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When the condition is critical, earthworm mud from leek fields is mashed, mixed with water, clarified, and drunk, resulting in immediate urination. Another prescription consists of Rhizoma et Radix Rhei (Dahuang), Talcum (Huashi), and Fructus Gleditsiae Sinensis (Zaojiao), each three qian, ground into powder. If urinary urgency is severe, double the amount of Talcum; if defecatory urgency is severe, double the amount of Rhizoma et Radix Rhei. Another method involves using seven chariots' wheels and seven mole crickets (Lougu), baked on new tiles until dry, then ground into powder, taken with a strong decoction of Cortex Polygoni Cuspidati (Huzhang) bark (specifically that facing southeast). Another method uses powder of Fructus Gleditsiae Sinensis, green onion whites with roots, two fen of Moschus (Shexiang), and a little honey, mashed and applied to the area below the navel down to the pubic region. For urinary retention due to damp-heat or phlegm-fire stagnation, with a surging pulse and painful limbs/joints (indicative of damp-heat), use Liangge San (see Fever) or Tongsheng San (see Stroke). For vomiting and reversal of qi with both urinary and fecal obstruction, use Daoqi Qingli Tang. For phlegm obstructing the Middle Jiao and qi accumulating in the Upper Jiao failing to descend, use Erchen Tang (see Phlegm) added with Caulis Akebiae (Mutong), administered first followed by inducing vomiting. Burnt powder of Fructus Gleditsiae Sinensis can be taken with rice water. Powder of Fructus Gleditsiae Sinensis (without skin and rind) and Succinum (Hupo), one qian each, with a little Moschus, formed into pills with Massa Medicata Fermentata (Shenqu), taken in two doses, delivered with herbs that promote ascending and separating/drainage, leading to immediate urination. If still obstructed shortly after, induce vomiting; there are no cases of failure.

Inability to pass even drops of urine, with distension and pain in the lower abdomen, is caused by blockage of the qi mechanism. (Six Excesses, Seven Emotions, phlegm-food stasis, blood and qi issues, and various internal/external pathogens can all close the qi mechanism.) Qi distribution involves the Upper, Middle, and Lower Jiao. The Upper Jiao qi is governed by the Lung; lung heat prevents qi from descending, so treatment should clear and descend. The Middle Jiao qi is governed by the Spleen and Stomach; excess dampness or heat causes qi stagnation, requiring treatment of damp-heat. If qi deficiency leads to sinking and failure to transport, clearing the upper and descending the turbid must be promoted. The Lower Jiao qi is governed by the Liver and Kidney; kidney heat transferring to the Bladder without yin fluid means yang cannot transform, requiring pure yin formulas like Zishen Wan. The Liver meridian passes through the genitalia; liver fire stagnating causes urinary retention (Longbi), while excessive liver fire dispersion causes enuresis; treatment should select acupoints from the Liver meridian. Additionally, the lower jiao pulse is located anterior to the Bladder meridian and posterior to the Gallbladder meridian, emerging at the Zhongwai Lian point, named Weiyang, which is the Luo-connecting point of the Bladder meridian. Excess fire in the lower jiao causes Longbi, while deficiency causes enuresis. The Du Meridian enters the Ting Kong in women and runs along the penis to the perineum in men; its diseases include Longbi and enuresis, treated by selecting acupoints from the Du Meridian. (Bladder Shu points are not selected because the Bladder merely stores urine, while the process of voiding is directed by the Sanjiao, Du Meridian, and Liver.) Danxi stated: Lung heat failing to generate water and clear metal (Lung) is a "two-steps away" treatment. Spleen dampness failing to transport, preventing clear ascent and turbid descent, causing Lung qi congestion and failure to descend, treating with drying dampness and strengthening the spleen is a "three-steps away" treatment. If unrelated to Spleen/Lung but involving Bladder heat, directly draining Bladder heat is the direct treatment. Dongyuan distinguished between Qi and Blood levels based on thirst. Thirst indicates heat in the Lung, belonging to the Qi level, treated with light diuretic herbs such as Poria (Fuling), Polyporus (Zhuling), Alisma (Zexie), Succinum (Hupo), Juncus Effusus (Dengxin), Tinosporae Caulis (Tongcao), Plantaginis Semen (Cheqian), Dianthus Superbus (Qumai), and Polygoni Cuspidati Herba (Bianfu). These are thin-qi substances, Yang within Yin, descending from Yang. No thirst indicates heat in the