金匮云。淋之为病。小便如粟状。小腹弦急。痛引脐中。趺阳脉数。胃中有热。即消谷引食。
大便必坚。小便即数。小便不利者。有水气。其人苦渴。栝蒌瞿麦丸主之。小便不利。蒲灰散主
之。滑石白鱼散、茯苓戎盐汤并主之。渴欲饮水。口干舌燥者。白虎加人参汤主之。脉浮发热。
渴欲饮水。小便不利者。猪苓汤主之。淋家不可发汗。发汗则便血。
金匮论淋证四条。一曰小便如粟状。小腹弦急。痛引脐中。此肝移热于膀胱。因肝热甚。失
其疏泄之令而然也。一曰胃中有热。消谷引食。大便坚。小便数。此因胃热炽甚。消烁津液。肠
胃膀胱之源俱涸也。一曰有水气。其人苦渴。此膀胱气化不行。水积胞中为患也。一曰小便不利。
用蒲灰散等治。此因膀胱血病。血属阴。阴病则阳亦不能施化也。其用栝蒌瞿麦丸者。盖缘肺气
不化。膀胱不通。致水渍则津液不行。而胃中燥渴。故用栝蒌根以生津。薯蓣以补肺。茯苓疏肺
气下行。瞿麦逐膀胱癃结。然欲散下焦之结。又需阳药始得开通。故少加附子为使。必水积而腹
中冷者。方可用之。若虽有水气而腹中不冷。即当效五苓之法。以桂易附。或因积热闭癃。又当
改附子为知、柏
也。其蒲灰散等三方。悉治膀胱血滞气不化而小便不利之证。蒲灰滑石者。薄灰治瘀血。滑石利
窍也。乱发滑石白鱼者。发灰消瘀血。白鱼去水气也。茯苓戎盐者。咸润走血。佐茯苓淡渗利小
水。白术兼利腰脐间血也。三方亦有轻重。乱发为重。蒲灰次之。戎盐又次之。至于渴欲饮水。
口干舌燥。明系热在上焦。故用白虎以荡涤膈上之热。加人参以救津液也。渴欲饮水。小便不利。
乃热结膀胱。津液固结之候。而见脉浮发热。太阳热邪循经发外也。故用猪苓汤以导热滋燥。慎
勿因其发热而与发汗。重伤其阴。必致便血。故为切戒。
诸淋所发。皆肾虚而膀胱生热也。水火不交。心肾气郁。遂使阴阳乖舛。清浊相干。蓄在下
焦。故膀胱里急。膏血砂石。从水道出焉。于是有淋沥不断之状。甚者窒塞其间。令人闷绝。凡
小肠有气。则小便胀。小肠有血。则小便涩。小肠有热。则小便痛。制剂之法。并宜流行滞气。
疏利小水。清解热邪。其于平调心火。又三者之纲领焉。心清则小便自利。血不妄行。最不可用
补气之药。气得补而愈胀。血得补而愈涩。热得补而愈盛。水窦不行。加之谷道闭遏。未见其有
能生者也。虽然。肾气虚弱。囊中受寒而成淋涩者有之。其证先寒栗而后溲血。盖冷气与正气交
争故也。又有胞系转戾不通者。其证脐下急痛。小便不通。凡强忍小便。疾行走马。或忍尿入房。
使水气逆上。气迫于胞。故屈戾而不得舒张也。胞落则殂。
石淋者。脐腹隐痛。小便难。痛不可忍。溲如砂石。或黄赤。或混浊。色泽不定。正如汤瓶
久受煎熬。底结白碱。宜清其积热。涤其砂石。如麦冬、葶苈、木通、葵子、滑石、车前、连翘、
瞿麦、知母。涩痛甚者。为膀胱蓄血。加琥珀、肉桂、大黄辛温以散之。加味葵子茯苓散。专治
石淋之圣药。紫雪亦佳。劳淋者。遇劳即发。小便淋沥不绝。如水滴沥而不断。有脾劳肾
劳之分。劳于脾者。补中益气加车前、泽泻。劳于肾者。六味丸加麦冬、五味。血淋者。虽主实
主血而与小肠为表里。然须看血色分冷热。色鲜紫者。为小肠实热。小肠热甚而血渗胞中。与溲
俱下。大剂生牛膝为主。兼车前、山栀、生地、紫菀、犀角、桃仁、芦根汁、生藕节汁。血虚而
热。用生地黄三两。黄芩、阿胶各半两。柏叶少许。水煎服之。此千金法也。若色瘀淡者。属肾
与膀胱虚冷。生料六味丸加肉桂。芦根捣水煎。候冷服。若两尺脉沉弦而数。必有瘀血停蓄。犀
角地黄汤加紫菀、牛膝。若琥珀、麝香、当归、川芎、萆 、木通、白术、木香、香燥破血利水
耗气之类切禁。气淋者。气化不及州都。胞中气胀。小腹满坚。溺有余沥。宜沉香、肉桂、茯苓、
泽泻。佐以木通、瞿麦、葵子、山栀、石苇之类。实则气滞不通。脐下妨闷。加香附、木香。不
应。加硝、黄。溺后疼痛。去石苇、木通、瞿麦、葵子、山栀。加秋石、生甘草梢、藕汁。气淋
服利水药不能通者。沉香降气、四磨汤选用。膏淋者。俨若脂膏。或便中有如蜓蚰之状。此名肉
淋。乃精溺俱出。精塞溺道。故便欲出不能而痛。宜茯苓、秋石、沉香、海金沙、泽泻、滑石。
如不甚痛者。须固涩其精。慎勿误与通利。鹿角霜、肉苁蓉、菟丝子、莲须、芡实、山药之类。
或桑螵蛸、菟丝子等分。泽泻减半。蜜丸服。后以六味丸合聚精丸调补之。冷淋者。寒气客于下
