伤。心肾不交。上下交损而成者。用归脾汤。妙香散。参术膏。补心丹等方。心脾肾兼治之法。
如阴虚不摄。湿热下注而遗滑者。用黄柏萆 。黄连苓泽等。苦泄厥阴郁热。兼通腑气为
主。如下虚上实。火风震动。脾肾液枯。而为遗滑者。用二至百补丸。及通摄下焦之法。如龙
相交炽。阴精走泄而成者。用三才封髓丹。滋肾丸。大补阴丸。峻补真阴。承制相火。以泻阴
中伏热为主。又有房劳过度。精竭阳虚。寐则阳陷而精道不禁。随触随泄。不梦而遗者。当
用固精丸。升固八脉之气。又有膏粱酒肉。饮醇浓味之人。久之脾胃酿成湿热。留伏阴中。
而为梦泄者。当用刘松石猪肚丸。清脾胃蕴蓄之湿热。立法虽为大备。然临症之生心化
裁。存乎其人耳。（邹滋九）
徐评 遗精之法。固不外乎填精镇心。本无神妙方法。俗医往往用温热及粘腻等物。必至伤
人。此老全不犯此。但此症总有伏邪为患。如火如痰。如湿如风。不能搜剔余邪。兼以调和脏气。
委曲施治。方无变病。一味安神填肾。犹多未尽之理也。
某（三二）湿热下注淋浊。当分利。（湿热）
萆 淡竹叶 瞿麦 赤苓 细木通 蓄
某（二八）湿热下注。溺痛淋浊。先用分利法。
萆 淡竹叶 木通 赤苓 茵陈 海金沙
魏 脉数垂。淋浊愈后再发。肛胀便不爽。余滴更盛。
萆 猪苓 泽泻 白通草 海金沙 晚蚕砂 丹皮 黄柏
又 滞浊下行痛缓。议养阴通腑。
阿胶 生地 猪苓 泽泻 山栀 丹皮
毛（三四）壮盛体丰。当夏令湿热蒸迫。水谷气坠而有淋浊。服寒凉。腹胀。得固涩无效。皆非腑病治
法。子和桂苓饮。
又 前用甘露饮。淋浊已止。而头晕左肢麻木。胃脘腹中饥则欲痛。咽喉中似有物粘着。咳咯
咽饮不解。诊脉左劲右濡。据症是水弱木失滋涵。肝阳化风。过膈绕咽达巅。木乘胃土。阳
明脉衰。不司束筋骨以利机关。脘腹中痛。得食则缓者。胃虚求助也。今壮年有此。已属痱中
根萌。养肝肾之液。以熄虚风。补胃土以充络脉。务在守常。勿图速效。可望全好。
制首乌 苁蓉 天冬 杞子 柏子霜 茯神 菊花炭 青盐
红枣肉丸服四钱 晚服猪肚丸方。
某 膏淋浊腻。湿热居多。然亦有劳伤肾伤。下虚不摄者。今以酒客。腹中气坠。便积。苦辛寒分消治。
黄柏 茯苓 萆 海金沙 川楝子 青皮 防己 蚕砂
汪 脉左坚入尺。湿热下坠。淋浊痛。（阴虚湿热）滋肾丸。
周（二二）便浊茎痛。 滋肾丸（三钱）
吴（二四）久疮不愈。已有湿热。知识太早。阴未生成早泄。致阳光易升易降。牙宣龈血。为浊为遗。欲
固其阴。先和其阳。仿丹溪大补阴丸。合水陆二仙丹。加牡蛎金樱膏丸。
黄 舌白气短。胸中痛。目暗。微淋。乃阴虚于下。气阻于上。暂停参剂。早上服都气丸三钱。晚服威喜丸二钱。
叶（三八）脉数形瘦。素有失血。自觉气从左升。痰嗽随之。此皆积劳。阳气鼓动。阴弱少制。六味壮水
和阳极是。近日便浊。虽宜清热。亦必顾其阴体为要。
生地 丹皮 甘草梢 泽泻 山栀 黑豆皮
某 阴虚。湿热在腑为浊。六味去萸加车前牛膝黄柏萆 。
某 遗由精窍。淋在溺窍。异出同门。最宜分别。久遗不摄。是精关不摄为虚。但点滴茎中痛痒。
久腹坚满。此属淋闭。乃隧道不通。未可便认为虚。况夏令足趾湿腐。其下焦先蕴湿热。热阻
气不流行。将膀胱撑满。故令胀坚。议理足太阳经。五苓散。
某（四五）淋浊。溺短涩痛。先通阳气。（下焦阳不流行）
萆 （三钱） 乌药（一钱） 益智（五分） 赤苓（三钱） 远志（四分） 琥珀末（五分）
萧（四一）脉沉淋浊。（心火下陷）厘清饮加山栀丹皮茯苓猪苓。
某（二三）淋浊。小便不利。当清利火腑。 导赤散生地用细者加赤苓瞿麦。
黄 心热。下遗于小肠。则为淋浊。用药以苦先入心。而小肠火腑。非苦不通也。既已得效。宗前议定法。
人参 黄柏 川连 生地 茯苓 茯神 丹参 桔梗 石菖蒲
王 淋属肝胆。浊属心肾。心火下陷。阴失上承。故溺浊不禁。
人参 川连 生地 茯神 柏子仁 远志
某（氏）气闭成淋。（气闭）
紫菀 枇杷叶 杏仁 降香末 栝蒌皮 郁金 黑山栀
又 食入痞闷。小便淋痛。照前方去紫菀黑栀加苡仁。
某（三四）小溲短赤。带血。（膀胱热血淋）导赤散加琥珀末五分赤茯苓。
胡（三五）热入膀胱。小溲血淋。茎中犹痛。非止血所宜。议用钱氏导赤散。加知柏以清龙雷。
许（十八）血淋。尿管溺出而痛。脉沉实。形色苍黑。治从腑热。
芦荟 山栀 郁李仁 红花 当归 酒大黄 龙胆草 丹皮
又 血淋未已。用坚阴清热。
小生地 粉丹皮 黄柏 知母 淡竹叶 山栀
祝（五四）中年以后。瘦人阴亏有热。饮酒。湿热下坠。精浊痔血。皆热走入阴。则阴不固摄。前方宗丹
溪补阴丸。取其介属潜阳。苦味坚阴。若用固涩。必致病加。（精浊阴虚）
水制熟地 龟版胶 咸秋石 天冬 茯苓 黄柏 知母 猪脊筋捣丸。
范（二五）精走浊淋。脊骨生热。属阴虚。胃弱勿用腻滞。
龟腹甲心 覆盆子 五味 归身 鹿角胶 秋石 芡实 金樱膏丸。
戈（四五）脉左细劲。腰酸。溺有遗沥。近日减谷难化。此下焦脏阴虚馁。渐及中焦腑阳。收纳肝肾。勿
损胃气。（肾气不摄）
熟地 杞子 柏子仁 当归身 紫衣胡桃 补骨脂 杜仲 茯苓 青盐 蜜丸。
某（六五）六旬有五。下焦空虚。二便不爽。溺管痹痛。姑与肾气汤主治。肾气汤细绢滤清服。
朱（三六）血淋管痛。腑热为多。经月来。每溺或大便。其坠下更甚。想阴精既损。肾气不收故也。
咸苁蓉 柏子仁 杞子 大茴 牛膝 茯苓
某 淋浊经年。阳损腰痛。畏冷。
熟地 杞子 鹿角胶 巴戟 杜仲 柏子仁 湖莲 芡实
叶（二七）淋属肝胆。浊属心肾。据述病。溺出混浊如脓。病甚则多。或因遗泄后。浊痛皆平。或遗后痛
浊转甚。想精关之间。必有有形败精凝阻其窍。故药中清湿热通腑。及固涩补阴。久饵不效。
先议通瘀腐一法。考古方通淋通瘀。用虎杖汤。今世无识此药。每以杜牛膝代之。（败精浊瘀阻窍）
用鲜杜牛膝根。水洗净。捣烂绞汁大半茶杯。调入真麝香一分许。隔汤炖温。空心服。只可
服三四服。淋通即止。倘日后病发再服。
又 淋病主治。而用八正厘清。导赤等方。因热与湿俱属无形。腑气为壅。取淡渗苦寒。湿去热
解。腑通病解。若房劳强忍精血之伤。乃有形败浊阻于隧道。故每溺而痛。徒进清湿热利小
