遗在常人则可言虚，此系热甚，肾火因之而动耳。遂用柴葛解肌汤加石膏，服下精即不泄；再用清火解热之药，
后用补养以回元气。（程星海）
梦遗之证，患者甚多，非必尽因色欲过度，大半起于心肾不交。凡人用心太过则火亢，火亢则水不升而心
肾不交矣。士子读书过劳，功名心急者，每有此病。其心一散，则水火既济而病自愈。先大夫少年极苦此病，
每临场则愈频，阳事着物即遗，苦无可奈，因将床席穿孔以卧，是科发解，梦泄便希，登第后则愈希矣。予少
年亦苦此，迨登第后顿减，渐老愈减。益信此病关心，不可独责于肾，而心病非药石所能疗也。○予壮年龟头时
有精出，初时惧甚，以为人身几许精血，堪此涓涓不绝乎？医之明者，慰予无害，但毋服涩药而勿热补，乃用
六味丸加沙苑、菟丝、黄柏，将此病付之度外，调理两年而愈。龙、砺等药，从未入口。盖人身气血周流，斯
得快畅，岂可涩之使滞？虽暂见效，贻害实深。予初有惧心，及后绝无倦态，岂此精与交媾之元精不同，故无
大害耶？（《折肱漫录》）
经义
太阴作初气，病中热胀，脾受积湿之气，小便黄赤，甚则淋。
○少阳作二气，风火郁于上，胆热，其病淋。（《素问》）
哲言
淋自膀胱，出于尿窍，或膏或血，与尿并出，出则无余。浊为败精，出自精窍，内虽大痛，而尿自清，或
在尿前，或在尿后，便后尚有余滴而沥，马口常湿。以此分别，庶知疗法。（郑重光）
淋有五淋之名，浊有精浊之别，数者当察气分、血分、精道、水道，确从何来。大凡痛则为淋，不痛为浊。
若心阳亢而下注者，利其火腑；湿热甚而不宣者，彻其泉源。气陷用升阳之法，血淤进化结之方。独厥阴内患，
其证最急，少腹绕前阴如刺，小水点滴难通，环阴之脉络皆痹，气化机关已息，先生引朱南阳方法，兼参李濒
湖意，用滑利通阳，辛咸泄急，佐以循经入络之品，发前人之所未发。夫便浊之恙，只在气虚与湿热推求，实
者宣通水道，虚者调养中州，若虚实两兼，又有益脏通腑之法。精浊者，盖因损伤肝肾，有精淤、精滑之分∶
精淤者，当先理其离宫腐浊，继与补肾；精滑者，用固补敛摄，不应，当从真气调之。景岳谓理其无形，以固
有形也。然此证但知治肝治肾，而不知有治八脉之妙，先生引孙真人九法，升奇阳，固精络，使督、任有权，
漏危自己。（《临证指南》）
淋病
淋之为病，小便如粟状，小腹弦急，痛引脐中。○淋家不可发汗，发汗则便血。（《金匮》）
淋病有五∶一曰劳淋，二曰血淋，三曰热淋，四曰气淋，五曰石淋。五淋之外，又有膏淋、沙淋、冷淋，
合为八也。（《东医宝鉴》）
热在脬中，煎熬日积，轻则凝如脂膏，甚则结如沙石。如汤瓶煎炼日久，熬成白碱；又如清水煎汤，热甚
沸溢，自然混浊。（徐春甫）
《内经》言淋，无非湿与热而已，然有因忿怒，气动生火者；
有因醇酒浓味，酿成湿热者；有因房劳，阴虚火动者。盖肾与膀胱为表里，凡水入小肠，则通于胞行于阴而为
溺。若肾气不足，热入膀胱，致水道涩而不利，或如豆汁膏血。亦有肾虚气弱，受寒夹冷者，其候必先寒战而
后溲便。然淋有五∶石、膏、劳、热、血是也。石淋者，水为热乘，如汤瓶久在水中，底结白碱，便则茎痛里
急；膏淋者，小便有脂如膏，此因肾虚不能制液而下行也；劳淋有二，因劳倦而作者属脾虚，强力入房者属肾
虚；热淋者，三焦有热，流入于胞，溺黄而涩；血淋者，盖心主血，热盛搏血，失其常道，心与小肠为表里，
乃下流而入于胞，与便齐出，脉必数而有力。若血色黑黯，面白脉迟者，此属下元虚冷也；若小腹硬满，茎痛
欲死者，此血淤也。尿而痛者为血淋，不痛为溺血。又有气淋、冷淋、虚淋、肉淋，总不外水火不交，心肾气
郁，遂使阴阳乖舛，清浊相干，自清而浊，自柔而坚，自无形而有形。要皆一火之化，犹水煮为盐之义。治宜
开郁行滞，破血滋阴，清解邪热，调平心火。心清则小便自利，火平则血不妄行，切勿误加补剂，盖气得补则
愈胀，血得补则愈涩，热得补则愈盛矣。（《冯氏锦囊》）
淋有虚实，不可不辨。如气淋脐下妨闷，诚为气滞，法当疏利；若气虚不运者，又宜补中。血淋腹硬茎
痛，诚为死血，法当去淤；然血虚、血冷者，又当补肾。惟膏淋有精溺混浊之异，非滋阴不效；劳淋有脾肾困
败之状，非养正不除。（《证治汇补》）
淋浊二证，时医好用渗利，殊不知淋浊久不愈者，多属阴虚，而渗利在所当忌。然又不可早用补涩，盖
此证之始，未有不因于湿热下流者，补涩太早，反闭其邪而病愈甚矣。是以有积年累月不愈者，皆由治法失其
先后次第故也。（《赤水玄珠》）
书云∶淋证不可服补药，气得补而愈胀，血得补而愈涩，热得补而愈盛。此言一出，人皆以为治淋闭者，
不过渗湿、清热、利水而已。殊不知邪气蕴结膀胱者，固不可补，若气虚则渗泄之
令不行，必须参、 补气；血虚则不得滋润流通，必须归、地补血。大抵肾虚宜补肾，以四物汤加知、柏，或
煎下滋肾丸；若气虚于下而不通者，宜补而升之。虽云升补不可独用，而渗利亦不可独行，须佐使得宜为要。
况行水难免不泄肾气，渗利难免不亡津液，果是邪热蕴结，而元气未虚者，投之庶可获效。设施于虚弱之人，
未见其有成功也。（《医宗粹言》）
治淋，不可纯用寒凉伤血，不可纯用热药助火。盖寒则坚凝，热则流通，均非至当，但宜清上固下为是。
（《医学入门》）
虚淋者，肾虚精败也。童子精未盛而御女，老人阴已痿而思色，则精不出而内败，茎中涩痛成淋者，惟
《金匮》肾气汤可救。若精已竭而复耗之，则大小便牵引而痛，宜滋化源，不可误用知、柏淡渗等剂，既泻其
阳，复耗其阴也。（薛立斋）
淋病主治，而用八正、厘清、导赤等方，因热湿俱属无形，腑气为壅，取淡渗苦寒，湿去热解，腑通病解。
若房劳强忍精血之伤，乃有形败浊阻于隧道，故每溺而痛，徒进清湿热利小便无用，以溺与精同门异路耳。古
方用虎杖散者，以麝香入络通血，杜牛膝亦开通血中败浊也。（《临证指南》）
淋闭一证，《玉机微义》阐述详尽，他如河间之热，罗知悌之寒，张洁古分在气在血，严用和之五淋，陈
无择之三因，朱彦修之积痰死血，刘宗浓之肾虚火炽，分门别类，惟妇人治法尚略。妇人经未绝年，厥阴肝经
用事，肝主谋虑，妇人多郁，郁久成火，凝滞浊液，渐结成粒，名曰石淋。治用五苓、八正，淡渗利窍，于病
未尝远也。不知淡渗皆在天之阳，但能利肺气，非治有形之阴病也。肾乃肺子，淡渗过剂，肾气夺矣。阴血日
亏，郁火日炽，无阳则阴无以生，无阴则阳无以化，淡渗皆泄气而损血，血损则窍愈涩，病愈剧。当开郁火，
补阴血，兼以导气，壮者气行则愈，阴血旺，气道通，病自瘳矣，如河涸舟粘，纵用力多，未若决水之为易也。
用丹溪牛膝膏，加郁金开郁、山栀降火、生地
补阴、琥珀导气利窍则愈。（孙一奎）
妇人血淋，多由冲任经脉之病，与男子不同。（张景岳）
诸淋皆属于热，虽有冷淋，盖千百中之一也。（《医学纲目》）
石淋，须清其积热，涤其砂石，宜麦冬、木通、冬葵子、滑石、车前子、连翘、瞿麦、知母。又加味葵子
茯苓散，专治石淋之圣药。○劳淋，有脾、肾之分，劳于脾者，宜补中益气汤加车前、泽泻；劳于肾者，宜六
味汤加麦冬、五味子。○血淋，须看血色分冷热，色鲜紫者为实热，以生牛膝为主，兼用车前子、山栀、生地、
犀角、桃仁、藕汁；血虚而热者，用生地、黄芩、阿胶、柏叶；若色淤淡者，属肾与膀胱虚冷也，宜六味丸加
肉桂；若尺脉沉弦而数者，必有蓄淤，宜犀角地黄汤加紫菀、牛膝。燥利耗气之类禁用。○气淋，宜沉香、肉桂、
茯苓、泽泻，佐以木通、瞿麦、葵子、山栀、石韦。实则气滞不通，脐下妨闷，服利药不效者，沉香降气四磨
汤选用。○膏淋，精溺俱出，小便阻塞，欲出不能而痛，宜茯苓、秋石、海金砂、泽泻、滑石；如不甚痛者，须
固涩其精，宜鹿角霜、苁蓉、菟丝、莲须、芡实、山药；或桑螵蛸、菟丝等分，蜜丸，服后，以六味丸合聚精
丸调补。○冷淋，宜肾气丸加鹿茸。○热淋，烦渴引饮，宜导赤散加黄芩；躁热不渴，宜滋肾丸，或淡竹叶煎汤
调辰砂益元散。（《张氏医通》）
浊病
溺与精所出之道不同，淋证在溺道，故《纲目》列之肝胆部；浊证在精道，故列之膀胱及肾部。今患浊者，
虽便时茎中如刀割火灼，而溺自清，唯窍端时有秽物如疮脓、目眵，淋漓不断，初与溲溺不相混滥，至易辨也。
每见时医以淋法治之，五苓、八正杂投而增剧者，不可胜数，故为正之。（《证治准绳》）
小便混浊，皆属于热。如夏月天热，则水液浊浑；冬月天寒，则水液清洁，水体清而火体浊故也。如清
水火煎自浊。（刘河间）
浊证有赤、白之分，精、溺之辨。赤者多由于火，白者寒热
俱有之。由精为浊者，病在心肾；由溺为浊者，病在膀胱肝脾。○赤浊一证，有溺色之赤，有带血之赤。若见
鲜血，从溺血治。（张景岳）
思虑过度，嗜欲无穷，心肾不交，精元失守，而为赤、白二浊。赤为心虚有热，由思虑得之；白为肾虚有
寒，由嗜欲得之。（朱丹溪）
色白如泔，或如腐花腐浆，而马口不干结者，为湿；色黄赤而马口干掩者，为火。此皆为浊，胃中湿热下
