古有白浊之名，而无赤浊之目，其赤浊并列者，殆滥HT 于子礼、登父两名医欤。
源由 虚劳小便白浊候，劳伤于肾，肾气虚冷故也。肾主水而开窍在阴，阴为 便之道，胞冷肾损，故
小便白而浊也。（《病源论》）
《素问》云∶夫精者，身之本也。盖五脏六腑皆有精，肾为都会关司之所，听命于心。人能法道清静，精气
内持，火来坎户，水到离扃，阴平阳秘，精元密固矣。若夫思虑不节，嗜欲过度，遂使水火不交，精元失守，由
是为赤浊、白浊之患焉。赤浊者，心虚有热也，多因思虑而得之，白浊者，肾虚有寒也，过于嗜欲而得之。其状
漩面如油，光彩不定，漩脚澄下，凝如膏糊，皆思虑嗜欲之所致耳。各分受病之由，施以治法，使坎离既济，阴
阳协和，然后火不上炎而神自清，水不下渗而精自固，安有赤浊、白浊之患哉。虽然，思虑过度，不特伤心，亦
能病脾，脾生虚热而肾不足，故土邪干水，亦令人便下混浊。史载之云∶夏则土燥而水浊，冬则土坚而水清。医
多峻补，则病愈甚。若以中和之药疗之，水火既济，脾土自坚，其流清矣。（《济生》）（按∶《妇人良方》说
白浊所由，其意相似，见治例中。又脾生虚热以下，《万安》引《究原方》同。又《外台·延年论》曰∶疗小便
赤色如浅红花汁，此是忧愁惊恐，心气虚热，客邪气与热搏于心，所以小便赤云云。此岂严氏之所本欤。）
精之主宰在心，精之藏制在肾。凡人酒色无度，思虑过情，心肾气虚，不能管摄，往往小便频数，漏浊之所
因生也。因小便而出者曰尿精，因见闻而出者曰漏精，心不足而
挟热者为赤浊，心不足而肾冷者为白浊。阴不升，精不降，上下乖暌，是以有清浊不分之证，要必体认之精，
而后发用之审欤。此外又有脾精不禁，小便漏浊，淋沥不止，手足力乏，腰背酸疼，盍用苍术等剂以敛脾精。
敛脾谓何？精生于谷也。（《直指》）
林诚中曰∶赤浊者，得于思虑过多，耗散心气，或饮酒过度，或服丹石，致心虚蕴热，水道难涩。且男子
精水二道相并而行，肾系丹田，精道居其上，水道居其下，而真气为火所搏，日渐消溶，尽从小便而出。其初
色黄赤，须臾如浆粉脂油，甚者股肉酸痹，小便作辛辣臭气。治法当清心凉水道，切勿补之。白浊者，肾虚有
寒也，过于色欲而得之，肾气不固，遗沥下收，初便不白，或如脂油，或如浆粉，或如鸡子清，或滑如油，或
甜如蜜，或冷如冰，面色恍白，此漏脱也。若手足指梢冰冷，口淡无味，腰重如石，脚弱气短，疲
倦力乏，急宜滋补之，使水火既济，阴阳冲和，然后火不上炎而神自清，水不下渗则精自固矣。又当绝欲三五
年，则庶乎无复作之患，可以苟全性命也。（《医林集要》）
精者血之所化，有浊去太多，精化不及，赤未变白，故成赤浊，此虚之甚也。何以知之？有人天癸未止，
强力好色，所泄半精半血。（《要诀》）（按∶《必读》此下曰∶则知丹溪以赤属血，白属气者，未必尽然
也。又今验浊证有如赤豆汁者，盖酝蒸所致，宜付别论。）
赤为心虚有热，由思虑而得，白为肾虚有寒，因嗜欲而得，亦非确论。总之，心动于欲，肾伤于色，强
行房事，或多服淫方，败精流溢，乃为白浊。虚滑者，血不及变，乃为赤浊。（《必读》）（按∶《名医汇
粹》柯韵伯说本于此，宜参。）
《原病式》以赤白浊均属于热，其辨甚明。（按∶《式》
曰∶小便混浊，天气热则水混浊，寒则清洁，水体清而火性浊故也。又如清水为汤，则自然浊也。）然因于虚
寒者，不可谓无，但热多寒少耳。虚热者，清心莲子饮。虚寒者，萆 厘清饮。（《统旨》）
脉候 洪大而涩，按之无力，或微细，或沉紧而涩，为元气不足。若尺脉虚或浮者急疾者皆难治，
迟者易治。（《医学集成》）
两尺脉洪数，必便浊失精。女人尺脉涩而弱者，或洪数而促者，皆为便浊白带。心脉短小，因心虚所致，
必遗精便浊。（《正传》）
遗精白浊之别 遗精白浊，皆本由心肾不交而得，惟所出之路非为一途，其可一例言之。盖遗精则自
精气道中而出，淫浊等则于小便窍中出。（《奇效》）
粘腻如胶，或心动辄遗，或溺后遗下者，皆精病，与浊无干。肥人白浊白带，多是胃中湿热，浊痰下流，
渗入膀胱，谓之便浊，与肾绝不相干，虽溺后便出浊块，却不牵腻。若肾虚淫火易动，精离其位，而成精浊
者，其精牵腻如膏，虽不便溺，亦常有之。（《医通》）
淋浊之别 如白浊甚，下淀如泥，或稠粘如胶，频逆而
涩痛异常，此非是热淋，此是精浊窒塞窍道而结，宜五苓妙香散，吞八味丸、小菟丝子丸。（《要诀》）
溺与精所出之道不同，淋病在溺道，故《纲目》列之肝胆部；浊病在精道，故《纲目》列之肾膀胱部。
今患浊者，虽便时茎中如刀割火灼，而溺自清，唯窍端时有秽物，如疮脓目眵，淋漓不断，初与便溺不相混
滥，犹河中之济焉，至易辨也。每见时医以淋法治之，五苓、八正杂投不已而增剧
者，不可胜数，予每正之，而其余尚难以户说也。盖由精败
而腐者什九，由湿热流注与虚者什一。（《准绳》）
湿热证（筋疝） 色白如泔，或如腐花腐浆，而马口不干结者为湿，色黄赤而马口干掩者为火，此皆
为浊，胃中湿热下流也。又浊而清者为湿，痛者湿兼热也。有溺时结块阻滞作痛，块中内蓄水泡者，此必醉酒
使内，酒湿乘虚袭入精窍也。（《医通》）
筋疝者，茎中作痛，筋急缩，或作痒，或肿，或筋缓不收，白物如精，随溺而下，此肾不虚，而肝经湿热
火旺也，龙胆泻肝汤。（同上）
治例 夫妇人小便白浊白淫者，皆由心肾不交养，水火不升降，或由劳伤于肾，肾气虚冷故也。肾主
水而开窍在阴，阴为溲便之道，胞冷肾损，故有白浊白淫，宜服《局方》金锁正元丹。或因心虚而得者，宜服
平补镇心丹、降心丹、威喜丸。若因思虑过当，致使阴阳不分，清浊相干，而成白浊者，然思则伤脾故也，宜
