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[Background Information]
Book: Shanghan Da Bai (Great Clarification of Cold Damage)
Author: Gao Shishi
Dynasty: Qing
Chapter: Difficulty in Urination (Xiaobian Buli)
Category: Cold Damage (Shanghan)

When the Taiyang channel is affected by heat accumulation causing difficulty in urination, Zhang Zhongjing uses Wuling San (Five-Ling Decoction), while our family secret formula uses Qiangdu Mutong Tang. When the Yangming channel is affected by heat accumulation causing difficulty in urination, Zhang Zhongjing uses Zhuling Tang, Mutong Tang, and Liuyi San. Additionally, when wind-dampness pathogens interact, causing body swelling and pain along with difficulty in urination, Tongling Tang or Qianghuo Shengshi Tang are used. In cases of heat accumulation in the intestines and stomach leading to constipation and difficulty in urination, Bazheng San is employed. If heart heat transfers to the small intestine causing difficulty in urination, Daochi Banban Tang is prescribed. For upper jiao lung heat causing difficulty in urination, Qingfei Yin is used. When fluid retention causes difficulty in urination, Pingwei Siling San combined with Erchen Tang is applied. If excessive sweating leads to the loss of body fluids and subsequent difficulty in urination, Shengmai Yiqi Tang is used. If excessive purging damages middle qi and depletes internal fluids resulting in difficulty in urination, Shengmai Jianzhong Tang is indicated. Regarding constipation discussed in the context of Six Qi theory, the *Neijing* states that during the governance of Yangming, the heavenly qi is urgent and earthly qi is bright, causing the people to suffer from long bi (difficulty in urination); this indicates dry-heat imposition, suitable for Baihu Tang and Qingzao Tang. It also states that during the governance of Shaoyin, the earthly qi is solemn and heavenly qi is bright, causing strangury; this indicates the action of Minister Fire, suitable for Xiexin Tang and Daochi Banban Tang. Furthermore, during Taicyin's position in the lower heaven, excessive dampness causes abdominal swelling and inability to urinate; this indicates the failure of Earth element, suitable for Pingwei Wuling San. It is said that insufficient Water qi is called "dried stream," causing difficulty in urination; this indicates fire blazing and drying Earth, with Metal failing to generate Water, suitable for Qingfei Yin and Liangge San. During Jueyin's governance, excessive Wind causes loose stools; Wood overacts on Earth, impairing its ability to separate clear turbid fluids, causing water and grain to leak into the large intestine. Initially, Qiangfang Shengshi Tang is used to disperse wind and remove dampness, followed by Wuling San and Zhuling Tang to separate and promote yin and yang. Additionally, food stagnation in the middle jiao causing dark, astringent, yellow, and turbid urine indicates unclear middle qi and changed urine color; Xinwen Huazhi Baohe San added with Amomum fruit and Cardamom seed, combined with Cangzhu Pingwei San, is suitable. Misuse of cold-natured herbs will cause food stagnation to congeal. In cases of interior cold in the Three Yin channels causing urinary obstruction, this is Yin syndrome cold closure. For deficiency of True Yang, Jin Kui Shenqi Wan is used; for deficiency-cold of middle qi where qi transformation fails to reach the Zhou Du (bladder), Buzhongqi Tang is used. Externally, edema with difficulty in urination, hiccups with difficulty in urination, prenatal conditions with difficulty in urination, and trauma with difficulty in urination are detailed separately in the miscellaneous diseases section.

In Taiyang disease, after sweating, profuse sweating occurs, causing dryness in the stomach, restlessness, insomnia, and desire for water. Give water sparingly; when stomach qi harmonizes, the patient recovers. If the pulse is floating, there is difficulty in urination, slight fever, and thirst with excessive drinking, treat with Wuling San.

After sweating, followed by profuse sweating, the exterior pathogen is resolved, but stomach dryness causes thirst. Water can resolve this dryness and cure the condition. However, if the pulse remains floating, the exterior pathogen has not dispersed, and accompanied by difficulty in urination, slight fever, and thirst, this indicates Taiyang heat accumulation in the Bladder.

In Taiyang disease, with jaundice, deep and knotted pulse, hardness in the lower abdomen, and difficulty in urination, this indicates absence of blood stasis.

This distinguishes between water accumulation and blood stasis in the lower abdomen. With identical symptoms of jaundice, deep knotted pulse, and lower abdominal hardness, patent urination indicates blood stasis (Xu Xue), while difficult urination indicates urine accumulation (Niao Jie).

After severe purging followed by sweating, if difficulty in urination occurs, it is due to the loss of body fluids. Do not treat it directly; once urination resumes, the disease will heal spontaneously.

