〔曾〕《巢氏病源》曰∶诸淋皆肾虚所致，肾与膀胱为表里，主水下入小肠，
通于胞，行于阴而为溲，肾气通于阴，下流之道也。淋有五名，曰膏、曰冷、曰热、
曰血、曰石，各具于后。膏淋，见小便有肥脂似膏，而浮于小便之上，此肾虚不
能制其肥液、而下行也。冷淋，先战栗而后小便，此亦肾虚而下焦受冷，冷气入
胞，与正气交争，故小便涩而战栗。热淋，下焦有热，热气传于肾，流入于胞，
其溺黄多而涩，间有鲜血而同来者。血淋，热之极也。心者血之主，外行经络，
内行脏腑，热盛、则失其常道，心与小肠为表里，故下流而入于胞，则为血淋。石
淋，肾主水，水结则化为石，肾为热所乘，遇小便则茎中痛，不得流利，痛引小腹，
则沙石从小便出，甚至塞痛，令人昏闷，遍身有汗而后醒，此痛之使然。盖五淋者，
虽曰肾虚所致，然小肠为受盛之府，气通于膀胱，膀胱为津液之府，气通于肾，余
化下流而不通，皆曰肾气不足。热入膀胱，水道涩而不利，出入起数，脐腹急痛，
蕴作有时，或如豆汁膏血，并以《局方》五淋散下龙脑鸡苏丸，自然平愈，及香芎
丸、补肾地黄丸、与之疏导补益为上。〔薛〕夫小儿诸淋者，肾与膀胱热也，二经
相为表里，俱主水道，水入小肠，下行于胞则为溺，若膀胱热，则津液内涸，水道
不通。肾气热，则小便淋沥，或少腹引脐而痛。夫淋有五，石淋者，肾热化石，内
塞水道，痛引膀胱。气淋者，肺气壅热，小腹胀满，小便涩滞。热淋者，三焦有热，
传入肾、膀胱，流入于胞，小便赤涩。血淋者，心热，血散，失其常经，溢渗入胞。
寒淋者，膀胱气冷，与正气交争，寒战气解是也。亦有因妊母肝热，及乳母恚怒者，
当分五脏蓄热治之。若心脏有热者，导亦散加黄连。肝脏有热者，柴胡栀子散。大
便不通泻青丸。脾脏有热者，泻黄散。脾气不足者，异功散。脾气下陷，补中益气
汤。肺脏有热者，泻白散。肺气虚热异功散加炒黑山栀。肾脏有热者，地黄丸。
或因乳母肝经热者，用栀子清肝散。恚怒者，用柴胡清肝散。乳母浓味者，用加味
清胃散。心小肠热者，用清心莲子饮。或儿早近色欲，小便涩滞或作痛，及更去后
大小便牵痛者，皆属肝肾不足也，用六味地黄丸、补中益气汤加牛膝、车前、肉桂，
未应，当参五脏所胜，不可轻用渗泄寒凉之药，大损胃气，仍参前小便不通证览之。
一小儿小便不通，服五苓之类不应，颏间及左腮色赤。乃肝肾虚热也。用四物、山
栀、及地黄丸而愈。后因感冒误汗，小便仍不利，余用补中益气汤加麦门、五味、
而安。一小儿小便不利，茎中涩痛，时或尿血。此禀父肾热为患也。先用五淋散
以疏导，又用滋肾丸、地黄丸，补肝肾渐愈。后出痘，色紫，小便短赤，颏间右腮
或赤或白，用补中益气汤、六味地黄丸，前证并愈。〔丹〕郑廉使之子年十六，初
生七个月患淋病，五七日必一发，其发则大痛，水道下状如黍如粟者约一杯许，
然后定。诊其脉轻则涩，重则弦，视其形瘦而长，其色青而苍，意其父必因多服下
部药遗毒在胎，留于子之命门而然。遂以紫雪和黄柏末，丸桐子大，晒极干，热汤
下百丸，以食物压之，又半日，痛大作腰连腹，水道乃行，下如黍如粟者一大碗许，
其病减十分之八，后又与陈皮一两，桔梗、木通、各半两，作一帖与之，又下如黍
粟者一合许而安。父得燥热，且能病，子况母得之者乎。予书此以证东垣红瘤之事，
此亦热在血分也。
五淋散
赤茯苓（去皮） 赤芍药（炒） 山栀子（去壳） 甘草（生） 当归（去芦） 黄芩（炒）
车前子 淡竹叶 灯心 木通（去皮节） 滑石（水飞） 葵子 葶苈（炒）
上 咀。用葱白一茎水煎，入车前草杵捣取汁，用五苓散调化，食前服。或硝
石末调化服。白淋，白茅根灯心煎汤服。有气淋，小腹胀满，尿后有余沥，
木通煎汤服。热淋，小便赤而淋沥，脐下痛，新水煎服。或黄芩煎汤服。
石淋，茎内痛，尿涩有砂石，令人闷绝，滑石膈纸炒焦为细末，葵子煎汤服。
《局方》五淋散 治膀胱有热，水道不通，淋沥不出，或尿如豆汁，或成砂石，或如
膏，或热怫便血。
赤茯苓（六钱） 当归 甘草（各五钱） 赤芍药 山栀子（各二钱）
上 咀。每服三钱，水一小盏，入灯心煎服。
导赤散 治小儿血淋。
生地黄 木通（各二钱） 黄芩 甘草（生用。各一钱）
上为末。每服一钱，井水入灯心煎服。仍以米饮调油发灰，空心灌下。
葵子散 治小儿诸淋。
葵子 车前子 木通 桑白皮（炒） 瞿麦 赤茯苓 山栀子 炙甘草（各等分）
上，水一盏，煎服。
香芎丸 治诸淋证，若患风闭，尤效。
净香附（盐水炒） 川芎 赤茯苓（去皮。各半两） 海金砂 滑石（各一两） 枳壳（泡，
去瓤，麸炒黄） 泽泻 石韦（去老梗，取叶） 槟榔（不过火。各二钱半）
上，锉晒为末，糯米粉煮为清糊，丸麻仁大。每服三十三丸至五十五丸或七十
七丸，并用麦门冬熟水空心送下。若小便涩痛，滴三五点者，取流水，用火微温，
入盐少许调匀，空心咽下。
木通散（见惊）
清心莲子饮 治小儿上盛下虚，心火炎上，口苦咽干，烦渴微热，小便赤涩，或欲
成淋，并宜服之。
黄芩 车前子 甘草（炙） 麦门冬（去心） 地骨皮（各半两） 黄 （蜜炙） 白茯苓
石莲肉（去心） 人参（各七钱半）
上锉碎。每服五钱，水一盏，煎至六分，去滓，食前服。如发热加柴胡薄荷。
金沙散 治小便淋沥不通。
郁金 海金砂 滑石 甘草（各等分）
上为末。每服一钱，煎地肤子汤调下。灯心、木通、亦可。
又方 冬瓜，最治实热小便不通，内热口渴。