便无用者。以溺与精同门异路耳。故虎杖散小效。以麝香入络通血。杜牛膝亦开通血中败浊也。
韭白汁九制大黄（一两） 生白牵牛子（一两） 归须（五钱） 桂枝木（三钱生） 炒桃仁（二两） 小茴（三
钱） 韭白汁法丸。
李 败精凝隧。通瘀痹宣窍已效。
生桃仁 杜牛膝 人中白 生黄柏 麝香（二分调入）
徐（五四）五旬又四。劳心阳动。阴液日损。壮年已有痔疡。肠中久有湿热。酒性辛温。亦助湿热。热下
注为癃为淋。故初病投八正五苓。疏气之壅也。半年不痊。气病渐入于血络。考古方惟虎杖
散最宜。虎杖散。
张 丹溪谓五淋症。湿热阻窍居多。三年前曾有是病。月前举发。竟有血块窒塞。尿管大痛。不
能溺出。想房劳强忍。败精离位。变成污浊瘀腐。且少腹坚满。大便秘涩。脏气无权。腑气不用。
考濒湖发明篇中。有外甥柳乔之病。与此适符。今仿其义。参入朱南阳法。
两头尖 川楝子 韭白 小茴 桂枝 归尾
冲入杜牛膝根汁。
又 痛胀皆减。滴沥成淋。前投通浊已效。只要凝块全无。便不反复。阴药呆钝。桂附劫液。通阳柔剂为宜。
苁蓉 归尾 柏子仁 炒远志 杞子 茯苓 小茴
马 淋 。属肝胆居多。桂附劫阴。与刚脏不合。诊脉沉涩无力。非五苓八正可投。议用朱南阳
法。仍是厥阴本方耳。
老韭根白（一两） 两头尖（一百粒） 小茴香（五分） 川楝子肉（一钱） 归须（二钱） 穿山甲末（一钱）
徐 由淋痛渐变赤白浊。少年患此。多有欲心暗动。精离本宫。腐败凝阻溺窍而成。乃有形精
血之伤。三年久病。形消肉减。其损伤已非一脏一腑。然补精充髓。必佐宣通为是。自能潜心
安养。尚堪带病延年。
熟地 生麋角 苁蓉 炒远志 赤苓 牛膝
某 每溺尿管窒痛。溺后混浊。败精阻窍。湿热内蒸。古方虎杖散。宣窍通腐甚妙。若去麝香。必
不灵效。较诸汤药。更上一筹矣。
酒煨大黄 炒龙胆草 炒焦黄柏 牵牛子 川楝子 黑山栀 小茴 沉香汁
某 阴精上蒸者寿。阳火下陷者危。血淋久而成形窒痛。烦心。心火直升。老人阴精已惫。五液
化成败浊。阻窍不通。欲溺必痛。得泄痛减。即痛则不通。痛随利缓之谓。故知柏六味。及归脾
逍遥之属。愈治愈剧。其守补升补。滋滞涩药。决不中病。用琥珀痛减。乃通血利窍之意。然非
久进之方。以不伤阴阳之通润立方。
生地 益母草 女贞子 阿胶 琥珀 豆皮
顾（二四）败精宿于精关。宿腐因溺强出。新者又瘀在里。经年累月。精与血并皆枯槁。势必竭绝成
劳不治。医药当以任督冲带调理。亦如女人之崩漏带下。医者但知八正厘清。以湿热治。亦
有地黄汤益阴泻阳。总不能走入奇经。（奇脉病）
鹿茸 龟甲 当归 杞子 茯苓 小茴 鲍鱼
夏（六三）案牍神耗。过动天君。阳燧直升直降。水火不交。阴精变为腐浊。精浊与便浊异路。故宣利
清解无功。数月久延。其病伤已在任督。凡八脉奇经。医每弃置不论。考孙真人九法。专究其
事。欲涵阴精不漏。意在升固八脉之气。录法参末。
鹿茸 人参 生菟丝粉 补骨脂 韭子 舶茴香 覆盆子 茯苓 胡桃肉 柏子霜 蒸饼为丸。
刘（三九）脉缓涩。溺后有血。或间成块。晨倾溺器。必有胶浊粘腻之物。四肢寒凛。纳食如昔。病伤奇脉。
生鹿茸 当归 杞子 柏子仁 沙苑子 小茴
王（五八）悲忧惊恐。内伤情志。沐浴熏蒸。外泄阳气。络中不宁。血从漏出。盖冲脉动。而诸脉皆动。任
脉遂失担任之司。下元真气。何以固纳。述小便欲出。有酸楚如淋之状。诊脉微小涩。最宜理阳通补。用青囊斑龙丸。
淋有五淋之名。浊有精浊便浊之别。数者当察气分与血分。精道及水道。确从何来。大凡
秘结宜通。滑脱当补。若因心阳亢而下注者。利其火腑。湿热甚而不宣者。彻其泉源。气陷
用升阳之法。血瘀进化结之方。此数端。人所易晓也。独不知厥阴内患。其症最急。少腹绕
前阴如刺。小水点滴难通。环阴之脉络皆痹。气化机关已息。先生引朱南阳方法。兼参李
濒湖意。用滑利通阳。辛咸泄急。佐以循经入络之品。岂非发前人之未发耶。若夫便浊之
恙。只在气虚与湿热推求。实者宣通水道。虚者调养中州。若虚实两兼。又有益脏通腑之
法。精浊者。盖因损伤肝肾而致。有精瘀精滑之分。精瘀当先理其离宫腐浊。继与补肾之
治。精滑者用固补敛摄。倘如不应。当从真 调之。景岳谓理其无形。以固有形也。然此症。
但知治肝治肾。而不知有治八脉之妙。先生引孙真人九法。升奇阳。固精络。使督任有
权。漏卮自已。可见平日若不多读古书。而临症焉知此理。若不经先生讲明。予今日亦不
知此方妙处。又尿血一症。虚者居多。若有火亦能作痛。当与血淋同治。倘清之不愈。则专
究乎虚。上则主于心脾。下则从乎肝肾。久则亦主于八脉。大约与前症相同。要在认定阴阳耳。（邵新甫）
徐评 治淋之法。有通有塞。要当分别。有瘀血积塞住溺管者。宜先通。无瘀积而虚滑者。宜峻
补。不但煎丸各别。并外治之法亦复多端。宜博识而详考之。案中并未见及也。
【遗精部分】
因劳伤导致心肾不交，上下俱损而形成的遗精，采用归脾汤、妙香散、参术膏、补心丹等方剂。这是心、脾、肾三脏兼治的方法。
如果是阴虚不能固摄，或者湿热下注导致的遗精滑泄，使用黄柏、萆薢、黄连、茯苓、泽泻等药物。以苦寒之品清泄厥阴肝经的郁热，同时疏通腑气为主。
如果是下元虚损而上焦实热，火风内动，脾肾阴液枯竭导致的遗精滑泄，使用二至丸、百补丸，以及通摄下焦的方法。
如果是心肾相交之火过盛，导致阴精走泄而成的遗精，使用三才封髓丹、滋肾丸、大补阴丸。峻补真阴，制约相火，以清泻阴分中的伏热为主。
又有因房事过度，精竭阳虚，睡眠时阳气下陷而精关不固，稍微触动就泄精，无梦而遗的情况。应当使用固精丸，提升固护奇经八脉之气。
又有喜好肥甘厚味、饮酒浓烈的人，日久脾胃酿成湿热，留伏于阴分，导致有梦而遗精。应当使用刘松石猪肚丸，清利脾胃中蕴积的湿热。
立法虽然已经非常完备，但在临证时的灵活变通，全凭医生的悟性与判断。（邹滋九评）
徐灵胎评：治疗遗精的方法，不外乎填补精气、镇心安神，本没有什么神奇的方法。世俗医生往往使用温热及粘腻的药物，必定会伤害人体。这位老医（叶天士）完全避免犯这种错误。但这种病症总有伏邪为患，如火、如痰、如湿、如风，如果不能搜剔清除余邪，兼以调和脏腑之气，委曲求全地施治，病情就会发生变化。一味安神填肾，还有很多未尽的道理。