用四七汤吞白丸子（按∶思虑过当以下，本出《易简》），此药极能分利，更宜小乌沉汤，每帖加茯苓一钱
重，益智二十枚去壳碾盐煎服。（《妇人良方》）（按∶此说可通男子，故录于此。）
有白浊人，服玄菟丹不愈，服附子八味丸即愈者，不可不知。有小便如常，停久才方淀浊，有小便出即如
泔，若小儿泔病者，并宜厘清饮，加白茯苓半钱。若服为末效，宜四七汤吞青州白丸子，及辰砂妙香散吞玄
兔丹及小菟丝子丸、山药丸。若溺不赤，无他热证，纵虽赤浊，不可以赤为热，只宜以治白浊施之。若溺赤，
下浊亦赤，口渴时发热者，辰砂妙香散吞灵砂丹，或清心莲子饮。发热不退，口燥舌干之
甚者，此乃精亏内燥，肾枯不润，四物汤吞玄菟丹。和八味丸久服乃效。（《要诀》）
盖由败积瘀腐者十中六七，由湿热下注与脾虚下陷者十常三四，必先补中气兼升举之，而后分其脏腑气血
赤白虚实以治。与夫他邪所伤者，固在泻热补虚，设肾气虚甚或火热亢极者，则不宜纯用寒凉，必反佐治之，
在达人观变耳。（《医通》）
凡属积滞郁热等症，贵在疏泄。医者不知，但用固涩，反增其疾矣。惟滚痰丸下之最好。（《沙篆》）（按
∶滚痰丸可疑。）
治方 《延年》茅根饮子，疗胞络中虚热，时小便如血色方。
茅根（一升） 茯苓（三两） 人参 干地黄（二两）
上四味切，以水五升，煮取一升五合，分温五六服，一日食尽。文仲处。（《外台》）
治虚劳衰损，小便白浊，宜服补益鹿茸丸方。
鹿茸（二两去毛涂酥炙微黄） 蛇床子（三分） 远志（三分去心） 熟干地黄（二两） 菟丝子（二两酒
浸一宿曝干别捣为末） 五味子（一两） 肉苁蓉（二两酒浸一宿刮去皴皮炙干） 白茯苓（一两） 薯蓣（一两）
上件药捣罗为末，炼蜜和捣三五百杵，丸如梧桐子大，每于食前，以暖酒下三十丸。（《圣惠》）（《圣
济》治虚劳小便利，菟丝子丸，用菟丝子、鹿茸、肉苁蓉、五味子四味。）
地黄丸，治白浊如神。（田监薄传）
熟地黄（九蒸十两） 菟丝子（淘洗酒浸蒸） 鹿角霜（各五两） 茯苓 柏子仁（各三两） 附子（一两）
上末，鹿角胶煮酒为丸，每服百十丸，盐酒任下。（《朱氏》）
萆 厘清散，治真元不足，下焦虚寒，小便白浊，频数无度，漩面如油，光彩不定，漩脚澄下，凝如膏
糊。或小便频数，虽不白浊，亦能治疗。
益智仁 川萆 石菖蒲 乌药
上件各等分为细末，每服三钱，水一盏半，入盐一捻，同煎至七分，温服食前。（《杨氏》）（《直指》
厘清饮，治思虑过度，清浊相干，小便白浊，于本方加白茯苓、甘草。）
清心莲子饮，治心中客热烦躁，赤浊肥脂。
石莲肉 白茯苓（各一两） 益智仁 远志（水浸取肉姜制炒） 麦门冬（去心） 人参（各半两） 石
菖蒲 车前子 白术 泽泻 甘草（微炙各一分）
上锉散，每服三钱，添灯心一握煎服。有热，加薄荷。（《直指》）（按∶此本《和剂》治心中蓄积，时
常烦躁，因而思虑劳力，忧愁抑郁，是致小便白浊，或有沙膜，夜梦走泄，遗沥涩痛，便赤如血方。今去黄 、
地骨皮、黄芩，加益智、远志、石菖蒲、白术、泽泻。）
参苓丸（《究原》七），治心肾气不足，小便淋沥，或不禁，或白浊。经云∶小肠为受盛之腑，传道水
液。如肥脂随便而下，索痛，此肾气虚而乃膏淋，此药尤宜服。
赤茯苓 白茯苓 人参（各等分）
上细末，用生地黄不犯铁器熬成膏，为丸如桐子大，每服五十丸、百丸，盐汤送下，空心临睡服，其效如
神。（《万安》）
《究原方》七云∶有人小便遗下，如白红粉之状，服遍药不效，遂令服消石末一钱，临睡冷水调服，遂
不再作。（同上）
白浊久不止，此系火不守耳。炒知母、炒黄柏、附子各等分。上末之，水丸。（《丹溪》）
一男子茎中痛，出白津，小便秘，时作痒，用小柴胡加山栀、泽泻，炒连、木通、胆草、茯苓，二剂顿
愈，又兼六味地黄而痊。（《内科摘要》）
古代有“白浊”这一病名，但没有“赤浊”这一名称。将赤浊与白浊并列论述的，大概是滥用了子礼、登父这两位医家的说法吧。
病因：虚劳导致的小便白浊，是因为劳损伤肾，肾气虚弱寒冷所致。肾主水液代谢，其窍开于前阴，前阴是大小便排出的通道。若胞宫寒冷、肾脏受损，就会导致小便色白且浑浊。（出自《诸病源候论》）
《素问》说：“精，是人体生命的根本。”大概五脏六腑都藏有精气，而肾是精气汇聚和调控的关键部位，听从心的指挥。人若能效法大道保持清静，精气就能在体内固守，心火下降至肾（坎户），肾水上济于心（离扃），达到阴平阳秘的状态，精元就会严密固摄。如果思虑没有节制，嗜欲过度，就会导致水火不交，精元失守，从而引发赤浊、白浊的病患。赤浊，是由于心虚有热，多因思虑过度而得；白浊，是由于肾虚有寒，多因嗜欲过度而得。其症状表现为：尿液表面浮油，光泽不定；尿底沉淀，凝结如膏糊状，这都是思虑和嗜欲过度所致。应当分别探究致病原因，施以治疗方法，使心肾相交（坎离既济），阴阳调和，然后心火不再上炎而神志自然清明，肾水不再下渗而精液自然固摄，哪里还会有赤浊、白浊的病患呢？虽然如此，思虑过度不仅伤心，也会伤脾，脾产生虚热而肾气不足，所以脾土之邪干扰肾水，也会导致大便或小便混浊。史载之说：“夏天土壤干燥则水浑浊，冬天土壤坚硬则水清澈。”医生多用峻猛补药，病情反而加重。如果用中和的药物来治疗，水火既济，脾土自然坚固，水流自然清澈。（出自《济生方》）（按语：《妇人良方》关于白浊成因的说法，意思与此相似，见治例中。另外，“脾生虚热以下”一段，《万安方》引用《究原方》内容相同。又《外台秘要·延年论》说：“治疗小便颜色像浅红花汁一样的，这是忧愁惊恐导致心气虚热，客邪之气与热搏结于心，所以小便发红云云。”这难道是严用和学说的本源吗？）
