〔曾〕《巢氏病源》曰∶诸淋皆肾虚所致，肾与膀胱为表里，主水下入小肠，
通于胞，行于阴而为溲，肾气通于阴，下流之道也。淋有五名，曰膏、曰冷、曰热、
曰血、曰石，各具于后。膏淋，见小便有肥脂似膏，而浮于小便之上，此肾虚不
能制其肥液、而下行也。冷淋，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。热淋，下焦有热，热气传于肾，流入于胞，
其溺黄多而涩，间有鲜血而同来者。血淋，热之极也。心者血之主，外行经络，
内行脏腑，热盛、则失其常道，心与小肠为表里，故下流而入于胞，则为血淋。石
淋，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，
则沙石从小便出，甚至塞痛，令人昏闷，遍身有汗而后醒，此痛之使然。盖五淋者，
虽曰肾虚所致，然小肠为受盛之府，气通于膀胱，膀胱为津液之府，气通于肾，余
化下流而不通，皆曰肾气不足。热入膀胱，水道涩而不利，出入起数，脐腹急痛，
蕴作有时，或如豆汁膏血，并以《局方》五淋散下龙脑鸡苏丸，自然平愈，及香芎
丸、补肾地黄丸、与之疏导补益为上。〔薛〕夫小儿诸淋者，肾与膀胱热也，二经
相为表里，俱主水道，水入小肠，下行于胞则为溺，若膀胱热，则津液内涸，水道
不通。肾气热，则小便淋沥，或少腹引脐而痛。夫淋有五，石淋者，肾热化石，内
塞水道，痛引膀胱。气淋者，肺气壅热，小腹胀满，小便涩滞。热淋者，三焦有热，
传入肾、膀胱，流入于胞，小便赤涩。血淋者，心热，血散，失其常经，溢渗入胞。
寒淋者，膀胱气冷，与正气交争，寒战气解是也。亦有因妊母肝热，及乳母恚怒者，
当分五脏蓄热治之。若心脏有热者，导亦散加黄连。肝脏有热者，柴胡栀子散。大
便不通泻青丸。脾脏有热者，泻黄散。脾气不足者，异功散。脾气下陷，补中益气
汤。肺脏有热者，泻白散。肺气虚热异功散加炒黑山栀。肾脏有热者，地黄丸。
或因乳母肝经热者，用栀子清肝散。恚怒者，用柴胡清肝散。乳母浓味者，用加味
清胃散。心小肠热者，用清心莲子饮。或儿早近色欲，小便涩滞或作痛，及更去后
大小便牵痛者，皆属肝肾不足也，用六味地黄丸、补中益气汤加牛膝、车前、肉桂，
未应，当参五脏所胜，不可轻用渗泄寒凉之药，大损胃气，仍参前小便不通证览之。
一小儿小便不通，服五苓之类不应，颏间及左腮色赤。乃肝肾虚热也。用四物、山
栀、及地黄丸而愈。后因感冒误汗，小便仍不利，余用补中益气汤加麦门、五味、
而安。一小儿小便不利，茎中涩痛，时或尿血。此禀父肾热为患也。先用五淋散
以疏导，又用滋肾丸、地黄丸，补肝肾渐愈。后出痘，色紫，小便短赤，颏间右腮
或赤或白，用补中益气汤、六味地黄丸，前证并愈。〔丹〕郑廉使之子年十六，初
生七个月患淋病，五七日必一发，其发则大痛，水道下状如黍如粟者约一杯许，
然后定。诊其脉轻则涩，重则弦，视其形瘦而长，其色青而苍，意其父必因多服下
部药遗毒在胎，留于子之命门而然。遂以紫雪和黄柏末，丸桐子大，晒极干，热汤
下百丸，以食物压之，又半日，痛大作腰连腹，水道乃行，下如黍如粟者一大碗许，
其病减十分之八，后又与陈皮一两，桔梗、木通、各半两，作一帖与之，又下如黍
粟者一合许而安。父得燥热，且能病，子况母得之者乎。予书此以证东垣红瘤之事，
此亦热在血分也。
五淋散
赤茯苓（去皮） 赤芍药（炒） 山栀子（去壳） 甘草（生） 当归（去芦） 黄芩（炒）
车前子 淡竹叶 灯心 木通（去皮节） 滑石（水飞） 葵子 葶苈（炒）
上 咀。用葱白一茎水煎，入车前草杵捣取汁，用五苓散调化，食前服。或硝
石末调化服。白淋，白茅根灯心煎汤服。有气淋，小腹胀满，尿后有余沥，
木通煎汤服。热淋，小便赤而淋沥，脐下痛，新水煎服。或黄芩煎汤服。
石淋，茎内痛，尿涩有砂石，令人闷绝，滑石膈纸炒焦为细末，葵子煎汤服。
《局方》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，或热怫便血。
赤茯苓（六钱） 当归 甘草（各五钱） 赤芍药 山栀子（各二钱）
上 咀。每服三钱，水一小盏，入灯心煎服。
导赤散 治小儿血淋。
生地黄 木通（各二钱） 黄芩 甘草（生用。各一钱）
上为末。每服一钱，井水入灯心煎服。仍以米饮调油发灰，空心灌下。
葵子散 治小儿诸淋。
葵子 车前子 木通 桑白皮（炒） 瞿麦 赤茯苓 山栀子 炙甘草（各等分）
上，水一盏，煎服。
香芎丸 治诸淋证，若患风闭，尤效。
净香附（盐水炒） 川芎 赤茯苓（去皮。各半两） 海金砂 滑石（各一两） 枳壳（泡，