焦。水道不宣。满于胞内。淋涩而白。先发寒栗。而后便数成淋。宜金匮肾气丸加鹿茸、沉香。
戴氏云。进冷剂愈甚者。此是冷淋。牛膝半两煎汤。加麝少许。下八味丸。冷淋小便闭涩。数起
不通。窍中苦痛。憎寒凛凛。或因烦渴饮水过多。水积胞中不行。生附子散。不应。用栝蒌瞿麦
汤。热淋者。心肺蕴热。不能滋其化源。小便赤涩如血而少。烦渴引饮者。导赤散加黄芩。躁热
不渴者。滋肾丸。或淡竹叶煎汤调辰砂益元散。凡人服金石大毒。以助入房。败精流入胞中。及
饮食痰积渗入者。则皆成淋。或忍精不泄。停凝作痛而致淋者。木通、车前、牛膝、泽泻、茯苓、
滑石、甘草。或汤或
丸俱效。有膏粱太过。食积成痰。流注为淋。宜尿浸山楂、川连、丹、皮海石、玄明粉之类。小
便艰涩如淋。短而不作痛者。虚也。六味丸加鹿茸、肉苁蓉。如茎中不痛而痒者。此属精虚。八
味丸。小便淋沥。茎中痛不可忍。相引胁下痛。参苓琥珀散。有服五苓散不效。用生料鹿茸丸却
愈。此皆下元虚冷之故。胞痹小便淋沥涩痛。肾虚膀胱积热也。肾沥汤。胞痹不得小便。小腹痛。
若沃以汤。则小便虽涩而略通者。此膀胱虚寒也。茯苓丸。虚寒甚者。巴戟丸。老人精气已衰。
犹不绝欲。小便淋沥。小腹胀闭而牵引谷道。或溺血梗痛。肾气丸加牛膝。热极成淋。茎中痛。
五苓散减桂大半。加滑石、木通、生甘草梢。口苦咽干。小便赤涩。或欲成淋。清心莲子饮。伏
暑成淋。五苓和益元散。虚人。生脉散。不时服之。小便自清。后有几点血者。五苓散加牛膝、
熟地、紫菀。有因怒而致淋者。非青皮、沉香、山栀、木通不能已也。有因思虑成淋者。归脾汤
和五苓散并进。汗多而小便痛。暑月常有之。盛暑冷冻饮料既多。上停为饮。外发为汗。津液不通。
小肠闭塞。五苓散加人参、甘草。名春泽汤。最为合剂。老人气虚下陷成淋者。补中益气加木通、
泽泻。以升麻、柴胡升九地之阴。木通、泽泻降九天之阳。服之殊验。心脾血虚。归脾汤、辰砂
妙香散选用。淡秋石治血淋茎中热痛。降火最捷。但元气下陷。小便多者禁用。血淋服诸药不效。
一味薏苡根捣汁服之。血淋每日用黄茧丝二两。煮汤饮之。七日必效。留丝 灰存性。蜜丸服之。
并主妇人血崩。又生鸡子黄。每日清晨沸汤调服二枚。其血自清。牛膝三两。煮成。入麝少许顿
服。名地髓汤。此治血淋要剂。但淋久不止。元气下陷者。又为切禁。且虚人能损胃气。及崩淋
下血不止者。皆不宜服。以其滑精故也。朴硝雪白者。治痛淋殊效。每服二钱。血淋。用冷水下。
气淋。木通汤下。石淋。炒研用温水下。石膏火 。同琥珀滑石。乃石淋之要药。然须质壮初起
者宜之。老人绝
欲太早成淋。生绿豆水浸。擂汁服之。然不若淡秋石擂水饮之。其效如神。一切淋浊属实热者。
应手获效。稍涉阴虚。甚于砒鸩。不可不慎。
〔诊〕少阴脉数。妇人则阴中生疮。男子则气淋。盛大而实者生。虚小而涩者死。
薛立斋治一人。素膏粱。小便赤数。口干。吐痰稠粘。右寸关数而有力。此脾肺积热移于膀
胱。先用黄芩清肺饮清理脾肺。次用滋肾丸、六味丸以滋肾水而安。
又治一儒者。发热饮水不绝。每如厕。小便涩痛。大便牵痛。此精竭复耗所致。用补中益气
送都气丸而安。
石顽治内阁文湛持。夏月热淋。医用香薷饮、益元散。五日不应。淋涩转甚。反加心烦不寐。
乃弟广文彦可。相邀往诊。见其唇赤齿燥。多汗喘促。不时引饮。脉见左手微细。右手虚数。知
为热伤元气之候。遂疏生脉散方。频进代茶。至夜稍安。明日复苦溲便涩数。然其脉已向和。仍
用前方不时煎服。调理五日而痊。
又治太史沈韩倬。患膏淋。小便频数。昼夜百余次。昼则滴沥不通。时如欲解。痛如火烧。
夜虽频迸。而所解倍常。溲中如脂如涕者甚多。先曾服清热利水药半月余。其势转剧。面色痿黄。
饮食艰进。延石顽诊之。脉得弦细而数。两尺按之益坚。而右关涩大少力。此肾水素亏。加以劳
心思虑。肝木乘脾所致。法当先实中土。使能堤水。则阴火不致下溜。清阳得以上升。气化通而
疼涩廖矣。或云。邪火亢极。反用参、 补之。得无助长之患乎。曷知阴火乘虚下陷。非开提清
阳不应。譬诸水注。塞其上孔。倾之涓滴不出。所谓病在下。取之上。若用清热利水。则气愈陷。
精愈脱。而溺愈不通矣。遂疏补中益气方。用人参三钱。服二剂。痛虽稍减。而病者求其速效。
或进四苓散加知母、门冬、沙
