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Shoulder and back pain accompanied by aversion to cold, shortness of breath with insufficient respiration, and change in urine color. It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify Lung Qi. The Winter pulse corresponds to the Kidney; if the Winter pulse is deficient, it causes internal coldness, pain in the spine, and abnormal urination. It is appropriate to use Dihuang Wan (Rehmannia Pill) to assist Kidney Qi. This is a deficiency syndrome. (*Zhengzhi Zhunshen*)

Regarding urination, people often see yellow urine and attribute it to Fire pathogen, not realizing that when one encounters fatigue or overwork, urine becomes yellow; when one is anxious and overthinking, urine also becomes yellow; when diarrhea or dysentery occurs unexpectedly, urine also becomes yellow; when wine and sexual excess damage Yin fluids, urine also becomes yellow. Unless accompanied by symptoms of strangury, pain, and heat, one should not conclude it is Fire merely because the urine is yellow. I have seen many cases where patients died due to being forced into a state of dried-up fluids based on such misjudgments. The *Classic* states: "When Middle Qi is insufficient, urination and defecation become abnormal." The meaning can be inferred from this. (Zhang Jingyue)

[Pulse Diagnosis]
Hematochezia presents with a Kou (scallion-stalk) pulse; rapid pulse indicates red-yellow urine; Excess pulse indicates strangury/urinary retention; Heat is in the Bladder. (*Maijue*)

[Selected Cases]
Wang Shanfu suffered from urinary retention, which gradually developed into abdominal fullness, with the abdomen hard as stone, skin cracking on the legs leaking fluid, inability to sleep at night, and inability to eat. He invited me to consult. Returning home, I could not sleep until dawn, recalling the *Suwen*: "Without Yang, Yin cannot be generated; without Yin, Yang cannot be transformed." It also states: "The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted." All cases of strangury and retention stem from the lack of Yin preventing the transformation of Yang. This case was caused by accumulated heat from rich foods damaging Kidney Water, with Fire rebelling upward causing vomiting and hiccups, presenting all signs of Guan-Ge (obstruction of upper and lower jiao), with death imminent. Therefore, I prescribed strong bitter-cold herbs: Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), each 1 liang, with Guizhi (Cinnamomi Ramulus) 1 qian as a guiding herb. Shortly after taking the medicine, the external genitalia felt like knife-stabbing and burning, and urine gushed out like a waterfall, with swelling subsiding immediately. In this condition, one aspect involves thirst due to Qi-level pathology in the Upper Jiao, while the other involves no thirst due to Blood-level pathology in the Lower Jiao; the distinction between the two is very easy to identify. (Li Dongyuan)

The father of Councilor Ma, aged eighty, initially suffered from scanty and obstructed urination. Due to excessive use of diuretic medicines, he became completely blocked, unable to pass even a drop. I reasoned that dietary injury had damaged Stomach Qi, causing it to sink into the Lower Jiao. Thus, I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). After one dose, urination resumed. However, because he had previously taken too many diuretics, damaging Kidney Qi, he experienced continuous enuresis after urination resumed. I then used Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) to tonify Kidney Qi, which resolved the issue. (Zhu Danxi)

The wife of Yao Gongmaozhi suffered from enuresis. Physicians attributed it to Kidney deficiency and used Kidney-tonifying formulas for three years without effect. I administered Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), and Sangpiaoxiao (Mantis Egg Case). After four doses, she was completely cured. (Cheng Huazhong)

