大意
滴沥涩痛谓之淋。急满不通谓之闭。五淋之别。虽有气砂血膏劳之异。然皆肾虚而膀胱生热也。（心法）
内因
由膏粱浓味。郁遏成疾。致脾土受害。不能化精微。别清浊。使肺金无助。而水道不清。渐成淋病。或用心过
度。房欲无节。以致水火不交。心肾气郁。遂使阴阳乖格。清浊相干。蓄于下焦膀胱。而水道涩焉。（正传）
外候
小便涩痛。欲去不去。不去又来。滴沥不断。甚则闷塞。（入门）
淋病分辨
气淋涩滞。余沥不断。血淋溺血。遇热则发。石淋茎痛。溺有砂石。又名砂淋。膏淋稠浊。凝如膏糊。又名肉淋。
劳淋遇劳即发。痛引气冲。又名虚淋。（汇补）
五淋微甚
淋虽五。总属于热。（丹溪）初为热淋。重为血淋。久则煎熬水液。或凝块如血。或稠浊如膏。或火烁而成砂石。
（绳墨）此即煮海为盐之义也。（医方考）
虚淋宜审
淋有虚实。不可不辨。如气淋脐下妨闷。诚为气滞。法当疏利。若气虚不运者。又宜补中。血淋腹硬茎痛。知
为死血。法当去瘀。然血虚血冷者。又当补肾。惟膏淋有精溺混浊之异。非滋阴不效。劳淋有脾肾困败之
状。非养正不除。（汇补）
脉法
少阴脉沉数。妇人为阴疮。男子为气淋。凡淋症盛大而坚者生。虚微而涩者死。（汇补）
治法
治淋之法。在渴与不渴。热在气分。渴而小便不利者。肺中伏热。火不能降。宜气薄淡渗之药。清金泻火以
滋水之上源。热在血分。不渴而小便不利者。肾膀无阴而阳气不化。宜气味俱阴之药。除热泻秘。以滋水
之下源。（入门）
淋症忌补
凡寸肠有气。小便胀。小肠有血。小便涩。小肠有热。小便痛。禁用补气之剂。盖气得补而愈胀。血得补而愈
涩。热得补而愈盛。水窦不行。加之谷道不通。未有见其能生也。（医统）
淋病治禁
淋病发汗者死。轻者必便血。为重亡津液也。又淋症口渴多汗者。不可轻用淡渗。（仲景）
用药
膀胱热结。用五淋散。肺脾气燥。用清肺饮。下焦阴虚。滋肾丸。下焦阳虚。肾气丸。脾经湿痰。二陈汤。加苍术、
泽泻、升麻、萆 。肝经气滞。逍遥散。加黄柏、泽泻、山栀、青皮。大抵淋病茎痛。必用甘草梢。溺赤。用淡竹
叶。有瘀。用牛膝。有热。用木通。行气。用青皮、木香、开郁。用琥珀、郁金。此东垣法也。血淋。用三生益元
散。气淋。用木香汤。膏淋。用萆 厘清饮。砂淋。用石苇散。劳淋。用清心连子饮。又有积久淋病。用前法不
效者。以补中益气汤升提阳气。（汇补）
【附冷淋】
膀胱为津液之腑。气化则出。今寒邪客于胞中。则气不化而成淋。必先寒栗。而后溲便涩数。窍中肿痛。盖
冷气入胞。与正气相争。寒气胜。则战寒而作淋。正气胜。则战寒而得便。治宜散寒扶正。用四君加茴香、木
香、益智、肉桂、木通、泽泻主之。（医统）
【附虚淋】
虚淋者。肾虚精败也。童子精未盛而御女。老人阴已痿而思色。则精不出而内败。茎中涩痛成淋者。惟金
匮肾气汤可救。若精已竭而复耗之。则大小便牵引而痛。愈痛则愈便。愈便则愈痛。宜倍加桂、附。以滋化
源。不可误用知柏淡渗等剂。既泻其阳。复耗其阴也。（立斋）
【附小便频数】
有先因大便燥热。水液只走小肠。小便频数。不计度数。茎中热痛。大便愈燥。甚则浑身壮热。烦燥思水。此
皆贪酒嗜色。或过食辛热荤秽。使热毒腐瘀。随虚注入小肠。故便时亦痛。与淋涩痛者不同。宜萆 盐炒
煎服。仍以葱汤频洗谷道。令水液转入大肠。而便数自已。（杨仁斋）
淋病选方
五淋散 治淋因膀胱热结。
茵陈 淡竹叶（各一钱） 木通 滑石 甘草（各一钱半） 山栀 赤芍 赤苓（各二钱）
清肺饮 治淋因肺脾气燥。
茯苓 黄芩 桑皮 麦冬 山栀 泽泻 木通 车前
滋肾丸 治膀胱阴虚溺淋。
黄柏 知母（各二两） 肉桂（二钱）
麦冬汤服。
瞿麦汤 治心经蕴热。小便淋痛。
瞿麦（七钱半） 冬瓜子 茅根（各五钱） 黄芩（六钱） 木通（二钱半） 滑石（二两研）
冬葵子（二两） 竹叶（一把）
为末。分三剂水煎。入滑石末。调匀服。
琥珀散 治五淋溺痛。脓血相杂。
琥珀 海金砂 没药 蒲黄（等分）
为末。每服三钱。通草汤下。
立效散 治小便淋闭作痛。有时尿血。
瞿麦穗 山栀 甘草（各三钱）
水煎。
牛膝膏 治死血作淋。
桃仁 归尾（各一两） 牛膝（四两） 赤芍 生地（各一两半） 川芎（五钱）
锉片。水十五钟。煎二钟。入麝少许。分四次服。
木香汤
木香 木通 槟榔 茴香 赤芍 青皮 陈皮 泽泻 甘草
草豆饮 治砂石淋。
黑大豆一百粒。生甘草水煎。入滑石末一钱服。
石苇散
石苇 冬葵子 瞿麦 滑石 车前
六味丸 治阴虚热淋。
八味丸 治阳虚膀胱溺淋。（二方俱见中风） 补中益气汤（方见中风） 清心莲子饮 萆
厘清饮（二方俱见便溺）
二陈汤 治脾胃湿痰下注而淋。（方见痰症）
逍遥散 治肝经热郁气滞。（方见火症）
三生益元散
即六一散加生柏叶、藕节、车前同捣汁各一杯。调服。
快捷方式方 治五淋。
车前子为末。牛膝汤下。
外治法
治热淋痛甚。或不通者。
猪胆一枚。去汁少许。入麝香三厘。以阴茎纳其中。外线兜住。于内良久。即愈。
治血淋胀痛
藕节汁。调发灰每服二钱。或用大蒜淡豆豉和。纸包煨熟。露一夜。新水下。
治热淋不通者
田螺十五枚。水养。待螺吐出泥。澄去清水。以泥入腻粉半钱调涂脐上。尿立通。将螺放之。如杀害之。则不效。
[General Principle]
Dribbling, incomplete emptying, and astringent pain during urination are termed Lin syndrome (Lin Zheng). Urgency, fullness, and complete inability to urinate are termed Bi syndrome (Bi Zheng). Although the five types of Lin differ—namely Qi Lin (Qi-type Lin), Sha Lin (Stone-type Lin), Xue Lin (Blood-type Lin), Gao Lin (Gooey-type Lin), and Lao Lin (Exhaustion-type Lin)—their root cause is always Kidney deficiency with Heat in the Bladder. (*Yi Zong Xin Fa*)
[Etiology: Internal Factors]
