一 一老人患淋，医以五淋等剂投之，遂腹中痛如刀割，大便如注，小便仍点滴不通，六脉肺部独
大。余云∶此肺移热于大肠之症。用桑皮、紫菀、杏仁、苏子、黄芩、橘红、茯苓、甘桔，一剂腹痛减，
大便稀，但小水仍不通利。用生地、枸杞、牛膝，补阴药中加桑皮、紫菀、茯苓、车前，二剂痊愈。
二 一放出宫人，年逾三十，两胯作痛，肉色不变，大小便中作痛如淋，登厕尤甚。立斋曰∶此瘀
血渍入隧道为患，乃男女失合之症也，难治。后溃不敛，又患瘰 而没。此妇出宫，为商人外家，可见在
宫久怀忧郁，既嫁又不能如愿，是以致生此疾，愈见流注，瘰 ，乃七情气血皆已损伤，不
可用攻伐皎然矣。按《精血篇》云∶精未通而御女以通其精，则五体有不满之处，异日有难状之疾；阴
已痿而思色，以降其精，精不出而内败，小便道涩而为淋，精已耗而复竭之，则大小便道牵痛，愈痛则
愈欲大小便，愈便愈痛，女人天癸既至，逾十年无男子合，则不调，不调则旧血不出，新血误行，或渍
而入骨，或变而为肿，或虽合而难孕。合男子多则沥枯虚人，产多则血枯杀人，观其精血，思过半矣。
浊症，有便浊、精浊之不同。便浊是便溺混浊而不痛。赤者，湿热在血分；白者在气分。经所谓水
液混浊，皆属于热者是也。譬之天气，热则水混浊，寒则澄清。又如清水煎汤，则自然白浊耳。吴氏云∶便
浊乃胃中湿热渗入膀胱所致。治宜理脾胃，清湿热，兼补肾水。亦有因色欲伤肾，思虑伤心，劳役伤脾所
致者。精浊则牵丝粘腻，虽不便溺，
亦时有之。此是肾水不足，淫火易动，精离其位，故渐渍而出。若多出不禁者，乃因房劳过度，关窍失
合，不戒色欲，必死。总宜壮水滋阴为主，佐以酸收固涩之剂。其因思虑伤心者，天王补心、归脾之属，
因劳倦伤脾者，补中益气之类，可加敛涩之品以治之，仍宜兼补其肾，此治浊之大略也。
便浊效方〔自制。〕治赤白浊。
川石斛〔清胃中湿热。〕茯苓〔祛膀胱湿热。〕米仁〔除湿健脾益胃。〕
川萆 〔除湿、祛浊厘清。〕生地〔肾为胃关，水脏得职，湿热自去，赤者多用。〕天
冬〔金为水源，肺气清肃，小便自清。〕知母、黄柏〔泻阴火，除湿热。〕便浊不禁加莲须、莲
肉，赤者再加白芍，可加水陆二仙膏。〔艾实生于水，金樱子生于陆也。〕
此理脾胃，清湿热兼补肾水之剂。浊症主此加减治之。
六味丸 左归丸饮〔俱见虚劳。〕
本方〔宜去渗泄助火诸品。〕加莲须、莲肉之属。〔清心则淫火不动，固肾则精气无遗。〕
精流不禁，加五味〔酸以收敛。〕鳔胶〔粘以止滑。〕龙骨、牡蛎〔涩以固脱。〕
此二方皆壮水滋阴，加清心安神，佐以敛涩之剂。精浊者，随宜加减采用。
天王补心丹 归脾汤〔俱见虚劳。〕
此因思虑伤心而致便浊精浊者，随宜加减采用。
补中益气汤〔见泄泻。〕
此因劳倦伤脾而致便浊精浊，随宜加减用之。
1. An elderly man suffered from Lin syndrome (dysuria with frequency, urgency, and pain). The physician administered formulas such as Wulin San (Five-Lin Decoction), which resulted in severe abdominal pain like knife-cutting, profuse watery diarrhea, and complete retention of urine. Among the six pulses, only the Lung pulse was notably large. I stated: This is a case where heat from the Lung has transferred to the Large Intestine. I prescribed Sangbai Pi (Cortex Mori Radicis), Ziwan (Radix Asteris), Xingren (Semen Armeniacae Amarum), Suzi (Fructus Perillae), Huangqin (Radix Scutellariae), Juhong (Pericarpium Citri Reticulatae Rubrum), Fuling (Poria), Gancao (Radix Glycyrrhizae), and Jiegeng (Radix Platycodonis). After one dose, the abdominal pain subsided, and the stool became loose, but urination remained obstructed. I then switched to Yin-nourishing herbs including Shengdi Huang (Radix Rehmanniae Preparata), Gouqi Zi (Fructus Lycii), and Niuxi (Radix Achyranthis Bidentatae), adding Sangbai Pi, Ziwan, Fuling, and Cheqian Cao (Herba Plantaginis) to the formula. After two doses, he recovered completely.
