浊属心肾，淋为肝胆。痛则为淋，不痛为浊。遗由精窍，淋在溺窍，异出同力，最宜分别，切勿混治。
浊症原分赤与白，白属气分赤属血。脾胃湿热注膀胱，水液混浊皆属热（本《内经》。主
治清心莲子饮，痰注膀胱二陈合。白由肾虚萆 饮，赤是血虚合四物。淋症血石劳气膏，滴
沥疼痛常呼号。心与小肠相表里，心火犹动相火烧。欲住不住住又至，总将津液常煎熬。八
正四苓合四物，山栀知柏淋应消。）
浊淋二症参看湿热下注
萆 木通 海金沙 赤茯 猪苓 泽泻 川黄柏 山栀 茵陈 鲜竹叶 丹皮
汉防己 子和桂苓饮 刘檀石猪肚丸
阴虚湿热淋浊
滋肾丸 丹溪大补阴丸合水陆二仙膏加牡蛎、金樱膏、六味丸，去萸肉，加车前、牛膝。
心火下陷淋浊（心阳亢而下注，利其火府）
厘清饮加山栀、丹皮、茯苓、猪苓。清利火府用导赤散加赤苓、瞿麦。又方川连、生地、人
参、桔梗、川柏、茯苓、丹参、菖蒲
气闭成淋
紫苑 栝蒌皮 郁金 降香 杏仁 枇杷叶 山栀
食入痞满便淋（照前方去紫菀、山栀，加苡仁）
膀胱蓄热血淋（小便短赤带血）
用导赤散加赤茯苓 西血珀屑（五分）
又方 黄柏 知母 山栀 生地 龙胆草 丹皮 酒大黄 淡竹叶 当归 郁李仁 元红花
精浊阴亏
炙龟版 熟地 天冬 肥知母 淡秋石 川柏 茯苓 猪脊筋
肾虚不摄，淋浊（脉细腰酸，遗沥胃减，宜收纳肝肾）
茯苓 青盐 胡桃 肾气汤加淡苁蓉鹿角 大茴香
败精浊瘀阻窍
用虎杖散加韭白汁 制大黄 麝香（少许）
入络通血 白丑 桃仁 归须 桂枝 小茴 杜牛膝 归尾 山栀 川楝子 韭白
两头尖 川柏 远志 淡苁蓉 柏仁 茯苓 生鹿角 大黄 小茴 加麝香
又方
阿胶 生地 女贞子 料豆皮 琥珀屑
淋浊（奇脉病）
败精内滞因溺强出，积久精血皆枯，当以冲督任带调理，亦如妇人之漏带也。
鹿茸 小茴香 归身 人参 杞子 龟版心 茯苓 柏霜 补骨脂 覆盆子 菟丝子
又方
鹿茸 韭子 胡桃 沙苑子 舶茴香
何书田曰∶便浊只在气虚与湿热。实者宣通水道，虚者调养中州，虚实两兼又宜益脏通
腑。精浊总由肝肾损伤，而有精瘀精滑之分。精瘀当先理离宫腐浊，然后补肾。精滑用固补
敛摄，不应，从真元气调之。张景岳所谓其无形以固有形也。然人必知八脉，治用孙真人九
法，升奇阳，固精络，使督任有权，漏卮自已。尿血一症，虚者居多，若有火亦能作痛，当与
血淋同治。如清之不愈，专究乎虚，则上注心脾，下从肝肾，久则主乎八脉。
陈参曰∶厥阴内患最急，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，必须仿朱南阳法，兼参李 湖意用滑利通阳，辛咸泄急，佐以循经入络之品。古
人云∶九窍不和多属胃病，六腑为治，以通为补。脾宜升则健，胃宜降则和。盖太阴之土得
阳始运，阳明之土得阴则安。脾喜刚燥，胃喜柔润，张仲景急下存津，治中胃也。李东垣大
升阳气，治在脾也。
八正散 治湿热便秘。
车前子 瞿麦 山栀 灯草 细木通 滑石 大黄 扁蓄草 甘草 木香
湿热盛而宣彻其泉源也。陈注。
浊证病位在心肾，淋证病位在肝胆。疼痛的是淋证，不疼痛的是浊证。遗精由精窍流出，淋证病在溺窍（尿道），二者虽症状不同但致病机理相似，必须仔细区分，切勿混淆治疗。
浊证原本分为赤浊和白浊，白浊属于气分病变，赤浊属于血分病变。脾胃湿热下注膀胱，导致水液混浊，这都属于热证（依据《黄帝内经》）。主治方剂为清心莲子饮；若兼有痰湿阻滞膀胱，可用二陈汤合用。白浊因肾虚所致，用萆薢分清饮；赤浊因血虚所致，合用四物汤。淋证分为血淋、石淋、劳淋、气淋四种，患者常因滴沥不尽、疼痛而痛苦呼号。心与小肠相表里，心火亢盛会引动相火。小便欲解不得解，解后又想解，总是煎熬津液。可用八正散、四苓散合四物汤，或山栀、知母、黄柏等药，淋证应能消除。（括号内为原书自注方义）
浊证与淋证需参考“湿热下注”进行辨证：
萆薢、木通、海金沙、赤茯苓、猪苓、泽泻、川黄柏、山栀、茵陈、鲜竹叶、丹皮。
汉防己、子和桂苓饮、刘檀石猪肚丸。
阴虚兼湿热导致的淋浊：
滋肾丸；丹溪大补阴丸合水陆二仙膏，加牡蛎、金樱膏、六味地黄丸，去掉山茱萸，加车前子、牛膝。
心火下陷导致的淋浊（心阳亢盛而下注，需清利火府）：
厘清饮加山栀、丹皮、茯苓、猪苓。清利火府可用导赤散加赤茯苓、瞿麦。另一方案：川黄连、生地、人参、桔梗、川黄柏、茯苓、丹参、石菖蒲。
气机闭塞导致的淋证：
