〔大〕妇人淋沥，由肾虚而膀胱热也。盖膀胱与肾为表里，主于水，行于脬者为小
便也。若肾虚则小便频数，膀胱热则小便淋沥，甚则不通，腹胀喘急，当速治之。
〔薛〕前证若膀胱热结，用五淋散。若脾肺虚热，用补中益气（杂病劳倦。）加山药、五
味、麦门。若脾经郁热，用加味归脾汤。（即归脾加丹皮、山栀。）若肺经郁火，用黄芩清肺饮。
若肝经湿热，用龙胆泻肝汤。（杂病淋。）血虚用加味逍遥散。（结核。）阴虚用六味丸（杂病虚劳。）加
柴胡、山栀。大抵不渴而不利者，热在下焦血分也，用滋肾丸。渴而不利者，热在气分
也，用清肺饮。尺脉数而无力者，阴火盛而阳不能化也，用六味丸、滋肾丸为主。尺脉
浮而无力者，阳气虚而阴不能生也，用加减八味丸、（杂病消瘅。）滋肾丸为主。一妇人素
有前患，内热体倦。余以为肝火血少，脾气虚弱，用八珍、逍遥二散，兼服月余而小便
利，又用八珍汤而血气复。一妇人患前证，面青胁胀，诸药不应。余以为肝经气滞而血
伤，用山栀、川芎煎服而愈。 一妇人小便不利，小腹并水道秘闷，或时腹胁胀痛，余
以为肝火，用加味逍遥散加龙胆草，四剂稍愈，乃去胆草佐以八珍散加炒黑山栀兼服而
瘥。
石韦散 治妇人小便卒然淋沥。
石韦 黄芩 瞿麦穗 榆白皮 木通 葵子（各一钱半） 甘草（半钱）
上作一服，水二盅，煎至一盅，食前服。
木通散 治妇人五淋。
木通 榆白皮 瞿麦穗 大麻仁 滑石（各一两） 葵子 贝齿 白茅根（各二两） 甘草（半
两）
上为粗末，每服五钱，水煎空心温服。
桃胶散 治妇人气淋、劳淋。
桃胶 榆白皮（各一两） 车前子 冬瓜子 鲤鱼齿 葵子 瞿麦 木通（各半两） 枳壳（二钱半）
上 咀，每服四钱重，水一盏，煎至七分，去滓温服。
金沙散 治妇人诸淋。
上海金沙草阴干为末，煎生甘草汤调服二钱。
又方 真琥珀（研末，不以多少，） 研木香白汤调下。（此二方出陈总领方。）
鸡苏散 治妇人血淋。
鸡苏叶 木通（各二两） 生干地黄 滑石（各三两） 刺苏根（一两）
上为粗末，每服半两，水盏半， 竹叶三七片，煎至七分，去滓食前温服。
治妇人血淋及尿血涩痛方。
生干地黄（三两） 郁金 蒲黄（各二两）
上为细末，每服二钱，车前子叶煎汤调下，以利为度。
亦有血瘕似淋，小便不通，脐腹胀满，宜桃仁煎。（方见前积聚 瘕门血瘕条。）
后有用乱发方治脬转不得小便，亦可治血淋、尿血。
火府丹 治心经热，小便涩，及治五淋。（加甘草，为 咀煎，名导赤散。出《本事方》。）
生地黄（二两） 木通 黄芩（各一两）
上为细末，炼蜜丸如梧桐子大。每服三十丸，木通煎汤下。兼治淋沥，脐下满痛。
许学士云∶壬戌年一卒渴病，一日饮水一斗，不食者三月，心中烦闷，时已十月。予谓曾
经三伏热，与此药数服。越二日来谢云∶当日三服渴止，又三服饮食如故。此本治淋，用
以治渴，可谓通变也。
治妇人诸般淋。
苦杖根俗呼为杜牛膝，多取洗净锉碎，取一合，用水五盏，煎至一盏，去滓，用麝香、
乳香少许调下。
鄞县武尉耿梦得，其内人患沙石淋者十三年，每漩痛楚不可忍，溺器中小便沙石剥
剥有声，百方不效。偶得此方服之，一夕而愈。目所视也。
《局方》五苓散、八正散、清心莲子饮皆可用。
滋肾丸 治热在血分，不渴而小便不利；或肾虚足热腿膝无力，不能履地；又下焦阴
虚，小便不利，肚腹肿胀，或皮肤胀裂，眼睛突出。此神剂也。
知母 黄柏（各酒炒，二两） 肉桂（去粗皮，二钱）
上各另为末，水丸如桐子大。每服二百丸，空心百滚汤下。
黄芩清肺饮 治肺热小便不利，宜用此药清之。
黄芩（炒） 山栀（炒，各一钱）
上水煎服。不利加盐豉二十粒。
五淋散 治膀胱有热，水道不通，淋沥不出，或尿如豆汁，或成砂石，或如膏汁，或
热怫便血。
赤茯苓（一钱半） 赤芍药 山栀（各一钱） 当归 甘草（各一钱二分）
上入灯心，水煎服。
【大论】妇女出现小便淋漓不尽的症状，是由于肾虚且膀胱有热所致。因为膀胱与肾互为表里，主管水液代谢，尿液在胞宫中运行排出即为小便。如果肾气虚弱，就会导致小便次数频繁；如果膀胱有热，就会导致小便淋漓不畅，严重时甚至完全不通，伴随腹部胀满、气喘急促，应当迅速进行治疗。
【薛己按语】上述病症，如果是膀胱热结，使用五淋散。如果是脾肺虚热，使用补中益气汤（参考杂病劳倦章节），并加入山药、五味子、麦门冬。如果是脾经郁热，使用加味归脾汤（即在归脾汤基础上加入牡丹皮、山栀）。如果是肺经郁火，使用黄芩清肺饮。如果是肝经湿热，使用龙胆泻肝汤（参考杂病淋证章节）。血虚者使用加味逍遥散（参考结核章节）。阴虚者使用六味丸（参考杂病虚劳章节），并加入柴胡、山栀。大抵而言，口不渴而小便不利者，是热邪在下焦血分，使用滋肾丸。口渴而小便不利者，是热邪在气分，使用清肺饮。尺脉数而无力者，是阴火旺盛而阳气不能气化，以六味丸、滋肾丸为主治。尺脉浮而无力者，是阳气虚弱而阴精不能化生，以加减八味丸（参考杂病消瘅章节）、滋肾丸为主治。
