（附∶关格）
论
《内经》曰∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱。夫膀胱者，主足太阳
寒水之化，其体有下口而无上口者也。长生在申，是故西方肺金以为之母而资其化也。肺金清肃，则水道通调而渗营于
下耳。然肺金又借脾土健旺，以资化原，而清气得以上升，而归于肺以营运也。故经又曰∶清阳出上窍，浊阴出下窍。
故清阳不升，则浊阴不降，而成淋闭之患矣。先哲以滴水之器譬之，上窍闭则下窍不出，此理甚明。故东垣使灸百会
穴，丹溪使吐以提其气之横格，是皆开上窍之法也。原其为病之由，皆膏粱之味，湿热之物，或烧酒炙肉之类，郁遏成
痰，以致脾土受害乏力，不能运化精微，清浊相混，故使肺金无助，而水道不清，渐成淋闭之候。或谓用心太过，房劳
无节，以致心肾不交，水火无制，清阳不升，浊阴不降，而成天地不交之否，皆先哲之法言也。古方有五淋之别，气、
砂、血、膏、劳是也。若夫气淋为病，小便涩滞，常有余沥不尽。砂淋为病，阴茎中有砂石而痛，溺不得卒出，砂出痛
止。膏淋为病，溺浊如膏。劳淋为病，遇房劳即发，痛引气冲。血淋为病，遇热则发，甚则溺血。候其鼻准色黄者，知
其为小便难也。东垣分在气、在血而治之，以渴与不渴而辨之耳。如渴而小便不利者，热在上焦气分，肺金主之，宜用
淡渗之药，茯苓、泽泻、琥珀、灯心、通草、车前子、瞿麦、 蓄之类，以清肺金之气，泻其火以滋水之上源也。不渴
而小便不利者，热在下焦血分，肾与膀胱主之，宜用气味俱阴之药，知母、黄柏之类，滋肾丸是也。除其热，泄其闭塞，
以滋膀胱肾水之下元也。治淋之法，无越于此，学人不可不知。
脉法
《脉经》曰∶少阴脉数，妇人则阴中生疮，男子则为气淋，脉细而数。脉盛大而实者生，虚细而涩者死。
方法
丹溪曰∶淋虽有五，皆属于热，宜解热利小水，山栀子之类。不可发汗，汗之必便血。
老人气虚淋闭，参、术中带木通、栀子之属。
有肾虚极而淋者，当补肾精而利小便，不可独用利水药。
有死血作淋者，用牛膝膏。（一云∶牛膝膏能损胃不食，宜斟酌用之。）
一方 治淋，用益元散加栀子仁、木通。或用栀子一合炒为末，白汤调下。夏月以茴香煎汤调益元散服效。
痰热隔滞中焦，淋涩不通，二陈汤煎大碗顿服，探吐之以提其气。
淋涩有血因火燥，下焦无血，气不得降，而渗泄之令不行也，宜补阴降火，以四物汤加知母、黄柏，或用四物汤煎
下滋肾丸。
阴茎痛，乃厥阴气滞兼热，用甘草梢，盖欲缓其气耳。
小便因热郁成淋不通，用赤茯苓、黄芩、泽泻、车前子、麦门冬、肉桂、滑石、木通、甘草梢。气虚者，加黄 、
木香。淋痛，加黄柏、生地黄。夏月煎调益元散。
（以上丹溪方法凡九条）
参苓琥珀汤 治小便淋涩，茎中痛，相引胁下痛，不可忍者。
人参 茯苓（各五分） 川楝子（去核） 生甘草梢 玄胡索（各七分） 琥珀 柴胡 川归尾 泽泻（各三分）
上细切，作一服，水一盏半，加灯心十数茎，煎至一盏服。
琥珀散（济生） 治五种淋涩疼痛，小便有脓血出证。
琥珀 没药 海金砂 蒲黄（各一两）
上为细末，每服三钱，空心煎萱草汤调下。
伤寒后脱阳，小便不通，用生姜自然汁，调茴香末，敷贴小腹上。又服益智茴香丸，调益元散送下。（丹溪）
老人气虚而小便不通，四物汤加黄 、人参，吞滋肾丸，下焦血气干者死。（丹溪）
小便黄，用黄柏。如涩数，加泽泻。若湿热流注下焦而小便黄赤涩数，用栀子、泽泻切当。湿多者，宜用滑石利之。
下焦无血，小便涩数而黄者，用四物汤加黄柏、知母、牛膝、甘草梢。
通关丸（即滋肾丸，东垣） 治不渴而小便闭，热在下焦血分。
黄柏（酒洗焙干） 知母（酒洗焙干，各一两） 肉桂（五分）
上为细末，熟水丸如梧桐子大，每服一百丸，空心白汤下。服后须顿两足，令药易下行也。如小便已利，茎中如刀
刺痛，当有恶物下为验。
清肺饮子（东垣） 治渴而小便闭涩不利，邪热在上焦气分。
灯心（一分） 通草（二分） 泽泻 瞿麦 琥珀（各五分） 蓄 木通（各七分） 车前子（炒另研） 茯苓
（去皮） 猪苓（去皮，各一钱）
上细切，作一服，水一盏半，煎至一盏，空心稍热服。
导气除燥汤（东垣） 治小便闭塞不通，乃血涩致气不运而窍涩也。
茯苓（去皮） 滑石（各一钱） 知母（去毛，酒浸炒） 泽泻（各一钱五分） 黄柏（二钱，酒炒）
上细切，作一服，水二盏，煎至一盏，空心稍热服。
肾疸汤（东垣） 治肾疸目黄，甚至浑身黄，小便赤。
羌活 防风 本 独活 柴胡（各五分） 升麻（一钱，以上治目黄浑身黄） 白茯苓（二分） 泽泻（三分） 猪
苓（四分） 白术（五分） 苍术（一钱，以上治小便赤涩） 黄柏（二分） 人参（三分） 葛根（五分） 神曲（六
分） 甘草（五分）
上细切，作一服，水二盏，煎至一盏，食前稍热服。
小蓟汤（东垣） 治下焦热结血淋。
生地黄 小蓟根 通草 滑石 栀子仁 蒲黄（炒） 淡竹叶 当归梢 生藕节 甘草梢（各五分）
上细切，作一服，水煎，空心服。
八正散（局方） 治大小便俱闭。
大黄 瞿麦 木通 滑石 蓄 车前子 栀子仁 甘草（各等分）
上细切，每服五钱重，入灯心七茎，水煎服。
牛膝膏 用川牛膝一合细切，以新汲水五大盏煎耗其四，入麝香少许，空心服。或单以酒煮，亦可。
茯苓汤（东垣） 治胃疸，阳明积热，食已辄饥，面色黄瘦，胸满胁胀，小便闭涩。
赤茯苓 陈皮（去白） 泽泻 桑白皮（各三分） 赤芍药 白术 人参 官桂（各二分） 石膏（八分）
病甚者，加大黄、朴硝各一钱。
上细切，作一服，加生姜五片，水一盏半，煎至一盏，温服。
倒换散（河间） 治无问久新癃闭，大小便不通，小腹急痛，肛门肿痛。
大黄（小便不通减半） 荆芥穗（大便不通减半，各等分）
上各别研为细末，每服二钱，温水调下，临时加减服。
葵子散（河间） 治小便不通。
黄蜀葵子（研细） 赤茯苓（各二钱）
上作一服，水一盏，煎二、三沸，食前服。
葵子汤（济生） 治膀胱实热，小便不通。（方见疝气门。）
琥珀散（河间） 治五淋。
滑石（二钱） 木通 当归 木香 郁金 蓄（各一钱） 琥珀（五分，研）
上作一服为末，用芦苇叶同煎，水一盏半，煎数沸，食前温服。
