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Urinary retention may be caused by Qi deficiency, Qi stagnation (stagnation of Qi mechanism), Blood deficiency, phlegm, or heat; treatment should be tailored to the specific syndrome. For Qi deficiency, use Shengma (Cimicifugae Rhizoma) and Renshen (Ginseng Radix et Rhizoma); for Blood deficiency, use Siwu Tang (Four Substances Decoction); for phlegm, use Erchen Tang (Two Aged Substances Decoction); for heat, use Bazheng San (Eight Correctnesses Powder). For Qi stagnation, use Chenpi (Citri Reticulatae Pericarpium), Xiangfu (Cyperi Rhizoma), and similar herbs; decoct and administer them separately, then decoct the dregs and induce vomiting afterward, so that clear Yang ascends and turbid Yin descends naturally. If Yang Qi is deficient, resulting in scanty urination or strangury (difficulty in urination with pain), one should greatly tonify Yuan Qi (Primary Qi); urination will regulate itself without need for diuretics. This is because Yuan Yang (Primary Yang) is weak and unable to transform and transport fluids to expel urine; thus, Dushen Tang (Single Ginseng Decoction) is used to achieve efficacy. The same applies to constipation; this pattern is common in the elderly or after illness. If it is due to phlegm obstructing the Middle Jiao and Qi stagnating below, use Erchen Tang (Two Aged Substances Decoction) with Muxiang (Aucklandiae Radix) and Wuyao (Linderae Radix) to promote movement.

Complete urinary obstruction is no trivial matter. It presents with acute pain in the lower abdomen, resembling an inverted bowl, with a sense of urgency and inability to hold back. If it persists for a day without relief, it leads to vomiting, a condition named Guan Ge (Obstruction and Reversal), which can lead to death if not resolved. Modern practitioners, upon seeing this syndrome, often rely solely on Wuling San (Five-Ingredient Powder with Poria) and remain helpless, waiting for death. Methods such as warming the Dantian with salt or applying earthworms and river snails to the umbilicus are also insufficient. If body fluids leak excessively into the intestines and stomach, causing diarrhea while urinary retention persists, use Wuling San (Five-Ingredient Powder with Poria) to separate and drain. If water accumulates beneath the heart and cannot descend to the Bladder, use Wuling San (Five-Ingredient Powder with Poria) again to infiltrate and drain. If pathogenic heat from the Six Fu Organs shifts to the Lower Jiao causing obstruction, use Yiyuan San (Benefit Origin Powder) to clear it. If phlegm and Qi blockage prevent ascending and descending, it means Qi is carrying the water. Use Erchen Tang (Two Aged Substances Decoction) with Shengma (Cimicifugae Rhizoma), Mutong (Akebiae Caulis), Xiangfu (Cyperi Rhizoma); administer first, then induce vomiting to lift it. When Qi ascends, water descends naturally, like a vessel for pouring water: when the upper aperture opens, the lower aperture flows. If Kidney Meridian Yin deficiency occurs, with Yang having no attachment, or Kidney Meridian Yang deficiency, with Yin unable to transform, leading to obstruction, mistakenly using diuretic-draining methods will further injure True Yang and True Yin, often leading to untreatable conditions.

In young children, essence has not yet circulated, but desire apertures open early; in the elderly, essence is exhausted and further depleted. Both result in essence failing to exit and internal damage, causing dryness and astringency in the two yin apertures, with pulling pain in the pathways of stool and urine. The more painful, the more frequent the urge; the more frequent, the more painful. Treatment requires nourishment and tonification, following the method for Lao Lin (Deficiency Strangury). If purgatives are used again, danger is immediate.

