此症以茯苓、灯心、条芩为主。若痰闭上焦。寸关必滑。宜探吐以提之。然必胸膈迷闷乃可
(〔吴按〕不可过于通利。亦不宜急用升提。只用萆 厘清饮最妥。)
日久倦怠。右脉微弱。属气虚。用人参。黄 。白术。麦冬。茯苓。加栀子。知母。条芩等
。清火药。
左脉细数形羸。每便则痛。属血虚。用四物汤。加黄柏。知母。条芩。济生方中。治子淋症
。用安荣散。煎麦冬汤下。但滑石、细辛二味稍峻。人之虚实。气血各有不同。达士变而通
之可也。(安荣散方具秘要中。)
人参 茯苓 通草(各一钱) 白术 当归 麦冬(各二钱) 甘草(四分) 灯心(五分) 如有
痰。宜清肺金。加黄芩(七分)
脐腹作胀。小便淋闭。盖孕妇胎系于肾之间。虚热而成斯疾。若项强筋挛。语涩痰盛
。用羚羊角。小便淋痛涩少。用安荣散。肝经风热。用加味逍遥散。腿足转筋。而小便不利。急服
八味丸。迟则不救。服燥药而小便频数。或不利。用生地。茯苓。牛膝。黄柏。知母。川芎
。当归。甘草。煎汤。频数而黄。用四物汤。加黄柏。知母。五味。麦冬。元参。肺气虚而
短少。用补中益气汤。加山药。麦冬。阴挺痿痹而频数。用地黄丸。热结膀胱而不利。用五
苓散。脾肺燥不能小便。用生黄芩。清肺热。膀胱阳虚。阴无所化。用肾气丸。膀胱阴虚。
阳无所生。用滋肾丸。
此症以茯苓、灯心草、黄芩为主药。若痰邪闭塞上焦,寸脉与关脉必然滑利,宜用探吐法以提举气机。然而必须胸膈部感到迷乱闷塞时才可使用。(吴氏按语:不可过于通利小便,也不宜急于使用升提之法,只用萆薢分清饮最为妥当。)
病程日久出现倦怠乏力,右脉微弱,属于气虚证,用人参、黄芪、白术、麦冬、茯苓,加入栀子、知母、黄芩等清热泻火药。
左脉细数且形体消瘦,每次排尿时疼痛,属于血虚证,用四物汤,加入黄柏、知母、黄芩。济生方中治疗子淋(妊娠期间小便淋沥涩痛)症,用安荣散,以麦冬汤送服。但滑石、细辛两味药性稍显峻烈,人的虚实状况及气血各有不同,通达之士应灵活变通处理。(安荣散的方剂组成见《秘要》中。)
人参、茯苓、通草(各一钱),白术、当归、麦冬(各二钱),甘草(四分),灯心草(五分)。如有痰邪,宜清肺金,加黄芩(七分)。
脐腹部胀满,小便淋沥闭塞。大概是因为孕妇的胎系于肾之间,因虚热而引发此疾。若出现颈项强直、筋脉拘挛、言语涩滞、痰涎壅盛,用羚羊角。小便淋沥疼痛、涩滞量少,用安荣散。肝经风热证,用加味逍遥散。腿足转筋(抽筋)且小便不利,急服八味丸,延误则无法救治。服用燥热药物后导致小便频数,或不畅利,用地黄、茯苓、牛膝、黄柏、知母、川芎、当归、甘草,煎汤服用。小便频数且色黄,用四物汤,加入黄柏、知母、五味子、麦冬、玄参。肺气虚而尿量短少,用补中益气汤,加入山药、麦冬。阴挺(子宫脱垂)痿痹且尿频,用地黄丸。热结膀胱导致小便不利,用五苓散。脾肺燥热导致不能小便,用生黄芩清肺热。膀胱阳虚,阴液无法化生,用肾气丸。膀胱阴虚,阳气无法滋生,用滋肾丸。
This syndrome is primarily treated with Poria (Fuling), Juncus effusus (Dengxincao), and Scutellaria baicalensis (Tiaoqin). If phlegm obstructs the Upper Jiao, the Cun and Guan pulses will necessarily be slippery; it is appropriate to induce vomiting by probing to lift the Qi. However, this should only be done when there is a sensation of confusion and oppression in the chest and diaphragm. ([Wu's Note:] Do not use overly draining methods for urination, nor should lifting methods be used hastily. Using Bixie Fenqing Yin is most appropriate.)