铁服丸（河间） 治大小便不通神效。
大皂角（烧存性）
上一味，不拘多少，细研，炼蜜丸如梧桐子大，每服七十丸，白汤下。
广济鸡苏饮子（外台） 治小便不通。
鸡苏（二握） 生地黄 通草（各四两） 滑石 杏仁（去皮尖，各二两） 冬葵子（一两五钱） 石苇（炙，去
毛，一两）
上七味细切，以水六升，煎至二升半，去渣分三服，空心进一服，如人行四、五里，又进一服，必通。
又方（外台） 治小便不通。
冬葵子 滑石（各三两） 通草 赤茯苓（各一两） 茅根（二两五钱） 芒硝（一两五钱）
上细切，以水六升，煎取二升，去渣纳芒硝，分作三服，连进即通。
集验方（外台） 治小便淋沥不通。
滑石（半斤） 石苇（三两） 通草（四两） 榆荚 冬葵子（各一斤） 一方加黄芩（三两）
上细切，以水一斗，煎取三升，分作三服，顿饮。
石苇散（河间） 治小便不利，茎中作痛。
石苇（去毛，二两） 瞿麦（一两） 滑石（五两） 车前子（三两） 冬葵子（二两）
上为细末，每服方寸匕，日三服。
（祖传方）
治小便淋闭，茎中作痛神效。
石苇（去毛） 滑石 瞿麦 蓄 冬葵子 木通 王不留行 地肤草（各等分）
上为细末，每服三钱，白汤调下。
又方 治小便溺血立效。
金陵草（一名旱莲草，一名墨斗草） 车前子（俗云虾蟆衣）
上二物各等分，杵自然汁，每服半茶盏，空腹服。
又方 治前证。
用壮年无病患头发，不拘多少，烧灰存性，以侧柏叶捣汁，入糯米糊为丸，如梧桐子大，每服一百丸，白汤下，或
四物汤下尤妙。
又方 治沙淋，乃茎中有砂作痛。
石首鱼脑骨（五对，火 ，出火毒。即白鲞脑中骨也） 滑石（五钱）
上共研为细末，分作二服，煎木通汤调下。未愈，再服数剂，必待砂出尽乃安。
又方 治孕妇转胞，小便不通，及男子小便不通，皆效。
冬葵子（五钱） 山栀子（五钱，炒研） 木通（三钱） 滑石（五钱，研）
上作一服，水一盏半，煎八分，温服。外以冬葵子、滑石、栀子为末，田螺肉捣膏，或生葱汁调膏，贴脐中，立通。
又方 治血淋。
侧柏叶 藕节 车前草（各等分）
上三味，同捣取其汁，调益元散，神效。
附∶关格证
《难经》曰∶关则不得小便，格则吐逆。脉两寸俱盛曰关格。其证呕逆而小便不通者是也。按《素问》谓人迎大四
倍于气口名曰格，气口大四倍于人迎名曰关，乃二证也。盖有格而不关者，亦有关而不格者，又或有人迎气口俱盛而吐
逆不便者，故丹溪总而言之曰关格者，是也。
丹溪曰∶寒在上而热在下，故多死，法当吐以提其气之横格，不必在出痰也。用二陈汤探而吐之，吐中便有降。
有气虚不运者，补气药中升降，用补中益气汤加槟榔，使清气升而浊气降也。
治关格证吐逆而小便不利，急宜先灸气海、天枢等穴各三七壮，其吐必止，然后以益元散等药以利小便。
（祖传方）
治关格吐逆，小便不通。
用藿香平胃散合五苓散，加姜枣煎服，立效。
（医案）
予长兄修德翁，年七十，秋间患小便不通，二十余日，百方不效，后得一方，取地肤草捣自然汁服之遂通。虽至微
之物，而有回生起死之功，故录于此，以为济利之一助云。（地肤草，一云白地芎是也。）
【附：关格】
论
《内经》说：饮食进入胃中，游散溢出的精气，向上输送到脾脏，脾气散布精微物质，向上归聚于肺，疏通调节水道，向下输送到膀胱。膀胱，主管足太阳寒水的变化，它的结构是有下口而没有上口。长生在申位（秋季），所以西方肺金作为它的母亲来资助它的化生。肺金清肃下行，则水道通畅调节，将津液渗入营血并流注于下焦。然而肺金又借助脾土的健旺，来资助化生的源头，使清气得以上升，回归于肺以进行营运。所以经书又说：清阳之气出于上窍，浊阴之气出于下窍。因此，如果清阳不升，那么浊阴就不降，从而形成淋证和闭证的病患。先哲用滴水之器来比喻，上面的孔窍闭塞，下面的孔窍就不会出水，这个道理非常明白。所以李东垣让人灸百会穴，朱丹溪让人催吐以提起横梗的气机，这都是开启上窍的方法。推究这种病的成因，都是因为食用膏粱厚味、湿热之物，或者烧酒烤肉之类，郁结遏制而成痰，导致脾土受损乏力，不能运化精微物质，清浊相混，致使肺金失去帮助，而水道不清，逐渐形成淋闭的候象。有人说用心过度，房事没有节制，导致心肾不交，水火失去制约，清阳不升，浊阴不降，形成天地不交的“否”卦状态，这些都是先哲的法言古训。古方有五种淋证的分别，即气淋、砂淋、血淋、膏淋、劳淋。至于气淋发病，小便涩滞，常有剩余尿沥不尽。砂淋发病，阴茎中有砂石且疼痛，尿液不能突然排出，砂石排出后疼痛停止。膏淋发病，尿液浑浊如膏脂。劳淋发病，遇到房劳就发作，疼痛牵引至气冲穴部位。血淋发病，遇到热邪就发作，严重时出现尿血。观察鼻准颜色发黄的人，知道他是小便困难。李东垣根据病在气分还是血分来治疗，通过口渴与不渴来辨别。如果口渴且小便不利，是热在上焦气分，由肺金主治，适宜使用淡渗的药物，如茯苓、泽泻、琥珀、灯心草、通草、车前子、瞿麦、萹蓄之类，以清泄肺金之气，泻火以滋补水之上源。如果不口渴且小便不利，是热在下焦血分，由肾与膀胱主治，适宜使用气味俱属阴的药物，如知母、黄柏之类，滋肾丸就是这类方剂。清除热邪，泄去闭塞，以滋补膀胱和肾水之下元。治疗淋证的方法，没有超出这个范围的，学习的人不可不知道。
脉法
《脉经》说：少阴脉数，妇人则阴中生疮，男子则为气淋，脉象细而数。脉象盛大而实的能生，脉象虚细而涩的难治致死。
方法
朱丹溪说：淋证虽然有五种，都归属于热，应当解热利小便，如山栀子之类。不可以发汗，发汗必然导致便血。
有肾虚至极导致的淋证，应当补肾精并利小便，不可以单独使用利水药。
有死血（瘀血）导致淋证的，使用牛膝膏。（另一种说法：牛膝膏可能损伤胃气导致食欲不振，应斟酌使用。）
一方 治疗淋证，用益元散加栀子仁、木通。或者用一合山栀子炒成末，用开水调服。夏季用小茴香煎汤调服益元散也有效。
痰热阻滞中焦，导致淋涩不通，用二陈汤煎一大碗顿服，探吐以提起气机。
淋涩有血是因为火燥，下焦无血，气不得下降，而渗泄的功能不行，应当补阴降火，用四物汤加知母、黄柏，或者用四物汤煎好后送服滋肾丸。
阴茎疼痛，是厥阴经气滞兼有热，用甘草梢，想要缓解其气急罢了。
