严 淋浊三年不止，肾虚湿热不化。阴头碎痒，筋骨微疼。六味补肾，能化湿热。耐心久服，莫计效迟。
大生地 怀山药 茯苓 山萸肉 五味子 麦冬 益智仁 丹皮 泽泻 湘莲肉
须 精浊连年不断，兼有血块淋漓。肝肾大虚，八脉无以固
摄，湿热混乱不清。舌苔白腻。法当脾肾双补，固摄下焦。
怀山药 茯苓 菟丝子 阿胶（赤石脂炒） 血余炭 五味子 杜仲 沙苑子 金樱子 莲须 旱莲草
渊按∶肝肾八脉之虚，由湿浊混淆，精血频下。若不先清湿
热以宁相火，徒事补肾固精，所谓不清其源而欲塞其流，能乎否乎？
顾 遗精无梦为肾虚，咳嗽寒热乃风邪，腹胀纳少兼肝气。
此三者当先何治？曰∶咳嗽盗汗出，不宜治肺；肝气横，不宜伐肝；然则治其肾乎？
六味丸去泽泻，加陈皮、白芍、沉香、牡蛎、芡实、湘莲肉。
又 遗精属肾，不寐属心。心火刑金则咳，心阳下陷则遗。阴虚则盗汗，肝虚则结瘕。法当交济坎离。
大生地 远志 芡实 茯苓 白芍 党参 龙齿 枣仁 怀
山药 龟板 六神曲 麦冬 牡蛎 五味子 丹皮 建莲肉
丁 水窍精窍，异路同门，二窍不并开。水窍开则湿热常泄，相火常宁，精窍常闭。若水窍为败精瘀浊
阻塞不通，则湿热不泄。病已二载，颇服滋补，使湿热败浊漫无出路，致下焦浊气上攻及胃，时时嗳气，腹中不
和，二便不爽，失下行为顺之理。诊脉细肢寒，肾阳与胃阳不布。法宜通阳渗湿，益肾化浊。
补故纸 韭菜子 茯苓 萆 小茴香 菟丝子
又 症势仍然，前方加减。
照前方加桂枝、白芍、龙齿、牡蛎。
又 杂药乱投，诸病不除，中气早戕，故腹中不和，大便不畅。至于本病清浊淆混，亦脾虚湿热所致。
萆 益智仁 半夏 陈皮 党参 黄柏 石菖蒲 乌药 砂仁
又 九窍不和，肠胃病也。胃以下行为顺，肠以传导为职。
肠胃失司，则嗳气，肠鸣，头眩，大便难，小溲混浊，肛门溺窍皆痒。
白术 苦参 茯苓 陈皮 香附 泽泻 六神曲 桃仁 火麻仁 槟榔 青皮 茵 草
又 湿热浊邪，混入清气之中，无路可出，外则肌肤生瘰，如粟且痒；上则头眩；下则溺窍后阴俱痒，
精浊时流，大便艰涩。三焦俱受其邪，虚实混淆之病也。疏泄浊邪从下而出，复入交济坎离，虚实同治。
朝服控涎丹十四粒，陈皮汤送下。暮服磁朱丸三钱，沙苑子
汤下。
渊按∶借控涎丹以泻中焦湿热痰浊，磁朱丸以交济坎离，可谓善于腾挪。
王 病起膏淋，变为石淋，今又成血淋矣。盖肾虚精不藏聚，湿热相火蒸灼，致精化为浊，浊凝成块；
阴伤日久，血亦下注，故见血块也。填补阴髓以化湿热，法当滑涩兼施。
大熟地 阿胶 龟板 天冬 血余炭 芡实 秋石 沙苑子 冬葵子 韭菜子（炒） 湘莲肉
李 北门之 得守，则阳气固；坤土之阳得运，则湿浊化。湿浊化则精旺，阳气固则精守。所嫌肌肉
尽削。夫肌肉，犹城垣也；元气，犹主宰也。城垣倾颓，主宰困穷，然则非大补元气不可。
大熟地 西党参 冬术 枸杞子 浓杜仲 麦冬 怀山药 淡苁蓉 当归 半夏 陈皮 茯苓 谷芽
萧 据述病情多系情怀郁勃，肝肾下虚。小溲频数澄脚，遍体机关骨节不利，头面觉麻。此由阴液内亏，
风阳绕络，源泉不足，膀胱不化使然。养阴液以熄风阳，救源泉以通气化，又须怡情安养，庶几可瘳。
大生地 二冬 龟板 沙苑子 五味子 川断 茯神 沙参 覆盆子 家韭子
渊按∶既从七情郁结而来，乃心火不能下交于肾水，致肾关不固，似宜心肾兼治。
张 男子十四发身太早，保真不固，究竟外丰内亏，不时内
热，身倦乏力，恐其延成劳损。培补先天，兼理后天，尤宜自知爱惜为上。
党参 大熟地 怀山药 丹皮 茯苓 陈皮 沙苑子 苡仁 杜仲 金狗脊
薛 左尺极细，寸关微而似数，右三部俱弦滑。下有遗精暗疾，肛门痒而出水；上则头眩耳鸣，舌苔粉
白。以脉合症，肾阴下亏，湿热相火下淫上混，清窍为之蒙闭。法当补肾之阴而清相
火，清金和胃，分利膀胱以化湿热。
萆 大生地（蛤粉炒） 知母 泽泻 龟板 麦冬 黄柏 赤苓 半夏 丹皮 牡蛎 怀山药
又丸方∶
大生地（砂仁、陈酒拌蒸） 冬术（土炒） 黄连（盐水炒） 苦参 天麻 怀
山药 丹皮（盐水炒） 川芎 芡实 龟板（酥炙） 牡蛎（ ） 泽泻（盐水炒）
黄柏（盐水炒） 知母（盐水炒） 半夏 萆 （盐水炒） 赤苓 麦冬（元米炒）
上药为末，用建莲粉四两，神曲四两，煮糊捣丸。
渊按∶此方治肾虚湿热遗精极妙，然须胃纳尚旺者。若谷食式微，连、柏等苦寒宜斟酌。
高 淋浊而兼遗滑，耳聋目花。肝肾大虚，不宜渗利，法当固摄。
沙苑子 怀山药 补故纸 茯神 家韭子 芡实 龙骨 牡蛎 朝暮服威喜丸三钱。
渊按∶纯属虚象，宜加熟地、山茱萸。
蒋 肾藏精，肝藏血，膀胱主疏泄，故前阴一物也，而有二窍。二窍不并开，水窍开则湿热常泄，相
火常宁。若房事过度，则相火旺而精血不藏，混入水窍，为血淋窍痛焉。
大生地 元精石 丹皮 龟板 五味子 川黄柏 血余炭 沙参 知母 麦冬 茯苓 阿胶
高 脉细固属阴虚，若下垂尺泽，是相火下淫，故精血下
流，小溲便数，溺窍疼痛，大便干结也。补养肾阴，兼清相火为法。
大生地 龟板 黄柏 大黄（酒炒） 木通 小蓟炭 阿胶（蒲黄炒）
