老埠头寿 泻犹未除，左脉虚细，右濡，小便不禁。姑宜厘清养阴。
生地（三钱） 川萆 （三钱） 淡秋石（八分） 潼蒺藜（三钱） 怀山药（三钱） 车前子（
三钱）
茯苓（四钱） 生米仁（四钱） 泽泻（三钱） 桑螵蛸（钱半） 石莲子（三钱） （引）陈淘米泔
水（并煎）
介按∶经曰∶下虚则遗尿。又曰∶膀胱不约为遗尿。今以膀胱失约，无气以固，而致小
便不
禁。又因脾气未健，湿热未净，而泻犹未除，故治法于渗湿扶脾之中，参用缩小便之味。
大义汪 湿热阻气，舌白浓，脘格，潮热，小便涩痛，便结。宜清利。（九月十七日。）
瞿麦（三钱） 焦栀子（三钱） 海金沙（四钱） 蕤仁（钱半） 车前（三钱） 淡芩（钱半）
木通
（钱半） 泽泻（三钱） 生牡蛎（四钱） 滑石（四钱） 川萆 （三钱） 两头尖（七十粒，包）
三帖。
介按∶丹溪谓五淋症，湿热阻窍居多，今兼气闭而小便涩痛，治以渗湿清热，固属佳妙
。此
方从八正散加减，合牡蛎泽泻以通调水道，下输膀胱。且其便结系是腑气不用，故用两头尖
以导浊。
东浦陈 湿热下注，溲溺赤流，脉濡右弦，舌滑跗肿。姑宜厘清养阴为主。
川萆 （三钱） 生地（四钱） 绵茵陈（三钱） 川柏（钱半，盐水炒） 泽泻（三钱） 怀药
（三钱） 生米仁（四钱） 通草（钱半） 车前（三钱） 丹皮（三钱） 草（三钱）
清煎四帖。
介按∶膀胱者，州都之官，津液藏焉，气化则能出也。兹因肾阴气逆于少腹，阻遏膀胱
之气化，以致小便短赤，足跗浮肿，故此方既利膀胱之湿，复滋肾脏之液。
渔庄沈 身热已退，脉弱，舌滑，小溲仍属淋漓。宜清利太阳。（八月初三日。）
西琥珀（八分） 银花（钱半） 木通（钱半） 海金沙（四钱） 车前（三钱） 六一散（三钱）
焦
栀子（三钱） 石苇（二钱） 青木香（八分） 瞿麦（三钱） 省头草（三钱） 陈淘米泔水（并煎）
三帖。
介按∶湿热下注成淋，清利之法极是。
安昌茹 湿热下注，小便涩痛带血，脉濡，肢冷背寒，舌黄。宜厘清利湿为主。（二月
十八日。）
川萆 （三钱） 西琥珀（八分冲） 蒲黄（钱半） 赤苓（四钱） 泽泻（二钱） 炒车前（三
钱） 当归（三钱） 木通（钱半） 海金沙（四钱） 血余炭（一钱） 粉丹皮（钱半）
清煎四帖。
又 湿热未清，溺后仍属有血，惟涩痛较差，脉濡，舌滑，借四物汤加减治之。（四月
九号癸卯二十三日。）
生地（四钱） 蒲黄（钱半） 生甘梢（八分） 焦栀子（三钱） 当归（钱半） 血余炭（一钱）
泽泻（三钱） 瞿麦（钱半） 丹皮（三钱） 炒车前（三钱） 木通（钱半）
清煎四帖。
又 尿血遇劳即发，脉濡细，舌黄滑，湿热蕴蓄。姑宜凉血、清热、分利。（五月十五
号甲辰二十九日。）
生地（四钱） 血余炭（一钱） 川萆 （三钱） 淡竹叶（钱半） 丹皮（三钱） 茯苓（四钱）
银花（钱半） 木通（钱半） 焦栀子（三钱） 泽泻（三钱） 生米仁（四钱）
清煎四帖。
又 尿血屡发屡瘥，脉涩数，肺气窒痹，胸次痰阻。姑宜瓜蒌薤白汤主之。（元月初八
日。）
栝蒌皮（三钱） 光杏仁（三钱） 炒蒲黄（钱半） 白薇（三钱） 薤白（一钱） 广郁金（三
钱） 血余炭（一钱） 儿茶（一钱） 焦栀子（三钱） 丹皮（二钱） 通草（钱半）
清煎三帖。
