宝鉴曰痹论云胞痹者小腹膀胱按之内痛若沃以汤涩于小便上为清涕夫膀胱为州都之官津
液藏
焉气化则能出焉今风寒湿邪客于胞中则气不能化出故胞满而水道不通其证小腹膀胱按之内痛
若沃以汤涩于小便以足太阳经其直行者上交额上入络脑气下灌于鼻窍则为清涕也
按此则知淋 有寒热之殊宜参脉理分治
陈无择云淋古谓之癃名称不同也癃者罢也淋者滴也古方皆云心肾气郁致小肠膀胱不利复
有冷
淋湿淋热淋等属外所因既言心肾气郁与夫惊思恐忧即内所因况饮啖冷热房室劳役及乘急忍溺
多致此病岂非不内外因也大率有五曰冷曰热曰膏曰血曰石五种不同皆以气为本
严氏曰五淋气石血膏劳是也气淋为病小便涩常有余沥石淋茎中痛尿不得卒出膏淋尿似膏
出劳
淋劳倦即发痛引气冲血淋遇热即发甚则溺血候其鼻头色黄者小便难也大抵此证多由心肾不交
积蕴热毒或酒后房劳服食热燥七情郁结所致癃闭淋 为病皆一类也
按此云五淋名各不同故两存之然石淋世俗又名沙石淋子和曰世人多为服金石燥热之剂得
之常
见农家有此证岂是服金石之人也大抵是膀胱蓄热而成此疾如汤瓶久在火中煮瓶底白碱而不能
去沙石淋之证与此理同其论最为得矣内经云少腹热溲出白液亦甚似之也
发明曰难经云脉有关有格何谓也然关则不得小便格则吐逆关者甚热之气格者甚寒之气是
关无
出之由故曰关格无入之理故曰格也按寒在胸中遏绝不入热在下焦填塞不便内经曰人迎大四倍
于气口名曰格气口大四倍于人迎名曰关关则不得小便格则吐逆夫小便者是足太阳膀胱所主长
生于申申者西方金也故金能生水金者肺也肺中伏热水不能出是绝小便之源也人辅相天地膀胱
之源自头项下至于足故曰阳中之阴如渴而小便不通者不得降是也故圣人立法皆用清燥金之正
化
气薄之药茯苓猪苓泽泻琥珀灯芯通草车前子瞿麦 竹之类皆为渗淡之药能泻肺火而清肺金滋
水
之化源也若热在下焦是绝其流而溺不泄也须用气味俱浓阴中之阴药治之长安王善夫病小便
不通渐成中满腹大坚硬如石壅塞之极腿脚坚胀裂裂出黄水双睛凸出昼夜不得眠饮食不下痛苦
不可名状伊芳戚赵谦甫诣予求治视归从夜至旦耿耿不寐究记素问有云无阴则阳无以生无阳则阴
无以化又云膀胱者州都之官津液藏焉气化则能出矣此病小便癃闭闭是无阴而阳气不化也凡利
小便之药皆淡味渗泄为阳止是气药阳中之阴非北方寒水阴中之阴所化者也此乃奉养太过膏粱
积
热损北方之阴肾水不足膀胱肾之室久而干涸小便不化火又逆上而为呕哕非膈上所生也独为关
非格病也洁古云热在下焦填塞不便是治关格之法今病者内关外格之病悉具死在旦夕但治下焦
可愈随处以禀北方寒水所化大苦寒之味者黄柏知母桂为引用丸如桐子大沸汤下二百丸少时来
报服药须臾如刀刺前阴火烧之痛溺如瀑泉涌出卧具皆湿床下成流顾盼之间肿胀消散予惊喜曰
大哉圣人之言岂可不遍览而执一者也其证小便闭塞而不渴时见躁者是也凡诸病居下焦皆不渴
也二者之病一居上焦在气分而必渴一居下焦在血分而不渴血中有湿故不渴也二者之殊至易分
别耳
谨按或问肝主小便淋溲今治法主肾何也然大凡病便数者多肾经气虚而然淋 者有标本之
分气
热郁结则膀胱津溢主合同不利为本病小腹痛不得便下焦气脉实而不利是客约不行为标病伤寒变
极者遗溲直视是少阴肾先绝也故此三经干于下部为病非独肝也或脾肺之气不能通调水道下输
膀胱清气不降皆能为癃 肾气虚而浊气不升虚热干于厥阴之络阴廷痿痹而神无所用乃旋溺烦
数人老年来多有此患矣肾虚极则水涸火炽真气散而死也或曰若久寡居之人病便数者岂肾气虚
之不为约乎然是金为火铄土为水濡腑脏兼体相资之道失湿热甚而经脉纵缓亦成斯疾也观先哲
用肾气丸等以收精气之虚脱为养气滋肾伐火导水使机关利而脾土健实之意是焉若全指为虚寒
处治者是则一概论也
*Baojian* (Mirror of Treasures) states in the *Bi Lun* (Treatise on Bi Syndrome): "Bao Bi (Bladder Bi syndrome) presents with pain inside the lower abdomen at the Bladder region upon palpation, feeling as if scalded by hot water, with difficult and scanty urination, and upper symptoms manifesting as clear nasal discharge. This is because the Bladder is the 'Official of the Reservoir' (the gathering place for fluids), where Jin Ye (body fluids) are stored; only through Qi transformation can they be excreted. Now, when Wind-Cold-Damp pathogens invade the Bao (uterus/bladder area), Qi cannot transform and excrete, resulting in abdominal fullness and obstruction of the water pathways. The manifestations include internal pain in the lower abdomen/Bladder region upon pressure, a sensation of being scalded by hot water, and urinary difficulty. This occurs because the straight branch of the Foot-Taiyang Bladder Meridian ascends to intersect at the forehead, enters and connects with the Brain, and its Qi descends to irrigate the nasal orifices, thus producing clear discharge."