This explains that excessive sweating and purging lead to external loss and internal depletion of fluids. Avoid using harsh diuretics that deplete bladder fluids; the disease will heal itself.

In cold damage after five or six days, having been sweated and then purged, presenting with fullness and slight knotting in the chest and hypochondrium, difficulty in urination, thirst without vomiting, only head sweating, alternating chills and fever, and irritability, the disease is unresolved. Treat with Chaihu Guizhi Ganjiang Tang.

Difficulty in urination is often due to interior heat, but since Shaoyang and Taiyang exterior signs remain, the method of dispersing the exterior is established.

In Yangming disease, fever and sweating indicate that heat escapes outward, preventing jaundice. Only head sweating, no body sweat up to the neck, difficulty in urination, and thirst for liquids indicate stagnant heat in the interior, leading to jaundice. Treat with Yinchen Tang. After seven or eight days of cold damage, if the body is yellow like an orange peel, with difficulty in urination and slight abdominal fullness, use Yinchen Hao Tang.

This section details jaundice. It states that if exterior sweat does not penetrate, heat stagnates internally, causing jaundice. With difficulty in urination and slight abdominal fullness, Yinchen Tang removes damp-heat, resolving jaundice, improving urination, and reducing abdominal fullness.

If a patient has difficulty in urination, intermittent difficulty and ease in defecation, occasional slight fever, wheezing, dizziness, and inability to lie down, there is dry feces. Use Da Chengqi Tang.

This syndrome involves hardened feces with slight fever and difficulty in urination. Purging the bowels will restore normal urination. This details the symptom of inability to lie down.

**Wuling San**
Alismatis Rhizoma, Polypori Parietis Sclerotium, Poria, Atractylodis Macrocephalae Rhizoma, Cinnamomi Ramulus.

For Yangming difficulty in urination, use Zhuling Tang. For Taiyang pathogenic heat accumulating internally in the Bladder causing difficulty in urination, this formula is used. However, Atractylodis Macrocephalae Rhizoma is cloying, and Cinnamomi Ramulus is pungent and hot; it is only suitable when there is no interior stagnant heat.

**Qianghuo Mutong Tang** (See Fever).

**Guizhi Wuling San** disperses Taiyang exterior pathogens externally and promotes bladder urination internally. It is not used in the southern hot climate; our family modified it. Notopterygii Radix et Rhizoma resolves the Taiyang exterior, while Akebiae Caulis benefits the bladder interior.

**Zhuling Tang**
Polypori Parietis Sclerotium, Poria, Alismatis Rhizoma, Talcum, Asini Corii Colla, Akebiae Caulis.

For Yangming heat accumulation causing difficulty in urination, instead of Wuling San, this formula is used. Our family secret replaces Asini Corii Colla with Scutellariae Radix for best efficacy.

**Liuyi Mutong Tang** is Mutong Tang taken with Liuyi San.

The previous clause used Qianghuo Mutong Tang to double-resolve Taiyang; this clause uses Talcum and Akebiae Caulis to separately benefit Yangming.

**Tongling Tang**
Akebiae Caulis, Polypori Parietis Sclerotium, Poria, Plantaginis Semen, Lophatheri Herba, Glycyrrhizae Radix et Rhizoma, Ophiopogonis Tuber.

This formula promotes urination. Our family adds Coptidis Rhizoma to clear Heart and Stomach heat; adds Platycodonis Radix, Scutellariae Radix, and Gypsum Fibrosum to clear Lung and Stomach heat; adds Rehmanniae Radix, Phellodendri Cortex, and Anemarrhenae Rhizoma to clear Kidney fire and nourish True Yin; adds Ginseng Radix et Rhizoma if qi transformation is insufficient to assist Lung qi.

**Qianghuo Shengshi Tang**
Notopterygii Radix et Rhizoma, Saposhnikoviae Radix, Atractylodis Rhizoma, Phellodendri Cortex, Alismatis Rhizoma, Poria, Citri Reticulatae Pericarpium, Glycyrrhizae Radix et Rhizoma.

This formula disperses the exterior and overcomes dampness, combining Alismatis Rhizoma and Phellodendri Cortex to clear and drain the Lower Jiao, excellently achieving the separation of exterior and interior.

**Bazheng San**
Plantaginis Semen, Dianthi Herba, Polygoni Avicularis Herba, Talcum, Gardeniae Fructus, Glycyrrhizae Radix et Rhizoma (tip), Akebiae Caulis, Rhei Radix et Rhizoma.

For anterior and posterior heat accumulation causing difficulty in both urination and defecation, use this formula. Our family adds Tetrapanacis Medulla and Aurantii Fructus for more focused power.

