天津李××，年二十六岁，得小便白浊证。
病因 于季秋乘大车还家，中途遇雨，衣服尽湿，夜宿店中，又
披衣至庭中小便，为寒风所袭，遂得白浊之证。
证候 尿道中恒发刺痒，每小便完时有类精髓流出数滴。今已三阅月，屡次服药无效，颇觉身
体衰弱，精神短少，其脉左部弦硬，右部微浮重按无力。
诊断 《内经》谓肾主蛰藏，肝主疏泄，又谓风气通于肝，又谓肝行肾之气。此证因风寒内袭
入肝，肝得风助，其疏泄之力愈大，故当小便时，肝为肾行气过于疏泄，遂致肾脏失其蛰
藏之用，尿出而精亦随之出矣。其左脉弦硬者，肝脉挟风之象，其右脉浮而无力者，因病久而气
血虚弱也。其尿道恒发刺痒者，尤显为风袭之明征也。此宜散其肝风，固其肾气，
而更辅以培补气血之品。
处方 生箭 （五钱） 净萸肉（五钱） 生怀山药（五钱） 生龙骨（五钱捣碎）
生牡蛎（五钱捣碎） 生杭芍（四钱） 桂枝尖（三钱） 生怀地黄（三钱） 甘草（钱半）
共煎汤一大盅，温服。
方解 方中以黄 为主者，因《神农本草经》原谓黄 主大风，是以风之入脏者，黄 能逐之
外出，且其性善补气，气盛自无滑脱之病也。桂枝亦逐风要药，因其性善平肝，故尤善逐肝家
之风，与黄 相助为理则逐风之力愈大也。用萸肉、龙骨、牡蛎者，以其皆为收敛之品，又皆善
收敛正气而不敛邪气，能助肾脏之蛰藏而无碍肝风之消散，药物解中论之详矣。用山药者，以
其能固摄下焦气化，与萸肉同为肾气丸中要品，自能保合肾气不使虚泻也。用芍药、地黄者，欲以调
剂黄 、桂枝之热，而芍药又善平肝，地黄又善补肾，古方肾气丸以干地黄为主药，即今之
生地黄也。用甘草者，取其能缓肝之急，即能缓其过于疏泄之力也。
效果 将药连服三剂，病即全愈，因即原方去桂枝以熟地易生地，俾再服数剂以善其后。
天津的李××，26岁，患小便白浊证。
病因 在深秋时节乘坐大车回家，途中遇到下雨，衣服全部湿透，晚上住在旅店中，又披着衣服到院子里小便，被寒风侵袭，于是得了白浊的病证。
证候 尿道中经常感到刺痒，每次小便结束时会有几滴类似精液的液体流出。到现在已经三个月了，多次服药无效，感觉身体衰弱，精神不足。其脉象左部弦硬，右部微浮且重按无力。
诊断 《黄帝内经》说肾主蛰藏（封藏精气），肝主疏泄（疏通宣泄），又说风气通于肝，还说肝运行肾的气机。此证是因为风寒内袭入肝，肝得到风的帮助，其疏泄之力更加强大，所以在小便时，肝为肾行气时疏泄过度，导致肾脏失去其蛰藏的功能，尿液排出而精液也随之外出。其左脉弦硬，是肝脉挟带风邪的表现；其右脉浮而无力，是因为病程长久导致气血虚弱。其尿道经常感到刺痒，更是风邪侵袭的明显征象。此证应当疏散肝风，固摄肾气，并辅以培补气血的药物。
处方 生黄芪（五钱） 山茱萸（五钱） 生怀山药（五钱） 生龙骨（五钱，捣碎） 生牡蛎（五钱，捣碎） 生杭芍（四钱） 桂枝尖（三钱） 生怀地黄（三钱） 甘草（一钱半）
共煎煮成一大盅汤剂，温服。
方解 方中以黄芪为主药，因为《神农本草经》原本记载黄芪主治大风，所以风邪侵入脏腑，黄芪能将其驱逐外出，而且黄芪性质善于补气，气盛自然就没有滑脱的疾病。桂枝也是驱逐风邪的重要药物，因为它性质善于平抑肝木，所以特别善于驱逐肝脏的风邪，与黄芪相助为理，则驱逐风邪的力量更大。使用山茱萸、龙骨、牡蛎，是因为它们都是收敛性质的药物，又都善于收敛正气而不敛留邪气，能帮助肾脏的蛰藏功能而无碍于肝风的消散，在药物解说中对此论述得很详细。使用山药，是因为它能固摄下焦的气化，与山茱萸同为肾气丸中的重要药材，自然能保全肾气不使其虚泻。使用芍药、地黄，是想用来调剂黄芪、桂枝的热性，而芍药又善于平抑肝木，地黄又善于补肾，古方肾气丸以干地黄为主药，就是现在的生地黄。使用甘草，是取它缓急止痛的作用，即能缓解肝气的急躁，也就是能缓解其过于疏泄的力量。
Li XX from Tianjin, aged 26, suffered from the syndrome of white turbid urine (Bai Zhuo).