流故也。浊而清者为湿，痛者湿兼热也。有溺时结块阻滞作痛，块中内蓄水泡者，此必醉酒使内，酒湿乘虚袭
入精窍也。（《张氏医通》）
精者，血之所化。有浊去多精化不及，赤未变白，故成赤浊，此虚之甚也。何以知之？有人天癸未至，强
力好色，所泄半精半血。若溺不赤，无他热证，不可以浊赤概作热治。（戴复庵）
脾气上行则运，运则为清；下行则滞，滞则成浊。故知白浊之病，由脾肾不交，土邪乘肾之虚而下溜也。
下温则上举，不升而自升之法。（程郊倩）
凡赤白浊，治须升提，若用利药，决不见效。丹溪谓∶此胃中浊气，渗入膀胱。此言深中病情。（汪双泉）
便浊，若有血块窒塞尿管，痛难溺出者，由于房劳忍精，败精离位，变成淤腐，少腹坚满，大便秘涩。治
宜两头尖、川楝子、韭白、小茴、桂枝、归尾，冲入杜牛膝汁。（叶天士）
人有交合时，忽闻雷轰，或值人至，精不得泄，变为白浊，溺管痛如针刺。人以为肾精内败，不知此乃胆
气阻塞之病也。夫胆喜泄，十一脏皆取决于胆，今胆受惊，则诸经之气皆不能外泄，所阻之精蓄于膀胱，遂变
为浊，壅塞而难出也。治当舒其胆气，少加导水之味，方用竹茹、枳实、车前子、苍术、滑石、木通、苡仁、
猪苓，名助胆导水汤。（陈士铎）
浊乃小病，亦有淹缠不愈者，皆用药无纪律故也。今将吃紧
要处，次第条陈，庶初学人有取则焉。大抵此病属湿热者为多，始缘中宫不清，以致痰浊下流，渗入膀胱。治
当审其小便痛与不痛，若小便将行而痛者，气之滞也；行后而痛者，气之陷也。若小便频数而痛，此名淋浊，
治以二陈汤加木通、山栀、升、柴；若只浊而不痛，治宜燥湿，以二陈汤加苍、白术、桔梗、升麻，提之即愈；
若久浊不痛为虚，宜补中益气汤，虚而下脱者加牡蛎、山萸涩之；久浊阴虚，腰膝酸疼者，宜六味丸，挟热者
加黄柏、知母，挟寒者加桂心、菟丝、巴戟，虚甚者加鹿茸。○曾见患白浊者，服诸药不效，一味生白果食之
即愈，以其专祛湿浊污垢故也。（孙一奎）
脉候
少阴脉数，妇人则阴中生疮，男子则气淋；盛大而实者生，虚小而涩者死。（《张氏医通》）
选案
鄞县尉耿，梦接内，患石淋十三年，痛不可忍，溺下沙石，剥剥有声，百治不效。偶得此方，一服而愈，
方用苦杖根洗净。锉一合，以水五合，煎一盏，去滓，服时冲入麝香少许。（《本草纲目》）
一人患淋证，每溺时必作战，点滴而出，用六味汤加鹿角霜治愈。（王协中）
[Nocturnal Emission]
In ordinary people, nocturnal emission can be said to be mostly due to deficiency; however, this case is caused by extreme heat, which stirs up kidney fire. Therefore, Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer) with added Gypsum (Shigao) was used, after which the emission stopped upon ingestion. Subsequently, herbs that clear fire and resolve heat were administered, followed by tonic nourishment to restore original qi. (Cheng Xinghai)
The syndrome of nocturnal emission during dreams is common among patients and is not necessarily entirely due to excessive sexual desire; most cases arise from the failure of communication between the Heart and Kidney. Whenever one exerts the mind excessively, heart fire becomes hyperactive. When heart fire is hyperactive, kidney water cannot ascend, resulting in a lack of interaction between the Heart and Kidney. Scholars who study too hard or are anxious about fame and success often suffer from this disease. Once the mind settles down, allowing Water and Fire to interact properly (Ji Ji), the disease heals itself. My late father suffered severely from this illness in his youth. Each time he took an examination, it occurred more frequently; any contact of the yang organ with objects would cause emission. He was extremely distressed and helpless, so much so that he pierced holes in his bed mat to sleep on. After passing the provincial examination as the top scholar (Jieyuan), nocturnal emissions became less frequent, and even rarer after he passed the metropolitan examination and achieved official rank. I also suffered from this in my youth. It decreased suddenly after I passed the examinations and diminished further as I aged. This confirms that this disease concerns the Mind (Shen) and cannot be blamed solely on the Kidneys. Moreover, diseases of the Mind cannot be cured by medicine alone. ○ In my prime, semen occasionally leaked from the glans penis. Initially, I was very fearful, wondering how much essence and blood the human body possesses to withstand such continuous leakage. A knowledgeable physician reassured me that it was harmless, advising against using astringent herbs or hot tonics. Instead, Liu Wei Wan (Six-Ingredient Pill with Rehmannia) was prescribed with additions of Semen Astragali Complanati (Shayuanzi), Semen Cuscutae (Tusizi), and Cortex Phellodendri (Huangbai). I set this illness aside mentally and recovered after two years of regulation. Minerals such as Dragon Bone (Longgu) and Cuttlefish Bone (Lizhike) were never ingested. Because the circulation of qi and blood in the body should be smooth and unobstructed, how can one forcibly astringe it to cause stagnation? Although temporary effects might be seen, the harm left behind is profound. Initially, I had fear, but later I felt no fatigue at all. Could it be that this leaked essence is different from the primordial essence released during intercourse, thus causing no major harm? (From *Zhe Gong Man Lu*)
