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Li Dongyuan treated Wang Shanfu of Chang'an. The patient suffered from urinary retention, which gradually developed into abdominal distension and enlargement, with the abdomen hard as stone. His legs and feet were swollen, cracking and oozing fluid. His eyes protruded, he could not sleep day or night, could not take food or drink, and his suffering was indescribable. He had taken sweet and bland diuretic herbs without effect. Li said, "The disease is deep; it requires careful contemplation to prescribe." He recalled a passage from *Suwen*: "Without Yang, Yin cannot be generated; without Yin, Yang cannot transform." It also states: "The Bladder is the official of the Zhou Du (capital), where body fluids are stored; only through Qi transformation can they be excreted." This case of urinary strangury and retention is due to a lack of Yin, causing Yang to fail in transformation. All herbs that promote urination have a bland taste and promote drainage, belonging to Yang. They are merely Qi-moving herbs, representing Yin within Yang, and are not transformed by the Yin within Yin of the Northern Cold Water. This condition resulted from excessive nourishment, where rich foods accumulated heat and damaged the Yin of the North. Kidney Water was insufficient. The Bladder is the chamber of the Kidney; over time it dried up, leading to an inability to transform urine. Fire rebelled upward, causing vomiting and hiccups; this did not originate above the Diaphragm. It was solely a "Guan" (closure) syndrome, not a "Ge" (regurgitation) syndrome. Zhang Jiegu said, "Heat in the Lower Jiao causes blockage and difficulty," which is the method for Guan-Ge. Now the patient exhibits both internal Guan and external Ge symptoms, and death is imminent. However, treating the Lower Jiao can cure him. Select herbs with a great bitter-cold flavor that embody the transformation of Northern Cold Water: Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). Use Guizhi (Cinnamon Twig) as a guiding herb. Form pills the size of sesame seeds. Administer 200 pills with boiling water. Shortly after, a report came: shortly after taking the medicine, the anterior orifice felt like being pierced by a knife or burned by fire, and urine gushed out like a waterfall. Bedding became wet, and streams formed under the bed. In the blink of an eye, the swelling and distension dissipated. Li exclaimed in surprise and joy, "How great are the words of the Sages! How can one simply browse them and adhere rigidly?" This syndrome presents as urinary obstruction without thirst, occasionally accompanied by restlessness. Diseases located in the Lower Jiao generally do not cause thirst. The difference between these two types of diseases is easy to distinguish: one is located in the Upper Jiao, involves the Qi level, and necessarily causes thirst; the other is located in the Lower Jiao, involves the Blood level, and does not cause thirst because dampness exists within the Blood.

Yu Zhen commented: What makes the sages of old incomparable is their ability to comprehend the essence of classics and establish treatment methods. If modern practitioners merely pick phrases from texts and have not even mastered established formulas, how can they innovate and precisely match the pathology?

Zhu Danxi treated a man with urinary retention. After physicians used diuretics, the condition worsened. The pulse at the right Cun position was slightly wiry and slippery, indicating phlegm accumulation in the Lung. The Lung is the Upper Jiao, and the Bladder is the Lower Jiao. When the Upper Jiao is closed, the Lower Jiao becomes blocked, similar to a vessel for dripping water: the upper aperture must open before the water flows from the lower aperture. He induced vomiting with medication, and the illness vanished as if lost.

Li Shicai treated Wang Jingru, Prefect of a Commandery. While suffering severely from phlegm-fire, wheezing, and coughing, he suddenly experienced urinary retention. He self-administered Cheqianzi (Plantaginis Semen), Mutong (Akebiae Caulis), Fuling (Poria), and Zexie (Alismatis Rhizoma), resulting in lower abdominal distension and fullness with no urine output. Li said, "The rapid and large pulse at the right Cun indicates Dryness of Metal failing to generate Water." He prescribed Ziwan (Asternatis Radix) 5 qian, Maidong (Ophiopogonis Radix) 3 qian, Beiwuweizi (Schisandrae Fructus) 10 grains, and Renshen (Ginseng Radix et Rhizoma) 2 qian. After one dose, urine gushed out like a spring. If bland diuretic herbs are used excessively, they反而 (instead) cause dryness and urgency; this must be carefully observed.

Yuan Qixin of Jiangxi usually exerted his mind and was sluggish in handling affairs. During the transition of Yin and Yang energies, he suffered urinary retention. Liu Yi San (Six-One Powder) was ineffective. Subsequently, Fuling (Poria), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), and Cheqianzi (Plantaginis Semen) were used, also without effect. Li palpated the two Cun positions and found them flooding and rapid, determining that Heart Fire was punishing Lung Metal, thus preventing Qi transformation from reaching the Zhou Du (Bladder). He prescribed Huanglian (Coptidis Rhizoma), Fushen (Poria with Hostwood), Niuxi (Achyranthis Bidentatae Radix), Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), and Wuweizi (Schisandrae Fructus). One dose cured him.

Li Shicai stated: "My elder brother Nianshan was demoted to the Surveillance Commissioner of Zhejiang. Amidst depression and anger, and during midsummer, he suffered urinary retention, with high Qi and wheezing. He took Weiling Tang (Stomach-Cooling Decoction) for four doses without effect. I said, 'The six pulses show knotted qualities, indicating Qi stagnation.' I prescribed only Zhike (Aurantii Fructus) 8 qian and Shengjiang (Zingiberis Rhizoma Recens) 5 slices, decocted rapidly. After one dose, there was slight patency; after four doses, he recovered completely."