精的主宰在心，精的封藏制约在肾。凡人酒色无度，思虑过情，导致心肾气虚，不能管摄，往往出现小便频数，漏浊就是由此产生的。因小便排出者叫尿精，因见闻刺激而出者叫漏精，心气不足兼有热者为赤浊，心气不足兼肾冷者为白浊。阴气不升，精微不降，上下乖违，因此出现清浊不分的证候，必须体认得非常精准，然后用药才能审慎恰当。此外又有脾精不禁，小便漏浊，淋沥不止，手足乏力，腰背酸痛，何不采用苍术等药剂来收敛脾精？什么叫收敛脾精？因为精是由水谷化生的。（出自《直指方》）
林诚中说：赤浊，是由于思虑过多，耗散心气，或者饮酒过度，或者服用丹石类药物，导致心虚蕴热，水道涩滞不畅。而且男子的精道与水道并行而行，肾系丹田，精道居上，水道居下，真气被火热所迫，日渐消溶，全部从小便排出。起初颜色黄赤，片刻后像浆粉脂油，严重时大腿肌肉酸麻痹痛，小便带有辛辣臭味。治疗方法应当清心凉血通利水道，切勿使用补法。白浊，是由于肾虚有寒，由于房事过度而得，肾气不固，遗沥下收，初起小便不一定白，或者像脂油，或者像浆粉，或者像鸡蛋清，或者滑如油，或者甜如蜜，或者冷如冰，面色恍白，这是漏脱之症。如果手指脚趾冰冷，口淡无味，腰部沉重如石，脚弱气短，疲倦乏力，急宜滋补，使水火既济，阴阳冲和，然后心火不上炎而神志自清，肾水不下渗则精液自固。还应当禁欲三五年，这样或许就没有复发的祸患，可以保全性命了。（出自《医林集要》）
精是由血化生的，如果浊物去除太多，精化不及，红色未变白，所以形成赤浊，这是虚损非常严重的表现。怎么知道的呢？有人天癸（月经）未止，强力好色，所泄出的半是精半是血。（出自《医学入门·要诀》）（按语：《必读》在此之下说：由此可知朱丹溪认为赤属血、白属气的观点，未必完全正确。另外现在验证浊证有像赤豆汁一样的，大概是酝酿蒸腾所致，应该另行讨论。）
赤浊是心虚有热，由思虑引起；白浊是肾虚有寒，因嗜欲引起，这也不是确切的结论。总之，心动于欲，肾伤于色，强行房事，或多服壮阳淫方，败精流溢，才成为白浊。虚滑者，血来不及变化，才成为赤浊。（出自《必读》）（按语：《名医汇粹》柯韵伯的说法基于此，应当参考。）
《原病式》将赤白浊都归属于热，辨析非常明确。（按语：《原病式》说：“小便混浊，天气热则水混浊，寒则清洁，水体清而火性浊故也。又如清水煮成汤，则自然浑浊。”）然而因虚寒引起的，不能说没有，只是热证多而寒证少罢了。虚热者，用清心莲子饮。虚寒者，用萆薢分清饮。（出自《统旨》）
脉象：洪大而涩，按之无力，或微细，或沉紧而涩，为元气不足。如果尺脉虚或浮，或急促疾速的都难治，迟脉的易治。（出自《医学集成》）
两尺脉洪数，必然出现便浊失精。女人尺脉涩而弱，或洪数而促的，都是便浊白带。心脉短小，因心虚所致，必然遗精便浊。（出自《正传》）
遗精与白浊的区别：遗精和白浊，原本都是由心肾不交引起的，只是排出的途径不同，不能一概而论。大概遗精是从精气道中排出，淫浊等则是从尿道窍中排出。（出自《奇效良方》）
粘腻如胶，或者心动就遗精，或者排尿后遗下的，都是精的病，与浊无关。肥胖人的白浊白带，多是胃中湿热，浊痰下流，渗入膀胱，称为便浊，与肾完全没有关系，虽然排尿后便出浊块，却不牵拉粘腻。如果是肾虚淫火易动，精离其位，而成精浊的，其精牵拉粘腻如膏，即使不便溺，也常有这种情况。（出自《医学纲目》）
淋证与浊证的区别：如果白浊严重，下淀如泥，或稠粘如胶，频繁逆乱且涩痛异常，这不是热淋，这是精浊阻塞窍道而结聚，宜用五苓妙香散，吞服八味丸、小菟丝子丸。（出自《医学入门·要诀》）
尿与精排出的通道不同，淋病在尿道，所以《本草纲目》将其列在肝胆部；浊病在精道，所以《本草纲目》将其列在肾膀胱部。现在患浊病的人，虽然排尿时茎中像刀割火灼一样疼痛，但尿液本身是清的，只有尿道口偶尔有秽物，像疮脓眼屎一样，淋漓不断，起初与大小便不混杂，就像河中的济水一样，很容易辨别。常见当时的医生用治淋证的方法治疗，五苓散、八正散杂投不停而病情加重的，数不胜数，我每次都纠正他们，但其余难以一一说明。大概由精败腐败引起的占十分之九，由湿热流注与虚证引起的占十分之一。（出自《医学纲目》）
湿热证（筋疝）：颜色白如米泔水，或如腐花腐浆，而马口（尿道口）不干结的是湿；颜色黄赤而马口干掩的是火，这些都称为浊，是胃中湿热下流所致。又浊而清的是湿，痛的则是湿兼热。有排尿时结块阻滞作痛，块中内蓄水泡的，这一定是醉酒后行房，酒湿乘虚袭入精窍所致。（出自《医学纲目》）
筋疝者，阴茎中疼痛，筋脉拘急收缩，或者发痒，或者肿胀，或者筋缓不收，白物如精，随尿而下，这是肾不虚，而是肝经湿热火旺，用龙胆泻肝汤。（同上）
治法：妇女小便白浊白淫的，都是由心肾不交养，水火不升降，或由劳损伤肾，肾气虚冷所致。肾主水而开窍于阴，阴是溲便之道，胞冷肾损，所以有白浊白淫，宜服用《局方》金锁正元丹。或因心虚而得的，宜服用平补镇心丹、降心丹、威喜丸。若因思虑过当，致使阴阳不分，清浊相干，而成白浊的，然而思虑伤脾，宜用四七汤吞服白丸子（按语：思虑过当以下，本出自《易简方》），此药极能分利，更宜用小乌沉汤，每帖加茯苓一钱重，益智仁二十枚去壳碾碎加盐煎服。（出自《妇人良方》）（按语：此说可通用于男子，故录于此。）
