先教谕尝曰∶淋之自梅毒者，特见窦汉卿《疮疡经验全书》，谓为内蛀疳。盖今之患淋者比比皆是，
虽彼土理必多有，而明清诸家无敢言及者，最为可怪，故窦氏之外，一无所采云。
名义 淋，古谓之癃，名称不同也。癃者，罢也，淋者，滴也。今名虽俗，于义为得。（《三
因》）（按∶癃、淋一声，癃即淋，元载侗《六书故》有说。今陈氏以为罢义者非是，
或有以癃为小便闭之名者亦非是。）
小便滴沥涩痛者，谓之淋。小便急满不通者，谓之闭。（《要诀》）
闭癃，合而言之，一病也，分而言之，有暴久之殊。盖闭者暴病为溺闭，点滴不出，俗名小便不通是
也。癃者久病为溺癃，淋沥点滴而出，一日数十次或百次。名淋病是也。（《纲目》）
癃即淋病。（同上）
源由诸说（互见次条）诸淋者，由肾虚而膀胱热故也。膀胱与肾为表里，俱主水。水入小肠，下于胞，行
于阴，为溲便也。肾气通于阴。阴，津液下流之道也。若饮食不节，喜怒不时，虚实不调，则腑脏不和，致肾
虚而膀胱热也。膀胱津液之府，热则津液内溢而流于睾，水道不通，水不上不下，停积于胞。肾虚则小便数，
膀胱热则水下涩，数而且涩，则淋沥不宣，故谓之为淋。其状小便出少起数，小腹弦疾，痛引于脐。（《病源论》）
诸淋大率有五∶曰冷，曰热，曰膏，曰血，曰石。五种
不同，皆以气为本。多因淫情交错，内外兼并，清浊相干，
阴阳不顺，结在下焦，遂为淋闭。（《三因》）
淋有五，皆属乎热。（《丹溪》）
巢氏之说如此，恐未必尽然。大抵皆三焦气化不及，热迫膀胱，令水道涸涩之所成也。劳、气、血、膏、
石，虽分五种，其病机必因劳动火，火盛搏气，甚及于血，血转为膏，膏转为石。自清而浊，自薄而浓，自柔
而坚，自无形而渐有形，亦熬汁成膏，煮水结盐之义，岂真有砂石出水藏
哉。至若肾虚不能制肥液，更可笑也。（《续焰》）
脉候 （见次条）
证状总说 诸淋与小便不利者，皆由五脏不通，六腑不和，三焦痞涩，荣卫耗失，冒热饮酒，过醉入
房，竭散精神，劳伤气血，或因女色兴而败精不出，或因迷宠不已而真髓多输，或惊惶不次，或思虑未宁，或
饥饱过时，或奔驰才定，或隐忍大小便，或发泄久兴，或寒入膀胱，或暑中胞囊，伤兹不慎，致起斯疾，状
候变异，名亦不同，则有冷、热、气、劳、膏、砂、虚、实之八种耳。冷淋者，小便数，色白如泔也。热淋
者，小便涩，而色赤如血也。气淋者，脐腹满闷，小便不通利而痛也。劳淋者，小便淋沥不绝，如水之滴
漏而不断绝也。膏淋者，小便中出物如脂膏也。砂淋者，脐腹中隐痛，小便难，其痛不可忍须臾。从小便中下
如砂石之类，有大者如皂子，或赤或白（一作黄），色泽不定，此由肾气弱而贪于女色，房而不泄，泄而
不止，虚伤真气，邪热渐强，结聚而成砂。又如以水煮盐，火大水少，盐渐成石之类。谓肾者水也，咸归
于肾，水消于下，虚热日甚，煎结而成，此非一时而作也，盖远久乃发，成即五岁，败即三年，
壮人五载，祸必至矣。宜乎急攻，八淋之中，惟此最危。其
脉盛大而实者可治，虚小而涩者不可治。虚者谓肾与膀胱俱
虚，而精滑梦泄，小便不禁者也。实则谓经络闭涩，水道不利，而茎痛腿酸者也。又诸淋之病，与脉相从者
活，反者凶。治疗之法，亦在详酌耳。（《中藏》）（按∶《医碥》曰∶脉实大，宜分理。脉虚细涩，精血败
坏，难治。）
淋有五种∶一者，茎中痛，溺不得卒出者，石淋也。二者，溺有白汁肥如脂，膏淋也，一名肉淋。三者，
溺难涩，常有余沥者，气淋也。四者，溺留茎中。数起不出，引小腹痛，劳淋也。五者，如豆汁或如血，结不
通者，一名血淋，一名痒淋也。（《肘后》）
《集验论》五淋者，石淋、气淋、膏淋、劳淋、热淋也。石淋之为病，小便茎中痛，尿不得卒出，时
自出，痛引少腹，膀胱里急。气淋之为病，小便难，常有余沥。膏淋之为病，尿似膏自出，少腹膀胱里急。劳
淋之为病，倦即发，痛引气冲，小便不利。热淋之为病，热即发，其尿血后如豆汁状，畜作有时。五淋各异，
疗方用杂。（《外台》）
石淋（宜参治血诸方） 石淋者，淋而出石也。肾主水，水结则化为石，故肾客砂石。肾虚为热所乘，
热则成淋。其病之状，小便则茎里痛，尿不能卒出，痛引少腹，膀胱里急，沙石从小便道出，甚者塞痛令
闷绝。（《病源论》）
沙淋凝脂而易散，石淋结块而难消。败精结者为沙。（《直指》）
热在脬中，下焦为之约，结成砂石，如汤瓶煎炼日久，熬成汤碱。今夫羊豕之脬，吹气令满，常不能透，
岂真有沙石而能漏者乎。以此知前人所说，服五石丸散而致者，恐未必然。（《十形三疗》）
五淋之中，惟石淋、膏淋最难治。石淋乃是膀胱蓄热而
成，正如汤瓶久在火中，底结白碱而不能去，理宜清彻积
热，使水道通，则砂石出而可愈。（《统旨》）
沙石淋者，小便混浊，如稠浆腐败浓汁，然又有努出粒如砂如块，色如玛瑙色者，或有长而如粉条者，
初出粉红，少顷则如白浓浆矣。此因少年斫丧太过，致有遗浊，而服补涩药多，积久而发。有信邪道，用蛤
蚧、海马、海牛、母丁香、紫稍花、哈芙蓉等，服贴封搽茎口或脐中，以阻精动火，及服健阳丸温暖之饵，甚
至五内败坏，燥热凝结，到中年后，衰而陷下，则发出以上恶症。（《会元》）
膏淋 （互见补肾诸方中）膏淋者，淋而有肥，状似膏，故谓之膏淋，亦曰肉淋，此肾虚不能制于
肥液，故与小便俱出也。（《病源论》）
精结散者为膏。（《直指》）
有似淋非淋，小便色如米泔，或便中有如鼻涕之状，此乃精溺俱出，精塞窍道，故便欲出不能而痛，宜大
菟丝子丸、鹿茸丸之类。然此即膏淋，谓其非淋亦不可。（《要诀》）
膏淋为因肾脏虚寒，精溺如膏，或如米泔，或如鼻涕，此必败精塞于窍道，故便欲出不能而痛。治当温养
下元，俾精气固，则便自清如常矣。（《统旨》）
热淋 热淋者，三焦有热，气搏于肾，流入于胞而成淋也，其状小便赤涩。亦有宿病淋，今得热而
发者，其热甚则变尿血。亦有小便后如似小豆羹汁状者，畜作有时也。（《病源论》）
