肾有两窍，一溺窍，一精窍。淋出溺窍，病在肝脾；浊出精窍，病在心肾；同门异路，分别宜详。《内
经》论淋，由于脾湿郁热，病源谓肾虚则小便数，膀胱热则水下涩，数而且涩则淋沥引
痛。凡小肠有气，则小便胀；小肠有血，则小便涩；小肠有热，则小便痛。症有五∶石淋、劳淋、血淋、气淋、
膏淋也。石淋系膀胱蓄热，溺则茎中急痛，频下沙石，如汤瓶久受煎熬，底结白碱也。宜清其积热，涤去沙石，
水道自利。神效琥珀散、如圣散。石淋初起，宜石膏、滑石、琥珀、木通，或加味葵子散。盖重则为石，轻则
为沙。二神散。劳淋有二，因思虑烦忧，负重远行，劳于脾者，补中汤加车前、泽泻。专因思虑者，归脾汤。
因强力入房，劳于肾者，生地黄丸加麦冬、五味子。老人精衰入房，溺涩腹胀，牵引谷道者，肾气丸。血淋热
甚搏血，失其常道，以心主血，与小肠为表里，血渗胞中，与溲俱下，须辨血瘀、血虚、血热、血冷。如小腹
坚，茎痛，脉沉弦而数者，为血瘀。鸡苏散，或四物汤加牛膝、丹皮、木通。脉虚弱者为血虚，六味丸加侧柏
叶、车前子、白芍、八珍汤，送益元散。如血色鲜红，脉数有力，心与小肠实热也。大厘清饮加生地、黄芩、
龙胆草。如血色黯淡，面枯白，尺脉沉迟者，肾与膀胱虚冷。肾气汤。血淋小肠热甚者，牛膝、山栀、生地、
犀角、藕节、车前子。血虚热者，生地三两，黄芩、阿胶各五钱，柏叶少许。血淋茎中痛，淡秋石宜之，或服
薏苡根汁，或日用黄茧丝煮汤服。气淋气化不及州都，胞中气胀，少腹满痛，溺有余沥，沉香散、瞿麦汤。
如气虚，八珍汤倍茯苓，加杜仲、牛膝。气虚下陷，补中汤。膏淋便有脂腻如膏，浮于漩面，此肾虚不能约制
脂液而下流也。海金沙散、鹿角霜丸、菟丝子丸、大沉香丸。膏淋溺不痛者，须固精，六味合聚精丸。有热
淋茎中痛者，导赤散加滑石、灯芯。茎不痛而痒者，八味丸去附子。溺艰涩如淋，不作痛，为虚，六味加鹿茸、
肉苁蓉。老人气虚成淋，补中益气汤。又有寒客下焦，水道不快，先寒战而后溲便，由冷气与正气争，则寒战
成淋，正气胜，则战解得便，是为冷淋。肾气丸、肉苁蓉丸。有过服金石，入房太甚，败精瘀隧而成淋者，海
金沙散。有湿痰渗注而成淋者，渗湿汤。有淋而小腹胀甚者，滑利通阳，韭白汁、小茴、桂枝、归尾、两头尖、
牛膝。妇人产后成诸淋者，白茅汤，不论石、膏淋皆治。以上淋症治法。此外有风寒湿客于胞中，气不能化，
胞满而水道不通，按之内痛
而涩者，为胞痹，肾着汤、肾沥汤。亦溺窍病也。至赤白浊，由心动于欲，肾伤于色，强忍不泄，败精流溢窍
端，时有秽物，如疮之脓，如眼之眵。淋沥不断，由精败而腐居多，亦有湿热流注而成者，须分便浊精浊。
浊在便者，色白如泔，乃湿热内蕴，由过食肥甘辛热炙爆所致。苓术二陈煎，或徙薪饮。浊在精者，相火妄动，
或逆精使然，至精溺并出。牛膝、赤苓、黄柏、远志、细生甘草。或血不及变精，乃为赤浊。远志丸、加味
清心饮。当分精瘀精滑，精瘀者先理其离宫腐浊，古方用虎杖散。继与补肾。六味丸。精滑者乃用固摄，秘元
煎、菟丝煎。浊久而滑，则任督脉必伤，须升固奇经。青囊斑龙丸，或鹿茸、龟甲、杞子、核桃、杜仲、补
骨脂、沙苑子、茯神。大法，夹寒者脉迟，萆 厘清饮、内补鹿茸丸。夹热者脉数，清心莲子饮、二苓清利饮。
湿痰流注者，苍术二陈汤，心经伏暑者，四苓散加香薷、麦冬、人参、石莲，或导赤散。小便如常，少顷澄浊
在底，或如米泔色者，萆 厘清饮。稠粘如胶，茎中涩痛者，肾气汤去桂、附。积想心动，烦扰伤精者，加味
清心饮、瑞莲丸。肾虚气下陷者，补中汤。以上浊症治法。此外有溺血症，其原由于肾虚。无比山药丸去巴戟、
苁蓉。加阿胶、丹皮、麦冬、赤芍。非如血淋因乎湿热，但以痛不痛为辨，痛为血淋，不痛为溺血也。有白淫
症，经言思想无穷，所愿不得，意淫于外，入房太甚，发为筋痿，及为白淫，宜降心火。半苓丸、清心莲子饮。
又精伤白浊，小便推出髓条，痛不可忍者，乃由房事失节。宜使出髓条方。凡此皆精窍病也。
〔诸淋〕皆肾虚膀胱生热，故小水涩而不利也。治法初起，宜清解结热，疏利水道，通用五淋散加藕汁。
不用补涩。淋而渴属上焦气分，宜淡渗轻药，如茯苓、通草、灯心、瞿麦、泽泻、琥珀、车前子之类。清肺气
以滋水之上源。淋而不渴，属下焦血分，宜味浓阴品，如知柏滋肾丸。滋肾阴以泄水之下流。如肺燥不能生水