有白浊病人，服用玄菟丹不愈，服用附子八味丸即愈的，不可不知道。有小便如常，停久才沉淀浑浊的，有小便一出就像米泔水，像小儿泔病的，都宜用厘清饮，加白茯苓半钱。如果服药为末无效，宜用四七汤吞服青州白丸子，及辰砂妙香散吞服玄兔丹及小菟丝子丸、山药丸。如果尿不红，没有其他热证，纵然虽是赤浊，不可以赤色为热，只宜用治白浊的方法施治。如果尿红，下浊也红，口渴时常发热的，用辰砂妙香散吞服灵砂丹，或清心莲子饮。发热不退，口燥舌干严重的，这是精亏内燥，肾枯不润，用四物汤吞服玄菟丹。配合八味丸久服才见效。（出自《医学入门·要诀》）
大概由败积瘀腐引起的占十中六七，由湿热下注与脾虚下陷引起的十常三四，必须先补中气兼升举之，然后分辨脏腑气血的赤白虚实以治疗。与其他邪气所伤的，固然在于泻热补虚，假设肾气虚甚或火热亢极的，则不宜纯用寒凉，必须反佐治疗，在于通达之人观察变化罢了。（出自《医学纲目》）
凡是属于积滞郁热等症，贵在疏泄。医生不知道，只用固涩药，反而增加疾病了。只有滚痰丸攻下最好。（出自《沙篆》）（按语：滚痰丸可疑。）
治方：《延年方》茅根饮子，治疗胞络中虚热，时常小便如血色方的方剂。
以上四味切碎，用水五升，煮取一升五合，分五六次温服，一天吃完。文仲处方。（出自《外台秘要》）
鹿茸（二两去毛涂酥炙微黄） 蛇床子（三分） 远志（三分去心） 熟干地黄（二两） 菟丝子（二两酒浸一宿曝干别捣为末） 五味子（一两） 肉苁蓉（二两酒浸一宿刮去皴皮炙干） 白茯苓（一两） 薯蓣（一两）
以上药物捣罗为末，炼蜜和捣三五百杵，丸如梧桐子大，每次饭前，用暖酒送下三十丸。（出自《太平圣惠方》）（《太平圣济总录》治疗虚劳小便利，菟丝子丸，用菟丝子、鹿茸、肉苁蓉、五味子四味。）
熟地黄（九蒸十两） 菟丝子（淘洗酒浸蒸） 鹿角霜（各五两） 茯苓 柏子仁（各三两） 附子（一两）
以上研末，用鹿角胶煮酒为丸，每次服百十丸，盐酒任下。（出自《朱氏集验方》）
萆薢分清散，治疗真元不足，下焦虚寒，小便白浊，频数无度，漩面如油，光彩不定，漩脚澄下，凝如膏糊。或小便频数，虽不白浊，亦能治疗。
以上各等分为细末，每次服三钱，水一盏半，入盐一捻，同煎至七分，温服食前。（出自《杨氏家藏方》）（《直指方》厘清饮，治疗思虑过度，清浊相干，小便白浊，于本方加白茯苓、甘草。）
石莲肉 白茯苓（各一两） 益智仁 远志（水浸取肉姜制炒） 麦门冬（去心） 人参（各半两） 石菖蒲 车前子 白术 泽泻 甘草（微炙各一分）
以上锉散，每次服三钱，添灯心一握煎服。有热，加薄荷。（出自《直指方》）（按语：此本《和剂局方》治疗心中蓄积，时常烦躁，因而思虑劳力，忧愁抑郁，致使小便白浊，或有沙膜，夜梦走泄，遗沥涩痛，便赤如血方。今去掉黄芪、地骨皮、黄芩，加益智、远志、石菖蒲、白术、泽泻。）
参苓丸（《究原方》七），治疗心肾气不足，小便淋沥，或不禁，或白浊。经云：小肠为受盛之腑，传道水液。如肥脂随便而下，索痛，这是肾气虚而乃膏淋，此药尤宜服。
以上细末，用生地黄不犯铁器熬成膏，为丸如桐子大，每次服五十丸、百丸，盐汤送下，空心临睡服，其效如神。（出自《万安方》）
《究原方》七说：有人小便遗下，如白红粉之状，服遍药不效，遂令服消石末一钱，临睡冷水调服，遂不再发作。（同上）
白浊久不止，这是火不守耳。炒知母、炒黄柏、附子各等分。以上研末，水丸。（出自《丹溪心法》）
一男子茎中痛，出白津，小便秘，时作痒，用小柴胡加山栀、泽泻，炒连、木通、胆草、茯苓，二剂顿愈，又兼六味地黄而痊。（出自《内科摘要》）
Ancient texts mention the name "White Turbidity" (Bai Zhuo), but do not have the term "Red Turbidity" (Chi Zhuo). The juxtaposition of Red and White Turbidity likely stems from an abuse of the theories of the two physicians, Zili and Dengfu.
Etiology: The condition of white turbidity in urine caused by deficiency exhaustion (Xu Lao) results from labor injury to the Kidney, leading to deficient and cold Kidney Qi. The Kidney governs water metabolism and opens into the yin organs; the yin is the pathway for urination and defecation. If the uterus is cold and the Kidney is damaged, the urine becomes white and turbid. (*Zhu Bing Yuan Hou Lun*)