介按∶阴亏而湿热下坠，致尿管阻痹而为血淋，初方宗厘清饮意，再加琥珀、赤苓。以
通血
利窍，是通则不痛，痛随利缓之义，故能涩痛较差，次方虽是四物汤加减，适与钱氏导赤之
意相符，以清小肠火腑之热，乃是滋阴凉血之方。但其阴未固摄，湿未退净，以致过劳即发
。且湿热蕴蓄不解，屡次化热劫液，又进清热渗湿，兼以凉血之剂，而血余炭尤擅一方之长
，在愚见尚堪兼用陈棕灰，则更为特效。至第四诊，湿化痰涎，阻痹肺气，又用栝蒌薤白汤
以除胸次之痰。此等方案，洵堪作为后学之师范。
茅蓬陈 湿火下注，茎肿作痛已溃，脉弦濡，舌白浓。宜龙胆泻肝汤治之。（四月十七
日。）
龙胆炭（七分） 银花（三钱） 泽泻（三钱） 绵茵陈（三钱） 当归（钱半） 生甘梢（七分）
条芩（钱半） 生米仁（四钱） 炒车前（三钱） 赤茯苓（四钱） 海金沙（四钱）
清煎四帖。
介按∶湿热下注前阴，用龙胆泻肝汤以清肝胆之湿热，但恐过于渗利，耗伤津液，故佐
当归以养肝。
长巷沈 浊流未除，小便仍属涩痛，脉濡，气口滑，舌根黄，咳逆，仍遵前法加减为妥
。（元月二十九日）
瞿麦（三钱） 栝蒌仁（三钱） 西琥珀（八分） 川萆 （三钱） 车前（三钱） 木通（钱半）
丹
皮（二钱） 光杏仁（三钱） 甘草梢（八分） 海金沙（四钱） 血余炭（一钱） （引）陈淘米泔水
（并煎）
四帖。
介按∶肺主气化，今被湿热阻滞，以致浊流未止，故治以清肺渗湿，通血利窍为主。
东关金 心肾不交，阴分尚亏，脉细数，手心热，精竭形怯，小溲乍赤。宜养阴清热为
主。（七月一号五月十七日。）
细生地（三钱） 钗斛（三钱） 夜交藤（三钱） 川 （三钱） 川柏（一钱，盐水炒） 茯神
（四钱） 远志肉（八分） 生甘梢（八分） 淡秋石（八分冲） 地骨皮（三钱） 生米仁（四钱）
清煎四帖。
复诊 养阴清热，精浊较差，脉尚细数，耳鸣，寝寐恍惚，仍遵前法加减为主。（五月
二十四日。）
细生地（四钱） 钗斛（三钱） 川萆 （三钱） 茯神（四钱） 怀山药（三钱） 炒远志（八
分）
泽泻（三钱） 生米仁（四钱） 淡秋石（八分，冲） 骨碎补（三钱） 夜交藤（三钱） 鲜带心莲
子（七粒）
八帖。
介按∶此系心神常动，肾精暗泄，以致有形败浊，阻于隧道，随尿而出。前后两方，均
是安神宁心，养阴通浊之品，洵属对症之药。
【老埠头寿案】腹泻症状尚未消除，左侧脉象虚细，右侧脉象濡软，出现小便失禁的情况。暂且适宜采用厘清饮加减以养阴利湿。
处方：生地黄（三钱）、川萆薢（三钱）、淡秋石（八分）、潼蒺藜（三钱）、怀山药（三钱）、车前子（三钱）、茯苓（四钱）、生薏苡仁（四钱）、泽泻（三钱）、桑螵蛸（一钱半）、石莲子（三钱）。（药引）陈年淘米水（与药物同煎）。
邵介按语：《内经》说：“下元虚损则导致遗尿。”又说：“膀胱约束无力则导致遗尿。”如今因膀胱失去约束功能，元气不足无法固摄，从而导致小便不禁。又因为脾气尚未健运，湿热之邪未完全清除，所以腹泻仍未停止。因此治疗方法在渗湿健脾的基础上，参入缩小便的药物。
【大义汪案】湿热阻滞气机，舌苔白厚腻，胃脘部痞塞不通，午后潮热，小便涩滞疼痛，大便干结。适宜采用清热利湿法。（九月十七日诊）