[Classical Texts]
When Taiyin acts as the first Qi, the disease manifests as internal heat and distension. The Spleen is affected by accumulated dampness, leading to yellow-red urine, which may progress to strangury if severe.
When Shaoyang acts as the second Qi, wind and fire are depressed in the upper jiao. Gallbladder heat causes strangury. (*Su Wen*)
[Philosophical Remarks]
Strangury originates in the Bladder and exits through the urethral orifice. It may contain mucus or blood, exiting together with urine, leaving a sensation of emptiness. Turbidity (Zhuo) consists of spoiled essence, exiting through the seminal orifice. Although there is severe internal pain, the urine itself remains clear. It may appear before or after urination, with residual drops dripping afterward, and the tip of the penis (Makou) remains constantly moist. Distinguishing these allows for appropriate treatment methods. (Zheng Zhongguang)
Strangury has five names (Wu Lin), while turbidity distinguishes between seminal turbidity and urinary turbidity. One must examine whether the pathogen lies in the Qi level, Blood level, seminal pathway, or urinary pathway to determine its origin. Generally, pain indicates strangury, while absence of pain indicates turbidity. If Heart Yang is hyperactive and sinks downward, the Fire Fu (Bladder/Gallbladder) should be cleared and drained. If damp-heat is extreme and obstructed, the source must be thoroughly eliminated. For sinking Qi, the method of raising Yang is used. For blood stasis, formulas resolving clumps are advanced. Only when the Jueyin Liver channel suffers internal pathology is the condition most urgent: stabbing pain around the lower abdomen and anterior yin, difficulty passing even drops of urine, obstruction of meridians surrounding the genitals, and cessation of qi transformation mechanisms. Mr. [Ye Tianshi] cited Zhu Nanyang’s methods, incorporating Li Shizhen’s ideas, using slippery, unblocking, and yang-promoting agents, along with pungent and salty herbs to relieve urgency, supplemented by herbs entering collaterals along the meridian pathways, thereby expounding theories previously undeveloped. Regarding urinary turbidity, one seeks either Qi deficiency or damp-heat. Excess patterns require unblocking the urinary pathway; deficiency patterns require nourishing the Middle Jiao (Spleen/Stomach). If both excess and deficiency coexist, methods benefiting organs and unblocking fu organs are employed. Seminal turbidity generally results from damage to the Liver and Kidneys, divided into seminal stasis and seminal slipping. For seminal stasis, one must first clear the corruption in the "Palace of Separation" (referring to the reproductive system/Heart), then tonify the Kidney. For seminal slipping, consolidating and astringing methods are used; if ineffective, adjustment of True Qi is necessary. Zhang Jingyue stated that treating the formless (pathogenic factors) consolidates the formed (essence). However, knowing only to treat the Liver and Kidney ignores the subtleties of treating the Eight Extraordinary Vessels. Mr. [Ye Tianshi] cited Sun Simiao’s Nine Methods, raising Odd Yang, securing the essence collaterals, empowering the Du and Ren vessels, thereby resolving critical leakage. (*Lin Zheng Zhi Nan*)
