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[Zhu Danxi] The disease of "Zhuanbao" (displacement of the bladder/urinary retention due to pregnancy) generally occurs in pregnant women who have a weak constitution, are prone to worry and depression, have an irritable temperament, or consume rich and heavy-flavored foods. Ancient formulas mostly used slippery and draining medications, but rarely achieved efficacy. Upon reflection, I believe this is because the fetus presses against the bladder, displacing it to one side, causing the bladder ligaments to twist and become obstructed. If the fetus can be lifted and suspended in the center, the bladder ligaments will relax, and the water pathway will function naturally. However, the downward displacement of the fetus must have a cause. One day, a patient surnamed Long from the Wu residence suffered from this condition. His pulse on both hands seemed choppy (Se), becoming wiry (Xian) upon heavy pressure, while the left hand was slightly harmonious. I said: This resulted from worry and distress. A choppy pulse indicates blood deficiency with excess Qi, and a wiry pulse indicates the presence of fluid retention. Blood deficiency makes the bladder ligaments weak, unable to lift the fetus by themselves; excess Qi with fluid retention causes turbidity in the Middle Jiao and overflow, leading the bladder to avoid pressure and descend, hence the tendency to drop. Therefore, I prescribed Siwu Tang (Four Substances Decoction) supplemented with Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Banxia (Pinellia Tuber), Chenpi (Tangerine Peel), Sheng Gancao (Raw Licorice Root), and Shengjiang (Fresh Ginger). He took it on an empty stomach, and I immediately induced vomiting by probing his throat with my finger until the medicinal juice was expelled. After a short while, when his Qi stabilized, he took another dose. The next day, the same procedure was repeated. After eight doses, he recovered. This method proved accurate, though perhaps coincidental. Later, several other patients showed clear effectiveness, though the exact reason remains unknown. Zhang Zhongjing stated: Women originally possess abundant flesh and fullness when lifting their heads/bodies; if they become emaciated and lose that fullness sensation upon lifting, due to twisted bladder ligaments, it also leads to Zhuanbao. The underlying principle is unclear, and there must be someone who understands it.

A forty-one-year-old woman, nine months pregnant, suffered from Zhuanbao with urinary retention for three days. Her lower abdomen felt urgent, her feet were swollen, and she was unbearable in her suffering, coming for emergency help. I examined her and saw her form was haggard; her right pulse was choppy and the left was slightly harmonious. This was caused by overeating damaging the Qi, making the fetal ligaments weak and unable to support the fetus, which then descended and pressed down, displacing the bladder to one side. The urgent Qi was blocked by this pressure, so the urinary aperture could not open. Diseases of Zhuanbao are generally like this. I therefore formulated a prescription to nourish blood and tonify Qi. Once blood and Qi are rectified, the fetal ligaments will naturally lift, preventing descent and pressure, thus ensuring safety. I prepared a decoction of Renshen (Ginseng), Danggui (Angelica Sinensis Root, body and tail), Baishaoyao (White Peony Root), Baizhu (Atractylodes Macrocephala Rhizome), Daibai Chenpi (Tangerine Peel with white pith), Zhigancao (Honey-fried Licorice Root), Banxia (Pinellia Tuber), and Shengjiang (Fresh Ginger). I brewed four strong doses, allowing her to drink freely. By dawn the next day, I gave another four doses. The dregs were combined into one dose, boiled, and taken in one gulp. I induced vomiting to expel the medicinal soup, after which urination immediately resumed, discharging dark water. Later, based on this formula, I added Fudupi (Bitter Orange Fruit), Zhiqiao (Aurantium Fructus), Qingcongye (Green Onion Leaf), and Suosharen (Amomum Fruit), giving her twenty doses in total to prevent deficiency before and after delivery. She indeed delivered safely and remained healthy postpartum.

