李士材曰∶小便闭与癃，二症也。新病为溺闭，盖点滴难通也；久病为溺癃，盖屡出而短少也。闭癃之
病，《内经》分肝与督脉，三焦与膀胱。膀胱但主藏溺，其主出溺者，皆肝经及督脉、三焦也。又考膀胱为
州都之官，津液藏焉，气化则能出矣。夫主气化，太阴肺经也。若使肺燥不能生水，则气化不及州都，法当
清金润肺，车前、紫菀、麦冬、桑皮之类。如脾湿不运，而精不上升，故肺不能生水，法当燥脾健胃，苍术、
白术、茯苓、半夏之类。如肾水燥热，膀胱不利，法当滋肾涤热，黄柏、知母、茯苓、泽泻、通草之类。
夫滋
肾泻膀胱，名为正治；清金润肺，名为隔二之治；健胃燥脾，名为隔三之治。
又或有水液只渗大肠，小腑因而燥竭，宜以淡渗之品，茯苓、猪苓、泽泻、通草之类，分利而已。
或有气滞，不能通调水道下输膀胱者，顺气为急，枳壳、木通、橘红之类。有实热者，非纯阴之剂，则阳
无以化。上焦热者，栀子、黄芩；中焦热者，黄连、白芍；下焦热者，黄柏、知母。
有大虚者，非与温补之剂，则水不能行，如金匮肾气丸及补中益气汤是也。如东垣治一人小便不通，目
突腹胀，皮肤欲裂，服淡渗之药无效。东垣曰∶疾急矣，非精思不能处。思至半夜，曰∶吾得之矣，膀胱为
州都之官，津液之腑，必气化而能出。服淡渗气薄，皆阳药也，孤阳无阴，欲化得乎？以滋肾丸群阴之剂投
之即愈。
丹溪言曰∶吾以吐法通小便，譬如滴水之器，上窍闭则下无以自通，必上窍开而下窍之水出焉。气虚
者补中益气汤，先服后吐。血虚者芎归汤，先服后吐。痰多者二陈。气闭者香附、木通，探吐。
更有淤血而小便闭者，牛膝、桃仁为要药。《别录》云∶小便不利，审是气虚，独参汤如神。由是观之，
受病之源，自非一途矣。
赵养葵曰∶小便不利，东垣分在气在血而治之。辨在渴乎不渴，如渴而小便不利，此属上焦气分。水生于
金，肺热则是消化之源绝矣，当于肺分助其秋令，用清金之药，如生脉散之类为当。又有脾虚，因饮食
失节伤其胃，气陷于下焦，经所谓脾胃一虚，令人九窍不通。用补中益气汤，以参 甘温之品，先调其胃气，
以升麻、柴胡从九原之下而提之，则清升而浊自降矣。清肺者隔二治，补脾者隔三治。东垣虚则
补母之妙。如不渴而小便不利，此属下焦血分。下焦者，肾与膀胱也，乃阴中之阴，阴受热，闭塞其下
流。经曰∶无阳则阴无以生，无阴则阳无以化，若淡渗之药，乃阳中之阴，非纯阴之剂，阳何以化？须用
滋肾丸，此气味俱阴，乃阴中之阴也。东垣尝治一人，便秘危急，以此法治，即愈。然真阴者，东垣未之
论。真阴虚，惟六味丸以补肾水，滋肾丸又所当禁。黄柏、知母，恐其苦寒泄水。又忌淡味渗泄之药。有
真阳虚者，须八味丸。戴氏云∶有似淋非淋，便中似鼻涕之状，此乃精溺俱出，精塞溺道，故欲出不能而
痛，宜大菟丝子丸、鹿茸丸。戴氏亦用褚侍中之法也。
丹溪治一老人，患小便不利，因服分利之药太过，遂致闭塞，点滴不出。予以其胃气下陷，用补中益
气汤，一服而通。因先多用利药，损其肾气，遂至通后遗尿，一夜不止，急补其肾，然后已。凡医之治是症
者，未有不用泄利之剂，谁能固其肾气之虚哉？书此以为世戒。
薛立斋曰∶小便赤涩短少，若津液偏渗于大肠，大便泻而小便少者，宜用猪苓、泽泻、茵陈、山栀分
利之。若阴阳已分，而小便短少者，此脾肺气虚不能生水也，宜补中益气汤加麦冬、五味。阴火上炎而小
便赤少者，此肺气受伤不能生水也，用六味丸加麦冬、五味。肾经阴虚，阳无所生而小便短少者，用补中益气
汤、六味丸。若误用渗泄分利者，先用滋肾丸，急投金匮加减肾气丸。
王节斋曰∶小便不禁或频数，古方多以为寒，而用温涩之药。殊不知属热者多，盖膀胱火邪妄动，水不
得宁，故不能禁而频数来也。故年老人多频数，是膀胱血少，阳火偏旺也。治法当补膀胱阴血，泻火邪为主，
而佐以收涩之味，如牡蛎、山萸、五味子之类，不可用温药也。病本属热，故宜
泻火。因水不足，故火动而致小便多，小便既多，水益虚矣，故宜补血泻火治其本也，收之涩之治
其标也。
薛立斋曰∶经云∶膀胱不约为遗溺。小便不禁，常常出而不觉也。人之旋溺，赖心肾两气之所传送。
盖心与小肠为表里，肾与膀胱为表里，若心肾气亏，传送失度，故有此症。治宜温暖下元，清心寡欲。女人
有产蓐不慎，致伤膀胱，属虚寒者，秘元丹、韭子丸。内虚湿热者，六味地黄加五味、杜仲、补骨脂。年老
者，八味丸，收生不谨，损破尿胞者，参术补胞汤加猪羊胞煎之类。窃谓肝主小便，若肝经血虚，用四物、
山栀。若小便涩滞，或茎中作痛，属肝经湿热，用龙胆泻肝汤。若小便频数，或劳而益甚，属脾气虚弱，
用补中益气加山药、五味。若小便无度，或淋沥不禁，乃阴挺痿痹也，用六味。若小便涩滞，或补而益甚，
乃膀胱热结也，用五淋散。其脾肺燥不能生化者，黄芩清肺饮。膀胱阴虚，阳无所生者，滋肾丸。膀胱阳虚，
阴无所化者，六味丸。若阴痿，思色精不出，茎道涩痛如淋，用加减八味丸料加车前、牛膝。治老人精竭
复耗，大小便牵痛如淋，亦用前药。不应，即加附子，多有生者。
遗尿，若脬中有热，宜加味逍遥散。若脾肺气虚，补中益气加益智仁。若肝肾阴虚，宜六味丸。
赵养葵曰∶脏腑秘一证，肾司二便，其不禁者，责之肾矣，然则大便不通者，独非肾乎？肾气虚则大
小便难，宜以地黄、苁蓉、车前、茯苓之属，补其阴，利水道；少佐辛药，开胰理，致津液而润其燥，洁
古云∶脏腑之秘，不可一概治疗。有热秘，有冷秘，有实秘，有虚秘，有风秘；有气秘。老人与产后，及发
汗利小便过多，病后气血未复者，皆能成秘。禁用硝、黄、巴豆、牵牛等药。世人但知热秘，不知冷闭，
冷