It arises from prolonged consumption of rich, greasy, and sweet foods, leading to Qi stagnation and disease. This damages the Spleen Earth, impairing its ability to transform and transport essence and separate the clear from the turbid. Consequently, Lung Metal loses support, water pathways become unclear, and Lin syndrome gradually develops. Alternatively, excessive mental exertion or unregulated sexual activity causes Water and Fire to fail to interact, leading to Qi stagnation in the Heart and Kidney. This results in Yin-Yang rebellion and obstruction, causing clear and turbid substances to interfere with each other and accumulate in the Lower Jiao Bladder, making the water pathway astringent and obstructed. (*Jing Yue Quan Shu: Zheng Zhuan*)
[External Manifestations]
Astringent pain in urination, the urge to void but inability to do so, dribbling continuously, and severe cases feeling stifled and blocked. (*Yi Xue Ru Men*)
[Differentiation of Lin Syndromes]
Qi Lin presents with astringency and obstruction, with residual drops continuing. Xue Lin presents with blood in the urine, flaring up when exposed to Heat. Shi Lin (Stone Lin) presents with penile pain and sand/stones in the urine, also known as Sha Lin. Gao Lin presents with thick, turbid urine coagulating like paste, also known as Rou Lin. Lao Lin manifests upon exertion, with pain radiating to the Qichong acupoint, also known as Xu Lin. (*Zheng Zhi Hui Bu*)
[Severity of the Five Lins]
Although there are five types of Lin, they all belong to Heat. (Zhu Danxi) Initially, it is Re Lin (Heat Lin); severely, it becomes Xue Lin. Over time, the heat boils down body fluids, forming clots like blood, or thick turbidity like paste, or stones formed by fire scorching. (*Shang Han Sheng Mo*) This is analogous to the principle of boiling seawater to make salt. (*Yi Fang Kao*)
[Examining Deficiency-type Lin]
Lin syndromes have Deficiency and Excess patterns that must be distinguished. For instance, Qi Lin with sub-umbilical distension and discomfort indicates Qi stagnation; the method should be to regulate and promote flow. If it is due to Qi deficiency failing to move, tonifying the Middle Jiao is appropriate. Xue Lin with abdominal hardness and penile pain indicates dead blood (stasis); the method should be to remove stasis. However, if it is Blood deficiency with Cold, tonifying the Kidney is required. Only Gao Lin, characterized by the mixture of essence and urine causing turbidity, responds effectively to Yin-nourishing treatments. Lao Lin, showing signs of Spleen and Kidney exhaustion, cannot be cured without nourishing Righteous Qi. (*Zheng Zhi Hui Bu*)
