Stirring Wild Desires
On The Two Yīn
In Chinese medicine, the nine orifices are said to be either the two eyes, two ears, two nostrils, and mouth, plus the front and rear yīn (urethra and anus); or, according to Classic of Difficulties (Nán Jīng), chapter 37, they are the eyes, ears, nostrils and mouth plus the tongue and throat rather than the two yīn (Wiseman, 1998).
In this edition of Clinical mulch, we’ll go with the first option, and discuss diseases of the two yīn as they are presented in Zhēn Jiǔ Féng Yuán (針灸逢源, Encountering the Origins of Acumoxa) by Lǐ Xuéchuān, written in 1815. I’ve already posted the discussion on ear diseases from the same book, and published the chapter on eye diseases in the Journal of Chinese Medicine June 2024 issue.
二陰病
Diseases of the Two Lower Orifices
遺精 夢交而出精者。謂之夢遺。無夢而泄精者。謂之滑精。
膏肓俞 腎俞 中極（以上灸隨年壯） 三陰交 曲泉（兼膝脛冷痛者效） 中封
又精宮二穴。在十四椎下旁開中三寸灸七壯效。
Seminal Emission: If one dreams of intercourse and semen comes out, this is known as dream emission [mèng yí]. If there are no dreams when semen is discharged, this is called seminal efflux [huá jīng].
Gāo Huāng Shù [UB43], Shèn Shù [UB23], Zhōng Jí [CV3] (use the above points with moxibustion, the number of rounds follows the number of years of the patient’s age)
Sān Yīn Jiāo [SP6], Qū Quán [LR8] (this is effective in cases with concurrent cold pain in the knees and shins); Zhōng Fēng [LR4]
Then the two points of Jīng Gōng, located below the 14th vertebra [2nd lumbar], 3 cùn from the midline; 7 rounds of moxibustion is effective.
[Comment: The location given for Jīng Gōng is that of Zhì Shì [UB52] – which is given in Wiseman 2022 as an alternate name for UB52. Maciocia (2015) gives Jīng Gōng as a separate point 0.5 cùn lateral to UB52.]
白濁
腎俞 關元 中極
White Turbidity
Shèn Shù [UB23], Guān Yuán [CV4], Zhōng Jí [CV3]
[Comment: This would be white urethral discharge, which could indicate a number of conditions, including urethritis, gonorrhea, and chlamydia.]
陽痿 此乃腎與膀胱虛寒之症。
腎俞 氣海 （多灸妙）
Yáng Wilting [Impotence]: This is a disease of vacuity cold of the kidney and urinary bladder.
Shèn Shù [UB23], Qì Hǎi [CV6] (lots of moxibustion is excellent)
小便不禁 此常常出而不覺也。蓋膀胱火邪妄動。水不得寧故不禁而頻來。宜補腎膀陰血。瀉火邪為主。有睡中遺溺此為虛證。嬰兒脬氣未固。老人下元不足。皆有此患。但小兒挾熱者多老人挾寒者多。不可不辨。
氣海（小兒遺溺灸亦效） 關元 陰陵泉 大敦
Urinary Incontinence: This is frequent emission [of urine] without one’s being aware of it. This is because of urinary bladder fire evil stirring wild desires. Water is unable to be tranquil and so can’t help but to come frequently. It is good to supplement the yīn-blood of the kidney and bladder. Make draining fire evil the priority. If there is incontinence in sleep, this is a vacuity pattern.
Infants’ bladder qi is not consolidated. Older people have insufficiency of the lower origin. This [condition] afflicts them all. But children often harbor heat where older people often harbor cold. One must not fail to differentiate this.
Qì Hǎi [CV6] (for pediatric incontinence moxibustion is also effective), Guān Yuán [CV4], Yīn Líng Quán [SP9], Dà Dūn [LR1]
五淋
氣淋 小便澀常有餘瀝
石淋 莖中痛。溺如砂石（又名砂淋）
血淋 溺血。遇熱即發。
膏淋 便出如膏。
勞淋 勞倦即發。痛引氣衝（有補遺）。
間使 氣海 關元 石門 陰陵泉
一用白鹽炒熱填滿臍中。艾炷灸七壯。或灸三陰交即愈。
Five Stranguries [Wǔ Lín]
Qì strangury [qì lín]: Urination is rough and usually there is some remaining that trickles out
Stone strangury [shí lín]: There is pain in the stalk [penis]. The urine appears to have gravel in it (also called sand [shā] lín)
Blood strangury [xuè lín]: Urine with blood. [Blood] receives heat, then promptly gushes out.
Unctuous strangury [gāo lín]: The urine coming out appears oily.
Taxation strangury [láo lín]: Exhaustion prompts its appearance. The pain refers to Qì Chōng [ST30] (there is an addendum).