去瓤，麸炒黄） 泽泻 石韦（去老梗，取叶） 槟榔（不过火。各二钱半）
上，锉晒为末，糯米粉煮为清糊，丸麻仁大。每服三十三丸至五十五丸或七十
七丸，并用麦门冬熟水空心送下。若小便涩痛，滴三五点者，取流水，用火微温，
入盐少许调匀，空心咽下。
木通散（见惊）
清心莲子饮 治小儿上盛下虚，心火炎上，口苦咽干，烦渴微热，小便赤涩，或欲
成淋，并宜服之。
黄芩 车前子 甘草（炙） 麦门冬（去心） 地骨皮（各半两） 黄 （蜜炙） 白茯苓
石莲肉（去心） 人参（各七钱半）
上锉碎。每服五钱，水一盏，煎至六分，去滓，食前服。如发热加柴胡薄荷。
金沙散 治小便淋沥不通。
郁金 海金砂 滑石 甘草（各等分）
上为末。每服一钱，煎地肤子汤调下。灯心、木通、亦可。
又方 冬瓜，最治实热小便不通，内热口渴。
立效散 治小儿诸淋不通，茎中作痛。
木通 甘草 王不留行 胡荽 滑石 海金砂 山栀子 槟榔（各等分）
上，每服一钱，水煎。
治血淋神效方
紫草 连翘 车前子（各等分）
水煎服。
又方
海螵蛸 生地黄 白茯苓
上，等分为末。柏叶、车前草煎汤调下。
治气淋
赤芍药（一两） 槟榔（一枚，面裹煨）
上为末。灯心同枣子煎汤调下。
〔张〕石燕丹 治小便淋涩痛闷。
石燕（烧赤，醋淬，放冷，细研） 瞿麦 滑石（各一两） 木通（锉） 海蛤（细研。各半两）
上件，捣罗为细末，炼蜜和，如黍米大。每服十粒，以葱白汤下，食前。量儿
大小加减。
石韦散 治诸淋涩水道中痛，脐下妨闷。
石韦（去毛，一两） 冬葵子 木通（锉） 赤茯苓（各半两） 车前子 瞿麦 榆白皮 滑石
甘草（各二钱半）
上件药，捣罗为散。每服一钱，以水一小盏，入葱白五寸，煎至六分，去滓，
温服，如人行十里，再服。量儿大小加减。
葵子散 治肾热水结，化为石淋，甚者水道中涩痛不可忍。
冬葵子（一两） 石楠 榆白皮（锉） 石韦（去毛） 木通（锉。各半两）
上件药，捣、罗为散。每服半钱，以葱白汤调下，日二服。量儿大小加减。
滑石散
滑石 栝蒌根 石韦（去毛。各等分）
上件药，捣、罗为散。每服半钱，煎大麦饮清调下，日二服。量儿大小加减。
蒲黄散 治膀胱热甚血淋，水道涩痛。
蒲黄 冬葵子 生地黄（各半两）
上件药，捣、罗为细末。每服一钱，以水一大盏，煎至六分，去滓，温服。量儿大小加减。
【曾世荣】《诸病源候论》说：各种淋证（以小便频数短涩、滴沥刺痛为主症）都是由于肾虚引起的。肾与膀胱互为表里，主管水液代谢，水液进入小肠，通达于胞宫（此处指代下焦泌尿生殖区域），流经阴部而成为尿液。肾气通达于阴部，这是下泄的通道。淋证有五种名称，即膏淋、冷淋、热淋、血淋、石淋，具体内容在后面分别论述。
膏淋，表现为小便中有类似脂肪膏样的物质，漂浮在小便表面，这是因为肾虚不能制约肥腻液体，导致其下行所致。
冷淋，先出现寒战颤抖，然后才排尿，这也是因为肾虚且下焦受寒，寒气侵入胞宫，与正气相互交争，所以小便涩滞并伴有寒战。
热淋，下焦有热邪，热气传导至肾脏，流入胞宫，导致尿液黄多且涩滞，偶尔会有鲜血随尿排出。
血淋，是热邪极盛的结果。心主血脉，在经络中运行，在内联系脏腑，当热邪炽盛时，血液就会失去正常的运行轨道。心与小肠互为表里，所以热邪导致的血液下流进入胞宫，就形成血淋。
石淋，肾主水，水液凝结则化为结石。肾受到热邪侵袭，排尿时尿道疼痛，小便不能流利，疼痛牵引小腹，沙石从小便排出，严重时甚至堵塞引起剧痛，使人昏闷，全身出汗后才清醒，这是疼痛导致的反应。大概这五淋虽然都说由肾虚引起，但小肠是受盛之腑，气机通于膀胱；膀胱是津液之腑，气机通于肾。其余转化后的浊液下流而不通畅，都归结为肾气不足。热邪进入膀胱，水道涩滞不通畅，导致尿频、尿急、脐腹拘急疼痛，发作有时，或者尿液像豆汁、膏血一样浑浊。对此应用《局方》的五淋散配合龙脑鸡苏丸治疗，自然能平复痊愈，以及香芎丸、补肾地黄丸等，给予疏导和补益为上策。
【薛己】小儿的各种淋证，多是肾与膀胱有热。这两经互为表里，共同主管水道。水液进入小肠，下行于胞宫就成为尿液。如果膀胱有热，则津液内耗干枯，水道不通。肾气有热，则小便淋漓不尽，或少腹部牵引肚脐疼痛。淋证分为五种：石淋，是肾热使水液结石化石，内部堵塞水道，疼痛牵引膀胱。气淋，是肺气壅滞有热，小腹胀满，小便涩滞不畅。热淋，是三焦有热，传入肾和膀胱，流入胞宫，小便赤红涩滞。血淋，是心热导致血液散乱，失去正常经脉，溢出渗入胞宫。寒淋，是膀胱气冷，与正气交争，表现为寒战气解。也有因怀孕母亲肝热，或乳母发怒引起的，应当分五脏蓄热来治疗。如果心脏有热，用导赤散加黄连。肝脏有热，用柴胡栀子散。大便不通，用泻青丸。脾脏有热，用泻黄散。脾气不足，用异功散。脾气下陷，用补中益气汤。肺脏有热，用泻白散。肺气虚热，用异功散加炒黑山栀。肾脏有热，用地黄丸。如果是因乳母肝经有热，用栀子清肝散。乳母发怒，用柴胡清肝散。乳母饮食浓味厚腻，用加味清胃散。心和小肠有热，用清心莲子饮。如果孩子过早接触色欲，小便涩滞或作痛，以及大小便后牵拉疼痛的，都属于肝肾不足，用六味地黄丸、补中益气汤加牛膝、车前子、肉桂。如果无效，应当参考五脏相胜的理论，不可轻易使用渗利泄下、寒凉的药物，以免大损胃气，仍应参考前面关于小便不通的证候进行查阅。
