浊之为证。茎中热痛。如火灼刀割。溲溺自清。惟窍端时流秽浊如脓。淋沥不断。初与溲溺
不相混滥。时医不知其故。多以利水之剂。杂投不已。因而增剧者。往往有之。盖由败积瘀腐者
十中六七。由湿热下注与脾虚下陷者。十常三四。必先补中气。兼升举之。而后分其脏腑气血。
赤白虚实以治。与夫他邪所伤者。固在泻热补虚。设肾气虚甚。或火热亢极者。则不宜纯用寒凉。
必反佐治之。在达人观变耳。色白如泔。或如腐花腐浆。而马口不干结者为湿。色黄赤而马口干
靥者为火。此皆为浊。胃中湿热下流也。又浊而清者为湿。痛者湿兼热也。有溺时结块阻滞作痛。
块中内蓄水泡者。此必醉酒使内。酒湿乘虚袭入精窍也。粘腻如胶。或心动辄遗。或溺后遗下者。
皆精病。与浊无干。肥人白独白带。多是胃中湿热。浊痰下流。渗入膀胱。谓之便浊。与肾绝不
相干。虽溺后便出浊块。却不牵腻。用二陈加川萆 、泽泻、姜汁炒黄柏。浊物中有水泡者。二
陈倍半夏加猪苓、泽泻、滑石、麝香、赤小豆、竹沥、姜汁之类。赤者。去半夏加琥珀、延胡索、
赤芍药、椿根皮。若肾虚淫火易动。精离其位而成精浊者。其精牵腻如膏。虽不便溺。亦常有之。
用九龙丹收摄之。若忍精不泄。流入窍隧而患白浊。用五苓散。赤浊。用猪苓汤。并加麝少许。
小便频数。茎中痛。调下益元散。赤者。少加朱砂。昼甚者。属上焦燥热。气化不行。益智、乌
药。皆不可用。宜清心莲子饮。虚者。妙香散二方选用。心经伏暑而赤浊者。五苓散减桂合生脉
散。肥人湿痰成浊。二陈加二术、黄柏、神曲。黑瘦人脉洪数。五心烦热。颊赤唇干。小便赤浊。
龙胆泻肝汤。曾见白浊人。服凉药不效。一味生白果即愈者。以其专祛湿浊污垢故也。脾
虚下陷者。补中益气加半夏、茯苓。有小便如常。放流浊物。两尺脉沉弱。足膝痿弱。白浊频数。
凝白如油。光彩不定。漩脚澄下如膏糊。六味丸加萆 、麦冬。茎中大痛。便赤口渴。脉来滑数
者。宜与清热利水。津液自行。四苓散加生地、麦冬、芩、栀、知、柏之类。丹方。治白浊。用
枸杞一钱五分。菟丝、车前、韭子各一钱。莲子去心二十一粒。入 猪尿脬内。煮一伏时。加葱
酒啜汁。并食猪脬、莲子。连服二三次效。
白淫者。一时流放白水。火郁故也。加味逍遥散。小腹急痛。便溺失精。溲出白液。桂枝加
龙骨牡蛎汤。脾风传肾。小腹痛。冤热出白液。名曰蛊。左传以丧志名为蛊病。乃真元不守也。
当归内补建中汤加黄 。
筋疝者。茎中作痛。筋急缩。或作痒。或肿。或筋缓不收。白物如精。随溺而下。此肾不虚。
而肝经湿热火旺也。龙胆泻肝汤。
〔诊〕浊证脉大而涩。按之无力。或微细。或沉紧而涩为虚。动滑为实。尺脉虚浮急疾者。皆
难治。迟者易治。
The syndrome of "Zhuo" (Turbid Discharge) manifests as burning pain in the urethra, feeling like fire scorching or a knife cutting. The urine itself is clear, but only at the meatus (opening of the urethra) does turbid fluid resembling pus flow intermittently and continuously. Initially, this turbid discharge does not mix with the urine. Physicians of the time, unaware of the cause, often indiscriminately administered diuretic agents, thereby exacerbating the condition, which was frequently observed. Approximately 60-70% of cases are due to the accumulation of stale essence, blood stasis, and putrefied matter, while 30-40% result from damp-heat pouring downward and spleen deficiency with qi sinking. Treatment must first tonify the middle qi and employ lifting methods, followed by differentiating the organs and meridians to treat based on the redness/whiteness and deficiency/excess of qi and blood. For injuries caused by other pathogens, clearing heat and tonifying deficiency are indeed required. However, if kidney qi is extremely deficient or fire is hyperactive, pure cold-cooling herbs should not be used; instead, counter-assistance methods must be employed, requiring the physician to demonstrate flexibility in observation and treatment.
If the discharged substance is white like rice washings or like rotten flowers/slurry, and the meatus is not dry or crusted, it indicates Dampness. If it is yellow-red and the meatus is dry with crusts, it indicates Fire. These are all forms of Zhuo, caused by damp-heat flowing downward from the Stomach. Furthermore, clear turbidity indicates Dampness, while painful turbidity indicates Dampness combined with Heat. If there are clumps causing obstruction and pain during urination, with water blisters retained within the clumps, this is certainly due to sexual intercourse after excessive alcohol consumption, where wine-dampness invaded the essence orifices when the body was deficient.