若热极成淋，服药不效者，宜减桂五苓散，加木通、滑石、灯心、瞿麦各少许。（《要诀》）
省元忽被湿侵，小便涩滞难通，或茎中作痛。予曰∶此
属肝胆湿热。先用龙胆泻肝汤罔效，茎中白津出，小便通则
疼甚，仍以牛膝、山栀、夏枯草、薏苡仁、木通、甘草（少）、牵牛子水煎服，全愈。（《石山》）
血淋（互见渗泄及治血诸方中） 血淋者，是热淋之甚者则尿血，谓之血淋。心主血，血之行身，通
遍经络，循环腑脏。劳甚者则散失其常经，溢渗入胞而成血淋也。（《病源论》）
血淋一证，须看血色分冷热，色鲜者心小肠实热，色瘀者肾膀胱虚冷（按∶此以心肾为别，似拘）。若的
是冷淋，及下元虚冷，血色瘀者，并宜漠椒根锉碎，不拘多少，白水煎，候冷进。（《要诀》）
血淋有血瘀、血虚、血冷、血热之分。小便硬满，茎中作痛欲死，血瘀也。血色黑黯，面色枯白，尺脉沉
迟，下元虚冷也（肾气丸）。然有内热过极，反兼水化而色黑者，未可
便以为冷也，须以脉证详辨之。（《必读》）
血受伤者，补血行血自愈，勿作淋治。死血作淋，牛膝膏妙。血淋，用侧柏叶、生藕节、车前草等分捣
汁，调益元散。（《准绳》）
溺血者略轻些，而血淋者乃精竭火动而血来也，与沙石淋兄弟然耳，乃死
里求生，苟幸获效，慎勿再犯。（《会元》）
建安林回甫秘校，熙宁中与予同客龙门李氏家。林一日下血，李兄弟煎八正散与服，既服不胜其苦，
小腹前阴痛益甚。余教林服菟丝山药丸（当考），林病去，气血亦小充实。盖不可专以热药、血得热则盈溢
为说也。（《鸡峰》）
气淋 气淋者，肾虚膀胱热，气胀所为也。膀胱合与肾为表里，膀胱热，热气流入于胞，热则生实，
令胞内气胀，则小腹满。肾虚不能制其小便，故成淋。其状膀胱小腹皆满，
尿涩常有余沥是也。亦曰气癃。诊其少阴脉数者，男子则气淋。（《病源论》）（按∶诊法出《脉经》。）
有淋病，下诸通便剂愈不通，用木香流气饮或别用通气香剂才愈者，此乃气淋，出于冷热淋之外。
（《要诀》）
劳淋（诸液燥证、暑月尿涩） 劳淋者，谓劳伤肾气而生热成淋也。肾气通于阴，其状尿留茎内，
数起不出，引小腹痛（《千金》痛引气冲），小便不利，劳倦即发也。（《病源论》）
有小便艰涩如淋，不痛而痒者，此亦属虚（按∶医碥曰∶淋证茎中必痛，若先痛后痒，则火退矣，或
实证转虚），宜八味丸、生料鹿茸丸之类。若因思虑用心过度致淋，辰砂妙香散吞威喜丸，或妙香散和五苓
散。汗多而小便赤涩，暑月多有此证，盛暑所饮既多，小便反涩少而赤，缘上停为饮，外发为汗，津道不通，
小肠涩闭，则水不运下。五苓散一名导逆，内有术、桂收汗，猪苓、泽泻、茯苓分水道，收其在外者使之内，
又从而利导焉。发者敛之，壅者通之，义取于此。然有虚劳汗多而小便赤涩者，却是五内枯燥，滋腴既
去，不能生津，故溺涩而赤。不宜过用通小便之剂竭其肾水，惟当温养润肺（按∶《医碥》曰∶敛汗清热滋
液可也），十全大补汤、养荣汤之类自足选用。汗者心液，心主血，血荣则心得所养，汗止津生，不待通而溺
自清矣。诸失精血及患痈毒人，忽有小便赤涩之证，此亦是桔竭不润之故。（《要诀》）
一人形肥苍白，年五十余，病淋，沙石涩痛。医用五苓或琥珀八正散之类，病益加。邀余往诊，脉皆
濡弱而缓近驶。曰∶此气血虚也。经云∶膀胱者津液之府，气化出焉。
今病气虚，不惟不能运化蒸溽，而亦气馁不能使之出也。经
又云∶血主濡之。血少则茎中枯涩，水道不利，安得不淋。医用通利，血愈燥，气愈伤矣。遂用大补汤加牛
膝煎服，月余病减。仍服八味丸，除附子，加黄 ，服半月余，遂获
安。（《石山》）（按∶《方考》清心莲子饮，劳淋者此方主之。）
邑宰严知非，患淋经年，痛如刀锥，凡清火疏利之剂计三百帖，病势日甚，岁暮来就诊。余曰∶两尺数而
无力，是虚火也。从来医者皆泥痛无补法，愈疏通则愈虚，愈虚则虚火愈炽。遂以八味地黄丸料，加车前、
沉香、人参，逾月而病去。（《必读》）
寒淋（互见温通诸方中） 寒淋者，其病状，先寒战然后尿是也。由肾气虚弱，下焦受于冷气，入
胞与正气交争，寒气胜则战寒而成淋，正气胜战寒解，故得小便也。（《病源论》）
进冷剂愈甚者，此是冷淋，宜地髓汤（用牛膝、麝香）下附子八味丸。有因服五苓散等药不效，用生料
鹿茸丸却愈。此证，病于下元虚冷之故。（《要诀》）
老人淋 精未通而御女以通其精，则五体有不备之处，异日有难状之疾。阴已痿而思色以降其精，其
精不出内败。小便道涩而为淋。精已耗而复竭之，则大小便道牵疼，愈疼
则愈欲大小便，愈便则愈疼。（《褚氏遗书》）
精败竭者，童男精未盛而御女，老人阴已痿而思色，以降其精，则精不出而内败，茎中痛涩为淋者，八
味丸料加车前子、牛膝煎服。若精已竭而复耗之，则大小便中牵疼，愈疼则愈欲大小便，愈
便则愈疼，倍附子救之。凡此当滋化源，不可误用知、柏、淡渗等剂，既泻真阳，复损真阴。（《入门》）
有年老衰弱，小便滴沥不通者，乃天真竭而元气虚也。不可服通利之剂，宜生脉散，加甘草稍连白色梗
并子通用，郁李仁、麻仁研，空心服之。（《会元》）
内蛀疳 （见清凉诸方中）
死证 淋病，下焦气血干者死。（《捷法》）
治法诸说 淋闭之病，不可一向作热治，亦有胞囊有寒而便溺不通者，亦有胞系了戾而不小便者，
宜审别之。（《鸡峰》）
执剂之法，并用流行滞气，疏利小便，清解邪热，其于调平心火，又三者之纲领焉。心清则小便自利，
心平则血不妄行，最不可姑息用补，气得补而愈胀，血得补而愈涩，热
得补而愈盛，水窦不行，加之谷道闭遏，未见其有能生者也。（《直指》）
小便涩痛，常急欲溺，及去点滴，茎中痛不可忍者，此五淋病。生料五苓散，加阿胶七分。或五苓散，
加车前子末少许。或五苓散和益元散等分。（《要诀》）
诸方中类多散热利小便，而于开郁行气、破血滋阴盖少焉。若夫散热利小便，只能治热淋、血淋而已；
其膏淋、砂淋、石淋三者，必须开郁利气、破血滋阴方可也。古方用郁金、琥珀，开郁药也；用青皮、木香，