者，生脉散加减。心火及小肠热者，导赤散。肺脾积热，移于膀胱者，黄芩清肺饮。肾水亏，小便赤涩者，
加减一阴煎。沙淋膀胱涩痛者，牛膝汤加秋石。劳淋脾肾不足者，朝用补中益气汤，夕用六味丸。血淋茎中热痛
者，淡秋石泡汤。溺涩不痛者，
一味琥珀末，薄荷、灯芯汤调服。气淋脐下妨闷，木香、沉香、枳壳、甘草梢、滑石、木通。膏淋乃精溺并出，
精塞溺隧，故小便涩痛。初用海金沙散、加茯苓。若不痛，须摄固其精，勿与通利。宜鹿角霜、菟丝子、莲须、
山药、芡实。后以六味丸，合聚精丸调补。冷淋寒客胞中，欲溺先发寒栗。肾气丸加鹿胶、沉香。热淋溺赤
如血而少，时烦渴者，导赤散。伏暑成淋，六一散。虚者，生脉散。因怒致淋，宜青皮、山栀、沉香、木通等。
因思虑成淋，归脾汤。暑月汗多津液不降，参泽汤。妊妇病淋，葵子汤。
〔赤白浊〕茎中热痛，如火灼刀割，溺浊或赤或白。赤伤血分，白伤气分也。赤浊有溺赤，有血赤，
其纯见鲜血，当从溺血条治。法见前论。若溺色黄赤，固多火症，然必赤而痛涩，兼见火脉，方可清利。若劳倦
伤中气，酒色伤肾阴，溺短欠而无痛涩等症，则系水亏液涸，不可清利，经所谓中气不足，溲溺为之变，但滋
补下元，气化则水自清。加减六味丸、鹿茸地黄丸。白浊有浊在溺者，白如泔浆，此湿热内生。有浊在精者，
由相火妄动。精离其位，不能闭藏，与溺并出，或移热膀胱，溺孔涩痛，皆白浊之因于热也。久之则有脾气下
陷，土不制湿，而水道不清者，有相火已杀，心肾不交，精滑不固，而遗浊不止者，皆白浊之因于虚也。热者当
辨心肾而清之，虚者常求脾肾而固之举之。
〔溺浊〕如泔，为胃中湿热下流。二陈汤加萆 、黄柏、泽泻、姜汁。精浊如膏，乃精溺并出，涩痛甚
者，先清火，抽薪饮。久则涩痛去，精浊未止，宜固摄，固阴煎、元菟丹。胃中湿热浊痰，下渗膀胱，为溺浊，
与肾无干。若牵腻如膏，心动即遗，或溺后遗出，皆精病，与浊无干。肥人多白浊，系湿痰，二术二陈汤。瘦人
多赤浊，系肝火，龙胆泻肝汤。心虚遗浊者，金锁玉关丸。脾虚下陷者，补中益气汤。心脾两虚者，菟丝煎。
虚寒带浊者，五味丸。淋沥湿浊者，威喜丸。浊久足膝痿弱，漩脚澄下如糊者，六味丸加萆 、麦冬。茎中
大痛，溺赤，脉滑数，宜清热利水，生地、麦冬、山栀、知母，加六一散。肾虚淫火易动，精滑粘腻如膏，
九龙丹收摄之。若忍精不泄而成白浊者，四苓散。丹方治白浊，杞子钱半，菟丝子、车前子、韭子各一钱，
莲子二十粒、
共入猪尿脬内煮，加葱酒啜汁，并食猪脬莲子，连服二三次效。赤浊者，猪苓汤，并加麝香、杜牛膝，以通瘀
腐之在隧窍者。有溺时结块，阻窍作痛，块中蓄水泡者，必醉酒使内，酒湿乘虚袭入精窍也。治同上。
肾脏有两个窍道，一个是排尿的溺窍，一个是排精的精窍。淋证是从溺窍排出，病位在肝和脾；浊证是从精窍排出，病位在心肾。两者虽然出口相同但路径不同，需要仔细分辨。《黄帝内经》论述淋证，认为是由于脾湿郁结化热所致。病因认为肾虚则小便频数，膀胱有热则尿液排泄涩滞，既频数又涩滞，就会淋漓不尽并牵引疼痛。凡是小肠有气，小便就会胀满；小肠有血，小便就会涩滞；小肠有热，小便就会疼痛。淋证的症状分为五种：石淋、劳淋、血淋、气淋、膏淋。
石淋是由于膀胱蓄积热邪，排尿时尿道急痛，频繁排出沙石，就像汤瓶长久受火煎熬，底部结成白色碱垢一样。应当清除积热，涤荡去除沙石，水道自然通利。可用神效琥珀散、如圣散。石淋初起，宜用石膏、滑石、琥珀、木通，或者加味葵子散。因为重者结成石头，轻者则为沙粒。可用二神散。
劳淋有两种情况：因思虑烦忧、负重远行，劳累于脾的，用补中汤加车前子、泽泻。专门因思虑过度的，用归脾汤。因强力房事，劳累于肾的，用生地黄丸加麦冬、五味子。老人精气衰败而行房事，出现小便涩滞、腹胀，牵引肛门不适的，用肾气丸。
血淋若热势严重迫血妄行，血液失去正常循行轨道，因为心主血脉，与小肠互为表里，血液渗入胞宫（此处指下焦血室），随小便一同排出，必须辨别是血瘀、血虚、血热还是血冷。如果小腹坚硬，尿道疼痛，脉象沉弦而数的，属于血瘀。可用鸡苏散，或四物汤加牛膝、牡丹皮、木通。脉象虚弱无力的属于血虚，可用六味丸加侧柏叶、车前子、白芍，或用八珍汤送服益元散。如果血色鲜红，脉象数而有力，属于心与小肠实热。可用大厘清饮加生地、黄芩、龙胆草。如果血色黯淡，面色枯白，尺脉沉迟的，属于肾与膀胱虚冷。可用肾气汤。血淋若小肠热势严重的，可用牛膝、山栀、生地、犀角、藕节、车前子。血虚而有热的，可用生地三两，黄芩、阿胶各五钱，少许柏叶。血淋尿道疼痛的，淡秋石适宜，或者服用薏苡根汁，或者每日用黄茧丝煮汤服用。
