淋，服三枚，八九年以还服二枚。服时以水如枣许着小杯中，用爪研之，当扁扁见于水中，仰面吞之，勿令
近牙齿间。药虽微，下喉自觉至下焦淋所。有顷药作，大烦急不可堪，饮干麦饭汁，则药热止也。若无干麦饭，
但水亦可耳。老小服三分之一。当下淋疾如浓血连连而去者，或如指头，或青或黄，不拘男女皆愈。若药不快，
淋不下，以意节度更增服之。此虫五六月为亭长，头赤身黑，七月为斑蝥，九月为地胆，随时变耳。（同上。）
李士材治严邑宰患淋，经年痛如刀锥。凡清火疏利之剂，计三百帖，病势日甚。脉之，两尺数而无力，是
虚火也。绿泥痛无补法，愈疏通则愈虚，愈虚则虚火愈炽。遂以八味地黄料加车前、沉香、人参，服八剂痛减
一二，而频数犹故。前医复云淋症作痛，定是实火，若多温补，恐数日后，必将闷绝不可救矣。彼疑而问李，
李曰∶若不宜温补，服药后病势必增。今既减矣，复何疑乎？朝服补中益气汤，晚服八味丸，逾月而疾去其九。
便倍用参、 ，十四日霍然矣。
杜司寇夫人淋沥两载，靡药不尝，卒无少效。诊之，两尺沉数，谓有瘀血停留，法当攻下。因年高不敢轻
投，但于补养气血之中加琥珀、牛膝。此等缓剂，须以数十剂收功。而夫人躁急求效，辄欲更端，遂致痼疾。
冯楚瞻治李参领，年将六旬，患淋两载。有时频利且速，有时点滴难通，急痛如割，肥液如脂如膏，或成
条紫血，日夜不堪，时欲自尽。询所服，有一医立通利、止涩二方，便频则用止涩，秘塞则用通利。（此辈伎俩，
原只如此。）乃服通利，则频数无度矣；服止涩，则结滞难通矣。按其脉，两寸甚洪，余皆无力，独肝肾更甚，曰∶
肝主疏泄，肾主闭藏，今肝肾俱病，各废乃职，利则益虚其虚，涩则愈增其滞，惟调补肝肾自愈。用八味加麦
冬二钱，升麻八分，红花四分，重用人参煎服，使清者升，浊者降，瘀者化。中气既足，肝肾既调，开阖自然
得所矣。后以生脉饮送八味丸，服于空心，以归脾加减，服于午后，全安。
一少年劳心色欲过度，患小便淋沥胀疼，且二便牵痛，其脉两寸沉微，左关甚弱，右关滑，两尺弦涩。乃
心肺之气不足，而下陷于肝肾，肝肾之气又不足，所以不能疏泄闭藏。中气既虚，则清阳不升，中宫郁滞，蒸
为湿热，渗入膀胱，乃似淋非淋，二便牵痛，如大瘕泄也。令早服六味丸加黄柏、制附子，使寒热互为向导，以
去湿热，疏通郁结，以扶其元气。晚用补中益气去陈皮、柴胡，加茯苓、防风，酒炒其渣，临晚煎服探吐，遂愈。
张路玉治内阁文湛持，夏月热淋。医用香薷饮、益元散，五日不应，淋涩转甚，反加心烦不寐。诊之，见
其唇赤齿燥，多汗喘促，不时引饮，脉见左手虚数。知为热伤元气之候。与生脉散，频进代茶，至夜稍安。明
日复苦溲便涩数，然其脉已和，仍用前方，不时煎服，调理五日而瘥。
太史沈韩倬患膏淋，小便频数，昼夜百余度。昼则滴沥不通，时如欲解，痛如火烧。夜虽频迸，而所解
倍常，溲中如脂如涕者甚多。服清热利水药半月余，其势转剧，面色萎黄，饮食兼退。脉得弦细而数，两尺按
之益坚，而右关涩大少力。此肾水素弱，加以劳心思虑，肝木乘脾所致。法当先实中土，使能堤水则阴火不致
下溜，清阳得以上升，气化通而瘀涩瘳矣。或曰∶邪火亢极，又用参、 补之，得毋助长之患乎？抑知阴火乘
虚下陷，非开提清阳不应。譬之水注，塞其上孔，倾之涓滴不出，所谓病在下取之上。若清热利水，气愈陷，
精愈脱而溺愈不通矣。遂与补中益气汤，用人参三钱，服二剂痛虽减，而病者求速效，或进四苓散加知母、门
冬、沙参、花粉，甫一剂，彻夜痛楚。于是专服前方，兼六味丸，用紫河车熬膏代蜜调理，服至五十剂，参尽
斤余而安。（俞东扶曰∶治淋如文垣诸案，经也。此案之治法，权也。经权合宜，皆审脉以为辨。审得明白，
病自显然。推之望、闻、问、切，素称四诊，可见四件都要细审也。）
陕客亢仁轩，年壮色苍，体丰善啖，患胞痹十余年，泊吴求治。其脉软大而涩涩不调，不时蹲踞于地，以
手揉其茎囊，则溲从谷道点滴而渗。必以热汤沃之，始得稍通，寐则有时而遗。其最苦者，中有结块如橘核，
外裹红丝，内包黄水，杂于脂腻之中。此因恣饮不禁，酒湿乘虚袭入髓窍而为患。因令坚戒烟草、火酒、湿面、
椒、蒜、糟、醋、鸡、豚、炙爆等味，与半夏、茯苓、猪苓、泽泻、萆 、犀角、竹茹作汤，四剂不愈，则以
不遵禁忌之故。乃令坚守勿犯，方与调治，仍用前药四剂，势减二三。次与肾沥汤加萆 数服，水道遂通，溲
亦不痛。但食不甘美，后以补中益气加车前、木通调之而安。（肥盛多湿，故先与清胃豁痰，而后理肾调脾。）
侍卫金汉光，年逾花甲，初夏误饮新酒致病，前则淋沥涩痛，后则四痔肿突，此阴虚热陷膀胱也。先与导