紫菀、栝蒌皮、郁金、降香、杏仁、枇杷叶、山栀。
膀胱蓄积热血导致的血淋（小便短少色赤带血）：
用导赤散加赤茯苓、西血珀屑（五分）。
另一方案：黄柏、知母、山栀、生地、龙胆草、丹皮、酒大黄、淡竹叶、当归、郁李仁、元红花。
精浊属阴液亏损：
炙龟版、熟地、天冬、肥知母、淡秋石、川黄柏、茯苓、猪脊筋。
肾虚不能固摄，导致淋浊（脉细、腰酸、遗尿沥尽、胃口减退，宜收纳肝肾之气）：
茯苓、青盐、胡桃、肾气汤加淡苁蓉、鹿角、大茴香。
败精瘀阻窍道：
用虎杖散加韭白汁、制大黄、麝香（少许）。
入络活血方：白丑、桃仁、归须、桂枝、小茴香、杜牛膝、归尾、山栀、川楝子、韭白、两头尖、川黄柏、远志、淡苁蓉、柏子仁、茯苓、生鹿角、大黄、小茴香，加麝香。
另一方案：阿胶、生地、女贞子、料豆皮、琥珀屑。
淋浊（奇经八脉病变）：
败精内滞，因强行排尿而出，日久精血皆枯，当以冲脉、督脉、任脉、带脉调理，也如同妇女的漏下和带下病。
鹿茸、小茴香、归身、人参、杞子、龟版心、茯苓、柏霜、补骨脂、覆盆子、菟丝子。
另一方案：鹿茸、韭子、胡桃、沙苑子、舶茴香。
何书田说：便浊只关乎气虚与湿热。实证宣通水道，虚证调养中焦，虚实夹杂则宜益脏通腑。精浊总由肝肾损伤，分为精瘀和精滑两种。精瘀应当先清理离宫（心/小肠）的腐浊，然后补肾。精滑用固补收敛之法，若无效，从真元气调理。这就是张景岳所说的“无形之邪化为有形之质”。然而医者必须懂得奇经八脉，治疗采用孙思邈的九法，升举奇阳，固护精络，使督任二脉有权衡，漏卮（指精气泄漏）自然停止。尿血一症，虚证居多，若有火也能作痛，应与血淋同治。如果清热不愈，专究其虚，则上注于心脾，下从肝肾，久病则主责于奇经八脉。
陈参说：厥阴肝经内患最为急迫，少腹绕前阴如针刺，小便点滴难通，环绕阴部的脉络全部痹阻，气化机关已停息，必须仿效朱南阳的方法，兼参李东垣之意，用滑利通阳、辛咸泄急的药物，佐以循经入络之品。古人说：九窍不和多属胃病，治疗六腑，以通为补。脾宜升则健运，胃宜降则调和。太阴脾土得阳气始能运化，阳明胃土得阴气则安宁。脾喜刚燥，胃喜柔润。张仲景急下存津，是治疗胃的方法。李东垣大升阳气，是治疗脾的方法。
Zhuo syndrome (Cloudy Urine) involves the Heart and Kidney, while Lin syndrome (Stranguria) involves the Liver and Gallbladder. Pain indicates Lin syndrome; absence of pain indicates Zhuo syndrome. Sperm leakage occurs via the spermatic orifice (Jing Qiao), whereas Lin syndrome affects the urinary orifice (Niao Qiao). Although they originate from different pathways, their pathogenic forces are similar and must be distinguished carefully; do not treat them indiscriminately.
Zhuo syndrome is originally divided into Red Zhuo and White Zhuo. White Zhuo belongs to the Qi level, and Red Zhuo belongs to the Blood level. Damp-heat in the Spleen and Stomach pouring downward into the Bladder causes turbid fluids, all of which belong to Heat (based on *Huangdi Neijing*). The primary treatment is Qingxin Lianzi Yin (Clear the Heart with Lotus Seed Decoction); if phlegm obstructs the Bladder, combine