一滴不出名闭，即小便不通。点滴而出名癃，即淋。二证皆由气闭涩，其理已
见上编。淋证大概肾虚膀胱热。（五脏六腑所受内外诸邪热，皆得入膀胱。）肾虚则火动，常欲泄
而不能藏，（火动欲泄则属之肝，故上编言肝火疏泄为癃。）故数。膀胱热则水道枯涩，故渗出涩滞，
数而且涩，茎中痛，淋沥不宣，故谓之淋。（肾虚膀胱热，则水液少。子和治一人，令顿食咸鱼，少
顷大渴，令恣意饮水，然后以药治之，立通。曰∶淋者无水，故涩也。）脉实大，
宜分理之。脉虚细涩，
精血败坏，难治。治法∶行滞气，解邪热，通水道，其大纲又在平心火。此证最忌
发汗，（淋证属热耗津液，发汗则愈涸，无水可出则动血矣。）汗之则尿血《准绳》
谓暑月多此证，以
汗多，小便常赤涩也，治用五苓散，（见伤湿。）敛其外发之汗，（意谓内有白术、桂
枝能敛汗也，
恐未必。不如去桂，合生脉散佳。）使液聚于内，又从而导下之。然有虚劳汗出而赤涩者，乃
津液枯燥，又不宜渗利矣，敛汗清热滋液可也。失血亡精者，同此论之。淋证茎中
必痛，若先痛后痒，则火退矣，或者实证转虚。
气淋。初起为气淋，以气滞而涩痛也，白茯苓、甘草稍、白芷、山栀、木通、
猪苓、泽泻、车前、地肤子、葱白。生料五苓散（见伤湿）加阿胶，或五苓、益元（见伤暑）各
半服。火府丹佐以导赤散、（见发热。）石韦散。或四苓（见伤湿）加木通、滑石、瞿麦、灯心。
肺热，清肃之气不下降，加味八正散。气虚，八物汤（见虚损）加杜牛膝、黄芩。
膏淋。久为膏淋及砂石淋。膏淋湿热伤气分，水液混浊如膏，如涕，如米泔。
实热八正散加苍术，虚热鹿角霜丸。精尿俱出，（精塞尿道，欲出不能而痛。）海金砂
散、菟丝子丸、鹿茸丸、（见血。）土牛膝、地肤叶汁、白茯苓、泽泻、山栀、甘草梢、
琥珀、郁金、萆 。
砂淋。尿为热所煎熬成砂石，如煮海水成盐。八正散、神效琥珀散、如圣散、
石燕丸、独圣散。石首鱼脑中石十个 ，滑石二钱，琥珀三分，为细末，每服一钱，
木通汤下。蝼蛄七个，盐一两，新瓦上铺盖，焙干为细末，每服一钱，温酒下。冬
葵子、滑石、瞿麦、琥珀、土牛膝、车前、泽泻、山栀、地肤叶汁。必断盐乃效，
一则淡食能渗利，一则无盐不作石也。
血淋。热伤血分，茎中必痛，（不痛为尿血，见血门。）归尾、土牛膝、赤芍、玄胡、车
前、泽泻、郁金、山栀、刘寄奴主之。血瘀则小腹硬痛，加红花、五灵脂。血热则
色鲜红，脉数有力，加生地。血虚，六味（见虚损）加车前、牛膝。血冷则色黯，面枯，
尺脉沉迟，肾气丸（见劳损。）死血，牛膝膏。牛膝根茎叶酒煮服，治小便不利，茎中痛
欲死，及妇人血结坚痛，如神。但虚人不宜用，当同补药用之，免损胃。侧柏叶、
生藕节、车前草等分，捣汁调益元散（见伤暑）、发灰散、小苏子饮、（并见血。）立效散、瞿
麦散。
痰淋。痰郁气成热所致，七气汤（见气）、青州白丸子（见中风）。
劳淋。劳则动火，热流膀胱所致，脾劳，（劳倦所伤。）补中益气（见气）合五苓（见伤湿）。肾
劳，（色伤。）阳虚肾气汤，阴虚知柏地黄汤。（并见虚损。）心劳，（思虑所伤。）清
心莲子饮（见赤白浊）。
热淋。火府丹、益元散、（见伤暑。）导赤散（见发热）、五淋散、榆白皮散。
冷淋。由冷气客于下焦，满于脬中，水道为寒所凝，不得宣通，故先寒战，而
后便数成淋，（邪正相争，正气怯邪气之冷，故寒战。又为冷气相激，则郁热而成淋。）
进冷剂愈甚者是
也。宜地髓汤下八味丸（见虚损），或用生料鹿茸丸（见血）、肉苁蓉丸、泽泻散、沉香散。若
下元虚冷，水寒冰凝，小便不通，或淋沥，证见转筋，喘急欲死，不问男女胎产，
急用八味丸料煎服，缓则不救。盖寒得热则流通，非附、桂何能直达膀胱，使雪消
春水来耶。
又有似淋非淋者。老人阴萎而思色，则精不出而内败，（火虽动而气已衰，不能送精使出
也。）小便涩如淋，（败精流入茎窍。）二便牵痛，（精伤血枯燥，故大便亦痛。）愈痛则愈便，愈便则愈
痛，（精伤血败，气亦下陷，大便红白似痢，小便白浊如淋，因其痛而欲便以求通，因便多
而气愈坠，故痛更甚。）
大菟丝子丸（见咳嗽）、鹿茸丸（见血）、肾气丸（见虚损）。
又有胞痹一证。小腹按之痛，（水闭故按之痛。）若沃以汤，（水闭气蒸成热。）小便不利，上
为清涕，由风寒湿三气客于胞中，痹而不通，故气不化。风寒由足太阳入，太阳经
络脑下鼻，故流清涕。治以肾着汤（见伤湿）、茯苓丸（见小便不禁）、巴戟丸。此本痹证
而兼淋者也。