From this, it is known that Lin Syndrome (Dysuria/Pollakiuria) has distinctions between Cold and Heat patterns; treatment should differentiate based on pulse conditions.
Chen Wuyue stated: "Lin was anciently called 'Long'. The names differ. 'Long' implies fatigue and weakness, while 'Lin' implies dripping drops. Ancient formulas attribute Small Intestine and Bladder dysfunction to Stagnation of Heart and Kidney Qi. There are also Cold Lin, Damp Lin, and Heat Lin, which belong to external causes. Since Heart-Kidney Qi stagnation and emotions like fright, thought, fear, and worry are mentioned, these are internal causes. Moreover, dietary extremes, sexual excess, labor, and holding urine often cause this disease; are these not non-internal/non-external causes? Generally, there are five types: Cold, Heat, Paste (Gao), Blood, and Stone. Although different, all are rooted in Qi dynamics."
Yan Shi stated: "The Five Lins are Qi, Stone, Blood, Paste, and Labor. Qi Lin manifests as difficult urination with residual dribbling; Stone Lin involves pain in the urethra and inability to void suddenly; Paste Lin presents with urine resembling paste; Labor Lin flares up after fatigue, with pain radiating to the Qichong point; Blood Lin occurs upon exposure to heat, potentially leading to hematuria. Observing a yellowish hue on the tip of the nose indicates difficult urination. Generally, this condition arises from failure of Heart-Kidney interaction, accumulation of heat toxins, post-coital activity after drinking, consumption of hot-drying substances, or emotional stagnation. Long Bi (Retention) and Lin are essentially the same category of disease."
Commentary: The names for the Five Lins vary, so both accounts are preserved. However, Stone Lin is colloquially known as Sand-Stone Lin. Hezi stated: "People often contract this from taking metallic/mineral hot-drying agents. It is common among farmers; does this mean those who ingest minerals are prone to it?" Generally, this results from Heat accumulation in the Bladder, similar to limescale accumulating in a pot boiled over fire for too long. The pathology of Stone Lin aligns with this reasoning, which is highly accurate. *Neijing* states: "Heat in the lower abdomen with white fluid discharge," which is also very similar.