参、花粉。甫一服。彻夜痛楚倍甚。于是专服补中益气。兼六味丸。用紫河车熬膏代蜜调理。补
中原方。服至五十剂。参尽斤余而安。
《金匮要略》说：淋证的病症表现，小便排出时像粟米颗粒状，小腹部拘急紧绷，疼痛牵引至肚脐中部。趺阳脉呈现数象，说明胃中有热，就会消谷善饥，食欲旺盛。大便必然干硬，小便次数增多。如果小便不通利，体内有水气停留，患者感到极度口渴，应当用栝蒌瞿麦丸主治。如果小便不利，应当用蒲灰散主治。滑石白鱼散、茯苓戎盐汤也都主治此类病症。如果有口渴想喝水，且口干舌燥的症状，应当用白虎加人参汤主治。如果脉浮、发热，口渴想喝水，同时小便不利，应当用猪苓汤主治。患有淋证的人不可使用发汗法治疗，如果误用发汗法，就会导致便血。
《金匮要略》论述淋证共有四条内容。第一条说小便像粟米颗粒状，小腹部拘急紧绷，疼痛牵引至肚脐中部，这是肝将热邪转移到了膀胱，因为肝热严重，失去了疏泄的功能所致。第二条说胃中有热，消谷善饥，大便干硬，小便频数，这是因为胃热炽盛，消耗灼烧津液，导致肠胃和膀胱的源头都枯竭了。第三条说有水气停留，患者极度口渴，这是因为膀胱气化功能不行，水积在胞中造成的危害。第四条说小便不利，用蒲灰散等方剂治疗，这是因为膀胱有血病，血属于阴，阴分有病则阳气也不能施化。之所以使用栝蒌瞿麦丸，是因为肺气不化，膀胱不通，导致水渍停留而津液不能运行，从而胃中干燥口渴，所以用栝蒌根来生津，用薯蓣（山药）来补肺，用茯苓疏导肺气下行，用瞿麦破除膀胱的癃结阻滞。然而想要消散下焦的结滞，又需要阳药才能开通，所以少加附子作为引导。必须是水积且腹中寒冷的人，才可以服用此方。如果虽然有水气但腹中不冷，就应当效法五苓散的方法，以桂枝代替附子。或者因为积热闭塞导致癃闭，又应当将附子改为知母、黄柏。那蒲灰散等三个方剂，全部治疗因膀胱血滞气不化而导致的小便不利证候。蒲灰散中的蒲灰和滑石，是用蒲灰治疗瘀血，用滑石通利窍道。乱发滑石白鱼散中的发灰消除瘀血，白鱼去除水气。茯苓戎盐汤中，戎盐味咸能润并能入血，辅助茯苓淡渗利小便，白术兼能利腰脐间的血。这三个方剂也有轻重之分，乱发丸为重，蒲灰散次之，戎盐汤又次之。至于口渴想喝水，口干舌燥，明显是热在上焦，所以用白虎汤来荡涤膈上的热邪，加入人参来救津液。口渴想喝水，小便不利，是热结在膀胱，津液固结的表现，并出现脉浮发热，这是太阳热邪循经发散于外。所以用猪苓汤来导热并滋润燥热，千万不要因为发热而给予发汗法，否则会重伤其阴，必然导致便血，因此这是切戒之事。
各种淋证的发生，都是肾虚而膀胱生热所致。水火不交，心肾气郁，致使阴阳乖舛，清浊相干，蓄积在下焦，所以膀胱里急，膏脂、血液、砂石，从水道排出。于是出现淋沥不断的症状，严重时堵塞其间，使人闷绝。凡是小肠有气，小便就胀；小肠有血，小便就涩；小肠有热，小便就痛。制剂的方法，都适宜流通滞气，疏利小便，清解热邪。其中平调心火，又是这三者的纲领。心清则小便自然通利，血不妄行。最不可使用补气药物，气得到补益会更加胀满，血得到补益会更加涩滞，热得到补益会更加旺盛。水窦不行，再加上谷道闭塞，没有能见到能生存的。虽然如此，肾气虚弱，囊中受寒而成淋涩的情况也是有的，这种证候先寒战然后尿血，这是因为冷气与正气交争的缘故。又有胞系扭转不通的情况，这种证候脐下急痛，小便不通。凡是强忍小便，疾走快跑，或者忍尿行房事，使水气逆上，气逼迫于胞，所以屈曲扭转而不能舒张。胞落则死亡。
石淋，脐腹部隐痛，小便困难，疼痛难以忍受，尿液像砂石一样，颜色或黄赤，或混浊，色泽不定，正如汤瓶长久受煎熬，底部结成白碱。适宜清除积热，涤除砂石，如麦冬、葶苈、木通、葵子、滑石、车前子、连翘、瞿麦、知母。涩痛严重的，为膀胱蓄血，加琥珀、肉桂、大黄辛温以散之。加味葵子茯苓散，是专门治疗石淋的圣药，紫雪也佳。
劳淋，遇到劳累就发作，小便淋沥不绝，像水滴沥而不断。有脾劳和肾劳之分。劳于脾者，用补中益气汤加车前子、泽泻。劳于肾者，用六味丸加麦冬、五味子。