气淋是因为气化功能不及于州都之官（膀胱），胞中气机胀满，少腹满痛，小便淋漓不尽，可用沉香散、瞿麦汤。如果气虚，用八珍汤倍加茯苓，加杜仲、牛膝。气虚下陷的，用补中汤。
膏淋表现为小便中有脂腻物质像膏一样，漂浮在尿液表面，这是肾虚不能约束脂液而下流所致。可用海金沙散、鹿角霜丸、菟丝子丸、大沉香丸。膏淋若小便不痛的，必须固摄精气，可用六味丸合聚精丸。
热淋表现为尿道疼痛的，用导赤散加滑石、灯芯草。尿道不痛而发痒的，用八味丸去掉附子。小便艰涩像淋证但不疼痛的，属于虚证，用六味丸加鹿茸、肉苁蓉。老人因气虚而成淋证的，用补中益气汤。又有寒气客居下焦，水道不通畅，先出现寒战然后才排尿，这是由于冷气与正气相争，所以寒战形成淋证，正气胜则寒战解除得以排尿，这称为冷淋。可用肾气丸、肉苁蓉丸。有过服金石类药物，或房事过度，导致败精瘀阻尿道而成淋证的，用海金沙散。有湿痰渗注而成淋证的，用渗湿汤。有淋证且小腹胀痛严重的，宜滑利通阳，可用韭白汁、小茴香、桂枝、当归尾、两头尖、牛膝。妇人产后出现各种淋证的，用白茅汤，不论石淋、膏淋皆治。以上是淋证的治疗方法。
此外，有风寒湿邪客居胞中，气机不能化生，胞中胀满而水道不通，按压内部疼痛且涩滞的，称为胞痹，可用肾着汤、肾沥汤。这也是溺窍的疾病。至于赤白浊，是由于心动于欲念，肾伤于色欲，强行忍耐不射精，败精流溢到窍端，时常有秽物排出，像疮疡的脓液，像眼睛的眼屎。淋沥不断，大多是由精败腐败所致，也有湿热流注而成的，必须区分便浊和精浊。
浊在粪便中的，颜色白像米泔水，这是湿热内蕴，由过食肥甘厚味、辛辣炙烤食物所致。可用苓术二陈煎，或徙薪饮。浊在精液中的，是相火妄动，或者是逆乱精液所致，导致精液和小便同时排出。可用牛膝、赤茯苓、黄柏、远志、细生甘草。或者是血液未能转化为精液，从而成为赤浊。可用远志丸、加味清心饮。应当区分精瘀和精滑。精瘀者，先调理离宫（心包）的腐浊，古方用虎杖散。随后再补肾，用六味丸。精滑者，再用固摄法，用秘元煎、菟丝煎。浊证日久且滑泄，任督二脉必然受损，须升提固摄奇经。可用青囊斑龙丸，或者鹿茸、龟甲、枸杞子、核桃、杜仲、补骨脂、沙苑子、茯神。大法则是：夹寒的脉象迟，用萆薢分清饮、内补鹿茸丸。夹热的脉象数，用清心莲子饮、二苓清利饮。湿痰流注的，用苍术二陈汤。心经伏暑的，用四苓散加香薷、麦冬、人参、石莲子，或者导赤散。小便外观正常，片刻后沉淀浑浊在底部，或者像米泔水颜色的，用萆薢分清饮。稠粘像胶冻，尿道涩痛的，用肾气汤去掉桂枝、附子。积想心动，烦扰损伤精气的，用加味清心饮、瑞莲丸。肾虚气机下陷的，用补中汤。以上是浊证的治疗方法。
此外还有溺血症，其根源在于肾虚。可用无比山药丸去掉巴戟天、肉苁蓉，加阿胶、牡丹皮、麦冬、赤芍。不像血淋是由于湿热，仅以疼痛与否来辨别，疼痛的是血淋，不疼痛的是溺血。
还有白淫症，经文说思想无穷，愿望不得满足，意念淫逸于外，房事过度，发展为筋痿，以及白淫，宜降心火。可用半苓丸、清心莲子饮。又有精伤导致的白浊，小便推出髓条，疼痛不可忍受的，这是由于房事失节。宜使用使出髓条方。凡此种种都是精窍的疾病。
【诸淋】都是因为肾虚膀胱生热，所以小便涩滞而不通利。治疗方法初起时，宜清解结热，疏利水道，通用五淋散加藕汁。不要用补益收敛的药物。淋证伴口渴的，属上焦气分，宜用淡渗轻药，如茯苓、通草、灯心草、瞿麦、泽泻、琥珀、车前子之类。清肺气以滋补水之上源。淋证不口渴的，属下焦血分，宜用味道浓厚阴柔之品，如知柏滋肾丸。滋肾阴以泄去水之下流。如果肺燥不能生水，用生脉散加减。心火及小肠热的，用导赤散。肺脾积热，移热于膀胱的，用黄芩清肺饮。肾水亏虚，小便赤涩的，用加减一阴煎。沙淋膀胱涩痛的，用牛膝汤加秋石。劳淋脾肾不足的，早晨用补中益气汤，晚上用六味丸。血淋尿道热痛的，用淡秋石泡汤。小便涩滞不痛的，一味琥珀末，用薄荷、灯心草汤调服。气淋脐下妨闷的，用木香、沉香、枳壳、甘草梢、滑石、木通。膏淋是精液和小便同时排出，精液堵塞溺道，所以小便涩痛。初起用海金沙散加茯苓。如果不痛，必须摄固精气，不要给予通利药物。宜用鹿角霜、菟丝子、莲须、山药、芡实。后用六味丸，合聚精丸调补。冷淋寒气客居胞中，想要排尿前先出现寒战发抖。用肾气丸加鹿角胶、沉香。热淋小便赤红像血且量少，时常烦躁口渴的，用导赤散。伏暑成淋的，用六一散。虚证的，用生脉散。因愤怒导致淋证的，宜用青皮、山栀、沉香、木通等。因思虑成淋的，用归脾汤。暑月汗多津液不降的，用参泽汤。孕妇患淋证的，用葵子汤。
