外兄贺晋卿因有不如意事，又当劳役之后，忽小腹急痛欲溺，溺中有白物如脓并血而
下，
茎中急痛不可忍，正如滞下后重之状，日数十行，更数医不效，问方于余。余作瘀血治，下
以牛膝四两，去芦酒浸一宿，长流水十二碗，煎至八碗，再入桃仁(一两去皮尖炒)，红
花
二钱五分，当归梢一两酒浸，赤芍药一两五钱，木通一两，生甘草二钱五分，苎
麻根二茎，同煎至二碗去渣，入琥珀末二钱，麝香少许，分作四服，一日夜饮尽，
势减大半。按∶《素问·奇病论》云∶病有癃者，一日数十溲，此不足也。今瘀血虽散，宜
用
地黄丸加菟丝子、杜仲、益智仁、牛膝之属，补肾阴之不足，以杜复至。因循未及修治，遂
不得全愈。
或闭或一夜数十起，溺讫痛甚，迳服前丸，及以补肾之药入煎剂调理而安。从兄淳甫得淋疾
，
日数十溲，略带黄，服五苓散顿减。因腹中未快，多服利药三五日，复忽见血星，医以八正
散治之不应，索方于余。询知其便后时有物如脓，小劳即发，诊得六脉俱沉细尤甚，此中气
不足也，便后浓血，精内败也。经云∶中气不足，则溲便为之变。宜补中益气汤，加顺气之
药，
以滋其阳。六味地黄丸，疏内败之精，以补其阴。更加五味子敛耗散，牛膝通血脉，终剂而
安。
此余初学医时所录，以用药颇中肯綮，故存之。小便黄赤，有寒热虚实之别。《素问》曰∶
诸病
水液混浊，皆属于热。宜黄柏、知母之类治之，此热症也。《脉经》云∶尺涩足胫逆冷，小
便赤
，宜服附子四逆汤，此寒症也。
《素问》云∶胃足阳明之脉盛，则身已前皆其有余。胃则消谷善饥，溺色黄，宜降胃火。
又云∶肝热病者，小便先黄，宜降肝火，皆实症也。又云∶肺手
太阴之脉，气虚则肩背痛而寒，少气不足以息，溺色变，宜补中益气汤之类，又补肺气。又
云∶冬脉者，肾脉也。冬脉不及，则令人眇中清，脊痛，小便变，宜地黄丸之类以助肾脉
，此虚症也。小便遗失，责在肺不在肾，盖肺者肾之上源，又其母也，上源治则下流
约
矣。《甲乙经》云∶肺脉不及，则少气不足以息，卒遗失无度。故东垣云∶宜安卧养气，禁
劳役，以黄 、人参之类补之。不愈，当责有热，加黄柏、生地。
淋有五种，气、血、砂、膏、劳。今茎中疼痛，乃血瘀为患，用血药获效，是治其源也
。若点滴涩痛，为津液
涸，茎中挟脓者，乃中气不足，且肺为水之上源。若肺虚气不上承，亦为淋也。《治验录》
辨之晰矣。
我的表兄贺晋卿因为遇到不顺心的事，加上在劳累服役之后，突然感到小腹部拘急疼痛并有尿意，排尿时流出像脓液一样的白色物质并伴有血液，尿道中剧烈疼痛难以忍受，症状正如痢疾里急后重一样，每天排便（排尿）数十次，多位医生治疗无效，向我询问方药。我将其作为瘀血证治疗，给予牛膝四两，去除芦头后用酒浸泡一夜，用长流水十二碗，煎煮至八碗，再加入桃仁一两（去皮尖炒制）、红花二钱五分、当归梢一两（酒浸）、赤芍药一两五钱、木通一两、生甘草二钱五分、苎麻根两茎，一同煎煮至二碗，去渣后加入琥珀末二钱、麝香少许，分四次服用，在一昼夜内饮完，病情减轻了一半以上。按语：《素问·奇病论》说：患有癃闭的病证，一天小便数十次，这是正气不足的表现。如今瘀血虽已消散，适宜使用地黄丸加菟丝子、杜仲、益智仁、牛膝等药物，以补肾阴之不足，以防止复发。因拖延未能及时调理治疗，最终未能完全痊愈。
有时小便闭塞不通，或一夜起夜数十次，排尿结束后疼痛剧烈，直接服用前面的地黄丸，并将补肾的药物加入汤剂中调理而安定下来。堂兄淳甫患淋证，每天小便数十次，尿液略带黄色，服用五苓散后症状立刻减轻。因为腹中感觉不快，多服用了利水药物三到五天，忽然又出现血丝，医生用八正散治疗没有效果，向我索要方药。询问得知他大便后偶尔有像脓一样的物质排出，轻微劳累就会发作，诊察发现六脉都沉细尤其严重，这是中气不足的表现，便后排出浓血，是精气内部败坏所致。经书说：中气不足，就会导致大小便异常。适宜使用补中益气汤，加入顺气的药物，以滋养其阳气。使用六味地黄丸，疏泄内部败坏的精微，以补充其阴液。再加五味子收敛耗散之气，牛膝疏通血脉，服药完毕而病情安定。
这是我初学医时所记录的病例，因为用药颇为切中要害，所以保存下来。小便黄赤，有寒证和虚实证的区别。《素问》说：各种水液混浊，都属于热证。适宜用黄柏、知母之类的药物治疗，这是热证。《脉经》说：尺脉涩且足胫逆冷，小便赤色，适宜服用附子四逆汤，这是寒证。
《素问》说：足阳明胃经的脉气旺盛，则身体前部都是有余之证。胃功能亢进则消谷善饥，尿液颜色黄，适宜清降胃火。又说：肝热病患者，小便先变黄，适宜清降肝火，这都是实证。又说：手太阴肺经脉气虚弱，则肩背疼痛且怕冷，气短不足以呼吸，尿液颜色改变，适宜使用补中益气汤之类，同时补益肺气。又说：冬脉即肾脉。冬季脉象不及，会导致人胁肋部清冷，脊背疼痛，小便异常，适宜用地黄丸之类来辅助肾脉，这是虚证。小便失禁，责任在肺而不在肾，因为肺是肾的上源，又是肾之母，上源治理得当则下流自然约束。《甲乙经》说：肺脉气虚，则气短不足以呼吸，突然小便失禁无度。所以李东垣说：适宜安静卧床养气，禁止劳累役使，用黄芪、人参之类的药物补益。如果不好转，应当责求有热，加入黄柏、生地。
