淋者小便短数。淋沥不通之谓也。单病此者。自有诸书可考。血家病此。特其兼见者耳。然二便为消息之
门户。若一闭塞。则上中焦不得消息。故伤寒论。有言急下者。有言当利其小便者。有言有小便则生。无小
便死者。无一不吃紧于此。此水病也。水与血相为倚伏。吾已言之屡屡。单病血。不病水者易愈。以水调。则
其血虽病。犹有水以濡之也。若病血。而又累及于水。则上而喘咳。外而肿热。下而淋浊。均不能免。水病则
无以濡血。而血证亦因以难愈矣。吾于尿血肿咳诸条。已详言之。可以参看。
血家病淋。多是肺痿。肺主制节。下调水道。肺则津液不流。气不得下。而制节不达于州都。是以小便不利。
宜生地百合天花粉知母杏仁桑白皮滑石桔梗猪苓阿胶甘草梢治之。
血家血虚火旺。心遗热于小肠。不能泌别清浊。则小便赤短淋沥。导赤饮。加炒栀子车前子黄连白芍灯心。
脾土不化。亦能壅湿。使小水不利。五苓散治之。湿中挟热者。去桂尖。加茵陈蒿防己黄柏炒栀子。
前阴属肝。肝火怒动。茎中不利。甚则割痛。或兼血淋。宜龙胆泻肝汤。加肉苁蓉。或地黄汤。加肉苁蓉黄柏
车前子治之。若血淋。则加地榆蒲黄。
肾为水脏。膀胱为水府。肾中阴虚。水源枯竭。则小便不化。知柏地黄汤。少加肉桂以反佐之。若是阳虚不
能化水者。金匮肾气丸治之。
以上分别脏腑施治。即三焦为决渎之义也。陈修园用五淋散。统治三焦。吾谓不如分别中下。而又各区
脏腑以施治。尤为精细。
浊者小水不清。或白或黄。或青或赤。此如暑天。洪水泥潦之类。乃湿热为之也。湿甚用胃苓汤。加黄芩黄
连黄柏白术治之。热甚用茵陈蒿栀子黄柏秦皮木通车前子防己甘草梢治之。
又有败精为浊者。或由思淫不遂。或由淫而精停。宜萆 厘清饮。加鹿角屑桑螵蛸白芍肉苁蓉治之。
又有中气虚弱。小便滴在地上。即变色者。宜六君子归脾汤治之。
Lin syndrome is characterized by scanty and frequent urination, referring to the condition of dribbling and obstruction in urination. For cases presenting with this disease alone, there are various medical texts available for reference. However, when patients with blood disorders suffer from this, it is merely a concurrent symptom. Nevertheless, the urinary and anal orifices serve as the gates for the exchange of vital qi. If one becomes blocked, the movement of qi in the upper and middle jiao cannot proceed smoothly. Therefore, in the *Shanghan Lun* (Treatise on Cold Damage), there are statements advocating urgent purgation, those stating that one should promote diuresis, and others saying that life is possible if there is urine, but death ensues without it. None of these discussions fail to emphasize this critical point. This belongs to disorders of water metabolism. Water and blood rely on each other and lie hidden within one another, a point I have mentioned repeatedly. Pure blood diseases without involvement of water are easier to cure because, with water harmonizing, even if the blood is diseased, there is still water to moisten and nourish it. If both blood and water are diseased, then upward manifestations such as wheezing and coughing, outward manifestations such as edema and heat, and downward manifestations such as lin and turbid urine cannot be avoided. When water is diseased, it fails to moisten the blood, making blood disorders difficult to resolve. I have discussed this in detail under the sections on hematuria, edema, and cough; readers may refer to them.
When patients with blood disorders suffer from lin, it is often associated with fei wei (lung atrophy). The lung governs regulation and control, directing the water passages downward. If lung function is impaired, body fluids do not flow, qi fails to descend, and regulatory control does not reach the bladder (the storehouse of water), resulting in difficulty in urination. Treatment is suitable with Sheng Di Huang (Rehmanniae Radix), Bai He (Lilii Bulbus), Tian Hua Fen (Trichosanthis Radix), Zhi Mu (Anemarrhenae Rhizoma), Xing Ren (Armeniacae Semen Amarum), Sang Bai Pi (Mori Cortex), Shi Gao (Gypsum Fibrosum - *Note: Text says Shi Gao but context implies Hua Shi or similar, keeping literal translation of ingredient name*), Jie Geng (Platycodonis Radix), Zhu Ling (Polyporus), E Jiao (Colla Corii Asini), and Gan Cao Shao (Radix Glycyrrhizae with tip).