血淋，虽然主实主血且与小肠互为表里，但是必须看血色来分辨冷热。颜色鲜紫的，为小肠实热，小肠热甚而血渗入胞中，与尿液一起排出，大剂量生牛膝为主药，兼用车前子、山栀、生地、紫菀、犀角、桃仁、芦根汁、生藕节汁。血虚而有热，用生地黄三两，黄芩、阿胶各半两，柏叶少许，水煎服，这是千金方的方法。如果颜色瘀淡的，属肾与膀胱虚冷，用生料六味丸加肉桂，芦根捣水煎，候冷服。如果两尺脉沉弦而数，必有瘀血停蓄，用犀角地黄汤加紫菀、牛膝。如果琥珀、麝香、当归、川芎、萆薢、木通、白术、木香、香燥破血利水耗气之类的药物切忌使用。
气淋，气化不及州都（膀胱），胞中气胀，小腹满坚，溺有余沥，适宜用沉香、肉桂、茯苓、泽泻，佐以木通、瞿麦、葵子、山栀、石苇之类。实证则是气滞不通，脐下妨闷，加香附、木香。如果不奏效，加硝石、大黄。溺后疼痛，去掉石苇、木通、瞿麦、葵子、山栀，加秋石、生甘草梢、藕汁。气淋服用利水药不能通利的，选用沉香降气汤、四磨汤。
膏淋，俨若脂膏，或者便中有如蜓蚰（蚯蚓）状的物体，这名叫肉淋，是精和溺一起排出，精堵塞溺道，所以想排出不出来而且疼痛。适宜用茯苓、秋石、沉香、海金沙、泽泻、滑石。如果疼痛不严重的，必须固涩其精，千万不要误用通利药物。鹿角霜、肉苁蓉、菟丝子、莲须、芡实、山药之类。或者桑螵蛸、菟丝子等分，泽泻减半，蜜丸服用。后用六味丸合聚精丸调补。
冷淋，寒气客于下焦，水道不宣，满于胞内，淋涩而白，先发寒战，然后便数成淋，适宜用金匮肾气丸加鹿茸、沉香。戴氏说，进冷剂反而加重的是冷淋，用牛膝半两煎汤，加麝香少许，送服八味丸。冷淋小便闭涩，数起不通，窍中苦痛，憎寒凛凛，或者因为烦渴饮水过多，水积胞中不行，用生附子散。如果不奏效，用栝蒌瞿麦汤。
热淋，心肺蕴热，不能滋其化源，小便赤涩如血而少，烦渴引饮者，用导赤散加黄芩。躁热不渴者，用滋肾丸，或者淡竹叶煎汤调辰砂益元散。凡人服用金石大毒之物，以助入房，败精流入胞中，以及饮食痰积渗入的，都会形成淋证。或者忍精不泄，停凝作痛而致淋的，用木通、车前子、牛膝、泽泻、茯苓、滑石、甘草，或者汤剂或者丸剂都有效。有膏粱太过，食积成痰，流注为淋的，适宜用尿浸山楂、川连、丹皮、海浮石、玄明粉之类。
小便艰涩像淋，短而不作痛的，是虚证，用六味丸加鹿茸、肉苁蓉。如果茎中不痛而痒的，这属精虚，用八味丸。小便淋沥，茎中痛不可忍，相互牵引胁下痛，用参苓琥珀散。有服用五苓散不有效的，用生料鹿茸丸却痊愈了，这都是下元虚冷的缘故。
胞痹，小便淋沥涩痛，是肾虚膀胱积热，用肾沥汤。胞痹不得小便，小腹痛，若沃以汤（感觉像浇了热水一样），则小便虽涩而略通，这是膀胱虚寒，用茯苓丸。虚寒甚重的，用巴戟丸。老人精气已衰，仍然不绝欲，小便淋沥，小腹胀闭而牵引谷道，或者溺血梗痛，用肾气丸加牛膝。热极成淋，茎中痛，五苓散减去大半桂枝，加滑石、木通、生甘草梢。口苦咽干，小便赤涩，或者欲成淋，用清心莲子饮。伏暑成淋，五苓散合益元散。虚人，用生脉散不时服用。小便自清，后面有几点血的，用五苓散加牛膝、熟地、紫菀。有因为愤怒而导致淋的，非青皮、沉香、山栀、木通不能治愈。有因为思虑成淋的，归脾汤和五苓散并进。汗多而小便痛，暑月常有，盛暑冷冻饮料既多，上停为饮，外发为汗，津液不通，小肠闭塞，用五苓散加人参、甘草，名叫春泽汤，最为合剂。老人气虚下陷成淋的，用补中益气汤加木通、泽泻，以升麻、柴胡升九地之阴，木通、泽泻降九天之阳，服用非常有效。心脾血虚，选用归脾汤、辰砂妙香散。淡秋石治血淋茎中热痛，降火最捷，但元气下陷，小便多者禁用。血淋服用诸药不有效的，一味薏苡根捣汁服用。血淋每日用黄茧丝二两，煮汤饮用，七日必有效。留丝灰存性，蜜丸服用，也主治妇人血崩。还有生鸡子黄，每日清晨沸汤调服二枚，其血自清。牛膝三两，煮成，入麝香少许顿服，名叫地髓汤，这是治疗血淋的要剂。但是淋久不止，元气下陷的，又是切禁。而且虚人能损胃气，及崩淋下血不止的，都不宜服用，因为它滑精的缘故。朴硝雪白者，治痛淋殊效，每服二钱，血淋用冷水下，气淋用木通汤下，石淋炒研用温水下。石膏火煅，同琥珀滑石，乃石淋的要药，然而须体质壮实初起者适宜。老人绝欲太早成淋，用生绿豆水浸，擂汁服用，然而不如淡秋石擂水饮之，其效如神。一切淋浊属实热的，应手获效，稍涉阴虚，甚于砒鸩，不可不慎。
〔诊〕少阴脉数，妇人则阴中生疮，男子则气淋。脉盛大而实的生，虚小而涩的死。
薛立斋治疗一个人，平时喜好膏粱厚味，小便赤数，口干，吐痰稠粘，右寸关数而有力，这是脾肺积热移于膀胱，先用黄芩清肺饮清理脾肺，次用滋肾丸、六味丸以滋肾水而安。
