天之温胃暖胸者。以肾阳为釜底之炊。其后天之上蒸下被者。以胃阳为分照之耀。夫此淋既为上虚中寒
所致。故用辛咸走肾之附子。纳其热于下焦。所以扶肾阳。而为温胃暖胸之地。即治小腹之弦急者。实在其
中矣。用甘温走胃之薯蓣。提其热于中焦。所以温胃阳。而为上蒸下被之地。即治脐中之痛引者。实在其中
矣。夫肾阳复。而先天之气从夹脊而上熏。胃阳复。而后天之气由脾肺而上贮。则上焦之神气自充。而提挈
有力分布有神。亦何虚淋之不愈哉。况以薯茯之渗泄者。去水以利小便。栝蒌之生津者。止渴以杜积水乎。
小丸吞服。欲其化于下焦。从下温中。又从中温上也。三丸渐增。恐虚寒者。不胜暴温。而益膀胱之假热也。曰
小便利。腹中温为知。其用意于中下二焦者可见矣。
十二条 小便不利。蒲灰散主之。滑石白鱼散。茯苓戎盐汤并主之。
蒲灰散方 蒲灰（七分） 滑石（三分）
上二味。杵为散。饮服方寸匕。日三服。
滑石白鱼散方 滑石（二分） 白鱼（二分） 乱发（二分烧）
上三味。杵为散。饮服半钱匕。日三服。
茯苓戎盐汤方 茯苓（半斤） 戎盐（弹丸大一枚） 白术（二两）
上三味。以水六升。煎取三升。分温三服。
此淫火停阁。浊淋之治例也。言病淋而小便不利。又有一种欲火流于两肾。不得有其事以下泄。因而肾络
以火气贯之。而肿重闭塞者。夫膀胱为肾之腑。肾移热于其中。故小便不利。肾精内动而不得下泄。又传其
精气于膀胱。而渐化为白淫以下注。故淋浊也。然则此火不散。而零星腐化。经年累月。其浊终不可止。蒲草
行根水中。具发生之性以泄水气。则为直至肾家而泻其火者也。又因此火。来自少阴心主。烧以为灰。色黑
味咸。黑入肾脏。咸则所以泻心火之留寄肾中也。配以甘寒分利之滑石。则直从水道而下散矣。故主之。若
此症经久失治。其阴精阴血。一则伤于邪火之内燔。再则耗于淋浊之下泄。则润槁逐瘀。为不可少。故又主
滑石白鱼散焉。滑石甘寒以泻邪火。分利以通小便。白鱼扁窄而长尾。故其激水之捷。为鱼中之最。以之入
散。欲其引滑石之速于走肾。而并用其分水之力以利小便也。发为血之余。既取其有润槁之功。乱发为败
血之余。复取其有逐瘀之性。烧灰则其味苦咸。所以败心火之下流肾部者。与蒲灰同义也。至若淋浊而小
便不利。以致积饮聚水。而水饮之害。较之淋症为尤急。故以淡渗之茯苓为主。燥土之白术为佐。先利其小
便以去水。加咸以润下。而并能泄心火之戎盐以治淋。则淋与小便不利。同愈矣。况肾为脏。脏无泻法。利水
以泻其腑者泻脏。则茯术亦未始非治淋之药也。曰并主之者。盖言总为浊淋之主方。而其所以应用者。又
自各有区别也。
十三条 渴欲饮水。口干舌燥者。白虎加人参汤主之。（方别见）
此条当冠淋之为病。小便不利二句。否则。不当入本门淋症之末矣。盖胸中热极。充塞中下。气机不行。故小
便不利。又胸中热极。呵嘘真阴逼迫下注。故淋也。白虎汤为金风荡热之剂。加人参为金液润枯之药。已详
伤寒本汤注。主此而膈中热解。则真气得以展舒。而小便自利。又膈中热解。则真阴得以上滋。而渴淋俱除
也。此因热而小便不利。因小便不利。则愈热而病淋者。故解热之外。而淋与小便不利。可不责而自愈矣。
十四条 脉浮发热。渴欲饮水。小便不利者。猪苓汤主之。
猪苓汤方 猪苓（去皮） 茯苓 泽泻 滑石 阿胶（各一两）
上五味。以水四升。先煮四味。取二升去滓。内下阿胶烊尽。温服七合。
此条当冠淋之为病一句。与上条同。夫脉浮发热。似属表症。渴欲饮水。似属里症。因其淋而小便不利。则知
渴饮为积水内热。因而烫膈所致。而浮热为热水内蒸。因而外鼓所致也。主本汤者。重用猪茯泽泻。以利小
便为主。随便加镇重甘寒之滑石。以降敛浮热。加滋阴补血之阿胶。以上止渴饮也。是此条又因小便不利。
故致上渴外热而下淋者。此利小便之外。兼止热渴。而淋症可不责而自愈矣。二条俱言热淋之治例也。
天气之所以能温暖胃部和胸部，是因为肾阳如同锅底燃烧的火焰。其后天之气之所以能向上蒸腾、向下覆盖，是因为胃阳如同分散照耀的光芒。既然这种淋证是由于上焦虚寒、中焦寒冷所致，因此使用辛咸入肾的附子，将热气收纳于下焦，以此来扶持肾阳，从而为温暖胃部和胸部创造条件。这就好比治疗小腹拘急疼痛的症状，其根本原因实在于此。使用甘温入胃的黄精（薯蓣），将热气提引至中焦，以此来温补胃阳，从而为上蒸下被提供基础。这就好比治疗脐中牵引作痛的症状，其根本原因也实在于此。当肾阳恢复，先天之气便从夹脊穴向上熏蒸；当胃阳恢复，后天之气便经由脾肺向上输布贮藏。这样，上焦的神气自然充盈，提挈有力，分布有神，那么虚性淋证怎么会不痊愈呢？况且利用黄精和茯苓的渗泄作用，去除水湿以利小便；利用栝蒌生津的作用，止渴以防止积水。制成小丸吞服，是希望药力在下焦化解，通过从下温中，进而从中温上。每次三丸逐渐增加剂量，是担心虚寒体质不能承受猛烈的温燥，以免助长膀胱的假热。说“小便利、腹中温暖”即为见效，由此可见其用意在于调理中、下二焦。
第十二条：小便不利，用蒲灰散主治。滑石白鱼散、茯苓戎盐汤也都主治。
蒲灰散方：蒲灰（七分）、滑石（三分）
以上两味药，研成细散，用米汤送服一方寸匕，每日三次。
滑石白鱼散方：滑石（二分）、白鱼（二分）、乱发（二分，烧成炭）
以上三味药，研成细散，用米汤送服半钱匕，每日三次。
茯苓戎盐汤方：茯苓（半斤）、戎盐（如弹丸大的一枚）、白术（二两）
以上三味药，用水六升，煎取三升，分三次温服。