【赤白浊】尿道热痛，如火灼刀割，小便浑浊或赤或白。赤色损伤血分，白色损伤气分。赤浊有小便赤，有血液赤，如果是纯见鲜血，应当从溺血条治疗。方法见前文论述。如果尿色黄赤，固然多是火证，但必须赤且痛涩，兼见火脉，才可以清利。如果劳倦损伤中气，酒色损伤肾阴，小便短少欠通畅但没有痛涩等症状，则是水亏液涸，不可清利，经书所谓中气不足，小便为之改变，只需滋补下元，气化则水自清。可用加减六味丸、鹿茸地黄丸。
白浊有浊在溺中的，白像米浆，这是湿热内生。有浊在精中的，由相火妄动引起。精液离开其位，不能闭藏，与小便一起排出，或者移热膀胱，尿道涩痛，这都是白浊因于热的原因。久而久之则有脾气下陷，土不制湿，而水道不清的；有相火已灭，心肾不交，精滑不固，而遗浊不止的，这都是白浊因于虚的原因。热者应当辨别心肾而清之，虚者常求之于脾肾而固举之。
【溺浊】像米泔水，是胃中湿热下流。可用二陈汤加萆薢、黄柏、泽泻、姜汁。精浊像膏脂，是精溺并出，涩痛严重的，先清火，用抽薪饮。久则涩痛去除，精浊未止，宜固摄，用固阴煎、元菟丹。胃中湿热浊痰，下渗膀胱，成为溺浊，与肾无关。如果牵拉腻浊像膏脂，心动即遗精，或者排尿后遗出，都是精的病，与浊无关。肥人多白浊，系湿痰，用二术二陈汤。瘦人多赤浊，系肝火，用龙胆泻肝汤。心虚遗浊的，用金锁玉关丸。脾虚下陷的，用补中益气汤。心脾两虚的，用菟丝煎。虚寒带浊的，用五味丸。淋沥湿浊的，用威喜丸。浊久足膝痿弱，洗脚水澄清后下沉如糊状的，用六味丸加萆薢、麦冬。尿道大痛，小便赤，脉滑数，宜清热利水，用地黄、麦冬、山栀、知母，加六一散。肾虚淫火易动，精滑粘腻像膏脂的，用九龙丹收摄。如果忍精不泄而成白浊的，用四苓散。丹方治疗白浊，用枸杞子半钱，菟丝子、车前子、韭子各一钱，莲子二十粒，共放入猪尿脬内煮，加葱酒喝汁，并吃猪脬莲子，连服二三次有效。赤浊者，用猪苓汤，并加麝香、杜牛膝，以通瘀腐在隧窍者。有排尿时结块，阻塞窍道作痛，块中蓄积水泡的，必定是醉酒行房，酒湿乘虚袭入精窍所致。治疗方法同上。
The kidneys have two orifices: one is the urinary orifice (niao qiao), and the other is the seminal orifice (jing qiao). Lin syndrome (strangury) discharges from the urinary orifice, with pathology in the Liver and Spleen; Zhuo syndrome (turbid discharge) discharges from the seminal orifice, with pathology in the Heart and Kidney. Although they share a common exit, their paths differ, requiring detailed differentiation. The *Neijing* discusses Lin syndrome as caused by Dampness stagnating in the Spleen transforming into Heat. The etiology states that Kidney Deficiency leads to frequent urination, while Bladder Heat causes difficult and scanty urination; when both frequency and