又治疗一位儒者，发热饮水不绝，每次如厕，小便涩痛，大便牵痛，这是精竭复耗所致，用补中益气汤送服都气丸而安。
石顽治疗内阁文湛持，夏月热淋，医生用香薷饮、益元散，五日不应，淋涩转甚，反加心烦不寐，乃弟广文彦可，相邀往诊，见其唇赤齿燥，多汗喘促，不时引饮，脉见左手微细，右手虚数，知道是热伤元气之候，遂开生脉散方，频进代茶，至夜稍安，明日复苦溲便涩数，然而其脉已向和，仍用前方不时煎服，调理五日而痊。
又治疗太史沈韩倬，患膏淋，小便频数，昼夜百余次，昼则滴沥不通，时如欲解，痛如火烧，夜虽频迸，而所解倍常，溲中如脂如涕者甚多，先前曾服清热利水药半月余，其势转剧，面色痿黄，饮食艰进，延石顽诊之，脉得弦细而数，两尺按之益坚，而右关涩大少力，这是肾水素亏，加以劳心思虑，肝木乘脾所致，法当先实中土，使能堤水，则阴火不致下溜，清阳得以上升，气化通则疼涩廖矣。有人说，邪火亢极，反用参、芪补之，得无助长之患乎？怎知阴火乘虚下陷，非开提清阳不应，譬诸水注，塞其上孔，倾之涓滴不出，所谓病在下，取之上，如果用清热利水，则气愈陷，精愈脱，而溺愈不通矣。遂疏补中益气方，用人参三钱，服二剂，痛虽稍减，而病者求其速效，或进四苓散加知母、门冬、沙参、花粉，甫一服，彻夜痛楚倍甚，于是专服补中益气，兼六味丸，用紫河车熬膏代蜜调理，补中原方，服至五十剂，参尽斤余而安。
The *Jin Gui Yao Lue* states: In the disease of Lin (strangury), urination resembles millet grains, the hypogastrium is tense and urgent, with pain radiating to the umbilicus. The Fuyang pulse is rapid, indicating heat in the Stomach, which leads to excessive appetite and consumption of food. The stool will inevitably be hard, and urination frequent. If urination is obstructed, there is fluid retention, and the patient suffers from extreme thirst; this should be treated with Gualou Qumai Wan (Trichosanthes Root and Epimedium Pill). If urination is obstructed, Puhui San (Reed Catkin Powder) should be used. Huashi Baiyu San (Talcus, White Fish, and Powder) and Fuling Rongyan Tang (Poria and Halite Decoction) are also indicated. If there is a desire to drink water accompanied by dry mouth and tongue, Baitu Jia Renshen Tang (White Tiger Decoction plus Ginseng) should be used. If the pulse is floating, there is fever, a desire to drink water, and obstructed urination, Zhuling Tang (Polyporus Decoction) should be used. Patients with Lin syndrome must not undergo sweating therapy; if sweating is induced, hematochezia or hematuria may occur.