秘者，冷气横于肠胃，凝阴固结，津液不通，胃气闭塞，其人肠内气攻，喜热恶冷，宜以八味料大剂煎之，
冷冻饮料即愈。或局方半硫丸，碾生姜调乳香下之。或海藏已寒丸俱效。其丸虽热，得芍药、茴香润剂，引而
下之，阴得阳化，故大小便自通。如遇春和之阳，则冰自消矣。东垣尝论治秘，予体之而不用其方，如润
肠丸、润燥汤、通幽散之类，俱不用。惟用六味地黄丸料煎服，自愈，如热秘而又兼气虚者，以前汤加参、
各五钱，立愈。此因气虚不能推送，阴虚不能濡润故耳。
李士材曰∶五淋∶石淋，清其积热，涤去砂石，则水道自利，宜神效琥珀散、如圣散，独圣散，选用。
劳淋，有脾劳、肾劳之分。多思多虑，负重远行，应酬纷忧，劳于脾也，宜补中益气与五淋散分进。专
思考虑者，归脾汤。若强力入房，或施泄无度，劳于肾也，生地黄丸，或黄 汤。肾虚而寒者，金匮肾气丸。
血淋，有血瘀、血虚、血冷、血热之别。小腹硬满，茎中作痛欲死，血瘀也，一味牛膝，煎膏酒服，
大效。但虚人能损胃耳，宜四物加桃仁、通草、红花、牛膝、丹皮。血虚者，六味丸加侧柏、车前子、白芍，
或八珍汤送益元散。血色鲜红者，心与小肠实热，脉必数而有力，柿蒂、侧柏、黄连、黄柏、生地、丹皮、
白芍、木通、泽泻、茯苓。血气黑暗，面色枯白，尺脉沉迟，下元虚冷也。金匮肾气丸。然有内热过极，反
兼水化而色黑者，未可便以为冷也。
气淋，有虚实之分。如气滞不通，脐下妨闷而痛者，沉香散、石韦散、瞿麦汤。气虚者，八珍汤加杜仲、
牛膝，倍茯苓。
凡膏淋，似淋非淋，小便色似米泔，或如鼻涕，此精溺
俱出，精塞溺道，故欲出不快而痛，鹿角霜丸、大沉香丸、海金砂散、菟丝子丸，随症选用。
冷淋，是肾虚，肉苁蓉丸、泽泻散、金匮肾气丸。
胞痹。膀胱者，州都之官，津液藏焉，气化则能出矣。风寒湿邪气客于胞中，则气不能化出，故胞满而水
道不通，小腹膀胱按之内痛，若沃以汤，涩于小便。以足太阳经上交于巅，入络脑，下灌鼻则为清涕也，肾
着汤、肾沥汤，巴戟丸。
方约之曰∶淋证，其感不一、或因房劳，或因忿怒，或因醇酒，或因浓味。夫房劳，阴虚火动也；忿怒
者，气动生火也；醇酒、浓味者，酿成湿热也。积热既久，热积下焦，所以小便淋沥，欲去不去，又来，而痛
不可忍者。初则热淋，血淋，久则煎熬水液，稠浊如膏，如沙如石也。故诸方中，类多散热，利小便，而于
开郁行气、破血滋阴盖少焉。若夫散热、利小便，只能治热淋、血淋而已，其膏淋、沙淋、石淋三者，必须
开郁行气、破血滋阴方可也。东垣用药凡例∶小腹痛，疏肝滋肾。盖小腹、小便乃肝肾之部位也，学人不可
不知。
戴院使曰∶五淋皆有冷有热，血有热有淤，气有热有冷，劳有虚冷虚热，与汤过差，精不由其道，妄
行不禁，与溺俱出，此热剂之伤，未可概以为冷也。治淋之法，除的然虚冷之外，其余诸症，若用本题不效，
便宜施于调气之剂。盖津道之逆顺，皆一气之通塞为之也。如木香流气饮，却为的当。其中自有木通、麦冬、
腹皮辈。此如不效，但宜受以益血之方。盖小便者，血之余也，血苟充满，则滋腴下润，自然流通。如火府
丹，却为的当，其中有地黄辈。然此非特言血淋、气淋，一应淋皆可用，独不可用之虚冷耳。淋病小便之色
多见赤，未可便以赤为热，气道蕴结，故如此耳。
张景岳曰∶淋病，小便滴沥痛涩，严氏有气、石、血、膏、劳之辨。亦有浊久而为淋者，多因心肾不交
，积热郁结而致。初病固因于热
亦有久寒不愈。或痛涩皆无，但下膏液如白浊者，此中气下陷，及命门不固之症，宜辨脉以定虚实。
治淋与浊同，热宜清，涩宜利，下陷者宜升，虚者宜补，阳不固者宜温补命门。
赵羽皇曰∶经云膀胱者，州都之官，津液藏焉，气化则能出矣。遍考诸方，独指膀胱立论，
如五苓、八正，清热渗利以为正治。而深于治者，又有隔二、隔三之论。然不能畅发气化之旨。岂知气化
之由，则有上焦、中焦与下焦之辨。盖水液虽潴于脬中，而降升总由乎肺。经云水出高源，又曰金
为水母。若肺金燥则气化之源绝，而寒水断流，肺金虚则治节之令失，而下输失职，以致溲溺不通，而或时
淋沥者，实由上焦之气不化也。治以生脉散加茯苓、牛膝，润燥清金，如天令至秋而白露降矣。平人饮食
入胃，精气输脾，肺不自专而上奉于肺，是天气之下降，本于地气之上升。今人久病而大气未复，汗下而津
液重亡，以致脾肺气虚，不能生水而小便数少者，由于中焦之气不化也。法以补中益气汤加麦冬、五味，滋
其化源，清阳升而浊阴自降矣。肾司开合，主二便，其藏主水，得阳则开，得阴则合。故肾中有火，则津液
干涸而小便涩；肾中无火，则天寒水冻而小便闭。古人用八味丸治此症效者，以其有桂附之辛温，蒸动肾气，
化而膀胱之气亦化也。三焦之说，大率如此。外有心移热于小肠而小便闭者，肝移热于膀胱而茎中痛者，又须
以导赤、逍遥加减治之，不可混也。
赵羽皇曰∶脱肛有二，一属虚寒，一属湿热。盖虚寒则中气馁而不能收，湿热则火邪迫而不能闭，此
芩连、参附，用药霄壤也。然虚者不痛，火热肿痛。