赤散，次进补中益气，势渐向安。惟孔中涩痛未除，或令进益元散三服，遂致遗溺不能自主，授剂不应。直至
新秋脉渐软弱，因采肾沥之义，以羯羊肾制补骨脂，羊脬制菟丝子，浓煎桑根皮汁制螵蛸，连进三日，得终夜
安寝，涓滴靡遗矣。
闵少江年高体丰，患胞痹十三年，历治罔效。凡遇劳心嗔恚，或饮食失宜，则小便频数滴沥，涩痛不已。
夜略交睫，即渗漉而遗，觉则阻塞如前。服人参、鹿茸、紫河车无算，然皆无碍。独犯丹皮、白术即胀痛不禁。（
香燥之药，误投杀人，世罕知也。）张诊之曰∶病名胞痹，（俗名尿梗病。）惟见于《内经》。由膏粱积热于
上，作强伤精于下，湿热乘虚聚于膀胱。《素问》云∶胞痹者，少腹膀胱按之内痛，若沃以汤，涩于小便，上
为清涕。详其文，则知膀胱虚滞，不能上吸肺气，肺气不清，不能下通水道，所以涩滞不利。得汤热之助，则小
便涩滞微通。其气循经蒸发，肺气暂开，则清涕得以上泄也。因与肾沥汤方服之，其效颇捷。原其寝则遗溺，
知肝虚火扰，疏泄失宜，所以服丹皮疏肝之药则胀者，不胜其气之窜，以击动阴火也。服白术亦胀者，不胜其
味之浊，以壅滞湿热也。服人参、鹿茸、河车无碍者，虚能受热，但补而不切于治也。更拟加减桑螵蛸散，用
羊肾汤泛丸，庶有合于病情。然八秩之年，犹恃体丰，不远房室，药虽中窍，难保其不复也。（与前陕客案症治
略同。俞东扶曰∶寤则淋涩，寐则溺遗，原与不禁有别，故以胞痹症治。其论药病不合处，理精义确。后来叶
氏处方，最讲此旨。再观其治黄元吉、亢仁轩案，病情同而治法不同，用药俱有妙解。能细细参之，庶不犯
枳、朴、归、芩，到手便撮之诮。）
黄元吉年六十余，因丧明蓄外家，患小便淋涩。春间因颠仆昏愦，遗溺，此后遂不时遗溺，或发或止。至一
阳后，其症大剧，昼则苦于不通，非坐于热汤，则涓滴不出，夜则苦于不禁。其脉或时虚大，或时细数，而左
关独弦。此肾气大亏，而为下脱之兆也。乃与地黄饮子，数服溺涩少可，遗亦少间。后与八味丸去丹皮、泽泻，
加鹿茸、五味、巴戟、远志，调理而安。
新安富室，有男子淋溺不止者，渐萎黄，诸医束手，孙卓三治之亦弗效。偶隐几坐，以手戏弄水灌后，孔
塞则前窍止，开则可通。脑后一穴，为灸火至三炷愈。（《江西通志》。）
王肯堂治外兄贺晋卿，因有不如意事，又当劳役之后，忽小腹急痛欲溺，溺中有白物如脓，并血而下，茎
中急痛不可忍，正如滞下后重之状，日夜十数行，更数医不效，乃作污血治。令以牛膝四两，酒浸一宿，长流
水十碗，煎至八碗，再入桃仁一两去皮，炒红花二钱五分，当归一两五钱，木通一两，生甘草二钱五分，苎麻
根二茎，同煎至二碗去渣，入琥珀末二钱，麝香少许，分作四服，一日夜饮尽，势减大半。按《素问·奇病论》
云∶病有癃者，一日数十溲，此不足也。今瘀血虽散，宜用地黄丸加菟丝、杜仲、益智、牛膝之属，补阴之不
足，以杜复至。因循未修治，遂不得全愈。或闭或通，一夜数十起，溺讫痛甚，竟服前丸及以补肾之药入煎剂，
调理而安。
从兄尔祝得淋疾，日数十溲，略带黄，服五苓散稍愈。因腹中未快，多服利药，三五日后忽见血星，医以
八珍散治之不应。询其便后时有物如脓，小劳即发。诊得六脉俱沉细，右尤甚，此中气不足也。便后脓血，精
内败也。经云∶中气不足，则溲便为之变。宜补中益气汤加顺气之药，以滋其阳，六味地黄丸疏内败之精，以
补其阴，（雄按∶补中益气升阳之剂而曰滋，六味渗涩互用，而曰疏败精，不无语病。）更加五味子敛耗散，
牛膝通脉络，数剂而安。
萧万舆治郑友患淋，经年屡治罔效。曰∶淋症有虚实寒热之殊，今君年未三旬，元气充实，因修途劳役，
饮食不调，复喜火酒，脾受湿气，时当炎令，丁火司权，丙火协应，故心移热于小肠，五火因而内灼，上则肺
燥口渴，下则肾燥淋结。前服八正、五淋，只专治淋，而未知清水上源，滋益肺金，故不效。以二陈、小柴胡，
加龙胆草、知母、木通、麦冬，（雄按∶此法谓之清湿火则可，何尝润上下之燥哉？）一剂减，数剂全瘳。
朱司马六间，年五旬，艰嗣不慎酒色，饮食起居失宜，面目青黑，怒则晕，大便秘塞脱血，小便淋血如割，
屡服清火通淋之剂反增剧。脉沉迟，两尺兼涩。此肾水枯竭，不能滋生肝血，遂致虚火上炎，移热二肠，迫血
下行，因而隧道枯涩，妨碍升降，故每欲便，疼塞难堪。须用甘温之品，滋益化源，补养肝木，使阴血盛则津
液充，而淋秘自解矣。以补中益气汤去柴胡，倍人参，加牛膝，少加肉桂，及加减八味丸入人参、苁蓉、远志，
服月余渐愈。
张云汀年近四十，因暑热往来道途，多饮火酒，遂成癃闭。广陵医者，多与清热渗利之剂，黄连服至三两
不能愈。旋里后诊之，右尺洪大，左尺不应指，口燥渴，知其三阴已伤，与六味地黄汤，殊未效。更医仍用车