Ye Maoqing's son contracted smallpox but failed to form proper pustules; the crusts were very thin. Two months later, some crusts remained adherent to the flesh. One night, he suffered abdominal pain, cried out loudly, and fainted. I took Pear Juice mixed with warm water and administered it; he slightly revived. Then, I decocted Huangqin (Scutellariae Radix) 2 liang, added Pear Juice, and gave it to him, stopping the pain. I instructed making a paste medicine for frequent intake, but he did not comply. Later, his abdomen suddenly became enormously distended. One night, he cried out in pain, and his small intestine protruded five cun outside the umbilicus, with the twisted portion measuring two and a half cun each, resembling the top of a bamboo-joint pot; the penis was twisted, eight or nine cun long, bright as a lantern. Such external manifestations had never been seen before. Since I knew the disease thoroughly, I continued treatment using Huangqin (Scutellariae Radix) and Ejiao (Asini Corii Colla), administering more than ten doses daily. After three days, he began to pass small amounts of urine; after five days, the urinary tract cleared, the umbilicus retracted, swelling subsided, and he recovered. The Qi of the whole body is entirely related to the Lung; if the Lung is clear, Qi flows; if the Lung is turbid, Qi stagnates. The Lung governs skin and hair. Failure of smallpox to form pus indicates Lung Heat and failure of Jin-Ye (Body Fluids) to circulate. Crusts adhering to flesh are called "Jiacuo" (criss-cross scaling); those with Jiacuo often develop Feiyong (Lung Abscess); Yong means obstruction. Is this not caused by Lung Qi obstruction? Severe abdominal pain and crying indicate severe obstruction; severe obstruction closes the urinary pathway as well, causing Qi to rush horizontally through the umbilicus, leading to intestinal protrusion. Flaccidity and elongation of the external genitals are merely secondary effects. I used Huangqin (Scutellariae Radix) and Ejiao (Asini Corii Colla) to clear Lung Heat and moisten Lung dryness, treating the root cause. When Qi flows, obstruction clears; when the source is pure, the flow is clear. Because the disease had reached an extreme degree, only single herbs in large doses could descend effectively and produce rapid results. (Yu Jiayan)

A woman had a lower abdomen swollen like a melon, with complete urinary retention. This was Zhuantong (Bladder Displacement) disease. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) mixed with a small cup of Chive Juice. After ingestion, the patient lay horizontally on the bed. A strong woman placed the patient's bent knees on her shoulders, suspending the lower body empty, lifted and swung the patient several times to invert the bladder upwards, then slowly lowered her. Before clothes could be put on, urine shot out, hot as boiling water and black as ink, filling the basin instantly, and abdominal swelling disappeared immediately. Subsequently, several similar cases were cured using this method.

A man suffered from urinary retention for ten days. Treatments with Wuling San (Five-Ling Powder) and Bazheng San (Eight-Right Powder) were ineffective. He lay supine on the bed, abdomen distended like a winnowing basket, unbearable distension and pain. Pulse was slow but forceful. This was Cold Obstruction, caused by Wind-Cold pathogenic qi blocking the Lower Jiao and remaining in the Bladder. Treatment used Jiang (Zingiberis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Binglang (Arecae Semen), Niuxi (Achyranthis Bidentatae Radix), Zhishi (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Wuyao (Linderae Radix), Chifuling (Poria cum Pini Radix), and Cheqianzi (Plantaginis Semen). Shortly after administration, rumbling occurred in the abdomen, and urine gushed out like a spring, with abdominal distension resolving and the patient rising.

[Supplementary Formulas]
Umbilical Application Formula: Treats urinary retention and drum-like abdominal distension. Use one large snail and half a spoonful of salt, pound into a paste, apply to 1.3 cun below the umbilicus, and bind with cloth to achieve patency.
Umbilical Moxibustion/Ironing Formula: Use three jin of scallions, chop finely, stir-fry until hot, wrap in cloth, and iron the lower abdomen. Urination will resume immediately. Divide into two packs for rotation. ○ Alternatively, use half a jin of stir-fried salt, place in a bag, and iron the area below the umbilicus to achieve patency.
Fumigation and Washing Method: Treats Qi-blockage causing urinary retention, distension, urgency, and critical danger. Use several liang each of Zaogiao (Gleditsiae Sinensis Fructus Spina), Congtou (Allii Fistulosi Bulbus), and Wangbulexing (Vaccariae Semen). Decoct in a basin of water. Let the patient sit and soak, fumigating and washing the lower body. Internal penetration of heat resolves obstruction naturally. For women, insert several stalks of scallion into the vagina, plus external fumigation and washing, for faster results.
Another Method: Treats residual semen and dried blood, crust formation in the urethral meatus, blocking the urinary pathway, causing distension, urgency, and retention. Have the patient lie supine. Insert a feather quill tube into the urethral meatus. Inject one or two qian of Mercury. Gently guide with hand to clear all obstructions. Mercury exits with urine, causing no harm.
Another Method: Use one pig bladder. Pierce a small hole in the base. Attach a feather quill tube to the hole. Tie the root tightly with thread. Plug the tube mouth with a thin stick. Seal the top with wax. Inflate the bladder mouth with air and tie it shut. Hold the tube root with hand. Remove wax seal. Insert feather quill tube into the urethral meatus. Untie the root. Squeeze air into the bladder. Urine will flow out immediately.