有一个小儿小便不通，服用五苓散之类药物无效，下巴及左腮颜色发红。这是肝肾虚热。用四物汤、山栀及地黄丸治疗后痊愈。后来因感冒误用发汗药，小便仍然不利，我用补中益气汤加麦门冬、五味子，病情得以安定。
另一个小儿小便不利，尿道涩痛，偶尔尿血。这是禀受父亲肾热所致。先用五淋散进行疏导，又用滋肾丸、地黄丸，补益肝肾，逐渐痊愈。后来出痘疹，颜色紫暗，小便短赤，下巴右腮有时红有时白，用补中益气汤、六味地黄丸，前面的症状全部痊愈。
【朱丹溪】郑廉使之子的儿子十六岁，出生七个月时就患淋病，每五到七天必发作一次，发作时剧烈疼痛，尿道排出像黍米、粟米大小的颗粒约一杯左右，然后疼痛停止。诊察他的脉象，轻取则涩，重按则弦。观察他的形体瘦长，面色青苍，推测他的父亲必定是因为多服用了下部药物，遗毒留在胎中，留存于儿子的命门而导致此病。于是用紫雪和黄柏末，制成梧桐子大小的药丸，晒得极干，用热开水送服一百丸，并用食物压住药力。过了半天，疼痛大作，腰部牵连腹部，尿道才得以通行，排出像黍米、粟米大小的颗粒一大碗左右，病情减轻了十分之八。后来又给他陈皮一两，桔梗、木通各半两，作为一帖药给他服用，又排出像黍米、粟米大小的颗粒一合左右，病情安定。父亲得了燥热尚且能致病，儿子通过母亲受孕得到的情况呢？我写下这些来验证东垣关于“红瘤”的事情，这也是热邪在血分中的表现。
五淋散
赤茯苓（去皮） 赤芍药（炒） 山栀子（去壳） 甘草（生） 当归（去芦） 黄芩（炒）
车前子 淡竹叶 灯心草 木通（去皮节） 滑石（水飞） 葵子 葶苈（炒）
以上药材切碎。用葱白一根水煎，加入车前草捣烂取汁，用五苓散调和化开，饭前服用。或者用硝石末调和化开服用。白淋，用白茅根、灯心草煎汤服用。有气淋，小腹胀满，尿后有残余滴沥，用木通煎汤服用。热淋，小便赤红且淋漓，脐下疼痛，用新汲水煎服。或者用黄芩煎汤服用。
石淋，尿道内疼痛，小便涩滞有砂石，令人昏闷欲绝，将滑石隔纸炒焦研为细末，用葵子煎汤送服。
《局方》五淋散 治疗膀胱有热，水道不通，淋沥不出，或者尿如豆汁，或者结成砂石，或者像膏脂，或者热郁便血。
赤茯苓（六钱） 当归 甘草（各五钱） 赤芍药 山栀子（各二钱）
以上药材切碎。每次服用三钱，水一小盏，加入灯心草煎服。
导赤散 治疗小儿血淋。
生地黄 木通（各二钱） 黄芩 甘草（生用。各一钱）
以上研为末。每次服用一钱，井水加入灯心草煎服。仍以米饮调匀油发灰，空腹灌下。
葵子散 治疗小儿各种淋证。
葵子 车前子 木通 桑白皮（炒） 瞿麦 赤茯苓 山栀子 炙甘草（各等分）
以上，用水一盏，煎服。
香芎丸 治疗各种淋证，如果患有风邪闭塞，尤其有效。
净香附（盐水炒） 川芎 赤茯苓（去皮。各半两） 海金砂 滑石（各一两） 枳壳（泡，去瓤，麸炒黄） 泽泻 石韦（去老梗，取叶） 槟榔（不过火。各二钱半）
以上，锉碎晒干研为末，糯米粉煮成清糊，制成麻仁大小的丸剂。每次服用三十三丸至五十五丸或七十七丸，都用麦门冬熟水空腹送下。如果小便涩痛，只滴三五点的，取流动的水，用火微微加热，加入少许盐调匀，空腹咽下。
木通散（见惊悸章节）
清心莲子饮 治疗小儿上盛下虚，心火炎上，口苦咽干，烦渴微热，小便赤涩，或者想要发展成淋证，都适宜服用。
黄芩 车前子 甘草（炙） 麦门冬（去心） 地骨皮（各半两） 黄芪（蜜炙） 白茯苓 石莲肉（去心） 人参（各七钱半）
以上锉碎。每次服用五钱，水一盏，煎至六成，去渣滓，饭前服用。如果发热加柴胡、薄荷。
金沙散 治疗小便淋沥不通。
郁金 海金砂 滑石 甘草（各等分）
以上研为末。每次服用一钱，煎地肤子汤调下。灯心草、木通也可以。
立效散 治疗小儿各种淋证不通，尿道作痛。
木通 甘草 王不留行 胡荽 滑石 海金砂 山栀子 槟榔（各等分）
以上，每次服用一钱，水煎。
又方
海螵蛸 生地黄 白茯苓
以上，等分为末。用柏叶、车前草煎汤调下。
治气淋
赤芍药（一两） 槟榔（一枚，面裹煨）
以上研为末。用灯心草同枣子煎汤调下。
【张涣】石燕丹 治疗小便淋涩痛闷。
