小便不通之谓闭，滴沥作痛之谓淋。二者因心肾不交，蕴积热毒，或酒后房劳，或饮食
燥热
，七情郁结所致，皆一类也。自严氏有五淋之分，气淋者，小腹满闷，便涩，常有余沥；砂
淋者，茎中痛，尿难卒出；膏淋者，尿如脂膏；劳淋者，劳倦即发，痛引气冲；血淋者，遇
热即发，甚则溺血，候其鼻色黄者，小便难也。至东垣论肺为生水之上源，肾为主液之元气
，若淋而口渴，身热脉数者，为肺受肝邪热，失其降水之令为气分证，宜以轻清淡渗药泻热
。若无身热口渴，为血分之候，宜以滋阴浓味药助肾。愚按严氏之意，乃以肾与膀胱本病论
之。东垣之辨，是兼他证而言也，何也？以其论中肺受热邪之证，及肺患喘嗽，与夫脾病胀
满，淋闭水泄，小便涩少，皆他病致淋，不因肾与膀胱也。是知淋闭之证，主乎心肾，而实
关乎脾肺矣。丹溪则又谓膀胱之府，有上口而无下口，得引升腾之气，乃施渗泄之令，气化
则能出。苟气血偏浊，或正虚下陷，遂郁成淋，譬之滴水之器。上窍不通，则下窍不出，宜
加柴胡、升麻等药提之。若中气弱，不能运化清浊而淋者，宜加补气之药。若因血虚而气不
能升提者，盖气为血配，血虚则气亦虚，而涌泄之令不行，宜补血加升提。若酒食过度，湿
痰积于胸膈，脉见弦滑，证见痞闷者，宜二陈汤加香附、木香探吐、次加山栀、木通调之，
此亦一法也。愚按造化之理，阳无阴不化，阴无阳不行，非升不能降，非降不能升。故吐者
，升之法也；渗利者，降之法也。利湿清热等剂者，阳分气药也；泻火滋阴等剂者，阴分血
药也。或升降同用，或气血兼加，但血分之病不用偏施渗泄，恐反耗其精液，以致虚而愈燥
，惟少用肺，引通子母相生之情。气分之病，不可纯用沉寒，恐更泥滞其化生，以致郁愈而
淋，惟少用辛润行气，令气化则渗泄而出。今人见用温药，遂疑淋有冷证，不知此气郁从治
之法耳。外有挟寒淋沥先寒战而后溲便，因寒气与正气争，邪气盛，则寒战成淋，正气盛，
则寒
战解而便利。有汗过多，小盒饭赤涩如淋，因五内枯燥，慎勿用利小便之剂。亦有小便艰难
，茎中不痛而痒者，乃积所致，非淋也。又有跌仆损伤，及服温药燥涩太过，致血污留并，
妇人经水不通，血积成瘕，并能作淋闭，则必小腹满痛，或手不可近，宜用红花、桃仁等破
血。更有难产为收生者损胞，致小便淋沥不断，其证必无痛涩，但滴而不自觉，或觉而不痛
，别当大补气血。若大小便皆闭，上为呕吐者，世称关格，最难调治。经云∶不得尽期而死
也。
小便排出不畅、完全阻塞的称为“闭”，排尿时点滴不尽且伴有疼痛的称为“淋”。这两种病症都是因为心肾不交，体内蕴积热毒，或者酒后行房过度，或者饮食过于燥热，以及七情郁结所导致，本质上属于同一类疾病。自从严用和提出“五淋”的分类后，气淋表现为小腹胀满闷痛，排尿涩滞，常有残余尿液；砂淋表现为尿道中疼痛，尿液难以突然排出；膏淋表现为尿液像脂膏一样浑浊；劳淋表现为劳累疲倦后即发作，疼痛牵引至气冲穴部位；血淋表现为遇热即发作，严重时出现尿血，如果观察到患者鼻部颜色发黄，则是小便困难的征象。到了李东垣论述认为肺是生成水液的上方源头，肾是主管津液的根本元气，如果淋证伴有口渴、身体发热、脉搏数动，这是肺受到肝邪热的影响，失去了通调水道下输膀胱的功能，属于气分证，适宜用轻清淡渗的药物来清热。如果没有身体发热和口渴，则属于血分的证候，适宜用滋阴厚味的药物来辅助肾脏功能。我按照严用和的意思，是从肾与膀胱的本病角度来论述的。李东垣的辨析，则是兼及其他证候而言的，为什么呢？因为在他的论述中，肺受热邪的证候，以及肺患喘咳，还有脾病导致的胀满，淋闭、水泄、小便涩少，都是其他疾病导致淋证，并非由肾与膀胱本身引起。由此可知，淋闭之证，主要在于心肾，但实际上关乎脾肺。朱丹溪又认为膀胱作为腑，只有上口而没有下口，需要依靠升腾之气，才能施行渗泄的命令，气化正常则尿液能排出。如果气血偏于浊滞，或者正气虚弱下陷，于是郁结形成淋证，就像滴水器一样，上窍不通，下窍就无法流出，适宜加入柴胡、升麻等药物来提升气机。如果中气虚弱，不能运化清浊而导致淋证，适宜加入补气的药物。如果是因血虚导致气不能升提，因为气依附于血，血虚则气也虚，而涌泄的功能无法执行，适宜补血并加入升提药物。如果因饮酒饮食过度，湿痰积聚在胸膈，脉象呈现弦滑，症状见痞闷者，适宜用二陈汤加入香附、木香进行探吐，随后加入山栀、木通来调理，这也是一种方法。我按照自然造化的道理，阳没有阴就不能化生，阴没有阳就不能运行，不升就不能降，不降就不能升。所以吐法，是升的方法；渗利法，是降的方法。利湿清热等方剂，属于阳分的气药；泻火滋阴等方剂，属于阴分的血药。或者升降同用，或者气血兼加，但血分的病不要单独施用渗泄之法，恐怕反而耗损精液，导致虚而更燥，只需少量使用肺经药物，以引导子母相生之情。气分的病，不可纯用沉寒药物，恐怕更加凝滞其化生过程，导致郁结更甚而成淋，只需少量使用辛润行气药物，令气化则渗泄而出。现在的人见到使用温药，就怀疑淋证有冷证，不知道这是气郁从治（顺从其性质而治疗）的方法罢了。另外有夹杂寒气的淋证，先出现寒战然后才排尿，这是因为寒气与正气相争，邪气盛则寒战成淋，正气盛则寒战解除而排尿便利。有出汗过多，小便赤涩像淋证一样，这是因为五脏内部枯燥，千万不要使用利小便的药剂。也有小便艰难，尿道中不痛而痒的，这是虫积所致，不是淋证。又有跌仆损伤，以及服用温药燥涩太过，导致血液污浊留滞，妇女月经不通，血积形成瘕块，都能导致淋闭，这时必然小腹胀满疼痛，或者手不可触碰，适宜用红花、桃仁等破血药物。更有难产被接生者损伤胞宫，导致小便淋沥不断，这种证候必定无痛涩感，只是滴出而不自觉，或者感觉但不痛，应当大补气血。如果大小便都闭塞，上部出现呕吐的，世称关格，最难调治。《内经》说：这种情况不能活到预定的期限就会死亡。
The inability to urinate is termed "Bi" (Urinary Retention), while dribbling with pain is termed "Lin" (Dysuria/Strangury). Both conditions arise from the failure of communication between the Heart and Kidney, accumulation of heat-toxins, excessive sexual activity after drinking alcohol, consumption of overly dry and hot foods, or emotional stagnation; essentially, they belong to the same category. Since Yan Yonghe proposed the classification of "Five Lin Syndromes," Qi Lin presents with lower abdominal