淋证分为五种：气淋、血淋、砂淋、膏淋、劳淋。如今尿道中疼痛，乃是血瘀为患，使用活血药物获得疗效，这是治本的方法。如果是点滴涩痛，属于津液枯竭；尿道中夹杂脓液的，是中气不足，且肺为水之上源。如果肺气虚导致气不能上承，也会形成淋证。《治验录》对此辨析得很清楚。
My cousin, He Jinqing, due to some unsatisfactory matters and following strenuous labor, suddenly experienced urgent pain in the lower abdomen with an urge to urinate. His urine contained white matter resembling pus mixed with blood. The pain in the urethra was unbearable, resembling the tenesmus of dysentery. He urinated dozens of times a day. Several physicians failed to effect a cure, so he asked me for a prescription. I treated it as Blood Stasis (Blood Stasis: accumulation of blood that fails to circulate normally). I prescribed Niuxi (Achyranthes Root) four liang, removing the rhizome and soaking it in wine overnight. Using twelve bowls of flowing water, decoct until eight bowls remain. Then add Taoren (Peach Kernel) one liang (skin and tip removed, stir-fried), Honghua (Safflower) two qian five fen, Danggui Shao (Radix Angelicae Sinensis Tip) one liang (soaked in wine), Chishao Yao (Red Peony Root) one liang five qian, Mutong (Akebia Stem) one liang, Sheng Gancao (Raw Licorice Root) two qian five fen, and Zhuma Gen (Ramie Root) two stems. Decoct together until two bowls remain, strain, then add Hupo (Amber) powder two qian and a small amount of Shexiang (Musk). Divide into four doses, drink all within one day and night. The condition reduced by more than half. Note: *Suwen · Qibing Lun* states: "In cases of Gong (Gong: difficulty in urination or retention of urine), there are dozens of urinations per day; this is deficiency." Now that the Blood Stasis has dispersed, it is appropriate to use Dihuang Wan (Rehmannia Pill) added with Tusizi (Cuscuta Seed), Duzhong (Eucommia Bark), Yizhiren (Bitter Apricot Seed), and Niuxi, to tonify the insufficiency of Kidney Yin (Kidney Yin: the yin aspect of the Kidney organ system responsible for nourishment and cooling) to prevent recurrence. Due to delay in treatment, full recovery was not achieved.