Li Shicai stated: Urinary retention (Bì) and dribbling (Lóng) are two distinct conditions. Acute onset is termed urinary retention, characterized by difficulty in passing even a few drops; chronic onset is termed dribbling, characterized by frequent urination with scanty output. Regarding the pathology of retention and dribbling, the *Nei Jing* (Inner Canon) categorizes them into Liver Meridian and Du Meridian, and Sanjiao and Bladder. The Bladder is primarily responsible for storing urine, while the function of expelling urine belongs to the Liver Meridian, Du Meridian, and Sanjiao. Furthermore, it is recorded that the Bladder is the "Official of the Metropolis," where fluids are stored and expelled through Qi transformation. The organ governing Qi transformation is primarily the Taiyin Lung Meridian. If Lung dryness fails to generate Water (Metal generates Water), causing Qi transformation to fail to reach the Metropolis (Bladder), the treatment principle should be to clear and moisten Lung Metal, using herbs such as Qiancaizi (Plantago Seed), Ziwan (Aster Root), Maidong (Ophiopogon Tuber), and Sangpi (Mulberry Bark). If Spleen dampness fails to transport, preventing Essence from ascending and thus preventing the Lung from generating Water, the treatment principle should be to dry dampness and strengthen the Spleen and Stomach, using herbs such as Cangzhu (Atractylodes Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), and Banxia (Pinellia Tuber). If Kidney Water is dry and hot, causing Bladder dysfunction, the treatment principle should be to nourish the Kidney and purge heat, using herbs such as Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Fuling (Poria), Zexie (Alisma Rhizome), and Tongcao (Tetrapanax Pith). Nourishing the Kidney and purging the Bladder is called direct treatment (Zheng Zhi); clearing and moistening the Lung is called treating the second removed organ (Ge Er Zhi); strengthening the Stomach and drying the Spleen is called treating the third removed organ (Ge San Zhi).
Alternatively, if fluids only seep into the Large Intestine, causing the Lower Jiao (Bladder) to become dry and exhausted, light diuretic herbs such as Fuling (Poria), Zhuling (Polyporus), Zexie (Alisma Rhizome), and Tongcao (Tetrapanax Pith) should be used to separate and drain the water passages. If Qi stagnation prevents the smooth flow of water pathways downward to the Bladder, regulating Qi is urgent, using herbs such as Zhike (Aurantium Fructus), Mutong (Akebia