行气药也；用蒲黄、牛膝，破血药也；川黄柏、生地黄，滋阴药也。（《丹溪附余》）
丹波先教谕曾说道：淋病中由梅毒引起的，仅在窦汉卿的《疮疡经验全书》中有记载，称之为“内蛀疳”。如今患淋病的人比比皆是，虽然这种病在西方医学理论中必然有很多论述，但明清以来的医家却无人敢提及，这实在是最为奇怪的事，因此除了窦氏之外，本书未采纳其他相关说法。
关于名称：淋，古代称为“癃”，名称不同罢了。“癃”的意思是疲弱，“淋”的意思是滴沥。现在的名字虽然通俗，但在意义上是恰当的。（出自《三因方》）（按语：癃、淋读音相近，癃即淋，元载侗在《六书故》中有解释。现在陈氏认为“罢”的意思是不对的，有人把癃当作小便闭塞的名字也是不对的。）
小便滴沥涩痛的，叫做淋。小便急胀不通的，叫做闭。（出自《要诀》）
闭和癃，合起来说是一种病，分开来说，有突发和久病的区别。所谓闭，是突发疾病导致的小便闭塞，点滴不出，俗称小便不通。所谓癃，是久病导致的小便淋漓，点滴而出，一天几十次或上百次，这就是所谓的淋病。（出自《纲目》）
癃就是淋病。（同上）
病因诸说（详见下一条）各种淋病，都是因为肾虚而膀胱有热。膀胱与肾互为表里，都主管水液。水进入小肠，下行到胞宫，流经阴部，形成尿液。肾气通于阴部。阴部，是津液下流的通道。如果饮食不节制，喜怒情绪没有定时，虚实不调和，就会导致脏腑不和，致使肾虚而膀胱有热。膀胱是津液之府，有热则津液内溢并流注于睾丸，水道不通，水不上不下，停积在胞中。肾虚则小便频数，膀胱有热则尿液下行涩滞，既频数又涩滞，于是淋沥不畅，所以称为淋。其症状是小便量少且次数多，小腹紧绷急迫，疼痛牵引至肚脐。（出自《诸病源候论》）
各种淋病大体上有五种：冷淋、热淋、膏淋、血淋、石淋。这五种虽然不同，都以气为本。多因情欲交错，内外邪气兼并，清浊之气相干扰，阴阳不顺，结聚在下焦，遂成为淋病或闭证。（出自《三因方》）
淋有五种，都属于热证。（出自朱丹溪）
巢元方的说法如此，恐怕未必完全正确。大抵都是三焦气化功能不及，热邪逼迫膀胱，导致水道干涩所形成的。劳淋、气淋、血淋、膏淋、石淋，虽然分为五种，但其病机必定是因为劳累生火，火盛搏结气机，甚则波及血液，血转化为膏，膏转化为石。从清变浊，从稀变浓，从软变硬，从无形逐渐变为有形，也如同熬煮汁液成膏、煮水结盐的道理，难道真有砂石从水脏中生出吗？至于说肾虚不能制约肥腻之液，更是可笑。（出自《续焰》）
脉象候诊（见下一条）
症状总述：各种淋病和小便不利，都是由五脏不通、六腑不和、三焦痞塞涩滞、营卫耗损所致。或因冒热饮酒，醉酒行房，耗尽精神，劳伤气血；或因见到女色兴起而败精不出；或因沉迷宠幸不已而真髓多泄；或因惊恐慌乱无序；或因思虑未宁；或因饥饱失时；或因奔驰刚定；或因强忍大小便；或因发泄时间过长；或因寒气侵入膀胱；或因暑热中伤胞囊。这些不慎的损伤，导致了这种疾病，症状表现变异，名称也不同，就有冷、热、气、劳、膏、砂、虚、实八种。冷淋，小便频数，颜色白如米泔。热淋，小便涩滞，颜色红如血。气淋，脐腹部满闷，小便不通利且痛。劳淋，小便淋沥不绝，像水滴漏一样不断绝。膏淋，小便中排出物像脂膏。砂淋，脐腹中隐痛，小便困难，疼痛难以忍受片刻。从小便中排出像砂石一样的东西，大的像皂角子，颜色或赤或白（一作黄），色泽不定，这是由于肾气虚弱而贪恋女色，性交而不射精，或射精不止，虚伤真气，邪热渐强，结聚而成砂石。又如同用水煮盐，火大水少，盐逐渐结成石头一样。说肾是水脏，咸味归于肾，水在下焦消耗，虚热日益严重，煎结而成，这不是一时造成的，而是长久以后才发作，形成需五年，败坏需三年，壮年人五年后，灾祸必至。应当紧急攻治，八种淋中，只有这种最危险。其脉盛大而实的可以治疗，脉虚小而涩的不可治疗。虚证是指肾与膀胱俱虚，而精滑梦遗，小便不禁。实证是指经络闭塞涩滞，水道不利，而阴茎疼痛、腿酸。另外，各种淋病的病情与脉象相符的预后良好，相反的预后凶险。治疗方法，也在于详细斟酌。（出自《中藏经》）（按语：《医碥》说：脉实大，宜分理。脉虚细涩，精血败坏，难治。）
淋有五种：第一，尿道中痛，尿不能突然排出的是石淋。第二，尿中有白色液体肥厚如脂膏的是膏淋，又名肉淋。第三，尿难涩滞，常有剩余滴沥的是气淋。第四，尿留滞茎中，多次起夜却排不出，牵引小腹痛的是劳淋。第五，像豆汁或像血，凝结不通的是血淋，又名痒淋。（出自《肘后备急方》）
《集验论》中的五淋是：石淋、气淋、膏淋、劳淋、热淋。石淋这种病，小便尿道中痛，尿不能突然排出，时常自行流出，疼痛牵引少腹，膀胱内部急迫。气淋这种病，小便困难，常有余沥。膏淋这种病，尿像膏脂一样自行流出，少腹膀胱内部急迫。劳淋这种病，疲倦时就发作，疼痛牵引气冲穴，小便不利。热淋这种病，发热时就发作，其后尿血像豆汁状，发作有定时。五淋各不相同，治疗方剂杂乱选用。（出自《外台秘要》）
石淋（宜参考治疗血证的各方）石淋，是排尿时排出砂石。肾主水，水结聚则化为石，所以肾中客居砂石。肾虚被热邪乘袭，热则成淋。其症状是小便尿道中痛，尿不能突然排出，疼痛牵引少腹，膀胱内部急迫，沙石从小便道排出，严重的堵塞疼痛令人昏厥。（出自《诸病源候论》）
沙淋凝聚脂膏而易消散，石淋结块而难消除。败精结聚形成沙。（出自《直指方》）
热在膀胱中，下焦为之约束，结聚成砂石，如同汤瓶煎炼日久，熬成汤碱。现在的羊猪膀胱，吹气使其充满，常常不能穿透，难道真有沙石能渗漏吗？由此可知前人所说的服用五石丸散导致的，恐怕未必是这样。（出自《十形三疗》）
五淋之中，只有石淋、膏淋最难治疗。石淋乃是膀胱蓄积热邪而成，正如汤瓶久在火中，底部结白碱而不能去除，理应清除积热，使水道通畅，则砂石排出即可痊愈。（出自《统旨》）
