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Li XX from Tianjin, aged 26, suffered from the syndrome of white turbid urine (Bai Zhuo).

Etiology During late autumn, while riding a large cart home, he encountered rain on the way, and his clothes became completely wet. He stayed overnight in an inn and, wearing only a coat, went to the courtyard to urinate, where he was attacked by cold wind, thus contracting the disease of white turbid urine.

Symptoms There is constant stinging and itching in the urethra, and upon completion of urination, several drops of fluid resembling essence are discharged. This has persisted for three months. Despite multiple courses of medication with no effect, he feels physically weak and mentally fatigued. His pulse is wiry and hard on the left side, and slightly floating yet powerless when pressed heavily on the right side.

Diagnosis The *Nei Jing* (Yellow Emperor's Inner Canon) states that the Kidney governs storage (Zhe Cang), and the Liver governs discharge (Shu Xie). It also states that Wind Qi connects with the Liver, and the Liver moves the Qi of the Kidney. In this case, Cold and Wind pathogens invaded internally and entered the Liver. Assisted by Wind, the Liver's discharge function became excessively strong. Consequently, during urination, the Liver moved the Kidney's Qi with excessive discharge, causing the Kidney to lose its storage function. Thus, as urine was expelled, essence followed it out. The wiry and hard left pulse indicates Liver Qi harboring Wind; the floating and powerless right pulse indicates Qi and Blood deficiency due to prolonged illness. The constant stinging and itching in the urethra is a clear sign of Wind invasion. Treatment should focus on dispersing Liver Wind and consolidating Kidney Qi, supplemented by herbs that tonify Qi and Blood.

Prescription Raw Astragali Radix (Huangqi, 5 qian); Processed Corni Fructus (Yurou, 5 qian); Raw Dioscoreae Hypoglaucae Rhizoma (Huai Shanyao, 5 qian); Raw Longgu (Os Draconis, 5 qian, crushed); Raw Muli (Concha Ostreae, 5 qian, crushed); Raw Paeoniae Radix Alba (Hang Shaoyao, 4 qian); Ramulus Cinnamomi (Guizhi Jian, 3 qian); Raw Rehmanniae Radix (Sheng Dihuang, 3 qian); Glycyrrhizae Radix et Rhizoma (Gancao, 1.5 qian).

Decoct together in a large cup of water and take warm.

Formula Analysis Huangqi is used as the chief herb because the *Shennong Bencao Jing* records that Huangqi treats severe Wind. Therefore, for Wind pathogens entering the Zang organs, Huangqi can expel them outward. Moreover, its nature is good at tonifying Qi; sufficient Qi prevents sliding and leakage. Guizhi is also an important herb for expelling Wind; because its nature is good at pacifying the Liver, it is particularly effective at expelling Wind from the Liver. When assisting Huangqi, the power to expel Wind is greatly increased. Yurou, Longgu, and Muli are used because they are all astringent herbs that gather Zheng Qi without retaining pathogenic factors. They assist the Kidney's storage function without hindering the dispersion of Liver Wind, as detailed in materia medica discussions. Shanyao is used because it secures the Qi transformation of the Lower Jiao. Together with Yurou, it is a key component in Shenqi Wan, naturally preserving Kidney Qi and preventing deficiency-induced diarrhea. Shaoyao and Dihuang are used to moderate the heat of Huangqi and Guizhi. Shaoyao pacifies the Liver, and Dihuang tonifies the Kidney. In the ancient formula Shenqi Wan, Gan Dihuang (Dry Rehmanniae Radix) is the chief herb, which corresponds to Sheng Dihuang (Raw Rehmanniae Radix) today. Gancao is used for its ability to relieve urgency, thereby moderating the Liver's excessive discharge function.

Outcome After taking the prescription continuously for three doses, the illness was completely cured. Subsequently, Guizhi was removed from the original formula, and Sheng Dihuang was replaced with Shu Dihuang (Prepared Rehmanniae Radix) to be taken for several more doses to consolidate the recovery.