脉
少阴脉细而微，为气淋，妇人则阴中生疮。盛大而坚者生，
虚弱而涩者死。鼻头色黄，小便必难。脉浮弦涩，为不小便。关格头汗者死。
病
夫淋者，小便淋沥涩痛，欲去不去，不去又来，曰淋。盖因恣食膏粱之味，湿热之物，或烧酒炙爆之类，
郁遏成疾，以致脾土受害乏力，不能运化精微，清浊相混，故使肺金无助，而水道不清，渐成淋闭之候；
或谓酒后房劳，或七情郁结，以致心肾不交，水火无制，清阳不升，浊阴不降，而成天地不交之痞。古
方有五淋之别∶气、砂、血、膏、劳也。气淋则小便涩滞，常有沥不尽；砂淋则茎中痛，溺不得卒出，乃精
气结成砂石，与溺俱出，出则痛止；血淋则遇热即发，小便涩痛，有血不痛者，名溺血；膏淋则尿浊如
膏，浮凝如脂；劳淋则遇房劳即发，痛引气中也。又云∶小肠有气则小便胀，小肠有血则小便涩，小肠有
热则小便痛，治之但当行滞清热，疏利小便，不可用补气药。盖气得补则愈胀，血得补则愈涩，热得补则愈盛
。又有挟冷而淋者，其状先寒战而后小便，谓冷气与正气交争，冷气胜则寒战而淋，正气胜则寒
战解而得便溺也，治当逐散寒邪，扶正气则自平矣。
治
闭者，小便急满不通也。有气虚，有血虚、有痰，有热，有风闭，皆宜吐之，以提其气，气升则水自降，
盖气承载其水也。譬如滴水之器，上窍闭则下窍不出，使吐之，是开上窍之法也。气虚以参、术、升麻等，
先服后吐，或就参 药中调理探吐之；血虚四物汤，先服后吐，或芎归汤探吐；痰多二陈汤，先服后吐；痰
气闭塞，二陈加木通、香附探吐；实热者，当利之，或八正散，大便动而小便自通。
遗尿失禁，经曰∶膀胱不利为癃，不约为遗。大抵热则燥涩为癃，寒则不禁为遗。亦有虚热而滑者，法
当温补，其溺自禁，或灸关元，五壮亦效。东垣曰∶小便遗失者，肺气虚也，以参 补之。
小便不禁，或频数，古方多以为寒，而以温涩之药，殊不知属热者多。盖膀胱火邪妄动，水不得宁，故不
能禁而频数来也，故年老人多频数者，是膀胱血少，少阳火偏旺也。治法当补膀胱阴血，泻火邪为主，而佐
以收涩之药，如牡蛎、山茱萸、五味子之类，不可用温药也。病本属热，故宜泻火；因水不足，故火动而
致小便多，水益虚矣，故宜补血。补血泻火，治其本也；涩之收之，治其标也。
治
五淋用补中益气汤有殊效。按此方治淋，多谓膀胱之气虚损，不能运用水道，故
滞而不通而成诸淋也。用此养元气，故有效焉。
方
五淋散 治肺气不足，膀胱有热，水道不通，淋沥不出，或尿如豆汁，或如砂石，或冷淋如膏，或热淋尿血。
赤茯苓（一钱二分） 赤芍药（二钱） 山栀子（二钱） 当归（一钱） 甘草（五分） 条黄芩（六分）
一方加生地黄、泽泻、木通、滑石、车前子（各等分）
上锉散，水煎，空心服。
八正散 治心经蕴热，脏腑闭结，小便赤涩，癃闭不通，及热淋
血淋；如酒后纵欲而得者，则小便将出而痛，既出而痒，以此药主之。
车前子 瞿麦 蓄 滑石 山栀仁 大黄 木通 甘草（各等分）
上锉作剂，灯心煎，空心服。小便淋滴，频数无度，加牛膝。
琥珀散（太医院传） 治血淋神方。
琥珀（二两） 当归（一两半） 蒲黄（二两） 生地黄（一两半） 瞿麦（一两） 血余
（四两，烧灰） 栀子（一两） 大、小蓟（各一两半） 甘草（三钱） 酸浆草（自然汁五碗）
上共研为末，将酸浆草汁和诸药晒干，为末。每服三钱，空心米饮调下。
阿胶散（秘方） 治血淋。
阿胶（二两，炒） 猪苓 泽泻 赤茯苓 滑石（各一两） 车前子（五钱）
上锉水煎，空心服。
治血淋，用干柿饼烧存性，为末。每服二钱，空心米饮调下。
高尚书方 治小便下血，多是湿热。
五苓散加苍术三分，一剂而愈。
散滞茴香汤（党都堂传） 治诸淋，并妇人赤白带下。
小茴香（一钱） 当归（一钱） 乌药（一钱） 荆芥穗（一钱） 黄连（一钱） 木通
（一钱） 扁竹（一钱） 砂仁（八分） 薄荷（八分） 香附子（五分）
上锉一剂、淡竹叶十片，水煎，空心温服。
琥珀郁金丸 治水火不既济，膀胱因心火所炽而浮，囊中积热，或癃闭不通，或遗泄不禁，或白
浊如泔水，或膏淋如脓，或如栀子汁，或如砂石米粒，或如粉糊相似，疼痛不已，俱热证也，此药治之。
黑牵牛（头末，二两，炒） 大黄（酒浸，二两） 黄连（一两） 黄芩（二两） 郁金
（一两） 滑石（四两） 真琥珀（二两，研） 茯苓（四两）
上共为末，水丸如梧子大，每服五十丸，空心熟水下。
六味地黄丸 治老人虚寒者，患死血作淋，痛不可忍，倍茯
苓、泽泻。又治小便频数不禁，去泽泻，用益智仁。
〔批〕（按此方治诸淋之剂） 治冷淋诸药不效，用四君子汤加猪苓、泽
