大意
胞移热于膀胱。则溺血。（内经）是溺血未有不本于热者。但有各藏虚实之不同耳。（汇补）
内因
或肺气有伤。妄行之血。随气化而下降。胞中或脾经湿热内陷之邪。乘所胜而下传水府。或肝伤血枯。或
肾虚火动。或思虑劳心。或劳力伤脾。或小肠结热。或心胞伏暑。俱使热乘下焦。血随火溢。（汇补）
外候
全无疼痛。血从精窍而出。非若血淋茎痛。血随溺窍而出也。（汇补）
治法
暴热实火。宜甘寒清火。房劳虚损。宜滋阴补肾。此病日久中枯。非清心静养。不可治也。（汇补）
用药
实热。用导赤散。加山栀、黄芩、淡竹叶、赤苓。煎成调滑石末饮之。虚热。宜四物汤。加生地、茯苓、山栀、牛
膝、麦冬。煎成调发灰饮之。久不止者。胶艾四物汤。虚甚者。鹿角秋石丸。阻塞不通。加冬葵子、生蒲黄以化之。
（汇补）
溺血选方
导赤散
生地 木通 甘草
胶艾汤（方见便血）
小蓟饮
小蓟 山栀 当归 生地 滑石 甘草 蒲黄 通草 淡竹叶 加冬葵子
鹿角胶丸
鹿角 熟地 发灰
茅根汁为丸。盐汤下。
大意
水液混浊。皆属于热。（内经）故赤白浊。皆因湿热浊气。渗入膀胱而为病。（入门）
内因
其因有二。肥人多湿热。瘦人多肾虚。（丹溪）肾虚者。因思想过度。嗜欲无节。肾水虚少。膀胱火盛。小便去涩。
所以成浊。（医鉴）湿热者。因脾胃湿热。中焦不清。下流膀胱。故便溲混浊。（正传）又有思虑劳心者。房欲伤肾
者。脾虚下陷者。脾移热于肾者。下元虚冷者。湿痰流注者。有属虚劳者。有因伏暑者。（汇补）
外候
小溺浊涩。茎中大痛。其状漩面如油。光彩不定。漩脚下澄。凝如膏糊。（心法）若初起先有消渴善饮。而后下
便见浊者。即下消症也。（汇补）
浊分气血
血虚而热甚者。则为赤浊。心与小肠主之。气虚热微者。则为白浊。肺与大肠主之。（正传）
浊分虚实
大约窍端结盖者。为多火。不结盖者。为兼湿。小水赤涩而痛。或浊带赤色者。为小肠湿热。小水不涩不痛。
而所下色白。或渗利转甚者。为脾气下陷。茎中痛痒。而发寒热。或有结痛者。为毒邪所侵。（汇补）
浊分精溺
要知浊出精窍。淋出溺道。由败精瘀腐者。十常六七。由湿热流注。与脾虚而下陷者。十中二三。（汇补）
脉法
两尺洪数。为阴火不宁。左寸短小。为心虚不摄。右脉大而涩。按之无力。或微细。或沉紧而涩。皆为虚。尺脉
虚浮。急疾者难治。迟者易治。（汇补）
治法
赤者当清心泻火。白者当滋阴补肾。使水火既济。阴阳叶和。精气自固。（正传）若属湿痰者。宜燥中宫之湿。
属虚滑者。宜提下陷之气。甚有色欲太过。阳虚生寒者。当壮火锁阳。此虽仅见。亦宜审也。（汇补）
治禁
不可纯用寒凉伤血。不可纯用热药助火。盖寒则坚凝。热则流通。均非当理。但宜清上固下。（入门）其必佐
以甘淡者。以甘能化气。淡能利窍。若用涩剂。则邪无从出。反增胀闷。（汇补）
用药
阴虚火动。主以地黄汤。去山萸。加萆 、黄柏。心虚火动。主以清心莲子饮。湿痰下注。主以苍白二陈汤。湿
热不清。主以四苓散。中气下陷。主以补中益气汤。下元虚冷。主以八味地黄汤。若暑月冒热便浊者。辰砂
六一散。
【附精浊】
精浊者。因败精流于溺窍。滞而难出。故注中如刀割火灼。而溺自清。惟窍端时有秽物。如疮脓目眵。淋漓
不断。与便溺绝不相混。此心肾二经火起精溢。故败精流出。而为白浊。虚滑者。血不及变。而为赤浊。宜滋
阴药中。如牛膝、冬葵子、萆 。去其败精。然后分治。挟寒者。脉迟无力。溺色清白。挟热者。口渴便黄。脉滑数
有力。寒者。萆 厘清饮。热者。清心莲子饮。
便浊选方
地黄加减汤 治阴虚火动便浊。
即地黄汤 加知母、黄柏、麦冬。
清心莲子饮 治心虚便浊有热。
茯苓 黄 石莲子（各七钱半） 地骨皮 麦冬 人参（各一钱半）
远志 菖蒲 车前 黄芩 炙草（各一钱）
水煎。加辰砂调服。
苍白二陈汤 治湿痰下注便浊。
苍术 白术 半夏 茯苓 陈皮（各八分） 甘草（四分）
一方。加升、柴各三分。
加味四苓散 治湿热不清便浊。
茯苓 白术 猪苓 泽泻（各等分）
加山栀、麦冬、木通、黄芩。水煎。
加减八味丸 治下元虚冷便浊。
即桂附八味丸。去茯苓、泽泻。加菟丝、五味子。
萆 厘清饮
萆 菖蒲 益智 乌药（各等分）
每服四钱。水煎。入盐一捻服。
珍珠粉丸 治阴虚火旺而白浊。
真蛤粉（四两） 黄柏（四两）
水丸。酒下。
小菟丝丸 治虚劳遗浊。
石莲肉 山药（各二两） 茯苓（一两） 菟丝（五两）
为末。山药糊丸。盐酒下。
辰砂六一散（方见暑症） 水陆二仙丹（方见遗精） 补中益气汤（方见中风）
[Nocturnal Emission of Blood / Hematuria]
General Principle
The heat from the Bao (uterus/lower jiao blood chamber) transfers to the Bladder, resulting in hematuria. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states that hematuria is invariably rooted in heat, differing only in the deficiency or excess patterns of various Zang-Fu organs. (*Zhengzhi Huibu*)
Internal Causes
Some cases arise from Lung Qi injury, where blood flows recklessly and descends following Qi transformation. Others result from damp-heat pathogens sinking inward from the Spleen Meridian, taking advantage of the controlling cycle to transmit downward to the Water Mansion (Bladder). Still others stem from Liver injury with blood depletion, Kidney deficiency with fire stirring, excessive worry exhausting the Heart, physical labor damaging the Spleen, heat accumulation in the Small Intestine, or latent summer-heat in the Pericardium. All these conditions allow heat to invade the Lower Jiao, causing blood to overflow following the fire. (*Zhengzhi Huibu*)