Xiaolian Yu Yanzhi, while compiling local gazetteers and exhausting his spirit, suddenly appeared disoriented, accompanied by urinary retention. Li Shicai said, "The Cun pulse is faint while the Chi pulse is drum-like, indicating exhaustion of Water and injury to Spirit." He used Dihuang (Rehmanniae Radix) and Zhimu (Anemarrhenae Rhizoma) each 2 qian, Renshen (Ginseng Radix et Rhizoma) and Danshen (Salviae Miltiorrhizae Radix) each 3 qian, Fuling (Poria) 1.5 qian, and Huangbai (Phellodendri Cortex) 1 qian. Symptoms decreased slightly after two doses and stabilized after ten doses.

Wang Jin stated: A fifty-year-old woman initially suffered from scanty and difficult urination. Physicians prescribed Bazheng San (Eight-Herb Powder for Unblocking Damp-Heat), which eventually led to complete urinary retention. Her body felt as if covered in thorns. I attributed it to exposure to prolonged rain and dampness, with pathogenic factors still on the exterior. Therefore, I used Cangzhu (Atractylodis Rhizoma) as the sovereign herb and Fuzi (Aconiti Lateralis Radix Praeparata) as an assistant to release the exterior. After one dose, she sweated, and urination immediately resumed.

He also treated the father of Political Counselor Ma, aged eighty. Initially, he suffered from short and scanty urination. Due to excessive use of diuretic drugs, he developed complete obstruction with no drops passing. I diagnosed that excessive food intake had damaged Stomach Qi, causing it to sink into the Lower Jiao. He was given Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). After one dose, urination resumed. Because previous diuretic use had damaged Kidney Qi, he experienced enuresis for a night after urination resumed. Urgent tonification of the Kidney stopped it. Physicians treating this syndrome invariably use draining and purgative agents; how can they attend to the deficiency of Kidney Qi?

[Appendix] *Ben Shi Fang* records: Previously in Piling, the wife of a noble official suffered urinary retention with unbearable umbilical and abdominal distension and pain. All physicians treated it as Lin syndrome (strangury), using formulas like Bazheng San (Eight-Herb Powder for Unblocking Damp-Heat), but none worked, and the condition worsened. Xu Shuwei said, "This is a Blood Mass (Xue Jia); only a drastic medication causing severe reaction (Mingxuan) can remove it." He used Taoren Jian (Peach Kernel Decoction). By noon after the first dose, severe pain was unbearable. After lying down briefly, several fist-sized blood clots were passed, followed by one to two sheng of urine resembling black bean juice. Pain ceased, and he recovered. This medicine is fierce and harsh; those with Qi deficiency and weak Blood should use it with caution.

Yu Zhen commented: Zhang Zhongjing stated, "If urination is free, there is Blood stasis; if urination is difficult, there is no Blood stasis." This is the rule for distinguishing Blood Accumulation in Shaoyin cold damage. Here, however, urinary closure is caused by Blood Accumulation. Does this not imply that rules require flexibility?

Sunongsu treated the wife of a wealthy family. In mid-autumn, she had constipation of both stool and urine for three days. Physicians administered two doses of Badou Wan (Croton Seed Pills). Although stool was purged, urinary retention worsened. She suffered distension and fullness, with the umbilicus protruding more than two cun, and the anterior orifice swollen and cracked, unable to sit or lie down, weeping bitterly. This was a Zhuanpao (displacement of the bladder) syndrome. He used root bark from the east side of a tree (Shudongxing Genpi) 1 cun, Huashi (Talcum) 3 qian, Yanhusuo (Corydalis Rhizoma), Taoren (Persicae Semen), Danggui (Angelicae Sinensis Radix), and Qumai (Dianthi Herba) each 1 qian. Decocted in water, with half a cup of Jiucail (Chinese Chive Juice) added. After eating for a short while post-medication, urination flowed slightly. The vulva hurt severely, and urine would not come out unless she strained forcefully. He then changed the prescription to Shengma (Cimicifugae Rhizoma), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus), and Yanhusuo (Corydalis Rhizoma). Decocted, mixed with Yuanmingfen (Natrii Sulfas Crystallicus) 2 qian. This embodies the intention of raising the clear and descending the turbid. Both stool and urine passed, and she recovered.

Monk Shenrou treated a fifty-year-old woman. During urination, a piece of snow-white ice-like substance would block her vaginal opening. To urinate, she had to manually remove it; otherwise, it was difficult. Shenrou said, "This is Cold-Dampness in the Stomach, caused by deficiency-cold of the Spleen and Stomach, condensing and sinking downward. It reaches the vaginal orifice but does not exit immediately because the Qi of the Spleen and Stomach has not yet collapsed, but has merely sunk." He prescribed Liujun Zi Tang (Six-Gentlemen Decoction) plus Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex). Twenty doses resulted in complete recovery.

Yu Zhen commented: Urinary retention is a critical and urgent condition. This collection selects only eleven cases, seemingly brief, yet all methods are complete and non-repetitive. If learners can apply these principles analogously, they will surely find infinite variations.