difficulty coexist, it results in dribbling pain. Generally, Qi stagnation in the Small Intestine causes urinary distension; Blood stasis in the Small Intestine causes urinary obstruction; Heat in the Small Intestine causes urinary pain. There are five types of Lin syndrome: Shi Lin (Stone Strangury), Lao Lin (Fatigue Strangury), Xue Lin (Blood Strangury), Qi Lin (Qi Strangury), and Gao Lin (Gelatinous Strangury).
Shi Lin is caused by Heat accumulation in the Bladder. During urination, there is urgent pain in the penis, and sand-like stones are frequently passed, resembling white alkali deposits forming at the bottom of a pot subjected to long-term boiling. Treatment should clear accumulated Heat and wash away the stones, allowing the water passages to flow freely. Shenxiao Hupo San (Miraculous Amber Powder) or Rusheng San may be used. In the early stage of Shi Lin, Shigao (Gypsum Fibrosum), Huashi (Talcum), Hupo (Succinum), Mutong (Akebiae Caulis) are indicated, or Jiawei Kuizi San. Heavy cases form stones, while mild cases form sand.ershensan may be used.
Lao Lin has two subtypes: One results from excessive worry, burden-carrying, and long-distance travel, exhausting the Spleen; treat with Buzhong Tang (Tonify the Middle Decoction) plus Cheqianzi (Plantaginis Semen) and Zexie (Alismatis Rhizoma). If caused solely by mental overwork, use Guipi Tang (Restore the Spleen Decoction). The other results from strenuous sexual activity, exhausting the Kidney; treat with Shengdi Huang Wan (Rehmannia Pill) plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus). For elderly patients with depleted Essence engaging in sex, presenting with difficult urination, abdominal distension, and traction pain in the anus, use Shenqi Wan (Kidney Qi Pill).
