吴茭山治一妇。患淋数而疼痛。身烦躁。医以热淋治之。用八正散、连子饮。服之愈剧
吴诊脉沉数无力。知气与火转郁于小肠故也。遂与木通、 节、车前子、淡竹叶、麦
冬、灯心、甘草梢、腹皮之类。服之而安。盖小肠乃多气少血之经。今病脉系气郁。反用大
黄、栀、芩味浓苦寒之药。寒极伤气。病转加矣。不知血中有热者。乃有形之热。为实热也
气中有热。乃无形之热。为虚热也。凡气中有热者。当行清凉薄剂。无不获效。更分气血
多少之经。辨温凉浓薄之味。审察病机。斯无失也。
中书右丞合剌合孙。病小便数而少。日夜约二十余行。脐腹胀满。腰脚沉重。不得安卧
至元癸未季春。罗谦甫奉旨诊之。脉沉缓。时时带数。常记小便不利者有三。不可一例而
论。若津液偏渗于肠胃。大便泄泻而小便涩少。一也。宜分利而已。若热抟下焦津液。则热
涩而不行。二也。必渗泄则愈。若脾胃气涩。不能通利水道。下输膀胱而化者。三也。可顺
气令施化而出也。今右丞平素膏粱湿热内蓄。不得施化。膀胱窍涩。是以起数而见少也。当
须缓之泄之。必以甘淡为主。遂用茯苓为君。滑石甘寒。滑以利窍。猪苓、琥珀之淡。以渗
泄而利水道。三味为臣。脾恶湿。湿气内蓄。则脾气不治。益脾胜湿。必用甘为助。故以甘
草、白术为佐。咸入肾。咸味下泄为阴。泽泻之咸以泻伏水。肾恶燥。急食辛以润之。津液
不行。以辛散之。桂枝味辛。散湿润燥。此为因用。故以二物为使。煎用长流甘澜水。使下
助其肾气。大作汤剂。令直达于下而急速也。两服减半。旬日良愈。
震按前两案论治淋道理。最为明白晓畅。后两案乃淋证别因。虽由问而知之。而唐公之
灵悟。更不可及。
罗又治刘太保淋疾。刘问曰。近夏月来。同行人多有淋证。气运使然。抑水土耶。罗曰
此间别无所患。独公有之。殆非气运水土使然。继问公近来多食何物。曰。宣使赐木瓜百
余对。遂多蜜煎之。每客至。以此待食。日三五次。曰。淋由此也。内经曰。酸多食之。令
人癃。夺饮则已。曰。醋味致淋。其理安在。曰。小便主气。经云。酸入于胃。其气涩以收
上之两焦。弗能出入也。不出则留胃中。胃中和温。则下注膀胱之胞。胞薄以懦。得酸则
缩蜷。约而不通。水道不行。故癃而涩。乃作淋也。果如言而愈。
唐与正治吴巡检。病不得前溲。卧则微通。立则不能涓滴。医遍用通小肠药。不效。唐
因问吴。常日服何药。曰。常服黑锡丹。问何人结砂。曰。自为之。唐洒然悟曰。是必结砂
时铅不死。硫黄飞去。铅砂入膀胱。卧则偏重。犹可溲。立则正塞水道。以故不能通。令取
金液丹三百粒。分为十服。煎瞿麦汤下之。膀胱得硫黄。积铅成灰。从水道下。犹累累如细
砂。病愈。
丹溪治一老人。因疝疼二十年。多服苍术、乌、附等药。疝稍愈。又患淋十余年。其间
服硝、黄诸淋药。不效。忽项右边发一大疽。连及缺盆。不能食。淋痛愈甚。叫号困惫。时
当六月。脉短涩。左微似弦。皆前乌、附积毒所致。凝积滞血。蓄满膀胱。脉涩为败血。短
为血耗。忍痛伤血。叫号伤气。知其溺后有如败脓者。询之果然。遂先治淋。令多取土牛膝
根茎叶浓煎汤。并四物汤大剂与之。三日痛与败脓渐减。五七日渐止。疮势亦定。盖四物能
生血也。但食少。疮未收敛。用四物加参、 、白术熬膏。以陈皮、半夏、砂仁、木香煎取
清汁。调膏与之。逐渐能食。一月疮安。
震按土牛膝汁。治血淋最效。以其能疏通滞血也。脉涩者。更宜之。丹溪合四物同
用。因脉兼短耳。即不短。亦宜之。涩为血瘀。亦主血虚也。
〔附〕周慎斋治一人年老。因入房忍而不泄。小便不利。诸药不效。此肾虚而气滞血凝
也。用土牛膝捣汁。酒服二碗。小便出物长三寸长六寸者二虫而愈。
丹溪又治一男子。患淋久。囊大如球。茎如槌。因服利药多。痛甚。脉微弱如线。以参
、归、术加肉桂、元胡各一钱。木通、山栀、赤芍、赤茯苓、甘草梢等药。一服痛稍减
二服不溲利。四服愈。
薛立斋治大尹刘天锡。内有湿热。大便滑利。小便涩滞。服淡渗之剂。愈加滴沥。小腹
