丹溪曰。一妇年近六十。形肥味浓。中焦不清。积为浊气。流入膀胱。下注而成白浊。
浊气即是湿痰。用二陈汤加升、柴、苍白术四帖。浊减半。觉胸满。因升、柴升动胃气。痰
阻而满闷耳。用二陈加炒面、白术、香附以泄其满。素无痰者。升动亦不闷也。继以青黛、
樗皮、蛤粉、黄柏、干姜、滑石为末。神曲为丸。服之全安。
丹溪又治一人。便浊半年。或时梦遗形瘦。作心虚治。以珍珠粉丸合定志丸。服之愈。
〔附〕南安太守张汝弼。曾患渴疾白浊。久服补肾药不效。遇一道人。俾服酒蒸黄连丸
以川连一斤。煮酒浸一宿。甑上累蒸至黑。晒干为末。蜜丸桐子大。日午临卧。酒吞三十
丸。遂全瘳。
潘见所弱冠患白浊。医治三年不愈。其脉两寸短弱。两关滑。两尺洪滑。孙东宿曰。君
疾易愈。第待来春之仲。一剂可瘳。而今时不可。因问何以必待来年。孙曰。经云。升降浮
沉必顺之。又云。天时不可伐。君脉为湿痰下流证也。洪大而见于尺部。是阳乘于阴。法当
从阴引阳。但今冬令。为闭藏之候。冬之闭藏。实为来春发生根本。天人一理。若罔顾天时
而强用升提之法。是伐天和而泄元气。根本既亏。来春何以发生。闻言不信。别寻医药。
仍无效。至春分。东宿以白螺蛳壳火 存性四两。牡蛎二两。半夏、葛根、柴胡、苦参、川
柏各一两。曲糊丸。早晚服。名曰端本丸。不终剂而全愈。
震按医书向有精浊、溺浊之分。以予验之。浊必由精。溺则有淋无浊也。凡患浊者。窍
端时有秽物粘渗不绝。甚则结盖。溺时必先滴出数点而后小便随之。小便却清。惟火盛则色
黄。亦不混浊。古书乃云漩面如油。光彩不定。漩脚下澄。凝如膏糊。此是膏淋与下消证。
非白浊也。白浊之因。有欲心萌而不遂者。有渔猎勉强之男色者。有醉酒及用春方以行房。
忍精不泄者。皆使相火郁遏。败精瘀腐而成。故白浊多有延成下疳重候。岂溺病乎。内经谓
水液混浊。皆属于热。热甚则为赤浊。或白浊久而血不及化为精。亦变赤浊。此则危矣。治
法不外养阴清热。佐以坚肾利水。盖癸窍宜闭。壬窍宜通也。初起者。当兼疏泄败精之品。
如滑石、冬葵子、牛膝、萆 之类。日久者。当兼补元实下之品。如人参、熟地、湘莲、芡
实之类。亦无甚艰难。兹选四案。湿痰湿热居其二。盖恐人只守定治肾一法耳。夫湿痰湿热
似非精病。不知湿热内侵肾脏。则精不清而为浊。生生子案。及世人用腐浆冲滑石。或白
果浆者。去其湿热。精自固也。湿痰下注肾脏。则精不宁而为浊。丹溪首案。及李士材治武
科张姓案。消其湿痰。精自驻也。若系溺病。何以不用淋证门石苇散、八正散等方耶。即日
久而元气下陷。有用补中益气汤者。亦以元气得补。才能升举其精。不使渗漏耳。惟夏月冒
暑便浊。用辰砂六一散。及筋疝之白物如精。随溲而下。用龙胆泻肝汤。二条方是溺病。然
与赤白浊情形原有别也。
朱丹溪说：有一位接近六十岁的女性，身体肥胖且饮食肥甘厚味，导致中焦脾胃不清爽，积聚形成浊气，流入膀胱，向下注泄而成为白浊。
这里的浊气就是湿痰。使用二陈汤（燥湿化痰、理气和中的方剂）加入升麻、柴胡、苍术、白术，服用四帖后，浊症减半。患者感到胸部胀满，这是因为升麻、柴胡升提动摇了胃气，导致痰湿阻滞而出现胸闷。于是改用二陈汤加入炒面粉、白术、香附来消除胀满。平时没有痰湿的人，即使使用升提药也不会感到闷堵。随后用青黛、樗白皮、蛤粉、黄柏、干姜、滑石研成粉末，以神曲为粘合剂制成丸药，服用后完全康复。
朱丹溪又治疗过一个人，患便浊半年，有时梦遗，身体消瘦，诊断为心虚进行治疗，使用珍珠粉丸配合定志丸，服用后痊愈。