石燕（烧红，醋淬，放冷，细研） 瞿麦 滑石（各一两） 木通（锉） 海蛤（细研。各半两）
以上，捣罗为细末，炼蜜调和，如黍米大小。每次服用十粒，用葱白汤送下，饭前。根据孩子大小加减剂量。
石韦散 治疗各种淋证涩滞，水道中疼痛，脐下妨闷。
石韦（去毛，一两） 冬葵子 木通（锉） 赤茯苓（各半两） 车前子 瞿麦 榆白皮 滑石 甘草（各二钱半）
以上药材，捣罗为散。每次服用一钱，用水一小盏，加入葱白五寸，煎至六成，去渣滓，温服。如果人行走十里路的路程时间，再服用一次。根据孩子大小加减剂量。
葵子散 治疗肾热水结，化为石淋，严重的在水道中涩痛难忍。
冬葵子（一两） 石楠 榆白皮（锉） 石韦（去毛） 木通（锉。各半两）
以上药材，捣、罗为散。每次服用半钱，用葱白汤调下，每日两次。根据孩子大小加减剂量。
滑石散
滑石 栝蒌根 石韦（去毛。各等分）
以上药材，捣、罗为散。每次服用半钱，煎大麦饮的清汁调下，每日两次。根据孩子大小加减剂量。
蒲黄散 治疗膀胱热甚引起的血淋，水道涩痛。
蒲黄 冬葵子 生地黄（各半两）
以上药材，捣、罗为细末。每次服用一钱，用水一大盏，煎至六成，去渣滓，温服。根据孩子大小加减剂量。
[Zeng Shirong] *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Manifestations of All Diseases) states: All types of strangury (strangury, characterized by frequent, urgent, and painful urination) are caused by Kidney deficiency. The Kidney and Bladder are interior-exteriorly related; they govern water metabolism. Water enters the Small Intestine, communicates with the Bao Palace (here referring to the lower jiao urogenital region), flows through the yin organs to become urine. Kidney Qi communicates with the yin organs; this is the pathway for downward excretion. There are five names for strangury: Gao Strangury (Fatty Strangury), Leng Strangury (Cold Strangury), Re Strangury (Heat Strangury), Xue Strangury (Bloody Strangury), and Shi Strangury (Stony Strangury). Their specific manifestations are described below.
Gao Strangury (Fatty Strangury): Manifests as fat-like substances floating on the surface of the urine. This is due to Kidney deficiency failing to control fatty fluids, causing them to descend.
Leng Strangury (Cold Strangury): Preceded by chills and trembling before urination. This is also due to Kidney deficiency and cold invading the Lower Jiao. Cold Qi enters the Bao Palace and contends with healthy Qi, resulting in difficult, dribbling urination accompanied by chills.