External Manifestations
There is complete absence of pain; blood exits from the Essence Orifice (Jing Qiao), unlike Blood Lin (Dysuria with blood) where pain occurs in the penis and blood exits with urine from the Urinary Orifice (Niao Qiao). (*Zhengzhi Huibu*)
Treatment Principles
For sudden onset of excess heat and blazing fire, use sweet-cold herbs to clear fire. For deficiency damage due to sexual exhaustion, nourish Yin and tonify the Kidney. If this disease persists for a long time leading to central depletion, it cannot be cured without calming the Heart and resting quietly. (*Zhengzhi Huibu*)
Medication
For excess heat, use Daochi San (Carpel Decoction) with added Gardenia Fruit (Shanzhi), Scutellaria Root (Huangqin), Light Bamboo Leaf (Dan Zhuye), and Red Poria (Chiling). After decoction, mix in Talc Powder (Huashi) and drink. For deficiency heat, use Siwu Tang (Four Substance Decoction) with added Rehmannia Root (Shengdi), Poria (Fuling), Gardenia Fruit (Shanzhi), Achyranthes Root (Niuxi), and Ophiopogon Tuber (Maidong). After decoction, mix in Hair Ash (Fahui) and drink. For chronic cases not stopping, use Jiao'ai Siwu Tang (Colla-Corvi and Four Substances Decoction). For severe deficiency, use Lujiao Qushi Wan (Deer Horn and Autumn Stone Pill). If there is obstruction and blockage, add Okra Seed (Dongkuizi) and Raw Polygonum Knotweed Rhizome (Sheng Puhuang) to resolve stasis. (*Zhengzhi Huibu*)
Selected Formulas for Hematuria
Daochi San (Carpel Decoction)
Rehmannia Root (Shengdi) Akebia Stem (Mutong) Licorice Root (Gancao)
Jiaoai Tang (Colla-Corvi Decoction) (See formula under Melena)
Xiaojiao Yin (Little Thistle Infusion)
Little Thistle (Xiaoji) Gardenia Fruit (Shanzhi) Angelica Sinensis Root (Danggui) Rehmannia Root (Shengdi) Talc (Huashi) Licorice Root (Gancao) Polygonum Knotweed Rhizome (Puhuang) Tongcao Dongkuizi (Okra Seed)
Lujiao Jiao Wan (Deer Horn Gelatin Pill)
Deer Horn (Lujiao) Prepared Rehmannia Root (Shudi) Hair Ash (Fahui)
Made into pills with Mugwort Root Juice (Maogen Zhi), taken with salt water.
[Cloudy Urine / Turbid Urination]
General Principle
Turbid fluids all belong to heat. The *Huangdi Neijing* states thus. Therefore, red turbidity and white turbidity are both caused by damp-heat turbid qi infiltrating the Bladder. (*Yixue Rumen*)
Internal Causes