腿膝皆肿。两眼胀痛。此肾经虚热在下焦。淡渗导损阳气。阴无以化。遂用地黄滋肾二丸。
小便如故。更以补中益气。加麦冬、五味。兼服而康。
震按服利药既多。脉微弱如线。法必宜补矣。犹兼延胡、赤芍、木通、赤苓、山栀等利
血利水药者。以其证仍痛甚也。可见淋证宜利者多。惟薛案所叙病因病情。必该用所用三方
其合滋肾丸者。以小便仍涩滞也。若果阳虚脉微。又当用金匮肾气丸。与知、柏不宜。至
如叶氏治淋。有虎杖、麝香、大黄、牵牛、两头尖、威喜丸、连、柏、胆、荟、参、茸、八
味等方。较薛氏法多而且备矣。
孙东宿治丁耀川令堂。年四十四。常患胃脘痛。孀居茹素十五年。七月中。触于怒。吐
血碗许。不数日平矣。九月又怒。吐血如前。加腹痛。至次年二月。忽里急后重。肛门大疼
两胯亦痛。小便短涩。出惟点滴。痛不可言。腰与小腹之热。如滚汤泡。日惟仰卧不能侧
一侧则左胯并腿痛甚。小便疼。则肛门之痛减。肛门疼。则小便之痛减。遇惊恐。则下愈
坠而疼。经不行者两月。往常经来时。腰腹必痛。下紫黑血块甚多。今又白带如注。口渴。
通宵不寐。不思饮食。多怒。面与手足虚浮。喉中梗梗有痰。肌肉半消。孙诊之。脉仅四至
两寸软弱。右关滑。左关弦。两尺涩。据脉。上焦气血不足。中焦有痰。下焦气凝血滞。郁
而为火。盖下焦之疾。肝肾所摄。腰胯乃肝之所经。而二便乃肾之所主也。据证面与手足虚
浮。则脾气极弱。饮食不思。则胃气不充。不寐由过于忧愁思虑而心血不足。总为七情所伤
故耳。内经云。二阳之病发心脾。女子不月。此病近之。且值火令当权之候。诚可虑也。所
幸者脉尚不数。声音清亮耳。因先为开郁清热。条达肝气。保过夏令后。再为骤补阴血。必
戒绝怒气。使血得循经。方可获生也。初投当归龙荟丸。以撤下部之热。继以四物汤、胆草
知、柏、柴胡、泽兰煎吞滋肾丸。连服四日。腰与小腹之热始退。后以香薷、石苇、胆草
桃仁、滑石、杜牛膝、甘草梢、柴胡煎吞滋肾丸。大小便痛全减。
东宿曰。族侄孙伍仲。三十岁。善饮好内。小便血淋疼痛。予以滑石、甘草梢、海金沙
琥珀、山栀、青蒿。以茅草根煎膏为丸。每晨灯心汤送三钱而愈。后五年。因子迟。服补
下元药过多。血淋又发。小便中痛极。立则不能解。必蹲下如妇女状。始能解出。皆大血块
每行一二碗许。诸通利清热药。遍尝不应。脉俱洪数。予以五灵脂、蒲黄、甘草梢各二钱
小蓟、龙牙草各三钱。二帖而痛减半。血仍旧。改用瞿麦、山栀、甘草梢各二钱。茅根、
杜牛膝、车前草叶各三钱。生地、柴胡、川柏、木通各一钱。四帖痛全减。血全止。惟小便
了而不了。六脉亦和缓不似前矣。后以四君子加葛根、青蒿、白芍、升麻、知、柏。调理万
全。
震按上条不用补。次条不用养阴。认证最清。设效立斋景岳。狃于归脾汤补中益气六味
生脉者。必为二证之戈矛矣。
又治李寅斋。患血淋几二年不愈。每发十余日。小水艰涩难出。窍痛不可言。将发。必
先面热牙疼。后则血淋。前数日饮汤水。欲温和。再二日欲热。又二日。非冷如冰者不可。
烦渴之甚。每连饮井水二三碗。其未发时。大便燥结。四五日一行。发则泻而不实。脉左寸
短弱。关弦大。右寸下半指与关皆滑大。两尺俱洪大。据此中焦有痰。肝经有瘀血也。向服
滋阴降火。及淡渗利窍之剂。皆无效。且年六十有三。病已久。血去多。何可不兼补治。当
去
瘀生新。提清降浊。用四物汤加杜牛膝补新血。滑石、桃仁消其瘀血。枳实、贝母以化痰。
山栀仁以降火。柴胡升提清气。二十帖而诸证渐减。再以滑石、知母、黄柏各一两。琥珀、
小茴、肉桂各一钱五分。元明粉三钱。海金沙。没药各五钱。茅根汁熬膏为丸。每服一钱。
空心及晚。茅根汤送下而愈。
又治祝芝岗秀才。每喜酒后御女。行三峰采战对景忘情之法。致成血淋。自仲夏至岁杪
未愈。便下或红或紫。中有块如筋膜状。或如苏木汁色。间有小黑子。三五日一发。或劳心