Xue Lin occurs when severe Heat forces blood out of its normal channels. Since the Heart governs Blood and is exterior-interior related to the Small Intestine, blood may seep into the lower jiao and pass with urine. Differentiation must distinguish between Blood Stasis, Blood Deficiency, Blood Heat, and Blood Cold. If the lower abdomen is hard, penile pain exists, and the pulse is deep, wiry, and rapid, it indicates Blood Stasis. Jisu San or Siwu Tang (Four Substances Decoction) plus Niuxi (Achyranthis Bidentatae Radix), Mudanpi (Moutan Cortex), and Mutong are indicated. If the pulse is weak and deficient, it indicates Blood Deficiency; Liuwei Wan (Six-Ingredient Pill) plus Cebaiye (Platycladi Cacumen), Cheqianzi, Baishao (Paeoniae Radix Alba), or Bazhen Tang (Eight-Treasure Decoction) sending Yiyuan San is indicated. If the blood color is bright red and the pulse is rapid and forceful, it indicates Excess Heat in the Heart and Small Intestine; Da Li Qing Yin is indicated plus Shengdi Huang, Huangqin (Scutellariae Radix), and Longdancao (Gentianae Radix). If the blood color is dull, the face is sallow and pale, and the Chi pulse is deep and slow, it indicates Deficiency-Cold of the Kidney and Bladder; Shenqi Tang is indicated. For severe Small Intestine Heat in Xue Lin, Niuxi, Zhizi (Gardeniae Fructus), Shengdi Huang, Xijiao (Rhinocerotis Cornu - note: substitute with Buffalo Horn in modern practice), Ou jie (Nelumbinis Node), and Cheqianzi are used. For Blood Deficiency with Heat, use 3 liang of Shengdi Huang, 5 qian each of Huangqin and Ejiao (Colla Corii Asini), and a small amount of Cebaiye. For penile pain in Xue Lin, Dan Qiushi (Natrii Uras) is suitable, or Yi yi gen juice, or daily decoction of Huang Jian si (Yellow Cocoon Silk).
Qi Lin arises when Qi transformation fails to reach the Zhou Du (Bladder), causing Qi distension in the Bao Zhong (uterus/lower abdomen), fullness and pain in the lower abdomen, and residual dribbling after urination. Chenxiang San or Qumai Tang are indicated. If Qi Deficient, use Bazhen Tang with doubled Fuling (Poria) plus Duzhong (Eucommiae Cortex) and Niuxi. If Qi sinks, use Buzhong Tang.
Gao Lin presents with greasy, gelatinous material floating on the urine surface. This is due to Kidney Deficiency failing to constrain lipid fluids, which then flow downward. Haijinsha San, Lujiaoshuang Wan (Deer Antler Frost Pill), Tiansizi Wan, or Dachenchang Wan are indicated. If Gao Lin involves no pain during urination, Essence must be secured; Liuwei Wan combined with Ju Jing Wan is used.
For Re Lin with penile pain, Daochi San plus Huashi and Dengxincao (Junci Medulla) is used. If there is itching but no pain, Bawei Wan minus Fuzi (Aconiti Lateralis Radix Preparata) is used. If urination is difficult and obstructed like strangury but without pain, it is Deficiency; Liuwei Wan plus Lurong (Deer Antler) and Rongrong (Cistanche) is used. For elderly patients with Qi Deficiency leading to strangury, Buzhong Yiqi Tang is used. Additionally, Cold pathogen lodging in the Lower Jiao obstructs water passages, causing chills before urination. This is Cold Lin, where Cold Qi contends with Healthy Qi; when Healthy Qi prevails, chills cease and urination occurs. Shenqi Wan or Rongrong Wan is used. For Lin caused by excessive ingestion of mineral drugs or excessive sexual activity leading to stale Essence blocking the urethra, Haijinsha San is used. For Lin caused by Damp-Phlegm infiltration, Shen Shi Tang is used. For Lin with severe lower abdominal distension, promote sliding and Yang transmission using Jiubai zhi (Garlic Juice), Xiaohui (Foeniculum Fructus), Guizhi (Cinnamomi Ramulus), Guiwei (Angelicae Sinensis Radix), Liangtoujian (Chuanxiong Rhizoma), and Niuxi. For postpartum women developing various Lins, Baimao Tang is used, effective for both Shi Lin and Gao Lin. These are the treatments for Lin syndromes.
Furthermore, if Wind-Cold-Dampness lodges in the Bao Zhong, preventing Qi transformation, causing bladder fullness and blocked water passages with internal pain and obstruction upon pressure, it is called Bao Bi (Bladder Bi). Shenzhe Tang or Shenli Tang are used. This is also a disease of the urinary orifice.
Regarding Chi Bai Zhuo (Red and White Turbidity), it arises from Heart desires moving and Kidney injury from lust. Forcing retention of ejaculation causes stale Essence to overflow the orifice, producing foul matter resembling pus or eye discharge. Continuous dribbling is mostly due to rotting of spoiled Essence, though Damp-Heat infiltration can also cause it. One must distinguish between Bian Zhuo (Turbidity in Urine) and Jing Zhuo (Turbidity in Essence).