[Strangury Disease]
The disease of strangury presents with urine resembling millet grains, tension and urgency in the lower abdomen, and pain radiating to the umbilicus. ○ Patients with strangury should not undergo sweating therapy; inducing sweat will lead to hematuria. (*Jin Gui Yao Lue*)
Strangury is classified into five types: 1. Lao Lin (Exhaustion Strangury), 2. Xue Lin (Blood Strangury), 3. Re Lin (Heat Strangury), 4. Qi Lin (Qi Strangury), 5. Shi Lin (Stone Strangury). Beyond these five, there are also Gao Lin (Mucus Strangury), Sha Lin (Sand Strangury), and Leng Lin (Cold Strangury), totaling eight types. (*Dong Yi Bao Jian*)
Heat in the bladder (Pao) boils and accumulates over days. Mildly, it congeals like fat/grease; severely, it forms sand or stones. Like a pot boiled for a long time forming white alkali residue; or like clear water boiling vigorously, becoming naturally turbid. (Xu Chunfu)
The *Nei Jing* states that strangury is nothing but dampness and heat. However, some cases arise from anger, where qi movement generates fire; some from rich wine and heavy flavors, brewing damp-heat; some from sexual exhaustion, causing yin deficiency and fire hyperactivity. The Kidney and Bladder are exterior-interior partners. Water entering the Small Intestine connects to the Pao (Bladder/Uterus), travels through the yin, and becomes urine. If Kidney Qi is insufficient, heat enters the Bladder, causing the water pathway to become涩 (astringent/stagnant) and obstructed, resembling bean juice, grease, or blood. There are also cases of Kidney deficiency and weak qi, where cold invades. Symptoms begin with chills followed by difficult urination. Thus, strangury has five types: Stone, Mucus, Exhaustion, Heat, and Blood. Stone Strangury: Water is attacked by heat, like a pot sitting in water forming bottom residue; urination causes penile pain and tenesmus. Mucus Strangury: Urine contains lipid-like substances; this is due to Kidney deficiency failing to control fluids, causing them to descend. Exhaustion Strangury has two types: caused by labor/fatigue belongs to Spleen deficiency; caused by forced intercourse belongs to Kidney deficiency. Heat Strangury: Heat in the San Jiao flows into the Pao, causing yellow, astringent urine. Blood Strangury: The Heart governs Blood; intense heat forces blood out of its normal course. The Heart and Small Intestine are exterior-interior; heat flows down into the Pao, exiting with urine. Pulse is rapid and forceful. If blood color is dark/blackish, complexion is pale, and pulse is slow, this is Lower Yuan Cold Deficiency. If lower abdomen is hard/full and penile pain is unbearable, this is Blood Stasis. Painful urination with blood is Blood Strangury; painless bleeding is Hematuria (Niao Xue). There are also Qi, Cold, Deficiency, and Flesh Stranguries, all essentially stemming from failure of Water and Fire interaction, Heart-Kidney qi depression, leading to yin-yang disharmony, mixing of clear and turbid, transforming from clear to turbid, soft to hard, formless to formed. All are transformations of Fire, like boiling water to make salt. Treatment should open depression, move stagnation, break blood stasis, nourish yin, clear evil heat, and calm Heart Fire. If the Heart is clear, urination becomes free; if Fire is calm, blood does not bleed recklessly. Do not mistakenly use tonics, as tonifying Qi worsens distension, tonifying Blood worsens astringency, and tonifying Heat increases intensity. (*Feng Shi Jin Nang*)