或劳力。或久立坐亦发。百治不效。东宿观其色白而清。肌肉削甚。诊其脉左寸沉弱。关
尺弦细。右寸略滑。据此。必肺经有浊痰。肝经有瘀血。总由酒后竭力纵欲。淫火交煽。精
离故道。不识澄心调气。摄精归源之法。以致凝滞经络。流于溺道。故新血行至。被阻塞而
成淋浊也。三五日一至者。盈科则溢耳。先与丹参、茅根浓煎服。小便以瓦器盛之。少顷即
成金色黄沙。乃用肾气丸加琥珀、海金沙、黄柏。以杜牛膝连叶捣汁熬膏为丸调理。外以川
芎三钱。当归七钱。杜牛膝草根煎服。临发时。用滑石、甘草梢、桃仁、海金沙、麝香为末
以韭菜汁、藕汁调服。去其凝精败血则新血始得归原。而病根可除矣。三月全愈。
震按前案云。何不可兼补治。而所谓补者。不过四物汤耳。其余则皆消瘀及清利药也。
次方知、柏各一两。小茴、肉桂各钱半。即滋肾丸意。而重用滑石、元明粉、没药、海金沙
为佐。茅根汁为丸。仍是清利兼消瘀。以六旬之老。二年之久。治法如此。信乎血淋之宜通
不宜补矣。后案用肾气丸加黄柏、琥珀、海金沙。以杜牛膝汁熬膏为丸。是于温补下元药中
佐清利湿热疏通瘀窍之法。较前案稍异。而煎方之芎、归、杜牛膝。末药之滑石、金沙、
桃仁、麝香、韭汁、藕汁。仍是行瘀通窍。并无参、 、熟地等药。大旨约略可见。
李士材治邑宰严知非。患淋经年。痛如刀锥。凡清火疏利之剂。计三百帖。病势日甚。
至岁暮。李诊之曰。两尺数而无力。是虚火也。从来医者皆泥痛无补法。愈疏通则愈虚。愈
虚则虚火愈炽。遂以八味丸料加车前、沉香、人参。服八剂。痛减一二。而频数犹故。原医
者进云。淋证作痛。定是实火。若多温补。恐数日后。必将闷绝不可救矣。知非疑惧。复来
商之。李曰。若不宜温补。则服药后病势必增。今既减矣。复何疑乎。朝服补中益气汤。晚
服八味丸。逾月而病去其九。更倍用参、 。十四日而霍然。
张路玉治太史沈韩倬。患膏淋。小便频数。昼夜百余次。昼则滴沥不通。时如欲解。痛
似火烧。夜虽频迸而所解倍常。溲中如脂如涕者甚多。先曾服清热利水药。半月余。其势转
剧。面色痿黄。饮食艰进。张诊之。脉得弦细而数。两尺按之益坚。而右关涩大少力。此肾
水素亏。加以劳心思虑。肝木乘脾所致。法当先实中土。使能堤水。则阴火不致下溜。清阳
得以上升。气化通而疼涩瘳矣。若用清热利水。则气愈陷而精愈脱。溺愈不通耳。乃定补中
益气汤。用人参三钱。服二剂。痛虽少减。而病者求其速效。改进四苓散加知母、门冬、沙
参、花粉。甫一服。彻夜痛苦倍甚。于是专服补中益气兼六味丸。用紫河车熬膏代蜜调理。
服参尽斤余而安。
震按淋证。如孙东宿之治法。经也。此二案之治法。权也。经权合宜。皆审脉以为辨。
庄子曰。匠石觉而诊其梦。梦何以诊。诊之为言审也。向来但云诊脉。未达诊字之义。不知
善诊。即是善审。审得明白。病自显然。推之望闻问切。素称四诊。可见四件都要细审也。
Yu Zhen's compilation of *Gujin Yi'an An* (Records of Medical Cases Ancient and Modern) regarding "Five Types of Lin Syndrome":
Wu Jiaoshan treated a woman suffering from frequent urination with pain, accompanied by bodily restlessness. The physician diagnosed it as Heat-Lin syndrome and prescribed Bazheng San (Eight-Positive Powder) and Lianzi Yin (Lotus Seed Decoction). After taking the medicine, her condition worsened.
