大司徒许函谷，在南银台时，因劳发热，小便自遗，或时不利，余作肝火阴挺不能约制，午前
用补中益气加山药、黄柏、知母，午后服地黄丸，月余诸症悉退。
此症若服燥剂而频数或不
利，用四物、麦门、五味、甘草。若数而黄，用四物加山茱、黄柏、知母、五味、麦门。若
肺虚而短少，用补中益气加山药、麦门。若阴挺、痿痹而频数，用地黄丸。若热结膀胱而不
利，用五淋散。若脾肺燥不能化生，用黄芩清肺饮。若膀胱阴虚，阳无以生而淋沥，用滋肾
丸。若膀胱阳虚，阴无以化而淋涩，用六味丸。若转筋小便不通，或喘急欲死，不问男女孕
妇，急用八味丸，缓则不救。若老人阴痿思色，精不出而内败，小便道涩如淋，用八
味丸料加车前、牛膝。若老人精已竭而复耗之，大小便道牵痛，愈痛愈欲便，愈便则愈痛，
亦治以前药，不应，急加附子。若喘嗽吐痰，腿足冷肿，腰骨大痛，面目浮肿，太阳作痛，
亦治以前药。若痛愈而小便仍涩，宜用加减八味丸以缓治之。（详见《褚氏遗书·精血篇》，但无
治法耳。）
司徒边华泉，小便频数，涩滞短赤，口干唾痰，此肾经阳虚热燥，阴无以化，用六味、滋肾二
丸而愈。
司马李梧山，茎中作痛，小便如淋，口干唾痰，此思色精降而内败，用补中益气、六味地黄而
愈。
考功杨村庵，口舌干燥，小便频数，此膀胱阳燥阴虚，先用滋肾丸以补阴，而小便愈，再用补
中益气、六味地黄以补肺肾而安。若汗多而小便短少，或体不禁寒，乃脾肺气虚也。
司空何燕泉，小便赤短，体倦食少，缺盆作痛，此脾肺虚弱，不能生肾水，当滋化源，用补中
益气、六味丸加五味而安。
商主客，素膏粱，小便赤数，口干作渴，吐痰稠粘，右寸关数而有
力，此脾肺积热遗于膀胱，用黄芩清肺饮调理脾肺，用滋肾、六味二丸，滋补肾水而愈。
一儒者，发热无时，饮水不绝，每登厕小便涩痛，大便牵痛，此精竭复耗所致，用六味丸加五
味子及补中益气，喜其谨守得愈。若肢体畏寒，喜热饮食，用八味丸。
儒者杨文魁，痢后，两足浮肿，胸腹胀满，小便短少，用分利之剂，遍身肿兼气喘。余曰∶两
足浮肿，脾气下陷也；胸腹胀满，脾虚作痞也；小便短少，肺不能生肾也；身肿气喘，脾不
能生肺也。用补中益气汤加附子而愈。半载后因饮食劳倦，两目浮肿，小便短少，仍服前药
顿愈。
甲戌年七月，余奉侍武庙汤药，劳役过甚，饮食失节，复兼怒气。次年春茎中作痒，时出白津
，时或痛甚，急以手紧捻才止，此肝脾之气虚也，服地黄丸及补中益气加黄柏、柴胡、山栀
、茯苓、木通而愈。至丁酉九月，又因劳役，小便淋沥，茎痒窍痛，仍服前汤加木通、茯苓
、胆草、泽泻及地黄丸而愈。
大尹顾荣甫，尾闾作痒，小便赤涩，左尺脉洪数，属肾经虚热，法当滋补。彼不信，乃服黄柏
、知母等药，年许，高骨肿痛，小便淋沥，肺肾二脉洪数无伦。余曰∶子母俱败，无能为矣。后
果殁。
余甲辰仲夏，在横金陈白野第，会其外舅，顾同崖求余诊脉，左尺涩结，右寸洪数。余曰∶此
肺金不能生肾水，诚可虑。果至季冬茎道涩痛如淋，愈痛则愈欲便，愈便则愈痛而殁。
Xu Handu, Grand Commandant, while serving in the Southern Yintai office, developed fever due to overexertion, accompanied by urinary incontinence and occasional difficulty in urination. I diagnosed this as liver fire causing flaccidity of the yin organs with loss of control. In the morning, he took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Dioscoreae Rhizoma (Shanyao), Phellodendri Cortex (Huangbai), and Anemarrhenae Rhizoma (Zhimu); in the afternoon, he took Dihuang Wan (Rehmannia Pill, specifically Liuwei Dihuang Wan). After more than a month, all symptoms subsided.