[Pulse Diagnosis]
A deep and rapid pulse at the Shaoyin position indicates Yin Chuang (Yin sores) in women and Qi Lin in men. Generally, if the pulse in Lin cases is large and firm, the prognosis is good (survival); if weak, minute, and choppy, the prognosis is poor (death). (*Zheng Zhi Hui Bu*)
[Therapeutic Principles]
The method for treating Lin depends on whether the patient is thirsty. If Heat is in the Qi level, accompanied by thirst and difficult urination, this indicates latent Heat in the Lung where Fire fails to descend. Light, thin, and bland-draining herbs should be used to clear Lung Metal and drain Fire to nourish the upper source of Water. If Heat is in the Blood level, without thirst but with difficult urination, this indicates Kidney and Bladder lack of Yin, preventing Yang from transforming. Herbs with both scent and flavor being Yin-nourishing should be used to clear Heat and relieve constipation to nourish the lower source of Water. (*Yi Xue Ru Men*)
[Contraindication of Tonification in Lin Cases]
If there is Qi in the intestines causing urinary distension, Blood in the small intestine causing astringent urination, or Heat in the small intestine causing painful urination, Qi-tonifying agents are strictly forbidden. Because Qi tonification worsens distension, Blood tonification worsens astringency, and Heat tonification exacerbates Heat. If the water passages are blocked and the grain passage (bowels) is also obstructed, survival is impossible. (*Yi Tong*)
[Treatment Contraindications for Lin]
Using diaphoresis (sweating methods) for Lin leads to death; mild cases will result in hematochezia due to severe depletion of body fluids. Furthermore, Lin cases presenting with thirst and excessive sweating should not lightly use bland-draining herbs. (Zhang Zhongjing)
[Medication Selection]
For Bladder Heat accumulation, use Wu Lin San. For Lung and Spleen Qi dryness, use Qing Fei Yin. For Lower Jiao Yin deficiency, use Zi Shen Wan. For Lower Jiao Yang deficiency, use Shen Qi Wan. For Spleen channel damp-phlegm, use Er Chen Tang, added with Cang Zhu, Ze Xie, Sheng Ma, and Bi Xie. For Liver channel Qi stagnation, use Xiao Yao San, added with Huang Bo, Ze Xie, Shan Zhi, and Qing Pi. Generally, for penile pain in Lin, Gan Cao Gao (Licorice tip) is essential. For red urine, Dan Zhu Ye is used. For stasis, Niu Xi is used. For Heat, Mu Tong is used. For moving Qi, Qing Pi and Mu Xiang are used. For opening depression, Hu Po and Yu Jin are used. This is Li Dongyuan's method. For Xue Lin, use San Sheng Yi Yuan San. For Qi Lin, use Mu Xiang Tang. For Gao Lin, use Bi Xie Fen Qing Yin. For Sha Lin, use Shi Wei San. For Lao Lin, use Qing Xin Lian Zi Yin. For chronic Lin unresponsive to previous methods, use Bu Zhong Yi Qi Tang to raise Yang Qi. (*Zheng Zhi Hui Bu*)