焦山栀 甘草梢 知母 茯苓 元明粉 车前子 牛膝
陈 遗精无梦，不特阴虚，阳亦衰矣；干咳无痰，不特肺虚，胃亦弱矣。补精纳气，温煦真阳，治其肾
也；补土生金，清肃高源，治其肺也。若夫救本之图，在于息心无妄。无妄二字所
该者广，心君镇定，自无震撼之虞。
大熟地 党参 五味子 枸杞子 茯神 菟丝子 龙骨 沙苑子 怀山药 牡蛎 龟板 丹皮 杜仲 芡实
华 病由丧子忧怒抑郁，肝火亢甚，小溲淋浊，渐至遗精，一载有余，日无虚度。今年新正，左少腹睾丸
气上攻胸，心神狂乱，龈血目青，皆肝火亢盛莫制也。经云∶肾主闭藏，肝司疏
泄。二脏皆有相火，其系上属于心。心为君火，君不制相，相火妄动，虽不交会，亦暗流走泄矣。当制
肝之亢，益肾之虚，宗越人东实西虚、泻南补北例。
川连 焦山栀 延胡索 鲜生地 赤苓 沙参 川楝子 知母 黄柏 龟板 芡实
另当归龙荟丸一钱，开水送下。
附丸方∶
川连（盐水炒） 苦参 白术（米泔浸，晒） 牡蛎
共研末，用雄猪肚一枚，将药末纳入肚中，以线扎好，用水酒各半煎烂，将酒药末共捣，如嫌烂，加建
莲粉拌干作丸。每朝三钱，开水送下。
张 操觚莲幕，形逸心劳。肾水下亏不能上承于心，心阳内亢而反下趋于肾，即坎离之不交也。不交则
诸病生，由是而下为淋浊尿血，宗筋绊痛；上为眩晕咳嗽，心中震跃，诊脉左小右大，
内伤虚症何疑！今远道初归，跋涉劳顿，且拟和平补益，庶无畸重畸轻之病。
马料豆 甘草梢 茯神 怀山药 麦冬 建莲肉 沙参 红枣 鲜藕 枇杷叶
又 心阴耗损，君不制相，相火妄动，强阳常举，精浊时流，肛门气坠，大便溏薄，心中嘈辣，干嗽
无痰。右脉空大，两尺皆虚。法宜补心阴以制相火，益肾气以固元精。
西洋参 黄柏 五味子 知母 牡蛎 大生地 龟板 麦冬
另补故纸盐水炒，韭菜子盐水炒，研末，炼蜜为丸。每服三钱。
渊按∶相火旺而肾阴亏极矣。二味为丸，专助肾阳，恐与此证不合。
包 劳碌气虚，湿热随之下陷。淋浊初起觉痛，今而不疼，但觉气坠，小便频数，色黄而混浊不清。仿
东垣补脾胃、去湿浊、泻阴火、升清阳方法。
黄 （盐水炒） 柴胡 升麻 沙参 茯苓 芡实 萆 黄柏 知母 灯心 食盐（冲服一捻）
仁渊曰∶遗精、淋、浊，古人每连类称之，其实三者因不同、病不同、治亦不同，未可一概论也。夫遗精
乃精关之病，少年者多起于意淫，或色欲过度；中年者或由用心太过，心火不能下交，致肾精下溜，不梦
而泄，甚则不寐亦泄，亦有湿热阻中，致肝木升阳之气不能上达，郁陷于至阴之下，蒸煽精关而病。古
人以有梦无梦分虚实，未必尽然。大抵从湿热来者多实，从意淫多欲、用心太过来者多虚。惟同一虚也，须
分阴虚阳虚及阴阳两虚、虚中夹实。今世医治此多不效者，由未辨明阴阳虚实，一味以补肾固精了事，及病者
未能养心寡欲耳。盖相火妄动致遗精，肾阳不能固摄亦致遗精。试观古方，其义自明。若淋症全由膀胱
溺窍为患，虽分五证，半由湿热而来，前人辨之甚详。即劳淋、虚淋，或从色欲起见，乃败精阻于溺管，溺
管伤损，或淋久膀胱气虚，致肾亦虚，乃由标及本，由腑及脏，非病起于肾也。至浊
证则肾与膀胱脏腑兼病，然脏病多而腑病少。小便短赤，塞而不通者，为膀胱湿热；小便清通，脓浊时流者，
为肾虚精不固。浊色黄浓为虚热，色白而清为虚寒。小便清通，但短数，时时欲便，
亦属肾气虚寒。前人于淋、浊二证，不甚分别，都以为湿热。余
少时执其说而治之，多不验。今阅历有年，始知淋属膀胱溺窍，浊属肾脏精窍。浊证虽有夹湿热，兼膀胱
病者，总属脏多腑少，脏主腑宾。俟湿热清而小便畅，即专益气固精；若阳气虚者，佐扶阳升阳。盖浊征大
都色欲时忍精不泄，精管受伤，致精关不固，肾液与阴精同下，病久则阴伤及阳，阳不摄阴耳。前案
兼病俱多，方亦不能一例，读者神而明之。
严某：淋证和浊证持续三年未愈，这是肾虚导致湿热无法化解。龟头破碎瘙痒，筋骨轻微疼痛。使用六味地黄丸补肾，能够化解湿热。需耐心长期服用，不要计较见效缓慢。
大生地 怀山药 茯苓 山萸肉 五味子 麦冬 益智仁 丹皮 泽泻 湘莲肉
须某：精浊连年不断，兼有血块淋漓不尽。肝肾严重亏虚，奇经八脉失去固摄能力，湿热混乱不清。舌苔白腻。治法应当脾肾双补，固摄下焦。
怀山药 茯苓 菟丝子 阿胶（用赤石脂炒） 血余炭 五味子 杜仲 沙苑子 金樱子 莲须 旱莲草
渊按：肝肾及奇经八脉的虚损，是由于湿浊混淆，导致精血频繁流失。如果不先清除湿热以平息相火，只是一味地补肾固精，这就是所谓的不清除源头却想堵塞水流，能做到吗？
顾某：无梦遗精属于肾虚，咳嗽寒热属于风邪侵袭，腹胀纳少兼有肝气郁结。
这三种情况应当先治疗哪一个？回答说：咳嗽盗汗，不宜直接治肺；肝气横逆，不宜直接伐肝；那么应该治疗肾脏吗？
六味地黄丸去掉泽泻，加入陈皮、白芍、沉香、牡蛎、芡实、湘莲肉。
又诊：遗精归属于肾，失眠归属于心。心火克制肺金则引起咳嗽，心阳下陷则导致遗精。阴虚则盗汗，肝虚则形成瘕积。治法应当交通心肾（坎离既济）。
大生地 远志 芡实 茯苓 白芍 党参 龙齿 枣仁 怀山药 龟板 六神曲 麦冬 牡蛎 五味子 丹皮 建莲肉
