小便淋 ，鼻头色黄。涩小无血，数大何妨。
淋者，淋沥不净。 者，闭塞不通。其证小便少而数，少腹弦急，痛引于脐。
病源论皆谓肾虚膀胱热之所成也。分有五种，曰石淋、劳淋、血淋、气淋、膏淋。
石淋者，淋而出石也。肾主水，水结则化为石。肾虚为热所乘，热则成淋。其病状，
小便则茎里痛，尿不能卒出，痛引少腹，膀胱里急，沙石从小便出。甚者塞痛，令
人闷绝。（宜局方石韦散、三因石燕丸之类。）气淋者，肾虚膀胱热，气胀所为也。膀胱合与肾
为表里。膀胱热，热气流入于胞。热则生实，令胞内气胀，则小腹满。肾虚不能制
其小便，故成淋。其状膀胱小便皆满，尿涩，常有余沥是也。亦曰气癃。（宜瞿麦汤、沉
香散之类。）膏淋者，淋而有肥，状似膏，故谓之膏淋，亦曰肉淋。此肾虚不能制肥液，
故与小便俱出也。（宜鹿角霜丸、菟丝子丸之类。）劳淋者，谓劳伤肾气，而生热成淋也。肾气
通于前阴。其状，尿留茎内，数起不出，引小腹痛，小便不利，劳倦即发也。（宜黄
汤、补中益气汤之类。）血淋是热淋之甚者，则尿血，谓之血淋。心主血，血之行身，通遍
经络，循环腑脏。热甚，则散失其常经，溢渗入胞，而成血淋也。（宜立效散、济生小蓟
饮子之类。）五种之外，复有寒热二种。寒淋者，其病状先寒战，然后尿是也。由肾气
虚弱，下焦受冷气，入胞与正气交争，寒气胜，则战寒而成淋。正气胜，则战寒解，
方得小便也。（宜肉苁蓉丸、八味丸之类。）热淋者，三焦有热，气搏于肾，流入于胞，而成
淋也。其状小便赤涩。亦有宿病淋，今得热而发者。其热甚，则变尿血。亦有小便
后，如小豆羹汁状者，蓄作有时也。（宜六一散、本事火府丹、导赤散、局方八正散之类。）巢氏之说
如此，恐未必尽然。大抵皆三焦气化不及，热迫膀胱，令水道涸涩之所成也。劳、
气、血、膏、石，虽分五种，其病机，必因劳动火，火盛搏气，甚及于血。血转为
膏，膏转为石。自清而浊，自薄而浓，自柔而坚，自无形而渐有形。亦熬汁成膏，
煮水结盐之义，岂真有砂石出水脏哉？至若肾虚不能制肥液，更可笑也。历考《内
经》，并运气等篇，肝、心、脾、肺、肾、小肠、督脉，亦皆有此证。三焦膀胱病此
者，为独多耳。夫三焦膀胱者，《素问》灵兰秘典虽列为二，在三焦，则曰决渎之官，
水道出焉。在膀胱，则曰州都之官，津液藏焉。气化则能出矣。三焦之下，即接膀
胱。一主藏，一主决，相为根据倚。故《灵枢》本藏篇云∶肾合三焦。三焦、膀胱者，
腠理毫毛其应。又四时气篇云∶小腹痛肿，不得小便，邪在三焦约，取之太阳大络。
又五癃津液篇云∶三焦闭不泻，津液不化，不得渗膀胱，则下焦胀。又本输篇云∶
膀胱者，津液之府也。少阳属肾，肾上连肺，故将两脏。三焦者，中渎之府也，水
道出焉。属膀胱，是孤之府也。观此，则知三焦、膀胱，名虽二而实一。故古人刺
灸之法，多取三焦穴，而不取膀胱，义可想矣。所谓少阳属肾者，少阳正指三焦手
少阳，非足少阳也。即肾合三焦之变文。肾上连肺者，言以最下之肾，而相将于最
上之肺。凡在两脏之中者，俱在相将之内。此所以成一三焦也。况肺主气而通调水
道，三焦亦主气而上下游行。如是，则淋秘又不独下焦为然。上中下之气，有一不
化，则不得如决渎之水而出矣。热乘津液，则水道不利。水道不利而有热，必郁蒸
而外发黄色。见于鼻者，以鼻为肺窍耳。脉涩小者，涩滞微小而不滑利也。征其正
衰而无血。数大为火象。火证见之，又何妨乎？较之无血者，是为易治。
小便淋沥不畅，鼻头颜色发黄。脉象涩小表示体内无血虚之患，脉象数大则提示有热，但这并不可怕。
淋证，是指小便淋漓不尽。癃证，是指小便闭塞不通。其症状表现为小便量少且次数频繁，少腹部拘急疼痛，疼痛牵引至肚脐周围。
《病源论》都认为这是由肾虚和膀胱热邪共同造成的。分为五种类型，分别是石淋、劳淋、血淋、气淋、膏淋。
石淋，是指排尿时伴有砂石排出。肾主水液，水液凝结就会化为石头。肾气虚弱导致热邪乘虚而入，热盛则形成淋证。其病症表现是：小便时尿道内疼痛，尿液不能突然排出，疼痛牵引少腹，膀胱内部急迫，沙石随小便排出。严重时堵塞疼痛，使人闷乱昏厥。（适宜使用局方石韦散、三因石燕丸等方剂。）
气淋，是由于肾虚膀胱热，气机胀满所致。膀胱与肾互为表里。膀胱有热，热气流入胞宫（此处指下焦泌尿生殖区域）。热盛则产生实邪，导致胞宫内气机胀满，从而引起小腹胀满。肾气虚弱不能制约小便，所以形成淋证。其症状表现为膀胱和小便部位都感觉胀满，排尿涩滞，经常有尿后余沥不尽的情况。这也称为气癃。（适宜使用瞿麦汤、沉香散等方剂。）
