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Also known as Tongguan Wan (Passage-Opening Pill).
Indicated for heat located in the Lower Jiao (Lower Burner), presenting with strangury and urinary retention, yet without thirst.
Huangbai (Phellodendri Cortex) two liang, processed with wine; Zhimu (Anemarrhenae Rhizoma) two liang, soaked in wine and stir-fried; Rougui (Cinnamomi Cortex) one qian. Grind the above herbs into a fine powder, make pills using cooked water, sized like wutong seeds. Take fifty pills per dose, on an empty stomach.

[Collected Annotations] Li Guo stated: Urination is governed by the Foot-Taiyang Bladder channel and originates from Lung Metal. If latent heat resides in the Lung, preventing the generation of fluids, this severs the source of urine; if accompanied by thirst and urinary obstruction, it is due to the failure of Lung Qi to descend. Therefore, one should use drugs that are light, thin, and diuretic to clear dryness from Lung Metal, purge fire, clear the Lung, and nourish the source of water generation. However, if heat is in the Lower Jiao without thirst, it indicates a blockage of flow where urine cannot be discharged; in such cases, drugs with strong flavors and potent properties, belonging to "Yin within Yin," must be used. The *Suwen* states: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." It also says: "The Bladder is the official of the metropolitan area, storing body fluids; only through Qi transformation can they be excreted." Strangury and constipation due to lack of fluids represent "without Yin, Yang cannot transform." One must use the strongly bitter and cold agents Zhi Mu and Huang Bai, with one qian of Rou Gui as a guiding agent. Shortly after ingestion, the external genitalia will feel as if pierced by knives or burned by fire, and urine will gush out like a spring, resulting in cure. This condition differs in that one type involves the Upper Jiao Qi level with thirst, while the other involves the Lower Jiao Blood level without thirst. The distinction between the two is very easy to identify. Ke Qin stated: Water is the substance of the Kidney, and Fire is the function of the Kidney. People know that having water in the Kidney allows it to control fire, but do not realize that having fire in the Kidney is what enables the generation of water. As Heaven generates Water with One, "One" refers to Yang Qi, which is Fire. Qi is the mother of Water, and Yang is the root of Yin. Only when Fire has its归宿 (return/anchoring point) can Water have its master. Therefore, Rou Gui's sweet and warm nature is added in reverse dosage (counter-agent) to guide Zhi Mu and Huang Bai into the Kidney to achieve their effects. This illustrates both the profound principle of mutual assistance (Xiang Xu) and mutual restraint (Xiang Zhi).