Bian Zhuo appears white like rice water, caused by internal Damp-Heat from overconsumption of rich, sweet, spicy, and fried foods. Lingzhu Erchen Jian or Xixin Yin may be used. Jing Zhuo results from reckless movement of Minister Fire or reversed Essence flow, causing simultaneous emission of Essence and urine. Niuxi, Chifuling (Poria with Red Core), Huangbai (Phellodendri Cortex), Yuanzhi (Polygalae Radix), and Gancao (Licorice Root) are used. If Blood fails to transform into Essence, it becomes Chi Zhuo (Red Turbidity). Yuanzhi Wan or Jiawei Qingxin Yin is used. Differentiate between Jing Yu (Essence Stasis) and Jing Hua (Essence Slippage). For Jing Yu, first resolve corruption in the Li Gong (Pericardium/Heart Palace); ancient formulas use Huzhang San. Then tonify the Kidney with Liuwei Wan. For Jing Hua, use securing methods like Miyuan Jian or Tiansi Jian. Chronic turbidity with slippage damages the Ren and Du meridians, requiring lifting and securing of the Extraordinary Vessels. Qinglang Banlong Wan, or Lu Rong, Guijia (Testudinis Carapax et Plastrum), Gouqi (Lycii Fructus), Hetao (Juglandis Semen), Duzhong, Buguzhi (Psoraleae Fructus), Shayuanzi (Astragali Complanati Semen), and Fushen (Poria with Pine Root) are used. General principles: If accompanied by Cold, the pulse is slow; use Bixie Fenqing Yin or Neibu Lurong Wan. If accompanied by Heat, the pulse is rapid; use Qingxin Lianzi Yin or Er Ling Qingli Yin. For Damp-Phlegm infiltration, Cangzhu Erchen Tang is used. For latent Summerheat in the Heart Meridian, Siling San plus Xiangru (Elsholtziae Herba), Maidong, Renshen (Ginseng Radix), and Shilian (Nelumbinis Nucis Plumula) or Daochi San is used. If urine looks normal initially but sediment settles at the bottom like rice water, use Bixie Fenqing Yin. If thick and sticky like glue with penile obstruction and pain, use Shenqi Tang minus Guizhi and Fuzi. For mental agitation injuring Essence, use Jiawei Qingxin Yin or Ruilian Wan. For Kidney Deficiency with sinking Qi, use Buzhong Tang. These are treatments for Zhuo syndromes.
Additionally, Niaoxue (Hematuria) originates from Kidney Deficiency. Wubi Shanyao Wan minus Bajitian (Morindae Officinalis Radix) and Rongrong, plus Ejiao, Mudanpi, Maidong, and Chishao (Paeoniae Radix Rubra) is used. Unlike Xue Lin caused by Damp-Heat, this is distinguished by pain: painful is Xue Lin, painless is Niaoxue.
There is also Baiyin (White Emission) syndrome. The classics state that endless thoughts and unfulfilled desires lead to external licentiousness and excessive intercourse, resulting in Jin Wei (Sinew Flaccidity) and Baiyin. Treatment should descend Heart Fire. Banling Wan or Qingxin Lianzi Yin is used. Another condition is Jing Shang Bai Zhuo, where semen strips are expelled during urination with unbearable pain, caused by irregular sexual habits. Use Fang Chu Shi Sui Tiao. All these are diseases of the seminal orifice.
[All Lins] are caused by Kidney Deficiency and Bladder Heat, leading to difficult and obstructed urination. Early treatment should clear constrained Heat and unblock water passages. Wulin San plus Lotus Juice is generally used. Avoid tonifying and astringing. Lin with thirst belongs to Upper Jiao Qi level; use light diuretics like Fuling, Tongcao (Tetrapanacis Medulla), Dengxincao, Qumai (Dianthi Herba), Zexie, Hupo, Cheqianzi. Clear Lung Qi to nourish the source of Water above. Lin without thirst belongs to Lower Jiao Blood level; use rich, yin-nourishing agents like Zhibai Zishen Wan. Nourish Kidney Yin to drain water below. If Lung Dryness fails to generate Water, use Shengmai San modified. For Heart Fire and Small Intestine Heat, use Daochi San. For Lung-Spleen Heat transferring to the Bladder, use Huangqin Qingfei Yin. For Kidney Water Deficiency with red, difficult urination, use Jianyi Yinyian Jian. For Sha Lin (Sand Strangury) with Bladder obstruction and pain, Niuxi Tang plus Qiushi is used. For Lao Lin with Spleen-Kidney insufficiency, use Buzhong Yiqi Tang in the morning and Liuwei Wan in the evening. For Xue Lin with hot pain in the penis, soak Dan Qiushi in water. For difficult but painless urination, take pure Hupo powder mixed with Bohe (Menthae Haplocalycis Herba) and Dengxincao decoction. For Qi Lin with umbilical oppression, use Muxiang (Aucklandiae Radix), Chenxiang (Aquilariae Lignum), Zhike (Aurantii Fructus), Gancao Shao (Licorice Root Tip), Huashi, and Mutong. Gao Lin involves simultaneous emission of Essence and urine, with Essence blocking the urinary passage, causing difficult and painful urination. Initially use Haijinsha San plus Fuling. If painless, secure Essence; do not use draining herbs. Use Lujiaoshuang, Tiansizi, Lianxu (Nelumbinis Stamen), Shanyao (Dioscoreae Rhizoma), and Qianshi (Euryales Semen). Later, tonify with Liuwei Wan combined with Ju Jing Wan. For Cold Lin with Cold lodging in the Bao Zhong, chills precede urination. Use Shenqi Wan plus Lujiao Jiao (Colla Corii Asini) and Chenxiang. For Re Lin with red, scanty urine resembling blood and frequent thirst/restlessness, use Daochi San. For Summerheat-induced Lin, use Liuyi San. For Deficiency, use Shengmai San. For Lin caused by anger, use Qingpi (Citri Reticulatae Pericarpium Viride), Zhizi, Chenxiang, and Mutong. For Lin caused by worry, use Guipi Tang. For excessive sweating in summer depleting fluids, use Shenze Tang. For pregnant women with Lin, use Kuizi Tang.
