典藏书目

The two yin (the anterior and posterior orifices) are the key junctions for conducting water pathways and transmitting dregs. The *Classic* states: "Turbid yin exits through the lower orifice." The lower orifice refers to the apertures of the lower jiao. Generally, when food and drink enter the stomach, their essence is first transported to the spleen, then returns to the lungs, ascending to follow the spring and summer commands, thereby nourishing the whole body; this is clear yang ascending to become heaven. After ascending, it descends to transport to the bladder, following the autumn and winter commands, to transmit and transform dregs, changing flavors and exiting; this is turbid yin descending to become earth. If a person can adapt to the qi of the four seasons, maintain regular daily routines to avoid cold and heat, regulate diet, and avoid excessive anger and joy to harmonize the spirit, maintaining balance among the four seasons without excess, they will remain healthy. Otherwise, external invasion by the six climatic pathogens and internal stirring of the five zang emotions' fire will lead to conditions such as obstruction or incontinence of urination and defecation, seminal emission, white turbidity, various types of strangury, hemorrhoids, and hernia. These conditions are listed below item by item.

1. Nocturnal emission and spermatorrhea. Zhu Danxi divided these into two syndromes: emission during dreams involving sexual intercourse is called "nocturnal emission" (meng yi), while spontaneous emission without dream sensation is called "spermatorrhea" (jing hua). In essence, both belong to the category of seminal emission. Dai Shi stated that there are four causes for seminal emission: first, excessive mental exertion causing the heart to fail to control the kidney, leading to loss of essence; second, unfulfilled desire for sex causing essence to lose its position and leak out; third, excessive sexual activity leading to uncontrollable slipping; fourth, vigorous constitution in youth with long-term abstinence, causing fullness of essence and subsequent leakage. Although the causes differ and symptoms vary, an examination of ancient prescriptions for nocturnal emission reveals that most cases belong to stagnation syndromes. Therefore, treatment does not solely focus on astringency. For kidney deficiency causing spermatorrhea, tonification and astringency should be used. For stagnation, promoting free flow and draining should be used. If damp-heat accumulates internally, treatment should consider the spleen and stomach. If desire fire is blazing due to endless thoughts, treatment should focus on the heart. The general principles of medical practice encompass these categories; careful assessment and application are sufficient.

2. White turbidity. The *Classic* mentions: "Endless thoughts and excessive coitus lead to white discharge" (bai yin), and "Spleen heat transferring to the kidney results in white discharge." Both involve substances discharged with urine. There are also cases of damp-phlegm flowing and pouring, or turbid qi from the stomach flowing downward and infiltrating the bladder. Zhu Danxi stated that red turbidity is due to heart deficiency with heat, caused by overthinking; white turbidity is due to kidney deficiency with cold, caused by indulgence in desires. He further explained that red turbidity belongs to blood because the small intestine belongs to fire; white turbidity belongs to qi because the large intestine belongs to metal. The *Ling Shu* states: "Deficiency of middle qi leads to abnormalities in urination and defecation." One must first tonify middle qi and raise it, then treat based on the red/white, qi/blood, and deficiency/excess of the zang-fu organs to align with the canonical principles.

3. Cold semen and infertility. How is this understood? Some individuals inherit the cold water qi of the north, resulting in a cold and unwarmed kidney and umbilical region. Even in their prime, they may emit semen driven by the stirring of liver yang. However, their constitution is inherently cold, akin to winter conditions in spring, preventing things from thriving; this condition is difficult to treat with standard methods. Another cause is damage to the Shaoyin organs from overwork, causing true yang to fail and cold qi to linger, depriving the stored essence of harmonious generation and transformation, thus rendering it useless for procreation. The treatment method should focus on dispelling cold and assisting warmth, allowing yang to distribute and yin to transform, naturally achieving ease. As stated, "Male and female combine to generate all things." Male and female interaction represents the Dao of Heaven and Earth. Qian (Heaven) changes its central line to Kun to form Kan (Water); Kun (Earth) changes its central line to Qian to form Li (Fire). Kan is Water, Li is Fire. When Fire enters Water, the image of Ji Ji (After Completion) forms, enabling generation and transformation. If Fire flares upward alone and Water moistens downward alone, with no interaction, it remains Wei Ji (Before Completion), lacking generation. The *Ling Shu* says: "Two spirits interact, combining to form shape, often preceding the body, which is called Jing (Essence)." Cold semen indicates kidney qi deficiency and cold.