处方：瞿麦（三钱）、焦栀子（三钱）、海金沙（四钱）、蕤仁（一钱半）、车前子（三钱）、淡黄芩（一钱半）、木通（一钱半）、泽泻（三钱）、生牡蛎（四钱）、滑石（四钱）、川萆薢（三钱）、两头尖（七十粒，包煎）。共三帖。
邵介按语：朱丹溪认为五淋病症中，多由湿热阻塞窍道所致，如今兼有气机闭塞而小便涩痛，治疗采用渗湿清热之法，确实非常精妙。此方从八正散加减而来，配合牡蛎、泽泻以通调水道，使水液下输膀胱。而且患者的大便干结是由于腑气不通所致，故使用两头尖以引导浊邪排出。
【东浦陈案】湿热下注，尿液赤红流淌，右侧脉象濡而弦，舌苔滑润，足背浮肿。暂且适宜以厘清饮加减为主，侧重养阴。
处方：川萆薢（三钱）、生地黄（四钱）、绵茵陈（三钱）、川黄柏（一钱半，盐水炒）、泽泻（三钱）、怀山药（三钱）、生薏苡仁（四钱）、通草（一钱半）、车前子（三钱）、牡丹皮（三钱）、草薢（三钱）。清水煎服，四帖。
邵介按语：膀胱是州都之官，津液藏存其中，依靠气化作用才能排出。如今因肾阴之气逆乱于少腹，阻遏了膀胱的气化功能，导致小便短少赤黄，足背浮肿。因此此方既通利膀胱的湿气，又滋养肾脏的阴液。
【渔庄沈案】身体发热已经退去，脉象虚弱，舌苔滑润，小便仍然淋漓不尽。适宜清利太阳经湿热。（八月初三日诊）
处方：西琥珀（八分）、金银花（一钱半）、木通（一钱半）、海金沙（四钱）、车前子（三钱）、六一散（三钱）、焦栀子（三钱）、石韦（二钱）、青木香（八分）、瞿麦（三钱）、省头草（三钱）、陈年淘米水（与药物同煎）。共三帖。
【安昌茹案】湿热下注，小便涩痛并带血，脉象濡软，四肢发冷，背部怕寒，舌苔黄。适宜以厘清饮加减为主，侧重利湿。（二月十八日诊）
处方：川萆薢（三钱）、西琥珀（八分，冲服）、蒲黄（一钱半）、赤茯苓（四钱）、泽泻（二钱）、炒车前子（三钱）、当归（三钱）、木通（一钱半）、海金沙（四钱）、血余炭（一钱）、粉牡丹皮（一钱半）。清水煎服，四帖。
复诊：湿热尚未清除，排尿后仍有出血，但涩痛程度减轻，脉象濡软，舌苔滑润，借用四物汤加减进行治疗。（四月九日，农历癸卯年二十三日）
处方：生地黄（四钱）、蒲黄（一钱半）、生甘草梢（八分）、焦栀子（三钱）、当归（一钱半）、血余炭（一钱）、泽泻（三钱）、瞿麦（一钱半）、牡丹皮（三钱）、炒车前子（三钱）、木通（一钱半）。清水煎服，四帖。
再诊：尿血遇劳累即发作，脉象濡细，舌苔黄滑，湿热蕴结蓄积。暂且适宜凉血、清热、分利小便。（五月十五日，农历甲辰年二十九日）
处方：生地黄（四钱）、血余炭（一钱）、川萆薢（三钱）、淡竹叶（一钱半）、牡丹皮（三钱）、茯苓（四钱）、金银花（一钱半）、木通（一钱半）、焦栀子（三钱）、泽泻（三钱）、生薏苡仁（四钱）。清水煎服，四帖。
再诊：尿血屡次发作又屡次痊愈，脉象涩而数，肺气窒闷痹阻，胸中痰浊阻滞。暂且适宜用瓜蒌薤白汤主治。（正月初八日）
处方：栝楼皮（三钱）、光杏仁（三钱）、炒蒲黄（一钱半）、白薇（三钱）、薤白（一钱）、广郁金（三钱）、血余炭（一钱）、儿茶（一钱）、焦栀子（三钱）、牡丹皮（二钱）、通草（一钱半）。清水煎服，三帖。