〔附记〕南安太守张汝弼，曾患口渴病和白浊，长期服用补肾药物无效。遇到一位道人，让他服用酒蒸黄连丸。方法是用川黄连一斤，用酒浸泡一夜，在甑上反复蒸至变黑，晒干研末，蜂蜜调和制成梧桐子大小的丸药。每天中午和临睡前，用酒送服三十丸，最终完全治愈。
潘见所二十岁时患白浊，医生治疗三年未愈。他的脉象两寸部短弱，两关部滑，两尺部洪滑。孙东宿说：“您的病容易治愈，只需等到明年仲春时节，一剂药即可痊愈。但现在这个时候不行。”于是询问为什么一定要等到来年。孙东宿说：“《内经》说：升降浮沉必须顺应自然规律。又说：天时不可违背。您的脉象属于湿痰下流的证候。脉象洪大且出现在尺部，这是阳邪乘袭阴分，治法应当从阴引阳。但是现在是冬季，是闭藏的时令。冬天的闭藏，实际上是来年春天万物生发的根本。天与人的道理是一致的。如果不顾天时，强行使用升提的方法，就是破坏天和之气而泄露元气。根本既然亏损，来年春天如何发生生机？”潘见所听了不相信，另外寻找医药，仍然无效。到了春分日，孙东宿用白螺蛳壳煅存性四两，牡蛎二两，半夏、葛根、柴胡、苦参、川柏各一两，用曲糊制成丸药，早晚服用，名为端本丸，没有服完一剂就完全痊愈了。
俞震按语：医书中向来有精浊、溺浊的区分。根据我的经验验证，浊症必然由精室引起，溺病只有淋证而没有浊症。凡是患浊症的人，尿道口时常有秽物粘渗不止，严重时甚至结盖，排尿时必定先滴出几点，然后小便随之而来，小便却是清澈的，只有火盛时颜色发黄，也不混浊。古书却说尿液表面像油一样，光彩不定，尿脚沉淀，凝结如膏糊，这是膏淋和下消证，不是白浊。白浊的原因，有因性欲萌动而不能遂愿的，有从事男色交易的，有醉酒及服用春药行房事并忍精不泄的，这些都使相火郁遏，败精瘀积腐败而成。所以白浊多会拖延发展成严重的下疳重症，这难道是溺病吗？《内经》说水液混浊都归属于热，热甚则成为赤浊，或者白浊久了，血不及化为精，也会变成赤浊，这就危险了。治疗方法不外乎养阴清热，佐以坚肾利水。因为癸窍（精窍）宜闭，壬窍（尿窍）宜通。初起者，应当兼用疏泄败精的药物，如滑石、冬葵子、牛膝、萆薢之类。日久者，应当兼用补元实下的药物，如人参、熟地、湘莲、芡实之类。也没有多么艰难。这里选取四个医案，其中两个属于湿痰湿热证。大概是担心人们只固守治疗肾脏这一种方法罢了。湿痰湿热似乎不是精的病，但不知道湿热内侵肾脏，则精不清而为浊，如生生子的医案，以及世人用腐浆冲服滑石，或用白果浆的情况，去除湿热，精自固摄。湿痰下注肾脏，则精不宁而为浊，如朱丹溪的首个医案，以及李士材治疗武科张姓患者的医案，消除湿痰，精自驻留。如果是溺病，为什么不用淋证门中的石苇散、八正散等方剂呢？即使日久导致元气下陷，有用补中益气汤治疗的，也是因为元气得到补充，才能升举其精，防止渗漏罢了。只有在夏季冒受暑邪导致的便浊，用辰砂六一散；以及筋疝出现的白物如精，随小便而下，用龙胆泻肝汤，这两条方证才是溺病。然而这与赤白浊的情形原本是有区别的。
Zhu Danxi said: A woman near sixty years of age, with a fat physique and a diet rich in fatty and strong flavors, suffered from unclear Qi in the Middle Jiao (Middle Burner). This accumulated to form turbid Qi, which flowed into the Bladder and descended to become White Turbidity (White Cloudy Urine).