一滴尿也排不出，称为“闭”，也就是小便完全不通。点滴而出，称为“癃”，也就是淋证。这两种病症都是由气机闭塞、水道涩滞引起的，其原理已在上一编中论述过。淋证的大致病机是肾虚兼膀胱有热。（五脏六腑所受的内邪和外邪之热，都能传入膀胱。）肾气虚则相火妄动，常想排泄而不能固藏，（相火妄动想要排泄，这属于肝的功能，所以上一篇说肝火疏泄过度导致癃证。）所以小便频数。膀胱有热则水道干枯涩滞，所以尿液渗出时涩滞不畅，尿频且涩痛，尿道中疼痛，淋漓不尽，所以称为淋。（肾虚和膀胱热，会导致体内水液减少。张子和治疗一个人，让他立刻吃很多咸鱼，过了一会儿他非常口渴，就让他大量喝水，然后用药物治疗，立刻通畅。他说：淋证是因为体内缺水，所以涩滞。）脉象实大，应当分理治疗。脉象虚细涩，说明精血败坏，难以治疗。治疗方法：行滞气，解邪热，通水道，其中关键又在于平抑心火。此证最忌讳发汗，（淋证属于热邪耗伤津液，发汗会使津液更加枯竭，没有水液可出就会动血。）发汗会导致尿血。《准绳》说暑月多有此证，因为出汗多，小便常赤涩，治疗用五苓散，（见伤湿章节。）收敛体表外发的汗，（意思是方中有白术、桂枝能敛汗，恐怕未必如此。不如去掉桂枝，合用生脉散更好。）使津液聚于体内，再顺势引导下行。然而有虚劳出汗而小便赤涩的，这是津液枯燥，又不宜使用渗利药物了，收敛汗液、清热、滋润津液即可。失血或亡精的人，也按此理论讨论。淋证尿道中必定疼痛，如果先痛后痒，说明火邪已退，也许是实证转为了虚证。
气淋。初起为气淋，因气机阻滞而涩痛，药用白茯苓、甘草梢、白芷、山栀、木通、猪苓、泽泻、车前子、地肤子、葱白。可用生料五苓散（见伤湿章节）加阿胶，或者五苓散、益元散（见伤暑章节）各半服。也可用火府丹佐以导赤散、（见发热章节。）石韦散。或者四苓散（见伤湿章节）加木通、滑石、瞿麦、灯心草。肺热者，清肃之气不能下降，加味八正散。气虚者，八物汤（见虚损章节）加杜牛膝、黄芩。
膏淋。久病发展为膏淋及砂石淋。膏淋因湿热损伤气分，水液混浊如膏，像鼻涕，像米泔水。实热证用八正散加苍术，虚热证用鹿角霜丸。精液与尿液俱出，（精液堵塞尿道，想排出不出来而疼痛。）海金砂散、菟丝子丸、鹿茸丸、（见血门章节。）土牛膝、地肤叶汁、白茯苓、泽泻、山栀、甘草梢、琥珀、郁金、萆薢。
砂淋。尿液被热邪煎熬形成砂石，就像煮海水成盐一样。可用八正散、神效琥珀散、如圣散、石燕丸、独圣散。取石首鱼脑中的石头十个，滑石二钱，琥珀三分，研为细末，每次服用一钱，用木通汤送下。蝼蛄七个，盐一两，铺在新瓦上焙干研为细末，每次服用一钱，温酒送下。冬葵子、滑石、瞿麦、琥珀、土牛膝、车前子、泽泻、山栀、地肤叶汁。必须断绝食盐摄入才有效，一方面淡食能渗利，另一方面没有盐就不会形成结石。
血淋。热邪损伤血分，尿道中必定疼痛，（不痛的称为尿血，见血门章节。）归尾、土牛膝、赤芍、玄胡索、车前子、泽泻、郁金、山栀、刘寄奴主治。血瘀则小腹硬痛，加红花、五灵脂。血热则颜色鲜红，脉数有力，加生地。血虚者，六味地黄丸（见虚损章节）加车前子、牛膝。血冷则颜色黯黑，面色枯槁，尺脉沉迟，用肾气丸（见劳损章节。）死血（瘀血），用牛膝膏。牛膝的根茎叶用酒煮服，治疗小便不利，尿道疼痛欲死，以及妇人血结坚痛，效果如神。但体虚之人不宜单独使用，应当配合补药一起使用，以免损伤胃气。侧柏叶、生藕节、车前草等分，捣汁调服益元散（见伤暑章节）、发灰散、小苏子饮、（均见血门章节。）立效散、瞿麦散。
痰淋。由痰郁气滞化热所致，用七气汤（见气门章节）、青州白丸子（见中风章节）。
劳淋。劳累则动火，热流注膀胱所致。脾劳，（因劳倦所伤。）用补中益气汤（见气门章节）合五苓散（见伤湿章节）。肾劳，（因房事过度所伤。）阳虚用肾气汤，阴虚用知柏地黄汤。（均见虚损章节。）心劳，（因思虑过度所伤。）用清心莲子饮（见赤白浊章节）。
热淋。用火府丹、益元散、（见伤暑章节。）导赤散（见发热章节）、五淋散、榆白皮散。
冷淋。由冷气客居下焦，充满膀胱，水道被寒邪凝滞，不得宣通，所以先寒战，然后小便频数成淋，（邪正相争，正气怯于邪气的寒冷，所以寒战。又因冷气相互激荡，郁而化热而成淋。）服用寒凉药物反而加重的是这种情况。宜用地髓汤送服八味丸（见虚损章节），或用生料鹿茸丸（见血门章节）、肉苁蓉丸、泽泻散、沉香散。若下元虚冷，水寒冰凝，小便不通，或淋漓不尽，证见转筋，喘急欲死，不问男女胎产，急用八味丸料煎服，迟缓则无法挽救。因为寒得热则流通，非附子、桂枝怎能直达膀胱，使冰雪消融春水来呢？
又有似淋非淋的情况。老人阴萎而思色欲，则精液不出而在体内腐败，（火虽动但气已衰，不能推送精液排出。）小便涩滞如淋，（败精流入尿道。）大小便牵拉疼痛，（精伤血枯燥，所以大便也痛。）越痛越想排便，越排便越痛，（精伤血败，气亦下陷，大便红白似痢疾，小便白浊如淋，因为疼痛而想通过排便来求通，因排便多而气更下坠，所以疼痛更甚。）大菟丝子丸（见咳嗽章节）、鹿茸丸（见血门章节）、肾气丸（见虚损章节）。
又有胞痹这一证候。小腹按压疼痛，（水液闭塞所以按压疼痛。）感觉像浇了热水一样，（水液闭塞气蒸腾化热。）小便不利，上部流出清涕，由风寒湿三气客居于胞中，痹阻而不通，所以气化功能失常。风寒从足太阳经侵入，太阳经络连接脑部向下至鼻，所以流清涕。治疗用肾着汤（见伤湿章节）、茯苓丸（见小便不禁章节）、巴戟丸。这本来是痹证而兼有淋证的表现。