沙石淋，小便混浊，像稠浆腐败浓汁，然而又有努责排出颗粒如砂如块，颜色像玛瑙色的，或有长而像粉条的，初出粉红，一会儿则像白浓浆了。这是因为少年时斫丧太过，导致遗浊，而服用补涩药过多，积久才发作。有的相信邪道，用蛤蚧、海马、海牛、母丁香、紫稍花、哈芙蓉等，敷贴封搽阴茎口或脐中，以阻碍精气发动之火，以及服用健阳丸温暖之药，甚至导致五脏败坏，燥热凝结，到了中年后，衰而陷下，则发出以上恶症。（出自《会元》）
膏淋（互见补肾诸方中）膏淋，是淋而有肥腻之物，形状像膏，所以叫膏淋，也叫肉淋，这是肾虚不能制约肥液，所以与小便一起排出。（出自《诸病源候论》）
精结散开形成膏。（出自《直指方》）
有类似淋非淋，小便颜色像米泔，或便中有像鼻涕的形状，这是精溺俱出，精液阻塞窍道，所以想排便但不能而痛，宜用大菟丝子丸、鹿茸丸之类。但这即是膏淋，说它不是淋也不对。（出自《要诀》）
膏淋是因为肾脏虚寒，精溺像膏，或像米泔，或像鼻涕，这必定是败精阻塞于窍道，所以想排便但不能而痛。治疗应当温养下元，使精气固摄，则小便自然清如常态。（出自《统旨》）
热淋热淋，是三焦有热，气搏结于肾，流入胞中而成淋，其症状是小便赤涩。也有宿患淋病，现在得热而发作的，热甚则变成尿血。也有小便后像小豆羹汁状的，发作有定时。（出自《诸病源候论》）
如果热极成淋，服药无效的，宜用减桂五苓散，加木通、滑石、灯心草、瞿麦各少许。（出自《要诀》）
省元忽然被湿气侵扰，小便涩滞难通，有时尿道作痛。我说：这属于肝胆湿热。先用龙胆泻肝汤无效，尿道流出白色津液，小便通则疼痛加剧，仍以牛膝、山栀、夏枯草、薏苡仁、木通、甘草（少量）、牵牛子水煎服，全愈。（出自《石山医案》）
血淋（互见渗泄及治血诸方中）血淋，是热淋的严重阶段则尿血，称为血淋。心主血，血的运行全身，通达经络，循环脏腑。劳损严重时则散失其常经，溢出渗入胞中而成血淋。（出自《诸病源候论》）
血淋一证，须看血色分冷热，色鲜红的属心与小肠实热，色瘀暗的属肾与膀胱虚冷（按语：此以心肾为区别，似乎拘泥）。如果是确切的冷淋，及下元虚冷，血色瘀暗的，都用漠椒根锉碎，不拘多少，白水煎，待冷后服用。（出自《要诀》）
血淋有血瘀、血虚、血冷、血热的区分。小便硬满，尿道作痛欲死，是血瘀。血色黑黯，面色枯白，尺脉沉迟，是下元虚冷（用肾气丸）。然而有内热过极，反兼水化而色黑的，不可便认为是冷，须以脉证详细辨别。（出自《必读》）
血受伤者，补血行血自愈，不要作为淋治疗。死血作淋，用牛膝膏妙。血淋，用侧柏叶、生藕节、车前草等分捣汁，调益元散。（出自《准绳》）
溺血稍微轻些，而血淋则是精竭火动而血来，与沙石淋是兄弟关系，乃是从死里求生，侥幸获得疗效，务必不要再犯。（出自《会元》）
建安林回甫秘校，熙宁年间与我同客居龙门李家。林某一日下血，李兄弟煎八正散给他服用，服药后不胜痛苦，小腹前阴疼痛更加厉害。我教林某服用菟丝山药丸（当考证），林某病去，气血也稍充实。大概不可专以热药、血得热则盈溢为说。（出自《鸡峰普济方》）
气淋气淋，是肾虚膀胱热，气胀所为。膀胱与肾互为表里，膀胱热，热气流入胞中，热则生实，令胞内气胀，则小腹满。肾虚不能制约其小便，故成淋。其症状是膀胱小腹皆满，尿涩常有余沥。也叫气癃。诊察其少阴脉数的，男子则为气淋。（出自《诸病源候论》）（按语：诊法出自《脉经》。）
有淋病，下诸通便剂愈不通，用木香流气饮或别用通气香剂才愈的，这是气淋，出于冷热淋之外。（出自《要诀》）
劳淋（诸液燥证、暑月尿涩）劳淋，是说劳伤肾气而生热成淋。肾气通于阴，其症状是尿留茎内，多次起夜却排不出，牵引小腹痛（《千金方》说痛引气冲），小便不利，劳倦即发作。（出自《诸病源候论》）
有小便艰涩像淋，不痛而痒的，这也属虚（按语：《医碥》说：淋证尿道必痛，若先痛后痒，则火退了，或实证转虚），宜用八味丸、生料鹿茸丸之类。如果因思虑用心过度致淋，用辰砂妙香散吞威喜丸，或妙香散和五苓散。汗多而小便赤涩，暑月多有此证，盛暑所饮既多，小便反涩少而赤，缘上停为饮，外发为汗，津道不通，小肠涩闭，则水不运下。五苓散一名导逆，内有术、桂收汗，猪苓、泽泻、茯苓分水道，收其在外者使之内，又从而利导焉。发者敛之，壅者通之，义取于此。然而有虚劳汗多而小便赤涩的，却是五脏枯燥，滋腴既去，不能生津，故溺涩而赤。不宜过用通小便之剂竭其肾水，只当温养润肺（按语：《医碥》说：敛汗清热滋液可也），十全大补汤、养荣汤之类自足选用。汗是心液，心主血，血荣则心得所养，汗止津生，不待通而溺自清矣。各种失精血及患痈毒人，忽有小便赤涩之证，这也是枯竭不润的缘故。（出自《要诀》）
一人形体肥胖苍白，年五十余岁，患淋，沙石涩痛。医生用五苓散或琥珀八正散之类，病更加重。邀请我去诊治，脉皆濡弱而缓近驶。我说：这是气血虚。经云：膀胱是津液之府，气化出焉。今病气虚，不但不能运化蒸溽，而且气馁也不能使之排出。经又云：血主濡之。血少则茎中枯涩，水道不利，怎能不淋。医生用通利之法，血愈燥，气愈伤。遂用大补汤加牛膝煎服，月余病减。仍服八味丸，除去附子，加黄芪，服半月余，遂获安。（出自《石山医案》）（按语：《方考》清心莲子饮，劳淋者此方主之。）
邑宰严知非，患淋经年，痛如刀锥，凡清火疏利之剂计三百帖，病势日甚，岁暮来就诊。我说：两尺脉数而无力，是虚火也。从来医者皆泥于痛无补法，愈疏通则愈虚，愈虚则虚火愈炽。遂以八味地黄丸料，加车前、沉香、人参，逾月而病去。（出自《必读》）
寒淋（互见温通诸方中）寒淋，其病症状，是先寒战然后尿出。由肾气虚弱，下焦受于冷气，入胞与正气交争，寒气胜则战寒而成淋，正气胜战寒解，故得小便。（出自《诸病源候论》）
进冷剂愈严重的，这是冷淋，宜用地髓汤（用牛膝、麝香）送服附子八味丸。有因服用五苓散等药无效，用生料鹿茸丸却愈的。此证，病于下元虚冷之故。（出自《要诀》）