4. Strangury (Lin Syndrome). The main categories are twofold: one is Damp Strangury, where the spleen receives accumulated damp qi, leading to yellow-red urine, progressing to strangury if severe; the other is Wind-Heat Strangury, where fire stagnates above causing heat, manifesting as strangury. Detailed classification includes: Stone Strangury, passing sand-like stones; Labor Strangury, triggered by fatigue; Blood Strangury, where the heart governs blood vessels connected to the small intestine; severe heat binds to blood vessels, causing blood to flow into the bladder and mix with urine; Paste Strangury, excreting fatty paste-like fluid, also known as Flesh Strangury; Qi Strangury, characterized by abdominal distension, frequent scanty urination, and dribbling after voiding; Cold Strangury, where cold qi lodges in the lower jiao, clashing with righteous qi, filling the bladder, obstructing waterways, starting with chills followed by frequent urination. A student who grasps the outline and details will understand the nature of strangury completely. Additionally, there is Bladder Bi syndrome. The *Classic* states: "Pressing the interior of the lower abdomen and bladder causes pain, feeling like hot water poured inside, with difficult urination and clear nasal discharge above." This occurs because wind-cold-damp pathogens lodge in the bladder, preventing qi transformation, causing fullness and obstruction. Symptoms resemble strangury but are distinct.

5. Diseases of urination and defecation stem from qi dysfunction. Excess pathogenic qi causes obstruction and constipation; deficiency of righteous qi leads to incontinence and loss of control. Constipation may be due to Wind, Cold, Qi stagnation, or Heat. It can also result from dry fluids in the elderly, blood loss postpartum in women, or recovery from sweating/diuretic therapies where qi and blood are depleted. Jie Gu stated that organ constipation cannot be treated uniformly. Zhang Zhongjing described Yang Jie (Yang Knotting) as floating-rapid pulse with appetite but constipation, and Yin Jie (Yin Knotting) as deep-slow pulse with anorexia, heaviness, and hard stool. Dong Yuan stated that Yang Jie requires dispersing, while Yin Jie requires warming. Abdominal accumulation pain is also Yin Jie, suitable for moxibustion. Urinary retention is caused by pathogenic heat, differentiated by blood or qi involvement. Thirst with difficulty urinating indicates heat in the Upper Jiao/Lung; no thirst with urinary retention indicates heat in the Lower Jiao/Blood. The *Nei Jing* states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." Also: "The Bladder is the official of the reservoir, storing fluids; only through qi transformation can they exit." Dan Xi used emesis to lift qi; as qi rises, water descends, relying on qi transformation. Regarding the San Jiao, the official of drainage, water flows through it. Moxibustion practitioners treat urinary difficulty by selecting San Jiao points, not Bladder points. Enuresis results from heart-kidney qi deficiency and declining yang cold, causing bladder loss of control. The *Classic* notes: "Bladder incontinence causes enuresis." Du Mai and Liver channel diseases also cause enuresis, as they traverse the genitalia and connect to the Ting Kong; pathology prevents Ying-Wei circulation and weakens qi-blood, failing to constrain the water pathway. Enuresis with testicular dragging involves Liver-Kidney disease. Hematuria and seminal discharge involve Heart-Lung symptoms. Generally, bowel/bladder disorders arise from Spleen-Stomach failure to transport, involving cold/heat, deficiency/excess, and inter-zang-fu interference, requiring careful differentiation based on authoritative texts.

