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(Attachment: Turbid Urine)

General Overview: Although strangury (Lin Zheng, a syndrome characterized by frequent, urgent, and painful urination) pain is divided into five types, one must clearly understand each category through detailed differentiation. Gao Lin (Fatty Strangury) and Leng Lin (Cold Strangury) share similar symptoms, while Xue Lin (Blood Strangury) and Shi Lin (Stony Strangury) are both attributed to heat.

Pulse Diagnosis: A rapid pulse at the Shaoyin position indicates that in women, sores will grow in the vagina, and in men, it manifests as Qi Lin (Qi Strangury). A fine and tight pulse with obstructed and difficult urination, often accompanied by post-void dribbling, indicates Qi Lin. If the tip of the nose appears yellow, it signifies difficulty in urination leading to strangury.

The *Neijing* states: Clear Yang emerges from the upper orifices, and turbid Yin exits from the lower orifices. Therefore, if Clear Yang fails to ascend, Turbid Yin fails to descend, resulting in the pathology of strangury and retention. Ancient sages used the analogy of a dripping vessel: if the upper orifice is blocked, water cannot flow out from the lower orifice; this principle is clear. Thus, Li Dongyuan advocated moxibustion on Baihui (GV20), and Zhu Danxi advocated inducing vomiting to lift the stagnant Qi, both being methods to open the upper orifices.

The *Yuanbing Shi* states: Strangury is characterized by painful and difficult urination; heat pathogen lodges in the Bladder, causing stagnation and failure to excrete fluids.

Chao Yuanfang stated: All forms of strangury are caused by Kidney deficiency. The Kidney and Bladder are interior-exteriorly related and both govern water. Water enters the Small Intestine, descends to the Bao (uterus/bladder), travels through the external genitalia, and becomes urine. Heat in the Bladder causes body fluids to overflow internally, blocking the water passages and accumulating in the Bao. Heat in the Kidney causes astringency, leading to impaired water passage and dribbling urine, hence termed strangury. Its presentation includes small amounts of frequent urination and acute pain in the lower abdomen radiating to the umbilicus.

Gao Lin (Fatty Strangury): Fat-like substances resembling paste float on the surface of the urine during voiding. This is due to Kidney deficiency failing to control the descent of fatty fluids.

Leng Lin (Cold Strangury): Chills and trembling precede urination. This is also due to Kidney deficiency and cold invading the Lower Jiao; cold qi enters the Bao and contends with healthy Qi, causing astringent urination and chills.

Re Lin (Heat Strangury): Heat exists in the Lower Jiao. Heat pathogen combats the Kidney and flows into the Bao, resulting in dark yellow, astringent urine, occasionally mixed with fresh blood.

Xue Lin (Blood Strangury): This represents extreme heat. The Heart is the master of Blood, circulating externally in the meridians and internally in the Zang-Fu organs. When heat is excessive and deviates from its normal pathway, and since the Heart and Small Intestine are interior-exteriorly related, the heat flows downward into the Bao, forming Blood Strangury.

Shi Lin (Stony Strangury): The Kidney governs water; when water condenses, it transforms into stones. When the Kidney is attacked by heat, urination causes pain in the urethra, preventing smooth flow. Pain radiates to the lower abdomen, and sand/stones are passed via urine. In severe cases, blockage causes intense pain, leading to faintness and confusion; the patient only regains consciousness after sweating profusely, which is a result of the pain. Treatments include selecting from Ju Fang Wu Lin San, Xiang Xiong Wan, Mu Tong San, Wu Ling San, or Dao Chi San. For Kidney deficiency, Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) combined with Lu Rong (Cervus Nippon Antler) and Chuan Niu Xi (Achyranthes Bidentata Root) is named Bu Shen Di Huang Wan (Kidney-Nourishing Rehmannia Pill).

If there is Qi in the Small Intestine, urination is distended; if there is Blood, urination is astringent; if there is Heat, urination is painful. Treatment should focus on moving stagnation, clearing heat, and promoting diuresis. Tonifying Qi herbs should not be used, as tonifying Qi worsens distension, tonifying Blood worsens astringency, and tonifying Heat exacerbates the condition. These two paragraphs align with Chao Yuanfang’s statement that all stranguries are caused by Kidney deficiency.

[Attached Formulas]
Wu Lin San (Five Stranguries Powder): Chi Shao (Red Peony Root), Chi Fu Ling (Red Poria), Shan Zhi (Gardeniae Fructus), Dang Gui (Angelica Sinensis Radix), Gan Cao (Licorice Root).
Xiang Xiong Wan (Xiang Xiong Pill): Xiang Fu (Cyperus Rhizome), Chuan Xiong (Ligusticum Chuanxiong Rhizoma), Hai Jin Sha (Spore of Lygodium Sporangium), Chi Fu Ling (Red Poria), Hua Shi (Talcum), Zhi Ke (Aurantii Fructus), Ze Xie (Alismatis Rhizoma), Shi Wei (Pyrrosiae Folium), Bing Lang (Areca Seed).
Mu Tong San (Akebia Decoction): Mu Tong (Akebiae Caulis), Hua Shi (Talcum), Hei Chou (Semen Canarii).
Wu Ling San (Five-Ingredient Powder with Poria): See under Convulsive Disease.
Dao Chi San (Guide Out Redness Powder): Sheng Di (Rehmanniae Radix), Mu Tong (Akebiae Caulis), Huang Qin (Scutellariae Radix), Chi Fu Ling (Red Poria), Gan Cao (Licorice Root).
Bu Shen Di Huang Wan (Kidney-Nourishing Rehmannia Pill): Identical to Liu Wei Di Huang Wan plus Lu Rong (Cervus Nippon Antler) and Chuan Niu Xi (Achyranthes Bidentata Root).