老人淋精未通而御女以通其精，则五体有不备之处，异日有难状之疾。阴已痿而思色以降其精，其精不出内败。小便道涩而为淋。精已耗而复竭之，则大小便道牵疼，愈疼则愈欲大小便，愈便则愈疼。（出自《褚氏遗书》）
精败竭者，童男精未盛而御女，老人阴已痿而思色，以降其精，则精不出而内败，茎中痛涩为淋的，用八味丸料加车前子、牛膝煎服。若精已竭而复耗之，则大小便中牵疼，愈疼则愈欲大小便，愈便则愈疼，倍加附子救之。凡此当滋化源，不可误用知母、黄柏、淡渗等剂，既泻真阳，复损真阴。（出自《入门》）
有年老衰弱，小便滴沥不通的，乃天真竭而元气虚也。不可服通利之剂，宜用生脉散，加甘草稍连白色梗并子通用，郁李仁、麻仁研，空心服之。（出自《会元》）
内蛀疳（见清凉诸方中）
死证淋病，下焦气血干的死。（出自《捷法》）
治法诸说淋闭之病，不可一向作热治，亦有胞囊有寒而便溺不通者，亦有胞系了戾而不小便者，宜审别之。（出自《鸡峰普济方》）
执剂之法，并用流行滞气，疏利小便，清解邪热，其于调平心火，又三者之纲领焉。心清则小便自利，心平则血不妄行，最不可姑息用补，气得补而愈胀，血得补而愈涩，热得补而愈盛，水窦不行，加之谷道闭遏，未见其有能生者也。（出自《直指方》）
小便涩痛，常急欲溺，及去点滴，尿道痛不可忍者，这是五淋病。生料五苓散，加阿胶七分。或五苓散，加车前子末少许。或五苓散和益元散等分。（出自《要诀》）
诸方中类多散热利小便，而于开郁行气、破血滋阴盖少焉。若夫散热利小便，只能治热淋、血淋而已；其膏淋、砂淋、石淋三者，必须开郁利气、破血滋阴方可也。古方用郁金、琥珀，开郁药也；用青皮、木香，行气药也；用蒲黄、牛膝，破血药也；川黄柏、生地黄，滋阴药也。（出自《丹溪附余》）
Tanbo, former instructor, once said: Among the cases of Lin syndrome (strangury) caused by syphilis, they are only recorded in Dou Hanqing's *Complete Experience Book on Sores and Ulcers* (Chuangyang Jingyan Quanshu), where they are referred to as "Internal Corrosive Chancre" (Nei Zhu Gan). Nowadays, those suffering from Lin syndrome are everywhere. Although Western medical theory must surely have much to say about this, physicians of the Ming and Qing dynasties dared not mention it, which is most strange. Therefore, apart from Dou's work, no other sources were adopted.
Regarding Nomenclature: Lin was anciently called "Long" (Lóng). The names differ. "Long" implies weakness or exhaustion, while "Lin" implies dripping. Although the current name is colloquial, it fits the meaning well. (*San Yin Fang*) [Note: Long and Lin have similar pronunciations; Long is essentially Lin. Yuan Zaitong explains this in *Liushu Gu*. Chen's view that "Long" means "exhaustion" is incorrect. It is also incorrect to define Long solely as urinary retention.]
Urination that is dribbling, astringent, and painful is called Lin. Urination that is urgent, full, and obstructed is called Bi (retention). (*Yaojue*)
Bi and Long, when discussed together, refer to one disease; when distinguished, there is a difference between acute onset and chronic duration. Bi refers to an acute condition of urinary retention, where not a drop can be passed, commonly known as "inability to urinate." Long refers to a chronic condition of strangury, where urine drips out drop by drop, occurring dozens or even hundreds of times a day. This is what is called Lin syndrome. (*Gangmu*)
Long is synonymous with Lin syndrome. (Ibid.)
