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The turbid waste products of the human body are eliminated through urination and defecation. When these two excretions are unobstructed, turbidity descends and clarity ascends; otherwise, clear and turbid energies become confused. Obstruction of urination is caused by heat in the Bladder (Bladder organ); the medication can follow the same principles as treating Lin syndrome (a pattern characterized by frequent, urgent, and painful urination). Incontinence of urine is caused by reckless movement of fire-evil in the Bladder, which is difficult to predict or control. Because water fails to remain in its proper place, incontinence occurs; Er Shen Wan (Two Spirit Pill) combined with Sang Piao Xiao San (Mantis Egg-case Powder), containing Chuan Lian (Sichuan Sichuan Peppercorn - *Note: Text says Chuan Lian but context implies herbs like Huanglian etc., sticking to text entities*), Chuan Xiong, Gan Cao, Sheng Di, Dang Gui. Obstruction of defecation is due to exhaustion of intestinal fluids; blood-invigorating and dryness-moistening prescriptions should not be discarded. When both urination and defecation are obstructed, it is due to heat in the Liver and Kidney; Ba Zheng San (Eight-Herb Corrective Powder) can resolve both. Constipation of the anus is caused by Lung heat, as the Lung and Large Intestine have a interior-exterior relationship that is clear. Rectal prolapse is caused by severe deficiency-cold of the Lung, occurring when deficiency sinks during dysentery or diarrhea. Decoctions using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) are excellent; for heat-type prolapse, Si Wu Tang (Four Substance Decoction) combined with Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rehmannia Pill) is invited.

Penile cysts are caused by excessive dampness sinking into the lower jiao; use Liu Hejian's method.
Herbs: Shi Gao (Gypsum Fibrosum), Han Shui Shi (Halloysitum Rubrum), Xing Ren (Armeniacae Semen Amarum), Ze Xie (Alismatis Rhizoma), Hua Shi (Talcum), Zi Chuan Pu (Magnoliae Officinalis Cortex), Zhu Ling (Polypori Sclerotium).

Obstruction of urination, caused by fire obstruction in the Small Intestine.
Formula: Dao Chi San (Guide Out the Red Powder) plus Dan Pi (Moutan Cortex) and Chi Fu Ling (Poria with Red Core).

Failure of Qi transformation in the Bladder.
Formula: Wu Ling San (Five-Ingredient Powder with Poria).

Dampness stagnating in the Three Jiao (use Liu Hejian's method of separating and eliminating).
Herbs: Xing Ren, Jie Geng, Hua Shi, Chuan Pu (Magnoliae Officinalis Cortex), Lian Qiao, Mu Tong, Xiang Ru, Chen Pi, Zhu Ling, Mu Gua, Chuan Lian (Coptidis Rhizoma - *Text says Chuan Lian, likely Huanglian*), Han Shui Shi, Ze Xie, Lu Gen, Huang Qin, Hai Jin Sha, Fang Ji, Sheng Shi Gao, Zhi Ke, Liu Yi San.

Dampness depression and latent heat causing Bi obstruction in the Small Intestine.
Formula: Xiao Wen Zhong Wan (Minor Warming the Middle Pill).

Kidney Yang obstruction.
Formula: Wu Ling San plus Gan Jiang (Zingiberis Rhizoma), Pao Jiang (Zingiberis Rhizoma Preparatum), Fu Zi (Aconiti Lateralis Radix Preparata), Pig Gallbladder Juice.

Heat accumulation in the Yin aspect of the Kidney and Bladder causes dryness; without Yin, Yang cannot transform. Use Zi Shen Wan (Nourish the Kidney Pill) to unblock heat closure in the extreme Yin of the Lower Jiao.

Damp-heat Bi obstruction in the Large Intestine.
Suitable for clearing heat and drying dampness with Xiao Wen Zhong Wan.

Severe constipation, fire fu obstruction.
Formula: Geng Yi Wan (Changing Clothes Pill).

Damp-fire constipation (use great bitter-cold methods to consolidate Yin and dry dampness).
Herbs: Chuan Bai (Phellodendri Chinensis Cortex), Bi Xie, Du Huo, Hai Jin Sha, Xi Xin, Chuan Lian, Fang Ji, Can Sha, Chuan Jin Wen (Rhei Radix et Rhizoma).

Kidney dryness and heat causing difficulty in defecation (suitable for warming and unblocking the Lower Jiao, use Zi Shen Wan).

Depressed heat and dryness obstruction with Qi blockage (bitter-cold to drain heat, acrid to open depression; this is a general treatment method for the Three Jiao).
Herbs: Chuan Lian, Lai Fu Zi, Chuan Lián Zǐ, Guang Pi, Lu Hui, Chao Shan Zha, Chao Shan Zhi, Zhi Pu, Qing Pi, Chi Fu Ling, Xing Ren, Guang Yu Jin.

Blood stasis causing constipation.
Herbs: Tao Ren Ni (Persicae Semen Paste), Dong Kui Zi, Chuan Yu Jin, Yu Li Ren, Jiang Zhen Xiang.
Another formula: Tao Ren Cheng Qi Tang.

Blood dryness and lack of moisture, causing constipation (suitable for nourishing blood and moistening dryness).
Herbs: Gui Shen (Angelicae Sinensis Radix), Bai Zi Ren, Mai Dong, Sha Yuan Zi, Ma Ren, Song Zi Ren, Fu Ling, Kui Bai Shao (Paeoniae Radix Alba).
Another formula: Sheng Di, E Jiao, Gui Ban.
Another formula: Hong Hua, Niu Xi, Bo Cai, Wu Ling Zhi, Tao Ren, Dan Pi, Jiu Cai, Yu Li Ren.
Another formula: Gou Qi Zi, Tian Dong, Ren Zhong Bai, Chuan Bi Xie.
Formulas: San Cai Tang, Wu Ren Tang, Hu Qian Wan removing Suo Yang and adding Dan Cong Rong, Tong You Tang, Sheng Di, Hong Hua, Shu Di, Tao Ren, Gan Cao, Gui Shen, Sheng Ma.

