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Urination obstruction is no trivial matter. The lower abdomen feels urgent and painful, shaped like an inverted bowl, with a sense of urgency that is hard to restrain. If urination does not occur for a day, it may cause vomiting; this condition is named Guan Ge (Obstruction and Reversal). It is also said that death will result if urination remains blocked. Nowadays, upon seeing this syndrome, people only resort to Wu Ling San (Five-Ingredient Powder with Poria) and then wait helplessly for death. Methods such as warming the Dantian (Conception Vessel 4) with salt or applying earthworms and snails to the umbilicus are merely treating the branch.

If body fluids leak excessively into the intestines and stomach, causing diarrhea while urination is blocked, it is appropriate to use Wu Ling San (Five-Ingredient Powder with Poria) to separate and drain dampness. If water stagnates in the epigastrium and cannot descend to the Bladder, Wu Ling San (Five-Ingredient Powder with Poria) should also be used to seep out and drain turbidity. If there is exogenous heat in the Six Fu Organs transferring to the Lower Jiao (Lower Burner) causing blockage, Yi Yuan San (Benefit Origin Powder) should be used to clear the heat. If Qi compression causes blockage and impedes ascending and descending movements, Sheng Ma (Cimicifugae Rhizoma) should be used to lift the Qi, or emesis can be induced by tickling the throat. This is like opening the upper orifice so that the lower orifice becomes patent.

The Classics state: "The Bladder is the official of the metropolis, where fluids are stored; only through Qi transformation can they be discharged." It also states: "The San Jiao (Triple Burner) is the official of irrigation, from which water fluids exit." From this, we can see that the Bladder can only store water; it requires the Qi transformation of the San Jiao (Triple Burner) to discharge urine. Some cases involve excessive consumption of Lung Yin due to overuse of hot herbs like Fuzi (Aconiti Lateralis Radix Praeparata), leading to failure of Qi transformation; these are treated with Huanglian Jiedu Tang (Coptis Decoction to Relieve Toxicity) to restore patency. Others are treated with Fuling Chenpi Gancao Tang (Poria, Tangerine Peel, and Licorice Decoction) administered with powdered Muxiang (Aucklandiae Radix) and Chenxiang (Aquilariae Lignum Resinatum) to achieve urination. These are all demonstrations of Qi transformation. The above treatments apply to Excess syndromes, meaning there is water originally in the Bladder, either bound by Heat or blocked by Qi stagnation; thus, treatment involves promoting the flow of existing water.

In contrast, Deficiency syndromes arise from chronic exhaustion and excessive sweating, leading to dryness within the Five Zang Organs. Once the essence and fat are depleted, body fluids cannot be generated. If one attempts to promote urination when there is no water accumulation in the Bladder, it is like begging food from a beggar who is already impoverished—adding to the poverty. Therefore, Li Dongyuan distinguished treatment based on whether the pathology lies in Qi or Blood, differentiating by thirst or lack thereof. If there is thirst accompanied by difficult urination, this belongs to the Qi aspect of the Upper Jiao (Upper Burner). Water is generated by Metal (Lung); Lung Heat cuts off the source of clear transformation. Treatment should support the Autumn function (Metal) at the Lung level, allowing water to generate naturally, akin to white dew falling in autumn. Clearing Metal (clearing the Lung) herbs, such as Shengmai San (Generate Pulse Powder), are appropriate.

Another scenario involves Spleen Deficiency, often caused by irregular diet damaging Stomach Qi, causing it to sink into the Lower Jiao. As the Classics state, when the Spleen and Stomach are deficient, the nine orifices become blocked. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used, containing sweet-warm herbs like Renshen (Ginseng Radix et Rhizoma) and Gancao (Glycyrrhizae Radix et Rhizoma) to first regulate Stomach Qi. Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) lift the Qi from the depths, causing clear Yang to ascend and turbid Yin to descend naturally. Clearing the Lung is a treatment separated by two organs (indirectly treating the mother organ via the child's path? Note: In TCM theory, Lung is Metal, Kidney is Water. Metal generates Water. Here "Ge Er" refers to treating the organ that generates the affected organ indirectly or via a specific pathway logic described by Dongyuan). Supplementing the Spleen is a treatment separated by three organs. This illustrates Li Dongyuan’s ingenious application of "Deficiency tonifies the Mother." These methods all nourish the source of post-heaven transformation.

If there is no thirst but urination is difficult, this belongs to the Blood aspect of the Lower Jiao (Kidney and Bladder), which is Yin within Yin. If Yin is affected by Heat, the downward flow is blocked. The Classics say: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." Diuretic herbs are "Yin within Yang," not pure Yin agents, so how can Yang transform? Zi Shen Wan (Nourish Kidney Pill) should be used. This formula has flavors and properties that are purely Yin, representing Yin within Yin.

Mr. Li Dongyuan once treated a patient with protruding eyes, abdominal distension like a drum, hardness above the knees, skin feeling ready to burst, inability to eat, and severe constipation. After deep contemplation until midnight, he found a remedy that cured the patient immediately. This was due to Yin Deficiency preventing Yang transformation. However, Li Dongyuan did not discuss True Yang and True Yin Deficiency. For True Yin Deficiency, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is used to tonify Kidney Water, while Zi Shen Wan (Nourish Kidney Pill) is contraindicated. Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) are avoided because their bitter-cold nature may drain water; bland diuretics are also contraindicated. For True Yang Deficiency, Bawei Wan (Eight-Ingredient Pill) is required.