丁某：水窍（尿道口）与精窍（射精口），路径不同但门户相同，两窍不会同时开启。水窍开启则湿热常泄，相火常宁，精窍常闭。如果水窍被败精瘀浊阻塞不通，则湿热无法排泄。患病已两年，颇受滋补药物影响，使得湿热败浊漫无出路，导致下焦浊气上攻至胃，时时嗳气，腹中不和，二便不畅，违背了下行顺通的生理规律。诊脉细弱肢体发冷，肾阳与胃阳不能布散。治法宜通阳渗湿，益肾化浊。
补骨脂 韭菜子 茯苓 萆薢 小茴香 菟丝子
又诊：病情依然如故，前方加减。
照前方加桂枝、白芍、龙齿、牡蛎。
又诊：杂药乱投，诸病不除，中气早伤，所以腹中不和，大便不畅。至于本病的清浊混淆，也是脾虚湿热所致。
萆薢 益智仁 半夏 陈皮 党参 黄柏 石菖蒲 乌药 砂仁
又诊：九窍不和，是肠胃的疾病。胃以下行为顺，肠以传导为职。
肠胃功能失调，则出现嗳气，肠鸣，头眩，大便难，小便混浊，肛门及尿道口皆痒。
白术 苦参 茯苓 陈皮 香附 泽泻 六神曲 桃仁 火麻仁 槟榔 青皮 茵陈 甘草
又诊：湿热浊邪，混入清气之中，无路可出，外则肌肤生瘰疬，如粟米状且痒；上则头眩；下则尿道口及后阴俱痒，精浊时常流出，大便艰涩。三焦都受到邪气侵害，虚实混淆的病证。疏泄浊邪从下而出，再行交通心肾，虚实同治。
早晨服用控涎丹十四粒，用陈皮汤送服。晚上服用磁朱丸三钱，用沙苑子汤送服。
渊按：借控涎丹以泻中焦湿热痰浊，磁朱丸以交通心肾，可谓善于灵活变通。
王某：病起于膏淋，变为石淋，如今又成了血淋。这是因为肾虚精不藏聚，湿热相火蒸灼，致使精化为浊，浊凝成块；阴伤日久，血亦下注，所以见到血块。填补阴髓以化湿热，治法应当滑利与固涩兼施。
大熟地 阿胶 龟板 天冬 血余炭 芡实 秋石 沙苑子 冬葵子 韭菜子（炒） 湘莲肉
李某：北门（指肾）得到守护，则阳气固密；坤土（指脾）之阳得以运化，则湿浊化解。湿浊化解则精旺，阳气固密则精守。所担忧的是肌肉尽削。肌肉，犹如城墙；元气，犹如主宰。城墙倾颓，主宰困穷，那么非大补元气不可。
大熟地 西党参 冬术 枸杞子 浓杜仲 麦冬 怀山药 淡苁蓉 当归 半夏 陈皮 茯苓 谷芽
萧某：据述病情多因情怀郁勃，肝肾下虚。小便频数澄清如水，遍体关节不利，头面感觉麻木。这是由于阴液内亏，风阳绕络，源泉不足，膀胱气化不利所致。养阴液以熄风阳，救源泉以通气化，又须怡情安养，或许可以痊愈。
大生地 二冬 龟板 沙苑子 五味子 川断 茯神 沙参 覆盆子 家韭子
渊按：既然从七情郁结而来，乃是心火不能下交于肾水，致肾关不固，似乎宜心肾兼治。
张某：男子十四岁发育太早，保真不固，终究是外表丰盈内里亏虚，不时内热，身倦乏力，恐怕其延成劳损。培补先天，兼理后天，尤其应当自知爱惜为上策。
党参 大熟地 怀山药 丹皮 茯苓 陈皮 沙苑子 苡仁 杜仲 金狗脊
薛某：左尺脉极细，寸关脉微而似数，右三部俱弦滑。下有遗精暗疾，肛门痒而出水；上则头眩耳鸣，舌苔粉白。以脉合症，肾阴下亏，湿热相火下淫上混，清窍为之蒙闭。治法当补肾之阴而清相火，清金和胃，分利膀胱以化湿热。
萆薢 大生地（蛤粉炒） 知母 泽泻 龟板 麦冬 黄柏 赤苓 半夏 丹皮 牡蛎 怀山药
又拟丸方：
大生地（砂仁、陈酒拌蒸） 冬术（土炒） 黄连（盐水炒） 苦参 天麻 怀山药 丹皮（盐水炒） 川芎 芡实 龟板（酥炙） 牡蛎（煅） 泽泻（盐水炒） 黄柏（盐水炒） 知母（盐水炒） 半夏 萆薢（盐水炒） 赤苓 麦冬（元米炒）
以上药物研为末，用建莲粉四两，神曲四两，煮糊捣丸。
渊按：此方治疗肾虚湿热遗精极妙，然而必须胃纳尚旺者适用。若饮食减少，黄连、黄柏等苦寒药物宜斟酌使用。
高某：淋浊而兼遗滑，耳聋目花。肝肾大虚，不宜渗利，治法当固摄。
沙苑子 怀山药 补骨脂 茯神 家韭子 芡实 龙骨 牡蛎 朝暮服用威喜丸三钱。
渊按：纯属虚象，宜加熟地、山茱萸。
蒋某：肾藏精，肝藏血，膀胱主疏泄，所以前阴一物，而有二窍。两窍不并开，水窍开则湿热常泄，相火常宁。如果房事过度，则相火旺而精血不藏，混入水窍，成为血淋窍痛。
大生地 元精石 丹皮 龟板 五味子 川黄柏 血余炭 沙参 知母 麦冬 茯苓 阿胶
高某：脉细固属阴虚，若尺脉沉取无力，是相火下淫，所以精血下流，小便频数，尿道口疼痛，大便干结。治法补养肾阴，兼清相火。
大生地 龟板 黄柏 大黄（酒炒） 木通 小蓟炭 阿胶（蒲黄炒） 焦山栀 甘草梢 知母 茯苓 元明粉 车前子 牛膝
陈某：遗精无梦，不仅阴虚，阳气也衰了；干咳无痰，不仅肺虚，胃也弱了。补精纳气，温煦真阳，是治其肾；补土生金，清肃高源，是治其肺。至于救本之图，在于息心无妄。无妄二字所涵盖的范围很广，心君镇定，自然没有震撼之虞。
大熟地 党参 五味子 枸杞子 茯神 菟丝子 龙骨 沙苑子 怀山药 牡蛎 龟板 丹皮 杜仲 芡实