Jiān Shǐ [PC5], Qì Hǎi [CV6], Guān Yuán [CV4], Shí Mén [CV5], Yīn Líng Quán [SP9]
Use white salt, fry until hot, and fill up the umbilicus with it. Apply seven moxa cones. Or moxa Sān Yīn Jiāo [SP6] to promptly cure.
[Comment: I have included the addendum at the end of the post. Though there are different categories of strangury, there is only one set of points included. I’m tempted to write a follow-up post with some more specific treatments for the various types of strangury; usually the way we teach it in acu-school is much more complicated.]
小便閉癃 閉不通也。癃。即淋瀝也。
小腸俞 陰交（當膀胱之上□故灸此） 陰陵泉
Dribbling urinary block: This is blockage without pain and with dribbling, namely dribbling discharge.
Xiǎo Cháng Shù [UB27], Yīn Jiāo [CV7] (one must □ above the bladder so moxa this), Yīn Líng Quán [SP9]
[Comment: The □ is a missing character. I don’t have a hard copy of the text so I was not able figure out what it is; possibly it is some sort of needling prohibition so moxa should be used.]
大便秘結
章門 太白 照海
Constipation [Defecation blocked and bound]
Zhāng Mén [LR13], Tài Bái [SP3], Zhào Hǎi [KD6]
[Comment: The interesting thing about this prescription is that it uses points related to the viscera to treat the bowel. LR13 is the mù-alarm point for the spleen and the huì-meeting point for the viscera, SP3 is the yuán-source point for the spleen, KD6 is indicated for constipation. But there are no stomach channel points like ST25 or ST37, no large intestine points like LI4 or LI11.]
脾虛不大便
三陰交（灸三十壯） 商丘
Spleen vacuity with inability to defecate
Sān Yīn Jiāo [SP6] (moxa 30 rounds), Shāng Qiū [SP5]
脫肛 此由氣血虛而下陷
臍中（灸隨年壯） 長強（三壯） 水分（灸百壯。治洞泄脫肛）
Anal desertion [prolapse]: This is caused by qì and blood vacuity which then sinks.
Qí Zhōng [CV8] (moxa number of rounds following patient’s age), Cháng Qiáng [GV1] (3 rounds), Shuǐ Fèn [CV9] (moxa 100 rounds. Treats throughflux diarrhea and anal desertion)
便血 病在胃與大腸。故名腸風亦名藏毒。糞前者謂之近血。糞後者謂之遠血。皆由濕熱下注也。
中脘 氣海（凡血脫。色白飲食少進。脈濡弱。手足冷灸此二穴妙。）
Bloody stool: The disease is in the stomach along with the large intestine. Therefore it is called intestinal wind, also called visceral toxin. [Bleeding] before defecation is called proximal bleeding. [Bleeding] after defecation is called distal bleeding. This is due to downpour of damp-heat.
Zhōng Wǎn [CV12], Qì Hǎi [CV6] (For all blood desertion, when the complexion is white with reduced intake of food and drink, the pulse is soggy and weak, and the hands and feet are cold, to moxa these two points is excellent.)
[Comment: Proximal bleeding is bleeding near the terminus of the colon, mainly the anorectal region. Distal bleeding is further up the gastrointestinal tract, and may include stomach and duodenal ulcers.]
一凡便血諸治不效者。但取脊骨中與臍相平。按高凸之處覺痠疼者灸七壯即止。如復發再灸七壯。永可除根。至於衄血一切血症百治不效者。經灸永不再發。
一法於脊間二十椎下。灸隨年壯。
In all cases where the treatment of bloody stool is ineffective, you can still choose the middle of the spine at the same level of the umbilicus. Press [to find] spots which protrude out and which produce aching and soreness; apply 7 rounds of moxibustion to stop [the bleeding]. If it recurs, repeat with 7 rounds of moxa. This is always able to eliminate the root [of the problem]. As for nosebleeds and all types of bleeding disorders that have a hundred ineffective treatments, moxa the channels and they will never recur.
Another method is at the intervertebral space below the 20th vertebra [S3-4]. Moxa rounds follow the age of the patient.
痔漏 痔疾若破。謂之。痔漏大便秘澀必作大痛。
二白（在掌後四寸） 長強 承山 復溜 商丘
又灸十四椎下各開一寸治腸風諸痔效。
Hemorrhoidal fistula: If a hemorrhoid is ruptured, it is called a hemorrhoidal fistula. Defecation is blocked and rough, and always causes great pain.
Èr Bái (located behind the palm, 4 cùn), Cháng Qiáng [GV1], Chéng Shān [UB57], Fù Liū [KD7], Shāng Qiū [SP5].
Then moxa below the 14th vertebra [L2-3] each [side] 1 cùn [lateral to the spine]; it treats intestinal wind and all hemorrhoids effectively.