立效散 治小儿诸淋不通，茎中作痛。
木通 甘草 王不留行 胡荽 滑石 海金砂 山栀子 槟榔（各等分）
上，每服一钱，水煎。
治血淋神效方
紫草 连翘 车前子（各等分）
水煎服。
又方
海螵蛸 生地黄 白茯苓
上，等分为末。柏叶、车前草煎汤调下。
治气淋
赤芍药（一两） 槟榔（一枚，面裹煨）
上为末。灯心同枣子煎汤调下。
〔张〕石燕丹 治小便淋涩痛闷。
石燕（烧赤，醋淬，放冷，细研） 瞿麦 滑石（各一两） 木通（锉） 海蛤（细研。各半两）
上件，捣罗为细末，炼蜜和，如黍米大。每服十粒，以葱白汤下，食前。量儿
大小加减。
石韦散 治诸淋涩水道中痛，脐下妨闷。
石韦（去毛，一两） 冬葵子 木通（锉） 赤茯苓（各半两） 车前子 瞿麦 榆白皮 滑石
甘草（各二钱半）
上件药，捣罗为散。每服一钱，以水一小盏，入葱白五寸，煎至六分，去滓，
温服，如人行十里，再服。量儿大小加减。
葵子散 治肾热水结，化为石淋，甚者水道中涩痛不可忍。
冬葵子（一两） 石楠 榆白皮（锉） 石韦（去毛） 木通（锉。各半两）
上件药，捣、罗为散。每服半钱，以葱白汤调下，日二服。量儿大小加减。
滑石散
滑石 栝蒌根 石韦（去毛。各等分）
上件药，捣、罗为散。每服半钱，煎大麦饮清调下，日二服。量儿大小加减。
蒲黄散 治膀胱热甚血淋，水道涩痛。
蒲黄 冬葵子 生地黄（各半两）
上件药，捣、罗为细末。每服一钱，以水一大盏，煎至六分，去滓，温服。量儿大小加减。
[Zeng] *Chao Shi Bing Yuan* (Source Book of Diseases by Chao Yuanfang) states: All types of Lin syndrome (a disease characterized by frequent, urgent, and painful urination with incomplete emptying) are caused by Kidney deficiency. The Kidney and Bladder are interior-exteriorly related, governing water metabolism. Water enters the Small Intestine, connects to the Bao Palace (uterus/bladder), passes through the Yin organs, and is excreted as urine. Kidney Qi connects to the Yin organs; this is the pathway for lower jiao excretion. There are five names for Lin syndrome: Gao Lin (Semenuria/Crystalluria), Leng Lin (Cold Lin), Re Lin (Heat Lin), Xue Lin (Hematuria), and Shi Lin (Calculus/Lithiasis). Their manifestations are detailed below.
Gao Lin presents with fat-like lipid substances floating on the surface of the urine. This is due to Kidney deficiency failing to control fatty fluids, causing them to descend.
Leng Lin begins with chills and shivering, followed by urination. This is also due to Kidney deficiency and cold invading the lower jiao. Cold qi enters the Bao Palace and contends with healthy Qi, resulting in difficult urination accompanied by chills.
Re Lin involves heat in the lower jiao. Heat transmits to the Kidney and flows into the Bao Palace, causing yellow, scanty, and difficult urination, occasionally mixed with fresh blood.
Xue Lin represents extreme heat. The Heart governs blood, circulating externally in the meridians and internally in the zang-fu organs. When heat is excessive, blood loses its normal course. Since the Heart and Small Intestine are interior-exteriorly related, blood descends into the Bao Palace, forming Xue Lin.