前、赤茯、琥珀、木通、瞿麦、 蓄、五苓、六一之类，遂致一夜必便百余次，溺惟点滴，少腹急痛而胀，窘
迫楚甚，面渐黧黑。此复伤少厥二阴，致疏泄秘密俱失其职，而太阴、太阳之升降气化亦紊也。令朝服补中益
气，暮服六味地黄，（雄按∶究治少厥二阴乎？抑治太阴、太阳耶？拘守二方，颟顸了事，未可为训也。）每方
各三十剂乃痊。
徐灵胎曰∶治淋之法，有通有塞，要当分别。有瘀血停积塞住溺管者，宜先通；无瘀积而虚滑者，宜峻补。
不但煎丸各别，并外治之法亦复多端，宜博识而详考之。
《广笔记》治疝气痛，用六味地黄丸古方，加北五味三两，肉桂二两，枸杞子四两，车前子米汁浸蒸三两，
将糯米一斗炊饭，乘热下白酒药，并前药料和匀，如常制白酒法，三两日后浆来，用上好烧酒五十斤，连酒浆
并糟入大瓮内，泥封固。一月开，去糟滤清，酒味甘香，空心或饥时随量饮之，饮多不渴。
张飞畴治田孟先，久患膏淋，溲中有块如橘核状，外裹血膜，中包黄水。乃醉后入房，酒湿流入肾脏所致。
遍服利水固精药不应。溽暑中忽然憎寒发热，喘促闷乱，腰背烦疼，脉见浮濡沉细，是淋久阴伤，暑气袭虚之
证。先与生料六味加川萆 作汤，下消暑丸，次用前汤送木车猪苓丸，八服诸症霍然。又孝廉蔡允恭，严冬患
浊，小腹结硬，大发寒热，巅痛自汗，脉得左大右涩，两尺紧细，乃风痰毒邪入犯厥阴之经。与当归四逆汤煎
服，覆汗而热除。即以前方去通草、姜、枣，加蝎梢陵鲤甲麝脐丸，服之令作汗，数日便消痛止。但浊犹未净，
或令嚼生银杏而愈。世人言银杏涩精，殊不知其专涤败浊也。
Lin syndrome (strangury), take three pills; after eight or nine years, reduce to two pills. When taking the medicine, place a amount of water the size of a jujube pit into a small cup, grind the medicine with fingernails until it appears flattened in the water. Swallow it while looking upward, ensuring it does not touch the teeth. Although the medicinal force is mild, upon swallowing one feels it reach the lower jiao where the lin syndrome resides. After a short while, the medicine takes effect, causing extreme restlessness and urgency that is unbearable. Drink dry wheat meal juice to stop the medicinal heat. If dry wheat meal is unavailable, plain water will suffice. The elderly and children should take one-third of the dose. The medicine will expel thick, blood-like discharge continuously, sometimes like a finger, either green or yellow, curing both men and women. If the medicine acts slowly and lin discharge does not occur, adjust the dosage according to judgment. This insect is called "Tingzhang" (Cicada Larva) in May and June, red-headed and black-bodied; in July it becomes "Banmao" (Mylabris); in September it becomes "Didan" (Blister Beetle); these are merely name changes over time. (Ibid.)
