、黄连、黄柏、干姜、乌梅肉各一钱来治疗。此症不完全是热证，因为《内经》有“各种气逆上冲，都归属于火”的训诫，所以将其列在热证章节中。
Lung Bi (obstruction of urination) presents with difficulty in passing even a few drops, resembling Lin syndrome (dysuria with frequency and urgency). Relying solely on diuretic methods is overly rigid. Provoking vomiting after administering Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can activate the mechanism of Qi transformation; adding Mahuang (Ephedrae Herba) and Xingren (Armeniacae Semen) to Wulin Tang (Five Lin Decoction) promotes Yang Qi and moistens Yin fluids. Shengqi Wan (Kidney Qi Pill) acts like a dragon rising, ensuring abundant fluid distribution; Tongguan Wan (Pass the Pass Pill, also known as Zishen Wan) facilitates urination like clouds gathering and rain falling. Additionally, Donggong (Tian Dong and Mai Dong), Xingren, Jiegeng, Renshen, Sangbaipai (a case from Li Shicai, employing the method of draining from the high source to guide flow), Haizhe (also known as Shuimu, jellyfish), and Qishi (water chestnut) may also be utilized.
Zhuo disease (turbid urine or seminal turbidity) is caused by damp-heat. When dampness exceeds heat, the discharge is white; when heat exceeds dampness, it is red. In the initial stage, Erchen Tang (Two Aged Substances Decoction) combined with Cangzhu, Baizhu, Huangbai, and Bibi is indicated. For Chi Zhuo (red turbidity), Danshen is added. If ineffective, one should secure the essence pathway and promote water passage using Bibi Qingfen Yin (Bibi Clearing and Separating Decoction). If the condition persists for a long time without resolution, supplement Heart Qi using Sijunzi Tang (Four Gentlemen Decoction) with two qian of Yuanzhi. If caused by Kidney Yin deficiency with hyperactive fire, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) combined with Huangbai, Cangzhu, and Yizhiren is appropriate. If caused by declining Fire of the Gate of Vitality failing to control the essence, Guifu Bawei Wan (Cinnamon Twig and Aconite Eight-Ingredient Pill) with Tusizi and Cheqianzi is suitable. Turbid discharge exits through the essence orifice, differing from Lin syndrome which exits through the urinary orifice. The primary treatment focuses on the Kidneys. However, since initial cases are often due to damp-heat, they are categorized under Heat Syndromes.
(Classical Basis) *Suwen: Zhentyao Dalun* states: "All cases of twisting, convulsions, and muscle cramps, as well as turbid body fluids, belong to Heat." "When Taiyang cold-water qi prevails, ulcers occur in the yin region, dysfunction of concealed areas arises, and pain radiates to the inner thighs." *Suwen: Feilun* states: "Endless thoughts, unfulfilled desires, mental wandering outward, and excessive sexual intercourse cause the Zongjin (major sinews) to relax, leading to Jin Wei (sinew flaccidity) and Baiyin (white efflorescence/seminal emission)." *Lingshu: Kouwen* states: "Deficiency of Middle Qi leads to abnormalities in urination and defecation." *Suwen: Yuji Zhenlun* states: "If the Winter pulse is insufficient, it causes fullness in the lower abdomen and changes in urination." Note: Refer to chapters on Lung Bi and Yini (involuntary urination).
Zhuo disease stems from damp-heat; Erchen Tang modified with Cangzhu, Baizhu, Danshen, and Huangbai is praised. Folk editions advocate Bibi Qingfen Yin to clear the water passages. Zhang Jingyue's works emphasize adding Yuanzhi to Sijunzi Tang to benefit the Heart. Declining Fire is treated primarily with Shengqi Wan; Water Deficiency is addressed commendably with Dihuang Tang (Liuwei Dihuang Wan). Borrowing the Fengsui Dan method for treating spermatorrhea, contemporary formulas do not contradict the Changsha school (Zhang Zhongjing).
Ou (vomiting water) derives from 'ou' (bubbles), referring to expelling water without food. Tu (spitting up food) derives from 'tu' (earth), referring to expelling food without water. Ou Tu involves both water and food. Yue (dry heaving/hiccough sound) refers to a foul odor in the mouth; it is also called Gan Ou (dry retching), implying that foul odor always accompanies dry heaving. E Ni (hiccups) refers to air rushing out with sound, short and frequent. Ancients also called this Yue, but contemporary books often distinguish them incorrectly; this text corrects such errors. Generally, Erchen Tang with doubled Banxia and added Shengjiang serves as the master formula. For Heat, add Huanglian, fresh Zhuru, and fresh Lugen; for Cold, add Wuzhuyu, Renshen, and Dazao; for Food Stagnation, add Liushenqu, fried Shanzha, Maiya, and Ganjiang; for Yue, add Xuanfuhua, Renshen, and Daizheshi; for E Ni, add four qian of Zhuru and double the amount of Chuanpi. If hiccups occur in chronic illness, indicating impending exhaustion of Spleen and Kidney Qi, use one liang of Renshen, three qian each of Ganjiang and Fuzi, and one qian each of Dingxiang, Chenxiang, and Shidi, saving one in ten patients. All above syndromes are diseases of Yangming Qi rebellion, hence one formula governs them. For vomiting worms, remove Gancao, and add one qian each of Chuanjiao, Renshen, Wuzhuyu, Huanglian, Huangbai, Ganjiang, and Wuumei. This syndrome is not entirely Heat-related; given the *Neijing* maxim "all rebellious upward movement belongs to Fire," it is listed under Heat Syndromes.