淫浊与带下之不同者,盖白带出于胞宫,精之余也;淫浊出于膀胱,水之浊也。虽膀胱与肾为表里,故带
浊之源,无非皆出于阴分。然带由脾肾之虚滑者多;淫浊由膀胱之湿热者多,此其所以有辨也。
若淫浊初起而见热涩者,宜大厘清饮。若初起无火,而但有窒塞者,宜小厘清饮或五苓散。若肝经怒火
下流,宜加味逍遥散。若肝火盛而见痛涩者,宜龙胆泻肝汤。若服寒凉利药太过,以致下焦虚寒不固者,宜萆
厘清饮。若元气虚寒下陷者,宜寿脾煎、补中益气汤。若脾湿下流者,宜归脾汤、六君子汤。若久而不愈,
肝肾虚滑下陷者,宜寿脾煎、秘元煎、家韭子丸。
大厘清饮(见《新方八阵·寒阵》)治积热闭结,小水不利,或致腰腹下部极痛,或湿热下利,黄胆
溺血,邪热蓄血,腹痛淋闭等证。
茯苓 泽泻 木通(各二钱) 猪苓(一钱) 栀子(二钱) 枳壳 车前子(各一钱)
水一钟半,煎八分,食远温服。如内热甚者,加黄芩、黄柏、草龙胆之属。如大便坚硬胀满者,加大黄二、
三钱。如黄胆小水不利热甚者,加茵陈二钱。如邪热蓄血腹痛者,加红花、青皮各一钱五分。
小厘清饮(见《新方八阵·和阵》)治小水不利,湿滞肿胀,不能受补等证,此方主之。
茯苓(二、三钱) 泽泻(二、三钱) 薏仁(二钱) 猪苓(二、三钱) 枳壳(一钱) 浓朴(一钱)
水一钟半,煎七分,食前服。如阴虚水不能达者,加生地、牛膝各二钱。如黄胆者,加茵陈二钱,如无内
热而寒滞不行者,加肉桂一钱。
仲景 五苓散(见《古方八阵·和阵》)治暑热烦躁,霍乱泄泻,小便不利而渴,淋涩作痛,下部
湿热。
白术 猪苓 茯苓(各七钱半) 桂枝(五钱) 泽泻(一两二钱半)
古法为细末,每服二钱,白汤调下,日三服。今法以水煎服。
加味逍遥散(见经不调)
龙胆泻肝汤(见产门不闭)
杨氏 萆 厘清饮(见《古方八阵·热阵》)治真元不足,下焦虚寒,或服寒凉刮药过多,小便白浊,
频数无度,澄如膏糊等证。
益智仁 川萆 石菖蒲 乌药(各等分)
上 咀,每服五、六钱,水一钟,入盐一捻,煎七分,食前温服。一方加茯苓、甘草。
寿脾煎(见血虚经乱)
补中益气汤(见经不调)
归脾汤(见经不调)
六君子汤(见经期腹痛)
秘元煎(见血虚经乱)
家韭子丸(见带下)
淫浊与带下的不同之处,在于白带出自胞宫,是精液的剩余部分;而淫浊出自膀胱,是水液中的浑浊物。虽然膀胱与肾互为表里,所以带下和淫浊的源头,无非都出于阴分。然而,带下多由脾肾虚弱滑脱所致;淫浊多由膀胱湿热所致,这就是二者需要辨别的原因。
如果淫浊初起且伴有热感和排尿涩痛,适宜使用大厘清饮。如果初起没有火邪,但仅有窒塞感,适宜使用小厘清饮或五苓散。如果是肝经怒火下行,适宜使用加味逍遥散。如果肝火旺盛且伴有疼痛和排尿涩痛,适宜使用龙胆泻肝汤。如果服用寒凉利尿药物太过,导致下焦虚寒不固,适宜使用萆薢分清饮(此处原文作“萆厘清饮”,结合方义及后文杨氏方,实指萆薢分清饮类方,但依指令保留原名“萆厘清饮”)。如果元气虚寒下陷,适宜使用寿脾煎、补中益气汤。如果脾湿下行,适宜使用归脾汤、六君子汤。如果病程长久不愈,肝肾虚弱滑脱下陷,适宜使用寿脾煎、秘元煎、家韭子丸。
大厘清饮(见《新方八阵·寒阵》)治疗积热闭结,小便不利,或者导致腰腹下部极度疼痛,或者湿热下注导致的痢疾、黄疸、尿血,邪热蓄血,腹痛淋证闭塞等证候。
茯苓、泽泻、木通(各二钱)、猪苓(一钱)、栀子(二钱)、枳壳、车前子(各一钱)。
用水一钟半,煎至八分,饭后稍远时温服。如果体内热邪严重,加入黄芩、黄柏、草龙胆之类。如果大便坚硬胀满,加入大黄二、三钱。如果黄疸且小便不利、热邪严重,加入茵陈二钱。如果邪热蓄血导致腹痛,加入红花、青皮各一钱五分。
小厘清饮(见《新方八阵·和阵》)治疗小便不利,湿滞肿胀,不能耐受补益等证候,此方主治这些情况。
茯苓(二、三钱)、泽泻(二、三钱)、薏仁(二钱)、猪苓(二、三钱)、枳壳(一钱)、浓朴(一钱)。
用水一钟半,煎至七分,饭前服用。如果阴虚导致水液不能通达,加入生地、牛膝各二钱。如果有黄疸,加入茵陈二钱。如果没有内热而是寒滞不行,加入肉桂一钱。
张仲景的五苓散(见《古方八阵·和阵》)治疗暑热烦躁,霍乱泄泻,小便不利且口渴,淋证涩痛,下部湿热。
白术、猪苓、茯苓(各七钱半)、桂枝(五钱)、泽泻(一两二钱半)。
古法将其研为细末,每次服用二钱,用白开水调服,每日三次。现在的用法是用水煎服。
杨氏的萆厘清饮(见《古方八阵·热阵》)治疗真元不足,下焦虚寒,或者因服用寒凉刮药过多,导致小便白浊,次数频繁无度,尿液澄清如膏糊等证候。
益智仁、川萆薢、石菖蒲、乌药(各等分)。
以上药材切碎,每次服用五、六钱,用水一钟,加入一捻盐,煎至七分,饭前温服。另一配方加入茯苓、甘草。
寿脾煎(见血虚经乱章节)