Li Shicai treated the magistrate of Yan County who suffered from lin syndrome for a year, with pain like knife or awl insertion. All clearing heat and draining fire, as well as promoting urination prescriptions, totaling three hundred doses, failed to control the worsening condition. Pulse diagnosis revealed rapid and deficient pulses at both chi positions, indicating deficiency fire. For this type of stubborn pain, there is no simple tonification method; the more one promotes drainage, the more deficient the righteous qi becomes, and the more deficient it is, the fiercer the deficiency fire burns. Thus, Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Root Pill) formula was used with added Che Qian Zi (Plantago Seed), Chen Xiang (Aquilaria Wood), and Ren Shen (Ginseng). After eight doses, pain decreased slightly, but urinary frequency remained unchanged. Previous physicians claimed that pain in lin syndrome must be excess heat, warning that excessive warming and tonification would lead to suffocation and death within days. The patient doubted this and asked Li Shicai. Li said, "If warming and tonification were unsuitable, the condition would worsen after taking the medicine. Since it has improved, what is there to doubt?" He prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning and Ba Wei Wan (Eight-Ingredient Pill) in the evening. After a month, ninety percent of the disease was gone. Doubling the dosage of Ren Shen (Ginseng) [and likely Huang Qi], he recovered completely in fourteen days.
The wife of Censor Du suffered from dribbling lin syndrome for two years, trying every medicine without effect. Pulse diagnosis showed deep and rapid pulses at both chi positions, indicating stagnant blood. According to the principles, purgation was indicated. However, due to her advanced age, harsh drugs were avoided. Instead, Hu Po (Amber) and Niu Xi (Achyranthes Root) were added to blood and qi tonifying formulas. Such mild remedies require dozens of doses to achieve results. Impatient for quick effects, she constantly changed treatments, leading to a chronic, stubborn disease.
Feng Chuzhan treated Li Shenling, nearly sixty years old, suffering from lin syndrome for two years. Sometimes frequent and rapid urination, sometimes difficulty passing even drops, with acute cutting pain. Urine was turbid like fat or paste, sometimes forming purple blood strips, causing unbearable day and night suffering, leading to suicidal thoughts. Inquiry revealed a previous doctor prescribed alternating "promoting urination" and "astringing" formulas: using astringents for frequency and promoting urination for retention. Taking promoting urination drugs led to uncontrolled frequency; taking astringents led to blockage. Pulse diagnosis showed very surging pulses at both cun positions, weak elsewhere, especially in liver and kidney areas. Feng stated, "The liver governs dispersion and excretion; the kidney governs closure and storage. Now both liver and kidney are diseased, failing their duties. Promoting urination further depletes deficiency; astringing further increases stagnation. Only by regulating and tonifying liver and kidney can one heal." He used Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Root Pill) with Mai Dong (Ophiopogon Tuber), Sheng Ma (Cimicifuga Rhizome), Hong Hua (Safflower), and heavy doses of Ren Shen (Ginseng) decocted. This raised clear yang, lowered turbid yin, and resolved stasis. Once middle qi was sufficient and liver/kidney regulated, opening and closing functions normalized. Later, Sheng Mai San (Generate the Pulse Powder) was used to deliver Ba Wei Wan on an empty stomach, and Gui Pi Tang (Restore the Spleen Decoction) modified in the afternoon, resulting in full recovery.