泻、木通，连进二服。又以菟丝子研极细，用鸡翎管吹入小便孔内，极效。
通关丸 治小便不通，热在下焦血分，兼治诸淋。
黄柏（二两，酒炒） 知母（二两，酒炒） 肉桂（三钱） 滑石（二两） 木通（一两）
上为末，水丸梧子大。每服百丸，白水下。
一方治小便不通，腹胀疼痛欲死，野地蒺藜子不拘多少，焙黄色为末，温黄酒调服。
一方用蚯蚓五七条，研烂，投凉水一碗，搅匀，澄清去泥滓，饮水，实时通。大解热疾，不知人事，
欲死者服之，立效。
一方用顷麻烧灰存性，为末，黄酒调服，登时就通。
一方用皮硝煎化，青布蘸水搭脐上，并上便上，热则易之，即通。
若小便不通，两尺脉俱沉微，乃阴虚也，曾服通滑之药不效
者，用大附子一个，重一两者，炮，去皮脐，盐水浸透；泽泻切，作四剂，每剂灯草七根，煎服。
治小便不通，诸药无效，或转胞至死，此法用之，小便自出。用猪尿胞一个，倾出水，用鹅毛去头尾，插
入窍孔内，线缚定，以口吹气，令满胞，内线管下再扎住，将管口放在小便头上，向孔窍
解后下线，手搓其气透里，小便自然出，神效。
〔批〕（按此方治小便不通之剂） 一阴阳关格，前后不通，寻常通利，大腑小水自行，中有转胞一证，
诸药不效，失救则胀满，闷乱而死，予尝以甘遂末，水调敷脐下，内以甘草节煎汤饮之，及药汁至
脐，二药相反，胞自转矣，小水来如泉涌，此急救之良诀也。
缩泉丸 治脬气不足，小便频数，一日夜百余次。
益智仁 天台乌药（大如臂者）
上各等分，为末，酒煮山药打糊为丸，如梧子大，每五七十丸，卧时盐汤送下。
既济丸 治小便不禁。
菟丝子（酒制） 益智仁（炒） 茯苓 韭子（炒） 肉苁蓉（酒洗） 当归 熟
地黄（各五钱） 黄柏 知母（各盐酒炒，三钱） 牡蛎（ ） 石枣（酒蒸，去核，各三钱） 五味子（一钱）
上为末，面糊为丸。每百丸，空心盐水下。
一方治小便不禁有热者，用去桂五苓散，加黄连、黄柏、栀子、石枣、五味子，水煎服。
一方治虚弱不禁，用五苓散合四物汤，加石枣、五味子，水煎，空心服。
一方治遗尿失禁，破故纸炒为末，每服二、三钱，空心热水调下。又宜气海穴灸之。
一方〔批〕（按此方治小便不禁之剂） 治夜多小便，益智仁二十个，
和皮锉，赤茯苓二钱，水煎，临睡热服。虚老人，宜八味地黄丸加益智仁，去泽泻。
Pulse Diagnosis
The Shaoyin pulse is thin and faint, indicating Qi Lin (Qi-type strangury); in women, it manifests as sores in the vagina. If the pulse is vigorous and firm, the prognosis is good; if weak and choppy, the prognosis is fatal. Yellow color of the nasal tip indicates difficult urination. A floating, wiry, and choppy pulse indicates urinary retention. In Guan-Ge syndrome (obstruction of upper and lower orifices), head sweating indicates a fatal prognosis.
Diseases
Lin syndrome (strangury) refers to dribbling, painful, and difficult urination, where the urge to void persists despite inability to pass urine. This is often caused by excessive consumption of rich, greasy, sweet foods, damp-heat inducing substances, or alcohol and fried/grilled foods, leading to qi stagnation. This damages the Spleen Earth, impairing its ability to transform and transport essence, causing turbid and clear qi to mix. Consequently, Lung