邵介按语：阴虚而湿热下坠，导致尿道阻塞痹阻而形成血淋。初诊方剂遵循厘清饮的意思，再加琥珀、赤茯苓，以通血利窍，这是“通则不痛，痛随利缓”的道理，所以涩痛得以减轻。次诊虽是用四物汤加减，恰好符合钱乙导赤散的意思，以清小肠火腑之热，乃是滋阴凉血的方剂。但是其阴液尚未固摄，湿气未退净，以致过度劳累即发作。且湿热蕴结不解，屡次化热劫伤阴液，又进用清热渗湿，兼以凉血的药剂，而血余炭尤其擅长一方之长，在我愚见中尚可兼用陈棕灰，则更为特效。到了第四诊，湿聚成痰，痰涎阻痹肺气，又用瓜蒌薤白汤以去除胸中的痰浊。这样的治疗方案，确实可以作为后学的典范。
【茅蓬陈案】湿火下注，阴茎肿胀作痛且已溃烂，脉象弦而濡，舌苔白厚腻。适宜用龙胆泻肝汤治疗。（四月十七日诊）
处方：龙胆炭（七分）、金银花（三钱）、泽泻（三钱）、绵茵陈（三钱）、当归（一钱半）、生甘草梢（七分）、黄芩（一钱半）、生薏苡仁（四钱）、炒车前子（三钱）、赤茯苓（四钱）、海金沙（四钱）。清水煎服，四帖。
邵介按语：湿热下注前阴，用龙胆泻肝汤以清肝胆之湿热，但担心过于渗利，耗伤津液，故佐以当归以养肝血。
【长巷沈案】浊流症状未除，小便仍然涩痛，脉象濡软，寸口脉滑，舌根部黄，咳嗽气逆，仍遵照前法加减为宜。（正月初二十九日）
处方：瞿麦（三钱）、栝楼仁（三钱）、西琥珀（八分）、川萆薢（三钱）、车前子（三钱）、木通（一钱半）、牡丹皮（二钱）、光杏仁（三钱）、甘草梢（八分）、海金沙（四钱）、血余炭（一钱）。（药引）陈年淘米水（与药物同煎）。共四帖。
邵介按语：肺主气化，如今被湿热阻滞，导致浊流不止，故治疗以清肺渗湿，通血利窍为主。
【东关金案】心肾不交，阴分尚亏，脉象细数，手心发热，精气枯竭形体怯弱，小便偶尔变赤。适宜以养阴清热为主。（七月一号，农历五月十七日）
处方：细生地黄（三钱）、石斛（三钱）、夜交藤（三钱）、川牛膝（三钱）、川黄柏（一钱，盐水炒）、茯神（四钱）、远志肉（八分）、生甘草梢（八分）、淡秋石（八分，冲服）、地骨皮（三钱）、生薏苡仁（四钱）。清水煎服，四帖。
复诊：经过养阴清热治疗后，精浊症状减轻，脉象依然细数，耳鸣，睡眠恍惚，仍遵照前法加减为主。（五月二十四日）
处方：细生地黄（四钱）、石斛（三钱）、川萆薢（三钱）、茯神（四钱）、怀山药（三钱）、炒远志（八分）、泽泻（三钱）、生薏苡仁（四钱）、淡秋石（八分，冲服）、骨碎补（三钱）、夜交藤（三钱）、鲜带心莲子（七粒）。共八帖。
邵介按语：这是心神经常妄动，肾精暗中泄漏，导致有形败浊之物，阻塞于尿道隧道，随尿液而出。前后两个方剂，都是安神宁心、养阴通浊的药物，确实属于对症之药。
[Case of Shou from Laobutou] The diarrhea has not yet subsided. The left pulse is deficient and fine, the right pulse is soggy (Ru), and there is incontinence of urine. It is tentatively appropriate to use Liqing Yin (Clearing and Purifying Decoction) modified to nourish Yin and drain dampness.
