人之九窍。阳七阴二。皆五脏主之。而六腑亡有。然清阳出上窍。浊阴走下
窍。则有形无形之别。今肾既开窍于耳。何以复开窍于二阴哉。或曰膀胱
者。州都之官。津液藏焉。气化则能出矣。三焦者。决渎之官。水道出焉。膀胱
乃肾之腑。三焦为命门之使。故隶之也。小肠者。受盛之官。化物出焉。大肠
者。传道之官。变化出焉。肾为胃关。下部法地。故隶之也。况肺主通调水道。
下输膀胱。则是又隶于手太阴矣。脾主消磨五谷。仓廪所司。则是又隶于
足太阴矣。又何以独主于肾也。不知北方黑色。开窍于二阴。入通于肾者。
盖阴窍不侔于阳窍。五脏主藏而不泻。故走空窍而无形。为精明之府。六
腑主泻而不藏。故走浊窍而有形。为传化之路。究竟与肾何与。殆化之者
阳。而所以化之者则阴。无阴则阳无以化。肾主五液是也。试观之肾虚之
人。小便必淋沥。大便则燥结。又有肾泄遗尿之候。益信肾之主二便也彰
彰矣。而小便闭。又甚于大便闭者。大便止苦精血亏损。艰涩之患。小便则
胀闷不堪。气不化而形坏矣。然则治之者。专主于肾与。不专主于肾与。曰
因肾虚而致者。治其肾。因他脏而致者。治他脏。阴阳者。变化之父母。生杀
之本始。上有病。下取之。下有病。上取之。或实或虚。或热或寒。老少异病。久
暂异候。缓急异宜。神而明之。存乎其人。是可与知者道也。
一老人年七旬。酒后不谨。患小便闭。及旬日。点滴不通。少腹胀满。连至腰
胯。坐卧不可。始延治。按其脉。或促或结。参伍不调。检其药。则五苓八正
六一补中肾气。遍尝罔应。余因思虞天民用地肤草自然汁。治百药不
应者曾验。即令其童采取之。时值初夏。其草尚嫩。遂收以捣汁。因以己
意用盐炒川萆 一两水煎。共汁饮之。以其能去膀胱宿水故也。试尝
之。小便涌决如泉。昼夜不止。其腹渐平。但阴囊为前医所熏。赤肿如斗。
延吾郡疡科疗之。用砭法出水。逾日复作。又延余治。余曰。小便不利。一
剂取效。此囊痈之兆。当以六十剂约两月全愈。老人曰。日服二剂何如。
余曰。则一月愈。遂以炒黑龙胆草柴胡山栀当归芍药熟地茯苓泽泻
牛膝丹皮之属。泻肝补阴。果日消一日。如期而痊。
一老人年六旬。因幼年曾参禅。习危坐运气法。得小便闭症。比时士材笠
泽两先生。以金匮肾气丸投之不受。反觉闷绝者三日。及晚年来。每至
冬至前一日。小便遂闭。极力攻出。解血块如蚬肉状。顷之复闭。三日不
通。则闷绝不醒。余曰。此少腹有瘀滞。极力欲解。则气反不化。故上攻而
晕。余以人参三钱。琥珀一钱五分。牛膝一钱五分。丹皮一钱。车前子二
钱。升麻五分。且攻且补。一降一升。用之取效。以后屡发。投此无不神应。
若用他药。便没干涉。
人的九窍，由阳气主导的有七个，由阴气主导的有两个，都由五脏所主管，而六腑并不直接主管这些孔窍。然而，清阳之气出于上部的七窍，浊阴之气走于下部的二窍，这又有有形与无形的区别。现在既然说肾开窍于耳，为什么又说它开窍于前后二阴呢？有人回答说：膀胱是州都之官，津液在其中储藏，经过气化作用才能排出。三焦是决渎之官，水道由此而出。膀胱是肾的腑，三焦是命门的使者，所以归属于肾。小肠是受盛之官，消化食物并分出清浊。大肠是传道之官，传导糟粕并发生变化。肾为胃之关，下部法应于地，所以也归属于肾。况且肺主通调水道，向下输送到膀胱，这样又归属于手太阴肺经了。脾主消磨五谷，掌管仓廪，这样又归属于足太阴脾经了。那为什么唯独说由肾主管呢？不知道北方属黑色，开窍于前后二阴，内通于肾，这是因为阴窍不同于阳窍。五脏主藏精而不泻，所以精气走空窍而无形，成为精明之府；六腑主传化而不藏，所以糟粕走浊窍而有形，成为传化的道路。这究竟与肾有什么关系呢？大概化生功能属于阳，而能够进行化生的物质基础则属于阴，没有阴就没有阳的化生，这就是肾主五液的道理。试看肾虚的人，小便必然淋沥不尽，大便则干燥结滞，又有肾泄、遗尿的症状，更加确信肾主管大小便的事实是显而易见的。而小便闭塞，又比大便闭塞更严重，大便闭只是苦于精血亏损导致的艰涩困难，小便闭则胀闷难忍，因为气不化而导致形体败坏。那么治疗时，是专门主治肾呢，还是不专门主治肾呢？回答说：如果是因肾虚导致的，就治肾；如果是因其他脏腑病变导致的，就治其他脏腑。阴阳是变化的父母，生死之本始。上面有病，从下面取穴治疗；下面有病，从上面取穴治疗。或者实证或者虚证，或者热证或者寒证，老少病情不同，病程久暂症状各异，缓急适宜也不同。神妙而明达的道理，在于医者个人的悟性与能力。这是只能与懂得的人谈论的。
有一位七十多岁的老人，酒后不慎，患上了小便闭塞症。到了十天，点滴不通，小腹胀满，一直连及腰胯，坐卧不安，这才请医生诊治。诊其脉象，或急促或结代，参差不齐。查看他之前用过的药，包括五苓散、八正散、六一散、补中益气汤、肾气丸等，遍尝无效。我想到虞天民曾用地肤草的自然汁，治疗百药无效的病例曾验证有效，于是让他的童仆去采集。当时正值初夏，草还嫩，就收集起来捣汁。我又根据自己的意思，加入盐炒过的川萆薢一两，用水煎煮，混合地肤草汁一起服用，因为它能去除膀胱中的宿水。尝试后，小便涌出如泉水，昼夜不停，腹部逐渐平复。但阴囊被前医熏蒸过，红肿如斗，请我们郡里的外科医生治疗，用了砭法放水，第二天又复发。再请我诊治。我说：小便不利，一剂药就能见效，这是囊痈的先兆，大约需要六十剂药，两个月左右能痊愈。老人问：每天服两剂怎么样？我说：那就一个月痊愈。于是用了炒黑的龙胆草、柴胡、山栀、当归、芍药、熟地、茯苓、泽泻、牛膝、丹皮等药物，以泻肝火、补阴液，果然每天消退一些，如期痊愈。
另一位六十岁的老人，因为年轻时曾参禅，练习危坐运气法，得了小便闭塞症。那时士材、笠泽两位先生，用金匮肾气丸投给他，他不接受，反而觉得胸闷窒息了三天。到了晚年，每到冬至前一天，小便就会闭塞，极力想排出，解出的血块像蚬肉状，一会儿又闭塞。三天不通，就会胸闷窒息不醒人事。我说：这是少腹有瘀滞，极力想解出，反而导致气机不化，所以上攻头部引起晕厥。我用三钱人参、一钱五分琥珀、一钱五分牛膝、一钱丹皮、二钱车前子、五分升麻，且攻且补，一降一升，用药后取得了效果。以后多次发作，投以此方无不神效。如果用其他药，就没有关联和效果了。
The nine orifices of the human body consist of seven governed by Yang and two governed by Yin, all under the control of the Five Zang Organs (Zang organs), while the Six Fu Organs (Fu organs) do not directly govern them. However, clear Yang Qi emerges from the upper orifices, and turbid Yin descends to the lower orifices, presenting a distinction between the formless and the formed. Now, since it is said that the Kidney opens into the ears, why does it also open into the two lower orifices? Some say: The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted. The San Jiao (Triple Burner) is the official of irrigation, where water pathways emerge. The Bladder is the Fu organ of the Kidney, and the San Jiao is the envoy of the Gate of Vitality (Mingmen); thus, they are subordinated to the Kidney. The Small Intestine is the official of reception and containment, transforming substances and separating the clear from the turbid. The Large Intestine is the official of transmission, changing and excreting waste. The Kidney acts as the gate of the Stomach, and the lower part corresponds to Earth; thus, they are also subordinated to the Kidney. Moreover, the Lung governs the free flow of water passages, transporting fluids downward to the Bladder; thus, this is further subordinated to the Hand Taiyin Lung Meridian. The Spleen governs the digestion of grains and manages the granary; thus, this is further subordinated to the Foot Taiyin Spleen Meridian. Then why is it solely attributed to the Kidney? One must understand that North corresponds to Black, opens into the two lower orifices, and connects internally with the Kidney. This is because Yin orifices differ from Yang orifices. The Five Zang Organs store essence without draining, so essence flows through empty orifices in a formless manner, becoming the residence of clarity and spirit. The Six Fu Organs drain without storing, so waste flows through turbid orifices in a formed manner, serving as pathways for transformation. What, after all, does this have to do with the Kidney? Essentially, the function of transformation belongs to Yang, but that which enables transformation belongs to Yin. Without Yin, Yang cannot transform; this is what is meant by the Kidney governing the five fluids. Observe those with Kidney deficiency: their urination is inevitably dribbling, and their defecation is dry and constipated. They also present symptoms of Kidney diarrhea and urinary incontinence. This confirms that the Kidney governs both urine and feces, a fact that is obvious. Urinary retention is more severe than fecal retention. Fecal retention merely suffers from difficulty due to the loss of essence and blood, whereas urinary retention causes unbearable distension and discomfort, leading to physical deterioration due to failed Qi transformation. Therefore, when treating, should one focus exclusively on the Kidney, or not? The answer is: If caused by Kidney deficiency, treat the Kidney; if caused by other Zang or Fu organs, treat those organs. Yin and Yang are the parents of change and the origin of life and death. Disease above should be treated by taking points below; disease below should be treated by taking points above. Whether excess or deficiency, heat or cold, the pathology differs between the young and old, and the presentation varies with duration. Acute cases require different management than chronic ones. The divine and illuminating principles depend on the individual practitioner. This can only be discussed with those who understand.