Elderly Yang deficiency causing wind closure (use warm and moistening methods to regulate flow).
Formula: Ban Shou Wan.

Obstruction of both urination and defecation, fire obstruction in the Small Intestine.
Herbs: Lu Hui, Chuan Lián Zǐ, Tao Ren, bloating at night use Xiao Wen Zhong Wan, Hong Hua, Dang Gui Xu, Li Ren.

Damp-heat causing failure of Lung Qi to descend.
Herbs: Wei Jing, Tao Ren, Xi Gua, Cui Yi, Hua Shi, Tong Cao.
Another stomach-nourishing method: Bei Sha Shen, Mai Dong, Xing Ren, Yi Ren, Zhi Mu.

Damp-heat stagnating in the Fu organs causing constipation.
Herbs: Chuan Lian, Shan Zhi Pi, Zhi Shi, Qing Pi, Huang Qin, Lai Fu Zi, Chuan Pu, Dan Pi.

Qi and Blood Bi obstruction causing constipation.
Herbs: Chuan Lián Zǐ, Tao Ren, Chuan Gui Zhi, Dang Gui Xu, Yu Li Ren, Hong Hua, Zhi Chuan Jun (Rhei Radix et Rhizoma), Xiao Hui Xiang, Chuan Xiong, Shan Zha Tan, Rou Gui, Cong Bai, Qing Pi, Wu Ling Zhi, Xiang Fu.

Blood depletion and menstrual obstruction causing difficult urination/defecation.
Herbs: Da Sheng Di, Niu Xi, Yu Li Ren, Gui Shen, Che Qian Zi, Dan Cong Rong, Bai Ren, Dong Kui Zi, Fu Ling, Xiao Hui Xiang.

Jueyin heat closure.
Symptoms: Both urination and defecation are obstructed, hypogastric distension and fullness, back cold, irritability, and thirst. This is Long Bi (difficulty in urination); one should use substances with turbid odors to directly drain the Jueyin closure.
Herbs: Liang Tou Jian, Jiu Gen, Xiao Hui Xiang, Ju Hong, Chuan Shan Jia, Gui Xu, Chuan Lián Zǐ, Ru Xiang, Chuan Lian, Shan Zhi, Tong Cao, Hai Jin Sha, Chuan Bai, Dan Wu Zhu Yu, Qing Pi, Hua Shi.
Also imitating Li Dongyuan's method for treating Long Bi, use Zi Shen Wan.

Chen Can said: Whenever urination is obstructed but defecation is smooth, it is either bladder heat obstruction or unclear water source, mostly dampness patterns. When defecation is obstructed but urination is smooth, it is either Large Intestine Qi stagnation or non-flowing body fluids, mostly dryness patterns. When both are obstructed, one should first unblock defecation, then urination will naturally flow. The Kidney governs both excretions; the Liver governs free flow and drainage. One must distinguish between Yin and Yang obstruction, or use the method of treating upper diseases from below, by lifting Lung Qi. Yu Jiayan said: Treat upper dryness with the Lung; treat lower dryness with the Liver.

Rectal prolapse, caused by damp-heat and Qi deficiency sinking.
Follow Dongyuan's treatment method, use Bu Zhong Yi Qi Tang.
Herbs: Ren Shen, Xi Yu Zhu (Atractylodis Macrocephalae Rhizoma), Gan Cao, Chen Pi, Dang Gui, Chai Hu, Da Zao, Sheng Ma, Sheng Jiang.

Rectal prolapse, purely due to Qi deficiency sinking.
Herbs: Ren Shen, Gui Shen, Bai Zhu, Guang Pi, Lv Sheng Ma, Chuan Lian, Bai Shao, Zhi Cao, Wu Mei, Shi Lian Zi.

Kidney Qi failing to return (symptoms: lower abdominal pain, anal heaviness/prolapse, loose stools).
Herbs: Shu Di, Wu Wei Zi, Yuan Zhi Rou, Huai Shan Yao Tan, Fu Ling, Yu Rou, Tu Si Bing, Yu Yu Liang.

Elderly Qi sinking causing rectal prolapse.
Herbs: Ren Shen, Bu Gu Zhi, Yang Qi Shi, Lu Rong, Da Hui Xiang.
Another: Yu Liang Shi Zhi Wan.

Chen Can said: Regarding rectal prolapse, some cases are due to Qi sinking from dysentery/diarrhea; some are due to middle Qi deficiency-cold failing to retain; some are due to alcohol-dampness injury; some are due to Kidney deficiency with dampness pouring down. Whether due to elderly decline of Qi and Blood, or young immaturity of Qi and Blood, rectal prolapse can occur. The Classics say: "What has sunk, lift it." Xu Zhicai said: "Astringents can remove prolapse." These are all methods for treating rectal prolapse. Ye Tianshi's Guide states that treatment involves three methods: lifting, astringing, and tonifying Qi. For cases where Qi and Blood heat cause the anus to protrude, use Huang Qin, Huang Lian, Huai Hua, Huang Bai, Si Wu Tang plus Sheng Ma and Chai Hu. However, such cases are rare and not standard practice; recorded here for reference. Rectal prolapse should not be over-treated with bitter-cold cooling agents; generally, Ye Tianshi's methods are considered orthodox.