有一位妇人素来患有前述病症，体内发热且身体疲倦。我认为是肝火旺盛、血液亏少，脾气虚弱，于是使用八珍汤和逍遥散两方合用，兼服一个月后小便通利，随后又使用八珍汤使气血恢复。另一位妇人患前述病症，面色发青、胁肋胀痛，服用其他药物无效。我认为是肝经气滞导致血伤，使用山栀、川芎煎服而痊愈。还有一位妇人小便不利，小腹部及尿道闭塞闷痛，有时腹部和胁肋胀痛，我认为是肝火，使用加味逍遥散加入龙胆草，服用四剂后稍有好转，于是去掉龙胆草，配合八珍散加入炒黑山栀兼服而康复。
石韦散：治疗妇女突然发生的小便淋漓。
药材：石韦、黄芩、瞿麦穗、榆白皮、木通、葵子（各一钱半），甘草（半钱）。
制法用法：以上为一服量，用水二盅，煎至一盅，饭前服用。
木通散：治疗妇女五种淋证。
药材：木通、榆白皮、瞿麦穗、大麻仁、滑石（各一两），葵子、贝齿、白茅根（各二两），甘草（半两）。
制法用法：以上捣成粗末，每次服用五钱，用水煎煮，空腹温服。
桃胶散：治疗妇女气淋、劳淋。
药材：桃胶、榆白皮（各一两），车前子、冬瓜子、鲤鱼齿、葵子、瞿麦、木通（各半两），枳壳（二钱半）。
制法用法：以上切碎，每次服用四钱重，用水一盏，煎至七分，去渣温服。
金沙散：治疗妇女各种淋证。
制法用法：取上海金沙草阴干研为细末，用生甘草汤调服二钱。
另一方法：真琥珀（研为细末，用量不限），研木香，用白开水调下。（这两个方子出自陈总领方。）
鸡苏散：治疗妇女血淋。
药材：鸡苏叶、木通（各二两），生干地黄、滑石（各三两），刺苏根（一两）。
制法用法：以上捣成粗末，每次服用半两，用水盏半，加竹叶三十七片，煎至七分，去渣饭前温服。
治疗妇女血淋及尿血涩痛的方子。
药材：生干地黄（三两），郁金、蒲黄（各二两）。
制法用法：以上研为细末，每次服用二钱，用车前子叶煎汤调下，以小便通畅为度。
也有血瘕类似淋证，导致小便不通，脐部腹部胀满，适宜使用桃仁煎（方见前文积聚 瘕门血瘕条）。
后来有用乱发治疗的方子治疗胞宫扭转导致的小便不通，也可以治疗血淋、尿血。
火府丹：治疗心经热盛，小便涩痛，以及治疗五种淋证。（加入甘草，切碎煎煮，名为导赤散。出自《本事方》。）
药材：生地黄（二两），木通、黄芩（各一两）。
制法用法：以上研为细末，用炼蜜制成梧桐子大小的丸药。每次服用三十丸，用木通煎汤送下。兼治淋沥，脐下满痛。
许学士说：壬戌年有一位卒官患口渴病，一天饮水一斗，三个月没吃东西，心中烦闷，当时已是十月。我认为他曾经经历三伏天的暑热，给他服用此药几服。过了两天来道谢说：当天服用三次后口渴停止，又服用三次后饮食恢复正常。这本来是治疗淋证的，用来治疗口渴，可以说是灵活变通了。
治疗妇女各种淋证。
苦杖根俗称为杜牛膝，多取洗净切碎，取一合，用水五盏，煎至一盏，去渣，用麝香、乳香少许调下。
鄞县武尉耿梦得，他的妻子患沙石淋长达十三年，每次排尿疼痛难忍，溺器中小便沙石发出剥剥的声音，用百种方法都不见效。偶然得到这个方子服用，一夜之间就痊愈了。这是亲眼所见的事实。
滋肾丸：治疗热在血分，口不渴而小便不利；或者肾虚足热腿膝无力，不能站立行走；又如下焦阴虚，小便不利，肚腹肿胀，或者皮肤胀裂，眼睛突出。这是神效之剂。
药材：知母、黄柏（各酒炒，二两），肉桂（去粗皮，二钱）。
制法用法：以上分别研为细末，用水泛丸如桐子大小。每次服用二百丸，空腹时用滚开水送下。
黄芩清肺饮：治疗肺热导致的小便不利，宜用此药清泄肺热。
药材：黄芩（炒）、山栀（炒，各一钱）。
制法用法：用水煎服。若小便不利，加盐豉二十粒。
五淋散：治疗膀胱有热，水道不通，淋沥不出，或者尿如豆汁，或者形成砂石，或者如膏汁，或者热郁便血。
药材：赤茯苓（一钱半），赤芍药、山栀（各一钱），当归、甘草（各一钱二分）。
制法用法：加入灯心草，用水煎服。
[Da Lun] Women experiencing dribbling dysuria are suffering from Kidney deficiency accompanied by Heat in the Bladder. The Bladder and Kidney are interior-exteriorly related, governing water metabolism; urine that flows through the bladder (Pao) is excreted as small urine. If Kidney Qi is deficient, urinary frequency occurs; if there is Heat in the Bladder, dribbling dysuria results. In severe cases, urination may be completely obstructed, accompanied by abdominal distension, fullness, panting, and urgency, requiring prompt treatment.