Master Chu stated: "If Jing (Essence) is already withered but one seeks sexual gratification to release essence, the essence will not exit but rot internally, causing the urinary channel to feel obstructed like strangury. If Jing is already exhausted and further depleted, the channels for stool and urine will pull and hurt; the more it hurts, the more one desires to defecate/urinate, and the more one tries, the more it hurts." Master Dai added: "There are cases resembling strangury but not being strangury, where mucus-like substances appear in the urine. This is because both Jing and urine are expelled; Jing blocks the urinary channel, making it difficult to pass and painful. Da Tusizi Wan (Large Dodder Seed Pill) and Lurong Wan (Deer Antler Pill) are appropriate." Master Dai also mastered Master Chu's methods.

If the condition progresses to muscle twitching, panting, and impending death, regardless of gender, pregnancy, or postpartum status, Bawei Wan (Eight-Ingredient Pill) decoction must be administered urgently; delay means death. Some doubt the use of Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) due to their acrid-hot nature. However, consider the principle of Kidney Qi deficiency and cold: water freezes in cold and flows with heat. What other substance can reach the Bladder directly and melt the snow like spring water arrives?

Zhu Danxi treated an elderly man with difficult urination. Due to excessive use of diuretic drugs, he became completely blocked with no drops passing. Zhu diagnosed Stomach Qi sinking and prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), which resolved the blockage after one dose. However, because previous diuretics had damaged Kidney Qi, the patient experienced enuresis (involuntary urination) all night after urination resumed. Urgent Kidney tonification stopped it. Physicians treating this condition rarely avoid draining/diuretic agents; few consider the underlying Kidney Qi deficiency. I highlight this as a warning for future generations.

Later practitioners who emulate Danxi might recognize Lung Deficiency and administer Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) alongside Shenqi Wan (Kidney Qi Pill). Is this not mutual support between upper and lower, and mutual benefit between Child and Mother? The *Ling Shu* states: "The collateral of Hand Taiyin [Lung] is named Lieque (LU 7). Its disease manifests as deficiency and lack, with enuresis and frequent urination." The Lung is the Upper Jiao, regulating water passages and transmitting downwards to the Bladder. The Kidney connects upward to the Lung; thus, these two Zang organs form a Mother-Child relationship. If the Mother is deficient, the Child is also deficient—a natural law. Li Dongyuan said: "Enuresis is due to Lung Metal Deficiency. One should rest, conserve Qi, avoid labor, and strongly tonify with Ren Shen (Ginseng Radix et Rhizoma). If ineffective, blame the Kidney." The Classics state: "If the Bladder fails to constrain, enuresis occurs." Zhang Zhongjing said: "When the Lower Jiao exhausts, enuresis and incontinence result." He also said: "When the Lower Jiao fails to return to its position, leakage of urine occurs." The Lower Jiao, located above the bladder opening, distinguishes clear from turbid and controls urination. If it fails to reside in its proper place, it cannot constrain urine, leading to enuresis. Generally, warm weather and thick clothing cause sweating; cold weather and thin clothing cause increased urination. Increased urination indicates Cold. Enuresis indicates extreme Deficiency-Cold, requiring Bawei Wan (Eight-Ingredient Pill) for efficacy. Ancient formulas like Tusizi Wan (Dodder Seed Pill), Lurong San (Deer Antler Powder), and Erqi Dan (Two-Qi Elixir) are also selectable options.

Master Dai said: "Nocturnal enuresis during sleep is caused by coldness in the Lower Yuan (Lower Source) leading to loss of urinary control. Da Tusizi Wan (Large Dodder Seed Pill) administered with decoction of roasted pig bladder is appropriate." All enuresis belongs to Deficiency. Liu Hejian argued that extreme Heat lodging in the Kidney region interferes with the Foot Jueyin [Liver] meridian, causing congestion in the urethral orifice. When Qi and Blood cannot circulate freely, flaccidity and numbness occur, rendering the Spirit useless, so fluids seep into the Bladder and are lost involuntarily. This corresponds to the *Nei Jing* statement: "Pathogenic factors causing enuresis indicate Bi Syndrome gathering in the Kidney." This is a Heat syndrome, which must be known.

Reviewing Xue Ji's medical records: A case involved fever and thirst due to overwork, with spontaneous enuresis or occasional retention. I diagnosed Liver Fire and Blood Deficiency, where the Yin structures failed to constrain. Morning administration of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Shanyao (Dioscoreae Rhizoma) and Shanzhuyu (Corni Fructus), and afternoon administration of Liuwei Wan (Six-Ingredient Pill), resolved symptoms within a month. Generally, enuresis is mostly Deficiency-Cold rather than Excess-Heat. Mistakenly prescribing fire-draining herbs for a Deficiency syndrome can lead to critical danger instantly. Be cautious, be cautious.