小便因热郁结导致淋证不通，用赤茯苓、黄芩、泽泻、车前子、麦门冬、肉桂、滑石、木通、甘草梢。气虚者，加黄芪、木香。淋痛，加黄柏、生地黄。夏季煎煮时调入益元散。
（以上朱丹溪的方法共九条）
参苓琥珀汤 治疗小便淋涩，茎中疼痛，牵连胁下疼痛，难以忍受。
人参、茯苓（各五分）、川楝子（去核）、生甘草梢、玄胡索（各七分）、琥珀、柴胡、当归尾、泽泻（各三分）。
以上切碎，作一服药量，用水一盏半，加灯心草十数根，煎至一盏服用。
琥珀散（济生方） 治疗五种淋涩疼痛，小便有脓血排出的证候。
琥珀、没药、海金沙、蒲黄（各一两）。
以上研为细末，每次服三钱，空腹时用萱草汤调服。
伤寒后脱阳，小便不通，用生姜自然汁，调匀茴香末，敷贴在小腹上。再服用益智茴香丸，用益元散送下。（朱丹溪）
老人气虚而小便不通，用四物汤加黄芪、人参，吞服滋肾丸，如果下焦血气干枯则难治。（朱丹溪）
小便黄，用黄柏。如果涩且频数，加泽泻。如果是湿热流注下焦导致小便黄赤涩数，用栀子、泽泻恰当。湿多者，宜用滑石利湿。
下焦无血，小便涩数而黄者，用四物汤加黄柏、知母、牛膝、甘草梢。
通关丸（即滋肾丸，李东垣方） 治疗不口渴而小便闭塞，热在下焦血分。
黄柏（酒洗焙干）、知母（酒洗焙干，各一两）、肉桂（五分）。
以上研为细末，用热水泛丸如梧桐子大，每次服一百丸，空腹用开水送下。服药后必须跺脚两次，使药物容易下行。如果小便已通，茎中如有刀刺痛，当有恶物排出为验证。
清肺饮子（李东垣方） 治疗口渴而小便闭涩不利，邪热在上焦气分。
灯心草（一分）、通草（二分）、泽泻、瞿麦、琥珀（各五分）、萹蓄、木通（各七分）、车前子（炒另研）、茯苓（去皮）、猪苓（去皮，各一钱）。
以上切碎，作一服药量，用水一盏半，煎至一盏，空腹稍热服用。
导气除燥汤（李东垣方） 治疗小便闭塞不通，是血涩导致气不运行而窍道涩滞。
茯苓（去皮）、滑石（各一钱）、知母（去毛，酒浸炒）、泽泻（各一钱五分）、黄柏（二钱，酒炒）。
以上切碎，作一服药量，用水二盏，煎至一盏，空腹稍热服用。
肾疸汤（李东垣方） 治疗肾疸目黄，甚至浑身发黄，小便赤色。
羌活、防风、藁本、独活、柴胡（各五分）、升麻（一钱，以上治疗目黄浑身黄）、白茯苓（二分）、泽泻（三分）、猪苓（四分）、白术（五分）、苍术（一钱，以上治疗小便赤涩）、黄柏（二分）、人参（三分）、葛根（五分）、神曲（六分）、甘草（五分）。
以上切碎，作一服药量，用水二盏，煎至一盏，食前稍热服用。
小蓟汤（李东垣方） 治疗下焦热结血淋。
生地黄、小蓟根、通草、滑石、栀子仁、蒲黄（炒）、淡竹叶、当归梢、生藕节、甘草梢（各五分）。
以上切碎，作一服药量，用水煎，空腹服用。
八正散（局方） 治疗大小便俱闭。
大黄、瞿麦、木通、滑石、萹蓄、车前子、栀子仁、甘草（各等分）。
以上切碎，每次服五钱重，入灯心草七根，水煎服。
牛膝膏 用川牛膝一合切碎，用新汲水五大盏煎去四分之一，入少许麝香，空腹服用。或者单用酒煮，也可以。
茯苓汤（李东垣方） 治疗胃疸，阳明积热，食后即饥，面色黄瘦，胸满胁胀，小便闭涩。
赤茯苓、陈皮（去白）、泽泻、桑白皮（各三分）、赤芍药、白术、人参、官桂（各二分）、石膏（八分）。
病重的，加大黄、朴硝各一钱。
以上切碎，作一服药量，加生姜五片，用水一盏半，煎至一盏，温服。
倒换散（刘河间方） 治疗无论久新癃闭，大小便不通，小腹急痛，肛门肿痛。
大黄（小便不通减半）、荆芥穗（大便不通减半，各等分）。
以上分别研为细末，每次服二钱，温水调下，临时加减服用。
葵子散（刘河间方） 治疗小便不通。
黄蜀葵子（研细）、赤茯苓（各二钱）。
以上作一服药量，用水一盏，煎二三沸，食前服用。
琥珀散（刘河间方） 治疗五淋。
滑石（二钱）、木通、当归、木香、郁金、萹蓄（各一钱）、琥珀（五分，研）。
以上作一服药量为末，用芦苇叶同煎，用水一盏半，煎数沸，食前温服。
铁服丸（刘河间方） 治疗大小便不通神效。
大皂角（烧存性）。
以上一味，不拘多少，细研，炼蜜丸如梧桐子大，每次服七十丸，开水送下。
广济鸡苏饮子（外台秘要） 治疗小便不通。
鸡苏（二握）、生地黄、通草（各四两）、滑石、杏仁（去皮尖，各二两）、冬葵子（一两五钱）、石苇（炙，去毛，一两）。
以上七味切碎，用水六升，煎至二升半，去渣分三次服，空腹进一服，如人行走四五里路程，又进一服，必通。
又方（外台秘要） 治疗小便不通。
冬葵子、滑石（各三两）、通草、赤茯苓（各一两）、茅根（二两五钱）、芒硝（一两五钱）。
以上切碎，用水六升，煎取二升，去渣纳入芒硝，分作三服，连续服用即通。
集验方（外台秘要） 治疗小便淋沥不通。
滑石（半斤）、石苇（三两）、通草（四两）、榆荚、冬葵子（各一斤），一方加黄芩（三两）。
以上切碎，用水一斗，煎取三升，分作三服，顿饮。
石苇散（刘河间方） 治疗小便不利，茎中作痛。
石苇（去毛，二两）、瞿麦（一两）、滑石（五两）、车前子（三两）、冬葵子（二两）。
以上研为细末，每次服方寸匕，每日三次服。
（祖传方）
治疗小便淋闭，茎中作痛神效。
石苇（去毛）、滑石、瞿麦、萹蓄、冬葵子、木通、王不留行、地肤草（各等分）。
以上研为细末，每次服三钱，开水调下。
又方 治疗小便溺血立效。
金陵草（一名旱莲草，一名墨斗草）、车前子（俗云虾蟆衣）。
以上两物各等分，杵碎取自然汁，每次服半茶盏，空腹服用。
又方 治疗前证。
用壮年无病患头发，不拘多少，烧灰存性，用侧柏叶捣汁，入糯米糊为丸，如梧桐子大，每次服一百丸，开水送下，或用四物汤送下尤其好。
又方 治疗沙淋，乃茎中有砂作痛。
石首鱼脑骨（五对，火煅，出火毒。即白鲞脑中骨也）、滑石（五钱）。
以上共研为细末，分作二服，煎木通汤调下。未愈，再服数剂，必待砂出尽乃安。
又方 治疗孕妇转胞，小便不通，及男子小便不通，皆效。
冬葵子（五钱）、山栀子（五钱，炒研）、木通（三钱）、滑石（五钱，研）。
以上作一服药量，用水一盏半，煎八分，温服。外用冬葵子、滑石、栀子为末，田螺肉捣膏，或生葱汁调膏，贴脐中，立通。
又方 治疗血淋。
侧柏叶、藕节、车前草（各等分）。