**Daochi Banban Tang** (See Fever).

Daochi San treats blood-heat causing difficulty in urination. Combined with Xiexin Tang, it clears both qi and blood. Using Akebiae Caulis and Coptidis Rhizoma together guides Heart fire downward through urination; using Rehmanniae Radix and Coptidis Rhizoma together cools Heart blood, allowing Heart fire to clear naturally. People know Coptidis Rhizoma cools Heart fire, but do not realize the Heart governs Blood; combined with Rehmanniae Radix, its efficacy is complete.

**Qingfei Yin**
Platycodonis Radix, Scutellariae Radix, Gardeniae Fructus, Forsythiae Fructus, Trichosanthis Radix, Scrophulariae Radix, Menthae Haplocalycis Herba, Glycyrrhizae Radix et Rhizoma.

Nothing promotes urination better than clearing the Lung. This formula does not use direct diuretics but deeply understands the method of promoting urination.

**Pingwei Siling Tang** is Pingwei San combined with Siling San.

Diuretics should avoid drying herbs. Here, due to fluid retention blocking the Middle Jiao with turbidity, pungent dispersants are used, which is another method of promoting water metabolism.

**Shengmai Buzhong Tang** is Shengmai San combined with Buzhong Yiqi Tang.

The Bladder is the official of the Zhou Du, storing fluids; qi transformation allows them to exit. This formula uses Shengmai to moisten fluids and tonify the Middle to assist qi transformation. Our family adds Plantaginis Semen for faster effect.

**Shengmai Jianzhong Tang**
Ginseng Radix et Rhizoma, Ophiopogonis Tuber, Schisandrae Chinensis Fructus, Paeoniae Radix Alba, Cinnamomi Ramulus, Glycyrrhizae Radix et Rhizoma.

The above formula combines Shengmai San with Buzhong Tang; this formula combines with Jianzhong Tang. One tonifies qi, the other nourishes blood, opening two major therapeutic gates.

**Baihu Tang** (See Thirst).

Yangming dry-heat restricts the Lung. This formula clears upper jiao dry-fire, allowing urination to flow freely.

**Qingzao Tang**
Mori Folium, Gypsum Fibrosum, Glycyrrhizae Radix et Rhizoma, Ginseng Radix et Rhizoma, Asini Corii Colla, Armeniacae Semen Amarum, Canavaliae Semen, Ophiopogonis Tuber, Eriobotryae Folium.

Detailed in the Wheezing section. Gypsum Fibrosum combined with Armeniacae Semen Amarum clears Lung fire, assisted by Asini Corii Colla and Ophiopogonis Tuber to moisten Lung dryness. Fire injures qi; supplemented by Ginseng Radix et Rhizoma and Glycyrrhizae Radix et Rhizoma. Lung dryness causes Large Intestine dryness; assisted by Canavaliae Semen, Lower Jiao fire drains, and urination flows freely.

**Jinkui Shenqi Wan**
Rehmanniae Radix, Moutan Cortex, Alismatis Rhizoma, Polypori Parietis Sclerotium & Poria, Corni Fructus, Dioscoreae Rhizoma, Plantaginis Semen, Aconiti Lateralis Radix Praeparata, Cinnamomi Cortex.

When Hand-Shaoyin Heart fire is hyperactive causing difficulty in urination, use Daochi Banban Tang; when Foot-Shaoyin Kidney channel fire is hyperactive causing difficulty in urination, use Zhibai Liuwei Wan; when Foot-Shaoyin Kidney channel fire is deficient causing difficulty in urination, use this formula to supplement fire within water. One formula treats extreme heat causing difficulty in urination; one treats water deficiency causing difficulty in urination; one treats fire deficiency causing difficulty in urination. External contraction causing difficulty in urination should not be listed under fire deficiency methods; this arises because external contraction triggers internal injury.

**Da Xianxiong Tang** (See Chest Binding).

Xianxiong Tang and Pills are originally not methods for promoting urination. However, in Chest Binding syndrome presenting with difficulty in urination, treating the Chest Binding is equivalent to promoting urination.

**Yinchen Hao Tang** (See Jaundice).

If difficulty in urination precedes jaundice, promoting urination resolves the jaundice. If jaundice accompanies difficulty in urination, clearing damp-heat resolves jaundice, and urination flows freely.

**Chaihu Guizhi Ganjiang Tang** (See Alternating Chills and Fever).

For difficulty in urination caused by exterior pathogens, first disperse the exterior. Since Shaoyang syndrome presents alongside Taiyang, this formula is used.

**Zhenwu Tang** (See Abdominal Pain).