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The disease of Lin (strangury) has been observed in the *Treatise on Pathogenesis and Symptoms* (*Bingyuan Shoulun*), which attributes it to Kidney deficiency with Bladder heat. The Bladder and Kidney are exterior-interiorly related and both govern water metabolism. Water enters the Small Intestine and Bao (uterus/bladder), and flows downward as urine. If diet is irregular, emotions of joy and anger are unregulated, leading to imbalance of deficiency and excess and disharmony of the Zang-Fu organs, it results in Kidney deficiency and Bladder heat. Kidney deficiency causes frequent urination, while Bladder heat causes difficult and astringent urination. When frequency is combined with astringency, urination becomes dribbling and incomplete, hence termed "Lin." Its manifestations include urgency and pain in the lower abdomen radiating to the umbilicus, scanty and frequent urination, and it is classified into six types: Shi Lin (Stone Lin), Lao Lin (Exhaustion Lin), Xue Lin (Blood Lin), Qi Lin (Qi Lin), Gao Lin (Grease Lin), and Leng Lin (Cold Lin).

Shi Lin (Stone Lin) feels like sand or stones are passing. Lao Lin (Exhaustion Lin) occurs upon fatigue. Xue Lin (Blood Lin): The Heart governs blood, and its qi connects to the Small Intestine. When heat is severe, it binds to the blood vessels; blood heated by fire flows rapidly, entering the Bao and exiting with urine. Gao Lin (Grease Lin): The urine is turbid like fatty grease, also known as Rou Lin (Flesh Lin). Qi Lin (Qi Lin): Qi distension within the Bao, hardness and fullness in the lower abdomen, scanty and frequent urination with post-void dribbling. Leng Lin (Cold Lin): Cold qi lodges in the Lower Jiao, pathogenic factors contend with healthy qi, filling the Bao, obstructing the water passages. It begins with chills, followed by urinary frequency becoming Lin. This describes the pathology comprehensively.

Examining the *Neijing*, the causes of Lin are not limited to this. The main principles are two: Dampness and Heat. When Taiyin acts as the first Qi, disease involves mid-jiao heat and distension; the Spleen receives accumulated dampness, causing yellow-red urine, progressing to Lin in severe cases. When Shaoyang acts as the second Qi, wind-fire stagnates upward generating heat, resulting in Lin. Since the qi of the five Zang and six Fu organs and twelve meridians interconnects, the Foot-Taiyang Bladder Meridian governs the exterior; ascending, it commands Yang qi; descending, it enters the Bladder. Furthermore, the Lung regulates water passages, transmitting downward to the Bladder. The Spleen and Stomach digest food and fluids. Whether the pathogen is in the exterior, upper, or middle jiao, if there is heat, all body fluids become hot, transmit downward, and thus the Bladder becomes heated. Moreover, the Small Intestine is the Fu organ of the Heart and governs heat. Water must seep from the Small Intestine into the Bladder. Heat in the Bao corresponding to the Heart makes the Small Intestine hot; the Bao receives this heat, and heat transfers from the Bao to the Bladder, causing Long (difficulty voiding) or hematuria. Thus, initial heat pathogens vary, but their etiology transmits to the Bladder to form Lin. If one does not treat the root cause initially, but only treats the branch heat in the Bao, it is not an optimal approach.

I have pondered that Lin disease must arise from extreme heat generating dampness; when dampness arises, body fluids become turbid, condensing to form Lin. Not only this, those who ingest mineral drugs, engage in excessive sexual activity, allowing essence residue to flow into the Bao, or where dietary phlegm accumulation seeps in, all can result in Lin. Danxi once treated a child who, due to residual toxicity from long-term mineral drug use in utero, suffered from Lin for fifteen years, cured by Zi Xue (Purple Snow). Is it acceptable to treat disease without seeking its root?

Scanty painful urination, urgent desire to void, yet only drops pass, with unbearable pain in the urethra, constitutes the Five Lin diseases. Use Sheng Liao Wu Ling San (Raw Material Five-Ling Decoction) plus E Jiao (Donkey-Hide Gelatin), or Che Qian Zi powder, or equal parts Wu Ling San and Yi Yuan San taken together. Huo Fu Dan can be swallowed, assisted by Dao Chi San and Shi Wei San. If extreme heat causes Lin and medication fails, use Jian Gui Wu Ling San (Cinnamon-Reduced Five-Ling Decoction), adding Mu Tong, Hua Shi, Deng Xin Cao, and Qu Mai in small amounts. Also, grind fresh juice from Mai Men Dong Cao, Che Qian Cao (with roots), and Bai Long Cao, mix with honey water, and take orally.