A complete inability to excrete even a single drop is termed "Bi" (Obstruction), which means total urinary retention. Excretion in drops is termed "Long" (Stagnation), which refers to strangury. Both conditions are caused by Qi obstruction and fluid pathway涩滞 (stagnation); the principle has already been discussed in the previous section. The general pathogenesis of strangury involves Kidney deficiency and Bladder heat. (The internal and external pathogenic heat received by the five Zang and six Fu organs can all enter the Bladder.) When the Kidney is deficient, ministerial fire moves restlessly, constantly desiring to discharge but unable to store, (when ministerial fire moves and desires discharge, it belongs to the Liver; hence, the previous section stated that excessive Liver fire dispersing leads to Long stagnation.) resulting in frequent urination. Bladder heat causes the water pathways to become dry and stagnant, so urine exudes with difficulty and stagnation. It is frequent yet difficult, painful in the glans penis, dribbling and incomplete, thus it is called strangury. (Kidney deficiency and Bladder heat lead to a scarcity of body fluids. He Zihe treated a patient by having him eat a large amount of salted fish immediately; after a short while, when he was extremely thirsty, he allowed him to drink freely, and then administered medicine, resulting in immediate relief. He said: Strangury is due to a lack of water, hence the stagnation.) If the pulse is excess and large, differentiation and regulation should be employed. If the pulse is deficient, fine, and choppy, it indicates destruction of essence and blood, making it difficult to treat. Treatment principles: Move stagnant Qi, resolve pathogenic heat, unblock the water pathways; the key outline lies in calming Heart fire. This condition strictly forbids diaphoresis (sweating therapy). (Strangury involves heat consuming body fluids; sweating will further deplete them. Without sufficient fluids to excrete, bleeding may occur.) Sweating induces hematuria. *Zhunsheng* states that this condition is common in summer months because excessive sweating leads to red and