Etiology During late autumn, while riding a large cart home, he encountered rain on the way, and his clothes became completely wet. He stayed overnight in an inn and, wearing only a coat, went to the courtyard to urinate, where he was attacked by cold wind, thus contracting the disease of white turbid urine.
Symptoms There is constant stinging and itching in the urethra, and upon completion of urination, several drops of fluid resembling essence are discharged. This has persisted for three months. Despite multiple courses of medication with no effect, he feels physically weak and mentally fatigued. His pulse is wiry and hard on the left side, and slightly floating yet powerless when pressed heavily on the right side.
Diagnosis The *Nei Jing* (Yellow Emperor's Inner Canon) states that the Kidney governs storage (Zhe Cang), and the Liver governs discharge (Shu Xie). It also states that Wind Qi connects with the Liver, and the Liver moves the Qi of the Kidney. In this case, Cold and Wind pathogens invaded internally and entered the Liver. Assisted by Wind, the Liver's discharge function became excessively strong. Consequently, during urination, the Liver moved the Kidney's Qi with excessive discharge, causing the Kidney to lose its storage function. Thus, as urine was expelled, essence followed it out. The wiry and hard left pulse indicates Liver Qi harboring Wind; the floating and powerless right pulse indicates Qi and Blood deficiency due to prolonged illness. The constant stinging and itching in the urethra is a clear sign of Wind invasion. Treatment should focus on dispersing Liver Wind and consolidating Kidney Qi, supplemented by herbs that tonify Qi and Blood.
Prescription Raw Astragali Radix (Huangqi, 5 qian); Processed Corni Fructus (Yurou, 5 qian); Raw Dioscoreae Hypoglaucae Rhizoma (Huai Shanyao, 5 qian); Raw Longgu (Os Draconis, 5 qian, crushed); Raw Muli (Concha Ostreae, 5 qian, crushed); Raw Paeoniae Radix Alba (Hang Shaoyao, 4 qian); Ramulus Cinnamomi (Guizhi Jian, 3 qian); Raw Rehmanniae Radix (Sheng Dihuang, 3 qian); Glycyrrhizae Radix et Rhizoma (Gancao, 1.5 qian).
Decoct together in a large cup of water and take warm.
Formula Analysis Huangqi is used as the chief herb because the *Shennong Bencao Jing* records that Huangqi treats severe Wind. Therefore, for Wind pathogens entering the Zang organs, Huangqi can expel them outward. Moreover, its nature is good at tonifying Qi; sufficient Qi prevents sliding and leakage. Guizhi is also an important herb for expelling Wind; because its nature is good at pacifying the Liver, it is particularly effective at expelling Wind from the Liver. When assisting Huangqi, the power to expel Wind is greatly increased. Yurou, Longgu, and Muli are used because they are all astringent herbs that gather Zheng Qi without retaining pathogenic factors. They assist the Kidney's storage function without hindering the dispersion of Liver Wind, as detailed in materia medica discussions. Shanyao is used because it secures the Qi transformation of the Lower Jiao. Together with Yurou, it is a key component in Shenqi Wan, naturally preserving Kidney Qi and preventing deficiency-induced diarrhea. Shaoyao and Dihuang are used to moderate the heat of Huangqi and Guizhi. Shaoyao pacifies the Liver, and Dihuang tonifies the Kidney. In the ancient formula Shenqi Wan, Gan Dihuang (Dry Rehmanniae Radix) is the chief herb, which corresponds to Sheng Dihuang (Raw Rehmanniae Radix) today. Gancao is used for its ability to relieve urgency, thereby moderating the Liver's excessive discharge function.
Outcome After taking the prescription continuously for three doses, the illness was completely cured. Subsequently, Guizhi was removed from the original formula, and Sheng Dihuang was replaced with Shu Dihuang (Prepared Rehmanniae Radix) to be taken for several more doses to consolidate the recovery.