Re Strangury (Heat Strangury): Heat in the Lower Jiao transmits to the Kidney and flows into the Bao Palace. The urine is yellow, scanty, and difficult to pass, occasionally mixed with fresh blood.
Xue Strangury (Bloody Strangury): This is the result of extreme heat. The Heart governs blood, circulating externally in the meridians and internally connecting with the zang-fu organs. When heat is excessive, blood loses its normal course. Since the Heart and Small Intestine are interior-exteriorly related, heat-induced blood flowing downward into the Bao Palace results in Bloody Strangury.
Shi Strangury (Stony Strangury): The Kidney governs water; when water coagulates, it transforms into stones. If the Kidney is attacked by heat, urination causes pain in the urethra, and the flow is not smooth. Pain radiates to the lower abdomen, and sand/stones are passed in the urine. In severe cases, blockage causes intense pain, leading to faintness and confusion. Sweating over the whole body precedes recovery from the stupor, caused by the pain. Although these five types of strangury are said to be caused by Kidney deficiency, the Small Intestine is the organ of reception and transformation, communicating Qi with the Bladder; the Bladder is the reservoir of fluid, communicating Qi with the Kidney. If the transformed turbid fluids fail to flow downward smoothly, it is attributed to insufficient Kidney Qi. When heat enters the Bladder, the water pathway becomes obstructed and difficult to flow, causing frequency, urgency, and cramping pain in the umbilical/abdominal region. Episodes occur intermittently, with urine resembling bean dregs or fatty blood. For such cases, *Wulin San* (Five-Strangury Powder) from *Ju Fang* combined with *Longnao Jisu Wan* (Borneol and Perilla Pill) should be used to achieve natural resolution. Additionally, *Xiangxiong Wan* (Costus and Ligusticum Pill) and *Bushen Dihuang Wan* (Kidney-Nourishing Rehmannia Pill) can be given to promote drainage and tonification.