stagnant urine; treatment uses Wuling San (Five-Ingredient Powder with Poria), (see Injury by Dampness chapter.) to收敛 (astringe) the outwardly released sweat. (This implies that Atractylodis Rhizoma and Cinnamomi Ramulus in the formula can astringe sweat, which may not necessarily be true. It is better to remove Cinnamomi Ramulus and combine with Shengmai San [Generate the Pulse Powder] for optimal results.) This gathers fluids internally and then guides them downward. However, in cases of consumptive disease with sweating and red/stagnant urine, this is due to dryness of body fluids, and diuretic/drainage methods are inappropriate; instead, astringing sweat, clearing heat, and nourishing fluids is suitable. Those who have lost blood or essence follow this same discussion. Strangury must involve pain in the glans penis; if pain precedes itching, the fire has subsided, possibly indicating a transformation from excess to deficiency.
Qi Strangury. Initially presenting as Qi strangury, characterized by Qi stagnation causing涩痛 (stagnant pain), herbs include Poria, Glycyrrhizae Radix et Rhizoma (specifically the tip), Angelicae Dahuricae Radix, Gardeniae Fructus, Akebiae Caulis, Polyporus, Alismatis Rhizoma, Plantaginis Semen, Kochiae Spica, and Allii Fistulosi Bulbus. One may use Shengliao Wuling San (Raw Material Five-Ingredient Powder) (see Injury by Dampness chapter) plus Asini Corii Colla, or take half doses of Wuling San and Yiyuan San (see Injury by Summerheat chapter). Huofu Dan (Fire Mansion Pill) can be used with Daochi San (Guide Out Redness Powder), (see Fever chapter,) or Shiwei San (Pyrola Powder). Alternatively, Siling San (Four-Ingredient Powder) (see Injury by Dampness chapter) plus Akebiae Caulis, Talcum, Polygoni Citrini Herba, and Junci Medulla. For Lung heat, where clear descending Qi fails to descend, Jiawei Bazheng San (Modified Eight-Regulation Powder) is used. For Qi deficiency, Bawu Tang (Eight-Substance Decoction) (see Deficiency and Damage chapter) plus Achyranthis Bidentatae Radix and Scutellariae Radix.