This turbid Qi is essentially Damp-Phlegm. Using Er Chen Tang (Two-Cured Decoction) added with Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Cang Zhu (Atractylodis Rhizoma), and Bai Zhu (Atractylodis Macrocephalae Rhizoma), after four doses, the turbidity decreased by half. The patient felt chest fullness because Sheng Ma and Chai Hu had lifted and disturbed Stomach Qi, causing Phlegm obstruction and stuffiness. Therefore, Er Chen Tang was modified with fried flour, Bai Zhu, and Xiang Fu (Cyperi Rhizoma) to drain the fullness. Those who do not normally have Phlegm will not feel stuffy even if lifting herbs are used. Subsequently, Qing Dai (Indigo Naturalis), Chu Pi (Stemonae Radix Bark), Ge Fen (Concha Meretricis et Cyclinae), Huang Bo (Phellodendri Cortex), Gan Jiang (Zingiberis Rhizoma), and Hua Shi (Talcum) were powdered, mixed with Shen Qu (Massa Medicata Fermentata) as a binder to make pills, which cured her completely.
Danxi also treated a man who had suffered from turbid urine for half a year, occasionally experiencing nocturnal emissions and emaciation. Diagnosed as Heart Deficiency, he was treated with Zhen Zhu Fen Wan (Pearl Powder Pill) combined with Ding Zhi Wan (Calming Will Pill), which cured him.
[Appendix] Zhang Rubi, Prefect of Nan'an, once suffered from thirst disease and white turbidity. Long-term use of Kidney-tonifying medicines was ineffective. He met a Daoist priest who advised him to take Wine-steamed Coptis Pills. One jin of Chuan Lian (Coptidis Rhizoma) was soaked in wine overnight, then steamed repeatedly over a steamer until black, dried, powdered, and honey-pilled to the size of paulownia seeds. Taken thirty pills at noon and before bed with wine, he was completely cured.
Pan Jiansuo suffered from white turbidity at the age of twenty. Medical treatment for three years failed. His pulse was short and weak at both Cun (inch) positions, slippery at both Guan (middle) positions, and surging and slippery at both Chi (cubit) positions. Sun Dongsu said, "Your illness is easy to cure; simply wait until mid-spring next year. One dose will suffice. But now is not the time." When asked why it must wait until next year, Sun replied, "The Classics state that ascending, descending, floating, and sinking must follow natural laws. It also states that one should not violate the timing of Heaven and Earth. Your pulse indicates a syndrome of Damp-Phlegm flowing downward. A surging pulse appearing at the Chi position indicates Yang invading Yin. The treatment method should be to draw Yang from Yin. However, it is currently winter, the season of closure and storage. Winter's closure and storage are actually the root for the generation of life in the coming spring. Heaven and humanity share the same principle. If one ignores the seasonal timing and forcibly uses lifting methods, it destroys the harmony of Heaven and leaks Yuan Qi. Once the root is depleted, how can life generate in the coming spring?" Pan did not believe this, sought other medical treatments, but remained ineffective. At the Spring Equinox, Dongsu used Si Li Ke (Shell of White River Snail) calcined to preserve its nature (four liang), Mu Li (Ostreae Concha) (two liang), Ban Xia (Pinelliae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Chai Hu (Bupleuri Radix), Ku Shen (Sophorae Flavescentis Radix), and Chuan Bai (Phellodendri Amurensis Cortex) (one liang each), made into pills with Qu paste, taken morning and evening, named Duan Ben Wan (Root-Establishing Pill). He was completely cured without finishing one dose.