Shi Lin: The Kidney governs water; when water coagulates, it transforms into stones. If the Kidney is attacked by heat, urination causes pain in the penis, flow is obstructed, and pain radiates to the lower abdomen. Sand and stones are passed in the urine. In severe cases, blockage causes intense pain, faintness, and profuse sweating before recovery, all due to pain.
Although these five Lin syndromes are said to be caused by Kidney deficiency, the Small Intestine is the fu organ of reception and containment, with Qi connecting to the Bladder; the Bladder is the fu organ of fluid retention, with Qi connecting to the Kidney. If residual turbid fluids fail to flow downward smoothly, it is attributed to insufficient Kidney Qi. When heat enters the Bladder, the water pathway becomes obstructed and difficult, causing frequency, urgency, and acute abdominal pain. Episodes occur intermittently, with urine resembling bean dregs, semen, or blood. Treatment should employ Wu Lin San (Five-Lin Powder) from *Ju Fang* combined with Long Nao Ji Su Wan (Borneol and Perilla Pill) for natural resolution, along with Xiang Xiong Wan (Aucklandia and Ligusticum Pill) and Bu Shen Di Huang Wan (Kidney-Nourishing Rehmannia Pill) to guide discharge and tonify.
[Xue] Pediatric Lin syndromes are primarily due to heat in the Kidney and Bladder. These two channels are interior-exteriorly related and jointly govern the water pathways. Water enters the Small Intestine and descends to the Bao Palace to become urine. If the Bladder has heat, body fluids dry up internally, and the water pathway is blocked. If Kidney Qi has heat, urination is dribbling, or there is pain radiating from the lower abdomen to the umbilicus.
There are five types of Lin:
1. Shi Lin: Kidney heat forms stones, blocking the water pathway internally, causing pain radiating to the Bladder.
2. Qi Lin: Lung Qi is congested with heat, causing lower abdominal fullness and stagnant, difficult urination.
3. Re Lin: Heat in the Triple Burner transmits to the Kidney and Bladder, flowing into the Bao Palace, causing red, scanty, and difficult urination.