膏淋，是指排尿时有脂液流出，状似膏脂，所以称为膏淋，也称为肉淋。这是因为肾气虚弱不能制约肥厚之液，所以随着小便一起排出。（适宜使用鹿角霜丸、菟丝子丸等方剂。）
劳淋，是指因劳累损伤肾气，进而产生热邪形成淋证。肾气通于前阴。其症状表现为：尿液滞留于尿道内，频繁想排尿却排不出，牵引小腹痛，小便不利，劳累后即发作。（适宜使用黄汤、补中益气汤等方剂。）
血淋是热淋的严重情况，表现为尿血，所以称为血淋。心主血脉，血液运行全身，通达经络，循环脏腑。热邪极盛时，血液失去正常的运行轨道，溢出渗入胞宫，从而形成血淋。（适宜使用立效散、济生小蓟饮子等方剂。）
在上述五种之外，还有寒热两种类型。寒淋，其病症表现是先出现寒战，然后才排尿。这是由于肾气虚弱，下焦受到冷气侵袭，寒气进入胞宫与正气交争，寒气占上风，则发生寒战并形成淋证。正气占上风，则寒战解除，随后才能排出小便。（适宜使用肉苁蓉丸、八味丸等方剂。）
热淋，是三焦有热邪，热气搏结于肾，流入胞宫，从而形成淋证。其症状表现为小便赤红涩痛。也有原本患有淋证的人，现在因受热而发作的。如果热邪极盛，则会转变为尿血。也有人在小便后，排出如小豆羹汁状液体的情况，这种症状有时蓄积发作。（适宜使用六一散、本事火府丹、导赤散、局方八正散等方剂。）
巢元方的说法如此，恐怕未必完全正确。大体上都是由于三焦气化功能不及，热邪逼迫膀胱，导致水道干涩所形成的。劳、气、血、膏、石这五种淋证，虽然名称不同，但其发病机理，必定是因为劳动导致火邪内生，火邪旺盛搏击气机，甚则波及血分。血转化为膏，膏转化为石。这是一个从清到浊、从稀薄到浓稠、从柔软到坚硬、从无形到有形的过程。这也如同熬煮汁液成膏、煮水结成盐的道理，难道真的会有砂石直接从肾脏或膀胱排出吗？至于说肾虚不能制约肥液，更是可笑的说法。仔细考证《内经》以及运气学说等篇章，肝、心、脾、肺、肾、小肠、督脉，也都可能出现此类证候。其中三焦和膀胱患病此证的，最为多见。
关于三焦和膀胱，《素问·灵兰秘典论》虽然将它们列为两个不同的官职，但在三焦方面，称其为“决渎之官”，水道由此而出；在膀胱方面，称其为“州都之官”，津液在此储藏。只有经过气化作用，尿液才能排出。三焦的下端，紧接着就是膀胱。一个主储藏，一个主疏通，二者相互依存依靠。所以《灵枢·本藏篇》说：“肾合三焦。”三焦和膀胱，是腠理毫毛的反应所在。又《四时气篇》说：“小腹痛肿，不得小便，邪在三焦约束，取太阳经的大络。”又《五癃津液别篇》说：“三焦闭塞不泻，津液不能化生，不能渗入膀胱，则下焦胀满。”又《本输篇》说：“膀胱是津液的府库。少阳属肾，肾向上连接肺，所以统摄这两个脏器。三焦是中渎之府，水道由此而出，隶属于膀胱，是孤独的府库。”观察这些记载，就知道三焦和膀胱，名字虽然有两个，但实际上是一个整体。所以古人针灸的方法，多选取三焦的穴位，而不选取膀胱的穴位，其中的道理可以想见。所谓“少阳属肾”，这里的少阳正指的是手少阳三焦，而不是足少阳胆经。这就是“肾合三焦”的另一种表述。所谓“肾上连肺”，是说最下面的肾，与最上面的肺相互贯通。凡是在这两脏之间的，都属于这种贯通联系之内。这就是形成一个完整的三焦系统的原因。况且肺主气而通调水道，三焦也主气而上下流行。像这样，那么淋证和小便不通就不只是下焦的问题了。上、中、下三焦的气，只要有一个不能气化，就不能像疏通沟渠的水那样排出了。热邪侵犯津液，就会导致水道不利。水道不利而产生热邪，必然郁蒸而向外发散黄色。表现在鼻子上，是因为鼻子是肺的窍道。脉象涩小，表示气血涩滞微小而不滑利。据此推断是正气衰弱且无血虚之患。脉象数大是火象。如果是火证出现这种情况，又有什么妨碍呢？相比于无血虚的情况，这算是比较容易治疗的。
Dysuria (Lin syndrome) with a yellowish complexion on the tip of the nose. A choppy and small pulse indicates no blood deficiency, while a rapid and large pulse suggests heat, which is not necessarily alarming.