Strangury has excess and deficiency patterns that must be distinguished. Qi Strangury with lower abdominal oppression is indeed Qi stagnation; the method should be draining and regulating. If it is Qi deficiency failing to transport, Mid-Jiao tonification is suitable. Blood Strangury with hard abdomen and penile pain is indeed dead blood; the method should remove stasis. However, for Blood deficiency or Cold, Kidney tonification is needed. Only Mucus Strangury differs in having mixed seminal/urinary turbidity; it requires Yin nourishment to be effective. Exhaustion Strangury shows Spleen-Kidney collapse; it requires supporting Righteous Qi to eliminate. (*Zheng Hui Hui Bu*)
For both strangury and turbidity, contemporary physicians often favor diuretic-draining herbs. They do not realize that chronic strangury/turbidity often belongs to Yin deficiency, making diuretics contraindicated. However, one must not use astringents too early. Since the onset is invariably due to damp-heat flowing downward, early astringency traps the pathogen and worsens the disease. Hence, cases lasting years fail due to incorrect sequencing of treatment. (*Chi Shui Xuan Zhu*)
Books state: Strangury should not be treated with tonics; tonifying Qi worsens distension, tonifying Blood worsens astringency, tonifying Heat increases intensity. Once this saying spread, people believed treating strangury/blockage only involved draining dampness, clearing heat, and promoting urination. They did not realize that while pathogens constrained in the Bladder cannot be tonified, if Qi is deficient, the command to drain fails, requiring Ginseng (Renshen) and Astragalus (Huangqi) to tonify Qi. If Blood is deficient, lubrication and flow fail, requiring Angelica Sinensis (Danggui) and Rehmannia (Dihuang) to tonify Blood. Generally, Kidney deficiency requires Kidney tonification, using Si Wu Tang plus Anemarrhena (Zhimu) and Phellodendron (Huangbai), or Zhi Shen Wan decoction. If Qi deficiency below causes obstruction, tonification and lifting are needed. Although lifting-tonification should not be used alone, nor should diuretics be used exclusively, proper adjuvant use is key. Moreover, moving water inevitably leaks Kidney Qi; diuretics inevitably destroy Body Fluids. Only if evil heat is constrained and Original Qi is not deficient will these drugs work. Applying them to weak persons rarely succeeds. (*Yi Zong Cui Yan*)
Treating strangury, one must not purely use cold-cooling herbs that injure Blood, nor purely use hot herbs that aid Fire. Cold causes solidification; Heat promotes flow. Neither is perfect. The best approach is clearing the Upper and securing the Lower. (*Yi Xue Ru Men*)
Deficiency Strangury is Kidney deficiency with essence decay. If youths have sex before essence is full, or elderly men with impotence seek sexual gratification, essence does not exit but rots internally, causing penile astringency/pain and strangury. Only *Jin Gui* Shen Qi Wan can save such cases. If essence is exhausted and further depleted, pain radiates to large and small intestines during urination/defecation. One should nourish the Source of Transformation (Kidney/Marrow) and must not mistakenly use Anemarrhena, Phellodendron, or bland-draining agents, which drain Yang and consume Yin. (Xue Lizhai)