【淋浊部分】
某人（32岁），湿热下注导致的淋浊。应当采用分利法。
处方：萆薢、淡竹叶、瞿麦、赤茯苓、细木通、蓄草。
某人（28岁），湿热下注，小便疼痛、淋浊。先用分利法。
处方：萆薢、淡竹叶、木通、赤茯苓、茵陈、海金沙。
魏姓患者，脉数且重按无力，淋浊痊愈后复发，肛门胀满，大便不爽，尿后余滴更多。
处方：萆薢、猪苓、泽泻、白通草、海金沙、晚蚕砂、牡丹皮、黄柏。
又诊：滞浊下行，疼痛缓解。议定养阴通腑之法。
处方：阿胶、生地、猪苓、泽泻、山栀、牡丹皮。
毛某（34岁），体格壮盛丰腴。正值夏令，湿热蒸迫，水谷之气下坠导致淋浊。服用寒凉药后腹胀，使用固涩药无效。这些都不是针对腑病的治疗方法。使用子和桂苓饮。
又诊：之前使用甘露饮，淋浊已止，但出现头晕、左肢麻木，胃脘腹部饥饿时欲痛，咽喉中有异物粘着感，咳嗽咯痰饮水不解。诊脉左脉劲急，右脉濡软。根据症状，这是水弱导致肝木失去滋润涵养，肝阳化风，风邪过膈绕咽直达头顶。肝木乘克胃土，阳明脉衰，不能束筋骨以利关节，所以脘腹疼痛，进食后缓解，这是胃虚求助的表现。现在壮年出现这种情况，已经是痱中风（类似中风先兆或轻症）的根萌。需滋养肝肾之液以熄虚风，补益胃土以充盈络脉。务必遵守常规疗法，不要图求速效，可望痊愈。
处方：制首乌、肉苁蓉、天冬、枸杞子、柏子霜、茯神、菊花炭、青盐。红枣肉为丸，每次服四钱。晚上服用猪肚丸方。
某人，膏淋浊腻，多为湿热所致。但也有因劳伤肾气，下虚不能固摄的情况。现在是酒客，腹中气坠，大便积滞。用苦辛寒法分消治疗。
处方：黄柏、茯苓、萆薢、海金沙、川楝子、青皮、防己、蚕砂。
汪姓患者，脉左坚入尺部，湿热下坠，淋浊疼痛。（属阴虚湿热）使用滋肾丸。
吴某（24岁），久疮不愈，已有湿热。知识太早（指过早性生活），阴精未生成即早泄，导致阳光（相火）易升易降，牙龈出血，形成浊证和遗精。想要固摄阴精，先要调和阳气。仿照丹溪的大补阴丸，合用水陆二仙丹，加牡蛎、金樱膏制成丸剂。
黄某，舌苔白，气短，胸中痛，目暗，微淋。这是阴虚于下，气阻于上。暂停使用人参等补气药剂。早上服都气丸三钱，晚上服威喜丸二钱。
叶某（38岁），脉数形体消瘦，素有失血史。自觉气从左上升，随之痰嗽。这都是积劳所致，阳气鼓动，阴弱少制。六味地黄丸壮水和极是合适的。近日便浊，虽然宜清热，但也必须顾护其阴体为要。
处方：生地、牡丹皮、甘草梢、泽泻、山栀、黑豆皮。
某人，阴虚。湿热在腑导致浊证。使用六味地黄丸去掉山茱萸，加车前子、牛膝、黄柏、萆薢。
某人，遗精由精窍出，淋证由溺窍出，异出同门，最宜分别。久遗不摄，是精关不固属于虚证。但如果点滴尿道中痛痒，久则腹部坚满，这属于淋闭，是隧道不通，不可便认为是虚证。况且夏令足趾湿腐，说明下焦先蕴湿热，热阻气机不流行，将膀胱撑满，所以令其胀坚。议理足太阳经，使用五苓散。
某人（45岁），淋浊，小便短涩痛。先通阳气。（属下焦阳不流行）
处方：萆薢（三钱）、乌药（一钱）、益智仁（五分）、赤茯苓（三钱）、远志（四分）、琥珀末（五分）。
萧某（41岁），脉沉淋浊。（属心火下陷）使用厘清饮加山栀、牡丹皮、茯苓、猪苓。
某人（23岁），淋浊，小便不利。当清利火腑。使用导赤散，生地用细者，加赤茯苓、瞿麦。
黄某，心热，下遗于小肠，则为淋浊。用药以苦味先入心，而小肠火腑，非苦味不能通也。既然已经得效，遵循前议定法。
处方：人参、黄柏、川连、生地、茯苓、茯神、丹参、桔梗、石菖蒲。
王某，淋属肝胆，浊属心肾。心火下陷，阴失上承，所以溺浊不禁。
处方：人参、川连、生地、茯神、柏子仁、远志。
某人（氏），气闭成淋。（属气闭）
处方：紫菀、枇杷叶、杏仁、降香末、栝蒌皮、郁金、黑山栀。
某人（34岁），小溲短赤，带血。（属膀胱热血淋）使用导赤散加琥珀末五分、赤茯苓。
胡某（35岁），热入膀胱，小溲血淋，茎中犹痛。不适合单纯止血。议用钱氏导赤散，加知母、黄柏以清龙雷之火。
许某（18岁），血淋，尿管溺出而痛，脉沉实，形色苍黑。治从腑热。
处方：芦荟、山栀、郁李仁、红花、当归、酒大黄、龙胆草、牡丹皮。
又诊：血淋未止，用坚阴清热法。
处方：小生地、粉牡丹皮、黄柏、知母、淡竹叶、山栀。
祝某（54岁），中年以后，瘦人阴亏有热，饮酒，湿热下坠，精浊痔血，都是热走入阴分，则阴不固摄。前方宗丹溪补阴丸，取其介类潜阳，苦味坚阴。若用固涩，必致病加重。（属精浊阴虚）
处方：水制熟地、龟版胶、咸秋石、天冬、茯苓、黄柏、知母、猪脊筋捣丸。
范某（25岁），精走浊淋，脊骨生热，属阴虚。胃弱勿用腻滞之品。
处方：龟腹甲心、覆盆子、五味子、归身、鹿角胶、秋石、芡实、金樱膏丸。
戈某（45岁），脉左细劲，腰酸，溺有遗沥。近日减食难化。此下焦脏阴虚馁，渐及中焦腑阳。收纳肝肾，勿损胃气。（属肾气不摄）
处方：熟地、枸杞子、柏子仁、当归身、紫衣胡桃、补骨脂、杜仲、茯苓、青盐、蜜丸。
某人（65岁），六旬有五，下焦空虚，二便不爽，溺管痹痛。姑与肾气汤主治。肾气汤用细绢滤清后服用。
朱某（36岁），血淋管痛，腑热为多。经月来，每溺或大便时，其坠下更甚。想是阴精既损，肾气不收故也。
处方：咸苁蓉、柏子仁、枸杞子、大茴香、牛膝、茯苓。
某人，淋浊经年，阳损腰痛，畏冷。
处方：熟地、枸杞子、鹿角胶、巴戟天、杜仲、柏子仁、湖莲、芡实。
叶某（27岁），淋属肝胆，浊属心肾。据述病，溺出混浊如脓，病甚则多。或因遗泄后，浊痛皆平；或遗后痛浊转甚。想是精关之间，必有有形败精凝阻其窍。所以药中清湿热通腑，及固涩补阴，久饵不效。
先议通瘀腐一法。考古方通淋通瘀，用虎杖汤。今世无识此药，每以杜牛膝代之。（属败精浊瘀阻窍）
用鲜杜牛膝根，水洗净，捣烂绞汁大半茶杯，调入真麝香一分许，隔汤炖温，空心服。只可服三四服，淋通即止。倘日后病发再服。
又诊：淋病主治，而用八正散、厘清饮、导赤散等方，因热与湿俱属无形，腑气为壅，取淡渗苦寒，湿去热解，腑通病解。若房劳强忍精血之伤，乃有形败浊阻于隧道，故每溺而痛。徒进清湿热利小便无用者，以溺与精同门异路耳。故虎杖散小效，以麝香入络通血，杜牛膝亦开通血中败浊也。