Another woman, seven or eight months pregnant, suffered from urinary obstruction. Many doctors failed to promote urination, and her urgency and distension worsened. Her pulse was fine and weak. I surmised it was due to blood and Qi deficiency; otherwise, it might be that water carrying the fetus made it heavy and pressing down on the lower opening of the bladder, preventing urine output. If tonic herbs were used to lift, the fetus would rise and relief would follow, but if the medicinal power had not yet arrived, the urgency and fullness would increase. I instructed an old woman to apply sesame oil to her hands, insert them into the vaginal opening, and manually lift the fetus. Urine gushed out, and the distension and urgency instantly resolved. Simultaneously, I had Ren Shen (Ginseng), Huangqi (Astragalus Root), and Shengma (Cimicifuga Rhizome) decocted in large doses for oral administration. If any slight urgency occurred, manual lifting was still performed to facilitate urination. After three days, the fetus gradually rose, and urination returned to normal.

[Zhang Zhongjing] Question: A woman suffers from illness where her diet remains normal, yet she experiences irritability, heat, inability to lie flat, and instead leans forward to breathe. What is the cause? Master said: This is named Zhuanbao, characterized by the inability to urinate. It is caused by twisted bladder ligaments. To cure this, simply promote urination. Use Shenqi Wan (Kidney Qi Pill) as the primary treatment. (This is the Eight-Ingredient Pill, see Treatment Methods section; take 15-20 pills with wine, twice daily.)

[Chanbao] Treats urinary obstruction and bladder displacement. Sandiaoxiao (Mantis Egg Case) is ground into powder and taken with rice water, one cun-bi per dose, three times daily.

[Zhang Zhongjing] In pregnancy with water qi accumulation, heaviness of the body, urinary difficulty, chills, and dizziness upon rising, use Kuizi Fuling San (Abelmoschus Seed and Poria Powder) as the primary treatment.
Kuizi (Abelmoschus Seed) and Fuling (Poria) (each 3 liang).
Grind these two ingredients into a powder. Take one cun-bi with water, three times daily. Relief comes when urination becomes smooth.

For difficult urination during pregnancy with normal diet, use Guimu Kushen Wan (Danggui, Fritillaria, and Sophora Pill).
Danggui (Angelica Sinensis Root), Beimu (Fritillaria Bulb), Kushen (Sophora Root) (each 4 liang).
Grind these three ingredients into powder, mix with refined honey, and make pills the size of small beans. Take three pills with water, increasing up to ten pills. (For men, add Banliang of Huashi [Talc]).

[Waibu] Treats sublin (painful dribbling urination) during pregnancy. Zhu Ling (Polyporus) 5 liang, ground alone into powder. Take one cun-bi with warm water, gradually increasing to two cun-bi, twice daily and once at night.

[Daqianjin] Treats sudden inability to urinate during pregnancy. Xingren (Apricot Seed), peeled and de-seeded, ground into pills the size of large green mung beans. Swallow seven pills with Dengxin Tang (Juncus Decoction); urination will resume immediately.

[Zhu Danxi] A woman from the Zhu residence, over thirty years old, four months pregnant, suffered from constipation of both stool and urine. After using promoting and draining drugs, including Dongkuizi (Abelmoschus Seed), the blockage was relieved, but her Qi was not yet smooth. This was due to an irritable nature consuming blood and disrupting Qi. It is necessary to harmonize the Qi and nourish the blood to achieve peace.
Chenpi (Tangerine Peel), Qingpi (Green Tangerine Peel), Shaoyao (Peony Root) (1 qian); Renshen (Ginseng), Danggui Shenywei (Angelica Sinensis Root, body and tail), Chuanxiong (Ligusticum Rhizome), Dihuang (Rehmannia Root), Baizhu (Atractylodes Macrocephala Rhizome) (0.5 liang); Fuling (Poria), Mutong (Akebia Stem), Gancao (Licorice Root) (2 fen).

[Jiayi Jing] For difficult urination, abdominal distension and fullness, scanty urine, bladder displacement, and inability to urinate, Qugu (CV2) is indicated. For bladder displacement with inability to urinate and lower abdominal fullness, Guanyuan (CV4) is indicated.