华某：病由丧子忧怒抑郁，肝火亢盛，小便淋浊，渐至遗精，一年有余，日无虚度。今年新正，左少腹睾丸之气上攻胸，心神狂乱，龈血目青，都是肝火亢盛莫制也。经云：肾主闭藏，肝司疏泄。二脏皆有相火，其系上属于心。心为君火，君不制相，相火妄动，虽不交会，亦暗流走泄矣。当制肝之亢，益肾之虚，宗越人东实西虚、泻南补北例。
川连 焦山栀 延胡索 鲜生地 赤苓 沙参 川楝子 知母 黄柏 龟板 芡实
另服当归龙荟丸一钱，开水送下。
附丸方：
川连（盐水炒） 苦参 白术（米泔浸，晒） 牡蛎
共研末，用雄猪肚一枚，将药末纳入肚中，以线扎好，用水酒各半煎烂，将酒药末共捣，如嫌烂，加建莲粉拌干作丸。每朝三钱，开水送下。
张某：操觚莲幕（从事文书工作），形逸心劳。肾水下亏不能上承于心，心阳内亢而反下趋于肾，即坎离之不交也。不交则诸病生，由是而下为淋浊尿血，宗筋绊痛；上为眩晕咳嗽，心中震跃，诊脉左小右大，内伤虚症何疑！今远道初归，跋涉劳顿，且拟和平补益，庶无畸重畸轻之病。
马料豆 甘草梢 茯神 怀山药 麦冬 建莲肉 沙参 红枣 鲜藕 枇杷叶
又诊：心阴耗损，君不制相，相火妄动，强阳常举，精浊时流，肛门气坠，大便溏薄，心中嘈辣，干咳无痰。右脉空大，两尺皆虚。法宜补心阴以制相火，益肾气以固元精。
西洋参 黄柏 五味子 知母 牡蛎 大生地 龟板 麦冬
另补骨脂盐水炒，韭菜子盐水炒，研末，炼蜜为丸。每服三钱。
渊按：相火旺而肾阴亏极矣。二味为丸，专助肾阳，恐与此证不合。
包某：劳碌气虚，湿热随之下陷。淋浊初起觉痛，今而不疼，但觉气坠，小便频数，色黄而混浊不清。仿东垣补脾胃、去湿浊、泻阴火、升清阳方法。
黄芪（盐水炒） 柴胡 升麻 沙参 茯苓 芡实 萆薢 黄柏 知母 灯心 食盐（冲服一捻）
仁渊曰：遗精、淋、浊，古人每连类称之，其实三者因不同、病不同、治亦不同，未可一概论也。夫遗精乃精关之病，少年者多起于意淫，或色欲过度；中年者或由用心太过，心火不能下交，致肾精下溜，不梦而泄，甚则不寐亦泄，亦有湿热阻中，致肝木升阳之气不能上达，郁陷于至阴之下，蒸煽精关而病。古人以有梦无梦分虚实，未必尽然。大抵从湿热来者多实，从意淫多欲、用心太过来者多虚。惟同一虚也，须分阴虚阳虚及阴阳两虚、虚中夹实。今世医治此多不效者，由未辨明阴阳虚实，一味以补肾固精了事，及病者未能养心寡欲耳。盖相火妄动致遗精，肾阳不能固摄亦致遗精。试观古方，其义自明。若淋症全由膀胱溺窍为患，虽分五证，半由湿热而来，前人辨之甚详。即劳淋、虚淋，或从色欲起见，乃败精阻于溺管，溺管伤损，或淋久膀胱气虚，致肾亦虚，乃由标及本，由腑及脏，非病起于肾也。至浊证则肾与膀胱脏腑兼病，然脏病多而腑病少。小便短赤，塞而不通者，为膀胱湿热；小便清通，脓浊时流者，为肾虚精不固。浊色黄浓为虚热，色白而清为虚寒。小便清通，但短数，时时欲便，亦属肾气虚寒。前人于淋、浊二证，不甚分别，都以为湿热。余少时执其说而治之，多不验。今阅历有年，始知淋属膀胱溺窍，浊属肾脏精窍。浊证虽有夹湿热，兼膀胱病者，总属脏多腑少，脏主腑宾。俟湿热清而小便畅，即专益气固精；若阳气虚者，佐扶阳升阳。盖浊征大都色欲时忍精不泄，精管受伤，致精关不固，肾液与阴精同下，病久则阴伤及阳，阳不摄阴耳。前案兼病俱多，方亦不能一例，读者神而明之。
Yan: Lin syndrome (dysuria) and Zhuo syndrome (cloudy urine) have persisted for three years without cessation. This is due to Kidney deficiency with damp-heat failing to transform. The glans penis feels broken and itchy, and the sinews and bones ache slightly. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) tonifies the Kidney and can resolve damp-heat. One must take patience and administer it for a long time; do not fret over the slow onset of efficacy.
Rehmanniae Radix Preparata (Shu Di Huang), Dioscoreae Rhizoma (Huai Shan Yao), Poria (Fu Ling), Corni Fructus (Shan Yu Rou), Schisandrae Fructus (Wu Wei Zi), Ophiopogonis Radix (Mai Dong), Alpiniae Oxyphyllae Fructus (Yi Zhi Ren), Moutan Cortex (Dan Pi), Alismatis Rhizoma (Ze Xie), Nelumbinis Plumula (Xiang Lian Rou).