4. Xue Lin: Heart heat causes blood to scatter and lose its normal meridian path, overflowing and seeping into the Bao Palace.
5. Han Lin (Cold Lin): Bladder Qi is cold, contending with healthy Qi, manifesting as chills and Qi exhaustion.
Some cases arise from maternal Liver heat or nursing mothers' anger. One must differentiate based on heat accumulation in the five Zang organs.
- Heart heat: Dao Chi San (Guide Out Redness Powder) plus Huang Lian (Coptis Rhizome).
- Liver heat: Chai Hu Zhi Zi San (Bupleurum and Gardenia Powder).
- Constipation: Xie Qing Wan (Drain Green Pill).
- Spleen heat: Xie Huang San (Drain Yellow Powder).
- Spleen Qi deficiency: Yi Gong San (Single Skill Powder).
- Spleen Qi sinking: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
- Lung heat: Xie Bai San (Drain White Powder).
- Lung Qi deficiency with heat: Yi Gong San plus fried black Zhi Zi (Gardenia Fruit).
- Kidney heat: Di Huang Wan (Rehmannia Pill).
- Nursing mother's Liver channel heat: Zhi Zi Qing Gan San (Gardenia Clear Liver Powder).
- Nursing mother's anger: Chai Hu Qing Gan San (Bupleurum Clear Liver Powder).
- Nursing mother's rich diet: Jia Wei Qing Wei San (Modified Stomach-Clearing Powder).
- Heart and Small Intestine heat: Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction).
If a child has early exposure to sexual desires, leading to difficult/painful urination or pain after defecation/urination, it belongs to Liver and Kidney deficiency. Use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Bu Zhong Yi Qi Tang plus Niu Xi (Achyranthes Root), Che Qian Zi (Plantago Seed), and Rou Gui (Cinnamon Bark). If ineffective, refer to the theory of Five Elements overcoming each other. Do not lightly use diuretic or cold-cooling herbs, as they severely damage Stomach Qi. Refer to previous sections on urinary obstruction.
Case 1: A child had urinary retention. Wu Ling San (Five-Ingredient Powder with Poria) was ineffective. The chin and left cheek were red. This was Liver-Kidney deficiency heat. Treated with Si Wu Tang (Four Substance Decoction), Zhi Zi, and Di Huang Wan. Cured. Later, due to mistaken sweating treatment for a cold, urination remained difficult. I used Bu Zhong Yi Qi Tang plus Mai Men Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Fruit). Stabilized.
Case 2: A child had difficult urination, penile涩 pain, and occasional hematuria. This was inherited Father's Kidney heat. First treated with Wu Lin San to guide discharge, then Zi Shen Wan (Nourish Kidney Pill) and Di Huang Wan to tonify Liver and Kidney. Gradually improved. Later, during smallpox eruption, lesions were purple, urine was short and red, chin/right cheek alternated red/white. Treated with Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan. All symptoms resolved.
[Dan] The son of Zheng Lianshi, aged sixteen, suffered from Lin syndrome since seven months old. It flared every five to seven days, causing severe pain. About one cup of material resembling millet grains was discharged from the urinary tract before relief. Pulse was choppy on light pressure and wiry on heavy pressure. The child was thin, tall, with a blue-green complexion. I surmised the father had taken many drugs for lower body ailments, leaving toxic residue in the fetus, which settled in the child's Mingmen (Gate of Life). I prescribed Zi Xue (Purple Snow) mixed with Huang Bo (Phellodendron Bark) powder, formed into pills the size of tung tree seeds, dried thoroughly. Administered 100 pills with hot water, covered with food. Half a day later, severe pain erupted in the waist and abdomen, and the urinary tract opened. About one bowl of millet-grain-like material was discharged. The illness reduced by 80%. Then, Chen Pi (Tangerine Peel) 1 liang, Jie Geng (Platycodon Root) and Mu Tong (Akebia Stem) 0.5 liang each were decocted as one dose. Another 1 he (approx. 200ml) of grain-like material was discharged, and the child stabilized. If the father's燥热 (dry-heat) could cause illness, how much more so if the mother contracted it? I record this to verify Dong Yuan's case of "Red Tumors," which is also heat in the Blood level.