Caulis), and Juhong (Citrus Reticulata Pericarpium). In cases of excess heat, pure Yin formulas are required, otherwise Yang cannot transform. Heat in the Upper Jiao is treated with Zhizi (Gardenia Fruit) and Huangqin (Scutellaria Root); heat in the Middle Jiao with Huanglian (Coptis Rhizome) and Baishao (White Peony Root); heat in the Lower Jiao with Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome).
In cases of severe deficiency, warming and tonifying agents are necessary, or water cannot move, such as Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). For instance, Dong Yuan treated a patient with urinary retention, protruding eyes, abdominal distension, and skin tight as if cracking, who showed no improvement after taking light diuretics. Dong Yuan said, "The disease is critical; it requires deep contemplation to prescribe." Contemplating until midnight, he said, "I have found the cause. The Bladder is the Official of the Metropolis and the vessel of fluids; it must rely on Qi transformation to expel contents. The previously administered light diuretics are thin in aroma and belong to Yang herbs. Solitary Yang without Yin cannot transform." He then administered Zi Shen Wan (Nourish the Kidney Pill), a formula composed of Yin herbs, and the patient recovered immediately.
Dan Xi stated: "I use emesis to promote urination. It is like a dripping vessel; if the upper orifice is blocked, the lower part cannot flow freely. One must open the upper orifice so that water flows from the lower part." For Qi deficiency, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), taken first, followed by inducing vomiting. For Blood deficiency, use Xiong Gui Tang (Angelica and Ligusticum Decoction), taken first, followed by inducing vomiting. For excessive phlegm, use Er Chen Tang (Two-Cured Decoction). For Qi closure, use Xiangfu (Cyperus Rhizome) and Mutong (Akebia Caulis) to induce vomiting via probing the throat.
There are also cases of urinary retention due to blood stasis, where Niuxi (Achyranthes Root) and Taoren (Peach Kernel) are key herbs. *Bie Lu* states: For difficult urination, if it is due to Qi deficiency, Dan Shen Tang (Single Ginseng Decoction) is miraculous. Thus, the source of disease is not limited to one pathway.