这是淫火停滞闭塞，导致浊淋的治疗范例。文中说病名为淋且小便不利，还有一种情况是欲火流注于两肾，无法通过性行为发泄，因而肾络被火热之气贯穿，导致肿胀沉重闭塞。膀胱是肾的腑，肾将热邪移注其中，所以小便不利。肾精在内躁动却无法下行排泄，又将精气传至膀胱，逐渐化为白淫向下流出，所以形成淋浊。然而，如果这股火气不散，零星腐化，经年累月，浊液终究无法停止。蒲草生长在水中，具有生发之性以宣泄水气，它能直达肾脏而泻除火邪。又因为这股火来自少阴心主，将其烧成灰烬，色黑味咸，黑色入肾脏，咸味则能泻除留寄在肾中的心火。配合甘寒分利的小滑石，就能直接从水道向下消散。所以用此方主治。如果此症经久失治，阴精和阴血，一方面被邪火内焚所伤，另一方面因淋浊下泄而耗损，那么润燥逐瘀就成为不可缺少的治法。所以又用滑石白鱼散主治。滑石甘寒以泻除邪火，分利以通利小便。白鱼身体扁窄且长尾，因此它激水的敏捷程度是鱼类中最强的，用它入散，是希望引导滑石迅速走肾，并共用其分水之力以利小便。头发为血液之余，既取其有润燥之功，乱发为败血之余，又取其有逐瘀之性，烧成灰后味道苦咸，所以能败除心火下流至肾部的邪气，这与蒲灰的意义相同。至于淋浊导致小便不利，以致积饮聚水，而水饮的危害比淋症更为急迫，所以以淡渗利水的茯苓为主药，燥湿健脾的白术为佐药，先利小便以去水，再加咸味以润下，并用能泄心火的戎盐来治疗淋证，那么淋证与小便不利就能同时痊愈。况且肾为脏，脏无泻法，通过利水来泻其腑，也就是泻其脏，那么茯苓和白术也未尝不是治疗淋证的药物。说“并主之”，是说总归是治疗浊淋的主方，而其具体应用，又各自有所区别。
第十三条：口渴想喝水，口干舌燥的，用白虎加人参汤主治。（方剂另见）
这一条应当冠以“淋之为病，小便不利”两句，否则就不应列入本门淋症的末尾了。大概是因为胸中热极，充塞中下焦，气机运行不畅，所以小便不利。又因为胸中热极，呵嘘真阴逼迫下注，所以发生淋证。白虎汤是金风荡涤热邪的方剂，加入人参成为金液滋润枯槁的药物，这在《伤寒论》本汤注中已详细说明。主治此证而膈中热解，真气得以舒展，小便自然通利。又因为膈中热解，真阴得以上滋，口渴和淋证都能消除。这是因热导致小便不利，因小便不利，导致愈热而病淋的情况，所以在解热之外，淋证与小便不利可不需专门针对它们治疗而自愈。
猪苓汤方：猪苓（去皮）、茯苓、泽泻、滑石、阿胶（各一两）
以上五味药，用水四升，先煮前四味，取二升去渣，加入阿胶烊化尽，温服七合。
这一条应当冠以“淋之为病”一句，与上一条相同。脉浮发热，似乎属于表证；口渴想喝水，似乎属于里证。但因为伴有淋证且小便不利，就知道口渴饮水是因为积水内热，因而烫灼膈膜所致；而浮热是因为热水内蒸，因而外鼓所致。主治本汤，重用猪苓、茯苓、泽泻，以利小便为主，顺便加入镇重甘寒的滑石，以降敛浮热；加入滋阴补血的阿胶，以止上焦口渴饮水。这一条又是因小便不利，导致上渴、外热而下淋的情况。除了利小便之外，兼以止热渴，淋证可不需专门针对它们治疗而自愈。这两条都是讲述热淋的治疗范例。
The reason why the heavenly warmth warms the stomach and chest is that Kidney Yang (Shen Yang) acts as the fire fueling the bottom of the cauldron. The reason why post-heaven Qi (Hou Tian Zhi Qi) steams upward and covers downward is that Stomach Yang (Wei Yang) acts as the radiating light. Since this type of Lin syndrome (dysuria with pain) is caused by deficiency-cold in the upper jiao and cold in the middle jiao, Aconite Radix Preparata (Fuzi), which is pungent and salty and enters the Kidney, is used to gather heat into the lower jiao. This supports Kidney Yang, thereby creating the condition for warming the stomach and chest. Similarly, regarding the treatment of tension and urgency in the lower abdomen, the root cause lies here. Yam Rhizome (Shuyu), which is sweet, warm, and enters the Stomach, is used to draw heat up to the middle jiao. This warms Stomach Yang, thereby providing the basis for steaming