处方：韭白汁、九制大黄（一两）、生白牵牛子（一两）、归须（五钱）、桂枝木（三钱生）、炒桃仁（二两）、小茴（三钱）。韭白汁法丸。
李某，败精凝隧，通瘀痹宣窍已效。
处方：生桃仁、杜牛膝、人中白、生黄柏、麝香（二分调入）。
徐某（54岁），五旬又四，劳心阳动，阴液日损。壮年已有痔疡，肠中久有湿热。酒性辛温，亦助湿热。热下注为癃为淋。故初病投八正散、五苓散，疏气之壅也。半年不痊，气病渐入于血络。考古方惟虎杖散最宜。使用虎杖散。
张某，丹溪谓五淋症，湿热阻窍居多。三年前曾有是病，月前举发，竟有血块窒塞，尿管大痛，不能溺出。想是房劳强忍，败精离位，变成污浊瘀腐。且少腹坚满，大便秘涩，脏气无权，腑气不用。考濒湖发明篇中，有外甥柳乔之病，与此适符。今仿其义，参入朱南阳法。
处方：两头尖、川楝子、韭白、小茴、桂枝、归尾。冲入杜牛膝根汁。
又诊：痛胀皆减，滴沥成淋。前投通浊已效，只要凝块全无，便不反复。阴药呆钝，桂附劫液，通阳柔剂为宜。
处方：肉苁蓉、归尾、柏子仁、炒远志、枸杞子、茯苓、小茴。
马某，淋证，属肝胆居多。桂附劫阴，与刚脏不合。诊脉沉涩无力，非五苓八正可投。议用朱南阳法。仍是厥阴本方耳。
处方：老韭根白（一两）、两头尖（一百粒）、小茴香（五分）、川楝子肉（一钱）、归须（二钱）、穿山甲末（一钱）。
徐某，由淋痛渐变赤白浊。少年患此，多有欲心暗动，精离本宫，腐败凝阻溺窍而成。乃有形精血之伤，三年久病，形消肉减，其损伤已非一脏一腑。然补精充髓，必佐宣通为是。自能潜心安养，尚堪带病延年。
处方：熟地、生麋角、苁蓉、炒远志、赤苓、牛膝。
某人，每溺尿管窒痛，溺后混浊，败精阻窍，湿热内蒸。古方虎杖散，宣窍通腐甚妙。若去麝香，必不灵效。较诸汤药，更上一筹矣。
处方：酒煨大黄、炒龙胆草、炒焦黄柏、牵牛子、川楝子、黑山栀、小茴、沉香汁。
某人，阴精上蒸者寿，阳火下陷者危。血淋久而成形窒痛，烦心，心火直升。老人阴精已惫，五液化成败浊，阻窍不通。欲溺必痛，得泄痛减。即“痛则不通，痛随利缓”之谓。故知柏六味，及归脾逍遥之属，愈治愈剧。其守补升补，滋滞涩药，决不中病。用琥珀痛减，乃通血利窍之意。然非久进之方，以不伤阴阳之通润立方。
处方：生地、益母草、女贞子、阿胶、琥珀、豆皮。
顾某（24岁），败精宿于精关，宿腐因溺强出，新者又瘀在里。经年累月，精与血并皆枯槁，势必竭绝成劳不治。医药当以任督冲带调理，亦如女人之崩漏带下。医者但知八正厘清，以湿热治，亦有地黄汤益阴泻阳，总不能走入奇经。（属奇脉病）
处方：鹿茸、龟甲、当归、枸杞子、茯苓、小茴、鲍鱼。
夏某（63岁），案牍神耗，过动天君，阳燧直升直降，水火不交，阴精变为腐浊。精浊与便浊异路，故宣利清解无功。数月久延，其病伤已在任督。凡八脉奇经，医每弃置不论。考孙真人九法，专究其事。欲涵阴精不漏，意在升固八脉之气。录法参末。
处方：鹿茸、人参、生菟丝粉、补骨脂、韭子、舶茴香、覆盆子、茯苓、胡桃肉、柏子霜。蒸饼为丸。
刘某（39岁），脉缓涩，溺后有血，或间成块。晨倾溺器，必有胶浊粘腻之物。四肢寒凛，纳食如昔。病伤奇脉。
处方：生鹿茸、当归、枸杞子、柏子仁、沙苑子、小茴。
王某（58岁），悲忧惊恐，内伤情志，沐浴熏蒸，外泄阳气，络中不宁，血从漏出。盖冲脉动，而诸脉皆动，任脉遂失担任之司，下元真气，何以固纳。述小便欲出，有酸楚如淋之状。诊脉微小涩，最宜理阳通补。用青囊斑龙丸。
淋有五淋之名，浊有精浊便浊之别。数者当察气分与血分，精道及水道，确从何来。大凡秘结宜通，滑脱当补。若因心阳亢而下注者，利其火腑；湿热甚而不宣者，彻其泉源；气陷用升阳之法；血瘀进化结之方。此数端，人所易晓也。独不知厥阴内患，其症最急，少腹绕前阴如刺，小水点滴难通，环阴之脉络皆痹，气化机关已息。先生引朱南阳方法，兼参李濒湖意，用滑利通阳，辛咸泄急，佐以循经入络之品，岂非发前人之未发耶？
若夫便浊之恙，只在气虚与湿热推求。实者宣通水道，虚者调养中州。若虚实两兼，又有益脏通腑之法。精浊者，盖因损伤肝肾而致，有精瘀精滑之分。精瘀当先理其离宫腐浊，继与补肾之治；精滑者用固补敛摄。倘如不应，当从真武汤调之。景岳谓理其无形，以固有形也。然此症，但知治肝治肾，而不知有治八脉之妙。先生引孙真人九法，升奇阳，固精络，使督任有权，漏卮自已。可见平日若不多读古书，而临症焉知此理。若不经先生讲明，予今日亦不知此方妙处。
又尿血一症，虚者居多。若有火亦能作痛，当与血淋同治。倘清之不愈，则专究乎虚。上则主于心脾，下则从乎肝肾。久则亦主于八脉。大约与前症相同，要在认定阴阳耳。（邵新甫评）
徐灵胎评：治淋之法，有通有塞，要当分别。有瘀血积塞住溺管者，宜先通；无瘀积而虚滑者，宜峻补。不但煎丸各别，并外治之法亦复多端。宜博识而详考之。案中并未见及也。
[Part 1: Spermatorrhea]
Spermatorrhea caused by injury leading to the failure of communication between the Heart and Kidney, resulting in damage to both upper and lower parts, is treated with formulas such as Guipi Tang (Restore the Spleen Decoction), Miao Xiang San (Wonderful Fragrance Powder), Shen Zhu Gao (Ginseng and Atractylodes Macrocephala Paste), and Buxin Dan (Nourish the Heart Pill). This represents a method of treating the Heart, Spleen, and Kidney simultaneously.