Zhao Yangkui stated: For difficult urination, Dong Yuan differentiated treatment based on whether the pathology lies in Qi or Blood. Differentiation depends on thirst. If there is thirst and difficult urination, it belongs to the Qi aspect of the Upper Jiao. Water originates from Metal (Lung); Lung heat cuts off the source of digestion. Treatment should assist the Autumnal function (constriction and descent) of the Lung using cooling Lung herbs, such as Sheng Mai San (Generate the Pulse Powder). There are also cases of Spleen deficiency caused by irregular diet damaging Stomach Qi, causing Qi to sink to the Lower Jiao. As the classics state, when Spleen and Stomach are deficient, the nine orifices become obstructed. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with sweet-warm herbs like Renshen (Ginseng Root) and Gancao (Licorice Root) to regulate Stomach Qi first, then use Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root) to lift from the depths of the Nine Origins. Then clear Qi ascends and turbid Yin descends naturally. Cooling the Lung is treating the second removed organ; tonifying the Spleen is treating the third removed organ. This is Dong Yuan's brilliance in "tonifying the mother when deficient." If there is no thirst but difficult urination, it belongs to the Blood aspect of the Lower Jiao. The Lower Jiao includes the Kidney and Bladder, which are Yin within Yin. Heat in the Yin blocks the downward flow. The classics say: Without Yang, Yin cannot be generated; without Yin, Yang cannot transform. Light diuretics are Yin within Yang, not pure Yin agents, so how can Yang transform? Zi Shen Wan (Nourish the Kidney Pill) must be used, as its flavor and nature are purely Yin, being Yin within Yin. Dong Yuan once treated a patient with critical constipation using this method, and they recovered. However, Dong Yuan did not discuss True Yin deficiency. For True Yin deficiency, Liu Wei Wan (Six-Ingredient Pill with Rehmannia) is used to tonify Kidney Water, and Zi Shen Wan should be contraindicated here, as Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) may be too bitter and cold, draining water. Also, avoid light and leaching herbs. For True Yang deficiency, Ba Wei Wan (Eight-Ingredient Pill) is required. Dai Shi said: There are cases resembling strangury but not strangury, where urine resembles mucus. This is essence and urine both exiting, with essence blocking the urinary channel, causing pain and difficulty in passing. Da Tusizi Wan (Large Dodder Seed Pill) and Lurong Wan (Deer Antler Pill) are suitable. Dai Shi also employed the method of Chu Shizhong.
Dan Xi treated an elderly man with difficult urination. Due to excessive use of diuretics, he became completely blocked with no urine output. I diagnosed sinking of Stomach Qi and used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). After one dose, urination resumed. However, because previous diuretics had damaged Kidney Qi, he experienced enuresis (involuntary urination) all night after urination resumed. Urgent Kidney tonification stopped it. Physicians treating this condition rarely use anything other than draining agents; who can protect the deficiency of Kidney Qi? I record this as a warning to the world.
Xue Lizhai stated: Red, burning, and scanty urine, if due to fluids seeping excessively into the Large Intestine causing diarrhea and scanty urine, should be treated with Zhu Ling (Polyporus), Zexie (Alisma Rhizome), Yichen (Artemisia Capillaris), and Shanzhi (Gardenia Fruit) to separate and drain. If Yin and Yang are separated but urine is scanty, this is Spleen and Lung Qi deficiency failing to generate Water. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry). If Yin fire flares up causing red, scanty urine, this is Lung injury failing to generate Water. Use Liu Wei Wan (Six-Ingredient Pill with Rehmannia) plus Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry). If Kidney Meridian Yin deficiency leads to Yang having no source and scanty urine, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Wan (Six-Ingredient Pill with Rehmannia). If mistakenly treated with leaching agents, first use Zi Shen Wan (Nourish the Kidney Pill), then urgently administer Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet).
Wang Jiezhai stated: Urinary incontinence or frequency was traditionally considered Cold, treated with warming and astringent herbs. However, Heat patterns are common. Bladder Fire evil moves recklessly, disturbing Water, causing inability to retain and frequent urination. Elderly people often have frequency due to Bladder Blood deficiency and dominant Yang Fire. Treatment should tonify Bladder Yin and Blood, primarily clearing Fire evil, assisted by astringents like Muli (Oyster Shell), Shanyuzi (Cornus Fruit), and Wuweizi (Schisandra Berry). Warming herbs should not be used. Since the root is Heat, clearing Fire is appropriate. Due to Water insufficiency, Fire moves causing frequent urination; frequent urination further depletes Water. Therefore, tonifying Blood and clearing Fire treats the root, while astringing treats the branch.