fullness and oppression, difficult urination, and frequent residual urine; Sha Lin (Gravel Strangury) presents with pain in the urethra and difficulty in sudden voiding; Gao Lin (Milky Strangury) presents with urine resembling fat or paste; Lao Lin (Fatigue Strangury) occurs upon fatigue and exertion, with pain radiating to the Qichong point; Xue Lin (Bloody Strangury) is triggered by heat, potentially progressing to hematuria, and if the nasal color is observed to be yellow, it indicates difficult urination. Later, Li Dongyuan argued that the Lung is the upper source for generating fluids, and the Kidney is the primordial qi governing body fluids. If Lin syndrome is accompanied by thirst, fever, and a rapid pulse, it indicates that the Lung has been affected by Liver-heat, losing its function of descending water, which constitutes a Qi-level syndrome; this should be treated with light, clear, and diuretic herbs to clear heat. If there is no fever or thirst, it belongs to the Blood level, and should be treated with nourishing yin and rich/flavorful herbs to assist the Kidney. In my opinion, Yan’s perspective discusses the primary disease of the Kidney and Bladder. Li’s differentiation, however, addresses concurrent syndromes. Why? Because his discussion includes symptoms of Lung heat, Lung wheezing and coughing, Spleen distension and fullness, strangury, retention, watery diarrhea, and scanty difficult urination—all indicating that other diseases cause Lin syndrome, not primarily the Kidney and Bladder. Thus, we know that Lin and Bi syndromes are primarily governed by the Heart and Kidney, but actually involve the Spleen and Lung. Zhu Danxi further stated that the Bladder, as a Fu organ, has an upper opening but no lower opening; it requires ascending and rising qi to execute the command of percolation and excretion, so that when qi transforms, urine can be expelled. If blood and qi become turbid, or if righteous qi is deficient and sinking, stagnation leads to Lin syndrome, similar to a dripping vessel: if the upper orifice is blocked, the lower orifice cannot flow. It is appropriate to add herbs such as Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma) to lift the qi. If middle qi is weak and unable to transform clear and turbid substances, leading to Lin, adding qi-tonifying herbs is appropriate. If blood deficiency prevents qi from ascending, since qi attaches to blood, blood deficiency implies qi deficiency, and the draining/excretory function fails; thus, tonifying blood and adding lifting herbs is suitable. If excessive alcohol and food intake lead to damp-phlegm accumulation in the chest and diaphragm, with a wiry-slippery pulse and symptoms of stuffiness and oppression, Er Chen Tang (Two-Cured Decoction) added with Xiang Fu (Cyperi Rhizoma) and Mu Xiang (Aucklandiae Radix) for induced vomiting, followed