Metal loses support, water passages become unclear, gradually forming Lin-Bi (strangury and retention). Alternatively, it may result from post-coital activity after drinking or emotional stagnation, leading to Heart-Kidney non-interaction, loss of control over Fire and Water, failure of Clear Yang to ascend and Turbid Yin to descend, resulting in a blockage akin to Heaven and Earth not interacting. Ancient texts classify five types of Lin: Qi Lin (Qi strangury), Sha Lin (Sand/Stone strangury), Xue Lin (Blood strangury), Gao Lin (Grease/Paste strangury), and Lao Lin (Exhaustion/Fatigue strangury). Qi Lin presents with sluggish urination and a sensation of incomplete emptying. Sha Lin involves pain in the urethra and sudden cessation of urine flow due to stones formed from essence and qi passing out with urine, relieving pain upon exit. Xue Lin occurs upon exposure to heat, with painful urination and blood; if there is blood without pain, it is called Ni Xue (blood in urine). Gao Lin features cloudy urine resembling grease or fat. Lao Lin is triggered by sexual exhaustion, with pain radiating to the Qihai region. Furthermore, gas in the Small Intestine causes urinary distension, blood in the Small Intestine causes urinary obstruction, and heat in the Small Intestine causes painful urination. Treatment should focus on moving stagnation, clearing heat, and promoting diuresis; tonifying Qi is contraindicated because tonification exacerbates distension in Qi cases, obstruction in Blood cases, and heat intensity in Heat cases. There are also cases of Lin complicated by Cold, characterized by chills preceding urination, representing a struggle between Cold pathogen and Healthy Qi. When Cold prevails, chills and strangury occur; when Healthy Qi prevails, chills cease and urination resumes. Treatment requires dispelling Cold and supporting Healthy Qi.