Wu Jiaoshan palpated her pulse, finding it deep, rapid, and deficient in strength. He determined that Qi and Fire were constrained in the Small Intestine channel. Consequently, he prescribed Tongcao (Akebia Stem), Cheqianzi (Plantago Seed), Danzhuye (Lophatherum Leaf), Maidong (Ophiopogon Tuber), Dengxincao (Juncus Effusus), Gancaoshao (Licorice Root Tip), and Fupi (Tangerine Peel). The patient's condition stabilized after taking the medicine. This is because the Small Intestine is a channel abundant in Qi but deficient in Blood. In this case, the pulse indicated Qi constraint; however, heavy, bitter-cold herbs like Dahuang (Rhubarb Rhizome), Zhizi (Gardenia Fruit), and Huangqin (Scutellaria Root) were used instead. Extreme cold damages Qi, thereby aggravating the disease. It is crucial to understand that heat within Blood is tangible heat, constituting Excess-Heat; whereas heat within Qi is intangible heat, constituting Deficiency-Heat. For cases involving heat in Qi, light and cooling formulas should be employed, which invariably prove effective. One must differentiate channels based on their abundance or deficiency of Qi and Blood, discern the properties of herbs regarding warmth/coolness and heaviness/lightness, and carefully examine the pathogenesis to avoid errors.
Helahesu Sun, Vice Minister of Central Secretariat, suffered from frequent urination with scanty output, occurring approximately twenty times day and night. He experienced abdominal distension and fullness, heaviness in the waist and legs, and inability to lie down comfortably.
In the third month of the Guiwei year of the Zhiyuan era, Luo Qianfu was commissioned to diagnose him. The pulse was deep, slow, and occasionally rapid. Luo often recalled that there are three types of difficulty in urination, which cannot be treated uniformly. First, if body fluids shift preferentially to the intestines and stomach, causing diarrhea and scanty, obstructed urine, this type requires diaphoretic and draining methods. Second, if heat binds with body fluids in the Lower Jiao, causing heat-obstruction and immobility, this type requires渗泄 (osmotic drainage) for recovery. Third, if Spleen and Stomach Qi is stagnant, failing to facilitate water passages and transform fluids for bladder excretion, this type requires promoting Qi movement to enable transformation and excretion. Currently, the Vice Minister has accumulated damp-heat from rich food internally, failing to transform it, leading to obstruction in the bladder orifice, hence the frequency and scantiness. Treatment should involve gentle draining, primarily using sweet and bland flavors. Fu Ling (Poria) was used as the Sovereign herb. Huashi (Talcum) is sweet and cold, facilitating orifices through slipperiness; Zhuling (Polyporus) and Hupo (Amber) are bland, facilitating osmotic drainage and water passages. These three served as Ministers. The Spleen dislikes dampness; internal accumulation of dampness impairs Spleen function. To benefit the Spleen and overcome dampness, sweet flavors are necessary as assistants. Thus, Gancao (Licorice Root) and Baizhu (Atractylodes Macrocephala Rhizome) were used as Assistant herbs. Salty flavors enter the Kidney; salty taste drains downward and belongs to Yin. Zexie (Alisma Rhizome) uses its salty nature to drain retained water. The Kidney dislikes dryness; urgent consumption of pungent flavors moistens it. When body fluids fail to circulate, pungent flavors disperse them. Guizhi (Cinnamon Twig) is pungent, dispersing dampness and moistening dryness, serving as a specific application. Therefore, these two were used as Envoy herbs. The decoction utilized long-flowing Ganlan Water (Agitated Water) to assist Kidney Qi below. Prepared as a strong decoction to reach the lower part rapidly. After two doses, symptoms halved; fully recovered within ten days.
Yu Zhen commented: The principles of treating Lin syndrome discussed in the first two cases are the most clear and lucid. The latter two cases present alternative etiologies for Lin syndrome, known through inquiry, yet Lord Tang's intuitive insight remains unsurpassable.
Luo Qianfu also treated Liu Taibao's Lin disease. Liu asked, "Recently in summer, many companions have developed Lin syndrome. Is this due to Qi dynamics or local water and soil?" Luo replied, "There are no other illnesses here, only yours. It is likely not caused by Qi dynamics or environment." He then asked what Liu had been eating recently. Liu answered, "The envoy gifted over a hundred pairs of Papayas, which I preserved in honey. I served this to guests daily, three to five times." Luo said, "Lin arises from this. The *Neijing* states: 'Excessive sour intake causes retention of urine (Long). Ceasing intake resolves it.'" Asked why vinegar/sour flavors cause Lin, Luo explained, "Urine governs Qi. As stated in the classics: 'Sour enters the Stomach, its Qi is astringent and收 (collects) upwards to the Upper and Middle Jiao, unable to exit or enter.' If it does not exit, it remains in the Stomach. The Stomach's warmth causes it to descend into the Bladder's sac. The sac is thin and weak; upon contact with sour flavors, it contracts and curls, becoming constricted and obstructed, blocking water passages, thus causing Long (retention) and涩 (obstruction), manifesting as Lin." Indeed, the patient recovered as predicted.