以上三味，同捣取其汁，调益元散，神效。
附：关格证
《难经》说：关则不得小便，格则吐逆。脉象两寸俱盛叫做关格。其证候是呕逆而小便不通。按《素问》说人迎脉大四倍于气口脉叫做格，气口脉大四倍于人迎脉叫做关，这是两种证候。大概有格而不关的，也有关而不格的，又或者有人迎气口俱盛而吐逆不便的，所以朱丹溪总括来说关格者，是指这种情况。
朱丹溪说：寒在上而热在下，所以多死，治法应当催吐以提起横梗的气机，不一定非要吐出痰涎。用二陈汤探吐，吐中便有降气的作用。
有气虚不运者，在补气药中加入升降之品，用补中益气汤加槟榔，使清气升而浊气降。
治疗关格证吐逆而小便不利，急宜先灸气海、天枢等穴各三七壮，其呕吐必止，然后用益元散等药以利小便。
（祖传方）
治疗关格吐逆，小便不通。
用藿香平胃散合五苓散，加姜枣煎服，立效。
（医案）
我的长兄修德翁，年七十岁，秋天患小便不通，二十多天，百方不效，后得一方，取地肤草捣自然汁服之遂通。虽然是微小的药物，却有回生起死之功，所以记录于此，作为济世利人的辅助之一。（地肤草，一说即白地芎。）
[Appendix: Guan-Ge Syndrome]
Treatise
The *Neijing* (Classic of Internal Medicine) states: When food and drink enter the stomach, their wandering and overflowing essence qi is transported upward to the Spleen. The Spleen scatters the refined substances, which ascend and return to the Lung. The Lung regulates the water passages, transporting them downward to the Bladder. The Bladder governs the transformation of the Cold Water of the Foot-Taiyang channel; its structure has a lower orifice but no upper orifice. It corresponds to the Shen position in autumn, so the Metal of the West Lung acts as its mother to nourish its transformation. When Lung Metal is clear and descending, the water passages are regulated, and fluids seep into the Ying (Nutritive) level and flow to the lower jiao. However, Lung Metal relies on the robustness of Spleen Earth to nourish the source of transformation, allowing clear yang to ascend and return to the Lung for circulation. Thus, the classics also state: Clear yang exits through the upper orifices, while turbid yin exits through the lower orifices. Therefore, if clear yang does not ascend, turbid yin will not descend, leading to disorders of Lin (strangury) and Bi (obstruction). Ancient sages compared this to a vessel dripping water: if the upper orifice is blocked, nothing comes out from the lower orifice; this principle is very clear. Therefore, Li Dongyuan prescribed moxibustion at Baihui (GV20), and Zhu Danxi prescribed inducing vomiting to lift the stagnant qi; both are methods of opening the upper orifices. Investigating the cause of this disease, it often stems from consuming rich foods, damp-heat producing items, or roasted meat and liquor, which condense and restrain to form phlegm. This damages Spleen Earth, causing weakness and an inability to transform refined substances, leading to a mixture of clear and turbid. Consequently, Lung Metal loses support, water passages become unclear, and gradually Lin-Bi conditions develop. Some say that excessive mental work and unregulated sexual activity lead to