薛立斋治商主客。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
积热移于膀胱。用黄芩清肺饮调理脾肺。再用滋肾丸、六味丸以滋肾水。寻愈。
司徒边华泉少便频数。涩滞短赤。口干吐痰。此肾经虚而热燥。阴无以化。用六味滋肾
二丸而愈。
大司徒许函谷因劳发热。小便自遗。或时不利。此因肝火阴挺。不能约制。午前用补中
益气加山药、黄柏、知母。午后服地黄丸。月余全愈。
司马李悟山小便如淋。茎中作痛。口干吐痰。此因思色精降而内败。用补中益气、六味
地黄。寻愈。
一儒者发热。饮水不绝。每如厕。小便涩痛。大便牵痛。此精极复耗所致。用都气丸及
补中益气。幸其自守谨笃。寻愈。后兼肢体畏寒。喜热饮食。用八味丸。
县令顾荣甫尾闾痒而小便赤涩。左尺脉洪数。属肾经虚热。法当滋补。渠不然其言。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。薛曰。子母俱败。鲜克济
矣。果寻卒。
震按小便数。有热有虚。数而少。为实热。宜渗之。频数不可略忍。又复短少。日数十
次。或有余沥。为肾大虚之候。数而多。色黄者。为阴虚。宜滋阴。数而多。色白体羸者。
为阳虚。升者少而降者多。宜补火。立斋诸案。具备诸法。
Xue Lizhai treated a guest of a merchant. The patient had been accustomed to a diet rich in fatty and sweet foods, presenting with red and frequent urination, dry mouth with thirst, and expectoration of thick, sticky phlegm. The pulse at the right Cun (inch) and Guan (middle) positions was rapid and forceful. This indicated that accumulated heat in the Spleen and Lungs had transferred to the Bladder. He prescribed Huangqin Qingfei Yin (Scutellaria Lung-Clearing Decoction) to regulate the Spleen and Lungs, followed by Zishen Wan (Kidney-Nourishing Pill) and Liuwei Wan (Six-Ingredient Rehmannia Pill) to nourish Kidney Water. The patient recovered shortly thereafter.
Bian Huaquan, a Situ (Minister of Education), suffered from frequent and numerous urinations, which were obstructed, short in volume, and red in color, accompanied by dry mouth and expectoration. This was attributed to deficiency and dryness-heat in the Kidney Meridian, where Yin fluids failed to transform. He was cured after taking Liuwei Zishen Erwan (Six-Ingredient Kidney-Nourishing Two Pills).
Xu Hanggu, a Grand Situ, developed fever due to overwork and experienced urinary incontinence, sometimes with difficulty in urination. This was caused by Liver Fire causing protrusion of the Yin organ, leading to an inability to restrain control. In the morning, he took Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanyao (Dioscoreae Rhizoma), Huangbai (Phellodendri Cortex), and Zhimu (Anemarrhenae Rhizoma); in the afternoon, he took Dihuang Wan (Rehmannia Pill). After more than a month, he fully recovered.
Li Wushan, a Sima (Minister of Justice), presented with urination resembling strangury (Lin syndrome), pain in the urethra, dry mouth, and expectoration. This resulted from excessive mental preoccupation with sexual desire, causing essence to descend and internal corruption. He was cured shortly after using Buzhong Yiqi Tang and Liuhuang Dadihuang Wan (Six-Ingredient Rehmannia Pill).
A scholar suffered from fever and incessant drinking. Whenever he went to the toilet, he experienced painful and obstructed urination, and pulling pain during defecation. This was caused by extreme depletion of essence followed by further consumption. He used Duqi Wan (Duqi Pill) and Buzhong Yiqi Tang. Fortunately, he maintained strict self-discipline and integrity, and recovered shortly. Later, he developed aversion to cold in his limbs and a preference for hot food and drink, so he was prescribed Bawei Wan (Eight-Ingredient Pill).
Gu Rongfu, a County Magistrate, experienced itching at the Weili (tailbone area) and red, obstructed urination. The pulse at the left Chi (cubit) position was surging and rapid, indicating deficiency-heat in the Kidney Meridian. The appropriate method was tonification and nourishment. However, he did not accept this advice and took herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) for over a year. This led to swelling and pain in the high bone (pubic symphysis area), dribbling urination, and uncontrolled surging and rapid pulses in both the Lung and Kidney positions. Xue said, "Both the Mother (Lung) and Child (Kidney) organs are failing; it is rare that they can be saved." Indeed, he died shortly thereafter.
Yu Zhen commented: Frequent urination can be due to Heat or Deficiency. If frequent and scanty, it is Excess Heat, suitable for promoting diuresis. One should not endure frequent urination; if it is also short in volume, occurring dozens of times a day, or with residual dripping, it indicates severe Kidney Deficiency. If frequent and abundant, with yellow urine, it is Yin Deficiency, suitable for nourishing Yin. If frequent and abundant, with white urine and emaciation, it is Yang Deficiency, characterized by less ascending Qi and more descending Qi, suitable for tonifying Fire (warming Kidney Yang). Xue Lizhai's cases cover all these methods.