Xu: Jingzhuo (seminal turbidity) has been continuous for years, accompanied by dripping blood clots. The Liver and Kidney are severely deficient, and the Eight Extraordinary Vessels fail to secure and hold. Damp-heat is chaotic and unclear. The tongue coating is white and greasy. The treatment method should be dual tonification of the Spleen and Kidney, securing and holding the Lower Jiao.
Dioscoreae Rhizoma (Huai Shan Yao), Poria (Fu Ling), Cuscutae Semen (Tu Si Zi), Eclipticae Herba (Han Lian Cao), Asini Corii Colla (E Jiao - stir-fried with Red Halloysite), Hominis Calx Carbonisata (Xue Yu Tan), Schisandrae Fructus (Wu Wei Zi), Eucommiae Cortex (Du Zhong), Astragali Complanati Semen (Sha Yuan Zi), Rubi Fructus (Jin Ying Zi), Lotus Stamen (Lian Xu).
Annotation by Yuan: The deficiency of the Liver, Kidney, and Eight Extraordinary Vessels stems from the confusion of damp-turbidity, causing frequent loss of essence and blood. If one does not first clear damp-heat to calm Ministerial Fire, but merely engages in tonifying the Kidney and securing essence, this is akin to trying to block the flow without clearing the source. Can this work?
Gu: No-dream seminal emission belongs to Kidney deficiency; cough with chills and fever belongs to Wind pathogen; abdominal distension with poor appetite accompanied by Liver Qi stagnation.
Which of these three should be treated first? It is said: For cough and night sweats, treating the Lung directly is inappropriate; for horizontal Liver Qi, attacking the Liver directly is inappropriate; then should we treat the Kidney?
Remove Alismatis Rhizoma (Ze Xie) from Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), add Tangerine Peel (Chen Pi), White Peony Root (Bai Shao), Agarwood (Chen Xiang), Oyster Shell (Mu Li), Euryale Seed (Qian Shi), and Lotus Plumule (Xiang Lian Rou).
Second visit: Seminal emission pertains to the Kidney; insomnia pertains to the Heart. Heart Fire insulting Metal causes cough; sinking of Heart Yang causes seminal emission. Yin deficiency causes night sweats; Liver deficiency leads to formation of masses (Jia). The treatment method should be to harmonize Kan and Li (Heart and Kidney).
Rehmanniae Radix Preparata (Shu Di Huang), Polygalae Radix (Yuan Zhi), Euryale Seed (Qian Shi), Poria (Fu Ling), White Peony Root (Bai Shao), Codonopsis Radix (Dang Shen), Dragon Bone (Long Gu), Ziziphus Seed (Zao Ren), Dioscoreae Rhizoma (Huai Shan Yao), Turtle Shell (Gui Ban), Massae Medicamentae Fermentatae Chinensis (Liu Shen Qu), Ophiopogonis Radix (Mai Dong), Oyster Shell (Mu Li), Schisandrae Fructus (Wu Wei Zi), Moutan Cortex (Dan Pi), Jianlian Rou (Lotus Plumule).
Ding: The water orifice (urethral meatus) and the essence orifice (ejaculatory duct) follow different paths but share the same gate; they do not open simultaneously. When the water orifice opens, damp-heat is often discharged, Ministerial Fire remains tranquil, and the essence orifice remains closed. If the water orifice is blocked by rotten essence and stasis-turbidity, damp-heat cannot be excreted. The disease has lasted two years. Extensive use of tonics has caused damp-heat and turbid stasis to have no outlet, leading to turbid Qi from the Lower Jiao attacking the Stomach, causing frequent belching, abdominal discomfort, and unsmooth urination and defecation, violating the principle that downward movement is smooth. The pulse is fine and limbs are cold; Kidney Yang and Stomach Yang are not disseminating. The treatment method should be to unblock Yang and leach out dampness, benefit the Kidney and transform turbidity.
Psoraleae Fructus (Bu Gu Zhi), Lepidii Semen (Jiu Cai Zi), Poria (Fu Ling), Dichroae Radix (Bi Xie), Foeniculi Fructus (Xiao Hui Xiang), Cuscutae Semen (Tu Si Zi).
Second visit: The condition remains unchanged; modify the previous prescription.
Add Cinnamon Twig (Gui Zhi), White Peony Root (Bai Shao), Dragon Bone (Long Gu), and Oyster Shell (Mu Li) to the previous formula.
Third visit: Random administration of miscellaneous medicines has failed to remove the diseases, damaging the Middle Qi early on, hence abdominal discomfort and unsmooth bowel movements. As for the confusion of clear and turbid in the primary disease, it is also caused by Spleen deficiency and damp-heat.
Dichroae Radix (Bi Xie), Alpiniae Oxyphyllae Fructus (Yi Zhi Ren), Pinelliae Tuber (Ban Xia), Citri Reticulatae Pericarpium (Chen Pi), Codonopsis Radix (Dang Shen), Phellodendri Cortex (Huang Bo), Acori Tatarinowii Rhizoma (Shi Chang Pu), Linderae Radix (Wu Yao), Amomi Fructus (Sha Ren).
Fourth visit: Disharmony of the nine orifices is a disease of the intestines and stomach. The Stomach follows downward movement as its norm; the Intestines function through conduction.
When the functions of the intestines and stomach are lost, belching, borborygmus, dizziness, difficulty in defecation, turbid urine, and itching of the anus and urethral orifice occur.
Atractylodis Macrocephalae Rhizoma (Bai Zhu), Sophorae Flavescentis Radix (Ku Shen), Poria (Fu Ling), Citri Reticulatae Pericarpium (Chen Pi), Cyperi Rhizoma (Xiang Fu), Alismatis Rhizoma (Ze Xie), Massae Medicamentae Fermentatae Chinensis (Liu Shen Qu), Peach Kernel (Tao Ren), Cannabis Seed (Huo Ma Ren), Arecae Semen (Bing Lang), Cyanoptidis Fructus (Qing Pi), Artemisiae Scopariae Herba (Yin Chen), Licorice Root (Gan Cao).
Fifth visit: Damp-heat and turbid pathogens mix into the clear Qi, having no way out. Externally, skin develops scrofula-like nodules, millet-sized and itchy; superiorly, dizziness occurs; inferiorly, both the urethral orifice and posterior orifice itch, seminal turbidity flows occasionally, and defecation is difficult. The Triple Burner is affected by the pathogen; this is a disease of mixed deficiency and excess. Discharge turbid pathogens from below, then harmonize Kan and Li (Heart and Kidney), treating both deficiency and excess simultaneously.