Prescription: Sheng Di Huang (Rehmanniae Radix Preparata, 3 qian), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Dan Qiu Shi (Nitrinum, 0.8 fen), Tong Ji Li (Tribuli Fructus, 3 qian), Huai Shan Yao (Dioscoreae Rhizoma, 3 qian), Che Qian Zi (Plantaginis Semen, 3 qian), Fu Ling (Poria, 4 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Sang Piao Xiao (Mantis Oötheca, 1.5 qian), Shi Lian Zi (Nelumbinis Semen, 3 qian). [Guiding drug] Chen Tao Mi Gan Shui (Old rice-washing water, decocted with herbs).
Shao Jie's commentary: The Classic says, "Deficiency in the lower jiao leads to enuresis." It also says, "When the bladder lacks constraint, it leads to enuresis." Currently, due to the loss of the bladder's constraining function and insufficient Qi to consolidate, urinary incontinence occurs. Furthermore, because the Spleen Qi has not yet recovered its healthy function and damp-heat has not been fully cleared, the diarrhea persists. Therefore, the treatment method involves draining dampness and supporting the Spleen, while incorporating herbs that reduce urination.
[Case of Wang from Dayi] Damp-heat obstructs Qi mechanism; the tongue coating is white and thick/greasy; there is epigastric fullness/stagnation, tidal fever, astringent and painful urination, and constipation. It is appropriate to clear heat and promote diuresis. (Diagnosed on Sept 17)
Prescription: Qu Mai (Dianthi Herba, 3 qian), Jiao Zhi Zi (Gardeniae Fructus Carbonized, 3 qian), Hai Jin Sha (Lygodii Spora, 4 qian), Rui Ren (Pruni Armeniacae Semen, 1.5 qian), Che Qian (Plantaginis Semen/Herb, 3 qian), Dan Qin (Scutellariae Radix, 1.5 qian), Mu Tong (Akebiae Caulis, 1.5 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Sheng Mu Li (Ostreae Concha, 4 qian), Hua Shi (Talcum, 4 qian), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Liang Tou Jian (Spatholobi Caulis/other, 70 grains, wrapped). Three doses.
Shao Jie's commentary: Danxi stated that among the five types of Lin syndrome (dysuria), most are caused by damp-heat blocking orifices. Now, accompanied by Qi closure causing astringent and painful urination, treating with damp-draining and heat-clearing methods is indeed excellent. This formula is modified from Bazheng San (Eight-Herb Correcting Powder), combined with Mu Li and Ze Xie to regulate water passages and direct fluids downward to the bladder. Moreover, the constipation is due to the failure of Fu organ Qi movement, so Liang Tou Jian is used to guide turbid matter out.
[Case of Chen from Dongpu] Damp-heat flows downward; urine is red and flowing; the right pulse is soggy and wiry; the tongue is slippery; there is edema on the dorsum of the foot. It is tentatively appropriate to prioritize Liqing Yin modified for nourishing Yin.
Prescription: Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Sheng Di Huang (Rehmanniae Radix Preparata, 4 qian), Mian Yin Chen (Artemisiae Scopariae Herba, 3 qian), Chuan Bai (Phellodendri Cortex, 1.5 qian, stir-fried with salt water), Ze Xie (Alismatis Rhizoma, 3 qian), Huai Yao (Dioscoreae Rhizoma, 3 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian), Tong Cao (Tetrapanacis Medulla, 1.5 qian), Che Qian (Plantaginis Semen/Herb, 3 qian), Dan Pi (Moutan Cortex, 3 qian), Cao Bi Xie (likely Chuan Bi Xie or similar, 3 qian). Decocted in clear water, four doses.
