一 一人忧愤经旬，忽小便不禁。医皆用补肾固脬之剂投之，一月而转甚。士材云∶六脉举之则
软，按之则坚,此肾肝之阴有伏热也。用猪胆炒黄连〔一钱。〕丹皮〔二钱。〕清肺经之伏热，盐炒
苦参〔八分。〕清肾经之伏热，白茯苓〔二钱。〕甘草梢〔六分。〕调鸡肠末，与服六剂而安。一医
云∶既愈，当大补之。数日后仍复不禁。士材云∶肝家素有郁热，得温补而弥炽，遂以龙胆泻肝汤加
减，调鸡肠末服之，四剂即止。更以四君子加黄连、山栀，一月而痊。
二 一妇患饮食不进，小便不禁。士材曰∶六脉沉迟。水泉不藏，是无火也。用八味丸料，兼
用异功散，加益智、肉桂二剂，数日而安。
淋者，欲尿而不能出，胀急痛甚，不欲尿而点滴淋沥。仲淳云∶此属肾虚，兼有湿热。丹溪则有五淋
之分。气滞不通，脐下闷痛者，为气淋，溺血而痛者，为血淋，溺出如面糊而痛者，为膏淋；溺出如砂石
而痛者，为砂淋；此以火灼膀胱，溺阴凝结，煮海为盐之象也。遇劳即小便淋涩而痛者，为劳淋。但宜辨
其因心劳、脾劳、肾劳之不同。凡治五淋，总宜壮水滋阴渗湿，分利小便为主；然虚各实异，宜补宜泻
临症之顷，所当详审。
五淋汤〔自制。〕淋症主此加减。
生地〔壮水滋阴。血淋多用。〕二冬〔清肺气，化及州都，小便自然顺利。〕知母〔
泄膀胱肾家之火，又能利水。〕黄柏〔利水窍涩痛。〕甘草梢〔止茎中作痛。〕牛膝〔独用
两许煎饮，治小便不利，茎中痛甚者立效，血淋更宜。〕车前〔开窍通淋。〕茯苓〔渗湿利水。〕
气淋加沉香、郁金；血淋，加茅根、藕汁；膏淋加川萆 、川石斛；砂淋，加滑石末调
服。〔滑可去着，为下石淋要药，〕因房劳伤肾者，加枸杞、苁蓉；〔取其滑润。〕因思劳心者，加
柏仁 丹参；因劳倦伤脾者，加人参。
此方通治五淋，须随症活法加减用之。按方书有冷淋一
症，言是肾虚丹田有寒所致。余考《内经》云∶胞移热于膀胱，则癃溺血。又《金匮》云∶热在下焦则
尿血，亦令淋，秘不通。丹溪言淋虽有五，皆主于热，此其常耳。
海藏泻肾丸〔见火。〕治或因惧泄强忍，或因思欲不遂，致败精流溢阏塞窍道，涩痛异常
者。〔外用吮法，或令御女一番，使败精尽行送出。〕宜加牛膝、车前，火盛加知柏。
此方下所列之症，即所谓精淋也，故宜滋阴通利为主。
淋症之脉，实大可疗，涩小难医。〔精血败坏之征。〕
1. A patient suffered from忧愤 (worry and indignation) for several weeks, suddenly developing urinary incontinence. Physicians all prescribed formulas to tonify the Kidney and secure the Bladder (Gu Su Pao), but after one month of treatment, the condition worsened. Zhang Shicai stated: "The six pulses are soft upon light palpation but firm upon heavy pressure; this indicates latent heat within the Yin of the Kidney and Liver." Therefore, Coptis Rhizoma (Huanglian) stir-fried with pig gallbladder juice (1 qian) and Moutan Cortex (Mudanpi) (2 qian) were used to clear latent heat in the Lung Meridian; Sophora Flavescens Root (Kushen) salt-stir-fried (8 fen) was used to clear latent heat in the Kidney Meridian; Alisma Rhizome (Fuling) (2 qian) and Glycyrrhiza uralensis Root Tip (Gancao Shao) (6 fen) were combined with powdered chicken intestine for administration. After six doses, the patient recovered. One physician remarked: "Since he has recovered, he should be strongly tonified." Several days later, urinary incontinence recurred. Zhang Shicai said: "The Liver system originally harbors stagnant heat; warm tonification caused the fire to blaze even more fiercely." Thus, Longdan Xiegan Tang (Gentiana Decoction to Drain the Liver) was modified and administered with powdered chicken intestine. The symptoms ceased after four doses. Subsequently, Sijunzi Tang (Four Gentlemen Decoction) was added with Coptis Rhizoma (Huanglian) and Gardenia Fruit (Shanzhi), leading to complete recovery after one month.
2. A female patient suffered from anorexia and urinary incontinence. Zhang Shicai said: "The six pulses are deep and slow. The 'water spring' is not contained, indicating a lack of Fire (Kidney Yang deficiency)." Therefore, the ingredients of Shenqi Wan (Eight-Ingredient Pill) were used, combined with Yigong San (Extraordinary Power Powder), adding Alpinia Oxyphylla Fruit (Yizhi) and Cinnamon Bark (Rougui). After two doses, the condition stabilized within a few days.