[Chi Bai Zhuo] Penile heat and pain feel like burning or cutting. Urine is turbid, red or white. Red injures the Blood level; White injures the Qi level. Chi Zhuo includes red urine and bloody urine. Pure fresh blood should be treated according to the Niaoxue section. If urine is yellow-red, it is usually a Fire syndrome, but only clear and drain if accompanied by pain, obstruction, and Fire pulses. If fatigue damages Middle Qi, or wine/lust damages Kidney Yin, causing short urine without pain/obstruction, it is Water Deficiency and fluid exhaustion. Do not clear/drain; instead, tonify the Lower Yuan. When Qi transforms, water clears naturally. Jiawei Liuwei Wan or Lurong Dihuang Wan is used.
Bai Zhuo includes turbidity in urine (white like rice milk, caused by internal Damp-Heat) and turbidity in essence (caused by reckless Minister Fire). Essence leaves its position, cannot be stored, and exits with urine, or transfers Heat to the Bladder causing penile obstruction/pain. These are Heat causes of Bai Zhuo. Long-term cases involve Spleen Qi sinking failing to control Dampness, or extinguished Minister Fire with Heart-Kidney non-interaction causing Essence slippage and continuous turbid discharge. These are Deficiency causes of Bai Zhuo. Heat types require clearing based on Heart/Kidney differentiation; Deficiency types require securing and lifting based on Spleen/Kidney differentiation.
[Niao Zhuo] Resembles rice milk, caused by Stomach Damp-Heat flowing downward. Erchen Tang plus Bixie, Huangbai, Zexie, and Jiangzhi (Ginger Juice) is used. [Jing Zhuo] resembles paste, with simultaneous Essence/urine emission. Severe obstruction/pain requires initial Fire clearing with Chouxin Yin. If obstruction/pain resolves but turbidity persists, use securing methods: Guyin Jian or Yuantuan Dan. Stomach Damp-Heat/Phlegm infiltrating the Bladder causes Niao Zhuo, unrelated to the Kidney. If viscous like paste, emitted upon mental arousal or after urination, it is an Essence disorder, not Turbidity. Obese people often have Bai Zhuo due to Damp-Phlegm; Erzhu Erchen Tang is used. Thin people often have Chi Zhuo due to Liver Fire; Longdan Xiegan Tang is used. Heart Deficiency with turbid emission uses Jin suo Yuguan Wan. Spleen Deficiency with sinking Qi uses Buzhong Yiqi Tang. Heart-Spleen Dual Deficiency uses Tiansi Jian. Deficiency-Cold with turbid discharge uses Wuwei Wan. Dribbling Damp-Turbidity uses Weixi Wan. Chronic turbidity with weak legs/knees and muddy leg-washing water uses Liuwei Wan plus Bixie and Maidong. Severe penile pain, red urine, slippery-rapid pulse indicates need for Heat-clearing and Diuresis: Shengdi Huang, Maidong, Zhizi, Zhimu, plus Liuyi San. Kidney Deficiency with easy-moving Lust Fire and sticky, pasty Essence slippage uses Jiulong Dan to secure. Retained Essence causing Bai Zhuo uses Siling San. A folk prescription for Bai Zhuo: 0.5 qian Gouqi, 1 qian each of Tiansizi, Cheqianzi, Jiu Zi (Allii Tuberosi Fructus), and 20 lotus seeds, boiled inside a pig bladder. Drink the broth with green onion and wine, and eat the bladder and seeds. Effective after 2-3 doses. For Chi Zhuo, Zhuling Tang plus She Xiang (Moschus) and Duniu Xi (Cyathulae Radix) is used to unblock瘀腐 (stagnant corruption) in the orifices. If clumps form during urination, blocking the orifice with pain and water blisters inside the clump, it is caused by alcohol dampness invading the seminal orifice after drunken intercourse. Treatment is the same as above.