Tang Yuzheng treated Wun Xunjian, who suffered from inability to urinate while standing, though slight flow occurred when lying down. Physicians repeatedly prescribed herbs to unblock the Small Intestine without effect. Tang asked what medication Wun took daily. Wun replied, "I regularly consume Heixi Dan (Black Tin Pill)." Tang asked who compounded it. Wun said, "Myself." Tang suddenly realized, "This must be due to incomplete calcination during pill preparation; lead remained while sulfur volatilized. Lead particles entered the bladder. When lying down, weight shifts, allowing some flow; when standing, they block the orifice directly, preventing passage." He ordered 300 grains of Jin Ye Dan (Golden Fluid Pill), divided into ten doses, taken with Qumai Decoction. The sulfur in the bladder dissolved the accumulated lead into ash, which passed through the urinary tract like fine sand. The disease was cured.
Zhu Danxi treated an elderly man who had suffered from Hernia pain for twenty years, having taken numerous doses of Cangzhu (Atractylodes Rhizome), Wutou (Aconite Lateral Root), and Fuzi (Prepared Aconite Root). The hernia improved slightly, but he subsequently developed Lin syndrome for over ten years, taking various Lin remedies containing Xiaoshi (Niter) and Dahuang (Rhubarb) without success. Suddenly, a large carbuncle erupted on the right side of his neck, extending to the collarbone, preventing eating, and worsening Lin pain, accompanied by groaning and exhaustion. It was June. The pulse was short and choppy, with the left side slightly wiry. All were attributed to accumulated toxicity from previous Wu Tou and Fu Zi usage. Congealed stagnant blood filled the bladder. Choppy pulse indicates decaying blood; short pulse indicates blood depletion. Enduring pain injures blood; groaning injures Qi. Knowing that post-urination discharge resembled pus, confirmation revealed this to be true. Treatment initially focused on Lin. He instructed taking thick decoctions of Tudunxi (Horseherb) roots, stems, and leaves, combined with a large dose of Siwu Tang (Four Substances Decoction). Pain and pus-like discharge gradually decreased over three days, stopping completely within five to seven days, and the wound condition stabilized. This is because Siwu Tang generates Blood. However, due to poor appetite and unhealed wounds, he prescribed Siwu Tang supplemented with Renshen (Ginseng Root), Huangqi (Astragalus Root), and Baizhu (Atractylodes Rhizome) boiled into a paste, mixed with clear juice extracted from Chenpi (Tangerine Peel), Banxia (Pinellia Tuber), Sharen (Amomum Fruit), and Muxiang (Vladimiria Root). Gradually, appetite returned, and the wound healed within a month.
Yu Zhen commented: Tudunxi juice is most effective for Blood-Lin due to its ability to unblock stagnant blood. It is particularly suitable for choppy pulses. Zhu Danxi combined it with Siwu Tang because the pulse was also short. Even if not short, it remains appropriate. Choppy indicates Blood stasis, but can also indicate Blood deficiency.
[Appendix] Zhou Shenzhai treated an elderly man who, after holding back ejaculation during intercourse, suffered from difficult urination unresponsive to all medicines. This was Kidney Deficiency with Qi stagnation and Blood coagulation. He prescribed fresh juice of Tudunxi (Horseherb) taken with wine, two bowls. Two worms, three inches and six inches long respectively, were passed in urine, and the patient recovered.
Zhu Danxi also treated a male patient suffering from chronic Lin syndrome, resulting in a scrotum enlarged like a ball and penis swollen like a club. Due to excessive use of draining herbs, pain was severe, and the pulse was faint and thread-like. He prescribed Renshen (Ginseng Root), Danggui (Angelica Sinensis Root), Baizhu (Atractylodes Rhizome), plus Rougui (Cinnamon Bark) and Yanhusuo (Corydalis Rhizome), each 1 qian, along with Mutong (Akebia Stem), Shanzhi (Gardenia Fruit), Chishao (Red Peony Root), Chifuling (Red Poria), and Gancaoshao (Licorice Root Tip). Pain subsided slightly after one dose; urination remained difficult after two doses; fully recovered after four doses.
Xue Lizhai treated Dayin Liu Tianxi, who had internal damp-heat, loose stools, and obstructed urination. After taking bland-draining agents, dribbling worsened, accompanied by swelling in the lower abdomen, legs, and knees, and distending pain in the eyes. This was Deficient-Heat in the Kidney channel affecting the Lower Jiao; bland-draining damaged Yang Qi, leaving Yin unable to transform. He prescribed Dizhi Zishen Wan (Two Pills for Nourishing the Kidney with Rehmannia). Urination normalized. Subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry). Combined administration led to recovery.