A young man suffered from dribbling, distending, and painful urination, with牵引 pain in both bowels and bladder, due to excessive mental labor and sexual indulgence. Pulses were deep and micro at both cun, very weak at left guan, slippery at right guan, and wiry-choppy at both chi. This indicated insufficient lung and heart qi sinking into liver and kidney, and insufficient liver and kidney qi failing to disperse and store properly. With deficient middle qi, clear yang fails to rise, middle jiao stagnates, steaming into damp-heat that infiltrates the bladder. This resembles lin syndrome but is distinct, causing traction pain in bowels/bladder, similar to Da Jia Xie (Great Mass Dysentery). He was instructed to take Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) with Huang Bo (Phellodendron Bark) and Zhi Fu Zi (Prepared Aconite Root) in the morning to guide cold and heat, removing damp-heat and resolving stagnation while supporting yuan qi. In the evening, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) without Chen Pi (Tangerine Peel) and Chai Hu (Bupleurum Root), plus Fu Ling (Poria) and Fang Feng (Saposhnikovia Root), with wine-fried dregs, decocted before bed and inducing vomiting, leading to cure.
Zhang Luyu treated Wen Zanchi, an inner cabinet official, with summer heat lin syndrome. Doctors used Xiang Ru Yin (Mosla Decumbens Decoction) and Yi Yuan San (Benefit the Origin Powder) for five days without effect; strangury worsened, accompanied by vexation and insomnia. Diagnosis showed red lips, dry teeth, profuse sweating, panting, frequent thirst, and a deficient-rapid pulse on the left hand. This was identified as heat damaging yuan qi. Sheng Mai San (Generate the Pulse Powder) was given frequently as tea, bringing slight relief at night. The next day, painful frequent urination returned, but the pulse had harmonized. The same formula was continued intermittently, and he recovered after five days of regulation.
Grand Historian Shen Hanzhuo suffered from gao lin (fatty strangury) with frequent urination, over a hundred times day and night. During the day, dribbling obstruction with burning pain; at night, frequent expulsion of large volumes, urine containing much lipid-like mucus. Clearing heat and promoting urination medicines taken for half a month worsened the condition, causing sallow complexion and loss of appetite. Pulse was wiry-thin-rapid, deep and firm at both chi, and choppy-large-deficient at right guan. This was due to inherent weak kidney water, exacerbated by mental labor, with liver wood overacting on spleen earth. The principle was to first strengthen middle earth to dam water, preventing yin fire from sinking, allowing clear yang to rise, restoring qi transformation, and resolving stasis. Some argued, "With extreme evil fire, adding Ren Shen (Ginseng) [and Huang Qi] might aid the pathogen." However, yin fire sinking due to deficiency requires lifting clear yang. Like a funnel blocked at the top, pouring yields nothing; thus, "disease below is treated from above." Clearing heat and draining water further sinks qi and depletes essence, worsening obstruction. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with 3 qian of Ren Shen (Ginseng) was given. Pain reduced after two doses, but the patient sought quick results and took Si Ling San (Four-Powder Decoction) with Zhi Mu (Anemarrhena Rhizome), Mai Dong (Ophiopogon Tuber), Sha Shen (Glehnia Root), and Hua Fen (Tiger Lily Bulb). One dose caused all-night agony. He then exclusively took the former formula combined with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), using Zi He Che (Placenta) paste instead of honey for regulation. After fifty doses and over a jin of Ginseng, he stabilized. (Yu Dongfu commented: Treating lin syndrome like the cases of Wenyuan et al. represents the standard method (Jing). This case's treatment represents flexibility (Quan). Combining Jing and Quan relies on pulse differentiation. Clear differentiation makes the disease obvious. Extending this to observation, listening/smelling, inquiry, and palpation—the Four Examinations—shows all must be carefully examined.)
Kang Renxuan, a merchant from Shaanxi, young, robust, dark-complexioned, obese, and hearty eater, suffered from bao bi (bladder obstruction) for over ten years. He traveled to Wu for treatment. Pulses were soft, large, and irregularly choppy. He often squatted on the ground, rubbing his penis and scrotum, causing urine to seep dropwise from the anus. Hot water application provided slight relief; nocturnal enuresis occurred. Most distressing was a lump inside like a tangerine seed, wrapped in red filaments, containing yellow fluid mixed with grease. This resulted from unrestrained drinking, allowing alcohol-dampness to invade marrow orifices when deficient. He was strictly forbidden from tobacco, strong liquor, damp noodles, pepper, garlic, pickles, vinegar, chicken, pork, and fried foods. Ban Xia (Pinellia Tuber), Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Alisma Rhizome), Bi Xie (Dioscorea Hypoglauca Rhizome), Xi Jiao (Rhinoceros Horn - *Note: now substituted*), and Zhu Ru (Bamboo Shavings) were decocted. Four doses failed due to non-compliance with dietary restrictions. Upon strict adherence, another four doses reduced symptoms by two or three parts. Then, Shen Li Tang (Kidney Strangury Decoction) with added Bi Xie was taken for several doses, unblocking the water pathway and stopping pain. Appetite remained poor; later, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Che Qian Zi (Plantago Seed) and Mu Tong (Akebia Stem) regulated him to health. (Obese individuals have much dampness; thus, clearing stomach and resolving phlegm came first, followed by regulating kidney and spleen.)