Xue Lizhai stated: The classics say: When the Bladder fails to constrain, it results in enuresis. Urinary incontinence is constant, unnoticed leakage. Urination relies on the transmission of Heart and Kidney Qi. Heart and Small Intestine are exterior-interior; Kidney and Bladder are exterior-interior. If Heart and Kidney Qi are deficient, transmission is disordered, causing this symptom. Treatment should warm the Lower Origin, calm the Heart, and reduce desires. Women who neglect care during confinement may injure the Bladder; for deficiency-cold, use Mi Yuan Dan (Secret Essence Pill) and Jiu Zi Wan (Leek Seed Pill). For internal deficiency with damp-heat, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Wuweizi (Schisandra Berry), Duzhong (Eucommia Bark), and Buguzhi (Psoralea Fruit). For the elderly, use Ba Wei Wan (Eight-Ingredient Pill). For those injured during childbirth damaging the bladder wall, use Shen Zhu Bu Bao Tang (Ginseng and Atractylodes Decoction to Tonify the Sac) decocted with pig or sheep bladders. I believe the Liver governs urination. If Liver Meridian Blood is deficient, use Si Wu Tang (Four Substance Decoction) plus Shanzhi (Gardenia Fruit). If urine is stagnant or painful in the urethra, it is Liver Meridian damp-heat; use Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver). If urine is frequent or worsens with fatigue, it is Spleen Qi deficiency; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shanyao (Dioscorea Rhizome) and Wuweizi (Schisandra Berry). If urine is uncontrolled or dribbles involuntarily, it is vaginal prolapse or atrophy; use Liu Wei Wan (Six-Ingredient Pill with Rehmannia). If urine is stagnant or worsens with tonification, it is Bladder heat knot; use Wu Lin San (Five Strangury Powder). If Spleen and Lung dryness fails to produce and transform, use Huang Qin Qing Fei Yin (Scutellaria Decoction to Clear the Lung). If Bladder Yin is deficient and Yang has no source, use Zi Shen Wan (Nourish the Kidney Pill). If Bladder Yang is deficient and Yin cannot transform, use Liu Wei Wan (Six-Ingredient Pill with Rehmannia). For impotence, where sexual thoughts do not result in emission and the urethra is painful and stagnant like strangury, use Jia Jian Ba Wei Wan Pian (Modified Eight-Ingredient Pill Material) plus Cheqianzi (Plantago Seed) and Niuxi (Achyranthes Root). For elderly patients with depleted essence suffering pain in bowel and bladder movements resembling strangury, use the same prescription. If ineffective, add Fuzi (Aconite Root); many recover.
For enuresis, if there is heat in the bladder, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If Spleen and Lung Qi are deficient, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Yizhiren (Bitter Apricot Seed). If Liver and Kidney Yin are deficient, use Liu Wei Wan (Six-Ingredient Pill with Rehmannia).
Zhao Yangkui stated: Constipation involves the organs; the Kidney governs the two excretions. Incontinence is blamed on the Kidney. Is constipation not also related to the Kidney? Kidney Qi deficiency causes difficulty in both bowel and bladder movements. Use Dihuang (Rehmannia Root), Congrong (Cistanche Stem), Cheqianzi (Plantago Seed), and Fuling (Poria) to tonify Yin and benefit water passages; add slight aromatic herbs to open the pancreas and regulate Qi, generating fluids to moisten dryness. Jie Gu said: Constipation of the organs cannot be treated uniformly. There is Heat constipation, Cold constipation, Excess constipation, Deficiency constipation, Wind constipation, and Qi constipation. The elderly, postpartum women, those who sweated or urinated excessively, and those recovering from illness with unrecovered Qi and Blood can develop constipation. Avoid Xiaoshi (Sodium Nitrate), Dahuang (Rhubarb Root), Badou (Croton Seed), and Qianniu (Morning Glory Seed). People only know Heat constipation, not Cold obstruction. Cold constipation involves Cold Qi horizontal in the intestines and stomach, congealing Yin and binding, blocking fluids, and closing Stomach Qi. The patient feels gas attacking inside the intestines, prefers warmth, and dislikes cold. Use Ba Wei Liao (Eight-Ingredient Formula) decocted heavily, served cold, and it will heal. Or Ju Fang Ban Shu Wan (Half-Sulfur Pill from the Bureau Formulary) ground with fresh ginger and mixed with Frankincense milk. Or Hai Zang Yi Han Wan (Hai Zang Cold-Resolving Pill) are effective. Although these pills are hot, aided by Sour and Fennel moistening agents, they guide downward. Yin transforms under Yang, so bowel and bladder movements pass naturally. Like spring sun melting ice. Dong Yuan discussed treating constipation; I understood it but did not use his formulas like Run Chang Wan (Moisten Intestines Pill), Run Zao Tang (Moisten Dryness Decoction), or Tong You San (Open Seclusion Powder). I only used Liu Wei Di Huang Wan Pian (Six-Ingredient Rehmannia Pill Material) decocted and taken orally, and it healed itself. If Heat constipation is accompanied by Qi deficiency, add Renshen (Ginseng Root) to the above decoction, five qian each, and it heals immediately. This is because Qi deficiency cannot push and Yin deficiency cannot moisten.