If spermatorrhea and slipping are due to Yin deficiency failing to secure, or damp-heat pouring downward, use Huangbai (Phellodendron Bark), Bibing (Dioscorea Hypoglauca Rhizome), Huanglian (Coptis Rhizome), Fuling (Poria), and Zexie (Alisma Rhizome). The main approach is to use bitter-cold herbs to drain the stagnant heat of the Jueyin Liver channel, while also unblocking the Fu organs.
If spermatorrhea and slipping result from deficiency in the lower origin and excess heat in the upper, with internal movement of fire and wind, and exhaustion of Spleen and Kidney fluids, use Erzhi Wan (Two Solstices Pill) and Baibu Wan (Hundred Tonics Pill), along with methods to unblock and secure the Lower Jiao.
If spermatorrhea results from excessive interaction of Heart and Kidney fire, causing leakage of Yin essence, use Santai Fengsui Dan (Three Talents Sealing the Marrow Pill), Zishen Wan (Nourish the Kidney Pill), and Dabu Yin Wan (Great Tonify Yin Pill). The goal is to vigorously tonify True Yin, control Ministerial Fire, and primarily clear latent heat within the Yin.
In cases where excessive sexual activity leads to essence depletion and Yang deficiency, causing Yang to sink during sleep and the essence pathway to be uninhibited, resulting in emission without dreams upon slight stimulation, use Gujing Wan (Secure Essence Pill) to raise and secure the Qi of the Eight Extraordinary Vessels.
In individuals who consume rich foods, alcohol, and strong flavors, damp-heat may accumulate in the Spleen and Stomach over time, lurking in the Yin aspect, leading to dream-emission. In such cases, use Liu Songshi Zhudu Wan (Liu Songshi's Pig Stomach Pill) to clear the damp-heat accumulated in the Spleen and Stomach.
Although these therapeutic principles are comprehensive, the flexible application in clinical practice depends entirely on the physician's judgment. (Commentary by Zou Zijiu)
Xu Lingtai comments: The treatment of spermatorrhea essentially involves filling essence and calming the Heart. There is no truly miraculous method. Quack doctors often use warming and cloying substances, which inevitably harm the patient. This master physician completely avoids such errors. However, this condition always involves latent pathogens, such as fire, phlegm, dampness, or wind. If one does not search out and eliminate these residual pathogens and harmonize the Zang organ Qi through nuanced treatment, the disease will change. Relying solely on calming the Heart and tonifying the Kidney leaves many aspects unresolved.
[Part 2: Strangury and Turbid Urine]
Patient (32 years old): Strangury and turbid urine due to damp-heat pouring downward. Treatment should focus on separating and draining.
Prescription: Bibing (Dioscorea Hypoglauca Rhizome), Danzhuye (Lophatherum Leaf), Qumai (Dianthus Herb), Chiling (Red Poria), Ximutong (Akebia Stem), Jixuecao (Polygonum Aviculare Herb).
Patient (28 years old): Strangury and turbid urine with painful urination due to damp-heat pouring downward. Initially use the separating and draining method.
Prescription: Bibing (Dioscorea Hypoglauca Rhizome), Danzhuye (Lophatherum Leaf), Mutong (Akebia Stem), Chiling (Red Poria), Ychen (Artemisia Capillaris Herb), Haijinsha (Lygodium Spore).
Patient Wei: Pulse is rapid and weak upon deep pressure. Strangury and turbid urine recurred after remission, accompanied by anal distension and incomplete defecation, with increased post-void dribbling.
Prescription: Bibing (Dioscorea Hypoglauca Rhizome), Zhuling (Polyporus), Zexie (Alisma Rhizome), Bitongcao (Tetrapanax Pith), Haijinsha (Lygodium Spore), Wancansha (Silkworm Frass), Mudanpi (Moutan Cortex), Huangbai (Phellodendron Bark).
Re-evaluation: As turbid matter moves downward, pain alleviates. Propose nourishing Yin and unblocking the Fu organs.
Prescription: Ejiao (Donkey-hide Gelatin), Shengdi (Rehmannia Root), Zhuling (Polyporus), Zexie (Alisma Rhizome), Shanzhi (Gardenia Fruit), Mudanpi (Moutan Cortex).
Patient Mao (34 years old): Robust and corpulent constitution. During summer, steaming damp-heat causes water and grain Qi to sink, leading to strangury and turbid urine. Cold-natured medicines caused abdominal distension; astringents were ineffective. These are not treatments for Fu organ diseases. Use Hezi Guiling Yin (Hezi's Cinnamon and Polyporus Decoction).
Re-evaluation: After using Ganlu Yin (Sweet Dew Decoction), strangury and turbid urine ceased, but dizziness and left limb numbness appeared. Epigastric and abdominal pain occurs when hungry. A sensation of something sticking in the throat persists despite coughing and swallowing. Left pulse is forceful, right pulse is soggy. Symptoms indicate Water deficiency failing to nourish Wood, leading to Liver Yang transforming into Wind. Wind passes through the diaphragm, winds around the throat, and reaches the vertex. Wood overacts on Stomach Earth, causing decline of Yangming pulses, failing to bind sinews and bones to facilitate joints, hence epigastric/abdominal pain relieved by eating (Stomach deficiency seeking help). In a young adult, this is the root of Feizhong (stroke precursor). Nourish Liver and Kidney fluids to extinguish deficient wind; tonify Stomach Earth to fill collaterals. Adhere to standard protocols, do not seek quick results, and full recovery is possible.
Prescription: Zhi Shouwu (Prepared Polygonum Multiflorum Root), Rongrong (Cistanche Stem), Tiandong (Asparagus Tuber), Gouqi (Goji Berry), Baizishuang (Bai Zi Ren Frost), Fushen (Poria with Hostwood), Juhua Tan (Chrysanthemum Charcoal), Qingyan (Green Salt). Form pills with red date flesh, take 4 qian at night. Also take Zhudu Wan (Pig Stomach Pill) at night.
Patient:膏淋 (Gao Lin - milky strangury) with thick turbidity, mostly due to damp-heat. However, it can also be due to labor-induced Kidney injury and lower deficiency failing to secure. As this patient is an alcoholic with sinking Qi in the abdomen and stool accumulation, treat with bitter-pungent-cold separation and elimination.