Gao Strangury (Paste Strangury). Long-standing cases develop into Gao strangury and Shashi strangury (gravel strangury). Gao strangury involves damp-heat injuring the Qi level, causing turbid fluids resembling paste, mucus, or rice wash water. For excess heat, Bazheng San plus Atractylodis Macrocephalae Rhizoma is used; for deficient heat, Lujiaoshuang Wan (Deer Horn Glue Pill) is used. When both essence and urine are discharged, (essence blocks the urethra, wanting to exit but unable to, causing pain,) Haijinsha San (Lygodii Spore Powder), Tusizi Wan (Cuscutae Seed Pill), Lurong Wan (Deer Antler Pill), (see Blood chapter,) Achyranthis Bidentatae Radix, Kochiae Spica juice, Poria, Alismatis Rhizoma, Gardeniae Fructus, Glycyrrhizae Radix et Rhizoma (tip), Succinum, Curcumae Radix, and Biexie (Dioscoreae Hypoglaucae Rhizoma) are indicated.
Shashi Strangury (Gravel Strangury). Urine is boiled down by heat into gravel, similar to boiling seawater to make salt. Treatments include Bazheng San, Shenxiao Hupo San (Miraculous Amber Powder), Rusheng San (Like-Sage Powder), Shiyan Wan (Stone Swallow Pill), and Dusheng San (Single-Sage Powder). Take ten stones from the brain of the Stenotaurus fish, 2 qian of Talcum, and 3 fen of Succinum, grind into fine powder, take 1 qian per dose, washed down with Akebiae Caulis decoction. Take 7 earthworms and 1 liang of salt, spread on a new tile, bake until dry, grind into fine powder, take 1 qian per dose, washed down with warm wine. Dongkuizi (Malvae Semen), Talcum, Polygoni Citrini Herba, Succinum, Achyranthis Bidentatae Radix, Plantaginis Semen, Alismatis Rhizoma, Gardeniae Fructus, and Kochiae Spica juice are also used. Salt intake must be completely stopped for efficacy: first, bland food promotes drainage; second, without salt, stones do not form.
Xue Strangury (Blood Strangury). Heat injures the Blood level, causing definite pain in the glans penis. (Absence of pain indicates Hematuria, see Blood chapter.) Principal herbs: Danggui Weilu (Angelica Sinensis Tail), Achyranthis Bidentatae Radix, Paeoniae Radix Rubra, Corydalis Rhizoma, Plantaginis Semen, Alismatis Rhizoma, Curcumae Radix, Gardeniae Fructus, and Liuji Nu (Lysimachiae Herba). If blood stasis causes hardness and pain in the lower abdomen, add Honghua (Carthami Flos) and Wulingzhi (Trogopteri Dung). If blood heat causes bright red color and a rapid, forceful pulse, add Shengdi Huang (Rehmanniae Radix). For blood deficiency, Liuwu Wan (Six-Ingredient Pill) (see Deficiency and Damage chapter) plus Plantaginis Semen and Achyranthis Bidentatae Radix. For blood cold, characterized by dark color, withered complexion, and deep-slow radial pulse, use Shenqi Wan (Kidney-Qi Pill) (see Consumptive Disease chapter.) For fixed blood stasis, Niuxi Gao (Achyranthes Paste) is used. Boiled in wine, the root, stem, and leaf of Achyranthes bidentata treat difficult urination, excruciating pain in the glans penis, and firm painful blood accumulation in women, acting like a divine remedy. However, it is unsuitable for weak individuals; it should be combined with tonics to avoid damaging the Stomach. Equal parts of Platycladi Cacumen, fresh lotus rhizome node, and Plantago herb are crushed for juice, mixed with Yiyuan San (see Injury by Summerheat chapter), Fahui San (Hair Ash Powder), Xiaosuzi Yin (Small Perilla Seed Drink), (all see Blood chapter,) Lixiao San (Instant Efficacy Powder), and Qumai San.