There are two main causes: obese individuals often have damp-heat, while thin individuals often have Kidney deficiency. (Zhu Danxi) In Kidney deficiency cases, excessive thinking and unregulated desires deplete Kidney Water, causing Bladder Fire to flourish, leading to astringent urination and turbidity. (*Yijian*) In damp-heat cases, spleen-stomach damp-heat fails to clear in the Middle Jiao and flows downward to the Bladder, causing cloudy urine and stool. (*Zhengzhuan*) There are also cases due to mental exertion, sexual injury to the Kidney, Spleen deficiency with sinking Qi, Spleen transferring heat to the Kidney, deficiency-cold of the Lower Origin, flowing damp-phlegm, deficiency-wasting diseases, or latent summer-heat. (*Zhengzhi Huibu*)
External Manifestations
Urine is turbid and astringent, with severe pain in the middle of the urethra. The appearance resembles oil floating on a vortex, with unstable luster, settling at the bottom like paste. (*Zhangshi Yitong*) If initially accompanied by Xiao Ke (Wasting-Thirst) and polydipsia, followed later by lower turbidity, it is Xia Xiao (Lower Wasting-Thirst). (*Zhengzhi Huibu*)
Differentiation of Turbidity by Qi and Blood
When Blood is deficient and heat is severe, it becomes Red Turbidity, governed by the Heart and Small Intestine. When Qi is deficient and heat is mild, it becomes White Turbidity, governed by the Lung and Large Intestine. (*Zhengzhuan*)
Differentiation of Turbidity by Deficiency and Excess
Generally, if the urethral orifice has a covering/knotting, it indicates excess Fire; if no covering, it indicates combined Dampness. If urine is red, astringent, painful, or turbid with red color, it is Small Intestine damp-heat. If urine is not astringent or painful, but the discharge is white, or diuresis worsens, it is Spleen Qi sinking. If there is penile pain/itching accompanied by chills and fever, or knotting pain, it is invasion by toxic pathogens. (*Zhengzhi Huibu*)
Differentiation of Turbidity by Essence and Urine
Know that turbidity comes from the Essence Orifice, while Lin syndrome comes from the Urinary Pathway. Cases caused by rotten essence and stasis account for six or seven out of ten; those caused by damp-heat flow and Spleen deficiency with sinking Qi account for two or three out of ten. (*Zhengzhi Huibu*)
Pulse Diagnosis
Hong and rapid pulses at both Chi positions indicate unsettled Yin Fire. Short and small pulse at the left Cun position indicates Heart deficiency failing to secure. Large and choppy Right pulse, weak upon pressure, or fine, or deep-tight-choppy, all indicate deficiency. Empty and floating Chi pulse, rapid and urgent, is difficult to treat; slow is easier to treat. (*Zhengzhi Huibu*)
Treatment Principles