*Faming* (Elucidations): *Nanjing* asks: "What is Guan Ge (Obstruction and Rejection)?" The answer is: "Guan leads to inability to urinate; Ge leads to vomiting. 'Guan' is extreme Heat; 'Ge' is extreme Cold. Guan means no exit, hence Guan; Ge means no entry, hence Ge." Commentary: Cold in the chest obstructs intake; Heat in the lower jiao blocks excretion. *Neijing* states: "If the Renying pulse is four times larger than the Qikou, it is named Ge; if the Qikou pulse is four times larger than the Renying, it is named Guan. Guan prevents urination; Ge causes vomiting." Urination is governed by the Foot-Taiyang Bladder, associated with Shen (Monkey/Metal). Metal generates Water; the organ corresponding to Metal is the Lung. Latent Heat in the Lung prevents water excretion, cutting off the source of urine. The human body assists Heaven and Earth; the source of the Bladder extends from the head/neck to the feet, thus termed Yin within Yang. For instance, thirst with urinary obstruction indicates failure of descent. Therefore, sages established methods using thin, aromatic, drying herbs that correspond to the proper transformation of Dry Metal, such as Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Alisma), Hu Po (Amber), Deng Xin Cao (Juncus Effusus), Tong Cao (Tetrapanax), Che Qian Zi (Plantago Seed), Qu Mai (Dianthus), and Zhu Ru (Bamboo Shavings). These are permeating and bland herbs that drain Lung Fire, clear Lung Metal, and nourish the source of Water generation. If Heat resides in the Lower Jiao, it cuts off the flow, preventing urination; this requires thick-flavored, heavy, Yin-within-Yin herbs. Wang Shanfu of Chang'an suffered from urinary retention progressing to abdominal distension, hard as stone, extreme blockage, swollen legs cracking with yellow fluid, protruding eyes, insomnia, and inability to eat or drink. His relative Zhao Qianfu sought my treatment. I observed him from night till dawn, restless. Recalling *Suwen*: "Without Yin, Yang has nothing to generate; without Yang, Yin has nothing to transform." And: "The Bladder is the Official of the Reservoir... only through Qi transformation can it excrete." This patient's retention is due to lack of Yin, causing Yang to fail to transform. Diuretics are bland and permeating (Yang), merely Qi-moving agents (Yin within Yang), not the cold-water Yin-within-Yin of the North. This resulted from excessive indulgence, rich diet generating heat, damaging Northern Yin, depleting Kidney Water. The Bladder, the chamber of the Kidney, dried out over time. Fire rebelled upward causing vomiting, not a Ge (Rejection) disorder but a Guan (Obstruction) one. Jiegu stated: "Heat in the Lower Jiao blocking excretion" treats Guan Ge. The patient exhibited both internal Guan and external Ge, facing imminent death, but treating the Lower Jiao could cure it. I used bitter-cold herbs derived from Northern Water, Huang Bo (Phellodendron) and Zhi Mu (Anemarrhena), guided by Gui Zhi (Cinnamon Twig), made into pills size of tung seeds, taken with boiling water (200 pills). Shortly after, the patient reported burning/stinging pain in the genitals, followed by a gush of urine wetting the bedding. Swelling vanished instantly. I exclaimed: "Great are the words of the Sages! One must not be dogmatic." This pattern features urinary obstruction without thirst, occasional restlessness. Diseases in the Lower Jiao generally do not cause thirst. The two disorders differ: Upper Jiao/Air level causes thirst; Lower Jiao/Blood level does not, due to dampness in blood. They are easy to distinguish.
Respectfully noted: Some ask why Liver governs urination/Lin, yet treatment focuses on Kidney. Generally, frequent urination stems from Kidney Qi deficiency. Lin has root (Ben) and branch (Biao) aspects: Qi-Heat stagnation causing Bladder fluid overflow and difficulty coordinating is the Root; lower abdominal pain with inability to void, characterized by Excess Qi/Stagnation in Lower Jiao, is the Branch. In severe Shanghan transformations, enuresis and staring indicate early exhaustion of Shaoyin Kidney. Thus, these three meridians affecting the lower body involve more than just the Liver. If Spleen/Lung Qi fails to regulate water passages descending to the Bladder, or Clear Qi fails to descend, Long Bi occurs. Kidney Qi deficiency with turbid Qi failing to ascend, and Deficient Heat harassing Jueyin collaterals, causing genital flaccidity and loss of spirit, leads to frequent, urgent urination. Elderly often suffer this. Extreme Kidney deficiency leads to dryness, blazing fire, dispersion of True Qi, and death. Some ask: Do widows suffering frequency have Kidney deficiency unable to restrain? Yes, but if Metal is scorched by Fire, Earth soaked by Water, and the mutual support of organs fails, with severe Damp-Heat and lax meridians, this disease arises. Ancients used Shen Qi Wan to consolidate essence/Qi, nourish Kidney, drain fire, guide water, benefit joints, and strengthen Spleen Earth. To treat solely as Deficiency-Cold would be an oversimplification.