upward and covering downward. Similarly, regarding the treatment of pain radiating from the umbilicus, the root cause also lies here. When Kidney Yang recovers, pre-heaven Qi (Xian Tian Zhi Qi) steams upward from the Jiaji points (BL12-BL23). When Stomach Yang recovers, post-heaven Qi transports upward via the Spleen and Lungs and stores there. Consequently, the divine Qi (Shen Qi) in the upper jiao becomes naturally abundant, with strong control and orderly distribution. In such a case, how could deficiency-type Lin syndrome fail to heal? Moreover, using the draining and leaching properties of Dioscorea (Shuyu) and Poria (Fuling) removes water to benefit urination; using Trichosanthes Fruit (Gualou) to generate fluids stops thirst and prevents water accumulation. Administered as small pills to be swallowed, the intention is for the medicine to transform in the lower jiao, warming the middle from below, and subsequently warming the upper from the middle. Starting with three pills and gradually increasing the dose avoids overwhelming patients with deficiency-cold with sudden intense warmth, which might exacerbate false heat in the Bladder. The indication "urine flows freely and the abdomen feels warm" signifies efficacy, revealing that the therapeutic intent focuses on the middle and lower jiao.
Article 12: For difficulty in urination, Putu San (Cattail Pollen Powder) is the primary formula. Huashi Baiyu San (Talcum and White Fish Powder) and Fuling Rongyan Tang (Poria and Military Salt Decoction) are also indicated.
Putu San Formula: Cattail Pollen (7 parts), Talcum (3 parts).
Grind the above two ingredients into powder. Take one fangcun bi (approx. 2-3 grams) with water, three times daily.
Huashi Baiyu San Formula: Talcum (2 parts), White Fish (2 parts), Human Hair (2 parts, burned to ash).
Grind the above three ingredients into powder. Take half a qian bi (approx. 1 gram) with water, three times daily.
Fuling Rongyan Tang Formula: Poria (half jin), Military Salt (one piece the size of a bullet), Atractylodes Macrocephala Rhizome (Bai Zhu, 2 liang).
Decoct the above three ingredients in six sheng of water until three sheng remain. Divide into three warm doses.