Shao Jie's commentary: The Bladder is the official of the Zhou Du (storage of fluids); fluids are stored within, and they can be excreted through Qi transformation. Now, Kidney Yin Qi rebels in the lower abdomen, obstructing the Qi transformation of the Bladder, resulting in short, red urine and edema on the dorsum of the foot. Thus, this formula both drains dampness from the Bladder and nourishes the fluid of the Kidneys.
[Case of Shen from Yuzhuang] Body heat has subsided; the pulse is weak; the tongue is slippery; small urination remains dribbling. It is appropriate to clear and drain the Taiyang channel. (Diagnosed on Aug 3)
Prescription: Xi Hu Po (Electrum, 0.8 fen), Yin Hua (Lonicerae Japonicae Flos, 1.5 qian), Mu Tong (Akebiae Caulis, 1.5 qian), Hai Jin Sha (Lygodii Spora, 4 qian), Che Qian (Plantaginis Semen/Herb, 3 qian), Liu Yi San (Six-to-One Powder, 3 qian), Jiao Zhi Zi (Gardeniae Fructus Carbonized, 3 qian), Shi Wei (Pyrrosiae Folium, 2 qian), Qing Mu Xiang (Vladamiris Radix, 0.8 fen), Qu Mai (Dianthi Herba, 3 qian), Sheng Tou Cao (Houttuyniae Herba, 3 qian), Chen Tao Mi Gan Shui (Old rice-washing water, decocted with herbs). Three doses.
Shao Jie's commentary: Damp-heat flowing downward forms Lin syndrome; the method of clearing and draining is very correct.
[Case of Ru from Anchang] Damp-heat flows downward; urination is astringent, painful, and contains blood; the pulse is soggy; limbs are cold, back feels cold; tongue coating is yellow. It is appropriate to prioritize Liqing Yin modified for draining dampness. (Diagnosed on Feb 18)
Prescription: Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Xi Hu Po (Electrum, 0.8 fen, taken with liquid), Pu Huang (Typhae Pollen, 1.5 qian), Chi Ling (Poria cum Rubro, 4 qian), Ze Xie (Alismatis Rhizoma, 2 qian), Chao Che Qian (Plantaginis Semen, stir-fried, 3 qian), Dang Gui (Angelicae Sinensis Radix, 3 qian), Mu Tong (Akebiae Caulis, 1.5 qian), Hai Jin Sha (Lygodii Spora, 4 qian), Xue Yu Tan (Spina Scrophulariae Carbonized, 1 qian), Fen Dan Pi (Moutan Cortex, 1.5 qian). Decocted in clear water, four doses.
Second visit: Damp-heat is not yet cleared; there is still blood after urination, but the astringency and pain have improved slightly. The pulse is soggy, tongue coating is slippery. Borrow Si Wu Tang (Four Substances Decoction) modified for treatment. (Diagnosed on Apr 9, Lunar Mar 23)
Prescription: Sheng Di Huang (Rehmanniae Radix Preparata, 4 qian), Pu Huang (Typhae Pollen, 1.5 qian), Sheng Gan Shao (Glycyrrhizae Radix et Rhizoma tip, 0.8 fen), Jiao Zhi Zi (Gardeniae Fructus Carbonized, 3 qian), Dang Gui (Angelicae Sinensis Radix, 1.5 qian), Xue Yu Tan (Spina Scrophulariae Carbonized, 1 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Qu Mai (Dianthi Herba, 1.5 qian), Dan Pi (Moutan Cortex, 3 qian), Chao Che Qian (Plantaginis Semen, stir-fried, 3 qian), Mu Tong (Akebiae Caulis, 1.5 qian). Decocted in clear water, four doses.