Treatment
Bi syndrome (urinary retention) refers to urgent, full, and obstructed urination. It can be caused by Qi deficiency, Blood deficiency, Phlegm, Heat, or Wind obstruction. Vomiting therapy is suitable for all these types to raise Qi; as Qi rises, Water descends, since Qi carries Water. Like a dripping vessel, if the upper orifice is blocked, water does not flow from the lower orifice; vomiting opens the upper orifice. For Qi deficiency, administer Shen (Ginseng), Zhu (Atractylodes), Shengma (Cimicifuga) before vomiting, or induce vomiting within Ginseng-based formulas. For Blood deficiency, use Si Wu Tang (Four Substances Decoction) before vomiting, or Xiong Gui Tang (Ligusticum and Angelica Decoction) to induce vomiting. For excessive Phlegm, use Er Chen Tang (Two-Cured Decoction) before vomiting. For Phlegm-Qi obstruction, use Er Chen Tang plus Mutong (Akebia) and Xiangfu (Cyperus) to induce vomiting. For Excess Heat, promote bowel movement or use Ba Zheng San (Eight Upright Powder); once bowels move, urination clears naturally.
Enuresis and Incontinence: The Classic states, "Bladder dysfunction leads to Long (difficulty in urination), lack of restraint leads to Yi (enuresis)." Generally, Heat causes dryness and obstruction (Long), while Cold causes lack of restraint (Yi). Some cases involve deficiency-Heat with slipping; treatment requires warming and tonifying to restore control, or moxibustion at Guanyuan (CV-4, Five moxa cones) is effective. Li Dongyuan stated that urinary leakage is due to Lung Qi deficiency, treated with Ginseng.
Urinary incontinence or frequency is often considered Cold in ancient texts, treated with warming and astringent herbs, but many cases are actually Heat. This is due to reckless movement of Bladder Fire disturbing Water, causing frequency. Elderly people often experience frequency due to Bladder Blood deficiency and hyperactive Shaoyang Fire. Treatment should primarily tonify Bladder Yin/Blood and drain Fire, assisted by astringents like Mu Li (Oyster Shell), Shan Zhu Yu (Cornus Fruit), and Wu Wei Zi (Schisandra Berry). Warming herbs are contraindicated. Since the root is Heat, draining Fire is essential; since Water is insufficient, tonifying Blood addresses the root. Astringents treat the branch.
Therapy
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is highly effective for the five types of Lin. This formula treats Lin by addressing Bladder Qi deficiency, which fails to regulate water passages, causing stagnation. By nourishing Original Qi, it proves effective.
Formulas
Wu Lin San (Five Stranguries Powder): Treats Lung Qi deficiency and Bladder Heat causing urinary obstruction, dribbling, urine resembling bean dregs or sand/stones, cold Lin resembling grease, or hot Lin with hematuria. Chi Fu Ling (Red Poria), Chi Shao Yao (Red Peony Root), Shan Zhi Zi (Gardenia Fruit), Dang Gui (Angelica Sinensis), Gan Cao (Licorice Root), Tiao Huang Qin (Scutellaria Root). Alternative addition: Sheng Di Huang (Rehmannia Root), Ze Xie (Alisma Rhizome), Mu Tong (Akebia Stem), Hua Shi (Talcum), Che Qian Zi (Plantago Seed) in equal parts. Decoct in water, take on an empty stomach.
Ba Zheng San (Eight Upright Powder): Treats Heart Heat accumulation, organ closure, red and scanty urine, Long-Bi (retention), Hot Lin, and Blood Lin. Effective for cases arising from post-coital indulgence, where pain precedes urination and itching follows. Che Qian Zi (Plantago Seed), Qu Mai (Dianthus Herb), Xu Shu (Polygonum Herb), Hua Shi (Talcum), Shan Zhi Ren (Gardenia Seed), Da Huang (Rhubarb Root), Mu Tong (Akebia Stem), Gan Cao (Licorice Root) in equal parts. Decoct with Deng Xin Cao (Juncus Medullary), take on an empty stomach. Add Niu Xi (Achyranthes Root) for frequent, uncontrolled dribbling.
Hu Po San (Amber Powder - Imperial Hospital Transmission): Divine prescription for Blood Lin. Hu Po (Amber), Dang Gui (Angelica Sinensis), Pu Huang (Typha Pollen), Sheng Di Huang (Rehmannia Root), Qu Mai (Dianthus Herb), Xue Yu (Human Hair, burnt to ash), Zhi Zi (Gardenia Fruit), Da Xiao Ji (Great and Lesser Cirsium Herbs), Gan Cao (Licorice Root), Suan Jiang Cao (Emilia Sonchus Juice). Grind all to powder, mix with juice, dry, and grind again. Take 3 qian with rice drink on an empty stomach.