The *Su Wen* states: "Essence (Jing) is the root of the body." Essentially, the five zang and six fu organs all store essence, while the Kidney is the hub and control center, obeying the command of the Heart. If a person can emulate the Dao by maintaining clarity and stillness, essence will be retained internally; Fire descends to the Kan (Kidney) door, Water ascends to the Li (Heart) latch; Yin and Yang are balanced and secreted, and the primordial essence is securely consolidated. However, if thoughts are unregulated and desires excessive, it causes Fire and Water to fail to interact, and the primordial essence is lost, leading to the affliction of Red or White Turbidity. Red Turbidity is due to Heart deficiency with heat, often caused by excessive thinking; White Turbidity is due to Kidney deficiency with cold, often caused by excessive lust. The symptoms present as urine with an oily surface and unstable luster, and sediment at the bottom that coagulates like paste. These are all caused by excessive thinking and lust. One should investigate the cause of each disease and apply corresponding treatments to achieve the intersection of Kan and Li (Heart-Kidney interaction) and harmony of Yin and Yang. Then, Fire will not flare upward, and the spirit will naturally clear; Water will not seep downward, and essence will naturally consolidate. How could there be afflictions of Red or White Turbidity? Although excessive thinking damages not only the Heart but also the Spleen, generating deficient heat and insufficient Kidney energy, causing Earth pathogen to interfere with Water, leading to turbid excretion. Shi Zai said: "In summer, when soil is dry, water is turbid; in winter, when soil is hard, water is clear." If doctors use harsh tonics, the disease worsens. If treated with neutral medicines, Fire and Water interact, Spleen Earth becomes firm, and the flow becomes clear. (*Ji Sheng Fang*) (Note: The explanation of the cause of White Turbidity in *Fu Ren Liang Fang* is similar; see treatment examples. Also, the section below 'Spleen generates deficient heat' is cited identically in *Wan An* from *Jiu Yuan Fang*. Furthermore, *Waitai Mi Yao · Yannian Lun* states: "To treat urine colored like light red flower juice, this is due to worry and fright causing Heart Qi deficiency and heat, where pathogenic qi combats with heat in the Heart, hence the red urine. Could this be the origin of Yan's theory?")
