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26. Fullness in the lower abdomen with pain upon pressure, if accompanied by cold extremities and clear, cold urine, indicates Cold Binding in the Bladder (Lengjie Pangguang); if there are no cold extremities, blood is retained in the lower jiao with free urination, whereas water retention causes harm when urination is obstructed.

[Note] Fullness in the lower abdomen with pain upon pressure: If accompanied by cold extremities and clear, white urine, this is Cold Binding in the Bladder, for which Danggui Sini Jia Wuzhuyu Shengjiang Tang (Cinnamon Twig Decoction plus Evodia and Fresh Ginger) is indicated. If there are no cold extremities and urination is free, this is Blood Retention in the Bladder, for which Taoren Chengqi Tang (Peach Kernel Decoction to Drain the Lower) is indicated. If urination is difficult, this is Water Retention in the Bladder, for which Wuling San (Five-Ingredient Powder with Poria) is indicated. If both stool and urine are obstructed, this is Water-Heat Binding, for which Bazheng San (Eight-Herb Powder for Rectification) is indicated.

27. Confusion due to extreme Stomach Heat, and mania due to Double Yang Heat, may be treated with Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction), the Three Chengqi Decoctions, or Baihu Jiedu Tang (White Tiger Detoxifying Decoction). Mania due to Blood Retention with free urination belongs to the Taiyang (Greater Yang) channel; Yangming (Yang Brightness) Blood Retention presents with black stools, a manic-like state, and forgetfulness, treatable with Taoren Chengqi Tang or Didang Tang (Siege Decoction). One must recognize cases of sudden mania occurring just prior to sweating as a sign of resolution.

[Note] "Confusion due to Stomach Heat" refers to confusion caused by extreme heat in the Stomach channel invading the Heart. "Double Yang Mania" refers to mania resulting from heat entering the Yang aspect. "Sanhuang" refers to Sanhuang Shigao Tang, used for confusion and mania with exterior excess and absence of sweating. "Three Cheng" refers to the three Chengqi Decoctions, used for confusion and mania with interior excess and constipation. "Baijie Tang" refers to Baihu Jiedu Tang, used for confusion and mania where there are neither exterior nor interior signs but extreme heat prevails. Taiyang Blood Retention causing mania presents with hardness and pain in the lower abdomen and free urination. If urination is difficult, it is Water-Heat retention, not Blood Retention. Yangming Blood Retention presenting as manic-like behavior includes forgetfulness and black stools. If stools are not black, it is extreme heat, not Blood Retention. For mild Blood Retention, use Taoren Chengqi Tang; for severe cases, use Didang Tang, choosing appropriately. However, in cases of mania, there are also individuals with excessive Yang and deficient Yin who, at the time of impending sweating for resolution, may suddenly become manic and then resolve with continuous sweating. This pattern must be recognized and should not be treated with medication.