E Jiao San (Donkey-Hide Gelatin Powder - Secret Recipe): Treats Blood Lin. E Jiao (Donkey-Hide Gelatin, stir-fried), Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), Chi Fu Ling (Red Poria), Hua Shi (Talcum), Che Qian Zi (Plantago Seed). Decoct in water, take on an empty stomach.
For Blood Lin: Burn dried persimmon cake until carbonized, grind to powder. Take 2 qian with rice drink on an empty stomach.
Gao Shangshu Formula: Treats hematuria, mostly due to Damp-Heat. Wu Ling San (Five-Ingredient Powder with Poria) plus Cang Zhu (Atractylodes Rhizome, 3 fen). One dose cures.
San Zhi Hui Xiang Tang (Disperse Stagnation Fennel Decoction - Tang Dutang Transmission): Treats various Lins and leukorrhea in women. Xiao Hui Xiang (Fennel Fruit), Dang Gui (Angelica Sinensis), Wu Yao (Lindera Root), Jing Jie Sui (Schizonepeta Spike), Huang Lian (Coptis Rhizome), Mu Tong (Akebia Stem), Bian Zhu (Smilax Rhizome), Sha Ren (Amomum Fruit), Bo He (Mint Leaf), Xiang Fu Zi (Cyperus Rhizome). Decoct one dose with Dan Zhu Ye (Lophatherum Leaf), take warm on an empty stomach.
Hu Po Yu Jin Wan (Amber and Curcuma Pill): Treats imbalance of Water and Fire, Bladder floating due to Heart Fire blazing, heat accumulation in the scrotum, Long-Bi, enuresis, white turbidity like rice water, paste-like Lin like pus, Gardenia-colored urine, sand/rice-grain-like urine, or paste-like urine with persistent pain. All are Heat syndromes treated by this pill. Hei Qian Niu (Black Morning Glory Seed, first wash, stir-fried), Da Huang (Rhubarb Root, wine-soaked), Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), Yu Jin (Curcuma Tuber), Hua Shi (Talcum), Zhen Hu Po (Real Amber, ground), Fu Ling (Poria). Make pills with water, size of wu zi (wu-tzu seeds). Take 50 pills on an empty stomach with cooked water.
Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill): For elderly with deficiency-cold suffering from dead-blood Lin with unbearable pain, double Fu Ling (Poria) and Ze Xie (Alisma Rhizome). For frequent, uncontrollable urination, remove Ze Xie and add Yi Zhi Ren (Alpinia Oxyphylla Fruit).
[Commentary]: For cold Lin unresponsive to other treatments, use Si Jun Zi Tang (Four Gentlemen Decoction) plus Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), Mu Tong (Akebia Stem), taken consecutively twice. Also, grind Tu Si Zi (Dodder Seed) finely and blow into the urethral orifice using a chicken feather tube; extremely effective.
Tong Guan Wan (Pass Through Obstruction Pill): Treats urinary retention due to Heat in the Lower Jiao Blood level, and various Lins. Huang Bai (Phellodendron Bark, wine-fried), Zhi Mu (Anemarrhena Rhizome, wine-fried), Rou Gui (Cinnamon Bark), Hua Shi (Talcum), Mu Tong (Akebia Stem). Make pills with water, size of wu zi. Take 100 pills with plain water.
Alternative for urinary retention with severe abdominal distension and pain: Wild Tribulus seeds, roasted yellow, ground to powder, taken with warm yellow wine.
Alternative: 5-7 earthworms, mashed, mixed with one bowl of cool water, stirred, clarified, and the liquid drunk; promotes immediate urination. Also effective for severe heat diseases causing unconsciousness and near-death states.
Alternative: Qing Ma (likely a typo for Qing Ma Zi or similar, context implies a laxative/diuretic herb) burnt to ash, ground, taken with yellow wine; immediate effect.