The master of essence lies in the Heart, and its storage and restraint lie in the Kidney. People who indulge in alcohol and sex without limit, or think excessively, suffer from Heart and Kidney Qi deficiency, failing to manage and control, often resulting in frequent urination and leakage of turbidity. What exits via urination is called "urine essence"; what exits upon seeing or hearing is called "leaking essence." Heart deficiency with heat constitutes Red Turbidity; Heart deficiency with Kidney cold constitutes White Turbidity. When Yin does not ascend and essence does not descend, upper and lower parts diverge, leading to syndromes of indistinct clear and turbid. It is essential to recognize this precisely before prescribing. Additionally, there is the condition of uninhibited Spleen essence, with urinary leakage, continuous dribbling, weakness in hands and feet, and soreness/pain in the waist and back. Why not use agents like Atractylodes macrocephala (Cangzhu) to consolidate Spleen essence? What is consolidating Spleen essence? Essence is generated from grain. (*Zhi Zhi Fang*)
Lin Chengzhong stated: Red Turbidity arises from excessive thinking, dissipating Heart Qi, or excessive drinking, or taking cinnabar/stone pills, causing Heart deficiency with accumulated heat and difficult, astringent urination. Moreover, the male's essence channel and water channel run together. The Kidney system is at the Dantian; the essence channel is above, and the water channel is below. When true Qi is constrained by fire, it gradually dissolves and exits entirely through urination. Initially yellow-red, soon resembling starch powder, fat, or oil. In severe cases, thigh muscles become sore and numb, and urine has a pungent, spicy odor. Treatment should focus on clearing the Heart and cooling the blood to promote urination; absolutely avoid tonification. White Turbidity is due to Kidney deficiency with cold, caused by excessive sexual desire. Kidney Qi is insecure, leading to residual dripping. Initially, urine may not be white, or may resemble fat/oil, starch powder, egg white, slippery oil, sweet honey, or cold ice. The complexion is pale and dull, indicating leakage. If fingertips are cold, taste is bland, waist feels heavy as stone, legs are weak, breath is short, and fatigue is severe, urgent tonification is needed to harmonize Fire and Water and balance Yin and Yang. Then Fire clears upward, spirit clarifies; Water stays down, essence consolidates. One must abstain from sex for three to five years to prevent recurrence and preserve life. (*Yi Lin Ji Yao*)
Essence is transformed from blood. If too much turbidity is expelled, essence transformation cannot keep up, and red does not turn white, resulting in Red Turbidity, which indicates extreme deficiency. How do we know this? There are cases where Tian Gui (menstruation) has not ceased, yet the person forces sexual activity, expelling half essence and half blood. (*Yi Xue Ru Men · Yao Jue*) (Note: *Bi Du* adds below: Thus, Zhu Danxi's view that red belongs to blood and white belongs to qi is not entirely correct. Also, current observations of turbidity include cases resembling red bean juice, likely due to fermentation and steaming; this should be discussed separately.)
Red is Heart deficiency with heat, caused by thinking; White is Kidney deficiency with cold, caused by lust. This is not a definitive conclusion. In summary, Heart moves with desire, Kidney is injured by color (sex). Forcing intercourse or taking many aphrodisiac formulas causes败精 (spoiled essence) to overflow, becoming White Turbidity. Deficiency and slipping, where blood fails to transform, becomes Red Turbidity. (*Bi Du*) (Note: Ke Yunbo's statement in *Ming Yi Hui Cui* is based on this; refer to it.)
*Yuan Bing Shi* attributes both Red and White Turbidity to Heat, with very clear differentiation. (Note: *Shi* says: "Urine is turbid; in hot weather water is turbid, in cold weather it is clear, because water nature is clear and fire nature is turbid. Like clear water turning to soup, it naturally becomes turbid.") However, cases due to deficiency-cold cannot be denied, though heat is more common than cold. For deficient-heat, use Qing Xin Lian Zi Yin. For deficient-cold, use Bi Xie Fen Qing Yin. (*Tong Zhi*)
Pulse Diagnosis: Surging, large, and choppy, powerless upon pressure, or fine, or deep-tight-choppy, indicates insufficient primal Qi. If the Chi pulse is deficient, floating, or rapid/agitated, it is difficult to treat; if slow, it is easy to treat. (*Yi Xue Ji Cheng*)
Surging-numerous pulses in both Chi positions indicate turbid urination and loss of essence. In women, choppy-weak or surging-numerous-with-interruption pulses in the Chi position all indicate turbid urination and leukorrhea. Short-small Heart pulses, caused by Heart deficiency, inevitably lead to seminal emission and turbid urination. (*Zheng Zhuan*)
Distinction between Seminal Emission and White Turbidity: Both stem from Heart-Kidney non-interaction, but the exit paths differ; they cannot be treated identically. Seminal emission exits from the essence channel, while turbid discharge exits from the urinary orifice. (*Qi Xiao Liang Fang*)
Viscous like glue, or emission upon heart movement, or post-micturition emission, are all diseases of essence, unrelated to turbidity. In obese people, white turbidity and leukorrhea are mostly due to damp-heat in the Stomach, where turbid phlegm flows down, infiltrates the Bladder, and is called urinary turbidity, having nothing to do with the Kidney. Even if turbid clumps appear after urination, they are not viscous. If Kidney deficiency allows libidinous fire to move easily, causing essence to leave its position and form essence-turbidity, the essence is viscous like paste, occurring even without urination. (*Yi Tong*)