Lin syndrome refers to dribbling and incomplete urination. Long syndrome refers to urinary retention or obstruction. The symptoms include scanty but frequent urination, tightness and pain in the lower abdomen radiating to the umbilicus.
The *Bing Yuan Lun* attributes this condition to Kidney deficiency combined with Bladder heat. It is classified into five types: Stone Lin, Labor Lin, Blood Lin, Qi Lin, and Paste Lin.
Stone Lin involves the passage of stones during urination. The Kidney governs water; when water condenses, it forms stones. Kidney deficiency allows heat pathogens to invade, and excessive heat generates Lin syndrome. Symptoms include pain within the urethra during urination, inability to void urine suddenly, pain radiating to the lower abdomen, urgency in the Bladder, and the passage of sand-like stones. In severe cases, obstruction causes pain leading to fainting or suffocation. (Suitable formulas include Shuwei San from Ju Fang and Shiyan Wan from Sanyin.)
Qi Lin results from Kidney deficiency and Bladder heat causing Qi stagnation and distension. The Bladder and Kidney are exterior-interior paired organs. Heat in the Bladder flows into the "Pa" (lower jiao/urinary bladder area). Excessive heat creates excess conditions, causing Qi distension in the lower abdomen. Kidney deficiency fails to control urination, resulting in Lin syndrome. Symptoms include fullness in the Bladder and urinary tract, difficult urination, and post-void dribbling. This is also called Qi Long. (Suitable formulas include Qumai Tang and Chenxiang San.)
Paste Lin involves the discharge of fatty substances resembling paste during urination, hence the name Paste Lin or Meat Lin. This occurs because Kidney deficiency fails to control thick fluids, which are discharged with urine. (Suitable formulas include Lujiaoshuang Wan and Tusizi Wan.)
