（附∶便浊）
总括 淋痛虽然分五种，要明各类在详明；曰膏曰冷同其症，血石均为热一般。
脉法 少阴脉数，女子则阴中生疮，男子则为气淋。脉细而紧，小便涩滞，常有余沥不尽，此为气淋，其鼻准色
黄者，知其为小便难而成淋也。
《内经》曰∶清阳出上窍，浊阴出下窍。故清阳不升则浊阴不降，而成淋闭之患矣。先哲以滴水之器譬之，上窍闭
则下窍不出，此理甚明，故东垣使灸百会，丹溪使吐以提其气之横格，是皆开上窍之法也。
《原病式》曰∶淋者小便涩痛也，热客膀胱，郁结不能渗泄也。
巢氏曰∶诸淋皆肾虚所致，肾与膀胱为表里，俱主水，水入小肠，下于胞，行于阴，为小便也。膀胱热则津液内溢，
水道不通，停积于胞。肾气热则涩，故令水道不利，小便淋沥，故谓之淋。其状小便出少而数，其小腹急痛引脐是也。
膏淋者，小便时有肥脂似膏，而浮于小便之上，此肾虚不能制其肥液而下行也。
冷淋者，必先战栗而后小便，此亦肾虚而下焦受冷，冷气入胞，与正气交争，故小便涩而战栗也。
热淋者，是下焦有热，热气搏于肾，流入于胞，其溺黄多而涩，间有鲜血也。
血淋者，热之极也。心者血之主，外行经络内行脏腑，热盛失其常道，心与小肠为表里，故下流而入于胞，则为血
淋。
石淋者，肾主水，水结则化为石，肾为热所乘，遇小便则茎中痛，不得流利，痛引小腹，则砂石从小便出。甚则塞
痛，令人昏闷，遍身有汗而后醒，此痛之使然也，并以局方五淋散及香芎丸、木通散、五苓散、导赤散选而用之。如肾
虚者，六味地黄丸加鹿茸、川牛膝，名补肾地黄丸。
小肠有气则小便胀，小肠有血则小便涩，小肠有热则小便痛，治当行滞清热疏利小便，不可用补气药，气得补则愈
胀，血得补则愈涩，热得补则愈盛。此两段正巢氏所谓诸淋皆肾虚所致也。
〔附方〕
五淋散 赤芍 赤茯苓 山栀 当归 甘草
香芎丸 香附 川芎 海金砂 赤茯苓 滑石 枳壳 泽泻 石韦 槟榔
木通散 木通 滑石 黑丑
五苓散 见惊风症内。
导赤散 生地 木通 黄芩 赤茯 甘草
补肾地黄丸 即六味地黄丸加鹿茸、川牛膝。
（附注：便浊）
总括：淋证疼痛虽然分为五种，但要明白各类病症必须详细辨析；膏淋和冷淋的症状相似，血淋和石淋则都属于热证。
脉法：少阴脉数，女子则阴道中生疮，男子则为气淋。脉象细而紧，小便涩滞不畅，常有尿后余沥不尽的感觉，这是气淋；如果鼻准部位颜色发黄，可知是小便困难而成淋证。
《内经》说：清阳之气出于上窍，浊阴之气出于下窍。所以清阳不升则浊阴不降，从而形成淋证和闭证的病患。先哲用滴水之器来比喻，上窍闭塞则下窍不出水，这个道理很明白，所以李东垣主张灸百会穴，朱丹溪主张通过催吐来提升横格之气，这都是开启上窍的方法。
《原病式》说：淋证就是小便涩痛，热气客居膀胱，郁结不能渗泄。
巢元方说：各种淋证都是肾虚所致，肾与膀胱互为表里，都主管水液，水进入小肠，下行至胞宫，运行于前阴，成为小便。膀胱有热则津液内溢，水道不通，停积在胞中。肾气有热则涩滞，所以导致水道不利，小便淋沥，因此称为淋。其症状是小便排出量少且次数多，小腹部急痛牵引肚脐。
膏淋，小便时有时有脂肪样物质像膏脂一样，浮在小便上面，这是肾虚不能制约肥液而下行的缘故。
冷淋，必须先出现寒战颤抖然后才小便，这也是肾虚且下焦受冷，冷气进入胞中，与正气交争，所以小便涩滞且寒战颤抖。
热淋，是下焦有热，热气搏结于肾，流入胞中，尿液黄多且涩滞，间或有鲜血。
血淋，是热邪极盛的表现。心是血液的主宰，外行经络内行脏腑，热盛失去常道，心与小肠互为表里，所以热邪下流进入胞中，就形成血淋。
石淋，肾主水，水液凝结则化为石头，肾被热邪所乘，遇到小便时尿道中疼痛，不能流利，疼痛牵引小腹，则砂石从小便排出。严重时堵塞疼痛，使人昏闷，全身出汗后才清醒，这是疼痛导致的，都用局方五淋散以及香芎丸、木通散、五苓散、导赤散选择使用。如果是肾虚者，用六味地黄丸加鹿茸、川牛膝，名为补肾地黄丸。
小肠有气则小便胀，小肠有血则小便涩，小肠有热则小便痛，治疗应当行滞清热疏利小便，不可用补气药，气得到补益则更加胀满，血得到补益则更加涩滞，热得到补益则更加旺盛。这两段话正是巢元方所说的各种淋证都是肾虚所致的意思。
〔附方〕
五淋散：赤芍、赤茯苓、山栀、当归、甘草
香芎丸：香附、川芎、海金砂、赤茯苓、滑石、枳壳、泽泻、石韦、槟榔
木通散：木通、滑石、黑丑
五苓散：见惊风症内。
导赤散：生地、木通、黄芩、赤茯、甘草
补肾地黄丸：即六味地黄丸加鹿茸、川牛膝。
(Attachment: Turbid Urine)
General Overview: Although strangury (Lin Zheng, a syndrome characterized by frequent, urgent, and painful urination) pain is divided into five types, one must clearly understand each category through detailed differentiation. Gao Lin (Fatty Strangury) and Leng Lin (Cold Strangury) share similar symptoms, while Xue Lin (Blood Strangury) and Shi Lin (Stony Strangury) are both attributed to heat.