[Xue Ji] Various stranguries in children are due to heat in the Kidney and Bladder. These two meridians are interior-exteriorly related and jointly govern the water pathway. Water enters the Small Intestine and descends into the Bao Palace to become urine. If there is heat in the Bladder, internal fluids dry up, and the water pathway is blocked. If there is heat in Kidney Qi, urination is dribbling and incomplete, or there is pain radiating from the lower abdomen to the umbilicus. There are five types of strangury:
1. Shi Strangury (Stony Strangury): Kidney heat causes water to crystallize into stones, blocking the water pathway internally, with pain radiating to the Bladder.
2. Qi Strangury: Lung Qi is congested with heat, causing lower abdominal fullness and stagnant, difficult urination.
3. Re Strangury (Heat Strangury): Heat in the Triple Burner transmits to the Kidney and Bladder, flowing into the Bao Palace, causing red, scanty, and difficult urination.
4. Xue Strangury (Bloody Strangury): Heart heat causes blood to scatter and leave its normal channels, overflowing and seeping into the Bao Palace.
5. Han Strangury (Cold Strangury): Bladder Qi is cold, contending with healthy Qi, manifesting as chills and subsequent relief.
There are also cases caused by Liver heat in the pregnant mother or anger in the wet nurse. Treatment should differentiate based on heat accumulation in the five Zang organs.
- Heart heat: Use *Daochi San* (Guide Out Red Powder) plus Huanglian (Coptis Rhizome).
- Liver heat: Use *Chaihu Zhizi San* (Bupleurum and Gardenia Powder).
- Constipation: Use *Xieqing Wan* (Drain Green Pill).
- Spleen heat: Use *Xiehuang San* (Drain Yellow Powder).
- Spleen Qi deficiency: Use *Yigong San* (Extraordinary Assistance Powder).
- Spleen Qi sinking: Use *Buzhong Yiqi Tang* (Decoction for Supplementing the Middle and Augmenting Qi).
- Lung heat: Use *Xiebai San* (Drain White Powder).
- Lung Qi deficiency with heat: Use *Yigong San* plus fried black Zhizi (Gardenia Fruit).
- Kidney heat: Use *Dihuang Wan* (Rehmannia Pill).
- Wet nurse’s Liver Meridian heat: Use *Zhizi Qinggan San* (Gardenia Clearing Liver Powder).
- Wet nurse’s anger: Use *Chaihu Qinggan San* (Bupleurum Clearing Liver Powder).
- Wet nurse’s rich/greasy diet: Use *Jiawei Qingwei San* (Modified Stomach-Clearing Powder).
- Heart and Small Intestine heat: Use *Qingxin Lianzi Yin* (Clear Heart Lotus Seed Decoction).
If a child has early exposure to sexual activity, resulting in difficult/painful urination or pulling pain after defecation/urination, this belongs to Liver and Kidney deficiency. Use *Liujun Dihuang Wan* (Six-Ingredient Rehmannia Pill) and *Buzhong Yiqi Tang* plus Niuxi (Achyranthes Root), Cheqianzi (Plantago Seed), and Rougui (Cinnamon Bark). If ineffective, refer to the theory of the Five Elements overcoming each other. Do not lightly use diuretic, purgative, or cold-cooling herbs, as they severely damage Stomach Qi. Refer to previous sections on obstruction of urination.
Case 1: A child had urinary retention unresponsive to *Wuling San*. The chin and left cheek were red. This was Deficient Heat of the Liver and Kidney. Treated with *Siwu Tang* (Four Substance Decoction), Zhizi (Gardenia Fruit), and *Dihuang Wan* (Rehmannia Pill), resulting in recovery. Later, due to mistaken sweating treatment for a cold, urination remained difficult. I used *Buzhong Yiqi Tang* (Decoction for Supplementing the Middle and Augmenting Qi) plus Maimendong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry), leading to stability.
Case 2: A child had difficult urination, urethral pain, and occasional hematuria. This was caused by inheriting Father’s Kidney heat. Initially treated with *Wulin San* (Five-Strangury Powder) for drainage, then *Zishen Wan* (Nourish Kidney Pill) and *Dihuang Wan* (Rehmannia Pill) to tonify Liver and Kidney, leading to gradual recovery. Later, during smallpox eruption, the spots were purple, urine was short and red, and the chin/right cheek alternated between red and white. Treated with *Buzhong Yiqi Tang* and *Liujun Dihuang Wan*, resolving all symptoms.