Red turbidity should be treated by clearing the Heart and draining fire; white turbidity by nourishing Yin and tonifying the Kidney, allowing Water and Fire to interact and Yin-Yang to harmonize, so Essence naturally secures. (*Zhengzhuan*) If due to damp-phlegm, dry the dampness of the Central Palace; if due to deficiency slipping, lift the sinking Qi. Even in cases of excessive sexual desire leading to Yang deficiency generating cold, strengthen Fire to lock Yang. Though rare, this must be carefully examined. (*Zhengzhi Huibu*)
Contraindications
Do not use purely cold-cooling herbs to injure Blood, nor purely hot herbs to aid Fire. Cold causes solidification; heat causes circulation; neither is appropriate. One should only clear the Upper and secure the Lower. (*Yixue Rumen*) It is necessary to assist with sweet-and-bland herbs, as sweet transforms Qi and bland promotes orifices. If astringents are used, pathogens have no way out,反而 increasing bloating and stuffiness. (*Zhengzhi Huibu*)
Medication
For Yin deficiency with fire stirring, primarily use Dihuang Tang (Rehmannia Decoction), remove Cornus Fruit (Shanyuzi), add Dioscorea Hypoglauca Rhizome (Bixie) and Phellodendron Bark (Huangbai). For Heart deficiency with fire stirring, primarily use Qingxin Lianzi Yin (Clear the Heart Lotus Seed Infusion). For damp-phlegm pouring downward, primarily use Cangbai Erchen Tang (Atractylodes Magna and White Atractylodes Two-Aged Decoction). For unclear damp-heat, primarily use Siling San (Four Poria Powder). For Middle Qi sinking, primarily use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For deficiency-cold of the Lower Origin, primarily use Bawei Dihuang Tang (Eight Ingredients Rehmannia Decoction). For turbid urine contracted with heat during summer months, use Chen Sha Liuyi San (Cinnabar Six-to-One Powder).
[Appendix: Essence Turbidity]
Essence Turbidity arises when rotten essence flows into the urinary orifice, stagnating and difficult to expel. Thus, urination feels like cutting or burning, yet the urine itself is clear. Only occasionally does foul matter discharge from the orifice end, like pus from sores or eye discharge, dripping continuously, completely distinct from feces and urine. This is caused by Fire arising in the Heart and Kidney meridians leading to essence overflow, resulting in white turbidity from expelled rotten essence. In deficiency-slippery cases, blood fails to transform, resulting in red turbidity. It is advisable to add Achyranthes Root (Niuxi), Okra Seed (Dongkuizi), and Dioscorea Hypoglauca Rhizome (Bixie) to yin-nourishing herbs to eliminate rotten essence, then treat separately. Those with cold have slow, powerless pulses and clear-white urine; those with heat have thirst, yellow urine, and slippery-rapid-strong pulses. For cold, use Bixie Qingfen Yin (Dioscorea Hypoglauca Clearing Turbidity Infusion); for heat, use Qingxin Lianzi Yin (Clear the Heart Lotus Seed Infusion).
