治膀胱结热, 水道不通, 淋涩热痛, 或尿如豆汁. 或成
砂石, 或如膏脓, 或小便血.
赤苓一钱五分 赤芍一钱 栀仁一钱 当归 甘草各钱二分, 右五味
,加灯心, 水煎服.
瞿麦 栀子 萹蓄 大黄 木通 滑石 车前子 甘草各一钱, 加灯
心一钱, 煎服 ( 朱震亨方: 加木香一钱 ).
【注】通调水道, 下输膀胱, 三焦之职也. 受藏津液, 气化能出, 膀
胱之职也. 若水道不输, 则内蓄喘胀, 外泛肤肿, 三焦之病也. 若受
藏不化, 则诸淋涩痛, 癃闭不通, 膀胱之病也. 经曰: 阴无阳无以生
,阳无阴无以化. 故阴阳偏盛, 皆不生化也. 阳盛阴虚, 而膀胱之气
不化为病者, 通关丸证也. 阴盛阳虚, 而膀胱之气不化为病者, 肾气
丸证也. 此关乎气化阴阳之为病也. 经曰: 下虚则遗尿. 又曰: 膀胱
不约为遗尿. 经曰: 胞移热于膀胱则癃. 又曰: 膀胱不利为癃. 故虚
而寒者, 藏而不能约; 实而热者, 约而不能出也. 膀胱气虚, 无气以
固,则藏而不约不禁, 遗失之病生, 补中固真汤证也. 膀胱气热, 壅
结不行, 则约而不出, 淋涩癃闭之病生, 八正五淋散证也. 此不全关
乎气化, 而又关乎虚寒, 实热之为病也. 八正, 五淋皆治淋涩癃闭之
药,而不无轻重之别. 轻者, 有热未结, 虽见淋涩尿赤, 豆汁, 砂石
,膏血, 癃闭之证, 但其痛则轻, 其病不急, 宜用五淋散单清水道,
故以栀, 苓清热而输水, 归, 芍, 益阴而化阳, 复佐以甘草调其阴阳
,而用稍者, 意在前阴也. 重者, 热已结实, 不但痛甚势急, 而且大
便亦不通矣, 宜用八正散兼泻二阴, 故于群走前阴药中, 加大黄直攻
后窍也. 丹溪方加木香者, 其意亦以气化者欤!
治疗膀胱积热，导致水道不通畅，出现小便淋漓涩痛、灼热疼痛的症状，或者尿液像豆汁一样浑浊。有的形成砂石，有的像膏脂脓液，或者小便带血。
赤茯苓一钱五分，赤芍药一钱，栀子仁一钱，当归，甘草各一钱二分。以上五味药，加入灯心草，用水煎煮后服用。
瞿麦，栀子，萹蓄，大黄，木通，滑石，车前子，甘草各一钱，加入灯心草一钱，煎煮后服用（朱震亨的方子：加入木香一钱）。
【注释】疏通调节水道，向下输送到膀胱，这是三焦的功能。接受和储存津液，通过气化作用排出体外，这是膀胱的功能。如果水道不能输布，那么体内就会积蓄喘息胀满，体表就会泛发皮肤浮肿，这是三焦的病变。如果接受储存但不能气化，就会出现各种淋证、淋漓涩痛、小便闭塞不通，这是膀胱的病变。医经说：阴没有阳就无法生成，阳没有阴就无法化生。所以阴阳偏盛，都不能正常生化。阳气盛而阴气虚，导致膀胱气化功能失常产生疾病的，是通关丸的适应证。阴气盛而阳气虚，导致膀胱气化功能失常产生疾病的，是肾气丸的适应证。这关系到气化与阴阳失调产生的疾病。医经说：下元虚弱就会遗尿。又说：膀胱约束无力就会遗尿。医经说：胞宫的热邪转移至膀胱就会导致小便不利。又说：膀胱气机不利会导致小便不利。所以虚寒的病症，是因为脏腑不能约束；实热的病症，是因为约束太过而不能排出。膀胱气虚，没有足够的元气来固摄，就会导致收藏而不能约束，不禁固，从而产生遗失（遗尿）的疾病，这是补中固真汤的适应证。膀胱气热，壅滞结聚而不行，就会导致约束太紧而不能排出，从而产生淋证、淋漓涩痛、小便闭塞不通的疾病，这是八正散和五淋散的适应证。这不完全关乎气化，还关乎虚寒和实热产生的疾病。八正散和五淋散都是治疗淋证、淋漓涩痛、小便闭塞不通的药物，但二者有轻重之别。病情较轻的，热邪尚未结实，虽然出现淋证、淋漓、尿色红赤、像豆汁、砂石、膏脂、血液、小便闭塞不通等症状，但是疼痛轻微，病情不紧急，适宜使用五淋散单纯清利水道，所以用栀子、茯苓清热并输泄水湿，用当归、芍药滋养阴血并化生阳气，再辅以甘草调和阴阳，用药较缓和，用意在于调理前阴。病情较重的，热邪已经结实，不仅疼痛剧烈、病势急迫，而且大便也不通畅了，适宜使用八正散兼泻前后二阴，所以在众多走向前阴的药物中，加入大黄直接攻逐后窍（肛门/大肠）。丹溪的方子中加入木香，其用意也是在于促进气化吧！
Treats heat accumulation in the Bladder (Bladder), causing obstruction of the water passages, resulting in strangury with dribbling, astringency, burning pain, or urine resembling bean dregs. Some cases form calculi (stones), some resemble paste or pus, or there is hematuria (blood in urine).