Main treatments for strangury use Ba Zheng San, Li Qing Yin, Dao Chi San, etc., because heat and dampness are formless, obstructing Fu Qi. Bland-draining and bitter-cold herbs remove dampness and resolve heat, unblocking the Fu organs to cure the disease. If injury comes from forced retention of essence/blood during intercourse, it is a formless敗浊 (decayed turbidity) blocking the tunnels, causing pain during urination. Simply clearing heat/dampness and promoting urination is useless because urine and essence share a gate but follow different paths. Ancient formulas use Hu Zhang San because Musk (Shexiang) enters collaterals to unblock Blood, and Achyranthes (Niuxi) opens decayed turbidity in the Blood. (*Lin Zheng Zhi Nan*)
The syndrome of strangury/blockage is detailed in *Yu Ji Wei Yi*. Others include He Jian’s Heat, Luo Zhiti’s Cold, Zhang Jiegu’s distinction of Qi/Blood, Yan Yonghe’s Five Stranguries, Chen Wuzhe’s Three Causes, Zhu Yanshou’s phlegm/dead blood, Liu Zongnong’s Kidney deficiency with blazing fire, categorized by type. Women’s treatments are still lacking. In women whose menstruation has not ceased, the Jueyin Liver channel is active. The Liver plans and schemes; women are prone to depression. Long-term depression turns to fire, condensing turbid fluids into particles, named Stone Strangury. Treatment uses Wu Ling San, Ba Zheng San, bland-draining to open orifices, which is not far from the disease. But bland-draining belongs to Heaven’s Yang, only benefiting Lung Qi, not treating formless Yin diseases. Kidney is the child of Lung; excessive bland-draining steals Kidney Qi. Yin Blood declines daily, Depressed Fire blazes daily. Without Yang, Yin cannot generate; without Yin, Yang cannot transform. Bland-draining leaks Qi and damages Blood. Damaged Blood makes orifices more astringent, worsening the disease. One should open Depressed Fire, tonify Yin Blood, and guide Qi. In robust individuals, Qi movement brings recovery; when Yin Blood is abundant and Qi pathways open, the disease heals. Like a boat stuck in a dried river, effort is futile compared to releasing water. Use Danxi Niuxi Gao, adding Curcuma (Yujin) to open depression, Gardenia (Shanzhi) to descend fire, Rehmannia (Shengdi) to tonify Yin, Amber (Hupo) to guide Qi and open orifices. (Sun Yikui)
Women’s Blood Strangury often stems from disorders of the Chong and Ren vessels, differing from men. (Zhang Jingyue)
All stranguries belong to Heat. Although Cold Strangury exists, it is one in a thousand. (*Yi Xue Gang Mu*)
Stone Strangury: Clear accumulated heat, wash away stones. Use Ophiopogon (Maidong), Azuki Bean Stem (Mutong), Winter Okra Seed (Dongkuizi), Talc (Huashi), Plantago Seed (Cheqianzi), Forsythia (Lianqiao), Knotweed (Qumai), Anemarrhena (Zhimu). Also, Jiawei Kuizi Fuling San is a holy medicine for Stone Strangury. ○ Exhaustion Strangury: Distinguish Spleen/Kidney. Spleen exhaustion: Buy Zhong Yi Qi Tang plus Cheqianzi, Ze Xie. Kidney exhaustion: Liu Wei Wan plus Maidong, Wuweizi. ○ Blood Strangury: Observe blood color to distinguish Cold/Heat. Bright purple indicates Excess Heat; use fresh Achyranthes (Sheng Niuxi) as chief, plus Cheqianzi, Shanzhi, Shengdi, Rhinoceros Horn (Xijiao - *note: substitute with Buffalo Horn in modern practice*), Peach Kernel (Taoren), Lotus Root Juice. Blood deficiency with Heat: Shengdi, Scutellaria (Huangqin), Donkey-hide Gelatin (Ejiao), Bamboo Leaf (Baye). Pale/stagnant color indicates Kidney/Bladder Cold Deficiency: Liu Wei Wan plus Cinnamon Bark (Rougui). If Chi pulse is deep, string-like, and rapid, there is likely blood stasis: Xi Jiao Di Huang Tang plus Zi Wan, Niuxi. Avoid drying/draining herbs that consume Qi. ○ Qi Strangury: Agarwood (Chenxiang), Cinnamon (Rougui), Poria (Fuling), Alisma (Zexie), assisted by Mutong, Qumai, Dongkuizi, Shanzhi, Pyracantha