Wu Lin San (Five-Lin Powder)
Chi Fu Ling (Red Poria, peeled) Chi Shao Yao (Red Peony Root, stir-fried) Shan Zhi Zi (Gardenia Fruit, husked) Gan Cao (Licorice Root, raw) Dang Gui (Angelica Sinensis, de-rutted) Huang Qin (Scutellaria Root, stir-fried)
Che Qian Zi (Plantago Seed) Dan Zhu Ye (Lophatherum Leaf) Deng Xin Cao (Juncus Medulla) Mu Tong (Akebia Stem, peeled and joint-free) Hua Shi (Talcum, water-ground) Kui Zi (Malva Seed) Ting Li (Descurainia Seed, stir-fried)
Crush ingredients. Decoct with one stem of Cong Bai (White Part of Scallion). Add juice from crushed Che Qian Cao (Plantago Herb). Mix with Wu Ling San to dissolve. Take before meals. Alternatively, mix with Xiao Shi (Niter) powder.
For Bai Lin (Leukorrhea/Cloudy Urine): Decoct Bai Mao Gen (Imperata Rhizome) and Deng Xin Cao.
For Qi Lin (Qi-type Lin): Lower abdominal fullness, post-void dribbling. Decoct Mu Tong.
For Re Lin: Red, scanty urination, lower abdominal pain. Decoct with fresh water or Huang Qin.
For Shi Lin: Penile pain, gritty urine, fainting. Stir-fry Hua Shi over paper until charred, grind to fine powder. Take with Kui Zi decoction.
Ju Fang Wu Lin San (Five-Lin Powder from *Prescriptions Worth a Thousand Gold*)
Treats Bladder heat, blocked water pathways, inability to urinate, urine like bean dregs, sandstones, semen-like substance, or heat-induced hematochezia/hematuria.
Chi Fu Ling (6 qian) Dang Gui Gan Cao (each 5 qian) Chi Shao Yao Shan Zhi Zi (each 2 qian)
Crush. Take 3 qian per dose. Decoct with one small cup of water and Deng Xin Cao.
Dao Chi San (Guide Out Redness Powder)
Treats pediatric Xue Lin.
Sheng Di Huang (Raw Rehmannia Root) Mu Tong (each 2 qian) Huang Qin Gan Cao (raw, each 1 qian)
Grind to powder. Take 1 qian per dose. Decoct with well water and Deng Xin Cao. Also, mix You Fa Hui (Ash of Human Hair) with Mi Yin (Rice Drink) and administer orally on an empty stomach.
Kui Zi San (Malva Seed Powder)
Treats pediatric Lin syndromes.
Kui Zi Che Qian Zi Mu Tong Sang Bai Pi (stir-fried) Qu Mai Chi Fu Ling Shan Zhi Zi Zhi Gan Cao (equal parts)
Decoct with one cup of water.
Xiang Xiong Wan (Aucklandia and Ligusticum Pill)
Treats various Lin syndromes; especially effective for wind-obstruction.
Jing Xiang Fu (Cyperi Rhizoma, salt-water fried) Chuan Xiong Chi Fu Ling (peeled, each 0.5 liang) Hai Jin Sha (Lygodium Spore) Hua Shi (each 1 liang) Zhi Ke (soaked, pith removed, bran-fried till yellow) Ze Xie Shi Wei (remove old stems, use leaves) Bin Lang (Areca Seed, avoid excessive heat, each 2.5 qian)
Grind, dry, and powder. Make paste with glutinous rice flour. Form pills the size of hemp seeds. Take 33-55 or 77 pills per dose. Swallow with Mai Men Dong (Ophiopogon) warm water on an empty stomach. For difficult/painful urination with only 3-5 drops, take running river water, warm slightly with fire, add a little salt, mix, and swallow on an empty stomach.
Mu Tong San (See Jing/Palpitation section)
Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction)
Treats pediatric upper excess/lower deficiency, flaming Heart Fire, bitter taste, dry throat, irritability/thirst, slight fever, red/scanty urination, or impending Lin syndrome.