Selected Formulas for Turbid Urination
Dihuang Jiajian Tang (Modified Rehmannia Decoction) Treats turbid urine due to Yin deficiency and fire stirring.
Based on Dihuang Tang, add Anemarrhena Rhizome (Zhimu), Phellodendron Bark (Huangbai), and Ophiopogon Tuber (Maidong).
Qingxin Lianzi Yin (Clear the Heart Lotus Seed Infusion) Treats Heart deficiency turbid urine with heat.
Poria (Fuling) Astragalus Root (Huangqi) Lotus Seed (Shi Lianzi) [7.5 qian each] Anemarrhena Rhizome (Digupi - Note: Text says Digupi which is Anemarrhena/Bone Earth Skin, usually Zhi Mu or Di Gu Pi, here likely Di Gu Pi/Morus Root Bark based on context but text says Digupi) Ophiopogon Tuber (Maidong) Codonopsis Ginseng (Renshen) [1.5 qian each] Polygala Root (Yuanzhi) Acorus Rhizome (Changpu) Plantago Seed (Cheqian) Scutellaria Root (Huangqin) Roasted Licorice Root (Zhigancao) [1 qian each]
Decoct in water, take with Cinnabar (Chen Sha).
Cangbai Erchen Tang (Atractylodes Magna and White Atractylodes Two-Aged Decoction) Treats turbid urine due to damp-phlegm pouring downward.
Atractylodes Macrocephala (Cangzhu) Atractylodes Alba (Baizhu) Pinellia Tuber (Banxia) Poria (Fuling) Tangerine Peel (Chenpi) [0.8 fen each] Licorice Root (Gancao) [0.4 fen]
Another prescription adds Cimicifuga Rhizome (Shengma) and Bupleurum Root (Chaihu) [0.3 fen each].
Jiawei Siling San (Modified Four Poria Powder) Treats turbid urine due to unclear damp-heat.
Poria (Fuling) Atractylodes Alba (Baizhu) Polyporus (Zhuling) Alisma Rhizome (Zexie) [Equal parts]
Add Gardenia Fruit (Shanzhi), Ophiopogon Tuber (Maidong), Akebia Stem (Mutong), Scutellaria Root (Huangqin). Decoct in water.
Jiawei Bawei Wan (Modified Eight Ingredients Pill) Treats turbid urine due to deficiency-cold of the Lower Origin.
Based on Guifu Bawei Wan (Cinnamon Twig and Aconite Eight Ingredients Pill), remove Poria (Fuling) and Alisma Rhizome (Zexie), add Dodder Seed (Tusizi) and Schisandra Berry (Wuweizi).
Bixie Qingfen Yin (Dioscorea Hypoglauca Clearing Turbidity Infusion)
Dioscorea Hypoglauca Rhizome (Bixie) Acorus Rhizome (Changpu) Smart Seed (Yizhi) Lindera Root (Wuyao) [Equal parts]
Take 4 qian per dose, decoct in water, add a pinch of salt.
Zhenzhu Fen Wan (Pearl Powder Pill) Treats white turbidity due to Yin deficiency and fire hyperactivity.
True Clam Powder (Zhen Gafen) [4 liang] Phellodendron Bark (Huangbai) [4 liang]
Make into water pills, take with wine.
Xiao Tusizi Wan (Small Dodder Seed Pill) Treats turbid emission due to deficiency-wasting.
Lotus Seed Core (Shilian Rou) Chinese Yam (Shanyao) [2 liang each] Poria (Fuling) [1 liang] Dodder Seed (Tusizi) [5 liang]
Grind into powder, make pills with Chinese Yam paste, take with salted wine.
Chen Sha Liuyi San (Cinnabar Six-to-One Powder) (See formula under Summerheat) Shuilu Erxian Dan (Water and Land Immortal Double Pill) (See formula under Nocturnal Emission) Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See formula under Stroke)