[Appendix: Cold Lin]
The Bladder is the fu organ of body fluids, relying on Qi transformation for excretion. Now, if Cold pathogen lodges in the Bao Zhong (uterus/lower jiao region), Qi fails to transform, resulting in Lin. There must first be chills, followed by astringent and frequent urination, and swelling/pain in the orifice. This is because Cold Qi enters the Bao and contends with Righteous Qi. When Cold wins, chills occur and Lin develops; when Righteous Qi wins, chills cease and urination occurs. Treatment should scatter Cold and support Righteous Qi, using Si Jun Zi Tang added with Hui Xiang, Mu Xiang, Yi Zhi Ren, Rou Gui, Mu Tong, and Ze Xie. (*Yi Tong*)
[Appendix: Deficiency Lin]
Deficiency Lin is caused by Kidney deficiency and essence deterioration. If youths with immature essence indulge in sex, or elderly men with impotence desire sexual activity, essence does not exit but rots internally, causing astringent pain in the penis and forming Lin. Only Jin Kui Shen Qi Tang can save such cases. If essence is already exhausted but further depleted, it causes pulling pain in both stool and urine; the more painful, the more one wants to defecate/void, and vice versa. One should double the dosage of Rou Gui and Fu Zi to nourish the source of transformation. Do not mistakenly use Zhi Mu, Huang Bo, or bland-draining agents, as they drain Yang and deplete Yin simultaneously. (Xue Ji)
[Appendix: Frequent Urination]
Some patients initially suffer from dry, hot stools, causing body fluids to flow only into the Small Intestine, resulting in frequent urination regardless of volume, hot pain in the penis, and increasingly dry stools, even leading to high fever, irritability, and thirst for water. This is due to indulgence in alcohol and sex, or overconsumption of spicy, warm, meaty, and foul foods, causing Heat toxicity and rotting stasis to enter the Small Intestine via deficiency. Thus, urination is painful, differing from the astringent pain of Lin. Use Bi Xie stir-fried with salt and decocted for oral administration. Also, frequently wash the anus with Scallion decoction to guide fluids into the Large Intestine, stopping the frequency naturally. (Yang Renzhai)
[Selected Formulas for Lin]
Wu Lin San: Treats Lin due to Bladder Heat accumulation.
Yin Chen, Dan Zhu Ye (1 qian each), Mu Tong, Hua Shi, Gan Cao (1.5 qian each), Shan Zhi, Chi Shao, Chi Ling (2 qian each).