[Comment: I don’t think I have ever used KD7 for hemorrhoids, but it makes sense to me – as I’ve said in previous posts, I believe KD7 to have an upbearing tendency, and the kidney governs the front and rear yīn. Usually I do well enough with LU6, UB57 and UB62, but KD7 fits nicely in there for cases that read as kidney vacuity rather than lung vacuity (the latter would then be LU6 and SP5 plus the UB points). I will endeavor to keep the differentiation in mind for the next time I get a hemorrhoid case.]
Here is the addendum on strangury from the last section of the book.
淋病
淋症所感不一或因房勞。或因忿怒。或因醇酒厚味。房勞者。陰虛火動也。忿怒者。氣動生火也。醇酒厚味者。釀成濕熱也。積久為滯。濁流下焦。所以小便淋瀝。欲去不去。不去又來。而痛不可忍者。初則熱淋血淋。宜散熱利小便。久則煎熬水液。如濁如膏。如砂如石也。宜開抑。行氣。破血滋陰。
Strangury Diseases
Strangury symptoms and sensations are not uniform; they are either caused by bedroom taxation, or caused by indignation and anger, or caused by liquor and rich food.
Cases of bedroom taxation are yīn vacuity fire stirring. Cases of indignation and anger are qì stirring engendering fire. Cases of liquor and rich food lead to damp heat. Accumulation over time turns to stagnation, and turbidity flows to the lower burner. As a result, the urine dribbles and drips. One wants to go but can’t go. If one doesn’t go, it comes again, and the pain is unbearable.
At first, the condition conforms to heat strangury or blood strangury. It is appropriate to disperse heat and disinhibt urine. Over time it stews [the urine] into thick fluid that appears turbid, or greasy, or sandy, or stony. [At that point] it is appropriate to open repression, move qi, break blood and enrich yīn.
凡小腸有氣。小便脹。小腸有血。小便澀。小腸有熱。小便痛。禁用補氣之劑。
膀胱為津液之府。氣化則出。寒邪客於胞中。則氣不化而成淋。必先寒慄而後溲便澀數。竅中腫痛。蓋冷氣入胞。與正氣相爭。寒氣勝。則戰寒而作淋。宜散寒扶正。（淋病大率心腎氣鬱清濁相干。熱蓄膀胱所致。冷氣滯於膀胱而作淋者。甚少。）
In general, if the small intestine has qì [stagnation], urination is distending. If the small intestine has blood [stasis], urination is rough. If the small intestine has heat, urination is painful. It is prohibited to use qì-supplementing medicinals.
The urinary bladder is the the palace of the liquids and humors [jīn-yè zhī fǔ]. Qì transformation results in outflow [of urine]. If cold evil settles into the bladder, it results in non-transformation of qì, which develops into strangury.
At the start there is always cold shivering and after that the excretion of urine is rough and frequent. Inside the orifice [i.e. the urethra] is swollen and painful. This is because cold qì enters the bladder and it and the correct qì contend with one another. The cold qì triumphs, and the strangury develops from the battle with the cold. It is appropriate to scatter cold and support the correct.
(Strangury diseases generally have to do with heart and kidney, qì depression, and clear and turbid. It is caused by heat accumulating in the urinary bladder. Cases of cold qì stagnating in the urinary bladder that develop into strangury are very few.)
[Comment: The last comment, in parentheses, appears to me to be from Lǐ Xuéchuān (or another commenter) clarifying a passage from an earlier text. Certainly I have seen both cold and heat patterns in treating urinary dysfunction, but I see much more damp heat than damp cold or vacuity cold, even in older patients.]
虛淋者。腎虛精敗也。童子精未盛。而御女。老人陰已痿而思色。則精不出而內敗。莖中澀痛成淋者。惟金匱腎氣湯可救。若精已竭而復耗之。則大小便牽引而痛。
Vacuity strangury is kidney vacuity with corrupt essence. Boys’ essence is not yet exuberant, nor [is that of] ladies-in-waiting. Old men’s yīn is already wilting [i.e. impotent] and yet they think of sex, so the essence [i.e. semen] is not emitted and rots within. Inside the stalk is rough and painful and strangury develops, in such cases only Jīn Guì Shèn Qì Tāng [Golden Cabinet Kidney Qì Decoction] can help. If the essence is already exhausted and is again consumed, then there will be pulling and pain in defecation and urination.
[Comment: Yīn wilting and yáng wilting both mean impotence. Yīn in this context more broadly can be used for the genitalia of either sex; also the unisex 人 character is used here, but the reference to the stalk 莖 gives me the impression that the passage is speaking about people with stalks, i.e. penises.]
Okay, that’s it for now, thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Lǐ, X. (1815). Zhēn jiǔ féng yuán. https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E9%80%A2%E6%BA%90/index.html
Maciocia, G. (2015). Foundations of Chinese Medicine: A Comprehensive Text (3rd Edition). Elsevier Health Sciences (US).
Wiseman, N. (1998). A practical dictionary of Chinese medicine. Paradigm Publications.
Wiseman, N. (2022). Chinese-English Dictionary of Chinese Medical Terms. Paradigm Publications.