Leaf (Shiwei). If Excess: Qi stagnation, lower abdominal oppression, ineffective with draining meds: Chen Xiang Jiang Qi Si Mo Tang. ○ Mucus Strangury: Essence and urine both exit, urinary blockage, painful inability to pass. Use Fuling, Autumn Stone (Qiushi), Goldsand (Haijinsha), Zexie, Huashi. If pain is mild, secure essence: Deer Antler Frost (Lujiaoshuang), Cistanche (Congrong), Tusizi, Lotus Stamen (Lianxu), Euryale Seed (Qianshi), Yam (Shanyao). Or Sangpiaoxiao and Tusizi equal parts, honey pills. Afterward, regulate with Liu Wei Wan combined with Ju Jing Wan. ○ Cold Strangury: Shen Qi Wan plus Deer Antler (Lurong). ○ Heat Strangury: Restlessness/thirst drinking water: Dao Chi San plus Huangqin. Restlessness/no thirst: Zhi Shen Wan, or Chen Sha Yi Yuan San mixed with Light Bamboo Leaf (Dan Zhuye) decoction. (*Zhang Shi Yi Tong*)
[Turbidity Disease]
The pathways for urine and essence differ. Strangury is in the urinary pathway, hence listed in Liver/Gallbladder sections in *Gang Mu*; Turbidity is in the seminal pathway, hence listed in Bladder/Kidney sections. Patients with Turbidity experience burning/stabbing pain in the penis during urination, yet urine remains clear. Only the orifice tip occasionally discharges foul matter like pus or eye discharge, dripping continuously, initially not mixing with urine, making it easy to distinguish. Often, contemporary doctors treat it as strangury, indiscriminately using Wu Ling San and Ba Zheng San, worsening the condition. This corrects that error. (*Zheng Zhi Zhun Sheng*)
Cloudy urine all belongs to Heat. In summer heat, water fluids become turbid; in winter cold, they remain clear. Water body is clear, Fire body is turbid. Thus, boiling clear water with fire naturally makes it turbid. (Liu Hejian)
Turbidity is divided into Red and White, distinguishing seminal vs. urinary origin. Red is mostly due to Fire; White involves both Cold and Heat. Turbidity from essence indicates disease in Heart/Kidney; turbidity from urine indicates disease in Bladder/Liver/Spleen. ○ Red Turbidity includes red urine color and blood-streaked red. If bright blood is seen, treat as Hematuria. (Zhang Jingyue)
Excessive thinking, endless desires, Heart-Kidney non-interaction, loss of guarding of Essence, leads to Red and White Turbidity. Red is Heart deficiency with Heat, caused by overthinking; White is Kidney deficiency with Cold, caused by lust. (Zhu Danxi)
White like rice water, or rotten flowers/sludge, with dry/non-crusted Makou indicates Dampness. Yellow-red with dry/crusted Makou indicates Fire. Both are Turbidity, caused by Stomach damp-heat flowing downward. Turbid but clear is Dampness; painful is Dampness combining with Heat. If blocks form during urination causing pain, with water blisters inside, this is surely due to drunken intercourse, where alcohol-dampness invaded the seminal orifice via deficiency. (*Zhang Shi Yi Tong*)
Essence is transformed from Blood. If turbid discharge is excessive and essence transformation cannot keep up, red does not turn white, resulting in Red Turbidity, indicating severe deficiency. How do we know? Some youths whose Tian Gui (menstrual/seminal maturity) has not arrived, forcing themselves into lust, ejaculate half-essence half-blood. If urine is not red and no other heat signs exist, one cannot generalize red turbidity as always Heat. (Dai Fu’an)
Spleen Qi ascending transports and clears; descending stagnates and becomes turbid. Thus, White Turbidity arises from Spleen-Kidney non-interaction, Earth pathogen exploiting Kidney deficiency to flow downward. Warming the lower lifts the upper; this is the method of rising without forcing. (Cheng Jiaoqian)
