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Those with difficult urination have pathogenic factors gathered in the Lower Jiao (Lower Burner), knotting and not dispersing; severely, this presents as hardness, fullness, and pain in the lower abdomen, which is termed urinary obstruction. Generally, for any difficulty in urination, one should employ methods to promote flow, utilizing diuretic and leaching properties. If excessive drinking leads to heat in the Lower Jiao, or if dampness causes jaundice, or if water retention stagnates, promoting urination should be the primary treatment. However, after sweating where body fluids are depleted and the Stomach is dry, or in Yangming disease with excessive sweating, promoting urination is contraindicated. If there is difficulty in urination accompanied by sweating only on the head, this indicates a critical condition of Yang collapse and Guan-Ge (obstruction). For excessive drinking leading to difficult urination and heat accumulation in the Lower Jiao: if the pulse is floating, use Wu Ling San (Five-Ingredient Powder with Poria); if the pulse is deep, use Zhu Ling Tang (Polyporus Decoction). In Taiyang disease, if there is yellowing of the body, a deep pulse, hardness in the lower abdomen, and difficult urination, it can be known that there is no blood stasis; combined with Yangming disease presenting with no sweat, difficult urination, and mental restlessness (Ao-Nao), jaundice will certainly occur; use Yin Chen Wu Ling San (Artemisia Capillaris Five-Ingredient Powder), after which the yellow color recedes and urination becomes clear.

Difficulty in urination indicates Yin deficiency, where Yang Qi inevitably congregates there due to heat in the Bladder, resulting in red, astringent, and non-smooth urination. There are cases where there has been no bowel movement for five or six days, yet urine output is scant; the stool may be hard initially but loose later, and if forced with purgatives, it will become loose. One must wait until urine output increases and the stool is confirmed to be hard before employing purgation. This occurs because there is little food and fluid in the Stomach; although the bowels move, the volume is small, and Zhu Ling Tang (Polyporus Decoction) may be used.

Spontaneous frequent urination indicates that body fluids are leaking preferentially to the anterior, causing the stool to become hard; purgative medication is appropriate. In Taiyin disease, jaundice should develop; however, if urination is spontaneous and frequent, damp-heat drains internally, preventing jaundice. In cases of blood disorders, with urgency in the lower abdomen and manic behavior, if urination is spontaneous and frequent, it indicates deficiency of the Kidney and Bladder failing to control fluids; use Tao Ren Cheng Qi Tang (Peach Kernel Da Huang Decoction) to purge. If there is spontaneous sweating and frequent urination, even if exterior symptoms exist, Gui Zhi Tang (Cinnamon Twig Decoction) should not be used, as it consumes body fluids. If mistakenly administered leading to cold limbs (Jue), treat with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction).

White coating on the tongue indicates heat in the Dan Tian (Elixir Field/Lower Abdomen) and cold in the Chest, signifying that cold pathogenic factors have just entered the interior; use Xiao Chai Hu Tang (Minor Bupleurum Decoction). The tongue is the sprout of the Heart, corresponding to the Fire of the South; when pathogens are at the exterior, no coating forms. When pathogens enter the interior and body fluids knot and bind, a slippery coating forms on the tongue. As heat intensifies, the coating becomes dry and rough. When heat gathers in the Stomach, the coating turns yellow; use Cheng Qi Tang (Order the Qi Decoction) to purge. If a black coating appears on the tongue, the heat has penetrated deeply and the disease is critical. The Classics state: in heat diseases, if the mouth is dry and the tongue is black, it indicates Kidney Water punishing Heart Fire. With a floating pulse, tightness in both Yin and Yang positions, warm breath from the mouth, dryness in the center of the tongue, curling up in bed, cold feet, nasal discharge, and a slippery tongue coating, do not treat rashly. After seven or eight days, if there is slight fever and warmth in the hands and feet, this indicates the disease is about to resolve. If instead there is high fever, it is difficult to treat. If there is aversion to cold, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction) with added Sheng Jiang (Dried Ginger).