Guard Jin Hanguang, over sixty, fell ill after mistakenly drinking new wine in early summer. Initially, dribbling and painful strangury; later, hemorrhoids swelled. This was yin deficiency with heat sinking into the bladder. Dao Chi San (Guide Out Redness Powder) was used first, followed by Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), gradually improving. Urethral涩痛 (astringent pain) persisted. Someone suggested Yi Yuan San (Benefit the Origin Powder) three doses, causing involuntary enuresis unresponsive to medication. By early autumn, pulses became weak. Applying the principle of Shen Li Tang (Kidney Strangury Decoction), Ge Yang Shen (Ram Kidney) processed with Gu Zhi (Psoralea Fruit), Yang Pao (Sheep Bladder) processed with Tu Si Zi (Cuscuta Seed), and Sang Gen Pi (Mulberry Root Bark) decocted juice to process Bie Jia (Turtle Shell) or similar astringents [Text says Piao Xiao/Octopus Bone processed with Mulberry bark], taken for three days, allowed whole-night sleep without leakage.
Min Shaojiang, elderly and obese, suffered from bao bi (bladder obstruction) for thirteen years, treatment ineffective. Stress, anger, or improper diet caused frequent, dribbling, painful urination. Sleep induced leakage; waking brought blockage again. Countless doses of Ren Shen (Ginseng), Lu Rong (Deer Antler Velvet), and Zi He Che (Placenta) had no adverse effects. Only Dan Pi (Moutan Bark) and Bai Zhu (Atractylodes Rhizome) caused uncontrollable distension and pain. (Aromatic-drying herbs, if misused, kill; few know this.) Zhang diagnosed: Bao Bi (Bladder Obstruction), known only in *Nei Jing* (Inner Canon). Caused by rich food accumulating heat above, sexual excess damaging essence below, damp-heat gathering in bladder due to deficiency. *Su Wen* states: "In Bao Bi, pressing the lower abdomen and bladder causes internal pain, feeling like hot water pouring, with difficult urination and clear nasal discharge above." Detailed analysis shows bladder deficiency/stagnation fails to absorb lung qi; unclear lung qi cannot descend to regulate water pathways, causing obstruction. Heat helps slightly open the passage. Qi evaporating along meridators temporarily opens lung qi, allowing clear nasal discharge. Shen Li Tang (Kidney Strangury Decoction) was effective. Nocturnal enuresis indicated liver deficiency with fire disturbance and improper dispersion. Distension from Dan Pi (Liver-soothing herb) was due to inability to handle qi movement stirring yin fire. Distension from Bai Zhu was due to inability to handle heavy flavors obstructing damp-heat. Lack of reaction to Ren Shen/Lu Rong/Zi He Che was because deficiency accepts heat, though tonification didn't directly treat the root. Modified Sang Piao Xiao San (Mantis Egg Case Powder) made into pills with sheep kidney decoction suited the condition. However, at eighty, relying on obesity and continuing sexual activity, recurrence was likely despite correct medication. (Similar to the Shaanxi merchant case. Yu Dongfu commented: Waking with strangury, sleeping with enuresis differs from incontinence, hence treating as Bao Bi. His analysis of drug-disease mismatch is precise. Ye Tianshi's later prescriptions emphasized this. Observing his treatments of Huang Yuanji and Kang Renxuan, same disease, different methods, yet excellent rationale. Careful study prevents the ridicule of blindly grabbing Zhi Shi, Hou Po, Dang Gui, Huang Qin.)
Huang Yuanji, over sixty, kept a concubine after losing sight, developing painful strangury. Spring trauma caused fainting and enuresis, leading to intermittent incontinence. After the return of Yang (Winter Solstice period), symptoms worsened: daytime obstruction requiring sitting in hot water to pass drops; nighttime incontinence. Pulses varied between large-deficient and thin-rapid, with left guan specifically wiry. This indicated severe kidney qi deficiency with signs of sinking/collapse. Di Huang Yin Zi (Rehmannia Infusion) was given, reducing strangury and incontinence after several doses. Later, Ba Wei Wan (Eight-Ingredient Pill) without Mu Dan Pi (Tree Peony Bark) and Ze Xie (Alisma Rhizome), plus Lu Rong (Deer Antler Velvet), Wu Wei Zi (Schisandra Berry), Ba Ji Tian (Morinda Root), and Yuan Zhi (Polygala Root), regulated him to health.