Li Shicai stated: Five Stranguries: Stone Strangury (Shi Lin), clear accumulated heat, wash away sand and stones, then water passages benefit. Select Shen Xiao Hu Po San (Miraculous Amber Powder), Ru Sheng San (Like Sage Powder), or Du Sheng San (Unique Sage Powder). Labor Strangury (Lao Lin) divides into Spleen labor and Kidney labor. Overthinking, heavy lifting, long travel, and social worries labor the Spleen; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Wu Lin San (Five Strangury Powder) alternately. Those who overthink use Gui Pi Tang (Restore the Spleen Decoction). Forceful intercourse or excessive emission labors the Kidney; use Sheng Di Huang Wan (Rehmannia Pill) or Huang Bo Tang. For Kidney deficiency with cold, use Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). Blood Strangury (Xue Lin) differentiates into Blood stasis, Blood deficiency, Blood cold, and Blood heat. Hardness and fullness in the lower abdomen, severe pain in the urethra, indicates Blood stasis. Single herb Niuxi (Achyranthes Root) decocted into paste with wine is highly effective. But it damages the Stomach in weak persons; use Si Wu Tang (Four Substance Decoction) plus Taoren (Peach Kernel), Tongcao (Tetrapanax Pith), Honghua (Safflower), Niuxi (Achyranthes Root), and Danpi (Moutan Cortex). For Blood deficiency, use Liu Wei Wan (Six-Ingredient Pill with Rehmannia) plus Cebaiye (Biota Leaf), Cheqianzi (Plantago Seed), and Baishao (White Peony Root), or Bazhen Tang (Eight Treasure Decoction) sending Yi Yuan San (Benefit Primary Powder). Bright red blood indicates Heart and Small Intestine excess heat; pulse is rapid and forceful. Use Shidi (Persimmon Calyx), Cebaiye (Biota Leaf), Huanglian (Coptis Rhizome), Huangbai (Phellodendron Bark), Shengdi (Rehmannia Root), Danpi (Moutan Cortex), Baishao (White Peony Root), Mutong (Akebia Caulis), Zexie (Alisma Rhizome), and Fuling (Poria). Dark blood qi, sallow complexion, deep and slow Chi pulse indicates Lower Origin deficiency cold. Use Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). However, extreme internal heat may mimic Water transformation appearing black; do not assume cold.
Qi Strangury (Qi Lin) has excess and deficiency types. Qi stagnation causing umbical oppression and pain uses Chenxiang San (Agarwood Powder), Shiwei San (Pyrola Powder), or Qumai Tang (Knotweed Decoction). Qi deficiency uses Bazhen Tang (Eight Treasure Decoction) plus Duzhong (Eucommia Bark) and Niuxi (Achyranthes Root), doubling Fuling (Poria).
Gao Strangury (Gao Lin) resembles strangury but is not; urine is like rice water or mucus. This is essence and urine both exiting, essence blocking the channel, causing pain and difficulty. Lujiaoshuang Wan (Deer Horn Frost Pill), Da Chenxiang Wan (Large Agarwood Pill), Haijinsha San (Lygodium Spore Powder), or Tusizi Wan (Dodder Seed Pill) selected by symptoms.
Cold Strangury (Leng Lin) is Kidney deficiency. Use Roucong Rong Wan (Cistanche Pill), Zexie San (Alisma Powder), or Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet).
Pao Bi (Bladder Obstruction). The Bladder is the Official of the Metropolis, storing fluids, expelled by Qi transformation. Wind-Cold-Damp pathogens invading the bladder cause Qi failure to transform, leading to bladder fullness and blocked water passages. Pressing the lower abdomen and bladder causes internal pain, feeling like pouring hot water, with difficult urination. The Foot Taiyang Meridian connects to the vertex, enters the brain, and descends to the nose causing clear discharge. Use Shen Zhuo Tang (Kidney Dampness Decoction), Shen Li Tang (Kidney Drip Decoction), or Bajqi Wan (Morinda Pill).
Fang Yuezhi stated: Strangury causes vary: coital exhaustion, anger, rich wine, or strong flavors. Coital exhaustion causes Yin deficiency and Fire movement; anger causes Qi movement generating Fire; wine and strong flavors brew damp-heat. Long-standing heat accumulates in the Lower Jiao, causing dribbling, hesitancy, and unbearable pain. Initially Heat Strangury or Blood Strangury; long-term boiling of fluids creates thick turbidity like paste, sand, or stone. Most formulas cool heat and promote urination, rarely opening depression, moving Qi, breaking stasis, or nourishing Yin. Cooling and promoting urination only treat Heat and Blood Strangury. Gao, Sha, and Shi Strangury require opening depression, moving Qi, breaking stasis, and nourishing Yin. Dong Yuan's medication principles: Lower abdominal pain, soothe Liver and nourish Kidney. The lower abdomen and urination are the domains of Liver and Kidney; students must know this.