Third visit: Hematuria recurs upon exertion; the pulse is soggy and fine; tongue coating is yellow and slippery; damp-heat is accumulated. It is tentatively appropriate to cool blood, clear heat, and separate pure from turbid (promote diuresis). (Diagnosed on May 15, Lunar Apr 29)
Prescription: Sheng Di Huang (Rehmanniae Radix Preparata, 4 qian), Xue Yu Tan (Spina Scrophulariae Carbonized, 1 qian), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Dan Zhu Ye (Lophatheri Herba, 1.5 qian), Dan Pi (Moutan Cortex, 3 qian), Fu Ling (Poria, 4 qian), Yin Hua (Lonicerae Japonicae Flos, 1.5 qian), Mu Tong (Akebiae Caulis, 1.5 qian), Jiao Zhi Zi (Gardeniae Fructus Carbonized, 3 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian). Decocted in clear water, four doses.
Fourth visit: Hematuria recurs repeatedly and heals repeatedly; the pulse is choppy and rapid; Lung Qi is obstructed and blocked; phlegm obstructs the chest. It is tentatively appropriate to treat primarily with Gua Lou Xie Bai Tang (Trichosanthis Reticulatae Pericarpium and Macstem Onion Decoction). (Diagnosed on Jan 8)
Prescription: Gua Lou Pi (Trichosanthis Pericarpium, 3 qian), Guang Xing Ren (Armeniacae Semen Amarum, 3 qian), Chao Pu Huang (Typhae Pollen, stir-fried, 1.5 qian), Bai Wei (Cistanches Herba, 3 qian), Xie Bai (Allii Macrostem Bulbus, 1 qian), Guang Yu Jin (Curcumae Radix, 3 qian), Xue Yu Tan (Spina Scrophulariae Carbonized, 1 qian), Er Cha (Catechu, 1 qian), Jiao Zhi Zi (Gardeniae Fructus Carbonized, 3 qian), Dan Pi (Moutan Cortex, 2 qian), Tong Cao (Tetrapanacis Medulla, 1.5 qian). Decocted in clear water, three doses.
Shao Jie's commentary: Yin deficiency with damp-heat sinking downward causes obstruction and blockage of the urethra, leading to bloody Lin syndrome. The initial prescription followed the intent of Liqing Yin, adding Hu Po (Electrum) and Chi Ling (Poria cum Rubro) to unblock blood and benefit orifices. This embodies the principle that "unblocked means no pain, pain eases as things flow," hence the improvement in astringency and pain. The second prescription, though modified Si Wu Tang, coincidentally aligns with Qian's Dao Chi San (Guide Out Red Powder) intent, clearing heat from the Small Intestine Fire Fu organ; it is a formula to nourish Yin and cool blood. However, since Yin was not yet consolidated and dampness not fully expelled, exertion triggered recurrence. Furthermore, accumulated damp-heat failed to resolve, repeatedly transforming into heat and consuming fluids. Subsequent treatments involved clearing heat, draining dampness, and cooling blood. Xue Yu Tan excels in this regard; in my humble opinion, combining it with Chen Zong Hui (Areca Seed Husk Ash) would be even more effective. In the fourth consultation, dampness transformed into phlegm, obstructing Lung Qi, so Gua Lou Xie Bai Tang was used to remove chest phlegm. Such treatment plans are truly exemplary models for students.
[Case of Chen from Maopeng] Damp-fire flows downward; the penis is swollen and painful, already ulcerated; the pulse is wiry and soggy; tongue coating is white and thick/greasy. It is appropriate to treat with Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction). (Diagnosed on Apr 17)
Prescription: Long Dan Tan (Gentianae Radix Carbonized, 0.7 fen), Yin Hua (Lonicerae Japonicae Flos, 3 qian), Ze Xie (Alismatis Rhizoma, 3 qian), Mian Yin Chen (Artemisiae Scopariae Herba, 3 qian), Dang Gui (Angelicae Sinensis Radix, 1.5 qian), Sheng Gan Shao (Glycyrrhizae Radix et Rhizoma tip, 0.7 fen), Tiao Qin (Scutellariae Radix, 1.5 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian), Chao Che Qian (Plantaginis Semen, stir-fried, 3 qian), Chi Fu Ling (Poria cum Rubro, 4 qian), Hai Jin Sha (Lygodii Spora, 4 qian). Decocted in clear water, four doses.