补中益气汤(见经不调章节)
归脾汤(见经不调章节)
六君子汤(见经期腹痛章节)
秘元煎(见血虚经乱章节)
家韭子丸(见带下章节)
The difference between Yin Zhuo (turbid discharge) and Dai Xia (leukorrhea) lies in the origin: Dai Xia originates from the Bao Gong (uterus/womb), being the residue of Jing (essence); whereas Yin Zhuo originates from the Pang Guang (bladder), being the turbidity within Shui (water/fluids). Although the Pang Guang and Shen (kidney) are exterior-interior paired, the source of both Dai and Zhuo ultimately stems from the Yin aspect. However, Dai Xia is mostly caused by deficiency and slipping of the Pi (spleen) and Shen; Yin Zhuo is mostly caused by Damp-Heat in the Pang Guang. This is why they must be distinguished.
If Yin Zhuo begins with heat sensation and dysuria, Da Li Qing Yin (Great Clarifying Decoction) is appropriate. If it begins without Fire pathogen but with a feeling of obstruction, Xiao Li Qing Yin (Small Clarifying Decoction) or Wu Ling San (Five-Ingredient Powder with Poria) is appropriate. If Liver Meridian Fire descends, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) is appropriate. If Liver Fire is excessive accompanied by pain and dysuria, Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) is appropriate. If cold-cooling diuretic medicines were taken excessively, leading to deficiency-cold and insecurity in the Lower Jiao (Lower Burner), Bi Li Qing Yin (Clarifying Decoction for Turbid Urine) is appropriate. If Yuan Qi (Primordial Qi) is deficient and cold with sinking, Shou Pi Jian (Spleen-Nourishing Decoction) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) are appropriate. If Pi Dampness flows downward, Gui Pi Tang (Restore the Spleen Decoction) and Liu Jun Zi Tang (Six-Gentleman Decoction) are appropriate. If the condition persists for a long time, with deficiency and slipping of the Gan (liver) and Shen causing sinking, Shou Pi Jian, Mi Yuan Jian (Secretify the Origin Decoction), and Jia Jiu Zi Wan (Leek Seed Pill) are appropriate.
