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(Related content is found in the section on Postpartum Abdominal Pain)

Enuresis refers to the involuntary passage of urine without conscious perception. Bi-long (urinary retention and dribbling) refers to the obstruction of urination with only scanty, drop-by-drop discharge. This condition is primarily governed by the Liver, Du Mai (Governing Vessel), San Jiao (Triple Burner), and Bladder.

The Liver Meridian and Du Mai govern this disease. The Classics state: "The Foot-Jueyin Liver Meridian passes through the genitalia. Diseases it generates include enuresis and bi-long." It also states: "The Du Mai enters and connects with the Ting Kong in women; this orifice is the end of the urinary meatus. In men, it follows the penis down to the perineum, equal to that of women. Its diseases include long (retention), hemorrhoids, and enuresis." Therefore, for treating enuresis and bi-long, one selects the Shu points of the Jueyin and Du Mai meridians.

The San Jiao governs this disease. The Classics state: "The descending meridian of the San Jiao is located anterior to the Foot-Taiyang and posterior to the Foot-Shaoyang, emerging at Zhonglian outside the ankle, named Weiyang, which is the Luo-connecting point of the Foot-Taiyang. The San Jiao is commanded by the Foot-Taiyang and Foot-Shaoyang; it is the branch of the Foot-Taiyang. Ascending five cun above the ankle, it branches off, penetrates through the intestines, emerges at Weiyang, joins the main channel of the Taiyang, enters and connects with the Bladder, and regulates the Lower Jiao. Excess manifests as bi-long, deficiency manifests as enuresis. Enuresis should be treated with tonification, and bi-long with sedation."

The Bladder governs this disease. The Classics state: "Bladder dysfunction leads to long (obstruction); lack of regulation leads to enuresis." However, when treating enuresis and bi-long, one does not select points from the Bladder meridian itself because the Bladder merely stores urine, while the process of urination is directed by the San Jiao, Liver, and Du Mai.

Bi-long, when combined, refers to a single disease; when separated, there is a distinction between acute and chronic onset. "Bi" refers to an acute condition where urine is completely obstructed with no drops coming out, commonly known as urinary retention. "Long" refers to a chronic condition where urine dribbles out drop by drop, occurring dozens or hundreds of times a day, known as strangury (Lin syndrome). Currently, these two conditions are divided into separate categories.

[Li Gao] Urinary difficulty differs based on whether it involves Qi or Blood. Urine is governed by the Foot-Taiyang Bladder, born in Shen (Monkey hour/Metal element). Metal generates Water; Metal corresponds to the Lung. If latent heat exists in the Lung, water cannot be generated, thus cutting off the source of urine. Humans mirror Heaven and Earth; the source of the Bladder extends from the head and neck down to the feet, hence it is called Yin within Yang. If thirst accompanies urinary obstruction, it is due to the Lung's inability to descend. The treatment method uses drugs with thin flavors and mild properties to clear and dry the Metal aspect, such as Poria (Fuling), Polyporus (Zuling), Alisma (Zexie), Amber (Hupo), Juncus (Dengxin), Tongcao, Plantago seed (Cheqianzi), Dianthus (Qumai), and Polygonum aviculare (Bianxu). These are all bland and leaching herbs that drain Lung fire, clear Lung Metal, and nourish the source of Water generation. If there is no thirst, the heat is in the Lower Jiao, blocking the flow so urine does not exit; one must use drugs with strong flavors and properties belonging to Yin within Yin. These two conditions differ in location: one is in the Upper Jiao, in the Qi level, and inevitably involves thirst; the other is in the Lower Jiao, in the Blood level, and involves no thirst. Dampness in the blood causes the lack of thirst. The distinction between these two is very easy to identify.

Qingfei San (Clear the Lung Powder): Treats thirst with urinary obstruction, yellow or涩 (astringent/difficult) urine, indicating pathogenic heat in the Qi level.
Poria (Er qian), Polyporus (San qian), Alisma (San qian), Amber (Wu fen), Juncus (Er fen), Akebia (Qi fen), Tongcao (Er fen), Plantago seed (Yi qian, stir-fried), Dianthus (Wu fen), Polygonum aviculare (Qi fen), Cinnamon Twig (Wu fen).
Grind all into powder. Take Wu qian each time, decoct in water, and take hot. Wuling San (Five-Ingredient Powder with Poria) and Bazheng San (Eight-Herb Powder for Rectifying the Regular) are also suitable.