Shao Jie's commentary: Damp-heat flows downward to the anterior yin (genitals); Long Dan Xie Gan Tang is used to clear damp-heat from the Liver and Gallbladder. However, fearing excessive draining might consume body fluids, Dang Gui is added to nourish the Liver.
[Case of Shen from Changxiang] Turbid discharge has not subsided; urination remains astringent and painful; the pulse is soggy; the Cun Kou (radial artery at wrist) is slippery; tongue root is yellow; cough and rebellious Qi persist. It is advisable to follow previous methods with modifications. (Diagnosed on Jan 29)
Prescription: Qu Mai (Dianthi Herba, 3 qian), Gua Lou Ren (Trichosanthis Semen, 3 qian), Xi Hu Po (Electrum, 0.8 fen), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Che Qian (Plantaginis Semen/Herb, 3 qian), Mu Tong (Akebiae Caulis, 1.5 qian), Dan Pi (Moutan Cortex, 2 qian), Guang Xing Ren (Armeniacae Semen Amarum, 3 qian), Gan Cao Shao (Glycyrrhizae Radix et Rhizoma tip, 0.8 fen), Hai Jin Sha (Lygodii Spora, 4 qian), Xue Yu Tan (Spina Scrophulariae Carbonized, 1 qian). [Guiding drug] Chen Tao Mi Gan Shui (Old rice-washing water, decocted with herbs). Four doses.
Shao Jie's commentary: The Lung governs Qi transformation. Now obstructed by damp-heat, turbid discharge does not stop. Thus, treatment focuses on clearing the Lung, draining dampness, unblocking blood, and benefiting orifices.
[Case of Jin from Dongguan] Heart and Kidney do not interact; Yin aspect is still deficient; the pulse is fine and rapid; palms are hot; essence is exhausted, physique is timid; small urination occasionally turns red. It is appropriate to prioritize nourishing Yin and clearing heat. (Diagnosed on Jul 1, Lunar May 17)
Prescription: Xi Sheng Di (Fine Rehmanniae Radix Preparata, 3 qian), Cha Hu (Dendrobii Caulis, 3 qian), Ye Jiao Teng (Polygoni Multiflori Caulis, 3 qian), Chuan Niu Xi (Cyathulae Radix, 3 qian), Chuan Bai (Phellodendri Cortex, 1 qian, stir-fried with salt water), Fu Shen (Poria with Hostwood, 4 qian), Yuan Zhi Rou (Polygalae Radix flesh, 0.8 fen), Sheng Gan Shao (Glycyrrhizae Radix et Rhizoma tip, 0.8 fen), Dan Qiu Shi (Nitrinum, 0.8 fen, taken with liquid), Di Gu Pi (Lycii Cortex, 3 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian). Decocted in clear water, four doses.
Second visit: After nourishing Yin and clearing heat, essence/turbidity symptoms have improved; the pulse remains fine and rapid; tinnitus occurs; sleep is vague/restless. Still prioritize following previous methods with modifications. (Diagnosed on May 24)
Prescription: Xi Sheng Di (Fine Rehmanniae Radix Preparata, 4 qian), Cha Hu (Dendrobii Caulis, 3 qian), Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma, 3 qian), Fu Shen (Poria with Hostwood, 4 qian), Huai Shan Yao (Dioscoreae Rhizoma, 3 qian), Chao Yuan Zhi (Polygalae Radix, stir-fried, 0.8 fen), Ze Xie (Alismatis Rhizoma, 3 qian), Sheng Yi Yi Ren (Coicis Semen, 4 qian), Dan Qiu Shi (Nitrinum, 0.8 fen, taken with liquid), Gu Sui Bu (Drynariae Rhizoma, 3 qian), Ye Jiao Teng (Polygoni Multiflori Caulis, 3 qian), Xian Dai Xin Lian Zi (Fresh Lotus Seed with Plumule, 7 grains). Eight doses.
Shao Jie's commentary: This is due to constant mental agitation and secret leakage of Kidney essence, leading to tangible corrupt turbid matter blocking the urinary tract, exiting with urine. Both prescriptions consist of herbs that calm the spirit, soothe the heart, nourish Yin, and clear turbidity; they are indeed appropriate remedies.