[Xue Ji's Commentary] For the aforementioned conditions: if caused by Heat accumulation in the Bladder, use Wulin San (Five Dribblings Powder). If due to Deficiency-Heat of the Spleen and Lung, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) [refer to Miscellaneous Diseases: Fatigue and Overwork], adding Dioscoreae Rhizoma (Shanyao), Schisandrae Fructus (Wuweizi), and Ophiopogonis Radix (Maimendong). If due to Stagnant Heat in the Spleen Meridian, use Jiawei Guipi Tang (Modified Gui Pi Decoction) [i.e., Gui Pi Decoction plus Moutan Cortex (Danpi) and Gardeniae Fructus (Zhizi)]. If due to Depressed Fire in the Lung Meridian, use Huangqin Qingfei Yin (Scutellaria Lung-Clearing Infusion). If due to Damp-Heat in the Liver Meridian, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction) [refer to Miscellaneous Diseases: Dysuria]. For Blood deficiency, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) [refer to Tuberculosis/Scrofula]. For Yin deficiency, use Liuwei Wan (Six-Ingredient Pill with Rehmannia) [refer to Miscellaneous Diseases: Consumptive Disease], adding Bupleuri Radix (Chaihu) and Gardeniae Fructus (Zhizi). Generally speaking, if there is no thirst but urination is difficult, the Heat is in the Blood aspect of the Lower Jiao; use Zishen Wan (Kidney-Nourishing Pill). If there is thirst but urination is difficult, the Heat is in the Qi aspect; use Qingfei Yin (Lung-Clearing Infusion). If the Chi pulse is rapid but forceless, it indicates flourishing Yin-Fire with Yang failing to transform; treat primarily with Liuwei Wan and Zishen Wan. If the Chi pulse is floating but forceless, it indicates Yang Qi deficiency with Yin failing to generate; treat primarily with Jiabajia Weiba Wan (Modified Eight-Ingredient Pill) [refer to Miscellaneous Diseases: Xiao-Dao/Wasting-Thirst] and Zishen Wan.