Distinction between Lin Syndrome and Turbidity: If white turbidity is severe, sedimenting like mud, or thick/sticky like glue, with frequent urgency and abnormal painful obstruction, this is not Heat-Lin syndrome. This is essence-turbidity blocking the orifices. Use Wu Ling Miao Xiang San, swallowing Ba Wei Wan and Xiao Tu Si Zi Wan. (*Yi Xue Ru Men · Yao Jue*)
The pathways for urine and essence differ. Lin disease affects the urinary channel, so *Ben Cao Gang Mu* lists it under Liver/Gallbladder; Turbidity disease affects the essence channel, so *Ben Cao Gang Mu* lists it under Kidney/Bladder. Patients with turbidity today often feel knife-like or burning pain in the penis during urination, yet the urine itself is clear. Only occasionally at the orifice is there foul matter, like pus or eye discharge, dripping continuously. Initially, it does not mix with urine/feces, like the Ji River within the Yellow River, making it easy to distinguish. I often see contemporary doctors treating turbidity as Lin syndrome, indiscriminately using Wu Ling San and Ba Zheng San, worsening the condition beyond count. I correct them frequently, though not everyone listens. Nine-tenths are due to spoiled/rotten essence accumulation; one-tenth is due to damp-heat flow or deficiency. (*Yi Tong*)
Damp-Heat Syndrome (Jin Han / Sinew Hernia): Color white like rice washings, or like rotting flowers/slurry, with the meatus (Ma Kou) not dry/crusted indicates Dampness; color yellow-red with dry/meatus covered indicates Fire. All are termed turbidity, caused by Stomach damp-heat flowing down. Turbidity that is clear is Dampness; painful turbidity is Dampness combined with Heat. If blocks form during urination causing pain, with water blisters inside, this is surely due to sexual activity while drunk, where wine-dampness invades the essence orifice due to deficiency. (*Yi Tong*)
Jin Han: Pain in the penis, tendon contraction/shrinking, itching, swelling, or flaccid tendons unable to retract, with white substance like essence exiting with urine. This indicates the Kidney is not deficient, but rather Liver Meridian damp-heat and fire are flourishing. Use Long Dan Xie Gan Tang. (Ibid.)
Treatment Examples: For women with white turbidity and white leukorrhea, the cause is Heart-Kidney non-nourishment, failure of Fire/Water ascent/descent, or labor injury to the Kidney causing deficient-cold Kidney Qi. Since the Kidney governs water and opens to the yin, and the yin is the path for urination, uterine cold and Kidney damage cause white turbidity/leukorrhea. Take *Ju Fang* Jin Suo Zheng Yuan Dan. If due to Heart deficiency, take Ping Bu Zhen Xin Dan, Jiang Xin Dan, or Wei Xi Wan. If excessive thinking causes Yin/Yang indistinction and clear/turbid interference, forming white turbidity, note that thinking injures the Spleen. Use Si Qi Tang swallowing Bai Wan Zi (Note: Below 'excessive thinking' originates from *Yi Jian*). This medicine effectively separates and drains; additionally use Xiao Wu Chen Tang, adding one qian of Poria (Fuling) and twenty peeled, crushed Alpinia oxyphylla (Yizhi) per dose, decocted with salt. (*Fu Ren Liang Fang*) (Note: This applies to men too, so recorded here.)
Some patients with white turbidity do not improve with Xuan Tu Dan but recover with Fu Zi Ba Wei Wan; this must be known. If urine is normal but turns turbid after standing, or exits immediately like rice water (like infant rice sickness), use Li Qing Yin with half a qian of Poria (Fuling). If powder form is ineffective, use Si Qi Tang swallowing Qingzhou Bai Wan Zi, or Chen Sha Miao Xiang San swallowing Xuan Tu Dan, Xiao Tu Si Zi Wan, or Shan Yao Wan. If urine is not red and no other heat signs exist, even if red turbidity, do not assume heat from redness; treat as white turbidity. If urine is red, turbidity is red, with thirst and fever, use Chen Sha Miao Xiang San swallowing Ling Sha Dan, or Qing Xin Lian Zi Yin. If fever persists, with severe dry mouth/tongue, this is essence deficiency with internal dryness, Kidney withering without moisture. Use Si Wu Tang swallowing Xuan Tu Dan. Long-term use of Ba Wei Wan is effective. (*Yi Xue Ru Men · Yao Jue*)
Generally, nine-tenths to six-tenths are due to stagnant/rotten accumulation; three-tenths to four-tenths are due to damp-heat flowing down or Spleen Qi sinking. First tonify Middle Qi and raise it, then differentiate organ/blood/qi red/white/deficient/excess to treat. Unlike other pathogens where clearing heat and tonifying deficiency is key, if Kidney Qi is extremely deficient or Fire is hyperactive, pure cold-cooling herbs are unsuitable; reverse supplementation is needed. This requires skilled observation. (*Yi Tong*)
For conditions involving stagnation and郁热 (stagnant heat), promoting drainage is crucial. Doctors who do not understand this and only use astringents exacerbate the disease. Gun Tan Wan for purgation is best. (*Sha Zhuan*) (Note: Gun Tan Wan is questionable.)
Prescriptions: *Yan Nian* Mao Gen Yin Zi, for treating empty-heat in the Bao Luo (uterus/pericardium collateral) causing urine resembling blood.
Rhizoma Imperatae (Maogen) (1 sheng), Poria (Fuling) (3 liang), Ginseng (Renshen), Radix Rehmanniae Preparata (Shu Dihuang) (2 liang).
Cut the four ingredients, boil in 5 sheng of water to obtain 1.5 sheng. Divide into 5-6 warm doses, finish in one day. Prescription from Wen Zhong. (*Waitai Mi Yao*)
For deficiency exhaustion and wasting-thirst, with white turbid urine, take Bu Yi Lu Rong Wan.