If the condition persists for a long time accompanied by fatigue and weakness, and the Right pulse is weak and thready, it belongs to Qi Deficiency. Use Ginseng (Renshen), Astragalus (Huangqi), Atractylodes macrocephala (Baizhu), Ophiopogon (Maidong), and Poria (Fuling), added with Gardenia (Zhizi), Anemarrhena (Zhimu), and Scutellaria (Tiaoqin) and other heat-clearing and fire-purging herbs.
If the Left pulse is fine and rapid, and the body is emaciated, with pain upon each urination, it belongs to Blood Deficiency. Use Siwu Tang (Four Substances Decoction), added with Phellodendron (Huangbai), Anemarrhena (Zhimu), and Scutellaria (Tiaoqin). In the Jisheng Fang, for treating Zilin (dysuria during pregnancy), Anrong San is used, taken with Maidong Tang. However, Talcum (Huashi) and Asarum (Xixin) are slightly harsh; since individuals vary in deficiency and excess, and Qi and Blood differ, knowledgeable practitioners should adapt flexibly. (The formula for Anrong San is found in Mi Yao.)
Ginseng (Renshen), Poria (Fuling), Akebia Caulis (Tongcao) (each 1 qian); Atractylodes macrocephala (Baizhu), Angelica sinensis (Danggui), Ophiopogon (Maidong) (each 2 qian); Licorice (Gancao) (4 fen); Juncus effusus (Dengxincao) (5 fen). If there is phlegm, clear the Lung Metal by adding Scutellaria (Huangqin) (7 fen).
Distension in the umbilical and abdominal regions with dysuria and urinary retention. Generally, the fetal ligament is connected between the Kidneys; this disease arises from deficient heat. If there is neck stiffness, muscle spasms, slurred speech, and abundant phlegm, use Antelope Horn (Lingyangjiao). For dysuria with painful, scanty, and astringent urination, use Anrong San. For Liver Meridian Wind-Heat, use Jiawei Xiaoyao San. For calf cramps with difficult urination, urgently take Bawei Wan (Eight-Ingredient Pill with Rehmannia); delay means no cure. After taking drying/hot herbs, if urination becomes frequent or difficult, use Rehmannia (Shengdi), Poria (Fuling), Achyranthes (Niuxi), Phellodendron (Huangbai), Anemarrhena (Zhimu), Ligusticum chuanxiong (Chuanxiong), Angelica sinensis (Danggui), and Licorice (Gancao), decocted as a soup. For frequent, yellow urination, use Siwu Tang (Four Substances Decoction), added with Phellodendron (Huangbai), Anemarrhena (Zhimu), Schisandra (Wuweizi), Ophiopogon (Maidong), and Scrophularia (Yuanshen). For shortness of urine due to Lung Qi Deficiency, use Buzhong Yiqi Tang, added with Dioscorea (Shanyao) and Ophiopogon (Maidong). For uterine prolapse (Yinting) with flaccidity and numbness accompanied by frequent urination, use Dihuang Wan. For difficulty in urination due to Heat binding the Bladder, use Wuling San. For inability to urinate due to Spleen and Lung Dryness, use raw Scutellaria (Sheng Huangqin) to clear Lung Heat. For Bladder Yang Deficiency where Yin cannot transform, use Shenqi Wan (Kidney Qi Pill). For Bladder Yin Deficiency where Yang cannot generate, use Zishen Wan (Nourish Kidney Pill).