Alternative: Pi Xiao (Mirabilite) dissolved, applied to the umbilicus with a blue cloth dipped in water; change when hot; promotes urination.
If urinary retention occurs with both Chi pulses (radial artery deep positions) being deep and faint, indicating Yin deficiency, and previous diuretics failed: Use one large Fu Zi (Aconite Root, 1 liang), processed, skin and navel removed, soaked in salt water. Cut Ze Xie (Alisma Rhizome), divide into four doses, decoct each with seven roots of Deng Xin Cao (Juncus Medullary), and take.
For urinary retention unresponsive to all medicines, or turning bladder (Zhuan Bao) leading to death: Use a pig bladder, empty it, insert a goose quill (trimmed) into the orifice, tie securely, blow air to inflate, tie below the tube inside, place the tube end at the urethral opening, untie after voiding, and massage to transmit air internally; promotes natural urination, miraculous effect.
[Commentary]: For Yin-Yang Guan-Ge with anterior/posterior obstruction, normal diuretics fail. Zhuan Bao (bladder torsion) causes distension and death if untreated. I once used Gan Sui (Kansui Root) powder mixed with water applied below the umbilicus, combined with internal administration of Gan Cao Jie (Licorice Knot) decoction. The antagonistic properties of the two drugs caused the bladder to rotate, and urine flowed like a spring. This is a critical emergency technique.
Suo Quan Wan (Retain Urine Pill): Treats Pa Qi (Bladder Qi) deficiency causing frequency (>100 times/day/night). Yi Zhi Ren (Alpinia Oxyphylla Fruit), Tian Tai Wu Yao (Lindera Root, arm-sized). Equal parts, ground to powder, made into pills with Yam paste boiled in wine, size of wu zi. Take 50-70 pills at bedtime with salt water.
Ji Ji Wan (Crossing Over Pill): Treats urinary incontinence. Tu Si Zi (Dodder Seed, wine-processed), Yi Zhi Ren (Alpinia Oxyphylla Fruit, stir-fried), Fu Ling (Poria), Jiu Zi (Garlic Chive Seed, stir-fried), Rou Cong Rong (Cistanche Stem), Dang Gui (Angelica Sinensis), Shu Di Huang (Prepared Rehmannia Root) [each 5 qian], Huang Bai (Phellodendron Bark), Zhi Mu (Anemarrhena Rhizome) [salt/wine-fried, 3 qian each], Mu Li (Oyster Shell), Shi Zao (Ziziphus Jujuba Seed, wine-steamed, pitted, 3 qian each), Wu Wei Zi (Schisandra Berry, 1 qian). Make pills with flour paste. Take 100 pills on an empty stomach with salt water.
Alternative for incontinence with Heat: Wu Ling San (Five-Ingredient Powder with Poria) minus Rou Gui (Cinnamon Bark), plus Huang Lian (Coptis Rhizome), Huang Bai (Phellodendron Bark), Zhi Zi (Gardenia Fruit), Shi Zao (Ziziphus Jujuba Seed), Wu Wei Zi (Schisandra Berry). Decoct and take.
Alternative for weakness-induced incontinence: Wu Ling San combined with Si Wu Tang (Four Substances Decoction), plus Shi Zao (Ziziphus Jujuba Seed), Wu Wei Zi (Schisandra Berry). Decoct and take on an empty stomach.
Alternative for enuresis/incontinence: Po Gu Zhi (Cassia Seed), stir-fried and ground. Take 2-3 qian with hot water on an empty stomach. Moxibustion at Qihai (CV-6) is also recommended.
Alternative [Commentary]: For nocturnal polyuria: Yi Zhi Ren (Alpinia Oxyphylla Fruit, 20 pieces, sliced with peel), Chi Fu Ling (Red Poria, 2 qian). Decoct and take hot before sleep. For deficient elderly, use Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) plus Yi Zhi Ren (Alpinia Oxyphylla Fruit), removing Ze Xie (Alisma Rhizome).