The *Jin Gui Yao Lue* discusses four aspects of Lin syndrome. First, urination resembling millet grains, hypogastric tension, and pain radiating to the umbilicus result from Liver heat transferring to the Bladder, where excessive Liver heat impairs its function of free flow and drainage. Second, heat in the Stomach causing excessive appetite, hard stool, and frequent urination results from intense Stomach heat consuming fluids, leading to the depletion of the sources of the intestines, stomach, and Bladder. Third, fluid retention causing extreme thirst indicates that Bladder Qi transformation fails, allowing water to accumulate in the bladder cavity. Fourth, obstructed urination treated with Puhui San etc., arises from blood pathology in the Bladder; since blood belongs to Yin, Yin pathology prevents Yang from transforming. Gualou Qumai Wan is used because Lung Qi fails to transform and the Bladder is blocked, causing water accumulation and failure of fluid distribution, leading to dryness and thirst in the Stomach. Thus, Gualou Gen (Trichosanthes Root) generates fluids, Shuyu (Dioscorea Hypoglauca) tonifies the Lung, Fuling (Poria) guides Lung Qi downward, and Qumai (Polygonum Aviculare) removes Bladder obstruction. To dissipate lower Jiao stagnation, Yang herbs are needed for opening; thus, a small amount of Fuzi (Aconite) is added as a guide. This formula is suitable only when water accumulates and the abdomen is cold. If there is fluid retention but the abdomen is not cold, one should follow the method of Wuling San (Five-Ingredient Powder with Poria), substituting Guizhi (Cinnamon Twig) for Fuzi. If stagnation is caused by accumulated heat, replace Fuzi with Zhimu (Anemarrhena) and Huangbai (Phellodendron). The three formulas involving Puhui San all treat obstructed urination due to Bladder blood stasis and Qi transformation failure. Puhui San uses Puhui (Catkin of Reed) to treat blood stasis and Huashi (Talcus) to open orifices. Luanfa Huashi Baiyu San uses hair ash to eliminate blood stasis and Baiyu (Leuciscus argenteus) to remove fluid retention. Fuling Rongyan Tang uses Rongyan (Halite), which is salty, moistening, and enters the blood, assisting Fuling in promoting diuresis; Baizhu (Atractylodes Macrocephala) benefits blood in the waist and umbilical region. These three formulas vary in potency: Luanfa Wan is heaviest, Puhui San is next, and Rongyan Tang is lightest. Thirst and dry mouth indicate heat in the Upper Jiao, so Baitu Tang (White Tiger Decoction) clears upper diaphragm heat, and Renshen (Ginseng) rescues fluids. Thirst with obstructed urination indicates heat binding in the Bladder and solidified fluids, presenting with floating pulse and fever, showing Taiyang heat pathogen moving outward along the meridian. Zhuling Tang conducts heat and moistens dryness. One must not induce sweating due to fever, as it severely injures Yin and causes bleeding; this is a strict prohibition.
All types of Lin originate from Kidney deficiency and Bladder heat. Water and Fire do not interact; Heart and Kidney Qi stagnate, causing Yin-Yang disharmony and mixing of clear and turbid pathogens accumulating in the Lower Jiao. This causes Bladder urgency, and semen, blood, and gravel discharge through the urinary tract, resulting in continuous dribbling. Severe cases cause blockage and suffocation. Qi in the Small Intestine causes urinary distension; blood causes涩 (astringency/roughness); heat causes pain. Treatment principles involve circulating stagnant Qi, promoting urination, and clearing heat. Regulating Heart Fire is the key principle. A clear Heart ensures smooth urination and prevents reckless blood movement. Tonifying Qi herbs must be avoided, as they worsen distension, astringency, and heat. Although Cold Lin can arise from Kidney Qi deficiency and cold in the scrotum, presenting with chills followed by hematuria due to cold-Qi conflict, and Twisted Cord Lin presents with acute lower abdominal pain and anuria due to holding urine or intercourse, these are specific variations.
Shi Lin (Gravel Strangury) involves dull pain in the umbilical and abdominal regions, difficult and unbearable urination, and passage of gravel-like urine of varying colors, resembling scale buildup in a kettle. Clear accumulated heat and wash out gravel using Maidong (Ophiopogon), Tingli (Descurainia Seed), Mutong (Akebia Stem), Kuizi (Abelmoschus Seed), Huashi (Talcus), Cheqianzi (Plantago Seed), Lianqiao (Forsythia), Qumai (Polygonum Aviculare), and Zhimu (Anemarrhena). For severe astringent pain indicating Bladder blood stasis, add Hupo (Amber), Rougui (Cinnamon Bark), and Dahuang (Rhubarb) for their acrid-warm dispersing action. Jiawei Kuizi Fuling San is a sacred medicine for Shi Lin; Zixue (Purple Snow) is also effective.