Chifuling (Red Poria) 1 qian 5 fen, Chishao (Red Peony Root) 1 qian, Zhiren (Gardenia Seed) 1 qian, Danggui (Angelica Sinensis), Gancao (Licorice Root) each 1 qian 2 fen. The above five herbs, plus Dengxincao (Juncus Effusus Pith), decocted in water and taken orally.
Qumai (Dianthus Herba), Zhizi (Gardeniae Fructus), Bianxu (Polygoni Avicularis Herba), Dahuang (Rhei Radix et Rhizoma), Mutong (Akebiae Caulis), Huashi (Talcum), Cheqianzi (Plantaginis Semen), Gancao (Licorice Root) each 1 qian, plus Dengxincao (Juncus Effusus Pith) 1 qian, decocted and taken orally (Zhu Zhenheng's formula: add Muxiang (Aucklandiae Radix) 1 qian).
[Note] To unblock and regulate the water passages, transporting them downward to the Bladder (Bladder), this is the function of the Sanjiao (Triple Burner). To receive and store body fluids, and discharge them through qi transformation, this is the function of the Bladder (Bladder). If the water passages fail to transport, internal accumulation leads to wheezing and distension, while external overflow causes skin edema; this is a disease of the Sanjiao (Triple Burner). If reception and storage occur but transformation fails, various types of strangury, astringency, pain, and urinary retention (Linchuang) arise; this is a disease of the Bladder (Bladder). The Classics state: "Yin cannot generate without Yang, and Yang cannot transform without Yin." Therefore, if Yin or Yang is in excess, normal generation and transformation cease. When Yang is excessive and Yin deficient, leading to failure of Bladder qi transformation, it is an indication for Tongguan Wan. When Yin is excessive and Yang deficient, leading to failure of Bladder qi transformation, it is an indication for Shenqi Wan. This concerns diseases arising from qi transformation and yin-yang imbalance. The Classics state: "Deficiency below leads to enuresis." It also states: "Inability of the Bladder to constrain leads to enuresis." The Classics state: "When heat shifts from the Bao (Uterus) to the Bladder, urinary difficulty occurs." It also states: "Imperfection of the Bladder leads to urinary difficulty (Long)." Therefore, deficiency-cold conditions involve the organ's inability to constrain; excess-heat conditions involve excessive constraint preventing expulsion. Bladder qi deficiency, lacking sufficient yuan qi to consolidate, results in the organ failing to constrain and control, leading to leakage diseases; this is an indication for Buzhong Guzhen Tang. Bladder qi heat, obstructed and stagnant, results in excessive constraint preventing expulsion, leading to strangury, astringency, and urinary retention; this is an indication for Bazheng San and Wulin San. This does not solely concern qi transformation, but also diseases arising from deficiency-cold and excess-heat. Both Bazheng San and Wulin San treat strangury, astringency, and urinary retention, but differ in severity. For mild cases, where heat has not yet solidified, although symptoms such as strangury, astringency, red urine, bean-dreg-like urine, stones, paste, blood, and urinary retention are present, the pain is mild and the condition is not urgent. It is appropriate to use Wulin San to simply clear and promote urination. Thus, Zhizi and Fuling are used to clear heat and drain water; Danggui and Shaoyao nourish yin and transform yang; supplemented by Gancao to harmonize yin and yang. The prescription is slightly milder, intending to focus on the anterior orifice. For severe cases, where heat has solidified, not only is the pain intense and the condition urgent, but defecation is also blocked. It is appropriate to use Bazheng San to purge both anterior and posterior orifices. Thus, within the group of herbs targeting the anterior orifice, Dahuang is added to directly attack the posterior orifice (intestines). Zhu Danxi's addition of Muxiang aims to facilitate qi transformation!