Da Li Qing Yin (see *New Formulas Eight Arrays · Cold Array*) treats accumulation of heat and closure, difficult urination, or extreme pain in the lower waist and abdomen, or damp-heat flowing downward causing dysentery, jaundice, hematuria, evil heat storing blood, abdominal pain, strangury, and urinary retention.
Fuling (Poria), Zexie (Alisma), Mutong (Akebia Stem) (each 2 qian), Zhuling (Polyporus) (1 qian), Zhizi (Gardenia) (2 qian), Zhiqiao (Bitter Orange Fruit), Cheqianzi (Plantago Seed) (each 1 qian).
Add 1.5 zhong of water, decoct to 0.8 zhong, take warm after meals with some distance. If internal heat is severe, add Huangqin (Scutellaria Root), Huangbai (Phellodendron Bark), Caolongdan (Gentiana Scabra Root). If stool is hard and distended, add Dahuang (Rhubarb Root) 2–3 qian. If jaundice with difficult urination and severe heat, add Yichen (Artemisia Capillaris Herba) 2 qian. If evil heat stores blood causing abdominal pain, add Honghua (Carthamus Flower), Qingpi (Aurantii Fructus Perfricatus) each 1.5 qian.
Xiao Li Qing Yin (see *New Formulas Eight Arrays · Harmonizing Array*) treats difficult urination, damp stagnation with swelling, inability to tolerate tonification, etc., which this formula primarily addresses.
Fuling (2–3 qian), Zexie (2–3 qian), Yiren (Coix Seed) (2 qian), Zhuling (2–3 qian), Zhiqiao (1 qian), Nongpo (Magnolia Bark) (1 qian).
Add 1.5 zhong of water, decoct to 0.7 zhong, take before meals. If Yin deficiency prevents water distribution, add Shengdi (Rehmannia Root) and Niuxi (Achyranthes Root) each 2 qian. If jaundice is present, add Yichen 2 qian. If there is no internal heat but cold stagnation impedes flow, add Rougui (Cinnamon Bark) 1 qian.
Zhang Zhongjing's Wu Ling San (see *Ancient Formulas Eight Arrays · Harmonizing Array*) treats summer-heat heat with irritability, cholera-like diarrhea, difficult urination with thirst, strangury with painful urination, and damp-heat in the lower body.
Baizhu (Atractylodes Macrocephala Rhizome), Zhuling, Fuling (each 7.5 qian), Guizhi (Cinnamon Twig) (5 qian), Zexie (1 liang 2.5 qian).
Ancient method: grind into fine powder, take 2 qian per dose, mix with plain hot water, three times daily. Modern method: decoct with water and take orally.
Jia Wei Xiao Yao San (see Menstrual Irregularity chapter)
Long Dan Xie Gan Tang (see Vaginal Incompetence chapter)
Yang Shi's Bi Li Qing Yin (see *Ancient Formulas Eight Arrays · Heat Array*) treats insufficiency of True Yuan, deficiency-cold in the Lower Jiao, or excessive consumption of cold-cooling scraping medicines, leading to white turbid urine, frequent urination without limit, urine clear like paste, etc.
Yizhiren (Alpinia Oxyphylla Fruit), Chuanbi (Dioscorea Hypoglauca Rhizome), Shichangpu (Acorus Tatarinowii Rhizome), Wuyao (Lindera Root) (equal parts).
Chop the above ingredients, take 5–6 qian per dose, add 1 zhong of water and a pinch of salt, decoct to 0.7 zhong, take warm before meals. Another prescription adds Fuling and Gancao (Licorice Root).
Shou Pi Jian (see Blood Deficiency Menstrual Disorder chapter)
Bu Zhong Yi Qi Tang (see Menstrual Irregularity chapter)
Gui Pi Tang (see Menstrual Irregularity chapter)
Liu Jun Zi Tang (see Dysmenorrhea chapter)
Mi Yuan Jian (see Blood Deficiency Menstrual Disorder chapter)
Jia Jiu Zi Wan (see Leukorrhea chapter)