Tan Strangury (Phlegm Strangury). Caused by phlegm stagnation transforming into Qi heat. Use Qiqi Tang (Seven-Qi Decoction) (see Qi chapter) or Qingzhou Baiwanzi (Qingzhou White Pills) (see Wind-Stroke chapter).
Lao Strangury (Fatigue Strangury). Fatigue generates fire, with heat flowing into the Bladder. For Spleen fatigue (injury by overwork), use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (see Qi chapter) combined with Wuling San (see Injury by Dampness chapter). For Kidney fatigue (injury by sexual excess), Yang deficiency is treated with Shenqi Tang, and Yin deficiency with Zhibai Dihuang Tang. (Both see Deficiency and Damage chapter.) For Heart fatigue (injury by overthinking), use Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink) (see Red and White Turbidity chapter).
Re Strangury (Heat Strangury). Use Huofu Dan, Yiyuan San, (see Injury by Summerheat chapter,) Daochi San, (see Fever chapter,) Wulin San (Five-Strangury Powder), and Yubai Pi San (Elm Bark Powder).
Cold Strangury. Caused by cold qi invading the Lower Jiao and filling the bladder, congealing the water pathways so they cannot circulate. Thus, chills occur first, followed by frequent urination forming strangury. (Pathogenic and righteous Qi struggle; the righteous Qi fears the cold of the pathogen, hence chills. Also, mutual agitation of cold qi generates constrained heat leading to strangury.) Conditions worsened by cold agents fall into this category. Treat with Disui Tang (Earth Marrow Decoction) delivering Bawei Wan (Eight-Ingredient Pill) (see Deficiency and Damage chapter), or use Shengliao Lurong Wan (Raw Deer Antler Pill), Rongrong Wan (Cistanche Pill), Zexie San (Alisma Powder), or Chenxiang San (Agarwood Powder). If the Lower Yuan is deficient and cold, with icy congealed water causing urinary retention or dribbling, accompanied by muscle cramps and fatal asthma, regardless of gender or pregnancy status, urgently administer Bawei Wan material decocted and taken orally; delay means no rescue. Cold flows only when warmed by heat; only Aconite and Cinnamon can reach the Bladder directly, melting snow like spring waters.
There are also conditions resembling strangury but not being strangury. In elderly men with impotence desiring sexual activity, essence does not exit but rots internally. (Although fire moves, Qi is too weak to expel essence.) Urine is stagnant like strangury. (Rotten essence flows into the urethral orifice.) Pain in both bowel and bladder movements occurs. (Essence injury and blood dryness cause bowel pain too.) The more painful, the more one desires to defecate/void; the more one voids, the more painful it becomes. (Essence injury and blood decay cause Qi to sink; stool resembles dysentery with red and white matter, urine is turbid white like strangury. Seeking relief through voiding due to pain, and excessive voiding further sinking Qi, makes pain worse.) Da Tusizi Wan (Large Cuscuta Seed Pill), Lurong Wan (Deer Antler Pill), and Shenqi Wan (Kidney-Qi Pill) are used.
There is also Bao Bi (Bladder Bi Syndrome). Pressing the lower abdomen causes pain. (Water blockage causes pain upon pressure.) It feels as if hot soup is poured inside. (Water blockage and Qi stagnation generate heat.) Urination is difficult, and clear mucus runs from the nose above. This is caused by Wind-Cold-Dampness three pathogens invading the bladder, causing Bi obstruction and failure of Qi transformation. Wind-Cold enters via the Foot-Taiyang channel; the Taiyang meridian connects to the brain and descends to the nose, hence clear nasal discharge. Treat with Shen Zhuo Tang (Spleen-Drying Decoction), Fuling Wan (Poria Pill), and Bajie Wan. This is fundamentally a Bi syndrome complicated by strangury symptoms.