6. Hernia (Shan Disease). Testicular swelling/pain and lower abdominal pain belong to the Foot Jueyin Liver Channel. The *Classic* states: "Ren Mai disease causes seven hernias in men and leukorrhea/masses in women." It also states: "Du Mai disease causes pain rushing from the lower abdomen to the heart, with inability to pass stool or urine, called Chong Hernia." "Kidney transmission causes Shan-Jia." "San Yang disease causes chills/fever, transmitting to Hernia." "Pathogens invading Foot Jueyin collaterals cause sudden hernia and acute pain." The *Ling Shu* describes: Foot Yangming tendon pain causes hernia with abdominal tightness; Foot Taiyin tendon disease causes twisting pain in genitals radiating to navel and hypochondrium; Foot Jueyin tendon disease causes genital dysfunction. These classical texts attribute hernia to various meridians. Zhang Zhongjing attributed them to cold pathogens. Later authors defined Seven Hernias: Cold, Water, Tendon, Blood, Qi, Fox, and Ju Hernia. Each has specific symptoms and prescriptions. However, this covers bilateral cases; unilateral cases require distinction. The left kidney belongs to Water (Blood), governed by Liver Wood; cold causes blood stasis, flowing to the left testicle. The right kidney belongs to Fire (Qi), governed by Lung Metal; qi stagnation causes dampness, flowing to the right testicle. Tendons connecting to testes include Taiyin and Yangming, not just Jueyin. Clinically, left-sided hernia often presents with more pain and less swelling; right-sided with less pain and more swelling.

7. Anterior Orifice Diseases. The *Classic* states: "When Taiyin dominates, dampness descends, Kidney qi ascends, leading to impotence and weakness." Impotence results from excessive depletion damaging Liver tendons. The *Classic* notes: "Foot Jueyin channel disease, if damaged internally, causes impotence." Also: "Foot Jueyin tendon disease, if damaged by heat, causes flaccidity/protrusion; if damaged by cold, causes retraction." Treatment involves promoting water flow and clearing Yin heat. Pain in the urethra indicates Jueyin qi stagnation, cold-damp condensation, damp-heat pouring down, blood deficiency distension, or qi deficiency dull pain. Etiology must be assessed. Pain associated with strangury requires separate discussion.

8. Hemorrhoids and Fistulas. Often caused by excessive alcohol and sex, leading to damp-heat filling organs and meridians, sinking to the anal region, forming hemorrhoids, which may become fistulas if chronic. The *Nei Jing* states: "Overeating causes vein dilation, leading to intestinal hemorrhoids." "Shaoyin recurrence causes hemorrhoids." "Du Mai disease causes strangury/hemorrhoids." Chao Yuanfang described Five Hemorrhoids: Mu (Male) hemorrhoid (rat-like protrusion with pus/blood); Nv (Female) hemorrhoid (swelling/ulceration with bleeding); Mai (Pulse) hemorrhoid (itching/pain/bleeding); Chang (Intestine) hemorrhoid (nodules/fever/bleeding); Xue (Blood) hemorrhoid (clear blood with stool). Jiu (Alcohol) hemorrhoid involves ulcers/bleeding. Qi hemorrhoid involves difficulty defecating and prolapse. Chronic hemorrhoids stem from qi-blood exhaustion becoming fistulas. Yellow discharge indicates damp-heat. Refer to Dong Yuan's formulas. Secret Moxibustion Method for Hemorrhoids/Fistulas: Calcined Alum (Zao Fan) 1 jin, placed on a new tile lined with mud to form a jar shape. Brush with sesame oil, bake dry, calcine alum to powder. Pangolin scales 1 qian, calcined in a purple pot to preserve nature, powdered. Mumiezi processed similarly, 2.5 qian. Frankincense and Myrrh 1.5 qian each, separately ground. Mix powders, bind with cold water into cakes, apply to lesion. Moxa 3-4 cones. Post-moxibustion fumigation/wash: Calcined alum approx. 2 handfuls, Rhizoma Anemarrhenae 1 liang, Rhizoma Belamcandae 1 liang, Green onion 7 stalks. Boil onions, pour into bottle, add decoction. Patient sits over bottle mouth to fumigate. When warm, wash half, save half for reheating later. Repeat until cured.

9. Rectal Prolapse. Common in chronic diarrhea, postpartum women, children, and the elderly. Postpartum strain, chronic diarrhea sinking qi-blood, underdeveloped qi-blood in children, and declining qi-blood in the elderly cause the anus to prolapse and lack constriction. The anus reflects the Large Intestine; Lung and Large Intestine are exterior-interior pairs. Lung heat causes obstruction; lung qi deficiency causes prolapse. Treatment depends on identifying the cause.