Prescription: Huangbai (Phellodendron Bark), Fuling (Poria), Bibing (Dioscorea Hypoglauca Rhizome), Haijinsha (Lygodium Spore), Chuanlianzi (Toosendan Fruit), Qingpi (Green Tangerina Peel), Fangji (Stephania Root), Cansha (Silkworm Frass).
Patient Wang: Left pulse is firm extending to the Chi position. Damp-heat sinking downward causes painful strangury and turbid urine. (Yin deficiency with damp-heat). Use Zishen Wan (Nourish the Kidney Pill).
Patient Zhou (22 years old): Turbid urine with penile pain. Use Zishen Wan (Nourish the Kidney Pill) (3 qian).
Patient Wu (24 years old): Chronic ulcer not healing indicates existing damp-heat. Premature sexual knowledge led to early ejaculation before Yin was fully formed, causing Ministerial Fire to rise and fall easily, resulting in bleeding gums, turbid urine, and spermatorrhea. To secure Yin, first harmonize Yang. Follow Danxi's Dabu Yin Wan (Great Tonify Yin Pill) combined with Shuilu Erxian Dan (Water and Land Two Immortals Pill), adding Muli (Oyster Shell) and Jinyingao (Rosa Laevigata Extract) to form pills.
Patient Huang: White tongue coating, shortness of breath, chest pain, dim vision, mild strangury. This is Yin deficiency below and Qi obstruction above. Temporarily stop Ginseng preparations. Take Duqi Wan (Duqi Pill) 3 qian in the morning, Weixi Wan (Weixi Pill) 2 qian in the evening.
Patient Ye (38 years old): Rapid pulse, emaciated body, history of blood loss. Sensation of Qi rising from the left, followed by phlegm cough. All due to chronic fatigue, Yang stirring, Yin weak and lacking restraint. Liujun Zishui Wan (Six Ingredient Water-Strengthening Pill) to strengthen Water and harmonize extreme Yang is appropriate. Recent turbid urine requires clearing heat, but protecting Yin is essential.
Prescription: Shengdi (Rehmannia Root), Mudanpi (Moutan Cortex), Gancao Shao (Licorice Tip), Zexie (Alisma Rhizome), Shanzhi (Gardenia Fruit), Heidoupi (Black Soybean Skin).
Patient: Yin deficiency. Damp-heat in the Fu organs causes turbidity. Use Liujun Wan (Six Ingredient Pill) removing Shanzhuyu (Cornus Fruit), adding Cheqianzi (Plantago Seed), Niuxi (Achyranthes Root), Huangbai (Phellodendron Bark), and Bibing (Dioscorea Hypoglauca Rhizome).
Patient: Emission exits via the Jing Qiao (Essence Orifice), strangury exits via the Niao Qiao (Urine Orifice); they emerge from different paths but share the same gate. Differentiation is crucial. Chronic emission without security indicates Jing Guan (Essence Gate) deficiency (Xu). However, if there is dribbling with penile pain/itching and long-term abdominal hardness, this belongs to Lin Bi (Strangury Obstruction), indicating blocked pathways, not merely deficiency. Moreover, summer damp-rotting toes suggest initial damp-heat in the Lower Jiao. Heat obstructs Qi flow, filling the bladder, causing distension and hardness. Treat the Foot Taiyang channel using Wuling San (Five-Ingredient Powder).
Patient (45 years old): Strangury and turbid urine, short and painful urination. First unblock Yang Qi. (Yang Qi stagnation in Lower Jiao).
Prescription: Bibing (Dioscorea Hypoglauca Rhizome) (3 qian), Wuyao (Lindera Root) (1 qian), Yizhi (Alpinia Oxyphylla Fruit) (0.5 qian), Chiling (Red Poria) (3 qian), Yuanzhi (Polygala Root) (0.4 qian), Hupo Mo (Amber Powder) (0.5 qian).
Patient Xiao (41 years old): Deep pulse with strangury and turbid urine. (Heart Fire sinking downward). Use Liqing Yin (Clearing Decoction) adding Shanzhi (Gardenia Fruit), Mudanpi (Moutan Cortex), Fuling (Poria), and Zhuling (Polyporus).
Patient (23 years old): Strangury and turbid urine, difficult urination. Clear and drain the Fire Fu organs. Use Daochi San (Direct Red Powder), using fine Shengdi (Rehmannia Root), adding Chiling (Red Poria) and Qumai (Dianthus Herb).
Patient Huang: Heart heat transmits downward to the Small Intestine, causing strangury and turbid urine. Medicines should enter the Heart via bitter taste, and the Small Intestine Fire Fu cannot be unblocked without bitterness. Since effective, adhere to previous protocol.
Prescription: Renshen (Ginseng Root), Huangbai (Phellodendron Bark), Chuanlian (Coptis Rhizome), Shengdi (Rehmannia Root), Fuling (Poria), Fushen (Poria with Hostwood), Danshen (Salvia Root), Jiegeng (Platycodon Root), Shichangpu (Acorus Rhizome).
Patient Wang: Strangury relates to Liver/Gallbladder; turbidity relates to Heart/Kidney. Heart Fire sinks downward, Yin fails to ascend, causing uncontrollable turbid urine.
Prescription: Renshen (Ginseng Root), Chuanlian (Coptis Rhizome), Shengdi (Rehmannia Root), Fushen (Poria with Hostwood), Baiziren (Bai Zi Seed), Yuanzhi (Polygala Root).
Patient (Female): Qi closure causing strangury. (Qi Closure).
Prescription: Ziwan (Aster Root), Pipaye (Loquat Leaf), Xingren (Apricot Seed), Jiangxiang Mo (Aquilaria Wood Powder), Gualou Pi (Trichosanthes Peel), Yujin (Curcuma Rhizome), Heishanzhi (Black Gardenia Fruit).
Re-evaluation: Fullness and stifling after eating, painful strangury. From previous formula, remove Ziwan (Aster Root) and Heishanzhi (Black Gardenia Fruit), add Yiyiren (Coix Seed).
Patient (34 years old): Short, red urine with blood. (Bladder Hot Blood Strangury). Use Daochi San (Direct Red Powder) adding Hupo Mo (Amber Powder) 0.5 qian and Chiling (Red Poria).
Patient Hu (35 years old): Heat enters Bladder, causing bloody strangury with penile pain. Hemostatics are not suitable. Use Qian Shi Daochi San (Qian's Direct Red Powder) adding Zhimu (Anemarrhena Rhizome) and Huangbai (Phellodendron Bark) to clear Longlei Fire (Dragon/Leopard Fire).
Patient Xu (18 years old): Bloody strangury, painful urination, deep and solid pulse, dark complexion. Treat from Fu organ heat.
Prescription: Lvhui (Aloe), Shanzhi (Gardenia Fruit), Yuliren (Prunus Seed), Honghua (Safflower), Danggui (Angelica Root), Jiudahuang (Wine-processed Rhubarb), Longdancao (Gentiana Root), Mudanpi (Moutan Cortex).
Re-evaluation: Bloody strangury persists. Use hardening Yin and clearing heat method.
Prescription: Xiaoshengdi (Young Rehmannia Root), Fen Mudanpi (Powdered Moutan Cortex), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Danzhuye (Lophatherum Leaf), Shanzhi (Gardenia Fruit).
Patient Zhu (54 years old): Post-middle age, thin person with Yin deficiency and heat. Alcohol consumption causes damp-heat sinking, leading to turbid essence and hemorrhoids. Heat enters Yin, failing to secure. Previous formula followed Danxi's Buyin Wan (Tonify Yin Pill), using shellfish to anchor Yang and bitter taste to harden Yin. Astringents would worsen the disease. (Turbid Essence Yin Deficiency).