Huang Qin Che Qian Zi Zhi Gan Cao Mai Men Dong (de-heart) Gu Pi (each 0.5 liang) Huang Qi (honey-fried) Bai Fu Ling Shi Lian Rou (de-heart) Ren Shen (each 0.75 liang)
Crush. Take 5 qian per dose. Decoct with one cup of water until 60% remains. Strain. Take before meals. Add Chai Hu (Bupleurum) and Bo He (Mint) if feverish.
Jin Sha San (Golden Sand Powder)
Treats dribbling urinary obstruction.
Yu Jin Turmeric Rhizome Hai Jin Sha Hua Shi Gan Cao (equal parts)
Grind to powder. Take 1 qian per dose. Mix with Di Fu Zi (Kochia Fruit) decoction. Deng Xin Cao or Mu Tong may also be used.
Another Prescription: Winter Melon (Dong Gua) best treats excess-heat urinary obstruction and internal heat with thirst.
Li Xiao San (Instant Effect Powder)
Treats pediatric Lin obstruction with penile pain.
Mu Tong Gan Cao Wang Bu Liu Xing Hu Sui Hua Shi Hai Jin Shan Zhi Zi Bin Lang (equal parts)
Take 1 qian per dose. Decoct in water.
Divine Efficacy Formula for Treating Xue Lin
Zi Cao Arnebiae Radix Lian Qiao Forsythiae Fructus Che Qian Zi Plantaginis Semen (equal parts)
Decoct in water and take.
Another Prescription
Hai Piao Xiao Cuttlefish Bone Sheng Di Huang Bai Fu Ling (equal parts)
Grind to powder. Take with Bai Ye (Catalpa Leaf) and Che Qian Cao (Plantago Herb) decoction.
Treating Qi Lin
Chi Shao Yao (1 liang) Bin Lang (one piece, wrapped in dough and baked)
Grind to powder. Take with Deng Xin Cao and Jujube decoction.
[Zhang] Shi Yan Dan (Stone Swallow Pill)
Treats difficult, painful, and stifling urination.
Shi Yan (burnt red, quenched in vinegar, cooled, finely ground) Qu Mai Hua Shi (each 1 liang) Mu Tong (crushed) Hai Ge (finely ground, each 0.5 liang)
Pulverize. Mix with refined honey. Form pills the size of millet seeds. Take 10 pills per dose with Cong Bai (Scallion White) decoction, before meals. Adjust dosage according to age.
Shi Wei San (Pyrrosia Leaf Powder)
Treats various Lin syndromes with涩 pain in the water pathway and stifling sensation below the umbilicus.
Shi Wei (remove hairs, 1 liang) Dong Kui Zi Mu Tong (crushed) Chi Fu Ling (each 0.5 liang) Che Qian Zi Qu Mai Yu Bai Pi Hua Shi Gan Cao (each 2.5 qian)
Pulverize. Take 1 qian per dose. Decoct with one small cup of water and 5 cun of Cong Bai until 60% remains. Strain. Take warm. Repeat after walking ten li. Adjust dosage according to age.
Kui Zi San (Malva Seed Powder)
Treats Kidney heat with water coagulation transforming into Shi Lin. Severe cases involve unbearable涩 pain in the water pathway.
Dong Kui Zi (1 liang) Shi Nan Yu Bai Pi (crushed) Shi Wei (remove hairs) Mu Tong (crushed, each 0.5 liang)
Pulverize. Take 0.5 qian per dose with Cong Bai decoction. Twice daily. Adjust dosage according to age.
Hua Shi San (Talcum Powder)
Hua Shi Gua Lou Gen Shi Wei (remove hairs, equal parts)
Pulverize. Take 0.5 qian per dose. Mix with clear barley drink. Twice daily. Adjust dosage according to age.
Pu Huang San (Polygonum Spore Powder)
Treats Bladder excess-heat Xue Lin with涩 pain in the water pathway.
Pu Huang Dong Kui Zi Sheng Di Huang (each 0.5 liang)
Pulverize finely. Take 1 qian per dose. Decoct with one large cup of water until 60% remains. Strain. Take warm. Adjust dosage according to age.