An elderly man in his seventies, having been immoderate after drinking alcohol, suffered from urinary retention. After ten days, he passed no drops, his lower abdomen was distended and full, extending to the waist and hips, making sitting and lying impossible. He finally sought treatment. His pulse was either rapid or knotted, irregular and inconsistent. Reviewing his previous medications, including Wu Ling San (Five-Ingredient Powder with Poria), Ba Zheng San (Eight-Right Powder), Liu Yi San (Six-to-One Powder), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), and Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), none had any effect. I recalled that Yu Tianmin had successfully used the natural juice of *Kochia scoparia* (Difukcao, 地肤草) to treat cases unresponsive to hundred medicines. I instructed his servant to collect it. It was early summer, and the herb was still tender, so we gathered it and crushed it to extract the juice. Following my own judgment, I added one liang of salt-fried *Bianxu* (Chuanbihe, 川萆薢) and decocted it with water, mixing it with the juice for oral administration, as it can eliminate stagnant water in the Bladder. Upon trial, urine gushed out like a spring, day and night, and his abdomen gradually flattened. However, his scrotum, having been fumigated by previous doctors, was red and swollen like a bean bag. We invited surgeons from our county to treat it; they used Bian fa (scarification therapy) to drain fluid, but it recurred the next day. He then sought my treatment again. I said: "Urinary difficulty responds to one dose of medicine; this is a sign of Scrotal Abscess (Nangyong, 囊痈). It will take approximately sixty doses over two months for complete recovery." The old man asked, "How about taking two doses daily?" I replied, "Then it will heal in one month." Thus, I prescribed fried black *Gentiana scabra* (Longdancao, 龙胆草), *Bupleurum chinense* (Chaihu, 柴胡), *Gardenia jasminoides* (Shanzhi, 山栀), *Angelica sinensis* (Danggui, 当归), *Paeonia lactiflora* (Shaoyao, 芍药), *Rehmannia glutinosa* (Shudi, 熟地), *Poria cocos* (Fuling, 茯苓), *Alisma orientale* (Zexie, 泽泻), *Achyranthes bidentata* (Niuxi, 牛膝), and *Moutan cortex* (Danpi, 丹皮), among others, to drain Liver fire and nourish Yin. Indeed, the swelling subsided daily, and he recovered as scheduled.
Another elderly man in his sixties developed urinary retention due to practicing Zen meditation and dangerous sitting breathing exercises in his youth. At that time, Mr. Shicai and Mr Lizé prescribed Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), but he refused it and instead experienced chest oppression and suffocation for three days. In his later years, every day before the Winter Solstice, his urine would become blocked. Straining to pass it, he would expel blood clots resembling clam meat, after which the blockage would return. If there was no passage for three days, he would suffer from chest oppression and faint unconsciousness. I said: "This is stasis in the lower abdomen. Straining to pass it causes Qi transformation to fail, leading to upward attack and dizziness." I prescribed three qian of *Panax ginseng* (Renshen, 人参), one qian and five fen of *Succinum* (Hupo, 琥珀), one qian and five fen of *Achyranthes bidentata* (Niuxi, 牛膝), one qian of *Moutan cortex* (Danpi, 丹皮), two qian of *Plantago seed* (Cheqianzi, 车前子), and half a qian of *Cimicifuga heracleifolia* (Shengma, 升麻). This formula simultaneously attacks pathogenic factors and tonifies deficiency, lowering and ascending Qi. It proved effective. Subsequent recurrences were all miraculously cured by this prescription. Other medications had no relevance or effect.