One woman had a history of these ailments, presenting with internal heat and physical fatigue. I diagnosed Liver Fire with Blood deficiency and Spleen Qi weakness, prescribing a combination of Bazhen Tang (Eight-Treasure Decoction) and Xiaoyao San (Free and Easy Wanderer Powder). After taking them for over a month, her urination became smooth. Subsequently, she took Bazhen Tang alone to restore Qi and Blood. Another woman suffered from these symptoms, presenting with a greenish complexion and hypochondriac distension, unresponsive to other medications. I diagnosed Liver Meridian Qi stagnation injuring Blood, treating her with Gardeniae Fructus (Zhizi) and Ligustici Rhizoma et Radix (Chuanxiong) decocted in water, resulting in recovery. A third woman presented with difficult urination, obstruction and stuffiness in the lower abdomen and urinary tract, and occasional abdominal and hypochondriac pain. I diagnosed Liver Fire, using Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Gentianae Radix (Longdancao). After four doses, she improved slightly. Then, Gentianae Radix was removed, and she took Bazhen San (Eight-Treasure Powder) combined with stir-fried black Gardeniae Fructus (Zhizi), leading to complete recovery.
Shiwei San (Pyrrosiae Folium Powder): Treats sudden dribbling dysuria in women.
Ingredients: Pyrrosiae Folium (Shiwei), Scutellariae Radix (Huangqin), Polygoni Multiflori Caulis Spike (Qumai Sui), Ulmi Cortex Albus (Yubai Pi), Akebiae Caulis (Mutong), Abelmoschi Semen (Kuizi) (each 1.5 qian); Licorice Root (Gancao) (0.5 qian).
Preparation and Administration: Combine as one dose, decoct in two sheng of water until one sheng remains. Take before meals.
Mutong San (Akebiae Caulis Powder): Treats five types of dysuria in women.
Ingredients: Akebiae Caulis (Mutong), Ulmi Cortex Albus (Yubai Pi), Polygoni Multiflori Caulis Spike (Qumai Sui), Cannabis Fructus (Dama Ren), Talcum (Huashi) (each 1 liang); Abelmoschi Semen (Kuizi), Concha Arcae (Beichi), Imperatae Rhizoma (Baimaogen) (each 2 liang); Licorice Root (Gancao) (0.5 liang).
Preparation and Administration: Coarsely powder above ingredients. Take 5 qian per dose, decoct in water, and take warm on an empty stomach.
Taojiao San (Prunus Persica Gum Powder): Treats Qi dysuria and Labor dysuria in women.
Ingredients: Prunus Persica Gum (Taojiao), Ulmi Cortex Albus (Yubai Pi) (each 1 liang); Plantaginis Semen (Cheqianzi), Benincasae Semen (Dongguazi), Cyprini Carapax et Plastrum (Liyuchi - *Note: Text says Liyu Chi, likely referring to fish teeth or specific part, literal translation used*), Abelmoschi Semen (Kuizi), Polygoni Multiflori Caulis (Qumai), Akebiae Caulis (Mutong) (each 0.5 liang); Aurantii Fructus (Zhiqiao) (2.5 qian).
Preparation and Administration: Cut into pieces. Take 4 qian weight per dose, decoct in one sheng of water until 0.7 sheng remains. Strain and take warm.
Jinsha San (Gold Sand Powder): Treats various dysurias in women.
Preparation and Administration: Dry Shanghai Jinsha Cao (likely a local herb name, literally Gold Grass) in the shade, powder it. Mix 2 qian with Sheng Gancao Tang (Raw Licorice Decoction) and take.
Alternative Method: True Amber (powdered, amount unspecified), mixed with powder of Costi Radix (Muxiang), taken with plain boiled water. (These two formulas are from Chen Zongling's Formulas.)
Jisu San (Elsholtzia Powder): Treats Blood dysuria in women.
Ingredients: Elsholtziae Herba (Jisu Ye), Akebiae Caulis (Mutong) (each 2 liang); Prepared Rehmanniae Radix (Sheng Gan Dihuang), Talcum (Huashi) (each 3 liang); Acanthopanacis Radix (Cisu Gen) (1 liang).
Preparation and Administration: Coarsely powder above ingredients. Take 0.5 liang per dose, decoct in 1.5 sheng of water with 37 leaves of Bambusa Leaves (Zhuye) until 0.7 sheng remains. Strain and take warm before meals.