Erchen Tang (Two-Cured Decoction). White Zhuo due to Kidney deficiency uses Bibi Fenqing Yin (Bibee Decoction for Separating the Clear); Red Zhuo due to Blood deficiency combines Siwu Tang (Four Substances Decoction). Lin syndrome includes Xue Lin (Blood Stranguria), Shi Lin (Stone Stranguria), Lao Lin (Labor Stranguria), and Qi Lin (Qi Stranguria); patients often cry out in pain from dribbling and discomfort. The Heart and Small Intestine are exterior-interior related; Heart Fire can stir up Ministerial Fire. Urination is interrupted and recurrent, constantly consuming Body Fluids. Bazen San (Eight-Right Powder), Siling San (Four-Ingredient Powder for Eliminating Water), combined with Siwu Tang, or Zhi Mu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) with Zhizi (Gardeniae Fructus) should resolve Lin syndrome.
For Zhuo and Lin syndromes, refer to "Damp-Heat Pouring Downward":
Bibi (Dioscoreae Hypoglaucae Rhizoma), Mutong (Akebiae Caulis), Haijinsha (Lygodii Spora), Chi Fuling (Poria with Red Hostwood), Zhuling (Polyporus), Zexie (Alismatis Rhizoma), Chuan Huangbai (Phellodendri Chinensis Cortex), Zhizi (Gardeniae Fructus), Yichen (Coix Seed), Xian Zhuye (Fresh Bamboo Leaf), Danpi (Moutan Cortex).
Han Fangji (Stephaniae Tetrandrae Radix), Hezi Gu Ling Yin (Hezi's Cinnamon and Polyporus Decoction), Liu Tan Shi Zhu Du Wan (Liu Tan Stone Pig Stomach Pill).
Yin Deficiency with Damp-Heat causing Lin/Zhuo:
Zishen Wan (Kidney-Nourishing Pill); Danxi Dabu Yin Wan (Danxi's Great Tonification Yin Pill) combined with Shuilu Erxian Gao (Water and Land Two Immortals Paste), plus Muli (Ostreae Concha), Jinying Gao (Chrysanthemi Fructus Paste), and Liujun Wan (Six-Ingredient Pill), removing Yurou (Corni Fructus), adding Cheqian (Plantaginis Semen) and Niuxi (Achyranthis Bidentatae Radix).