[Zhu Danxi] The son of Zheng Lianshi, aged sixteen, suffered from strangury starting at seven months old. It recurred every five to seven days. During attacks, there was severe pain, and about one cup of granules resembling millet or broomcorn millet grains were passed from the urethra, after which the pain subsided. Pulse diagnosis: superficial pulse was choppy (Se), deep pulse was wiry (Xian). The child was thin and tall, with a bluish-pale complexion. I surmised that the father must have taken many drugs affecting the lower body, leaving toxic residue in the fetus, which remained in the child’s Mingmen (Gate of Life). I prescribed *Zixue* (Purple Snow) mixed with Huangbai (Phellodendron Bark) powder, formed into pills the size of tung tree seeds, dried thoroughly. Administered 100 pills with hot water, followed by food to suppress the drug's force. Half a day later, severe pain erupted in the waist and abdomen, and the urethra opened, passing about one bowl of millet-like granules. The condition improved by 80%. Subsequently, I gave Chenpi (Tangerine Peel) 1 liang, Jiegeng (Platycodon Root) and Mutong (Akebia Stem) 0.5 liang each, as one dose. Another half-he of millet-like granules were passed, and the child stabilized. If the father’s燥热 (dry-heat) could cause illness, how much more so for the child conceived by the mother? I record this to verify Dongyuan’s case of "Hongliu" (Red Tumors), which is also heat in the Blood level.
**Wulin San (Five-Strangury Powder)**
Chi Fuling (Red Poria, peeled), Chi Shaoyao (Red Peony Root, stir-fried), Shanzhizi (Gardenia Fruit, husked), Gancao (Licorice Root, raw), Danggui (Angelica Sinensis, de-gelled), Huangqin (Scutellaria Root, stir-fried), Cheqianzi (Plantago Seed), Danyezhu (Light Bamboo Leaf), Dengxincao (Juncus Effusus), Mutong (Akebia Stem, nodes removed), Huashi (Talcum, water-ground), Kuizi (Abelmoschus Seeds), Tingli (Descurainia Seed, stir-fried).
Crush the ingredients. Decoct with one stalk of Congbai (Green Onion White). Add juice from crushed Cheqiancao (Plantago Herb). Mix with *Wuling San* (Five-Ingredient Powder with Poria) to dissolve. Take before meals. Alternatively, mix with Xiaoshi (Niter) powder.
For Bai Strangury (White Strangury): Decoct Baimaogen (Imperata Rhizome) and Dengxincao.
For Qi Strangury (with lower abdominal fullness and post-void dribbling): Decoct Mutong.
For Re Strangury (red, scanty urine, lower abdominal pain): Decoct with fresh water or Huangqin.
For Shi Strangury (pain in urethra, gritty urine, faintness): Roast Huashi (Talcum) over paper until charred, grind to fine powder. Take with Kuizi decoction.
**Ju Fang Wulin San (Five-Strangury Powder from Bureau Formulary)**
Treats Bladder heat, blocked water pathway, inability to urinate, urine resembling bean dregs, stones, fatty substance, or heat-stagnation hematochezia/hematuria.
Chi Fuling (6 qian), Danggui, Gancao (each 5 qian), Chi Shaoyao, Shanzhizi (each 2 qian).
Crush. Take 3 qian per dose. Decoct with one small cup of water and Dengxincao.
**Daochi San (Guide Out Red Powder)**
Treats pediatric Bloody Strangury.
Shengdihuang (Rehmannia Root, raw), Mutong (each 2 qian), Huangqin, Gancao (raw, each 1 qian).
Grind to powder. Take 1 qian per dose. Decoct well water with Dengxincao. Alternatively, mix Youfahui (Ash of Oiled Hair) with Rice Drink and administer on an empty stomach.
**Kuizi San (Abelmoschus Powder)**
Treats various pediatric stranguries.
Kuizi, Cheqianzi, Mutong, Sangbaipi (Mulberry Root Bark, stir-fried), Qumai (Dianthus Herb), Chi Fuling, Shanzhizi, Zhigancao (each equal parts).
Decoct with one cup of water.
**Xiangxiong Wan (Costus and Ligusticum Pill)**
Treats various stranguries; especially effective for Wind-obstruction.
Jing Xiangfu (Cyperi Rhizoma, salt-water fried), Chuanxiong, Chi Fuling (peeled, each 0.5 liang), Haijinsha (Lygodium Spore), Huashi (each 1 liang), Zhiqiao (Aurantium Fructus, soaked, pith removed, bran-fried), Zexie (Alisma Rhizome), Shiwei (Pyrrosiae Folium, remove old stems, use leaves), Binglang (Areca Seed, not burnt excessively, each 2.5 qian).
Grind and dry. Make paste with glutinous rice flour. Form pills the size of hemp seeds. Take 33–77 pills per dose, washed down with Maimendong (Ophiopogon) warm water on an empty stomach. For scanty, painful urination (only a few drops), take running water, warm slightly with fire, add a little salt, and swallow on an empty stomach.