a lack of communication between Heart and Kidney, with Fire and Water losing control, clear yang failing to ascend, and turbid yin failing to descend, creating a state akin to the hexagram Pi (Stagnation) where Heaven and Earth do not interact. These are all teachings of the ancient sages. Ancient formulas distinguish five types of Lin: Qi Lin, Sha Lin, Xue Lin, Gao Lin, and Lao Lin. As for Qi Lin, urination is astringent and滞 (stagnant), often with residual urine remaining. Sha Lin involves stones in the penis causing pain, with urine unable to be expelled suddenly; pain ceases when stones are passed. Gao Lin presents with turbid urine resembling paste. Lao Lin occurs upon sexual exertion, with pain radiating to the Qichong point. Xue Lin flares up upon exposure to heat, potentially resulting in hematuria. Observing a yellow color on the nasal tip indicates difficulty in urination. Li Dongyuan treated based on whether the pathology was in the Qi or Blood level, distinguishing by thirst or lack thereof. If thirsty with difficult urination, heat is in the Upper Jiao Qi level, governed by Lung Metal; light and leaching herbs such as Poria (Fuling), Alisma (Zexie), Amber (Hupo), Juncus (Dengxincao), Tetsuka Throughvine (Tongcao), Plantago Seed (Cheqianzi), Knotweed (Qumai), and Smartweed (Bianxu) should be used to clear Lung Qi, drain fire, and nourish the upper source of water. If not thirsty with difficult urination, heat is in the Lower Jiao Blood level, governed by Kidney and Bladder; herbs with Yin flavors and odors such as Anemarrhena (Zhimu) and Phellodendron (Huangbai) should be used; Zishen Wan is representative. This clears heat, drains obstruction, and nourishes the lower origin of Bladder and Kidney water. Treatment of Lin never exceeds these principles; students must not ignore them.
Pulse Diagnosis
The *Maijing* (Pulse Classic) states: A rapid Shaoyin pulse in women causes sores in the vagina; in men, it causes Qi Lin, with a fine and rapid pulse. A large, full, and solid pulse indicates survival, while a deficient, fine, and choppy pulse indicates death.
Methods
Zhu Danxi stated: Although there are five types of Lin, they all belong to Heat. One should resolve heat and promote urination using herbs like Gardenia (Shanzhizi). Sweating must not be induced, as it will inevitably cause blood in the stool or urine.
For elderly patients with Lin-Bi due to Qi deficiency, use Ginseng (Renshen) and Atractylodes (Baizhu) combined with Akebia (Mutong) and Gardenia (Shanzhizi).