Yu Zhen commented: After extensive use of draining drugs and a faint, thread-like pulse, tonification was clearly indicated. Yet, herbs like Yanhusuo, Chishao, Mutong, Chifuling, and Shanzhi (blood-moving and water-draining) were included because severe pain persisted. This shows that Lin syndrome often benefits from draining. Only in Xue's case, considering the etiology and pathology, were the three formulas appropriately selected. The combination with Zishen Wan was due to persistent obstructed urination. If Yang Deficiency with a faint pulse were present, Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) would be appropriate, avoiding Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark). Regarding Ye's treatment of Lin, formulas include Huzhang (Polygonum Cuspidatum Rhizome), Shexiang (Musk), Dahuang (Rhubarb), Qianniu (Morning Glory Seed), Liangtoujian (Saussurea Root), Weixi Wan (Weixi Pill), Lianqiao (Forsythia Fruit), Huangbai (Phellodendron Bark), Danning (Bitter Orange), Luhui (Aloe), Renshen (Ginseng), Rongsu (Deer Antler), and Bawei Wan (Eight-Ingredient Pill). These are more numerous and comprehensive than Xue's methods.
Sun Dongsu treated the mother of Ding Yaochuan, aged forty-four, who frequently suffered from epigastric pain. Having lived as a widow and vegetarian for fifteen years, in mid-July, anger triggered vomiting of about a bowl of blood, resolving within days. In September, another episode of anger caused similar bleeding with added abdominal pain. By February of the next year, she suddenly experienced tenesmus, severe anal pain, and pain in both hips. Urine was scanty and obstructed, passing only drops, with unbearable pain. Heat in the waist and lower abdomen felt like boiling water. She could only lie supine; turning to either side caused severe pain in the left hip and leg. Pain in urination reduced anal pain, and vice versa. Fear or surprise caused further prolapse and pain. Menstruation had ceased for two months. Previously, menstruation was accompanied by waist and abdominal pain with passage of many dark purple blood clots. Now, leukorrhea flowed profusely. She was thirsty, sleepless all night, anorexic, irritable, with puffy face and extremities, globus sensation with phlegm in throat, and significant muscle wasting. Sun palpated the pulse: only four beats per breath, weak and soft at both Cun positions, slippery at Right Guan, wiry at Left Guan, and choppy at both Chi positions. Based on the pulse: Upper Jiao Qi and Blood deficiency; Middle Jiao Phlegm; Lower Jiao Qi stagnation and Blood stasis, transforming into Fire. Diseases of the Lower Jiao are governed by Liver and Kidney; hips/waist are Liver channels; urination/defecation are Kidney functions. Facial/extremity puffiness indicates extreme Spleen Qi weakness; anorexia indicates Stomach Qi insufficiency; insomnia results from excessive worry/thought depleting Heart Blood. Overall, this is injury from Seven Emotions. The *Neijing* states: "Diseases of the Two Yangs originate in Heart and Spleen; women experience amenorrhea." This case aligns closely. Moreover, it occurs during the peak of Fire season, warranting concern. Fortunately, the pulse is not rapid, and voice is clear. Initially, he promoted depression resolution and heat clearing, smoothing Liver Qi, preserving health through summer before abruptly tonifying Yin and Blood. Strict avoidance of anger was required to allow blood to follow meridians for survival. Initially, Danggui Longhui Wan (Angelica and Gardenia Pill) was given to withdraw heat from the lower part. Subsequently, Siwu Tang (Four Substances Decoction) combined with Longdancao (Gentian Root), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Chaihu (Bupleurum Root), and Zelán (Leonurus Herba), swallowed with Zishen Wan (Kidney-Nourishing Pill), taken for four days, until heat in waist and lower abdomen subsided. Later, Xiangru (Elsholtzia Herb), Shiwei (Pyrrosia Leaf), Longdancao (Gentian Root), Taoren (Peach Kernel), Huashi (Talcum), Dununiuxi (Dipsacus Root), Gancaoshao (Licorice Root Tip), and Chaihu (Bupleurum Root) decocted, swallowed with Zishen Wan, completely relieved pain in urination and defecation.
Sun Dongsu stated: My clan nephew Sun Wuzhong, aged thirty, fond of drinking and sexual activity, suffered from Hematuria-Lin with pain. I prescribed Huashi (Talcum), Gancaoshao (Licorice Root Tip), Haijinsha (Lygodium Spore), Hupo (Amber), Shanzhi (Gardenia Fruit), Qinghao (Artemisia Annua Herb), made into pills with Mugen (Imperata Rhizome) paste. Taken with Dengxincao (Juncus Effusus) tea every morning, three qian, cured. Five years later, due to delayed conception, excessive intake of Kidney-tonifying herbs triggered recurrence of Hematuria-Lin. Severe pain in urination prevented standing voiding; squatting like a woman was necessary. Large blood clots, one to two bowls per passage. Various clearing-heat and draining herbs failed. Pulse was surging and rapid. I prescribed Wulingzhi (Trogopterus Dung), Puhuang (Typha Pollen), Gancaoshao (Licorice Root Tip), each 2 qian; Xiaoji (Cirsium Root), Longyacao (Agrimony Herb), each 3 qian. After two doses, pain halved, but bleeding continued. Changed to Qumai (Persicaria Herb), Shanzhi (Gardenia Fruit), Gancaoshao (Licorice Root Tip), each 2 qian; Mugen (Imperata Rhizome), Dununiuxi (Dipsacus Root), Cheqiancaoye (Plantago Leaf), each 3 qian; Shengdi (Rehmannia Root), Chaihu (Bupleurum Root), Chuanbai (Phellodendron Bark), Mutong (Akebia Stem), each 1 qian. After four doses, pain ceased completely, bleeding stopped. Only the sensation of incomplete voiding remained; six pulses became harmonious and slow. Finally, Sizijunzi Tang (Four Gentlemen Decoction) supplemented with Gegen (Kudzu Root), Qinghao (Artemisia Annua Herb), Baishao (White Peony Root), Shengma (Cimicifuga Rhizome), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark) was used for complete regulation.