Prescription: Shuidu Shudi (Water-processed Prepared Rehmannia Root), Gui Ban Jiao (Turtle Shell Gelatin), Xian Qiushi (Salt Sea Stone), Tiandong (Asparagus Tuber), Fuling (Poria), Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome). Pill with pig spinal cord.
Patient Fan (25 years old): Essence leakage and turbid strangury, heat in spine, belonging to Yin deficiency. Stomach is weak, avoid cloying/stagnant herbs.
Prescription: Guifujiaxin (Turtle Plastron Center), Fupenzi (Raspberry), Wuwei (Schisandra Berry), Guishen (Angelica Sinensis Root), Lu Jiao Jiao (Deer Antler Gelatin), Qiushi (Sea Stone), Qianshi (Euryale Seed), Jinyingao (Rosa Laevigata Extract) pill.
Patient Ge (45 years old): Left pulse fine and forceful, sore back, dribbling after urination. Recently reduced appetite and poor digestion. Lower Jiao Zang Yin deficiency affecting Middle Jiao Fu Yang. Tonify Liver and Kidney without damaging Stomach Qi. (Kidney Qi failing to secure).
Prescription: Shudi (Prepared Rehmannia Root), Gouqi (Goji Berry), Baiziren (Bai Zi Seed), Dangguishen (Angelica Sinensis Root Head), Ziyi Hutao (Purple-skin Walnut), Buguzhi (Psoralea Fruit), Duzhong (Eucommia Bark), Fuling (Poria), Qingyan (Green Salt). Honey pills.
Patient (65 years old): Over sixty, Lower Jiao empty, difficulty with urination and defecation, numb pain in urethra. Temporarily treat with Shenqi Tang (Kidney Qi Decoction). Filter Shenqi Tang through fine silk before taking.
Patient Zhu (36 years old): Painful bloody strangury, mostly Fu organ heat. For months, prolapse sensation worsens during urination or defecation. Likely due to damaged Yin essence and unrestrained Kidney Qi.
Prescription: Xian Rongrong (Salty Cistanche Stem), Baiziren (Bai Zi Seed), Gouqi (Goji Berry), Da Hui (Star Anise), Niuxi (Achyranthes Root), Fuling (Poria).
Patient: Chronic strangury and turbidity, Yang damage causing back pain and cold aversion.
Prescription: Shudi (Prepared Rehmannia Root), Gouqi (Goji Berry), Lu Jiao Jiao (Deer Antler Gelatin), Bajitian (Morinda Root), Duzhong (Eucommia Bark), Baiziren (Bai Zi Seed), Hulian (Lotus Seed), Qianshi (Euryale Seed).
Patient Ye (27 years old): Strangury relates to Liver/Gallbladder; turbidity relates to Heart/Kidney. Urine is turbid like pus, worsening significantly. Sometimes pain/turbidity resolves after emission; sometimes it worsens. Suspect有形败精 (tangible spoiled essence) blocking the orifice in the Jing Guan (Essence Gate). Therefore, clearing damp-heat/unblocking Fu organs and astringing/tonifying Yin have failed over long use.
First propose unblocking stasis and rotting corruption. Ancient formulas for unblocking strangury/stasis use Huzhang Tang (Polygonum Sieboldii Decoction). Modern physicians do not know this herb and substitute Duniu Xi (Cyathula Root).
Use fresh Duniu Xi root, wash clean, crush and squeeze juice (half teacup), mix with genuine Moshe (Musk) approx. 1 fen, warm in double boiler, take on empty stomach. Only take 3-4 doses; stop once strangury clears. Re-take if relapse occurs.
Re-evaluation: Standard treatments for strangury use Bazheng San (Eight Correctness Powder), Liqing Yin (Clearing Decoction), Daochi San (Direct Red Powder). Since heat and dampness are intangible, causing Fu Qi obstruction, light permeating bitter-cold herbs resolve damp and heat, unblocking Fu organs cures the disease. However, sexual exhaustion causing tangible spoilage blocking tunnels causes pain during urination. Simply clearing damp-heat/diuretics are useless because urine and essence share a gate but different paths. Thus, Huzhang San (Polygonum Sieboldii Powder) has small effect; Musk enters collaterals to move blood, and Duniu Xi opens blood stasis/spoilage.
Prescription: Jiu Bai Zhi (Garlic Juice), Jiuzhi Dahuang (Nine-processed Rhubarb) (1 liang), Sheng Bainiuzi (Raw White Morning Glory Seed) (1 liang), Guixu (Angelica Tail) (5 qian), Guizhi Mu (Cinnamon Twig Wood) (3 qian raw), Chao Taoren (Fried Peach Kernel) (2 liang), Xiao Hui (Small Fennel) (3 qian). Pill with garlic juice.
Patient Li: Spoiled essence blocking tunnels, unblocking stasis/numbing orifices effective.
Prescription: Sheng Taoren (Raw Peach Kernel), Duniu Xi (Cyathula Root), Renzhongbai (Human Tooth Ash), Sheng Huangbai (Raw Phellodendron Bark), Moshe (Musk) (2 fen mixed in).
Patient Xu (54 years old): Over fifty-four, mental labor stirs Yang, daily loss of Yin fluids. Had hemorrhoids in youth, long-standing damp-heat in intestines. Wine is pungent-warm, aiding damp-heat. Heat sinking downward causes retention and strangury. Initial treatment used Bazheng San and Wuling San to vent Qi stagnation. Half year no cure, Qi disease entering blood collaterals. Ancient texts say Huzhang San is most suitable. Use Huzhang San.
Patient Zhang: Danxi stated that Five Stranguries are mostly due to damp-heat blocking orifices. Had this disease 3 years ago, relapsed recently with blood clots obstructing, severe penile pain, inability to urinate. Suspect sexual exhaustion forcing retention, causing spoiled essence to leave its place, becoming turbid stasis/corrosion. Lower abdomen hard/full, constipation, Zang Qi powerless, Fu Qi inactive. Referencing Binhu's "Invention Chapter" regarding nephew Liu Qiao's case, which matches perfectly. Now imitate its meaning, incorporating Zhu Nanyang's method.
Prescription: Liangtoujian (Glechoma Longituba), Chuanlianzi (Toosendan Fruit), Jiu Bai (Garlic White), Xiao Hui (Small Fennel), Guizhi (Cinnamon Twig), Guiwei (Angelica Tail). Mix in Duniu Xi root juice.
Re-evaluation: Pain and distension reduced, dripping strangury. Previous unblocking turbidity was effective; complete removal of clumps prevents recurrence. Yin herbs are dull; Gui/Fu (Cinnamon/Aconite) deplete fluids; unblocking Yang with soft agents is suitable.
Prescription: Rongrong (Cistanche Stem), Guiwei (Angelica Tail), Baiziren (Bai Zi Seed), Chao Yuanzhi (Fried Polygala Root), Gouqi (Goji Berry), Fuling (Poria), Xiao Hui (Small Fennel).
Patient Ma: Strangury mostly relates to Liver/Gallbladder. Gui/Fu (Cinnamon/Aconite) deplete Yin, incompatible with rigid Zang. Pulse deep, choppy, weak; Wuling/Bazheng not applicable. Use Zhu Nanyang's method. Still the Jueyin base formula.
Prescription: Lao Jiugen Bai (Old Garlic Root White) (1 liang), Liangtoujian (Glechoma Longituba) (100 grains), Xiao Huixiang (Small Fennel) (0.5 fen), Chuanlianzi Rou (Toosendan Flesh) (1 qian), Guixu (Angelica Tail) (2 qian), Chanshanjia Mo (Pangolin Scale Powder) (1 qian).