For Lin caused by extreme Kidney deficiency, one should tonify Kidney essence and promote urination; diuretics alone should not be used.
For Lin caused by dead blood (blood stasis), use Niuxi Gao. (Another view: Niuxi Gao may damage Stomach Qi and cause loss of appetite, so use with caution.)
One formula for treating Lin uses Yi Yuan San plus Gardenia Kernel (Shanzhiren) and Akebia (Mutong). Alternatively, grind one heaping measure of Gardenia into powder and take with warm water. In summer, taking Yi Yuan San mixed with Fennel (Huixiang) decoction is effective.
For phlegm-heat blocking the Middle Jiao causing obstructed and astringent urination, boil Er Chen Tang in a large bowl and take in one dose; induce vomiting to lift the Qi.
For Lin with blood due to fire-dryness, where Lower Jiao lacks blood and Qi cannot descend, causing failure of excretion, one should nourish Yin and descend fire using Si Wu Tang plus Anemarrhena (Zhimu) and Phellodendron (Huangbai), or take Zishen Wan after decocting Si Wu Tang.
Penile pain is due to Liver-Yin channel Qi stagnation combined with heat; use Licorice Root Tip (Gancao Shao) to relieve the urgency of Qi.
For urinary obstruction due to heat constraint forming Lin, use Red Poria (Chifuling), Scutellaria (Huangqin), Alisma (Zexie), Plantago Seed (Cheqianzi), Ophiopogon (Mendong), Cinnamon Twig (Rougui), Talc (Huashi), Akebia (Mutong), and Licorice Root Tip (Gancao Shao). For Qi deficiency, add Astragalus (Huangqi) and Costus Root (Muxiang). For Lin pain, add Phellodendron (Huangbai) and Rehmannia (Shengdihuang). In summer, mix Yi Yuan San into the decoction.
(Above are nine methods from Zhu Danxi.)
Renshen Linghu Hupo Decoction treats astringent urination, penile pain, and radiating pain to the hypochondrium that is unbearable.
Ginseng (Renshen), Poria (Fuling) [each 5 fen], Toosendan Fruit (Chuansuanzi, pitted), Raw Licorice Root Tip (Sheng Gancao Shao), Corydalis (Yanhusuo) [each 7 fen], Amber (Hupo), Bupleurum (Chaihu), Angelica Sinensis Tail (Chuan Guiwei), Alisma (Zexie) [each 3 fen].
Cut finely, prepare as one dose. Add 1.5 cups of water and over a dozen stalks of Juncus (Dengxincao). Decoct to 1 cup and take.
Hupo Powder (Jisheng Fang) treats painful astringency of the five Lins and passage of pus and blood in urine.
Amber (Hupo), Myrrh (Moyao), Goldsand (Haijinsha), Polygonum Knotweed Root (Puhuang) [each 1 liang].
Grind into fine powder. Take 3 qian per dose, mixed with Daylily (Xuancao) decoction on an empty stomach.
After Shanghan (Cold Damage), Yang escapes, causing urinary retention. Use fresh Ginger juice mixed with Fennel powder and apply to the lower abdomen. Also take Yizhi Huixiang Wan, delivered with Yi Yuan San. (Danxi)
For elderly patients with Qi deficiency and urinary retention, use Si Wu Tang plus Astragalus (Huangqi) and Ginseng (Renshen), swallowing Zishen Wan. If Lower Jiao blood and Qi are dry, it is fatal. (Danxi)
For yellow urine, use Phellodendron (Huangbai). If astringent and frequent, add Alisma (Zexie). If damp-heat flows to the Lower Jiao causing yellow, red, astringent, and frequent urine, Gardenia (Shanzhizi) and Alisma (Zexie) are appropriate. For heavy dampness, use Talc (Huashi) to drain it.
For Lower Jiao lacking blood, with astringent, frequent, and yellow urine, use Si Wu Tang plus Phellodendron (Huangbai), Anemarrhena (Zhimu), Achyranthes (Niuxi), and Licorice Root Tip (Gancao Shao).
Tongguan Wan (i.e., Zishen Wan, Dongyuan) treats non-thirsty urinary obstruction due to heat in the Lower Jiao Blood level.
Phellodendron (Huangbai, wine-washed and dried), Anemarrhena (Zhimu, wine-washed and dried) [each 1 liang], Cinnamon Twig (Rougui) [5 fen].
Grind into powder, make pills with hot water the size of Sophora seeds. Take 100 pills per dose with warm water on an empty stomach. After taking, stomp feet twice to facilitate downward movement of the medicine. If urination resumes and there is a knife-like stabbing pain in the penis, expulsion of foul matter confirms efficacy.
Qingfei Yinzi (Dongyuan) treats thirst with obstructed and astringent urination due to pathogenic heat in the Upper Jiao Qi level.
Juncus (Dengxincao) [1 fen], Tetsuka Throughvine (Tongcao) [2 fen], Alisma (Zexie), Knotweed (Qumai), Amber (Hupo) [each 5 fen], Smartweed (Bianxu), Akebia (Mutong) [each 7 fen], Plantago Seed (Cheqianzi, stir-fried and ground separately), Poria (Fuling, peeled), Polyporus (Zhuling, peeled) [each 1 qian].
Cut finely, prepare as one dose. Add 1.5 cups of water, decoct to 1 cup, and take slightly warm on an empty stomach.
Daoqi Chuzao Tang (Dongyuan) treats urinary obstruction due to blood astringency causing Qi stagnation and orifice blockage.
Poria (Fuling, peeled), Talc (Huashi) [each 1 qian], Anemarrhena (Zhimu, de-haired, wine-soaked and fried), Alisma (Zexie) [each 1.5 qian], Phellodendron (Huangbai) [2 qian, wine-fried].