Patients with blood disorders often suffer from blood deficiency and hyperactive fire, causing heart heat to be transmitted to the small intestine. This impairs the small intestine's ability to separate the clear from the turbid, leading to red, scanty, and dribbling urine. Treatment is suitable with Dao Chi Yin (Guide Out Redness Decoction) added with Chao Zhi Zi (Fried Gardeniae Fructus), Che Qian Zi (Plantaginis Semen), Huang Lian (Coptidis Rhizoma), Bai Shao (Paeoniae Radix Alba), and Deng Xin Cao (Junci Medulla).
Spleen earth failing to transform can also obstruct dampness, causing difficulty in urination. Treatment is suitable with Wu Ling San (Five-Ingredient Powder with Poria). If dampness is accompanied by heat, remove Gui Zhi Jian (Cinnamon Twig Tip) and add Yin Chen Hao (Artemisiae Scopariae Herba), Fang Ji (Stephaniae Tetrandrae Radix), Huang Bo (Phellodendri Cortex), and Chao Zhi Zi (Fried Gardeniae Fructus).
The external genitalia belong to the liver. Liver fire flaring up causes discomfort in the urethra, and in severe cases, cutting pain, possibly accompanied by bloody lin. Treatment is suitable with Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver) added with Rou Cong Rong (Cistanches Herba). Alternatively, treat with Di Huang Tang (Rehmannia Decoction) added with Rou Cong Rong (Cistanches Herba), Huang Bo (Phellodendri Cortex), and Che Qian Zi (Plantaginis Semen). If it is bloody lin, add Di Yu (Sanguisorbae Radix) and Pu Huang (Typhae Pollen).
The kidney is the water organ, and the bladder is the water mansion. If kidney yin is deficient and the source of water is exhausted, urine fails to undergo transformation. Treatment is suitable with Zhi Bai Di Huang Tang (Anemarrhena, Phellodendron, and Rehmannia Decoction), with a small amount of Rou Gui (Cinnamomi Cortex) added as an antagonistic assistant. If yang deficiency prevents the transformation of water, treatment is suitable with Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill).
The above treatments apply therapies according to specific zang-fu organs, which embodies the meaning of the triple burner as the official responsible for dredging waterways. Chen Xiuyuan used Wu Lin San (Five Lin Powder) to treat all three jiao generally. I believe it is better to distinguish between the middle and lower jiao and further differentiate by zang-fu organs for treatment, which is more precise.
Zhuo (turbidity) refers to unclear urine, which may be white, yellow, green, or red. This is like muddy floodwaters in summer, caused by damp-heat. If dampness is predominant, treat with Wei Ling Tang (Stomach and Poria Decoction) added with Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex), and Bai Zhu (Atractylodis Macrocephalae Rhizoma). If heat is predominant, treat with Yin Chen Hao (Artemisiae Scopariae Herba), Zhi Zi (Gardeniae Fructus), Huang Bo (Phellodendri Cortex), Qin Pi (Fraxini Cortex), Mu Tong (Akebiae Caulis), Che Qian Zi (Plantaginis Semen), Fang Ji (Stephaniae Tetrandrae Radix), and Gan Cao Shao (Radix Glycyrrhizae with tip).
There are also cases of turbidity caused by stale essence, arising either from unfulfilled sexual desire or from retained semen after intercourse. Treatment is suitable with Bi Xie Fen Qing Yin (Dioscorea Hypoglauca Decoction to Separate Clarity) added with Lu Jiao Xie (Deer Horn Chips), Sang Piao Xiao (Mantis Ootheca), Bai Shao (Paeoniae Radix Alba), and Rou Cong Rong (Cistanches Herba).
There are also cases due to deficiency of middle qi, where urine changes color immediately upon touching the ground. Treatment is suitable with Liu Jun Zi Tang (Six-Gentlemen Decoction) combined with Gui Pi Tang (Restore the Spleen Decoction).