Sometimes there is urinary obstruction, or waking dozens of times at night to urinate, with severe pain after voiding. Directly taking the aforementioned pill, along with decoctions containing Kidney-tonifying herbs, brought relief. My paternal cousin, Chunfu, suffered from Lin Syndrome (Lin Syndrome: painful and frequent urination). He urinated dozens of times daily, with urine slightly yellow. After taking Wuling San (Five-Ingredient Poria Powder), symptoms decreased instantly. Because his abdomen felt uncomfortable, he took diuretic herbs for three to five days, and suddenly blood spots appeared. A physician treated him with Bazheng San (Eight-Herb Corrective Powder) without success, and sought my prescription. Inquiry revealed that after defecation, pus-like material occasionally appeared. Mild exertion triggered the condition. Pulse diagnosis showed all six positions were deep and fine, especially pronounced. This indicates Middle Qi Deficiency (Middle Qi Deficiency: weakness of Spleen and Stomach Qi). The purulent blood after defecation indicates internal deterioration of Essence (Essence: the fundamental substance of life derived from congenital endowment and acquired nutrition). The Classics state: "When Middle Qi is deficient, urination and defecation become abnormal." It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Qi-regulating herbs to nourish Yang. Use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to vent internally deteriorated Essence and tonify Yin. Additionally, use Wuweizi (Schisandra Berry) to astringe dissipating Qi, and Niuxi to unblock blood vessels. Treatment concluded with stability.
This was recorded when I first studied medicine. Because the medication hit the mark precisely, I preserved it. Yellow and red urine has distinctions between Cold and Excess/Deficiency patterns. *Suwen* says: "All turbid fluids belong to Heat." Treat with Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome); this is a Heat pattern. *Maijing* says: "If the Chi pulse is choppy and the calves are cold, and urine is red, take Fuzi Sini Tang (Aconite Counterflow Decoction); this is a Cold pattern."
*Suwen* states: "When the Foot-Yangming Stomach meridian is excessive, the anterior body shows excess." Hyperactive Stomach function leads to rapid digestion and hunger, with yellow urine; clear Stomach Fire is indicated. It also states: "In Liver Heat disease, urine turns yellow first"; clear Liver Fire is indicated. These are Excess patterns. It further states: "When Hand-Taiyin Lung meridian Qi is deficient, shoulder and back pain with cold occur, shortness of breath, and urine color changes." Use Buzhong Yiqi Tang to tonify Lung Qi. It also states: "The Winter pulse is the Kidney pulse. If the Winter pulse is insufficient, it causes coldness in the flanks, back pain, and abnormal urination." Use Dihuang Wan to assist the Kidney pulse; this is a Deficiency pattern. Urinary incontinence is attributed to the Lung, not the Kidney, because the Lung is the Upper Source of the Kidney and its Mother. If the Upper Source is regulated, the Lower Flow is constrained. *Jiayi Jing* states: "Lung pulse insufficiency leads to shortness of breath and sudden, uncontrollable urinary incontinence." Therefore, Li Dongyuan said: Rest quietly to nurture Qi, avoid labor, and tonify with Huangqi (Astragalus Root) and Renshen (Ginseng Root). If ineffective, suspect Heat and add Huangbai and Shengdi (Prepared Rehmannia Root).
Lin Syndrome has five types: Qi, Blood, Sand, Paste, and Labor. Current urethral pain is caused by Blood Stasis; using Blood-invigorating herbs was effective, treating the root. If dribbling and painful, it is due to fluid depletion. If pus accompanies urine in the urethra, it is Middle Qi Deficiency, and since the Lung is the Upper Source of Water, if Lung Qi is deficient and cannot ascend, Lin Syndrome also results. *Zhiyan Lu* distinguishes this clearly.