In the morning, take Kongxian Dan (Control Saliva Pill) 14 pills, taken down with Tangerine Peel Decoction. In the evening, take Cizhu Wan (Magnetite and Cinnabar Pill) 3 qian, taken down with Astragali Complanati Semen Decoction.
Annotation by Yuan: Using Kongxian Dan to drain damp-heat, phlegm, and turbidity from the Middle Jiao, and Cizhu Wan to harmonize Kan and Li, demonstrates skillful maneuvering.
Wang: The disease began as Gao Lin (fatty dysuria), transformed into Shi Lin (stone dysuria), and now has become Xue Lin (bloody dysuria). This is because Kidney deficiency fails to store essence; damp-heat and Ministerial Fire steaming and burning cause essence to transform into turbidity, which coagulates into clumps. Long-term Yin injury causes blood to pour downward, hence blood clots are seen. Tonify Yin and marrow to transform damp-heat; the treatment method should combine slippery (unblocking) and astringent (securing) actions.
Rehmanniae Radix Preparata (Shu Di Huang), Eclipticae Herba (Han Lian Cao), Turtle Shell (Gui Ban), Asparagi Radix (Tian Dong), Hominis Calx Carbonisata (Xue Yu Tan), Euryale Seed (Qian Shi), Autumn Stone (Qiu Shi), Astragali Complanati Semen (Sha Yuan Zi), Malvae Semen (Dong Kui Zi), Lepidii Semen (Jiu Cai Zi - stir-fried), Lotus Plumule (Xiang Lian Rou).
Li: When the North Gate (Kidney) is guarded, Yang Qi is secured; when the Yang of Kun Earth (Spleen) moves, damp-turbidity transforms. When damp-turbidity transforms, essence becomes abundant; when Yang Qi is secured, essence is retained. What is worrying is the emaciation of muscles. Muscles are like city walls; Yuan Qi (Original Qi) is like the ruler. If the walls collapse and the ruler is impoverished, only massive tonification of Yuan Qi will suffice.
Rehmanniae Radix Preparata (Shu Di Huang), Codonopsis Radix (Xi Dang Shen), Atractylodis Rhizoma (Dong Zhu), Lycii Fructus (Gou Qi Zi), Eucommiae Cortex (Nong Du Zhong), Ophiopogonis Radix (Mai Dong), Dioscoreae Rhizoma (Huai Shan Yao), Cistanche Stem (Dan Cong Rong), Angelicae Sinensis Radix (Dang Gui), Pinelliae Tuber (Ban Xia), Citri Reticulatae Pericarpium (Chen Pi), Poria (Fu Ling), Hordei Fructus Germinatus (Gu Ya).
Xiao: According to the history, the condition mostly arises from emotional depression, with deficiency in the lower Liver and Kidney. Frequent urination with clear sediment, stiffness of joints throughout the body, and numbness of the head and face. This is due to internal deficiency of Yin fluids, Wind-Yang winding around collaterals, insufficient source, and failure of Bladder transformation. Nourish Yin fluids to extinguish Wind-Yang; save the source to facilitate Qi transformation; additionally, one must cultivate emotions and rest peacefully, so recovery may be expected.
Rehmanniae Radix Preparata (Shu Di Huang), Two Winters (Er Dong - Ophiopogonis and Asparagus), Turtle Shell (Gui Ban), Astragali Complanati Semen (Sha Yuan Zi), Schisandrae Fructus (Wu Wei Zi), Drynariae Rhizoma (Chuan Duan), Poria (Fu Shen), Glehniae Radix (Sha Shen), Ribes Fruit (Fu Pen Zi), Lepidii Semen (Jia Jiu Zi).
Annotation by Yuan: Since it originates from seven-emotions stagnation, Heart Fire fails to descend to Kidney Water, causing the Kidney gate to be insecure. It seems appropriate to treat both Heart and Kidney.
Zhang: A male developing too early at fourteen, preservation is not secure. Ultimately, external fullness masks internal deficiency. Occasional internal heat, fatigue, and weakness suggest fear of progression into consumptive disease. Tonify the Pre-Heaven (Congenital) and regulate the Post-Heaven (Acquired); self-care is paramount.
Codonopsis Radix (Dang Shen), Rehmanniae Radix Preparata (Shu Di Huang), Dioscoreae Rhizoma (Huai Shan Yao), Moutan Cortex (Dan Pi), Poria (Fu Ling), Citri Reticulatae Pericarpium (Chen Pi), Astragali Complanati Semen (Sha Yuan Zi), Coicis Semen (Yi Yi Ren), Eucommiae Cortex (Du Zhong), Drynariae Rhizoma (Jin Gou Ji).
Xue: The left Chi pulse is extremely fine; Cun and Guan pulses are faint and seemingly rapid; all three positions on the right are wiry and slippery. There is an underlying dark ailment of seminal emission, anal itching with discharge; superiorly, dizziness and tinnitus; tongue coating is powdery white. Matching pulse to symptoms, Kidney Yin is deficient below, while damp-heat and Ministerial Fire overflow downward and confuse upward, obscuring the clear orifices. The treatment method should tonify Kidney Yin and clear Ministerial Fire, clear Metal and harmonize the Stomach, separate and drain the Bladder to transform damp-heat.
Dichroae Radix (Bi Xie), Rehmanniae Radix Preparata (Shu Di Huang - stir-fried with Araneae Pulvis/Hai Fen), Anemarrhenae Rhizoma (Zhi Mu), Alismatis Rhizoma (Ze Xie), Turtle Shell (Gui Ban), Ophiopogonis Radix (Mai Dong), Phellodendri Cortex (Huang Bo), Red Poria (Chi Ling), Pinelliae Tuber (Ban Xia), Moutan Cortex (Dan Pi), Oyster Shell (Mu Li), Dioscoreae Rhizoma (Huai Shan Yao).
Second prescription: Pill Formula.
Rehmanniae Radix Preparata (Shu Di Huang - steamed with Amomi Fructus and aged wine), Atractylodis Rhizoma (Dong Zhu - stir-fried with soil), Coptidis Rhizoma (Huang Lian - stir-fried with salt water), Sophorae Flavescentis Radix (Ku Shen), Gastrodiae Rhizoma (Tian Ma), Dioscoreae Rhizoma (Huai Shan Yao), Moutan Cortex (Dan Pi - stir-fried with salt water), Ligustici Chuanxiong Rhizoma (Chuan Xiong), Euryale Seed (Qian Shi), Turtle Shell (Gui Ban - roasted with fat), Oyster Shell (Mu Li - calcined), Alismatis Rhizoma (Ze Xie - stir-fried with salt water), Phellodendri Cortex (Huang Bo - stir-fried with salt water), Anemarrhenae Rhizoma (Zhi Mu - stir-fried with salt water), Pinelliae Tuber (Ban Xia), Dichroae Radix (Bi Xie - stir-fried with salt water), Red Poria (Chi Ling), Ophiopogonis Radix (Mai Dong - stir-fried with Job's Tears).