Patient Xu: Strangury pain gradually changed to red-white turbidity. Youthful onset often involves hidden desire, essence leaving original palace, rotting and blocking urine orifice. Tangible injury to essence/blood. Three-year chronic illness, emaciation, damage beyond single Zang/Fu. Tonifying essence/marrow must assist unblocking. With quiet cultivation, life extension is possible.
Prescription: Shudi (Prepared Rehmannia Root), Sheng Mujiao (Fresh Deer Horn), Rongrong (Cistanche Stem), Chao Yuanzhi (Fried Polygala Root), Chiling (Red Poria), Niuxi (Achyranthes Root).
Patient: Urethral obstruction/pain during urination, turbidity after urination, spoiled essence blocking orifice, internal steaming damp-heat. Ancient Huzhang San (Polygonum Sieboldii Powder) is excellent for opening orifices and resolving corruption. Removing Musk renders it ineffective. Superior to decoctions.
Prescription: Jiuwei Dahuang (Wine-baked Rhubarb), Chao Longdancao (Fried Gentiana Root), Chaojiao Huangbai (Charred Phellodendron Bark), Qianniuzi (Morning Glory Seed), Chuanlianzi (Toosendan Fruit), Heishanzhi (Black Gardenia Fruit), Xiao Hui (Small Fennel), Chenxiang Zhi (Aquilaria Juice).
Patient: Upward steaming of Yin essence leads to longevity; sinking of Yang fire leads to danger. Chronic bloody strangury forming clots/obstruction, irritability, direct rising of Heart Fire. Elderly Yin essence exhausted, five fluids turning to corrupt turbidity, blocking orifices. Urination causes pain, relief upon discharge. This is "pain implies blockage, pain eases with free flow." Therefore, Zhibai Liujun (Anemarrhena/Phellodendron Six Ingredient) and Guipi/Xiaoyao (Restore Spleen/Free Wanderer) worsen the condition. Conservative tonification/astringents do not hit the target. Amber reduces pain by moving blood/opening orifices. Not for long-term use; formulate with non-damaging, moistening unblocking agents.
Prescription: Shengdi (Rehmannia Root), Yimucao (Motherwort Herb), Nvzhenzi (Privet Fruit), Ejiao (Donkey-hide Gelatin), Hupo (Amber), Doupi (Bean Skin).
Patient Gu (24 years old): Spoiled essence lodged in Jing Guan (Essence Gate), old corruption forced out by urine, new stasis remains inside. Months/years, essence and blood both withered, inevitably exhausting into consumptive incurable disease. Medicine should regulate Ren, Du, Chong, Dai vessels, similar to female metrorrhagia/leukorrhea. Physicians only know Bazheng/Liqing for damp-heat, or Dihuang Tang for tonifying Yin/draining Yang, failing to reach the Extraordinary Vessels. (Extraordinary Vessel Disease).
Prescription: Lurong (Deer Antler), Guijia (Turtle Shell), Danggui (Angelica Root), Gouqi (Goji Berry), Fuling (Poria), Xiao Hui (Small Fennel), Baoyu (Abalone).
Patient Xia (63 years old): Mental exertion consumes Spirit, overstimulating Tianjun (Heavenly Ruler/Heart). Yang fire rises/falls directly, Water/Fire fail to communicate, Yin essence turns to corrupt turbidity. Jing turbidity and Bian turbidity follow different paths, so promoting/drain-clearing is ineffective. Months prolong, damage in Ren/Du. Physicians often ignore the Eight Extraordinary Vessels. Referencing Sun Simiao's Nine Methods, specifically investigating this. To contain Yin essence without leakage, aim to raise and secure Qi of Eight Vessels. Record method at end.
Prescription: Lurong (Deer Antler), Renshen (Ginseng Root), Sheng Tusifen (Raw Dodder Seed Powder), Buguzhi (Psoralea Fruit), Jiu Zi (Garlic Seed), Bo Huixiang (Imported Fennel), Fupenzi (Raspberry), Fuling (Poria), Hutao Rou (Walnut Meat), Baizishuang (Bai Zi Ren Frost). Pill with steamed dough.
Patient Liu (39 years old): Slow/choppy pulse, blood after urination, occasionally clots. Morning urination vessel shows sticky turbid substance. Cold limbs, normal appetite. Damage to Extraordinary Vessels.
Prescription: Sheng Lurong (Raw Deer Antler), Danggui (Angelica Root), Gouqi (Goji Berry), Baiziren (Bai Zi Seed), Shayuanzi (Astragalus Complanatus Seed), Xiao Hui (Small Fennel).
Patient Wang (58 years old): Sadness/worry/fear injures emotions internally; bathing/steaming leaks Yang externally, disturbing collaterals, blood leaks. Chong vessel moves, all vessels move; Ren vessel loses its governing function, how can Lower Origin True Qi secure? Describes urge to urinate with sour/sore strangury-like sensation. Pulse minute/small/choppy. Best to regulate Yang and tonify unblocking. Use Qingnang Banlong Wan (Qingnang Dragon Pill).
Strangury has names of Five Stranguries; turbidity distinguishes Jing turbidity (Essence) and Bian turbidity (Stool/Urine). One must observe Qi vs. Blood levels, Jing Dao (Essence Path) vs. Shui Dao (Water Path), and determine origin. Generally, constipation requires unblocking; sliding/incontinence requires tonifying. If Heart Yang hyperactivity sinks downward, drain the Fire Fu. If damp-heat is severe and unvented, remove the source. Qi sinking uses raising Yang method; Blood stasis progressing to congealment uses breaking congealment formula. These are common knowledge.
However, few know Jueyin internal disorders are most urgent: lower abdomen piercing pain around anterior yin, scanty difficult urination, meridians around yin blocked, Qi transformation mechanism stopped. Master physician cites Zhu Nanyang's method, referencing Li Binhu, using slippery unblocking Yang, pungent-salty releasing urgency, assisted by meridian-entering collaterals herbs. Did he not uncover what predecessors missed?
Regarding Bian turbidity (Stool/Urine turbidity), seek Qi deficiency or damp-heat. Excess: unblock water path; Deficiency: tonify Middle Jiao. Both: benefit Zang/unblock Fu.
Jing turbidity (Essence turbidity) results from Liver/Kidney damage, divided into Jing Yu (Essence Stasis) and Jing Hua (Essence Slippage). Jing Yu: first manage corrupted turbidity in the "Palace of Departure," then tonify Kidney. Jing Hua: use solidifying/tonifying/astringing. If ineffective, treat with Zhenwu Tang (True Warrior Decoction). Jingyue said: manage the intangible to secure the tangible. However, knowing only Liver/Kidney treatment misses the subtlety of treating Eight Vessels. Master physician cites Sun Simiao's Nine Methods, raising Odd Yang, securing essence collaterals, empowering Du/Ren, stopping leaks naturally. Clearly, without reading ancient books, how could one know this clinically? Without the Master explaining, I too would not know the efficacy of this formula today.
Regarding Hematuria, deficiency is common. If fire causes pain, treat like Bloody Strangury. If clearing fails, investigate deficiency exclusively. Upper: focus on Heart/Spleen; Lower: focus on Liver/Kidney. Chronic: focus on Eight Vessels. Roughly same as previous conditions,关键在于 recognizing Yin/Yang. (Commentary by Shao Xinpu)
Xu Lingtai comments: Treatment of strangury involves both unblocking and stopping, requiring differentiation. If blood stasis blocks the urethra, unblock first. If no stasis but deficient/sliding, tonify vigorously. Decoctions and pills differ; external treatments also vary widely. One should study extensively. These are not seen in the cases.