The Classics state: "The Bladder is the official of the provincial capital, storing body fluids; only through Qi transformation can they be excreted." It also states: "The San Jiao (Triple Burner) is the official of the irrigation channels, where water fluids emerge." Thus, the Bladder can only store water; it requires the Qi transformation of the San Jiao (Triple Burner) to release water. Some cases involve excessive consumption of hot medicines like Fuzi (Aconiti Lateralis Radix Praeparata), which consumes Lung Yin, preventing Qi transformation; these are treated with Huanglian Jiedu Tang (Coptis Decoction to Resolve Toxicity) to restore flow. Some cases involve scorched skin and stagnant Qi blocked by cold; administering Fuzi (Aconiti Lateralis Radix Praeparata) allows urination to resume spontaneously. Others are treated with a decoction of Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), and Gancao (Glycyrrhizae Radix et Rhizoma), taken with powdered Muxiang (Aucklandiae Radix) and Chenxiang (Aquilariae Lignum Resinatum) to restore flow. These are all manifestations of Qi transformation. The above treatments address excess syndromes, meaning there was originally water in the Bladder, either bound by heat or Qi stagnation; since water exists, it can be unblocked. As for deficiency syndromes, involving chronic wasting, excessive sweating, dryness of the five viscera, loss of fatty tissues preventing fluid generation, and no water accumulation in the Bladder, attempting to force urination is like begging a beggar for food—already destitute, becoming even poorer. Therefore, Dongyuan distinguished treatment based on whether the issue lies in Qi or Blood, differentiating by thirst. If thirsty with difficult urination, this belongs to the Upper Jiao and Qi aspect. Water is generated by Metal (Lung); Lung heat cuts off the source of clear transformation. One must assist the Autumn function in the Lung division, allowing water to generate naturally. Just as dew falls in autumn, one must use herbs that clear Metal (Lung). When the Lung becomes clear and肃 (descending), the water passages regulate themselves, such as with Shengmai San (Generate Pulse Powder). For Spleen deficiency, caused by irregular diet injuring Stomach Qi sinking to the Lower Jiao—the Classics say, "When Spleen and Stomach are deficient, the nine orifices become blocked"—especially since Lung Metal relies on robust Spleen Earth to nourish the source of transformation. Then clear Qi can ascend to the Lung and distribute downward. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with sweet-warm herbs like Renshen (Ginseng Radix et Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) to first regulate Stomach Qi, lifting with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) from the depths, so clear Qi ascends and turbid Yin descends. Clearing the Lung is the "treatment separated by two" (treating the mother organ). Tonifying the Spleen is the "treatment separated by three." Dongyuan’s subtle application of tonifying the mother when deficient illustrates nourishing the postnatal source. If not thirsty with difficult urination, this belongs to the Lower Jiao and Blood aspect. The Lower Jiao comprises the Kidney and Bladder, being Yin within Yin. Heat closes the Yin, blocking the lower flow. The Classics state: "Without Yang, Yin cannot generate; without Yin, Yang cannot transform." Diuretic-draining herbs are Yin within Yang, not pure Yin agents; how can Yang transform? One must use Zishen Wan (Nourish Kidney Pill), which has both flavor and aroma of Yin, being Yin within Yin. Mr. Dongyuan treated a patient with protruding eyes, abdominal distension like a drum, hardness above the knees, skin ready to split, inability to eat, and critical constipation. After deep thought until midnight, he prescribed Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) as sovereign, with Rougui (Cinnamomi Cortex) as guide. Shortly after administration, the anterior genitalia felt like knife-stabbing and burning, urine flowed like a waterfall, swelling subsided, and the patient recovered. This is Yin deficiency with Yang unable to transform. Regarding True Yin and True Yang deficiency, Dongyuan did not discuss it. For True Yin deficiency, only Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) should be used to tonify Kidney Water; Zishen Wan (Nourish Kidney Pill) is contraindicated, lest the bitter-cold Zimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex) drain water and further injure the Kidney Yuan. Also avoid bland diuretic-draining herbs, lest they dry up body fluids further. For True Yang deficiency, Bawei Wan (Eight-Ingredient Pill) is required. Master Chu said: "If one suffers impotence and desires sexual gratification, releasing essence causes essence to fail to exit and rot internally, making the urinary pathway astringent like strangury. If essence is already depleted and further exhausted, the pathways for stool and urine pull painfully; the more painful, the more frequent the urge; the more frequent, the more painful." Master Dai said: "There are cases resembling strangury but not strangury, with mucus-like discharge in stool; this is essence and urine exiting together, with essence blocking the urinary pathway, causing pain upon attempted passage. Da Tussizi Wan (Large Dodder Seed Pill) and Lurong Wan (Deer Antler Pill) are suitable. Master Dai also mastered Master Chu’s method." For constipation with tetany, panting and near-death distress, regardless of gender, in pregnant women or postpartum, urgently use Bawei Wan (Eight-Ingredient Pill) decoction; delay means untreatable. Some doubt the pungent-hot nature of Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) and dare not use them lightly. Do they not know that Kidney Qi deficiency and cold are like frozen ice? Only when warm Yang arrives can Yin condensation flow. What else can reach the Bladder directly and make snow melt into spring water? Furthermore, in the intestines and stomach, if Central Qi is weak, causing stool and urine to want to pass but stop, or heavy stagnation in the two yin apertures, this is Qi deficiency failing to transport. Only by taking Dushen Tang (Single Ginseng Decoction) can Qi become abundant and freely circulate stool and urine.

Forcibly suppressing intercourse can cause bladder torsion and obstruction, treatable only with Chenxiang (Aquilariae Lignum Resinatum), whose nature sinks and directs downward, pungent and warm, thus benefiting the lower part. Pregnant women often suffer urinary retention because the uterus is pressed down by the fetus. One should raise Qi, or administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and induce vomiting. Zhang Zhongjing used Bawei Wan (Eight-Ingredient Pill) taken with wine. Some advised letting the pregnant woman lie on a bed, then tilting the bed upright so the fetus does not press down, allowing urine to flow. After relief, if deficiency remains, tonify immediately.

For women with prolonged vomiting leading to urinary retention and sweating on the head, this is Qi collapse, indicating imminent death.