**Mutong San (See Jing/Palpitation section)**
**Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction)**
Treats pediatric upper excess/lower deficiency, flaming Heart Fire, bitter taste, dry throat, irritability/thirst, slight fever, red/scanty urine, or impending strangury.
Huangqin, Cheqianzi, Zhigancao (roasted), Maimendong (de-heart), Digupi (Lycium Cortex, each 0.5 liang), Huangqi (Astragalus Root, honey-roasted), Bai Fuling, Shilianrou (Lotus Seed Embryo, de-heart), Renshen (each 0.75 liang).
Crush. Take 5 qian per dose. Decoct with one cup of water until reduced to 60%. Strain. Take before meals. Add Chaihu (Bupleurum Root) and Bohe (Mint) if feverish.
**Jinsha San (Gold Sand Powder)**
Treats dribbling, obstructed urination.
Yujin (Curcuma Radix), Haijinsha, Huashi, Gancao (each equal parts).
Grind to powder. Take 1 qian per dose, mixed with Difuzi (Kochia Herb) decoction. Dengxincao or Mutong may also be used.
**Another Formula:** Winter melon is best for excess-heat urinary retention and internal heat with thirst.
**Lixiao San (Instant Efficacy Powder)**
Treats pediatric strangury obstruction with urethral pain.
Mutong, Gancao, Wangbulexing (Lycium Chinense Herb), Hucui (Coriander), Huashi, Haijinsha, Shanzhizi, Binglang (each equal parts).
Take 1 qian per dose, decoct in water.
**Divine Efficacy Formula for Treating Bloody Strangury**
Zicao (Arnebia Root), Lianqiao (Forsythia Fruit), Cheqianzi (each equal parts).
Decoct in water.
**Another Formula**
Haipiaoxiao (Cuttlebone), Shengdihuang, Bai Fuling.
Grind to powder. Take with Baoye (Betel Leaf) and Cheqiancao (Plantago Herb) decoction.
**Treating Qi Strangury**
Chi Shaoyao (1 liang), Binglang (one piece, wrapped in dough and baked).
Grind to powder. Take with Dengxincao and Jujube decoction.
[Zhang Huan] **Shiyan Dan (Stone Swallow Pill)**
Treats painful, difficult, and stifling urination.
Shiyan (Swallow Stone, fired red, quenched in vinegar, cooled, finely ground), Qumai, Huashi (each 1 liang), Mutong (crushed), Haige (Clam Shell, finely ground, each 0.5 liang).
Grind to fine powder. Mix with refined honey. Form pills the size of millet seeds. Take 10 pills per dose with Congbai (Green Onion White) decoction, before meals. Adjust dosage according to age.
**Shiwei San (Pyrrosia Powder)**
Treats various stranguries with涩 (astringent/difficult) sensation and pain in the water pathway, stifling sensation below the umbilicus.
Shiwei (de-hair, 1 liang), Dongkuizi, Mutong (crushed), Chi Fuling (each 0.5 liang), Cheqianzi, Qumai, Yubaipi (Elm Bark), Huashi, Gancao (each 2.5 qian).
Grind to powder. Take 1 qian per dose. Decoct with one small cup of water and 5 cun of Congbai until reduced to 60%. Strain. Take warm. Repeat after walking ten li. Adjust dosage according to age.
**Kuizi San (Abelmoschus Powder)**
Treats Kidney heat with water coagulation transforming into Stony Strangury. Severe cases involve unbearable pain in the water pathway.
Dongkuizi (1 liang), Shinan, Yubaipi (crushed), Shiwei (de-hair), Mutong (crushed, each 0.5 liang).
Grind and sieve. Take 0.5 qian per dose with Congbai decoction, twice daily. Adjust dosage according to age.
**Huashi San (Talcum Powder)**
Huashi, Gualougen (Trichosanthes Root), Shiwei (de-hair, each equal parts).
Grind and sieve. Take 0.5 qian per dose, mixed with clear Barley Drink, twice daily. Adjust dosage according to age.
**Puhuang San (Lygodium Spore Powder)**
Treats Bladder excess heat causing Bloody Strangury with涩 pain in the water pathway.
Puhuang (Lygodium Spore), Dongkuizi, Shengdihuang (each 0.5 liang).
Grind to fine powder. Take 1 qian per dose. Decoct with one large cup of water until reduced to 60%. Strain. Take warm. Adjust dosage according to age.