Secretions that are sticky like gum, or seminal emission triggered by mental arousal, or post-urinary leakage, all belong to Essence diseases (Jing Bing), unrelated to Zhuo. In obese individuals, leukorrhea is mostly due to stomach damp-heat, where turbid phlegm flows downward and infiltrates the Bladder, termed Bian Zhuo (Turbid Urine). This has nothing to do with Kidney deficiency. Although turbid clumps may be passed after urination, they are not sticky or dragging. Treat with Er Chen Tang (Two-Cured Decoction) plus Chuan Bi Xie (Dioscorea Hypoglauca Rhizome), Ze Xie (Alisma Rhizome), and Huang Bo (Phellodendron Bark) stir-fried with ginger juice. If water blisters are present in the turbid matter, use Er Chen Tang with doubled Ban Xia (Pinellia Tuber), plus Zhu Ling (Polyporus), Ze Xie, Hua Shi (Talcum), She Xiang (Musk), Chi Xiao Dou (Adzuki Bean), Zhu Li (Bamboo Sap), and Jiang Zhi (Ginger Juice). For red discoloration, remove Ban Xia and add Hu Po (Amber), Yan Hu Suo (Corydalis Rhizome), Chi Shao Yao (Red Peony Root), and Chun Gen Pi (Toona Root Bark). If Kidney deficiency leads to hyperactive ministerial fire, causing essence to leave its proper position resulting in Jing Zhuo (Essence Turbidity), the essence will be sticky like paste. This occurs even without urination. Use Jiu Long Dan (Nine Dragon Pill) to consolidate and secure. If semen is retained without emission, flowing into the orifices and causing Bai Zhuo (White Turbidity), use Wu Ling San (Five-Ingredient Powder with Poria). For Chi Zhuo (Red Turbidity), use Zhu Ling Tang (Poria Decoction) with a small amount of She Xiang. For frequent urination with penile pain, administer Yi Yuan San (Yuan Base Powder) with adjustments: add a little Zhu Sha (Cinnabar) for red color. If symptoms worsen during the day, it belongs to Upper Jiao dryness-heat with failed qi transformation; Yi Zhi Ren (Alpinia Oxyphylla Fruit) and Wu Yao (Lindera Root) are contraindicated. Use Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction). For deficiency patterns, choose Miao Xiang San (Miraculous Fragrance Powder). For Chi Zhuo caused by latent summer-heat in the Heart Meridian, use Wu Ling San minus Gui Zhi (Cinnamon Twig) combined with Sheng Mai San (Generate Pulse Powder). For turbidity caused by damp-phlegm in obese individuals, use Er Chen Tang plus Bai Zhu (Atractylodes Macrocephala Rhizome), Cang Zhu (Atractylodes Rhizome), Huang Bo, and Shen Qu (Medicated Leaven). For thin, dark-skinned individuals with surging-rapid pulse, five-center heat, red cheeks, and dry lips, with red turbid urine, use Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction). A case was seen where a patient with Bai Zhuo did not respond to cooling herbs but was cured by raw Bai Guo (Ginkgo Seed) alone, because it specifically expels damp-turbid filth. For Spleen deficiency with qi sinking, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ban Xia and Fu Ling (Poria).
In cases where urination is normal but turbid matter flows out, with deep-weak pulses at both Chi positions, weak and flaccid legs and knees, frequent white turbidity that is coagulated like oil, unstable luster, and sediment at the bottom of the urine vessel resembling paste, use Liu Wei Wan (Six-Ingredient Pill) plus Bi Xie and Mai Dong (Ophiopogon Tuber). For severe penile pain, red urine, thirst, and slippery-rapid pulse, clear heat and promote urination so that body fluids restore naturally; use Si Ling San (Four-Poria Powder) plus Sheng Di Huang (Rehmannia Root), Mai Dong, Huang Qin (Scutellaria Root), Zhi Zi (Gardenia Fruit), Zhi Mu (Anemarrhena Rhizome), and Huang Bo.
Prescription from a Da Fang (Emperor's Formula): For Bai Zhuo, use Gou Qi Zi (Goji Berry) 1.5 qian, Tu Si Zi (Dodder Seed), Che Qian Zi (Plantago Seed), and Jiu Zi (Leek Seed) each 1 qian, and 21 lotus seeds with hearts removed. Place inside a pig bladder, boil for one fu shi (approx. 2 hours), drink the broth with green onion and wine, and consume the bladder and lotus seeds. Effective after 2-3 doses.
"Bai Yin" (White Lust) refers to the sudden discharge of white fluid, caused by constrained Fire. Use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). For urgent lower abdominal pain, loss of essence in urination/defecation, and discharge of white fluid, use Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell). When Spleen wind transmits to the Kidney, causing lower abdominal pain and hot sensation discharging white fluid, it is named Gu (Gu Syndrome). The Zuo Zhuan attributes Gu disease to loss of spirit, indicating failure of true yuan to remain. Use Dang Gui Nei Bu Jian Zhong Tang (Angelica Internal Nourishing and Middle-Building Decoction) plus Huang Qi (Astragalus Root).
"Jin Shan" (Sinew Hernia) presents as penile pain, sinew tension and retraction, itching, swelling, or sinew laxity and inability to retract, with white substance like semen discharging with urine. This is not Kidney deficiency, but Damp-Heat and Fire Hyperactivity in the Liver Meridian. Use Long Dan Xie Gan Tang.
[Diagnosis] The pulse for Zhuo syndrome is large and choppy, powerless upon pressure, or fine, or deep-tight and choppy, indicating Deficiency. Moving and slippery pulses indicate Excess. Chi pulses that are deficient-floating, rapid, and urgent are difficult to treat; slow pulses are easier to treat.