Qing Fei Yin: Treats Lin due to Lung and Spleen Qi dryness.
Fu Ling, Huang Qin, Sang Bai Pi, Mai Dong, Shan Zhi, Ze Xie, Mu Tong, Che Qian Zi.
Zi Shen Wan: Treats Bladder Yin deficiency causing urinary Lin.
Huang Bo, Zhi Mu (2 liang each), Rou Gui (2 qian). Take with Mai Dong decoction.
Qu Mai Tang: Treats Small Urinary Pain due to Heart Channel latent Heat.
Qu Mai (7.5 qian), Dong Gua Zi, Mao Gen (5 qian each), Huang Qin (6 qian), Mu Tong (2.5 qian), Hua Shi (2 liang, powdered), Dong Kui Zi (2 liang), Zhu Ye (one handful).
Powdered, divided into three doses, decocted in water, mixed with Hua Shi powder, and taken.
Hu Po San: Treats pain in urination from the Five Lins, mixed with pus and blood.
Hu Po, Hai Jin Sha, Mo Yao, Pu Huang (equal parts).
Powdered, take 3 qian per dose, washed down with Tong Cao decoction.
Li Xiao San: Treats urinary blockage and pain, sometimes with blood in urine.
Qu Mai Sui, Shan Zhi, Gan Cao (3 qian each).
Decoct in water.
Niu Xi Gao: Treats Lin caused by dead blood (stasis).
Tao Ren, Gui Wei (1 liang each), Niu Xi (4 liang), Chi Shao, Sheng Di (1.5 liang each), Chuan Xiong (5 qian).
Sliced, decocted in 15 zhong of water until 2 zhong remain, add a little She Xiang, divide into four doses.
Mu Xiang Tang
Mu Xiang, Mu Tong, Bing Lang, Hui Xiang, Chi Shao, Qing Pi, Chen Pi, Ze Xie, Gan Cao.
Cao Dou Yin: Treats Stone Lin.
100 Black Soybeans, raw Gan Cao, decocted in water, mix with 1 qian Hua Shi powder and take.
Shi Wei San
Shi Wei, Dong Kui Zi, Qu Mai, Hua Shi, Che Qian Zi.
Liu Wei Wan: Treats Yin deficiency Heat Lin.
Ba Wei Wan: Treats Yang deficiency Bladder urinary Lin. (Both formulas see Stroke chapter) Bu Zhong Yi Qi Tang (Formula see Stroke chapter) Qing Xin Lian Zi Yin, Bi Xie Fen Qing Yin (Both formulas see Urination chapter).
Er Chen Tang: Treats Lin caused by Spleen/Stomach damp-phlegm sinking downward. (Formula see Phlegm chapter)
Xiao Yao San: Treats Lin caused by Liver channel Heat depression and Qi stagnation. (Formula see Fire chapter)
San Sheng Yi Yuan San
Is Liu Yi San added with Ce Bai Ye, Ou Jie, and Che Qian Zi, pounded together to extract juice (1 cup each), mixed and taken.
Quick Method Formula: Treats the Five Lins.
Che Qian Zi powdered, taken with Niu Xi decoction.
[External Therapies]
Treating severe pain or obstruction in Heat Lin.
One Pig Gallbladder, remove some bile, add 3 li of She Xiang. Insert the penis into it, secure externally with thread, leave inside for a long time, then it heals.
Treating bloating and pain in Blood Lin.
Ou Jie juice, mixed with Fa Hui (burnt hair), take 2 qian per dose. Or mix Da Suan and Dan Dou Chi, wrap in paper, roast until cooked, expose overnight, take with fresh water.
Treating obstruction in Heat Lin.
15 River Snails, keep in water. Wait for snails to spit out mud, clarify and discard clear water. Take the mud, mix with Ni Fen (Lead Subcarbonate) half a qian, apply to the umbilicus. Urine will immediately flow freely. Release the snails afterwards. If the snails are killed, it will be ineffective.