Labor Lin arises from labor damaging Kidney Qi, generating heat that leads to Lin syndrome. Kidney Qi connects to the anterior yin. Symptoms include urine retention in the urethra, frequent urges without output, pain radiating to the lower abdomen, difficulty urinating, and exacerbation upon fatigue. (Suitable formulas include Huang Tang and Buzhong Yiqi Tang.)
Blood Lin is a severe form of Heat Lin characterized by hematuria. The Heart governs blood, which circulates through meridians and zang-fu organs. When heat is extreme, blood deviates from its normal pathways, overflowing into the Pa, causing Blood Lin. (Suitable formulas include Lixiao San and Jisheng Xiaoji Yinzi.)
Beyond these five, there are Cold Lin and Heat Lin. Cold Lin presents with chills preceding urination. It stems from weak Kidney Qi and cold pathogens invading the lower jiao, clashing with healthy Qi. If cold dominates, chills occur before urination; if healthy Qi dominates, chills resolve, allowing urination. (Suitable formulas include Rongcongrou Wan and Bawei Wan.)
Heat Lin results from heat in the Triple Burner clashing with the Kidney and flowing into the Pa. Symptoms include red, painful, and difficult urination. Pre-existing Lin may flare up due to heat. Severe heat can transform into hematuria. Some patients pass fluid resembling mung bean soup after urination, occurring intermittently. (Suitable formulas include Liuyi San, Huofu Dan from Ben Shi, Daochi San, and Bazheng San from Ju Fang.)
Chao Yuanfang’s theory may not be entirely accurate. Generally, these conditions arise from impaired Qi transformation in the Triple Burner and heat forcing the Bladder, causing dryness and obstruction in the water passages. Although categorized into five types (Labor, Qi, Blood, Paste, Stone), their pathogenesis involves labor-induced fire, which agitates Qi and affects Blood. Blood transforms into paste, and paste into stone. This process moves from clear to turbid, thin to thick, soft to hard, and formless to formed. It is akin to boiling juice into paste or water into salt; it is unlikely that actual stones originate directly from the Kidneys or Bladder. The idea that Kidney deficiency controls fatty fluids is also questionable. Examining the *Neijing* and theories of Five Movements and Six Qi, similar syndromes appear in the Liver, Heart, Spleen, Lung, Kidney, Small Intestine, and Du Mai. However, they are most common in the Triple Burner and Bladder.
Although the *Suwen* lists the Triple Burner as the "Official of Ditches" responsible for water passages and the Bladder as the "Official of the Capital" storing fluids, they are functionally linked. The lower end of the Triple Burner connects directly to the Bladder. One stores, the other drains; they support each other. The *Lingshu* states, "The Kidney combines with the Triple Burner." Both respond to the skin and hair. The *Sishi Qi* chapter notes that lower abdominal swelling and inability to urinate due to Triple Burner constraint should be treated via the Great Luo of the Taiyang channel. The *Wu Long Jin Ye Pian* states that if the Triple Burner is blocked and fluids do not transform or seep into the Bladder, the lower jiao becomes distended. The *Benshu* chapter describes the Bladder as the storehouse of fluids, noting that Shaoyang belongs to the Kidney, which connects upward to the Lung, thus governing both. The Triple Burner is the middle ditch storehouse, belonging to the Bladder, making it an isolated organ. Thus, although named separately, the Triple Burner and Bladder are essentially one. Ancient acupuncture often selected Triple Burner points rather than Bladder points, reflecting this unity. "Shaoyang belongs to the Kidney" refers specifically to Hand-Shaoyang (Triple Burner), not Foot-Shaoyang (Gallbladder). "Kidney connects upward to the Lung" implies communication between the lowest and highest organs, encompassing all intermediate connections, forming a unified Triple Burner system. Since the Lung governs Qi and regulates water passages, and the Triple Burner governs Qi circulation, dysuria is not solely a lower jiao issue. If Qi transformation fails in any of the three burners, water cannot flow freely. Heat invading fluids obstructs water passages; obstruction generates heat, which steams outward, manifesting as yellow color on the nose (the orifice of the Lung). A choppy, small pulse indicates sluggish, minute, and unsmooth Qi/Blood, suggesting healthy Qi deficiency without blood loss. A rapid, large pulse indicates Fire. If Fire signs are present, it is not detrimental and is easier to treat than cases involving blood deficiency.