If such cases are treated with drying agents leading to frequent or difficult urination, Siwu Tang (Four Substances Decoction) combined with Ophiopogonis Radix (Maimen), Schisandrae Fructus (Wuweizi), and Glycyrrhizae Radix et Rhizoma (Gancao) may be used. If urination is frequent and yellow, Siwu Tang added with Corni Fructus (Shanzhuyu), Huangbai, Zhimu, Wuweizi, and Maimen is indicated. If lung deficiency leads to scanty urine, Buzhong Yiqi Tang added with Shanyao and Maimen should be used. If there is flaccidity, impotence, and frequent urination, Dihuang Wan is appropriate. If heat binds in the bladder causing obstruction, Wulin San (Five Strangury Powder) is used. If spleen and lung dryness prevents fluid transformation, Huangqin Qingfei Yin (Scutellaria Lung-Clearing Infusion) is prescribed. If bladder yin deficiency results in yang failing to generate fluids, leading to dribbling, Zishen Wan (Kidney-Nourishing Pill) is indicated. If bladder yang deficiency causes yin to fail to transform, resulting in strangury and涩 pain, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used. If muscle spasms occur with urinary retention, or severe asthma threatens life, regardless of gender or pregnancy, Bajui Wan (Eight-Ingredient Pill, specifically Jin Gui Shenqi Wan) must be administered urgently; otherwise, it is untreatable. For elderly men with impotence desiring sexual activity, where essence fails internally without emission, causing urethral涩 pain like strangury, Bajui Wan material added with Plantaginis Seed (Cheqianzi) and Achyranthis Bidentatae Radix (Niuxi) is used. If an elderly person’s essence is exhausted and further depleted, causing pulling pain in the large and small bowel passages—where increased pain increases the urge to defecate/urinate, which in turn increases pain—the same medicines are used; if ineffective, Aconiti Lateralis Radix Praeparata (Fuzi) is added urgently. If asthma, cough, expectoration, cold swelling of legs and feet, severe lumbar bone pain, facial edema, and Taiyang channel headache occur, the aforementioned medicines are also used. If pain subsides but urine remains涩, Jiajian Bajui Wan (Modified Eight-Ingredient Pill) should be used for slow treatment. (See *Chu Shi Yi Shu · Jing Xue Pian*, though it lacks treatment methods.)
Bian Huaquan, Grand Commandant, suffered from frequent,涩, short, and red urine, dry mouth, and spitting of phlegm. This was due to kidney meridian yang deficiency with heat and dryness, preventing yin transformation. He was cured using Liuwei Dihuang Wan and Zishen Wan.
Li Wushan, Sima, experienced pain in the glans penis, urine resembling strangury, dry mouth, and spitting of phlegm. This resulted from desiring sexual activity, causing essence to descend and internal failure. He was cured using Buzhong Yiqi Tang and Liuwei Dihuang Wan.
Yang Cun’an, Kaogong, had dry mouth and tongue with frequent urination. This was bladder yang dryness and yin deficiency. Initially, Zishen Wan was used to nourish yin, curing the urination; subsequently, Buzhong Yiqi Tang and Liuwei Dihuang Wan were used to tonify lung and kidney, bringing stability. If excessive sweating leads to scanty urine or intolerance to cold, it indicates spleen and lung qi deficiency.
He Yanquan, Sikong, presented with red, short urine, fatigue, poor appetite, and pain in the clavicular fossa (Quepen). This was spleen and lung weakness failing to generate kidney water. The source of transformation should be nourished using Buzhong Yiqi Tang, Liuwei Dihuang Wan, and Wuweizi, resulting in recovery.
A merchant official, accustomed to rich and greasy food, had red, frequent urine, dry mouth with thirst, thick sticky phlegm, and a rapid, forceful pulse at the right Cun and Guan positions. This indicated spleen and lung accumulated heat lingering in the bladder. Huangqin Qingfei Yin was used to regulate spleen and lung, while Zishen Wan and Liuwei Dihuang Wan were used to nourish kidney water, leading to cure.
A scholar suffered from irregular fever, incessant drinking, and涩 painful urination and defecation upon visiting the toilet. This was caused by exhaustion of essence followed by further depletion. Liuwei Dihuang Wan added with Wuweizi and Buzhong Yiqi Tang were used; adherence to the prescription led to recovery. If limbs feel cold and hot drinks are preferred, Bajui Wan is indicated.
Yang Wenkui, a scholar, after dysentery, developed edema in both feet, chest and abdominal distension, and scanty urine. Treatment with diuretic agents caused generalized edema and asthma. I stated: Edema in both feet indicates sinking of spleen qi; chest and abdominal distension indicates spleen deficiency causing stagnation; scanty urine indicates lung’s inability to generate kidney water; generalized edema and asthma indicate spleen’s inability to generate lung qi. Buzhong Yiqi Tang added with Fuzi cured him. Half a year later, due to dietary indiscretion and overwork, bilateral eye edema and scanty urine recurred; taking the previous medicine again brought immediate relief.
In July of the Ji Xu year, while attending to the Emperor Wu’s decoctions, I suffered from excessive labor, irregular diet, and anger. The following spring, itching in the glans penis occurred, with occasional discharge of white fluid and severe pain relieved only by tight manual pressure. This was deficiency of liver and spleen qi. Dihuang Wan and Buzhong Yiqi Tang added with Huangbai, Chaihu, Gardeniae Fructus (Shanzhi), Poria (Fuling), and Akebia Caulis (Mutong) cured him. In September of the Ding You year, due to labor, dribbling urine, penile itching, and orifice pain recurred. The previous decoction was taken again with added Mutong, Fuling, Gentianae Radix (Dancao), Alismatis Rhizoma (Zexie), and Dihuang Wan, leading to recovery.
Gu Rongfu, Dayin, had itching at the Weilu area, red and涩 urine, and a flooding, rapid left Chi pulse, indicating kidney meridian deficiency heat. The method should have been tonification and nourishment. Disbelieving this, he took Huangbai and Zhimu etc. After about a year, high bone swelling and pain, dribbling urine, and extremely flooding, rapid lung and kidney pulses appeared. I said: Both mother and child are failed; nothing can be done. He subsequently died.
In mid-summer of the Jia Chen year, at the residence of Chen Baiye in Hengjin, I examined the pulse of his father-in-law, Gu Tongya. The left Chi pulse was涩 and knotted, and the right Cun pulse was flooding and rapid. I said: This is lung metal failing to generate kidney water, truly worrying. Indeed, by late winter, urethral涩 pain like strangury occurred, where increased pain increased the urge to void, which increased pain, leading to death.