Dai Yuanshi stated: All five stranguries have Cold and Heat aspects. Blood has Heat and Stasis; Qi has Heat and Cold; Labor has Deficiency-Cold and Deficiency-Heat. Incorrect prescriptions cause essence to flow wrongly, mixing with urine. This is damage from hot agents; do not generalize as Cold. For treating strangury, except for obvious deficiency-cold, if standard treatments fail, adjust Qi agents are appropriate. The smoothness of fluid channels depends on Qi flow. Muxiang Liuqi Yin (Costus Flowing Qi Decoction) is accurate, containing Mutong (Akebia Caulis), Maidong (Ophiopogon Tuber), and Fupi (Tangerine Peel). If ineffective, use Blood-tonifying formulas. Urine is the surplus of Blood; if Blood is full, it moistens and flows naturally. Huofu Dan (Fire Mansion Pill) is accurate, containing Dihuang (Rehmannia Root). This applies to all stranguries except Blood and Qi Strangury, but not for deficiency-cold. Strangury urine is often red; do not assume Heat solely from redness; Qi path obstruction causes this.
Zhang Jingyue stated: Strangury involves dribbling, pain, and astringency. Yan Shi differentiated Qi, Stone, Blood, Paste, and Labor strangury. Turbidity lasting long becomes strangury, often due to Heart-Kidney non-interaction and accumulated heat stagnation. Initial disease is due to Heat; long-term disease may be Cold. Some have no pain or astringency, only white turbid fluid. This is sinking of Middle Qi and insecurity of Mingmen. Differentiate pulse to determine excess or deficiency. Treating strangury and turbidity is similar: Heat clears, astringency benefits, sinking lifts, deficiency tonifies, Yang insecurity warms and tonifies Mingmen.
Zhao Yuhuang stated: The classics say the Bladder is the Official of the Metropolis, storing fluids, expelled by Qi transformation. Reviewing formulas, most focus on the Bladder, such as Wu Ling San (Five-Ingredient Powder with Poria) and Ba Zheng San (Eight-Ingredient Powder for Rectification), clearing heat and promoting urination as direct treatment. Deep practitioners discuss treating the second and third removed organs. However, they do not fully explain Qi transformation. Qi transformation involves Upper, Middle, and Lower Jiao distinctions. Although fluids store in the bladder, ascent and descent depend on the Lung. The classics say water comes from the high source (Lung); Metal is the mother of Water. If Lung Metal is dry, the source of Qi transformation is cut off, and cold water stops flowing. If Lung Metal is deficient, regulatory commands fail, and downward transmission fails, causing urinary blockage or intermittent strangury, actually due to Upper Jiao Qi failure to transform. Treat with Sheng Mai San (Generate the Pulse Powder) plus Fuling (Poria) and Niuxi (Achyranthes Root) to moisten dryness and clear Metal, like autumn dew falling. Normal diet enters the Stomach, essence transports to the Spleen, and Lung receives it. Heaven Qi descends based on Earth Qi ascending. Now, chronic illness leaves Great Qi unrecovered; sweating and purging severely lose fluids, causing Spleen-Lung Qi deficiency failing to generate Water and frequent scanty urination, due to Middle Jiao Qi failure to transform. Use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry) to nourish the transformation source; Clear Yang ascends and Turbid Yin descends. The Kidney controls opening and closing, governing two excretions, storing Water. With Yang, it opens; with Yin, it closes. Fire in the Kidney dries fluids causing astringent urination; lack of Fire freezes water causing blockage. Ancient use of Ba Wei Wan (Eight-Ingredient Pill) was effective due to Gui (Cinnamon Twig) and Fu (Aconite) warming and steaming Kidney Qi, transforming Bladder Qi. The Sanjiao theory is generally like this. Additionally, Heart transferring heat to Small Intestine causing blockage, or Liver transferring heat to Bladder causing penile pain, must be treated with Dao Chi San (Guide Out Red Powder) and Xiao Yao San (Free and Easy Wanderer Powder) modifications, not mixed.
Zhao Yuhuang stated: Rectal prolapse has two types: deficiency-cold and damp-heat. Deficiency-cold means Center Qi is weak and cannot retract; damp-heat means Fire evil forces and cannot close. Qinlian (Scutellaria and Coptis) versus Shenfu (Ginseng and Aconite) differ vastly. Deficiency does not hurt; Fire-Heat causes swelling and pain.