Grind the above herbs into powder. Use 4 liang of Jianlian Powder and 4 liang of Massae Medicamentae Fermentatae Chinensis, boil into paste, and knead into pills.
Annotation by Yuan: This formula is excellent for treating seminal emission due to Kidney deficiency with damp-heat, but it requires robust stomach appetite. If food intake is low, bitter-cold herbs like Coptis and Phellodendron should be used with caution.
Gao: Linzhuo (dysuria and cloudy urine) accompanied by seminal slip, deafness, and blurred vision. Severe deficiency of Liver and Kidney; diuresis is inappropriate. The treatment method should focus on securing and holding.
Astragali Complanati Semen (Sha Yuan Zi), Dioscoreae Rhizoma (Huai Shan Yao), Psoraleae Fructus (Bu Gu Zhi), Poria (Fu Shen), Lepidii Semen (Jia Jiu Zi), Euryale Seed (Qian Shi), Dragon Bone (Long Gu), Oyster Shell (Mu Li). Take Weixi Wan (Weixi Pill) 3 qian morning and evening.
Annotation by Yuan: Purely a deficiency pattern; add Prepared Rehmannia (Shu Di Huang) and Corni Fructus (Shan Zhu Yu).
Jiang: The Kidney stores essence, the Liver stores blood, and the Bladder governs drainage. Thus, the anterior yin is one organ with two orifices. They do not open simultaneously. When the water orifice opens, damp-heat is discharged, and Ministerial Fire remains tranquil. If sexual activity is excessive, Ministerial Fire becomes hyperactive, and essence and blood are not stored, mixing into the water orifice, resulting in bloody dysuria and painful orifices.
Rehmanniae Radix Preparata (Shu Di Huang), Yuan Jing Shi (Mineral Salt), Moutan Cortex (Dan Pi), Turtle Shell (Gui Ban), Schisandrae Fructus (Wu Wei Zi), Phellodendri Cortex (Chuan Huang Bo), Hominis Calx Carbonisata (Xue Yu Tan), Glehniae Radix (Sha Shen), Anemarrhenae Rhizoma (Zhi Mu), Ophiopogonis Radix (Mai Dong), Poria (Fu Ling), Eclipticae Herba (E Jiao).
Gao: A fine pulse certainly indicates Yin deficiency. If the Chi pulse sinks to the depth of Ruze, it indicates Ministerial Fire overflowing downward, causing essence and blood to flow downward, frequent urination, painful urethral orifice, and dry stool. The treatment method is to nourish Kidney Yin and clear Ministerial Fire.
Rehmanniae Radix Preparata (Shu Di Huang), Turtle Shell (Gui Ban), Phellodendri Cortex (Huang Bo), Rheum Radix et Rhizoma (Da Huang - stir-fried with wine), Akebiae Caulis (Mu Tong), Small Thistle Charcoal (Xiao Ji Tan), Eclipticae Herba (E Jiao - stir-fried with Lygodii Spora), Scorpio (Jiao Shan Zhi), Licorice Root Tip (Gan Cao Shao), Anemarrhenae Rhizoma (Zhi Mu), Poria (Fu Ling), Mirabilite (Yuan Ming Fen), Plantaginis Seed (Che Qian Zi), Achyranthes Bidentatae Radix (Niu Xi).
Chen: No-dream seminal emission indicates not only Yin deficiency but also Yang decline; dry cough without sputum indicates not only Lung deficiency but also Stomach weakness. Tonify essence and grasp Qi, warm and nourish True Yang—this treats the Kidney; tonify Earth to generate Metal, clear and purify the high source—this treats the Lung. As for the strategy to save the root, it lies in ceasing妄 thoughts (delusions/unreal desires). The term "no delusion" covers a wide range; if the Heart Monarch is stabilized, there is naturally no fear of agitation.
Prepared Rehmannia (Shu Di Huang), Codonopsis Radix (Dang Shen), Schisandrae Fructus (Wu Wei Zi), Lycii Fructus (Gou Qi Zi), Poria (Fu Shen), Cuscutae Semen (Tu Si Zi), Dragon Bone (Long Gu), Astragali Complanati Semen (Sha Yuan Zi), Dioscoreae Rhizoma (Huai Shan Yao), Oyster Shell (Mu Li), Turtle Shell (Gui Ban), Moutan Cortex (Dan Pi), Eucommiae Cortex (Du Zhong), Euryale Seed (Qian Shi).
Hua: The illness arose from grief and anger over the loss of a son, leading to depression. Liver Fire was hyperactive, causing urinary turbidity, gradually progressing to seminal emission for over a year, every day without exception. In the new year, Qi from the left lower abdomen and testicles attacked the chest, mental madness, bleeding gums, and dark eyes—all due to unrestrained hyperactivity of Liver Fire. The Classics state: The Kidney governs closure and storage; the Liver governs drainage. Both organs possess Ministerial Fire, which connects upward to the Heart. The Heart is Sovereign Fire; if the Sovereign does not control the Minister, Ministerial Fire moves recklessly. Even without intercourse, secret leakage occurs. One must restrain Liver hyperactivity and benefit Kidney deficiency, following Yuè Jūn's example of draining South (Fire) and tonifying North (Water) for East Excess and West Deficiency.
Coptidis Rhizoma (Chuan Lian), Scorpio (Jiao Shan Zhi), Corydalis Rhizoma (Yan Hu Suo), Fresh Rehmanniae Radix (Xian Sheng Di), Red Poria (Chi Ling), Glehniae Radix (Sha Shen), Toosendan Fruit (Chuan Li Zi), Anemarrhenae Rhizoma (Zhi Mu), Phellodendri Cortex (Huang Bo), Turtle Shell (Gui Ban), Euryale Seed (Qian Shi).
Separately, take Danggui Longhui Wan (Angelica and Gardenia Pill) 1 qian, taken down with boiled water.
Attached Pill Formula:
Coptidis Rhizoma (Chuan Lian - stir-fried with salt water), Sophorae Flavescentis Radix (Ku Shen), Atractylodis Macrocephalae Rhizoma (Bai Zhu - soaked in rice wash, dried), Oyster Shell (Mu Li).
