徐蔼辉曰∶此“淋”字,与俗所云“赤淋”淋字不同。彼指赤带言,系女精;此系指小水言也。
妊妇淋曰子淋。小便不出曰转胞。子淋小便频数,点滴而痛;转胞频数,而溲少不痛。淋属肝经阴亏火
炽;转胞因膀胱被胎压住。膀胱止有一口,未溺时其口向上,口端横一管,上半管即名下焦,下半管即是
溺孔。未溺时,膀胱之底下垂如瓶状,其口在上,与下焦直对,溺从下焦渗入,故曰“下焦者,别回肠,而
渗入膀胱焉。”欲溺时,大气举膀胱之底,如倾瓶状,其口向下,从溺孔注出,故曰“气化则能出矣”。转胞
一证,因胎大压住膀胱,或因气虚不能举膀胱之底。气虚者补气,胎压者托胎。若浪投通利,无益于病,反
伤正气。
徐蔼辉曰∶汪 庵又谓胞系转戾,脐下急痛为转胞,溲或数或闭。二说小异。
子淋方
生地 阿胶 黄芩 黑山栀 木通 甘草 水煎服。
丹溪治一妊妇小便不通,令一妇用香油涂手,自产门入,托起其胎,溺出如注。即用人参、黄 、升麻大
剂煎服。又治一妇转胞,用参、归煎服,探吐得愈。
沈尧封曰∶ 庵载其方名参术饮。用当归、熟地黄、芎 、芍药、人参、白术、留白陈皮、半夏、炙
甘草,加姜煎,空心服。丹溪论曰∶窘胞之病,妇之禀受弱者、忧闷多者、性躁急者、食味浓者,多有
之。古方用滑药鲜效,因思胞不自转,为胎被压,若举起胎,胞必自疏,水道自通矣。近吴宅宠人患此,
脉似涩,重则弦。予曰∶此得之忧患。涩为血少气多;弦为有饮。血少则胎弱不能举;气多有饮,中焦不清
而溢,则胎避而就下。乃以上药与饮,随以指探喉中,吐出药汁,候气定,又与之而安。此恐偶中,后治数
人皆效。
仲景云∶妇人本肥盛,今反羸瘦,胞系了戾,但
利小便则愈,宜服肾气丸∶以中有茯苓故也;地黄为君,功在补胞。又法∶将孕妇倒竖,胞转而小便自通矣。
沈尧封曰∶汪昂采《本事》安荣散,治子淋心烦闷乱。云子淋,膀胱小肠虚热也,虚则不能制水,
热则不能通利,故淋。心与小肠相表里,故烦闷。方用人参、甘草之甘以补虚;木通、灯草之渗,滑石之
滑,以通淋 。肺燥则天气不降,而麦冬能清之;肾燥则地气不升,而细辛能润之;血燥则沟渎不濡,而
当归能滋之也。亦有因房劳内伤胞门,冲任虚者,宜八珍汤或肾气丸。
徐蔼辉说:这个“淋”字,与世俗所说的“赤淋”的“淋”字含义不同。世俗所说的“赤淋”是指赤色带下,属于女性精血;而此处指的是小便异常。
孕妇患淋证称为子淋。小便排不出称为转胞。子淋的症状是小便频数,点滴而出且伴有疼痛;转胞的症状是尿频但尿量少且不痛。子淋属于肝经阴液亏损、虚火炽盛所致;转胞是因为膀胱被胎儿压迫所致。膀胱只有一个出口,未排尿时其口向上,口端横亘着一根管子,上半部分即名为下焦,下半部分即是尿道口。未排尿时,膀胱底部下垂如瓶状,其口在上,与下焦相对,尿液从下焦渗入,所以说:“下焦,别回肠,而渗入膀胱焉。”欲排尿时,大气托举膀胱底部,使其像倾倒瓶子一样,其口向下,尿液从尿道口流出,所以说:“气化则能出矣。”转胞这一病症,是因为胎体过大压迫膀胱,或者因为气虚不能托举膀胱底部。气虚者应当补气,胎压者应当托举胎儿。如果盲目投用通利小便的药物,对病情无益,反而损伤正气。
徐蔼辉说:汪昂又认为,胞系扭转错乱,脐下急痛为转胞,小便或频数或闭塞。这两种说法略有差异。
朱丹溪治疗一位孕妇小便不通,让一位妇女用香油涂抹手部,从产门伸入,托起胎儿,尿液随即如注般流出。随后让人参、黄芪、升麻大剂量煎服。又治疗一位妇女患转胞,用人参、当归煎服,并通过探吐法治愈。
沈尧封说:汪昂记载该方名为参术饮。使用当归、熟地黄、川芎、芍药、人参、白术、留白陈皮、半夏、炙甘草,加生姜煎煮,空腹服用。朱丹溪论述道:窘胞之病,禀赋虚弱、忧闷多虑、性情急躁、饮食浓厚的人,多有此病。古方使用滑利药物鲜有疗效,因此思考胞宫不自行转动,是因为被胎儿压迫,若能举起胎儿,胞宫必自舒展,水道自然通畅。近来吴宅宠妾患此病,脉象似涩,重按则弦。我说:这是因忧患所致。涩脉主血少气多;弦脉主有水饮。血少则胎弱不能托举;气多且有水饮,中焦不清而溢满,则胎儿避让而下移。于是给予上述药物与汤剂,随即用手指探喉催吐,吐出药汁,待气息平稳后,再服药而安。起初担心只是偶然有效,后来治疗数人皆有效验。
张仲景说:妇人原本形体丰盛,如今反见羸瘦,胞系扭转错乱,只需利小便即可痊愈,适宜服用肾气丸:因为方中含有茯苓的缘故;地黄为君药,功效在于补益胞宫。另一方法:将孕妇倒竖起来,胞系回转则小便自然通畅。
沈尧封说:汪昂采集《本事方》中的安荣散,治疗子淋伴心烦闷乱。他认为子淋是膀胱与小肠虚热所致,虚则不能制约水液,热则不能通利,故而淋证。心与小肠相表里,所以出现烦闷。方中使用人参、甘草的甘味以补虚;木通、灯芯草的渗利,滑石的滑利,以通淋止痛。肺燥则天气不降,麦冬能清润之;肾燥则地气不升,细辛能润之;血燥则沟渎不濡,当归能滋养之。也有因房劳内伤胞门,导致冲任虚损的,适宜服用八珍汤或肾气丸。