2. A palace maid released from service, aged over thirty, complained of pain in both hips/crotches with no change in skin color. She experienced pain during urination and defecation resembling Lin syndrome, which worsened when using the toilet. Xue Lizhai (Xue Ji) said: This is caused by stagnant blood infiltrating the urinary tract, resulting from sexual incompatibility or imbalance between male and female energies. It is difficult to treat. Later, the sores ulcerated and failed to heal, and she eventually died after developing Luoli (scrofula/lymphatic tuberculosis). This woman, having left the palace to become a merchant's concubine, likely harbored long-term depression in the palace and could not fulfill her desires after marriage, leading to this disease. The progression to Liuzhu (flowing abscesses) and Luoli indicates that the Seven Emotions, Qi, and Blood were all damaged, making aggressive treatment clearly inappropriate. According to the "Jingxue Pian" (Chapter on Essence and Blood): If one engages in intercourse before the essence is fully developed to drain it, the five viscera will have deficiencies, leading to obscure diseases later; if the Yin is already weak but one lusts for women to drain essence, the essence fails to exit and rots internally, causing涩 (obstruction) in the urinary channel and resulting in Lin syndrome; if essence is exhausted and drained again, the urinary and anal channels will pull and hurt. The more painful, the more one desires to urinate or defecate; the more one goes, the more painful it becomes. For women, if Tian Gui (menstruation) has arrived but there is no intercourse with men for over ten years, menstruation will be irregular. Irregularity causes old blood to remain and new blood to flow erratically, sometimes infiltrating bones or turning into swelling. Even if intercourse occurs, pregnancy may be difficult. Excessive intercourse depletes essence and weakens the body; excessive childbirth depletes blood and can be fatal. Observing their essence and blood reveals half the truth.
Zhuo syndrome (turbid discharge) differs into Bian Zhuo (urinary turbidity) and Jing Zhuo (seminal turbidity). Bian Zhuo refers to turbid urine without pain. Red turbidity indicates damp-heat in the Blood level; white turbidity indicates damp-heat in the Qi level. This aligns with the Classic saying: "All turbid fluids belong to Heat." Just as weather dictates water clarity—heat makes it turbid, cold makes it clear—or like boiling clear water which naturally turns milky. Wu Shi said: Bian Zhuo is caused by damp-heat in the Stomach seeping into the Bladder. Treatment should regulate the Spleen and Stomach, clear damp-heat, and supplement Kidney Water. It can also result from sexual excess damaging the Kidney, overthinking damaging the Heart, or physical labor damaging the Spleen. Jing Zhuo presents with sticky, thread-like filaments in the urine, occurring even without frequent urination. This is due to insufficient Kidney Water allowing Ministerial Fire to move easily, causing essence to leave its proper position and gradually leak out. If leakage is excessive and uncontrollable, it is due to excessive sexual activity causing the orifices to lose control; without abstaining from sex, death is inevitable. Generally, treatment should focus on strengthening Water and nourishing Yin, assisted by sour astringent agents. For cases caused by overthinking damaging the Heart, use Tianwang Buxin Dan (Emperor of Heaven's Special Pill to Tonify the Heart) or Guipi Tang (Restore the Spleen Decoction); for cases caused by fatigue damaging the Spleen, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), adding astringents. One must still tonify the Kidney. This is the general principle for treating Zhuo syndrome.
Effective Formula for Bian Zhuo [Self-made]. Treats red and white turbidity.
Chuan Shihu (Dendrobii Caulis) [Clears damp-heat in the Stomach.] Fuling (Poria) [Dispels damp-heat in the Bladder.] Yiyiren (Semen Coicis) [Removes dampness, strengthens Spleen, benefits Stomach.]
Chuan Bibo (Rhizoma Dioscoreae Hypoglaucae) [Removes dampness, clears turbidity.] Sheng Di Huang (Radix Rehmanniae Recens) [The Kidney is the gate of the Stomach; when the Water organ functions properly, damp-heat departs. Use more for red turbidity.] Tiandong (Radix Asparagi) [Metal is the source of water; when Lung Qi is clear and descending, urine becomes clear.] Zhi Mu (Rhizoma Anemarrhenae) and Huangbai (Cortex Phellodendri) [Drain ministerial fire, remove damp-heat.] For uncontrollable turbidity, add Lianxu (Stamen Nelumbinis) and Lianrou (Endocarpium Nelumbinis); for red turbidity, add Baishao (Radix Paeoniae Alba); can add Shuilu Erxian Gao (Two Immortals Paste of Water and Land) [Tumu (Fructus Tiliaceae) grows in water, Jinyingzi (Fructus Rosae Laevigatae) grows on land.]
This formula regulates the Spleen and Stomach, clears damp-heat, and supplements Kidney Water. Zhuo syndrome is treated with modifications of this formula.
Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Zuogui Wan Yin (Left Restoring Pill Decoction) [Both seen in Xu Lao (Deficiency Consumption).]
Modify this formula [remove diuretic and fire-assisting herbs.] Add Lianxu, Lianrou, etc. [Clearing the Heart keeps ministerial fire still; securing the Kidney prevents essence loss.]
For uncontrolled seminal emission, add Wuweizi (Fructus Schisandrae Chinensis) [Sour to astringe.] Biaojiao (Colla Corii Corii) [Sticky to stop slipping.] Longgu (Os Draconis) and Muli (Concha Ostreae) [Astringent to secure collapse.]
These two formulas strengthen Water and nourish Yin, added with heart-clearing and calming agents, assisted by astringents. For Jing Zhuo, adopt them with appropriate modifications.
Tianwang Buxin Dan (Emperor of Heaven's Special Pill to Tonify the Heart) and Guipi Tang (Restore the Spleen Decoction) [Both seen in Xu Lao (Deficiency Consumption).]
For Bian Zhuo and Jing Zhuo caused by overthinking damaging the Heart, adopt them with appropriate modifications.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) [Seen in Xie Xie (Diarrhea).]
For Bian Zhuo and Jing Zhuo caused by fatigue damaging the Spleen, adopt them with appropriate modifications.