[Zhang Zhongjing] Zhu Ling Tang (Polyporus Decoction): Treats floating pulse, fever, thirst, and urinary difficulty. (Formula see Shanghan Lun.)
Wuling San (Five-Ingredient Powder with Poria): Treats irritability, excessive thirst and drinking, vomiting immediately after drinking, palpitations in the heart, and urinary difficulty. (Formula see Shanghan Lun.)
Fuling Rongyan Tang Formula
Poria (Ban jin), Atractylodes (Liang liang), Rongyan (One pill-sized piece).
Grind the three ingredients into powder, mix with warm water, and take.

[Beiji Qianjin Yaofang] For urinary obstruction. Use one jin of fresh Plantago herb, decoct in three sheng of water to obtain one and a half sheng, divide into three doses.

[Li Gao] Zishen Wan (Kidney-Nourishing Pill): Treats Yin deficiency in the Lower Jiao, weakness in legs and knees, sweating in the genital area, impotence, heat in the soles preventing walking, no thirst but urinary obstruction, indicating pathogenic heat in the Blood level.
Phellodendron (Liang liang, wine-washed, dried), Anemarrhena (Liang liang, wine-washed, dried), Cinnamon Bark (Er qian).
The Neijing states: "Heat is treated with cold." It also states: "The Kidney dislikes dryness; urgently eat pungent substances to moisten it." Phellodendron's bitter-cold nature drains heat and nourishes water to moisten dryness, serving as the Sovereign drug. Anemarrhena's bitter-cold nature drains Kidney fire, serving as the Assistant. Cinnamon's pungent-hot nature is used counter-intuitively with cold drugs (reverse adjuvant).
Grind into fine powder, make pills with hot water, size of chicken beans. Take Bai wan initially, increase to Er bai wan, swallow with boiling water, on an empty stomach.
Previously, a wealthy merchant in Chang'an named Wang Shanfu suffered from urinary obstruction, gradually developing abdominal fullness, hard and stone-like abdomen, extreme blockage, swollen legs and feet rupturing with yellow fluid, protruding eyes, insomnia day and night, inability to eat, and indescribable pain. I asked about the onset and learned he had no thirst but recent vomiting and hiccups. Other doctors used bland, leaching diuretics for abdominal fullness; I hesitated to act and left. Sleepless from night to dawn, pondering the principle, I suddenly recalled the Suwen: "Without Yang, Yin cannot be born; without Yin, Yang cannot transform." Also: "The Bladder is the Official of the Zhoudu, storing fluids; transformation allows them to exit." This patient's urinary retention was due to Yin deficiency failing to transform Yang. All diuretics are bland and leaching, belonging to Yang, specifically Qi drugs within Yang-Yin, not the transformation of Northern Cold Water (Yin-within-Yin). This was caused by excessive indulgence in rich foods generating heat, damaging Northern Yin, leading to insufficient Kidney Water. Thus, the Bladder and Kidney chambers dried up over time, urine could not transform, and Fire rebelled upward causing vomiting/hiccups, not a Ge (regurgitation) disease but a Guan (closure) disease. Jiegu Laoren said: "Heat in the Lower Jiao causing blockage is the method for treating Guan-Ge." Now the patient has both internal Guan and external Ge, dying soon, but treating the Lower Jiao can cure. Select Phellodendron and Anemarrhena, large bitter-cold and Yin-natured, using Cinnamon as a guide, make pills size of sesame seeds, swallow Er bai wan with boiling water. Shortly after taking, the urethra felt like knife-stabbing and burning, then urine gushed like a waterfall, wetting bedding and flowing under the bed; swelling dissipated instantly. I exclaimed in surprise: "How great are the words of the Sages! How can one not read widely and stick to one view?" This syndrome is urinary closure without thirst, occasionally with restlessness. All diseases in the Lower Jiao involve no thirst. The distinction between Qi and Blood levels is easiest to identify.

[Zhang Yuansu] Huanglian Wan (Coptis Pill): Treats urinary difficulty caused by excessive intake of hot medicines, unresponsive to other drugs. Or unbearable pain below the umbilicus.
Coptis (stir-fried), Phellodendron (stir-fried), Licorice (equal parts).
Cut into pieces, decoct in water, take warm before meals. If still blocked, add Anemarrhena. This drug assists Qi, allowing Qi transformation to achieve patency.

[Luo Tianyi] Baihua San (White Flower Powder): Treats urinary obstruction due to Heat in the Bladder. Use Mirabilite ground to fine powder, take Er qian each time, mixed with Fennel decoction, before meals. Jianyao Jizhong Fang suggests mixing with Fennel wine first.