Yu Zhen commented: The first case avoided tonification; the second avoided Yin-nourishment. Diagnosis was precise. Had they followed Lizhai or Jingyue, relying on Guipi Tang (Restore the Spleen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), or Shengmai San (Generate the Pulse Powder), these would have been weapons against these two conditions.
He also treated Li Yinzhai, suffering from Hematuria-Lin for nearly two years without cure. Each attack lasted over ten days, with difficult, obstructed urination and unbearable orifice pain. Before onset, facial heat and toothache occurred, followed by Hematuria. Initially, warm drinks were desired; later, hot drinks; finally, ice-cold water was needed. Thirst was extreme, drinking two to three bowls of well water continuously. Before attacks, stool was dry and hard, once every four to five days; during attacks, loose and incomplete. Pulse: Left Cun short and weak, Guan wiry and large; Right Cun lower half and Guan slippery and large; both Chi surging and large. This indicates Middle Jiao Phlegm and Liver Channel Blood stasis. Previous treatments with Yin-nourishing fire-descending and bland-draining orifice-opening agents were ineffective. At sixty-three years old, with chronic illness and significant blood loss, tonification must be combined. The method is to remove stasis and generate new blood, raise clear Yang and descend turbid Yin. Siwu Tang (Four Substances Decoction) plus Dununiuxi (Dipsacus Root) generated new blood; Huashi (Talcum) and Taoren (Peach Kernel) eliminated stasis; Zhishi (Immature Bitter Orange) and Beimu (Fritillaria Bulb) transformed Phlegm; Shanzhiren (Gardenia Seed) descended Fire; Chaihu (Bupleurum Root) raised Clear Qi. After twenty doses, symptoms gradually subsided. Then, Huashi (Talcum), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), each 1 liang; Hupo (Amber), Xiaohui (Fennel Fruit), Rougui (Cinnamon Bark), each 1.5 qian; Yuanmingfen (Mirabilite), 3 qian; Haijinsha (Lygodium Spore), Moyao (Myrrh), each 5 qian, were made into pills with Mugen (Imperata Rhizome) juice paste. One qian taken fasting and at night with Mugen tea cured the patient.
He also treated Scholar Zhu Zhigang, who enjoyed sexual activity after drinking, practicing specific techniques leading to Hematuria-Lin, unresolved from mid-summer to year-end. Urine contained red or purple fluid with membrane-like clots or Suxmu (Sappan Wood) colored fluid, interspersed with small black spots, occurring every three to five days. Triggered by mental labor, physical exertion, or prolonged standing/sitting. Hundred treatments failed. Dongsu observed pale, clear complexion and severe emaciation. Pulse: Left Cun deep and weak, Guan and Chi wiry and fine; Right Cun slightly slippery. This indicates Lung Channel turbid Phlegm and Liver Channel Blood stasis. Caused by exhausting oneself after drinking and indulging lust, igniting libidinal fire, sperm leaving its proper path, lacking methods to calm the mind, regulate Qi, and return essence to its source. This led to stagnation in collaterals, flowing into urinary pathways. New blood arriving gets blocked, causing Lin-Turbidity. Occurring every three to five days reflects filling up before overflowing. Initially, Danshen (Salvia Root) and Mugen (Imperata Rhizome) were decocted heavily. Urine collected in clay vessels turned golden yellow sand shortly after. Then, Shenqi Wan (Kidney Qi Pill) supplemented with Hupo (Amber), Haijinsha (Lygodium Spore), Huangbai (Phellodendron Bark), made into pills with Dununiuxi (Dipsacus Root) juice paste for regulation. Externally, Chuanxiong (Ligusticum Rhizome) 3 qian, Danggui (Angelica Sinensis Root) 7 qian, Dununiuxi root decocted for drinking. During attacks, Huashi (Talcum), Gancaoshao (Licorice Root Tip), Taoren (Peach Kernel), Haijinsha (Lygodium Spore), Shexiang (Musk) powdered, mixed with Jiucui (Chinese Chive) juice and Oujiang (Lotus Root Juice) for oral administration. Removing congealed essence and decaying blood allows new blood to return to its origin, eliminating the root cause. Fully recovered in three months.