Yu Zhen commented: Medical books have traditionally distinguished between Jing Zhuo (Essence Turbidity) and Niao Zhuo (Urine Turbidity). Based on my experience, turbidity necessarily originates from the Essence chamber; urinary diseases have Lin syndrome but not turbidity. Patients with turbidity often have foul discharge sticking and oozing from the orifice, sometimes forming a crust. Before urination, a few drops appear, followed by clear urine. Only when Fire is excessive does the color turn yellow, but it remains not turbid. Ancient texts describe urine surface like oil, with unstable luster, and sediment at the bottom condensing like paste. This is Gao Lin (Paste-like Lin Syndrome) and Xia Xiao (Lower Wasting-Thirst), not white turbidity. The causes of white turbidity include unfulfilled sexual desire, prostitution with males, drunkenness, use of aphrodisiacs during intercourse, and retaining semen. All these cause Ministerial Fire to be depressed, leading to the stasis and putrefaction of ruined essence. Thus, white turbidity often prolongs into severe conditions like Chancre. How can this be a urinary disease? The Inner Canon states that turbid fluids all belong to Heat. Excessive heat becomes Red Turbidity. Or, long-standing white turbidity where blood fails to transform into essence may also change into red turbidity, which is critical. Treatment methods mainly involve nourishing Yin and clearing Heat, assisted by firming the Kidney and promoting urination. Since the Gui Qiao (Essence Orifice) should be closed and the Ren Qiao (Urinary Orifice) should be open, early cases should include herbs that vent ruined essence, such as Hua Shi (Talcum), Dong Kui Zi (Malvae Semen), Niu Xi (Achyranthis Bidentatae Radix), and Bi Xie (Dioscoreae Hypoglaucae Rhizoma). For long-standing cases, herbs that tonify Yuan and secure the lower body, such as Ren Shen (Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Preparata), Xiang Lian (Nelumbinis Semen), and Qian Shi (Euryales Semen), should be included. It is not difficult. Here I select four cases, two of which are Damp-Phlegm and Damp-Heat syndromes. This is likely to prevent people from only adhering to the single method of treating the Kidney. Although Damp-Phlegm and Damp-Heat seem unrelated to essence disorders, if Damp-Heat invades the Kidney internally, essence becomes unclear and turbid. As seen in Sheng Shengzi's case, and when laypeople use fermented slurry with Hua Shi or Bai Guo (Ginkgo Seed) paste to remove Damp-Heat, essence naturally consolidates. If Damp-Phlegm flows downward to the Kidney, essence becomes restless and turbid. As in Danxi's first case and Li Shicai's treatment of a military candidate surnamed Zhang, eliminating Damp-Phlegm allows essence to remain stable. If it were a urinary disease, why not use Shi Wei San (Pyrosperma Powder) or Ba Zheng San (Eight-Ingredient Corrective Powder) from the Lin syndrome section? Even if long-standing depletion leads to sinking of Yuan Qi, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) may be used because tonified Yuan Qi can lift essence and prevent leakage. Only in summer cases of turbid urine due to Summerheat, treated with Chen Sha Liu Yi San (Cinnabar Six-to-One Powder); and in Jin Shan (Sinew Chancre) where white substance like essence follows urine, treated with Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver), are these truly urinary diseases. However, these differ originally from the condition of red and white turbidity.