Heart Fire sinking causing Lin/Zhuo (Heart Yang hyperactive pouring downward, clear the Fire Mansion):
Li Qing Yin (Clarifying Decoction) plus Zhizi (Gardeniae Fructus), Danpi (Moutan Cortex), Fuling (Poria), Zhuling (Polyporus). To clear and drain the Fire Mansion, use Daochi San (Guide Out Redness Powder) plus Chi Fuling (Poria with Red Hostwood) and Qumai (Dianthi Herba). Another prescription: Chuanlian (Coptidis Rhizoma), Shengdi (Rehmanniae Radix), Renshen (Ginseng Radix et Rhizoma), Jiegeng (Platycodonis Radix), Chuanbai (Phellodendri Chinensis Cortex), Fuling (Poria), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Changpu (Acori Tatarinowii Rhizoma).
Qi Obstruction causing Lin:
Ziwan (Asari Radix et Rhizoma), Gualou Pi (Trichosanthis Pericarpium), Yujin (Curcumae Radix), Jiangxiang (Daemonorops Draco), Xingren (Armeniacae Semen Amarum), Pipaye (Eriobotryae Folium), Zhizi (Gardeniae Fructus).
Postprandial fullness and dribbling (Refer to previous formula, remove Ziwan and Zhizi, add Yiren [Coicis Semen]):
Bladder Accumulation of Hot Blood causing Xue Lin (Urine short, red, with blood):
Use Daochi San (Guide Out Redness Powder) plus Chi Fuling (Poria with Red Hostwood) and Xi Xu Po Xie (Tiger Blood Amber Dust, 5 fen).
Another formula: Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Zhizi (Gardeniae Fructus), Shengdi (Rehmanniae Radix), Longdancao (Gentianae Radix), Danpi (Moutan Cortex), Jiu Dahuang (Rhei Radix et Rhizoma processed with wine), Dan Zhuye (Bambusae Folium), Danggui (Angelicae Sinensis Radix), Yuliren (Pruni Semen), Yuan Honghua (Carthami Flos).
Essence Turbidity due to Yin Deficiency:
Zhi Guiban (Testudinis Carapax et Plastron processed), Shudi (Rehmanniae Radix Preparata), Tiandong (Asparagi Radix), Fei Zhimu (Anemarrhenae Rhizoma), Dan Qiushi (Halitum), Chuanbai (Phellodendri Chinensis Cortex), Fuling (Poria), Zhu Jijin (Porcine Spinal Cord).
Kidney Deficiency failing to secure, causing Lin/Zhuo (Fine pulse, sore waist, post-void dribbling, reduced appetite, appropriate to gather and secure Liver and Kidney):
Fuling (Poria), Qingyan (Halitum), Hetao (Juglandis Semen), Shenqi Tang (Kidney-Qi Decoction) plus Rongrong (Cynomorii Fructus), Lujiao (Cervi Cornus Degelatinatum), Da Huixiang (Foeniculi Fructus).
Stagnant Essence and Turbidity blocking the orifices:
Use Huzhang San (Polygoni Divaricati Powder) plus Jiubaiju (Allium Tuberosum Juice), Zhi Dahuang (Rhei Radix et Rhizoma processed), Shexiang (Moschus, a small amount).
Meridian-penetrating Blood-invigorating formula: Baiqiu (Strychni Semen), Taoren (Persicae Semen), Guixu (Angelicae Sinensis Radix tip), Guizhi (Cinnamomi Ramulus), Xiaohui (Foeniculi Fructus), Du Niuxi (Cyathulae Radix), Guiwei (Angelicae Sinensis Radix tail), Zhizi (Gardeniae Fructus), Chuanlianzi (Meliae Fructus), Jiubai (Allium Tuberosum), Liangtoujian (Euodiae Fructus), Chuanbai (Phellodendri Chinensis Cortex), Yuanzhi (Polygalae Radix), Rongrong (Cynomorii Fructus), Bairén (Ziziphi Spinosae Semen), Fuling (Poria), Sheng Lujiao (Cervi Cornus Degelatinatum raw), Dahuang (Rhei Radix et Rhizoma), Xiaohui (Foeniculi Fructus), plus Shexiang (Moschus).