For Qi Lin, caused by Qi stagnation and obstruction, urinary dribbling and knotting, oppression and pain below the umbilicus, use Qu Mai Tang, Shi Wei San, Yu Zhi Tang, or Mu Xiang Liu Qi Yin. For Qi Deficiency Lin, use Ba Wu Tang plus Du Niu Xi and Huang Qin juice. Elderly people with Qi deficiency can also suffer from Lin; add Mu Tong and Shan Zhi to Ren Shen and Bai Zhu. If injured by blood loss, tonifying and moving blood will heal it spontaneously; do not treat as Lin. If caused by dead blood (stasis), Niu Xi Gao is excellent. However, it may damage the Stomach in deficient persons and should not be eaten. *Qian Jin Fang* states: Boil Niu Xi in wine and take it to treat Lin pain. *Zhou Hou Bei Ji Fang* uses Niu Xi roots, stems, and leaves boiled in wine to treat difficult urination, unbearable urethral pain, and women's blood-stagnation hard pain, effectively. Niu Xi is indeed the sacred herb for treating Lin. But for deficient persons, it should be controlled with tonic formulas.

For Xue Lin, use Ce Bai Ye, Sheng Ou Jie, and Che Qian Cao in equal parts, crush to extract juice, and mix with Yi Yuan San, Li Xiao San, Qu Mai San, Xiao Ji Yin Zi, Shi Di San, Dang Gui Tang, Ling Yang Jiao Yin, Ji Su Yin Zi, Jin Huang San, or Fa Hui San. Dai says: In Xue Lin, distinguish cold and heat by blood color. Bright red indicates Heart and Small Intestine Excess Heat. Dark/stagnant indicates Kidney and Bladder Deficiency Cold. If it is truly Cold Lin or Lower Yuan Deficiency Cold with stagnant blood, boil Han Jiao Gen (root of Zanthoxylum) in plain water, cool, and administer. Note: Blood often turns black and coagulates due to extreme heat combining with water transformation; do not hastily assume it is cold.

For Gao Lin, use Lu Jiao Shuang Wan, Chen Xiang San, Chen Xiang Wan, Ci Shi Wan, Hai Jin Sha San, or Tu Si Wan. Dai Yun says: There is a condition resembling Lin but not Lin, where urine is like rice washings or contains mucus-like strands. This is essence and urine exiting together, blocking the urinary pathway, causing pain and inability to void. Use Da Tu Si Zi Wan or Lu Rong Wan. Note: This is Gao Lin.

Sha Shi Lin (Sand-Stone Lin) is formed by accumulated heat in the Bladder, like a pot left on fire forming white scale at the bottom. One must clear accumulated heat so water passages open, allowing stones to exit and healing to occur. Use Shen Xiao Hu Po San, Ru Sheng San, Shi Yan Wan, or Du Sheng San. Take ten Stonefish brain bones, calcined, 2 qian of Hua Shi, and 3 fen of Hu Po, all powdered. Take 1 qian per dose, mixed with Tong Cao decoction on an empty stomach. Take one nine-rib softshell turtle shell, fried in butter until crisp, powdered. Take one spoonful per dose, decocted in wine, to expel stones. Burn male magpie to ash, collect juice, and drink to expel stones.

In Shi Lin, sand and stones flow during urination, blocking the passage, causing unbearable pain. After time, blockage causes Qi to attack upward, leading to headache and facial swelling; severely, limbs and joints swell. Large stones resemble plum pits, hard with angles; small stones are fragments binding together, breaking upon passage. Use this stone-expelling formula: Dong Kui Zi, Hua Shi, She Gan, Zhi Mu (each 1 fen), Tong Cao (3 fen), powdered. Take 2.5 qian per dose, decoct with 1.5 cups of water and 10 bitter bamboo leaves, reduce to 1 cup, strain, and take hot before meals. For large bowel heat and headache in robust individuals, take the following prescription 2-3 cups first, then the stone formula. Ma Huang (de-jointed), Qiang Huo, She Gan, Jing Jie Sui, Zi Wan, Fang Feng, Zhi Mu, Man Jing Zi, Qian Niu (each 1 fen), Ban Xia (2 zhu), powdered. Take 2 qian per dose, decoct 1 cup of water to 0.9 cup, strain, take hot after meals. For Shi Lin water-guiding, use 7 earthworms, 1 liang salt, spread on new tile, bake dry, powder. Take 1 qian per dose, mixed with warm wine.

For Lao Lin, use Di Huang Wan, Huang Qi Tang, or Bai Shao Yao Wan. For Leng Lin, use Rou Cong Rong Wan, Ze Xie San, Chen Xiang San, Bing Lang San, or Sheng Fu San. Dai says: If cold medicines worsen the condition, it is Leng Lin. Use Di Sui Tang to deliver Fu Zi Ba Wei Wan. Some cured by Raw Material Lu Rong Wan after Wu Ling San failed, due to Lower Yuan Deficiency Cold. Liu Hejian argues it is also due to heat lodging in the Bladder, stagnating and failing to excrete, not true cold.