Cut finely, prepare as one dose. Add 2 cups of water, decoct to 1 cup, and take slightly warm on an empty stomach.
Shendan Tang (Dongyuan) treats Shendan (Kidney Jaundice) with yellow eyes, extending to whole-body jaundice, and red urine.
Notopterygium (Qianghuo), Saposhnikovia (Fangfeng), Ligusticum (Gben), Angelica Pubescens (Duhuo), Bupleurum (Chaihu) [each 5 fen], Cimicifuga (Shengma) [1 qian, above treat eye and body jaundice], White Poria (Baifuling) [2 fen], Alisma (Zexie) [3 fen], Polyporus (Zhuling) [4 fen], Atractylodes Macrocephala (Baizhu) [5 fen], Atractylodes Lancea (Cangzhu) [1 qian, above treat red and astringent urine], Phellodendron (Huangbai) [2 fen], Ginseng (Renshen) [3 fen], Kudzu Root (Gegen), Medicated Leaven (Shenqu) [6 fen], Licorice (Gancao) [5 fen].
Cut finely, prepare as one dose. Add 2 cups of water, decoct to 1 cup, and take slightly warm before meals.
Xiaoji Tang (Dongyuan) treats Lower Jiao heat accumulation causing Blood Lin.
Raw Rehmannia (Sheng Dihuang), Small Thistle Root (Xiaoji Gen), Tetsuka Throughvine (Tongcao), Talc (Huashi), Gardenia Kernel (Shanzhiren), Polygonum Knotweed Root (Puhuang, stir-fried), Light Bamboo Leaf (Dan Zhuye), Angelica Sinensis Tail (Danggui Shao), Raw Lotus Node (Sheng Ou Jie), Licorice Root Tip (Gancao Shao) [each 5 fen].
Cut finely, prepare as one dose. Decoct in water and take on an empty stomach.
Bazheng San (Ju Fang) treats simultaneous obstruction of large and small intestines (urine and feces).
Rhubarb (Dahuang), Knotweed (Qumai), Akebia (Mutong), Talc (Huashi), Smartweed (Bianxu), Plantago Seed (Cheqianzi), Gardenia Kernel (Shanzhiren), Licorice (Gancao) [equal parts].
Cut finely. Take 5 qian per dose, add 7 stalks of Juncus (Dengxincao), decoct in water, and take.
Niuxi Gao uses 1 heaping measure of Sichuan Achyranthes (Chuan Niuxi) cut finely. Decoct in 5 large cups of fresh well water until reduced by one-fourth. Add a little Musk (Shexiang) and take on an empty stomach. Alternatively, decoct alone in wine.
Fuling Tang (Dongyuan) treats Weidan (Stomach Jaundice), Yangming accumulated heat, hunger immediately after eating, sallow and thin complexion, chest fullness and hypochondriac distension, and obstructed astringent urination.
Red Poria (Chifuling), Tangerine Peel (Chenpi, white part removed), Alisma (Zexie), Mulberry Root Bark (Sangbaipi) [each 3 fen], Red Peony Root (Chi Shaoyao), Atractylodes Macrocephala (Baizhu), Ginseng (Renshen), Official Cinnamon (Guangui) [each 2 fen], Gypsum (Shigao) [8 fen].
For severe cases, add Rhubarb (Dahuang) and Mirabilite (Puxiao) each 1 qian.
Cut finely, prepare as one dose. Add 5 slices of Ginger, 1.5 cups of water, decoct to 1 cup, and take warm.
Daohuan San (Hejian) treats chronic or acute Peng-Bi (obstruction), simultaneous obstruction of urine and feces, urgent lower abdominal pain, and anal swelling/pain.
Rhubarb (Dahuang, reduce by half for urinary obstruction), Schizonepeta Spike (Jingjie Sui, reduce by half for fecal obstruction) [equal parts].
Grind separately into fine powder. Take 2 qian per dose with warm water, adjusting dosage as needed.
Kuizi San (Hejian) treats urinary retention.
Yellow Hibiscus Seed (Huang Shukui Zi, ground fine), Red Poria (Chifuling) [each 2 qian].
Prepare as one dose. Add 1 cup of water, boil 2-3 times, and take before meals.
Kuizi Tang (Jisheng Fang) treats Bladder excess heat causing urinary retention. (Formula see Shan Men chapter.)
Hupo Powder (Hejian) treats the five Lins.
Talc (Huashi) [2 qian], Akebia (Mutong), Angelica (Danggui), Costus Root (Muxiang), Curcuma (Yujin), Smartweed (Bianxu) [each 1 qian], Amber (Hupo) [5 fen, ground].
Prepare as one dose into powder. Decoct together with Reed Leaf (Lubi Ye) in 1.5 cups of water, boil several times, and take warm before meals.
Tiefu Wan (Hejian) treats simultaneous obstruction of urine and feces with miraculous effect.
Large Soap Pod (Da Zaojiao, burned to retain charred nature).
Take any amount, grind finely, make pills with refined honey the size of Sophora seeds. Take 70 pills per dose with warm water.
Guangji Jisu Yinzi (Waitai) treats urinary retention.
Elsholtzia (Jisu) [two handfuls], Raw Rehmannia (Sheng Dihuang), Tetsuka Throughvine (Tongcao) [each 4 liang], Talc (Huashi), Apricot Seed (Xingren, peeled and cored) [each 2 liang], Winter Okra Seed (Dong Kuizi) [1.5 liang], Periploca Shell (Shiwei, roasted, de-haired) [1 liang].
Cut seven ingredients finely. Add 6 sheng of water, decoct to 2.5 sheng. Strain and divide into three doses. Take one dose on an empty stomach; after walking 4-5 li, take another dose. Urination will surely resume.
Another Formula (Waitai) treats urinary retention.