Lin Syndrome (Stranguria) refers to the inability to urinate despite the urge, accompanied by severe distending pain in the lower abdomen; or the desire to urinate is absent, yet only drops dribble out continuously. Zhongchun stated: "This belongs to Kidney deficiency complicated with damp-heat. Danxi distinguished five types of Lin." When Qi stagnation obstructs flow, causing stifling pain below the umbilicus, it is called Qi Lin (Qi Stranguria); when hematuria occurs with pain, it is called Xue Lin (Blood Stranguria); when urine resembles paste and causes pain, it is called Gao Lin (Paste Stranguria); when urine contains sand-like particles and causes pain, it is called Sha Lin (Sand Stranguria); this is due to fire scorching the Bladder, causing coagulation of urinary yin, resembling the process of boiling seawater to make salt. When exertion triggers painful, difficult urination, it is called Lao Lin (Exhaustion Stranguria). However, one must differentiate whether the cause lies in Heart exhaustion, Spleen exhaustion, or Kidney exhaustion. In treating the five types of Lin, the general principle is to strengthen Water, nourish Yin, promote dampness drainage, and facilitate urination; however, since deficiency and excess vary, one must carefully examine whether tonification or purgation is appropriate during clinical practice.
Wu Lin Tang (Five Lin Decoction) [Self-made]. This formula serves as the main prescription for Lin syndrome, subject to modification.
Rehmanniae Radix Preparata (Shengdi) [Strengthens Water and nourishes Yin. Frequently used for Blood Lin.] Tian Dong (Asparagus Tuber) and Mai Dong (Ophiopogon Tuber) [Clear Lung Qi, transform fluids reaching the Zhou Du (Bladder), ensuring smooth urination.] Anemarrhenae Rhizoma (Zhimu) [Drains fire from the Bladder and Kidney, and promotes diuresis.] Phellodendri Cortex (Huangbai) [Relieves painful obstruction in the water passages.] Glycyrrhiza uralensis Root Tip (Gancao Shao) [Stops pain in the urethra.] Achyranthes Bidentata Root (Niuxi) [When used alone in large quantities (two xu) decocted for drinking, it effectively treats difficult urination and severe urethral pain, especially suitable for Blood Lin.] Plantaginis Semen (Cheqian) [Opens orifices and unblocks stranguria.] Poria (Fuling) [Promotes dampness drainage and diuresis.]
For Qi Lin, add Aquilariae Lignum Resinatum (Chenxiang) and Curcuma Aromatica Rhizome (Yujin); for Blood Lin, add Imperatae Rhizoma (Maogen) and Lotus Rhizome Juice (Ou Zhi); for Gao Lin, add Dioscoreae Hypoglaucae Rhizoma (Chuan Bi Xie) and Dendrobii Caulis (Chuan Shi Hu); for Sha Lin, add Talcum (Huashi) powder mixed for administration. [Slippery herbs remove adherence; this is a key herb for expelling stone Lin.] For cases caused by sexual exhaustion damaging the Kidney, add Lycium Fruit (Gouqi) and Cynomorii Herba (Congrong) [for their slippery and moistening properties]; for cases caused by mental overwork, add Ziziphi Spinosae Semen (Bairen) and Salvia Miltiorrhiza Root (Danshen); for cases caused by fatigue damaging the Spleen, add Ginseng Radix et Rhizoma (Renshen).
This formula generally treats the five types of Lin, but must be modified flexibly according to symptoms. Medical texts mention Cold Lin, attributing it to cold in the Dantian due to Kidney deficiency. I examined the *Neijing*, which states: "If heat transfers from the Bao (uterus/bladder) to the Bladder, there will be difficulty in urination and blood in urine." The *Jingui Yaolue* also states: "Heat in the Lower Jiao causes blood in urine and can also lead to Lin syndrome with obstruction." Danxi stated that although there are five types of Lin, they are primarily due to heat; this is the common pattern.
Haizang Xieshen Wan (Sea Storehouse Kidney-Draining Pill) [See Fire section]. Treats cases where forced retention due to fear, or unfulfilled desires, cause residual essence to overflow and block the orifices, resulting in abnormal涩痛 (astringent pain). [External suction methods or sexual intercourse may be used to expel residual essence.] Add Achyranthes Bidentata Root (Niuxi) and Plantaginis Semen (Cheqian); if fire is excessive, add Anemarrhenae Rhizoma (Zhimu) and Phellodendri Cortex (Huangbai).
The symptoms listed under this formula refer to Jing Lin (Essence Stranguria), so the treatment should primarily focus on nourishing Yin and promoting unblocking.
Regarding the pulse in Lin syndrome, a substantial and large pulse indicates treatability, whereas a choppy and small pulse indicates difficulty in treatment. [This is a sign of deterioration of essence and blood.]