Yu Zhen commented: The previous case asked, "Why not combine tonification?" But the so-called tonification was merely Siwu Tang (Four Substances Decoction). The rest were stasis-resolving and clearing-draining herbs. The secondary formula used Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark) 1 liang each, Xiaohui (Fennel Fruit) and Rougui (Cinnamon Bark) 1.5 qian each, reflecting the intent of Zishen Wan (Kidney-Nourishing Pill), but heavily supplemented with Huashi (Talcum), Yuanmingfen (Mirabilite), Moyao (Myrrh), Haijinsha (Lygodium Spore) as assistants, and Mugen juice for pills. This remains clearing-draining combined with stasis-resolving. For a sixty-year-old with a two-year duration, such treatment confirms that Blood-Lin favors unblocking over tonification. The subsequent case used Shenqi Wan (Kidney Qi Pill) with Huangbai (Phellodendron Bark), Hupo (Amber), Haijinsha (Lygodium Spore), made into pills with Dununiuxi (Dipsacus Root) juice. This adds clearing-damp-heat and unblocking-stasis methods to warming-tonifying Lower Yuan herbs, differing slightly from the previous case. However, the decoction of Chuanxiong (Ligusticum Rhizome), Danggui (Angelica Sinensis Root), Dununiuxi (Dipsacus Root), and the powder of Huashi (Talcum), Haijinsha (Lygodium Spore), Taoren (Peach Kernel), Shexiang (Musk), Jiuzhi (Chive Juice), Oujiang (Lotus Root Juice) still focus on moving stasis and unblocking orifices, without Renshen (Ginseng), Huangqi (Astragalus), or Shudi (Prepared Rehmannia). The general principle is roughly visible.
Li Shicai treated County Magistrate Yan Zhifei, suffering from Lin syndrome for a year, pain like knife thrusts. Over three hundred doses of fire-clearing and draining agents worsened the condition. By year-end, Li palpated: both Chi pulses rapid but weak, indicating Deficient-Fire. Physicians traditionally adhere to "pain implies no tonification," believing more unblocking leads to more deficiency, and more deficiency fuels Deficient-Fire. He prescribed Bawei Wan (Eight-Ingredient Pill) material supplemented with Cheqianzi (Plantago Seed), Chenxiang (Aquilaria Wood), and Renshen (Ginseng Root). After eight doses, pain decreased slightly, but frequency remained. The original physician warned, "Painful Lin is definitely Excess-Fire. Excessive warming-tonification may cause suffocation and death in a few days." Yan Zhifei doubted and feared, consulting again. Li said, "If warming-tonification were unsuitable, symptoms would worsen after taking medicine. Since they improved, why doubt?" Morning: Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); Evening: Bawei Wan (Eight-Ingredient Pill). After a month, nine-tenths of the disease vanished. Doubling Renshen (Ginseng Root) and Huangqi (Astragalus Root) led to complete recovery in fourteen days.
Zhang Luyu treated Grand Historian Shen Hanzhuo, suffering from Gao-Lin (Fat-Lin), frequent urination, over a hundred times day and night. Daytime: dribbling obstruction, feeling urge, burning pain. Nighttime: frequent emission, double the volume, urine resembling fat or mucus. Previous half-month treatment with heat-clearing and water-draining herbs worsened the condition. Complexion sallow, difficulty eating. Zhang palpated: pulse wiry, fine, and rapid; both Chi pulses firm upon pressure; Right Guan choppy, large, and weak. This indicates inherent Kidney Water deficiency, exacerbated by mental labor and thought, causing Liver Wood to overact on Spleen Earth. Method: First strengthen Middle Earth to act as a dam, preventing Yin-Fire from sinking, allowing Clear Yang to rise, Qi transformation to pass, and pain/obstruction to heal. Using heat-clearing and water-draining would sink Qi further, deplete Essence, and obstruct urination. He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with 3 qian Renshen (Ginseng Root). After two doses, pain lessened slightly, but the patient sought quick results and switched to Siling San (Four-Powder Decoction) plus Zhimu (Anemarrhena Rhizome), Mendong (Ophiopogon Tuber), Shashen (Glehnia Root), Huafen (Peucedanum Root). After one dose, excruciating pain persisted all night. Thereafter, exclusively took Buzhong Yiqi Tang combined with Liuwei Wan (Six-Ingredient Pill), using Ziheche (Placenta Humanum) paste代替 honey for regulation. Consuming over a jin of Ginseng brought peace.
Yu Zhen commented: Regarding Lin syndrome, Sun Dongsu's treatment method is the standard (Jing). These two cases represent flexibility (Quan). Standard and flexible approaches are appropriate, both distinguishing based on pulse examination. Zhuangzi said: "Craftsman Shi woke and diagnosed his dream." How to diagnose a dream? "Diagnose" means to examine carefully. Traditionally, only pulse diagnosis was mentioned, missing the meaning of the character "Zhen." True skill in diagnosis is skill in careful examination. Examining clearly makes the disease obvious. Extending this to Observation, Listening/Smelling, Inquiry, and Palpation—the Four Diagnostic Methods—it is evident that all four require meticulous examination.