Winter Okra Seed (Dong Kuizi), Talc (Huashi) [each 3 liang], Tetsuka Throughvine (Tongcao), Red Poria (Chifuling) [each 1 liang], Imperata Rhizome (Maogen) [2.5 liang], Mirabilite (Mangxiao) [1.5 liang].
Cut finely. Add 6 sheng of water, decoct to 2 sheng. Strain and add Mirabilite. Divide into three doses. Continuous intake leads to passage.
Jiyan Fang (Waitai) treats dribbling and obstructed urination.
Talc (Huashi) [half jin], Periploca Shell (Shiwei) [3 liang], Tetsuka Throughvine (Tongcao) [4 liang], Elaeocarpus Fruit (Yujia), Winter Okra Seed (Dong Kuizi) [each 1 jin]. One variation adds Scutellaria (Huangqin) [3 liang].
Cut finely. Add 1 dou of water, decoct to 3 sheng. Divide into three doses and drink in one gulp.
Shiwei San (Hejian) treats difficult urination and penile pain.
Periploca Shell (Shiwei, de-haired) [2 liang], Knotweed (Qumai) [1 liang], Talc (Huashi) [5 liang], Plantago Seed (Cheqianzi) [3 liang], Winter Okra Seed (Dong Kuizi) [2 liang].
Grind into fine powder. Take one fangcun bi per dose, three times daily.
(Ancestral Formula)
Miraculous for treating Lin-Bi and penile pain.
Periploca Shell (Shiwei, de-haired), Talc (Huashi), Knotweed (Qumai), Smartweed (Bianxu), Winter Okra Seed (Dong Kuizi), Akebia (Mutong), Immortelle (Wangbuliuxing), Kochia Herb (Dicao) [equal parts].
Grind into fine powder. Take 3 qian per dose with warm water.
Another Formula provides immediate relief for hematuria.
Jinling Cao (also known as Hanlian Cao, Modou Cao), Plantago Seed (Cheqianzi, colloquially Hamayi).
Take equal parts of both, pound to extract natural juice. Take half a tea cup per dose on an empty stomach.
Another Formula treats the aforementioned condition.
Use hair from a healthy young person, burn to ash retaining charred nature. Mix with Juice of Platycladus (Ce Baiye) pounded fresh, add glutinous rice paste to make pills the size of Sophora seeds. Take 100 pills per dose with warm water, or delivered with Si Wu Tang for better effect.
Another Formula treats Sha Lin (Sand Lin), where sand in the penis causes pain.
Stone Fish Brain Bone (Shishou Yu Naogu, 5 pairs, calcined to remove fire toxicity; i.e., bone from dried croaker brain), Talc (Huashi) [5 qian].
Grind together into fine powder. Divide into two doses, taken with Akebia (Mutong) decoction. If not cured, take several more doses until all sand is expelled.
Another Formula treats pregnant women with Zhuanbao (uterine displacement) causing urinary retention, and men with urinary retention; both are effective.
Winter Okra Seed (Dong Kuizi) [5 qian], Gardenia (Shanzhizi) [5 qian, stir-fried and ground], Akebia (Mutong) [3 qian], Talc (Huashi) [5 qian, ground].
Prepare as one dose. Add 1.5 cups of water, decoct to 0.8 cup, and take warm. Externally, powder Winter Okra Seed, Talc, and Gardenia. Mix with Apple Snail Meat paste or raw Green Onion juice to make a plaster. Apply to the umbilicus for immediate passage.
Another Formula treats Blood Lin.
Platycladus Leaf (Ce Baiye), Lotus Node (Ou Jie), Plantago Herb (Cheqian Cao) [equal parts].
Pound the three ingredients together to extract juice. Mix with Yi Yuan San for miraculous effect.
Appendix: Guan-Ge Syndrome
The *Nanjing* (Classic of Difficult Issues) states: Guan means inability to urinate; Ge means vomiting and regurgitation. A pulse that is excessively strong in both Cun positions is called Guan-Ge. The syndrome is characterized by vomiting/regurgitation and urinary obstruction. According to the *Suwen*, when the Renying pulse is four times larger than the Qikou pulse, it is called Ge; when the Qikou pulse is four times larger than the Renying pulse, it is called Guan. These are two distinct syndromes. There can be Ge without Guan, or Guan without Ge. Sometimes both Renying and Qikou are strong with vomiting and difficulty passing urine. Therefore, Zhu Danxi summarized Guan-GE as referring to this situation.
Zhu Danxi stated: Cold in the Upper and Heat in the Lower usually leads to death. The method should involve inducing vomiting to lift the horizontal obstruction of Qi; it is not necessary to expel phlegm. Use Er Chen Tang to induce vomiting; within vomiting lies the mechanism of descending.
For those with Qi deficiency failing to move, add ascending and descending agents to Qi-tonifying herbs. Use Buzhong Yiqi Tang plus Areca Nut (Binglang) to raise clear Yang and descend turbid Qi.
For treating Guan-GE with vomiting and difficult urination, urgently moxa Qihai (CV6) and Tianshu (ST25) acupoints, 21-27 moxa cones each. Vomiting will stop first, then use Yi Yuan San etc. to promote urination.
(Ancestral Formula)
Treats Guan-GE vomiting and urinary retention.
Use Huoxiang Pingwei San combined with Wuling San, add Ginger and Jujube, decoct and take. Immediate effect.
(Medical Case)
My eldest brother, Mr. Xiude, aged seventy, suffered from urinary retention in autumn for over twenty days. Hundreds of prescriptions failed. Later, I obtained a formula: crush Dicoma zeylanica (Dicao) to extract natural juice and administer. Urination resumed immediately. Though a humble herb, it has the power to revive the dying. Therefore, I record it here as an aid to benefiting others. (Dicao is said to be Baixi Xiong/Baidi Xiong.)