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(Profuse Urination / Frequent Urination)
Cheng Wuji: The condition of "Xiaolian" (smooth and frequent urination, often implying a lack of retention or pathological frequency depending on context) can be in the exterior, in the interior; it can be facilitated by heat or by cold. This is a syndrome that appears across all six channels, making it difficult to treat with a single general method. One should examine the specific channel条文 (textual passages) to distinguish them. Regarding "Xiaobian shu" (frequent urination), there are cases in the Three Yang channels involving the exterior and the interior; however, there are no cases of frequent urination in the Three Yin channels, so careful observation is required.

Taiyang Channel: In Taiyang disease lasting six or seven days, if the exterior syndrome persists, the pulse is faint and deep, and there is no formation of Jie Xiong (chest binding syndrome), but the patient goes mad because heat is in the lower jiao. If the lower abdomen is hard and full, and urination is smooth/frequent, blood stasis should be expelled for recovery, using Didang Tang. In Taiyang disease, if the body is yellow, the pulse is deep and knotted, the lower abdomen is hard, urination is smooth, and the patient is like one who is mad, this is a blood syndrome, treated with Didang Tang. In Shanghan (cold damage) with heat symptoms, if the lower abdomen is full, urination should be obstructed; now that it is smooth, this indicates blood stasis. It should be purged, not with other medicines, but with Didang Wan. After thirteen days of Shanghan remaining unresolved, passing into another channel and presenting with delirium, if urination is smooth and stool is also loose, but the pulse is harmonious, this is a Tiaowei Chengqi Tang syndrome (see Delirium). In Taiyang wind-strike, after fire therapy forced sweating leading to jaundice, desire for nasal bleeding, difficulty in urination, sweat only on the head, abdominal fullness, slight wheezing, dry mouth and rotten throat, or constipation leading to delirium over time, and severely even to moaning, picking at clothes, and touching the bed, if urination is smooth, it is treatable (see Delirium). In Taiyang disease, if urination is smooth and the patient drinks much water, palpitations in the epigastrium will occur; if urine output is low, there will be distress in the interior (lower abdominal urgency). For obstructed urination, use Gancao Fuling Tang. After eight or nine days of Shanghan, if wind-dampness combats each other, causing body pain and vexation, inability to turn over, without vomiting or thirst, and with a floating, deficient, and choppy pulse, use Guizhi Fuzi Tang. If the patient has smooth urination, remove Guizhi and add Baizhu Tang. In Shanghan with fever and aversion to cold, great thirst wanting to drink, and abdominal fullness, spontaneous sweating, and smooth urination, this indicates the pathogen is about to resolve. This is Liver attacking Lung, named "Heng" (horizontal attack); puncture Qimen (LR14).

Yangming Channel: The disease presents with no sweat but smooth urination. After two or three days, vomiting and coughing occur, hands and feet are cold, and the patient suffers from headache (see Headache). Two or three days after onset, if the pulse is weak, without Taiyang or Chaihu syndromes, but with irritability and hardness in the epigastrium, use Xiao Chengqi Tang to gently harmonize. If there is no bowel movement for six or seven days, and urine is scanty, although the patient cannot eat, if the stool is hard at the beginning but loose later, do not purge. If urination is smooth, use Da Chengqi Tang. In Shanghan, if the pulse is floating and slow, and hands and feet are warm, it relates to Taiyang and should lead to jaundice; if urination is smooth, jaundice will not develop. By the seventh or eighth day, if stool becomes hard, it is Yangming disease, treated with Da Chengqi Tang. In Yangming disease, with spontaneous sweating, further sweating, and smooth urination leading to internal depletion of fluids, although stool is hard, do not purge. Use Honey Suppository (Mi Jian Dao) to guide passage; pig bile or Trichosanthes root (Tugua Gen) can also be used as guides.

Taiyang Channel (Commentary): In Shanghan, if the pulse is floating and slow, and hands and feet are warm, it relates to Taiyin and should lead to jaundice; if urination is smooth, jaundice will not develop. By the seventh or eighth day, although sudden irritability and diarrhea for more than ten times occur, it will stop spontaneously. The above clauses all use smooth urination to judge the pathology, verifying whether purging is indicated. If urination is obstructed and the lower abdomen is hard, it is urinary retention, requiring diuresis. If urination is smooth and the lower abdomen is hard, it is either blood stasis or dry feces, requiring unblocking and purging. Whether jaundice develops or not, and whether the outcome is death or survival, can all be verified through this.

Shaoyin Channel: Two to four or five days after onset, if there is abdominal fullness, obstructed urination, heavy and painful limbs, and spontaneous diarrhea, this is water qi, treatable with Zhenwu Tang (see Diarrhea). If there is both vomiting and diarrhea, urination becomes frequent/profuse, with profuse sweating, diarrhea of undigested food, internal cold with external heat, and a faint pulse nearly disappearing, use Sini Tang.

Jueyin Channel: In Shanghan, with little heat and slight cold extremities (only fingertips cold), silent desire not to eat, and irritability for several days, if urination is smooth and white in color, this indicates heat has been eliminated. Desire for food indicates recovery.

Frequent Urination
In Shanghan, if the pulse is floating, there is spontaneous sweating, frequent urination, heart vexation, slight aversion to cold, and leg cramps, Guizhi Tang must absolutely not be used (Gancao Ganjiang Tang and Shaoyao Gancao Tang may be used).

Zhao Sizhen: In Taiyang disease with spontaneous sweating, limb stiffness and difficulty in flexion/extension, heart vexation, slight aversion to cold, and leg cramps, if urination is frequent, Guizhi Tang must absolutely not be used. Instead, give Gancao Ganjiang Tang and Shaoyao Gancao Tang, as this is caused by deficiency-cold, completely different from the excess-heat syndromes mentioned earlier. The addition of "limb stiffness and difficulty in flexion/extension" links it to the "difficult urination" syndrome in previous chapters, yet it is placed under "frequent urination." Why? Also, if Shanghan presents with a floating pulse and frequent urination, and stomach disharmony leads to delirium, give a small amount of Tiaowei Chengqi Tang. Zhang Zhongjing's discussion here specifically targets stomach disharmony causing delirium, not the combination of floating pulse, spontaneous sweating, and frequent urination. Would it not be more appropriate to say, "If after taking Gancao Ganjiang Tang, stomach disharmony leads to delirium, then give a small amount of Tiaowei Chengqi Tang"?

Fuyang Pulse: Floating and choppy. Floating indicates strong stomach qi; choppy indicates frequent urination. The interaction of floating and choppy leads to difficult defecation. This is Pi Yue (Spleen Constraint), treated with Mahuang Wan. After sweating, vomiting, or purging in Taiyang disease, if there is slight vexation, frequent urination, and consequently hard stool, harmonize with Xiao Chengqi Tang for recovery. In Taiyang disease, if the Cun pulse is slow, Guan pulse is floating, Chi pulse is weak, and the patient has fever, sweating, aversion to cold, no vomiting, but epigastric stuffiness, this is due to premature purging. If the patient does not purge, is not averse to cold, but is thirsty, this has transferred to Yangming. Frequent urination leads to hard stool.

Wu Kun: Frequent urination refers to the frequent urge to void with little output. Treatment for Taiyang and Yangming diseases follows specific principles. For frequent urination due to kidney deficiency with heat, use Qingxin Lianzi Yin, or Renshen Sanbai Tang added with Zhimu, Huangbai, Maidong, Shilianrou, etc., or take tonifying pills. Alternatively, use Buzhong Yiqi Tang added with Zhimu, Huangbai, Shengdihuang, and Maidong.