[Li Gao] Daoqi Chuzao Tang (Guiding Qi and Removing Dryness Decoction): Treats urinary obstruction caused by Blood-Dampness blocking Qi and causing orifice涩滞.
Anemarrhena (San fen, wine-washed), Phellodendron (Si qian), Talc (Er qian, stir-fried yellow), Alisma (San fen), Poria (Er qian, peeled).
Mix evenly. Take Ban liang each time, decoct in water, take slightly hot on an empty stomach. For urgent urinary closure, do not restrict timing.

[Doumen Fang] For urinary obstruction. Crush earthworms, wash with cold water, take thick liquid half bowl, immediate relief. Effective for severe heat diseases causing unconsciousness and near-death.

[Zhang Zhongjing] For urinary difficulty with Water-Qi and severe thirst, Gualou Qumai Wan (Trichosanthes Root and Dianthus Pill) is indicated.
Trichosanthes Root (Liang liang), Poria, Dioscorea (each San liang), Prepared Aconite (One piece, processed), Dianthus (Yi liang).
Grind five ingredients into powder, make pills with refined honey, size of sesame seeds. Take San wan, three times daily. If ineffective, increase to Qi-Ba wan. Relief is indicated by free urination and warmth in the abdomen.

For urinary obstruction with lower abdominal pain, shape like an inverted bowl, unbearable pain/stifling sensation, this is dryness of intestines and stomach, with Danzhong Qi failing to descend. Thus, the Classics say the Bladder is the Official of Zhoudu, storing fluids; transformation allows exit. The Danzhong is the Official of the Envoy. San Jiao Xianghuo, Kidney is the Sea of Qi. Wang Bing's commentary: "The Bladder is the mansion of fluids, housing the Bao (uterus/bladder). The lower abdomen contains the Bao organ within the pubic hair. If Qi from the Qi Sea transforms, urine flows; if Qi from the Qi Sea is insufficient, secretion is blocked, hence inability to urinate." First use Musk (Muxiang) and Agarwood (Chenxiang), each San qian, taken with wine, or Bazheng San. Severe cases require emesis to promote Qi circulation, achieving natural patency, as the Classics say: "Disease below, treat above." Wang Bing's commentary: "Heat attacking above hinders below; Qi excess above requires warm-pungent dispersal and bitter draining." (Alternative: Decoct Tangerine Peel and Poria soup, mix with Musk and Agarwood powder, take on empty stomach.)

[Zhu Zhenheng] Urinary obstruction belongs to Qi deficiency, Blood deficiency, Excess Heat, or Phlegm-Qi blockage; all are suitable for emesis to lift Qi. When Qi rises, Water descends, as Qi carries Water. For Qi deficiency, use Ginseng, Atractylodes, Cimicifuga, etc., take medicine then induce vomiting, or adjust within Ginseng/Atractylodes formulas to induce vomiting. For Blood deficiency, use Siwu Tang, take then induce vomiting, or probe vomit within Xionggui Tang. For Phlegm, use Erchen Tang, take then probe vomit. For Phlegm-Qi blockage, use Erchen Tang plus Cyperus and Akebia to probe vomit. For Excess Heat, promote urination, or use Bazheng San; moving stool promotes urination.

[Zhu Zhenheng] Treating a man with urinary obstruction using emesis resulted in immediate profuse urination. Discussion see Treatment of Deficiency/Excess, Disease Below Treating Above section.

[Zhang Zhongjing] For urinary difficulty, Puhui San, Shihui Baiyu San, and Fuling Rongyan Tang are indicated. (Puhui/Fahui eliminate stagnant blood. Talc, according to Danxi, eliminates stagnant blood.)
Puhui San Formula
Puhui (Seven fen, likely Typha pollen powder), Talc (Three fen).
Grind two ingredients into powder, take Wu fen fangcunbi with water, three times daily.

Shihui Baiyu San Formula
Talc (Two fen), Loose Hair (Two fen, burnt), Baiyu (Two fen, silverfish).
Grind three ingredients into powder, take Wu fenbi with water, three times daily.

[Wukao] Fahui San: Treats urgency/fullness below umbilicus, urinary obstruction. Use finely ground hair ash, take Er qian, mixed with Er he rice vinegar. Another method: Mix with Sesame leaf powder equally, take Er qian, then cover with stir-fried black soybean leaves, immediate relief. (Danxi says: Hair/bangs have swift Yin-nourishing effects.)