Etiology and Pathogenesis (See next section): Various types of Lin syndrome arise from Kidney deficiency combined with Heat in the Bladder. The Bladder and Kidney are exterior-interior partners, both governing water. Water enters the Small Intestine, descends to the Bladder (Pao), flows through the genitalia, and becomes urine. Kidney Qi connects to the genitalia. The genitalia are the pathways for the downward flow of body fluids. If diet is irregular, emotions like joy and anger are unregulated, and deficiency/excess are unbalanced, the Zang-Fu organs become disharmonious, leading to Kidney deficiency and Bladder Heat. The Bladder is the mansion of body fluids; Heat causes fluids to overflow internally and flow into the testes. The water passages become obstructed, water neither ascends nor descends, and stagnates in the Bladder. Kidney deficiency leads to frequent urination; Bladder Heat causes difficult, astringent flow. Frequency combined with astringency results in incomplete, dribbling voiding, hence the term Lin. Symptoms include small volume but high frequency of urination, tension and urgency in the lower abdomen, with pain radiating to the umbilicus. (*Zhubing Yuanhou Lun*)
Generally, there are five types of Lin syndrome: Cold, Hot, Gao (Paste/Grease), Xue (Blood), and Shi (Stone). Although these five differ, they all originate from Qi. They often result from disordered sexual desire, internal and external pathogenic factors combining, interference between clear and turbid Qi, and disharmony of Yin and Yang, leading to stagnation in the Lower Jiao, resulting in Lin or Bi. (*San Yin Fang*)
There are five types of Lin, all belonging to Heat. (Zhu Danxi)
Chao Yuanfang's explanation may not be entirely accurate. Generally, these conditions are formed due to the failure of Qi transformation in the Three Jiao, with Heat forcing the Bladder, causing the water passages to become dry and astringent. Although Labor, Qi, Blood, Gao, and Stone Lin are divided into five types, their pathogenesis inevitably involves Fire generated by labor/overwork. Excessive Fire clashes with Qi, affecting Blood; Blood transforms into Gao (paste/grease), and Gao transforms into Shi (stone). From clear to turbid, from thin to thick, from soft to hard, from formless to gradually forming—this is akin to boiling juice into paste or boiling water to form salt crystals. Is it truly that sand and stones are born within the water organ? As for the claim that Kidney deficiency fails to control fatty fluids, this is laughable. (*Xu Yan*)
Pulse Diagnosis (See next section)
General Description of Symptoms: Various Lin syndromes and difficulty in urination are caused by obstruction of the Five Zang organs, disharmony of the Six Fu organs, stagnation and astringency of the Three Jiao, and depletion of Ying (Nutritive) and Wei (Defensive) Qi. Causes include exposure to heat and alcohol consumption, excessive drunkenness followed by sexual intercourse, exhaustion of spirit, and injury to Qi and Blood. It may result from sexual arousal without emission of semen, or from excessive indulgence leading to loss of essence. It may also stem from sudden fright, unresolved anxiety, irregular eating habits, physical exertion immediately after running, holding back urination or defecation, prolonged sexual activity, cold invading the Bladder, or summer-heat damaging the Bladder. Such negligence leads to this disease. Due to varying symptoms, names differ, including Cold, Hot, Qi, Labor, Gao, Sand, Deficiency, and Excess types.
Cold Lin: Frequent urination, white color like rice washings.
Hot Lin: Astringent urination, red color like blood.
Qi Lin: Fullness and oppression in the navel and abdomen, difficult and painful urination.
Labor Lin: Continuous dribbling urination, like a leaking drip that never stops.
Gao Lin: Excretion of substances resembling fat or paste in urine.
Sand Lin: Dull pain in the navel and abdomen, difficult urination, unbearable pain for moments. Passing sand-like or stone-like particles from the urethra, some as large as soap nuts, varying in color (red, white, or yellow). This is due to weak Kidney Qi and lustful behavior, either withholding ejaculation or continuous emission, damaging true Qi. Evil Heat strengthens and aggregates into sand. Like boiling water with little water and strong fire, salt gradually forms stones. Since the Kidney governs water and salty flavors enter the Kidney, as water depletes below, deficiency-Heat intensifies, frying and aggregating into stones. This does not happen overnight but develops over time. Formation takes five years, destruction three years. For robust individuals, disaster strikes after five years. Urgent treatment is required; among the eight types, this is the most critical. Pulse surging and excess indicates treatability; pulse deficient, small, and astringent indicates untreatability. Deficiency refers to dual deficiency of Kidney and Bladder, with seminal slipperiness, nocturnal emission, and incontinence. Excess refers to closed and astringent meridians, obstructed water passages, penile pain, and leg soreness. Furthermore, if the disease pattern matches the pulse, survival is likely; if contrary, prognosis is poor. Treatment methods require careful deliberation. (*Zhongzang Jing*) [Note: *Yi Que* states: Surging/excess pulse requires differentiation and regulation. Deficient/fine/astringent pulse indicates deterioration of essence and blood, making it difficult to treat.]
There are five types of Lin: 1. Pain in the glans penis, inability to pass urine suddenly, is Stone Lin. 2. White fluid in urine, thick like fat/paste, is Gao Lin, also called Meat Lin. 3. Difficult, astringent urination with residual drops is Qi Lin. 4. Urine retained in the urethra, frequent urges without passage, drawing lower abdominal pain, is Labor Lin. 5. Urine resembling bean soup or blood, congealed and obstructed, is Blood Lin, also called Itching Lin. (*Zhouhou Beiji Fang*)
*Jiyan Lun* lists the Five Lin as: Stone, Qi, Gao, Labor, and Hot Lin.
Stone Lin: Pain in the urethra, inability to pass urine suddenly, occasional spontaneous leakage, pain radiating to the lower abdomen, urgency in the Bladder.
Qi Lin: Difficulty in urination, constant residual drops.
Gao Lin: Urine flows out like paste, urgency in the lower abdomen and Bladder.
Labor Lin: Onset upon fatigue, pain radiating to the Qichong point, difficulty in urination.