Lower Jiao, belonging to the Blood level, requiring pure yin agents like Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), and Talcum (Huashi). (Light diuretics are Yang within Yin, not Yin within Yang, do not use them for this purpose.) For heat-excess patterns, use Bazheng San (see Strangury) added with Aucklandiae Radix (Muxiang). For unbearable abdominal pain, use Mutong Tang. For upper asthma, use Hongshu San. For Kidney deficiency-cold with failure of qi transformation, potentially leading to muscle spasms and poor prognosis, use Shenqi Wan (see Deficiency Damage). This is cold constipation of the lower origin, often treated with Cinnamomi Ramulus (Guizhi) and Aconiti Lateralis Radix Praeparata (Fuzi) to achieve flow. For qi deficiency failing to transform without urgent fullness, only fatigue and reluctance to speak, use Chunze Tang (see Injury from Dampness). Fluids are stored in the Bladder and exit via qi transformation; thus, Aquilariae Lignum Resinatum (Chenxiang) and Citri Reticulatae Pericarpium (Juhong) are used. Vomiting methods may be used to lift qi; when qi ascends, water descends, like a dripping vessel where opening the upper orifice opens the lower. (For qi deficiency failing to ascend and transform, use Ginseng [and other tonics], administer first then induce vomiting; for phlegm blocking qi, use Erchen Tang, administer first then induce vomiting; extend this logic exhaustively.) Sometimes, fecal obstruction leads to gradual urinary closure; unblocking stool allows spontaneous urination. For blood stasis blocking qi, use more Achyranthis Bidentatae Radix (Niuxi); for excess patterns, use Taoren Jian, Daidi Dang Wan (see Blood Stasis), or Niuxi Gao (see Strangury). Thirst with cold abdomen indicates Water Qi (water accumulation in abdomen causes cold; stagnation prevents clear ascent and fluid generation, causing thirst; turbid descent fails, causing urinary closure). Treat with Gualou Qumai Wan, aiming for free bowel/bladder movements and warm abdomen. For urinary retention and acute Zhuantao (retention due to bladder torsion) where drugs fail, use one pig bladder, pierce a small hole in the base, insert a hollow feather quill, tie tightly, seal quill end with wax, blow air into the bladder until 70% full, tie tight, pinch quill root to prevent leakage, remove wax, insert quill into urethra, release hand, then squeeze bladder to force air into bladder, causing urination. Urinary retention with vomiting and inability to eat is called Guange (Closed and Reversed). Head sweating indicates Yang collapse (death); fine and choppy pulse indicates Yin exhaustion (death). One jin of green onion white, chopped, mixed with five fen of Moschus, divided into two packs. Place one pack on the navel, iron with charcoal iron for half an incense stick time, switch to the second pack, iron with cold water-filled iron, alternate until urination resumes. Alternatively, drink Mutong and old green onion decoction, induce vomiting after a moment, repeat until passage. Or, if no sweat, sit in a wooden tub filled with green onion water up to the navel, wrap waist with skirt, wait for sweat and urination, remain in tub to prevent qi retraction. In pregnant women, fetal pressure on the bladder causes Zhuantao (torsion/flipping of the bladder sac), named Zhuantao. The fetus must be lifted; a midwife with oiled hands inserts into the vagina to lift the fetus, allowing urine to gush out. Then administer Ren Shen, Bai Zhu, Chen Pi, Sheng Ma added to Siwu Tang (see Blood Stasis), boil and drink, induce vomiting with finger after a short while, repeat 3-4 times to lift the fetus. Another method: have the pregnant woman lie on a bed, tilt the bed vertically upside down, urine flows naturally, superior to manual lifting. Men also suffer from Zhuantao. Women's Zhuantao is not always due to fetal pressure, often due to urgent urination and bladder distension. Sudden riding or running causes bladder flipping, or water overflowing to Middle Jiao, food filling intestines pressing on Bladder, leaving no room to retreat, causing twisting/flipping (pushable by heat attacking and qi forcing). All require vomiting methods. Huashi San. *Jinkui Yaolue* states: Women's disease, normal diet (disease not in Stomach), irritability, heat, inability to lie flat, orthopnea (asthma, upward disturbance due to downward blockage causes irritability/asthma, forced floating of Yang causes heat), this is Zhuantao with inability to urinate (due to deficiency-cold, qi failure to transform, urgent urine causing bladder distension and heavy twisting). Use Shenqi Wan (i.e., Babawei Wan, see Deficiency Damage).