[Bencao] Taoren Jian (Peach Kernel Decoction): Treats accumulated Blood in women. Previously in Piling, a nobleman's wife had urinary obstruction, unbearable umbilical/abdominal distension/pain. Doctors treated as strangury with Bazheng San etc., ineffective, condition worsened. I diagnosed as Xuejia (Blood mass), requiring Mingxuan (severe reaction) drugs to remove. Using this drug, initial dose caused unbearable pain until noon; after lying briefly, expelled several fist-sized blood clots, urine like black bean juice one-two sheng, pain stopped, cured. This drug is fierce and峻烈; use cautiously in Qi/Blood deficient patients.
Peach Kernel, Rhubarb, Mirabilite (each Yi liang), Blister Beetle (Ban liang, stir-fried black).
Grind four ingredients into powder, slow-fire decoct in Er sheng ban strong vinegar in silver/copper vessel to obtain Yi sheng wu he. Add Rhubarb, Peach Kernel, Blister Beetle, stir constantly, remove after some time, make pills size of wu zi. Fast dinner previous night, at fifth watch swallow Wu wan with warm wine. By noon, discharge like red bean juice or chicken liver/toad skin appearance. If not discharged, repeat. Stop if bright red blood appears. Follow with Blood-Qi regulating tonics. Source: Qianjin Fang. (Do not use recklessly.)
The above four formulas treat urinary difficulty due to stagnant blood. First three are mild agents; the last is a峻 agent, use only after clear differentiation.

[Zhu Zhenheng] Lv Zhongnian, age 66, contracted Shanghan, sweated, fever subsided, but pulse remained flooding. Interpreted flooding pulse as deficiency, given Ginseng, Astragalus, Atractylodes, Roasted Licorice, Angelica, Peony, Tangerine Peel. Days later pulse still large, not converging, developed urinary obstruction, lower abdominal oppression/discomfort, suffering greatly, only dropping urine when supine. I said: Tonification dosage insufficient. Double Astragalus and Ginseng in previous formula, give large dose. Two days later, urination became free.

Lower abdominal pain/distension like inverted bowl indicates Excess. Two methods: Qi stagnation below, use emesis to lift; Stagnant Blood below, use Peach Kernel etc. to break blood. (Two formulas see Blood-Qi section.)

[Shichuan] Treat urinary obstruction. Use large living snail, remove shell, crush fine, apply to umbilicus, immediate relief. For post-Shanghan urinary obstruction, use 8-9 pieces ginger, crush, decoct in ten-plus bowls water with 5-6 chi hemp cloth for several boils. Hold in bucket, wait until hand-tolerable temperature, frequently apply cloth to lower abdomen for long time. Then take one bi Red Bean powder, two bi Jiang tea, mixed well spring water, miraculous effect, urine flows like injection.

[Bencao] Treat difficult urination, lower abdominal fullness. If not treated urgently, fatal. Use one jin scallion white, finely chop, stir-fry hot, wrap in cloth, divide into two parts, alternate applying to below umbilicus, immediate relief.

[Xuanzhu] Yin-Yang Guan-Ge, front-back obstruction, promoting stool makes urine flow naturally. Among these is Zhongbao (reversed bladder) syndrome, unresponsive to drugs, without rescue, death from distension/oppression. I once used Kansui powder mixed with water applied to below umbilicus, internally drank Licorice Joint soup. Medicine reached umbilicus, two drugs antagonistic, bladder rotated itself, urine flowed like spring, this is a good emergency method.

[Shengji Zonglu] Treat difficult urination, abdominal fullness/oppression, if not treated urgently, fatal. Use Gentiana (Qinjiao) Yi liang remove roots, decoct in Yi da zhen water to obtain Qi fen, remove dregs, take two doses before meals until cured.

[Shichuan] Treat urinary obstruction, use twenty-one large apricot kernels, grind, mix with water, divide into two doses, effective. (Apricot kernel, Aster resolves Lung depression to benefit urination; depression resolved, Qi descends, urine exits.)

[Qianjin Fang] Treat sudden urinary retention in women. Use Aster powder, take San cuo with well water, immediate relief. For bloody urine, take Wu cuo, stops immediately.

[Waitai Miyao] If urinary obstruction, multiple diseases with slight swelling, take one old pen tip, burn to ash, mix with water and take. (This formula details unknown.)

Classics state: Kidney combines with Bladder; Bladder is the mansion of fluids. Small Intestine belongs to Kidney; Kidney connects up to Lung, thus linking two organs. San Jiao is the mansion of channels/ditches, fluids exit here, belonging to Bladder, which is the mansion of Kidney. Also: Bladder is the Official of Zhoudu, storing fluids; transformation allows exit. From this, Bladder stores water, San Jiao outputs water. For treating urinary difficulty, acupuncture/moxibustion only selects San Jiao points, not Bladder points. Small Intestine belongs to Kidney/Lung, hence Dongyuan uses Qingfei Yinzi, Zishen Wan to benefit urination.