Formula for treating Blood dysuria and painful hematuria in women.
Ingredients: Prepared Rehmanniae Radix (Sheng Gan Dihuang) (3 liang), Curcumae Radix (Yujin), Poria Cocos (Puhuang - *Note: Text says Puhuang, usually Pteridis Spora, but context implies Hemostatic*) (each 2 liang).
Preparation and Administration: Fine powder. Take 2 qian per dose, mix with decoction of Plantaginis Folium et Semen (Cheqianzi Ye) and take. Continue until urination becomes smooth.
There are also cases of Blood masses (Xue Jia) mimicking dysuria, causing urinary retention, umbilical and abdominal distension. Tao Ren Jian (Peach Kernel Decoction) is appropriate (see previous section on Masses and Fixed Lumps - Blood Jia).
Later, formulas using human hair were used to treat bladder torsion causing urinary retention, which can also treat Blood dysuria and hematuria.
Huofu Dan (Fire Mansion Pill): Treats Heart Meridian Heat, astringent urination, and five types of dysuria. (Add Licorice Root, cut and decoct; named Daochi San (Guide Out Redness Decoction). From *Ben Shi Fang*.)
Ingredients: Raw Rehmanniae Radix (Sheng Dihuang) (2 liang), Akebiae Caulis (Mutong), Scutellariae Radix (Huangqin) (each 1 liang).
Preparation and Administration: Fine powder. Make pills with refined honey, size of Sophora Seed (Wutong Zi). Take 30 pills per dose, washed down with Akebiae Caulis decoction. Also treats dribbling dysuria and fullness/pain below the navel.
Scholar Xu stated: In the Renxu year, a military officer suffered from excessive thirst, drinking one dou of water daily and not eating for three months. He felt restless internally. It was already October. I reasoned he had previously endured the heat of the Three Fu days. I gave him this medicine for several doses. Two days later, he returned to thank me, saying: "After three doses on that day, my thirst stopped. After another three doses, my appetite returned to normal." This formula originally treated dysuria but was used here for thirst, demonstrating flexible application.
Treatment for various dysurias in women.
Kuzhang Gen (root of *Achyranthes bidentata*, commonly called Duniu Xi), taken in large quantities, cleaned, and chopped. Take one he, decoct in five sheng of water until one sheng remains. Strain. Mix with a small amount of Moschus (Shexiang) and Boswelliae Resina (Ruxiang) and take.
Geng Mengde, Military Commander of Yinxian, had a wife who suffered from Gravel Dysuria for thirteen years. Each time she urinated, the pain was unbearable, and gravel could be heard rattling in the urinal. Hundreds of methods failed. She accidentally obtained this formula, took it, and was cured overnight. This is based on personal observation.
Wuling San (Five-Ling Powder), Bazheng San (Eight-Righteousness Powder), and Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Infusion) from *Ju Fang* (Formulary of the Bureau) are all applicable.
Zishen Wan (Kidney-Nourishing Pill): Treats Heat in the Blood aspect, characterized by no thirst but difficult urination; or Kidney deficiency with heat in feet, weakness in legs and knees, inability to walk; or Yin deficiency in Lower Jiao, difficult urination, abdominal swelling, skin cracking, or protruding eyes. This is a miraculous agent.
Ingredients: Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai) (each wine-fried, 2 liang); Cinnamomi Cortex (Rougui) (bark removed, 2 qian).
Preparation and Administration: Powder each separately. Make water-habit pills size of Sophora Seed. Take 200 pills per dose, wash down with boiling water on an empty stomach.
Huangqin Qingfei Yin (Scutellaria Lung-Clearing Infusion): Treats difficult urination due to Lung Heat; use this medicine to clear the Lung.
Ingredients: Scutellariae Radix (Huangqin) (stir-fried), Gardeniae Fructus (Zhizi) (stir-fried) (each 1 qian).
Preparation and Administration: Decoct in water and take. If urination is difficult, add 20 grains of Salted Fermented Soybeans (Yanchi).
Wulin San (Five Dribblings Powder): Treats Heat in the Bladder, obstruction of the urinary pathway, dribbling without release, urine resembling bean juice, formation of gravel, urine resembling paste, or heat stagnation with bloody stool.
Ingredients: Red Poria (Chifuling) (1.5 qian), Red Peony Root (Chishaoyao), Gardeniae Fructus (Zhizi) (each 1 qian), Angelicae Sinensis Radix (Danggui), Licorice Root (Gancao) (each 1.2 qian).
Preparation and Administration: Add Juncus Effusus (Dengxincao), decoct in water and take.