Lao Lin (Exhaustion Strangury) occurs upon exertion, with continuous dribbling like dripping water. It is divided into Spleen exhaustion and Kidney exhaustion. Spleen exhaustion is treated with Buzhong Yiqi Tang plus Cheqianzi and Zexie. Kidney exhaustion is treated with Liuwei Wan plus Maidong and Wuweizi.
Xue Lin (Blood Strangury) relates to the Small Intestine. Fresh purple blood indicates Small Intestine excess heat, where heat forces blood into the bladder to exit with urine. Use large doses of Sheng Niuxi (Raw Achyranthes Root) with Cheqianzi, Shanzhi (Gardenia), Shengdi (Rehmannia), Ziwan (Veronica), Xijiao (Rhinoceros Horn - substitute with alternatives in modern practice), Taoren (Peach Kernel), Luzhen juice, and Oujie juice. For blood deficiency with heat, use Sheng Dihuang (3 liang), Huangqin (Scutellaria) and Ejiao (Donkey-hide Gelatin) (0.5 liang each), and a little Baiye (Bamboo Leaf), decocted in water (Qianjin Fang method). Pale/dull blood indicates Kidney and Bladder deficiency-cold; use Shengliao Liuwei Wan plus Rougui, decocted with Luzhen root and taken cold. If both Chi pulses are deep, wiry, and rapid, blood stasis is present; use Xijiao Dihuang Tang plus Ziwan and Niuxi. Avoid acrid-warm, blood-breaking, Qi-consuming herbs like Musxiang (Musk), Danggui (Angelica), Chuanxiong (Ligusticum), Bibi (Dioscorea Hirta), Mutong, Baizhu, and Muxiang (Aucklandia).
Qi Lin (Qi Strangury) involves failed Qi transformation in the Du Dou (Bladder), abdominal Qi distension, fullness and hardness of the lower abdomen, and residual dripping. Use Chenxiang (Aquilaria), Rougui, Fuling, and Zexie, assisted by Mutong, Qumai, Kuizi, Shanzhi, and Shiwei (Pyrrosia). Excess type features Qi stagnation, lower abdominal oppression; add Xiangfu (Cyperus) and Muxiang. If ineffective, add Xiaoshi (Niter) and Dahuang. Post-urination pain requires removing Shiwei, Mutong, Qumai, Kuizi, and Shanzhi, adding Qiushi (Labradorite), Sheng Gancao Gao (Licorice tip), and Ou juice. If diuretics fail, choose Chenxiang Jiangqi Tang or Simo Tang.
Gao Lin (Paste Strangury) resembles fat or earthworms, named Rou Lin (Meat Strangury), where semen and urine exit together, blocking the urethra and causing pain. Use Fuling, Qiushi, Chenxiang, Jinshacao (Lygodium Spore), Zexie, and Huashi. If pain is mild, astringe the essence; do not use draining herbs. Use Lujiaoshuang (Deer Antler Glaze), Rongrong (Cistanche), Tusizi (Cuscuta), Lianxu (Lotus Stamen), Qianshi (Euryale Seed), and Shanyao (Dioscorea). Or Sangpiaoxiao (Mantis Egg Case) and Tusizi in equal parts, with half dose Zexie, honey pills. Follow with Liuwei Wan combined with Ju Jing Wan.
Leng Lin (Cold Strangury) involves cold pathogens in the Lower Jiao, failing to disseminate the water passages, filling the bladder, causing white, astringent dribbling, starting with chills then frequent urination. Use Jin Gui Shenqi Wan plus Lurong (Deer Antler) and Chenxiang. Dai Shi notes that worsening with cold agents confirms Cold Lin; use Niuxi decoction with a little Musk to deliver Bawei Wan. For closed, painful, frequent urination with aversion to cold, or excessive drinking causing fluid retention, use Sheng Fuzi San. If ineffective, use Gualou Qumai Tang.
Re Lin (Heat Strangury) involves Heat in Heart and Lung failing to nourish the source, causing red, astringent, scanty urine with irritability and thirst. Use Daochi San plus Huangqin. For irritability without thirst, use Zishen Wan, or Danzhuye (Bamboo Leaf) decoction mixed with Chensha Yi Yuan San. Using toxic minerals to enhance sexual activity, retaining stale semen, or dietary phlegm-damp entering the bladder can cause Lin. Retaining ejaculation causing stagnation pain is treated with Mutong, Cheqianzi, Niuxi, Zexie, Fuling, Huashi, and Gancao. Dietary excess causing phlegm-damp Lin is treated with Shan Zha (Hawthorn), Chuanlian (Coptis), Danpi (Moutan), Haishi (Floating Stone), and Xuanmingfen (Mirabilite). Scanty, difficult, non-painful urination indicates deficiency; use Liuwei Wan plus Lurong and Rongrong. Itching without pain in the urethra indicates Essence deficiency; use Bawei Wan. Painful, radiating urination uses Shenling Hupo San. If Wuling San fails, Shengliao Lurong Wan cures it, indicating Lower Yuan deficiency-cold.