Pulse Diagnosis: A rapid pulse at the Shaoyin position indicates that in women, sores will grow in the vagina, and in men, it manifests as Qi Lin (Qi Strangury). A fine and tight pulse with obstructed and difficult urination, often accompanied by post-void dribbling, indicates Qi Lin. If the tip of the nose appears yellow, it signifies difficulty in urination leading to strangury.
The *Neijing* states: Clear Yang emerges from the upper orifices, and turbid Yin exits from the lower orifices. Therefore, if Clear Yang fails to ascend, Turbid Yin fails to descend, resulting in the pathology of strangury and retention. Ancient sages used the analogy of a dripping vessel: if the upper orifice is blocked, water cannot flow out from the lower orifice; this principle is clear. Thus, Li Dongyuan advocated moxibustion on Baihui (GV20), and Zhu Danxi advocated inducing vomiting to lift the stagnant Qi, both being methods to open the upper orifices.
The *Yuanbing Shi* states: Strangury is characterized by painful and difficult urination; heat pathogen lodges in the Bladder, causing stagnation and failure to excrete fluids.
Chao Yuanfang stated: All forms of strangury are caused by Kidney deficiency. The Kidney and Bladder are interior-exteriorly related and both govern water. Water enters the Small Intestine, descends to the Bao (uterus/bladder), travels through the external genitalia, and becomes urine. Heat in the Bladder causes body fluids to overflow internally, blocking the water passages and accumulating in the Bao. Heat in the Kidney causes astringency, leading to impaired water passage and dribbling urine, hence termed strangury. Its presentation includes small amounts of frequent urination and acute pain in the lower abdomen radiating to the umbilicus.
Gao Lin (Fatty Strangury): Fat-like substances resembling paste float on the surface of the urine during voiding. This is due to Kidney deficiency failing to control the descent of fatty fluids.
Leng Lin (Cold Strangury): Chills and trembling precede urination. This is also due to Kidney deficiency and cold invading the Lower Jiao; cold qi enters the Bao and contends with healthy Qi, causing astringent urination and chills.
Re Lin (Heat Strangury): Heat exists in the Lower Jiao. Heat pathogen combats the Kidney and flows into the Bao, resulting in dark yellow, astringent urine, occasionally mixed with fresh blood.
Xue Lin (Blood Strangury): This represents extreme heat. The Heart is the master of Blood, circulating externally in the meridians and internally in the Zang-Fu organs. When heat is excessive and deviates from its normal pathway, and since the Heart and Small Intestine are interior-exteriorly related, the heat flows downward into the Bao, forming Blood Strangury.
Shi Lin (Stony Strangury): The Kidney governs water; when water condenses, it transforms into stones. When the Kidney is attacked by heat, urination causes pain in the urethra, preventing smooth flow. Pain radiates to the lower abdomen, and sand/stones are passed via urine. In severe cases, blockage causes intense pain, leading to faintness and confusion; the patient only regains consciousness after sweating profusely, which is a result of the pain. Treatments include selecting from Ju Fang Wu Lin San, Xiang Xiong Wan, Mu Tong San, Wu Ling San, or Dao Chi San. For Kidney deficiency, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) combined with Lu Rong (Cervus Nippon Antler) and Chuan Niu Xi (Achyranthes Bidentata Root) is named Bu Shen Di Huang Wan (Kidney-Nourishing Rehmannia Pill).
If there is Qi in the Small Intestine, urination is distended; if there is Blood, urination is astringent; if there is Heat, urination is painful. Treatment should focus on moving stagnation, clearing heat, and promoting diuresis. Tonifying Qi herbs should not be used, as tonifying Qi worsens distension, tonifying Blood worsens astringency, and tonifying Heat exacerbates the condition. These two paragraphs align with Chao Yuanfang’s statement that all stranguries are caused by Kidney deficiency.
[Attached Formulas]
Wu Lin San (Five Stranguries Powder): Chi Shao (Red Peony Root), Chi Fu Ling (Red Poria), Shan Zhi (Gardeniae Fructus), Dang Gui (Angelica Sinensis Radix), Gan Cao (Licorice Root).
Xiang Xiong Wan (Xiang Xiong Pill): Xiang Fu (Cyperus Rhizome), Chuan Xiong (Ligusticum Chuanxiong Rhizoma), Hai Jin Sha (Spore of Lygodium Sporangium), Chi Fu Ling (Red Poria), Hua Shi (Talcum), Zhi Ke (Aurantii Fructus), Ze Xie (Alismatis Rhizoma), Shi Wei (Pyrrosiae Folium), Bing Lang (Areca Seed).
Mu Tong San (Akebia Decoction): Mu Tong (Akebiae Caulis), Hua Shi (Talcum), Hei Chou (Semen Canarii).
Wu Ling San (Five-Ingredient Powder with Poria): See under Convulsive Disease.
Dao Chi San (Guide Out Redness Powder): Sheng Di (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Huang Qin (Scutellariae Radix), Chi Fu Ling (Red Poria), Gan Cao (Licorice Root).
Bu Shen Di Huang Wan (Kidney-Nourishing Rehmannia Pill): Identical to Liu Wei Di Huang Wan plus Lu Rong (Cervus Nippon Antler) and Chuan Niu Xi (Achyranthes Bidentata Root).