A wealthy man from Xin'an suffered from continuous strangury, becoming sallow. Doctors were helpless; Sun Zhuosan also failed. While resting, playing with water, he noticed blocking the posterior orifice stopped anterior flow, while opening it allowed flow. Moxibustion on a point behind the head (likely Baihui or similar) with three moxa cones cured him. (*Jiangxi General Gazetteer*.)
Wang Kentang treated his brother-in-law He Jinqing. Due to dissatisfaction and post-labor exhaustion, sudden lower abdominal urgency and pain to urinate, with white pus-like matter and blood in urine, unbearable penile pain, resembling dysentery tenesmus. Occurred ten-plus times daily. Multiple doctors failed, so it was treated as foul blood. Prescription: Niu Xi (Achyranthes Root) 4 liang, soaked in wine overnight, decocted in running water (10 bowls to 8 bowls), plus Tao Ren (Peach Kernel) 1 liang (skin removed), Chao Hong Hua (Safflower) 2.5 qian, Dang Gui (Angelica Sinensis) 1.5 liang, Mu Tong (Akebia Stem) 1 liang, Sheng Gan Cao (Raw Licorice Root) 2.5 qian, Zhu Ma Gen (Urtica Root) 2 stems. Decocted to 2 bowls, strained, added Hu Po (Amber) powder 2 qian and a little She Xiang (Musk). Divided into four doses, consumed in one day/night. Condition reduced by half. Citing *Su Wen·Qi Bing Lun*: "Disease of Long involves frequent urination, indicating deficiency." Although blood stasis dispersed, Di Huang Wan (Rehmannia Pill) plus Tu Si Zi (Cuscuta Seed), Du Zhong (Eucommia Bark), Yi Zhi Ren (Alpinia Oxyphylla Fruit), and Niu Xi (Achyranthes Root) should tonify yin deficiency to prevent recurrence. Neglecting follow-up prevented full cure. Intermittent obstruction/frequency, nocturia, severe pain post-void. Finally, taking the former pill and kidney-tonifying decoctions regulated him to health.
Cousin Er Zhu suffered from lin syndrome, urinating dozens of times daily, slightly yellow. Wu Ling San (Five-Ingredient Powder with Poria) helped slightly. Due to abdominal discomfort, he took too many draining medicines. Three to five days later, blood spots appeared. Ba Zhen San (Eight-Treasure Powder) failed. Inquiry revealed pus-like matter after bowel movements, triggered by slight exertion. Six pulses were deep-thin, worse on right, indicating middle qi deficiency. Pus/blood after stool indicated internal essence decay. Classic says: "Middle qi deficiency causes changes in urination and defecation." Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with qi-regulating herbs tonified yang; Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) cleared decayed essence and tonified yin. (Xu Lingtai noted: Calling Bu Zhong Yi Qi 'nourishing' and Liu Wei 'clearing decayed essence' is terminologically imprecise.) Added Wu Wei Zi (Schisandra Berry) to astringe scattering, Niu Xi (Achyranthes Root) to unblock collaterals. Several doses brought peace.
Xiao Wanyu treated Zheng You with lin syndrome, untreated for a year. Stated: Lin syndrome has excess/deficiency, cold/heat distinctions. Patient under thirty, originally robust, but due to long travel labor, irregular diet, and love for strong liquor, spleen absorbed dampness. In summer heat, Ding Fire (Heart) dominated, assisted by Bing Fire (Small Intestine), transferring heat to Small Intestine, five fires burning internally. Upper: lung dryness/thirst; Lower: kidney dryness/lin knotting. Previous Ba Zheng San (Eight-Ingredient Decoction) and Wu Lin San (Five-Lin Powder) only targeted lin, ignoring clearing the upper source (lung) and nourishing metal. Used Er Chen Tang (Two-Aged Decoction) and Xiao Chai Hu Tang (Minor Bupleurum Decoction) with Long Dan Cao (Gentian Root), Zhi Mu (Anemarrhena Rhizome), Mu Tong (Akebia Stem), Mai Dong (Ophiopogon Tuber). (Xu Lingtai noted: This clears damp-heat/fire, but does it moisten upper/lower dryness?) One dose reduced symptoms; several doses cured.