by Zhi Zi (Gardeniae Fructus) and Mu Tong (Akebiae Caulis) for regulation, is also one method. I reason according to the principles of nature: yang cannot transform without yin, and yin cannot move without yang; non-ascending prevents descending, and non-descending prevents ascending. Therefore, emesis is a method of ascending; percolation and diuresis are methods of descending. Herbs for promoting diuresis and clearing heat belong to the qi category of the yang aspect; herbs for purging fire and nourishing yin belong to the blood category of the yin aspect. One may use ascending and descending methods together, or combine qi and blood treatments. However, for blood-level diseases, one must not solely apply percolating and draining methods, lest they consume essence and fluids, causing deficiency and increased dryness; instead, use lung-channel herbs sparingly to guide the mutual generation between mother and child organs. For qi-level diseases, one must not use purely cold and heavy herbs, lest they stagnate transformation and generation, worsening stagnation and causing Lin; instead, use pungent and moistening qi-moving herbs sparingly to allow qi transformation and subsequent excretion. Modern practitioners, seeing the use of warm herbs, suspect that Lin syndrome has a cold pattern, unaware that this is a treatment method following the nature of qi stagnation. Additionally, there are cases of Lin complicated by cold, where chills precede urination; this occurs because cold pathogen contends with righteous qi: if the pathogen is strong, chills manifest as Lin; if righteous qi is strong, chills resolve and urination becomes smooth. Excessive sweating can lead to red, astringent urine resembling Lin due to internal dryness of the five zang organs; in such cases, diuretic agents must be avoided. There are also cases of difficult urination with itching but no pain in the urethra, caused by intestinal parasites, which is not Lin syndrome. Trauma from falls or blows, or excessive use of warm, drying, and astringent herbs, can cause blood stasis and turbidity; women with amenorrhea and blood accumulation forming masses (Jia) can also develop Lin and Bi, presenting with lower abdominal fullness and pain, or tenderness to touch; these require blood-breaking herbs such as Hong Hua (Carthami Flos) and Tao Ren (Persicae Semen). Furthermore, difficult labor damaged by midwives injuring the uterus can cause continuous dribbling of urine; this condition lacks pain and astringency, merely dripping unconsciously or with sensation but no pain, and requires substantial tonification of qi and blood. If both stool and urine are retained, accompanied by upper vomiting, it is known in the world as "Guan Ge" (Obstruction and Reversal), which is extremely difficult to treat. The Classics state: "Death will occur before the expected time."