Grind together into powder. Use one male pig stomach, insert the powder inside, tie securely with thread, and boil until soft with half water and half wine. Mash the medicine and wine together. If too soft, add Jianlian Powder to dry and form pills. Take 3 qian every morning, taken down with boiled water.
Zhang: Engaging in literary work, the body is idle but the mind labors. Kidney Water deficiency below fails to ascend to the Heart; Heart Yang internally hyperacts and descends toward the Kidney, which is the non-interaction of Kan and Li. Non-interaction generates various diseases: downward, Linzhuo, hematuria, and pain of the sinews; upward, dizziness, cough, and palpitations. The pulse is small on the left and large on the right. How can there be doubt about internal injury and deficiency patterns! Having just returned from a long journey, exhausted from travel, propose mild tonification to avoid imbalance of heavy and light.
Vigna Radiata Seed (Ma Liao Dou), Licorice Root Tip (Gan Cao Shao), Poria (Fu Shen), Dioscoreae Rhizoma (Huai Shan Yao), Ophiopogonis Radix (Mai Dong), Lotus Plumule (Jian Lian Rou), Glehniae Radix (Sha Shen), Red Date (Hong Zao), Fresh Lotus Root (Xian Ou), Loquat Leaf (Pi Pa Ye).
Second visit: Heart Yin is depleted; the Sovereign does not control the Minister, Ministerial Fire moves recklessly, persistent erection, occasional flow of seminal turbidity, sensation of Qi sinking in the anus, loose stools, heartburn, dry cough without sputum. The Right pulse is empty and large; both Chi pulses are deficient. The treatment method should tonify Heart Yin to control Ministerial Fire, and benefit Kidney Qi to secure Original Essence.
American Ginseng (Yang Shen), Phellodendri Cortex (Huang Bo), Schisandrae Fructus (Wu Wei Zi), Anemarrhenae Rhizoma (Zhi Mu), Oyster Shell (Mu Li), Rehmanniae Radix Preparata (Shu Di Huang), Turtle Shell (Gui Ban), Ophiopogonis Radix (Mai Dong).
Separately, stir-fry Psoraleae Fructus (Bu Gu Zhi) and Lepidii Semen (Jiu Cai Zi) with salt water, grind into powder, make pills with refined honey. Take 3 qian per dose.
Annotation by Yuan: Ministerial Fire is hyperactive and Kidney Yin is extremely depleted. Making pills with these two ingredients specifically assists Kidney Yang, which may not suit this condition.
Bao: Laboriousness causes Qi deficiency; damp-heat sinks along with it. Initially, Linzhuo felt painful; now it is painless, but there is a sensation of Qi sinking, frequent urination, yellow color, and unclear turbidity. Imitate Dong Yuan's method of tonifying Spleen and Stomach, removing damp-turbidity, draining Yin Fire, and ascending Clear Yang.
Astragali Radix (Huang Qi - stir-fried with salt water), Bupleuri Radix (Chai Hu), Cimicifugae Rhizoma (Sheng Ma), Glehniae Radix (Sha Shen), Poria (Fu Ling), Euryale Seed (Qian Shi), Dichroae Radix (Bi Xie), Phellodendri Cortex (Huang Bo), Anemarrhenae Rhizoma (Zhi Mu), Juncus Effusus (Deng Xin), Table Salt (Yan Shi - dissolve a pinch).
Ren Yuan says: Seminal emission, Lin, and Zhuo are often grouped together by ancients, but their causes, diseases, and treatments differ; they cannot be generalized. Seminal emission is a disease of the essence gate. In youth, it often starts from lustful imagination or excessive sexual desire; in middle age, it may arise from excessive mental labor, where Heart Fire fails to descend, causing Kidney essence to leak, resulting in emission without dreams, or even emission during insomnia. There are also cases where damp-heat blocks the middle, preventing Liver Wood's ascending Yang Qi from reaching up, depressing into the lowest Yin, steaming and stirring the essence gate. Ancients distinguished deficiency and excess by presence or absence of dreams, which is not entirely accurate. Generally, those arising from damp-heat are mostly excess; those from lustful imagination, excessive desire, or mental labor are mostly deficiency. Even within deficiency, one must distinguish Yin deficiency, Yang deficiency, combined Yin-Yang deficiency, and deficiency with夹杂 excess. Current treatments often fail because practitioners do not clearly distinguish Yin-Yang and deficiency-excess, blindly using Kidney tonification and essence securing, and patients fail to cultivate the mind and reduce desires. Ministerial Fire moving recklessly causes seminal emission; Kidney Yang failing to secure also causes seminal emission. Examining ancient formulas clarifies this. Lin syndrome is entirely caused by issues in the Bladder and urinary orifice. Although divided into five types, half arise from damp-heat, as previously distinguished in detail. Even Lao Lin (fatigue Lin) and Xu Lin (deficiency Lin), possibly arising from sexual desire, involve rotten essence blocking the urinary tube, damage to the tube, or long-term Lin causing Bladder Qi deficiency leading to Kidney deficiency. This progresses from branch to root, from Fu organ to Zang organ, not originating in the Kidney. Zhuo syndrome involves both Kidney and Bladder, but Zang disease is more common than Fu disease. Short, red, obstructed urination is Bladder damp-heat; clear urination with flowing pus/turbidity is Kidney deficiency failing to secure essence. Yellow and thick turbidity indicates deficiency heat; white and clear turbidity indicates deficiency cold. Clear urination but short and frequent, always needing to urinate, also belongs to Kidney Qi deficiency and cold. Ancients did not distinguish well between Lin and Zhuo, attributing both to damp-heat. When I was young, I adhered to this view and treated them, often without success. After years of experience, I realized Lin belongs to the Bladder and urinary orifice, while Zhuo belongs to the Kidney and essence orifice. Although Zhuo may involve damp-heat and Bladder disease, it is predominantly Zang with Fu as secondary. Once damp-heat is cleared and urination is smooth, focus on benefiting Qi and securing essence; if Yang Qi is deficient, assist with raising Yang. Most Zhuo signs result from retaining semen during sexual desire, injuring the spermatic duct, causing insecurity of the essence gate, with Kidney fluid and Yin essence descending together. Long-term illness injures Yin affecting Yang, and Yang fails to control Yin. Previous cases had many concurrent diseases, so formulas cannot be uniform. Readers should understand this profoundly.