Simu Liu Jian, fifty years old, infertile, indulgent in alcohol/sex, irregular lifestyle, dark face, fainting on anger, constipation with bleeding, painful bloody strangury. Clearing heat/draining lin medicines worsened it. Pulse deep-slow, chi choppy. Kidney water exhausted, failing to generate liver blood, causing deficiency fire flaming up, transferring heat to intestines, forcing blood down, drying channels, obstructing ascent/descent. Urgency caused severe pain/blockage. Sweet-warm herbs were needed to nourish the source, tonify liver wood, enrich yin/blood/fluids, resolving strangury. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) minus Chai Hu (Bupleurum Root), doubled Ren Shen (Ginseng), plus Niu Xi (Achyranthes Root), slight Rou Gui (Cinnamon Bark), plus modified Ba Wei Wan (Eight-Ingredient Pill) with Ren Shen (Ginseng), Cong Rong (Cistanche), Yuan Zhi (Polygala Root). Taken for a month, gradually improved.
Zhang Yunting, nearly forty, contracted Long Bi (obstruction) from summer heat travel and heavy liquor consumption. Guangling doctors used heat-clearing/drain-promoting herbs; 3 liang of Huang Lian (Coptis Rhizome) failed. Return home, pulse: right chi surging, left chi imperceptible, dry mouth/thirst. Three yin meridians damaged. Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) ineffective. Other doctors used Che Qian Zi (Plantago Seed), Chi Fu Ling (Red Poria), Hu Po (Amber), Mu Tong (Akebia Stem), Qu Mai (Dianthus Herb), Bian Xu (Knotweed Herb), Wu Ling San (Five-Ingredient Powder with Poria), Liu Yi San (Six-to-One Powder). Result: >100 voids nightly, drops only, lower abdominal urgent pain/distension, severe distress, sallow-black face. Re-injured Shaoyin/Jueyin, losing dispersal/storage functions, disrupting Taiyin/Taiyang qi transformation. Morning: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); Evening: Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction). (Xu Lingtai noted: Is this treating Shaoyin/Jueyin or Taiyin/Taiyin? Dogmatically sticking to two formulas is sloppy and not a model.) Thirty doses of each cured him.
Xu Lingtai said: Treatment of lin syndrome involves both promoting flow and blocking/astringing, requiring distinction. If blood stasis blocks the urethra, promote flow first; if no stasis but deficiency/slippage, strongly tonify. Decoctions and pills differ; external therapies vary widely. One must be knowledgeable and investigate thoroughly.
*Guang Biji* treats hernia pain with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) ancient formula, adding Bei Wu Wei Zi (Schisandra Berry) 3 liang, Rou Gui (Cinnamon Bark) 2 liang, Gou Qi Zi (Goji Berry) 4 liang, Che Qian Zi (Plantago Seed) steamed in rice juice 3 liang. Cook 1 dou glutinous rice, add yeast while hot, mix with herbs, ferment like wine. After three days, add 50 jin good sorghum liquor to mash/wine/lees in a jar, seal with mud. Open after one month, filter clear. Wine is sweet/aromatic. Drink freely when hungry/empty stomach without thirst.
Zhang Feichou treated Tian Mengxian with chronic gao lin (fatty strangury), urine containing lumps like tangerine seeds wrapped in blood membrane with yellow fluid. Caused by intercourse after drunkenness, alcohol-dampness entering kidneys. Water-draining/astringent herbs failed. In humid summer, suddenly chills/fever, panting/confusion, back pain. Pulses floating-soft/deep-thin. Long-term lin damaged yin; summer heat attacked deficiency. First, Sheng Liao Liu Wei Di Huang Wan (Raw Ingredient Six-Ingredient Rehmannia Pill) with Chuan Bi Xie (Dioscorea Hypoglauca Rhizome) decocted, administered Xiao Shu Wan (Summer-Relief Pill). Next, the decoction delivered Mu Che Zhu Ling Wan (Wood-Cart Polyporus Pill). Eight doses resolved all symptoms. Also, Cai Yonggong, a successful candidate, suffered from turbid urine in deep winter, hard lower abdomen, severe chills/fever, vertex headache/sweating. Pulses: left large, right choppy, chi tight-thin. Wind-phlegm/toxic pathogen invaded Jueyin meridian. Dang Gui Si Ni Tang (Angelica Frigid Extremities Decoction) decocted induced sweating, resolving heat. Same formula minus Tong Cao (Tetrapanax Pith), Ginger, Jujube, added Scorpion Tail, Ling Li Jia (Monitor Lizard Carapace), She Qi (Musk Umbilicus) pills to induce sweating. Pain/swelling subsided in days. Turbidity remained; chewing raw Yin Xing (Ginkgo Nut) cured it. People say Ginkgo astringes essence, but it actually cleanses败浊 (decayed turbidity).