Xu Aihui stated: The character "lin" (strangury) here differs from the common usage of "lin" in "chi lin" (red strangury). The latter refers to red leukorrhea, pertaining to female essence and blood; whereas this refers to abnormalities in urination.
Strangury during pregnancy is termed Zi Lin (Fetal Strangury). Inability to urinate is termed Zhuan Bao (Displacement of the Bladder). Zi Lin presents with frequent urination, scanty drops, and pain; Zhuan Bao presents with frequency but scanty urine without pain. Zi Lin belongs to deficiency of Yin in the Liver meridian with blazing fire; Zhuan Bao occurs because the bladder is compressed by the fetus. The bladder has only one opening. When not urinating, its opening faces upward. At the end of the opening lies a horizontal tube; the upper half is named the Lower Jiao (Lower Burner), and the lower half is the urethral meatus. Before urination, the base of the bladder hangs down like a bottle, with its opening at the top, facing directly opposite the Lower Jiao. Urine seeps in from the Lower Jiao, hence it is said: "The Lower Jiao separates from the ileum and seeps into the bladder." When desiring to urinate, the Qi lifts the base of the bladder, tilting it like an inverted bottle, so that its opening faces downward, and urine flows out from the urethral meatus. Hence it is said: "When Qi transforms, it can be excreted." The condition of Zhuan Bao arises because the large fetus compresses the bladder, or due to Qi deficiency failing to lift the base of the bladder. For Qi deficiency, tonify Qi; for fetal compression, support the fetus. Blindly administering diuretic agents is of no benefit to the disease and instead damages healthy Qi.
Xu Aihui stated: Wang Ang further posited that twisting and inversion of the membrane system, accompanied by acute pain below the umbilicus, constitutes Zhuan Bao, where urination may be either frequent or obstructed. These two explanations differ slightly.