Hot Lin: Onset upon fever, urine appears bloody like bean soup afterwards, attacks occur at specific times. The five Lin differ, so treatment formulas vary. (*Waitai Miyao*)
Stone Lin (Refer to formulas for treating Blood syndromes): Stone Lin involves passing stones. The Kidney governs water; water aggregation turns to stone, so stones reside in the Kidney. Kidney deficiency allows Heat to invade; Heat creates Lin. Symptoms: Pain in the urethra, inability to pass urine suddenly, pain radiating to the lower abdomen, Bladder urgency, passage of sand/stones via the urethra. Severe cases involve blockage causing suffocation and fainting. (*Zhubing Yuanhou Lun*)
Sand Lin coagulates fat and disperses easily; Stone Lin forms clumps and is hard to dissolve. Coagulated stale semen forms sand. (*Zhizhi Fang*)
Heat in the Bladder constrains the Lower Jiao, forming sand/stones, like a kettle boiled for a long time until alkali remains. Consider sheep or pig bladders inflated with air; they cannot be penetrated. How could real sand/stones leak? Thus, the claim that taking Five-Stone Powders causes this is likely incorrect. (*Shixing Sanliao*)
Among the Five Lin, Stone and Gao Lin are the hardest to treat. Stone Lin is caused by accumulated Heat in the Bladder, just like a kettle left on fire for too long, accumulating white alkali at the bottom. One should clear accumulated Heat, open the water passages, and the stones will pass, leading to recovery. (*Tongzhi*)
Sand/Stone Lin: Urine is turbid, like thick, spoiled paste. However, straining may expel grains like sand or blocks like stones, colored like agate, or long like vermicelli. Initially pink, turning to white thick paste shortly after. This results from excessive debauchery in youth leading to turbid emissions, compounded by excessive use of tonifying and astringent herbs, manifesting later. Some believe in heterodox methods, using Gecko, Seahorse, Sea Cow, Mother Clove, Zi Shao Hua, Ha Fu Rong, etc., applied to the urethral opening or umbilicus to suppress sexual fire, or taking Jianyang Pills for warmth. This leads to internal decay, dryness-heat condensation. In middle age, decline and sinking occur, triggering these malignant symptoms. (*Huiyuan*)
Gao Lin (See Kidney-tonifying formulas): Gao Lin involves passing fatty substances resembling paste, hence the name. Also called Meat Lin. This is due to Kidney deficiency failing to control fatty fluids, which exit with urine. (*Zhubing Yuanhou Lun*)
Scattered coagulated essence forms Gao. (*Zhizhi Fang*)
Some cases resemble Lin but are not: Urine color like rice washings, or mucus-like discharge. This is simultaneous emission of essence and urine; essence blocks the orifices, causing pain when attempting to void. Use Da Tusi Wan or Lurong Wan. However, this is indeed Gao Lin; denying it is incorrect. (*Yaojue*)
Gao Lin is caused by Kidney deficiency-cold, with essence and urine resembling paste, rice washings, or mucus. Stale semen blocks the orifices, causing pain upon attempted voiding. Treatment should warm and nourish the Lower Yuan, securing essence and Qi, so urine clears naturally. (*Tongzhi*)
Hot Lin: Heat in the Three Jiao clashes with the Kidney, flowing into the Bladder to create Lin. Symptoms: Red and astringent urination. Existing chronic Lin may flare up due to new Heat; severe Heat transforms into hematuria. Some present with urine resembling mung bean soup after voiding, with timed attacks. (*Zhubing Yuanhou Lun*)
If extreme Heat causes Lin unresponsive to medication, use Gui Zhi Wu Ling San with reduced Cinnamon Twig, adding Tong Cao, Hua Shi, Deng Xin Cao, and Qu Mai in small amounts. (*Yaojue*)
The Provincial Scholar suddenly suffered dampness invasion, causing astringent and difficult urination, sometimes with penile pain. I diagnosed Liver-Gallbladder Damp-Heat. Long Dan Xie Gan Tang was ineffective. White fluid discharged from the urethra; upon urination, pain intensified. Prescribed Niuxi, Zhizi, Xiakucao, Yiyiren, Tong Cao, Gancao (small dose), and Qianniuzi decocted in water. Complete recovery. (*Shishan Yi'an*)
Blood Lin (See Diuretic and Hemostatic formulas): Blood Lin is severe Hot Lin resulting in hematuria. The Heart governs Blood; Blood circulates through meridians and Zang-Fu. Severe exhaustion causes Blood to leave its normal channels, overflowing into the Bladder, creating Blood Lin. (*Zhubing Yuanhou Lun*)
In Blood Lin, distinguish Cold vs. Heat by blood color: Bright red indicates Heart/Small Intestine Excess-Heat; Dark/clotted indicates Kidney/Bladder Deficiency-Cold. [Note: Distinguishing by Heart/Kidney seems rigid.] If confirmed Cold Lin or Lower Yuan Deficiency-Cold with dark blood, use Mojiao Gen (Peucedani Radix), chopped, decocted in plain water, taken cold. (*Yaojue*)
Blood Lin is classified into Blood Stasis, Blood Deficiency, Blood Cold, and Blood Heat. Hard/full lower abdomen, excruciating penile pain indicates Blood Stasis. Dark blood, sallow complexion, deep-slow Chi pulse indicates Lower Yuan Deficiency-Cold (use Shenqi Wan). However, extreme internal Heat may mimic Water transformation with black color; do not assume Cold without detailed pulse/symptom analysis. (*Bidu*)
If Blood is injured, tonify and invigorate Blood for self-healing; do not treat as Lin. If Dead Blood causes Lin, Niuxi Gao is excellent. For Blood Lin, equal parts Ce Bai Ye, raw Lotus Rhizome Node, and Cheqian Cao, crushed for juice, mixed with Yi Yuan San. (*Zhunsheng*)
Ni Xue (Hematuria without pain) is slightly milder; Xue Lin involves essence depletion and Fire agitation causing bleeding, closely related to Stone Lin. It is a desperate situation; if effective, avoid recurrence. (*Huiyuan*)
Lin Huifu, a secretarial scholar from Jian'an, lived with me in the Li family home in Longmen during the Xining era. One day he had lower bleeding. The Li brothers prepared Ba Zheng San for him. After ingestion, he suffered greatly, with worsening lower abdominal and genital pain. I advised him to take Tusishan Yao Wan (to be verified). His illness resolved, and Qi/Blood slightly recovered. One cannot simply argue that hot medicines cause blood to overflow. (*Jifeng Puji Fang*)
Qi Lin: Caused by Kidney deficiency and Bladder Heat, resulting from Qi distension. The Bladder and Kidney are exterior-interior. Bladder Heat sends Qi into the Bladder; Heat creates Excess, causing Qi distension in the Bladder and lower abdominal fullness. Kidney deficiency fails to control urination, causing Lin. Symptoms: Fullness in Bladder and lower abdomen, astringent urination with residual drops. Also called Qi Long. Palpation of a rapid Shaoyin pulse in men indicates Qi Lin. (*Zhubing Yuanhou Lun*) [Note: Diagnostic method from *Maijing*.]