Another formula: Ejiao (Colla Corii Asini), Shengdi (Rehmanniae Radix), Nvzhenzi (Ligustri Lucidi Fructus), Liaodoupi (Sojae Semen Nigrum Pericarpium), Hupo Xie (Ambarum Pulvis).
Lin/Zhuo (Extraordinary Vessel Disease):
Stagnant essence inside, forced out during urination, leading to exhaustion of essence and blood over time. Regulate Chong, Du, Ren, and Dai vessels, similar to treating leukorrhea and metrorrhagia in women.
Lurong (Cervi Cornu Cornu), Xiaohui (Foeniculi Fructus), Guishen (Angelicae Sinensis Radix tip), Renshen (Ginseng Radix et Rhizoma), Qizi (Lycii Fructus), Guiban Xin (Testudinis Carapax et Plastron heart part), Fuling (Poria), Baishuang (Juniperi Fructus powder), Buguzhi (Psoraleae Fructus), Fupenzi (Rubiae Fructus), Tusizi (Cuscutae Semen).
Another formula: Lurong (Cervi Cornu Cornu), Jiuizi (Allii Tuberosi Semen), Hetao (Juglandis Semen), Shayuanzi (Astragali Complanati Semen), Bo Huixiang (Foeniculi Fructus imported).
He Shutian said: Cloudy urine relates only to Qi Deficiency and Damp-Heat. Excess patterns require unblocking the water passages; deficiency patterns require nourishing the Middle Jiao. Mixed excess-deficiency requires tonifying viscera and draining bowels. Essence turbidity stems from Liver-Kidney damage, divided into Essence Stasis and Essence Slippage. For Essence Stasis, first clear the corruption in the Li Gong (Heart/Small Intestine), then tonify the Kidney. For Essence Slippage, use astringent tonification; if ineffective, regulate the True Original Qi. This is what Zhang Jingyue meant by "formless becoming formed." However, physicians must understand the Eight Extraordinary Vessels and apply Sun Simiao's Nine Methods to raise Odd Yang, secure the Essence Collaterals, empower the Du and Ren vessels, and stop the leak. Hematuria is mostly deficiency; if heat causes pain, treat it as Xue Lin. If clearing heat fails, investigate deficiency: upper involvement in Heart-Spleen, lower in Liver-Kidney, chronic cases involve the Eight Extraordinary Vessels.
Chen Can said: Jueyin internal pathology is most urgent. Lower abdomen and anterior yin feel like stabbing; urine passes drop by drop with difficulty; meridians around the yin are blocked; Qi transformation mechanisms have ceased. One must imitate Zhu Nanyang's method, referencing Li Dongyuan's intent, using slippery and unblocking Yang-promoting agents, pungent-salty drugs to relieve urgency, assisted by meridian-penetrating herbs. Ancients said: Disharmony of the nine orifices mostly belongs to Stomach disease. Treating the Six Fu organs, unblocking is tonification. Spleen thrives on ascending; Stomach harmonizes on descending. Taiyin Earth moves with Yang; Yangming Earth rests with Yin. Spleen likes dryness; Stomach likes moistness. Zhang Zhongjing's rapid purgation to preserve fluids treats the Stomach. Li Dongyuan's great raising of Yang Qi treats the Spleen.
Bazen San (Eight-Right Powder): Treats Damp-Heat constipation.
Cheqianzi (Plantaginis Semen), Qumai (Dianthi Herba), Zhizi (Gardeniae Fructus), Dengcao (Junci Medulla), Mutong (Akebiae Caulis), Huashi (Talcum), Dahuang (Rhei Radix et Rhizoma), Bianxu (Polygoni Avicularis Herba), Gancao (Glycyrrhizae Radix et Rhizoma), Muxiang (Aucklandiae Radix).
When Damp-Heat is abundant, vent its source (Chen's annotation).