This illustrates the treatment of turbid Lin syndrome caused by the stagnation of licentious fire. The text states that when the disease is named Lin and accompanied by difficulty in urination, there is another scenario where desire-fire flows into both Kidneys but cannot be discharged through sexual activity. Consequently, the Kidney collaterals are penetrated by fire qi, leading to swelling, heaviness, and obstruction. The Bladder is the Fu organ of the Kidney; when Kidney heat transfers to it, urination becomes difficult. Kidney essence moves internally but cannot descend, transmitting its essence to the Bladder, where it gradually transforms into white turbidity (bai yin) flowing downward, resulting in Lin and turbid urine. However, if this fire does not dissipate, causing gradual corruption over years, the turbidity will never cease. Cattail grass grows in water and possesses a generating nature to vent water qi; it reaches directly to the Kidney house to drain fire. Furthermore, since this fire originates from the Shao Yin Heart Master, burning it to ash yields a black color and salty taste. Black enters the Kidney, and saltiness drains the heart fire lodged in the Kidney. Paired with sweet-cold Talcum, which separates and promotes urination, the pathogen descends directly through the urinary pathway. Hence, this formula is indicated. If this condition persists due to mismanagement, yin essence and blood are damaged by internal blazing evil fire and depleted by downward discharge of Lin turbidity. Therefore, moistening dryness and expelling stasis become indispensable. Thus, Huashi Baiyu San is indicated. Talcum is sweet and cold to drain evil fire and promote urination. The white fish is flat, narrow, and long-tailed, making it the most agile at stirring water among fish. Used in the powder, it aims to guide Talcum quickly to the Kidney and utilize its water-partitioning power to benefit urination. Hair is the surplus of blood; it is taken for its ability to moisten dryness. Broken hair is the surplus of stale blood; it is taken for its property to expel stasis. Burned to ash, it becomes bitter and salty, capable of defeating heart fire flowing down to the Kidney region, similar to the function of Cattail Pollen Ash. Regarding Lin turbidity causing difficulty in urination, leading to fluid retention and water accumulation, the harm of fluid retention is more urgent than that of Lin syndrome itself. Therefore, bland-leaching Poria is used as the chief herb, and earth-drying Atractylodes Macrocephala Rhizome as the assistant. First, urination is promoted to remove water. Adding saltiness to moisten and descend, along with Military Salt (Rong Yan) to drain heart fire and treat Lin, allows both Lin syndrome and difficulty in urination to resolve simultaneously. Moreover, the Kidney is a Zang organ, and Zang organs have no draining method. Draining the Fu organ through promoting urination is effectively draining the Zang organ. Thus, Poria and Atractylodes are not necessarily ineffective for treating Lin. The phrase "both are indicated" implies that these are all main formulas for turbid Lin, but their specific applications differ according to the pattern.
Article 13: For thirst with desire to drink water, accompanied by dry mouth and tongue, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. (Formula seen elsewhere.)
This article should ideally be prefixed with "Lin syndrome presents with difficulty in urination." Otherwise, it would not belong at the end of the Lin syndrome section. Generally, extreme heat in the chest fills the middle and lower jiao, obstructing qi mechanism, thus causing difficulty in urination. Additionally, extreme heat in the chest forces true yin to descend, causing Lin syndrome. Baihu Tang is a formula like autumn wind dispersing heat; adding Ginseng makes it a liquid gold that moistens dryness, as detailed in the commentary on the original Baihu Tang in Shanghan Lun. By resolving heat in the diaphragm, true qi can expand and relax, allowing urination to flow freely. Once heat in the diaphragm resolves, true yin can nourish upward, eliminating both thirst and Lin syndrome. This is a case where heat causes difficulty in urination, and difficulty in urination leads to increased heat and Lin syndrome. Therefore, beyond resolving heat, Lin syndrome and difficulty in urination will heal spontaneously without direct targeting.
Article 14: For floating pulse, fever, thirst with desire to drink water, and difficulty in urination, Zhuling Tang (Polyporus Decoction) is indicated.
Zhuling Tang Formula: Polyporus (Zhu Ling, peeled), Poria (Fu Ling), Alisma Rhizome (Ze Xie), Talcum (Hua Shi), Donkey-hide Gelatin (E Jiao) (each 1 liang).
Decoct the first four ingredients in four sheng of water until two sheng remain. Strain, then dissolve E Jiao in the decoction. Take seven he of the warm solution.
This article should also be prefixed with "Lin syndrome," consistent with the previous article. A floating pulse and fever seem to indicate exterior syndrome; thirst with desire to drink seems to indicate interior syndrome. However, given the presence of Lin syndrome and difficulty in urination, it is known that thirst arises from internal heat due to water accumulation scalding the diaphragm, and the floating heat results from internal steam of hot water pushing outward. The primary action of this formula relies on heavy use of Polyporus, Poria, and Alisma to promote urination. Talcum, being heavy, sweet, and cold, is added to subdue floating heat. Donkey-hide Gelatin, which nourishes yin and tonifies blood, is added to stop thirst and drinking. This article describes a situation where difficulty in urination leads to upper thirst, external heat, and lower Lin syndrome. Besides promoting urination, stopping heat-thirst ensures that Lin syndrome heals spontaneously. Both articles illustrate the treatment of heat-type Lin syndrome.