Some Lin cases unresponsive to purgatives resolve with Muxiang Liuqi Yin or other Qi-moving aromatic agents. This is Qi Lin, distinct from Cold/Hot Lin. (*Yaojue*)
Labor Lin (See Dry Fluid Syndromes, Summer Heat Astringent Urine): Labor Lin arises from Labor injuring Kidney Qi, generating Heat and Lin. Kidney Qi connects to the genitalia. Symptoms: Urine retained in the urethra, frequent urges without passage, drawing lower abdominal pain (*Qianjin* says pain radiates to Qichong), difficulty in urination, onset upon fatigue. (*Zhubing Yuanhou Lun*)
Difficult, astringent urination resembling Lin, but painless and itchy, belongs to Deficiency. [Note: *Yi Que* states Lin always involves penile pain; pain then itch suggests Fire subsiding or Excess turning to Deficiency]. Use Bawei Wan or Shengliao Lurong Wan. If caused by excessive mental effort, use Chensha Miaoxiao San swallowed with Weixi Wan, or Miaoxiao San combined with Wu Ling San. Profuse sweating with red/astringent urine is common in summer. High fluid intake in intense heat paradoxically reduces urine output and reddens it because fluids stop above as Phlegm-Rheum, escape externally as sweat, Jin pathways block, Small Intestine closes, and water fails to descend. Wu Ling San, also called Dao Ni, uses Atractylodes and Cinnamon to secure sweat, Polyporus, Alisma, and Poria to separate water pathways, drawing external fluids inward and promoting diuresis. "Disperse by gathering, unblock congestion." However, in deficiency-Labor with profuse sweat and red/astringent urine, the internal organs are dry, nutrients depleted, unable to generate fluids. Do not overuse diuretics to exhaust Kidney Water; instead, warm-nourish and moisten the Lungs. [Note: *Yi Que* suggests securing sweat, clearing Heat, and nourishing fluids is appropriate]. Shiquan Dabu Tang or Yangrong Tang are suitable. Sweat is Heart fluid; Heart governs Blood. When Blood is abundant, Heart is nourished, sweat stops, fluids generate, and urine clears without diuretics. Patients losing essence/blood or suffering from carbuncles who suddenly develop red/astringent urine suffer from dryness/lack of moisture. (*Yaojue*)
A man, obese and pale, over fifty, suffered Lin with sand/stone astringent pain. Doctors used Wu Ling San or Hupo Ba Zheng San, worsening the condition. I diagnosed a soggy, weak, slow-but-rapid pulse. I said: This is Qi and Blood deficiency. Classics state: The Bladder is the mansion of fluids, governed by Qi transformation. Now, Qi deficiency prevents vaporization and expulsion. Classics also state: Blood moistens. Blood deficiency causes dryness/astringency in the urethra and obstructed water passages, inevitably causing Lin. Doctors used draining methods, drying Blood further and injuring Qi. I prescribed Dabu Tang plus Niuxi decocted. After a month, symptoms improved. Continued with Bawei Wan minus Fuzi, plus Huangqi. After half a month, relief was achieved. (*Shishan Yi'an*) [Note: *Fangkao* recommends Qingxin Lianzi Yin for Labor Lin.]
Magistrate Yan Zhifei suffered Lin for years, pain like knives/cones. He took 300 doses of cooling/drainage herbs, worsening daily. Seeking consultation at year-end, I found rapid, forceless Chi pulses, indicating Deficiency-Heat. Physicians traditionally adhere to "pain has no tonification method," believing drainage increases deficiency, which fuels Deficiency-Heat. I prescribed Badihuang Wan base plus Cheqianzi, Chenxiang, and Renshen. Illness resolved after a month. (*Bidu*)
Cold Lin (See Warming-Unblocking formulas): Cold Lin presents with chills preceding urination. Due to weak Kidney Qi and Cold invading the Lower Jiao into the Bladder, clashing with Righteous Qi. Cold dominance causes shivering and Lin; Righteous Qi dominance resolves shivering, allowing urination. (*Zhubing Yuanhou Lun*)
Worsening with cold herbs indicates Cold Lin. Use Didui Tang (Niuxi, Shexiang) to administer Fuzi Bawei Wan. Cases unresponsive to Wu Ling San may recover with Shengliao Lurong Wan. This syndrome stems from Lower Yuan Deficiency-Cold. (*Yaojue*)
Elderly Lin: If a youth engages in sex before essence is established, the five bodies remain incomplete, leading to difficult diseases later. If an impotent elder seeks sexual release, essence does not exit but rots internally. Urethral astringency causes Lin. If essence is exhausted and further depleted, both urinary and fecal tracts ache. More pain increases urge to void; more voiding increases pain. (*Chu Shi Yishu*)
Rotted/Exhausted Essence: If a boy engages in sex before essence matures, or an impotent elder seeks release, essence fails to exit and rots internally, causing penile pain/astringency (Lin). Use Bawei Wan base plus Cheqianzi and Niuxi. If essence is exhausted and further depleted, causing pain in both tracts, increase Fuzi dosage to rescue. Nourish the Source of Transformation. Do not mistakenly use Zimu, Huangbai, or mild-draining herbs, which drain True Yang and damage True Yin. (*Rumen*)
For elderly frailty with dribbling obstruction, Tianzhen is exhausted and Yuan Qi is deficient. Do not use draining herbs. Use Shengmai San plus Gancao (with white stalk and seeds), crushed Durili Ren and Mah Ren, taken on an empty stomach. (*Huiyuan*)
Internal Corrosive Chancre (See Cooling formulas)
Death Prognosis: Lin syndrome with dried-up Qi and Blood in the Lower Jiao is fatal. (*Jiefa*)
Treatment Principles: Lin and Bi should not always be treated as Heat. There are cases of Cold in the Bladder causing obstruction, or twisted Bladder ligaments preventing urination. Differentiate carefully. (*Jifeng Puji Fang*)
Principles of Prescription: Combine moving stagnant Qi, promoting urination, and clearing Heat. These are the guidelines alongside regulating Heart Fire. Clear Heart leads to free urination; Balanced Heart prevents reckless bleeding. Never tolerate using tonics blindly. Tonifying Qi worsens distension; tonifying Blood worsens astringency; tonicking Heat worsens intensity. If water passages fail and bowels are blocked, survival is unlikely. (*Zhizhi Fang*)
Astringent/painful urination, urgent need to void, passing only drops with unbearable penile pain constitutes the Five Lin. Use Shengliao Wu Ling San plus Ejiao (7 fen). Or Wu Ling San plus minor amount of Cheqian Zi powder. Or Wu Ling San mixed equally with Yi Yuan San. (*Yaojue*)
Most formulas focus on clearing Heat and promoting urination, rarely addressing Opening Depression, Moving Qi, Breaking Blood, or Nourishing Yin. Clearing Heat/promoting urination only treats Hot and Blood Lin. Gao, Sand, and Stone Lin require Opening Depression, Moving Qi, Breaking Blood, and Nourishing Yin. Ancient formulas use Yujin and Hupo (Opening Depression); Qingpi and Muxiang (Moving Qi); Puhuang and Niuxi (Breaking Blood); Chuan Huangbai and Sheng Dihuang (Nourishing Yin). (*Danxi Fuyu*)