Urinary dribbling with unbearable urethral pain radiating to hypochondriac pain: Can Shen Ling Hu Po Tang. Urinary difficulty like Lin but painless and itchy is a deficiency syndrome. Use Ba Wei Wan or Raw Material Lu Rong Wan. If caused by overthinking, use Gui Pi Tang, or Chen Sha Miao Xiang San, swallow Wei Xi Wan, or Miao Xiang San combined with Wu Ling San. Profuse sweating with red-scanty urine is common in summer. Excessive drinking in heat leads to scanty red urine because fluid stops above, sweats out externally, fluids fail to circulate, Small Intestine closes, and water fails to transport down. Wu Ling San (also called Dao Ni) contains Bai Zhu and Gui Zhi to retain sweat, Zhu Ling, Ze Xie, and Fu Ling to separate water passages, drawing external fluids inward and promoting diuresis. Disperse what needs gathering, unblock what is congested. For deficiency consumption with profuse sweat and red-scanty urine, internal organs are dry, nourishment gone, unable to generate fluids, causing scanty red urine. Do not overuse diuretics to deplete Kidney water; instead, warm-nourish and moisten the Lung. Shi Quan Da Bu Tang or Yang Rong Tang are sufficient. Sweat is Heart fluid; Heart governs blood. When blood is abundant, Heart is nourished, sweat stops, fluids generate, and urine clears without diuretics. Those losing essence/blood or suffering carbuncles with red-scanty urine also suffer from dryness; use previous methods.

[Bao Bi] The *Bi Lun* states: Pressing the lower abdominal Bladder causes internal pain, feeling like pouring hot water, with difficult urination and clear nasal discharge above. The Bladder is the Official of the Metropolis, storing fluids; Qi transformation allows excretion. Now, Wind-Cold-Damp pathogens lodge in the Bao, preventing Qi transformation, causing Bao fullness and blocked water passages. Symptoms: lower abdominal Bladder tenderness, feeling of hot water, difficult urination. Because the Foot-Taiyang Meridian goes up to the vertex, connects to the brain, and descends to irrigate nasal cavities, clear discharge occurs. Treat with Shen Zhuo Tang, Fu Ling Wan, Ba Ji Wan, or Shen Li Tang.

[Pregnancy Lin] Due to Kidney and Bladder deficiency-heat failing to control water. Pregnant women's Bao is tied to the Kidney; deficiency-heat in the Kidney creates this syndrome. Severe cases involve mental restlessness, named Zi Lin. If neck stiffness, slurred speech, and phlegm occur, use Ling Yang Jiao San. If urinary difficulty and dribbling, use An Rong San. If Liver Meridian Damp-Heat, use Long Dan Xie Gan Tang. If Liver Meridian Deficiency-Heat, use Jia Wei Xiao Yao San. Leg cramps with urinary difficulty require urgent Ba Wei Wan, or rescue is impossible. If dry herbs cause frequency or difficulty, use Sheng Di, Fu Ling, Niu Xi, Huang Bai, Zhi Mu, Chuan Xiong, Dang Gui, Gan Cao. If frequent and yellow, use Si Wu Tang plus Huang Bai, Zhi Mu, Wu Wei Zi, Mai Men Dong, Xuan Shen. If Lung Qi deficiency with short volume, use Bu Zhong Yi Qi Tang plus Shan Yao, Mai Men Dong. If vaginal prolapse/numbness with frequency, use Di Huang Wan. If heat knotting in Bladder causing difficulty, use Wu Lin San. If Spleen/Lung dryness failing to transform, use Huang Qin Qing Fei Yin. If Bladder Yin deficiency lacking Yang generation, use Zi Shen Wan. If Bladder Yang deficiency lacking Yin transformation, use Shen Qi Wan.

[Postpartum Lin] Due to heat lodging in the Pao (Bladder); deficiency causes frequency, heat causes astringent pain. Qi deficiency with heat, blood entering the Bao, exits with urine as Xue Lin. If Bladder deficiency-heat, use Liu Wei Wan. If Yin deficiency failing to transform Yang, use Zi Yin Shen Qi Wan. Earth generates Metal, Metal generates Water; nourish the source. Chen says: Treating pre/post-partum Lin differs. Pre-partum: calm fetus; Post-partum: remove stasis. Qu Mai and Pu Huang are key post-partum herbs. Mao Gen Tang treats various post-partum Lin.

[Diagnosis] Kidney pulse slippery and solid indicates Long (obstruction). Bi pulse very slippery indicates Long. Shao Yin pulse rapid: women get genital sores, men get Qi Lin. Pulse large, strong, and solid indicates survival; small, weak, and astringent indicates death. Dryness of Qi and Blood in Lower Jiao indicates death. Yellow nose tip indicates difficult urination.

*Suwen: Qibing Lun*: Disease with Long, urinating dozens of times daily, is deficiency. Body hot as charcoal, neck/chest like a barrier, Ren Ying pulse restless and vigorous, panting with reversed Qi, is excess. Tai Yin pulse fine as hair is deficiency. Where is the disease? Name? Qibo says: Disease in Taiyin, excess in Stomach, involvement in Lung, named Jue. Death, untreatable.