Bao Bi (Bladder Obstruction) with painful dribbling is Kidney deficiency with Bladder heat; use Shenli Tang. Bladder inability to urinate with lower abdominal pain and sensation of hot liquid pouring indicates Bladder deficiency-cold; use Fuling Wan. Severe deficiency-cold uses Bajii Wan. Elderly with depleted essence continuing sexual activity suffer dribbling, lower abdominal closure pulling to the anus, or bloody obstruction; use Shenqi Wan plus Niuxi. Extreme heat causing urethral pain uses Wuling San minus most Guizhi, plus Huashi, Mutong, and Sheng Gancao Gao. Bitter mouth, dry throat, red astringent urine or impending Lin uses Qingxin Lianzi Yin. Summerheat-induced Lin uses Wuling San combined with Yi Yuan San. Deficient persons use Shengmai San. Clear urine with later blood drops uses Wuling San plus Niuxi, Shudi, and Ziwan. Anger-induced Lin requires Qingpi, Chenxiang, Shanzhi, and Mutong. Overthinking-induced Lin uses Guipi Tang combined with Wuling San. Sweating with painful urination in summer, due to cold drinks stopping fluids and sweating opening pores, blocking Small Intestine, uses Wuling San plus Renshen and Gancao, named Chunze Tang. Qi sinking in elderly uses Buzhong Yiqi Tang plus Mutong and Zexie, using Shengma and Chaihu to raise Yin and Mutong/Zexie to descend Yang. Heart-Spleen blood deficiency uses Guipi Tang or Chensha Miaoxiang San. Dan Qiushi (Salted Labradorite) rapidly clears fire in Blood Strangury but is contraindicated in Qi sinking with polyuria. Refractory Blood Strangury uses Yiyiren Gen (Coix Root) juice. Daily Huangjiansi (Yellow Cocoon Silk) decoction cures in seven days. Ashed silk honey pills also treat women's metrorrhagia. Raw egg yolk taken morning with boiling water clears blood. Di Sui Tang (Niuxi decoction with Musk) is a key Blood Strangury formula but contraindicated in chronic Lin with Qi sinking or deficient persons damaging Stomach Qi. Piao Xiao (Niter) treats painful Lin; take 2 qian with cold water for Blood Lin, Mutong Tang for Qi Lin, warm water for Shi Lin. Calcined Shigao (Gypsum) with Hupo and Huashi is a key Shi Lin drug for strong, early-stage cases. Premature celibacy in elderly causing Lin is treated with Lu Dou (Mung Bean) juice, though Dan Qiushi is more effective. All damp-heat Lin responds quickly; slight Yin deficiency makes treatment worse than arsenic, requiring caution.
[Diagnosis] Rapid Shaoyin pulse: women develop genital ulcers, men develop Qi Lin. Large and solid pulse indicates survival; empty and choppy pulse indicates death.
Xue Lizhai treated a man accustomed to rich foods, with red frequent urination, dry mouth, thick sticky sputum, and rapid forceful Right Cun/Guan pulses. This was Spleen-Lung heat transferring to the Bladder. He first used Huangqin Qingfei Yin to clear Spleen-Lung, then Zishen Wan and Liuwei Wan to nourish Kidney Water.
He treated a scholar with incessant fever and thirst, painful urination and defecation. This was Essence depletion and further loss. He used Buzhong Yiqi Tang delivered with Duqi Wan to resolve it.
Shiwan treated Wen Zhanchi of the Grand Secretariat with Summer Heat Lin. Doctors used Xiangru Yin and Yi Yuan San for five days without effect, worsening strangury with restlessness and insomnia. Shiwan diagnosed Heat injuring Yuan Qi based on red lips, dry teeth, sweating, panting, and weak Left/Rapid Right pulses. He prescribed Shengmai San frequently as tea. The patient improved at night. Next day, urination remained difficult but pulse normalized. Continuing the prescription for five days cured him.
He treated Shen Hanzhuo, a Grand Secretary, with Gao Lin, urinating over 100 times daily. Daytime dribbling with burning pain; nighttime frequent voiding with large amounts of fatty/mucus-like urine. Previous cooling/diuretic herbs worsened symptoms, causing sallow complexion and poor appetite. Pulse was wiry-thin-rapid, deep-strong Chi, and weak-rough-large Guan. This was innate Kidney Yin deficiency exacerbated by mental labor and Liver overacting on Spleen. Treatment prioritized strengthening Earth to control water, preventing Yin Fire from sinking and allowing Clear Yang to rise, restoring Qi transformation and relieving pain. Some argued against tonifying with Ginseng/Astragalus fearing fueling fire. Shiwan explained that Yin Fire sinking requires lifting Clear Yang, like unclogging a bottle top. Cooling/diuretics would sink Qi further and deplete Essence. He prescribed Buzhong Yiqi Tang with 3 qian Renshen. Pain reduced slightly, but the patient sought quick results and took Siling San plus Zhimu, Maidong, Shashen, and Huafen, causing severe night pain. He then exclusively took Buzhong Yiqi Tang combined with Liuwei Wan, using Zijheche (Placenta) paste instead of honey. After 50 doses and over a jin of Ginseng, he recovered.