Horn of Cervus Nippon (Lurong) (2 liang, remove hair, coat with butter, roast until slightly yellow), Fructus Cnidii (Shechuangzi) (3 fen), Radix Polygalae (Yuanzhi) (3 fen, remove heart), Prepared Radix Rehmanniae (Shu Dihuang) (2 liang), Semen cuscutae (Tusizi) (2 liang, soak in wine overnight, dry, crush separately), Fructus Schisandrae (Wuweizi) (1 liang), Cortex CSPseudocistanche (Roucongrong) (2 liang, soak in wine overnight, scrape bark, roast dry), Poria (Fuling) (1 liang), Rhizoma Dioscoreae (Shuyu) (1 liang).
Grind all to powder, mix with refined honey, pound 300-500 times. Form pills like paulownia seeds. Take 30 pills before meals with warm wine. (*Taiping Shenghui Fang*) (*Taiping Shengji Zonglu* treats deficiency exhaustion with frequent urination using Tusizi Wan, composed of Tusizi, Lurong, Roucongrong, Wuweizi.)
Di Huang Wan, miraculous for white turbidity. (Transmitted by Tian Jianbo)
Prepared Radix Rehmanniae (Shu Dihuang) (9-steamed, 10 liang), Semen cuscutae (Tusizi) (washed, soaked in wine, steamed), Horn Powder Cervi (Lujiaoshuang) (each 5 liang), Poria (Fuling), Semen Juglandis (Baiziren) (each 3 liang), Radix Aconiti Lateralis Preparata (Fuzi) (1 liang).
Grind to powder. Use gelatin from deer horn boiled in wine to form pills. Take 100-110 pills per dose with salt wine. (*Zhu Shi Ji Yan Fang*)
Bi Xie Fen Qing San, for insufficiency of true yuan, deficiency-cold in lower jiao, white turbid urine, frequent/uncontrolled urination, oily surface, unstable luster, sediment like paste. Or frequent urination without turbidity, also treatable.
Fructus Alpiniae Oxyphyllae (Yizhiren), Rhizoma Dioscoreae Hypoglaucae (Chuan Bixie), Rhizoma Acori Tatarinowii (Shichangpu), Radix Linderae (Wuyao).
Equal parts ground to fine powder. Take 3 qian per dose, decoct in 1.5 cups of water with a pinch of salt until 0.7 cup remains. Warm and take before meals. (*Yang Shi Jia Zang Fang*) (*Zhi Zhi Fang* Li Qing Yin, for excessive thinking causing clear/turbid interference and white turbidity, adds Fuling and Gancao to this formula.)
Qing Xin Lian Zi Yin, for guest-heat and irritability in the Heart, red turbidity with fatty deposits.
Fructus Nelumbinis (Shilianrou), Poria (Fuling) (each 1 liang), Fructus Alpiniae Oxyphyllae (Yizhiren), Radix Polygalae (Yuanzhi) (soaked, meat taken, ginger-processed, roasted), Radix Ophiopogonis (Mendong) (remove heart), Ginseng (Renshen) (each 0.5 liang), Rhizoma Acori Tatarinowii (Shichangpu), Semen Plantaginis (Cheqianzi), Rhizoma Atractylodis Macrocephalae (Baizhu), Radix Alismatis (Zexie), Radix Glycyrrhizae (Gancao) (lightly roasted, each 1 fen).
Cut into pieces. Take 3 qian per dose, decoct with a handful of Juncus effusus (Dengxin) tea rush. Add Mentha (Bohe) if heat is present. (*Zhi Zhi Fang*) (Note: Originally from *He Ji Ju Fang* for accumulated heat in Heart, frequent irritability due to thinking/labor/worry/depression, causing white turbidity, sand/membrane in urine, nocturnal emission, residual dribbling, painful urination, red urine like blood. Now removed Huangqi, Digupi, Huangqin; added Yizhi, Yuanzhi, Shichangpu, Baizhu, Zexie.)
Shen Ling Wan (*Jiu Yuan Fang* No. 7), for Heart/Kidney Qi insufficiency, dribbling urination, incontinence, or white turbidity. Classics state: Small Intestine is the official of reception and transformation, transmitting fluids. If fatty substances follow urine, causing pain, this is Gao Lin due to Kidney Qi deficiency; this medicine is especially suitable.
Radix Alismatis Rubra (Chi Fuling), Poria (Bai Fuling), Ginseng (Renshen) (equal parts).
Fine powder. Boil fresh Radix Rehmanniae (Sheng Dihuang) without iron contact into a paste. Form pills like paulownia seeds. Take 50-100 pills with salt water, on empty stomach before sleep. Effect is miraculous. (*Wan An Fang*)
*Jiu Yuan Fang* No. 7 states: Someone had urine leaking like white/red powder, all medicines failed. Then administered 1 qian of Sal Nitri (Xiaoshi) powder, mixed with cold water before sleep. Recurrence stopped. (Ibid.)
Persistent white turbidity is due to Fire not being anchored. Roasted Radix Anemarrhenae (Zhimu), Roasted Cortex Phellodendri (Huangbai), Radix Aconiti Lateralis Preparata (Fuzi) in equal parts. Grind to powder, make water pills. (*Dan Xi Xin Fa*)
A man had penile pain, white secretion, constipation, and occasional itching. Used Xiao Chai Hu Tang plus Gardenia (Shanzhi), Alisma (Zexie), fried Coptis (Lian), Uncaria (Mutong - *Note: likely Akebia or similar diuretic in context*), Gentiana (Dancao), Poria (Fuling). Two doses cured instantly. Also recovered with Liu Wei Di Huang Wan. (*Nei Ke Zhao Ya*)