For all Red/White Turbidity, treatment requires lifting. Using draining herbs will definitely fail. Danxi said: This is turbid Qi from the Stomach seeping into the Bladder. This insight deeply hits the pathology. (Wang Shuangquan)
Urinary turbidity, if blood blocks the urethra, causing pain and difficult urination, results from sexual labor with retained essence. Spoiled essence leaves its place, becoming stasis/rot, causing hard/full lower abdomen and constipation. Treatment uses Liang Tou Jian, Sichuan Chinaberry (Chuanlianzi), Leek White (Jiu Bai), Fennel (Xiaohui), Cinnamon Twig (Guizhi), Angelica Tail (Guiwei), mixed with Achyranthes (Du Niuxi) juice. (Ye Tianshi)
During intercourse, if startled by thunder or someone arriving, essence cannot release, turning into White Turbidity, with urethral pain like needles. People think Kidney essence rots internally, but this is actually Gallbladder Qi obstruction. The Gallbladder likes to vent; all eleven Zang-Fu depend on the Gallbladder. Now, the Gallbladder is frightened, so Qi of all channels cannot vent outward. Retained essence accumulates in the Bladder, turning to turbidity, blocking and difficult to exit. Treatment should soothe Gallbladder Qi, add a little water-guiding flavor. Formula: Bamboo Sheath (Zhuru), Immature Orange (Zhishi), Cheqianzi, Atractylodes (Cangzhu), Talc (Huashi), Mutong, Coix Seed (Yiren), Polyporus (Zhuling). Named Zhu Dan Dao Shui Tang. (Chen Shiduo)
Turbidity is a minor disease, yet sometimes lingers uncured due to undisciplined medication. Here are the key points sequentially arranged for beginners. Mostly, this disease belongs to Damp-Heat, originating from unclear Central Palace (Spleen/Stomach), causing Phlegm-Turbidity to flow downward and seep into the Bladder. Treatment must assess pain during urination. Pain before urination indicates Qi stagnation; pain after urination indicates Qi sinking. Frequent painful urination is called Lin-Zhuo, treated with Er Chen Tang plus Mutong, Shanzhi, Sheng Ma, Chai Hu. Only turbidity without pain: Dry Dampness, Er Chen Tang plus Cang Zhu, Bai Zhu, Jiegeng, Shengma; lifting cures it. Chronic turbidity without pain is Deficiency: Buy Zhong Yi Qi Tang. If sinking/depletion, add Oyster Shell (Muli), Cornus (Shanzhuyu) to astringe. Chronic turbidity with Yin deficiency, sore waist/knees: Liu Wei Wan. With Heat: add Huangbai, Zhimu. With Cold: add Rougui, Tusizi, Morinda (Ba Ji). Severe deficiency: add Deer Antler (Lurong). ○ I once saw a patient with White Turbidity who failed all medicines, but eating raw Ginkgo nuts (Baiguo) cured him instantly, as it specifically removes damp-turbidity filth. (Sun Yikui)
[Pulse Diagnosis]
Shaoyin pulse rapid: Women get ulcers in the vagina; Men get Qi Strangury. Large/solid/excess pulse indicates survival; small/weak/astringent pulse indicates death. (*Zhang Shi Yi Tong*)
[Selected Cases]
Geng, Magistrate of Yin County, dreamed of intercourse, suffered Stone Strangury for 13 years, unbearable pain, sand/stones passed in urine with rattling sound, hundred treatments failed.偶然ly obtained this formula, cured in one dose. Formula: Washed Kuzhang Gen (Root of Polygonum multiflorum or similar). Chop one he, boil in five he of water to one liter, strain, take with a little Musk (Shexiang) mixed in. (*Ben Cao Gang Mu*)
One patient with Strangury, shaking/chills every time urinating, dropping by drop, cured with Liu Wei Wan plus Deer Antler Frost (Lujiaoshuang). (Wang Xiezho ng)