Formula for Zi Lin:
Sheng Di Huang (Rehmanniae Radix), E Jiao (Colla Corii Asini), Huang Qin (Scutellariae Radix), Hei Shan Zhi (Gardeniae Fructus Carbonized), Mu Tong (Akebiae Caulis), Gan Cao (Glycyrrhizae Radix et Rhizoma). Decoct in water and take orally.
Zhu Danxi treated a pregnant woman with urinary retention. He instructed a woman to apply sesame oil to her hand, insert it into the vagina, and lift the fetus. Urine then flowed out like a stream. Subsequently, he prescribed a large dose of Ren Shen (Ginseng Radix et Rhizoma), Huang Qi (Astragali Radix), and Sheng Ma (Cimicifugae Rhizoma) decocted in water. He also treated another woman with Zhuan Bao using Ren Shen and Dang Gui (Angelicae Sinensis Radix) decocted, curing her through induced vomiting.
Shen Yaofeng stated: Wang Ang recorded this formula as Shen Zhu Yin (Ginseng and Atractylodes Decoction). It uses Dang Gui, Shu Di Huang (Prepared Rehmanniae Radix), Xiong Qiong (Ligustici Chuanxiong Rhizoma), Shao Yao (Paeoniae Radix), Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium retaining white pith), Ban Xia (Pinelliae Rhizoma Praeparatum), and Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma), added with fresh ginger, decocted and taken on an empty stomach. Zhu Danxi discussed: The disease of constrained bladder often affects women who are constitutionally weak, prone to worry and depression, irritable in temperament, or consume rich flavors. Ancient formulas using slippery/diuretic drugs rarely yielded efficacy. Therefore, I reasoned that the bladder does not rotate itself; it is compressed by the fetus. If the fetus is lifted, the bladder will naturally relax, and the water pathway will clear. Recently, a favored concubine in the Wu household suffered from this. Her pulse was seemingly choppy (Se), becoming wiry (Xian) upon heavy pressure. I said: This resulted from worry and distress. A choppy pulse indicates deficient Blood and excess Qi; a wiry pulse indicates fluid retention. Deficient Blood means the fetus is weak and cannot be supported; excess Qi with fluid retention causes turbidity in the Middle Jiao which overflows, causing the fetus to shift downward. Thus, I administered the aforementioned medicine and decoction, followed by inducing vomiting with a finger to expel the medicinal juice. After the Qi settled, I administered the medicine again, resulting in peace. Initially fearing it was merely a lucky coincidence, subsequent treatments on several patients were all effective.
Zhang Zhongjing stated: If a woman was originally robust but now appears emaciated, and the membrane system is twisted and inverted, healing can be achieved by promoting urination. It is appropriate to administer Shen Qi Wan (Kidney Qi Pill): primarily due to the presence of Fu Ling (Poria). Di Huang (Rehmanniae Radix) serves as the Sovereign herb, its function being to nourish the uterus. Another method: Invert the pregnant woman vertically; once the membrane system rotates back, urination will naturally resume.
Shen Yaofeng stated: Wang Ang collected An Rong San (Peaceful Glory Powder) from *Ben Shi Fang* to treat Zi Lin accompanied by vexation and restlessness. He asserted that Zi Lin is caused by deficient heat in the Bladder and Small Intestine. Deficiency fails to control water; heat fails to promote free flow, resulting in strangury. The Heart and Small Intestine are exterior-interior paired, hence vexation and stuffiness occur. The formula uses the sweetness of Ren Shen and Gan Cao to tonify deficiency; the permeating nature of Mu Tong and Deng Cao (Junci Medulla), and the slippery nature of Hua Shi (Talcum), to unblock strangury. Lung dryness prevents Heaven Qi from descending, which Mai Dong (Ophiopogonis Radix) can clear; Kidney dryness prevents Earth Qi from ascending, which Xi Xin (Asari Radix et Rhizoma) can moisten; Blood dryness leaves the channels unfed, which Dang Gui can nourish. There are also cases caused by internal injury to the uterine gate from sexual exhaustion, leading to deficiency of the Chong and Ren meridians. In such cases, Ba Zhen Tang (Eight Treasures Decoction) or Shen Qi Wan is appropriate.