妇人便浊，或赤如血，或白如泔，不痛者是，痛则淋矣，属湿热，分虚实而治。肥白之妇，
脉沉滑，胸膈不利，小便白浊，属湿痰，宜燥中之湿。如
面色不泽，身倦无力者，属气虚，宜补气。黑瘦之妇，脉洪数，五心烦热，颊赤唇干，小便
赤浊，或白，属相火，宜滋阴。肝脉弦数有力，火盛者，龙胆泻肝汤。治法分渗清热，燥湿
健脾，滋阴降火，实下固阳。
浊气下流，为赤白浊。赤者，升、柴、二术、二陈最妙。白者，黄柏、当归、知母、白芍。
丹溪谓二术二陈，能使大便润而小便长。如两尺脉沉弱，白浊频数，凝白如油，光彩不定，
漩脚澄下，凝如膏糊，古方悉指为阳虚，亦有虚而挟相火者，不可不辨，宜萆 厘清饮，专
主阳虚白浊。《内经》曰∶中气不足，小便为之色变，必先补气升举之，而后分其脏腑气血
赤白虚实治之。有邪热者泻热，虚者补虚。设使肾气虚甚，或火热亢极者，则不宜纯用凉药
，必反佐治之。要在权衡轻重而已。赤者，热伤血，宜滋阴。白者，湿热伤气，又宜燥湿。
白浊不止，宜服珍珠粉丸，用之屡验。气虚，四君子汤，血虚。四物汤，气血两虚，八珍汤
下珍珠粉丸。
珍珠粉丸
樗皮（炒黄） 黄柏（盐水炒） 青黛 蛤粉 滑石 珍珠
等分为末，神曲糊丸。无火者，加炮姜。方用樗皮、黄柏，能燥湿清热，青黛能解郁热，蛤
粉咸寒引下，滑石利窍，珍珠宁神定志。
如上盛下虚，心火上炎，口苦燥渴，五心烦热，小便赤涩，或下白浊，宜清心莲子饮。
清心莲子饮
石莲子（即建莲中择有黑壳者） 人参 赤苓 麦冬 黄 地骨皮 黄芩 车前子 生甘草
白浊经年不愈者，形神衰瘦，心神不安，当作心虚治。珍珠粉丸合定志丸间服。
定志丸
远志 石菖蒲（各二两） 人参 白茯苓（各三两）
共为末，蜜丸，朱砂为衣，每服七丸，空心米汤下。
龙胆泻肝汤
胆草 黄芩 山栀 泽泻 木通 车前 当归 生地 柴胡 甘草
萆 厘清饮
智仁 萆 石菖蒲 乌药（等分） 茯苓 甘草 飞滑石
加盐少许。
厘清饮
芡实 茯苓 黄蜡
蜜丸，如桐子大，每服百丸，淡盐汤下。
二术二陈汤
白术 苍术 广皮 半夏 茯苓 甘草 升麻 柴胡
水煎服。
In women, turbid urine may appear red like blood or white like rice water. If it is painless, it is termed *bian zhuo* (turbid urine); if painful, it is *lin* (dysuria). This belongs to damp-heat and should be treated by distinguishing between deficiency and excess.
In obese women with a fair complexion, a deep and slippery pulse, chest and diaphragm discomfort, and white turbid urine indicates phlegm-dampness. Treatment should focus on drying dampness and resolving phlegm.
If the complexion lacks luster and the body feels fatigued and weak, it indicates Qi deficiency; tonifying Qi is appropriate.
In thin women with a dark complexion, a surging and rapid pulse, heat sensation in the five centers (palms, soles, and chest), flushed cheeks, and dry lips, with red or white turbid urine, it indicates hyperactivity of ministerial fire; nourishing Yin is appropriate.
If the Liver pulse is wiry, rapid, and forceful, indicating excessive fire, *Longdan Xiegan Tang* (Gentian Liver-Draining Decoction) is used. Therapeutic methods include promoting urination to clear heat, drying dampness and strengthening the Spleen, nourishing Yin and descending fire, and consolidating Yang.
Turbid Qi flowing downward results in red or white turbidity. For red turbidity, Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), and Erchen Tang (Two-Aged Decoction) are most effective. For white turbidity, Huangbai (Phellodendri Cortex), Danggui (Angelicae Sinensis Radix), Zhimu (Anemarrhenae Rhizoma), and Baishao (Paeoniae Radix Alba) are used.
Zhu Danxi stated that Cangzhu and Baizhu combined with Erchen Tang can moisten the large intestine and promote urination.
If the pulses at both Chi positions are deep and weak, with frequent white turbidity where the urine appears coagulated white like oil, lacking luster, and the sediment settles like paste, ancient formulas attribute this to Yang deficiency. However, there are cases of deficiency complicated by ministerial fire, which must be distinguished. *Bixie Fenqing Yin* (Dioscorea Hypoglauca Decoction for Clearing Turbidity) is suitable, specifically targeting Yang deficiency causing white turbidity.