Yunqi (Six Qi) theory, urinary difficulty has three types:
First, damp pathogen attacks San Jiao. Classics: "Taiyin ruling underground, dampness excess wins, disease lower abdominal pain/swelling, inability to urinate." Also: "Water deficiency called Heliu; era of Heliu, Upper Gong same as Zheng Gong, disease is long/bi."
Second, wind pathogen attacks Spleen. Classics: "Jueyin ruling heaven, wind excess wins, disease loose stools, masses, diarrhea, water closure."
Third, dryness-heat. Classics: "Yangming ruling heaven's administration, heaven qi urgent, earth qi bright, people disease long/bi. First Qi period, disease urine yellow-red, severe strangury." Also: "Shaoyin ruling heaven's administration, earth qi solemn, heaven qi bright, Second Qi period, disease strangury."

Neijing acupuncture/moxibustion methods for urinary difficulty have five:
First, select Liver. Classics: "Foot-Jueyin Liver Meridian, diseases generated include long/bi." Also: "Lower abdominal fullness, body chills/fever, urinary difficulty, select Foot-Jueyin." Also: "Long select Yinqiao and Sanmao, up to blood collaterals bleed."
Second, select San Jiao. Classics: "San Jiao disease, abdominal Qi fullness, lower abdominal ball-hard, inability to urinate, distress, overflow leads to water flow becoming distension sign, in Foot-Taiyang outer large collateral, large collateral between Foot-Taiyang/Shaoyang, also seen in pulse, select Weiyang." Also: "Lower abdominal pain/swelling, inability to urinate, pathogen in San Jiao, approximately select Foot-Taiyang large collateral, (large collateral, Weiyang), view collateral vessels,結 with Jueyin small collaterals and blood (should have 'select' two characters)."
Third, select Kidney collateral. Classics: "Foot-Shaoyin branch, named Dazhong, behind ankle winding heel, branches to Taiyang. Disease excess is long/bi, select its branch."
Fourth, select Spleen. Classics: "Foot-Taiyin meridian generated, disease loose stools, masses, diarrhea, water closure, view deficiency/excess cold/heat sinking, apply tonification/sedation rapid moxibustion."
Fifth, miscellaneous selection. Classics: "Internal closure unable to urinate, puncture Foot-Shaoyin/Taiyang and thigh bone upper, with long needle, Qi rebellion select Taiyin/Yangming/Jueyin, severe select Shaoyin/Yangming, moving meridian."

[Jing] Treat urinary dribbling, possibly with blood. Use red-root scallion, cut one cun near root, place in umbilicus, moxa seven zhuang on top.

[Luo Tianyi] Treat urinary dribbling/blockage. Use salt unlimited amount, stir-fry hot fill patient's umbilicus, use moxa chopstick-head size, moxa seven zhuang, urine self-exits.

[Zhaiyuan Fang] (Nei Yinggu from Miyu) Guanyuan (Ba fen, let patient feel dribbling 3-5 times as limit, then rub lower abdomen, then remove needling point). Sanyinjiao (San fen penetrate). Yinggu.

[Cuoyao] Frequent urinary closure: Yinggu (Yi cun wu fen, moxa). Yinlingquan (sedate).

Biaofu Youfa Pianli.

[Jijiu] Urinary closure: Yinlingquan, Yinggu, Sanyinjiao, Qihai, Guanyuan (moxa thirty zhuang, needle two cun wu fen). If not better, select lower points: Taixi, Yinjiao.

[Li Gao] Heat strangury, yellow urine, abdominal fullness: Yinlingquan, Guanyuan (each Er cun). Qichong (Er qi zhuang).
Stone strangury unable to urinate: Guanyuan (San qi zhuang). Qimen, Dadun (each Er qi zhuang).
Blood strangury: Qihai, Tiandann (each needle/moxa San qi zhuang).
Hot painful urination, red eyes, urine like blood: Lieque (along skin one cun). Daling, Chengjiang (each Wu fen). Another method: Qugu (moxa Er qi zhuang). Yin-Yang Erlingquan (each Er cun wu fen).

[Jiayi Jing] Lower abdominal fullness, heat closure unable to urinate, select Zuwuli on foot. Difficult urination, pain, white turbidity, sudden hernia, lower abdominal swelling, cough/reverse vomiting, sudden genital jumping/lower back pain unable to bend/extend, dark face, heat, abdominal痞满, body heat/jue pain, Xingjian governs.