The *Neijing* states: "When Middle Qi is insufficient, the color of urine changes." One must first tonify and raise Qi, then treat according to the red/white and deficiency/excess patterns of the Zang-Fu organs and Qi-Blood. Heat pathogens are drained; deficiency is tonified. If Kidney Qi is extremely deficient or Fire is excessively hyperactive, pure cooling herbs should not be used exclusively; contrary assistance (fan zuo) methods are required. The key lies in weighing the severity. Red turbidity indicates heat damaging Blood; nourishing Yin is appropriate. White turbidity indicates damp-heat damaging Qi; drying dampness is appropriate.
For persistent white turbidity, *Zhenzhu Fen Wan* (Pearl Powder Pill) is recommended, having proven effective in repeated use. For Qi deficiency, *Sijunzi Tang* (Four Gentlemen Decoction); for Blood deficiency, *Siwu Tang* (Four Substance Decoction); for dual Qi and Blood deficiency, *Shenzhen Tang* (Eight Treasures Decoction) taken with *Zhenzhu Fen Wan*.
**Zhenzhu Fen Wan (Pearl Powder Pill)**
Composed of Chupi (Cortex Bignoniae, stir-fried until yellow), Huangbai (Phellodendri Cortex, salt-fried), Qingdai (Indigo Naturalis), Gafen (Concha Meretricis et Cyprinae), Huashi (Talcum), and Zhenzhu (Margarita). Equal parts are ground into powder and formed into pills using Shenqu paste (Massa Medicata Fermentata). If there is no internal heat, Paojiang (Rhizoma Zingiberis Preparatum) is added. Chupi and Huangbai dry dampness and clear heat; Qingdai resolves constrained heat; Gafen is salty and cold, guiding herbs downward; Huashi unblocks orifices; Zhenzhu calms the Spirit and stabilizes will.
For upper excess and lower deficiency, with Heart Fire flaring upward, bitter taste, dry thirst, heat in the five centers, red and scanty urine, or lower white turbidity, *Qingxin Lianzi Yin* (Heart-Clearing Lotus Seed Decoction) is indicated.
**Qingxin Lianzi Yin (Heart-Clearing Lotus Seed Decoction)**
Composed of Shilianzi (Loto Semen Nuciferae, specifically those with black shells from Jianlian), Renshen (Ginseng Radix et Rhizoma), Chiling (Poria Cocos), Maidong (Ophiopogonis Radix), Huangqi (Astragali Radix), Digupi (Lycii Cortex), Huangqin (Scutellariae Radix), Cheqianzi (Plantaginis Semen), and Sheng Gancao (Glycyrrhizae Radix et Rhizoma Recens).
For white turbidity persisting for years, leading to emaciation, mental fatigue, and restlessness, it should be treated as Heart deficiency. *Zhenzhu Fen Wan* and *Dingzhi Wan* (Spirit-Calming Pill) should be taken alternately.
**Dingzhi Wan (Spirit-Calming Pill)**
Composed of Yuanzhi (Polygalae Radix) and Shichangpu (Acori Tatarinowii Rhizoma, 2 liang each), Renshen (Ginseng Radix et Rhizoma), and Baifuling (Poria Cocos, 3 liang each). Ground into powder, formed into honey pills, coated with Zhusha (Cinnabar). Take 7 pills per dose, downed with rice soup on an empty stomach.
**Longdan Xiegan Tang (Gentian Liver-Draining Decoction)**
Composed of Dancao (Gentianae Radix), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), Cheqian (Plantaginis Semen), Danggui (Angelicae Sinensis Radix), Shengdi (Rehmanniae Radix), Chaihu (Bupleuri Radix), and Gancao (Glycyrrhizae Radix et Rhizoma).
**Bixie Fenqing Yin (Dioscorea Hypoglauca Decoction for Clearing Turbidity)**
Composed of Yiren (Alpiniae Oxyphyllae Fructus), Bixie (Dioscoreae Hypoglaucae Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), Wuyao (Linderae Radix) in equal parts, Fuling (Poria Cocos), Gancao (Glycyrrhizae Radix et Rhizoma), and Fei Huashi (Talcum). Add a small amount of salt.
**Li Qing Yin (Clearing Turbidity Decoction)**
Composed of Qianshi (Nucellae Nelumbinis), Fuling (Poria Cocos), and Huangla (Beeswax). Formed into honey pills, size of sesame seeds. Take 100 pills per dose, downed with light salt soup.
**Erchu Erchen Tang (Two Atractylodes and Two-Aged Decoction)**
Composed of Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Fuling (Poria Cocos), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix). Decoct in water and take.